BRPI0904823A2 - ferramentas intercambiáveis para instrumentos cirúrgicos - Google Patents
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
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Abstract
FERRAMENTAS INTERCAMBIáVEIS PARA INSTRUMENTOS CIRúRGICOS. A presente invenção refere-se a um sistema de ferramenta cirúrgica. Várias modalidades de um sistema de ferramenta cirúrgica podem compreender um instrumento cirúrgico que é dotado de um conjunto de manopla que suporta operacionalmente um sistema de acionamento no mesmo para gerar movimentos de acionamento com o acionamento de uma porção de manopla móvel acoplada de modo operacional ao conjunto de manopla. Um corpo alongado se salienta a partir do conjunto de manopla e suporta de modo operacional uma haste de controle no mesmo que interfaceia com o sistema de acionamento. O sistema de ferramenta cirúrgica adicionalmente inclui pelo menos duas ferramentas cirúrgicas selecionadas a partir do grupo de ferramentas cirúrgicas que consistem em: manipuladores, alicates, tesouras, endocortadores, dispositivos de medição de espessura de tecido, aplicadores de grampos, aplicadores de clips, seringas para aplicar cola, selante, fármacos ou medicamentos e dispositivos de cauterização em que cada uma das ferramentas cirúrgicas inseridas no grupo de ferramentas cirúrgicas é dotada pelo menos de um alojamento que é acoplado de forma removível ao corpo alongado e um conjunto de acionamento que é acoplado de forma removível à haste de controle para receber os movimentos de acionamento a partir do mesmo.
Description
Relatório Descritivo da Patente de Invenção para "FERRA-MENTAS INTERCAMBIÁVEIS PARA INSTRUMENTOS CIRÚRGICOS".
CAMPO DA INVENÇÃO
A presente invenção refere-se em geral a instrumentos cirúrgi-cos que incluem, mas não são limitados a, instrumentos cirúrgicos normal-mente usados com unidades de corte e grampeamento descartáveis que sãocapazes de aplicar linhas de grampos aos tecidos e ainda cortar o tecidoentre a referida linha de grampos e, mais particularmente, a uma coleção deferramentas intercambiáveis para uso com os referidos instrumentos.
Pedidos de Patente Pertencentes
O cessionário do presente pedido também possui os pedidos depatente US os quais se encontram aqui incorporados por referência:
Pedido de patente US N0 de série 11/729.008,) intitulado Lapa-roscopic Tissue Thickness and Clamp Load Meàsuring Devices, depositadoem 28 de Março de 2007;
Pedido de patente US N0 de série 11/652.170, intitulado SurgicalStapler With Tapered Distai End, depositado em 11 de Janeiro de 2007;
Pedido de patente US N0 de série 12/031.628, intitulado Dispos-able Motor Driven Loading Unit For Use With a Surgical Cutting and StaplingApparatus para Kyle P. Moore et al„ Docket No. END6213USNP/070330; ePedido de patente US N0 de série 12/031,001, intitulado Articula-table Loading Units For Surgical Stapling and Cutting Instruments, para Je-rome R. Morgan et al., depositado em 14 de Fevereiro de 2008.
Antecedentes
Cirurgias endoscópicas são com freqüência preferidas em rela-ção aos procedimentos cirúrgicos abertos tradicionais pelo fato de que a in-cisão menor necessária para os procedimentos cirúrgicos endoscópicos ten-dem a reduzir o tempo de recuperação de pós-operatório e as complicações.Uma variedade de procedimentos cirúrgicos é atualmente realizada por téc-nicas laparoscópicas ou outras técnicas endoscópicas. Os referidos proce-dimentos podem incluir, por exemplo, operações intestinais e de estomagotais como a remoção de câncer de cólon, reparos de hérnia, grampeamentode estomago, remoção da vesícula biliar, cirurgias relacionadas a Ob/Gynassim como outros procedimentos, tais como aqueles que envolvem manipu-lações do baço, fígado, pulmões, coração, etc., do paciente.
Consequentemente, um significante desenvolvimento ocorreu nagama de instrumentos cirúrgicos endoscópicos que são aptos para disposi-ção precisa no manipulador de extremidade distai em um campo cirúrgicodesejado através de uma cânula de um trocarte que foi inserido no paciente.
Os referidos manipuladores de extremidade distais engatam ou interagemcom o tecido em uma série de maneiras para alcançar um diagnóstico dese-jado ou efeito terapêutico. Os referidos dispositivos são com freqüência con-figurados para realizar um único tipo de ação cirúrgica (por exemplo, endo-cortador, pinças, cortador, grampeadores, aplicador de clips, dispositivos deacesso, dispositivo de envio de terapia de fármaco/gene, e dispositivo deenergia usando ultrassom, RF, laser, etc.), o que com freqüência necessitaque o médico use diversos diferentes instrumentos que são cada um dosquais apenas adaptados para realizar uma ação durante uma única opera-ção. Por exemplo, Patente US N0 5.352.235; Patente US N0 5.383.895; ePatente US N0 5.728.121 cada uma das quais descreve instrumentos de pe-gar que podem ser usados para procedimentos endoscópicos e laparoscópi-cos. Para os procedimentos que necessitam de remoção de tecido ou deespécimes a partir do corpo (por exemplo, remoção de uma vesícula biliardoente, apêndice, etc.), instrumentos dedicados de retirada de espécime taiscomo aqueles descritos na Patente US N0 6.406.440 foram desenvolvidos.
Para procedimentos que necessitam de corte e partição de tecido, instru-mentos de tesoura dedicados tais como os descritos na Patente US N06.168.605 também foram desenvolvidos.
Para os referidos procedimentos que envolvem o corte e ogrampeamento de tecido, diversos dispositivos cirúrgicos de grampeamentoforam projetados. Os referidos dispositivos de grampeamento cirúrgico co-mumente incluem um manipulador de extremidade que simultaneamenteproduz uma incisão longitudinal no tecido e aplica linhas de grampos em la-dos opostos da incisão. A manipulador de extremidade inclui um par demembros de garras cooperantes os quais, se o instrumento for pretendidopara aplicações endoscópicas ou laparoscópicas, são capazes de passaratravés da passagem da cânula. Uma forma de dispositivo de corte e gram-peamento cirúrgico é descrita na Patente US N0 6.905.057. Os referidos dis-positivos apresentam um de acionamento reutilizável dedicado e um feixe defaca e são projetados para serem usados com cartuchos de grampos des-cartáveis. Os cartuchos removíveis construídos para medir a espessura dotecido tais como aqueles descritos no pedido de patente US N0 de série11/729,008, intitulado Laparoscopic Tissue Thickness and Clamp Load Mea-suring Devices, foram também projetados para uso com os referidos instru-mentos. Disposições de manipuladores de extremidade curvos alternativastais como aquelas descritas no pedido de patente US N0 de série11/729.008, intitulado Surgical StapIerWith Tapered Distai End1 apresentamtambém faca reutilizável dedicada e disposições de feixe de acionamentopara uso com cartuchos de grampos removíveis/substituíveis.
Outros tipos de dispositivos de grampeamento cirúrgicos taiscomo os descritos na Patente US N0 5.865.361 são configurados para ope-rar com unidades de carga descartáveis (DLU's) que são construídas parasuportar um cartucho de grampos dedicado e um conjunto de faca no mes-mo. Uma vez que o procedimento seja concluído, toda a DLU é descartada.
Os referidos instrumentos que são projetados para acomodar o suporte deDLU para oferecer a vantagem de uma lâmina de faca "nova" para cada a-cionamento do instrumento. A porção de peça de mão reutilizável dos referi-dos instrumentos de grampeamento cirúrgico foi limitada para uso em cone-xão com unidades de carga descartáveis que foram construídas para cortare grampear tecido. Assim, para operações que envolvem diversas ações eprocedimentos (por exemplo, pegar e manipular tecido, cortar tecido, remo-ção de tecido, aplicação de grampos e/ou clips, cauterização de tecido, en-vio de fármacos e medicamentos, etc.), uma coleção de diferentes instru-mentos cirúrgicos que é projetada especificamente para realizar uma dasreferidas ações que antigamente precisavam ser realizadas a mão.
Assim, já uma necessidade de diferentes tipos de fixações deferramentas cirúrgicas intercambiáveis que podem ser usadas com uma úni-ca peça de instrumento cirúrgico manual.
Sumário
Em um aspecto geral de várias modalidades da presente inven-ção, é proporcionada uma ferramenta cirúrgica para uso com um instrumen-to cirúrgico que é dotado de um conjunto de manopla que suporta operacio-nalmente um sistema de acionamento na mesma para gerar movimentos deacionamento com o acionamento de uma porção de manopla móvel domesmo. O instrumento cirúrgico é adicionalmente dotado de um corpo alon-gado que suporta operacionalmente uma haste de controle no mesmo paratransferir os movimentos de acionamento. Várias modalidades da ferramentacirúrgica compreendem um alojamento que é acoplado de forma removívelao corpo alongado. Um conjunto de acionamento pode ser suportado demodo operacional no alojamento e é acoplado de forma removível à hastede controle. Um par de placas de apoio de formação sem grampo é acopla-do de modo operacional ao conjunto de acionamento de modo que com aaplicação de um movimento de acionamento ao conjunto de acionamentoem uma primeira direção cada uma placas de apoio de formação sem gram-po simultaneamente se move em uma direção de fechamento uma em dire-ção à outra e com a aplicação de outro movimento de acionamento em umasegunda direção, as placas de apoio de formação sem grampo cada umadas quais simultaneamente se move em uma direção de abertura em afas-tamento uma da outra.
Ainda em outro aspecto geral das várias modalidades da pre-sente invenção, é proporcionada uma ferramenta cirúrgica para uso com uminstrumento cirúrgico que é dotado de um conjunto de manopla que suportaoperacionalmente um sistema de acionamento no mesmo para gerar movi-mentos de acionamento com o acionamento de uma porção de manoplamóvel do mesmo. O instrumento cirúrgico pode ser adicionalmente dotadode um corpo alongado que suporta operacionalmente uma haste de controleno mesmo para transferir os movimentos de acionamento. Várias modalida-des da ferramenta cirúrgica podem compreender um transportador que édotado de um alojamento acoplado ao mesmo. O alojamento pode ser aco-plado de forma móvel ao corpo alongado. Um conjunto de acionamento podeser suportado de modo operacional no alojamento e transportador e ser a-coplado de forma removível à haste de controle. Uma placa de apoio de for-mação sem grampo pode ser suportada de forma móvel no transportador econfigurado para agir de modo operacional com o conjunto de acionamentopara seletivamente mover a placa e apoio de formação sem grampo em di-reção e em afastamento do transportador. Um cartucho de medição de es-pessura de tecido pode ser suportado no transportador. O cartucho de medi-ção de espessura de tecido pode ser dotado de um membro indicador queinterage com o alojamento para proporcionar uma indicação de uma faixa deespessura do tecido preso entre a placa de apoio de formação sem grampoe o cartucho de medição de espessura de tecido.
Em outro aspecto geral das várias modalidades da presente in-venção, é proporcionada uma ferramenta cirúrgica para uso com um instru-mento cirúrgico que é dotado de um conjunto de manopla que suporta ope-racionalmente um sistema de acionamento no mesmo para gerar movimen-tos de acionamento com o acionamento de uma porção de manopla móveldo mesmo. O instrumento cirúrgico pode ser adicionalmente dotado de umcorpo alongado que suporta operacionalmente uma haste de controle nomesmo para transferir os movimentos de acionamento. Em várias modalida-des, a ferramenta cirúrgica compreende um alojamento que é diretamenteacoplável ao corpo alongado. Um conjunto de acionamento pode ser supor-tado de modo operacional no alojamento e transportador. O conjunto de a-cionamento pode ser acoplado de forma removível à haste de controle. Umaplaca de apoio de formação de grampo pode ser suportada de forma não-móvel pelo alojamento. Uma pluralidade de grampos pode ser suportada naextremidade distai do alojamento e ser orientadas para ser seqüencialmentedirecionada para dentro da placa de apoio de formação de grampo com aaplicação de um movimento de acionamento ao conjunto de acionamento.
Em outro aspecto geral de várias modalidades da presente in-venção, é proporcionada uma ferramenta cirúrgica para uso com um instru-mento cirúrgico que é dotado de um conjunto de manopla que suporta ope-racionalmente um sistema de acionamento no mesmo para gerar movimen-tos de acionamento com o acionamento de uma porção de manopla móveldo mesmo. O instrumento cirúrgico pode ser adicionalmente dotado de umcorpo alongado que suporta operacionalmente uma haste de controle nomesmo para transferir os movimentos de acionamento. Em várias modalida-des, a ferramenta cirúrgica compreende um alojamento que é diretamenteacoplável ao corpo alongado. Um par de garras móveis opostas pode serfixado a e se estender a partir do o eixo. As garras são configuradas parareceber cada um dos clips cirúrgicos em série nas mesmas quando as gar-ras estão em uma posição aberta. As garras podem também formar cada umdos clips cirúrgicos recebidos em série nas mesmas quando as garras sãomovidas para uma posição fechada. Um mecanismo de formação móvel po-de ser acoplado de forma removível à haste de controle quando o alojamen-to é acoplado ao corpo alongado. O mecanismo de formação pode ser confi-gurado para mover as garras a partir da posição aberta para a posição fe-chada com a aplicação de um primeiro movimento de acionamento a partirda haste de controle de modo a formar cada um dos clips cirúrgicos recebi-dos em série nas mesmas. O mecanismo de formação pode ser adicional-mente configurado para mover a partir da posição fechada para a posiçãoaberta com a aplicação de um segundo movimento de acionamento para omecanismo de formação pela haste de controle. Um mecanismo de alimen-tação pode operacionalmente interagir com o mecanismo de formação mó-vel. O mecanismo de alimentação pode ser dotado de uma placa de alimen-tação que é móvel em resposta ao movimento do mecanismo de formação epode ser acoplado de modo liberável a um impulsionador de clip do meca-nismo de alimentação. O impulsionador de clip pode ser estacionário e de-sacoplado a partir da placa de alimentação com a aplicação do primeiro mo-vimento de acionamento para o mecanismo de formação. O impulsionadorde clip pode ser móvel e acoplado de modo operacional à placa de alimenta-ção com a aplicação do segundo movimento de acionamento ao mecanismode formação móvel de modo a mover cada um dos clips cirúrgicos em sériea partir do eixo para dentro das garras.
Em relação com outro aspecto geral da presente invenção, éproporcionada uma ferramenta cirúrgica para uso com um instrumento cirúr-gico que é dotado de um conjunto de manopla que suporta operacionalmen-te um sistema de acionamento no mesmo para gerar movimentos de acio-namento com o acionamento de uma porção de manopla móvel do mesmo.O instrumento cirúrgico pode ser adicionalmente dotado de um corpo alon-gado que suporta operacionalmente uma haste de controle no mesmo paratransferir os movimentos de acionamento. Várias modalidades da ferramentacirúrgica da presente invenção podem compreender um transportador que édotado de um alojamento acoplado ao mesmo. O alojamento pode ser aco-plado de forma removível ao corpo alongado. Um conjunto de acionamentopode ser suportado de modo operacional no alojamento e transportador etambém ser acoplado de forma removível à haste de controle. Uma placa deapoio de formação de grampo pode ser suportada de forma móvel no trans-portador e interagir de modo operacional com o conjunto de acionamentopara seletivamente mover a placa de apoio de formação de grampo em dire-ção a e em afastamento do transportador. Um cartucho de suporte de gram-pos que é dotado de um raio de curvatura pode ser suportado no transporta-dor. O cartucho de suporte de grampos pode ser dotado de uma fenda curvaatravés do mesmo definindo uma passagem curva para receber uma extre-midade distai do conjunto de acionamento através da mesma com a aplica-ção de um movimento de acionamento à mesma.
De acordo com outro aspecto geral da presente invenção, éproporcionada uma ferramenta cirúrgica para uso com um instrumento cirúr-gico que é dotado de um conjunto de manopla que suporta operacionalmen-te um sistema de acionamento no mesmo para gerar movimentos de acio-namento com o acionamento de uma porção de manopla móvel do mesmo.Um corpo alongado pode suportar de modo operacional uma haste de con-trole no mesmo para transferir os movimentos de acionamento. Várias mo-dalidades da ferramenta cirúrgica podem compreender um alojamento que éacoplado de forma removível ao corpo alongado. Um corpo de seringa podeser acoplado ao alojamento. Uma agulha oca pode se salientar a partir docorpo de seringa. Um conjunto de acionamento pode ser suportado de modooperacional no alojamento e pode ser acoplado de forma removível à hastede controle. Um êmbolo de seringa pode ser suportado de forma móvel nocorpo de seringa e pode ser acoplado ao conjunto de acionamento para mo-vimento seletivo com o mesmo.
De acordo ainda com outro aspecto geral da presente invençãoé proporcionada uma ferramenta cirúrgica para uso com um instrumento ci-rúrgico que é dotado de um conjunto de manopla que suporta operacional-mente um sistema de acionamento no mesmo para gerar movimentos deacionamento com o acionamento de uma porção de manopla móvel domesmo. Um corpo alongado pode suportar de modo operacional uma hastede controle no mesmo para transferir os movimentos de acionamento. Váriasmodalidades da ferramenta cirúrgica podem compreender um alojamentoque é acoplado de forma removível ao corpo alongado. Um manipulador deextremidade de não-aplicação de grampo pode se salientar operacionalmen-te a partir de uma extremidade distai do alojamento. A manipulador de ex-tremidade de não-aplicação de grampo pode suportar pelo menos um mem-bro eletricamente acionado. Uma bateria pode ser suportada de forma móveldentro do alojamento e ser configurada para eletricamente se comunicarcom o pelo menos um membro eletricamente acionado. A bateria pode seracoplada de forma removível à haste de controle de modo que com a aplica-ção de um primeiro movimento de acionamento à mesma, a bateria aplicaenergia ao membro eletricamente acionado e, com a aplicação de um se-gundo movimento de acionamento à mesma, a bateria descontínua a aplica-ção de energia ao membro eletricamente acionado.
De acordo com outro aspecto geral da presente invenção é pro-porcionada um sistema de ferramenta cirúrgica que inclui um instrumentocirúrgico que pode compreender um conjunto de manopla que é dotado deum sistema de acionamento suportado de modo operacional no mesmo paragerar movimentos de acionamento com o acionamento de uma porção demanopla móvel que é acoplada de modo operacional ao conjunto de mano-pia. Um corpo alongado pode se salientar a partir do conjunto de manopla euma haste de controle pode ser suportada de modo operacional no corpoalongado. A haste de controle pode interfacear com o sistema de aciona-mento para receber os movimentos de acionamento a partir do mesmo. Osistema pode adicionalmente incluir pelo menos duas ferramentas cirúrgicasque são selecionadas a partir do grupo de ferramentas cirúrgicas que consis-tem em: manipuladores, alicates, tesouras, endocortadores, dispositivos demedição de espessura de tecido, aplicadores de grampos, aplicadores decips, seringas aplicadoras de cola/selante/fármaco/medicamento e dispositi-vos de cauterização onde cada ferramenta cirúrgica inserida no grupo deferramentas cirúrgicas pelo menos é dotada de um alojamento que é aco-plado de forma removível ao corpo alongado e um conjunto de acionamentoque é acoplado de forma removível à haste de controle para receber os mo-vimentos de acionamento a partir do mesmo.
Os referidos e outros objetivos e vantagens da presente inven-ção devem ser aparentes a partir dos desenhos anexos e da descrição damesma.
Breve Descrição das Figuras
Os desenhos anexos, os quais são incorporados e constituemuma parte do presente relatório descritivo, ilustram modalidades da presenteinvenção, e, junto com a descrição geral das várias modalidades da presenteinvenção oferecidas acima, e a descrição detalhada das modalidades ofere-cidas abaixo, servem para explicar vários princípios da presente invenção.
A figura 1 é uma vista em perspectiva de um aparelho de corte egrampeamento cirúrgico da técnica anterior.
A figura 2 é uma vista lateral de uma modalidade de ferramentacirúrgica da presente invenção.
A figura 3 é uma vista em seção transversal da modalidade deferramenta cirúrgica da figura 2 com alguns componentes da mesma mos-trados em vista completa para clareza.
A figura 4 é outra vista em seção transversal da modalidade deferramenta cirúrgica das figuras 2 e 3 em uma posição fechada.A figura 5 é uma vista em perspectiva mostrando um uso exem-plificativo da modalidade de ferramenta cirúrgica das figuras 2 - 4 em relaçãocom outra modalidade de ferramenta cirúrgica da presente invenção pararemover tecido a partir de um paciente.
A figura 6 é uma vista em seção transversal de outra modalida-de de ferramenta cirúrgica da presente invenção com alguns componentesda mesma mostrados em vista completa para clareza.
A figura 7 é uma vista em perspectiva de outra modalidade deferramenta cirúrgica da presente invenção.
A figura 8 é uma vista em perspectiva de outra modalidade deferramenta cirúrgica da presente invenção.
A figura 9 é uma vista em seção transversal da modalidade deferramenta cirúrgica da figura 8.
A figura 10 é uma vista em seção transversal ampliada da ex-tremidade distai da ferramenta cirúrgica das figuras 8 e 9 em uma posiçãopré-acionada.
A figura 11 é outra vista em seção transversal ampliada da ex-tremidade distai da ferramenta cirúrgica das figuras 8-10 onde um grampoestá sendo acionado no tecido.
A figura 12 é outra vista em seção transversal ampliada da ex-tremidade distai da ferramenta cirúrgica das figuras 8-11 após o primeirogrampo ter sido acionado.
A figura 13 é uma vista em perspectiva de outra modalidade deferramenta cirúrgica da presente invenção.
A figura 14 é uma vista em seção transversal da modalidade deferramenta cirúrgica da figura 13 com alguns componentes da mesma mos-trados em vista completa para clareza.
A figura 15 é uma vista em perspectiva de outra modalidade deferramenta cirúrgica da presente invenção.
A figura 16 é uma vista explodida do conjunto de uma porção damodalidade de ferramenta cirúrgica da figura 15.
A figura 17 é uma vista elevada lateral da modalidade de ferra-menta cirúrgica das figuras 15 e 16 com o conjunto de placa de apoio emuma posição aberta.
A figura 18 é uma outra vista elevada lateral da modalidade deferramenta cirúrgica das figuras 15 e 16 com uma porção da mesma mostra-da em seção transversal e com o conjunto de placa de apoio mostrado emuma primeira posição fechada sem tecido preso na mesma.
A figura 19 é uma vista ampliada da extremidade distai da mo-dalidade de ferramenta cirúrgica ilustrada na figura 18.
A figura 20 é uma vista em seção transversal da ferramenta α-rúrgica da figura 18 tomada ao longo da linha 20 - 20 na figura 18.
A figura 21 é uma vista ampliada da porção de extremidade dis-tai da ferramenta cirúrgica mostrados na figura 20.
A figura 22 é uma vista explodida do conjunto da porção de car-tucho de medição de espessura da ferramenta cirúrgica das figuras 15-21.
A figura 23 é outra vista explodida do conjunto de porções docartucho de medição de espessura da figura 21.
A figura 24 é uma vista em seção transversal de uma porção daferramenta cirúrgica da figura 17 tomada ao longo da linha 24 - 24 na figura17.
A figura 25 é uma vista em seção transversal de uma porção daferramenta cirúrgica da figura 17 tomada ao longo da linha 25 - 25 na figura17.
A figura 26 é uma vista elevada lateral da modalidade de ferra-menta cirúrgica das figuras 15 - 25 com o conjunto de placa de apoio emuma posição fechada para prender tecido dotado de uma primeira faixa deespessura na mesma.
A figura 27 é uma vista ampliada da extremidade distai da mo-dalidade de ferramenta cirúrgica ilustrada na figura 26.
A figura 28 é uma vista elevada lateral da modalidade de ferra-menta cirúrgica das figuras 15-27 com o conjunto de placa de apoio emuma posição fechada para prender tecido dotado de uma segunda faixa deespessura na mesma.A figura 29 é uma vista elevada lateral da modalidade de ferra-menta cirúrgica das figuras 15-28 com o conjunto de placa de apoio emuma posição fechada para prender tecido dotado de uma terceira faixa deespessura na mesma.
A figura 30 é uma vista elevada lateral da modalidade de ferra-menta cirúrgica das figuras 15 - 29 com o conjunto de placa de apoio emuma posição fechada para prender tecido dotado de uma quarta faixa deespessura no mesmo.
A figura 31 é uma vista em perspectiva de uma porção de outramodalidade de ferramenta cirúrgica da presente invenção com a coberturaremovida a partir da mesma.
A figura 32 é uma vista em perspectiva de porções da disposi-ção de placa de formação e placa de alimentação da ferramenta cirúrgica dafigura 31.
A figura 33 é uma vista plana da modalidade de ferramenta ci-rúrgica da figura 31 com a cobertura removida para clareza.
A figura 34 é uma vista em seção transversal da ferramenta ci-rúrgica das figuras 31 - 33.
A figura 35 é uma vista em seção transversal da ferramenta ci-rúrgica da figura 34 tomada ao longo da linha 35 - 35 na figura 34.
A figura 36 é uma vista plana de outra modalidade de ferramen-ta cirúrgica da presente invenção com uma porção do conjunto de placa deapoio omitida para clareza.
A figura 37 é uma vista plana de outra modalidade de ferramen-ta cirúrgica da presente invenção com uma porção do conjunto de placa deapoio omitida para clareza.
A figura 38 é uma vista em perspectiva de outra modalidade deferramenta cirúrgica da presente invenção.
A figura 39 é uma vista em seção transversal de uma porção doalojamento da ferramenta cirúrgica da figura 38.
A figura 40 é uma vista explodida do conjunto de outra modali-dade de ferramenta cirúrgica da presente invenção usada em relação a outramodalidade de instrumento cirúrgico da presente invenção.
A figura 41 é uma vista em perspectiva de uma modalidade dealojamento alternativa da presente invenção com uma porção do mesmomostrada em linhas pontilhadas para ilustrar a capacidade de articular sobreum membro de articulação formado na mesma.
A figura 42 é uma vista em perspectiva de outra modalidade al-ternativa de alojamento da presente invenção.
Descrição Detalhada
Voltando agora aos desenhos, onde números similares denotamcomponentes similares através das diversas vistas, a figura 1 ilustra um ins-trumento cirúrgico da técnica anterior 10 que inclui um conjunto de alojamen-to 12 e um corpo alongado 14 o qual se salienta a partir do mesmo. Tambémmostrada na figura 1 está uma unidade de carga descartável 16 que com-preende um endocortador de uso único para cortar tecido e aplicar linhas degrampos em cada lado do corte. A unidade de carga descartável 16 incluium conjunto de ferramenta 17 dotado de um conjunto de cartucho 18 alojan-do uma pluralidade de clips cirúrgicos e um conjunto de placa de apoio 20fixado de forma móvel em relação ao conjunto de cartucho 18. Em váriasmodalidades, o instrumento cirúrgico convencional 10 e a unidade de cargadescartável 16 podem compreender o instrumento cirúrgico e unidade decarga descartável descritos na Patente US N0 5.865.361, a descrição daqual foi aqui incorporada por referência. Assim, a presente descrição deta-lhada não irá especificamente discutir aqui os vários componentes do ins-trumento cirúrgico 10 e da unidade de carga descartável 16 e a operaçãodos mesmos, além do que será necessário para descrever a operação dasdiversas modalidades de ferramenta cirúrgica da presente invenção as quaispodem ser usadas com um instrumento cirúrgico 10.
Na medida em que a descrição detalhada presente prossegue,será observado que os termos "proximal" e "distai" são usados aqui com re-ferência a um médico pegando um conjunto de manopla 12 do instrumentocirúrgico 10 ao qual uma ferramenta cirúrgica particular é acoplada de modooperacional. Assim, a ferramenta cirúrgica é "distai" com relação ao conjuntode manopla mais proximal 12. Será adicionalmente observado que, por con-veniência e clareza, termos espaciais tais como "vertical", "horizontal", "paracima", "para baixo", "direita", e "esquerda" são usados aqui com relação aosdesenhos. Entretanto, ferramentas cirúrgicas e instrumentos são usados emmuitas orientações e posições, e os referidos termos não são pretendidospara ser Iimitantes e absolutos.
As figuras 2 - 4 ilustram uma ferramenta cirúrgica 1000 de umamodalidade da presente invenção que pode ser acoplada de modo opera-cional ao instrumento cirúrgico 10 e usada para manipular tecido, órgãos,etc. Como pode ser visto nas referidas figuras, a ferramenta cirúrgica 1000pode incluir um alojamento 1010 que é dotado de uma extremidade proximal1012 que é configurada para fixação removível ao corpo alongado 14 do ins-trumento cirúrgico 10. Em particular, a extremidade proximal 1012 pode serdotada de protuberâncias de engate 254 formadas na mesma as quais ser-vem para formar um acoplamento do tipo baioneta com a extremidade distaida porção de corpo alongada 14 do aparelho de grampeamento cirúrgicocomo descrito na Patente US N0 5.865.361.
A ferramenta cirúrgica 1000 inclui um conjunto de acionamento1020 que pode incluir um segmento de feixe de acionamento proximal 1022que é acoplado a um segmento de feixe de acionamento distai 1030 por umconjunto de ligação reversível 1040. Os segmentos direcionamento de acio-namento 1020, 1030 podem cada um dos quais ser construído a partir deuma única folha de material ou, preferivelmente, a partir de múltiplas folhasempilhadas. Entretanto, segmentos de direcionamento de acionamento1020, 1030 podem ser fabricados a partir de outros materiais e disposiçõesadequadas. Como pode ser visto na figura 3, o segmento de feixe de acio-namento proximal 1022 é dotado de uma seção de engate 1024 formada nomesmo que pode incluir um par de dedos de engate 1024a e 1024b que sãodimensionados e configurados para engatar por montagem um membro deacionamento 1026. O membro de acionamento 1026 inclui uma vigia proxi-mal 1028 configurada para receber a extremidade distai 276 da haste decontrole 52 (Ver a Figura 1) quando a extremidade proximal 1012 da fixaçãode ferramenta 100 é acoplada ao corpo alongado 14 do aparelho cirúrgico10. Como pode ser visto na figura 3, a extremidade proximal 1012 é dotadode uma passagem oca 1014 na mesma através da qual a extremidade distai276 da haste de controle 52 pode se estender.
A extremidade distai do segmento de feixe proximal 1022 é do-tada de uma aba que se salienta distalmente 1028 que é fixa a uma ligaçãouma ligação 1042 do conjunto de ligação reversível 1040. A ligação 1042 épivotavelmente fixada ao alojamento 1010 por pino 1044 e é também fixadaà porção de aba proximal 1032 do segmento de feixe de acionamento distai1030. A extremidade distai 1034 do segmento de feixe de acionamento distai1030 pode ser pivotavelmente fixada a uma garra de manipulação de forma-ção sem grampo superior 1050 por uma primeira ligação pivô 1052 e tam-bém fixada a uma garra de manipulação de formação sem grampo inferior1060 por uma segunda ligação pivô 1062. Como usado aqui, o termo "for-mação sem grampo" se refere a garras que são projetadas para prender oumanipular tecido, mas não são projetadas para formar, suportar ou direcio-nar grampos, tais como, por exemplo, placas de apoio, cartuchos de gram-pos ou porções de unidades projetadas para suportar cartuchos de grampos.
As figuras 2 e 3 ilustram as garras de manipulação superior e in-ferior 1050, 1060 em uma orientação aberta e a figura 4 ilustra as garras demanipulação superior e inferior 1050, 1060 em uma orientação fechada.
Uma vez que a ferramenta cirúrgica 1000 é acoplada ao corpo alongado 14do aparelho cirúrgico 10 (e a extremidade distai 276 da haste de controle 52é acoplada ao membro de acionamento 2026), o médico pode mover as gar-ras de manipulação superior e inferior 1050, 1060 entre as posições aberta efechada ao manipular a porção de manopla móvel 24 do aparelho cirúrgico10. Por exemplo, o pivotamento da porção de manopla móvel 24 em direçãoda porção estacionária 22 do conjunto de manopla 12, faz com que a hastede controle 52 mova o segmento de feixe de acionamento proximal 1022 emuma "primeira" direção distai "DD". Na medida em que o segmento de feixede acionamento proximal 1022 se move na primeira direção distai "DD", aligação reversível 1040 puxa o segmento de feixe de acionamento distai1030 em uma "segunda" direção proximal "PD" o que faz com que cada umadas ligações 1052, 1062 simultaneamente mova as garras de manipulaçãode formação sem grampo superiores e inferiores 1050, 1060 uma em dire-ção à outra a uma orientação fechada. Ao mover a haste móvel 24 em afas-tamento a partir da porção de manopla estacionária 22 se faz com que cadauma das garras de manipulação de formação sem grampo superior e inferior1050, 1060 simultaneamente se mova em afastamento uma da outra para aposição aberta.
Aquele versado na técnica entenderá que as garras de manipu-lação de formação sem grampo superior e inferior 1050, 1060 podem serproporcionadas em diferentes formatos e tamanhos sem se desviar do espí-rito e âmbito da presente invenção. Por exemplo, a figura 5 ilustra um uso daferramenta cirúrgica 1000 da presente invenção em relação com a remoçãode tecido, etc., a partir de uma cavidade corporal 600. Mais especificamente,a figura 5 ilustra o uso de um primeiro trocarte convencional 610 que é usa-do para formar uma primeira passagem 604 através de uma parede do corpo602 para dentro de uma cavidade corporal 600. Uma ferramenta cirúrgica1000 da presente invenção é fixada a um primeiro aparelho cirúrgico con-vencional 10. A ferramenta cirúrgica 1000 é então inserida através de umacânula no primeiro trocarte 610 e para dentro de uma cavidade corporal 600para pegar e manipular uma porção de tecido 606.
Alguns procedimentos médicos podem requerer porções de te-cido doente ou órgãos a serem removidos a partir de uma cavidade corporal600. Para facilitar a remoção de pequenas quantidades do referido tecido apartir de uma cavidade corporal 600, outra ferramenta cirúrgica 1100 da pre-sente invenção pode ser empregada. Como pode ser visto na figura 5, a fer-ramenta cirúrgica 1100 pode incluir uma porção de alojamento 1110 que édotada de uma extremidade proximal 1112 que é dotada de protuberâncias254 formadas na mesma para facilitar fixação à porção de corpo alongado14 do aparelho cirúrgico 10' da maneira acima descrita. O alojamento 1110pode ser dotado de uma cavidade oca no mesmo, a qual facilitaria o movi-mento da haste de controle 52 no mesmo. Entretanto, em várias modalida-des, a extremidade distai 276 da haste de controle não está diretamente a-coplada a qualquer componente dentro do alojamento. Fixado à extremidadedistai 1114 do alojamento 1110 está uma bolsa de recuperação de espécime1120 que pode ser formado a partir de uma porção de anel de bolsa dobrá-vel 1122 que é dotada de um membro de bolso flexível 1124 fixado à mes-ma. O anel de bolsa dobrável 1122 pode ser fabricado a partir de braços demola 1226 ou similares que permitiriam que a porção de anel de bolsa 1122se sobre para permitir que a bolsa de recuperação de espécime 1120 sejainserida e retraída a partir da cânula de um trocarte convencional 610 ousimilar.
Retornando à figura 5, é também ilustrada uma ferramenta ci-rúrgica 1100 da presente invenção que foi fixada a outro instrumento cirúrgi-co convencional 10' que foi inserido através de outro trocarte convencional610. Após o conjunto de bolsa 1120 ter sido passado através da cânula detrocarte para dentro da cavidade corporal 600, o anel de bolsa dobrável 1122se abre. A ferramenta cirúrgica 1000 pode ser empregada para pegar tecidodoente 606 (por exemplo, pedras de vesícula, etc.) e dispor o tecido doente606 dentro do conjunto de bolsa 1120 o qual pode então ser retraído atravésda cânula do segundo trocarte convencional 610. Um cordão de puxar 1121se estende em torno do anel de bolsa 1112 e através do alojamento 1110 aser amarrado através de uma porção do corpo alongado 14 e pode sair atra-vés de um orifício no mesmo adjacente ao conjunto de manopla 12. O cor-dão de puxar 1121 pode ser usado para fechar a bolsa de recuperação deespécime 1120 quando se remove a bolsa cheia 1120 a partir de uma cavi-dade corporal.
Determinados outros procedimentos médicos envolvem o cortee a remoção de pequenas porções de tecido tais como a remoção de umpólipo 700 ou a extração de uma pequena porção de tecido para teste. Umamodalidade de ferramenta cirúrgica 1200 da presente invenção pode serusada para realizar as referidas atividades. Mais especificamente e com re-ferência à figura 6, uma ferramenta cirúrgica 1200 pode incluir uma porçãode alojamento 1110 e segmentos de direcionamento de acionamento 1022,1030 como foi acima descrito. A ferramenta cirúrgica 1200 é acoplada à por-ção de corpo alongado 14 e à haste de controle 52 da maneira acima descri-ta e é operada ao mover a porção de manopla móvel 24 em direção a e emafastamento a partir da porção de manopla estacionária 22 como foi tambémacima descrito. Entretanto, em várias modalidades, em vez de ter garras demanipulação superior e inferior acopladas à mesma, uma garra superior depinçamento de tecido 1210 e uma garra inferior de pinçamento de tecido1220 são fixadas a umas ligações 1052 e 1062, respectivamente. Como po-de ser visto na figura 6, as garras superior e inferior de pinçamento de tecido1210 e 1220 são projetadas para pinçar tecido preso entre as mesmas. Pelomenos uma das garras 1210, 1220 é dotada de uma porção de cavidade1211 na mesma para recuperar o tecido pinçado. Na modalidade ilustradana figura 6, cada garra de pinçamento de tecido 1210, 1220 é dotada deuma porção de cavidade 1211 formada na mesma que coopera para formaruma área de receptáculo oca em geral designada como 1230 quando as gar-ras 1210, 1220 são substancialmente fechadas. Assim, após o tecido 700 tersido pinçado ao fechar as garras 1210, 1220, o tecido 700 é então recebidona área de receptáculo oca 1230 para remoção a partir do corpo.
A figura 7 ilustra outra ferramenta cirúrgica 1300 da presente in-venção que inclui uma porção de alojamento 1110 e conjunto de acionamen-to 1020 como acima descrito. Como pode ser visto na figura 7, entretanto, aferramenta cirúrgica 1300 emprega garras de tesoura 1310 e 1320. Em par-ticular, a garra de tesoura superior 1310 é fixada a uma ligação 1052 e agarra de tesoura inferior é fixada a uma ligação 1062. Um membro de supor-te 1380 se salienta a partir da extremidade distai de uma porção de aloja-mento 1110 e pivotavelmente suporta as garras de tesoura 1310, 1320 sobreum pino pivô 1382 como mostrado. A ferramenta cirúrgica 1300 é acoplada àporção de corpo alongado 14 e à haste de controle 52 do instrumento cirúr-gico 10 da maneira acima descrita e é operada ao mover a porção de mano-pia móvel 24 em direção de e em afastamento a partir da porção de manoplaestacionária 22 como foi também acima descrito. Assim, as garras de tesou-ra 1310, 1320 podem ser alinhadas uma à outra para permitir que a ferra-menta cirúrgica 1300 seja inserida através da cânula (trocarte) dentro dacavidade corporal e então ativada para cortar tecido ao mover a porção demanopla móvel 24 do instrumento cirúrgico 10.
As figuras 8-12 ilustram outra ferramenta cirúrgica 1400 quepode ser usada com o instrumento cirúrgico convencional 10. Como podeser visto nas referidas figuras, a ferramenta cirúrgica 1400 compreende umgrampeador para grampear tecido. Mais particularmente e com referência àfigura 8, a ferramenta cirúrgica 1400 pode incluir uma porção de alojamento1410 que é dotada de uma porção de extremidade proximal 1412 que é con-figurada para fixação removível ao corpo alongado 14 do instrumento cirúr-gico 10. Em particular, a porção de extremidade proximal 1412 pode ser do-tada de protuberâncias de engate 254 formadas na mesma as quais servempara formar um acoplamento do tipo baioneta com a extremidade distai daporção de corpo alongada 14 do instrumento cirúrgico 10 como acima des-crito. A ferramenta cirúrgica 1400 pode incluir um conjunto de acionamento1420 que inclui um feixe de acionamento alongado 1422 que pode ser cons-truído a partir de uma única folha de material ou, preferivelmente, a partir demúltiplas folhas empilhadas. Entretanto, o feixe de acionamento 1422 podeser fabricado a partir de outros materiais e disposições adequadas. Comopode ser visto na figura 9, o feixe de acionamento 1422 é dotado de umaseção de engate 1424 formada no mesmo que pode incluir um par de dedosde engate 1424a e 1424b que são dimensionados e configurados para enga-tar por montagem um membro de acionamento 1426. O membro de aciona-mento 1426 inclui uma vigia proximal 1428 configurada para receber a ex-tremidade distai 276 da haste de controle 52 (Ver a Figura 1) quando a ex-tremidade proximal 1412 da ferramenta cirúrgica 1400 é acoplada ao corpoalongado 14 de um instrumento cirúrgico 10. Como pode ser visto na figura9, a extremidade proximal 1412 é dotada de uma passagem oca 1414 namesma através da qual a extremidade distai 276 da haste de controle 52pode se estender.
Como pode também ser visto nas figuras 9 - 12, o alojamento1410 é dotado de uma porção de extremidade distai 1416 a qual aloja demodo operacional colunas 1430 de clips cirúrgicos 1432 nas mesmas. Emvárias modalidades, o alojamento 1410 pode ser fabricado em múltiplossegmentos para permitir a instalação dos grampos 1432 no mesmo. Paramodalidades de uso único, os grampos 1432 podem ser instalados na fábri-ca e as porções de alojamento permanentemente montadas juntas por ade-sivos, encaixes, etc. Em outras modalidades, as porções de alojamento po-dem ser acopladas juntas de modo removível para permitir a instalação degrampos adicionais 1432. Como pode também ser visto nas figuras 9-12,um de acionamento de grampo 1440 é fixado a uma extremidade distai dofeixe de acionamento 1422. A extremidade distai 1442 do de acionamentode grampo 1440 pode ser dotada de uma chanfradura de recebimento degrampo 1444 formada na mesma como pode ser visto nas figuras 10-12.
A ferramenta cirúrgica 1400 é acoplada à porção de corpo alon-gado 14 e à haste de controle 52 do instrumento cirúrgico 10 da maneiraacima descrita e é operada ao mover a porção de manopla móvel 24 em di-reção de e em afastamento a partir da porção de manopla estacionária 22como foi também acima descrito. Uma mola de retorno 1450 é suportadaentre uma porção de parede 1418 do alojamento 1410 e uma porção de abade retorno 1446 no acionamento de grampo 1440 para ajudar no retorno deacionamento de grampo 1440 para a posição de retorno onde outro grampo1432 deve ser disposto para a posição de acionamento como mostrado nafigura 10. Como pode ser visto na figura 10, quando em uma posição de a-cionamento, o grampo de fundo 1432 na coluna mais distai 1430 de gram-pos 1432 foi posto em engate com a chanfradura de recebimento de grampo1444 no de acionamento de grampo 1440. Uma mola de alimentação do tipode folhas 1470 pode ser proporcionada para orientar cada grampo que se-gue 1432 na coluna mais distai 1430 de grampos para baixo em direção dode acionamento de grampo 1440. Adicionalmente, um conjunto de mola1480 (ilustrada em forma de caixa nas figuras 10 - 12) é montado na porçãode extremidade distai 1416 do alojamento 1410 para orientar as colunas1430 de grampos 1432 na direção distai "DD" no de acionamento de grampo1440 de modo que na medida em que uma coluna de grampos 1432 é esva-ziada, a próxima coluna de grampos adjacente 1432 é orientada para a posi-ção de acionamento mostrada na figura 10.
Assim, para usara ferramenta cirúrgica 1400, a extremidade dis-tai 1416 de uma porção de alojamento 1410 é trazida em engate com o teci-do "T" a ser grampeado. Ver a Figura 11. Como pode ser visto nas figuras10 - 12, a porção de extremidade distai 1416 é dotada de uma extremidadealongada 1417 que é dotada de uma abertura 1419 na mesma para expor ogrampo 1432 sendo acionado. Na medida em que o grampo 1432 é aciona-do (isto é, orientado na direção distai "DD" pelo de acionamento de grampo1440) através do movimento da porção de manopla móvel 24 do instrumentocirúrgico 10, o mesmo é formado na medida em que entra em contato comuma placa de apoio de grampo 1490 montado de modo não-móvel dentro doalojamento 1410. A figura 10 ilustra a ferramenta cirúrgica 1400 antes doacionamento. A figura 11 ilustra o acionamento de um grampo 1432 no teci-do "Τ". A figura 12 ilustra o de acionamento de grampo 11440 após ter sidoretraído para permitir que outro grampo 1432 seja disposto na posição pron-ta. Embora a ferramenta cirúrgica 1400 seja particularmente bem adequadapara procedimentos endoscópicos, aqueles versados na técnica irão tam-bém observar que a ferramenta cirúrgica 1400 pode também ser usada paragrampear incisões abertas que não necessitem de uma ferramenta cirúrgica1400 a ser inserida através da cânula no interior de uma cavidade corporal.
As figuras 13 e 14 ilustram outra ferramenta cirúrgica 1500 quepode ser usada com o instrumento cirúrgico convencional 10. Como podeser visto nas referidas figuras, a ferramenta cirúrgica 1500 compreende umaseringa para administração, por exemplo, de cola, selante, um fármaco ououtro medicamento. Mais particularmente e com referência à figura 14, aferramenta cirúrgica 1500 pode incluir uma porção de alojamento 1500 que édotada de uma porção de extremidade proximal 1512 que é configurada pa-ra fixação removível ao corpo alongado 14 do instrumento cirúrgico 10. Emparticular, a porção de extremidade proximal 1512 pode ser dotada de pro-tuberâncias de engate 254 formadas na mesma as quais servem para formarum acoplamento do tipo baioneta com a extremidade distai da porção decorpo alongada 14 do instrumento de grampeamento cirúrgico 10 como aci-ma descrito. A ferramenta cirúrgica 1500 pode incluir um conjunto de acio-namento 1520 que compreende um feixe de acionamento alongado 1522que pode ser construído a partir de uma única folha de material ou, preferi-velmente, a partir de múltiplas folhas empilhadas. Entretanto, o feixe de a-cionamento 1522 pode ser fabricado a partir de outros materiais e disposi-ções adequadas. Como pode ser visto na figura 14, o feixe de acionamento1522 é dotado de uma seção de engate 1524 formada na mesma que podeincluir um par de dedos de engate 1524a e 1524b que são dimensionados econfigurados para engatar por montagem um membro de acionamento 1526.O membro de acionamento 1526 inclui uma vigia proximal 1528 configuradapara receber a extremidade distai 276 da haste de controle 52 (Ver a Figura1) quando a extremidade proximal 1512 da ferramenta cirúrgica 1500 é aco-plada ao corpo alongado 14 do instrumento cirúrgico 10. Como pode ser vis-to na figura 14, a extremidade proximal 1512 é dotada de uma passagemoca 1514 no mesmo através da qual a extremidade distai 276 da haste decontrole 52 pode se estender.
Como pode também ser visto nas figuras 13 e 14, um corpo deseringa 1570 é fixado a uma extremidade distai 1516 por um colar 1572 ououtro meio de fixação. O colar 1572 pode ser fixado ao alojamento 1510 e aocorpo de seringa 1570, por adesivo ou outros meios adequados. Como podeser visto na figura 14, uma extremidade distai 1523 do feixe de acionamento1522 é fixada a um êmbolo de seringa 1574 que é suportada de forma móveldentro do corpo de seringa 1570. Uma agulha oca ou cânula 1580 pode serfixada à extremidade distai do corpo de seringa 1570 como mostrado. Ocorpo de seringa 1570 pode ser preenchido com um fármaco ou medicamen-to ao primeiro se avançar o êmbolo de seringa 1574 para a extremidade dis-tai do corpo de seringa 1570 ao mover a haste móvel 24 do instrumento ci-rúrgico 10 (figura 1) em direção da porção de manopla estacionária 22 doconjunto de manopla 12. Após, a extremidade pontiaguda 1582 da agulha1580 pode ser inserida em um frasco ou reservatório de cola, selante, fár-maco ou medicamento (não mostrado). O médico pode então sorver o mate-rial a partir do reservatório para dentro do corpo de seringa 1570 através daagulha 1580 ao mover a haste móvel 24 em afastamento a partir da porçãoestacionária 22 do conjunto de manopla 12 que serve para mover o feixe deacionamento 1522 e o êmbolo de seringa 1574 na direção proximal "PD".Uma vez que a quantidade desejada de fármaco ou medicamento ter sidosorvido para dentro do corpo de seringa 1574, o médico pode então inserir aferramenta cirúrgica 1500 para dentro da cavidade corporal através de umacânula ou outra abertura e então expelir o fármaco ou medicamento a partirdo corpo de seringa 1570 para mais uma vez mover a haste móvel 24 emdireção da porção de manopla estacionária 22 do conjunto de manopla 12.Uma escala ou outra forma de indicio de medição 1590 pode ser proporcio-nada no corpo de seringa 1570 para permitir que o médico monitore a quan-tidade de cola, selante, fármaco ou medicamento que foi descarregada a partir do corpo de seringa 1574.
Quando um procedimento cirúrgico envolve o grampeamento detecido, o médico deve selecionar o lado adequado do grampo para usar combase na espessura do tecido a ser grampeado. Por exemplo, grampos quesão comumente usados para procedimentos endoscópicos são em geral fa-bricados em vários tamanhos para proporcionar várias alturas formadas taiscomo 0,75 mm, 1,0 mm, 1,5 mm, 2,0 mm, etc. O médico deve cuidadosa-mente corresponder o tamanho do grampo à espessura do tecido. Se ogrampo é muito grande, o tecido pode não ser mantido junto adequadamen-te ou se o grampo é muito pequeno, o mesmo pode rasgar através do tecido.Antigamente, entretanto, o médico com freqüência teria que estimar a es-pessura do tecido e então esperar que a estimativa fosse suficientementeprecisa. Assim, há necessidade de uma ferramenta cirúrgica que possa serusada em relação com um instrumento cirúrgico 10 que pode medir comprecisão a espessura do tecido de modo que o tamanho apropriado degrampos possa ser usado.
As figuras 15 - 30 ilustram uma modalidade de ferramenta cirúr-gica 1600 da presente invenção que pode ser acoplada de modo operacionalao instrumento cirúrgico 10 e usada para medir a espessura do tecido "T"que pode precisar ser cortado e grampeado. Como pode ser visto nas referi-das figuras, a ferramenta cirúrgica 1600 pode incluir um transportador 216que é dotado de um alojamento 1610 fixado à mesma. O alojamento 1610pode ser fixado a paredes verticais 217 do transportador 216 por caracterís-ticas de encaixe 219 ou outro meio adequado. O alojamento 1610 é dotadode uma extremidade proximal 1612 que é configurada para fixação removí-vel ao corpo alongado 14 do instrumento cirúrgico 10. Em particular, a ex-tremidade proximal 1612 pode ser dotada de protuberâncias de engate 254formadas na mesma as quais servem para formar um acoplamento do tipobaioneta com a extremidade distai da porção de corpo alongada 14 do ins-trumento cirúrgico 10 como foi acima descrito.
A ferramenta cirúrgica 1600 adicionalmente inclui um conjuntode acionamento 1620 que inclui um feixe de acionamento 1622 que pode serconstruído a partir de uma única folha de material ou, preferivelmente, a par-tir de múltiplas folhas empilhadas. Entretanto, o feixe de acionamento 1622pode ser fabricado a partir de outros materiais e disposições adequadas.
Como pode ser visto na figura 16, o segmento de feixe de acionamento 1622é dotado de uma seção de engate 1624 formada no mesmo que pode incluirum par de dedos de engate 1624a e 1624b que são dimensionados e confi-gurados para engatar por montagem um membro de acionamento 1626. Omembro de acionamento 1626 inclui uma vigia proximal (não mostrada) parareceber a extremidade distai 276 da haste de controle 52 (Ver a Figura 1)quando a extremidade proximal 1612 da ferramenta cirúrgica 1600 é acopla-da ao corpo alongado 14 do instrumento cirúrgico 10.
A extremidade distai 1626 do feixe de acionamento 1622 podeser dotada de um pino de carne ou rolo 286 (figura 16) disposto para engataruma porção de carne 209 (figura 18) de um conjunto de placa de apoio semgrampo 20 que é pivotavelmente acoplado ao transportador 216. Um par demembros pivô 211 é formado no conjunto de placa de apoio 20 e é posicio-nado dentro de fendas 213 formadas no transportador 216 para guiar a por-ção de placa de apoio entre as posições aberta e fechada. Na medida emque o feixe de acionamento 1622 é direcionado para a direção distai "DD" aomover a haste móvel 24 em direção da porção de manopla estacionária 22do conjunto de manopla 12 do instrumento cirúrgico 10, o rolo de carne naextremidade distai do feixe de acionamento 1622 engata a porção de carne209 do conjunto de placa de apoio 20 e faz com que o conjunto de placa deapoio 20 pivote para uma posição determinada capaz de ser repetida e fe-chada que forma uma superfície de referência para estabelecer uma medi-ção de espessura.
A ferramenta cirúrgica 1600 pode adicionalmente incluir um car-tucho de medição de espessura de tecido 1650 que é suportado dentro dotransportador 216. Como pode ser visto nas figuras 18 - 22, um cartucho demedição de espessura 1650 inclui uma porção de corpo 1652 que é monta-da dentro do transportador 216 e retida no mesmo por características de en-caixe 6154 (figura 22) ou outros meios de fixação apropriados. Como podeser visto na figura 22, por exemplo, o corpo do cartucho 1652 pode ser fabri-cado a partir de dois segmentos de corpo 1652a, 1652b que podem ser fixa-dos juntos por adesivo ou outros fixadores apropriados. Como pode ser adi-cionalmente visto na figura 22, o corpo do cartucho 1652 suporta de modooperacional uma plataforma móvel de medição de tecido 1660. A plataformade tecido 1660 pode ser configurada como mostrado nas figuras 22 e 23 e édotada de uma porção de extremidade proximal 1662 que é acoplada à por-ção de corpo de cartucho 1652 por um pino de articulação 1664. Uma molade plataforma 1666 pode ser articulada no pino de articulação 1664 paraorientar a plataforma de tecido 1660 em direção do conjunto de placa de a-poio 20 (representado pela seta "U" nas figuras 17 e 19). O pino de articula-ção 1664 pode ser montado dentro de orifícios correspondentes 1653 nossegmentos de corpo 1652a, 1652b. Ver a Figura 22. Como pode também servisto nas figuras 23 e 26 - 30, a extremidade distai 1668 da placa de tecido1660 é dotada de um segmento de cremalheira que se salienta para baixo1669 na mesma que é adaptado para direcionalmente interfacear com umconjunto de engrenagem 1670.
Como pode ser visto nas figuras 22 e 23, o conjunto de engre-nagem 1670 pode incluir uma primeira cremalheira 1672 que é encaixadasobre o primeiro eixo de engrenagem 1680 que é rotativamente suportadoem orifícios 1682 nos segmentos de corpo 1652a, 1652. Uma segunda en-grenagem de fase 1674 pode também ser encaixada sobre o primeiro eixode engrenagem 1680. O conjunto de engrenagem 1670 pode adicionalmenteincluir uma terceira engrenagem de transferência 1676 que é encaixada so-bre o segundo eixo de engrenagem 1690 que é rotativamente suportado emorifícios 1692 nos segmentos de corpo 1652a, 1652b e em engate de cor-respondência com a segunda engrenagem de fase 1674. Uma quarta engre-nagem de saída 1678 é também encaixada sobre o segundo eixo de engre-nagem 1690 e está em engate de correspondência com a porção de crema-Iheira 1702 de um membro indicador ou base 1700 que é suportada de mo-do deslizável no transportador 216. Assim, como pode ser observado comreferência à figura 27, na medida em que a plataforma de tecido 1660 épressionada para baixo (seta "DW"), o segmento de cremalheira 1669 quese salienta a partir da mesma faz com que a primeira cremalheira 1672 gireno sentido anti-horário "CCW" na figura 27 o que também faz com que a se-gunda engrenagem de fase 1674 também gire no sentido anti-horário. A se-gunda engrenagem de fase 1674 está em engate de correspondência com aterceira engrenagem de transferência 1676 e é girada no sentido horário"CW" na figura 27. Na medida em que a terceira engrenagem de transferên-cia 1676 gira no sentido horário, assim também ocorre com a engrenagemde saída 1678. Na medida em que a engrenagem de saída 1678 gira no sen-tido horário ("CW"), a mesma direciona a base indicadora 1700 na direçãodistai "DD" em virtude de seu engate correspondente com a chassi indicado-ra 1702. Em várias modalidades, por exemplo, uma proporção de engrena-gem de aproximadamente 30 para 1 pode ser empregada de modo que 60mm de movimento de acionamento linear é realizado em aproximadamente3 segundos. Entretanto, outras proporções de engrenagem podem ser con-cebíveis e empregadas.
Como pode ser mais particularmente visto na figura 23, a baseindicadora 1700 pode ser bifurcada em duas porções de perna indicadoraslaterais 1710 que cada uma das quais termina em uma placa indicadora ver-tical 1712. Cada placa indicadora 1712 pode ser dotada de uma série deindicadores ou identificadores de espessura na mesma. Em particular, cadaplaca indicadora 1712 pode ser dotada de um primeiro identificador de es-pessura 1720 que corresponde a uma primeira faixa de espessura de tecido"T1". Por exemplo, a primeira faixa de espessura de tecido "T1" pode repre-sentar um tecido dotado de uma espessura de cerca de 75 mm a cerca de1,0 mm o que pode requerer um tamanho de grampo formado de 0,75 mm.Cada placa indicadora 1712 pode ser adicionalmente dotada de um segundoidentificador de espessura 1722 que corresponde a uma segunda faixa deespessura de tecido "T2". Por exemplo, a segunda faixa de espessura detecido "T2" pode ser para um tecido dotado de uma espessura de cerca de1,0 mm a cerca de 1,5 mm o que pode requerer o tamanho de grampo for-mado, por exemplo, de 1,0 mm. Cada placa indicadora 1712 pode ser adi-cionalmente dotada de um terceiro identificador de espessura de tecido 1724que corresponde a uma terceira faixa de espessura de tecido "T3" que cor-responde a um terceiro tamanho particular do tecido. Por exemplo, a terceirafaixa de espessura "T3" pode ser para um tecido dotado de uma espessurade cerca de 1,5 mm a 2,0 mm o que pode requerer um tamanho de grampoformado, por exemplo, de 1,5 mm. Cada placa indicadora 1712 pode ser a-dicionalmente dotada de um quarto identificador de espessura do tecido1726 que corresponde a uma quarta faixa de espessura de tecido "T4" quecorresponde a um quarto tamanho particular do tecido. Por exemplo, a quar-ta faixa de espessura de tecido "T4" pode ser para um tecido dotado de umaespessura de cerca de 2,0 mm o que pode requerer um tamanho de grampoformado, por exemplo, de 2,0 mm. Os identificadores de tecido 1720, 1722,1724, 1726 podem compreender, por exemplo, números, letras, cores, etc.,que são cada um dos quais entendidos como correspondentes a uma parti-cular faixa de espessura de tecido. Em várias modalidades, um batente detecido proximal 1721 pode ser proporcionado no cartucho 1652 para propor-cionar uma parede de contato para posicionar o tecido entre o cartucho 1652e o conjunto de placa de apoio 20. Ver figuras 17, 22, e 24. Ainda em váriasmodalidades, membros de pegar tecido 1723 podem ser proporcionados nocartucho 1652 como mostrado na figura 22 para ajudar a prender e posicio-nar o tecido entre o cartucho 1652 e o conjunto de placa de apoio 20.
Como pode ser visto na figura 25, uma janela de visualização1730 pode ser proporcionada em cada porção de lado do alojamento 1610para coincidir com os identificadores de tecido 1720, 1722, 1724, 1726 comoserá descrito em detalhes adicionais abaixo. As figuras 18 e 19 ilustram asposições da placa indicadora 1712 quando nenhum tecido foi preso entre oconjunto de placa de apoio 20 e a plataforma de tecido 1660. Como pode servisto nas referidas figuras, nenhum dos indicadores de espessura 1720,1722, 1724, 1726 pode ser observado através das janelas de visualização1730. As figuras 26 e 27 ilustram as posições da placa indicadora 1712quando tecido dotado de uma faixa de espessura de tecido T1 é preso entreo conjunto de placa de apoio 20 e a plataforma de tecido 1660. Como podeser visto nas referidas figuras, o primeiro indicador de tecido 1720 é vistoatravés da janela de visualização correspondente 1730.
A figura 28 ilustra as posições da placa indicadora 1712 quandotecido dotado de uma faixa de espessura de tecido T2 é preso entre o con-junto de placa de apoio 20 e a plataforma de tecido 1660. Como pode servisto na referida figura, um segundo indicador de tecido 1722 é visualizávelatravés da janela de visualização correspondente 1730. A figura 29 ilustra asposições da placa indicadora 1712 quando tecido dotado da faixa de espes-sura de tecido T3 é preso entre o conjunto de placa de apoio 20 e a plata-forma de tecido 1660. Como pode ser visto na referida figura, um terceiroindicador de tecido 1724 é visualizável através da janela de visualização cor-respondente 1730. A figura 30 ilustra as posições da placa indicadora 1712quando tecido dotado da faixa de espessura de tecido T4 é preso entre oconjunto de placa de apoio 20 e a plataforma de tecido 1660. Como pode servisto na referida figura, um quarto indicador de tecido 1726 é visualizávelatravés da janela de visualização correspondente 1730. Assim, ao se fixarde modo operacional a ferramenta cirúrgica 1600 ao instrumento cirúrgico 10e prender uma porção de tecido alvo a ser grampeado entre a plataforma detecido 1660 e o conjunto de placa de apoio 20 (por ativação da porção demanopla móvel 24 em direção da porção de manopla estacionária 22), omédico pode se certificar da espessura aproximada do tecido a ser grampe-ado e então selecionar uma unidade de grampeamento descartável, por e-xemplo, do tipo descrito na Patente US N0 5.865.361 com os grampos apro-priadamente dimensionados. O médico então simplesmente destaca a fer-ramenta cirúrgica 1600 a partir do instrumento cirúrgico 10 e então fixa demodo operacional a unidade de grampeamento descartável selecionada aoinstrumento cirúrgico 10 e opera a mesma como descrito na Patente US N05.865.361.
As figuras 31 - 35 ilustram outra modalidade de ferramenta ci-rúrgica 1800 que compreende um aplicador de grampos para uso com uminstrumento cirúrgico 10 para aplicar pelo menos um clip cirúrgico 1801 a umcorpo humano. Várias modalidades da ferramenta cirúrgica 1800 podemempregar várias componentes dos aplicadores de clips descritos na PatenteUS N0 5.951.574, a descrição da qual se encontra aqui incorporada por refe-rência. O uso de clips cirúrgicos 1801 para ligar estruturas dentro do corpotais como vasos, dutos, e tecido é bem-conhecido na técnica cirúrgica. Vá-rias modalidades da ferramenta cirúrgica 1800 podem ser dotadas de um pardistai de garras móveis opostas 1820 para receber clips 1801 em série nasmesmas quando as garras 1820 são abertas e formam o clip 1801 recebidoem série nas mesmas quando as garras 1820 são fechadas. Ver a Figura33. As garras 1820 podem ser conectadas a uma extremidade distai do eixoem geral retangular 1830 que se salienta a partir de um conjunto de aloja-mento 1840. O eixo 1830 pode ser dotado de um envoltório externo em for-ma de "U" estrutural 1832, um recobrimento superior transparente 1834, eum cartucho de grampos contendo uma pluralidade de clips (não mostrada)localizada no mesmo.
O conjunto de alojamento 1840 pode incluir uma porção de base1842 que é dotada de uma cobertura 1844 fixada à mesma. Ver a Figura 34.
A porção de base 1842 é dotada de uma extremidade proximal 1846 que éconfigurada para fixação operável ao corpo alongado 14 e a haste de contro-le 52 do instrumento cirúrgico 10. A porção de extremidade proximal 1846 édotada de uma porção de conexão oca 1848 que inclui protuberâncias deengate 254 para engatar de modo liberável o corpo alongado 14 do instru-mento cirúrgico 10.
O instrumento 1800 pode adicionalmente incluir um conector dehaste de acionamento 1850 que é dotado de uma vigia 1852 no mesmo parareceber a extremidade distai 276 da haste de controle 52. Ver a Figura 34. Oconector de haste de acionamento 1850 é acoplado à placa de formação1860 que pode ser de outro modo de construção similar ao mecanismo deformação 85 descrito na Patente US N0 5.951.574, exceto para as diferençasdiscutidas aqui. Como pode ser visto nas figuras 31 - 33 e 35, a placa deformação 1860 pode ser dotada de um chassis de formação 1862 na mesmapara engate por entrosamento com um conjunto de engrenagem 1870. Oconjunto de engrenagem 1870 pode ser rotativamente suportado em umacoluna de engrenagem 1872 que se salienta a partir da porção de base 1842e se estende através de uma fenda alongada 1864 na placa de formação1860. O conjunto de engrenagem 1870 pode ser dotado de uma porção deengrenagem de formação 1874 que está em engate de correspondênciacom o chassis de formação 1862. O conjunto de engrenagem 1870 podetambém compreender uma engrenagem de alimentação 1876 que é fixada àengrenagem de formação 1874. A engrenagem de alimentação 1876 estáem engate de correspondência com uma chassi de alimentação 1882 forma-da em uma placa de alimentação 1880 que realiza as mesmas funções queo mecanismo de alimentação 100 da Patente US N0 5.951.574. Em váriasmodalidades, o conjunto de engrenagem 1870 e chassis de engrenagem1862, 1882 podem ser dotados de uma proporção de engrenagem de 2:1, demodo que na medida em que a placa de formação 1860 é orientada na dire-ção distai "DD", a placa de alimentação 1880 é simultaneamente orientadana direção proximal "PD" apenas a metade do que a placa de formação1860 foi orientada na direção distai "DD".
A ferramenta cirúrgica 1800 também é dotada de um impulsio-nador de clip 1890 (figura 33) que permanece em geral estacionário atravésda maior parte do movimento simultâneo. O impulsionador de clip 1890 éacoplado de modo liberável à placa de alimentação móvel 1880 na medidaem que a haste de controle 52 move a placa de alimentação 1880 na direçãoproximal para a colocação de um clip 1801 nas garras que se abrem 1820. Ocartucho de clips dentro do eixo 1830 fornece clips adicionais 1801 à placade alimentação 1880 e impulsionador de clips 1890 para a disposição emsérie dos clips 1801 para dentro das garras 1802.
A ferramenta cirúrgica 1800 é ativada ao mover a haste de con-trole 52 na direção distai "DD" o que ocasiona o fechamento das garras 1820e a formação de cada um dos clips 1801 recebidos em série nas mesmas.
Ao se mover a haste de controle 52 na direção proximal "PD" se abre as gar-ras 1820, se libera o clip completamente formado 1801, e alimenta um gram-po não-formado 1801 em série para dentro das garras abertas 1820. A fer-ramenta cirúrgica 1800 é acoplada à porção de corpo alongado 14 e à hastede controle 52 da maneira acima descrita e é operada ao mover a porção demanopla móvel 24 em direção de e em afastamento a partir da porção demanopla estacionária 22 como foi também acima descrito. Aquele versadona técnica entenderá que a ferramenta cirúrgica 1800 é especialmenteadaptada para uso em aplicações cirúrgicas abertas deste modo expandindoo uso do instrumento cirúrgico convencional 10 o que, no passado, foilimitado para uso em relação a procedimentos cirúrgicos endoscópicos.
Os conjuntos de ferramenta das unidades de carga descartáveisanteriores que foram projetadas para uso com o instrumento cirúrgico con-vencional 10 são configurados para dispor grampos em linhas retas. Durantemuitas técnicas cirúrgicas, tais como a ressecção de tecido de estômago,por exemplo, a referida disposição linear é com freqüência preferida. Duran-te as referidas técnicas, a unidade de carga descartável é tipicamente inseri-da através da cânula para se acessar o campo cirúrgico e, como um resulta-do, é com freqüência desejável para o conjunto de ferramenta do mesmo seter uma configuração linear que pode ser alinhada com um eixo da cânulaantes do conjunto de ferramenta ser inserido através do mesmo. Entretanto,em algumas circunstâncias, os referidos conjuntos de ferramenta que apre-sentam a referida configuração linear são relativamente difíceis de usar.Mais particularmente, por exemplo, quando o conjunto de ferramenta deveser disposto adjacente a ou contra a parede da cavidade, tal como a parededa cavidade toráxica, por exemplo, é com freqüência difícil para o cirurgiãoposicionar a garra do conjunto de ferramentas atrás do tecido delicado oufrágil que é proximal a e/ou fixado à parede da cavidade. Adicionalmente,mesmo se o cirurgião obtiver sucesso no posicionamento da garra atrás dotecido, em virtude da configuração linear do conjunto de ferramenta, o cirur-gião pode não ser capaz de ver a extremidade distai do conjunto de ferra-menta. Em algumas circunstâncias, instrumentos cirúrgicos que apresentamuma lâmina e sistema de acionamento reutilizáveis foram desenvolvidos pa-ra empregar manipuladores de extremidade curvas. Exemplos dos referidosdispositivos são descritos no pedido de patente US comumente cessionadode No. de série 11/652.170, depositado em 11 de Janeiro de 2007 e intitula-do Surgical Stapler End Effector With a Tapered Distai End, a descrição doqual está aqui incorporada por referência.
A figura 36 ilustra outra modalidade de ferramenta cirúrgica1900 da presente invenção que pode ser usada em relação com um instru-mento cirúrgico 10. Como pode ser visto na referida figura, a ferramenta ci-rúrgica 1900 pode incluir um transportador curvo 1916 que é dotado de ummembro de alojamento 1910 fixado ao mesmo. O alojamento 1910 pode serfixado a paredes verticais 1917 da porção de transportador por característi-cas de encaixe ou outro meio adequado. O membro de alojamento 1610 édotado de uma extremidade proximal 1912 que é configurada para fixaçãoremovível ao corpo alongado 14 do instrumento cirúrgico 10. Em particular, aextremidade proximal 1912 pode ser dotada de protuberâncias de engate254 formadas na mesma as quais servem para formar um acoplamento dotipo baioneta com a extremidade distai da porção de corpo alongada 14 doinstrumento cirúrgico 10 como foi acima descrito.
Em várias modalidades da presente invenção, o transportador1916 e o cartucho de grampos 1920 suportado no mesmo são curvos. Emvárias modalidades, por exemplo, a curvatura dos referidos componentespode ser configurada para substancialmente corresponder ao contorno datípica parede da cavidade toráxica. Nas referidas modalidades, a curvaturadas diversas paredes da cavidade toráxica pode ser medida e estatistica-mente analisada para determinar o perfil ideal das manipuladores de extre-midade curvas. O referido perfil pode incluir diversas porções arqueadas e,adicionalmente, diversas porções lineares. Em outras modalidades, a curva-tura da parede da cavidade toráxica pode ser aproximada por um único raiode curvatura. A referida modalidade pode ser mais simples e menos onerosade fabricar. Em pelo menos uma modalidade, o referido raio de curvatura é1,2". Em outras várias modalidades, a curvatura do transportador 1916 e ocartucho de grampos 1920 pode ser configurada para corresponder ao perfildo reto inferior, pélvis, ou abdômen inferior. A figura 37 ilustra, por exemplo,instrumento cirúrgico alternativo 1900' que emprega um transportador 1916'que é dotado de uma curvatura que difere a partir da curvatura do transpor-tador 1916. Outras curvaturas descritas no pedido de Patente US N0 de série11/652.170 acima mencionado podem também ser empregadas.
Em várias modalidades da presente invenção, o cartucho degrampos 1920 inclui uma fenda curva 1922 para controlar o movimento doconjunto de acionamento axial 1966 ao longo de um trajeto curvo. A referidafenda curva 1922 pode incluir diversas porções arqueadas e diversas por-ções lineares. Em várias modalidades, a fenda curva 1922 pode ser definidapor um raio de curvatura. O conjunto de placa de apoio 1930 que pode deoutro modo ser similar aos conjuntos de placa de apoio descritos acima, po-de ser dotado de uma porção curva (omitida para clareza nas figuras 36 e37) a qual substancialmente corresponde à curvatura do transportador 1916e ao cartucho de grampos 1920. Nas modalidades ilustradas nas figuras 36e 37, o cartucho de grampos 1920 é dotado de uma fenda curva 1922. Otransportador 1916 e o conjunto de placa de apoio podem cada um dosquais ser dotado de uma fenda idêntica (não mostrada) nos mesmos quequal, em relação com a fenda 1922, são configurados para receber uma por-ção correspondente de um feixe de acionamento 1966 no mesmo. A extre-midade distai do membro de acionamento 1966 pode ser configurada domodo acima descrito com relação a um feixe de acionamento 266 para facili-tar a sua ação de acionamento para movimento da haste de controle 52 co-mo acima descrito. A extremidade proximal do feixe de acionamento 1966contendo a lâmina (não mostrada) pode ser configurada de modo que, namedida em que o feixe de acionamento 1966 é orientado na direção distai"DD" para movimento da haste móvel 24 do instrumento cirúrgico 10, o feixede acionamento 1966 rastreia o trajeto curvo definido pela fenda 1922.
As figuras 38 e 39 ilustram uma modalidade de ferramenta cirúr-gica 2000 da presente invenção que pode ser acoplada ao instrumento ci-rúrgico 10 e usada para cauterizar tecido em uma instalação cirúrgica aber-ta. Como pode ser visto nas referidas figuras, a ferramenta cirúrgica 2000pode incluir um alojamento 2010 que é dotado de uma extremidade proximal2011 que é configurada para fixação removível ao corpo alongado 14 do ins-trumento cirúrgico 10. Em particular, a extremidade proximal 2011 pode serdotada de protuberâncias de engate 254 formadas na mesma as quais ser-vem para formar um acoplamento do tipo baioneta com a extremidade distaida porção de corpo alongada 14 do instrumento cirúrgico 10 como foi acimadescrito.
O alojamento 2010 pode adicionalmente incluir uma porção co-mutadora 2013 a qual aloja de forma móvel uma bateria 2030 no mesmo. Abateria móvel 2030 pode ser do tipo de construção descrita no pedido dePatente US comumente cessionado intitulado Disposable Motor Driven Loa-ding Unit For Use With a Surgical Cutting and Stapling Apparatus para MarkH. Ransick et al., Documento N0 END6213USNP/070330, o qual foi deposi-tado na mesma data que o presente e o qual se encontra aqui incorporadopor referência. Mais especificamente e com referência à figura 39, a porçãocomutadora 2013 do alojamento 2010 define uma cavidade de bateria 2032a qual suporta de modo móvel um suporte de bateria 2034 que aloja a bate-ria 2030 no mesmo. Como pode ser visto na figura 39, um primeiro contatode bateria 2036 é suportado em contato elétrico com a bateria 2030 e sesalienta através de um suporte de bateria 2034 para engate de deslize coma parede interna 2033 da cavidade de bateria 2032. De modo similar, umsegundo contato de bateria 2038 é montado em contato elétrico com a bate-ria 2030 e também se salienta a partir do suporte de bateria 2034 para desli-zar ao longo da parede interna 2033 da cavidade de bateria 2032. Um supor-te de bateria 2034 é dotado de um soquete de haste de controle 2035 nomesmo configurado para receber a extremidade distai 276 da haste de con-trole 52 quando a extremidade proximal 2011 da ferramenta cirúrgica 2000 éacoplada ao corpo alongado 14 do aparelho de grampeamento cirúrgico 10.Como pode também ser visto na figura 39, um par de contatos 2026, 2028pode ser orientado para dentro da parede 2033 para contato com os conta-tos de bateria 2036, 2038, respectivamente. O objetivo dos contatos 2026,2028 serão discutidos em detalhes adicionais abaixo. Como pode tambémser visto na figura 39, um membro de orientação ou mola de comutação2040 é posicionado no interior de uma cavidade de bateria 2032 para orien-tar um suporte de bateria 2034 na direção proximal "PD" de modo que quan-do a ferramenta cirúrgica 2000 não é fixada ao corpo alongado 14, um su-porte de bateria 2034 é orientado para a sua posição mais proximal mostra-da na figura 39. Quando retida na referida posição "pré-uso" ou "desconec-tada" para a mola 2040, os contatos de bateria 2036 e 2038 não entram emcontato com seus respectivos contatos 2026, 2028 no interior da cavidadede bateria 2032 para evitar que a bateria 2030 seja drenada durante não-uso.
Como pode ser visto na figura 38, a ferramenta cirúrgica 2000pode adicionalmente incluir um manipulador de extremidade de aplicaçãosem grampo na forma de um membro de extremidade em forma de esfera2050 que pode ser pivotavelmente confinado em uma forquilha 2052 que éacoplada à extremidade distai do alojamento 2010. Em várias modalidades,o manipulador de extremidade 2050 pode ser fabricada a partir de um mate-rial condutor tal como aço inoxidável, titânio, etc. e ser dotado de pelo menosum membro eletricamente acionado 2060 no mesmo. Na modalidade ilustra-da na figura 38, o membro eletricamente acionado 2060 pode compreenderum elemento de aquecimento. Aqueles versados na técnica observarão quea manipulador de extremidade 2050 pode ser proporcionada em uma varie-dade de outros formatos e configurações sem se desviar do espírito e âmbitoda presente invenção. Como pode ser adicionalmente visto na figura 38, oelemento de aquecimento 2060 pode ser eletricamente acoplado aos conta-tos 2026, 2028 por cabos 2022, 2024, respectivamente.
Assim, quando a ferramenta cirúrgica 2000 não é fixada ao cor-po alongado 14 do instrumento cirúrgico 10, a bateria 2030 será orientadapara uma posição não acionada (figura 39) e portanto não será drenada.Adicionalmente, a fixação da ferramenta cirúrgica 2000 ao corpo alongado14 e a fixação da haste de controle 52 a um suporte de soquete de bateria2035 não resultará na operação ou drenagem da bateria 2030. Para usar aferramenta 2000, o médico simplesmente move a haste móvel 24 em direçãoda porção estacionária 22 do conjunto de manopla (figura 1) para direcionaros contatos de bateria 2036, 2038 em contato com os contatos 2026, 2028,respectivamente os quais então acionam o elemento de aquecimento 2060no manipulador de extremidade 2050. Uma luz ou outro indicador 2070 podeser suportada pelo alojamento 2010 e acionada por uma bateria 2030 paraproporcionar o médico com uma indicação de que o elemento de aqueci-mento 2060 está sendo acionado.
A figura 40 ilustra outra modalidade de ferramenta cirúrgica2000' que é substancialmente similar à ferramenta cirúrgica 2000 acimadescrita. Entretanto, na referida modalidade, a ferramenta cirúrgica 2000'não é dotada de uma bateria na mesma. A ferramenta cirúrgica 2000' éconstruída para uso com um instrumento cirúrgico 10' que é dotado de umabateria 2030' que é operada por uma chave 2090 que é montada no conjun-to de manopla 12'. A chave 2090 se comunica com um conjunto de contato2092 que é localizado na extremidade distai do corpo alongado 14. O con-junto de contato 2092 é orientado para contato com um contato 2094 monta-do na extremidade proximal de uma porção de alojamento da ferramenta2000' quando a ferramenta 2000' é acoplada ao corpo alongado 14. Paraativar o elemento de aquecimento 2060 no manipulador de extremidade2050, o médico ativa a tecla 2090 no conjunto de manopla 12'. Uma luz2070' pode também ser montada no conjunto de manopla 12' para propor-cionar uma indicação de quando a ferramenta 2000' está sendo acionada.As figuras 41 e 42 ilustram modalidades de alojamento alternati-vas 2200 e 2200' que podem ser usadas em vez das diversas configuraçõesde alojamento acima descritas quando conjuntos de acionamento flexívelsão empregados. Em particular, os referidos alojamentos 2200, 2200' podempelo menos ser empregados em relação às várias modalidades ilustradasnas figuras 2 - 30 e 36 - 40 quando conjuntos de acionamento que são ca-pazes de flexão ou pelo menos ser dotados de porções que são capazes deflexão são empregadas. O alojamento 2200 ilustrado na figura 41 pode serconfigurado como mostrado com uma porção de extremidade proximal 2202que é configurada para receber a extremidade distai da haste de controle 52na mesma e que é dotada de protuberâncias 254 na mesma para facilitar afixação ao corpo alongado 14 como foi acima descrito. Na referida modali-dade, entretanto, o alojamento 2200 é dotado de um membro de junta dearticulação passiva 2300 formado no mesmo que facilita a articulação passi-va sobre o eixo longitudinal L-L do alojamento 2200 como mostrado. Omembro de junta de articulação passiva 2300 podem compreender uma se-ção de conduto flexível 2302 que é dotada de nervuras de intertravamento2304 que são construídas para reter a junta passivamente articulada 2300em uma orientação articulada.
A figura 42 ilustra outro alojamento articulável 2200' que é dota-do de outro membro de junta de articulação passiva 2300' que é acoplado àporção de alojamento proximal 2400, por exemplo, por um colar de corpoproximal 2310. O membro de articulação flexível 2300' é dotado de uma por-ção de corpo 2301 e inclui uma pluralidade de entalhes 2302 separados pornervuras 2304. Em várias modalidades, os entalhes 2303 e as nervuras2304 podem ser igualmente espaçados ao longo membro de articulação fle-xível 2300' deste modo promovendo um raio de curvatura contínuo quando omembro de articulação flexível é articulado. Um membro de articulação flexí-vel 2300' dotado de múltiplos raios de flexão pode ser alcançado ao propor-cionar espaçamento desigual entre os entalhes 2303 e as nervuras 2304.Por exemplo, a referida disposição pode ser alcançada ao se espaçar asnervuras 2304 mais proximamente em uma extremidade e mais afastadauma da outra. Como será observado por aqueles versados na técnica, ao seaumentar o espaçamento dos entalhes 2303 e/ou das nervuras 2304 se re-duz o raio de curvatura da seção dotada de maior espaçamento, mais pro-ximamente se aproximando de uma conexão de flexão de ponto pivô. Demodo oposto, o espaçamento dos entalhes 2303 e/ou das nervuras 2304mais proximamente resultam em uma curvatura mais gradual, dotada de umraio de curvatura maior.
Na modalidade ilustrada na figura 42, os entalhes 2302 compre-endem ranhuras anulares que se estendem pelo menos parcialmente emtorno do perímetro do membro de articulação flexível 2300'. Os entalhes2302 preferivelmente, entretanto, compreendem semirranhuras anulares asquais são separadas por uma espinha central longitudinal 2306 que passapelo eixo longitudinal L-L do membro de articulação flexível 2300' de modoque uma primeira pluralidade de nervuras é formada em uma lateral da espi-nha 2306 e uma segunda pluralidade de nervuras 2304 é formada na outralateral da espinha 2306. A referida espinha 2306 ajuda em proporcionar enri-jecimento do membro de articulação flexível 2300' e acomoda a fenda (nãomostrada) para receber um conjunto de acionamento através do mesmo. Aespinha longitudinal 2306 pode percorrer todo o comprimento longitudinal domembro de articulação flexível 2300'. O membro de articulação flexível 2300'pode ainda incluir um par de fendas laterais (não mostradas) que passa a-través de cada nervura 2304 em cada lateral para receber uma placa de arti-culação correspondente (não mostrada) como discutido no pedido de paten-te US comumente cessionado N0 12/031.001, intitulado Articulatable LoadingUnits For Surgical Stapling and Cutting Instrument para Frederick E. Shelton,IV et al., depositado na mesma data que a presente, a descrição do qual seencontra aqui incorporada por referência. Como discutido no mesmo, as re-feridas placas de articulação podem ser fabricadas a partir da material que érelativamente inelástico. Ou seja, as placas podem ser fabricadas a partir deum material que retém a sua posição após flexão. As placas de articulaçãopodem, por exemplo, ser fabricadas a partir de materiais tais como chumbo,cobre, etc. Aqueles versados na técnica entenderão que pelo menos umaporção flexível ou de outro modo articulável de um conjunto de acionamentosuportado dentro seja dos alojamentos 2300, 2300' é posicionado para cor-responder com o membro de articulação flexível 2300, 2300' para facilitar aarticulação da ferramenta cirúrgica sem afetar adversamente a operação doconjunto de acionamento que se estende através do mesmo.
Assim, como será observado pelo que foi dito acima, as váriasmodalidades de ferramentas cirúrgicas da presente invenção são especial-mente adequadas para uso com instrumentos cirúrgicos que foram especifi-camente projetados para uso em relação com unidades de corte e grampe-amento descartáveis que apresentam sua própria lâmina de corte dedicadae são construídos para serem descartados após um único uso. Embora osreferidos instrumentos possam ser comumente usados em relação com múl-tiplas unidades de corte e grampeamento descartáveis, um médico terá queter em mãos diversos outros instrumentos dedicados para realizar outrosprocedimentos durante uma operação. O sistema de ferramenta intercambi-ável da presente invenção soluciona o referido problema. Assim, várias mo-dalidades da presente invenção podem compreender um sistema de ferra-menta cirúrgica que pode incluir o instrumento cirúrgico 10 e pelo menosduas das várias ferramentas cirúrgicas descritas aqui. Por exemplo, as fer-ramentas cirúrgicas podem compreender um manipulador 1000, alicates1200, tesouras 1300, um endocortador descartável 16, um dispositivo demedição de espessura de tecido 1600, aplicadores de grampos 1400, apli-cadores de clips 1800, dispositivos de cauterização 2000 e dispositivos derecuperação de espécime 1100.
Embora diversas modalidades da presente invenção tenham si-do descritas, deve ser aparente, entretanto, que várias modificações, altera-ções e adaptações àquelas modalidades podem ocorrer para aqueles versa-dos na técnica com a consecução de algumas ou de todas as vantagens dapresente invenção. Por exemplo, de acordo com várias modalidades, umúnico componente pode ser redisposto por múltiplos componentes, e múlti-plos componentes podem ser redispostos por um único componente, pararealizar uma determinada função ou funções. A referida aplicação pretende,portanto, cobrir todas as referidas modificações, alterações, e adaptaçõessem se desviar do espírito e âmbito da presente invenção descrita e comodefinida pelas reivindicações anexas.
Qualquer patente, publicação, ou outro material descrito, em suatotalidade ou em parte, é dito estar aqui incorporado por referência apenasna extensão de que os materiais incorporados não entrem em conflito comas definições, determinações existentes, ou outra descrição de material de-terminada na presente descrição. Como tal, e na extensão necessária, adescrição como explicitamente determinada aqui supera qualquer materialconflitante incorporado aqui por referência. Qualquer material, ou porção domesmo, que é dito estar incorporado aqui por referência, mas que entre emconflito com as definições, determinações existentes, ou outra descrição dematerial determinada aqui será apenas incorporada desde que não surjamconflitos entre o referido material incorporado e a descrição do material exis-tente.
A presente invenção que se tem a intenção de proteger não édeve ser construída como limitada às modalidades particulares descritas. Asmodalidades devem, portanto, ser vistas como ilustrativas em vez de restriti-vas. Variações e mudanças podem ser produzidas por outros sem se desviardo espírito da presente invenção. Assim, é expressamente pretendido quetodas as referidas equivalentes, variações e mudanças que se insiram noespírito e âmbito da presente invenção como definida nas reivindicaçõessejam englobadas deste modo.
Claims (22)
1. Ferramenta cirúrgica para uso com um instrumento cirúrgicodotado de um conjunto de manopla que suporta operacionalmente um sis-tema de acionamento no mesmo para gerar movimentos de acionamentocom o acionamento de uma porção de manopla móvel do mesmo e um cor-po alongado suportando de modo operacional uma haste de controle nomesmo para transferir os movimentos de acionamento, a referida ferramentacirúrgica compreendendo:um alojamento acoplado de forma removível ao referido corpoalongado;um conjunto de acionamento suportado de modo operacionalno referido alojamento e acoplado de forma removível à referida haste decontrole; eum par de garras de formação sem grampo acopladas de modooperacional ao referido conjunto de acionamento de modo que com a aplica-ção do referido movimento de acionamento ao referido conjunto de aciona-mento em uma primeira direção faz com que o referido par de garras de for-mação sem grampo simultaneamente se mova em uma direção de fecha-mento uma em direção à outra e com a aplicação de outro referido movimen-to de acionamento em uma segunda direção, as referidas garras de forma-ção sem grampo simultaneamente se movem em uma direção de aberturaem afastamento uma da outra.
2. Ferramenta cirúrgica, de acordo com a reivindicação 1, ondeo referido conjunto de acionamento compreende:um segmento de feixe de acionamento proximal acoplado deforma removível à haste de controle; eum segmento de feixe de acionamento distai pivotavelmente a-coplado ao referido segmento de feixe de acionamento proximal e o referidopar de garras de formação sem grampo.
3. Ferramenta cirúrgica, de acordo com a reivindicação 2, emque o referido segmento de feixe de acionamento distai é pivotavelmenteacoplado ao referido segmento de feixe de acionamento proximal por umaligação reversível suportada de modo operacional dentro do referido aloja-mento e em que o referido segmento de feixe de acionamento distai é pivo-tavelmente acoplado ao referido par de garras de formação sem grampo porum par de ligações pivô.
4. Ferramenta cirúrgica, de acordo com a reivindicação 1, emque as referidas garras de formação sem grampo cada uma das quais com-preende garras de pinçamento de tecido.
5. Ferramenta cirúrgica, de acordo com a reivindicação 4, emque pelo menos uma referida garra de pinçamento de tecido é dotada deuma porção de cavidade formada na mesma para receber tecido cortado namesma.
6. Ferramenta cirúrgica, de acordo com a reivindicação 1, emque as referidas garras de formação sem grampo cada uma das quais com-preende garras de tesoura.
7. Ferramenta cirúrgica, de acordo com a reivindicação 1, emque o referido alojamento é dotado de uma junta de articulação passiva nomesmo.
8. Ferramenta cirúrgica para uso com um instrumento cirúrgicodotado de um conjunto de manopla que suporta operacionalmente um sis-tema de acionamento no mesmo para gerar movimentos de acionamentocom o acionamento de uma porção de manopla móvel do mesmo e um cor-po alongado que suporta de modo operacional uma haste de controle nomesmo para transferir os movimentos de acionamento, a referida ferramentacirúrgica compreendendo:um transportador;um alojamento acoplado ao referido transportador e acoplado deforma removível ao referido corpo alongado;um conjunto de acionamento suportado de modo operacional noreferido alojamento e transportador e acoplado de forma removível à referidahaste de controle;uma placa de apoio sem grampo suportada de forma móvel noreferido transportador e que interage de modo operacional com o referidoconjunto de acionamento para seletivamente mover a referida placa de apoiode formação sem grampo em direção de e em afastamento a partir do referi-do transportador; eum cartucho de medição de espessura de tecido suportado noreferido transportador e dotado de um membro indicador que interage com oreferido alojamento para proporcionar uma indicação de uma faixa de es-pessura do tecido preso entre a referida placa de apoio de formação semgrampo e o referido cartucho de medição de espessura de tecido.
9. Ferramenta cirúrgica, de acordo com a reivindicação 8, emque o referido membro indicador de tecido é configurado para distinguir entreuma pluralidade de diferentes faixas de espessura de tecidos.
10. Ferramenta cirúrgica, de acordo com a reivindicação 8, emque o referido alojamento é dotado de uma junta de articulação passiva nomesmo.
11. Ferramenta cirúrgica para uso com um instrumento cirúrgicodotado de um conjunto de manopla que suporta operacionalmente um sis-tema de acionamento no mesmo para gerar movimentos de acionamentocom o acionamento de uma porção de manopla móvel do mesmo e um cor-po alongado que suporta de modo operacional uma haste de controle nomesmo para transferir os movimentos de acionamento, a referida ferramentacirúrgica compreendendo:um alojamento diretamente acoplável ao referido corpo alongado;um conjunto de acionamento suportado de modo operacional noreferido alojamento e transportador e acoplado de forma removível à referidahaste de controle;uma placa de apoio de grampo suportada de forma não-móvelpelo referido alojamento; euma pluralidade de grampos suportados na extremidade distaido referido alojamento e orientados para serem seqüencialmente direciona-dos para dentro da referida placa de apoio de formação de grampos com aaplicação do referido movimento de acionamento ao referido conjunto deacionamento.
12. Ferramenta cirúrgica, de acordo com a reivindicação 11, emque o referido alojamento é dotado de uma junta de articulação passiva nomesmo.
13. Ferramenta cirúrgica para uso com um instrumento cirúrgicodotado de um conjunto de manopla que suporta operacionalmente um sis-tema de acionamento no mesmo para gerar movimentos de acionamentocom o acionamento de uma porção de manopla móvel do mesmo e um cor-po alongado que suporta de modo operacional uma haste de controle nomesmo para transferir os movimentos de acionamento, a referida ferramentacirúrgica compreendendo:um alojamento diretamente acoplável ao referido corpo alongado;um eixo que se estende a partir do referido alojamento e dotadode uma pluralidade de clips cirúrgicos no mesmo;um par de garras móveis opostas fixadas a e que se estendem apartir do referido eixo, as referidas garras para receber cada um dos referi-dos clips cirúrgicos em série nas mesmas quando as referidas garras estãoem uma posição aberta, e para formar cada um dos referidos clips cirúrgicosrecebidos em série nas mesmas quando as referidas garras são movidaspara uma posição fechada;um mecanismo de formação móvel acoplado de forma removívelà haste de controle quando o referido alojamento é acoplado ao corpo alon-gado, o referido mecanismo de formação movendo as referidas garras a par-tir da posição aberta para a posição fechada com a aplicação de um primeiromovimento de acionamento a partir da haste de controle de modo a formarcada um dos referido clips cirúrgicos recebidos em série nas mesmas, e apartir da posição fechada para a posição aberta com a aplicação de um se-gundo movimento de acionamento ao referido mecanismo de formação pelahaste de controle; eum mecanismo de alimentação que interage de modo operacio-nal com o referido mecanismo de formação móvel, o referido mecanismo dealimentação dotado de uma placa de alimentação móvel em resposta aomovimento do referido mecanismo de formação e sendo acoplado de modoliberável a um impulsionador de clip do referido mecanismo de alimentação,em que o referido impulsionador de grampos é estacionário e desacoplado apartir da referida placa de alimentação com a aplicação do referido primeiromovimento de acionamento ao referido mecanismo de formação, e o referidoimpulsionador de grampos é móvel e acoplado de modo operacional a refe-rida placa de alimentação com a aplicação do referido segundo movimentode acionamento ao referido mecanismo de formação móvel de modo a mo-ver cada um dos referidos clips cirúrgicos em série a partir do referido eixodentro das referidas garras.
14. Ferramenta cirúrgica, de acordo com a reivindicação 13, emque o referido mecanismo de formação móvel compreende uma placa deformação móvel acoplada de forma removível à haste de controle e em quea referida placa de alimentação é ligada de modo móvel à referida placa deformação móvel por um conjunto de engrenagem de modo que com a apli-cação do referido primeiro movimento de acionamento à referida placa deformação móvel faz com que a referida placa de formação móvel se movaem uma primeira direção e a referida placa de alimentação simultaneamentese move em uma segunda direção que é oposta à referida primeira direção.
15. Ferramenta cirúrgica para uso com um instrumento cirúrgicodotado de um conjunto de manopla que suporta operacionalmente um sis-tema de acionamento no mesmo para gerar movimentos de acionamentocom o acionamento de uma porção de manopla móvel do mesmo e um cor-po alongado que suporta de modo operacional uma haste de controle nomesmo para transferir os movimentos de acionamento, a referida ferramentacirúrgica compreendendo:um transportador;um alojamento acoplado ao referido transportador e acoplado deforma removível ao referido corpo alongado;um conjunto de acionamento suportado de modo operacional noreferido alojamento e transportador e acoplado de forma removível à hastede controle;uma placa de apoio de formação de grampo suportada de formamóvel no referido transportador e que interage de modo operacional com oreferido conjunto de acionamento para seletivamente mover a referida placade apoio de formação de grampo em direção de e em afastamento a partirdo referido transportador; eum cartucho de suporte de grampos dotado de um raio de cur-vatura e sendo suportado no referido transportador e dotado de uma fendacurva através do mesmo definindo uma passagem curva para receber umaextremidade distai do referido conjunto de acionamento através do mesmocom a aplicação da movimento de acionamento à mesma.
16. Ferramenta cirúrgica, de acordo com a reivindicação 15, emque o referido alojamento é dotado de uma junta de articulação passiva nomesmo.
17. Ferramenta cirúrgica para uso com um instrumento cirúrgicodotado de um conjunto de manopla que suporta operacionalmente um sis-tema de acionamento no mesmo para gerar movimentos de acionamentocom o acionamento de uma porção de manopla móvel do mesmo e um cor-po alongado que suporta de modo operacional uma haste de controle nomesmo para transferir os movimentos de acionamento, a referida ferramentacirúrgica compreendendo:um alojamento acoplado de forma removível ao referido corpoalongado;um corpo de seringa acoplado ao referido alojamento e dotadode uma agulha oca que se salienta a partir do mesmo;um conjunto de acionamento suportado de modo operacional noreferido alojamento e acoplado de forma removível à haste de controle; eum êmbolo de seringa suportado de forma móvel no referidocorpo de seringa e acoplado ao referido conjunto de acionamento para mo-vimento seletivo com o mesmo.
18. Ferramenta cirúrgica, de acordo com a reivindicação 17, emque o referido alojamento é dotado de uma junta de articulação passiva nomesmo.
19. Ferramenta cirúrgica para uso com um instrumento cirúrgicodotado de um conjunto de manopla que suporta operacionalmente um sis-tema de acionamento no mesmo para gerar movimentos de acionamentocom o acionamento de uma porção de manopla móvel do mesmo e um cor-po alongado que suporta de modo operacional uma haste de controle nomesmo para transferir os movimentos de acionamento, a referida ferramentacirúrgica compreendendo:um alojamento acoplado de forma removível ao referido corpoalongado;um manipulador de extremidade de não-aplicação de grampoque se salienta operacionalmente a partir de uma extremidade distai do refe-rido alojamento, a referida manipulador de extremidade de não-aplicação degrampo suportando pelo menos um membro eletricamente acionado;uma bateria suportada de forma móvel dentro do referido aloja-mento e eletricamente se comunicando com o referido pelo menos ummembro eletricamente acionado, a referida bateria acoplada de forma remo-vível à haste de controle de modo que com a aplicação de um primeiro oreferido movimento de acionamento à mesma, a referida bateria aplica ener-gia ao referido membro eletricamente acionado e, com a aplicação do se-gundo referido movimento de acionamento à mesma, a referida bateria des-contínua a referida aplicação de energia ao referido membro eletricamenteacionado.
20. Ferramenta cirúrgica, de acordo com a reivindicação 19, emque o referido alojamento é dotado de uma junta de articulação passiva nomesmo.
21. Sistema de ferramenta cirúrgica compreendendo:um instrumento cirúrgico compreendendo:um conjunto de manopla;um sistema de acionamento suportado de modo operacional noreferido conjunto de manopla para gerar movimentos de acionamento com oacionamento de uma porção de manopla móvel acoplada de modo opera-cional ao referido conjunto de manopla;um corpo alongado que se salienta a partir do referido conjuntode manopla;uma haste de controle suportada de modo operacional no refe-rido corpo alongado e interfaceando com o referido sistema de acionamentopara receber os referidos movimentos de acionamento a partir do mesmo; epelo menos duas ferramentas cirúrgicas selecionadas a partirdo grupo de ferramentas cirúrgicas que consistem em: manipuladores, alica-tes, tesouras, endocortadores, dispositivos de medição de espessura de te-cido, aplicadores de grampos, aplicadores de clips, seringas para aplicarcola, selante, fármacos ou medicamentos e dispositivos de cauterização emque cada uma das referidas ferramentas cirúrgicas dentro do referido grupode ferramentas cirúrgicas é dotada de pelo menos um alojamento que é a-coplado de forma removível ao referido corpo alongado e um conjunto deacionamento que é acoplado de forma removível à referida haste de controlepara receber os referidos movimentos de acionamento a partir do mesmo.
22. Sistema de ferramenta cirúrgica, de acordo com a reivindi-cação 21, adicionalmente compreendendo uma ferramenta de recuperaçãode espécime compreendendo:um alojamento acoplado de forma removível ao referido corpoalongado;uma bolsa de recuperação de espécime em uma extremidadedistai do referido alojamento.
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US12/031,611 US8758391B2 (en) | 2008-02-14 | 2008-02-14 | Interchangeable tools for surgical instruments |
US12/031,611 | 2008-02-14 |
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BRPI0904823A2 true BRPI0904823A2 (pt) | 2011-03-15 |
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EP (1) | EP2098170B1 (pt) |
JP (1) | JP5442271B2 (pt) |
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BR (1) | BRPI0904823B8 (pt) |
HK (1) | HK1137636A1 (pt) |
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2008
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2009
- 2009-02-13 JP JP2009031218A patent/JP5442271B2/ja not_active Expired - Fee Related
- 2009-02-13 RU RU2009105148/14A patent/RU2495637C2/ru not_active IP Right Cessation
- 2009-02-13 BR BRPI0904823A patent/BRPI0904823B8/pt active IP Right Grant
- 2009-02-13 PL PL09250375T patent/PL2098170T3/pl unknown
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- 2009-02-16 CN CN2009101346326A patent/CN101530340B/zh active Active
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2010
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JP2009189830A (ja) | 2009-08-27 |
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US20140243865A1 (en) | 2014-08-28 |
RU2009105148A (ru) | 2010-08-20 |
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EP2098170A3 (en) | 2013-06-26 |
EP2098170B1 (en) | 2015-12-16 |
RU2495637C2 (ru) | 2013-10-20 |
US20140330161A1 (en) | 2014-11-06 |
US20180078248A1 (en) | 2018-03-22 |
US20200375585A1 (en) | 2020-12-03 |
HK1137636A1 (zh) | 2010-08-06 |
JP5442271B2 (ja) | 2014-03-12 |
CN101530340B (zh) | 2013-08-21 |
BRPI0904823B8 (pt) | 2021-06-22 |
US20090209946A1 (en) | 2009-08-20 |
CN101530340A (zh) | 2009-09-16 |
US10743851B2 (en) | 2020-08-18 |
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