BRPI0904877A2 - grampeador cirúrgico dotado de uma posição de fechamento intermediária - 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
- A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
- A61B17/105—Wound clamp magazines
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B17/2909—Handles
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/0042—Surgical instruments, devices or methods, e.g. tourniquets with special provisions for gripping
- A61B2017/00446—Surgical instruments, devices or methods, e.g. tourniquets with special provisions for gripping for use only by lefthanded or only by righthanded persons
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07242—Stapler heads achieving different staple heights during the same shot, e.g. using an anvil anvil having different heights or staples of different sizes
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/0725—Stapler heads with settable gap between anvil and cartridge, e.g. for different staple heights at different shots
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07285—Stapler heads characterised by its cutter
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/03—Automatic limiting or abutting means, e.g. for safety
- A61B2090/037—Automatic limiting or abutting means, e.g. for safety with a frangible part, e.g. by reduced diameter
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0801—Prevention of accidental cutting or pricking
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0801—Prevention of accidental cutting or pricking
- A61B2090/08021—Prevention of accidental cutting or pricking of the patient or his organs
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0813—Accessories designed for easy sterilising, i.e. re-usable
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0814—Preventing re-use
Abstract
GRAMPEADOR CIRúRGICO DOTADO DE UMA POSIçãO DE FECHAMENTO INTERMEDIáRIA. A presente invenção refere-se a um instrumento de grampea- mento cirúrgico incluindo primeiro e segundo membros de mandíbula os quais podem ser conectados de modo pivotável entre si e fixados em posição um com relação ao outro por uma trava. Os primeiro e segundo membros de mandíbula podem incluir primeiro e segundo membros de travamento os quais podem permitir que os primeiro e segundo membros de mandíbula sejam girados um com relação ao outro mas evitam, ou pelo menos inibem que, os primeiro e segundo membros de mandíbula sejam separados um a partir do outro. As referidas modalidades podem ser particularmente úteis em circunstâncias quando a trava está em uma posição parcialmentefechada e os primeiro e segundo membros de mandíbula estão sendo mani- pulados para posicionar tecido entre os mesmos. Os primeiro e segundo membros de mandíbula podem ser suficientemente conectados entre si de modo a evitar, ou pelo menos reduzir a possibilidade dos primeiro e segundo membros de mandíbula se tornarem destacados um a partir do outro e expor um membro de corte.
Description
Relatório Descritivo da Patente de Invenção para "GRAMPEA-DOR CIRÚRGICO DOTADO DE UMA POSIÇÃO DE FECHAMENTO INTERMEDIÁRIA".
Antecedentes
Campo Técnico
A presente invenção refere-se a instrumentos de grampeamentoe, em diversas modalidades, a um instrumento de grampeamento cirúrgicopara produzir uma ou mais fileiras de grampos.
Antecedentes da Técnica Relacionada
Em anos recentes, tem havido uma tendência cada vez maiorpara os cirurgiões usarem instrumentos de grampeamento para suturar teci-dos do corpo tais como um pulmão, um esôfago, um estômago, um duodenoe/ou outros órgãos no trato intestinal. O uso de um instrumento de grampe-amento apropriado em muitos casos pode realizar um trabalho melhor emmenos tempo e simplificar procedimentos cirúrgicos anteriormente difíceistais como anastomoses gastrointestinais. Grampeadores anteriores de cortede duas e quatro fileiras lineares compreendiam instrumentos desprovidosde cartucho dentro dos quais os grampos foram individualmente abastecidosa mão. Outros dispositivos anteriores incluíram uma unidade de abasteci-mento de grampos pré-esterilizada e um membro de corte que podia ser uti-lizado para dividir o tecido e formar as fileiras de grampos simultaneamente.Um exemplo do referido grampeador cirúrgico é divulgado na Patente US n°3,499,591, intitulada INSTRUMENT FOR PLACING LATERAL GASTROIN-TESTINAL ANASTOMOSES, a qual foi depositada em 10 de Março de 1970,a descrição total da qual se encontra aqui incorporada por referência.
Um instrumento de grampeamento pode incluir um par de mem-bros de mandíbula alongados cooperantes, em que cada membro de mandí-bula pode ser adaptado para ser inserido em um órgão interno de corpo tu-bular a ser anastomosado. Em diversas modalidades, um dos membros demandíbula pode suportar um cartucho de grampos com pelo menos duasfileiras de grampos lateralmente espaçadas, e o outro membro de mandíbulapode suportar uma bigorna com bolsos de formação de grampos alinhadoscom as fileiras de grampos no cartucho de grampos. Em geral, o instrumentode grampeamento pode adicionalmente incluir uma barra de impulsão e lâ-mina de faca as quais são deslizáveis com relação aos membros de mandí-bula para seqüencialmente ejetar os grampos a partir do cartucho de gram-pos por meio de superfícies de carne na barra de impulsão. Em pelo menosuma modalidade, as superfícies de carne podem ser configuradas para ativaruma pluralidade de direcionadores de grampo portada pelo cartucho e asso-ciada com os grampos individuais para impulsionar os grampos contra a bi-gorna e formar fileiras lateralmente espaçadas de grampos deformados notecido preso entre os membros de mandíbula. Em instrumentos de grampe-amento típicos, entretanto, a bigorna é imóvel com relação ao cartucho degrampos uma vez que os membros de mandíbula foram montados juntos e aaltura formada dos grampos não pode ser ajustada. Em pelo menos umamodalidade, a lâmina de faca pode trilhar a barra de impulsão e cortar o te-cido ao longo de uma linha entre as fileiras de grampos. Exemplos dos refe-ridos instrumentos de grampeamento são divulgados na Patente US n°4.429.695, intitulada SURGICAL INSTRUMENTS, a qual foi emitida em 7 deFevereiro de 1984, a descrição total da qual se encontra aqui incorporadapor referência.
Em diversas modalidades, um instrumento de grampeamentotípico pode incluir primeiro e segundo membros de mandíbula os quais po-dem ser fixados juntos por uma trava, em que a trava pode ser movida entreuma posição aberta, uma posição parcialmente fechada, e uma posição fe-chada. Nas posições aberta e parcialmente fechada da trava, entretanto, osprimeiro e segundo membros de mandíbula de um instrumento de grampe-amento típico podem ser não intencionalmente destacados um a partir dooutro, deste modo necessitando tempo adicional para remontar os membrosde mandíbula. Em determinadas circunstâncias, o destaque dos primeiro esegundo membros de mandíbula pode expor a lâmina de faca. Em váriascircunstâncias, além das da acima, um instrumento de grampeamento podeincluir um botão acionador que se estende a partir da barra de impulsão quepode ser configurada para ser pega por um cirurgião e avançada distalmentepara avançar a barra de impulsão e a lâmina de faca dentro do cartucho degrampos. Em determinadas circunstâncias, entretanto, o botão acionadorpode ser avançado com relação a um membro de mandíbula embora os pri-meiro e segundo membros de mandíbula não tenham sido montados. Umavez montados, em pelo menos uma circunstância, o botão acionador, namedida em que o mesmo pode se estender para fora a partir do instrumentocirúrgico, pode não intencionalmente entrar em contato com o tecido circun-dando o campo cirúrgico e, como resultado, o tecido pode impedir o avançodo botão acionador. Nas referidas circunstâncias, um cirurgião pode ter queforçar o botão acionador adiante do tecido e/ou re-posicionar o instrumentode grampeamento que pode aumentar o tempo necessário para completar acirurgia. O que é necessário é um aprimoramento em relação ao que foi ditoacima.
Sumário
Em pelo menos uma forma da presente invenção, um instru-mento de grampeamento cirúrgico pode incluir primeiro e segundo membrosde mandíbula os quais podem ser conectados de modo pivotável entre si efixados em posição um com relação ao outro por uma trava. Em diversasmodalidades, os primeiro e segundo membros de mandíbula podem incluirprimeiro e segundo membros de travamento os quais podem permitir que osprimeiro e segundo membros de mandíbula sejam girados um com relaçãoao outro mas evitar, ou pelo menos inibir, que os primeiro e segundo mem-bros de mandíbula sejam separados um a partir do outro. As referidas moda-lidades podem ser particularmente úteis em circunstâncias quando a travaestá em uma posição parcialmente fechada e os primeiro e segundo mem-bros de mandíbula estão sendo manipulados para posicionar tecido entre osmesmos. Em pelo menos uma referida modalidade, os primeiro e segundomembros de mandíbula podem ser suficientemente conectados entre si demodo a evitar, ou pelo menos reduzir a possibilidade, dos primeiro e segun-do membros de mandíbula se tornarem destacados um a partir do outro eexpor um membro de corte. Em pelo menos uma forma da presente inven-ção, um instrumento de grampeamento cirúrgico pode incluir um alojamentoque pode se estender pelo menos parcialmente sobre e/ou em torno domembro de corte. Em diversas modalidades, o alojamento pode pelo menosparcialmente cobrir o membro de corte quando os primeiro e segundo mem-bros de mandíbula são destacados um a partir do outro, e ainda permitir queo membro de corte seja movido com relação aos primeiro e segundo mem-bros de mandíbula durante o uso.
Em diversas modalidades, o instrumento de grampeamento ci-rúrgico pode adicionalmente incluir um membro de corte e/ou carrinho degrampos que pode ser avançado e/ou retraído com relação aos primeiro esegundo membros de mandíbula. Em determinadas modalidades, o carrinhode grampos pode ser avançado por, e/ou ao longo, do membro de corte demodo a posicionar os grampos a partir de um cartucho de grampos em umdos primeiro e segundo membros de mandíbula. Em pelo menos uma formada presente invenção, um instrumento de grampeamento cirúrgico pode in-cluir uma trava que pode evitar, ou pelo menos inibir, o membro de cortee/ou carrinho de grampos de ser movido, ou pelo menos avançado, com re-lação aos primeiro e segundo membros de mandíbula antes da trava ter sidofechada. Em pelo menos uma modalidade, a trava pode ser configurada pa-ra engatar o fecho na medida em que a trava é movida a partir de uma posi-ção completamente aberta para uma posição completamente fechada e de-sengata de modo operacional o fecho a partir do membro de corte e/ou car-rinho de grampos. Em pelo menos uma modalidade, um dos primeiro e se-gundo membros de mandíbula pode incluir uma bigorna dotada de pelo me-nos uma superfície de formação que pode ser configurada para deformar osgrampos na medida em que as mesmas são proporcionadas a partir do car-tucho de grampos. Em pelo menos uma forma da presente invenção, a bi-gorna pode ser ajustada de modo móvel com relação ao cartucho de gram-pos de modo a ajustar a quantidade na qual os grampos são deformados.Em diversas modalidades, a bigorna pode ser ajustada por uma placa deajuste deslizável e/ou a carne giratório.
Breve Descrição dos Desenhos
As características e vantagens acima mencionadas e outras dapresente invenção, e a maneira de alcançar as mesmas, se tornarão maisaparentes e a presente invenção em si será melhor entendida por referênciaà descrição a seguir das modalidades da presente invenção tomadas emconjunto com os desenhos anexos nos quais:
A figura 1 é uma vista em perspectiva de um instrumento degrampeamento cirúrgico de acordo com pelo menos uma modalidade dapresente invenção;
A figura 2 é uma vista em perspectiva explodida do instrumentode grampeamento cirúrgico da figura 1;
A figura 3 é uma vista elevada explodida do instrumento degrampeamento cirúrgico da figura 1;
A figura 4 é uma vista em seção transversal parcial do instru-mento de grampeamento cirúrgico da figura 1 ilustrando primeira e segundaporções sendo montadas juntas;
A figura 5 é uma vista em seção transversal parcial do instru-mento de grampeamento cirúrgico da figura 1 ilustrando a extremidade pro-ximal da primeira porção da figura 4 sendo travada para a extremidade pro-ximal da segunda porção da figura 4 e ilustrando a segunda porção sendogirada em direção da primeira porção;
A figura 6 é uma vista em seção transversal parcial do instru-mento de grampeamento cirúrgico da figura 1 ilustrando uma trava montadade modo giratório à primeira porção, em que a trava é engatada com a se-gunda porção e em que a trava foi girada dentro de uma posição parcialmen-te fechada;
A figura 7 é uma vista em seção transversal parcial do instru-mento de grampeamento cirúrgico da figura 1 ilustrando a trava da figura 6em uma posição fechada;
A figura 8 é uma vista em perspectiva de um conjunto de cartu-cho de grampos do instrumento de grampeamento cirúrgico da figura 1;
A figura 9 é uma vista explodida do conjunto de cartucho degrampos da figura 8;
A figura 10 é uma vista em seção transversal do conjunto de car-tucho de grampos da figura 8 tomada ao longo da linha 10 -10 na figura 9;
A figura 11 é uma vista explodida de um conjunto de carrinho degrampo e membro de corte do conjunto de cartucho de grampos da figura 8;
A figura 12 é uma vista em perspectiva do conjunto de carrinhode grampos e membro de corte da figura 11;
A figura 13 é uma vista em perspectiva do instrumento de gram-peamento cirúrgico da figura 1 ilustrando um acionador ativador movido dis-talmente ao longo de um primeiro lado do instrumento de grampeamentocirúrgico;
A figura 14 é uma vista em perspectiva do instrumento de gram-peamento cirúrgico da figura 1 ilustrando o acionador ativador da figura 13movido distalmente ao longo de um segundo lado do instrumento de gram-peamento cirúrgico;
A figura 15 é uma vista em seção transversal de um instrumentode grampeamento cirúrgico de acordo com pelo menos uma modalidade al-ternativa da presente invenção ilustrando uma trava em uma posição parci-almente fechada e um mecanismo de travamento engatado com um aciona-dor ativador;
A figura 16 é uma vista em seção transversal do instrumento degrampeamento cirúrgico da figura 15 em que a trava foi movida dentro deuma posição fechada e desengatou o mecanismo de travamento a partir doacionador ativador;
A figura 17 é uma vista em perspectiva de um conjunto de bigor-na do instrumento de grampeamento cirúrgico da figura 1;
A figura 18 é uma vista em perspectiva explodida de um conjun-to de bigorna da figura 17;
A figura 19 é outra vista em perspectiva explodida de um conjun-to de bigorna da figura 17;
A figura 20 é uma vista elevada em seção transversal explodidade um conjunto de bigorna da figura 17;
A figura 21 é uma vista do conjunto de seção transversal de umconjunto de bigorna da figura 17 ilustrando um membro de ajuste de bigornaem uma primeira posição;
A figura 22 é uma vista do conjunto de seção transversal de umconjunto de bigorna da figura 17 ilustrando um membro de ajuste de bigornada figura 21 em uma segunda posição;
A figura 23 é uma vista do conjunto de seção transversal de umconjunto de bigorna da figura 17 ilustrando um membro de ajuste de bigornada figura 21 em uma terceira posição;
A figura 24 é uma vista em perspectiva de um instrumento degrampeamento cirúrgico de acordo com pelo menos uma modalidade alter-nativa da presente invenção;
A figura 25 é uma vista em seção transversal do instrumento degrampeamento cirúrgico da figura 24 tomada ao longo da linha 25 - 25 nafigura 24;
A figura 26 é uma vista parcial explodida da extremidade proxi-mal do instrumento de grampeamento cirúrgico da figura 24 incluindo ummecanismo de detenção para reter de modo liberável um membro giratóriode ajuste de bigorna em posição;
A figura 27 é uma vista em perspectiva do instrumento de gram-peamento cirúrgico da figura 24 com alguns componentes removidos e ou-tros mostrados em seção transversal;
A figura 28 é uma vista explodida de porções do instrumento degrampeamento cirúrgico da figura 24 ilustrando um membro giratório de a-juste de bigorna em uma primeira orientação;
A figura 29 é uma vista em perspectiva do membro giratório deajuste de bigorna da figura 28;
A figura 30 é uma vista de extremidade do instrumento de gram-peamento cirúrgico da figura 24 com alguns componentes removidos e ou-tros mostrados em linhas pontilhadas ilustrando o membro giratório de ajustede bigorna na primeira orientação da figura 28;
A figura 31 é uma vista de extremidade em seção transversal doinstrumento de grampeamento cirúrgico da figura 24 tomada ao longo dalinha 31 - 31 na figura 24;A figura 32 é uma vista de extremidade do instrumento de gram-peamento cirúrgico da figura 24 ilustrando o membro giratório de ajuste debigorna da figura 28 girada em uma primeira direção dentro de uma segundaorientação;
A figura 33 é uma vista de extremidade em seção transversal doinstrumento de grampeamento cirúrgico da figura 24 ilustrando um membrode ajuste de bigorna na segunda orientação da figura 32;
A figura 34 é uma vista de extremidade do instrumento de gram-peamento cirúrgico da figura 24 ilustrando o membro giratório de ajuste debigorna da figura 28 girada em uma segunda direção dentro de uma terceiraorientação;
A figura 35 é uma vista de extremidade em seção transversal doinstrumento de grampeamento cirúrgico da figura 24 ilustrando um membrode ajuste de bigorna na terceira orientação da figura 34;
A figura 36 é uma vista em perspectiva de um acionador paragirar um membro de ajuste de bigorna da figura 28; e
A figura 37 é uma vista em seção transversal parcial de um ins-trumento de grampeamento cirúrgico incluindo uma mola configurada paraorientar a extremidade distai de uma primeira porção de haste em afasta-mento a partir da extremidade distai de uma segunda porção de haste quan-do o instrumento de grampeamento está em uma configuração parcialmentefechada.
Caracteres de referência correspondentes indicam partes cor-respondentes através das diversas vistas. O conjunto de exemplificaçõesaqui determinado ilustra as modalidades preferidas da presente invenção,em uma forma, e as referidas exemplificações não devem ser construídascomo limitantes do âmbito da presente invenção em qualquer modo.
Descrição Detalhada
Determinadas modalidades exemplificativas serão agora descri-tas para proporcionar um entendimento geral dos princípios da estrutura,função, fabricação, e uso dos dispositivos e métodos divulgado aqui. Um oumais exemplos das referidas modalidades são ilustrados nos desenhos ane-xos. Aqueles versados na técnica entenderão que os dispositivos e métodosespecificamente descritos aqui e ilustrados nos desenhos anexos não sãomodalidades exemplificativas Iimitantes e que o âmbito das diversas modali-dades da presente invenção é unicamente definido pelas reivindicações. Ascaracterísticas ilustradas ou descritas em relação com uma modalidade e-xemplificativa pode ser combinada com as características de outras modali-dades. As referidas modificações e variações pretendem estar incluídas noâmbito da presente invenção.
Três pedidos de patentes US não-provisórias comumente ces-sionadas foram depositadas contemporaneamente ao presente pedido. Naocasião do depósito, os referidos três pedidos foram identificados como:
SURGICAL STAPLING INSTRUMENT WITH CUTTING MEM-BER ARRANGEMENT, Atty. Docket n° END6414USNP/080203, Inventores:Chester Baxter e James Bedi;
SURGICAL STAPLER WITH APPARATUS FOR ADJUSTINGSTAPLE HEIGHT, Atty. Docket n° END6406USNP/080195, Inventores:Chester Baxter e James Bedi, e
LOCKOUT ARRANGEMENT FOR A SURGICAL STAPLER,Atty. Docket n° END6405USNP/080194, Inventores: Chester Baxtere JamesBedi, as descrições totais dos quais se encontram aqui incorporados por re-ferência.
Com referência à figura 1, um instrumento de grampeamentocirúrgico, em geral 100, pode compreender uma primeira porção de haste102 e uma segunda porção de haste 104. Em diversas modalidades, a pri-meira porção de haste 102 e a segunda porção de haste 104 podem serconfiguradas para serem pegas por um cirurgião, por exemplo, e podemcompreender uma porção de empunhamento manual 106. Em pelo menosuma modalidade, a primeira porção de haste 102, com referência às figuras2 e 3, pode incluir uma primeira cobertura 108 fixada em uma primeira arma-ção 110 e, similarmente, a segunda porção de haste 104 pode incluir umasegunda cobertura 112 fixada em uma segunda armação 114. As coberturas108 e 112 podem ser ergonomicamente contornadas, ou de outro modo a-dequadamente contornadas, para ajudar um cirurgião a manipular o instru-mento de grampeamento 100 dentro de um campo cirúrgico. Em diversasmodalidades, coberturas de haste 108 e 112, por exemplo, podem incluirprotuberâncias ampliadas 109 e 113, respectivamente, as quais podem faci-Iitar a inserção do instrumento de grampeamento 100 dentro de um campocirúrgico. Em diversas modalidades, as coberturas de haste 108 e 112 po-dem ser produzidas de materiais leves de plástico, e/ou de qualquer outromaterial adequado, por exemplo, enquanto as armações de haste 110 e 114podem ser produzidas de aço inoxidável, titânio, e/ou qualquer outro materialadequado, por exemplo.
Em diversas modalidades, com referência mais uma vez às figu-ras 1 - 3, as extremidades distais das porções de haste 102 e 104 podemcompreender uma extremidade executora 120 que pode ser configurada pa-ra tratar tecido dentro de um campo cirúrgico, por exemplo. Em pelo menosuma referida modalidade, a extremidade executora 120 pode incluir um ca-nal de cartucho de grampos 122 configurado para receber e/ou reter um car-tucho de grampos como descrito em mais detalhes adicionais abaixo. Emdeterminadas modalidades, o canal de cartucho de grampos 122 pode com-preender uma armação em forma de canal alongado de peça única que seestende a partir da primeira porção de armação de haste 110. Em pelo me-nos uma modalidade, o canal de cartucho de grampos 122 pode incluir umpar de paredes laterais alongadas opostas entre si 124 conectadas por umaparede de fundo 126. Ao longo da porção traseira ou proximal de canal decartucho de grampos 122, um par de flanges laterais eretos e espaçadosentre si 128 pode se estender verticalmente a partir das paredes laterais o-postas entre si 124. Em diversas modalidades, a largura do canal de cartu-cho de grampos 122 entre flanges laterais 128 pode ser maior do que a lar-gura do membro de mandíbula superior, ou bigorna, 130 que se estende apartir de segunda porção de haste 104. Em pelo menos uma modalidade, adistância entre os flanges 128 pode ser configurada para permitir que pelomenos uma porção de bigorna 130 seja recebida entre os flanges laterais128 quando o instrumento de grampeamento é montado para operação.Como mostrado na figura 2, cada flange lateral 128 pode incluir uma chan-fradura, ou reentrância, 127, por exemplo, que pode ser configurada parareceber uma ou mais projeções de engate 131, por exemplo, que se esten-dem a partir da bigorna 130, e/ou qualquer outra porção adequada da se-gunda porção de haste 104, como descrito em mais detalhes adicionais a-baixo.
Como indicado acima, com referência mais uma vez às figuras 1- 3, o canal de cartucho de grampos 122 pode ser configurado para suportare/ou reter um cartucho de grampos, tal como o cartucho de grampos 150,por exemplo, dentro da extremidade executora 120, em que o cartucho degrampos pode incluir um ou mais grampos (não-ilustrados) armazenados demodo removível no mesmo. Em diversas modalidades, com referência àsfiguras 8 -10, o cartucho de grampos 150 pode incluir uma ou mais cavidadede grampos 151 que podem ser configuradas para armazenar grampos emqualquer modo adequado, tal como em pelo menos duas fileiras longitudi-nais lateralmente espaçadas entre si, por exemplo. Em pelo menos umamodalidade, com referência às figuras 9 e 10, o cartucho de grampos 150pode incluir um corpo de cartucho de grampos 152 e compartimento 154, emque corpo de cartucho de grampos 152 e/ou compartimento 154 pode serconfigurado para definir um canal, ou trajeto, para receber de modo deslizá-vel um carrinho de grampo e/ou membro de corte no mesmo. Em pelo me-nos uma modalidade, o compartimento 154 pode incluir braços flexíveis 155,por exemplo, que podem ser configurados para engatar o corpo de cartuchode grampos 152 em um encaixe ajustado e/ou um arranjo de encaixe depressão. Com referência às figuras 10 -12, o cartucho de grampos 150 podeadicionalmente incluir o conjunto de carrinho de grampos 160 que pode in-cluir uma porção de carrinho de grampos 162 e, adicionalmente, o membrode corte 164. Em diversas modalidades, o membro de corte 164 pode incluirborda de corte 165 e braço de travamento 166, por exemplo, em que o braçode travamento 166 pode ser configurado para ser encaixado por pressãoe/ou por encaixe ajustado dentro da abertura 163 no carrinho de grampos162 quando o membro de corte 164 é montado na porção de carrinho degrampos 162. Em outras diversas modalidades, a porção de carrinho degrampos 162 pode ser integralmente moldada ao membro de corte 164.
Além do dito acima, com referência às figuras 8 -10, o corpo decartucho de grampos 152 pode incluir uma fenda, tal como a fenda 156, porexemplo, que pode ser configurada para receber pelo menos uma porção domembro de corte 164 na mesma, e/ou qualquer outra porção de conjunto decarrinho de grampos 160 e conjunto de barra de impulsão 200 (discutido a-baixo), em que a fenda 156 pode ser configurada para permitir que o mem-bro de corte 164 seja movido entre primeira e segunda posições dentro docartucho de grampos 150. Em diversas modalidades, a fenda 156 pode serconfigurada para permitir que o membro de corte 164 seja movido entre umaposição proximal (Figura 10) e uma posição distai de modo a seccionar teci-do posicionado intermediário ao cartucho de grampos 150 e a bigorna 130,por exemplo. Com referência mais uma vez às figuras 10 - 12, a porção decarrinho de grampos 162 pode incluir superfícies de carne, rampa ou de a-cionador 167 que podem ser configuradas para engatar os direcionadores degrampo posicionados dentro do cartucho de grampos 150. Em diversas mo-dalidades, com referência à figura 9, o cartucho de grampos 150 pode incluirdirecionadores de grampo 168 que podem ser elevados, ou deslizados, ver-ticalmente dentro da cavidade de grampos 151 pela porção de carrinho 162,de modo que o movimento para cima dos direcionadores de grampo 168pode ejetar, ou posicionar, os grampos pelo menos parcialmente posiciona-dos dentro da cavidade de grampos 151. Enquanto os direcionadores degrampo 168 podem, de fato, ser elevados verticalmente, o termo para cima,e similar, pode significar que os direcionadores de grampo 168, por exemplo,são movidos em direção da superfície de topo, ou plataforma, 158 do cartu-cho de grampos e/ou em direção da bigorna 130, por exemplo. Em determi-nadas modalidades, como ilustrado na figura 9, cada direcionador de gram-po 168 pode incluir um ou mais superfícies inclinadas 169 orientadas nomesmo ângulo que a superfície de carne 167, e/ou qualquer outro ânguloadequado, que pode proporcionar uma superfície de contato deslizante rela-tivamente plana, ou pelo menos substancialmente plana, entre o carrinho degrampos 162 e os direcionadores de grampo 168. Em diversas modalidades,um direcionador de grampo pode ser configurado para posicionar apenas umgrampo, enquanto, em determinadas modalidades, um direcionador degrampo pode ser configurado para simultaneamente posicionar dois ou maisgrampos localizados em fileiras adjacentes, por exemplo. Outros dispositivossão divulgados na Pedido de Patente US n° de série 12/030,424, intituladaSURGICAL STAPLING INSTRUMENT WITH IMPROVED FIRING TRIGGERARRANGEMENT, a qual foi depositada em 13 de Fevereiro de 2008, a des-crição total da qual é aqui incorporada por referência.
Em diversas modalidades, como descrito acima, um instrumentode grampeamento cirúrgico pode incluir um membro de corte/conjunto decarrinho de grampos configurado para seccionar tecido e posicionar gram-pos a partir de um cartucho de grampos. Em determinadas modalidades,entretanto, um instrumento de grampeamento cirúrgico pode não requerer,ou incluir, um membro de corte. Em pelo menos uma referida modalidade,um cartucho de grampos pode incluir um carrinho de grampo posicionado nomesmo e/ou um instrumento cirúrgico pode ser configurado para mover umcarrinho de grampo dentro de um cartucho de grampos de modo a grampeartecido, por exemplo, sem de outro modo seccionar o mesmo. Em determina-das outras modalidades, um cartucho de grampos pode incluir um carrinhode grampo posicionado no mesmo onde um instrumento cirúrgico pode inclu-ir um membro de corte móvel dentro de, ou com relação a, o cartucho degrampos. Em pelo menos uma referida modalidade, o membro de corte podeser avançado em contato com o carrinho de grampos de modo que o mem-bro de corte e o carrinho de grampos podem ser avançados juntos. Após, omembro de corte pode ser suficientemente retraído para permitir que o car-tucho de grampos seja destacado a partir do instrumento cirúrgico e substitu-ído com um novo cartucho de grampos dotado de um novo carrinho degrampos. As referidas modalidades podem ser úteis quando um carrinho degrampo pode se tornar gasto ou deformado durante o uso. Outras modalida-des são previstas onde um cartucho de grampos pode incluir um membro decorte posicionado no mesmo onde um instrumento cirúrgico pode incluir umcarrinho de grampo móvel dentro de, ou com relação a, o cartucho de gram-pos. Em pelo menos uma referida modalidade, similar à acima, o carrinho degrampos pode ser avançado em contato com o membro de corte de modoque o membro de corte e o carrinho de grampos podem ser avançados jun-tos. Após, o carrinho de grampos pode ser suficientemente retraído parapermitir que o cartucho de grampos seja destacado a partir do instrumentocirúrgico e substituído com um novo cartucho de grampos dotado de um no-vo membro de corte. As referidas modalidades podem ser úteis quando ummembro de corte pode se tornar gasto ou deformado durante o uso. Em di-versas modalidades, como descrito em mais detalhes abaixo, o cartucho degrampos pode incluir um alojamento protetor ou cobertura configurada paraevitar, ou pelo menos reduzir a possibilidade de, um cirurgião ou outro clíni-co toque o membro de corte posicionado dentro do cartucho de gramposenquanto manipula o cartucho de grampos, por exemplo.
Em diversas modalidades, além da acima, o canal de cartuchode grampos 122 e/ou o cartucho de grampos 150, por exemplo, pode incluiruma ou mais projeções cooperantes e/ou reentrâncias, por exemplo, quepodem ser configuradas para reter de modo removível o cartucho de gram-pos 150 dentro do canal de cartucho de grampos 122. Uma vez que o cartu-cho de grampos 150 tenha sido inserido no canal de cartucho de grampos122, em diversas modalidades, a primeira porção de haste 102 pode sermontada na segunda porção de haste 104. Em outras diversas modalidades,o cartucho de grampos pode ser inserida no canal de cartucho de gramposapós a primeira e a segunda porção de haste serem montadas juntas. Emqualquer caso, com referência às figuras 1 - 7, a primeira porção de haste102 e a segunda porção de haste 104 podem incluir extremidades proximais103 e 105, respectivamente, que podem ser montadas juntas de modo que aprimeira e a segunda porção de haste podem ser rotativamente ou pivota-velmente acopladas uma a outra. Em diversas modalidades, com referênciaàs figuras 2 e 3, a primeira porção de haste 102 pode incluir um ou mais pi-nos, ou projeções, 111 que se estendem a partir da mesma que podem serconfiguradas para serem deslizavelmente recebidas dentro de uma ou maisranhuras, canais, ou fendas 115 na segunda porção de haste 104. Em de-terminadas modalidades, fendas 115 podem ser definidas na segunda arma-ção de haste 114 e projeções 111 podem se estender a partir de uma colunade extremidade proximal 107 que se estende a partir da primeira armação dehaste 110, por exemplo. De modo a montar a primeira porção de haste 102 ea segunda porção de haste 104, com referência à figura 4, a extremidadeaberta das fendas 115 pode ser alinhada com as projeções 111 de modoque a segunda porção de haste 104, por exemplo, pode ser interpretadacom relação a primeira porção de haste 102 e as projeções 111 podem serdeslizadas dentro das fendas 115. Em pelo menos uma modalidade, comoilustrado nas figuras 2 e 3, as extremidades abertas das fendas 115 podemser localizadas proximalmente com relação a suas extremidades fechadas.
Em pelo menos uma referida modalidade, a extremidade proximal 105 dasegunda porção de haste 104 pode ser posicionada distalmente com relaçãoa extremidade proximal 103 da primeira porção de haste 102 de modo que asegunda porção de haste 104 pode ser movida proximalmente de modo aposicionar as projeções 111 dentro das fendas 115. Em várias outras cir-cunstâncias, a primeira porção de haste 102 pode ser posicionada proxi-malmente com relação a segunda porção de haste 104 e deslizada distal-mente de modo a posicionar as projeções 111 dentro das fendas 115.
Em diversas modalidades, com referência à figura 5, a segundaporção de haste 104 pode ser girada em direção da primeira porção de has-te 102 de modo que a bigorna 130 pode ser movida em posição com relaçãoao cartucho de grampos 150 e/ou canal de cartucho de grampos 122. Emdeterminadas modalidades, a primeira porção de haste 102 pode ser giradaem direção da segunda porção de haste 104 e/ou as primeira e segundaporções de haste podem ser giradas uma em direção da outra. Em qualquerevento, as projeções 111 e as fendas 115, quando engatadas uma com aoutra, podem compreender um pivô sobre o qual uma ou ambas de primeirae segunda porções de haste pode ser movida uma com relação a outra. Emdiversas modalidades, a segunda porção de haste 104 pode ser movida comrelação a primeira porção de haste 102 de modo que bigorna 130 é movidaem próxima oposição ao cartucho de grampos 150. Em determinadas moda-lidades, com referência à figura 6, a segunda porção de haste 104 pode sermovida com relação a primeira porção de haste 102 de modo que as proje-ções de engate 131 que se estendem a partir de segunda porção de haste104 podem ser alinhadas com e/ou inseridas nas reentrâncias 127 dentro daprimeira porção de haste 102. Em diversas modalidades, com referênciaprincipalmente a Figuras 2 e 3, a primeira porção de haste 102 pode adicio-nalmente incluir mecanismo de engate 180 montado de modo giratório àmesma o qual pode ser utilizado para engatar as projeções de engate 131que se estendem a partir da segunda porção de haste 104 e fixar as primeirae segunda porções de haste juntas. Embora não-ilustrado, outras modalida-des são previstas nas quais um mecanismo de travamento é montado demodo giratório na segunda porção de haste e as projeções de engate podemse estender a partir da primeira porção de haste. Em qualquer evento, empelo menos uma modalidade, o mecanismo de engate 180 pode ser monta-do à primeira armação 110 por um ou mais pinos pivô 182 que podem serconfigurados para definir um eixo sobre o qual o engate 180 pode ser girado.
Em determinadas modalidades, com referência agora às figuras4 e 5, o mecanismo de engate 180 pode incluir uma armação de engate 184e, adicionalmente, cobertura de engate 186 montada à armação de engate184. Em outras diversas modalidades, uma cobertura de trava e uma arma-ção de trava podem compreender uma unidade integral ou, em determina-das modalidades, um mecanismo de engate pode nem mesmo incluir umacobertura. Em determinadas modalidades, a armação de engate 184 podeser em forma de canal e pode incluir um par de paredes laterais alongadasopostas entre si 185 as quais são espaçadas por uma distância suficientepara expandir a primeira porção de armação 110. Em pelo menos uma mo-dalidade, a cobertura de engate 186 pode ser produzida de plástico, materi-ais leves, e/ou qualquer outro material adequado, por exemplo, enquanto aarmação de engate 184 pode ser produzida de aço inoxidável e/ou qualqueroutro material adequado, por exemplo. Em determinadas modalidades,quando o mecanismo de engate 180 é fechado, como ilustrado na figura 7, acobertura de engate 186 pode ser alinhada com a primeira cobertura de has-te 108. A cobertura de engate 186 pode incluir porção contornada 187 quepode ser configurada para ajudar um cirurgião a manipular o instrumentocirúrgico 100 em que, em pelo menos uma modalidade, a porção contornada187 pode ser alinhada com, ou pelo menos substancialmente alinhada com,a protuberância 109 que se estende a partir da primeira cobertura de haste108. O mecanismo de engate 180 pode adicionalmente incluir um ou maisbraços de engate 188 que se estendem a partir do mesmo que pode serconfigurado para engatar uma ou mais projeções de engate 131 que se es-tendem a partir da segunda porção de haste 104 e puxar e/ou fixar as proje-ções 131 dentro das reentrâncias 127 como ilustrado na figura 7. Em pelomenos uma modalidade, pelo menos um dos braços de engate 188 pode serintegralmente formado com a armação de engate 184. Em determinadasmodalidades, com referência à figura 6, pelo menos um dos braços de enga-te 188 pode incluir um gancho distai 189 que pode ser configurado para cir-cundar pelo menos uma porção das projeções 131 de modo a abranger oucircundar, ou pelo menos parcialmente abranger ou circundar, as projeções131. Em pelo menos uma modalidade, os braços de engate 188 podem agircomo um engate sobre-central para manter o mecanismo de engate 180 emsua posição engatada, ou fechada.
Em uso, em várias circunstâncias, uma da primeira porção dehaste 102 e da segunda porção de haste 104 pode ser posicionada em umprimeiro lado de tecido dentro de um campo cirúrgico e a outra porção dehaste pode ser girada em posição no lado oposto do tecido. Nas referidasmodalidades, o cartucho de grampos 150 pode ser posicionado em um ladodo tecido e a bigorna 130 pode ser posicionada no outro lado do tecido. A-pós, como também delineado acima, o mecanismo de engate 180 pode seracionado de modo que o mesmo pode ser movido entre uma posição abertae uma posição fechada de modo a engatar a segunda porção de haste 104na primeira porção de haste 102 e aplicar uma força de grampeamento aotecido posicionado entre o cartucho de grampos 150 e a bigorna 130. Emdeterminadas circunstâncias, o mecanismo de engate 180 pode ser movidoentre uma posição aberta (Figura 5), uma posição parcialmente-fechada, ouintermediária, (Figura 6), e uma posição fechada (Figura 7). Em pelo menosuma referida modalidade, com referência às figuras 5 e 6, o mecanismo deengate 180 pode ser movido entre uma posição aberta na qual os braços deengate 188 não são engatados com as projeções 131 e uma posição parci-almente fechada na qual os braços de engate 188 são engatados com asprojeções 131 de modo que, embora a bigorna 130 tenha sido pelo menosparcialmente trazida em oposição ao cartucho de grampos 150, um espaçosuficiente pode permanecer entre a bigorna 130 e o cartucho de grampos150 o qual pode permitir que a extremidade executora 120 seja reposiciona-da com relação ao tecido, por exemplo. Uma vez que a bigorna 130 e o car-tucho de grampos 150 tenham sido suficientemente posicionados com rela-ção ao tecido, o mecanismo de engate 180 pode ser movido entre sua posi-ção parcialmente fechada e posição fechada, como ilustrado na figura 7.
Em diversas modalidades, além da acima, um instrumento degrampeamento cirúrgico pode adicionalmente incluir um membro de orienta-ção que pode ser configurado para orientar a primeira porção de haste deum instrumento de grampeamento em afastamento a partir de uma segundaporção de haste. Em pelo menos uma modalidade, como descrito em maisdetalhes adicionais abaixo, uma mola, e/ou qualquer material adequadamen-te flexível, pode ser posicionado intermediário às primeira e segunda por-ções de haste de modo que a bigorna e o cartucho de grampos do instru-mento de grampeamento podem ser orientados em afastamento uma a partirda outra. Em determinadas modalidades, a mola pode ser configurada parapelo menos parcialmente separar as primeira e segunda porções de hastede modo que um espaço exista entre a bigorna e o cartucho de grampos, emque o espaço pode ser suficiente para permitir que o tecido seja posicionadoentre as mesmas. Em uso, um cirurgião pode posicionar o referido instru-mento de grampeamento cirúrgico sem ter que separar e manter as primeirae segunda porções de haste em afastamento uma a partir da outra. O referi-do instrumento pode ser especialmente útil quando o instrumento de gram-peamento está em uma configuração parcialmente fechada e o cirurgião es-tá manipulando o instrumento dentro de um campo cirúrgico. Após o cirurgi-ão estará satisfeito com o posicionamento do instrumento de grampeamento,o cirurgião pode comprimir e/ou desengatar a mola e colocar o instrumentode grampeamento em uma configuração fechada.
Em várias circunstâncias, como delineado acima, a extremidadedistai da primeira porção de haste 102 pode ser movida com relação à ex-tremidade distai da segunda porção de haste 104, especialmente quando omecanismo de engate 180 não está engatado com, ou apenas parcialmenteengatada com, as projeções 131 da segunda porção de haste 104. Em taiscircunstâncias, as projeções 111 e as fendas 115 nas extremidades proxi-mais das primeira e segunda porções de haste podem ser configuradas parareter pelo menos as extremidades proximais das primeira e segunda porçõesde haste juntas quando as extremidades distais das primeira e segunda por-ções de haste estão sendo movidas uma com relação a outra, por exemplo.
Posto de outro modo, as projeções 111 e as fendas 115 podem cooperarpara evitar, ou pelo menos inibir, que a primeira porção de haste 102 se tor-ne completamente destacada a partir da segunda porção de haste 104. Emdeterminadas modalidades, uma primeira porção de haste pode incluir umaprimeira porção de trava e uma segunda porção de haste pode incluir umasegunda porção de trava, em que as primeira e segunda porções de travapodem ser configuradas para serem engatadas uma com a outra e evitarque a primeira porção de haste se torne completamente destacada a partirda segunda porção de haste. Em pelo menos uma modalidade, as projeções111 podem compreender a primeira porção de trava e as fendas 115 podemcompreender a segunda porção de trava. Os instrumentos de grampeamen-to anteriores eram desprovidos das referidas porções de trava e em vez dis-so se baseavam em um único mecanismo de engate para manter as primei-ra e segunda porções de haste juntas. Em circunstâncias onde um meca-nismo de engate dos referidos instrumentos de grampeamento anterioresnão foi completamente engatado com ambas as primeira e segunda porçõesde haste, as primeira e segunda porções de haste podem se tornar comple-tamente destacadas uma a partir da outra, deste modo necessitando que umcirurgião, por exemplo, reposicione e reorganize as porções de haste. Emdeterminadas circunstâncias, um destaque completo das primeira e segundaporções de haste dos referidos grampos anteriores pode expor pelo menos aporção de um membro de corte.
Em diversas modalidades, como delineado acima, o mecanismode engate 180 pode ser configurado para ser movido entre uma posição a-berta, uma posição parcialmente fechada, e uma posição fechada. Quando omecanismo de engate 180 está em sua posição aberta, como também deli-neado acima, as projeções 111 podem ser inseridas em e/ou removidos apartir das fendas 115. Quando o mecanismo de engate 180 está em sua po-sição parcialmente fechada, com referência à figura 6, os braços de engate188 podem ser configurados para engatar as projeções de engate 131 demodo que as projeções 111 não podem ser removidas a partir das fendas115. Em pelo menos uma referida modalidade, os braços de engate 188 e asprojeções de engate 131 podem ser configurado para evitar, ou pelo menosinibir, que a segunda porção de haste 104 seja movida distalmente com re-lação a primeira porção de haste 102 e, como resultado, evitar, ou pelo me-nos inibir, que as projeções 111 sejam desengatadas a partir das fendas115. De modo correspondente, os braços de engate 188 e as projeções deengate 131 podem ser configurados para evitar que a primeira porção dehaste 102 seja movida proximalmente com relação à segunda porção dehaste 104. De modo similar ao dito acima, em diversas modalidades, os bra-ços de engate 188 e as projeções de engate 131 podem também ser confi-gurados para evitar, ou pelo menos inibir, que as projeções 111 sejam remo-vidas a partir das fendas 115 quando o mecanismo de engate 180 está emsua posição fechada (Figura 7). Em determinadas modalidades, além daacima, as projeções de engate 131 podem se estender a partir de segundaporção de haste 104 em um local que é intermediário às suas extremidadesproximal e distai. Em pelo menos uma referida modalidade, as projeções 111e as fendas 115 podem ser configuradas para manter as primeira e segundaporções de haste juntas em suas extremidades proximais enquanto o meca-nismo de engate 180 pode ser utilizado para manter as primeira e segundaporções de haste juntas em um local intermediário. Em qualquer evento, emdeterminadas modalidades, as primeira e segunda porções de haste nãopodem ser desengatadas uma a partir da outra a não ser que o mecanismode engate 180 seja movido para a sua posição completamente aberta. Empelo menos uma referida modalidade, as projeções 111 e as fendas 115 nãopodem ser desengatadas uma a partir da outra quando o mecanismo de en-gate 180 está em uma posição fechada e/ou parcialmente fechada.
Uma vez que a bigorna 130 e o cartucho de grampos 150 te-nham sido suficientemente posicionados, o tecido posicionado intermediárioa bigorna 130 e ao cartucho de grampos 150 pode ser grampeado e/ou sec-cionado. Em diversas modalidades, com referência à figura 3, o instrumentode grampeamento cirúrgico 100 pode adicionalmente incluir um conjunto debarra de impulsão 200 que pode ser configurado para avançar e/ou retrair oconjunto de carrinho de grampos 160 dentro do cartucho de grampos 150,por exemplo. Em pelo menos uma modalidade, o conjunto de barra de im-pulsão 200 pode incluir uma barra de impulsão 202 e acionador de disparo204, em que acionador de disparo 204 pode ser configurado para mover abarra de impulsão 202 e o conjunto de carrinho de grampos 160 distalmentepara posicionar os grampos a partir de cartucho de grampos 150 e deformaros grampos contra a bigorna 130, como descrito acima. Em pelo menos umamodalidade, com referência às figuras 11 e 12, o carrinho de grampos 162pode incluir uma ranhura, canal, ou fenda 161 que pode ser configurada pa-ra receber, e pode ser conectada de modo operacional a, uma extremidadedistai 201 (Figura 3) da barra de impulsão 202. Em determinadas modalida-des, o conjunto de carrinho de grampos 160 pode ser engatado de modooperacional com a barra de impulsão 202 quando o cartucho de grampos150 é inserido no canal de cartucho de grampos 122. Em pelo menos umamodalidade, a extremidade distai 201 e a fenda 161 podem incluir caracterís-ticas cooperantes as quais podem permitir que a extremidade distai 201 e afenda 161 sejam montadas em uma direção transversal mas evitar, ou pelomenos inibir, que a extremidade distai 201 e a fenda 161 sejam desmonta-das uma a partir da outra na direção proximal e/ou distai. Em outras modali-dades, a barra de impulsão 202 pode ser avançada distalmente antes deentrar em contato e engatar o conjunto de carrinho de grampos 160. Em pelomenos uma referida modalidade, o conjunto de carrinho de grampos 160pode permanecer estacionário até que seja colocado em contato pela barrade impulsão 202. Em qualquer evento, como delineado acima, o acionador204 pode ser conectado de modo operacional à barra de impulsão 202 demodo que uma força de empurrar e/ou puxar pode ser aplicada ao acionador204 e transmitida à barra de impulsão 202. Em determinadas modalidades,como descrito em mais detalhes abaixo, o acionador 204 pode ser pivota-velmente conectado a uma extremidade proximal 203 da barra de impulsão202 de modo que o acionador 204 pode ser seletivamente girado entre pelomenos as primeira e segunda posições.
Além do dito acima, com referência às figuras 1, 13, e 14, o a-cionador 204 pode ser móvel entre uma primeira posição em um primeirolado 116 do instrumento de grampeamento cirúrgico 100 (Figura 13), umasegunda posição em um segundo lado 117 (Figura 14), e uma posição in-termediária (Figura 1) localizada nas extremidades proximais 103 e 105 dasprimeira e segunda porções de haste 102 e 104. Uma vez que o acionador204 tenha sido girado em posição em um de primeiro e segundo lados 116,117, o acionador 204 pode ser avançado distalmente. Em várias circunstân-cias, como resultado, um cirurgião pode selecionar se mover o acionador204 distalmente ao longo do primeiro lado 116 ou segundo lado 117. As refe-ridas circunstâncias podem surgir quando é mais provável que o acionador204 pode impingir no tecido circundando o campo cirúrgico, por exemplo,quando o acionador 204 é movido distalmente ao longo de um lado do ins-trumento cirúrgico em comparação ao outro. Em diversas modalidades, comreferência às figuras 2 e 3, o acionador 204 pode incluir um braço 206 quese estende a partir do mesmo onde o braço 206 pode ser pivotavelmentemontado para extremidade proximal 203 de barra de impulsão 202. Em de-terminadas modalidades, com referência mais uma vez às figuras 1, 13, e14, o instrumento cirúrgico 100 pode incluir uma primeira fenda (não-ilustrada) que se estende ao longo do primeiro lado 116 e uma segunda fen-da 118 que se estende ao longo do segundo lado 117, em que as primeira esegunda fendas podem ser configuradas para receber de modo deslizávelpelo menos a porção de acionador 204. Em pelo menos uma modalidade, asparedes laterais das primeira e segunda fendas podem confinar, ou pelomenos ajudar a confinar, o movimento do acionador 204 de modo que omesmo pode ser movido ao longo de um trajeto determinado. Com referên-cia à figura 14, a segunda fenda 118, por exemplo, pode ser definida entre aprimeira porção de haste 102 e a segunda porção de haste 104 de modoque, quando o acionador 204 é movido distalmente ao longo do segundolado 117, o braço 206 de acionador 204 pode ser deslizado intermediário àsprimeira e segunda porções de haste. De modo similar ao dito acima, a pri-meira fenda pode também ser definida intermediário às primeira e segundaporções de haste. Em diversas modalidades, com referência mais uma vezàs figuras 13 e 14, o instrumento cirúrgico 100 pode adicionalmente incluiruma fenda intermediária 119 que pode também ser configurada para permitirque o braço 206, e/ou qualquer outra porção adequada de acionador 204,para deslizar no mesmo. Em pelo menos uma referida modalidade, a fendaintermediária 119 pode conectar as primeira e segunda fendas de modo que,quando o acionador 204 é posicionado em sua posição intermediária, o a-cionador 204 pode ser movido para uma das suas primeira e segunda posi-ções. Em determinadas modalidades, a primeira fenda, a segunda fenda117, e a fenda intermediária 119 podem ser paralelas entre si, ou pelo me-nos substancialmente paralelas entre si, uma a outra e/ou se encontrar nomesmo plano, embora outras modalidades sejam previstas nas quais umaou mais das fendas não sejam paralelas uma à outra e/ou permaneçam emdiferentes planos. Adicionalmente, embora os primeiro e segundo lados damodalidade ilustrada sejam localizados em lados opostos do instrumentocirúrgico 100, outras modalidades são previstas onde as primeira e segundafendas, por exemplo, são localizadas em lados adjacentes e/ou lados quenão são diretamente opostos um ao outro. Adicionalmente, outras modalida-des são previstas nas quais os lados de um instrumento de grampeamentonão são prontamente discerníveis, tais como instrumentos dotados de por-ções arredondadas e/ou arqueadas.
Em diversas modalidades, além da acima, o instrumento degrampeamento cirúrgico 100 pode adicionalmente incluir um mecanismo detravamento que pode evitar, ou pelo menos inibir, o acionador 204 e, de mo-do correspondente, o conjunto de carrinho de grampos 160, de ser avançadoprematuramente. Em pelo menos uma modalidade, o mecanismo de trava-mento pode ser configurado para evitar, ou pelo menos inibir, o acionador204 de ser avançado distalmente antes do mecanismo de engate 180 sermovido para uma posição fechada, ou uma posição pelo menos parcialmen-te fechada. Em determinadas modalidades, em geral com referência à figura5, o instrumento de grampeamento cirúrgico 100 pode adicionalmente incluirum mecanismo de travamento 220 que pode ser engatado com o acionador204 e pode permanecer engatado com o acionador 204 enquanto o meca-nismo de engate 180 está em uma posição completamente aberta (Figura 5)e/ou uma posição pelo menos substancialmente aberta. Em diversas moda-lidades, um mecanismo de travamento 220 pode incluir uma trava 222 quepode ser orientada em engate com o acionador 204 por uma força de dire-cionamento aplicada à mesma por mola de trava 224, por exemplo. Em pelomenos uma referida modalidade, o acionador 204 pode incluir uma ou maisranhuras, canais, ou fendas (não-ilustradas) que podem ser configuradaspara receber pelo menos a porção de trava 222. Em uso, um mecanismo detravamento 220 pode manter o acionador 204 em posição até que o meca-nismo de engate 180 seja movido para a sua posição completamente fecha-da (Figura 7) e/ou uma posição pelo menos substancialmente fechada. Emtais circunstâncias, em pelo menos uma modalidade, o mecanismo de enga-te 180 pode ser configurado para engatar um mecanismo de travamento 220e desengatar a trava 222 a partir do acionador 204. Em pelo menos umareferida modalidade, com referência às figuras 5 - 7, o mecanismo de engate180 pode adicionalmente incluir carne 183 que pode ser configurado paraengatar a superfície de carne 223 na trava 222 quando o mecanismo de en-gate 180 é movido para a sua posição fechada e, como resultado, deslizar,e/ou de outro modo mover, a trava 222 em afastamento a partir do acionador204. Em diversas modalidades, o carne 183 pode compreender uma parede,nervura, e/ou sulcos que se estendem a partir da cobertura de engate 186e/ou da armação de engate 184. Em qualquer evento, uma vez que a trava222 tenha sido suficientemente desengatada a partir do acionador 204, empelo menos uma modalidade, o acionador 204 pode ser movido a partir desua posição intermediária, ilustrada na figura 1, para uma de suas primeira esegunda posições, como ilustrado nas figuras 13 e 14.
Como descrito acima, um mecanismo de travamento 220 podeser configurado para evitar, ou pelo menos inibir, que a barra de direciona-mento 202 seja avançada distalmente antes do mecanismo de engate 180ser movido para uma posição predeterminada, tal como, por exemplo, umaposição fechada e/ou posição parcialmente fechada. Vantajosamente, ummecanismo de travamento 220 pode também evitar, ou pelo menos inibir,que o conjunto de carrinho de grampos 160 seja avançado antes da primeiraporção de haste 102 e da segunda porção de haste 104 serem montadasjuntas. De fato, um mecanismo de travamento 220 pode evitar que o tecidoposicionado intermediário à bigorna 130 e ao cartucho de grampos 150 sejacortado e/ou grampeado antes da bigorna 130 e do cartucho de grampos150 serem adequadamente posicionados com relação ao tecido. Também,de fato, um mecanismo de travamento 220 pode evitar que os grampos se-jam proporcionados no tecido antes de uma força de grampeamento apro-priada ser aplicada ao tecido. Em qualquer evento, quando o mecanismo deengate 180 é retornado para a sua posição completamente aberta, e/ou umaposição parcialmente aberta, o carne 183 pode ser movido em afastamentoa partir da trava 222 de modo que a mola de trava 124 pode orientar a trava222 em engate com o acionador 204 mais uma vez. Em várias outras moda-lidades, com referência às figuras 15 e 16, um mecanismo de travamento220' pode incluir uma trava 222' compreendendo uma superfície de carne223' e, adicionalmente, um batente 226' que pode limitar o movimento relati-vo da trava 222'. Em pelo menos uma modalidade, o carne 183, por exem-plo, pode ser configurado para contato com a superfície de carne 223' e, emvirtude da superfície contornada, chanfrada, e/ou angulada da superfície decarne 223', o carne 183 pode ser configurado para direcionar a trava 222'distalmente como ilustrado na figura 16. A trava 222' pode ser direcionadadistalmente de modo que o pino 228', que se estende a partir da trava 222",pode ser movido entre uma primeira posição (Figura 15) na qual o mesmo éposicionado dentro de abertura 229' no acionador 204' e uma segunda posi-ção (Figura 16) na qual o pino 228' tenha sido suficientemente removido apartir de abertura 229'. Em diversas modalidades, o batente 226' pode serconfigurado de modo que, as travas 222' sejam direcionadas distalmente, obatente 226' pode entrar em contato com o carne 183 uma vez que a trava222' tenha sido suficientemente deslocada. Nas referidas modalidades, obatente 226' pode ser configurado para controlar a segunda, posição de tra-va ou deslocada 222'. De modo similar ao dito acima, na medida em que oacionador 180 é movido para fora de sua posição fechada e o carne 183 édesengatado a partir de um mecanismo de travamento 220', a mola de trava224' pode mover a trava 222' em engate com o acionador 204' mais uma vez.
Em diversas modalidades, como descrito acima, um acionadorativador pode ser utilizado para mover uma barra de impulsão, carrinho degrampos, e/ou membro de corte entre as primeira e segunda posições. Co-mo também descrito acima, o conjunto de barra de impulsão 200, por exem-plo, pode ser utilizado para mover um conjunto de carrinho de grampo, talcomo o conjunto de carrinho de grampos 160, por exemplo, entre uma posi-ção proximal (Figura 10) e uma posição distai. Em determinadas modalida-des, um cartucho de grampos, tal como o cartucho de grampos 150, por e-xemplo, pode incluir um conjunto de carrinho de grampo 160 contido nomesmo, em que o conjunto de carrinho de grampos 160 pode ser posiciona-do em uma posição distai, como ilustrado na figura 10, quando o cartucho degrampos é montado em ou inserido no canal de cartucho de grampos 122.
Em pelo menos uma referida modalidade, com referência às figuras 8 -10, ocartucho de grampos 150 pode incluir um alojamento adicional 170 que podeser configurado para cobrir pelo menos a porção do membro de corte 164quando o conjunto de carrinho de grampos 160 está em sua posição distai,por exemplo. Em diversas modalidades, o alojamento 170 pode ser configu-rado para proteger um cirurgião, por exemplo, quando manipula o cartuchode grampos, quando insere o cartucho de grampos dentro do grampeadorcirúrgico, e/ou monta duas ou mais porções do grampeador cirúrgico juntas,por exemplo. Em pelo menos uma referida modalidade, pelo menos an por-ção superior de borda de corte 165 pode se estender acima da plataforma,ou superfície de topo, 158 do cartucho de grampos 150 e, sem um alojamen-to protetor, tal como o alojamento 170, por exemplo, a porção superior deborda de corte 165 pode ser exposta.
Em diversas modalidades, como descrito acima, o membro decorte 165 pode ser pelo menos parcialmente posicionado dentro da fenda,ou canal, 156 e, como ilustrado na figura 10, pelo menos a porção do mem-bro de corte superior ou de topo 164 pode se estender acima da plataforma158. Em pelo menos uma modalidade, com referência às figuras 8 - 10, oalojamento 170 pode incluir uma primeira parede, ou porção, 172 que seestende a partir de uma primeira porção 157 de corpo de cartucho de gram-pos 152, uma segunda parede, ou porção, 174 que se estende a partir deuma segunda porção 159 de corpo de cartucho de grampos 152, e uma pa-rede de topo, ou porção, 176 que se estende entre a primeira parede 172 e asegunda parede 174. Em determinadas modalidades, um alojamento podecompreender apenas uma parede de suporte, ou porção de suporte, que seestende a partir de um corpo de cartucho de grampos e, adicionalmente,uma parede de topo, ou porção de topo, que se estende a partir da mesma.
Em outras modalidades, um alojamento pode compreender uma ou maisparedes laterais, ou porções, e nenhuma parede de topo. Em pelo menosuma referida modalidade, as paredes laterais do alojamento podem ser con-figuradas de modo que as mesmas se estendem acima do topo do membrode corte, ou pelo menos se estendem acima da borda de corte do membrode corte, por exemplo. Em qualquer evento, como ilustrado na figura 10, pelomenos a porção do membro de corte 164 pode ser posicionada debaixo daparede de topo 176 e/ou entre paredes laterais 172 e 174 quando conjuntode carrinho de grampos 160 está em sua posição proximal. Em determina-das modalidades, o membro de corte 164 pode ser inteiramente posicionadodebaixo da parede de topo 176, e/ou inteiramente posicionado dentro doalojamento 170. Em pelo menos uma modalidade, o membro de corte 164pode ser posicionado debaixo da parede de topo 176 de modo que a super-fície de corte 165 não se estende adiante da borda distai 175 e/ou a bordaproximal 177 da parede de topo 176. Em pelo menos uma modalidade, oalojamento 170 pode incluir uma parede traseira 178 que pode ser configu-rada para limitar o movimento proximal do membro de corte 164 e/ou qual-quer outra porção de conjunto de carrinho de grampos 160. Em diversasmodalidades, pelo menos a porção do alojamento 170, por exemplo, podeser integralmente formada com o corpo de cartucho de grampos 152. Empelo menos uma referida modalidade, a primeira parede 172, a segunda pa-rede 174, a parede de topo 176, e/ou a parede traseira 178 pode ser forma-da quando o corpo de cartucho de grampos 152 é moldado a injeção, porexemplo. Em determinadas modalidades, pelo menos a porção do alojamen-to 170 pode ser montada ao corpo de cartucho de grampos 152 por meio deum arranjo de encaixe ajustado, arranjo de encaixe de pressão, e/ou qual-quer outro modo adequado.
Em diversas modalidades, além da acima, o membro de corte164 pode ser definido por um corpo plano, ou um pelo menos substancial-mente plano, dotado de uma borda de faca que se estende ao longo de pelomenos um lado do corpo do membro de corte. Em pelo menos uma referidamodalidade, a primeira parede 172 e/ou a segunda parede 174 pode serconfigurada e disposta de modo que a mesma pode incluir superfícies inter-nas planas, ou pelo menos substancialmente planas 173, as quais são para-lelas ou pelo menos substancialmente paralelas, às superfícies laterais domembro de corte 164. Em determinadas modalidades, o membro de corte164 pode ser proximamente recebido entre as superfícies interiores 173 dasparedes 172 e 174. Em pelo menos uma referida modalidade, a distânciaentre as paredes 172 e 174 pode ser a mesma que, ou pelo menos substan-cialmente a mesma que, a largura da fenda 156. Em qualquer evento, umalojamento pode ser configurado de modo que pelo menos a porção do alo-jamento se estende sobre pelo menos a porção de fenda 156, por exemplo.
Em determinadas modalidades, o alojamento 170 pode completamente in-cluir ou circundar um membro de corte 164 e/ou superfície de corte 165. Empelo menos uma modalidade, embora não-ilustrado, um alojamento podeincluir uma porção de rompimento e/ou seccionável que pode ser pelo me-nos parcialmente destacada, separada, e/ou de outro modo deformada demodo a permitir que um membro de corte saia do alojamento. Em pelo me-nos uma referida modalidade, a superfície do tecido de corte pode ser confi-gurada para contato com o alojamento para romper e/ou seccionar uma pa-rede de alojamento, por exemplo. Em diversas modalidades, a parede dealojamento pode incluir uma porção delgada, uma porção de espessura re-duzida, marca de pontuação, e/ou qualquer outra configuração para facilitara deformação e/ou incisão da parede de alojamento. Em determinadas mo-dalidades, um membro de corte pode incluir uma ou mais superfícies de cor-te adicionais e/ou bigornas, por exemplo, que podem ser configuradas paradeformar e/ou seccionar o alojamento. Em pelo menos uma modalidade, oalojamento pode incluir uma porção móvel e/ou flexível, tal como um mem-bro articulado e/ou aba flexível, por exemplo, que pode ser configurado parasuficientemente mover e/ou flexionar para permitir que o membro de cortepasse deste modo. Em qualquer evento, modalidades são previstas nasquais o membro de corte pode ser dotado de qualquer configuração ade-quada para seccionar tecido e o alojamento protetor pode ser dotado dequalquer configuração adequada para pelo menos parcialmente encerrar oucircundar o membro de corte. Adicionalmente, embora um membro de cortepossa compreender uma borda afiada como descrito acima, outros membrosde corte adequados são previstos, tais como aqueles fornecidos com umacorrente elétrica suficiente para seccionar tecido, por exemplo.
Como descrito acima, o alojamento 170 pode ser configuradopara pelo menos parcialmente cobrir, incluir, e/ou circundar um membro decorte quando o mesmo está em sua posição proximal. Em diversas modali-dades, o membro de corte pode ser avançado distalmente para seccionartecido, por exemplo, e então retraído proximalmente de modo a posicionar omembro de corte dentro do alojamento 170 mais uma vez. Nas referidasmodalidades, o membro de corte pode ser pelo menos parcialmente cobertopelo alojamento 170 quando o cartucho de grampos é montado para e re-movidos a partir de um instrumento de grampeamento cirúrgico. Em deter-minadas modalidades, um cartucho de grampos novo, ou não usado, podeser inserido no canal de cartucho de grampos para substituir o cartucho degrampos pelo menos parcialmente usado. Em pelo menos uma referida mo-dalidade, o novo cartucho de grampos pode incluir um novo membro de cor-te e/ou conjunto de carrinho de grampos posicionado no mesmo, emboramodalidades sejam previstas nas quais o membro de corte previamente u-sado e/ou conjunto de carrinho de grampos pode ser suficientemente retira-do a partir do cartucho de grampos usado e avançado dentro do cartucho degrampos novo de modo a ser reutilizado mais uma vez. Em modalidadesonde um novo membro de corte e/ou conjunto de carrinho de grampos éproporcionado com cada novo cartucho de grampos, uma borda de corteafiada, por exemplo, pode ser utilizado com cada cartucho de grampos.
Em diversas modalidades, embora não-ilustrado, um cartucho degrampos pode incluir dois ou mais alojamentos configurados para pelo me-nos parcialmente cobrir um membro de corte quando o mesmo está em duasou mais posições. Em pelo menos uma modalidade, um cartucho de gram-pos pode incluir um alojamento proximal configurado para pelo menos parci-almente cobrir o membro de corte quando o mesmo está em uma posiçãoproximal, por exemplo, e, adicionalmente, um alojamento distai configuradopara pelo menos parcialmente cobrir o membro de corte quando o mesmo éem uma posição distai, por exemplo. Em pelo menos uma referida modali-dade, o membro de corte pode ser posicionado dentro do alojamento proxi-mal quando o cartucho de grampos é montado para um instrumento degrampeamento cirúrgico e, em determinadas modalidades, o membro decorte pode ser avançado dentro do alojamento distai após o mesmo ter cor-tado transversalmente o tecido posicionado dentro da extremidade executo-ra, por exemplo. Nas referidas modalidades, como resultado, o membro decorte pode ser pelo menos parcialmente posicionado dentro do alojamentodistai quando o cartucho de grampos é removido a partir do grampeador ci-rúrgico. As referidas modalidades podem ser particularmente úteis quandoum recipiente, por exemplo, é posicionado intermediário ao alojamento pro-ximal e ao alojamento distai do cartucho de grampos. Em diversas modali-dades, embora não-ilustrados, um membro de corte pode ser movida proxi-malmente a partir de uma posição distai para uma posição proximal, e/ouqualquer outra posição adequada.
Em diversas modalidades, além da acima, a bigorna 130 podeincluir uma ou mais aberturas, fendas, ou reentrâncias 179 (Figura 17) quepode ser configurada para receber pelo menos a porção do alojamento 170quando bigorna 130 é trazida em próxima oposição para o cartucho degrampos 150, por exemplo. Em pelo menos uma modalidade, suficiente es-paço pode estar presente entre o alojamento 170 e a reentrância 179 demodo que a bigorna 130 e o cartucho de grampos 150 podem ser movidauma com relação a outra sem interferência, ou pelo menos substancial inter-ferência, entre as mesmas. Em modalidades dotadas de mais de um aloja-mento do membro de corte como delineado acima, uma bigorna oposta podeser dotada de mais de uma abertura correspondente para receber o aloja-mento. Em diversas modalidades, uma bigorna pode incluir um membro decorte móvel e pelo menos um alojamento para pelo menos parcialmente co-brir, encerrar, e/ou circundar o membro de corte. Em determinadas modali-dades, embora não-ilustradas, não só uma bigorna mas também um cartu-cho de grampos pode compreender pelo menos um membro de corte móvele/ou pelo menos um alojamento configurado para pelo menos parcialmentecobrir, circundar, ou incluir os membros de corte quando os mesmos estãoem uma posição proximal, por exemplo.
Como delineado acima, o conjunto de barra de impulsão 200pode ser avançado distalmente de modo a mover o conjunto de carrinho degrampos 160 dentro do conjunto de cartucho de grampos 150. Em diversasmodalidades, como também delineado acima, as superfícies de carne emforma de cunha 167 do carrinho de grampos 162 podem ser movidas emengate com as superfícies inclinadas 169 nos direcionadores de grampo 168para seqüencialmente, e/ou simultaneamente, direcionar os grampos a partirde cartucho de grampos 150 contra a bigorna 130 e formar os grampos den-tro de qualquer configuração adequada, tal como configurações em forma deB, por exemplo. Em pelo menos uma referida modalidade, com referência àfigura 17, a bigorna 130 pode incluir uma ou mais superfícies de formaçãode grampo, tais como bolsos de grampo 132, por exemplo, que podem serconfigurados para deformar os grampos. Em determinadas modalidades, abigorna 130 pode adicionalmente incluir uma fenda, canal, ou ranhura 133que pode ser configurada para receber de modo deslizável pelo menos aporção de carrinho de grampos 162, membro de corte 164, e/ou barra deimpulsão 202, por exemplo. Em pelo menos uma modalidade, embora não-ilustrado, uma bigorna pode incluir uma placa de bigorna que pode ser posi-cionada de modo seguro e/uo imóvel dentro de um canal de bigorna definidodentro de a bigorna. Em várias outras modalidades, como ilustrado nas figu-ras 18 e 19 e descrito em mais detalhes abaixo, a bigorna 130 pode incluiruma placa de bigorna 134 posicionada de modo móvel dentro do canal debigorna 136. Em determinadas modalidades, o canal de bigorna 136 podeincluir paredes de lados opostos entre si 137 e, adicionalmente, uma base138 que se estende entre as paredes laterais 137. Em pelo menos uma mo-dalidade, a bigorna 130 pode adicionalmente incluir uma porção de narizdistai 139, por exemplo, montada na mesma em que a porção de nariz 139pode ser configurada para ser encaixada por pressão e/ou por encaixe ajus-tado dentro do canal de bigorna 136, por exemplo, de modo que a porção denariz 139 pode ser firmemente retida no mesmo. Em determinadas modali-dades, a porção de nariz 139 pode ser compreendida de um material macioe/ou dobrável, tal como borracha, por exemplo, e pode compreender qual-quer formato adequado que pode facilitar a inserção de bigorna 130 dentrode um campo cirúrgico, por exemplo. Em algumas modalidades, com refe-rência à figura 28, a porção de nariz, tal como a porção de nariz 139' podeser retida em uma bigorna por um ou mais prendedores 139a'. Similarmente,com referência à figura 1, um canal de cartucho de grampos e/ou cartuchode grampos, tal como o cartucho de grampos 150, por exemplo, pode incluiruma porção de nariz, tal como a porção de nariz 153, por exemplo, que podefacilitar a inserção do cartucho de grampos 150 dentro de um campo cirúrgi-co, por exemplo.
Como indicado acima, grampos podem ser proporcionados apartir de um cartucho de grampos e deformados contra uma bigorna. Emvárias circunstâncias, a distância entre as superfícies de formação de gram-po na bigorna 130 e no carrinho de grampos 162 pode determinar a quanti-dade na qual os grampos são deformados. Por exemplo, se a distância entreos bolsos de bigorna 132 na bigorna 130 e as superfícies de topo 135 nocarrinho de grampos 162 (Figuras 10 - 12) for relativamente grande, osgrampos serão deformados em uma menor quantidade em comparação aquando a distância entre os bolsos de bigorna 132 e as superfícies de carri-nho 135 for relativamente pequena. De modo correspondente, se a distânciaentre os bolsos de bigorna 132 e as superfícies de carrinho 135 for relativa-mente pequena, os grampos serão deformados em uma maior quantidadeem comparação a quando a distância entre os bolsos de bigorna 132 e assuperfícies de carrinho 135 for relativamente grande. Com freqüência, a dis-tância entre os bolsos de bigorna 132 e as superfícies de carrinho 135 é re-ferida como a formação da altura dos grampos. Algumas vezes a formaçãoda altura dos grampos pode ser medida entre a superfície de topo, ou a pla-taforma, do cartucho de grampos e as superfícies de formação de grampona bigorna. Para o objetivo do presente pedido, entretanto, qualquer referên-cia para a formação da altura do grampo, ou similar, pode incluir uma ouambas as maneiras de medição, onde apropriado, e/ou qualquer outro modoadequado de medição. Em qualquer evento, como descrito em mais deta-lhes abaixo, um instrumento de grampeamento cirúrgico, tal como o instru-mento de grampeamento 100, por exemplo, pode incluir meios para ajustar aformação da altura do grampo.
Em diversas modalidades, além da acima, uma bigorna podeincluir uma ou mais superfícies de formação que podem ser movidas em di-reção de e/ou em afastamento a partir de um cartucho de grampos de modoa ajustar a formação da altura dos grampos. Em pelo menos uma modalida-de, com referência às figuras 17 -23, a bigorna 130 pode incluir uma placade bigorna 134 que pode ser posicionada de modo móvel e/ou deslizáveldentro do canal de bigorna 136. Em determinadas modalidades, a bigorna130 pode adicionalmente incluir um ou mais pinos de retenção, ou guia 140,em que a placa de bigorna 134 pode incluir uma ou mais fendas de reten-ção, ou guia 141 configuradas para receber de modo deslizável pelo menosa porção de pinos 140. Em pelo menos uma referida modalidade, os pinos140 e/ou fendas 141 podem ser configurados para definir um trajeto deter-minado ao longo do qual a placa de bigorna 134 pode ser movida. Com refe-rência à figura 18, os pinos 140 e as fendas 141 podem ser estruturados edispostos de modo que a placa de bigorna 134 possa ser movida ao longode um trajeto linear, ou pelo menos substancialmente linear, em que o trajetolinear pode ser pelo menos parcialmente definido por eixos 142 e 143, porexemplo. Outras modalidades são previstas nas quais uma placa de bigornapode ser movida ao longo de um trajeto não-linear, tal como um trajeto en-curvado e/ou curvilíneo, por exemplo. Em determinadas modalidades, pelomenos a porção de pinos 140 pode ser retida dentro das aberturas 144 emparedes laterais 137 em que, em pelo menos uma modalidade, os pinos 140podem ser encaixes de pressão dentro de aberturas 144. Em qualquer even-to, como descrito aqui, os pinos 140 podem guiar a placa de bigorna 134 namedida em que a mesma é movida em direção de e/ou em afastamento apartir do cartucho de grampos 150, por exemplo.
Em diversas modalidades, além da acima, um instrumento degrampeamento cirúrgico, tal como o instrumento de grampeamento 100, porexemplo, pode incluir um ou mais membros de ajuste configurados para po-sicionar a porção de uma bigorna, tal como a placa de bigorna 134, por e-xemplo, com relação a outras porções de um conjunto de bigorna e/ou umcartucho de grampos oposto. Em determinadas modalidades, com referênciaàs figuras 18 e 19, o instrumento de grampeamento 100 pode incluir a placado membro de ajuste de bigorna 230 que pode ser configurada para limitar aamplitude de movimento da placa de bigorna 134. Em pelo menos uma refe-rida modalidade, com referência às figuras 20 e 21, membro de ajuste 230pode ser posicionado intermediário à placa de bigorna 134 em uma primeiraposição na qual a primeira superfície, ou degrau, 231 do membro de ajuste230 é posicionada intermediária à base 138 do canal de bigorna 136 e aprimeira superfície de posicionamento 145 na placa de bigorna 134. Na refe-rida primeira posição, o primeiro degrau 231 pode definir a quantidade demovimento relativo possível, ou permitido, entre a placa de bigorna 134 e ocanal de bigorna 136. Por exemplo, quando a bigorna 130 é presa contra otecido como descrito acima, a placa de bigorna 134 pode entrar em contatocom o tecido e deslizar verticalmente em direção da base 138 até que a pri-meira superfície de posicionamento 145 entre em contato com o primeirodegrau 231. Uma vez que a superfície 145 e o degrau 231 estão em contato,o membro de ajuste 230 pode evitar, ou pelo menos inibir, que a placa debigorna 134 se mova adicionalmente em direção da base 138. Em pelo me-nos uma referida modalidade, como resultado, o membro de ajuste 230 podeagir como um batente de modo que a distância entre a base 138 e a superfí-cie de contato com o tecido 148 na placa de bigorna 134 pode ser definidapor uma primeira distância 234. Enquanto a base 138 é usada como um da-do de referência no presente exemplo, outras porções de bigorna 130 e/ouum cartucho de grampos oposto, por exemplo, podem ser usadas como da-dos de referência. Quando o membro de ajuste 230 está em sua primeiraposição, como descrito acima, a segunda superfície, ou degrau, 232 domembro de ajuste 230 pode ser posicionada intermediário à base 138 e asegunda superfície de posicionamento 146 na placa de bigorna 134, e, adi-cionalmente, a terceira superfície, ou degrau, 233 pode ser posicionado in-termediário à base 138 e a terceira superfície de posicionamento 147. Comreferência à figura 20, o membro de ajuste 230 pode incluir dois ou maisconjuntos de degraus, 231, 232, e/ou 233 e a placa de bigorna 134 podeincluir dois ou mais conjuntos de superfícies de posicionamento 145, 146,e/ou 147. Enquanto o primeiro degrau 231 e a primeira superfície de posi-cionamento 145 são descritas acima como sendo configuradas para contro-lar a posição da placa de bigorna 134, os segundo e terceiro degraus (232,233) do membro de ajuste 230 e as segunda e terceira superfícies de posi-cionamento (146, 147) da placa de bigorna 134, respectivamente, podemtambém ser configuradas para controlar a posição da placa de bigorna 134.
Por uma questão de brevidade, entretanto, o presente exemplo será descritoem referência à primeira superfície, ou degrau 231, como sendo a superfícieque controla a posição de placa de bigorna 134, embora o leitor compreen-derá que os degraus 232 e 233 podem controlar a posição da placa de bi-gorna 134 da mesma forma.
Em determinadas modalidades, a primeira posição do membrode ajuste 230 pode proporcionar uma formação de altura do grampo relati-vãmente pequena ou curta. Em outras modalidades, embora não-ilustrado, aprimeira posição de um membro de ajuste pode proporcionar uma formaçãoda altura do grampo intermediária, relativamente grande, e/ou qualquer outraadequada. No caso em que a formação da altura associada com a primeiraposição do membro de ajuste seja adequada, um cirurgião pode proceder aouso do instrumento de grampeamento cirúrgico para grampear e/ou seccio-nar tecido como descrito acima. No evento, entretanto, de que a formaçãoda altura do grampo seja inadequada, um cirurgião, ou outro médico, podemover o membro de ajuste 230 de modo que o membro de ajuste 230 podepermitir que a placa de bigorna 134 deslize verticalmente uma distância dife-rente quando a placa de bigorna 134 entra em contato com o tecido posicio-nado intermediário à bigorna 130 e ao cartucho de grampos 150. Pelo me-nos na referida circunstância, a distância na qual a placa de bigorna 134 épermitida deslizar verticalmente pode ser maior, deste modo proporcionandouma maior formação de altura para os grampos. De modo correspondente,em outras circunstâncias, o membro de ajuste pode ser movido de modo quea placa de bigorna 134 possa deslizar verticalmente uma distância mais cur-ta quando a placa de bigorna 134 entra em contato com o tecido, por exem-plo, deste modo proporcionando uma formação mais curta da altura dogrampo. Enquanto o termo "para cima", e similar, pode significar vertical-mente para cima, o termo não é deste modo limitado; em vez disto, "paracima" pode significar qualquer direção que esteja na direção da base da bi-gorna e/ou em afastamento a partir de um cartucho de grampos, por exem-pio. Em qualquer evento, o membro de ajuste 230 pode ser movido entresua primeira posição, ilustrada na figura 21, e uma segunda posição, ilustra-da na figura 22, de modo a aumentar a formação da altura do grampo. Comoindicado pela seta "P" na figura 22, o membro de ajuste 230 pode ser desli-zado proximalmente de modo a mover o membro de ajuste 230 entre suasprimeira e segunda posições, embora modalidades sejam previstas onde ummembro de ajuste pode ser deslizado distalmente e/ou em qualquer outraadequada direção de modo a ajustar o membro de ajuste 230. Uma vez quemembro de ajuste 230 tenha sido movido para a sua segunda posição, comreferência à figura 22, a primeira superfície, ou degrau, 231 pode ser posi-cionado intermediário à base 138 e a segunda superfície de posicionamento146 de placa de bigorna 134. Na referida segunda posição, o primeiro de-grau 231 pode mais uma vez definir a quantidade de movimento relativopermitida entre a placa de bigorna 134 e o canal de bigorna 136. Em pelomenos uma modalidade, de modo similar ao dito acima, o membro de ajuste230 pode agir como um batente de modo que a distância entre a base 138 ea superfície de contato com o tecido 148 na placa de bigorna 134 pode serdefinida por uma segunda distância 235.
Além da acima, o membro de ajuste 230 pode ser movido entresua segunda posição, ilustrada na figura 22, e uma terceira posição, ilustra-da na figura 23, de modo a mais uma vez aumentar a formação da altura dogrampo. Como indicado pela seta "P" na figura 23, o membro de ajuste 230pode ser deslizado proximalmente de modo a mover o membro de ajuste230 entre suas segunda e terceira posições. Uma vez que o membro de a-juste 230 tenha sido movido dentro de sua terceira posição, com referência àfigura 23, a primeira superfície, ou degrau, 231 pode ser posicionado inter-mediário à base 138 e à terceira superfície de posicionamento 147. Na refe-rida terceira posição, o primeiro degrau 231 pode mais uma vez definir aquantidade de movimento relativo entre a placa de bigorna 134 e o canal debigorna 136. Em pelo menos uma modalidade, de modo similar ao dito aci-ma, o membro de ajuste 230 pode agir como um batente de modo que a dis-tância entre a base 138 e a superfície de contato com o tecido 148 na placade bigorna 134 pode ser definida por uma terceira distância 236. Enquanto omembro de ajuste 230 pode ser seletivamente movido entre três posiçõescomo descrito acima para proporcionar três diferentes alturas de formaçãode grampo, Outras modalidades são previstas as quais compreendem ummembro de ajuste que pode ser movido entre mais de três posições paraproporcionar mais de três diferentes alturas de formação de grampo. Porexemplo, um membro de ajuste pode ser móvel entre quatro posições demodo a proporcionar quatro alturas de formação de grampo. Modalidadesadicionais são previstas as quais compreendem um membro de ajuste quepode ser movido entre duas posições para proporcionar duas alturas de for-mação de grampo. Adicionalmente, enquanto as superfícies, ou degraus,231, 232, e 233 do membro de ajuste 230 são dispostas em uma ordemdescendente, outros arranjos são previstos nos quais as superfícies, ou de-graus, são dispostos em uma ordem ascendente. Outros arranjos são previs-tos nos quais as superfícies, ou degraus, não são necessariamente dispos-tos seja em uma ordem ascendente ou em uma ordem descendente. Simi-larmente, as superfícies de posicionamento 145, 146, e 147 de placa de bi-gorna 134 podem ser dispostas em uma ordem ascendente, uma ordemdescendente (Figura 20), e/ou qualquer outra ordem adequada. Adicional-mente, enquanto o membro de ajuste 230 pode ser deslizado ao longo deum eixo, outras modalidades são previstas onde um membro de ajuste podeser movido ao longo de qualquer trajeto adequado tal como trajetos curvose/ou curvilíneos, por exemplo.
Como descrito acima, com referência à figura 21, o membro deajuste 230 pode compreender três superfícies, ou degraus, 231, 232, e 233enquanto a placa de bigorna 134 pode compreender três superfícies de ajus-te correspondentes 145, 146, e 147. Quando o membro de ajuste 230 estáem sua primeira posição, por exemplo, a primeira superfície 231 pode serposicionada de modo que a mesma toca ou é adjacente a primeira superfíciede ajuste 145, segunda superfície 232 pode ser posicionada de modo que amesma toca ou é adjacente a segunda superfície de ajuste 146, e a terceirasuperfície 233 pode ser posicionada de modo que a mesma toca ou é adja-cente a terceira superfície de ajuste 147. Na medida em que o membro deajuste 230 é deslizado com relação a placa de bigorna 134, como descritoacima e com referência às figuras 22 e 23, as superfícies 231, 232, e 233 domembro de ajuste 230 podem ser seqüencialmente indexadas com relaçãoàs superfícies 145, 146, e 147 da placa de bigorna 134. Em pelo menos umareferida modalidade, um membro de ajuste pode ser dotado do mesmo nú-mero de degraus que o número de superfícies de posicionamento em umaplaca de bigorna. Outras modalidades são previstas onde um membro deajuste é dotado de mais degraus do que superfícies de posicionamento naplaca de bigorna. Em pelo menos uma referida modalidade, uma placa debigorna pode incluir uma superfície de posicionamento em que os degrausde um membro de ajuste podem ser seletivamente utilizados para limitar omovimento para cima da placa de bigorna, por exemplo. Em diversas moda-lidades, com referência em geral ao membro de ajuste 230 e a placa de bi-gorna 134, uma placa de bigorna pode incluir uma superfície de posiciona-mento, tal como a superfície de posicionamento 145, por exemplo, onde osdegraus 231, 232, e 233 do membro de ajuste 230, por exemplo, podem serseletivamente posicionados intermediário à base 138 e à superfície de posi-cionamento 145. Nas referidas modalidades, o primeiro degrau 231 pode serdotado de uma primeira espessura ou altura que pode parar, ou limitar, omovimento para cima da placa de bigorna 134 de modo a definir uma primei-ra formação da altura do grampo, o segundo degrau 232 pode ser dotado deuma segunda espessura ou altura que pode parar, ou limitar, o movimentopara cima da placa de bigorna 134 de modo a definir uma segunda formaçãoda altura do grampo, e, adicionalmente, o terceiro degrau 233 pode ser do-tado de uma terceira espessura ou altura que pode parar, ou limitar, o movi-mento para cima de placa de bigorna 134 de modo a definir uma terceiraformação da altura do grampo. Em pelo menos uma modalidade, a espessu-ra ou altura dos degraus 231, 232, e/ou 233 pode ser medida entre a super-fície traseira 237 do membro de ajuste 230 e a superfície nos degraus (231,232, 233) que irá entrar em contato com a placa de bigorna 134. Em diver-sas modalidades, a diferença em altura, ou espessura, entre o primeiro de-grau 231 e o segundo degrau 232 pode ser a mesma, ou pelo menos subs-tancialmente a mesma, que a diferença em altura, ou espessura, entre o se-gundo degrau 232 e o terceiro degrau 233. Em pelo menos uma referidamodalidade, como resultado, as alturas dos degraus podem aumentar emum coeficiente linear, ou um coeficiente pelo menos substancialmente linear.Em modalidades alternativas, a diferença em altura, ou espessura, entre osprimeiro e segundo degraus pode ser diferente da diferença em altura, ouespessura, entre os segundos e terceiro degraus. Em pelo menos uma refe-rida modalidade, o primeiro, o segundo, e o terceiro degraus podem nãoaumentar ou reduzir em altura, ou espessura, em um coeficiente linear; emvez disso, embora não-ilustrados, os degraus podem aumentar ou reduzirem altura, ou espessura, em um coeficiente não-linear e/ou geométrico.
Como descrito acima, um membro de ajuste, tal como o membrode ajuste 230, por exemplo, pode ser móvel entre duas ou mais posições.Em diversas modalidades, um instrumento de grampeamento cirúrgico podeincluir um acionador configurado para mover o membro de ajuste. Em pelomenos uma modalidade, com referência às figuras 17 - 20, o instrumento degrampeamento cirúrgico 100 pode incluir um acionador 250 que pode serfixado de modo operacional ao membro de ajuste 230 de modo que umaforça pode ser aplicada ao acionador 250 e transmitida ao membro de ajuste230. Em determinadas modalidades, o acionador 250 pode incluir porçõesde pegar, ou hastes, 252 que podem ser configuradas para ser pegas porum cirurgião, por exemplo, de modo a avançar ou retrair o membro de ajuste230 dentro da bigorna 130 como descrito acima. Em determinadas modali-dades, as porções de pegar 252 podem se estender a partir do corpo acio-nador 251, em que o corpo acionador 251 pode incluir uma ou mais abertu-ras, fendas, ou cavidades 253 que podem ser configuradas para receberpelo menos a porção do membro de ajuste 230. Em pelo menos uma referi-da modalidade, com referência à figura 19, o membro de ajuste 230 podeincluir a trava 254 que se estende a partir da mesma, em que pelo menos aporção de trava 254 pode ser recebida dentro da abertura 253 de modo areter o corpo acionador 251 no membro de ajuste 230. Em diversas modali-dades, a trava 254 pode incluir uma ou mais pernas flexíveis ou elásticas255 que podem ser desviadas quando as mesmas são inseridas na abertura253 mas retornam flexivelmente, ou pelo menos retornam parcialmente, àssuas posições não flexionadas após os pés 256 das pernas 255 serem sufi-cientemente impulsionados através da abertura 253. Em pelo menos umareferida modalidade, os pés 256 podem evitar, ou pelo menos inibir, que ocorpo acionador 251 seja destacado a partir do membro de ajuste 230.
Em diversas modalidades, além da acima, o instrumento degrampeamento cirúrgico 100 pode adicionalmente incluir um mecanismo dedetenção que pode ser configurado para manter, ou manter de modo liberá-vel, o acionador 250 e/ou o membro de ajuste 230 em posição. Em pelo me-nos uma modalidade, com referência à figura 19, o membro de detenção 260pode ser fixado ao acionador 250 em que, em pelo menos algumas modali-dades, o corpo acionador 251 pode incluir um ou mais canais, ranhuras, oureentrâncias 257 que podem ser configurados para receber e/ou reter umcorpo de detenção 261 do membro de detenção 260 no mesmo. Em pelomenos uma modalidade, o corpo de detenção 261 pode incluir uma ou maisaberturas 263, e/ou quaisquer outros canais, fendas, ou ranhuras, adequa-das que podem ser configuradas para receber um ou mais prendedores parafixar o corpo de detenção 261 ao acionador 251, por exemplo. O membro dedetenção 260 pode adicionalmente incluir pernas de detenção 262 que po-dem ser configuradas para engatar uma ou mais reentrâncias, aberturas, ouranhuras 101 (Figuras 2 - 7) na primeira porção de armação 110, por exem-plo. Mais particularmente, com referência às figuras 2 e 3, cada flange lateral128 pode incluir uma ou mais reentrâncias 101 (101a, 101b, e 101c) defini-das no mesmo em que as pernas de detenção 262 podem ser orientadas emengate com as superfícies de topo dos flanges laterais 128 de modo que aspernas de detenção 262 podem ser deslizadas dentro das, e deslizadas parafora das, reentrâncias 101. Em uma modalidade ilustrada, cada flange lateralpode incluir três reentrâncias 101 que podem ser configuradas para manterde modo removível o acionador 250 em uma primeira, posição distai, umasegunda, posição intermediária, e uma terceira, posição proximal, em que asprimeira, segunda, e terceira posições do acionador 250 podem respectiva-mente corresponder com as primeira, segunda, e terceira posições do mem-bro de ajuste 230 descritas acima. Por exemplo, quando o acionador 250 éem sua primeira, posição distai, as pernas de detenção 262 do membro dedetenção 260 podem ser posicionadas dentro da reentrância 101a de modoa reter de modo removível o acionador 250 e o membro de ajuste 230 emsuas primeiras posições. Com a aplicação de uma força suficiente, o aciona-dor 250 pode ser movido proximalmente dentro de sua segunda posição demodo que as pernas de detenção 162 são posicionadas dentro da reentrân-cia 101b e o acionador 250 e o membro de ajuste 230 são retidos em suassegundas posições. Similarmente, com a aplicação de uma força suficiente,o acionador 250 pode ser movido proximalmente dentro de sua terceira po-sição de modo que as pernas de detenção 162 são posicionadas dentro dareentrância 101c e o acionador 250 e o membro de ajuste 230 são retidosem suas terceiras posições. Em diversas modalidades, as pernas de deten-ção 162 podem ser configuradas de modo que o acionador 250 pode serretornado para suas primeira e/ou segunda posições.
Como descrito acima, o membro de ajuste 230 pode ser movidoao longo de um trajeto predeterminado entre duas ou mais posições do a-cionador 250. Em diversas modalidades, o instrumento de grampeamentocirúrgico 100, por exemplo, pode incluir um ou mais guias para controlar oulimitar o movimento do membro de ajuste 230 e/ou acionador 250. Em algu-mas modalidades, o membro de ajuste 230 pode ser proximamente recebidoentre as paredes laterais 137 de bigorna 130 de modo que as paredes Iate-rais 137 podem guiar o membro de ajuste 230. Em pelo menos uma referidamodalidade, as paredes laterais 137 podem ser configuradas para controlarou limitar o movimento lateral ou de lado-para-lado do membro de ajuste230. Em diversas modalidades, as pernas de detenção 162 do membro dedetenção 160 podem compreender membros flexíveis que podem ser confi-gurados para aplicar uma força de orientação para cima ou força de empuxono membro de ajuste 230 de modo a posicionar o membro de ajuste 230contra, ou pelo menos adjacente à base 138 e intermediário às paredes late-rais 137. Em determinadas modalidades, com referência à figura 19, a base138 de bigorna 130 pode adicionalmente incluir fenda guia 149 que pode serconfigurada para receber pelo menos a porção do membro de ajuste 230e/ou do acionador 250 no mesmo de modo que a fenda guia 149 possa Iimi-tar o movimento do membro de ajuste 230 e do acionador 250. Em pelo me-nos uma referida modalidade, a trava 254 do membro de ajuste 230 podeser configurada para se estender através da fenda guia 149 de modo que,quando a trava 254 é inserida na abertura 253 do acionador 250 como des-crito acima, a base 138 da bigorna 130 pode ser capturada intermediária aomembro de ajuste 230 e ao acionador 250. Em determinadas modalidades, afenda guia 149 pode ser configurada para limitar o movimento de trava 254de modo que o membro de ajuste 230 pode ser impedido, ou pelo menosinibido, de ser movido distalmente quando o membro de ajuste 230 está emsua primeira posição, ou posição mais distai e/ou, similarmente, impedido,ou pelo menos inibido, de ser movido proximalmente quando o membro deajuste 230 está em sua terceira posição ou mais posição mais proximal.
Em diversas modalidades, além da acima, um membro de de-tenção, similar ao membro de detenção 260, por exemplo, pode ser utilizadopara orientar a primeira porção de haste 102 e a segunda porção de haste104 em afastamento uma a partir da outra. Em pelo menos uma modalidade,com referência à figura 37, o instrumento de grampeamento cirúrgico 100'pode incluir um membro de detenção 260' configurado para posicionar aprimeira porção de haste 102 e a segunda porção de haste 104 de modoque um espaço existe entre a bigorna 130 e o cartucho de grampos 150. Areferida característica, como delineado acima, pode permitir que um cirurgi-ão manipule com facilidade o instrumento cirúrgico sem ter que manter asprimeira e segunda porções de haste em afastamento uma a partir da outra.
Em determinadas modalidades, o membro de detenção 260' pode ser sufici-entemente montado na segunda porção de haste 104 de modo que as per-nas de detenção 262' que se estende a partir do membro de detenção 260'podem entrar em contato com os flanges 128 e, quando comprimidas, apli-cando uma força de direcionamento nas primeira e segunda porções de has-te. Como visto na figura 37, as pernas 262' podem entrar em contato com assuperfícies 101 d nos flanges 128. De modo a comprimir as pernas de deten-ção 262', o mecanismo de engate 180 pode ser movido para uma posiçãoparcialmente fechada de modo que os braços de engate 188 podem engatar,e pelo menos parcialmente circundar, as projeções de engate 131. Nestaconfiguração, um cirurgião pode manipular o instrumento e, quando satisfeitocom sua posição, mover o mecanismo de engate 180 para uma posição fe-chada e adicionalmente comprimir as pernas de detenção 262'. De modosimilar ao dito acima, o membro de detenção 260' pode ser fixado, ou deoutro modo engatado de modo operacional com, o acionador 250 de modoque, quando o acionador 250 é movido entre suas primeira, segunda, e ter-ceira posições como descrito acima, as pernas 262' podem engatar as reen-trâncias 101a, 101b, e 101c, respectivamente. Em pelo menos uma referidamodalidade, como resultado, o acionador 250 pode ser dotado de uma posi-ção pré-montada na qual o acionador 250 é posicionado distalmente comrelação a sua primeira posição e, adicionalmente, as superfícies 101 d po-dem compreender superfícies pré-montadas contra as quais as pernas 262'podem ser posicionadas quando o acionador 250 está em sua posição pré-montada.
Como delineado acima, um membro de ajuste pode ser desliza-do, ou transladado, entre as primeira e segunda posições de modo a ajustara formação da altura de grampos proporcionada por um instrumento degrampeamento cirúrgico. Em diversas modalidades, embora não-ilustrado,um membro de ajuste pode ser configurado para deslocar de modo positivouma placa de bigorna em direção de e/ou em afastamento a partir de umcartucho de grampos oposto, por exemplo. Em pelo menos uma referidamodalidade, um instrumento de grampeamento cirúrgico pode incluir um oumais membros de orientação, tais como molas, por exemplo, configuradaspara posicionar a placa de bigorna contra o membro de ajuste de modo que,quando o membro de ajuste é movido entre suas primeira e segunda posi-ções, o membro de ajuste pode deslocar a placa de bigorna entre as primei-ra e segunda posições de modo a ajustar as primeira e segunda alturas deformação de grampo. Em diversas modalidades, como resultado do dito a-cima, um membro de ajuste pode ser configurado para trabalhar com carne aporção de uma bigorna em posição. Em pelo menos uma referida modalida-de, um membro de ajuste pode ser deslizado ao longo de um eixo de modoa deslocar de modo positivo uma placa de bigorna. Em outras modalidades,um membro giratório de ajuste pode ser configurado para deslocar de modopositivo uma placa de bigorna em direção de e/ou em afastamento a partirde um cartucho de grampos, por exemplo.
Além do acima, como descrito em mais detalhes abaixo, ummembro de ajuste pode ser girado para ajustar a formação da altura dogrampo. Com referência às figuras 24 - 36, o instrumento cirúrgico 100' podeincluir, de modo similar ao dito acima, uma primeira porção de haste 102',uma segunda porção de haste 104', e um mecanismo de travamento 180'que pode ser utilizado para prender o tecido intermediário à bigorna 130' eao cartucho de grampos 150'. Com referência à figura 25, também de modosimilar ao dito acima, o mecanismo de engate 180' pode ser pivotavelmenteacoplado à primeira porção 102' por um ou mais pinos pivô 182', em que omecanismo de engate 180' pode incluir um ou mais braços de engate 188'que podem ser configurados para engatar a segunda porção 104' e engataras primeira e segunda porções de haste juntas. Também de modo similar aodito acima, com referência às figuras 25 e 27, o instrumento cirúrgico 100'pode adicionalmente incluir um conjunto de barra de impulsão 200' que podeser configurado para avançar um membro de corte e/ou carrinho de grampospara dentro da extremidade executora 120'. Em pelo menos uma referidamodalidade, o conjunto de barra de impulsão 200' pode incluir uma extremi-dade proximal 203' e um acionador 204', em que acionador 204' pode sermontado de modo giratório na extremidade proximal 203' e seletivamenteposicionado nos primeiro e segundo lados do instrumento de grampeamento100'. Em diversas modalidades, o instrumento de grampeamento cirúrgico100' pode compreender as mesmas, ou características similares em relaçãoàquelas descritas em relação ao instrumento de grampeamento cirúrgico100 e podem ser operadas da mesma maneira, ou uma maneira similar, quea do instrumento 100 e, como resultado, os referidos detalhes não são repe-tidos aqui.
Em diversas modalidades, com referência à figura 27, o instru-mento cirúrgico 100' pode incluir um membro giratório de ajuste 230' quepode ser seletivamente posicionado em pelo menos as primeira e segundaposições de modo a proporcionar diferentes alturas de formação de grampo.Em determinadas modalidades, o instrumento cirúrgico 100' pode incluir umacionador 250' que pode ser conectado de modo operacional um membro deajuste 230' de modo que o acionador 250' pode mover o membro de ajuste230' entre pelo menos suas primeira e segunda posições. Em pelo menosuma modalidade, com referência à figura 28, o acionador 250' pode incluir ocorpo acionador 251' e a porção de pegar, ou haste, 252'. O corpo acionador251' pode incluir uma abertura 258' que pode ser configurada para receberuma extremidade proximal 238' do membro de ajuste 230' de modo que omovimento rotacional, torque, e/ou forças podem ser transmitidas entre oacionador 250' e o membro de ajuste 230'. Em pelo menos uma referida mo-dalidade, com referência à figura 36, a abertura 258' pode compreender umperfil não-circular e/ou um perfil que inclui uma ou mais superfícies planas dedirecionamento configuradas para transmitir movimento rotacional entre ocorpo acionador 251' e o acionador 230'. Em determinadas modalidades, aabertura 258' pode ser dimensionado e configurado para proximamente re-ceber a extremidade proximal 238' de acionador 230'. Em pelo menos umamodalidade, a abertura 258' pode ser configurada para receber a extremida-de proximal 238' em um encaixe de pressão e/ou arranjo de encaixe ajusta-do. Em diversas modalidades, com referência mais uma vez à figura 28, por-ção de haste 104' pode incluir uma ou mais fendas 259' que podem ser con-figuradas para permitir que pelo menos a porção do corpo acionador 251'para se estender através da mesma de modo que porção de pegar 252' po-de ser montada ao corpo acionador 251' com pelo menos a porção de por-ção de haste 104' posicionada entre as mesmas. Em pelo menos uma refe-rida modalidade, a segunda porção de haste 104' pode adicionalmente inclu-ir a reentrância 253' que pode ser configurada de modo que pelo menos umaporção, se não toda, a porção de pegar 252' é posicionada dentro da reen-trância 253'. Em determinadas modalidades, a reentrância 253' pode serconfigurada de modo que a porção de pegar 252' não se estende acima dasuperfície de topo da segunda porção de haste 104' embora, em outras mo-dalidades, uma porção superior da porção de pegar 252' pode se estenderacima da segunda porção de haste 104, como ilustrado na figura 30, de mo-do que a porção de pegar 252' pode ser facilmente acessada por um cirurgião.
Em diversas modalidades, como delineado acima, um membrode ajuste pode ser giratório entre pelo menos as primeira e segunda posi-ções de modo a ajustar a formação da altura de grampos proporcionada porum grampeador cirúrgico. Em determinadas modalidades, com referência àfigura 28, um instrumento de grampeamento cirúrgico pode incluir um mem-bro de ajuste posicionado de modo giratório dentro de uma bigorna em que omembro de ajuste pode ser configurado para limitar o movimento relativo deuma porção de bigorna móvel. Em pelo menos uma referida modalidade, oinstrumento de grampeamento cirúrgico 100' pode incluir uma placa de bi-gorna 134' que pode ser retida de modo deslizável dentro do canal de bigor-na 136' pelos pinos de retenção, ou guia, 140', em que os pinos guia 140'podem ser configurado para permitir que a placa de bigorna 134' deslize ver-ticalmente quando a placa de bigorna 134' entra em contato com o tecidocomo descrito acima. Com referência às figuras 27, 30, e 31, o membro deajuste 230' pode ser capaz de ser posicionado em uma primeira posição, ouorientação, de modo que o mesmo pode limitar o movimento para cima daplaca de bigorna 134' dentro do canal de bigorna 136' e ditar a formação daaltura do grampo dos grampos. Em pelo menos uma referida modalidade,com referência às figuras 30 e 31, o membro de ajuste 230' pode incluir pri-meiras superfícies opostas 231' que podem ser posicionadas intermediáriasà base 138' do canal de bigorna 136' e a superfície de posicionamento 145'de placa de bigorna 134' de modo que, quando a superfície de posiciona-mento 145' entre em contato com uma de primeiras superfícies 231', superfí-cies de contato com o tecido 148' de placa de bigorna 134' podem ser posi-cionadas a uma primeira distância 234' em afastamento a partir de uma su-perfície dada 129' na bigorna 130', por exemplo. De modo correspondente,as superfícies de formação 132' podem ser posicionadas a uma primeira dis-tância em afastamento a partir de um cartucho de grampos de modo que,quando os grampos são proporcionados a partir do cartucho de grampos, osgrampos podem ser deformados para uma primeira altura de grampo. Alémdo acima, um primeiro diâmetro 241' pode ser definido entre a primeira su-perfície 231' em que o primeiro diâmetro 241' pode definir a posição máximapara cima da placa de bigorna 134' dentro do canal de bigorna 136'.
Como indicado acima, o membro de ajuste 230' pode ser giradode modo a ajustar a formação da altura dos grampos. Em diversas modali-dades, o membro de ajuste 230' pode ser girado entre sua a primeira posi-ção, ou orientação, (Figuras 30 e 31) e uma segunda posição, ou orientação(figuras 32 e 33). Em pelo menos uma modalidade, com referência às figuras32 e 33, a haste 252' pode ser girada na direção indicada pela seta "A" demodo a mover o membro de ajuste 230' entre suas primeira e segunda posi-ções. De modo similar ao dito acima, quando o acionador 230' está em suasegunda posição, ou orientação, o acionador 230' pode limitar o movimentopara cima da placa de bigorna 134' dentro do canal de bigorna 136' e ditar aformação da altura do grampo dos grampos. Em pelo menos uma referidamodalidade, com referência às figuras 32 e 33, o membro de ajuste 230' po-de incluir segundas superfícies opostas 232" que podem ser posicionadasintermediárias à base 138' e à superfície de posicionamento 145' de modoque, quando a superfície de posicionamento 145' entre em contato com umadas segundas superfícies 232', a superfície de contato com o tecido 148' deplaca de bigorna 134' pode ser posicionada a uma segunda distância 235'em afastamento a partir da superfície dada 129', por exemplo. De modo cor-respondente, as superfícies de formação 132' podem ser posicionadas auma segunda distância em afastamento a partir de um cartucho de gramposde modo que, quando grampos são proporcionados a partir do cartucho degrampos, os grampos podem ser deformados para uma segunda altura degrampo. Em diversas modalidades, de modo similar ao dito acima, um se-gundo diâmetro 242' pode ser definido entre as segunda superfícies 232', emque o segundo diâmetro 242' pode definir a posição máxima para cima daplaca de bigorna 134' dentro de canal de bigorna 136'. Embora as primeirassuperfícies 231' e as segundas superfícies 232' podem ser definidas por su-perfícies planas, ou pelo menos substancialmente planas, outras modalida-des são previstas nas quais as primeira e segunda superfícies 231' e 232'podem incluir pelo menos contornos arqueados ou pelo menos parcialmentearqueados. Em qualquer evento, com referência à figura 27, o membro deajuste 230' pode incluir um ou mais fendas de espaçamento 240' que podemser configuradas para proporcionar espaço entre o acionador 230' e pinos deretenção 140'. As fendas de espaçamento 240' podem ser configuradas paraproporcionar espaço entre o acionador 230' e os pinos de retenção 140'quando o acionador 230' está em sua primeira posição, segunda posição,e/ou qualquer outra posição adequada.
Em diversas modalidades, além da acima, o membro de ajuste230' pode ser girado entre a sua primeira posição, ou orientação, (Figuras 30e 31) e uma terceira posição, ou orientação (Figuras 34 e 35). Em pelo me-nos uma modalidade, com referência às figuras 34 e 35, a haste 252' podeser girada em uma direção indicada pela seta "B" de modo a mover o mem-bro de ajuste 230' entre as suas primeira e terceira posições. De modo simi-lar ao dito acima, quando o acionador 230' está em sua terceira posição, ouorientação, o acionador 230' pode limitar o movimento para cima de placa debigorna 134' dentro do canal de bigorna 136' e ditar a formação da altura dogrampo dos grampos. Em pelo menos uma referida modalidade, com refe-rência às figuras 34 e 35, o membro de ajuste 230' pode incluir terceiras su-perfícies opostas entre si 233' que pode ser posicionado intermediário à ba-se 138' e superfície de posicionamento 145' de modo que, quando a superfí-cie de posicionamento 145' entre em contato com uma das terceiras superfí-cies 233', a superfície de contato com o tecido 148' de placa de bigorna 134'pode ser posicionada a uma terceira distância 236' em afastamento a partirde superfície dada 129', por exemplo. De modo correspondente, as superfí-cies de formação 132' podem ser posicionadas a uma terceira distância emafastamento a partir de um cartucho de grampos de modo que, quando osgrampos são proporcionados a partir do cartucho de grampos, os grampospodem ser deformados para uma terceira altura de grampo. Em diversasmodalidades, de modo similar ao dito acima, um terceiro diâmetro 243' podeser definido entre as terceiras superfícies 233', em que o terceiro diâmetro243' pode definir a posição máxima para cima da placa de bigorna 134' den-tro do canal de bigorna 136'. Com referência mais uma vez às figuras 34 e35, as terceiras superfícies 233' podem ser definidas por um contorno ar-queado ou pelo menos parcialmente arqueado, embora outras modalidadessejam previstas nas quais as terceiras superfícies 233' possam incluir con-tornos planos, ou pelo menos substancialmente planos. Em pelo menos umamodalidade, o membro de ajuste 230' pode ser configurado de modo que adistância maior, ou diâmetro, entre as terceiras superfícies arqueadas 233'pode ser utilizada para definir a terceira altura de grampo.
Como descrito acima, com referência às figuras 30 e 31, omembro de ajuste 230' pode ser posicionado em uma primeira posição, ouorientação, para ajustar uma primeira formação de altura para os gramposproporcionada pelo instrumento de grampeamento cirúrgico 100'. Comotambém descrito acima, com referência às figuras 32 e 33, o acionador 250'pode ser utilizado para mover o membro de ajuste 230' dentro de sua se-gunda posição, ou orientação, para ajustar uma segunda formação de alturapara os grampos. Para isto, em pelo menos uma modalidade, uma força po-de ser aplicada para haste 252' que pode fazer com que a haste 252', e omembro de ajuste 230' fixado à mesma, gire na direção indicada pela seta"A". Em pelo menos uma modalidade, o membro de ajuste 230' e/ou aciona-dor 250' pode ser suficientemente retido de modo que, quando o membro deajuste 230' é girado, o membro de ajuste 230' pode ser girado sobre um ei-xo, tal como o eixo 245' (Figura 27), por exemplo. Em pelo menos uma mo-dalidade, com referência à figura 25, a extremidade proximal 203' do conjun-to de barra de impulsão 200' pode incluir uma ou mais ranhuras, canais, oureentrâncias 205' que podem ser configuradas para receber e/ou reter pelomenos a porção do membro de ajuste 230' e/ou acionador 250' nas mesmas.Em qualquer evento, como ilustrado nas figuras 30 - 33, a segunda posição,ou orientação, do membro de ajuste 230' pode permitir que a placa de bigor-na 134' deslize uma distância maior dentro do canal de bigorna 136' emcomparação a quando o membro de ajuste 230' está em sua primeira posi-ção. Em pelo menos uma modalidade, como resultado, a segunda formaçãoda altura do grampo pode ser maior do que a primeira formação da altura dogrampo. Como também descrito acima, com referência às figuras 34 e 35, oacionador 250' pode ser utilizado para mover o membro de ajuste 230' den-tro de sua terceira posição, ou orientação, para ajustar uma terceira forma-ção de altura para os grampos. Para isto, em pelo menos uma modalidade,uma força pode ser aplicada para haste 252' que pode fazer com que a has-te 252', e o membro de ajuste 230' fixado à mesma, para girar em uma dire-ção indicada pela seta "B". Como ilustrado nas figuras 30, 31, 34, e 35, aterceira posição, ou orientação, do membro de ajuste 230' pode permitir quea placa de bigorna 134' para deslizar uma distância menor dentro do canalde bigorna 136' em comparação a quando o membro de ajuste 230' está emsua primeira posição. Em pelo menos uma modalidade, como resultado, asprimeira e segunda alturas de formação de grampo pode ser maior do que aterceira formação da altura do grampo. Em pelo menos uma referida modali-dade, a primeira posição do membro de ajuste 230', e o acionador 250', po-de representar uma posição intermediária, em que o membro de ajuste 230'pode ser seletivamente movido para as suas segunda e terceira posiçõesdiretamente a partir de sua primeira posição. De fato, a primeira posição domembro de ajuste 230' pode representar um intermediário a altura de gram-po, em que as segunda e terceira posições de grampo do membro de ajuste230' pode representar alturas de grampo maior e menor, respectivamente.
Em determinadas modalidades, com referência à figura 24, o instrumento degrampeamento cirúrgico 100' pode incluir um ou mais indícios no mesmoque podem ser configurados para transportar as alturas de formação degrampo, ou pelo menos formações de alturas relativas, que podem ser sele-cionadas. Por exemplo, a segunda porção de haste 104' pode incluir umprimeiro indício 245' que pode indicar uma altura de grampo intermediária,ou primeira, um segundo indício 246' que pode indicar uma segunda alturade grampo ou maior, e, adicionalmente, um terceiro indício 247' que podeindicar uma terceira altura de grampo ou mais curta.
Em diversas modalidades, além da acima, uma ou mais de pri-meiras superfícies 231', segundas superfícies 232', e terceiras superfícies233' pode compreender ou definir, ou pelo menos parcialmente compreenderou definir, um perímetro, ou circunferência, do membro de ajuste 230'. Comodiscutido acima, em virtude dos primeiro, segundo, e terceiro diâmetros(241', 242', e 243') definidos pelas primeira, segunda, e terceira superfícies(231', 232', e 233'), respectivamente, o perímetro, ou circunferência, domembro de ajuste 230' pode ser não-circular. Em determinadas modalida-des, entretanto, o perímetro, ou circunferência do membro de ajuste 230',pode ser simétrico, substancialmente simétrico, e/ou não-simétrico. Em di-versas modalidades, além da acima, um membro de ajuste pode compreen-der um carne posicionado de modo giratório intermediário à base 138' debigorna 130' e superfície de ajuste 145' de placa de bigorna 134', por exem-plo. Em pelo menos uma referida modalidade, uma ou mais de primeira su-perfícies 231', segunda superfícies 232', e terceira superfícies 233', por e-xemplo, pode compreender ou definir um perfil de carne o qual, de modosimilar ao dito acima, pode ser configurado para ou positivamente posiçãoplaca de bigorna 134' e/ou proporcionar um batente contra o qual a placa debigorna 134' pode ser posicionada. Em qualquer evento, embora não-ilustrado, diversas modalidades são previstas nas quais um membro de ajus-te pode ser deslizado e girado de modo a ajustar duas ou mais alturas deformação de grampo para grampos proporcionados por um instrumento degrampeamento cirúrgico. Em pelo menos uma referida modalidade, ummembro de ajuste pode compreender um perfil de carne que pode ser defini-do ao longo do comprimento do membro de ajuste em que o movimento lon-gitudinal e/ou rotacional pode ser utilizado para mover o perfil de carne entrepelo menos as primeira e segunda posições.
Em diversas modalidades, de modo similar ao dito acima, o ins-trumento cirúrgico 100' pode adicionalmente incluir um mecanismo de de-tenção configurado para manter, ou pelo menos manter de modo liberável, oacionador 250' em posição. Em pelo menos uma modalidade, com referên-cia às figuras 25 e 26, o instrumento cirúrgico 100' pode adicionalmente in-cluir o membro de detenção 260' compreendendo o corpo de detenção 261'e uma ou mais pernas de detenção 262'. Com referência à figura 26, o corpode detenção 261' pode incluir uma ou mais ranhuras, reentrâncias, ou canais263' que podem ser configurados para receber pelo menos a porção de ex-tremidade proximal 105' da segunda porção de haste 104' no mesmo demodo que o membro de detenção 260' pode ser retido em posição. Em pelomenos uma referida modalidade, a extremidade proximal 105' pode adicio-nalmente incluir uma ou mais ranhuras, canais, ou reentrâncias 265' que po-dem ser configuradas para proximamente receber o membro de detenção260'. Em determinadas modalidades, pelo menos a porção do corpo de de-tenção 261', tal como o canal 263', por exemplo, pode ser retido por encaixede pressão, de encaixe ajustado, e/ou de outro modo adequadamente retidona reentrância 265'. Como também ilustrado na figura 26, cada perna de de-tenção 262' do membro de detenção 260' pode incluir uma ou mais proje-ções 264' que se estendem a partir da mesma que podem ser configuradaspara engatar o corpo acionador 251' e manter de modo liberável o acionador250' em posição. Em pelo menos uma modalidade, com referência à figura36, o corpo acionador 251' pode incluir uma ou mais reentrâncias, ou orifí-cios, 269' que podem ser configurados para receber uma projeção 264'.
Quando uma projeção 264' é posicionada dentro da reentrância 269', a pro-jeção pode ser configurada para manter o acionador 250' em sua primeiraposição, por exemplo, até que uma força suficiente seja aplicada ao aciona-dor 250' de modo a fazer com que a projeção 264' seja deslocada para forada reentrância 269'. Mais particularmente, a força aplicada ao acionador 250'pode ser transmitida à projeção 264' e, em virtude das superfícies cooperan-tes entre a projeção 264' e a reentrância 269', a perna de detenção 262' as-sociada com a projeção 264' pode ser flexionada ou movida proximalmentepara permitir que o corpo acionador 251' seja movido com relação à mesma.
De modo a acomodar o referido movimento proximal, com referência à figura25, a reentrância 265' pode incluir porções alongadas 266' que podem cadauma das quais ser configuradas para receber pelo menos a porção das per-nas 262' de modo que as pernas 262' podem se mover com relação a umaporção de haste 104'. Na medida em que o acionador 250' é movido sejapara a sua segunda ou terceira posição, o corpo acionador 251' pode entrarem contato com uma projeção 264' que se estende a partir da outra perna262' e defletir a perna 262' proximalmente de modo que, uma vez que o a-cionador 250' está em sua segunda ou terceira posições, a perna 262' podemover-se para frente, ou distalmente, de modo que a projeção 264' pode serfixada dentro da reentrância 269'. Em pelo menos uma modalidade, além daacima, a interação entre as projeções 264' e as paredes laterais de reen-trância 269' pode ser de modo que o acionador 250'pode ser firmementemantido em uma de suas primeira, segunda, e terceira posições, por exem-plo, e ainda permitir que o acionador 250' seja movida com uma suficienteaplicação de força. Nas referidas modalidades, o membro de detenção 260'pode evitar, ou pelo menos inibir, que o acionador 250' e, de modo corres-pondente, o membro de ajuste 230' sejam não intencionalmente deslocados.
Os dispositivos divulgados aqui podem ser projetados para se-rem descartados após um único uso, ou os mesmos podem ser projetadospara serem usados múltiplas vezes. Em qualquer caso, entretanto, o disposi-tivo pode ser recondicionado para reutilização após pelo menos um uso. Orecondicionamento pode incluir qualquer combinação das etapas de des-montagem do dispositivo, seguido de limpeza ou substituição de peças parti-culares, e remontagem subsequente. Em particular, o dispositivo pode serdesmontado, e qualquer número de peças particulares ou partes do disposi-tivo pode ser seletivamente substituído ou removido em qualquer combina-ção. Com a limpeza e/ou substituição de partes particulares, o dispositivopode ser remontados para que o uso subsequente seja em uma instalaçãode recondicionamento, ou por uma equipe cirúrgica logo antes do procedi-mento cirúrgico. Aqueles versados na técnica observarão que o recondicio-namento um dispositivo pode utilizar uma variedade de técnicas para des-montagem, limpeza/substituição, e remontagem. O uso das referidas técni-cas, e o dispositivo recondicionado resultante, estão todos dentro do âmbitoda presente aplicação.
Preferivelmente, a presente invenção descrita aqui será proces-sada antes da cirurgia. Primeiro, um instrumento novo ou usado é obtido ese necessário limpo. O instrumento pode então ser esterilizado. Em umatécnica de esterilização, o instrumento é disposto em um recipiente fechadoe selado, tal como um saco de plástico ou TYVEK. O recipiente e o instru-mento são então dispostos em um campo de radiação que pode penetrar orecipiente, tal como radiação gama, raio-x, ou elétrons de alta energia. Aradiação extermina bactéria no instrumento e no recipiente. O instrumentoesterilizado pode então ser armazenado em um recipiente estéril. O recipien-te selado mantém o instrumento estéril até que o mesmo é aberto na instala-ção médica.
Embora a presente invenção tenha sido descrita como dotada deconfigurações exemplificativas, a presente invenção pode ser adicionalmen-te modificada e ainda estar dentro do espírito da descrição. O presente pedi-do pretende, portanto cobrir quaisquer variações, usos, ou adaptações dapresente invenção usando seus princípios gerais. Ademais o presente pedi-do pretende cobrir os referidos desvios a partir da presente descrição comoestando inseridos na prática comum e conhecida da técnica à qual pertencea presente invenção.
Claims (24)
1. Grampeador cirúrgico, compreendendo:uma primeira porção de haste incluindo:uma extremidade proximal;uma extremidade distai; eum canal de cartucho de grampos configurado para receber umcartucho de grampos;uma segunda porção de haste incluindo:uma extremidade proximal;uma extremidade distai; euma bigorna, em que a extremidade proximal de uma da referidaprimeira porção de haste e referida segunda porção de haste inclui um pinoe a extremidade proximal da outra da referida primeira porção de haste ereferida segunda porção de haste inclui uma fenda configurada para receberde modo deslizável o referido pino; euma trava acoplada de modo giratório a uma da referida primeiraporção de haste e referida segunda porção de haste, em que a referida travaé configurada para engatar a outra da referida primeira porção de haste ereferida segunda porção de haste em um local que é intermediário a sua ex-tremidade proximal e sua extremidade distai, em que a referida trava é gira-tória entre uma posição aberta, uma posição parcialmente fechada, e umaposição fechada, e em que a referida fenda e o referido pino são configura-dos de modo que o referido pino não pode ser desengatado a partir da refe-rida fenda quando a referida trava está na referida posição parcialmente fe-chada.
2. Grampeador cirúrgico, de acordo com a reivindicação 1, emque a referida trava é montada de modo giratório à referida primeira porçãode haste, em que a referida segunda porção de haste inclui uma projeçãoque se estende a partir da mesma, e em que a referida trava é configuradapara engatar a referida projeção para mover a referida bigorna em próximaoposição ao referido canal de cartucho de grampos quando a referida trava émovida entre a referida posição aberta e a referida posição fechada.
3. Grampeador cirúrgico, de acordo com a reivindicação 1, emque o referido pino e a referida fenda são configurados para compreenderum pivô sobre o qual a referida segunda porção de haste pode ser girada emdireção da referida primeira porção de haste.
4. Grampeador cirúrgico, de acordo com a reivindicação 1, emque a referida primeira porção de haste inclui o referido pino, em que a refe-rida segunda porção de haste inclui a referida fenda, e em que a referidafenda inclui uma extremidade aberta e uma extremidade fechada, e em quea referida extremidade aberta é proximal com relação a referida extremidadefechada.
5. Grampeador cirúrgico, de acordo com a reivindicação 1, emque o referido pino pode ser desengatado a partir da referida fenda quando areferida trava está na referida posição aberta.
6. Grampeador cirúrgico, compreendendo:uma primeira porção de haste incluindo:uma extremidade proximal; eum canal de cartucho de grampos configurado para receber umcartucho de grampos;uma segunda porção de haste incluindo:uma extremidade proximal; euma bigorna, em que a extremidade proximal de uma da referidaprimeira porção de haste e referida segunda porção de haste inclui um pinoe a extremidade proximal da outra da referida primeira porção de haste ereferida segunda porção de haste inclui uma fenda configurada para receberde modo deslizável o referido pino; euma trava acoplada de modo giratório a uma da referida primeiraporção de haste e referida segunda porção de haste, em que a referida travaé configurada para engatar a outra da referida primeira porção de haste ereferida segunda porção de haste, em que a referida trava é giratória entreuma posição completamente aberta e uma posição completamente fechada,e em que a referida fenda e o referido pino são configurados de modo que oreferido pino pode ser desengatado a partir da referida fenda apenas quandoa referida trava está na referida posição completamente aberta.
7. Grampeador cirúrgico, de acordo com a reivindicação 6, emque a referida trava é montada de modo giratório a referida primeira porçãode haste, em que a referida segunda porção de haste inclui uma projeçãoque se estende a partir da mesma, e em que a referida trava é configuradapara engatar a referida projeção para mover a referida bigorna em próximaoposição ao referido canal de cartucho de grampos quando a referida trava émovida entre a referida posição completamente aberta e a referida posiçãocompletamente fechada.
8. Grampeador cirúrgico, de acordo com a reivindicação 7, emque o engate entre a referida trava e a referida projeção evita o referido pinoseja desengatado a partir da referida fenda.
9. Grampeador cirúrgico, de acordo com a reivindicação 6, emque o referido pino e a referida fenda são configurados para compreenderum pivô sobre o qual a referida segunda porção de haste pode ser girada emdireção da referida primeira porção de haste.
10. Grampeador cirúrgico, de acordo com a reivindicação 6, emque a referida primeira porção de haste inclui o referido pino, em que a refe-rida segunda porção de haste inclui a referida fenda, e em que a referidafenda inclui uma extremidade aberta e uma extremidade fechada, e em quea referida extremidade aberta é proximal com relação a referida extremidadefechada.
11. Grampeador cirúrgico, compreendendo:uma primeira porção de haste incluindo:uma extremidade proximal;uma primeira porção de trava; eum canal de cartucho de grampos configurado para receber umcartucho de grampos;uma segunda porção de haste incluindo:uma extremidade proximaluma segunda porção de trava; euma bigorna, em que a referida primeira porção de trava é confi-gurada para ser engatada com a referida segunda porção de trava para aco-plar pivotavelmente a referida extremidade proximal da referida primeira por-ção de haste e a referida extremidade proximal de referida segunda porçãode haste; euma trava acoplada de modo giratório a uma da referida primeiraporção de haste e referida segunda porção de haste, em que a referida travaé configurada para engatar a outra da referida primeira porção de haste ereferida segunda porção de haste e mover a referida bigorna em posiçãocom relação ao referido canal de cartucho de grampos.
12. Grampeador cirúrgico, de acordo com a reivindicação 11, emque a referida trava é giratória entre uma posição aberta, uma posição parci-almente fechada, e uma posição fechada, e em que a referida primeira por-ção de trava e a referida segunda porção de trava são configuradas paraevitar que a referida primeira porção de haste seja desengatada a partir dareferida segunda porção de haste quando a referida trava está na referidaposição parcialmente fechada e a referida posição fechada.
13. Grampeador cirúrgico, de acordo com a reivindicação 11, emque a referida trava é giratória entre uma posição completamente aberta euma posição completamente fechada, e em que a referida primeira porçãode trava e a referida segunda porção de trava são configuradas para seremdesengatadas uma a partir da outra apenas quando a referida trava está nareferida posição completamente aberta.
14. Grampeador cirúrgico, de acordo com a reivindicação 11, emque a referida trava é montada de modo giratório a referida primeira porçãode haste, em que a referida segunda porção de haste inclui uma projeçãoque se estende a partir da mesma, e em que a referida trava é configuradapara engatar a referida projeção para mover a referida bigorna em próximaoposição ao referido canal de cartucho de grampos quando a referida trava émovida entre uma posição aberta e uma posição fechada.
15. Grampeador cirúrgico, de acordo com a reivindicação 11, emque uma da referida primeira porção de haste e a referida segunda porçãode haste inclui um pino, em que a outra da referida primeira porção de hastee referida segunda porção de haste inclui uma fenda, e em que o referidopino e a referida fenda são configurados para compreender um pivô sobre oqual a referida segunda porção de haste pode ser girada em direção da refe-rida primeira porção de haste.
16. Grampeador cirúrgico, compreendendo:uma primeira porção de haste incluindo:uma extremidade proximal; eum canal de cartucho de grampos configurado para receber umcartucho de grampos;uma segunda porção de haste incluindo:uma extremidade proximal; euma bigorna;meios pivô para acoplar de modo pivotável a referida extremida-de proximal da referida primeira porção de haste à referida extremidade pro-ximal de referida segunda porção de haste; euma trava acoplada de modo giratório a uma da referida primeiraporção e a referida segunda porção, em que a referida trava é configuradapara engatar a outra da referida primeira porção e a referida segunda porçãoe mover a referida bigorna em posição com relação ao referido canal de car-tucho de grampos.
17. Grampeador cirúrgico, de acordo com a reivindicação 16, emque a referida trava é giratória entre uma posição aberta, uma posição parci-almente fechada, e uma posição fechada, e em que a referida primeira por-ção de haste não pode ser desengatada a partir da referida segunda porçãode haste quando a referida trava está na referida posição parcialmente fe-chada e a referida posição fechada.
18. Grampeador cirúrgico, de acordo com a reivindicação 16, emque a referida trava é giratória entre uma posição completamente aberta euma posição completamente fechada, em que a referida primeira porção dehaste pode ser desengatada a partir da referida segunda porção de hasteapenas quando a referida trava está na referida posição completamente a-berta.
19. Grampeador cirúrgico, de acordo com a reivindicação 16, emque a referida trava é montada de modo giratório a referida primeira porçãode haste, em que a referida segunda porção de haste inclui uma projeçãoque se estende a partir da mesma, e em que a referida trava é configuradapara engatar a referida projeção para mover a referida bigorna em próximaoposição ao referido canal de cartucho de grampos quando a referida trava émovida entre uma posição aberta e uma posição fechada.
20. Grampeador cirúrgico, de acordo com a reivindicação 16, em que umada referida primeira porção de haste e referida segunda porção de haste in-clui um pino, em que a outra da referida primeira porção de haste e referidasegunda porção de haste inclui uma fenda, e em que o referido pino e a refe-rida fenda compreendem os referidos meios pivô.
21. Grampeador cirúrgico, compreendendo:uma primeira porção de haste incluindo um canal de cartucho degrampos configurado para receber um cartucho de grampos;uma segunda porção de haste incluindo uma bigorna;uma trava acoplada de modo giratório a uma da referida primeiraporção de haste e a referida segunda porção de haste, em que a referidatrava é configurada para engatar a outra da referida primeira porção de has-te e referida segunda porção de haste, e em que a referida trava é giratóriaentre uma posição aberta e uma posição fechada; eum membro de orientação configurado para orientar a referidabigorna em afastamento a partir do referido canal de cartucho de grampos.
22. Grampeador cirúrgico, de acordo com a reivindicação 21, emque o referido membro de orientação é posicionado intermediário à referidaprimeira porção de haste e referida segunda porção de haste.
23. Grampeador cirúrgico, de acordo com a reivindicação 21, emque a referida trava é giratória para uma posição parcialmente fechada, e emque o referido membro de orientação é configurado para posicionar a referi-da bigorna com relação ao referido cartucho de grampos de modo que háum espaço de recebimento de tecido presente entre a referida bigorna e oreferido canal de cartucho de grampos quando a referida trava está na refe-rida posição parcialmente fechada.
24. Grampeador cirúrgico, de acordo com a reivindicação 21, emque a referida primeira porção de haste compreende uma extremidade pro-ximal incluindo uma primeira porção de trava, em que a referida segundaporção de haste compreende uma extremidade proximal incluindo uma se-gunda porção de trava, e em que a referida primeira porção de trava é confi-gurada para ser engatada com a referida segunda porção de trava para aco-plar pivotavelmente a referida extremidade proximal da referida primeira por-ção de haste e a referida extremidade proximal de referida segunda porçãode haste.
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US12/234,113 US7832612B2 (en) | 2008-09-19 | 2008-09-19 | Lockout arrangement for a surgical stapler |
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US12/234,143 | 2008-09-19 |
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BRPI0904877B1 BRPI0904877B1 (pt) | 2019-07-16 |
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BRPI0905166A BRPI0905166B8 (pt) | 2008-09-19 | 2009-09-18 | grampeador cirúrgico |
BRPI0904877-4A BRPI0904877B1 (pt) | 2008-09-19 | 2009-09-18 | Grampeador cirúrgico |
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CA (4) | CA2679222C (pt) |
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