BRPI0905604A2 - instrumento cirúrgico de corte acionado a motor - Google Patents
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- 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
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- 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
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- 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
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/3205—Excision instruments
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- G16Z—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS, NOT OTHERWISE PROVIDED FOR
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00137—Details of operation mode
- A61B2017/00154—Details of operation mode pulsed
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- A—HUMAN NECESSITIES
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
- A61B2017/00398—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00681—Aspects not otherwise provided for
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07271—Stapler heads characterised by its cartridge
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07278—Stapler heads characterised by its sled or its staple holder
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—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
- 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
- A61B2017/2912—Handles transmission of forces to actuating rod or piston
- A61B2017/2923—Toothed members, e.g. rack and pinion
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B2017/320052—Guides for cutting instruments
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Abstract
INSTRUMENTO CIRúRGICO DE CORTE ACIONADO A MOTOR. A presente invenção refere-se a instrumento cirúrgico de fixação e corte acionado por motor que compreende um efetor de extremidade, um eixo conectado ao efetor de extremidade e um manípulo conectado a um eixo. O efetor de extremidade pode compreender um instrumento de corte que, quando atuado, atravessa longitudinalmente o efetor de extremidade para cortar o tecido preso no efetor de extremidade. O manípulo pode compreender um motor elétrico para atuação no instrumento de corte e um circuito de controle motor para controle do motor. O circuito de controle motor pode compreender uma fonte de alimentação conectada ao motor para acionar eletricamente o motor e um circuito de controle de corrente, conectada à fonte de alimentação, para variação da corrente fornecida da fonte de alimentação ao motor. O circuito de controle de corrente pode variar a corrente fornecida ao motor e, consequentemente, o torque de saida fornecido pelo motor, de modo que o motor tenha pelo menos (i) um primeiro, módulo ope- racional de baixa potência para uma primeira porção de um ciclo de curso de corte do instrumento de corte, e (ii) um segundo, módulo operacional de alta potência para a segunda porção do ciclo de curso de corte do instrumento de corte.
Description
Relatório Descritivo da Patente de Invenção para "INSTRU-MENTO CIRÚRGICO DE CORTE ACIONADO A MOTOR".
ANTECEDENTES
Grampeadores cirúrgicos são usados para fazer uma incisãolongitudinal em um tecido e, simultaneamente, aplicar linhas de grampos noslados opostos da incisão. Tais instrumentos incluem comumente um efetorde extremidade que tem um par de membros em mandíbula cooperativosque, se o instrumento for proposto para aplicações endoscópicas ou Iapa-roscópicas, são capazes de passar através de uma passagem de cânula.
Um dos membros em mandíbula recebe um cartucho de grampos que tempelo menos duas fileiras espaçadas lateralmente de grampos - uma em ca-da lado do canal da faca. O outro membro em mandíbula define uma bigornaque tem bolsos que formam grampos alinhados com as fileiras de gramposno cartucho. O instrumento inclui uma pluralidade de cunhas alternadas que,qúàndo acionada distalmente, passa através das aberturas no cartucho degrampo e se encaixam em acionadores que suportam os grampos para efe-tuar o disparo dos grampos na direção da bigorna. Simultaneamente, uminstrumento de corte (ou faca) é puxado distalmente ao longo do membro emmandíbula de modo que o tecido preso é fixado e cortado (por exemplo,grampeado) ao mesmo tempo.
Um exemplo de grampeador cirúrgico adequado para aplicaçõesendoscópicas é descrita no Pedido de Patente publicado N0 U.S.2004/0232196 A1, intitulado, "Surgical stapling instrument having separatedistinct closing and firing systems", cuja descrição é aqui incorporada inte-gralmente como referência. Em uso, um clínico é capaz de fechar os mem-bros em mandíbula do grampeador frente ao tecido para posicionar o tecidoantes do disparo. Uma vez que o clínico tenha determinado que os membrosem mandíbula apertem o tecido corretamente, o clínico pode, então, dispararo grampeador cirúrgico, e assim separar e grampear o tecido. As ações si-multâneas de separar e grampear evitam complicações que podem surgirquando se pratica tais ações seqüencialmente com ferramentas cirúrgicasdiferentes que apenas separam e grampeiam respectivamente.Endocortadores acionados por motor são conhecidos na técnica.Em tais dispositivos, um motor energiza a ação de fixação e corte do instru-mento. É também conhecido o uso de uma bateria interna, colocada no ma-nipulo do instrumento, para energizar o motor. Pedido de Patente publicadoN0 U.S. 2007/0175952 A1, intitulado "Motor-driven surgical cutting and faste-ning instrument with Ioading force feedback", cuja descrição que está inte-gralmente incorporada no presente como referência, descreve tal instrumen-to cirúrgico acionado por motor.
SUMÁRIO
Sob um aspecto geral, a presente invenção é direcionada a uminstrumento cirúrgico de fixação e corte acionado por motor. De acordo comvárias modalidades, o instrumento pode compreender um efetor de extremi-dade, um eixo conectado ao efetor de extremidade e um manipulo conecta-do ao eixo. O efetor de extremidade pode compreender um instrumento decorte que, quando atuado, atravessa longitudinalmente o efetor de extremi-dade para cortar o tecido grampeado ηο efetor de extremidade. O manipulopode compreender um motor elétrico para atuar o instrumento de corte e umcircuito de controle motor para controlar o motor. O circuito de controle motorpode compreender uma fonte de alimentação conectada ao motor para acio-nar eletricamente o motor e um circuito de controle de corrente, conectado àfonte de alimentação, para variação de corrente fornecida ao motor pela fon-te de alimentação. O circuito de controle de corrente pode variar a correntefornecida ao motor, e consequentemente, o torque de rendimento fornecidopelo motor, de modo que o motor tenha pelo menos (i) um primeiro modooperacional de baixa potência para uma primeira porção de um ciclo de cur-so de corte do instrumento de corte e (ii) um segundo modo operacional dealta potência para uma segunda porção de ciclo de curso de corte do instru-mento de corte.
Dessa forma, por exemplo, de acordo com várias modalidades, omotor pode iniciar em um modo de baixa potência no começo do curso decorte para fornecer uma qualidade de início leve. Após a partida suave inici-al, o motor pode evoluir para força total na maioria dos cursos de corte, masentão a transição para um modo de potência menor, antes e pouco depoisque o corte reverta a direção. Além disso, o motor pode alternar de um modode alta potência para um modo de baixa potência antes do instrumento decorte atingir sua posição final, ou inicial, quando está na ação de retração.
São providos os ajustes das configurações de circuito para controlar a cor-rente fornecida ao motor.
Além disso, de acordo com várias modalidades, o circuito decontrole motor pode ativar o freio do motor antes que ele reverta a direção.Por exemplo, o circuito de controle motor pode remover a potência fornecidaao motor bem antes do ponto em tempo em que o instrumento de corte atin-ge sua posição de final de curso e o motor reverta a direção. Em várias mo-dalidades, o circuito de controle motor pode compreender uma memória quearmazena dados que referem-se ao cartucho carregado no efetor de extre-midade, a partir do qual os dados do circuito de controle de motor pode de-terminar, quando no ciclo de corte, o motor deveria estar ativamente freado.
Em outras modalidades, o circuito de controle de motor pode não~ incluirqualquer circuitos integrados. Em tais modalidades, uma interface entre oefetor de extremidade e o cartucho pode completar um circuito elétrico queestá conectado ao circuito de controle de motor e que tenha características(por exemplo, resistência) que controlam quando o motor é ativamente frea-do pelo circuito de controle de motor.
Esses e outros benefícios da presente invenção se evidenciarãoa partir da descrição abaixo.
FIGURAS
Várias modalidades da presente invenção são descritas aqui naforma de exemplo em conjunto com as figuras seguintes, em que:
As Figuras 1, 2 e 24 retratam um instrumento cirúrgico com umefetor de extremidade articulável de acordo com várias modalidades da pre-sente invenção;
As Figuras 3 a 5 são vistas explodidas de um efetor de extremi-dade e eixo do instrumento de acordo com várias modalidades da presenteinvenção;A Figura 6 é uma vista lateral do efetor de extremidade de acor-do com várias modalidades da presente invenção;
A Figura 7 é uma vista explodida do manipulo do instrumento deacordo com várias modalidades da presente invenção;
As Figuras 8 e 9 são vistas parciais em perspectiva do manipulode acordo com várias modalidades da presente invenção;
A Figura 10 é uma vista lateral do manipulo de acordo com vá-rias modalidades da presente invenção;
As Figuras 11, 13a 18e25 são diagramas do circuito de contro-Ie de motor de acordo com várias modalidades da presente invenção;
As Figuras 12 e 19 são diagramas de tempo ilustrando a opera-ção do instrumento de acordo com várias modalidades da presente invenção;
As Figuras 20 e 23 são diagramas do efetor de extremidade,sem um cartucho, de acordo com várias modalidades da presente invenção;e
As Figuras 21 a 22 são diagramas de um cartucho substituívelde acordo com várias modalidades da presente invenção.
DESCRIÇÃO
As Figuras 1 e 2 retratam um instrumento cirúrgico de fixação ecorte acionado por motor 10 de acordo com várias modalidades da presenteinvenção. A modalidade ilustrada é instrumento endoscópico e, em geral, asmodalidades do instrumento 10 descritas aqui são instrumentos cirúrgicosendoscópicos de fixação e corte. Deve ser notado, porém, que a invençãonão é limitada e que de acordo com várias modalidades da presente inven-ção, o instrumento pode ser um instrumento cirúrgico não endoscópico defixação e corte, assim como um instrumento laparoscópico.
O instrumento cirúrgico 10 retratado nas Figuras 1 e 2 compre-ende um manipulo 6, um eixo 8 e um efetor de extremidade articulável 12conectado pivotavelmente ao eixo 8 em um pivô de articulação 14. Um con-trole de articulação 16 pode ser fornecido adjacente ao manipulo 6 para efe-tuar a rotação do efetor de extremidade 12 em torno do pivô de articulação
14. Na modalidade ilustrada, o efetor de extremidade 12 é configurado paraatuar como um endocortador para prender, separar e grampear o tecido,embora, em outras modalidades, diferentes tipos de efetores de extremidadepossam ser usados, assim como efetores de extremidade para outros tiposde dispositivos cirúrgicos, como agarradores, cortadores, grampeadores,aplicadores de grampo, dispositivos de acesso, dispositivo de terapia porfármaco/gene, ultrassom, dispositivos laser ou RF, etc. Mais detalhes sobredispositivos RF podem ser achados na Patente U.S. 5.403.312 e no Pedidode Patente N0 de Série U.S. 12/031.573, cedido à mesma cessionária dopresente intitulado "Surgical cutting and fastening instrument having RF elec-trodes", depositado em 14 de fevereiro de 2008, ambos os quais são incor-porados para referência em sua totalidade.
O manipulo 6 do instrumento 10 pode incluir um gatilho de fe-chamento 18 e um gatilho de disparo 20 para atuação do efetor de extremi-dade 12. Verificar-se-á que instrumentos que tem efetores de extremidadepara diferentes tarefas cirúrgicas podem ter números diferentes ou tipos degatilhos ou outros controles adequados para operar o efetor de extremidade12. O efetor de extremidade 12 é mostrado separado do manipulo 6 por umeixo preferivelmente alongado 8. Em uma modalidade, o clínico ou operadordo instrumento 10 pode articular o efetor de extremidade 12 relativo ao eixo8 através da utilização do controle de articulação 16, como descrito maisdetalhadamente no Pedido de Patente publicado N0 U.S. 2007/0158385 A1,intitulado "Surgical instrument having na articulating end effector", por Geof-frey C. Hueil et al., que é aqui incorporada por referência em sua totalidade.
O efetor de extremidade 12 inclui neste exemplo, entre outrascoisas, um canal de grampeamento 22 e um membro de fixação pivotavel-mente transladável, assim como uma bigorna 24, que são mantidas em úmespaço que assegura, quando a bigorna 24 está em sua posição presa, umgrampeamento e separação eficazes do tecido grampeado no efetor de ex-tremidade 12. o manipulo 6 inclui uma empunhadura de pistola estendidadescendentemente 26, na direção da qual um gatilho de fechamento 18 épuxado pivotavelmente pelo clínico para ocasionar grampeamento ou fe-chamento da bigorna 24 na direção do canal de grampeamento 22 do efetorde extremidade 12 para assim grampear o tecido posicionado entre a bigor-na 24 e o canal 22. O gatilho de disparo 20 é mais distante do lado exteriordo gatilho de fechamento 28. Uma vez que o gatilho de fechamento 18 étravado na posição de fechamento como descrito adicionalmente abaixo, ogatilho de disparo 20 pode girar levemente em direção à empunhadura empistola 26 de modo que ela pode ser alcançada pelo operador usando umadas mãos. Então o operador pode puxar pivotavelmente o gatilho de disparo20 em direção à empunhadura em pistola 12 para ocasionar o grampeamen-to e separação do tecido preso no efetor de extremidade 12. Em outras mo-dalidades, além da bigorna 24 poderiam ser usados diferentes tipos demembros de fixação.
Verificar-se-á que os termos "proximal" e "distai" são usados a-qui com referência à empunhadura do manipulo 6 de um instrumento 10 porparte de um clínico. Assim, o efetor de extremidade 12 é distai no que refere-se ao manipulo 6 mais próxima. Será apreciado adicionalmente que, paraconveniência e clareza, termos espaciais como "vertical" e "horizontal" sãousados aqui no que refere-se aos desenhos. Porém, instrumentos cirúrgicospodem ser usados em muitas orientações e posições e esses termos nãosão propostos para limitar e restringir.
Em uso operacional, o gatilho de fechamento 18 pode ser atua-do primeiro. Uma vez que o clínico esteja satisfeito com o posicionamento doefetor de extremidade 12, o clínico pode puxar de volta o gatilho de fecha-mento 18 para seu fechamento completo, na posição travada próxima à em-punhadura de pistola 26. O gatilho de disparo 20 pode então ser atuado. Ogatilho de disparo 20 retorna para a posição de abertura (mostrado nas Figu-ras 1 e 2) quando o clínico remove a pressão, como descrito mais comple-tamente abaixo. Um botão de soltura no manipulo 6, quando comprimidopode liberar o gatilho de fechamento 18 travado. O botão de soltura pode serimplementado de várias formas assim como, por exemplo, como descrito noPedido de Patente publicado de N0 U.S. 2007/0175955, intitulado "Surgicalcutting and fastening instrument with closure trigger Iocking mechanism", queé aqui incorporada para referência em sua totalidade.
A Figura 3 é uma vista explodida do efetor de extremidade 12 deacordo com várias modalidades. Como mostrado na modalidade ilustrada, oefetor de extremidade 12 pode incluir, além do canal 22 e bigorna 24 men-cionado previamente, um instrumento de corte 32, um malho 33, um cartu-cho de grampo 34 que fica assentado removivelmente no canal 22 e um eixode parafuso helicoidal 36. O instrumento de corte 32 pode ser, por exemplo,uma faca. A bigorna 24 pode abrir e fechar pivotavelmente em um ponto pivô25 conectado à extremidade próxima do canal 22 entre as posições de aber-tura e fechamento, respectivamente. A bigorna 24 pode incluir também umaIingueta 27 em sua extremidade próxima que é inserida em um componentede um sistema de fechamento mecânico (descrito adicionalmente abaixo)para abrir e fechar a bigorna 24. Quando o gatilho de fechamento 18 é atua-do, ou seja, puxado por um usuário do instrumento 10 na direção da porçãode empunhadura da pistola 26, a bigorna 24 pode pivotar-se em torno doponto de pivô 25 na posição de aperto ou fechamento, Se o apertamento doefetor de extremidade 12 for satisfatório, o operador pode atuar o gatilho dedisparo 20, que ocasiona o percurso longitudinal da faca 32 e do malho 33ao longo do canal 22, desta forma, cortando o tecido preso dentro do efetorde extremidade 12. O movimento do malho 33 ao longo do canal 22 ocasio-na o acionamento dos grampos do cartucho de grampos 34 através do teci-do separado e contra a bigorna 24 fechada, que faz com que os gramposfixem o tecido separado. Em várias modalidades, o malho 33 pode ser umcomponente integral do cartucho 34. A Patente U.S. 6.978.921, intitulada"Surgical stapling instrument incorporating an E-beam firing mechanism",que é integralmente incorporada no presente como referência, fornece maisdetalhes sobre tal instrumento de corte e fixação de dois ciclos. Em váriasmodalidades, o malho 33 pode ser parte do cartucho 34, de modo que quan-do a faca 32 se retrai após a operação de corte, o malho 33 não se retraia.
Deve ser notado que embora as modalidades do instrumento 10descrevam aqui o emprego dé um efetor de extremidade 12 que grampeia otecido separado, em outras modalidades, técnicas diferentes para fixação ouselagem do tecido separado podem ser usadas. Por exemplo, também po-dem ser usados efetores de extremidade que usem energia RF ou adesivospara fixar o tecido separado. A Patente N0 U.S. 5.709.680, intitulada "ELEC-TROSURGICAL HEMOSTATIC DEVICE" de Yates et al. e a Patente N0 U.S.5.688.270, intitulada "ELECTROSURGICAL HEMOSTATIC DEVICE WITHRECESSED AND/OR OFFSET ELECTRODES" de Yates et al., as quais seencontram aqui integralmente incorporadas como referência, descrevem uminstrumento endoscópico de corte que usa energia RF para selar o tecidoseparado. O Pedido de Patente publicado N0 U.S. 2007/0102453 A1, de Je-rome R. Morgan e o Pedido de Patente publicado N0 U.S. 2007/0102452 A1de Frederick E. Shelton IV et al., que também estão aqui incorporados comoreferência, descrevem um instrumento endoscópico de corte que usa adesi-vos para fixar o tecido separado. Nesse sentido, embora esta descrição serefira às operações de corte/grampeamento e similares conforme abaixo,deve-se perceber que esta é uma modalidade exemplificativa e não foi proje-tada com caráter limitativo. Outras técnicas também podem ser usadas parafixar tecido.
As Figuras 4 e 5 são vistas explodidas e a Figura 6 é uma vistalateral do efetor de extremidade 12 e eixo 8 de acordo com várias modalida-des. Como mostrado nas modalidades ilustradas, o eixo 8 pode incluir umtubo de fechamento próximo 40 e um tubo de fechamento distai 42 unidopivotavelmente por ligações de um pivô 44. O tubo de fechamento distai 42inclui uma abertura 45 na qual a Iingueta 27 sobre a bigorna 24 é inseridapara abrir e fechar a bigorna 24, como descrito adicionalmente abaixo. Dis-posto dentro dos tubos de fechamento 40, 42 pode haver um tubo de susten-tação proximal 46. Disposto dentro do tubo de sustentação proximal 46 podehaver um eixo de acionamento rotacional principal (ou próximo) 48 que secomunica com um eixo de acionamento secundário (ou distai) 50 através deuma montagem de engrenagens inclinada 52. O eixo de acionamento se-cundário 50 é conectado a uma engrenagem de acionamento 54 que engre-na uma engrenagem de acionamento próxima 56 do eixo de parafuso heli-coidal 36. A engrenagem inclinada vertical 52b pode assentar e pivotar-seem uma abertura 57 na extremidade distai do tubo de sustentação proximal46. Um tubo de sustentação distai 58 pode ser usado para encerrar o eixode acionamento secundário 50 e as engrenagens de acionamento 54, 56.Coletivamente, o eixo de acionamento principal 48, o eixo de acionamentosecundário 50 e a montagem de articulação (por exemplo, as montagens deengrenagem inclinada 52a a c), são as vezes chamadas aqui de "montagemde eixo de acionamento principal".
Um mancai 38, posicionado em uma extremidade distai do canalde grampo 22, recebe o parafuso de acionamento helicoidal 36, que permitea rotação livre do parafuso de acionamento helicoidal 36 no canal 22. O eixode parafuso helicoidal 36 pode se conectar a uma abertura rosqueada (nãomostrada) da faca 32, de modo que a rotação do eixo 36 ocasiona a transla-ção distai ou proximal (dependendo da direção da rotação), da faca 32 atra-vés do canal de grampo 22. Consequentemente, quando o eixo de aciona-mento principal 48 rotaciona em virtude da atuação do gatilho de disparo 20(como explicado em mais detalhes abaixo), a montagem de engrenageminclinada 52a a c ocasiona a rotação do eixo de acionamento secundário 50,que sucessivamente, em virtude do engatamento das engrenagens de acio-namento 54, 56, ocasiona a rotação do eixo de parafuso helicoidal 36, queocasiona o movimento longitudinal do membro de acionamento da faca 32ao longo do canal 22 para cortar qualquer tecido preso no efetor de extremi-dade. O malho 33 pode ser feito de, por exemplo, plástico e pode ter umasuperfície distai inclinada. Como o malho 33 atravessa o canal 22, a superfí-cie em direção inclinada pode empurrar ou direcionar os grampos do cartu-cho de grampos através do tecido preso e contra a bigorna 24. A bigorna 24gira os grampos, grampeando, assim, o tecido separado. Quando a faca 32é retraída, a faca 32 e o malho 33 podem ficar desengatados, deixando, as-sim, o malho 33 na extremidade distai do canal 22.
Além disso, de acordo com várias modalidades, o instrumento10 pode compreender um sensor de posição do instrumento de corte 150que percebe a posição do instrumento de corte 32 no canal de grampo 22.Em uma modalidade, o sensor de posição do instrumento de corte 150 podecompreender um codificador posicionado para perceber a rotação do eixo deparafuso helicoidal 36, ou qualquer outro eixo ou engrenagem que estejarelacionado à posição da faca 32 no efetor de extremidade 12. Devido aofato de a rotação do eixo 36 ou outros eixos/engrenagens de acionamentoser proporcional ao movimento do instrumento de corte 32 ao longo do com-primento do canal 22, o sinal gerado pelo codificador 150 é também propor-cional ao movimento do instrumento de corte 32 no canal 22.
As Figuras 7 a 10 ilustram uma modalidade exemplificativa deum endocortador acionado por motor. A modalidade ilustrada fornece umainformação de retorno ao usuário no que refere-se à distribuição e carrega-mento da força do instrumento de corte no efetor de extremidade. Além dis-so, a modalidade pode usar força fornecida pelo usuário na retração do gati-lho de disparo para energizar o dispositivo (um autodenominado modo "forçaauxiliar"). Como mostrado na modalidade ilustrada, o manipulo 6 inclui pe-ças laterais inferiores exteriores 59, 60 e peças laterais superiores exteriores61, 62 que se encaixam para formarem, em geral, o exterior do manipulo 6.
A bateria (ou "fonte de alimentação" ou "pacote de alimentação") 64, assimcomo uma bateria de íon Li, pode ser fornecida na porção de empunhadurade pistola 26 do manipulo 6. A bateria 64 alimenta um motor elétrico 65 dis-posto em uma porção superior da porção de empunhadura de pistola 26 domanipulo 6. De acordo com várias modalidades, inúmeras células de bateriaconectadas em série podem ser usadas para energizar o motor 65. Alémdisso, a fonte de alimentação 64 pode ser substituível e/ou recarregável.
O motor 65 pode ser um motor de acionamento escovado de DCcom uma rotação máxima de, aproximadamente, 25.000 RPM. Em outrasmodalidades, o motor 65 pode incluir um motor sem escova, um motor semfio, um motor sincronizado, um motor escalonado ou qualquer outro motorelétrico adequado. O motor 64 pode acionar uma montagem de engrenageminclinada 66 a 90° que compreende uma primeira engrenagem inclinada 68 euma segunda engrenagem inclinada 70. A montagem de engrenagem incli-nada 66 pode direcionar uma montagem de engrenagens planetárias 72. Amontagem de engrenagem planetária 72 pode incluir uma engrenagem deroda dentada 74 conectada à um eixo de acionamento 76. A engrenagem depinhão 74 pode direcionar uma engrenagem de anel de cruzamento 78 queaciona um tambor de engrenagem helicoidal 80 através do eixo de aciona-mento 82. Um anel 84 pode ser rosqueado no tambor de engrenagem heli-coidal 80. Assim, quando o motor 65 rotacionar, é ocasionado ao anel 84 semovimentar ao longo do tambor de engrenagem helicoidal 80 por meios deinterposição à montagem de engrenagem inclinada 66, montagem de engre-nagem planetária 72 e engrenagem de anel 78.
O manipulo 6 pode incluir, também, um sensor de função do mo-tor 110 em comunicação com o gatilho de disparo 20 para detectar quando ogatilho de disparo 20 foi puxado (ou fechado) na direção da porção de garraem pistola 26 do manipulo 6 pelo operador para assim atuar a operação decorte/grampeio pelo efetor de extremidade 12. O sensor 110 pode ser umsensor proporcional de modo que, por exemplo, um resistor reostato ou vari-ável. Quando o gatilho de disparo 20 é puxado, o sensor 110 detecta o mo-vimento, e completa o circuito usado para alimentar o motor 65. Quando osensor 110 é um resistor variável ou parecido, a corrente fornecida ao motor65 e, portanto, o torque de rendimento do motor 65, pode ser geralmenteproporcional à quantidade de movimento do gatilho de disparo 20. Isto é, seo operador apenas puxar ou fechar um pouco o gatilho de disparo 20, a ro-tação do motor 65 é relativamente baixa. Quando o gatilho de disparo 20 épuxado completamente (ou na posição completamente fechada), a rotaçãodo motor 65 é máxima. Em outras palavras, quanto mais forte o usuário pu-xar o gatilho de disparo 20, mais voltagem é aplicada ao motor 65, que oca-siona altas taxas de rotação. Em outras modalidades, o sensor 110 pode serum comutador do tipo liga/desliga. Em tal modalidade, quando o gatilho dedisparo 20 é retraído, o comutador do sensor 110 é fechado, assim comple-tando o circuito usado para alimentar o motor 65.
O manipulo 6 pode incluir um peça de manipulo intermediário104 adjacente à porção posterior do gatilho de disparo 20. O manipulo 6também pode compreender uma mola oblíqua 112 conectada entre colunasna peça do manipulo intermediária 104 e o gatilho de disparo 20. A molaoblíqua 112 pode tender o gatilho de disparo 20 para sua posição comple-tamente aberta. Dessa forma, quando o operador libera o gatilho de disparo20, a mola oblíqua 112 irá puxar o gatilho de disparo 20 para sua posiçãoaberta, assim remove a atuação do senso 110, assim para a rotação do mo-tor 65. Ademais, por virtude da mola oblíqua 112, em qualquer hora um usu-ário fecha o gatilho de disparo 20, o usuário irá experimentar a resistênciapara a operação de fechamento, assim fornecendo ao usuário informação deretorno como a quantidade de rotação exercida pelo motor 65. Adicional-mente, o operador poderia parar de retrair o gatilho de disparo 20 para re-mover assim a força do sensor 100, para assim parar o motor 65. Como tal,o usuário pode interromper a disposição do efetor de extremidade 12, assimfornecendo uma medida de controle da operação de corte/fixação ao operador.
A extremidade distai do tambor de engrenagem helicoidal 80inclui um eixo de acionamento distai 120 que direciona uma engrenagem deanel 122, que emparelha com uma engrenagem de roda dentada 124. A en-grenagem de roda dentada 124 é conectada ao eixo de acionamento princi-pal 48 da montagem de eixo de acionamento principal. Dessa forma, a rota-ção do motor 65 ocasiona a rotação da montagem do eixo de acionamentoprincipal, que ocasiona a atuação do efetor de extremidade 12, como descri-to acima.
O anel 84 rosqueado no tambor de engrenagem helicoidal 80pode incluir uma coluna 86 que está disposta dentro de uma fenda 88 de umbraço fendido 90. O braço fendido 90 tem uma abertura 92 em sua extremi-dade oposta 94 que recebe um pino pivô 96 que é conectado entre as peçaslaterais exterior do manipulo 59, 60. O pino pivô 96 é também disposto atra-vés de uma abertura 100 no gatilho de disparo 20 e uma abertura 102 napeça do manipulo intermediário 104.
Além disso, o manipulo 6 pode incluir um sensor de motor reveso (ou de final de curso) 130 e um sensor de motor de parada (ou início decurso) 142. Em várias modalidades, o sensor de motor reverso 130 pode serum comutador limite localizado na extremidade distai do tambor de engrena-gem helicoidal 80 de modo que o anel 84 rosqueado no tambor de engrena-gem helicoidal 80 se liga e desengata o sensor de motor reverso 130 quandoo anel 84 atinge a extremidade distai do tambor de engrenagem helicoidal80. O sensor de motor reverso 130 pode ser parte do circuito usado paracontrolar o motor 65. Quando o sensor de motor reverso é ativado, o circuitode controle motor pode reverter a direção do motor 65, assim retira a faca 32do efetor de extremidade 12 que continua a operação de corte. O sensor demotor de parada 142 pode ser, por exemplo, um comutador limite normal-mente fechado, e pode também ser parte do circuito de controle motor. Emvárias modalidades, pode estar localizada na extremidade próxima do tam-bor de engrenagem helicoidal 80 de modo que o anel 84 desengate o comu-tador 142 quando o anel 84 atingir a extremidade próxima do tambor de en-grenagem helicoidal 80, que indica que o instrumento de corte 32 atingiu suaposição próxima (inicial) no efetor de extremidade 12.
Na operação, quando um operador de instrumento 10 puxa devolta o gatilho de disparo 20, o sensor 110 detecta a disposição do gatilho dedisparo 20 e o circuito de controle motor ocasiona a rotação avançada domotor 65 em, por exemplo, uma taxa proporcional de quão forte o operadorpuxou de volta o gatilho de disparo 20. A rotação avançada do motor 65 o-casiona sucessivamente a rotação da engrenagem de anel 78 na extremida-de distai da montagem de engrenagem planetária 72, assim ocasiona a rota-ção do tambor de engrenagem helicoidal 80, que ocasiona o movimento dis-tai do anel 84 rosqueado no tambor de engrenagem helicoidal 80 ao longodo tambor de engrenagem helicoidal 80. A rotação do tambor de engrena-gem helicoidal 80 também direciona a montagem do eixo de acionamentoprincipal, como descrito acima, que ocasiona sucessivamente a disposiçãoda faca 32 no efetor de extremidade 12. Isto é, a faca 32 e o malho 33 sãoobrigados a atravessar longitudinalmente o canal 22, e assim cortam o teci-do preso no efetor de extremidade 12. Também, a operação de grampea-mento dó efetor de extremidade 12 é obrigada a acontecer em modalidadesonde é usado um efetor de extremidade do tipo de grampeamento.
No momento em que a operação de corte/grampeio do efetor deextremidade 12 é completa, o anel 84 no tambor de engrenagem helicoidal80 terá atingido a extremidade distai do tambor de engrenagem helicoidal80, e assim ocasiona a movimentação do sensor de motor reverso 130, quefaz com que o circuito de controle motor reverta a rotação do motor 65. Isto,sucessivamente, ocasiona a retração da faca 32, e também ocasiona o mo-vimento de volta do anel 84 no tambor de engrenagem helicoidal 80 para aextremidade próxima do tambor de engrenagem helicoidal 80.
O peça do manipulo intermediária 104 inclui um ombro exterior106 que se engata ao braço fendido 90 como melhor mostrado nas Figuras 8e 9. A peça do manipulo intermediária 104 também tem uma parada do me-canismo avançado 107 que engata o gatilho de disparo 20. O movimento dobraço fendido 90 é controlado, como explicado acima, pela rotação do motor65. Quando o braço fendido 90 rotaciona de forma CCW como o anel 84 semovimenta da extremidade próxima do tambor de engrenagem helicoidalpara a extremidade distai, a peça do manipulo intermediário 104 será livrepara rotacionar de forma CCW. Assim, quando o usuário puxa no gatilho dedisparo 20, o gatilho de disparo 20 irá engatar a parada do mecanismo a-vançado 107 da peça do manipulo intermediária 104, que ocasiona a rota-ção de forma CCW da peça do manipulo intermediária 104. Devido ao om-bro exterior 106 que engata o braço fendido 90, porém, a peça do manipulointermediária 104 apenas estará disponível para rotacionar de forma CCWtão longe o braço fendido 90 permitir. Dessa forma, se o motor 65 precisarparar a rotação por-alguma razão, o braço-fendido 90Jrá parar a rotação, e ousuário não poderá puxar mais no gatilho de disparo 20 porque o peça domanipulo intermediária 104 não estará livre para rotacionar de forma CCWdevido ao braço fendido 90.
Componentes de um sistema de fechamento exemplificativo pa-ra fechamento (ou prender) a bigorna 24 do efetor de extremidade 12 porretração do gatilho de fechamento 18 são também mostrados na Figuras 7 a10. Na modalidade ilustrada, o sistema de fechamento inclui uma bobina 250conectada ao gatilho de fechamento 18 por um pino 251 que está inseridoatravés de aberturas alinhadas em ambos os gatilho de fechamento 18 ebobina 250. Um pino pivô 252, em torno de onde o gatilho de fechamento 18pivota, está inserido através de outra abertura no gatilho de fechamento 18que está projetado de onde o pino 251 está inserido através do gatilho defechamento 18. Assim, a retração do gatilho de fechamento 18 ocasiona arotação de forma CCW da parte superior do gatilho de fechamento 18, emque a bobina 250 é anexada através do pino 251. A extremidade distai dabobina 250 está conectada, através do pino 254, a um primeiro suporte defechamento 256. O primeiro suporte de fechamento 256 se conecta a umsegundo suporte de fechamento 258. Coletivamente, os suportes de fecha-mento 256, 258 definem uma abertura no qual a extremidade final do tubode fechamento próximo 40 (ver Figura 4) está instalado e apoiado de modoque o movimento longitudinal dos suportes de fechamento 256, 258 ocasio-nam um movimento longitudinal pelo tubo de fechamento próximo 40. O ins-trumento 10 também inclui uma alavanca de fechamento 260 disposta dentrodo tubo de fechamento próximo 40. A alavanca de fechamento 260 podeincluir uma janela 261 em que uma coluna 263 em um das peças exterioresdo manipulo, como peças laterais inferiores exterior 59 na modalidade ilus-trada, está disposta para conectar firmemente a alavanca de fechamento260 à manipulo 6. Dessa forma, o tubo de fechamento próximo é capaz dese mover longitudinalmente em relação à alavanca de fechamento 260. Aalavanca de fechamento 260 pode também incluir uma argola distai 267 quese encaixa na cavidade 269 no tubo de sustentação proximal 46 e é retidoaqui por uma cápsula 271-(ver Figura 4).
Em operação, quando a bobina 250 rotaciona devido à retraçãodo gatilho de fechamento 18, os suportes de fechamento 256, 258 ocasionao movimento distai do tubo de fechamento próximo 40 (isto é, para longe daextremidade do manipulo do instrumento 10), que ocasiona o movimentodistai do tubo de fechamento distai 42, que ocasiona a rotação da bigorna 24em torno do ponto pivô 25 na posição presa ou fechada. Quando o gatilhode fechamento 18 estiver destravado da posição travada, o tubo de fecha-mento próximo 40 é obrigado a deslizar proximamente, que ocasiona o des-lizamento proximamente do tubo de fechamento distai 42, que, por virtudeda Iingueta 27 que está inserida na janela 45 do tubo de fechamento distai42, ocasiona a pivotação da bigorna 24 em torno do ponto pivô 25 na posi-ção aberta ou solta. Dessa forma, por retração ou travamento do gatilho defechamento 18, um operador pode prender o tecido entre a bigorna 24 e ocanal 22 e pode soltar o tecido seguindo a operação de corte/grampeio pormeio do destravamento do gatilho de fechamento 20 da posição travada.
Configurações adicionais para instrumentos cirúrgicos motoriza-dos são descritos na Pedido publicado de N0 U.S. 2007/0175962 A1, intitu-lada "Motor-driven surgical cutting and fastening instrument with tactile posi-tion feedback", que é aqui incorporada para referência em sua totalidade.
A Figura 11 é um diagrama esquemático do circuito de controlemotor de acordo com várias modalidades da presente invenção. Em váriasmodalidades, o circuito de controle motor pode incluir um de muitos circuitosintegrados (ICs)1 como, por exemplo, um processador, memória, circuito detempo, etc. Em outras modalidades, o circuito de controle motor pode nãocompreender qualquer ICs. Como um circuito de controle motor sem IC podeser vantajoso porque é freqüentemente difícil, complicado e caro esterilizarum instrumento cirúrgico que inclui IC.
Quando um operador puxa inicialmente no gatilho de disparo 20após travar o gatilho de fechamento 18, o sensor 110 é ativado (ou fechado,quando o sensor 110 for um comutador), que permite o fluxo da correnteatravés dele. Se comutador de sensor de motor reverso normalmente aberto130 estiver aberto (significa que não foi atingida a extremidade do curso doefetor de extremidade), a corrente irá fluir para um pólo simples, motor auxi-liar de percurso duplo 132. Quando o comutador do sensor de motor reverso130 não está aberto, um espiral 134 do motor auxiliar 132 não será energi-zado, assim o motor auxiliar 132 ficará em seu estado não energizado.
Como mostrado na Figura 11, o circuito pode incluir também umelemento resistivo 144 e um comutador 146 conectado em paralelo, comelementos em paralelo conectado em série com o motor auxiliar 132. O ele-mento resistivo 144 e o comutador 146 são também conectados à fonte dealimentação 64. O comutador 146 pode ser controlado pelo circuito de con-trole 148 que é responsável pelo sensor de posição do instrumento de corte150. De acordo com várias modalidades, o circuito de controle 148 pode a-brir o comutador 146 quando o instrumento de corte 32 estiver (i) muito pró-ximo ao começo de seu curso e (ii) muito próximo do final de seu curso. Porexemplo, o circuito de controle pode abrir o comutador quando o instrumento32 estiver (i) a 0,00254 cm (0,001 polegadas) do ponto de começo de seucurso e (ii) 0,00254 cm (0,001 polegadas) do final de seu curso, como de-terminado pelo sensor de posição do instrumento de corte 150. Com o co-mutador 146 aberto, a corrente flui através do elemento resistivo 144, e en-tão através do motor auxiliar 132, o motor auxiliar 138, o comutador do sen-sor do motor de funcionamento 110, ao motor 65. A corrente que flui atravésdo elemento resistivo 144 reduz a magnitude da corrente entregue ao motor65, assim reduz a força entregue ao motor 65. Assim, quando o instrumentode corte 32 estiver (i) muito próximo do começo de seu curso ou (ii) muitopróximo do final de seu curso, a força entregue ao motor 65 é reduzida. In-versamente, uma vez que instrumento de corte 32, se move suficientementepara longe de seu ponto de começo ou final de curso, o circuito de controle148 pode fechar o comutador 146, e assim encurta o elemento resistivo 144,e assim aumenta a corrente para o motor 65, e assim aumenta a força en-tregue pelo motor.
De acordo com várias modalidades, o circuito elétrico inclui ain-da comutadores de sensor de travamento 136a a d definido coletivamenteum circuito para ligar 137 através do qual a corrente do motor auxiliar 132,quando não energizado, passa para ser iniciada a operação elétrica do mo-tor 65. Gada comutador de sensor de travamento 136a a d pode ser configu-rado para manter um estado de comutador aberto (isto é, não condutivo) ouum estado dè comutador fechado (isto é, condutivo) responsável pela pre-sença ou ausência, respectivamente, de uma condição correspondente.
Qualquer das condições correspondentes, se presentes quando o instrumen-to 10 é disparado, pode resultar em uma operação de corte e grampeio insa-tisfatório e/ou danificar o instrumento 10. Condições as quais os comutado-res sensor de travamento 136a a d podem responder incluem, por exemplo,(a) a ausência do cartucho de grampos 34 no canal 22, (b) a presença decartucho de grampo 34 desgastado (isto é, disparado anteriormente) no ca-nal 22, e (c) uma posição de abertura (ou ao contrário, fechado insuficiente-mente) da bigorna 24 no que refere-se ao canal 22. Outras condições àsquais os comutadores de sensor de travamento 136a a d podem responder,como componente deteriorado, podem concluir baseada em um número a-cumulado de operações de disparo produzidas pelo instrumento 10. Conse-quentemente, em várias modalidades, se qualquer dessas condições existi-rem, os comutadores de sensor de travamento 136a a d correspondentemantém um estado de comutador aberto, assim impede a passagem da cor-rente necessária para iniciar a operação do motor 65. A passagem da cor-rente pelos sensores de travamento 136a a d é permitida, em várias modali-dades, apenas após que todas as condições tenham sido remediadas. Seráapreciado que as condições descritas acima são fornecidas apenas na formade exemplos e que pode ser fornecido comutadores de sensor de travamen-to adicional para responder a outras condições prejudiciais à operação doinstrumento 10. Será similarmente apreciado que para modalidades na qualuma ou mais condições descritas acima podem não existir ou estão fora depreocupação, o número de comutadores de sensor de travamento pode sermenor que retratado.
Como mostrado na Figura 11, o comutador de sensor de trava-mento 136a pode ser implementado usando uma configuração de comutadornormalmente aberto de modo que um estado de comutador fechado é man-tido quando o cartucho de grampo 34 estiver em uma posição corresponden-te ao seu recebimento próprio pelo canal 22. Quando o cartucho de grampo34 não está instalado no canal 22, ou está instalado impropriamente (isto é,desalinhado), o comutador de sensor de travamento 136a mantém um esta-do de comutador aberto. O comutador de sensor de travamento 136b podeser implementado usando uma configuração de comutador normalmenteaberto de modo que um estado de comutador fechado é mantido apenasquando um cartucho de grampo 34 não usado (isto é, um cartucho de gram-po 34 que tem um malho 33 em posição de não disparo) estiver presente nocanal 22. A presença de um cartucho de grampo 34 usado no canal 22 cau-sa a manutenção do comutador em estado aberto pelo comutador de sensorde travamento 136b. O comutador de sensor de travamento 136c pode serimplementado usando uma configuração de comutação normalmente aberta,de forma que o estado de comutação fechada seja mantida quando a bigor-na 24 estiver em uma posição fechada com respeito ao canal 22. O comuta-dor de sensor de travamento 136c pode ser controlado de acordo com umacaracterística de atraso de tempo em que um estado de comutador fechadoseja mantido apenas depois que a bigorna 24 esteja em posição fechadapara um período predeterminado de tempo.
O comutador de sensor de travamento 1.36d pode ser implemen-tado usando uma configuração de comutador normalmente aberta de modoque um estado de comutador fechado é mantido apenas quando um númerode disparos acumulados produzidos pelo instrumento 10 for menor que umnúmero predeterminado. O comutador de sensor de travamento 136d podeestar em comunicação com um contador 139 configurado para manter a con-tagem representativa do número de disparos acumulados de operações e-xecutadas pelo instrumento 10, que compara a contagem ao número prede-terminado e controla o estado do comutador de sensor de travamento 136dbaseada à comparação. Embora mostrado separadamente na Figura 11,será apreciado que o contador 139 pode ser integral com o comutador desensor de travamento 136d na forma de um dispositivo comum. Preferivel-mente, o contador 139 é implementado como um dispositivo eletrônico quetem uma entrada para incrementar a contagem mantida em base à transiçãode um sinal elétrico distinto fornecido pelo mesmo. Será apreciado que ocontador mecânico configurado para manter a contagem com base a umaentrada mecânica (isto é, retração do gatilho de disparo 20) pode ser usado.
Quando implementado como um dispositivo eletrônico, qualquer sinal distin-to presente no circuito elétrico que transita uma vez para cada operação dedisparo pode ser utilizado para a entrada do contador 139. Como mostradona Figura 11, por exemplo, o sinal elétrico distinto resultante da atuação dosensor de final de curso 130 pode ser utilizado. O contador 139 pode contra-lar o estado do comutador de sensor de travamento 136d de modo que umestado de comutador fechado é mantido quando a contagem mantida formenor que um número armazenado predeterminado no contador 139.
Quando a contagem mantida for igual ao número predeterminado, o conta-dor 139 ocasiona a manutenção de um estado de comutador aberto do co-mutador de sensor de travamento 136d, assim impede a passagem de cor-rente nele. Será apreciado que o número predeterminado armazenado nocontador 139 pode ser ajustado seletivamente como requerido. De acordocom várias modalidades, o contador 304 pode estar em comunicação comum aparato externo (não mostrado), como um aparato LCD, integral ao ins-trumento 10 para indicar ao usuário a contagem mantida ou a diferença en-tre o número predeterminado e a contagem mantida.
De acordo com várias modalidades, o circuito ligado 137 podecompreender um ou mais indicadores visíveis ao usuário do instrumento 10para mostrar uma situação de pelo menos um dos comutadores de sensorde travamento 136a a d. Mais detalhes sobre tais indicadores podem serencontradas no Pedido de Patente publicado sob N0 U.S. 2007/0175956,intitulado "Electronic travamentos and surgical instrument including same",que é aqui incorporada para referência em sua totalidade. Este pedido tam-bém inclui exemplos de distribuições de montagem e configurações para oscomutadores de sensor de travamento 136a a d.
Em uma modalidade ilustrada, quando os comutadores de sen-sor de travamento 136a a d mantém coletivamente um estado de comutadorfechado, um pólo único, o motor auxiliar de percurso único 138 é energizado.
Quando o motor auxiliar 138 é energizado, a corrente flui através do motorauxiliar 138, através do sensor de comutador de motor de funcionamento110 e ao motor 65 através de um pólo duplo, motor auxiliar de percurso du-plo 140, e assim energiza o motor 65, que permite a sua rotação em direçãoavançada. De acordo com várias modalidades, por ocasiona da saída domotor auxiliar 138, uma vez energizado, mantém o motor auxiliar 138 em umestado energizado até o motor auxiliar 132 ser energizado, o circuito ligado137 não irá funcionar para impedir a operação do motor 165 uma vez inicia-do, mesmo se um ou mais comutadores de sensor de travamento 136a a dmantiver subseqüentemente um estado de comutador aberto. Em outrasmodalidades, porém, pode ser necessário ou pelo menos desejável que co-necte o circuito ligado 137 e o motor auxiliar 138 de modo que um ou maiscomutadores de sensor de travamento 136a a d possam manter um estadode comutador fechado para suportar a operação do motor 165 uma vez iniciada.
A rotação do motor na direção avançada ocasiona o movimentodistai do anel 84 e assim a não atuação do comutador de sensor de motorde parada 142 em várias modalidades. Em razão do comutador 142 estarnormalmente fechado, um solenóide 141 conectado ao comutador 142 podeser energizado. O solenóide 141 pode ser um solenóide de tipo de empurraconvencional que, quando energizado, ocasiona uma extensão axial de umêmbolo (não mostrado). A extensão do êmbolo pode operar a retenção dogatilho de fechamento 18 na posição retraída, assim impede a abertura dabigorna 24 enquanto a operação de disparo está em progresso (isto é, en-quanto o comutador 142 não é atuado). Com a não energização do solenói-de 141, o êmbolo é retraído de modo que seja possível a liberação manualdo gatilho de fechamento 18.
Quando o efetor de extremidade 12 atingir o final de seu curso, osensor de motor reverso 130 será ativado, e assim fecha o comutador 130 eenergiza o motor auxiliar 132. Isto faz com que o motor auxiliar 132 assumaseu estado energizado (não mostrado na Figura 11), que ocasiona a passa-gem secundária da corrente pelo circuito ligado 137 e o comutador de sen-sor de motor de funcionamento 110 e em vez de ocasionar o fluxo da corren-te em ambos os pólos duplos normalmente fechados, motor auxiliar de per-curso duplo 140 e volta ao motor 65, mas em uma maneira, através do motorauxiliar 140, que ocasiona a reversão da direção rotacional do motor 65. Emrazão do comutador de sensor de motor de parada 142 estar normalmentefechado, a corrente irá fluir de volta ao motor auxiliar 132 para se manterenergizado até que o comutador 142 se abra. Quando a faca 32 é totalmenteretraída, o comutador de sensor de motor de parada 142 é ativada, que oca-siona a abertura do comutador 142, e assim remove a força do motor 65 enão energiza o solenóide 141.
A Figura 12 ilustra uma linha de tempo da operação do circuitode acordo com várias modalidades. Assumindo que os comutadores de tra-vamento 136a a d estejam em seu estado apropriado, em tempo TO o ope-rador retrai o gatilho de disparo 20, fechando o comutador de sensor de mo-tor de funcionamento 110, que ocasiona a rotação avançada do motor 65.Nesse tempo, o comutador 146 está aberto, então a corrente flui através doelemento resistivo 144, que reduz a corrente ao motor 65 do tempo TO aotempo T1. No tempo T1, que o instrumento de corte está suficientementelonge de sua posição inicial, o comutador 146 está fechado, e assim encurtao elemento resistivo 144 e fornece um aumento de força ao motor 65. Dotempo T1 ao tempo T2, o motor está em seu módulo de força completo como comutador 146 fechado. No tempo T2, como o instrumento de corte 32 seaproxima do final de seu curso, o comutador 146 está aberto, e assim reduza corrente fornecida ao motor 65. Assim, de T2 a T3 o motor 65 está abaixoda força completa.
No tempo T3, o comutador de sensor de final de curso 130 estáfechado, que ocasiona a rotação reversa do motor 65. O motor 65 continuaem seu estado de força reduzida porque o comutador 146 está aberto e omotor 65 permanece em seu estado de força reduzida até o tempo T4,quando o comutador 146 está fechado porque o instrumento de corte 32 semoveu suficientemente longe de sua posição de final de curso. Do tempo T4a T5 o motor 65 opera em força total que retrai o instrumento de corte 32. Notempo T5, como o instrumento de corte 32 se aproxima de sua posição inici-al (ou parar), o comutador 146 está novamente aberto, e assim limita a cor-rente ao motor 65, e assim reduz a força entregue pelo motor 65. No tempoT6, o comutador de sensor de motor de parada 142 está aberto, e assim re-move a corrente do motor, que ocasiona a parada de sua rotação.
Em uma arquitetura de comutação, o instrumento acionado pormotor 10 exibe uma "leve" qualidade de início por limitar a habilidade do mo-tor para exercer o carregamento total imediatamente. O motor 65 está inici-almente em um modo de força reduzida (do tempo TO ao tempo T1), comopara limitar o início abrupto repentino. Ainda assim, por iniciar no modo deinício leve, a probabilidade de o motor exceder o mecanismo de travamentodo cartucho é reduzida. Ademais, reduzindo a força anterior para faca atin-gindo sua posição de curso final (ou distai) facilita a reversão da direção domotor.
Em outras modalidades, o eomutador conectado em paralelo146 e o elemento resistivo 144 são conectados em lugares diferentes, maspreferivelmente eles estão sempre no laço de corrente independentementede o motor 65 estar em rotação avançada ou rotação reversa. Ademais, oelemento resistivo 144 pode ser de qualquer tipo de elemento de circuito oucomponente elétrico que forneça resistência suficiente. Por exemplo, o ele-mento resistivo 144 pode ser um ou vários resistores conectados em paralelo.
Ademais, o elemento resistivo 144 pode compreender um resis-tor variável, como mostrado na Figura 13. Em tal modalidade, o eomutador146 pode ser usado ou não. A Figura 13 mostra uma modalidade sem o eo-mutador 146. O circuito de controle 148 pode variar a resistência do elemen-to resistivo variável 144 com base na posição do instrumento de corte 32,por exemplo. Dessa forma, ao invés de ter dois níveis de força para o motor65, terá um número de nível de força discreta ou uma quantidade continuade níveis de força para o motor 65, dependendo da natureza do elementoresistivo variável 144. Em várias modalidades, o elemento resistivo variávelpode compreender um potenciômetro de corda ou transformador de energiaem posição de cabo, onde, p»or exemplo, a resistência é relacionada à posi-ção da faca 32 no efetor de extremidade 12. Ademais, um elemento ativo,como um transistor, pode ser usado para fornecer uma resistência variável.
Por exemplo, a Figura 14 ilustra um circuito onde um FET 147 é usado comoum resistor variável para limitar a corrente para o motor 65 em vários esta-dos operacionais.
Em ainda outras modalidades, um controlador de modo de eo-mutador integrado, como o modelo UC2637 da Texas Instrument, ou algumoutro circuito de acionamento de motor adequado, pode ser usado para limi-tar o torque e/ou a velocidade do motor 65 em vários momentos durante ociclo de curso de corte, como uma partida "leve", sem a região travamento,antes de parar ou reverter a direção, etc. De acordo com ainda outra modali-dade, como mostrado na Figura 15, um circuito de modulação de largura depulso 148 pode ser usado para controlar a velocidade do motor 65 direcio-nado o motor com pulsos curtos. A duração dos pulsos pode ser variada pa-ra controlar a velocidade do motor 65; quanto mais longo os pulsos, maisrápido o motor gira e vice-versa. Consequentemente, pulsos de curta dura-ção podem ser usados quando o instrumento de corte 32 estiver inicialmentedeixando ou retornado à sua posição inicial ou aproximando ou deixandosua posição de final de curso, etc. Ademais, em ainda outras modalidades,um circuito de modulação de freqüência 149, como mostrado na Figura 16,pode ser usado para controlar a velocidade do motor 65. Em um circuito demodulação de freqüência, o trabalho de ciclo de pulso se mantém constante,pela freqüência das mudanças dos pulsos para variar a velocidade do motor.
Consequentemente, pulsos de freqüência baixa podem ser usados quando oinstrumento de corte 32 estiver inicialmente deixando ou retornado à suaposição inicial ou se aproximando ou deixando sua posição de final de curso,etc., e pulsos de freqüência alta podem ser usados quando for necessárioaumentar a velocidade do motor.
Em ainda outra modalidade, um circuito amplificador 151 podeser usado para controlar a velocidade do motor 65, como mostrado na Figu-ra 17. O circuito amplificador 151 pode amplificar, por exemplo, a corrente ouvoltagem aplicada ao motor 65. De acordo com várias modalidades, o circui-to amplificador 151 pode compreender um par de transistores Darlington oualgum outro circuito amplificador com base em transistor adequado.
Em outras modalidades, ao invés de usar um comutador de sen-sor de motor de funcionamento de tipo liga/desliga 110, pode ser usado umsensor resistor variável de tipo proporcional. Em tais modalidades, a taxa derotação do motor 65 deverá ser proporcional à força aplicada pelo operador.O sensor de motor de funcionamento 110 pode fornecer uma resistência decircuito aberta quando o gatilho de disparo 20 não está atuado/retraído eentão fornece uma resistência decrescente conforme o gatilho de disparo éretraído. O comutador 110 compreende tanto um comutador do tipo li-ga/desliga ou um resistor variável, se o operador liberar o gatilho de disparo20 durante um procedimento enquanto o motor estiver em direção avançada,será eliminada ou pelo menos reduzida a força ao motor 65, fornecendodesse modo uma apresentação parada da dinâmica para o instrumento 10.
Em várias modalidades, como mostrado na Figura 18, os comu-tadores 140a e 140b podem ser controlados ativamente, melhor qüe atravésdo motor auxiliar 140 mostrado na Figura 11, por exemplo. Em tais modali-dades, no momento antes de o final de curso ser captado, um dos comuta-dores 140a, 140b pode comutar a polaridade de modo que ambos os comu-tadores 140a, 140b se conectem ao mesmo terminal de polaridade para omotor 65 (isto é, tanto ambos positivos ou ambos negativos). Isto irá removera força do motor 65, que o faz parar. A Figura 18 mostra uma modalidadeonde os comutadores 104a e 140b são ambos conectados ao terminal posi-tivo. Então, ao mesmo tempo em que o final de curso é captado ou logo de-pois, o outro comutador 140a, 140b pode comutar a polaridade, permitindo arotação do motor 65 na direção reversa. No exemplo da Figura 18, isto podeser feito comutando o comutador 140a ao terminal negativo. Evidentemente,em outras modalidades, o comutador 140a poderia ser comutado primeiro aoterminal negativo e então o comutador 140b poderia ser comutado ao termi-nal positivo. Também, outras disposições de comutações poderiam ser usa-das para remover temporariamente a força do motor 65 anterior para comu-tar a direção para fornecer tal "parada ativa". Por exemplo, os comutadores140a, 140b podem ainda ser controlados por um motor auxiliar indutivo, e ocircuito pode incluir outro circuito de comutação para parar ativamente o mo-tor 65.
A parada ativa poderia ser combinada com níveis de força variá-veis fornecidas ao motor 65 como descrito acima em relação às Figuras 11 e12, por exemplo. A Figura 19 mostra um diagrama de tempo que incorpora aparada ativa. No tempo T2.1, entre os tempos 12 e T3, a força pode ser re-movida do motor 65 pela comutação de um dos comutadores 140a, 104b,por exemplo, parando desse modo o motor. Então no tempo T3, o comuta-dor de final de curso 130 pode ser fechado e outro comutador 140a, 140bpode ser comutado para fornecer força ao motor 65, mas na direção reversa,como descrito acima.
O circuito de controle 135 ou outro circuito de controle pode con-trolar a comutação dos comutadores 140a, 140b. De acordo com várias mo-dalidades, o circuito de controle 135 pode compreender um processador oumemória. Por exemplo, o circuito de controle 135 pode compreender um mi-crocontrolador com base IC. A memória pode armazenar dados indicativosdo tipo de cartucho 34 carregado no efetor de extremidade 12. Por exemplo,a memória pode armazenar dados indicativos do comprimento do corte ne-cessários para o cartucho 34. Baseado neste dado, o circuito de controle135 pode controlar quando os comutadores 146, 140a e 140b comutam.
Como os cartuchos 34 são substituídos constantemente em certos tipos deinstrumentos 10, a identificação de dados pode ser transmitida ao circuito decontrole 135 por uma etiqueta ou transponder RFID conectado ao ou associ-ado ao cartucho 34 ou por outros meios. O sinal RFID da etiqueta pode serrecebida pelo circuito de controle 135 e armazenado na memória. Em outrasmodalidades, um transponder associado ao cartucho 34 pode enviar dadosidentificados ao circuito de controle 135 através de um ou mais enlaces indu-tivos, como descrito no Pedido de Patente publicado N0 U.S. 2008/0167522,intitulado "Surgical instrument with wireless communication between contraiunit and sensor transponders", que é aqui incorporado em sua totalidade porreferência.
De acordo com outras modalidades, o circuito de controle 135pode não conter quaisquer circuitos integrados. Por exemplo, o circuito decontrole 135 pode compreender circuitos de temporizadores analógicos (istoé, circuitos de timer com base RC) para controle do tempo de comutaçãodos comutadores 146, 140a a b. De acordo com tais modalidades, o circuitode controle 135 pode receber informação a cerca do comprimento do cortepara o cartucho particular 34 que é usado com base na complementação deum circuito elétrico quando o cartucho 34 está inserido no canal 22. Por e-xemplo, como mostrado na Figura 20, o canal 22 pode compreender umnúmero de placas de contato 220 posicionadas para encarar a superfícieinferior do cartucho 34 quando o cartucho 34 estiver carregado no canal 22.
A superfície interior do cartucho 34 pode compreender também um númerode contatos 222 no cartucho 34 que podem identificar o tipo de cartucho. Porexemplo, o número e posicionamento de contatos 222 podem identificar ocomprimento do corte para o cartucho 34. Todos os cartuchos de mesmocomprimento de corte devem ter preferencialmente o mesmo padrão de con-tato; cartuchos com diferentes comprimentos de corte devem ter diferentespadrões de contato. Õ circuito fica completo quando os contatos 222 do car-tucho 34 contatam os contatos 222 do canal 22 que pode ter um número deresistores diferente, um subconjunto do que estão conectados no circuitocompleto quando os contatos 222 do cartucho 34 contatam os contatos 220do canal 22. Dependendo do padrão de contato no cartucho 34, resistoresdiferentes podem estar no circuito completo. Os resistores podem estar co-nectados ao circuito controle 135 e pode ser usados nos circuitos RC paragerar os sinais de tempo para os comutadores 146, 140a, 140b. Dessa for-ma, o circuito de controle 135 pode controlar os comutadores 146, 140a a bbaseado no tipo de cartucho 34 carregado no efetor de extremidade 12.
Em outra modalidade, a superfície inferior do cartucho 34 podecompreender um êmbolo 230, como mostrado na Figura 22. O canal 22 po-de compreender um número de comutadores 232, como mostrado na Figura23, um dos quais é atuado pelo êmbolo 230 quando o cartucho 34 é carre-gado no efetor de extremidade 12. O comutador 232 pode ter um circuito deresistor associado diferente. Cada um dos circuitos resistores pode estarconectado ao circuito controle 135, mas apenas um iria ser ativado quando ocartucho 34 for carregado no canal 22, dependendo da localização do êmbo-lo 230. Cada cartucho substituível 34 que tem o mesmo comprimento de cor-te poderia, preferivelmente, ter um êmbolo 230 na mesma posição. Cartu-chos 34 com comprimentos diferentes iriam, preferivelmente, ter êmbolos230 em posições diferentes. Porque o efetor de extremidade 12 pode ape-nas acomodar um número finito de cartuchos diferentes (isto é, 5), o canal22 iria apenas precisar de um número correspondente de comutadores 232e ali iria apenas ser um número correspondente de localizações que aceitamêmbolo.
Em outras modalidades, o instrumento 10 pode compreender umseletor externo 240, como comutador DIP ou outro dispositivo de entradaadequado, por onde um operador do instrumento ou outra pessoa poderiaentrar com dados identificados para o cartucho 34 sendo usado. Como mos-trado na Figura 24, o manipulo pode compreender tal seletor 140 para mo-dalidades onde o circuito controle 135 compreende um IC ou modalidadesonde o circuito controle 135 não compreender qualquer ICs.
A Figura 25 mostra outra modalidade de circuito motor. Quandoo comutador do motor de funcionamento (ou disparo) 110 está fechado (émostrado em um estado aberto na Figura 25), quando o comutador de segu-rança 240 está fechado (é mostrado aberto na Figura 25) que indica que oinstrumento não está em uma condição travamento, a corrente flui atravésdo comutador de segurança 240, através do indicador de travamento 244(que pode ser um LED como mostrado na Figura 25) ao motor 65. Quando éatingido o final de curso de corte, o comutador de acionamento ou de final decurso 130 é comutado, que reverte a direção do motor 65 (que o comutadorde disparo 110 também é liberado). Neste estado, a corrente também fluiatravés de um indicador de acionamento reverso 246, como um LED, forne-cendo uma indicação visual que a direção do motor foi revertida.
Como mostrado na Figura 25, o circuito pode também compre-ender um comutador de retorno manual 248. O operador pode acionar ma-nualmente este comutador se o instrumento de corte 32 tenha sido apenasdisparado parcialmente. Comutando o comutador de retorno manual 248ocasiona a rotação reversa do motor 65, que ocasiona o retorno do instru-mento de corte 32 a sua posição original ou inicial.
A bateria 64 do instrumento 10 pode compreender um ou maiscélulas de baterias conectadas em séries. Em várias modalidades, um co-mutador de seleção de célula pode controlar como quantas das células debaterias está sendo usadas para energizar o motor 65 em um dado momen-to de o instrumento ter um melhor controle em ambas as velocidade e forçado motor 65. Em outra modalidade, o instrumento pode compreender umregulador de força, que inclui, por exemplo, um conversor DC-para-DC, queregula a voltagem fornecida ao motor. Adicionalmente, o ponto definido devoltagem para o regulador de força poderia ser definido de modo que a vol-tagem entregue da fonte de alimentação é menor que a voltagem na qual afonte de alimentação entrega força máxima. Dessa forma, a fonte de alimen-tação (isto é, um número de células de baterias conectadas em séries) pode-ria operar à "esquerda" ou aumentando o lado da curva de força, de modoque aumentasse a força que seria disponível.
Ademais, de acordo com várias modalidades, a fonte de alimen-tação 64 pode compreender dispositivos acumuladores secundários, comobaterias ou supercapacitadores recarregáveis. Tais dispositivos acumulado-res secundários podem ser carregados repetidamente por baterias substituí-veis. Um circuito de administração de carga pode controlar o carregamentodos dispositivos acumuladores de carga e fornecer variados sinais de situa-ção, como um alerta, quando é completada os dispositivos acumuladores decarga.
Em outras modalidades, a fonte de alimentação ou pacote deforça compreendido pelos dispositivos acumuladores de carga podem serremovidos do instrumento e conectável a uma base carregadora remota. Abase carregadora pode carregar os dispositivos acumuladores de carga,como dos dutos elétricos AC ou uma bateria. A base carregadora pode com-preender também um processador ou unidade de memória. Dados armaze-nados em uma memória do pacote de força substituível podem ser transferi-dos por download a uma base carregadora, da qual pode ser transferida porupload para uso e analise posterior, como pelo usuário (isto é, físico), o fa-bricante ou distribuidor do instrumento, etc. O dado pode compreender pa-râmetros operacionais, como informação do ciclo de carga, como tambémvalores ID para vários componentes substituíveis do instrumento, como ocartucho de grampeamento.Mais detalhes sobre tais fontes de alimentação podem ser acha-dos nos Pedidos cedidos à mesma cessionária do presente, N0 de SérieU.S. 12/031.556, intitulado "Motorized surgical cutting and fastening instru-ment" e N0 Série 12/031.567, intitulado "Motorized surgical cutting and faste-ning instrument having handle based Power source", ambos depositados em14 de fevereiro de 2008 e ambos incorporados aqui como referência em suatotalidade.
Os dispositivos descritos aqui podem ser desenhados para se-rem dispostos após um uso único ou eles podem ser desenhados para serusado múltiplas vezes. Em ambos os casos, porém, o dispositivo pode serrecondicionado para reuso após pelo menos um uso. Recondicionamentopode incluir qualquer combinação de etapas de desmontagem do dispositivo,seguido por limpeza ou recolocação de peças particulares e subsequenteremontagem. Em particular, o dispositivo pode ser desmontado e qualquernúmero de peças ou partes particulares do dispositivo pode ser removido ourecolocado seletivamente em qualquer combinação. Sobre limpeza e/ou re-colocação de partes particulares, o dispositivo pode ser remontado para usosubsequente mesmo em uma localidade recondicionante ou por um timecirúrgico imediatamente anterior ao procedimento cirúrgico. Aqueles versa-dos na técnica apreciarão que recondicionamento de um dispositivo podeutilizar um variedade de técnicas de desmontagem, limpeza/recolocamento eremontagem. O uso de tais técnicas, assim como o dispositivo recondiciona-do resultante, estão todos dentro do escopo da presente invenção.
Preferivelmente, as várias modalidades da invenção descritasaqui serão processadas antes da cirurgia. Primeiro, um instrumento novo ouusado é obtido e se necessário limpo. O instrumento pode ser esterilizado.Em uma técnica de esterilização, o instrumento colocado em um comparti-mento fechado e vedado, como um plástico termoformado deve cobrir comoconcha com uma folha de TYVEK. O compartimento e instrumento são entãocolocados em um campo de radiação que pode penetrar o compartimento,como radiação gama, raios-X ou elétrons de energia alta. A radiação mataas bactérias no instrumento e no compartimento. O instrumento esterilizadopode ser armazenado em um compartimento estéril. O compartimento veda-do mantém o instrumento estéril até sua abertura na localidade médica.
É preferido que o dispositivo seja esterilizado. Pode ser feito emqualquer número de formas conhecidas para aqueles versados na técnicaque inclui radiação beta ou gama, oxido etileno, vapor e outros métodos.
Enquanto a presente invenção foi ilustrada pela descrição devárias modalidades e enquanto as modalidades ilustradas foram descritasem detalhes consideráveis, não é intenção do pedido restringir ou de qual-quer forma limitar o escopo das reivindicações anexadas para tais detalhes.
Vantagens adicionais e modificações podem aparecer prontamente para a-queles versados na técnica. As várias modalidades da presente invençãorepresentam vastos melhoramentos sobre métodos de grampeamento ante-riores que requeriam o uso de tamanhos de grampos diferentes em um car-tucho único para atingir grampos que tem comprimentos formados (final) quediferem.
Consequentemente, a presente invenção foi discutida em termosde aparelhos e procedimentos endoscópicos. Porém, o uso aqui dos termoscomo "endoscópico" não deve ser interpretado no sentido de limitar a pre-sente invenção a um instrumento cirúrgico de grampeamento e separaçãopara uso apenas com um tubo endoscópico (isto é, trocarte). Ao contrário,acredita-se que a presente invenção pode ser usada em qualquer procedi-mento onde o acesso for limitado, incluindo mas sem caráter Iimitativo pro-cedimentos laparoscópicos, como também procedimentos de abertura. Ain-da assim, os aspectos únicos e originais de várias modalidades de cartuchode grampeamento da presente invenção podem ter utilidade quando usadosem conexão com outras formas de aparelhos de grampeamento sem que seabandone o espírito e escopo da presente invenção.
Claims (22)
1. Instrumento cirúrgico de fixação e corte, compreendendo:um efetor de extremidade compreendendo um instrumento decorte que, quando atuado, atravessa longitudinalmente o efetor de extremi-dade para cortar o tecido preso no efetor de extremidade;um eixo conectado em sua extremidade distai ao efetor de ex-tremidade; eum manipulo conectado a uma extremidade próxima do eixo, emque a pega compreende:um motor elétrico para atuar no instrumento de corte;um circuito de controle motor para controle do motor, em que ocircuito de controle motor compreende:uma fonte de alimentação conectada ao motor para acionar ele-tricamente o motor;eum circuito de controle de corrente, conectada à fonte de alimen-tação, para variação da corrente fornecida ao motor a partir da fonte de ali-mentação, de modo que o motor tenha pelo menos:um primeiro, modo operacional de baixa potência para uma pri-meira porção de um ciclo de curso de corte do instrumento de corte; eum segundo, modo operacional de alta potência para uma se-gunda porção do ciclo de curso de corte do instrumento de corte.
2. Instrumento cirúrgico de fixação e corte, de acordo com a rei-vindicação 1, em que o circuito de controle de corrente compreende:um comutador conectado a uma fonte de alimentação;um resistor conectado em paralelo ao comutador; eum circuito de controle para controle do comutador.
3. Instrumento cirúrgico de fixação e corte, de acordo com a rei-vindicação 1, em que o circuito de controle de corrente compreende um re-sistor variável.
4. Instrumento cirúrgico de fixação e corte, de acordo com a rei-vindicação 1, em que o circuito de controle de corrente compreende um cir-cuito de controle de modulação de amplitude de pulso.
5. Instrumento cirúrgico de fixação e corte, de acordo com a rei-vindicação 1, em que o circuito de controle de corrente compreende um cir-cuito de controle de modulação de freqüência.
6. Instrumento cirúrgico de fixação e corte, de acordo com a rei-vindicação 1, em que o circuito de controle de corrente compreende um cir-cuito amplificador.
7. Instrumento cirúrgico de fixação e corte, de acordo com a rei-vindicação 1, em que o circuito de controle de corrente controla o motor deacordo com uma arquitetura de comutação, de modo que o motor esteja noprimeiro modo operacional de baixa potência quando o instrumento de corteestiver em uma distância limítrofe de uma posição inicial do instrumento decorte.
8. Instrumento cirúrgico de fixação e corte, de acordo com a rei-vindicação 7, em que o circuito de controle de corrente controla o motor deacordo com uma arquitetura de comutação, de modo que o motor esteja emum segundo modo operacional de baixa potência quando o instrumento decorte estiver em uma distância limítrofe de uma posição de final de curso doinstrumento de corte
9. Instrumento cirúrgico de fixação e corte, de acordo com a rei-vindicação 8, em que o circuito de controle de corrente reverte uma direçãorotacional do motor quando o instrumento de corte atinge a posição de finalde curso.
10. Instrumento cirúrgico de fixação e corte, de acordo com areivindicação 9, em que o circuito de controle de corrente remove a correntedo motor antes de o instrumento de corte atingir a posição de final de curso.
11. Instrumento cirúrgico de fixação e corte, de acordo com a rei-vindicação 10, em que o circuito de controle de corrente remove a corrente domotor antes de o instrumento de corte atingir a posição original quando o ins-trumento de corte estiver sendo retraído de sua posição de final de curso.
12. Instrumento cirúrgico de fixação e corte, de acordo com areivindicação 1, em que o circuito de controle de motor não inclui um circuitointegrado.
13. Instrumento cirúrgico de fixação e corte, de acordo com areivindicação 11, em que o circuito de controle motor não inclui um circuitointegrado.
14. Instrumento cirúrgico de fixação e corte, de acordo com areivindicação 1, em que o circuito de controle motor compreende adicional-mente um indicador para indicar visualmente uma direção rotacional do motor.
15. Instrumento cirúrgico de fixação e corte, de acordo com areivindicação 1, em que o circuito de controle motor compreende adicional-mente um comutador de retorno manual que, quando ativado, ocasiona arotação reversa do motor.
16. Instrumento cirúrgico de fixação e corte, de acordo com areivindicação 1, em que:o motor compreende um motor CC; ea fonte de alimentação compreende uma fonte de alimentaçãon CC.
17. Instrumento cirúrgico de fixação e corte que compreende:um efetor de extremidade que compreende um instrumento decorte que, quando atuado, atravessa longitudinalmente o efetor de extremi-dade para cortar o tecido preso no efetor de extremidade;um eixo conectado em sua extremidade distai ao efetor de ex-tremidade; eum manipulo conectado a uma extremidade próxima do eixo, emque o manipulo compreende:um motor elétrico para atuar no instrumento de corte;uma fonte de alimentação conectada ao motor para acionar ele-tricamente o motor; eum circuito de controle conectado à fonte de alimentação e aomotor, em que o circuito de controle serve para:avançar a rotação do motor durante uma primeira porção de umciclo de curso de corte do instrumento de corte;reverter a rotação do motor durante uma segunda porção do ci-clo de curso de corte após o instrumento de corte atingir uma posição definal de curso;eremover a corrente do motor antes de o instrumento de corteatingir a posição de final de curso.
18. Instrumento cirúrgico de fixação e corte, de acordo com areivindicação 17, em que o circuito de controle serve adicionalmente pararemoção da corrente do motor antes de o instrumento de corte atingir umaposição inicial para o instrumento de corte quando o instrumento de corte éretraído de sua posição de final de curso.
19. Instrumento cirúrgico de fixação e corte, de acordo com areivindicação 17, em que o efetor de extremidade compreende:um canal que possui uma pluralidade de blocos de contato; eum cartucho substituível que compreende uma pluralidade decontatos que fazem face com os blocos de contato do canal, em que os blo-cos de contato no canal são conectados ao circuito de controle.
20. Instrumento cirúrgico de fixação e corte, de acordo com areivindicação 17, em que o efetor de extremidade compreende:um canal que possui uma pluralidade de comutadores indicado-res de comprimento do cartucho; eum cartucho substituível que compreende um êmbolo para atuarem um dentre uma pluralidade de comutadores de indicadores de compri-mento do cartucho quando o cartucho estiver carregado no canal, em que oscomutadores indicadores de comprimento do cartucho são conectados aocircuito de controle.
21. Instrumento cirúrgico de fixação e corte, de acordo com areivindicação 17, em que o circuito de controle não compreende quaisquercircuitos integrados.
22. Instrumento cirúrgico de fixação e corte, de acordo com areivindicação 20, em que o circuito de controle não compreende quaisquercircuitos integrados.
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US12/235,782 | 2008-09-23 | ||
US12/235,782 US8210411B2 (en) | 2008-09-23 | 2008-09-23 | Motor-driven surgical cutting instrument |
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BRPI0905604A2 true BRPI0905604A2 (pt) | 2011-03-29 |
BRPI0905604B1 BRPI0905604B1 (pt) | 2019-07-30 |
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BRPI0905604-1A BRPI0905604B1 (pt) | 2008-09-23 | 2009-09-23 | Instrumento cirúrgico de fixação e corte |
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2008
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2009
- 2009-09-18 JP JP2009216541A patent/JP5701492B2/ja active Active
- 2009-09-21 CA CA2679516A patent/CA2679516C/en not_active Expired - Fee Related
- 2009-09-22 PL PL09252253T patent/PL2165664T3/pl unknown
- 2009-09-22 EP EP09252253.1A patent/EP2165664B1/en active Active
- 2009-09-22 RU RU2009135321/14A patent/RU2534520C2/ru not_active IP Right Cessation
- 2009-09-23 BR BRPI0905604-1A patent/BRPI0905604B1/pt active IP Right Grant
- 2009-09-23 CN CN2009101750324A patent/CN101683284B/zh active Active
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2012
- 2012-06-01 US US13/486,175 patent/US8602287B2/en active Active
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2013
- 2013-03-05 US US13/784,960 patent/US20130175317A1/en not_active Abandoned
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2015
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2016
- 2016-12-08 US US15/372,984 patent/US20170086830A1/en not_active Abandoned
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2017
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2018
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2019
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2020
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Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 23/09/2009, OBSERVADAS AS CONDICOES LEGAIS. (CO) 20 (VINTE) ANOS CONTADOS A PARTIR DE 23/09/2009, OBSERVADAS AS CONDICOES LEGAIS |