ES2216038T3 - Dispositivo de tratamiento quirurgico de tejido con mecanismo de bloqueo. - Google Patents
Dispositivo de tratamiento quirurgico de tejido con mecanismo de bloqueo.Info
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- ES2216038T3 ES2216038T3 ES96303149T ES96303149T ES2216038T3 ES 2216038 T3 ES2216038 T3 ES 2216038T3 ES 96303149 T ES96303149 T ES 96303149T ES 96303149 T ES96303149 T ES 96303149T ES 2216038 T3 ES2216038 T3 ES 2216038T3
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Abstract
UN MECANISMO DE BLOQUEO PARA ASEGURAR EL USO CORRECTO SECUENCIAL DE UN INSTRUMENTO QUIRURGICO, PARA UN INSTRUMENTO QUE UTILIZA ENERGIA DE TRATAMIENTO DE TEJIDO, ESPECIALMENTE UNA ENERGIA CALENTADORA DE TEJIDO, POR EJEMPLO, ENERGIAS ELECTROQUIRURGICAS, ULTRASONICAS, TERMICAS, DE LASER, LUZ INFRARROJA ETC. UNA ADAPTACION INCLUYE UN ELEMENTO DE CORTE PARA SU UTILIZACION UNA VEZ COMPLETADO EL TRATAMIENTO DE CALOR DEL TEJIDO HASTA UN GRADO DESEADO. EL INSTRUMENTO DE LA ADAPTACION PREFERIDA INCLUYE UN MONITOR DE RETROALIMENTACION DISPUESTO PARA PROPORCIONAR UNA FINALIZACION DE SEÑAL INDICADORA DEL TRATAMIENTO DE TEJIDO. UNA ADAPTACION INCLUYE UN MECANISMO DE BLOQUEO ELECTROMECANICO QUE RESPONDE A LA SEÑAL DE RETROALIMENTACION DE FINALIZACION DEL TRATAMIENTO DE TEJIDO, Y DEPUESTO PARA DESBLOQUEARSE CUANDO SE COMPLETA DICHO TRATAMIENTO.
Description
Dispositivo de tratamiento quirúrgico de tejido
con mecanismo de bloqueo.
Esta invención se refiere a un mecanismo de
fijación para un instrumento electroquirúrgico para la
cauterización, coagulación y/o soldadura del tejido durante la
realización de procedimientos quirúrgicos, especialmente
procedimientos endoscópicos.
Los procedimientos quirúrgicos que requieren el
corte de tejido, pueden ocasionar un sangrado en el lugar del corte.
Se han adaptado diversas técnicas para controlar el sangrado con
grados de éxito variables, tales como, por ejemplo, la suturación,
la aplicación de clips a los vasos sanguíneos, y el grapado, así
como también la electrocauterización y otras técnicas de
calentamiento del tejido. Los avances en la unión o soldadura del
tejido, en la reparación del tejido y en el cierre de heridas, han
permitido procedimientos quirúrgicos que anteriormente no eran
posibles o entrañaban demasiado riesgo.
Las grapadoras quirúrgicas han sido utilizadas
para la aproximación y unión, con seguridad, del tejido, y para
proporcionar hemostasis en conjunción con el corte del tejido. Tales
dispositivos incluyen, por ejemplo, instrumentos de corte lineal y
circular y de grapado. Típicamente, un cortador lineal posee filas
paralelas de grapas con una ranura para que el medio de corte se
desplace entre las filas de grapas. Este tipo de grapadora
quirúrgica asegura un corte perfeccionado del tejido, une las capas
de tejido, y proporciona hemostasis mediante la aplicación de filas
paralelas de grapas a las capas de tejido circundante según el medio
de corte efectúa el corte entre las filas paralelas. En estos
dispositivos, se han descrito mecanismos de cierre para evitar el
redisparo de cartuchos de grapas de disparo único.
Los dispositivos electroquirúrgicos han sido
utilizados para efectuar una hemostasis perfeccionada mediante
calentamiento del tejido y de los vasos sanguíneos, para provocar la
coagulación o la cauterización. La Patente U.S. núm. 5.403.312
describe un dispositivo de corte y grapado que grapa el tejido,
aplica energía electroquirúrgica al tejido, y corta el tejido. Se
han utilizado otros instrumentos para cortar y coagular el tejido,
utilizando otras energías de calentamiento del tejido, tales como,
por ejemplo, ultrasonidos, láser, térmica, y luz infrarroja.
Resulta deseable proporcionar un medio para
controlar un dispositivo de calentamiento de tejido hemostático, con
funciones de corte y/o grapado, para evitar una aplicación
secuencial inapropiada de estas funciones. Por ejemplo, para evitar
el corte antes de proporcionar hemostasis. También es deseable
proporcionar un medio para evitar el uso del instrumento cuando el
cartucho de grapas está vacío, con anterioridad a que la energía de
calentamiento del tejido haya sido aplicada, o cuando el tratamiento
del tejido está incompleto.
En consecuencia, un objeto de la presente
invención consiste en proporcionar un instrumento de tratamiento
hemostático del tejido, dotado de un mecanismo de fijación para
asegurar una secuencia apropiada de actuación del dispositivo.
Una realización preferida proporciona un
instrumento quirúrgico con una porción de tratamiento del tejido que
tiene un dispositivo de suministro de energía terapéutica dispuesto
de modo que suministra energía terapéutica al tejido, y un
dispositivo de manipulación del tejido. La energía terapéutica es
energía, por ejemplo, electroquirúrgica, calorífica, luminosa,
ultrasónica, etc., utilizada para tratar el tejido con el fin de
proporcionar un efecto terapéutico, por ejemplo para calentar,
cortar, coagular, soldar, cauterizar, etc., el tejido. Un
dispositivo de manipulación del tejido consiste en un dispositivo
que se utiliza para tratar o manipular tejido, dotado de un medio
mecánico o de un medio que tiene un efecto mecánico sobre el tejido,
por ejemplo, para dividir, cortar, unir, sujetar, poner clips,
grapar, etc.
La porción de tratamiento del tejido de la
presente invención, se encuentra acoplada a un eje. El eje incluye
un dispositivo de comunicación de energía terapéutica que suministra
energía terapéutica al dispositivo de suministro de energía
terapéutica en la porción de tratamiento de tejido. Tal dispositivo
de comunicación de energía puede comprender cables o conductores
para suministrar energía eléctrica a un electrodo o calentador, un
eje metálico para suministrar energía ultrasónica, fibras luminosas
para suministrar láser o energía luminosa, etc.
Un dispositivo actuador de manipulación de tejido
acciona el dispositivo de manipulación de tejido, y un mecanismo de
fijación mueve o cambia el dispositivo actuador de manipulación
desde una posición de fijado hasta una de liberado, o viceversa. Con
preferencia, esto ocurre después de que se ha iniciado o completado
el suministro de energía terapéutica al tejido.
La realización preferida incluye, además, un
dispositivo de control de instrumento y de medición de parámetros
del tejido, que proporciona una señal de realimentación
representativa del estado de tratamiento del tejido, por ejemplo,
soldadura o coagulación completa, y se encuentra acoplado a, y/o
controla, la porción de tratamiento del tejido, ya sea directamente
o ya sea indirectamente, mediante el control de la energía
suministrada al dispositivo de suministro de energía, accionando el
dispositivo de manipulación de tejido, habilitando o inhabilitando
una cualquiera de estas características, o provocando que el
dispositivo opere, o sea operado por el usuario, de una manera
secuencial. En lo que sigue se describen diversas características
alternativas de la invención.
Un aspecto de la invención proporciona un
dispositivo de corte con un medio de suministro de energía para la
soldadura, coagulación o cauterización del tejido, en particular a
lo largo de una trayectoria de corte. La presente invención
proporciona un mecanismo de fijación para evitar el corte o la
actuación del elemento de corte hasta que se aplique energía
terapéutica, o hasta después de que haya ocurrido la coagulación,
cauterización o soldadura.
En una realización preferida, se utiliza energía
electroquirúrgica, aunque otros dispositivos son también
contemplados por la invención. En consecuencia, la invención va a
ser descrita con relación a su uso con un instrumento
electroquirúrgico.
En varias realizaciones de la presente invención,
la energía electroquirúrgica puede ser aplicada junto con la
aplicación de uno o más sujetadores de tejido tales como, por
ejemplo, grapas, clips, sujetadores absorbibles, etc., utilizando un
aplicador para aplicar el sujetador, tal como un accionador para
impulsar las grapas sobre el tejido. Cuando se usa con un
instrumento de corte y grapado, el mecanismo de fijación evita con
preferencia el disparo de la grapa hasta después de que se ha
aplicado la energía electroquirúrgica, y evita el redisparo una vez
que las grapas han sido disparadas. En consecuencia, un mecanismo de
fijación de una realización evita la actuación del elemento de corte
y de los impulsores de grapas sin la aplicación de energía de RF, o
sin hemostasis apropiada, y a continuación evita el redisparo de un
cartucho de grapas ya gastado.
Estos y otros objetos de la invención son
descritos en una realización preferida en la que un dispositivo
electroquirúrgico incluye un efector extremo con superficies de
entrecara opuestas para enganchar el tejido entre ambas, y dos
electrodos eléctricamente diferentes, correspondientes a potenciales
eléctricamente distintos, estando al menos un electrodo situado
sobre una o sobre ambas superficies opuestas. Con preferencia, los
electrodos están desviados cada uno del otro con respecto a las
superficies de entrecara, es decir, están desviados cada uno del
otro de modo que no son diametralmente opuestos cada uno respecto al
otro en una superficie o superficies de entrecara.
Un instrumento electroquirúrgico de una
realización preferida, comprime el tejido en una zona de compresión
entre una primera superficie de entrecara y una segunda superficie
de entrecara, y aplica energía eléctrica a través de la zona de
compresión. La primera superficie de entrecara comprende: un primer
electrodo correspondiente a un primer polo de una fuente de energía
bipolar, y un segundo electrodo correspondiente a un segundo polo de
una fuente de energía bipolar. El segundo electrodo se sitúa en la
misma, o en la opuesta, superficie de entrecara que el primer
electrodo. En esta realización particular de la invención, la zona
de compresión es un área definida por un reborde de compresión sobre
una o más superficies de entrecara, que comprime el tejido contra la
otra superficie de entrecara. Una zona de coagulación se define
mediante el primer electrodo, el segundo electrodo, y un aislante
que aísla el primer electrodo del segundo electrodo.
En una realización preferida, el dispositivo
hemostático se incorpora en un cortador lineal similar a una
grapadora mecánica de corte lineal. En esta realización, el
dispositivo hemostático comprende dos barras de electrodo alargadas
y una ranura para un medio de corte, para cortar el tejido
enganchado por el efector extremo del dispositivo. Con preferencia,
las barras son lateralmente adyacentes a un aislante que forma un
reborde para comprimir el tejido que ha de ser cauterizado.
Opcionalmente, se puede prever una o más filas de grapas a cada lado
de la ranura y de las barras, para proporcionar seguridad mecánica
al tejido o aproximación durante el proceso de curación. En
funcionamiento, el tejido se grapa entre dos mordazas. La energía
eléctrica en forma de corriente de radiofrecuencia, se aplica al
tejido comprimido con el fin de cauterizar el tejido. El dispositivo
proporciona líneas hemostáticas adyacentes a la trayectoria del
elemento de corte. Se pueden utilizar también otros instrumentos de
corte y grapado, tales como, por ejemplo, un instrumento de corte
circular interluminal.
El mecanismo de cierre de la presente invención
puede incluir elementos de fijación mecánicos, eléctricos y/o
electromecánicos, y puede ser accionado en respuesta a una señal de
control, desde un controlador.
En una realización, un indicador comunica al
usuario que el tejido ha sido cauterizado hasta un grado deseado o
predeterminado. En la realización preferida, un sensor de impedancia
del tejido se encuentra incorporado en el dispositivo con el fin de
determinar el estado de coagulación en base a la impedancia del
tejido que se haya medido. El sensor de impedancia puede incluir un
controlador que proporcione una señal de control basada en el estado
de tratamiento del tejido. La señal de control puede ser utilizada
para controlar el generador, para controlar eléctricamente el
mecanismo de fijación, y/o para proporcionar una señal perceptible
por un usuario.
Estos y otros objetos de la invención podrán ser
mejor comprendidos a partir de la Descripción Detallada de los
Dibujos adjuntos que sigue, tomada junto con la Descripción
Detallada de la invención.
La Figura 1 es una vista en perspectiva de un
instrumento electroquirúrgico endoscópico de una realización de la
presente invención;
la Figura 2 es una vista en alzado lateral de la
realización de la Figura 1, mostrada en una posición enclavada,
cerrada, con anterioridad al corte o grapado;
la Figura 3 es una vista en alzado lateral de la
realización de la Figura 2, mostrada según se aplica la energía de
RF al tejido;
la Figura 4 es una vista en alzado lateral
similar a la Figura 3, mostrada después de que la energía de RF ha
sido aplicada y el tejido ha sido cortado y grapado;
la Figura 5 es una vista en perspectiva,
despiezada, de la porción de mango proximal del instrumento de la
Figura 1;
la Figura 6 es una vista en perspectiva,
despiezada, de la porción intermedia y distal del instrumento de la
Figura 1;
la Figura 7 es una vista en alzado lateral de la
porción de mango proximal en una primera posición, abierta, del
instrumento de la Figura 1, representada con la tapa lateral
izquierda del mango y con los alambres metálicos separados;
la Figura 8 es una vista en alzado del interior
de la porción lateral izquierda del mango, que muestra la posición
de los alambres metálicos y de los conectores utilizados en la
presente invención;
la Figura 9 es una vista en sección longitudinal
de la porción intermedia del instrumento;
la Figura 10 es una vista en alzado del extremo
proximal de la porción intermedia, que muestra el contacto de los
alambres metálicos en sus respectivas posiciones de contacto;
la Figura 11 es una vista en sección transversal,
a mayor tamaño, del extremo proximal de la porción intermedia del
instrumento;
la Figura 11a es una vista en sección transversal
tomada a lo largo de la línea 11a - 11a de la Figura 11;
la Figura 12 es una vista en perspectiva que
muestra los alambres metálicos que contactan con sus respectivas
posiciones de contacto;
la Figura 13 es una vista extrema de la Figura
11, que muestra un ligero empuje de los alambres metálicos que
permite la presión de los alambres metálicos sobre sus respectivas
posiciones de contacto
la Figura 14 es una vista en sección longitudinal
del extremo distal del instrumento de la Figura 1, representado en
posición cerrada y enclavado;
la Figura 15 es una vista en sección transversal
parcial, a mayor tamaño, de la porción distal de la Figura 13;
la Figura 16 es una vista en sección transversal
tomada a lo largo de la línea 16 - 16 de la Figura 14;
la Figura 17 es una vista en sección transversal
tomada a lo largo de la línea 17 - 17 de la Figura 14;
la Figura 18 es un diagrama de flujo que ilustra
el uso del instrumento de la Figura 1 con un mecanismo de fijación
de la presente invención;
la Figura 19 ilustra una vista lateral de un
miembro de mango de una realización alternativa de un mecanismo de
fijación en posición fijada;
la Figura 20 ilustra una vista lateral del mango
del instrumento de la Figura 19, con el mecanismo de fijación en
posición liberada;
la Figura 21 ilustra una vista lateral del mango
de las Figuras 19 y 20, mostrando el mecanismo de fijación que está
siendo repuesto después de haber sido disparado, y
la Figura 22 es un diagrama de bloques que
ilustra el uso preferido de los dispositivos de cierre de las
Figuras 19 - 21.
Mientras que la presente invención es aplicable,
en general, a una diversidad de instrumentos electroquirúrgicos
incluyendo los monopolares, bipolares y multipolares (es decir, que
incluyen dos o más electrodos terapéuticos que proporcionan energía
en formas de onda desde un polo cualquiera hasta el otro polo como
si tuvieran una relación fásica), y ambos convencionales o
endoscópicos, aquí se va a describir con referencia a un instrumento
de corte y grapado lineal bipolar endoscópico.
El funcionamiento de los instrumentos de corte y
grapado lineal, es conocido en la técnica y se ha discutido, por
ejemplo, en las Patentes US núms. 4.608.981 y 4.633.874.
Haciendo ahora referencia a las Figuras 1 - 17,
se ha ilustrado un instrumento según la presente invención que ha de
ser usado junto con un dispositivo de realimentación de impedancia.
Se ha representado un instrumento 10 de corte y grapado lineal
endoscópico provisto de un alojamiento 16 acoplado a una funda 30
con un lumen que se extiende a través de ésta, y un efector 15
extremo que se extiende desde el extremo distal de la funda 30. El
efector 15 extremo comprende un primer y un segundo elementos que
están provistos de miembros 32, 34 de mordaza de entrecara. El
miembro 32 de mordaza está sujeto de forma móvil al miembro 34 de
mordaza. El alojamiento 16 posee un gatillo de grapado 12 para
cerrar los miembros de mordaza 32, 34, un brazo 58 de tope de
conmutador de RF, y contactos 67a, 67b de conmutación eléctrica,
acoplados a un conmutador eléctrico 59 para conectar la energía de
RF, y un gatillo 14 para hacer avanzar el elemento 11 a través del
tejido, y una cuña 13 para aplicar grapas 17. Los miembros de
mordaza 32, 34 han sido representados en posición desenclavada en la
Figura 1; en posición enclavada con anterioridad a la aplicación de
energía electroquirúrgica y con anterioridad al corte y grapado en
la Figura 2; en posición enclavada tras la aplicación de energía
electroquirúrgica y antes del corte y grapado en la Figura 3; y en
posición enclavada tras el corte y grapado en la Figura 4.
El miembro 32 de mordaza comprende un yunque 18,
un electrodo terapéutico 39 en forma de U que se extiende a lo largo
de la longitud de la mordaza 32, y un material 31 aislante en forma
de U que rodea la parte exterior del electrodo 39 terapéutico. El
miembro 32 de mordaza posee una superficie 33 interna que se
enfrenta sustancialmente a la superficie 35 interna del miembro 34
de mordaza. El electrodo 39 en forma de U comprende dos barras 27,
28 de electrodo que se comunican eléctricamente, que forman un
primer polo y que están situadas sobre, y extendiéndose
sustancialmente a lo largo de, la longitud de la superficie 33
interna. El electrodo 39 en forma de U comprende un conductor, tal
como de aluminio o de acero inoxidable de grado quirúrgico. El
aislador en forma de U está formado, con preferencia, por un
polímero tal como polifenilenóxido. Las barras 27, 28 están
separadas por un canal 29 de cuchilla que se extiende
longitudinalmente a través del centro del electrodo 39. Las bolsas
36 situadas en el yunque 18 para recibir los extremos de las grapas,
están situadas a lo largo de la superficie 33 interna, a lo largo de
la longitud y de la parte exterior de las barras 27, 28, para formar
una fila de grapas a cada lado del electrodo 39. Las barras 27, 28
de electrodo y el material 31 aislante forman un reborde 56 que se
extiende hacia fuera en relación con la porción 33a de yunque de la
superficie 33 interna (Figura 16). El electrodo 39 actúa como un
primer polo de un sistema terapéutico o de tratamiento de tejido
bipolar. El yunque 18 está formado por un material eléctricamente
conductor y actúa como un segundo electrodo terapéutico del sistema
terapéutico o de tratamiento bipolar, siendo el yunque
eléctricamente opuesto al electrodo 39 de tratamiento. El yunque 18
está aislado eléctricamente del electrodo 39 por medio del material
31 aislante en forma de U.
El miembro 34 de mordaza comprende un canal 22 de
cartucho y un cartucho 23 insertado liberablemente en el canal 22 de
cartucho. El cartucho 23 incluye una pista 25 para la cuña 13, un
canal de cuchilla 26 que se extiende longitudinalmente por el centro
del cartucho 23, una serie de actuadores 24 que se extienden hacia
la pista 25, y grapas 17 dispuestas según dos conjuntos de filas
simples.
La funda 30 ha sido formada con un material
aislante, y posee un tubo 38 de cierre eléctricamente conductor, que
se extiende a través del lumen. En una realización preferida, el
tubo 38 de cierre actúa como tubo de cierre de mordaza y como
contacto eléctrico. Un retenedor 37a de canal se extiende desde el
extremo proximal del tubo 38 de cierre y se ha fijado al canal 37
que se extiende distalmente a través del resto del tubo 38 de cierre
para formar el miembro 34 de mordaza. El canal 37 incluye un canal
22 de cartucho que se extiende distalmente desde el tubo 38 de
cierre.
El cuerpo 16 posee un gatillo 12 de grapado para
hacer avanzar el tubo de cierre 38 para cerrar las mordazas 23, 23
cada una hacia la otra, enganchando el tejido entre ambas. La
rotación del gatillo 12 de grapado provoca que el tubo 38 de cierre
avance coaxialmente a través de la funda sobre una superficie 32a a
modo de leva de la mordaza 32, para cerrar las mordazas 32, 34 sobre
el tejido situado entre las mordazas 32, 34.
El retenedor 37a de canal guía el movimiento
coaxial de una varilla 41 actuadora por dentro del canal 37. La
varilla 41 actuadora se hace avanzar mediante la rotación del
gatillo de disparo 14, como se describe con mayor detalle en lo que
sigue. La varilla 41 actuadora está acoplada, por su extremo distal,
a un bloque 43. El bloque 43 está acoplado a un medio 11 de corte y
a una cuña 13 de impulsión de grapa, cuya varilla actuadora 41
avanza por medio del bloque 43 hacia el efector extremo 15. Se
utiliza una guía 46 de cuña para guiar la cuña 13 hacia la pista 25.
El miembro 32 de mordaza se ha fijado por medio del canal 37 al
miembro 34 de mordaza.
Cuando la varilla actuadora 41 hace avanzar al
elemento 11 de corte, el elemento 11 de corte avanza a través del
canal 26 de cuchilla entre las barras 27, 28 para cortar el tejido
enganchado por las mordazas 32, 34 cuando el tejido ha sido
cauterizado. De este modo, la línea de corte ocupa posición medial
respecto a las líneas de coagulación formadas por los electrodos de
barra 27, 28. La varilla actuadora 41 hace avanzar simultáneamente
al bloque 43, y por tanto a la cuña 13 que impulsa los actuadores 24
hacia las grapas 17, provocando que las grapas 17 se disparen a
través del tejido, y hacia las bolsas 36 del yunque 18. Las grapas
17 se aplican en filas longitudinales simples a cada lado del
elemento 11 de corte, según corta el elemento 11 de corte el
tejido.
Un botón 44 situado en el extremo distal del
cuerpo 16, hace girar al tubo 38 de cierre, al retenedor de canal
37a, al canal 37 y al efector extremo 15, los cuales están
acoplados, directa o indirectamente, al botón 44, de modo que el
botón 44 puede ser utilizado para la colocación posicional de las
mordazas 32, 34 del efector extremo. El botón 44 incluye una clavija
(no representada) que se acopla en, y que engancha con, la muesca
38a del tubo de cierre 38. El tubo de cierre 38 se encuentra
acoplado, por su extremo distal, en el alojamiento 16.
Se suministra energía eléctrica al electrodo 39 y
al yunque 18, 70 por medio de conexiones tales como las que se
describen más adelante, o de otros medios de conexión tales como,
por ejemplo, del tipo de las que se describen en la Patente US núm.
5.403.312, incorporada aquí como referencia. El generador 70 está
controlado por el usuario a través del conmutador de RF 59, situado
en el alojamiento 16. Los cables 19c, 19d se extienden desde el
conmutador 59 hasta un controlador incluido en el generador 70, como
se describe a continuación.
Los cables 19a y 19b se extienden hacia el cuerpo
16 del instrumento, y entregan energía a los electrodos 39, 18,
respectivamente. Los cables 19a, 19b están acoplados a elementos
20a, 20b de contacto de baja impedancia, respectivamente, y los
elementos 20a, 20b de contacto están acoplados a alambres metálicos
47a, 47b, respectivamente. Los alambres metálicos 47a, 47b están al
descubierto por sus extremos distales 48a, 48b. Los alambres
metálicos 47a y 47b están empujados respectivamente hacia el tubo de
cierre 38 y el anillo de contacto 49b situado en el extremo proximal
del retenedor 37a de canal, con el fin de establecer contacto
eléctrico con el tubo 38 de cierre y con el anillo 49b,
respectivamente.
El cable 19a suministra corriente eléctrica al
yunque 18 por medio de un primer alambre metálico 47a que contacta
con el tubo de cierre 38 eléctricamente conductor, que contacta con
el yunque 18 eléctricamente conductor según realiza el tubo de
cierre 38 el cierre de las mordazas 32, 34.
El cable 19b suministra corriente eléctrica al
electrodo 39 a través de segundo alambre metálico 47b que contacta
con el anillo 49b de contacto acoplado al cable 40b que se extiende
a través del tubo 38 de cierre hasta el electrodo 39.
El tubo 38 de cierre y el contacto 49b de anillo
permiten que el botón 44 gire mientras se mantiene el contacto entre
el tubo de cierre 38, el anillo 49b, y los alambres metálicos 47a,
47b, respectivamente. El anillo 49b está aislado eléctricamente del
tubo 38 de cierre.
El cable 40b se extiende a través del sello 45
que se acopla en el retenedor 37a de canal, el cual se acopla en el
tubo 38 de cierre.
El gatillo 12 de enclavamiento, incluye dientes
de engranaje 12a que encajan de forma móvil con los dientes 66b del
yugo 66. El yugo 66 esta acoplado, por su extremo distal, al tubo 38
de cierre. Cuando se acciona el gatillo 12 de enclavamiento, los
dientes de engranaje 12a encajan con los dientes 66b del yugo 66,
provocando que el yugo 66 avance distalmente. El tubo 38 de cierre
efectúa el cierre de las mordazas 32, 34 según avanza sobre la
superficie 32a de leva de la mordaza 32.
El conmutador 59 de RF se gira para conectar la
energía de RF que ha de ser suministrada a los electrodos
terapéuticos. Cuando se gira el conmutador 59 de RF, el saliente 59a
de tope del conmutador 59 engancha por debajo del saliente 58a de
tope en el brazo 58 de tope, evitando que el conmutador 59 desactive
la energía de RF a menos que el conmutador 59 de RF sea girado
manualmente de nuevo hasta su posición original. La energía de RF
puede ser también desconectada eléctricamente.
El conmutador 59 posee un contacto móvil 67a y un
contacto estacionario 67b. El contacto móvil 67a gira con el
conmutador 59 para contactar con el contacto estacionario 67b cuando
el conmutador está en conexión. Se suministra una señal al generador
70 a través de los cables 19c, 19d acoplados al contacto
estacionario 67b y al contacto móvil 67a, respectivamente.
El reborde 60a del botón de liberación 60 está
enganchado al extremo proximal del yugo 66 adyacente al reborde 66a
en escalón del extremo proximal del yugo 66. Cuando se hace avanzar
el yugo 66 mediante el gatillo 12 de enclavamiento, el reborde 60a
gira hacia abajo por detrás del extremo proximal del yugo 66,
evitando con ello que el yugo 66 se retraiga hasta que se haya
presionado la liberación del botón 60. Así, las mordazas 32, 34
permanecerán en posición cerrada hasta que un usuario libere las
mordazas 32, 34 mediante el botón de liberación 60.
El conmutador 59 incluye dedos 59c que asientan
justamente por encima del extremo proximal del yugo 66. El reborde
60a del botón 60 de liberación se acopla entre los dedos 59c. El
conmutador 59 de RF no puede ser activado, es decir, girado hacia
delante, hasta que el yugo 66 haya sido avanzado distalmente de modo
que los dedos 59c del conmutador 59 estén libres para girar por
detrás del extremo proximal del yugo 66.
El conmutador 59 incluye también un gancho 59b
inferior que engancha con la ranura 53a de la cremallera de disparo
53. La cremallera de disparo 53 incluye dientes de engranaje 53b que
son enganchados por los dientes de engranaje 14a del gatillo de
disparo 14. La cremallera de disparo 53 está acoplada por su extremo
distal al engranaje piñón 54 que a su vez engancha con la varilla
actuadora 41.
Cuando se empuja el gatillo 14 de disparo, se
hace avanzar a la cremallera 53 de disparo distalmente para hacer
girar el piñón 54, el cual hace avanzar la varilla actuadora 41
distalmente para accionar el elemento 11 de corte y para impulsar
las grapas 17 hacia el tejido enganchado por el efector extremo
15.
La cremallera 53 de disparo no puede avanzar, sin
embargo, hasta que el gancho inferior 59b del conmutador de RF se
desencaja de la ranura 53a de la cremallera 53 de disparo. Esto
ocurre solamente cuando el conmutador 59 de RF ha sido activado.
De este modo, el dispositivo descrito actualmente
incluye un dispositivo, o dispositivos, de cierre, para evitar la
aplicación de energía de RF, de grapas, o la actuación de la
cuchilla hasta que las mordazas 32, 34 hayan sido cerradas. El (los)
dispositivo(s) de cierre requiere(n) que se siga la
secuencia apropiada según se ilustra en las Figuras 1 - 4 y 18, y
según se describe con mayor detalle en lo que sigue.
La presente invención proporciona también un
conmutador de RF mantenido, de modo que se aplique continuamente
energía de RF hasta que el conmutador 59 sea liberado manualmente, o
hasta que la energía de RF se conmute a desconexión, por ejemplo,
mediante una señal de control de realimentación eléctrica enviada al
generador.
El gatillo 12 de cierre y el gatillo 14 de
disparo, se encuentran interconectados, y un resorte 57 se encuentra
acoplado mecánicamente a ambos gatillos 12, 14.
Cuando el tejido está enganchado entre los
miembros 32, 34 de mordaza enclavados, y se aplica la energía de RF,
el gatillo 14 de disparo situado en el alojamiento 16 puede ser
accionado para hacer avanzar el elemento 11 de corte a través del
tejido enganchado, con el fin de cortar el tejido. Simultáneamente,
cuando se acciona el gatillo de disparo 14, se hace avanzar a la
cuña 13 a través de la pista 25, provocando que los accionadores 24
se desplacen hacia las grapas 14, impulsando con ello las grapas a
través del tejido y hacia las bolas 36 del yunque.
Una realización preferida de la presente
invención incluye un sistema de realimentación diseñado para indicar
cuándo ha ocurrido un efecto deseado predeterminado en el tejido. Se
puede utilizar un sistema de realimentación audible, visible, táctil
o de otro tipo para indicar cuándo se ha producido suficiente
cauterización, en cuyo momento la energía de RF puede ser
desconectada. En una realización particular, el sistema de
realimentación mide uno o más parámetros eléctricos del sistema, por
ejemplo, la impedancia eléctrica del tejido al que se aplica la
energía eléctrica, para determinar características del tejido, por
ejemplo, completar la coagulación. Un ejemplo de sistema de
realimentación de este tipo se encuentra descrito en la Patente U.S.
núm. 5.558.671, depositada el 23 de Septiembre de 1994.
Con la utilización de un sistema de
realimentación de este tipo, se puede proporcionar una señal
eléctrica para desconectar la energía de RF. Se puede utilizar una
señal de este tipo para abrir eléctricamente un mecanismo de
fijación con el fin de permitir la actuación de un elemento de corte
o la aplicación de grapas. Una vez que se ha desconectado la energía
de RF, el medio 11 de corte se hace avanzar, y las grapas 17 son
disparadas con la utilización del gatillo 14 de disparo.
En una realización, el cartucho proporciona
múltiples capacidades de grapado al disponer de filas simples de
grapas, al contrario que las dobles filas de grapas convencionales
de los cartuchos de los dispositivos laparoscópicos de corte y
grapado actualmente en uso. Con el fin de proporcionar una mejor
hemostasis, este tipo de grapadora fue diseñada con vistas a
proporcionar una doble fila de grapas para cada fila paralela.
Debido al tamaño del espacio necesario para contener la doble fila
de grapas, no se ha preferido un cartucho redisparable con grapas
apiladas, debido al espacio adicional que se requiere para el
apilamiento de las grapas. En la realización de grapadora
multidisparo, se utiliza una única fila de grapas. La utilización de
una sola fila de grapas permite el apilamiento de grapas en el
espacio ocupado anteriormente por la segunda fila de grapas,
proporcionando capacidades de multidisparo. El dispositivo de la
presente invención puede incluir sin embargo, si se desea, dobles,
triples, etc., filas de grapas. También, en una realización
adicional, no se requieren grapas, y las líneas de coagulación
eléctrica son las que proporcionan la hemostasis necesaria o efecto
de soldadura del tejido. Un cartucho se define aquí como un
mecanismo que contiene grapas.
Con referencia a la Figura 18, se ha ilustrado un
método preferido de actuación del instrumento de las Figuras 1 - 17.
Las mordazas 32, 34 del instrumento 10 se abren al presionar el
botón 60 (bloque 500). Si el cartucho 22 está usado, el cartucho se
sustituye (bloques 501, 502). A continuación, las mordazas 32, 34 se
posicionan sobre el tejido (bloque 503). El instrumento 10 se cierra
a continuación accionando el gatillo 12 (bloque 504). Si el
instrumento no está completamente cerrado, el cierre de RF se
mantiene en su lugar y no se puede aplicar RF (bloque 505). El
instrumento debe ser reposicionado sobre el tejido nuevamente, y/o
el instrumento debe ser cerrado. Si el instrumento está
completamente cerrado, el conmutador de RF puede ser activado
mediante la actuación del conmutador 59 de RF (bloque 506). El
accionamiento del conmutador 59 de RF libera el cierre de corte y
grapado (bloque 507). Según se aplica energía de RF, el tejido es
tratado y monitorizado en cuanto a la terminación del tratamiento
del tejido. Una señal generada, indica al usuario que el tratamiento
se ha completado, y la energía de RF de salida del generador se
controla mediante una señal correspondiente de control del generador
(bloque 508). El usuario puede accionar entonces el corte y grapado
con el gatillo 14 (bloque 509).
Haciendo ahora referencia a las Figuras 19 - 21,
se ha ilustrado una realización alternativa del cierre de la
presente invención. Se ha ilustrado un mango o alojamiento 116
provisto de un gatillo 112 de enclavamiento, y un gatillo 114 de
disparo. El gatillo 112 de enclavamiento se ha dispuesto para hacer
avanzar el tubo de cierre (no representado) similar al ilustrado en
las Figuras 1 a 17, mediante el enganche de los dientes 166b del
yugo 166 con los dientes de engranaje 112a del gatillo de
enclavamiento. Puesto que el yugo 166 se hace avanzar distalmente,
el tubo de cierre realiza el cierre de las mordazas del efector
extremo de una manera similar a la que se ha ilustrado con respecto
a las Figuras 1 - 17.
Un conmutador 159 de RF, es accionado por el
usuario para suministrar energía de RF al efector extremo (no
representado) del instrumento. (El efector extremo del instrumento
de esta realización se ha configurado de la misma manera que el de
las Figuras
1 - 17). El conmutador de RF puede estar situado, por ejemplo, en el mango 116, o a modo de conmutador de pie. El conmutador de RF 159 envía señales al generador para el suministro de energía al efector extremo.
1 - 17). El conmutador de RF puede estar situado, por ejemplo, en el mango 116, o a modo de conmutador de pie. El conmutador de RF 159 envía señales al generador para el suministro de energía al efector extremo.
El instrumento puede incluir alternativamente un
conmutador de RF que actúe justamente de la manera que se ha
descrito en las Figuras 1 - 17, en el que un conmutador de RF
previsto en el mango no puede ser activado hasta que las mordazas se
hayan cerrado, es decir, se haya hecho avanzar al yugo
distalmente.
El generador se encuentra dispuesto para recibir
información de impedancia del tejido que está siendo tratado por el
efector extremo. Un dispositivo y un método de este tipo se
encuentran ilustrados en la Patente U.S. núm. 5.558.671, depositada
el 23 de Septiembre de 1994. Cuando el generador ha detectado una
condición de coagulación completa utilizando la realimentación de
impedancia del tejido, se proporciona una señal a un mecanismo de
cierre electromecánico, como se describe a continuación.
El mecanismo de cierre electromecánico comprende
un solenoide 180 que recibe una señal eléctrica a través de cables
181 desde el generador 170. El solenoide 180 es un solenoide de
tracción que incluye un extremo 182 móvil que se mueve
descendentemente en respuesta a una señal apropiada suministrada a
través de cables 181. El extremo 182 del solenoide 180 se encuentra
acoplado a una palanca 183 mecánica por medio de un perno 184. La
palanca 183 incluye un gancho 185 con un botón 186 de retención. En
posición fijada, el gancho 185 engancha con una ranura 153a de una
cremallera 153 de disparo. La cremallera de disparo 153 incluye
dientes de engranaje 153b que son enganchados por los dientes de
engranaje 114a del gatillo 114 de disparo. La cremallera de disparo
153 actúa de modo que hace avanzar al elemento de corte y a los
impulsores de grapa en el efector extremo de una manera similar a la
que se describe en las Figuras 1 - 17.
Una vez que las mordazas han sido cerradas con la
utilización del gatillo 112 de enclavamiento, y la energía de RF ha
sido conectada con la utilización del conmutador de pie, se debe
enviar una señal al solenoide 180 por medio de los cables 181 para
hacer que el solenoide 180 tire de la palanca 183, de modo que el
gancho 185 sea girado hacia fuera desde la ranura 153a de la
cremallera de disparo 153, liberando con ello la cremallera 153 de
disparo para que avance distalmente. Un monitor de tejido
incorporado en el generador 170, determina si se ha completado la
coagulación, utilizando un monitor de realimentación de impedancia.
Con la terminación de la coagulación, se envía una señal de control
desde los cables 181 hasta el solenoide 180, para provocar que el
extremo 182 se retraiga hacia el solenoide 180. Esto provoca que la
palanca 183 haga girar el gancho 185 hacia fuera desde la cremallera
153. El tope 186 previsto en la palanca 183, engancha con el tope
187 situado en el alojamiento, para mantener la palanca 183 fuera de
la cremallera 153.
Una vez que las grapas han sido disparadas, el
botón de liberación 160 debe ser presionado para liberar las
mordazas desde su posición de cerradas, y con ello el instrumento
respecto al tejido. El botón 160 de liberación incluye un dedo 161
que engancha con el reborde 162 de la palanca 183 cuando se presiona
el botón de liberación. El dedo 162 provoca una fuerza ascendente
sobre el reborde 162 que hace que la palanca 183 se libere del tope
187, y que la ranura 153a de la cremallera de disparo 153 se
reenganche con el gancho 185 de la palanca 183.
Haciendo ahora referencia a la Figura 22, se ha
ilustrado un método de utilización del instrumento de las Figuras 19
- 21. Las mordazas del instrumento 110 se abren al presionar el
botón de liberación 160 (bloque 600). Si el cartucho es usado, dicho
cartucho se sustituye (bloques 601, 602). A continuación, se
posicionan las mordazas del instrumento sobre el tejido (bloque
603), y se cierran mediante el gatillo 112 (bloque 604). Se aplica
energía de RF por parte del usuario, con la activación del
conmutador de pie 159, una vez que el usuario ha determinado que las
mordazas se encuentran posicionadas apropiadamente sobre el tejido
(bloque 605). El tejido se monitoriza en cuanto a terminación del
tratamiento (bloques 606, 607), utilizando un dispositivo de
realimentación de monitor de tejido, tal como, por ejemplo, el
dispositivo descrito en la Patente U.S. núm. 5.558.671. Se
proporciona una señal generada de tratamiento de tejido cuando se ha
completado el tratamiento. Cuando el tratamiento del tejido está
completo, se desconecta la energía de RF (bloque 609), y se acciona
el solenoide 180 para liberar el cierre de corte y grapado (bloque
610). Los mecanismos de corte y grapado pueden ser accionados a
continuación (bloque 610).
Se han descrito diversas variantes de la
invención en relación con realizaciones específicas, que incluyen
dispositivos hemostáticos electroquirúrgicos y de corte y grapado
endoscópico. Naturalmente, la invención puede ser utilizada en
numerosas aplicaciones donde se desee la hemostasis. También, el
mecanismo de fijación puede ser utilizado en numerosos dispositivos
en los que se utiliza energía de tratamiento del tejido, y con
anterioridad al corte y/o grapado mediante el instrumento. Se pueden
utilizar diversas energías hemostáticas con anterioridad al corte,
grapado, u otra manipulación mecánica del tejido, tal como energía
ultrasónica, energía térmica, energía láser, energía por luz
infrarroja, etc. Se pueden utilizar diversos medios o parámetros de
monitorización de tejido para proporcionar una señal de
realimentación electromecánica de respuesta. Por ejemplo, se puede
utilizar la impedancia eléctrica, la impedancia mecánica, la
temperatura o la absorción luminosa o la reflectancia como
realimentación para generar la señal de realimentación. En
consecuencia, los expertos en la materia comprenderán que se pueden
realizar diversos cambios y modificaciones en la invención sin
apartarse de su alcance, el cual está definido por las
reivindicaciones que siguen.
Claims (2)
1. Un instrumento (10) electroquirúrgico, que
comprende:
un eje (30) con un extremo distal;
un efector (15) extremo, situado en el extremo
distal del eje, estando dicho efector extremo adaptado para recibir
energía para llevar a cabo una acción electroquirúrgica con el
mismo, comprendiendo el citado efector extremo: un primer y un
segundo elementos que comprenden una primera y una segunda
superficies (32, 34) opuestas de contacto con el tejido,
respectivamente, siendo dichas superficies móviles cada una en
relación con la otra desde una posición abierta, de separación, para
el posicionamiento del tejido entre ambas, hasta una posición
cerrada para enganchar el tejido, siendo al menos una porción de una
de las citadas superficies eléctricamente conductora, y estando
dispuesta para recibir la energía para la realización de la acción
electroquirúrgica, y un elemento (11) de corte móvil para cortar el
tejido enganchado por el citado efector extremo;
un dispositivo (14) actuador acoplado
operativamente al elemento (11) de corte, extendiéndose dicho
dispositivo actuador a través del citado eje hasta dicho elemento de
corte, y estando dispuesto para accionar el citado elemento de corte
con el fin de cortar el tejido, y
un mecanismo de bloqueo acoplado operativamente a
dicho dispositivo actuador, teniendo el citado mecanismo de bloqueo
una primera posición en la que dicho mecanismo de bloqueo puede
enganchar con dicho dispositivo actuador para impedir la actuación
de dicho elemento de corte, y una segunda posición en la que dicho
mecanismo de bloqueo puede liberar el citado dispositivo actuador
para permitir la actuación del citado elemento de corte,
que se caracteriza porque dicho mecanismo
de bloqueo comprende un dispositivo electromecánico (180, 182,
183).
2. El instrumento electroquirúrgico de la
reivindicación 1, que comprende además un dispositivo de control de
instrumento y de medición de parámetros del tejido, adaptado para
proporcionar una señal de realimentación representativa del estado
de tratamiento de un tejido del tejido que se está tratando, estando
dicho dispositivo de control de instrumento y medición de parámetros
acoplado al citado efector extremo de dicho instrumento.
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US437262 | 1995-05-08 | ||
US08/437,262 US5807393A (en) | 1992-12-22 | 1995-05-08 | Surgical tissue treating device with locking mechanism |
Publications (1)
Publication Number | Publication Date |
---|---|
ES2216038T3 true ES2216038T3 (es) | 2004-10-16 |
Family
ID=23735721
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
ES96303149T Expired - Lifetime ES2216038T3 (es) | 1995-05-08 | 1996-05-07 | Dispositivo de tratamiento quirurgico de tejido con mecanismo de bloqueo. |
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US (2) | US5807393A (es) |
EP (1) | EP0741996B1 (es) |
JP (1) | JP3857357B2 (es) |
AU (1) | AU722398B2 (es) |
CA (1) | CA2175870C (es) |
DE (1) | DE69631613T2 (es) |
ES (1) | ES2216038T3 (es) |
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- 1996-05-07 DE DE69631613T patent/DE69631613T2/de not_active Expired - Lifetime
- 1996-05-07 ES ES96303149T patent/ES2216038T3/es not_active Expired - Lifetime
- 1996-05-07 EP EP96303149A patent/EP0741996B1/en not_active Expired - Lifetime
- 1996-05-07 AU AU52135/96A patent/AU722398B2/en not_active Expired
- 1996-05-08 JP JP14777296A patent/JP3857357B2/ja not_active Expired - Lifetime
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1997
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AU5213596A (en) | 1996-11-21 |
EP0741996A3 (en) | 1997-04-23 |
EP0741996B1 (en) | 2004-02-25 |
US5807393A (en) | 1998-09-15 |
JPH08336544A (ja) | 1996-12-24 |
CA2175870A1 (en) | 1996-11-09 |
DE69631613T2 (de) | 2004-12-16 |
JP3857357B2 (ja) | 2006-12-13 |
US6024741A (en) | 2000-02-15 |
DE69631613D1 (de) | 2004-04-01 |
EP0741996A2 (en) | 1996-11-13 |
CA2175870C (en) | 2007-01-02 |
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