ES2221226T3 - Instrumento electroquirurgico bipolar laparoscopico. - Google Patents
Instrumento electroquirurgico bipolar laparoscopico.Info
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- ES2221226T3 ES2221226T3 ES98958575T ES98958575T ES2221226T3 ES 2221226 T3 ES2221226 T3 ES 2221226T3 ES 98958575 T ES98958575 T ES 98958575T ES 98958575 T ES98958575 T ES 98958575T ES 2221226 T3 ES2221226 T3 ES 2221226T3
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
- A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
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Abstract
Instrumento electroquirúrgico bipolar laparoscópico (10), que comprende: miembros de mordaza primero (15) y segundo (16) unidos de manera que pivotan en relación de oposición uno respecto del otro, siendo los miembros de mordaza movibles de manera relativa desde una primera posición abierta, en la que los miembros de mordaza están dispuestos en relación separada uno respecto de otro, a una segunda posición de apriete, en que los miembros de mordaza cooperan para agarrar el tejido entre ellos; una varilla impulsora (22) eléctricamente conductora que conecta el primer miembro de mordaza a un primer polo y un tubo eléctricamente conductor (13) que conecta el segundo miembro de mordaza a un segundo polo tal que los miembros de mordaza son capaces de conducir energía bipolar a través del tejido sujetado entre ellos; una horquilla (17) unida al extremo distal de la varilla impulsora y unida entre los miembros de mordaza, incluyendo el miembro de horquilla un par de pasadores (25, 26) que cooperancon un par de ranuras (19, 21) correspondientes de una manera similar a un seguidor de leva para proporcionar movimiento a los miembros de mordaza desde las posiciones primera y segunda; un par de partes de hombros (29, 30) unidas a la horquilla; y un mango (14) unido a la varilla impulsora para proporcionar movimiento a la horquilla, y caracterizado porque: cada uno de los miembros de mordaza incluye una brida (18, 20) que se extiende desde allí; y las partes de hombro están dimensionadas para quedar en contacto con las bridas de los miembros de mordaza cuando los miembros de mordaza se mueven a una segunda posición para aliviar los esfuerzos de corte sobre los pasadores durante la sujeción y el sellado del tejido.
Description
Instrumento electroquirúrgico bipolar
laparoscópico.
Esta invención trata de un instrumento
electroquirúrgico para realizar procedimientos quirúrgicos
laparoscópicos, y más particularmente de un instrumento
electroquirúrgico laparoscópico que es capaz de agarrar vasos y
tejido vascular con suficiente fuerza entre dos mordazas bipolares
para sellar el vaso o tejido vascular.
El documento WO 94/08524 expone las
características del preámbulo de la reivindicación 1.
Los instrumentos quirúrgicos laparoscópicos se
utilizan para realizar intervenciones quirúrgicas sin realizar
incisiones grandes en el paciente. Los instrumentos laparoscópicos
son insertados en el paciente a través de una cánula, o abertura,
que ha sido hecha con un trocar. Tamaños típicos de cánulas se
extienden desde tres milímetros a doce milímetros. Cánulas menores
son preferidas habitualmente, y esto presenta un desafío de diseño
para los fabricantes de instrumentos, quienes deben de encontrar
modos de fabricar instrumentos quirúrgicos que quepan a través de
las cánulas.
Ciertos procedimientos quirúrgicos requieren
cortar vasos sanguíneos o tejido vascular. Esto a veces presenta un
problema para los cirujanos ya que es difícil suturar vasos
sanguíneos utilizando herramientas laparoscópicas. Los vasos
sanguíneos muy pequeños, en el margen por debajo de dos milímetros
de diámetro, a menudo pueden ser cerrados utilizando técnicas
electroquirúrgicas convencionales. Si un vaso mayor es cortado,
puede ser necesario que el cirujano convierta el procedimiento
laparoscópico en un procedimiento de cirugía abierta y por este
motivo, dejar a un lado los beneficios de la laparoscopia.
Varios artículos de revistas han divulgado
métodos para sellar pequeños vasos sanguíneos utilizando
electrocirugía. Un artículo titulado Studies on Coagulation and
the Development of an Automatic Computerized Bipolar Coagulator
(Estudios sobre la coagulación y el desarrollo de un coagulador
bipolar computerizado automático), J. Neurosurg., Volumen 75, julio
1991, describe un coagulador bipolar que se utiliza para sellar
pequeños vasos sanguíneos. El artículo afirma que no era posible
coagular de manera segura arterias de un diámetro mayor de 2 a 2,5
mm. Un segundo artículo se titula Automatically Controlled
Bipolar Electrocoagulation - "COA-COMP"
(Electrocoagulación bipolar controlada automáticamente), Neurosurg.
Rev. (1984), pp. 187-190. Este artículo describe un
método para interrumpir la potencia electroquirúrgica en el vaso, de
manera que puede evitarse la carbonización de las paredes del
vaso.
Ha sido determinado recientemente que los métodos
electroquirúrgicos pueden ser capaces de sellar vasos mayores
utilizando una curva de potencia electroquirúrgica apropiada,
acoplada con un instrumento capaz de aplicar una gran fuerza de
cierre a las paredes del vaso. Se piensa que el proceso de coagular
vasos pequeños es diferente de manera fundamental al sellado
electroquirúrgico de vasos. La coagulación se define como un proceso
de desecación de un tejido en el que se rompen y se secan las
células del tejido. El sellado de un vaso se define como el proceso
de licuar el colágeno del tejido de manera que se entrecruza y se
reforma en una masa fundida. De esta manera, la coagulación de
pequeños vasos es suficiente para cerrarlos permanentemente. Los
vasos mayores necesitan ser sellados para asegurar su cierre
permanente.
Sería deseable tener una herramienta quirúrgica
capaz de aplicar energía electroquirúrgica, capaz de aplicar una
gran fuerza de cierre a las paredes del vaso, y también capaz de
caber a través de una cánula. Una gran fuerza de cierre entre las
mordazas requiere típicamente un par elevado sobre el pivote de cada
mordaza. Esto presenta un desafío ya que los pasadores primero y
segundo tienen un pequeño brazo de par con respecto al pivote de
cada mordaza. Una fuerza grande, unida a un brazo de par pequeño, no
es deseable, ya que las fuerzas grandes pueden cizallar los
pasadores primero y segundo. Tampoco es deseable incrementar el
brazo de par de los pasadores primero y segundo porque el tamaño
físico de la horquilla podría no caber a través de la cánula.
Se conocen varios instrumentos laparoscópicos
bipolares. Por ejemplo, la patente estadounidense 3.938.527 expone
un instrumento laparoscópico bipolar para cauterización de
conductos. La patente estadounidense 5.250.047 expone un instrumento
laparoscópico bipolar con un conjunto de punta de electrodo
reemplazable. La patente estadounidense 5.445.638 expone un fórceps
de corte y coagulación bipolar con unos conductores primero y
segundo que se extienden a partir del extremo distal. La patente
estadounidense 5.391.166 expone un instrumento endoscópico bipolar
que tiene un extremo de trabajo que se puede separar. La patente
estadounidense 5.342.359 describe un dispositivo de coagulación
bipolar.
La presente invención resuelve el problema de
proporcionar una fuerza de cierre grande entre las mordazas de un
instrumento electroquirúrgico bipolar laparoscópico, que utiliza un
diseño compacto que cabe a través de una cánula, sin arriesgarse a
un fallo estructural de la horquilla del instrumento.
De acuerdo con la presente invención, se
proporciona un instrumento electroquirúrgico bipolar laparoscópico,
que comprende:
miembros de mordaza primero y segundo unidos de
manera pivotante, opuestos uno respecto de otro, siendo los miembros
de mordaza movibles de manera relativa desde una primera posición
abierta, en la que los miembros de mordaza están dispuestos
separados uno respecto de otro, hacia una segunda posición de
apriete, en la que los miembros de mordaza cooperan para coger el
tejido entre ellos;
una varilla impulsora eléctricamente conductora
que conecta el primer miembro de mordaza con un primer polo, y un
tubo eléctricamente conductor que conecta el segundo miembro de
mordaza con un segundo polo, de manera que los miembros de mordaza
son capaces de conducir energía bipolar a través del tejido sujeto
entre ellos;
una horquilla unida al extremo distal de la
varilla impulsora y unida entre los miembros de mordaza, incluyendo
el miembro de horquilla un par de pasadores que cooperan con un par
de ranuras correspondientes de una manera similar a un seguidor de
leva para transmitir el movimiento de los miembros de mordaza desde
las posiciones primera y segunda;
un par de partes de hombro unidas a la horquilla;
y
un mango unido a la varilla impulsora para
transmitir movimiento a la horquilla, y caracterizado porque:
cada uno de los miembros de mordaza incluye una
brida que se extiende desde él; y
las partes de hombro están dimensionadas para
quedar en contacto con las bridas de los miembros de mordaza cuando
los miembros de mordaza se mueven a la segunda posición para aliviar
los esfuerzos cortantes sobre los pasadores durante el apriete y el
sellado del tejido.
Una ventaja de la presente invención es que el
tejido puede ser agarrado y apretado con una fuerza de cierre
relativamente grande sin dañar la horquilla. La horquilla es capaz
de transmitir la fuerza de cierre grande a las mordazas del
instrumento aun siendo lo suficientemente pequeño para caber a
través de una cánula.
El instrumento electroquirúrgico bipolar
laparoscópico comprende mordazas primera y segunda que tienen
respectivamente bridas primera y segunda con ranuras primera y
segunda. El instrumento está eléctricamente conectado a un generador
electroquirúrgico, y conduce corriente electroquirúrgica bipolar a
las mordazas primera y segunda. Una horquilla está unida a una
varilla impulsora y está colocada para aislar eléctricamente la
primera brida de la segunda brida. Los pasadores primero y segundo
de la horquilla están diseñados para acoplarse en las ranuras
primera y segunda, respectivamente, en una disposición de seguidor
de leva que abre y cierra las mordazas con movimiento lineal de la
horquilla. La horquilla es preferiblemente una "horquilla
impulsora" que significa que el movimiento lineal de la horquilla
en el sentido del extremo distal del instrumento hará que las
mordazas se cierren juntas.
La horquilla tiene hombros primero y segundo que
están separados de las bridas primera y segunda hasta que las
mordazas están en proximidad arqueada cerrada una de otra. En ese
punto, los hombros primero y segundo se acoplan en las bridas
primera y segunda, por lo que un movimiento adicional distal de la
horquilla aplica una fuerza a las bridas primera y segunda que crea
un momento en el pivote de cada mordaza. En general, la disposición
de seguidor de leva de pasadores y ranuras puede estar diseñada para
proporcionar movimiento rápido de las mordazas con fuerzas
relativamente pequeñas. Pueden obtenerse fuerzas de cierre grandes,
una vez que las mordazas están relativamente cerradas juntas,
presionando los hombros contra las bridas. Los pasadores primero y
segundo se mueven hacia dentro de orificios ciegos en las ranuras
primera y segunda para protegerlas de esfuerzos cortantes grandes
cuando los hombros están aplicando fuerzas relativamente grandes a
las bridas. Así, los pasadores primero y segundo pueden ser hechos
de un material eléctricamente aislante que no esté diseñado para
manejar esfuerzos cortantes grandes, pueden obtenerse grandes
fuerzas de cierre, y el conjunto completo puede ser compacto y caber
a través de una cánula.
Se describe un método para realizar el
instrumento electroquirúrgico bipolar laparoscópico que comprende
las siguientes etapas: formar una primera mordaza que tiene una
primera brida con una primera ranura, y una segunda mordaza que
tiene una segunda brida con una segunda ranura; unir una horquilla a
una varilla impulsora; aislar eléctricamente la primera brida de la
segunda brida con la horquilla; acoplar los pasadores primero y
segundo con las ranuras primera y segunda; colocar los orificios
ciegos primero y segundo respectivamente en las ranuras primera y
segunda para aliviar los esfuerzos cortantes sobre los pasadores
primero y segundo con un ángulo subtendido aproximadamente en el que
los hombros primero y segundo se acoplan con las bridas primera y
segunda.
La figura 1 es una vista en perspectiva de un
instrumento electroquirúrgico bipolar laparoscópico.
La figura 2 es una vista en perspectiva del
extremo distal y de las mordazas del instrumento de la figura 1.
La figura 3 es una vista en despiece ordenado del
extremo distal mostrado en la figura 2.
La figura 4 es una vista en perspectiva del
extremo distal del instrumento con las mordazas quitadas.
La figura 5 es otra perspectiva de la figura
4.
La figura 6 es una vista lateral de un contacto
de resorte eléctrico.
La figura 7 es una vista frontal del contacto de
resorte mostrado en la figura 6.
Un instrumento 10 electroquirúrgico bipolar
laparoscópico se muestra en la figura 1. El instrumento 10 tiene un
extremo proximal 11 con un mango 14 para sujetar y manipular el
instrumento 10. Un extremo distal 12 del instrumento 10 se utiliza
para la manipulación quirúrgica del tejido. El instrumento 10
comprende un tubo alargado 13 que está dimensionado para caber a
través de una cánula para intervenciones laparoscópicas, y en
diferentes realizaciones puede ser dimensionado para caber en una
cánula de cinco o de siete milímetros.
Una porción del extremo distal 12 del instrumento
10 se muestra en la figura 2. Una primera mordaza 15 y una segunda
mordaza 16 se muestran en una posición abierta. Un ángulo \alpha
está subtendido por las mordazas 15 y 16. El cierre de las mordazas
15 y 16 está definido como una reducción del ángulo \alpha
subtendido por las mordazas 15 y 16. De manera similar, la apertura
de las mordazas 15 y 16 se define como una ampliación del ángulo
\alpha. El ángulo \alpha es cero cuando las mordazas 15 y 16
están cerradas juntas. El centro de rotación de la primera mordaza
15 está en el primer pivote 41, y el centro de rotación de la
segunda mordaza 16 está en el segundo pivote 42. El primer pivote 41
está situado en una pieza de saliente exterior 32, y se encaja en un
primer orificio de pivote 43 situado en la primera brida 18. El
segundo pivote 42 está situado sobre una pieza de saliente interior
31, y se encaja en un segundo orificio de pivote 44 situado en la
segunda brida 20.
Las piezas que comprenden el extremo distal 12
del instrumento 10 se muestran en una vista en despiece ordenado de
la figura 3. La primera mordaza 15 y la segunda mordaza 16 se
muestran separadas de una horquilla 17. La primera mordaza 15 tiene
una primera brida 18 y una primera ranura 19 en la misma. La segunda
mordaza 16 tiene una segunda brida 20 y una segunda ranura 21 en la
misma. Cada mordaza 15 y 16 está formada preferiblemente por una
pieza simple de acero inoxidable u otro material eléctricamente
conductor.
En referencia de nuevo a la figura 3, la
horquilla 17 está unida a una varilla impulsora 22. La horquilla 17
está formada preferiblemente por un material eléctricamente aislante
tal como el plástico. Una primera cara 23 de la horquilla 17 se
enfrenta a la primera brida 18. Una segunda cara 24 de la horquilla
17 se enfrenta a la segunda brida 20. Cuando la horquilla 17 está
situada entre las bridas 18 y 20, la horquilla 17 también actúa para
aislar eléctricamente la primera mordaza 15 de la segunda mordaza
16. De esta manera, la corriente electroquirúrgica bipolar puede ser
conducida a través del tejido agarrado por las mordazas 15 y 16 sin
que se produzca un cortocircuito entre las bridas 18 y 20.
Un primer pasador 25 está situado en la primera
cara 23 para acoplarse de manera movible con la primera ranura 19.
De manera similar, un segundo pasador 26 está situado en la segunda
cara 24 para acoplarse de manera movible con la segunda ranura 21.
Cada combinación de pasador y ranura trabaja como un enlace mecánico
de seguidor de leva. El movimiento de la varilla impulsora 22 mueve
la horquilla 17 haciendo que los pasadores 25 y 26 deslicen dentro
de sus respectivas ranuras 19 y 21. Las ranuras 19 y 21 presentan un
ángulo con respecto a los extremos distales de las mordazas 15 y 16,
de tal modo que las mordazas 15 y 16 se mueven de una manera
arqueada acercándose y alejándose una con respecto a la otra. Los
pasadores 25 y 26 son diferentes de los pivotes 41 y 42. Los
pasadores 25 y 26 proveen una fuerza contra las paredes de las
ranuras 19 y 21, creando un momento en los pivotes 41 y 42.
Las ranuras 19 y 21 están dispuestas de manera
que el movimiento distal de la varilla impulsora 22 hace que las
mordazas 15 y 16 se muevan juntas. El movimiento distal de la
varilla impulsora 22 se define como el movimiento en el sentido del
extremo distal 12 del instrumento 10. Una vez que las mordazas 15 y
16 están cerradas juntas, la presente invención mantiene las
mordazas 15 y 16 juntas con una fuerza de compresión sobre la
varilla impulsora 22.
Una de las ventajas de esta invención es que las
fuerzas de corte sobre los pasadores 25 y 26 pueden ser descargadas
para evitar un fallo mecánico cuando grandes fuerzas están siendo
transmitidas a las mordazas 15 y 16. Cada ranura 19 y 21 tiene un
orificio ciego 27 y 28, respectivamente, como se muestra en la
figura 3. El primer orificio ciego 27 es una ampliación de la
primera ranura 19 cerca de su extremo distal. El segundo orificio
ciego 28 es una ampliación de la segunda ranura 21 cerca de su
extremo distal. El movimiento de seguidor de leva de los pasadores
25 y 26 de las ranuras 19 y 21 traerá a los pasadores 25 y 26 a sus
orificios ciegos 27 y 28 respectivos. La posición de los pasadores
25 y 26 deja un brazo de momento muy pequeño entre los pasadores 25
y 26 y los pivotes 41 y 42. La horquilla 17 tiene hombros 29 y 30
que pueden proporcionar un momento relativamente grande en los
pivotes 41 y 42 para llevar a cabo una fuerza de cierre elevada
entre las mordazas 15 y 16 sin unas fuerzas de corte elevadas sobre
los pasadores 25 y 26, como se describe abajo.
Una vez que los pasadores 25 y 26 están en los
orificios ciegos 27 y 28, la fuerza proveniente de la horquilla se
transmite a las bridas 18 y 20 a través de un primer hombro 29 y un
segundo hombro 30. Los hombros 29 y 30 hacen contacto de tope en el
extremo proximal de las bridas 18 y 20 para hacer que las mordazas
15 y 16 se cierren juntas. Los pivotes 41 y 42 están fabricados
preferiblemente de metal y pueden soportar fuerzas de corte
relativamente elevadas. Por el contrario, los pasadores 25 y 26
están fabricados preferiblemente de plástico y se romperán bajo
fuerzas de corte relativamente elevadas. Así, los hombros 29 y 30
proporcionan un momento en los pivotes 41 y 42, que evita por este
motivo la necesidad de aplicar fuerzas de corte elevadas a los
pasadores 25 y 26 cuando el brazo de momento de los pasadores 25 y
26 sea pequeño. Hay un ángulo \alpha en el que los pasadores 25 y
26 se introducen en sus respectivos orificios ciegos 27 y 28 y los
hombros 29 y 30 quedan en contacto con las bridas 18 y 20. El ángulo
\alpha en el cual sucede lo anterior está preferiblemente
alrededor de tres grados.
El instrumento electroquirúrgico bipolar 10 tiene
unos polos primero y segundo de potencial alterno que son conducidos
a lo largo del instrumento 10 y a través del tejido que es agarrado
entre las mordazas 15 y 16. El primer polo es conducido desde el
extremo proximal 11 hacia el extremo distal 12 a lo largo de la
varilla impulsora 22. El segundo polo es conducido desde el extremo
proximal 11 hacia el extremo distal 12 a lo largo del tubo 13. La
superficie exterior del tubo 13 está recubierta preferiblemente de
un material eléctricamente aislante. Hay también preferiblemente una
barrera eléctricamente aislante entre la varilla impulsora 22 y el
tubo 13 para evitar cortocircuitos en el instrumento 10.
En la realización preferida, el extremo distal
del instrumento 10 comprende una pieza de saliente interior 31 y una
pieza de saliente exterior 32, como se muestra en la figura 2. La
pieza de saliente interior 31 está conectada eléctricamente con la
varilla impulsora 22, mientras que la pieza de saliente exterior
está conectada eléctricamente con el tubo 13. La pieza de saliente
interior 31 y la pieza de saliente exterior 32 apresan la horquilla
17, junto con las bridas primera y segunda 18 y 20, como se muestra
en la figura 2. La horquilla 17 se mueve en la dirección axial, a lo
largo de un eje definido por el tubo, en un espacio entre las piezas
de saliente interior y exterior 31 y 32. Una estaquilla espaciadora
33 mantiene la separación de las piezas de saliente 31 y 32 en sus
extremos distales. Las piezas de saliente 31 y 32 proporcionan apoyo
lateral a las bridas 18 y 20 para ayudar a asegurar que los
pasadores 25 y 26 permanezcan dentro de las ranuras 19 y 21.
La realización preferida comprende también un
aislador interior 34 y un aislador exterior 35 para mantener el
aislamiento eléctrico entre los polos. El aislador exterior 35 está
asentado entre el tubo 13 y el saliente interior 31, como se muestra
en las figuras 2 y 4. El aislador interior 34 está asentado entre el
tubo 13 y la varilla impulsora 22. De esta manera, la pieza saliente
exterior 32 puede proveer continuidad eléctrica entre el tubo 13 y
la segunda mordaza 16, mientras la pieza saliente interior 34 puede
proveer continuidad eléctrica entre la varilla impulsora 22 y la
mordaza primera 15. Dado que la varilla impulsora 22 está montada de
manera que puede deslizar dentro del tubo 13, la realización
preferida tiene un contacto 36 de resorte, como se muestra en las
figuras 6 y 7, montado en la varilla impulsora 22 para mantener una
conexión eléctrica con la pieza saliente interior 34 durante el
movimiento axial.
Las mordazas primera y segunda 15 y 16 tienen
cada una crestas 37 y 38 en sus extremos distales que encajan
preferiblemente juntos. Las mordazas 15 y 16 también tienen
superficies de sellado 39 y 40, como se muestra en la figura 2. La
anchura de las superficies de sellado 39 y 40 es un parámetro que
afecta a la calidad del resultado quirúrgico. La fuerza de cierre
entre las mordazas 15 y 16 varía a lo largo de la longitud de las
superficies de sellado 39 y 40, con la fuerza mayor en la punta
distal y la fuerza menor en el extremo proximal de las superficies
de sellado 39 y 40. Se ha encontrado a través de experimentación que
los buenos resultados de sellado de vasos se obtienen cuando la
fuerza de cierre en gramos dividida por la anchura en milímetros
está en el margen de 400 a 650. Dado que la fuerza de cierre varía
con la longitud de las superficies de sellado 39 y 40, se ha
encontrado que es ventajoso ir estrechando la anchura de las
superficies de sellado 39 y 40 a lo largo de su longitud, con la
anchura más ancha en el extremo proximal y la anchura más estrecha
en el extremo distal. Este diseño permite que las mordazas 15 y 16
apliquen una fuerza de cierre relativamente constante por unidad de
anchura, preferiblemente de 525 gramos por milímetro de ancho.
Un método para hacer un instrumento 10
electroquirúrgico bipolar laparoscópico se describe también en este
documento. El método comprende la etapa de formar una primera
mordaza 15 que tiene una primera brida 18 con una primera ranura 19,
y una segunda mordaza 16 que tiene una segunda brida 20 con una
segunda ranura 21. Las mordazas 15 y 16 están formadas
preferiblemente en un proceso de fundición, aunque también es
posible mecanizar las mordazas 15 y 16 a partir de la materia prima.
El proceso de fundición puede incluir la inyección de metal
pulverizado bajo presión hacia dentro de un molde, y a continuación
aplicar calor.
Otras etapas del método incluyen unir una
horquilla 17 a una varilla impulsora 22, y aislar eléctricamente la
primera brida 18 de la segunda brida 20 con la horquilla 17. La
horquilla 17 es preferiblemente una pieza de plástico moldeada por
inyección con características que incluyen un primer hombro 29 y un
segundo hombro 30.
Durante el montaje de la parte distal del
instrumento 10, las etapas del método incluyen acoplar un primer
pasador 25 con la primera ranura 19, y acoplar un segundo pasador 26
con la segunda ranura 21. Las ranuras 19 y 21 están formadas de
manera que un ángulo \alpha subtendido entre las mordazas primera
y segunda 15 y 16 decrece con el movimiento distal de la varilla
impulsora 17, y las ranuras 19 y 21 están formadas con orificios
ciegos 27 y 28 colocados para aliviar las tensiones de cizalla de
los pasadores primero y segundo 25 y 26 en el ángulo subtendido
\alpha aproximadamente con que los hombros primero y segundo 29 y
30 se acoplan con las bridas primera y segunda 18 y 20.
Etapas adicionales del método comprenden: rodear
al menos una porción de la varilla impulsora 22 con un tubo
eléctricamente conductor 13; aislar eléctricamente el tubo 13 de la
varilla impulsora 22; conectar eléctricamente una pieza saliente
interior 31 a la varilla impulsora 22; y conectar eléctricamente una
pieza saliente exterior 32 al tubo 13, donde la pieza saliente
interior 31 y la pieza saliente exterior 32 apresan la horquilla 17
junto con las bridas primera y segunda 18 y 20 para conducir
corriente electroquirúrgica bipolar a las mordazas primera y segunda
15 y 16. En la realización preferida, hay una etapa de conectar
eléctricamente la varilla impulsora 22 y la pieza saliente interior
31 con un contacto 36 de resorte.
El método para fabricar el instrumento 10, en
algunas realizaciones, incluye las etapas de ir estrechando la
anchura de las superficies de sellado 39 y 40 a lo largo de la
longitud de cada una de las mordazas primera y segunda 15 y 16.
Aun cuando una realización particular preferida
ha sido ilustrada y descrita, el alcance de la protección solicitada
está en las reivindicaciones que siguen.
Claims (9)
1. Instrumento electroquirúrgico bipolar
laparoscópico (10), que comprende:
miembros de mordaza primero (15) y segundo (16)
unidos de manera que pivotan en relación de oposición uno respecto
del otro, siendo los miembros de mordaza movibles de manera relativa
desde una primera posición abierta, en la que los miembros de
mordaza están dispuestos en relación separada uno respecto de otro,
a una segunda posición de apriete, en que los miembros de mordaza
cooperan para agarrar el tejido entre ellos;
una varilla impulsora (22) eléctricamente
conductora que conecta el primer miembro de mordaza a un primer polo
y un tubo eléctricamente conductor (13) que conecta el segundo
miembro de mordaza a un segundo polo tal que los miembros de mordaza
son capaces de conducir energía bipolar a través del tejido sujetado
entre ellos;
una horquilla (17) unida al extremo distal de la
varilla impulsora y unida entre los miembros de mordaza, incluyendo
el miembro de horquilla un par de pasadores (25, 26) que cooperan
con un par de ranuras (19, 21) correspondientes de una manera
similar a un seguidor de leva para proporcionar movimiento a los
miembros de mordaza desde las posiciones primera y segunda;
un par de partes de hombros (29, 30) unidas a la
horquilla; y
un mango (14) unido a la varilla impulsora para
proporcionar movimiento a la horquilla, y
caracterizado porque:
cada uno de los miembros de mordaza incluye una
brida (18, 20) que se extiende desde allí; y
las partes de hombro están dimensionadas para
quedar en contacto con las bridas de los miembros de mordaza cuando
los miembros de mordaza se mueven a una segunda posición para
aliviar los esfuerzos de corte sobre los pasadores durante la
sujeción y el sellado del tejido.
2. Un instrumento electroquirúrgico bipolar
laparoscópico (10) de acuerdo con la reivindicación 1, en el
que:
el par de ranuras está dispuesto de manera que la
brida (18) de la primera mordaza (15) tiene la primera ranura (19),
y la brida (20) de la segunda mordaza (16) tiene la segunda ranura
(21);
la primera ranura y la segunda ranura están
formadas de manera que un ángulo, subtendido por las mordazas
primera y segunda, decrece con el movimiento distal de la varilla
impulsora;
los orificios ciegos primero (27) y segundo (28)
están posicionados respectivamente en las ranuras primera y segunda
para aliviar los esfuerzos de corte en los pasadores primero (25) y
segundo (26) aproximadamente cuando los hombros primero (29) y
segundo (30) se acoplan respectivamente con las bridas primera y
segunda para proporcionar una fuerza de cierre entre las mordazas
primera y segunda; y en el que
la horquilla (17) unida a la varilla impulsora
(22) aísla eléctricamente la brida primera (18) de la brida segunda
(20), teniendo la horquilla una primera cara que se enfrenta a la
primera brida y una segunda cara que se enfrenta a la brida
segunda.
3. El instrumento electroquirúrgico bipolar
laparoscópico (10) de las reivindicaciones 1 ó 2, en el que:
el tubo eléctricamente conductor (13) rodea al
menos una parte de la varilla impulsora (22); y
la capa eléctricamente aislante (34) está
dispuesta entre el tubo y la varilla impulsora capaz de soportar un
potencial electroquirúrgico alterno a través del tubo y la varilla
impulsora.
4. El instrumento electroquirúrgico bipolar
laparoscópico (10) de cualquier reivindicación precedente, que
comprende además:
una pieza saliente interior (31) conectada
eléctricamente a la varilla impulsora (22), y
una pieza saliente exterior (32) conectada
eléctricamente al tubo (13), en el que la pieza saliente interior y
la pieza saliente exterior apresan la horquilla (17), junto con las
bridas primera (18) y segunda (20), para conducir corriente
electroquirúrgica bipolar a las mordazas primera (15) y segunda
(16).
5. El instrumento electroquirúrgico bipolar
laparoscópico (10) de la reivindicación 4, que comprende además un
contacto (36) de resorte eléctrico entre la varilla impulsora (22) y
la pieza saliente interior (31) para proporcionar continuidad
eléctrica entre ellas.
6. El instrumento electroquirúrgico bipolar
laparoscópico (10) de cualquier reivindicación precedente, que
comprende además crestas (37, 38) en cada una de las mordazas
primera y segunda (15, 16).
7. El instrumento electroquirúrgico bipolar
laparoscópico (10) de cualquiera de las reivindicaciones
precedentes, en el que cada una de las mordazas primera y segunda
tiene una superficie de sellado (39, 40) con una anchura y una
longitud, y en que al menos una posición a lo largo de la longitud
tiene una anchura tal que la fuerza de cierre en gramos dividida por
la anchura en milímetros está en el margen de 400 a 650.
8. El instrumento electroquirúrgico bipolar
laparoscópico (10) de la reivindicación 7, en que la anchura de cada
superficie de sellado (39, 40) se va estrechando a lo largo de su
longitud respectiva.
9. El instrumento electroquirúrgico bipolar
laparoscópico (10) de acuerdo con las reivindicaciones 7 u 8, en el
que la fuerza de cierre dividida por la anchura es aproximadamente
constante a lo largo de la longitud para cada una de las mordazas
primera y segunda.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US970472 | 1997-11-14 | ||
| US08/970,472 US6228083B1 (en) | 1997-11-14 | 1997-11-14 | Laparoscopic bipolar electrosurgical instrument |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| ES2221226T3 true ES2221226T3 (es) | 2004-12-16 |
Family
ID=25516997
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| ES98958575T Expired - Lifetime ES2221226T3 (es) | 1997-11-14 | 1998-11-13 | Instrumento electroquirurgico bipolar laparoscopico. |
Country Status (8)
| Country | Link |
|---|---|
| US (5) | US6228083B1 (es) |
| EP (1) | EP1030612B1 (es) |
| JP (1) | JP4010479B2 (es) |
| AU (1) | AU732660B2 (es) |
| CA (1) | CA2310004C (es) |
| DE (1) | DE69823862T2 (es) |
| ES (1) | ES2221226T3 (es) |
| WO (1) | WO1999025261A1 (es) |
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-
1997
- 1997-11-14 US US08/970,472 patent/US6228083B1/en not_active Expired - Lifetime
-
1998
- 1998-11-13 ES ES98958575T patent/ES2221226T3/es not_active Expired - Lifetime
- 1998-11-13 EP EP98958575A patent/EP1030612B1/en not_active Expired - Lifetime
- 1998-11-13 WO PCT/US1998/024281 patent/WO1999025261A1/en active IP Right Grant
- 1998-11-13 CA CA002310004A patent/CA2310004C/en not_active Expired - Fee Related
- 1998-11-13 JP JP2000520699A patent/JP4010479B2/ja not_active Expired - Fee Related
- 1998-11-13 DE DE69823862T patent/DE69823862T2/de not_active Expired - Lifetime
- 1998-11-13 AU AU14590/99A patent/AU732660B2/en not_active Ceased
-
2000
- 2000-06-09 US US09/591,330 patent/US6451018B1/en not_active Expired - Lifetime
-
2002
- 2002-09-13 US US10/243,274 patent/US6960210B2/en not_active Expired - Lifetime
-
2005
- 2005-06-29 US US11/169,927 patent/US7207990B2/en not_active Expired - Fee Related
-
2008
- 2008-03-27 US US12/056,488 patent/US7828798B2/en not_active Expired - Fee Related
Also Published As
| Publication number | Publication date |
|---|---|
| US20060009764A1 (en) | 2006-01-12 |
| AU1459099A (en) | 1999-06-07 |
| US20080215051A1 (en) | 2008-09-04 |
| US6228083B1 (en) | 2001-05-08 |
| US20030032956A1 (en) | 2003-02-13 |
| CA2310004C (en) | 2007-01-09 |
| US7828798B2 (en) | 2010-11-09 |
| US6451018B1 (en) | 2002-09-17 |
| US7207990B2 (en) | 2007-04-24 |
| AU732660B2 (en) | 2001-04-26 |
| DE69823862D1 (de) | 2004-06-17 |
| WO1999025261A1 (en) | 1999-05-27 |
| US6960210B2 (en) | 2005-11-01 |
| DE69823862T2 (de) | 2005-01-05 |
| CA2310004A1 (en) | 1999-05-27 |
| JP4010479B2 (ja) | 2007-11-21 |
| EP1030612A4 (en) | 2002-10-29 |
| EP1030612B1 (en) | 2004-05-12 |
| JP2001522685A (ja) | 2001-11-20 |
| EP1030612A1 (en) | 2000-08-30 |
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