ES2267726T3 - Una union mediante grapas de tejido para usar con un dispositivo de accionamiento electromecanico. - Google Patents
Una union mediante grapas de tejido para usar con un dispositivo de accionamiento electromecanico. Download PDFInfo
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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
- A61B17/0682—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil
- A61B17/0684—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil having a forming anvil staying above the tissue during stapling
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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
- A61B2017/00367—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
- A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
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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
- A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
- A61B2017/00473—Distal part, e.g. tip or head
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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
- A61B17/28—Surgical forceps
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- A61B2017/2905—Details of shaft flexible
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- A61B34/74—Manipulators with manual electric input means
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
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Abstract
Una grapadora quirúrgica (100), que comprende: un alojamiento (102) que tiene una abertura (108), estando formado un labio (110) en la abertura; un miembro de cierre de grapa (124) configurado para avanzar longitudinalmente dentro de dicho alojamiento; un miembro de soporte de grapa (118) configurado para soportar una grapa (130) y avanzar longitudinalmente dentro de dicho alojamiento hasta que un avance adicional es impedido por contacto entre dicho miembro de soporte y dicho labio; un árbol de accionamiento giratorio (112) acoplado al miembro de cierre de grapa (124), en el que la rotación del árbol de accionamiento giratorio (112) hace avanzar tanto al miembro de sujeción de grapa (118), como al miembro de cierre de grapa (124) hasta que un avance adicional del miembro de sujeción de grapa (118) es impedido por contacto entre el miembro de soporte de grapa (118) y el labio (110); caracterizado porque comprende además un resorte (126) que acopla el miembro de cierre de grapa (124) al miembro de soporte de grapa (118) y configurado para ser comprimido por el avance de dicho miembro de cierre en la dirección longitudinal, en que la rotación continuada del árbol de accionamiento giratorio (112) hace avanzar más dicho miembro de cierre de grapa (124) de manera que el miembro de cierre de grapa (124) comprime el resorte (126) en la dirección longitudinal y cierra la grapa (130) mientras se impide al miembro de soporte de grapa (118) avanzar más
Description
Una unión mediante grapas de tejido para usar
con un dispositivo de accionamiento electromecánico.
El presente invento se refiere generalmente a
uniones para dispositivos de accionamiento electromecánicos, y más
específicamente a una unión para un dispositivo de accionamiento
electromecánico que puede ser usado para grapar tejido.
Al identificarse una región de musculatura
herniada en la pared abdominal, casi siempre se requiere la
intervención quirúrgica. El procedimiento es de concepto sencillo,
pero incluye varias características técnicamente sofisticadas,
especialmente en la medida en que es usualmente realizada a
distancia, es decir, a través de pequeños portales formados en el
tronco inferior del paciente. Más particularmente, la técnica
utilizada más a menudo implica la formación de dos o tres pequeños
agujeros de pinchazos en el abdomen inferior del paciente, la
inserción de un tubo cilíndrico correspondiente a través de cada
uno de los agujeros, el paso de instrumentos alargados a través de
los tubos, la retirada de los tejidos blandos lejos de la zona de la
hernia, y el grapado del tejido rasgado cerrado. Este paso final de
cierre a menudo incluye además el uso de una malla sintética, que
es colocada sobre el agujero con el propósito de soportar los
tejidos blandos y órganos dispuestos por encima del agujero
curativo. La malla es grapada directamente a la musculatura, en la
proximidad del defecto. El presente invento está dirigido a la
instrumentación que es el componente de grapado.
Los mecanismos de grapado tradicionales
funcionan de una manera simple. La grapa está inicialmente dispuesta
en forma de U. El componente de accionamiento de la grapa hace
contacto con la parte inferior de la grapa y hace avanzar las dos
puntas o púas de la grapa que se extienden hacia arriba a través de
los elementos que han de ser unidos y hacia una parte de yunque
estacionario. A menudo los elementos que han de ser acoplados
requieren que la parte de yunque esté dispuesta por detrás de ellos
para proporcionar un soporte adecuado de modo que las puntas de la
grapa puedan ser empujadas a su través. Una vez que las puntas de la
grapa han avanzado a través de los elementos que han de ser unidos,
las puntas contactan con el yunque. El yunque a menudo comprende
ranuras de guiado de curvado de la grapa formadas en él para guiar
la deformación plástica de las grapas cuando avanzan bajo la
motivación del dispositivo de accionamiento de la grapa. Esta
deformación plástica curva (o dobla) las grapas sobre sí mismas con
el fin de formar la tradicional forma de caja a partir de la forma
de U original. La grapa en forma de caja es a continuación retirada
del mecanismo de grapado en virtud de que está acoplada a los
elementos que ha unido.
Los dispositivos de grapado utilizados en
laparoscopia y cirugía endoscópica son significativamente diferentes
de los mecanismos de grapado tradicionales en diseño y función. A
diferencia de los mecanismos de grapado tradicionales, una parte de
yunque especialmente distinta y opuesta no es práctica y por ello no
es usada. En vez de ello, los dispositivos de grapado quirúrgicos
comprenden un dispositivo de accionamiento de la grapa y un
componente de yunque integrados que mantienen y hacen avanzar la
grapa hacia el tejido que ha de ser unido y a su través. Más
particularmente, como se ha mostrado en la fig. 1, los dispositivos
de grapado de tejido quirúrgico interno de la técnica anterior
comprenden un tubo alargado 10 que está diseñado para deslizar a
través del tubo de portal del agujero de entrada mínimamente
invasivo. La extremidad 12 del tubo 10 incluye una pluralidad de
grapas individuales que son aplicadas secuencialmente por el
dispositivo de accionamiento de la grapa. Cada grapa está
inicialmente dispuesta en forma de U. La forma de U puede ser
descrita más específicamente identificando las diferentes regiones
de la misma. La parte inferior plana de la grapa tiene una parte
central, y partes laterales. Las puntas que se extienden hacia
arriba, que están dispuestas en las extremidades laterales extremas
de la parte inferior plana, son cada una equivalentes
aproximadamente en longitud, y son aproximadamente iguales a una
tercera parte de la longitud de la parte inferior plana. El
dispositivo de accionamiento de la grapa empuja inicialmente la
grapa hacia delante apretando contra la parte inferior de la grapa
en la parte central de la misma. La grapa es hecha avanzar hacia
delante hasta que las puntas se hayan extendido más allá de la
extremidad del alojamiento, y hayan penetrado en el tejido que ha de
ser unido. Además el avance de la grapa es impedido por una parte
de yunque que está fijada en la extremidad del mecanismo. El yunque,
de modo diferente al yunque de mecanismos de grapado tradicionales,
sólo contacta con la parte central de la parte inferior de la
grapa, opuesta al dispositivo de accionamiento de la grapa. Dicho de
otro modo, una vez que la grapa ha sido hecha avanzar completamente
dentro de la extremidad del dispositivo, el yunque de la extremidad
impide que la grapa se mueva hacia delante cuando resulta
restringida entre el dispositivo de accionamiento de la grapa en el
lado posterior y el yunque en la parte frontal.
En este momento, un segundo mecanismo es
aplicado con el fin de cerrar la grapa. Este mecanismo de cierre
comprende un par de dientes rectos que avanzan hacia delante desde
dentro de la extremidad, y contactan con la grapa en las partes
laterales de la parte plana interior. El avance continuado de los
dientes que curvan la punta causa la deformación de la grapa cuando
las puntas de la grapa son giradas por la fuerza una hacia la otra.
Sin embargo, la zona real de curvado no es a lo largo de las puntas.
Está en la unión de las partes lateral y central de la parte
inferior plana. Esto hace que la grapa sea deformada completamente
en este dispositivo de grapado quirúrgico para alcanzar una forma
de D en oposición a la forma de B que alcanzan las grapas deformadas
completamente de los mecanismos de grapado tradicionales. La
liberación de la grapa, una vez que ha sido acoplada al tejido
unido, es conseguida retrayendo en primer lugar los dientes que
curvan la grapa, y a continuación retorciendo el árbol del
dispositivo para retirar la grapa del yunque.
Una característica adicional de los dispositivos
de grapado quirúrgicos de la técnica anterior que debería
apreciarse a la luz del presente invento son los medios por los que
todos los elementos de avance, es decir el dispositivo de
accionamiento de la grapa y los dientes de curvado de la punta, son
motivados. En los dispositivos de grapado quirúrgicos mínimamente
invasivos de la técnica anterior, la parte tubular alargada termina
en una empuñadura que incluye un disparador o gatillo. El gatillo
tiene una doble función porque la compresión del gatillo hace
avanzar inicialmente el dispositivo de accionamiento de la grapa sin
mover los dientes que curvan la punta. Una vez que la grapa ha sido
hecha avanzar completamente y está lista para ser curvada, los
dientes son hechos avanzar a través de la extremidad para contactar
con la grapa, por compresión continuada del disparador de estilo de
empuñadura.
Un ejemplo del tipo general de este dispositivo
general de grapado de la técnica anterior está mostrado en el
documento US 5.389.098.
Será fácilmente reconocible que el requerimiento
de disparo manual así como el mecanismo de dos etapas para hacer
avanzar y luego formar la grapa, están ambos cargados de fallos
potenciales. Además, la necesidad de retorcer el árbol del
dispositivo para retirar la grapa del yunque una vez que la grapa ha
unido el tejido presenta un riesgo significativo de desgarrar el
tejido ya que esta acción provoca tensiones tanto en la grapa como
en el tejido.
Además, otro inconveniente es que el mecanismo
para descargar las grapas es un disparador acoplado a un árbol
alargado rígido que se traslada hacia delante y hacia atrás en
correspondencia con la compresión y liberación del disparador. La
rigidez del árbol requiere que el cirujano manipule el dispositivo
entero con el fin de alinear la grapadora adecuadamente,
considerando que las hernias de la cavidad abdominal ocurren a
menudo en la base del abdomen, esta manipulación es a menudo muy
difícil.
Finalmente, con respecto al uso de los
dispositivos de grapado quirúrgicos de la técnica anterior, los
dispositivos están construidos para ser completamente desechables.
La imposibilidad de volver a utilizar los dispositivos aumenta el
coste de usar los dispositivos. Más específicamente, esta
característica no disminuye el coste total de fabricación debido a
los obvios requisitos del uso médico, pero incrementa el coste por
procedimiento ya que un nuevo dispositivo debe ser usado para cada
cirugía. De hecho, si son requeridas más grapas para la cirugía de
las que están previstas en el dispositivo, debe usarse un
dispositivo completamente nuevo porque no hay posibilidad de
reemplazar de manera simple el cartucho de grapas vacío.
Es por ello un objeto principal del presente
invento proporcionar un dispositivo de grapado quirúrgico que pueda
ser fácilmente manipulado a la posición apropiada sin tener que
deformar extremadamente los tejidos blandos a través de los cuales
pasa el árbol alargado del dispositivo.
Es también un objeto del presente invento
proporcionar un dispositivo de grapado quirúrgico que tiene un
mecanismo de descarga de grapas de una sola parada.
Es un objeto relacionado del presente invento
proporcionar un dispositivo de grapado quirúrgico que no produzca
tensiones en el tejido circundante cuando la grapa es liberada de la
extremidad del dispositivo.
Es un objeto adicional del presente invento
proporcionar un dispositivo de grapado quirúrgico que no requiera
el desecho de la extremidad y del dispositivo de accionamiento de
las grapas, minimizando por ello los residuos o desechos médicos y
el coste asociado con el uso del dispositivo comparado con los
dispositivos de grapado quirúrgicos de la técnica
anterior.
anterior.
Otros objetos del presente invento serán
reconocidos de acuerdo con la descripción del mismo proporcionada a
continuación, y en la descripción detallada de la realización
preferida en unión con las figuras adjuntas.
Los objetos precedentes del invento son
proporcionados por una unión mediante grapas del presente invento
que es acoplable a un dispositivo de accionamiento electromecánico y
accionable a distancia. En particular, el invento proporciona una
grapadora quirúrgica como se ha descrito en la reivindicación 1ª.
Esta grapadora se acopla en un extremo de acoplamiento proximal a
un extremo distal de un árbol de accionamiento flexible del
dispositivo de accionamiento electromecánico, acoplando por ello un
árbol roscado de la unión a un árbol de tracción flexible del árbol
flexible del dispositivo de accionamiento electromecánico. Cuando
los gatillos accionados en el dispositivo de accionamiento
electromecánico, provocan que el árbol de tracción flexible gire,
el árbol roscado hace girar y avanzar en el alojamiento de la unión
a un elemento de accionamiento roscado de la unión que sigue en el
alojamiento. El avance del elemento de accionamiento roscado hace
avanzar un miembro de cierre de grapa montado en el elemento de
accionamiento roscado así como un miembro de soporte de grapa
acoplado por un resorte al miembro de cierre de grapa. De esta
manera, una grapa llevada en una ranura de transporte de grapa de
un elemento de transporte de grapa del miembro de soporte de grapa
es hecha avanzar hacia una abertura de un extremo distal de
descarga de grapa de la unión y al tejido que ha de ser unido.
Después de que la grapa haya penetrado en el tejido y el miembro de
soporte de grapa contacte con un labio de abertura formado en la
abertura del extremo distal de descarga de grapa, el resorte se
comprime cuando el miembro de cierre de grapa continua haciendo
avanzar la grapa hacia la abertura. El avance continuado del
mecanismo de cierre de grapa empuja la grapa contra un labio de
ranura de la ranura que lleva la grapa y dientes salientes del
miembro de cierre de grapa se aplican a las partes laterales de la
parte inferior plana de la grapa para cerrar las puntas de la grapa
para formar una forma de D y unir por ello el tejido. Otro avance
del mecanismo de cierre de grapa hace que una superficie pendiente o
inclinada del miembro de cierre de grapa se aplique a la parte
inferior plana de la grapa para forzar la grapa fuera de la ranura
de transporte de grapa para descargar y liberar completamente la
grapa de la unión. Como los gatillos accionados en el dispositivo
de accionamiento electromecánico hacen que el árbol de tracción
flexible gire en sentido inverso, el árbol roscado gira en sentido
inverso y retira el elemento de accionamiento roscado, provocando
que el elemento de transporte de grapa y el miembro de soporte de
grapa se retraigan dentro del alojamiento hasta que el elemento de
transporte de grapa sea devuelto a una posición de recepción de
grapa adyacente a un cartucho de grapas en el alojamiento que
contiene una pluralidad de grapas. Cuando el elemento que lleva la
grapa es devuelto a esta posición, una grapa de la pluralidad de
grapas es empujada desde el cartucho de grapa a la ranura de
transporte de grapa por un dispensador de grapas cargado
elásticamente en comunicación funcional con el cartucho de grapas,
en preparación para un segundo procedimiento de
grapado.
grapado.
Más específicamente, con referencia ahora a la
fig. 2 con respecto al dispositivo de accionamiento electromecánico,
una realización ejemplar de un dispositivo de accionamiento
electromecánico 50 tiene una empuñadura 52 y un árbol flexible 54.
La empuñadura 52 tiene un diseño de estilo culata de pistola, que
tiene un par de gatillos 58a, 58b que están acoplados de manera
independiente a motores separados 60, 62 acoplados y alimentados por
una fuente de energía 64 y que cada giro separan árboles de
accionamiento flexibles 78a, 78b (descritos más completamente en lo
que sigue). Los motores 60, 62 son cada uno motores de doble
sentido, y están acoplados también a un interruptor de
accionamiento manual 66 montado en la parte superior de la
empuñadura 50, por lo que el usuario puede alterar selectivamente el
sentido de giro de cada motor 60, 62. En este ejemplo, la fuente de
energía 64 es un paquete de batería recargable que proporciona una
corriente continua.
La empuñadura 50 incluye además (1) un indicador
de estado remoto 68; (2) un medio de dirección de árbol flexible 70
y (3) una alimentación eléctrica adicional opcional (no mostrada).
El indicador de estado remoto 68 comprende un dispositivo de
lectura de LCD o similar por el que el usuario adquiere conocimiento
de la posición de los componentes (por ejemplo, si el extremo
distal de descarga de grapa del alojamiento de la unión de grapadora
está en la posición apropiada antes del accionamiento de las
grapas). En segundo lugar, la empuñadura 50 incluye también un
medio de orientación 70 accionable manualmente, por ejemplo, un
mando o bola de seguimiento, para dirigir el movimiento del árbol
flexible 72 (descrito más completamente en lo que sigue).
Finalmente, la empuñadura 50 puede incluir una alimentación de
corriente eléctrica (no mostrada) y un interruptor de
encendido/apagado (no mostrado) para suministrar selectivamente
energía eléctrica a las uniones.
Más particularmente, con respecto al árbol
flexible 72, el árbol flexible comprende una funda tubular 74,
preferiblemente formada de un material elastómero simple que es
compatible con el tejido y que se puede esterilizar (es decir, es
suficientemente resistente para un autoclave). Distintas longitudes
del árbol flexible 72 pueden estar previstas en unión con el
presente invento. En tal caso, el árbol flexible 72 y la empuñadura
50 deberían ser separables y de manera que el enlace entre el
extremo proximal del árbol flexible 72 y el extremo distal de la
empuñadura 50 incluya un medio de acoplamiento para los componentes
de accionamiento. Específicamente con respecto a los componentes de
accionamiento del árbol flexible 72, dentro de la funda de
elastómero hay un par de tubos fijos menores 76a, 76b que contienen
cada uno un árbol de accionamiento flexible 78a, 78b que es capaz
de girar dentro del tubo fijo correspondiente 76a, 76b. Cada árbol
de accionamiento flexible 78a, 78b es capaz de trasladar por sí
mismo un par desde el motor de accionamiento 60, 62 correspondiente
en la empuñadura 50 al extremo distal 80 del árbol flexible 72,
mientras que aún es lo suficientemente flexible para ser curvado,
inclinado, etc. cuando el cirujano estime necesario para
"ondular" el árbol flexible 72 a través del intestino del
paciente. Por ejemplo, los árboles de accionamiento flexibles 78a,
78b pueden comprender un cable de fibra de acero tejido. Se
reconocerá que los árboles de accionamiento flexible pueden ser
adecuados para este propósito. Con el fin de acoplar el extremo
distal 80 del árbol flexible 72 con una unión, tal como la unión
mediante grapas del presente invento (como se ha descrito más
completamente en lo que sigue), las extremidades distales 82a, 82b
de los árboles de accionamiento flexibles 78a, 78b tienen una
conformación que permite la traslación continuada de par. Por
ejemplo, las extremidades distales 82a, 82b de los árboles de
accionamiento flexible 78a, 78b son hexagonales, fijándose por ello
en una base o zócalo, o rebaje hexagonal, del extremo de
acoplamiento proximal del alojamiento de la unión de grapadora. Como
se ha sugerido antes, en unión con los medios de orientación 70
accionables manualmente montados en la empuñadura 50, el árbol
flexible 72 incluye además al menos dos alambres de orientación 84
que son flexibles, pero están acoplados a la superficie interior
del árbol flexible 72 cerca del extremo distal 80 del mismo. Los
cables de orientación 84 pueden ser trasladados axialmente uno con
relación a otro por accionamiento de los medios de orientación 70
accionables manualmente, cuya acción hace que el árbol flexible 72
se curve consiguientemente. También, como se ha sugerido antes, en
unión con el indicador 68 de estado remoto de la empuñadura 50, el
árbol flexible 72 contiene además un conductor eléctrico 86 para
acoplar a las uniones. Este conductor eléctrico 86 canaliza una
señal desde la unión a la empuñadura 50 para indicar el estado de
la unión (por ejemplo, indicar si el tejido que ha de ser unido es
adyacente al extremo distal de descarga de grapa de la unión
mediante grapas, o indicar el número de grapas restantes en el
cartucho de grapas). De manera similar, puede haber provistos
conductores eléctricos adicionales para alimentar energía para
separar aspectos de la unión si es así requerido.
Más particularmente, con respecto a la unión
mediante grapas del presente invento, la unión comprende un
alojamiento que tiene un extremo distal de descarga de grapas y un
extremo proximal de acoplamiento que tiene una base o zócalo para
acoplar la unión al extremo distal del árbol flexible. El extremo
distal de descarga de grapas tiene una abertura a través de la cual
las grapas son descargadas secuencialmente, y un labio de abertura
formado en la abertura. La unión comprende además un árbol roscado
que se aplica al árbol de tracción flexible del árbol flexible del
dispositivo de accionamiento electromecánico cuando el extremo
proximal de acoplamiento está acoplado al extremo distal del árbol
flexible, de tal manera que el árbol roscado gira en correspondencia
con la rotación del árbol de tracción flexible del árbol flexible.
El árbol roscado tiene, montado alrededor de él, un elemento de
accionamiento roscado que es similar en estructura a una tuerca,
pero que es seguido dentro del alojamiento de manera que la
rotación del árbol roscado hace que el elemento de accionamiento
roscado avance o se retraiga a lo largo del árbol roscado dentro del
alojamiento de la unión.
La unión comprende además un miembro de soporte
de grapas, un elemento de transporte de grapas de una pieza con
dicho miembro de soporte de grapas, y una parte de yunque integral
con el elemento de soporte de grapas. La unión comprende además un
miembro de cierre de grapa montado concéntricamente alrededor del
miembro de soporte de grapas El miembro de soporte de grapas y el
miembro de cierre de grapas están acoplados juntos por un resorte y
montados al elemento de accionamiento roscado de tal manera que el
avance del elemento de accionamiento roscado hace avanzar el
miembro de soporte de grapas y el miembro de cierre de grapas. El
miembro de cierre de grapas comprende un par de salientes, o
dientes salientes que están colocados para aplicar la grapa en las
partes laterales de la parte inferior plana de la grapa. El miembro
de cierre de grapas comprende además una superficie inclinada que
está destinada a aplicarse a la parte central de la parte inferior
plana de la grapa. El elemento de transporte de grapa comprendes
una ranura de transporte de grapa inclinada que tiene la parte de
yunque o labio de ranura.
La unión comprende además un cartucho de grapas
reemplazable montado en el alojamiento de la unión. El cartucho de
grapas contiene una pluralidad de grapas. El cartucho de grapas está
en comunicación funcional con un dispensador de grapas cargado
elásticamente.
Cuando el extremo proximal de acoplamiento del
alojamiento de la unión mediante grapas es acoplado al extremo
distal del árbol flexible del dispositivo de accionamiento
electromecánico, el árbol roscado de la unión mediante grapas se
aplica al árbol de tracción flexible del árbol flexible. El
accionamiento remoto del árbol de tracción flexible usando un
primer gatillo del dispositivo de accionamiento electromecánico hace
que el árbol de tracción flexible gire, lo que a su vez provoca que
al árbol roscado gire, lo que hace que el elemento de accionamiento
roscado avance dentro del alojamiento de la unión. El accionamiento
alternativo remoto del árbol de tracción flexible usando un segundo
gatillo hace que el árbol de tracción flexible gire en sentido
inverso, lo que a su vez provoca que el árbol roscado gire en
sentido inverso, lo que hace que el elemento de accionamiento
roscado se retraiga dentro del alojamiento de la unión. Así, como se
ha indicado antes, el miembro de soporte de grapas y el elemento de
transporte de grapas avanzan y se retraen con el elemento de
accionamiento roscado. Cuando el elemento de transporte de grapas
es retraído a una posición de recepción de grapa, adyacente al
cartucho de grapas, una grapa es empujada por el dispensador de
grapas cargado elásticamente desde el cartucho de grapas a la
ranura de transporte de grapas del elemento de transporte de grapas.
Cuando el miembro de soporte de grapas y el miembro de cierre de
grapas avanzan dentro del alojamiento, la grapa es llevada adentro
de la ranura de transporte de grapas. El ángulo de la ranura de
transporte de grapas asegura que la grapa permanece en la ranura de
transporte de grapas durante este avance. La grapa es llevada al
extremo distal de descarga de grapas del alojamiento y las puntas
de la grapa son insertadas en el tejido que ha de ser unido. Después
de que las puntas hayan penetrado en el tejido, el labio de
abertura del extremo distal de descarga de grapas detiene al
miembro de soporte de grapas. Al producirse el avance continuado del
elemento de accionamiento roscado, el resorte que acopla al miembro
de cierre de grapa y al miembro de soporte de grapas se comprime,
haciendo que el miembro de cierre de grapas avance más. Cuando el
miembro de cierre de grapas avanza más, los dientes salientes se
aplican a la grapa en las partes laterales de la parte inferior
plana de la grapa, presionan la grapa contra el labio de ranura de
la ranura de transporte de grapa, y curvan las partes laterales de
la parte inferior plana de la grapa para cerrar las puntas de la
grapa para formar una D y unir por ello el tejido. Al continuar el
avance del elemento de accionamiento roscado, el miembro de cierre
de grapa avanza más, y la superficie inclinada del miembro de
cierre de grapa se aplica a la parte central de la parte inferior
plana de la grapa para forzar a la grapa fuera de la ranura de
transporte de grapa para descargar y liberar completamente la grapa
desde la unión. Después de ello, el elemento de accionamiento
roscado es retraído, haciendo que el elemento de transporte de
grapas y el miembro de soporte de grapas se retraigan adentro del
alojamiento. Cuando el elemento de transporte de grapa es devuelto a
una posición de recepción de grapa, adyacente al cartucho de
grapas, una segunda grapa es empujada por el dispensador de grapas
cargado elásticamente desde el cartucho de grapas a la ranura de
transporte de grapas del elemento de transporte de grapas en
preparación para un segundo procedimiento de grapado.
La fig. 1 es una vista en perspectiva de un
dispositivo de grapadora quirúrgica de la técnica anterior;
La fig. 2 es una vista en perspectiva de un
dispositivo de accionamiento electromecánico para usar con el
presente invento;
La fig. 3 es una vista en sección transversal
lateral de una unión mediante grapas del presente invento, en que
el miembro de soporte de grapas y el miembro de transporte de grapas
están en una posición de carga de grapa; y
La fig. 4 es una vista en sección transversal
lateral de una unión mediante grapas del presente invento (girada
90° con respecto a la fig. 3) en que el miembro de soporte de grapas
y el miembro de transporte de grapas están en una disposición de
descarga de grapa.
Como se ha descrito antes, el presente invento
comprende una unión mediante grapas de tejido para usar con un
dispositivo de accionamiento electromecánico. Más particularmente, y
con referencia ahora a las figs. 3 y 4, una realización preferida
de la unión 100 comprende un alojamiento 102 que tiene un extremo
distal 104 de descarga de grapa y un extremo proximal 106 de
acoplamiento que tiene una base o zócalo 114 para acoplar la unión
100 al extremo distal (mejor mostrado como elemento 80 de la fig. 2)
del árbol flexible (mejor mostrado como elemento 72 de la fig. 2)
del dispositivo de accionamiento electromecánico (mejor mostrado en
la fig. 2). (Generalmente véase la solicitud de patente pendiente
norteamericana, Número de serie 09/324.452, titulada "Un
Dispositivo de Accionamiento Electromecánico para usar con
Instrumentos de Anastomosis, Grapado y Resección"). El extremo
distal 104 de descarga de grapa tiene una abertura 108 a través de
la cual las grapas son descargadas secuencialmente, y un labio 110
de abertura formado en la abertura 108. La unión 100 comprende
además un árbol roscado 112 que se aplica al árbol de tracción
flexible (mejor mostrado como elemento 78a o elemento 78b de la
fig. 2) del árbol flexible cuando el extremo proximal 106 de
acoplamiento está acoplado al extremo distal del árbol flexible, de
tal manera que el árbol roscado 112 gire en correspondencia con la
rotación del árbol de tracción flexible del árbol flexible. El
árbol roscado 112 tiene, montado a su alrededor, un elemento de
accionamiento roscado 116 que es similar en estructura a una tuerca,
pero que es seguido dentro del alojamiento 102 de manera que la
rotación del árbol roscado 112 hace que el elemento de accionamiento
roscado 116 avance o se retraiga a lo largo del árbol roscado 112
dentro del alojamiento 102 de la unión 100.
La unión 100 comprende además un miembro de
soporte de grapa 118, un elemento de transporte de grapa 120 de una
pieza con dicho miembro de soporte de grapa 118, y una parte de
yunque 122 integral con el elemento de transporte de grapa 120. La
unión 100 comprende además un miembro de cierre de grapa 124 montado
concéntricamente sobre el miembro de soporte de grapa 118. El
miembro de soporte de grapa 118 y el miembro de cierre de grapa 124
están acoplados juntos por un resorte 126 y montados en el elemento
de accionamiento roscado 116 de tal manera que el avance del
elemento de accionamiento roscado 116 hace avanzar al miembro de
soporte de grapa 118 y al miembro de cierre de grapa 124. El
miembro de cierre de grapa 124 comprende un par de salientes, o
dientes salientes 128 que están posicionados para aplicarse a la
grapa 130 en las partes laterales 132 (mejor mostradas en la fig.
4) de la parte inferior plana 134 (mejor mostrada en la fig. 4) de
la grapa 130. El miembro de cierre de grapa 124 comprende además
una superficie inclinada 136 que está destinada a aplicarse a la
parte central 138 (mejor mostrada en la fig. 4) de la parte
inferior plana 134 de la grapa 130. El elemento de transporte de
grapa 120 comprende una ranura 140 de transporte de grapa inclinada
que tiene la parte de yunque, o labio de ranura 142.
La unión 100 comprende además un cartucho
reemplazable 144 de grapas montado en el alojamiento 102 de la unión
100. El cartucho de grapas 144 contiene una pluralidad de grapas
146. El cartucho de grapas 144 está en comunicación funcional con
un dispensador de grapas 148 cargado elásticamente.
En funcionamiento, cuando el extremo proximal
106 de acoplamiento del alojamiento 102 de la unión mediante grapas
está acoplado al extremo distal del árbol flexible del dispositivo
de accionamiento electromecánico (mejor mostrado en la fig. 2), el
árbol roscado 112 de la unión mediante grapas 100 se aplica al árbol
de tracción flexible (mejor mostrado como elemento 78a o elemento
78b en la fig. 2) del árbol flexible (mejor mostrado como elemento
72 en la fig. 2). El accionamiento a distancia o remoto del árbol de
tracción flexible usando un gatillo (mejor mostrado como elemento
58a o elemento 58b en la fig. 2) del dispositivo de accionamiento
electromecánico hace que el árbol de tracción flexible gire, lo que
a su vez hace que el árbol roscado 112 gire, lo que hace que el
elemento de accionamiento roscado 116 avance dentro del alojamiento
102 de la unión 100. La conmutación remota del interruptor de
accionamiento manual (mejor mostrado como elemento 66 en la fig. 2)
del dispositivo de accionamiento electromecánico y el accionamiento
remoto subsiguiente del gatillo del dispositivo de accionamiento
electromecánico hace que el árbol preliminar flexible gire en
sentido inverso, lo que a su vez hace que al árbol roscado 112 gire
en sentido inverso, lo que hace que el elemento de accionamiento
roscado 116 se retraiga dentro del alojamiento 102 de la unión 100.
Así, como se ha indicado antes, el miembro de soporte de grapa 118
y el elemento de transporte de grapa 120 avanzan y se retraen con el
elemento de accionamiento roscado 116. Cuando el elemento de
transporte de grapa 120 es retraído a una posición de recepción de
grapa, adyacente al cartucho de grapas 144, una grapa de la
pluralidad de grapas 146 es empujada por un dispensador de grapas
148 cargado elásticamente desde el cartucho de grapas 144 a la
ranura de transporte de grapa 140 del elemento de transporte de
grapa 120. Cuando el miembro de soporte de grapa 118 y el miembro de
cierre de grapa 124 avanzan dentro del alojamiento 102, la grapa
130 es llevada adentro de la ranura de transporte de grapa 140. El
ángulo de la ranura de transporte de grapa 140 asegura que la grapa
130 permanece en la ranura de transporte de grapa 140 durante este
avance. La grapa 130 es llevada al extremo distal 104 de descarga
de grapas del alojamiento 102 y las puntas 150 (mejor mostradas en
la fig. 4) de la grapa 130 son insertadas en el tejido que ha de
ser unido. Después de que las puntas 150 hayan penetrado en el
tejido, el labio de abertura 110 del extremo distal de descarga de
grapa 104 detiene al miembro de sujeción de grapa 118. Al producirse
el avance continuado del elemento de accionamiento roscado 116, el
resorte 126 que acopla al miembro de cierre de grapa 124 y al
miembro de soporte de grapa 118 se comprime, provocando que el
miembro de cierre de grapa 124 avance más. Cuando el miembro de
cierre de grapa 124 avanza más, los dientes salientes 128 se aplican
la grapa 130 en las partes laterales 132 (mejor mostradas en la
fig. 4) de la parte inferior plana 134 (mejor mostrada en la fig.
4) de la grapa 130, presionan a la grapa 130 contra el labio de
ranura 142 de la ranura de transporte de grapa 140, e inclinan las
partes laterales 132 de la parte inferior plana 134 de la grapa 130
para cerrar las puntas 150 de la grapa 130 para formar una D y unir
por ello el tejido. Al seguir el avance del elemento de
accionamiento roscado 116, el miembro de cierre de grapa 124 avanza
más, y la superficie inclinada 136 del miembro de cierre de grapa
124 se aplica a la parte central 138 de la parte inferior plana 134
de la grapa 130 para forzar que la grapa 130 salga de la ranura de
transporte de grapa 140 para descargar y liberar completamente la
grapa 130 de la unión 100. Después de ello, el elemento de
accionamiento roscado 116 es retraído, haciendo que el elemento de
transporte de grapa 120 y el miembro de sujeción de grapa 118 se
retraigan dentro del alojamiento 102. Cuando el elemento de
transporte de grapa 120 es devuelto a una posición de recepción de
grapa, adyacente al cartucho de grapas 144, una segunda grapa es
empujada a la ranura 140 de transporte de grapa del elemento de
transporte de grapa 120 en preparación para un segundo procedimiento
de grapado.
Claims (11)
1. Una grapadora quirúrgica (100), que
comprende: un alojamiento (102) que tiene una abertura (108),
estando formado un labio (110) en la abertura; un miembro de cierre
de grapa (124) configurado para avanzar longitudinalmente dentro de
dicho alojamiento; un miembro de soporte de grapa (118) configurado
para soportar una grapa (130) y avanzar longitudinalmente dentro de
dicho alojamiento hasta que un avance adicional es impedido por
contacto entre dicho miembro de soporte y dicho labio; un árbol de
accionamiento giratorio (112) acoplado al miembro de cierre de
grapa (124), en el que la rotación del árbol de accionamiento
giratorio (112) hace avanzar tanto al miembro de sujeción de grapa
(118), como al miembro de cierre de grapa (124) hasta que un avance
adicional del miembro de sujeción de grapa (118) es impedido por
contacto entre el miembro de soporte de grapa (118) y el labio
(110); caracterizado porque comprende además un resorte (126)
que acopla el miembro de cierre de grapa (124) al miembro de
soporte de grapa (118) y configurado para ser comprimido por el
avance de dicho miembro de cierre en la dirección longitudinal, en
que la rotación continuada del árbol de accionamiento giratorio
(112) hace avanzar más dicho miembro de cierre de grapa (124) de
manera que el miembro de cierre de grapa (124) comprime el resorte
(126) en la dirección longitudinal y cierra la grapa (130) mientras
se impide al miembro de soporte de grapa (118) avanzar más.
2. La grapadora quirúrgica (100) según la
reivindicación 1ª, en la que el miembro de cierre de grapa (124)
tiene una superficie inclinada (136), y en la que la rotación
continuada del árbol de accionamiento giratorio (112) hace avanzar
al miembro de cierre de grapa (124) de manera que la superficie
inclinada (136) se aplica a la grapa (130) y libera la grapa (130)
del miembro de soporte de grapa (118).
3. La grapadora quirúrgica (100) según la
reivindicación 1ª, en la que la grapadora quirúrgica (100) es parte
de un sistema quirúrgico electromecánico que comprende además: un
árbol alargado (72); un segundo árbol de accionamiento giratorio
axialmente (78a, 78b) dispuesto dentro del árbol alargado (72); y un
sistema motor (60, 62) configurado para accionar el segundo árbol
de accionamiento giratorio axialmente (78a, 78b), en la que la
grapadora quirúrgica (100) está configurada para acoplarse de manera
separable a un extremo distal (80) del árbol alargado (72), y en la
que la grapadora quirúrgica (100) incluye un dispositivo de
accionamiento (116) dispuesto en el alojamiento (102), el miembro
de cierre de grapa (124) montado en el dispositivo de accionamiento
(116) y que se traslada dentro del alojamiento (102) en
correspondencia con el dispositivo de accionamiento (116).
4. La grapadora quirúrgica (100) según la
reivindicación 3ª, en la que el dispositivo de accionamiento (116)
incluye un árbol de accionamiento giratorio (112), estando roscado
el árbol de accionamiento giratorio (112), estando configurado el
árbol de accionamiento giratorio (112) para ser acoplado al segundo
árbol de accionamiento giratorio axialmente (78a, 78b).
5. La grapadora quirúrgica (100) según la
reivindicación 3ª, en la que el sistema quirúrgico electromecánico
comprende además: un sistema de control (66) configurado para
controlar el sistema motor (60, 62); y una unidad de control remoto
configurada para comunicar con el sistema de control para controlar
el sistema motor mediante el sistema de control.
6. La grapadora quirúrgica (100) según la
reivindicación 5ª, en la que la unidad de control remoto incluye una
unidad de control remoto cableada.
7. La grapadora quirúrgica (100) según la
reivindicación 1ª, en la que una grapa (130) es cargada al miembro
de sujeción de grapa (118) a través del uso de un mecanismo cargado
elásticamente (148) cuando el miembro de soporte de grapa (118) está
en una posición de recepción de grapa dentro del alojamiento
(102).
8. La grapadora quirúrgica (100) según la
reivindicación 7ª, en la que la grapa (130), antes de ser cargada al
miembro de sujeción de grapa (118), es mantenida en un cartucho de
grapas (144) y es cargada al miembro de soporte de grapa (118)
siendo empujada desde el cartucho de grapas (144) al miembro de
soporte de grapa (118).
9. La grapadora quirúrgica (100) según la
reivindicación 1ª, en la que el miembro de soporte de grapa (118)
incluye una ranura de transporte de grapa (140) dentro de la cual
una grapa (130) es llevada durante el avance del miembro de soporte
de grapa (118), teniendo la ranura de transporte de grapa (140) un
labio de ranura (142) contra el que una parte inferior plana de la
grapa (130) es presionada por el miembro de cierre de grapa (124)
después de que el miembro de sujeción de grapa (118) hace contacto
con el labio de abertura (110).
10. La grapadora quirúrgica (100) según la
reivindicación 9ª, en la que el miembro de cierre de grapa (124)
incluye salientes (128) que se aplican a las partes laterales de la
parte inferior plana de la grapa (130).
11. La grapadora quirúrgica (100) según la
reivindicación 9ª, en la que el miembro de cierre de grapa incluye
una superficie inclinada que se aplica a una parte central de la
parte inferior plana de una grapa, y en la que después de que la
grapa se ha cerrado dentro del tejido, el avance continuado del
dispositivo de accionamiento hace que la superficie inclinada
empuje la grapa fuera de la ranura (140) que transporta la
grapa.
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| US510931 | 2000-02-22 |
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| ES2267726T3 true ES2267726T3 (es) | 2007-03-16 |
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| EP (1) | EP1257206B1 (es) |
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| ES (1) | ES2267726T3 (es) |
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-
2000
- 2000-02-22 US US09/510,931 patent/US6533157B1/en not_active Expired - Lifetime
-
2001
- 2001-02-21 PT PT01911108T patent/PT1257206E/pt unknown
- 2001-02-21 ES ES01911108T patent/ES2267726T3/es not_active Expired - Lifetime
- 2001-02-21 AU AU2001238643A patent/AU2001238643A1/en not_active Abandoned
- 2001-02-21 WO PCT/US2001/005728 patent/WO2001062161A1/en active IP Right Grant
- 2001-02-21 AT AT01911108T patent/ATE331472T1/de not_active IP Right Cessation
- 2001-02-21 JP JP2001561232A patent/JP4277470B2/ja not_active Expired - Fee Related
- 2001-02-21 DE DE60121138T patent/DE60121138T2/de not_active Expired - Lifetime
- 2001-02-21 EP EP01911108A patent/EP1257206B1/en not_active Expired - Lifetime
Also Published As
| Publication number | Publication date |
|---|---|
| JP2003523253A (ja) | 2003-08-05 |
| DE60121138T2 (de) | 2007-07-12 |
| PT1257206E (pt) | 2006-11-30 |
| JP4277470B2 (ja) | 2009-06-10 |
| AU2001238643A1 (en) | 2001-09-03 |
| EP1257206B1 (en) | 2006-06-28 |
| ATE331472T1 (de) | 2006-07-15 |
| DE60121138D1 (de) | 2006-08-10 |
| WO2001062161A1 (en) | 2001-08-30 |
| US6533157B1 (en) | 2003-03-18 |
| EP1257206A1 (en) | 2002-11-20 |
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