ES2286725T3 - Aparato de grapado quirurgico. - Google Patents
Aparato de grapado quirurgico. Download PDFInfo
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- ES2286725T3 ES2286725T3 ES05003449T ES05003449T ES2286725T3 ES 2286725 T3 ES2286725 T3 ES 2286725T3 ES 05003449 T ES05003449 T ES 05003449T ES 05003449 T ES05003449 T ES 05003449T ES 2286725 T3 ES2286725 T3 ES 2286725T3
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- 238000010168 coupling process Methods 0.000 description 5
- 238000005859 coupling reaction Methods 0.000 description 5
- 238000003780 insertion Methods 0.000 description 5
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- 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
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00477—Coupling
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B2017/320052—Guides for cutting instruments
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Abstract
Un aparato quirúrgico (10), que comprende: un alojamiento (14); un vástago de control (52) que se extiende distalmente desde el alojamiento (14); y una unidad de carga (16) que puede ser soportada en un extremo distal del alojamiento (14), cuya unidad de carga (16) incluye: una parte (200) de alojamiento; y un conjunto (212) de accionamiento soportado a deslizamiento dentro de la parte (200) de alojamiento de la unidad de carga (16); estando destinado el conjunto (212) de accionamiento a aplicarse con el vástago de control (52) e incluyendo, al menos, un dedo elástico (270a) que se extiende radialmente hacia dentro; caracterizado porque: la parte (200) de alojamiento incluye un par de ranuras orientadas axialmente y diametralmente opuestas (250a, 250b) formadas en ella; y en el que, cuando el extremo distal (276) del vástago de control (52) es hecho avanzar axialmente en dirección a dicho al menos un dedo elástico (270a) y se aplica con él, el extremo distal del vástago de control (52) carga a dicho al menos un dedo elástico (270a) radialmente hacia fuera, dentro de las ranuras (250a, 250b) de la parte (200) de alojamiento.
Description
Aparato de grapado quirúrgico.
La presente exposición se refiere a un aparato
quirúrgico, por ejemplo un aparato para la aplicación de grapas
quirúrgicas. Más particularmente, la presente exposición se refiere
a un aparato de grapado quirúrgico endoscópico que incluye una
característica de conexión para conectar el conjunto de
accionamiento de una unidad de carga, por ejemplo, una unidad de
carga de un solo uso ("SULU") o una unidad de carga desechable
("DLU") en el miembro de accionamiento o vástago de control de
un aparato de grapado quirúrgico, para asegurar la aplicación total
o apropiada de la SULU o de la DLU, especialmente de su conjunto de
accionamiento, con el aparato de grapado quirúrgico. Para
simplificar, en lo que sigue, con "DLU" se hará referencia
tanto a una SULU como a una DLU, pero debe entenderse que dicha
sigla incluye una DLU y/o una SULU.
Los dispositivos quirúrgicos en los que primero
se coge o se sujeta un tejido entre una estructura de mordazas
opuestas y, luego, se le une mediante sujetadores quirúrgicos, son
bien conocidos en la técnica. En algunos instrumentos, se prevé una
cuchilla para cortar el tejido que se ha unido mediante los
sujetadores. Los sujetadores tienen, típicamente, la forma de grapas
quirúrgicas pero, también, pueden utilizarse sujetadores polímeros
de dos piezas.
Los instrumentos diseñados con este propósito
pueden incluir dos miembros de mordaza alargados que se utilizan,
respectivamente, para capturar o sujetar tejido. De manera típica,
uno de los miembros de mordaza lleva un cartucho de grapas que
aloja una pluralidad de grapas dispuestas en, al menos, dos filas
laterales, mientras que el otro miembro de mordaza tiene un yunque
que define una superficie para dar forma a las patas de las grapas
cuando se clavan éstas a partir del cartucho de las mismas.
Generalmente, la operación de grapado se efectúa merced a miembros
de leva que se desplazan longitudinalmente a través del cartucho de
grapas, actuando los miembros de leva sobre empujadores de grapas
para expulsar en secuencia las grapas desde el cartucho de grapas.
Entre las filas de grapas puede desplazarse una cuchilla para cortar
longitudinalmente y/o abrir el tejido grapado entre las filas de
grapas. Instrumentos de esta clase se describen, por ejemplo, en la
patente norteamericana núm. 3.079.606 y en la patente
norteamericana núm. 3.490.675.
Una grapadora posterior, descrita en la patente
norteamericana núm. 3.499.591 aplica, también, una doble fila de
grapas a cada lado de la incisión. Esta patente describe una
grapadora quirúrgica que tiene una unidad de carga desechable en la
que un miembro de leva se mueve siguiendo un trayecto de guía
alargado entre dos grupos de gargantas escalonadas que llevan las
grapas. Hay miembros para clavar las grapas situados en las
gargantas y posicionados de tal manera que el miembro de leva que se
desplaza longitudinalmente entre en contacto con ellos para llevar
a cabo la expulsión de las grapas desde el cartucho de grapas de la
unidad de carga desechable. Otros ejemplos de tales grapadoras se
describen en las patentes norteamericanas núms. 4.429.695 y
5.065.929.
Todos los instrumentos descritos en lo que
antecede están diseñados para utilizarlos en procedimientos
quirúrgicos usuales, en los que los cirujanos tienen acceso manual
directo a la zona de la intervención. Sin embargo, en
procedimientos endoscópicos o laparoscópicos, la cirugía se realiza
a través de una pequeña incisión o a través de una estrecha cánula
introducida por pequeñas heridas de entrada hechas en la piel. Con
el fin de atender a las necesidades específicas de los
procedimientos quirúrgicos endoscópicos y/o laparoscópicos, se han
desarrollado dispositivos endoscópicos de grapado quirúrgico que se
describen en, por ejemplo, la patente norteamericana núm. 5.040.715
(de Green y otros); la patente norteamericana núm. 5.307.976 (de
Olson y otros); la patente norteamericana núm. 5.312.023 (de Green
y otros); la patente norteamericana núm. 5.318.221 (de Green y
otros); la patente norteamericana núm. 5.326.013 (de Green y otros);
la patente norteamericana núm. 5.332.142 (de Robinson y otros); y
la patente norteamericana núm. 6.241.139 (de Milliman y otros), a
las que se dirige al lector para mayor referencia.
Tyco Healthcare Group, LP, cesionario de la
presente solicitud, ha fabricado y comercializado, durante varios
años, instrumentos de grapado endoscópicos tales como los
instrumentos Multifire ENDO GIA^{MR} 30 y Multifire ENDO
GIA^{MR} 60. Estos instrumentos incluyen un aparato de grapado
quirúrgico y una DLU. Típicamente, la DLU se une al aparato
inmediatamente antes de la cirugía. Después del uso, la DLU puede
ser retirada del aparato y se puede fijar una DLU nueva al aparato
para realizar operaciones adicionales de grapado y/o de corte. Estos
instrumentos han aportado importantes beneficios clínicos. No
obstante, todavía es posible introducir mejoras en estos
instrumentos.
Sería deseable proporcionar una DLU mejorada
para un aparato de grapado quirúrgico y un aparato de grapado
quirúrgico mejorado con la DLU cargada en él.
También sería deseable proporcionar una
característica de conexión para una DLU que garantice la carga
apropiada de la DLU en el vástago de un aparato de grapado
quirúrgico.
En consecuencia, un objeto de esta exposición es
satisfacer los deseos antes expresados.
Otro objeto de esta exposición es proporcionar
una DLU con una característica de conexión que proporcione una
conexión operativa apropiada entre el conjunto de accionamiento de
una DLU y el miembro de accionamiento de un aparato de grapado
quirúrgico.
Otro objeto de esta exposición es proporcionar
la DLU antes mencionada que permita tal conexión apropiada para una
DLU ya montada en el aparato sin tal conexión.
Aún otro objeto de esta exposición es
proporcionar una DLU mejorada con una característica de conexión que
garantice que si la DLU no se carga inicialmente en forma apropiada
en el vástago del cuerpo alargado de un aparato de grapado
quirúrgico, porque el conjunto de accionamiento de la DLU no se
aplique, acople o conecte inicialmente de manera apropiada a un
miembro de accionamiento del aparato de grapado quirúrgico, la
característica de bloqueo o de conexión asegure, no obstante, la
conexión apropiada del conjunto de accionamiento con el miembro de
accionamiento y el funcionamiento apropiado de la DLU y del aparato
de grapado quirúrgico. Como ejemplo, la DLU adoptará una conexión
apropiada, al menos, durante la fijación de los conjuntos de
cartucho y de yunque y/o durante el disparo de las grapas. Como
otro ejemplo, tras el disparo, la DLU permitirá la retracción del
conjunto de accionamiento y la apertura del conjunto de cartucho y/o
del conjunto de yunque.
Todavía otro objeto de la exposición es
proporcionar una DLU que, tras el disparo y la retracción, pueda
desconectarse del aparato de grapado quirúrgico.
Aún otro objeto de la presente exposición es
proporcionar los anteriores objetos en una DLU roticulante, es
decir, articulable a rotación.
El invento está definido por las
reivindicaciones independientes, cuyos preámbulos se basan en la
patente norteamericana núm. 6.241.139. Las reivindicaciones
subordinadas están dirigidas a realizaciones preferidas.
De acuerdo con la presente exposición, se
proporciona un aparato quirúrgico, por ejemplo un aparato de grapado
quirúrgico, que incluye una disposición para asegurar la aplicación
o la conexión apropiada de una unidad de carga desechable a un
extremo del aparato quirúrgico. De acuerdo con un aspecto de la
presente exposición, el aparato quirúrgico incluye un alojamiento,
un vástago de control que se extiende distalmente desde el
alojamiento y que tiene un extremo distal agrandado, y una unidad
de carga que puede ser soportada en un extremo distal del
cuerpo
alargado.
alargado.
La unidad de carga incluye, de preferencia, una
parte de alojamiento que puede incluir una media parte superior del
alojamiento y una media parte inferior del alojamiento, en la que
las medias partes del alojamiento, por ejemplo, cada una de las
medias partes, superior e inferior, del alojamiento, incluye una
ranura o abertura axialmente orientada, formada en ella o a través
de ella. La unidad de carga incluye también, preferiblemente, un
conjunto de accionamiento soportado a deslizamiento dentro de la
parte de alojamiento de la unidad de carga, incluyendo el conjunto
de accionamiento, al menos, un dedo elástico que se extiende
radialmente hacia dentro. Los dedos están adaptados de tal forma
que, cuando el extremo distal preferiblemente agrandado del vástago
de control es hecho avanzar axialmente en la dirección de los dedos
elásticos y se aplica con ellos, el extremo distal agrandado del
vástago de control carga a los dedos radialmente hacia fuera, hacia
las ranuras formadas en las medias partes de alojamiento superior e
inferior, y dentro de ellas. Preferiblemente, las ranuras están
orientadas radialmente.
De preferencia, cada dedo elástico incluye una
punta. Más preferiblemente, las puntas de los dedos están orientadas
unas hacia otras. En funcionamiento, los dedos elásticos retornan a
un estado sin carga cuando el extremo distal agrandado del vástago
de control ha sobrepasado las puntas de los dedos elásticos.
Deseablemente, el aparato quirúrgico es una
grapadora quirúrgica.
La presente exposición proporciona, también, una
unidad de carga para uso con un extremo distal de un aparato de
grapado quirúrgico, y/o que puede ser soportada por él. La unidad de
carga incluye una parte de alojamiento que incluye una
característica de conexión, preferiblemente en forma de par de
ranuras orientadas axialmente y diametralmente opuestas, formadas
en ella, y un conjunto de accionamiento soportado a deslizamiento
dentro de la parte de alojamiento de la unidad de carga, incluyendo
el conjunto de accionamiento un par de dedos axialmente espaciados,
que se extienden radialmente hacia dentro, en la que cuando el
extremo distal del vástago de control es hecho avanzar axialmente
en la dirección de los dedos elásticos y se aplica con ellos, el
extremo distal del vástago de control carga a los dedos elásticos
radialmente hacia fuera, dentro de las ranuras de la parte de
alojamiento.
A partir de la descripción que sigue, tomada en
conjunto con los dibujos anejos, resultarán evidentes otras
ventajas.
La presente exposición se elucidará con mayor
detalle con referencia a los dibujos adjuntos, en los que números
de referencia similares se refieren a partes similares en las
diversas vistas, y en los que:
la Fig. 1 es una vista en perspectiva de una
realización preferida del aparato de grapado quirúrgico que se está
describiendo;
la Fig. 2 es una vista desde arriba del aparato
de grapado quirúrgico ilustrado en la Fig. 1;
la Fig. 3 es una vista lateral del aparato de
grapado quirúrgico representado en las Figs. 1 y 2;
la Fig. 4 es una vista en perspectiva, desde
arriba, del aparato de grapado quirúrgico de las Figs.
1-3 con la DLU desaplicada del cuerpo alargado del
aparato de grapado quirúrgico;
la Fig. 5 es una vista en perspectiva, desde
abajo, de una DLU no articulable;
la Fig. 6 es una vista en perspectiva, desde
abajo, de la DLU articulable, preferida, del aparato de grapado
quirúrgico de las Figs. 1-4;
la Fig. 7 es una vista en perspectiva, desde
arriba, de la DLU de la Fig. 6;
la Fig. 8 es una vista en perspectiva, desde
arriba, de la DLU de las Figs. 6 y 7;
la Fig. 9 es una vista en perspectiva, desde
arriba, agrandada, con partes separadas, de la parte proximal del
alojamiento y del conjunto de montaje de la DLU de las Figs.
6-8;
la Fig. 10 es una vista en perspectiva, desde
arriba, de la parte proximal del alojamiento y del conjunto de
montaje de la DLU de las Figs. 6-9, con la mitad
superior del alojamiento retirada;
la Fig. 11 es una vista en perspectiva, desde
arriba, con partes separadas, del conjunto de accionamiento axial
de la DLU de las Figs. 6-9;
la Fig. 12 es una vista en perspectiva, desde
arriba, del conjunto de accionamiento axial de la Fig. 11 de la DLU
de las Figs. 6-9;
la Fig. 13 es una vista en perspectiva desde
arriba, agrandada, de la mitad inferior del alojamiento de la parte
proximal del alojamiento de la DLU de las Figs.
6-9;
la Fig. 14 es una vista en perspectiva,
agrandada, del extremo distal del cuerpo alargado del aparato de
grapado ilustrado en la Fig. 4;
la Fig. 15 es una vista en sección transversal
vertical, agrandada, del extremo proximal de la DLU como se vería
por la línea 15-15 de la Fig. 9 con la DLU
montada;
la Fig. 16 es una vista en sección transversal
vertical, agrandada, del extremo proximal de la DLU como se vería
por la línea 15-15 de la Fig. 9, con la DLU montada,
ilustrando una etapa del acoplamiento de la DLU al extremo distal
del vástago de accionamiento del cuerpo alargado;
la Fig. 17 es una vista en sección transversal
vertical, agrandada, del extremo proximal de la DLU como se vería
por la línea 15-15 de la Fig. 9, con la DLU montada,
ilustrando otra etapa de la conexión de la DLU al extremo distal
del vástago de accionamiento del cuerpo alargado;
la Fig. 18 es una vista en sección transversal
vertical, agrandada, del extremo proximal de la DLU como se vería
por la línea 15-15 de la Fig. 9, con la DLU montada,
ilustrando todavía otra etapa de la conexión de la DLU al extremo
distal del vástago de accionamiento del cuerpo alargado;
la Fig. 19 es una vista en sección transversal
vertical, agrandada, del extremo proximal de la DLU como se vería
por la línea 15-15 de la Fig. 9, con la DLU montada,
ilustrando aún otra etapa de la conexión de la DLU al extremo
distal del vástago de accionamiento del cuerpo alargado;
la Fig. 20 es una vista en perspectiva, desde
arriba, de una DLU de acuerdo con la presente exposición;
la Fig. 21 es una vista en perspectiva, desde
arriba, agrandada, del área de detalle indicada en la Fig. 20; y
la Fig. 22 es una vista en perspectiva, desde
arriba, agrandada, del área de detalle indicada en la Fig. 20, con
el alojamiento inferior retirado.
Se describirán ahora con detalle realizaciones
preferidas del aparato quirúrgico de la presente exposición, la DLU
y el mecanismo de bloqueo o de re-aplicación,
haciendo referencia a los dibujos, en los que números de referencia
similares designan elementos idénticos o correspondientes en todas
las diversas vistas.
En los dibujos y en la descripción que sigue, el
término "proximal", como es tradicional, se referirá al extremo
del aparato de grapado que se encuentra más cerca del operador,
mientras que el término "distal" se referirá al extremo del
aparato que está más alejado del operador.
Las Figs. 1-4 muestran un
aparato quirúrgico, por ejemplo un aparato de grapado quirúrgico,
designado generalmente con 10. Para abreviar, esta exposición se
enfocará, principalmente, sobre sistemas, métodos y estructuras
para cargar, aplicar, acoplar o conectar una unidad de carga
desechable ("DLU") 16 a un aparato de grapado quirúrgico 10.
Una descripción detallada de los restantes componentes y del método
de uso del aparato de grapado quirúrgico 10, está contenida en la
patente norteamericana 6.241.139.
El aparato de grapado quirúrgico 10 es un
aparato endoscópico e incluye un conjunto de mango 12 y un cuerpo
alargado 14 que se extiende desde el conjunto de mango 12. Una DLU
16 está asegurada de forma liberable al extremo distal del cuerpo
alargado 14. Si bien esta exposición se refiere al uso de una DLU
con el aparato de grapado quirúrgico 10, se entiende y cae dentro
del ámbito de la presente exposición que, en cooperación con el
aparato de grapado quirúrgico 10 puede utilizarse, igualmente, una
unidad de carga de un solo uso (SULU) u otro elemento terminal y/o
conjunto de útil.
La DLU 16 incluye un conjunto 17 de útil que
tiene un conjunto 18 de cartucho que aloja una pluralidad de grapas
quirúrgicas (no mostradas) y un conjunto de yunque 20 asegurado de
forma que pueda moverse con relación al conjunto 18 de cartucho.
Como se muestra en este documento, la DLU 16 está configurada para
aplicar seis (6) filas lineales de grapas en las DLU que midan de
desde unos 30 mm a unos 60 mm de longitud. También se contemplan
DLU para aplicar cualquier número de filas de grapas, con cavidades
para grapas dispuestas en diversos diseños y/o DLU y elementos
terminales que tengan cualesquiera otras longitudes, por ejemplo, 45
mm. El conjunto de mango 12 incluye un miembro de mango
estacionario 22, un miembro de mango móvil 24 y una parte de cañón
26.
Un miembro giratorio 28 está montado,
preferiblemente, en el extremo delantero de la parte de cañón 26
para facilitar la rotación del cuerpo alargado 14 y la DLU 16 unida
con respecto al conjunto de mango 12. Una palanca 30 de
articulación está montada también, preferiblemente, en el extremo
delantero de la parte de cañón 26 junto al miembro giratorio 28,
para facilitar la articulación del conjunto 17 de útil.
Preferiblemente, un par de mandos 32 están posicionados, de manera
que puedan moverse a lo largo de la parte de cañón 26. Los mandos
32 son hechos avanzar distalmente para aproximar o cerrar el
conjunto 18, 20 de cartucho y/o de yunque, y son retraídos en
dirección proximal para separar o abrir el conjunto 18, 20 de
cartucho y/o de yunque.
Como se ve en la Fig. 4, una DLU 16 puede
acoplarse de forma retirable selectivamente, de manera deseable, al
cuerpo alargado 14. La DLU 16 incluye una parte 200 de alojamiento
que tiene un extremo proximal destinado a aplicarse, de forma
liberable al extremo distal del cuerpo alargado 14. Un conjunto 202
de montaje está asegurado a pivotamiento en 203 al extremo distal
de la parte 200 de alojamiento, y está configurado para recibir el
extremo proximal del conjunto 17 de útil de tal manera que el
movimiento de pivotamiento del conjunto 202 de montaje alrededor de
un eje geométrico en 203, perpendicular al eje geométrico
longitudinal de la parte 200 de alojamiento realice la articulación
del conjunto 17 de útil.
Las Figs. 5-8 ilustran varias
vistas en perspectiva de la DLU 16. El aparato de grapado quirúrgico
10 es capaz de recibir una DLU 16a no articulable, como se ve en la
Fig. 5, o una DLU 16 articulable, como se ve en las Figs.
6-8. La patente norteamericana 6.241.139 incluye una
detallada descripción de una DLU articulable y no articulable.
Con referencia en general a las Figs.
9-14, 20 y 21 y con referencia, en particular, a las
Figs. 9-14, la DLU 16 incluye un conjunto 235 de
montaje. El conjunto 235 de montaje incluye una parte de montaje
superior y una parte de montaje inferior, 236, 238,
respectivamente. Un miembro de pivote 284 situado centralmente se
extiende desde cada una de las partes de montaje superior e inferior
236, 238 a través de respectivas aberturas 246a formadas en
miembros de acoplamiento 246. Cada uno de los miembros de
acoplamiento 246 incluye una parte proximal 246b de enclavamiento,
configuradas para ser recibidas en gargantas 290 formadas en el
extremo proximal de mitades de alojamiento superior e inferior 250,
252, para retener el conjunto 235 de montaje y las mitades de
alojamiento superior e inferior 250, 252 en posición fija
longitudinalmente uno con respecto a otro.
La mitad superior 250 del alojamiento y la mitad
inferior 252 del alojamiento están contenidas dentro de un
manguito, cuerpo o alojamiento exterior 251. El extremo proximal de
la mitad superior 250 del alojamiento incluye protuberancias 254 de
aplicación para aplicarse en forma soltable con el extremo distal
del cuerpo 14. Las protuberancias 254 forman un acoplamiento del
tipo de bayoneta con el extremo distal del cuerpo 14. Las mitades
252 y 254 de alojamiento definen un canal 400 para recibir a
deslizamiento en ellas el conjunto 212 de accionamiento, axial. Una
conexión de articulación 256 está dimensionada para ser posicionada
a deslizamiento dentro de una ranura 402 formada en las mitades de
alojamiento superior e inferior, 250, 252. Un par de conjuntos 255
de placa de soplado están posicionados junto al extremo distal de la
parte 200 de alojamiento, junto al extremo distal del conjunto 212
de accionamiento, axial, para impedir el pandeo hacia fuera y el
abombamiento del conjunto de accionamiento 212 durante la
articulación y el disparo del aparato de grapado quirúrgico 10.
Para una descripción detallada de la estructura y el funcionamiento
de los conjuntos 255 de placa de soplado, se hace referencia a la
solicitud internacional número de serie PCT/US02/32031, presentada
el 4 de Octubre de 2002, titulada "Dispositivo de grapado
quirúrgico", a la que se dirige al lector como referencia.
Haciendo referencia a la Fig. 9, opcionalmente,
un miembro de bloqueo 288 puede estar soportado en la sección 270
de aplicación del conjunto 212 de accionamiento axial. En
funcionamiento, cuando se activa el conjunto 212 de accionamiento
axial, aplicando una fuerza predeterminada al miembro de mango
movible 24 para hacer avanzar distalmente al conjunto 212 de
accionamiento axial, el miembro de bloqueo 288 proporciona una
indicación audible y táctil de que se ha accionado el aparato de
grapado quirúrgico 10. Para una descripción detallada de la
estructura y del funcionamiento del miembro de bloqueo 288, se hace
referencia a la solicitud internacional, antes mencionada, número
de serie PCT/US02/32031. El miembro de bloqueo 288 puede impedir,
también, la actuación parcial inadvertida de la DLU 16, por
ejemplo, durante el transporte, bloqueando el conjunto 212 de
accionamiento axial en una posición fija dentro de la DLU 16 hasta
que se haya aplicado una fuerza axial predeterminada al conjunto
212 de accionamiento axial.
Con referencia a las Figs. 9-12,
el conjunto 212 de accionamiento axial incluye una viga alargada 266
de accionamiento (Fig. 11) que incluye una cabeza de trabajo 268
distal (Fig. 12) y una sección proximal 270 de aplicación. La viga
de accionamiento 266 puede estar construida a partir de una única
lámina de material o, preferiblemente, de múltiples láminas
apiladas, como se muestra en la Fig. 11. La sección 270 de
aplicación incluye un par de dedos de aplicación elásticos 270a y
270b que están dimensionados y configurados para aplicarse en
relación de montaje con un par de ranuras de retención 272a y 272b
correspondientes, formadas en el miembro de accionamiento 272 (Fig.
12). El miembro de accionamiento 272 incluye una portilla proximal
274 configurada para recibir el extremo distal 276 de un miembro de
accionamiento, por ejemplo el vástago de accionamiento o vástago de
control 52 (Figs. 14 y 16-18) cuando el extremo
proximal de la DLU 16 está aplicándose con el cuerpo alargado 14
del aparato de grapado quirúrgico 10. El vástago de control 52
funciona para comunicar un movimiento axial al conjunto de
accionamiento 212 a partir del conjunto 12 de mango.
Con referencia a las Figs. 9-12
y 15-21, cada dedo 270a, 270b incluye una región de
altura incrementada, cuya región, de preferencia, está formada por,
y define, una lengüeta respectiva 273a, 273b. Cada lengüeta 273a,
273b se encuentra, preferiblemente, en el mismo plano definido por
la viga de accionamiento 266.
Como se ve en las Figs. 1,4, 7-9
y 15-21, la mitad superior 250 del alojamiento
incluye una abertura alargada o ranura 250a, orientada longitudinal
o axialmente. De preferencia, la ranura alargada 250a está
axialmente alineada con la protuberancia de aplicación 254 de la
punta de inserción 193. Como se ve en las Figs. 5, 6, 13 y
15-20, la mitad inferior 252 del alojamiento incluye
una abertura alargada o ranura 252a, orientada longitudinal o
axialmente. Preferiblemente, la ranura alargada 252a está axialmente
alineada con una respectiva protuberancia de aplicación 254 de la
punta de inserción 193 cuando la mitad inferior 252 del alojamiento
se acopla a la mitad superior 250 del alojamiento. Como se
describirá con mayor detalle en lo que sigue, las aberturas
alargadas o ranuras 250a, 252a, están dimensionadas para permitir
que las partes superiores o lengüetas 273a, 273b del par de dedos
de aplicación 270a, 270b de la sección 270 de aplicación del
conjunto 212 de accionamiento axial se desvíen respectivamente en
ellas durante la aplicación de la DLU 16 al extremo distal del
cuerpo alargado 14. Si bien se prefiere que las ranuras 250a, 250b
se extiendan completamente a través de las mitades superior e
inferior, 250, 252, del alojamiento, se contempla que las ranuras
250a, 250b puedan adoptar la forma de canales, depresiones o
gargantas no pasantes formados en la superficie interior o que
ocupen menos del grosor de las mitades superior e inferior 250,
252, del alojamiento. Preferiblemente, la característica de conexión
del presente invento incluye aberturas alargadas o ranuras 250a,
252a y lengüetas 273a, 273b, así como la aplicación mutua,
operativa, de las ranuras 250a, 252a con las respectivas lengüetas
273a, 273b.
Con referencia a las Figs.
15-19, se describe un método de conectar la DLU 16
al extremo distal del cuerpo alargado 14. Como se ve en la Fig. 15,
antes de la introducción de la punta de inserción 193 en el extremo
abierto del extremo distal del cuerpo alargado 14 (no mostrado en
los dibujos), el conjunto de accionamiento 212 se encuentra, de
preferencia, en la posición más proximal (por ejemplo, tal que las
superficies enfrentadas más proximales 277c, 277d de los dedos
270a, 270b más proximales del conjunto 212 de accionamiento, están
en estrecha proximidad con las superficies enfrentadas distales
250b, 252b de los extremos distales de las mitades superior e
inferior 250, 252, del alojamiento previstos cerca de las
superficies enfrentadas distales 193a de la punta de inserción
193). El conjunto de accionamiento 212 es mantenido,
preferiblemente, en la posición más proximal mediante una fuerza de
resistencia normal que mantiene separados o abiertos al conjunto 20
de yunque y al conjunto 18 de cartucho. La fuerza de resistencia
normal es generada por un rodillo de levas 286 del conjunto de
accionamiento 212 (Fig. 11) en aplicación con una superficie de leva
(no mostrada) del conjunto 20 de yunque. Para disponer de una
descripción detallada del funcionamiento del rodillo de levas 286,
se hace referencia a la solicitud internacional número de serie
PCT/US02/32031, presentada el 4 de Octubre de 2002, titulada
"Dispositivo de grapado quirúrgico".
Como se ve en la Fig. 16, cuando se introduce la
punta de inserción 193 en el extremo distal del cuerpo alargado 14
(no mostrado) en la dirección de la flecha "A", el extremo
distal 276 del vástago de control 52 apoya contra las superficies
en ángulo 275a, 275b de los dedos 270a, 270b. Inicialmente, el
cierre o la aproximación del conjunto 20 de yunque y del conjunto
18 de cartucho merced al desplazamiento distal del vástago de
control 52 (por ejemplo, haciendo avanzar distalmente los mandos 32
y/o mediante una primera actuación del mango móvil 24), vencerá la
fuerza de resistencia normal y desplazará al conjunto 212 de
accionamiento en dirección distal hasta que las lengüetas 273a,
273b de los dedos 270a, 270b se encuentren por debajo o en
coincidencia con respectivas ranuras alargadas 250a, 252a de las
mitades superior e inferior 250 y 252 del alojamiento, y sean
cargadas al interior de las mismas.
El conjunto 212 de accionamiento es mantenido en
posición axial con relación al alojamiento 200 con las lengüetas
273a, 273b en coincidencia con las ranuras 250a, 252a debido a una
resistencia importante generada por la fuerza requerida para
sujetar y disparar el aparato 10. Las situaciones axiales de las
ranuras alargadas 250a, 252a y de las lengüetas 273a, 273b del
miembro 212 de accionamiento, se calculan para que coincidan
axialmente basándose en la fuerza requerida para aproximar el
conjunto de cartucho y el conjunto de yunque, 18, 20. Mientras las
lengüetas 273a, 273b están en coincidencia radial con las ranuras
250a, 250b, un avance adicional en la dirección distal del conjunto
212 de accionamiento es contrarrestado sustancialmente por la fuerza
distal requerida para hacer avanzar el conjunto 212 de
accionamiento lo suficiente hacia delante a través del conjunto 18
de cartucho, para sujetar tejido entre el conjunto de cartucho y el
conjunto de yunque, 18, 20 y para disparar y conformar las grapas.
Una segunda actuación del mango móvil 24 vence esa resistencia y
hace avanzar al miembro 272 de accionamiento para llevar a cabo la
sujeción y el disparo. Como ocurre inicialmente, los dedos 270a,
270b son empujados radialmente hacia fuera, al interior de las
ranuras 250a, 250b, por el extremo distal 276 del vástago de
control 52.
Más particularmente, el desplazamiento inicial
continuado del vástago de control 52 en dirección opuesta a la de
la flecha "A" con relación al conjunto 212 de accionamiento,
tendrá como consecuencia una acción de leva entre las superficies
en ángulo 275a, 275b de los dedos 270a, 270b y el extremo distal 276
del vástago de control 52, que empuja y carga a los dedos 270a,
270b y a las respectivas lengüetas 273a, 273b radialmente hacia
fuera, en la dirección de las flechas "B" y al interior de las
ranuras alargadas 250a, 252a formadas en el alojamiento 200.
Preferiblemente, las ranuras 250a, 252a son
diametralmente opuestas y están formadas en y a través de las
mitades superior e inferior, 250 y 252, del alojamiento,
respectivamente. Cuando las lengüetas 273a y 273b están
posicionadas en las ranuras 250a y 252a, respectivamente, los bordes
distales mostrados en este documento como superficies de transición
en ángulo, 279a, 279b, de las lengüetas 273a, 273b, son adyacentes a
los bordes distales de las ranuras 250a, 252a (como se ve en la
Fig. 17) y, por tanto, axialmente seguros para impedir,
temporalmente, el ulterior movimiento distal del conjunto 212 de
accionamiento dentro de la parte 200 de alojamiento de la DLU 16.
Mientras las lengüetas 273a, 273b están forzadas dentro de las
ranuras 250a, 250b de las mitades superior e inferior, 250, 252,
del alojamiento (como se ve en la Fig. 17), se permite que la cabeza
276a o el extremo distal 276 del vástago de control 52 pase
distalmente más allá de las respectivas puntas 277a, 277b, vueltas
hacia dentro, de los dedos 270a, 270b.
El extremo distal 276 del vástago de control 52
tiene, preferiblemente, una o más superficies de aplicación y, en
este documento, se le representa incluyendo superficies en la cabeza
276a (Fig. 14) que corresponden a las superficies en ángulo 275a,
275b de los dedos 270a, 270b y un rebajo anular de menor diámetro,
276b (Fig. 14) situado justamente en posición proximal con respecto
a la cabeza 276a y parcialmente definido por la cabeza 276a.
Como se muestra en la Fig. 18, cuando el extremo
distal 276 del vástago de control 52 pasa distalmente más allá de
las puntas 277a, 277b vueltas hacia dentro de los dedos 270a, 270b,
los dedos 270a, 270b recuperan su condición de no cargados o no
empujados radialmente hacia dentro y saltan elásticamente, de
preferencia en forma audible, sobre el extremo distal 276 y,
preferiblemente, sobre el vástago de control 52, dentro de rebajos
276b del vástago de control, para conectar o bloquear apropiadamente
la DLU 16 respecto al miembro de accionamiento o vástago de control
52 del cuerpo alargado 14 del aparato de grapado 10.
A continuación de la conexión antes mencionada
de la sección 270 de aplicación del conjunto 212 de accionamiento
con el vástago de control 52, se hace avanzar adicionalmente al
vástago de control 52 distalmente dentro del miembro 272 de
accionamiento al continuarse la segunda actuación del mango móvil
24, hasta que el extremo distal 276 del vástago de control 52 entra
en contacto o se aplica operativamente de otro modo con una
superficie enfrentada proximal u otra parte interna, en el presente
caso un resalto 272a (Figs. 15-19) formado dentro
del miembro 272 de accionamiento (Fig. 18). La actuación continuada
del mango 24 hace que los bordes distales de las ranuras 250a, 252a
y la superficie interior de las mitades superior e inferior, 250,
252, del alojamiento actúen contra las superficies de transición
279a, 279b en ángulo y a lo largo del borde exterior de las
lengüetas 273a, 273b para llevar a éstas más allá de las ranuras
250 y al interior del alojamiento 200 a fin de mantener a los dedos
270a, 270b cerrados sobre el vástago de control 52. Como tal,
durante la segunda actuación del mango móvil 24, el extremo distal
276 del vástago de control 52 se aplica con el resalto 272a del
miembro 272 de accionamiento para hacer avanzar distalmente la
cabeza de trabajo 268 del conjunto 212 de accionamiento al interior
de los conjuntos de cartucho y de yunque, 18, 20, para sujetar el
miembro de útil 17 y disparar el aparato grapador 10.
Preferiblemente, como se ve del mejor modo en
las Figs. 15-18, cada dedo 270a, 270b incluye una
superficie de transición 279a, 279b en ángulo, respectivamente,
entre las partes principales de los miembros 212 de accionamiento y
las lengüetas 273a, 273b. De esta forma, si es necesario, cuando el
conjunto 212 de accionamiento es hecho avanzar en la dirección de
la flecha "A" para hacer avanzar las lengüetas 273a, 273b más
allá de las ranuras alargadas 250a, 252a, las superficies de
transición 279a, 279b actúan como superficies de acción de leva
contra las mitades superior e inferior, 250, 252, del alojamiento,
para empujar así a los dedos 270a, 270b de nuevo uno hacia
otro.
En el caso en que el conjunto 212 de
accionamiento esté situado en la posición menos proximal cuando se
mueve la DLU 16 al extremo distal del cuerpo alargado 14 para
acoplamiento mutuo, y/o en el caso en que el conjunto 212 de
accionamiento no se conecte apropiadamente a un miembro de
accionamiento, por ejemplo, el vástago de control 52, el movimiento
distal del vástago de control 52 durante la aproximación de los
miembros de mordaza y/o, al menos, durante la sujeción y el disparo
de las grapas dará lugar, no obstante, a que el extremo distal 276
del vástago de control 52 entre en contacto con los dedos 270a, 270b
del conjunto 212 de accionamiento, como se ve en las Figs. 16 y 17,
y a la acción de leva entre las superficies en ángulo 275a, 275b de
los dedos 270a, 270b y el extremo distal 276 del vástago de control
52 empujará y cargará a los dedos 270a, 270b y a las respectivas
lengüetas 273a, 273b radialmente hacia fuera, en la dirección de las
flechas "B" y al interior de las ranuras alargadas 250a, 252a,
hasta que el extremo distal 276 del vástago de control 52 pase
distalmente más allá de las respectivas puntas 277a, 277b, vueltas
hacia dentro, de los dedos 270a, 270b y se aplique apropiadamente
con el conjunto 212 de accionamiento y quede conectado de forma
totalmente operativa con él.
La Fig. 19 muestra el conjunto 212 de
accionamiento retraído a la posición más proximal en la que, por
tanto, no sujeta y/o no aproxima, los conjuntos de cartucho y de
yunque, 18, 20.
Claims (16)
1. Un aparato quirúrgico (10), que
comprende:
un alojamiento (14);
un vástago de control (52) que se extiende
distalmente desde el alojamiento (14); y
una unidad de carga (16) que puede ser soportada
en un extremo distal del alojamiento (14), cuya unidad de carga
(16) incluye:
una parte (200) de alojamiento; y
un conjunto (212) de accionamiento soportado a
deslizamiento dentro de la parte (200) de alojamiento de la unidad
de carga (16); estando destinado el conjunto (212) de accionamiento
a aplicarse con el vástago de control (52) e incluyendo, al menos,
un dedo elástico (270a) que se extiende radialmente hacia dentro;
caracterizado porque:
la parte (200) de alojamiento incluye un par de
ranuras orientadas axialmente y diametralmente opuestas (250a,
250b) formadas en ella; y
en el que, cuando el extremo distal (276) del
vástago de control (52) es hecho avanzar axialmente en dirección a
dicho al menos un dedo elástico (270a) y se aplica con él, el
extremo distal del vástago de control (52) carga a dicho al menos
un dedo elástico (270a) radialmente hacia fuera, dentro de las
ranuras (250a, 250b) de la parte (200) de alojamiento.
2. El aparato quirúrgico (10) de acuerdo con la
reivindicación 1, en el que la parte (200) de alojamiento de la
unidad de carga (16) incluye una parte media superior (250) del
alojamiento y una parte media inferior (252) del alojamiento, y
cada una de las partes medias (250, 252), superior e inferior, del
alojamiento, incluye una del par de ranuras (250a, 250b) formada en
ella.
3. El aparato quirúrgico (10) de acuerdo con la
reivindicación 2, en el que las ranuras (250a, 250b) formadas en
cada una de las partes medias (250, 252), superior e inferior, del
alojamiento de la unidad de carga (16) está orientada
radialmente.
4. El aparato quirúrgico (10) de acuerdo con la
reivindicación 3, en el que las ranuras (250a, 250b) se extienden,
al menos en parte, dentro de la parte (200) de alojamiento de la
unidad de carga (16).
5. El aparato quirúrgico (10) de acuerdo con la
reivindicación 3, en el que las ranuras (250a, 250b) se extienden
por completo a través de la parte (200) de alojamiento de la unidad
de carga (16).
6. El aparato quirúrgico (10) de acuerdo con la
reivindicación 5, en el que cada dedo elástico (270a, 270b) de la
unidad de carga (16) incluye una punta (277a, 277b) y en el que las
puntas están orientadas una hacia otra.
7. El aparato quirúrgico (10) de acuerdo con la
reivindicación 6, en el que los dedos elásticos (270a, 270b) de la
unidad de carga (16) vuelven a un estado no cargado cuando el
extremo distal agrandado (276) del vástago de control (52) ha
pasado distalmente más allá de las puntas (277a, 277b) de los dedos
elásticos (270a, 270b).
8. El aparato quirúrgico (10) de acuerdo con la
reivindicación 7, en el que el aparato quirúrgico es una
grapadora.
9. Una unidad de carga (16) para uso con un
aparato de grapado quirúrgico y/o que puede ser soportada en un
extremo distal de tal aparato, cuya unidad de carga (16)
comprende:
una parte (200) de alojamiento; y
un conjunto (212) de accionamiento soportado a
deslizamiento dentro de la parte (200) de alojamiento de la unidad
de carga (16), estando destinado el conjunto (212) de accionamiento
a aplicarse con un vástago de control (52) del aparato de grapado
quirúrgico y que incluye, al menos, un dedo elástico (270a, 270b)
que se extiende radialmente hacia dentro, caracterizada
porque:
la parte (200) de alojamiento incluye un par de
ranuras (250a, 250b) orientadas axialmente y diametralmente
opuestas, formadas en ella; y
en la que, cuando el extremo distal (276) del
vástago de control (52) es hecho avanzar axialmente en dirección a
dicho al menos un dedo elástico (270a, 270b) y se aplica con él, el
extremo distal (2767) del vástago de control (52) carga a dicho al
menos un dedo elástico (270a, 270b) radialmente hacia fuera, al
interior de las ranuras (250a, 250b) de la parte (200) de
alojamiento.
10. La unidad de carga (16) de acuerdo con la
reivindicación 9, en la que la parte (200) de alojamiento incluye
una parte media superior (250) del alojamiento y una parte media
inferior (252) del alojamiento, y cada una de las partes medias
(250, 252), superior e inferior, del alojamiento, incluye una del
par de ranuras (250a, 250b) formadas en ella.
11. La unidad de carga (16) de acuerdo con la
reivindicación 10, en la que las ranuras (250a, 250b) formadas en
cada una de las partes medias (250, 252), superior e inferior, del
alojamiento, están orientadas radialmente.
12. La unidad de carga (16) de acuerdo con la
reivindicación 11, en la que las ranuras (250a, 250b) se extienden,
al menos en parte, dentro de la parte (200) de alojamiento.
13. La unidad de carga (16) de acuerdo con la
reivindicación 11, en la que las ranuras (250a, 250b) se extienden
por completo a través de la parte (200) de alojamiento.
14. La unidad de carga (16) de acuerdo con la
reivindicación 13, en la que cada dedo elástico (270a, 270b)
incluye una punta (277a, 277b) y en la que las puntas están
orientadas una hacia otra.
15. La unidad de carga (16) de acuerdo con la
reivindicación 14, en la que los dedos elásticos (270a, 270b)
vuelven a un estado sin carga cuando el extremo distal agrandado
(276) del vástago de control (52) ha pasado distalmente más allá de
las puntas (277a, 277b) de los dedos elásticos (270a, 270b).
16. La unidad de carga (16) de acuerdo con la
reivindicación 15, cuya unidad de carga (16) funciona como una
grapadora quirúrgica.
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| US5865361A (en) | 1997-09-23 | 1999-02-02 | United States Surgical Corporation | Surgical stapling apparatus |
| US7285131B1 (en) * | 1999-07-28 | 2007-10-23 | Cardica, Inc. | System for performing anastomosis |
| US10285694B2 (en) | 2001-10-20 | 2019-05-14 | Covidien Lp | Surgical stapler with timer and feedback display |
| US7464847B2 (en) | 2005-06-03 | 2008-12-16 | Tyco Healthcare Group Lp | Surgical stapler with timer and feedback display |
| US9060770B2 (en) | 2003-05-20 | 2015-06-23 | Ethicon Endo-Surgery, Inc. | Robotically-driven surgical instrument with E-beam driver |
| US20070084897A1 (en) | 2003-05-20 | 2007-04-19 | Shelton Frederick E Iv | Articulating surgical stapling instrument incorporating a two-piece e-beam firing mechanism |
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-
2005
- 2005-02-17 US US11/059,804 patent/US7172104B2/en active Active
- 2005-02-17 EP EP05003449A patent/EP1563793B1/en not_active Expired - Fee Related
- 2005-02-17 ES ES05003449T patent/ES2286725T3/es active Active
- 2005-02-17 DE DE602005001328T patent/DE602005001328T2/de active Active
Also Published As
| Publication number | Publication date |
|---|---|
| US7172104B2 (en) | 2007-02-06 |
| DE602005001328T2 (de) | 2008-02-14 |
| DE602005001328D1 (de) | 2007-07-26 |
| US20050279804A1 (en) | 2005-12-22 |
| EP1563793B1 (en) | 2007-06-13 |
| EP1563793A1 (en) | 2005-08-17 |
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