ES2345632T3 - Aparato quirurgico de accionamiento autonomo. - Google Patents
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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
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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
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- 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
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- H—ELECTRICITY
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- H01H—ELECTRIC SWITCHES; RELAYS; SELECTORS; EMERGENCY PROTECTIVE DEVICES
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- H01H9/02—Bases, casings, or covers
- H01H9/06—Casing of switch constituted by a handle serving a purpose other than the actuation of the switch, e.g. by the handle of a vacuum cleaner
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Abstract
Un aparato quirúrgico de accionamiento mecánico (200) para aplicar broches quirúrgicos a tejido del cuerpo humano, que comprende: a) un cuerpo alargado (210) que define un eje longitudinal; b) un canal (226) soportado por dicho cuerpo alargado; c) un cartucho (228) retenido por dicho canal, alojando el cartucho una pluralidad de broches quirúrgicos (230); d) un miembro de yunque (232) montado para moverse con respecto al cartucho, siendo el yunque relativamente movible con respecto al cartucho entre una posición abierta y una posición cerrada; e) un conjunto de motor (212) que tiene un eje de accionamiento giratorio (280); caracterizado por: f) una fuente de energía (214) para activar el conjunto de motor; y g) un conjunto de actuación (24) accionado por el conjunto de motor; teniendo el conjunto de actuación una viga de accionamiento (260) configurada para trasladarse a través del cartucho para expulsar los broches quirúrgicos del mismo, siendo accionado la viga de accionamiento por un miembro de accionamiento (268) y un husillo de accionamiento axial (270), definiendo el miembro de accionamiento un agujero roscado asociado de manera roscada con el husillo de accionamiento axial, estando conectado el husillo de accionamiento axial con el eje de accionamiento; y h) teniendo la viga de accionamiento una porción superior (284) para aplicarse con el miembro de yunque, y una porción inferior (288); en donde el miembro de yunque tiene una ranura longitudinal (294) con un extremo distante y una extensión de ranura transversal (296) en el extremo distante de la ranura longitudinal; y la porción superior de la viga de accionamiento tiene un rodillo de leva (284) para aplicarse con el miembro de yunque, y la porción inferior tiene una viga de leva (288) para aplicarse con el canal para efectuar el cierre progresivo del miembro de yunque y equilibrar las fuerzas ejercidas sobre el miembro de yunque, pasando el rodillo de leva a través de la extensión de ranura transversal cuando alcance el extremo distal de la ranura longitudinal.
Description
Aparato quirúrgico de accionamiento
autónomo.
Se proporciona un aparato para el grapado
quirúrgico de accionamiento mecánico autónomo para aplicar
sucesivamente una pluralidad de broches quirúrgicos a tejido del
cuerpo humano y opcionalmente hacer una incisión en el tejido
sujeto con los broches.
Son bien conocidos en la técnica los
dispositivos quirúrgicos en los que primero se agarra o se fija el
tejido entre estructuras de mordazas opuestas y luego se une por
medio de broches quirúrgicos. En algunos instrumentos se ha
proporcionado una cuchilla para cortar el tejido que ha sido unido
mediante los broches. Los broches están típicamente en forma de
grapas quirúrgicas, aunque también se utilizan broches de polímero
de dos partes.
Los instrumentos para este fin pueden incluir
dos miembros alargados que se usan, respectivamente, para aprisionar
o fijar el tejido. Típicamente, uno de los miembros lleva un
cartucho desechable que aloja una pluralidad de grapas dispuestas
en al menos dos filas laterales, mientras que el otro miembro
incluye un yunque que define una superficie para formar las patas
de las grapas a medida que van siendo impulsados los broches desde
el cartucho. En general, la operación de grapado se efectúa
mediante un empujador que se desplaza longitudinalmente a través
del miembro que lleva el cartucho, actuando el empujador sobre las
grapas para expulsarlas sucesivamente del cartucho. Con el
empujador puede hacer el recorrido una cuchilla entre las filas de
grapas, para cortar y/o abrir longitudinalmente el tejido grapado
entre las filas de grapas. Tales instrumentos se han descrito en la
Patente de EE.UU. Nº 3.079.606 concedida a Bobrov y otros, y en la
Patente de EE.UU. Nº 3.490.675 concedida a Green.
Una grapadora más reciente, descrita en la
Patente de EE.UU. Nº 3.499.591 concedida a Green, aplica una doble
fila de grapas a cada lado de la incisión. Esto se consigue
proporcionando un conjunto de cartucho en el cual un miembro de
leva se mueve a través de un camino de guía alargado entre dos
conjuntos de estrías que llevan grapas dispuestas alternadamente.
Los miembros de impulsión de las grapas están situados dentro de las
estrías y colocados de tal manera que haga contacto con ellos la
leva que se mueve longitudinalmente para efectuar la expulsión de
las grapas.
Cada uno de los instrumentos descritos en lo que
antecede fue diseñado para uso en procedimientos quirúrgicos
usuales en los que los cirujanos tienen acceso manual directo a la
zona de la operación. Sin embargo, en procedimientos endoscópicos o
laparoscópicos, la cirugía se efectúa a través de una pequeña
incisión, o bien a través de una estrecha cánula introducida a
través de pequeñas heridas de entrada en la piel. A fin de abordar
las necesidades específicas de los procedimientos quirúrgicos
endoscópicos y/o laparoscópicos, se ha desarrollado un aparato para
el grapado quirúrgico endoscópico y que se ha descrito en la Patente
de EE.UU. Nº 5.040.715. Este aparato es adecuado para tales
procedimientos e incluye un conjunto de aplicación de broches que
tiene un yunque y un cartucho de grapas previsto en el extremo
distante de una parte de cuerpo endoscópico que permite que sea
insertado el instrumento dentro de una cánula y que sea manejado a
distancia por el cirujano a través de manipulación de un mecanismo
de mango próximo.
Todos los instrumentos considerados en lo que
antecede precisan de un cierto grado de fuerza aplicada manualmente,
a fin de fijar, sujetar y/o cortar tejido. Los cirujanos han
reconocido por tanto las ventajas de usar instrumentos de
accionamiento mecánico automático que sean accionables con solamente
un grado limitado de fuerza física. Se han proporcionado
instrumentos quirúrgicos de accionamiento mecánico automático para
satisfacer estas necesidades y que incluyen grapadoras quirúrgicas
accionadas por gas, como se ha ilustrado, por ejemplo, en la Patente
de EE.UU. Nº 5.312.023, e instrumentos quirúrgicos de accionamiento
mecánico alimentados con energía eléctrica, como los descritos en
las Patentes de EE.UU. Números 4.635.638 y 5.258.007, y en la
Solicitud de Patente Europea Nº 0 552 050. En general, los
instrumentos quirúrgicos de accionamiento mecánico alimentados con
energía eléctrica han sido alimentados con fuentes de energía
eléctrica externas. Los instrumentos eran conectados a las fuentes
de energía eléctrica mediante cables conductores. Tales cables, sin
embargo, podían resultar enredados durante un procedimiento
quirúrgico, complicándose por ello la operación. El preámbulo de la
reivindicación 1 está basado en el documento de EP 0 552 050.
Sería beneficioso proporcionar un aparato
quirúrgico de accionamiento mecánico para aplicar una pluralidad de
grapas quirúrgicas a tejido del cuerpo humano y hacer al mismo
tiempo una incisión en el tejido grapado. Tal aparato debiera ser
compacto, ligero y de fácil fabricación. Actualmente, los
instrumentos quirúrgicos están diseñados para uso ya sea en
procedimientos abiertos, es decir, invasores, o ya sea en
endoscópicos/laparoscópicos. Como se ha indicado en lo que
antecede, los instrumentos endoscópicos requieren ejes alargados
para acceso a zonas quirúrgicas alejadas. Los instrumentos
quirúrgicos usuales no están construidos de esta manera. Sería
ventajoso proporcionar un instrumento quirúrgico de accionamiento
mecánico que pudiera ser fácilmente adaptado para uso tanto en
procedimientos tradicionales como en procedimientos
laparoscópicos.
Se proporciona, de acuerdo con la reivindicación
1, un aparato quirúrgico de accionamiento mecánico autónomo para
aplicar una pluralidad de broches quirúrgicos a tejido del cuerpo
humano. El aparato incluye un cuerpo de instrumento alargado que
define un eje geométrico longitudinal, un conjunto de cartucho que
aloja a una pluralidad de broches quirúrgicos, y un miembro de
yunque montado adyacente al conjunto de cartucho y configurado para
movimiento con respecto al mismo, entre una posición de abierto y
una posición de cerrado.
El aparato incluye además un conjunto de motor
dispuesto dentro del cuerpo del instrumento alargado, un conjunto
de accionamiento impulsado por el conjunto de motor para efectuar el
cierre gradual del yunque y la expulsión sucesiva de los broches
quirúrgicos, y una fuente de energía dispuesta dentro del cuerpo
para alimentar de energía al conjunto de motor. Preferiblemente, el
conjunto de accionamiento incluye un miembro de accionamiento que
está asociado a rosca con un husillo de accionamiento axial que es
accionado por el conjunto de motor.
En una realización preferida, el conjunto de
accionamiento incluye un primer mecanismo de acción de leva
configurado para mover al miembro de yunque llevándolo a una
posición de cerrado para fijar el tejido, y un segundo mecanismo de
acción de leva configurado para expulsar sucesivamente los broches
desde el cartucho al trasladarse el mismo a su través.
Preferiblemente, hay un miembro de corte de tejido asociado con el
conjunto de accionamiento para trasladarse a través del conjunto de
cartucho para practicar una incisión en el tejido del cuerpo
grapado. Un control para el conjunto de motor para hacer funcionar
el aparato quirúrgico de accionamiento mecánico incluye,
preferiblemente, botones de control primero y segundo para efectuar
movimiento distante y próximo del conjunto de accionamiento.
En una realización, el aparato quirúrgico de
accionamiento mecánico incluye un eje alargado configurado para
aplicarse a un extremo próximo del cuerpo del instrumento principal,
para facilitar la utilización del aparato durante un procedimiento
endoscópico. Preferiblemente, el eje de extensión actúa en
reciprocidad con los botones de control del motor en el extremo
próximo del cuerpo del instrumento principal, para hacer funcionar
el aparato desde un lugar alejado de la zona quirúrgica.
En otra realización, el aparato quirúrgico de
accionamiento mecánico está destinado a ser empleado durante un
procedimiento laparoscópico, proporcionando para ello una mano
mecánica que está configurada para extenderse dentro de la cavidad
abdominal a través de una cánula, y ser manipulada a distancia para
hacer actuar al aparato.
En otra realización, el aparato quirúrgico de
accionamiento mecánico incluye un cuerpo alargado que define un eje
geométrico longitudinal, y un conjunto de cartucho desechable que
está soportado de modo que pueda soltarse en una parte extrema
distante del cuerpo alargado.
El conjunto de cartucho desechable incluye un
bastidor que tiene una parte extrema próxima configurada para
aplicarse a la parte extrema distante del cuerpo alargado, y un
alojamiento soportado dentro del bastidor y que contiene una
pluralidad de broches quirúrgicos. Un miembro de yunque está
asociado a pivotamiento con el bastidor y está montado para
movimiento con respecto al alojamiento entre una posición de abierto
y una posición de cerrado. Dentro del bastidor hay dispuesto un
conjunto de accionamiento que está configurado para trasladarse en
una dirección longitudinal con relación al alojamiento y al yunque,
para mover el yunque gradualmente desde la posición de abierto a la
posición de cerrado, y expulsar sucesivamente los broches
quirúrgicos desde el alojamiento, para que sean conformados contra
el yunque. Un husillo de accionamiento axial está montado para
rotación dentro del bastidor y asociado a rosca con el conjunto de
accionamiento, para efectuar el traslado longitudinal del
mismo.
El aparato quirúrgico incluye además un conjunto
de motor que tiene un eje de accionamiento axial, y un acoplamiento
para conectar de modo que pueda soltarse el husillo de accionamiento
axial del conjunto de cartucho con el eje de accionamiento axial
del motor. Dentro del cuerpo alargado hay dispuesta una fuente de
energía para alimentar al conjunto de motor. Preferiblemente, un
acoplamiento del tipo de bayoneta está asociado con la parte
extrema distante del cuerpo alargado y con la parte extrema próxima
del bastidor para facilitar la conexión que puede soltarse del
conjunto de cartucho.
Otras características del aparato quirúrgico de
accionamiento mecánico resultarán más fácilmente evidentes para los
expertos en la técnica a la vista de la descripción detallada que
sigue del invento, considerada conjuntamente con los dibujos.
En lo que sigue se describirán varias
realizaciones del aparato quirúrgico de accionamiento mecánico, con
referencia a los dibujos, en los que:
La Fig. 1 es una vista en perspectiva de un
dispositivo de grapado de accionamiento mecánico construido de
acuerdo con una realización preferida;
La Fig. 2A es una ilustración en la que se ha
representado el dispositivo de grapado de accionamiento mecánico de
la Fig. 1 con un eje de extensión flexible unido al mismo en uso
durante un procedimiento laparoscópico;
La Fig. 2B es una ilustración en la que se ha
representado el dispositivo de grapado de accionamiento mecánico de
la Fig. 1 con un eje de extensión rígido unido al mismo en uso
durante un procedimiento laparoscópico;
La Fig. 3 es una ilustración en la que se ha
representado una mano mecánica manejando el dispositivo de grapado
de accionamiento mecánico de la Fig. 1 durante un procedimiento
laparoscópico;
La Fig. 4 es una vista en perspectiva en
despiece ordenado del dispositivo de grapado de accionamiento
mecánico de la Fig. 1;
La Fig. 5 es una representación esquemática del
mecanismo de conmutación para controlar el funcionamiento del
conjunto de motor;
La Fig. 6 es una vista en alzado lateral, en
corte transversal dado a lo largo de la línea 6-6 de
la Fig. 1, en la que se ha ilustrado la posición relativa de los
componentes internos del dispositivo de grapado de accionamiento
mecánico antes de la actuación;
La Fig. 7 es una vista en planta por arriba, en
corte transversal, en la que se ha ilustrado la posición relativa
de los componentes internos del dispositivo de grapado de
accionamiento mecánico antes de la actuación;
La Fig. 8 es una vista en corte transversal dado
a lo largo de la línea 8-8 de la Fig. 6, en la que
se ha ilustrado el conjunto de accionamiento;
La Fig. 9 es una vista en corte transversal dado
a lo largo de la línea 9-9 de la Fig. 6, en la que
se ha ilustrado el eje de accionamiento del conjunto de motor;
La Fig. 10 es una vista en corte transversal
dado a lo largo de la línea 10-10 de la Fig. 6, en
la que se ha ilustrado la acción recíproca entre el eje de
accionamiento del conjunto de motor y el husillo de accionamiento
axial;
La Fig. 11 es una vista en alzado lateral, en
corte transversal, en la que se ha ilustrado la posición relativa
de los componentes internos del dispositivo de grapado de
accionamiento mecánico durante una operación de grapado;
La Fig. 12 es una vista en alzado lateral, en
corte transversal, en la que se ha ilustrado la posición relativa
de los componentes internos del dispositivo de grapado de
accionamiento mecánico, una vez completada una operación de
grapado;
La Fig. 13 es una vista en perspectiva de otro
dispositivo de grapado de accionamiento mecánico construido de
acuerdo con la invención que incluye un conjunto de cartucho
desechable que puede ser desechado después de una operación de
grapado;
La Fig. 14 es una vista en perspectiva en
despiece ordenado del conjunto de cartucho desechable ilustrado en
la Fig. 13;
La Fig. 15 es una vista en alzado lateral,
ampliada, en corte transversal, de una parte del dispositivo de
grapado de la Fig. 13, en la que se ha ilustrado la aplicación de
acoplamiento del husillo de accionamiento axial del conjunto de
cartucho y el eje de accionamiento axial del conjunto de motor;
La Fig. 16 es una vista en perspectiva en
despiece ordenado, en corte transversal parcial, en la que se han
ilustrado los componentes del dispositivo de grapado que facilitan
la conexión que puede soltarse del conjunto de cartucho con el
cuerpo del instrumento;
La Fig. 17 es una vista en alzado lateral, en
corte transversal dado a lo largo de la línea 17-17
de la Fig. 13, en la que se ha ilustrado el conjunto de motor y las
células de alimentación de energía dentro del cuerpo alargado del
aparato quirúrgico de la Fig. 13;
La Fig. 18 es una vista en alzado lateral, en
corte transversal dado a lo largo de la línea 17-17
de la Fig. 13, en la que se ha ilustrado el conjunto de cartucho de
la presente aplicación antes de una operación de grapado; y
La Fig. 19 es una vista en alzado lateral, en
corte transversal dado a lo largo de la línea 17-17
de la Fig. 13, en la que se ha ilustrado el conjunto de cartucho
del presente invento a la conclusión de una operación de
grapado.
En los dibujos y en la descripción que sigue,
con el término "próximo" se hará referencia, como es
tradicional, al extremo del aparato que está más próximo al
operador, mientras que con el término "distante" se hará
referencia al extremo del aparato que está más alejado del
operador.
El aparato será considerado en términos de
procedimientos tanto tradicionales como endoscópicos. No obstante,
el uso que aquí se haga de términos tales como "endoscópico",
"por procedimiento endoscópico", y "parte endoscópica",
entre otros, no deberá entenderse que limita el presente aparato
para uso únicamente junto con un tubo endoscópico. Por el
contrario, se cree que el presente aparato puede ser de uso en
procedimientos en los que el acceso esté limitado a una pequeña
incisión, incluyendo, aunque sin quedar limitados a ellos, los
procedimientos artroscópicos y/o laparoscópicos.
Con referencia ahora a los dibujos, en los que
se han representado por los mismos números de referencia los
elementos estructurales del aparato que son similares, se ha
ilustrado en la Fig. 1 una grapadora quirúrgica de accionamiento
mecánico autónoma construido de acuerdo con una realización
preferida y designada en general por el número 10.
Con referencia a la Fig. 1, el aparato
quirúrgico de accionamiento mecánico 10 está configurado para uso
como un dispositivo manual para aplicar una pluralidad de grapas
quirúrgicas a vasos tubulares y a tejido del cuerpo humano durante
los procedimientos quirúrgicos invasores tradicionales. A modo de
ejemplo únicamente, el aparato quirúrgico 10 puede tener una
longitud comprendida entre aproximadamente 120 mm (5,0 pulgadas) y
aproximadamente 180 mm (7,0 pulgadas), y un diámetro exterior de
aproximadamente 11.4 mm (0,450 pulgadas) y aproximadamente 12,7 mm
(0,500 pulgadas). Preferiblemente, la longitud del aparato
quirúrgico 10 está comprendida entre 150 mm (6,0 pulgadas) y 170 mm
(6,5 pulgadas), mientras que el diámetro preferido está comprendido
entre 11,9 mm (0,470 pulgadas) y 12,2 mm (0,480 pulgadas). Por
supuesto que se contemplan otras dimensiones. En una realización,
el aparato quirúrgico 10 está además adaptado para uso en
procedimientos endoscópicos a través de la actuación a distancia
desde un lugar fuera del cuerpo del paciente, como se ha ilustrado
en las Figs. 2A y 2B. Esto se consigue proporcionando un eje de
extensión alargado 12, que se une al extremo próximo del aparato
quirúrgico por métodos de conexión corrientemente conocidos tales
como el de ajuste a presión. El eje de extensión 12 está
preferiblemente dimensionado y configurado para ser insertado a
través de una cánula o de un dispositivo de trocar, y tiene una
longitud que mide desde aproximadamente 250 mm (10,0 pulgadas) hasta
aproximadamente 430 mm (17,0 pulgadas). Se puede utilizar un eje
flexible 12 o un eje rígido 12'.
Con referencia a la Fig. 3, en otra realización,
el aparato quirúrgico 10 está destinado a ser hecho funcionar
mediante una mano mecánica 15 que está configurada para extenderse a
través del dispositivo de trocar 17 durante un procedimiento
quirúrgico laparoscópico. La mano mecánica 15 incluye cuatro dedos
articulados 15a-15d y un pulgar antagonista 15e,
que están articulados juntos para hacer posible el movimiento
relativo entre una posición encogida, en la que el antebrazo y los
dedos son llevados juntos en una formación estrechada, para
facilitar su extensión a través del trocar 17, y una posición
relajada, en la que el antebrazo y los dedos están desplegados a
una posición extendida para efectuar tareas que requieran destreza,
tales como la de manejar el aparato quirúrgico 10 accionando para
ello un conmutador previsto en el aparato.
Con referencia a la Fig. 4, el aparato
quirúrgico 10 incluye un cuerpo alargado 20 que incluye secciones de
cuerpo complementarias 22 y 24 que definen una serie de cámaras
internas para alojar y soportar a varios componentes mecánicos del
aparato 10. Las cámaras internas definidas dentro de las secciones
de cuerpo 22 y 24 incluyen la cámara distante 26, la cámara media
28, y la cámara próxima 30.
Los componentes alojados dentro de las secciones
de cuerpo 22 y 24 del aparato quirúrgico 10 incluyen un canal de
alojamiento alargado 32 que tiene una base 34 y paredes de canal
verticales opuestas 38a y 38b. El canal de alojamiento 32 es
mantenido dentro de la cámara distante 26 del cuerpo 20 y está
articulado para soportar el conjunto 40 y el conjunto de
accionamiento 42.
El conjunto 40 incluye un cartucho de grapas
alargado 44 que tiene una pluralidad de ranuras transversales 46,
que cada una está configurada para soportar una grapa 48 respectiva
y el empujador de grapas 50. El cartucho 44 está además provisto de
cinco ranuras longitudinales espaciadas entre sí que incluyen una
ranura central 52 y pares de ranuras laterales 54a, 54b y 56a, 56b.
Los pares de ranuras laterales 54a, 54b y 56a, 56b sirven para
acomodar la traslación longitudinal de las barras de acción de leva
alargadas 58a, 58b y 60a, 60b, del conjunto de accionamiento 42,
mientras que la ranura central 52 sirve para acomodar la traslación
longitudinal de una hoja de corte 62. El conjunto de accionamiento
42 y los componentes asociados con el mismo se describen con más
detalle aquí en lo que sigue.
El conjunto 40 incluye además un yunque alargado
64 que define una superficie 65 de formación de broche interior,
contra la cual son impulsadas las grapas cuando son expulsadas del
cartucho 44 por el conjunto de accionamiento 42. Un par de alas que
cuelgan hacia fuera 66a y 66b están formadas adyacentes al extremo
próximo del yunque 64 para aplicarse a un par de ranuras de
recepción situadas en correspondencia 68a y 68b formadas en las
paredes de canal verticales opuestas 38a y 38b del canal de
alojamiento 32. La aplicación de las alas 66a y 66b dentro de las
ranuras 68a y 68b facilita el movimiento de pivotamiento del yunque
64 con respecto al cartucho 44. A lo largo de una parte sustancial
de la longitud del yunque 64 se extiende una ranura longitudinal 70
para acomodar la traslación longitudinal de la hoja de corte 62 y
la parte del conjunto de accionamiento 42 que soporta a la hoja de
corte. Análogamente, en la base 34 del canal de alojamiento 32 hay
formada una ranura longitudinal 75 (véase la Fig. 6). La
orientación y la longitud de las ranuras 70 y 75 se corresponden
sustancialmente con las de la ranura central 52 prevista en el
cartucho 44.
Un resorte 65 se extiende desde el extremo
próximo del yunque 64 y está unido a la sección de cuerpo 22 (o
alternativamente a la base 34) para cargar al yunque hacia el
cartucho 44. Así, en uso, cuando se sitúa tejido entre el yunque y
el cartucho, se fuerza al yunque a que se separe del cartucho
mediante el tejido. La actuación del conjunto de accionamiento (que
se considera en lo que sigue) fuerza al yunque 64 a una alineación
cooperante más estrecha con el cartucho 44 para fijar el tejido de
un modo más firme y gradual. En una realización alternativa, el
yunque 64 está cargado a una posición de abierto, es decir, cargado
hacia fuera del cartucho 44, mediante, por ejemplo, un par de
resortes situados en un extremo próximo del yunque, entre el yunque
y el cartucho 44. Está también contemplado que el yunque pueda ser
conectado para movimiento libre con respecto al zuncho, sin la
carga de un resorte.
Como se ve mejor en la Fig. 4, el conjunto de
accionamiento 42 incluye dos pares barras de acción de leva 58a,
58b y 60a, 60b. Las barras de acción de leva sirven para expulsar
sucesivamente las grapas 48 del cartucho 44 a través de una acción
recíproca con los empujadores de grapas 50. En particular, cada una
de las barras de acción de leva alargadas incluye una parte de
cabeza distante 72 que tiene una superficie de acción de leva en
ángulo 7. La superficie de acción de leva 74 está configurada para
hacer contacto con los empujadores de grapas 50 y llevar a los
empujadores de grapas en una dirección transversal al eje geométrico
longitudinal del cartucho 44, empujando con ello a las grapas desde
el cartucho 44. Adyacente al extremo próximo de cada una de las
barras de acción de leva hay formada una muesca 76 de aplicación
para aplicarse estrías correspondientes 78 previstas en el miembro
de accionamiento 80.
El miembro de accionamiento 80 incluye un ánima
roscada 82 para engrane operativo con un husillo de accionamiento
axial 84. El husillo de accionamiento 84 es accionado por un
conjunto de motor 86 y está conectado al eje de accionamiento 88
del conjunto de motor 86 mediante un conjunto de cubo de soporte que
incluye un cubo de soporte exterior 90, un cubo de soporte
intermedio 82, y un cubo de aplicación interior 94 (véase la Fig.
9). El cubo de aplicación 94 está sujeto al extremo próximo del
husillo de accionamiento 84 y está aplicado dentro del cubo de
soporte intermedio 92. Como se ha ilustrado en la Fig. 10, el eje de
accionamiento 88 está enchavetado dentro del extremo opuesto del
cubo de soporte 92. El cubo de soporte 92 está dispuesto
coaxialmente dentro del cubo porte exterior 90, el cual es
mantenido con la cámara media 28 del cuerpo alargado 20. El
conjunto de motor 86 y las células de alimentación de energía
98a-98c, que suministran energía al mismo, son
mantenidos con la cámara próxima 30 del cuerpo alargado 20. Entre la
célula de alimentación de energía más distante 98a y el extremo
próximo del conjunto de motor 86, hay dispuesta una placa de
transferencia 158 para transferir energía desde la célula de
alimentación de energía al conjunto de motor.
El conjunto de accionamiento 42 incluye además
una viga 100 de acción de leva para efectuar el cierre gradual del
yunque 64 para fijar el tejido del cuerpo humano dispuesto entre la
superficie 65 de formación de broche del yunque 64 y la superficie
45 de contacto con el tejido del cartucho de grapas 44. La viga 100
de acción de leva incluye una parte de viga superior 102, una parte
de alma central 104, y una parte de viga inferior 106. La parte de
alma central 104 soporta a la hoja de corte 62. Las extensiones de
la viga superior e inferior 108 y 109 se extienden próximamente
desde la parte de alma central 104, para aplicarse al miembro de
accionamiento 80. Como se ha ilustrado, las partes de viga superior
e inferior 102, 106 son sustancialmente planas. Por consiguiente,
el mecanismo para fijar el yunque (viga de acción de leva 100) y el
mecanismo para disparar las grapas desde el cartucho (barras de
acción de leva 58a, 58b y 60a, 60b) están conectados directamente
al miembro de accionamiento 80. En uso, la parte de viga superior
102 de la viga de acción de leva 100 hace contacto gradualmente con
la superficie exterior 67 del yunque 64 para efectuar el cierre
gradual del yunque. El alma central 104 se traslada a través de las
ranuras 52, 70 y 75, y la parte de viga inferior 106 se traslada a
lo largo de la superficie exterior 35 de la base 34 del canal de
alojamiento 32, para mantener el cierre del yunque durante un
procedimiento de grapado.
Con referencia a la Fig. 8, conjuntamente con la
Fig. 4, una puerta de soporte 110 está montada en la parte
intermedia del canal de alojamiento 32, el cual tiene una abertura
115 para soportar la parte extrema distante del husillo de
accionamiento axial 84. Como se ve mejor en la Fig. 4, la puerta de
soporte 110 incluye un par de aletas opuestas 112a y 112b para
aplicación con ranuras de recepción correspondientes 114a y 114b en
las paredes de canal opuestas 38a y 38b del canal de alojamiento 32.
En la puerta de soporte 110 hay formadas estrías superior e
inferior 116 y 118 para acola traslación de las extensiones de viga
superior e inferior 108 y 109. Se han previsto pares de ranuras
laterales 120a, 120b y 122a, 122b en la puerta de soporte 110, para
acomodar la traslación de los pares de barras de acción de leva 58a,
58b y 60a, 60b.
El aparato quirúrgico 10 incluye además un
conjunto de conmutación 130 para controlar selectivamente el
funcionamiento del conjunto de motor 86. El conjunto de conmutación
130 incluye alojamientos de conmutador distante y próximo 132 y
134, y botones de accionamiento cargados por resorte derecho e
izquierdo 136 y 138. Una pluralidad de resortes de compresión en
espiral 135 cargan a los botones de accionamiento 136 y 138 en una
dirección próxima. Los alojamientos de conmutador 132 y 134 están
montados uno en otro y sujetos al extremo próximo del aparato
quirúrgico 10 mediante un conectador roscado 140, y están separados
para funcionamiento el uno del otro por un anillo aislante
distante, una placa de contacto distante 142, un anillo aislante
medio 143, y una placa de contacto próxima 144.
Entre el alojamiento 132 de conmutador distante y el resorte 132 hay dispuesto un anillo de contacto distante 145.
Entre el alojamiento 132 de conmutador distante y el resorte 132 hay dispuesto un anillo de contacto distante 145.
La placa de contacto distante 142 incluye un par
de orejetas de contacto vueltas hacia arriba opuestas 142a y 142b,
y la placa de contacto próxima 144 incluye un par de orejetas de
contacto vueltas hacia arriba opuestas 144a y 144b, que están
situadas con un desfase de 60º con respecto a las orejetas 142a y
142b. Cada botón de accionamiento tiene asociadas con el mismo tres
espigas de contacto, dos de las cuales actúan en reciprocidad con
las placas de contacto 142 y 144 para controlar el movimiento
relativo del husillo de accionamiento 84. En particular, el botón
de accionamiento 136 incluye dos espigas largas 146a y 146b y una
espiga corta 146c. La espiga corta 146c está asentada dentro de una
lumbrera de recepción central 147c, mientras que las espigas largas
146a y 146b están asentadas dentro de lumbreras de recepción
laterales 147a y 147b.
La espiga larga 146a y la espiga corta 146c
están situadas para aplicarse selectivamente con las orejetas de
contacto 142a y 144b, respectivamente, mientras que la espiga larga
146b permanece libre de contacto eléctrico.
Análogamente, el botón de accionamiento 138
incluye espigas largas 150a y 150b, y una espiga corta 150c. La
espiga corta 150c está asentada dentro de una lumbrera de recepción
central 151c, mientras que las espigas largas 150a y 150b están
asentadas dentro de lumbreras de recepción laterales 151a y 151b. La
espiga larga 150b y la espiga corta 150c están situadas para
aplicarse selectivamente con las orejetas de contacto 142b y 144b,
respectivamente, mientras que la espiga larga 150a permanece libre
de contacto eléctrico.
La configuración de cableado del conjunto de
conmutación 130 se ha ilustrado en la Fig. 5, e incluye la línea de
motor 152 que interconecta el terminal positivo 86a del conjunto de
motor 86 con las espigas de contacto 146a y 150c, y una línea de
motor 154 que interconecta el terminal negativo 86b del conjunto de
motor 86 con las espigas de contacto 146c y 150b. Además, una línea
de transmisión 156 se extiende entre la placa 158 de transferencia
de la pila y la placa
de contacto 144, y una línea de transmisión 160 interconecta la placa de contacto 142 con el anillo de contacto 145.
de contacto 144, y una línea de transmisión 160 interconecta la placa de contacto 142 con el anillo de contacto 145.
En uso, cuando se oprime el botón de
accionamiento 138, la espiga la 150b hace contacto con la orejeta
142b de la placa de contacto distante 142, y la espiga corta 150c
hace contacto con la orejeta 144b de la placa de contacto próxima
144. Por consiguiente, los terminales positivos de las células de
alimentación de energía 98a-98c estarán conectados
al terminal negativo 86b del conjunto de motor 86, y los terminales
negativos de las células de alimentación de energía
98a-98c estarán conectados al terminal positivo 86a
del conjunto de motor 86, haciendo que el eje de accionamiento 88
gire en sentido a derechas, para mover el miembro de accionamiento
80 a distancia. Cuando se haya oprimido el botón de accionamiento
136, la espiga larga 146a hace contacto con la orejeta 142a de la
placa de contacto distante 142, y la espiga corta 146c hace contacto
con la orejeta 144a de la placa de contacto próxima 144. Por
consiguiente, los terminales positivos de las células de
alimentación de energía 98a-98c estarán conectados
al terminal positivo 86a del conjunto de motor 86, y los terminales
negativos de las células de alimentación de energía
98a-98c estarán conectados al terminal negativo 86b
del conjunto de motor 86, haciendo que el eje de accionamiento 88
gire en sentido a izquierdas para mover al miembro de accionamiento
axial 80 llevándolo en una dirección próxima. Se ha contemplado
también que pueda proporcionarse un solo botón actuador que sea
accionable para hacer funcionar a un husillo de accionamiento axial
que tenga formada en el mismo una rosca inversa. La rosca inversa
hará que un husillo de accionamiento de traslación a distancia se
traslade automáticamente en una dirección próxima, a la conclusión
de una carrera de formación de broche.
Como se ha considerado aquí brevemente en lo que
antecede, el aparato quirúrgico 10 está diseñado, preferiblemente,
para inserción través de un trocar o un dispositivo de cánula para
aplicar grapas quirúrgicas a tejido del cuerpo humano situado
dentro de una cavidad del cuerpo, al tiempo que es accionable a
distancia de la zona quirúrgica. El eje 12 incluye miembros de
transmisión alargados 12a y 12b (o 12a' y 12b') para efectuar el
accionamiento a distancia del conjunto de conmutación 130 (véanse
las Figs. 2a y 2b). Los miembros de transmisión 12a y 12b (o 12a' y
12b') pueden incluir un par de varillas sustancialmente rígidas para
transmitir una señal mecánica a los botones de accionamiento 136 y
138, o bien, como alternativa, los miembros de transmisión pueden
incluir cables de transmisión para dirigir una señal eléctrica al
conjunto de conmutación 130. En uno u otro caso, el eje incluiría
dos botones de accionamiento para accionar, respectivamente, a los
botones 136 y 138, y producir la rotación del husillo de
accionamiento 84 en sentidos opuestos.
Con referencia ahora a las Figs. 6 y 7, antes de
hacer funcionar el dispositivo de grapado quirúrgico 10, se dispone
el yunque 64 en una posición de libre movimiento para facilitar el
aprisionamiento del tejido del cuerpo humano (o bien se carga por
resorte a una posición de cerrado o a una posición de abierto como
en las antes mencionadas realizaciones alternativas). El movimiento
del yunque 64 es acomodado por la aplicación a pivotamiento de las
alas 66a y 66b del yunque en ranuras de recepción 68a y 68b. El
movimiento de pivotamiento del yunque 64 puede verse mejor en la
Fig. 6. Antes del accionamiento, se mantiene la viga de acción de
leva 100 dentro de un asiento de soporte 26a definido en la cámara
distante 26 del cuerpo 20 del instrumento. En ese momento, la parte
de viga superior 102 está fuera de contacto con la superficie
exterior 67 del yunque 64, permitiendo el movimiento de
pivotamiento del mismo. También en ese momento, la parte de cabeza
distante 72 de cada una de las barras de acción de leva 58a, 58b y
60a,
60b está dispuesta próxima a, y fuera de contacto con, los empujadores de grapas más próximos 50 en el cartucho 44.
60b está dispuesta próxima a, y fuera de contacto con, los empujadores de grapas más próximos 50 en el cartucho 44.
Al tener lugar el accionamiento, es decir,
cuando se oprime el botón de accionamiento 136, se excita el
conjunto de motor 86 y el eje de accionamiento 88 hace girar al
husillo de accionamiento axial 84, haciendo que el miembro de
accionamiento 80 se traslade en una dirección a distancia. Como se
ve mejor en la Fig. 11, al trasladarse el miembro de accionamiento
80 a distancia, la parte de viga superior 102 de la viga de acción
de leva 100 empuja gradualmente al yunque 64 hacia el cartucho 44,
para fijar entre ellos el tejido 162 del cuerpo humano.
Simultáneamente, la superficie de acción de leva 74 en la parte de
cabeza distante 72 de cada una de las barras de acción de leva del
conjunto de accionamiento 42 actúa en reciprocidad con los
empujadores de grapas 50, para expulsar sucesivamente las grapas
quirúrgicas 48 del cartucho 44.
Las grapas expulsadas del cartucho 44 son
llevadas a través del tejido 162 del cuerpo humano y formadas contra
la superficie de formación de broche interior 65 del yunque 64. Al
ser colocadas las filas de grapas en el tejido 162 del cuerpo
humano, la hoja de corte 62, que se desplaza por detrás parte de
cabeza distante 72 de cada una de las barras de acción de leva del
conjunto de accionamiento 42, corta el tejido del cuerpo humano
grapado, formando una incisión entre las filas de grapas.
Al continuar actuando el conjunto de motor 86,
efectúa la traslación a distancia del miembro de accionamiento 80
hasta que el miembro de accionamiento haga contacto con la puerta de
soporte 110. En ese momento, la viga de acción d eleva 100 está
dispuesta en el extremo distante del conjunto 40 de aplicación de
broches, y la cabeza distante 70 de cada una de las barras de
acción de leva está dispuesta dentro de la parte distante 45 del
cartucho de grapas 44. A continuación de la operación de grapado, al
ser oprimido el botón de accionamiento 138 hace que el miembro de
accionamiento 80 se traslade próximamente, llevando consigo a la
viga de acción de leva 100 y a las barras de acción de leva 58a,
58b y 60a, 60b, a sus posiciones más próximas (Fig. 6).
Se ha contemplado también que el cartucho de
grapas 44 pueda ser desmontable, de modo que una vez que el conjunto
de accionamiento 42 haya retornado a su posición más próxima
después de disparar los broches, se pueda retirar el cartucho de
grapas 44 y sustituirlo por un cartucho de grapas cargado y se puede
oprimir de nuevo el botón de accionamiento 136 para disparar el
aparato de grapar.
Con referencia ahora a la Fig. 13, se ha
ilustrado en ella otro aparato quirúrgico de accionamiento mecánico
autónomo construido de acuerdo con la presente invención y designado
en general por el número de referencia 200. El aparato quirúrgico
200 está configurado para aplicar sucesivamente una pluralidad de
broches quirúrgicos a tejido del cuerpo humano durante los
procedimientos quirúrgicos tradicionales y/o los endoscópicos.
Brevemente expuesto, el aparato quirúrgico 200 incluye un cuerpo de
instrumento alargado 210 y un conjunto de cartucho desechable 220,
el cual está conectado de modo que puede soltarse a una parte
extrema distante del cuerpo 210 del instrumento mediante una
disposición de acoplamiento del tipo de bayoneta. El cuerpo 210 del
instrumento aloja a un conjunto de motor 212 y a una pluralidad de
células de alimentación de energía o pilas 214, para excitar al
conjunto de motor. Las células de alimentación de energía pueden ser
de litio, alcalinas, o pilas de níquel-cadmio.
Alrededor de las células de alimentación de energía hay arrollado un
material aislante para aislarlas de la caja exterior conductora
215. Entre el extremo terminal 212a del conjunto de motor 212 y la
pila más distante 214a hay dispuesta una placa de contacto
conductora 216, y dentro del extremo próximo del cuerpo 210 del
instrumento hay dispuesto un resorte en espiral 218 para empujar las
pilas a distancia (véase la Fig. 17).
Con referencia a las Figs. 13 y 14, el conjunto
de cartucho 220 incluye un bastidor 222 que tiene un adaptador 224
configurado para aplicarse de modo que puede soltarse a una parte
extrema distante del cuerpo 210 del instrumento (véase, en general,
la Fig. 16), y un canal de alojamiento 226 configurado para retener
a un cartucho 228 que contiene una pluralidad de broches
quirúrgicos 230. El conjunto de cartucho 220 incluye además un
yunque 232 que está montado a pivotamiento en el canal de
alojamiento 226, y un conjunto de accionamiento designado en
general por el número de referencia 240, que es accionado por el
conjunto de motor 212 y está configurado para expulsar los broches
quirúrgicos 230 del cartucho 228, y mover simultáneamente el yunque
232 entre una posición de abierto y una posición de cerrado (véanse,
en general, las Figs. 18 y 19).
Continuando con referencia a la Fig. 14, el
adaptador 224 incluye una parte distante alargada 234 y una parte
de montaje próxima 236 dimensionadas y configuradas para ser
recibidas dentro del extremo distante del cuerpo 210 del
instrumento. El canal de alojamiento 226 incluye paredes laterales
opuestas 226a y 226b y un suelo 226c. En el suelo 226c está
definida una abertura 238 adyacente al extremo próximo del canal de
alojamiento 226 para recibir a un broche roscado 242 que monta el
canal de alojamiento 226 en el adaptador 224. En las paredes
laterales 226a y 226b del canal de alojamiento 226 están definidas
un par de aberturas opuestas 244a y 244b para recibir a un par de
pestañas 232a y 232b que se extienden hacia fuera, las cuales están
formadas adyacentes al extremo próximo del yunque 232 y alrededor
de las cuales pivota el yunque 232 entre posiciones de cerrado y de
abierto, para aprisionar y liberar el tejido del cuerpo humano.
Dentro de aberturas 244a y 244b están dispuestos un par de miembros
de resorte 246a y 246b para carga yunque 232 a una posición de
abierto. También están definidas muescas de aplicación opuestas
248a y 248b en las paredes laterales opuestas 226a y 226b del canal
de alojamiento 226, para recibir a un par de fiadores
correspondientes formados en el cartucho 228, es decir, el fiador
228b. Los fiadores están formados monolíticamente con el cartucho de
retención de broches 228, y aseguran el cartucho dentro de la parte
distante del canal de alojamiento 226.
Continuando con referencia a la Fig. 14, el
conjunto de accionamiento 240 del conjunto de cartucho 220 incluye
una corredera de accionamiento 250 configurada para trasladarse a
través del cartucho 228 para efectuar la expulsión de los broches
quirúrgicos desde el mismo. La corredera 250 incluye una pluralidad
de placas de leva verticales espaciadas entre sí 252 que cada una
tiene un borde delantero en ángulo 254 para aplicarse sucesivamente
a una pluralidad de impulsores de grapas 256 que impulsan a los
broches quirúrgicos 230 desde el cartucho 228. La corredera de
accionamiento 250 es accionada a través del cartucho 228 por una
viga de accionamiento 260 y un husillo de accionamiento axial 270.
La viga de accionamiento 260 tiene un par de extensiones de viga
alargadas paralelas 262 y 264 cuyos extremos próximos están montados
en un alojamiento seguidor 266. El alojamiento seguidor 266 soporta
a una tuerca de accionamiento 268 que está asociada a rosca con un
husillo de accionamiento axial 270. El alojamiento seguidor 266
está montado dentro del bastidor 222, de tal manera que la rotación
axial del husillo de accionamiento 270 produce la traslación
longitudinal del mismo. El extremo distante 270a del husillo de
accionamiento 270 está soportado para rotación en una montura de
soporte estacionaria 272 que es mantenida dentro del bastidor 222 y
aplicada en una región ranurada 235 de la parte distante del
adaptador 234. La montura de soporte 272 sirve también para guiar la
traslación longitudinal de las extensiones de viga 262 y 264 al ser
accionada la viga de accionamiento 260 en una dirección longitudinal
mediante el alojamiento seguidor 266. Una hoja de cuchilla 265 está
montada adyacente al borde delantero de la viga de accionamiento
260 para cortar el tejido del cuerpo humano al trasladarse el
actuador 250 a través del cartucho 228.
Con referencia a las Figs. 14 a 16, el extremo
próximo 270b del husillo de accionamiento 270 está configurado para
aplicarse a un acoplamiento de husillo 274. El acoplamiento de
husillo 274 está soportado para rotación dentro de un ánima axial
276 definida en la parte de montaje próxima 236 del adaptador 224, y
está conectado de modo que puede soltarse por un extremo próximo a
un acoplamiento de eje 276 que está soportado sobre el eje de
accionamiento 280 del conjunto de motor 212. La aplicación
cooperante de los dos acoplamientos será considerada aquí con mayor
detalle en lo que sigue.
Con referencia de nuevo a la Fig. 14, el extremo
distante de la viga de accionamiento 260 incluye una pestaña de
retención 282 para soportar a un rodillo de leva, en general
cilíndrico, 284, y una ranura de aplicación 286 para retener a una
viga de leva sustancialmente plana 288. El rodillo de leva 284 se
aplica y se traslada con relación a una superficie de acción de
leva superior 290 del yunque 232 para efectuar el cierre gradual
del mismo al trasladarse el alojamiento seguidor 266 y la viga de
accionamiento 260 a través del canal de alojamiento 226, para
disparar los broches quirúrgicos 230 desde el cartucho 228. La viga
de leva 288 se aplica y se traslada con relación a la superficie
exterior del suelo 226c del canal de alojamiento 226 para equilibrar
las fuerzas ejercidas sobre el yunque 232 por el rodillo de leva
284 durante el cierre. En el suelo 226c del canal de alojamiento
226 está definida una ranura longitudinal 292, y en el yunque 232
está definida una ranura longitudinal correspondiente 294 para
acomodar la traslación longitudinal de la viga de accionamiento 260.
En el extremo distante de la ranura 294 del yunque está definida
una extensión de ranura transversal 296 para recibir al rodillo de
leva 284 al final de su traslación, y permitir con ello que el
yunque 232 retorne a una posición abierta bajo la carga de los
miembros de resorte 246a y 246b, a continuación de una operación de
sujeción. Por consiguiente, el tejido del cuerpo humano es
automáticamente soltado de su fijación tan pronto como hayan sido
disparados todos los broches.
Con referencia ahora a las Figs. 13 y 16, como
se ha indicado aquí en lo que antecede, el conjunto de cartucho 220
del aparato quirúrgico 200 está configurado como una unidad separada
que está montada de modo que puede soltarse en el extremo distante
del cuerpo 210 del instrumento mediante una disposición de
acoplamiento del tipo de bayoneta. La disposición de acoplamiento
de bayoneta incluye un par de ranuras 304 de forma en general de J,
definidas adyacentes al extremo distante del cuerpo 210 del
instrumento, y un par de espigas de aplicación correspondientes 312
y 314 montadas en la parte de montaje próxima 234 del adaptador 224
(véase también la Fig. 14). Durante la fijación del conjunto de
cartucho 220, se hace girar axialmente la parte de montaje próxima
236 del adaptador 224 aproximadamente 20 grados, para aplicar las
espigas 312 y 314 en las correspondientes ranuras 302,
304.
304.
Con referencia a las Figs. 16 y 17, un resorte
de compresión en espiral 316 está soportado sobre el eje de
accionamiento 280 del conjunto de motor 212 para cargar al
acoplamiento del eje 278 en una dirección distante. El acoplamiento
278 del eje está soportado dentro de un ánima axial escalonada 318
definida en el cuerpo 210 del instrumento e incluye una ranura
transversal 320 que está dimensionada y configurada para encajar a
un diente correspondiente 322 formado en el extremo próximo del
acoplamiento de husillo 274. La función del resorte de acoplamiento
316 es doble. En primer lugar, si no están alineados los dientes 322
y la pestaña 322 cuando se introduce la parte de montaje próxima
del adaptador 224 en el extremo distante del cuerpo 210 del
instrumento, el resorte de acoplamiento 316 compensará la
desalineación y facilitará la aplicación de los acoplamientos al
tener lugar la rotación inicial del eje de accionamiento 280. Más en
particular, al introducir el adaptador, si está desalineado, los
dientes 322 apoyarán a tope en la superficie más distante de
acoplamiento 278 del eje. Cuando se gire inicialmente el eje 280 de
accionamiento y se alinee la ranura 320 con la pestaña 322, el
resorte de acoplamiento 316 se descomprimirá y forzará al
acoplamiento 278 del eje en la dirección distante, para hacer que
los dos acoplamientos se apliquen de forma que puede soltarse. La
segunda función del resorte de acoplamiento 316 es la de cargar al
adaptador 224 en la dirección distante cuando esté aplicado el
acoplamiento de bayoneta que mantiene al conjunto de cartucho 220
en la parte de cuerpo 210 de modo que puede soltarse.
Con referencia a las Figs. 15 a 17, se
proporciona un conmutador 330 para controlar selectivamente el
funcionamiento del conjunto de motor 212. El conmutador 330 es un
conmutador de contacto, sensible al tacto, que está envuelto
alrededor de la circunferencia del cuerpo 210 del instrumento dentro
de un área rebajada 332. El conmutador 330 incluye una capa de
contacto exterior 330a, una capa aislante media 330b, y una capa
conductora interior 330c. Se ha previsto una ranura 333 en la capa
aislante 330b para permitir el contacto entre la capa de contacto
exterior 330a y la capa conductora interior 330c. Un circuito de
control del motor está definido por una primera tira metálica
conductora eléctrica 334 que conecta el conmutador 330 con la caja
exterior conductora 215 del cuerpo 210 del instrumento, una segunda
tira conductora 335 que conecta la caja exterior 215 con el terminal
T de la célula de alimentación de energía más próxima 214d, y una
tercera tira conductora 336 que conecta el conmutador 330 con el
extremo terminal 212a del conjunto de motor 212.
Con referencia ahora a las Figs. 18 y 19, en
funcionamiento, cuando se introduce el aparato quirúrgico 200 en
una zona quirúrgica, se aprisiona el tejido del cuerpo entre el
yunque 232 y el cartucho 228. Una fuerza dirigida radialmente hacia
dentro en dos lugares sobre el conmutador 330 lleva la capa exterior
330a a contacto con la capa interior 330c, haciendo entonces que
circule corriente al conjunto de motor 212 para hacer girar al eje
de accionamiento 280 del conjunto de motor 212. El movimiento de
rotación del eje de accionamiento 280 es transferido al husillo de
accionamiento 270 a través de los acoplamientos 274 y 178. La
rotación axial del husillo de accionamiento 270 origina la
correspondiente traslación longitudinal del alojamiento seguidor
266, y de la viga de accionamiento 260.
\newpage
Al trasladarse la viga de accionamiento 260 en
la dirección distante, el rodillo de leva 284 mueve gradualmente al
yunque 232 desde la posición de abierto, normalmente cargado
representado en la Fig. 18, a la posición de cerrado ilustrada en
la Fig. 19. Simultáneamente el la corredera de accionamiento 250 es
llevada desde la posición próxima ilustrada en la Fig. 18, a través
del cartucho 228 de retención de broches, a la posición más
distante representada en la Fig. 19, aplicándose sucesivamente a los
impulsores de grapas 256, de modo que impulse los broches
quirúrgicos 230 a través del tejido 350 del cuerpo humano. Al mismo
tiempo, la hoja de cuchilla 265 sigue a la corredera de
accionamiento 250 para practicar una incisión en el tejido 350 del
cuerpo grapado. Cuando el rodillo de leva 284 llega al extremo
distante de la ranura longitudinal 294, cae dentro de la extensión
296 de la ranura transversal, permitiendo que el yunque 232 retorne
a una posición de abierto y suelte el tejido 350 del cuerpo
grapado. A la conclusión de la operación de aplicación de broches,
se manipula el conjunto de cartucho 212 de tal manera que se
desapliquen las espigas 312 y 314 de las ranuras 302 y 304, y se
suelta el adaptador de cartucho 224 del extremo distante del cuerpo
210 del instrumento. Después se puede desechar el conjunto de
cartucho y se puede montar de modo que puede soltarse un conjunto de
cartucho en el cuerpo 210 del instrumento.
Claims (5)
1. Un aparato quirúrgico de accionamiento
mecánico (200) para aplicar broches quirúrgicos a tejido del cuerpo
humano, que comprende:
- a)
- un cuerpo alargado (210) que define un eje longitudinal;
- b)
- un canal (226) soportado por dicho cuerpo alargado;
- c)
- un cartucho (228) retenido por dicho canal, alojando el cartucho una pluralidad de broches quirúrgicos (230);
- d)
- un miembro de yunque (232) montado para moverse con respecto al cartucho, siendo el yunque relativamente movible con respecto al cartucho entre una posición abierta y una posición cerrada;
- e)
- un conjunto de motor (212) que tiene un eje de accionamiento giratorio (280); caracterizado por:
- f)
- una fuente de energía (214) para activar el conjunto de motor; y
- g)
- un conjunto de actuación (24) accionado por el conjunto de motor; teniendo el conjunto de actuación una viga de accionamiento (260) configurada para trasladarse a través del cartucho para expulsar los broches quirúrgicos del mismo, siendo accionado la viga de accionamiento por un miembro de accionamiento (268) y un husillo de accionamiento axial (270), definiendo el miembro de accionamiento un agujero roscado asociado de manera roscada con el husillo de accionamiento axial, estando conectado el husillo de accionamiento axial con el eje de accionamiento; y
- h)
- teniendo la viga de accionamiento una porción superior (284) para aplicarse con el miembro de yunque, y una porción inferior (288); en donde
el miembro de yunque tiene una ranura
longitudinal (294) con un extremo distante y una extensión de ranura
transversal (296) en el extremo distante de la ranura longitudinal;
y
la porción superior de la viga de accionamiento
tiene un rodillo de leva (284) para aplicarse con el miembro de
yunque, y la porción inferior tiene una viga de leva (288) para
aplicarse con el canal para efectuar el cierre progresivo del
miembro de yunque y equilibrar las fuerzas ejercidas sobre el
miembro de yunque, pasando el rodillo de leva a través de la
extensión de ranura transversal cuando alcance el extremo distal de
la ranura longitudinal.
\vskip1.000000\baselineskip
2. El aparato reivindicado en la reivindicación
1, que comprende además un actuador (330) para controlar
selectivamente el conjunto de motor para operar o manejar el
aparato.
3. El aparato reivindicado en una cualquiera de
las reivindicaciones anteriores, que comprende además un botón de
actuador para efectuar la traslación próxima del conjunto de
actuación.
4. El aparato reivindicado en una cualquiera de
las reivindicaciones anteriores, en el que un extremo distal del
eje de accionamiento está acoplado de manera liberable a un extremo
próximo del husillo de accionamiento axial.
5. El aparato reivindicado en una cualquiera de
las reivindicaciones anteriores, en el que la viga de actuación
soporta una hoja de cuchilla (265).
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US319907 | 1994-10-07 | ||
| US08/319,907 US5779130A (en) | 1994-08-05 | 1994-10-07 | Self-contained powered surgical apparatus |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| ES2345632T3 true ES2345632T3 (es) | 2010-09-28 |
Family
ID=23244107
Family Applications (4)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| ES07020205T Expired - Lifetime ES2386646T3 (es) | 1994-10-07 | 1995-08-03 | Aparato quirúrgico de accionamiento mecánico autónomo |
| ES04004059T Expired - Lifetime ES2294379T3 (es) | 1994-10-07 | 1995-08-03 | Aparato quirurgico de accionamiento autonomo. |
| ES07010882T Expired - Lifetime ES2345632T3 (es) | 1994-10-07 | 1995-08-03 | Aparato quirurgico de accionamiento autonomo. |
| ES95112235T Expired - Lifetime ES2216002T3 (es) | 1994-10-07 | 1995-08-03 | Aparato quirurgico de accionamiento mecanico autonomo. |
Family Applications Before (2)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| ES07020205T Expired - Lifetime ES2386646T3 (es) | 1994-10-07 | 1995-08-03 | Aparato quirúrgico de accionamiento mecánico autónomo |
| ES04004059T Expired - Lifetime ES2294379T3 (es) | 1994-10-07 | 1995-08-03 | Aparato quirurgico de accionamiento autonomo. |
Family Applications After (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| ES95112235T Expired - Lifetime ES2216002T3 (es) | 1994-10-07 | 1995-08-03 | Aparato quirurgico de accionamiento mecanico autonomo. |
Country Status (5)
| Country | Link |
|---|---|
| US (1) | US5779130A (es) |
| EP (6) | EP1889576B1 (es) |
| CA (1) | CA2155475A1 (es) |
| DE (3) | DE69535626T2 (es) |
| ES (4) | ES2386646T3 (es) |
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-
1995
- 1995-08-03 EP EP07020205A patent/EP1889576B1/en not_active Expired - Lifetime
- 1995-08-03 ES ES07020205T patent/ES2386646T3/es not_active Expired - Lifetime
- 1995-08-03 EP EP10162549A patent/EP2243432A3/en not_active Withdrawn
- 1995-08-03 DE DE69535626T patent/DE69535626T2/de not_active Expired - Lifetime
- 1995-08-03 EP EP04004059A patent/EP1426012B1/en not_active Expired - Lifetime
- 1995-08-03 EP EP07010882A patent/EP1839596B1/en not_active Expired - Lifetime
- 1995-08-03 DE DE69536077T patent/DE69536077D1/de not_active Expired - Lifetime
- 1995-08-03 DE DE69532942T patent/DE69532942T2/de not_active Expired - Lifetime
- 1995-08-03 EP EP95112235A patent/EP0705570B1/en not_active Expired - Lifetime
- 1995-08-03 ES ES04004059T patent/ES2294379T3/es not_active Expired - Lifetime
- 1995-08-03 ES ES07010882T patent/ES2345632T3/es not_active Expired - Lifetime
- 1995-08-03 EP EP10172006.8A patent/EP2243433B8/en not_active Expired - Lifetime
- 1995-08-03 ES ES95112235T patent/ES2216002T3/es not_active Expired - Lifetime
- 1995-08-04 CA CA002155475A patent/CA2155475A1/en not_active Abandoned
Also Published As
| Publication number | Publication date |
|---|---|
| US5779130A (en) | 1998-07-14 |
| EP2243433A2 (en) | 2010-10-27 |
| EP2243433B8 (en) | 2013-12-11 |
| EP2243432A2 (en) | 2010-10-27 |
| CA2155475A1 (en) | 1996-02-06 |
| DE69536077D1 (de) | 2010-06-24 |
| EP1426012A1 (en) | 2004-06-09 |
| EP1889576B1 (en) | 2012-05-02 |
| EP0705570A1 (en) | 1996-04-10 |
| EP2243433A3 (en) | 2011-05-11 |
| EP2243432A3 (en) | 2011-05-04 |
| EP2243433B1 (en) | 2013-10-30 |
| EP1426012B1 (en) | 2007-10-17 |
| EP1839596B1 (en) | 2010-05-12 |
| ES2216002T3 (es) | 2004-10-16 |
| EP1889576A2 (en) | 2008-02-20 |
| DE69532942D1 (de) | 2004-06-03 |
| DE69535626D1 (de) | 2007-11-29 |
| EP1839596A1 (en) | 2007-10-03 |
| EP1889576A3 (en) | 2009-09-09 |
| DE69532942T2 (de) | 2005-05-25 |
| ES2294379T3 (es) | 2008-04-01 |
| ES2386646T3 (es) | 2012-08-24 |
| EP0705570B1 (en) | 2004-04-28 |
| DE69535626T2 (de) | 2008-07-24 |
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