ES2364666T3 - Obturador y divisor de vasos con miembros de tope no conductivos. - Google Patents
Obturador y divisor de vasos con miembros de tope no conductivos. Download PDFInfo
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Abstract
Un forceps bipolar endoscópico (10) para obturar y dividir tejido, que comprende: un árbol alargado (12) que tiene unos miembros de mordaza opuestos (22, 24) en un extremo distal de él, siendo los miembros de mordaza desplazables entre sí desde una primera posición, en la que dichos miembros de mordaza están dispuestos en relación espaciada entre sí, a una segunda posición en la que los miembros de mordaza cooperan para asir tejido entre ellos; una fuente de energía eléctrica conectada a cada uno de los miembros de mordaza, teniendo cada miembro de mordaza una superficie (35) eléctricamente conductiva que mira hacia el interior, tal que la superficie eléctrica conductiva de los miembros de mordaza sean capaces de conducir energía a través del tejido sujeto entre ellos para efectuar una obturación; donde al menos una superficie eléctricamente conductiva que mira hacia dentro incluye un canal (36) orientado longitudinalmente para dividir la superficie eléctricamente conductiva en una primera mitad y una segunda mitad; una cuchilla (60) de movimiento alternativo dispuesta en el canal orientado longitudinalmente para cortar tejido próximo a la obturación; caracterizado por: al menos un miembro de tope no conductivo (50) dispuesto sobre la superficie eléctricamente conductiva que mira hacia dentro de al menos uno de los miembros de mordaza, que controlan la distancia entre los miembros de mordaza cuando el tejido está sujeto entre ellos, donde al menos un miembro de tope incluye una serie de lengüetas que están dispuestas a lo largo de una longitud de la primera mitad de la superficie eléctricamente conductiva y a lo largo de una longitud de la segunda mitad de la superficie eléctricamente conductiva, donde las lengüetas son: (1) lengüetas de diferente forma geométrica (50a, 50b, 50c, 50g); o (2) lengüetas de tipo alargado (50f) que están dispuestas a un ángulo relativo al canal orientado longitudinalmente; o (3) lengüetas a modo de círculo (50c) que están dispuestas de manera alternativa y descentrada lateralmente entre sí a lo largo de una longitud de la primera mitad de la superficie eléctricamente conductiva y a lo largo de una longitud de la segunda mitad de la superficie eléctricamente conductiva.
Description
ANTECEDENTES
La presente memoria descriptiva se refiere a un instrumento electroquirúrgico y a un método para efectuar procedimientos quirúrgicos endoscópicos. Más particularmente, esta memoria se refiere a un fórceps electroquirúrgico bipolar endoscópico y a un método de uso del mismo, que incluye un miembro de tope no conductivo asociado a uno o ambos miembros de mordaza opuestos. Los miembros de tope no conductivos están diseñados para controlar la distancia entre los miembros de mordaza opuestos, y mejorar la manipulación y sujeción del tejido durante los procedimientos de obturación y división.
Campo técnico
Los fórceps endoscópicos utilizan la acción mecánica para apretar, asir, diseccionar, t/o sujetar tejido. Dichos fórceps electroquirúrgicos utilizan tanto la acción mecánica de sujeción como la energía eléctrica para efectuar hemóstsis para el caldeo del tejido y de los vasos sanguíneos, para coagular, cauterizar, y/o obturar el tejido.
Los instrumentos endoscópicos son insertados dentro del paciente a través de un cánula u orificio, hecho con un trocar
o dispositivo similar, Los tamaños típicos de las cánulas están dentro de un margen de tres a doce milímetros. Por lo general se prefieren cánulas más pequeñas, lo que representa un desafío en cuanto al diseño para los fabricantes de estos instrumentos, que deben hallar maneras para que los instrumentos quirúrgicos ajusten a través de las cánulas.
Cierto procedimientos quirúrgicos endoscópicos requieren el corte de vasos sanguíneos o de tejido vascular. Sin embargo, debido a limitaciones de espacio, los cirujanos pueden hallar dificultades en la sutura de vasos o en la ejecución de otros métodos tradicionales para el control del sangrado, por ejemplo, sujeción y/o atadura de vasos sanguíneos cortados. Los vasos sanguíneos, dentro de un margen inferior a dos milímetros de diámetro, pueden ser cerrados con frecuencia con el uso de técnicas electroquirúrgicas estándar. No obstante, si es cortado un vaso mayor, puede ser necesario para el cirujano convertir el procedimiento endoscópico en un procedimiento quirúrgico abierto, y abandonar así los beneficios de la laparoscopia.
Varios artículos en revistas han descrito métodos para obturar pequeños vasos sanguíneos con el uso de la electrocirugía. Un artículo titulado “Estudios sobre coagulación y desarrollo de un coagulador bipolar computerizado automático”, de la revista J.Neurosurg, vol, 75, Julio de 1991, describe un coagulador bipolar que es utilizado para obturar pequeños vasos sanguíneos. El artículo expone que no es posible coagular con seguridad arterias con diámetro superior a un margen de 2 a 2,6 mm. Un segundo artículo titulado “Electrocoagulación bipolar controlada automáticamente – “COA-COMP”, Rev. de Neurosurg. (1984), págs. 187-190, describe un método para cortar el suministro de potencia electroquirúrgica al vaso, de modo que pueda ser evitado el chamuscamiento de las paredes de él.
Como antes se ha dicho, mediante la utilización de fórceps electroquirúrgicos, un cirujano puede cauterizar, coagular / desecar , y/o simplemente reducir un sangrado lento, mediante el control de la intensidad, la frecuencia, y la duración de la energía electroquirúrgica aplicada al tejido a través de miembros de mordaza. El electrodo de cada miembro de mordaza es cargado con un potencial eléctrico diferente, de modo que cuando los miembros de mordaza asen el tejido, energía eléctrica puede ser transferida selectivamente a través de dicho tejido.
Con objeto de efectuar una obturación apropiada en vasos mayores, dos parámetros mecánicos predominantes deben ser controlados con precisión: la presión aplicada al vaso, y la distancia de separación entre los electrodos, cuyos dos factores resultan afectados por el grosor del vaso obturado.. Más particularmente, es importante una aplicación precisa de la presión a las paredes opuestas del vaso, para reducir la impedancia del tejido a un valor suficientemente bajo que permita el paso de una suficiente energía electroquirúrgica a través del tejido para vencer las fuerzas de expansión durante el caldeo del tejido, y contribuir así a un grosor final del tejido que sea una indicación de una buena obturación. Se ha determinado que una pared de vaso fundida típica es óptima entre 25,4 �m y 127 �m. Por debajo de este margen, la obturación puede despedazarse o rasgarse, y por encima de él, los lúmenes pueden no resultar obturados de manera adecuada o efectiva.
Los métodos electroquirúrgicos pueden ser capaces de obturar vasos mayores con el uso de una curva de potencia electroquirúrgica apropiada, acoplada a un instrumento capaz de aplicar una gran fuerza de cierre a las paredes del vaso-Esa es la idea por la que el procedimiento de obturar vasos pequeños es fundamentalmente diferente a la obturación electrogirúrgica de vasos. A los fines aquí presentes , “coagulación” se define como un procedimiento de desecación de tejido en el que las células de dicho tejido son rotas y secadas. La obturación de un vaso se define como el procedimiento de licuar el colágeno en el tejido, de modo que se reforme en una masa fundida. Por tanto, la coagulación de vasos pequeños es suficiente para cerrarlos permanentemente. Los vasos mayores necesitan ser obturados para asegurar un cierre permanente.
Las patentes de EE.UU. núms. 2.176.479 de Willis; 4.005.714 y 4.031.898 de Hiltebrandt; 5.826.274, 5.289.287, y
En su mayor parte, estos instrumentos se basan sólo en la presión de sujeción para producir un grosor de obturación apropiado, y no están diseñados para tener en cuenta las tolerancias de hueco y/o de paralelismo, y los requerimientos de aplanamiento, que son parámetros que sin son debidamente controlados pueden asegurar una obturación del tejido uniforme y efectiva. Por ejemplo, es sabido que es difícil controlar adecuadamente el grosor del tejido obturado resultante mediante el control de la presión de sujeción solamente, por cualquiera de estas dos razones: 1) si se aplica demasiada fuerza existe la posibilidad de que los dos polos se toquen, y que no sea transferida energía a través del tejido, de lo que resulta una obturación inefectiva; o 2) se se aplica una fuerza demasiado baja, el tejido puede moverse prematuramente antes de la activación, y puede ser creada una obturación más gruesa y menos fiable.
Típicamente y en particular con respecto a procedimientos electroquirúrgicos endoscópicos, una vez obturado un vaso, el cirujano tiene que retirar el instrumento de obturación del lugar de la operación, sustituirlo por un nuevo instrumento a través de la cánula, y cortar con precisión el vaso a través de la obturación del tejido recién formada. Como puede apreciarse, esta operación adicional puede consumir tiempo (en particular cuando se obtura un número significativo de vasos) y puede contribuir a una separación imprecisa del tejido a lo largo de la línea de obturación, debido a la falta de obturación o defecto de colocación del instrumento de corte a lo largo del centro de la línea de obturación del tejido.
Se han hecho varios intentos por diseñar un instrumento que incorpore un miembro de hoja o cuchilla que corte con efectividad el tejido después de formar una obturación en él. Por ejemplo, la patente de EE.UU. núm. 5.674.220 de Fox y col, describe un instrumento transparente de obturación de vasos que incluye una cuchilla de movimiento alternativo longitudinalmente, que corta el tejido una vez obturado. El instrumento incluye una pluralidad de aberturas que permiten la visualización directa del tejido durante el procedimiento de obturación y corte. Dicha visualización directa permite que un usuario regule de modo visual y manual la fuerza de cierre y la distancia del hueco entre los miembros de mordaza, para reducir y/o limitar que se produzcan ciertos efectos indeseables que se sabe se producen cuando se obturan vasos, expansión térmica, chamuscamiento, etc. Como puede apreciarse, el éxito general de la obturación de un tejido con este instrumento se basa en gran medida en la maestría, visión, destreza, y experiencia del usuario al estimar la fuerza de cierre apropiada, distancia de separación, y longitud del movimiento alternativo de la cuchilla, para obturar de modo uniforme, consistente, y efectivo el vaso, y separar el tejido en la obturación. El preámbulo de la reivindicación 1 se basa en este documento.
La patente de EE.UU. núm. 5.702.390 de Austin y col, describe un instrumento de obturación de vaso que incluye un electrodo de forma triangular que es giratorio desde una primera posición de obturación del tejido, a una segunda posición para cortarlo, De nuevo, el usuario debe fiarse de la visualización directa y de su destreza, para controlar los diversos efectos de la obturación y corte del tejido.
El documento de EE.UU. 5.445.638 describe un fórceps de corte y coagulación bipolar. El documento de EE.UU.
5.891.142 describe un fórceps electroquirúrgico que tiene un conjunto espaciador aislante eléctricamente dispuesto en una superficie para asir tejido.
Por tanto, existe la necesidad de desarrollar un instrumento electroquirúrgido endoscópico que de modo efectivo y uniforme obture y separe el tejido vascular, y resuelva los problemas antes citados. Este instrumento regula las distancias del hueco entre miembros de mordaza opuestos, reduce las posibilidades de cortocircuitar dichas mordazas opuestas durante la activación, y ayuda a la manipulación, asido, y sujeción del tejido antes y durante la activación y separación de dicho tejido.
SUMARIO
La presente invención se define en las reivindicaciones. La presente invención se refiere a un fórceps electroquirúrgico bipolar endoscópico para sujetar, obturar, y dividir el tejido. El fórceps incluye un árbol alargado que cuenta con unos miembros de mordaza opuestos en un extremo distal de él. Los miembros de mordaza son desplazables entre sí desde una primera posición, en relación espaciada de uno frente al otro, a una segunda posición en la que dichos miembros de mordaza cooperan para asir el tejido entre ellos. Una fuente de energía electroquirúrgica está conectada a los miembros de mordaza, de modo que éstos sean capaces de conducir energía a través del tejido sujeto entre ellos, para efectuar la obturación de dicho tejido, Al menos un miembro de tope, no conductivo y separado, está dispuesto sobre una superficie que mira hacia el interior de al menos uno de los miembros de mordaza, y está situado para controlar la distancia de separación entre los miembros de mordaza opuestos cuando el tejido es sujetado entre ellos. Una cuchilla, de desplazamiento alternativo longitudinal, corta el tejido en proximidad al lugar de la obturación, una vez formada una obturación efectiva.
El fórceps puede incluir un conjunto de vástago de accionamiento que conecta los miembros de mordaza con la fuente de energía eléctrica, de modo que el primer miembro de mordaza tenga un primer potencial eléctrico, y el segundo miembro de mordaza tenga un segundo potencial eléctrico. Con preferencia, una empuñadura está acoplada mecánicamente al conjunto de vástago de accionamiento, e imparte movimiento entre sí a los miembros de mordaza primero y segundo.
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Uno de los miembros de mordaza incluye una superficie eléctricamente conductiva, que tiene un canal orientado longitudinalmente definido en él, que facilita el desplazamiento alternativo longitudinal de la cuchilla para el corte del tejido. Preferiblemente, el fórceps incluye un disparador para accionar la cuchilla, que es accionable con independencia del conjunto de accionamiento.
Según la presente invención según se recoge en las reivindicaciones, al menos un miembro de tope no conductivo está dispuesto en la superficie eléctricamente conductiva que mira hacia el interior de al menos uno de los miembros de mordaza, que controla la distancia entre los miembros de mordaza cuando el tejido está entre ellos. El al menos un miembro de tope incluye una serie de lengüetas que están dispuestas a lo largo de una longitud de la primera mitad de la superficie eléctricamente conductiva y a lo largo de una longitud de la segunda mitad de la superficie eléctricamente conductiva. Las lengüetas son lengüetas de diferentes formas geométricas, lengüetas de tipo alargado que están dispuestas a un ángulo en relación al canal orientado longitudinalmente, o lengüetas a modo de círculo, que están dispuestas en una manera alternativa descentradas lateralmente unas en relación a otras a lo largo de una longitud de la primera mitad de la superficie eléctricamente conductiva y a lo largo de una longitud de la segunda mitad de la superficie eléctricamente conductiva.
El fórceps incluye al menos dos miembros de tope dispuestos como una serie de proyecciones orientadas longitudinalmente, que se extienden a lo largo de la superficie orientada hacia dentro, desde el extremo proximal hacia el extremo distal y del miembro de mordaza. En otra realización, los miembros de tope incluyen una serie de lengüetas a modo de círculo, que sobresalen desde la superficie que mira hacia el interior y se extienden desde el extremo proximal hasta el extremo distal del miembro de mordaza. Los miembros de tope pueden estar dispuestos en cualquier miembro de mordaza opuesto, y en los lados opuestos del canal orientado longitudinalmente, y están dispuestos en una manera alternativa, descentrados lateralmente entre sí a todo lo largo de la superficie de uno cualquiera o de ambos miembros de mordaza.
Preferiblemente, los miembros de tope están fijos o unidos al miembro o miembros de mordaza mediante estampación, pulverización térmica, sobremoldeo, y/o por medio de un adhesivo. Los miembros de tope sobresalen desde aproximadamente 0,03 mm a aproximadamente 0,1 mm, y preferiblemente desde aproximadamente 0,05 mm a aproximadamente 0,08 mm, desde la superficie enfrentada hacia dentro de al menos uno de los miembros de mordaza. Está previsto que los miembros de tope puedan ser hechos de un material aislante, tal como parileno, nilón, y/o cerámica. Se contemplan también otros materiales, por ejemplo, poliestirenos sindiotácticos, tales como QUESTRA® fabricado por DOW CHEMICAL, poliestireno sindiotáctico (SPS), poli(tereftalado de butileno) (PBT), policarbonato (PC), acrilonitrilo butadieno estireno (ABS), poliftalamida (PPA), poliamida, poli(tereftalato de etileno) (PET), poliamida-imida (PAI), acrílico (PMMA), poliestireno (PS y HIPS). Poli(etersulfona) (PES), poli(quetona alifática), copolímero de acetal (POM), poliuretano (PU y YPU), nilón con dispersión de poli(óxido de fenileno), y acrilato de acrilonitrilo estireno.
También se describe, pero no se recoge en las reivindicaciones, un método para obturar y dividir tejido, e incluye las operaciones de: disponer un fórceps bipolar endoscópico, que incluye:
-un árbol alargado que cuenta con unos miembros de mordaza opuestos en su extremo distal, que deben cooperar para asir un tejido entre ellos;
-al menos un miembro de tope no conductivo y separado, dispuesto sobre una superficie enfrentada al interior de al menos uno de los miembros de mordaza, que controla la distancia entre dichos miembros de mordaza cuando h ay tejido sujeto entre ellos: y
-una cuchilla.
El método incluye también las operaciones de conectar los miembros de mordaza a una fuente de energía eléctrica; accionar dichos miembros de mordaza para asir tejido entre los citados miembros opuestos: conducir energía a los miembros de mordaza a través del tejido sujeto entre ellos para efectuar una obturación; y accionar la cuchilla para cortar el tejido en proximidad a la obturación.
Preferiblemente, al menos uno de los miembros de mordaza de la operación de proporcionar el fórceps incluye una superficie eléctricamente conductiva, que tiene un canal orientado longitudinalmente definido en él, que facilita la actuación de la cuchilla en una acción de movimiento alternativo longitudinal dentro del canal, para cortar el tejido.
BREVE DESCRIPCIÓN DE LOS DIBUJOS
Varias realizaciones del presente instrumento se describen aquí con referencia a los dibujos, en los que:
-la fig. 1 es una vista en perspectiva de un fórceps endoscópico que muestra una empuñadura y un accionador de acuerdo con la presente descripción;
-la fig. 2 es una vista parcial de un corte transversal del fórceps de la fig. 1, que muestra los componentes internos de trabajo de la empuñadura, y el accionador de extremo en configuración cerrada:
-la fig. 3 es una vista en perspectiva ampliada del conjunto accionador de extremo, mostrado en configuración abierta; -la fig. 4 es una vista lateral muy ampliada de un extremo proximal del accionador de extremo de la fig. 3;
-la fig. 5 es una vista en perspectiva muy ampliada de un extremo distal del accionador de extremo de la fig. 3, que muestra una cuchilla y una serie de miembros de tope dispuestos a lo largo de una superficie enfrentada hacia dentro de un miembro de mordaza:
-las figs. 6A a 6F muestran varias configuraciones de los miembros de tope sobre la superficie que mira hacia dentro de uno de los miembros de mordaza:
-la fig. 7 es una vista en perspectiva ampliada de un lugar de obturación de un vaso tubular;
-la fig. 8 es un corte transversal longitudinal del lugar de obturación, tomado a lo largo de la línea B-B de la fig. 7:
-la fig. 9 es un corte transversal longitudinal del lugar de obturación de la fig. 7, después de la separación del vaso tubular;
DESCRIPCIÓN DETALLADA
Con referencia ahora a las figs. 1 a 5, se muestra una realización de un fórceps bipolar endoscópico 10 para uso con varios procedimientos quirúrgicos, e incluye un conjunto 80 de alojamiento y empuñadura, que tiene un accionador de extremo 20 unido a él. Más particularmente, el fórceps 10 incluye un árbol 12 que cuenta con un extremo distal 14 dimensionado para acoplarse mecánicamente al conjunto 20 accionador de extremo, y un extremo proximal 16 que se acopla mecánicamente al conjunto 80 de alojamiento y empuñadura. En los dibujos y en las descripciones que siguen, el término “proximal”, como es tradicional, se refiere al extremo del fórceps 10 que está más próximo al usuario, y el término “distal” se refiere al extremo que está más alejado del usuario.
El conjunto 20 accionador de extremo está unido al extremo distal 14 del árbol 12, e incluye un par de miembros de mordaza opuestos 22 y 24. Preferiblemente, el conjunto 80 de alojamiento y empuñadura están unidos al conjunto proximal 16 del árbol 12, e incluyen unos mecanismos de activación dispuestos interiormente, por ejemplo, una empuñadura móvil 82 y un conjunto de accionamiento 70, que cooperan mecánicamente para impartir movimiento a los miembros de mordaza 22 y 24 desde una posición abierta, en la que dichos miembros de mordaza 22 y 24 están dispuestos en relación espaciada entre sí, a una posición cerrada o de sujeción en la que dichos miembros 22 y 24 cooperan para asir un tejido 150 (fig. 7) entre ellos.
Está previsto que el fórceps 10 pueda ser diseñado de modo que sea toral o parcialmente desechable, en función de una finalidad particular o para conseguir un resultado particular. Por ejemplo, el conjunto accionador de extremo 20 puede ser selectiva y liberablemente acoplable al extremo distal 14 del árbol 12, y/o el extremo proximal 16 del árbol puede ser acoplable de modo selectivo y liberable al alojamiento y conjunto 80 de empuñadura. En cualquiera de estos dos casos, el fórceps 10 debe ser considerado “parcialmente desechable”, es decir, que un nuevo y diferente conjunto 20 accionador de extremo (o conjunto 20 accionador de extremo y árbol 12) reemplaza al viejo conjunto 20 cuando se necesite.
Las figuras 1 y 2 muestran los elementos operativos y los componentes internos de trabajo del alojamiento y conjunto 90 de empuñadura, qye a los fines de la presente invención se describen aquí en general. Las funciones específicas y relaciones operativas de estos elementos, y los diversos componentes internos de trabajo, se describen con más detalle en la publicación de patente WO 2002/080795 ”Obturador y divisor de vasos” de Dycus y col.
Como se aprecia mejor en la fig. 2, el conjunto 80 de alojamiento y empuñadura incluyen una empuñadura desplazable 82 y una empuñadura fija. La empuñadura desplazable 82 incluye una abertura 89 definida a su través, que permite al usuario asir y mover la empuñadura 82 con relación a la empuñadura fija 84. La empuñadura desplazable 82 es selectivamente móvil en torno a un pivote 87 desde una primera posición con relación a la empuñadura fija 84, a una segunda posición en proximidad inmediata a la empuñadura fija 84, que como se explica más adelante imparte un movimiento relativo entre sí a los miembros de mordaza 22 y 24 .
Más particularmente, el conjunto 80 de alojamiento y empuñadura aloja un conjunto de alojamiento 70 que coopera con la empuñadura móvil 82 para impartir el movimiento de los miembros de mordaza 22 y 24 desde una posición abierta, en la que dichos miembros están dispuestos en relación espaciada entre sí, a una posición de sujeción o cerrada, en la que dichos miembros de mordaza 22 y 24 cooperan para asir tejido 150 (fig. 7) entre ellos. Los parámetros operativos generales del conjunto de accionamiento 70 y los componentes de trabajo del mismo, son explicados de manera más generalizada más adelante, y son explicados con detalle especifico en la solicitud antes citada también pendiente pendiente “Obturador y divisor de vaso. A los fines de la presente memoria descriptiva, el alojamiento y el conjunto de empuñadura 80 pueden ser caracterizados en general como una conexión mecánica de cuatro barras compuesta de los siguientes elementos: empuñadura móvil 82, enlace 73, enlace a modo de leva 76, y enlace de base, materializados por los puntos de pivotar fijos 75 y 76. El movimiento de la empuñadura 82 activa la conexión de cuatro barras, que a su vez acciona el conjunto de accionamiento 70 para impartir el movimiento de los miembros de mordaza opuestos 22 y 24 entre sí para asir tejido 150 entre ellos. Está previsto que el empleo de una conexión mecánica de cuatro barras permita al usuario ganar una ventaja mecánica significativa cuando se comprimen los miembros de mordaza 22 y 24 contra el tejido 150, como se explica en detalle más adelante con respecto a los parámetros operativos descritos en general del conjunto de accionamiento 70.
Preferiblemente, la empuñadura fija 84 incluye un canal 85 definido en ella, que está dimensionado para recibir una pestaña 83 que se extiende proximalmente desde la empuñadura móvil 82. Preferiblemente, la pestaña 83 incluye un extremo fijo 90 que está unido a la empuñadura móvil 82, y un extremo libre 92 que está dimensionado para una fácil recepción dentro del canal 85 de la empuñadura 84. Está previsto que la pestaña 83 pueda ser dimensionada para permitir al usuario mover los miembros de mordaza 22 y 24 entre sí de manera selectiva, progresiva, e incrementalmente, desde la posición abierta a la posición cerrada. Por ejemplo, se contempla también que la pestaña 83 pueda incluir una interfaz a modo de carraca, que se acople de modo bloqueable a la empuñadura móvil 83, y con ello los miembros de mordaza 22 y 24 en posiciones incrementales selectivas entre sí, en función de una finalidad particular. Pueden ser empleados también otros mecanismos para controlar y/o limitar el movimiento de la empuñadura 82 con respecto a la empuñadura 84 (y los miembros de mordaza 22 y 24) tales como, por ejemplo, sistemas hidráulicos, semihidráulicos, y de engranajes.
Como puede ser apreciado en la presente memoria descriptiva, y es explicado con más detalle en la Solicitud antes mencionada, del mismo cesionario que ésta y también pendiente “Obturador y divisor de vaso”, el canal 85 de la empuñadura fija 84 incluye un camino de entrada 91 y un pasaje de salida 95 para la reciprocidad de la pestaña 83. Como se aprecia mejor en la fig, 2, al moverse la empuñadura 82 en modalidad en general pivotante hacia la empuñadura fija 84 en torno al pivote 87, el enlace 74 gira en torno a un pasador de guía 74 dispuesto dentro de la empuñadura 82. Como resultado, en enlace 73 gira aproximadamente en torno a un pivote 76. Como puede ser apreciado, el camino de pivotar de la empuñadura 82 con relación a la empuñadura fija 84 empuja el enlace 76 a modo de leva para girar en torno al pivote 75 en una dirección en general proximal. El movimiento del enlace a modo de leva 76 imparte movimiento al conjunto de accionamiento 70, como se explica más adelante.
Como se aprecia mejor en la fig. 2, al producirse el movimiento inicial de la empuñadura 82 hacia la empuñadura fija 84, el extremo libre 92 de la pestaña 83 se mueve en general proximalmente y hacia arriba a lo largo del camino de entrada 91, hasta que el extremo 82 rebasa o se acopla mecánicamente al miembro de carril 97 dispuesto a lo largo del camino 91, Está previsto que el carril 97 permita el movimiento de la pestaña 83 proximalmente, hasta el punto en el que el extremo 92 libra el carril 97, Una vez que el extremo 92 libra dicho carril 97, el movimiento distal de la empuñadura 82 y la pestaña 83, es decir, la liberación, es redirigida por el carril 97 dentro del camino de salida 95.
Más particularmente, a la liberación de la presión inicial, es decir, a la reducción de la presión de cierre de la empuñadura 82 contra la empuñadura 84, la empuñadura 82 retorna distalmente de modo escaso hacia el camino 81, pero es dirigida hacia el camino de salida 95. En este punto, la liberación de la presión de retorno entre las empuñaduras 82 y 84, que es atribuible y directamente proporcional a la presión de liberación asociada a la compresión del conjunto 70 de accionamiento (que se expone más adelante), hace que el extremo 92 de la pestaña 83 se fije o bloquee dentro de un hueco de retención 93. La empuñadura 82 está ahora sujeta en su sitio dentro de la empuñadura 84, que a su vez, bloquea los miembros de mordaza 22 y 24 en una posición cerrada contra el tejido. El instrumento está ahora situado para la aplicación selectiva de energía electroquirúrgica para la formación de la obturación 152 en el tejido. De nuevo, los diversos elementos operativos y sus funciones relevantes son explicados con más detalle en la solicitud antes citada, delmismo cesionario que ésta y también pendiente “Obturador y divisor de vasos”.
Como se aprecia mejor en la fig . 2, la reiniciación o el asido de nuevo de la empuñadura 82, mueve la pestaña 83 en general proximalmente a lo largo del nuevo camino de salida redirigido 95, hasta que el extremo 92 libera un reborde 94 expuesto a lo largo del camino de salida 95. Una vez que el reborde 94 está suficientemente despejado, la empuñadura 82 y la pestaña 83 son total y libremente liberables de la empuñadura 84 a lo largo del camino de salida 95 a la reducción de la presión de asir, que a su vez retorna los miembros de mordaza 22 y 24 a la posición abierta y preactivada.
Como antes se ha dicho, el conjunto 80 de alojamiento y empuñadura aloja un conjunto 70 de accionamiento que coopera con la empuñadura móvil 82, para impartir un movimiento relativo de los miembros de mordaza 22 y 24 para asir el tejido 150. El funcionamiento del conjunto 70 de vástago de accionamiento y de los diversos componentes de trabajo del conjunto de accionamiento 70 son explicados en detalle en la solicitud antes citada, del mismo cesionario que ésta y también pendiente “Obturador y divisor de vasos”.
En general, y a los fines de la presente memoria descriptiva, el conjunto de accionamiento 70 incluye un resorte de compresión 72, un vástago de accionamiento 40, y un manguito de compresión 98 (fig . 2). Como se aprecia mejor en la vista ampliada de la fig. 4, el vástago de accionamiento 40 es desplazable telescópica e interiormente dentro de un manguito 48 de la cuchilla. El movimiento del vástago de accionamiento 40 con relación al manguito de la cuchilla 48 imparte movimiento a los miembros de mordaza 22 y 24. Un miembro de lengüeta 46 está dispuesto en el extremo libre 42 del vástago de accionamiento 40, que define una muesca 43 entre la lengüeta 46 y el extremo 42. La lengüeta 46 y la muesca 43 cooperan mecánicamente con el resorte de compresión 72 para impartir movimiento al árbol 40 con relación al manguito 49 de cuchilla, lo que a su vez abre y cierra los miembros de mordaza 22 y 24 en torno al tejido
150.
Como antes se ha expuesto, el movimiento del conjunto 80 de empuñadura por medio de la conexión de cuatro barras, hace finalmente que el enlace a modo de leva 76 gire en general en sentido a la derecha en torno al pivote 75 (es decir, proximalmente), que a su vez comprime el resorte 72 proximalmente contra una pestaña 77 dispuesta dentro de la porción superior de la empuñadura fija 84, A su vez, el movimiento del resorte 72 mueve el vástago de accionamiento 49 con relación al manguito 48 de la cuchilla, que mueve los miembros de mordaza opuestos 22 y 24 entre sí. Como puede apreciarse, la ventaja mecánica significativa asociada a la conexión de cuatro barras permite una fácil, consistente, y uniforme compresión del resorte 72, que a su vez permite una fácil, consistente, y uniforme compresión de los miembros de mordaza 22 y 24 en torno al tejido 150. Otros detalles y ventajas de la conexión mecánica de cuatro barras se expone con más amplitud en la solicitud antes mencionada del mismo cesionario que ésta y también pendiente “Obturador y divisor de vasos”
Una vez asido el tejido 150 entre los miembros de mordaza opuestos 22 y 24, energía electroquirurgica puede ser suministrada a dichos miembros 22 y 24 a través de una interfaz electroquirúrgica 110 dispuesta dentro de la empuñadura 64. De nuevo ha de decirse que estas características están explicadas con más detalle en la solicitud antes citada ·”Obturador y divisor de vasos”.
El fórceps 10 incluye también un disparador 86 que desplaza alternativamente el manguito de cuchilla 48, que a su vez desplaza alternativamente una cuchilla 60 dispuesta dentro del conjunto accionador de extremo 20 como se expone más adelante (fig. 5). Una vez formada la obturación 152 del tejido (fig. 7), el usuario puede activar el disparador 86 para separar el tejido 150, como se muestra en la fig. 9, a lo largo de la citada obturación 152. Como puede apreciarse, la cuchilla de desplazamiento alternativo permite al usuario separar rápidamente el tejido 150 inmediatamente después de la obturación, sin sustituir un instrumento de corte a través de la cánula o trocar (no mostrados). Esta previsto que la cuchilla 60 facilite también una separación más precisa del vaso 150 a lo largo de un plano de corte ideal “B-B” asociado a la obturación 152 de tejido formada recientemente (véanse las figs. 7 a 9). La cuchilla 60 incluye preferiblemente un borde aguzado 62 para cortar el tejido 150 sostenido entre los miembros de mordaza 22 y 24 en el lugar de la obturación 152 (fig. 7). Está previsto que la cuchilla 60 pueda ser acoplada también a la fuente de energía electroquirúrgica, para facilitar la separación del tejido 150 a lo largo de la obturación 162.
Preferiblemente y como se explica con más detalle en la solicitud mencionada anteriormente “Obturador y divisor de vasos”, el conjunto de empuñadura 80 puede incluir también un mecanismo de bloqueo (no mostrado) que impida la activación del disparador 86 hasta que los miembros de mordaza 22 y 24 estén cerrados, y se hallen cerrados sustancialmente en torno al tejido 150. Por ejemplo, y como se aprecia mejor en la fig. 2, el camino de salida 95 puede estar dimensionado de modo que el disparador 86 se active sólo cuando la pestaña 83 esté dispuesta en una posición predefinida o predeterminada, que proporcione suficiente holgura para la activación del disparador 86, por ejemplo, asentada dentro de un hueco de captación 93. Está previsto que la configuración del conjunto de empuñadura 80 de este modo pueda reducir las posibilidades de activación prematura del disparador 86, antes de la activación electroquirúrgica y la obturación.
Un conjunto giratorio 88 puede ser incorporado también con el fórceps 10. Preferiblemente, el conjunto giratorio 88 está asociado mecánicamente al árbol 12 y al conjunto de accionamiento. Como se aprecia mejor en la fig. 4, el árbol 12 incluye una abertura 44 situada en él, que establece una interfaz mecánica con el correspondiente retenedor (no mostrado) fijo al conjunto giratorio 88, de modo que el movimiento giratorio del conjunto giratorio 88 imparta un movimiento rotatorio similar al árbol 12, que a su vez gira el conjunto 20 accionador de extremo en torno a un eje longitudinal ·”A”. Estas características, junto con la configuración eléctrica única para la transferencia de energía electroquirúrgica a través del conjunto de empuñadura 80, el conjunto giratorio 88, y el conjunto de accionamiento 70, se describen con más detalle en la repetidamente citada solicitud del mismo cesionario que ésta y también pendiente “Obturador y divisor de vasos”.
Como se aprecia mejor en las figs. 3, 5, y 6A a 6F, el conjunto 20 accionador de extremo se une al extremo distal 14 del árbol 12. Dicho conjunto 20 incluye el primer miembro de mordaza 22, el segundo miembro de mordaza 24, y la cuchilla 60 de movimiento alternativo dispuesta entre aquéllas. Los miembros de mordaza 22 y 24 son pivotables preferiblemente en torno a un pivote 37 desde las posiciones abierta a cerrada, al producirse el movimiento alternativo relativo, es decir, el movimiento longitudinal, del vástago de accionamiento 42 como antes se ha dicho. De nuevo ha de decirse que las relaciones operativas con respecto a los diversos elementos móviles del conjunto 20 accionador del extremo se describen con detalle en la ya citada solicitud “Obturador y divisor de vasos”.
Cada una de los miembros de mordaza incluye una superficie obturadora 35 eléctricamente conductiva, dispuesta en la superficie enfrentada hacia dentro 34 de aquéllos, y un aislador 30 dispuesto sobre una superficie 39 que mira hacia fuera de ellos. Está previsto que las superficies conductoras eléctricamente 35 cooperen para obturar el tejido 150 sostenido entre ellas al aplicar la energía electroquirúrgica. Los aisladores 30, juntamente con las superficies exteriores no conductivas 35 de los miembros de mordaza 22 y 24, están dimensionados preferiblemente para limitar y/o reducir muchos de los defectos indeseables conocidos relacionados con la obturación de tejidos, por ejemplo, formación de arco, expansión térmica. y disipación de corrientes de fuga.
Está previsto que las superficies obturadoras conductivas eléctricamente 35 puedan incluir también superficies bien igualadas que faciliten el acoplamiento seguro de la superficie eléctricamente conductiva 35 al aislador 30, y que simplifiquen también el procedimiento general de fabricación. Está previsto que la superficie obturadora eléctricamente conductiva 35 pueda incluir también un borde periférico exterior que tenga un radio, y que el aislador 30 se junte a la superficie obturadora 35 eléctricamente conductiva a lo largo de un borde de unión que en general sea tangencial al radio y/o se encuentre a lo largo del radio. Preferiblemente, en la interfaz, la superficie eléctricamente conductiva 35 está elevada con relación al aislador 30. Estas y otras realizaciones contempladas son expuestas en la publicación de patente WO 2002/080798, titulado “Instrumento electroquirúrgico que reduce los daños colaterales en tejidos adyacentes”, de Jonson y col, y en la publicación de patente WO 2002/080785 titulado “Instrumento electroquirúrgico diseñado para reducir la incidencia del arco eléctrico” de Jonson y col.
Preferiblemente, al menos una de las superficies eléctricamente conductivas 35 de los miembros de mordaza, por ejemplo el 22, incluye un canal 36 orientado longitudinalmente definido en ella, que se extiende desde un extremo proximal 26 a un extremo distal 28 del miembro de mordaza 22, Está previsto que el canal 36 facilite el desplazamiento alternativo longitudinal de la cuchilla 60 a lo largo de un plano de corte preferido “B-B”, para separar de modo efectivo y seguro el tejido 150 a lo largo de la obturación de tejido formada 152 (véanse las figs. 7 a 9). Preferiblemente y como se explica en detalle en la solicitud antes mencionada “Obturador y divisor de vasos”, los miembros de mordaza 22 y 24 del conjunto 20 accionador de extremo están aislados eléctricamente entre sí, de modo que energía electroquirúrgica pueda ser transferida de modo efectivo a través del tejido 150, para formar el obturador 152.
Como antes se ha dicho, al moverse la empuñadura 82, los miembros de mordaza 22 y 24 se juntan y asen tejido 150. En este punto, la pestaña 83 queda retenida dentro del espacio captor 93, que junto con la ventaja mecánica asociada al mecanismo de cuatro barras y al resorte 70, mantiene una fuerza axial proporcional sobre el vástago de accionamiento 40, que a su vez mantiene una fuerza compresiva entre los miembros de mordaza opuestos 22 y 24 contra el tejido 150, Esta previsto que el conjunto accionador 20 del extremo pueda ser dimensionado para descargar unas fuerzas de sujeción excesivas, para prevenir el fallo mecánico de ciertos elementos operativos internos del accionador de extremo.
Mediante el control de la intensidad, la frecuencia, y la duración de la energía electroquirúrgica aplicada al tejido 150, el usuario puede cauterizar, obturar por coagulación / desecación, y/o simplemente reducir o retardar el sangrado. Como antes se ha mencionado, dos factores mecánicos juegan un papel importante en la determinación del grosor resultante del tejido obturado, y de la efectividad de la obturación, es decir, la presión aplicada entre los miembros de mordaza opuestos 22 y 24 y la distancia de separación entre las superficies obturadoras opuestas 35 de los miembros de mordaza 22 y 24 durante el procedimiento de obturación, Sin embargo, el grosor de la obturación resultante del tejido 152 no puede ser controlada adecuadamente sólo por la fuerza . Dicho en otros términos, con demasiada fuerza los dos miembros de mordaza 22 y 24 se tocan. y posiblemente entran en cortocircuito, lo que hará se que una escasa energía se desplace a través del tejido 150, resultando así una mala obturación 152 del tejido, Con una fuerza demasiado pequeña, la obturación 152 resultará demasiado gruesa.
La aplicación de una fuerza correcta es también importante por otras razones: para exponer las paredes del vaso, para reducir la impedancia del tejido a un valor suficientemente bajo que permita una corriente suficiente a través del tejido 150, y para vencer las fuerzas de expansión durante el caldeo del tejido, además de contribuir a la creación del requerido grosor del tejido final, que es una indicación de una buena obturación.
Preferiblemente, las superficies obturadoras conductivas 35 de los miembros de mordaza 22 y 24 son relativamente planas, para evitar concentraciones de corriente en bordes agudos, y para evitar arcos entre puntos altos, Además. y debido a la fuerza de reacción del tejido 150 cuado es acoplado, los miembros de mordaza 22 y 24 son fabricados preferiblemente para resistirse al curvado. Por ejemplo, y como se aprecia mejor en la fig. 6A, los miembros de mordaza 22 y 24 son ahusados preferiblemente a lo largo de la anchura “W”, lo que resulta ventajoso por dos razones: 1) el ahusamiento aplicará una presión constante para un grosor del tejido constante en paralelo, b) la porción proximal más gruesa de los miembros de mordaza 22 y 24 se resistirá al curvado debido a la fuerza de reacción del tejido 150.
Como se aprecia mejor en las figs. 5 a 6F, con objeto de conseguir un espaciado deseado entre las superficies 36 eléctricamente conductivas y los respectivas miembros de mordaza 22 y 24 (por ejemplo, el hueco de separación), y aplicar una fuerza deseada para obturar el tejido 150, al menos uno de los miembros de mordaza 22 y/o 24 incluye al menos un miembro de tope, por ejemplo, 60a que limita el movimiento de los miembros de mordaza opuestos 22 y 24 entre sí. Preferiblemente, el miembro de tope, por ejemplo 50a, se extiende desde la superficie obturadora o superficie 35 de contacto del tejido una distancia predeterminada de acuerdo con las propiedades del material especificas (por ejemplo, resistencia a la compresión, expansión térmica, etc) para proporcionar una distancia del hueco uniforme y precisa durante la obturación. Preferiblemente, la distancia del hueco entre superficies de obturación opuestas 35 durante unos márgenes de trabajo de aproximadamente 0,03 mm a aproximadamente 0,1 mm, y más preferiblemente de entre aproximadamente 0,05 mm y aproximadamente 0,08 mm.
Con preferencia, los miembros de tope están 50a-50g están hechos de un material aislante, por ejemplo, parileno, nilón, y/o cerámica, y están dimensionados para limitar los movimientos opuestos de los miembros de mordaza 22 y 24 dentro del margen de separación antes citado. Está previsto que los miembros de tope 50a-50g puedan ser dispuestos en uno
o ambos miembros de mordaza 22 y 24, en función de la finalidad particular o para conseguir un resultado particular.
Las figs. 6A-6F muestran varias configuraciones contempladas de los miembros de tope no conductivos 50a-50g dispuestos sobre, a lo largo, o sobresaliendo a través del miembro de mordaza 24. Está previsto que uno o más miembros de tope, por ejemplo, 50a y 50g puedan ser situados en uno cualquiera o ambos miembros de mordaza 22 y 24, en función de una finalidad particular o para conseguir un resultado deseado. Como puede ser apreciado en la presente memoria descriptiva, las diversas configuraciones de los miembros de tope 50a-50g están diseñadas para limitar el movimiento del tejido 150 antes y durante la activación, y evitar el cortocircuitado de los miembros de mordaza 22 y 24 a medida que es comprimido dicho tejido 150.
Las figs. 6A y 6B muestran una posible configuración de los miembros de tope 50a-50g para controlar la distancia de separación entre superficies de obturación opuestas 35. La invención reivindicada requiere miembros de tope dispuestos a lo largo de una longitud de las primera y segunda mitades de la superficie eléctricamente conductiva. Los miembros de tope mostrados en la Figura 6A están dispuestos en un lado del canal de la cuchilla y por tanto, el dispositivo mostrado en la Figura 6A no forma una realización de la presente invención. Más particularmente, un par de miembros de tope 50a a modo de lengüeta orientados longitudinalmente, están dispuestos en proximidad al centro de la superficie 35 de obturación, sobre un lado del canal 36 de cuchilla del miembro de mordaza 24. Un segundo miembro de tope, por ejemplo, 50b, está dispuesto en el extremo proximal 26 del miembro de mordaza 24, y un tercer miembro de tope 50g está dispuesto en la punta distal 28 del miembro de mordaza 24. Preferiblemente, los miembros de tope 50a50g pueden estar configurados de cualquier modo geométrico, por ejemplo, triangular, rectilíneo, circular, ovalado, festoneado, en función de la finalidad particular. Además, se contempla que cualquier combinación de miembros de tope diferentes 50a-50g pueda ser montada a lo largo de las superficies de obturación 35, para conseguir la distancia de separación deseada. Está previsto también que los miembros de tope puedan estar diseñados como una punta elevada (no mostrada) que sobresalga desde la periferia exterior del miembro de mordaza 24.
La fig 6C muestra una primera serie de miembros de tope 50c a modo de círculo extendidos desde el extremo proximal 28 del miembro de mordaza 24 de manera alterna y descentrada lateralmente entre sí, sobre un lado del canal 36 de cuchilla, y una segunda serie de miembros de tope a modo de círculo extendidos desde el extremo distal 26 hasta el extremo proximal 28 del miembro de mordaza 24, de manera alterna y lateralmente descentrada entre sí sobre el otro lado del canal 36 de cuchilla, que forma otra realización de la presente invención. Está previsto que los miembros de tope 50c a modo de círculo sean sustancialmente de igual tamaño, No obstante, uno o más de dichos miembros de tope 50c pueden estar dimensionados para ser mayores o menores que los otros miembros de tope 50c, según dependa de una finalidad particular o para conseguir un resultado deseado.
La fig. 6D muestra otra configuración más en la que el miembro de tope está configurado como una cresta 50e orientada longitudinalmente, extendida desde un extremo proximal 26 hasta un extremo distal 28 del miembro de mordaza 82, a lo largo del lado del canal 36 de cuchilla. La invención reivindicada requiere una serie de miembros de tope dispuestos a lo largo de una longitud de primera y segunda mitades de la superficie eléctricamente conductiva. Por lo tanto, la figura 6D no muestra una realización de la presente invención. Como antes se ha dicho, un segundo borde 50e orientado longitudinalmente puede disponerse sobre el miembro de mordaza opuesto 22, sobre el lado opuesto del canal 36 de cuchilla con fines de obturación. La fig. 6E muestra un serie de miembros 50f a modo de lengüeta alargados dispuestos con un cierto ángulo con relación al canal 36 de cuchilla, que forma una realización de la presente invención. La fig. 6F muestra otra configuración más en la que miembros de tope diferentes, por ejemplo, 50a, 50c, y 50g están dispuestos como topes de la superficie de obturación 35 en ambos lados del canal 36 de cuchilla, que forma una realización adicional de la presente invención.
Preferiblemente, los miembros de tope no conductivos 50a-50g están moldeados sobre los miembros de mordaza 22 y 24 (por ejemplo, mediante sobremoldeo, moldeo por inyección, etc.), estampados sobre los miembros de mordaza 22 y 24, o depositados (por ejemplo, por deposición) sobre dichos miembros 22 y 24. Los miembros de tope 60a-50g pueden ser unidos también deslizablemente a los miembros de mordaza, y/o unidos a las superficies eléctricamente conductivas 35 mediante encaje rápido a presión. Otras técnicas requieren la pulverización térmica de un material de cerámica sobre la superficie del miembro de mordaza 22 y 24, para formar los miembros de tope 50a-50g. Se contemplan varias técnicas de pulverización térmica, que requieren la deposición de un margen amplio de materiales aislantes y resistentes al calor sobre las superficies eléctricamente conductivas 35, para crear unos miembros de tope 50a-50g, por ejemplo, deposición de Oxi-fuel a alta velocidad, deposición de plasma, etc.
Está previsto que los miembros de tope 50a-50g sobresalgan aproximadamente 0,3 mm hasta aproximadamente 0,1 mm desde las superficies enfrentadas hacia dentro 35 de los miembros de mordaza 22 y 24, como puede ser apreciado en la presente memoria descriptiva, lo que reduce la posibilidad de cortocircuito entre las superficie eléctricamente conductivas, y mejora las características asidoras de los miembros de mordaza 22 y 24 durante la obturación y la división. Preferiblemente, los miembros de tope 59a-50g sobresalen aproximadamente 0,05 mm hasta aproximadamente 0,08 mm desde la superficie eléctricamente conductiva 35 que ha sido determinada como que proporciona una distancia de separación ideal para producir unas obturaciones del tejido efectivas, uniformes, y consistentes.
Alternativamente, los miembros de tope 50a-50g pueden ser moldeados sobre la superficie 35 que mira hacia dentro de uno o ambos miembros de mordaza 22 y 24, o en algunos casos, puede ser preferible adherir el miembro de tope 50a50g a las superficies 35 que miran hacia dentro de uno o ambos miembros de mordaza 22 y 24, mediante cualquier método de adherencia conocido. La estampación es definida aquí como que abarca virtualmente cualquier operación prensora conocida en este campo, incluyendo, sin limitarse a ello, el punzonamiento, cizallamiento, formación en frío o en caliente, tracción, curvado, y troquelado.
Las figs. 6A a 6F muestran algunas de las posibles configuraciones de los miembros de tope 50a-50f; no obstante, estas configuraciones se muestran a título de ejemplo, y no constituyen una limitación. Se contemplan también otras configuraciones de dichos miembros de tope, que puede resultar igualmente efectivas en la reducción de la posibilidad de cortocircuitos entre superficies 35 eléctricamente conductivas, y que mejoran la sujeción del tejido durante la obturación y la división.
Además, aunque es preferible que los miembros de tope 50a-50g sobresalgan de aproximadamente 0,03 mm a aproximadamente 0,1 mm, y con preferencia de aproximadamente 0,05 mm a aproximadamente 0,08 mm desde las superficies 35 que miran hacia dentro de los miembros de mordaza 22 y 24, en algunos casos puede ser preferible hacer que dichos miembros de tope 50a-50g sobresalgan más o menos, en función de una finalidad particular. Por ejemplo, se contempla que el tipo de material utilizado para los miembros de tope 50a-50g, y que la capacidad de los materiales para absorber las grandes fuerzas de compresión de cierre entre los miembros de mordaza 22 y 24 varíen, y por tanto, las dimensiones generales de los miembros de tope 50a-50g pueden variar también para producir la distancia de separación deseada.
Dicho en otros términos, la fuerza de compresión del material junto con la distancia de separación última o deseada requerida para una obturación efectiva, son parámetros que son considerados cuidadosamente cuando se forman los miembros de tope 50a-50g, y un material puede tener que ser dimensionado diferentemente de otro material, para conseguir la misma distancia de separación o resultado deseado. Por ejemplo, la fuerza de compresión del nilón es diferente de la de la cerámica, y por tanto, el material de nilón puede tener que ser dimensionado diferentemente, por ejemplo, más grueso, para contrarrestar la fuerza de cierre de los miembros de mordaza opuestos 22 y 24, y conseguir la misma distancia de hueco deseada cuando se utiliza un miembro de tope de cerámica
La presente descripción se refiere también un método para obturar y dividir tejido e incluye las operaciones de: proporcionar un fórceps bipolar endoscópico 10, que incluye:
-un árbol alargado 12 que tiene unos miembros de mordaza opuestos 22 y 24 en un extremo distal 14 de él, que cooperan para asir el tejido 150 entre ellos;
-al menos un miembro de tope no conductivo y separado 50a-50g, dispuesto sobre una superficie que mira hacia dentro 35 de al menos uno de los miembros de mordaza, por ejemplo, el 24, que controla la distancia entre los miembros de mordaza 22 y 24 cuando el tejido 150 es sostenido entre ellos; y
-una cuchilla 60.
El método incluye también las operaciones de conectar los miembros de mordaza 22 y 24 a una fuente 110 de energía eléctrica; accionar los miembros de mordaza 22 y 24 para asir tejido 150 entre dichos miembros 22 y 24 opuestos, conduciendo energía a través del tejido 150 sujeto entre ellos, para efectuar una obturación 152 (figs,. 7 a 9); y accionar la cuchilla 60 para cortar el tejido en proximidad a la obturación 152.
Preferiblemente, al menos uno de los miembros de mordaza, por ejemplo el 24, de la operación de proporcionar el fórceps, incluye una superficie eléctricamente conductiva 35 que tiene un canal 36 orientado longitudinalmente definido en ella, que facilita la actuación de la cuchilla 60 desplazable alternativamente de modo longitudinal dentro del canal 36, para cortar el tejido 150 en proximidad al lugar de la obturación en él.
De todo lo expuesto y con referencia a los dibujos expuestos, los expertos en la técnica apreciarán que ciertas modificaciones pueden ser introducidas también en la presente descripción, sin apartarse del alcance de ella. Por ejemplo, puede ser preferible añadir otras características al fórceps 10, por ejemplo, un conjunto articulado para desplazar axialmente el conjunto accionador 20 de extremo con respecto al árbol alargado 12.
Además. Se contempla que el fórceps aquí descrito pueda incluir un conjunto accionador de extremo desechable, que selectivamente es acoplable al menos a una porción del instrumento electroquirúrgico, por ejemplo el árbol 12 y/o el conjunto de empuñadura 80.
Claims (11)
- REIVINDICACIONES1. Un forceps bipolar endoscópico (10) para obturar y dividir tejido, que comprende:un árbol alargado (12) que tiene unos miembros de mordaza opuestos (22, 24) en un extremo distal de él, siendo los miembros de mordaza desplazables entre sí desde una primera posición, en la que dichos miembros de mordaza están dispuestos en relación espaciada entre sí, a una segunda posición en la que los miembros de mordaza cooperan para asir tejido entre ellos;una fuente de energía eléctrica conectada a cada uno de los miembros de mordaza, teniendo cada miembro de mordaza una superficie (35) eléctricamente conductiva que mira hacia el interior, tal que la superficie eléctrica conductiva de los miembros de mordaza sean capaces de conducir energía a través del tejido sujeto entre ellos para efectuar una obturación;donde al menos una superficie eléctricamente conductiva que mira hacia dentro incluye un canal (36) orientado longitudinalmente para dividir la superficie eléctricamente conductiva en una primera mitad y una segunda mitad;una cuchilla (60) de movimiento alternativo dispuesta en el canal orientado longitudinalmente para cortar tejido próximo a la obturación; caracterizado por:al menos un miembro de tope no conductivo (50) dispuesto sobre la superficie eléctricamente conductiva que mira hacia dentro de al menos uno de los miembros de mordaza, que controlan la distancia entre los miembros de mordaza cuando el tejido está sujeto entre ellos,donde al menos un miembro de tope incluye una serie de lengüetas que están dispuestas a lo largo de una longitud de la primera mitad de la superficie eléctricamente conductiva y a lo largo de una longitud de la segunda mitad de la superficie eléctricamente conductiva, donde las lengüetas son:
- (1)
- lengüetas de diferente forma geométrica (50a, 50b, 50c, 50g); o
- (2)
- lengüetas de tipo alargado (50f) que están dispuestas a un ángulo relativo al canal orientado longitudinalmente; o
- (3)
- lengüetas a modo de círculo (50c) que están dispuestas de manera alternativa y descentrada lateralmente entre sí a lo largo de una longitud de la primera mitad de la superficie eléctricamente conductiva y a lo largo de una longitud de la segunda mitad de la superficie eléctricamente conductiva.
-
- 2.
- El fórceps bipolar endoscópico para obturar y dividir tejido de acuerdo con la reivindicación 1, en el que el miembro de tope está fabricado de perileno, nilón, o cerámica.
-
- 3.
- El fórceps bipolar endoscópico para obturar y dividir tejido de acuerdo con una cualquiera de las reivindicaciones anteriores, en el que el miembro de tope sobresale aproximadamente 25,4 µm a 127 µm desde la superficie que mira hacia dentro del miembro de mordaza.
-
- 4.
- El fórceps bipolar endoscópico para obturar y dividir tejido de acuerdo con una cualquiera de las reivindicaciones anteriores, en el que el miembro de tope sobresale aproximadamente 50,8 µm a 76,2 µm desde la superficie que mira hacia dentro del miembro de mordaza.
-
- 5.
- El fórceps bipolar endoscópico para obturar y dividir tejido de acuerdo con una cualquiera de las reivindicaciones 1 a 4, en el que el miembro de tope está fijo al miembro de mordaza mediante rociadura térmica.
-
- 6.
- El fórceps bipolar endoscópico para obturar y dividir tejido de acuerdo con una cualquiera de las reivindicaciones 1 a 4, en el que el miembro de tope está fijo al miembro de mordaza mediante un adhesivo.
-
- 7.
- El fórceps bipolar endoscópico para obturar y dividir tejido de acuerdo con una cualquiera de las reivindicaciones 1 a 4, en el que el miembro de tope está fijo al miembro de mordaza mediante un procedimiento de moldeo.
-
- 8.
- El forceps bipolar endoscópico para obturar y dividir tejido de acuerdo con una cualquiera de las reivindicaciones precedentes, donde el fórceps incluye un conjunto (70) de vástago de accionamiento que conecta los miembros de mordaza a la fuente de energía eléctrica, de modo que el primer miembro de mordaza tiene un primer potencial eléctrico, y el segundo miembro de mordaza tiene un segundo potencial eléctrico; y
una empuñadura (82) unida al conjunto de vástago de accionamiento para impartir el movimiento de los miembros de mordaza primero y segundo desde las posiciones primera y segunda. -
- 9.
- El fórceps bipolar endoscópico para obturar y dividir tejido de acuerdo con la reivindicación 8, en el que el fórceps incluye un disparador (86) que mueve alternativamente longitudinalmente la cuchilla para el corte de tejido en proximidad a la obturación.
-
- 10.
- El fórceps bipolar endoscópico para obturar y dividir tejido de acuerdo con una cualquiera de las reivindicaciones anteriores, en el que un primer miembro de tope está dispuesto sobre la superficie eléctricamente conductiva de uno de los miembros de mordaza, y al menos un segundo miembro de tope está dispuesto sobre la superficie eléctricamente conductiva del otro miembro de mordaza.
5 11. El fórceps endoscópico según una cualquiera de las reivindicaciones anteriores, en el que la anchura de los miembros de mordaza disminuye a lo largo de su longitud. - 12. El fórceps endoscópico según una cualquiera de las reivindicaciones anteriores, incluyendo las lengüetas de diferentes formas geométricas, donde se dispone un par de lengüetas (50a) de una primera forma geométrica orientadas longitudinalmente sobre cada lado del canal de la cuchilla, próximo al centro de la superficie de obturación,10 un miembro de tope (50b) de una segunda forma geométrica diferente se dispone sobre cada lado del canal de la cuchilla en un extremo proximal de el al menos un miembro de mordaza y un miembro de tope (50g) de una tercera forma geométrica diferente se dispone sobre cada lado del canal de la cuchilla a un extremo distal (28) del al menos un miembro de mordaza.
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2001
- 2001-04-06 ES ES01923220T patent/ES2262639T3/es not_active Expired - Lifetime
- 2001-04-06 JP JP2002578835A patent/JP4499992B2/ja not_active Expired - Lifetime
- 2001-04-06 ES ES06002279T patent/ES2332143T3/es not_active Expired - Lifetime
- 2001-04-06 WO PCT/US2001/011413 patent/WO2002080796A1/en active IP Right Grant
- 2001-04-06 EP EP01923220A patent/EP1372507B1/en not_active Expired - Lifetime
- 2001-04-06 DE DE60121229T patent/DE60121229T2/de not_active Expired - Lifetime
- 2001-04-06 EP EP06002279A patent/EP1656901B1/en not_active Expired - Lifetime
- 2001-04-06 DE DE60139815T patent/DE60139815D1/de not_active Expired - Lifetime
- 2001-04-06 CA CA2442598A patent/CA2442598C/en not_active Expired - Lifetime
- 2001-04-06 EP EP06008515A patent/EP1685806B1/en not_active Expired - Lifetime
- 2001-04-06 US US10/471,818 patent/US7473253B2/en not_active Expired - Lifetime
- 2001-04-06 ES ES06008515T patent/ES2364666T3/es not_active Expired - Lifetime
- 2001-04-06 AU AU2001249933A patent/AU2001249933B2/en not_active Expired
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2009
- 2009-01-05 US US12/348,748 patent/US8241284B2/en not_active Expired - Lifetime
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2012
- 2012-08-13 US US13/584,194 patent/US20120303026A1/en not_active Abandoned
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2015
- 2015-05-22 US US14/719,887 patent/US20150257819A1/en not_active Abandoned
- 2015-05-22 US US14/719,584 patent/US20150250532A1/en not_active Abandoned
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2016
- 2016-10-31 US US15/338,663 patent/US20170042607A1/en not_active Abandoned
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2018
- 2018-03-05 US US15/911,739 patent/US10251696B2/en not_active Expired - Fee Related
- 2018-08-02 US US16/053,052 patent/US10265121B2/en not_active Expired - Fee Related
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2019
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Also Published As
Publication number | Publication date |
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EP1685806A2 (en) | 2006-08-02 |
US7473253B2 (en) | 2009-01-06 |
JP4499992B2 (ja) | 2010-07-14 |
DE60121229T2 (de) | 2007-05-24 |
DE60139815D1 (de) | 2009-10-15 |
US20190247111A1 (en) | 2019-08-15 |
WO2002080796A1 (en) | 2002-10-17 |
EP1685806A3 (en) | 2009-02-04 |
ES2332143T3 (es) | 2010-01-27 |
EP1656901B1 (en) | 2009-09-02 |
US10687887B2 (en) | 2020-06-23 |
EP1656901A1 (en) | 2006-05-17 |
US8241284B2 (en) | 2012-08-14 |
CA2442598C (en) | 2011-10-04 |
AU2001249933B2 (en) | 2006-06-08 |
US20180193087A1 (en) | 2018-07-12 |
US20120303026A1 (en) | 2012-11-29 |
US20180344385A1 (en) | 2018-12-06 |
US20170042607A1 (en) | 2017-02-16 |
US10251696B2 (en) | 2019-04-09 |
CA2442598A1 (en) | 2002-10-17 |
US20150250532A1 (en) | 2015-09-10 |
JP2004532676A (ja) | 2004-10-28 |
EP1372507B1 (en) | 2006-06-28 |
DE60121229D1 (de) | 2006-08-10 |
EP1372507A1 (en) | 2004-01-02 |
US20040122423A1 (en) | 2004-06-24 |
EP1685806B1 (en) | 2011-06-08 |
US20090171350A1 (en) | 2009-07-02 |
US20150257819A1 (en) | 2015-09-17 |
ES2262639T3 (es) | 2006-12-01 |
US10265121B2 (en) | 2019-04-23 |
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