ES2377813T5 - Conjunto de herramienta para un dispositivo de grapado quirúrgico - Google Patents

Conjunto de herramienta para un dispositivo de grapado quirúrgico Download PDF

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ES2377813T5
ES2377813T5 ES10009127T ES10009127T ES2377813T5 ES 2377813 T5 ES2377813 T5 ES 2377813T5 ES 10009127 T ES10009127 T ES 10009127T ES 10009127 T ES10009127 T ES 10009127T ES 2377813 T5 ES2377813 T5 ES 2377813T5
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anvil
cartridge assembly
clamping member
stapling device
surgical stapling
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ES2377813T3 (es
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David C Racenet
Lee Ann Olson
Phillip Roy
John W Beardsley
Ralph A Stearns
Clifford L Emmons
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Covidien LP
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
    • A61B17/105—Wound clamp magazines
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/0682—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil
    • A61B17/0686—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil having a forming anvil staying below the tissue during stapling
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003—Steerable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07257—Stapler heads characterised by its anvil
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07271—Stapler heads characterised by its cartridge
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07278—Stapler heads characterised by its sled or its staple holder
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07285—Stapler heads characterised by its cutter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2932—Transmission of forces to jaw members
    • A61B2017/2939—Details of linkages or pivot points
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B2017/320052—Guides for cutting instruments

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Description

DESCRIPCIÓN
Conjunto de herramienta para un dispositivo de grapado quirúrgico
Antecedentes
1. Campo técnico
La presente descripción se refiere a un conjunto de herramienta para tratar tejido. Más particularmente, la presente descripción se refiere a un conjunto de herramienta quirúrgica endoscópica con articulación y rotación para tratar tejido.
2. Antecedentes de la técnica relacionada
Las grapadoras quirúrgicas para sujetar tejido entre estructuras de mordazas opuestas de un conjunto de herramienta y luego agarrar el tejido sujetado son bien conocidas en la técnica. Estos dispositivos pueden incluir una cuchilla para hacer una incisión en el tejido sujetado. Tales grapadoras que tienen configuraciones laparoscópicas o endoscópicas también son bien conocidas en la técnica. Ejemplos de estas grapadoras quirúrgicas endoscópicas se describen en las patentes de los Estados Unidos con números 6,330,965, 6,250,532, 6,241,139, 6,109,500 y 6,079,606.
El documento US 6,241,139 describe una grapadora quirúrgica que tiene un miembro de sujeción dinámico formado por un rodillo de levas y un miembro de soporte arqueado.
El documento EP 0640 317 describe un dispositivo electroquirúrgico que tiene un miembro de sujeción formado como una envoltura conductora de electricidad.
Típicamente, estas grapadoras incluyen un miembro de herramienta que contiene un cartucho de grapas que aloja una pluralidad de grapas dispuestas en al menos dos filas espaciadas lateralmente y un yunque que incluye una pluralidad de cavidades de formación de grapas para recibir y formar las patas de las grapas a medida que las grapas son expulsadas desde el cartucho. El yunque, típicamente, está soportado de manera giratoria adyacente al cartucho y puede girar entre las posiciones abierta y cerrada.
Durante los procedimientos quirúrgicos laparoscópicos o endoscópicos, el acceso al sitio quirúrgico se logra a través de una pequeña incisión o mediante una cánula estrecha insertada a través de una pequeña herida de entrada realizada en un paciente. Debido al área limitada para acceder al sitio quirúrgico, muchas grapadoras endoscópicas incluyen mecanismos para rotar la porción del cuerpo endoscópico del dispositivo o articular el conjunto de herramienta del dispositivo. Típicamente, cada mecanismo está controlado por un actuador que tiene que ser manipulado por un cirujano para orientar adecuadamente el conjunto de herramienta en relación con el tejido a tratar. Dichas manipulaciones requieren mucho tiempo y pueden no dar como resultado la orientación exacta del conjunto de herramienta deseada por el cirujano.
En consecuencia, existe la necesidad de un dispositivo de grapado quirúrgico endoscópico mejorado que incluya un mecanismo para ajustar la orientación de un conjunto de herramienta que sea fácil de operar y que sea capaz de colocar un conjunto de herramienta en cualquier orientación deseada.
Resumen
Los aspectos y modalidades de la presente invención se exponen en las reivindicaciones adjuntas.
También se describe un instrumento quirúrgico que incluye un conjunto de herramienta que tiene un par de mordazas. El conjunto de herramienta incluye un yunque y un conjunto de cartucho que tiene una pluralidad de sujetadores soportados en el mismo. El conjunto de cartucho es móvil en relación con el yunque entre una posición separada y una posición aproximada. Un miembro de sujeción se puede mover desde una posición retraída hasta una posición avanzada para mover el conjunto de cartucho en relación con el yunque desde la posición separada hasta la posición aproximada. Un miembro de sujeción dinámico se coloca de manera móvil en relación con el yunque y el conjunto de cartucho desde una posición retraída hasta una posición avanzada para expulsar la pluralidad de sujetadores desde el conjunto de cartucho. Un miembro de accionamiento formado a partir de un cable flexible está conectado de manera funcional al miembro de sujeción y al miembro de sujeción dinámico y es móvil para poder desplazar el miembro de sujeción y el miembro de sujeción dinámico entre sus posiciones retraída y avanzada.
Preferiblemente, el miembro de accionamiento incluye un cable coaxial compuesto de una envoltura exterior y una barra central. La barra central se mueve y rota de forma axial en relación con la envoltura exterior. La envoltura exterior está conectada de manera funcional al miembro de sujeción y la barra central está conectada de manera funcional al miembro de cierre.
Preferiblemente, un collar está asegurado de manera giratoria a una porción del cuerpo de un dispositivo de grapado. La porción del cuerpo puede formar el extremo distal de un dispositivo de grapado quirúrgico o el extremo proximal de una unidad de carga desechable.
Preferiblemente, el conjunto de herramienta está montado de manera giratoria respecto al miembro del collar. En una modalidad preferida, la barra central del cable coaxial está conectada al dispositivo de sujeción dinámico de manera que la rotación de la barra central efectúa la rotación del miembro de cierre para hacer rotar el conjunto de herramienta en relación con el miembro del collar para facilitar la rotación independiente del conjunto de herramienta.
El miembro de sujeción dinámico puede incluir una primera porción de brida colocada para acoplarse con la superficie del yunque y una segunda porción de brida colocada para acoplarse con la superficie del conjunto de cartucho. Las primera y segunda porciones de brida juntas definen un espacio de tejido máximo entre el yunque y el conjunto de cartucho. Breve descripción de las figuras
Varias modalidades preferidas del dispositivo de grapado quirúrgico descrito aquí se describen en el presente documento con referencia a los dibujos, en donde:
La figura 1 es una vista en perspectiva lateral de una modalidad preferida del dispositivo de grapado quirúrgico actualmente descrito con el yunque y el conjunto de cartucho en la posición separada;
La figura 1A es una vista en perspectiva lateral del extremo proximal del yunque, el collar de rotación y el adaptador del dispositivo de grapado quirúrgico que se muestra en la figura 1;
La figura 2 es una vista lateral del dispositivo de grapado quirúrgico que se muestra en la figura 1;
La figura 3 es una vista superior con los componentes internos ocultos del dispositivo de grapado quirúrgico que se muestra en la figura 2;
La figura 4 es una vista en sección transversal del dispositivo de grapado quirúrgico que se muestra en la figura 2 tomada a lo largo de un eje longitudinal del dispositivo a través del conjunto de cartucho;
La figura 5 es una vista en sección transversal del dispositivo de grapado quirúrgico que se muestra en la figura 3 tomada a lo largo de un eje transversal a través del miembro de sujeción dinámico con el miembro de herramienta aproximado; La figura 6 es una vista en sección transversal del dispositivo de grapado quirúrgico que se muestra en la figura 3 tomada a lo largo de un eje transversal del conjunto de herramienta a través del conjunto de cartucho y del yunque;
La figura 7 es una vista en perspectiva superior del miembro de sujeción dinámico del dispositivo de grapado quirúrgico que se muestra en la figura 1;
La figura 8 es una vista en perspectiva superior del miembro de sujeción del dispositivo de grapado quirúrgico que se muestra en la figura 1;
La figura 9 es una vista en perspectiva superior del collar de accionamiento del dispositivo de grapado quirúrgico que se muestra en la figura 1;
La figura 10 es una vista en perspectiva lateral en despiece del conjunto de herramienta del dispositivo de grapado quirúrgico que se muestra en la figura 1;
La figura 11 es una vista ampliada del extremo proximal del conjunto de herramienta que se muestra en la figura 10; La figura 12 es una vista en perspectiva lateral en despiece de la porción del cuerpo endoscópico del dispositivo de grapado quirúrgico que se muestra en la figura 1;
La figura 13 es una vista lateral en sección transversal del dispositivo de grapado quirúrgico que se muestra en la figura 1;
La figura 14 es otra modalidad del miembro de cierre de acuerdo con la presente descripción;
La figura 15 es una vista en planta superior de la carcasa del cartucho de la presente descripción;
Las figuras 16A y 16B son vistas en perspectiva de los miembros del elemento deslizante y empujador de la presente descripción;
La figura 17A es una vista en sección transversal del extremo de una porción del conjunto de cartucho de la figura 16B, tomada a lo largo de las líneas 17A, que ilustra la disposición del elemento deslizante, del elemento empujador y la grapa de acuerdo con una modalidad de la presente descripción: y
La figura 17B es una vista en sección transversal del extremo de una porción del conjunto de cartucho que ilustra la disposición del elemento deslizante, el elemento empujador y la grapa de acuerdo con otra modalidad de la presente descripción.
Descripción detallada de las modalidades preferidas
A continuación, se describirán en detalle las modalidades preferidas del dispositivo de grapado quirúrgico descrito en la presente con referencia a los dibujos en donde números de referencia similares designan elementos idénticos o correspondientes en cada una de las diversas vistas.
Las figuras 1-13 ilustran una modalidad preferida del dispositivo de grapado quirúrgico actualmente descrito que se muestra generalmente como 10. El dispositivo de grapado 10 incluye un conjunto de herramienta 12 que tiene un yunque 14 y un conjunto de cartucho 16, una porción de cuerpo endoscópico 18, un miembro de sujeción 20 y un collar de rotación 22. El conjunto de herramienta 12 está soportado de manera giratoria en el extremo distal de la porción del cuerpo endoscópico 18 alrededor de un miembro de pivote 24. Un adaptador 26 está asegurado al extremo distal de la porción del cuerpo 18 e incluye extensiones superior e inferior 28. Se puede colocar un separador 18a (figura 12) dentro del cuerpo anterior 8 para mantener la posición de los componentes internos del dispositivo. Alternativamente, el adaptador 26 puede formarse monolíticamente con la porción del cuerpo endoscópico 18. El miembro de pivote 24 se extiende entre las extensiones superior e inferior 28 y una porción proximal 22a (figura 1A) del collar de rotación 22 de modo que el conjunto de herramienta 12 puede articularse en relación con el eje longitudinal de la porción endoscópica 18 aproximadamente 90°. Se prevé que se puede proporcionar una variedad de diferentes tipos de articulación, por ejemplo, rótula, acoplamiento flexible, articulación universal, etc., para permitir mayores grados de articulación.
El conjunto de cartucho 16 incluye una carcasa de cartucho 16a, una pluralidad de grapas (no mostradas), una porción de canal 30 que define una cavidad para recibir el cartucho 16a, un miembro de sujeción dinámico 32 (figura 7) y un elemento deslizante 31. El miembro de sujeción dinámico 32 se coloca preferiblemente a una distancia proximal del elemento deslizante 31 dentro del cartucho 16a. Una hoja de cuchilla 34 se coloca preferiblemente en una porción intermedia, preferiblemente en el centro del cuerpo 32a del miembro de sujeción dinámico 32 para realizar una incisión en el tejido sujetado. La hoja de cuchilla 34 puede ser trabajada a máquina directamente en el miembro de sujeción dinámico o puede estar asegurada de manera fija o desmontable al mismo. Alternativamente, la hoja de cuchilla 34 puede estar formada o fijada, asegurada de manera desmontable o giratoria al elemento deslizante. El elemento deslizante 31 se coloca de forma deslizable para trasladarse a través del cartucho 16a para expulsar grapas del cartucho de una manera conocida. El miembro de sujeción dinámico 32 incluye bridas superior e inferior 36a y 36b. Como se muestra en la figura 5, la brida 36a se coloca dentro de una ranura o cavidad 38 formada en el cartucho 16a y la brida 36b se coloca dentro de una cavidad 40 formada en el yunque 14. Alternativamente, las bridas 36a y 36b no necesitan colocarse de manera deslizable en las cavidades, sino que solo necesitan acoplarse a una superficie de apoyo superior en el yunque 14 y una superficie de apoyo inferior en el conjunto de cartucho 16. Como se ilustra en la figura 7, las bridas 36a y 36b son preferiblemente arqueadas o semicirculares para minimizar la desviación y mantener la alineación del yunque y/o cartucho durante el accionamiento de la grapadora. El miembro de sujeción dinámico 32 se coloca a una distancia proximal del elemento deslizante en acoplamiento con el mismo y es trasladable a través del cartucho. El miembro de cierre 32 proporciona, restaura y/o mantiene un espacio de tejido deseado, preferiblemente uniforme, en el área del conjunto de herramienta 12 adyacente al elemento deslizante 31 durante el disparo del dispositivo 10. El movimiento del miembro de sujeción dinámico 32 a través del conjunto de cartucho 16 hace avanzar el elemento deslizante a través del conjunto de cartucho.
Se prevé que el yunque y/o el miembro de sujeción dinámico, preferiblemente ambos, estén formados de un material y sean de tal grosor o calibre para minimizar la desviación del yunque y/o miembro de sujeción dinámico respectivos durante la sujeción, traslación y disparo del dispositivo. Dichos materiales incluyen acero inoxidable de grado quirúrgico. Preferiblemente, el yunque se forma como una unidad sólida de una pieza. Alternativamente, como se conoce en la técnica, el yunque puede estar formado por un conjunto de partes que incluyen un cuerpo de yunque y una placa de yunque que tiene una pluralidad de cavidades de formación de grapas. Se desea que el yunque sea tan fuerte como sea razonablemente posible y necesario para minimizar la distorsión, por ejemplo, el extremo distal del yunque que se inclina hacia arriba durante la sujeción o preamortiguamiento y/o durante el disparo de las grapas.
Con referencia a la figura 1A, el extremo proximal del yunque 14 incluye una porción cilíndrica 14a que tiene una cavidad anular 14b. La porción cilíndrica 14a está dimensionada para ser recibida dentro del orificio 22a del collar 22. Al menos un pasador de pivote 23 (figura 1) se extiende a través del collar 22 dentro de la cavidad 14b para fijar axialmente el extremo proximal del yunque 14 dentro del orificio 22a. Dado que el pasador 23 se coloca dentro de la cavidad anular 14b, el yunque 14 se puede rotar dentro del collar 22. Se prevé que se puedan proporcionar otros medios para unir de manera giratoria el yunque 14 al collar 22. Un segundo pasador 25 (figura 1) se extiende a través del collar 22 para asegurar el collar 22 a un extremo distal del enlace de articulación 52 como se describirá a continuación.
Aunque no se muestra, de manera conocida, el extremo proximal de la porción de canal 30 del conjunto de cartucho 16 incluye una cavidad para recibir un miembro de pivote, por ejemplo, una pestaña o pasador, formado o unido al extremo proximal del yunque 14. Los extremos proximales del yunque 14 y el cartucho 16 están confinados dentro del collar 22 para evitar que el miembro de pivote del yunque se desacople de la cavidad en la porción de canal 30 del conjunto de cartucho 16. Alternativamente, se pueden utilizar otras disposiciones mecánicas conocidas en la técnica para asegurar de manera giratoria el yunque 14 al conjunto de cartucho 16. Se observa que, dado que el conjunto de cartucho 16 está unido de manera giratoria al yunque 14, ambos son giratorios en relación con el collar 22.
Con referencia a las figuras 1 y 4, se proporciona un mecanismo de articulación para articular el conjunto de herramienta 12 en relación con la porción del cuerpo endoscópico 18. El mecanismo de articulación incluye un enlace de articulación proximal 50 y un enlace de articulación distal 52. El enlace de articulación proximal 50 tiene un primer extremo 50a que se extiende desde el extremo proximal de la porción del cuerpo endoscópico 18 y un segundo extremo 50b colocado dentro de la porción del cuerpo 18 y conectado de manera giratoria a un primer extremo 52a del segundo enlace de articulación 52. Un segundo extremo 52b del enlace de articulación 52 está conectado de manera giratoria al collar de rotación 22 por el pasador 25 (figura 1) en un punto desplazado del miembro de pivote 24, es decir, el eje de pivote del conjunto de herramienta 12. El enlace de articulación 52 está confinado en una ranura 54 formada en la porción del cuerpo endoscópico 18. Debido al confinamiento, el mecanismo de articulación solo es capaz de articular el conjunto de herramienta 12 sobre un área a un lado del eje longitudinal del dispositivo. Preferiblemente, cada una de las conexiones giratorias identificadas anteriormente incluye un pasador de pivote. Alternativamente, los miembros de pivote se pueden formar integralmente con los componentes mencionados anteriormente o se pueden utilizar miembros de pivote que no incluyen pasadores. Se contemplan además otros tipos de enlaces de articulación.
Al utilizarse, cuando el eje longitudinal del conjunto de herramienta 12 se alinea con el eje longitudinal de la porción del cuerpo 18 y el enlace de articulación proximal 50 se retrae en la dirección indicada por la flecha "A" en la figura 4, el enlace 50 retrae el enlace 52 para efectuar la articulación del conjunto de herramienta 12 alrededor del miembro de pivote 24 en la dirección indicada por la flecha "B" en la figura 4. El conjunto de herramienta 12 puede devolverse a una posición no articulada haciendo avanzar el enlace 50 en la dirección indicada por la flecha "C". El mecanismo para controlar el movimiento del mecanismo de articulación se discutirá a continuación.
Con referencia a las Figuras 3-9, se proporciona un mecanismo de accionamiento para aproximar el yunque 14 y el conjunto de cartucho 16, disparar las grapas y girar el conjunto de herramienta 12 en relación con el collar 22. El mecanismo de accionamiento incluye un cable coaxial o miembro de accionamiento 60 (figura 3) que tiene una barra central 62 y una envoltura exterior 64, un collar de accionamiento 66 (figura 9), un miembro de sujeción, que se muestra aquí como anillo de sujeción 20, y miembro dinámico de sujeción 32. La barra central 62 es o incluye un miembro flexible que tiene una resistencia de compresión adecuada para empujar el miembro de sujeción dinámico 32 a través del cartucho 16a. Preferiblemente, la barra central 62 incluye un cable flexible enrollado manual a la izquierda o a la derecha. Alternativamente, también se pueden utilizar otros materiales que tengan características de resistencia adecuadas, por ejemplo, Nitinol™. El diámetro de la barra central 62 debe ser lo suficientemente pequeño como para colocarse dentro del espacio disponible dentro del cartucho 16a. La envoltura exterior 64 se coloca alrededor de la barra central 62 y en parte funciona para estabilizar y evitar el doblez de la barra central 62 mientras está bajo compresión. Preferiblemente, la envoltura exterior 64 es además un cable flexible formado a partir de una malla de acero, plástico reforzado o una aleación de níquel titanio como Nitinol™. Para formar la envoltura exterior también se prevé que se puedan utilizar otros materiales adecuados que tengan los requisitos de resistencia requeridos, incluyendo un material de poli parafenilenetereftalamida como Kevlar™ comercialmente disponible en DuPont.
La barra central 62 se coloca de manera deslizante dentro de la envoltura exterior 64 e incluye un primer extremo proximal 62a (figura 4) que se extiende preferiblemente desde el extremo proximal de la porción del cuerpo endoscópico 18 y un segundo extremo 62b unido al miembro de sujeción dinámico 32. El miembro de sujeción dinámico 32 incluye preferiblemente una cavidad 68 (figura 7) formada en el mismo para recibir el segundo extremo 62b de la barra central 62. El segundo extremo 62b se puede asegurar al miembro de sujeción dinámico 32 a través de plisado, soldadura como se muestra en la figura 4, soldadura fuerte, pasadores, etc. dentro o utilizando, por ejemplo, la cavidad 68 y, también puede ser trabajado a máquina para adaptarse a la forma de la cavidad 68.
La envoltura exterior 64 tiene un primer extremo proximal 64a que se extiende preferiblemente desde el extremo proximal de la porción del cuerpo alargado 18 y un segundo extremo distal 64b conectado de manera fija al collar de accionamiento 66. El collar de accionamiento 66 (figura 9) incluye preferiblemente un orificio central 70 para recibir la envoltura exterior 64 y proporcionar un canal para el paso de la barra central 62 a través del mismo. La superficie exterior del collar de accionamiento 66 incluye preferiblemente una estructura de acoplamiento, por ejemplo, muescas 72, para el acople del miembro de sujeción o el anillo 20 en una relación fija giratoria. El anillo de sujeción 20 también incluye una estructura de acoplamiento, por ejemplo, venas o proyecciones 74, para acoplarse con la estructura de acoplamiento del collar de accionamiento 66 para asegurar de manera giratoria el collar de accionamiento 66 al anillo de sujeción 20 para que giren juntos. El extremo distal 20a del anillo de sujeción 20 incluye un par de recortes 76 configurados para engañar y acoplar las porciones de la brida 36a y 36b del miembro de sujeción dinámico 32.
Al utilizarse, la barra central 62 y la envoltura exterior 64 se mueven juntas desde una posición retraída hasta una posición parcialmente avanzada para hacer avanzar el collar de accionamiento 66, el anillo de sujeción 20 y el miembro de sujeción dinámico 32 a una primera posición avanzada. El anillo de sujeción 20 se coloca alrededor del extremo proximal del yunque 14 y el conjunto de cartucho 16. El conjunto de cartucho 16 incluye una superficie de leva 80 (figura 2) formada en una superficie externa de la misma. A medida que el miembro de sujeción dinámico 32 se mueve desde la posición retraída hacia la primera posición avanzada, la brida 36b del miembro de sujeción dinámico 32 acopla la superficie de leva 80 del conjunto de cartucho 16 con el pivote del conjunto de cartucho 16 desde la posición abierta hasta la posición cerrada o sujeta. El anillo de sujeción 20 también se mueve distalmente desde la primera posición avanzada hasta una posición que encierra las porciones proximales del yunque 14 y el conjunto de cartucho 16. En esta posición, el anillo de sujeción 20 evita que el espacio entre las porciones proximales del yunque 14 y el conjunto de cartucho 16 exceda una distancia predeterminada.
Después de que la barra central 62 y la envoltura exterior 64 han sido movidos a la primera posición avanzada para mover el conjunto de cartucho 16 y, en consecuencia, el yunque 14 a la posición sujeta, la barra central 62 puede ser adelantada independientemente de la envoltura exterior 64 a una segunda posición avanzada para mover el miembro de sujeción dinámico 32 a través del cartucho 16a para expulsar las grapas desde el conjunto del cartuchos y cortar el tejido del miembro de cierre 32 mediante la utilización de la hoja de cuchilla 34. Se contempla que, alternativamente, las bridas 36a y 36b del miembro de cierre 32 podrían acoplar una superficie de leva en el yunque 14 y/o el conjunto de cartucho 16 para hacer girar uno o ambos para proporcionar la sujeción del tejido. Con referencia a las Figuras 5 y 6, se forma un canal 82 en el cartucho 16a para proporcionar soporte lateral a la barra central 62 para evitar que la barra central 62 salga de su posición durante el movimiento de la barra central 62 desde la posición retraída hasta la segunda posición avanzada.
Como se discutió anteriormente, el yunque 14 está asegurado de manera giratoria al collar 22, la barra central 62 está unida de manera fija al miembro de sujeción dinámico 32, y la envoltura exterior 64 está unida de manera fija al collar de accionamiento 66. Cuando se gira el miembro coaxial 60, todo el conjunto de herramienta gira alrededor del eje central del collar 22. Más específicamente, dado que el miembro de sujeción dinámico 32 está confinado dentro del yunque 14 y el conjunto de cartucho 16, cualquier par aplicado a la barra central 62 se transfiere a través del miembro de sujeción dinámico 32 al conjunto de herramienta 12. De este modo, el miembro coaxial 60 se puede girar para rotar el conjunto de herramienta 12 alrededor del eje longitudinal del collar 22.
El conjunto de herramienta descrito anteriormente puede modificarse para ser incorporado o puede incorporarse a una unidad de carga desechable tal como se describe en la Patente de los Estados Unidos Núm. 6,330,965 o puede unirse directamente al extremo distal de cualquier dispositivo de grapado quirúrgico conocido. Aunque no se ha descrito específicamente aquí un conjunto de mango para accionar el miembro de articulación y la aproximación o sujeción, el disparo y mecanismos de rotación de herramienta, debe entenderse que se prevé la utilización de una amplia variedad de diferentes mecanismos actuadores y configuraciones de mango que incluyen botones, perillas giratorias y deslizables, palancas o disparadores giratorios, empuñaduras de pistola, manijas en línea, sistemas operados a distancia y cualquier combinación de los mismos. Por ejemplo, como se muestra en la figura 13A, el conjunto de mango puede incluir un tipo de pistola 200 que incluye una perilla de rotación del conjunto de herramienta 210, una palanca de articulación 212 y una perilla de rotación del cuerpo 214. También se prevé la utilización de un conjunto de herramienta como se describe anteriormente como parte de un sistema robótico.
Se prevé que la utilización de un material de calibre más pesado solo para el conjunto de yunque, y preferiblemente también para el miembro de cierre y el anillo de sujeción, proporciona una presión de sujeción mejorada a lo largo del tejido que, a su vez, proporciona un espacio de tejido más uniforme entre las respectivas superficies de yunque y superficies de cartuchos adyacentes y delante de donde se forman las grapas a través del tejido. Además, la utilización del anillo de sujeción para pre-sujetar el tejido, es decir, sujetar el tejido antes de la deformación de las grapas, tiende a forzar algo de fluido tisular distalmente y radialmente hacia afuera, lo que reduce la probabilidad de desplazamiento hidráulico de las grapas durante su deformación. La utilización de un miembro de cierre o similar que se sujeta a medida que se traslada a lo largo del miembro de herramienta ayuda a compensar el flujo de fluido y/o desde el interior del tejido y/o el corrimiento del extremo distal del yunque y, de esta manera, mantiene el espacio deseado del tejido entre el yunque y el conjunto de cartucho.
En otra modalidad preferida como la que se muestra en la figura 14, el miembro de cierre 132 incluye bridas superiores e inferiores 136a, 136b separadas y unidas a una porción intermedia 132a. Como en la modalidad anterior, el miembro de cierre 132 se coloca preferiblemente a una distancia proximal del elemento deslizante 140 parcialmente dentro de un cartucho 118 del conjunto de cartucho 116. Una hoja de cuchilla 134 se coloca preferiblemente en la porción intermedia 132a del miembro de cierre 132 para realizar una incisión en el tejido sujetado. La hoja de cuchilla 134 puede ser trabajada a máquina directamente en una sección de la porción intermedia 132a o puede estar unida de manera fija o desmontable a la porción intermedia 132a. Alternativamente, la hoja de cuchilla 134 puede ser formada como parte del elemento deslizante 140 o puede asegurarse de manera fija o desmontable al elemento deslizante 140. Las bridas superiores e inferiores 136a, 136b son generalmente estructuras arqueadas con curvaturas sustancialmente idénticas. Alternativamente, la curvatura de las bridas superior e inferior 136a, 136b puede diferir para proporcionar un soporte de estructura mayor o menor. Cada brida 136a, 136b incluye además una superficie interna 135a, 135b y una superficie externa 137a, 137b. Preferiblemente, el miembro de cierre 132 se construye de modo que las superficies internas 135a, 135b queden de frente entre sí. Las bridas superior e inferior 136a, 136b funcionan para definir la separación máxima de tejido entre el yunque y las superficies de los cartuchos.
En una modalidad preferida, el conjunto de cartucho 116 incluye una pluralidad de ranuras de retención 122 dispuestas a lo largo de un eje longitudinal de la carcasa del cartucho 118. Como se muestra en la figura 15, las ranuras de retención 122 están dispuestas para formar el primer y segundo grupos 124, 126. Preferiblemente, cada grupo 124, 126 incluye tres filas de ranuras de retención 122 configuradas de tal manera que al menos una de las filas está desplazada longitudinalmente de las filas restantes. Se prefiere además que al menos dos filas de ranuras de retención 122 estén dispuestas en cada grupo 124, 126 del conjunto de cartucho 118 de modo que cada ranura de retención 122 de una fila interna se encuentre en alineación longitudinal sustancial con una ranura de retención 122 correspondiente en la fila exterior y la fila intermedia de las ranuras de retención 122 está desplazada longitudinalmente de las filas interiores y exteriores. Por lo tanto, las filas internas y externas de las ranuras de retención 122 se alinean longitudinalmente desde la ubicación más proximal hasta la ubicación más distal de la carcasa del cartucho 118. Preferiblemente, una ranura de retención 122 en las filas interiores y exteriores define la ranura de retención más proximal y más distal. Como se describe, la posición ventajosa de las ranuras de retención 122 mejora la fijación del tejido y minimiza el sangrado.
Con referencia a las Figuras 16A-17B, se ilustran modalidades adicionales del elemento deslizante 140 y del miembro empujador 150. El miembro empujador 150 incluye una porción de base 152. En las figuras 16A, el elemento deslizante 140 se ha avanzado longitudinalmente en la carcasa del cartucho 118 y comienza a acoplarse a la base 152 del miembro empujador 150. A medida que el elemento deslizante 140 avanza en una dirección longitudinal (figura 16B), la base 152 del miembro empujador 150 se acopla en las cuñas de leva verticales 144 del elemento deslizante 140. El movimiento longitudinal del elemento deslizante 140 transfiere las fuerzas motrices longitudinales a lo largo de las cuñas de leva 144 y, de esta manera, a los miembros empujadores 150. Preferiblemente, los miembros empujadores 150 se encuentran en una relación fija con el movimiento longitudinal del elemento deslizante 140 y se mueven sustancialmente de manera ortogonal respecto al eje longitudinal del conjunto de cartucho 118, transfiriendo así las fuerzas motrices a la parte posterior 162 de la grapa 160 para mover la grapa 160 a través de la ranura de retención 122. En una modalidad preferida, como se ilustra en la figura 17a , las cuñas de leva 144 del elemento deslizante 140 se acoplan a una cavidad 154 en el miembro empujador 122. La cavidad 154 está configurada y adaptada para el acoplamiento deslizante de la cuña de leva 144. Una vez que la cuña de leva 144 acopla en la cavidad 154, el movimiento longitudinal adicional del elemento deslizante 140 actúa para mantener el miembro empujador 150 en una alineación vertical sustancial con el eje longitudinal. Configurado de este modo, una vez acoplado por el elemento deslizante 140, el miembro empujador 150 mantiene su relación sustancialmente ortogonal con el eje longitudinal a medida que se mueve a través de la ranura de retención 122. Alternativamente, el miembro empujador 150a puede configurarse para permanecer con un espacio 146a entre las cuñas de leva 144a del elemento deslizante 140a como se muestra en la figura 17B. Como en la modalidad anterior, la base 152a del miembro empujador 150a está configurada y adaptada para un acoplamiento deslizante con el espacio 146a del elemento deslizante 140a. Aún más, mientras el miembro empujador 150a se acopla a la cuña de leva 144a del elemento deslizante 140a, el miembro empujador 150a mantiene su relación sustancialmente ortogonal con el eje longitudinal a medida que se mueve a través de la ranura de retención 122.
Se comprenderá que pueden realizarse diversas modificaciones a las modalidades descritas en este documento. Por ejemplo, aunque el conjunto de herramienta se describe exclusivamente como un dispositivo de grapado, se puede utilizar para aplicar sujetadores en vez de grapas, incluidos los sujetadores de dos partes. Por lo tanto, la descripción anterior no debe interpretarse como limitante, sino simplemente como ejemplos de modalidades preferidas. Los expertos en la técnica prevén otras modificaciones dentro del alcance de las reivindicaciones adjuntas.
La descripción incluye los siguientes párrafos numerados.
1. Un conjunto de herramienta que comprende:
un yunque y un conjunto de cartucho, el conjunto de cartucho tiene una pluralidad de sujetadores y es móvil en relación con el yunque entre una posición separada y una posición aproximada, el conjunto de cartucho y el yunque definen un espacio de tejido en la posición aproximada;
un miembro de sujeción que se puede mover desde una posición retraída hasta una posición avanzada para mover el conjunto de cartucho en relación con el yunque desde la posición separada hasta la posición aproximada; y un miembro de sujeción dinámico se coloca de manera móvil en relación con el yunque y el conjunto de cartucho, el miembro de sujeción dinámico pudiéndose mover desde una posición retraída hasta una posición avanzada para expulsar la pluralidad de sujetadores desde el conjunto de cartucho; y
un miembro de accionamiento conectado de manera funcional al miembro de sujeción y al miembro de sujeción dinámico, el miembro de accionamiento formado a partir de un cable flexible y siendo móvil para mover el miembro de sujeción y el miembro de sujeción dinámico entre sus posiciones retraída y avanzada.
2. Un conjunto de herramienta de acuerdo con el párrafo 1, en donde el miembro de accionamiento incluye un cable de accionamiento coaxial, el cable de accionamiento coaxial incluye una envoltura exterior y una barra central.
3. Un conjunto de herramienta de acuerdo con el párrafo 2, en donde la barra central se mueve en relación con la barra central.
4. Un conjunto de herramienta de acuerdo con el párrafo 2, en el que la barra central se mueve axialmente con respecto a la envoltura exterior.
5. Un conjunto de herramienta de acuerdo con el párrafo 2, en donde la barra central es giratoria en relación con la envoltura exterior.
6. Un conjunto de herramienta de acuerdo con cualquiera de los párrafos 2-5, en donde la envoltura exterior está conectada de manera funcional al miembro de sujeción.
7. Un conjunto de herramienta de acuerdo con cualquiera de los párrafos 2 a 6, en donde la barra central está conectada de manera funcional al miembro de sujeción dinámico.
8. Un conjunto de herramienta de acuerdo con cualquiera de los párrafos 1-7 anteriores, en donde el conjunto de herramienta está asegurado de manera giratoria a una porción del cuerpo.
9. Un conjunto de herramienta de acuerdo con el párrafo 8, en donde el conjunto de herramienta está conectado de manera funcional a un miembro de collar y el miembro de collar está asegurado de manera giratoria a la porción del cuerpo.
10. Una grapadora con conjunto de herramienta de acuerdo con el párrafo 9, en donde el conjunto de herramienta está montado de manera giratoria en el miembro de collar.
11. Un conjunto de herramienta de acuerdo con cualquiera de los párrafos 2 a 10, en donde la barra central del cable coaxial está conectada de manera funcional al miembro de sujeción dinámico de tal manera que la rotación de la barra central efectúa la rotación del miembro de sujeción dinámica, el cual efectúa la rotación del conjunto de herramienta.
12. Un conjunto de herramienta de acuerdo con cualquiera de los párrafos 1-11 anteriores en donde el miembro de sujeción dinámico incluye una primera porción de brida colocada para acoplar con una superficie del yunque y una segunda porción de brida colocada para acoplar con una superficie del conjunto de cartucho, las porciones primera y segunda de la brida están colocadas para definir un espacio de tejido máximo durante el movimiento del miembro de sujeción dinámico desde su posición retraída hasta su posición avanzada.
13. Un conjunto de herramienta de acuerdo con cualquiera de los párrafos 1-12 anteriores en donde el miembro de sujeción es anular y cuando se coloca alrededor de un extremo proximal del yunque y del conjunto de cartucho y está en su posición avanzada, el miembro de sujeción define un espacio máximo de tejido en un extremo proximal del conjunto de herramienta.
14. Un conjunto de herramienta de acuerdo con el párrafo 2, en donde la barra central está formada a partir de un cable flexible enrollado.
15. Un conjunto de herramienta de acuerdo con el párrafo 2, en donde la envoltura exterior se selecciona del grupo que consiste en una malla de acero, plástico, nitonol y Kevlar.
16. Un conjunto de herramienta de acuerdo con el párrafo 1, que incluye además una hoja de cuchilla asociada con el miembro de sujeción dinámico.
17. Un conjunto de herramienta de acuerdo con el párrafo 14, en donde la hoja de cuchilla se forma en el miembro de sujeción dinámico.
18. Un conjunto de herramienta de acuerdo con cualquiera de los párrafos 2 a 17, en donde el conjunto de herramienta incluye un collar de accionamiento y la envoltura exterior está unida al collar de accionamiento.
19. Un conjunto de herramienta para ser utilizado con una grapadora quirúrgica que comprende:
un yunque;
un conjunto de cartucho que tiene al menos una grapa, el conjunto de cartucho se mueve en relación con el yunque entre posiciones separadas y aproximadas;
un miembro de sujeción colocado de manera adyacente a un extremo proximal del conjunto de herramienta, el miembro de sujeción se puede mover desde una posición retraída hasta una posición avanzada para mover el yunque y el conjunto de cartucho a la posición aproximada; y
un miembro de sujeción dinámico colocado dentro del conjunto de herramienta y que se mueve desde una posición retraída a través del conjunto de herramienta hasta una posición avanzada para expulsar las grapas desde el conjunto de cartucho, el miembro de sujeción dinámico incluye una porción de la brida superior que se acopla a una superficie del yunque y una porción de la brida inferior que se acopla a una superficie del conjunto de cartucho, al menos una de las porciones de la brida superior e inferior tiene una sección transversal arqueada a lo largo de un eje transversal respecto al eje longitudinal del conjunto de cartucho.
20. Un conjunto de herramienta de acuerdo con el párrafo 19, que incluye además una hoja de cuchilla asociada con el miembro de sujeción dinámico.
21. Un conjunto de herramienta de acuerdo con el párrafo 19 o 20, en donde la hoja de cuchilla se forma en una porción central del cuerpo del miembro de sujeción dinámico.
22. Un conjunto de herramienta de acuerdo con cualquiera de los párrafos 19 a 21, en donde el conjunto de cartucho incluye un elemento deslizante y un empujador asociados cada uno como mínimo con una grapa, el elemento deslizante se acciona a través del miembro de cierre para acoplarse con el empujador para impulsar el empujador hacia el acoplamiento con al menos una grapa para expulsar la grapa desde el conjunto de cartucho.
23. Un conjunto de herramienta de acuerdo con el párrafo 22, en donde el conjunto de cartucho incluye una pluralidad de grapas y empujadores.
24. Un conjunto de herramienta de acuerdo con cualquiera de los párrafos 19 a 23, en donde la brida superior y la brida inferior están sustancialmente alineadas verticalmente.
25. Un conjunto de herramienta de acuerdo con cualquiera de los párrafos 20-24, en donde la hoja de cuchilla está dispuesta en la porción central del cuerpo entre las bridas superior e inferior.

Claims (8)

  1. REIVINDICACIONES
    i. Un dispositivo de grapado quirúrgico (10) para su uso con una grapadora quirúrgica que comprende:
    un conjunto de herramienta que incluye un yunque (14) y un conjunto de cartucho (16) que tiene al menos una grapa, el conjunto de cartucho se mueve en relación con el yunque entre posiciones separada y aproximada; un miembro de sujeción (20) colocado de manera adyacente a un extremo proximal del conjunto de herramienta, el miembro de sujeción se puede mover desde una posición retraída hasta una posición avanzada para mover el yunque y el conjunto de cartucho hasta la posición aproximada y evitar que el espacio entre las porciones proximales del yunque y el conjunto de cartucho exceda una distancia predeterminada;
    un miembro de sujeción dinámico (32) colocado dentro del conjunto de herramienta y que se mueve desde una posición retraída a través del conjunto de herramienta hasta una posición avanzada para mover el yunque y el conjunto de cartucho hasta la posición aproximada y expulsar las grapas desde el conjunto de cartucho, el miembro de sujeción dinámico incluye una porción de brida superior (36a) que se acopla con una superficie del yunque y una porción de brida inferior (36b) que se acopla con una superficie del conjunto de cartucho (16), al menos una de las porciones de brida superior (36a) e inferior (36b) tiene una sección transversal arqueada a lo largo de un eje transversal respecto a un eje longitudinal del conjunto de cartucho (16).
  2. 2. El dispositivo de grapado quirúrgico (10) de acuerdo a la reivindicación 1, incluye además una hoja de cuchilla (34) asociada con el miembro de sujeción dinámico (32).
  3. 3. El dispositivo de grapado quirúrgico (10) de acuerdo a la reivindicación 2, en donde la hoja de cuchilla (34) se forma en una porción central del cuerpo del miembro de sujeción dinámico (32).
  4. 4. El dispositivo de grapado quirúrgico (10) de acuerdo a la reivindicación 1, en donde el conjunto de cartucho (16) incluye un elemento deslizante (140) y un empujador (150) cada uno asociado al menos con una grapa, el elemento deslizante (140) es accionado por el miembro de sujeción dinámica (32) hacia el acoplamiento con el empujador (150) para impulsar el empujador (150) hacia el acoplamiento con al menos una grapa para expulsar la grapa desde el conjunto de cartucho (16).
  5. 5. El dispositivo de grapado quirúrgico (10) de acuerdo con la reivindicación 4, en donde la cuchilla (34) es parte del elemento deslizante (140).
  6. 6. El dispositivo de grapado quirúrgico (10) de acuerdo con la reivindicación 1, en donde el conjunto de cartucho (16) incluye una pluralidad de grapas y empujadores (150).
  7. 7. El dispositivo de grapado quirúrgico (10) de acuerdo con cualquiera de las reivindicaciones 1, en donde la brida superior (36a) y la brida inferior (36b) están sustancialmente alineadas verticalmente.
  8. 8. El dispositivo de grapado quirúrgico (10) de acuerdo con la reivindicación 2 o la reivindicación 3, en donde la hoja de cuchilla (34) está dispuesta en una porción central del cuerpo entre las bridas superior (36a) e inferior (36b).
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