ES2383252T3 - Estructuras anulares de soporte - Google Patents
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- ES2383252T3 ES2383252T3 ES10006624T ES10006624T ES2383252T3 ES 2383252 T3 ES2383252 T3 ES 2383252T3 ES 10006624 T ES10006624 T ES 10006624T ES 10006624 T ES10006624 T ES 10006624T ES 2383252 T3 ES2383252 T3 ES 2383252T3
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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
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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
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
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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
- A61B17/00491—Surgical glue applicators
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- 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
- A61B17/07292—Reinforcements for staple line, e.g. pledgets
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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
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/1114—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis of the digestive tract, e.g. bowels or oesophagus
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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
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
- A61B17/1155—Circular staplers comprising a plurality of staples
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B2017/1132—End-to-end connections
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Abstract
Una estructura de soporte rígida o semirrígida para su uso en conjunto con un instrumento de grapado endoscópico circular que tiene un montaje de cartucho de grapas con al menos una disposición anular de grapas y un montaje de pieza de choque que tiene un eje, que comprende: un anillo (200) anular rígido o semirrígido configurado y adaptado para cubrir sustancialmente la al menos una disposición anular de grapas, teniendo el anillo anular un anillo (202) radial externo, un anillo (204) radial interno y un radio (218) de soporte para soportar la estructura de soporte en el eje.
Description
Estructuras anulares de soporte.
ANTECEDENTES
Campo de la técnica
La presente descripción se refiere a estructuras anulares de soporte y, más particularmente, al anillo de refuerzo de lumen para su uso en conjunto con un instrumento de grapado endoscópico circular para mantener el lumen anastomótico resultante en un estado abierto.
Antecedentes de la técnica relacionada
Tradicionalmente se han utilizado grapas para sustituir a la sutura cuando para unir o conseguir la anastomosis de varias estructuras corporales, como, por ejemplo, el intestino o los bronquios. Los dispositivos quirúrgicos de grapado que se utilizan para aplicar estas grapas están generalmente diseñados para cortar y sellar simultáneamente un segmento extendido de tejido de un paciente, reduciendo por tanto en gran medida el tiempo y los riesgos de tales procedimientos.
Los dispositivos quirúrgicos de grapado lineal son empleados por los cirujanos para aplicar, secuencialmente o simultáneamente, una o más filas lineales de uniones quirúrgicas, por ejemplo, grapas o uniones de dos piezas, al tejido corporal para unir segmentos de tejido corporal. Tales dispositivos generalmente incluyen un par de mandíbulas o estructuras similares a dedos entre las cuales se dispone el tejido a unir. Cuando se acciona el dispositivo de grapado y/o las barras de disparo "disparadas" se desplazan longitudinalmente y contacta con los miembros de accionamiento en una de las mandíbulas, las grapas quirúrgicas son empujadas a través del tejido corporal hasta entrar/chocar contra una pieza de choque en la mandíbula opuesta, plegando así las grapas para cerrarlas. Si se debe extraer el tejido, se puede disponer una hoja de cuchillo para que corta entre las filas/líneas de grapas. Algunos ejemplos de tales instrumentos se describen en las patentes US 4,354,628, US 5,014,899 y US 5,040,715.
En la mayoría de los procedimientos, el uso únicamente de grapas, estando las grapas en contacto directo con el tejido del paciente, es generalmente aceptable. La integridad del tejido normalmente servirá para evitar que las grapas rasguen el tejido y comprometan el sellado antes de que se haya producido la cicatrización. Sin embargo, en algunas operaciones quirúrgicas, los cirujanos utilizan soportes quirúrgicos, como por ejemplo mallas, para puentear, reparar y/o reforzar defectos en los tejidos de un paciente, especialmente aquellos que se producen en la pared abdominal, la pared pectoral, el diafragma y otras áreas músculo-aponeuróticas del cuerpo. Algunos ejemplos de soportes quirúrgicos se describen en las patentes US 3,054,406, US 3,124,136, US 4,347,847, US 4,655,221, US 4,838,884 y US 5,002,551.
Cuando se aplican las grapas en una operación quirúrgica utilizado soportes quirúrgicos (es decir, material de refuerzo), las patas de la grapa típicamente pasan desde la mandíbula del cartucho a través de capas de material de refuerzo, y luego a través del tejido del paciente, antes de encontrarse la mandíbula de la pieza de choque. Cuando las grapas están en posición, el tejido grapado es sujetado entre las capas del material de refuerzo.
Aunque los soportes quirúrgicos descritos anteriormente se utilizan en conjunto con grapadoras quirúrgicas lineales, existe una necesidad de una estructura de soporte para su uso en conjunto con una grapadora quirúrgica anular, por ejemplo, una grapadora de anastomosis de extremo-a-extremo, como el Modelo “EEA®”, instrumento disponible en United States Surgical, una División de Tyco Health-Care Group, LP, Norwalk, CT y que se describe en la patente US 5,392,979 de Green et al. En general, una grapadora de anastomosis de extremo-a-extremo típicamente dispone una matriz de grapas en las secciones aproximadas de los intestinos de un paciente, u otros órganos tubulares. La anastomosis resultante contiene una sección invertida de intestino que contiene numerosas grapas con forma de “B” para mantener una conexión segura entre las secciones de intestino aproximadas.
Un posible efecto colateral de la anastomosis de intestino de extremo-a-extremo es su tendencia a estrecharse con el tiempo, pudiendo dicha estenosis disminuir el diámetro del lumen a lo largo del tiempo. En consecuencia, existe una necesidad de una estructura de apoyo quirúrgico que pueda funcionar en conjunto con un dispositivo de anastomosis de extremo-a-extremo y ayudar a mantener abierto a lo largo del tiempo el lumen del intestino u otro órgano tubular con anastomosis.
El documento DE 19924311 describe una estructura en forma de anillo para su uso con una grapadora quirúrgica. La estructura de anillo comprende un anillo de colágeno y/o material de fibrina a la que se conecta un anillo de material elástico. El anillo de material elástico está formado de tal forma que pueda ser empujado por encima de los bordes periféricos de un cabezal de grapado y/o placa de presión de grapado.
COMPENDIO
La presente invención está definida por la reivindicación 1, mientras que ciertas realizaciones preferidas son definidas en las reivindicaciones dependientes.
La presente aplicación está dedicada en parte a estructuras de soporte configuradas y adaptadas para su uso en conjunto con un instrumento quirúrgico de grapado que tiene un montaje de cartucho de grapas y un montaje de pieza de choque. Las estructuras de soporte son rígidas o semirrígidas, y están adaptadas para mantener un lumen anastomotico resultante, formado por medio del aparato de grapado circular, en un estado abierto.
En una realización preferida, la estructura de soporte incluye un anillo anular rígido configurado y adaptado para recubrir al menos una disposición anular de grapas del montaje de cartucho de grapas. El anillo anular puede incluir una pared anular externa con un diámetro, una pared anular interna separada una distancia radial hacia dentro de la pared anular externa y que define un espacio, una pared superior que interconecta la pared anular externa y la pared anular interna, y una pared inferior separada una distancia de la pared superior y que interconecta la pared anular externa y la pared anular interna. La pared anular externa, la pared anular interna, y las paredes superior e inferior definen un depósito interno. La estructura de soporte incluye además un material de cierre de herida retenido dentro del depósito.
El diámetro de la pared anular externa es preferiblemente sustancialmente igual que un diámetro externo del montaje de cartucho de grapas y el diámetro de la pared anular interna es radialmente interior con relación a la al menos una disposición anular de grapas.
El anillo anular puede tener un perfil de sección transversal circular, rectilínea, ovalada, triangular y arqueada.
La estructura de soporte además incluye un radio de soporte conectado y que se extiende diametralmente a lo largo de la pared anular interna. Se prevé que el montaje de pieza de choque incluya un eje alargado. El radio de soporte incluye un núcleo central que tiene una abertura axial central formada a través del mismo, de modo que la abertura axial central está configurada y dimensionada para recibir el eje del montaje de pieza de choque a través de la misma.
Preferiblemente, el material de cierre de herida es al menos uno de entre un adhesivo, un material hemostático, y un material sellante. El adhesivo puede incluir materiales de albúmina/gluteraldehído, materiales derivados de proteínas, y materiales basados en cianoacrilatos. El material sellante puede incluir materiales basados en fibrina, materiales basados en colágeno, materiales basados en polímeros sintéticos, materiales basados en glicol polietileno sintético, y materiales de hidrogel. El material hemostático puede incluir materiales basados en fibrina, materiales basados en colágeno, materiales basados en celulosa regenerada oxidada, materiales basados en gelatina, y combinaciones de materiales basados en fibrinógeno-trombina.
Se prevé que al menos uno de entre la pared anular externa y la pared anular interna esté hecha de un material rígido. El material rígido puede incluir acero inoxidable y titanio. El material rígido puede incluir además un material bio-absorbible.
Se prevé que el anillo anular rígido pueda incluir una pluralidad de espacios intersticiales que se extienden a través del mismo, estando los espacios configurados y adaptados para permitir que las patas de las grapas pasen a través de los espacios.
El anillo anular rígido puede tener una pluralidad de miembros de orientación de cartucho adaptados para orientar los espacios de la estructura anular de soporte para que recubran radialmente y circunferencialmente las ranuras de las grapas del montaje de cartucho de grapas. Los miembros de orientación de cartucho pueden ser una pluralidad de nudos que sobresalen del mismo, estando los nudos separados uno de otro y adaptados y configurados para acoplarse a cavidades complementarias formadas en la superficie de extremo distal del montaje de cartucho de grapas.
La presente solicitud describe un ejemplo de método para reforzar un lumen anastomótico o cuerpo hueco. El método incluye el paso de cortar el cuerpo hueco en un par de secciones cortadas, insertar un montaje de pieza de choque de un aparato de grapado circular en uno del par de secciones cortadas del cuerpo hueco de modo que un eje del montaje de pieza de choque sobresalga hacia fuera de un extremo terminal de uno de entre el par de secciones cortadas, suturar el extremo terminal de uno del par de secciones cortadas alrededor del eje del montaje de pieza de choque, insertar un montaje de cartucho de grapas dentro del otro del par de secciones cortadas de modo que el extremo abierto del montaje de cartucho esté enfrentado al extremo abierto de las secciones cortadas del cuerpo hueco, suturar el extremo terminal del otro del par de secciones cortadas, proporcionar un anillo rígido de refuerzo de lumen entre el montaje de pieza de choque y el montaje de cartucho de grapas de modo que cuando se dispara el aparato circular de grapado, las grapas quirúrgicas penetran en los extremos terminales del par de secciones cortadas y el anillo de refuerzo de lumen, acoplando y aproximando el montaje de pieza de choque al montaje de cartucho de grapas, y disparando el aparato de grapado circular.
El método puede incluir además disponer el anillo de refuerzo de lumen entre los extremos terminales del par de secciones cortadas. El método puede incluir proporcionar el anillo de refuerzo de lumen entre el montaje de pieza de choque y el par de secciones cortadas. El método puede incluir proporcionar el anillo de refuerzo de lumen entre el montaje de cartucho de grapas y el otro del par de secciones cortadas. Preferiblemente, el anillo de refuerzo de lumen está alineado centralmente con el montaje de pieza de choque y el montaje de cartucho de grapas.
El método puede incluir además el paso de orientar y alinear el anillo de refuerzo de lumen con el montaje de cartucho de grapas. El anillo de refuerzo de lumen incluye espacios intersticiales definidos por una pluralidad de patas que se extienden sustancialmente en dirección radial, donde una pluralidad de las patas atraviesan preferiblemente una porción central de una pluralidad de ranuras de grapas del montaje de cartucho de grapas.
Es un objeto de la presente invención proporcionar una estructura de soporte, en forma de anillo, para reforzar o proporcionar una mayor integridad estructural a un lumen anastomótico.
Es un objeto adicional de la presente descripción proporcionar un anillo de refuerzo de lumen que evite o suprima la incidencia de estenosis en, o a lo largo de, el lugar de la anastomosis.
Es otro objeto de la presente descripción proporcionar un anillo de refuerzo de lumen configurado y adaptado para recibir las grapas disparadas de un aparato endoscópico de grapado circular.
Estos y otros objetos se ilustrarán más claramente más adelante por medio de la descripción de los dibujos y de la descripción detallada de realizaciones preferidas.
BREVE DESCRIPCIÓN DE LAS FIGURAS
Únicamente a modo de ejemplo, se describirán realizaciones preferidas de la descripción haciendo referencia a las figuras adjuntas, en las que:
La FIG. 1 es una vista en perspectiva ampliada, con porciones quitadas, de un extremo distal de un aparato de grapado anular circular que ilustra la posición de una estructura de soporte entre la pieza de choque y el cartucho de grapas del aparato de grapado;
La FIG. 2 es una vista de una sección transversal en alzado de un par de intestinos aproximados con anastomosis y que incluye la estructura de soporte de acuerdo con la FIG. 1 grapada a una superficie de extremo de los mismos;
La FIG. 3 es una vista superior en planta de una estructura de soporte de acuerdo con una realización de la presente descripción;
La FIG. 4 es una vista de alzado de una sección transversal lateral, con porciones quitadas, de las porciones de extremo de un intestino, que ilustra la colocación de porciones de un aparato de grapado circular dentro de las porciones de extremo de los intestinos antes de la aproximación, y de la estructura de soporte de la FIG. 3 alrededor de un eje de la pieza de choque entre las porciones de extremo del intestino;
La FIG. 5 es una vista de alzado de una sección transversal lateral de las porciones de extremo de los intestinos de la FIG. 4, después de que se haya llevado a cabo la anastomosis y el grapado con la estructura de soporte de la FIG. 3 entre ellos;
La FIG. 6 es una vista superior en planta de una realización alternativa de una estructura de soporte que no está de acuerdo con la presente invención;
La FIG. 7 es una vista de alzado de una sección transversal lateral de la estructura de soporte de la FIG. 6, tomada a lo largo de la línea A-A;
La FIG. 8 es una vista de alzado de una sección transversal lateral de una realización alternativa de la estructura de soporte de la FIG. 6, como se vería a lo largo de la línea A-A;
La FIG. 9 es una vista superior en planta de una realización alternativa de una estructura de soporte de acuerdo con la presente descripción;
La FIG. 10 es una vista de alzado de una sección transversal lateral de una realización alternativa de la estructura de soporte mostrada en la FIG. 9, tomada a lo largo de la línea B-B;
La FIG. 11 es una vista superior en planta de otra realización más de una estructura de soporte que no está de acuerdo con la presente descripción;
La FIG. 12 es una vista superior en planta de otra realización más de una estructura de soporte que no está de acuerdo con la presente descripción, que se muestra dispuesta en una posición superpuesta sobre la superficie de extremo distal del cartucho de grapas;
La FIG. 13 es una vista de una sección transversal a través de la sección C-C de la FIG. 12;
La FIG. 14 es una vista de una sección transversal a través de la sección D-D de la FIG. 12;
La FIG. 15 es una vista superior en planta de otra realización más de una estructura de soporte que no está de acuerdo con la presente descripción;
La FIG. 16 es una vista superior en planta de otra realización más de una estructura de soporte que no está de acuerdo con la presente descripción;
La FIG. 17 es una vista en perspectiva de otra realización de una estructura de soporte que no está de acuerdo con la presente descripción; y
La FIG. 18 es una vista de una sección transversal a través de E-E de la FIG. 17.
DESCRIPCIÓN DETALLADA DE REALIZACIONES PREFERIDAS
A continuación se describirán con mayor detalle realizaciones preferidas y ejemplares de la estructura de soporte descrita haciendo referencia a las figuras, en las que números de referencia similares identifican elementos similares
o idénticos.
Haciendo referencia inicialmente con detalle a la FIG. 1, se muestra en general como 100 un ejemplo de estructura quirúrgica de soporte de grapado en forma de un anillo de refuerzo de lumen que no está de acuerdo con una realización de la presente invención. El anillo 100 de refuerzo incluye un anillo 102 anular definido por un borde 104 terminal externo, un borde 106 terminal interno, una superficie 108 superior y una superficie 110 inferior. El borde 106 terminal interior del anillo 100 de refuerzo define una abertura 112 central.
Como se aprecia en la FIG. 1, el anillo 100 de refuerzo coopera con un aparato 10 de grapado circular. El aparato 10 de grapado incluye un cuello 12 alargado con un montaje 14 de cartucho de grapas operativamente acoplado a un extremo del mismo, y un montaje 16 de pieza de choque configurado y adaptado para acoplarse, de manera extraíble, al extremo distal del montaje 14 de cartucho de grapas. El montaje 14 de cartucho de grapas está configurado y adaptado para expulsar una matriz anular de grapas 20 (ver FIG. 2) desde su extremo distal. Preferiblemente, el montaje 14 de cartucho de grapas incluye una pluralidad de filas anulares de ranuras 18 de grapa que tienen grapas en su interior. El montaje 16 de pieza de choque incluye un eje 22 que está adaptado para montarse, de manera extraíble, en un montaje 14 de cartucho de grapas y una pieza 24 de choque que está montada sobre el eje 22 y está orientada para su posicionamiento en dirección al extremo distal del montaje 14 de cartucho de grapas. La pieza 24 de choque está dotada de una matriz anular de cavidades 19 de formación de grapas (ver FIG. 13), que se corresponden con las filas anulares y el número de ranuras 18 de grapa, estando las cavidades configuradas y adaptadas para formar grapas 20, por ejemplo, en forma de B, cuando éstas son expulsadas desde el montaje 14 de cartucho de grapas.
El anillo 100 de refuerzo está fijado, de manera que se puede liberar, bien al montaje 16 de pieza de choque o bien al montaje 14 de cartucho de grapas. Alternativamente, el montaje 16 de pieza de choque y el montaje 14 de cartucho de grapas pueden tener ambos un anillo 100 de refuerzo dispuesto en los mismos (no mostrado) para
proporcionar un tejido/soporte tipo “sándwich” cuando se acciona y/o dispara el aparato 10 de grapado.
La unión del anillo 100 de refuerzo al aparato 10 de grapado circular debería ser lo suficientemente segura como para evitar que el anillo 100 de refuerzo se desliza fuera del aparato 10 de grapado, y a la vez no tan fuerte como para impedir la separación del anillo 100 de refuerzo del dispositivo 10 de grapado después de que se haya accionado el dispositivo 10 de grapado. Dicha unión que se puede liberar se puede llevar a cabo ventajosamente utilizando una pluralidad de pasadores como los descritos en la patente estadounidense de titularidad común US 5,542,594, cuyo contenido completo se incorpora al presente documento por referencia. También se contempla que se pueda utilizar un adhesivo, por ejemplo, un adhesivo que se pueda liberar, o una pluralidad de clips separados longitudinalmente (no se muestran en el presente documento), como los medios para fijar el anillo 100 de refuerzo al aparato 10 de grapado. También se puede utilizar una combinación de pasadores, clips y/o adhesivo(s). El número y ubicación precisos de los pasadores y/o clips o la cantidad o colocación de los puntos o líneas de adhesivos no es crítica siempre que el anillo 100 de refuerzo se fije de manera liberable al aparato 10 de grapado.
Haciendo referencia a las FIGS. 1 y 2, se describirá el método preferido de utilizar la estructura 100 de soporte en una operación quirúrgica de anastomosis. Después de haber cortado el órgano hueco del paciente (por ejemplo, el intestino), se inserta el montaje 16 de pieza de choque en un extremo de una sección cortada del intestino, utilizando
técnicas quirúrgicas conocidas, de modo que el eje 22 se extienda hacia fuera del extremo abierto del intestino “B”.
Preferiblemente, el montaje 16 de pieza de choque se fija en su lugar en el extremo libre del intestino utilizando una sutura de tipo bolsa de tabaco para disponer el extremo del órgano hueco alrededor del eje 22. El montaje 14 de cartucho de grapas del aparato 10, que tiene el anillo 100 de refuerzo acoplado operativamente a la superficie distal del mismo, se inserta bien en otro área del intestino "B" que tenga una incisión o en otra abertura del paciente, y el extremo libre de la otra sección de intestino se sutura con un tipo de sutura de bolsa de tabaco dejando una pequeña abertura para el paso del eje 22 a través del mismo.
El eje 22 es hecho pasar a través de la pequeña abertura y se acopla operativamente al montaje 14 de cartucho de grapas y el montaje 16 de pieza de choque es impulsada en dirección al montaje 14 de cartucho de grapas. Cuando la distancia entre el montaje 14 de cartucho de grapas y el montaje 16 de pieza de choque ha alcanzado un valor adecuado para la anastomosis, se acciona o dispara el aparato 10 de grapado. Cuando se dispara el aparato 10, las grapas 20 son expulsadas del montaje 14 de cartucho de grapas, de modo que sus patas pasan a través del anillo 100 de refuerzo, a través de ambas capas de intestinos unidas por una sutura de tipo bolsa de tabaco, y chocan con las cavidades de deformación de la pieza de choque. Al mismo tiempo, el exceso de tejido situado radialmente hacia dentro de la línea de grapado más interna es cortado por medio de una hoja cilíndrica (no mostrada).
La anastomosis resultante tendrá una estructura de soporte anular (es decir, el anillo 100 de refuerzo) en el lugar de la conexión grapada. El anillo 100 de refuerzo da a la anastomosis más integridad estructural al proporcionar de manera efectiva una "columna vertebral” que ayuda a mantener el lumen abierto en el lugar de la anastomosis.
Se contempla que el anillo 100 de refuerzo rígido pueda estar hecho o comprender una malla de tipo quirúrgico. La malla permitiría que las patas de las grapas 20 pasaran libremente a través del anillo 100 de refuerzo y entrasen en el tejido corporal adyacente del órgano hueco del cuerpo. También se contempla que el anillo 100 de refuerzo esté
hecho de un material biocompatible no absorbible (es decir, permanente), como, por ejemplo, “TEFLON”, que es una
marca registrada de DuPont de Nemours, o un material absorbible biocompatible. Los materiales biocompatibles pueden estar tejidos, hechos con tejido de punto, o no tejidos. Los materiales bio-absorbibles incluyen aquellos fabricados a partir de homopolímeros, copolímeros, o mezclas obtenidas a partir de uno o más monómeros seleccionados del grupo consistente en glicolida, ácido glicólico, lactida, ácido láctico, p-dioxanona, α-caprolactona y carbonato trimetileno. Los materiales no-absorbibles incluyen aquellos fabricados a partir de polímeros tales como polietileno, polipropileno, nylon, tereftalato de polietileno, politetrafluoroetileno, fluoruro de polivinilideno, y similares. Otros materiales no absorbibles incluyen, aunque no se limitan a los mismos, acero inoxidable, titanio y similares. Es preferido que la estructura anular de soporte sea o comprenda una malla y es preferido que la malla comprenda titanio biocompatible y que sea rígida al menos para evitar la estenosis radial hacia dentro del anillo 100 de refuerzo. Como se describirá más adelante con mayor detalle, la malla permite que las patas de las grapas pasen a través del plano de la estructura de soporte a la vez que la parte posterior abarca una pluralidad de grapas que se enganchan a un hilo o hilos de la malla y no pasan a través del miembro de soporte anular.
También se contempla que el anillo 100 de refuerzo esté hecho o comprenda un material bio-absorbible de tipomédico, como por ejemplo Ácido Poliglicólico (PGA) y Ácido Poliláctico (PLA). Por ejemplo, es preferible que el anillo 100 de soporte permanezca en su lugar durante aproximadamente 2-3 semanas para que la anastomosis haya sanado lo suficiente antes de que el anillo 100 sea absorbido por el cuerpo.
También se contempla que el anillo 100 de refuerzo pueda actuar como una barrera de adhesión, agente hemostático, refuerzo, acelerador de crecimiento del tejido, y similares. Además, se entiende que el anillo 100 de refuerzo puede tener incorporado en el mismo y/o sobre el mismo una o más sustancias quirúrgicamente y/o médicamente útiles, como fármacos, enzimas, factores de crecimiento, péptidos, proteínas, tintes, agentes de diagnosis o agentes de hemostasis, o cualquier otro fármaco utilizado en la prevención de la estenosis.
Pasando ahora a las FIGS. 3-5, se muestra generalmente como 200 una realización de una estructura de soporte en forma de anillo de refuerzo de lumen de acuerdo con la presente descripción. El anillo 200 de refuerzo incluye un anillo 202 radial externo, un anillo 204 radial interno, y un radio 218 de soporte. El anillo 202 radial externo incluye una superficie 206 terminal exterior, una superficie 208 terminal interior, una superficie 210 superior y una superficie 212 inferior, respectivamente, que definen un perfil de sección rectangular, como se muestra en la FIG. 5. Aunque se muestra un perfil rectangular, se prevé que el anillo 202 radial externo pueda tener cualquier perfil de sección transversal, como, por ejemplo, circular, ovalado, triangular, arqueado, etc. En una realización preferida, el anillo 202 radial exterior está hecho de un material rígido o, menos preferiblemente, semirrígido que bien es bioabsorbible o no-bioabsorbible.
El anillo 200 de refuerzo incluye también un anillo 204 radial interno que se extiende desde una superficie 208 terminal interior del anillo 202 radial exterior y que termina en un borde 214 terminal interior. El borde 214 terminal interno del anillo 200 de refuerzo tiene una abertura 216 central. Se contempla que el anillo 204 radial interior esté hecho o comprenda un material rígido o semirrígido que es bien bioabsorbible o bien no bio-absorbible. Aunque se contempla un material no rígido, como una malla quirúrgica integralmente formada como un anillo 202 anular exterior, es preferible que el anillo 204 radial interior esté hecho de un material rígido o semirrígido para que se pueda fijar el radio 218 de soporte al mismo con seguridad.
Preferiblemente, el anillo 202 radial externo tiene un diámetro interno ligeramente mayor que un diámetro externo del montaje 14 de cartucho de grapas. De este modo, la estructura 200 de soporte puede asentarse en el extremo distal del montaje 14 de cartucho de grapas, de modo que el anillo 204 radial interno se apoye sobre la superficie de extremo distal del montaje 14 de cartucho de grapas. Preferiblemente, el anillo 204 radial interno tiene una extensión radial o anchura que es suficiente como para al menos extenderse por la pluralidad de filas de grapas 18 del montaje 14 de cartucho de grapas. De este modo, cuando se disparan las grapas 20 fuera del montaje 14 de cartucho de grapas, las patas de las grapas 20 pasarán a través del anillo 204 radial interno.
El anillo 200 de refuerzo incluye además un radio 218 de soporte que tiene un núcleo 220 central dotado de una abertura 216 central. Preferentemente, el núcleo 220 central y la abertura 216 central comparten un eje central común. El núcleo 220 central tiene una abertura 222 central que se extiende a través del mismo, donde la abertura 222 central tiene un tamaño suficiente como para permitir a través del mismo el paso del eje 22 del montaje 16 de pieza de choque. El radio 218 de soporte preferiblemente se extiende diametralmente a través del anillo 200 de refuerzo e incluye un núcleo 220 central. Preferiblemente, los brazos 224 de soporte están unidos al borde 214 terminal interno de tal modo que la disposición 218 del radio de soporte puede romperse y ser extraída de la estructura 200 de soporte. Aunque se han mostrado y descrito un par de brazos 224 de soporte, se contempla, y por tanto está dentro del ámbito de la presente descripción, que se pueda disponer cualquier número de brazos.
Haciendo referencia a las FIGS. 4 y 5, se describirá a continuación el método preferido de uso de un anillo 200 de refuerzo, en una operación quirúrgica de anastomosis. Después de cortar el órgano hueco del paciente (es decir, el intestino), se inserta el montaje 16 de pieza de choque en un extremo de la sección cortada del intestino, utilizando técnicas quirúrgicas conocidas, de modo que el eje 22 sobresale hacia fuera del extremo del intestino "B". El montaje 16 de pieza de choque preferiblemente se fija en su posición en el extremo del intestino utilizando una sutura de tipo bolsa de tabaco para enrollar el extremo del órgano hueco alrededor del eje 22. La estructura 200 de soporte se coloca entonces sobre el eje 22 de modo que el eje 22 es alimentado a través de una abertura 222 central del núcleo 220 central de radio 218 de soporte. El montaje 14 de cartucho de grapas del aparato 10 se inserta entonces en bien otro área perforada del intestino o bien una abertura del paciente, y el otro extremo de la sección cortada del intestino se sutura con una sutura de tipo bolsa de tabaco, dejando una pequeña abertura para el paso del eje 22 a través del mismo, como se observa en la FIG. 4.
El eje 22 pasa a través de la pequeña abertura y se acopla operativamente al montaje 14 de cartucho de grapas, y el montaje 16 de pieza de choque es impulsado en dirección al montaje 14 de cartucho de grapas. Cuando la distancia entre el montaje 14 de cartucho de grapas y el montaje 16 de pieza de choque ha alcanzado un valor adecuado para la anastomosis, se dispara el aparato 10 de grapado. Cuando el aparato 10 es disparado, se expulsan grapas 20 del montaje 14 de cartucho de grapas, de modo que sus patas pasan a través de una primera capa del tejido intestinal, a través del anillo 204 anular interno y a través de una segunda capa de tejido intestinal. Las patas de las grapas 20 se doblan contra las cavidades 19 de formación de la pieza de choque. Al mismo tiempo, el exceso de tejido que sobresale radialmente hacia dentro de la línea de grapado más interna, así como los brazos 224 de soporte diametralmente opuestos, son cordados con una hoja cilíndrica (no mostrada), lo que da como resultado un lumen intestinal como el de la FIG. 5.
El anillo 200 de refuerzo ayuda a mantener el lumen del órgano hueco (es decir, intestino) abierto a lo largo del tiempo y a contrarrestar los efectos de la estenosis. Con el anillo 204 radial interno fijado al órgano hueco de la anastomosis, el anillo 206 radial interno actúa como un refuerzo para evitar el colapso del órgano hueco con anastomosis debido a la estenosis. En otras palabras, como el órgano hueco del cuerpo está anclado al anillo 204 radial interno del anillo 200 de refuerzo, a medida que el órgano hueco del cuerpo tiende a retraerse radialmente hacia dentro debido a la estenosis, el anillo 200 de refuerzo retiene su forma (es decir, contrarresta de manera efectiva el empuje radial hacia dentro del órgano hueco del cuerpo), manteniendo así abierto el lumen a través del órgano hueco del cuerpo.
Volviendo ahora a las FIGS. 6-8, se muestra en general como 300 un ejemplo de realización de una estructura de soporte en forma de un anillo de refuerzo de lumen de acuerdo con la presente descripción. El anillo 300 de refuerzo incluye un anillo 302 anular que tiene una sección transversal rectangular, como se observa en la FIG. 7. Cuando se utiliza una estructura de soporte que tiene una sección rectangular, se prevé que una grapadora quirúrgica tenga un borde anular externo, sobresaliendo un borde anular interno o ambos del extremo distal del mismo (no mostrado). En consecuencia, los bordes anulares interno y/o externo aseguran que el anillo 300 de refuerzo esté adecuadamente asentado sobre el extremo de la grapadora 10 quirúrgica.
Aunque en la FIG. 7 se muestra una sección transversal generalmente rectangular, se prevé que el anillo 302 anular del anillo 300 de refuerzo tenga un perfil de sección transversal generalmente triangular, como se aprecia en la FIG.
8. Preferiblemente, se utiliza una estructura de soporte que tenga una sección transversal de perfil triangular en conjunto con un montaje de cartucho de grapas que tenga una superficie distal que se estrecha para cooperar y complementarse con una superficie que se estrecha del anillo 300 de refuerzo, así como que tenga una pieza de choque que tenga una superficie proximal que se estrecha para cooperar y complementarse con la superficie opuesta de la estructura de soporte a utilizar. En consecuencia, a medida que el montaje de pieza de choque es impulsado en dirección al montaje de cartucho de grapas, las superficies que se estrechan cooperan una con la otra para provocar que la estructura de soporte se auto-alinee centralmente de manera automática en el extremo de la grapadora quirúrgica.
Preferiblemente, como se aprecia en la FIG. 8, el anillo 302 anular tiene un grosor mayor que el borde terminal externo y un menor grosor en el borde terminal interno del mismo. Sin embargo, se prevé que la estructura de soporte pueda tener un anillo anular en el que el borde terminal interno tiene un grosor mayor que el borde terminal externo.
Haciendo referencia ahora a las FIGS. 9 y 10, se muestra en general como 400 una realización alternativa de una estructura de soporte en forma de anillo de refuerzo de lumen de acuerdo con la presente descripción. El anillo 400 de refuerzo incluye un anillo 402 radial que tiene una pared 404 radial externa, una pared 406 radial interna y una pared superior e inferior 408 y 410, respectivamente, que interconectan la pared 404 radial externa y la pared 406 radial interna. La pared 406 radial interna tiene una abertura 416 central en la misma. La pared 404 radial externa, la pared 406 radial interna, la pared 408 superior y la pared 410 inferior definen un depósito 412. Preferiblemente, las paredes 408 y 410 superior e inferior tienen una anchura que es al menos igual o ligeramente mayor que la anchura de la pluralidad de filas de grapas 20 del montaje 14 de cartucho de grapas.
En una realización preferida, el depósito 412 retiene una cantidad de adhesivo biológico en su interior. Aunque se ha descrito que un adhesivo biológico está retenido dentro del depósito 412, se prevé que el depósito 412 pueda
retener cierto tipo de material “W” de cierre de heridas en su interior. Se prevé que el material “W” de cierre de
heridas pueda incluir uno o una combinación de adhesivos, material hemostático y material sellante. Materiales de cierre de heridas quirúrgicos biocompatibles que puedan retenerse dentro del depósito 412 incluyen adhesivos cuya función es unir o sujetar órganos, tejidos o estructuras, material sellante para evitar la pérdida de fluidos, y material hemostático para detener o evitar el sangrado. Ejemplos de adhesivos que se pueden emplear incluyen derivados de proteínas, materiales adhesivos basados en aldehídos, por ejemplo los materiales de albúmina/glutaraldehído que están comercialmente disponibles a la venta bajo la marca BioGlue® de Cryolife, y materiales basados en cianoacrilatos que se venden bajo la marca Indermil® y Derma Bond ® de Tyco Healthcare Group, LP y Ethicon Endosurgery, respectivamente. Ejemplos de materiales sellantes que se pueden emplear incluyen sellantes de fibrina y sellantes de tejidos basados en colágeno y basados en polímero sintético. Ejemplos de materiales sellantes comercialmente disponibles son los materiales de hidromel, basados en polietileno glicol sintético vendidos bajo la marca CoSeal® por Cohesion Technologies y Baxter International. Ejemplos de materiales hemostáticos que se pueden emplear incluyen materiales hemostáticos tópicos basados en fibrina, basados en colágeno, basados en celulosa regenerada oxidada y basados en gelatina. Ejemplos de materiales hemostáticos comercialmente disponibles son los materiales combinados fibrinogeno-trombina vendidos bajo la marca CoStasis® de Tyco Healthcare Group y Tisseel® vendido por Baxter International. Materiales hemostáticos en el presente documento incluyen astringentes, por ejemplo, sulfato de aluminio y coagulantes.
El método preferido de uso del anillo 400 de refuerzo es similar al método de uso de la estructura 100 de soporte y sólo se describirá con el detalle necesario para identificar las diferencias entre ellos.
En consecuencia, cuando el aparato 10 es disparado, las grapas 20 son expulsadas del montaje 14 de cartucho de grapas, pasan a través de una primera capa de tejido intestinal, a través de las paredes superior e inferior 408, 410
respectivamente, liberando así el material “W” de cierre de heridas del depósito 412 del anillo 400 de refuerzo, y a
través de una segunda capa de tejido intestinal. Las patas de las grapas 20 son pliegan entonces al golpear contra las cavidades de deformación de la pieza de choque. Al mismo tiempo, el exceso de tejido que sobresale radialmente hacia dentro de la línea de grapado más interna, así como los brazos 424 de soporte diametralmente opuestos, son cortados por medio de una hoja cilíndrica (no mostrada), lo que da como resultado un lumen del intestino abierto como se aprecia en la FIG. 5.
Se prevé que el anillo 400 de refuerzo se pueda fabricar sin radio 418 de soporte. En dicha realización, el anillo 402 anular se puede configurar y dimensionar de modo que una pared 404 anular externa sea radialmente más grande que el extremo distal del montaje 14 de cartucho de grapas y una pared 406 anular interna sea radialmente más pequeña que el extremo distal del montaje 14 de cartucho de grapas. De este modo, el anillo 400 de refuerzo se configura y dimensiona para asentarse sobre el extremo distal del montaje 14 de cartucho de grapas de modo que las paredes superior e inferior 408, 410 respectivamente recubran la superficie de extremo distal del montaje 40 de cartucho de grapas.
Preferiblemente, el depósito 412 está herméticamente sellado por medio de una pata de grapa penetrable y/o material rompible, como, por ejemplo, una película o membrana delgada.
Opcionalmente, el depósito 412 puede dividirse en cualquier número de depósitos disponiendo paredes 414 de división anulares entre la pared 404 anular externa y la pared 406 anular interna. De este modo, el anillo 400 de refuerzo puede retener más de un material "W" de cierre de heridas como, por ejemplo, una combinación de un adhesivo, un astringente y/o un material hemostático.
Preferiblemente, alguna porción de la estructura de soporte de la invención, preferiblemente la pared 404 anular externa y/o la pared anular interna está fabricada de un material rígido que incluye, aunque sin limitarse al mismo, acero inoxidable y titanio.
Pasando ahora a la FIG. 11, se muestra un ejemplo de realización de una estructura de soporte designada generalmente como 500. Como se observa en la FIG. 11, la estructura 500 de soporte toma la forma de un anillo triangular o parecido a una onda que tiene unos picos 502 periféricos y unos valles 504 radialmente interiores unidos por las patas 506. Como se aprecia en la vista superior en planta, una pluralidad de patas 506 atraviesan o interseccionan preferiblemente una porción central (que no es aquella de la que son expulsadas las grapas 20) de una pluralidad de, preferiblemente cada uno de las ranuras 18 de grapas del cartucho. Durante el uso, la estructura 500 de soporte se debe apoyar contra y/o situar de modo que recubra y esté fijada de manera que se pueda liberar a la superficie de extremo distal del montaje 14 de cartucho de grapas de tal modo que las grapas 20 se formen alrededor de las patas 506 cuando se disparen desde el montaje 14 de cartucho de grapas.
Pasando ahora a las FIGS. 12-14, se muestra como 500a una modificación más rígida y más preferida de la estructura 500 de soporte. La estructura 500a de soporte se muestra en una posición apoyada sobre la superficie de extremo distal del montaje 14 de cartucho de grapas. Como se aprecia en la FIG. 12, los picos 502 están unidos por medio de una banda 508 periférica radialmente externa y los valles 504 están unidos por medio de una banda 510 periférica radialmente interna. La estructura 500a de soporte preferiblemente incluye al menos uno, preferiblemente una pluralidad de miembros 511 de orientación de cartucho, aquí mostrados, por ejemplo, como salientes o nudos 514 que dependen del brazo 512 fijado a y que se extiende radialmente hacia dentro desde la banda 508 periférica externa. Los nudos 514 pueden, además o en lugar de ello, sobresalir de las patas 506, picos 502, valles 504 y/o de la banda 510 periférica interna.
Como se aprecia en las FIGS. 13 y 14, cada miembro 511 de orientación de cartucho incluye un brazo 512 que se extiende radialmente hacia dentro desde la banda 508 periférica interna y un nudo 514 que se extiende en dirección al montaje 14 de cartucho de grapas para acoplarse al menos a uno, preferiblemente a una pluralidad de cavidades
o depresiones 516 formadas en la superficie de extremo distal del montaje 14 de cartucho de grapas. Preferiblemente, los nudos están configurados y dimensionados para complementar las cavidades 516 y crear una acoplamiento a fricción o a presión entre ellos. Los nudos 514 cooperan con las cavidades 516 para conectar la estructura 500a de soporte a la superficie más distal del montaje 14 de cartucho. Los nudos 514 y cavidades 516 también orientan o alinean la estructura 500a de soporte radialmente y circunferencialmente a lo largo de la superficie de extremo distal del montaje 14 de cartucho de grapas, de modo que las patas 506 se extiendan transversalmente a través, o intersectando las ranuras 18 de grapa.
Como se aprecia en las FIGs. 12 y 13, las patas 506, que se extienden entre la banda 508 radialmente externa y la banda 510 radialmente interna, están orientadas de modo que al menos una pata 506, preferiblemente una pluralidad de patas 506, se extienden transversalmente a lo largo de ranuras 18 de grapa formadas en el montaje 14 de cartucho de grapas. En consecuencia, como se aprecia en las FIGS. 13 y 14, cuando las grapas 20 son disparadas, las patas de las grapas 20 se deforman contra las cavidades 19 de formación de grapas a lo largo de la(s) pata(s) 506 y fijan la estructura 500a de soporte al tejido "T". En particular, las patas de las grapas 20 entran en los espacios 518 intersticiales, definidos por las patas 506, la banda 508 externa y la banda 510 interna de la estructura 500a de soporte, de una manera no obstaculizada.
Preferiblemente, la banda 508 radialmente externa y la banda 510 radialmente interna están hechas de un material rígido (por ejemplo, acero inoxidable, titanio, etc.). Las patas 506 de la estructura 500a de soporte pueden estar formadas a partir de un material no rígido (por ejemplo, Teflon, nylon y similares), mientras que las patas 506 de la estructura 500 de soporte están preferiblemente formadas de un material rígido (por ejemplo, acero inoxidable, titanio, etc.).
Pasando ahora a la FIG. 15, se muestra una estructura 500b de soporte modificada de la estructura 500a de soporte. La estructura 500b de soporte incluye una matriz radial de patas 506b que están todas orientadas sustancialmente en la misma dirección radial. Las patas 506b están orientadas entre las bandas interna y externa 508, 510, respectivamente, de modo que las patas 506b atraviesan por encima de las ranuras 18 de grapa formadas en el montaje 14 de cartucho de grapas. En esta realización, las patas 506b están preferiblemente fabricadas a partir de un material rígido.
Pasando ahora a la FIG. 16, se muestra otra estructura de soporte modificada como 500c. La estructura 500c de soporte incluye una matriz radial de patas 506c' de intersección orientadas entre las bandas externa e interna 508, 510 respectivamente, de modo que cuando la estructura 500c de soporte es alineada adecuadamente las patas 506c’ atraviesan las ranuras 18 de grapa. La estructura 500c de soporte incluye además una matriz radial de patas
506c’’ que pasan por las ranuras, que están orientadas entre las bandas 508, 510 externa e interna respectivamente,
de modo que cuando la estructura 500c de soporte está adecuadamente alineada, las patas 506c'' no atraviesan las ranuras 18 de grapa.
Pasando ahora a las FIGS. 17 y 18, se muestra otra estructura de soporte modificada como 500d. La estructura 500d de soporte incluye un anillo 530 anular que incluye al menos una, preferiblemente un par de filas anulares de ranuras 532 de grapa de anillo. Preferiblemente, las ranuras 532 de grapa de anillo están posicionadas de manera idéntica a las ranuras 18 de grapa del montaje 14 de cartucho de grapas (ver FIG. 1). El anillo 530 anular está preferiblemente fabricado a partir de un material rígido como, por ejemplo, acero inoxidable y/o titanio.
La estructura 500d de soporte preferiblemente incluye también una lámina o membrana 534 anular dispuesta sobre una superficie, preferiblemente la superficie 536 proximal orientada hacia el cartucho. La membrana 534 preferiblemente cubre las ranuras 534 de grapa de anillo. Deseablemente, la membrana 534 está hecha de Teflón, aunque se prevé que se puedan utilizar otros materiales como, por ejemplo, cualquiera de los materiales descritos anteriormente. Deseablemente, se puede utilizar una malla rígida, semirrígida o flexible en lugar de, o en combinación con, la membrana 534.
La estructura 500d de soporte incluye además al menos uno, preferiblemente una pluralidad de miembros 538 de orientación (ver FIG. 18) que se extienden desde la superficie 536 del anillo 530 anular. Los miembros 538 de orientación son preferiblemente salientes y/o nudos que sobresalen de la superficie 536 del anillo 530 anular y que están configurados para acoplarse (por ejemplo, por fricción o a presión, etc.) a las cavidades 516 (ver FIGS. 12-14) formadas en la superficie más distal del montaje 14 de cartucho de grapa.
Durante el uso, se dispone un anillo 530 anular sobre la superficie más distal del montaje 14 de cartucho de grapa de forma que la membrana 534 esté en contacto con la superficie más distal del montaje 14 de cartucho de grapa. En consecuencia, cuando se disparan las grapas 20, las patas de las grapas 20 penetrarán en la membrana 534 y tomarán forma contra las cavidades 19 de formación, capturando la membrana 534 y fijando así el anillo 530 anular
al tejido “T”.
Aunque la estructura 500d de soporte ha sido mostrada y descrita teniendo una membrana 534 dispuesta en el lado de contacto del cartucho de grapas del anillo 530 anular, se prevé y está dentro del ámbito de la presente invención que la membrana 534 se disponga en el lado opuesto del lado de contacto del cartucho de grapas del anillo 530 anular o que se pueda disponer una membrana 534 en ambos lados del anillo 530 anular.
Cada una de las estructuras de soporte descritas anteriormente están configuradas y adaptadas para ayudar a prevenir o suprimir la incidencia de la estenosis en el lugar de una anastomosis.
Aunque en la descripción anterior se hace referencia en general a la anastomosis de los intestinos, está claro que las estructuras de soporte de la presente descripción pueden utilizarse en conjunto con la anastomosis de cualquier tipo de órgano hueco del cuerpo.
Además, aunque la estructura de soporte se ha descrito en el presente documento en conjunto con ciertas realizaciones y ciertos detalles estructurales y de procedimiento, está claro que un experto en la materia podría emplear cambios, modificaciones o equivalentes. Por tanto, la descripción anterior no se debería interpretar como limitante, sino simplemente como ejemplos de realizaciones preferidas. Los expertos en la materia podrán idear otras modificaciones dentro del ámbito de las presentes reivindicaciones.
Claims (10)
- REIVINDICACIONES
- 1.
- Una estructura de soporte rígida o semirrígida para su uso en conjunto con un instrumento de grapado endoscópico circular que tiene un montaje de cartucho de grapas con al menos una disposición anular de grapas y un montaje de pieza de choque que tiene un eje, que comprende:
un anillo (200) anular rígido o semirrígido configurado y adaptado para cubrir sustancialmente la al menos una disposición anular de grapas, teniendo el anillo anular un anillo (202) radial externo, un anillo (204) radial interno y un radio (218) de soporte para soportar la estructura de soporte en el eje. -
- 2.
- La estructura de soporte rígida o semirrígida de acuerdo con la reivindicación 1, donde el anillo (202) radial externo tiene un perfil de sección transversal seleccionado del grupo que consiste en circular, rectangular, ovalado, triangular o arqueado.
-
- 3.
- La estructura rígida o semirrígida de soporte de acuerdo con la reivindicación 1, donde el radio (218) de soporte incluye un núcleo (220).
-
- 4.
- La estructura rígida o semirrígida de soporte de acuerdo con la reivindicación 3, donde el núcleo (220) tiene una abertura (222) central axial para recibir un eje alargado del montaje de pieza de choque.
-
- 5.
- La estructura de soporte rígida o semirrígida de acuerdo con cualquiera de las reivindicaciones anteriores, donde la estructura de soporte incluye material bioabsorbible.
-
- 6.
- La estructura de soporte rígida o semirrígida de acuerdo con cualquiera de las reivindicaciones precedentes, donde al menos uno de entre el anillo (202) radial externo y el anillo (204) radial interno está hecho de un material rígido.
-
- 7.
- La estructura de soporte rígida o semirrígida de acuerdo con la reivindicación 6, donde el anillo (202) radial externo tiene una malla quirúrgica.
-
- 8.
- La estructura de soporte rígida o semirrígida de acuerdo con la reivindicación 7, donde el anillo (204) radial interno está hecho a partir de un material rígido o semirrígido.
-
- 9.
- La estructura de soporte rígida o semirrígida de acuerdo con cualquiera de las reivindicaciones precedentes, donde el anillo (204) radial interno tiene una extensión radial que es suficiente como para extenderse al menos sobre una fila de la disposición anular de grapas.
-
- 10.
- La estructura de soporte rígida o semirrígida de acuerdo con cualquiera de las reivindicaciones precedentes, donde el radio (218) de soporte tiene una pluralidad de brazos (224) de soporte.
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US38956702P | 2002-06-17 | 2002-06-17 | |
US389567P | 2002-06-17 |
Publications (1)
Publication Number | Publication Date |
---|---|
ES2383252T3 true ES2383252T3 (es) | 2012-06-19 |
Family
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Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
ES03742074T Expired - Lifetime ES2268384T3 (es) | 2002-06-17 | 2003-06-17 | Estructuras anulares de soporte. |
ES10006625T Expired - Lifetime ES2426719T3 (es) | 2002-06-17 | 2003-06-17 | Estructuras de soporte anular |
ES06016962T Expired - Lifetime ES2327768T3 (es) | 2002-06-17 | 2003-06-17 | Estruturas anulares de soporte. |
ES09161658T Expired - Lifetime ES2366425T3 (es) | 2002-06-17 | 2003-06-17 | Estructuras anulares de soporte. |
ES10006624T Expired - Lifetime ES2383252T3 (es) | 2002-06-17 | 2003-06-17 | Estructuras anulares de soporte |
Family Applications Before (4)
Application Number | Title | Priority Date | Filing Date |
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ES03742074T Expired - Lifetime ES2268384T3 (es) | 2002-06-17 | 2003-06-17 | Estructuras anulares de soporte. |
ES10006625T Expired - Lifetime ES2426719T3 (es) | 2002-06-17 | 2003-06-17 | Estructuras de soporte anular |
ES06016962T Expired - Lifetime ES2327768T3 (es) | 2002-06-17 | 2003-06-17 | Estruturas anulares de soporte. |
ES09161658T Expired - Lifetime ES2366425T3 (es) | 2002-06-17 | 2003-06-17 | Estructuras anulares de soporte. |
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US (6) | US7744627B2 (es) |
EP (4) | EP2087844B1 (es) |
JP (3) | JP4551214B2 (es) |
AU (1) | AU2009200795B2 (es) |
CA (1) | CA2489328C (es) |
DE (2) | DE60307637T2 (es) |
ES (5) | ES2268384T3 (es) |
WO (1) | WO2003105698A2 (es) |
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