ES2390161T3 - Estructura que contiene material de tratamiento de heridas - Google Patents

Estructura que contiene material de tratamiento de heridas Download PDF

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ES2390161T3
ES2390161T3 ES10173363T ES10173363T ES2390161T3 ES 2390161 T3 ES2390161 T3 ES 2390161T3 ES 10173363 T ES10173363 T ES 10173363T ES 10173363 T ES10173363 T ES 10173363T ES 2390161 T3 ES2390161 T3 ES 2390161T3
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staple
surgical stapling
wound treatment
treatment material
stapling apparatus
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Frank J. Viola
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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
    • 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
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • 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
    • A61B17/07292—Reinforcements for staple line, e.g. pledgets
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00831—Material properties
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00831—Material properties
    • A61B2017/00884—Material properties enhancing wound closure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00831—Material properties
    • A61B2017/00893—Material properties pharmaceutically effective
    • 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
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides

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  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
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  • Animal Behavior & Ethology (AREA)
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Abstract

Aparato (10) de grapado quirúrgico que incluye un conjunto (26) yunque configurado para soportar una placa deyunque en el mismo y una placa (36) de yunque conectada operativamente al conjunto yunque y que define unapluralidad de cavidades (38) formadoras de grapas en el mismo, en el que el aparato está caracterizado por:un material de tratamiento de heridas 5 dispuesto en cada cavidad formadora de grapas de la placa de yunque,en el que el material (W) de tratamiento de heridas está contenido en una cápsula (42), en el que cada cápsulaestá configurada para su retención en el interior de las cavidades formadoras de grapas.

Description

Estructura que contiene material de tratamiento de heridas
Antecedentes
Campo técnico
La presente divulgación se refiere a instrumentos quirúrgicos para mejorar las propiedades de tejido reparado o unido mediante grapas quirúrgicas y, más particularmente, a instrumentos quirúrgicos y a una estructura configurada para aplicar elementos de sujeción mecánicos quirúrgicos de manera concomitante con un material de tratamiento de heridas, biocompatible, no mecánico, para mejorar las propiedades del tejido reparado o unido en un sitio quirúrgico objetivo.
Descripción de la técnica relacionada
A lo largo de los años, el campo médico ha utilizado diversas técnicas en un esfuerzo de juntar o unir entre sí tejidos corporales. Históricamente, la sutura fue la técnica aceptada para volver a unir tejidos seccionados y cerrar heridas. La sutura se ha conseguido históricamente con una aguja quirúrgica y un hilo quirúrgico, y más recientemente, con una diversidad de grapas poliméricas o metálicas, tal como se describirá más adelante. La función deseada de las suturas es mantener los bordes de una herida o tejido, uno contra el otro, durante el proceso de curación para reducir la incomodidad, el dolor, la cicatrización y el tiempo requerido para la curación.
Recientemente, muchos procedimientos, que en el pasado requerían una sutura tradicional, han sido reemplazados por una sutura con grapas que implica la aplicación de las grapas a los bordes de la herida o tejido con el uso de una grapadora quirúrgica. Las grapadoras quirúrgicas han sido desarrolladas para unir tejido adyacente, para proporcionar hemostasis de tejido adyacente y para proporcionar hemostasis en conjunción con un corte de tejido adyacente. Dichas grapadoras quirúrgicas incluyen tanto configuraciones de tipo lineal como configuraciones de tipo anular. Una grapadora y cortadora lineal típica incluye filas paralelas de grapas con una ranura para que unos medios de corte sean desplazados entre las filas de grapas.
Las grapadoras de tipo lineal típicas se divulgan en la patente US No. 6.045.560 de McKean et al., en la patente US No.
6.032.849 de Mastri et al., y en la patente US No. 5.964.394 de Robertson, de titularidad compartida. Una grapadora y cortadora anular típica, que incluye una pluralidad de filas anulares de grapas, típicamente dos, y una cuchilla anular dispuesta en el interior de las filas de grapas, se divulga en la patente US No. 5.799.857 de Robertson et al., y el documento 5.915.616 de Viola et al., de titularidad compartida.
Estos tipos de grapadoras quirúrgicas aseguran el tejido corporal contiguo para un corte mejorado, para unir capas de tejido entre sí y para proporcionar hemostasis aplicando filas paralelas o anulares de grapas para rodear el tejido conforme los medios de corte realizan un corte entre las filas paralelas o anulares. Consiguientemente, al permitir que un cirujano realice todas estas tareas simultáneamente, las grapadoras quirúrgicas han sido efectivas para disminuir la cantidad de tiempo necesario para sujetar el tejido. Para mejorar adicionalmente la unión y la hemostasis en casos en los que la grapadora es usada en tejido muy vascularizado, se han usado grapadoras quirúrgicas con múltiples filas de grapas, con un alto grado de éxito.
Otros procedimientos quirúrgicos utilizan compresas, contrafuertes u otros tipos de tejidos y materiales de refuerzo. Estos contrafuertes son colocados, típicamente, sobre la superficie de contacto con el tejido del yunque y/o la superficie de contacto con el tejido del cartucho del instrumento de grapado quirúrgico, y son asegurados contra el tejido objetivo durante el disparo del instrumento de grapado quirúrgico. Puede hacerse referencia a la patente US No. 5.542.594 para una descripción más detallada del uso de contrafuertes en cooperación con un instrumento de grapado quirúrgico.
Otros procedimientos quirúrgicos adicionales implican la etapa de aplicar (por ejemplo, mediante pulverización, cepillado, etc.) un material adhesivo y/o un material sellador a la superficie externa del sitio quirúrgico objetivo después del procedimiento de grapado quirúrgico.
Otro procedimiento que ha sido desarrollado incluye el uso de adhesivos de tejido biológicos que han sido desarrollados recientemente para la reparación de tejido y la creación de anastomosis. Generalmente, los adhesivos biológicos unen entre sí tejidos separados para ayudar en el proceso de curación y para mejorar la resistencia del tejido. Dichos adhesivos pueden ser usados en lugar de una sutura y un grapado, por ejemplo, en procedimientos quirúrgicos para la reparación del tejido o la creación de anastomosis. Los documentos WO 03/094746 y WO 03/105698 divulgan instrumentos de grapado quirúrgico ejemplares.
La aplicación de un adhesivo biocompatible adecuado ofrece muchas ventajas tanto para el paciente como para el cirujano, tales como, por ejemplo, la prevención de la penetración del tejido por agujas y/o grapas, así como el sellado
inmediato del tejido que está siendo tratado. Además, el uso de un adhesivo biocompatible tiende a minimizar la reacción a un cuerpo extraño y la cicatrización.
Resumen
Según la presente divulgación, se divulga un aparato de grapado quirúrgico que incluye un conjunto yunque y una placa de yunque en el mismo; en el que la placa de yunque define una pluralidad de cavidades formadoras de grapas en la misma; y un material de tratamiento de heridas dispuesto en cada cavidad formadora de grapas de la placa de yunque.
El material de tratamiento de heridas está contenido en una cápsula. Consiguientemente, cada cápsula está configurada para su retención dentro de las cavidades formadoras de grapas. El conjunto yunque puede incluir además un revestimiento que cubre la pluralidad de cavidades formadoras de grapas. Idealmente, las cavidades formadoras de grapas están dispuestas en un par de anillos anulares, concéntricos, separados. Las cavidades formadoras de grapas están alineadas con las ranuras de retención de grapas respectivas formadas en un conjunto cartucho de grapas del aparato de grapado quirúrgico.
Idealmente, el material de tratamiento de heridas es al menos uno de entre un adhesivo, un sellador, un hemostato y un medicamento.
El adhesivo incluye al menos uno de entre un adhesivo que se endurece con el contacto con el tejido, un adhesivo que se endurece tras la exposición a luz ultravioleta (UV), y un adhesivo que es sensible a la presión. El adhesivo puede incluir también al menos un material adhesivo basado en aldehído, derivado de proteína, y un material basado en cianoacrilato.
El material sellador incluye al menos uno de entre un material sellador de fibrina, un material sellador de tejido basado en colágeno y basado en polímero sintético, y un material sellador de hidrogel, basado en polietilenglicol sintético.
El material hemostático incluye al menos uno de entre un material basado en fibrina, un material basado en colágeno, un material basado en celulosa regenerada oxidada, un material basado en gelatina, y un material de fibrinógeno-trombina.
El medicamento incluye al menos uno de entre fármacos, enzimas, factores de crecimiento, péptidos, proteínas, tintes y agentes de diagnóstico.
Breve descripción de los dibujos
Las características anteriores de la presente divulgación se harán más evidentes y podrán comprenderse con referencia a la descripción detallada siguiente de una realización ilustrada de un instrumento, estructura o aparato quirúrgico, tomada en conjunción con los dibujos adjuntos, en los que:
La Fig. 1 ilustra una vista en perspectiva de un aparato de grapado quirúrgico según una realización de la presente divulgación;
La Fig. 2 es una vista en perspectiva de un conjunto yunque según una realización de la presente divulgación;
La Fig. 3 es una vista en sección transversal del conjunto yunque, tomada a través de la línea 3-3 de la Fig. 2;
La Fig. 4 es una vista en sección transversal de un conjunto yunque alternativo según la presente divulgación, tomada a lo largo de 3-3 de la Fig. 2;
La Fig. 5 es una vista en perspectiva de la zona intestinal de un paciente, que ilustra un procedimiento de posicionamiento del conjunto yunque de las Figs. 2-4 al realizar una anastomosis intestinal;
La Fig. 6 es una vista detallada, aumentada, del conjunto yunque de las Figs. 2-4 y un conjunto cartucho de grapas del aparato de grapado quirúrgico posicionado en el sitio quirúrgico objetivo justo antes de disparar el aparato de grapado quirúrgico;
La Fig. 7 es una vista detallada, aumentada, del suministro de material de tratamiento de heridas desde el conjunto yunque tras el disparo del aparato de grapado quirúrgico; y
La Fig. 8 es una vista detallada, aumentada, del conjunto yunque de las Figs. 2-4 y un conjunto cartucho de grapas de un aparato de grapado quirúrgico según otra realización de la presente divulgación, antes de disparar el aparato de grapado quirúrgico.
Descripción detallada de la realización
Las realizaciones del aparato de grapado quirúrgico divulgado en la presente memoria, serán descritas ahora, en detalle,
con referencia a las figuras de los dibujos, en las que los números de referencia similares identifican elementos similares o idénticos. Tal como se usa en la presente memoria y como es tradicional, el término “distal” se refiere a aquella parte que está más lejos del usuario mientras que el término “proximal” se refiere a aquella parte que está más cerca del usuario.
Con referencia ahora en detalle específico a los dibujos, en los que los números de referencia similares identifican elementos similares o idénticos a lo largo de las diversas vistas, la Fig. 1 muestra un aparato 10 de grapado quirúrgico que emplea la estructura para aplicar un adhesivo dispersable según la presente divulgación. El aparato 10 incluye un conjunto 12 empuñadura que tiene al menos un miembro 14 empuñadura, de accionamiento pivotable, e incluye además medios 16 de avance. Los medios 16 de avance incluyen un miembro 18 de agarre giratorio, cuya función se describirá a continuación.
Extendiéndose desde el conjunto 12 empuñadura, hay provista una parte 20 cuerpo tubular que puede estar construida de manera que tenga una forma curvada a lo largo de al menos una parte de su longitud. La parte 20 cuerpo tubular puede ser también recta, o en otras realizaciones, la parte 20 cuerpo tubular puede ser flexible para plegarse a cualquier configuración. La parte 20 cuerpo termina en un conjunto 22 cartucho de grapas. El conjunto 22 cartucho de grapas incluye un conjunto anular de grapas “S”. Posicionado frente al conjunto 22 cartucho de grapas hay provisto un conjunto 26 yunque que está conectado al aparato 10 por un eje 28 en los medios 30 de conexión. El conjunto 26 yunque y el conjunto 22 cartucho de grapas se divulgan en la patente US No. 5.119.983, concedida el 9 de Junio de 1992 de titularidad compartida.
Aunque el aparato 10 se muestra y describe de manera que utiliza un conjunto cartucho de grapas que tiene un conjunto anular de grapas posicionadas sobre la parte cuerpo tubular, y que tiene el conjunto yunque posicionado frente al conjunto cartucho de grapas para un movimiento acercándose y alejándose del conjunto cartucho de grapas, se contempla, por supuesto, que el conjunto yunque pueda estar posicionado sobre la parte cuerpo tubular y el conjunto cartucho de grapas y el conjunto de grapas puedan estar posicionados frente al conjunto yunque para un movimiento acercándose y alejándose del conjunto yunque. Dicha una construcción debe considerarse dentro del alcance de la presente divulgación.
En funcionamiento, el aparato 10 es posicionado en el interior de un órgano tubular en el cuerpo del paciente y los extremos del órgano a ser unidos son posicionados en el hueco entre el conjunto 22 cartucho de grapas y el conjunto 26 yunque, de manera que el conjunto 26 yunque esté completamente extendido. Como es convencional, los extremos del órgano pueden ser asegurados sobre el conjunto 26 yunque y el conjunto 22 cartucho de grapas mediante una sutura en bolsa de tabaco previamente a la aproximación del conjunto 26 yunque en relación al conjunto 22 cartucho de grapas. Con el conjunto 26 yunque y el conjunto 22 cartucho de grapas suturados en bolsa de tabaco, el vástago 28 del conjunto 26 yunque es acoplado a los medios 30 de conexión dispuestos en el interior del conjunto 22 cartucho de grapas.
Con el propósito de aproximar el conjunto 26 yunque hacia el conjunto 22 cartucho de grapas, el miembro 18 de agarre es girado para desplazar un miembro vástago interior (no mostrado) en una dirección proximal. Esto coloca el conjunto 26 yunque en una posición contigua al conjunto 22 cartucho de grapas y sitúa los extremos del tejido entre estos dos miembros.
Una vez establecida la distancia apropiada entre el conjunto 26 yunque y el conjunto 22 cartucho de grapas, los medios 32 de enclavamiento pueden ser liberados y las empuñaduras 14 de accionamiento pueden ser pivotadas para accionar las grapas a través del tejido y contra el conjunto 26 yunque para completar la anastomosis circular del órgano tubular. Puede hacerse referencia a la patente US No. 5.119.983 para una descripción y una exposición más detalladas de la estructura y del funcionamiento del aparato 10 de grapado quirúrgico.
Tal como se observa en las Figs. 1-4, el conjunto 26 yunque incluye un cabezal 34 de yunque y un vástago 28 que se extiende desde el cabezal 34 de yunque. El cabezal 34 de yunque está configurado para soportar una placa 36 de yunque en el mismo. Idealmente, las cavidades 38 formadoras de grapas están dispuestas en un par de anillos anulares, concéntricos, separados, formados en una placa 36 de yunque.
Tal como se observa en las Figs. 3 y 4, cada cavidad 38 formadora de grapas incluye una cantidad de material “W” de tratamiento de heridas en la misma. Tal como se observa en la Fig. 3, una película o revestimiento 40 puede ser colocada sobre o en la superficie de la placa 36 de yunque cubriendo, de esta manera, las cavidades 38 formadoras de grapas y reteniendo el material “W” de tratamiento de heridas en las mismas. Tal como se observa en la Fig. 4, el material “W” de tratamiento de heridas está contenido en una cápsula o gel 42 líquido colocado en cada cavidad 38 formadora de grapas. Cada cápsula 42 está adherida o si no está contenida de manera fija en las cavidades 38 formadoras de grapas.
Idealmente, el revestimiento 40 es fabricado a partir de un material que puede ser penetrado o roto por grapas “S” quirúrgicas. Por ejemplo, el revestimiento 40 puede ser fabricado a partir de un material polimérico, tal como, polietileno, poliéster, poliuretano y similares. Se prevé que el revestimiento 40 sea fabricado a partir de un material bio-absorbible. De esta manera, en caso de que una parte o la totalidad del revestimiento 40 permanezca en el cuerpo después del
procedimiento quirúrgico, esa parte del revestimiento 40 será absorbida en el cuerpo.
El material de tratamiento de heridas incluye, y no está limitado a, un adhesivo, un sellador, un hemostato y/u otro medicamento. Idealmente, en el uso, el componente sellador del material “W” de tratamiento de heridas funciona para retardar cualquier hemorragia que pueda ocurrir desde el tejido, y el componente adhesivo del material “W” de tratamiento de heridas funciona para asegurar el tejido aproximado unido.
Se prevé que el adhesivo incluya, y no esté limitado a, adhesivos que se endurecen al hacer contacto con el tejido, que se endurecen con la exposición a la luz ultravioleta (UV), que son sensibles a la presión, que son cualquier combinación de los mismos, o cualquier otro adhesivo adecuado conocido. En una realización, se prevé que pueda usarse un adhesivo que tiene un tiempo de curado de aproximadamente 10 a 15 segundos. En otra realización, se prevé que pueda usarse un adhesivo que tiene un tiempo de curado de aproximadamente 30 segundos.
Se prevé que el material “W” de tratamiento de heridas pueda ser un adhesivo o un sellador pre-curado. El sellador o adhesivo pre-curado reaccionará con la humedad y/o el calor del tejido corporal para activar, de esta manera, las propiedades selladoras y/o adhesivas del sellador o adhesivo. Se prevé que el sellador o adhesivo pre-curado pueda ser un hidrogel o similar.
Los ejemplos de adhesivos que pueden ser empleados incluyen materiales adhesivos basados en aldehído, derivados de proteína, por ejemplo, los materiales de albúmina/glutaraldehido comercialmente disponibles, comercializados bajo la marca registrada BioGlueTM por Cryolife, Inc., y materiales basados en cianoacrilato, comercializados bajo las marcas registradas IndermilTM y Derma BondTM por Tyco Healthcare Group, LP y Ethicon Endosurgery, Inc., respectivamente. Los ejemplos de selladores, que pueden ser empleados, incluyen selladores de fibrina y selladores de tejido basados en colágeno y basados en polímero sintético. Los ejemplos de selladores disponibles comercialmente son materiales de hidrogel basados en polietilenglicol sintético, comercializados bajo la marca registrada CoSealTM por Cohesion Technologies y Baxter International, Inc. Los ejemplos de materiales hemostáticos, que pueden ser empleados, incluyen hemostatos tópicos basados en fibrina, basados en colágeno, basados en celulosa regenerada oxidada y basados en gelatina. Los ejemplos de materiales hemostáticos disponibles comercialmente, son materiales de combinación de fibrinógeno-trombina comercializados bajo las marcas registradas CoStasisTM por Tyco Group Healthcare Group, LP, y TisseelTM comercializados por Baxter International, Inc. Los hemostatos en la presente memoria incluyen astringentes, por ejemplo, sulfato de aluminio y coagulantes.
El material “W” de tratamiento de heridas puede incluir también medicamentos. Los medicamentos pueden incluir una o más sustancias, médica y/o quirúrgicamente útiles, tales como fármacos, enzimas, factores de crecimiento, péptidos, proteínas, tintes, agentes de diagnóstico o agentes hemostáticos o cualquier otra sustancia farmacéutica usada en la prevención de estenosis.
Con referencia ahora las Figs. 5-7, en las mismas se ilustra el uso de un dispositivo 10 de grapado quirúrgico y un conjunto 100 yunque desmontable en un procedimiento de anastomosis para efectuar una unión de secciones intestinales “T1” y “T2” contiguas. El procedimiento de anastomosis es realizado, típicamente, usando técnicas quirúrgicas mínimamente invasivas que incluyen instrumentación y medios laparoscópicos. En el punto del procedimiento mostrado en la Fig. 5, se ha retirado previamente una sección intestinal enferma, el conjunto 26 yunque ha sido aplicado a la zona de la operación, bien a través de una incisión quirúrgica o bien transanalmente y ha sido posicionado dentro de la primera sección intestinal “T1”, y una parte 20 cuerpo tubular del dispositivo 10 de grapado quirúrgico ha sido insertada transanalmente en la segunda sección intestinal “T2”. Las secciones intestinales “T1” y “T2” se muestran también aseguradas temporalmente alrededor de sus componentes respectivos (por ejemplo, el eje 28 del conjunto 26 yunque, y el extremo distal de la parte 20 cuerpo tubular) mediante medios convencionales, tales como una sutura en bolsa de tabaco (no mostrada).
A continuación, el cirujano manipula el conjunto 26 yunque hasta que un extremo proximal del eje 28 es conectado operativamente a los medios 30 de conexión de la parte 20 cuerpo tubular. A continuación, el conjunto 26 yunque y la parte 20 cuerpo tubular son aproximados a las secciones intestinales “T1” y “T2” aproximadas.
Con referencia ahora a la Fig. 6, con el conjunto 26 yunque aproximado hacia el conjunto 22 cartucho de grapas y las secciones intestinales “T1” y “T2” sujetadas o capturadas entre los mismos, las cavidades 38 formadoras de grapas del conjunto 26 yunque están alineadas con las ranuras 24 de retención de grapas del miembro 22 de sujeción de grapas. En particular, las grapas “S”, retenidas en las ranuras 24 de retención de grapas, están alineadas con las cavidades 38 formadoras de grapas del conjunto 26 yunque.
Con el conjunto 26 yunque posicionado de esta manera en relación al conjunto 22 cartucho de grapas, el dispositivo 10 de grapado quirúrgico es disparado, grapando y adhiriendo, de esta manera, las secciones intestinales “T1” y “T2” entre sí. Tal como se observa en la Fig. 7, tras disparar el dispositivo 10 de grapado quirúrgico, las grapas “S” son impulsadas
desde el conjunto 22 cartucho de grapas y son impulsadas a través de las secciones intestinales “T1” y “T2”, asegurando mecánicamente, de esta manera, las secciones intestinales “T1” y “T2” entre sí. Conforme las grapas S son impulsadas a través de las secciones intestinales “T1” y “T2”, las grapas “S” penetran en el revestimiento 40 y liberan el material “W” de tratamiento de heridas contenido en las cavidades 38 formadoras de grapas de la placa 36 de yunque sobre del tejido intestinal “T2”. Idealmente, el material “W” de tratamiento de heridas se extiende junto con las grapas “S” a la interfaz entre los tejidos intestinales “T1” y “T2”. De esta manera, si el material “W” de tratamiento de heridas contiene un adhesivo, el material “W” de tratamiento de heridas ayuda a que las secciones intestinales “T1” y “T2” se adhieran entre sí.
Se prevé además que si el material “W” de tratamiento de heridas contiene un sellador, la filtración de sangre en o sobre el lado yunque de la grapa “S” (por ejemplo, en el primer tejido intestinal “T1”) es reducida con relación a un aparato quirúrgico que tiene un conjunto yunque sin material de tratamiento de heridas. En el uso, conforme las grapas “S” son impulsadas al interior de las cavidades 38 formadoras de grapas del conjunto 26 yunque, el material “W” de tratamiento de heridas, que incluye un sellador, es desplazado a la zona que rodea las grapas “S”.
Simultáneamente, la cuchilla 50 secciona las partes de las secciones intestinales “T1” y “T2” situadas radialmente hacia el interior de la cuchilla 50.
Con referencia ahora a la Fig. 8, el material “W” de tratamiento de heridas, que incluye un sellador, puede estar dispuesto dentro (por ejemplo, cargado en, envasado en, etc.) de las ranuras 24 de retención de grapas. Consiguientemente, en el uso, cuando el aparato 10 de grapado quirúrgico es disparado, el material “W” de tratamiento de heridas es dispensado sobre o si no es extendido sobre el área de la segunda sección intestinal “T2” que rodea una longitud de grapas “S”.
Aunque se han ilustrado y descrito diversas formas particulares de conjuntos yunque, y un procedimiento particular para usar los mismos, será evidente también que pueden realizarse diversas modificaciones sin alejarse del alcance de la presente divulgación. Por ejemplo, se prevé, y está dentro del alcance de la presente divulgación, que un material de tratamiento de heridas, activado con luz ultravioleta, (por ejemplo, un adhesivo) sea usado en las cavidades 38 formadoras de grapas del conjunto 26 yunque. Consiguientemente, en el uso, bien antes o bien después de disparar el dispositivo 10 de grapado quirúrgico, la zona de anastomosis es irradiada con luz UV para activar, de esta manera, el adhesivo.
De esta manera, debería comprenderse que pueden realizarse diversos cambios en la forma, los detalles y la aplicación del conjunto yunque de la presente divulgación sin alejarse del alcance de la presente divulgación.

Claims (10)

  1. REIVINDICACIONES
    1.
    Aparato (10) de grapado quirúrgico que incluye un conjunto (26) yunque configurado para soportar una placa de yunque en el mismo y una placa (36) de yunque conectada operativamente al conjunto yunque y que define una pluralidad de cavidades (38) formadoras de grapas en el mismo, en el que el aparato está caracterizado por:
    un material de tratamiento de heridas dispuesto en cada cavidad formadora de grapas de la placa de yunque, en el que el material (W) de tratamiento de heridas está contenido en una cápsula (42), en el que cada cápsula está configurada para su retención en el interior de las cavidades formadoras de grapas.
  2. 2.
    Aparato de grapado quirúrgico según la reivindicación 1, que comprende además un revestimiento (40) que cubre la pluralidad de cavidades formadoras de grapas.
  3. 3.
    Aparato de grapado quirúrgico según la reivindicación 1 ó 2, en el que las cavidades formadoras de grapas están dispuestas en un par de anillos anulares, concéntricos, separados.
  4. 4.
    Aparato de grapado quirúrgico según la reivindicación 1, 2 ó 3, en el que las cavidades formadoras de grapas están alineadas con las ranuras (24) de retención de grapas respectivas formadas en un conjunto (22) cartucho de grapas del aparato de grapado quirúrgico.
  5. 5.
    Aparato de grapado quirúrgico según la reivindicación 1, en el que el material de tratamiento de heridas es un adhesivo.
  6. 6.
    Aparato de grapado quirúrgico según la reivindicación 1, en el que el material de tratamiento de heridas es un sellador.
  7. 7.
    Aparato de grapado quirúrgico según la reivindicación 1, en el que el material de tratamiento de heridas es un hemostato.
  8. 8.
    Aparato de grapado quirúrgico según la reivindicación 1, en el que el material de tratamiento de heridas es un medicamento.
  9. 9.
    Aparato de grapado quirúrgico según una cualquiera de las reivindicaciones 2 a 4, en el que el revestimiento es fabricado a partir de un material bioabsorbible.
  10. 10.
    Aparato de grapado quirúrgico según una cualquiera de las reivindicaciones anteriores, en el que las cápsulas están adheridas a las cavidades formadoras de grapas.
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