ES2392797T3 - Instrumento quirúrgico que tiene una superficie de plástico - Google Patents

Instrumento quirúrgico que tiene una superficie de plástico Download PDF

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ES2392797T3
ES2392797T3 ES11152265T ES11152265T ES2392797T3 ES 2392797 T3 ES2392797 T3 ES 2392797T3 ES 11152265 T ES11152265 T ES 11152265T ES 11152265 T ES11152265 T ES 11152265T ES 2392797 T3 ES2392797 T3 ES 2392797T3
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assembly
surgical instrument
tool assembly
drive beam
closure apparatus
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Paul A Scirica
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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
    • 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
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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
    • A61B17/10—Surgical instruments, devices or methods 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
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B17/115—Staplers for performing anastomosis, e.g. in a single operation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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
    • A61B2017/0023—Surgical instruments, devices or methods disposable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/0046—Surgical instruments, devices or methods with a releasable handle; with handle and operating part separable
    • A—HUMAN NECESSITIES
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    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/0046—Surgical instruments, devices or methods with a releasable handle; with handle and operating part separable
    • A61B2017/00473—Distal part, e.g. tip or head
    • A—HUMAN NECESSITIES
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    • A61B2017/00526—Methods of manufacturing
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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    • A61B2017/00831—Material properties
    • A61B2017/0084—Material properties low friction
    • A—HUMAN NECESSITIES
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    • A61B2017/00845—Material properties low friction of moving parts with respect to each other
    • A—HUMAN NECESSITIES
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    • A61B2017/00831—Material properties
    • A61B2017/00853—Material properties low friction, hydrophobic and corrosion-resistant fluorocarbon resin coating (ptf, ptfe, polytetrafluoroethylene)
    • A—HUMAN NECESSITIES
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    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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    • A61B2017/00964—Material properties composite
    • A—HUMAN NECESSITIES
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    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A—HUMAN NECESSITIES
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    • 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
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    • 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
    • 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
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2901—Details of shaft
    • A61B2017/2902—Details of shaft characterized by features of the actuating rod
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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
    • 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
    • A61B2017/2933—Transmission of forces to jaw members camming or guiding means
    • A61B2017/2936—Pins in guiding slots
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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
    • A61B2017/2943—Toothed members, e.g. rack and pinion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2946—Locking means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B2017/320052—Guides for cutting instruments

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
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  • Surgical Instruments (AREA)

Abstract

Instrumento (500) quirúrgico, que comprende: una parte (510) de asidero; una parte (512) de cuerpo que se extiende distalmente desde la parte (510) de asidero y que define un primer eje longitudinal; un asidero (516) móvil dispuesto en la parte (510) de asidero y que actúa conjuntamente de manera mecánica con un elemento (520) de accionamiento; un conjunto (17) de herramienta que incluye un conjunto (20) de yunque, un conjunto (18) de cartucho y una superficie (42) de contacto, estando soportado el conjunto (17) de herramienta de manera adyacente a un extremo distal de la parte (512) de cuerpo; una viga (802) de accionamiento que tiene una parte de enganche proximal dispuesta adyacente a un extremo proximal de la misma y que está configurada para engancharse con una parte del elemento (520) de accionamiento; un aparato (800) de cierre dispuesto adyacente a un extremo distal de la viga (802) de accionamiento que está configurado para engancharse con la superficie (42) de contacto del conjunto (17) de herramienta, mediante lo cual al menos un accionamiento parcial del asidero (516) móvil mueve el aparato (800) de cierre distalmente para su enganche con la superficie (42) de contacto para aproximarse al yunque y al conjunto (20, 18) de cartucho, teniendo el aparato (800) de cierre una parte (806) horizontal situada para engancharse con la superficie (42) de contacto para efectuar la aproximación del conjunto (20) de yunque y el conjunto (18) de cartucho; y caracterizado porque: al menos la parte (806) horizontal del aparato (800) de cierre incluye una tapa (804) de plástico que tiene una sección (810) reforzada.

Description

Instrumento quirúrgico que tiene una superficie de plástico
Campo técnico
La presente descripción se refiere a un instrumento quirúrgico y a una unidad de carga desechable que incluyen una superficie de plástico sobre los mismos. Más particularmente, la presente descripción se refiere a un instrumento quirúrgico que incluye una superficie de plástico sobre al menos uno de un aparato de cierre y una superficie de contacto de un conjunto de herramienta.
Antecedentes
Los dispositivos quirúrgicos en los que el tejido primero se agarra o sujeta entre una estructura de mandíbulas opuestas y después se une mediante elementos de sujeción quirúrgicos se conocen bien en la técnica. En algunos instrumentos, se proporciona un bisturí para cortar el tejido que se ha unido mediante los elementos de sujeción. Los elementos de sujeción son normalmente en forma de grapas quirúrgicas aunque también pueden utilizarse elementos de sujeción poliméricos de dos partes.
Instrumentos para este fin pueden incluir dos elementos alargados que se usan respectivamente para atrapar o sujetar tejido. Normalmente, uno de los elementos lleva un cartucho de grapas que aloja una pluralidad de grapas dispuestas en al menos dos filas laterales mientras que el otro elemento tiene un yunque que define una superficie para formar las patas de la grapa a medida que las grapas se clavan desde el cartucho de grapas. En algunos instrumentos, el cierre de los dos elementos alargados, o conjunto de herramienta, se efectúa mediante el accionamiento de un asidero móvil que mueve una viga de accionamiento que tiene un aparato de cierre sobre la misma al interior de una superficie de contacto de un conjunto de herramienta, por tanto aproximando los elementos del conjunto de herramienta. Puede haber una gran fuerza de fricción entre el aparato de cierre y la superficie de contacto del conjunto de herramienta, lo que requiere por tanto posiblemente aplicar relativamente una gran cantidad de fuerza al asidero móvil.
El documento US 2006/016853 da a conocer un dispositivo de grapado quirúrgico que incluye un conjunto de herramienta que puede girar independientemente. El conjunto de herramienta incluye un yunque y un conjunto de cartucho que son móviles entre sí entre posiciones separadas y aproximadas. El elemento de cierre del documento US 2006/016853 está hecho de un material de gran calibre. El preámbulo de la reivindicación adjunta 1 se basa en esta descripción.
Sumario
La presente descripción se refiere a la reivindicación 1. La parte de cuerpo se extiende distalmente desde la parte de asidero y define un primer eje longitudinal. El asidero móvil está ubicado en la parte de asidero y actúa conjuntamente de manera mecánica con un elemento de accionamiento. El conjunto de herramienta está soportado adyacente a un extremo distal de la parte de cuerpo e incluye un yunque, un conjunto de cartucho y una superficie de contacto. La viga de accionamiento incluye una parte de enganche proximal ubicada adyacente a un extremo proximal de la misma y está configurada para engancharse con una parte del elemento de accionamiento. El aparato de cierre está ubicado adyacente a un extremo distal de la viga de accionamiento y está configurado para engancharse con la superficie de contacto del conjunto de herramienta e incluye una superficie de corte en una realización dada a conocer. Al menos un accionamiento parcial del asidero móvil mueve el aparato de cierre distalmente para su enganche con la superficie de contacto para aproximarse al yunque y al conjunto de cartucho.
Al menos una parte horizontal del aparato de cierre incluye una tapa de plástico que tiene una sección reforzada. Se da a conocer que al menos una parte del aparato de cierre está hecha de plástico o sobremoldeada con plástico.
En una realización dada a conocer, la viga de accionamiento incluye una pluralidad de capas. También se da a conocer que el aparato de cierre tiene una sección transversal en forma de I.
En una realización, el conjunto de herramienta define un segundo eje longitudinal y puede moverse de una primera posición en la que el segundo eje longitudinal está sustancialmente alineado con el primer eje longitudinal a una segunda posición en la que el segundo eje longitudinal está dispuesto formando un ángulo con el primer eje longitudinal. En esta realización, el conjunto de herramienta puede ser articulado.
En una realización, el aparato de cierre forma parte de una unidad de carga desechable. La presente descripción también se refiere a una unidad de carga desechable que incluye características del aparato de cierre y el conjunto de herramienta, tal como se ha descrito anteriormente.
Descripción de los dibujos
Diversas realizaciones del instrumento quirúrgico dado a conocer ahora se dan a conocer en el presente documento con referencia a los dibujos, en los que:
2
la figura 1 es una vista en perspectiva lateral desde el extremo distal de una realización del instrumento quirúrgico dado a conocer con conjunto de herramienta articulado;
la figura 1A es una vista en perspectiva lateral desde el extremo proximal de una unidad de carga desechable (DLU) del instrumento quirúrgico mostrado en la figura 1 que incluye el conjunto de herramienta;
la figura 2 es una vista en perspectiva lateral del extremo distal del conjunto de montaje y el conjunto de herramienta, con partes separadas, de la DLU del instrumento quirúrgico mostrado en la figura 1
la figura 3 es una vista en perspectiva lateral del conjunto de montaje y de la parte de cuerpo proximal de la DLU mostrados en la figura 1A con partes separadas;
la figura 3A es una vista en perspectiva lateral de un elemento de acoplamiento del instrumento quirúrgico mostrado en la figura 1;
la figura 3B es una vista en perspectiva lateral de una parte de montaje superior del conjunto de montaje de la DLU del instrumento quirúrgico mostrado en la figura 1;
la figura 3C es una vista en perspectiva lateral de una parte de montaje inferior del conjunto de montaje de la DLU del instrumento quirúrgico mostrado en la figura 1;
la figura 3D es una vista en perspectiva lateral desde arriba de la parte de cuerpo proximal, el conjunto de montaje y el conjunto de herramienta de la DLU del instrumento quirúrgico con el conjunto de herramienta en su posición no articulada;
la figura 3E es una vista en perspectiva lateral desde arriba de la parte de cuerpo proximal, el conjunto de montaje y el conjunto de herramienta mostrados en la figura 3D con el conjunto de herramienta en una posición articulada;
la figura 3F es una vista en perspectiva lateral desde abajo de la parte de cuerpo proximal, el conjunto de montaje y el conjunto de herramienta de la DLU del instrumento quirúrgico con el conjunto de herramienta en su posición no articulada;
la figura 3G es una vista en perspectiva lateral desde abajo de la parte de cuerpo proximal, el conjunto de montaje y el conjunto de herramienta mostrado en la figura 3F con el conjunto de herramienta en una posición articulada;
la figura 4 es una vista en sección transversal lateral del conjunto de herramienta de la DLU mostrada en la figura 1A;
la figura 5 es una vista en perspectiva desde arriba del actuador de elemento de bloqueo del mecanismo de bloqueo de la parte de cuerpo proximal mostrado en la figura 3;
la figura 6 es una vista en perspectiva desde abajo de un elemento de bloqueo del mecanismo de bloqueo mostrado en la figura 3;
la figura 7 es una vista desde arriba del extremo proximal de la parte de cuerpo proximal de la DLU mostrada en la figura 1A con el mecanismo de bloqueo en su posición bloqueada;
la figura 8 es una vista en sección transversal tomada a lo largo de las líneas de sección 8-8 de la figura 7;
la figura 9 es una vista desde arriba del extremo proximal de la parte de cuerpo proximal de la DLU mostrada en la figura 1A con el mecanismo de bloqueo en su posición desbloqueada;
la figura 10 es una vista en sección transversal tomada a lo largo de las líneas de sección 10-10 de la figura 9;
la figura 11 es una vista en perspectiva lateral de la DLU y el instrumento quirúrgico mostrados en la figura 1 antes de la unión de la DLU al instrumento quirúrgico;
la figura 12 es una vista desde arriba del extremo proximal de la DLU y el extremo distal del instrumento quirúrgico mostrado en la figura 11 antes de la unión al extremo distal del instrumento quirúrgico;
la figura 13 es una vista desde arriba del extremo proximal de la DLU mostrado en la figura 11 a medida que la DLU se hace avanzar linealmente hacia el extremo distal del instrumento quirúrgico;
la figura 14 es una vista desde arriba del extremo proximal de la DLU y el extremo distal del instrumento quirúrgico mostrado en la figura 12 tras haber hecho avanzar linealmente la DLU pero antes de bloquear la DLU al instrumento quirúrgico;
la figura 15 es una vista desde arriba del extremo proximal de la DLU y el extremo distal del instrumento quirúrgico mostrado en la figura 13 tras haber hecho avanzar linealmente la DLU y haberla bloqueado giratoriamente al instrumento quirúrgico;
3
la figura 16 es una vista en perspectiva de un conjunto de bloqueo para su uso con un instrumento quirúrgico según una realización de la presente descripción;
la figura 17 es una vista en perspectiva de diversos componentes del conjunto de bloqueo de la figura 16;
la figura 18 es una vista en perspectiva ampliada de una parte del conjunto de bloqueo de las figuras 16 y 17 ilustrado con el conjunto de herramienta articulado en una posición no articulada;
la figura 19 es una vista en perspectiva ampliada de una parte del conjunto de bloqueo de las figuras 16-18 y que incluye un enlace;
la figura 20 es una vista en perspectiva ampliada de una parte del conjunto de bloqueo de las figuras 16-19 ilustrado con el conjunto de herramienta articulado en una posición articulada;
la figura 21 es una vista en perspectiva ampliada de otro conjunto de bloqueo para su uso con un instrumento quirúrgico según una realización de la presente descripción;
la figura 22 es una vista en perspectiva desde abajo ampliada del conjunto de bloqueo de la figura 21;
la figura 23 es una vista en perspectiva de una viga de accionamiento que tiene una pluralidad de capas y un aparato de cierre según una realización de la presente descripción;
la figura 24 es una vista en perspectiva de la viga de accionamiento y el aparato de cierre de la figura 23 con partes separadas;
la figura 25 es una vista en sección transversal de una parte de la viga de accionamiento y el aparato de cierre de las figuras 23 y 24;
la figura 26 es una vista en sección transversal de una viga de accionamiento y un aparato de cierre según una realización de la presente invención;
la figura 27 es una vista en sección transversal de la viga de accionamiento y el aparato de cierre de la figura 26;
la figura 28 es una vista en perspectiva de un conjunto de herramienta según una realización de la presente descripción; y
la figura 29 es una vista de conjunto del conjunto de herramienta de la figura 28.
Descripción detallada de realizaciones
A continuación se describirán realizaciones del instrumento quirúrgico y la DLU dados a conocer ahora en detalle con referencia a los dibujos, en los que números de referencia similares designan elementos idénticos o correspondientes en cada una de las diversas vistas.
En referencia a la figura 1, el instrumento 500 quirúrgico incluye una parte 510 de asidero, una parte 512 de cuerpo, y una unidad 16 de carga desechable (“DLU”). La parte 510 de asidero incluye un asidero 514 estacionario y un asidero móvil o gatillo 516. El asidero 516 móvil puede moverse en relación con el asidero 514 estacionario para hacer avanzar a una varilla 520 de control que sobresale desde el extremo distal de la parte 512 de cuerpo. La parte 510 de asidero y la parte 512 de cuerpo pueden estar construidas de la manera dada a conocer en la patente U.S. n.o 6.330.965. Como alternativa, pueden usarse otros instrumentos quirúrgicos con la DLU 16 para realizar intervenciones quirúrgicas endoscópicas.
En referencia a las figuras 1 y 1A, brevemente, la DLU 16 incluye un conjunto 17 de herramienta, una parte 200 de cuerpo proximal y un conjunto 202 de montaje. La parte 200 de cuerpo tiene un extremo proximal adaptado para engancharse de manera liberable con el extremo distal de un instrumento 500 quirúrgico (figura 11) de la manera que va a comentarse en detalle a continuación. El conjunto 202 de montaje está asegurado de manera pivotante a un extremo distal de la parte 200 de cuerpo y está asegurado de manera fija a un extremo proximal del conjunto 17 de herramienta. El movimiento pivotante del conjunto 202 de montaje alrededor de un eje perpendicular a un eje longitudinal de la parte 200 de cuerpo efectúa la articulación del conjunto 17 de herramienta entre una posición no articulada en la que el eje longitudinal del conjunto 17 de herramienta está alineado con el eje longitudinal de la parte 200 de cuerpo y una posición articulada en la que el eje longitudinal del conjunto 17 de herramienta está dispuesto formando un ángulo con el eje longitudinal de la parte 200 de cuerpo.
En referencia a las figuras 2-4, el conjunto 17 de herramienta incluye un conjunto 18 de cartucho y un conjunto 20 de yunque. El conjunto 20 de yunque incluye una parte 28 de yunque que tiene una pluralidad de concavidades 30 de deformación de grapas (figura 4) y una placa 32 de cubierta asegurada a una superficie superior de la parte 28 de yunque. La placa 32 de cubierta y la parte 28 de yunque definen una cavidad 34 (figura 4) entre las mismas que está dimensionada para alojar un extremo distal de un conjunto 212 de accionamiento (figura 3). La placa 32 de cubierta encierra el extremo distal del conjunto 212 de accionamiento para evitar pellizcar el tejido durante el accionamiento de la DLU 16.
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Una ranura 38 longitudinal se extiende a través de la parte 28 de yunque para facilitar el paso de un reborde 40 de retención del conjunto 212 de accionamiento. Una superficie 42 de acción de leva formada en la parte 28 de yunque está situada para engancharse con un par de elementos 40a de leva soportados en la pestaña 40 de retención del conjunto 212 de accionamiento para efectuar la aproximación del yunque y los conjuntos de cartucho. Están formados un par de elementos 44 de pivote. Un par de elementos 50 de estabilización se enganchan con un reborde 52 respectivo formado en el carro 48 para evitar que la parte 28 de yunque se deslice axialmente en relación con el cartucho 54 de grapas a medida que la superficie 42 de acción de leva pivota alrededor de los elementos 44 de pivote.
El conjunto 18 de cartucho incluye el carro 48 que define un canal 56 de soporte alargado que está dimensionado y configurado para alojar el cartucho 54 de grapas. lengüetas 58 y ranuras 60 correspondientes formadas a lo largo del cartucho 54 de grapas y el canal 56 de soporte alargado, respectivamente, funcionan para retener el cartucho 54 de grapas en una ubicación fija dentro del canal 56 de soporte. Un par de riostras 62 de soporte formadas en el cartucho 54 de grapas están situadas para apoyarse en paredes laterales del carro 48 para estabilizar adicionalmente el cartucho 54 de grapas dentro del canal 56 de soporte. El carro 48 tiene ranuras 46 para alojar los elementos 44 de pivote de la parte 28 de yunque y permitir que la parte 28 de yunque se mueva entre la posición separada y aproximada.
El cartucho 54 de grapas incluye ranuras 64 de retención (figura 2) para alojar una pluralidad de grapas o elementos 66 de sujeción y empujadores 68. Una pluralidad de ranuras 70 longitudinales separadas lateralmente se extienden a través del cartucho 54 de grapas para alojar cuñas 72 de leva verticales de una deslizadera 74 de accionamiento (figura 2). Una ranura 76 longitudinal central se extiende a lo largo de sustancialmente la longitud del cartucho 54 de grapas para facilitar el paso de la hoja 78 de bisturí (figura 4). Durante el funcionamiento de la grapadora 10 quirúrgica, el conjunto 212 de accionamiento hace tope con la deslizadera 74 de accionamiento y empuja la deslizadera 74 de accionamiento a través de las ranuras 70 longitudinales del cartucho 54 de grapas para hacer avanzar las cuñas 72 de leva para entrar en contacto de manera secuencial con los empujadores 68. Los empujadores 68 se trasladan verticalmente a lo largo de las cuñas 72 de leva dentro de las ranuras 64 de retención del elemento de sujeción y empujan los elementos 66 de sujeción desde las ranuras 64 de retención al interior de las cavidades 30 de deformación de grapas (figura 4) del conjunto 20 de yunque.
En referencia a la figura 3, el conjunto 235 de montaje incluye una parte 236 de montaje superior y una parte 238 de montaje inferior. Un elemento 284 de pivote ubicado de manera centrada se extiende desde la parte 236 de montaje superior a través de una abertura 246a respectiva formada en un primer elemento 246 de acoplamiento. La parte 238 de montaje inferior incluye un orificio 239 para alojar el elemento 284 de pivote (véase la figura 3F). El elemento 284 de pivote se extiende a través del orificio 239 y la abertura 247a de un segundo elemento 247 de acoplamiento. Cada uno de los elementos 246, 247 de acoplamiento incluye una parte 246b, 247b proximal de inmovilización configurada para alojarse en muescas 290 formadas en el extremo distal de un alojamiento interior que está formado a partir de las mitades 250 y 252 de alojamiento superior e inferior. Los elementos 246, 247 de acoplamiento retienen el conjunto 235 de montaje y las mitades 250 y 252 de alojamiento superior e inferior en una posición fija longitudinalmente entre sí al tiempo que permiten el movimiento pivotante del conjunto 235 de montaje en relación con los mismos.
En referencia a las figuras 3A-3C, cada elemento 246, 247 de acoplamiento incluye un brazo 246c de resorte en voladizo que tiene un extremo 246d distal situado para engancharse con el conjunto 235 de montaje. Más específicamente, la parte 236 de montaje superior incluye una superficie 236a superior que incluye un rebaje 236b dimensionado para alojar el extremo 246d distal del brazo 246c de resorte de un elemento 246 de acoplamiento respectivo. La parte 238 de montaje inferior incluye una superficie 238a inferior que tiene un par de superficies 238b elevadas que definen un rebaje 238c que está dimensionado para alojar el brazo 247c de resorte de un elemento 247 de acoplamiento respectivo. Alternativamente, puede formarse al menos un rebaje en el extremo proximal del conjunto 17 de herramienta.
Tal como se ilustra en las figuras 3D-3G, cuando el extremo distal de los brazos 246c, 247c de resorte de los elementos 246, 247 de acoplamiento se sitúa en los rebajes 236b y 238c de las partes 236 y 238 de montaje superior e inferior, respectivamente, los brazos 246c, 247c de resorte retienen el conjunto 235 de montaje en una posición no articulada. Los brazos 246c, 247c de resorte retendrán el conjunto 235 de montaje en su posición no articulada hasta que una fuerza predeterminada suficiente para desviar los brazos 246c de resorte de los rebajes 236b y 238c se aplique para efectuar la articulación del conjunto 235 de montaje y el conjunto 17 de herramienta. Cuando se aplica la fuerza predeterminada al conjunto 235 de montaje y al conjunto 17 de herramienta, los brazos 246c, 247c de resorte se deformarán o desviarán hacia fuera de los rebajes 236b y 238c, tal como se muestra en las figuras 3E y 3G, para permitir el movimiento pivotante del conjunto 235 de montaje (y, por tanto, el conjunto 17 de herramienta) en relación con el extremo distal de la parte 200 de cuerpo proximal de la DLU 16.
Tal como se comentó anteriormente, los brazos 246c de resorte y los rebajes 236b y 238c mantienen el conjunto 17 de herramienta en su posición no articulada hasta que se ha aplicado una fuerza predeterminada al conjunto 235 de montaje para desenganchar los brazos 246c, 247c de resorte de los rebajes 236b y 238c del conjunto 235 de montaje. Se prevé que los brazos de resorte/rebajes pueden incorporarse en cualquier dispositivo quirúrgico articulado que incluye grapas, elementos de agarre (véase la figura 3H), dispositivos de sellado mecánicos, por ejemplo, dispositivos de sellado RF, etc. Además, aunque se muestran dos brazos de resorte/rebajes, puede proporcionarse un único brazo de resorte. Además, no es necesario que el conjunto de herramienta articulado forme parte de una DLU sino que en su lugar puede estar soportado directamente en el extremo distal de un instrumento quirúrgico. Por ejemplo, el conjunto de mon
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taje puede asegurarse de manera desmontable o no desmontable al conjunto de herramienta y asegurarse directamente al extremo distal de un instrumento quirúrgico.
La mitad 250 de alojamiento superior y mitad 252 de alojamiento inferior están contenidas dentro de un manguito 251 exterior de la parte 200 de cuerpo (figura 3). La parte 200 de cuerpo incluye un corte 251a dimensionado para alojar un saliente o resalte 250a formado en la mitad 250 de alojamiento superior. La disposición del resalte 250a dentro del corte 251a evita el movimiento axial y giratorio de las mitades 250 y 252 de alojamiento superior e inferior dentro del manguito 251 exterior de la parte 200 de cuerpo. En una realización, el saliente 250a tiene una configuración sustancialmente rectangular que tiene una dimensión axial mayor que la dimensión lateral. La dimensión axial mayor proporciona una mayor área de superficie para evitar el giro de las mitades 250 y 252 de alojamiento superior e inferior dentro del manguito 251. Una parte 250b proximal del saliente 250a está en pendiente. La parte 250b proximal en pendiente permite que el manguito 251 se deslice sobre el saliente 250a a medida que las mitades 250 y 252 de alojamiento superior e inferior se sitúan dentro del manguito 253. Se prevé que el saliente 250a pueda adoptar otras configuraciones, por ejemplo, circular, cuadrada, triangular, etc., e igualmente cumplir la función para la que está previsto. Además, el saliente 250a puede resituarse en cualquier lugar a lo largo de la mitad 250 de alojamiento superior o, como alternativa, situarse en la mitad 252 de alojamiento inferior o parcialmente en cada mitad 250 y 252 de alojamiento.
El extremo proximal o punta 193 de inserción de la mitad 250 de alojamiento superior incluye botones 254 de enganche para enganchar de manera liberable el extremo distal de un instrumento quirúrgico a modo de bayoneta (véase las figuras 1A y 7). Las mitades 250 y 252 de alojamiento definen un canal 400 para alojar de manera deslizante el conjunto 212 de accionamiento axial en el mismo. Un enlace 256 de articulación está dimensionado para situarse de manera deslizante dentro de una ranura 402 formada entre las mitades 250 y 252 de alojamiento superior e inferior. Un par de conjuntos 255 de bloque en H están situados adyacentes al extremo distal de la parte 200 de alojamiento y adyacentes al extremo distal del conjunto 212 de accionamiento axial para evitar el pandeo y la comba hacia fuera del conjunto 212 de accionamiento durante la articulación y el disparo del aparato 10 de grapado quirúrgico. Cada conjunto 255 de bloque en H incluye un cuerpo 255a flexible que incluye un extremo proximal asegurado de manera fija a la parte 200 de cuerpo y un extremo distal asegurado de manera fija al conjunto 235 de montaje (figura 3).
Un elemento 288 de retención está soportado en la sección 270 de enganche del conjunto 212 de accionamiento axial. Elemento 288 de retención incluye un par de dedos 288a que están situados de manera liberable dentro de ranuras o rebajes 252a formados en la mitad 252 de alojamiento inferior. En funcionamiento, cuando la SULU 16 está unida a un instrumento quirúrgico y se acciona el conjunto 212 de accionamiento axial aplicando una fuerza predeterminada a un elemento 516 accionamiento del instrumento 500 quirúrgico (figura 11), el conjunto 212 de accionamiento axial se hace avanzar distalmente para mover conjunto 212 de accionamiento y el elemento 288 de retención distalmente. A medida que el elemento 288 de retención se hace avanzar distalmente, los dedos 288a se fuerzan respecto a los rebajes 252a para proporcionar una indicación audible y táctil de que el instrumento quirúrgico se ha accionado. El elemento 288 de retención está diseñado para evitar el accionamiento parcial involuntario de la DLU 16, tal como durante el transporte, manteniendo el conjunto 212 de accionamiento axial en una posición fija dentro de la DLU 16 hasta que se ha aplicado una fuerza axial predeterminada al conjunto 212 de accionamiento axial.
El conjunto 212 de accionamiento axial incluye una viga 266 de accionamiento alargada que incluye una cabeza 268 de trabajo distal y una sección 270 de enganche proximal. En una realización, la viga 266 de accionamiento está construida a partir de múltiples láminas de material apiladas. La sección 270 de enganche incluye un par de dedos 270a y 270b de enganche elásticos que se enganchan para el montaje con un par de ranuras de retención correspondientes formadas en el elemento 272 de accionamiento. El elemento 272 de accionamiento incluye un orificio 274 proximal configurado para alojar el extremo distal de una varilla 520 de control (figura 11) de un instrumento quirúrgico cuando el extremo proximal de la DLU 16 se engancha con la parte 512 de cuerpo de un instrumento 500 quirúrgico.
En referencia también a las figuras 5-10, la DLU 16 incluye además un mecanismo de bloqueo que incluye un elemento 300 de bloqueo y un accionador 302 de elemento de bloqueo. El elemento 300 de bloqueo (figura 6) está soportado de manera giratoria dentro de una ranura 310 longitudinal o axial (figura 7) formada en una parte proximal de la mitad 250 de alojamiento superior de la parte 200 de cuerpo de la DLU 16. El elemento 300 de bloqueo puede moverse de una primera posición (figuras 7 y 8), en la que el elemento 300 de bloqueo mantiene el conjunto 212 de accionamiento en una posición de predisparo, a una segunda posición (figuras 9 y 10), en la que el conjunto 212 de accionamiento puede moverse axialmente con libertad.
Tal como se ilustra en la figura 6, el elemento 300 de bloqueo incluye el cuerpo 312 semicilíndrico que se sitúa de manera deslizante dentro de la ranura 310 transversal formada en la mitad 250 de alojamiento superior de la parte 200 de cuerpo. El cuerpo 312 incluye un elemento 314 de leva que se extiende hacia dentro radialmente y un dedo 316 que se extiende hacia dentro radialmente. El dedo 316 está dimensionado para alojarse de manera deslizante dentro de una muesca o ranura 270c (figura 3) formada en el conjunto 212 de accionamiento. El enganche del dedo 316 en la muesca 270c del conjunto 212 de accionamiento evita que el conjunto 212 de accionamiento se mueva linealmente dentro de la parte 200 de cuerpo y, por tanto, evita el accionamiento de la DLU 16.
En referencia a las figuras 3, 5 y 7, un accionador 302 de elemento de bloqueo se sitúa de manera deslizante dentro de una ranura 320 axial (figura 7) formada en la mitad 250 de alojamiento superior de la parte 200 de cuerpo de la DLU 16.
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El accionador 302 incluye un elemento 322 de tope proximal, una guía 324 de resorte distal, y una ranura 326 de leva central. La ranura 320 axial interseca con la ranura 310 transversal de tal manera que el elemento 314 de leva del elemento 300 de bloqueo se sitúa de manera deslizante dentro de la ranura 326 de leva del accionador 302 de elemento de bloqueo. Un elemento de desviación o resorte 328 (figura 7) se sitúa alrededor de la guía 324 de resorte entre una superficie 330 distal del accionador 302 y una pared 332 (figura 7) que define el extremo distal de la ranura 320 axial. El resorte 328 empuja al accionador 302 a su posición retraída dentro de la ranura 320 axial. En su posición retraída, el elemento 322 de tope se sitúa en y se extiende radialmente hacia fuera del extremo proximal de la DLU 16 adyacente a la punta 193 de inserción de la parte 200 de cuerpo proximal y la ranura 326 de leva se sitúa para ubicar el elemento 314 de leva de tal manera que el dedo 316 del elemento 300 de bloqueo se sitúa dentro de la muesca 270c del conjunto 212 de accionamiento.
Las figuras 11-15 ilustran la DLU 16 y el instrumento 500 quirúrgico antes de y durante la unión de la DLU 16 al instrumento 500 quirúrgico. Antes de la unión de la DLU 16 al instrumento 500 quirúrgico, el resorte 328 empuja el accionador 302 a su posición retraída para mover el elemento 300 de bloqueo a su posición bloqueada tal como se comentó anteriormente. Cuando la punta 193 de inserción de la DLU 16 se inserta linealmente en el extremo 522 abierto (figura 11) de la parte 512 de cuerpo (figura 13) de un instrumento 500 quirúrgico, los botones 254 se mueven linealmente a través de las ranuras (no mostradas) formadas en el extremo 522 abierto de la parte 512 de cuerpo. A medida que los botones 254 pasan a través de las ranuras, el extremo 322a proximal del elemento 322 de tope, que está desplazado angularmente respecto a los botones 254, hace tope con una pared 276c que define las ranuras para alojar los botones 254. A medida que la DLU 16 se mueve adicionalmente al interior de la parte 512 de cuerpo, el accionador 302 de elemento de bloqueo se mueve de su posición retraída a su posición avanzada en la dirección indicada por la flecha “T” en la figura
14. A medida que el accionador 302 se mueve a su posición avanzada, el elemento 300 de bloqueo se acciona por leva en la dirección indicada por la flecha “U” en la figura 14 de su posición bloqueada (figura 8) enganchado con el conjunto 212 de accionamiento a su posición desbloqueada (figura 10) para mover el dedo 316 respecto a la muesca 270c. El mecanismo de bloqueo que incluye el elemento 300 de bloqueo y el accionador 302 de elemento de bloqueo evita el avance o la manipulación accidental o involuntaria del elemento de accionamiento de la DLU 16 tal como durante la carga de la DLU 16 en el instrumento 500 quirúrgico.
Cuando la DLU 16 se ha movido linealmente en relación con el instrumento 500 a una posición en la que una superficie 530 proximal de la parte 200 de cuerpo hace tope con la superficie 276c interior de la parte 512 de cuerpo (figura 15), la DLU 16 puede hacerse girar en relación con la parte 512 de cuerpo en una acción de tipo de bayoneta para situar los botones 254 dentro de las aberturas 536 de la parte 512 de cuerpo para bloquear la DLU 16 en la parte 512 de cuerpo. Se prevé que otros tipos de acoplamiento además de los acoplamientos de bayoneta puedan usarse para conectar la DLU 16 al instrumento 500, por ejemplo, fiador de resorte o acoplamiento a presión, acoplamientos por ajuste de fricción, elementos de inmovilización, acoplamientos roscados, etc.
En una realización de la presente descripción ilustrada en las figuras 16-20, se ilustra un conjunto 600 de bloqueo para su uso con el instrumento 500 quirúrgico y la unidad 16 de carga desechable (véase la figura 1, por ejemplo). En las realizaciones ilustradas, el conjunto 600 de bloqueo incluye un alojamiento 602, un empujador 604, una varilla 606, una guía 608 de deslizamiento, al menos un resorte 610, un dedo 612 de leva, una placa 614 de pivote que tiene ranuras 616 y un enlace 618. El conjunto 600 de bloqueo generalmente ayuda al conjunto 17 de herramienta (véase la figura 1, por ejemplo) a mantener su posición durante el disparo del instrumento 500 quirúrgico.
En referencia a las figuras 16 y 17, una parte del conjunto 600 de bloqueo está al menos parcialmente contenida dentro de un alojamiento 602. La figura 16 ilustra el conjunto 600 de bloqueo dispuesto en relación con el alojamiento 602, mientras que la figura 17 ilustra el conjunto 600 de bloqueo aislado del alojamiento 602. En la realización ilustrada de la figura 17, el empujador 604 se muestra con la varilla 606 extendiéndose distalmente del mismo. La guía 608 de deslizamiento se extiende distalmente de la varilla 606 y está en relación deslizante con ésta, permitiendo por tanto que la guía 608 de deslizamiento se mueva axialmente con respecto a la varilla 606. El resorte 610 o par de resortes (no mostrados explícitamente en esta realización) desvía distalmente la guía 608 de deslizamiento de la varilla 606.
Ahora en referencia a las figuras 18-20, se ilustran el dedo 612 de leva y la placa 614 de pivote. El dedo 612 de leva se extiende distalmente de la guía 608 de deslizamiento y la placa 614 de pivote puede disponerse en el conjunto 235 de montaje (véase la figura 3), por ejemplo. Se prevé que la placa 614 de pivote pueda disponerse en o incorporarse con una parte del conjunto 17 de herramienta. Una pluralidad de las ranuras 616 (se ilustran cinco ranuras 616) se dispone en la placa 614 de pivote y están dimensionadas para aceptar al menos una parte del dedo 612 de leva en su interior. A diferentes cantidades de articulación del conjunto 17 de herramienta (que incluyen sin articulación sustancial) con respecto a la parte 512 de cuerpo (véase la figura 1, por ejemplo), el dedo 612 de leva está aproximadamente alineado con una ranura 616 individual de la placa 614 de pivote. Las figuras 18 y 19 ilustran el dedo 612 de leva sustancialmente alineado con una ranura 616a central (oculta de la vista en la figura 19) y la figura 20 ilustra el dedo 612 de leva sustancialmente alineado con una ranura 616b lateral.
El enlace 618, ilustrado en las figuras 17 y 19, está enganchado mecánicamente con la placa 614 de pivote y el dedo 612 de leva. (En la figura 18, el enlace se ha retirado.) El enlace 618 se ilustra con una abertura 620 y una ranura 622 (figura 19). La abertura 620 está en relación pivotante con un saliente 624 en la placa 614 de pivote y la ranura 622 está enganchada de manera deslizante con el dedo 612 de leva. Esta relación permite la articulación de la placa 614 de pivo
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te con respecto a la parte 512 de cuerpo y la traslación longitudinal de la guía 608 de deslizamiento con respecto a la placa 614 de pivote.
En funcionamiento, al accionar al menos parcialmente el asidero 516 móvil (véase la figura 1, por ejemplo), el empujador 604 se fuerza distalmente, por ejemplo, a través de la varilla 520 de control (véase la figura 11, por ejemplo), provocando por tanto la traslación distal del dedo 612 de leva al menos parcialmente al interior de una ranura 616 de la placa 614 de pivote. Se prevé que accionar el asidero 516 móvil para aproximar el conjunto 18 de cartucho y un conjunto 20 de yunque (véase la figura 1A, por ejemplo) también funciona para trasladar el dedo 612 de leva distalmente. En una realización de este tipo, cuando el conjunto 17 de herramienta articulado está en su sitio y sujeto en el tejido, no puede conseguirse una articulación adicional (sin liberar el asidero 516 móvil, por ejemplo). Por tanto, el conjunto 600 de bloqueo ayuda a mantener el conjunto 17 de herramienta articulado en posición con respecto a la parte 512 de cuerpo, antes de colocar las grapas en el tejido, por ejemplo.
Tal como se comentó anteriormente, el resorte 610 desvía distalmente la guía 608 de deslizamiento de la varilla 606. Esta desviación proporcionada por el resorte 610 ayuda a garantizar que el dedo 612 de leva no se salga accidental o prematuramente de la ranura 616 de placa 614 de pivote, lo que puede dar como resultado una cantidad significativa de “juego” entre las mismas. Además, la desviación distal proporcionada por el resorte 610 ayuda a eliminar las tolerancias y/u holguras de fabricación que hay entre la guía 608 de deslizamiento y la placa 614 de pivote. También se prevé que al menos una parte del dedo 612 de leva y/o la ranura 616 puedan tener forma de cuña para ayudar a reducir cualquier movimiento involuntario entre los mismos. En una realización de este tipo, una parte distal del dedo 612 de leva y la ranura 616 sería más estrecha que una parte proximal correspondiente.
En una realización de la presente descripción ilustrada en las figuras 21 y 22, se ilustra un conjunto 700 de bloqueo para su uso con el instrumento 500 quirúrgico y la unidad 16 de carga desechable (véase la figura 1, por ejemplo). En la realización ilustrada, el conjunto 700 de bloqueo incluye un adaptador 702, un empujador 704, un pivote 706, un elemento de desviación (por ejemplo, un par de resortes 708) y un enlace 710. El conjunto 700 de bloqueo generalmente ayuda a mantener el conjunto 17 de herramienta en una posición predeterminada.
Con referencia a la figura 21, el adaptador 702 del conjunto 700 de bloqueo se aloja generalmente dentro de la parte 512 de cuerpo (véase la figura 1, por ejemplo) del instrumento 500 quirúrgico o dentro de la unidad 16 de carga desechable. En la realización ilustrada, el empujador 704 está ubicado distalmente de un par de resortes 708. El empujador 704 se desvía distalmente a través del par de resortes 708 hacia el pivote 706 del conjunto 17 de herramienta articulado. Una parte distal del empujador 704 incluye una superficie 712 de acoplamiento de empujador (figura 22) que está conformada y dimensionada para acoplarse con una superficie 714 de acoplamiento de pivote (figura 22) dispuesta adyacente a una parte proximal del pivote 706. El enlace 710 se ilustra actuando conjuntamente de manera mecánica con una parte del empujador 704 y conectado de manera pivotante a una parte del pivote 706, permitiendo por tanto que el conjunto 17 de herramienta articulado se mueva entre su primera posición y su segunda posición con respecto a la parte 512 de cuerpo. Más específicamente, el enlace 710 incluye una abertura 711 que se ajusta sobre una protuberancia 707 del pivote 706, permitiendo por tanto el movimiento pivotante entre los mismos. Además, el enlace 710 se engancha de manera deslizante con una parte del adaptador 702, permitiendo por tanto el movimiento longitudinal entre los mismos.
Ahora en referencia a la figura 22, la superficie 712 de acoplamiento de empujador es sustancialmente plana a lo largo de una mayor parte de su longitud en esta realización. Correspondientemente, la superficie 714 de acoplamiento de pivote es también plana a lo largo de una mayor parte de su longitud en la realización ilustrada. Por tanto, la desviación distal del empujador 704 hacia el pivote 706 (en la dirección de la flecha A) a través del par de resortes 708, ayuda a mantener el conjunto 17 de herramienta articulado en su primera posición, no articulada, dado que la fuerza de desviación ayuda a que el conjunto 17 de herramienta articulado resista el pivotado. Aunque se ilustran dos resortes 708, pueden proporcionarse más o menos resortes 708.
Para pivotar la herramienta 17 articulada de su primera posición, no articulada, debe superarse la fuerza de desviación distal procedente del par de resortes 708. Una acción de pivotado de este tipo, mueve el empujador 704 de manera proximal (en la dirección de la flecha B) contra la desviación del par de resortes 708. También se prevé que la superficie 714 de acoplamiento de empujador incluya fiadores (no mostrados explícitamente en esta realización) para ayudar a estabilizar el elemento 17 de mandíbula articulado en posiciones articuladas seleccionadas.
Todavía en referencia a la figura 22, el pivote 706 incluye una repisa 716 en el mismo. Tal como se muestra en la figura 22, la repisa 716 se superpone al menos con una parte del empujador 704 cuando la superficie 712 de acoplamiento de empujador está en contacto con la superficie 714 de acoplamiento de pivote. La repisa 716 está situada y configurada para ayudar a evitar pellizcar el tejido entre el empujador 704 y el pivote 706 cuando el conjunto 17 de herramienta articulado se hace girar y/o se articula.
En una realización de la presente descripción ilustrada en las figuras 23-25, se ilustra una viga 750 de accionamiento de múltiples capas que tiene una pluralidad de capas 750a-750e y puede incluirse en una unidad 16 de carga desechable (véase la figura 1, por ejemplo). Un aparato 760 de cierre, tal como una viga en I, también se ilustra. El aparato 760 de cierre incluye una parte 762 horizontal que puede hacerse avanzar hacia la superficie 42 de acción de leva (u otra su
8
perficie de contacto) para aproximar el conjunto 17 de herramienta, tal como se ha descrito en detalle anteriormente con referencia a la figura 2.
Con referencia a la figura 24, se ilustra la viga 750 de accionamiento de múltiples capas que tiene cinco capas 750a 750c. Se prevé y dentro del alcance de la presente descripción que puedan usarse menos o más capas para formar la viga 750 de accionamiento de múltiples capas. También se prevé que la viga 750 de accionamiento de múltiples capas pueda sustituir a la viga 266 de accionamiento en otras realizaciones de esta descripción. El uso de la viga 750 de accionamiento de múltiples capas puede proporcionar una mayor resistencia y flexibilidad durante el uso, específicamente, por ejemplo, mientras que el conjunto 17 de herramienta está en una posición articulada.
Una pluralidad de cortes 770 se ilustra en las figuras 23-25 que se extienden a través de cada capa de la viga 750 de accionamiento de múltiples capas. Aunque las figuras muestran entre cinco y diez cortes por capa de la viga 750 de accionamiento de múltiples capas, el número exacto de cortes 770 puede ser menor de cinco, entre cinco y diez, o mayor de diez. Además, los cortes 770 de capas adyacentes de la viga 750 de accionamiento pueden estar o no alineados entre sí. El uso de los cortes 770 reduce las dimensiones en sección transversal de la viga 750 de accionamiento y permite ajustar la fuerza de flexión. Aunque se ilustran cortes 770 rectangulares, también se contempla el uso de cortes 770 con otras formas regulares o no regulares.
La unión de cada capa 750a -750e de la viga 750 de accionamiento de múltiples capas y la unión al aparato 760 de cierre se ilustran en la figura 25. En la realización ilustrada, una capa exterior (750a ó 750e de la figura 24) se fija al aparato 760 de cierre en dos ubicaciones (estando indicada cada ubicación mediante el número 780 en la figura 25), a través de un par de soldaduras por puntos, por ejemplo. Se prevé también que cada capa 750a, 750e exterior incluya una abertura 776 que se ajusta sobre un saliente 778 que sobresale del aparato 760 de cierre. Cada capa 750a, 750e exterior se fija también a una capa adyacente (por ejemplo, 750b ó 750d) en dos ubicaciones (estando indicada cada ubicación mediante el número 781 en la figura 25), posiblemente a través de un par de soldaduras por puntos. Además, cada capa interior (por ejemplo, 750b, 750e y 750d) está unida a una capa interior adyacente (por ejemplo, 750b está unida a 750c; 750c está unida a 750b y 750d; y 750d está unida a 750c) en dos ubicaciones, a través de soldaduras por puntos, por ejemplo. Aunque se da a conocer como método de unión la soldadura por puntos, se prevén otros métodos para unir cada capa entre sí y las capas exteriores al aparato de cierre y están dentro del alcance de la presente descripción. Las realizaciones ilustradas muestran puntos 780 de unión de capas interiores adyacentes al aparato 760 de cierre, pero se prevé y está dentro del alcance de la presente descripción que los puntos 780 de unión estén dispuestos en otras ubicaciones en la viga 750 de accionamiento. Además, se prevé que al menos una capa de la viga 750 de accionamiento esté hecha de un metal, tal como acero inoxidable. Partes de la viga 750 de accionamiento y/o del aparato 760 de cierre pueden estar hechas también de o al menos parcialmente revestidas con un material de plástico, tal como se describe a continuación. Además, el aparato 790 de cierre puede incluir una superficie 766 de corte (figura 23) en el mismo para cortar el tejido.
En una realización de la presente invención ilustrada en las figuras 26 y 27, se muestran un aparato 800 de cierre y una parte de la viga 802 de accionamiento. El aparato de cierre y/o una superficie de contacto (por ejemplo, la superficie 42 de acción de leva) del conjunto 17 de herramienta (véase la figura 2, por ejemplo) puede incluir una superficie de plástico o revestimiento de plástico. En esta realización, el aparato 800 de cierre se ilustra con un par de tapas 804 que cubren al menos parcialmente las partes 806 horizontales del aparato 800 de cierre. Las tapas 804 están hechas de plástico en esta realización. Tales superficies de plásticos dispuestas en el aparato 800 de cierre y/o en la superficie de contacto del conjunto 17 de herramienta reducen generalmente la cantidad de fricción entre los mismos con respecto a dos superficies metálicas. Es decir, una interacción entre plástico y metal o entre plástico y plástico puede crear menos fricción que la interacción entre un par de superficies metálicas. Esta cantidad reducida de fricción puede corresponderse con una fuerza de disparo reducida.
Se prevé que una parte del aparato 800 de cierre, tal como el par de tapas 804, esté hecha de plástico, sobremoldeada con plástico o incluya un revestimiento de plástico. Además, una superficie de contacto del conjunto 17 de herramienta,
o al menos una parte de la misma, puede estar hecha también de plástico, sobremoldeada con plástico o incluir un revestimiento de plástico.
En una realización de la descripción, el aparato 800 de cierre puede incluir una sección transversal en forma de I, tal como se ilustra en las figuras 26 y 27. Además, el aparato 800 de cierre y la viga 802 de accionamiento pueden formar parte de una unidad 16 de carga desechable y/o parte de un instrumento 500 quirúrgico que puede ser articulado. Además, la viga 802 de accionamiento puede incluir una única capa o una pluralidad de capas (tal como se muestra en la figura 26) y al menos una parte de la viga 802 de accionamiento puede estar hecha de plástico. Aún adicionalmente, el aparato 800 de cierre puede incluir una superficie 808 de corte (figura 27) en el mismo para cortar el tejido.
Todavía en referencia a las figuras 26 y 27, la tapa 804 de plástico incluye una sección 810 reforzada que puede aumentar la resistencia del aparato 800 de cierre o puede proporcionar una conexión más resistente entre la tapa 804 y la parte 806 horizontal del aparato 800 de cierre. Se prevé también que la tapa 804 puede unirse de manera desmontable al aparato 800 de cierre. En una realización de este tipo, la tapa 804 puede desmontarse y sustituirse si se produce cualquier desgaste o daño sustancial.
9
En una realización de la presente descripción ilustrada en las figuras 28 y 29, se ilustra un conjunto 850 de herramienta. El conjunto 850 de herramienta de esta realización incluye un canal 852, un primer elemento 860 de unión, un segundo elemento 870 de unión, un conjunto 80 de yunque, una primera varilla 890 de unión y una segunda varilla 892 de unión. Las varillas 890, 892 de unión primera y segunda proporcionan una conexión resistente que facilita que los elementos del conjunto 850 de herramienta permanezcan juntos.
El canal 852 incluye una abertura 854 (se ilustran dos aberturas) adyacentes a su extremo proximal y el primer elemento 860 de unión incluye un saliente 862 (se ilustran dos salientes) que se extiende desde el mismo. El canal 852 puede conectarse al primer elemento de unión situando la(s) abertura(s) 854 sobre el/los saliente(s) 862, proporcionando así una conexión pivotante entre los mismos. Aunque no se ilustra explícitamente en la presente realización, el canal 852 puede alojar una pluralidad de elementos de sujeción quirúrgicos o un cartucho de grapas.
El conjunto 880 de yunque incluye una cubierta 882 de yunque y un yunque 886. El yunque 886 está configurado para el enganche mecánico con la cubierta 882 de yunque, por ejemplo, a través de una conexión a presión. Una abertura 884 se extiende al menos parcialmente a través de una parte de la cubierta 882 de yunque. Una abertura 884 está configurada para ajustarse sobre una protuberancia 872 dispuesta en el segundo elemento 870 de unión, proporcionando de este modo una conexión entre el conjunto 880 de yunque y el segundo elemento 870 de unión. Adicionalmente, la cubierta 882 de yunque incluye al menos una abertura 888 que se extiende al menos parcialmente a través de la misma en una realización de la descripción. La abertura 888 está configurada para ajustarse sobre el saliente 862 del primer elemento 860 de unión. En una realización de este tipo, el conjunto 880 de yunque puede hacerse pivotar con respecto al primer elemento 860 de unión y al segundo elemento 870 de unión.
El primer elemento 860 de unión incluye una primera abertura 864 y una segunda abertura 866 que se extiende a través del mismo. El segundo elemento 870 de unión también incluye una primera abertura 874 y una segunda abertura 876 que se extienden a través del mismo (figura 29). Además, el primer elemento 860 de unión y el segundo elemento 870 de unión están enganchados mecánicamente, de tal manera que las primeras aberturas 864, 874 están alineadas sustancialmente y las segundas aberturas 866, 876 están alineadas sustancialmente.
Para asegurar el primer elemento 860 de unión con el segundo elemento 870 de unión (y por tanto el canal 852 y el conjunto 880 de yunque), la primera varilla 890 de unión, o una parte de la misma, se inserta a través de las primeras aberturas 864 y 874. Para asegurar adicionalmente los elementos del conjunto 850 de herramienta, la segunda varilla 892 de unión, o una parte de la misma, se inserta a través de las segundas aberturas 866 y 876. Se prevé que la primera varilla 890 de unión y/o la segunda varilla 892 de unión sean remaches, tales como remaches de dos partes que se pueden tensar.
En una realización de la descripción, el conjunto 850 de herramienta forma parte de una unidad de carga desechable, que puede ser articulada. La articulación del conjunto 850 de herramienta puede facilitarse uniendo de manera pivotante el conjunto 850 de herramienta a una parte de cuerpo de un instrumento quirúrgico a través de la protuberancia 874 que se extiende desde el segundo elemento 870 de unión y un enlace (tal como el enlace 710 en la figura 21). Además, la presente descripción contempla un método para ensamblar el conjunto 850 de herramienta, tal como se ha descrito anteriormente.
Se entenderá que pueden hacerse diversas modificaciones a las realizaciones dadas a conocer en el presente documento. Por ejemplo, el conjunto de bloqueo descrito anteriormente puede incorporarse en una variedad de instrumentos quirúrgicos que incluyen DLU y no se limita al uso en grapadoras lineales. Además, la DLU puede estar configurada para alojar una punta de inserción de instrumento quirúrgico a diferencia de la dada a conocer. Por tanto, la descripción anterior no debe interpretarse como limitativa, sino meramente como ejemplos de diversas realizaciones.
10

Claims (4)

  1. REIVINDICACIONES
    1. Instrumento (500) quirúrgico, que comprende:
    una parte (510) de asidero;
    una parte (512) de cuerpo que se extiende distalmente desde la parte (510) de asidero y que define un primer eje longitudinal;
    un asidero (516) móvil dispuesto en la parte (510) de asidero y que actúa conjuntamente de manera mecánica con un elemento (520) de accionamiento;
    un conjunto (17) de herramienta que incluye un conjunto (20) de yunque, un conjunto (18) de cartucho y una superficie (42) de contacto, estando soportado el conjunto (17) de herramienta de manera adyacente a un extremo distal de la parte (512) de cuerpo;
    una viga (802) de accionamiento que tiene una parte de enganche proximal dispuesta adyacente a un extremo proximal de la misma y que está configurada para engancharse con una parte del elemento (520) de accionamiento;
    un aparato (800) de cierre dispuesto adyacente a un extremo distal de la viga (802) de accionamiento que está configurado para engancharse con la superficie (42) de contacto del conjunto (17) de herramienta, mediante lo cual al menos un accionamiento parcial del asidero (516) móvil mueve el aparato (800) de cierre distalmente para su enganche con la superficie (42) de contacto para aproximarse al yunque y al conjunto (20, 18) de cartucho, teniendo el aparato
    (800) de cierre una parte (806) horizontal situada para engancharse con la superficie (42) de contacto para efectuar la aproximación del conjunto (20) de yunque y el conjunto (18) de cartucho; y
    caracterizado porque:
    al menos la parte (806) horizontal del aparato (800) de cierre incluye una tapa (804) de plástico que tiene una sección (810) reforzada.
  2. 2.
    Instrumento (500) quirúrgico según la reivindicación 1, en el que al menos la parte (806) horizontal del aparato (800) de cierre está sobremoldeada con plástico para formar la tapa (804) de plástico.
  3. 3.
    Instrumento (500) quirúrgico según la reivindicación 1, en el que la tapa (804) de plástico está unida de manera desmontable al aparato (800) de cierre.
  4. 4.
    Instrumento (500) quirúrgico según la reivindicación 1, en el que la tapa (804) de plástico está unida a la parte
    (806) horizontal del aparato (800) de cierre.
    11
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US544982 2006-10-06
US11/544,983 US7637410B2 (en) 2006-10-06 2006-10-06 Surgical instrument including a locking assembly
US11/544,982 US7845535B2 (en) 2006-10-06 2006-10-06 Surgical instrument having a plastic surface
US11/544,519 US8584921B2 (en) 2006-10-06 2006-10-06 Surgical instrument with articulating tool assembly
US11/544,518 US8608043B2 (en) 2006-10-06 2006-10-06 Surgical instrument having a multi-layered drive beam
US11/544,479 US20080083807A1 (en) 2006-10-06 2006-10-06 Surgical instrument including a locking assembly

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ES07253815T Active ES2376036T3 (es) 2006-10-06 2007-09-26 Instrumento quirúrgico con una superficie de pl�?stico.
ES07253822T Active ES2366386T3 (es) 2006-10-06 2007-09-26 Instrumento quirúrgico que incluye un conjunto de bloqueo.
ES11152265T Active ES2392797T3 (es) 2006-10-06 2007-09-26 Instrumento quirúrgico que tiene una superficie de plástico
ES10011352.1T Active ES2474597T3 (es) 2006-10-06 2007-09-26 Instrumento quirúrgico que incluye un conjunto de bloqueo
ES14178631.9T Active ES2637800T3 (es) 2006-10-06 2007-10-04 Instrumento quirúrgico que tiene una viga de impulsión multicapa
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ES07253815T Active ES2376036T3 (es) 2006-10-06 2007-09-26 Instrumento quirúrgico con una superficie de pl�?stico.
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