ES2569709T3 - Fijación de contrafuerte para una grapadora circular - Google Patents

Fijación de contrafuerte para una grapadora circular Download PDF

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ES2569709T3
ES2569709T3 ES13187911.6T ES13187911T ES2569709T3 ES 2569709 T3 ES2569709 T3 ES 2569709T3 ES 13187911 T ES13187911 T ES 13187911T ES 2569709 T3 ES2569709 T3 ES 2569709T3
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staple
anchor
notch
buttress
grooves
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Scott J. Prior
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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
    • A61B17/11—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
    • 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
    • A61B17/068—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
    • A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
    • A61B17/105—Wound clamp magazines

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

Un aparato de grapado circular (10) que comprende: un conjunto (20) de yunque con un miembro (21) de yunque y un vástago (23), teniendo el miembro de yunque una formación circular de rebajos de formación de grapas; una porción (14) de cuerpo tubular que tiene un cartucho (32) de grapas, siendo conectable el vástago del conjunto (20) de yunque a la porción (14) de cuerpo tubular de modo que el conjunto de yunque sea móvil hacia y desde la porción de cuerpo tubular, comprendiendo el cartucho (32) de grapas que una pluralidad de acanaladuras (52) receptoras de grapas alineadas con los rebajos de formación de grapas, estando definidas las ranuras en una superficie (51) de contacto con tejido del cartucho; una pluralidad de grapas y un empujador (64) que tiene una pluralidad de dedos (65) que tienen una forma correspondiente a la forma de las acanaladuras (52) receptoras de grapas y que están alineadas con las acanaladuras (52) receptoras de grapas para el accionamiento de las grapas fuera del cartucho hacia los rebajos de formación de grapas del miembro del miembro de yunque; y un material de contrafuerte (74) sujeto de manera separable al cartucho (32) de grapas por el menos un anclaje (72); caracterizado por que al menos una de las acanaladuras (52) receptoras de grapas en la superficie de contacto con tejido del cartucho (32) de grapas tiene una muesca (56) conformada para retener el anclaje (72), estando configurada la muesca para pinzar el anclaje, y al menos uno de la pluralidad de dedos (65) incluye un saliente (67) dispuesto en la muesca (56), con lo que el avance de los dedos (65) del empujador (64) hace avanzar al saliente (67) hacia su acoplamiento con el anclaje (72) en la muesca (56) para empujar el anclaje hacia fuera de la muesca.

Description

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DESCRIPCION
Fijacion de contrafuerte para una grapadora circular Campo tecnico
La presente solicitud se refiere a un aparato de grapado quirurgico y, en particular, a un aparato de grapado quirurgico tiene un contrafuerte fijado de forma desmontable al mismo.
Antecedentes
Se conoce la fijacion de contrafuertes quirurgicos o materiales de refuerzo de llnea de grapas a grapadoras quirurgicas. Trumbull y otros, en la Patente de EE.UU. n° 5.263.629, revelan un material de vendaje absorbente y bioabsorbible unido a una grapadora quirurgica. Se han propuesto contrafuertes utilizados junto con un manguito tubular. Por ejemplo, la Patente de EE.UU. n° 5.503.638 de Cooper y otros propone un manguito tubular dimensionado para encajar sobre y rodear estrechamente las mordazas de una grapadora. El manguito puede estar hecho de polietileno no tejido unido a una tira de material fabricada de tejido animal.
McKean y otros, en la Patente de EE.UU. n° 5.542.594, revelan un aparato de grapado que tiene una tela biocompatible unida de manera liberable al mismo. La tela puede ser de configuration tubular para su fijacion al aparato de grapado, o se puede sujetar mediante pasadores.
Tarinelli y otros, en la Publication Internacional N° WO 08/109125, revelan un anclaje, o un material de sutura, para la fijacion de un contrafuerte, que se libera cuando el anclaje, o la sutura, es cortado por una cuchilla.
Mooradian y otros, en el documento WO 03/082126, revelan un aparato de grapado circular que tiene un material de contrafuerte colocado en el cartucho de grapas y/o el yunque. El material de contrafuerte puede estar preformado de manera que tenga una region central elevada para que se pueda colocar en el cartucho de grapas y/o el yunque. La solicitud publicada EP2620106 del solicitante describe la action de sujetar un material de contrafuerte por una sutura que se hace pasar a traves de las ranuras de grapa, sobre el contrafuerte, y que se asegura por abrazaderas dispuestas en las superficies interior y exterior del cartucho de grapas.
Existe una necesidad de metodos fiables para fijar de manera retirable un material de refuerzo o un material de contrafuerte de llnea de grapas sobre un aparato de grapado circular, u otro aparato de grapado, de manera que el material no interfiera con el funcionamiento del aparato, permanezca en el aparato hasta despues de que se disparen las grapas, y sea comodo y facil de instalar y utilizar.
Sumario
En un aspecto de la presente revelation, un aparato de grapado circular tiene un conjunto de yunque con un miembro de yunque y un vastago, y una portion de cuerpo tubular, siendo el aparato como se define en la revindication 1. El vastago del conjunto de yunque es conectable a la porcion de cuerpo tubular de manera que el conjunto de yunque sea movil hacia y fuera de la porcion de cuerpo tubular. Un material de contrafuerte esta sujeto de forma desmontable al conjunto de yunque, el cartucho de grapas o a ambos, por al menos un anclaje, y al menos uno del conjunto de yunque y cartucho de grapas tiene una muesca conformada para retener el anclaje en el mismo.
El aparato tiene un empujador con unos dedos para el accionamiento de las grapas. Al menos uno de los dedos incluye un saliente. Al menos uno del conjunto de yunque y cartucho de grapas tiene una muesca confirmada para retener el anclaje, siendo movil el empujador para mover el saliente hacia su acoplamiento con el anclaje en la muesca.
El anclaje puede ser un tramo de sutura. El aparato puede comprender ademas un adhesivo. El aparato puede comprender ademas un fiador que sujeta el anclaje y que esta situado adyacente a la muesca. En ciertas realizaciones, la muesca pinza el anclaje. La muesca se puede definir en una superficie de contacto con tejido del al menos uno del conjunto de yunque y cartucho de grapas. La muesca se puede comunicar con un rebajo de reception de grapas del cartucho de grapas. La muesca puede comunicarse con un rebajo de formation de grapas del miembro de yunque.
En ciertas realizaciones, la muesca tiene una primera porcion y una segunda porcion, siendo la primera porcion de una dimension mas pequena que el diametro del anclaje y siendo la segunda porcion mas grande que la primera porcion.
El material de contrafuerte puede definir caracterlsticas seleccionadas del grupo que consiste en hendiduras y perforaciones. El material de contrafuerte puede definir hendiduras que se extienden desde un borde exterior del mismo. El saliente puede cortar el anclaje.
Breve descripcion de los dibujos
Realizaciones del dispositivo quirurgico ahora descrito se revelan en este documento con referencia a los siguientes
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dibujos:
La figura 1A es una vista en perspectiva de un instrumento de grapado segun una realizacion de la presente revelacion;
La figura 1B es una vista en seccion transversal parcial del instrumento de grapado mostrado en la figura 1A;
La figura 2 es una vista en planta superior de un cartucho de grapas, y una vista detallada de una porcion del mismo, segun una realizacion de la presente revelacion;
La figura 3 es una vista en planta superior de un contrafuerte quirurgico segun una realizacion de la presente revelacion;
La figura 4 es una vista en planta superior de un cartucho de grapas, y una vista detallada de una porcion del mismo, segun una realizacion de la presente revelacion;
La figura 5 es una vista en perspectiva de un miembro empujador segun una realizacion de la presente revelacion; y
La figura 6 es una vista en planta superior de un contrafuerte con un borde exterior segun otra realizacion de la presente revelacion.
Descripcion detallada
Las personas expertas en la materia entenderan la presente invencion a partir de la lectura de la siguiente descripcion en conjuncion con los dibujos anexos. Los caracteres de referencia indican los mismos elementos o elementos similares en todos los dibujos. Como es habitual, el termino "distal" se refiere a un lugar mas alejado del usuario del instrumento y el termino "proximal" se refiere a un lugar que esta mas cerca del usuario del instrumento.
Se muestra en la figura 1A un instrumento de grapado circular 10 que tiene una porcion 12 de mango, una porcion 14 de cuerpo tubular y un conjunto 20 de yunque. El conjunto 20 de yunque esta en el extremo distal del instrumento y es movil hacia y fuera de la porcion de cuerpo tubular. La porcion 12 de mango tiene al menos un mango movil 33 para accionar el disparo de las grapas y el corte de tejido. Un boton 35 esta en el extremo proximal de la porcion 12 de mango y se puede girar para mover el conjunto 20 de yunque hacia la porcion de cuerpo tubular o fuera de la porcion de cuerpo tubular. Se muestra un contrafuerte dispuesto generalmente alrededor del vastago 23.
Aunque se describe en detalle un aparato de grapado circular en el presente documento, en cualquiera de las realizaciones reveladas en el presente documento el aparato de grapado puede ser una grapadora endoscopica lineal, una grapadora lineal para cirugla abierta, una grapadora quirurgica transversal u otro dispositivo quirurgico. Grapadoras circulares se revelan en la Patente de EE.UU. N° 5.915.616. Grapadoras endoscopicas se revelan en las patentes de EE.UU. Numeros 6.330.965 y 6.241.139. Grapadoras quirurgicas transversales se revelan en la patente de EE.UU. N° 5.964.394. La patente de EE.UU. N° 7.334.717 revela una grapadora destinada a intervenciones quirurgicas abiertas.
La porcion de cuerpo tubular puede ser flexible, recta o curva, o puede estar configurada de otra manera para la intervencion quirurgica. El extremo distal de la porcion 14 de cuerpo tubular tiene un cartucho 32 de grapas dispuesto en su interior. El cartucho de grapas tiene una formacion circular de acanaladuras 52 receptoras de grapas definida en una superficie 51 de contacto con tejido del cartucho 32 de grapas. El conjunto 20 de yunque tiene un miembro 21 de yunque con una formacion circular de rebajos de formacion de grapas que se corresponden con las acanaladuras 52 receptoras de grapas. El conjunto de yunque tambien tiene un vastago 23 que se conecta con una varilla 15 en la porcion 14 de cuerpo tubular.
Un empujador de grapas esta dispuesto en el cartucho 32 de grapas y tiene una pluralidad de dedos o empujadores 65 que estan alineados con las acanaladuras 52 de recepcion de grapas. El empujador de grapas es un miembro conico que esta dispuesto en el cartucho de grapas. El empujador es movil en la direccion distal para impulsar las grapas fuera del cartucho y hacia los rebajos de formacion de grapas en el miembro 21 de yunque. Hay tres filas circulares de grapas que son impulsadas hacia el tejido, segun se muestra en la figura 2. Una cuchilla tiene una forma cillndrica y esta dispuesta radialmente hacia el interior del empujador. La cuchilla esta montada en una superficie del empujador de grapas de manera que, despues de que las grapas son impulsadas a traves del tejido y hacia los rebajos de formacion de grapas, se corta el tejido radialmente interior a las filas circulares de grapas. El cartucho 32 de grapas puede ser un conjunto desmontable y reemplazable de manera que el resto del aparato de grapado circular se pueda volver a esterilizar y a utilizar, o el aparato de grapado circular 10 se puede reutilizar en el mismo paciente sin reesterilizacion.
La varilla 15 en el interior de la porcion 14 de cuerpo tubular se extiende proximalmente a traves del aparato hasta el boton 35. El extremo distal del boton 35 esta sujeto a un miembro que tiene una ranura helicoidal definida en una superficie del mismo. Un pasador fijado a un extremo proximal de la varilla esta dispuesto en la ranura de modo que, cuando se hace girar el boton 35, el pasador se desplaza en la ranura, moviendo la varilla 15 en una direccion distal o proximal. El vastago 23 de yunque, que esta sujeto a la varilla, tambien se mueve, moviendo el conjunto 20 de
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yunque hacia o lejos de la porcion 14 de cuerpo tubular. Cuando el boton 35 se hace girar en una primera direccion, el conjunto de yunque se mueve alejandose de la porcion de cuerpo tubular, permitiendo que se coloque tejido entre el conjunto de yunque y la superficie de contacto con el tejido del cartucho de grapas. Cuando el boton 35 se hace girar en una segunda direccion, el conjunto de yunque se mueve hacia la porcion de cuerpo tubular, permitiendo que el tejido quede sujeto entre el cartucho de grapas y el conjunto de yunque. Se contemplan otros medios para mover el conjunto de yunque con respecto a la porcion de cuerpo tubular. Se contempla tambien, en cualquiera de las realizaciones reveladas en el presente documento, que el instrumento 10 se pueda conectar a un conjunto motorizado. Por ejemplo, se puede disponer un conjunto motorizado en la porcion 12 de mango, y se puede suministrar alimentacion electrica desde fuentes externas, o desde una baterla dispuesta en la porcion 12 de mango.
El mango o mangos pivotables 33 pueden conectarse a un miembro tubular o a un par de bandas que estan sujetas al empujador 64 de grapas, por ejemplo varillajes o similares. De esta manera, cuando se presionan el mango o mangos 33, se hacen avanzar el miembro tubular o las bandas, moviendo hacia delante al empujador 64 de grapas, guiando las grapas a traves del tejido y contra el yunque, y haciendo avanzar la cuchilla para cortar tejido radialmente hacia el interior de las filas de grapas quirurgicas.
Como se muestra en la figura 2, un sistema 70 de fijacion de contrafuerte esta dispuesto en el cartucho 32 de grapas. El cartucho de grapas tiene una pluralidad de acanaladuras 52 receptoras de grapas definidas en una superficie 51 de contacto con tejido del mismo. Solo se muestra en la figura 2 una parte de las acanaladuras 52 receptoras de grapas, pero se entiende que las filas de acanaladuras 52 receptoras de grapas se extienden por todo el recorrido de la cara circular del miembro 21 de yunque. Las acanaladuras 52 receptoras de grapas tienen una fila interior 53, una fila central 54 y una fila exterior 55. La fila central 54 de acanaladuras 52 receptoras de grapas incluye al menos una muesca 56 que se extiende hacia fuera desde la varilla 15 del aparato. Esta al menos una muesca 56 recibe un anclaje, que es una correa, cable, alambre, hilo, filamento o similar, que puede ser, por ejemplo, un tramo de sutura 72. La muesca 56 esta configurada para tener una forma que pinza el tramo de sutura 72. Por ejemplo, la muesca 56 tendra una primera porcion 56a con una primera dimension y una segunda porcion 56b con una segunda dimension. La primera dimension es menor que el diametro, o dimension en seccion transversal, del tramo de sutura, de modo que el tramo de sutura es retenido en la muesca. La segunda dimension es mayor que la primera dimension, permitiendo que el tramo de sutura se mueva fuera de la muesca. En cualquiera de las realizaciones reveladas en el presente documento, la muesca puede tener una forma similar al numero 8, la forma de la letra V o cualquier forma para retener y liberar el anclaje o sutura.
El anclaje 72, que puede ser una correa, cable, alambre, hilo, filamento, sutura o similares, es deseablemente una sutura bioabsorbible, que se puede fabricar a partir de acido poliglicolico, glicolida-carbonato de trimetileno, acido polilactico o cualquiera de los materiales bioabsorbibles a partir de los cuales se pueden hacer suturas, materiales de contrafuerte y otros implantes medicos. Materiales derivados de animales, que son conocidos en la tecnica, se contemplan tambien para el contrafuerte y/o el anclaje. En cualquiera de las realizaciones reveladas en el presente documento, la sutura puede ser un material que no sea bioabsorbible. En ciertas realizaciones, el anclaje se fija a la grapadora y se retira con la grapadora despues de que se han disparado las grapas. En ciertas realizaciones, el anclaje es bioabsorbible y se sujeta al contrafuerte o se forma como parte del contrafuerte, y se deja en el cuerpo del paciente. Alternativamente, el cirujano puede recortar el anclaje o anclaje durante la cirugla.
El tramo de sutura se puede sujetar al contrafuerte 74 por soldadura, o usando un adhesivo, o por prensado termico, o cualquier metodo conocido. Alternativamente, el tramo de sutura puede estar formado integralmente con el contrafuerte 74, como una extension del mismo. Por ejemplo, el contrafuerte 74 se puede formar como un disco circular, como se muestra en la figura 3, y puede tener unas correas que se extienden desde el borde exterior 76 del mismo. Las correas pueden separarse del contrafuerte 74 en unas perforaciones, o en virtud de la capacidad de bioabsorcion del material. Por ejemplo, las correas se pueden hacer mucho mas delgadas que el contrafuerte 74. En otro ejemplo, las correas o el tramo de sutura pueden ser recortado por el cirujano despues de que se disparen las grapas y el instrumento de grapado 10 se retire del sitio. El anclaje 72 o los anclajes 72 pueden ser uno o mas tramos de material de sutura. Es decir, el anclaje 72 puede ser una unica pieza de sutura con porciones que se extienden dentro de la muesca o muescas 56 para retener el contrafuerte. En cualquiera de las realizaciones reveladas en el presente documento, el anclaje 72 comprende una pluralidad de piezas de material de sutura que se extienden dentro de las muescas correspondientes.
En cualquiera de las realizaciones reveladas en el presente documento, un fiador se puede sujetar al anclaje, al instrumento quirurgico 10 o a ambos, para ayudar a retener el anclaje y el contrafuerte sobre el instrumento. Por ejemplo, e fiador puede ser un herrete o un anillo o pinza de aplastamiento sujeto al anclaje en un lugar adyacente a la muesca.
El sistema 70 de fijacion de contrafuerte permite que el contrafuerte 74 sea liberado de la grapadora de modo que la grapadora 10 pueda ser retirada del sitio. El empujador 64 de grapas tiene una pluralidad de empujadores o dedos 65, cada uno de los cuales se extiende dentro de las acanaladuras 52 de recepcion de grapas para expulsar las grapas. Los dedos tienen una forma que se corresponde con la forma de la acanaladura 52 de recepcion de grapas. Los dedos 65, que estan dispuestos en la acanaladura o acanaladuras 52 de recepcion de grapas que tiene la muesca 56, tienen una extension correspondiente 67 que esta dispuesta en la muesca 56. Cuando el empujador 64 de grapas se hace avanzar, los dedos avanzan, y el dedo o dedos 65 que tienen la extension 67 empujaran el tramo
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de sutura, correa o similar desde la muesca 56.
En cualquiera de las realizaciones reveladas en el presente documento, el contrafuerte en si mismo puede estar fabricado de una variedad de materiales biologicamente compatibles, y puede estar fabricado del mismo material que el anclaje. En ciertas realizaciones preferidas, el material de contrafuerte es un material bioabsorbible, tal como acido poliglicolico, copolimero de glicolida-carbonato de trimetileno, acido polilactico y se pueden utilizar materiales absorbibles de glicolida, tal como polipropileno o poliester. El contrafuerte puede estar hecho de materiales derivados de animales, que son conocidos en la tecnica. Por ejemplo, el material de contrafuerte se puede hacer de tejido porcino o bovino, tal como el colageno dermico porcino, colageno de pericardio bovino u otros materiales. El contrafuerte puede fabricarse por extrusion, afieltrado, tricotado o trenzado, moldeo, tecnicas de no tejido, tales como metodos de pegado por soplado, fusion de pegado por hilatura union u otros metodos. El contrafuerte puede ser poroso o no poroso. El contrafuerte puede ser una espuma o una malla. El contrafuerte puede tener capas de diferentes materiales o ser alguna otra forma de material compuesto. El material de contrafuerte se puede hacer como se describe en la Solicitud de Patente de EE.UU. N° 13/293.215.
En cualquiera de las realizaciones reveladas en el presente documento, el contrafuerte 74 tiene una forma que desalienta el combado o arrugamiento del contrafuerte. Por ejemplo, el contrafuerte 74, mostrado en la figura 3, tiene hendiduras que se extienden desde el borde exterior 76 del mismo. Se pueden practicar otras hendiduras o aberturas en el contrafuerte 74. El contrafuerte 74 tiene un agujero en su parte media para permitir que el vastago de la grapadora lo atraviese.
En una realizacion adicional mostrada en la figura 4, el instrumento de grapado circular 10 tiene dos filas de acanaladuras 152 receptoras de grapas. El cartucho 132 de grapas tiene una superficie 151 de contacto con tejido que define una fila interior 153 y una fila exterior 155 de las acanaladuras receptoras de grapas. Aunque solo se muestran en la figura 4 siete acanaladuras receptoras de grapas, se entiende que las acanaladuras se extienden alrededor de toda la superficie de contacto con tejido de la grapadora. Al menos una de las acanaladuras receptoras de grapas en la fila interior 153 tiene una muesca 156 para la recepcion de un anclaje, tramo de sutura, correa, alambre, etc., como se ha descrito anteriormente con relacion a las figuras 2 y 3. La muesca 156 tiene una primera porcion 156a y la segunda porcion 156b, como se describio anteriormente con relacion a la figura 2. Este sistema 170 de fijacion de contrafuerte permite que el contrafuerte sea liberado de la grapadora de modo que la grapadora 10 se pueda retirar del sitio. La segunda porcion 156b es como se describio anteriormente con relacion a la figura 2. Este sistema 170 de fijacion de contrafuerte permite que el contrafuerte sea liberado de la grapadora de modo que la grapadora 10 pueda retirarse del sitio. La grapadora esta dispuesta en lo demas como se ha discutido anteriormente con relacion a las figuras 1 a 3. El empujador de grapas, tal como el empujador 64, es un miembro conico que puede hacerse avanzar para expulsar las grapas desde las acanaladuras 152 y tiene una pluralidad de empujadores o dedos 65, cada uno de los cuales se extiende dentro de las acanaladuras 152 receptoras de grapas. Los dedos tienen una forma que se corresponde con la forma de la acanaladura 152 receptora de grapas. Los dedos 65 que estan dispuestos en la acanaladura o acanaladuras 152 receptoras de grapas que tienen la muesca 156 tienen una extension correspondiente 67 que esta dispuesta en la muesca 156. Cuando se hace avanzar al empujador de grapas, los dedos avanzan y el dedo o dedos 65 que tienen la extension 167 empujaran el tramo de sutura, correa o similares desde la muesca 156. El contrafuerte puede ser como se muestra en la figura 3, o puede ser cualquier contrafuerte generalmente circular, formado por cualquiera de los materiales descritos anteriormente. El anclaje esta dispuesto en la muesca para retener el contrafuerte en la grapadora y puede sujetarse al contrafuerte, o a la grapadora, como se discutio anteriormente con relacion a la figura 3.
Las figuras 2 y 4 muestran la superficie 51 o 151 de contacto con tejido y solo una seccion de las acanaladuras 52 o 152 receptoras de grapas. En ciertas realizaciones, el sistema 70 o 170 de fijacion de contrafuerte tiene doce rebajos receptores de grapas distribuidos a lo largo de la superficie 51 o 151 de contacto con tejido y tienen la muesca 56 o 156. Se pueden practicar mas o menos de tales muescas para fijar firmemente el contrafuerte al instrumento de grapado.
Uno de los dedos 65 del empujador de grapas se muestra en la figura 5 e incluye el saliente 67 para empujar el anclaje hacia fuera de la muesca 156. En cualquiera de las realizaciones reveladas en este documento, la grapadora incluye uno o mas miembros empujadores para expulsar las grapas desde las acanaladuras receptoras 52, 152 de grapas y tiene un dedo 65 que se corresponde con cada una de las acanaladuras. Los dedos que corresponden a las acanaladuras que tienen la muesca para retener el anclaje tienen salientes 67 para empujar el anclaje hacia fuera de la acanaladura.
Como se muestra en la figura 6, el sistema de fijacion de contrafuerte puede ser como se ha descrito anteriormente con relacion a las figuras 1 a 5, con anclajes para retener el contrafuerte. El contrafuerte 274 mismo incluye unas lenguetas 278 en el borde exterior 276 del contrafuerte, que se puede formar practicando hendiduras que se extienden desde el borde exterior del contrafuerte, o mediante la formacion de lenguetas que se extienden hacia fuera desde el borde exterior 278. Asimismo, se pueden formar las lenguetas de manera que se extiendan desde la superficie inferior del contrafuerte 274, adyacente a una fila interior o a una fila exterior de acanaladuras. Las lenguetas estan dispuestas para extenderse en al menos algunas de las acanaladuras receptoras de grapas, tales como las acanaladuras 152 o 52 de las figuras 2 y 4, y un anclaje se extiende dentro de la muesca asociada con al menos algunas de las acanaladuras, tales como las muescas 156 o 56. De esta manera, el anclaje retiene por
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friccion el contrafuerte sobre la grapadora, acoplandose con la lengueta 278 del contrafuerte. En cualquiera de las realizaciones reveladas en el presente documento, el sistema de fijacion de contrafuerte incluye un contrafuerte con lenguetas, anclajes o ambos, para retener de manera liberable el contrafuerte.
En cualquiera de las realizaciones reveladas en el presente documento, la superficie de contacto con tejido del cartucho de grapas y/o la superficie de contacto con tejido del miembro de yunque tienen forma en seccion transversal escalonada o ahusada. Deseablemente, una o mas filas de acanaladuras 52 receptoras de grapas estan definidas en una superficie que tiene una altura diferente de la superficie en la que estan definidas una o mas filas de acanaladuras receptoras de grapas. Ademas, en cualquiera de las realizaciones reveladas en este documento, el tamano de las grapas en algunas de las acanaladuras receptoras de grapas puede ser diferente del tamano de las grapas en otras de las acanaladuras receptoras de grapas. Por ejemplo, la fila interior de grapas puede ser de menor tamano (tal como una longitud de patilla) que la fila exterior de grapas (que tiene una mayor longitud de patilla) o, si hay tres filas de acanaladuras receptoras de grapas, la fila interior de grapas puede ser menor que la fila central de grapas y la fila exterior de grapas.
En cualquiera de las realizaciones reveladas en este documento, las acanaladuras receptoras de grapas pueden tener una forma curva o angulada. Esto permite que las acanaladuras receptoras de grapas se coloquen mas cerca una de otra dentro del cartucho de grapas y/o el yunque. Los rebajos formadores de grapas en el miembro de yunque pueden tener una forma correspondiente de manera que los rebajos puedan estar mas estrechamente posicionados unos con respecto a otros en el miembro de yunque. Las grapas tienen deseablemente una forma correspondiente.
Aunque se han descrito anteriormente instrumentos de grapado circulares, el instrumento de grapado podrla tener filas de grapas, rebajos formadores de grapas y acanaladuras receptoras de grapas que no definan un clrculo completo, sino mas bien una forma semicircular, ovalada o semiovalada. El instrumento de grapado podrla tener filas de grapas, rebajos de formacion de grapas y acanaladuras receptoras de grapas que produzcan alguna otra forma, tales como diversas formas poligonales, o formas parcialmente poligonales. Aunque la presente invencion ha sido descrita en varias realizaciones, no es la intencion restringir o limitar en modo alguno el alcance de las reivindicaciones adjuntas. Ventajas y modificaciones adicionales pueden hacerse evidentes facilmente a los expertos en la materia.

Claims (7)

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    REIVINDICACIONES
    1. Un aparato de grapado circular (10) que comprende:
    un conjunto (20) de yunque con un miembro (21) de yunque y un vastago (23), teniendo el miembro de yunque una formacion circular de rebajos de formacion de grapas;
    una porcion (14) de cuerpo tubular que tiene un cartucho (32) de grapas, siendo conectable el vastago del conjunto (20) de yunque a la porcion (14) de cuerpo tubular de modo que el conjunto de yunque sea movil hacia y desde la porcion de cuerpo tubular, comprendiendo el cartucho (32) de grapas que una pluralidad de acanaladuras (52) receptoras de grapas alineadas con los rebajos de formacion de grapas, estando definidas las ranuras en una superficie (51) de contacto con tejido del cartucho; una pluralidad de grapas y un empujador (64) que tiene una pluralidad de dedos (65) que tienen una forma correspondiente a la forma de las acanaladuras (52) receptoras de grapas y que estan alineadas con las acanaladuras (52) receptoras de grapas para el accionamiento de las grapas fuera del cartucho hacia los rebajos de formacion de grapas del miembro del miembro de yunque; y un material de contrafuerte (74) sujeto de manera separable al cartucho (32) de grapas por el menos un anclaje (72);
    caracterizado por que al menos una de las acanaladuras (52) receptoras de grapas en la superficie de contacto con tejido del cartucho (32) de grapas tiene una muesca (56) conformada para retener el anclaje (72), estando configurada la muesca para pinzar el anclaje, y al menos uno de la pluralidad de dedos (65) incluye un saliente (67) dispuesto en la muesca (56),
    con lo que el avance de los dedos (65) del empujador (64) hace avanzar al saliente (67) hacia su acoplamiento con el anclaje (72) en la muesca (56) para empujar el anclaje hacia fuera de la muesca.
  2. 2. El aparato de grapado circular segun la reivindicacion 1, en el que el anclaje (72) es un tramo de sutura.
  3. 3. El aparato de grapado circular segun la reivindicacion 1 o la reivindicacion 2, que comprende ademas un adhesivo que fija el material de contrafuerte (74) al conjunto (20) de yunque, al cartucho (32) de grapas o a ambos.
  4. 4. El aparato de grapado circular segun cualquier reivindicacion precedente, que comprende ademas un fiador que sujeta el anclaje (72) y que esta situado adyacente a la muesca (56).
  5. 5. El aparato de grapado circular segun cualquier reivindicacion precedente, en el que la muesca (56) tiene una primera porcion (56a) y una segunda porcion (56b), siendo la primera porcion mas pequena en dimension que el diametro del anclaje (72), y siendo la segunda porcion mas grande que la primera porcion.
  6. 6. El aparato de grapado circular segun cualquier reivindicacion precedente, en el que el material de contrafuerte (74) define caracterlsticas seleccionadas del grupo que consiste en hendiduras y perforaciones.
  7. 7. El aparato de grapado circular segun la reivindicacion 6, en el que el material de contrafuerte (74) define hendiduras que se extienden desde un borde exterior (76) del mismo.
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US20140097224A1 (en) 2014-04-10
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US11759211B2 (en) 2023-09-19
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