ES2586814T3 - Instrumento quirúrgico motorizado - Google Patents
Instrumento quirúrgico motorizado Download PDFInfo
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- ES2586814T3 ES2586814T3 ES11005057.2T ES11005057T ES2586814T3 ES 2586814 T3 ES2586814 T3 ES 2586814T3 ES 11005057 T ES11005057 T ES 11005057T ES 2586814 T3 ES2586814 T3 ES 2586814T3
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Abstract
Un instrumento quirúrgico motorizado (1000) que incluye: un alojamiento (1100); una parte endoscópica (1400) que se extiende distalmente desde el alojamiento (1100) y que define un primer eje longitudinal; una parte de eje (1500) que se puede conectar selectivamente a un extremo distal (1402) de la parte endoscópica (1400); y un efector de extremo (1600) que se puede conectar selectivamente a un extremo distal (1502) de la parte de eje (1500) y que define un segundo eje longitudinal que se extiende a través de él, caracterizado por que al menos un componente electrónico (1700) se incluye en una parte del instrumento quirúrgico (1000); donde el instrumento quirúrgico comprende una pluralidad de diferentes partes de eje (1500) y una pluralidad de diferentes efectores de extremo (1600) que se pueden conectar selectivamente al instrumento quirúrgico (1000); y donde el al menos un componente electrónico es un sensor que detecta el tipo de parte de eje (1500) conectada a la parte endoscópica (1400) o el tipo de efector de extremo (1600) que está conectado a la parte de eje (1500).
Description
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DESCRIPCION
Instrumento quirurgico motorizado
Antecedentes
Campo tecnico
La presente divulgacion se refiere a instmmentos quirurgicos para sujetar tejido corporal y, con caracter mas particular, a un instrumento quirurgico motorizado que tiene un engranaje impulsor configurado para que se pueda mover con el fin de afectar a la rotacion, a la articulacion y al accionamiento del instrumento.
Antecedentes de la tecnica relacionada con la invencion
Se conocen bien en la tecnica los instrumented quirurgicos en los que el tejido en primer lugar se agarra o se abraza entre una estructura de mordazas opuestas y luego se une mediante elementos de sujecion quirurgicos. En algunos instrumentos, se provee un bistun para cortar el tejido que se ha unido mediante los elementos de sujecion. Los elementos de sujecion incluyen tfpicamente grapas quirurgicas y elementos de sujecion de polfmeros en dos piezas.
Los instrumentos destinados a este fin podnan incluir dos miembros alargados que se usen respectivamente para capturar o abrazar tejido. Tfpicamente, uno de los miembros porta un cartucho de grapas que aloja una pluralidad de grapas dispuestas en filas, mientras que el otro miembro tiene un yunque que define una superficie para formar las patas de las grapas a medida que las grapas se impulsan desde el cartucho de grapas. Varios instrumentos incluyen abrazaderas, empunaduras o mandos para efectuar el accionamiento junto con la articulacion y la rotacion de un efector de extremo. Dichos instrumentos quirurgicos pueden requerir que el usuario aplique una fuerza significativa en el accionamiento de las empunaduras, mandos, etc., y requieran mas de una mano para manejar el instrumento.
Sena conveniente disponer de instrumentos quirurgicos con dispositivos de accionamiento que requieran menos esfuerzo para manejarlos. Adicionalmente, conviene tambien disponer de instrumentos quirurgicos que realicen multiples funciones en una operacion con una sola mano.
Sumario
La presente divulgacion se refiere a un instrumento quirurgico para la colocacion de grapas que incluye un conjunto de empunadura, una primera parte endoscopica, un motor y un primer efector de extremo. La primera parte endoscopica se puede conectar selectivamente a una parte distal del conjunto de empunadura, define un eje geometrico longitudinal, incluye un alojamiento adyacente a una parte proximal del mismo e incluye un miembro de accionamiento. El motor esta dispuesto en cooperacion mecanica con el alojamiento de la primera parte endoscopica. El motor esta conectado operativamente al miembro de accionamiento para mover al miembro de accionamiento sustancialmente a lo largo del eje geometrico longitudinal. El primer efector de extremo se puede conectar selectivamente a la parte distal de la primera parte endoscopica y esta configurado para realizar una primera funcion de colocacion de grapas.
La presente descripcion tambien se refiere a un instrumento quirurgico para la colocacion de grapas que incluye un conjunto de empunadura, una parte endoscopica y un conjunto de efector de extremo. El conjunto de empunadura incluye una parte conductora dispuesta operativamente con el mismo. La parte endoscopica se puede conectar selectivamente a una parte distal del conjunto de empunadura y define un eje geometrico longitudinal. El efector de extremo se puede conectar selectivamente a una parte distal de la parte endoscopica, y esta configurado para realizar una funcion de colocacion de grapas. El conjunto de empunadura esta configurado para conectarse selectiva y operativamente a una parte endoscopica controlable manualmente y a una parte endoscopica que incluye un motor en relacion de asociacion con la misma.
La invencion se define en la reivindicacion 1. Las realizaciones preferidas se describen en las reivindicaciones dependientes. El documento de patente de EE.UU. US 2005/075657 A1 describe las caractensticas del preambulo de la reivindicacion 1.
Descripcion de los dibujos
En la presente memoria se divulga una realizacion del instrumento quirurgico motorizado que ahora se describe con referencia a los dibujos, en los que:
La Figura 1 es una vista en perspectiva de un instrumento quirurgico motorizado segun una realizacion de la presente divulgacion;
La Figura 2 es una vista parcial en perspectiva y a escala ampliada del instrumento quirurgico motorizado de la Figura 1;
La Figura 3 es una vista parcial en perspectiva y a escala ampliada del instrumento quirurgico motorizado de las Figuras 1 y 2;
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La Figura 4 es una vista parcial en perspectiva de los componentes internos del instrumento quirurgico motorizado de las Figuras 1 a 3 segun una realizacion de la presente divulgacion;
Las Figuras 5 y 6 son vistas parciales en perspectiva y en corte que muestran los componentes internos del instrumento quirurgico motorizado de las Figuras 1 a 4 dispuesto en una primera posicion;
La Figura 7 es una vista en corte transversal de los componentes internos del instrumento quirurgico motorizado de las Figuras 1 a 5 dispuesto en una segunda posicion;
La Figura 8A es una vista parcial en perspectiva que incluye una parte endoscopica del instrumento quirurgico motorizado de las Figuras 1 a 7 segun una realizacion de la presente divulgacion;
La Figura 8B es una vista en perspectiva a escala ampliada de una parte del instrumento quirurgico motorizado indicado en la Figura 8 A;
Las Figuras 9 a 11 son vistas parciales en perspectiva y en corte de los componentes internos del instrumento quirurgico motorizado de las figuras 1 a 8 dispuesto en una tercera posicion;
Las Figuras 12 y 13 son vistas en perspectiva a escala ampliada de partes del instrumento quirurgico motorizado de las Figuras 1a 11 segun una realizacion de la presente divulgacion;
La Figura 14 es una vista en corte transversal de una parte del instrumento quirurgico motorizado que incluye una parte de empunadura segun una realizacion de la presente divulgacion;
Las Figuras 15A y 15B son vistas en perspectiva de un eje de articulacion de la parte distal del instrumento quirurgico motorizado de la Figura 1 segun una realizacion de la presente divulgacion;
La Figura 16 es una vista en perspectiva de un instrumento quirurgico motorizado que tiene una parte de eje que se puede conectar selectivamente segun una realizacion de la presente divulgacion;
Las Figuras 17A a 17C son cada una vistas en perspectiva de un efector de extremo que tiene unos cartuchos circulares para grapas acoplados con una parte de eje, pudiendose conectar cada parte de eje con el instrumento quirurgico motorizado de la Figura 16;
La Figura 18 es una vista en perspectiva de un efector de extremo que tiene un miembro de mordazas paralelas acoplado con una parte de eje, cuya parte de eje se puede conectar con el instrumento quirurgico motorizado de la Figura 16;
La Figura 19 es una vista posterior en perspectiva del instrumento quirurgico accionado a motor de la Figura 16; y
Las Figuras 20 y 21 son vistas parciales de conjunto de instrumentos quirurgicos motorizados segun realizaciones de la presente invencion, cada una de cuyas vistas ilustra un conjunto de empunadura y una parte endoscopica.
Descripcion detallada de realizaciones
A continuacion se describen detalladamente realizaciones del instrumento quirurgico motorizado presentemente divulgado con referencia a los dibujos, en los que los numeros de referencia similares designan elementos identicos o correspondientes en cada una de las diversas vistas. Tal como se usa en la presente memoria, el termino “distal” se refiere a la parte del instrumento quirurgico motorizado, o de un componente del mismo, que este mas lejos del usuario, mientras que el termino “proximal” se refiere a la parte del instrumento quirurgico motorizado, o de un componente del mismo, que este mas cerca del usuario.
En las figuras se hace referencia a un instrumento quirurgico motorizado, por ejemplo una grapadora quirurgica, con el numero 100 de referencia. Refiriendose inicialmente a la Figura 1, el instrumento quirurgico motorizado 100 incluye un alojamiento 110, una parte endoscopica 140 que define un eje geometrico longitudinal A-A que se extiende a traves de ella, y un efector de extremo 160, que define un eje geometrico longitudinal B-B (ilustrado sustancialmente alineado con el eje geometrico A-A de la Figura 1) que se extiende a traves del mismo. La parte endoscopica 140 se extiende distalmente desde el alojamiento 110, y un efector de extremo 160 esta dispuesto junto a una parte distal 142 de la parte endoscopica 140.
Con referencia a las Figuras 2 y 3, se ha ilustrado una vista a escala ampliada del alojamiento 110 segun una realizacion de la presente divulgacion. En la realizacion ilustrada, el alojamiento 110 incluye una parte de empunadura 112 que tiene al menos un pulsador 114 sobre ella (se han mostrado dos pulsadores 114a y 114b). La parte de empunadura 112, que define un eje geometrico H-H de empunadura, se ha mostrado teniendo unas hendiduras 116 que corresponden a los dedos de un usuario. Cada pulsador 114a y 114b se ha mostrado como estando instalado sobre una hendidura 116 para facilitar su pulsacion por el dedo de un usuario.
Continuando refiriendose a las Figuras 2 y 3,un area proximal 118 del alojamiento 110 incluye una interfaz 120 de usuario. En la realizacion ilustrada, la interfaz 120 de usuario incluye una pantalla 122 y al menos un interruptor 124
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(se han mostrado siete interruptores 124a-124g). La pantalla 122 presenta en la misma informacion legible, incluyendo la informacion del estado del instrumento quirurgico motorizado 100 en una realizacion. Los interruptores 124a -124g controlan diversas acciones del instrumento quirurgico motorizado 100, como se explica detalladamente mas adelante.
Las Figuras 4 a 7, 9 a 11 y 14 ilustran diversos componentes internos del instrumento quirurgico motorizado 100, incluyendo un engranaje impulsor 200 o miembro impulsor, un motor impulsor 210 y un motor de cambio 220. Se contempla que podna utilizarse un solenoide de tres posiciones, por ejemplo, como una alternativa al motor de cambio 220. El engranaje impulsor 200 puede rotar alrededor de un eje geometrico C-C de engranaje impulsor que se extiende a traves de el (Figura 4) y se puede mover selectivamente a lo largo del eje geometrico C-C de engranaje impulsor. El motor impulsor 210 esta instalado en cooperacion mecanica con el engranaje impulsor 200 y esta configurado para hacer rotar el engranaje impulsor 200 alrededor del eje geometrico C-C. El motor de cambio 220 esta dispuesto en cooperacion mecanica con el engranaje impulsor 200 (el motor impulsor 210 se ha ilustrado entre el engranaje impulsor 200 y el motor de cambio 220 segun una realizacion divulgada) y esta configurado para trasladar el engranaje impulsor 200 axialmente a lo largo del eje geometrico C-C de engranaje impulsor. En una realizacion divulgada, el motor impulsor 210 o el motor de cambio 220 podnan ser un motor normal o un motor de engranajes, que podna incluir unos engranajes incorporados dentro de su alojamiento.
El motor de cambio 220 esta configurado para mover selectivamente al engranaje impulsor 200 entre una pluralidad de posiciones; en las realizaciones ilustradas se han mostrado tres posiciones. La primera posicion, ilustrada en las Figuras 5 y 6, habilita la rotacion del efector de extremo 160; la segunda posicion, ilustrada en la Figura 7, habilita la articulacion del efector de extremo 160; y la tercera posicion, ilustrada en las Figuras 9 a 11 y 14, habilita el accionamiento del instrumento quirurgico motorizado 100.
En las Figuras 4 a 7, 9 a 10 y 14 se ha ilustrado una vista recortada de la carcasa 212 del motor impulsor, que circunda al motor impulsor 210. La carcasa 212 de motor impulsor incluye una pluralidad de ranuras 214 (se han ilustrado tres ranuras 214a, 214b y 214c) en la misma. Cada ranura 214 puede estar en relacion conjugada con un enclavamiento 216 de posicion que sirve para mantener al engranaje impulsor 210 en una posicion prevista. Por ejemplo, en la Figura 5, el enclavamiento 216 de posicion se ha mostrado en relacion conjugada con la ranura 214a, que corresponde a que el engranaje impulsor 200 esta en su primera posicion. En la Figura 7, el enclavamiento 216 de posicion se ha mostrado en relacion conjugada con la ranura 214b, que corresponde a que el engranaje impulsor 200 esta en su segunda posicion. Las Figuras 9, 10 y 14 ilustran el enclavamiento 216 de posicion en relacion conjugada con la ranura 214c, que corresponde a que el engranaje impulsor 200 esta en su tercera posicion. El enclavamiento de posicion 216, en las realizaciones ilustradas, esta cargado con muelle hacia la carcasa 212 de motor impulsor, lo cual ayuda a mantener al motor impulsor 210 en una posicion prevista.
En las realizaciones ilustradas, el motor de cambio 220 esta situado en un lugar proximal del motor impulsor 210 y configurado para trasladar al motor impulsor 210 a lo largo del eje geometrico C-C de engranaje impulsor entre sus posiciones primera, segunda y tercera. Refiriendose a la Figura 10, se ha ilustrado el motor de cambio 220 impulsando un tornillo sinfm 222 de cambio conjuntamente con un alojamiento 223 de tornillo sinfm roscado internamente (vease Figura 10) segun una realizacion divulgada. Se divulga ademas que un sensor 224 de cambio (vease Figura 4) (por ejemplo, un sensor de proximidad del tipo de interruptor o ferromagnetico activado por el enclavamiento 216 de posicion), dispuesto junto al enclavamiento 216 de posicion, comunica electricamente con al menos un interruptor 124 para poner en marcha o parar el motor de cambio 220, o proporciona una realimentacion relacionada con la posicion del motor impulsor 210; por ejemplo, el modo de funcionamiento para el instrumento quirurgico motorizado 100 se presenta visualmente de un modo conveniente en la pantalla 122. Por ejemplo, se podna indicar la posicion del motor impulsor 210 en la pantalla 122 de la interfaz 120 de usuario.
Con referencia a las Figuras 5 y 6, se ha ilustrado la primera posicion del engranaje impulsor 200. En este caso, una corona dentada 230 o miembro de rotacion esta instalada dentro del alojamiento 110, y la rotacion de la corona dentada 230 produce la rotacion de la parte endoscopica 140, del efector de extremo 160 y de una parte distal 110a de alojamiento del instrumento quirurgico motorizado 100. Se contempla que una superficie interior de la corona 230 incluya unos hilos de rosca o unos dientes para engranar con el engranaje impulsor 200, y se fije a la parte distal 110a de alojamiento, que esta dispuesta en un lugar distal de la parte proximal 110b de alojamiento. Ademas, la parte distal 110a de alojamiento puede rotar con respecto a la parte proximal 110b de alojamiento por medio de un canal 232 dispuesto perifericamente practicado dentro de la parte distal 110a de alojamiento y de una pestana correspondiente 234 dispuesta perifericamente dentro de la parte proximal 110b de alojamiento.
En una realizacion, la corona dentada 230 esta sujeta ngidamente dentro de la parte distal 110a de alojamiento y se puede acoplar en relacion conjugada con el engranaje impulsor 200. De ese modo, la rotacion del engranaje impulsor 200 causa que rote la corona dentada 230, y por tanto la parte distal 110a de alojamiento. En la Figura 2, se muestra un labio 235 que afsla la mano de un usuario de la parte rotatoria distal 110a de alojamiento. Se contempla que una pluralidad de arandelas o de cojinetes de bolas (posiblemente fabricados de polfmeros de resina sintetica que contengan fluor, que se venden con la marca comercial Teflon® ) esten dispuestos entre la parte distal 110a de alojamiento y la parte proximal 110b de alojamiento para reducir la friccion por rotacion entre ellas
Continuando con la referencia a la realizacion ilustrada en la Figura 6, una pluralidad de retenes 231 estan
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dispuestos alrededor de una superficie 233 de la parte distal 110a de alojamiento. Se muestra una lengueta 237 dispuesta en la parte proximal 110b de alojamiento y que podna comprender un gatillo o miembro cargado con muelle. En una realizacion divulgada, la lengueta 237 esta cargada elasticamente en la direccion distal y, en cooperacion mecanica con al menos uno de la pluralidad de retenes 231. La combinacion de los retenes 231 y de la lengueta 237, ayuda a sujetar la parte distal 110a de alojamiento en una posicion rotatoria con respecto a la parte proximal 110b de alojamiento. Ademas, los retenes 231 y la lengueta 237 se podnan proveer para dar al usuario una realimentacion audible o tactil cuando se rote la parte endoscopica 140. En una realizacion divulgada, se podna usar un solenoide de tres posiciones para enclavar la posicion de rotacion del efector de extremo 160 una vez que se haya seleccionado la posicion de rotacion prevista.
En la Figura 7 se ha ilustrado el engranaje impulsor 200 en su segunda posicion, cuando el enclavamiento 216 de posicion esta alineado con la ranura 214b. En este caso, el engranaje impulsor 200 esta acoplado en relacion conjugada con un engranaje de articulacion 240, que esta instalado al menos en parte dentro del alojamiento 110. La rotacion del engranaje de articulacion 240 causa que el efector de extremo 160 se mueva desde su primera posicion, en la que el eje geometrico longitudinal B-B esta alineado sustancialmente con el eje geometrico longitudinal A- A, hacia una posicion en la que el eje geometrico longitudinal B-B esta dispuesto formando un angulo con el eje geometrico longitudinal A-A. Preferiblemente, se obtiene una pluralidad de posiciones articuladas.
En las realizaciones ilustradas, y con referencia espedfica a las Figuras 7 y 8, la articulacion del efector de extremo 160 se realiza mediante un engranaje 240 de articulacion, un tornillo 242 de articulacion, un enlace 244 de articulacion y al menos un vastago 260 de articulacion. Mas espedficamente, el engranaje 240 de articulacion esta montado ngidamente al tornillo 242 de articulacion, de tal manera que, cuando se rote el engranaje 240 de articulacion por la rotacion del engranaje impulsor 200 mientras este se encuentre en su segunda posicion, rote tambien el tornillo 242 de articulacion. Se ha ilustrado una pluralidad de cojinetes 262 en diversas ubicaciones en el tornillo 242 de articulacion para facilitar la retencion y alineacion del tornillo impulsor 242 de articulacion, asf como para reducir la friccion entre el tornillo 242 de articulacion y el alojamiento 110, por ejemplo.
Continuando con la referencia a la Figura 7, el tornillo 242 de articulacion incluye una parte roscada 246, que se extiende a traves de una parte 248 roscada internamente del enlace 244 de articulacion. Esta relacion entre el tornillo 242 de articulacion y el enlace 244 de articulacion causa que el enlace 244 de articulacion se mueva en la direccion distal o en la direccion proximal (direcciones de las flechas D y E) a lo largo de la parte roscada 246 del tornillo 242 de articulacion tras la rotacion del tornillo 242 de articulacion. Por ejemplo, cuando el tornillo 242 de articulacion rota en un primer sentido (por ejemplo, en sentido dextrogiro) el enlace 244 de articulacion se mueve en la direccion distal, y cuando el tornillo 242 de articulacion se mueve en un segundo sentido (por ejemplo, en el sentido levogiro), el enlace 244 de articulacion se mueve en la direccion proximal.
Se ha mostrado al menos un brazo 250 de articulacion que se extiende desde el enlace 244 de articulacion. En una realizacion, el brazo 250 de articulacion esta conectado ngidamente a un vastago 260 de articulacion, y se contempla que se pueda conectar mas de un brazo 250 de articulacion a mas de un vastago 260 de articulacion. Cuando el enlace 244 de articulacion se traslada en la direccion distal o en la direccion proximal en respuesta a la rotacion del engranaje 240 de articulacion, el vastago (o vastagos) 260 de articulacion se traslada (o se trasladan) tambien en la direccion distal o en la direccion proximal (en las direcciones de las flechas F y G), a lo largo del eje geometrico longitudinal A-A), en respuesta al mismo. Se podnan utilizar cualesquiera combinaciones de interruptores limitadores, sensores de proximidad (por ejemplo, opticos o ferromagneticos), transductores lineales de desplazamiento variable y codificadores de eje (instalados dentro del alojamiento 110, por ejemplo), para controlar o registrar la ubicacion del enlace 244 de articulacion o el angulo de articulacion del efector de extremo 160 o la posicion del vastago de disparo 306 ( segun se describe mas adelante con referencia a las Figuras 9 y 11)
Con referencia a las Figuras 8A y 8B, se muestra el vastago 260 de articulacion que se extiende a traves de al menos una fraccion de la parte endoscopica 140 en cooperacion mecanica con un vastago 264 de enlace. Por tanto, el vastago 264 de enlace se mueve similarmente a lo largo del eje geometrico longitudinal A- A tras la rotacion del engranaje 240 de articulacion. Una parte distal 266 del vastago 264 de articulacion esta en cooperacion mecanica con el efector de extremo 160, de tal manera que el movimiento proximal y distal del vastago 264 de enlace causa que el efector de extremo 160 se mueva desde su primera posicion hacia su segunda posicion alrededor del pivote P. Por ejemplo, el vastago 264 de enlace esta conectado al efector de extremo 160 en una ubicacion desviada lateralmente del pivote P. Mas espedficamente, y a tttulo ilustrativo, cuando el vastago 264 de enlace se mueve en la direccion distal, el efector de extremo 160 se articula en la direccion de la flecha H, y cuando el vastago 264 de enlace se traslada en la direccion proximal, el efector de extremo 160 se articula en la direccion de la flecha I. . Se contempla tambien que una parte del vastago 260 de enlace este en cooperacion mecanica con el efector de extremo 160 para efectuar la articulacion del mismo. En la patente de EE.UU. de propiedad en comun Numero 6.953.139 concedida a Milliman y colaboradores, se describen detalladamente los detalles adicionales de la provision de articulacion al efector de extremo 160.
Segun una realizacion de la presente divulgacion, el efector de extremo 160 incluye un conjunto de cartucho (por ejemplo, el miembro de mordaza 164) y un conjunto de yunque (por ejemplo, el miembro de mordaza 162) que incluye una parte de yunque para desplegar los elementos de sujecion quirurgicos en el tejido humano y formar los elementos de sujecion quirurgicos. El efector de extremo 160 esta montado pivotablemente alrededor de un eje
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geometrico sustancialmente perpendicular al eje geometrico longitudinal de la parte endoscopica 140. El conjunto de cartucho 164 aloja una pluralidad de grapas. El conjunto de yunque 162 se puede mover con respecto al conjunto de cartucho 164 entre una posicion abierta, separada del conjunto de cartucho 164, y una posicion aproximada o abrazada en alineacion yuxtapuesta con el conjunto de cartucho 164. Preferiblemente, las grapas se alojan en el conjunto de cartucho 164 para aplicar filas lineales de grapas al tejido corporal. El efector de extremo 160 esta fijado a una parte de montaje, que a su vez esta fijada de forma pivotable a una parte de cuerpo. La parte de cuerpo podna estar integrada con la parte endoscopica 140 del instrumento quirurgico motorizado 1O0, o bien se podna fijar de forma retirable a la misma para proveer una unidad de carga reemplazable o desechable. La unidad de carga se podna conectar a la parte endoscopica 140 por medio de una conexion de bayoneta. Se contempla que la unidad de carga tenga un enlace de articulacion conectado a la parte de montaje de la propia unidad de carga, y que el enlace de articulacion se conecte al vastago de enlace de tal manera que el efector de extremo 160. se articule cuando el vastago de enlace se traslade en la direccion distal-proximal a lo largo del eje geometrico longitudinal. Se podnan usar otros medios de conectar el efector de extremo 160 a la parte endoscopica 140 para permitir la articulacion. Por ejemplo, se podna usar un tubo flexible o una pluralidad de miembros pivotables.
Una unidad de carga podna incorporar (o estar configurada para incorporar) varios efectores de extremo, tales como dispositivos de cierre hermetico de vaso, dispositivos lineales de colocacion de grapas., dispositivos circulares de colocacion de grapas, cuchillas, etc. Dichos efectores de extremo se podnan acoplar a la parte endoscopica 140 del instrumento quirurgico motorizado 100. Se podna incluir un eje flexible intermedio 500 entre la parte de empunadura 112 y la unidad de carga. Por ejemplo, como se muestra en las Figuras 15A y 15B, las partes endoscopica y distal 140, 142 se han mostrado como un eje flexible 500. El eje flexible 500 incluye una pluralidad de tubos exteriores angulados interconectados 501 y 502. La Figura 15A muestra el eje flexible en una formacion no articulada, y la Figura 15B muestra el eje flexible 500 en una formacion articulada. Cuando el eje flexible 500 es recto, los tramos estrechos de los tubos 501 se alternan con los tramos anchos de los tubos 502, como se muestra en la Figura 15A. Cuando el eje flexible 500 es totalmente articulado, los lados cortos y los lados anchos de los tubos 501 y 502 estan alineados, como se ha mostrado en la Figura 15B. Dicho tubo flexible 500 podna facilitar el acceso en ciertas areas del cuerpo.
Ademas, cuando puedan usarse varias unidades de carga, un modulo de control digital (en adelante DCM) 130 (Figura 4) puede controlar la fuerza que se este aplicando al vastago 306 para que el vastago 306 pueda impulsar al efector de extremo particular que se encuentre en uso en ese momento en la unidad de carga. Para mayor claridad, no se han mostrado en las Figuras los cables que conectan el DCM 130 a los diversos componentes del instrumento quirurgico motorizado 100, pero la presente divulgacion contempla dichos cables. La unidad de carga podna incluir tambien un sensor electrico o mecanico que indique al DCM 130 que efector de extremo esta en la unidad de carga. En una realizacion, el DCM 130 es capaz tambien de guardar en memoria informacion relativa a la fuerza aplicada al vastago 306. Adicionalmente, se podnan medir la tension y la intensidad de corriente del motor impulsor 210 para suministrar informacion o realimentacion con respecto al estado del instrumento quirurgico motorizado 100. Por ejemplo, si el usuario esta intentando acabar con la fijacion de un tejido que es demasiado grueso, aumentaran la tension o la intensidad de la corriente. Esta informacion se puede suministra al usuario o se puede interrumpir o cesar la alimentacion de energfa electrica. Se contempla que esta propiedad caractenstica ayude a prevenir danos en los mecanismos del instrumento.
Con referencia a las Figuras 9 a 11 y 14, se ha ilustrado el engranaje impulsor 200 en su tercera posicion, .con el enclavamiento 216 de posicion alineado con la ranura 214c. En este caso, el engranaje impulsor 200 esta acoplado en relacion conjugada con un engranaje de accionamiento 300, que esta dispuesto al menos en parte dentro del alojamiento 110. Mas espedficamente, un conjunto de dientes 202 dispuestos en una cara frontal 204 (Figura 4) del engranaje impulsor 200 engranan en relacion conjugada con los dientes del engranaje de accionamiento 300 para proporcionar al menos una de las operaciones de agarrar el tejido, fijar el tejido, disparar el efector de extremo 160 (por ejemplo, grapar y cortar) y retirar los elementos a su posicion original.
Continuando con la referencia a las Figuras 9 y 11, se incluyen tambien un tubo impulsor 302, un tapon truncado 304 y un vastago de disparo 306. El tubo impulsor 302 incluye unos hilos de rosca internos (que no se han mostrado explfcitamente), a lo largo de como mmimo una parte de su longitud, y esta ngidamente fijado al engranaje de accionamiento 300. El tapon truncado 304 esta acoplado por rosca con los hilos de rosca internos del tubo impulsor 302 y se puede trasladar dentro del tubo impulsor 302 con respecto al engranaje de accionamiento 300. La Figura 9 presenta el tapon truncado 304 cerca de su posicion mas proximal, y la Figura 11 muestra el tapon truncado 304 cerca de su posicion mas distal. El vastago de disparo 306 esta ngidamente unido al tapon truncado 304 y se extiende desde el mismo en la direccion distal. En una realizacion de la divulgacion, el vastago de disparo 306 se extiende al menos hasta la parte distal 142 de la parte endoscopica 140.
En respuesta a la rotacion del engranaje impulsor 200, el engranaje de accionamiento 300 y el tubo impulsor 302 rotan tambien. Cuando rota el tubo impulsor 302, el tapon truncado 304 y el vastago de disparo 306 se trasladan en la direccion proximal o distal dentro de los confines del tubo impulsor 302. La traslacion en la direccion distal del vastago de disparo 306 (que corresponde a una rotacion en sentido dextrogiro del engranaje impulsor 200, por ejemplo), puede causar que los miembros de mordaza 162, 164 (vease Figura 1) del efector de extremo 160 agarren o abracen el tejido sujeto entre ellos. La traslacion adicional en la direccion distal del vastago de disparo 306 podna causar que los elementos quirurgicos de sujecion sean expulsados del efector de extremo 160 (por ejemplo, por
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medio de barras con accion de leva o de un trineo de accionamiento, ninguno de los cuales se ha mostrado expUcitamente en esta realizacion) para sujetar el tejido, y podnan causar tambien que un bistun (no mostrado expUcitamente en esta realizacion) corte el tejido. La traslacion en la direccion proximal del vastago de disparo 306 (correspondiente con una rotacion en sentido levogiro del engranaje impulsor 200, por ejemplo) puede causar que los miembros de mordaza 162, 164 o el bistun vuelvan a sus posiciones anteriores al disparo. En la patente de EE.UU. publicada en comun con el numero 6.953.139 y concedida a Milliman y colaboradores se describen detalladamente detalles adicionales y del efector de extremo 160 en el disparo y en otras operaciones del mismo.
En una realizacion de la divulgacion, la parte de yunque del efector de extremo 160 incluye una superficie con accion de leva para ser acoplada por el conjunto impulsor del efector de extremo 160. El conjunto impulsor incluye un brazo impulsor, que convenientemente tiene un bistun para cortar el tejido. El brazo impulsor tiene un rodillo de leva posicionado para acoplarse con la superficie con accion de leva, y una pestana posicionada para acoplarse al conjunto de cartucho con el fin de efectuar la aproximacion del conjunto de yunque 162 y del conjunto de cartucho 164 uno con respecto al otro cuando se hace avanzar en la direccion distal al brazo impulsor. Ademas, cuando el brazo impulsor avanza mas en la direccion distal, el brazo se acopla con un miembro de accionamiento para desplegar los elementos quirurgicos de sujecion del conjunto de cartucho, segun se ha divulgado en la patente '139 de Milliman anteriormente mencionada.
Se podna posicionar cualquier combinacion de sensores dentro del instrumento quirurgico motorizado 100 para determinar la posicion de diversos componentes o su estado operativo, por ejemplo, la articulacion, la rotacion, la fijacionj o el disparo del efector de extremo 160. Por ejemplo, se podnan usar interruptores limitadores, sensores de proximidad (por ejemplo, lineales o ferromagneticos), potenciometros, transductores lineales de desplazamiento variable (en adelante LVDT), codificadores de eje, etc.) para ayudar a controlar o registrar la ubicacion del enlace de articulacion 244, del vastago de disparo 306 o de la corona dentada 230, segun se ha indicado anteriormente.
Refiriendose ahora a las Figuras 9, 11 y 12, la parte endoscopica 140 incluye un alojamiento 144 de tubo que se extiende desde un area adyacente al alojamiento 110 hacia el efector de extremo 160. Cuando rota el tubo impulsor 302, el efector de extremo 160 no rota, como una consecuencia directa de la misma. Refiriendose a la Figura 13, el alojamiento 144 de tubo incluye en el mismo unas partes planas 148, que se corresponden con las partes planas 310 del vastago de disparo 306. El par de partes planas 148 y 310 ayudan a prevenir la rotacion del vastago de disparo 306 mediante su colaboracion a limitar al movimiento axial al vastago de disparo 306.
Con referencia a la Figura 9, se muestra un eje 218 de motor impulsor que se extiende desde el motor impulsor 210 y esta conectado al engranaje impulsor 200. Se podna usar un elemento de sujecion (que no se ha mostrado explfcitamente en esta realizacion) para retener el engranaje impulsor 220 sobre el eje 218 del motor impulsor. El eje 218 del motor impulsor se hace rotar mediante el motor impulsor 210, lo que resulta en la rotacion del engranaje impulsor 220. El eje 218 del motor impulsor se ha mostrado teniendo una parte plana 219 (se podnan incluir mas de una parte plana 219), que permite el “juego” o la “flotacion a rotacion” entre el engranaje impulsor 220 y el eje 218 del motor impulsor para facilitar la alineacion de los dientes de los engranajes y ayudar a permitir que el engranaje impulsor 220 cambie entre posiciones. La Figura 9 ilustra tambien un cojinete 308 instalado dentro del alojamiento 110 y rodeando al menos en parte al tubo impulsor 302. El cojinete 308 facilita la rotacion del tubo impulsor 302 y ayuda a alinear el tubo impulsor 302 a traves de la parte endoscopica 140 y soporta toda la carga de empuje entre el engranaje impulsor 200 y el engranaje de accionamiento 300.
En la Figura 10, se muestra un transductor 420 junto a un motor impulsor 210 y un motor de cambio 220. El transductor 420 (por ejemplo, un transductor de fuerza o de presion) podna medir o controlar la fuerza requerida para la presion prevista sobre el engranaje de accionamiento 300. El transductor 420 podna estar en comunicacion con partes de la interfaz 120 de usuario, que puedan suministrar realimentacion a un usuario. Adicionalmente, se ha ilustrado un acoplamiento por muelle 430 entre el motor impulsor 210 y el motor de cambio 220. Espedficamente, en una realizacion divulgada, el acoplamiento 430 por muelle incluye un muelle 432 montado en una jaula telescopica 434. Un tornillo sinfm 222 de cambio se muestra extendiendose a traves del muelle 432 y se podna configurar para aplicar una carga de compresion sobre el muelle 432. Se contempla que la jaula 434 se pueda aplastar cuando se comprima el muelle 432. La fuerza aplicada al motor impulsor 210 se podna ajustar usando el muelle 432 o la jaula 434.
En una realizacion de la divulgacion, el engranaje impulsor 200 y el engranaje de accionamiento 300 forman una cara frontal de embrague Los dientes de los engranajes estan dispuestos para deslizarse, a no ser que se aplique una fuerza de un valor umbral al motor impulsor 210 por el motor de cambio 200 y un acoplamiento por muelle 430 (segun se describe mas adelante en relacion con la Figura 10) dispuestos entre ellos. Ademas, cuando el motor de cambio 200 y el acoplamiento por muelle 430 aplican la fuerza de un valor umbral necesaria para que engranen sin deslizamiento el engranaje impulsor 200 y el engranaje de accionamiento 300, el vastago 306 sera impulsado en la direccion distal. La jaula telescopica 434 podna incluir un tope incorporado con ella, de tal manera que la jaula 434 retire al vastago 306, en lugar de descomprimir el acoplamiento por muelle 430.
Con referencia a la Figura 3, se muestra una interfaz 120 de usuario que incluye una pantalla 122 y siete interruptores 124a-124g. En la realizacion ilustrada, la interfaz de usuario presenta visualmente el “modo de operacion” (por ejemplo, rotacion, articulacion, accionamiento).que podna comunicarse a la interfaz 120 de usuario
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por medio del sensor de cambio 224 (Figura 4), el “estado” (por ejemplo, angulo de articulacion, velocidad de rotacion, o tipo de accionamiento) y la “realimentacion” tal como si se han disparado grapas. El interruptor 124a se ha mostrado presentando una “M”, que significa modo, que podna usarse para posicionar el engranaje impulsor 200 por medio del motor de cambio 220 para seleccionar entre rotacion, articulacion, agarre, fijacion, y disparo. Se contempla tambien que el interruptor 124a se pueda usar para dejar que un usuario introduzca como entrada diferentes tipos de tejidos, y varios tamanos y longitudes de cartuchos de grapas.
Los interruptores 124b-124e de la interfaz 120 de usuario se han mostrado con unas flechas sobre ellos, y se podnan usar para seleccionar la direccion, velocidad o par de torsion con que el engranaje impulsor 200 es rotado por el motor impulsor 210. Se contempla tambien que como mmimo un interruptor 124 se pueda usar para seleccionar un modo de emergencia que no haga caso de varios reglajes, por ejemplo. Ademas, los interruptores 124f y 124g se han ilustrado teniendo en ellos una “N” y una “Y”. Se contempla que estos interruptores 124f y 124g se podnan usar para ayudar a un usuario a buscar y seleccionar diversos reglajes del instrumento quirurgico motorizado 100. Las senales informativas que aparecen en los interruptores 124a-124g y sus respectivas funciones no se limitan a lo que se ha mostrado en las figuras adjuntas, porque se contemplan desviaciones con respecto a las mismas que estan dentro del alcance de la presente divulgacion. Adicionalmente, y con referencia a las Figuras 1 y 2, los pulsadores 114a y 114b se podnan usar para iniciar o detener el movimiento del motor impulsor 210 o del motor de cambio 220. Se anticipan tambien otras funciones para los pulsadores 114a y 114b, asf como disponer de mas o menos pulsadores 114. En una realizacion particular, los interruptores 124a-124g podnan incluir uno o varios interruptores microelectronicos de membrana, por ejemplo. Este tipo de interruptor microelectronico de membrana incluye una fuerza de accionamiento de una intensidad relativamente pequena, un tamano pequeno de paquete, un tamano y una fuerza ergonomicos, un perfil bajo, la posibilidad de incluir letras moldeadas en el interruptor, sfmbolos, representaciones graficas, o indicaciones, y un pequeno coste de material. Adicionalmente, los interruptores 124a- 124g (tales como los interruptores microelectronicos de membrana) se podnan cerrar hermeticamente para facilitar la esterilizacion del instrumento quirurgico motorizado 100, asf como para ayudar a prevenir la contaminacion por fluidos o por partfculas.
Como una alternativa a - o ademas de - los interruptores 124 o pulsadores 114, otros dispositivos de introduccion de informacion podnan incluir tecnologfa de entrada de voz, que podna incluir hardware o software incorporados en un modulo de control digital (en adelante DCM) 130 (Figura 4), o un modulo digital independiente conectado al DCM 130. La tecnologfa de entrada de voz podna incluir reconocimiento de voz, accionamiento de voz, rectificacion de voz o voz incrustada. El usuario podna ser capaz de controlar el funcionamiento del instrumento en su totalidad o en parte por medio de ordenes de ejecucion por voz, dejando libres de ese modo una o las dos manos del usuario para manejar otros instrumentos, Se podna usar tambien una salida audible para suministrar realimentacion al usuario.
En una realizacion, se usa el acoplamiento 430 por muelle en la realimentacion y control del instrumento quirurgico motorizado 100. Segun se ha indicado anteriormente, el DCM 130 se podna conectar a uno o varios pulsadores 114 o interruptores 124 y a una o varias pantallas de presentacion visual 122 para suministrar realimentacion al usuario y para ayudar a controlar el funcionamiento del instrumento quirurgico motorizado 100. El DCM 130 podna ser una placa digital incorporada en el alojamiento 110 del instrumento quirurgico motorizado 100. El acoplamiento 430 por muelle podna incluir un transductor de presion que pueda interactuar con el DCM 130 para controlar la fuerza que se aplique al vastago 306.
Se contempla tambien que la interfaz 120 de usuario incluya diferentes colores o intensidades de texto en la pantalla 122 o en los interruptores 124a-124g para una diferenciacion adicional entre los elementos presentados visualmente. Se puede incluir tambien una realimentacion de usuario en la forma de patrones pulsados de luz, realimentacion acustica (zumbadores, timbres o tonos de corta duracion que podnan hacerse sonar en intervalos de tiempo seleccionados), realimentacion verbal, o realimentacion vibratoria haptica (tal como un motor asincronico o solenoides), por ejemplo. La realimentacion visual, audible o haptica se puede aumentar o disminuir en intensidad. Por ejemplo, la intensidad de la realimentacion se podna usar para indicar que las fuerzas aplicadas sobre el instrumento estan llegando a ser excesivas. Adicionalmente, los interruptores 124a-124g se podnan posicionar en diferentes alturas entre sf o podnan incluir senales informativas en relieve u otras caractensticas de texto (por ejemplo concavidad o convexidad) para permitir que un usuario pulse un interruptor apropiado 124 sin necesidad de mirar en la interfaz 120 de usuario. Ademas, se podna usar la parte 110b de alojamiento proximal como un sistema de control del tipo de palanca de mando.
Adicionalmente, la interfaz 120 de usuario podna incluir una pantalla o pantallas separadas de presentacion visual 122 y dispositivos de entrada (tales como los interruptores 124 o los pulsadores 114), o bien los dispositivos de entrada se podnan incorporar en toda o en parte de la pantalla 122. Por ejemplo, se podna usar una presentacion visual con pantalla tactil de cristal lfquido (en adelante LCD) para permitir que el usuario suministre informacion de entrada mientras ve la realimentacion operativa. La LCD de pantalla tactil podna incluir controles resistivos, capacitivos o de ondas acusticas de superficie. Esta solucion podna habilitar la facilitacion de un cierre hermetico a los componentes de la pantalla 122 para ayudar a esterilizar el instrumento quirurgico motorizado 100, asf como para prevenir la contaminacion por partfculas o por fluidos. En ciertas realizaciones, la pantalla 122 esta montada de forma pivotable o rotatoria al instrumento quirurgico motorizado 100 para mayor flexibilidad en la vision de la pantalla 122 durante el uso o la preparacion del instrumento. La pantalla 122 se podna montar de forma articulada o con una rotula al instrumento quirurgico motorizado 100, por ejemplo.
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En una realizacion divulgada, al menos alguna informacion monitorizada por los diversos sensores en el instrumento quirurgico motorizado 100 se podna suministrar a un sistema de pantalla de v^deo o de monitorizacion en una sala de operacion. Por ejemplo, los datos se podnan transmitir a un receptor para el sistema de monitorizacion de la sala de operacion desde un transmisor de comunicacion incorporado en - o en relacion de asociacion con - el instrumento quirurgico motorizado 100, por medio de una tecnologfa que incluya Blue Tooth, ANT3, KNX, Onda Z, X10, sistemas inalambricos USB, WiFi, IrDa, Nanonet, Tiny OS, ZigBee, radio, UHF y VHF. Estas caractensticas podnan facilitar la monitorizacion por parte del usuario del instrumento quirurgico motorizado 100 o por otra sala de operacion o por personal del hospital o personas ubicadas en lugares lejanos.
Refiriendose a la Figura 4, se podna usar cualquier combinacion de un bloque 400 de pilas secas, celulas de combustible o condensadores de alta energfa para suministrar energfa electrica al instrumento quirurgico motorizado 100. Por ejemplo, se podnan usar condensadores conjuntamente con un bloque 400 de pilas secas. En este caso, se pueden usar los condensadores para suministrar un aumento repentino de alimentacion electrica cuando se requiera o se desee energfa de un modo mas rapido que el que puede aportar una batena por sf sola (por ejemplo, cuando se fije un tejido grueso, para un disparo rapido, una fijacion, etc.) porque las batenas son tfpicamente unos dispositivos de descarga lenta de los que no se puede extraer rapidamente una corriente electrica. Se contempla que una batena se pueda conectar a un condensador para cargarlo.
Se contempla tambien que el bloque 400 de pilas secas incluya al menos una batena desechable. La batena desechable podna ser de entre aproximadamente 9 voltios y alrededor de 30 voltios, y utilizarse en un instrumento quirurgico desechable. Se contemplan tambien otros medios de suministro de energfa que incluyen energfa electrica. En realizaciones alternativas se provee un cable para conectar el instrumento 100 a un generador.
En una realizacion divulgada, el DCM esta conectado al motor de cambio 220 y al motor impulsor 210, y esta configurado y destinado a monitorizar la impedancia, la tension, la temperatura o la descarga de intensidad de corriente de la batena 400 y para controlar el funcionamiento del instrumento quirurgico motorizado 100. La carga o las cargas en la batena 400, en la transmision, en los motores 220, 210 y en los componentes impulsores del instrumento quirurgico motorizado 100 se determinan con el fin de controlar una velocidad de motor si la carga o las cargas indican que se ha alcanzado o se aproxima una limitacion de los danos. Por ejemplo, se podnan determinar la energfa remanente en la batena 400, el numero de disparos que quedan, si se debe reemplazar o cargar la batena 400, o la aproximacion a los lfmites de carga potenciales del instrumento quirurgico motorizado 100.
El DCM se puede configurar o disponer para controlar o ayudar al control del funcionamiento del motor de cambio 220 o del motor impulsor 210 para responder a la informacion monitorizada. Para controlar la salida se podna usar la modulacion de impulsos, que podna incluir un embrague electronico. Por ejemplo, el DCM puede regular la tension o modular por impulsos la tension para ajustar la potencia y la salida de par con el fin de prevenir danos al sistema o de optimizar el uso de la energfa. Se podna usar un circuito de frenado electrico para controlar el motor impulsor 210 o el motor de cambio 220, que utilice la fuerza contraelectromotriz (en adelante EMF) actual para rotar al motor impulsor 210 con el fin de contrarrestar y reducir sustancialmente la cantidad de movimiento del engranaje impulsor 200. El circuito de frenado electrico podna perfeccionar el control del motor impulsor 210 o del motor de cambio 220 en cuanto a la precision de la parada o la ubicacion del cambio del instrumento quirurgico motorizado 100. Los sensores para monitorizar los componentes del instrumento quirurgico motorizado 100 y para ayudar a prevenir la sobrecarga de los instrumentos quirurgicos motorizados 100 podnan incluir sensores del tipo termico, tales como sensores termicos, termistores, termopilas, termopares o formacion de imagenes termicas por infrarrojos y suministrar realimentacion al DCM. El DCM podna controlar a los componentes de instrumento quirurgico motorizado 100 en el caso de que se alcancen los lfmites o se llegue cerca de estos, y dicho control puede incluir el corte de la alimentacion de energfa del bloque 400 de pilas secas, que interrumpa temporalmente la alimentacion de energfa o que se pase a un modo de pausa con modulacion de impulsos para limitar la energfa usada, y el DCM puede monitorizar la temperatura de los componentes para determinar cuando se puede reanudar el funcionamiento normal. Los usos anteriormente indicados del DCM se podnan emplear independientemente de -o relacionados con - medidas de intensidad de corriente, tension, temperatura o impedancia.
En la realizacion ilustrada en la Figura 5, el motor de cambio 220 se muestra incluyendo un alojamiento 226 en dos partes. Cada parte 226a y 226b del alojamiento 226 de dos partes esta acoplada de forma deslizante una con la otra. Se contempla que la parte 226a este sujeta ngidamente a la carcasa 212 del motor impulsor, mientras que la parte 226b este fijada al motor de cambio 220 y se pueda trasladar dentro del alojamiento 110. Adicionalmente, se podna incluir una ranura 228 de conexionado para permitir que pasen los conductores (que no se han mostrado explfcitamente en esta realizacion) desde el transductor 420 hacia la interfaz 120 de usuario, por ejemplo (vease tambien la Figura 10).
Refiriendose a la Figura 14, se ha ilustrado el instrumento quirurgico motorizado 100 teniendo una parte 112 de mango con empunadura de pistola. En este caso, la parte de empunadura 112 esta dispuesta formando un angulo (por ejemplo, sustancialmente de 90°) con el eje geometrico longitudinal A-A. En esta realizacion, se contempla que al menos un pulsador 114 este instalado sobre la misma. Adicionalmente, se podna situar una interfaz 120 de usuario en la posicion mostrada en la Figura 14. Ademas, se podna emplear una empunadura movil (que no se ha mostrado explfcitamente en esta realizacion) para controlar diversas funciones del instrumento quirurgico motorizado 100.
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Se contempla que el efector de extremo 160 sea reutilizable, y pueda aceptar un cartucho de grapas o sea parte de una unidad de carga desechable. En la patente de EE.UU. de propiedad en comun numero 5.752.644, concedida a Bolanos y colaboradores, se describen con detalle caractensticas adicionales de una unidad de carga desechable. Las unidades de carga desechables o reemplazables pueden incluir efectores de extremo sin articulacion, como se divulga en la patente de EE.UU. N° 6.953.139 concedida a Milliman y colaboradores. Se podna proveer un interruptor junto a la parte de empunadura 112 para desactivar electronicamente la segunda posicion del motor de cambio 220. Tambien se podnan usar otros medios, tales como medios mecanicos.
Una unidad de carga desechable o reemplazable que incorpore un efector de extremo quirurgico 160, en ciertas realizaciones de la presente divulgacion, incluye unos sensores posicionados dentro de la unidad de carga para determinar la posicion de varios componentes o el funcionamiento del efector de extremo 160, tales como la articulacion, la rotacion, la fijacion y el disparo del efector de extremo 160. Por ejemplo, se usan contactos electricos, sensores de proximidad, sensores opticos, fotodiodos, o sensores metalicos o mecanicos para controlar o registrar la informacion concerniente al efector de extremo 160. Se podnan determinar tambien la ubicacion del conjunto de yunque 162 y del conjunto de cartucho 164 una con respecto a la otra, la posicion articulada o no articulada del efector de extremo 160, la rotacion del efector de extremo 160, o la carga correcta de la unidad de carga, del cartucho de carga o de componentes del cartucho de grapas.
Se podna incluir tambien un sistema de identificacion para determinar y comunicar al DCM informacion diversa, incluyendo la velocidad, la potencia, el par de torsion, la fijacion, la longitud del desplazamiento y las limitaciones de resistencia mecanica para la operacion del efector de extremo 160 en particular. El DCM podna determinar tambien el modo de operacion y ajustar la tension, la carga del del muelle del embrague y los puntos de detencion para el desplazamiento de los componentes. Mas espedficamente, el sistema de identificacion podna incluir un componente (por ejemplo, un microchip, emisor o transmisor) en el efector de extremo 160 que comunique (por ejemplo, de forma inalambrica, por medio de senales de infrarrojos, etc.) con el DCM, o con un receptor instalado en el mismo. Se contempla tambien que podna enviarse una senal a traves del vastago de disparo 306, de tal manera que el vastago de disparo 306 funcione como un conducto para las comunicaciones entre el DCM y el efector de extremo 160.
La unidad de carga, en ciertas realizaciones segun la presente divulgacion, incluye un conjunto impulsor axial que coopera con el vastago de disparo 306 para aproximar el conjunto de yunque 162 y el conjunto de cartucho 164 del efector de extremo 160, y disparar grapas del cartucho de grapas. El conjunto impulsor axial podna incluir un brazo que se desplace en la direccion distal a traves del cartucho de grapas y que podna retirarse despues que se hayan disparado las grapas, como se describe en ciertas realizaciones de la patente de EE.UU. N° 6.953.139 concedida a Milliman y colaboradores. A tftulo de ejemplo, los sensores indicados anteriormente se podnan usar para determinar si se han disparado las grapas del cartucho de grapas, si se han disparado totalmente, si - y la extension a la que - se ha retirado el brazo en la direccion proximal a traves del cartucho de grapas, y otra informacion relacionada con el funcionamiento de la unidad de carga. En ciertas realizaciones de la presente divulgacion, la unidad de carga incorpora componentes para identificar el tipo de unidad de carga, o el cartucho de grapas cargado en el instrumento 100, incluyendo chips de identificacion por infrarrojos, identificacion celular o por radiofrecuencia (tal como por tecnologfa Sensormatic o similar). El tipo de unidad de carga o del cartucho de grapas podna ser recibido por un receptor en relacion de asociacion con el DCM, o por un dispositivo externo en la sala de operacion para suministrar realimentacion, control o analisis de inventario. La alimentacion de energfa electrica del bloque de pilas secas 400 puede incorporar un componente para identificar el tipo de bloque de pilas secas 400 cargado con el instrumento quirurgico motorizado 100 o para enviar realimentacion concerniente al estado del bloque de pilas secas 400.
En ciertas realizaciones de la presente divulgacion, el instrumento quirurgico motorizado 100 incluye unidades de carga desechables o reemplazables que incorporan un efector quirurgico de extremo 160 y una parte reutilizable que incluye un alojamiento 110 y una parte endoscopica 140 que se puede fijar de forma retirable a la unidad de carga. La parte reutilizable podna configurarse para su esterilizacion y reutilizacion en una intervencion quirurgica subsiguiente. En una realizacion, los componentes del alojamiento 110 estan sellados contra la infiltracion de una contaminacion por partfculas o por fluidos y para ayudar a prevenir danos del componente mediante el proceso de esterilizacion. El bloque de pilas secas 400, en ciertas realizaciones segun la presente divulgacion, comprende una batena recargable. La batena recargable se puede conectar a unos contactos accesibles en el alojamiento 110 del instrumento 100, por ejemplo, o bien, la batena recargable se podna recargar por medo de una interfaz de carga inductiva cerrada hermeticamente dentro del alojamiento 110. La interfaz de carga inductiva podna eliminar la puesta en cortocircuito de los contactos y provee una batena interna que se podna cerrar hermeticamente o sellar para su resistencia a los lfquidos.
La presente divulgacion se refiere tambien a un metodo de aplicacion de elementos de sujecion quirurgicos a tejido. El metodo incluye el uso del instrumento quirurgico motorizado 100, segun se ha descrito anteriormente.
Refiriendose ahora a las Figuras 16 a 19, a un instrumento quirurgico motorizado, por ejemplo una grapadora quirurgica, segun otras realizaciones de la presente divulgacion, se ha hecho referencia con el numero 1000. El instrumento quirurgico motorizado 1000 incluye un alojamiento 1100, una parte endoscopica 1400 que define un primer eje geometrico longitudinal D-D que se extiende a traves de ella, una parte de eje 1500 y un efector de extremo 1600 que define un segundo eje geometrico longitudinal E-E que se extiende a traves de el. En la patente de EE.UU, con Numero de serie 11/786.933 (H-US-00977; 203-5562) se incluyen detalles adicionales del
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instrumento quirurgico motorizado 1000.
Aunque se han mostrado las caractensticas de las realizaciones ilustradas en las Figuras 16 a 19 en relacion con un tipo particular de instrumento quirurgico 1000, se contempla que las caractensticas descritas con respecto a las Figuras 16 a 19 puedan aplicarse a otros instrumentos quirurgicos, tales como el instrumento quirurgico motorizado 100 de las Figuras 1 a 15.
Continuando con la referencia a la Figura 16, la parte endoscopica 1400 se extiende en la direccion distal desde el alojamiento 1100, la parte de eje 1500 se puede conectar selectivamente a un extremo distal 1402 de la parte endoscopica 1400, y el efector de extremo 1600 se puede conectar selectivamente a un extremo distal 1502 de la parte de eje 1500. Como se ha mostrado en las Figuras 16 a 18, se podna usar una pluralidad de partes de eje 1500 diferentes con los instrumentos quirurgicos 1000 y tambien se podna usar una pluralidad de efectores de extremo 1600 diferentes con el instrumento quirurgico 1000.
Mas espedficamente, se pueden conectar de forma retirable una pluralidad de diferentes partes de eje 1500 a la parte endoscopica 1400, por ejemplo, para un fin particular. Se contempla que al menos una fraccion de la parte de eje 1500 podna ser articulable (Figura 17A), curva (Figura 17B) o fabricada de un material elastico adecuado (segun se ha ilustrado en la Figura 17C, por ejemplo).
Como se muestra en las Figuras 16 a 18, una pluralidad de diferentes clases de efectores de extremo 1600 se podna conectar de forma retirable a la parte de eje 1500 del instrumento quirurgico 1000. Se contempla que las clases de efector de extremo 1600 que se puedan conectar selectivamente al extremo distal 1502 de la parte de eje 1600 incluyan las que tienen un conjunto de cartucho pivotable. (Figuras 16 y 19), un conjunto de cartucho sustancialmente circular (Figuras 17A, 17B y 17C) y miembros de mordaza paralelos (Figura 18). Se contempla ademas que diferentes subclases de cada clase de efector de extremo 1600 podnan ser conectables a la parte de eje 1500.
Por ejemplo, dentro de la clase de efectores de extremo 1600 que incluyen un conjunto de cartucho sustancialmente circular, se pueden mencionar los dispositivos del tipo de anastomosis gastrointestinal, los dispositivos del tipo de anastomosis transversal, (veanse, por ejemplo, las patentes de EE.UU. Numeros 4.383.634, 5.782.396, 5.865.361 y 5.318.221) y los dispositivos del tipo de anastomosis circular (vease, por ejemplo, la patente de EE.UU. N° 4.304.236). Los dispositivos del tipo de anastomosis gastrointestinal estan configurados para impulsar y doblar grapas alineadas en una hilera secuencialmente en una secuencia rapida, mientras que los dispositivos del tipo de anastomosis transversal impulsan y doblan todas las grapas simultaneamente. Los dispositivos del tipo de anastomosis circular estan configurados para aplicar simultaneamente hileras anulares de grapas al tejido.
Adicionalmente, dentro de la clase de efectores de extremo 1600 que tienen un conjunto de cartucho pivotable, las subclases podnan incluir efectores de extremo 1600 configurados para impulsar grapas secuencialmente y efectores de extremo 1600 configurados para impulsar grapas simultaneamente.
Por tanto, se contempla que una parte particular de eje 1500 se podna configurar para su uso con una clase particular de efectores de extremo 1600, tales como los efectores de extremo 1600 que incluyan un conjunto de cartucho sustancialmente circular. En dicha realizacion, se podna configurar otra parte de eje 1500 para su uso con otra clase particular de efectores de extremo 1600, tales como los efectores de extremo 1600 que incluyan un conjunto de cartucho pivotable o efectores de extremo 1600 que tengan unos miembros de mordaza que se aproximen entre sf mientras permanecen sustancialmente paralelos.
Se contempla ademas que una parte particular de eje 1500 se podna configurar para su uso con un tipo particular de efector de extremo 1600, tales como unos efectores de extremo 1600 configurados para el disparo en secuencia de grapas (incluyendo los efectores de extremo 1600 que incluyen un conjunto de cartucho sustancialmente circular, efectores de extremo 1600 que incluyan un conjunto de cartucho pivotable, o efectores de extremo 1600 que tengan miembros de mordaza que se aproximen paralelamente) o efectores de extremo 1600 configurados para el disparo en secuencia de grapas, por ejemplo.
Adicionalmente, se contempla que una parte particular de eje 1500 se podna configurar para su uso con varios tipos de efectores de extremo 1600, incluyendo efectores de extremo 1600 que incluyan un conjunto de cartucho sustancialmente circular, un conjunto de cartucho pivotable, miembros de mordaza que se aproximen paralelamente, configurados para el disparo en secuencia de grapas o configurados para el disparo simultaneo de grapas. En este caso, un facultativo podna seleccionar una parte particular de eje 1500 basandose en otras caractensticas, tales como, por ejemplo, una parte de eje 1500 que sea articulable, curva, o elastica.
Se incluye tambien al menos un componente electronico 1700 en una parte de instrumento quirurgico 1000. Se contempla que un primer sensor 1700a se incluya en la parte endoscopica 1400, un segundo sensor 1700b se incluya en la parte de eje 1500, y un tercer sensor 1700c se incluya en el efector de extremo 1600. Se contempla que los sensores 1700 cooperen con un receptor/controlador en el alojamiento 1100, en otra parte del instrumento 1000, o con un dispositivo separado del instrumento 1000 para diversos fines. Por ejemplo, el primer sensor 1700a se podna configura para detectar el tipo de parte de eje 1500 que este acoplado con la parte endoscopica 1400. Ademas el segundo sensor 1700b se podna configurar para detectar el tipo de efector de extremo 1600 que este
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acoplado con la parte de eje 1500.
Se contempla ademas que se incluya una interfaz 1800 de usuario en el alojamiento 1100. En una realizacion divulgada, la interfaz 1800 de usuario incluye una pantalla que presenta visualmente al menos algo de la informacion (por ejemplo, tipo de parte de eje 1500 conectada a la parte endoscopica 1400, tipo de efector de extremo 1600 conectado a la parte de eje 1500, etc) detectados por los sensores 1700 en el instrumento quirurgico 1000. La interfaz 1800 de usuario podna presentar visualmente tambien una condicion de efector de extremo 1600, tal como el angulo de articulacion o rotacion, si se han disparado grapas desde el mismo, si existe tejido entre los miembros de mordaza, etc. Esta informacion se podna suministrar tambien a una pantalla de video o a un sistema de monitores de la sala de operacion, Por ejemplo, los datos se podnan transmitir a un receptor para el sistema de monitores de la sala de operacion desde un transmisor de comunicacion incorporado a - o en relacion de asociacion con - el instrumento quirurgico motorizado 1000, por medio de tecnologfa que incluya Blue Tooth, ANT3, KNX, Onda Z, X10, USB inalambrico, WiFi, IrDa , Nanonet, Tiny OS, ZigBee, radio, UhF y VHF.
La presente divulgacion se refiere tambien a un metodo de aplicacion de elementos quirurgicos de sujecion al tejido. El metodo incluye la etapa de proveer un instrumento quirurgico motorizado 100, 1000, segun se han descrito anteriormente. El metodo incluye tambien conectar la parte de eje 1500 al extremo distal 1402 de la parte endoscopica 1400 y conectar el efector de extremo 1600 al extremo distal 1502 de la parte de eje 1500.
Con referencia a las Figuras 20 y 21, se muestra un instrumento 2000 para colocar grapas quirurgicas segun la presente divulgacion. La Figura 20 ilustra el instrumento 2000 para colocar grapas quirurgicas que incluye un conjunto de empunadura 2010, una primera parte endoscopica 2020a y un primer efector de extremo 2030a. La Figura 21 ilustra el instrumento 2000 para colocar grapas quirurgicas que incluye el conjunto de empunadura 2010, una segunda parte endoscopica 2020b y un segundo efector de extremo 2030b. Cada una de la primera parte endoscopica 2020a y segunda parte endoscopica 2020b incluye un miembro de accionamiento (por ejemplo, al menos una parte del vastago de disparo 306, indicada anteriormente) configurado para acoplarse a una parte del efector de extremo 2030, y que se puede conectar selectivamente a una parte distal 2012 del conjunto de empunadura 2010 y define un eje geometrico longitudinal F-F. Cada uno del primer efector de extremo 2030a y segundo efector de extremo 2030b esta configurado para realizar una funcion de grapar y se puede conectar selectivamente a una parte distal 2022 de la primera parte endoscopica 2020a y de la segunda parte endoscopica 2020b, respectivamente.
Refiriendose espedficamente a la Figura 20, se muestran el conjunto de empunadura 2010, la primera parte endoscopica 2020a y el primer efector de extremo 2030a. En este caso, el conjunto de empunadura 2010 incluye unos contactos electricos (por ejemplo, los anillos conductores 2014) dispuestos junto a la parte distal 2012 del mismo. Los anillos conductores 2014 estan conexionados internamente dentro del conjunto de empunadura 2010 a una fuente de alimentacion de energfa electrica (bien dentro del conjunto de empunadura 2010 o externamente a este) o a un microcontrolador. Se contempla que los anillos conductores 2014 se puedan retirar del conjunto de empunadura 2010.
Con referencia a las Figuras 20 y 21, cada una de la primera parte endoscopica 2020a y segunda parte endoscopica 2020b, puede rotar alrededor del eje geometrico F-F con respecto a la parte distal 2012 del conjunto de empunadura 2010. Se ha mostrado un mando 2035 en cooperacion mecanica con las partes endoscopicas 2020a, 2020b para facilitar dicha rotacion. La inclusion de una estructura de rotacion adecuada, tal como un acoplamiento 2037 del tipo bayoneta (Figura 21), podna ayudar a facilitar o controlar la rotacion.
La primera parte endoscopica 2020a se ha mostrado teniendo un mecanismo de articulacion o dispositivo de accionamiento 2040 dispuesto en cooperacion mecanica con la misma. Como se ha indicado anteriormente, el mecanismo de articulacion 2040 esta configurado para pivotar al efecto de extremo 2030 con respecto a un eje geometrico longitudinal (mostrado en esta realizacion como “F-F”). En este caso, un mando 2042 de articulacion que esta dispuesto operativamente en la primera parte endoscopica 2020a, o un motor 2044 instalado dentro de un alojamiento 2046 de la primera parte endoscopica 2020a, se podnan usar para articular al efector de extremo 2030 acoplado con la primera parte endoscopica 2020a..
.En la realizacion donde se usa el motor 2044 para proveer articulacion (Figura 20), al menos un contacto electrico 2050 (se han mostrado un par de contactos electricos 2050a y 2050b) esta dispuesto operativamente con la primera parte endoscopica 2020a. El contacto electrico 2050 esta en comunicacion electrica con el motor 2044 de la primera parte endoscopica 2020a y esta configurado para comunicar energfa electrica entre los anillos conductores 2014 del conjunto de empunadura 2010 y el motor 2044. En este caso, el motor 2044 esta conectado operativamente al miembro de accionamiento para mover a este sustancialmente a lo largo del eje geometrico longitudinal F-F, por ejemplo, para articular al efector de extremo 2030a. Se contempla que el motor 2044 provea o ayude a proveer energfa que se utilice para la articulacion del efector de extremo 2030, la rotacion de la parte endoscopica 2020, la traslacion del vastago de disparo 306, etc.
Como se muestra en la Figura 20, los anillos conductores 2014 son sustancialmente de forma circular y estan dispuestos alrededor de la parte distal 2012 del conjunto de empunadura 2010. Como se puede apreciar, la forma o la configuracion de los anillos conductores 2014 alrededor de la parte distal 2012 del conjunto de empunadura 2010
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ayudan sustancialmente a establecer un contacto continuo entre los anillos conductores 2014 y los contactos electricos 2050 cuando la primera parte endoscopica 2020a se esta rotando alrededor del eje geometrico longitudinal F-F con respecto al conjunto de empunadura 2010. De ese modo, es posible una rotacion completa de 360°. Es posible la comunicacion de energfa entre el motor 2044 y el contacto electrico 2050, a pesar de la direccion de rotacion de la primera parte endoscopica 2020a con respecto al conjunto de empunadura 2010. Adicionalmente, se contempla que podnan disponerse unos topes mecanicos o electricos en la parte endoscopica 2020a o en la parte distal 2012 del conjunto de empunadura 2010 para limitar el desplazamiento a rotacion de la primera parte endoscopica 2020a.
Aunque solamente se han ilustrado dos tipos de efectores de extremo 2030 en las Figuras 20 y 21, se contempla que se podnan usar varios tipos de efectores de extremo 2030 (por ejemplo, efectores de extremo que incluyan un conjunto de cartucho sustancialmente circular (Figura 21), un conjunto de cartucho pivotable (Figura 20), unos miembros de modaza que se aproximen paralelamente, configurados para el disparo de grapas en secuencia o configurados para el disparo de grapas simultaneamente) en relacion con el dispositivo 2000 de colocacion de grapas quirurgicas, y se podnan usar con diferentes tipos de partes endoscopicas 2020 (por ejemplo, una primera parte endoscopica 2020a que tenga un motor 2044, y una segunda parte endoscopica 2020b).
Se entendera que podnan hacerse diversas modificaciones a las realizaciones divulgadas en la presente memoria. Por ejemplo, las ubicaciones a lo largo del eje geometrico longitudinal para el motor impulsor 210 o el engranaje impulsor 200 podnan ser diferentes a las mostradas. Se podnan usar tipos diferentes de engranajes para impulsion, rotacion, articulacion o accionamiento. Por tanto, la descripcion anterior no se considerara con caracter limitativo, sino solamente como ejemplificaciones de varias realizaciones. Los expertos en la tecnica contemplaran otras modificaciones dentro del alcance de las reivindicaciones que se adjuntan como apendice a la presente memoria.
Se describe un instrumento quirurgico que incluye un conjunto de empunadura, una primera parte endoscopica, un motor, y un primer efector de extremo. La primera parte endoscopica se puede conectar selectivamente a una parte distal del conjunto de empunadura y define un eje geometrico longitudinal. La primera parte endoscopica incluye un alojamiento adyacente a su parte proximal, e incluye un miembro de accionamiento. El motor esta dispuesto en cooperacion mecanica con el alojamiento de la primera parte endoscopica, y esta conectado operativamente al miembro de accionamiento para mover a este sustancialmente a lo largo del eje geometrico longitudinal. El primer efector de extremo se puede conectar selectivamente a una parte distal de la primera parte endoscopica, y esta configurado para realizar una primera funcion de colocacion de grapas.
Claims (13)
- 51015202530354045REIVINDICACIONES1. Un instrumento quirurgico motorizado (1000) que incluye:un alojamiento (1100);una parte endoscopica (1400) que se extiende distalmente desde el alojamiento (1100) y que define un primer eje longitudinal;una parte de eje (1500) que se puede conectar selectivamente a un extremo distal (1402) de la parte endoscopica (1400); yun efector de extremo (1600) que se puede conectar selectivamente a un extremo distal (1502) de la parte de eje (1500) y que define un segundo eje longitudinal que se extiende a traves de el,caracterizado por que al menos un componente electronico (1700) se incluye en una parte del instrumento quirurgico (1000);donde el instrumento quirurgico comprende una pluralidad de diferentes partes de eje (1500) y una pluralidad de diferentes efectores de extremo (1600) que se pueden conectar selectivamente al instrumento quirurgico (1000); ydonde el al menos un componente electronico es un sensor que detecta el tipo de parte de eje (1500) conectada a la parte endoscopica (1400) o el tipo de efector de extremo (1600) que esta conectado a la parte de eje (1500).
- 2. El instrumento quirurgico motorizado (1000) segun la reivindicacion 1, en el que la parte endoscopica (1400) incluye un primer sensor (1700a); la parte de eje incluye un segundo sensor (1700b); y el efector de extremo (1600) incluye un tercer sensor (1700c).
- 3. El instrumento quirurgico motorizado (1000) segun la reivindicacion 2, en el que los sensores (1700) cooperan con un receptor/controlador en el alojamiento (1100), en otra parte del instrumento (1000) o con un dispositivo separado del instrumento (1000).
- 4. El instrumento quirurgico motorizado (1000) segun la reivindicacion 3, en el que el primer sensor (1700a) esta configurado para detectar el tipo de parte de eje (1500) que esta acoplado con la parte endoscopica (1400).
- 5. El instrumento quirurgico motorizado (1000) segun la reivindicacion 3 o la reivindicacion 4, en el que el segundo sensor (1700b) esta configurado para detectar el tipo de efector de extremo que esta acoplado con la parte de eje (1500).
- 6. El instrumento quirurgico motorizado (1000) segun cualquiera de las reivindicaciones anteriores, en el que la pluralidad de partes de eje (1500) diferentes estan conectados de forma retirable a la parte endoscopica (1400).
- 7. El instrumento quirurgico motorizado (1000) segun cualquiera de las reivindicaciones anteriores, en el que se incluye una interfaz (1800) de usuario en el alojamiento (1100).
- 8. El instrumento quirurgico motorizado (1000) segun cualquiera de las reivindicaciones anteriores, en el que al menos una parte de la parte de eje (1500) es articulable, curva o esta hecha de un material elastico.
- 9. El instrumento quirurgico motorizado (1000) segun cualquiera de las reivindicaciones anteriores, en el que una pluralidad de clases diferentes de efectores de extremo (1600) estan conectados de forma retirable a la parte de eje (1500).
- 10. El instrumento quirurgico motorizado (1000) segun la reivindicacion 9, en el que las diferentes clases de efectores de extremo (1600) incluyen las que tienen un conjunto de cartucho pivotable, un conjunto de cartucho sustancialmente circular o miembros de mordaza paralelos.
- 11. El instrumento quirurgico motorizado (1000) segun la reivindicacion 9 o la reivindicacion 10, en el que diferentes subclases de efector de extremo (1600) se pueden conectar a la parte de eje (1500).
- 12. El instrumento quirurgico motorizado (1000) segun cualquiera de las reivindicaciones anteriores, en el que el efector de extremo (1600) incluye un conjunto de cartucho sustancialmente circular, un dispositivo del tipo de anastomosis gastrointestinal, un dispositivo del tipo de anastomosis transversal o un dispositivo del tipo de anastomosis circular.
- 13. El instrumento quirurgico motorizado (1000) segun cualquiera de las reivindicaciones anteriores, en el que el efector de extremo (1600) esta configurado para impulsar grapas de manera secuencial y/o simultanea.
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2008
- 2008-10-16 US US12/252,427 patent/US7922063B2/en not_active Expired - Fee Related
- 2008-10-27 EP EP16159624.2A patent/EP3066992A1/en not_active Withdrawn
- 2008-10-27 EP EP12171855.5A patent/EP2505147B1/en active Active
- 2008-10-27 EP EP12171845.6A patent/EP2505145B1/en active Active
- 2008-10-27 EP EP12171850.6A patent/EP2505146B1/en not_active Revoked
- 2008-10-27 ES ES11005057.2T patent/ES2586814T3/es active Active
- 2008-10-27 AT AT08253489T patent/ATE520358T1/de not_active IP Right Cessation
- 2008-10-27 ES ES12171845.6T patent/ES2548182T3/es active Active
- 2008-10-27 ES ES12171850.6T patent/ES2550239T3/es active Active
- 2008-10-27 EP EP08253489A patent/EP2055243B1/en active Active
- 2008-10-27 EP EP12171841.5A patent/EP2505144B1/en active Active
- 2008-10-27 EP EP11005057.2A patent/EP2394588B1/en active Active
- 2008-10-27 ES ES08253489T patent/ES2368466T3/es active Active
- 2008-10-29 JP JP2008278583A patent/JP5356774B2/ja active Active
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