ES2587354T3 - Aplicador y método de sellador extraluminal - Google Patents
Aplicador y método de sellador extraluminal Download PDFInfo
- Publication number
- ES2587354T3 ES2587354T3 ES05811931.4T ES05811931T ES2587354T3 ES 2587354 T3 ES2587354 T3 ES 2587354T3 ES 05811931 T ES05811931 T ES 05811931T ES 2587354 T3 ES2587354 T3 ES 2587354T3
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- Prior art keywords
- sealant
- jaw members
- effector
- jaw
- terminal effector
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00491—Surgical glue applicators
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/08—Wound clamps or clips, i.e. not or only partly penetrating the tissue ; Devices for bringing together the edges of a wound
-
- 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
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B2017/1125—Forceps, specially adapted for performing or assisting anastomosis
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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)
- Materials For Medical Uses (AREA)
Abstract
Un aparato (10) para aplicar sellador a un tejido diana de un sitio quirúrgico, que comprende: una empuñadura (12) que incluye una estructura aplicadora (16) de sellador para aplicar sellador al tejido diana; un efector terminal en forma de pinza que comprende dos miembros (28,30) de mordaza en asociación operativa con la empuñadura; al menos un conducto (22) para transportar el sellador hasta el efector terminal; y paredes laterales (40) para confinar el sellador proporcionado a ambos lados de cada miembro de mordaza, o extendiéndose desde el mismo, caracterizado porque cada pared lateral incluye un primer extremo conectado operativamente al miembro de mordaza y un segundo extremo que se extiende radialmente hacia el interior desde el miembro de mordaza para entrar con contacto con un tejido cuando el efector terminal se encuentra en la posición cerrada.
Description
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sus propiedades antimicrobianas, su capacidad de promover la reparación o la reconstrucción y/o el nuevo crecimiento de tejido. Pueden aplicarse de esta manera agentes antimicrobianos, tales como un antibiótico de amplio espectro (sulfato de gentamicina, eritromicina o glicopéptidos derivatizados), que sean liberados lentamente al interior del tejido para contribuir a combatir infecciones clínicas y subclínicas en un sitio de reparación de tejido. Para promover la reparación y/o el crecimiento de tejido, el sellador 34 puede incluir uno o varios factores promotores del crecimiento, por ejemplo factor de crecimiento de fibroblastos, factor de crecimiento óseo, factor de crecimiento epidérmico, factor de crecimiento derivado de plaquetas, factor de crecimiento derivado de macrófagos, factor de crecimiento derivado alveolar, factor de crecimiento derivado de monocitos, magainina, etcétera. Algunas indicaciones terapéuticas son: glicerol con activador del plasminógeno tisular o renal para causar trombosis, superóxido dismutasa para neutralizar los radicales libres que dañan los tejidos, factor de necrosis tumoral para la terapia del cáncer, o factor estimulador de colonias e interferón, interleucina-2 u otras linfocinas para mejorar el sistema inmunológico.
El efector terminal medio 18 de bloqueo es representado en la FIG. 1 como un botón que puede ser pulsado para bloquear el efector terminal 24 en la posición cerrada. Se contempla por esta divulgación que el efector terminal 24 esté precargado mediante resorte en la posición abierta. En consecuencia, en uso, una vez que el efector terminal 24 es accionado a la posición cerrada (mostrada como líneas discontinuas en la FIG. 1), el usuario puede activar el medio 18 de bloqueo para mantener el efector terminal 24 en la posición cerrada. Aunque el medio 18 de bloqueo es representado como un botón en el miembro 12 de empuñadura, se contempla que el medio 18 de bloqueo pueda ser también, por ejemplo, una palanca, un dispositivo corredizo o que esté incorporado en el medio operativo 14 del efector terminal como un gatillo de tipo trinquete. También se contempla que pueda disponerse un medio 18 de bloqueo en el extremo distal de cada miembro 28, 30 de mordaza (mostrado en la FIG. 2), de modo que los dos medios 18 de bloqueo se acoplen entre sí cuando el efector terminal 24 esté en la posición cerrada. Los diferentes tipos de medios 18 de bloqueo contemplados por esta presente divulgación puede ser usados individualmente o de forma conjunta entre sí.
Según se ve en la FIG. 1, el conducto 22 de la barra 20 es mostrado como una única luz o canal. Se contempla que en la barra 20 puedan disponerse múltiples conductos 22. En una realización, en la barra 20 pueden disponerse dos canales, suministrando sellador 34 cada conducto 22 a cada uno de los dos miembros 28, 30 de mordaza. Cada uno de los dos conductos 22 dispuestos en la barra 20 también puede ser usado para transportar una parte de un sellador de dos partes, de modo que las dos partes del sellador se mezclen entre sí para formar un sellador 34 antes de entrar en contacto con el órgano 36 o tejido corporal (FIG. 2) o cuando son distribuidas desde los miembros 28, 30 de mordaza. También se contempla que haya dispuestos cuatro conductos 22 en la barra 20, suministrando dos conductos 22 a cada miembro 28, 30 de mordaza. Como tal, cada parte de un sellador de dos partes puede ser suministrada a cada uno de los dos miembros 28, 30 de mordaza. También se contempla tener dispuestos cualquiera o todos los conductos 22 en una porción externa de la barra 20, o a lo largo de la misma, en vez de dentro de la barra 20.
Pasando ahora a las FIGURAS 2-4, se muestra al efector terminal 24 del aplicador 10 de sellador extraluminal cerrado alrededor de un órgano corporal 36. Por ejemplo, el órgano corporal 36 puede ser un bronquio, el intestino, etc., o cualquier otra parte del cuerpo que haya sido unida mediante grapado lineal (FIG. 17). Según se ve en las FIGURAS 2-4, el órgano corporal 36 está representado después de que haya tenido lugar un procedimiento de grapado usando una grapadora integral de anastomosis. Durante tal procedimiento, se usan comúnmente grapas quirúrgicas 38 para unir dos secciones del órgano corporal 36.
Según se ve en las FIGURAS 3 y 4, se ha distribuido una capa de sellador 34 entre el efector terminal 24 y el órgano corporal 36. El sellador 34 rodea, como mínimo, sustancialmente, preferentemente rodea por completo el perímetro del órgano corporal 36 y sella cualquier agujero o desgarro (no mostrados) creados por cada grapa quirúrgica 38, cualquier hueco que pudiera existir entre grapas quirúrgicas 38 adyacentes, y la unión entre los tejidos adyacentes para reforzar la unión entre los mismos.
Según se ve en las FIGURAS 2 y 3, los miembros 28, 30 de mordaza están representados en la posición cerrada alrededor del órgano corporal 36 y están bloqueados conjuntamente a través del medio 18 de bloqueo.
Según se ve en la FIG. 4, un par de estructuras de confinamiento del sellador, por ejemplo paredes laterales 40, son proporcionadas a ambos lados de cada miembro 28, 30 de mordaza o se extienden desde los mismos, y extienden la longitud de los mismos. Las paredes laterales 40 están configuradas y adaptadas para retener sellador 34 en estrecha proximidad a las grapas quirúrgicas 38 y superpuestas a las mismas para impedir que el sellador 34 se desparrame extendiéndose desde la fila de grapas quirúrgicas 38. Un primer extremo 40a de cada pared lateral 40 está conectado operativamente con cada miembro 28, 30 de mordaza, y un segundo extremo 40b de cada pared lateral se extiende radialmente hacia el interior, de modo que el segundo extremo 40b de la pared lateral 40 haga contacto con el órgano corporal 36 cuando el efector terminal 24 esté en la posición cerrada.
Está dentro del alcance de la presente divulgación que las paredes laterales 40 del efector terminal 24 estén fabricadas ya sea de un material rígido (FIGURAS 5 y 6), de un material flexible (FIG. 7), o de alguna combinación de los mismos. Según ha de apreciarse, las paredes laterales 40, que son flexibles, se adaptan sustancialmente a
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los contornos del órgano corporal 36. Se contempla que el segundo extremo 40b de las paredes laterales 40 pueda contener elementos 44 de aumento de la fricción para aumentar la fricción entre el segundo extremo 40b de la pared lateral 40 y el órgano corporal 36, según se ilustra en las FIGURAS 5 y 6. Se contempla que tales elementos 44 de aumento de la fricción puedan ser una serie de fiadores (véase la FIG. 5), una o más púas (véase la FIG. 6), cualquier combinación de los mismos, o cualquier otro medio razonable para aumentar la fricción entre el segundo extremo 40b de la pared lateral 40 y el órgano corporal 36. Los elementos 44 de aumento de la fricción pueden contribuir a mantener el efector terminal 24 en su sitio cuando está en contacto con el órgano corporal 36.
Con referencia de nuevo a la FIG. 4, hay formado al menos un depósito 42 en cada miembro 28, 30 de mordaza para contener y/o distribuir sellador 34 al sitio del tejido diana. El depósito 42 puede tener la forma de un canal que se extiende al menos parcialmente alrededor o a lo largo de los miembros 28, 30 de mordaza. El depósito 42 está en comunicación de fluido con el conducto 22 para recibir el sellador 34 del mismo. Según se ve en la FIG. 4, el sellador 34 se ha soltado o distribuido desde el depósito 42, rodea sustancialmente el órgano corporal 36 y cubre sustancialmente el sitio quirúrgico y las grapas quirúrgicas 38 situadas alrededor del mismo. Las paredes laterales 40 de los miembros 28, 30 de mordaza pueden contribuir a confinar el sellador 34 al sitio del tejido diana. El efector terminal 24 es extraído del órgano corporal 36 una vez que el sellador 34 ha endurecido total o parcialmente.
Se contempla que la forma del depósito 42 sea tal que el efector terminal 24 y los miembros 28, 30 de mordaza del mismo puedan ser libremente liberados del órgano corporal 36 aunque el sellador 34 se endurezca por completo o se endurezca parcialmente mientras sigue llenando completa o parcialmente el depósito 42. También se contempla que, antes de la distribución del sellador 34 desde los miembros 28, 30 de mordaza, se aplique un lubricante (no mostrado) al depósito 42 y/o a las superficies de los miembros 28, 30 de mordaza orientadas hacia el interior para impedir que el sellador completa o parcialmente endurecido 34 se pegue a tales superficies.
La presente divulgación contempla que se proporcione una serie de depósitos individuales 42a (véanse las FIGURAS 8 y 8A) en la longitud de cada miembro 28, 30 de mordaza y/o, según se ha mencionado anteriormente, un depósito alargado 42b que se extienda toda la longitud o una porción de la longitud de los miembros 28, 30 de mordaza (véanse las FIGURAS 9 y 9A).
También se contempla que el aparato de la presente divulgación contenga un depósito 42 dispuesto hacia la porción proximal de cada miembro 28, 30 de mordaza (no mostrado). En tal realización, un cordón de sellador 34 hará contacto o estará cerca de hacer contacto con la porción proximal del órgano corporal 36 cuando el efector terminal 24 esté en la posición abierta. Cuando el efector terminal 24 sea movido hacia la posición cerrada, cada uno de los miembros 28, 30 de mordaza empujará/distribuirá el sellador 34 sobre la superficie del órgano corporal 36 mientras los miembros 28, 30 de mordaza entran gradualmente en contacto con una mayor área superficial del órgano corporal 36.
También se contempla que pueda usarse un medio externo 200 (véase la FIG. 16) para suministrar el sellador 34 al órgano corporal 36 a través del efector terminal 24. El medio externo 200, tal como una jeringa, puede ser usado para inyectar en los miembros 28, 30 de mordaza el sellador 34 que se distribuiría y/o suministraría al órgano corporal 36 a través de aberturas en los miembros 28, 30 de mordaza.
Se contempla, además, que cada uno de los dos miembros 28, 30 de mordaza pueda sujetar de forma liberable un apósito de refuerzo (no mostrado) que esté impregnado con sellador. En tal realización, cada miembro 28, 30 de mordaza tendría un apósito impregnado de sellador (no mostrado) dispuesto en el mismo. Cuando los miembros 28, 30 de mordaza pasan a la posición cerrada, los apósitos pueden hacer contacto y adherirse a la línea de grapas (liberándose de los miembros 28, 30 de mordaza), sellando así el sitio con el sellador 34.
Pasando ahora a las FIGURAS 10 -12, se muestran y se describirán diferentes realizaciones de los miembros 28, 30 de mordaza. La FIG. 10 muestra un efector terminal 24a que incluye un par arqueado rígido de miembros 28a, 30a de mordaza. Estos pueden ser usados cuando el órgano corporal 36 no se deforma significativamente cuando se aplica presión al mismo. La FIG. 11 representa un efector terminal 24b que incluye un par planario rígido de miembros 28b, 30b de mordaza. Este par puede ser usado cuando el órgano corporal 36 se deforma adquiriendo una forma un tanto aplanada debido a la presión de la cirugía de grapado o a la presión asociada con el cierre de los miembros 28b, 30b de mordaza. La FIG. 12 ilustra un efector terminal 24c que incluye un par deformable de miembros 28c, 30c de mordaza. Estas pinzas pueden ser usadas cuando el órgano corporal 36 se deforma cuando es sometido a la presión resultante de la cirugía y/o del cierre de los miembros 28c, 30c de mordaza. Los miembros 28c, 30c de mordaza están diseñados y configurados para adaptarse o adaptarse esencialmente a la curvatura resultante que adopta el órgano corporal 36 por la presión de la cirugía y/o la presión de los propios miembros 28c, 30c de mordaza. Los cirujanos podrán determinar qué conjunto de miembros 28, 30 de mordaza usar, ya sea por la experiencia anterior o por prueba y error.
Según se ve en las FIGURAS 13 y 14, también se contempla que los miembros 28, 30 de mordaza estén configurados para el grapado lineal. La FIG. 13 representa a los miembros 28, 30 de mordaza unidos de manera pivotante a la barra 20 para sujetar tejido entre los mismos. La FIG. 14 representa a los miembros 28, 30 de mordaza unidos de manera operativa a la barra 20 de manera paralela para sujetar tejido entre los mismos. Estas realizaciones pueden ser usadas para aplicar el sellador 34 al tejido que ha sido unido mediante grapado lineal.
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Claims (1)
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Applications Claiming Priority (3)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US62001804P | 2004-10-18 | 2004-10-18 | |
| US620018P | 2004-10-18 | ||
| PCT/US2005/037252 WO2006044799A2 (en) | 2004-10-18 | 2005-10-14 | Extraluminal sealant applicator and method |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| ES2587354T3 true ES2587354T3 (es) | 2016-10-24 |
Family
ID=36203629
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| ES05811931.4T Active ES2587354T3 (es) | 2004-10-18 | 2005-10-14 | Aplicador y método de sellador extraluminal |
Country Status (7)
| Country | Link |
|---|---|
| US (6) | US7744624B2 (es) |
| EP (2) | EP3095396B1 (es) |
| JP (2) | JP5043670B2 (es) |
| AU (1) | AU2005295476B2 (es) |
| CA (1) | CA2584005C (es) |
| ES (1) | ES2587354T3 (es) |
| WO (1) | WO2006044799A2 (es) |
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| DE10204119A1 (de) * | 2002-02-01 | 2003-08-14 | Disetronic Licensing Ag | Vorrichtung zur dosierten Verabreichung eines injizierbaren Produkts |
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-
2005
- 2005-10-14 EP EP16174227.5A patent/EP3095396B1/en not_active Expired - Fee Related
- 2005-10-14 CA CA2584005A patent/CA2584005C/en not_active Expired - Fee Related
- 2005-10-14 EP EP05811931.4A patent/EP1804685B1/en not_active Expired - Fee Related
- 2005-10-14 ES ES05811931.4T patent/ES2587354T3/es active Active
- 2005-10-14 AU AU2005295476A patent/AU2005295476B2/en not_active Ceased
- 2005-10-14 JP JP2007537000A patent/JP5043670B2/ja not_active Expired - Fee Related
- 2005-10-14 WO PCT/US2005/037252 patent/WO2006044799A2/en active Application Filing
- 2005-10-14 US US11/251,118 patent/US7744624B2/en not_active Expired - Fee Related
-
2007
- 2007-12-11 US US12/001,625 patent/US7972357B2/en not_active Expired - Fee Related
-
2010
- 2010-04-22 US US12/765,133 patent/US8449571B2/en active Active
-
2011
- 2011-06-03 US US13/152,625 patent/US8480705B2/en active Active
- 2011-07-14 JP JP2011156144A patent/JP2011235134A/ja active Pending
-
2013
- 2013-05-08 US US13/889,646 patent/US8945176B2/en not_active Expired - Fee Related
- 2013-06-14 US US13/917,796 patent/US8951282B2/en not_active Expired - Fee Related
Also Published As
| Publication number | Publication date |
|---|---|
| JP5043670B2 (ja) | 2012-10-10 |
| US20130282055A1 (en) | 2013-10-24 |
| US8480705B2 (en) | 2013-07-09 |
| US8951282B2 (en) | 2015-02-10 |
| WO2006044799A3 (en) | 2009-04-30 |
| US20080125811A1 (en) | 2008-05-29 |
| US7744624B2 (en) | 2010-06-29 |
| AU2005295476A1 (en) | 2006-04-27 |
| EP3095396B1 (en) | 2018-04-18 |
| US20110238097A1 (en) | 2011-09-29 |
| US8449571B2 (en) | 2013-05-28 |
| JP2011235134A (ja) | 2011-11-24 |
| AU2005295476B2 (en) | 2011-03-24 |
| US20100204728A1 (en) | 2010-08-12 |
| EP3095396A1 (en) | 2016-11-23 |
| US20130245679A1 (en) | 2013-09-19 |
| US7972357B2 (en) | 2011-07-05 |
| WO2006044799A2 (en) | 2006-04-27 |
| EP1804685B1 (en) | 2016-07-27 |
| CA2584005C (en) | 2013-09-10 |
| CA2584005A1 (en) | 2006-04-27 |
| US8945176B2 (en) | 2015-02-03 |
| EP1804685A4 (en) | 2014-12-24 |
| EP1804685A2 (en) | 2007-07-11 |
| US20060085031A1 (en) | 2006-04-20 |
| JP2008516697A (ja) | 2008-05-22 |
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