ES2611480T3 - Canal de cartucho mecánicamente pivotante para instrumento quirúrgico - Google Patents

Canal de cartucho mecánicamente pivotante para instrumento quirúrgico Download PDF

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ES2611480T3
ES2611480T3 ES09251392.8T ES09251392T ES2611480T3 ES 2611480 T3 ES2611480 T3 ES 2611480T3 ES 09251392 T ES09251392 T ES 09251392T ES 2611480 T3 ES2611480 T3 ES 2611480T3
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cam surface
surgical instrument
proximal
jaw
distal
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Sachin Shah
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Covidien LP
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0023—Surgical instruments, devices or methods, e.g. tourniquets disposable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0042—Surgical instruments, devices or methods, e.g. tourniquets with special provisions for gripping
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07271—Stapler heads characterised by its cartridge
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B17/2909—Handles
    • A61B2017/2912—Handles transmission of forces to actuating rod or piston
    • A61B2017/2919—Handles transmission of forces to actuating rod or piston details of linkages or pivot points
    • A61B2017/2922—Handles transmission of forces to actuating rod or piston details of linkages or pivot points toggle linkages
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B17/2909—Handles
    • A61B2017/2912—Handles transmission of forces to actuating rod or piston
    • A61B2017/2923—Toothed members, e.g. rack and pinion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2932—Transmission of forces to jaw members
    • A61B2017/2933—Transmission of forces to jaw members camming or guiding means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2946—Locking means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B2017/320052—Guides for cutting instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03—Automatic limiting or abutting means, e.g. for safety
    • A61B2090/033—Abutting means, stops, e.g. abutting on tissue or skin
    • A61B2090/034—Abutting means, stops, e.g. abutting on tissue or skin abutting on parts of the device itself
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0807—Indication means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0814—Preventing re-use

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
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Abstract

Un instrumento quirúrgico (100), que comprende: un armazón (110); una parte alargada (140) que se extiende distalmente desde el armazón (110); una barra de accionamiento (310) dispuesta al menos parcialmente dentro de la parte alargada (140) y que se puede trasladar proximalmente y distalmente con respecto a la parte alargada (140); un efector de extremo (150) dispuesto de manera adyacente a un extremo distal de la parte alargada (140), en donde el efector de extremo (150) incluye un primer elemento de mordaza y un segundo elemento de mordaza, el primer elemento de mordaza se puede mover con respecto al segundo elemento de mordaza entre una posición abierta y una posición próxima, el primer elemento de mordaza incluye una superficie de leva proximal (152b) y una superficie de leva distal (152a) en este, un cartucho de sujetadores quirúrgicos (170) dispuesto en el primer elemento de mordaza; y una parte accionadora (330) de la barra de accionamiento (310), caracterizada por que dicha parte accionadora (330) es una parte horizontal superior de una barra en I y está adaptada para entrar en contacto con la superficie de leva distal (152a) produciendo la aproximación de los elementos de mordaza y donde la traslación proximal de la barra de accionamiento (310) produce que la parte accionadora (330) de la barra de accionamiento (310) entre en contacto con la superficie de leva proximal (152b), lo que produce la apertura de los elementos de mordaza .

Description

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DESCRIPCION
Canal de cartucho mecanicamente pivotante para instrumento quirurgico
Antecedentes
Campo tecnico
La presente descripcion se refiere a un instrumento quirurgico que tiene mordazas que se pueden mover entre las posiciones abierta y cerrada, y mas particularmente a un instrumento quirurgico que contiene una barra de cuchilla.
Antecedentes de la tecnica relacionada
Los dispositivos quirurgicos en donde el tejido se agarra o sujeta primero entre la estructura de mordazas opuestas y luego se une mediante sujetadores quirurgicos son muy conocidos en la tecnica. En algunos instrumentos se proporciona una cuchilla para cortar el tejido que ha sido unido por los sujetadores. Tfpicamente los sujetadores tienen forma de grapas quirurgicas, pero tambien pueden utilizarse sujetadores polimericos de dos partes.
Los instrumentos con este fin pueden incluir dos elementos alargados que se utilizan respectivamente para capturar o sujetar tejido. Tfpicamente, uno de los elementos lleva un cartucho de grapas que alberga multiples grapas dispuestas en al menos dos filas laterales mientras que el otro elemento tiene un yunque que define una superficie para darle forma a las patas de la grapa a medida que las grapas salen del cartucho de grapas. La operacion de grapado se efectua por medio de barras de leva que se desplazan longitudinalmente a traves del cartucho de grapas, en donde las barras de leva actuan sobre los empujadores de grapas para eyectar secuencialmente las grapas desde el cartucho de grapas.
US5,749,893 describe un instrumento quirurgico que tiene una estructura de mordaza articulada y una cuchilla desmontable.
Este documento muestra un instrumento quirurgico con un efector de extremo dispuesto de forma adyacente a un extremo distal de un eje, en el que el efector de extremo incluye un primer y un segundo elementos de mordaza, con un cartucho sujetador quirurgico en el primer elemento de mordaza. La apertura y el cierre de los elementos de mordaza se producen por una clavija que se desliza en las ranuras de la leva.
Compendio
Los aspectos y las realizaciones de la presente invencion se presentan en las reivindicaciones.
La presente descripcion se refiere a un instrumento quirurgico que incluye un armazon, una parte alargada, una barra de accionamiento y un efector de extremo. La parte alargada se extiende distalmente desde el armazon. La barra de accionamiento esta dispuesta al menos parcialmente dentro de la parte alargada y se puede trasladar con respecto a la parte alargada. El efector de extremo esta dispuesto de forma adyacente a un extremo distal de la parte alargada e incluye un primer y un segundo elementos de mordaza. El primer elemento de mordaza se puede mover con respecto al segundo elemento de mordaza entre una posicion abierta y una posicion proxima. El primer elemento de mordaza incluye una superficie de leva proximal y una superficie de leva distal sobre este. El instrumento quirurgico tambien incluye un cartucho de sujetadores quirurgicos dispuesto en el primer elemento de mordaza. Una parte accionadora de la barra de accionamiento tiene un elemento superior dispuesto para entrar en contacto con la superficie de leva distal para producir la aproximacion de los elementos de mordaza. La traslacion proximal de la barra de accionamiento produce que la parte accionadora de la barra de accionamiento entre en contacto con la superficie de leva proximal, lo que produce la apertura de los elementos de mordaza.
La presente descripcion tambien se refiere a un metodo para unir tejido quirurgicamente. El metodo incluye la etapa de proporcionar un instrumento quirurgico que incluye un armazon, una parte alargada, una barra de accionamiento y un efector de extremo. La parte alargada se extiende distalmente desde el armazon. La barra de accionamiento se puede trasladar con respecto a la parte alargada. El efector de extremo esta dispuesto de forma adyacente a un extremo distal de la parte alargada. El efector de extremo incluye un primer elemento de mordaza y un segundo elemento de mordaza. El primer elemento de mordaza se puede mover con respecto al segundo elemento de mordaza y tiene un cartucho de sujetador quirurgico dispuesto en el. El primer elemento de mordaza incluye una superficie de leva proximal y una superficie de leva distal. El metodo tambien incluye trasladar la barra de accionamiento distalmente de forma tal que una parte accionadora de la barra de accionamiento entre en contacto con la superficie de leva distal para aproximar los elementos de mordaza, y trasladar la barra de accionamiento proximalmente de manera que la parte accionadora de la barra de accionamiento entre en contacto con la superficie de leva proximal para abrir los elementos de mordaza.
Descripcion de las figuras
En la presente se describen varias realizaciones del aparato quirurgico de grapado que aqrn se describe, con referencia a las figuras, en donde:
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La Figura 1 ilustra una vista lateral de un instrumento quirurgico de acuerdo con una realizacion de la presente descripcion;
La Figura 2 ilustra una vista de corte transversal parcial de un armazon del elemento quirurgico la Figura 1 que muestra un mango de sujecion en una posicion abierta;
La Figura 3 ilustra una vista de corte transversal parcial del armazon de la Figura 2 que muestra un mango de sujecion en una posicion proxima;
La Figura 4 ilustra una vista de corte transversal parcial del armazon de la Figura 2 con partes del armazon omitidas;
La Figura 5 ilustra una parte distal del instrumento quirurgico de la Figura 1 que muestra los elementos de mordaza en
una posicion abierta de acuerdo con una realizacion de la presente descripcion;
La Figura 6 ilustra una vista ampliada de la seccion de la parte distal del instrumento quirurgico indicada en la Figura 5;
La Figura 7 ilustra una parte distal del instrumento quirurgico de la Figura 1 que muestra los elementos de mordaza en
una posicion proxima de acuerdo con una realizacion de la presente descripcion;
La Figura 8 ilustra una vista ampliada de la seccion de la parte distal del instrumento quirurgico indicada en la Figura 7;
La Figura 9 ilustra una vista de corte transversal ampliada de una parte distal de una realizacion del instrumento quirurgico de la presente descripcion que muestra una conexion de cuchilla en una posicion separada de acuerdo con una realizacion de la presente descripcion;
La Figura 10 ilustra la conexion de cuchilla de la Figura 9 en una posicion unida;
La Figura 11 ilustra una vista de corte transversal de una conexion de cuchilla en una posicion separada de acuerdo con una realizacion de la presente descripcion.
La Figura 12 ilustra la conexion de la cuchilla de la Figura 11 en una posicion unida;
La Figura13 ilustra una vista de corte transversal de una conexion de cuchilla en una posicion separada de acuerdo con una realizacion de la presente descripcion;
La Figura 14 ilustra la conexion de la cuchilla de la Figura 13 en una posicion ligada;
La Figura 15 ilustra una vista de corte transversal superior de una conexion de cuchilla en una posicion separada de acuerdo con una realizacion de la presente descripcion;
La Figura 16 ilustra la conexion de cuchilla de la Figura 15 en una posicion unida;
La Figura 17 ilustra una vista lateral de la conexion de cuchilla de la Figura 16;
La Figura 18 ilustra una vista detallada de un ensamblaje de cartucho de acuerdo con una realizacion de la presente descripcion; y
La Figura 19 ilustra una vista de corte transversal parcial del ensamblaje de cartucho de la Figura 18.
Descripcion detallada de las realizaciones
Las realizaciones del instrumento quirurgico de la presente descripcion se describen en detalle con referencia a las figuras, en donde los numeros similares designan elementos identicos o correspondientes en cada una de las diversas vistas. Como es comun en la tecnica, el termino "proximal" hace referencia a la parte o al componente que esta mas cercano al usuario u operador, p. ej., cirujano o medico, mientras que el termino "distal" hace referencia a la parte o al componente mas alejado del usuario.
Con referencia a la FIG. 1, se ilustra una realizacion de un instrumento quirurgico 100 de la presente descripcion. El instrumento quirurgico 100 de esta realizacion incluye un armazon 110, un mango de sujecion 120, un mango de disparo 130, una parte alargada 140 y un efector de extremo 150. La parte alargada 140 define un eje longitudinal "X-X" para el instrumento quirurgico 100. El armazon 110 es de un tamano y forma general conveniente para ser sostenido en la mano. Tanto el mango de sujecion 120 como el mango de disparo 130 estan montados pivotalmente con respecto al armazon 110 para su accionamiento entre las posiciones abierta y cerrada.
Un ejemplo de varios aspectos de la presente descripcion, incluidos el armazon, el mango de sujecion y el mango de disparo, se describe en la patente estadounidense de propiedad comun n.° 5,318,221. Determinados aspectos de la presente descripcion, incluido el accionamiento del efector de extremo 150, se describen en la patente estadounidense de propiedad comun n.° 6,953,139 de Milliman et al.
Como se indica en mas detalle a continuacion, el efector de extremo 150 incluye dos elementos de mordaza - un
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yunque 160 y un ensamblaje de cartucho 170. El yunque 160 y el ensamblaje de cartucho 170 se extienden desde una parte distal de la parte alargada 140. Al menos uno del yunque 160 y el ensamblaje de cartucho 170 se puede mover pivotalmente con respecto al otro. El yunque 160 incluye una superficie de contacto con el tejido que tiene depresiones que forman las grapas (no se muestran explfcitamente en las realizaciones ilustradas). El ensamblaje de cartucho 170 incluye multiples sujetadores quirurgicos (no se muestran explfcitamente en las realizaciones ilustradas), que se pueden eyectar a traves del tejido al yunque 160.
Se puede utilizar un cartucho de grapas reemplazable (o unidad de carga) con el instrumento 100 de la Figura 1. El cartucho de grapas reemplazable puede alojar multiples grapas dispuestas en al menos dos filas laterales y puede ser montable en un canal de cartucho 210 del ensamblaje de cartucho 170. En la patente estadounidense de propiedad comun n.° 5,752,644 de Bolanos et al. se describen ejemplos de unidades de carga para uso con un instrumento de grapado quirurgico.
Una parte de un ensamblaje de accionamiento 300 se ilustra en la Figuras 2-4. El ensamblaje de accionamiento 300 de esta realizacion incluye una barra de accionamiento 310. Al menos un accionamiento parcial del mango de sujecion 120 esta configurado para trasladar la barra de accionamiento 310 longitudinalmente para aproximar el yunque 160 y el ensamblaje de cartucho 170 entre sf Al menos un accionamiento parcial del mango disparador 130 esta configurado para trasladar longitudinalmente una varilla de disparo 320 (examinada en mas detalle a continuacion) para eyectar los sujetadores quirurgicos (p. ej., grapas) desde el ensamblaje de cartucho 170 y/o para cortar tejido. La varilla de disparo 320 esta dispuesta en la parte alargada 140 y esta conectada a la cuchilla 400 como se indica a continuacion. La varilla de disparo 320 esta dispuesta al costado de, o en forma concentrica con la barra de accionamiento 310.
Para sujetar tejido, se hace pivotar hacia abajo el mango de sujecion 120 (en la direccion de la flecha "A" de la Figura 2) hacia el armazon 110. El mango de sujecion 120 esta conectado a una union de mango 122 de forma tal que la barra de accionamiento 310 se mueva longitudinalmente cuando el mango de sujecion 120 se pivota para cerrarlo. Este movimiento longitudinal distal produce que una parte de la barra de accionamiento 310 (p. ej., una barra en I o la parte accionadora 330) entre en contacto con la superficie de leva 152 del efector de extremo 150 impulsando al menos uno del yunque 160 y el ensamblaje de cartucho 170 hacia el otro. Se describen detalles adicionales sobre el mango de sujecion 120 y la barra de accionamiento 310 en la patente estadounidense de propiedad comun n.° 5,318,221 de Green et al.
Cuando el cirujano esta listo para colocar los sujetadores y cortar tejido, se acciona el mango de disparo 130, que traslada la varilla de disparo 320 longitudinalmente (p. ej., distalmente). Se puede posicionar un trineo de accionamiento distalmente con respecto al extremo distal de la varilla de disparo 320 de forma tal que el movimiento longitudinal distal de la varilla de disparo 320 haga avanzar el trineo de accionamiento en la direccion distal. Luego del accionamiento, el mango de disparo 130 se libera y vuelve a su posicion original. Se describen detalles adicionales del disparo de los sujetadores y de la retraccion del mango de disparo 130 en la patente estadounidense de propiedad comun n.° 5,318,221 de Green et al.
Aun con referencia a las Figuras 2-4, se muestran detalles adicionales del mango de sujecion 120 y las partes internas del armazon 110 de acuerdo con una realizacion de la presente descripcion. Aqrn, una parte proximal 124 de la union de mango 122 (p. ej., una union formada monolfticamente) se engancha de forma pivotante con el mango de sujecion 120 (p. ej., una parte proximal de este) y una parte distal 126 de la union de mango 122 se engancha de forma pivotante con una parte proximal 312 de la barra de accionamiento 310. Se ilustra un elemento de inclinacion 180 (ver Figura 4), que esta configurado para inclinar la barra de accionamiento 310 proximalmente (lo que inclina los elementos de mordaza en una posicion abierta). Una parte proximal del elemento de inclinacion 180 se dispone en cooperacion mecanica con el armazon 110 (p. ej., por medio de una clavija 182) y una parte distal del elemento de inclinacion 180 se encuentra en cooperacion mecanica con la parte proximal 312 de la barra de accionamiento 310 (ver Figura 4). Como se puede apreciar, al menos un accionamiento parcial (es decir, el movimiento en la direccion de la flecha "A") del mango de sujecion 120 impulsa la parte distal 126 de la union de mango 122 distalmente, lo que produce que la barra de accionamiento 310 se desplace distalmente contra la inclinacion del elemento de inclinacion 180. Como se indico anteriormente, la traslacion distal de la barra de accionamiento 310 produce la aproximacion de los elementos de mordaza para sujetar tejido entre estos.
Con referencia espedfica a las Figuras 2 y 3, el instrumento quirurgico 100 de esta realizacion incluye una estructura de cierre 190 dispuesta en cooperacion mecanica con al menos uno del armazon 110 y el mango de sujecion 120. Por ejemplo, la estructura de cierre 190 puede incluir una primera parte 192 dispuesta en el mango de sujecion 120 y una segunda parte 194 dispuesta en el armazon 110, de forma tal que el accionamiento del mango de sujecion 120 (p. ej., un accionamiento completo) produzca que la primera parte 192 se enganche con la segunda parte 194 para que de forma liberable mantenga el mango de sujecion 120 en una posicion cerrada. Adicionalmente, se puede disponer un mecanismo de liberacion 196 en una parte del instrumento quirurgico 100 (p. ej., el mango de sujecion 120) de manera tal que al aplicar presion al mecanismo de liberacion 196 (p. ej., presion hacia arriba) se produzca la liberacion del mango de sujecion 120 de su posicion cerrada. Esto quiere decir que la activacion del mecanismo de liberacion 196 produce que las partes 192, 194 del mecanismo de cierre 190 se desenganchen o se suelten una de la otra.
En una realizacion prevista, el elemento de inclinacion 180 es un resorte con una constante de resorte que esta configurada para impedir que los elementos de mordaza alcancen su posicion proxima cuando un tejido entre estos
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supere un espesor predeterminado. Un ejemplo en el que un tejido es "demasiado grueso" es cuando el espesor del tejido entre los elementos de mordaza impedina sustancialmente la correcta colocacion de los sujetadores en este y/o a traves de este.
En una realizacion descrita, el accionamiento del mango de sujecion 120 tambien esta configurado para proporcionar una respuesta tactil al usuario. Por ejemplo, la resistencia experimentada por un usuario al accionar el mango de sujecion 120 puede ser proporcional al espesor del tejido sujetado entre los elementos de mordaza. Por lo tanto, se proporciona una respuesta al usuario (en la forma de resistencia) mientras se acciona el mango de sujecion 120 para aproximar los elementos de mordaza alrededor del tejido entre estos. Esta respuesta puede ser directa o indirectamente proporcional al espesor del tejido sujetado. Se preve adicionalmente que esta cantidad de fuerza sea insuficiente para superar la resistencia ofrecida por tejido "demasiado grueso" posicionado entre los elementos de mordaza, impidiendo sustancialmente de este modo que un usuario sujete tejido que sea "demasiado grueso".
Con referencia espedfica a la Figura 2, en su posicion no accionada o abierta, el mango de sujecion 120 (que incluye la union de mango 122 y varios puntos pivote) esta configurado para tener una altura relativamente baja con respecto al eje longitudinal. Dicha distancia relativamente pequena le proporciona en general al instrumento quirurgico 100 un perfil mas pequeno, lo cual generalmente es una caractenstica deseable ya que el instrumento es menos voluminoso y por ende mas facil de manipular. Adicionalmente, se preve que un usuario pueda accionar este mango de sujecion 120 de "bajo perfil" con el pulgar de la misma mano que el usuario utiliza para accionar el mango movil 130 para disparar grapas, por ejemplo. Por lo tanto, el mango de sujecion 120 esta configurado y dimensionado para facilitar la operacion con una mano del instrumento quirurgico 100.
Con referencia ahora a las Figuras 5-8, se muestra una realizacion de la presente descripcion relacionada con la aproximacion de los elementos de mordaza. En esta realizacion, el efector de extremo 150 incluye un par de superficies de levas 152a y 152b. Las Figuras 5 y 6 ilustran los elementos de mordaza en una posicion abierta (es decir, no proxima). Aqrn, la parte accionadora 330 es una parte horizontal superior de una barra en I. La parte accionadora 330 de la barra de accionamiento 310 se encuentra en una primera posicion proximal. Como se indico anteriormente, la aproximacion del mango de sujecion 120 produce que la parte accionadora 330 de la barra de accionamiento se traslade distalmente. Tras la traslacion distal de la barra de accionamiento 310, la parte accionadora 330 entra en contacto con la superficie de leva distal 152a, que produce la aproximacion de los elementos de mordaza (p. ej., el ensamblaje de cartucho 170 se mueve hacia un yunque fijo 160). Las Figuras 7 y 8 ilustran el resultado de al menos el accionamiento parcial del mango de sujecion 120, es decir, la parte accionadora 330 en una posicion distal y los elementos de mordaza en una posicion proxima.
Una vez que los elementos de mordaza estan proximos, un usuario puede, por ejemplo, accionar al menos parcialmente el mango de disparo 130 para hacer avanzar la varilla de disparo y eyectar las grapas desde el ensamblaje de cartucho 170. El mango de disparo esta convenientemente inclinado hacia su posicion inicial de manera que despues del disparo, la varilla de disparo y la parte accionadora 330 se retraigan. Antes de la eyeccion de las grapas, el usuario puede elevar el mango de sujecion 120 (p. ej., en la direccion sustancial de la flecha "B" de la Figura 3) para retraer la barra de accionamiento 310 y hacer que la parte accionadora 330 se mueva proximalmente y entre en contacto con la superficie de leva proximal 152b. Mientras la parte accionadora 330 de la barra de accionamiento 310 entra en contacto con la superficie de leva proximal 152b, los elementos de mordaza se abren uno con respecto al otro (p. ej., el ensamblaje de cartucho 170 se aleja del yunque 160). Como se mostro, la superficie de leva distal 152a y la superficie de leva proximal 152b pueden ser adyacentes entre ellas, formando de esa manera una forma de V.
En la realizacion ilustrada, el elemento de mordaza movil (p. ej. el ensamblaje de cartucho 170) incluye tambien un borde 154 dispuesto en la parte proximal de este. El borde 154 se eleva sobre la superficie de leva 152b y esta configurado para ayudar a impedir que la parte accionadora 330 de la barra de accionamiento 310 se traslade demasiado lejos proximalmente.
De manera adicional, el elemento de mordaza movil se muestra con una superficie 156 sustancialmente plana (es decir, sustancialmente paralela al eje longitudinal cuando los elementos de mordaza estan proximos) adyacente a, y distal de, la superficie de leva 152a (ver Figura 6). En esta configuracion, la parte accionadora 330 de la barra de accionamiento 310 puede continuar trasladandose distalmente luego de entrar en contacto con la superficie de leva distal 152a (y luego de que los elementos de mordaza han sido al menos parcialmente aproximados) y puede enganchar la superficie 156. Se preve que el enganche entre la parte accionadora 330 y la superficie 156 pueda ayudar a mantener los elementos de mordaza en la posicion proxima.
De manera adicional, aunque no se ilustra explfcitamente en la presente, se preve que el instrumento quirurgico 100 de la presente descripcion no incluya un mango de sujecion. En dicha realizacion, se puede utilizar un accionamiento parcial del mango de disparo 130 para aproximar los elementos de mordaza y que un accionamiento superior, mas completo, del mango de disparo 130 dispare las grapas, por ejemplo. El mango de disparo, en estas realizaciones, tiene un trinquete que esta inclinado para engancharse con una cremallera dentada unida a la barra de accionamiento. Los multiples accionamientos del mango de disparo se utilizan para hacer avanzar la barra de accionamiento. El avance inicial de la barra de accionamiento cierra los elementos de mordaza. Con el accionamiento continuado del mango de disparo, la parte accionadora 330 continua moviendose distalmente, disparando las grapas. El ensamblaje
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de cartucho y el yunque incluyen una ranura para permitir que la parte accionadora 330 se desplace hacia el extremo distal de los elementos de mordaza. Se puede utilizar el ensamblaje de mango descrito en la patente estadounidense n.° 6,953,139. En esta realizacion, la parte accionadora 330 esta conectada a un elemento de cuchilla que empuja el trineo 650 para disparar las grapas.
Con referencia ahora a las Figuras 9-17, se muestran realizaciones de la presente descripcion relacionadas con varias conexiones de cuchilla/varilla de disparo. En estas realizaciones, la estructura de una parte de la varilla de disparo 320 y/o una parte de la cuchilla 400 se configura para permitir la conexion entre la varilla de disparo 320 y una cuchilla 400 de un solo uso, permitiendo de esta manera que se utilice una nueva cuchilla 400 para cada disparo del instrumento quirurgico 100.
Con referencia particular a las Figuras 9 y 10, se muestra una primera realizacion de una conexion de cuchilla/varilla de disparo. Espedficamente, la Figura 9 ilustra la varilla de disparo 320a en una primera posicion proximal donde una unidad de carga, o cartucho reemplazable, ha sido insertada en el ensamblaje de cartucho y la varilla de disparo 320a y la cuchilla 400a estan separadas. La Figura 10 ilustra la varilla de disparo 320a en una segunda posicion distal en donde la varilla de disparo 320a y la cuchilla 400a estan unidas. La varilla de disparo 320a y la cuchilla 400a de esta realizacion estan configuradas de forma tal que el movimiento distal de la varilla de disparo 320a produzca que un extremo distal 322a de esta se una con la cuchilla 400a cuando el efector de extremo 150 esta enganchado con la parte alargada 140 del elemento quirurgico 100. De manera adicional, el movimiento proximal de la varilla de disparo 320a produce que la cuchilla 400a (que esta unida a esta) se mueva proximalmente. Asimismo, la varilla de disparo 320a y la cuchilla 400a estan configuradas para separarse una de la otra cuando la varilla de disparo 320a ha sido trasladada proximalmente a una posicion predeterminada (p. ej., correspondiente a cuando el mango de disparo 130 ha sido sustancialmente retrafdo por completo en la direccion de la flecha "C" de la Figura 1).
En la posicion separada (es decir, donde existe una distancia suficiente entre la superficie 401a de la cuchilla 400a y la superficie 323a del extremo distal 322a de la varilla de disparo 320a (ver Figura 9)), un usuario puede reemplazar la cuchilla 400a con una nueva cuchilla mediante el reemplazo del ensamblaje de cartucho 160, por ejemplo. Aunque las realizaciones ilustradas ilustran los elementos de mordaza en la posicion proxima, se preve que un usuario pueda remover y/o reemplazar la cuchilla 400a cuando los elementos de mordaza esten en una posicion abierta.
En la presente se describen detalles adicionales de la interaccion entre la varilla de disparo 320a y la cuchilla 400a con referencia continuada a las Figuras 9 y 10. Mientras se hace avanzar distalmente la varilla de disparo 320a, al menos una proyeccion 142 (p. ej., un par de proyecciones, una proyeccion dispuesta radialmente, etc.) dispuesta en la parte alargada 140 se configura para mover al menos una parte de la varilla de disparo 320a de forma transversal al eje longitudinal (p. ej. en la direccion de la flecha "D" de la Figura 10). Por ejemplo, una proyeccion 143 puede entrar en contacto con una rampa 324a de la varilla de disparo 320a. Tal como puede apreciarse con referencia a las Figuras 9 y 10, la combinacion del movimiento distal y el movimiento transversal hace que el extremo distal 322a (p. ej., en forma de J) de la varilla de disparo 320a se enganche (p. ej., se una) a la parte proximal 402a (p. ej., en forma de J) de la cuchilla 400a. Consecuentemente, mientras se desplaza proximalmente la varilla de disparo 320a, al menos una proyeccion 142 esta configurada para mover al menos una parte de la varilla de disparo 320a de forma transversal al eje longitudinal (p. ej., en la direccion de la flecha "E" de la Figura 9). Por ejemplo, la proyeccion 142 puede entrar en contacto con una rampa 326a formada en la varilla de disparo 320a. Por lo tanto, la combinacion del movimiento proximal y el movimiento transversal produce que el extremo distal 322a de la varilla de disparo 320a se desenganche (p. ej., se separe) de la parte proximal 402a de la cuchilla 400a.
Con referencia particular a las Figuras 11 y 12, se muestra una segunda realizacion de una conexion de cuchilla/varilla de disparo. Espedficamente, la Figura 11 ilustra los elementos de mordaza en una posicion abierta donde la cuchilla 400b no esta enganchada o unida con un conector 360 dispuesto distalmente con respecto a, y adyacente a, la varilla de disparo 320b. La Figura 12 ilustra los elementos de mordaza en una posicion proxima donde la cuchilla 400b esta enganchada o unida con el conector 360. El conector 360 y la cuchilla 400b estan configurados de manera tal que cuando los elementos de mordaza estan en la posicion abierta, el conector 360 y la cuchilla 400b estan separados (Figura 11, permitiendo de este modo que el cartucho (que incluye la cuchilla 400b) sea removido. Cuando los elementos de mordaza estan en una posicion proxima (Figura 12), una superficie del elemento de mordaza yunque entra en contacto con la cuchilla 400b, rotando la cuchilla 400b de forma tal que el conector 360 y la cuchilla 400b se unan, de manera que la traslacion proximal y distal de la varilla de disparo 320 (y por lo tanto del conector 360) resulte en la traslacion proximal y distal de la cuchilla 400b, respectivamente. Cuando los elemento de mordaza se aproximan, el cartucho no puede ser removido del instrumento quirurgico 100, como puede apreciarse con referencia a la Figura 12.
En la modalidad que se muestra en las Figuras 11 y 12, el conector 360 incluye una parte similar a un gancho que esta configurada para enganchar la parte similar a un gancho de la cuchilla 400b. Se muestra el conector 360 que tiene una forma sustancialmente en J, pero cualquier forma adecuada puede ser utilizada para el cuchillo 400b y el conector 360.
Se preve que el conector 360 se pueda mover (p. ej., que sea pivotante, giratorio) con respecto al extremo distal de la varilla de disparo 320). Por ejemplo, cuando los elementos de mordaza se mueven hacia su posicion abierta, una parte proximal 402b de la cuchilla 400b puede entrar en contacto con la parte superior 362 del conector 360 para pivotar/girar la parte superior 362 distalmente, creando de este modo el espacio suficiente (o mas espacio) para que la
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cuchilla 400b sea removida del instrumento quirurgico 100. Asimismo, cuando los elementos de mordaza estan proximos, la parte superior 362 del conector 360 puede pivotar/girar proximalmente, uniendo de ese modo (o uniendo mas) el conector 360 con la cuchilla 400b, no permitiendo de esta forma que la cuchilla 400b sea removida de allt De manera adicional, se muestra una brida 370 que se puede configurar para ayudar a mantener el conector 360 en su posicion y/o para ayudar a que la parte superior 362 del conector 360 se mueva proximalmente.
Se ilustra otra realizacion de una conexion de cuchilla/varilla de disparo en las Figuras 13 y 14. Espedficamente, la Figura 13 ilustra la varilla de disparo 320c en una primera posicion proximal donde la varilla de disparo 320c y la cuchilla 400c estan separadas. La Figura 14 ilustra la varilla de disparo 320c en una segunda posicion distal donde la varilla de disparo 320c y la cuchilla 400c estan unidas. La varilla de disparo 320c y la cuchilla 400c de esta realizacion estan configuradas de forma tal que el movimiento distal de la varilla de disparo 320c produzca que el extremo distal 322c de esta se una con la cuchilla 400c cuando el efector de extremo 150 esta enganchado con la parte alargada 140 del elemento quirurgico 100.
Mas espedficamente, esta realizacion de conexion de cuchilla/varilla de disparo incluye un elemento de resorte 500 (p. ej., un resorte de lamina) dispuesto en cooperacion mecanica con la cuchilla 400c. Una parte proximal 502 (p. ej., sustancialmente con forma de J) del elemento de resorte 500 esta inclinada hacia un eje K-K de la cuchilla. Aqm, el movimiento distal de la varilla de disparo 320c impulsa la parte proximal 502 del elemento de resorte 500 hacia afuera (es decir, alejandola del eje K-K de la cuchilla). La varilla de disparo 320 incluye una abertura 321 para recibir el elemento de resorte 500. Por consiguiente, la parte proximal 502 del elemento de resorte 500 se asegura temporalmente a la varilla de disparo 320c. Por lo tanto, la continua traslacion distal de la varilla de disparo 320c produce la traslacion distal de la cuchilla 400c. Ademas, la traslacion proximal de la varilla de disparo 320c produce la traslacion proximal de la cuchilla 400c hasta que la varilla de disparo 320c alcance una ubicacion predeterminada (p. ej., correspondiente a cuando el mango de disparo 130 ha sido sustancialmente retrafdo por completo en la direccion de la flecha "C" de la Figura 1) donde la varilla de disparo 320c se desengancha del elemento de resorte 500. Convenientemente, la forma de la abertura 321 y del elemento de resorte 500 (o elementos de resorte 500) es tal que el elemento de resorte 500 quede inclinado hacia afuera al remover el cartucho del dispositivo, desconectando la varilla de disparo 320 de la cuchilla 400.
Con referencia particular a las Figuras 15-17, se muestra una cuarta realizacion de una conexion de cuchilla/varilla de disparo. Espedficamente, la Figura 15 ilustra la varilla de disparo 320d en una primera posicion proximal en donde la varilla de disparo 320d y la cuchilla 400d estan separadas. La Figura 16 ilustra la varilla de disparo 320d en una segunda posicion distal donde la varilla de disparo 320d y la cuchilla 400d estan unidas. La Figura 17 es una vista lateral de la Figura 16. La varilla de disparo 320d y la cuchilla 400d de esta realizacion estan configuradas de forma tal que el movimiento distal de la varilla de disparo 320d produzca que un extremo distal 322d de esta se una con la cuchilla 400d cuando el efector de extremo 150 esta enganchado con la parte alargada 140 del instrumento quirurgico 100. De manera adicional, el movimiento proximal de la varilla de disparo 320d produce que la cuchilla 400d (que esta unida a esta) se mueva proximalmente. Ademas, la varilla de disparo 320d y la cuchilla 400d estan configuradas para separarse una de la otra cuando la varilla de disparo 320d ha sido trasladada proximalmente a una posicion predeterminada (p. ej., correspondiente a cuando el mango de disparo 130 ha sido sustancialmente retrafdo por completo en la direccion de la flecha "C" de la Figura 1). El extremo distal 322d y el receptaculo 402d de la cuchilla 400d tienen una forma tal que el extremo distal 322d este inclinado hacia afuera al remover el cartucho del dispositivo, desconectando la varilla de disparo 320 de la cuchilla 400.
En la posicion separada (Figura 15), un usuario puede reemplazar la cuchilla 400d con una nueva cuchilla mediante el reemplazo del ensamblaje de cartucho 160, por ejemplo. Se preve que la configuracion del efector de extremo y de la varilla de disparo 320d permita al usuario remover y/o reemplazar el cartucho cuando los elementos de mordaza estan en una posicion abierta y/o proxima.
En la presente se describen detalles adicionales de la interaccion entre la varilla de disparo 320d y la cuchilla 400d con referencia continuada a las Figuras 15 y 16. La conexion puede formarse cuando el extremo distal 322d se encaja resistentemente en el receptaculo 402d. De manera alternativa, mientras se hace avanzar distalmente la varilla de disparo 320d, una pendiente 142d dispuesta en la parte alargada 140 se configura para mover el extremo distal 322d de la varilla de disparo 320d de forma transversal al eje longitudinal (p. ej., en la direccion de la flecha "F" de la Figura 16) hacia un receptaculo 402d de la cuchilla 400d. De manera adicional, o de manera alternativa, una pendiente en la parte alargada puede estar configurada y dispuesta para forzar el extremo distal 322 para que se desenganche de la cuchilla. Tal como puede apreciarse con referencia a las Figuras 15 y 16, la combinacion del movimiento distal y del movimiento transversal puede ser usada para producir que el extremo distal 322d de la varilla de disparo 320d enganche el receptaculo 402d de la cuchilla 400d. La combinacion del movimiento proximal y del movimiento transversal puede ser utilizada para producir que el extremo distal 322d de la varilla de disparo 320d enganche el receptaculo 402d de la cuchilla 400d. Se pueden utilizar mecanismos similares para la conexion entre la cuchilla y la varilla de disparo que se muestran en las Figuras 13 y 14.
De manera adicional, se preve que un extremo distal 322d de la varilla de disparo 320d este inclinado hacia afuera de la cuchilla 400d, es decir, en la direccion sustancial de la flecha "G" de la Figura 15. Por lo tanto, a medida que la varilla de disparo 320d es trasladada proximalmente de manera tal que el extremo distal 322d quede proximo a la pendiente 142d, el extremo distal 322d sale del receptaculo 402d de la cuchilla 400d. Por lo tanto, esta combinacion de
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movimiento separa la varilla de disparo 320d y el cuchillo 400d.
Con referencia a las Figuras 18-19, la presente descripcion se refiere tambien al ensamblaje de cartucho 600 para uso con un instrumento de grapado quirurgico 100. El ensamblaje de cartucho 600 esta configurado para impedir que el usuario dispare un cartucho de un solo uso que ya ha sido utilizado. Mas espedficamente, el ensamblaje de cartucho 600 esta configurado para bloquear su cuchilla 640 e impedir la reutilizacion del cartucho, luego de que el cartucho ha sido disparado.
Una vista de conjunto del ensamblaje de cartucho 600 se muestra en la Figura 18. Como se muestra, el ensamblaje de cartucho 600 incluye un canal 610, una cubierta 620, un cartucho de grapas 630 y una cuchilla 640. La cubierta 620 esta configurada para engancharse mecanicamente (p. ej., una conexion de cierre a presion) con el canal 610. El cartucho de grapas 630 esta configurado para engancharse mecanicamente con la cubierta 620 y la cuchilla 640 esta configurada para trasladarse con respecto a la cubierta 620 y al cartucho. La Figura 18 tambien ilustra un trineo 650, que esta configurado para trasladarse con respecto a la cubierta 620 (p. ej., para eyectar grapas desde el cartucho de grapas 630).
Como se muestra, el canal 610 incluye en el una protuberancia 612 para engancharse con un elemento de bloqueo 622 (p. ej., un dedo flexible) de la cubierta 620. Luego del enganche entre el canal 610 y la cubierta 620, la protuberancia 612 hace que el elemento de bloqueo 622 se mueva de una primera posicion donde el elemento de bloqueo 622 esta sustancialmente paralelo con un plano definido por la superficie 624 de la cubierta 620, a una segunda posicion donde al menos una parte del elemento de bloqueo 622 (p. ej., la parte proximal 626) este separado del plano de la superficie 624. En su segunda posicion, el elemento de bloqueo 622 esta configurado para impedir sustancialmente la traslacion distal de la cuchilla 640 luego de que la cuchilla 640 ha sido desplegada para disparar las grapas, y luego trasladada proximalmente mas alla de una posicion predeterminada (ver Figura 19). Se preve que el ensamblaje de cartucho 600 este configurado para permitir la traslacion proximal de la cuchilla 640 mas alla del elemento de bloqueo 622 cuando el elemento de bloqueo 622 esta en su segunda posicion. Por ejemplo, el elemento de bloqueo 622 puede estar formado como un elemento resistente. En la posicion inicial de la cuchilla, el elemento de bloqueo 622 esta hundido por la cuchilla. Una vez que se hizo avanzar la cuchilla, empujando el trineo distalmente para disparar las grapas, la cuchilla se retrae a la posicion mostrada en la Figura 19. El elemento de bloqueo 622 se eleva ofreciendo resistencia, enganchando una superficie en la cuchilla. Como puede apreciarse, el ensamblaje de cartucho 600 puede ser utilizado con varias realizaciones del instrumento de grapado quirurgico 100 que se describe en la presente.
Se entendera que pueden realizarse diferentes modificaciones a las diferentes realizaciones de la presente descripcion aqrn descrita sin apartarse del alcance de esta. Por ejemplo, el instrumento de grapado quirurgico de la presente descripcion puede incluir un unico mango movil para realizar todas las funciones (p. ej., aproximar los elementos de mordaza, disparar grapas, cortar tejido, abrir los elementos de mordaza). Se preve que el mango movil unico pueda ser parcialmente accionado para desarrollar una primera funcion y que el accionamiento continuado desarrolle una segunda funcion. Tambien se preve que un primer accionamiento completo desarrolle una primera funcion y que un segundo accionamiento completo desarrolle una segunda funcion.
Ademas, el instrumento de grapado quirurgico descrito puede no incluir ningun mango movil; en cambio, el instrumento de grapado quirurgico puede ser impulsado por medios (p. ej., batena, electricidad, etc.) distintos al accionamiento de un mango o una palanca. Un ejemplo de una grapadora quirurgica impulsada se describe en US2008251568, con el tftulo Instrumento quirurgico impulsado. De manera adicional, el instrumento de grapado quirurgico de la presente descripcion tambien puede tener funcionalidades de articulacion, que pueden mover el efector de extremo entre una primera posicion donde un eje del efector de extremo sea paralelo a un eje de la parte alargada, y una segunda posicion donde el eje del efector de extremo este en un angulo con respecto al eje de la parte alargada. En US2008083811 se describe un ejemplo de un instrumento de grapado quirurgico con un efector de extremo articulable, con el tftulo Instrumento quirurgico con ensamblaje de herramienta articulada. Por lo tanto, la descripcion que antecede no debe interpretarse como limitante de la descripcion, sino como meros ejemplos de las diferentes realizaciones de esta. Los expertos en la tecnica preveran otras modificaciones dentro del alcance de la presente descripcion tal como se define en las reivindicaciones adjuntas en esta.

Claims (10)

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    REIVINDICACIONES
    1. Un instrumento quirurgico (100), que comprende: un armazon (110);
    una parte alargada (140) que se extiende distalmente desde el armazon (110); una barra de accionamiento (310) dispuesta al menos parcialmente dentro de la parte alargada (140) y que se puede trasladar proximalmente y distalmente con respecto a la parte alargada (140);
    un efector de extremo (150) dispuesto de manera adyacente a un extremo distal de la parte alargada (140), en donde el efector de extremo (150) incluye un primer elemento de mordaza y un segundo elemento de mordaza, el primer elemento de mordaza se puede mover con respecto al segundo elemento de mordaza entre una posicion abierta y una posicion proxima, el primer elemento de mordaza incluye una superficie de leva proximal (152b) y una superficie de leva distal (152a) en este, un cartucho de sujetadores quirurgicos (170) dispuesto en el primer elemento de mordaza; y
    una parte accionadora (330) de la barra de accionamiento (310), caracterizada por que dicha parte accionadora (330) es una parte horizontal superior de una barra en I y esta adaptada para entrar en contacto con la superficie de leva distal (152a) produciendo la aproximacion de los elementos de mordaza y donde la traslacion proximal de la barra de accionamiento (310) produce que la parte accionadora (330) de la barra de accionamiento (310) entre en contacto con la superficie de leva proximal (152b), lo que produce la apertura de los elementos de mordaza .
  2. 2. El elemento quirurgico de la Reivindicacion 1, que comprende ademas un reborde (154) dispuesto en una parte proximal del elemento de mordaza movil, en donde el reborde (154) esta elevado sobre la superficie de leva proximal exterior configurado para ayudar a prevenir que la parte accionadora (330) de la barra de accionamiento (310) se mueva demasiado lejos proximalmente.
  3. 3. El instrumento quirurgico de la Reivindicacion 1, donde el primer elemento de mordaza incluye un ensamblaje de cartucho (170) y el segundo elemento de mordaza incluye un ensamblaje de yunque (160), y donde el ensamblaje de cartucho (170) es movil con respecto al ensamblaje de yunque (160).
  4. 4. El instrumento quirurgico de la Reivindicacion 3, donde el ensamblaje de yunque (160) esta sustancialmente fijo en el movimiento con respecto a la parte alargada (140).
  5. 5. El instrumento quirurgico de la Reivindicacion 1, donde el efector de extremo (150) puede moverse entre una primera posicion donde el efector de extremo (150) esta sustancialmente alineado con el eje longitudinal y al menos una segunda posicion donde el efector de extremo (150) esta dispuesto en un angulo con respecto al eje longitudinal.
  6. 6. El instrumento quirurgico de la Reivindicacion 1, que comprende ademas una superficie sustancialmente plana (156) adyacente a, y distal con respecto a, la superficie de leva distal (152a) de forma tal que la parte accionadora (330) de la barra de accionamiento (310) entre en contacto con la superficie plana luego de que los elementos de mordaza hayan sido puestos al menos parcialmente proximos, con la superficie plana sustancialmente paralela al eje longitudinal cuando los elementos de mordaza estan proximos.
  7. 7. El instrumento quirurgico de la Reivindicacion 1, donde la superficie de leva proximal (152b) es adyacente a la superficie de leva distal (152a).
  8. 8. El instrumento quirurgico de la Reivindicacion 1, donde la superficie de leva proximal (152b) y la superficie de leva distal (152a) se encuentran en un angulo una con respecto a la otra.
  9. 9. El instrumento quirurgico de la Reivindicacion 8, donde la superficie de leva proximal (152b) y la superficie de leva distal (152a) forman una forma similar a una V.
  10. 10. El instrumento quirurgico de la Reivindicacion 1, que comprende ademas un mango movil (130) dispuesto en el armazon (110) y en cooperacion mecanica con la barra de accionamiento (310), en donde el mango movil (130) se puede mover entre una primera posicion y una segunda posicion, y donde al menos un accionamiento parcial del mango movil (130) efectua la traslacion de la barra de accionamiento (310).
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EP2130499A1 (en) 2009-12-09
EP3187123A3 (en) 2017-09-06

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