ES2617218T3 - Aparato aplicador de elementos de sujeción quirúrgicos - Google Patents

Aparato aplicador de elementos de sujeción quirúrgicos Download PDF

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ES2617218T3
ES2617218T3 ES12745973.3T ES12745973T ES2617218T3 ES 2617218 T3 ES2617218 T3 ES 2617218T3 ES 12745973 T ES12745973 T ES 12745973T ES 2617218 T3 ES2617218 T3 ES 2617218T3
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stationary housing
ucuu
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Nikhil R. KATRE
Cinish P. VARGHESE
Arvind Kumar Gupta
Salman KAPADIA
Sandeep H. AMBARDEKAR
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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
    • 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
    • A61B17/0682—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil
    • A61B17/0686—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil having a forming anvil staying below the tissue during stapling
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, 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
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/115—Staplers for performing anastomosis in a single operation
    • 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
    • A61B2017/07278—Stapler heads characterised by its sled or its staple holder
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2946—Locking means

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

Abstract

Un aparato aplicador (10) de elementos de sujeción quirúrgicos que comprende: una semisección (12) de yunque que incluye una parte distal (12b) de yunque y una parte proximal (12a) de mango; una semisección (14) receptora de cartucho que define un miembro (22) de canal alargado; un carcasa estacionaria (26) configurada para estar soportada de manera desprendible dentro del miembro (22) de canal alargado de la semisección (14) receptora de cartucho, soportando la carcasa estacionaria (26) componentes de disparo del aparato, estando la carcasa estacionaria (26) dimensionada para recibir de manera desprendible una unidad cargadora (18) de un solo uso, estando caracterizado dicho aparato aplicador de elementos de sujeción quirúrgicos por que la carcasa estacionaria (26) incluye una estructura (342, 442) de cierre que impide la inserción completa de la unidad cargadora (18) de un solo uso en la carcasa estacionaria (26) después de haber montado la carcasa estacionaria en la semisección (14) receptora de cartucho.

Description

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Durante el montaje de la semisección 12 de yunque y la semisección 14 receptora de cartucho, los miembros 172 de soporte lateral están soportados en rebajes 174 en forma de U definidos en una parte central 173 de la semisección 14 receptora de cartucho (Figura 28). Una pared distal 173a de la parte central 173 define un tope para tejido (Figura 3). Los miembros 172 de soporte lateral también están situados para ser recibidos en recortes 176 formados en partes 178 de pestaña distanciadas de la palanca pinzadora 16 de sujeción cuando se desplaza la palanca pinzadora 16 a la posición pinzada (Figura 2B). La parte proximal 12a de mango está conformada ergonómicamente e incluye un apoyo 180 para acople del pulgar y una parte 182 de asimiento. Un extremo proximal de la parte 12a de mango incluye un dedo 184 que se prolonga hacia abajo, que incluye un par de salientes 186 enfrentados, con forma de lágrima, que se discutirán con mayor detalle más adelante. Como alternativa, los salientes 186 pueden asumir varias configuraciones.
La semisección 14 receptora de cartucho incluye rebajes 174 en forma de U distanciados, dispuestos centralmente, situados para soportar miembros 172 de soporte lateral de la semisección 12 de yunque. El extremo proximal de la semisección 14 receptora de cartucho incluye un par de miembros 188 de soporte vertical. Cada miembro 188 de soporte vertical incluye una ranura vertical alargada 188a que tiene una superficie de fondo redondeada. Las ranuras verticales 188a están dimensionadas para recibir salientes 186 formados sobre el dedo 184 de la semisección 12 de yunque (Figura 21) cuando la semisección 12 de yunque está soportada sobre la semisección 14 receptora de cartucho durante el montaje. Al colocar el saliente 186 dentro de las ranuras verticales 188a, se puede hacer pivotar la semisección 12 de yunque a modo de tijera con respecto a la semisección 14 receptora de cartucho, entre las posiciones abierta y cerrada. En una realización, los salientes 186 tienen un perfil con forma de lágrima. Al menos una pared lateral de la semisección 14 receptora de cartucho incluye una depresión 189 (véase la Figura 3) que se discutirá con mayor detalle más adelante.
La palanca pinzadora 16 incluye también una parte 190 de mango que incluye un asidero 190a y un apoyo 192 para acoplamiento del pulgar. Como se ha discutido más arriba, un par de partes 178 de pestaña distanciadas están soportadas en el extremo distal de la palanca pinzadora 16. Cada parte 178 de pestaña define un recorte 176 dimensionado para recibir un respectivo miembro 172 de soporte lateral de la semisección 12 de yunque cuando la grapadora 10 se desplaza hacia la posición pinzada (Figura 2B). El extremo distal de la palanca pinzadora 16 también define un par de aberturas 194 que están dimensionadas para recibir un miembro 187 de pivote. El miembro 187 de pivote está dimensionado para prolongarse a través de aberturas 195 de la semisección 14 receptora de cartucho y aberturas 194 de la palanca pinzadora 16, para afianzar de manera pivotante la palanca pinzadora 16 a la semisección 14 receptora de cartucho.
Tal como se muestra en la Figura 3A, una pared interna de la palanca pinzadora 16 incluye un saliente 201. El saliente 201 está situado dentro de la depresión 189 (Figura 2A) formada en la pared lateral de la semisección 14 receptora de cartucho, con el fin de retener de manera desprendible la palanca pinzadora 16 en la posición no pinzada o posición abierta (Figura 2A).
Para cargar el conjunto disparador 20 dentro de la parte proximal 24b del miembro 22 de canal, se desliza la carcasa estacionaria 26 del conjunto disparador 20 en el miembro 22 de canal a través del extremo proximal del miembro 22 de canal hasta que los miembros 29 de pivote son recibidos en rebajes 30 formados en el extremo proximal del miembro 22 de canal. Después de haber cargado el conjunto disparador 20 se puede cargar la UCUU 18 en la parte distal 24a de la manera discutida más arriba.
Haciendo referencia a las Figuras 2 y 2B, después de haber cargado la UCUU 18 y el conjunto disparador 20 en el miembro 22 de canal, se puede montar la sección 12 de yunque en la semisección 14 receptora de cartucho. Para conectar la semisección 12 de yunque a la semisección 14 receptora de cartucho, se colocan los salientes 186 de los dedos 184 en ranuras verticales 188a del miembro 188 de soporte vertical de la semisección 14 receptora de cartucho. A continuación, se hace girar la semisección 12 de yunque hacia la semisección 14 receptora de cartucho con el fin de situar los miembros 172 de soporte lateral en rebajes 174 en forma de U.
Para llevar la grapadora quirúrgica 10 a la posición pinzada, se hace girar la palanca pinzadora 16 en sentido contrario a las agujas del reloj desde la posición mostrada en la Figura 2A. Cuando la palanca pinzadora 16 gira, los miembros 172 de soporte lateral son recibidos en recortes 176 (Figura 2) de partes 178 de pestaña y reciben acción de leva hacia la semisección 14 receptora de cartucho. Tal como se muestra en la Figura 3, un miembro 200 de resorte está afianzado a una superficie interna de la palanca pinzadora 16, por ejemplo mediante soldadura, en una posición para acoplarse a la parte 14 receptora de cartucho con el fin de obligar a la palanca pinzadora 16 hacia la posición no pinzada que se muestra en la Figura 2A. En la posición pinzada que se muestra en la Figura 1, la parte 198 deformante de grapa está situada muy próxima a la superficie superior de la UCUU 18.
Haciendo referencia a las Figuras 3, 3A y 12, como se ha discutido más arriba, un miembro pivotante 206 de cierre está soportado de manera pivotante sobre el extremo proximal de la carcasa estacionaria 26 del conjunto disparador 20. El miembro pivotante 206 de cierre incluye miembros 29 de pivote que se prolongan a través de aberturas 28 definidas en la carcasa estacionaria 26. Un miembro 212 de acoplamiento de dedo está situado en un extremo del miembro 206 de cierre y una parte 210 de pestillo está situada en el otro extremo del miembro 206 de cierre. La parte 206 de pestillo incluye un miembro 210a de gancho. Un miembro desviador 214 está situado sobre un miembro 29 de pivote para obligar a la parte 210 de pestillo hacia dentro, hacia la carcasa estacionaria 26 del
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conjunto disparador 20. Cuando el miembro 206 de cierre está afianzado sobre el conjunto disparador 26, la parte 210 de pestillo se prolonga hacia abajo a través de una abertura 216 de un extremo proximal de la carcasa estacionaria 26 hasta una posición por debajo de una superficie de fondo del miembro 22 de canal (Figura 20). Como se ha discutido más arriba, los extremos de los miembros 29 de pivote son recibidos en recortes 30 formados en el extremo proximal de la semisección 14 receptora de cartucho con el fin de afianzar de manera desprendible el conjunto disparador 20 dentro de la parte proximal 24b del canal del miembro 22 de canal (Figura 21). Los recortes 30 están definidos parcialmente por dedos 220 vueltos hacia abajo con el fin de retener el conjunto disparador 26 dentro del miembro 22 de canal (Figura 3).
Haciendo referencia a la Figura 3A, un extremo proximal de la palanca 16 de sujeción incluye un miembro de acoplamiento, por ejemplo un poste cilíndrico 218, que está situado para ser acoplado por el miembro 210a de gancho de la parte 210 de pestillo cuando la palanca pinzadora 16 se desplaza a la posición pinzada (Figura 27). Aunque se ilustra un poste, se prevén otras configuraciones de miembro de acoplamiento. Como es evidente al observar la Figura 27, cuando la palanca pinzadora 16 se desplaza hacia la posición pinzada una cara angulada 222 de la parte 210 de pestillo se acopla al poste 218. Este acoplamiento provoca que el miembro 206 de cierre pivote sobre los miembros 29 de pivote de manera que el miembro 210a de gancho de la parte 210 de pestillo supera el poste 218 y luego encaja a presión en acoplamiento con el mismo. Para liberar la parte 210 de pestillo del poste 218, se presiona hacia abajo el miembro 212 de acoplamiento del miembro 206 de cierre para hacer pivotar la parte 210 de pestillo fuera del acoplamiento con el poste 218. Cuando esto ocurre, el miembro 200 de resorte obliga a la palanca pinzadora 16 hacia la posición no pinzada.
Haciendo referencia a las Figuras 3, 12, 19 y 26, como se ha discutido más arriba, el bloque guía 48 está soportado de manera pivotante en la carcasa estacionaria 26 del conjunto disparador 20. El bloque guía 48 incluye una parte 220 de proa que se prolonga distalmente (Figuras 12 y 26), que descansa bajo la UCUU 18 cuando la UCUU 18 se apoya en el miembro 22 de canal. La superficie interna del bloque guía 48 incluye superficies 222 de cierre (Figura 19) que son recibidas en muescas 49 y 51 de la barra 44 accionadora de cuchilla cuando la grapadora 10 está en una posición no pinzada. Cuando la UCUU 18 está situada en el miembro 22 de canal, antes de desplazar la palanca pinzadora 16 a la posición pinzada, la UCUU 18 está situada encima de la parte 220 de proa y no está completamente asentada en el miembro 22 de canal, como se ha discutido más arriba. Cuando se desplaza la grapadora 10 a la posición pinzada, los dedos colocadores 170 (Figura 3) se acoplan a una superficie superior del cuerpo 120 de la UCUU 18 con el fin de asentar por completo la UCUU 18 en el miembro 22 de canal. Como se discutido más arriba, los dedos colocadores 170 son recibidos en surcos de la UCUU 18 para situar correctamente la UCUU 18 con respecto a la parte 12b de yunque. Cuando la UCUU 18 está completamente asentada en el miembro 22 de canal, la UCUU 18 presiona hacia abajo sobre la parte 220 de proa del bloque guía 48 para hacer que el bloque guía 48 pivote sobre los salientes 72. Cuando el bloque guía 48 pivota, las superficies 222 de cierre se desplazan de las muescas 49 y 51 con el fin de desbloquear la barra 44 accionadora de cuchilla (Figura 26). Esta configuración impide el movimiento de la barra 44 accionadora de cuchilla con respecto al bloque guía 48 antes del pinzamiento, con el fin de asegurar que la barra 44 accionadora de cuchilla y la cuchilla 40 de la UCUU continúan situadas correctamente para su acoplamiento operativo antes del uso.
Haciendo referencia a las Figuras 24-28, cuando la grapadora 10 está en la posición pinzada, no disparada, el bloque deslizante 52 del conjunto disparador 20 se encuentra en la posición retraída en el extremo proximal del miembro 22 de canal y la carcasa estacionaria 26. Véase la Figura 27. En esta posición, el pedal 54 está situado en el recorte 55 del miembro 22 de canal y el pasador 88 del pedal 54 está situado en el rebaje arqueado 94 de la palanca disparadora 50 por debajo de los rebajes 94a de parada. Así, se puede hacer que la palanca disparadora 50 pivote para facilitar el accionamiento de la grapadora 10 desde cualquier lado de la grapadora 10. Además, en esta posición del bloque deslizante 52, el dedo 108 de la barra 44 accionadora de cuchilla está situado adyacente a la pared distal del rebaje 110 del bloque 52 de deslizamiento. La parte 210 de pestillo del miembro 206 de cierre también está acoplada con el poste 218, a fin de retener la palanca pinzadora 16 en la posición pinzada.
Haciendo referencia a la Figura 26, cuando el bloque deslizante 52 está en la posición retraída, la cuchilla 40 y las superficies 114b de leva de la barra 46 de leva están situadas en el extremo proximal de la UCUU 18 y el gancho proximal 156 del cierre 128 de seguridad se encuentra en acoplamiento con el miembro 158 de acoplamiento de la cuchilla 40, con el fin de retener el cierre 128 de seguridad en la orientación bloqueada. Además, la parte 40b de gancho vuelto hacia abajo de la cuchilla 40 está acoplada con la parte 106 de gancho vuelto hacia arriba de la barra 44 accionadora de cuchilla, con el fin de conectar el conjunto disparador 20 a la cuchilla 40 de la UCUU 18.
Haciendo referencia a las Figuras 29-32, cuando se hace avanzar distalmente la palanca disparadora 50 en la dirección indicada por la flecha "A" en la Figura 29, el bloque deslizante 52 se desplaza distalmente dentro de la carcasa estacionaria 26 del conjunto disparador 20 para provocar el movimiento correspondiente de la barra 46 de leva y el movimiento retardado de la barra 44 accionadora de cuchilla. Como se ha discutido más arriba, el movimiento retardado de la barra 44 accionadora de cuchilla es igual a la longitud del rebaje 110 del bloque deslizante 52 y es consecuencia del movimiento del dedo 108 de la barra 44 accionadora de cuchilla dentro del rebaje 110 del bloque deslizante 52. El movimiento de la barra 44 accionadora de cuchilla con el bloque deslizante 52 comienza cuando el dedo 108 hace tope en la pared proximal 112 del rebaje 110. A medida que se desplaza distalmente la barra 46 de leva a través de la carcasa estacionaria 26 del conjunto disparador 20, se hacen avanzar a través de la UCUU 18 superficies 114b de leva de paredes laterales 114 de la barra 46 de leva para
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acoplarse secuencialmente a empujadores 122 con el fin de expulsar grapas 126 de ranuras 130 del cuerpo 120. Al mismo tiempo, puesto que el extremo distal de la barra 44 accionadora de cuchilla está acoplado con la cuchilla 40, después del retardo preestablecido se hace avanzar la cuchilla 40 a través de la UCUU 18 para cortar tejido entre las líneas de grapas.
Tal como se muestra en transparencia en la Figura 32, cuando el bloque deslizante 52 se desplaza distalmente dentro de la carcasa estacionaria 26, el pedal 54 corre por encima del miembro 22 de canal y se desplaza a lo largo de la superficie interna de la carcasa estacionaria 26 del conjunto disparador 20. Cuando esto ocurre, el pasador 88 del pedal 54 se desplaza a un rebaje 94a de parada con el fin de evitar un movimiento pivotante adicional de la palanca disparadora 50.
Haciendo referencia a las Figuras 31 y 32, cuando se desplaza distalmente la cuchilla 40 dentro de la UCUU 18, el elemento 158 de acoplamiento de la cuchilla 40 se desacopla del gancho proximal 156 del cierre 128 de seguridad.
Haciendo referencia a las Figuras 33 y 34, cuando la palanca disparadora 50 es devuelta a su posición más proximal para retraer la barra 46 de leva y la cuchilla 40, y se empuja hacia abajo el miembro de cierre 206 para desacoplar la parte 210 de pestillo del poste 218, el muelle 200 obliga a la palanca pinzadora 16 a su posición no pinzada, para permitir que la grapadora 10 vaya a la posición abierta. En la posición abierta, la semisección 12 de yunque está separada de la semisección 14 receptora de cartucho y el resorte 152 (Figura 17) hace pivotar hasta su posición desbloqueada el cierre 128 de seguridad en la dirección indicada por la flecha B en la Figura 34, sobre el miembro 150 de pivote, de manera que el cierre 128 de seguridad sobresale hacia arriba desde la UCUU 18. En la posición desbloqueada, el cierre 128 de seguridad impide el retorno de la grapadora 10 a la posición pinzada. Para utilizar nuevamente la grapadora 10, hay que reemplazar la UCUU 18 usada por una UCUU 18 nueva.
Durante un procedimiento quirúrgico, se puede reemplazar múltiples veces la UCUU 18 con el fin de facilitar múltiples usos de la grapadora 10 en un solo paciente. Al estar cada UCUU 18 dotada de una cuchilla 40 nueva, se minimiza el desgarro de tejido. Después del procedimiento quirúrgico, la o las UCUU 18 usadas y el conjunto disparador 20 se pueden retirar del miembro 22 de canal y desecharlas de una manera adecuada. En ese momento se pueden esterilizar la semisección 12 de yunque, la semisección 14 receptora de cartucho y la palanca pinzadora 16, por ejemplo mediante tratamiento en autoclave, y volverlas a utilizar con una UCUU 18 y conjunto disparador 20 esterilizados, de la manera discutida más arriba. Puesto que el miembro 206 de cierre forma parte del conjunto disparador 20 y es desechable, hay menos zonas en los componentes reutilizables en las que puedan quedar atrapados tejidos y fluidos. Así, los componentes reutilizables del aparato pueden esterilizarse más fácilmente.
En la grapadora quirúrgica descrita en lo que antecede, la UCUU 18 y el conjunto disparador 20 se afianzan de manera independiente en el miembro 22 de canal de la semisección 14 receptora de cartucho, y se retiran del mismo de manera independiente. En realizaciones alternativas ilustradas en las Figuras 35-36B, la UCUU 18 y el conjunto disparador 20 están configurados para formar una única unidad desechable, y la semisección receptora de cartucho está configurada para recibir la unidad desechable única. En particular, la carcasa estacionaria del conjunto disparador está configurada para soportar tanto la UCUU como los componentes de disparo de la grapadora quirúrgica 10, por ejemplo la barra accionadora de cuchilla, barra de leva, bloque guía y bloque deslizante mostrados en las Figuras 8-12. Cuando la carcasa estacionaria está insertada en el miembro 22 de canal de la semisección receptora de cartucho, la UCUU y los componentes de disparo están simultáneamente montados en la semisección receptora de cartucho. La carcasa estacionaria incluye una estructura de cierre para evitar la inserción de la UCUU en la carcasa estacionaria después de haber insertado la carcasa estacionaria en la semisección receptora de cartucho. Por tanto, en estas realizaciones se debe insertar la UCUU en la carcasa estacionaria antes de insertar la carcasa estacionaria en la semisección receptora de cartucho. A continuación se discuten realizaciones específicas de la carcasa estacionaria.
La Figura 35 ilustra esquemáticamente una realización alternativa de la carcasa estacionaria 326 asociada con el conjunto disparador 320. La carcasa estacionaria 326 puede definir una longitud sustancialmente similar a la de la semisección 14 receptora de cartucho (Figura 3). La carcasa estacionaria 326 está configurada para ser recibida de manera desprendible dentro del miembro 22 de canal (véase también la Figura 3) de la semisección 14 receptora de cartucho. La carcasa estacionaria 326 incluye una parte proximal 330, una parte distal 332 y una parte central 340 entre ellas.
La parte proximal 330 de la carcasa estacionaria 326 está configurada para soportar los componentes de disparo de la grapadora quirúrgica 10 mostrada en las Figuras 8-12 del mismo modo que la carcasa estacionaria 26, incluyendo tales componentes de disparo la barra accionadora de cuchilla, barra de leva, bloque guía y bloque deslizante (no mostrado en la Figura 35).
La parte distal 332 y la parte central 340 de la carcasa estacionaria 326 tienen juntas una longitud sustancialmente similar a la de la UCUU (unidad cargadora de un solo uso) 318, y juntas están configuradas para recibir de manera desprendible la UCUU 318. La carcasa estacionaria 326 tiene una primera posición que impide la inserción operativa completa de la UCUU 318 dentro de la parte distal 332 y la parte central 340 de la carcasa estacionaria 326, y una segunda posición que permite la inserción operativa completa de la UCUU 318 dentro de la parte distal 332 y la
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estacionaria 426 en la semisección receptora de cartucho sin haber insertado primeramente la UCUU 418 en la carcasa estacionaria 426, la semisección receptora de cartucho confinaría las paredes laterales 442 de la parte central 440 de la carcasa estacionaria 426 en su primera posición, formando así una estructura de cierre que impide
o bloquea la posterior inserción de la UCUU 418 en la carcasa estacionaria 426. Es decir, las paredes laterales 442
5 son obstruidas por las paredes laterales de la semisección receptora de cartucho, de forma que no tienen espacio suficiente para pivotar o inclinarse, bloqueando así la entrada de la UCUU 418 entre ellas.
Nótese que las paredes laterales 442 pueden estar conformadas para estar normalmente en la primera posición. Como alternativa, las paredes laterales pueden estar conformadas para estar normalmente en la posición no bloqueante, y se desplazan a la posición bloqueante por acoplamiento con las paredes laterales de la semisección
10 receptora de cartucho. En otras realizaciones alternativas, las paredes laterales 442 pueden estar conformadas de manera que se requiera la aplicación manual de fuerza para hacer pivotar las paredes laterales 442 entre la primera posición y la segunda.
Como puede apreciarse, las Figuras 35-36B ilustran distintas realizaciones de estructura de cierre que se pueden utilizar para evitar la inserción de la UCUU en la carcasa estacionaria 326 o 426 si se monta la carcasa estacionaria
15 en la semisección receptora de cartucho antes de la inserción de la UCUU en la carcasa estacionaria. En realizaciones preferidas, la UCUU y la respectiva carcasa estacionaria 326, 426 son desechables y la sección receptora de cartucho y la de yunque son reutilizables.
Se pueden considerar conjuntamente la UCUU y la carcasa estacionaria 326 o 426 como el conjunto disparador (320 y 420 de las Figuras 35 y 36, respectivamente), conteniendo la carcasa estacionaria el conjunto empujador
20 para hacer avanzar (disparar) grapas desde la UCUU.
Se entenderá que se pueden efectuar diversas modificaciones a las realizaciones del aparato aplicador de elementos de sujeción quirúrgicos descrito en la presente memoria. Por tanto, no debe interpretarse la descripción precedente como limitativa, sino meramente como ilustración de realizaciones. Los expertos en la técnica concebirán otras modificaciones dentro del alcance de la presente descripción.
25
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