ES2640895T3 - Mecanismos de bloqueo de cuchilla para instrumento quirúrgico - Google Patents

Mecanismos de bloqueo de cuchilla para instrumento quirúrgico Download PDF

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ES2640895T3
ES2640895T3 ES09251399.3T ES09251399T ES2640895T3 ES 2640895 T3 ES2640895 T3 ES 2640895T3 ES 09251399 T ES09251399 T ES 09251399T ES 2640895 T3 ES2640895 T3 ES 2640895T3
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Sachin Shah
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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
    • A61B2017/00477—Coupling
    • 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
    • A61B2017/07285—Stapler heads characterised by its cutter
    • 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
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    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
    • Y10T29/00—Metal working
    • Y10T29/49—Method of mechanical manufacture
    • Y10T29/49826—Assembling or joining

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Abstract

Un conjunto (600) de cartucho para utilizar con un instrumento (100) de grapado quirúrgico, comprendiendo el conjunto de cartucho: un canal (610) que incluye una protuberancia (612) en él; una cubierta (620) configurada para aplicación mecánica con el canal, incluyendo la cubierta un miembro de bloqueo (622) e incluyendo una superficie (624) que define un plano; un cartucho (630) de grapas configurado para aplicación mecánica con la cubierta; una cuchilla (640) configurada para traslación con respecto a la cubierta y al cartucho de grapas; caracterizado por que: la aplicación entre el canal (610) y la cubierta (620) hace que la protuberancia (612) mueva al menos una porción del miembro de bloqueo (622) desde una primera posición en la que el miembro de bloqueo es sustancialmente paralelo con el plano de la superficie de la cubierta a una segunda posición en la que al menos una porción del miembro de bloqueo está separada del plano de la superficie, en donde en la segunda posición el conjunto de cartucho está configurado para permitir la traslación proximal de la cuchilla más allá de una posición predeterminada y el miembro de bloqueo (622) está configurado para impedir la traslación distal de la cuchilla después de que la cuchilla ha sido trasladada proximalmente más allá de la posición predeterminada.

Description

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DESCRIPCION
Mecanismos de bloqueo de cuchilla para instrumento quirurgico
Antecedentes
Campo Tecnico
Esta presente exposicion se refiere a instrumentos quirurgicos que tienen mordazas que pueden moverse entre posiciones abierta y cerrada, y mas particularmente a un instrumento quirurgico que tiene una barra de cuchilla.
Antecedentes de Tecnica relacionada
Son bien conocidos en la tecnica los dispositivos quirurgicos en los que el tejido es en primer lugar cogido o sujetado entre una estructura de mordazas opuestas y a continuacion unido por sujetadores quirurgicos. En algunos instrumentos, hay prevista una cuchilla para cortar el tejido que ha sido unido por los sujetadores. Los sujetadores tienen tipicamente la forma de grapas quirurgicas pero tambien pueden ser utilizados sujetadores de polfmero de dos piezas.
Los instrumentos para este proposito pueden incluir dos miembros alargados que son utilizados respectivamente para capturar o sujetar tejido. Tfpicamente, uno de los miembros lleva un cartucho de grapas que aloja una pluralidad de grapas dispuestas en al menos dos filas laterales mientras el otro miembro tiene un yunque que define una superficie para conformar las patas de la grapa cuando las grapas son impulsadas desde el cartucho de grapas. La operacion de grapado es efectuada por barras de leva que se desplazan longitudinalmente a traves del cartucho de grapas, actuando las barras de leva sobre empujadores de grapas para expulsar secuencialmente las grapas desde el cartucho de grapas.
El documento US 5.106.008 describe un aparato de grapado quirurgico que contiene un mecanismo de bloqueo para impedir la reactivacion del aparato. El mecanismo de bloqueo comprende un clip elastico que tiene un gancho que puede aplicarse con una muesca de bloqueo sobre el retenedor de la barra de leva. El clip elastico es inicialmente sujetado en una posicion que no se puede aplicar mediante una cuna movil. Cuando la grapadora es accionada por primera vez, el retenedor de la barra de leva empuja a la cuna a una posicion subsiguiente donde la cuna ya no bloquea el clip elastico. El clip elastico se mueve entonces a una posicion en la que el gancho puede aplicarse con la muesca de bloqueo. Una vez que el retenedor de la barra de leva es retrafdo ya no puede ser reactivado.
Resumen
La presente exposicion se refiere a un conjunto de cartucho para utilizar con un instrumento de grapado quirurgico. El conjunto de cartucho incluye un canal, una tapa o cubierta, un cartucho de grapas y una cuchilla. El canal incluye una protuberancia en el. La cubierta esta configurada para aplicacion mecanica con el canal e incluye un miembro de bloqueo y una superficie que define un plano. Al menos una parte del miembro de bloqueo esta configurada para alejarse del plano al hacer contacto con la protuberancia. El cartucho de grapas esta configurado para aplicacion mecanica con la cubierta. El miembro de bloqueo esta configurado para impedir sustancialmente la traslacion distal de la cuchilla despues de que la cuchilla ha sido trasladada de manera proximal mas alla de una posicion predeterminada.
La presente exposicion tambien se refiere a un instrumento de grapado quirurgico que incluye un bastidor, una parte alargada que se extiende de manera distal desde el bastidor y que define un eje longitudinal, y un conjunto de cartucho. El conjunto de cartucho esta dispuesto en cooperacion mecanica con la parte alargada e incluye una superficie que define un plano, una protuberancia, un miembro de bloqueo y una cuchilla. Al menos una parte del miembro de bloqueo esta configurada para alejarse del plano al aplicarse con la protuberancia. La cuchilla esta configurada para traslacion con respecto a la superficie. El miembro de bloqueo esta configurado para impedir sustancialmente la traslacion distal de la cuchilla despues de que la cuchilla ha sido trasladada de manera proximal mas alla de una posicion predeterminada. La invencion proporciona un conjunto de cartucho segun la reivindicacion 1.
Descripcion de los dibujos
Se han descrito distintas realizaciones del aparato de grapado quirurgico actualmente expuesto en este documento con referencia a los dibujos, en los que:
La fig. 1 ilustra una vista lateral de un instrumento quirurgico de acuerdo con una realizacion de la presente exposicion.
La fig. 2 ilustra una vista en seccion transversal parcial de un bastidor del instrumento quirurgico de la fig. 1 que muestra una empunadura de sujecion en una posicion abierta.
La fig. 3 ilustra una vista en seccion transversal parcial del bastidor de la fig. 2 que muestra la empunadura de sujecion en una posicion aproximada.
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La fig. 4 ilustra una vista en seccion transversal parcial del bastidor de la fig. 2 con partes del bastidor omitidas.
La fig. 5 ilustra una parte distal del instrumento quirurgico de la fig. 1 que muestra miembros de mordaza en una posicion abierta de acuerdo con una realizacion de la presente descripcion.
La fig. 6 ilustra una vista ampliada de la parte de la porcion distal del instrumento quirurgico indicado en la fig. 5.
La fig. 7 ilustra una parte distal del instrumento quirurgico de la fig. 1 que muestra los miembros de mordaza en una posicion aproximada de acuerdo con una realizacion de la presente descripcion.
La fig. 8 ilustra una vista ampliada de la parte de la porcion distal del instrumento quirurgico indicado en la fig. 7.
La fig. 9 ilustra una vista en seccion transversal ampliada de una porcion distal de una realizacion del instrumento quirurgico de la presente descripcion que muestra una conexion de cuchilla en una posicion no vinculada de acuerdo con una realizacion de la presente descripcion.
La fig. 10 ilustra la conexion de cuchilla de la fig. 9 en una posicion vinculada.
La fig. 11 ilustra una vista en seccion transversal de una conexion de cuchilla en una posicion no vinculada de acuerdo con una realizacion de la presente descripcion.
La fig. 12 ilustra la conexion de cuchilla de la fig. 11 en una posicion vinculada.
La fig. 13 ilustra una vista en seccion transversal de una conexion de cuchilla en una posicion no vinculada de acuerdo con una realizacion de la presente descripcion.
La fig. 14 ilustra la conexion de cuchilla de la fig. 13 en una posicion vinculada.
La fig. 15 ilustra una vista en seccion transversal, superior de una conexion de cuchilla en una posicion no vinculada de acuerdo con una realizacion de la presente descripcion.
La fig. 16 ilustra la conexion de cuchilla de la fig. 15 en una posicion vinculada.
La fig. 17 ilustra una vista lateral de la conexion de cuchilla de la fig. 16.
La fig. 18 ilustra una vista despiezada ordenadamente de un conjunto de cartucho de acuerdo con una realizacion de la presente descripcion; y
La fig. 19 ilustra una vista en seccion transversal, parcial del conjunto de cartucho de la fig. 18.
Descripcion detallada de realizaciones
Realizaciones del instrumento quirurgico expuesto actualmente estan descritas en detalle con referencia a los dibujos en donde numeros similares designan elementos identicos o correspondientes en cada una de las distintas vistas. Como es comun en la tecnica, el termino "proximal" se refiere a aquella parte o componente mas proximo al usuario, por ejemplo, cirujano o medico, mientras que el termino "distal" se refiere a aquella parte o componente mas alejado del usuario.
Con referencia a la fig. 1, se ha ilustrado una realizacion de un instrumento quirurgico 100 de la presente exposicion. El instrumento quirurgico 100 de esta realizacion incluye un bastidor 110, una empunadura de sujecion 120, una empunadura de disparo 130, una parte alargada 140 y un efector 150. La parte alargada 140 define un eje longitudinal "X-X" para el instrumento quirurgico 100. El bastidor 110 es de un tamano y forma totales conveniente para ser sujetado con la mano. La empunadura de sujecion 120 y la empunadura de disparo 130 estan ambas montadas pivotablemente al bastidor 110 para accionamiento entre las posiciones abierta y cerrada.
Un ejemplo de distintos aspectos de la presente exposicion incluyendo el bastidor, la empunadura de sujecion, y la empunadura de disparo, estan descritos en la Patente de los Estados Unidos de la misma Cesionaria N° 5.318.221. Ciertos aspectos de la presente exposicion, incluyendo el accionamiento del efector de extremidad 150, estan descritos en la Patente de los estados Unidos de la misma Cesionaria N° 6.953.139 de Milliman y col.
Como se ha descrito en mayor detalle a continuacion, el efector de extremidad 150 incluye dos miembros de mordaza - un yunque 160 y un conjunto de cartucho 170. El yunque 160 y el conjunto de cartucho 170 se extienden desde una porcion distal de la parte alargada 140. Al menos uno de entre el yunque 160 y el conjunto de cartucho 170 son movibles de manera pivotante relativamente entre sf. El yunque 160 incluye una superficie de contacto con el tejido con una depresion de conformacion de la grapa en ella (no mostrada explfcitamente en las realizaciones ilustradas). El conjunto de cartucho 170 incluye una pluralidad de sujetadores quirurgicos en el (no mostrados explfcitamente en las realizaciones ilustradas), que son eyectables a traves del tejido y al yunque 160.
Un cartucho de grapas reemplazable (o unidad de carga) puede ser utilizado con el instrumento quirurgico 100 de la fig. 1. El cartucho de grapas reemplazable puede alojar una pluralidad de grapas dispuestas en al menos dos filas
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laterales y puede montarse en un canal 210 de cartucho del conjunto de cartucho 170. Ejemplos de unidades de carga para utilizar con un instrumento de grapado quirurgico estan descritos en la Patente de los Estados Unidos de la misma Cesionaria N° 5.752.644 de Bolanos y col.
Una porcion de un conjunto de accionamiento 300 esta ilustrada en las figs. 2-4. El conjunto de accionamiento 300 de esta realizacion incluye una viga de accionamiento 310. Al menos una activacion parcial de la empunadura de sujecion 120 esta configurada para trasladar la viga de accionamiento 310 longitudinalmente para aproximar el yunque 160 y el conjunto de cartucho 170 entre st Al menos una activacion parcial de la empunadura de disparo 130 esta configurada para trasladar un vastago de disparo 320 (descrito con mas detalle a continuacion) longitudinalmente para expulsar sujetadores quirurgicos (por ejemplo grapas) desde el conjunto de cartucho 170 y/o para cortar el tejido. El vastago de disparo 320 esta dispuesto en la parte alargada 140 y esta conectado a la cuchilla 400 como se ha descrito a continuacion. El vastago de disparo 320 esta dispuesto junto o concentricamente con la viga de accionamiento 310.
Para sujetar el tejido, la empunadura de sujecion 120 es hecha pivotar hacia abajo (en la direccion de la flecha "A" en la fig. 2) hacia el bastidor 110. La empunadura de sujecion 120 esta conectada a una varilla 122 de la empunadura de tal modo que la viga de accionamiento 310 se mueve longitudinalmente cuando la empunadura de sujecion 120 es hecha pivotar para cerrarla. Este movimiento longitudinal es tal hace que una porcion de la viga de accionamiento 310 (por ejemplo una viga en I o parte de activacion 330) haga contacto con una superficie de leva 152 del efector de extremidad 150 forzando al menos a uno de entre el yunque 160 y el conjunto de cartucho 170 hacia el otro. Otros detalles de la empunadura de sujecion 120 y de la viga de accionamiento 310 estan descritos en la patente de los Estados Unidos de la misma Cesionaria N° 5.318.221 de Green y col.
Cuando el cirujano esta listo para emplazar los sujetadores y cortar el tejido, la empunadura de disparo 130 es activada, lo que traslada el vastago de disparo 320 longitudinalmente (por ejemplo distalmente). Un trineo de accionamiento puede estar posicionado de manera distal de la extremidad distal del vastago de disparo 320 de tal modo que el movimiento longitudinal distal del vastago de disparo 320 hace avanzar el trineo de accionamiento en la direccion distal. Despues de la activacion, la empunadura de disparo 130 es soltada y vuelve a su posicion original. Otros detalles de sujetadores de disparo y de la retraccion de la empunadura de disparo 130 estan descritos en la patente de los Estados Unidos n° 5.318.221 de Green y col.
Con referencia continuada a las figs. 2-4, otros detalles de la empunadura de sujecion 120 y partes internas del bastidor 110 estan mostrados de acuerdo con una realizacion de la presente exposicion. En este documento, una porcion proximal 124 de la varilla 122 de empunadura (por ejemplo una varilla formada monoltticamente) esta aplicada de manera pivotante con la empunadura de sujecion 120 (por ejemplo una parte proximal de la misma) y una parte distal 126 de la varilla 122 de empunadura esta aplicada de manera pivotante con una parte proximal 312 de la viga de accionamiento 310. Se ha ilustrado un miembro de carga elastica 180 (vease la fig. 4), que esta configurado para cargar la viga de accionamiento 310 de manera proximal (lo que carga los miembros de mordaza a una posicion abierta). Una porcion proximal del miembro de carga 180 esta dispuesta en cooperacion mecanica con el bastidor 110 (por ejemplo, mediante el pasador 182) y una parte distal del miembro de carga 180 esta en cooperacion mecanica con la porcion proximal 312 de la viga de accionamiento 310 (vease la fig. 4). Como puede apreciarse, al menos una activacion parcial (es decir movimiento en la direccion de la flecha "A") de la empunadura de sujecion 120 fuerza a la porcion distal 126 de la varilla 122 de empunadura de manera distal, lo que hace que la viga de accionamiento 310 sea trasladada de manera distal contra la carga del miembro de carga elastica 180. Como se ha descrito anteriormente, la traslacion distal de la viga de accionamiento 310 provoca la aproximacion de los miembros de mordaza para sujetar el tejido entre ellos.
Con referencia espedfica a las figs. 2 y 3, el instrumento quirurgico 100 de esta realizacion incluye una estructura de retencion 190 dispuesta en cooperacion mecanica con al menos uno, o bien del bastidor 110 o bien de la empunadura de sujecion 120. Por ejemplo, la estructura de retencion 190 puede incluir una primera parte 192 dispuesta en la empunadura de sujecion 120 y una segunda parte 194 dispuesta sobre el bastidor 110, de tal modo que la activacion de la empunadura de sujecion 120 (por ejemplo un accionamiento completo) hace que la parte de disparo 192 se aplique con la segunda parte 194 para mantener de manera que se pueda liberar la empunadura de sujecion 120 en una posicion cerrada. Ademas, un mecanismo de liberacion 196 puede estar dispuesto sobre una parte del instrumento quirurgico 100 (por ejemplo la empunadura de sujecion 120) de tal modo que aplicar presion al mecanismo de liberacion 196 (por ejemplo presion hacia arriba) hace que la empunadura de sujecion 120 sea liberada desde su posicion cerrada. Es decir, la activacion del mecanismo de liberacion 196 hace que las partes 192, 194 del mecanismo de retencion 190 se liberen o desbloqueen una de otra.
En una realizacion considerada, el miembro de carga elastica 180 es un resorte que incluye una constante de resorte que esta configurada para impedir que los miembros de mordaza alcancen su posicion aproximada cuando el tejido entre ellos excede de un grosor predeterminado. Un ejemplo cuando el tejido es "demasiado grueso" es cuando el grosor del tejido entre los miembros de mordaza impedina de manera sustancial el emplazamiento apropiado de los sujetadores en el y/o a su traves.
En una realizacion descrita, la activacion de la empunadura de sujecion 120 esta tambien configurada para proporcionar al usuario una realimentacion tactil. Por ejemplo, la resistencia que un usuario experimenta en
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respuesta al accionamiento de la empunadura de sujecion 120 puede ser proporcional al grosor del tejido que esta siendo sujetado entre los miembros de mordaza. As^ el usuario es provisto con realimentacion (en forma de resistencia) cuando la empunadura de sujecion 120 es accionada para aproximar los miembros de mordaza alrededor del tejido situado entre ellos. Esta realimentacion puede ser directa o indirectamente proporcional al grosor del tejido que se esta sujetando. Se ha considerado ademas que esta cantidad de fuerza es insuficiente para superar la resistencia proporcionada por un tejido "demasiado grueso" que esta posicionado entre los miembros de mordaza, impidiendo asf sustancialmente que un usuario sujete el tejido que es "demasiado grueso".
Con referencia espedfica a la fig. 2, en su posicion no activada o abierta, la empunadura de sujecion 120 (que incluye la varilla 122 de empunadura y distintos puntos de pivotamiento) esta configurada para tener una altura relativamente baja desde el eje longitudinal. Tal distancia relativamente pequena proporciona a todo el instrumento quirurgico 100 con un perfil menor, que es una caractenstica deseable en general, ya que el instrumento es menos voluminoso y asf mas facil de manipular. Adicionalmente, se ha considerado que un usuario puede activar esta empunadura 120 de sujecion de "perfil bajo" con su pulgar de la misma mano que el usuario utiliza para accionar la empunadura movil 130 para disparar grapas, por ejemplo. Asf, la empunadura de sujecion 120 esta configurada y dimensionada para facilitar una operacion con una sola mano del instrumento quirurgico 100.
Con referencia ahora a las figs. 5-8, se ha mostrado una realizacion de la presente exposicion con relacion a miembros de mordaza que se aproximan. En esta realizacion, el efector de extremidad 150 incluye un par de superficies de leva 152a y 152b. Las figs. 5 y 6 ilustran los miembros de mordaza en una posicion abierta (es decir, no aproximada). Aqrn, la parte de activacion 330 (por ejemplo una parte horizontal superior de una viga en I) de la viga de accionamiento 310 esta en una primera posicion proximal. Como se ha descrito anteriormente, la aproximacion de la empunadura de sujecion 120 hace que la parte de activacion 330 de la viga de accionamiento se traslade de manera distal. Al producirse la traslacion distal de la viga de accionamiento 310 la parte de activacion 330 hace contacto con la superficie de leva distal 152a, lo que provoca la aproximacion de los miembros de mordaza (por ejemplo el conjunto de cartucho 170 se mueve hacia un yunque estacionario 160). Las figs. 7 y 8 ilustran el resultado de al menos una activacion parcial de la empunadura de sujecion 120, es decir, de la parte de accionamiento 330 en una posicion distal y los miembros de mordaza en una posicion aproximada.
Una vez que los miembros de mordaza son aproximados, un usuario puede, por ejemplo, activar al menos parcialmente la empunadura de disparo 130 para hacer avanzar el vastago de disparo y expulsar grapas desde el conjunto de cartucho 170. La empunadura de disparo es cargada elasticamente de manera deseable hacia su posicion inicial de modo que despues del disparo, el vastago de disparo y la parte de accionamiento 330 son retrafdos. Antes de la expulsion de grapas, el usuario puede levantar la empunadura de sujecion 120 (por ejemplo en la direccion sustancial de la flecha "B" en la fig. 3) para retraer la viga de accionamiento 310 y hacer que la parte de activacion 330 se mueva de manera proximal y haga contacto con la superficie de leva proximal 152b. Cuando la parte de activacion 330 de la viga de accionamiento 310 hace contacto con la superficie de leva proximal 152b, los miembros de mordaza se abren uno con respecto al otro (por ejemplo el conjunto de cartucho 170 se aleja del yunque 160). Como se ha mostrado, la superficie de leva distal 152a y la superficie de leva proximal 152b pueden ser adyacentes entre sf, formando asf una forma a modo de V.
En la realizacion ilustrada, el miembro de mordaza movil (por ejemplo el conjunto de cartucho 170) tambien incluye un labio 154 dispuesto en una porcion proximal del mismo. El labio 154 es levantado por encima de la superficie de leva 152b y esta configurado para ayudar a impedir que la parte de activacion 330 de la viga de accionamiento 310 sea trasladada demasiado lejos de manera proximal.
Adicionalmente, el miembro de mordaza movil esta mostrado con una superficie 156 sustancialmente plana (es decir sustancialmente paralela con el eje longitudinal cuando los miembros de mordaza son aproximados) adyacente a y distalmente de la superficie de leva distal 152a (vease la fig. 6). En esta configuracion, la parte de activacion 330 de la viga de accionamiento 310 puede continuar trasladandose de manera distal despues de hacer contacto con la superficie de leva distal 152a (y despues de que los miembros de mordaza hayan sido al menos parcialmente aproximados) y puede aplicarse con la superficie 156. Se ha considerado que la aplicacion entre la parte de activacion 330 y la superficie 156 puede ayudar a mantener los miembros de mordaza en la posicion aproximada.
Adicionalmente, aunque no se ha ilustrado explfcitamente en este documento, se ha considerado que el instrumento quirurgico 100 de la presente exposicion no incluye una empunadura de sujecion. En tal realizacion, una activacion parcial de la empunadura de disparo 130 puede ser utilizada para aproximar los miembros de mordaza y otra activacion, mas completa, de la empunadura de disparo 130 dispara las grapas, por ejemplo. La empunadura de disparo, en estas realizaciones, tiene un diente que es cargado elasticamente a aplicacion con una cremallera dentada unida a la viga de accionamiento. Multiples activaciones de la empunadura de disparo son utilizadas para hacer avanzar la viga de accionamiento. El avance inicial de la viga de accionamiento cierra los miembros de mordaza. Con la activacion continuada de la empunadura de disparo, la parte de activacion 330 continua desplazandose de manera distal, disparando las grapas. El conjunto de cartucho y yunque incluyen una ranura para permitir que la parte de activacion 330 se desplace hacia la extremidad distal de los miembros de mordaza. El conjunto de empunadura descrito en la patente de los Estados Unidos N° 6.953.139 de Milliman y col. En esta realizacion, la parte de activacion 330 esta conectada al miembro de cuchilla, que empuja el trineo 650 para disparar las grapas.
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Con referencia ahora las figs. 9-17, se han mostrado realizaciones de la presente exposicion que se refieren a distintas conexiones de cuchilla/vastago de disparo. En estas realizaciones, la estructura de una parte de vastago de disparo 320 y/o una parte de una cuchilla 400 esta configurada para permitir la conexion entre el vastago de disparo 320 y una cuchilla 400 de un solo uso, permitiendo asf que una cuchilla nueva 400 sea utilizada para cada disparo del instrumento quirurgico 100.
Con referencia particular a las figs. 9 y 10, se ha mostrado una realizacion de una conexion de cuchilla/vastago de disparo. Espedficamente, la fig. 9 ilustra el vastago de disparo 320a en una primera posicion proximal en la que una unidad de carga, o cartucho reemplazable, ha sido insertado en el conjunto de disparo y el vastago de disparo 320a y la cuchilla 400a no estan vinculados. La fig. 10 ilustra el vastago de disparo 320a en una segunda posicion distal, donde el vastago de disparo 320a y la cuchilla 400a estan vinculados. El vastago de disparo 320a y la cuchilla 400a de esta realizacion estan configurados de tal manera que el movimiento distal del vastago de disparo 320a hace que una extremidad distal 322a del mismo enlace con la cuchilla 400a cuando el efector de extremidad 150 esta aplicado con la parte alargada 140 del instrumento quirurgico 100. Adicionalmente, el movimiento proximal del vastago de disparo 320a hace que la cuchilla 400a (que esta vinculada al mismo) se mueva de manera proximal. Ademas, el vastago de disparo 320a y la cuchilla 400a estan configurados para resultar desvinculados entre sf cuando el vastago de disparo 320a ha sido trasladado de manera proximal a una posicion predeterminada (por ejemplo correspondiente a cuando la empunadura de disparo 130 ha sido retrafda de manera sustancialmente completa en la direccion de la flecha "C" de la fig. 1).
En la posicion desvinculada (es decir cuando hay una distancia suficiente entre una superficie 401a de la cuchilla 400a y una superficie 323a de la extremidad distal 322a del vastago de disparo 320a (vease la fig. 9)), un usuario puede reemplazar la cuchilla 400a con una cuchilla nueva reemplazando el conjunto de cartucho 160, por ejemplo. Aunque las realizaciones ilustradas ilustran los miembros de mordaza en la posicion aproximada, se ha considerado que un usuario puede retirar y/o reemplazar la cuchilla 400a cuando los miembros de mordaza estan en una posicion abierta.
Otros detalles de la interaccion entre el vastago de disparo 320a y la cuchilla 400a estan descritos en este documento con referencia continuada a las figs. 9 y 10. Cuando el vastago de disparo 320a es hecho avanzar de manera distal, al menos un saliente 142 (por ejemplo un par de salientes, un saliente dispuesto radialmente, etc.) dispuesto sobre la parte alargada 140 esta configurado para mover al menos una parte del vastago de disparo 320a transversal al eje longitudinal (por ejemplo en la direccion de la flecha "D" en la fig. 10). Por ejemplo, un saliente 143 puede hacer contacto con una rampa 324a del vastago de disparo 320a. Como puede apreciarse con respecto a las figs. 9 y 10, la combinacion del movimiento distal y del movimiento transversal hace que la extremidad distal 322a (por ejemplo en forma de J) del vastago de disparo 320a se aplique (por ejemplo enlace) con una porcion proximal 402a (por ejemplo en forma de J) de la cuchilla 400a. De manera correspondiente, cuando un vastago de disparo 320a es trasladado de manera proximal, al menos un saliente 142 esta configurado para mover al menos una parte del vastago de disparo 320a transversal al eje longitudinal (por ejemplo en la direccion de la flecha "E" en la fig. 9). Por ejemplo, el saliente 142 puede hacer contacto con una rampa 326a formada en el vastago de disparo 320a. Asf, la combinacion del movimiento proximal y del movimiento transversal hace que la extremidad distal 322a del vastago de disparo 320a se libere (por ejemplo se desenlace) de la porcion proximal 402a de la cuchilla 400a.
Con referencia particular a las figs. 11 y 12, se ha mostrado una segunda realizacion de una conexion de cuchilla/vastago de disparo. Espedficamente, la fig. 11 ilustra los miembros de mordaza en una posicion abierta en que la cuchilla 400b no esta aplicada o vinculada con un conector 360 dispuesto distalmente y junto al vastago de disparo adyacente 320b. La fig. 12 ilustra los miembros de mordaza en una posicion aproximada en donde la cuchilla 400b esta aplicada o vinculada con el conector 360. El conector 360 y la cuchilla 400b estan configurados de tal modo que cuando los miembros de mordaza estan en la posicion abierta, el conector 360 y la cuchilla 400b estan desvinculados (fig. 11), permitiendo asf que el cartucho (incluyendo la cuchilla 400b) sea retirado. Cuando los miembros de mordaza estan en una posicion aproximada (fig. 12), una superficie del miembro de mordaza de yunque hace contacto con la cuchilla 400b, haciendo girar la cuchilla 400b de manera que el conector 360 y la cuchilla 400b queden vinculados, de tal modo que la traslacion proximal y distal del vastago de disparo 320 (y asf del conector 360) da como resultado la traslacion proximal y distal de la cuchilla 400b, respectivamente. Cuando los miembros de mordaza son aproximados, el cartucho no puede ser retirado del instrumento quirurgico 100, como puede apreciarse con referencia a la fig. 12.
En la realizacion mostrada en las figs. 11 y 12, el conector 360 incluye una parte en forma de gancho que esta configurada para aplicarse a la parte en forma de gancho de la cuchilla 400b. El conector 360 esta mostrado con una forma sustancial de J, pero pueden utilizarse cualesquiera formas adecuadas para la cuchilla 400b y el conector 360.
Se ha considerado que el conector 360 es movible (por ejemplo pivotable, giratorio, etc.) con respecto a la extremidad distal del vastago de disparo 320. Por ejemplo, cuando los miembros de mordaza son movidos hacia su posicion abierta, una porcion proximal 402b de la cuchilla 400b puede hacer contacto con una parte superior 362 del conector 360 para hacer pivotar/girar la parte superior 362 de manera distal, creando asf bastante espacio (o mas espacio) para que la cuchilla 400b sea retirada del instrumento quirurgico 100. De modo similar, cuando los miembros de mordaza son aproximados, la parte superior 362 del conector 360 puede pivotar/girar de manera proximal, vinculando asf (o vinculando ademas) el conector 360 con la cuchilla 400b, no permitiendo asf que la
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cuchilla 400b sea retirada del mismo. Adicionalmente, se ha mostrado una pestana 370, que puede estar configurada 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 de manera proximal.
Otra realizacion de una conexion de cuchilla/vastago de disparo esta ilustrada en las figs. 13 y 14. Espedficamente, la fig. 13 ilustra un vastago de disparo 320c en una primera posicion proximal cuando el vastago de disparo 320c y la cuchilla 400c no estan vinculados. La fig. 14 ilustra el vastago de disparo 320c en una segunda posicion distal en la que el vastago de disparo 320c y la cuchilla 400c estan vinculados. El vastago de disparo 320c y la cuchilla 400c de esta realizacion estan configurados de tal manera que el movimiento distal del vastago de disparo 320c hace que una extremidad distal 322c del mismo enlace con la cuchilla 400c cuando el efector de extremidad 150 es aplicado con la parte alargada 140 del instrumento quirurgico 100.
Mas espedficamente, esta realizacion de conexion cuchilla/vastago de disparo incluye un elemento elastico 500 (por ejemplo un resorte de lamina) dispuesto en cooperacion mecanica con la cuchilla 400c. Una porcion proximal 502 (por ejemplo que tiene sustancialmente forma de J) del elemento de resorte 500 es cargada hacia un eje K-K de la cuchilla. Aqm, el movimiento distal del vastago de disparo 320c empuja la porcion proximal 502 del elemento de resorte 500 hacia fuera (es decir lejos del eje K-K de la cuchilla). El vastago de disparo 320 incluye una abertura 321 para recibir el elemento de resorte 500. Por consiguiente, la porcion proximal 502 del elemento de resorte 500 esta asegurada de manera temporal al vastago de disparo 320c. Asf, la traslacion distal continuada del vastago de disparo 320c provoca la traslacion distal de la cuchilla 400c. Ademas, la traslacion proximal del vastago de disparo 320c provoca la traslacion proximal de la cuchilla 400c hasta que el vastago de disparo 320c alcanza una ubicacion predeterminada (por ejemplo correspondiente a cuando la empunadura de disparo 130 ha sido retrafda sustancialmente de manera completa en la direccion de la flecha "C" de la fig. 1) donde el vastago de disparo 320c se libera del elemento de resorte 500. De manera deseable, 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 es cargado hacia fuera al retirar el cartucho del dispositivo, desconectando el vastago de disparo 320 de la cuchilla 400.
Con referencia particular a las figs. 15-17, se ha mostrado una cuarta realizacion de una conexion de cuchilla/vastago de disparo. Espedficamente, la fig. 15 ilustra el vastago de disparo 320d en una primera posicion proximal en la que el vastago de disparo 320d y la cuchilla 400d no estan vinculados. La fig. 16 ilustra el vastago de disparo 320d en una segunda posicion distal en la que el vastago de disparo 320d y la cuchilla 400d estan vinculados. La fig. 17 es una vista lateral de la fig. 16. El vastago de disparo 320d y la cuchilla 400d de esta realizacion estan configurados de tal modo que el movimiento distal del vastago de disparo 320d provoca que una extremidad distal 322d del mismo enlace con la cuchilla 400d cuando un efector de extremidad 150 es aplicado con la parte alargada 140 del instrumento quirurgico 100. Adicionalmente, el movimiento proximal del vastago de disparo 320d hace que la cuchilla 400d (que esta vinculada al mismo) se mueva de manera proximal. Ademas, el vastago de disparo 320d y la cuchilla 400d estan configurados para resultar desvinculados entre sf cuando el vastago de disparo 320d ha sido trasladado de manera proximal a una posicion predeterminada (por ejemplo correspondiente a cuando la empunadura de disparo 130 ha sido retrafda de manera sustancial completamente en la direccion de la flecha "C" en la fig. 1). La extremidad distal 322d y el receptaculo 402d de la cuchilla 400d estan conformados de manera que la extremidad distal 322d es cargada elasticamente hacia fuera al retirar el cartucho del dispositivo, desconectando el vastago de disparo 320 de la cuchilla 400.
En la posicion no vinculada (fig. 15), un usuario puede reemplazar la cuchilla 400d con una cuchilla nueva reemplazando el conjunto de cartucho 160, por ejemplo. Se ha considerado que la configuracion del efector de extremidad y del vastago de disparo 320d permite que un usuario retire y/o reemplace el cartucho cuando los miembros de mordaza estan en una posicion abierta y/o aproximada.
Otros detalles de la interaccion entre el vastago de disparo 320d y la cuchilla 400d estan descritos en este documento con referencia continuada a las figs. 15 y 16. La conexion puede ser formada cuando en la extremidad distal 322d salta elasticamente al receptaculo 402d. Alternativamente, cuando el vastago de disparo 320d es hecho avanzar de manera distal, una pendiente 142d prevista sobre la parte alargada 140 esta configurada para mover la extremidad distal 322d del vastago de disparo 320d transversal al eje longitudinal (por ejemplo en la direccion de la flecha "F" en la fig. 16) hacia un receptaculo 402d en la cuchilla 400d. Adicional, o alternativamente, una pendiente sobre la parte alargada puede estar configurada y dispuesta para levantar la extremidad distal 322 lejos de aplicacion con la cuchilla. Como puede apreciarse con respecto a las figs. 15 y 16, la combinacion del movimiento distal y del movimiento transversal puede ser utilizada para hacer que la extremidad distal 322d del vastago de disparo 320d se aplique al receptaculo 402d de la cuchilla 400d. La combinacion del movimiento proximal y del movimiento transversal puede ser utilizada para hacer que la extremidad distal 322d del vastago de disparo 320d se aplique al receptaculo 402d de la cuchilla 400d. Pueden utilizarse disposiciones similares para la conexion entre la cuchilla y el vastago de disparo mostrados en las figs. 13 y 14.
Adicionalmente, se ha considerado que la extremidad distal 322d del vastago de disparo 320d es cargada elasticamente lejos de la cuchilla 400d, es decir, en la direccion sustancial de la flecha "G" en la fig. 15. Por ello, cuando el vastago de disparo 320d es trasladado de manera proximal de tal forma que la extremidad distal 322d este proximal a la pendiente 142d, la extremidad distal 322d se mueve fuera del receptaculo 402d de la cuchilla 400d. Asf, esta combinacion de movimientos desvincula el vastago de disparo 320d y la cuchilla 400d.
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Con referencia a las figs. 18-19, la presente exposicion se refiere tambien a un conjunto de cartucho 600 segun la invencion para utilizar con un instrumento 100 de grapado quirurgico. El conjunto de cartucho 600 esta configurado para impedir que un usuario dispare un cartucho de un solo uso que ha sido ya disparado. Mas espedficamente, el conjunto de cartucho 600 esta configurado para bloquear su cuchilla 640 e impedir la reutilizacion de un cartucho, despues de que el cartucho haya sido disparado.
Una vista de conjunto del conjunto de cartucho 600 esta mostrada en la fig. 18. Como se ha mostrado, el conjunto 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 aplicacion mecanica (por ejemplo una conexion de fijacion por salto elastico) con el canal 610. El cartucho de grapas 630 esta configurado para aplicacion mecanica con la cubierta 620 y la cuchilla 640 esta configurada para traslacion con respecto a la cubierta 620 y al cartucho. La fig. 18 ilustra tambien un trineo 650, que esta configurado para traslacion con respecto a la cubierta 620 (por ejemplo para expulsar grapas desde el cartucho de grapas 630).
Como se ha mostrado, el canal 610 incluye una protuberancia 612 en el para aplicacion con un miembro de bloqueo 622 (por ejemplo dedo flexible) de la cubierta 620. Al producirse la aplicacion entre el canal 610 y la cubierta 620, la protuberancia 612 hace que el miembro de bloqueo 622 se mueva desde una primera posicion en la que el miembro de bloqueo 622 es sustancialmente paralelo con un plano definido de una superficie 624 de la cubierta 620 a una segunda posicion donde al menos una parte del miembro de bloqueo 622 (por ejemplo una porcion proximal 626) esta separada del plano de superficie 624. En su segunda posicion, el miembro de bloqueo 622 esta configurado para impedir la traslacion distal de la cuchilla 640 despues de que la cuchilla 640 ha sido desplegada para disparar grapas, y a continuacion trasladada de manera proximal mas alla de una posicion predeterminada (vease la fig. 19). Se ha considerado que el conjunto de cartucho 600 esta configurado para permitir la traslacion proximal de la cuchilla 640 mas alla del miembro de bloqueo 622 cuando el miembro de bloqueo 622 esta en su posicion cerrada. Por ejemplo, el miembro de bloqueo 622 puede estar formado como un miembro elastico. En la posicion inicial de la cuchilla, el miembro de bloqueo 622 es oprimido por la cuchilla. Despues de que la cuchilla ha sido hecha avanzar, empujando el trineo de manera distal para disparar grapas, la cuchilla es retrafda a la posicion mostrada en la fig. 19. El miembro de bloqueo 622 se levanta elasticamente, aplicandose a una superficie de la cuchilla. Como puede apreciarse, el conjunto de cartucho 600 puede ser utilizado con distintas realizaciones de instrumento 100 de grapado quirurgico descrito en este documento.
Se comprendera que pueden hacerse distintas modificaciones a las diferentes realizaciones de la presente exposicion descritas en este documento sin apartarse del alcance de las mismas. Por ejemplo, el instrumento de grapado quirurgico de la presente exposicion puede incluir una unica empunadura movil para realizar todas las funciones (por ejemplo aproximar los miembros de mordaza, disparar grapas, cortar tejido, abrir los miembros de mordaza). Se ha considerado que la unica empunadura movil puede ser activada parcialmente para realizar una primera funcion y una activacion continuada realizana una segunda funcion. Se ha considerado tambien que una primera activacion completa realizana una primera funcion y una segunda activacion total realizana una segunda funcion.
Ademas, el instrumento de grapado quirurgico descrito puede no incluir ninguna empunadura movil; en vez de ello, el instrumento de grapado quirurgico puede ser accionado por medios (por ejemplo, batena, electrico, etc.) distintos que mediante la activacion de una empunadura de sujecion. Un ejemplo de una grapadora quirurgica accionada esta descrito en la solicitud de patente de los Estados Unidos de la misma Cesionaria con N° de serie 11/786.934, titulada Instrumento Quirurgico Accionado. Adicionalmente, el instrumento de grapado quirurgico de la presente exposicion puede tambien tener capacidades de articulacion, que pueden mover el efector de extremidad entre una primera posicion donde un eje del efector de extremidad es paralelo a un eje de la parte alargada, y una segunda posicion en donde el eje del efector de extremidad forma un angulo con respecto al eje de la parte alargada. Un ejemplo de un instrumento de grapado quirurgico con un efector de extremidad articulable esta descrito en la solicitud de patente de los Estados Unidos de la misma cesionaria con un N° de serie 11/544.203, titulada Instrumento Quirurgico con Conjunto de Herramienta Articulado. Por ello la anterior descripcion no debena ser considerada como limitativa de la exposicion sino simplemente como ejemplificaciones de distintas realizaciones de la misma. Los expertos en la tecnica consideraran otras modificaciones dentro del alcance de la invencion segun ha sido definido por las reivindicaciones adjuntas a la misma.

Claims (8)

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    REIVINDICACIONES
    1. Un conjunto (600) de cartucho para utilizar con un instrumento (100) de grapado quirurgico, comprendiendo el conjunto de cartucho:
    un canal (610) que incluye una protuberancia (612) en el;
    una cubierta (620) configurada para aplicacion mecanica con el canal, incluyendo la cubierta un miembro de bloqueo (622) e incluyendo una superficie (624) que define un plano;
    un cartucho (630) de grapas configurado para aplicacion mecanica con la cubierta;
    una cuchilla (640) configurada para traslacion con respecto a la cubierta y al cartucho de grapas;
    caracterizado por que:
    la aplicacion entre el canal (610) y la cubierta (620) hace que la protuberancia (612) mueva al menos una porcion del miembro de bloqueo (622) desde una primera posicion en la que el miembro de bloqueo es sustancialmente paralelo con el plano de la superficie de la cubierta a una segunda posicion en la que al menos una porcion del miembro de bloqueo esta separada del plano de la superficie, en donde en la segunda posicion el conjunto de cartucho esta configurado para permitir la traslacion proximal de la cuchilla mas alla de una posicion predeterminada y el miembro de bloqueo (622) esta configurado para impedir la traslacion distal de la cuchilla despues de que la cuchilla ha sido trasladada proximalmente mas alla de la posicion predeterminada.
  2. 2. El conjunto de cartucho de la reivindicacion 1, que comprende ademas un trineo (650) configurado para su traslacion con respecto a la cubierta.
  3. 3. El conjunto de cartucho de la reivindicacion 1, en el que el miembro de bloqueo incluye un dedo flexible.
  4. 4. El conjunto de cartucho de la reivindicacion 1, en el que el miembro de bloqueo esta configurado para permitir que la cuchilla se desplace de manera proximal mas alla cuando el miembro de bloqueo es desplazado desde el plano.
  5. 5. Un instrumento de grapado quirurgico (100), que comprende:
    un bastidor (110);
    una parte alargada (140) que se extiende de manera distal desde el bastidor y que define un eje longitudinal; y
    un conjunto de cartucho (600) segun una cualquiera de las reivindicaciones 1 a 4.
  6. 6. El instrumento de grapado quirurgico de la reivindicacion 5, que comprende ademas un cartucho de grapas dispuesto en cooperacion mecanica con el conjunto de cartucho, incluyendo el cartucho de grapas una pluralidad de grapas separadas en el.
  7. 7. El instrumento de grapado quirurgico de la reivindicacion 5, que comprende ademas una empunadura (130) movil dispuesta en cooperacion mecanica con el bastidor, en donde al menos una activacion parcial de la empunadura movil traslada la cuchilla.
  8. 8. El instrumento de grapado quirurgico de la reivindicacion 7, en el que al menos una activacion parcial de la empunadura movil en una primera direccion traslada la cuchilla de manera distal y donde al menos una activacion parcial de la empunadura movil en una segunda direccion traslada la cuchilla de manera proximal mas alla de la posicion predeterminada.
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CA2665364A1 (en) 2009-12-06
US20110180586A1 (en) 2011-07-28
EP2371297B1 (en) 2016-11-02
US20110309129A1 (en) 2011-12-22
US8276594B2 (en) 2012-10-02
EP2133029B1 (en) 2017-08-23
AU2009201814B8 (en) 2014-08-28
US7942303B2 (en) 2011-05-17
US8015976B2 (en) 2011-09-13
JP2014061389A (ja) 2014-04-10
AU2009201814A8 (en) 2014-08-28
JP5492452B2 (ja) 2014-05-14
ES2606003T3 (es) 2017-03-17
US20090302090A1 (en) 2009-12-10
AU2009201814A1 (en) 2009-12-24
JP2015147115A (ja) 2015-08-20
AU2009201814B2 (en) 2014-08-21
EP2133029A1 (en) 2009-12-16
JP2009291604A (ja) 2009-12-17

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