ES2811752T3 - Aparatos de grapado quirúrgico - Google Patents
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Abstract
Un aparato de grapado quirúrgico (100), que comprende: una carcasa (102) que tiene un actuador (136); un miembro alargado (104) que se extiende desde la carcasa; un efector final (106) dispuesto en un extremo del miembro alargado (104), el efector final (106) que incluye las primera y segunda mordazas (108, 110); una pluralidad de sujetadores (114) dispuestos en el efector final (106); una pluralidad de miembros empujadores (130) ubicados en el efector final (106), cada miembro empujador de la pluralidad de miembros empujadores (130) acoplados operativamente a varios sujetadores; un mecanismo de accionamiento (138) acoplado operativamente al actuador (136), el mecanismo de accionamiento (138) que incluye un miembro de accionamiento longitudinalmente trasladable (140) y un deslizador de accionamiento (132) acoplado al mismo, el deslizador de accionamiento (132) configurado para acoplarse a la pluralidad de miembros empujadores (130); un elemento sensible a la presión (150) dispuesto en una de las mordazas (108,110), el elemento sensible a la presión (150) comunica una señal (152) a un controlador (120) acoplado al aparato de grapado quirúrgico (100), la señal es representativa de la presión aplicada al elemento sensible a la presión (150), en donde el elemento sensible a la presión (150) incluye sensores de presión (126) escalonados desde las posiciones proximal a la distal en relación con los sujetadores en los que al menos un sensor de presión corresponde a cada sujetador o miembro empujador, caracterizado porque el elemento sensible a la presión (150) incluye al menos un circuito (124), en donde cada circuito (124) tiene un rango eléctrico específico o valor de resistencia, inductancia o impedancia que puede leer el controlador (120) para determinar el tipo exacto de efector final (106) cargado.
Description
DESCRIPCIÓN
Aparatos de grapado quirúrgico
Antecedentes
1. Campo técnico
La presente descripción se refiere a aparatos de grapado quirúrgico que son capaces de aplicar líneas de sujetadores al tejido mientras se corta el tejido entre esas líneas de sujetador y, más particularmente, a mejoras relacionadas con el despliegue y la formación del sujetador.
2. Antecedentes de la técnica relacionada
Los aparatos quirúrgicos endoscópicos y laparoscópicos a menudo se prefieren sobre los dispositivos quirúrgicos tradicionales, ya que una incisión más pequeña tiende a reducir el tiempo de recuperación posoperatorio y las complicaciones. El uso de procedimientos quirúrgicos laparoscópicos y endoscópicos ha sido relativamente popular y ha proporcionado un incentivo adicional para desarrollar aún más los procedimientos. En los procedimientos laparoscópicos, la cirugía se realiza en el interior del abdomen a través de una pequeña incisión. De manera similar, en los procedimientos endoscópicos, la cirugía se realiza en cualquier víscera hueca del cuerpo a través de tubos endoscópicos estrechos que se insertan a través de pequeñas heridas de entrada en la piel.
Los procedimientos laparoscópicos y endoscópicos generalmente requieren que la región quirúrgica esté insuflada. En consecuencia, cualquier instrumentación insertada en el cuerpo debe sellarse para garantizar que los gases no entren o salgan del cuerpo a través de la incisión. Además, los procedimientos laparoscópicos y endoscópicos a menudo requieren que el cirujano actúe sobre órganos, tejidos y/o vasos alejados de la incisión. Por lo tanto, los aparatos utilizados en tales procedimientos son típicamente largos y estrechos mientras son funcionalmente controlables desde un extremo proximal del aparato.
Se ha producido un desarrollo significativo en una gama de aparatos quirúrgicos endoscópicos que son adecuados para la colocación precisa de un efector final distal en el sitio quirúrgico deseado a través de una cánula de un trocar. Estos efectores finales distales comprometen el tejido de varias maneras para lograr un efecto diagnóstico o terapéutico (por ejemplo, endocortador, pinza, cortador, grapadoras, aplicador de clips, dispositivo de acceso, dispositivo de administración de medicamentos/terapia génica y dispositivo de energía mediante ultrasonido, RF, láser, etc.).
Los aparatos de grapado quirúrgico conocidos incluyen un efector final que hace una incisión longitudinal en el tejido y posteriormente aplica líneas de sujetadores en los lados opuestos de la incisión. El efector final incluye un par de mordazas cooperantes que, si el aparato está destinado a aplicaciones endoscópicas o laparoscópicas, son capaces de pasar a través de un paso de cánula. Una de las mordazas recibe un cartucho de sujetadores que tiene al menos dos filas de sujetadores separadas lateralmente. La otra mordaza define un yunque que tiene cavidades de formación de sujetadores alineados con las filas de sujetadores en el cartucho. El aparato incluye una pluralidad de cuñas o barras de levas alternantes que, cuando se accionan distalmente, pasan a través de las aberturas en el cartucho de sujetadores y se acoplan a los conductores que sostienen los sujetadores para efectuar el disparo de los sujetadores hacia el yunque.
Se utilizan pequeños videoscopios de diversos tipos (por ejemplo, endoscopios) para controlar el posicionamiento y el funcionamiento correctos del aparato de grapado quirúrgico. Si bien es efectivo hasta cierto punto, es deseable tener una mejor supervisión del funcionamiento del aparato de grapado quirúrgico, especialmente si dicha monitorización permite un mejor despliegue del sujetador y una mejor calidad de formación realizada por el aparato de grapado quirúrgico. Cuando se utilizan dispositivos de grapado que contienen múltiples sujetadores en cada carga de cartucho, también es beneficioso determinar qué sujetadores se están desplegando y formando correctamente. Es importante comprender dónde se encuentran los problemas de formación o progresión porque hay varios problemas de holgura y deformación que pueden influir en el despliegue y la formación adecuados del sujetador.
El documento EP1769756 describe una grapadora que tiene varios sensores (sensores de carga, articulación y barra de disparo) colocados en una tira o serie de tiras entre un cartucho de grapas y un canal de grapas que controlan la fuerza de sujeción en el conjunto. Los sensores de carga están vinculados a un controlador que genera una señal para componentes activados electrónicamente
El documento US2009076534 se refiere a un sensor de carga de yunque colocado en la superficie interior del canal de grapas y en contacto con un lado inferior del cartucho de grapas. Cuando se cierra un yunque, la fuerza se transfiere al sensor y se produce una señal del sensor a un convertidor.
El documento EP19974383 generalmente describe el uso de un sensor de presión de carga como uno de varios tipos diferentes de sensor que alimenta información al controlador y mecanismos de grabación para proporcionar retroalimentación útil al usuario sobre diversos parámetros del aparato.
El documento EP1813201 también describe el uso de varios sensores que, en comunicación con un controlador y dispositivo de memoria, proporcionan un dispositivo quirúrgico con capacidad de grabación.
En consecuencia, existe una necesidad continua de un aparato de corte y grapado quirúrgico mejorado que incorpore el despliegue de sujetadores y las capacidades de monitoreo de presión de formación para asegurar la integridad mecánica y hemostática de un dispositivo de grapado quirúrgico.
Resumen
El aparato de grapado quirúrgico de la invención se define en la reivindicación 1. Las modalidades preferidas se definen en las reivindicaciones dependientes.
De acuerdo con una realización de la presente descripción, se describe un aparato de grapado quirúrgico. El aparato de grapado quirúrgico tiene una carcasa que tiene un actuador; un miembro alargado que se extiende desde la carcasa; un efector final dispuesto en un extremo del miembro alargado, el efector final incluye las primera y segunda mordazas; una pluralidad de sujetadores dispuestos en el efector final; una pluralidad de miembros empujadores ubicados en el efector final, cada miembro empujador en la pluralidad de miembros empujadores se acopla operativamente a varios sujetadores; un mecanismo de accionamiento acoplado operativamente al actuador, el mecanismo de accionamiento que incluye un miembro de accionamiento longitudinalmente trasladable y un deslizador de accionamiento acoplado al mismo, el deslizador de accionamiento configurado para acoplarse a la pluralidad de miembros empujadores; y un elemento sensible a la presión dispuesto en una de las mordazas, el elemento sensible a la presión comunica una señal a un controlador acoplado al aparato de grapado quirúrgico, la señal es representativa de la presión aplicada al elemento sensible a la presión, en donde el elemento sensible a la presión incluye sensores de presión escalonados.
En una realización, la interacción entre el deslizador de accionamiento y los miembros empujadores aplica presión al elemento sensible a la presión. El elemento sensible a la presión incluye sensores de presión escalonados en un circuito. El circuito, en algunas manifestaciones, es un circuito de presión impreso o un circuito flexible dispuesto en la superficie de un canal colocado en una de las mordazas.
En otra realización, el aparato de grapado quirúrgico puede incluir un circuito que está dispuesto en la superficie exterior de al menos una de las mordazas. En esta versión, el aparato de grapado también incluye una viga, la viga se dispone en la superficie exterior de al menos una de las mordazas y se asienta en una ranura dispuesta dentro de al menos una de las mordazas para que la viga se pueda configurar para trasladarse a lo largo de la ranura. La viga puede ser una viga I o una viga E.
El circuito puede tener una capa de laminado en el circuito e incluso puede tener un recubrimiento lubricante en la capa de laminado. La señal comunicada al controlador será leída periódicamente por el controlador como irregular. En tal caso, el controlador activará una respuesta de retroalimentación, como un código de error, advertencia, o incluso puede detener por completo el despliegue del sujetador. Se contempla que el elemento sensible a la presión comunica la señal al controlador a través de cualquiera de los siguientes: voltaje, resistencia, impedancia, electromagnetismo, radiofrecuencia, corriente, inductancia, capacitancia, infrarrojo, óptica o cualquiera de sus combinaciones.
Otra realización prevé una cuchilla configurada para trasladarse a través de la mordaza para cortar el tejido. Sin embargo, en ciertas irregularidades predeterminadas, el controlador puede evitar que la cuchilla corte, si esas irregularidades caen dentro de esas condiciones predeterminadas. Un codificador está configurado para reconocer las posiciones irregulares de los componentes en relación con la presión aplicada y enviar una señal al controlador. El codificador puede configurarse para reconocer posiciones irregulares de varios componentes, incluyendo el mecanismo de accionamiento, la cuchilla, el actuador, el deslizador de accionamiento, el miembro empujador, la primera mordaza, la segunda mordaza, o incluso varias de sus combinaciones. Estos codificadores pueden ser lineales o rotacionales.
Ciertas modalidades contemplan el circuito que incluye un elemento de identificación del cartucho. Otras modalidades pueden tener un controlador configurado para establecer limitaciones de posición y modo de ejecución para una carga particular o tipo de sujetador. Aún más, una de las mordazas se puede configurar y dimensionar para alojar un cartucho no lineal.
En otras realizaciones, el controlador incluye un elemento de comunicación de retroalimentación del usuario final. El elemento de comunicación de retroalimentación del usuario final está configurado para comunicar la retroalimentación a un usuario final a través de señales perceptivas tales como audibles, visuales, táctiles o cualquiera de sus combinaciones.
Breve descripción de los dibujos
Los aspectos anteriores y otros aspectos, elementos y ventajas de la presente descripción serán más evidentes a la luz de la siguiente descripción detallada, cuando se toma junto con los dibujos adjuntos en los que:
La Figura 1A es una vista en perspectiva de un aparato de grapado quirúrgico motorizado;
La Figura 1B es una vista en perspectiva de un aparato de grapado quirúrgico manual;
La Figura 1C es una vista en perspectiva ampliada del efector final de un aparato de grapado quirúrgico;
La Figura 1D es una vista en perspectiva del efector final durante una operación de aplicación de sujetadores a medida que la cuña se traslada a través del cartucho para expulsar secuencialmente los sujetadores del cartucho e impulsarlos contra una de las mordazas que se formarán con el mismo;
La Figura 2 es una vista esquemática de un sistema de grapado quirúrgico de acuerdo con la presente descripción; La Figura 3A es una vista lateral en sección transversal de una porción del efector final del aparato de grapado quirúrgico' de las Figuras 1A y 1B;
La Figura 3B es una vista lateral en sección transversal de una porción del efector final del aparato de grapado quirúrgico' de las Figuras 1A y 1B con una pared de cartucho retirada para mayor claridad;
La Figura 4A es una vista en alzado lateral del aparato de grapado quirúrgico de la Figura 1B con la carcasa seccionada para ilustrar el mecanismo de actuación cuando el actuador se manipula a través de una carrera de accionamiento para aplicar una porción de los sujetadores desde el cartucho al tejido;
La Figura 4B es una vista en perspectiva en sección transversal parcial del aparato de grapado quirúrgico de la Figura 4A de acuerdo con la presente descripción;
La Figura 5 es un gráfico de la presión aplicada para formar grapas frente al tiempo;
La Figura 6 es una vista en perspectiva del canal interior del cartucho con un circuito de presión impreso dispuesto en él;
La Figura 7 es una vista en perspectiva de un efector final extraíble de las Figuras 1A y 1B que ilustran una ranura para cuchilla en una de las mordazas;
La Figura 8A es una vista en perspectiva del efector final de la Figura 7 con la cubierta del yunque retirada para mayor claridad mostrando un circuito de presión;
La Figura 8B es una vista en perspectiva ampliada de la realización descrita en la Figura 8A;
La Figura 9 es una vista esquemática del elemento de comunicación de retroalimentación del usuario final de acuerdo con una realización de la presente descripción;
La Figura 10 es una vista esquemática del elemento de identificación del cartucho de acuerdo con una realización de la presente descripción; y
La Figura 11 es un esquema del elemento codificador de acuerdo con una realización de la presente descripción.
Descripción detallada de las modalidades
Las modalidades del aparato de grapado quirúrgico descrito en la actualidad se describirán ahora en detalle con referencia a los dibujos, en los que los mismos números de referencia designan elementos idénticos o correspondientes en cada una de las diversas vistas.
Como se muestra en los dibujos y como se describe a lo largo de la siguiente descripción, y como es tradicional cuando se hace referencia al posicionamiento relativo en un objeto, el término "proximal" se refiere al extremo del aparato que está más cerca del usuario y el término "distal" se refiere al extremo del aparato que está más lejos del usuario. En la siguiente descripción, las funciones o construcciones que se conocen bien no se describen en detalle para evitar complicar la presente descripción con detalles innecesarios.
La Figura 1A ilustra un aparato de grapado quirúrgico motorizado que se muestra generalmente como 100. La Figura 1B ilustra un aparato de grapado quirúrgico manual que se muestra generalmente como 200. Brevemente, el aparato de grapado quirúrgico 100, 200 incluye un alojamiento 102 que tiene un actuador 136, un miembro alargado 104 que se extiende desde la carcasa 102, y un efector final 106 dispuesto en un extremo del miembro alargado 104. De las Figuras 1C-1D, el efector final 106 incluye una primera y una segunda mordazas 108, 110, una pluralidad de sujetadores 114 dispuestos en el efector final 106 y una pluralidad de miembros empujadores 130 ubicados en el efector final 106. Cada miembro empujador 130 en la pluralidad de miembros empujadores 130 está acoplado operativamente a una serie de sujetadores 114. Como se ve en las Figuras 3A-4B, el aparato de grapado quirúrgico 100, 200 incluye un mecanismo de accionamiento 138 acoplado operativamente al actuador 136. El mecanismo de accionamiento 138 incluye un miembro de accionamiento longitudinalmente trasladable 140 y un deslizador de accionamiento 132 acoplado al mismo. El deslizador de accionamiento 132 está configurado para acoplar la pluralidad de miembros empujadores 130.
De acuerdo con una realización de la presente descripción, la Figura 2 representa un sistema de grapado quirúrgico que tiene un aparato de grapado quirúrgico 100, 200, el aparato de grapado quirúrgico 100, 200 que tiene un elemento sensible a la presión 150 y un controlador 120. Se prevé que el elemento sensible a la presión esté dispuesto en una de las mordazas 108, 110 (Figuras 3A-3B y 8A -8B). El elemento sensible a la presión 150 puede comunicar una señal de presión 152 (no mostrada) al controlador 120 acoplado al aparato de grapado quirúrgico 100, 200. El controlador 120 es un microcontrolador o un circuito analógico que permite el control, el posicionamiento, el estado y la
retroalimentación de calidad del sujetador 114. La señal de presión 152 es representativa de la presión aplicada al elemento sensible a la presión 150. Se prevé que esta realización pueda incluir una cuchilla 164 o no tener cuchillas, la cuchilla 164 se puede trasladarse de forma deslizable a través de una ranura de cuchilla 174 (Figura 1C).
Con referencia a la Figura 5, la presión aplicada puede medirse en forma de pulsaciones de forma de onda como se ve en el gráfico de tiempo versus presión aplicada. Por ejemplo, una muestra normal podría leer de acuerdo con el gráfico que cubre el período de tiempo de 0 - t1. Si las pulsaciones de la forma de onda indican una presión baja (t2 -t3) o alta (t1 - t2) durante un determinado muestreo, esto podría ser una indicación de que los sujetadores 114 no se están desplegando o formando correctamente debido a una distribución de presión aplicada inadecuada necesaria para un correcto despliegue o formación del sujetador 114. Alternativamente, si la forma de onda no es una forma que se ha correlacionado con formas de onda de prueba exitosas (t3 - t4), el controlador 120 inicia un código de error o retroalimentación para detener el despliegue o la progresión de la formación. Esto le da al usuario final la capacidad de comprender adecuadamente la irregularidad del rendimiento antes de continuar o retroceder.
Como se ve en las Figuras 3A-3B, la primera mordaza 108 incluye un canal de cartucho 128 para recibir un cartucho 112. El cartucho 112 incluye una pluralidad de sujetadores 114 dispuestos en el mismo. Típicamente, los sujetadores 114 tienen la forma de una pluralidad de grapas quirúrgicas. El cartucho 112 aloja los sujetadores 114 en una pluralidad de filas lineales, que están acopladas operativamente a los miembros empujadores 130.
Con referencia ahora a la Figura 6, el elemento sensible a la presión 150 de una manifestación incluye un circuito 124 en el que al menos un cable 154 conecta al menos un sensor de presión 126. También se contempla que una pluralidad de sensores de presión 126 estén dispuestos en el aparato de grapado quirúrgico 100, 200. En un caso, un cable 154 se extiende a través de una pluralidad de sensores de presión 126 en progresión lineal a lo largo del eje longitudinal, en donde al menos un sensor de presión 126 corresponde a cada elemento de fijación 114 o miembro empujador 130. Cada fila lineal de sujetadores 114 y/o miembros empujadores 130 está conectada por al menos un cable 154 que se extiende a lo largo de la fila lineal y a lo largo del eje longitudinal del circuito 124. El circuito 124 es un circuito de presión flexible o impreso 124.
En esta realización, el circuito 124 está adherido a la superficie superior (de trabajo) del canal de cartucho 128 de modo que el circuito 124 puede interactuar con el deslizador de accionamiento 132 que se traslada a través del mismo. En otras palabras, el circuito 124 está dispuesto dentro del canal de cartucho 128 para acoplarse de manera coincidente con el deslizador de accionamiento 132 a medida que el deslizador de accionamiento 132 se traslada a través del canal de cartucho 128 (Figuras 3A-3B).
Las Figuras 7-8B muestran otra realización del aparato de grapado quirúrgico 100, 200. Como se ve en las Figuras 8A-8B, el aparato de grapado quirúrgico 100, 200 incluye un elemento sensible a la presión 150 que incluye un circuito 124 y está dispuesto en la superficie exterior de al menos una de las mordazas 108, 110. Preferiblemente, el circuito 124 está dispuesto en la superficie exterior de la segunda mordaza 110. Esta realización incluye una viga 162. La viga 162 está dispuesta en la superficie exterior de al menos una de las mordazas 108, 110. Preferiblemente, la viga 162 está dispuesta en la superficie exterior de la segunda mordaza 110. También se contempla que la viga 162 esté asentada de manera deslizante en una ranura 116 dispuesta dentro de al menos una de las mordazas 108, 110 y conectada al deslizador de accionamiento 132 (Figuras 8A y 8B). La viga 162 está asentada de forma deslizante en una ranura 116 dispuesta dentro de la segunda mordaza 110. La viga 162 está configurada para trasladarse a lo largo de la ranura 116. La viga es una viga I o una viga E. Se prevé que este circuito 112 sea muy delgado con respecto al aparato de grapado quirúrgico 100, 200, que tenga dimensiones al menos geométricamente lo suficientemente delgadas como para no comprometer o impactar en gran medida el tamaño o la función general del cartucho 112.
En algunas manifestaciones, los sensores de presión 126 están escalonados (Figuras 3B, 6, 8A, 8B). El circuito 124 en una disposición está escalonado y optimizado para que pueda obtenerse información detallada para cada sujetador 114 o grupo de sujetadores 114 formados por su miembro empujador 130 asociado. Al tener los sensores de presión 126 escalonados desde las posiciones proximal a distal con respecto a los sujetadores 114 dentro del aparato de grapado quirúrgico 100, 200, el aparato de grapado quirúrgico 100, 200 puede configurarse para determinar el tiempo de despliegue y la finalización de cada sujetador 114. Esto es valioso para controlar el aparato de grapado quirúrgico 100, 200 con un controlador 120 para verificar los límites con cada cartucho específico 112 para sujeción, parada distal o posición inicial. El controlador 120 puede tener un circuito analógico o microelectrónico.
A medida que se desarrolla la progresión del sujetador 114, el elemento sensible a la presión 150 comunica una señal de presión 152 al controlador 120 a través de al menos un medio de comunicación seleccionado del grupo que comprende voltaje, resistencia, impedancia, electromagnetismo, radiofrecuencia, corriente, inductancia, capacitancia, infrarrojo, y óptica. En funcionamiento, el elemento sensible a la presión 150 sigue la presión aplicada a medida que los sujetadores 114 se despliegan y se forman en progresión (Figura 5). En algunos casos, la presión aplicada puede rastrearse en forma de pulsaciones de forma de onda. Cuando el controlador 120 reconoce patrones de presión irregulares representados por la señal de presión 152 comunicada desde el elemento sensible a la presión 150, el controlador 120 registra correspondientemente un error y puede configurarse para emitir un código de error, emitir una advertencia, detener las formaciones del sujetador 114, o incluso detener el despliegue del sujetador 114.
El elemento sensible a la presión 150 también puede configurarse para configuraciones de cartucho 112 tanto lineales como no lineales. Se prevé que al menos una de las mordazas 108, 110, preferiblemente la primera mordaza 108, incluya un cartucho no lineal. En otras palabras, el elemento sensible a la presión 150 puede usarse para los aparatos de grapado quirúrgico de cartucho lineal 112 100, 200 o los aparatos de grapado quirúrgico de cartucho no lineal 112 100, 200 necesarios para evaluar la calidad del sujetador o el estado de progresión.
A menudo, el aparato de grapado quirúrgico 100, 200 puede incluir una cuchilla 164. En una manifestación de la presente descripción, el aparato de grapado quirúrgico 100, 200 está configurado y dimensionado de manera que el controlador 120 evita que la cuchilla 164 corte. En otras palabras, el controlador 120 incluye un codificador 166, es decir, una función de prevención de corte con la cuchilla. Como se ve en la Figura 11, una configuración contempla el codificador 166 configurado para reconocer el comportamiento irregular del aparato de grapado quirúrgico 100, 200. En algunos casos, el codificador 166 está configurado y dimensionado para reconocer las posiciones de los componentes en relación con la presión aplicada. Los componentes de los cuales se seleccionan del grupo que comprende el mecanismo de accionamiento 138, la cuchilla 164, el actuador 136, el deslizador de accionamiento 132, el miembro empujador 130, la primera mordaza 108 y la segunda mordaza 110, o cualquiera de sus combinaciones. El codificador 166 puede ser giratorio, o incluso lineal.
Con referencia a la Figura 9, el controlador 120, en algunas manifestaciones, incluye un elemento de comunicación de retroalimentación del usuario final 170. El elemento de comunicación de retroalimentación del usuario final 170 está configurada para comunicar la retroalimentación a un usuario final después de recibir y descifrar una señal 152, 191 a través de al menos un medio seleccionado del grupo que comprende audible (campanas, habla, zumbadores, pitidos, etc.), visual (luces, LED, LCD o pantallas electroluminiscentes de diferentes colores, texto y/o símbolos) y táctiles (vibratorias). Por ejemplo, la retroalimentación puede configurarse para indicar la finalización exitosa o no exitosa de una tarea, como el inicio de la progresión del despliegue del sujetador, la finalización del despliegue y la formación del sujetador, el despliegue individual del sujetador, la formación individual del sujetador u otras tareas similares reconocidas por un experto en la técnica.
Para proteger el circuito 124 contra rasgaduras o abrasiones y para obtener retroalimentación precisa y repetible, se puede laminar un material de superficie delgada y dura como una película de poliimida Kapton® o una lámina de aleación de titanio o acero o un revestimiento de níquel, cromo o nitruro con recubrimiento instantáneo sobre la capa superior del circuito 124, definiendo un laminado 158. Además, un recubrimiento lubricante 160 también puede aplicarse a la capa laminada. El revestimiento lubricante 160 es cualquier plástico de baja fricción, grasa, material mezclado de PTFe o cualquier otro lubricante comparable. El lubricante 160 es beneficioso para lograr una señal de presión de salida de calidad 152 y para mejorar la robustez de los componentes de trabajo.
Como se ve en la Figura 10, el aparato de grapado quirúrgico 100, 200 puede tener un circuito 124 que incluye un elemento de identificación de cartucho 168. En particular, el elemento sensible a la presión 150 incluye al menos un circuito 124, en donde cada circuito 124 tiene un rango eléctrico específico o valor de resistencia, inductancia o impedancia que puede leer el controlador 120 para determinar el tipo exacto de cartucho 112 o efector final 106 cargado para identificación. Con esta característica, el aparato de grapado quirúrgico 100, 200 incluye un controlador 120 configurado para configurar el modo de funcionamiento y/o limitaciones de posición específicas del cartucho 112 o del sujetador 114.
En funcionamiento, cuando un usuario final (no mostrado) acciona el actuador 136, el mecanismo de accionamiento 138 hace que el deslizador de accionamiento 132 interactúe con los miembros empujadores 130 (Figura 4A). En ciertas variaciones, el actuador 136 incluye elementos de accionamiento separados para accionar el deslizador de accionamiento 132 y las primera y segunda mordazas 108, 110. Por ejemplo, un actuador del deslizador de accionamiento 136a se usa para accionar de forma remota el deslizador de accionamiento 132, y un actuador de mordaza 136b se usa para accionar la primera y segunda mordazas 108, 110. Alternativamente, se usa un único actuador 136 para accionar tanto el deslizador de accionamiento 132 como las mordazas 108, 110. En otro ejemplo, actuadores separados 136 están conectados a las primera y segunda mordazas individuales 108, 110.
Tras el accionamiento, el deslizador de accionamiento 132 acuña los elementos de empuje 130 hacia arriba, forzando los sujetadores 114 hacia arriba en la segunda superficie opuesta de la mordaza 110, y en particular, dentro de las cavidades 156 que forman el sujetador (Figura 1D). De las Figuras 1D, en su configuración inicial, el sujetador 114 está conformado en una configuración sustancialmente en forma de U. En su configuración completamente formada, el 114 más rápido está conformado en una configuración sustancialmente en forma de B. En el proceso de transformar el sujetador 114 de la primera configuración a la segunda configuración, la segunda mordaza 110 actúa como un yunque y comprime correspondientemente el sujetador 114 en su segunda configuración en forma de B a medida que los dientes del sujetador 114a, 114b se acoplan a las cavidades de formación de sujetador 156. Esta presión resultante aplicada al elemento sensible a la presión 150 es, por lo tanto, el resultado de la interacción entre el deslizador de accionamiento 132 y los miembros empujadores 130.
En modalidades en las que el elemento sensible a la presión 150 incluye un circuito 112 dispuesto dentro del canal del cartucho 128, la fuerza hacia abajo de la segunda mordaza 110 sobre el sujetador de accionamiento ascendente 114, el miembro empujador 130 y la combinación del deslizador de accionamiento 132 hace que las fuerzas de
reacción pasen a través de los sujetadores 114, el miembro empujador 130 y la combinación del deslizador de accionamiento 132 en la dirección descendente opuesta y sobre el circuito 112 y cualquier sensor de presión 126, que registran correspondientemente la presión aplicada. El elemento sensible a la presión 150 comunica una señal de presión 152 al controlador 120, donde la señal de presión 152 es representativa de la presión aplicada al elemento sensible a la presión 152. El controlador 120 recibe la señal de presión 152 y emite selectivamente una respuesta o retroalimentación basada en la señal de presión 152.
En modalidades donde el elemento sensible a la presión 150 incluye un circuito 112 dispuesto en la superficie exterior de una de las mordazas 108, 110. Por ejemplo, cuando el circuito 112 está dispuesto en la superficie exterior de la segunda mordaza 110, la presión aplicada se desplaza desde la viga 162, que está conectada al deslizador de accionamiento 132, sobre el circuito 112 cuando la viga 162 y el deslizador de accionamiento 132 se trasladan longitudinalmente a lo largo de las primera y segunda mordazas 108, 110. En otras palabras, a medida que el deslizador de accionamiento 132 se traslada y se acopla a los miembros empujadores 130, los miembros empujadores 130 empujan los sujetadores 114 hacia arriba en la segunda mordaza 110 y las cavidades de formación de sujetadores 156. En consecuencia, esto hace que las fuerzas de reacción hacia abajo se desplacen hacia la viga 162 sobre el circuito 112 a medida que el deslizador de accionamiento 132 tira hacia abajo de la viga 162 mediante las fuerzas de reacción hacia abajo resultantes desde las cavidades de formación de sujetadores 156 que pasan a través de los sujetadores 114 y los miembros empujadores 130 sobre el deslizador de accionamiento 132. Los sensores de presión 126 registran correspondientemente la presión aplicada. El elemento sensible a la presión 150 comunica una señal de presión 152 al controlador 120, donde la señal de presión 152 es representativa de la presión aplicada al elemento sensible a la presión 152. El controlador 120 recibe la señal de presión 152 y emite selectivamente una respuesta o retroalimentación basada en la señal de presión 152.
En modalidades que incluyen un codificador 166, el codificador 166 está configurado para reconocer el comportamiento irregular de un componente del aparato de grapado quirúrgico 100, 200 cuyos componentes pueden seleccionarse del grupo que comprende el mecanismo de accionamiento 138, la cuchilla 164, el actuador 136, el deslizador de accionamiento 132, el miembro empujador 130, la primera mordaza 108 y la segunda mordaza 110. En un ejemplo en el que el codificador 166 está configurado para controlar las posiciones de la cuchilla 164, y donde el codificador 166 reconoce una posición irregular de la cuchilla 164, el codificador 166 comunica la irregularidad al controlador 120 a través de una señal codificadora 191, la señal regular 191a o irregular 191b. Al recibir una señal irregular 191b, el controlador 120 registra un código de error y, en algunos casos, está configurado para evitar el corte sin sujeción.
El codificador 166 comunica la señal del codificador 191 al controlador 120 a través de al menos un medio seleccionado del grupo que comprende voltaje, resistencia, impedancia, electromagnetismo, radiofrecuencia, corriente, inductancia, capacitancia, infrarrojo y óptica. También se prevé que el controlador 120 esté configurado y dimensionado para recibir una señal codificadora 191 del elemento sensible a la presión 150 y para determinar las disparidades de despliegue y formación del sujetador 114 con respecto al comportamiento del componente, por ejemplo, el posicionamiento irregular de la cuchilla 164. El controlador 120 también está configurado y dimensionado para iniciar un código de error o modificar la configuración de despliegue del sujetador 114.
Si bien en los dibujos se han mostrado varias modalidades ilustrativas de la descripción, no se pretende que la descripción se limite a las mismas, ya que se pretende que la descripción tenga un alcance tan amplio como lo permita la técnica y que la descripción se lea de la misma manera. Por lo tanto, la descripción anterior no debe interpretarse como limitante, sino simplemente como ejemplos de modalidades preferidas. Así, el alcance de la invención debería determinarse por las reivindicaciones adjuntas, más que por los ejemplos dados.
Claims (16)
1. Un aparato de grapado quirúrgico (100), que comprende:
una carcasa (102) que tiene un actuador (136);
un miembro alargado (104) que se extiende desde la carcasa;
un efector final (106) dispuesto en un extremo del miembro alargado (104), el efector final (106) que incluye las primera y segunda mordazas (108, 110);
una pluralidad de sujetadores (114) dispuestos en el efector final (106);
una pluralidad de miembros empujadores (130) ubicados en el efector final (106), cada miembro empujador de la pluralidad de miembros empujadores (130) acoplados operativamente a varios sujetadores;
un mecanismo de accionamiento (138) acoplado operativamente al actuador (136), el mecanismo de accionamiento (138) que incluye un miembro de accionamiento longitudinalmente trasladable (140) y un deslizador de accionamiento (132) acoplado al mismo, el deslizador de accionamiento (132) configurado para acoplarse a la pluralidad de miembros empujadores (130);
un elemento sensible a la presión (150) dispuesto en una de las mordazas (108,110), el elemento sensible a la presión (150) comunica una señal (152) a un controlador (120) acoplado al aparato de grapado quirúrgico (100), la señal es representativa de la presión aplicada al elemento sensible a la presión (150), en donde el elemento sensible a la presión (150) incluye sensores de presión (126) escalonados desde las posiciones proximal a la distal en relación con los sujetadores en los que al menos un sensor de presión corresponde a cada sujetador o miembro empujador, caracterizado porque el elemento sensible a la presión (150) incluye al menos un circuito (124), en donde cada circuito (124) tiene un rango eléctrico específico o valor de resistencia, inductancia o impedancia que puede leer el controlador (120) para determinar el tipo exacto de efector final (106) cargado.
2. El aparato de grapado quirúrgico (100) de acuerdo con la reivindicación 1, en donde la interacción entre el deslizador de accionamiento (132) y los miembros empujadores (130) aplica presión al elemento sensible a la presión (150).
3. El aparato de grapado quirúrgico (100) de acuerdo con cualquier reivindicación anterior, en donde el al menos un circuito (124) incluye un circuito flexible.
4. El aparato de grapado quirúrgico (100) de acuerdo con cualquier reivindicación anterior, en donde una de las mordazas (108, 110) comprende además un canal (128), el circuito (124) está dispuesto dentro del canal (128).
5. El aparato de grapado quirúrgico (100) de acuerdo con cualquier reivindicación anterior, en donde cuando el controlador (120) reconoce patrones de presión irregulares, el controlador está configurado para activar al menos una respuesta de retroalimentación seleccionada del grupo que comprende emitir un código de error, emitir una advertencia, y detener el despliegue del sujetador.
6. El aparato de grapado quirúrgico (100) de acuerdo con la reivindicación 5, que comprende además una cuchilla (164), el controlador que tiene un elemento de prevención de corte con la cuchilla.
7. El aparato de grapado quirúrgico (100) de acuerdo con la reivindicación 6, que comprende además un codificador (166) configurado para reconocer las posiciones irregulares de los componentes en relación con la presión aplicada, los componentes seleccionados del grupo que consiste en el mecanismo de accionamiento, la cuchilla, el actuador, el deslizador de accionamiento, el miembro empujador, la primera mordaza y la segunda mordaza.
8. El aparato de grapado quirúrgico (100) de acuerdo con la reivindicación 7, en donde el codificador (166) es giratorio o el aparato de grapado quirúrgico (100) de acuerdo con la reivindicación 7, en donde el codificador (166) es lineal.
9. El aparato de grapado quirúrgico (100) de acuerdo con cualquier reivindicación anterior, en donde el controlador (120) puede configurarse para establecer limitaciones de posición y modo de funcionamiento para una carga particular o tipo de sujetador.
10. El aparato de grapado quirúrgico (100) de acuerdo con cualquier reivindicación anterior, en donde al menos una de las mordazas (108, 110) incluye un cartucho no lineal.
11. El aparato de grapado quirúrgico (100) de acuerdo con cualquier reivindicación anterior, que comprende además una capa laminada en el circuito (124), que preferiblemente comprende además un recubrimiento lubricante en la capa laminada.
12. El aparato de grapado quirúrgico (100) de acuerdo con cualquier reivindicación anterior, en donde el elemento sensible a la presión (150) comunica la señal al controlador a través de al menos un medio seleccionado del
grupo que comprende voltaje, resistencia, impedancia, electromagnetismo, radiofrecuencia, corriente, inductancia, capacitancia, infrarrojos y óptica.
13. El aparato de grapado quirúrgico (100) de acuerdo con cualquier reivindicación anterior, en donde el controlador (120) incluye un elemento de comunicación de retroalimentación del usuario final, preferiblemente en donde el elemento de comunicación de retroalimentación del usuario final está configurado para comunicar la retroalimentación a un usuario final a través de al menos un medio seleccionado del grupo que comprende audible, visual y táctil.
14. El aparato de grapado quirúrgico (100) de acuerdo con cualquier reivindicación anterior, en donde el circuito (124) está dispuesto en la superficie exterior de al menos una de las mordazas (108, 110).
15. El aparato de grapado quirúrgico (100) de acuerdo con la reivindicación 14, que comprende además una viga (162), la viga (162) está dispuesta en la superficie exterior de al menos una de las mordazas (108, 110) y asentada en una ranura (116) dispuesta dentro de al menos una de las mordazas (108, 110), preferiblemente en donde la viga (162) está configurada para trasladarse a lo largo de la ranura (116).
16. El aparato de grapado quirúrgico (100) de acuerdo con la reivindicación 15, en donde la viga (162) es una viga en I o la viga (162) es una viga en E.
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| US5865361A (en) | 1997-09-23 | 1999-02-02 | United States Surgical Corporation | Surgical stapling apparatus |
| US20070084897A1 (en) | 2003-05-20 | 2007-04-19 | Shelton Frederick E Iv | Articulating surgical stapling instrument incorporating a two-piece e-beam firing mechanism |
| US9060770B2 (en) | 2003-05-20 | 2015-06-23 | Ethicon Endo-Surgery, Inc. | Robotically-driven surgical instrument with E-beam driver |
| US8215531B2 (en) | 2004-07-28 | 2012-07-10 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument having a medical substance dispenser |
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| CA2709777C (en) | 2017-08-22 |
| CA2709777A1 (en) | 2011-02-11 |
| JP5745716B2 (ja) | 2015-07-08 |
| EP2283781A1 (en) | 2011-02-16 |
| AU2010203027A1 (en) | 2011-03-03 |
| US20130105550A1 (en) | 2013-05-02 |
| US20110036887A1 (en) | 2011-02-17 |
| CN101991448B (zh) | 2015-04-01 |
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