ES2819053T3 - Estructura para la fijación de material de refuerzo a yunques y cartuchos de grapadoras quirúrgicas - Google Patents
Estructura para la fijación de material de refuerzo a yunques y cartuchos de grapadoras quirúrgicas Download PDFInfo
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- ES2819053T3 ES2819053T3 ES10250715T ES10250715T ES2819053T3 ES 2819053 T3 ES2819053 T3 ES 2819053T3 ES 10250715 T ES10250715 T ES 10250715T ES 10250715 T ES10250715 T ES 10250715T ES 2819053 T3 ES2819053 T3 ES 2819053T3
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- reinforcing material
- anvil
- staple cartridge
- projection
- end effector
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Abstract
Un efector final de una grapadora quirurgica, que comprende: un par de mordazas que incluyen un cartucho de grapas (522) y un yunque, el cartucho de grapas que tiene una superficie superior orientada hacia el tejido e incluye al menos una proyeccion (532, 636) que se extiende longitudinalmente en un extremo proximal del mismo y una ranura (530, 630) colocada en un extremo distal del mismo; y un material de refuerzo (526, 626) que se fija de manera liberable al cartucho de grapas (522, 622) sobre la superficie superior orientada hacia el tejido del cartucho de grapas, el material de refuerzo que se hace de un material elastico e incluye al menos una abertura (531, 631) en un extremo proximal para recibir la al menos una proyeccion y una lengueta (535, 635) en un extremo distal, caracterizado porque la lengueta se dobla hacia abajo alejandose de la superficie superior orientada hacia el tejido y se extiende dentro de la ranura para acoplarse a la ranura.
Description
DESCRIPCIÓN
Estructura para la fijación de material de refuerzo a yunques y cartuchos de grapadoras quirúrgicas
Antecedentes
Campo técnico
La presente divulgación se refiere a sistemas de fijación para materiales de refuerzo de líneas de grapas. Más particularmente, la presente divulgación se refiere a la fijación temporal de materiales de refuerzo de líneas de grapas a un yunque y un cartucho que contiene grapas de un instrumento de grapado quirúrgico.
Antecedentes de la técnica relacionada
Los instrumentos de grapado quirúrgico o "dispositivos de grapado", se emplean por los cirujanos para aplicar de manera secuencial o simultánea una o más filas de sujetadores, por ejemplo, grapas o sujetadores de dos partes, al tejido corporal con el fin de unir los segmentos de tejido corporal. Tales dispositivos generalmente incluyen un par de mordazas o estructuras en forma de dedos entre las cuales se coloca el tejido corporal a unir. Cuando el dispositivo de grapado se acciona, o "dispara", las barras de disparo que se mueven longitudinalmente contactan los miembros de empuje de grapas en una de las mordazas. Los miembros de empuje de grapas empujan las grapas quirúrgicas a través del tejido corporal y dentro de un yunque en la mordaza opuesta que cierra las grapas. Si se va a retirar o separar el tejido, se puede proporcionar una hoja de cuchilla en las mordazas del dispositivo para cortar el tejido entre las líneas de grapas.
Al grapar tejidos relativamente delgados o frágiles, es importante sellar eficazmente las líneas de grapas contra fugas de aire o fluido. Además, a menudo es necesario reforzar las líneas de grapas contra el tejido para evitar desgarres en el tejido o tirar de las grapas a través del tejido. Un método para prevenir desgarres o tirones implica la colocación de un material de reforzamiento de tela biocompatible, o material de "refuerzo", entre la grapa y el tejido subyacente. En este método, se coloca una capa de material de refuerzo contra el tejido y el tejido se grapa de manera convencional. En métodos más recientes, el material de refuerzo se posiciona en el propio instrumento de grapado antes de grapar el tejido. Un ejemplo ilustrativo de esto se divulga en la Patente de los Estados Unidos núm. 5,542,594 de McKean y otros. En McKean y otros, se desliza un tubo de material de refuerzo sobre la mordaza de la grapadora. A continuación, se acciona la grapadora para grapar el tejido en cuestión y asegurar el material de refuerzo entre el tejido y la línea de grapas para reforzar el tejido y la línea de grapas.
Algunas grapadoras quirúrgicas novedosas utilizan sujetadores o prensadores para conectar temporalmente el material de refuerzo a las mordazas de las grapadoras. Sin embargo, en algunos casos, sería deseable moldear o maquinar la estructura en las propias mordazas para facilitar la fijación de materiales de refuerzo estructurados correspondientemente. Además, sería deseable proporcionar tal estructura de una manera que no interfiera con el funcionamiento de una hoja de cuchilla asociada con las mordazas.
El documento EP-A-2005894 describe grapadoras quirúrgicas que tienen un efector final y un material de refuerzo que se fija de forma liberable a al menos una mordaza del efector final de acuerdo con el preámbulo de la reivindicación 1.
El documento US-A-5441193 describe un aparato de grapado quirúrgico que incluye una hoja de material elástico curvado que se fija a una o ambas de sus mordazas para presionar el tejido corporal cuando las mordazas se cierran sobre el tejido.
Resumen
La presente invención proporciona un efector final de una grapadora quirúrgica, que comprende: un par de mordazas que incluyen un cartucho de grapas y un yunque, el cartucho de grapas que tiene una superficie superior orientada hacia el tejido e incluye al menos una proyección que se extiende longitudinalmente en un extremo proximal del mismo y una ranura colocada en un extremo distal del mismo; y un material de refuerzo que se fija de forma liberable al cartucho de grapas, el material de refuerzo que se hace de un material elástico e incluye al menos una abertura en un extremo proximal para recibir la al menos una proyección y una lengüeta en un extremo distal, caracterizado porque la lengüeta se dobla hacia abajo alejándose de la superficie superior orientada hacia el tejido y se extiende dentro de la ranura para acoplarse a la ranura.
Convenientemente, la al menos una proyección es relativamente recta con respecto al cartucho de grapas. Convenientemente, la al menos una proyección tiene una sección transversal rectangular. En otras realizaciones, convenientemente la al menos una proyección tiene una sección transversal en forma de cruz. En aún otras realizaciones adecuadas, la al menos una proyección tiene forma de hongo.
Convenientemente, la al menos una proyección incluye una porción de cuello y una cabeza bulbosa adyacente a la
porción de cuello, la al menos una proyección se adapta para asegurar el material de refuerzo entre la cabeza bulbosa y el cartucho de grapas. En estas realizaciones, convenientemente el material de refuerzo incluye una hendidura longitudinal que se extiende a través de la al menos una abertura.
Convenientemente, el cartucho de grapas incluye una ranura de cuchilla que se extiende longitudinalmente. En estas realizaciones, convenientemente, la al menos una proyección y la al menos una abertura se colocan para permitir el paso de una cuchilla dentro del cartucho de grapas.
En las realizaciones, la al menos una proyección se acopla con la al menos una abertura en un ajuste por interferencia.
Convenientemente, el cartucho de grapas incluye un par de proyecciones. En estas realizaciones, convenientemente el material de refuerzo incluye un par de aberturas para recibir el par de proyecciones.
Convenientemente, la colocación del material de refuerzo en el cartucho de grapas resulta en una confirmación audible de la colocación correcta sobre el mismo.
Descripción de los dibujos
Varias realizaciones de los sistemas de retención de refuerzo entrelazado se divulgan en la presente descripción con referencia a los dibujos, en los que las Figuras 1-26 muestran realizaciones de referencia fuera del alcance de la presente invención, y las Figuras 27-30 muestran realizaciones de acuerdo con la invención:
La Figura1 es una vista en perspectiva de un instrumento de grapado quirúrgico que incorpora realizaciones de sistemas de retención para la fijación de materiales de refuerzo de la línea de grapa a un yunque y a un cartucho que contiene grapas del instrumento de grapado quirúrgico;
La Figura 2 es una vista en perspectiva ampliada del extremo distal del instrumento de grapado quirúrgico de la Figura 1;
La Figura 3 es una vista en perspectiva, con partes separadas, de una realización de un yunque y un sistema de retención del material de refuerzo;
La Figura 4 es una vista en perspectiva del sistema de retención del material de refuerzo del yunque ensamblado; La Figura 5 es una vista superior del extremo distal del sistema de retención del material de refuerzo del yunque de la Figura 4;
La Figura 6 es una vista en sección transversal que se toma a lo largo de la línea 6-6 de la Figura 4;
La Figura 7 es una vista en perspectiva, con partes separadas, del extremo proximal del sistema de retención del refuerzo del yunque de la Figura 4;
La Figura 8 es una vista en sección transversal que se toma a lo largo de la línea 8-8 de la Figura 7;
La Figura 9 es una vista en perspectiva, con partes separadas, de una realización alternativa del extremo proximal de un sistema de retención del refuerzo del yunque;
La Figura 10 es una vista en sección transversal que se toma a lo largo de la línea 10-10 de la Figura 9;
La Figura 11 es una vista en perspectiva, con partes separadas, de una realización de un cartucho que contiene grapas y un sistema de retención del material de refuerzo;
La Figura 12 es una vista en perspectiva del sistema de retención del refuerzo del cartucho ensamblado de la Figura 11;
La Figura 13 es una vista superior del extremo proximal del sistema de retención del refuerzo del cartucho de la Figura 12;
La Figura 14 es una vista superior de una realización alternativa de un extremo proximal de un sistema de retención del refuerzo del cartucho;
La Figura 15 es una vista en sección transversal que se toma a lo largo de la línea 15-15 de la Figura 12;
La Figura 16 es una vista en perspectiva, con partes separadas, del extremo distal del sistema de retención del refuerzo del cartucho de la Figura 12;
La Figura 17 es una vista en sección transversal que se toma a lo largo de la línea 17-17 de la Figura 16;
La Figura 18 es una vista en perspectiva, con partes separadas, de una realización alternativa de un extremo distal del sistema de retención del refuerzo del cartucho;
La Figura 19 es una vista en sección transversal que se toma a lo largo de la línea 19-19 de la Figura 18;
La Figura 20 es una vista en perspectiva, con partes separadas, de una realización alternativa adicional de un extremo distal de un sistema de retención del refuerzo del cartucho;
La Figura 21 es una vista en sección transversal que se toma a lo largo de la línea 21-21 de la Figura 20;
La Figura 22 es una vista en perspectiva del extremo distal del instrumento de grapado quirúrgico de la Figura 1 colocado alrededor de una sección de tejido;
La Figura 23 es una vista lateral, parcialmente mostrada en sección, del extremo distal del instrumento de grapado quirúrgico colocado alrededor de la sección de tejido;
La Figura 24 es una vista lateral, parcialmente mostrada en sección, durante el accionamiento inicial del instrumento de grapado quirúrgico de la Figura 1;
La Figura 25 es una vista en perspectiva de una sección de tejido grapada y dividida;
La Figura 26 es una vista en sección transversal que se toma a lo largo de la línea 26-26 de la Figura 25;
La Figura 27 es una vista en perspectiva, con partes separadas, de una realización de un cartucho que contiene grapas
y un sistema de retención de material de refuerzo de acuerdo con la presente invención;
La Figura 28 es una vista en perspectiva del sistema de retención del refuerzo del cartucho ensamblado de la Figura 27;
La Figura 29 es una vista inferior del extremo proximal del sistema de retención del refuerzo del cartucho de la Figura 28;
La Figura 30A es una vista en perspectiva, con partes separadas, de una realización adicional de un cartucho que contiene grapas y un sistema de retención de material de refuerzo de acuerdo con la presente invención; y
La Figura 30B es una vista en perspectiva del sistema de retención del refuerzo del cartucho ensamblado de la Figura 30A.
Descripción detallada de las realizaciones
Las realizaciones de los sistemas de retención de material de refuerzo entrelazado divulgados en la presente para su uso con instrumentos de grapado quirúrgico, se describirán ahora en detalle con referencia a los dibujos, en los que, los numerales similares designan elementos idénticos o correspondientes en cada una de las diversas vistas. Como es común en la técnica, el término "proximal" se refiere a esa parte o componente más cercano al usuario u operador, es decir, cirujano o médico, mientras que el término "distal" se refiere a esa parte o componente más alejado del usuario.
Con referencia ahora a la Figura 1, se divulga un instrumento de grapado quirúrgico lineal o una grapadora quirúrgica 10 para su uso en el grapado de tejido y la aplicación de capas de material de refuerzo entre las grapas y el tejido subyacente. Un ejemplo ilustrativo de este tipo de instrumento de grapado quirúrgico se divulga en la Patente de los Estados Unidos núm. 7,128,253. La grapadora quirúrgica 10 generalmente incluye un mango 12 que tiene un miembro tubular alargado 14 que se extiende distalmente desde el mango 12. Un conjunto de mordaza 16 se monta en un extremo distal 18 del miembro tubular alargado 14. El conjunto de mordaza 16 incluye un yunque de remachado de grapas 20 y un cartucho que contiene grapas o cartucho de grapas 22. El cartucho de grapas 22 puede fijarse permanentemente al miembro tubular alargado 14 o puede ser desmontable y, por lo tanto, reemplazable con un nuevo cartucho de grapas 22. El yunque de remachado de grapas 20 se monta de forma móvil en el extremo distal 18 del miembro tubular alargado 14 y puede moverse entre una posición abierta separada del cartucho de grapas 22 a una posición cerrada sustancialmente adyacente al cartucho de grapas 22.
El yunque de remachado de grapas 20 se proporciona con una capa de material de refuerzo del yunque 24 y el cartucho de grapas 22 se proporciona con una capa de material de refuerzo del cartucho 26 en las formas que se describen con más detalle a continuación. Un sistema de retención del refuerzo del yunque 28 se incorpora en el yunque 20 y el material de refuerzo del yunque 24 y se proporciona para asegurar de forma liberable el material de refuerzo del yunque 24 al yunque de remachado de grapas 20. Asimismo, un sistema de retención del refuerzo del cartucho 30 incorporado en el cartucho de grapas 22 y el material de refuerzo del cartucho 26, se proporciona para asegurar de manera liberable el material de refuerzo del cartucho 26 al cartucho de grapas 22. El material de refuerzo del yunque 24 y el material de refuerzo del cartucho 26 se proporcionan para reforzar y sellar las líneas de grapas aplicadas al tejido por la grapadora quirúrgica 10.
El sistema de retención del refuerzo del yunque 28 y el sistema de retención del refuerzo del cartucho 30 se configuran particularmente para permitir que los respectivos materiales de refuerzo se ubiquen en las superficies orientadas hacia adentro del yunque 20 y el cartucho de grapas 22 para facilitar el paso de la grapadora quirúrgica 10 dentro del cuerpo de un paciente sin riesgo de desgarramiento o arrugamiento de los respectivos materiales de refuerzo cuando la grapadora quirúrgica 10 se inserta y se manipula dentro del cuerpo de un paciente.
La grapadora quirúrgica 10 incluye además un gatillo 32 que se monta de forma móvil en el mango 12. El accionamiento del gatillo 32 opera inicialmente para mover el yunque 20 desde la posición abierta a la cerrada con relación al cartucho de grapas 22 y, posteriormente, acciona la grapadora quirúrgica 10 para aplicar líneas de grapas al tejido. Para orientar correctamente el conjunto de mordaza 16 con respecto al tejido a grapar, la grapadora quirúrgica 10 se proporciona adicionalmente con una perilla de rotación 34 que se monta en el mango 12. La rotación de la perilla de rotación 34 con respecto al mango 12 gira el miembro tubular alargado 14 y el conjunto de mordaza 16 con respecto al mango 12 para orientar correctamente el conjunto de mordaza 16 con respecto al tejido a grapar.
Con referencia a las Figuras 1 y 2, se proporciona un impulsor 36 para mover el yunque 20 entre las posiciones abierta y cerrada con respecto al cartucho de grapas 22. El impulsor 36 se mueve entre una ranura longitudinal 38 que se forma en el yunque 20. Una hoja de cuchilla (no mostrada) se asocia con el impulsor 32 para cortar el tejido capturado entre el yunque 20 y el cartucho de grapas 22 cuando el impulsor 36 pasa a través de la ranura 38.
Con referencia a la Figura 3, para mover el yunque 20 entre las posiciones abierta y cerrada, el yunque 20 incluye un borde 40 proximal, en ángulo o inclinado que se configura para ser acoplado por el impulsor 36 con el fin de mover el yunque 20 a la posición cerrada. La ranura 38 se extiende distalmente desde el borde inclinado 40 y termina en una ranura transversal 42 que se configura para capturar el impulsor 36 tras el accionamiento completo de la grapadora quirúrgica 10 para evitar cualquier accionamiento adicional de la grapadora quirúrgica 10. Para asegurar las grapas proporcionadas por el cartucho de grapas 22 alrededor de los tejidos y los materiales de refuerzo, el yunque 20 se
proporciona con filas de cavidades de remachado de grapas 44 que se extienden longitudinalmente, ubicadas a cada lado de la ranura longitudinal 38.
Con referencia todavía a la Figura 3, se describirá ahora el sistema de retención del refuerzo del yunque 28, incorporado en el yunque 20 y el material de refuerzo del yunque 24. El material de refuerzo del yunque 24, así como el material de refuerzo del cartucho 26 (es decir, el material de refuerzo para el cartucho de grapas 22 y/o el yunque 20) pueden hacerse de cualquier material natural o sintético biocompatible. El material a partir del cual se forma el material de refuerzo puede ser bioabsorbible o no bioabsorbible. Debe entenderse por supuesto que cualquier combinación de materiales naturales, sintéticos, bioabsorbibles y no bioabsorbibles puede usarse para formar el material de refuerzo.
Algunos ejemplos no limitantes de materiales a partir de los cuales se puede hacer el material de refuerzo incluyen, entre otros, poli (ácido láctico), poli (ácido glicólico), poli (hidroxibutirato), poli (fosfazina), poliésteres, polietilenglicoles, óxidos de polietileno, poliacrilamidas, polihidroxiethilmetilacrilato, polivinilpirrolidona, alcoholes de polivinilo, ácido poliacrílico, poliacetato, policaprolactona, polipropileno, poliésteres alifáticos, gliceroles, poli (aminoácidos), copoli (éter-ésteres), oxalatos de polialquileno, poliamidas, poli (iminocarbonatos), oxalatos de polialquileno, polioxaésteres, poliortoésteres, polifosfacenos y copolímeros, copolímeros de bloque, homopolímeros, mezclas y sus combinaciones.
En las realizaciones, se usan polímeros biológicos naturales para formar el material de refuerzo. Los polímeros biológicos naturales adecuados incluyen, entre otros, colágeno, gelatina, fibrina, fibrinógeno, elastina, queratina, albúmina, hidroxietilcelulosa, celulosa, hidroxipropilcelulosa, carboxietilcelulosa, quitan, quitosano y sus combinaciones. Además, los polímeros biológicos naturales pueden combinarse con cualquiera de los otros materiales poliméricos descritos en la presente descripción para producir el material de refuerzo.
El material de refuerzo puede ser poroso o no poroso, o una combinación de capas porosas y no porosas. Cuando el material de refuerzo es no poroso, el material de refuerzo puede retardar o evitar el crecimiento hacia adentro de tejidos circundantes, actuando por consiguiente como una barrera de adhesión y evitando la formación de tejido cicatricial no deseado. Por lo tanto, en las realizaciones, el material de refuerzo posee propiedades antiadhesivas. Las técnicas para formar capas no porosas a partir de dichos materiales están dentro del alcance de los expertos en la técnica e incluyen, por ejemplo, fundición, moldeo y similares.
En las realizaciones, el material de refuerzo es poroso y posee propiedades hemostáticas. Cuando el material de refuerzo es poroso, tiene aberturas o poros sobre al menos una porción de una superficie del mismo. Los materiales adecuados para formar la capa porosa incluyen, entre otros, espumas (por ejemplo, espumas de celdas abiertas o cerradas). En las realizaciones, los poros pueden tener un número y un tamaño suficientes para interconectarse a través del grosor completo de la capa porosa. En otras realizaciones, los poros no se interconectan a través del grosor completo de la capa porosa. En aún otras realizaciones, los poros no se extienden a través del grosor completo de la capa porosa, sino que están presentes en una porción de la superficie de la misma. En las realizaciones, las aberturas o poros se ubican en una porción de la superficie de la capa porosa, con otras porciones de la capa porosa que tienen una textura no porosa. Los expertos en la técnica que lean la presente divulgación imaginarán otros patrones y configuraciones de distribución de poros para la capa porosa.
Cuando el material de refuerzo es poroso, los poros se pueden formar usando cualquier método adecuado para formar una espuma o esponja que incluye, entre otros, la liofilización o congelación-secado de una composición. Las técnicas adecuadas para fabricar espumas están dentro del alcance de los expertos en la técnica. Los materiales de refuerzo porosos pueden tener al menos 0,2 cm de grosor, en las realizaciones de aproximadamente 0,3 a aproximadamente 1,5 cm de grosor. Los materiales de refuerzo porosos pueden tener una densidad de no más de aproximadamente 75 mg/cm2 y, en las realizaciones por debajo de aproximadamente 20 mg/cm2. El tamaño de los poros en los materiales de refuerzo poroso puede ser de aproximadamente 20 |_im a aproximadamente 300 |_im, en las realizaciones de aproximadamente 100 |_im a aproximadamente 200 |_im.
El material de refuerzo también puede incluir un miembro de reforzamiento. El miembro de reforzamiento puede asociarse con una capa porosa o no porosa o puede colocarse entre una capa no porosa y una capa porosa del material de refuerzo. Alternativamente, el miembro de reforzamiento puede colocarse completamente dentro de una o más de las capas individuales (es decir, incrustado dentro de la capa porosa, la capa no porosa, o ambas) del material de refuerzo. También se visualiza que el miembro de reforzamiento pueda colocarse en la superficie de una de las capas que forman el material de refuerzo y, en las realizaciones, se pueda colocar en una superficie exterior del material de refuerzo.
Algunos ejemplos no limitantes adecuados de miembros de reforzamiento incluyen telas, mallas, monofilamentos, trenzas multifilamento, fibras cortadas (a veces referidas en la técnica como fibra corta) y sus combinaciones. Cuando el miembro de reforzamiento es una malla, se puede preparar usando cualquier técnica conocida por los expertos en la técnica, tal como tejido de punto, tejedura, encaje, nudo o similares. Cuando se usan monofilamentos o trenzas multifilamento como el miembro de reforzamiento, los monofilamentos o trenzas multifilamento pueden orientarse de cualquier manera deseada. Por ejemplo, los monofilamentos o trenzas multifilamento pueden colocarse aleatoriamente entre sí dentro del material de refuerzo. Como otro ejemplo, los monofilamentos o trenzas
multifilamentos pueden orientarse en una dirección común dentro del material de refuerzo. Cuando se usan fibras cortadas como el miembro de reforzamiento, las fibras cortadas pueden orientarse de cualquier manera deseada. Por ejemplo, las fibras cortadas pueden orientarse aleatoriamente o pueden orientarse en una dirección común. Las fibras cortadas pueden así formar un material no tejido, tal como una esterilla o un fieltro. Las fibras cortadas pueden unirse (por ejemplo, mediante fusión por calor) o pueden estar sueltas entre sí. Las fibras cortadas pueden ser de cualquier longitud adecuada. Por ejemplo, el corte puede tener una longitud de 0,1 mm a 100 mm, en las realizaciones, de 0,4 mm a 50 mm de longitud. En una realización ilustrativa, el material de refuerzo tiene fibras cortadas orientadas aleatoriamente que no se han fusionado previamente, incrustadas en el material de refuerzo.
Se visualiza que el miembro de reforzamiento pueda formarse a partir de cualquier material bioabsorbible, no bioabsorbible, natural o sintético descrito anteriormente en la presente descripción y combinaciones de los mismos. Cuando se usan monofilamentos o trenzas multifilamento como el miembro de reforzamiento, cualquier material de sutura disponible comercialmente puede emplearse ventajosamente como el miembro de reforzamiento.
En las realizaciones, al menos un agente bioactivo puede combinarse con el material de refuerzo y/o cualquiera de los componentes individuales (la capa porosa, la capa no porosa y/o el miembro de reforzamiento) que se usan para construir el material de refuerzo. En estas realizaciones, el material de refuerzo también puede servir como vehículo para la administración del agente bioactivo. El término "agente bioactivo", como se usa en la presente descripción, se usa en su sentido más amplio e incluye cualquier sustancia o mezcla de sustancias que tienen un uso clínico. En consecuencia, los agentes bioactivos pueden o no tener actividad farmacológica de por sí, por ejemplo, un tinte o fragancia. De forma alternativa, un agente bioactivo podría ser cualquier agente que proporcione un efecto terapéutico o profiláctico, un compuesto que afecta o participa en el crecimiento de tejidos, el crecimiento celular, la diferenciación celular, un compuesto antiadhesivo, un compuesto que pueda invocar una acción biológica tal como una respuesta inmune, o podría desempeñar cualquier otro papel en uno o más procesos biológicos.
Los ejemplos de clases de agentes bioactivos que se pueden utilizar de acuerdo con la presente divulgación incluyen antiadhesivos, antimicrobianos, analgésicos, antipiréticos, anestésicos, antiepilépticos, antihistamínicos, antiinflamatorios, fármacos cardiovasculares, agentes de diagnóstico, simpatomiméticos, colinomiméticos, antimuscarínicos, antiespasmódicos, hormonas, factores de crecimiento, relajantes musculares, bloqueadores de las neuronas adrenérgicas, antineoplásicos, agentes inmunogénicos, inmunosupresores, fármacos gastrointestinales, diuréticos, esteroides, lípidos, lipopolisacáridos, polisacáridos y enzimas. También se pretende que puedan usarse combinaciones de agentes bioactivos.
Pueden usarse agentes antiadhesivos o antiadhesión para, evitar que se formen adherencias entre el material de refuerzo y los tejidos circundantes opuestos al tejido tratado. Algunos ejemplos de estos agentes incluyen, entre otros, poli (vinilpirrolidona), carboximetilcelulosa, ácido hialurónico, óxido de polietileno, alcoholes polivinílicos y sus combinaciones.
Los agentes antimicrobianos adecuados que pueden incluirse como agente bioactivo en el material de refuerzo de la presente divulgación incluyen triclosán, también conocido como 2,4,4'-tricloro-2'-hidroxidifenil éter, clorhexidina y sus sales, incluyendo acetato de clorhexidina, gluconato de clorhexidina, clorhidrato de clorhexidina y sulfato de clorhexidina, plata y sus sales, incluidos acetato de plata, benzoato de plata, carbonato de plata, citrato de plata, yodato de plata, yoduro de plata, lactato de plata, laurato de plata, nitrato de plata, óxido de plata, palmitato de plata, proteína de plata y sulfadiazina de plata, polimixina, tetraciclina, aminoglucósidos, tales como tobramicina y gentamicina, rifampicina, bacitracina, neomicina, cloranfenicol, miconazol, quinolonas, como ácido oxolínico, norfloxacina, ácido nalidíxico, pefloxacina, enoxacina y ciprofloxacina, penicilinas tales como oxacilina y pipracil, nonoxinol 9, ácido fusídico, cefalosporinas y sus combinaciones. Además, las proteínas y péptidos antimicrobianos tales como la lactoferrina bovina y la lactoferricina B pueden incluirse como agente bioactivo en el recubrimiento bioactivo de la presente divulgación.
Otros agentes bioactivos que pueden incluirse como agente bioactivo en el material de refuerzo de acuerdo con la presente divulgación incluyen: anestésicos locales; agentes antifertilidad no esteroideos; agentes parasimpaticomiméticos; agentes psicoterapéuticos; tranquilizantes; descongestionantes; hipnóticos sedantes; esteroides; sulfonamidas; agentes simpaticomiméticos; vacunas; vitaminas; antipalúdicos; agentes antimigraña; agentes antiparkinsonianos tales como L-dopa; antiespasmódicos; agentes anticolinérgicos (por ejemplo, oxibutinina); antitusivos; broncodilatadores; agentes cardiovasculares tales como vasodilatadores coronarios y nitroglicerina; alcaloides; analgésicos narcóticos tales como codeína, dihidrocodeinona, meperidina, morfina y similares; no narcóticos tales como salicilatos, aspirina, acetaminofeno, d-propoxifeno y similares; antagonistas de los receptores de opioides, tales como la naltrexona y la naloxona; agentes anticancerígenos; anticonvulsivos; antieméticos; antihistamínicos; agentes antiinflamatorios tales como agentes hormonales, hidrocortisona, prednisolona, prednisona, agentes no hormonales, alopurinol, indometacina, fenilbutazona y similares; prostaglandinas y fármacos citotóxicos; estrógenos antibacterianos; antibióticos; antifúngicos; antivirales; anticoagulantes; anticonvulsivos; antidepresivos; antihistamínicos y agentes inmunológicos.
Otros ejemplos de agentes bioactivos adecuados que pueden incluirse en la composición de recubrimiento incluyen virus y células; péptidos, polipéptidos y proteínas, análogos, muteínas y fragmentos activos de las mismas, tales como
inmunoglobulinas, anticuerpos, citocinas (por ejemplo, linfocinas, monocinas, quimiocinas), factores de coagulación de la sangre, factores hemopoyéticos, interleucinas (IL-2, IL-3, IL-4, IL-6), interferones (P-IFN, (a-IFN y y-IFN), eritropoyetina, nucleasas, factor de necrosis tumoral, factores estimulantes de colonias (por ejemplo, GCSF, Gm -CSF, MCSF), insulina, agentes antitumorales y supresores de tumores, proteínas de la sangre, gonadotropinas (por ejemplo, FSH, LH, CG, etc.), hormonas y análogos hormonales (por ejemplo, hormona de crecimiento), vacunas (por ejemplo, antígenos tumorales, bacterianos y virales); somatostatina; antígenos; factores de coagulación de la sangre; factores de crecimiento (por ejemplo, factor de crecimiento nervioso, factor de crecimiento insulínico); inhibidores de proteínas, antagonistas de proteínas y agonistas de proteínas; ácidos nucleicos tales como moléculas antisentido, ADN y ARN; oligonucleótidos; polinucleótidos y ribozimas.
Se proporciona un sistema de retención del refuerzo del yunque 28 para asegurar de forma liberable el material de refuerzo del yunque 24 al yunque 20 antes de grapar al tejido. El sistema de retención del refuerzo del yunque 28 incluye una región que se eleva distalmente 46 formada en una superficie inferior 48 del yunque 20. Como se muestra mejor en las Figuras 3 y 5, la región que se eleva distalmente 46 incluye un par de dedos o proyecciones 50 y 52 que se extienden proximalmente que se configuran para asegurar de forma liberable un extremo distal del material de refuerzo del yunque 24 en el yunque 20. Como se usa en la presente descripción, el término "proyecciones" se refiere a aquellas estructuras que se proporcionan en las mordazas del instrumento que se asemejan a dedos y se configuran para acoplarse con el material de refuerzo colocado entre los dedos en forma de ajuste por fricción. Las proyecciones 50 y 52 incluyen cuellos respectivos 54, 56 y porciones bulbosas 58, 60 que se extienden proximalmente desde los cuellos 54 y 56. Se proporcionan cortes 62 y 64 en un extremo distal 66 del yunque 20 para acoplarlo con las proyecciones 50 y 52 del yunque 20. Los cortes 62 y 64 se configuran con los cuellos respectivos 68, 70 y las porciones bulbosas 72 y 74 que corresponden a los cuellos 54, 56 y las porciones bulbosas 58, 60 del yunque 20. Las proyecciones 50 y 52 junto con los cortes 62 y 64 forman pares de dedos entrelazados para sujetar el material de refuerzo del yunque 24 en el yunque 20.
El sistema de retención del refuerzo del yunque 28 incluye además un poste 76 que se forma en un extremo proximal 78 del yunque 20. El material de refuerzo del yunque 24 se proporciona con un orificio 80 en un extremo proximal 82 que se configura para acoplarse al poste 76 y mantener el material de refuerzo del yunque 24 tenso a través de la superficie inferior 48 del yunque 20.
Como se muestra mejor en las Figuras 3-6, el poste 76 se divide en las mitades de poste 76a y 76b que definen un canal 84 entre ellas. El canal 84 corresponde a la ranura 38 en el yunque 20 y permite el movimiento del impulsor 36, así como de la cuchilla asociada con el impulsor 36, a través de la ranura 38 para cerrar el yunque 20 y cortar el material de refuerzo del yunque 24 por la mitad después del grapado.
Volviendo por el momento a las Figuras 3 y 4, para fijar el material de refuerzo del yunque 24 al yunque 20 usando el sistema de retención del refuerzo del yunque 28, los cortes 62 y 64 en el extremo distal 66 del material de refuerzo del yunque 24 se colocan sobre o alineados con las proyecciones 50 y 52 en la región que se eleva distalmente 46 del yunque 20. A continuación, el material de refuerzo del yunque 24 se tensa proximalmente y el orificio 80 se coloca sobre el poste 76 en el extremo proximal 78 del yunque 20 para asegurar el material de refuerzo del yunque 24 contra la superficie inferior 48 del yunque 20.
Con referencia a las Figuras 7 y 8, se divulga una realización alternativa de un sistema de retención 86 para asegurar el extremo proximal 82 del material de refuerzo del yunque 24 al yunque 20 de manera que permita el paso del impulsor 36 a través de la ranura 38 en el yunque 20. El sistema de retención 86 incluye un poste o protrusión 88 en forma de hongo que tiene una tapa agrandada 90 que se coloca a través del orificio 80 en el material de refuerzo del yunque 24. La tapa 90 define una superficie inferior o brida 92 que se configura para acoplarse con el material de refuerzo del yunque 24. De manera similar al poste 76 descrito anteriormente, la protrusión 88 se divide en mitades de protrusión 88a y 88b que definen una ranura 94 entre ellas para el paso del impulsor 36 y una hoja de cuchilla asociada. La tapa 90 ayuda a impedir la liberación prematura del extremo proximal 82 del material de refuerzo del yunque 24. Aunque no se muestra específicamente, el área alrededor del orificio 80 puede incluir un área perforada para facilitar la separación del material de refuerzo del yunque 24 de la protrusión 88.
Con referencia a las Figuras 9 y 10, se ilustra otra realización alternativa de un sistema de retención 94 para retener el extremo proximal 82 del material de refuerzo del yunque 24 en el yunque 20. El yunque 20 se proporciona con un par de postes 96 y 98 separados horizontalmente colocados a cada lado de la ranura 38. El extremo proximal 82 del material de refuerzo del yunque 24 se proporciona con un par de orificios correspondientes 100 y 102 que se configuran para acoplarse con los postes 96 y 98, respectivamente. Los postes 96 y 98 ubican el área que asegura el material de refuerzo del yunque 24 hacia fuera de la ranura 38 en el yunque 20. Esto ayuda a mantener tensos los bordes exteriores 104 y 106 del material de refuerzo del yunque 24 durante el uso de la grapadora quirúrgica 10.
Con referencia ahora a las Figuras 11 y 12, se describirá ahora el sistema de retención del refuerzo del cartucho 30. Como se indicó anteriormente, el sistema de retención del refuerzo del cartucho 30 se proporciona para retener el material de refuerzo del cartucho 26 en el cartucho de grapas 22 antes de grapar el tejido. El cartucho de grapas 22 incluye generalmente un canal exterior en forma de U 108 que rodea un inserto que contiene grapas 110. El inserto que contiene grapas 110 se proporciona con filas de cavidades de grapas 112, cuya función se describe con más
detalle a continuación. Un canal de cuchilla 114 pasa longitudinalmente a través del inserto que contiene grapas 110 entre las filas de cavidades de grapas 12.
Con referencia por el momento a las Figuras 11 y 15, el sistema de retención del refuerzo del cartucho 30 incluye un poste 116 que se forma en un extremo distal 118 del inserto que contiene grapas 110. El poste 116 es similar al poste 76 descrito anteriormente y se divide en las mitades 116a y 116b para acomodar el paso de una hoja de cuchilla para cortar el tejido y el material de refuerzo del cartucho 26. El material de refuerzo del cartucho 26 incluye una abertura correspondiente 120 que se forma en un extremo distal 122 del material de refuerzo del cartucho y que se configura para encajar en el poste 116 sobre el inserto que contiene grapas 110.
Volviendo a las Figuras 11 y 12, y con respecto a la Figura 13, el sistema de retención del refuerzo del cartucho 30 incluye además un par de dedos o proyecciones 124 y 126 espaciados y relativamente rectos que se extienden distalmente formados en un extremo proximal 128 del inserto que contiene grapas 110. Las proyecciones 124 y 126 se colocan a ambos lados del canal de cuchilla 114 para asegurar el material de refuerzo del cartucho 26 adyacentes a los bordes exteriores 130 y 132 del material de refuerzo del cartucho 26. El material de refuerzo del cartucho 26 se proporciona con las ranuras correspondientes 134 y 136 que se forman en un extremo proximal 138 del material de refuerzo del cartucho 26. Las ranuras 134 y 136 se configuran para acoplarse a las proyecciones 124 y 126 del inserto que contiene grapas 110 en forma de ajuste por fricción para retener el extremo proximal 138 del material de refuerzo del cartucho 26 en el extremo proximal 128 del inserto que contiene grapas 110.
Para ensamblar el sistema de retención del refuerzo del cartucho 30, la abertura 120 en el material de refuerzo del cartucho 26 se coloca sobre la protrusion 116 en el extremo distal 118 del inserto que contiene grapas 110. A continuación, el extremo proximal 138 del material de refuerzo del cartucho 26 se coloca sobre el extremo proximal 128 del inserto que contiene grapas 110. Las ranuras 134 y 136 en el material de refuerzo del cartucho 26 se fuerzan sobre las proyecciones 124 y 126 en el inserto que contiene grapas 110 para acoplar el material de refuerzo del cartucho 26 con el inserto que contiene grapas 110 en forma de ajuste por fricción.
Con referencia por el momento a la Figura 14, en una realización alternativa, el extremo proximal 128 del inserto que contiene grapas 110 se proporciona con múltiples conjuntos de dedos o proyecciones 140, 142 y 144, 146 que se colocan a cada lado del canal de cuchilla 114. Las proyecciones 140, 142 y 144, 146 se acoplan a los conjuntos correspondientes de ranuras 148, 150 y 152, 154, respectivamente, para asegurar el extremo proximal 138 del material de refuerzo del cartucho 26 al extremo proximal 128 del inserto que contiene grapas 110. Al proporcionar múltiples conjuntos de dedos en la mordaza y las ranuras correspondientes en el material de refuerzo, se aumenta el área de superficie disponible para el contacto por fricción, proporcionando una conexión más segura. Aunque no se muestra específicamente, se pueden proporcionar más de dos conjuntos de dedos y ranuras en dependencia de la naturaleza del material de refuerzo y la cantidad de contacto por fricción requerido.
Con referencia ahora a las Figuras 16-21, e inicialmente con respecto a las Figuras 16 y 17, se describirán ahora métodos alternativos para asegurar de forma liberable el material de refuerzo a una mordaza de un instrumento quirúrgico. Una protrusion dividida 156, similar a la protrusion 88 descrita anteriormente, se forma en un extremo distal 118 del inserto que contiene grapas 110 e incluye las mitades de tapa 158a y 158b que definen las bridas 160a y 160b. La abertura 120, en el extremo distal 122 del material de refuerzo del cartucho 26, se ajusta sobre la protrusion dividida 156 para asegurar el extremo distal 122 del material de refuerzo del cartucho 26 al extremo distal 118 del inserto que contiene grapas 110.
Con referencia a las Figuras 18 y 19, los extremos distales 118 y 122 del inserto que contiene grapas 110 y el material de refuerzo del cartucho 26 se pueden proporcionar con postes separados 162, 164 y orificios separados 166, 168, respectivamente. Los postes 162, 164 y los orificios 166, 168 funcionan sustancialmente de manera idéntica a los postes 96, 98 y los orificios 100, 102, descritos anteriormente, para asegurar el extremo distal 122 del material de refuerzo del cartucho 26 al extremo distal 118 del inserto que contiene grapas 110.
Con respecto a las Figuras 20 y 21, un poste sólido no dividido 170, se proporciona en el extremo distal 118 del inserto que contiene grapas 110. El poste 170 se ubica de forma distal de un extremo distal 172 del canal de cuchilla 114. Se proporciona un orificio 174 en el extremo distal 120 del material de refuerzo del cartucho 26 y se forma una hendidura longitudinal 176 a través del área que define el orificio 174. En uso, una cuchilla que se asocia con la grapadora quirúrgica 10 corta completamente el material de refuerzo del cartucho 26 a lo largo del canal de cuchilla 114. Una vez que el material de refuerzo del cartucho 26 se ha grapado al tejido y se ha cortado casi por completo por la mitad, la hendidura longitudinal 176 permite que el material de refuerzo del cartucho 26 se separe por la mitad sin que se desgarre o enganche.
Con referencia ahora a las Figuras 22 a 26, e inicialmente con respecto a las Figuras 22 y 23, se describirá ahora el uso de la grapadora quirúrgica 10 para grapar y dividir una sección T de tejido tubular. Inicialmente, el conjunto de mordaza 16, que incluye el yunque 20 y el cartucho que contiene grapas 22, se colocan alrededor del tejido T que se va a grapar. El impulsor 36 está en una posición proximal con respecto a la ranura 38 del yunque. Como se muestra mejor en la Figura 23, el inserto que contiene grapas 110 incluye grapas 178 colocadas dentro de las cavidades de grapas individuales 180 de la fila de cavidades de grapas 112. Las grapas 178 son de tipo convencional e incluyen un
tramo posterior 182 que tiene un par de patas 184 y 186 que se extienden desde el tramo posterior 182. Las patas 184 y 186 terminan en las puntas penetrantes de tejido 188 y 190. Los empujadores 192 se ubican dentro de las cavidades de grapas 180 y se posicionan entre las grapas 178 y la trayectoria de una barra de empuje 194.
Con referencia ahora a la Figura 24, la grapadora quirúrgica 10 se acciona inicialmente mediante el movimiento del gatillo 32 respecto al mango 12 (Figura 1) haciendo que el impulsor 36 se mueva en la dirección de la flecha B y contra el borde inclinado 40 del yunque 20 dando lugar a que el yunque 20 se mueva a la posición cerrada con respecto al cartucho de grapas 22. A medida que la barra de empuje 194 avanza distalmente dentro del inserto que contiene grapas 110, la barra de empuje 194 impulsa a los empujadores 192 hacia arriba contra los tramos posteriores 182 de las grapas 178 empujando las grapas 178 a través del material de refuerzo del cartucho 26, el tejido T, el material de refuerzo del yunque 24 y hacia las cavidades de remachado de grapas 44 en el yunque 20. Las puntas penetrantes de tejido 188 y 190 se doblan dentro de las cavidades de remachado de grapas 44 en el yunque 20 para asegurar de ese modo el material de refuerzo del yunque 24 contra el tejido T mientras que el tramo posterior 182 asegura el material de refuerzo del cartucho 26 contra el tejido T.
Aunque no se muestra específicamente, tras el accionamiento completo de la grapadora quirúrgica 10, una hoja de cuchilla asociada con la grapadora quirúrgica 10 y trasladada por el impulsor 36 corta el tejido T, así como el material de refuerzo del yunque 24 y el material de refuerzo del cartucho 26 entre las filas de grapas 102 ahora remachadas. Tras el movimiento del yunque 20 a la posición abierta separada del cartucho de grapas 22, el material de refuerzo del yunque 24 se separa del yunque 20 y el material de refuerzo del cartucho 26 se separa del cartucho de grapas 22. Específicamente, el extremo distal 122 del material de refuerzo del cartucho 26 se corta completamente por la cuchilla y se libera del poste 116. El extremo proximal 138 del material de refuerzo del cartucho 26 se libera de las proyecciones longitudinales 124, 126 en el extremo proximal 128 del inserto que contiene grapas 110. Asimismo, el extremo distal 66 del material de refuerzo del yunque 24 se libera de las proyecciones 50, 52 que se extienden proximalmente y el extremo proximal 82 del material de refuerzo del yunque 24 se libera del poste 78.
El tejido T resultante, dividido y cerrado con grapas 178, se ilustra mejor en las Figuras 25 y 26. Específicamente, el material de refuerzo del cartucho 26 se asegura contra el tejido T por los tramos posteriores 182 de las grapas 178 y el material de refuerzo del yunque 24 se asegura contra el tejido T por las puntas penetrantes de tejido 188 y 190 de las grapas 178 ahora remachadas. De esta manera, el material de refuerzo del yunque 24 y el material de refuerzo del cartucho 26 se grapan al tejido T sellando y reforzando así estas líneas de grapas creadas por las grapas 178.
Con referencia ahora a las Figuras 27-29, se describirá ahora el sistema de retención del cartucho 500 para retener el material de refuerzo del cartucho 526 en un cartucho de grapas 522 antes de grapar el tejido. Como se muestra en las Figuras 27 y 28, se proporciona al menos una proyección 532 en un extremo proximal o primero del cartucho de grapas 522 y se forma una ranura 530 en un extremo distal o segundo del mismo. El cartucho de grapas 522 puede incluir al menos dos proyecciones 532 que se proporcionan a cada lado de una ranura de cuchilla 540. El material de refuerzo 526 incluye al menos una abertura 531 para la recepción de una de las proyecciones 532 respectivas y una lengüeta 535 en un extremo distal del mismo que se configura para acoplarse con la ranura 530. La lengüeta 535 puede proporcionar una presión interna o acción de resorte debido a la elasticidad del material del que está hecha la lengüeta 535. Por consiguiente, cuando la lengüeta 535 se inserta en la ranura 530, la lengüeta 535 encaja en una posición bloqueada dentro de la ranura 530.
La Figura 28 muestra el material de refuerzo 526 que se fija de forma liberable al cartucho de grapas 522. Para ensamblar el sistema de retención del refuerzo del cartucho 500, las aberturas 531 del material de refuerzo 526 se colocan sobre las proyecciones 532 del cartucho de grapas 522. Las proyecciones 532 pueden tener un tamaño ligeramente mayor que las aberturas 531, proporcionando así un ajuste por interferencia al insertar las proyecciones 532 en las aberturas 531. Las proyecciones 532 y las correspondientes aberturas 531 pueden tener cualquier geometría más adecuada para retener las proyecciones 532 dentro de las aberturas 531. Las proyecciones 532 pueden ser relativamente rectas o pueden tener una forma que incluye, entre otras, geometrías rectangulares, circulares y en forma de cruz. Tras colocar las aberturas 531 sobre las proyecciones 532, la lengüeta 535 del material de refuerzo 526 se coloca sobre la ranura 530. Una vez colocada de esta manera, la lengüeta 535 es forzada a entrar en la ranura 530, como se muestra mejor en la figura 29, asegurando así el material de refuerzo 526 al cartucho de grapas 522. Un indicador audible, por ejemplo, un sonido de clic, puede confirmar la colocación del material de refuerzo 526 en el cartucho de grapas 522.
En una realización adicional, que se muestra en las Figuras 30A y 30B, se proporciona un sistema de retención de refuerzo 600 que incluye un material de refuerzo 626 y un cartucho de grapas 622. El material de refuerzo 626 incluye las aberturas 631 que se adaptan para recibir una o más proyecciones 636 que se proporcionan en el cartucho de grapas 622. Cada proyección 636 incluye una cabeza bulbosa 632 soportada en una porción de cuello 633. El cartucho de grapas 622 puede incluir al menos dos proyecciones 636, en el que, las al menos dos proyecciones 636 se separan por una ranura de cuchilla 640 que se extiende longitudinalmente. Una hendidura 634 puede extenderse radialmente o hacia fuera de la abertura 631 para evitar desgarramiento o enganche al insertar la proyección 636 en la abertura 631. Una lengüeta 635 en un extremo del material de refuerzo 626 se puede enganchar en una ranura 630 en un extremo del cartucho de grapas 622.
Se comprenderá que pueden realizarse diversas modificaciones a las realizaciones divulgadas en la presente descripción. Por ejemplo, pueden proporcionarse varios números de dedos o proyecciones entrelazados para aumentar el contacto por fricción entre una mordaza y un material de refuerzo asociado. Además, los materiales de refuerzo divulgados pueden proporcionarse con varias regiones perforadas para facilitar su liberación de los dedos o proyecciones y postes descritos. Por lo tanto, la descripción anterior no debe ser interpretada como limitante, sino meramente como ejemplificaciones de realizaciones particulares. Los expertos en la técnica visualizarán otras modificaciones dentro del alcance de las reivindicaciones adjuntas a la misma.
Claims (13)
1. Un efector final de una grapadora quirúrgica, que comprende:
un par de mordazas que incluyen un cartucho de grapas (522) y un yunque, el cartucho de grapas que tiene una superficie superior orientada hacia el tejido e incluye al menos una proyección (532, 636) que se extiende longitudinalmente en un extremo proximal del mismo y una ranura (530, 630) colocada en un extremo distal del mismo; y
un material de refuerzo (526, 626) que se fija de manera liberable al cartucho de grapas (522, 622) sobre la superficie superior orientada hacia el tejido del cartucho de grapas, el material de refuerzo que se hace de un material elástico e incluye al menos una abertura (531, 631) en un extremo proximal para recibir la al menos una proyección y una lengüeta (535, 635) en un extremo distal, caracterizado porque la lengüeta se dobla hacia abajo alejándose de la superficie superior orientada hacia el tejido y se extiende dentro de la ranura para acoplarse a la ranura.
2. El efector final de la reivindicación 1, en el que, la al menos una proyección (532) es relativamente recta con respecto al cartucho de grapas (522).
3. El efector final de cualquier reivindicación anterior, en el que, la al menos una proyección (532) tiene una sección transversal rectangular.
4. El efector final de la reivindicación 1, en el que, la al menos una proyección tiene una sección transversal en forma de cruz.
5. El efector final de la reivindicación 1, en el que, la al menos una proyección tiene forma de hongo.
6. El efector final de la reivindicación 1, en el que, la al menos una proyección (636) incluye una porción de cuello (633) y una cabeza bulbosa (632) adyacente a la porción de cuello, la al menos una proyección que se adapta para asegurar el material de refuerzo (626) entre la cabeza bulbosa y el cartucho de grapas (622).
7. El efector final de cualquier reivindicación anterior, en el que, el cartucho de grapas (522, 622) incluye una ranura de cuchilla (540, 640) que se extiende longitudinalmente.
8. El efector final de la reivindicación 1, en el que, la al menos una proyección (532) se acopla con la al menos una abertura (531) en un ajuste por interferencia.
9. El efector final de la reivindicación 6, en el que, el material de refuerzo (626) incluye una hendidura longitudinal (634) que se extiende a través de la al menos una abertura (631).
10. El efector final de la reivindicación 7, en el que, la al menos una proyección (532, 636) y la al menos una abertura (531,631) se colocan para permitir el paso de una cuchilla dentro de dicho cartucho de grapas.
11. El efector final de cualquier reivindicación anterior, en el que, el cartucho de grapas (522, 622) incluye un par de dichas proyecciones (532, 636).
12. El efector final de la reivindicación 11, en el que, el material de refuerzo (526, 626) incluye un par de dichas aberturas (531,631) para la recepción del par de dichas proyecciones.
13. El efector final de cualquier reivindicación anterior, en el que, la colocación del material de refuerzo en el cartucho de grapas (522, 622) da como resultado una confirmación audible de la colocación adecuada en el mismo.
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US12/418,763 US7950561B2 (en) | 2007-06-18 | 2009-04-06 | Structure for attachment of buttress material to anvils and cartridges of surgical staplers |
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2009
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2010
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EP2238918A1 (en) | 2010-10-13 |
US20110215133A1 (en) | 2011-09-08 |
CA2697819C (en) | 2017-05-02 |
CA2697819A1 (en) | 2010-10-06 |
AU2010201031B2 (en) | 2014-05-08 |
AU2010201031A1 (en) | 2010-10-21 |
US20090218384A1 (en) | 2009-09-03 |
EP2238918B1 (en) | 2020-07-29 |
JP2010240429A (ja) | 2010-10-28 |
US7950561B2 (en) | 2011-05-31 |
JP5581101B2 (ja) | 2014-08-27 |
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