ES2828716T3 - Aparato de grapado quirúrgico con bolsas de tejido - Google Patents
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- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
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- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
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Abstract
Un aparato de grapado quirúrgico (10) que comprende: un primer miembro de mordaza que tiene una primera superficie de contacto con el tejido (332a), definiendo la primera superficie de contacto con el tejido una pluralidad de filas de ranuras de retención de grapas que se extienden longitudinalmente (332b); una pluralidad de grapas (334), cada una de las grapas de la pluralidad de grapas recibidas en una respectiva de la pluralidad de ranuras de retención de grapas de la primera superficie de contacto con el tejido; un segundo miembro de mordaza que tiene una segunda superficie de contacto con el tejido (314a), definiendo la segunda superficie de contacto con el tejido una pluralidad de filas de bolsas de grapas que se extienden longitudinalmente (314b) alineadas con la pluralidad de ranuras de retención de grapas de la primera superficie de contacto con el tejido, cada bolsa de grapas de la segunda superficie de contacto con el tejido configurada para formar una respectiva de las grapas de la pluralidad de grapas cuando se dispara el aparato de grapado quirúrgico; y caracterizado porque el aparato de grapado quirúrgico comprende además una pluralidad de bolsas de tejido internas (314d) definidas en la segunda superficie de contacto con el tejido y colocadas a lo largo del segundo miembro de mordaza entre la pluralidad de bolsas de grapas; las bolsas de tejido internas configuradas para capturar tejido en su interior para evitar que el tejido migre lejos de la primera y segunda superficies de contacto con el tejido cuando se dispara el aparato de grapado quirúrgico, siendo cada una de las bolsas de tejido internas más pequeña que cada una de las bolsas de grapas.
Description
DESCRIPCIÓN
Aparato de grapado quirúrgico con bolsas de tejido
Campo técnico
La presente divulgación se refiere a un aparato de grapado quirúrgico para realizar procedimientos quirúrgicos endoscópicos y métodos de uso del mismo.
Antecedentes
Los aparatos de grapado quirúrgico que sujetan, cortan y/o grapan tejido entre estructuras de mordazas opuestas son bien conocidos en la técnica. Tal aparato de grapado quirúrgico puede incluir unidades de carga con un conjunto de herramienta que tiene dos miembros de mordaza alargados utilizados para capturar o sujetar tejido. Uno de los dos miembros de mordaza generalmente lleva un cartucho de grapas que aloja una pluralidad de grapas, mientras que el otro de los dos miembros de mordaza tiene un yunque para formar las grapas a medida que las grapas son conducidas desde el cartucho de grapas a un área de grapado definida entre los dos miembros de mordaza. Generalmente, una operación de grapado se efectúa mediante un miembro de accionamiento (por ejemplo, una barra de leva, una corredera de accionamiento u otro mecanismo similar) que tiene un miembro de leva que se desplaza longitudinalmente a través de los canales definidos en el cartucho de grapas y actúa sobre los empujadores de grapas en los canales para secuencialmente expulsar las grapas del cartucho de grapas. Puede ser necesario grapado adicional cuando el tejido capturado entre los dos miembros de la mordaza migra desde el área de grapado en respuesta a las fuerzas de compresión que actúan sobre los tejidos resultantes del desplazamiento longitudinal del miembro de accionamiento a lo largo de los dos miembros de la mordaza cuando se dispara el aparato de grapado.
Sería ventajoso proporcionar un aparato de grapado quirúrgico que reduzca la migración de tejido desde el área de grapado para mejorar el grapado quirúrgico.
Resumen
Según un aspecto de la presente divulgación, se proporciona un aparato de grapado quirúrgico, en donde la invención se especifica en la reivindicación 1 adjunta.
En algunas modalidades, la bolsa de tejido puede colocarse entre dos ranuras de retención de grapas adyacentes de las ranuras de retención de grapas.
En determinadas modalidades, la bolsa de tejido puede colocarse entre dos bolsas de grapas adyacentes de las bolsas de grapas.
En algunas modalidades, el aparato de grapado quirúrgico puede incluir además una segunda bolsa de tejido definida en la primera superficie de contacto con el tejido.
En ciertas modalidades, la bolsa de tejido puede incluir bolsas de tejido definidas en la primera superficie de contacto con el tejido y colocadas a lo largo del primer miembro de mordaza entre las ranuras de retención de grapas.
En determinadas modalidades, la bolsa de tejido puede incluir bolsas de tejido que incluyen un primer conjunto de bolsas de tejido y un segundo conjunto de bolsas de tejido. El primer conjunto de bolsas de tejido puede definirse en la primera superficie de contacto con el tejido y colocarse a lo largo del primer miembro de mordaza entre las ranuras de retención de grapas. El segundo conjunto de bolsas de tejido puede definirse en la segunda superficie de contacto con el tejido y colocarse a lo largo del segundo miembro de mordaza entre las bolsas de grapas.
En algunas modalidades, el primer miembro de mordaza puede extenderse hasta un primer borde periférico y el segundo miembro de mordaza puede extenderse hasta un segundo borde periférico. La bolsa de tejido puede estar definida en uno de los primeros o segundos bordes periféricos. La bolsa de tejido puede incluir bolsas de tejido definidas en uno o en ambos del primer y segundo borde periférico. Las bolsas de tejido pueden incluir un primer conjunto de bolsas de tejido y un segundo conjunto de bolsas de tejido. El primer conjunto de bolsas de tejido puede definirse en la primera superficie de contacto con el tejido en una ubicación desplazada del primer borde periférico. El segundo conjunto de bolsas de tejido puede definirse en la segunda superficie de contacto con el tejido en una ubicación desplazada del segundo borde periférico.
En ciertas modalidades, la bolsa de tejido puede definir una curva abierta. En algunas modalidades, la bolsa de tejido puede definir una curva cerrada.
Según otro aspecto más de la presente divulgación, se proporciona un efector final para un aparato de grapado quirúrgico. El efector de extremo incluye un conjunto de cartucho, un conjunto de yunque, un conjunto de cuchilla y una bolsa de tejido. El conjunto de cartucho tiene una primera superficie de contacto con el tejido y el conjunto de
yunque tiene una segunda superficie de contacto con el tejido. El conjunto de yunque y el conjunto de cartucho se colocan para moverse entre una posición abierta y una posición cerrada para sujetar selectivamente el tejido entre la primera y la segunda superficies de contacto con el tejido. El conjunto de cuchilla incluye una cuchilla configurada para moverse con relación a los conjuntos de yunque y cartucho para cortar el tejido sujetado entre la primera y segunda superficies de contacto con el tejido de los conjuntos de yunque y cartucho, respectivamente. La bolsa de tejido está definida en la segunda superficie de contacto con el tejido y está configurada para capturar tejido en su interior para evitar que el tejido migre lejos de la segunda superficie de contacto con el tejido cuando la cuchilla se mueve con respecto a los conjuntos de yunque y cartucho.
En algunas modalidades, el efector final incluye además una segunda bolsas de tejido definida en la primera superficie de contacto con el tejido.
En determinadas modalidades, la bolsa de tejido puede incluir bolsas de tejido definidas en la primera superficie de contacto con el tejido.
En algunas modalidades, el elemento de cartucho puede extenderse hasta un primer borde periférico y el conjunto de yunque puede extenderse hasta un segundo borde periférico. La bolsa de tejido puede estar definida en uno de los primeros o segundos bordes periféricos. La bolsa de tejido puede incluir bolsas de tejido definidas en uno o en ambos del primer y segundo borde periférico. Las bolsas de tejido pueden incluir un primer conjunto de bolsas de tejido y un segundo conjunto de bolsas de tejido. El primer conjunto de bolsas de tejido puede definirse en la primera superficie de contacto con el tejido en una ubicación desplazada del primer borde periférico. El segundo conjunto de bolsas de tejido puede definirse en la segunda superficie de contacto con el tejido en una ubicación desplazada del segundo borde periférico.
De acuerdo con otro aspecto más de la presente divulgación, un efector final incluye un conjunto de cartucho, un conjunto de yunque y una o más bolsas de tejido. El conjunto de cartucho tiene una primera superficie de contacto con el tejido y el conjunto de yunque tiene una segunda superficie de contacto con el tejido. Los conjuntos de yunque y cartucho están acoplados de forma operativa entre sí y se colocan para moverse entre una posición abierta y una posición cerrada para sujetar selectivamente el tejido entre la primera y la segunda superficies de contacto con el tejido. Las bolsas de tejido están definidas en las segundas superficies de contacto con el tejido y están configuradas para capturar tejido en ellas mientras que los conjuntos de yunque y cartucho están dispuestos en la posición cerrada. Las una o más bolsas de tejido están configuradas para evitar que el tejido migre fuera de la segunda superficie de contacto con el tejido mientras el tejido se sujeta entre la primera y la segunda superficies de contacto con el tejido.
Otros aspectos, características y ventajas serán evidentes a partir de la descripción, los dibujos y las reivindicaciones que siguen.
Breve descripción de los dibujos
Los dibujos adjuntos, que se incorporan y constituyen una parte de esta divulgación, ilustran modalidades de la divulgación y, junto con una descripción general de la divulgación dada anteriormente y la descripción detallada de la(s) modalidad(es) dadas a continuación, sirven para explicar los principios de la divulgación, en donde:
La Figura 1 es una vista en perspectiva de un aparato de grapado quirúrgico de acuerdo con los principios de la presente divulgación;
La Figura 2 es una vista en perspectiva de una unidad de carga del aparato de grapado quirúrgico de la Figura 1;
La Figura 3 es una vista en perspectiva ampliada de una parte de un efector final de la unidad de carga de la Figura 2 con el efector final en posición abierta;
La Figura 3A es una vista desde abajo de una parte de un conjunto de yunque del efector de extremo de la Figura 3;
La Figura 4 es una vista en perspectiva del efector terminal de la Figura 3 mostrado en una posición cerrada con tejido sujetado entre el conjunto de yunque y un conjunto de cartucho del efector final;
La Figura 5 es una vista en sección transversal ampliada tomada a lo largo de la línea de sección 5-5 de la Figura 4; y
La Figura 6 es una ilustración esquemática de una estación de trabajo médica y una consola de operación de acuerdo con la presente divulgación.
Descripción detallada
Las modalidades de los aparatos de grapado quirúrgico divulgados en la actualidad se describen ahora en detalle con referencia a los dibujos, en los que los números de referencia designan elementos idénticos o correspondientes en
cada una de las diversas vistas. Tal como se usa en el presente documento el término "distal" se refiere a la parte del aparato, y/o componente del mismo, más alejada del usuario, mientras que el término "proximal" se refiere a la parte del aparato, y/o componente del mismo, más cercana al usuario. Tal como se usa en el presente documento, el término "clínico" se refiere a un médico, una enfermera, u otro proveedor de atención y puede incluir al personal de apoyo. Como se usa en el presente documento, el término "migración de tejido" o similar se refiere al movimiento de desplazamiento de tejido desde un área de grapado de un aparato de grapado quirúrgico en respuesta a las fuerzas de extrusión, fuerzas de compresión y/u otras fuerzas similares impartidas al tejido como resultado de operación del aparato de grapado quirúrgico. En la siguiente descripción, las funciones o construcciones que se conocen bien no se describen en detalle para evitar complicar la presente divulgación con detalles innecesarios.
Volviendo ahora a las Figuras 1 y 2, un sistema o aparato de grapado quirúrgico electromecánico, generalmente referido como 10, incluye un dispositivo quirúrgico 100 en forma de un instrumento electromecánico de mano motorizado, un conjunto adaptador 200 y una unidad de carga quirúrgica (por ejemplo, una unidad de carga de múltipleo simple-uso) o un efector final 300. El efector de extremo 300 incluye un conjunto de yunque 310 y un conjunto de cartucho 320 que pueden moverse entre una posición abierta (Figura 3) y una posición cerrada (Figura 4) para sujetar selectivamente el tejido "T" (Figura 4) para cortar y cortar y/o grapar el tejido "T". El conjunto de cartucho 320 incluye un cartucho de grapado y corte o recarga 330 que puede retirarse selectivamente del conjunto de cartucho 320. El dispositivo quirúrgico 100 está configurado para una conexión selectiva con el conjunto adaptador 200 y, a su vez, el conjunto adaptador 200 está configurado para una conexión selectiva con el efector final 300. Juntos, el dispositivo quirúrgico 100 y el conjunto adaptador 200 cooperan para accionar el efector final 300.
En algunas modalidades, el dispositivo quirúrgico 100 del sistema de grapado quirúrgico electromecánico 10 define un eje longitudinal "X" e incluye un alojamiento de mango 102 que define una cavidad "C" para la recepción extraíble selectiva de una batería 103 recargable. La batería 103 está configurada para suministrar energía a los componentes eléctricos del dispositivo quirúrgico 100. La cavidad "C" soporta un controlador o placa de circuito 105 configurada para controlar varias operaciones del dispositivo quirúrgico 100 y un mecanismo de accionamiento 106 configurado para impulsar ejes giratorios y/o componentes de engranajes (no se muestran) dentro del alojamiento del mango 102 con el fin de realizar diversas operaciones del dispositivo quirúrgico 100. Por ejemplo, el mecanismo de accionamiento 106 puede ser operable para articular y/o rotar selectivamente el efector final 300 alrededor y/o con respecto al eje longitudinal "X" del sistema de grapado quirúrgico electromecánico 10; para mover selectivamente el conjunto de yunque 310 y/o el conjunto de cartucho 320 entre sí entre las posiciones abierta y cerrada para sujetar el tejido; y/o disparar la recarga 330. La batería 103, el controlador 105 y/o el mecanismo de accionamiento 106 pueden acoplarse operativamente a uno o más disparadores 107a, 107b tales como botones de control accionados con los dedos, dispositivos basculantes y/o similares para realizar diversas funciones del sistema de grapado quirúrgico electromecánico 10 como los descritos anteriormente.
Puede hacerse referencia a la Solicitud Internacional de número PCT/US2008/077249, presentada el 22 de septiembre de 2008 (Pub. Inter. núm. WO 2009/039506), solicitud de patente de los EE.UU. 2015/0157320, presentada el 21 de noviembre de 2014, y publicación de solicitud de Patente de los EE.UU. núm. 2011/0121049, presentada el 20 de noviembre de 2009 para una descripción detallada de la construcción y operación de varios sistemas quirúrgicos electromecánicos ejemplares, cuyos componentes son combinables y/o intercambiables con uno o más componentes de los sistemas quirúrgicos electromecánicos 10 descritos en el presente documento.
Aunque el aparato de grapado quirúrgico se describe como un aparato de grapado quirúrgico accionado electromecánicamente, el aparato de grapado quirúrgico divulgado actualmente puede proporcionarse como un aparato de grapado accionado manualmente. Para una descripción más detallada de la construcción y operación de un aparato de grapado de accionamiento manual ejemplar, uno o más componentes de los cuales pueden combinarse y/o intercambiarse con el aparato de grapado de accionamiento electromecánico descrito en el presente documento, puede hacerse referencia a la patente de los EE.UU. núm. 8,777,082, presentada el 20 de diciembre de 2012. Además, el aparato de grapado quirúrgico divulgado actualmente puede proporcionarse como cualquier aparato de grapado quirúrgico adecuado tal como un aparato de grapado transversal, un aparato de grapado abierto, un aparato de grapado endoscópico, un aparato de grapado circular y/o combinaciones de uno o más componentes de uno o más de estos aparatos de grapado. Para una descripción más detallada de la construcción y operación de ejemplos de dicho aparato de grapado, puede hacerse referencia a la patente de los EE.UU. núm. 7,407,075 para una descripción general de ejemplos de cada uno de estos aparatos de grapado quirúrgico, y/o a la patente de los EE.UU. núm.
5,915,616 (aparato de grapado circular), patente de los EE.UU. núm. 6,202,914 (aparato de grapado abierto), patente de los EE.UU. núm. 5,865,361 (aparato de grapado endoscópico) y/o patente de los EE.UU. núm. 5,964,394 (aparato de grapado transversal) para descripciones más detalladas de cada uno de estos aparatos de grapado quirúrgico.
Volviendo ahora a las Figuras 3-5, el conjunto de yunque 310 del efector de extremo 300 incluye un cuerpo de yunque 312 y una placa de yunque 314 soportada sobre el cuerpo de yunque 312. La placa de yunque 314 se extiende hasta los bordes periféricos 315 e incluye una superficie de contacto con el tejido 314a (Figura 3A). La superficie de contacto con el tejido 314a de la placa de yunque 314 define bolsas formadoras de grapas 314b configuradas para recibir y formar grapas 334 expulsadas del conjunto de cartucho 320. Las bolsas de formación de grapas 314b de la superficie de contacto con el tejido 314a están colocadas en una o más filas que pueden tener la forma de conjuntos longitudinales a lo largo de la superficie de contacto con el tejido 314a. Las bolsas de formación de grapas adyacentes
314b de la superficie de contacto con el tejido 314a pueden estar dispuestas en una relación de separación longitudinal y/o lateral. En algunas modalidades, las bolsas de formación de grapas adyacentes 314b y/o las bolsas de tejido internas y/o externas 314d, 314c pueden tener la forma de conjuntos anulares que están separados radialmente (por ejemplo, un aparato de grapado circular).
La placa de yunque 314 incluye además bolsas de tejido externas 314c formadas en los bordes periféricos 315 de la superficie de contacto con el tejido 314a de la placa de yunque 314 y bolsas de tejido internas 314d formadas a lo largo de la superficie de contacto de tejido 314a en ubicaciones adyacentes a las bolsas de formación de grapas 314b y entre las bolsas de tejido externas 314c. Por ejemplo, las bolsas de tejido internas adyacentes 314d pueden colocarse en ubicaciones espaciadas longitudinal y/o lateralmente entre sí a lo largo de la superficie de contacto con el tejido 314a de la placa de yunque 314.
Cada una de las bolsas de tejido internas y externas 314c y 314d están configuradas para capturar tejido en "T" sujetado entre los conjuntos de yunque y cartucho 310, 320 mientras que los conjuntos de yunque y cartucho 310, 320 están dispuestos en la posición cerrada (Figura 4) para prevenir la migración de tejido durante un disparo del sistema quirúrgico 10. La placa de yunque 314 también define un canal 314e de cuchillas que se extiende longitudinalmente a través de la placa 314 de yunque. El canal de cuchilla 314e puede estar dispuesto centralmente entre una o más de las filas de las bolsas de formación de grapas 314b o bolsas de tejido 314c, 314d.
El conjunto de cartucho 320 del efector final 300 incluye un cuerpo de soporte 322 y una recarga 330 configurada para la unión selectiva al cuerpo de soporte 322. En algunas modalidades, el conjunto de cartucho 320 soporta además un tornillo de avance 324 (Figura 5) que está acoplado operativamente al mecanismo de accionamiento 106 (Figura 1) del dispositivo quirúrgico 100 para permitir que el mecanismo de accionamiento 106 gire el tornillo de avance 324. El tornillo de avance 324 está acoplado de manera roscada a una barra de accionamiento 326 y puede girar para hacer avanzar la barra de accionamiento 326 a lo largo de los conjuntos de yunque y cartucho 310, 320. La barra de accionamiento 326 soporta una cuchilla 328 que se extiende distalmente y está configurada para trasladarse longitudinalmente a través del efector de extremo 300 para aproximar/no aproximar los conjuntos de yunque y cartucho 310, 320 entre las posiciones abierta y cerrada (Figuras 3 y 4, respectivamente) y para cortar el tejido "T".
La recarga 330 del conjunto de cartucho 320 incluye un cuerpo de cartucho 332 que tiene una superficie de contacto con el tejido 332a. La superficie de contacto con el tejido 332a del cuerpo del cartucho 332 define filas de ranuras de retención de grapas 332b que se extienden longitudinalmente que soportan filas de grapas 334 en su interior. Las filas de ranuras de retención de grapas 332b que se extienden longitudinalmente del conjunto de cartucho 320 corresponden a, y se alinean con, las filas que se extienden longitudinalmente de las bolsas formadoras de grapas 314b (Figura 3A) del conjunto de yunque 310. El cuerpo de cartucho 332 incluye además lengüetas 332c que encajan a presión en el cuerpo de soporte 322 del conjunto de cartucho 320. La recarga 330 define además una ranura de cuchilla que se extiende longitudinalmente 332d que se extiende a través de la superficie de contacto con el tejido 332a y está configurada para recibir la cuchilla 328 de la barra de accionamiento 326 cuando la barra de accionamiento 326 avanza a través de ella. La recarga 330 soporta además una corredera de accionamiento 336 (Figura 5) que puede acoplarse con la barra de accionamiento 326 y avanzar a lo largo del cuerpo del cartucho 332 de la recarga 330 para acoplar los empujadores 338 (Figura 5) soportados dentro del cuerpo del cartucho 332. Los empujadores 338 están posicionados para soportar las grapas 334 en la recarga 330. Los empujadores 338 también están posicionados para avanzar verticalmente a través de las ranuras de retención de grapas 332b de la superficie de contacto con el tejido 332a del cuerpo del cartucho 332 para expulsar las grapas 334 para la formación de las grapas 334 contra las bolsas de formación de grapas 314b (Figura 3A) del conjunto de yunque 310 cuando la corredera de accionamiento 336 se acopla con los empujadores 338.
Similar a la superficie de contacto con el tejido 314a del conjunto de yunque 310, la superficie de contacto con el tejido 332a de la recarga 330 define las bolsas de tejido internas 332e y las bolsas de tejido externas 332f que pueden tener la misma función y construcción que las bolsas de tejido internas y externas 314c, 314d del conjunto de yunque 310. Cada una de las bolsas de tejido 314c, 314d, 332e, 332f está configurada para evitar la migración de tejido desde un área de grapado "SA" (Figura 5) definida entre la primera y la segunda superficies de contacto con el tejido 314a, 332a de la placa de yunque 314 y el cuerpo del cartucho 332 durante un disparo del sistema quirúrgico 10 (Figura 1).
Las bolsas de tejido internas y externas 314d, 314c del conjunto de yunque 310 y las bolsas de tejido internas y externas 332e, 332f de la recarga 330 pueden tener cualquier forma adecuada, como circular, no circular, poligonal, rectangular, abierta, cerrada, etc. Por ejemplo, las bolsas de tejido internas 314d del conjunto de yunque 310 y/o las bolsas de tejido internas 332e de la recarga 330 pueden incluir curvas cerradas de forma circular y las bolsas de tejido externas 314c del conjunto de yunque 310 y/o las bolsas de tejido externas 332f de la recarga pueden incluir curvas abiertas en forma de media luna. En determinadas modalidades, las bolsas de tejido externas 314c, 332f pueden definir un perfil escalonado a lo largo de la longitud del efector 300 final. En algunas modalidades, una o más de las bolsas de tejido 314c, 314d, 332e, 332f pueden incluir múltiples formas en una ubicación. Una o más de las bolsas de tejido 314c, 314d, 332e, 332f pueden incluir cualquier dimensión adecuada tal como más pequeña y/o más grande que una o más de las bolsas de formación de grapas 314b y/o las ranuras de retención de grapas 332b.
En uso, el gatillo 107b (Figura 1) del instrumento quirúrgico 100 puede accionarse para hacer que el tomillo de avance 324 del efector de extremo 300 haga avanzar la barra de accionamiento 326 del efector de extremo 300 axialmente a través del efector de extremo 300. A medida que la barra de accionamiento 326 avanza a través del efector final 300, los conjuntos de yunque y cartucho 310, 320 del efector final 300 se sujetan juntos en la posición cerrada (Figura 4) para sujetar el tejido "T" en el área de grapado "SA" definida entre los conjuntos de yunque y cartucho 310, 320. A medida que se aproximan los conjuntos de yunque y cartucho 310, 320, los conjuntos de yunque y cartucho 310, 320 sujetan el tejido "T" para comprimir el tejido sujetado "CT" (Figura 5) en las bolsas de tejido internas y externas 314c, 314d, 332e, 332f de los respectivos conjuntos 310, 320 de yunque y cartucho.
El avance distal continuado de la barra de accionamiento 326 del efector final 300 hace que la barra de accionamiento 326 se acople a la corredera de accionamiento 336 de la recarga 330 y avance a través de las ranuras longitudinales de cuchilla 332d, 314e de la recarga 330 y la placa de yunque 314, respectivamente. El avance distal de la barra de accionamiento 326 hace avanzar la corredera de accionamiento 336 en acoplamiento con los empujadores 338 de la recarga 330 para disparar las grapas 334 desde las ranuras de retención de grapas 332b de la recarga 330 para formarse contra las correspondientes bolsas de formación de grapas 314b definidas dentro de la placa de yunque 314 del conjunto de yunque 310. A medida que avanza la barra de accionamiento 326, la barra de accionamiento 326 empuja y comprime el tejido sujetado "CT" (Figura 5) cuando la cuchilla 328 de la barra de accionamiento 326 corta el tejido sujetado "CT". Con partes del tejido sujetado "CT" capturadas dentro de las bolsas de tejido 314c, 314d, 332e, 332f de los conjuntos de yunque y cartucho 310, 320, las bolsas de tejido 314c, 314d, 332e, 332f evitan que el tejido sujetado "CT" migre alejándose o extruyéndose de otra manera del área de grapado "SA" en respuesta a las fuerzas de empuje o compresión impartidas sobre el tejido sujetado "CT" a medida que la barra de accionamiento 326 empuja a través del tejido sujetado "CT".
La rotación inversa del tornillo de avance 334 hace que la barra de accionamiento 326 se retraiga de modo que los conjuntos de yunque y cartucho 310, 320 se abran o desaprovechen el efector final 300, por lo que la recarga 330 puede reemplazarse de modo que el efector final 300 pueda volver a dispararse según sea necesario o deseado.
Como puede apreciarse, la sujeción de cualquiera de los componentes de los dispositivos divulgados actualmente puede efectuarse usando técnicas de sujeción conocidas tales como soldadura, engarzado, encolado, etc.
Las diversas modalidades divulgadas en el presente documento también pueden configurarse para funcionar con sistemas quirúrgicos robóticos y lo que se denomina comúnmente "Telecirugía". Tales sistemas emplean varios elementos robóticos para ayudar al médico y permitir la operación remota (o la operación remota parcial) de la instrumentación quirúrgica. Pueden emplearse varios brazos robóticos, engranajes, levas, poleas, motores eléctricos y mecánicos, etc. para este propósito y pueden diseñarse con un sistema quirúrgico robótico para ayudar al médico durante el curso de una operación o tratamiento. Dichos sistemas robóticos pueden incluir sistemas dirigibles de forma remota, sistemas quirúrgicos flexibles automáticamente, sistemas quirúrgicos flexibles de forma remota, sistemas quirúrgicos de articulación remota, sistemas quirúrgicos inalámbricos, sistemas quirúrgicos operados remotamente modulares o configurables selectivamente, etc.
Los sistemas quirúrgicos robóticos pueden emplearse con una o más consolas que están al lado del quirófano o ubicadas en una ubicación remota. En este caso, un equipo de médicos puede preparar al paciente para la cirugía y configurar el sistema quirúrgico robótico con uno o más de los instrumentos divulgados en el presente documento mientras otro médico (o grupo de médicos) controla remotamente los instrumentos a través del sistema quirúrgico robótico. Como puede apreciarse, un médico altamente calificado puede realizar múltiples operaciones en múltiples ubicaciones sin dejar su consola remota, lo que puede ser tanto económicamente ventajoso como beneficioso para el paciente o una serie de pacientes.
Los brazos robóticos del sistema quirúrgico se acoplan típicamente a un par de empuñaduras maestras mediante un controlador. Las empuñaduras pueden ser movidas por el médico para producir un movimiento correspondiente de los extremos de trabajo de cualquier tipo de instrumento quirúrgico (por ejemplo, efectores terminales, pinzas, cuchillas, tijeras, etc.) que pueden complementar el uso de una o más de las modalidades descritas en el presente documento. El movimiento de las empuñaduras maestras puede escalarse de modo que los extremos de trabajo tengan un movimiento correspondiente que sea diferente, más pequeño o más grande, que el movimiento realizado por las manos operativas del médico. El factor de escala o la relación de engranajes pueden ajustarse para que el operador pueda controlar la resolución de los extremos de trabajo de los instrumentos quirúrgicos.
Las empuñaduras maestras pueden incluir varios sensores para proporcionar retroalimentación al médico en relación con varios parámetros o condiciones del tejido, por ejemplo, resistencia del tejido debido a la manipulación, corte o tratamiento, presión del instrumento sobre el tejido, temperatura del tejido, impedancia del tejido, etc. Como puede apreciarse, dichos sensores proporcionan al médico una respuesta táctil mejorada que simula las condiciones de funcionamiento reales. Las empuñaduras maestras también pueden incluir una variedad de actuadores diferentes para la manipulación o el tratamiento de tejidos delicados, mejorando aún más la capacidad del médi condiciones operativas reales.
Haciendo referencia también a la Figura 6, una estación de trabajo médico se muestra generalmente como estación de trabajo 1000 y generalmente puede incluir una pluralidad de brazos robóticos 1002, 1003; un dispositivo de control 1004; y una consola operativa 1005 acoplada con el dispositivo de control 1004. La consola operativa 1005 puede incluir un dispositivo de visualización 1006, que puede configurarse en particular para visualizar imágenes tridimensionales; y dispositivos de entrada manual 1007, 1008, por medio de los cuales una persona (no se muestran), por ejemplo, un médico, puede ser capaz de telemanipular los brazos robóticos 1002, 1003 en un primer modo operativo.
Cada uno de los brazos robóticos 1002, 1003 puede incluir una pluralidad de miembros, que están conectados a través de articulaciones, y un dispositivo de fijación 1009, 1011, al que puede conectarse, por ejemplo, una herramienta quirúrgica "ST" que soporta un efector final 1100 (por ejemplo, un par de miembros de mordaza) que incluyen bolsas de tejido de acuerdo con cualquiera de las varias modalidades divulgadas en el presente documento.
Los brazos robóticos 1002, 1003 pueden ser accionados por accionamientos eléctricos (no se muestran) que están conectados al dispositivo de control 1004. El dispositivo de control 1004 (por ejemplo, un ordenador) puede configurarse para activar los accionamientos, en particular por medio de un programa informático, de tal manera que los brazos robóticos 1002, 1003, sus dispositivos de fijación 1009, 1011 y, por tanto, la herramienta quirúrgica (incluyendo el efector final 1100) ejecute un movimiento deseado de acuerdo con un movimiento definido por medio de los dispositivos de entrada manual 1007, 1008. El dispositivo de control 1004 puede configurarse además de tal manera que regule el movimiento de los brazos robóticos 1002, 1003 y/o de los accionamientos.
La estación de trabajo médico 1000 puede configurarse para su uso en un paciente "P" acostado sobre una mesa de paciente 1012 para ser tratado de una manera mínimamente invasiva por medio del efector final 1100. La estación de trabajo médico 1000 también puede incluir más de dos brazos robóticos 1002, 1003, los brazos robóticos adicionales conectados igualmente al dispositivo de control 1004 y telemanipulables por medio de la consola operativa 1005. Un sistema quirúrgico, tal como el sistema quirúrgico divulgado actualmente, también puede unirse al brazo de robot adicional. La estación de trabajo médico 1000 puede incluir una base de datos 1014 acoplada con el dispositivo de control 1004. En algunas modalidades, los datos preoperatorios del paciente/ser vivo "P" y/o atlas anatómicos pueden almacenarse en la base de datos 1014. Para una descripción más detallada de estaciones de trabajo médico ejemplares y/o componentes de las mismas, puede hacerse referencia a la publicación de solicitud de patente de los EE.UU. núm. 2012/0116416, presentada el 3 de noviembre de 2011, titulada "Medical Workstation" y publicación de solicitud PCT núm. WO2016/025132, presentada el 21 de julio de 2015, titulada "Robotically Controlling Mechanical Advantage Gripping".
Los expertos en la técnica entenderán que las estructuras y los métodos específicamente descritos en el presente documento e ilustrados en las figuras adjuntas son modalidades ejemplares no limitantes, y que la descripción, la divulgación y las figuras deben interpretarse simplemente como ejemplos de modalidades particulares. Debe entenderse, por tanto, que la invención se define en la reivindicación 1 adjunta. Por ejemplo, el aparato puede incluir una unidad de carga con un conjunto de cartucho de grapas que no es reemplazable de forma independiente, estando dispuesta la unidad de carga para su conexión a un mango de grapado quirúrgico motorizado, un mango de grapado quirúrgico operado manualmente o un sistema quirúrgico robótico. Además, los elementos y las características ilustrados o descritos en conexión con ciertas modalidades ejemplares pueden combinarse con los elementos y las características de otras modalidades sin apartarse del alcance de la presente divulgación, y que se pretende que dichas modificaciones y variaciones estén también incluidas dentro del alcance de la presente divulgación.
Claims (11)
1. Un aparato de grapado quirúrgico (10) que comprende:
un primer miembro de mordaza que tiene una primera superficie de contacto con el tejido (332a), definiendo la primera superficie de contacto con el tejido una pluralidad de filas de ranuras de retención de grapas que se extienden longitudinalmente (332b);
una pluralidad de grapas (334), cada una de las grapas de la pluralidad de grapas recibidas en una respectiva de la pluralidad de ranuras de retención de grapas de la primera superficie de contacto con el tejido;
un segundo miembro de mordaza que tiene una segunda superficie de contacto con el tejido (314a), definiendo la segunda superficie de contacto con el tejido una pluralidad de filas de bolsas de grapas que se extienden longitudinalmente (314b) alineadas con la pluralidad de ranuras de retención de grapas de la primera superficie de contacto con el tejido, cada bolsa de grapas de la segunda superficie de contacto con el tejido configurada para formar una respectiva de las grapas de la pluralidad de grapas cuando se dispara el aparato de grapado quirúrgico; y
caracterizado porque el aparato de grapado quirúrgico comprende además una pluralidad de bolsas de tejido internas (314d) definidas en la segunda superficie de contacto con el tejido y colocadas a lo largo del segundo miembro de mordaza entre la pluralidad de bolsas de grapas;
las bolsas de tejido internas configuradas para capturar tejido en su interior para evitar que el tejido migre lejos de la primera y segunda superficies de contacto con el tejido cuando se dispara el aparato de grapado quirúrgico, siendo cada una de las bolsas de tejido internas más pequeña que cada una de las bolsas de grapas.
2. El aparato de grapado quirúrgico (10) de la reivindicación 1, en donde las bolsas de tejido internas (314d) definidas en la segunda superficie de contacto con el tejido (314a) están colocadas entre dos bolsas de grapas adyacentes (314b) de la pluralidad de bolsas de grapas.
3. El aparato de grapado quirúrgico (10) de la reivindicación 1, que comprende además una pluralidad de bolsas de tejido internas (332e) definidas en la primera superficie de contacto con el tejido (332a) y colocadas a lo largo del primer miembro de mordaza entre la pluralidad de ranuras de retención de grapas (332b), siendo cada una de las bolsas de tejido internas en la primera superficie de contacto con el tejido más pequeña que cada una de las ranuras de retención de grapas.
4. El aparato de grapado quirúrgico (10) de la reivindicación 3, en donde las bolsas de tejido internas (332e) definidas en la primera superficie de contacto con el tejido (332a) están colocadas cada una entre dos ranuras de retención de grapas adyacentes (332b) de la pluralidad de ranuras de retención de grapas.
5. El aparato de grapado quirúrgico (10) de cualquier reivindicación anterior, en donde el primer miembro de mordaza se extiende hasta un primer borde periférico y el segundo miembro de mordaza se extiende hasta un segundo borde periférico (315), en donde se define una bolsa de tejido externa (314c, 332f) en uno de los primeros o segundos bordes periféricos.
6. El aparato de grapado quirúrgico (10) de la reivindicación 5, que incluye una pluralidad de bolsas de tejido externas (314e, 332f) definidas en al menos uno de los bordes periféricos primero y segundo.
7. El aparato de grapado quirúrgico (10) de la reivindicación 6, en donde la pluralidad de bolsas de tejido externas (314e, 332f) incluye un primer conjunto de bolsas de tejido externas (332f) y un segundo conjunto de bolsas de tejido externas (313e), el primer conjunto de bolsas de tejido externas definidas en la primera superficie de contacto con el tejido (332a) en el primer borde periférico, el segundo conjunto de bolsas de tejido externas definidas en la segunda superficie de contacto con el tejido (314a) en el segundo borde periférico (315).
8. El aparato de grapado quirúrgico (10) de cualquier reivindicación anterior, en donde las bolsas de tejido internas (314d, 332e) definen una curva cerrada.
9. El aparato de grapado quirúrgico (10) de la reivindicación 6 o la reivindicación 7, en donde las bolsas de tejido externas (314e, 332f) definen cada una, una curva cerrada.
10. El aparato de grapado quirúrgico (10) de cualquier reivindicación anterior, que es un efector de extremo en donde
el primer miembro de mordaza incluye un conjunto de cartucho (320) que tiene la primera superficie de contacto con el tejido (332a);
el segundo miembro de mordaza incluye el conjunto de yunque (310) que tiene la segunda superficie de contacto con el tejido (314a), el conjunto de yunque y el conjunto de cartucho colocados para moverse entre una posición abierta y una posición cerrada para sujetar selectivamente el tejido entre la primera y segunda superficies de contacto con el tejido; y
el efector de extremo incluye un conjunto de cuchilla que incluye una cuchilla (328) configurada para moverse con relación a los conjuntos de yunque y cartucho para cortar el tejido sujetado entre la primera y segunda superficies de contacto con el tejido de los conjuntos de yunque y cartucho, respectivamente;
en donde las bolsas de tejido internas (314d, 332e) están configuradas para capturar tejido en ellas para evitar que el tejido migre lejos de la primera y segunda superficies de contacto con el tejido cuando la cuchilla se mueve con respecto a los conjuntos de yunque y cartucho.
11. El aparato de grapado quirúrgico (10) de la reivindicación 7, en donde las bolsas de tejido externas (314e, 332f) definen un perfil escalonado a lo largo de la longitud del primer y segundo miembros de mordaza.
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2016
- 2016-11-04 US US15/344,091 patent/US11642126B2/en active Active
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2017
- 2017-11-02 JP JP2017212640A patent/JP2018069078A/ja active Pending
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|---|---|
| US20220202419A1 (en) | 2022-06-30 |
| US20180125487A1 (en) | 2018-05-10 |
| JP2018069078A (ja) | 2018-05-10 |
| EP3318201A1 (en) | 2018-05-09 |
| US11771429B2 (en) | 2023-10-03 |
| AU2017254951A1 (en) | 2018-05-24 |
| CA2984656A1 (en) | 2018-05-04 |
| EP3318201B1 (en) | 2020-09-23 |
| US11642126B2 (en) | 2023-05-09 |
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