MX2014011566A - Dispositivo de grapado quirurgico con sistema de bloqueo para impedir su accionamiento en ausencia de un cartucho de grapas instalado. - Google Patents
Dispositivo de grapado quirurgico con sistema de bloqueo para impedir su accionamiento en ausencia de un cartucho de grapas instalado.Info
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- MX2014011566A MX2014011566A MX2014011566A MX2014011566A MX2014011566A MX 2014011566 A MX2014011566 A MX 2014011566A MX 2014011566 A MX2014011566 A MX 2014011566A MX 2014011566 A MX2014011566 A MX 2014011566A MX 2014011566 A MX2014011566 A MX 2014011566A
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- anvil
- staple cartridge
- surgical
- mounting portion
- surgical stapling
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
- A61B17/105—Wound clamp magazines
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
- A61B2017/003—Steerable
- A61B2017/00305—Constructional details of the flexible means
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
- A61B2017/003—Steerable
- A61B2017/00318—Steering mechanisms
- A61B2017/00323—Cables or rods
- A61B2017/00327—Cables or rods with actuating members moving in opposite directions
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07257—Stapler heads characterised by its anvil
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07271—Stapler heads characterised by its cartridge
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B17/2909—Handles
- A61B2017/2912—Handles transmission of forces to actuating rod or piston
- A61B2017/2923—Toothed members, e.g. rack and pinion
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2932—Transmission of forces to jaw members
- A61B2017/2933—Transmission of forces to jaw members camming or guiding means
- A61B2017/2936—Pins in guiding slots
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/03—Automatic limiting or abutting means, e.g. for safety
- A61B2090/033—Abutting means, stops, e.g. abutting on tissue or skin
- A61B2090/034—Abutting means, stops, e.g. abutting on tissue or skin abutting on parts of the device itself
- A61B2090/035—Abutting means, stops, e.g. abutting on tissue or skin abutting on parts of the device itself preventing further rotation
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- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Heart & Thoracic Surgery (AREA)
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Abstract
Se describen instrumentos de grapado quirúrgico y cartuchos de grapado quirúrgico; al menos una modalidad incluye un efector de extremo que tiene un canal alargado que se configura para soportar operativamente un cartucho de grapas quirúrgicas en este y un yunque que se soporta móvil en el canal alargado entre una posición abierta y posiciones cerradas en respuesta a una aplicación de movimientos de apertura y cierre aplicados a este; un miembro de bloqueo del yunque (260, 400) coopera con el yunque para retener el yunque en una posición abierta cuando un cartucho de grapas no se ha instalado en el canal alargado e impide que el yunque se mueva a una posición cerrada hasta que el cartucho de grapas se haya asentado dentro del canal alargado; los cartuchos de grapas quirúrgicas se configuran para mover el yunque desde una posición abierta hasta una posición accionable cuando el cartucho se ha instalado dentro del efector de extremo.
Description
DISPOSITIVO DE GRAPADO QUIRÚRGICO CON SISTEMA DE BLOQUEO PARA IMPEDIR SU ACCIONAMIENTO EN AUSENCIA DE UN CARTUCHO
DE GRAPAS INSTALADO
ANTECEDENTES
La presente invención se relaciona con instrumentos quirúrgicos y, en varias modalidades, con instrumentos para corte y grapado quirúrgicos y cartuchos de grapas para estos que se diseñan para el corte y grapado de tejidos.
BREVE DESCRIPCIÓN DE LA INVENCIÓN
De acuerdo con al menos una forma general, se proporciona un instrumento de grapado quirúrgico que incluye un efector de extremo que tiene un canal alargado que se configura para soportar, operativamente, un cartucho de grapas quirúrgicas en este. Un yunque se soporta móvil en el canal alargado entre una posición abierta y posiciones cerradas en respuesta a una aplicación de movimientos de apertura y cierre aplicados a este. Un miembro de bloqueo del yunque coopera con el yunque para retener el yunque en una posición abierta cuando un cartucho de grapas no se ha instalado en el canal alargado e impide que el yunque se mueva a una posición cerrada hasta que el cartucho de grapas se haya asentado dentro del canal alargado.
De acuerdo con al menos otra forma general, se proporciona un instrumento de grapado quirúrgico que incluye un mango y una unidad de vástago alargado que se acopla, operativamente, al mango. Un sistema de cierre se soporta, operativamente, por el mango para generar los movimientos de cierre y apertura en respuesta al accionamiento de un disparador de cierre soportado operativamente por el mango. El instrumento incluye, además, un canal alargado que se acopla a la unidad de vástago alargado. El instrumento incluye, además, un yunque que tiene una porción de montaje del yunque que se soporta móvil en el canal alargado entre una posición abierta y posiciones cerradas en respuesta a la aplicación de movimientos de apertura y cierre transmitidos a esta mediante la unidad de vástago alargado. Un miembro de bloqueo del yunque se soporta, operativamente, por la unidad de vástago alargado para el acoplamiento móvil con la porción de montaje del yunque. Un cartucho de grapas quirúrgicas se configura para asentarse dentro del canal alargado y coopera con la porción de montaje del yunque de tal manera que cuando el cartucho de grapas quirúrgicas no se ha asentado dentro del canal alargado, el miembro de bloqueo del yunque coopera con la porción de montaje del yunque para retener el yunque en la posición abierta. Además, cuando el cartucho de grapas quirúrgicas se asienta dentro del canal alargado, el cartucho de grapas mueve la porción de montaje del yunque a una posición en donde el yunque puede cerrarse después de la aplicación de los movimientos de cierre de este.
De acuerdo con otra forma general, se proporciona un cartucho de grapas quirúrgicas para su uso con un instrumento de grapado quirúrgico
que incluye un efector de extremo con un yunque que se soporta en una posición abierta hasta que se mueve a una posición accionable, en donde el yunque puede moverse a las posiciones cerradas en respuesta a un movimiento de cierre aplicado a este por un sistema de cierre. En al menos una forma, el cartucho de grapas quirúrgicas comprende un cuerpo del cartucho que se dimensiona para asentarse extraíblemente dentro de una porción del efector de extremo, de tal manera que una porción del cuerpo del cartucho entra en contacto con el yunque para mover el yunque de la posición abierta a la posición accionable cuando se asienta dentro del efector de extremo.
BREVE DESCRIPCIÓN DE LAS FIGURAS
Las características y ventajas de la presente invención, así como la manera de obtenerlas, serán más evidentes y la invención en sí se comprenderá mejor con referencia a la siguiente descripción de modalidades de la invención tomadas en conjunto con las figuras que se acompañan, en donde:
La Figura 1 es una vista en perspectiva de una modalidad de un instrumento de grapado quirúrgico;
La Figura 2 es una vista de ensamble en despiece del instrumento de grapado quirúrgico de la Figura 1 ;
La Figura 3 es una vista de ensamble en despiece de una porción de una modalidad de la unidad de articulación;
La Figura 4 es una vista en perspectiva en despiece parcial de
una porción del mango;
La Figura 5 es una vista lateral del mango con una carcasa del mango retirada;
La Figura 6 es una vista en perspectiva en despiece parcial de un efector de extremo y la modalidad del bloqueo del yunque;
La Figura 6A es una vista en perspectiva en despiece parcial de otro efector de extremo y la modalidad del miembro de bloqueo del yunque;
La Figura 7 es una vista en perspectiva de una modalidad del miembro de bloqueo del yunque;
La Figura 7A es una vista en perspectiva de una modalidad del miembro de bloqueo del yunque de la Figura 6A;
La Figura 8 es una vista en elevación lateral de una modalidad de un efector de extremo en una posición abierta;
La Figura 9 es una vista superior del efector de extremo de la Figura 8;
La Figura 10 es una vista inferior del efector de extremo representado en las Figuras 8 y 9;
La Figura 11 es una vista inferior parcial en perspectiva de una modalidad del yunque;
La Figura 12 es una vista en perspectiva de una modalidad del soporte pivotante;
La Figura 13 es una vista en perspectiva inferior de la modalidad del soporte pivotante de la Figura 12;
La Figura 14 es una vista en perspectiva de una porción del extremo proximal de una modalidad del cartucho de grapas quirúrgicas;
La Figura 15 es una vista en elevación lateral de la modalidad del cartucho de grapas quirúrgicas representada en la Figura 14;
La Figura 16 es una vista lateral de una modalidad de un efector de extremo antes de asentar un cartucho de grapas en el canal alargado;
La Figura 17 es una vista en sección transversal del efector de extremo representado en la Figura 16;
La Figura 18 es una vista lateral de una modalidad de un efector de extremo de las Figuras 16 y 17 con el yunque en la posición abierta y en donde un cartucho de grapas quirúrgicas se inserta en el canal alargado;
La Figura 9 es una vista en sección transversal del efector de extremo de la Figura 18;
La Figura 20 es una vista lateral del efector de extremo de las Figuras 16 a 19 con la modalidad del cartucho de grapas asentada dentro del canal alargado;
La Figura 21 es una vista en sección transversal del efector de extremo de la Figura 20;
La Figura 22 es una vista en elevación lateral del efector de extremo de las Figuras 16 a 22 que sujeta el tejido;
La Figura 23 es una vista en sección transversal del efector de extremo de la Figura 22;
La Figura 24 es una vista en elevación lateral del efector de
extremo de las Figuras 16 a 23 en una posición completamente sujeta listo para disparar;
La Figura 25 es una vista en sección transversal del efector de extremo de la Figura 24;
La Figura 26 es una vista de ensamble en despiece de otra modalidad de un instrumento de grapado quirúrgico;
La Figura 27 es una vista en perspectiva de otra modalidad del soporte pivotante;
La Figura 28 es una vista en perspectiva inferior de la modalidad del soporte pivotante de la Figura 27;
La Figura 29 es una vista en perspectiva en despiece parcial de un efector de extremo y otra modalidad del miembro de bloqueo del yunque;
La Figura 30 es una vista en perspectiva de otra modalidad del miembro de bloqueo del yunque;
La Figura 31 es una vista en elevación lateral parcial de una porción del extremo proximal de otra modalidad del cartucho de grapas quirúrgicas;
La Figura 32 es una vista en perspectiva de una porción del extremo proximal de la modalidad del cartucho de grapas quirúrgicas de la Figura 31 ;
La Figura 33 es una vista lateral de otra modalidad de un efector de extremo antes de asentar un cartucho de grapas en el canal alargado;
La Figura 34 es una vista en sección transversal del efector de
extremo representado en la Figura 33;
La Figura 35 es una vista lateral de una modalidad de un efector de extremo de las Figuras 33 y 34 con el yunque en la posición abierta y en donde un cartucho de grapas quirúrgicas se inserta en el canal alargado;
La Figura 36 es una vista en sección transversal del efector de extremo de la Figura 35;
La Figura 37 es una vista lateral del efector de extremo de las Figuras 33 a 36 con la modalidad del cartucho de grapas asentada dentro del canal alargado;
La Figura 38 es una vista en sección transversal del efector de extremo de la Figura 37;
La Figura 39 es una vista en elevación lateral del efector de extremo de las Figuras 33 a 38 que sujeta el tejido;
La Figura 40 es una vista en sección transversal del efector de extremo de la Figura 39;
La Figura 41 es una vista en elevación lateral del efector de extremo de las Figuras 33 a 40 en una posición completamente sujeta listo para disparar; y
La Figura 42 es una vista en sección transversal del efector de extremo de la Figura 41.
DESCRIPCIÓN DETALLADA DE LA INVENCIÓN
A continuación se describirán ciertas modalidades ilustrativas para lograr una comprensión general de los principios de la estructura, la función, la elaboración y el uso de los instrumentos y métodos descritos en la presente invención. En las figuras anexas se ilustran uno o más ejemplos de dichas modalidades. Aquellos con experiencia en la materia entenderán que los dispositivos y métodos específicamente descritos en la presente invención e ilustrados en las figuras anexas son modalidades ejemplares no limitantes y que el alcance de la presente invención se define solamente por las reivindicaciones. Las características ilustradas o descritas en referencia a una modalidad ilustrativa pueden combinarse con las características de otras modalidades. Se pretende que dichas modificaciones y variaciones se incluyan dentro del alcance de la presente invención.
La referencia a lo largo de toda la descripción a "varias modalidades", "algunas modalidades", "una modalidad" o similares significa que un aspecto particular, una estructura o característica descritos en conexión con la modalidad se incluye en al menos una modalidad. Por lo tanto, las apariciones de las frases "en varias modalidades", "en algunas modalidades", "en una modalidad" o similares en lugares a lo largo de toda la descripción no se refieren, necesariamente, a la misma modalidad. Además, los aspectos particulares, las estructuras o características pueden combinarse de cualquier manera adecuada en una o más modalidades. Por lo tanto, los aspectos
particulares, las estructuras o características que se ilustran o describen en conexión con una modalidad pueden combinarse, total o parcialmente, con los aspectos, las estructuras o las características de una o más de otras modalidades sin limitación. Se pretende que dichas modificaciones y variaciones se incluyan dentro del alcance de la presente invención.
Los términos "proximal" y "distal" se usan, en la presente descripción, con referencia a un profesional clínico que manipula la porción de mango de un instrumento quirúrgico. El término "proximal" se refiere a la porción que está más cerca del profesional clínico, y el término "distal" se refiere a la porción que está lejos del profesional clínico. Además se apreciará que, por motivos de conveniencia y claridad, en la presente descripción pueden usarse términos espaciales tales como "vertical", "horizontal", "arriba" y "abajo" con respecto a las figuras. Sin embargo, los instrumentos quirúrgicos se usan en muchas orientaciones y posiciones, y estos términos no pretenden ser limitantes ni absolutos.
Se proporcionan varios dispositivos y métodos ilustrativos para realizar procedimientos laparoscópicos y procedimientos quirúrgicos mínimamente invasivos. Sin embargo, la persona de experiencia ordinaria en la materia comprenderá fácilmente que los diversos métodos y dispositivos descritos en la presente descripción pueden usarse en varios procedimientos quirúrgicos y aplicaciones que incluyen, por ejemplo, las relacionadas con procedimientos de cirugía abierta. A medida que avanza la descripción detallada, los expertos en la materia comprenderán, además, que los diversos instrumentos
descritos en la presente descripción pueden insertarse en un cuerpo de cualquier manera, tal como a través de un orificio natural, a través de una incisión u orificio de punción formado en un tejido, etc. Las porciones de trabajo o las porciones de efector de extremo de los instrumentos pueden insertarse, directamente, en el cuerpo de un paciente o pueden insertarse a través de un dispositivo de acceso que tiene un canal de trabajo a través del cual puede avanzar el efector de extremo y el vástago alargado de un instrumento quirúrgico.
Con relación a las figuras en donde números similares denotan componentes similares por las varias vistas, las Figuras 1 y 2 representan un dispositivo de grapado quirúrgico 10 que es capaz de llevar a la práctica los beneficios únicos de varias modalidades descritas en la presente descripción. Un dispositivo quirúrgico ilustrativo que tiene características con las cuales las modalidades de la presente invención pueden emplearse, eficazmente, se describe en la patente de Estados Unidos núm. 5,704,534, titulada "Articulation Assembly For Surgical Instruments", concedida el 6 de junio de 1998, la descripción completa de la cual se incorpora en la presente invención como referencia. Otras modalidades ilustrativas del dispositivo de grapado quirúrgico se describen en mayor detalle en las siguientes patentes de Estados Unidos cada una de las cuales se incorpora en la presente invención como referencia en sus respectivas versiones completas: patente de Estados Unidos núm. 6,964,363, titulada "Surgical Stapling Instrument Having Articulation Joint Support Plates For Supporting a Firing Bar", concedida el 15 de noviembre de 2005; patente de Estados Unidos núm. 7,000,818, titulada
"Surgical Stapling Instrument Having Sepárate Distinct Closing and Firing Motions", concedida el 21 de febrero de 2006; patente de Estados Unidos núm. 7,044,352, titulada "Surgical Stapling Instrument Having A Single Lockout Mechanism For Prevention of Firing", concedida el 16 de mayo de 2006; patente de Estados Unidos núm. 7,111 ,769, titulada "Surgical Instrument Incorporating An Articulation Mechanism Having Rotation About the Longitudinal Axis", concedida el 26 de septiembre de 2006; y patente de Estados Unidos núm. 7,143,923, titulada "Surgical Stapling Instrument Having A Firing Lockout For an Unclosed Anvil", concedida el 5 de diciembre de 2006.
Con referencia de nuevo a las Figuras 1 y 2, el dispositivo de grapado quirúrgico 10 representado incluye un mango 20 que se conecta, operativamente, a una porción del implemento 22, este último comprende, además, una unidad de vastago alargado 30 que se acopla, operativamente, a un efector de extremo 200. El mango 20 incluye una empuñadura 24 hacia la cual un disparador de cierre 152 se atrae de manera giratoria por el clínico para provocar la sujeción, o el cierre de un yunque 220 hacia un canal alargado 210 del efector de extremo 200. Un gatillo de disparo 102 está fuera del disparador de cierre 152 y se atrae de manera giratoria por el clínico para grapar y cortar el tejido sujeto en el efector de extremo 200.
Por ejemplo, el disparador de cierre 152 se acciona primero. Una vez satisfecho con la ubicación del efector de extremo 200, el clínico puede retraer el disparador de cierre 152 a su posición de bloqueo totalmente cerrada próxima a la empuñadura 24. Después, se acciona el gatillo de
disparo 102. El gatillo de disparo 102 regresa mediante resortes cuando el clínico retira la presión. Un botón de liberación 120, cuando se presiona en el extremo proximal del mango 20, libera el disparador de cierre bloqueado 152. Sistema de articulación
La modalidad representada incluye una unidad de articulación 62 que se configura para facilitar la articulación del efector de extremo 200 alrededor del eje alargado A-A del dispositivo 10. Sin embargo, pueden emplearse varias modalidades, eficazmente, además, en relación con dispositivos de grapado quirúrgico no articulables. Como puede verse en la Figura 2, por ejemplo, la unidad de vástago alargado 30 incluye un segmento proximal del tubo de cierre 151 que se soporta, operativamente, por una boquilla 60 que se soporta en el mango 20. El mango 20 puede formarse a partir de dos carcasas del mango 21, 23 que contienen, operativamente, los sistemas de disparo y de cierre 100, 150. Una porción del extremo proximal 153 del segmento proximal del tubo de cierre 151 se soporta de manera giratoria por el mango 20 para facilitar su rotación selectiva alrededor del eje alargado A-A. Ver la Figura 1. Como puede verse, además, en las Figuras 1 y 2, en al menos una modalidad, una porción del extremo distal 157 del segmento proximal del tubo de cierre 151 se acopla a una unidad de cuello flexible 70. La unidad de cuello flexible 70 tiene la primera y la segunda porciones de cuello flexible, 72 y 74, que reciben la primera y la segunda unidades de bandas de transmisión flexibles alargadas 83, 85. La primera y la segunda unidades de bandas de transmisión 83, 85 tienen las porciones exteriores de bandas de
refuerzo 86, 87, respectivamente, que se extienden, distalmente, desde las porciones estructurales de las bandas. Cada porción exterior de bandas de refuerzo 86, 87 tiene una pluralidad de agarraderas de acoplamiento 88 para asegurar la primera y la segunda bandas interiores de articulación 89, 90. Ver la Figura 2. Las unidades de bandas de transmisión 83, 85 pueden componerse, por ejemplo, de un plástico, especialmente una poliamida amorfa reforzada con fibra de vidrio, vendida comercialmente bajo el nombre comercial Grivory GV-6H por EMS-American Grilon. Por el contrario, puede desearse que las bandas interiores de articulación 89, 90 de las unidades de bandas de transmisión 83, 85 se compongan de un metal, favorablemente acero inoxidable 301 totalmente endurecido o su equivalente. Las agarraderas de acoplamiento 88 en las porciones exteriores de bandas de refuerzo 86, 87 de las bandas de transmisión 83, 85 se reciben en y se aseguran dentro de una pluralidad de agujeros para agarraderas 91 en la correspondiente banda interior de articulación 89, 90. En el extremo distal de la primera y la segunda unidades de banda interior de articulación 89, 90 están el primer y el segundo conectores 92, 93. La unidad de articulación comprende, además, las bandas distales de articulación 96 y 97 que se configuran para acoplar y enganchar el primer y el segundo conectores 92, 93, respectivamente. Las bandas de articulación 96 y 97 tienen los receptáculos 98, 99 para acoplar las bandas 96, 97 al efector de extremo 200 como se describirá en más detalle más adelante.
En al menos una forma, la unidad de cuello flexible 70 se compone, preferentemente, de un poliuretano termoplástico rígido vendido
comercialmente como ISOPLAST grado 2510 por la Dow Chemical Company. Como puede verse en la Figura 3, la unidad de cuello flexible 70 tiene la primera y la segunda porciones de cuello flexible 72, 74. Estas porciones de cuello 72, 74 se separan por una nervadura longitudinal central 73. Ver la Figura 6. Cada una de las porciones de cuello 72, 74 tiene una pluralidad de nervaduras de cuello 75 configuradas prácticamente como discos semicirculares. Las porciones de cuello flexible 72, 74 juntas forman, generalmente, una configuración cilindrica. Una ranura lateral 76 se extiende a través de cada una de las nervaduras de cuello 75 para proporcionar un paso a través de la primera y la segunda porciones de cuello flexible 72, 74 para recibir las bandas interiores de articulación 89, 90 y las porciones exteriores de bandas de refuerzo 86, 87 de las unidades de bandas flexibles 83, 85. De manera similar, la nervadura longitudinal central 73 que separa la primera y la segunda porciones de cuello flexible 72, 74 tiene una ranura longitudinal central para proporcionar un paso para recibir los miembros de accionamiento de la grapadora. Proximalmente desde la primera y la segunda porciones de cuello flexible 72, 74 se extienden la primera y la segunda superficies guías de soporte 77, 78 para soportar el movimiento alternante de las bandas interiores de articulación 89, 90 y las porciones exteriores de refuerzo 86, 87 de las unidades de bandas de transmisión flexibles 83, 85. Desde el extremo distal de las porciones de cuello flexible 72, 74 se extiende una guía del canal 79 para guiar el movimiento de los miembros de accionamiento de la grapadora en un cartucho de grapas 300 del efector de extremo 200 como se describirá,
adicionalmente, más adelante.
En al menos una forma, cuando la primera y la segunda unidades de bandas de transmisión 83, 85 se ponen en contacto entre sí durante el ensamble del instrumento 10, forman un cilindro alargado que tiene una cavidad longitudinal a través de él que se posiciona, concéntricamente, entre las unidades de bandas 83, 85 para el paso de una varilla de disparo 110. Los extremos proximales de la primera y la segunda bandas tienen la primera y la segunda cremalleras 94, 95 las cuales, como se describirá más adelante, acoplan y engranan con una unidad de articulación 62.
Al girar la unidad de articulación 62, una de la primera y la segunda unidades de bandas de transmisión flexibles se mueve hacia adelante y la otra unidad de bandas se mueve hacia atrás. En respuesta al movimiento alternante de las unidades de bandas 83, 85 dentro de la primera y la segunda porciones de cuello flexible 72, 74 de la unidad de cuello flexible 70, la unidad de cuello flexible 70 se dobla para proporcionar articulación. Como puede verse en la Figura 5, una unidad de articulación 62 incluye un accionador 63, un cuerpo de articulación 64 y la boquilla 60. El movimiento giratorio del accionador 63 provoca la correspondiente rotación del cuerpo de articulación 64 dentro de la boquilla 60. La primera y la segunda unidades de bandas de transmisión alargadas 83, 85, consiguientemente se mueven, alternativamente, en la dirección axial en direcciones opuestas paralelas al eje longitudinal A-A del vástago endoscópico 30 del dispositivo de grapado 10 para provocar que la articulación remota del efector de extremo 200 pase a través de la unidad de cuello flexible 70. El cuerpo
de articulación 64 incluye, además, un engranaje de accionamiento 65 en él. Como puede verse en la Figura 4, el engranaje de accionamiento 65 tiene una abertura abocinada 66 a través de él, y un pivote inferior 67. Dentro de la abertura abocinada 66 del engranaje de accionamiento 65, está un orificio de la varilla de disparo 68 para recibir la varilla de disparo 110 que permite disparar las grapas en el tejido sujeto en respuesta a la rotación sobre el pivote del gatillo de disparo 102. El engranaje de accionamiento 65 se soporta para su acoplamiento por engrane con la primera y la segunda cremalleras de accionamiento 94, 95 en las unidades de bandas de transmisión alargadas flexibles 83, 85 para efectuar el movimiento alternante deseado de las unidades de bandas 83, 85.
Como puede verse en la Figura 5, la boquilla 60 de la unidad de articulación 62 tiene un cuerpo de boquilla 61. El cuerpo de boquilla 61 tiene un barreno axial 69 que se extiende a través de él para recibir el engranaje de accionamiento 65 del cuerpo de articulación 64. El barreno 69 proporciona una abertura continua, axialmente, desde el bastidor en el vástago endoscópico alargado 30 y, por lo tanto, la varilla de disparo 110 y otros componentes operativos del dispositivo de grapado 0 pueden comunicarse con el efector de extremo 200. Detalles adicionales en relación con la unidad de articulación 62 pueden encontrarse en la patente de Estados Unidos núm. 5,704,534, la cual se incorporó, anteriormente, en la presente como referencia.
Sistema de cierre
Como se describirá en más detalle más adelante, el efector de extremo 200 comprende un canal alargado 210 que se configura para recibir,
operativamente, un cartucho de grapas quirúrgicas 300. Un yunque 220 se soporta móvil con respecto al canal alargado 210 y se mueve desde una posición abierta (Figuras 16 y 17) a las posiciones cerradas en donde el tejido puede cortarse y graparse (Figuras 24 y 25). El movimiento del yunque 220 entre la posición abierta y cerrada se controla al menos parcialmente por un sistema de cierre, designado generalmente como 150, el cual, como se indicó, anteriormente, se controla por el disparador de cierre 152. El sistema de cierre 150 incluye el segmento proximal del tubo de cierre 151 que aloja, operativamente, las unidades de bandas de articulación 83, 85 de la manera descrita anteriormente y el cual sé acopla inmóvil a la unidad de cuello flexible 70.
En varias formas, el segmento proximal del tubo de cierre 151 incluye una porción del extremo proximal 153 que se extiende, axialmente, a través del barreno 69 en la boquilla 60. El segmento proximal del tubo de cierre 151 tiene ranuras axiales alargadas 155 a través de él para permitir que el cuerpo de articulación 64 se extienda a través de él. Ver la Figura 2. Las ranuras 155 permiten que el cuerpo de articulación 64 gire alrededor del eje de articulación B-B con respecto al segmento proximal del tubo de cierre 151 a la vez que facilita el movimiento axial del segmento proximal del tubo de cierre 151 a lo largo del eje A-A con respecto al cuerpo de articulación 64. Las bandas de transmisión 83, 85 funcionan como un bastidor sobre el cual puede moverse, axialmente, el segmento proximal del tubo de cierre 151. El extremo proximal 153 del segmento proximal del tubo de cierre 151 se
acopla, giratoriamente, a un yugo de cierre 154 que se soporta dentro del mango 20 para el movimiento alternante en este. Ver las Figuras 4 y 5.
El disparador de cierre 152 tiene una sección del mango 156, una sección de segmento de engranaje 158 y una sección intermedia 160. Ver la Figura 5. Un barreno se extiende a través de la sección intermedia 160. Un miembro de soporte cilindrico 162 que se extiende desde la segunda carcasa del mango 23 atraviesa el barreno para montar de manera giratoria el disparador de cierre 152 en la porción del mango 20. Un extremo proximal 98 del yugo de cierre 154 tiene una cremallera 164 que se acopla por la sección de segmento de engranaje 158 del disparador de cierre 152. Cuando el disparador de cierre 152 se mueve hacia la empuñadura 24 de la porción del mango 20, el yugo de cierre 154 y, por lo tanto, el segmento proximal del tubo de cierre 151 se mueven, distalmente, y comprimen un resorte 166 que desvía el yugo de cierre 152 proximalmente.
En al menos una forma, el sistema de cierre 150 incluye, además, un segmento distal del tubo de cierre 170 que se acopla inmóvil a la guía de la porción del canal 79 de la unidad de cuello flexible 70 por las lengüetas de acoplamiento 72, 74. Ver las Figuras 9 y 10. El segmento distal del tubo de cierre 170 tiene una abertura 176 en este que se adapta para interactuar con una lengüeta levantada 224 formada en el yunque 220 como se describirá en más detalle más adelante. Así, el movimiento axial del segmento proximal del tubo de cierre 151 resulta en el movimiento axial de la unidad de cuello flexible 70, así como también del segmento distal del tubo de cierre 170. Por ejemplo,
el movimiento distal del segmento proximal del tubo de cierre 151 efectúa el movimiento de traslación giratorio del yunque 220 distalmente y hacia el canal alargado 210 del efector de extremo 200 y el movimiento proximal efectúa la apertura del yunque 220 como se describirá en más detalle más adelante. Sistema de disparo
En al menos una forma, el instrumento quirúrgico 10 incluye, además, un sistema de disparo, designado generalmente como 100, para aplicar los movimientos de disparo a la varilla de disparo 110 en respuesta al accionamiento del gatillo de disparo 102. En al menos una forma, el sistema de disparo 100 incluye, además, un miembro de accionamiento 104 que tiene la primera y la segunda cremalleras 105, 106 en él. Una primera muesca 109 se proporciona en el miembro de accionamiento 105 entre la primera y la segunda cremalleras 105, 106. Durante el movimiento de retorno del gatillo de disparo 102, un diente 112 en el gatillo de disparo 102 se acopla con la primera muesca 109 para regresar el miembro de accionamiento 104 a su posición inicial después del disparo de las grapas. Una segunda muesca 114 se localiza en un extremo proximal de la varilla de disparo 110 para bloquear la varilla de disparo 110 a un brazo del seguro superior 122 del botón de liberación 120 en su posición no disparada. El sistema de disparo 150 incluye, además, el primer y el segundo piñones integrales 111, 113. El primer piñón integral 111 se acopla con una cremallera de accionamiento 115 que se proporciona en la varilla de disparo 110. El segundo piñón integral 113 se acopla con la primera cremallera 105 en el miembro de accionamiento 104. El
primer piñón integral 111 tiene un primer diámetro y el segundo piñón integral 113 tiene un segundo diámetro que es más pequeño que el primer diámetro.
En varias modalidades, el gatillo de disparo 102 se proporciona con una sección de segmento de engranaje 103. La sección de segmento de engranaje 03 se acopla con la segunda cremallera 106 en el miembro de accionamiento 104 de tal manera que el movimiento del gatillo de disparo 102 provoca que el miembro de accionamiento 104 se mueva en vaivén entre la primera y la segunda posiciones de accionamiento. Con el objetivo de impedir el disparo de las grapas antes de que se haya producido la sujeción del tejido, el brazo del seguro superior 122 en el botón de liberación 120 se acopla con la segunda muesca 114 en la cremallera de accionamiento 115 de tal manera que la varilla de disparo 110 se bloquea en su posición extrema proximal. Cuando el brazo del seguro superior 122 cae en un rebaje en el yugo de cierre, el brazo del seguro superior 122 se desacopla de la segunda muesca 114 para permitir el movimiento distal de la varilla de disparo 110. Debido a que la primera cremallera 105 en el miembro de accionamiento 104 y la cremallera de accionamiento 115 en la varilla de disparo 110 están acopladas, el movimiento del gatillo de disparo 102 provoca que la varilla de disparo 110 se mueva, alternativamente, entre una primera posición alternante y una segunda posición alternante. Los detalles adicionales concernientes a varios aspectos del sistema de disparo 150 pueden recabarse a partir de la referencia a la patente de Estados Unidos núm. 7,000,818 la cual se ha incorporado en la presente como referencia en su totalidad.
Como puede verse en la Figura 3, en varias modalidades, el extremo distal 117 de la varilla de disparo 110 se recibe, giratoriamente, dentro de un yugo de soporte de la varilla de disparo 118. El yugo de soporte de la varilla de disparo 18 tiene una ranura 119 para recibir y enganchar un gancho 132 formado en un extremo proximal de una varilla de cuchilla 130. Además, como se muestra en la Figura 3, una varilla de soporte 140 se soporta para el movimiento axial entre la primera y la segunda superficies guías de soporte 77, 78 de la unidad de cuello flexible 70. La varilla de soporte 140 tiene una ranura 142 que se configura para permitir que la varilla de cuchilla 130 pase a través de ella de manera deslizante. La varilla de la cuchilla metálica 130 tiene un borde de corte del tejido 134 formado en su extremo distal y se configura para interactuar, operativamente, con un deslizador en cuña soportado operativamente dentro de un cartucho de grapas quirúrgicas 300.
Efector de extremo
Como se describió, anteriormente, en al menos una forma, un efector de extremo 200 incluye un canal alargado 210 que se configura para soportar, operativamente, un cartucho de grapas quirúrgicas 300 en este. Como se muestra en las Figuras 2 y 6, el canal alargado 210 tiene una porción del extremo proximal que incluye dos lengüetas de soporte separadas 212 que se configuran para acoplarse por los ganchos 98, 99 en los extremos distales de las bandas de articulación 96, 97. Así, los movimientos alternantes de las bandas de articulación 96, 97 provocan que el canal alargado 210 se articule con respecto a la unidad de cuello flexible 70. Como adicionalmente
se indicó, anteriormente, el efector de extremo 200 incluye, además, un yunque 220. En al menos una forma, el yunque 220 se fabrica de, por ejemplo, acero inoxidable 416 cementado y templado RC35 Min (o material similar) y tiene una superficie inferior conformadora de grapas 222 sobre este que se configura para el acoplamiento de frente con el cartucho de grapas 300 cuando se monta en el canal alargado 210. El yunque 220 se forma con una porción de montaje que se extiende, proximalmente, 223 que incluye dos paredes de soportes giratorios 226, 228 que cada una tiene un soporte giratorio 30 que sobresale desde este. Ver la Figura 11. Además, formada en la parte inferior 232 de la porción de montaje 223 existe una lengüeta pivotante que sobresale hacia abajo 234 que tiene una ranura 236 que se extiende a través de esta que se configura para recibir y soportar la varilla de cuchilla 130 cuando esta se avanza, axialmente, a través del efector de extremo 200 durante el corte y el grapado. Además, la lengüeta de apertura del yunque 224 se forma en la porción de montaje 223 de tal manera que puede ¡nteractuar, operativamente, con la abertura 176 en el segmento distal del tubo de cierre 170 como se describirá, adicionalmente, más adelante. Como puede verse en las Figuras 16 a 25, los soportes giratorios del yunque 230 se configuran para recibirse móviles en las correspondientes ranuras para soporte giratorio 214 formadas en el extremo proximal del canal alargado 210. Cada ranura para soporte giratorio 214 tiene un segmento curvo 216 que se comunica con una muesca de bloqueo 218.
Para facilitar el recorrido giratorio de la porción de montaje del
yunque 223 con respecto al canal alargado 210, varias modalidades incluyen un soporte pivotante 240. Como puede verse en las Figuras 12 y 13, una forma de un soporte pivotante 240 tiene una porción del cuerpo 242 que se configura para unirse al canal alargado 210. Por ejemplo, la porción del cuerpo 242 puede formarse con dos lengüetas de unión opuestas 243 que se configuran para acoplar y retener las aberturas de las lengüetas 211 (Figura 6) formadas en el canal alargado 210. Además, el soporte pivotante 240 tiene una porción base que se extiende, proximalmente, 244 que tiene un saliente de retención 245 que sobresale desde esta que se configura para recibirse en una abertura correspondiente 211 en el canal alargado 210. Ver la Figura 17. El soporte pivotante 240 puede fabricarse a partir de, por ejemplo, el polímero de cristal líquido Vectra A435, materiales naturales o similares. Como puede verse, adicionalmente, en las Figuras 12 y 13, la porción del cuerpo 242 tiene una porción central levantada 246 que tiene una ranura 247 que se extiende a través de esta para recibir, axialmente, la varilla de cuchilla 130. La porción central 246 proporciona soporte lateral a la varilla de cuchilla 130 cuando esta se conduce a través del tejido sujeto dentro del efector de extremo 200. Varias modalidades del soporte pivotante 240 incluyen, además, las superficies de balancín 248 formadas en cada lado de la porción central 246 para recibir de manera giratoria las paredes de los soportes giratorios 226, 228 del yunque 220 sobre estas.
Sistema de bloqueo del yunque
Varias modalidades incluyen un único y novedoso sistema de
bloqueo del yunque 250 que impide el cierre del yunque 220 cuando un cartucho de grapas 300 no se ha instalado, correctamente, en el canal alargado 210. Con referencia a las Figuras 6 y 7, por ejemplo, una modalidad de un sistema de bloqueo del yunque 250 incluye un miembro móvil de bloqueo del yunque 260 que puede moverse en respuesta al contacto por una porción o porciones de un cartucho de grapas 300 como se describirá en más detalle más adelante. En al menos una forma, el miembro de bloqueo del yunque 260 comprende una porción del cuerpo 262 que tiene una lengüeta de soporte central que sobresale, distalmente, 264 formada en esta. Una ranura 266 se extiende a través de la porción del cuerpo 262 y de la lengüeta de soporte central 264 para permitir que la varilla de cuchilla 130 pase a través de ella. La porción del cuerpo 262 incluye, además, la barra de soporte que se extiende, proximalmente, 268 que se configura para recibirse de manera deslizante dentro de una correspondiente abertura de soporte 270 en la guía del canal 79 de la unidad de cuello flexible 70. Además, un miembro de desviación en forma de, por ejemplo, un muelle espiral 269 se soporta dentro de la abertura 270 para desviar el miembro de bloqueo del yunque 260 en la dirección distal "DD". Ver la Figura 16. Cuando el yunque 220 se monta al canal alargado 210, los soportes giratorios 230 se reciben dentro de sus correspondientes ranuras para soporte giratorio 214 en el canal alargado 210, la lengüeta de soporte central 264 del miembro de bloqueo del yunque 260 se recibe entre las paredes de los soportes giratorios 226, 228 para proporcionar soporte adicional al yunque 220. La
porción del cuerpo 262 del miembro de bloqueo del yunque 260 se forma, además, con dos superficies de leva 263 configuradas para acoplar las superficies del extremo proximal 227, 229 de las paredes de los soportes giratorios 226, 228. Ver las Figuras 6 y 7. Varias modalidades del miembro de bloqueo del yunque pueden fabricarse a partir de, por ejemplo, el polímero de cristal líquido Vectra A435, materiales naturales o similares.
Las Figuras 6A y 7A ilustran un miembro alternativo de bloqueo del yunque 260' que puede moverse en respuesta al contacto por una porción o porciones de un cartucho de grapas 300. En al menos una forma, el miembro de bloqueo del yunque 260' comprende una porción del cuerpo 262 que tiene una lengüeta de soporte central que sobresale, distalmente, 264 formada en esta. Una ranura 266 se extiende a través de la porción del cuerpo 262 y de la lengüeta de soporte central 264 para permitir que la varilla de cuchilla 130 pase a través de ella. La porción del cuerpo 262 incluye, además, la barra de soporte que se extiende, proximalmente, 268' que se configura para recibirse de manera deslizante y retenerse dentro de una correspondiente abertura de soporte 270' en la guía del canal 79' de la unidad de cuello flexible 70'. Además, un miembro de desviación en forma de, por ejemplo, un muelle espiral 269 se soporta dentro de la abertura 270' para desviar el miembro de bloqueo del yunque 260' en la dirección distal "DD". El miembro de bloqueo del yunque 260' por lo demás funciona de manera igual que el miembro de bloqueo del yunque 260. Cuando el yunque 220 se monta al canal alargado 210, los soportes giratorios 230 se reciben dentro de sus correspondientes ranuras para soporte giratorio 214 en el
canal alargado 210, la lengüeta de soporte central 264 del miembro de bloqueo del yunque 260' se recibe entre las paredes de los soportes giratorios 226, 228 para proporcionar soporte adicional al yunque 220. La porción del cuerpo 262 del miembro de bloqueo del yunque 260 se forma, además, con dos superficies de leva 263 configuradas para acoplar las superficies del extremo proximal 227, 229 de las paredes de los soportes giratorios 226, 228. El segmento distal del tubo de cierre 170' funciona de manera igual que el segmento distal del tubo de cierre 170 descrito anteriormente.
Cartucho de grapas quirúrgicas
Varias modalidades incluyen un único y novedoso cartucho de grapas quirúrgicas 300 que se configura para interactuar con el sistema de bloqueo del yunque 250 cuando se instala en el canal alargado 210. Como puede verse en las Figuras 14 y 15, en al menos una forma, el cartucho de grapas quirúrgicas 300 incluye un cuerpo del cartucho 302 que puede fabricarse a partir de, por ejemplo, Vectra A435, 20 % PTFE/15 % GF, natural. El cuerpo del cartucho 302 se dimensiona y se conforma para recibirse dentro del canal alargado 210. En al menos una forma, el cuerpo del cartucho 302 se configura para asentarse en el canal alargado 210 de tal manera que se retiene de manera extraíble en este. El cuerpo del cartucho 302 puede formarse con una ranura dispuesta centralmente 304 en este para recibir la vanlla de cuchilla 130. A cada lado de la ranura 304, se proporcionan las filas 306, 308, 310 de aberturas para grapas 312 que se configuran para soportar una grapa quirúrgica en ellas. En la modalidad representada, las tres filas 306,
308, 310 se proporcionan a cada lado de la ranura 304. Las grapas quirúrgicas pueden soportarse en impulsores de grapas que se soportan móviles dentro de las aberturas para grapas 312. Además, apoyado dentro del cuerpo del cartucho de grapas 302 está un deslizador en cuña que se configura para su movimiento axial a través del cuerpo del cartucho 302 cuando entra en contacto con la varilla de corte. El deslizador en cuña se configura con miembros de accionamiento en forma de cuñas que entran en contacto con los impulsores de grapas y accionan los impulsores y sus correspondientes grapas hacia el yunque cerrado cuando el deslizador en cuña se acciona, distalmente, a través del cuerpo del cartucho 302. Los ejemplos de disposiciones de impulsores de grapas y disposiciones del deslizador en cuña que pueden emplearse se describen en detalles adicionales en la patente de Estados Unidos núm. 7,669,746, la descripción completa de la cual se incorpora en la presente descripción como referencia. En varias modalidades, para facilitar la instalación del deslizador en cuña y los impulsores en el cuerpo del cartucho 302, las bandejas metálicas del cartucho 314, 316 pueden unirse al cuerpo del cartucho 302 como se muestra en las Figuras 14 y 15. Las bandejas del cartucho 314 y 316 sirven para retener el deslizador en cuña y los impulsores dentro del cuerpo del cartucho 302.
En varias modalidades, el cuerpo del cartucho 302 tiene, adicionalmente, al menos un miembro de liberación conformado sobre este que sobresale en la dirección proximal. En la modalidad representada en la Figura 14, dos miembros de liberación 320 se conforman en el extremo
proximal 319 del cartucho 300. Cada uno de los miembros de liberación 320 tiene una forma de cuña que define una superficie inclinada pivotante 321 que se configura para soportar de manera giratoria una parte de la porción de montaje del yunque 223 sobre ellas.
Instalación de un cartucho de grapas
Una comprensión del funcionamiento de un sistema de bloqueo del yunque puede recabarse a partir de la referencia a las Figuras 16-25. Las Figuras 16 y 17 ilustran la posición del yunque 220 con respecto al canal alargado 210 antes de instalar un cartucho de grapas 300. Cuando está en esa posición "descargada" y abierta, el miembro de bloqueo del yunque 260 se desvía en la dirección distal por el resorte 269 de tal manera que las superficies de leva 263 en el miembro de bloqueo del yunque 260 entran en contacto con las superficies de extremo 227, 229 de las paredes de los soportes giratorios 226, 228. El miembro de bloqueo del yunque 260 empuja la porción de montaje del yunque 223 en la dirección distal "DD" de tal manera que los soportes giratorios 230 se asientan en sus respectivas muescas de bloqueo 218. Las superficies de leva 263 en el miembro de bloqueo del yunque 260, en cooperación con las superficies de la pared de extremo 227, 229, sirven, además, para girar y retener el yunque en la posición abierta como se muestra en las Figuras 16 y 17. Como puede verse en la Figura 16, cuando están en esa posición, las paredes de los soportes giratorios 226, 228 se apoyan en las superficies de balancín 248 en el soporte pivotante 240. Cuando están en esa posición, el cirujano no puede cerrar el yunque 220 mediante el accionamiento del disparador de cierre 152 para
avanzar el tubo de cierre distal 170. Debido a que los segmentos del tubo de cierre no pueden avanzar, distalmente, para cerrar el yunque 220, el disparador de cierre 152 no puede accionarse a su posición completamente cerrada por cuyo medio puede accionarse el gatillo de disparo 102. Así, cuando el cartucho 300 no está presente, no puede accionarse el efector de extremo 200.
Las Figuras 18 y 19 ¡lustran la inserción inicial del cartucho de grapas 300 en el canal alargado 210. Las Figuras 20 y 21 ilustran el efector de extremo 200 después de que el cartucho de grapas 300 se ha asentado, completamente, en el canal alargado 210. Como puede verse en la Figura 20, por ejemplo, cuando el cartucho 300 se ha asentado, completamente, los miembros de liberación 320 en el cartucho 300 acoplan en las paredes de los soportes giratorios 226, 228 y sirven para mover la porción de montaje del yunque 223 en una dirección proximal "PD" de tal manera que las paredes de los soportes giratorios 226, 228 se apoyan ahora de manera giratoria en los miembros de liberación 320. Como puede verse en la Figura 21 , cuando están en esa posición, la porción de montaje del yunque 223 se ha movido, proximalmente, de tal manera que los soportes giratorios 230 se mueven fuera de sus respectivas muescas de bloqueo 218 y dentro de la parte inferior del segmento de ranura curva 216 en una posición "accionable" por cuyo medio el yunque 220 puede cerrarse por rotación mediante el accionamiento del disparador de cierre 152.
Cuando el dispositivo 10 está en la posición de inicio y el cartucho de grapas 300 se ha cargado en el canal alargado como se describió,
anteriormente, ambos disparadores 152, 102 están hacia adelante y el yunque 220 se ha movido a la posición accionable, tal como sería típico después de insertar el efector de extremo cargado 200 a través de un trocar u otra abertura en una cavidad corporal. El instrumento 10 se manipula después por el clínico de tal manera que el tejido "T" que se va a grapar y cortar se posiciona entre el cartucho de grapas 300 y el yunque 200, como se representa en las Figuras 22 y 23. Como se describió, anteriormente, el movimiento del disparador de cierre 152 hacia la empuñadura 24 provoca que el segmento proximal del tubo de cierre 151 , la unidad de cuello flexible 70 y el segmento distal del tubo de cierre 170 se muevan, distalmente. Cuando el segmento distal del tubo de cierre 170 se mueve, distalmente, entra en contacto con un saliente de cierre 221 en el yunque 220. La presión del tejido capturado entre el yunque 220 y el cartucho de grapas 300 sirve para mover el yunque 220 de tal manera que los soportes giratorios 230 se posicionan para moverse dentro de los segmentos de ranura curva para soporte giratorio 216. El cirujano puede girar el yunque 220 con respecto al cartucho de grapas 300 para manipular y capturar el tejido "T" deseado en el efector de extremo 200. Cuando el segmento distal del tubo de cierre 170 entra en contacto con el saliente de cierre 221 , el yunque 220 gira hacia una posición sujeta. La varilla de cuchilla replegada 130 no impide la apertura y el cierre selectivos del yunque 220.
Una vez que el tejido "T" deseado se ha posicionado entre el yunque 220 y el cartucho 300, el clínico mueve el disparador de cierre 152 proximalmente hasta que se posiciona, directamente, adyacente a la
empuñadura 24, que bloquea el mango 20 en la posición cerrada y sujeta. Como puede verse en la Figura 25, cuando están en la posición completamente sujeta, los soportes giratorios del yunque 230 se localizan en el extremo superior de la porción de ranura curva 216 y la lengüeta del yunque 224 se recibe dentro de la abertura 176 en el segmento distal del tubo de cierre 170. Después de que se haya producido la sujeción del tejido, el clínico mueve el gatillo de disparo 102 proximalmente lo que provoca que la varilla de cuchilla 130 se mueva, distalmente, dentro del efector de extremo 200. En particular, la varilla de cuchilla 130 se mueve a través de la ranura 236 en la porción de la lengüeta pivotante 234 del yunque 220 y dentro de la ranura 304 en el cuerpo del cartucho 302 para entrar en contacto con el deslizador en cuña posicionado operativamente dentro del cartucho de grapas 300. Cuando la varilla de cuchilla 130 se acciona, distalmente, corta el tejido T y acciona el deslizador en cuña distalmente el cual provoca que las grapas se disparen, secuencialmente, para entrar en contacto conformador con la superficie inferior conformadora de grapas 222 del yunque 220. El clínico continúa el movimiento del gatillo de disparo 102 hasta traerlo proximal al disparador de cierre 152 y la empuñadura 24. De esa manera, todos los extremos de las grapas se doblan como resultado de su acoplamiento con el yunque 220. El borde de corte 132 ha atravesado, completamente, a través del tejido T. El proceso se completa mediante la liberación del gatillo de disparo 102 y al oprimir después el botón de liberación 120 mientras se aprieta, simultáneamente, el disparador de cierre 152. Tal acción resulta en el movimiento del segmento distal del tubo de cierre 170 en la dirección proximal
"D". Cuando la lengüeta del yunque 224 se acopla por la abertura 176 en el segmento distal del tubo de cierre 170 esto provoca que el yunque se abra, giratoriamente. Las superficies de extremo 227, 229 entran de nuevo en contacto con las superficies de empuje 263 en el miembro de bloqueo del yunque 260 para girar el yunque a la posición abierta mostrada en las Figuras 20 y 21 para permitir que el cartucho gastado 300 se retire del canal alargado 210.
Las Figuras 26 a 42 ilustran un instrumento alternativo de grapado quirúrgico 10' que es similar en construcción y funcionamiento al instrumento de grapado quirúrgico 10 excepto por las diferencias descritas más adelante. Esta modalidad, por ejemplo, emplea el soporte pivotante 240' ilustrado en las Figuras 29 y 30. Como puede verse en las Figuras 27 y 28 una forma de un soporte pivotante 240' tiene una porción del cuerpo 242' que se configura para unirse al canal alargado 210. Por ejemplo, la porción del cuerpo 242' puede formarse con dos lengüetas de unión opuestas 243' que se configuran para acoplar y retener las aberturas de las lengüetas 211 (Figura 26) formadas en el canal alargado 210. Además, el soporte pivotante 240' tiene una porción base que se extiende, proximalmente, 244' que tiene una ranura 247' que se extiende a través de él para recibir, axialmente, la varilla de cuchilla 130. Varias modalidades del soporte pivotante 240' incluyen, además, superficies de balancín 248' formadas en la porción del cuerpo 242' para recibir de manera giratoria las paredes de los soportes giratorios 226, 228 del yunque 220 sobre estas.
Esta modalidad incluye, además, un sistema de bloqueo del yunque 250' que impide el cierre del yunque 220 cuando un cartucho de grapas
300' no se ha instalado, correctamente, en el canal alargado 210. Con referencia a las Figuras 29 y 30, por ejemplo, una modalidad de un sistema de bloqueo del yunque 250' incluye un miembro de bloqueo del yunque 400 que se configura para entrar en contacto con la porción de montaje del yunque 223 como se describirá en más detalle más adelante. En al menos una forma, el miembro de bloqueo del yunque 400 comprende un resorte de hoja 402 que tiene una ranura 404 en este para acomodar la varilla de cuchilla 130. El resorte de hoja 402 se configura para su unión a la guía del canal 79" de la unidad de cuello flexible 70".
Como puede verse en las Figuras 31 y 32, en al menos una forma, el cartucho de grapas quirúrgicas 300' incluye un cuerpo del cartucho 302' que es similar al cartucho de grapas quirúrgicas 300 descrito anteriormente, excepto por las diferencias descritas más adelante. La Figura 29 representa un deslizador en cuña 360 que se soporta dentro del cuerpo del cartucho 302' de la manera descrita anteriormente. En esta modalidad, la porción del extremo proximal 303 del cuerpo del cartucho 302' se configura para entrar en contacto con una parte de la porción de montaje del yunque 223 e impulsa el yunque 220 proximalmente cuando el cuerpo del cartucho 302' se asienta dentro del canal alargado 210.
Una comprensión del funcionamiento de un sistema de bloqueo del yunque 250' puede recabarse a partir de la referencia a las Figuras 33 a 43. Las Figuras 33 y 34 ilustran la posición del yunque 220 con respecto al canal alargado 210 antes de instalar un cartucho de grapas 300'. Cuando está en esa posición "descargada", el miembro de bloqueo del yunque 400 ha acoplado la superficie superior de la porción de montaje del yunque 223 de tal
manera que el yunque 220 gira a la posición abierta en las superficies de balancín 248' en el soporte pivotante 140'. Cuando está en esa posición, los soportes giratorios 230 se asientan en sus respectivas muescas de bloqueo 218. Cuando está en esa posición, el cirujano no puede cerrar el yunque 220 mediante el accionamiento del disparador de cierre 152 para avanzar el tubo de cierre distal 170'. Debido a que los segmentos del tubo de cierre no pueden avanzarse, distalmente, para cerrar el yunque 220, el disparador de cierre 152 no puede accionarse a su posición completamente cerrada por cuyo medio puede accionarse el gatillo de disparo 102. Así, cuando el cartucho 300' no está presente, no puede accionarse el efector de extremo 200.
Las Figuras 35 y 36 ilustran la inserción inicial del cartucho de grapas 300' en el canal alargado 210. Las Figuras 37 y 38 ilustran el efector de extremo 200 después de que el cartucho de grapas 300' se ha asentado, completamente, en el canal alargado 210. Como puede verse en la Figura 37, por ejemplo, cuando el cartucho 300' se ha asentado, completamente, la porción del extremo proximal 303 en el cartucho 300' se acopla a las paredes de los soportes giratorios 226, 228 y sirve para mover la porción de montaje del yunque 223 en una dirección proximal "PD" de tal manera que los soportes giratorios se mueven fuera de sus respectivas muescas de bloqueo 218 y en una posición accionable en la parte inferior del segmento de ranura curva 216. El yunque 220 está ahora en posición de cerrarse por rotación mediante el accionamiento del disparador de cierre 152.
Cuando el dispositivo 10' está en la posición de inicio y el cartucho
de grapas 300' se ha cargado en el canal alargado 210 como se describió, anteriormente, ambos disparadores 152, 102 están hacia adelante y el yunque 220 está abierto y en la posición accionable, tal como sería típico después de insertar el efector de extremo cargado 200 a través de un trocar u otra abertura en una cavidad corporal. El instrumento 10' se manipula después por el clínico de tal manera que el tejido "T" que se va a grapar y cortar, se posiciona entre el cartucho de grapas 300' y el yunque 220, como se representa en las Figuras 39 y 40. Como se describió, anteriormente, el movimiento del disparador de cierre 152 hacia la empuñadura 24 provoca que el segmento proximal del tubo de cierre 151 , la unidad de cuello flexible 70" y el segmento distal del tubo de cierre 170" se muevan, distalmente. Cuando el segmento distal del tubo de cierre 170' se mueve, distalmente, entra en contacto con un saliente de cierre 221 en el yunque 220. La presión del tejido capturado entre el yunque 220 y el cartucho de grapas 300' sirve para mover el yunque 220 de tal manera que los soportes giratorios 230 se posicionan para moverse dentro de los segmentos de ranura curva para soporte giratorio 216. El cirujano puede girar el yunque 220 con respecto al cartucho de grapas para manipular y capturar el tejido "T" deseado en el efector de extremo 200. Cuando el segmento distal del tubo de cierre 170" entra en contacto con el saliente de cierre 221 , el yunque 220 gira hacia una posición sujeta. La varilla de cuchilla replegada 30 no impide la apertura y el cierre selectivos del yunque 220.
Una vez que el tejido "T" deseado se ha posicionado entre el yunque 220 y el cartucho 300', el clínico mueve el disparador de cierre 152
proximalmente hasta que se posiciona, directamente, adyacente a la empuñadura 24, que bloquea el mango 20 en la posición cerrada y sujeta. Como puede verse en la Figura 42, cuando están en la posición completamente sujeta, los soportes giratorios del yunque 230 se localizan en el extremo superior de la porción de ranura curva 216 y la lengüeta del yunque 224 se recibe dentro de la abertura 176 en el segmento distal del tubo de cierre 170". Después de que se haya producido la sujeción del tejido, el clínico mueve el gatillo de disparo 102 proximalmente que provoca que la varilla de cuchilla 130 se mueva, distalmente, dentro del efector de extremo 200. En particular, la varilla de cuchilla 130 se mueve a través de la ranura 236 en la porción de la lengüeta pivotante 234 del yunque 220 y dentro de la ranura 304 en el cuerpo del cartucho 302' para entrar en contacto con el deslizador en cuña 360 posicionado operativamente en este. Cuando la varilla de cuchilla 130 se acciona, distalmente, corta el tejido T y acciona el deslizador en cuña 360 distalmente el cual provoca que las grapas se disparen, secuencialmente, para entrar en contacto conformador con la superficie inferior conformadora de grapas 222 del yunque 220. El clínico continúa el movimiento del gatillo de disparo 102 hasta traerlo proximal al disparador de cierre 152 y la empuñadura 24. De esa manera, todos los extremos de las grapas se doblan como resultado de su acoplamiento con el yunque 220. El borde de corte 132 ha atravesado, completamente, a través del tejido T. El proceso se completa mediante la liberación del gatillo de disparo 102 y al oprimir después el botón de liberación 120 mientras se aprieta, simultáneamente, el disparador de
cierre 152. Tal acción resulta en el movimiento del segmento distal del tubo de cierre 170" en la dirección proximal "D". Cuando la lengüeta del yunque 224 se acopla por la abertura 176 en el segmento distal del tubo de cierre 170", provoca que el yunque 220 se abra, giratoriamente. El miembro de bloqueo del yunque 400 aplica una fuerza de desviación a la superficie superior de las paredes de los soportes giratorios de la porción de montaje del yunque 223 y sirve para girar el yunque a la posición abierta mostrada en las Figuras 33 y 34 para permitir que el cartucho gastado 300' se retire del canal alargado 210.
Las varias características únicas y novedosas de las modalidades mencionadas anteriormente sirven para impedir que el efector de extremo se cierre cuando un cartucho de grapas quirúrgicas no está presente o no se ha asentado, correctamente, dentro del canal alargado. Cuando el yunque está en la posición bloqueada en donde los soportes giratorios del yunque se retienen en sus respectivas muescas de bloqueo, el yunque se retiene en la posición abierta. Cuando está en la posición abierta, el efector de extremo no puede insertarse, inadvertidamente, a través de un trocar. Debido a que se impide una carrera de cierre completa, el sistema de disparo no puede accionarse. Así, incluso si el clínico intenta accionar el gatillo de disparo, el dispositivo no disparará. Varias modalidades proporcionan, además, al clínico con realimentación que indica que un cartucho o no está presente o no se ha instalado, correctamente, en el canal alargado.
Los dispositivos descritos en la presente descripción pueden diseñarse para desecharse después de un solo uso, o pueden diseñarse para
usarse múltiples veces. En cualquier caso, sin embargo, el dispositivo puede repararse para volver a usarlo al menos después de un uso. La reparación puede incluir cualquier combinación de pasos de desensamble del dispositivo, seguido por la limpieza o reemplazo de piezas particulares, y su montaje posterior. Particularmente, el dispositivo puede desensamblarse, y cualquier número de piezas o partes particulares del dispositivo pueden reemplazarse o retirarse selectivamente en cualquier combinación. Después de la limpieza y/o reemplazo de partes particulares, el dispositivo puede volver a ensamblarse para usarse posteriormente en un centro de reacondicionamiento, o por un equipo quirúrgico, inmediatamente antes de un procedimiento quirúrgico. Las personas con experiencia en la materia apreciarán que para el reacondicionamiento de un dispositivo pueden usarse una variedad de técnicas para desensamblar, limpiar/reemplazar, y reensamblar. Tanto el uso de tales técnicas como el dispositivo reacondicionado están dentro del alcance de la presente solicitud.
Preferentemente, la invención descrita en la presente descripción se procesará antes de la cirugía. Primero, se obtiene un instrumento nuevo o usado y se limpia, si es necesario. El instrumento puede esterilizarse después. En una técnica de esterilización, se coloca el instrumento en un recipiente cerrado y sellado, tal como una bolsa plástica o TYVEK. Después, el recipiente e instrumento se colocan en un campo de radiación que pueda penetrar al recipiente, tal como radiaciones gamma, rayos x o electrones de alta energía. La radiación mata las bacterias en el instrumento y en el recipiente. El instrumento esterilizado puede almacenarse, después, en un recipiente estéril. El recipiente
sellado mantiene al instrumento estéril hasta que se abra en el centro médico.
Cualquier patente, publicación u otro material de descripción, total o parcial, que se dice que se incorpora como referencia en la presente descripción se incorpora en la presente descripción solamente en la medida que los materiales incorporados no estén en conflicto con las definiciones, declaraciones u otro material de descripción existente que se expone en la presente descripción. Como tal, y en la medida necesaria, la descripción como se expone, explícitamente, en la presente invención reemplaza cualquier material en conflicto incorporado a la presente invención como referencia. Cualquier material, o porción de este, que se incorpora como referencia en la presente invención, pero que está en conflicto con las definiciones, enunciados u otro material descrito incorporado que se exponen en esta descripción solo se incorporará en la medida que ningún conflicto surja entre aquel material incorporado y el material descrito existente.
Si bien se ha descrito que esta invención tiene diseños ilustrativos, la presente invención puede modificarse aún más siempre que esas modificaciones estén dentro del espíritu y alcance de la descripción. Por lo tanto, esta solicitud pretende cubrir cualquier variación, uso o adaptación de la invención siempre que se basen en los principios generales indicados en ella. Además, esta solicitud está prevista para cubrir todas las desviaciones de la presente invención que puedan surgir dentro de la práctica conocida o habitual en la materia a la cual pertenece la presente invención.
Claims (20)
1. Un instrumento de grapado quirúrgico que comprende: un efector de extremo que comprende: un canal alargado configurado para soportar, operativamente, un cartucho de grapas quirúrgicas en este; y un yunque soportado móvil en el canal alargado entre una posición abierta y posiciones cerradas en respuesta a una aplicación de movimientos de apertura y cierre aplicados a este; y un miembro de bloqueo del yunque que coopera con el yunque para retener el yunque en una posición abierta cuando un cartucho de grapas no se ha instalado en el canal alargado e impedir que el yunque se mueva a una posición cerrada hasta que el cartucho de grapas se haya asentado dentro del canal alargado.
2. El instrumento de grapado quirúrgico de conformidad con la reivindicación 1 , caracterizado además porque el yunque comprende una porción de montaje del yunque soportada de manera giratoria en el canal alargado y en donde el miembro de bloqueo del yunque se desvía para entrar en contacto con la porción de montaje del yunque.
3. El instrumento de grapado quirúrgico de conformidad con la reivindicación 2, caracterizado además porque la porción de montaje del yunque comprende, además, un par de soportes giratorios del yunque opuestos que se reciben móviles en las correspondientes ranuras para soporte giratorio en el canal alargado.
4. El instrumento de grapado quirúrgico de conformidad con la reivindicación 3, caracterizado además porque cada ranura para soporte giratorio del yunque comprende: una muesca de bloqueo para recibir en ella el correspondiente soporte giratorio del yunque cuando el cartucho de grapas quirúrgicas no se ha asentado dentro del canal alargado; y un segmento de ranura curva para recibir en ella el correspondiente soporte giratorio del yunque cuando el cartucho se haya asentado dentro del canal alargado de tal manera que el correspondiente soporte giratorio del yunque puede atravesarse móvil dentro del segmento de ranura curva después de la aplicación de un movimiento de cierre al yunque.
5. El instrumento de grapado quirúrgico de conformidad con la reivindicación 4, caracterizado además porque el miembro de bloqueo del yunque desvía el miembro de soporte del yunque para asentar y retener los soportes giratorios del yunque en las correspondientes muescas de bloqueo cuando el cartucho de grapas quirúrgicas no se ha asentado dentro del canal alargado.
6. El instrumento de grapado quirúrgico de conformidad con la reivindicación 5, caracterizado además porque la porción de montaje del yunque se configura para girar sobre una porción del canal alargado.
7. El instrumento de grapado quirúrgico de conformidad con la reivindicación 6, caracterizado además porque la porción de montaje del yunque comprende una lengüeta pivotante configurada para girar sobre un soporte pivotante soportado dentro del canal alargado.
8. El instrumento de grapado quirúrgico de conformidad con la reivindicación 2, caracterizado además porque el miembro de bloqueo del yunque comprende: una porción del cuerpo configurada para entrar en contacto con la porción de montaje del yunque; y un miembro de desviación que coopera con la porción del cuerpo para desviar la porción del cuerpo para entrar en contacto con la porción de montaje del yunque.
9. El instrumento de grapado quirúrgico de conformidad con la reivindicación 8, caracterizado además porque la porción del cuerpo incluye sobre ella al menos una superficie de leva para entrar en contacto con la porción de montaje del yunque para llevar el yunque a la posición abierta cuando el cartucho de grapas quirúrgicas no se ha asentado en el canal alargado.
10. El instrumento de grapado quirúrgico de conformidad con la reivindicación 2, caracterizado además porque el miembro de bloqueo del yunque comprende un resorte de hoja configurado para entrar en contacto de presión con la porción de montaje del yunque.
11. Un instrumento de grapado quirúrgico que comprende: un mango; una unidad de vástago alargado acoplada operativamente al mango; un sistema de cierre soportado operativamente por el mango para generar los movimientos de cierre y apertura en respuesta al accionamiento de un disparador de cierre soportado operativamente por el mango; un canal alargado acoplado a la unidad de vástago alargado; un yunque que incluye una porción de montaje del yunque soportada móvil en el canal alargado entre una posición abierta y posiciones cerradas en respuesta a la aplicación de movimientos de apertura y cierre transmitidos a esta mediante la unidad de vástago alargado; un miembro de bloqueo del yunque soportado operativamente por la unidad de vástago alargado para su acoplamiento móvil con la porción de montaje del yunque; y un cartucho de grapas quirúrgicas configurado para asentarse dentro del canal alargado y que coopera con la porción de montaje del yunque de tal manera que: cuando el cartucho de grapas quirúrgicas no se ha asentado dentro del canal alargado, el miembro de bloqueo del yunque coopera con la porción de montaje del yunque para retener el yunque en la posición abierta; y cuando el cartucho de grapas quirúrgicas se asienta dentro del canal alargado, el cartucho de grapas mueve la porción de montaje del yunque a una posición, caracterizado además porque el yunque puede cerrarse después de la aplicación de los movimientos de cierre a este.
12. El instrumento de grapado quirúrgico de conformidad con la reivindicación 11 , caracterizado además porque la porción de montaje del yunque comprende, además, un par de soportes giratorios del yunque opuestos que se reciben móviles en las correspondientes ranuras para soporte giratorio en el canal alargado.
13. El instrumento de grapado quirúrgico de conformidad con la reivindicación 12, caracterizado además porque cada ranura para soporte giratorio comprende: una muesca de bloqueo para recibir en ella el correspondiente soporte giratorio del yunque cuando el cartucho de grapas quirúrgicas no se ha asentado dentro del canal alargado; y un segmento de ranura curva para recibir el correspondiente soporte giratorio del yunque en este cuando el cartucho de grapas quirúrgicas se haya asentado dentro del canal alargado de tal manera que el correspondiente soporte giratorio del yunque puede atravesarse móvil en este después de la aplicación de un movimiento de cierre al yunque.
14. El instrumento de grapado quirúrgico de conformidad con la reivindicación 13, caracterizado además porque el cartucho de grapas quirúrgicas se configura para entrar en contacto con la porción de montaje del yunque cuando el cartucho de grapas quirúrgicas se haya asentado en el canal alargado para mover la porción de montaje del yunque de tal manera que los soportes giratorios del yunque se mueven desde las correspondientes muescas de bloqueo hasta el segmento correspondiente de ranura curva.
15. El instrumento de grapado quirúrgico de conformidad con la reivindicación 14, caracterizado además porque el cartucho de grapas quirúrgicas comprende: un cuerpo del cartucho configurado para asentarse dentro del canal alargado; y al menos una porción pivotante configurada para entrar en contacto giratorio con la porción de montaje del yunque cuando el cartucho de grapas quirúrgicas se haya asentado dentro del canal alargado.
16. El instrumento de grapado quirúrgico de conformidad con la reivindicación 15, caracterizado además porque al menos la única porción pivotante comprende un par de miembros pivotantes en forma de cuña formados en un extremo proximal del cuerpo del cartucho caracterizado además porque cada uno de los miembros pivotantes define una superficie inclinada pivotante para entrar en contacto con una parte correspondiente de la porción de montaje del yunque.
17. El instrumento de grapado quirúrgico de conformidad con la reivindicación 1 , caracterizado además porque el miembro de bloqueo del yunque comprende: una porción del cuerpo configurada para entrar en contacto con la porción de montaje del yunque; y un miembro de desviación que coopera con la porción del cuerpo para desviar la porción del cuerpo para entrar en contacto con la porción de montaje del yunque.
18. El instrumento de grapado quirúrgico de conformidad con la reivindicación 11 , caracterizado además porque el miembro de bloqueo del yunque comprende un resorte de hoja configurado para entrar en contacto de presión con la porción de montaje del yunque.
19. Un cartucho de grapas quirúrgicas para usarse con un instrumento de grapado quirúrgico que incluye un efector de extremo con un yunque que se soporta en una posición abierta hasta que se mueve a una posición accionable, en donde el yunque puede moverse a las posiciones cerradas en respuesta a un movimiento de cierre aplicado a este por un sistema de cierre, el cartucho de grapas quirúrgicas que comprende un cuerpo del cartucho dimensionado para asentarse de manera extraíble dentro de una porción del efector de extremo de tal manera que una porción del cuerpo del cartucho entra en contacto con el yunque y mueve el yunque desde la posición abierta hasta la posición accionable cuando se asienta dentro del efector de extremo.
20. El cartucho de grapas quirúrgicas de conformidad con la reivindicación 19, caracterizado además porque el cuerpo del cartucho comprende, además, un par de miembros pivotantes en forma de cuña formados en un extremo proximal del cuerpo del cartucho, en donde cada uno de los miembros pivotantes define una superficie inclinada pivotante para entrar en contacto con una porción correspondiente del yunque.
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PCT/US2013/031423 WO2013148253A2 (en) | 2012-03-26 | 2013-03-14 | Surgical stapling device with lockout system for preventing actuation in the absence of an installed staple cartridge |
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US9078653B2 (en) | 2015-07-14 |
CN104220012A (zh) | 2014-12-17 |
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WO2013148253A3 (en) | 2014-03-13 |
BR112014023954B1 (pt) | 2021-04-20 |
US20150289874A1 (en) | 2015-10-15 |
RU2640947C2 (ru) | 2018-01-12 |
EP3878379A1 (en) | 2021-09-15 |
MX346997B (es) | 2017-04-06 |
EP3653138C0 (en) | 2023-11-29 |
CN104220012B (zh) | 2017-09-29 |
WO2013148253A2 (en) | 2013-10-03 |
US10166025B2 (en) | 2019-01-01 |
EP3653138A1 (en) | 2020-05-20 |
EP2833803A2 (en) | 2015-02-11 |
RU2014143016A (ru) | 2016-05-20 |
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JP2015512715A (ja) | 2015-04-30 |
US20130248577A1 (en) | 2013-09-26 |
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EP2833803B1 (en) | 2019-12-25 |
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