MXPA06009780A - Tijeras quirurgicas ultrasonicas y metodo para sellar un vaso sanguineo usando las mismas. - Google Patents
Tijeras quirurgicas ultrasonicas y metodo para sellar un vaso sanguineo usando las mismas.Info
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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
- A61B17/32—Surgical cutting instruments
- A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
- A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
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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
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
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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
- A61B17/28—Surgical forceps
- A61B17/2812—Surgical forceps with a single pivotal connection
- A61B17/282—Jaws
- A61B2017/2825—Inserts of different material in jaws
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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
- A61B17/32—Surgical cutting instruments
- A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
- A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
- A61B2017/320093—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw additional movable means performing cutting operation
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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
- A61B17/32—Surgical cutting instruments
- A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
- A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
- A61B2017/320094—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw additional movable means performing clamping operation
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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
- A61B17/32—Surgical cutting instruments
- A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
- A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
- A61B2017/320095—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw with sealing or cauterizing means
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Abstract
Unas tijeras quirurgicas ultrasonicas incluyen una cuchilla quirurgica ultrasonica, un brazo de sujecion operable para abrir y cerrar hacia la cuchilla, y una almohadilla de tejido unida al brazo de sujecion; un metodo para sellar un vaso sanguineo de un paciente incluye obtener unas tijeras quirurgicas ultrasonicas y posicionar el vaso sanguineo entre la cuchilla y la almohadilla de tejido; se opera el brazo de sujecion para ejercer una presion media de coadaptacion sobre el vaso sanguineo entre e incluyendo 4.218 cm/kg2 y 14.763 cm/kg2; se hace vibrar ultrasonicamente la cuchilla para seccionar y sellar el vaso sanguineo.
Description
TIJERAS QUIRÚRGICAS ULTRASÓNICAS Y MÉTODO PARA SELLAR UN VASO SANGUÍNEO USANDO LAS MISMAS
REFERENCIA A SOLICITUDES RELACIONADAS
La presente solicitud reclama el beneficio de prioridad de la solicitud de patente provisional de E.U.A. con número de serie 60/548,308, presentada el 27 de febrero de 2004, cuyo contenido se incorpora aquí por referencia. Esta solicitud contiene material relacionado con la solicitud de patente de propiedad común No. 10/289,787, presentada el 7 de noviembre de 2002, titulada "Ultrasonic Clamp Coagulator Apparatus Having an Improved Camping End-Effector", cuyo contenido se incorpora aquí por referencia.
CAMPO DE LA INVENCIÓN
La presente invención se refiere generalmente a instrumentos quirúrgicos, y muy particularmente a tijeras quirúrgicas ultrasónicas y a un método para sellar un vaso sanguíneo usando unas tijeras quirúrgicas ultrasónicas.
ANTECEDENTES DE LA INVENCIÓN
Se conocen instrumentos quirúrgicos ultrasónicos que incluyen unas tijeras quirúrgicas ultrasónicas que tienen una cuchilla quirúrgica ultrasónica, un brazo de sujeción operable para abrir y cerrar hacia la cuchilla, una almohadilla de tejido unida al brazo de sujeción y que incluye un área de superficie de sujeción de 0.21 cm2, y un dispositivo para ejercer una fuerza de sujeción de 0.681 kg sobre el brazo de sujeción que crea una presión de sujeción de 3.16 kg/cm2 (kilogramos por centímetro cuadrado) sobre un vaso sanguíneo que es colocado entre el área de superficie de sujeción de la almohadilla de tejido y la cuchilla. Cabe notar que el área de superficie de sujeción es el área en donde la cuchilla y la almohadilla de tejido están en estrecha proximidad cuando el brazo de sujeción está en una posición cerrada. Se describen dispositivos ilustrativos en las patentes de E.U.A con números de serie 5,322,055 y 6,325,811 , cuyos contenidos se incorporan aquí por referencia. El resultado de la cuchilla quirúrgica ultrasónica que vibra ultrasónicamente y la presión de sujeción sobre el vaso sanguíneo es una coaptación del vaso sanguíneo (juntar las paredes del vaso sanguíneo), un corte transversal (un corte) del vaso sanguíneo coaptado, y una coagulación (un sellado) de los extremos cortados coaptados del vaso sanguíneo. Se sabe que los tiempos de corte transversal del vaso sanguíneo pueden disminuir con la aplicación de una fuerza de sujeción más alta. Sin embargo, esto no se hace porque se piensa convencionalmente que la disminución del tiempo de
corte transversal del vaso sanguíneo usando una fuerza de sujeción más alta conducirá a una degradación en el rendimiento de la coagulación (es decir, una reducción de la presión de ruptura de un extremo sellado del vaso sanguíneo cortado transversalmente). Las tijeras quirúrgicas ultrasónicas convencionales no se usan en vasos sanguíneos mayores que 3 mm debido a que la fuerza de sujeción usada es inadecuada para la coaptación apropiada. Sin embargo, existe la necesidad en la industria de dispositivos médicos de unas tijeras quirúrgicas ultrasónicas mejoradas y métodos mejorados para sellar un vaso sanguíneo usando unas tijeras quirúrgicas ultrasónicas.
BREVE DESCRIPCIÓN DE LA INVENCIÓN
Un primer método de la invención es sellar un vaso sanguíneo de un paciente e incluye los pasos a) a d). El paso a) incluye obtener unas tijeras quirúrgicas ultrasónicas que incluyen una cuchilla quirúrgica ultrasónica, un brazo de sujeción operable para abrir y cerrar hacia la cuchilla y una almohadilla de tejido unida al brazo de sujeción. El paso b) incluye colocar el vaso sanguíneo entre la cuchilla y la almohadilla de tejido. El paso c) incluye operar el brazo de sujeción para ejercer una presión de coaptación promedio sobre el vaso sanguíneo entre e incluyendo 4.22 y 14.76 kg/cm2. El paso d) incluye hacer vibrar ultrasónicamente la cuchilla para cortar transversalmente y sellar el vaso sanguíneo.
Una primera modalidad de la invención es para unas tijeras quirúrgicas ultrasónicas que incluyen una cuchilla quirúrgica ultrasónica, un brazo de sujeción y una almohadilla de tejido. El brazo de sujeción es operable para abrir y cerrar hacia la cuchilla. La almohadilla de tejido se une al brazo de sujeción. Las tijeras quirúrgicas ultrasónicas también incluyen un dispositivo para ejercer una fuerza de sujeción sobre el brazo de sujeción para crear una presión de sujeción promedio entre e incluyendo 4.22 y 14.76 kg/cm2 sobre el tejido colocado entre la almohadilla de tejido y la cuchilla. Una segunda modalidad de la invención es para unas tijeras quirúrgicas ultrasónicas que incluyen una cuchilla quirúrgica ultrasónica, un brazo de sujeción y una almohadilla de tejido. El brazo de sujeción es operable para abrir y cerrar hacia la cuchilla. La almohadilla de tejido se une al brazo de sujeción. Las tijeras quirúrgicas ultrasónicas también incluyen un mecanismo para limitar una fuerza de sujeción aplicada por el usuario sobre el brazo de sujeción para crear una presión de sujeción promedio entre y que incluye 4.22 y 14.76 kg/cm2 sobre el tejido colocado entre la almohadilla de tejido y la cuchilla. Varios beneficios y ventajas se obtienen de uno o más del método y las modalidades de la invención. Al ejercer una presión de coaptación de las tijeras quirúrgicas ultrasónicas de 4.22 y 14.76 kg/cm2 se provee un sellado de vaso sanguíneo mejorado con tiempos de corte transversal más cortos sobre vasos sanguíneos de 3 mm o más pequeños de lo que es posible convencionalmente y se provee sellado de vaso sanguíneo
con tiempos de corte transversal y presiones de ruptura aceptables sobre vasos sanguíneos mayores de de 3 mm, lo cual no es convencionalmente posible. Los solicitantes encontraron experimentalmente que al aplicar una presión de coaptación de las tijeras quirúrgicas ultrasónicas que varía de de 4.22 y 14.76 kg/cm2 (correspondiente a un área de superficie de sujeción de 0.21 cm2, y una fuerza de sujeción que varía de 0.908 a 3.178 kg) sobre vasos sanguíneos de 4.5 mm a 5 mm de diámetro dio por resultado un sellado de vasos sanguíneos exitoso con tiempos de corte transversal de 2 a 4 segundos y con presiones de ruptura generalmente de 500 a 700 mm Hg comparado con un tiempo de corte transversal de por arriba de 9 segundos y una presión de ruptura generalmente de 100 mm Hg para una presión de sujeción de 3.16 kg/cm2 (correspondiente a un área de superficie de sujeción completamente enganchada de 0.21 cm2 y una fuerza de sujeción de 0.681 kg). Los solicitantes también encontraron experimentalmente una presión de coaptación de las tijeras quirúrgicas ultrasónicas que varía de 8.436 kg/cm2 a 12.65 kg/cm2 (correspondiente a un área de superficie de sujeción completamente enganchada de 0.21 cm2 y una fuerza de sujeción que varía de 1.81 kg a 2.72 kg) sobre un vaso sanguíneo de 5 mm a 7 mm de diámetro dio por resultado un sellado de vasos sanguíneos exitoso con tiempos de corte transversal de 1.5 a 2.0 segundos y con presiones de ruptura generalmente de 500 mm Hg comparado con un tiempo de corte transversal generalmente de 4.5 segundos y una presión de ruptura generalmente de 30
mm Hg para una presión de sujeción de 3.16 kg/cm2 (correspondiente a un área de superficie de sujeción completamente enganchada de 0.21 cm2 y una fuerza de sujeción de 0.681 kg). La presente invención tiene, sin limitación, aplicación en cuchillas quirúrgicas ultrasónicas rectas o curvas como se describe en las patentes incorporadas por referencia para usarse en procedimientos abiertos o endoscópicos así como instrumentos auxiliados por robótica.
BREVE DESCRIPCIÓN DE LOS DIBUJOS
La figura 1 es un diagrama de bloques de un método de la invención; La figura 2 es una vista en elevación lateral esquemática de una porción de una primera modalidad de unas tijeras quirúrgicas ultrasónicas de la invención que, en una aplicación, se usa para realizar el método e la figura
1 ; La figura 3 es una vista en elevación lateral esquemática de una porción de una segunda modalidad de unas tijeras quirúrgicas ultrasónicas de la invención; La figura 4 es una vista en sección transversal de las tijeras quirúrgicas ultrasónicas de la figura 2, tomada a lo largo de las líneas 4-4 de la figura 2; y La figura 5 es una vista, como en la figura 4, pero de una
construcción diferente de las tijeras quirúrgicas ultrasónicas de la figura 2.
DESCRIPCIÓN DETALLADA DE LA INVENCIÓN
Antes de explicar la presente invención en detalle, cabe señalar que la invención no está limitada en su aplicación o uso a los detalles de construcción y disposición de partes ilustradas en los dibujos anexos y la descripción. Las modalidades ilustrativas de la invención se pueden ¡mplementar o incorporar en otras modalidades, variaciones y modificaciones, y se pueden poner en práctica o llevar a cabo de varias maneras. Además, a menos que se indique otra cosa, los términos y expresiones utilizados aquí se han escogido para el propósito de describir las modalidades ilustrativas de la presente invención para la conveniencia del lector y no son para el propósito de limitar la invención. Se entiende que cualquiera o más de las modalidades, ejemplos, etc., descritos a continuación se pueden combinar con cualquiera o más de las otras modalidades, ejemplos, etc., descritos a continuación. Con referencia ahora a las figuras anexas, en las cuales números similares indican elementos similares, la figura 1 ilustra un método de la invención. El método es para sellar un vaso sanguíneo de un paciente e incluye los pasos a) a d). El paso a) es marcado como "obtener tijeras quirúrgicas ultrasónicas" en el bloque 10 de la figura 1. El paso a) incluye obtener unas tijeras quirúrgicas ultrasónicas que incluye una cuchilla
quirúrgica ultrasónica, un brazo de sujeción operable para abrir y cerrar hacia la cuchilla y una almohadilla de tejido unida al brazo de sujeción. El paso b) es marcado como "colocar el vaso sanguíneo" en el boque 12 de la figura 1. El paso b) incluye colocar el vaso sanguíneo entre la cuchilla y la almohadilla de tejido. El paso c) es marcado como "ejercer presión de coaptación" en el bloque 14 de la figura 1. El paso c) incluye operar el brazo de sujeción para ejercer una presión de coaptación promedio sobre el vaso sanguíneo entre e incluyendo 4.22 y 14.76 kg/cm2. El paso d) es marcado como "operar la cuchilla" en el bloque 16 de la figura 1. El paso d) incluye hacer vibrar ultrasónicamente la cuchilla para cortar transversalmente y sellar el vaso sanguíneo. En una ilustración del método de la invención, el paso b) incluye colocar la cuchilla y el brazo de sujeción con la cuchilla y la almohadilla de tejido rodeando al vaso sanguíneo de modo que el vaso sanguíneo es colocado entre la cuchilla y la almohadilla de tejido. En una aplicación del método de la invención, la presión de coaptación promedio en el paso c) es entre e incluyendo 8.43 y 12.65 kg/cm2. En una variación, la presión de coaptación promedio en el paso c) es sustancialmente de 10.54 kg/cm2. En un ejemplo del método, el vaso sanguíneo tiene un diámetro externo mayor que sustancialmente 3 mm. En una variación, el vaso sanguíneo tiene un diámetro externo entre e incluyendo 5.0 mm y 7.0 mm. En otro ejemplo, el vaso sanguíneo tiene un diámetro externo menor que o igual a sustancialmente 3 mm.
En una construcción ilustrativa que utiliza el método de la invención, como se muestra en la figura 4, la cuchilla 20 tiene una porción que se opone a la almohadilla de tejido 24 y que tiene una sección transversal sustancialmente redonda, y la almohadilla de tejido, que está unida al brazo de sujeción 22, tiene una sección transversal sustancialmente en forma de "T" con la parte inferior de la "T" definiendo un área de superficie de sujeción 26, el área de superficie de sujeción 26 está de frente sustancialmente hacia la cuchilla 20, y el paso b) coloca el vaso sanguíneo entre la cuchilla 20 y el área de superficie de sujeción 26. En una construcción diferente, como se muestra en la figura 5, la cuchilla 120 tiene una porción que se opone a la almohadilla de tejido 124 y que tiene una sección transversal sustancialmente cuadrada con un borde redondeado que define un área de superficie de sujeción 127, la almohadilla de tejido 124, que está unida al brazo de sujeción 122, tiene una sección transversal sustancialmente rectangular, el área de superficie de sujeción 127 de la cuchilla 120 está de frente sustancialmente hacia la almohadilla 124, y el paso b) coloca el vaso sanguíneo entre el área de superficie de sujeción 127 y la almohadilla de tejido 124. Otras cuchillas, conocidas por los expertos en la técnica, son igualmente útiles para poner en práctica esta invención. En una implementación del método de la invención, la almohadilla de tejido tiene un área de superficie de sujeción sustancialmente de 0.21 cm2. En una variación, el paso c) ejerce una fuerza de sujeción sobre el brazo de sujeción entre e incluyendo 0.908 a 3.178 kg. Cabe señalar que la
presión es fuerza por área unitaria, y que para la misma fuerza aplicada por el brazo de sujeción, la presión sobre la porción enganchada de un vaso sanguíneo que engancha completamente el área de superficie de sujeción entera es menor que la presión sobre la porción enganchada de un vaso sanguíneo que, debido al diámetro más pequeño, engancha sólo una fracción del área de superficie de sujeción. Las presiones aquí descritas son presiones vistas por tejido cuando el área de superficie de sujeción entera está en contacto con el tejido. Como se mencionó antes, un área de superficie de sujeción es el área en donde la cuchilla y la almohadilla de tejido están en estrecha proximidad cuando el brazo de sujeción está en una posición cerrada. Una primera modalidad de la invención es para unas tijeras quirúrgicas ultrasónicas 18 y se muestra en la figura 2. Las tijeras quirúrgicas ultrasónicas 18 incluyen una cuchilla quirúrgica ultrasónica 20, un brazo de sujeción 22, y una almohadilla de tejido 24. El brazo de sujeción 22 es operable para abrir y cerrar hacia la cuchilla 20. La almohadilla de tejido 24 se une al brazo de sujeción 22. Las tijeras quirúrgicas ultrasónicas 18 también incluyen medios 28 para ejercer una fuerza de sujeción sobre el brazo de sujeción 22 para crear una presión de sujeción entre e incluyendo 4.22 y 14.76 kg/cm2 sobre tejido colocado entre la almohadilla de tejido 24 y la cuchilla 20. En una posibilidad de la primera modalidad de la figura 2, los medios para crear una fuerza de sujeción 28 ¡ncluyen un motor que hace girar
uno del brazo de sujeción y la cuchilla en relación con el otro del brazo de sujeción y la cuchilla, en donde el motor es preseleccionado para hacer que un área de superficie de sujeción de tamaño conocido ejerza la presión deseada sobre tejido suficientemente grande para cubrir el área de superficie de sujeción. En otra posibilidad, los medios para crear una fuerza de sujeción 28 incluyen fijaciones por el usuario para fijar el valor o intervalo de la fuerza o presión, dichas fijaciones operando para seleccionar un voltaje o corriente para controlar un motor de par de torsión variable para hacer que una superficie de fijación de tamaño conocido ejerza la presión deseada o una presión dentro de un intervalo de presiones deseadas. En una posibilidad adicional, los medios para crear una fuerza de sujeción 28 incluyen un resorte de fuerza sustancialmente constante, que aplica una fuerza predeterminada al brazo de sujeción. En una variación, el resorte es de torsión en su aplicación de fuerza. En otra variación, el resorte es axial en su aplicación de fuerza. Cabe señalar que la patente de E.U.A. con número de serie 6,325,811 describe una modalidad de un diseño de resorte de fuerza constante. Otras posibilidades equivalentes se dejan al experto. En una aplicación de la primera modalidad de la figura 2, la presión de sujeción es entre e incluyendo 8.43 y 12.65 kg/cm2. En una variación, la presión de sujeción es sustancialmente de 10.54 kg/cm2. En una implementación de la primera modalidad de la figura 2, la almohadilla de tejido 24 tiene un área de superficie de sujeción 26 sustancialmente de 0.21 cm2. En una variación de esta implementación, la fuerza de sujeción sobre el brazo de
sujeción 22 es entre e incluyendo 0.908 a 3.178 kg. Una segunda modalidad de la invención es para unas tijeras quirúrgicas ultrasónicas 30 y se muestra en la figura 3. Las tijeras quirúrgicas ultrasónicas 30 incluyen una cuchilla quirúrgica ultrasónica 32, un brazo de sujeción 34 y una almohadilla de tejido 32. El brazo de sujeción 34 es operable para abrir y cerrar hacia la cuchilla 32. La almohadilla de tejido 36 está unida al brazo de sujeción 34. Las tijeras quirúrgicas ultrasónicas 30 también incluyen medios 40 para limitar una fuerza de sujeción aplicada por el usuario sobre el brazo de sujeción 34 para crear una presión de sujeción entre e incluyendo 4.22 y 14.76 kg/cm2 sobre tejido colocado entre la almohadilla de tejido 36 y la cuchilla 32. En una posibilidad de la segunda modalidad de la figura 3, los medios de limitación de fuerza 40 incluyen un mecanismo limitador de par de torsión como en una llave de par torsión convencional. Otras posibilidades equivalentes se dejan al experto. En una aplicación de la segunda modalidad de la figura 3, la presión de sujeción es entre e incluyendo 8.43 y 12.65 kg/cm2. En una variación, la presión de sujeción es sustancialmente de 10.54 kg/cm2. En una implementación de la segunda modalidad de la figura 3, la almohadilla de tejido 36 tiene un área de superficie de sujeción 38 de sustancialmente 0.21 cm2. En una variación de esta implementación, la fuerza de sujeción sobre el brazo de sujeción es entre e incluyendo 0.908 a 3.178 kg. Otras modalidades de las tijeras quirúrgicas ultrasónicas (no
mostradas) que se pueden usar en el método de la invención incluyen, sin limitación, aquellas que incluyen un sensor de fuerza y/o presión y una indicación detectada por el usuario de la fuerza y/o presión aplicada por el usuario medida por el sensor de fuerza y/o presión permitiendo al usuario controlar la fuerza o presión. Las indicaciones detectadas por el usuario incluyen, sin limitación, un valor o intervalo visualmente observado en un calibrador, un valor o intervalo visualmente observado en la pantalla de un monitor de computadora, un color o colores visualmente observados, una señal o comunicación audiblemente escuchada, una vibración táctilmente sentida, etc. Varios beneficios y ventajas se obtienen de uno o más del método y las modalidades de la invención. Al ejercer una presión de coaptación de las tijeras quirúrgicas ultrasónicas de 4.22 y 14.76 kg/cm2 se provee un sellado de vaso sanguíneo mejorado con tiempos de corte transversal más cortos sobre vasos sanguíneos de 3 mm o más pequeños de lo que es posible convencionalmente y se provee sellado de vaso sanguíneo con tiempos de corte transversal y presiones de ruptura aceptables sobre vasos sanguíneos mayores de de 3 mm, lo cual no es convencionalmente posible. Los solicitantes encontraron experimentalmente que al aplicar una presión de coaptación de las tijeras quirúrgicas ultrasónicas que varía de de 4.22 y 14.76 kg/cm2 (correspondiente a un área de superficie de sujeción de 0.21 cm2, y una fuerza de sujeción que varía de 0.908 a 3.178 kg) sobre
vasos sanguíneos de 4.5 mm a 5 mm de diámetro dio por resultado un sellado de vasos sanguíneos exitoso con tiempos de corte transversal de 2 a 4 segundos y con presiones de ruptura generalmente de 500 a 700 mm Hg comparado con un tiempo de corte transversal de por arriba de 9 segundos y una presión de ruptura generalmente de 100 mm Hg para una presión de sujeción de 3.16 kg/cm2 (correspondiente a un área de superficie de sujeción completamente enganchada de 0.21 cm2 y una fuerza de sujeción de 0.681 kg). Los solicitantes también encontraron experimentalmente una presión de coaptación de las tijeras quirúrgicas ultrasónicas que varía de 8.436 kg/cm2 a 12.65 kg/cm2 (correspondiente a un área de superficie de sujeción completamente enganchada de 0.21 cm2 y una fuerza de sujeción que varía de 1.81 kg a 2.72 kg) sobre un vaso sanguíneo de 5 mm a 7 mm de diámetro dio por resultado un sellado de vasos sanguíneos exitoso con tiempos de corte transversal de 1.5 a 2.0 segundos y con presiones de ruptura generalmente de 500 mm Hg comparado con un tiempo de corte transversal generalmente de 4.5 segundos y una presión de ruptura generalmente de 30 mm Hg para una presión de sujeción de 3.16 kg/cm2 (correspondiente a un área de superficie de sujeción completamente enganchada de 0.21 cm2 y una fuerza de sujeción de 0.681 kg). Aunque la presente invención se ha ilustrado mediante una descripción de varias modalidades y un método, no es intención de los solicitantes restringir o limitar el espíritu y alcance de las reivindicaciones anexas a dichos detalles. Muchas otras variaciones, cambios y sustituciones
se le ocurrirán al experto en la técnica sin apartarse del alcance de la invención. Por ejemplo, las tijeras quirúrgicas ultrasónicas y el método para sellar un vaso sanguíneo de la invención tienen aplicación en cirugía asistida por robótica tomando en cuenta las modificaciones obvias de dichos sistemas, componentes y métodos que han de ser compatibles con un sistema robótico. Se entenderá que la descripción anterior se provee a manera de ejemplo, y que otras modificaciones se le pueden ocurrir al experto en la técnica sin apartarse del alcance y espíritu de las reivindicaciones anexas.
Claims (20)
1.- Un método para sellar un vaso sanguíneo de un paciente que comprende los pasos de: a) obtener unas tijeras quirúrgicas ultrasónicas que incluyen una cuchilla quirúrgica ultrasónica, un brazo de sujeción operable para abrir y cerrar hacia la cuchilla y una almohadilla de tejido unida al brazo de sujeción; b) colocar el vaso sanguíneo entre la cuchilla y la almohadilla de tejido; c) operar el brazo de sujeción para ejercer una presión de coaptación promedio sobre el vaso sanguíneo entre e incluyendo 4.22 kg/cm2 y 14.76 kg/cm2; y d) hacer vibrar ultrasónicamente la cuchilla para cortar transversalmente y sellar el vaso sanguíneo.
2.- El método de conformidad con la reivindicación 1 , caracterizado además porque la presión de coaptación promedio en el paso c) es entre e incluyendo 8.436 kg/cm2 a 12.65 kg/cm2.
3.- El método de conformidad con la reivindicación 2, caracterizado además porque la presión de coaptación promedio en el paso c) es sustancialmente de 10.54 kg/cm2.
4.- El método de conformidad con la reivindicación 1 , caracterizado además porque el vaso sanguíneo tiene un diámetro externo más grande que sustancialmente 3 mm.
5.- El método de conformidad con la reivindicación 4, caracterizado además porque el vaso sanguíneo tiene un diámetro externo entre e incluyendo 4.5 mm a 5.0 mm.
6.- El método de conformidad con la reivindicación 4, caracterizado además porque el vaso sanguíneo tiene un diámetro externo entre e incluyendo 5.0 mm y
7.0 mm. 7 '.- El método de conformidad con la reivindicación 1 , caracterizado además porque la cuchilla tiene una porción que se opone a la almohadilla de tejido y que tiene una sección transversal sustancialmente redonda, y la almohadilla de tejido tiene una sección transversal sustancialmente en forma de "T" con la parte inferior de la "T" definiendo un área de superficie de sujeción, en donde el área de superficie de sujeción está de frente sustancialmente hacia la cuchilla, y en donde el paso b) coloca el vaso sanguíneo entre la cuchilla y el área de superficie de sujeción.
8.- El método de conformidad con la reivindicación 7, caracterizado además porque el área de superficie de sujeción es sustancialmente de 0.21 cm2.
9.- El método de conformidad con la reivindicación 8, caracterizado además porque el paso c) ejerce una fuerza de sujeción sobre el brazo de sujeción entre e incluyendo 0.908 kg a 3.178 kg.
10.- El método de conformidad con la reivindicación 1 , caracterizado además porque la cuchilla tiene una porción que se opone a la almohadilla de tejido y que tiene una sección transversal sustancialmente cuadrada con un borde redondeado que define un área de superficie de sujeción, en donde la almohadilla de tejido tiene una sección transversal sustancialmente rectangular en donde el área de superficie de sujeción está de frente sustancialmente hacia ia almohadilla, y en donde el paso b) coloca el vaso sanguíneo entre el área de superficie de sujeción y la almohadilla de tejido.
11.- Unas tijeras quirúrgicas ultrasónicas que comprenden: a) una cuchilla quirúrgica ultrasónica; b) un brazo de sujeción operable para abrir y cerrar hacia la cuchilla; c) una almohadilla de tejido unida al brazo de sujeción; y d) medios para ejercer una fuerza de sujeción sobre el brazo de sujeción para crear una presión de sujeción promedio entre e incluyendo 4.22 kg/cm2 y 14.76 kg/cm2 sobre el tejido colocado entre la almohadilla de tejido y la cuchilla.
12.- Las tijeras quirúrgicas ultrasónicas de conformidad con la reivindicación 11 , caracterizadas además porque la presión de sujeción promedio es entre e incluyendo 8.436 kg/cm2 a 12.65 kg/cm2.
13.- Las tijeras quirúrgicas ultrasónicas de conformidad con la reivindicación 12, caracterizadas además porque la presión de sujeción promedio es sustancialmente de 10.54 kg/cm2.
14.- Las tijeras quirúrgicas ultrasónicas de conformidad con la reivindicación 11 , caracterizadas además porque la almohadilla de tejido tiene un área de superficie de sujeción es sustancialmente de 0.21 cm2.
15.- Las tijeras quirúrgicas ultrasónicas de conformidad con la reivindicación 14, caracterizadas además porque la fuerza de sujeción es entre e incluyendo 0.908 kg a 3.178 kg.
16.- Unas tijeras quirúrgicas ultrasónicas que comprenden: a) una cuchilla quirúrgica ultrasónica; b) un brazo de sujeción operable para abrir y cerrar hacia la cuchilla; c) una almohadilla de tejido unida al brazo de sujeción; y d) medios para limitar una fuerza de sujeción aplicada por el usuario sobre el brazo de sujeción para crear una presión de sujeción promedio entre e incluyendo 4.22 kg/cm2 y 14.76 kg/cm2 sobre tejido colocado entre la almohadilla de tejido y la cuchilla.
17.- Las tijeras quirúrgicas ultrasónicas de conformidad con la reivindicación 16, caracterizadas además porque la presión de sujeción promedio es entre e incluyendo 8.436 kg/cm2 a 12.65 kg/cm2.
18.- Las tijeras quirúrgicas ultrasónicas de conformidad con la reivindicación 17, caracterizadas además porque la presión de sujeción promedio es sustancialmente de 10.54 kg/cm2.
19.- Las tijeras quirúrgicas ultrasónicas de conformidad con la reivindicación 16, caracterizadas además porque la almohadilla de tejido tiene un área de superficie de sujeción es sustancialmente de 0.21 cm2.
20.- Las tijeras quirúrgicas ultrasónicas de conformidad con la reivindicación 19, caracterizadas además porque la fuerza de sujeción es entre e incluyendo 0.908 kg a 3.178 kg.
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EP1742581B1 (en) | 2014-01-15 |
US20150351792A1 (en) | 2015-12-10 |
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