RU2559019C2 - Хирургический сшивающий инструмент с дозатором медицинских препаратов - Google Patents
Хирургический сшивающий инструмент с дозатором медицинских препаратов Download PDFInfo
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- A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
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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
- A61B17/00491—Surgical glue applicators
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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
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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
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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
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- A—HUMAN NECESSITIES
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- 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
- A61B17/07292—Reinforcements for staple line, e.g. pledgets
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- A—HUMAN NECESSITIES
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
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- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
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Abstract
Изобретение относится к медицине. Узел хирургического инструмента содержит корпус, режущий элемент и картридж для препарата. Режущий элемент имеет возможность перемещения относительно корпуса и содержит режущую поверхность, тело, включающее в себя первую поверхность, и паз, по меньшей мере частично определенный первой поверхностью. Картридж для препарата присоединен к корпусу и имеет полость, способную вмещать медицинский препарат. Паз режущего элемента сообщается по текучей среде с полостью. Паз выполнен с возможностью доставки медицинского препарата из полости, расположенной в непосредственной близости от режущей поверхности. Узел обеспечивает доставку медицинского препарата непосредственно к режущей поверхности режущего элемента. 2 н. и 13 з.п. ф-лы, 33 ил.
Description
ПЕРЕКРЕСТНЫЕ ССЫЛКИ НА СМЕЖНЫЕ ИЗОБРЕТЕНИЯ
Настоящая заявка является частичным продолжением заявки, испрашивающей приоритет в соответствии с §120 раздела 35 Кодекса законов США в отношении находящейся на одновременном рассмотрении заявки на патент США «ХИРУРГИЧЕСКИЙ СШИВАЮЩИЙ ИНСТРУМЕНТ С ДОЗАТОРОМ МЕДИЦИНСКИХ ПРЕПАРАТОВ, КОТОРЫЙ ПРИВОДИТСЯ В ДЕЙСТВИЕ С ПОМОЩЬЮ ЭЛЕКТРОАКТИВНОГО ПОЛИМЕРА» от 1 июня 2005 г. с серийным № 11/141753, заявляющей преимущество в соответствии с §119(e) раздела 35 Кодекса законов США предварительной заявки на патент США «ХИРУРГИЧЕСКИЙ ИНСТРУМЕНТ С ЭЛЕКТРИЧЕСКИМ ШАРНИРНЫМ МЕХАНИЗМОМ» от 28 июля 2004 г. с серийным № 60/591694, которые полностью включены в настоящий документ путем ссылки. Настоящая заявка также является частичным продолжением заявки, испрашивающей приоритет в соответствии с §120 раздела 35 Кодекса законов США в отношении находящейся на одновременном рассмотрении заявки на патент США «ОДНОРАЗОВОЕ ЗАГРУЗОЧНОЕ УСТРОЙСТВО И ХИРУРГИЧЕСКИЕ ИНСТРУМЕНТЫ, ВКЛЮЧАЮЩИЕ В СЕБЯ ДАННОЕ УСТРОЙСТВО» от 30 марта 2007 г. с серийным № 11/731521, которая является продолжением заявки на патент США «ОДНОРАЗОВОЕ ЗАГРУЗОЧНОЕ УСТРОЙСТВО И ХИРУРГИЧЕСКИЕ ИНСТРУМЕНТЫ, ВКЛЮЧАЮЩИЕ В СЕБЯ ДАННОЕ УСТРОЙСТВО» от 10 ноября 2005 г. с серийным № 11/271234, которые представлены в патентной публикации США № 7354447 от 8 апреля 2008 г. и полностью включены в настоящий документ путем ссылки.
ПРЕДПОСЫЛКИ СОЗДАНИЯ ИЗОБРЕТЕНИЯ
Настоящее изобретение в целом относится к хирургическим сшивающим инструментам, которые позволяют накладывать ряды скоб на ткань при одновременном рассечении ткани между рядами скоб, и, в частности, к внесению улучшений, которые относятся к таким сшивающим инструментам, а также к внесению улучшений в способы получения различных деталей таких сшивающих инструментов. В настоящей заявке также описаны устройства, которые относятся в целом и в различных вариантах осуществления к одноразовому загрузочному устройству, выполненному с возможностью присоединения к хирургическому инструменту многоразового использования, а также к хирургическим инструментам, включающим в себя одноразовое загрузочное устройство.
Специалистам в данной области известны хирургические инструменты, которые используют для одновременного выполнения продольных разрезов тканей и наложения рядов скоб на противоположные от разреза стороны. Ткани могут включать в себя, например, человеческие ткани, ткани животных, мембраны, а также другие органические субстанции. Как правило, такие хирургические инструменты включают в себя две противолежащие бранши, которые смыкаются, чтобы захватить или зажать ткань между ними и режущей поверхностью. При эндоскопическом или лапароскопическом применении противолежащие бранши могут проходить через канал канюли. Одна из браншей обычно удерживает картридж со скобами, имеющий по меньшей мере два латерально расположенных ряда скоб и совмещенные со скобами толкатели. Другая бранша выполнена с возможностью перемещения между открытым положением и закрытым положением и образует упорную пластину, имеющую скобоформирующие углубления, соответствующим образом совмещенные с рядами скоб в картридже со скобами. Такие инструменты могут также включать в себя клин, который при приведении в действие последовательно контактирует с толкателями, чтобы проталкивать скобы через ткань в направлении упорной пластины.
Пример хирургического сшивающего инструмента, допустимого для эндоскопического использования, описан в патенте США № 5465895. Его преимуществом является возможность выполнения отдельных действий - смыкания браншей и наложения скоб. Врач может сомкнуть бранши на ткани, чтобы придать ей надлежащее положение перед наложением скоб. Если врач считает, что бранши удерживают ткань надлежащим образом, он может привести в действие хирургический сшивающий инструмент, таким образом рассекая и сшивая ткань. Одновременное рассечение и сшивание исключают осложнения, которые могут возникать при последовательном выполнении этих операций разными хирургическими инструментами, например, только режущими или только сшивающими.
Тем не менее, в результате таких действий ткань может быть сильно травмирована. Как правило, снизить риск инфицирования и/или значительно улучшить процесс заживления и обеспечить надлежащую герметизацию разреза возможно путем доставки достаточного количества медицинских препаратов к месту травмирования ткани. Применение медицинских препаратов в месте травмирования ткани часто осуществляется с помощью средств, отличных от хирургического инструмента, с помощью которого выполняли разрез и накладывали скобы. Такие средства обычно повышают сложность процедуры и ее стоимость. Однако они часто необходимы, поскольку многие хирургические инструменты, которые используют для одновременного рассечения ткани и наложения скоб, не приспособлены для размещения и доставки необходимого количества медицинских препаратов к месту травмирования ткани, при этом доставка некоторых медицинских препаратов к месту травмирования ткани с помощью хирургического инструмента может привести к невозможности повторного использования такого хирургического инструмента.
Представленное выше описание приведено только как иллюстрация данной области техники и не должно рассматриваться в качестве отрицания объема формулы.
КРАТКОЕ ОПИСАНИЕ ИЗОБРЕТЕНИЯ
В различных вариантах осуществления представлен узел хирургического инструмента. По меньшей мере в одном варианте осуществления узел может содержать корпус, режущий элемент, сравнительно подвижный относительно корпуса, и картридж для препарата, присоединенный к корпусу. В таких вариантах осуществления режущий элемент может содержать режущую поверхность, тело, включающее в себя первую поверхность, и паз, по меньшей мере частично определяемый первой поверхностью. Дополнительно в таких вариантах осуществления картридж для препарата может включать в себя полость, выполненную с возможностью размещения в ней медицинского препарата. Кроме того, в этих вариантах осуществления паз режущего элемента может сообщаться по текучей среде с полостью. Также в этих вариантах осуществления паз может быть выполнен с возможностью доставки медицинского препарата из полости, расположенной в непосредственной близости от режущей поверхности.
По меньшей мере в одном варианте осуществления представлен узел хирургического инструмента, который может содержать корпус, сравнительно подвижный относительно корпуса элемент и картридж для препарата. В этих вариантах осуществления элемент может содержать режущую поверхность, тело, включающее в себя первую поверхность, и канал, по меньшей мере частично определяемый первой поверхностью. Дополнительно в этих вариантах осуществления картридж для препарата может включать в себя часть для хранения препарата, выполненную с возможностью размещения в ней медицинского препарата. Кроме того, в этих вариантах осуществления канал элемента может сообщаться по текучей среде с частью для хранения медицинского препарата. Также в этих вариантах осуществления канал может быть выполнен с возможностью доставки медицинского препарата из части для хранения медицинского препарата непосредственно к режущей поверхности.
Хирургический инструмент представлен в различных вариантах осуществления. По меньшей мере в одном варианте осуществления хирургический инструмент может содержать рамку, сравнительно подвижный относительно рамки элемент и картридж для препарата. В таких вариантах осуществления элемент может содержать режущую поверхность, тело, включающее в себя первую поверхность, и паз, по меньшей мере частично определяемый первой поверхностью. Дополнительно в этих вариантах осуществления картридж для препарата может включать в себя часть для хранения медицинского препарата, выполненную с возможностью размещения в ней медицинского препарата. Кроме того, в этих вариантах осуществления паз элемента может сообщаться по текучей среде с частью для хранения медицинского препарата. Также в этих вариантах осуществления паз может быть выполнен с возможностью доставки медицинского препарата из части для хранения медицинского препарата непосредственно к режущей поверхности.
КРАТКОЕ ОПИСАНИЕ ФИГУР
Новые характеристики вариантов осуществления, описанные в настоящем документе, подробно изложены в приложенной формуле изобретения. Однако варианты осуществления изобретения с точки зрения конструкции и способов функционирования станут более понятными из представленного ниже описания со ссылками на сопроводительные фигуры, как описано далее.
На фиг.1 представлен вид в перспективе хирургического сшивающего и режущего инструмента, имеющего верхнюю браншу (упорную пластину) с гидравлическим приводом в открытом положении и вал из электроактивного полимера (ЭАП) для дозирования медицинского препарата.
На фиг.2 представлен вид в перспективе разобранной рабочей части хирургического сшивающего и режущего инструмента, изображенного на фиг.1.
На фиг.3 представлена вертикальная проекция вида сбоку левой стороны рабочей части хирургического сшивающего и режущего инструмента, изображенного на фиг.1, в поперечном сечении, проходящем по существу вдоль продольной оси, а также через смещенный относительно оси ЭАП-шприц и емкость, сообщающуюся по текучей среде с дозирующим пазом в спусковом стержне трехрогого элемента.
На фиг.4 представлен детальный вид сбоку левой стороны дистальной части рабочей части хирургического сшивающего и режущего инструмента, изображенного на фиг.1, в поперечном сечении, проходящем по существу вдоль продольной оси, но демонстрирующий латерально смещенный привод эластичного баллона для жидкости, который открывает упорную пластину.
На фиг.5 представлен детальный вид сбоку левой стороны спускового стержня трехрогого элемента, включающего каналы для медицинского препарата.
На фиг.6 представлен детальный вид левой стороны дистальной части рабочей части хирургического сшивающего и режущего инструмента, изображенного на фиг.4, в поперечном сечении, проходящем по существу вдоль продольной оси, с закрытой упорной пластиной.
На фиг.7 представлен детальный вид левой стороны спускового стержня трехрогого элемента, изображенного на фиг.6.
На фиг.8 представлен детальный вид сверху присоединяемой части нижней бранши (желоб для скоб) концевого зажима и удлиненного вала в поперечном сечении по линии 8-8, которую используют для наведения спускового стержня трехрогого элемента.
На фиг.9 представлен вид спереди направителя спускового стержня рабочей части хирургического сшивающего и режущего инструмента, изображенного на фиг.2.
На фиг.10 представлен вид левой стороны направителя спускового стержня, изображенного на фиг.9, в поперечном сечении по линии 9-9.
На фиг.11 представлена вертикальная проекция вида спереди удлиненного вала хирургического сшивающего и режущего инструмента, изображенного на фиг.3, выполненная по линии 11-11, проведенной через дистальный конец ЭАП-шприца для медицинских препаратов.
На фиг.12 представлен вид левой стороны ЭАП-шприца для медицинских препаратов, изображенного на фиг.11.
На фиг.13 представлен вид левой стороны рабочей части хирургического сшивающего и режущего инструмента, изображенного на фиг.1, частично в разрезе для демонстрации проксимальных креплений для ЭАП-шприца для медицинских препаратов.
На фиг.14 представлен детальный вид левой стороны ЭАП-шприца для медицинских препаратов и гнезда удлиненного вала хирургического сшивающего и режущего инструмента, изображенного на фиг.13.
На фиг.15 представлен вид сверху спускового стержня хирургического сшивающего и режущего инструмента, изображенного на фиг.2.
На фиг.16 представлен вид сбоку левой стороны слоистого спускового стержня с внутренним каналом для текучей среды в полуразрезе в хирургическом сшивающем и режущем инструменте, изображенном на фиг.1.
На фиг.17 представлен детальный вид левой стороны альтернативного варианта трехрогого элемента с внутренним каналом для текучей среды в полуразрезе.
На фиг.18 представлена вертикальная проекция вида спереди слоистого спускового стержня, изображенного на фиг.15, в поперечном сечении по линии 18-18 через проксимально открытый паз канала для жидкости.
На фиг.19-20 представлен вариант осуществления одноразового загрузочного устройства.
На фиг.21 представлен вариант осуществления картриджа для препарата.
На фиг.22 представлен вариант осуществления одноразового загрузочного устройства.
На фиг.23 представлен вариант осуществления одноразового загрузочного устройства.
На фиг.24 представлен вариант осуществления одноразового загрузочного устройства.
На фиг.25 представлен вариант осуществления одноразового загрузочного устройства.
На фиг.26 представлен вариант осуществления одноразового загрузочного устройства.
На фиг.27 представлен вариант осуществления одноразового загрузочного устройства.
На фиг.28 представлен вариант осуществления одноразового загрузочного устройства.
На фиг.29 представлен вариант осуществления одноразового загрузочного устройства.
На фиг.30 представлен вариант осуществления одноразового загрузочного устройства.
На фиг.31 представлен вариант осуществления одноразового загрузочного устройства.
На фиг.32 представлен вариант осуществления одноразового загрузочного устройства.
На фиг.33 представлен вариант осуществления хирургического инструмента.
ПОДРОБНОЕ ОПИСАНИЕ
Следует понимать, что фигуры и описания вариантов осуществления упрощены, чтобы продемонстрировать элементы, необходимые для четкого понимания описанных вариантов осуществления, в то время как другие элементы для ясности проигнорированы. Однако специалистам в данной области будет понятно, что эти и другие элементы могут быть желательными. Тем не менее, поскольку эти элементы хорошо известны специалистам и их описание не способствует лучшему пониманию описанных вариантов осуществления, обсуждение таких элементов в настоящем документе не предусмотрено.
Для более полного понимания конструкции, принципов работы, процесса изготовления и использования устройств и способов, описанных в настоящем документе, приведено описание некоторых вариантов осуществления настоящего изобретения. Один или несколько примеров вариантов осуществления представлены на сопроводительных фигурах. Специалистам в данной области будет понятно, что конкретные устройства и способы, описанные в настоящем документе и проиллюстрированные на сопроводительных фигурах, не являются ограничивающими вариантами осуществления настоящего изобретения, а также что объем данных вариантов осуществления определяется только формулой изобретения. Особенности, проиллюстрированные или описанные применительно к одному варианту осуществления, могут сочетаться с особенностями других вариантов осуществления. Кроме того, если указан порядок этапов в процессе, его можно изменить, или шаги при необходимости можно выполнять одновременно, если это не противоречит логике, или если следовать указанному порядку не требуется однозначно. Предполагается, что объем прилагаемой формулы изобретения охватывает все такие модификации и изменения.
Также следует понимать, что в последующем описании такие термины, как «вперед», «назад», «спереди», «сзади», «справа», «слева», «над», «под», «вверх», «вниз», «проксимально», «дистально», и аналогичные термины используются для удобства и не должны рассматриваться как ограничивающие условия. Последующее описание предназначено для описания различных вариантов осуществления и не предназначено для ограничения прилагаемой формулы изобретения.
Возвращаясь к фигурам, на которых для аналогичных компонентов на нескольких видах использованы аналогичные обозначения, на фиг.1-2 представлен хирургический сшивающий и режущий инструмент 10, способный продемонстрировать уникальные преимущества по меньшей мере в одном варианте осуществления, включая в себя гидравлический привод (например, открытие, закрытие/сжимание) верхней бранши (упорной пластины) 12 концевого зажима 14, а также дозирование медицинского препарата на ткань при рассечении. Гидравлический привод концевого зажима 14 дает возможность разработки ряда вариантов осуществления, что позволяет избежать некоторых конструктивных ограничений традиционных механических сопряжений. Например, можно избежать возможного застревания или выхода из строя какого-либо элемента. Кроме того, дозирование жидкостей на рассеченную ткань позволяет выполнить ряд эффективных терапевтических процедур, таких как нанесение анестетиков, клеев, прижигающих веществ, антибиотиков, коагулянтов и т.д.
Хирургический сшивающий и режущий инструмент 10, изображенный на фиг.2, включает в себя рабочую часть 16, сформированную удлиненным валом 18 и концевым зажимом 14, показанными в виде узла сшивающего инструмента 20. Хирургический сшивающий и режущий инструмент 10 также включает в себя рукоятку 22 (фиг.1), примыкающую проксимально к валу 18. Рукоятка 22 остается снаружи относительно тела пациента, в то время как рабочую часть 16 вводят через хирургическое отверстие или, главным образом, через канюлю троакара, которая формирует пневмоперитонеум для проведения малоинвазивных хирургических процедур.
Левый и правый эластичные баллоны для жидкости (надувные мешки) 24 и 26 удерживаются в задней части 28 желоба для скоб 30. Упорная пластина 12 включает в себя два направленных вовнутрь боковых шарнирных штифта 32 и 34, которые входят в шарнирное зацепление с открытыми наружу боковыми шарнирными гнездами 36 и 38, расположенными в желобе для скоб 30 дистальнее задней части 28. Упорная пластина 12 включает в себя проксимально направленный рычажный лоток 40, который выступает в заднюю часть 28 желоба для скоб 30, возвышаясь над ней и контактируя с эластичными баллонами для жидкости (надувными мешками) 24 и 26 таким образом, что заполнение жидкостью эластичных баллонов 24 и 26 приводит к тому, что дистальная зажимающая секция 41 упорной пластины 12 вращается подобно качелям в направлении картриджа со скобами 42, который удерживается в дистальной части 44 желоба для скоб 30. Опорожнение и сжатие эластичных баллонов для жидкости 24 и 26 или другого эластичного элемента концевого зажима 14 приводит к открытию упорной пластины 12. Левый и правый каналы для отвода жидкости 46 и 48 сообщаются с левым и правым эластичными баллонами для жидкости 24 и 26, соответственно, для двунаправленной передачи жидкости для активации. Необходимо отметить, что заявки в соответствии с настоящим вариантом осуществления могут включать в себя рукоятку 22 с механическим приводом (например, закрывающее пусковое устройство) (не показано), в котором пользователь нажимает на элемент управления, что приводит к закрытию или сжатию концевого зажима 12.
Необходимо принять во внимание, что термины «проксимальный» и «дистальный» используются в настоящем документе по отношению к врачу, удерживающему рукоятку инструмента. Таким образом, узел для наложения скоб 20 расположен дистально по отношению к более проксимальной рукоятке 22. Необходимо также принять во внимание, что для удобства и ясности такие пространственные термины как «вертикальный» и «горизонтальный» используются в настоящем документе по отношению к фигурам. Однако использование хирургических инструментов предполагает множество ориентаций и положений, поэтому указанные термины не являются абсолютными и не ограничивают настоящее изобретение.
Удлиненный вал 18, изображенный на фиг.2, включает в себя рамку 50, проксимальный конец которой присоединен с возможностью вращения к рукоятке 22 (фиг.1) так, что поворотная рукоятка 52 вращает рамку 50 вместе с концевым зажимом 14. Дистальный конец рамки 50 имеет боковые углубления 54, которые зацепляют проксимальный выступ 56 желоба для скоб 30. Рамка 50 включает в себя латерально центрированную нижнюю спусковую щель 58, которая проходит продольно через рамку 50 и может вмещать двухкомпонентный спусковой стержень 60, включая спусковой стержень 62 и дистально прикрепленный трехрогий элемент 64, который, преобразуясь в узле для наложения скоб 20, рассекает и сшивает ткань. Дистальная часть рамки 50 включает в себя верхнюю полость 66, дистальный и проксимальный концы которой сообщаются с дистальным и проксимальным отверстиями 68 и 70, которые находятся между поперечной планкой 72, над которой дистально выступающий зажим 74 зажимной пружины 76 зацепляется за нижний пружинный рычаг 78 и, выступая дистально вниз через верхнюю полость 66, смещает спусковой стержень 62 вниз до зацепления с желобом для скоб 30, в особенности когда нижний пружинный рычаг 78 наталкивается на приподнятую часть 80 на спусковом стержне 62.
Система дозирования медицинского препарата встроена в удлиненный вал 18 путем добавления латерально смещенной цилиндрической полости 90, сформированной в рамке 50, которая сообщается продольно по своей длине с внешней средой через прямоугольное отверстие 92, которое чуть короче шприца 100, изготовленного из электроактивного полимера (ЭАП), который вводят через отверстие 92 в цилиндрическую полость 90. Проксимальная часть цилиндрической полости 90 содержит продольно ориентированную пружину сжатия 102, которая вынуждает дистальный конус дозатора 104 ЭАП-шприца 100 дистально контактировать с рамкой 50 с образованием герметичного уплотнения и позволяет сдвигать ЭАП-шприц 100 для его введения и извлечения. Электрический проводник 106 проходит через рамку 50 и крепится к пружине сжатия 102, также выполненной из проводящего металла. Задняя часть ЭАП-шприца 100 является электропроводной и, соприкасаясь с пружиной 102, образует катод на ЭАП-приводе 110, который удерживается в проксимальной части ЭАП-шприца 100. Необходимо учитывать, что в случае перемещения с проводником 106 другого проводника последний также образует электрическую связь с ЭАП-приводом 110 и служит анодом.
При активации ЭАП-привод 110 вытягивается в продольном направлении и используется в качестве поршня, проталкивающего медицинский препарат 112 в дистальной части ЭАП-шприца 100 через дистальный конус дозатора 104. Поскольку ЭАП-привод 110 латерально сжимается, чтобы компенсировать продольное расширение, уплотнитель поршня 114 обеспечивает поперечное уплотнение в ЭАП-шприце 100. После дозирования медицинского препарата 112 отверстие (не показано), например отверстие вокруг проводника 106, позволяет воздуху заполнить ЭАП-шприц 100 за уплотнителем поршня 114. Чтобы избежать протекания, отверстие может быть выполнено с расчетом на поверхностное натяжение медицинского препарата 112 или может быть выполнено в виде одноходового клапана. Как описано ниже, рамка 50 проводит медицинский препарат 112 к боковому пазу для подачи жидкости 120, выполненному в спусковом стержне 62 и трехрогом элементе 64, чтобы направить медицинский препарат к режущей поверхности 122 трехрогого элемента 64. Размер щели рамки 58 выбран таким образом, чтобы герметично закрывать боковой паз для подачи жидкости 120. Часть бокового паза для подачи жидкости 120, которая находится под пружинным зажимом 76, герметично закрывается направителем спускового стержня 124. В проиллюстрированной версии внешняя оболочка 130 охватывает рамку 50 и проксимально выступающий рычажный лоток 40 упорной пластины 12. Верхнее дистальное отверстие 131 позволяет закрыть упорную пластину 12.
Внешнее прямоугольное отверстие 132 внешней оболочки 130 имеет такой размер и продольное расположение, которые соответствуют прямоугольному отверстию 92 в рамке 50. В некоторых случаях внешняя оболочка 130 может быть повернута для выборочного совмещения прямоугольного отверстия 92 с внешним прямоугольным отверстием 132 для установки и извлечения ЭАП-шприца 100. Необходимо отметить, что в некоторых случаях ЭАП-шприц 100 может быть полностью вмонтирован в удлиненный вал, что не позволяет выбрать необходимый медицинский препарат. Например, одноразовая рабочая часть со встроенным картриджем со скобами и резервуар дозатора медицинского препарата могут быть выбраны врачом в виде единого целого. Однако считается, что возможность присоединять части в процессе использования имеет определенные преимущества, включая широкие возможности выбора медицинского препарата (например, анестетиков, клеев, антибиотиков, прижигающих препаратов и т.д.), а также более длительный срок эксплуатации/простые условия хранения и упаковку рабочей части 16.
В проиллюстрированной версии удлиненная контактная группа, состоящая из множества слоев электроактивного полимера, имеющих форму дисков, продольно ориентирована и выполнена с возможностью расширяться вдоль продольной оси. Электроактивные полимеры (ЭАП) представляют собой группу электропроводящих допированных полимеров, которые изменяют форму под воздействием электрического напряжения. По существу проводящий полимер связан с какой-либо формой ионной жидкости или геля в паре с электродами. Приложенный потенциал индуцирует поток ионов из жидкости/геля в проводящий полимер или из него, и этот поток провоцирует изменение формы полимера. В зависимости от используемого полимера и ионной жидкости потенциал составляет от IV до 4 кВ. При подаче напряжения некоторые электроактивные полимеры сжимаются, другие - расширяются. Электроактивные полимеры могут быть присоединены к механическим средствам, таким как пружины или гибкие пластины, чтобы изменить эффект, вызванный приложенным напряжением.
Существуют два основных типа электроактивных полимеров и множество конфигураций каждого типа. Двумя основными типами являются оптоволоконный жгут и слоистая пластина. Оптоволоконный жгут состоит из нитей размером приблизительно 30-50 микрон. Такие нити могут быть сплетены в жгут наподобие текстильного, поэтому их часто называют пучком электроактивных полимеров. Этот тип электроактивных полимеров при подаче напряжения сокращается. Электроды, как правило, состоят из центрального сердечника и проводящей внешней оболочки, которая также содержит ионную жидкость, окружающую оптоволоконные жгуты. Примером доступного в продаже оптоволоконного электроактивного материала является волокно производства компании Santa Fe Science and Technology, которое представлено в продаже под названием PANION™. Его описание представлено в патенте США № 6667825, который полностью включен в настоящий документ путем ссылки.
Вторым типом является слоистая структура, которая состоит из слоя электроактивного полимера, слоя ионного геля и двух гибких планшетов, прикрепленных к обеим сторонам слоистой пластины. Когда подается напряжение, площадь слоистой пластины увеличивается в одном направлении и уменьшается в перпендикулярном направлении. Примером слоистого ЭАП-материала (пластины) является продукт компании Artificial Muscle Inc, подразделения SRI Laboratories. Пластины из электроактивного полимерного материала производит японская компания EAMEX. Их называют тонкими ЭАП-пленками.
Необходимо отметить, что электроактивные полимеры не изменяют объем при подаче напряжения, они лишь расширяются или сжимаются в одном направлении с обратным эффектом в поперечном направлении. Слоистую пластину можно использовать в основной форме при опоре одной стороной на жесткую структуру и использовании второй в качестве поршня. Слой электроактивного полимера можно также прикрепить к любой стороне гибкой слоистой пластины. При подаче напряжения на одну сторону гибкой ЭАП-пластины она расширяется, изгибаясь в обратном направлении. Это позволяет пластине изгибаться в любом направлении в зависимости от того, к какой стороне подают напряжение.
ЭАП-привод, как правило, состоит из большого количества слоев или волокон, связанных друг с другом для обеспечения их согласованной работы. ЭАП-привод и его способность двигаться определяется механической конфигурацией электроактивного полимера. Электроактивный полимер может быть сформирован в длинные звенья и обернут вокруг одного центрального электрода. Гибкая внешняя муфта образует другой электрод для привода, а также содержит ионную жидкость, необходимую для работы устройства. В этой конфигурации, когда на электроды воздействует электрическое поле, нити электроактивного полимера сокращаются. Такая конфигурация ЭАП-привода называется ЭАП-волоконным приводом. Аналогичным образом слоистая конфигурация для увеличения ее возможностей может быть размещена в несколько слоев на каждой из сторон гибкой пластины или слоями сама по себе. Для стандартных волоконных структур эффективная деформация составляет 2-4%, при этом деформация стандартных слоистых структур достигает 20-30%, используя гораздо более высокое напряжение.
Например, слоистый композитный ЭАП-материал может быть изготовлен из слоя положительно заряженной пластины-электрода, скрепленной со слоем из ЭАП, который, в свою очередь, крепится к ионному клеточному слою, прикрепленному к слою отрицательно заряженной пластины-электрода. Множество слоистых композитных ЭАП-материалов может быть скреплено в контактную группу слоями клея между ними с получением привода из ЭАП-пластины. Необходимо отметить, что также могут быть изготовлены противолежащие ЭАП-приводы, которые могут селективно изгибаться в любом направлении.
Сокращающийся ЭАП-волоконный привод может включать в себя продольный катод из платиновой проволоки, которая проходит через изолирующий полимерный колпачок на проксимальном конце и удлиненную цилиндрическую полость, сформированную в стенке пластикового цилиндра, которая легирована электрически активными смесями и используется в качестве положительно заряженного анода. Дистальный конец катода из платиновой проволоки встроен в изолирующий полимерный колпачок на дистальном конце. Множество сокращающихся полимерных волокон расположены параллельно катодной проволоке и окружают ее. Их концы вставлены в колпачки на соответствующих концах. Пластиковая стенка цилиндра по периферии примыкает по кругу к соответствующим колпачкам на концах, окружая цилиндрическую полость и изолируя ионную жидкость или гель, заполняющий пространство между сокращающимися полимерными волокнами и катодной проволокой. При подаче напряжения к пластиковой стенке цилиндра (анод) и катодной проволоке ионная жидкость поступает в сокращающиеся полимерные волокна, провоцируя увеличение их внешнего диаметра при соответствующем сокращении длины и притягивая колпачки на концах друг другу.
Как показано на фиг.1, рукоятка 22 управляет закрытием упорной пластины 12, работой спускового стержня 60, состоящего из двух частей (фиг.2), и дозированием медицинского препарата. В проиллюстрированной версии для управления закрытием упорной пластины 12 можно использовать рукоятку пистолетного типа 140 и при необходимости нажать на клавишу 142. Клавиша 142 обеспечивает подачу пропорционального электрического сигнала к дозирующему ЭАП-приводу (не показан) подобно ЭАП-шприцу 100 для перемещения жидкости по каналам 46 и 48 к эластичным баллонам для жидкости 24 и 26, чтобы закрыть упорную пластину 12 (фиг.2). Когда клавиша 142 нажата полностью, механический рычажный затвор (не показан) зацепляется за клавишу 142 и удерживает ее нажатой до тех пор, пока клавишу 142 не освободят, нажав на нее до упора и освободив рычажный затвор. Таким образом, когда клавиша 142 удерживается в нажатом состоянии, хирург получает визуальный сигнал о том, что концевой зажим 14 закрыт и зажат. Такое положение может поддерживаться непрерывной активацией дозирующего ЭАП-привода или с помощью запорного устройства. Например, система управления может реагировать на движение клавиши 142, вынуждая запорный ЭАП-клапан (не показан), обычно находящийся в закрытом состоянии, открыться для формирования сообщения между дозирующим ЭАП-приводом и каналами 46 и 48. Как только движение прекращается, запорный ЭАП-клапан снова закрывается, поддерживая положение упорной пластины 12. Кроме того, для предотвращения застопоривания при открытии упорной пластины 12 может быть предусмотрена возможность ручной разблокировки.
В качестве альтернативы может быть включено закрывающее пусковое устройство (не показано) или другое пусковое устройство, которое двунаправленно перемещает жидкость к эластичным баллонам для жидкости 24 и 26, как описано в совместной заявке на патент США № 11/061908 «ХИРУРГИЧЕСКИЙ ИНСТРУМЕНТ, ВКЛЮЧАЮЩИЙ ШАРНИРНЫЙ МЕХАНИЗМ, УПРАВЛЯЕМЫЙ ДВИЖЕНИЕМ ЖИДКОСТИ» от 18 февраля 2005 г., принадлежащей Kenneth Wales и Chad Boudreaux, содержание которой полностью включено в настоящий документ путем ссылки. Описано несколько типов гидравлических приводов для управления поворотным валом, которые могут быть приспособлены для закрытия упорной пластины 12. Чтобы воспользоваться всеми преимуществами дифференциального перемещения жидкостей, описанного для нескольких таких вариантов, необходимо понимать, что над рычажным лотком 40 упорной пластины 12 может находиться противолежащий надувной мешок (не показан), чтобы в случае сжатия левого и правого эластичных баллонов для жидкости (надувных мешков) 24 и 26 создать открывающую силу.
Как показано на фиг.3, рукоятка 22 включает в себя спусковой механизм 150 (фиг.1), который притягивается в проксимальном направлении к рукоятке пистолетного типа 140, вынуждая выталкивающий стержень 152 перемещаться в дистальном направлении в проксимальной части 154 удлиненного вала 18. Дистальный кронштейн 156 выталкивающего стержня 152 зацепляет верхний проксимальный крючок 158 спускового стержня 62. Динамическое уплотнение 160 в рамке 50 плотно прилегает к выталкивающему стержню 152 таким образом, чтобы рабочая часть 16 была пневматически загерметизирована при попадании в инсуффлированную брюшную полость.
Механизм блокировки обратного хода 170 выталкивающего стержня 152 может быть предпочтительно включен в рукоятку 22, которая включает в себя многотактный спусковой механизм 150 и втягивающий смещенный спусковой механизм, соединенный с выталкивающим стержнем 152 (не показан). В частности, запирающая пластина блокировки обратного хода 172 с выталкивающим стержнем 152 проходит через плотно прилегающее сквозное отверстие (не показано), которое зажимается, когда втягивающийся выталкивающий стержень 152 наклоняет запирающую пластину 172 в обратном направлении, как показано, нижней частью запирающей пластины 172, которая удерживается в положении в пределах рамки 50. Кулачковая муфта с блокировкой обратного хода 174 расположена дистально по отношению к запирающей пластине с блокировкой обратного хода 172 и приводится в контакт с помощью более дистальной пружины сжатия 176, через которую проходит выталкивающий стержень 152 и которая удерживается в сжатом положении в рамке 50. Необходимо отметить, что с помощью механизмов в рукоятке 22 можно вручную высвободить механизм блокировки обратного хода 170, чтобы втянуть выталкивающий стержень 152.
На фиг.4-5 концевой зажим 14, который в проиллюстрированном варианте представляет собой узел для наложения скоб 20, открывается, когда эластичный баллон для жидкости 24 спускается и рычажный лоток 40 упорной пластины 12 притягивается вниз, при этом упорная пластина вращается вокруг штифта 32, поднимая дистальную зажимающую секцию 41 и позволяя разместить ткань тела 180 между упорной пластиной 12 и картриджем со скобами 42. Трехрогий элемент 64 имеет верхний штифт 182, который располагается в углублении упорной пластины 184, способствуя многократному открытию и закрытию упорной пластины 12. Верхний штифт 182 входит в щель упорной пластины 186, расположенную вдоль упорной пластины 12, когда упорная пластина 12 закрыта и спусковой стержень 60, состоящий из двух частей, продвинут в дистальном направлении. Центральный штифт 188 плавно движется в картридже со скобами 42 над желобом для скоб 30 противоположно нижнему штифту (опоре) 190, который плавно движется вдоль нижней поверхности желоба для скоб 30.
На фиг.6-7 узел для наложения скоб 20 закрыт за счет того, что эластичный баллон для жидкости (надувной мешок) 24, расширяясь, поднимает рычажный лоток 40 упорной пластины 12 до касания с внешней оболочкой 130, при этом проксимальный изогнутый вверх наконечник 192 рычажного лотка 40 входит в верхнее дистальное отверстие 131. Такой изогнутый наконечник 192 в сочетании с отверстием 131, а также наличие сопряженной поверхности являются преимуществами перед наконечником, перфорирующим расположенный ниже эластичный баллон для жидкости 24, так как предоставляют возможность большего радиального перемещения упорной пластины 12. Когда упорная пластина 12 закрыта, верхний штифт 182 совмещен с щелью упорной пластины 186, что позволяет накладывать скобы. Ткань 180 зажата до такой толщины, при которой становится возможным рассечение и сшивание ткани.
На фиг.7-8 трехрогий элемент 64 представлен в разрезе, чтобы показать его нижнюю опору 190, двигающуюся вдоль открытого вниз латерально расширенного углубления 200, сообщающегося с узкой продольной щелью 202, через которую проходит вертикальная часть 204 трехрогого элемента 64. Проксимальное отверстие 206, проходящее до узкой продольной щели 202, представляет собой узел для входа нижней опоры 190. На спусковом стержне 62 расположена нижняя выпуклая часть 208, которая попадает в проксимальное отверстие 206 на начальном этапе движения при срабатывании под действием поджимающего усилия зажимной пружины 76 (фиг.6) при опоре на приподнятую часть 80 спускового стержня 62 для надлежащего зацепления и возможного взаимодействия с механизмом, блокирующим запуск концевого зажима (не показан). Кроме того, такая позиция позволяет зажать концевой зажим 14 для облегчения введения через хирургическое входное отверстие, например, через канюлю троакара (не показан). Как показано на фиг.8-10, направитель спускового стержня 124 латерально соприкасается с частью спускового стержня 62, закрывая соответствующую часть бокового паза для подачи жидкости 120. На фиг.11 дистальный конус дозатора 104 ЭАП-шприца 100 в цилиндрической полости 90 сообщается с радиальным каналом для жидкости 220, расположенным в рамке 50, который, в свою очередь, сообщается с боковым пазом для подачи жидкости 120. Как показано на фиг.12, до установки в хирургический сшивающий и режущий инструмент 10 ЭАП-шприц 100 может быть предпочтительно герметично закрыт одноразовым колпачком 230. На фиг.13-14 ЭАП-шприц 100 показан без одноразового колпачка 230. Он поджимается пружиной 102 в дистальном направлении для сообщения дистального конуса дозатора 104 с радиальным каналом для жидкости 220.
Необходимо отметить, что один или более датчиков в хирургическом сшивающем и режущем инструменте 10 при получении сигнала о наложении скоб (например, движение спускового стержня или механизма, соединенного со спусковым стержнем, положение спускового механизма, отдельный регулятор для дозирования пользователем и т.д.) активирует систему управления дозатором для дозирования препарата.
На фиг.15-18 представлен альтернативный спусковой стержень 300, состоящий из двух частей, который выполнен из продольно уплощенных левой и правой частей спускового стержня 302 и 304, образующих спусковой стержень 305, и присоединен к трехрогому элементу 309. Таким образом, движение жидкости по спусковому стержню 300 может быть дополнительно ограничено. В частности, левый паз для подачи жидкости 310 в левой части 302 спускового стержня проходит дистально к двум совмещенным внутренним пазам для подачи жидкости 312 и 314, соответственно, в левой и правой частях спускового стержня 302 и 304, которые определяют внутренний канал для жидкости 316. Поскольку трехрогий элемент 309 является широким в латеральном направлении и коротким в продольном направлении, между режущей поверхностью 322 и задним краем проложен канал для жидкости 320 таким образом, чтобы сообщаться с внутренним каналом для жидкости 316.
Несмотря на то что данный вариант осуществления проиллюстрирован с помощью различных вариантов осуществления, и указанные варианты осуществления описаны достаточно подробно, автор заявки не намеревается уменьшить или иным образом ограничить сферу действия изобретения. Дополнительные преимущества и модификации могут быть очевидными для специалистов в данной области.
Например, в настоящем документе для ясности описан нешарнирный вал, однако необходимо понимать, что дозирование медицинских препаратов может осуществляться и с помощью шарнирного вала. Кроме того, в него могут быть включены каналы для отвода жидкости, которые проходят через шарнирное сочленение вала к приводам эластичных баллонов для жидкости, закрывающих концевой зажим.
Также необходимо учитывать, для примера, что в настоящем документе продемонстрированы как процесс дозирования медицинского препарата, так и процесс закрывания упорной пластины с гидравлическим приводом, однако в модели, соответствующей аспектам различных вариантов осуществления, может быть использована любая из этих функций. Кроме того, необходимо отметить, что в моделях, в которых выполняется дозирование клея и/или прижигающего медицинского препарата, может отсутствовать такая функция, как наложение скоб.
Также необходимо учитывать, для примера, что в настоящем документе показан узел для наложения скоб 20, однако для других концевых зажимов (захватывающие зажимы, режущие инструменты и т.д.) предпочтительно либо закрытие с помощью гидравлического привода, либо дозирование медицинского препарата, либо обе данные функции.
Следующим примером может быть гнездо для ЭАП-шприца, выполненное не в удлиненном вале, а в рукоятке.
Следующим дополнительным примером может быть симметричное расположение второго ЭАП-шприца в удлиненном канале, благодаря чему во время работы может осуществляться дозирование сразу двух медицинских препаратов.
Также необходимо учитывать, для примера, что в проиллюстрированном варианте осуществления представлен аппарат для наложения скоб, однако возможность дозировать жидкость на дистальном конце инструмента или рядом с ним может быть предпочтительной и для других эндоскопических инструментов. Неограничивающие примеры таких инструментов могут включать в себя инструмент для хирургической абляции, зажим, инструмент для прижигания, устройство для наложения анастомозного кольца, хирургический сшивающий инструмент, линейный сшивающий инструмент и т.д. Инструменты, в которых спусковой стержень не используется в качестве удобного канала для подведения жидкости к режущей поверхности, как описано в настоящем документе, могут включать проводящие каналы или каналы, отводящие жидкость в надлежащее местоположение.
Несмотря на то, что поршень, изготовленный из электроактивного полимера, имеет ряд преимуществ, необходимо отметить, что для дозирования медицинского препарата на концевой зажим можно использовать и другие типы приводных устройств.
Например, на фиг.19-20 показаны различные варианты осуществления одноразового загрузочного устройства 1010. На фиг.20 представлено изображение в разобранном виде одноразового загрузочного устройства 1010. Одноразовое загрузочное устройство 1010 включает в себя первый конец 1012, выполненный с возможностью разъемного соединения с хирургическим инструментом (см. фиг.33), и второй конец 1014, противоположный первому концу 1012. Одноразовое загрузочное устройство 1010 содержит узел корпуса 1016, картридж для препарата 1018, режущий узел 1020, картридж со скобами 1022 и узел упорной пластины 1024. После однократного использования одноразовое загрузочное устройство 1010 может быть извлечено и утилизировано.
Узел корпуса 1016 содержит желоб 1026 и крышку желоба 1028, соединенную с желобом 1026. Желоб 1026 и крышка желоба 1028 могут быть изготовлены из любого допустимого материала, например пластика. Желоб 1026 включает в себя первый конец 1030, расположенный в непосредственной близости от первого конца 1012 одноразового загрузочного устройства 1010, и второй конец 1032, расположенный в непосредственной близости от второго конца 1014 одноразового загрузочного устройства 1010. Желоб 1026 содержит основание 1034, первую стенку 1036 и вторую стенку 1038. В соответствии с различными вариантами осуществления основание 1034 определяет отверстие 1040, расположенное в непосредственной близости от первого конца 1030 желоба 1026, первую щель 1042, расположенную в непосредственной близости от первого конца 1030 желоба 1026, вторую щель 1044, расположенную в непосредственной близости от первого конца 1030 желоба 1026, и третью щель 1046, расположенную в непосредственной близости от второго конца 1032 желоба. Первая стенка 1036 сообщается с основанием 1034 и выходит из него по существу перпендикулярно. Вторая стенка 1038 противоположна первой стенке 1036, сообщается с основанием 1034 и выходит из него по существу перпендикулярно. Вторая стенка 1038 может быть зеркальным отражением первой стенки 1036. Первая и вторая стенки 1036 и 1038 могут быть выполнены в виде единой конструкции с основанием 1034. В соответствии с различными вариантами осуществления каждая из первой и второй стенок 1036 и 1038 определяют четвертую прорезь 1048, первый язычок 1050, первую выемку 1052, пятую прорезь 1054, вторую выемку 1056, шестую прорезь 1058, третью выемку 1060, четвертую выемку 1062, седьмую прорезь 1064, восьмую прорезь 1066 и первую закраину 1068.
Крышка желоба 1028 включает в себя первый конец 1070, расположенный в непосредственной близости от первого конца 1012 одноразового загрузочного устройства 1010, и второй конец 1072, противоположный первому концу 1070, и может быть симметрична относительно оси, проходящей от первого конца 1070 крышки желоба 1028 ко второму концу 1072 крышки желоба 1028. Крышка желоба 1028 выполнена с возможностью сцепления с желобом 1026 в нескольких местах. В соответствии с различными вариантами осуществления крышка желоба 1028 определяет пару стыкующих штифтов 1074 вблизи первого конца 1070 крышки желоба 1028, выступающего из крышки желоба 1028. Один из стыкующих штифтов 1074 проходит через отверстие 1040 в желобе 1026. В крышке желоба 1028 также выполнена щель 1076 вблизи второго конца 1072 крышки желоба 1028. В соответствии с различными вариантами осуществления в крышке желоба 1028 обозначена первая пара язычков 1078, которые проходят через четвертые прорези 1048 и зацепляют их, первая пара внутренних выступов, которые сопрягаются с первыми выемками 1052, вторая пара язычков 1080, которые проходят через пятые прорези 1054 и зацепляют их, вторая пара внутренних выступов, которые сопрягаются со вторыми выемками 1056, и третья пара внутренних выступов, которые зацепляют шестые прорези 1058. В соответствии с другими вариантами осуществления желоб 1026 и крышка желоба 1028 могут быть выполнены с другим расположением язычков, прорезей, выступов, выемок и т.д., необходимых для соединения крышки желоба 1028 с желобом 1026.
Картридж для препарата 1018 присоединен к узлу корпуса 1016 и вмещает по меньшей мере один медицинский препарат. Медицинский препарат может быть любого типа. Например, медицинский препарат может содержать анестетик, клей, антибиотик, прижигающее вещество, коагулянт, гормон роста, кровоостанавливающее средство, герметик и т.д. или их комбинации.
Картридж для препарата 1018 включает в себя первый конец 1082, расположенный в непосредственной близости от первого конца 1012 одноразового загрузочного устройства 1010, и второй конец 1084, противоположный первому концу 1082. Картридж для препарата 1018 содержит тело 1086 (см. фиг.24), которое может быть выполнено из любого допустимого материала (например, пластика), совместимого с медицинским препаратом. В соответствии с различными вариантами осуществления тело 1086 содержит первую секцию 1088 и вторую секцию 1090. Первая секция 1088 может определять выступающую из нее первую планку и проходит через первую щель 1042 основания 1034 желоба 1026, зацепляясь с ней. Как показано на фиг.21, первая секция 1088 также может определять первый выступ 1094 и первый порт дозирования 1096, расположенный в непосредственной близости от второго конца 1084 картриджа для препарата 1018. Первый выступ 1094 может иметь любую форму (например, прямоугольную, треугольную, полусферическую и т.д.). Первый порт дозирования 1096 расположен между первым выступом 1094 и вторым концом 1084 картриджа для препарата 1018. Вторая секция 1090 находится на некотором расстоянии от первой секции 1088 и может являться ее зеркальным отражением. Вторая секция 1090 может определять выступающую из нее вторую планку и проходит через вторую щель 1044 основания 1034 желоба 1026, зацепляясь с ней. Как показано на фиг.21, вторая секция 1090 может определять второй выступ 1100 и второй порт дозирования 1102, расположенный в непосредственной близости от второго конца 1084 картриджа для препарата 1018. Второй выступ 1100 может иметь любую форму (например, прямоугольную, треугольную, полусферическую и т.д.). Второй порт дозирования 1102 расположен между вторым выступом 1100 и вторым концом 1084 картриджа для препарата 1018. В соответствии с другими вариантами осуществления тело 1086 может быть выполнено с другими вариантами расположения планок, язычков, крепежных элементов и т.д., необходимых для соединения картриджа для препарата 1018 с узлом корпуса 1016.
В соответствии с различными вариантами осуществления картридж для препарата 1018 также содержит первый уплотняющий элемент 1104 (см. фиг.21) и второй уплотняющий элемент 1106 (см. фиг.21). Первый уплотняющий элемент 1104 присоединен к первой секции 1088 и вместе с первой секцией 1088 используется для размещения медицинского препарата. Аналогичным образом, второй уплотняющий элемент 1106 присоединен ко второй секции 1090 и вместе со второй секцией 1090 используется для размещения второго медицинского препарата. Первый медицинский препарат может быть аналогичен второму медицинскому препарату или может отличаться от него.
Режущий узел 1020 присоединен к узлу корпуса 1016 и включает в себя первый конец 1108, расположенный в непосредственной близости от первого конца 1012 одноразового загрузочного устройства 1010, и второй конец 1110, противоположный первому концу 1108. Режущий узел 1020 содержит тело 1112 и режущую поверхность 1114. В соответствии с различными вариантами осуществления режущая поверхность 1114 содержит лезвие ножа, которое соединено с телом 1112 и расположено в непосредственной близости от второго конца 1110 режущего узла 1020. Тело 1112 может быть выполнено из любого допустимого материала, например, из пластика. В соответствии с различными вариантами осуществления тело 1112 содержит первый зажимной элемент 1116, расположенный в непосредственной близости от первого конца 1108 режущего узла 1020, второй зажимной элемент 1118, расположенный в непосредственной близости от первого конца 1108 режущего узла 1020, и опорный элемент 1120, расположенный в непосредственной близости от второго конца 1110 режущего узла 1020. Опорный элемент 1120 проходит через третью щель 1046 основания 1034 желоба 1026 и сцепляется с фиксатором 1122, который расположен снаружи от узла корпуса 1016 и используется для скользящего соединения тела 1112 с узлом корпуса 1016 так, чтобы режущий узел 1020 мог избирательно продвигаться вдоль третьей щели 1046 в направлении второго конца 1032 желоба 1026.
Тело 1112 режущего узла 1020 также содержит первую поверхность 1124 и вторую поверхность 1126 (см. фиг.24), противоположную первой поверхности 1124. Первая поверхность 1124 тела 1112 смежна с первой секцией 1088 картриджа для препарата 1018, и вторая поверхность 1126 тела 1112 смежна со второй секцией 1090 картриджа для препарата 1018. Первая поверхность 1124 тела 1112 определяет первый паз 1128, и вторая поверхность 1126 тела 1112 определяет второй паз 1130 (см. фиг.24). Первый паз 1128 примыкает к режущей поверхности 1114 режущего узла 1020 и может проходить на некотором расстоянии вдоль первой поверхности 1124 тела 1112 в направлении первого конца 1108 режущего узла 1020. Первый паз 1128 смежен с первым портом дозирования 1096 и выполнен с возможностью вмещать первый выступ 1094 первой секции 1088 тела 1086. Второй паз 1130 примыкает к режущей поверхности 1114 режущего узла 1020 и может проходить на некотором расстоянии вдоль второй поверхности 1126 тела 1112 в направлении первого конца 1108 режущего узла 1020. Второй паз 1130 смежен со вторым портом дозирования 1102 и выполнен с возможностью вмещать второй выступ 1100 второй секции 1090 тела 1086. Каждый из первого и второго паза 1128 и 1130 может иметь любую форму (например, прямоугольную, треугольную, полусферическую и т.д.), которая позволяет вмещать первый выступ 1094 и второй выступ 1100, соответственно. Тело 1112 режущего узла 1020 также может определять отверстие 1132, которое проходит от первой поверхности 1124 ко второй поверхности 1126 и расположено в непосредственной близости от второго конца 1110 режущего узла 1020.
Картридж со скобами 1022 соединен с узлом корпуса 1016. Картридж со скобами 1022 включает в себя первый конец 1134 и второй конец 1136, противоположный первому концу 1134. Второй конец 1136 картриджа со скобами 1022 находится в непосредственной близости от второго конца 1014 одноразового загрузочного устройства 1010. Картридж со скобами 1022 может быть аналогичен другим картриджам со скобами, известным специалистам в данной области. Например, картридж со скобами 1022 может содержать множество хирургических крепежных элементов и множество соответствующих толкателей. В соответствии с различными вариантами осуществления картридж со скобами 1022 определяет щель 1142, которая совмещается с третьей щелью 1046 основания 1034 желоба 1026 и проходит от первого конца 1134 картриджа со скобами 1022 в направлении второго конца 1136 картриджа со скобами 1022. Картридж со скобами 1022 также может определять язычки, которые проходят от картриджа со скобами 1022 через седьмые прорези 1064 и восьмые прорези 1066 желоба 1026 и зацепляются с ними. Картридж может дополнительно содержать закраины 1146, которые зацепляют с помощью силы трения первую и вторую стенки 1036 и 1038 желоба 1026 в непосредственной близости от второго конца 1032 желоба 1026. В соответствии с другими вариантами осуществления картридж со скобами 1022 может быть выполнен с другими вариантами расположения петель, закраин, крепежных элементов и т.д., необходимых для соединения картриджа со скобами 1022 с узлом корпуса 1016.
Узел упорной пластины 1024 присоединен к узлу корпуса 1016. Узел упорной пластины 1024 включает в себя первый конец 1148 и второй конец 1150, противоположный первому концу 1148. Второй конец 1150 узла упорной пластины 1024 находится в непосредственной близости от второго конца 1014 одноразового загрузочного устройства 1010. Узел упорной пластины 1024 может быть аналогичен другим узлам упорной пластины, известным специалистам в данной области. Например, узел упорной пластины 1024 выполнен с возможностью перемещения между открытым положением и закрытым положением и может содержать плиту упорной пластины 1152 и корпус упорной пластины 1154, соединенный с плитой упорной пластины 1152. В соответствии с различными вариантами осуществления плита упорной пластины 1152 определяет щель 1156, которая совмещена с щелью 1142 картриджа со скобами 1022. Корпус упорной пластины 1154 определяет щель 1158, которая совмещена с щелью 1156 плиты упорной пластины 1152. Плита упорной пластины 1152 также может определять первую пару проушин 1160, примыкающих к первому концу 1148 узла упорной пластины 1024, и вторую пару проушин 1162, расположенную между первой парой проушин 1160 и вторым концом 1150 узла упорной пластины 1024. Одна из проушин второй пары проушин 1162 зацепляется за третью выемку 1060 в первой стенке 1036 желоба 1026, а другая проушина второй пары проушин 1162 зацепляется за третью выемку 1060, определенную второй стенкой 1038 желоба 1026. Чтобы сдвинуть узел упорной пластины 1024 в открытое положение, можно использовать пружинный элемент 1164 или другое смещающее устройство. Чтобы сдвинуть узел упорной пластины 1024 в закрытое положение, можно использовать шарнир упорной пластины 1166, который проходит через отверстие 1132 режущего узла 1020. В соответствии с другими вариантами осуществления узел упорной пластины 1024 может быть выполнен с иным расположением крепежных элементов для присоединения узла упорной пластины 1024 к узлу корпуса 1016.
Одноразовое загрузочное устройство 1010 может дополнительно содержать направитель первого медицинского препарата 1168, расположенный в непосредственной близости от первого конца 1082 картриджа для препарата 1018, и направитель второго медицинского препарата 1170 (см. фиг.24), расположенный в непосредственной близости от первого конца 1082 картриджа для препарата 1018. В соответствии с различными вариантами осуществления направители первого и второго медицинских препаратов 1168 и 1170 могут содержать часть приводного блока 1172, который присоединяется к режущему узлу 1020 на его первом конце 1108. В таких вариантах осуществления направитель первого медицинского препарата 1168 может быть выполнен с возможностью скользящей установки в первую секцию 1088 тела 1086 картриджа для препарата 1018. Направитель второго медицинского препарата 1170 может быть выполнен с возможностью скользящей установки во вторую секцию 1090 тела 1086 картриджа для препарата 1018. В соответствии с другими вариантами осуществления направитель первого медицинского препарата 1168 может содержать электрически активируемый полимер, контактирующий с первой секцией 1088 тела 1086 картриджа для препарата 1018, как показано на фиг.13 и 14. Аналогичным образом, направитель второго медицинского препарата 1170 может содержать электрически активируемый полимер, контактирующий со второй секцией 1090 тела 1086 картриджа для препарата 1018. В таких вариантах осуществления каждый из направителей первого и второго медицинских препаратов 1168 и 1170 может быть электрически связан с контактом 1174 (см. фиг.32), который находится в непосредственной близости от первого конца 1012 одноразового загрузочного устройства 1010 и связан с источником напряжения.
Как показано на фиг.2, одноразовое загрузочное устройство 1010 также может содержать стопорный элемент 1176, связанный с приводным блоком 1172, фиксатор 1178 для соединения стопорного элемента 1176 с приводным блоком 1172 и салазки 1180, расположенные в непосредственной близости от второго конца 1110 режущего узла 1020. Приводной блок 1172, стопорный элемент 1176, фиксатор 1178 и салазки 1180 могут быть аналогичны другим подобным деталям, известным специалистам в данной области. Одноразовое загрузочное устройство 1010 может дополнительно содержать спусковой адаптер 1182, соединенный с приводным блоком 172. Спусковой адаптер 1182 выполнен с возможностью вмещать спусковой элемент, который не содержит часть одноразового загрузочного устройства 1010.
На фиг.22 представлен вариант осуществления одноразового загрузочного устройства 1010. Для большей ясности некоторые части одноразового загрузочного устройства 1010 на данной фигуре не показаны. Первый и второй зажимные элементы 1116 и 1118 присоединены к приводному блоку 1172; стопорный элемент 1176 и фиксатор 1178 также присоединены к приводному блоку 1172. Направитель первого медицинского препарата 1168 соединен с приводным блоком 1172. Салазки 1180 находятся в непосредственной близости от второго конца 1110 режущего узла 1020. Общие положения представленных компонентов относительно желоба 1026 представляют собой положения компонентов до продвижения спускового элемента (то есть они находятся в предпусковом состоянии).
На фиг.23 представлен вариант осуществления одноразового загрузочного устройства 1010. Для большей ясности некоторые части одноразового загрузочного устройства 1010 на данной фигуре не показаны. Фиг.23 аналогична фиг.22 и показывает, что направитель первого медицинского препарата 1168 совмещен с первой секцией 1088 тела 1086 картриджа для препарата 1018. Общие положения представленных компонентов относительно желоба 1026 представляют собой положения компонентов до продвижения спускового элемента (то есть они находятся в предпусковом состоянии).
На фиг.24 представлен вариант осуществления одноразового загрузочного устройства 1010 в поперечном разрезе по линии 6-6, показанной на фиг.23. Как показано на фиг.24, первый и второй порты дозирования 1096 и 1102 могут проходить соответственно через первую и вторую секции 1088 и 1090 под углом к основанию 1034 желоба 1026.
На фиг.25 показан вариант осуществления одноразового загрузочного устройства 1010. Для большей ясности некоторые части одноразового загрузочного устройства 1010 на данной фигуре не показаны. На фиг.25 узел упорной пластины 1024 показан в открытом положении относительно картриджа со скобами 1022. Общие положения представленных компонентов относительно желоба 1026 представляют собой положения компонентов до продвижения спускового элемента (то есть они находятся в предпусковом состоянии).
На фиг.26 показан вариант осуществления одноразового загрузочного устройства 1010. Для большей ясности некоторые части одноразового загрузочного устройства 1010 на данной фигуре не показаны. Фиг.26 аналогична фиг.25, но на ней также изображена первая секция 1088 тела 1086 картриджа для препарата 1018.
На фиг.27 представлен вариант осуществления одноразового загрузочного устройства 1010, в котором часть одноразового загрузочного устройства 1010, показанная на фиг.26, представлена более подробно.
На фиг.28 представлен вариант осуществления одноразового загрузочного устройства 1010, в котором часть одноразового загрузочного устройства 1010, показанная на фиг.26, представлена более подробно.
На фиг.29 представлен вариант осуществления одноразового загрузочного устройства 1010. Для большей ясности некоторые части одноразового загрузочного устройства 1010 на данной фигуре не показаны. Общие положения представленных компонентов относительно желоба 1026 представляют собой положения компонентов после продвижения спускового элемента (то есть они находятся в послепусковом состоянии). На фиг.29 узел упорной пластины 1024 представлен в закрытом положении, а послепусковые положения режущего узла 1020, узла упорной пластины 1024, направителя первого медицинского препарата 1168, приводного блока 1172 и стопорного элемента 1176 отличаются от их предпусковых положений относительно желоба 1026.
На фиг.30 представлен вариант осуществления одноразового загрузочного устройства 1010, при этом часть одноразового загрузочного устройства 1010, изображенная на фиг.29, представлена более подробно. Как показано на фиг.30, направитель первого медицинского препарата 1168 в послепусковом положении может находиться на некотором расстоянии от первого порта дозирования 1096. Аналогичным образом, направитель второго медицинского препарата 1170 в послепусковом положении может находиться на некотором расстоянии от второго порта дозирования 1102.
На фиг.31 представлен вариант осуществления одноразового загрузочного устройства 1010. Для большей ясности некоторые части одноразового загрузочного устройства 1010 на данной фигуре не показаны. Фиг.31 аналогична фиг.22, однако на ней показана первая секция 1088 тела 1086 картриджа для препарата 1018, а также направитель первого медицинского препарата 1168, выполненный из электрически активируемого полимера. На фиг.31 также показаны проводники 1184, которые обеспечивают электрическую связь между направителем первого медицинского препарата 1168 и контактом 1174. Общие положения представленных компонентов относительно желоба 1026 представляют собой положения компонентов до продвижения спускового элемента (то есть они находятся в предпусковом состоянии).
На фиг.32 представлен вариант осуществления одноразового загрузочного устройства 1010. Для большей ясности некоторые части одноразового загрузочного устройства 1010 на данной фигуре не показаны. Фиг.32 аналогична фиг.26, однако на ней показан направитель первого медицинского препарата 1168, выполненный из электрически активируемого полимера. На фиг.32 также показан контакт 1174 и проводники 1184, соединяющие по электрической сети контакт 1174 и направитель первого медицинского препарата 1168. Общие положения представленных компонентов относительно желоба 1026 представляют собой положения компонентов до продвижения спускового элемента (то есть они находятся в предпусковом состоянии).
На фиг.33 представлен вариант осуществления хирургического инструмента 1200. Хирургический инструмент 1200 включает в себя узел рукоятки 1202, удлиненное тело 1204, соединенное с узлом рукоятки 1202, и одноразовое загрузочное устройство 1010, присоединенное к удлиненному телу 1204 с возможностью отсоединения. Одноразовое загрузочное устройство 1010 может быть любым способом присоединено к удлиненному телу 1204 с возможностью отсоединения. Например, одноразовое загрузочное устройство 1010 может быть присоединено к удлиненному телу 1204 с возможностью отсоединения с помощью стыкующих штифтов 1074, описанных выше в настоящем документе. Узел рукоятки 1202 и удлиненное тело 1204 могут быть аналогичны другим узлам рукоятки и удлиненным телам, известным специалистам в данной области. Например, узел рукоятки 1202 может включать в себя средство для продвижения спускового элемента, который расположен в удлиненном теле 1204 и используется для продвижения приводного блока 1172 одноразового загрузочного устройства 1010.
В процессе работы при продвижении спускового элемента приводной блок 1172 продвигается в направлении второго конца 1014 одноразового загрузочного устройства 1010. При продвижении приводного блока 1172 режущий узел 1020 продвигается в направлении второго конца 1014 одноразового загрузочного устройства 1010. При продвижении режущего узла 1020 шарнир упорной пластины 1166 вместе с корпусом упорной пластины 1154 переводят узел упорной пластины 1024 в закрытое положение. При продвижении режущего узла 1020 салазки 1180 продвигаются в направлении второго конца 1014 одноразового загрузочного устройства 1010. При продвижении салазок 1180 скошенные под углом направляющие кромки салазок 1180 последовательно контактируют с толкателями, которые удерживаются в картридже со скобами 1022, в результате чего толкатели известным способом выталкивают хирургические крепежные элементы из картриджа со скобами 1022.
В тех вариантах осуществления, в которых направители первого и второго медицинских препаратов 1168 и 1170 соединены с режущим узлом 1020, при продвижении приводного блока 1172 направители первого и второго медицинских препаратов 1168 и 1170 продвигаются в пределах первой и второй секций 1088 и 1090 тела 1086 в направлении второго конца 1084 картриджа для препарата 1018. При продвижении направителей первого и второго медицинских препаратов 1168 и 1170 они вступают в контакт с первым и вторым уплотняющими элементами 1104 и 1106 и выдавливают первый и второй медицинские препараты из первого и второго портов дозирования 1096 и 1102. Так как в послепусковом положении направители первого и второго медицинских препаратов 1168 и 1170 могут находиться на некотором расстоянии от первого и второго портов дозирования 1096 и 1102, после продвижения направителей первого и второго медицинских препаратов 1168 и 1170 из предпускового в послепусковое положение некоторое количество медицинского препарата может оставаться в картридже для препарата 1018.
Для тех вариантов осуществления, в которых направители первого и второго медицинских препаратов 1168 и 1170 изготовлены из электрически активируемого полимера, продвижение спускового элемента приводит к замыканию электрического контакта 1174, в результате чего к направителям первого и второго медицинских препаратов 1168 и 1170 подается напряжение. В ответ на приложенное напряжение направители первого и второго медицинских препаратов 1168 и 1170 расширяются в пределах первой и второй секций 1088 и 1090 тела 1086 картриджа для препарата 1018 и выдавливают первый и второй медицинские препараты из первого и второго портов дозирования 1096 и 1102.
Первый выступ 1094 и второй выступ 1100 используются в качестве упоров, которые ограничивают поток первого и второго медицинских препаратов вдоль пазов 1128 и 1130 в направлении первого конца 1012 одноразового загрузочного устройства 1010. Медицинские препараты выдавливаются из первого и второго портов дозирования 1096 и 1102 и продвигаются вдоль соответствующих пазов 1128 и 1130 в направлении режущей поверхности 1114 одноразового загрузочного устройства 1010. При продвижении режущего узла 1020 вдоль щели 1142, определенной в картридже со скобами 1022, картридж со скобами 1022 также удерживает медицинские препараты в пазах 1128 и 1130 до тех пор, пока медицинские препараты не выйдут из пазов 1128 и 1130 в непосредственной близости от режущей поверхности 1114. Таким образом, медицинские препараты эффективно доставляются к месту рассечения и сшивания ткани.
После однократного использования одноразовое загрузочное устройство 1010 отделяют от удлиненного тела 1204 и могут заменить следующим одноразовым загрузочным устройством 1010 для дальнейшего использования. Указанный процесс может повторяться любое количество раз. При этом узел рукоятки 1202 и присоединенное к нему удлиненное тело 1204 могут быть повторно использованы неограниченное количество раз.
Несмотря на некоторые описанные варианты осуществления, специалистам в данной области очевидно, что возможны различные модификации, изменения и адаптации данных вариантов осуществления с сохранением части или всех преимуществ различных вариантов осуществления. Например, в соответствии с различными вариантами осуществления один компонент может быть заменен множеством компонентов, а множество компонентов может быть заменено одним компонентом для выполнения заданной функции или функций. Таким образом, настоящая заявка охватывает все такие модификации, изменения и адаптации, не выходящие за рамки описанных вариантов осуществления и не нарушающие их сущности, определенной в прилагаемой формуле изобретения.
Любой патент, публикация или другая информация, которые полностью или частично включены в настоящий документ путем ссылки, являются составной частью данного документа в той степени, в которой они не противоречат определениям, положениям или другой информации, представленной в настоящем документе. В связи с этим описание, представленное в настоящем документе, в той мере, в которой это необходимо, превалирует над любой информацией, противоречащей положениям данного документа, которая была включена в указанный документ посредством ссылки. Любой материал или его часть, которая включена в настоящий документ посредством ссылки и которая противоречит указанным определениям, положениям или другой информации, представленной в настоящем документе, включается в данный документ в той мере, в которой между включенным посредством ссылки материалом и настоящим документом не возникает противоречий.
Claims (15)
1. Узел хирургического инструмента, содержащий:
корпус;
режущий элемент, сравнительно подвижный относительно корпуса, при этом режущий элемент содержит режущую поверхность, тело, включающее в себя первую поверхность, и паз, по меньшей мере частично определенный первой поверхностью; и
картридж для препарата, присоединенный к корпусу, при этом картридж для препарата включает в себя полость, выполненную с возможностью вмещать медицинский препарат, при этом паз режущего элемента сообщается по текучей среде с полостью, причем режущий элемент выполнен с возможностью перемещения относительно картриджа для препарата так, что перемещение режущего элемента относительно картриджа вызывает доставку медицинского препарата, размещенного в полости, через паз и его дозирование в непосредственной близости от режущей поверхности.
корпус;
режущий элемент, сравнительно подвижный относительно корпуса, при этом режущий элемент содержит режущую поверхность, тело, включающее в себя первую поверхность, и паз, по меньшей мере частично определенный первой поверхностью; и
картридж для препарата, присоединенный к корпусу, при этом картридж для препарата включает в себя полость, выполненную с возможностью вмещать медицинский препарат, при этом паз режущего элемента сообщается по текучей среде с полостью, причем режущий элемент выполнен с возможностью перемещения относительно картриджа для препарата так, что перемещение режущего элемента относительно картриджа вызывает доставку медицинского препарата, размещенного в полости, через паз и его дозирование в непосредственной близости от режущей поверхности.
2. Узел по п. 1, в котором картридж для препарата содержит тело, причем тело картриджа для препарата и паз режущего элемента определяют канал между ними, выполненный с возможностью доставки медицинского препарата из полости, расположенной в непосредственной близости от режущей поверхности.
3. Узел по п. 1, в котором картридж для препарата включает в себя порт дозирования, сообщающийся по текучей среде с полостью, и при этом паз выполнен таким образом, что он сохраняет сообщение по текучей среде с портом дозирования при перемещении режущего элемента относительно корпуса.
4. Узел по п. 1, в котором хирургический инструмент содержит рукоятку и удлиненное тело, выходящее из рукоятки, причем корпус выполнен с возможностью разъемного присоединения к удлиненному телу.
5. Узел по п. 1, в котором корпус неподвижно присоединен к части хирургического инструмента.
6. Узел по п. 1, в котором картридж для препарата присоединен непосредственно к корпусу.
7. Узел по п. 1, дополнительно содержащий картридж со скобами, присоединенный к корпусу.
8. Узел по п. 1, дополнительно содержащий направитель медицинского препарата, выходящий из режущего элемента, причем направитель выполнен с возможностью зацеплять картридж для препарата и дозировать медицинский препарат из полости картриджа для препарата в паз при перемещении режущего элемента относительно корпуса.
9. Узел хирургического инструмента, содержащий:
корпус;
элемент, сравнительно подвижный относительно корпуса, причем указанный элемент содержит режущую поверхность, тело, включающее в себя первую поверхность, и канал, по меньшей мере частично определенный первой поверхностью; и
картридж для препарата, причем картридж для препарата включает в себя часть для хранения медицинского препарата, выполненную с возможностью размещения в ней медицинского препарата, при этом канал элемента сообщается по текучей среде с частью для хранения медицинского препарата, и при этом подвижный элемент выполнен с возможностью перемещения относительно части для хранения медицинского препарата так, что перемещение подвижного элемента относительно части для хранения медицинского препарата вызывает доставку медицинского препарата, размещенного в части для хранения медицинского препарата, через канал к режущей поверхности.
корпус;
элемент, сравнительно подвижный относительно корпуса, причем указанный элемент содержит режущую поверхность, тело, включающее в себя первую поверхность, и канал, по меньшей мере частично определенный первой поверхностью; и
картридж для препарата, причем картридж для препарата включает в себя часть для хранения медицинского препарата, выполненную с возможностью размещения в ней медицинского препарата, при этом канал элемента сообщается по текучей среде с частью для хранения медицинского препарата, и при этом подвижный элемент выполнен с возможностью перемещения относительно части для хранения медицинского препарата так, что перемещение подвижного элемента относительно части для хранения медицинского препарата вызывает доставку медицинского препарата, размещенного в части для хранения медицинского препарата, через канал к режущей поверхности.
10. Узел по п. 9, в котором хирургический инструмент содержит рукоятку и удлиненное тело, выходящее из рукоятки, и при этом корпус выполнен с возможностью разъемного присоединения к удлиненному телу.
11. Узел по п. 9, в котором корпус неподвижно присоединен к части хирургического инструмента.
12. Узел по п. 9, в котором картридж для препарата включает в себя порт дозирования, сообщающийся по текучей среде с частью для хранения медицинского препарата, и при этом канал выполнен таким образом, что он сохраняет сообщение по текучей среде с портом дозирования при перемещении элемента относительно корпуса.
13. Узел по п. 9, в котором картридж для препарата присоединен непосредственно к корпусу.
14. Узел по п. 9, дополнительно содержащий картридж со скобами, присоединенный к корпусу.
15. Узел по п. 9, дополнительно содержащий направитель медицинского препарата, выходящий из подвижного элемента, причем направитель выполнен с возможностью зацеплять картридж для препарата и дозировать медицинский препарат из части для хранения медицинского препарата в канал при перемещении режущего элемента относительно корпуса.
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US12/696,397 | 2010-01-29 | ||
US12/696,397 US8215531B2 (en) | 2004-07-28 | 2010-01-29 | Surgical stapling instrument having a medical substance dispenser |
PCT/US2011/021051 WO2011094066A1 (en) | 2010-01-29 | 2011-01-13 | Surgical stapling instrument having a medical substance dispenser |
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RU2012136821A RU2012136821A (ru) | 2014-03-10 |
RU2559019C2 true RU2559019C2 (ru) | 2015-08-10 |
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RU2012136821/14A RU2559019C2 (ru) | 2010-01-29 | 2011-01-13 | Хирургический сшивающий инструмент с дозатором медицинских препаратов |
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US (5) | US8215531B2 (ru) |
EP (1) | EP2528513A1 (ru) |
JP (1) | JP2013517891A (ru) |
CN (1) | CN103384499B (ru) |
AU (1) | AU2011209890A1 (ru) |
BR (1) | BR112012018993B1 (ru) |
CA (1) | CA2786038C (ru) |
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RU2790316C1 (ru) * | 2019-08-29 | 2023-02-16 | Тачстоун Интернэшнл Медикал Сайенс Ко., Лтд. | Закрывающий приводной механизм и медицинский сшиватель, содержащий этот механизм |
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CA2786038A1 (en) | 2011-08-04 |
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US20120273551A1 (en) | 2012-11-01 |
US11135352B2 (en) | 2021-10-05 |
CN103384499A (zh) | 2013-11-06 |
BR112012018993A2 (pt) | 2016-09-13 |
US8517244B2 (en) | 2013-08-27 |
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