ES2289334T3 - Conjunto de herramienta para dispositivo de grapado quirurgico. - Google Patents
Conjunto de herramienta para dispositivo de grapado quirurgico. Download PDFInfo
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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
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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
- A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
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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
- A61B2017/07214—Stapler heads
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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
- A61B2017/07214—Stapler heads
- A61B2017/07271—Stapler heads characterised by its cartridge
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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
- A61B2017/07214—Stapler heads
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- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
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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
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2931—Details of heads or jaws with releasable head
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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
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2932—Transmission of forces to jaw members
- A61B2017/2933—Transmission of forces to jaw members camming or guiding means
- A61B2017/2934—Transmission of forces to jaw members camming or guiding means arcuate shaped guiding means
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2932—Transmission of forces to jaw members
- A61B2017/2933—Transmission of forces to jaw members camming or guiding means
- A61B2017/2936—Pins in guiding slots
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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
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2932—Transmission of forces to jaw members
- A61B2017/2944—Translation of jaw members
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Abstract
Un conjunto de herramienta (10), que comprende: un par de mandíbulas, con una primera mandíbula (12) y una segunda mandíbula (14), presentando cada una de las mandíbulas un extremo proximal y un extremo distal, siendo movibles la primera y la segunda mandíbulas, una en relación con otra, entre una posición separada y una posición aproximada; un primero (32) y un segundo (36) seguidores de leva, soportados en la primera o en la segunda mandíbulas; y un miembro (16) de aproximación, que incluye, al menos, una superficie (28, 30) de leva destinada a aplicarse con el primero y el segundo seguidores de leva, siendo movible el miembro de aproximación con el fin de desplazar dicha, al menos, una superficie de leva en relación con el primero y el segundo seguidores de leva, presentando el miembro de aproximación una carrera de accionamiento que incluye partes inicial, segunda y final, en el que el miembro (16) de aproximación puede ser hecho mover con el fin de desplazar dicha, al menos,una superficie de leva (28, 30) en relación con el primero y el segundo seguidores (32, 36) de leva para producir el movimiento de la primera y la segunda mandíbulas (12, 14) entre la posición separada y la posición aproximada, estando configurada dicha, al menos, una superficie de leva (28, 30), durante la parte inicial de la carrera de accionamiento, con el fin de aproximar los extremos distales de la primera y la segunda mandíbulas previamente a la aproximación de los extremos proximales de la primera y la segunda mandíbulas durante la segunda parte de la carrera de accionamiento, caracterizado porque: durante la segunda parte de la carrera de accionamiento, los extremos distales de la primera y la segunda mandíbulas se separan, uno de otro, hasta una posición resultante en la que las mandíbulas sean paralelas, y, después, durante la parte final de la carrera de accionamiento se acercan la primera y la segunda mandíbulas, entre sí, en relación de cierre sustancialmente paralelo, de modo que definan un espacio libre para el tejido.
Description
Conjunto de herramienta para dispositivo de
grapado quirúrgico.
La presente descripción se refiere, en general,
a un conjunto de herramienta quirúrgica para manipular fijaciones
y/o aplicarlas en tejidos. Más concretamente, la presente invención
se refiere a conjuntos de herramienta y a dispositivos
quirúrgicos.
Las grapadoras quirúrgicas y los conjuntos de
herramienta para sujetar tejido entre estructuras de mandíbula
opuestas de un conjunto de herramienta y, después, fijar el tejido
sujetado, son bien conocidos en la técnica. Estos dispositivos
pueden incluir una cuchilla para cortar el tejido fijado. Tales
grapadoras con configuraciones laparoscópicas o endoscópicas,
también, son bien conocidas en la técnica. Ejemplos de grapadoras
quirúrgicas endoscópicas de este tipo se describen en las patentes
norteamericanas nos. 6.330.965, 6.250.532, 6.241.139, 6.109.500 y
6.079.606.
Típicamente, tales grapadoras incluyen un
miembro o conjunto de herramienta, con un par de mandíbulas que
incluyen un cartucho de grapas para alojar una pluralidad de grapas
previstas en, al menos, dos filas separadas lateralmente, y un
yunque, que incluye una pluralidad de cavidades de formación de
grapas para recibir y formar ramas de grapas a medida que éstas
sean impulsadas a partir del cartucho. El yunque y el cartucho están
soportados, de modo pivotante, uno junto a otro, y pueden ser
hechos pivotar, uno respecto a otro, entre posiciones abierta y
cerrada. En uso, el tejido se coloca entre las mandíbulas, en la
posición abierta, y las mandíbulas son hechas pivotar hasta la
posición cerrada, con el fin de sujetar el tejido entre ellas.
Un problema asociado con las grapadoras y los
conjuntos de herramienta convencionales consiste en que al pivotar
el yunque y el cartucho, uno en relación con otro, el cierre se
produce, primero, en el extremo proximal de las mandíbulas, y,
después, en el extremo distal de las mismas. Esta secuencia de
cierre de mandíbulas produce el efecto de mover el tejido
posicionado entre las mandíbulas hacia el extremo distal de las
mismas, expulsándolo, por tanto, de las mandíbulas.
Durante los procesos laparoscópicos o
endoscópicos, el acceso al sitio de cirugía se logra mediante una
incisión pequeña o merced a una cánula estrecha insertada a través
de una pequeña abertura de entrada en un paciente. Como
consecuencia de la zona limitada disponible para acceder al sitio
quirúrgico, a veces se usan grapadoras endoscópicas para agarrar
y/o manipular tejido. Las grapadoras convencionales con un yunque o
un cartucho montados en un punto de pivote fijo, susceptibles de
ser hechos pivotar hasta una posición cerrada, no son
particularmente adecuadas para agarrar tejido, porque en el extremo
distal de las mandíbulas se produce, solamente, una fuerza de
sujeción limitada.
Por consiguiente, existe la necesidad de un
miembro o conjunto de herramienta de grapado quirúrgico endoscópico
con mandíbulas pivotantes que puedan ser hechas funcionar de modo
que agarren, manipulen y/o fijen tejido de manera efectiva, incluso
mediante el extremo de las mandíbulas, sin desplazamiento distal del
tejido posicionado entre las mandíbulas, o minimizando dicho
desplazamiento.
El documento
US-A-5 816 471 describe un
dispositivo quirúrgico, de acuerdo con el preámbulo de la
reivindicación 1, con un par de mandíbulas montadas en el extremo
distal. Las mandíbulas están montadas de manera rígida en un cuerpo
inflexible, conectado con un mango de accionamiento en el extremo
proximal. Las mandíbulas están previstas para un cierre de "punta
a cola", por el que los extremos distales de las mandíbulas se
cierran contra un tejido, y, luego, se acercan los extremos
proximales de las mandíbulas, mientras que las puntas de las
mandíbulas mantienen el tejido en posición.
De acuerdo con la presente invención, se ofrece
un conjunto de herramienta que comprende: un par de mandíbulas con
una primera y una segunda mandíbulas, presentando cada una de las
mandíbulas un extremo proximal y un extremo distal, pudiendo ser
movidas la primera y la segunda mandíbulas, una en relación con
otra, entre una posición separada y una posición aproximada; un
primero y un segundo seguidores de leva, soportados en la primera
mandíbula o en la segunda mandíbula; y un miembro de aproximación,
que incluye, al menos, una superficie de leva destinada a aplicarse
con el primero y el segundo seguidores de leva, pudiendo ser movido
el miembro de aproximación con el fin de desplazar dicha, al menos,
una superficie de leva en relación con el primero y el segundo
seguidores de leva, presentando el miembro de aproximación una
carrera de accionamiento que incluye partes inicial, segunda y
final, en el que el miembro de aproximación puede ser movido con el
fin de desplazar dicha, al menos, una superficie de leva en
relación con el primero y el segundo seguidores de leva para
producir el movimiento de la primera y la segunda mandíbulas entre
la posición separada y la posición aproximada, estando configurada
dicha, al menos, una superficie de leva, durante la parte inicial de
la carrera de accionamiento, de modo que permita aproximar los
extremos distales de la primera y la segunda mandíbulas previamente
a la aproximación de los extremos proximales de la primera y la
segunda mandíbulas durante la segunda parte de la carrera de
accionamiento, y, después, durante la parte final de la carrera de
accionamiento, de modo que permita acercar la primera y la segunda
mandíbulas, en relación de cierre sustancialmente paralelo, y
definir un espacio libre para el tejido, caracterizado porque
durante la segunda parte de la carrera de accionamiento, los
extremos distales de la primera y la segunda mandíbulas son
separados, uno de otro, hasta una posición resultante en la que las
mandíbulas sean paralelas.
Se ofrece, también, un dispositivo quirúrgico
que comprende un conjunto de herramienta de este tipo.
Para permitir una mejor comprensión de la
presente invención y para mostrar el modo en que puede ser puesta
en práctica, se hará referencia ahora, a modo de ejemplo solamente,
a los dibujos adjuntos, en los que:
la figura 1 es una vista, en perspectiva
lateral, de una realización del conjunto de herramienta descrito en
lo que sigue, en la posición de aproximación;
la figura 2 es una vista, lateral, del conjunto
de herramienta mostrado en la figura 1;
la figura 3 es una vista de despiece, en
perspectiva lateral, del conjunto de herramienta mostrado en la
figura 1;
la figura 4A es una vista, esquemática, de las
mandíbulas del conjunto de herramienta mostrado en la figura 1, en
una primera etapa de aproximación de las mismas;
la figura 4B es una vista, esquemática, de las
mandíbulas mostradas en la figura 4A en una segunda etapa de
aproximación de las mismas;
la figura 4C es una vista, esquemática, de las
mandíbulas mostradas en la figura 4B en posición aproximada;
la figura 5 es una vista, en perspectiva
lateral, de otra realización del conjunto de herramienta descrito
en lo que sigue, en la posición aproximada;
la figura 6 es una vista de despiece, en
perspectiva lateral, del conjunto de herramienta mostrado en la
figura 5;
la figura 7 es una vista, en perspectiva
lateral, del miembro de aproximación del conjunto de herramienta
mostrado en la figura 6;
la figura 8 es una vista, en perspectiva
lateral, del miembro de sujeción dinámica del conjunto de
herramienta mostrado en la figura 6;
la figura 9 es una vista desde arriba, en
sección transversal parcial, con partes arrancadas, de parte del
conjunto de cartucho y que muestra el accionador de articulación y
disparo del conjunto de herramienta mostrado en la figura 6; y
la figura 10 es una vista, en sección
transversal, con partes eliminadas y partes añadidas, en sección por
las líneas 10-10 de la figura 9.
En la descripción detallada que sigue, se
divulga un conjunto de herramienta con un par de mandíbulas. Cada
una de las mandíbulas presenta un extremo proximal y un extremo
distal, y la primera mandíbula puede ser hecha mover en relación
con la segunda mandíbula entre una posición separada y una posición
aproximada. Un primero y un segundo seguidores de leva están
soportados en la primera mandíbula. Hay un miembro de aproximación
movible en relación con la primera mandíbula e incluye, al menos,
una superficie de leva destinada a aplicarse con el primero y el
segundo seguidores de leva. El miembro de aproximación es movible en
relación con la primera mandíbula con el fin de desplazar dicha, al
menos, una superficie de leva en relación con el primero y el
segundo seguidores de leva, para producir el movimiento de la
primera y la segunda mandíbulas desde la posición separada a la
posición aproximada. Dicho, al menos, un canal de leva está
configurado con el fin de aproximar los extremos distales de la
primera y la segunda mandíbulas previamente a la aproximación de los
extremos proximales de las mismas. Al aproximar primero los
extremos distales de la primera y la segunda mandíbulas, el tejido
posicionado entre las mandíbulas no es empujado hacia delante en las
mandíbulas durante el cierre de las mismas. Además, las mandíbulas
pueden agarrar y manipular tejido de mejor manera usando sus
extremos distales.
En una realización, la primera mandíbula incluye
un yunque y la segunda mandíbula incluye un conjunto de cartucho
que aloja una pluralidad de grapas. En otra realización, dicha, al
menos, una superficie de leva incluye un primero y un segundo
canales de leva, y el miembro de aproximación incluye una placa
plana con los canales de leva formados en ella. La primera
mandíbula incluye una ranura longitudinal formada en su extremo
proximal, y el miembro de aproximación está posicionado, a
deslizamiento, en la ranura longitudinal. El primero y el segundo
seguidores de leva están soportados en el extremo proximal de la
primera mandíbula y se extienden a través de la ranura longitudinal
adyacente al primero y al segundo canales de leva. El primer
seguidor de leva se extiende a través del primer canal de leva y el
segundo seguidor de leva se extiende a través del segundo canal de
leva. Ventajosamente, el conjunto de herramienta puede estar
asociado, de modo pivotante, con una parte de cuerpo, merced a una
unión articulada. La parte de cuerpo puede formar el extremo distal
de un dispositivo de grapado quirúrgico o la parte proximal de una
unidad de carga desechable.
En otra realización, el conjunto de herramienta
incluye un yunque, un conjunto de cartucho que aloja una pluralidad
de grapas y un miembro de sujeción dinámica. El yunque y el conjunto
de cartucho pueden ser hechos mover, uno en relación con otro,
entre una posición separada y una posición aproximada. El miembro de
sujeción dinámica puede ser hecho mover en relación con el yunque y
el conjunto de cartucho con el fin de expulsar las grapas del
conjunto de cartucho. El conjunto de herramienta está unido, de modo
pivotante, con una parte de cuerpo y puede ser hecho pivotar en
relación con la parte de cuerpo desde una posición alineada con el
eje longitudinal de la parte de cuerpo hasta una posición orientada
en ángulo en relación con el eje longitudinal de la parte de
cuerpo. Un accionador de articulación y disparo se extiende, al
menos parcialmente, en la parte de cuerpo y el conjunto de
herramienta. El accionador de articulación y disparo está asociado
operativamente con el miembro de sujeción dinámica y el conjunto de
herramienta y es movible en relación con ellos para, selectivamente,
pivotar el conjunto de herramienta en relación con la parte de
cuerpo y/o mover el miembro de sujeción dinámica en relación con el
conjunto de herramienta con el fin de expulsar las grapas del
cartucho.
Ventajosamente, el accionador de articulación y
disparo puede incluir una banda flexible con una primera parte de
extremo, que se extienda, al menos parcialmente, en la parte de
cuerpo y en el conjunto de cartucho, una parte central, que se
extienda desde la primera parte de extremo, asociada operativamente
con el miembro de sujeción dinámica, y una segunda parte de
extremo, que se extienda desde la parte central, en el conjunto de
cartucho, y, al menos parcialmente, en la parte de cuerpo, hasta una
posición adyacente al primer extremo. El accionador de articulación
y disparo está asociado operativamente con el conjunto de
herramienta, de modo que el movimiento de la primera parte de
extremo o de la segunda parte de extremo de la banda flexible,
proximal e independientemente de la otra parte de extremo, produzca
el pivotamiento del conjunto de herramienta en relación con la
parte de cuerpo, y el movimiento simultáneo de la primera y la
segunda partes de extremo de la banda flexible produzca el
movimiento del miembro de sujeción dinámica, con el fin de expulsar
las grapas del conjunto de cartucho. En otra realización, un
miembro de aproximación está asociado operativamente con el
conjunto de herramienta y puede ser hecho mover en relación con
éste, con el fin de mover el yunque y el conjunto de cartucho desde
la posición separada a la posición aproximada.
En lo que sigue se describirán con detalle
realizaciones específicas del presente conjunto de herramienta para
un dispositivo de grapado, con referencia a los dibujos, en los que
números de referencia similares designan elementos idénticos o
correspondientes en cada una de las distintas vistas.
Las figuras 1-3 muestran una
realización del presente conjunto de herramienta, mostrado en
general con 10, para uso con un dispositivo de grapado quirúrgico.
El conjunto 10 de herramienta incluye un par de mandíbulas que
incluyen un yunque 12, un conjunto 14 de cartucho y un miembro 16 de
aproximación. El conjunto 14 de cartucho incluye un canal 18 de
soporte para recibir un cartucho 14a de grapas. El canal 18 de
soporte presenta una parte distal 18a, de canal abierto, y una
parte proximal 18b, que define un cilindro truncado 18c. Aunque no
se muestra con detalle, el cartucho 14a de grapas aloja una
pluralidad de grapas y puede incluir empujadores convencionales (no
mostrados) para convertir el movimiento de un conjunto de impulsión
de grapas, que incluye, típicamente, una deslizadera (por ejemplo,
131, en la figura 6) en movimiento de las grapas a través de
aberturas o ranuras en una superficie 25 de aplicación con el
tejido del cartucho 14a.
El yunque 12 presenta una superficie 20 de
aplicación con el tejido, con un extremo distal 20a, un extremo
proximal 20b y una parte de cuerpo proximal 22. Una ranura
longitudinal 24 se extiende a lo largo del eje geométrico
longitudinal del yunque 12, en la superficie 20 de aplicación con el
tejido, y está destinada a recibir, a deslizamiento, parte de un
conjunto de impulsión. El conjunto de impulsión incluye,
típicamente, una barra de impulsión, un conjunto de cierre, una
deslizadera y una pluralidad de empujadores. El conjunto de
impulsión está destinado a expulsar grapas del cartucho y,
preferiblemente, también, durante el disparo del dispositivo,
mantiene un espacio libre uniforme deseado para el tejido entre el
cartucho y el yunque. La parte de cuerpo proximal 22 del yunque 12
está destinada a ser recibida, de modo generalmente pivotante,
dentro del cilindro truncado 18c de la parte proximal 18b del canal
18 de soporte, de modo que la superficie 20 de aplicación con el
tejido del yunque 12 pueda pivotar desde una posición separada de la
superficie 25 de aplicación con el tejido del cartucho 14a hasta
una posición aproximada, en alineación y yuxtaposición con ella.
El conjunto 10 de herramienta incluye un miembro
16 de aproximación con uno o más canales 28 y 30 de leva.
Preferiblemente, el miembro de aproximación incluye un par de
canales de leva, aunque puede preverse un único canal de leva con
un par de superficies de leva. El miembro 16 de aproximación está
previsto de modo que sea deslizable linealmente en la parte
proximal 18b del canal 18 y en una ranura 22a formada en la parte de
cuerpo proximal 22 del yunque 12. Un seguidor 32 de leva atraviesa
un orificio 34 formado en la parte proximal 22 del yunque 12 y un
orificio 35 en la parte proximal 18b del canal 18 de soporte, y está
posicionado dentro del canal 28 de leva. Un seguidor 36 de leva,
insertado en el orificio 39 de la parte proximal 18b, atraviesa un
segundo orificio 38 formado en la parte proximal 22 del yunque 12, y
está posicionado dentro del canal 30 de leva. Cuando el miembro 16
de aproximación sea hecho avanzar en la ranura 22a de la parte
proximal 22 del yunque 12, los seguidores 32 y 36 de leva se
mueven, respectivamente, en los canales 28 y 30 de leva. Como el
miembro 16 de aproximación sólo puede moverse linealmente en la
ranura 22a, el movimiento del miembro 16 de aproximación en
dirección distal produce el movimiento pivotante del yunque 12 desde
la posición abierta o separada hasta la posición cerrada o
aproximada. Los ángulos de las ranuras de leva pueden preverse de
manera que permitan una gran diversidad de movimientos de
aproximación, con el fin de mejorar las ventajas mecánicas y
conseguir resultados específicos, por ejemplo, el agarre del
tejido.
Con referencia, también, a las figuras
4A-4C, los canales 28 y 30 de leva están
configurados para hacer pivotar el yunque 12, desde una posición
abierta (figura 4A), en dirección al conjunto de cartucho 14 de
manera controlada para facilitar, inicialmente, el agarre del
tejido y, después, permitir el cierre, sustancialmente en paralelo,
del yunque y del conjunto de cartucho. De modo más específico, los
canales 28 y 30 de leva están configurados, preferiblemente, con el
fin de posicionar el extremo distal 20a de la superficie 20 de
contacto con el tejido del yunque 12, sustancialmente en contacto
con el cartucho 14 (figura 4B) durante la parte inicial de la
carrera de accionamiento del miembro 16 de aproximación. Ello
facilita el agarre de tejido, incluso tejido muy delgado. Durante
una segunda parte de la carrera de accionamiento del miembro 16 de
aproximación, el extremo distal 20a del yunque 12 es separado del
conjunto 14 de cartucho hasta una posición resultante en la que la
superficie 20 de aplicación con el tejido del yunque 12 sea
paralela, o sustancialmente paralela, a la superficie 25 de
aplicación con el tejido del conjunto 14 de cartucho. Durante la
parte final de la carrera de accionamiento del miembro 16 de
aproximación, el yunque 12 y el conjunto 14 de cartucho se acercan,
en relación de cierre paralelo o sustancialmente paralelo, de modo
que definan un espacio libre deseado para el tejido (figura 4C).
Debe señalarse que puede conseguirse cualquier movimiento deseado
del yunque 12 usando los seguidores de leva descritos en este
documento. Al mover el yunque 12 en relación con el conjunto 14 de
cartucho desde la posición separada a la posición aproximada de la
manera descrita en lo que antecede, es decir, cierre frontal o
distal a trasero o proximal, se elimina, sustancialmente, la
tendencia del tejido a moverse hacia delante en las mandíbulas,
como en dispositivos convencionales.
Aunque el miembro de aproximación 16 se ilustra
en forma de placa con dos canales de leva distintos, pueden
preverse miembros de aproximación configurados de modo diferente.
Por ejemplo, puede preverse un único canal de leva que se aplique
con dos seguidores de leva. Además, los canales de leva no tienen
carácter limitativo y pueden estar formados en la superficie de una
placa, barra o similar. En un dispositivo de este tipo, el yunque
puede ser empujado mediante un miembro de carga hasta la posición
cerrada o de sujeción.
Aunque no se hayan considerado uno o más
accionadores para hacer avanzar el miembro de aproximación y/o
disparar grapas a partir del conjunto de cartucho, está previsto
que puedan usarse uno o más de una diversidad de accionadores
pivotables, giratorios o deslizables conocidos, por ejemplo,
disparadores, botones, palancas, etc., para aproximar el presente
conjunto de cartucho y/o disparar grapas a partir del cartucho. Debe
señalarse, también, que el conjunto de herramienta descrito puede
constituir o formar la parte distal de una unidad de carga
desechable o puede estar incorporado directamente en el extremo
distal de un instrumento quirúrgico, por ejemplo, una grapadora
quirúrgica, y puede incluir un conjunto de cartucho
reemplazable.
Las figuras 5-10 describen otra
realización del presente conjunto de herramienta, mostrada en
general con 100. El conjunto 100 de herramienta incluye un yunque
112 y un conjunto 114 de cartucho, un miembro 116 de aproximación y
una parte de cuerpo alargada 120 que incluye una unión articulada,
designada, en general, con 122. La parte de cuerpo alargada 120
puede constituir el extremo proximal de una unidad de carga
desechable o el extremo distal de un dispositivo de grapado
quirúrgico. El conjunto 100 de herramienta incluye, también, un
mecanismo 124 combinado de accionamiento de articulación y disparo
para hacer girar el conjunto 100 de herramienta en torno a la unión
articulada 122 y expulsar grapas del conjunto 114 de cartucho.
Aunque la unión articulada 122 se ilustra a modo de miembro
ondulado flexible con zonas curvadas preformadas, puede ser
cualquier tipo conocido de unión que permita articulación, por
ejemplo, una espiga de pivote, una unión de rótula, una unión
universal, etc.
El miembro 116 de aproximación es
sustancialmente similar al miembro 16 de aproximación e incluye,
también, canales 129 y 130 de leva (figura 7). El miembro 116 de
aproximación incluye, además, un par de canales 126 de guía. Los
canales 126 de guía están destinados a recibir espigas 128 de guía
que se extienden a través de la parte 120 de cuerpo alargada y cuya
función consiste en mantener el miembro 116 de aproximación a lo
largo de una trayectoria de desplazamiento lineal. El miembro 116 de
aproximación está hecho de un material flexible, por ejemplo, acero
para muelles, susceptible de curvarse en torno a la unión articulada
122. Alternativamente, puede preverse que el miembro 116 de
aproximación pueda incluir un vástago elástico, una banda o similar
con superficies de leva formadas en ellos. El miembro 116 de
aproximación funciona sustancialmente de la misma manera que el
miembro 16 de aproximación y no se describirá con más detalle en
este documento.
El conjunto 114 de cartucho incluye un canal 118
de soporte, una deslizadera 131 y un miembro 132 de sujeción
dinámica, que, preferiblemente, incluye una pestaña superior 134a
destinada a aplicarse, a deslizamiento, con una superficie de apoyo
del yunque, y una pestaña inferior 134b destinada a aplicarse, a
deslizamiento, con una superficie de apoyo del cartucho. Una
cuchilla 134 está soportada, preferiblemente, en una parte central
134c del miembro 132 de sujeción dinámica, con el fin de cortar
tejido. La cuchilla 134 puede estar asegurada en el miembro 132 de
sujeción dinámica de manera amovible o fija, puede estar formada de
modo enterizo con el miembro 132 de sujeción dinámica, o estar
conformada, directamente por amolado, en el miembro 132 de sujeción
dinámica. La deslizadera 131 está posicionada a deslizamiento en el
cartucho 114, para desplazarse por él de manera conocida, con el
fin de expulsar grapas del cartucho. La deslizadera 131 o similar
puede ser enteriza o monolítica con el miembro 132 de sujeción
dinámica. La deslizadera 131 está posicionada de modo distal en
relación con el miembro 132 de sujeción dinámica, está aplicada con
él y es empujada por él. La función de 131 consiste en producir el
disparo o la expulsión de las grapas con el fin de sujetar el tejido
antes de cortar el tejido grapado. La pestaña 134b,
preferiblemente, se posiciona dentro de un rebajo 138 formado en la
base del cartucho 114. Preferiblemente, la pestaña 134a se posiciona
dentro de un rebajo único o separado formado en el yunque 112. Por
otra parte, las pestañas 134a y 134b no tienen que estar
posicionadas en un rebajo sino que pueden aplicarse, a
deslizamiento, con una superficie, respectivamente, del yunque y del
cartucho. Preferiblemente, el miembro 132 de sujeción dinámica está
posicionado de modo proximal, en relación con la deslizadera 131,
en el conjunto 114 de cartucho. El miembro 132 de sujeción dinámica
está destinado a disponer, restablecer y/o mantener el espacio
libre deseado para el tejido en la zona del conjunto 100 de
herramienta adyacente a la deslizadera 131, durante el disparo de
grapas.
Es deseable que el material y el grosor del
yunque, y, de preferencia, del miembro de sujeción dinámica, se
seleccionen de modo que se minimice la deformación de éstos durante
el disparo del dispositivo. Tales materiales incluyen acero
inoxidable de calidad quirúrgica. El yunque se forma,
preferiblemente, a modo de unidad maciza. Alternativamente, el
yunque puede estar formado por un conjunto de partes con componentes
convencionales.
Con referencia a las figuras 6, 9 y 10, el
mecanismo 124 de articulación y disparo incluye un miembro 140 de
tensión que puede presentar bucles 124 u otras partes de conexión o
conectores para su conexión con miembros de conexión adecuados de
uno o más accionadores o de un mecanismo de accionamiento. Aunque se
ilustra a modo de banda flexible, el miembro 140 de tensión puede
ser, o puede incluir, uno o más miembros de impulsión flexibles
cualesquiera con los requisitos de resistencia mecánica necesarios y
susceptibles de realizar las funciones descritas en lo que sigue,
por ejemplo, una correa o un cable trenzados o tejidos, un material
polimérico, una para-aramida tal como
Kevlar^{TM}, etc. Kevlar^{TM} es la designación comercial del
poli(fenilenotereftalamida), vendido por DuPont. Un par de
miembros fijos o giratorios adecuados, preferiblemente rodillos 142a
y 142b, están asegurados en el extremo distal del conjunto 114 de
cartucho. Los rodillos 142a y 142b pueden estar formados en una
tapa amovible 114b (figura 6) del conjunto de cartucho 114, o
soportados en ella. Alternativamente, la tapa 114b puede estar
formada de modo enterizo con el cartucho 114a de grapas o con el
canal 118 del cartucho. Los rodillos 142a y 142b pueden estar
asegurados, también, en el canal 118 de soporte de cartucho o
formados a partir de él. El miembro 140 de tensión se extiende de
modo distal en relación con el cuerpo alargado 120 del conjunto 100
de herramienta, de modo distal en un canal periférico 142 del
cartucho 114a de grapas, en torno al rodillo 142a, de modo
proximal, preferiblemente, a lo largo de la ranura longitudinal
central 144 formada en el cartucho 114a, a través de una ranura
200, preferiblemente una ranura transversal, en una parte proximal
del miembro 132 de sujeción dinámica, o en torno a dicha parte
proximal, de modo distal en torno al rodillo 142b, y, de nuevo, de
modo proximal en un canal 146 formado en el cartucho 114a hasta una
parte proximal del cuerpo alargado 120. Alternativamente, pueden
emplearse dos miembros de tensión, cada uno de los cuales puede
estar asegurado en el miembro 132 de sujeción dinámica. Como se
ilustra en la figura 10, los canales 142 y 146 pueden estar
definidos, al menos parcialmente, por una pared interior y/o una
pared exterior del cartucho 114a y/o por el canal 118 de soporte
del cartucho. A diferencia de la ilustración, los canales 142 y 146
tienen que estar en posiciones consistentes, es decir, idénticas,
funcionalmente idénticas o similares, a ambos lados del cartucho de
grapas. Por tanto, puede preverse que haya dos canales periféricos
142 o dos canales 146.
En uso, cuando un primer extremo o parte 150 del
miembro 140 de tensión sea hecho retraer, merced a medios
adecuados, en la dirección indicada por la flecha "A", como se
muestra en la figura 9, el conjunto de herramienta 100 girará en
torno al miembro 122a de pivote en la dirección indicada por la
flecha "D". Cuando un segundo extremo o parte 152 del miembro
140 de tensión sea hecho retraer en la dirección indicada por la
flecha "B", el conjunto 100 de herramienta girará en la
dirección indicada por la flecha "C". Cuando ambos extremos del
miembro 140 de tensión sean hechos retraer simultáneamente, el
miembro 140 de tensión hará avanzar el miembro 132 de sujeción
dinámica, distalmente, en la ranura 144 del cartucho 114a, de modo
que el miembro 132 de sujeción dinámica y la deslizadera 131 sean
hechos avanzar en el cartucho 114a, con el fin de, mediante
empujadores de aplicación, expulsar grapas del cartucho y cortar
tejido en el espacio libre del tejido. Para evitar que el miembro
132 de sujeción dinámica avance en la ranura 144 cuando el conjunto
de herramienta esté siendo hecho girar, es decir, cuando sólo un
extremo del miembro 140 de tensión sea hecho retraer, puede preverse
un dispositivo de bloqueo (no mostrado), por ejemplo, una espiga de
corte, para evitar el movimiento del miembro de sujeción dinámica o
retardarlo hasta que una fuerza predeterminada haya sido aplicada al
miembro de sujeción dinámica. Está previsto que puedan emplearse
múltiples miembros de tensión, por ejemplo, bandas, para realizar,
respectivamente, funciones individuales o una combinación de
funciones. Por ejemplo, pueden emplearse un par de miembros de
tensión, uno para articular, y otro para aproximar, sujetar y
disparar. Los miembros de tensión pueden fijarse en el miembro de
sujeción dinámica, en el miembro que monte la cuchilla o en la
combinación miembro de sujeción dinámica, miembro de cuchilla y/o
miembro de deslizadera.
El conjunto de herramienta descrito en lo que
antecede puede incorporarse en una unidad de carga desechable, tal
como la descrita en la patente norteamericana nº 6.330.965, o unirse
directamente con el extremo distal de cualquier dispositivo de
grapado quirúrgico conocido. Aunque en este documento no se hayan
descrito, específicamente, un conjunto de mango para accionar el
miembro de aproximación y el mecanismo combinado de articulación y
disparo, debe entenderse que está previsto el uso de una amplia
diversidad de configuraciones diferentes de mecanismos de
accionamiento y mangos, que incluyen clavijas, botones giratorios y
deslizantes, palancas pivotantes o disparadores, empuñaduras de
pistola, mangos en línea, sistemas accionados por control remoto y
una combinación de los mismos. Puede preverse el uso de un conjunto
de herramienta descrito en lo que antecede como parte de un sistema
robotizado.
Los conjuntos de herramienta descritos en este
documento tienen pares de mandíbulas e incluyen un mecanismo de
aproximación singular que facilita una sujeción y una manipulación
de tejido mejoradas.
Se entenderá que pueden realizarse distintas
modificaciones en las realizaciones descritas en este documento.
Por ejemplo, aunque esta aplicación se centre, principalmente, en el
uso de grapas quirúrgicas, pueden incluirse en este dispositivo
otros dispositivos de sujeción, tales como fijaciones de dos partes.
En un dispositivo en el que se usen fijaciones de dos partes, cada
una de las cavidades de formación de grapas del yunque pueden
configurarse de modo que reciban una parte de la fijación de dos
partes. Por otro lado, está previsto que las enseñanzas ofrecidas
en esta descripción puedan incorporarse en dispositivos quirúrgicos
que incluyan prensores, distintos a los dispositivos de grapado.
Por tanto, la descripción que antecede no debe considerarse
limitativa, sino simplemente como ilustrativa de realizaciones
preferidas. Los expertos en la técnica podrán concebir otras
modificaciones dentro del alcance de las reivindicaciones adjuntas a
este documento.
Claims (16)
1. Un conjunto de herramienta (10), que
comprende:
un par de mandíbulas, con una primera mandíbula
(12) y una segunda mandíbula (14), presentando cada una de las
mandíbulas un extremo proximal y un extremo distal, siendo movibles
la primera y la segunda mandíbulas, una en relación con otra, entre
una posición separada y una posición aproximada;
un primero (32) y un segundo (36) seguidores de
leva, soportados en la primera o en la segunda mandíbulas; y
un miembro (16) de aproximación, que incluye, al
menos, una superficie (28, 30) de leva destinada a aplicarse con el
primero y el segundo seguidores de leva, siendo movible el miembro
de aproximación con el fin de desplazar dicha, al menos, una
superficie de leva en relación con el primero y el segundo
seguidores de leva, presentando el miembro de aproximación una
carrera de accionamiento que incluye partes inicial, segunda y
final,
en el que el miembro (16) de aproximación puede
ser hecho mover con el fin de desplazar dicha, al menos, una
superficie de leva (28, 30) en relación con el primero y el segundo
seguidores (32, 36) de leva para producir el movimiento de la
primera y la segunda mandíbulas (12, 14) entre la posición separada
y la posición aproximada, estando configurada dicha, al menos, una
superficie de leva (28, 30), durante la parte inicial de la carrera
de accionamiento, con el fin de aproximar los extremos distales de
la primera y la segunda mandíbulas previamente a la aproximación de
los extremos proximales de la primera y la segunda mandíbulas
durante la segunda parte de la carrera de accionamiento,
caracterizado porque:
durante la segunda parte de la carrera de
accionamiento, los extremos distales de la primera y la segunda
mandíbulas se separan, uno de otro, hasta una posición resultante en
la que las mandíbulas sean paralelas,
y, después, durante la parte final de la carrera
de accionamiento se acercan la primera y la segunda mandíbulas,
entre sí, en relación de cierre sustancialmente paralelo, de modo
que definan un espacio libre para el tejido.
2. Un conjunto de herramienta según la
reivindicación 1, en el que la primera mandíbula incluye un yunque
(12) y la segunda mandíbula incluye un conjunto (14) de cartucho,
alojando el conjunto de cartucho una pluralidad de grapas.
3. Un conjunto de herramienta según las
reivindicaciones 1 o 2, en el que dicha, al menos, una superficie
de leva incluye, al menos, un canal (28, 30) de leva.
4. Un conjunto de herramienta según la
reivindicación 3, en el que dicho, al menos, un canal de leva
incluye un primero (28) y un segundo (30) canales de leva.
5. Un conjunto de herramienta según la
reivindicación 1, en el que el miembro de aproximación (16) incluye
una placa plana con dicha, al menos, una superficie (28, 30) de leva
formada en ella.
6. Un conjunto de herramienta según la
reivindicación 1, en el que la primera mandíbula incluye una ranura
longitudinal (24) formada en su extremo proximal, estando el miembro
(16) de aproximación posicionado, a deslizamiento, en la ranura
longitudinal.
7. Un conjunto de herramienta según la
reivindicación 6, en el que el primero y el segundo seguidores (32,
36) de leva están soportados en el extremo proximal (22) de la
primera mandíbula (12) y se extienden a través de la ranura
longitudinal adyacente a dicha, al menos, una superficie de
leva.
8. Un conjunto de herramienta según la
reivindicación 7, en el que dicha, al menos, una superficie de leva
incluye un primero y un segundo canales de leva, extendiéndose el
primer seguidor (32) de leva a través del primer canal (28) de
leva, y extendiéndose el segundo seguidor (36) de leva a través del
segundo canal (30) de leva.
9. Un conjunto de herramienta según la
reivindicación 1, que incluye, además, una parte (120) de cuerpo,
estando unido el conjunto de herramienta con la parte de cuerpo, de
modo pivotante, mediante una unión articulada (122).
10. Un conjunto de herramienta según la
reivindicación 9, en el que la parte (120) de cuerpo constituye el
extremo distal de un dispositivo de grapado quirúrgico.
11. Un conjunto de herramienta según cualquiera
de las reivindicaciones 1, 9 y 10, en el que la parte de cuerpo
constituye la parte proximal de una unidad de carga desechable.
12. Un conjunto de herramienta según cualquiera
de las reivindicaciones precedentes, que comprende una unidad de
carga desechable.
\newpage
13. Un dispositivo quirúrgico, que
comprende:
un conjunto (100) de herramienta según
cualquiera de las reivindicaciones precedentes; y
un miembro (132) de sujeción dinámica asociado
operativamente con la primera y la segunda mandíbulas (112, 114) y
que puede ser hecho mover en relación con la primera y la segunda
mandíbulas con el fin de accionar el conjunto de herramienta y
mantener el espacio libre para el tejido entre la primera y la
segunda mandíbulas en una posición adyacente al miembro de sujeción
dinámica.
14. Un dispositivo quirúrgico según la
reivindicación 13, en el que la primera mandíbula incluye un yunque
(112) y la segunda mandíbula incluye un conjunto (114) de cartucho
con una pluralidad de grapas, pudiendo ser hecho mover el miembro
de sujeción dinámica en relación con el conjunto de cartucho para
expulsar la pluralidad de grapas del conjunto de cartucho.
15. Un dispositivo quirúrgico según la
reivindicación 14, en el que el miembro (132) de sujeción dinámica
incluye una pestaña superior (134a) destinada a aplicarse, a
deslizamiento, con el yunque (112), y una pestaña inferior (134b),
destinada a aplicarse, a deslizamiento, con el conjunto (114) de
cartucho.
16. Un dispositivo de grapado quirúrgico según
la reivindicación 15, en el que el primero y el segundo seguidores
(32, 36) de leva están soportados en un extremo proximal del yunque
(112).
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ES2377813T5 (es) * | 2002-10-04 | 2020-12-18 | Covidien Lp | Conjunto de herramienta para un dispositivo de grapado quirúrgico |
US7380696B2 (en) * | 2003-05-20 | 2008-06-03 | Ethicon Endo-Surgery, Inc. | Articulating surgical stapling instrument incorporating a two-piece E-beam firing mechanism |
US9060770B2 (en) | 2003-05-20 | 2015-06-23 | Ethicon Endo-Surgery, Inc. | Robotically-driven surgical instrument with E-beam driver |
US20070084897A1 (en) | 2003-05-20 | 2007-04-19 | Shelton Frederick E Iv | Articulating surgical stapling instrument incorporating a two-piece e-beam firing mechanism |
CA2529442C (en) * | 2003-06-17 | 2012-08-21 | David C. Racenet | Surgical stapling device |
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2003
- 2003-10-06 ES ES06003688T patent/ES2300076T3/es not_active Expired - Lifetime
- 2003-10-06 WO PCT/US2003/031653 patent/WO2004032754A2/en active IP Right Grant
- 2003-10-06 DE DE60315846T patent/DE60315846T2/de not_active Expired - Lifetime
- 2003-10-06 ES ES03770659T patent/ES2289334T3/es not_active Expired - Lifetime
- 2003-10-06 DE DE60319443T patent/DE60319443T2/de not_active Expired - Lifetime
- 2003-10-06 US US10/529,568 patent/US7617961B2/en active Active
- 2003-10-06 JP JP2004543422A patent/JP4448449B2/ja not_active Expired - Fee Related
- 2003-10-06 CA CA2500796A patent/CA2500796C/en not_active Expired - Fee Related
- 2003-10-06 CA CA2712039A patent/CA2712039C/en not_active Expired - Fee Related
- 2003-10-06 EP EP06003688A patent/EP1671593B1/en not_active Expired - Fee Related
- 2003-10-06 EP EP03770659A patent/EP1545332B1/en not_active Expired - Fee Related
- 2003-10-06 AU AU2003279152A patent/AU2003279152B2/en not_active Expired
-
2009
- 2009-03-11 AU AU2009200962A patent/AU2009200962B2/en not_active Expired
- 2009-10-28 US US12/607,637 patent/US7857184B2/en active Active
- 2009-11-20 JP JP2009265748A patent/JP2010042295A/ja active Pending
-
2010
- 2010-10-21 US US12/909,396 patent/US8091753B2/en not_active Expired - Fee Related
-
2011
- 2011-12-22 US US13/334,381 patent/US8292151B2/en not_active Expired - Lifetime
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CA2712039A1 (en) | 2004-04-22 |
AU2009200962B2 (en) | 2011-10-06 |
US8616427B2 (en) | 2013-12-31 |
CA2500796C (en) | 2011-03-15 |
AU2003279152B2 (en) | 2008-12-11 |
AU2009200962A1 (en) | 2009-04-02 |
US20110036893A1 (en) | 2011-02-17 |
CA2712039C (en) | 2013-03-12 |
CA2500796A1 (en) | 2004-04-22 |
US8091753B2 (en) | 2012-01-10 |
US20120091184A1 (en) | 2012-04-19 |
DE60319443T2 (de) | 2009-02-19 |
US8292151B2 (en) | 2012-10-23 |
AU2003279152A1 (en) | 2004-05-04 |
US7617961B2 (en) | 2009-11-17 |
JP2010042295A (ja) | 2010-02-25 |
EP1545332A2 (en) | 2005-06-29 |
EP1671593B1 (en) | 2008-02-27 |
JP2006501955A (ja) | 2006-01-19 |
DE60319443D1 (de) | 2008-04-10 |
ES2300076T3 (es) | 2008-06-01 |
WO2004032754A2 (en) | 2004-04-22 |
DE60315846D1 (de) | 2007-10-04 |
US20100044411A1 (en) | 2010-02-25 |
EP1671593A1 (en) | 2006-06-21 |
US7857184B2 (en) | 2010-12-28 |
US20130015233A1 (en) | 2013-01-17 |
WO2004032754A3 (en) | 2004-07-01 |
JP4448449B2 (ja) | 2010-04-07 |
DE60315846T2 (de) | 2008-05-21 |
EP1545332B1 (en) | 2007-08-22 |
US20060100644A1 (en) | 2006-05-11 |
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