BRPI0913095A2 - instrumento cirúrgico com atuador de extremidade articulado reconfigurável automaticamente - Google Patents

instrumento cirúrgico com atuador de extremidade articulado reconfigurável automaticamente Download PDF

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BRPI0913095A2
BRPI0913095A2 BRPI0913095-0A BRPI0913095A BRPI0913095A2 BR PI0913095 A2 BRPI0913095 A2 BR PI0913095A2 BR PI0913095 A BRPI0913095 A BR PI0913095A BR PI0913095 A2 BRPI0913095 A2 BR PI0913095A2
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end actuator
articulation
surgical instrument
control unit
motor
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Frederick E. Shelton Iv
David C. Yates
Richard C. Smith
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Ethicon Endo-Surgery, Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00022—Sensing or detecting at the treatment site
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00022—Sensing or detecting at the treatment site
    • A61B2017/00026—Conductivity or impedance, e.g. of tissue
    • A61B2017/0003—Conductivity or impedance, e.g. of tissue of parts of the instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00022—Sensing or detecting at the treatment site
    • A61B2017/00039—Electric or electromagnetic phenomena other than conductivity, e.g. capacity, inductivity, Hall effect
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00535—Surgical instruments, devices or methods pneumatically or hydraulically operated
    • A61B2017/00539—Surgical instruments, devices or methods pneumatically or hydraulically operated hydraulically
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/06—Measuring instruments not otherwise provided for
    • A61B2090/067—Measuring instruments not otherwise provided for for measuring angles

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
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  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

INSTRUMENTO CIRÚRGICO COM ATUADOR DE EXTREMIDADE ARTICULADO RECONFIGURÁVEL AUTOMATICAMENTE. A presente invenção refere-se a um instrumento cirúrgico, como um instrumento cirúrgico de corte e união com um atuador de extremidade articulável automaticamente. O instrumento cirúrgico pode compreender um atuador de extremidade, uma haste, e um conjunto de junta articulável conectado entre o atuador de extremidade e a haste. O conjunto de junta compreende pelo menos um motor para articular o atuador de extremidade em relação à haste. O conjunto de junta compreende pelo menos um sensor de articulação para detectar a articulação do atuador de extremidade em relação à haste. O instrumento compreende adicionalmente uma unidade de controle em comunicação com um sensor de articulação e o motor. A unidade de controle compreende pelo menos uma unidade de memória para armazenar dados de articulação provenientes do, pelo menos um, sensor de articulação. Quando ativada, a unidade de controle envia sinais de controle para o motor do conjunto de junta para articular automaticamente o atuador de extremidade para a posição desejada, com base nos dados de articulação provenientes do sensor de articulação, os quais estão armazenados na unidade de memória da unidade de controle.

Description

Relatório Descritivo da Patente de lnvenção para "INSTRUMENTO CIRÚRGICO COM ATUADOR DE EXTREMIDADE " ARTICULADO RECONFIGURÁVEL AUTOMATICAMENTE".
ANTECEDENTES 5 A presente invenção refere-se a grampeadores cirúrgicos que foram usados na técnica anterior para fazer uma incisão longitudinal no tecido e simultaneamente aplicar linhas de grampos em lados opostos da incisão. Tais instrumentos incluem comumente um atuador de extremidade tendo um par de membros de garra cooperadores que, se o instrumento é 10 pretendido para aplicações endoscópicas ou laparoscópicas, é capaz de . passar através da passagem de uma cânula. Um dos membros de garra recebe um cartucho de grampos tendo pelo menos duas fileiras de grampos " lateralmente espaçadas—uma em cada lado da canaleta da faca. O outro membro de garra define uma garra fixa tendo bolsos formadores de grampos 15 alinhados com as fileiras de grampos dentro do cartucho. O instrumento inclui uma pluralidade de cunhas reciprocantes que, quando acionadas distalmente, passam através das aberturas no cartucho de grampos e engatam controladores que suportam os grampos para realizar a descarga dos grampos em direção à garra fixa. Simultaneamente, um instrumento 20 cortante (ou faca) é puxado distalmente ao longo do membro de garra de modo que o tecido fixado seja cortado e unido (por exemplo, grampeado) ao mesmo tempo. Um exemplo de grampeador cirúrgico para aplicações endoscópicas é descrito na patente U.S. n° 7.000.818 B2, intitulada, 25 "Surgical stapling instrument having separate distinct closing and firing systems", cuja descrição está aqui incorporada na Íntegra, a título de referência. Em uso, um clínico é capaz de fechar os membros de garra do grampeador sobre o tecido para posicionar o tecido antes da descarga de grampos. Quando o clínico determina que os membros de garra estão 30 prendendo apropriadamente o tecido, o clínico pode então descarregar o grampeador cirúrgico, seccionando e grampeando assim o tecido. As ações de seccionamento e grampeamento simultâneas evitam complicações que podem surgir durante a realização dessas ações sequencionalmente com diferentes instrumentos cirúrgicos que respectivamente apenas seccionam - ou grampeiam o tecido. A técnica anterior também inclui endocortadores com atuadores 5 de extremidade articuláveis, tal como descrito e publicado na publicação de pedido de patente U.S. n° 2007/0175959, aqui incorporada na Íntegra, a título de referência. Tal instrumento compreende um controle de articulação que permite ao usuário (por exemplo, um cirurgião) executar a rotação do atuador de extremidade sobre um pivô de articulação. 10 Comumente, um procedimento que requer o uso de tal endocortador precisa de um cirurgião para realizar vários lances de - seccionamento/união em um local, em geral comum, dentro do paciente.
" Portanto, após cada lance de seccionamento/fixação, o clínico tem de retirar o instrumento através da cânula e substituir o cartucho de grampos gasto no 15 atuador de extremidade. Então o cIínico tem de reinserir o intrumento de volta através da cânula para dentro do paciente e posicionar novamente o atuador de extremidade, incluindo a articulação do atuador de extremidade de volta para a mesma posição normal que ele estava antes do lance de seccionamento/união. 20 SUMÁRIO Sob um aspecto geral, a presente invenção é direcionada a um instrumento cirúrgico, como um instrumento cirúrgico de corte e união, com um atuador de extremidade articulável automaticamente. De acordo com várias modalidades, o instrumento cirúrgico pode compreender um atuador 25 de extremidade, uma haste, e um conjunto de junta articulável conectado entre o atuador de extremidade e a haste. O conjunto de junta compreende pelo menos um motor para articulação do atuador de extremidade em relação à haste. O conjunto de junta também compreende pelo menos um sensor de articulação com ação de detecção da articulação do atuador de 30 extremidade em relação à haste. O instrumento compreende adicionalmente uma unidade de controle em comunicação com o sensor de articulação e o motor. A unidade de controle compreende pelo menos uma unidade de memória para armazenar dados da articulação a partir do, pelo menos um, sensor de articulação.
Além disso, quando ativada, a unidade de controle envia sinais de controle para o motor do conjunto de junta para articular automaticamente 5 o atuador de extremidade para a posição desejada (ou estado de articulação), com base nos dados de articulação do sensor de articulação que são armazenados na unidade de memória da unidade de controle.
Por exemplo, a unidade de controle pode fazer com que o atuador de extremidade seja articulado para um estado anterior da articulação (como o 10 estado de articulação em que o instrumento foi descarregado pela última vez) ou algum outro estado da articulação.
A unidade de controle também pode ser capaz de fazer com que o atuador de extremidade articule-se
" automaticamente de volta ao seu estado original ou não articulado.
Desse modo, um clínico pode (i) inserir o atuador de extremidade dentro de um 15 paciente através de uma cânula, (ii) articular automaticamente o atuador de extremidade para a posição desejada, (iii) descarregar o instrumento, (iv) rearticular o atuador de extremidade de volta ao seu estado original para (V) retirá-lo do paciente através da cânula, e (vi) substituir o cartucho de modo que o processo possa ser repetido.
A tendência disso é levar a uma maior 20 exatidão e repetitividade no reposicionamento do atuador de extremidade, o que é importante em procedimentos em que o atuador de extremidade precisa ser posicionado na mesma posição geral para descargas repetidas.
De acordo com várias modalidades, o instrumento cirúrgico pode ser um instrumento cirúrgico de corte e união, como um endocortador.
Como 25 tal, o atuador de extremidade pode compreender dois membros de garra opostos e conectados por meio de um pivô.
Um membro de garra pode transportar um instrumento de corte para seccionar o tecido fixado entre os dois membros de garra.
O atuador de extremidade também compreende um cartucho de grampos substituível que aloja vários grampos, de modo que 30 quando o instrumento é descarregado, os grampos são impelidos através do tecido fixado e dobrados pelo outro membro de garra, que atua como uma garra fixa.
Sob um aspecto geral a presente invenção é direcionada a um método para realizar um procedimento cirúrgico. Na modalidade, o processo - compreende: (a) inserir o atuador de extremidade articulável dentro de um paciente através de uma cânula enquanto o atuador de extremidade está em 5 um primeiro estado de articulação; (b) após a etapa (a), ativar um dispositivo de entrada de dados no instrumento cirúrgico para levar o atuador de extremidade a articular-se automaticamente para um segundo estado de articulação que é diferente do primeiro estado de articulação; (C) após a etapa (b), descarregar o instrumento cirúrgico para seccionar e unir o tecido 10 fixado no atuador de extremidade; (d) após a etapa (C), ativar o dispositivo de entrada de dados para Ievar o atuador de extremidade a articular-se automaticamente para o primeiro estado de articulação; e (e) após a etapa (d), retirar o atuador de extremidade do paciente através da cânula. Esses e outros benefícios da presente invenção serão aparentes 15 a partir da descrição abaixo.
FIGURAS Várias modalidades da presente invenção são descritas aqui a título de exemplo em conjunto com as seguintes figuras, sendo que: as figuras 1 e 2 representam um instrumento cirúrgico com um 20 atuador de extremidade articulável de acordo com várias modalidades da presente invenção; a figura 3 é uma vista explodida do instrumento cirúrgico das figuras 1 e 2 de acordo com várias modalidades da presente invenção; a figura 4 é um diagrama de blocos que representa uma unidade 25 de controle e sensores do instrumento cirúrgico de acordo com várias modalidades de presente invenção; e a figura 5 é um diagrama de um conjunto de articulação de junta do instrumento cirúrgico de acordo com as várias modalidades da presente invenção. 30 DESCRIÇÃO As figuras 1 e 2 representam um instrumento de corte e união 10 com um atuador de extremidade articulável automaticamente de acordo com várias modalidades de presente invenção.
A modalidade ilustrada é um instrumento cirúrgico endoscópico 10 e, em geral, as modalidades do - instrumento 10 aqui descritas são instrumentos cirúrgicos endoscópicos de corte e união.
Deve ser observado, entretanto, de acordo com outras 5 modalidades da presente invenção, que o instrumento 10 pode ser um instrumento de corte cirúrgico não endoscópico, como um instrumento laparoscópico, com um atuador de extremidade articulável automaticamente.
O instrumento cirúrgico 10 representado nas figuras 1 e 2 compreende um cabo 6, uma haste 8, e um atuador de extremidade 10 articulado 12 conectado de forma articulada à haste 8 a um pivô de articulação 14. Um controle de articulação 16 pode ser fornecido adjacente ao cabo 6 para realizar a rotação do atuador de extremidade 12 sobre o pivô de articulação 14. Na modalidade ilustrada, o atuador de extremidade 12 é configurado para atuar como um endocortador para fixar, seccionar, e 15 grampear o tecido, embora, em outras modalidades, diferentes tipos de atuadores de extremidade possam ser usados como atuadores de extremidade para outros tipos de dispositivos cirúrgicos, como garras, cortadores, grampeadores, aplicadores de clipes, dispositivos de acesso, dispositivos de terapia por fármacos e/ou gênica, ultrassom, dispositivos a 20 laser ou RFS, etc.
O cabo 6 do instrumento 10 pode incluir um gatilho de fechamento 18 e um gatilho de descarga 20 para acionar o atuador de extremidade 12. Será reconhecido que os instrumentos que têm atuadores de extremidade direcionados a diferentes tarefas cirúrgicas podem ter 25 números ou tipos diferentes de gatilhos ou outros controles adequados para operar o atuador de extremidade 12. O atuador de extremidade 12 é mostrado separadamente do cabo 6 por uma haste 8, de preferência, alongada.
Em uma modalidade, um clínico ou operador do instrumento 10 pode articular o atuador de extremidade 12 em relação à haste 8 utilizando o 30 controle de articulação 16. Um tipo de controle de articulação adequado é descrito na publicação de pedido de patente U.S. n° 2007/0158385 Al, intitulado "Surgical lnstrument Having An Articulating End Effector", de
- Geoffrey C.
Hueil et al., aqui incorporado na Íntegra, a título de referência.
O atuador de extremidade 12 inclui nesse exemplo, entre outras - coisas, uma canaleta de grampos 22 e um membro de fixação transladável de modo articulado, tal como uma garra fixa 24, que são mantidos em um 5 espaçamento que assegura o grampeamento efetivo ou seccionamento do tecido fixado no atuador de extremidade 12. O cabo 6 inclui uma pega de pistola 26 em direção ao qual um gatilho de fechamento 18 é puxado de forma articulada pelo clínico para levar à fixação ou fechamento da garra fixa 24 em direção à canaleta de grampos 22 do atuador de extremidade 12 para 10 desse modo fixar o tecido posicionado entre a garra da garra fixa 24 e a canaleta 22. Na modalidade ilustrada, o gatilho de descarga 20 está mais afastado do gatilho de fechamento 18. De acordo com essa modalidade, quando o gatilho de fechamento 18 está travado na posição de fechamento, o gatilho de descarga 20 pode girar levemente em direção à pega de pistola 15 26 de modo que ele possa ser alcançado pelo operador com o uso de uma mão.
Então o operador pode puxar o gatilho de descarga 20 de forma articulada em direção à pega de pistola 26 para causar o grampeamento e seccionamento de tecido fixado no atuador de extremidade 12. Em outras modalidades, diferentes tipos de membros de fixação além da garra fixa 24 20 podem ser usados, como, por exemplo, um mordente de oposição, etc.
Será reconhecido que os termos "proximal" e "d istal" são usados aqui com referência ao ato de apertar o cabo 6 de um instrumento 10 pelo clínico.
Portanto, o atuador de extremidade 12 é distal em relação ao cabo mais proximal 6. Será reconhecido adicionalmente que, para conveniência e 25 clareza, termos espaciais como "vertical" e "horizontal" são usados na presente invenção com relação aos desenhos.
Entretanto, instrumentos cirúrgicos podem ser usados em muitas orientações e posições, e não pretende-se que esses termos sejam limitadores e absolutos.
Em uso, o gatilho de fechamento 18 pode ser acionado primeiro. 30 Quando satisfeito com o posicionamento do atuador de extremidade 12, o cIínico pode retrair o gatilho de fechamento 18 para a posição completamente fechada e travada adjacente à pega de pistola 26. O gatilho
" de descarga 20 pode então ser acionado.
O gatilho de descarga 20 retorna à sua posição aberta (mostrada nas figuras 1 e 2) quando o clínico remove a pressão.
Um botão de liberação do cabo 6, quando abaixado, pode Iiberar o gatilho de fechamento 18 travado. 5 Conforme mostrado nas figuras 1 e 2, o cabo 6 pode compreender um ou múltiplos dispositivos de seleção de entrada de dados pelo usuário externo 90 e 92, que podem ser, por exemplo, um botão(ões) de pressão, um botão(ões) de alternância, um discador(es), um botão(ões) de membrana, um microfone, um botão sensível ao toque, um dispositivo de 10 cursor e ponteiro, ou qualquer outro tipo adequado de botão ou dispositivo de entrada de dados pelo usuário, que permita ao operador do instrumento - 10 articular automaticamente o atuador de extremidade 12 para o seu estado de articulação anterior e de volta ao seu estado original/normal (por exemplo, sem articulação). Mais detalhes relativos a essas características 15 são fornecidos abaixo.
A figura 3 é uma vista explodida do atuador de extremidade 12 de acordo com várias modalidades.
Conforme mostrado na modalidade ilustrada, o atuador de extremidade 12 pode incluir, em adição à canaleta 22 e à garra fixa 24 previamente mencionadas, um instrumento de corte 32, um 20 trilho 33, um cartucho de grampos 34 que é assentado de modo removível na canaleta 22, e uma haste de parafuso helicoidal 36. O instrumento de corte 32 pode ser, por exemplo, uma faca.
A garra fixa 24 pode ser aberta e fechada de modo articulado em um ponto de pivô 25 conectado à extremidade adjacente da canaleta 22. A garra fixa 24 também pode incluir 25 uma aba 27 em sua extremidade adjacente que é inserida dentro de um componente de um sistema de fechamento mecânico para abrir e fechar a garra fixa 24. Quando o gatilho de fechamento 18 é acionado, isto é, puxado por um usuário do instrumento 10, a garra fixa 24 pode girar em torno do ponto de pivô 25 para a posição fixada ou fechada.
Se a fixação do atuador 30 de extremidade 12 é satisfatória, o operador pode acionar o gatilho de descarga 20, o que faz com que a faca 32 e o trilho 33 corram longitudinalmente ao Iongo da canaleta 22, cortando desse modo o tecido
" fixado dentro do atuador de extremidade 12. O movimento do trilho 33 ao longo da canaleta 22 faz com que os grampos do cartucho de grampos 34 sejam dirigidos para o tecido seccionado e contra a garra fixa 24 fechada, o que faz com que os grampos unam o tecido seccionado.
Em várias 5 modalidades, o trilho 33 pode ser um componente integral do cartucho 34. A patente U.S. n° 6.978.921, intitulada "Surgical stapling instrument incorporating an E-beam firing mechanism", que está aqui incorporada na Íntegra, a título de referência, fornece mais detalhes sobre tais instrumentos de corte e união de dois lances.
O trilho 33 pode ser parte do cartucho 34, 10 de modo que quando a faca 32 retrai-se após a operação de corte, o trilho 33 não se retrai.
Deve ser obseNado que embora as modalidades do instrumento 10 aqui descritas empreguem um atuador de extremidade 12 que grampeia o tecido seccionado, em outras modalidades técnicas diferentes para unir ou 15 selar o tecido seccionado podem ser usadas.
Por exemplo, atuadores de extremidade que usam energia RF ou adesivos para unir o tecido seccionado também podem ser usados.
A patente U.S. n° 5.709.680 intitulada "ELECTROSURGICAL HEMOSTATIC DEVICE", de Yates et al., e a patente U.S. n° 5.688.270 intitulada "ELECTROSURGICAL HEMOSTATIC 20 DEVICE WITH RECESSED AND/OR OFFSET ELECTRODES" de Yates et al., aqui incorporadas na Íntegra, a título de referência, apresentam um instrumento de corte endoscópico que usa energia RF para selar o tecido seccionado.
A publicação do pedido de patente U.S. n° 2007/0102453, intitulado "Surgical stapling instruments structured for delivery of medical 25 agents", de Jerome R.
Morgan, et al., e a publicação de pedido de patente U.S. n° 2007/0102452, intitulado "Surgical stapling instruments structured for pump-assisted delivery of medical agents", de Frederick E.
Shelton, lV, et al., aqui incorporados na Íntegra, também a título de referência, apresentam um instrumento de corte endoscópico que usa adesivos para unir o tecido 30 seccionado.
Desse modo, embora a descrição da presente invenção refira- se em geral a operações de corte/grampeamento e similares, deve ser reconhecido que esta é uma modalidade exemplificadora, e não pretende
" ser limitadora.
Outras técnicas de união de tecidos também podem ser usadas. - Mais detalhes em relação a atuadores de extremidade adequados, mecanismos de travamento de gatilho de fechamento, e 5 sistemas de fechamento mecânico para o atuador de extremidade podem ser encontrados na publicação de pedido de patente U.S. n° 2007/0175958 Al, intitulado "Motor-driven surgical cutting and fastening instrument with user feedback system", por Shelton et al., aqui incorporado na Íntegra, a título de referência. 10 O instrumento 10 também pode compreender um motor elétrico
- para alimentar o atuador de extremidade 12. A publicação de pedido de patente U.S. n° 2007/0175958 A1, referida no parágrafo precedente, apresenta um endocortador que tem um motor elétrico para alimentar o atuador de extremidade.
Em tal modalidade, o motor, que pode ser 15 alimentado por uma bateria (ou baterias) no cabo, alimenta, através de um trem de acionamento, as operações relatadas de corte e união do atuador de extremidade.
O instrumento 10 também pode incluir vários sensores que detectam vários estados relatados para o instrumento 10. Por exemplo, 20 conforme descrito na publicação de pedido de patente U.S. n° 2007/0175958 Al, mencionado acima, o instrumento 10 pode incluir um sensor de fim de curso para detecção do fim do curso de corte pelo instrumento de corte no atuador de extremidade, e um sensor de início do curso para detectar o início do curso de corte pelo instrumento de corte.
Os sinais desses 25 sensores podem ser usados, por exemplo, para controlar o motor.
Além disso, com referência à figura 4, o instrumento 10 pode compreender: um sensor de gatilho de fechamento 50 para detectar a retração do gatilho de fechamento 18; um sensor de fechamento 52 da garra fixa para detectar o fechamento da garra fixa 24; em sensor de carga de 30 fechamento 54 da garra fixa para detectar a força exercida sobre o sensor 54, o qual pode ser colocado na superfície interna do fundo do cartucho de grampos 22 devido ao fechamento da garra fixa 24; um sensor de gatilho de
" descarga 56 para detectar a retração do gatilho de descarga 20; um sensor de posição de faca 58 para detectar a posição longitudinal da faca (isto é, instrumento de corte) ao longo da canaleta 22 no atuador de extremidade 12; um sensor de presença de cartucho 60 para detectar se o cartucho de 5 grampos 34 está presente no atuador de extremidade 12; e um sensor de estado de cartucho 62 para detectar o estado do cartucho de grampos 34 (por exemplo, se o cartucho foi ou não usado). Os sensores 50 a 62 podem estar em comunicação com uma unidade de controle 64, localizada de preferência no cabo 6 do instrumento. 10 A unidade de controle 64 pode compreender um processador 70, uma unidade de memória só de leitura 72, e uma unidade de memória de leitura e gravação 74. A unidade de controle 64 também pode compreender conversores analógico-digital (ADC) e conversores digital-analógico (DAC) (não mostrado) para comunicação com os sensores 50 a 62. A unidade de 15 memória só de leitura 72 pode compreender unidades de memória EPROM e/ou EEPROM instantânea.
A unidade de memória de Ieitura e gravação 74 pode compreender uma unidade de memória volátil como uma unidade de memória de acesso aleatório (RAM). Os vários componentes da unidade de controle 64 podem ser discretos ou podem estar integrados em um ou 20 poucos componentes.
Por exemplo, em uma modalidade, o processador 70, ROM 72, RAM 74, DACs, e ADCs pode ser parte de um microcontrolador ou computador em um único circuito integrado (chip). A unidade de controle 64 pode ser alimentada por uma fonte de alimentação 76, como uma bateria.
Para os instrumentos 10 que têm um 25 motor CC para alimentar o atuador de extremidade, a fonte de alimentação 76 que alimenta a unidade de controle 64 pode ser a mesma fonte de alimentação que alimenta o motor, ou fontes de alimentação diferentes podem ser usadas para a unidade de controle 64 e o motor.
Dados de saída de vários sensores podem ser armazenados em 30 formato digital em uma ou ambas as unidades de memória 72 e 74. A publicação do pedido de patente n° 2007/0175964 A1, aqui incorporado na Íntegra, a título de referência, apresenta um endocortador tendo um
" dispositivo de armazenamento para armazenar e gravar os dados do sensor.
Dados de saída de alguns dos sensores mencionados acima podem estar - em formato analógico.
Para esses tipos de sensores, os ADCS podem ser usados para converter sinais do sensor analógico para o formato digital, para 5 armazenagem nas unidades de memória 72 e 74. Os sensores também podem estar acoplados na unidade de controle 64 por meio de enlaces de comunicação com fio e/ou sem fio.
Para modalidades em que os sensores comunicam-se com a unidade de controle 64 no modo sem fio, os sensores podem compreender receptores-transmissores (transponders) que se 10 comunicam com um transceptor (não mostrado) da unidade de controle 64. De acordo com várias modalidades, o instrumento 10 pode compreender um pivô de articulação motorizado.
A figura 5 apresenta um conjunto de junta com pivô de articulação 2400 de acordo com uma modalidade.
Conforme pode ser visto na figura 5, o segmento de tubo distal 15 2410 tem uma extremidade proximal 2414 e um eixo distal H"-H". Embora não mostrado na figura 5, o segmento de tubo distal 2410 tem uma extremidade distal que está acoplada mecanicamente ao atuador de extremidade 12. Dependendo da disposição de fechamento da garra fixa empregada, a extremidade distal pode ser fixada de modo não móvel ao 20 atuador de extremidade ou por um cabo, membro flexível, ou membro pivotante.
O segmento do tubo distal 2410 pode ser parcialmente oco com a extremidade proximal 2414 sendo sólida e com uma passagem de recepção de mangueira/fio 2416 através do mesmo.
A passagem 2416 pode ter uma porção com formato cônico 2417. O conjunto de junta 2400 inclui um 25 segmento de tubo proximal 2450, que tem uma extremidade distal 2454, e um eixo proximal I"-|". Embora não mostrado na figura 5, o segmento de tubo proximal 2450 tem uma extremidade proximal que é vinculada ao conjunto de cabo 6. Em uma modalidade, o segmento de tubo distal 2410 está 30 acoplado de forma articulada ao segmento de tubo proximal 2450 por um conjunto de junta esférica 2460. Em uma modalidade, o conjunto de junta esférica 2460 compreende um membro esférico 2462 que está montado ou é
" formado na extremidade distal 2454 do segmento de tubo proximal 2450. O membro esférico 2462 tem uma passagem oca 2464 que tem uma porção de extremidade alargada ou de outro modo ampliada 2465 para possibilitar a comunicação com as porções de passagem 2416 e 2417, de modo que, 5 independentemente da posição do membro esférico 2462, as mangueiras 480 e/ou fios que se estendem através dos mesmos não serão comprimidos ou de outra forma danificados.
O membro esférico 2462 é recebido em um soquete 2458 fornecido na extremidade proximal 2414 do segmento do tubo distal 2410, de modo que o membro esférico 2462 fique livre para girar nele. 10 Em uma modalidade, o conjunto de atuação, em geral designado como 2500, é empregado para articular o segmento de tubo distal 2410 em relação ao segmento de tubo proximal 2450. Como pode ser visto na figura 5, em uma modalidade não limitadora, dois cabos de engrenagem de rosca sem-fim flexíveis 2510 e 2520 são empregados.
O primeiro cabo de 15 engrenagem de rosca sem-fim flexível 2510 é adaptado para engatar de modo dirigido nos dentes da engrenagem de rosca sem-fim, roscas, etc. (não mostrado) dentro de uma primeira passagem de engrenagem 2465 formada no membro esférico 2462. O primeiro cabo de engrenagem de rosca sem-fim flexível 2510 está acoplado a um primeiro motor 2512 que 20 está montado dentro do segmento de tubo distal 2410. De modo similar, nessa modalidade não limitadora, um segundo cabo de engrenagem de rosca sem-fim flexível 2520 é adaptado para engatar de modo dirigido nos dentes, roscas, etc. da engrenagem dentro de uma segunda passagem de engrenagem 2467 formada no membro esférico 2462 que tem dentes, 25 roscas, etc. de engrenagem de rosca-sem-fim 2469 formados nisso.
O segundo cabo de engrenagem de rosca sem-fim flexível 2520 está acoplado a um segundo motor 2522 montado no segmento de tubo distal 2410. Embora descritos como "cabos de engrenagem de rosca sem-fim flexíveis," será compreendido que esse termo é usado para abranger todos os tipos de 30 disposições de acionadores ou cabos dirigidos flexíveis que não empregam necessariamente dentes do tipo engrenagem de rosca-sem-fim.
O primeiro e o segundo motores 2512 e 252 podem ser
" alimentados eletricamente por uma bateria (por exemplo, uma bateria local ou um conjunto de baterias no cabo 6) ou por corrente alternada, ou podem ser alimentados por fluido ou ar hidráulico. Em uma modalidade, os motores 2512 e 2522 são alimentados eletricamente e operados por uma ou mais 5 chaves ou botões no conjunto de cabo 6. Por meio do controle da quantidade de rotação e da direção de rotação do primeiro e do segundo cabos de engrenagem de rosca sem-fim 2510 e 2520, o membro esférico 2462 é levado a girar dentro do soquete 2458 e assim articular o segmento de tubo distal 2410 (e o atuador de extremidade 12 fixado ao mesmo) em 10 relação ao segmento de tubo proximal 2450. O leitor reconhecerá que tal disposição facilita a articulação esquerda, conforme mostrado na figura 5, e a articulação direita (não mostrada). Entretanto, novamente, o leitor reconhecerá que, embora duas disposições de motor/cabo de engrenagem de rosca sem-fim flexível tenham sido descritas acima, outras modalidades 15 da presente invenção podem empregar apenas uma disposição de cabo de engrenagem de rosca sem-fim flexível, se apenas uma articulação de grau um for necessária ou desejada. Também, embora o membro esférico 2462 tenha sido descrito como estando montado de modo não móvel ao segmento de tubo proximal 2450 com o soquete 2458 no segmento de tubo distal 20 2410, os versados na técnica entenderão que o membro esférico 2462 pode ser vinculado, em outras modalidades não-limitadoras e sem se desviar do espírito e escopo da presente invenção, de modo não móvel ao segmento de tubo distal 2410 e ao soquete 2458 fornecidos no segmento de tubo proximal
2450. 25 O conjunto de junta 2400 pode incluir um ou mais sensores 66 (vide figura 4) que detectam a articulação do pivô de articulação 14. Dados de saída dos sensores 66 são gravados em um ou ambos os dispositivos de memória 72 e 74 da unidade de controle 64. Por exemplo, os sensores 66 podem incluir sensores giratórios ópticos ou magnéticos (por exemplo, 30 sensores de efeito Hall) e/ou acelerômetros que detectam, coIetivamente, a articulação, seja direta ou indiretamente, do atuador de extremidade 12. Por exemplo, os sensores 66 podem detectar diretamente a articulação/rotação
" do atuador de extremidade.
Em outra modalidade, os sensores 66 podem detectar a rotação ou direção dos cabos de engrenagem de rosca sem-fim 2510 e 2520 para detectar assim indiretamente a articulação do atuador de extremidade 12. A unidade de controle 64 pode armazenar e gravar a 5 informação dos sensores de articulação 66, o que pode facilitar ao usuário do instrumento 10 na replicação da articulação exata ou aproximada no uso subsequente do instrumento, conforme descrito adicionalmente abaixo.
Os sensores 66 podem comunicar-se com a unidade de controle 64 por meio de enlaces de comunicação com fio e/ou sem fio.
Também, dados de saída dos 10 sensores 66 podem ser sinais analógicos que são convertidos em formato digital por ADCS da unidade de controle 64. A publicação de pedido de patente U.S. n° 2007/0106317 Al, intitulado "Hydraulically and electrically actuated articulation joints for surgical instruments", de Shelton et al., descreve em mais detalhes um pivô de 15 articulação motorizado.
Esse pedido também fornece outras modalidades de pivôs de articulação motorizados.
Esse pedido também descreve pivôs de articulação alimentados hidraulicamente.
Para instrumentos que têm pivôs de articulação hidráulicos, os sensores de articulação 66 podem incluir acelerômetros ou outros sensores adequados para detectar, direta ou 20 indiretamente, a articulação do atuador de extremidade 12. O dispositivo de seleção 90 (vide figuras 1 e 2) pode ser um dispositivo com múltiplos estados ou estado único, de acordo com várias modalidades.
Para um dispositivo de múltiplos estados, o usuário do instrumento pode ativar a chave para fazer com que o instrumento articule- 25 se para um estado de articulação anterior (por exemplo, o estado de articulação imediatamente anterior) quando o instrumento 10 for descarregado pela última vez.
O usuário pode então ativar a chave novamente para retornar o atuador de extremidade 12 ao seu estado normal, não articulado.
O usuário pode também ativar o dispositivo 90 para gravar os 30 dados de articulação na unidade de controle 64 quando o clínico tiver posicionado o atuador de extremidade no estado desejado.
Em outra modalidade, os dados do sensor articulado podem ser gravados
" automaticamente todas as vezes que o instrumento 10 for descarregado ou fixado.
Desse modo, o clínico não precisa fazer uma ação afirmativa, a não ser descarregar o instrumento, como pressionar o dispositivo 90, para ter os dados de articulação provenientes dos sensores de articulação 66 gravados 5 nas unidades de memória 72 e 74 da unidade de controle.
Para uma modalidade com dispositivos de entrada de dados de estados múltiplos e de estado único 90 e 92, o usuário pode usar um dispositivo de entrada de dados 90 para articular automaticamente o atuador de extremidade ao estado anterior, e um segundo dispositivo de entrada de 10 dados 92 para retornar o atuador de extremidade 12 ao seu estado normal, não articulado.
Os dispositivos de entrada de dados 90 e 92 podem estar em comunicação com a unidade de controle 64. Também pode haver um terceiro dispositivo de entrada de dados (não mostrado) que o usuário pode ativar para fazer com que os dados de articulação sejam gravados na 15 unidade de controle 64. Alternativamente, os dados do sensor de articulação podem ser gravados automaticamente todas as vezes que o instrumento 10 for descarregado e/ou fixado.
Para articular automaticamente o atuador de extremidade, quando o dispositivo de seleção 90 for ativado pelo usuário, a unidade de 20 controle 64 pode transmitir sinais aos controles 2512 e 2522 no conjunto de junta 2400 do pivô de articulação 14 (ou acionadores hidráulicos para um conjunto de junta que tenha acionadores hidráulicos). Os sinais enviados aos motores 2512 e 2522 podem ser baseados no estado anterior da articulação do atuador de extremidade (por exemplo, a rotação e direção do 25 atuador de extremidade 12 em relação à haste) que é armazenado em uma ou ambas as unidades de memória 72 e 74 com base nos dados do sensor recebidos dos sensores de articulação 66. Dessa maneira, pela ativação do dispositivo de seleção 90, o usuário do instrumento 10 pode fazer com que o atuador de extremidade 12 articule-se automaticamente ao mesmo estado 30 de articulação de um uso anterior (por exemplo, o estado de articulação em que o instrumento 10 foi descarregado pela última vez). lsso pode ser vantajoso para procedimentos em que o clínico tem que fazer lances
" repetidos de corte/união no mesmo local geral do paciente.
Em vez de ter que articular o atuador de extremidade 12 todas as vezes ao mesmo local geral, o cIínico pode articular automaticamente o atuador de extremidade 12 para sua última posição pela ativação do dispositivo de seleção 90. 5 O que segue abaixo descreve um exemplo de como o instrumento 10 pode ser usado.
Nesse exemplo, assume-se o uso de um dispositivo de seleção de entrada de dados de estados múltiplos 90, reconhecendo-se que o exemplo pode ser facilmente estendido a uma modalidade que tenha dois ou mais dispositivos de entrada de dados.
Nesse 10 exemplo, o clínico pode inserir o atuador de extremidade 12 através da cânula.
Então, com o uso do controle de articulação manual 16, o médico pode articular o atuador de extremidade 12 para a posição desejada, isto é, a posição em que o clínico deseja executar as ações simultâneas de corte e união do instrumento de corte 10. Após o clínico ter articulado o atuador de 15 extremidade 12 para a posição desejada, o clínico pode retrair o gatilho de fechamento para sua posição travada, prendendo o tecido entre as garras opostas 22 e 24 do atuador de extremidade 12. Então o clínico pode retrair o gatilho de descarga 20, levando o instrumento de corte 32 a, primeiro, atravessar longitudinalmente a canaleta 22 do atuador de extremidade 12, 20 cortando assim o tecido fixado no atuador de extremidade 12 e, a seguir, fazer com que os grampos no cartucho de grampos 34 sejam impelidos através do tecido fixado e dobrados pela garra fixa 24, grampeando assim o tecido fixado em cada lado da incisão criada pelo instrumento de corte 32. Antes ou após a descarga, ou antes ou após a fixação, o usuário pode ativar 25 o dispositivo de entrada 90 (ou algum outro dispositivo de entrada) para Ievar os dados de articulação provenientes dos sensores de articulação 66, indicando o estado da articulação do atuador de extremidade 12 em relação à haste 8, para serem gravados pela unidade de controle 64. Em outra modalidade, os dados de articulação são gravados quando o instrumento é 30 descarregado ou quando o atuador de extremidade está fixado.
Então o clínico pode desarticular automaticamente o atuador de extremidade 12 de volta ao seu estado normal desarticulado (por exemplo,
" reto) quando ele pressiona o dispositivo de seleção de entrada de dados pelo usuário 90 (para entrada única, modalidade de dispositivo de 2 estados, ou dispositivo de seleção de entrada de dados pelo usuário 92 para uma modalidade de dispositivo de dupla entrada) de modo que o clínico possa 5 retirá-lo de volta através da cânula.
Então o cIínico pode substituir o cartucho de grampos gasto 34 por um novo cartucho (isto é, com grampos) e inserir o atuador de extremidade 12 de volta através da cânula para dentro do paciente.
Então, ao pressionar ou de outro modo ativar o dispositivo de seleção de entrada de dados pelo usuário 90, o clínico pode levar o atuador 10 de extremidade 12 a articular-se automaticamente para a mesma posição de articulação que ele estava quando o instrumento 10 foi descarregado pela última vez, com base nos dados de saída do sensor de articulação a partir da última descarga armazenada na unidade de controle 64. Dessa maneira, o clínico pode articular automaticamente o atuador de extremidade 12 de 15 volta à mesma posição geral que ele estava na última descarga, e não ter que articular manualmente o atuador de extremidade 12. lsso deveria tender a causar uma maior exatidão e repetitividade no reposicionamento do atuador de extremidade 12, quando for importante reposicioná-lo na mesma posição geral da descarga anterior. 20 Seguindo a segunda descarga do instrumento 10, o clínico pode desarticulá-lo automaticamente de volta para a posição não articulada, retirá- Io através da cânula, e, se necessário, substituir o cartucho de grampos novamente e reinserir o atuador de extremidade para a próxima descarga, com o atuador de extremidade sendo articulado automaticamente ao seu 25 estado de articulação da descarga anterior.
Para os instrumentos em que o usuário ativa um dispositivo de entrada de dados pelo usuário para fazer com que os dados de articulação sejam gravados, o usuário pode gravar os dados do estado articulado apenas da primeira descarga, de modo que nas descargas subsequentes, o atuador de extremidade 12 será articulado 30 automaticamente para a mesma posição geral da primeira descarga.
Alternativamente, o usuário pode gravar os estados de articulação para cada descarga, de modo que o atuador de extremidade possa ser articulado
" automaticamente para a mesma posição geral da descarga imediatamente precedente.
Os dispositivos apresentados na presente invenção podem ser projetados para serem descartados após um único procedimento (o que 5 pode compreender descargas múltiplas), ou eles podem ser projetados para serem usados em procedimentos múltiplos.
Entretanto, em cada caso, o dispositivo pode ser recondicionado para reuso após o último procedimento, no mínimo.
O recondicionamento pode incluir qualquer combinação das etapas de desmontagem do dispositivo, seguido de Iimpeza ou substituição 10 de peças particulares, e remontagem subsequente.
Em particular, o dispositivo pode ser desmontado, em qualquer número de peças particulares ou partes do dispositivo podem ser seletivamente substituídas ou removidas, em qualquer combinação.
Com a limpeza e/ou substituição de partes particulares, o dispositivo pode ser remontado para uso subsequente em 15 uma instalação de recondicionamento ou por uma equipe cirúrgica imediatamente antes de um procedimento cirúrgico.
Aqueles versados na técnica apreciarão que o recondicionamento de um dispositivo pode utilizar uma variedade de técnicas para desmontagem, Iimpeza/substituição, e remontagem.
O uso de tais técnicas e o dispositivo recondicionado 20 resultante estão todos no escopo do presente pedido.
De preferência, as várias modalidades da invenção aqui descritas, serão processadas antes da cirurgia.
Primeiro, um instrumento novo ou usado é obtido e se necessário limpo.
O instrumento pode ser então esterilizado.
Em uma técnica de esterilização, o instrumento é coIocado em 25 um recipiente fechado e Iacrado, como uma carcaça plástica termoformada coberta com uma folha de TYVEK.
O recipiente e o instrumento são então coIocados em um campo de radiação, como radiação gama, raios X, ou elétrons de alta energia, que pode penetrar no recipiente.
A radiação extermina bactérias no instrumento e no recip iente.
O instrumento 30 esterilizado pode então ser armazenado em um recipiente estéril.
O recipiente estéril mantém o instrumento estéril até que seja aberto na instalação médica.
W É preferencial que o dispositivo seja esterilizado. lsso pode ser feito por várias técnicas conhecidas pelos versados na técnica, incluindo radiação gama ou beta, óxido de etileno, vapor d'água e outros métodos.
Embora a presente invenção tenha sido ilustrada pela descrição 5 de várias modalidades e embora as modalidades ilustrativas tenham sido descritas em detalhes consideráveis, não é intenção dos requerentes restringir ou de qualquer forma limitar o escopo das reivindicações em anexo a tais detalhes.
Vantagens e modificações adicionais podem mostrar-se facilmente disponíveis para os versados na técnica.
As várias modalidades 10 da presente invenção representam vastos aprimoramentos sobre os métodos anteriores relativos a grampos, que requerem o uso de diferentes - tamanhos de grampos em um único cartucho para fazer com que os grampos tenham alturas finais diferentes.
Consequentemente, a presente invenção foi discutida em termos 15 de procedimentos e aparelhos endoscópicos.
Entretanto, termos como "endoscópico" não devem ser interpretados de modo a limitar a presente invenção a um instrumento de grampeamento e seccionamento cirúrgico para uso apenas em conjunto com um tubo endoscópicos (isto é, uma cânula ou trocarte). Ao contrário, acredita-se que a presente invenção pode 20 ter uso em qualquer procedimento onde o acesso é limitado, incluindo, mas não se limitando a, procedimentos laparoscópicos, bem como procedimentos abertos.
Além disso, os aspectos exclusivos e inovadores das várias modalidades de cartucho de grampos da presente invenção podem ter utilidade quando usados em associação com outras formas de aparelhos de 25 grampeamento sem desviar-se do espírito e escopo da presente invenção.

Claims (6)

W REIVINDICAÇÕES
1. lnstrumento cirúrgico que compreende: um atuador de extremidade; uma haste; 5 um conjunto de junta articulável conectado entre o atuador de extremidade e a haste para articulação do atuador de extremidade em relação à haste, em que o conjunto de junta articulável automaticamente compreende: pelo menos um sensor de articulação para detectar a articulação 10 do conjunto de junta articulável automaticamente; e - pelo menos um motor para articular automaticamente o atuador de extremidade em relação à haste; - uma unidade de controle em comunicação com o, pelo menos um, sensor de articulação, em que a unidade de controle compreende pelo 15 menos uma unidade de memória para armazenar dados de articulação a partir de o, pelo menos um, sensor de articulação, e em que a unidade de controle está em comunicação com o, pelo menos um, motor do conjunto de junta articulável.
2. lnstrumento cirúrgico, de acordo com a reivindicação 1, em 20 que a unidade de controle serve para controlar o, pelo menos um, motor no conjunto de junta articulável, para Ievar o motor a articular o atuador de extremidade para uma posição com base nos dados de articulação armazenados na, pelo menos uma, unidade de memória.
3. lnstrumento cirúrgico, de acordo com a reivindicação 2, em 25 que o, pelo menos um, motor compreende um motor elétrico.
4. lnstrumento cirúrgico, de acordo com a reivindicação 2, em que o, pelo menos um, motor compreende um motor hidráulico.
5. lnstrumento cirúrgico, de acordo com a reivindicação 2, que compreende adicionalmente um cabo conectado à haste, em que a unidade 30 de controle está no cabo.
6. lnstrumento cirúrgico, de acordo com a reivindicação 2, em que o atuador de extremidade compreende:
- um primeiro membro de garra; e um segundo membro de garra conectado de modo articulável ao - primeiro membro do garra.
7. lnstrumento cirúrgico, de acordo com a reivindicação 6, em 5 que a unidade de controle compreende um processador em comunicação com a, pelo menos uma, unidade de memória.
8. lnstrumento cirúrgico, de acordo com a reivindicação 7, que compreende, adicionalmente, pelo menos um dispositivo de entrada de dados pelo usuário em comunicação com a unidade de controle, o qual, 10 quando ativado pela primeira vez, leva a unidade de controle a controlar o motor do conjunto de junta articulável para levar o conjunto de junta articulável a articular-se para um estado de articulação com base nos dados de articulação armazenados na, pelo menos uma, unidade de memória da unidade de controle. 15 9. lnstrumento cirúrgico, de acordo com a reivindicação 8, em que o, pelo menos um, dispositivo de entrada de dados pelo usuário está posicionado no cabo.
10. lnstrumento cirúrgico, de acordo com a reivindicação 8, em que, quando o dispositivo de entrada de dados pelo usuário é ativado uma 20 segunda vez, a unidade de controle faz com que o motor do conjunto de junta articulável seja articulado para uma posição não articulada.
11. Instrumento cirúrgico, de acordo com a reivindicação 8, em que o estado de articulação é baseado na articulação do atuador de extremidade em um tempo anterior. 25 12. Instrumento cirúrgico, de acordo com a reivindicação 11, em que o tempo anterior compreende um tempo na qual o instrumento foi descarregado anteriormente.
13. lnstrumento cirúgico de corte e união que compreende: um atuador de extremidade que compreende: 30 um instrumento de corte móvel para cortar um objeto posicionado no atuador de extremidade; um primeiro membro de garra que compreende uma canaleta
" alongada para alojar o instrumento de corte; e um segundo membro de garra conectado de modo articulável a, . e oposto ao primeiro membro de garra; uma haste; 5 um conjunto de junta articulável conectado entre o atuador de extremidade e a haste para articular o atuador de extremidade em relação à haste, em que o conjunto de junta articulável automaticamente compreende: pelo menos um sensor de articulação para detectar a articulação do conjunto de junta articulável automaticamente; e 10 pelo menos um motor para articular automaticamente o atuador de extremidade em relação à haste; - um cabo conectado à haste, em que o cabo compreende: uma unidade de controle em comunicação com o, pelo menos um, sensor de articulação, em que a unidade de controle compreende pelo 15 menos uma unidade de memória para armazenar os dados de articulação a partir do, pelo menos um, sensor de articulação, e em que a unidade de controle está em comunicação com o, pelo menos um, motor do conjunto de junta articulável, para controlar o, pelo menos um, motor que leva o mesmo a articular o atuador de extremidade para um posição com base nos dados 20 de articulação armazenados na, pelo menos uma, unidade de memória; e pelo menos um dispositivo de entrada de dados pelo usuário em comunicação com a unidade de controle, que, quando ativado uma primeira vez, leva a unidade de controle a controlar o motor do conjunto de junta articulável para levar o conjunto de junta articulável a articular-se para um 25 estado de articulação com base nos dados de articulação armazenados na, pelo menos uma, unidade de memória da unidade de controle.
14. lnstrumento cirúrgico, de acordo com a reivindicação 13, em que, quando o dispositivo de entrada de dados pelo usuário é ativado uma segunda vez, a unidade de controle leva o motor do conjunto de junta 30 articulável a levar conjunto de junta articulável a articular-se para um estado não articulado.
15. lnstrumento cirúrgico, de acordo com a reivindicação 13, em
" que o estado de articulação é baseado na articulação do atuador de extremidade em um tempo anterior.
16. lnstrumento cirúrgico, de acordo com a reivindicação 13, em que o tempo anterior compreende um tempo em que o instrumento foi 5 anteriormente descarregado.
17. Método para realizar um procedimento médico em um paciente, o método compreende: (a) inserir um atuador de extremidade articulável de um instrumento cirúrgico de corte e união em um paciente através de uma 10 cânula, em que o atuador de extremidade está em um primeiro estado de articulação quando o atuador de extremidade é inserido através da cânula; (b) após a etapa (a), ativar um dispositivo de entrada de dados - em um instrumento cirúrgico de corte e união para levar o atuador de extremidade a articular-se automaticamente em um segundo estado de 15 articulação que é diferente do primeiro estado de articulação; (C) após a etapa (b), descarregar o instrumento cirúrgico de corte e união para seccionar e unir o tecido fixado no atuador de extremidade; (d) após a etapa (C), ativar o dispositivo de entrada de dados para levar o atuador de extremidade a articular-se automaticamente em um 20 segundo estado de articulação; e (e) após a etapa (d), retirar o atuador de extremidade do paciente através de uma cânula.
18. Método, de acordo com a reivindicação 17, que compreende adicionalmente 25 (f) após a etapa (e), substituir um cartucho de grampos no atuador de extremidade; e (g) repetir as etapas (a) até (e).
19. Método, de acordo com a reivindicação 17, que compreende adicionalmente, antes da etapa (a): 30 (h) inserir o atuador de extremidade articulável no paciente através de uma cânula, em que o atuador de extremidade está no primeiro estado de articulação quando o atuador de extremidade é inserido através da cânula; (i) após a etapa (h), articular manualmente o atuador de - extremidade ao segundo estado de articulação; Ú") após a etapa (i), descarregar o instrumento cirúrgico de corte 5 e união para seccionar e unir o tecido fixado no atuador de extremidade; (k) após a etapa Ú"), ativar o dispositivo de entrada de dados para levar o atuador de extremidade a articular-se automaticamente para o primeiro estado de articulação; e (I) após a etapa (k), retirar o atuador de extremidade do paciente 10 através da cânula
20. Método, de acordo com a reivindicação 19, que compreende ~ adicionalmente: - (m) após a etapa (e), substituir um cartucho de grampos no atuador de extremidade; e 15 (n) repetir as etapas (a) até (e)-
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RU2497468C2 (ru) 2013-11-10
WO2009143092A1 (en) 2009-11-26
RU2010152241A (ru) 2012-06-27
JP2011520564A (ja) 2011-07-21
US20090289096A1 (en) 2009-11-26
EP2296559B8 (en) 2016-10-12
US7922061B2 (en) 2011-04-12
CN102076270B (zh) 2014-06-11
CA2724511C (en) 2017-07-04
CA2724511A1 (en) 2009-11-26
CN102076270A (zh) 2011-05-25
BRPI0913095B1 (pt) 2020-12-29
BRPI0913095B8 (pt) 2021-06-22
EP2296559A1 (en) 2011-03-23
EP2296559B1 (en) 2016-08-03
PL2296559T3 (pl) 2017-05-31

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