ES2197306T3 - Mecanismo de transmision de articulacion para instrumentos quirurgicos. - Google Patents
Mecanismo de transmision de articulacion para instrumentos quirurgicos.Info
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- ES2197306T3 ES2197306T3 ES97303215T ES97303215T ES2197306T3 ES 2197306 T3 ES2197306 T3 ES 2197306T3 ES 97303215 T ES97303215 T ES 97303215T ES 97303215 T ES97303215 T ES 97303215T ES 2197306 T3 ES2197306 T3 ES 2197306T3
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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
- A61B2017/00535—Surgical instruments, devices or methods pneumatically or hydraulically operated
-
- 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
- A61B2017/2901—Details of shaft
- A61B2017/2905—Details of shaft flexible
-
- 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
- A61B17/2909—Handles
- A61B2017/2912—Handles transmission of forces to actuating rod or piston
- A61B2017/2913—Handles transmission of forces to actuating rod or piston cams or guiding means
-
- 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
- A61B17/2909—Handles
- A61B2017/2912—Handles transmission of forces to actuating rod or piston
- A61B2017/2923—Toothed members, e.g. rack and pinion
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- 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
- A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft
-
- 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
- A61B2017/2932—Transmission of forces to jaw members
-
- 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
- A61B2017/2946—Locking means
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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)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Surgical Instruments (AREA)
Abstract
LA INVENCION SE REFIERE A UNA INSTRUMENTO QUIRURGICO CON ARTICULACION (20) QUE TIENE UN CONJUNTO DE TRANSMISION DE ARTICULACION (31) PARA ARTICULAR A DISTANCIA UN ACCIONADOR DE EXTREMO (27) DEL INSTRUMENTO. EL CONJUNTO DE TRANSMISION DE ARTICULACION INCLUYE UN ALOJAMIENTO DE DETENCION (65) MONTADO SOBRE EL INSTRUMENTO CON UNA PLURALIDAD DE DIENTES DE DETENCION CUANDO EL CONJUNTO ESTA EN UNA PRIMERA POSICION BLOQUEADA. UN ACCIONADOR (37) ESTA MONTADO EN EL ALOJAMIENTO DE DETENCION PARA APLICAR UNA FUERZA GIRATORIA A LA CUBIERTA. UN ELEMENTO IMPULSOR (53) ESTA EN COMUNICACION CON LA CUBIERTA PARA CONVERTIR UN MOVIMIENTO GIRATORIO DE LA CUBIERTA EN UN MOVIMIENTO AXIAL DE UN ELEMENTO DE TRANSMISION ALARGADO QUE ESTA FIJADO AL ELEMENTO IMPULSOR. CUANDO SE APLICA UNA FUERZA GIRATORIA AL ACCIONADOR, LA CUBIERTA SE COMPRIME PARA DESACOPLAR LOS DIENTES DE LA CUBIERTA DE LOS DIENTES QUE ESTA EN EL ALOJAMIENTO DE DETENCION. EL DESACOPLAMIENTO DE LOS DIENTES REDUCE LA FUERZA GIRATORIA NECESARIA PARA HACER GIRAR LA CUBIERTA Y POR CONSIGUIENTE EL ELEMENTO IMPULSOR QUE MUEVE EL ELEMENTO DE TRANSMISION ALARGADO AXIALMENTE PARA EFECTUAR LA ARTICULACION. EN CONSECUENCIA SE FACILITA DE MANERA IMPORTANTE, LA ROTACION DE TRINQUETE DE LA CUBIERTA A PARTIR DE LA PRIMERA POSICION BLOQUEADA HASTA UNA SEGUNDA POSICION BLOQUEADA, Y POR LO TANTO, LA ARTICULACION DEL ACCIONADOR DE EXTREMO A PARTIR DE UNA PRIMERA POSICION A UNA SEGUNDA POSICION ANGULAR DESDE LA PRIMERA POSICION.
Description
Mecanismo de transmisión de articulación para
instrumentos quirúrgicos.
La presente invención se refiere a unos
instrumentos quirúrgicos para realizar diversos procedimientos
quirúrgicos, especialmente procedimientos quirúrgicos endoscópicos.
En particular, se refiere al mecanismo instrumental que permite que
el cirujano sitúe de modo preciso el instrumento en el área
quirúrgica endoscópica convenientemente y con un elevado grado de
seguridad.
Durante un procedimiento quirúrgico,
particularmente un procedimiento quirúrgico endoscópico, el acceso
al área quirúrgica del interior de la cavidad corporal puede
obtenerse mediante aberturas de pequeño diámetro practicadas en la
pared corporal. Un instrumento frecuentemente empleado para obtener
este acceso es el trocar. El trocar es un ensamblaje que incluye un
obturador y una cánula. El obturador tiene una punta aguda que se
emplea para puncionar la pared corporal para llevar a cabo la
abertura de acceso. El obturador se desliza dentro de la cánula, que
es un manguito cilíndrico, hueco. Cuando el obturador ha puncionado
la pared corporal, el obturador es retirado de la cánula. La cánula,
sin embargo, permanece en posición dentro de la abertura practicada
en la pared corporal por el obturador. En consecuencia, la cánula
proporciona un paso cilíndrico para acceder al área quirúrgica
dentro de la cavidad corporal.
De acuerdo con ello, un rasgo característico de
muchos instrumentos quirúrgicos endoscópicos es el constituido por
un eje cilíndrico que puede deslizarse a través de la cánula del
trocar. En el extremo operativo del eje, que es el extremo del
instrumento que entra en contacto con el tejido al nivel del área
quirúrgica del interior de la cavidad corporal, se dispone un
``efector terminal'' para manipular de alguna forma el tejido para
llevar a cabo el procedimiento quirúrgico deseado. El extremo
operativo incluye el efector terminal. Debe asimismo ser capaz de
deslizarse a través de la cánula del trocar. En el extremo opuesto
del eje hay un accionador conectado operativamente al extremo
operativo para controlar a distancia el funcionamiento del efector
terminal. El accionador está convenientemente alojado en una carcasa
que puede incluir una empuñadura de agarre de pistola con uno o más
disparadores pivotantes. Alternativamente, el accionador puede
incluir una palanca, o la combinación de un disparador pivotante y
una palanca. El accionador es accionado cuando el cirujano hace
pivotar el disparador u oprime la palanca. Estas acciones a su vez
provocan que el efector terminal realice la función deseada.
Antes de que el cirujano pueda accionar el
efector terminal para manipular el tejido y llevar a cabo el
procedimiento quirúrgico deseado, el efector terminal puede ser
cuidadosamente posicionado en la localización deseada dentro del
área quirúrgica endoscópica. Debe también estar posicionado en una
orientación apropiada si, por ejemplo, deben expulsarse unas grapas
en una determinada dirección para sujetar apropiadamente el tejido.
Por consiguiente, los instrumentos quirúrgicos endoscópicos incluyen
normalmente mecanismos que permiten al cirujano variar la
orientación y posicionamiento del efector terminal en el extremo
operativo del instrumento. Por supuesto, los mecanismos deben ser
operables al nivel de o cerca de la carcasa del instrumento de forma
que el cirujano pueda fácilmente manipular y controlar estos
mecanismos al tiempo que agarra el instrumento con la mano.
A menudo, puede resultar deseable girar el
efector terminal y un instrumento quirúrgico endoscópico alrededor
del eje geométrico longitudinal del eje del instrumento para variar
la orientación del efector terminal. De acuerdo con ello muchos
instrumentos quirúrgicos endoscópicos incluyen un botón o dial
situado sobre o adyacente al bastidor y que, cuando es accionado por
el cirujano manualmente, hace girar el eje del instrumento y de
conformidad con ese giro el efector final.
Otra característica crítica de ciertos
instrumentos endoscópicos es la capacidad para pivotar el efector
terminal de forma que dicho efector terminal se sitúe en una
posición ``articulada'' con respecto al eje geométrico longitudinal
del eje. En consecuencia, los instrumentos endoscópicos a menudo
incluyen un dial o botón de articulación situado en o cerca del
bastidor para articular a distancia el efector terminal para el
posicionamiento preciso del efector terminal dentro del área
quirúrgica endoscópica. Abundan numerosos ejemplos de estos
mecanismos de articulación en instrumentos quirúrgicos endoscópicos.
Por ejemplo, se anima al lector a revisar las Patentes
estadounidenses Nos. 4.728.020; 4.869.414; 5.312.023; 5.326.013;
5.330.502; 5.374.277; 5.381.943; 5.383.888; 5.403.342; 5.405.344;
5.409.498; 5.411.519; 5.417.203 y 5.456.684. Los mecanismos de
articulación para pivotar el efector terminal se describen también
en el documento EP-A-0 686 374.
El documento
EP-A-0 674 876, que se considera
como la técnica anterior más próxima, describe un instrumento de
articulación con una carcasa que incluye un medio de agarre manual,
un eje alargado, un efector terminal, un ensamblaje de transmisión
de la articulación, un miembro motriz y una palanca para girar dicho
cuerpo de articulación. El ensamblaje de transmisión de la
articulación incluye un cuerpo de articulación para el movimiento
rotacional desde una pluralidad de posiciones de bloqueo separadas
entre una pluralidad de posiciones de desbloqueo. El miembro motriz
tiene un primer y segundo miembros de transmisión alargados unidos
al mismo que se extienden a través de dicho eje.
Asimismo es de interés el documento
EP-A-0 717 959 que describe un
mecanismo para doblar el efector terminal de un instrumentos
endoscópico por medio de una porción flexible del eje.
Aunque los instrumentos quirúrgicos endoscópicos
de articulación pueden ser en la actualidad libremente disponibles
en el comercio y han sido descritos en la literatura pertinente, los
mecanismos que controlan la articulación normalmente tienen un
inconveniente significativo. Cuando el efector terminal del
instrumento es articulado hasta una posición deseada, el efector
terminal a menudo presiona contra el tejido antes de que el efector
terminal sea manipulado para realizar la función quirúrgica deseada.
En algunos casos el cirujano intencionadamente emplea el efector
terminal articulado para presionar el tejido porque desea retraer o
diseccionar tejido para proporcionar suficiente espacio en el
interior del área para manipular con precisión el efector final para
realizar la función quirúrgica. Desgraciadamente, y esto a menudo
ocurre cuando se aplica una fuerza al efector terminal en una
posición articulada lo que sucede es que el efector terminal resulta
forzado desde su posición articulada deseada. En otras palabras, el
efector se ``desenrolla'' de la posición articulada deseada, y puede
cambiar de posición hasta otra posición articulada no deseada o
volver de nuevo a la posición original no articulada. Obviamente,
esto es una molestia que sería deseable superar.
Además, cuando se dota al ensamblaje de
articulación de resistencia al movimiento a partir de una posición
articulada, para mantener un adecuado posicionamiento (como se
describe en el documento EP-A-0 686
374), debe también dotarse al ensamblaje de la correspondiente
resistencia cuando el cirujano articula el efector terminal hasta la
posición articulada deseada. En otras palabras, el cirujano debe
aplicar una fuerza o par de fuerzas mayor al botón o dial de
articulación para obtener un incremento correspondiente de la
resistencia del efector terminal al movimiento desde la posición
articulada.
Además, si se aplica una fuerza demasiado grande
al efector terminal en una posición articulada, no sólo puede el
efector terminal desenrollarse, sino que también los componentes del
ensamblaje de articulación se pueden romper, conduciendo a un fallo
catastrófico.
De acuerdo con ello, se requiere un instrumento
quirúrgico que incluya de modo característico un efector terminal en
el extremo operativo del eje que sea capaz de ser articulado a
distancia para posicionar apropiadamente el efector terminal. La
habilidad para articular a distancia el efector terminal es
especialmente importante en instrumentos quirúrgicos endoscópicos,
los cuales característicamente incluyen un eje cilíndrico alargado
que separa la carcasa del instrumento respecto del efector terminal.
De modo significativo, el mecanismo de articulación ofrecería de
forma deseable resistencia al desplazamiento del efector terminal en
una posición articulada cuando se aplicara una fuerza al efector
terminal. Adicionalmente, la resistencia se obtendría sin requerir
fuerza excesiva para posicionar el efector terminal desde una
posición inarticulada a una articulada. Asimismo, sería deseable que
se incorporara un mecanismo de seguridad en caso de avería para
evitar la ruptura de los componentes lo que recompondría el
ensamblaje de articulación si se aplicara una fuerza demasiado
grande al efector terminal articulado.
En su sentido más amplio, la presente invención
proporciona un instrumento quirúrgico de articulación que comprende
un ensamblaje de transmisión de la articulación para articular a
distancia un efector terminal de dicho instrumento. Dicho ensamblaje
de transmisión de la articulación incluye un accionador, y un
miembro motriz. La presente invención se caracteriza porque dicho
ensamblaje de transmisión de la articulación adicionalmente
comprende: un alojamiento de retenida montado en dicho instrumento,
teniendo dicho alojamiento de retenida una pluralidad de dientes de
retenida; y un puente comprimible con una pluralidad de dientes del
puente de trinquete en dicho bloque, estando dichos dientes del
puente acoplados en perfecto ajuste con dichos dientes de retenida
cuando dicho ensamblaje de transmisión de la articulación está en
una primera posición bloqueada. Dicho accionador está acoplado en
dicho alojamiento de retenida para aplicar una fuerza rotacional
sobre dicho puente, en el que cuando se aplica dicha fuerza
rotacional, dicho puente se comprime para desconectar dichos dientes
de la plataforma de conmutación de dichos dientes de retenida para
facilitar la rotación de trinquete de dicho bloque de
engranajes desde dicha primera posición bloqueada hasta una segunda
posición bloqueada. Dicho miembro motriz está en comunicación
con dicho puente para trasladar el movimiento rotacional de dicho
puente en movimiento axial de un miembro de transmisión alargado
unido a dicho miembro motriz.
El ensamblaje de transmisión de la articulación
del instrumento quirúrgico de una forma de realización preferente de
la presente invención dota al cirujano de la capacidad de articular
a distancia el efector terminal del instrumento. La rotación del
accionador proporciona el movimiento axial del miembro de transición
alargado para articular el efector terminal.
De modo significativo, la rotación del accionador
del ensamblaje de transmisión de la articulación desacopla los
dientes del puente del alojamiento de retenida para reducir
significativamente la resistencia a la rotación. En consecuencia, se
reduce la resistencia rotacional y la articulación deseada del
efector terminal se facilita de un modo más conveniente. Si no se
aplica una fuerza rotacional al accionador, el ensamblaje de
transmisión de la articulación permanece en posición bloqueada.
Cuando el efector terminal está en posición articulada, bloqueada,
debe aplicarse una mayor fuerza sobre el efector terminal para
desacoplar los dientes y en consecuencia cambiar la posición
articulada porque el puente no quedará sometido a la compresión
resultante de la rotación del accionador. Por consiguiente, cuando
el cirujano quiere girar el accionador para su articulación, la
resistencia a la rotación es significativamente menor que la
resistencia que debe superarse cuando se aplica una fuerza al
efector terminal articulado.
Además, el ensamblaje de transmisión de la
articulación del instrumento quirúrgico proporciona una rotación de
trinquete del efector terminal. Dado que puede aplicarse una fuerza
para desacoplar los dientes del puente respecto de los dientes del
alojamiento de retenida, puede limitarse la cantidad total de fuerza
a la que están sometidos los componentes del ensamblaje de
transmisión de la articulación. En consecuencia, el ensamblaje de
transmisión de la articulación de la presente invención proporciona
un mecanismo de protección en caso de fallos para evitar la ruptura
de los componentes.
En una forma de realización preferente de la
presente invención, se proporciona un instrumento quirúrgico
articulado particularmente adaptado para cirugía endoscópica. El
instrumento comprende una carcasa que incluye un medio de agarre
manual para agarrar y manipular el instrumento al nivel de un
primer extremo del instrumento. Un eje endoscópico alargado se
extiende desde la carcasa. El eje tiene un eje geométrico
longitudinal. El instrumento tiene un efector terminal en
comunicación con el eje al nivel de un extremo opuesto del
instrumento para manipular tejido para llevar a cabo la función
quirúrgica deseada. El efector terminal es amovible para
proporcionar la articulación del efector terminal desde una
primera posición paralela al eje geométrico longitudinal del eje
hasta una segunda posición en ángulo respecto de este eje
geométrico.
El instrumento preferente tiene un ensamblaje de
transmisión de la articulación adyacente a la carcasa para articular
a distancia el efector terminal de la primera posición a la segunda
posición. Este ensamblaje de transmisión de la articulación incluye
una boquilla y un cuerpo de articulación. La boquilla está acoplada
al eje y sujeta a la carcasa. Tiene un cuerpo con un taladro que se
extiende a través de él de forma genéricamente paralela al eje
geométrico longitudinal del eje. Tiene también un alojamiento de
retenida que se extiende desde el cuerpo de la boquilla. El
alojamiento de retenida comprende una pluralidad de dientes de
retenida situados en el alojamiento. El cuerpo de articulación está
montado dentro del alojamiento de retenida del cuerpo de la boquilla
para su desplazamiento rotacional desde una pluralidad de posiciones
de bloqueo separadas entre una pluralidad de posiciones de
desbloqueo. El cuerpo de articulación incluye un puente, un miembro
motriz y una palanca. A continuación se efectuará una breve
descripción de estos componentes.
El puente tiene un par de mitades del puente
espaciadas, separadas por un primer y segundo medios de retenida
opuestos entre sí. Cada una de las mitades del puente tiene una
pluralidad de dientes del puente. Los dientes del puente están
situados para su relación interaccionante con los dientes de
retenida del alojamiento de retenida. Cuando el cuerpo de
articulación está en una de las posiciones de bloqueo, los dientes
del puente engranan con los dientes de retenida. Por contra, cuando
el cuerpo de articulación está en una de las posiciones de
desbloqueo, los dientes del puente no engranan con los dientes de
retenida.
El miembro motriz del cuerpo de articulación está
acoplado al puente. El miembro motriz desciende dentro del taladro
del cuerpo de la boquilla. Tiene, acoplados a él, un primer y
segundo miembros de transmisión alargados. Estos miembros de
transmisión se extienden por todo el taladro dentro del eje para
articular a distancia el efector terminal en respuesta al
accionamiento del ensamblaje de transmisión de la articulación.
Finalmente, la palanca del ensamblaje de
transmisión de la articulación está sujeta al cuerpo de articulación
para hacer que gire el cuerpo de articulación dentro del alojamiento
de retenida de la boquilla. La palanca incluye una tapa ajustada
sobre el alojamiento de retenida. La tapa contiene una ranura
situada en el interior de la tapa para recibir el primer y segundo
medios de retenida de las mitades del bloque de engranaje para que
las mitades del bloque de engranaje se acoplen a la tapa.
Significativamente, cuando se aplica una fuerza
de rotación a la palanca del ensamblaje de transmisión de la
articulación, la ranura de la tapa ejerce presión sobre el primer y
segundo medios de retenida acercándolos mutuamente. Esto provoca que
los dientes del puente abandonen los dientes de retenida,
facilitando con ello la rotación del cuerpo de articulación dentro
del alojamiento de retenida desde las posiciones de bloqueo hasta
las posiciones de desbloqueo.
La forma de realización preferente del
instrumento de la presente invención está particularmente adaptada
para cirugía endoscópica porque facilita la articulación a distancia
del efector terminal adyacente a la carcasa del instrumento. Además,
el uso de la ranura de la tapa de la palanca haciendo que contacten
entre sí las mitades del puente para impedir que los dientes del
puente entren en contacto con los dientes del alojamiento de
retenida, constituye un mecanismo simple y efectivo para reducir las
fuerzas rotacionales que el cirujano debe aplicar a la palanca
cuando quiere articular el efector terminal. En efecto, las mitades
separadas del puente del cuerpo de articulación proporcionan un
ensamblaje del puente comprimible dentro del cuerpo de articulación.
Cuando la palanca se gira, las paredes de la ranura aplican una
fuerza compresora sobre el primer y segundo medios de retenida de
las mitades del puente para hacer que las mitades del puente
contacten entre sí. De esta forma, los dientes del puente quedan
fácilmente separados de los dientes de retenida.
En la forma de realización más preferente de la
presente invención, el efector terminal del instrumento quirúrgico
de la presente invención es un ensamblaje quirúrgico de sujeción, y
el instrumento es una grapadora quirúrgica articulada
particularmente adaptada para cirugía endoscópica. El ensamblaje
quirúrgico de sujeción tiene un yunque alargado que encara un canal
alargado para recibir un cartucho de grapas. El ensamblaje
quirúrgico de sujeción es capaz de prender tejido, y a continuación
disparar las grapas dentro del tejido aprisionado.
El instrumento de la presente invención puede
utilizarse en cualquier aplicación quirúrgica en la que resulte
deseable articular a distancia un efector terminal del instrumento
para un mejor posicionamiento del efector terminal en el área
quirúrgica. La articulación a distancia resulta particularmente
deseable en aplicaciones quirúrgicas endoscópicas, aunque puede
también resultar deseable en procedimientos quirúrgicos
abiertos.
La Figura 1 es una vista en alzado lateral
reducida de la grapadora quirúrgica articulada preferente de la
presente invención. Se ha dejado al descubierto una porción de la
carcasa de la grapadora para mostrar la unión del ensamblaje de
transmisión de la articulación de la grapadora a la carcasa.
La Figura 2 es una vista en planta de la
grapadora de la Figura 1 que ilustra la articulación a distancia del
ensamblaje de sujeción quirúrgico de la grapadora en respuesta al
accionamiento del ensamblaje de transmisión de la articulación.
La Figura 3 es una vista isométrica en despiece
ordenado del ensamblaje de transmisión de la articulación de la
grapadora de la Figura 1.
La Figura 4 es una vista en alzado lateral de la
tapa de la palanca del ensamblaje de transmisión de la articulación
de la Figura 3.
La Figura 5 es una vista desde abajo de la tapa
de la palanca de la Figura 4.
La Figura 6 es una vista en planta del cuerpo de
articulación del ensamblaje de transmisión de la articulación de la
Figura 3.
La Figura 7 es una vista en alzado lateral del
cuerpo de articulación de la Figura 6.
La Figura 8 es una vista en alzado frontal del
cuerpo de articulación de la Figura 6.
La Figura 9 es una vista en planta de la boquilla
del ensamblaje de transmisión de la articulación de la Figura 3.
La Figura 10 es una vista en alzado lateral de la
boquilla de la Figura 9.
La Figura 11 es una vista en planta del
ensamblaje de transmisión de la articulación de la grapadora de la
Figura 1 en la que el cuerpo de articulación del ensamblaje se
muestra en posición de bloqueo. Las caras laterales de la tapa de la
palanca han sido truncadas para ilustrar los detalles del interior
del ensamblaje. La parte superior de la tapa de la palanca ha sido
adicionalmente seccionada para ilustrar la interconexión entre la
tapa y el cuerpo de articulación.
La Figura 12 es una sección transversal del
ensamblaje de transmisión de la articulación genéricamente tomada a
lo largo de la línea 12-12 de la Figura 11. El
cuerpo de articulación del ensamblaje se muestra en posición de
bloqueo para evitar que el ensamblaje de sujeción quirúrgico de la
grapadora modifique su ángulo de articulación.
La Figura 13 es una sección transversal del
ensamblaje de transmisión de la articulación de la Figura 12 en la
cual el cuerpo de articulación del ensamblaje ha sido girado de la
posición de bloqueo a la posición de desbloqueo para la articulación
del ensamblaje de sujeción quirúrgico de la grapadora.
La Figura 14 es una vista en planta similar a la
Figura 11 excepto porque el cuerpo de articulación ha sido girado
hasta la posición de desbloqueo.
Con referencia inicial a la Figura 1, en ella se
muestra la grapadora endoscópica articulada preferente 20 de la
presente invención. Al nivel de un primer extremo proximal 21, la
grapadora tiene una carcasa 22 adaptada para permitir que el usuario
agarre y manipule la grapadora. La carcasa tiene un medio de agarre
manual fijo 23 para su acoplamiento en la palma de la mano del
usuario, y, montado sobre pivote, unos gatillos de prensión y
disparo, 24 y 25, para prender tejido y disparar grapas a distancia,
respectivamente, introduciéndolas en el tejido prendido.
Al nivel de un extremo distal opuesto 26 de la
grapadora 20 se encuentra el efector terminal en forma de ensamblaje
de sujeción quirúrgico 27. El ensamblaje de sujeción quirúrgico
tiene un yunque alargado 28 que encara un canal alargado 29 adaptado
para recibir un cartucho quirúrgico que contiene, dentro del mismo,
una pluralidad de grapas (no se muestra el cartucho quirúrgico).
Extendiéndose desde la carcasa 22 de la grapadora y acoplando la
carcasa al ensamblaje de sujeción quirúrgico 27 se encuentra un eje
endoscópico alargado 30.
En la Patente estadounidense 5.465.895 y en la
solicitud de Patente 5.553.765, en tramitación junto a la presente,
legalmente transferida, se describen el ensamblaje de accionamiento
preferente dentro de la carcasa de la grapadora para prender tejido
y disparar grapas a distancia introduciéndolas en el tejido
prendido, en respuesta a la rotación en sentido sinistrorso y
mediante pivote de los gatillos de disparo y prensión. El mecanismo
de prensión preferente situado dentro del ensamblaje de sujeción
quirúrgico para provocar que el yunque se desplace desde una primera
posición separada respecto del canal alargado hasta una segunda
posición adyacente al canal se describe en el documento
EP-A-0 769 273.
Con referencia a las Figuras 1 y 2, la grapadora
articulada preferente 20 tiene un ensamblaje 31 de transmisión de la
articulación que une la carcasa 22 a un eje endoscópico alargado 30
de la grapadora. Cuando el ensamblaje de transmisión de la
articulación se gira, ello provoca la articulación a distancia del
ensamblaje de sujeción quirúrgico 27 de la grapadora. El eje
endoscópico alargado contiene un cuello flexible 32 que permite la
articulación del ensamblaje de sujeción quirúrgico 27 de la
grapadora. El cuello flexible tiene unas primera y segunda porciones
de cuello flexible 33 y 34, que reciben unas primera y segunda
bandas de transmisión flexibles alargadas 35 y 36. Mediante la
rotación del ensamblaje de transmisión de la articulación, una de
las primera y segunda bandas de transmisión flexibles se desplaza
hacia adelante y la otra banda se desplaza hacia atrás. En respuesta
al desplazamiento en vaivén de las bandas dentro de las primera y
segunda porciones de cuello flexibles del cuello flexible, las
bandas del cuello flexible proporcionan la articulación. Una
descripción adicional del cuello flexible en una grapadora
endoscópica articulada se describe en la solicitud de Patente
estadounidense legalmente transferida, en tramitación junto a la
presente, No. 359.107, solicitada el 19 de diciembre de 1994, véase
también el documento EP-A-717.359
que tiene como prioridad la solicitud en tramitación junto a la
presente.
Las piezas componentes del ensamblaje 31 de
transmisión de la articulación se ilustran en la Figura 3. Los
componentes principales del ensamblaje son un accionador 37, un
cuerpo de articulación 38 y una boquilla 39. El desplazamiento
rotacional del accionador 37 provoca la rotación correspondiente del
cuerpo de articulación 38 dentro de la boquilla 39. La primera y
segunda bandas de transmisión alargadas 35 y 36, actúan en
consecuencia axialmente en vaivén en direcciones opuestas paralelas
al eje geométrico longitudinal del eje endoscópico 30 de la
grapadora para provocar la articulación a distancia del ensamblaje
de sujeción quirúrgico a lo largo del cuello flexible del eje
endoscópico.
Con referencia específicamente a la Figura 3 en
combinación con las Figuras 6 a 8, se brinda una ilustración
detallada del cuerpo de articulación 38. El cuerpo de articulación
tiene un puente 40 compuesto de una primera y una segunda mitades
del puente semicirculares, separadas, 41 y 42. Las mitades del
puente están mutuamente opuestas entre sí y representan
esencialmente imágenes especulares una de otra. La primera y segunda
mitades del puente tienen, sobresaliendo de sus superficies, unos
primer y segundo medios de retenida 43 y 44, mutuamente opuestos.
Cada mitad del puente tiene un conjunto de dientes 45 del puente
separados unos 180º del conjunto de dientes del puente situado en la
otra mitad del puente.
El cuerpo de articulación tiene también una base
genéricamente circular 46. La base tiene un par de topes de rotación
47 que descienden de su superficie así como un par de rebajos 48
para los dedos de retenida. La base 46 soporta flexiblemente el
puente 40 sobre dos series de columnas. Las primeras interior y
exterior columnas flexibles, 49 y 50, se extienden hacia arriba
desde la base y están unidas a la primera mitad 41 del puente
formando una pieza con ella. Asimismo, las segundas interior y
exterior columnas flexibles, 51 y 52, se extienden hacia arriba
desde la base y están unidas a la segunda mitad del puente formando
una pieza con ella. Las primera y segunda columnas exteriores
flexibles, y las primera y segunda columnas interiores flexibles, se
despliegan en relación mutuamente opuesta.
Centrándonos de nuevo en la Figura 3 y en las
Figuras 6 a 8, el cuerpo de articulación 38 incluye adicionalmente
un engranaje motriz 53 que desciende desde la base 46. El engranaje
motriz tiene una abertura en voladizo 54 que lo atraviesa, y un
pivote inferior 55. Dentro de la abertura en voladizo del engranaje
motriz, hay un orificio 56 para el percutor para recibir el percutor
57 que permite el disparo de grapas en el tejido prendido en
respuesta a la rotación mediante pivote del gatillo de disparo
(véase la Figura. 12). Unas cavidades moldeadas 58 se encuentran
embebidas en la base para optimizar la fabricación. El engranaje
motriz está acoplado a un par de engranajes de cremallera motrices,
59 y 60, situados en las bandas de transmisión alargadas flexibles,
35 y 36, para efectuar el deseado movimiento en vaivén de las
bandas.
La boquilla 39 del ensamblaje de transmisión de
la articulación se ilustra específicamente en la Figura 3 en
combinación con las Figuras 9 y 10. La boquilla tiene un cuerpo de
boquilla 61. El cuerpo de boquilla tiene un taladro axial 62 que se
extiende a su través para recibir el engranaje motriz 53 del cuerpo
de articulación 38. El taladro proporciona una abertura continua
axial desde la carcasa hacia el interior del eje endoscópico
alargado. Y, por consiguiente, el percutor 57 y otros componentes
operativos de la grapadora pueden comunicar con el ensamblaje de
sujeción quirúrgico 27 desde la carcasa 22. El cuerpo de boquilla
tiene también un canal para la carcasa 63 y un reborde 64 para
ajustar el ensamblaje de transmisión de la articulación a la carcasa
(véase la Figura 1).
Extendiéndose desde el cuerpo de boquilla 61 de
la boquilla 39 está un alojamiento de retenida 65. Dentro del
alojamiento, hay un conjunto anular de dientes de retenida 66.
Separado de los dientes de retenida está un piso 67 del alojamiento
de retenida. El piso 67 se despliega adyacente al cuerpo de boquilla
61. Tiene un par de resaltes 78 que interactúan dentro de los topes
de rotación 47 del cuerpo de articulación para limitar el grado de
rotación. Cuando el cuerpo de articulación se inserta en el
alojamiento de retenida, la base del cuerpo de articulación se
asienta sobre el piso situado en el interior del alojamiento de
retenida, y el engranaje 45 del bloque de engranajes de las primera
y segunda mitades, 41 y 42, del puente 40, se alinean con los
dientes de retenida 66 del alojamiento de retenida para proporcionar
una superficie esencialmente continua. Adicionalmente, cuando se
inserta el cuerpo de articulación, el pivote inferior 55 del
engranaje motriz 53 se aloja en un orificio 68 de pivote situado
interiormente dentro del cuerpo de boquilla adyacente al taladro
axial 62 (véase la Figura 12).
La Figura 3 en combinación con las Figuras 4 y 5
ilustra el accionador 37 del ensamblaje de transmisión de la
articulación. El accionador está compuesto de un brazo 69 de
palanca, de una tapa circular 70 y de un par de dedos de retenida
71. El brazo de palanca está montado en la parte superior de la
tapa. El par de dedos de retenida descienden hacia abajo desde la
parte inferior de la tapa. Cada uno de los dedos de retenida tiene
un estribo de retenida 72. Los dedos de retenida se alojan dentro de
los rebajos 48 para los dedos del cuerpo de articulación 38. La
parte inferior de la tapa (Figura 5) tiene una depresión acanalada
73 embebida dentro de la tapa. La depresión acanalada está limitada
por un par de paredes acanaladas paralelas 74 y de superficies
planas en diagonal 75. En consecuencia, los puntos de presión 76
están dispuestos al nivel de la unión entre las paredes paralelas y
las superficies planas en diagonal.
El primer y segundo medios de retenida, 43 y 44,
de las mitades del puente del cuerpo de articulación se insertan en
la depresión acanalada 73 situada en la parte inferior de la tapa
circular 70. A consecuencia de ello, las paredes acanaladas
paralelas 74 efectúan un contacto de fricción con el primer y
segundo medios de retenida del puente, fijando así el accionador 37
al cuerpo de articulación 38. Asimismo, cuando el cuerpo de
articulación se inserta en el alojamiento 65 de retenida del bloque
61 de boquilla para que el cuerpo de articulación quede retenido
cuando el percutor 57 se aloja a lo largo del orificio 56 del
percutor del engranaje motriz 53, la tapa 57 queda sujeta en el
alojamiento de retenida cuando la tapa descansa en un borde 77 de la
tapa del accionador del alojamiento de retenida.
Ventajosamente, cada uno de los tres componentes
significativos del ensamblaje de transmisión de la articulación, a
saber, el accionador, el cuerpo de articulación y la boquilla, son
componentes moldeados por inyección. El material preferente de
construcción de cada uno de los componentes es una poliamida amorfa
reforzada con fibra de vidrio, expendida comercialmente bajo el
nombre comercial Grivory GV-4H por EMS - American
Grilon a partir de la fecha en la cual se depositó la aplicación que
abocó en la Patente actual.
Con referencia a continuación a las Figuras 11 y
12, en ellas se muestra el ensamblaje 31 de transmisión de la
articulación de la grapadora 20 cuando el ensamblaje está en la
posición de bloqueo. En esta posición de bloqueo, los dientes 45 del
puente del cuerpo de articulación 38 están acoplados de manera
coincidente a, y engranan con, los dientes de retenida 66 del
alojamiento de retenida 65. Esta conexión del puente y los dientes
de retenida fija la posición de la articulación del ensamblaje de
sujeción quirúrgico 27 de la grapadora. La depresión acanalada 73
situada en el interior de la parte inferior de la tapa 70 del
accionador 37 recibe mediante fricción el primer y segundo medios de
retenida, 43 y 44, del puente 40.
Con referencia a continuación a las Figuras 13 y
14, en ellas se muestra el ensamblaje de transmisión de la
articulación en posición de desbloqueo. En la posición de
desbloqueo, los dientes del puente están desacoplados y
desconectados de los dientes de retenida. Las posiciones de
desbloqueo del ensamblaje de transmisión de la articulación están
separadas entre las posiciones de bloqueo del ensamblaje. Cuando se
aplica una fuerza rotacional al brazo 69 de palanca de la tapa 70,
los puntos de presión 76 situados al nivel de la unión entre las
superficies planas en diagonal 75 y las paredes acanaladas paralelas
74 obligan a que se acerquen mutuamente el primer y segundo medios
de retenida 40, 43 y 44, del puente. Cuando los medios de retenida
resultan mutuamente presionados, la primera y segunda mitades, 41 y
42 del puente, son comprimidos entre sí de modo eficaz para permitir
la retirada de los dientes del puente de su conexión con los dientes
de retenida situados dentro del alojamiento de retenida de la
boquilla. Cuando el puente y los dientes de retenida se separan y
desacoplan entre sí, cada uno de los dientes de las series de
dientes del puente encajará automáticamente con un diente respectivo
del conjunto de dientes de retenida a menos que se aplique una
fuerza rotacional adicional al brazo de palanca del accionador. Si
se aplica la fuerza adicional, los puntos de presión situados dentro
de la depresión acanalada de la tapa continuarán acercando entre sí
las mitades del puente, teniendo lugar la rotación de trinquete para
continuar hasta que cese la fuerza rotacional.
De acuerdo con ello, se proporciona la rotación
de trinquete del ensamblaje de transmisión de la articulación,
provocando en correspondencia la articulación del ensamblaje de
sujeción quirúrgico en una pluralidad de posiciones individuales en
ángulo respecto del eje geométrico longitudinal del eje endoscópico
de la grapadora. La compresión del puente en respuesta al movimiento
rotacional de la palanca reduce la fuerza que el usuario debe
aplicar para articular el ensamblaje de los medios de sujeción
quirúrgicos con respecto a la fuerza que debe superarse para
provocar una articulación del ensamblaje de los medios de sujeción
quirúrgicos cuando se aplica presión al ensamblaje de los medios de
sujeción quirúrgicos.
Asimismo, cuando el cuerpo de articulación 38 se
gira en una primera dirección en respuesta al movimiento rotacional
del accionador 37 para provocar la articulación del ensamblaje de
los medios de sujeción quirúrgicos en esa primera dirección, se
alcanzará una posición rotacional en la que los topes rotacionales
47 de la base 46 del cuerpo de articulación se apoyen en el par de
resaltos 78 que sobresalen del piso 67 del alojamiento de retenida
65. A consecuencia de ello, se evita el desplazamiento de rotación
adicional del cuerpo de articulación en la primera dirección, y la
articulación adicional del ensamblaje de los medios de sujeción
quirúrgicos en esa primera dirección. A consecuencia de ello, la
interacción de los topes de rotación con el par de resaltos del piso
del alojamiento de retenida actúa para limitar el grado de
movimiento rotacional del cuerpo de articulación, y con ello el
grado de articulación del ensamblaje de los medios de sujeción
quirúrgicos de la grapadora.
Aunque la presente invención ha sido descrita en
conexión con su forma de realización más preferente, deben resultar
evidentes para los expertos en la materia numerosas formas de
realización adicionales. Por ejemplo, aunque la invención se ha
descrito en conexión con una grapadora endoscópica articulada, la
invención es igualmente aplicable a instrumentos quirúrgicos para
intervenciones abiertas convencionales. Adicionalmente, aunque la
invención ha sido descrita en conexión con un ensamblaje de
transmisión de la articulación que proporciona la articulación a
distancia de un ensamblaje de unos medios de sujeción quirúrgicos,
es igualmente aplicable a un instrumento que proporciona
articulación a distancia de un efector terminal de tipo diferente.
De acuerdo con ello, la forma de realización preferente descrita en
conexión con la presente descripción detallada tiene por objeto
únicamente ilustrar la invención, y no pretende en modo alguno
limitar el ámbito de la invención reivindicada.
Claims (10)
1. Instrumento quirúrgico articulado que
comprende un ensamblaje (31) de transmisión de la articulación para
articular a distancia un efector terminal de dicho instrumento,
incluyendo dicho ensamblaje (31) de transmisión de la
articulación
- a)
- un accionador (37); y
- b)
- un miembro motriz (53); caracterizado porque dicho ensamblaje de transmisión de la articulación comprende adicionalmente:
- c)
- un alojamiento de retenida (65) montado en dicho instrumento, teniendo dicho alojamiento de retenida (65) dentro de él una pluralidad de dientes de retenida (66); y
- d)
- un puente (40) comprimible con una pluralidad de dientes (45) de trinquete del puente situados sobre el mismo, resultando acoplados de modo coincidente dichos dientes (45) del puente con dichos dientes de retenida (66) cuando dicho ensamblaje (31) de transmisión de la articulación está en una primera posición de bloqueo; en el que
dicho accionador (37) está ajustado sobre dicho
alojamiento de retenida (65) para aplicar una fuerza rotacional
sobre dicho puente (40) en el que cuando se aplica dicha fuerza
rotacional, dicho puente (40) se comprime para desacoplar dichos
dientes (45) del puente de dichos dientes de retenida (66) para
facilitar la rotación de trinquete de dicho puente (40) desde dicha
primera posición de bloqueo hasta una segunda posición de bloqueo;
y
dicho miembro motriz (53) está en comunicación
con dicho puente (40) para trasladar dicho movimiento rotacional de
dicho puente (40) en movimiento axial de un miembro de transmisión
alargado (35) unido a dicho miembro motriz (53).
2. El instrumento de la reivindicación 1 en el
que dicho puente (40) tiene un par de mitades (41, 42) del puente
separadas, y dicho puente (40) es comprimido cuando dichas mitades
(41, 42) del puente resultan presionadas una hacia la otra.
3. El instrumento de la reivindicación 2 en el
que dichas mitades (41, 42) del puente tienen unos medios de
retenida (43, 44) compresores, mutuamente opuestos, y dichas mitades
(41, 42) del puente son presionadas una hacia la otra cuando dichos
medios de retenida (43, 44) compresores son presionados uno en
dirección al otro.
4. El instrumento articulado de la reivindicación
3 adaptado para cirugía endoscópica, comprendiendo dicho instrumento
adicionalmente:
- a)
- una carcasa (22) que incluye una empuñadura de agarre manual (23) para agarrar y manipular dicho instrumento al nivel de un primer extremo de dicho instrumento;
- b)
- un eje endoscópico alargado (30) que se extiende desde dicha carcasa (22), teniendo dicho eje (30) un eje geométrico longitudinal;
- c)
- un efector terminal en comunicación con dicho eje (30) al nivel de un extremo opuesto de dicho instrumento para manipular tejido para llevar a cabo una función quirúrgica deseada, siendo dicho efector terminal amovible para proporcionar la articulación de dicho efector terminal desde una primera posición genéricamente paralela al eje geométrico longitudinal de dicho eje (30) hasta una segunda posición en ángulo respecto del eje geométrico longitudinal de dicho eje (30); en el que
dicho ensamblaje (31) de transmisión de la
articulación es adyacente a dicha carcasa (22) para articular a
distancia dicho efector terminal desde dicha primera posición hasta
dicha segunda posición, incluyendo adicionalmente el ensamblaje de
transmisión de la articulación:
- i)
- una boquilla (39) acoplada a dicho eje (30) y fijada a dicho bastidor (22) teniendo dicha boquilla (39) un cuerpo (61) de boquilla con un taladro (62) que se extiende por todo lo largo y de forma genéricamente paralela al eje geométrico longitudinal de dicho eje (30), y en el que dicho alojamiento de retenida (65) se extiende desde dicho cuerpo de boquilla;
- ii)
- un cuerpo (38) de articulación montado de forma rotatoria dentro de dicho alojamiento de retenida (65) de dicho cuerpo (61) de boquilla para el movimiento rotacional desde una pluralidad de posiciones de bloqueo separadas entre una pluralidad de posiciones de desbloqueo, incluyendo dicho cuerpo de articulación:
- a)
- dicho puente (40) comprimible situado dentro del mismo, en el que cuando dichos dientes (45) del puente engranan con dichos dientes de retenida (66), dicho cuerpo (38) de articulación está en una de dichas posiciones de bloqueo, y cuando dichos dientes (45) del puente no engranan con dichos dientes de retenida (66), dicho cuerpo (38) de articulación está en una de dichas posiciones de desbloqueo; y
- b)
- dicho miembro motriz (53) desciende hacia el interior de dicho taladro (62) de dicho cuerpo (61) de boquilla, teniendo dicho miembro motriz (53) un primer y un segundo miembros de transmisión alargados (35, 36) unidos al mismo y que se extienden a lo largo de dicho taladro (62) hacia el interior de dicho eje (30);
- iii)
- dicho accionador (37) es una palanca fijada a dicho cuerpo de articulación (38) para girar dicho cuerpo articulado (38) dentro de dicho alojamiento de retenida (65) de dicha boquilla (39), incluyendo dicha palanca (37), situada sobre la misma, una tapa (70) encajada sobre dicho alojamiento de retenida (65), conteniendo dicha tapa (70), situada dentro de ella, un canal (73) para recibir dichos primer y segundo medios de retenida (43, 44) de dichas mitades (41, 42) del puente para el acoplamiento de dichas mitades (41, 42) del puente a dicha tapa (70), en el que:
cuando se aplica una fuerza de rotación a dicha
palanca (37), dicho canal (73) de la tapa presiona dichos primer y
segundo medios de retenida (43, 44) uno en dirección al otro para
liberar dichos dientes (45) del puente de dichos dientes de retenida
(66) para facilitar la rotación de dicho cuerpo de articulación (38)
en el interior de dicho alojamiento de retenida (65) desde dichas
posiciones de bloqueo hasta dichas posiciones de desbloqueo.
5. El instrumento de la reivindicación 4 en el
que dicho cuerpo de articulación (38) tiene una base (46) situada
dentro del mismo desde la cual y saliendo de la misma se extiende
dicho miembro motriz (53), y dicha base (43) soporta dichas mitades
(41, 42) del puente.
6. El instrumento de la reivindicación 5 en el
que cada una de dichas mitades (41, 42) del puente está conectada a
dicha base (46) de dicho cuerpo de articulación (38) por una columna
exterior flexible (50) y una columna interior flexible (49).
7. El instrumento de cualquier reivindicación
precedente en el que dicho miembro motriz (53) de dicho cuerpo de
articulación (38) es un engranaje motriz.
8. El instrumento de cualquiera de las
reivindicaciones 4 a 6 en el que dicho alojamiento de retenida (65)
de dicha boquilla (39) tiene un piso (67) adyacente a dicho cuerpo
(61) de boquilla y dicha base (46) de dicho cuerpo de articulación
(38) se asienta sobre dicho piso (67).
9. El instrumento de la reivindicación 8 en el
que dicha base (46) de dicho cuerpo de articulación (38) tiene un
par de topes de rotación (47) situados en ella, y dicho piso (67) de
dicho alojamiento de retenida (65) tiene un par de resaltos (78)
situados en él, en el que cuando dichos topes de rotación (47) están
en contacto con dichos resaltos (78) después de que dicho cuerpo de
articulación (38) ha sido girado en una primera dirección de
rotación, se impide de esta forma que dicho cuerpo de articulación
(38) gire en dicha primera dirección.
10. El instrumento quirúrgico articulado de
cualquier reivindicación precedente en el que dicho instrumento es
una grapadora, comprendiendo dicha grapadora adicionalmente:
- a)
- un ensamblaje (27) de medios de sujeción quirúrgicos en comunicación con dicho eje (30) en un extremo opuesto de dicha grapadora para prender tejido y disparar grapas dentro del tejido prendido, conteniendo dicho ensamblaje (27) de medios de sujeción quirúrgicos un yunque alargado (28) que encara un canal alargado (29) para recibir en él un cartucho de grapas, siendo dicho ensamblaje (27) de unos medios de sujeción quirúrgicos amovible para proporcionar la articulación de dicho ensamblaje (27) de unos medios de sujeción quirúrgicos desde una primera posición genéricamente paralela a dicho eje geométrico longitudinal de dicho eje (30) hasta una segunda posición en ángulo respecto de dicho eje geométrico longitudinal de dicho eje (30).
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US08/645,355 US5713505A (en) | 1996-05-13 | 1996-05-13 | Articulation transmission mechanism for surgical instruments |
| US08/645355 | 1996-05-13 |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| ES2197306T3 true ES2197306T3 (es) | 2004-01-01 |
Family
ID=24588673
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| ES97303215T Expired - Lifetime ES2197306T3 (es) | 1996-05-13 | 1997-05-12 | Mecanismo de transmision de articulacion para instrumentos quirurgicos. |
Country Status (7)
| Country | Link |
|---|---|
| US (1) | US5713505A (es) |
| EP (1) | EP0807408B1 (es) |
| JP (1) | JPH1043189A (es) |
| AU (1) | AU707607B2 (es) |
| CA (1) | CA2204952C (es) |
| DE (1) | DE69721372T2 (es) |
| ES (1) | ES2197306T3 (es) |
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-
1996
- 1996-05-13 US US08/645,355 patent/US5713505A/en not_active Expired - Lifetime
-
1997
- 1997-05-09 AU AU20157/97A patent/AU707607B2/en not_active Expired
- 1997-05-09 CA CA002204952A patent/CA2204952C/en not_active Expired - Lifetime
- 1997-05-09 JP JP9134470A patent/JPH1043189A/ja active Pending
- 1997-05-12 EP EP97303215A patent/EP0807408B1/en not_active Expired - Lifetime
- 1997-05-12 DE DE69721372T patent/DE69721372T2/de not_active Expired - Lifetime
- 1997-05-12 ES ES97303215T patent/ES2197306T3/es not_active Expired - Lifetime
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|---|---|
| EP0807408B1 (en) | 2003-05-02 |
| US5713505A (en) | 1998-02-03 |
| AU707607B2 (en) | 1999-07-15 |
| CA2204952C (en) | 2007-01-16 |
| JPH1043189A (ja) | 1998-02-17 |
| DE69721372T2 (de) | 2004-03-25 |
| EP0807408A1 (en) | 1997-11-19 |
| CA2204952A1 (en) | 1997-11-13 |
| DE69721372D1 (de) | 2003-06-05 |
| AU2015797A (en) | 1997-11-20 |
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