ES2238768T3 - Instrumento bipolar para la fusion de vasos. - Google Patents
Instrumento bipolar para la fusion de vasos.Info
- Publication number
- ES2238768T3 ES2238768T3 ES98946876T ES98946876T ES2238768T3 ES 2238768 T3 ES2238768 T3 ES 2238768T3 ES 98946876 T ES98946876 T ES 98946876T ES 98946876 T ES98946876 T ES 98946876T ES 2238768 T3 ES2238768 T3 ES 2238768T3
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
- A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
- A61B2017/00296—Surgical instruments, devices or methods for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means mounted on an endoscope
-
- 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
- A61B2017/2945—Curved jaws
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B2018/1405—Electrodes having a specific shape
- A61B2018/1425—Needle
- A61B2018/1432—Needle curved
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B2018/1495—Electrodes being detachable from a support structure
Landscapes
- Health & Medical Sciences (AREA)
- Surgery (AREA)
- Engineering & Computer Science (AREA)
- Life Sciences & Earth Sciences (AREA)
- Biomedical Technology (AREA)
- Otolaryngology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Plasma & Fusion (AREA)
- Physics & Mathematics (AREA)
- Heart & Thoracic Surgery (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
Un instrumento bipolar para utilización por un cirujano para sellar tejidos con electrocirugía bipolar, comprendiendo el instrumento bipolar: dos miembros alargados (11, 12), teniendo cada miembro alargado un extremo proximal (16, 16'') para ser sostenido por un cirujano y un extremo distal (17, 17''), definiendo los miembros alargados (11, 12) sustancialmente un plano, los miembros alargados hechos de por lo menos algún material eléctricamente conductor para realizar electrocirugía bipolar; un eje (13) que conecta los dos miembros alargados (11, 12) de una manera que hace posible un movimiento tipo tijera entre los miembros alargados (11, 12), el eje (13) transversal al plano, el eje (13) dispuesto lejos de los extremos distales (17, 17'') para permitir movimiento transversal de los extremos distales (17, 17''); un primer polo (18) en contacto con tejido integral con un miembro alargado y posicionado en su extremo distal, el primer polo (18) en contacto con tejido eléctricamente conductor pararealizar electrocirugía bipolar; dos terminales eléctricos (30, 31) ubicados próximos con relación al eje (13) y configurados para recibir energía electroquirúrgica bipolar; un primer conductor (23) entre un terminal y el primer polo (18) en contacto con tejido; caracterizado porque el instrumento tiene: una sobrezapata (19) aislada para ubicarse sobre el otro miembro alargado en su extremo distal, la sobrezapata (19) de aislamiento para acoplarse al otro miembro alargado en relación de ajuste deslizante sobre ese extremo distal para impedir movimiento longitudinal o transversal entre la sobrezapata (19) aislada, el miembro alargado y el otro extremo distal; un segundo polo (22) en contacto con tejido fijado sobre la sobrezapata (19) aislada, el segundo polo (22) en contacto con tejido dispuesto en relación especular con el primer polo (18) en contacto con tejido; y un segundo conductor (24) que acopla eléctricamente el otro terminal y el segundo polo (22) en contacto con tejido para proporcionar un circuito para transportar energía electroquirúrgica bipolar desde el primer polo (18) en contacto con tejido hacia el segundo polo (22) en contacto con tejido.
Description
Instrumento bipolar para la fusión de vasos.
Esta invención se refiere a un instrumento
quirúrgico para ocluir vasos de forma permanente en un ser humano o
animal y más particularmente a una pinza hemostática modificada que
funde el tejido del vaso utilizando una combinación de presión y
corriente electroquirúrgica.
Una pinza hemostática es utilizada comúnmente en
procedimientos quirúrgicos para ocluir venas y arterias. Esta es
típicamente una simple herramienta tipo tenaza que utiliza la
acción mecánica entre sus mandíbulas para estrangular un vaso sin
cortarlo. También es típico tener un trinquete de enganche entre los
mangos de forma tal que el dispositivo puede ser sujetado y
bloqueado en posición.
Muchas pinzas hemostáticas son utilizadas en un
procedimiento quirúrgico abierto típico. Una vez que una estructura
ha sido sujetada, es común que un cirujano realice una sutura
alrededor de la estructura para ocluir de forma permanente antes de
quitar la pinza hemostática. Muchas pinzas hemostáticas pueden ser
dejadas en el campo quirúrgico hasta que el cirujano tenga la
oportunidad de ligar todo. Sería deseable para los cirujanos
fundir los vasos inmediatamente y, de este modo, evitar tener las
pinzas hemostáticas obstruyendo el acceso a la zona quirúrgica.
Un número de fórceps electroquirúrgicos bipolares
y abrazaderas son conocidos en el campo. Todos esos diseños sufren
el inconveniente de que no combinan la simplicidad y familiaridad de
una pinza hemostática con la corriente electroquirúrgica bipolar.
Por ejemplo, la Patente de los Estados Unidos 5.462.546 describe
fórceps bipolares electroquirúrgicos que comprenden dos miembros de
hoja giratorios enfrentados entre sí que son individualmente
giratorios uno con relación al otro. El movimiento giratorio de los
miembros es efectuado por dos barras rígidas eléctricamente
conductoras que se extienden a través de un miembro tubular
alargado.
La Patente de Estados Unidos 5.827.271 describe
un aparato y un método para sellar vasos.
La Patente de Estados Unidos 5.776.130 describe
una herramienta quirúrgica para sellar vasos.
La Patente de Estados Unidos 5.116.332 a Lottick
describe una pinza hemostática de electrocauterización. La pinza
hemostática incluye mangos de plástico sintético tipo ostra con un
interruptor incorporado en el mismo.
La Patente de Estados Unidos 5.025.370 a Lottick
describe un instrumento de electrocauterización con un mecanismo de
interrupción eléctrico cerrado no eliminable. La Patente de
Estados Unidos 4.370.980 describe un instrumento de
electrocauterización que puede ser utilizado como un dispositivo de
sujeción y un aparato para cauterizar vasos sanguíneos que sangran
durante la cirugía.
La Patente de Estados Unidos 5.484.436 a Eggers
describe instrumentos electroquirúrgicos bipolares. Los
instrumentos bipolares incluyen electrodos de polaridad opuesta
aislados por una capa de aislamiento eléctrico depositada y
preparada especialmente para reducir fallos eléctricos y aumentar la
suavidad.
La Patente de Estados Unidos 5.443.464 a Stern y
otros describe unos fórceps de coagulación que tienen una pluralidad
de electrodos y sensores sobre las mandíbulas. Los sensores
proporcionan una señal de retroalimentación a un generador de
corriente electroquirúrgica con el fin de controlar la cantidad de
calor en los fórceps.
La Patente de Estados Unidos 4.005.714 a
Hiltebrandt describe fórceps bipolares de coagulación en los cuales
los fórceps están diseñados para coagular la trompa de Falopio y el
mesosalpinx adyacente.
En la Patente de Estados Unidos 5.472.443 se
describe un aparato electroquirúrgico que emplea tensión constante.
Unos fórceps bipolares incluyen miembros de soporte opuestos que
están conectados de forma giratoria a un eje. Cada uno de los
miembros de soporte tiene un terminal para energizar porciones de
electrodo en el extremo distal de los fórceps.
El objetivo general de esta invención es
proporcionar un instrumento que puede fundir estructuras sin la
necesidad de una sutura. El instrumento tiene corriente
electroquirúrgica que circula entre las mandíbulas de trabajo. La
corriente electroquirúrgica pasa a través de la estructura sujetada
y forma un sello permanente.
La presente invención está definida en la
reivindicación 1. Las reivindicaciones dependientes están
dirigidas a características preferidas y opcionales.
La Figura 1 es una vista en perspectiva de la
pinza hemostática bipolar modificada para entregar corriente
electroquirúrgica.
La Figura 2 es una vista en perspectiva de la
pinza hemostática modificada de la Figura 1 sin sobrezapata de
aislamiento en su lugar, que muestra uno de los miembros alargados
con un extremo distal de sección transversal reducida.
La Figura 3 es una vista en perspectiva de la
sobrezapata aislada como aparecería desde arriba.
La Figura 4 es una vista en despiece ordenado del
cableado para la porción de interruptor de la sobrezapata aislada,
con la porción de soporte y aislamiento de la misma quitada.
La Figura 5 es un diagrama de circuito para el
interruptor mostrado en la Figura 4.
La Figura 6 es una vista en perspectiva de la
sobrezapata aislada como aparecería desde abajo.
La Figura 7 es una vista en alzado lateral de la
sobrezapata aislada de la Figura 3.
La Figura 8 es una vista en sección transversal
de la sobrezapata aislada de la Figura 7 como se vería a lo largo de
las líneas 8-8 de la misma.
La Figura 9 es una vista en sección transversal
de la sobrezapata aislada de la Figura 7 como se vería a lo largo de
las líneas 9-9 de la misma.
La Figura 10 es una vista en sección transversal
de la sobrezapata aislada de la Figura 7 como se vería a lo largo de
las líneas 10-10 de la misma.
En la realización preferida de un instrumento
bipolar, cada uno de los miembros alargados 11 y 12 está hecho de un
material eléctricamente conductor. Un eje 13 conecta los dos
miembros alargados 11 y 12 de una manera que hace posible un
movimiento tipo tijera como en una pinza hemostática modificada 15.
El eje 13 puede ser un simple perno, como en las Figuras 1 y 2, o
puede ser una parte integral de un conjunto 14 de caja de bloqueo.
La Figura 1 muestra el instrumento bipolar 10 en una vista en
perspectiva desde arriba y la Figura 2 muestra la pinza hemostática
modificada 15 en una vista en perspectiva desde abajo. De una
manera bien conocida, el eje 13 puede estar aislado eléctricamente
para impedir la circulación de corriente electroquirúrgica desde
cualquiera de los miembros alargados 11 o 12 hacia el otro. En la
realización preferida, el eje 13 no está aislado porque no hay un
camino potencial entre los dos polos de energía electroquirúrgica
bipolar. La pinza hemostática modificada 15 del instrumento
bipolar 10 está hecha en gran medida como una pinza hemostática
estándar y puede ser utilizada para electrocirugía bipolar y puede
ser esterilizada como una pinza hemostática estándar. Esta es la
invención descrita que permite la conversión de una pinza
hemostática estándar para utilizar con corriente electroquirúrgica
bipolar. La Figura 1 es una vista en perspectiva del instrumento
bipolar 10 basado en la pinza hemostática modificada 15 mostrada en
la Figura 2 de forma tal que puede ser entregada corriente
electroquirúrgica bipolar.
El instrumento bipolar 10, como la pinza
hemostática modificada 15 de la Figura 2, puede incluir dos miembros
alargados 11 y 12. Cada miembro alargado 11 o 12 tiene
preferentemente un extremo proximal 16 o 16' para ser sostenido por
el cirujano y un extremo distal 17 o 17' para manipulación del
tejido o vasculatura. En las figuras, y en toda esta descripción,
el extremo proximal 16 sobre el primer miembro alargado 11 será
denominado 16 y el extremo distal 17 sobre el primer miembro
alargado 11 será llamado 17. De forma similar, el extremo proximal
16' sobre el otro miembro alargado 12 ser denominado 16' y el
extremo distal 17' sobre el otro miembro alargado 12 será llamado
17'. El extremo proximal 16 o 16' puede tener características que
facilitan al cirujano el asimiento, tal como anillos para los dedos
del cirujano.
Un primer polo 18 en contacto con el tejido es
integral con el primer miembro alargado 11 y está ubicado sobre el
extremo distal 17, como mejor se ve en la Figura 2. El primer polo
18 en contacto con el tejido es preferentemente integral con el
primer miembro alargado 11 que está hecho preferentemente de un
material eléctricamente conductor tal como acero inoxidable o
aluminio de forma tal que éste puede conducir corriente
electroquirúrgica bipolar.
El instrumento bipolar 10 tiene una sobrezapata
19 aislada para ubicarse sobre el otro miembro alargado 12 en su
extremo distal 17'. La sobrezapata 19 aislada se acopla al otro
miembro alargado 12 en relación de ajuste deslizante sobre el otro
extremo distal 17' para impedir movimiento longitudinal o
transversal entre la sobrezapata 19 aislada, el otro miembro
alargado 12 y el otro extremo distal 17'. La Figura 2 es una vista
en perspectiva de la pinza hemostática modificada de la Figura 1
sin la sobrezapata 19 de aislamiento en posición, mostrando el otro
miembro alargado 12 con una sección transversal reducida en el
extremo distal 17'. El extremo distal 17' tiene una sección
transversal reducida para recibir la sobrezapata 19 aislada en
relación de ajuste deslizante. La Figura 3 es una vista en
perspectiva de la sobrezapata 19 de aislamiento tal como aparecería
desde arriba. Consecuentemente, la sobrezapata 19 de aislamiento
incluye una abertura 20 que se extiende dentro de la misma a modo de
túnel para una relación de ajuste deslizante sobre la sección
transversal reducida del extremo distal 17'. De este modo, se
impide el movimiento longitudinal o transversal entre la
sobrezapata 19 aislada, el otro miembro alargado 12 y su extremo
distal 17'. La sobrezapata 19 de aislamiento tiene abrazaderas 21
para acoplamiento con y alrededor del otro miembro alargado 12. La
sobrezapata 19 de aislamiento está diseñada para llevar circuitería
para conducir la energía electroquirúrgica bipolar a lo largo del
otro miembro alargado 12 a su respectivo segundo polo 22 en contacto
con tejido. Específicamente, el segundo polo 22 en contacto con
tejido está sobre la sobrezapata 19 aislada en una posición para
oponerse al primer polo 18 en contacto con tejido de forma tal que
la ubicación de la sobrezapata 19 aislada sobre el otro extremo
distal 17' causará alineación precisa a lo ancho del primero y
segundo polos 28 y 22 en contacto con tejido entre uno y otro. El
primero y segundo polos 18 y 22 en contacto con tejido están
conectados al primero y segundo conductores 23 y 24,
respectivamente, como se entiende mejor de las Figuras 4 y 5.
Un interruptor 25, mejor mostrado en las Figuras
4 y 5, la última esquemáticamente, interrumpe la continuidad del
segundo conductor 24 entre el segundo polo 22 en contacto con
tejido y una fuente 26 de corriente electroquirúrgica bipolar. Una
fuente 26 preferida de corriente electroquirúrgica bipolar está
fabricada por Valleylab Inc. de Boulder, Colorado, el cesionario de
esta invención; específicamente, el generador electroquirúrgico
Force FX que tiene una salida bipolar. Como se muestra en el
diagrama esquemático de la Figura 5, hay un circuito 27 entre la
fuente 26 de corriente electroquirúrgica bipolar y unas placas de
contacto 28 y 29. Las placas de contacto 28 y 29 también son
mostradas en la Figura 5 en la cual la placa de contacto 28 está
simplemente para transferir corriente electroquirúrgica a la pinza
hemostática modificada 15 mediante contacto íntimo de presión. De
forma similar, la placa de contacto 29 es equivalente al segundo
polo 22 en contacto con tejido de la realización preferida; técnicos
expertos sabrán que la placa de contacto 29 y el segundo polo 22 en
contacto con el tejido pueden ser piezas separadas que están
eléctricamente acopladas mediante, tal vez, el ensamblaje de la
sobrezapata 19 aislada sobre el otro extremo distal 17'. En las
Figuras 3, 4, 5, 6 y 7 se muestran terminales 30 y 31 para acoplar
eléctricamente de manera desmontable y fácil la fuente 26 de
corriente electroquirúrgica bipolar al instrumento bipolar 10 y,
más particularmente, los primero y segundo conductores 23 y 24,
respectivamente, como mejor se entiende de la Figura 5, acoplados a
terminales 30 y 31. La placa de contacto 28 está, de este modo,
conectada directamente mediante el primer conductor 23 al terminal
31 mientras que el segundo conductor 24 está conectado entre el
terminal 30 y el interruptor 25. El otro lado del interruptor 25
está directamente acoplado eléctricamente al segundo polo 22 en
contacto con tejido mediante la continuación del primer conductor
24 en la realización preferida. Los terminales 30 y 31 se acoplan a
la salida bipolar de la fuente de corriente electroquirúrgica
bipolar 26; es decir, ambos lados de la salida bipolar. El
interruptor 25, en la Figura 5, incluye un control en el interruptor
manual 32 para activar la fuente de corriente electroquirúrgica
bipolar 26 para suministrar salida bipolar según lo necesite el
cirujano. De este modo, cuando el interruptor 25 está cerrado, la
salida de corriente electroquirúrgica bipolar es recibida en los
terminales 30 y 31 para el paso selectivo controlado de corriente
electroquirúrgica bipolar desde el primer polo 18 en contacto con
el tejido hacia el segundo polo 22 en contacto con el tejido. El
interruptor 25 preferentemente está dispuesto en la parte superior
del eje 13, en una posición conveniente para el cirujano, para
controlar la circulación de corriente electroquirúrgica. La Figura
4 es una vista en despiece ordenado del cableado para el
interruptor 25 de la sobrezapata aislada y la Figura 5 es un
diagrama de circuito para el interruptor 25 mostrado en la Figura 4.
La Figura 6 es una vista en perspectiva de la sobrezapata 19
aislada tal como aparecería desde abajo. La pinza hemostática 15
modificada y sus miembros alargados 11 y 12 están construidos de un
material eléctricamente conductor, tal como acero inoxidable o
aluminio. Consecuentemente, la corriente electroquirúrgica bipolar
pasará a través del tejido entre el primero y el segundo polos 18 y
22 en contacto cuando el tejido sea sujetado entre ellos y el
interruptor 25 sea cerrado.
El instrumento bipolar 10 tiene ciertas
similitudes con el aspecto y tacto de una pinza hemostática
estándar de forma tal que será confortable y familiar para los
cirujanos. Sin embargo, el instrumento bipolar 10 tiene la capacidad
añadida de liga vasos y sellar tejido vascular. La fuente de
corriente electroquirúrgica bipolar 26 está conectada
eléctricamente a los terminales 30 y 31 del instrumento bipolar 10
para proporcionar corriente electroquirúrgica bipolar de alta
frecuencia.
Los primero y segundo conductores 23 y 24 están
mostrados, en la realización preferida de la Figura 4, como cables
aislados llevados en la sobrezapata 19 aislada por el otro miembro
alargado 12 para transportar corriente electroquirúrgica desde los
terminales 30 y 31. Los cables aislados pueden estar ajustados a
presión o estar moldeados por inyección como parte de la
sobrezapata aislada 19. De este modo, no es necesario que el eje 13
esté aislado eléctricamente. La Figura 7 es una vista en alzado
lateral de la sobrezapata aislada 19 de la Figura 3 que muestra
cuán compacta y, de este modo, ligera es ésta. La Figura 8 es una
vista en sección transversal de la sobrezapata aislada 19 de la
Figura 7 tal como se vería a lo largo de las líneas
8-8 de la misma. La Figura 9 es una vista en
sección transversal de la sobrezapata aislada de la Figura 7 como
se vería a lo largo de las líneas 9-9 de la misma.
La Figura 10 es una vista en sección transversal de la sobrezapata
aislada 19 de la Figura 7 como se vería a lo largo de las líneas
10-10 de la misma. Las abrazaderas 21 están mejor
mostradas en las Figuras 6, 7, 8, 9 y 10 mientras que la
sobrezapata aislada 19 montada en la pinza hemostática modificada
15 está ilustrada en la Figura 1.
Una alternativa, no mostrada pero familiar para
los expertos en diseño y utilización de pinzas hemostáticas es
curvar los extremos distales 17 y 17', más que lo ya mostrado, para
extenderse transversalmente con relación al plano y generalmente
paralelos a, pero separados de, el eje 13. Las pinzas hemostáticas
curvas ofrecen acceso para facilitar la manipulación al cirujano
durante ciertas cirugías. La sobrezapata 19 aislada debería ser
suficientemente flexible para ser fácilmente deslizada sobre el
extremo distal 17' de sección transversal reducida. Se prefieren
polímeros que tengan una alta capacidad dieléctrica, alta
resistencia a la temperatura y bajo costo. De forma similar, el
interruptor 25 tiene una tarjeta de circuito impreso para facilitar
su manufactura a bajo costo.
Unos elementos de cierre 33 y 34 están ubicados
sobre cada miembro alargado 11 y 12 preferentemente próximo al eje
13. De este modo, en la realización preferida, esos elementos de
cierre 33 y 34 están ubicados cerca de los extremos proximales 16 y
16' del instrumento bipolar 10, es decir, próximos a los anillos
para los dedos. Los elementos de cierre 33 y 34 preferentemente
tienen rampas opuestas 35 y topes 36 de apoyo para su conocido
acoplamiento deslizante de conjugación. Por lo menos tres topes de
apoyo 36 pueden estar proporcionados para producir sucesivamente
fuerzas de cierre mayores entre los primero y segundo polos de
contacto 18 y 22. Por lo menos un tope de apoyo 36 sobre cada
miembro alargado 11 y 12 producirá una pequeña fuerza de cierre
entre los primero y segundo polos 18 y 22 en contacto con tejido
para vasos pequeños. Por lo menos otro tope de apoyo 36 sobre cada
miembro alargado 11 y 12 producirá una gran fuerza de cierre entre
los primero y segundo polos 18 y 22 en contacto con tejido para
vasos más grandes. En la realización preferida, los elementos de
cierre 33 y 34 soportarán la fuerza de cierre contra la energía
deformación de los miembros alargados 11 y 12 que serán ligeramente
desviados por la acción de leva opuesta de las rampas 35 antes de
alcanzar la yuxtaposición de cada tope de apoyo 6 sucesivo. Esta
acción descrita es común a cualquier pinza hemostática estándar
pero representa algo diferente en una pinza hemostática bipolar.
El primer miembro alargado 11 está acoplado a una
polaridad eléctrica diferente en el circuito 27 electroquirúrgico
bipolar que el otro miembro alargado 12 que lleva la sobrezapata
aislada 19 en su extremo distal. Debido a la sobrezapata aislada
19 el eje 13 no necesita estar eléctricamente aislado para impedir
un cortocircuito eléctrico entre los miembros alargados 11 y 12
dado que estos están a la misma polaridad en las inmediaciones del
eje 13. De este modo, es posible utilizar diseños y técnicas de
fabricación de pinzas hemostáticas estándares para realizar la
pinza hemostática modificada 15 de la Figura 2, o similares. De
forma similar, los elementos de cierre 33 y 34 no necesitan estar
eléctricamente aislados para impedir un cortocircuito eléctrico en
las inmediaciones de sus rampas 35 y topes de apoyo. Esto es
particularmente bueno dado que el acoplamiento de fricción de las
rampas 35 y los topes de apoyo 36 tensionaría los recubrimientos
dieléctricos y/o las técnicas de aislamiento típicos.
Los dos terminales eléctricos 30 y 31 están
preferentemente ubicados cerca del cirujano o de los extremos
proximales 16 y 16' y preferentemente sobre el último. Como se
explicó, los terminales 30 y 31 son alimentados por la fuente 26 de
corriente electroquirúrgica bipolar con polaridades opuestas. Una
punta 37 conectada al control 32 del interruptor manual está para
realizar la interrupción como mejor se muestra en la Figura 5. En
la realización preferida, los terminales están soportados sobre el
otro miembro alargado 12 cerca de su extremo proximal 16'. Para
instrumentos bipolares que son reutilizables, los terminales 30 y
31 y la punta 37 están diseñados para una rápida desconexión de la
fuente 26 de corriente electroquirúrgica bipolar para quitar la
pinza hemostática modificada 15.
Un método de montaje de la sobrezapata aislada 19
y la pinza hemostática modificada 15 incluye las etapas de
deslizamiento de la sobrezapata aislada 19 sobre el otro extremo
distal 17' y, después, acoplamiento de la sobrezapata aislada 19 al
otro miembro alargado 12 para impedir el movimiento longitudinal o
transversal entre la sobrezapata aislada 19, el otro miembro
alargado 12 y su otro extremo distal 17'.
Generalmente, agarradores y abrazaderas bipolares
y similares disponibles comercialmente están diseñados para ser
desechados después de cada operación o, si son reutilizables, cada
uno debe ser esterilizado y verificado para seguridad eléctrica,
por ejemplo, fugas. El instrumento bipolar 10 divulgado es
separable de los componentes eléctricos de forma tal que sólo estos
últimos necesitan ser desechables y, de este modo, se mejora la
seguridad y se reduce el costo, y se asegura la facilidad de
esterilización.
Debe entenderse que el instrumento bipolar 10
descrito y reivindicado es sólo ilustrativo de una aplicación de los
principios de la presente invención. Numerosas modificaciones y
disposiciones alternativas pueden ser ideadas por los expertos en
la técnica sin apartarse del alcance de la presente invención. Las
reivindicaciones añadidas están destinadas a cubrir tales
modificaciones y disposiciones.
Claims (10)
1. Un instrumento bipolar para utilización por un
cirujano para sellar tejidos con electrocirugía bipolar,
comprendiendo el instrumento bipolar:
dos miembros alargados (11, 12), teniendo cada
miembro alargado un extremo proximal (16, 16') para ser sostenido
por un cirujano y un extremo distal (17, 17'), definiendo los
miembros alargados (11, 12) sustancialmente un plano, los miembros
alargados hechos de por lo menos algún material eléctricamente
conductor para realizar electrocirugía bipolar;
un eje (13) que conecta los dos miembros
alargados (11, 12) de una manera que hace posible un movimiento tipo
tijera entre los miembros alargados (11, 12), el eje (13)
transversal al plano, el eje (13) dispuesto lejos de los extremos
distales (17, 17') para permitir movimiento transversal de los
extremos distales (17, 17');
un primer polo (18) en contacto con tejido
integral con un miembro alargado y posicionado en su extremo distal,
el primer polo (18) en contacto con tejido eléctricamente conductor
para realizar electrocirugía bipolar;
dos terminales eléctricos (30, 31) ubicados
próximos con relación al eje (13) y configurados para recibir
energía electroquirúrgica bipolar;
un primer conductor (23) entre un terminal y el
primer polo (18) en contacto con tejido;
caracterizado porque el instrumento
tiene:
una sobrezapata (19) aislada para ubicarse sobre
el otro miembro alargado en su extremo distal, la sobrezapata (19)
de aislamiento para acoplarse al otro miembro alargado en relación
de ajuste deslizante sobre ese extremo distal para impedir
movimiento longitudinal o transversal entre la sobrezapata (19)
aislada, el miembro alargado y el otro extremo distal;
un segundo polo (22) en contacto con tejido
fijado sobre la sobrezapata (19) aislada, el segundo polo (22) en
contacto con tejido dispuesto en relación especular con el primer
polo (18) en contacto con tejido; y
un segundo conductor (24) que acopla
eléctricamente el otro terminal y el segundo polo (22) en contacto
con tejido para proporcionar un circuito para transportar energía
electroquirúrgica bipolar desde el primer polo (18) en contacto con
tejido hacia el segundo polo (22) en contacto con tejido.
2. El instrumento bipolar según la reivindicación
precedente, en el cual elementos de cierre (33, 34) cerca de los
extremos proximales (16, 16') se extienden desde cada miembro
alargado (11, 12) para interacoplamiento cooperativo, teniendo los
elementos de cierre (33, 34) por lo menos unas primera y segunda
rampas (35) opuestas y topes (36) para conjugación deslizante para
sujetar los primero y segundo polos (18, 22) en contacto con tejido
con una primera o segunda fuerza predeterminada entre ellos.
3. El instrumento bipolar según cualquiera de las
reivindicaciones precedentes, en el cual el instrumento es una pinza
hemostática modificada con el eje (13) para un movimiento tipo
tijera entre los extremos distales (17, 17'), la pinza hemostática
modificada con los extremos distales (17, 17') curvados para
extenderse transversalmente con relación al plano y generalmente
paralelos a, pero separados de, el eje (13).
4. El instrumento bipolar según cualquiera de las
reivindicaciones precedentes, en el cual un interruptor (25)
interrumpe la continuidad del segundo conductor (24) entre su
terminal hacia el segundo polo (22) en contacto con tejido, es
controlado el paso selectivo de corriente electroquirúrgica bipolar
entre el primer polo (18) en contacto con tejido y el segundo polo
(22) en contacto con tejido, el interruptor (25) está dispuesto en
la parte superior del eje (13) en posición para que el cirujano
controle la circulación de corriente electroquirúrgica y una punta
(37) ubicada cerca de los terminales se conecta al interruptor (25)
para dar señal de la necesidad de corriente electroquirúrgica.
5. El instrumento bipolar según cualquiera de las
reivindicaciones precedentes, en el cual el otro miembro alargado
tiene en su extremo distal una sección transversal reducida para
recibir la sobrezapata (19) aislada.
6. El instrumento bipolar según cualquiera de las
reivindicaciones precedentes, en el cual la sobrezapata (19) aislada
tiene una abertura (20) que se extiende dentro de la misma a modo
de túnel para una relación de ajuste deslizante sobre la sección
transversal reducida del otro extremo distal para impedir el
movimiento longitudinal o transversal entre la sobrezapata aislada
(19), el miembro alargado y el otro extremo distal.
7. El instrumento bipolar según cualquiera de las
reivindicaciones precedentes, en el cual la sobrezapata (19) aislada
tiene abrazaderas (21) para acoplamiento con y alrededor del otro
miembro alargado.
8. El instrumento bipolar según cualquiera de las
reivindicaciones precedentes, en el cual el instrumento es una pinza
hemostática modificada con el eje (13) entre los extremos
proximales y distales (16, 16', 17, 17') para un movimiento tipo
tijera de los miembros alargados entre los extremos distales (17,
17').
9. El instrumento bipolar según cualquiera de las
reivindicaciones precedentes, en el cual una fuente (26) de
corriente electroquirúrgica bipolar se conecta separadamente a los
terminales (30, 31) para suministrar a estos, respectivamente,
corriente electroquirúrgica bipolar de alta frecuencia.
10. El instrumento bipolar según cualquiera de la
reivindicaciones precedentes, en el cual los extremos distales (17,
17') de cada miembro alargado están curvados para extenderse
transversalmente con relación al plano y generalmente paralelos a,
pero separados de, el eje (13).
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US92686997A | 1997-09-10 | 1997-09-10 | |
| US926869 | 1997-09-10 |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| ES2238768T3 true ES2238768T3 (es) | 2005-09-01 |
Family
ID=25453818
Family Applications (3)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| ES98946876T Expired - Lifetime ES2238768T3 (es) | 1997-09-10 | 1998-09-08 | Instrumento bipolar para la fusion de vasos. |
| ES09171462T Expired - Lifetime ES2368478T3 (es) | 1997-09-10 | 1998-09-08 | Instrumento de electrodos bipolares con disposición de electrodos separable. |
| ES04027478T Expired - Lifetime ES2335760T3 (es) | 1997-09-10 | 1998-09-08 | Instrumento de electrodos bipolares. |
Family Applications After (2)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| ES09171462T Expired - Lifetime ES2368478T3 (es) | 1997-09-10 | 1998-09-08 | Instrumento de electrodos bipolares con disposición de electrodos separable. |
| ES04027478T Expired - Lifetime ES2335760T3 (es) | 1997-09-10 | 1998-09-08 | Instrumento de electrodos bipolares. |
Country Status (8)
| Country | Link |
|---|---|
| US (1) | US6334861B1 (es) |
| EP (3) | EP2130506B1 (es) |
| JP (1) | JP4031616B2 (es) |
| AU (1) | AU739648B2 (es) |
| CA (1) | CA2303194C (es) |
| DE (2) | DE69829480T2 (es) |
| ES (3) | ES2238768T3 (es) |
| WO (1) | WO1999012488A1 (es) |
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- 1998-09-08 CA CA002303194A patent/CA2303194C/en not_active Expired - Fee Related
- 1998-09-08 ES ES09171462T patent/ES2368478T3/es not_active Expired - Lifetime
- 1998-09-08 DE DE69829480T patent/DE69829480T2/de not_active Expired - Lifetime
- 1998-09-08 EP EP09171462A patent/EP2130506B1/en not_active Expired - Lifetime
- 1998-09-08 DE DE69841285T patent/DE69841285D1/de not_active Expired - Lifetime
- 1998-09-08 EP EP98946876A patent/EP1011493B1/en not_active Expired - Lifetime
- 1998-09-08 WO PCT/US1998/018640 patent/WO1999012488A1/en not_active Ceased
- 1998-09-08 ES ES04027478T patent/ES2335760T3/es not_active Expired - Lifetime
- 1998-09-08 EP EP04027478A patent/EP1510179B1/en not_active Expired - Lifetime
- 1998-09-08 AU AU93795/98A patent/AU739648B2/en not_active Ceased
- 1998-09-08 JP JP2000510390A patent/JP4031616B2/ja not_active Expired - Fee Related
-
1999
- 1999-08-17 US US09/376,779 patent/US6334861B1/en not_active Expired - Lifetime
Also Published As
| Publication number | Publication date |
|---|---|
| EP1011493B1 (en) | 2005-03-23 |
| EP1011493A1 (en) | 2000-06-28 |
| ES2335760T3 (es) | 2010-04-05 |
| CA2303194A1 (en) | 1999-03-18 |
| JP2001515751A (ja) | 2001-09-25 |
| AU9379598A (en) | 1999-03-29 |
| WO1999012488A1 (en) | 1999-03-18 |
| EP1011493A4 (en) | 2001-01-10 |
| DE69829480D1 (de) | 2005-04-28 |
| JP4031616B2 (ja) | 2008-01-09 |
| EP1510179B1 (en) | 2009-11-11 |
| DE69829480T2 (de) | 2006-02-09 |
| EP2130506A1 (en) | 2009-12-09 |
| EP2130506B1 (en) | 2011-06-29 |
| EP1510179A1 (en) | 2005-03-02 |
| DE69841285D1 (de) | 2009-12-24 |
| US6334861B1 (en) | 2002-01-01 |
| CA2303194C (en) | 2006-04-11 |
| ES2368478T3 (es) | 2011-11-17 |
| AU739648B2 (en) | 2001-10-18 |
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