ES2248288T3 - Dispositivo para suministro de fluido. - Google Patents
Dispositivo para suministro de fluido.Info
- Publication number
- ES2248288T3 ES2248288T3 ES01911030T ES01911030T ES2248288T3 ES 2248288 T3 ES2248288 T3 ES 2248288T3 ES 01911030 T ES01911030 T ES 01911030T ES 01911030 T ES01911030 T ES 01911030T ES 2248288 T3 ES2248288 T3 ES 2248288T3
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- staples
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- Expired - Lifetime
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- 239000012530 fluid Substances 0.000 title claims abstract description 24
- 238000000926 separation method Methods 0.000 claims description 5
- 238000004891 communication Methods 0.000 claims description 2
- 102000009123 Fibrin Human genes 0.000 abstract description 17
- 108010073385 Fibrin Proteins 0.000 abstract description 17
- BWGVNKXGVNDBDI-UHFFFAOYSA-N Fibrin monomer Chemical compound CNC(=O)CNC(=O)CN BWGVNKXGVNDBDI-UHFFFAOYSA-N 0.000 abstract description 17
- 229950003499 fibrin Drugs 0.000 abstract description 17
- 239000003814 drug Substances 0.000 abstract description 8
- 229940079593 drug Drugs 0.000 abstract description 8
- 230000035876 healing Effects 0.000 abstract description 7
- 230000007246 mechanism Effects 0.000 abstract description 7
- 238000002347 injection Methods 0.000 abstract description 2
- 239000007924 injection Substances 0.000 abstract description 2
- 210000001519 tissue Anatomy 0.000 description 22
- 230000003872 anastomosis Effects 0.000 description 21
- 210000001072 colon Anatomy 0.000 description 19
- 230000009471 action Effects 0.000 description 14
- 230000008878 coupling Effects 0.000 description 12
- 238000010168 coupling process Methods 0.000 description 12
- 238000005859 coupling reaction Methods 0.000 description 12
- 239000012528 membrane Substances 0.000 description 12
- 238000000034 method Methods 0.000 description 9
- 239000000126 substance Substances 0.000 description 5
- 238000001356 surgical procedure Methods 0.000 description 5
- 230000006870 function Effects 0.000 description 4
- 230000008569 process Effects 0.000 description 4
- 230000005540 biological transmission Effects 0.000 description 3
- 210000001035 gastrointestinal tract Anatomy 0.000 description 3
- 210000000936 intestine Anatomy 0.000 description 3
- 206010028980 Neoplasm Diseases 0.000 description 2
- 230000002159 abnormal effect Effects 0.000 description 2
- 230000004913 activation Effects 0.000 description 2
- 230000006978 adaptation Effects 0.000 description 2
- 210000000436 anus Anatomy 0.000 description 2
- 230000008901 benefit Effects 0.000 description 2
- 201000011510 cancer Diseases 0.000 description 2
- 230000006835 compression Effects 0.000 description 2
- 238000007906 compression Methods 0.000 description 2
- 238000011109 contamination Methods 0.000 description 2
- 238000012377 drug delivery Methods 0.000 description 2
- 239000004744 fabric Substances 0.000 description 2
- 238000010304 firing Methods 0.000 description 2
- 239000004973 liquid crystal related substance Substances 0.000 description 2
- 230000001954 sterilising effect Effects 0.000 description 2
- 238000004659 sterilization and disinfection Methods 0.000 description 2
- 206010002091 Anaesthesia Diseases 0.000 description 1
- 235000004936 Bromus mango Nutrition 0.000 description 1
- 206010017993 Gastrointestinal neoplasms Diseases 0.000 description 1
- 240000007228 Mangifera indica Species 0.000 description 1
- 235000014826 Mangifera indica Nutrition 0.000 description 1
- 235000009184 Spondias indica Nutrition 0.000 description 1
- 210000001015 abdomen Anatomy 0.000 description 1
- 230000001133 acceleration Effects 0.000 description 1
- 230000004308 accommodation Effects 0.000 description 1
- 230000037005 anaesthesia Effects 0.000 description 1
- 230000000903 blocking effect Effects 0.000 description 1
- 239000007767 bonding agent Substances 0.000 description 1
- 239000003795 chemical substances by application Substances 0.000 description 1
- 210000002808 connective tissue Anatomy 0.000 description 1
- 230000006378 damage Effects 0.000 description 1
- 238000013461 design Methods 0.000 description 1
- 229920001971 elastomer Polymers 0.000 description 1
- 239000000806 elastomer Substances 0.000 description 1
- 239000013536 elastomeric material Substances 0.000 description 1
- 210000003736 gastrointestinal content Anatomy 0.000 description 1
- 238000007726 management method Methods 0.000 description 1
- 238000004519 manufacturing process Methods 0.000 description 1
- 230000004048 modification Effects 0.000 description 1
- 238000012986 modification Methods 0.000 description 1
- 235000004252 protein component Nutrition 0.000 description 1
- 230000036573 scar formation Effects 0.000 description 1
- 210000000813 small intestine Anatomy 0.000 description 1
- 230000003874 surgical anastomosis Effects 0.000 description 1
- 238000011477 surgical intervention Methods 0.000 description 1
- 230000017423 tissue regeneration Effects 0.000 description 1
- 238000009966 trimming Methods 0.000 description 1
- 239000002699 waste material Substances 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
- A61B17/1114—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis of the digestive tract, e.g. bowels or oesophagus
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis, e.g. in a single operation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/00491—Surgical glue applicators
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis, e.g. in a single operation
- A61B17/1155—Circular staplers comprising a plurality of staples
Landscapes
- Health & Medical Sciences (AREA)
- Surgery (AREA)
- Life Sciences & Earth Sciences (AREA)
- Medical Informatics (AREA)
- Animal Behavior & Ethology (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Veterinary Medicine (AREA)
- Molecular Biology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Physiology (AREA)
- Surgical Instruments (AREA)
- Infusion, Injection, And Reservoir Apparatuses (AREA)
- External Artificial Organs (AREA)
- Manipulator (AREA)
Abstract
Un dispositivo para el suministro de fluido, que comprende: una cámara de dispensación (95), que contiene un fluido; un paso o canal (90), que establece una comunicación entre un lugar de tratamiento y dicha cámara de dispensación (95); un dispositivo (110) de accionamiento de suministro, configurado para desplazarse dentro de dicha cámara de dispensación (95) y para empujar dicho fluido a través de dicho canal (90); caracterizado por que el dispositivo de suministro de fluido incluye también una bolsita (100), situada dentro de dicha cámara de dispensación (95) y que encierra dicho fluido; y en él dicho dispositivo (110) de accionamiento de suministro está configurado para comprimir y romper la bolsita (100) situada dentro de dicha cámara de dispensación (95).
Description
Dispositivo para suministro de fluido.
La presente invención se refiere generalmente a
un dispositivo de suministro de fluido para uso con herramientas
quirúrgicas de anastomosis, colocación de grapas y recorte, y, más
específicamente, a un mecanismo de inyección de fibrina por medio
del cual tales herramientas pueden suministrar fibrina al lugar de
colocación de grapas y de corte de un colon recortado.
Al identificar tejido canceroso u otro tejido
anómalo en el tracto gastrointestinal, con frecuencia se prescribe
la intervención quirúrgica. El campo de la cirugía del cáncer, y,
más específicamente, el procedimiento quirúrgico por el que se
recorta una sección o tramo del tracto gastrointestinal que
comprende el tejido canceroso o el tejido anómalo, incluye un cierto
número de instrumentos diseñados específicamente para ello. Se
proporcionará también, en combinación con una descripción de la
presente instrumentación y de sus funciones, una descripción del
estado de la técnica en este procedimiento quirúrgico.
La primera cuestión que debe responderse a la
hora de determinar cómo tratar el cáncer gastrointestinal se refiere
a la posición concreta del tejido canceroso. Esto es muy importante
por cuanto que los instrumentos que se proporcionan en la técnica
presente presentan limitaciones en cuanto a la distancia hasta la
que se pueden insertar en el tracto gastrointestinal. En el caso de
que el tejido canceroso se encuentre demasiado arriba en el colon,
por ejemplo, la instrumentación convencional que se proporciona es
entonces inutilizable, por lo que se requieren adaptaciones
especiales. Estas adaptaciones incrementan generalmente el riesgo de
contaminación de contaminación de los tejidos circundantes con el
contenido intestinal, aumentan la longitud de la cirugía y la
correspondiente necesidad de anestesia, y suprimen los beneficios de
una anastomosis y una colocación de grapas precisas que se obtienen
del uso de un dispositivo mecanizado.
Más específicamente, en el caso de que el tejido
canceroso se encuentre situado en una posición del colon que sea
accesible por los instrumentos actuales, el abdomen del paciente se
abre en un principio para dejar al descubierto el intestino. El
cirujano se sirve entonces de un dispositivo cortador y de
colocación de grapas rectilíneo que corta el tubo del colon por
ambos lados del tejido canceroso, con lo que se crean dos extremos
grapados del intestino (un extremo distal o más alejado, que se
dirige hacia el ano, y el extremo proximal o más cercano, que se
encuentra más cerca del intestino delgado). Esto se hace con el fin
de minimizar temporalmente la contaminación.
Más concretamente, haciendo referencia a la
Figura 1, el intestino se coloca entre los elementos de tijera 1, 2,
situados en la punta del instrumento de colocación de grapas
rectilíneo 5. Al apretar el gatillo 3 existente en el mango 4 del
dispositivo, el cirujano hace que los elementos de tijera 1, 2 se
junten entre sí. Se hace funcionar entonces un segundo gatillo (o
bien una acción secundaria del mismo gatillo) de manera que impulse
una serie de grapas 6 a través del extremo abrazado o pinzado del
colon, con lo que se cierran y se cortan transversalmente los
extremos.
El cirujano abre entonces parcialmente el extremo
proximal e inserta la parte de yunque susceptible de retirarse de un
instrumento de anastomosis y colocación de grapas, dentro del
extremo proximal al descubierto. Esta etapa, así como las del resto
del procedimiento quirúrgico, está relacionada con el funcionamiento
de este instrumento quirúrgico. Más concretamente, y con respecto a
la Figura 2, el cirujano comienza por tomar el instrumento 7 y hacer
girar manualmente la rueda de regulación 8 situada en la base del
mango 9, lo que hace que la cabeza de yunque 10 que se encuentra en
el extremo opuesto avance hacia delante. El cirujano continúa
haciendo girar la rueda de regulación 8 hasta que la cabeza de
yunque 10 ha avanzado hasta su posición extendida más extrema. Este
giro manual requiere casi treinta rotaciones completas. Una vez que
esta completamente extendida, la cabeza de yunque del instrumento es
desacoplada del mismo y insertada dentro de la abertura parcial del
extremo proximal, de tal manera que el poste o columna de
acoplamiento se extiende hacia fuera a través de la misma. Esta
abertura parcial del extremo proximal se cierra entonces mediante
puntos de sutura. El árbol extensible 11 del instrumento 7 de
anastomosis y colocación de grapas, se inserta entonces y se hace
avanzar dentro del colon inferior, a través del ano, hasta que el
vástago de acoplamiento 12 del mismo se extiende a través del
extremo distal grapado. El cirujano une entonces entre sí los
extremos de acoplamiento del yunque y del árbol, y de nuevo comienza
a hacer girar manualmente la rueda de regulación existente en el
mango, llevando esta vez la cabeza del yunque más cerca del extremo
13 del árbol.
Una vez que la cabeza del yunque y el árbol se
han llevado más cerca una del otro, después de que el cirujano ha
hecho girar manualmente la rueda de regulación otras treinta veces,
un gatillo 14 del tipo de empuñadura situado en el mango se acciona
manualmente. Esta actuación hace avanzar una cuchilla circular 15
axialmente fuera de la punta del árbol, hasta entrar en contacto con
la cara opuesta 16 del yunque 10. La cuchilla corta a través de los
extremos cerrados con grapas de los extremos proximal y distal del
colon, con lo que produce también por corte un nuevo par de extremos
de las porciones proximal y distal del colon. El tejido que ha sido
cercenado se mantiene dentro de un volumen interior situado en el
extremo del árbol.
En una etapa de bloqueo conjunta con el corte,
los extremos que se acaban de abrir se unen entre sí por medio de
una serie de grapas 17 que se hacen avanzar a través de orificios
existentes en perímetro de la punta del árbol (al ser presionadas
contra la cara opuesta del yunque y cerradas por ésta). El árbol y
el yunque acoplados son entonces retirados del paciente.
Como con muchos de tales dispositivos de la
técnica anterior, todos los dispositivos anteriores se consideran
totalmente desechables, y son, de hecho, desechados después de un
único uso. Se trata de dispositivos complicados que tienen múltiples
partes móviles que requieren una integridad estructural sustancial,
y son, en consecuencia, de fabricación costosa. El hecho de que se
utilicen una sola vez y no se pueda usar de nuevo ninguna parte,
convierte el uso de tales dispositivos en costoso y derrochador de
recursos.
Además de este inconveniente, como puede
apreciarse fácilmente de las descripciones precedentes, los
dispositivos de la técnica anterior adolecen de otras numerosas
limitaciones que sería deseable superar. Éstas incluyen el requisito
de que el cirujano accione manualmente un cierto número de funciones
diferentes (incluyendo las asociadas con la rueda de regulación y
con el gatillo del instrumento de anastomosis y colocación de
grapas, así como con los múltiples gatillos del instrumento de corte
y colocación de grapas).
Otro fallo es que los dispositivos de la técnica
anterior no proporcionan medio alguno que permita el suministro
fluido al lugar del tejido que se acaba de cortar. Ciertos
medicamentos u otras sustancias que aceleran el proceso de
cicatrización, si se suministran al lugar de forma simultánea con el
procedimiento de colocación de grapas y de corte, o subsiguiente al
mismo, podrían acelerar la cicatrización del tejido o realizar otras
funciones médicas. Una de tales sustancias es la fibrina, que es el
componente proteínico principal del tejido conectivo y sirve como el
elemento fundamental del proceso de reparación del tejido,
concretamente del proceso de formación de cicatrices y de unión de
dos tejidos previamente separados. En consecuencia, la capacidad de
inyectar dichas sustancias en el lugar del tejido que acaba de ser
grapado y cortado, proporcionará una ventaja sobre los dispositivos
de la técnica anterior, que no preven tal suministro.
Por lo tanto, constituye un propósito principal
de la presente invención proporcionar un dispositivo de suministro
de fluido que sea capaz de llevar a cabo dicho aporte de medicamento
en el lugar de la colocación de grapas y el corte del tejido de
objetivo o pretendido.
Es también un propósito principal de la presente
invención proporcionar dicho dispositivo de suministro de fluido de
una forma integral con un instrumento para el corte, anastomosis y
colocación de grapas, que reduzca el derroche de recursos al
permitir la reutilización de ciertas partes del mismo.
Constituye un objetivo adicional de la presente
invención proporcionar un tal dispositivo de suministro de fluido
que reduzca los requisitos de que el cirujano accione manualmente
diferentes componentes y mecanismos.
Otros objetivos de la presente invención se
constatarán de acuerdo con la descripción de la misma que se
proporciona aquí en lo que sigue, así como en la Descripción
Detallada de Realizaciones Preferidas, en combinación con las
Figuras que se acompañan.
El documento WO 90/05489 describe un instrumento
para anastomosis. La Figura 5 del documento 90/05489 muestra un
dispositivo de aplicación 112 destinado a hacer pasar un agente de
unión de dos partes de un tejido a través de una mangueta delgada y
flexible 113, hasta un extremo de punta 110 de una parte de mango
111 del instrumento. En el extremo de punta 110, la mangueta 113
está conformada a modo de anillo cerrado 115 que tiene ranuras (no
mostradas) para la dispensación del agente de unión.
De acuerdo con la presente invención, se
proporciona un dispositivo de suministro de fluido tal y como se
establece en la reivindicación 1.
En la realización preferida, la presente
invención se utiliza en combinación con un accesorio para
anastomosis y colocación de grapas de un dispositivo de
accionamiento de un dispositivo electromecánico. Éste comprende una
cámara de dispensación cilíndrica, adyacente a la cuchilla
cilíndrica del accesorio. La cámara de dispensación contiene una
bolsita llena de fibrina. Una pluralidad de pasos o canales se
extiende dentro de la cuchilla y establece una comunicación entre la
cámara de dispensación y el borde de corte de la cuchilla. Un árbol
de accionamiento de giro del accesorio, que se encuentra unido al
dispositivo de accionamiento electromecánico, acciona un dispositivo
de impulsión de grapas, un dispositivo de accionamiento de cuchilla
y un dispositivo de accionamiento de suministro (émbolo). Cuando se
activa el árbol de accionamiento de giro (por medio del gatillo
situado en el mango del dispositivo de accionamiento
electromecánico), el dispositivo de impulsión de grapas se desplaza
hacia delante para empujar una pluralidad de grapas a través de
puertas para grapa correspondientes, y contra el yunque del
accesorio, de manera que pasen a través del tejido de objetivo y lo
unan por grapado. Entretanto, por el mismo mecanismo de activación,
el dispositivo de accionamiento de cuchilla del accesorio se
desplaza hacia delante con el fin de cortar el tejido residual
indeseable (el tejido que ya no se necesita). También entretanto, el
dispositivo de accionamiento del émbolo se desplaza hacia delante a
través de la cámara de dispensación, a fin de comprimir la bolsita
hasta su punto de rotura. Cuando se rompe la bolsita, el fluido es
liberado al interior de la cámara de dispensación. El dispositivo de
accionamiento de émbolo continúa avanzando, empujando al fluido
dentro y a través de los canales de la cuchilla, para suministrar el
medicamento al borde de corte de la cuchilla y, de esta forma, al
lugar del tejido de objetivo que se acaba de grapar, al objeto de
comenzar la aceleración del procedimiento de cicatrización.
Específicamente, con respecto al dispositivo de
accionamiento electromecánico, el dispositivo de accionamiento se
muestra en la Figura 3 y está provisto de un mango 150 y de un árbol
de accionamiento flexible 155. El mango 150 tiene un diseño del
estilo de la empuñadura de una pistola, que tiene uno o más, y
preferiblemente dos, gatillos de dedo 160 que están acoplados
independientemente a al menos uno, y preferiblemente dos, motores
independientes 165, cada uno de los cuales hace girar un árbol de
accionamiento independiente y flexible 170 (que se describen aquí en
lo que sigue más exhaustivamente). Cada uno de los motores 165 es un
motor de doble sentido, y éstos están acoplados a un conmutador de
accionamiento manual 172 dispuesto en la parte superior del mango,
por medio del cual el usuario puede alterar selectivamente el
sentido de giro de cada motor. Esta capacidad de sentido doble puede
conseguirse de la forma más sencilla escogiendo motores que giren en
un sentido en correspondencia con el sentido de la corriente, de
manera que la actuación sobre los conmutadores de accionamiento
altere el sentido de la corriente en consecuencia. En este ejemplo,
la fuente de suministro de potencia 175 que alimenta a los motores
ha de ser una fuente de corriente directa o continua, tal como un
grupo de baterías (y, de la forma más deseable, un grupo de baterías
recargables). En el caso de que el dispositivo haya de poder
utilizarse con una corriente alterna, puede incluirse, bien un
transformador o bien un conjunto de transmisión intermedio más
sofisticado. En combinación con la presente descripción, las
realizaciones de la presente invención que pueden describirse se
sirven de un grupo de baterías recargables que proporcionan una
corriente continua.
Además de los componentes de motor, el mango
incluye adicionalmente varias otras características, incluyendo un
indicador de estado a distancia 180, unos medios de dirección o guía
de árbol 185 y un conmutador de conexión/desconexión (no mostrado).
En primer lugar, el indicador de estado a distancia puede comprender
un LCD (o dispositivo de lectura similar), por el cual el usuario
puede tener conocimiento de la posición de los componentes (por
ejemplo, si un elemento de abrazamiento se encuentra en la posición
adecuada antes del accionamiento de las grapas). En segundo lugar,
el mango incluye también unos medios de dirección susceptibles de
ser accionados manualmente, por ejemplo, una palanca de dirección o
una bola de seguimiento, destinados a dirigir el movimiento del
árbol flexible (por medio de cables de dirección implantados en la
parte de árbol que se describe más exhaustivamente aquí en lo que
sigue). Finalmente, el mango puede incluir un suministro de potencia
eléctrica adicional y un conmutador de conexión/desconexión,
destinado a suministrar selectivamente potencia eléctrica a los
accesorios.
Más concretamente, con respecto al árbol
flexible, el árbol comprende una funda o vaina conductora 195,
formada, preferiblemente, de un simple material elastómero que es
compatible con el tejido y que es susceptible de esterilizarse (es
decir, es lo suficientemente robusto como para soportar un
autoclave). Es posible proporcionar varias longitudes de este árbol.
El árbol flexible y las porciones de mango pueden ser separables. En
el caso de que sean separables, la interfaz o parte de separación
entre el extremo proximal del árbol y el extremo distal del mango
deberán incluir unos medios de acoplamiento para los componentes de
accionamiento.
En relación, específicamente, con los componentes
de accionamiento del mango, dentro de la vaina de elastómero se
encuentran un par de tubos fijos más pequeños 215, cada uno de los
cuales contiene un árbol de accionamiento flexible 220 que es capaz
de girar dentro del tubo. El propio árbol de accionamiento flexible
transmite un par desde el motor dispuesto en el mango al extremo
distal del árbol, si bien es lo suficientemente flexible como para
ser doblado, dispuesto en ángulo, curvado, etc., según el cirujano
considere necesario "serpentear" a través del colon del
paciente. Con el fin de que el extremo distal del árbol de
accionamiento se acople con un accesorio, tal como el accesorio de
anastomosis y colocación de grapas aquí expuesto, las puntas
distales o más alejadas de los árboles de accionamiento han de tener
una conformación que permita la transmisión continuada de par. Por
ejemplo, las puntas distales 200 de los árboles de accionamiento
pueden ser hexagonales, con lo que se ajustan en el interior de un
rebaje hexagonal existente en la interfaz de acoplamiento del
accesorio. Es posible suministrar unos mecanismos de transmisión
apropiados en el extremo distal del árbol, o bien en la parte de
interfaz del accesorio, a fin de garantizar que se proporciona el
par apropiado al accesorio.
Como se ha sugerido anteriormente, en combinación
con los medios de dirección susceptibles de ser accionados
manualmente que están montados en el mango, la vaina incluye
adicionalmente al menos dos cables de dirección o guiado 205 que son
flexibles pero que están acoplados a la superficie interna de la
vaina, cerca del extremo distal de la misma. Los cables de dirección
pueden ser trasladados axialmente unos con respecto de otros
mediante el accionamiento de los medios de dirección, acción que
hace que la vaina se doble y curve en correspondencia.
También como se ha sugerido en lo anterior, en
combinación con el indicador de LCD (dispositivo de presentación
visual de cristal líquido -"liquid crystal display") del mango,
el árbol contiene adicionalmente un terminal o contacto eléctrico
210 para su acoplamiento a los accesorios. Este terminal eléctrico
canaliza una señal desde el accesorio hasta el mango, al objeto de
indicar el estado de la fijación (por ejemplo, si la parte de yunque
está en estrecha proximidad con la parte de SBR, de tal manera que
el cirujano sabe que es seguro colocar las grapas). De forma
similar, es posible proporcionar un segundo terminal eléctrico para
el suministro de potencia a aspectos independientes del accesorio,
en caso de que así se requiera.
Haciendo referencia a continuación al dispositivo
de suministro de fluido de la presente invención, que se describe
aquí en combinación con un accesorio de anastomosis y colocación de
grapas, se describen aquí en lo que sigue una realización preferida
y una realización alternativa, como ejemplos de las diferentes
variaciones que podrían construirse para el propósito
equivalente.
El accesorio para anastomosis y colocación de
grapas comprende una parte de yunque y una parte de grapas, cuchilla
y depósito (parte de SBR -"staple, blade and reservoir
portion"), la cual incluye un par de árboles de accionamiento de
giro que son susceptibles de acoplarse a los componentes de
accionamiento del elemento de árbol descritos anteriormente, y un
par correspondiente de tuercas de avance y retroceso, montadas en
los árboles de accionamiento de giro, pero cuya rotación se impide
y, en consecuencia, avanzan y retroceden linealmente a lo largo de
los árboles cuando éstos giran.
La parte de yunque tiene forma de bala, con una
parte superior con forma de nariz roma, una superficie de soporte de
corte plana, situada en la parte inferior, y una columna de
acoplamiento de rotación libre, que se extiende axialmente desde la
superficie de fondo. Este poste de acoplamiento se ha diseñado para
ser selectivamente acoplable y susceptible de retirarse de la
correspondiente tuerca, montada en uno de los árboles de
accionamiento de giro.
La parte de SBR es de forma cilíndrica y
configura un alojamiento que tiene su interior hueco. Es este
interior hueco el que forma el depósito. En la superficie situada
axialmente de cara hacia fuera de la pared cilíndrica del
alojamiento existe una serie de puertas o accesos para las grapas, a
través de los cuales se descargan las grapas del dispositivo. Existe
una serie de dispositivos de impulsión de grapas montados dentro de
las paredes cilíndricas, por debajo de las puertas para las grapas,
a fin de impulsar las grapas a su través. Más precisamente, los
dispositivos de impulsión de grapas consisten en una serie de
protuberancias situadas en el borde exterior de un único componente
cilíndrico provisto de asientos en la pared de la parte de SBR. Las
grapas, antes de ser descargadas, están montadas en los orificios, y
se hacen avanzar a través de los orificios por el movimiento hacia
delante del dispositivo de impulsión de grapas y de las
protuberancias del mismo.
La cuchilla es, similarmente, cilíndrica, y se
asienta en el interior del alojamiento, contra la superficie interna
de la pared del mismo. Tanto la cuchilla como el dispositivo de
impulsión de grapas están montados en la segunda tuerca, la cual, a
su vez, está montada en el otro árbol de accionamiento de giro. A
medida que rota el árbol de accionamiento de giro, la tuerca (que
está confinada de manera que no rote) avanza a lo largo del árbol,
con lo que hace avanzar de esta forma la cuchilla y el dispositivo
de impulsión de grapas linealmente. La cuchilla y el dispositivo de
impulsión de grapas son, por tanto, susceptibles de hacerse avanzar
axialmente de forma selectiva hacia fuera desde el alojamiento, de
acuerdo con la actuación sobre el gatillo apropiado del mango.
Con el fin de acelerar el proceso de
cicatrización, el accesorio se ajusta en la presente invención, esto
es, un mecanismo para suministrar fluido, medicamento o una
sustancia cicatrizante, tal como fibrina, en el lugar del corte y la
colocación de las grapas, inmediatamente después de la acción de
corte y de colocación de las grapas que se ha descrito en lo
anterior. Este mecanismo puede adoptar cualquiera de entre diversas
realizaciones, dos de las cuales se describen aquí en lo que sigue
como ejemplos. En general, la fibrina está contenida dentro de una
bolsita formada por una delgada piel o membrana. La bolsita está
contenida dentro de una cámara de dispensación, a través de la cual
se desplaza un dispositivo de accionamiento de suministro o émbolo.
Una vez que la cuchilla y el dispositivo de impulsión de grapas
llegan hasta el yunque, la cuchilla y el dispositivo de impulsión de
grapas son detenidos por el yunque, con lo que se realizan de forma
simultánea las acciones de colocación de grapas y de corte
anteriormente descritas. El dispositivo de accionamiento de
suministro o émbolo, que está acoplado a la segunda tuerca
conjuntamente con la cuchilla y el dispositivo de impulsión de
grapas, prosigue, impulsado axialmente hacia fuera desde el
alojamiento, comprimiendo la bolsita y haciendo que la presión se
acumule dentro de la bolsita. Una vez que la presión alcanza el
punto de rotura de la membrana, la fibrina es liberada y se
transfiere desde la bolsita al lugar del corte y la colocación de
las grapas, a través de los pasos o canales existentes en la
cuchilla.
En la práctica, este accesorio se utiliza una vez
que se ha recortado el tramo del colon que ha de ser retirado (pero
antes de que se haya completado la etapa de abrazamiento o
pinzamiento lineal y de colocación de las grapas), de la siguiente
manera. El cirujano comienza por acoplar el accesorio de anastomosis
y colocación de grapas al dispositivo de accionamiento
electromecánico, y hacer avanzar la parte de yunque hasta su
extensión completa. Se retira entonces la cabeza del yunque y se
inserta en el extremo proximal que se ha dejado al descubierto. Este
extremo proximal se cierra entonces mediante la colocación de grapas
(de manera que la columna de acoplamiento sobresale del extremo
proximal grapado). El cirujano hace avanzar entonces el árbol y la
parte de SBR del accesorio hacia arriba por el colon, hasta que ésta
se extiende a través del extremo distal grapado del colon. El
cirujano acopla a continuación el yunque a la tuerca de avance y
retroceso del árbol de accionamiento correspondiente. El disparo
subsiguiente del motor del interior del mango hace que el yunque
retroceda hacia la parte de SBR. Cuando la parte de yunque y la
parte de SBR han llegado a estar lo suficientemente cerca como para
accionar la cuchilla y el dispositivo de impulsión de grapas, la
actuación subsiguiente sobre el otro gatillo del mango hace que el
otro árbol de accionamiento de giro correspondiente provoque el
avance de la cuchilla y del dispositivo de accionamiento del mango
hacia la superficie de soporte de corte plana de la parte de yunque.
La cuchilla corta a través de los extremos cerrados mediante grapas
del colon, dejando el tejido que ha sido cercenado en el depósito
interior. Simultáneamente con el corte, los extremos que se acaban
de abrir se unen entre sí mediante la serie de grapas que se hacen
avanzar a través de los orificios existentes en el borde perimetral
de la SBR (al ser presionadas contra la cara opuesta del yunque y
cerradas por ésta). Un poco más tarde, como se ha descrito en lo
anterior, el dispositivo de accionamiento de émbolo avanza, con lo
que se incrementa la presión en la membrana que contiene la fibrina.
Una vez que se rompe la membrana, la fibrina se libera y es
transferida al lugar del corte y la colocación de grapas, a través
de los orificios existentes en la cuchilla. La fijación y el árbol
flexible son entonces retirados del paciente.
Ha de apreciarse que la presente invención puede
ser utilizada en combinación con accesorio de colocación de grapas
únicamente, de tal modo que la cámara de dispensación es adyacente a
la grapadora y los canales se extienden dentro de la grapadora o
adyacentes a la misma, con el fin de suministrar el medicamento o la
sustancia cicatrizante, tal como la fibrina, al lugar de la
colocación de las grapas. Éste puede utilizarse en el caso de que no
se necesite la acción de corte. En tanto en cuanto la presente
invención puede utilizarse para aplicaciones y en combinación con
dispositivos no relacionados con la anastomosis ni la fijación de
grapas, o ni siquiera con herramientas para el recorte del colon,
sino que, en lugar de ello, puede emplearse para aplicaciones que
comprenden otros dispositivos quirúrgicos y que están en combinación
con ellos, la presente invención puede ser utilizada sola o con una
cuchilla, o con una grapadora, o bien con otros dispositivos o
combinaciones de dispositivos.
La Figura 1 es una vista lateral en perspectiva
de un instrumento de abrazamiento o pinzamiento lineal y de
colocación de grapas de la técnica anterior;
la Figura 2 es una vista lateral en perspectiva
de un instrumento de anastomosis y de colocación de grapas de
acuerdo con la técnica anterior;
la Figura 3 es una vista lateral de un mango y de
un árbol flexible de un dispositivo de accionamiento de dispositivo
electromecánico que se utiliza para accionar el accesorio de
anastomosis y colocación de grapas que se describe aquí;
la Figura 4 es una vista en perspectiva de un
accesorio de anastomosis y colocación de grapas que tiene un
dispositivo integrado de suministro de medicamento, de acuerdo con
la presente invención;
la Figura 5 es una vista lateral recortada de una
primera realización del dispositivo de suministro de medicamento de
la presente invención, que es integral con un accesorio de
anastomosis y colocación de grapas; y
la Figura 6 es una vista lateral recortada de una
segunda realización del dispositivo de suministro de medicamento de
acuerdo con la presente invención, que es integral con un accesorio
de anastomosis y fijación de grapas.
Si bien la presente invención se describirá más
exhaustivamente aquí en lo que sigue, con referencia a los dibujos
que se acompañan, en los que se muestran realizaciones concretas, ha
de comprenderse como punto de partida que las personas expertas en
la técnica pueden modificar la invención que aquí se describe
mientras cumpla las funciones y satisfaga los resultados de esta
invención. En consecuencia, las descripciones que siguen han de
comprenderse como ilustrativas y en calidad de ejemplos de
estructuras, aspectos y características concretos de la presente
invención. Los números iguales se refieren a características
similares de elementos análogos a todo lo largo de ella.
En las Figuras 4-6 se ilustra una
realización preferida del dispositivo de suministro de fluido para
un accesorio de anastomosis y fijación de grapas de acuerdo con la
presente invención. Más concretamente, haciendo referencia, a
continuación, a la Figura 4, se muestra en ella una vista en
perspectiva desde el exterior de un accesorio de anastomosis y
fijación de grapas, en una posición extendida. La parte de yunque 20
y la parte 25 de grapas, cuchilla y depósito (SBR -"staple, blade
and reservoir portion") están unidas por medio de un poste o
columna de acoplamiento 30 que se extiende desde la superficie de
soporte de corte plana 35 de la parte de yunque 20 y es susceptible
de acoplarse y retirarse selectivamente de la tuerca
correspondiente, montada en uno de los árboles 40 de accionamiento
de giro de la parte de SBR 25.
Haciendo referencia ahora también a la Figura 5,
se muestra en ella una vista recortada del interior de la parte de
SBR 25. La parte de SBR 25 es de forma cilíndrica y tiene un
interior hueco, o depósito 45. Una superficie 50 de colocación de
grapas se encuentra de cara axialmente hacia fuera, en dirección a
la superficie de soporte de corte 35 de la parte de yunque 20, y
contiene una serie de accesos o puertas 55 para grapas, a través de
las cuales son descargadas las grapas 60. Existe una serie de
dispositivos 65 de impulsión de grapas, montados dentro de un árbol
80 de impulsión de grapas, por detrás de las puertas 55 para grapas
correspondientes, al objeto de impulsar las grapas 60 a su través.
Más precisamente, los dispositivos 65 de impulsión de grapas
consisten en una serie de protuberancias situadas en el borde
exterior de un cilindro de impulsión 70 que se asienta en la parte
de SBR 25 y que está unido al segundo árbol de impulsión (no
mostrado) de la parte de SBR 25. Las grapas 60, antes de ser
descargadas, están montadas por detrás de las puertas 55 para
grapas, tal y como se muestra, y se hacen avanzar a través de las
puertas 55 por el movimiento hacia delante de los dispositivos 65 de
impulsión de grapas y por las protuberancias de los mismos.
La hoja 75 es, similarmente, cilíndrica, y se
asienta en la parte de SBR adyacente al árbol 80 de impulsión de
grapas. Tanto la hoja 75 como los dispositivos 65 de impulsión de
grapas están montados, por medio de muelles o resortes
semi-rígidos 85, en el cilindro de impulsión 70, tal
como se muestra, y éste está unido al segundo árbol de impulsión (no
mostrado) de la parte de SBR 25. La naturaleza
semi-rígida de los resortes 85 se explicará más
adelante. La cuchilla 75 tiene además una serie de pasos o canales
90 que se comunican con una cámara de dispensación 95. La cámara 95
se extiende desde la cara interior de la cuchilla 75 y cubre o
abarca la circunferencia de la cuchilla 75, en tanto que los canales
90 son de naturaleza tubular y están colocados a intervalos a lo
largo de la longitud de la cuchilla 75, a fin de mantener la
integridad estructural de la cuchilla 75 mientras ésta se está
utilizando para el corte. Dentro de la cámara 95 está contenida una
bolsita 100 formada por una membrana 105 obturada o cerrada
herméticamente y que contiene fibrina (que no se ha designado).
Inmediatamente detrás de la bolsita 100 se ha colocado un
dispositivo 110 de accionamiento de émbolo que está montado en el
cilindro de impulsión 70, tal como se muestra.
Haciendo referencia, a continuación, a la Figura
6, se ilustra en ella la realización preferida del dispositivo de
suministro de fluido de un accesorio de anastomosis y colocación de
grapas de acuerdo con la presente invención. Todos los componentes
son como se ha descrito en lo anterior para la Figura 5, si bien los
dispositivos 65 de impulsión de grapas y la cuchilla 75 están
montados en el cilindro de impulsión 70 no por medio de resortes 85,
sino, en lugar de ello, por medio de una prolongación 115 de
separación por rotura, como se muestra con el sombreado.
En funcionamiento (el funcionamiento de ambas
realizaciones se describirá más adelante), el accesorio se utiliza
una vez que ha sido recortado el tramo del colon que se ha de
retirar (pero antes de que la etapa de pinzamiento lineal y
colocación de grapas haya sido completada). El cirujano comienza por
acoplar el accesorio de anastomosis y colocación de grapas al
dispositivo de accionamiento electromecánico, y hacer avanzar la
parte de yunque 20 hasta su total extensión, por medio del disparo o
arranque del motor (no mostrado) existente dentro del mango (no
mostrado). La parte de yunque 20 se desacopla entonces del
dispositivo de accionamiento electromecánico y se inserta en el
extremo proximal que queda al descubierto. Este extremo proximal se
cierra entonces por colocación de grapas (de manera que la columna
de acoplamiento 30 sobresale del extremo proximal grapado). El
cirujano hace avanzar entonces el primer árbol 40 de accionamiento
de giro y la parte de SBR 25 del accesorio hacia arriba por el colon
hasta que éste se extiende a través del extremo distal grapado del
colon. El cirujano vuelve a acoplar entonces la parte de yunque 20,
a través de la columna de acoplamiento 30, al primer árbol 40 de
accionamiento de giro. El subsiguiente arranque inverso del motor
(no mostrado) existente dentro del mango (que no se muestra) hace
que la parte de yunque 20 retroceda hacia la parte de SBR 25,
llevando de esta forma a los extremos proximal y distal, cerrados
con grapas, a juntarse uno con otro. Cuando la parte de yunque 20 y
la parte de SBR 25 han llegado a estar lo suficientemente cerca para
accionar la cuchilla 75 y el dispositivo 65 de impulsión de grapas,
el accionamiento subsiguiente de un segundo gatillo (no mostrado)
situado en el mango (no mostrado) provoca que el segundo árbol de
accionamiento de giro correspondiente (no mostrado) haga avanzar la
cuchilla 75 y el dispositivo 65 de impulsión de grapas hacia la
superficie de soporte de corte plana 35 de la parte de yunque 25.
Una vez que la cuchilla 75 llega hasta la superficie de soporte de
corte plana 35 de la parte de yunque 25, la hoja 75 corta a través
de los extremos proximal y distal del colon, cerrados con grapas,
dejando el tejido ahora cercenado dentro del depósito 45.
Entretanto, los dispositivos 65 de impulsión de grapas (que se han
hecho avanzar con la hoja 75 pero aún se encuentran situados
ligeramente por detrás del plano de la hoja 75, según se muestra,
con el fin de regular correctamente en el tiempo la acción de
colocación de las grapas de modo que llegue inmediatamente después
de la acción de corte) alcanzan los cantos o lomos de las grapas 60
y continúan hacia delante para empujar las grapas 60 a través de las
puertas 55 para grapas, y en dirección a la superficie 50 de
colocación de grapas, y, finalmente, contra la superficie de soporte
de corte plana 35, acción que dobla las puntas de las grapas para
cerrar las grapas 60, con lo que se unen entre sí los extremos
proximal y distal del colon, que acaban de ser abiertos por corte.
Entretanto, el dispositivo 110 de accionamiento de émbolo (que se ha
estado avanzando con la cuchilla 75 y con los dispositivos de
impulsión de grapas, y sin embargo está situado ligeramente por
detrás del plano de los dispositivos 65 de impulsión de grapas, tal
como se muestra, con el fin de regular correctamente en el tiempo la
acción de impulsión del émbolo de manera que llegue inmediatamente
después de la acción de colocación de las grapas) avanza, alcanzando
la membrana obturada 105 conforme se completa la acción de
colocación de las grapas.
Tras esto, en la primera realización que se ha
descrito anteriormente, los resortes semi-rígidos 85
(mostrados en la Figura 5) de la cuchilla 75 y de los dispositivos
65 de impulsión de grapas comienzan a comprimirse a partir del
desplazamiento hacia delante del segundo árbol de accionamiento de
giro (no mostrado). Esto permite que el dispositivo 110 de
accionamiento de émbolo continúe también su movimiento hacia
delante, e inicie con ello la compresión de la membrana obturada
105, por lo que se incrementa la presión dentro de la membrana
obturada 105 que contiene la fibrina (no designada). Ha de
apreciarse que esta realización permite la reutilización del
accesorio, ya que los resortes 85 se descomprimirán una vez que la
presión sobre los dispositivos 65 de impulsión de grapas se haya
liberado al retirar el segundo árbol de accionamiento de giro. Una
vez que se ha colocado una nueva bolsita 100 en la cámara de
dispensación 95, el accesorio está listo para la siguiente operación
(suponiendo que se hayan seguido los procedimientos de
esterilización apropiados).
Alternativamente, en la segunda realización
(preferida) anteriormente descrita, una vez que se ha completado la
acción de colocación de las grapas, la prolongación 115 de
separación por rotura (que se muestra en la Figura 6), desde la que
se extienden la cuchilla 75 y los dispositivos 65 de colocación de
grapas, se desprende con una rotura brusca y sus restos quedan
atrapados dentro del cuerpo del accesorio, a medida que el
movimiento hacia delante del segundo árbol de accionamiento de giro
(no mostrado) continúa desplazando hacia delante el dispositivo 110
de accionamiento de émbolo. El desplazamiento hacia delante del
dispositivo 110 de accionamiento de émbolo inicia la compresión de
la membrana obturada 105, con lo que se incrementa la presión en la
membrana obturada 105 que contiene la fibrina (sin designación). Ha
de apreciarse que la destrucción de la prolongación 115 de
separación por rotura no permite que este accesorio sea
reutilizado.
Una vez que el dispositivo 110 de accionamiento
de émbolo ha comprimido la membrana 105 hasta su límite de esfuerzo
máximo, la membrana 105 se rompe, la fibrina se libera y pasa a
través de los canales 90 existentes en la cuchilla 75, para ser
transferida con ello al lugar del corte y la colocación de las
grapas (el tejido que se acaba de cortar). La cuchilla 75, los
dispositivos 65 de impulsión de grapas y el dispositivo 110 de
accionamiento de émbolo pueden ser retirados mediante la activación
o disparo inverso del segundo árbol de accionamiento de giro (no
mostrado). El accesorio y el árbol flexible son entonces retirados
del paciente.
Si bien se han descrito e ilustrado realizaciones
concretas de los nuevos y novedosos dispositivos para el suministro
de fluido, se pondrá de manifiesto para los expertos de la técnica
que son posibles variaciones y modificaciones.
Claims (18)
1. Un dispositivo para el suministro de fluido,
que comprende:
una cámara de dispensación (95), que contiene un
fluido;
un paso o canal (90), que establece una
comunicación entre un lugar de tratamiento y dicha cámara de
dispensación (95);
un dispositivo (110) de accionamiento de
suministro, configurado para desplazarse dentro de dicha cámara de
dispensación (95) y para empujar dicho fluido a través de dicho
canal (90);
caracterizado por que
el dispositivo de suministro de fluido incluye
también una bolsita (100), situada dentro de dicha cámara de
dispensación (95) y que encierra dicho fluido; y en él dicho
dispositivo (110) de accionamiento de suministro está configurado
para comprimir y romper la bolsita (100) situada dentro de dicha
cámara de dispensación (95).
2. El dispositivo para el suministro de fluido de
acuerdo con la reivindicación 1, en el cual dicho canal (90) se
comunica también con un borde cortante de una cuchilla (75).
3. El dispositivo de acuerdo con la
reivindicación 2, en el cual dicha cámara de dispensación (95) es
adyacente a dicha cuchilla (75).
4. El dispositivo de acuerdo con la
reivindicación 3, en el cual dicho dispositivo (110) de suministro
de fluido es rígido y dicha cuchilla (75) es accionada por un
dispositivo (70) de accionamiento de cuchilla, que tiene una parte
compresible.
5. El dispositivo de acuerdo con la
reivindicación 4, en el cual dicha parte compresible comprende un
muelle o resorte (85).
6. El dispositivo de acuerdo con la
reivindicación 3, en el cual dicho dispositivo (110) de
accionamiento de suministro es rígido y dicha cuchilla (75) es
accionada por un dispositivo (70) de accionamiento de cuchilla que
tiene una porción de separación por rotura que presenta una rigidez
que es menor que la rigidez de dicho dispositivo (110) de
accionamiento de suministro.
7. El dispositivo de acuerdo con la
reivindicación 2, en el cual dicho canal (90) se extiende dentro de
dicha cuchilla (75).
8. El dispositivo para el suministro de fluido de
acuerdo con la reivindicación 1, en el cual dicho canal (90) se
comunica también con una superficie (50) de colocación de grapas de
una grapadora.
9. El dispositivo de acuerdo con la
reivindicación 8, en el cual dicha cámara de dispensación (95) es
adyacente a dicha grapadora.
10. El dispositivo de acuerdo con la
reivindicación 9, en el cual dicho dispositivo (110) de
accionamiento de suministro es rígido y dicha grapadora es accionada
por un dispositivo (65) de impulsión de grapas, que tiene una parte
compresible.
11. El dispositivo de acuerdo con la
reivindicación 10, en el cual dicha parte compresible comprende un
muelle o resorte (85).
12. El dispositivo de acuerdo con la
reivindicación 9, en el cual dicho dispositivo (110) de
accionamiento de suministro es rígido y dicha grapadora es accionada
por medio de un dispositivo (65) de impulsión de grapas, que tiene
una parte de separación por rotura que presenta una rigidez que es
menor que la rigidez de dicho dispositivo (110) de accionamiento de
suministro.
13. El dispositivo de acuerdo con la
reivindicación 8, en el cual dicho canal (90) se extiende dentro de
dicha grapadora.
14. El dispositivo de acuerdo con la
reivindicación 3, en el cual dicha cuchilla (75) es adyacente a una
grapadora que tiene una superficie (50) de colocación de grapas, de
tal manera que dicha cuchilla (75) tiene un borde de corte que se
desplaza adyacente a dicha superficie (50) de colocación de grapas,
y en el que dicho canal (90) se comunica también con dicho borde
cortante de dicha cuchilla (75).
15. El dispositivo de acuerdo con la
reivindicación 14, en el cual dicho dispositivo (110) de
accionamiento de suministro es rígido, dicha cuchilla (75) es
accionada por un dispositivo (70) de accionamiento de cuchilla,
unido a dicho dispositivo (110) de accionamiento de suministro, y
dicha grapadora es accionada por un dispositivo (65) de
accionamiento de grapadora, unido a dicho dispositivo (110) de
accionamiento de suministro.
16. El dispositivo de acuerdo con la
reivindicación 15, en el cual al menos uno de entre dicho
dispositivo (70) de accionamiento de cuchilla y dicho dispositivo
(65) de impulsión de grapas tiene una parte compresible.
17. El dispositivo de acuerdo con la
reivindicación 15, en el cual al menos uno de entre dicho
dispositivo (70) de accionamiento de cuchilla y dicho dispositivo
(65) de impulsión de grapas tiene una parte de separación por rotura
que presenta una rigidez que es menor que la rigidez de dicho
dispositivo (110) de accionamiento de suministro.
18. El dispositivo de acuerdo con la
reivindicación 15, en el cual dicha cuchilla (75), dicho dispositivo
(70) de accionamiento de cuchilla, dicha grapadora, dicho
dispositivo (65) de impulsión de grapas, dicha cámara de
dispensación (95) y dicho dispositivo (110) de accionamiento de
suministro son cilíndricos y comparten un eje de cilindro común.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US510933 | 2000-02-22 | ||
| US09/510,933 US6488197B1 (en) | 2000-02-22 | 2000-02-22 | Fluid delivery device for use with anastomosing resecting and stapling instruments |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| ES2248288T3 true ES2248288T3 (es) | 2006-03-16 |
Family
ID=24032787
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| ES01911030T Expired - Lifetime ES2248288T3 (es) | 2000-02-22 | 2001-02-21 | Dispositivo para suministro de fluido. |
Country Status (8)
| Country | Link |
|---|---|
| US (2) | US6488197B1 (es) |
| EP (1) | EP1257216B1 (es) |
| JP (3) | JP4491566B2 (es) |
| AT (1) | ATE310452T1 (es) |
| AU (1) | AU2001238574A1 (es) |
| DE (1) | DE60115209T2 (es) |
| ES (1) | ES2248288T3 (es) |
| WO (1) | WO2001062158A2 (es) |
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-
2000
- 2000-02-22 US US09/510,933 patent/US6488197B1/en not_active Expired - Lifetime
-
2001
- 2001-02-21 JP JP2001561229A patent/JP4491566B2/ja not_active Expired - Fee Related
- 2001-02-21 WO PCT/US2001/005480 patent/WO2001062158A2/en not_active Ceased
- 2001-02-21 AT AT01911030T patent/ATE310452T1/de active
- 2001-02-21 ES ES01911030T patent/ES2248288T3/es not_active Expired - Lifetime
- 2001-02-21 DE DE60115209T patent/DE60115209T2/de not_active Expired - Lifetime
- 2001-02-21 AU AU2001238574A patent/AU2001238574A1/en not_active Abandoned
- 2001-02-21 EP EP01911030A patent/EP1257216B1/en not_active Expired - Lifetime
-
2002
- 2002-11-25 US US10/303,294 patent/US6681979B2/en not_active Expired - Lifetime
-
2009
- 2009-12-14 JP JP2009283509A patent/JP5059091B2/ja not_active Expired - Fee Related
-
2012
- 2012-01-12 JP JP2012004187A patent/JP5563606B2/ja not_active Expired - Fee Related
Also Published As
| Publication number | Publication date |
|---|---|
| ATE310452T1 (de) | 2005-12-15 |
| DE60115209T2 (de) | 2006-07-27 |
| EP1257216B1 (en) | 2005-11-23 |
| EP1257216A2 (en) | 2002-11-20 |
| JP5563606B2 (ja) | 2014-07-30 |
| US6488197B1 (en) | 2002-12-03 |
| JP2010057965A (ja) | 2010-03-18 |
| JP4491566B2 (ja) | 2010-06-30 |
| US20030073982A1 (en) | 2003-04-17 |
| AU2001238574A1 (en) | 2001-09-03 |
| JP2003523251A (ja) | 2003-08-05 |
| WO2001062158A2 (en) | 2001-08-30 |
| DE60115209D1 (de) | 2005-12-29 |
| WO2001062158A3 (en) | 2002-02-14 |
| JP2012106002A (ja) | 2012-06-07 |
| US6681979B2 (en) | 2004-01-27 |
| JP5059091B2 (ja) | 2012-10-24 |
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