ES2285586T3 - Aparato quirurgico de grapado con mecanismo de bloqueo. - Google Patents
Aparato quirurgico de grapado con mecanismo de bloqueo. Download PDFInfo
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- ES2285586T3 ES2285586T3 ES05003446T ES05003446T ES2285586T3 ES 2285586 T3 ES2285586 T3 ES 2285586T3 ES 05003446 T ES05003446 T ES 05003446T ES 05003446 T ES05003446 T ES 05003446T ES 2285586 T3 ES2285586 T3 ES 2285586T3
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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
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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
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B2017/0023—Surgical instruments, devices or methods disposable
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B2017/0046—Surgical instruments, devices or methods with a releasable handle; with handle and operating part separable
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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
- A61B2017/07214—Stapler heads
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Abstract
Un aparato quirúrgico de grapado (10) que comprende: una envoltura (14); y una unidad cargadora (16) soportable en un extremo distal de la envoltura, incluyendo la unidad cargadora: una parte de envoltura (200) que incluye un extremo distal y un extremo proximal; un conjunto de accionamiento (212) soportado de modo deslizable dentro de la parte de envoltura de la unidad cargadora; y caracterizado por: un mecanismo de bloqueo (300) soportado de modo pivotal sobre la parte de envoltura de la unidad cargadora, teniendo el mecanismo de bloqueo una primera posición en la que el mecanismo de bloqueo engancha una parte del conjunto de accionamiento y mantiene la posición del conjunto de accionamiento respecto a la parte de envoltura de la unidad cargadora, y teniendo el mecanismo de bloqueo una segunda posición en la que el mecanismo de bloqueo desengancha el conjunto de accionamiento y permite que el conjunto de accionamiento se mueva respecto a la parte de envoltura.
Description
Aparato quirúrgico de grapado con mecanismo de
bloqueo.
La presente publicación se refiere a un aparato
quirúrgico, p. ej., un aparato quirúrgico de grapado. Más
particularmente, la presente publicación se refiere a un aparato
quirúrgico endoscópico de grapado que incluye un mecanismo de
bloqueo que incluye un miembro de bloqueo para retener el conjunto
de accionamiento de una unidad cargadora, p. ej., una unidad
cargadora de un solo uso ("UCUU") o una unidad cargadora
desechable ("UCD"), en una posición axial substancialmente
fija hasta que la UCUU o la UCD se haya cargado en o afianzado a un
aparato quirúrgico de grapado, para asegurar el enganche apropiado o
completo de la UCUU o UCD, especialmente su conjunto de
accionamiento, al aparato quirúrgico de grapado. Por simplicidad, en
lo sucesivo se aludirá a la UCUU o a la UCD como "UCD", pero
debe entenderse que incluye una UCD o una UCUU o ambas.
En la técnica son bien conocidos los
dispositivos quirúrgicos en los que el tejido primero se agarra o
sujeta mediante una estructura de mordazas opuestas y después se
une con sujetadores quirúrgicos. En algunos instrumentos se
proporciona un bisturí para cortar el tejido que se ha unido con los
sujetadores. Típicamente, los sujetadores tienen la forma de grapas
quirúrgicas, pero también pueden utilizarse sujetadores poliméricos
de dos piezas.
Los instrumentos destinados a esta finalidad
pueden incluir dos miembros alargados de mordaza que se usan,
respectivamente, para prender o sujetar el tejido. Típicamente, uno
de los miembros de mordaza lleva un cartucho de grapas que contiene
una pluralidad de grapas colocadas en al menos dos filas laterales,
mientras que el otro miembro de mordaza tiene un yunque que define
una superficie destinada a conformar las patas de las grapas a
medida que se impulsan las grapas desde el cartucho de grapas.
Generalmente, la operación de grapado se efectúa mediante miembros
excéntricos que se desplazan longitudinalmente a través del cartucho
de grapas, cuyos miembros excéntricos actúan sobre unos impulsores
de grapas para expulsar secuencialmente las grapas del cartucho de
grapas. Entre las filas de grapas puede desplazarse un bisturí para
cortar y/o abrir longitudinalmente entre las filas de grapas el
tejido grapado. Tales instrumentos están publicados, por ejemplo, en
la Patente de EE.UU. n.º 3.079.606 y en la Patente de EE.UU. n.º
3.490.675.
Una grapadora posterior, publicada en la Patente
de EE.UU. n.º 3.499.591, también aplica una doble fila de grapas en
cada lado de la incisión. Esta patente describe una grapadora
quirúrgica que tiene una unidad cargadora desechable en la que un
miembro excéntrico se mueve a través de un recorrido guía alargado
entre dos conjuntos de acanaladuras escalonadas portadoras de las
grapas. Unos miembros impulsores de las grapas están situados
dentro de las acanaladuras y están posicionados de manera que el
miembro excéntrico, móvil longitudinalmente, entre en contacto con
ellos para efectuar la expulsión de las grapas del cartucho de
grapas de la unidad cargadora desechable. Otros ejemplos de tales
grapadoras están publicados en las Patentes de EE.UU. n.^{os}
4.429.695 y 5.065.929.
Cada uno de los instrumentos anteriormente
descritos está diseñado de modo que se use en procedimientos
quirúrgicos convencionales en los que los cirujanos tienen acceso
manual directo al lugar operativo. No obstante, en los
procedimientos endoscópicos o laparoscópicos la cirugía se realiza a
través de una pequeña incisión o a través de una cánula estrecha
insertada a través de pequeños cortes de entrada realizados en la
piel. Para afrontar las necesidades específicas de los
procedimientos quirúrgicos endoscópicos y/o laparoscópicos se han
desarrollado dispositivos quirúrgicos endoscópicos de grapado que
están descritos, por ejemplo, en la Patente de EE.UU. n.º 5.040.715
(Green, et al.); la Patente de EE.UU. n.º 5.307.976 (Olson,
et al.); la Patente de EE.UU. n.º 5.312.023 (Green, et
al.); la Patente de EE.UU. n.º 5.318.221 (Green, et al.);
la Patente de EE.UU. n.º 5.326.013 (Green, et al.); la
Patente de EE.UU. n.º 5.332.142 (Robinson, et al.); y la
Patente de EE.UU. n.º 6.241.139 (Milliman et al.); a las
cuales se remite al lector para su consulta adicional.
Tyco Healthcare Group, LP, cesionario de la
presente solicitud, ha fabricado y comercializado durante varios
años instrumentos endoscópicos de grapado, tales como los
instrumentos Multifire ENDO GIA^{TM} 30 y Multifire ENDO
GIA^{TM} 60. Estos instrumentos incluyen un aparato quirúrgico de
grapado y una UCD. Típicamente, la UCD se sujeta al aparato
inmediatamente antes de la cirugía. Después de usarse puede quitarse
del aparato la UCD y puede sujetarse al aparato otra UCD nueva para
llevar a cabo operaciones adicionales de grapado y/o corte. Estos
instrumentos han proporcionado beneficios clínicos significativos.
Sin embargo, aún son posibles ciertas mejoras de estos
instrumen-
tos.
tos.
Sería deseable proporcionar una UCD mejorada
para un aparato quirúrgico de grapado y un aparato quirúrgico
mejorado de grapado que tenga cargada en él la UCD.
También sería deseable proporcionar en una UCD
un mecanismo de bloqueo para asegurar la carga apropiada de la UCD
en el eje de un aparato quirúrgico de grapado.
Por consiguiente, un objeto de esta publicación
es proporcionar una UCD mejorada que bloquea o retiene su conjunto
de accionamiento en la posición apropiada para cargarse sobre el eje
de un aparato quirúrgico de grapado (denominada en lo sucesivo como
la o una "posición de preparado para cargar") hasta que la UCD
esté cargada sobre un aparato quirúrgico de grapado, para asegurar
que cuando la UCD esté cargada en el mismo, el conjunto de
accionamiento está enganchado con, acoplado o conectado
apropiadamente a un miembro impulsor del eje, contribuyendo de este
modo a asegurar la operación apropiada de la UCD y del aparato
quirúrgico de grapado. Por ejemplo, con la UCD cargada sobre el
aparato quirúrgico de grapado y después del disparo del aparato
quirúrgico de grapado, el retroceso del vástago de control separará
o abrirá y/o soltará los conjuntos del yunque y del cartucho.
Un objeto de la publicación es proporcionar una
UCD mejorada que incluye un miembro de bloqueo que retiene el
conjunto de accionamiento en tal posición de preparado para cargar
hasta que la UCD esté cargada sobre el aparato quirúrgico de
grapado.
Otro objeto de la presente publicación es
proporcionar un mecanismo de bloqueo en una UCD y una UCD que tiene
un mecanismo de bloqueo, de modo que se impide el disparo del
aparato quirúrgico de grapado salvo que y hasta que la UCD esté
cargada sobre el eje del aparato quirúrgico de grapado.
Otro objeto más de la publicación es
proporcionar una UCD que, después del disparo, puede desconectarse
del aparato quirúrgico de grapado.
Aún otro objeto de la publicación es
proporcionar una UCD que sólo tiene dos estados, uno en el que no
está cargada y su conjunto de accionamiento está bloqueado o
retenido en la posición de preparado para cargar, y otro en el que
la UCD está cargada sobre el eje de un aparato quirúrgico de grapado
y en el que el conjunto de accionamiento está desbloqueado y puede
accionarse libremente.
Todavía otro objeto de la presente publicación
es proporcionar los objetos anteriores en una UCD rotoarticular, es
decir, rotoarticulable.
La invención está definida por las
reivindicaciones independientes, cuyos preámbulos se basan en la
Patente de los EE.UU. n.º 6.241.139. Las reivindicaciones
dependientes se refieren a realizaciones preferidas.
Según la presente publicación se proporciona un
aparato quirúrgico, p. ej., un aparato quirúrgico de grapado, que
incluye un mecanismo de bloqueo para asegurar el enganche apropiado
de una unidad cargadora desechable en un extremo, preferiblemente
el extremo distal, del aparato quirúrgico. Según un aspecto de la
presente publicación, el aparato quirúrgico incluye una envoltura,
un mango soportado por la envoltura, y una unidad cargadora
soportable en un extremo distal de la envoltura. La unidad cargadora
incluye una parte de envoltura que incluye un extremo distal y un
extremo proximal, un conjunto de accionamiento soportado de modo
deslizable dentro de la parte de envoltura de la unidad cargadora,
y un mecanismo de bloqueo soportado de modo pivotante en la parte
de envoltura de la unidad cargadora. El mecanismo de bloqueo puede
tener una primera posición en la que el mecanismo de bloqueo
engancha en una parte del conjunto de accionamiento y mantiene la
posición del conjunto de accionamiento respecto a la parte de
envoltura de la unidad cargadora. El mecanismo de bloqueo puede
tener una segunda posición en la que el mecanismo de bloqueo está
desenganchado del conjunto de accionamiento y permite que el
conjunto de accionamiento se mueva respecto a la parte de
envoltura.
Se ha previsto que el mecanismo de bloqueo puede
incluir una palanca conectada de modo pivotable a la parte de
envoltura y que define un punto de giro. La palanca incluye un
extremo distal que se extiende distalmente desde el punto de giro y
un extremo proximal que se extiende proximalmente desde el punto de
giro. El extremo distal de la palanca preferiblemente incluye un
miembro, preferiblemente un gancho, que engancha selectivamente en
la parte del conjunto de accionamiento, de modo que cuando el
mecanismo de bloqueo está en la primera posición el gancho engancha
en una parte del conjunto de accionamiento y cuando el mecanismo de
bloqueo está en la segunda posición el gancho está desenganchado de
la parte del conjunto de accionamiento.
Se ha previsto que cuando el mecanismo de
bloqueo se mueve desde la primera posición hasta la segunda
posición, el extremo proximal de la palanca se mueve radialmente
hacia el interior y el extremo distal de la palanca se mueve
radialmente hacia el exterior. El mecanismo de bloqueo se mueve
desde la primera posición hasta la segunda posición al acoplar la
unidad cargadora al extremo distal del cuerpo alargado.
Preferiblemente, el mecanismo de bloqueo se mueve desde la primera
posición hasta la segunda posición con un movimiento de torsión de
la unidad cargadora, respecto al cuerpo alargado, cuando se inserta
la punta de inserción de la unidad cargadora en el extremo distal
del cuerpo alargado.
El mecanismo de bloqueo además puede incluir un
miembro de empuje asociado operativamente con él. Preferiblemente,
el miembro de empuje empuja a la palanca hacia la primera
posición.
Se ha previsto que cuando el mecanismo de
bloqueo esté en la primera posición, el extremo proximal de la
palanca se extienda radialmente por encima de una superficie
externa de la parte de envoltura. Deseablemente, el extremo
proximal de la palanca del mecanismo de bloqueo puede definir una
superficie sesgada que facilite la conexión con el cuerpo
alargado.
Preferiblemente, el aparato quirúrgico es una
aplicadora de sujetadores o una grapadora, preferiblemente una
grapadora laparoscópica o endoscópica.
Esta publicación también es de una UCD,
preferiblemente una UCD rotoarticular para una aplicadora quirúrgica
de sujetadores o una grapadora quirúrgica.
Deseablemente, el extremo proximal de la parte
de envoltura de la unidad cargadora define una punta de
inserción.
Se ha previsto que el aparato quirúrgico pueda
incluir un cuerpo alargado que se extienda distalmente desde la
envoltura.
La presente publicación también prevé una unidad
cargadora destinada a usarse con y/o soportable en un extremo
distal de un aparato quirúrgico de grapado. La unidad cargadora
incluye una parte de envoltura que incluye un extremo distal y un
extremo proximal, un conjunto de accionamiento soportado de modo
deslizable dentro de la parte de envoltura de la unidad cargadora,
y un mecanismo de bloqueo soportado en la parte de envoltura de la
unidad cargadora, teniendo el mecanismo de bloqueo una primera
posición en la que el mecanismo de bloqueo engancha una parte del
conjunto de accionamiento y mantiene la posición, preferiblemente la
posición axial, del conjunto de accionamiento respecto a la parte
de envoltura de la unidad cargadora, y teniendo el mecanismo de
bloqueo una segunda posición en la que el mecanismo de bloqueo
desengancha el conjunto de accionamiento y permite que el conjunto
de accionamiento se mueva respecto a la parte de envoltura.
Las ventajas adicionales resultarán evidentes a
partir de la descripción que sigue, considerada junto con los
dibujos anejos.
Ahora se describirá más en detalle la presente
publicación con referencia a los dibujos anejos, en los que las
referencias numéricas iguales se refieren a partes iguales en las
diversas vistas, y en los que:
la Fig. 1 es una vista superior en perspectiva
de una realización preferida del aparato quirúrgico de grapado
publicado actualmente;
la Fig. 2 es una vista superior del aparato
quirúrgico de grapado mostrado en la Fig. 1;
la Fig. 3 es una vista lateral del aparato
quirúrgico de grapado mostrado en las Figs. 1 y 2;
la Fig. 4 es una vista superior en perspectiva
del aparato quirúrgico de grapado de las Figs. 1-3,
con la UCD desenganchada del cuerpo alargado del aparato quirúrgico
de grapado;
la Fig. 5 es una vista inferior en perspectiva
de una UCD no articular destinada a usarse con el aparato quirúrgico
de grapado de las Figs. 1-4;
la Fig. 6 es una vista inferior en perspectiva
de la UCD articular preferida del aparato quirúrgico de grapado de
las Figs. 1-4;
la Fig. 7 es una vista superior en perspectiva
de la UCD de la Fig. 6;
la Fig. 8 es una vista superior en perspectiva
de la UCD de las Figs. 6 y 7;
la Fig. 9 es una vista superior ampliada y en
perspectiva, con partes separadas, de la parte proximal de envoltura
y del conjunto de montaje de la UCD de las Figs.
6-8;
la Fig. 9a es una vista superior ampliada y en
perspectiva de la parte proximal de la mitad superior de envoltura
de la UCD de las Figs. 6-9;
la Fig. 10 es una vista superior en perspectiva
de la parte proximal de envoltura y del conjunto de montaje de la
UCD de las Figs. 6-9, con la mitad superior de la
envoltura retirada;
la Fig. 11 es una vista superior en perspectiva,
con partes separadas, del conjunto de accionamiento axial de la UCD
de las Figs. 6-9;
la Fig. 12 es una vista superior en perspectiva
del conjunto de accionamiento axial de la Fig. 11, de la UCD de las
Figs. 6-9;
\newpage
la Fig. 13 es una vista superior ampliada y en
perspectiva de una mitad inferior de envoltura de la parte proximal
de envoltura de la UCD de las Figs. 6-9;
la Fig. 14 es una vista ampliada y en
perspectiva del extremo distal del cuerpo alargado del aparato de
grapado mostrado en la Fig. 4;
la Fig. 15 es una vista ampliada y en
perspectiva del extremo proximal de la UCD de las Figs.
6-9 que ilustra un mecanismo de bloqueo según la
presente publicación;
la Fig. 16 es una vista ampliada y en
perspectiva de un extremo distal del cuerpo alargado del aparato de
grapado según la presente publicación;
la Fig. 17 es una vista ampliada y en
perspectiva, parcialmente desprendida, del extremo proximal de la
UCD de la Fig. 15, que ilustra el mecanismo de bloqueo en una
primera posición;
la Fig. 18 es una vista longitudinal en sección
transversal del extremo proximal de la UCD de las Figs.
6-9, tomada por la línea 18-18 de
la Fig. 15, con el mecanismo de bloqueo en una primera posición;
la Fig. 19 es una vista ampliada y en
perspectiva, parcialmente desprendida, del extremo proximal de la
UCD de la Fig. 15, que ilustra el mecanismo de bloqueo en una
segunda posición;
la Fig. 20 es una vista longitudinal en sección
transversal del extremo proximal de la UCD de las Figs.
6-9, tomada por la línea 18-18 de
la Fig. 15, con el mecanismo de bloqueo en una segunda posición;
la Fig. 21 es una vista transversal ampliada y
en sección transversal del extremo proximal de la UCD de las Figs.
6-9, tomada por la línea 21-21 de la
Fig. 18;
la Fig. 22 es una vista transversal ampliada y
en sección transversal del extremo proximal de la UCD de las Figs.
6-9, tomada por la línea 23-23 de la
Fig. 20, que ilustra la posición del mecanismo de bloqueo antes de
la rotación de la UCD respecto al cuerpo alargado; y
la Fig. 23 es una vista transversal ampliada y
en sección transversal del extremo proximal de la UCD de las Figs.
6-9, tomada por la línea 23-23 de la
Fig. 20, que ilustra la posición del mecanismo de bloqueo después
de la rotación de la UCD respecto al cuerpo alargado.
Ahora se describirán con detalle realizaciones
preferidas del aparato quirúrgico, de la UCD y del mecanismo o
miembro de bloqueo publicados actualmente, con referencia a los
dibujos, en los que las referencias numéricas iguales designan
elementos idénticos o correspondientes en cada una de las diversas
vistas.
En los dibujos y en la descripción que sigue, el
término "proximal", como es tradicional, se referirá al extremo
del aparato de grapado que esté más cerca del operador, mientras
que el término "distal" se referirá al extremo del aparato que
esté más lejos del operador.
Las Figs. 1-4 muestran un
aparato quirúrgico, p. ej., un aparato quirúrgico de grapado,
indicado en general con 10. Por motivos de brevedad esta
publicación se centrará ante todo en sistemas, métodos y estructuras
para cargar, enganchar, acoplar o conectar en el aparato quirúrgico
de grapado 10 una unidad cargadora desechable ("UCD") 16. En
la Patente de EE.UU. n.º 6.241.139 se publica una discusión
detallada del resto de componentes y del método de uso del aparato
quirúrgico de grapado 10.
El aparato quirúrgico de grapado 10 es un
aparato endoscópico e incluye un conjunto de mango 12 y un cuerpo
alargado 14 que se extiende desde el conjunto de mango 12. Una UCD
16 está afianzada al extremo distal del cuerpo alargado 14 de modo
separable. Aunque esta publicación se refiere al uso de una UCD con
el aparato quirúrgico de grapado 10 se sobreentiende que, dentro
del ámbito de la presente publicación, puede usarse igualmente una
unidad cargadora de un solo uso (UCUU) u otro órgano final y/o un
conjunto instrumental en cooperación con el aparato quirúrgico de
grapado 10.
La UCD 16 incluye un instrumento 17 que tiene un
conjunto de cartucho 18, que contiene una pluralidad de grapas
quirúrgicas (no mostradas), y un conjunto de yunque 20 afianzado de
modo movible respecto al conjunto de cartucho 18. Tal como se
muestra en la presente memoria, la UCD 16 está configurada de modo
que se apliquen seis (6) filas de grapas, midiendo las UCD entre
unos 30 mm y unos 60 mm de longitud. También están previstas las UCD
que apliquen cualquier número de filas de grapas, que tengan
cámaras de grapas dispuestas según diversas configuraciones y/o las
UCD y los órganos finales que tengan cualquier otra longitud, p.
ej., 45 mm. El conjunto de mango 12 incluye un miembro de mango
estacionario 22, un miembro de mango movible 24 y una parte tubular
26.
En el extremo delantero de la parte tubular 26
preferiblemente está montado un miembro girable 28 para facilitar
la rotación del cuerpo alargado 14 y de la UCD 16 respecto al
conjunto de mango 12. En el extremo delantero de la parte tubular
26 y adyacente al miembro girable 28 preferiblemente está montada
también una palanca de articulación 30 para facilitar la
articulación del conjunto instrumental 17. Preferiblemente, a lo
largo de la parte tubular 26 está situado un par de manillas 32 de
modo movible. Las manillas 32 se avanzan distalmente para aproximar
o cerrar el conjunto de cartucho y/o el conjunto de yunque 18, 20, y
se retiran proximalmente para separar o abrir el conjunto de
cartucho y/o el conjunto de yunque 18, 20.
Como puede verse en la Fig. 4, la UCD 16
deseablemente es acoplable selectivamente al cuerpo alargado 14 de
modo separable. La UCD 16 incluye una parte de envoltura 200 que
tiene un extremo proximal adaptado para que enganche de modo
separable en el extremo distal del cuerpo alargado 14. En el extremo
distal de la parte de envoltura 200 está afianzado de modo
pivotante en 203 un conjunto de montaje 202 y está configurado de
modo que reciba el extremo proximal del conjunto instrumental 17 de
manera que el movimiento pivotal del conjunto de montaje 202
alrededor de un eje, en 203, perpendicular al eje longitudinal de la
parte de envoltura 200 efectúe la articulación del conjunto
instrumental 17.
El aparato quirúrgico de grapado 10 es capaz de
recibir una UCD no articular 16a, como puede verse en la Fig. 5, o
una UCD articular 16, como puede verse en las Figs.
6-8. La Patente de EE.UU. n.º 6.241.139 incluye una
discusión detallada de una UCD articular y una UCD no articular.
Con referencia general a las Figs. 9, 9a,
10-13, 15 y 17-23 y referencia
particular a las Figs. 9, 9a, 15, 17 y 18, la UCD 16 incluye un
conjunto de montaje 235. El conjunto de montaje 235 incluye una
parte superior de montaje y una parte inferior de montaje 236, 238,
respectivamente. Un miembro de pivote 284, situado centralmente, se
extiende desde cada una de las partes superior e inferior de montaje
236, 238 a través de sendos orificios 246a formados en miembros de
acoplamiento 246. Cada uno de los miembros de acoplamiento 246
incluye una parte proximal de interbloqueo 246b configurada de modo
que se reciba en acanaladuras 290 formadas en el extremo proximal
de las mitades superior e inferior de envoltura 250, 252 para
retener el conjunto de montaje 235 y las mitades superior e
inferior de envoltura 250, 252 en una posición longitudinalmente
fija entre sí.
La mitad superior de envoltura 250 y la mitad
inferior de envoltura 252 están contenidas dentro de un manguito,
revestimiento o funda exterior 251. El extremo proximal de la mitad
superior de envoltura 250 incluye resaltes de enganche 254 que se
extienden hacia fuera y que enganchan de modo soltable en el extremo
distal del cuerpo 14. Los resaltes 254 forman un acoplamiento de
tipo bayoneta con el extremo distal del cuerpo 14. Las mitades de
envoltura 250 y 252 definen un canal 400 que recibe de manera
deslizable el conjunto de accionamiento axial 212. Una varilla de
articulación 256 está dimensionada de modo que quede posicionada de
modo deslizable dentro de una ranura 402 formada en las mitades
superior e inferior de envoltura 250, 252. Un par de conjuntos de
placas de descarga 255 está posicionado de manera adyacente al
extremo distal de la parte de envoltura 200, adyacente al extremo
distal del conjunto de accionamiento axial 212, para impedir la
deformación hacia fuera y el pandeo del conjunto de accionamiento
212 durante la articulación y el disparo del aparato quirúrgico de
grapado 10. Para una discusión detallada de la estructura y de la
operación de los conjuntos de placas de descarga 255 se remite a la
Solicitud Internacional con N.º de Serie PCT/US02/32031 (WO
03/030743), presentada el 4 de Octubre de 2002, titulada
"Dispositivo Quirúrgico de Grapado" (Surgical Stapling
Device).
Con referencia a la Fig. 9, opcionalmente, en
la sección de enganche 270 del conjunto de accionamiento axial 212
puede soportarse un miembro de bloqueo 288. En operación, cuando se
acciona el conjunto de accionamiento axial 212 aplicando una fuerza
predeterminada al miembro de mango movible 24 para hacer avanzar
distalmente el conjunto de accionamiento axial 212, el miembro de
bloqueo 288 proporciona una indicación audible y táctil de que se
ha accionado el aparato quirúrgico de grapado 10. Para una discusión
detallada de la estructura y de la operación del miembro de bloqueo
288 se remite a la Solicitud Internacional con N.º de Serie
PCT/US02/32031 (WO 03/030743) antes mencionada. El miembro de
bloqueo 288 también puede impedir el accionamiento parcial
involuntario de la UCD 16, por ejemplo durante el transporte,
bloqueando el conjunto de accionamiento axial 212 en una posición
fija dentro de la UCD 16 hasta que se aplique una fuerza axial
predeterminada al conjunto de accionamiento axial 212.
Con referencia a las Figs. 9-12,
el conjunto de accionamiento axial 212 incluye un brazo impulsor
alargado 266 (Fig. 11) que incluye una cabeza distal de trabajo 268
(Fig. 12) y una sección proximal de enganche 270. El brazo impulsor
266 puede construirse a partir de una sola lámina de material o,
preferiblemente, de múltiples láminas superpuestas, como se muestra
en la Fig. 11. La sección de enganche 270 incluye un par de dedos
flexibles de enganche 270a y 270b que están dimensionados y
configurados de modo que enganchen por montaje en un par de ranuras
de retención correspondientes 272a y 272b formadas en el miembro
impulsor 272 (Fig. 12). El miembro impulsor 272 incluye un orificio
proximal 274 configurado de modo que reciba el extremo distal 276 de
un miembro impulsor, p. ej., un vástago impulsor o vástago de
control 52 (Figs. 14 y 16-18), cuando se esté
enganchando el extremo proximal de la UCD 16 con el cuerpo alargado
14 del aparato quirúrgico de grapado 10. El vástago de control 52
tiene la función de transmitir el movimiento axial del conjunto de
accionamiento 212 procedente del conjunto de mango 12.
Con referencia a las Figs. 9, 9a y
15-23, la UCD 16 además incluye un mecanismo de
bloqueo 300 soportado preferiblemente de modo pivotable sobre una
envoltura, p. ej., sobre la mitad superior de envoltura 250. El
mecanismo de bloqueo 300 es manipulable desde una primera posición,
en la que se mantiene el conjunto de accionamiento 212 en una
posición de preparado para cargar para efectuar la carga
apropiadamente, hasta una segunda posición en la que el conjunto de
accionamiento 212 puede moverse con libertad. La UCD 16 se considera
cargada en el cuerpo alargado 14 cuando el mecanismo de bloqueo 300
está en la segunda posición, es decir, cuando el conjunto de
accionamiento 212 está conectado al vástago de control 52 del cuerpo
alargado 14. Como puede verse en las Figs. 9, 9a y
15-23, el mecanismo de bloqueo 300 incluye una
palanca 302 conectada de modo pivotal a la mitad superior de
envoltura 250 mediante un pasador pivote 308 que se extiende a su
través, definiendo con ello un punto de giro. La palanca 302
incluye un extremo distal libre 304 que se extiende distalmente
desde el pasador pivote 308 y un extremo proximal libre 306 que se
extiende proximalmente desde el pasador pivote 308. El extremo
proximal 306 de la palanca 302 termina en una superficie sesgada
306a formada a lo largo de una superficie superior de la misma y
que engancha en una parte del cuerpo alargado 14, como se discutirá
después con mayor detalle. El extremo distal 304 de la palanca 302
termina en un miembro de gancho 304a formado a lo largo de una
superficie inferior de la misma y que engancha el miembro impulsor
272, como se discutirá después con mayor detalle.
El mecanismo de bloqueo 300 además incluye un
miembro o resorte de empuje 312, preferiblemente un resorte
laminar, asociado operativamente con la mitad superior de envoltura
250 y el extremo distal 304 de la palanca 302. Preferiblemente, el
resorte 312 mantiene la palanca 302 en la primera posición de modo
que el miembro de gancho 304a esté enganchado con el miembro
impulsor 272. El resorte 312 incluye un extremo proximal 312a,
asociado operativamente con el extremo distal 304 de la palanca 302,
y un extremo distal 312b afianzado a la mitad superior de envoltura
250. Preferiblemente, el extremo distal 312b tiene la forma de un
gancho o un brazo acodado que se extiende dentro de una ranura o
hendidura 250a (véanse las Figs. 17-20) de la mitad
superior de envoltura 250 de tal manera que en el extremo proximal
312a del resorte 312 (véase la Fig. 17) se crea una fuerza "F"
que actúa radialmente hacia el interior. El extremo proximal 312a
está posicionado de modo que se aplica sobre una superficie externa
304b del extremo distal 304 de la palanca 302. Como tal, la fuerza
"F" actúa a su vez sobre el extremo distal 304 de la palanca
302 empujando de este modo al extremo distal 304 también
radialmente hacia el interior. Al hacerlo así, el extremo proximal
306 de la palanca 302 queda impulsado radialmente hacia fuera
debido a la acción pivotante de la palanca 302 alrededor del pasador
pivote 308.
Antes de la sujeción de la UCD 16 al aparato
quirúrgico de grapado 10, la palanca 302 del mecanismo de bloqueo
300 está impulsada por el resorte 312 (Figs. 15, 17 y 18) hacia la
posición de bloqueo. Como se ha discutido anteriormente, en la
posición de bloqueo, la palanca 302 ha pivotado alrededor del
pasador pivote 308 de modo que el miembro de gancho 304a de la
palanca 302 engancha con una cara distal 272c del miembro impulsor
272 y el extremo proximal 306 está posicionado radialmente por el
exterior de una superficie externa 193a de la punta de inserción
193 (véase la Fig. 18). En esta posición de bloqueo, el miembro de
gancho 304a impide el avance distal involuntario del miembro
impulsor 272 manteniendo al miembro impulsor 272 en su posición
extrema proximal de preparado para cargar. Esto asegura que la
sección de enganche 270 del conjunto de accionamiento 212 enganche
apropiadamente con el extremo distal 276 del vástago de control 52
(véase la Fig. 14) del aparato de grapado 10 cuando se monte la UCD
16 en el cuerpo alargado 14 del aparato de grapado 10. El extremo
distal 276 del vástago de control 52 tiene una o más superficies de
enganche, preferiblemente, y tal como se muestra aquí incluye una
cabeza 276a y un rebaje anular proximal de menor diámetro 276b de la
cabeza 276a y definido parcialmente por la cabeza 276a.
Cuando se monta la UCD 16 en el cuerpo alargado
14 del aparato de grapado 10, de una manera que se discute después
con mayor detalle, la superficie sesgada 306a del extremo proximal
306 de la palanca 302 ajusta con una superficie en rampa 276c del
cuerpo alargado 14 (véanse las Figs. 20, 22 y 23). El ajuste entre
la superficie sesgada 306a y la superficie en rampa 276c hace
pivotar o girar la palanca 302 alrededor del pasador pivote 308
desplazando el extremo proximal 306 de la palanca 302 radialmente
hacia el interior. El movimiento del extremo proximal 306
radialmente hacia el interior efectúa el movimiento del gancho 304a
radialmente hacia el exterior en contra de la fuerza "F" del
resorte 312, de modo que el gancho 304a se suelta del y/o se
desengancha de otra manera del miembro impulsor 272 dejando libre
al conjunto de accionamiento 212 y permitiendo la operación o la
operación continuada del aparato quirúrgico de grapado 10.
Como puede verse mejor en la Fig. 16, el extremo
distal del cuerpo alargado 14 preferiblemente incluye un rebaje
276b formado en el mismo y que tiene una forma que facilita la
manipulación del mecanismo de bloqueo 300 desde la primera posición
hasta la segunda posición. Preferiblemente, el rebaje 276b incluye
una superficie en rampa 276c con la que hace contacto la superficie
sesgada 306a de la palanca 302. En particular, la superficie en
rampa 276c está conformada de manera que el movimiento de torsión de
la UCD 16 respecto al cuerpo alargado 14 del aparato de grapado 10,
después de haberse insertado la punta de inserción 193 de la UCD 16
en el extremo distal del cuerpo alargado 14, hace que el extremo
proximal 306 de la palanca 302 sea empujado o desplazado progresiva
y radialmente hacia el interior. El extremo proximal 306 de la
palanca 302 se desplazará radialmente hacia el interior una
distancia suficiente para soltar del miembro impulsor 272 al miembro
de gancho 304a sólo después de que se haya girado un arco
suficiente la UCD 16 respecto al cuerpo 14.
Continuando con la referencia a las Figs.
15-23 se discutirá un método de uso y/o de operación
del miembro de bloqueo 300 cuando se afianza la UCD 16 al extremo
distal del cuerpo alargado 14. Inicialmente, con el mecanismo de
bloqueo 300 en la primera posición de modo que el gancho 304a esté
enganchado con el miembro impulsor 272, se introduce
longitudinalmente la punta de inserción 193 de la UCD 16 en el
extremo distal del cuerpo alargado 14, en la dirección de la flecha
"A" (Fig. 19). Como puede verse en las Figs. 19, 20 y 22,
durante la introducción de la punta de inserción 193 en el extremo
distal del cuerpo alargado 14, el extremo proximal 306 de la
palanca 302 entra en el rebaje 276b (Fig. 22) formado en el extremo
distal del cuerpo alargado 14.
Cuando la punta de inserción 193 se ha insertado
totalmente en el extremo distal del cuerpo alargado 14, y más
particularmente cuando los resaltes 254 han entrado completamente en
los canales 276d (Figs. 16, 22 y 23), se gira la UCD 16 en la
dirección de la flecha "B" (Figs. 19 y 23) de modo que la
superficie en rampa 276c del rebaje 276b actúe contra y ajuste con
la superficie sesgada 306a del extremo proximal 306 de la palanca
302. Como se ha descrito anteriormente, la acción de desplazamiento
entre la superficie en rampa 276c del rebaje 276b y la superficie
sesgada 306a del extremo proximal 306 hace que el extremo proximal
306 de la palanca 302 sea empujado radialmente hacia el interior,
como se indica con la flecha "C" de la Fig. 23, y alrededor
del pasador pivote 308, venciendo así la fuerza "F" del resorte
312 e impulsando al extremo distal 304 radialmente hacia el
exterior, de modo que se empuja a la palanca 302 desde la primera
posición hasta la segunda posición. El desplazamiento del extremo
distal 304 en una dirección radial hacia el exterior hace que el
gancho 304a se desenganche del miembro impulsor 272, dejando libre
de este modo al conjunto de accionamiento 212 para efectuar la
operación continuada del aparato quirúrgico de grapado 10. La UCD 16
se considera cargada en el cuerpo alargado 14 cuando la palanca 302
está en la segunda posición, p. ej., cuando el conjunto de
accionamiento 212 está conectado al miembro impulsor o vástago de
control 52 del cuerpo alargado 14.
Por consiguiente se impide la sujeción de una
UCD, que tenga un conjunto de accionamiento 212, al extremo distal
del cuerpo alargado 14 cuando el conjunto de accionamiento 212 no
está en su posición extrema proximal o de carga apropiada.
Claims (20)
1. Un aparato quirúrgico de grapado (10) que
comprende:
una envoltura (14); y
una unidad cargadora (16) soportable en un
extremo distal de la envoltura, incluyendo la unidad cargadora:
una parte de envoltura (200) que incluye un
extremo distal y un extremo proximal;
un conjunto de accionamiento (212) soportado de
modo deslizable dentro de la parte de envoltura de la unidad
cargadora; y caracterizado por:
un mecanismo de bloqueo (300)
soportado de modo pivotal sobre la parte de envoltura de la unidad
cargadora, teniendo el mecanismo de bloqueo una primera posición en
la que el mecanismo de bloqueo engancha una parte del conjunto de
accionamiento y mantiene la posición del conjunto de accionamiento
respecto a la parte de envoltura de la unidad cargadora, y teniendo
el mecanismo de bloqueo una segunda posición en la que el mecanismo
de bloqueo desengancha el conjunto de accionamiento y permite que el
conjunto de accionamiento se mueva respecto a la parte de
envoltu-
ra.
ra.
2. El aparato quirúrgico de grapado de la
reivindicación 1, en el que el mecanismo de bloqueo incluye:
una palanca (302) conectada de modo
pivotable a la parte de envoltura y que define un punto de giro
(308), teniendo la palanca un extremo distal que se extiende
distalmente desde el punto de giro y un extremo proximal que se
extiende proximalmente desde el punto de giro, incluyendo el extremo
distal de la palanca un gancho (304a) formado en la misma y que
engancha selectivamente una parte del conjunto de accionamiento, en
el que cuando el mecanismo de bloqueo está en la primera posición
el gancho engancha la parte del conjunto de accionamiento y cuando
el mecanismo de bloqueo está en la segunda posición el gancho está
desenganchado de la parte del conjunto de
accionamiento.
3. El aparato quirúrgico de grapado de la
reivindicación 2, en el que cuando el mecanismo de bloqueo se mueve
desde la primera posición hasta la segunda posición, el extremo
proximal de la palanca se mueve radialmente hacia el interior y el
extremo distal de la palanca se mueve radialmente hacia el
exterior.
4. El aparato quirúrgico de grapado de la
reivindicación 3, en el que el mecanismo de bloqueo se mueve desde
la primera posición hasta la segunda posición al acoplar la unidad
cargadora al extremo distal de la envoltura.
5. El aparato quirúrgico de grapado de la
reivindicación 4, en el que el mecanismo de bloqueo se mueve desde
la primera posición hasta la segunda posición mediante un movimiento
de torsión de la unidad cargadora respecto a la envoltura cuando se
inserta el extremo proximal de la parte de envoltura de la unidad
cargadora en el extremo distal de la envoltura.
6. El aparato quirúrgico de grapado de la
reivindicación 5, en el que el mecanismo de bloqueo además incluye
un miembro de empuje (312) asociado operativamente con él, en el que
el miembro de empuje empuja a la palanca hacia la primera
posición.
7. El aparato quirúrgico de grapado de la
reivindicación 6, en el que cuando el mecanismo de bloqueo está en
la primera posición, el extremo proximal de la palanca se extiende
radialmente por encima de una superficie externa de la parte de
envoltura.
8. El aparato quirúrgico de grapado de la
reivindicación 7, en el que el extremo proximal de la palanca del
mecanismo de bloqueo define una superficie sesgada (306a) que
facilita la conexión con la envoltura.
9. El aparato quirúrgico de grapado según la
reivindicación 8, en el que el aparato quirúrgico de grapado es una
grapadora.
10. El aparato quirúrgico de grapado de la
reivindicación 9, que además comprende un cuerpo alargado (14) que
se extiende desde la envoltura, incluyendo el cuerpo alargado un
extremo distal configurado y dimensionado de modo que reciba
selectivamente el extremo proximal de la parte de envoltura de la
unidad cargadora.
11. El aparato quirúrgico de grapado de la
reivindicación 10, en el que el extremo proximal de la parte de
envoltura de la unidad cargadora define una punta de inserción
(193).
12. Una unidad cargadora (16) destinada a usarse
con y/o soportable sobre un extremo distal de un aparato quirúrgico
de grapado (10), comprendiendo la unidad cargadora:
una parte de envoltura (200) que incluye un
extremo distal y un extremo proximal;
un conjunto de accionamiento (212) soportado de
modo deslizable dentro de la parte de envoltura de la unidad
cargadora; y caracterizada por:
un mecanismo de bloqueo (300)
soportado de modo pivotal sobre la parte de envoltura de la unidad
cargadora, teniendo el mecanismo de bloqueo una primera posición en
la que el mecanismo de bloqueo engancha una parte del conjunto de
accionamiento y mantiene la posición del conjunto de accionamiento
respecto a la parte de envoltura de la unidad cargadora, y teniendo
el mecanismo de bloqueo una segunda posición en la que el mecanismo
de bloqueo desengancha el conjunto de accionamiento y permite que el
conjunto de accionamiento se mueva respecto a la parte de
envoltura.
13. La unidad cargadora de la reivindicación 12,
en la que el mecanismo de bloqueo incluye:
una palanca (302) conectada de modo
pivotable a la parte de envoltura y que define un punto de giro
(308), teniendo la palanca un extremo distal que se extiende
distalmente desde el punto de giro y un extremo proximal que se
extiende proximalmente desde el punto de giro, incluyendo el extremo
distal de la palanca un gancho (304a) formado en la misma y que
engancha selectivamente una parte del conjunto de accionamiento, en
la que cuando el mecanismo de bloqueo está en la primera posición
el gancho engancha la parte del conjunto de accionamiento y cuando
el mecanismo de bloqueo está en la segunda posición el gancho está
desenganchado de la parte del conjunto de
accionamiento.
14. La unidad cargadora de la reivindicación 13,
en la que cuando el mecanismo de bloqueo se mueve desde la primera
posición hasta la segunda posición, el extremo proximal de la
palanca se mueve radialmente hacia el interior y el extremo distal
de la palanca se mueve radialmente hacia el exterior.
15. La unidad cargadora de la reivindicación 14,
en la que el mecanismo de bloqueo se mueve desde la primera
posición hasta la segunda posición al acoplar la unidad cargadora al
extremo distal de un cuerpo alargado del aparato quirúrgico de
grapado.
16. La unidad cargadora de la reivindicación 15,
en la que el mecanismo de bloqueo se mueve desde la primera
posición hasta la segunda posición mediante un movimiento de torsión
de la unidad cargadora respecto al cuerpo alargado cuando se
inserta el extremo proximal de la parte de envoltura de la unidad
cargadora en el extremo distal del cuerpo alargado.
17. La unidad cargadora de la reivindicación 16,
en la que el mecanismo de bloqueo además incluye un miembro de
empuje (312) asociado operativamente con él, en la que el miembro de
empuje empuja a la palanca hacia la primera posición.
18. La unidad cargadora de la reivindicación 17,
en la que cuando el mecanismo de bloqueo está en la primera
posición, el extremo proximal de la palanca se extiende radialmente
por encima de una superficie externa de la parte de envoltura.
19. La unidad cargadora de la reivindicación 18,
en la que el extremo proximal de la palanca del mecanismo de
bloqueo define una superficie sesgada (306a) que facilita la
conexión con el cuerpo alargado.
20. La unidad cargadora de la reivindicación 19,
en la que la unidad cargadora cumple la función de una
grapadora.
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| ES07007782T Expired - Lifetime ES2365547T3 (es) | 2004-02-17 | 2005-02-17 | Aparato quirúrgico de grapado con mecanismo de bloqueo. |
| ES05003446T Expired - Lifetime ES2285586T3 (es) | 2004-02-17 | 2005-02-17 | Aparato quirurgico de grapado con mecanismo de bloqueo. |
| ES10176671T Expired - Lifetime ES2377496T3 (es) | 2004-02-17 | 2005-02-17 | Aparato quirúrgico de grapado con un mecanismo de bloqueo |
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| ES10176668T Expired - Lifetime ES2395916T3 (es) | 2004-02-17 | 2005-02-17 | Aparato de grapado quirúrgico con mecanismo de bloqueo |
| ES07007782T Expired - Lifetime ES2365547T3 (es) | 2004-02-17 | 2005-02-17 | Aparato quirúrgico de grapado con mecanismo de bloqueo. |
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| ES10176671T Expired - Lifetime ES2377496T3 (es) | 2004-02-17 | 2005-02-17 | Aparato quirúrgico de grapado con un mecanismo de bloqueo |
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| US (4) | US7225963B2 (es) |
| EP (3) | EP2253278B1 (es) |
| DE (1) | DE602005000889T2 (es) |
| ES (4) | ES2395916T3 (es) |
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-
2005
- 2005-02-17 ES ES10176668T patent/ES2395916T3/es not_active Expired - Lifetime
- 2005-02-17 EP EP10176671A patent/EP2253278B1/en not_active Expired - Lifetime
- 2005-02-17 EP EP10176668A patent/EP2253277B1/en not_active Expired - Lifetime
- 2005-02-17 EP EP05003446A patent/EP1563791B1/en not_active Expired - Lifetime
- 2005-02-17 ES ES07007782T patent/ES2365547T3/es not_active Expired - Lifetime
- 2005-02-17 ES ES05003446T patent/ES2285586T3/es not_active Expired - Lifetime
- 2005-02-17 DE DE602005000889T patent/DE602005000889T2/de not_active Expired - Lifetime
- 2005-02-17 US US11/059,773 patent/US7225963B2/en not_active Expired - Lifetime
- 2005-02-17 ES ES10176671T patent/ES2377496T3/es not_active Expired - Lifetime
-
2007
- 2007-01-23 US US11/657,307 patent/US7694865B2/en not_active Expired - Lifetime
-
2009
- 2009-12-28 US US12/647,626 patent/US7967180B2/en not_active Expired - Fee Related
-
2011
- 2011-06-15 US US13/160,722 patent/US8157148B2/en not_active Expired - Fee Related
Also Published As
| Publication number | Publication date |
|---|---|
| EP2253278B1 (en) | 2011-12-28 |
| US20050184123A1 (en) | 2005-08-25 |
| EP2253278A1 (en) | 2010-11-24 |
| ES2395916T3 (es) | 2013-02-18 |
| US7967180B2 (en) | 2011-06-28 |
| ES2377496T3 (es) | 2012-03-28 |
| US20100096432A1 (en) | 2010-04-22 |
| US7694865B2 (en) | 2010-04-13 |
| EP1563791A1 (en) | 2005-08-17 |
| US8157148B2 (en) | 2012-04-17 |
| US20110240711A1 (en) | 2011-10-06 |
| EP2253277B1 (en) | 2012-09-19 |
| DE602005000889D1 (de) | 2007-05-31 |
| US7225963B2 (en) | 2007-06-05 |
| EP1563791B1 (en) | 2007-04-18 |
| US20070187454A1 (en) | 2007-08-16 |
| DE602005000889T2 (de) | 2008-01-17 |
| EP2253277A1 (en) | 2010-11-24 |
| ES2365547T3 (es) | 2011-10-06 |
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