ES2293909T3 - Microinstrumentos. - Google Patents

Microinstrumentos. Download PDF

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Publication number
ES2293909T3
ES2293909T3 ES00944546T ES00944546T ES2293909T3 ES 2293909 T3 ES2293909 T3 ES 2293909T3 ES 00944546 T ES00944546 T ES 00944546T ES 00944546 T ES00944546 T ES 00944546T ES 2293909 T3 ES2293909 T3 ES 2293909T3
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instrument
polymer
instrument according
catheter
instruments
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Olle Inganas
Edvin Jager
Anders Selbing
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Micromuscle AB
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Micromuscle AB
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/22—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/122—Clamps or clips, e.g. for the umbilical cord
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/128—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord for applying or removing clamps or clips
    • A61B17/1285—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord for applying or removing clamps or clips for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00017—Electrical control of surgical instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
    • A61B2017/00345—Micromachines, nanomachines, microsystems
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • A61B2017/00398—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00831—Material properties
    • A61B2017/00867—Material properties shape memory effect
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00831—Material properties
    • A61B2017/00867—Material properties shape memory effect
    • A61B2017/00871—Material properties shape memory effect polymeric
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B2017/1205—Introduction devices
    • A61B2017/12054—Details concerning the detachment of the occluding device from the introduction device
    • A61B2017/1209—Details concerning the detachment of the occluding device from the introduction device detachable by electrical current or potential, e.g. electroactive polymer
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Molecular Biology (AREA)
  • General Health & Medical Sciences (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Animal Behavior & Ethology (AREA)
  • Engineering & Computer Science (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Vascular Medicine (AREA)
  • Surgical Instruments (AREA)
  • Media Introduction/Drainage Providing Device (AREA)
  • Crystals, And After-Treatments Of Crystals (AREA)

Abstract

Instrumento para cirugía biomédica, en el que el instrumento comprende un micromúsculo de polímero estratificado configurado para inducir cambios geométricos y movimientos a través de un cambio de volumen electroquímicamente inducido en por lo menos una capa de polímero, caracterizado porque el instrumento se monta sobre un portador con forma de aguja adaptado para que sea insertado en una cánula o en un catéter, a través del cual el instrumento puede accionarse eléctricamente por medio de unos medios externos para inducir un movimiento mecánico para actuar sobre una estructura biológica.

Description

Microinstrumentos.
Campo técnico
Esta invención se refiere a un instrumento para cirugía biomédica según la parte precaracterizante de la reivindicación 1. Dichos instrumentos pueden utilizarse para adaptar, ensamblar, separar, fortalecer, dilatar, cerrar y sujetar estructuras biológicas dentro del cuerpo durante una operación y después de la misma. Los instrumentos pueden ser stents, válvulas, clips, mallas, cuchillos, tijeras, dilatadores, grapas, pinzas, etc.
Antecedentes
La utilización de microestructuras para ensamblar, fortalecer o dilatar estructuras biológicas dentro del cuerpo durante una operación y después de la misma puede ayudar al cirujano de diversas maneras. El funcionamiento de instrumentos eléctricamente accionados puede ayudar al cirujano a colocar, operar manualmente y observar de manera simultánea. Colocando el instrumento a mano y operándolo de forma separada a través de un control externo (es decir, "footswicth" o interruptor de pie, control de voz, otro tipo de control software) se espera obtener un grado de precisión mucho mayor. En la microcirugía, ésta es una ventaja especialmente deseada.
La combinación de microactuadores y catéteres no está bien documentada en la técnica. Una búsqueda de patentes pone de manifiesto unos pocos ejemplos aunque ninguno describe la utilización de microactuadores como instrumentos alojados dentro de un catéter, varios ejemplos de microactuadores utilizados para colocar un catéter pueden encontrarse en las siguientes patentes:
US5771902
Actuadores/sensores micromecanizados para un posicionamiento/guiado intratubular
US5819749
Microválvula
W09837816A1
Actuadores terapéuticos microfabricados
W09739688A2
Procedimiento y aparato para la administración de un aparato en un vaso
W09739674A1
Instrumento médico multiuso basado en muelles
US5855565
Catéter cardiovascular de expansión mecánica.
El preámbulo de la reivindicación 1 está basado en el documento US5771902.
En estas aplicaciones se sugieren varios mecanismos para los microactuadores, encontrados entre aleaciones con memoria de forma (incluyendo materiales poliméricos) y materiales piezoeléctricos. La utilización de polímeros conjugados en micromúsculos no está documentada para instrumentos para catéter.
Poder aplicar, previamente a un procedimiento invasivo o durante el mismo, un instrumento de unas dimensiones y una geometría requeridas (diseñado para cortar, taladrar, sujetar, dilatar, suturar, adaptar o soportar) de entre instrumentos que, por ejemplo, pudieran ser introducidos, colocados en el interior o situados en el extremo de un catéter o una aguja, es otra función deseada, que requiere de un desarrollo de microactuadores.
Resumen de la invención
La presente invención proporciona un instrumento para cirugía biomédica que presenta las características de la reivindicación 1. Las formas de realización son presentadas en las reivindicaciones dependientes, en la descripción que sigue a continuación y en los dibujos adjuntos.
Por tanto la novedad y la innovación de la presente invención reside en el uso de microactuadores basados en polímeros conjugados que son eléctricamente operados y montados dentro de un catéter o una aguja o sobre el catéter o la aguja, a ser colocados con la ayuda del catéter, y activando a continuación las estructuras de los microactuadores portados en la aguja. La microfabricación de dichos microactuadores hace posibles una seria de geometrías en dimensiones desde los 10 \mum y mayores, difíciles de producir mediante técnicas de producción mecánicas. Pueden producirse mediante el uso del procedimiento presentado en el documento WO-A-96/28841 y a continuación montarse dentro de un catéter o una aguja o sobre el catéter o la aguja, o podrían producirse mediante nuevos procedimientos de fabricación. Con la ayuda de esta invención, se encuentran disponibles instrumentos completamente
nuevos.
Breve descripción de los dibujos
Las Figuras 1A a 1C muestran unos clips y unos conjuntos de clips, en el que los clips están montados en serie, y se encuentran confinados por un alojamiento cilíndrico, y en el que la activación del clip más extremo C1, abriendo el clip para unir la estructura abierta W1, y siendo a continuación liberado por la operación simultánea de C2, para que permanezca en la estructura W1, sujetando las estructuras juntas.
La Figura 2 muestra unas pinzas tubulares, unas pinzas y unos cuchillos, basados en microactuadores. El movimiento indicado es realizado mediante unos microactuadores adecuadamente montados y diseñados.
Las Figuras 3A a 3B muestran un conector neural, en el que una serie de pequeñas uñas se enrollan alrededor de un nervio cilíndrico formando una sujeción fuerte alrededor del nervio. De esta manera se unen dos nervios separados con la ayuda de un conector neural común, lo que sería deseable para conseguir el rebrote de los nervios. Además, pueden colocarse unos pequeños electrodos conjuntamente con las microuñas, y utilizarse para activar o excitar las señales de los nervios.
Las figuras 4A a 4C muestran un dispositivo de inserción, para formar un orificio temporalmente permanente a través de una membrana. El dispositivo se aloja en un catéter/una cánula/una aguja y se inserta a través de la membrana con el fin de que el dispositivo forme un orificio a través de la membrana.
Las Figuras 5A a 5B muestran un dispositivo stent.
Descripción de las formas de realización
La aplicación de una estructura dentro de un catéter o una aguja, o introducida a través del catéter o de la aguja, es de particular interés en la aplicación de instrumentos, que deben permanecer en el sitio tras su inserción, y que tienen que ejecutar su función durante una duración de tiempo limitada. El primer ejemplo es el de unos clips de cirugía, estructuras que van desde dimensiones submilimétricas hasta milimétricas, que se utilizarían para sujetar dos estructuras biológicas separadas, de forma unida, por ejemplo durante un período de cicatrización (Figuras 1A a 1C). Otro ejemplo hace referencia a unas estructuras para controlar el flujo a través de los vasos sanguíneos. El nivel más simple hace referencia a un clip utilizado para prevenir que la sangre fluya hacia una estructura biológica aguas abajo en el flujo sanguíneo. Dicho clip, o serie de clips, se montaría y permanecería para sujetar un soporte o elemento de retención firme sobre el vaso sanguíneo y de esta manera prevenir el flujo de la sangre. En la Figura 2 se muestran una serie de estructuras adecuadas para el estrangulamiento de los vasos sanguíneos.
El tercer ejemplo se encuentra a un nivel de alguna manera más complejo con estructuras construidas en una geometría en la que las mismas podrían utilizarse dentro o fuera de estructuras con forma de tubo, como los denominados stent para dilatar un área de estenosis o para fortalecer o unir la estructura o las estructuras internamente o externamente (Figuras 5A y 5B). Los stents son de un interés particular ya que deben insertarse dentro del tubo, para que a continuación permanezcan ahí para expandir un área de estenosis (ejemplos: vaso sanguíneo, conducto biliar) o para fortalecer una parte débil (ejemplos: vaso sanguíneo con aneurisma, conducto biliar dividido) de una estructura tubular.
Podrían utilizarse unos conjuntos de uñas para sujetar objetos cilíndricos, tales como nervios y fibras de nervios, o vasos sanguíneos. Con la ayuda de microactuadores que sujeten las estructuras (Figuras 3A a 3B), las microestructuras adyacentes que operan como unos electrodos de excitación o activación neurales, permitirán grabar señales de los nervios o activar los mismos. Esto podría utilizarse como un conector neural sintético, puenteando un nervio lesionado o una fibra de nervio lesionada.
En las membranas podrían introducirse elementos con alguna función mecánica temporal (Figuras 4A a 4C). Podrían utilizarse dispositivos de inserción de este tipo para formar un agujero a través de una membrana tal como se utiliza comúnmente en la cirugía del oído para el equilibrado de la presión. Fabricándolos en forma de microdispositivos se reducirá mucho el esfuerzo para colocar y retirar los dispositivos insertados y para mantenerlos en su sitio durante el periodo de tiempo deseado.
Los clips, los stents, los conjuntos de uñas y los dispositivos de inserción, una vez aplicados, podrían ser reabsorbibles o permanentes. Podrían expresar diversos grados de estimulación de crecimiento celular en sus superficies, diversos grados de actividad antitrombótica así como diferentes actividades antibióticas. También pueden ser portadores de componentes bioquímicos o biológicos.
Los elementos necesarios para llevar a cabo estas funciones son los micromúsculos electroquímicamente activados, construidos mediante el micromecanizado de un metal fino y de capas de polímeros (Elisabeth Smela, Olle Inganäs and Ingemar Lundström: "Controlled Folding of Micron-size Structures", Science 268 (1995) pp. 1735-1738) o solamente de capas de polímeros. Estos actuadores pueden producirse en unas dimensiones que van desde micrómetros hasta centímetros, y funcionan bien en fluidos biológicos, tales como plasma sanguíneo, sangre y orina. Por tanto son instrumentos adecuados para operaciones microinvasivas en el interior del cuerpo. La versatilidad de construcción y la velocidad de respuesta, así como la fuerza de estos actuadores hacen de ellos unos de los mejores tipos de microactuadores dentro del cuerpo. Una patente internacional abarca una ruta de fabricación de dichos dispositivos (Elisabeth Smela, Olle Inganäs e Ingemar Lundström: "Methods for the fabrication of micromachined structures and micromachined structures manufactured using such methods", documento WO 96/28841.
\newpage
La producción de conjuntos de instrumentos accionados de manera individual presenta pocas dificultades más allá de la producción del instrumento individual; debe entenderse que se proporcionan unos contactos eléctricos para accionar cada microactuador de forma separada. Esto puede llevarse a cabo cableando el microactuador individual, a ser utilizado como el electrodo de trabajo; entonces se utiliza el catéter como contraelectrodo, y podrá proporcionar toda la carga necesaria para accionar todos esos microactuadores. Ya que los cables pueden producirse fácilmente en anchos de hasta 10 \mum mediante fotolitografía o mediante litografía blanda, resultará posible colocar por lo menos 50 microactuadores a lo largo del conjunto de instrumentos situados dentro de una aguja de 1 mm de ancho o sobre la misma, con la simple filosofía de colocar cables conductores paralelos. En caso de necesitar más, podrían necesitarse esquemas de direccionamiento más elaborados. En caso de que surgiera la necesidad de sistemas de tres electrodos en cualquiera de las aplicaciones, los electrodos microfabricados de referencia o los electrodos de macrodimensiones de referencia portados en el alojamiento del catéter ofrecen una solución a este problema.
En caso de tener que direccionar los conjuntos de instrumentos de manera colectiva, y diseñar el conjunto de instrumentos para dejar libre el clip más extremo al accionar todas los clips, será necesario un mecanismo de confinamiento de los movimientos de todos los clips excepto el clip más extremo. Esto se lleva a cabo ensamblando el conjunto de clips dentro de un alojamiento cilíndrico, preferentemente el catéter, previamente a su inserción en el cuerpo. De esta manera, el alojamiento cilíndrico confina el movimiento de los microactuadores, que buscan en vano expandir la fuerte cubierta de metal al actuar. Cuando se acciona el clip más extremo C1, el clip se encuentra abierto; asimismo el clip siguiente al clip más extremo C2 se encuentra parcialmente libre para moverse ya que sobresale fuera del alojamiento cilíndrico. Por tanto, la apertura parcial de C2 deja libre a C1, y lo abre para un cierre espontáneo posterior en el sitio a sujetar.
\vskip1.000000\baselineskip
Referencias citadas en la descripción Esta lista de referencias citadas por el solicitante de la presente invención se proporciona solamente para conveniencia del lector. Dicha lista no forma parte del documento de patente europea. A pesar de que se ha tenido mucho cuidado durante la recopilación de las referencias, no debe excluirse la posibilidad de que se hayan producido errores u omisiones y a este respecto la OEP se exime de toda responsabilidad. Documentos de patente citados en la descripción
\bullet US 5771902 A
\bullet WO 9739674 A1
\bullet US 5819749 A
\bullet US 5855565 A
\bullet WO 9837816 A1
\bullet WO 9628841 A
\bullet WO 9739688 A2.
Documentos que no son patentes citados en la descripción
\bullet ELISABETH SMELA; OLLE INGANÄS; INGEMAR LUNDSTRÖM. Controlled Folding of Micron-size Structures. Science, 1995, vol. 268, 1735-1738.

Claims (25)

1. Instrumento para cirugía biomédica, en el que el instrumento comprende un micromúsculo de polímero estratificado configurado para inducir cambios geométricos y movimientos a través de un cambio de volumen electroquímicamente inducido en por lo menos una capa de polímero, caracterizado porque el instrumento se monta sobre un portador con forma de aguja adaptado para que sea insertado en una cánula o en un catéter, a través del cual el instrumento puede accionarse eléctricamente por medio de unos medios externos para inducir un movimiento mecánico para actuar sobre una estructura biológica.
2. Instrumento según la reivindicación 1, en el que el polímero estratificado consiste de un polímero de una única capa o monocapa.
3. Instrumento según la reivindicación 1, en el que el polímero estratificado consiste de un polímero de doble capa o bicapa.
4. Instrumento según la reivindicación 1, en el que el polímero estratificado consiste de un polímero de múltiples capas o multicapa y de capas de metal.
5. Instrumento según una o más reivindicaciones de entre las reivindicaciones 1 a 4, en el que los micromúsculos de polímero están construidos en capas, de las cuales por lo menos una es un polímero conjugado.
6. Instrumento según la reivindicación 5, en el que el polímero conjugado se selecciona de entre el grupo que consiste de polímeros y copolímeros de pirrol, anilina, tiofeno, parafenileno, vinileno, y fenileno, incluyendo formas sustituidas de los diferentes monómeros.
7. Instrumento según la reivindicación 1, en el que el instrumento está construido en un polímero bicapa, en el que el cambio de volumen eléctricamente activado de dicho, por lo menos un copolímero conjugado se configura para provocar una flexión de dicha bicapa.
8. Instrumento según la reivindicación 1, en el que el instrumento está construido en un polímero multicapa, en el que el cambio de volumen eléctricamente activado de dicho, por lo menos un copolímero conjugado de se configura para provocar una flexión de dicha multicapa.
9. Instrumento según una o más reivindicaciones de entre las reivindicaciones 1 a 8, en el que el instrumento comprende unos medios para proporcionar el movimiento mecánico para colocar una estructura biológica.
10. Instrumento según una o más reivindicaciones de entre las reivindicaciones 1 a 8, en el que el instrumento comprende unos medios para proporcionar el movimiento mecánico para sujetar una estructura biológica.
11. Instrumento según una o más reivindicaciones de entre las reivindicaciones 1 a 8, en el que el instrumento comprende unos medios para proporcionar el movimiento mecánico para cortar una estructura biológica.
12. Instrumento según una o más reivindicaciones de entre las reivindicaciones 1 a 8, en el que el instrumento comprende unos medios para proporcionar el movimiento mecánico para dilatar una estructura biológica.
13. Instrumento según una o más reivindicaciones de entre las reivindicaciones 1 a 8, en el que el instrumento comprende unos medios para proporcionar el movimiento mecánico para fortalecer una estructura biológica.
14. Instrumento según una o más reivindicaciones de entre las reivindicaciones 1 a 8, en el que el instrumento comprende unos medios para proporcionar el movimiento mecánico para implantar una estructura biológica.
15. Instrumento según una o más reivindicaciones de entre las reivindicaciones 1 a 14, caracterizado porque el instrumento individual es un par de tijeras.
16. Instrumento según una o más reivindicaciones de entre las reivindicaciones 1 a 14, caracterizado porque el instrumento individual es un cuchillo, que es dispuesto sobre un actuador que es configurado para un movimiento lineal y/o angular.
17. Instrumento según una o más reivindicaciones de entre las reivindicaciones 1 a 14, caracterizado porque el instrumento individual es una aguja puntiaguda, que es dispuesta sobre un actuador que es configurado para un movimiento lineal y/o angular.
18. Instrumento según una o más reivindicaciones de entre las reivindicaciones 1 a 14, caracterizado porque el instrumento individual es un dilatador.
19. Instrumento según una o más reivindicaciones de entre las reivindicaciones 1 a 14, caracterizado porque el instrumento individual es una grapa.
20. Instrumento según una o más reivindicaciones de entre las reivindicaciones 1 a 14, caracterizado porque el instrumento individual es un par de pinzas.
21. Conjunto de instrumentos que comprende un instrumento según una o más reivindicaciones de entre las reivindicaciones 1 a 8, en el que se sitúan una serie de instrumentos idénticos en un conjunto de instrumentos extendiéndose a lo largo de una longitud de la cánula, el catéter o la aguja, y en el que el accionamiento de un instrumento lo más cercano a la salida del catéter se configura para liberar un instrumento del conjunto de instrumentos y se configura para dejar el mismo en el punto de salida del catéter para montar el instrumento al nivel de alguna estructura biológica o dentro de la misma.
22. Conjunto de instrumentos según la reivindicación 21, en el que se sitúa una serie de instrumentos idénticos sobre el conjunto de instrumentos extendiéndose a lo largo del catéter o de la aguja y en el que cada instrumento se configura para que sea accionado de manera individual.
23. Conjunto de instrumentos según la reivindicación 21, en el que se sitúa una serie de instrumentos no idénticos sobre el conjunto de instrumentos extendiéndose a lo largo del catéter o de la aguja y en el que cada instrumento se configura para que sea accionado de manera individual.
24. Conjunto de instrumentos según cualquiera de las reivindicaciones 21 a 23, caracterizado porque el instrumento individual es un clip configurado para unir tejidos biológicos o partes de tejidos, y configurado para sujetar dichos tejidos o partes de tejidos para permitir la cicatrización.
25. Conjunto de instrumentos según cualquiera de las reivindicaciones 21 a 23, caracterizado porque el instrumento individual es un objeto cilíndrico expandible diseñado para ser insertado, en un estado contraído, dentro de un tubo biológico, y configurado para expandirse para mantener dicho tubo en un estado expandido o para unir dos o más tubos biológicos.
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AU777277B2 (en) 2004-10-07
EP1194072B1 (en) 2007-09-26
ATE373990T1 (de) 2007-10-15
JP4263405B2 (ja) 2009-05-13
SE9902348L (sv) 2000-12-22
WO2000078222A1 (en) 2000-12-28
BR0011808A (pt) 2002-04-23
EP1194072A1 (en) 2002-04-10
US7331969B1 (en) 2008-02-19
JP2003502095A (ja) 2003-01-21
CA2377368C (en) 2009-04-14
CA2377368A1 (en) 2000-12-28
SE9902348D0 (sv) 1999-06-21
EP1194072B9 (en) 2008-02-20
US20060287644A1 (en) 2006-12-21
AU5863100A (en) 2001-01-09
DE60036547D1 (de) 2007-11-08
DE60036547T2 (de) 2008-06-26

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