ES2335523T3 - Aparato grapador quirurgico. - Google Patents

Aparato grapador quirurgico. Download PDF

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Publication number
ES2335523T3
ES2335523T3 ES06023618T ES06023618T ES2335523T3 ES 2335523 T3 ES2335523 T3 ES 2335523T3 ES 06023618 T ES06023618 T ES 06023618T ES 06023618 T ES06023618 T ES 06023618T ES 2335523 T3 ES2335523 T3 ES 2335523T3
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stapling device
surgical stapling
ratchet
cam
elongated body
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Keith L. Milliman
Frank J. Viola
Joseph P. Orban Iii
Randolph F. Lehn
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Covidien LP
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Tyco Healthcare Group LP
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • 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
    • A61B17/0682—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil
    • A61B17/0686—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil having a forming anvil staying below the tissue during stapling
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/10—Surgical instruments, devices or methods for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
    • A61B17/105—Wound clamp magazines
    • 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
    • A61B2017/0023—Surgical instruments, devices or methods disposable
    • 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
    • A61B2017/00473—Distal part, e.g. tip or head
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00477—Coupling
    • 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
    • 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
    • A61B2017/07278—Stapler heads characterised by its sled or its staple holder
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B17/2909—Handles
    • A61B2017/2912—Handles transmission of forces to actuating rod or piston
    • A61B2017/2923—Toothed members, e.g. rack and pinion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2946—Locking means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0804—Counting number of instruments used; Instrument detectors
    • A61B2090/0806—Instrument detectors with a removable part, e.g. working tip
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0807—Indication means
    • A61B2090/0808—Indication means for indicating correct assembly of components, e.g. of the surgical apparatus

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
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  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
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  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
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Abstract

Un aparato grapador quirúrgico (10) que comprende: a) un alojamiento (36); b) un mango móvil (24) soportado por el alojamiento (36), pudiendo moverse el mango móvil (24) a lo largo de una carrera de actuación; c) un cuerpo alargado (14) que se extiende distalmente desde el alojamiento (36) y que define un eje longitudinal, teniendo el cuerpo alargado (14) un extremo distal adaptado para aplicarse de manera liberable a una unidad de carga desechable (16); d) un conjunto de avance que incluye un árbol del actuación (46), un trinquete de accionamiento (42) y un trinquete de bloqueo (54), teniendo el árbol del actuación (46) una cremallera dentada (48) y apoyándose, por lo menos en parte, dentro del alojamiento (36), estando el trinquete de accionamiento (42) operativamente asociado con el mango movible (24) y que se puede mover en el acoplamiento con la cremallera (48) para efectuar el avance longitudinal del árbol de actuación (46) durante la carrera o recorrido de actuación, estando el trinquete de bloqueo (54) desviado en el acoplamiento con la cremallera (48) para retener el árbol del actuación (46) en una posición fijada longitudinalmente; caracterizado porque el aparato grapador quirúrgico (10) además comprende e) un mecanismo de embrague antirreversión que incluye un conjunto de engranaje y una placa de corredera (102), estando el conjunto de engranaje colocado para convertir el movimiento del árbol de actuación (46) en el movimiento de la placa de corredera (102), teniendo la placa de corredera (102) una superficie de leva (108) y que es movible, en respuesta al avance longitudinal del árbol de actuación (46), desde una primera posición en la que la superficie de leva (108) se acopla con el trinquete de bloqueo (54) para impulsar el trinquete de bloqueo (54) fuera del acoplamiento con la cremallera (48) hasta una segunda posición en que la superficie de leva (108) se separa del trinquete de bloqueo (54).

Description

Aparato grapador quirúrgico.
Antecedentes 1. Campo técnico
Esta solicitud se refiere a un aparato grapador quirúrgico y, más particularmente, a un mecanismo de articulación para su uso con un aparato grapador quirúrgico endoscópico para aplicar secuencialmente una pluralidad de sujetadores quirúrgicos a tejido corporal y opcionalmente practicar una incisión en el tejido sujeto.
2. Antecedentes de la técnica relacionada
Son bien conocidos en la técnica dispositivos quirúrgicos en lo que primero se agarra o sujeta tejido entre una estructura de mordazas opuestas y luego se une dicho tejido por medio de sujetadores quirúrgicos. En algunos instrumentos está prevista una cuchilla para cortar el tejido que ha sido unido por los sujetadores. Los sujetadores tienen típicamente la forma de grapas quirúrgicas, pero se pueden utilizar también sujetadores polímeros de dos partes.
Los instrumentos para este fin pueden incluir dos miembros alargados que se usan respectivamente para capturar o sujetar tejido. Típicamente, uno de los miembros lleva un cartucho de grapas que aloja una pluralidad de grapas dispuestas en al menos dos filas laterales, mientras que el otro miembro tiene un yunque que define una superficie para formar las patas de las grapas cuando éstas son hincadas desde el cartucho de grapas. En general, la operación de grapado es efectuada por barras de leva que se desplazan longitudinalmente a través del cartucho de grapas, actuando las barras de leva sobre empujadores de grapas para expulsar secuencialmente las grapas del cartucho de grapas. Una cuchilla puede desplazarse entre las filas de grapas para cortar y/o abrir longitudinalmente el tejido grapado entre las filas de grapas. Instrumentos de esta clase se describen, por ejemplo, en las patentes US No. 3,079,606 y No. 3,490,675.
Una grapadora posterior descrita en la patente US No. 3,499,591 aplica una doble fila de grapas a cada lado de la incisión. Esto se realiza habilitando una unidad de carga desechable en la que un miembro de leva se mueve a través de un trayecto de guía alargado entre dos juegos de surcos escalonados portadores de grapas. Unos miembros de hincado de grapas están situados dentro de los surcos y posicionados de tal manera que sean contactados por el miembro de leva longitudinalmente móvil para efectuar la expulsión de las grapas desde el cartucho de grapas de la unidad de carga desechable. Otros ejemplos de tales grapadoras se describen en las patentes US Nos. 4,429,695 y 5,065,929.
Cada uno de los instrumentos descritos anteriormente en las patentes anteriores estaban diseñados para su uso en intervenciones quirúrgicas convencionales, en las que los cirujanos tienen acceso manual directo al sitio de la operación. Sin embargo, en intervenciones endoscópicas o laparoscópicas, la cirugía se realiza a través de una pequeña incisión o través de una estrecha cánula inserta a través de pequeñas heridas de entrada practicadas en la piel. Para abordar las necesidades específicas de las intervenciones quirúrgicas endoscópicas y/o laparoscópicas, se han desarrollado dispositivos grapadores quirúrgicos endoscópicos y éstos se describen, por ejemplo, en las patentes US Nos. 5,040,715 (Green et al.); 5,307,976 (Olson et al.); 5,312,023 (Green et al.); 5,318,221 (Green et al.); 5,326,013 (Green et al.); y 5,332,142 (Robinson et al.).
U.S. Surgical, la cesionaria de la presente solicitud, ha fabricado y comercializado instrumentos grapadores endoscópicos, tales como los instrumentos Multifire ENDO GIA* 30 y Multifire ENDO GIA* 60 o los descritos en el documento EP 0 760 230, durante varios años. Estos instrumentos han proporcionado importantes beneficios clínicos. No obstante, son posibles mejoras, por ejemplo reduciendo el coste y la complejidad de fabricación.
Los actuales dispositivos grapadores lineales laparoscópicos están configurados para funcionar con unidades de carga desechables (U.S. Surgical) y cartuchos de grapas (Ethicon) de solamente un tamaño. Por ejemplo, están disponibles actualmente grapadoras lineales individuales para aplicar filas paralelas de grapas que miden 30 mm, 45 mm y 60 mm de longitud. Así, durante una operación normal, puede requerirse que un cirujano utilice varios instrumentos grapadores diferentes para realizar una sola intervención quirúrgica laparoscópica. Tales prácticas aumentan el tiempo, la complejidad y los costes totales asociados con las intervenciones quirúrgicas laparoscópicas. Además, son mayores los costes para diseñar y fabricar múltiples tamaños de grapadoras, en contraste con la creación de una sola grapadora multiuso.
Sería extremadamente beneficioso proporcionar un dispositivo quirúrgico para uso durante intervenciones quirúrgicas laparoscópicas y/o endoscópicas que pueda emplearse con varias unidades de carga desechables de diferentes tamaños para reducir los costes totales asociados con tales intervenciones. Sería también particularmente beneficioso que el dispositivo pudiera realizar múltiples tareas, utilizando unidades de carga desechables de tamaño variable y finalidad variable, tal como, por ejemplo, para grapar, pinzar, cortar y/o articular.
Al hacer mejoras o modificaciones en los instrumentos actuales, sería altamente deseable no sacrificar ninguno de los importantes beneficios de los instrumentos MULTIFIRE ENDO GIA* 30 y 60 en comparación con otros productos comercialmente disponibles, por ejemplo los instrumentos grapadores endoscópicos fabricados y comercializados por Ethicon, Inc. Por ejemplo, cualquier mejora deberá proporcionar ventajosamente una hoja de cuchilla nueva para cada disparo del instrumento y garantizar que la unidad de carga desechable sea retenida con seguridad en el instrumento grapador, a menos y hasta que el equipo operador decida retirarla. Estas ventajas se han encontrado históricamente en los instrumentos de U.S. Surgical, pero no en los instrumentos de Ethicon.
Los rasgos técnicos de la parte de caracterización previa de la reivindicación 1, son revelados en el documento EP-0 760 230 qué describe un dispositivo grapador quirúrgico que puede utilizarse con unidades de carga desechables. El dispositivo incluye un conjunto de mango con un mango de actuación y un cuerpo alargado que se extiende distalmente desde el conjunto de mango. El mango de actuación interactúa con un árbol de actuación apoyado, al menos en parte, dentro del conjunto de mango. Durante una carrera de actuación, la eyección de grapas desde la unidad de carga desechable se efectúa mediante el árbol de actuación manipulando el mango de actuación.
Sumario
De acuerdo con la presente invención, se proporciona un aparato grapador quirúrgico, tal como se define en las reivindicaciones, para aplicar secuencialmente una pluralidad de sujetadores a tejido corporal y simultáneamente practicar una incisión en el tejido. El aparato grapador quirúrgico está adaptado para recibir unidades de carga desechables que tienen filas de grapas de una longitudinal lineal de entre 30 mm y 60 mm. El aparato grapador quirúrgico puede ser adaptado también para recibir unidades de carga desechables articulantes y no articulantes.
El aparato grapador quirúrgico incluye un conjunto de mango que tiene un mango móvil y un mango estacionario. El mango móvil puede moverse a lo largo de una carrera de actuación para sujetar tejido y efectuar la expulsión de grapas desde la unidad de carga desechable. Un cuerpo alargado se extiende distalmente desde el conjunto de mango y define un eje longitudinal. Un árbol de actuación que tiene una cremallera dentada está asociado operativamente con el mango móvil por un mecanismo de trinquete. El extremo distal del árbol de actuación está conectado a una varilla de control que tiene un extremo distal adaptado para acoplarse operativamente con un conjunto de accionamiento axial dispuesto dentro de una unidad de carga desechable.
El aparato grapador incluye un mecanismo de articulación con una palanca de articulación operativamente acoplada con un miembro de leva que tiene un canal escalonado de acción de leva. El miembro de leva se acopla con un miembro de traslación que incluye una espiga dimensionada para ser recibida dentro del canal escalonado de acción de leva de tal manera que el movimiento pivotable de la palanca origine un movimiento lineal del miembro de traslación. Una primera barra de articulación incluye un extremo proximal adaptado para acoplarse con el miembro de traslación y un extremo distal adaptado para acoplarse con una segunda barra de articulación posicionada dentro de la unidad de carga desechable. El movimiento lineal del miembro de traslación provoca un movimiento lineal de los eslabones de articulación para producir la articulación de un conjunto de utillaje de la unidad de carga desechable.
El aparato grapador quirúrgico incluye también preferiblemente un mecanismo sensor para percibir el tipo de unidad de carga desechable asegurada al cuerpo alargado del aparato. El mecanismo sensor incluye un tubo sensor posicionado dentro del cuerpo alargado para acoplarse a una unidad de carga desechable asegurada al cuerpo alargado. Un cilindro sensor conectado al tubo sensor se acopla con un anillo de bloqueo que tiene una porción de patilla configurada para acoplarse al mecanismo de articulación en una primera posición para impedir el movimiento de la palanca de articulación. El anillo de bloqueo es movido por el cilindro sensor cuando una unidad de carga desechable articulante está asegurada al cuerpo alargado del aparato grapador hasta una segunda posición para desacoplar la porción de patilla del mecanismo de articulación a fin de permitir el movimiento de la palanca de articulación. En contraste, una unidad de carga desechable no articulante no desbloqueará la palanca de articulación.
Breve descripción de los dibujos
Se describen aquí diversas realizaciones preferidas con referencia a los dibujos, en los que:
La figura 1 es una vista en perspectiva de una realización preferida del aparato grapador quirúrgico descrito en el presente documento;
La figura 2 es una vista en planta desde arriba del aparato quirúrgico mostrado en la figura 1;
La figura 3 es una vista lateral del aparato quirúrgico mostrado en la figura 1;
La figura 4 es un vista en perspectiva con partes separadas del conjunto de mango del aparato quirúrgico mostrado en la figura 1;
La figura 5 es una vista en sección transversal de una porción del mecanismo de bloque antidisparo mostrado en la figura 4;
La figura 6 es una vista en perspectiva de la placa de corredera del mecanismo de embrague antirreversión del aparato quirúrgico;
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La figura 7 es una vista en perspectiva agrandada del mecanismo de embrague antirreversión mostrado en la
figura 1;
La figura 8 es una vista lateral en sección transversal del aparato grapador quirúrgico mostrado en la figura 1 en la posición no actuada con la unidad de carga desechable retirada;
La figura 9 es una vista en perspectiva con partes separadas del miembro de rotación, el mecanismo de articulación y el cuerpo alargado del aparato grapador quirúrgico mostrado en la figura 1;
La figura 10 es una vista ampliada del área de detalle indicada mostrada en la figura 8;
La figura 10a es una vista en perspectiva del miembro de traslación del mecanismo articulante y del extremo proximal del cuerpo alargado del aparato grapador quirúrgico mostrado en la figura 1;
La figura 10b es una vista ampliada en sección transversal del área de detalle indicada de la figura 8;
La figura 10c es una vista en sección transversal a lo largo de la línea de sección 10c-10c de la figura 8;
La figura 11 es una vista en perspectiva del miembro de leva del mecanismo de articulación del aparato grapador quirúrgico mostrado en la figura 1;
La figura 12 es una vista en planta desde arriba del miembro de leva del mecanismo de articulación del aparato grapador quirúrgico mostrado en la figura 1;
La figura 12a es una vista en perspectiva de una unidad de carga desechable no articulante utilizable con el aparato grapador quirúrgico mostrado en la figura 1;
La figura 12b es una vista en perspectiva de la unidad de carga desechable articulante preferida del aparato grapador quirúrgico mostrado en la figura 1;
La figura 13 es una vista en sección transversal tomada a lo largo de la línea de sección 13-13 de la figura 10;
La figura 14 es una vista en sección transversal tomada a lo largo de la línea de sección 14-14 de la figura 10;
La figura 15 es una vista en sección transversal tomada a lo largo de la línea de sección 15-15 de la figura 10;
La figura 16 es una vista ampliada del área de detalle indicada mostrada en la figura 8;
La figura 17 es una vista lateral en perspectiva de la placa de bloqueo del aparato grapador quirúrgico mostrado en la figura 1;
La figura 18 es una vista en perspectiva desde arriba de la placa de bloqueo del aparato grapador quirúrgico mostrado en la figura 1;
La figura 19 es una vista en perspectiva de una unidad de carga desechable utilizable con el aparato grapador quirúrgico de la figura 1;
La figura 20 es otra vista en perspectiva de una unidad de carga desechable utilizable con el aparato grapador quirúrgico de la figura 1;
La figura 21 es una vista en perspectiva del conjunto de utillaje del aparato grapador quirúrgico de la figura 1 con partes separadas;
La figura 22 es una vista en perspectiva ampliada del extremo distal del conjunto de yunque que muestra una pluralidad de cavidades deformadoras de grapas;
La figura 23 es una vista en perspectiva ampliada del extremo distal del cartucho de grapas del aparato grapador quirúrgico mostrado en la figura 1;
La figura 24 es una vista lateral en sección transversal tomada a lo largo de la línea de sección 24-24 de la figura 23;
La figura 25 es una vista en perspectiva desde abajo del cartucho de grapas mostrado en la figura 21;
La figura 26 es una vista en perspectiva ampliada del patín de actuación, los empujadores y los sujetadores mostrados en la figura 21;
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La figura 27 es una vista en perspectiva ampliada con partes separadas de la porción de alojamiento proximal y del conjunto de montaje de la unidad de carga desechable mostrada en la figura 19;
La figura 28 es una vista en perspectiva ampliada del conjunto de montaje de la unidad de carga desechable mostrada en la figura 19, montado en una porción extrema distal de la porción de alojamiento proximal;
La figura 29 es una vista en perspectiva ampliada de la porción de alojamiento proximal y del conjunto de montaje de la unidad de carga desechable mostrada en la figura 19 con la mitad superior del alojamiento retirada;
La figura 30 es una vista en perspectiva de la porción de alojamiento proximal y del conjunto de montaje de la unidad de carga desechable mostrada en la figura 19 con la mitad superior del alojamiento retirada;
La figura 31 es una vista en perspectiva con partes separadas del conjunto de accionamiento axial;
La figura 32 es una vista en perspectiva ampliada del conjunto de accionamiento axial mostrado en la figura 31;
La figura 33 es una vista en perspectiva ampliada del extremo proximal del conjunto de accionamiento axial mostrado en la figura 31, incluyendo el dispositivo de bloqueo;
La figura 34 es una vista en perspectiva ampliada del extremo distal del conjunto de accionamiento axial mostrado en la figura 31;
La figura 35 es una vista en perspectiva ampliada del extremo distal del cuerpo alargado del aparato grapador mostrado en la figura 1;
La figura 36 es una vista en perspectiva ampliada del dispositivo de bloqueo mostrado en la figura 33;
La figura 37 es una vista en perspectiva ampliada de una mitad inferior del alojamiento de la porción de alojamiento proximal de la unidad de carga desechable mostrada en la figura 27;
La figura 38 es una vista lateral en sección transversal de la unidad de carga desechable mostrada en la figura 20;
La figura 39 es una vista ampliada del área de detalle indicada mostrada en la figura 38;
La figura 40 es una vista en perspectiva del aparato grapador quirúrgico mostrado en la figura 1 con la unidad de carga desechable de la figura 19 desprendida del cuerpo alargado;
La figura 41 es una vista en perspectiva ampliada de la unidad de carga desechable de la figura 19 durante la fijación al cuerpo alargado del aparato grapador quirúrgico mostrado en la figura 1;
La figura 42 es otra vista en perspectiva ampliada de la unidad de carga desechable de la figura 1 durante la fijación al cuerpo alargado del aparato grapador quirúrgico mostrado en la figura 1;
La figura 43 es una vista en sección transversal tomada a lo largo de la línea de sección 43-43 de la figura 41;
La figura 43a es una vista lateral en sección transversal del mando de rotación, del mecanismo de articulación y del mecanismo sensor durante la inserción de una unidad de carga desechable en el cuerpo alargado del aparato grapador quirúrgico;
La figura 44 es una vista en sección transversal tomada a lo largo de la línea de sección 44-44 de la figura 42;
La figura 45 es una vista lateral en sección transversal del extremo distal de la unidad de carga desechable de la figura 1 con tejido posicionado entre los conjuntos de yunque y de abrazadera;
La figura 46 es una vista lateral en sección transversal del conjunto de mango con el mango móvil en una posición actuada;
La figura 47 es una vista ampliada del área de detalle indicada mostrada en la figura 46;
La figura 48 es una vista en sección transversal del extremo proximal de la unidad de carga desechable de la figura 19 y del extremo distal del cuerpo alargado del aparato grapador quirúrgico mostrado en la figura 1 con la varilla de control en una posición parcialmente avanzada;
La figura 49 es una vista en sección transversal del conjunto de utillaje del aparato grapador quirúrgico mostrado en la figura 1 posicionado alrededor de tejido en la posición sujeta;
La figura 50 es una vista en sección transversal del conjunto de mango del aparato grapador de la figura 1 durante la carrera de sujeción del aparato;
La figura 51 es una vista lateral en sección transversal del extremo distal del conjunto de utillaje del aparato grapador mostrado en la figura 1 durante el disparo del aparato;
La figura 52 es una vista lateral en sección transversal del extremo distal del conjunto de utillaje del aparato grapador mostrado en la figura 1 después del disparo del aparato;
La figura 53 es una vista lateral en sección transversal del conjunto de mango del aparato durante la retracción del árbol de actuación;
La figura 54 es una vista lateral en sección transversal del conjunto de mango del aparato grapador durante la actuación del botón de liberación de emergencia;
La figura 55 es una vista en planta desde arriba del mecanismo de articulación del aparato grapador quirúrgico;
La figura 56 es una vista lateral en sección transversal del mecanismo de articulación y del miembro de rotación del aparato grapador quirúrgico mostrado en la figura 1;
La figura 57 es una vista en planta desde arriba del extremo distal del cuerpo alargado, del conjunto de montaje y del extremo proximal del conjunto de utillaje durante la articulación del aparato grapador;
La figura 58 es una vista en perspectiva del aparato grapador quirúrgico durante la articulación del conjunto de utillaje;
La figura 59 es una vista en perspectiva del aparato grapador quirúrgico durante la articulación y rotación del conjunto de utillaje;
La figura 60 es una vista en planta desde arriba del extremo distal de la unidad de carga desechable inmediatamente antes de la articulación;
La figura 61 es una vista en planta desde arriba del extremo distal del cuerpo alargado, del conjunto de montaje y del extremo proximal del conjunto de útiles durante la articulación del aparato grapador;
La figura 62 es una vista en sección transversal parcial de una porción de la unidad de carga desechable durante la retracción del dispositivo de bloqueo; y
La figura 63 es una vista en sección transversal parcial de una porción de la unidad de carga desechable con el dispositivo de bloqueo en la posición bloqueada.
Descripción detallada de realizaciones preferidas
Se describirán ahora en detalle realizaciones preferidas del aparato grapador quirúrgico endoscópico descrito en el presente documento con referencia a los dibujos, en los cuales los números de referencia iguales designan elementos iguales o correspondientes en cada una de las diversas vistas.
En los dibujos y en las descripción que sigue, el término "proximal", como es tradicional, se referirá al extremo del aparato grapador que está más próximo al cirujano, mientras que el término "distal" se referirá al extremo del aparato que está más alejado del cirujano.
Las figuras 1 a 3 ilustran una realización del aparato grapador quirúrgico descrito en el presente documento mostrado en general como 10. Brevemente, el aparato grapador quirúrgico 10 incluye un conjunto de mango 12 y un cuerpo alargado 14. Una unidad de carga desechable o DLU 16 está asegurada de forma liberable a un extremo distal del cuerpo alargado 14. La unidad de carga desechable 16 incluye un conjunto de utillaje 17 que tiene un conjunto de cartucho 18 que aloja una pluralidad de grapas quirúrgicas y un conjunto de yunque 20 asegurado de forma móvil con relación al conjunto de cartucho 18. La unidad de carga desechable 16 está configurada para aplicar filas lineales de grapas que miden de aproximadamente 30 mm a aproximadamente 60 mm de longitud. Se contemplan también unidades de carga desechables que tengan filas lineales de grapas de otras longitudes, por ejemplo 45 mm. El conjunto de mango 12 incluye un miembro de mango estacionario 22, un miembro de mango móvil 24 y una porción de tambor 26. Un miembro giratorio 28 está montado preferiblemente en el extremo delantero de la porción de tambor 26 para facilitar la rotación del cuerpo alargado 14 con respecto al conjunto de mango 12. Una palanca de articulación 30 está montada también preferiblemente en el extremo delantero de la porción de tambor 26 junto a un mando giratorio 28 para facilitar la articulación del conjunto de utillaje 17. Un par de mandos de retracción 32 están posicionados en forma móvil a lo largo de la porción de tambor 26 para devolver el aparato grapador quirúrgico 10 a una posición retraída, tal como se describirá con detalle más adelante.
Haciendo referencia a la figura 4, el conjunto de mango 12 incluye un alojamiento 36 que está constituido preferiblemente por semisecciones de alojamiento moldeadas 36a y 36b que forman el miembro de mango estacionario 22 y la porción de tambor 26 del conjunto de mango 12 (véase la figura 1). El miembro de mango móvil 24 está soportado de forma pivotable entre las semisecciones de alojamiento 36a y 36b alrededor de una espiga pivote 38. Un miembro de solicitación 40, que es preferiblemente un muelle de torsión, solicita al mango móvil 24 en sentido de alejarlo del mango estacionario 22. Un árbol de actuación 46 está soportado dentro de la porción de tambor 26 del alojamiento 36 e incluye una cremallera dentada 48. Un trinquete de accionamiento 42 que tiene un dedo 43 de engrane con la cremallera, dotado de alas 43a y 43b que se extienden lateralmente, está montado de forma pivotable en un extremo del mango móvil 24 alrededor de una espiga pivote 44. Un miembro de solicitación 50, que es preferiblemente también un muelle de torsión, está posicionado para empujar al dedo de engrane 43 del trinquete de accionamiento 42 hacia la cremallera dentada 48 del árbol de actuación 46. El mango móvil 24 es pivotable para mover el dedo de engrane 43 del trinquete de accionamiento 42 hacia una posición de contacto con la cremallera dentada 48 del árbol de actuación 46 para hacer avanzar dicho árbol linealmente en la dirección distal. El extremo delantero del árbol de actuación 46 recibe de forma giratoria el extremo proximal 49 de una varilla de control 52 de tal manera que el avance lineal del árbol de actuación 46 provoca un avance lineal correspondiente de la varilla de control 52. Un trinquete de bloqueo 54 que tiene un miembro 55 de engrane con la cremallera está montado de forma pivotable dentro del alojamiento 36 alrededor de una espiga pivote 57 y es solicitado hacia la cremallera dentada 48 por un miembro de solicitación 56 que es preferiblemente también un muelle de torsión. El miembro de engrane 55 del trinquete de bloqueo 54 es móvil en el sentido de engranarlo con la cremallera dentada 48 para retener el árbol de actuación 46 en una posición longitudinalmente fija.
Un mecanismo de retracción 58, que incluye un par de mandos retractores 32 (véase la figura 1), puede estar conectado al extremo proximal del árbol de actuación 46 por una varilla de acoplamiento 60. La varilla de acoplamiento 60 incluye porciones de engrane derecha e izquierda 62a y 62b para recibir los mandos retractores 32 y una porción central 62c que está dimensionada y configurada para trasladarse dentro de un par de ranuras longitudinales 34a formadas en el árbol de actuación 46 junto al extremo proximal del mismo. Una placa de liberación 64 está operativamente asociada con el árbol de actuación 46 y montada para moverse con respecto al mismo en respuesta a la manipulación de los mandos retractores 32. Un par de pasadores espaciados 66 se extienden hacia fuera desde una cara lateral del árbol de actuación 46 para encajar en un par de ranuras de leva anguladas correspondientes 68 formadas en la placa de liberación 64. Al producirse un movimiento de retroceso de los mandos retractores 32, los pasadores 66 pueden liberar la placa 64 hacia abajo con respecto al árbol de actuación 46 y con respecto a la cremallera dentada 48 de tal manera que la porción inferior de la placa de liberación 64 se extienda por debajo de la cremallera dentada 48 para desacoplar el dedo de engrane 43 del trinquete de accionamiento 42 de la cremallera dentada 48. Una ranura transversal 70 está formada en el extremo proximal de la placa de liberación 64 para dar acomodo a la porción central 62c de la varilla de acoplamiento 60, y unas ranuras alargadas 34 (véase la figura 1) están definidas en la sección de tambor 26 del conjunto de mango 12 para absorber la traslación longitudinal de la varilla de acoplamiento cuando se tira de los mandos de retracción 32 hacia atrás para retraer el árbol de actuación 46 y retraer así la varilla de control 52 hacia atrás. El árbol de actuación 46 es solicitado proximalmente por un muelle 72 que está asegurado en un extremo a la porción de varilla de acoplamiento 62 a través de un conector 74 y en el otro extremo a un tetón 76 del árbol de actuación 46.
Haciendo referencia también a la figura 5, el conjunto de mango 12 incluye un conjunto 80 de bloqueo antidisparo que incluye un émbolo buzo 82 y un miembro de bloqueo pivotable 83. El émbolo buzo 82 está solicitado hacia una posición central por muelles de solicitación 84 e incluye superficies de leva estrechadas anulares 85. Cada extremo del émbolo buzo 82 se extiende a través del alojamiento 36 (véase la figura 1) junto a un extremo superior del mango estacionario 22. El miembro de bloqueo pivotable 83 está fijado de manera pivotable en su extremo distal entre las semisecciones de alojamiento 36a y 36b alrededor de una espiga pivote 86 e incluye una superficie de bloqueo 88 y una prolongación proximal 90 que tiene una ranura 89 formada en ella. El miembro de bloqueo 83 está solicitado por un muelle 92 en sentido levógiro (según se ve en la figura 4) para mover la superficie de bloqueo 88 hasta una posición adecuada para apoyarse en el extremo distal del árbol de actuación 46 e impedir el avance de este árbol 46 y el subsiguiente disparo del aparato grapador 10. Una superficie de leva estrechada anular 85 está posicionada para extenderse hacia dentro de la ranura estrechada 93 de la prolongación proximal 90. Un movimiento lateral del émbolo buzo 82 en una u otra dirección en contra de la solicitación de uno u otro muelle 84 mueve la superficie de leva estrechada 85 para acoplarla con las paredes laterales de la ranura estrechada 89 a fin de pivotar el miembro de bloqueo 83 en sentido dextrógiro alrededor de la espiga pivote 86, según se ve en la figura 4, para mover la superficie de bloqueo 88 hasta una posición adecuada para permitir el avance del árbol de actuación 46 y, por tanto, el disparo del aparato grapador 10. La superficie de bloqueo 88 está retenida en esta posición por unos rebajos 87 que reciben la punta estrechada de la superficie de leva 85 para bloquear el miembro 83 en una posición levógira. Se ilustrará seguidamente con más detalle el funcionamiento del conjunto 80 de bloqueo antidisparo.
Haciendo referencia a las figuras 4, 6 y 7, el mecanismo de mango 12 incluye también un mecanismo de embrague antirreversión que incluye una primera rueda dentada 94 montada a rotación sobre un primer árbol 96 y una segunda rueda dentada 98 montada sobre un segundo árbol 100, y una placa de corredera 102 (figuras 6 y 7) montada a deslizamiento dentro del alojamiento 36. La placa de corredera 102 incluye una ranura alargada 104 dimensionada y configurada para ser posicionada de forma deslizable alrededor de la espiga pivote 57 del trinquete de bloqueo, una placa de engrane 106 configurada para engranar con los dientes de la segunda rueda dentada 98 y una superficie de leva 108. En la posición retraída, la superficie de leva 108 de la placa de corredera 102 engrana con el trinquete de bloqueo 54 para impedir que este trinquete de bloqueo 54 engrane con la cremallera dentada 48. El árbol de actuación 46 incluye un juego distal de dientes de engrane 110a espaciado de un juego proximal de dientes de engrane 110b posicionado para engranar con la primera rueda dentada o engranaje 94 del árbol de actuación 46 durante el movimiento de dicho árbol de actuación 46. Cuando se hace avanzar el árbol de actuación 46 pivotando el mango móvil 24 alrededor de la espiga pivote 38, los dientes de engrane distales 110a del árbol de actuación 46 engranan con la primera rueda dentada o engranaje 94 y el primer árbol 96 y giran con éstos. El primer árbol 96 está conectado al segundo árbol 100 por un conjunto de embrague de muelle de tal manera que la rotación del primer árbol 96 causará una rotación correspondiente del segundo árbol 100. La rotación del segundo árbol 100 provoca una rotación correspondiente de la segunda rueda dentada o engranaje 98 engranada con la placa de engrane 106 de la placa de corredera 102 para producir un avance lineal de dicha placa de corredera 102. El avance lineal de la placa de corredera 102 se limita a la longitud de la ranura alargada 104. Cuando la placa de corredera ha sido hecha avanzar en la longitud de la ranura 104, la superficie de leva 108 libera el trinquete de bloqueo 54 de tal manera que éste se mueve en el sentido de engranar con la cremallera dentada 48. El avance continuado del árbol de actuación 46 mueve finalmente los dientes de engrane 110b hacia su engrane con la placa de engrane 104. Sin embargo, dado que la placa de corredera 102 está longitudinalmente fija en posición, el embrague de muelle es forzado a soltarse de tal manera que se permita un avance distal continuado del árbol de actuación 46.
Cuando el árbol de actuación 46 es devuelto a la posición retraída (tirando proximalmente de los mandos de retracción 34, según se ha discutido más arriba), los dientes de engrane 110b engranan con la primera rueda dentada o engranaje 94 para hacer girar la segunda rueda dentada o engranaje 98 en dirección contraria a fin de retraer proximalmente el miembro de corredera 102 dentro del alojamiento 36. El movimiento proximal del miembro de corredera 102 hace que avance la superficie de leva 108 hacia dentro del trinquete de bloqueo 54 antes del engrane entre el trinquete de bloqueo 54 y la cremallera dentada 48 para empujar a dicho trinquete de bloque 54 hasta una posición adecuada para permitir la retracción del árbol de actuación 46.
Haciendo referencia nuevamente a la figura 4, el conjunto de mango 12 puede incluir un botón de retorno de emergencia 112 montado de forma pivotante dentro del alojamiento 36 alrededor de un miembro de pivote 114 soportado entre las semisecciones 36a y 36b del alojamiento. El botón de retorno 112 incluye un miembro externamente posicionado 116 colocado en el extremo proximal de la porción de tambor 26. El miembro 116 es móvil alrededor del miembro de pivote 114 para acoplarse con el extremo proximal del trinquete de bloqueo 54 a fin de empujar al miembro 55 de engrane con la cremallera para que deje de estar engranado con la cremallera dentada 48 y permita la retracción del árbol de actuación 46 durante la carrera de disparo del aparato grapador 10. Como se ha discutido más arriba, durante la porción de avance de aprisionamiento del árbol de actuación 46, la placa de corredera 102 desacopla el trinquete 54 de la cremallera 48 y, por tanto, no es necesaria la actuación del botón de retorno 112 para retraer el árbol de actuación 46.
La figura 8 ilustra la interconexión del cuerpo alargado 14 y del conjunto de mango 12. Haciendo referencia a las figuras 8 a 10, el alojamiento 36 incluye un canal anular 117 configurado para recibir un nervio anular 118 formado en el extremo proximal del miembro de rotación 28, que se ha formado preferiblemente a partir de semisecciones moldeadas 28a y 28b. El canal 117 y el nervio 118 anulares permiten un movimiento relativo entre el miembro de rotación 28 y el alojamiento 36. El cuerpo alargado 14 incluye un alojamiento interior 22 y una envolvente exterior 124. El alojamiento interior 122 está dimensionado para ser recibido dentro de la envolvente exterior 124 e incluye un ánima interna 126 (figura 8) que se extiende a su través y está dimensionada para recibir a deslizamiento una primera barra de articulación 123 y la varilla de control 52. El extremo proximal del alojamiento 122 y de la envolvente 124 incluyen cada uno un par de aberturas diametralmente opuestas 130 y 128, respectivamente, que están dimensionadas para recibir salientes radiales 132 formados en el extremo distal del miembro de rotación 28. Los salientes 132 y las aberturas 128 y 130 aseguran fijamente el miembro de rotación 28 y el cuerpo alargado 14 uno con relación a otro, ambos en sentido longitudinal y en forma rotativa. La rotación del mando de rotación 28 con respecto al conjunto de mango 12 da así como resultado una rotación correspondiente del miembro alargado 14 con respecto al conjunto de mango 12.
Un mecanismo de articulación 120 está soportado por el miembro rotativo 28 e incluye la palanca de articulación 30, un miembro de leva 136, un miembro de traslación 138 y la primera barra de articulación 123 (figura 9). La palanca de articulación 30 está montada de forma pivotable alrededor de un miembro de pivote 140 que se extiende hacia fuera desde el miembro de rotación 28 y que está formado preferiblemente en una sola pieza con éste. Un saliente 142 se extiende hacia abajo desde la palanca de articulación 30 para acoplarse con el miembro de leva 136.
Haciendo referencia temporalmente a las figuras 11 y 12, el miembro de leva 136 incluye un alojamiento 144 que tiene una ranura alargada 146 que se extiende a través de un lado del mismo y una superficie de leva escalonada 148 formada en el otro lado del mismo. Cada escalón de la superficie de leva 148 corresponde a un grado particular de articulación del aparato grapador 10. Aunque se ilustran cinco escalones, pueden disponerse menos o más escalones. La ranura alargada 146 está configurada para recibir el saliente 142 formado en la palanca de articulación 30. El alojamiento 144 incluye una porción escalonada distal 150 y una porción escalonada proximal 152. La porción escalonada proximal 152 incluye un rebajo 154.
Haciendo referencia otra vez a las figuras 8 a 10 y también a las figuras 13 a 15, el miembro de traslación 138 incluye una pluralidad de crestas 156 que están configuradas para ser recibidas a deslizamiento dentro de surcos 158 formados a lo largo de las paredes interiores del miembro de rotación 28. El acoplamiento entre las crestas 156 y los surcos 158 impide una rotación relativa del miembro de rotación 28 y del miembro de traslación 138, al tiempo que permite un movimiento lineal relativo. El extremo distal del miembro de traslación 138 incluye un brazo 160 que presenta una abertura 162 configurada para recibir un dedo 164 que se extiende desde el extremo proximal de la barra de articulación 123 (véase la figura 10a). Una espiga 166 que tiene un alojamiento 168 construido de un material no abrasivo, por ejemplo Teflon, está asegurada al miembro de traslación 138 y dimensionada para ser recibida dentro de la superficie de leva escalonada 148.
En un estado ensamblado, las porciones escalonadas proximal y distal 150 y 152 del miembro de leva 136 están posicionadas debajo de pestañas 170 y 172 formadas en el miembro de rotación 28 para restringir el miembro de leva 136 a un movimiento transversal con respecto al eje longitudinal del aparato grapador 10. Cuando se hace pivotar la palanca de articulación 30 alrededor del miembro de pivote 140, el miembro de leva 136 se mueve transversalmente sobre el miembro de rotación 28 para mover la superficie de leva escalonada 148 en dirección transversal con relación a la espiga 166, forzando a la espiga 166 a que se mueva proximal o distalmente a lo largo de la superficie de leva escalonada 148. Dado que la espiga 166 está fijamente sujeta al miembro de traslación 138, este miembro de traslación 138 es movido proximal o distalmente para efectuar un movimiento proximal o distal correspondiente de la primera barra de articulación 123.
Haciendo referencia a las realizaciones de las figuras 8 a 10 y 16, un mecanismo sensor de la unidad de carga desechable se extiende dentro del aparato grapador 10 desde el cuerpo alargado 14 hasta dentro del conjunto de mango 12. El mecanismo sensor incluye un tubo sensor 176 que está soportado a deslizamiento dentro del ánima 26 del cuerpo alargado 14. El extremo distal del tubo sensor 176 está posicionado hacia el extremo distal del cuerpo alargado 14 y el extremo proximal del tubo sensor 176 está asegurado dentro del extremo distal de un cilindro sensor 178 a través de un par pezones 180. El extremo distal de una barra articulada sensora 182 está asegurado al extremo proximal del cilindro sensor 178. La barra articulada sensora 182 (véanse las figuras 8a y 8c) tiene un extremo bulboso 184 que se aplica a una superficie de leva 83a del miembro de bloqueo pivotable 83. Cuando se inserta una unidad de carga desechable (no mostrada) en el extremo distal del cuerpo alargado 14, dicha unidad de carga desechable se aplica al extremo distal 177 del tubo sensor 176 para impulsar dicho tubo sensor 176 en dirección proximal e impulsar así al cilindro sensor 178 y a la barra articulada sensora 182 en dirección proximal. El movimiento de la barra articulada sensora 182 en dirección proximal hace que el extremo bulboso 184 de la barra articulada sensora 182 se mueva en dirección distal respecto de la superficie de leva 83a para permitir que el miembro de bloqueo 83 pivote bajo la solicitación del muelle 92 desde una posición que permite el disparo del aparato grapador 10 hasta una posición de bloqueo, en la que el miembro de bloqueo 83 está posicionado para aplicarse al árbol de actuación 46 e impedir el disparo del aparato grapador 10. La barra articulada sensora 182 y el miembro de bloqueo 83 funcionan para impedir el disparo del aparato grapador quirúrgico 10 después de que se haya asegurado una unidad de carga desechable al cuerpo alargado 14, sin accionar primero el conjunto 80 de bloqueo antidisparo. Es de hacer notar que el movimiento de la barra articulada 182 en dirección proximal permite que el miembro de bloqueo 83 se mueva hasta su posición mostrada en la figura 5.
Haciendo referencia otra vez a las figuras 9 a 12, el miembro de leva 136 incluye un rebajo 154. Un anillo de bloqueo 184 que tiene una porción de pezón 186 configurada para ser recibida dentro del rebajo 154 está posicionado alrededor del cilindro sensor 178 entre una porción de patilla de control 188 y una porción de pestaña proximal 190. Un muelle 192 posicionado entre la porción de pestaña 190 y el anillo de bloqueo 184 empuja a dicho anillo de bloqueo en dirección distal alrededor del cilindro sensor 178. Cuando una unidad de carga desechable articulante 16b que tiene una punta de inserción prolongada 193 es insertada en el extremo distal del cuerpo alargado 14 del aparato grapador 10, la punta de inserción 193 hace que la porción de patilla 188 se mueva en dirección proximal para acoplarse con el anillo de bloqueo 184 a fin de empujar a dicho anillo de bloqueo 184 y al pezón 186 en dirección proximal con respecto al rebajo 154 del miembro de leva 136 (véase la figura 12b). Con el pezón 186 posicionado proximalmente respecto del rebajo 154, el miembro de leva 136 es libre de moverse transversalmente para efectuar la articulación del aparato grapador 10. Una unidad de carga desechable no articulante no tiene una punta de inserción prolongada (véase la figura 12a). Como tal, cuando se inserta una unidad de carga desechable no articulante en el cuerpo alargado 14, el cilindro sensor 178 no es retraído proximalmente en una distancia suficiente para mover el pezón 186 hacia fuera del rebajo 154. Por tanto, se impide el movimiento transversal del miembro de leva 136 por medio del pezón 186 del anillo de bloqueo 184, que está posicionado en el rebajo 154, y la palanca articulada 30 es bloqueada en su posición central.
Haciendo referencia a las figuras 16 a 18, el extremo distal del cuerpo alargado 14 incluye un mecanismo de bloqueo 190 de la varilla de control que es activado durante la inserción de una unidad de carga desechable en el cuerpo alargado 14. El mecanismo de bloqueo 190 de la varilla de control incluye una placa de bloqueo 192 que es solicitada distalmente por un muelle 194 y que incluye un dedo proximal 189 que tiene una superficie de leva angulada 195. Un miembro de acoplamiento semicircular 196 es solicitado transversalmente hacia la varilla de control 52 por un muelle 197. La varilla de control 52 incluye un rebajo anular 199 configurado para recibir el miembro de acoplamiento 196. La placa de bloqueo 192 es móvil desde una posición distal espaciada del miembro de acoplamiento 196 hasta una posición proximal situada detrás del miembro de acoplamiento 196. En la posición proximal se impide que el miembro de acoplamiento 196 sea solicitado hacia fuera del rebajo 199 por acoplamiento del mismo con la placa de bloqueo 192. Durante la inserción de una unidad de carga desechable 16 (véase la figura 1) en el extremo distal del cuerpo alargado 14, tal como se describirá seguidamente con más detalle, la superficie de leva 195 de la placa de bloqueo 192 es cogida por un pezón 254 (figura 30) de la unidad de carga desechable 16 mientras dicha unidad de carga desechable es hecha girar para acoplarse con el cuerpo alargado 14 a fin de empujar la placa 192 hasta la posición proximal. El miembro de acoplamiento 196, que está posicionado dentro del rebajo 199, es retenido en éste por la placa de bloqueo 192 mientras el pezón 254 se aplica a la superficie de leva 195 para impedir el movimiento longitudinal de la varilla de control 52 durante el montaje. Cuando la unidad de carga desechable 16 está apropiadamente posicionada con respecto al cuerpo alargado 14, el pezón 254 del extremo proximal de la unidad de carga desechable 16 se separa de la superficie de leva 195 permitiendo que el muelle 194 devuelva la placa de bloqueo 192 a su posición distal para permitir un movimiento longitudinal subsiguiente de la varilla de control 52. Es de hacer notar que, cuando el pezón de la unidad de carga desechable se separa de la superficie de leva 195, se produce un chasquido audible indicando que la unidad de carga desechable 16 está apropiadamente sujeta al cuerpo alargado 14.
Haciendo referencia a las figuras 19 y 20, la unidad de carga desechable 16 incluye una porción de alojamiento proximal 200 adaptada para acoplarse en forma liberable al extremo distal de la porción de cuerpo 14 (figura 1). Un conjunto de montaje 202 está asegurado de forma pivotante al extremo distal de la porción de alojamiento 200 y está configurado para recibir el extremo proximal del conjunto de utillaje 17 de tal manera que el movimiento pivotante del conjunto de montaje 202 alrededor de un eje perpendicular al eje longitudinal de la porción de alojamiento 200 efectúe la articulación del conjunto de utillaje 17.
Haciendo referencia a las figuras 21 a 26, el conjunto de utillaje 17 incluye preferiblemente un conjunto de yunque 20 y un conjunto de cartucho 18. El conjunto de yunque 20 incluye una porción de yunque 204 que tiene una pluralidad de cavidades 206 de deformación de grapas (figura 22) y una placa de cubierta 208 asegurada a una superficie superior de la porción de yunque 204 para definir una cavidad 210 (figura 24) entre ellas. La placa de cubierta 208 está prevista para impedir el pinzado de tejido durante el apriete y disparo del aparato grapador 10. La cavidad 210 está dimensionada para recibir un extremo distal de un conjunto de accionamiento axial 212 (véase la figura 27). Una ranura longitudinal 214 se extiende a través de la porción de yunque 204 para facilitar el paso de una pestaña de retención 284 del conjunto de accionamiento axial 212 hasta el interior de la cavidad de yunque 210. Una superficie de leva 209 formada en la porción de yunque 204 está posicionada para aplicarse al conjunto de accionamiento axial 212 para facilitar el apriete de tejido 198. Un par de miembros de pivote 211 formados en la porción de yunque 204 están posicionados dentro de ranuras 213 formadas en el portador 216 para guiar la porción de yunque entre las posiciones abierta y apretada. Un par de miembros de estabilización 215 se aplican a un hombro respectivo 217 formado en el portador 216 para impedir que la porción de yunque 204 se deslice axialmente con relación al cartucho de grapas 220 a medida que se deforma la superficie de leva 209.
El conjunto de cartucho 18 incluye un portador 216 que define un canal de soporte alargado 218. El canal de soporte alargado 218 está dimensionado y configurado para recibir un cartucho de grapas 220. Unas patillas 222 y unas ranuras 224 correspondientes formadas a lo largo del cartucho de grapas 220 y del canal de soporte alargado 218 funcionan para retener el cartucho de grapas 220 dentro del canal de soporte 218. Un par de puntales de soporte 223 formados en el cartucho de grapas 220 están posicionados para descansar sobre paredes laterales del portador 216 a fin de estabilizar aún más el cartucho de grapas 220 dentro del canal de soporte 218.
El cartucho de grapas 220 incluye ranuras de retención 225 para recibir una pluralidad de sujetadores 226 y empujadores 228. Una pluralidad de ranuras longitudinales espaciadas 230 se extienden a través del cartucho de grapas 220 para dar acomodo a cuñas de leva verticales 232 de un patín de actuación 234. Una ranura longitudinal central 282 se extiende a lo largo de la longitud del cartucho de grapas 220 para facilitar el paso de una hoja de cuchilla 280. Durante el funcionamiento de la grapadora quirúrgica 10, el patín de actuación 234 se traslada por las ranuras longitudinales 230 del cartucho de grapas 220 para hacer avanzar cuñas de leva 232 hasta posiciones de contacto secuencial con los empujadores 228 a fin de hacer que estos empujadores 228 se trasladen verticalmente dentro de las ranuras 224 y empujen sujetadores 226 pasándolos de las ranuras 224 a las cavidades 206 de deformación de grapas del conjunto de yunque 20.
Haciendo referencia a las figuras 27 y 28, el conjunto de montaje 202 incluye porciones de montaje superior e inferior 236 y 238. Cada porción de montaje incluye un taladro roscado 240 a cada lado de la misma, dimensionado para recibir pernos roscados 242 (véase la figura 21) destinados a asegurar el extremo proximal del portador 216 a la misma. Un par de miembros de pivote centralmente situados 244 (véase la figura 21) se extienden entre las porciones de montaje superior e inferior a través de un par de miembros de acoplamiento 246 que se aplican al extremo distal de la porción de alojamiento 200. Los miembros de acoplamiento 246 incluyen cada uno de ellos una porción proximal de enclavamiento 248 configurada para ser recibida en surcos 250 formados en el extremo proximal de la porción de alojamiento 200 a fin de retener el conjunto de montaje 202 y la porción de alojamiento 200 en una posición longitudinalmente fija con relación a la misma.
La porción de alojamiento 200 de la unidad de carga desechable 16 incluye una mitad de alojamiento superior 250 y una mitad de alojamiento inferior 252 contenidas dentro de una envuelta exterior 251. El extremo proximal de la mitad de alojamiento 250 incluye unos pezones de acoplamiento 254 destinados a acoplarse en forma liberable con el cuerpo alargado 14 y una punta de inserción 193. Los pezones 254 forman un acoplamiento del tipo de bayoneta con el extremo distal del cuerpo 14, lo cual se describirá seguidamente con mayor detalle. Las mitades de alojamiento 250 y 252 definen un canal 253 destinado a recibir en forma deslizable el conjunto de accionamiento axial 212. Una segunda barra de articulación 256 está dimensionada para ser posicionado en forma deslizable dentro de una ranura 258 formada entre las mitades de alojamiento 250 y 252. Un par de placas expulsoras 254 están posicionadas junto al extremo distal de la porción de alojamiento 200 adyacente al extremo distal del conjunto de accionamiento axial 212 para impedir el abultamiento hacia fuera del conjunto de accionamiento 212 durante la articulación del conjunto de utillaje 17.
Haciendo referencia a las realizaciones de las figuras 29 y 30, la segunda barra de articulación 256 incluye al menos una placa metálica alargada. Preferiblemente, dos o más placas metálicas están apiladas formando la barra articulada 256. El extremo proximal de la barra de articulación 256 incluye una porción de gancho 258 configurada para acoplarse con la primera barra de articulación 123 (véase la figura 9) y el extremo distal incluye un bucle 260 dimensionado para acoplarse con un saliente 262 formado en el conjunto de montaje 202. El saliente 262 está lateralmente desplazado respecto de la espiga pivote 244 de tal manera que el movimiento lineal de la segunda barra de articulación 256 hace que el conjunto de montaje 202 pivote alrededor de pasadores de pivote 244 para articular el conjunto de utillaje 17.
Haciendo referencia también a las figuras 31 a 34, el conjunto de accionamiento axial 212 incluye un vástago barra de accionamiento alargado 266 que tiene una cabeza de trabajo distal 268 y una sección de acoplamiento proximal 270. El vástago de accionamiento 266 puede estar construido de una sola lámina de material o, preferiblemente, de múltiples láminas apiladas. La sección de acoplamiento 270 incluye un par de dedos de acoplamiento 270a y 270b que están dimensionados y configurados para acoplarse en situación de montaje con un par de ranuras de retención correspondientes 272a y 272b formadas en el miembro de accionamiento 272. El miembro de accionamiento 272 incluye una portilla proximal 274 configurada para recibir el extremo distal 276 de la varilla de control 52 (véase la figura 35) cuando se acopla el extremo proximal de la unidad de carga desechable 16 con el cuerpo alargado 14 del aparato grapador quirúrgico 10.
El extremo distal del vástago de accionamiento 266 está definido por un puntal de soporte vertical 278 que soporta una hoja de cuchilla 280, y una superficie de apoyo 283 que se aplica a la porción central del patín de actuación 234 durante una operación de grapado. La superficie 285 en la base de la superficie 283 está configurada para recibir un miembro de soporte 287 posicionado en forma deslizable a lo largo del fondo del cartucho de grapas 220. La hoja de cuchilla 280 está posicionada para trasladarse ligeramente por detrás del patín de actuación 234 a través de una ranura longitudinal central 282 del cartucho de grapas 220 (figura 20) para formar una incisión entre filas de tejido corporal grapado. Una pestaña de retención 284 se proyecta distalmente desde el puntal vertical 278 y soporta un rodillo de leva cilíndrico 286 en su extremo distal. El rodillo de leva 286 está dimensionado y configurado para aplicarse a la superficie de leva 209 del cuerpo de yunque 204 para apretar la porción de yunque 204 contra el tejido corporal.
Haciendo referencia también a las figuras 36 a 39, un dispositivo de bloqueo 288 está asegurado de forma pivotante al miembro de accionamiento 270 alrededor de una espiga pivote 290. El miembro de bloqueo 288 incluye un par de deslizaderas alargadas 292 y 294 que definen un canal 296. Un alma 298 une una porción de las superficies superiores de las deslizaderas 292 y 294 y está configurada y dimensionada para ajustar dentro de la ranura alargada 298 formada en el vástago de accionamiento 266 en una posición distal respecto del miembro de accionamiento 270. Unas levas horizontales 300 y 302 se extienden desde las deslizaderas 292 y 294, respectivamente, y están acomodadas a lo largo de una superficie interior de la mitad de alojamiento inferior 252. Como se muestra de forma óptima en la figura 42, un muelle de torsión 304 está posicionado junto al miembro de accionamiento 270 y se aplica a las levas horizontales 300 y 302 del dispositivo de bloqueo 288 para solicitar normalmente al dispositivo de bloqueo 288 hacia abajo en dirección a la mitad de alojamiento inferior 252 y colocarlo sobre un lomo 310. El dispositivo de bloqueo 288 se traslada a través de la porción de alojamiento 200 con el conjunto de accionamiento axial 212. Se describirá seguidamente el funcionamiento del dispositivo de bloqueo 288.
Secuencia de funcionamiento
Haciendo referencia a las figuras 40 a 44, para utilizar el instrumento grapador 10 se asegura primero una unidad de carga desechable 16 al extremo distal del cuerpo alargado 14. Como se ha discutido anteriormente, el aparato grapador 10 puede utilizarse con unidades de carga desechables tanto articulantes como no articulantes que tengan filas lineales de grapas de entre aproximadamente 30 mm y aproximadamente 60 mm. Para asegurar la unidad de carga desechable 16 al cuerpo alargado 14, se inserta el extremo distal 276 de la varilla de control 52 en la punta de inserción 193 de la unidad de carga desechable 16 y se desliza la punta de inserción 193 longitudinalmente hacia dentro del extremo distal del cuerpo alargado 14 en la dirección indicada por la flecha "A" en la figura 1 de tal manera que la porción de gancho 258 de la segunda barra de articulación 256 se deslice dentro de un canal 314 del cuerpo alargado 14. Los pezones 254 se alinearán cada uno de ellos en un respectivo canal (no mostrado) del cuerpo alargado 14. Cuando la porción de gancho 258 se aplica a la pared proximal 312 del canal 314, se gira la unidad de carga desechable 16 en la dirección indicada por la flecha "B" en las figuras 41 a 44 para mover la porción de gancho 258 de la segunda barra de articulación 256 hacia una posición de acoplamiento con el dedo 164 de la primera barra de articulación 123. Los pezones 254 forman también un acoplamiento del tipo de bayoneta dentro del canal anular 314 del cuerpo 14. Durante la rotación de la unidad de carga 16, los pezones 258 se aplican a la superficie de leva 195 (figura 41) de la placa de bloqueo 192 para mover inicialmente dicha placa 192 en la dirección indicada por la flecha "C" en las figuras 41 y 43 a fin de bloquear el miembro de acoplamiento 196 dentro del rebajo 199 de la varilla de control 52 para impedir un movimiento longitudinal de dicha varilla de control 52 durante la fijación de la unidad de carga desechable 16. Durante el grado final de rotación, los pezones 254 se desacoplan de la superficie de leva 195 para permitir que la placa de bloqueo 192 se mueva en la dirección indicada por la flecha "D" de las figuras 42 y 44 desde detrás del miembro de acoplamiento 196 para permitir una vez más un movimiento longitudinal de la varilla de control 52.
Haciendo referencia a las figuras 43 y 43a, cuando se aplica la punta de inserción 193 al extremo distal del tubo sensor 176, se activa el mecanismo sensor de la unidad de carga desechable. La punta de inserción 193 se aplica al tubo sensor 176 y lo mueve proximalmente en la dirección indicada por la flecha "E" en la figura 43. Como se ha discutido anteriormente, el movimiento proximal del tubo sensor 176 efectúa un movimiento proximal del cilindro sensor 178 y de la barra articulada sensora 182 en la dirección indicada por la flecha "E" en la figura 43a para hacer que el miembro de bloqueo 83 pivote en sentido levógiro, según se indica por la flecha "Y" en la figura 43a, desde una posición de ausencia de bloqueo a un movimiento de bloqueo de posición del árbol de actuación 46.
Haciendo referencia a las figuras 46 a 49, con una unidad de carga desechable fijada al instrumento grapador 10, el conjunto de utillaje 17 puede ser posicionado alrededor del tejido 320 (figura 45). Para aprisionar el tejido entre el conjunto de yunque 20 y el conjunto de cartucho 18, se mueve el mango estacionario 24 en la dirección indicada por la flecha "E" en la figura 46 en contra de la solicitación del muelle de torsión 40 para mover el trinquete de accionamiento 42 en el sentido de acoplarlo con el hombro 322 del árbol de actuación 46. El acoplamiento entre el hombro 322 y el trinque de accionamiento 42 hace que avance el árbol de actuación 46 y, por tanto, que avance la varilla de control 52 en dirección distal. La varilla de control 52 está conectada en su extremo distal al conjunto de accionamiento axial 212 (figura 48), que incluye el vástago de accionamiento 266, de tal manera que el movimiento distal de la varilla de control 52 efectúe un movimiento distal del vástago de accionamiento 266 en la dirección indicada por la flecha "F" en las figuras 48 y 49, moviendo el rodillo de leva 286 en el sentido de acoplarse con la superficie de leva 209 de la porción de yunque 204 para empujar dicha porción de yunque 204 en la dirección indicada por la flecha "G" en la figura 49. Es de hacer notar que una carrera completa del mango móvil 24 hace que avance el árbol de actuación 46 aproximadamente 15 mm, lo cual es suficiente para aprisionar el tejido durante la primera carrera, pero no para disparar grapas.
Como se ha discutido anteriormente con respecto al mecanismo de embrague antirreversión, durante la primera carrera (aprisionamiento) del mango móvil 24, la placa de corredera 102 (figura 46) impide que el trinquete de bloqueo 54 engrane con la cremallera dentada 48. Para mantener el árbol de accionamiento 46 en su posición longitudinal después de que se suelta el mango 24, está previsto un miembro de acoplamiento 324 (figura 47) en el miembro de bloqueo 83 para que se aplique al hombro 326 del árbol de actuación 46 y retenga dicho árbol 46 en su posición longitudinal (véase la figura 47). Tras la liberación del mango móvil 24, el trinquete de accionamiento 42 se mueve sobre la cremallera 48 a medida que el muelle de torsión 40 hace que el mango 24 retorne a una posición espaciada del mango estacionario 22. En esta posición, el trinquete de accionamiento 42 es empujado en el sentido de engranar con la cremallera dentada 48 para retener el árbol de actuación 46 en su posición longitudinal fija.
Para disparar grapas, se actúa otra vez sobre el mango móvil 24, es decir, se le mueve a lo largo de otra carrera. Como se ha discutido anteriormente, el aparato grapador 10 es capaz de recibir unidades de carga desechables que tengan filas lineales de grapas de entre aproximadamente 30 mm y aproximadamente 60 mm. Dado que cada carrera del mango móvil 24 hace preferiblemente que avance el árbol de actuación 46 en 15 mm, y se requiere una carrera para aprisionar tejido, el mango móvil ha de ser actuado en (n+1) carreras para disparar grapas, siendo n la longitud de las filas lineales de grapas en la unidad de carga desechable fijada al instrumento grabador 10 dividida por 15 mm.
Haciendo referencia a la figura 50, antes de que se puedan disparar grapas, se tiene que activar el conjunto de bloqueo antidisparo 80 (figura 4) para mover la superficie de bloqueo 88 desde su posición de bloqueo (figura 47) a una posición de ausencia de bloqueo. Esto se consigue presionando hacia abajo sobre el émbolo buzo 82 para mover la superficie de leva 85 hacia una posición de acoplamiento con paredes laterales de la ranura 89 del miembro de bloqueo 83 a fin de pivotar dicho miembro de bloqueo 83 en la dirección indicada por la flecha "G" en la figura 50 (véase también la figura 5). Seguidamente, se puede actuar sobre el mango móvil 24 durante un número apropiado de carreras para hacer avanzar distalmente el árbol de actuación 46, y, por tanto, la varilla de control 52 y el vástago de accionamiento 266, en la dirección indicada por la flecha "H" en las figuras 51 y 52 a fin de hacer avanzar el patín de actuación 234 a través del cartucho de grapas 220 para efectuar la eyección de las grapas. Es de hacer notar que, después de la primera carrera o carrera de aprisionamiento del mango móvil 54 (durante la segunda carrera), la corredera 102 pasa sobre el trinquete de bloqueo 54 permitiendo que el muelle de torsión 56 mueva dicho trinquete de bloqueo 54 en la dirección indicada por la flecha "I" en la figura 5 hasta una posición de engrane con la cremallera dentada 48 para retener el árbol de actuación 46 en su posición longitudinal.
Haciendo referencia a la figura 53, para retraer el árbol de actuación 46 y, por tanto, la varilla de control 52 y el miembro de accionamiento 266 después de disparar grapas, se tira proximalmente de los mandos de retracción 32 (véase la figura 1) haciendo que las espigas 66 muevan la placa de liberación 64 en la dirección indicada por la flecha "J" en la figura 53 sobre los dientes 48 para desacoplar el trinquete de accionamiento 42 de su engrane con los dientes 48. Como se ha discutido anteriormente, con respecto al mecanismo de embrague antirreversión, el trinquete de bloqueo 54 es empujado por la placa de corredera 102 hacia fuera de su posición de engrane con la cremallera dentada 48 (no mostrado) para permitir que se mueva proximalmente el árbol de actuación 46, en la dirección indicada por la flecha "L", después de que el trinquete de accionamiento 42 se desacople de los dientes 48.
Haciendo referencia a la figura 54, para retraer el árbol de actuación 46 antes de disparar el aparato grapador, es decir, cuando el trinquete de bloqueo está engranado en ese momento con la cremallera dentada 48, se empuja el botón de retorno de emergencia 112 en la dirección indicada por la flecha "Z" en la figura 54 para desacoplar el trinquete de bloqueo 54 de la cremallera dentada 48. Se ha de tirar también concurrentemente de los mandos de retracción 32 (figura 1) hacia atrás, tal como se ha discutido anteriormente, para liberar el trinquete de bloqueo 42 de la cremallera 48.
Haciendo referencia a las figuras 56 a 61, cuando se asegura una unidad de carga desechable articulante al cuerpo alargado 14 y se pivota la palanca de articulación 30 en la dirección indicada por la flecha "M" en la figura 55, el miembro de leva 136 es movido transversalmente por el saliente 142 (figura 10) en la dirección indicada por la flecha "N" entre las pestañas 170 y 172 del mando de rotación 28. Dado que el miembro de traslación 138 es impedido de girar por las crestas 156 (figura 13), la espiga 166, que está fijamente asegurada al miembro de traslación 138, es obligada a moverse a lo largo de la superficie de leva escalonada 148. El movimiento de la espiga 166 produce un movimiento correspondiente del miembro de traslación 138 en la dirección indicada por la flecha "P" en las figuras 55 y 56 para hacer avanzar la primera barra de articulación 123 en la dirección distal. El extremo distal de la primera barra de articulación 123 se aplica al extremo proximal de la segunda barra de articulación 256 (figura 42), que está conectado al saliente 262 del conjunto de montaje 202 para hacer avanzar la segunda barra articulada 256 en la dirección indicada por la flecha "Q" en la figura 57. El saliente 262 está lateralmente desplazado respecto de los miembros de pivote 244, de tal manera que el avance distal de la segunda barra de articulación 256 hace que el conjunto de montaje 202 y, por tanto, el conjunto de utillaje 17 pivoten en la dirección indicada por la flecha "R" en las figuras 57 y 58. Obsérvese en la figura 59 que el miembro de rotación 28 puede ser hecho girar para que el cuerpo alargado 14 gire alrededor de su eje longitudinal mientras se articula el conjunto de utillaje 17.
Las figuras 60 y 61 ilustran la articulación del conjunto de utillaje 17 en la dirección opuesta a la descrita anteriormente. Cuando la segunda barra de articulación 256 es retraída por el giro de la palanca de articulación 30 en sentido levógiro (no mostrado), como se ve en la figura 55, el pasador 66 es obligado a moverse proximalmente a lo largo de la superficie de leva escalonada 148, moviendo proximalmente al miembro de traslación 138 y a la primera barra de articulación 123. El movimiento de la primera barra de articulación 123 en dirección proximal hace que la segunda barra de articulación 256 se mueva proximalmente, como se indica por la flecha "S" en la figura 58, para hacer girar el conjunto de utillaje 17 en sentido dextrógiro, según se indica por la flecha "T" en la figura 61.
Haciendo referencia a la figura 12, el movimiento de la espiga 166 (figura 9) entre porciones de escalón adyacentes 340 hace que el conjunto de utillaje 19 se articule en 22,5 grados. La superficie de leva 148 incluye cinco porciones de escalón 340. La tercera porción de escalón corresponde a la posición del conjunto de utillaje no articulado, mientras que las porciones de escalón primera y quinta corresponden a la articulación del conjunto de utillaje 17 hasta 45 grados. Cada porción de escalón es plana para retener la palanca de articulación 30 en una posición fija cuando se aplica a ella el pasador 66.
Haciendo referencia ahora a las figuras 37, 39, 62 y 63, se describirá con detalle la secuencia de la operación de bloqueo. En la figura 39 se muestra el dispositivo de bloqueo 288 en su posición predisparada con las levas horizontales 300 y 302 descansando encima de los salientes 330 formados en las paredes laterales de la mitad de alojamiento inferior 252 (figura 37). En esta posición se mantiene el dispositivo de bloqueo 288 en situación de fuera de alineación con el saliente 332 formado en la superficie inferior de la mitad de alojamiento inferior 252, y el alma 298 está en yuxtaposición longitudinal con el estante 334 definido en el vástago de accionamiento 266. Esta configuración permite que el yunque 20 (figura 38) sea abierto y reposicionado sobre el tejido a grapar hasta que el cirujano esté satisfecho con la posición sin activar el dispositivo de bloqueo 288 para inhabilitar la unidad de carga desechable 16.
Como se muestra en la figura 62, al producirse el movimiento distal del vástago de accionamiento 266, el dispositivo de bloqueo 288 corre separándose de los salientes 330 (no mostrados) y es solicitado hacia una posición de acoplamiento con la base de la mitad de alojamiento inferior 252 por el muelle 304, distal con respecto al saliente 332. El dispositivo de bloqueo 288 permanece en esta configuración durante todo el proceso de disparo del aparato.
Al retraer el vástago de accionamiento 266 en la dirección indicada por la flecha "U" de la figura 62, el dispositivo de bloqueo 288 pasa por debajo de los salientes 330 y corre sobre el saliente 332 hasta que la porción más distal del dispositivo de bloqueo 288 es proximal con respecto al saliente 332. El muelle 304 solicita el dispositivo de bloqueo 288 hacia una posición de alineación yuxtapuesta con el saliente 332, inhabilitando efectivamente la unidad de carga desechable. Si se hace un intento de volver a activar el aparato, la varilla de control 52 se apoyará en una superficie extrema proximal del dispositivo de bloqueo 288, cuya superficie está diagonalmente inclinada para impartir un par de giro alrededor de la espiga pivote 342 de tal manera que el extremo distal del dispositivo de bloqueo 288 sea empujado con movimiento rotativo hacia una posición de contacto con el saliente 332. La fuerza distal continuada en la dirección indicada por la flecha "W" en la figura 63 servirá solamente para incrementar el par aplicado al dispositivo de bloqueo, y así este dispositivo de bloqueo se apoyará en el saliente 332 e inhibirá el movimiento distal de la varilla de control 52.
Haciendo referencia otra vez a las figuras 41 a 44, la unidad de carga desechable inhabilitada o bloqueada puede ser retirada del extremo distal del cuerpo alargado 14 haciendo girar dicha unidad de carga desechable 16 en la dirección opuesta a la dirección indicada por la flecha "B" en las figuras 41, 42 y 44, para dar lugar a que la porción de gancho 258 de la segunda barra de articulación 256 se separe del dedo 164 de la primera barra de articulación 123 y para extraer los pezones 254 de dentro del canal 314 del cuerpo alargado 14. Después de la rotación, la unidad de carga desechable 16 puede ser deslizada en la dirección opuesta a la indicada por la flecha "A" en la figura 41 para separar el cuerpo 14 de la unidad de carga desechable 16. Seguidamente, se pueden asegurar unidades de carga desechable articulantes y/o no articulantes al extremo distal del cuerpo alargado, según se ha descrito anteriormente, para realizar intervenciones quirúrgicas adicionales de grapado y/o de corte. Como se ha discutido anteriormente, cada unidad de carga desechable puede incluir filas lineales de grapas que varían de aproximadamente 30 mm a aproximadamente
60 mm.
Se entenderá que pueden hacerse diversas modificaciones a las realizaciones descritas en esta memoria. Por ejemplo, el aparato grapador no necesita aplicar grapas, sino que, por el contrario, puede aplicar sujetadores de dos partes, tal como es conocido en la materia. Además, la longitud de la fila lineal de grapas o sujetadores puede ser modificada para satisfacer los requisitos de una intervención quirúrgica particular. Por tanto, la longitud de una sola carrera del árbol de actuación y/o la longitud de la fila lineal de grapas y/o sujetadores dentro de una unidad de carga desechable pueden ser variadas de manera correspondiente. Por tanto, la descripción anterior no deberá interpretarse como limitativa, sino meramente como ejemplificaciones de realizaciones preferidas. Los expertos en la materia contemplarán otras modificaciones dentro del alcance de las reivindicaciones adjuntas a esta memoria.

Claims (18)

  1. \global\parskip0.900000\baselineskip
    1. Un aparato grapador quirúrgico (10) que comprende:
    a)
    un alojamiento (36);
    b)
    un mango móvil (24) soportado por el alojamiento (36), pudiendo moverse el mango móvil (24) a lo largo de una carrera de actuación;
    c)
    un cuerpo alargado (14) que se extiende distalmente desde el alojamiento (36) y que define un eje longitudinal, teniendo el cuerpo alargado (14) un extremo distal adaptado para aplicarse de manera liberable a una unidad de carga desechable (16);
    d)
    un conjunto de avance que incluye un árbol del actuación (46), un trinquete de accionamiento (42) y un trinquete de bloqueo (54), teniendo el árbol del actuación (46) una cremallera dentada (48) y apoyándose, por lo menos en parte, dentro del alojamiento (36), estando el trinquete de accionamiento (42) operativamente asociado con el mango movible (24) y que se puede mover en el acoplamiento con la cremallera (48) para efectuar el avance longitudinal del árbol de actuación (46) durante la carrera o recorrido de actuación, estando el trinquete de bloqueo (54) desviado en el acoplamiento con la cremallera (48) para retener el árbol del actuación (46) en una posición fijada longitudinalmente; caracterizado porque el aparato grapador quirúrgico (10) además comprende
    e)
    un mecanismo de embrague antirreversión que incluye un conjunto de engranaje y una placa de corredera (102), estando el conjunto de engranaje colocado para convertir el movimiento del árbol de actuación (46) en el movimiento de la placa de corredera (102), teniendo la placa de corredera (102) una superficie de leva (108) y que es movible, en respuesta al avance longitudinal del árbol de actuación (46), desde una primera posición en la que la superficie de leva (108) se acopla con el trinquete de bloqueo (54) para impulsar el trinquete de bloqueo (54) fuera del acoplamiento con la cremallera (48) hasta una segunda posición en que la superficie de leva (108) se separa del trinquete de bloqueo (54).
  2. 2. Un aparato grapador quirúrgico (10) según la reivindicación 1, en el que el conjunto de engranaje incluye una primera rueda dentada o engranaje (94) y una segunda rueda dentada o engranaje (98) conectadas operativamente entre sí, el árbol de actuación (46) y la placa de corredera (102) teniendo, cada una de ellas, una serie o juego de dientes de engrane, estando la primera rueda dentada o engranaje (94) colocada para engranarse con los dientes de engrane (106) de la placa de corredera de manera que el avance longitudinal del árbol de actuación (46) se traduce o convierte en el avance longitudinal de la placa de corredera (102) durante por lo menos una parte del avance longitudinal del árbol de actuación (46).
  3. 3. Un aparato grapador quirúrgico (10) según la reivindicación 2, que incluye además una espiga pivote 57, montada de manera fija dentro del alojamiento (36), en el que la placa de corredera (102) incluye una ranura alargada (104) configurada para recibir la espiga pivote (57), estando dicha espiga pivote (57) colocada para lindar con los extremos de la ranura (104) para limitar o restringir el avance longitudinal de la placa de corredera (102).
  4. 4. Un aparato grapador quirúrgico (10) según la reivindicación 3, en el que la primera rueda dentada o engranaje (94) está montada de manera giratoria en un primer árbol (96) y la segunda rueda dentada o engranaje (98) está giratoriamente montada en un segundo árbol (100), estando dichos primer árbol (96) y segundo árbol (100) operativamente conectados entre sí mediante un embrague de muelle o resorte, permitiendo dicho embrague de muelle o resorte girar al primer árbol (96) de manera independiente con respecto al segundo árbol (100) después de que la espiga pivote (57) prevenga el avance longitudinal posterior de la placa de corredera (102).
  5. 5. Un aparato grapador quirúrgico (10) según la reivindicación 4, en el que el árbol de actuación (46) incluye primeros (110a) y segundos (110b) juegos de dientes de engrane, estando colocados dichos primer (110a) y segundo (110b) juegos de engrane para engranar con la primera rueda dentada o engranaje (94) durante, por lo menos, una parte del avance longitudinal del árbol de actuación (46), estando el primer juego de dientes de engrane (110a) colocado en el árbol de actuación (46) para avanzar longitudinalmente la placa de corredera (102) desde una posición en la que la superficie de leva (108) se acopla con el trinquete de bloqueo (54) hasta una posición en la que la superficie de leva (108) se separa del trinquete de bloqueo (54) y el segundo juego de dientes de engrane (110b) está colocado en el árbol de actuación (46) para hacer regresar a la placa de corredera (102) de manera proximal durante la retracción del árbol de actuación (46) desde una posición en la que la superficie de leva (108) está separada del trinquete de bloqueo (54) hasta una posición en la que la superficie de leva (108) se acopla con el trinquete de bloqueo (54) para impulsar el trinquete de bloqueo (54) fuera del acoplamiento de la corredera (48).
  6. 6. Un aparato grapador quirúrgico (10) según una cualquiera de las reivindicaciones 1 a 5, que comprende además:
    un mecanismo de retracción (58) que incluye una placa de liberación (64) asociada operativamente con el árbol de actuación (46), pudiendo moverse la placa de liberación con relación al árbol de actuación (46) hacia una posición de acoplamiento operativo con el trinquete de accionamiento (42) para separar o desacoplar dicho trinquete de accionamiento (42) de la cremallera (48).
    \global\parskip1.000000\baselineskip
  7. 7. Un aparato grapador quirúrgico (10) según la reivindicación 6, en el que
    el mecanismo de retracción (58) además incluye por lo menos un mando retractor (32) colocado externamente en el alojamiento (36), estando al menos un mando retractor (32) operativamente conectado con la placa de liberación (64) y que sea móvil para mover la placa de liberación (64) en el acoplamiento con el trinquete de accionamiento (42).
  8. 8. Un aparato grapador quirúrgico (10) según la reivindicación 7, en el que la placa de liberación (64) incluye por lo menos una ranura de leva (68) y el árbol de actuación (46) tiene una espiga o pasador (66) colocado dentro de cada ranura de leva (68), estando conectada la placa de liberación (64) al menos a un mando retractor (32) mediante una varilla de acoplamiento (60) de manera que el movimiento de la varilla de acoplamiento (60) ocasiona que la placa de liberación (64) se mueva en relación con el árbol de actuación (46) haciendo que el pasador o espiga (66) leve la placa de liberación (64) en el acoplamiento con el trinquete de accionamiento (42).
  9. 9. Un aparato grapador quirúrgico (10) según la reivindicación 7 o la reivindicación 8, en el que el trinquete de accionamiento (42) incluye un ala de extensión lateral (43a, 43b), siendo móvil la placa de liberación (64) en el acoplamiento con el ala de extensión lateral (43a, 43b) para desacoplar el trinquete de accionamiento (42) de la cremallera (48).
  10. 10. Un aparato grapador quirúrgico (10) según una cualquiera de las reivindicaciones 1 a 9, que comprende además:
    una unidad de carga (16) soportada en el extremo distal del cuerpo alargado (14), incluyendo la unidad de carga (16) una porción de alojamiento proximal (200) y un conjunto de utillaje distal (17), teniendo la porción de alojamiento proximal (200) un eje longitudinal coincidente con el eje longitudinal del cuerpo alargado (14) y una primera barra de articulación (256) conectada operativamente al conjunto de utillaje distal (17), estando el conjunto de utillaje distal (17) asegurado de manera pivotable a la porción de alojamiento proximal (200); y
    un mecanismo de articulación (120) que incluye una palanca (30) y un miembro de leva (136), estando la palanca (30) conectada operativamente al miembro de leva (136), estando el miembro de leva (136) conectado operativamente a la primera barra de articulación (256) e incluyendo una ranura de leva escalonada (148), en donde la palanca (30) es móvil para articular el conjunto de utillaje (17) con relación al eje longitudinal de la porción de alojamiento proximal (200), definiendo cada escalón de la ranura de leva escalonada (148) una posición articulada predeterminada del conjunto de utillaje (17).
  11. 11. Un aparato grapador quirúrgico (10) según la reivindicación 10, en el que el conjunto de articulación (120) incluye además un miembro de traslación (138) que incluye una espiga (166) que tiene un primer extremo asegurado al miembro de traslación (138) y un segundo extremo dimensionado para ser recibido dentro de la ranura de leva escalonada (148), estando el extremo distal del miembro de traslación (138) conectado operativamente a la primera barra de articulación (256).
  12. 12. Un aparato grapador quirúrgico (10) según la reivindicación 11, en el que la palanca de articulación (30) está montada de forma pivotable junto al extremo distal del alojamiento (36).
  13. 13. Un aparato grapador quirúrgico (10) según la reivindicación 12, en el que el miembro de leva (136) está confinado a realizar movimientos en una dirección sustancialmente perpendicular al eje longitudinal del cuerpo alargado (14) y el miembro de traslación (138) está confinado a realizar movimientos en una dirección sustancialmente paralela al eje longitudinal del cuerpo alargado (14).
  14. 14. Un aparato grapador quirúrgico (10) según las reivindicaciones 12 ó 13, en el que el mecanismo de articulación (120) incluye además una segunda barra de articulación (123), teniendo la segunda barra de articulación (123) un extremo distal acoplado operativamente con un extremo proximal de la primera barra de articulación (256) y un extremo proximal acoplado operativamente con el miembro de traslación (138).
  15. 15. Un aparato grapador quirúrgico (10) según una cualquiera de las reivindicaciones 1 a 9, que comprende además:
    un conjunto de mango (12) que incluyen el mango móvil (24), en el que el cuerpo alargado (14) se extiende distalmente desde el conjunto de mango (12) y que tiene su extremo distal adaptado para acoplar de manera liberable ambos tipos de unidades de carga desechables, articulantes y no articulantes, y el árbol de actuación (46) es soportado, al menos en parte, dentro del conjunto de mango (12);
    un mecanismo de articulación (120) que incluye una palanca de articulación (30) montada junto al conjunto de mango (12) y a una barra de articulación (123), teniendo la barra de articulación (123) un extremo proximal operativamente conectado a la palanca de articulación (30) y un extremo distal colocado junto al extremo distal del cuerpo alargado (14); y
    un mecanismo sensor colocado dentro del cuerpo alargado (14) y asociado operativamente con el mecanismo de articulación (120), incluyendo el mecanismo sensor un miembro sensor (182) para percibir el tipo de unidad de carga desechable (16) acoplada con el cuerpo alargado (14).
  16. 16. Un aparato grapador quirúrgico (10) según la reivindicación 15, en el que el miembro sensor (182) está posicionado en forma móvil dentro del cuerpo alargado (14), pudiendo moverse el miembro sensor (182) hasta una primera posición en respuesta al acoplamiento de una unidad de carga desechable no articulante con el cuerpo alargado (14) y hasta una segunda posición en respuesta al acoplamiento de una unidad de carga desechable articulante con el cuerpo alargado (14).
  17. 17. Un aparato grapador quirúrgico (10) según la reivindicación 16, en el que, en la primera posición, el mecanismo sensor está operativamente acoplado con el mecanismo de articulación (120) para impedir el movimiento de la palanca de articulación (30).
  18. 18. Un aparato grapador quirúrgico (10) según la reivindicación 17, en el que el mecanismo de articulación (120) incluye un miembro de leva (136) que tiene una ranura de leva escalonada (148), estando el miembro de leva (136) posicionado operativamente entre la palanca de articulación (30) y la barra de articulación (123).
ES06023618T 1997-09-23 1998-09-18 Aparato grapador quirurgico. Expired - Lifetime ES2335523T3 (es)

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