ES2357343T3 - Yunque con parte superior inclinable para un dispositivo de sujeción quirúrgico. - Google Patents
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Abstract
Un conjunto (10, 200) de yunque con parte superior inclinable para un dispositivo de sujeción quirúrgico, que comprende: una cabeza (14, 214) de yunque; una varilla central (18, 218); un miembro de solicitación (41) posicionado para empujar la cabeza de yunque hacia la posición inclinada de perfil reducido; en donde la cabeza de yunque está fijada pivotablemente a la varilla central y es pivotable entre una posición de disparo operativa y una posición inclinada de perfil reducido; caracterizado por: un miembro de apoyo (54, 254) posicionado en el conjunto de yunque; siendo móvil axialmente el miembro de apoyo a lo largo de la varilla central para mover la cabeza de yunque desde la posición inclinada de perfil reducido hasta la posición de disparo operativa.
Description
ANTECEDENTES
1.-Campo técnico
La presente descripción se refiere a un conjunto de yunque para uso en un dispositivo grapador quirúrgico. Más particularmente, la presente descripción se refiere a un conjunto de yunque que tiene un cabeza de yunque normalmente 5 inclinada que se puede usar con un instrumento grapador quirúrgico abierto o con uno mínimamente invasivo para efectuar anastomosis circular de órganos de tejido hueco.
2.- Antecedentes de la técnica relacionada
La anastomosis es la unión quirúrgica de secciones de órganos huecos independientes para permitir que las secciones se intercomuniquen unas con otras. Típicamente, una intervención de anastomosis sigue a una cirugía en la que 10 se retira una sección enferma o defectuosa de tejido hueco y se han de unir las secciones extremas restantes. Dependiendo de la intervención de anastomosis deseada, las secciones extremas pueden unirse según métodos de reconstrucción de órganos circular, de extremo con extremo, de extremo con lado o de lado con lado.
En una intervención de anastomosis circular, los dos extremos de las secciones de órgano se unen por medio de un instrumento grapador que impulsa una formación circular de grapas a través de las secciones extremas de órgano y 15 simultáneamente ennuclea y retira cualquier tejido solapado para liberar un pasadizo tubular. En algunas aplicaciones de una intervención de anastomosis circular, una varilla de yunque que tiene fijada una cabeza de yunque se monta en el extremo distal de un eje de instrumento grapador quirúrgico antes de la inserción del instrumento en el tejido que se han de anastomizar. Sin embargo, en otras aplicaciones, es preferible utilizar una varilla de yunque desprendible que pueda montarse en el instrumento a continuación del posicionamiento del instrumento y del conjunto de yunque dentro de unas 20 secciones de tejido respectivas. En tales casos, el instrumento grapador y el conjunto de yunque se entregan por separado en el lugar de la intervención. Cada sección de tejido se fija entonces a un respectivo componente de yunque o de retención de grapa mediante una sutura de hilo fruncida. El conjunto de yunque se monta en el instrumento quirúrgico insertando una porción de montaje de la varilla de yunque dentro del extremo distal del instrumento de modo que un mecanismo de montaje dentro del instrumento se acople fijamente con la varilla. La preparación de las secciones de tejido que se han de unir y el 25 montaje de la varilla de yunque en el instrumento se realizan, preferiblemente, usando técnicas quirúrgicas mínimamente invasivas, es decir, bajo guiado laparoscópico.
Una dificultad particular relativa al enfoque antes mencionado para realizar una anastomosis de órganos corporales huecos con un conjunto de yunque desprendible, ya se realice la anastomosis de manera laparoscópica o mediante otras técnicas quirúrgicas abiertas convencionales, se refiere a la entrega y colocación del conjunto de yunque en el lugar deseado 30 dentro del órgano hueco. Esta dificultad se atribuye, entre otros, al hecho de que el conjunto de yunque, particularmente la cabeza de yunque inmóvil rígida, presenta un perfil obstrusivo que se acopla con la pared interior del órgano hueco durante su avance a través del mismo. En algunos casos, la dimensión de la cabeza de yunque es mayor que la dimensión en sección transversal del órgano hueco a través del cual debe pasar. En consecuencia, el avance del conjunto de yunque a través del órgano hueco puede ser traumático y resulta dificultado y posiblemente impedido. Además, si la intervención 35 quirúrgica se realiza laparoscópicamente, la dificultad de maniobra del conjunto de yunque a través del órgano hueco puede requerir el abandono de tal enfoque laparoscópico y necesitar una conversión a una laparotomía convencional para finalizar la anastomosis.
Con el fin de reducir el perfil transversal del conjunto de yunque durante la colocación y retirada del conjunto de yunque en un órgano hueco, se han desarrollado conjuntos de yunque que tienen una cabeza de yunque inclinable. Un 40 conjunto de yunque de esta clase se describe en la patente norteamericana número 6.053.390. La cabeza de yunque pivotable está bloqueada normalmente en la posición de disparo operativa. Tras el disparo del dispositivo grapador, se libera el cerrojo y se fuerza la cabeza de yunque hacia la posición inclinada por medio de un resorte.
El documento US 5.639.008 describe un conjunto de yunque para un instrumento de sujeción quirúrgico configurado de modo que el yunque pivote con relación a un eje de yunque después de disparar el instrumento de sujeción 45 quirúrgico. El preámbulo de las reivindicaciones independientes está basado en este documento.
El documento DE 196 00 519 describe un instrumento quirúrgico de sujeción que incluye un disco y un conducto de caña. Se emplean unos hilos de tracción para enderezar el disco con relación al conducto de caña y aproximar el disco al conducto de caña para su sujeción.
A pesar de las mejoras recientes de los instrumentos de anastomosis circular, aún existe la necesidad de un 50 conjunto de yunque mejorado que se pueda usar con un instrumento de anastomosis circular que incluya una cabeza de yunque que sea más fácil de entregar dentro de tejidos huecos que se van a unir, que pueda entregarse con menos contacto con tales tejidos y también que pivote automáticamente entre posiciones inclinada y operativa durante la entrega y retirada del instrumento en los tejidos.
SUMARIO
La presente invención proporciona un conjunto de yunque con parte superior inclinable y un dispositivo grapador quirúrgico según se define en las reivindicaciones independientes.
Según una realización de la presente invención, se proporciona un conjunto de yunque con parte superior inclinable para su uso con un dispositivo grapador quirúrgico con el fin de realizar anastomosis de extremo con extremo de tejido. El 5 conjunto de yunque con parte superior inclinable incluye una cabeza de yunque, una varilla central y un miembro de solicitación. La cabeza de yunque se fija de manera pivotante a la varilla central alrededor de un eje transversal que está desplazado con respecto al eje longitudinal de la varilla central. El miembro de solicitación está soportado sobre el conjunto de yunque en una posición en la que empuja la cabeza de yunque hacia una posición inclinada de perfil reducido. El conjunto de yunque incluye una primera superficie de apoyo que está conectada operativamente a la cabeza de yunque y 10 que es móvil hacia acoplamiento con una segunda superficie de apoyo formada en un dispositivo grapador quirúrgico durante la aproximación del conjunto de yunque para mover la cabeza de yunque desde la posición inclinada de perfil reducido hacia una posición de disparo operativa.
En una realización preferida, la varilla central incluye un taladro longitudinal. Un manguito exterior está posicionado deslizablemente dentro del taladro longitudinal y un manguito interior está posicionado deslizablemente dentro del manguito 15 exterior. Los manguitos interior y exterior están conectados pivotadamente a la cabeza de yunque por unas conexiones respectivas. El miembro de solicitación está posicionado dentro del taladro longitudinal para empujar el manguito interior hacia la cabeza de yunque con el fin impulsar la cabeza de yunque hacia la posición inclinada de perfil reducido. El manguito exterior incluye una primera superficie de apoyo que está posicionada para acoplarse con una segunda superficie de apoyo soportada sobre un dispositivo grapador quirúrgico cuando el conjunto de yunque se mueve desde una posición separada de 20 un conjunto de envuelta del dispositivo grapador quirúrgico hasta una posición aproximada en estrecha alineación con el conjunto de envuelta del dispositivo grapador quirúrgico. Tras el acoplamiento entre las superficies de apoyo primera y segunda y la aproximación continuada, se hace pivotar la cabeza de yunque desde la posición de perfil reducido hacia la posición de disparo operativa. Cuando el conjunto de yunque se mueve de nuevo hasta la posición separada, el miembro de solicitación empuja de vuelta a la cabeza de yunque hasta la posición inclinada de perfil reducido. De este modo, la cabeza 25 de yunque se mueve automáticamente hacia una posición inclinada de perfil reducido durante la entrega y retirada del instrumento en el lugar anastomático. Alternativamente, se contemplan otros mecanismos de varillaje articulados para hacer pivotar la cabeza de yunque desde la posición inclinada de perfil reducido hasta la posición de disparo operativa.
En otra realización preferida, un conjunto de envuelta del dispositivo grapador quirúrgico puede incluir un manguito anular posicionado en él. Preferiblemente, la segunda superficie de apoyo se forma en el manguito anular en una posición 30 que le permite acoplarse con la primera superficie de apoyo del conjunto de yunque. Alternativamente, el segundo apoyo puede posicionarse en otros lugares del dispositivo grapador quirúrgico.
BREVE DESCRIPCIÓN DE LOS DIBUJOS
Se describen a continuación realizaciones preferidas del conjunto de yunque con parte superior inclinable aquí revelado con referencia a los dibujos, en los que: 35
La figura 1 es una vista lateral de una realización preferida del conjunto de yunque con parte superior inclinable aquí revelado con la cabeza de yunque en la posición inclinada de perfil reducido;
La figura 1A es una vista en sección transversal parcial desde abajo del conjunto de yunque mostrado en la figura 1;
La figura 2 es una vista en sección transversal lateral del conjunto de yunque con parte superior inclinable mostrado en la figura 1 con la cabeza de yunque en la posición inclinada de perfil reducido; 40
La figura 3 es una vista en sección transversal lateral del conjunto de yunque con parte superior inclinable mostrado en la figura 1 con la cabeza de yunque posicionada entre la posición inclinada de perfil reducido y la posición de disparo operativa;
La figura 4 es una vista en sección transversal lateral del conjunto de yunque con parte superior inclinable mostrado en la figura 1 con la cabeza de yunque en la posición de disparo operativa; 45
La figura 5 es una vista en sección transversal lateral del conjunto de yunque con parte superior inclinable mostrado en la figura 1 con la cabeza de yunque posicionada en la posición inclinada de perfil reducido y fijada al conjunto de envuelta de una dispositivo grapador quirúrgico;
La figura 6 es una vista en sección transversal lateral del conjunto de yunque con parte superior inclinable mostrado en la figura 1 con la cabeza de yunque posicionada entre la posición inclinada de perfil reducido y la posición de 50 disparo operativa;
La figura 7 es una vista en sección transversal lateral del conjunto de yunque con parte superior inclinable mostrado en la figura 1 con la cabeza de yunque posicionada en la posición de disparo operativa;
La figura 8 es una vista lateral del conjunto de yunque con parte superior inclinable mostrado en la figura 1 con la cabeza de yunque posicionada en la posición de disparo operativa y fijada al conjunto de envuelta de un dispositivo grapador quirúrgico;
La figura 9 es una vista en perspectiva desde arriba del manguito anular del conjunto de envuelta de un dispositivo grapador quirúrgico con el que puede usarse el yunque superior de inclinada aquí descrito; 5
La figura 10 es una vista en sección transversal lateral del cuerpo del conjunto de envuelta mostrado en la figura 8;
La figura 11 es una vista superior del cuerpo del conjunto de envuelta mostrado en la figura 10;
La figura 12 es una vista en sección transversal lateral de otra realización preferida del conjunto de yunque con parte superior inclinable aquí descrito fijado al conjunto de envuelta de un dispositivo grapador quirúrgico, con la cabeza de yunque posicionada en la posición de disparo operativa; 10
La figura 13 es una vista en sección transversal lateral del conjunto de yunque con parte superior inclinable mostrado en la figura 12 con la cabeza de yunque en la posición inclinada de perfil reducido;
La figura 14 es una vista en perspectiva lateral del conjunto de yunque con parte superior inclinable mostrado en la figura 12 con la cabeza de yunque posicionada en la posición inclinada de perfil reducido y con un trocar retirable acoplado con la varilla central; y 15
La figura 15 es una vista en perspectiva lateral desde un lado diferente del conjunto de yunque con parte superior inclinable mostrado en la figura 14 con el trocar retirable extraído de la varilla central de yunque.
DESCRIPCIÓN DETALLADA DE REALIZACIONES PREFERIDAS
Se describirán ahora en detalle realizaciones preferidas del conjunto de yunque con parte superior inclinable aquí revelado haciendo referencia a los dibujos, en los que números de referencia iguales designan elementos idénticos o 20 correspondientes en cada una de las diversas vistas.
Haciendo referencia a las figuras 1 y 2, un conjunto 10 de yunque incluye un poste 12 de yunque, una cabeza 14 de yunque, una placa 16 de yunque, una varilla central 18, un manguito interior 20 y un manguito exterior 22. La cabeza 14 de yunque incluye un taladro pasante 24 situado centralmente dimensionado para recibir el poste 12 de yunque, un rebajo anular interior 26 y un rebajo anular exterior 28. El rebajo anular exterior 28 está configurado para recibir la placa 16 de 25 yunque. La placa 16 de yunque incluye una lengüeta 30 (figura 1A) que está dimensionada para ser recibida dentro de una ranura 32 formada en la cabeza 14 de yunque. La lengüeta 30 y la ranura 32 cooperan para posicionar la placa 16 de yunque en la orientación adecuada dentro del rebajo exterior 28. El rebajo anular interior 26 está configurado para recibir un anillo de corte 34 que incluye una abertura central dimensionada para ser posicionada alrededor del poste 12 de yunque y de una porción de la cabeza 14 de yunque que define el rebajo anular 26. 30
El poste 12 de yunque incluye un taladro transversal para recibir un miembro 38 de pivote. El miembro 38 de pivote conecta de manera pivotable el poste 12 de yunque a un extremo de la varilla central 18. Preferiblemente, el miembro 38 de pivote incluye un pasador o poste que define un eje transversal que está separado lateralmente del eje longitudinal “x” de la varilla central 18 de tal manera que la cabeza 14 de yunque pueda pivotar aproximadamente 90 grados desde una posición operativa (figura 4), en la que un plano definido por la superficie de contacto tejido de la cabeza 14 de yunque es 35 sustancialmente perpendicular al eje longitudinal de la varilla central 18, hasta una posición inclinada de perfil reducido (figura 2) en la que la cabeza 14 de yunque es sustancialmente paralela al eje longitudinal de la varilla central 18. Alternativamente, pueden incorporarse al conjunto de yunque otros tipos de miembros de pivote en una variedad de localizaciones con respecto al eje “x” de la varilla central.
La varilla central 18 incluye un taladro pasante 40 que tiene un primer extremo 42 y un segundo extremo 44. 40 Preferiblemente, el primer extremo 42 incluye al menos un taladro 46 dimensionado para recibir una sutura o similar con el fin de facilitar el posicionamiento del conjunto 10 de yunque dentro de un órgano hueco. El segundo extremo 44 del taladro pasante 40 está dimensionado para recibir deslizablemente el manguito interior 20 y el manguito exterior 22. El manguito exterior 22 está posicionado deslizablemente dentro del segundo extremo 44 del taladro pasante 40 y una porción del manguito interior 20 está posicionada deslizablemente dentro del manguito exterior 22. Un resorte o miembro de solicitación, 45 por ejemplo un resorte helicoidal 41, está posicionado en el segundo extremo 44 del taladro pasante 40 apoyándose en el manguito interior 20 para empujar el manguito interior 20 hasta una posición avanzada hacia el extremo distal de un conjunto 10 de yunque. Una biela de accionamiento 52 está conectada pivotablemente en un extremo al manguito exterior 22 y en el otro extremo al poste 12 de yunque. Una biela de retorno 50 está conectada pivotablemente en un extremo al manguito interior 20 y en el otro extremo al poste 12 de yunque. El manguito exterior 22 incluye un apoyo 54 (figura 4) que se 50 expondrá con mayor detalle a continuación.
La varilla central 18 está dimensionada para acoplarse desprendiblemente con un fiador de yunque (no mostrado) de un dispositivo grapador quirúrgico de anastomosis circular. Un dispositivo grapador quirúrgico de esta clase que tiene un fiador de yunque y con el que puede usarse el conjunto 10 de yunque se describe en la solicitud de patente WO
20021080781. La varilla central 18 incluye un saliente anular 56 que está dimensionado para acoplarse de manera bloqueante con el fiador de yunque. Un collar 60 de guía está formado monolíticamente con la varilla central 18. Alternativamente, el collar 60 de guía puede incluir un manguito que esté formado separadamente de la varilla central 18. El collar 60 de guía incluye ranurados circunferencialmente separados 62 cuya función es alinear el conjunto 10 de yunque con el conjunto 100 de envuelta (figuras 5-8) del dispositivo grapador quirúrgico durante el movimiento del conjunto de yunque 5 desde una posición separada de un conjunto de envuelta del dispositivo grapador quirúrgico hasta una posición aproximada en estrecha alineación con el conjunto de envuelta.
El manguito interior 20 es móvil entre una posición avanzada y una posición retraída. El miembro de solicitación 41 del manguito interior empuja normalmente el manguito interior 20 hacia la posición avanzada. En la posición avanzada, la biela de retorno 50 se mueve hacia la cabeza 14 de yunque para hacer pivotar la cabeza 14 de yunque, alrededor del 10 miembro 38 de pivote, hasta la posición inclinada de perfil reducido (figura 2).
Haciendo referencia a las figuras 5-8, el conjunto 10 de yunque se mueve hasta la posición operativa haciendo avanzar el apoyo 54 del manguito exterior 22 hacia la cabeza 14 de yunque. Esto tendrá lugar automáticamente cuando el conjunto 10 de yunque sea fijado al fiador de yunque de un dispositivo grapador quirúrgico y el dispositivo sea aproximado. Más específicamente, durante la aproximación de un dispositivo grapador quirúrgico, el apoyo 54 se acopla con un apoyo 70 15 posicionado sobre o dentro del conjunto 100 de envuelta de un dispositivo grapador quirúrgico para hacer avanzar el manguito exterior 22 en la dirección indicada por la flecha “A” en las figuras 5 y 6 hacia el cabeza 14 de yunque. El apoyo 70 puede disponerse sobre un manguito anular 80 destinado a ser encajado dentro del conjunto de envuelta de un dispositivo grapador quirúrgico. El movimiento del manguito exterior 22 hacia la cabeza 14 de yunque hace avanzar la biela de accionamiento 52 hacia la cabeza 14 de yunque contra la solicitación del miembro de solicitación 41 del manguito interior en 20 la dirección indicada por la flecha “B” de la figura 6 desde la posición inclinada de perfil reducido (figura 5) hasta la posición de disparo operativa (figura 7). Posteriormente, cuando el dispositivo grapador quirúrgico se mueve desde la posición aproximada hasta la posición no aproximada o separada y el apoyo 54 se mueve distalmente abandonando el acoplamiento con el apoyo 70, el miembro de solicitación 41 del manguito interior devolverá el conjunto 10 de yunque a su posición inclinada de perfil reducido. 25
Haciendo referencia a las figuras 5-11, se ilustra una realización preferida de un manguito anular 80 que incluye el apoyo 70. El manguito anular 80 incluye una primera porción de cuerpo cilíndrica 82 y una segunda porción de cuerpo cilíndrica 84. La segunda porción de cuerpo cilíndrica 84 tiene un diámetro mayor que el de la primera porción de cuerpo cilíndrica 82 de tal manera que se define un resalto 86 en una pared interna del manguito 80 entre las porciones primera y segunda 82 y 84. La segunda porción 84 de cuerpo incluye cuatro cortes alargados 88 (figura 9, únicamente se muestra uno) 30 y una ventana 90. Los cortes 88 están dimensionados para posicionarse deslizablemente sobre unos nervios 92 (figura 11) formados dentro del conjunto 100 de envuelta. El manguito 80 está formado de un material que tiene alguna flexibilidad para facilitar el posicionamiento de la ventana 90 sobre un tope 94 (figura 10) formado dentro del conjunto 100 de envuelta, de tal manera que el tope 94 esté confinado de manera axialmente deslizable dentro de la ventana 90. Alternativamente, el manguito 80 puede configurarse de manera diferente, es decir, el manguito 80 no necesita ser anular, sino que, por el 35 contrario, puede incluir un apoyo, fijo o móvil, que tenga una configuración posicionada para acoplarse con el primer apoyo del conjunto de yunque.
En uso, la segunda porción 84 de cuerpo del manguito anular 80 es posicionada dentro del conjunto 100 de envuelta, con la segunda porción 84 de cuerpo posicionada deslizablemente sobre la porción cilíndrica interior 102 del conjunto 100 de envuelta (figuras 5-7), los cortes 88 posicionados sobre los nervios 92 (figura 11) y la ventana 90 40 posicionada sobre el tope 94. Un miembro de solicitación de resorte, preferiblemente un resorte helicoidal 96, es posicionado entre el resalto 86 del manguito anular 80 y un corte 104 formado sobre la porción cilíndrica interior 102 del conjunto 100 de envuelta. El miembro de solicitación 96 es posicionado para empujar al manguito anular 80 hacia la cabeza 14 de yunque. El apoyo 70 está formado sobre el extremo distal de la primera porción cilíndrica 82 del manguito anular 80.
Como se expuso anteriormente, cuando el conjunto 10 de yunque es fijado a un dispositivo grapador quirúrgico y se 45 aproxima el dispositivo, el apoyo 54 del manguito exterior 22 se acoplará con el apoyo 70 (figuras 5-7). Cuando esto ocurre, dado que el miembro de solicitación 96 tiene una mayor fuerza de compresión que el miembro de solicitación 41, el manguito exterior 22 será hecho avanzar hacia la cabeza 14 de yunque cuando el conjunto de yunque sea aproximado aún más con el fin de mover la cabeza 14 de yunque desde la posición inclinada de perfil reducido (figura 5) hasta la posición de disparo operativa (figura 7). Cuando la cabeza 14 de yunque se ha hecho pivotar hacia la posición operativa y el manguito exterior 50 22 no puede ser hecho avanzar nada más hacia la cabeza 14 de yunque, una aproximación adicional de la cabeza 14 de yunque y del conjunto 100 de envuelta comprimirá el miembro de solicitación 96 y hará que el manguito anular 80 se retraiga dentro del conjunto 100 de envuelta de un modo telescópico alrededor de la porción cilíndrica interior 102 del conjunto 100 de envuelta.
Las figuras 12-15 ilustran otra realización preferida del conjunto de yunque con parte superior inclinable aquí 55 descrito, mostrado generalmente como un conjunto 200 de yunque con parte superior inclinable. El conjunto 200 de yunque con parte superior inclinable es sustancialmente el mismo que el yunque superior 100 de inclinación e incluye un poste 212 de yunque, una cabeza 214 de yunque, una placa 216 de yunque, una varilla central 218, un manguito interior 220 y un manguito exterior 222. Una biela de accionamiento 252 está conectada pivotablemente en un extremo con el manguito exterior 222 y en el otro extremo con el poste 212 de yunque. Una biela de retorno 250 está conectada pivotablemente en un 60
extremo con el manguito interior 220 y en el otro extremo con el poste 212 de yunque. El manguito exterior 222 incluye un apoyo 254. La varilla central 218 incluye una pluralidad de brazos elásticos 215 que se flexionan hacia fuera para acoplarse desprendiblemente como un fiador de yunque (no mostrado) de un dispositivo grapador quirúrgico o un trocar retirable 270 (figura 14).
El conjunto 200 de yunque con parte superior inclinable difiere del conjunto 10 de yunque con parte superior 5 inclinable en unos pocos aspectos que se describirán a continuación. Según se ilustra en la figura 13, el conjunto 200 de yunque con parte superior inclinable está configurado para permitir que la cabeza 214 de yunque pivote con respecto a la varilla central 218 para definir un ángulo θ de aproximadamente 20º con respecto al eje longitudinal del conjunto. (Nota: la cabeza 14 de yunque se inclina hasta una posición sustancialmente paralela al eje longitudinal del conjunto 10 de yunque con parte superior inclinable). El grado de inclinación de la cabeza 214 de yunque se controla variando la longitud de una 10 ranura 260 de la varilla central 218 a través de la cual se posiciona el apoyo 254 de manera móvil. El ángulo θ puede aumentarse acortando la longitud de la ranura 260 y disminuirse aumentando la longitud de la ranura 260. Se prefiere que el ángulo θ no sea menor de unos 20º. Si el ángulo θ es mayor de aproximadamente 20º, existe menor resistencia del tejido frente al pivotamiento de la cabeza 214 de yunque hacia la posición operativa cuando se aproxima el dispositivo. Sin embargo, se contempla que existan aplicaciones quirúrgicas en las que sería deseable tener un ángulo θ de menos de 20º. 15
La varilla central 214 incluye un corte 261 posicionado junto a unos ranurados 262. El corte 261 proporciona un área en la varilla central 214 que puede ser agarrada fácilmente por un cirujano utilizando una herramienta de agarre.
El conjunto de yunque antes descrito es adecuado particularmente para su uso en intervenciones de bypass gástrico mínimamente invasivas. Una intervención de esta clase se describe en la solicitud de patente WO 2001/66020. Alternativamente, el conjunto de yunque antes descrito puede usarse en otras intervenciones quirúrgicas, especialmente en 20 aquellas en las que resulta deseable un conjunto de yunque de perfil reducido.
Se comprenderá que pueden hacerse diversas modificaciones a las realizaciones aquí descritas. Por ejemplo, el apoyo 70 no necesita estar formado sobre un manguito anular telescópico, sino que, por el contrario, puede ser un apoyo no anular que esté soportado de manera móvil o fija dentro del conjunto de envuelta de un dispositivo grapador quirúrgico. Por tanto, la anterior descripción no deberá interpretarse como limitativa, sino meramente como ejemplificaciones de 25 realizaciones preferidas.
Claims (17)
- REIVINDICACIONES
- 1.- Un conjunto (10, 200) de yunque con parte superior inclinable para un dispositivo de sujeción quirúrgico, que comprende:una cabeza (14, 214) de yunque;una varilla central (18, 218); 5un miembro de solicitación (41) posicionado para empujar la cabeza de yunque hacia la posición inclinada de perfil reducido; en donde la cabeza de yunque está fijada pivotablemente a la varilla central y es pivotable entre una posición de disparo operativa y una posición inclinada de perfil reducido; caracterizado por:un miembro de apoyo (54, 254) posicionado en el conjunto de yunque;siendo móvil axialmente el miembro de apoyo a lo largo de la varilla central para mover la cabeza de yunque desde 10 la posición inclinada de perfil reducido hasta la posición de disparo operativa.
- 2.- Un conjunto de yunque con parte superior inclinable según la reivindicación 1, en el que la varilla central incluya un taladro pasante longitudinal (40), incluyendo además el conjunto de yunque un manguito interior (20, 220), y en el que el miembro de apoyo comprende un manguito exterior (22, 222), estando posicionado deslizablemente el manguito exterior dentro del taladro pasante de la varilla central y estando conectado operativamente a la cabeza de yunque, y estando 15 posicionado deslizablemente el manguito interior dentro del manguito exterior y estando conectado operativamente a la cabeza de yunque, en donde el miembro de solicitación está posicionado para empujar a los manguitos interior y exterior hacia una posición adecuada para mover la cabeza de yunque hacia la posición inclinada de perfil reducido.
- 3.- Un conjunto de yunque con parte superior inclinable según la reivindicación 2, que además incluye una biela de accionamiento (52, 252) conectada pivotablemente entre el manguito exterior y la cabeza de yunque, y una biela de retorno 20 (50, 250) conectada pivotablemente entre la cabeza de yunque y el manguito interior.
- 4.- Un conjunto de yunque con parte superior inclinable según las reivindicaciones 2 o 3, en el que el miembro de apoyo está posicionado en el manguito exterior, estando posicionado el apoyo para acoplarse con una superficie (70) de un dispositivo grapador quirúrgico (100) durante la aproximación del conjunto de yunque con el fin de mover el conjunto de yunque desde la posición inclinada de perfil reducido hasta la posición de disparo operativa. 25
- 5.- Un conjunto de yunque con parte superior inclinable según una cualquiera de las reivindicaciones anteriores, en el que la cabeza de yunque está fijada pivotablemente a la varilla central por un miembro (38) de pivote, teniendo el miembro de pivote un eje transversal que está desplazado con respecto al eje longitudinal de la varilla central.
- 6.- Un conjunto de yunque con parte superior inclinable según una cualquiera de las reivindicaciones anteriores, en el que la varilla central incluye un collar (60, 260) de guía que tiene una pluralidad de ranurados (62). 30
- 7.- Un conjunto de yunque con parte superior inclinable según una cualquiera de las reivindicaciones anteriores, en el que la cabeza de yunque incluye un anillo de corte (34) posicionado para acoplarse con una cuchilla dispuesta en un dispositivo grapador quirúrgico (100).
- 8.- Un conjunto de yunque con parte superior inclinable según una cualquiera de las reivindicaciones anteriores, en el que la varilla central incluye al menos un taladro pasante (46) dimensionado para recibir una sutura. 35
- 9.- Un conjunto de yunque con parte superior inclinable según una cualquiera de las reivindicaciones anteriores, en el que, en la posición inclinada de perfil reducido, un ángulo θ definido entre el eje longitudinal del conjunto de yunque y un plano definido por una superficie de contacto de tejido de la cabeza de yunque no es menor de aproximadamente 20º.
- 10.- Un dispositivo grapador quirúrgico (100) que comprende.una porción de mango; 40una porción de cuerpo endoscópica que se extiende distalmente desde la porción de mango;un conjunto (100) de envuelta soportado por el extremo distal de la porción endoscópica, alojando el conjunto de envuelta una pluralidad de sujeciones quirúrgicas;un conjunto (10, 100) de yunque con parte superior inclinable según una cualquiera de las reivindicaciones anteriores configurado para ser posicionado junto al conjunto de envuelta; estando posicionado el miembro (54, 254) de apoyo 45 para mover la cabeza de yunque desde la posición inclinada de perfil reducido hasta la posición de disparo operativa en respuesta a la aproximación del conjunto de yunque y el conjunto de envuelta.
- 11.- Un dispositivo grapador quirúrgico según la reivindicación 10, en el que el miembro de apoyo es un primer miembro (54, 254) de apoyo soportado por el conjunto de yunque con parte superior inclinable y el dispositivo incluye unsegundo miembro (70) de apoyo soportado junto al conjunto de envuelta, estando conectado operativamente el primer miembro de apoyo a la cabeza de yunque y siendo móvil durante el movimiento del conjunto de yunque desde una posición separada del conjunto de envuelta hasta una posición aproximada en acoplamiento con el segundo miembro de apoyo para mover la cabeza de yunque desde la posición de perfil reducido inclinada hasta la posición de disparo operativa.
- 12.- Un dispositivo grapador quirúrgico según la reivindicación 11, que incluye además un manguito anular (80) 5 soportado dentro del conjunto de envuelta, estando formado el segundo miembro de apoyo en el manguito anular.
- 13.- Un dispositivo grapador quirúrgico según la reivindicación 12, en el que el manguito anular es móvil desde una posición extendida hasta una posición retraída, estando posicionado un segundo miembro de solicitación (96) para empujar el manguito anular hacia la posición extendida.
- 14.- Un dispositivo grapador quirúrgico según la reivindicación 13, en el que el segundo miembro de solicitación 10 tiene una fuerza de compresión mayor que la del primer miembro de solicitación de tal modo que durante el movimiento del conjunto de yunque desde la posición separada hasta la posición aproximada, cuando el primer miembro de apoyo se acople con el segundo miembro de apoyo, la cabeza de yunque se mueva desde la posición inclinada de perfil reducido hasta la posición de disparo operativa antes del movimiento del manguito anular desde la posición extendida hasta la posición retraída 15
- 15.- Un dispositivo grapador quirúrgico según una cualquiera de las reivindicaciones 10 a 14, en el que, en la posición inclinada de perfil reducido, un ángulo θ definido entre el eje longitudinal del conjunto de yunque y un plano definido por una superficie de contacto con tejido de la cabeza de yunque no es menor de aproximadamente 20º.
- 16.- Un dispositivo grapador quirúrgico según la reivindicación 10, en el que, cuando el yunque se mueva desde la posición aproximada hasta la posición separada y el primer apoyo se mueva abandonando el acoplamiento con el segundo 20 miembro de apoyo, el miembro de solicitación devolverá el conjunto de yunque a su posición inclinada de perfil reducido.
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| US32772701P | 2001-10-05 | 2001-10-05 | |
| US327727P | 2001-10-05 |
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| ES2357343T3 true ES2357343T3 (es) | 2011-04-25 |
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| ES (1) | ES2357343T3 (es) |
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| US8590764B2 (en) | 2003-12-24 | 2013-11-26 | Boston Scientific Scimed, Inc. | Circumferential full thickness resectioning device |
-
2002
- 2002-10-04 JP JP2003533782A patent/JP4346439B2/ja not_active Expired - Fee Related
- 2002-10-04 US US10/491,253 patent/US6957758B2/en not_active Expired - Lifetime
- 2002-10-04 DE DE60238550T patent/DE60238550D1/de not_active Expired - Lifetime
- 2002-10-04 WO PCT/US2002/032033 patent/WO2003030745A1/en not_active Ceased
- 2002-10-04 EP EP02800943A patent/EP1437970B1/en not_active Expired - Lifetime
- 2002-10-04 ES ES02800943T patent/ES2357343T3/es not_active Expired - Lifetime
- 2002-10-04 MX MXPA04003176A patent/MXPA04003176A/es active IP Right Grant
- 2002-10-04 AU AU2002362751A patent/AU2002362751B2/en not_active Ceased
- 2002-10-04 CA CA2462536A patent/CA2462536C/en not_active Expired - Fee Related
-
2005
- 2005-06-09 US US11/148,741 patent/US7325713B2/en not_active Expired - Lifetime
-
2007
- 2007-05-18 US US11/804,386 patent/US7516877B2/en not_active Expired - Fee Related
Also Published As
| Publication number | Publication date |
|---|---|
| JP2005505336A (ja) | 2005-02-24 |
| EP1437970A1 (en) | 2004-07-21 |
| US20070272722A1 (en) | 2007-11-29 |
| US20040195289A1 (en) | 2004-10-07 |
| JP4346439B2 (ja) | 2009-10-21 |
| WO2003030745A1 (en) | 2003-04-17 |
| CA2462536C (en) | 2010-03-30 |
| MXPA04003176A (es) | 2004-07-08 |
| US20050279803A1 (en) | 2005-12-22 |
| AU2002362751B2 (en) | 2008-07-03 |
| EP1437970B1 (en) | 2010-12-08 |
| US6957758B2 (en) | 2005-10-25 |
| CA2462536A1 (en) | 2003-04-17 |
| US7516877B2 (en) | 2009-04-14 |
| US7325713B2 (en) | 2008-02-05 |
| DE60238550D1 (de) | 2011-01-20 |
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