ES2395916T3 - Aparato de grapado quirúrgico con mecanismo de bloqueo - Google Patents

Aparato de grapado quirúrgico con mecanismo de bloqueo Download PDF

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ES2395916T3
ES2395916T3 ES10176668T ES10176668T ES2395916T3 ES 2395916 T3 ES2395916 T3 ES 2395916T3 ES 10176668 T ES10176668 T ES 10176668T ES 10176668 T ES10176668 T ES 10176668T ES 2395916 T3 ES2395916 T3 ES 2395916T3
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locking mechanism
elongated body
lever
drive assembly
assembly
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Paul A Scrica
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Covidien 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
    • 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
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads

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Abstract

Aparato (10) quirúrgico, que comprende: un conjunto (12) de mango; un cuerpo (14) alargado que tiene extremos proximal y distal y que se extiende distalmente desde el conjunto (12) demango para definir un eje longitudinal, teniendo el cuerpo (14) alargado un elemento (52) de impulsión que se extiende a través del mismo; y una unidad (16) de carga soportada de manera liberable adyacente a un extremo distal del cuerpo alargado y que define un eje longitudinal y que incluye: un conjunto (18) de cartucho de grapas que tiene grapas quirúrgicas; un conjunto (212) de impulsión dispuesto para el movimiento longitudinal con respecto al conjunto (18) de cartucho degrapas para facilitar la expulsión de las grapas quirúrgicas des del mismo; y caracterizado porque la unidad de carga comprende además: un mecanismo (300) de bloqueo configurado y dimensionado para desengancharse selectivamente del conjunto (212)de impulsión para permitir el movimiento del mismo; en el que la unidad (16) de carga está configurada y dimensionada para rotar alrededor del eje longitudinal con respectoal cuerpo (14) alargado, con lo que la rotación de la unidad (16) de carga facilita la recolocación del mecanismo (300) debloqueo entre una primera posición, en la que el mecanismo (300) de bloqueo está enganchado con el conjunto (212)de impulsión para impedir el movimiento del mismo, y una segunda posición, en la que el mecanismo (300) de bloqueopermite el movimiento del conjunto (212) de impulsión, incluyendo el mecanismo de bloqueo una palanca (302) con extremos (306, 304) primero y segundo y un punto (308) de pivote entre los extremos (306, 304) primero y segundo.

Description

Aparato de grapado quirurgico con mecanismo de bloqueo
Antecedentes
5 1. Campo tecnico
La presente descripcion se refiere a un aparato quirurgico, por ejemplo, un aparato de grapado quirurgico. Mas particularmente, la presente descripcion se refiere a un aparato de grapado quirurgico endoscopico que incluye un mecanismo de bloqueo que incluye un elemento de bloqueo para retener el conjunto de impulsion de una unidad de carga, por ejemplo, una unidad de carga de un solo uso ("SULU") o una unidad de carga desechable ("DLU"), en una posicion axial
10 sustancialmente fija hasta que la SULU o DLU se haya cargado con o sujetado a un aparato de grapado quirurgico, para garantizar el enganche apropiado o completo de la SULU o DLU, especialmente su conjunto de impulsion, al aparato de grapado quirurgico. Por motivos de simplicidad, a continuacion en el presente documento, SULU o DLU se denominara "DLU", aunque debe entenderse que incluye cualquiera o ambas de DLU o SULU
2. Antecedentes de la tecnica relacionada
15 Los dispositivos quirurgicos en los que en primer lugar se agarra o sujeta el tejido entre una estructura de mordazas opuestas y a continuacion se une mediante fijadores quirurgicos se conocen bien en la tecnica. En algunos instrumentos se preve una cuchilla para cortar el tejido que se ha unido mediante los fijadores. Los fijadores estan normalmente en forma de grapas quirurgicas aunque tambien pueden utilizarse fijadores polimericos de dos partes.
Los instrumentos para este fin pueden incluir dos elementos de mordaza alargados que se usan respectivamente para
20 capturar o sujetar el tejido. Normalmente, uno de los elementos de mordaza lleva un cartucho de grapas que aloja una pluralidad de grapas dispuestas en al menos dos filas laterales mientras que el otro elemento de mordaza tiene un yunque que define una superficie para formar las patas de grapa cuando las grapas se impulsan desde el cartucho de grapas. Generalmente, la operacion de grapado se efectua mediante elementos de leva que se desplazan longitudinalmente a traves del cartucho de grapas, con los elementos de leva actuando sobre los empujadores de grapa para expulsar
25 de manera secuencial las grapas desde el cartucho de grapas. Una cuchilla puede desplazarse entre las filas de grapas para cortar longitudinalmente y/o abrir el tejido grapado entre las filas de grapas. Tales instrumentos se dan a conocer, por ejemplo, en la Patente estadounidense n.D 3.079.606 y la patente estadounidense n.D 3.490.675.
Una grapadora posterior dada a conocer en la patente estadounidense n.D 3.499.591 tambien aplica una doble fila de grapas en cada lado de la incision. Esta patente da a conocer una grapadora quirurgica que tiene una unidad de carga
30 desechable en la que un elemento de leva se mueve a traves de un trayecto de guia alargado entre dos conjuntos de ranuras que llevan grapas escalonadas. Los elementos de impulsion de grapas se ubican dentro de las ranuras y se colocan de manera que se ponen en contacto con el elemento de leva que se mueve longitudinalmente para efectuar la expulsion de las grapas desde el cartucho de grapas de la unidad de carga desechable. Otros ejemplos de tales grapadoras se dan a conocer en las patentes estadounidenses nos 4.429.695 y 5.065.929.
35 Cada uno de los instrumentos descritos anteriormente esta diserado para su uso en procedimientos quirurgicos convencionales en los que los cirujanos tienen acceso manual directo al sitio de operacion. Sin embargo, en procedimientos endoscopicos o laparoscopicos, la cirugia se realiza a traves de una pequera incision o a traves de una canula estrecha insertada a traves de pequeras heridas de entrada en la piel. Para abordar las necesidades especificas de los procedimientos quirurgicos endoscopicos y/o laparoscopicos, se han desarrollado dispositivos de grapado quirurgicos endosco
40 picos y se dan a conocer, por ejemplo, en la patente estadounidense n.D 5.040.715 (Green, et al.); la patente estadounidense n.D 5.307.976 (Olson, et al.); la patente estadounidense n.D 5.312.023 (Green, et al.); la patente estadounidense
n.D 5.318.221 (Green, et al.); la pate nte estadounidense n.D 5.326.013 (Green, et al.); la pate nte estadounidense n.D
5.332.142 (Robinson, et al); y la patente estadounidense n.D 6.241.139 (Milliman et al.).
El documento US 6.241.139 da a conocer un aparato de grapado quirurgico que puede usarse con unidades de articula
45 cion y de no articulacion. Los dispositivos quirurgicos dados a conocer en el documento US 6.241.139 comprenden una carcasa, un mango movil soportado por la carcasa, un cuerpo alargado que se extiende distalmente desde la carcasa, un vastago de accionamiento, una unidad de carga soportada en el extremo distal del cuerpo alargado y un mecanismo de articulacion.
Tyco Healthcare Group, LP, el cesionario de la presente solicitud, ha fabricado y comercializado instrumentos de grapa
50 do endoscopicos, tales como los instrumentos Multifire ENDO GIA™ 30 y Multifire ENDO GIA™ 60, durante varios aros. Estos instrumentos incluyen un aparato de grapado quirurgico y una DLU. Normalmente, la DLU se une al aparato inmediatamente antes de la cirugia. Despues de su uso, la DLU pu ede retirarse del aparato y puede fijarse una nueva DLU al aparato para realizar operaciones de grapado y/o corte adicionales. Estos instrumentos han proporcionado beneficios clinicos significativos. Sin embargo, aun son posible mejoras en estos instrumentos.
Seria deseable proporcionar una DLU mejorada para un aparato de grapado quirurgico y un aparato de grapado quirurgico mejorado que tenga la DLU cargada en el mismo.
Tambien seria deseable proporcionar un mecanismo de bloqueo para una DLU para asegurar una carga apropiada de la DLU en el vastago de un aparato de grapado quirurgico.
Por consiguiente, es un objeto de esta descripcion proporcionar una DLU mejorada que bloquee o retenga su conjunto de impulsion en la posicion apropiada para cargarse en el vastago de un aparato de grapado quirurgico (a continuacion en el presente documento denominada la o una "posicion lista para la carga") hasta que la DLU se carga en un aparato de grapado quirurgico para asegurar que cuando la DLU esta cargada en el mismo, el conjunto de impulsion se engancha por, se acopla a o se conecta a un elemento de impulsion del vastago de manera apropiada, ayudando asi a garantizar el funcionamiento apropiado de la DLU y el aparato de grapado quirurgico. Por ejemplo, con la DLU cargada en el aparato de grapado quirurgico, despues de disparar el aparato de grapado quirurgico, la retraccion de la varilla de control alejara o abrira y/o soltara los conjuntos de yunque y cartucho.
Un objeto de la descripcion es proporcionar una DLU mejorada que incluye un mecanismo de bloqueo que retiene el conjunto de impulsion en unaposicion lista para la carga de este tipo hasta que la DLU se carga en el aparato de grapado quirurgico.
Otro objeto de la presente descripcion es proporcionar un mecanismo de bloqueo para una DLU y una DLU que tiene un mecanismo de bloqueo, de modo que se evita el disparo del aparato de grapado quirurgico a menos que y hasta que la DLU se cargue en el vastago del aparato de grapado quirurgico.
Aun otro objeto de la descripcion es proporcionar una DLU que, tras el disparo, puede desconectarse del aparato de grapado quirurgico.
Aun otro objeto de la descripcion es proporcionar una DLU que tiene solo dos estados, uno en el que no esta cargada y su conjunto de impulsion esta bloqueado o retenido en la posicion lista para la carga, y otro en el que la DLU esta cargada en el vastago de un aparato de grapado quirurgico y en el que el conjunto de impulsion esta desbloqueado y puede accionarse libremente.
Todavia otro objeto de la presente descripcion es proporcionar los objetos anteriores en una DLU que pueda girar, es decir giratoria, con respecto a una articulacion.
Sumario
La presente invencion se refiere a un aparato quirurgico segun se define mediante la reivindicacion 1 independiente y a una unidad de carga segun se define mediante la reivindicacion 9 independiente.
Las reivindicaciones dependientes se refieren a realizaciones preferidas de la invencion.
Segun la presente descripcion, se proporciona un aparato quirurgico, por ejemplo, un aparato de grapado quirurgico, que incluye un mecanismo de bloqueo para garantizar el enganche apropiado de una unidad de carga desechable a un extremo, preferiblemente el extremo distal, del aparato quirurgico. En un aspecto, se proporciona un aparato quirurgico, que comprende: un conjunto de mango; un cuerpo alargado que tiene extremos proximal y distal y que se extiende distalmente desde el conjunto de mango para definir un eje longitudinal, teniendo el cuerpo alargado un elemento de impulsion que se extiende a traves del mismo; y una unidad de carga soportada de manera liberable adyacente a un extremo distal del cuerpo alargado y que define un eje longitudinal y que incluye: un conjunto de cartucho de grapas que tiene grapas quirurgicas; un conjunto de impulsion dispuesto para el movimiento longitudinal con respecto al conjunto de cartucho de grapas para facilitar la expulsion de las grapas quirurgicas des del mismo; y caracterizado porque la unidad de carga comprende ademas: un mecanismo de bloqueo configurado y dimensionado para desengancharse selectivamente del conjunto de impulsion para permitir el movimiento del mismo; en el que la unidad de carga esta configurada y dimensionada para rotar alrededor del eje longitudinal con respecto al cuerpo alargado, con lo que la rotacion de la unidad de carga facilita la recolocacion del mecanismo de bloqueo entre una primera posicion, en la que el mecanismo de bloqueo esta enganchado con el conjunto de impulsion para impedir el movimiento del mismo, y una segunda posicion, en la que el mecanismo de bloqueo permite el movimiento del conjunto de impulsion, incluyendo el mecanismo de bloqueo una palanca con extremos primero y segundo y un punto de pivote entre los extremos primero y segundo.
Se preve que el mecanismo de bloqueo incluya una palanca conectada de manera pivotante a la parte de carcasa y que defina un punto de pivote. La palanca incluye un extremo distal que se extiende distalmente del punto de pivote y un extremo proximal que se extiende proximalmente del punto de pivote. El extremo distal de la palanca incluye preferiblemente un elemento, preferiblemente un gancho, para enganchar selectivamente la parte del conjunto de impulsion, en el que cuando el mecanismo de bloqueo esta en la primera posicion el gancho se engancha en una parte del conjunto de impulsion ycuando el mecanismo de bloqueo esta en la segunda posicion el gancho se desengancha de la parte del conjunto de impulsion.
Se preve que cuando el mecanismo de bloqueo se mueva de la primera posicion, a la segunda posicion el extremo proximal de la palanca se mueva radialmente hacia dentro y el extremo distal de la palanca se mueva radialmente hacia
fuera. El mecanismo de bloqueo se mueve de la primera posicion a la segunda posicion con el acoplamiento de la unidad de carga al extremo distal del cuerpo alargado. Preferiblemente, el mecanismo de bloqueo se mueve de la primera posicion a la segunda posicion mediante una accion de giro de la unidad de carga con respecto al cuerpo alargado cuando la punta de insercion de la unidad de carga se inserta en el extremo distal del cuerpo alargado.
El mecanismo de bloqueo puede incluir ademas un elemento de solicitacion asociado operativamente con el mismo. Preferiblemente, el elemento de solicitacion solicita la palanca a la primera posicion.
Se preve que cuando el mecanismo de bloqueo este en la primera posicion, el extremo proximal de la palanca se extienda radialmente mas alla de una superficie externa de la parte de carcasa. De manera deseable, el extremo proximal de la palanca del mecanismo de bloqueo puede definir una superficie angulada para facilitar la conexion con el cuerpo alargado.
Preferiblemente, el aparato quirurgico es una grapadora o aplicador de fijadores, preferiblemente una grapadora laparoscopica o endoscopica.
Esta descripcion tambien es de una DLU, preferiblemente una DLU que puede girar alrededor de una articulacion para una grapadora o aplicador de fijadores quirurgico.
De manera deseable, el extremo proximal de la parte de carcasa de la unidad de carga define una punta de insercion.
Se preve que el aparato quirurgico pueda incluir un cuerpo alargado que se extiende distalmente desde la carcasa.
En un aspecto adicional, la presente invencion se refiere a una unidad de carga configurada y dimensionada para engancharse de manera liberable con un cuerpo alargado de un aparato quirurgico, incluyendo la unidad de carga: una parte de carcasa que tiene extremos proximal y distal y que define un eje longitudinal; un conjunto de cartucho de grapas configurado ydimensionado para retener una pluralidad de grapas quirurgicas en el mismo, estando colocado el cartucho de grapas adyacente al extremo distal de la parte de carcasa; un conjunto de impulsion dispuesto para el movimiento longitudinal a traves de la parte de carcasa para facilitar la expulsion de las grapas quirurgicas desde el conjunto de cartucho de grapas; y caracterizada porque la unidad de carga comprende ademas: un mecanismo de bloqueo configurado y dimensionado para engancharse con el conjuntodeimpulsion; estando configurada y dimensionada la unidad de carga para rotar alrededor del eje longitudinal con respecto al cuerpo alargado durante la union de la unidad de carga al aparato quirurgico y la separacion de la unidad de carga del aparato quirurgico, en la que la rotacion de la unidad de carga con respecto al cuerpo alargado en una primera direccion facilita el desenganche del mecanismo de bloqueo del conjunto de impulsion para permitir el movimiento del conjunto de impulsion a traves de la parte de carcasa, y la rotacion de la unidad de carga con respecto al cuerpo alargado en una segunda direccion facilita el enganche del mecanismo de bloqueo con el conjunto de impulsion para impedir el movimiento del conjunto de impulsion a traves de la parte de carcasa, incluyendo el mecanismo de bloqueo una palanca con extremos primero y segundo y un punto de pivote entre los extremos primero y segundo.
Las ventajas adicionales seran evidentes a partir de la siguiente descripcion, tomada junto con los dibujos adjuntos.
Breve descripcion de los dibujos
La presente descripcion se describira adicionalmente con referencia a los dibujos adjuntos, en los que los numeros de referencia similares se refieren a partes similares en las diversas vistas, y en los que:
la figura 1 es una vista en perspectiva desde arriba de una realizacion preferida del aparato de grapado quirurgico dado a conocer en el presente documento;
la figura 2 es una vista desde arriba del aparato de grapado quirurgico mostrado en la figura 1;
la figura 3 es una vista lateral del aparato de grapado quirurgico mostrado en las figuras 1 y 2;
la figura 4 es una vista en perspectiva desde arriba del aparato de grapado quirurgico de las figuras 13 con la DLU desenganchada del cuerpo alargado del aparato de grapado quirurgico;
la figura 5 es una vista en perspectiva desde abajo de una DLU de no articulacion para su uso con el aparato de grapado quirurgico de las figuras 14;
la figura 6 es una vista en perspectiva desde abajo de la DLU de articulacion preferida del aparato de grapado quirurgico de las figuras 14;
la figura 7 es una vista en perspectiva desde arriba de la DLU de la figura 6;
la figura 8 es una vista en perspectiva desde arriba de la DLU de las figuras 6 y 7;
la figura 9 es una vista en perspectiva desde arriba ampliada, con partes separadas, de la parte de carcasa proximal y el conjunto de montaje de la DLU de las figuras 68;
la figura 9a es una vista en perspectiva desde arriba ampliada de la parte proximal de la mitad de carcasa superior de la DLU de las figuras 69;
la figura 10 es una vista en perspectiva desde arriba de la parte de carcasa proximal y el conjunto de montaje de la DLU de las figuras 69 con la mitad de carcasa superior retirada;
la figura 11 es una vista en perspectiva desde arriba, con partes separadas, del conjunto de impulsion axial de la DLU de las figuras 69;
la figura 12 es una vista en perspectiva desde arriba del conjunto de impulsion axial de la figura 11 de la DLU de las figuras 69;
la figura 13 es una vista en perspectiva desde arriba ampliada de una mitad de carcasa inferior de la parte de carcasa proximal de la DLU de las figuras 69;
la figura 14 es una vista en perspectiva ampliada del extremo distal del cuerpo alargado del aparato de grapado mostrado en la figura 4;
la figura 15 es una vista en perspectiva ampliada del extremo proximal de la DLU de las figuras 69 que ilustra un mecanismo de bloqueo segun la presente descripcion;
la figura 16 esunavista en perspectiva ampliada de un extremo distaldel cuerpo alargado del aparato degrapado segun la presente descripcion;
la figura 17 es una vista en perspectiva ampliada, parcialmente seccionada, del extremo proximal de la DLU de la figura 15 que ilustra el mecanismo de bloqueo en una primera posicion;
la figura 18 es una vista en seccion transversal longitudinal del extremo proximal de la DLU de las figuras 69, tomada a traves de 18 18 de la figura 15, con el mecanismo de bloqueo en una primera posicion;
la figura 19 es una vista en perspectiva ampliada, parcialmente seccionada, del extremo proximal de la DLU de la figura 15 que ilustra el mecanismo de bloqueo en una segunda posicion;
la figura 20 es una vista en seccion transversal longitudinal del extremo proximal de la DLU de las figuras 69 tomada a traves de 18 18 de la figura 15, con el mecanismo de bloqueo en una segunda posicion;
la figura 21 es una vista en seccion transversal ampliadadelextremo proximal de la DLU de las figuras 69, tomada a traves de 21 21 de la figura 18;
la figura 22 es una vista en seccion transversal ampliadadelextremo proximal de la DLU de las figuras 69, tomada a traves de 22 22 de la figura 20, que ilustra la posicion del mecanismo de bloqueo antes de la rotacion de la DLU con respecto al cuerpo alargado; y
la figura, 23 es una vista en seccion transversal ampliada del extremo proximal de la DLU de las figuras 69, como seria si se tomara a traves de 22 22 de la figura 20, que ilustra la posicion del mecanismo de bloqueo tras la rotacion de la DLU con respecto al cuerpo alargado.
Descripcion detallada de realizaciones preferidas
A continuacion se describiran en detalle realizaciones preferidas del aparato quirurgico, la DLU yel elemento o mecanismo de bloqueo dados a conocer enel presente documento con referencia a los dibujos, en los que los numeros de referencia similares indican elementos identicos o correspondientes en cada una de las diversas vistas.
En los dibujos y en la descripcion que sigue, el termino "proximal", como es habitual, se referira al extremo del aparato de grapado que esta mas pr oximo al operador, mientras que el termino "distal" se ref erira al extremo del aparato que esta mas lejos del operador.
Las figuras 14 muestran un aparato quirurgico, por ejemplo, un aparato de grapado quirurgico, al que se hace referencia generalmente con 10. Para abreviar, esta descripcion se centrara principalmente en sistemas y estructuras para cargar, enganchar, acoplar o conectar una unidad 16 de carga desechable ("DLU") al aparato 10 de grapado quirurgico. En la patente estadounidense 6.241.139 se da a conocer una discusion detallada de los componentes restantes y el metodo de uso del aparato 10 de grapado quirurgico.
El aparato 10 de grapado quirurgico es un aparato endoscopico e incluye un conjunto 12 de mango y un cuerpo 14 alargado que se extiende desde el conjunto 12 de mango. Una DLU 16 se sujeta de manera liberable al extremo distal del cuerpo 14 alargado. Aunque esta descripcion se refiere al uso de una DLU con aparato 10 de grapado quirurgico, se entiende y esta dentro del alcance de la presente descripcion que una unidad de carga de un solo uso (SULU) u otro efector de extremo y/o conjunto de herramientas pueden usarse igualmente en cooperacion con el aparato 10 de grapado quirurgico.
La DLU 16 incluye una herramienta 17 que tiene un conjunto 18 de cartucho que aloja una pluralidad de grapas quirurgicas (no mostradas) y un conjunto 20 de yunque sujeto de manera movil con respecto al conjunto 18 de cartucho. Tal como se muestra en el presente documento, la DLU 16 esta configurada para aplicar seis (6) filas lineales de grapas, en DLU que miden desde aproximadamente 30 mm hasta aproximadamente 60 mm de longitud. Tambien se preven DLU para aplicar cualquier numero de filas de grapas, con cavidades de grapa dispuestas en diversos patrones y/o DLU y efectores de extremo con cualquier otra longitud, por ejemplo, 45 mm. El conjunto 12 de mango incluye un elemento 22 de mango estacionario, un elemento 24 de mango movil, y una parte 26 de cilindro.
Un elemento 28 rotatorio esta montado preferiblemente en el extremo delantero de la parte 26 de cilindro para facilitar la rotacion del cuerpo 14 alargado y se une a la DLU 16 con respecto al conjunto 12 de mango. Una palanca 30 de articulacion tambien esta montada preferiblemente en el extremo delantero de la parte 26 de cilindro adyacente al elemento 28 rotatorio para facilitar la articulacion del conjunto 17 de herramienta. Preferiblemente, un par de botones 32 estan colocados de manera movil a lo largo de la parte 26 de cilindro. Los botones 32 se hacen avanzar de manera distal para aproximar o cerrar el conjunto 18, 20 de cartucho y/o yunque, y se retraen de manera proximal para alejar o abrir el conjunto 18, 20 de cartucho y/o yunque.
Tal como se observa en la figura 4, la DLU 16 puede acoplarse de manera deseable selectivamente de forma liberable al cuerpo 14 alargado. La DLU 16 incluye una parte 200 de carcasa que tiene un extremo proximal adaptado para engancharse de manera liberable al extremo distal del cuerpo 14 alargado. Un conjunto 202 de montaje esta sujeto de manera pivotante en 203 al extremo distal de la parte 200 de carcasa, y esta configurado para recibir el extremo proximal del conjunto 17 de herramienta de modo que el movimiento pivotante del conjunto 202 de montaje alrededor de un eje en 203 perpendicular al eje longitudinal de la parte 200 de carcasa efectua la articulacion del conjunto 17 de herramienta.
El aparato 10 de grapado quirurgico puede recibir una DLU 16a de no articulacion, tal como se observa en la figura 5, o una DLU 16 de articulacion, tal como se observa en las figuras 68. La patente estadounidense 6.241.139 incluye una discusion detallada de DLU de articulacion y de no articulacion.
Con referencia general a las figuras, 9, 9a, 1013, 15 y 1723 y referencia particular a las figuras 9, 9a, 15, 17 y 18, la DLU 16 incluye un conjunto 235 de montaje. El conjunto 235 de montaje incluye una parte 236, 238 de montaje superior e inferior, respectivamente. Un elemento 284 de pivote ubicado centralmente se extiende desde cada parte 236, 238 de montaje superior e inferior a traves de respectivas aberturas 246a formadas en elementos 246 de acoplamiento. Cada uno de los elementos 246 de acoplamiento incluyeuna parte 246b proximal de interbloqueo configurada para recibirse en ranuras 290 formadas en el extremo proximal de mitades 250, 252 de carcasa superior e inferior para retener el conjunto 235 de montaje y mitades 250, 252 de carcasa superior e inferior en una posicion longitudinalmente fija entre si.
La mitad 250 de carcasa superior y la mitad 252 de carcasa inferior estan contenidas dentro de un manguito, revestimiento o alojamiento 251 externo. El extremo proximal de la mitad 250 de carcasa superior incluye salientes 254 de enganche que se extienden radialmente hacia fuera para engancharse de manera liberable con el extremo distal del cuerpo 14. Los salientes 254 forman un acoplamiento de tipo bayoneta con el extremo distal del cuerpo 14. Las mitades 250 y 252 de carcasa definen un canal 400 para recibir de manera deslizante el conjunto 212 de impulsion axial en su interior. Un enlace 256 de articulacion esta dimensionado para colocarse de manera deslizante dentro de una muesca 402 formada en las mitades 250, 252 de carcasa superior e inferior. Un par de conjuntos 255 de placa de seguridad estan colocados adyacentes al extremo distal de la parte 200 de carcasa adyacente al extremo distal del conjunto 212 de impulsion axial para evitar que se tuerza y sobresalga hacia fuera el conjunto 212 de impulsion durante la articulacion y que se dispare el aparato 10 de grapado quirurgico. Para una descripcion detallada de la estructura y el funcionamiento de los co njuntos 255 d e p laca d e seg uridad, se hace referenci a a la solic itud i nternacional n umero d e ser ie PCT/US02/32031, WO 03/030743, presentada el 4 de octubre, 2002, titulada "Surgical Stapling Device".
Con referencia a la figura 11, opcionalmente, un elemento 288 de bloqueo puede estar soportado en la seccion 270 de enganche del conjunto 212 de impulsion axial. En funcionamiento, cuando se acciona el conjunto 212 de impulsion axial, aplicando una fuerza predeterminada al elemento 24 de mango movil para hacer avanzar el conjunto 212 de impulsion axial distalmente, el elemento 288 de bloqueo proporciona una indicacion audible y tactil de que el aparato 10 de grapado quirurgico se ha accionado. Para una discusion detallada de la estructura y el funcionamiento del elemento 288 de bloqueo, se hace referencia a la solicitud internacional mencionada anteriormente numero de serie PCT/US02/32031, WO 3/030743. El elemento 288 de bloqueo tambien puede evitar el accionamiento parcial involuntario de la DLU 16, tal como durante el transporte, mediante el bloqueo del conjunto 212 de impulsion axial en una posicion fija dentro de la DLU 16 hasta que se ha aplicado una fuerza axial predeterminada al conjunto 212 de impulsion axial.
Con referencia a las figuras 912, el conjunto 212 de impulsion axial incluye una barra 266 de impulsion alargada (figura 11) que incluye una cabeza 268 de trabajo distal (figura 12) y una seccion 270 de enganche proximal. La barra 266 de impulsion puede construirse a partir de una unica hoja de material o, preferiblemente, multiples hojas apiladas, tal como se muestra en la figura 11. La seccion 270 de enganche incluye un par de dedos 270ay 270b de enganche elasticos que estan dimensionados y configurados para engancharse con montaje con un par de muescas 272a y 272b de retencion correspondientes formadas en el el emento 272 de impulsion (figura 12). El elemento 272 de im pulsion incluye un orificio 274 proximal configurado para recibir el extremo 276 distal de un elemento de impulsion, por ejemplo, una varilla de impulsion o varilla 52 de control (figuras 14 y 1618) cuando el extremo proximal de la DLU 16 esta enganchandose
con el cuerpo 14 alargado del aparato 10 de grapado quirurgico. La varilla 52 de control funciona para transmitir un movimiento axial del conjunto 212 de impulsion desde el conjunto 12 de mango.
Con referencia a las figuras 9, 9a y 1532, la DLU 16 incluye ademas un mecanismo 300 de bloqueo, soportado preferiblemente de manera pivotante en una carcasa, por ejemplo, en la mitad 250 de carcasa superior. El mecanismo 300 de bloqueo puede manipularse de una primera posicion, en la que el conjunto 212 de impulsion se mantiene en una posicion lista para la carga para la carga apropiada, a una segunda posicion, en la que el conjunto 212 de impulsion es libre para moverse. La DLU 16 se considera que se carga en el cuerpo 14 alargado cuando el mecanismo 300 de bloqueo esta en la segunda posicion, es decir, cuando el conjunto 212 de impulsion esta conectado a la varilla 52 de control del cuerpo 14 alargado. Tal como se observa en las figuras 9, 9a y 1523, el mecanismo 300 de bloqueo incluye una palanca 302 conectada de manera pivotante a la mitad 250 de carcasa superior mediante un perno 308 de pivote que se extiende a traves de la misma, definiendo de este modo un punto de pivote. La palanca 302 incluye un extremo 304 distal libre que se extiende distalmente con respecto al perno 308 de pivote y un extremo 306 proximal libre que se extiende proximalmente con respecto al perno 308 de pivote. El extremo 306 proximal de la palanca 302 termina en una superficie 306a angulada formada a lo largo de una superficie superior de la misma para engancharse con una parte del cuerpo 14 alargado, tal como se comentara en mas detalle a continuacion. El extremo304distal de la palanca 302 termina en un elemento 304a de gancho formado a lo largo de una superficie inferior del mismo para engancharse con el elemento 272 de impulsion, tal como se comentara en mas detalle a continuacion.
El mecanismo 300 de bloqueo incluye ademas un elemento de solicitacion o resorte 312, preferiblemente un resorte de hojas, asociado operativamente con la mitad 250 de carcasa superior y el extremo 304 distal de la palanca 302. Preferiblemente, el resorte 312 mantiene lapalanca 302 en laprimera posicion de modoque el elemento304a de gancho se engancha con el elemento 272 de impulsion. El resorte 312 incluye un extremo 312a proximal asociado operativamente con el extremo 304 distal de la palanca 302, y un extremo 312b distal sujeto a la mitad 250 de carcasa superior. Preferiblemente, el extremo 312b distal esta en forma de gancho o brazo curvado que se extiende al interior de una muesca o ranura 250a (vease las figuras 1720) en la mitad 250 de carcasa superior de manera que se crea una fuerza "F" que actua radialmente hacia dentro en el extremo 312a proximal del resorte 312 (vease la figura 17). El extremo 312a proximal esta colocado enganchado con una superficie 304b externa del extremo 304 distal de la palanca 302. Como tal, la fuerza "F" a su vez actua sobre el extremo 304 distal de la palanca 302 para de este modo empujar el extremo 304 distal radialmente hacia dentro del mismo modo. Asi, el extremo 306 proximal de la palanca 302 se empuja radialmente hacia fuera debido a la accion pivotante de la palanca 302 alrededor del perno 308 de pivote.
Antes de la union de la DLU 16 al aparato 10 de grapado quirurgico, la palanca 302 del mecanismo 300 de bloqueo se empuja a la posicion bloqueada mediante el resorte 312 (figuras 15, 17 y 18). Como se comento anteriormente, en la posicion bloqueada, la palanca 302 se hace pivotar alrededor del perno 308 de pivote de modo que el elemento 304a de gancho de la palanca 302 se engancha con una cara 272c distal del elemento 272 de impulsion y el extremo 306 proximal se coloca radialmente hacia fuera de una superficie 193a externa de la punta 193 de insercion (vease la figura 18). En esta posicion bloqueada, el elemento 304a de gancho evita el avance distal involuntario del elemento 272 de impulsion para mantener el elemento 272 de impulsion en su posicion lista para la carga mas proximal. Esto garantiza que la seccion 270 de enganche del conjunto 212 de impulsion se enganche de manera apropiada con el extremo 276 distal de la varilla 52 de control (vease la figura 14) del aparato 10 de grapado cuando la DLU 16 esta montada en el cuerpo 14 alargado del aparato 10 de grapado. El extremo 276 distal de la varilla 52 de control tiene una o mas superficies de enganche, preferiblemente, y aqui se muestra como, incluyendo una cabeza 276a y un rebaje 276b anular de menor diametro justo proximal con respecto a la cabeza 276a y que se define parcialmente por la cabeza 276a.
Cuando la DLU 16 esta montada en el cuerpo 14 alargado del aparato 10 de grapado, de una manera que va a comentarse en mas detalle a continuacion, la superficie 306a angulada del extremo 306 proximal de la palanca 302 se engancha con la superficie 276c inclinada del cuerpo 14 alargado (vease las figuras 20, 22 y 23). El enganche entre la superficie 306a angulada y la superficie 276c inclinada hace pivotar o rotar la palanca 302 alrededor del perno 308 de pivote para engranar el extremo 306 proximal de la palanca 302radialmente hacia dentro. El movimiento del extremo 306 proximal radialmente hacia dentro efectua el movimiento del gancho 304a radialmente hacia fuera contra la fuerza "F" del resorte 312, de modo que el gancho 304a se libera de y/o se desengancha de otro modo del elemento 272 de impulsion para liberar el conjunto 212 de impulsion y permitir el funcionamiento o el funcionamiento continuado del aparato 10 de grapado quirurgico.
Como mejor se observa en la figura 16, preferiblemente el extremo distal del cuerpo 14 alargado incluye un rebaje 276b formado en el mismo que tiene una forma para facilitar la manipulacion del mecanismo 300 de bloqueo de la primera posicion a la segunda posicion. Preferiblemente, el rebaje 276b incluye una superficie 276c inclinada con la que entra en contacto la superficie 306a angulada de la palanca 302. En particular, la superficie 276c inclinada esta conformada de modo que el giro de la DLU 16 con respecto al cuerpo 14 alargado del aparato 10 de grapado, despues de que la punta 193 de insercion de la DLU 16 se haya insertado en el extremo distal del cuerpo 14 alargado, de como resultado que el extremo 306 proximal de la palanca 302 se empuje o engrane progresivamente radialmente hacia dentro. Solo despues de que la DLU 16 se haya hecho rotar por un arco suficiente con respecto al cuerpo 14 el extremo 306 proximal de la palanca 302 se engranara radialmente hacia dentro una distancia suficiente para liberar el elemento 304a de gancho del elemento 272 de impulsion.
Con referencia continuada a las figuras 1523, se comentara un metodo de uso y/o funcionamiento del mecanismo 300 de bloqueo, cuando se sujeta la DLU 16 al extremo distal del cuerpo 14 alargado. Inicialmente, con el mecanismo 300 de bloqueo en la primera posicion de modo que el gancho 304a esta enganchado con el elemento 272 de impulsion, la punta 193 de insercion de la DLU 16 se introduce longitudinalmente en el extremo distal del cuerpo 14 alargado, en
5 cualquier sentido de la flecha "A" (figura 19). Tal como se observa en las figuras 19, 20 y 22, durante la introduccion de la punta 193 de insercion en el extremo distal del cuerpo 14 alargado, el extremo 306 proximal de la palanca 302 entra en el rebaje 276b (figura 22) formado en el extremo distal del cuerpo 14 alargado.
Cuando la punta 193 de insercion se ha insertado completamente en el extremo distal del cuerpo 14 alargado, y mas particularmente, cuando los salientes 254 han entrado completamente en los canales 276d (figuras 16, 22 y 23), la DLU 10 16 se hace rotar, en el sentido de la flecha "B" (figuras 19 y 23), de modo que la superficie 276c inclinada del rebaje 276b actua contra y se engancha con la superficie 306a angulada del extremo 306 proximal de la palanca 302. Como se describio anteriormente, la accion de engrane entre la superficie 276c inclinada del rebaje 276b y la superficie 306a angulada del extremo 306 proximal provoca que el extremo 306 proximal de la palanca 302 se empuje radialmente hacia dentro, tal como se indica mediante la flecha "C" de la figura 23, y alrededor del perno 308 de pivote, superando asi la 15 fuerza "F" del resorte 312, y empujando el extremo 304 distal radialmente hacia fuera de modo que la palanca 302 se empuje de la primera posicion a la segundaposicion. El desplazamiento del extremo304distal en una direccion radialmente hacia fuera da como resultado que el gancho 304a se desenganche del elemento 272 de impulsion liberando asi el conjunto 212 de impulsion para el funcionamiento continuado del aparato 10 de grapado quirurgico. La DLU 16 se considera cargada en el cuerpo 14 alargado cuando la palanca 302 esta en la segunda posicion, por ejemplo, cuando el
20 conjunto 212 de impulsion esta conectado al elemento de impulsion o varilla 52 de control del cuerpo 14 alargado.
Por consiguiente, se evita la union de una DLU, que tiene un conjunto 212 de impulsion, al extremo distal del cuerpo 14 alargado cuando el conjunto 212 de impulsion no esta en su posicion de carga mas apropiada o proximal.

Claims (13)

  1. REIVINDICACIONES
    1. Aparato (10) quirurgico, que comprende:
    un conjunto (12) de mango;
    un cuerpo (14) alargado que tiene extremos proximal y distal y que se extiende distalmente desde el conjunto (12) de mango para definir un eje longitudinal, teniendo el cuerpo (14) alargado un elemento (52) de impulsion que se extiende a traves del mismo; y
    una unidad (16) de carga soportada de manera liberable adyacente a un extremo distal del cuerpo alargado y que define un eje longitudinal y que incluye:
    un conjunto (18) de cartucho de grapas que tiene grapas quirurgicas;
    un conjunto (212) de impulsion dispuesto para el movimiento longitudinal con respecto al conjunto (18) de cartucho de grapas para facilitar la expulsion de las grapas quirurgicas des del mismo; y
    caracterizado porque la unidad de carga comprende ademas:
    un mecanismo (300) de bloqueo configurado y dimensionado para desengancharse selectivamente del conjunto (212) de impulsion para permitir el movimiento del mismo;
    en el que la unidad (16) de carga esta configurada y dimensionada para rotar alrededor del eje longitudinal con respecto al cuerpo (14) alargado, con lo que la rotacion de la unidad (16) de carga facilita la recolocacion del mecanismo (300) de bloqueo entre una primera posicion, en la que el mecanismo (300) de bloqueo esta enganchado con el conjunto (212) de impulsion para impedir el movimiento del mismo, y una segunda posicion, en la que el mecanismo (300) de bloqueo permite el movimiento del conjunto (212) de impulsion, incluyendo el mecanismo de bloqueo una palanca (302) con extremos (306, 304) primero y segundo y un punto (308) de pivote entre los extremos (306, 304) primero y segundo.
  2. 2. Aparato quirurgico segun la reivindicacion 1, en el que el extremo distal del cuerpo (14) alargado incluye una superficie (276c) inclinada configurada y dimensionada para engancharse con el mecanismo (300) de bloqueo de modo que la rotacion de la unidad (16) de carga con respecto al cuerpo (14) alargado provoca la recolocacion del mecanismo
    (300) de bloqueo.
  3. 3.
    Aparato quirurgico segun la reivindicacion 2, en el que la superficie (267c) inclinada incluida en el extremo distal del cuerpo (14) alargado esta configurada y dimensionada de modo que la rotacion de la unidad (16) de carga en una primera direccion facilita el movimiento del mecanismo (300) de bloqueo hacia la segunda posicion, y la rotacion de la unidad (16) de carga en una segunda direccion opuesta facilita el movimiento del mecanismo (300) de bloqueo hacia la primera posicion.
  4. 4.
    Aparato quirurgico segun cualquiera de las reivindicaciones 2 o 3, en el que la superficie (276c) inclinada se extiende radialmente hacia dentro hacia una parte interior del cuerpo (14) alargado para definir una dimension interna reducida.
  5. 5.
    Aparato quirurgico segun las reivindicaciones 2 a 4, en el que la superficie (276c) inclinada se extiende circunferencialmente a lo largo de una parte de pared interna del cuerpo alargado (140) para definir progresivamente una dimension radial aumentada.
  6. 6.
    Aparato quirurgico segun cualquiera de las reivindicaciones 1 a 5, en el que la unidad (16) de carga incluye una carcasa alargada y el primer extremo de la palanca (302) es un extremo (306) proximal de la palanca (302) y el segundo extremo de la palanca (302) es un extremo (304) distal de la palanca (302).
  7. 7.
    Aparato quirurgico segun cualquiera de las reivindicaciones anteriores, en el que el mecanismo (300) de bloqueo se solicita para engancharse con el conjunto (212) de impulsion.
  8. 8.
    Aparato quirurgico segun cualquiera de las reivindicaciones anteriores, en el que el mecanismo (300) de bloqueo esta configurado para un movimiento pivotante de la primera posicion a la segunda posicion, en una direccion radial, con respecto a la parte de carcasa de la unidad (16) de carga en respuesta a una conexion de la unidad (16) de carga a un eje longitudinal del cuerpo (14) alargado.
  9. 9.
    Unidad (16) de carga configurada y dimensionada para engancharse de manera liberable con un cuerpo (14) alargado de un aparato quirurgico, incluyendo la unidad (16) de carga:
    una parte de carcasa que tiene extremos proximal y distal y que define un eje longitudinal;
    un conjunto (18) de cartucho de grapas configurado y dimensionado para retener una pluralidad de grapas quirurgicas en el mismo, estando colocado el cartucho de grapas adyacente al extremo distal de la parte de carcasa;
    un conjunto (212) de impulsion dispuesto para el movimiento longitudinal a traves de la parte de carcasa para facilitar la expulsion de las grapas quirurgicas desde el conjunto (18) de cartucho de grapas; y
    caracterizada porque la unidad de carga comprende ademas:
    un mecanismo (300) de bloqueo configurado y dimensionado para engancharse con el conjunto (212) de impulsion;
    estando configurada y dimensionada la unidad (16) de carga para rotar alrededor del eje longitudinalconrespecto al cuerpo (14) alargado durante la union de la unidad (16) de carga al aparato quirurgico y la separacion de la unidad (16) de carga del aparato quirurgico, en la que la rotacion de la unidad (16) de carga con respecto al cuerpo (14) alargado en una primera direccion facilita el desenganche del mecanismo (300) de bloqueo del conjunto (212) de impulsion para permitir el movimiento del conjunto (212) de impulsion a traves de la parte de carcasa, y la rotacion de la unidad (16) de carga con respecto al cuerpo (14) alargado en una segunda direccion facilita el enganche del mecanismo (300) de bloqueo con el conjunto (212) de impulsion para impedir el movimiento del conjunto (212) de impulsion a traves de la parte de carcasa, incluyendo el mecanismo (300) de bloqueo una palanca (302) con extremos (306, 304) primero y segundo y un punto (308) de pivote entre los extremos (306, 304) primero y segundo.
  10. 10.
    Unidad (16) de carga segun la reivindicacion 9, en la que el mecanismo (300) de bloqueo se solicita para engancharse con el conjunto (212) de impulsion.
  11. 11.
    Unidad (16) de carga segun la reivindicacion 10, en la que el extremo distal del cuerpo (14) alargado incluye una estructura configurada y dimensionada para engancharse con el mecanismo (300) de bloqueo de modo que la rotacion de la unidad (16) de carga con respecto al cuerpo (14) alargado supera la solicitacion aplicada al mecanismo (300) de bloqueo para provocar la recolocacion del mecanismo (300) de bloqueo.
  12. 12.
    Unidad (16) de carga segun la reivindicacion 10, en la que la unidad (16) de carga incluye una carcasa alargada y el primer extremo de la palanca (302) es un extremo (306) proximal de la palanca (302) y el segundo extremo de la palanca (302) es un extremo (304) distal de la palanca (302).
  13. 13.
    Unidad (16) de carga segun cualquiera de las reivindicaciones 9 a 12, en la que el mecanismo (300) de bloqueo esta configurado para un movimiento pivotante de la primera posicion a la segunda posicion, en una direccion radial, con respecto a la parte de carcasa de la unidad (16) de carga en respuesta a una conexion de la unidad (16) de carga al cuerpo (14) alargado de la carcasa.
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US20070187454A1 (en) 2007-08-16
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US8157148B2 (en) 2012-04-17
US7225963B2 (en) 2007-06-05
US7967180B2 (en) 2011-06-28
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