ES2396321T3 - Impulsor de grapas para grapadora quirúrgica aplicada - Google Patents

Impulsor de grapas para grapadora quirúrgica aplicada Download PDF

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ES2396321T3
ES2396321T3 ES07254774T ES07254774T ES2396321T3 ES 2396321 T3 ES2396321 T3 ES 2396321T3 ES 07254774 T ES07254774 T ES 07254774T ES 07254774 T ES07254774 T ES 07254774T ES 2396321 T3 ES2396321 T3 ES 2396321T3
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staples
staple
cavity
body part
band
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Frank J. Viola
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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
    • A61B17/0682—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil
    • A61B17/0684—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 above the tissue during stapling
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • 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
    • A61B2017/2901—Details of shaft
    • A61B2017/2905—Details of shaft flexible
    • 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
    • A61B2017/2932—Transmission of forces to jaw members
    • A61B2017/2933—Transmission of forces to jaw members camming or guiding means
    • A61B2017/2937—Transmission of forces to jaw members camming or guiding means with flexible part

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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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  • Animal Behavior & Ethology (AREA)
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  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

Conjunto (20) de impulsión de grapas que comprende un cartucho (58) que tiene una parte de cuerpo, teniendo la parte (58) de cuerpo al menos una cavidad (62)para contener grapas; una banda (70) alargada montada de manera móvil dentro de la parte (58) de cuerpo, pudiendo moverse labanda (70) por debajo de la al menos una cavidad (62) para contener grapas de modo que la banda (70) alargada haceque una grapa (64) contenida dentro de la al menos una cavidad (62) para contener grapas salga de la parte (58) decuerpo a medida que la banda (70) alargada pasa por debajo de la cavidad (62) para contener grapas; caracterizado porque la parte (58) de cuerpo incluye: una primera cavidad (62) para contener grapas en un primer lado de la parte (58) de cuerpo; una segunda cavidad (62) para contener grapas en un segundo lado de la parte (58) de cuerpo; y una columna (60) situada de manera intermedia entre los lados primero y segundo de la parte (58) de cuerpode modo que la banda (70) alargada pasa desde el primer lado alrededor de la columna (60) al segundo lado a medidaque la banda (70) alargada pasa por debajo de las cavidades (62) que contienen grapas primera y segunda.

Description

Impulsor de grapas para grapadora quirúrgica articulada
ANTECEDENTES
1. Campo técnico
La presente descripción se refiere a un impulsor de grapas para un instrumento de grapado quirúrgico articulado. Más particularmente, la presente descripción se refiere a un impulsor de grapas para su uso en un instrumento de grapado quirúrgico con una capacidad de articulación mayor que 90 grados.
2. Antecedentes de la técnica relacionada
Se conocen diversos tipos de grapadoras quirúrgicas para grapar tejido dentro del cuerpo. Algunas de tales grapadoras quirúrgicas están configuradas para curvarse o articularse en un punto a lo largo de un árbol distal o adyacente a un efector de extremo asociado con la grapadora. Estas grapadoras quirúrgicas incluyen generalmente un extremo distal que contiene grapas configurado para expulsar grapas al interior del tejido. Un elemento de impulsión está asociado con la grapadora quirúrgica y se impulsa distalmente con su accionamiento para expulsar las grapas al interior del tejido.
De vez en cuando, a medida que el elemento de impulsión se mueve distalmente a través de la grapadora quirúrgica, el elemento de impulsión puede tener la tendencia a arquearse o combarse hacia fuerza en el punto de articulación o curvatura a lo largo de la grapadora quirúrgica. Esto puede reducir la eficacia de la grapa quirúrgica o, en algunos casos, incapacitar la grapadora por completo.
El documento EP 0 648 476 da a conocer un aparato quirúrgico endoscópico alimentado por gas independiente para colocar líneas laterales de fijadores quirúrgicos en el tejido de un cuerpo. El aparato incluye un conjunto de aplicación de fijadores. El conjunto de aplicación de fijadores incluye una parte de base, un alojamiento de cartucho de grapas y un elemento de yunque contra el que se impulsan los fijadores quirúrgicos a medida que se expulsan desde el alojamiento de cartucho. El conjunto de aplicación de fijadores incluye dos barras de leva separadas que impulsan las grapas fuera de la cavidad para contener grapas.
Por tanto, es deseable proporcionar una grapadora quirúrgica articulada que tenga un conjunto de impulsión de grapas configurado para evitar un arqueamiento o combadura del elemento de impulsión a medida que se acciona la grapadora para impulsar las grapas al interior del tejido.
Sumario
La presente invención se refiere a un conjunto (20) de impulsión de grapas que comprende un cartucho (58) que tiene una parte de cuerpo, teniendo la parte (58) de cuerpo al menos una cavidad (62) para contener grapas; una banda (70) alargada montada de manera móvil dentro de la parte (58) de cuerpo, pudiendo moverse la banda (70) por debajo de la al menos una cavidad (62) para contener grapas de modo que la banda (70) alargada hace que una grapa (64) contenida dentro de la al menos una cavidad (62) para contener grapas salga de la parte (58) de cuerpo a medida que la banda
(70) alargada pasa por debajo de la cavidad (62) para contener grapas; caracterizado porque la parte (58) de cuerpo incluye: una primera cavidad (62) para contener grapas en un primer lado de la parte (58) de cuerpo; una segunda cavidad (62) para contener grapas en un segundo lado de la parte (58) de cuerpo; y una columna (60) situada de manera intermedia entre los lados primero y segundo de la parte (58) de cuerpo de modo que la banda (70) alargada pasa desde el primer lado alrededor de la columna (60) al segundo lado a medida que la banda (70) alargada pasa por debajo de las cavidades (62) que contienen grapas primera y segunda. La banda puede moverse por debajo de la al menos una cavidad para contener grapas de modo que la banda hace que una grapa contenida dentro de la cavidad entre en el tejido. La banda alargada está formada como un elemento flexible que puede moverse dentro de la parte de cuerpo. La banda alargada incluye generalmente una primera parte que tiene una primera altura y una segunda parte que tiene una segunda altura mayor que la primera altura. La diferencia entre las alturas primera y segunda es suficiente para expulsar una grapa del interior de la cavidad para contener grapas.
En una realización, la banda puede incluir una tercera parte que tiene una altura menor que la segunda parte. En una realización alternativa, la banda puede incluir una tercera parte que tiene una altura sustancialmente igual a la de la segunda parte.
En una realización particular, la parte de cuerpo puede incluir una primera cavidad para contener grapas en un primer lado de la parte de cuerpo y una segunda cavidad para contener grapas en el segundo lado de la parte de cuerpo. Una columna está situada de manera intermedia entre los lados primero y segundo de modo que la banda alargada puede pasar alrededor de la columna y por debajo de las cavidades para contener grapas primera y segunda. La columna puede estar configurada como un rodillo situado en un extremo distal de la parte de cuerpo. La parte de cuerpo puede incluir un empujador situado entre una grapa contenida dentro de la cavidad para contener grapas y la banda alargada para recibir presión desde la banda alargada y transferirla a la grapa.
También se da a conocer un instrumento quirúrgico que tiene un mango, extendiéndose un elemento tubular alargado articulado distalmente con respecto al mango y estando previsto un conjunto de apriete de grapa en un extremo distal del elemento tubular alargado. El conjunto de apriete de grapa incluye un conjunto de impulsión de grapas y un elemento de yunque que puede moverse en relación con el conjunto de impulsión de grapas. El conjunto de impulsión de grapas incluye una pluralidad de cavidades para contener grapas. Las grapas se sitúan dentro de las cavidades para contener grapas y unos empujadores están situados entre las grapas y una banda de impulsión alargada que está montada de manera móvil dentro del instrumento quirúrgico.
El instrumento quirúrgico incluye un mecanismo de accionamiento que está configurado para desplazar la banda de impulsión alargada distalmente de modo que la banda de impulsión alargada puede pasar alrededor de una sección articulada del instrumento quirúrgico sin riesgo de arqueamiento o flexión.
El instrumento quirúrgico incluye adicionalmente un mecanismo de engranaje configurado para engranarse con un elemento de yunque del instrumento quirúrgico en relación con el conjunto de impulsión de grapas.
Descripción de los dibujos
En el presente documento se dan a conocer diversas realizaciones del impulsor de grapas dado a conocer en el presente documento para su uso en un dispositivo de grapado quirúrgico articulado con referencia a los dibujos, en los que:
la figura 1 es una vista en perspectiva de una grapadora quirúrgica articulada;
la figura 2 es una vista lateral, mostrada parcialmente en sección, del extremo distal de la grapadora quirúrgica;
la figura 3 es una vista desde arriba, mostrada parcialmente en sección, del extremo distal de la grapadora quirúrgica;
la figura 4 es una vista de extremo, mostrada parcialmente en sección, tomada a lo largo de la línea 4-4 de la figura 2;
la figura 5 es una vista en perspectiva de un mecanismo de rodillo doble;
la figura 6 es una vista en perspectiva del mecanismo de mango de la figura 1 con la mitad del alojamiento de mango retirada;
la figura 7 es una vista lateral de una realización de una cinta de impulsión para su uso en la grapadora quirúrgica de la figura 1;
la figura 8 es una vista lateral de una realización alternativa de una cinta de impulsión;
la figura 9 es una vista lateral, mostrada parcialmente en sección, del extremo distal de la grapadora quirúrgica durante el accionamiento;
la figura 10 es una vista lateral, mostrada parcialmente en sección, del extremo distal de la posición de la grapadora quirúrgica alrededor de una sección de tejido tubular;
la figura 11 es una vista lateral, mostrada parcialmente en sección, del extremo distal de la grapadora quirúrgica con un elemento de yunque engranado con la sección de tejido;
la figura 12 es una vista lateral, mostrada parcialmente en sección, durante el accionamiento de la cinta de impulsión para impulsar grapas en el elemento de yunque; y
la figura 13 es una vista lateral, mostrada parcialmente en sección, tras el accionamiento completo de la cinta de impulsión que impulsa todas las grapas a través del tejido y al interior del elemento de yunque.
Descripción detallada de realizaciones
Ahora se describirán en detalle realizaciones del conjunto de impulsión de grapas dado a conocer en el presente documento para su uso con una grapadora quirúrgica articulada, con referencia a los dibujos en los que los números de referencia similares designan elementos idénticos o correspondientes en cada una de las diversas vistas. Como es común en la técnica, el término “proximal” se refiere a la parte o componente más próximo al usuario u operario, es decir el cirujano o médico, mientras que el término “distal” se refiere a la parte o componente más alejado del usuario.
La figura 1 ilustra una realización de una grapadora 10 quirúrgica articulada. La grapadora 10 quirúrgica incluye generalmente un mango 12 y un elemento 14 tubular alargado que se extiende distalmente desde el mango 12. Un conjunto 16 de apriete de grapa está previsto en un extremo 18 distal del elemento 14 tubular alargado. El conjunto 16 de apriete de grapa incluye un conjunto 20 de impulsión de grapas y un elemento 22 de yunque fijado de manera pivotante a un extremo 24 proximal del conjunto 20 de impulsión de grapas. El elemento 22 de yunque puede moverse desde una posición abierta separada del conjunto 20 de impulsión de grapas a una posición cerrada generalmente adyacente al conjunto 20 de impulsión de grapas. Específicamente, un extremo 26 proximal del elemento 22 de yunque está fijado de manera pivotante al conjunto 20 de impulsión de grapas en un punto 28 de pivote.
Para mover el elemento 22 de yunque entre las posiciones abierta y cerrada, el conjunto 16 de apriete de grapa incluye adicionalmente un collar 30 deslizante o de engranaje que está previsto para enganchar y mover el elemento 22 de yunque de una manera descrita en más detalle a continuación en el presente documento. Un primer disparador 32 está previsto en el mango 12 para mover el collar 30 de manera distal y proximal en relación con el elemento 14 tubular alargado para abrir y cerrar el elemento 22 de yunque. Un segundo disparador 34 está previsto en el mango 12 para accionar el conjunto 20 de impulsión de grapas e impulsar las grapas (figura 2) fuera del conjunto 20 de impulsión de grapas y al interior del elemento 22 de yunque.
Como se indicó anteriormente en el presente documento, en la técnica se conocen diversos tipos de grapadoras quirúrgicas articuladas. La grapadora 10 quirúrgica está configurada para articularse en un punto a lo largo del elemento 14 tubular alargado. Específicamente, el elemento 14 tubular alargado incluye un extremo 36 proximal que se extiende distalmente con respecto a una parte 38 cónica de punta del mango 12. El elemento 14 tubular alargado incluye una sección 40 proximal y una sección 42 distal. El elemento 14 tubular alargado está configurado para articularse en una parte 44 intermedia ubicada entre las secciones 40 y 42 proximal y distal, respectivamente. En esta realización particular, la parte 44 intermedia tiene la capacidad de curvarse un ángulo a que es mayor que 90 grados y puede ser de hasta casi 180 grados.
Con referencia ahora a las figuras 2-5, ahora se describirán los detalles del conjunto 16 de apriete de grapa. Inicialmente con respecto a las figuras 2 y 3, como se indicó anteriormente en el presente documento, un elemento 22 de yunque puede moverse entre una posición abierta separada del conjunto 20 de impulsión de grapas y una posición cerrada sustancialmente adyacente al conjunto 20 de impulsión de grapas. El collar 30 de engranaje incluye un borde 46 de entrada que está configurado para enganchar una superficie 48 inclinada formada en el extremo 26 proximal del elemento 22 de yunque. Para mover el collar 30 de engranaje, se proporciona un cable 50 de bucle continuo que se extiende desde el mango 12 a través del elemento 14 tubular alargado y a través del conjunto 20 de impulsión de grapas.
Con referencia por el momento específicamente a la figura 3, el cable 50 está fijado a un lado del collar 30 de engranaje en un punto 52 de fijación. En esta realización particular, el punto 52 de fijación está unido a un lado 54 de avance del cable 50 mientras que un lado 56 de retracción es libre para deslizarse a través del collar 30 de engranaje. Una parte 58 de cuerpo del conjunto 20 de impulsión de grapas está dotada de un rodillo 60 compuesto para adaptarse al paso y movimiento del cable 50 a través del conjunto 20 de impulsión de grapas. El cable 50 pasa alrededor de una parte del rodillo 60 compuesto de una manera descrita en más detalle a continuación en el presente documento. Moviendo el lado 54 de avance distalmente en relación con el conjunto 20 de impulsión de grapas, el lado 54 de avance del cable 50 mueve el collar 30 de engranaje distalmente haciendo que el borde 46 de entrada enganche la superficie 48 inclinada del elemento 22 de yunque y mueva el elemento 22 de yunque a una posición cerrada en relación con el conjunto 20 de impulsión de grapas. Debe indicarse que puesto que el cable 50 forma un bucle continuo dentro del instrumento 10 quirúrgico articulado alrededor del rodillo 60 compuesto, se aplica una tensión constante tanto al lado 54 de avance como al lado 56 de retracción del cable 50 evitando de este modo cualquier combadura o arqueamiento del cable 50 a medida que pasa a través de la sección 44 articulada intermedia del elemento 14 tubular alargado.
Con referencia de nuevo a las figuras 2 y 3, se proporciona el conjunto 16 de apriete de grapa para hacer avanzar una fila de grapas fuera del conjunto 20 de impulsión de grapas y al interior del elemento 22 de yunque para grapar tejido capturado entremedias. Por tanto, la parte 58 de cuerpo del conjunto 20 de impulsión de grapas contiene una pluralidad de cavidades 62 para contener grapas formadas en su interior. Las grapas 64 están previstas dentro de cavidades 62 para contener grapas y los empujadores 66 están situados dentro de las cavidades 62 para contener grapas por debajo de las grapas 64. Haciendo avanzar los empujadores 66 hacia arriba dentro de las cavidades 62 para contener grapas, las grapas 64 se hacen avanzar fuera de las cavidades 62 para contener grapas y al interior del elemento 22 de yunque. Como se indicó anteriormente en el presente documento, el rodillo 60 compuesto está previsto en un extremo 68 distal de la parte 58 de cuerpo para proporcionar un trayecto de retorno para el cable 50 y ayudar a mantener una presión constante en el cable 50 a medida que pasa a través de la grapadora 10.
Para hacer avanzar los empujadores 66 hacia arriba, y, por tanto, impulsar las grapas 64 fuera de las cavidades 62 para contener grapas, el conjunto 20 de impulsión de grapas está dotado de un impulsor novedoso o banda 70 de impulsión flexible que se extiende desde el mango 12 a través del elemento 14 tubular alargado y al interior del conjunto 20 de impulsión de grapas. La banda 70 de impulsión pasa alrededor del rodillo 60 compuesto y de vuelta a través de un trayecto de retorno al mango 12. La banda 70 de impulsión está situada dentro de la parte 58 de cuerpo de modo que la banda 70 de impulsión pasa directamente por debajo de las cavidades 62 para contener grapas. De manera similar al cable 50, la banda 70 de impulsión se mantiene bajo tensión constante para evitar cualquier combadura o arqueamiento de la banda 70 de impulsión a medida que pasa a través de la sección 44 articulada intermedia del elemento 14 tubular alargado. Para mover los empujadores 66 dentro de las cavidades 62 para contener grapas, la banda 70 de impulsión incluye una primera parte 72 o parte de entrada y una segunda parte 74 o parte de impulsión que tiene una altura mayor que la parte 72 de entrada. Por tanto, a medida que la parte 74 de impulsión pasa por debajo de las cavidades 62 para contener grapas, la parte 74 de impulsión fuerza a los empujadores 66 y las grapas 64 hacia arriba dentro de las cavidades 62 para contener grapas.
Con referencia por el momento a las figuras 4 y 5, y como se indicó anteriormente en el presente documento, la parte 58 de cuerpo del conjunto 20 de impulsión de grapas está dotada de un rodillo 60 compuesto. El rodillo 60 compuesto proporciona un trayecto de retorno para el cable 54 así como una banda 70 de impulsión flexible. El rodillo 60 compuesto ayuda adicionalmente a proporcionar una tensión constante al cable 54 y la banda 70 de impulsión flexible para evitar que el cable 54 y la banda 70 de impulsión flexible se flexionen o arqueen a medida que pasan a través de la sección 44 articulada del elemento 14 tubular alargado. Específicamente, el rodillo 60 compuesto está fijado dentro del extremo 68 distal de la parte 58 de cuerpo mediante una espiga 76. En una realización particular, el rodillo 60 compuesto incluye un rodillo 78 de cable y un rodillo 80 de banda. El rodillo 78 de cable y el rodillo 80 de banda son libres para rotar de manera independiente alrededor de la espiga 76 para adaptarse a los movimientos independientes del cable 54 y la banda 70 de impulsión flexible.
Con referencia ahora a la figura 6, ahora se describirá el uso del primer disparador 32 y el segundo disparador 34 en el mango 12 para accionar el cable 50 y la banda 70 de impulsión flexible, respectivamente. Una rueda 82 de impulsión de cable está montada de manera rotatoria dentro del mango 12. La rueda 82 de impulsión de cable proporciona un segundo extremo para tensar el bucle continuo de cable 50 así como medios para hacer avanzar y retraer el cable 50 a través del instrumento 10 quirúrgico. Específicamente, una cremallera 84 prevista en una parte 86 superior del primer disparador 32 incluye una pluralidad de dientes 88 que están configurados para enganchar dientes correspondientes (no mostrados) en un lado inferior de la rueda 82 de impulsión para, de este modo, hacer rotar la rueda 82 de impulsión en respuesta al accionamiento del primer disparador 32. Cuando se acciona el primer disparador 32, se hace rotar la rueda 82 de impulsión para tirar del lado 56 de retracción del cable 50. A medida que se tira del lado 56 de retracción de manera proximal, el lado 54 de avance del cable 50 se mueve distalmente para hacer que el collar 32 de engranaje se mueva distalmente y fuerce al elemento 22 de yunque a una posición cerrada. Asimismo, cuando se libera el primer disparador 32, la rueda 82 de impulsión rota en un sentido opuesto para desplazar el collar 32 de manera proximal y permitir que el elemento 22 de yunque se mueva a la posición abierta.
Como se indicó anteriormente en el presente documento, la grapadora 10 quirúrgica articulada incorpora la banda 70 de impulsión flexible novedosa para expulsar grapas 64 fuera del conjunto 20 de impulsión de grapas. A diferencia de las grapadoras quirúrgicas articuladas convencionales, que empujan o fuerzan a los elementos de impulsión flexibles alrededor de un punto de articulación a lo largo de la grapadora quirúrgica, la banda 70 de impulsión flexible se tensa o desplaza distalmente a través del punto de articulación durante el accionamiento eliminando de este modo cualquier posibilidad de que la banda 70 de impulsión flexible se arquee o flexione hacia fuera en el punto de articulación.
El conjunto 20 de impulsión de grapas incluye una primera bobina 90 o bobina de distribución alrededor de la que se sitúa una parte de la banda 70 de impulsión flexible. La bobina 90 de distribución está fijada de manera rotatoria a una barra 92 de montaje situada dentro del mango 12. La bobina 90 de distribución puede estar dotada de diversos dispositivos de resorte o fricción para proporcionar una ligera cantidad de tensión proximal sobre la banda 70 de impulsión flexible. El conjunto 20 de impulsión de grapas incluye adicionalmente una segunda bobina 94 o bobina de impulsión también montada de manera rotatoria en la barra 92 de montaje. La bobina 94 de impulsión está configurada para desplazar la banda 70 de impulsión flexible a través del elemento 14 tubular alargado, alrededor del rodillo 80 de banda y de vuelta a través del elemento 14 tubular alargado. Específicamente, el segundo disparador 34 está dotado de una cremallera 96 en una parte 98 superior del segundo disparador 34. La cremallera 96 incluye dientes 100 que están configurados para enganchar dientes correspondientes en un lado inferior de la bobina 94 de impulsión para hacer rotar la bobina 94 de impulsión en respuesta al accionamiento del segundo disparador 34.
Por tanto, con el accionamiento del segundo disparador 34, la bobina 94 de impulsión se hace rotar para desplazar la primera parte 72 o parte de entrada de la banda 70 de impulsión flexible de manera proximal haciendo que la segunda parte 74 o parte de impulsión de la banda 70 de impulsión flexible se mueva distalmente a través del elemento 14 tubular alargado y por debajo de los empujadores 66 ubicados dentro del conjunto 20 de impulsión de grapas. Debe indicarse que, para desplazar la parte 74 de impulsión completamente por debajo de todos los empujadores 66 ubicados dentro del conjunto 20 de impulsión de grapas, puede ser necesario accionar el segundo disparador 34 varias veces. En este caso, pueden proporcionarse adaptaciones conocidas a la cremallera 96 para permitir que la cremallera 96 vuelva a su posición inicial en relación con la bobina 94 de impulsión para activaciones adicionales o múltiples.
Con referencia ahora a la figura 7, se ilustra la configuración de una realización de la banda 70 de impulsión flexible, que incluye la parte 72 de entrada y la parte 74 de impulsión. La banda 70 de impulsión flexible puede estar formada a partir de cualquier de diversos materiales flexibles incluyendo acero inoxidable, plástico u otros materiales poliméricos que sean suficientemente rígidos a lo ancho para impulsar los empujadores 66 dentro de las cavidades 62 para contener grapas.
La parte 72 de entrada de la banda 70 de impulsión flexible tiene una primera altura h1 que es relativamente pequeña para permitir un movimiento inicial sencillo de la banda 70 de impulsión flexible a través del conjunto 20 de impulsión de grapas y por debajo de las cavidades 62 para grapas. La parte 74 de impulsión de la banda 70 de impulsión flexible tiene una segunda altura h2 que es mayor que la de la altura h1. La parte 74 de impulsión define un borde 102 de entrada en la segunda altura h2. La diferencia de distancia entre las alturas h1 y h2 es sustancialmente equivalente a la distancia necesaria para impulsar los empujadores 66 dentro de las cavidades 62 para contener grapas para sacar las grapas 64 de la cavidad 62 para grapas e introducirlas en el elemento 22 de yunque. Debe indicarse que el rodillo 80 de banda tiene un ancho suficiente para adaptarse a la altura h2 de la parte 74 de impulsión de modo que la banda 70 flexible pueda desplazarse a través de una primera fila de cavidades 62 para contener grapas, alrededor del rodillo 80 de banda y de vuelta a través de una segunda fila de cavidades 62 para contener grapas en un lado opuesto de la primera fila de cavidades 62 para contener grapas. De este modo, puede adaptarse múltiples filas de cavidades 62 para contener grapas dentro del conjunto 20 de impulsión de grapas.
Con referencia ahora a la figura 8, se da a conocer una realización alternativa de una banda 106 de impulsión flexible para su uso con un conjunto 20 de impulsión de grapas. La banda 106 de impulsión flexible incluye una primera parte 108 o parte de entrada que tiene una primera altura h4 y una segunda parte 110 o parte de impulsión que tiene una segunda altura h5 suficiente para impulsar los empujadores 66 y las grapas 64 dentro de las cavidades 62 para contener grapas. Una parte 112 proximal de la parte 110 de impulsión tiene una tercera altura h6 que es sustancialmente igual a la segunda altura h5. Manteniendo la altura de la parte 112 proximal sustancialmente similar a la de la parte 110 de impulsión, la banda 106 de impulsión flexible mantiene los empujadores 66 en una condición hacia arriba dentro de las cavidades 62 para contener grapas, a medida que la banda 106 de impulsión flexible se desplaza por debajo, para mantener una presión sobre las grapas 64 contra el elemento 22 de yunque hasta que todas las grapas 64 se hayan introducido en el elemento 22 de yunque.
Como se muestra de la mejor manera en la figura 9, el collar 30 de engranaje se ha movido a una posición más distal mediante el cable 50 para hacer que el borde 46 de entrada desplace la superficie 48 inclinada hacia abajo moviendo así el elemento 22 de yunque a una posición cerrada en relación con el conjunto 20 de impulsión de grapas. Como se muestra adicionalmente en la figura 9, la banda 70 de impulsión flexible se ilustra como habiéndose movido una distancia distalmente haciendo que el borde 102 de entrada desplace los empujadores 66 hacia arriba dentro de las cavidades 62 para contener grapas haciendo de este modo que una grapa 64 respectiva se apriete contra el elemento 22 de yunque.
Con referencia ahora a las figuras 6 y 10 a 13, ahora se describirá el uso del instrumento quirúrgico articulado o grapadora 10 para grapar tejido. Inicialmente, con respecto a la figura 10, se sitúa un tejido T entre el elemento 22 de yunque y el conjunto 20 de impulsión de grapas. El collar 30 de engranaje está en la posición más proximal en relación con el elemento 22 de yunque.
Con referencia ahora a las figuras 6 y 11, inicialmente se acciona el primer disparador 32 para mover el cable 50 a través del elemento 14 tubular alargado y alrededor del rodillo 78 de cable. Específicamente, se hace rotar la rueda 82 de impulsión para desplazar el lado 56 de retracción del cable 50 y para hacer avanzar el lado 54 de avance del cable
50. A medida que el lado 54 de avance del cable 50 se mueve distalmente, el collar 30 de engranaje se mueve distalmente haciendo que el borde 46 de entrada enganche la superficie 48 inclinada en el elemento 22 de yunque moviendo de este modo el elemento 22 de yunque a una posición cerrada. De este modo, el tejido T queda capturado entre el elemento 22 de yunque y el conjunto 20 de impulsión de grapas.
Con el accionamiento del segundo disparador 34 (figura 6) se hace rotar la bobina 94 de impulsión para desplazar la parte 72 de entrada de la banda 70 de impulsión flexible de manera proximal mientras que al mismo tiempo se desplaza la parte 74 de impulsión distalmente de modo que la parte 74 de impulsión, y por tanto el borde 102 de entrada, pasa por debajo de los empujadores 66 forzando a las grapas 64 hacia arriba a través del tejido T y al interior del elemento 22 de yunque apretando de este modo las grapas 64 a través del tejido T (figura 12). Como se indicó anteriormente en el presente documento, el rodillo 80 de banda tiene un ancho suficiente para adaptarse a la parte 74 de impulsión de modo que la parte 74 de impulsión pueda desplazarse de manera proximal por debajo de una segunda fila de cavidades 62 para contener grapas para introducir una segunda fila de grapas 64 en el elemento 22 de yunque (figura 13).
Como se comentó anteriormente en el presente documento, la previsión de la banda 70 de impulsión flexible junto con el rodillo 60 compuesto, permite que la banda 70 de impulsión flexible se desplace distalmente a través del elemento 14 tubular alargado y alrededor de la sección 44 articulada intermedia (figura 1) mientras que al mismo tiempo se evita que la banda 70 de impulsión flexible se flexione o arquee hacia fuera a medida que pasa alrededor de la sección 44 articulada intermedia.
Se entenderá que pueden realizarse diversas modificaciones de las realizaciones dadas a conocer en el presente documento. Por ejemplo, como se indicó anteriormente en el presente documento, el conjunto de apriete de grapa puede incluir múltiples filas de cavidades para contener grapas para proporcionar múltiples filas de grapas a través del tejido. Además, el elemento de impulsión dado a conocer puede comprender una estructura diferente de una banda, tal como, por ejemplo, un cable de sección decreciente, etc. que pueda desplazarse distalmente a través de una parte articulada de una grapadora quirúrgica sin riesgo de combadura o arqueamiento. Por tanto, la descripción anterior no debe interpretarse como limitativa, sino simplemente como ejemplificación de realizaciones particulares.

Claims (9)

  1. REIVINDICACIONES
    1. Conjunto (20) de impulsión de grapas que comprende
    un cartucho (58) que tiene una parte de cuerpo, teniendo la parte (58) de cuerpo al menos una cavidad (62) para contener grapas;
    una banda (70) alargada montada de manera móvil dentro de la parte (58) de cuerpo, pudiendo moverse la banda (70) por debajo de la al menos una cavidad (62) para contener grapas de modo que la banda (70) alargada hace que una grapa (64) contenida dentro de la al menos una cavidad (62) para contener grapas salga de la parte (58) de cuerpo a medida que la banda (70) alargada pasa por debajo de la cavidad (62) para contener grapas;
    caracterizado porque la parte (58) de cuerpo incluye:
    una primera cavidad (62) para contener grapas en un primer lado de la parte (58) de cuerpo;
    una segunda cavidad (62) para contener grapas en un segundo lado de la parte (58) de cuerpo; y
    una columna (60) situada de manera intermedia entre los lados primero y segundo de la parte (58) de cuerpo de modo que la banda (70) alargada pasa desde el primer lado alrededor de la columna (60) al segundo lado a medida que la banda (70) alargada pasa por debajo de las cavidades (62) que contienen grapas primera y segunda.
  2. 2.
    Conjunto (20) de impulsión de grapas según la reivindicación 1, en el que la banda (70) alargada es flexible.
  3. 3.
    Conjunto (20) de impulsión de grapas según la reivindicación 2, en el que la banda (70) alargada tiene una primera parte (72) que tiene una primera altura y una segunda parte (74) próxima a la primera parte y que tiene un borde de entrada, teniendo el borde de entrada una segunda altura mayor que la primera altura.
  4. 4.
    Conjunto (20) de impulsión de grapas según la reivindicación 3, en el que la diferencia entre la primera altura y la segunda altura es sustancialmente igual a la distancia requerida para impulsar la grapa (64) fuera de la cavidad (62) para contener grapas.
  5. 5.
    Conjunto (20) de impulsión de grapas según la reivindicación 3, en el que la banda (70) alargada incluye una tercera parte intermedia entre la primera parte (72) y la segunda parte (74), teniendo la tercera parte una sección decreciente entre las partes (72, 74) primera y segunda de modo que el movimiento de la banda (70) alargada por debajo de la cavidad (62) para contener grapas impulsa progresivamente la grapa (64) fuera de la cavidad (62) para contener grapas.
  6. 6.
    Conjunto (20) de impulsión de grapas según la reivindicación 3, en el que la banda (70) alargada tiene una altura constante próxima al borde de entrada
  7. 7.
    Conjunto (20) de impulsión de grapas según la reivindicación 3, en el que la altura de la banda alargada disminuye de manera proximal con respecto al borde de entrada.
  8. 8.
    Conjunto (20) de impulsión de grapas según la reivindicación 1, en el que la columna (60) incluye un rodillo
    (80) montado de manera móvil en la columna de modo que la banda alargada pasa alrededor del rodillo (80).
  9. 9. Conjunto (20) de impulsión de grapas según la reivindicación 1, en el que la parte (58) de cuerpo incluye además un empujador (66) situado dentro de la primera cavidad (62) para contener grapas de manera intermedia entre la grapa (64) contenida dentro de la primera cavidad (62) para contener grapas y la banda (70) alargada.
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EP1935351A3 (en) 2009-12-02
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US20080149684A1 (en) 2008-06-26
AU2007237305A1 (en) 2008-07-10
US7434716B2 (en) 2008-10-14
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AU2007237305B2 (en) 2013-06-20
US7641095B2 (en) 2010-01-05
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CA2615088C (en) 2015-03-31
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US20090039137A1 (en) 2009-02-12
EP1935351B1 (en) 2012-09-26

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