ES2398082T3 - Tope de tejido para instrumento quirúrgico - Google Patents

Tope de tejido para instrumento quirúrgico Download PDF

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ES2398082T3
ES2398082T3 ES11178544T ES11178544T ES2398082T3 ES 2398082 T3 ES2398082 T3 ES 2398082T3 ES 11178544 T ES11178544 T ES 11178544T ES 11178544 T ES11178544 T ES 11178544T ES 2398082 T3 ES2398082 T3 ES 2398082T3
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surgical instrument
jaw
stop
leg
assembly
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David Farascioni
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Covidien LP
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Tyco Healthcare Group LP
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—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
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • 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
    • A61B2017/07221—Stapler heads curved
    • 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
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2945—Curved jaws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B2018/1405—Electrodes having a specific shape
    • A61B2018/1425—Needle
    • A61B2018/1432—Needle curved

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
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  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

Un instrumento quirúrgico (100) para unir quirúrgicamente tejidos, comprendiendo el instrumento quirúrgico (100): un conjunto (160) de empuñadura; una parte (120) alargada que se extiende de forma distal desde el conjunto (160) de empuñadura y que define un eje longitudinal; un actuador extremo (154) dispuesto junto a una parte distal de la parte alargada (120), incluyendo el actuador extremo (154) un primer elemento (130) de mordaza con una superficie (134) de contacto con el tejido y un segundo elemento (140) de mordaza, siendo movible al menos uno de los elementos de mordaza con respecto al otro elemento de mordaza entre posiciones separada y próxima, incluyendo el primer elemento (130) de mordaza un canal (138) de cuchilla; un elemento (170) de tope adaptado para facilitar la retención del tejido entre el primer y segundo elementos (130, 140) de mordaza durante el funcionamiento del instrumento quirúrgico (100), estando dispuesto el elemento (170) de tope junto una la parte distal del primer elemento (130) de mordaza y siendo capaz de pivotar con respecto al primer elemento (130) de mordaza entre una primera posición y una segunda posición, incluyendo además el elemento (170) de tope una primera pata (177) y una segunda pata (177), en el que la primera pata (177) y la segunda pata (177) están ubicadas en lados opuestos del canal (138) de cuchilla.

Description

Tope de tejido para instrumento quirúrgico. Antecedentes Campo de la técnica La presente descripción se refiere en general a instrumentos quirúrgicos y, más concretamente, a instrumentos
quirúrgicos para unir tejidos quirúrgicamente. Antecedentes de la técnica relacionada Instrumentos quirúrgicos de grapado utilizados para aplicar filas paralelas de grapas a través de tejido vivo
comprimido son bien conocidos en la técnica. Estos instrumentos quirúrgicos se emplean normalmente para cerrar tejidos u órganos antes de la operación o la resección, para ocluir órganos en operaciones abdominales o torácicas, y para suturar tejido en anastomosis.
Normalmente, tales instrumentos de grapado quirúrgico incluyen un conjunto de yunque, un conjunto cartucho para soportar una serie de grapas quirúrgicas, un mecanismo de aproximación para aproximar el yunque y los conjuntos de yunque y cartucho, y un mecanismo de disparo para expulsar las grapas quirúrgicas procedentes del conjunto cartucho.
En la práctica, un cirujano generalmente aproxima inicialmente los elementos de yunque y cartucho. A continuación, el cirujano puede disparar el instrumento para colocar las grapas en el tejido. Adicionalmente, el cirujano puede utilizar el mismo instrumento u otro instrumento diferente para cortar el tejido adyacente o entre la(s) fila(s) de grapas. Alternativamente, el instrumento quirúrgico para grapar puede expulsar las grapas secuencialmente mientras el yunque y el cartucho se aproximan.
La forma de dos partes de la reivindicación 1 adjunta que se basa en la descripción de US 5 816 471. La EP 600182 describe una grapadora quirúrgica con un elemento de tope pivotante.
Compendio La presente descripción se refiere a un instrumento quirúrgico para unir quirúrgicamente tejidos como se define en las reivindicaciones adjuntas. El instrumento quirúrgico incluye un conjunto de empuñadura, una parte alargada, un actuador extremo y un elemento de tope.
Breve descripción de las figuras Se describen en la presente memoria varias realizaciones del instrumento quirúrgico descrito con referencia a los dibujos, en los que:
la figura 1 es una vista en perspectiva de una realización del instrumento quirúrgico de la presente descripción; las figuras 2-4 son vistas en perspectiva de una parte del instrumento quirúrgico de la figura 1, mostrando
un elemento de tope en una primera posición;
las figuras 5-7 son vistas laterales de un actuador extremo del instrumento quirúrgico de la figura 1, mostrado en diferentes etapas de funcionamiento; la figura 8 es una vista en perspectiva de una parte del instrumento quirúrgico de la figura 1, mostrando un
elemento de tope en su segunda posición;
la figura 9 es una vista en perspectiva de un elemento de mordaza curvo según otra realización de la presente descripción, mostrando un elemento de tope en una primera posición; la figura 10 es una vista despiezada en perspectiva del elemento de mordaza curvo de la figura 9; la figura 11 es una vista en perspectiva del elemento de mordaza curvo de la figura 9, mostrando la sección
transversal de una parte distal tomada a lo largo de la línea de sección 11-11 de la figura 9; y la figura 12 es una vista en perspectiva del elemento de mordaza curvo de la figura 9, mostrando el
elemento de tope en una segunda posición. Descripción detallada Se describen con detalle realizaciones del instrumento quirúrgico descrito en esta memoria, en referencia a los
dibujos, en los que los mismos números de referencia designan elementos similares o idénticos en cada una de las diversas vistas. En los dibujos y en la descripción que sigue, el término "proximal" se refiere al extremo del instrumento quirúrgico que está más cerca del operador, mientras que el término "distal" se refiere al extremo del instrumento quirúrgico que está más lejos del operador. Como apreciará un especialista en la técnica, el instrumento quirúrgico representado dispara grapas, pero puede adaptarse para disparar cualquier otro sujetador adecuado como clips y sujetadores de dos piezas. Adicionalmente, el elemento de tope descrito se puede utilizar con una pinza o fórceps electro-quirúrgico. En la publicación de la solicitud de patente de propiedad común, número US 2003 229344 se describen detalles adicionales del fórceps electro-quirúrgico.
Con referencia a la figura 1, el número 100 de referencia designa una realización del instrumento quirúrgico ahora descrito. En aras de la brevedad, la presente descripción se centra en un actuador extremo y un elemento de tope del instrumento quirúrgico 100. Las solicitudes de patente US, números de publicación 2008/0105730; 2008/0110960; 2008/0142565; 2008/0041916; 2007/187456 Y EP 2116194 describen en detalle la estructura y el funcionamiento de otros conjuntos de sujeción quirúrgicos. Cualquiera de los conjuntos de sujeción quirúrgicos descritos en las solicitudes de patente citadas pueden incluir el elemento de tope descrito en esta memoria.
El instrumento 100 quirúrgico se configura para abrazar, sujetar y/o cortar tejido. En general, el instrumento quirúrgico 100 incluye un conjunto 160 de empuñadura, una parte 120 alargada que se extiende de forma distal a partir del conjunto 160 de empuñadura y que define un eje longitudinal "A-A", y un conjunto 150 de herramienta adaptado para abrazar y sujetar tejidos. La parte alargada 120 tiene una parte proximal 122 y una parte distal 124 y acopla funcionalmente el conjunto 160 de empuñadura con el conjunto 150 de herramienta. El conjunto 150 de herramienta incluye el actuador extremo 154 y el elemento 170 de tope. El actuador extremo 154, que está dispuesto junto a la parte distal 124 de la parte alargada 120, incluye un primer elemento 130 de mordaza y un segundo elemento 140 de mordaza. Al menos uno de los elementos 130, 140 de mordaza está adaptado para moverse respecto del otro elemento (130 ó 140) de mordaza entre posiciones separada y próxima. En la realización ilustrada, el primer elemento 130 de mordaza contiene un conjunto 132 de cartucho, mientras que el segundo elemento 140 de mordaza incluye un conjunto 142 de yunque. Como se comenta más adelante, el conjunto 142 de yunque se mueve respecto al conjunto 132 de cartucho entre posiciones separada y próxima mediante el accionamiento del elemento 160 de empuñadura o mango, por ejemplo. Sin embargo, también se prevé que otros métodos de aproximación de los elementos de mordaza sean también utilizables, incluyendo el deslizamiento de una barra 168 de sujeción.
El conjunto 160 de empuñadura incluye una empuñadura fija 162 y una empuñadura movible 164. La empuñadura movible 164 está adaptada para moverse acercándose o alejándose de manera pivotante con respecto a la empuñadura fija 162. Además, la empuñadura movible 164 se conecta funcionalmente al conjunto 140 de yunque a través de un mecanismo adaptado para convertir al menos un accionamiento parcial de la empuñadura movible 164 en un movimiento pivotante de al menos uno de los conjuntos 132 de cartucho y del conjunto 142 de yunque entre posiciones separada y próxima. Como reconocerá un especialista en la técnica, cualquier mecanismo de accionamiento convencional se puede emplear para acoplar funcionalmente la empuñadura movible 164 al conjunto 150 de herramienta.
Con referencia a las figuras 2-5, el conjunto 132 cartucho tiene una superficie 134 de contacto con el tejido y una pluralidad de ranuras 136 para retener sujetadores. La superficie 134 de contacto con el tejido normalmente se enfrenta al conjunto 142 de yunque (véase la figura 1) y, durante el funcionamiento, se aplica al tejido cuando el conjunto 142 de yunque se aproxima al conjunto 132 cartucho. Las ranuras 136 para retener elementos de fijación se disponen en filas a lo largo de la superficie 134 de contacto con el tejido. Cada ranura 136 para retener sujetadores está adapta para retener un sujetador (no mostrado) hasta que un usuario acciona el conjunto 160 empuñadura (véase la figura 1), por ejemplo. Cuando la empuñadura movible 164 pivota hacia la empuñadura fija 162, los sujetadores son expulsados de las ranuras 134 para retener sujetadores y se mueven hacia el conjunto 142 de yunque.
Además de las ranuras 136 para retener sujetadores, el conjunto 132 de cartucho tiene un canal 138 de cuchilla adaptado para alojar deslizablemente una cuchilla (no mostrada) o cualquier otra herramienta de corte adecuada. El canal 138 de cuchilla está dispuesto entre filas de ranuras 136 para retener sujetadores y se extiende a lo largo de la superficie 134 de contacto con el tejido. En funcionamiento, una cuchilla (no mostrada) desliza a través del canal 138 de cuchilla cuando la empuñadura movible 164 pivota hacia la empuñadura fija 162. Alternativamente, se pueden utilizar otros mecanismos para conducir la cuchilla a través del canal 138 de cuchilla. Además del canal 138 de cuchilla, el conjunto 132 de cartucho tiene un par de ranuras 139 conformadas sobre la superficie 134 de contacto con el tejido. Cada ranura 139 facilita acceso a la parte interior del conjunto 132 de cartucho y está configurada para alojar partes del elemento 170 de tope.
En realizaciones descritas, el conjunto 160 de empuñadura contiene un mecanismo de accionamiento para el despliegue de los sujetadores desde las ranuras 136 para retener sujetadores y hacer avanzar una cuchilla a lo largo del canal 138 de cuchilla. Este mecanismo de accionamiento incluye una barra de disparo conectada funcionalmente a la empuñadura movible 164. En funcionamiento, el pivotamiento de la empuñadura movible 164 hacia la empuñadura fija 162 hace avanzar la barra de disparo de forma distal. La barra de disparo está a su vez
funcionalmente acoplada a un conjunto de accionamiento axial colocado al menos parcialmente dentro del conjunto 150 de herramienta. El conjunto de accionamiento axial está configurado para moverse de forma distal en respuesta a una traslación distal de la barra de disparo. La traslación distal del conjunto de accionamiento axial origina que el segundo elemento 140 de mordaza pivote hacia el primer elemento 130 de mordaza. Además, el conjunto de accionamiento axial empuja a un deslizador de actuación dispuesto dentro del primer elemento 130 de mordaza en una dirección distal, mientras que el deslizador de actuación se traslada de forma distal a través del actuador extremo 154. A medida que el deslizador de actuación avanza de forma distal a través del primer elemento 130 de mordaza, este deslizador de actuación empuja a los sujetadores fuera de las ranuras 136 de retención de sujetadores. En una realización, el conjunto de accionamiento axial incluye una cuchilla montada en una parte distal del mismo. En funcionamiento, esta cuchilla se mueve a través del canal 138 de cuchilla cuando el conjunto de accionamiento axial se mueve de forma distal a través del actuador extremo 154.
El elemento 170 de tope se dispone junto a una parte distal 137 del primer elemento 130 de mordaza (que se muestra como conjunto 132 de cartucho, pero que también puede ser conjunto 142 de yunque). El elemento 170 de tope es capaz de pivotar con respecto al primer elemento 130 de mordaza entre una primera posición, como se ilustra en la figura 5, y una segunda posición, como la representada en la figura 7. En la primera posición, al menos una parte del elemento 170 de tope está ubicada exteriormente al primer elemento 130 de mordaza, mientras que, en la segunda posición, al menos una parte del elemento 170 de tope está ubicada al menos parcialmente debajo de la superficie 134 de contacto con el tejido del primer elemento 130 de mordaza. En varias realizaciones, una parte significativa del elemento 170 de tope está dispuesta exteriormente al primer elemento 130 de mordaza cuando el elemento 170 de tope está ubicado en la primera posición. Se prevé que el término "significativa" quiere decir que al menos la mitad de cada pata 177 de la parte 170 de tope está dispuesta exteriormente al primer elemento 130 de mordaza cuando el elemento 170 de tope está ubicado en la primera posición. Adicionalmente, según se utiliza en la presente memoria, "significativo" puede querer decir que más de un tercio del elemento 170 de tope está dispuesto exteriormente al primer elemento 130 de mordaza cuando el elemento 170 de tope está ubicado en la primera posición.
El elemento 170 de tope incluye una base 172 adaptada para aplicarse a una superficie exterior de la parte distal 137 del primer elemento 130 de mordaza y una parte 174 de detención adaptada para aplicarse al tejido. Un pasador 176 de pivote, o cualquier otro órgano adecuado, conecta de forma pivotante la parte 174 de tope a la base
172. En consecuencia, la parte 174 de detención está configurada para pivotar alejándose y acercándose a la superficie 134 de contacto con el tejido. En una realización, el elemento 170 de tope incluye un elemento de empuje (por ejemplo un resorte) para empujar la parte 174 de detención alejándola del primer elemento 130 de mordaza.
La parte 174 de detención contiene un cuerpo 175 y al menos una pata 177 que se extiende de forma proximal desde el cuerpo 175. En la realización representada en la figura 2, la parte 174 de detención tiene dos patas 177 que se extienden de forma proximal desde el cuerpo 175. No obstante, la parte 174 de detención puede incluir más
o menos patas 177. Las dos patas 177 mostradas en la figura 2 definen un espacio entre ellas adaptado para recibir una cuchilla. Cada pata 177 está dimensionada para alojarse dentro de una ranura 139 e incluye una superficie proximal 173. Cuando el elemento 170 de detención se sitúa en la primera posición, cada superficie proximal 173 define un ángulo oblicuo respecto a la superficie 134 de contacto con el tejido, como se ve en la figura 5. A la inversa, cuando el elemento 170 de detención se sitúa en la segunda posición (véase la figura 7), cada superficie proximal 173 define una ángulo prácticamente perpendicular a la superficie 134 de contacto con el tejido. Independientemente de la posición del elemento 170 de tope, las patas 177 se muestran ubicadas en lados opuestos del canal 138 de cuchilla. Las ranuras 139, que están dimensionadas para alojar las patas 177, están por consiguiente ubicadas también en lados opuestos del canal 138 de cuchilla.
En referencia a las figuras 6-8, el elemento 170 de tope facilita la retención del tejido entre el primer y segundo elementos 130, 140 de mordaza durante el funcionamiento del instrumento quirúrgico 100 (véase la figura 1). Esto es, el elemento 170 de tope ayuda a evitar que el tejido migre o se traslade de forma distal más allá de su ubicación deseada entre los elementos de mordaza. En la práctica, un usuario coloca inicialmente el instrumento quirúrgico 100 junto al tejido objetivo. Concretamente, el tejido objetivo se coloca entre el primer y segundo elementos 130, 140 de mordaza. El ángulo definido por el cuerpo 175 respecto a la superficie 136 de contacto con el tejido facilita la introducción del tejido "T" objetivo en el conjunto 150 de herramienta en la dirección general de la flecha "A" como se muestra en la figura 6. Una vez el usuario ha colocado al menos una parte del tejido objetivo entre el primer y segundo elementos 130, 140 de mordaza, el usuario tira de la empuñadura movible 164 hacia la empuñadura estacionaria 162 para aproximar el conjunto 152 de yunque hacia el conjunto 132 de cartucho. Mientras el usuario tira de la empuñadura movible 164, el conjunto 152 de yunque se aproxima hacia el conjunto 132 de cartucho y el tejido objetivo "1" es capturado entre la superficie 134 de contacto con el tejido del conjunto 132 de carlucho. Al mismo tiempo, el conjunto 142 de yunque empuja a la parte 174 de detención hacia el conjunto 132 de cartucho. En respuesta a la fuerza ejercida por el conjunto 142 de yunque sobre la parte 174 de detención, la parte 174 de detención pivota alrededor del pasador 176 de pivote hacia el conjunto 132 cartucho, por ejemplo, contra el empuje del elemento de empuje (no mostrado). Mientras la parte 174 de detención se aproxima al conjunto 132 de cartucho, al menos una parte de las patas 177 se mueve hacia una parte interior del conjunto 132 de cartucho a través de las ranuras 139, como se ve en la figura 7. Cuando el elemento 170 de tope está en la segunda posición (como se muestra en la figura 7), una parte de las patas 177 se ubica dentro del conjunto 132 de cartucho; en
1 O
correspondencia, una parte de las superficies proximales 173 se ubica fuera del conjunto 132 de cartucho. Como se ha explicado anteriormente, las superficies proximales 173 definen un ángulo prácticamente ortogonal respecto a la superficie 134 de contacto con el tejido cuando el elemento 170 de tope está en la segunda posición, obstaculizando de ese modo el escape de tejido durante la sujeción.
La presente invención contempla también que el elemento 170 de tope sea acoplable de manera liberable al actuador extremo 150 a través de medios mecánicos convencionales, por ejemplo, acoplamiento de bayoneta, pestillo, fiador o una conexión de ajuste por saldo elástico.
Con referencia a las figuras 9-12, se prevé otra realización de un primer elemento 230 de mordaza. El primer elemento 230 de mordaza de esta realización tiene una forma curva (es decir, con respecto al eje longitudinal "A. A"). Se prevé que los elementos de mordaza curvos pueden facilitar la realización de ciertos tipos de operaciones quirúrgicas. Por ejemplo, los elementos de mordaza curvos, comparados con los elementos de mordaza rectos (tales como los elementos de mordaza ilustrados en la figura 1), pueden ayudar a facilitar el acceso a zonas pélvicas inferiores, por ejemplo, durante la resección anterior inferior ("LAR") u otra cirugía colorrectal.
El primer elemento 230 de mordaza incluye una abertura 239 (figura 10) para alojar ambas patas 277 de la parte 270 de tope en lugar de dos ranuras 139 cada una capaz de alojar una pata 177 del elemento 170 de tope. El elemento 270 de tope es similar al elemento 170 de tope. Sin embargo, el elemento 270 de tope tiene una parte 274 de detención directamente conectada a una parte distal 237 del primer elemento 230 de mordaza. La parte distal 237 contiene un agujero 235 (figura 10) adaptado para alojar un pasador 276 de pivote. El pasador 276 de pivote, o cualquier otro órgano adecuado, acopla de forma pivotante el elemento 270 de tope al primer elemento 230 de mordaza.
En general, el primer elemento 230 de mordaza incluye un alojamiento curvo 231 y un conjunto 232 de cartucho curvo. El alojamiento 231 tiene un canal curvo 233 adaptado para alojar el conjunto 232 de cartucho curvo. El conjunto 232 de cartucho curvo contiene una superficie 234 de contacto con el tejido configurada para aplicarse al tejido, filas de ranuras 236 para retener sujetadores, que se extienden a lo largo de su perfil curvo, y un canal 238 de cuchilla adaptado para alojar de forma deslizante una cuchilla (no mostrada). El canal 238 de cuchilla está dispuesto entre las filas de las ranuras 236 para retener sujetadores.
Como se ha explicado anteriormente, accionando el conjunto 160 de empuñadura no solamente se expulsan los sujetadores, sino que también se acciona una cuchilla a lo largo del canal 238 de cuchilla (por ejemplo, mediante un único impulso o múltiples impulsos de la empuñadura movible 164). El canal 238 de cuchilla llega hasta una abertura 239 formada en la parte distal 237 del conjunto 232 de cartucho. Un rebaje 280 está situado distal mente con respecto de la abertura 239 e incluye una pared inclinada 282 (véase la figura 11) que define un ángulo oblicuo respecto a la superficie 234 de contacto con el tejido y está adaptado para alojar una parte del elemento 270 de tope en el mismo. Además de una pared inclinada 282, el rebaje 280 tiene una cavidad 284 adaptada para alojar una parte del elemento 270 de tope.
El elemento 270 de tope incluye un cuerpo 275, un par de patas que se extienden de forma proximal a partir del cuerpo 275, y un saliente pivotante 286 que se extiende transversalmente desde el cuerpo 275. Las patas 277 definen un espacio entre ellas dimensionado para alojar una cuchilla. Cada pata 277 tiene una superficie proximal 273 que define un ángulo oblicuo respecto a la superficie 234 de contacto con el tejido cuando la parte 270 de tope está en la primera posición, como se muestra en la figura 9, y un ángulo prácticamente perpendicular respecto a la superficie 234 de contacto con el tejido cuando la parte 270 de tope está en la segunda posición, como se ilustra en la figura 12.
El cuerpo 275 define un ángulo oblicuo con respecto a la superficie 234 de contacto con el tejido. El saliente pivotante 286 del elemento 270 de tope está adaptado para alojarse dentro de la cavidad 284 y tiene un agujero 288 configurado para alojar el pasador 276 de pivote. El pasador 276 de pivote se extiende a través del agujero 235 del conjunto 232 de cartucho y del agujero 288 del saliente pivotante 286 y permite al elemento 270 de tope pivotar desde una primera posición en la que al menos una parte del elemento 270 de tope se coloca exteriormente al primer elemento 230 de mordaza, como se muestra en la figura 9, y una segunda posición en la que al menos una parte del elemento 270 de tope se coloca al menos parcialmente por debajo de la superficie 234 de contacto con el tejido del primer elemento 230 de mordaza, como se ve en la figura 12.
Como se ve en la figura 11, el cuerpo 275 contiene adicionalmente un orificio pasante 290 que conduce a la pared inclinada 282 y una pared 292 de apoyo que sobresale hacia el orificio pasante 290. La pared 292 de apoyo está configurada para retener un primer extremo 294a de un elemento 294 de empuje, y la pared inclinada 282 está adaptada para soportar un segundo extremo 294b del elemento 294 de empuje. El elemento 294 de empuje, empuja el elemento 270 de tope hacia su primera posición. En la realización representada en las figuras 10 y 11, el elemento 294 de empuje es un resorte, pero el elemento 294 de empuje puede ser alternativamente cualquier órgano adecuado o medios capaces de empujar el elemento 270 de tope hacia fuera del primer elemento 230 de mordaza.
El funcionamiento del primer elemento 230 de mordaza es prácticamente similar al funcionamiento del primer elemento 130 de mordaza. El primer elemento 230 de mordaza trabaja conjuntamente con un conjunto de yunque
para cortar y/o sujetar el tejido. Al accionar un usuario el conjunto de empuñadura 160, los elementos de mordaza se aproximan, lo cual empuja al elemento 270 de tope desde la primera posición (véase la figura 9) hacia la segunda posición (véase la figura 12). En la primera posición, la orientación del elemento 270 de tope facilita la introducción del tejido entre el primer elemento 230 de mordaza y un conjunto de yunque. Además, el elemento 270 de tope
5 impide al tejido escapar de forma distal del conjunto de herramienta cuando el elemento 270 de tope se orienta en su segunda posición. Cuando el conjunto de yunque se mueve alejándose del primer elemento 230 de mordaza, el elemento 270 de tope, bajo la influencia del elemento 294 de empuje, retorna a su primera posición.
Se comprenderá que se pueden hacer varias modificaciones a las realizaciones de los instrumentos quirúrgicos descritos en esta memoria. Por lo tanto, la descripción anterior no debe tomarse como limitante, sino simplemente
10 como ejemplos de realizaciones.

Claims (9)

  1. REIVINDICACIONES
    1.-Un instrumento quirúrgico (100) para unir quirúrgicamente tejidos, comprendiendo el instrumento quirúrgico
    (100)
    un conjunto (160) de empuñadura;
    una parte (120) alargada que se extiende de forma distal desde el conjunto (160) de empuñadura y que define
    un eje longitudinal;
    un actuador extremo (154) dispuesto junto a una parte distal de la parte alargada (120), incluyendo el actuador extremo (154) un primer elemento (130) de mordaza con una superficie (134) de contacto con el tejido y un
    segundo elemento (140) de mordaza, siendo movible al menos uno de los elementos de mordaza con respecto al otro elemento de mordaza entre posiciones separada y próxima, incluyendo el primer elemento (130) de
    mordaza un canal (138) de cuchilla;
    un elemento (170) de tope adaptado para facilitar la retención del tejido entre el primer y segundo elementos
    (130, 140) de mordaza durante el funcionamiento del instrumento quirúrgico (100), estando dispuesto el elemento (170) de tope junto una la parte distal del primer elemento (130) de mordaza y siendo capaz de pivotar
    con respecto al primer elemento (130) de mordaza entre una primera posición y una segunda posición,
    incluyendo además el elemento (170) de tope una primera pata (177) y una segunda pata (177), en el que la primera pata (177) y la segunda pata (177) están ubicadas en lados opuestos del canal (138) de cuchilla.
  2. 2.-El instrumento quirúrgico (100) de la reivindicación 1, en el que el primer elemento (130) de mordaza contiene un
    conjunto (132) de cartucho.
  3. 3.-El instrumento quirúrgico (100) de la reivindicación 2, en el que el conjunto (132) de cartucho es curvo con respecto al eje longitudinal.
  4. 4.-El instrumento quirúrgico (100) de la reivindicación 1, en el que el segundo elemento (140) de mordaza incluye un
    conjunto (142) de yunque.
  5. 5.-El instrumento quirúrgico (100) de una cualquiera de las reivindicaciones precedentes, que comprende además un elemento de empuje dispuesto en cooperación mecánica con el elemento (170) de tope, en el que el elemento de empuje impulsa al elemento (170) de tope hacia una primera posición.
  6. 6.-El instrumento quirúrgico (100) de una cualquiera de las reivindicaciones precedentes, en el que el elemento
    (170) de tope incluye una base (172) y una parte (174) de detención, estando la base (172) conectada funcionalmente a la parte (174) de detención.
  7. 7.-El instrumento quirúrgico (100) de la reivindicación 6, en el que la parte (174) de detención está conectada de forma pivotante a la base (172).
  8. 8.-El instrumento quirúrgico (100) de una cualquiera de las reivindicaciones precedentes, que comprende además una primera y segunda ranuras (139) dispuestas en el primer elemento (130) de mordaza, estando adaptada cada una de las primera y segunda ranuras (139) para alojar por lo menos una parte de una de las primera y segunda
    patas (177) en ella.
  9. 9.-El instrumento quirúrgico (100) de la reivindicación 6, en el que cada una de las primera y segunda patas (177) está configurada para moverse al menos parcialmente a través de la primera o segunda ranura (139) cuando el elemento (170) de tope se mueve hacia su segunda posición.
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