ES2539948T3 - Instrumento quirúrgico - Google Patents

Instrumento quirúrgico Download PDF

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ES2539948T3
ES2539948T3 ES10075563.6T ES10075563T ES2539948T3 ES 2539948 T3 ES2539948 T3 ES 2539948T3 ES 10075563 T ES10075563 T ES 10075563T ES 2539948 T3 ES2539948 T3 ES 2539948T3
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instrument
fiberglass
force
control unit
work element
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Michel Petronella Hubertus Vleugels
Markus Cornelis Jakobus Lazeroms
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Vleugels Holding BV
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30—Surgical robots
    • A61B34/35—Surgical robots for telesurgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/70—Manipulators specially adapted for use in surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/70—Manipulators specially adapted for use in surgery
    • A61B34/76—Manipulators having means for providing feel, e.g. force or tactile feedback
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00022—Sensing or detecting at the treatment site
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00022—Sensing or detecting at the treatment site
    • A61B2017/00026—Conductivity or impedance, e.g. of tissue
    • 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
    • A61B2017/00398—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
    • 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
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/06—Measuring instruments not otherwise provided for
    • A61B2090/064—Measuring instruments not otherwise provided for for measuring force, pressure or mechanical tension
    • A61B2090/065—Measuring instruments not otherwise provided for for measuring force, pressure or mechanical tension for measuring contact or contact pressure

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Medical Informatics (AREA)
  • General Health & Medical Sciences (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • Robotics (AREA)
  • Ophthalmology & Optometry (AREA)
  • Surgical Instruments (AREA)
  • Manipulator (AREA)
  • Agricultural Chemicals And Associated Chemicals (AREA)

Abstract

Instrumento quirúrgico, en particular, para cirugía mínimamente invasiva, comprendiendo el instrumento un elemento de mando y un bastidor alargado que comprende por lo menos un elemento de trabajo que se puede desplazar con respecto al bastidor, en el que el instrumento (1) comprende unos medios para retroalimentar una fuerza que se ejerce sobre el elemento de trabajo (4) del instrumento al elemento de mando (3), comprendiendo los medios por lo menos un primer sensor de fuerza (6) para medir la fuerza que se ejerce sobre el elemento de trabajo, una unidad de control (10) y un primer accionador (11), que se acopla al elemento de mando, controlando la unidad de control por lo menos el primer accionador basándose en una señal que se origina en el primer sensor de fuerza, en el que el instrumento (1) presenta una varilla de unión (13) o elemento similar, que se acopla con el elemento de trabajo (4) a fin de accionar el elemento de trabajo, la varilla de unión o elemento similar que se acciona mediante un segundo accionador (12), que es además controlado mediante la unidad de control (10). caracterizado porque el instrumento comprenden un primer sensor de posición (7) para determinar la posición del elemento de trabajo (4) con respecto al bastidor (2), donde el instrumento comprende un segundo sensor de fuerza (8) para medir la fuerza que se ejerce sobre el elemento de mando (3) y un segundo sensor de posición (9) para determinar la posición del elemento de mando.

Description

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DESCRIPCIÓN
Instrumento quirúrgico.
La presente invención se refiere a un instrumento quirúrgico, en particular, para cirugía mínimamente invasiva, comprendiendo el instrumento un bastidor alargado que, en la proximidad de un primer extremo del mismo, comprende un elemento de mando, que puede funcionar manualmente y, en un segundo extremo del mismo, por lo menos un elemento de trabajo que se puede desplazar con respecto al bastidor.
Un instrumento de este tipo se utiliza en particular en los procedimientos quirúrgicos que utilizan técnicas quirúrgicas mínimamente invasivas. En una intervención mínimamente invasiva de este tipo, se realiza un cierto número de pequeñas incisiones y los instrumentos y elementos similares se pueden introducir a través de dichas incisiones. En general, se dispone un tubo cilíndrico en la incisión y los instrumentos se disponen a través del mismo. Los instrumentos que se utilizan corresponden, en principio, a los instrumentos que se utilizan en las técnicas quirúrgicas convencionales. Sin embargo, se requiere un instrumento estrecho y alargado a fin de satisfacer las necesidades específicas del procedimiento mínimamente invasivo, es decir, el instrumento se ha de disponer a través del tubo relativamente estrecho, sobresaliendo el elemento de trabajo en un extremo del tubo, mientras que el elemento de mando sobresale en el otro extremo del tubo. Un instrumento adecuado comprende, por lo tanto, por lo menos un bastidor alargado, un elemento de trabajo que se puede desplazar con respecto al bastidor y un elemento de mando, mediante el que se puede accionar el elemento de trabajo del instrumento. El elemento de trabajo del instrumento puede desempeñar diversas funciones. Por ejemplo, se puede utilizar para sujetar, fijar, cortar o grapar. En los casos que requieren una pluralidad de acciones o de instrumentos, se utilizarán dos o más elementos de trabajo se pueden desplazar con respecto al bastidor.
Las técnicas quirúrgicas mínimamente invasivas presentan la ventaja de que se requiere una incisión más pequeña y, por lo tanto, existe generalmente un menor riesgo de infección y, en promedio, es necesario un período de hospitalización más corto.
Aparte de los beneficios conocidos de las técnicas quirúrgicas mínimamente invasivas, se ha de mencionar asimismo un cierto número de inconvenientes. El cirujano no dispone de una visión directa de las acciones que está realizando. Resulta necesario utilizar cámaras y pantallas de televisión o elementos similares para obtener la información visual que está directamente disponible en las técnicas quirúrgicas convencionales. La forma específica de los instrumentos utilizados, es decir, relativamente estrechos y alargados, tiene como resultado una mayor fricción en términos relativos y los instrumentos son más flexibles, de tal modo que resulta peor la reacción mecánica de la fuerza ejercida sobre el elemento de trabajo para el mecanismo de funcionamiento. Por consiguiente, el cirujano tiene menos conocimiento de la fuerza que ejerce mediante el elemento de trabajo del instrumento sobre algo que se encuentra en el elemento de trabajo del instrumento. En consecuencia, es posible, por ejemplo, que pueda producir daños en un tejido como resultado de sujetar el mismo con demasiada fuerza.
El documento WO 98/11833 describe un instrumento para técnicas quirúrgicas mínimamente invasivas en el que se reduce la fricción en el instrumento en comparación con los diseños convencionales mediante la utilización de cojinetes de contactos rodantes. Ello tiene como resultado una mejor reacción mecánica de la fuerza que se ejerce sobre el elemento de trabajo del instrumento. Sin embargo, como consecuencia de la forma específica requerida para los instrumentos destinados a la cirugía mínimamente invasiva, la fricción y la histéresis se encuentran todavía presentes en el diseño y, por lo tanto, la fuerza que se ejerce sobre el elemento de trabajo del instrumento no se retroalimenta correctamente al mecanismo de funcionamiento del instrumento. Como resultado de ello, el usuario de un instrumento de este tipo no tiene una "sensación" óptima del tejido o elemento similar que se está manipulando con el instrumento. Resulta, por lo tanto, difícil para un cirujano disponer con precisión el elemento de trabajo del instrumento.
El documento US 5339799 describe un instrumento que presenta las características del preámbulo de la reivindicación 1.
El objetivo del presente invento es proporcionar un instrumento mejorado para utilizar en cirugía, en particular, en cirugía mínimamente invasiva, que elimine el inconveniente mencionado anteriormente.
El objetivo se alcanza mediante un instrumento según el preámbulo de la reivindicación 1. Las realizaciones preferidas son descritas en las reivindicaciones dependientes.
Al determinar la fuerza que se ejerce sobre el elemento de trabajo utilizando un sensor de fuerza y retroalimentándola a través de una unidad de control hacia el elemento de mando, el usuario puede sentir la fuerza que se ejerce mediante el elemento de trabajo sin que esta sensación se vea influida por la fricción y/o la histéresis en el instrumento. El elemento de mando se controla, por así decirlo, mediante el primer accionador.
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El elemento de trabajo utilizado en el instrumento puede desempeñar diversas funciones. Por ejemplo, puede ser apto para sujetar, fijar, apretar o grapar o para soportar una aguja o elemento similar. A menudo, existen dos o más de dichos elementos de trabajo que se pueden desplazar con respecto al bastidor. Además, se puede diseñar el instrumento de tal modo que los elementos de trabajo se puedan disponer de un modo intercambiable en el instrumento.
El elemento de mando puede ser accionado manualmente y es generalmente una palanca de mando que se encuentra presente en un instrumento quirúrgico convencional. Sin embargo, resulta posible asimismo que el elemento de mando se diseñe de un modo distinto, por ejemplo, como un botón giratorio o de un modo similar.
El instrumento quirúrgico se sujeta preferentemente con la mano.
Los sensores, los accionadores y la unidad de control se integran preferentemente en el instrumento o se fijan directamente al instrumento. Como resultado de ello, el instrumento continúa siendo fácil de manejar, de tal modo que resulta fácil de utilizar para el usuario y puede presentar unos movimientos muy flexibles. El instrumento según la presente invención se puede diseñar ventajosamente con unas dimensiones que correspondan sustancialmente a las dimensiones de los instrumentos convencionales mínimamente invasivos o una versión solo ligeramente ampliada de los mismos.
Preferiblemente, la unidad de control determina la impedancia a la que se somete el elemento de trabajo, por ejemplo, como resultado de la presencia de un tejido o elemento similar, basándose en la fuerza que se ejerce sobre el elemento de trabajo, la posición en la que se dispone el elemento de trabajo con respecto al bastidor y la velocidad a la que el elemento de trabajo se desplaza con respecto al bastidor, controlando la unidad de control por lo menos el primer accionador basándose en la impedancia.
La impedancia de un material específico, constituye una buena medida de la sensación proporcionada por un material de este tipo cuando se toca. La unidad de control según la presente invención retroalimenta al elemento de mando la impedancia a la que se somete el elemento de trabajo del instrumento, de tal modo que el usuario tiene una "sensación" muy realista del tejido o elemento similar que se está manipulado mediante el elemento de trabajo.
La fuerza que se ejerce sobre el elemento de trabajo y la posición del elemento de trabajo con respecto al bastidor se determinan con la ayuda del primer sensor de fuerza y el primer sensor de posición, respectivamente. La velocidad del elemento de trabajo se determina preferentemente mediante la derivada con respecto al tiempo de la señal de posición determinada mediante el primer sensor de posición, pero es posible asimismo, a título de ejemplo, determinar la velocidad utilizando un sensor de velocidad independiente.
El instrumento presenta una varilla de unión o elemento similar, que se acopla al elemento de trabajo a fin de guiar el elemento de trabajo, la varilla de unión o elemento similar, accionándose mediante un segundo accionador que se controla mediante la unidad de control.
En lo que se conoce como un instrumento totalmente activo de este tipo, los controles de los movimientos de mando del cirujano y del movimiento del elemento de trabajo pasan a través de la unidad de control. La unidad de control controla los dos accionadores basándose en las señales que se obtienen a partir de los sensores de fuerza y posición.
La unidad de control preferiblemente determina una impedancia a la que se somete el elemento de mando basándose en la fuerza que se ejerce sobre el elemento de mando, la posición y la velocidad del elemento de mando, cuya impedancia se retroalimenta asimismo hacia los accionadores. De este modo, se mejora aún más la retroalimentación de la sensación. En este caso, la fuerza sobre el elemento de mando y la posición del elemento de mando se determinan mediante un segundo sensor de fuerza y el sensor de posición, respectivamente. La velocidad se determina preferentemente como la derivada respecto al tiempo de la señal de posición determinada mediante el segundo sensor de posición.
Ventajosamente, por lo menos uno de los sensores de fuerza y/o posición de los sensores comprende fibra de vidrio, por lo que se dispone una fuente de luz y un sensor de luz en la proximidad de un primer extremo de la fibra de vidrio, y por lo que se dispone una superficie reflectora, que se desplaza en función de la posición y/o la fuerza que se va a determinar, a una cierta distancia de un segundo extremo de la fibra de vidrio. Los sensores de fuerza y/o posición utilizan fibras de vidrio y superficies reflectantes, siendo el grado en que la luz que proviene de la fuente de luz y emerge desde el segundo extremo de la fibra de vidrio se refleja en el segundo extremo de la fibra de vidrio siendo representativo de la fuerza o de la posición que se pretende medir. La cantidad de luz que se refleja se detecta en este caso mediante el sensor de luz.
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Los sensores de este tipo presentan la ventaja sobre los sensores más convencionales de que no se utilizan señales eléctricas por lo menos en la proximidad del elemento de trabajo. La utilización de señales eléctricas no es aconsejable, ya que las señales de medición de los sensores se pueden interferir por otros equipos presentes en el quirófano. Además, la fibra de vidrio no es costosa y ocupa poco espacio.
En un sensor de fuerza, el segundo extremo de la fibra de vidrio y la superficie reflectora se fijan en el elemento de trabajo. Una fuerza ejercida sobre el elemento de trabajo provocará que dicho elemento de trabajo se flexione ligeramente o cambie su forma de algún otro modo. Dicha flexión u otro cambio de forma cambiará la posición y/o la orientación de la superficie reflectora con respecto al segundo extremo de la fibra de vidrio. Como resultado de ello, cambiará el grado en que la luz que emerge del segundo extremo de la fibra de vidrio se refleja en el segundo extremo de la fibra de vidrio. La fuerza ejercida sobre el elemento de trabajo se puede determinar basándose en dicho cambio en la cantidad de luz que se refleja.
La posición del elemento de trabajo se puede determinar del modo correspondiente utilizando un sensor de posición. En un sensor de posición, de este tipo, sin embargo, el segundo extremo de la fibra de vidrio no se dispone en el elemento de trabajo, sino en el bastidor, de tal modo que el nivel de reflexión depende de la posición del elemento de trabajo con respecto al bastidor.
Como alternativa a las fibras de vidrio, incidentalmente resulta asimismo posible utilizar otros conductores de luz aptos.
Ventajosamente, el instrumento comprende por lo menos dos partes que se pueden separar entre sí, de los que una parte es apta para su reutilización, generalmente tras la esterilización, y otra parte es apta para un solo uso, pudiendo acoplarse las dos partes entre sí mediante una conexión.
La utilización de fibras de vidrio provoca que el instrumento en conjunto resulte más difícil de esterilizar, ya que las fibras de vidrio se deterioran al calentarse. Sin embargo, al ser el instrumento desechable, la utilización del instrumento resulta muy costosa, a causa de la electrónica necesaria para la unidad de control y el / los sensor(es) de luz y los accionadores. Al separar los componentes costosos del instrumento, en particular la electrónica y accionadores, de la sección del instrumento que recorren las fibras de vidrio, resulta posible mantener el instrumento en uso de un modo fiable y económico.
Una ventaja particular es que con el instrumento resulta posible registrar los datos determinados por diversos sensores. Los datos de este tipo pueden ser importantes para desarrollar modelos informáticos que se utilizan, por ejemplo, en ejercicios de entrenamiento con simulaciones o similares. Con este objetivo, un simulador quirúrgico comprende un elemento de mando que se puede accionar manualmente, un primer accionador para controlar el elemento de mando mediante una fuerza y unos medios de control diseñados para controlar el primer accionador basándose en una impedancia de un procedimiento quirúrgico real realizado utilizando un instrumento tal como se ha descrito anteriormente. La utilización del instrumento según la presente invención en una intervención quirúrgica específica se puede aplicar, por lo tanto, simulando el elemento de trabajo y las fuerzas ejercidas sobre el mismo con la ayuda de los medios de control. En este caso, el primer accionador se puede controlar del mismo modo que si se controlara mediante la unidad de control del instrumento y se pueden utilizar asimismo el segundo sensor de fuerza y el segundo sensor de posición mencionados anteriormente del modo correspondiente. Además, la sección de mando del instrumento se puede utilizar en un instrumento de telecirugía, que comprenda un elemento de mando que se pueda accionar manualmente, un primer accionador para controlar el elemento de mando mediante una fuerza y unos medios de control diseñados para controlar el primer accionador basándose en la impedancia de un procedimiento quirúrgico realizado a distancia. También en este caso, el primer accionador se puede controlar del mismo modo que si se controlara mediante la unidad de control del instrumento, y se pueden utilizar asimismo el segundo sensor de fuerza y el segundo sensor de posición mencionados anteriormente del modo correspondiente.
Otras características y ventajas adicionales del instrumento según la presente invención se describirán más detalladamente a continuación haciendo referencia a un cierto número de formas de realización que se ilustran en los dibujos adjuntos, en los que:
la figura 1 representa esquemáticamente una primera forma de realización preferida de un instrumento según la presente invención, la figura 2 representa esquemáticamente una segunda forma de realización preferida de un instrumento según la presente invención, la figura 3 representa esquemáticamente un sensor de fuerza de un instrumento según la presente invención, y la figura 4 representa esquemáticamente un sensor de posición de un instrumento según la presente invención.
En las distintas figuras, las mismas referencias numéricas se utilizan para referirse a los elementos correspondientes
o a elementos que realizan una acción correspondiente.
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La figura 1 representa una primera forma de realización preferida del instrumento según la presente invención, indicada globalmente con la referencia numérica 1. Los distintos elementos del instrumento 1 se representan esquemáticamente en la figura El instrumento 1 comprende un bastidor alargado 2 que presenta, en un primer extremo, por lo menos un elemento de mando 3 y, en el segundo extremo, un elemento de trabajo 4 que se fija de un modo desplazable al bastidor y un segundo elemento de trabajo 5, que en este caso se fija al bastidor y constituye un elemento del mismo. Resulta posible asimismo realizar un segundo elemento de trabajo móvil con respecto al bastidor y proporcionar más de dos elementos de trabajo fijos o móviles.
Se disponen asimismo en o próximos al elemento de trabajo 4 un sensor de fuerza 6 para determinar la fuerza que se ejerce sobre el elemento de trabajo 4 y un sensor de posición 7 para determinar la posición del elemento de trabajo 4 con respecto al bastidor 2. Se dispone en o próximo al elemento de mando 3 un sensor de fuerza 8 para determinar la fuerza que se ejerce sobre el elemento de mando y un sensor de posición 9 para determinar la posición del elemento de mando con respecto al bastidor. Las señales determinadas a partir de los sensores de fuerza 6, 8 y de los sensores de posición 7, 9 se transmiten a una unidad de control 10.
Los sensores de fuerza 6, 8 y los sensores de posición 7, 9 pueden ser sensores convencionales que, a título de ejemplo, utilicen indicadores, potenciómetros o elementos similares. En particular, se prefiere que los sensores que se disponen en o próximos al elemento de trabajo 4 utilicen sensores que empleen fibras de vidrio. Los sensores de este tipo son menos sensibles a las interferencias que los sensores eléctricos y se describirán más detalladamente a continuación.
El instrumento 1 comprende asimismo un accionador 11 que se acopla al elemento de mando 3 y un accionador 12 que acciona una varilla de unión 13 a la que se acopla el elemento de trabajo 4. Los accionadores se pueden controlar independientemente entre sí mediante la unidad de control. Los accionadores son preferentemente accionadores electromagnéticos lineales.
En la unidad de control 10, la impedancia a la que se somete el elemento de trabajo 4 se determina basándose en la fuerza que se ejerce sobre el elemento de trabajo 4, la posición del elemento de trabajo 4 y la velocidad del elemento de trabajo 4. Se determina asimismo la impedancia a la que se somete el elemento de mando basándose en la fuerza a la que se somete el elemento de mando, la posición del elemento de mando y la velocidad del elemento de mando. Las velocidades se calculan en este caso a partir de la derivada con respecto al tiempo de la señal de los sensores de posición. Los dos accionadores 11, 12 se controlan mediante la unidad de control 10 basándose en las dos impedancias que se han determinado.
El instrumento 1 comprende por lo menos dos piezas que se pueden separar entre sí, de las que una parte reutilizable es apta para volver a utilizar tras la esterilización y la otra, la parte desechable, es apta para un único uso. Las dos partes que se pueden separar entre sí se indican mediante la línea A-A en la figura Las dos partes se pueden acoplar entre sí mediante un acoplamiento. El acoplamiento comprende un acoplamiento mecánico 14 para accionar la varilla de unión 13 en la parte desechable. Existe asimismo un acoplamiento óptico 15 para acoplar la información óptica, es decir, acoplar las fibras de vidrio en la parte disponible con unos medios optoelectrónicos, tales como el sensor de luz y la fuente de luz.
La parte reutilizable comprende los accionadores 11, 12, la unidad de control 10, la fuente de luz, el sensor de luz, que se alojan preferentemente en una carcasa estanca, de modo que se encuentran protegidos de la humedad y similares.
Una segunda forma de realización preferida del instrumento según la presente invención se representa en la figura
2. En este caso, la varilla de unión 13 se acopla mecánicamente directamente con el elemento de mando 3. La fuerza que ejerce el usuario sobre el elemento de mando 3 se transmite directamente al elemento de trabajo 4 mediante la varilla de unión 13. Un sensor de fuerza 6 y un sensor de posición 7 se disponen en o próximos al elemento de trabajo 4. Las señales del sensor de fuerza 6 y del sensor de posición 7 se transmiten a una unidad de control 10, que controla un accionador 11, que se acopla con el elemento de mando 3. La unidad de control 10 controla el accionador 11, a fin de controlar la palanca de funcionamiento, basándose en la impedancia que se determina en la unidad de control mediante la posición y la fuerza medidas y la velocidad calculada. Como resultado de ello, el usuario dispone de buena retroalimentación sobre la forma en la que está manipulando un tejido o elemento similar mediante el elemento de trabajo.
El instrumento 1 comprende una parte desechable y una parte reutilizable que comprende un acoplamiento en la zona de la línea A-A. El acoplamiento presenta un acoplamiento mecánico 14 para accionar el elemento de trabajo 4 y un acoplamiento óptico 15 para transmitir información óptica.
La figura 3 representa por lo menos una parte de una forma de realización preferida del sensor de fuerza del
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instrumento según la presente invención, comprendiendo el sensor de fuerza fibra de vidrio. La figura representa un extremo de un instrumento, en el que se disponen dos elementos de trabajo 4 que se pueden desplazar con respecto al bastidor y constituir una mordaza de sujeción. La mordaza de sujeción se abre desplazando la varilla de unión 13 en la dirección de la mordaza de sujeción, y la mordaza de sujeción se cierra desplazando la varilla de
5 unión 13 alejándose de la mordaza de sujeción. Un extremo de la fibra de vidrio 16 se extiende por lo menos en parte hacia el interior de uno de los elementos de trabajo 4. Una fuente de luz y un sensor de luz (no representados) se disponen en la proximidad del otro extremo de la fibra de vidrio 16. La fuente de luz emite luz a través de la fibra de vidrio 16 y la fuente de luz detecta la luz que vuelve a través de la fibra de vidrio 16.
10 En la proximidad del extremo de un elemento de trabajo 4 de la mordaza de sujeción que está alejado del instrumento, se encuentra una superficie reflectora 17 que por lo menos en parte refleja la luz que emerge del extremo de la fibra de vidrio 16 en la fibra de vidrio 16. La superficie reflectora se coloca a una distancia determinada desde el extremo de la fibra de vidrio 16. Si a continuación se ejerce una fuerza sobre el elemento de trabajo 4, el elemento de trabajo 4 se flexiona ligeramente. El resultado de esta desviación es que cambia la cantidad de luz que
15 refleja la superficie reflectora 17 hacia la fibra de vidrio 16. Dicho cambio, que se detecta mediante el sensor de luz, es una medida de la fuerza que se ejerce sobre el elemento de trabajo 4. La cantidad de luz que se mide se convierte mediante el sensor de luz en una señal eléctrica que es representativa de la fuerza ejercida sobre el instrumento. Dicha señal se transmite a la unidad de control 10.
20 La figura 4 representa por lo menos una parte de una forma de realización preferida del sensor de posición del instrumento según la presente invención, comprendiendo el sensor de posición fibra de vidrio 18. La figura representa un extremo de un instrumento que corresponde a la figura 3. La fibra de vidrio 18 se fija al bastidor 2 del instrumento 1. Un extremo se dirige hacia una superficie reflectora 19, que se fija a uno de los elementos de trabajo
4. La luz que se emite mediante una fuente de luz (no representada) dispuesta en el otro extremo de la fibra de
25 vidrio se refleja por lo menos parcialmente mediante la superficie reflectora 19 hacia la fibra de vidrio 18. Si la mordaza de sujeción se desplaza con respecto al bastidor 2, se reflejará más o menos luz en la fibra de vidrio 18. La cantidad de luz que se refleja y que se detecta mediante el sensor de luz constituye una medida de la posición de un elemento de trabajo 4 de la mordaza de sujeción con respecto al bastidor 2. Basándose en la cantidad de luz recibida, el sensor de luz emite una señal eléctrica, que es representativa de la posición de los elementos de trabajo
30 4, hacia la unidad de control 10.

Claims (9)

  1. REIVINDICACIONES
    1. Instrumento quirúrgico, en particular, para cirugía mínimamente invasiva, comprendiendo el instrumento un elemento de mando y un bastidor alargado que comprende por lo menos un elemento de trabajo que se puede 5 desplazar con respecto al bastidor, en el que el instrumento (1) comprende unos medios para retroalimentar una fuerza que se ejerce sobre el elemento de trabajo (4) del instrumento al elemento de mando (3), comprendiendo los medios por lo menos un primer sensor de fuerza (6) para medir la fuerza que se ejerce sobre el elemento de trabajo, una unidad de control (10) y un primer accionador (11), que se acopla al elemento de mando, controlando la unidad de control por lo menos el primer accionador basándose en una
    10 señal que se origina en el primer sensor de fuerza, en el que el instrumento (1) presenta una varilla de unión
    (13) o elemento similar, que se acopla con el elemento de trabajo (4) a fin de accionar el elemento de trabajo, la varilla de unión o elemento similar que se acciona mediante un segundo accionador (12), que es además controlado mediante la unidad de control (10). caracterizado porque
    15 el instrumento comprenden un primer sensor de posición (7) para determinar la posición del elemento de trabajo (4) con respecto al bastidor (2),
    donde el instrumento comprende un segundo sensor de fuerza (8) para medir la fuerza que se ejerce sobre el elemento de mando (3) y un segundo sensor de posición (9) para determinar la posición del elemento de
    20 mando.
  2. 2. Instrumento según la reivindicación 1, caracterizado porque la unidad de control (10) determina la impedancia a la que se somete el elemento de trabajo (4) basándose en la fuerza que se ejerce sobre el elemento de trabajo, la posición en la que se encuentra el elemento de trabajo con respecto al bastidor (2) y la velocidad a la que se
    25 desplaza el elemento de trabajo con respecto al bastidor, controlando la unidad de control por lo menos en el primer accionador (11) basándose en la impedancia,
  3. 3. Instrumento según la reivindicación 1 o 2, caracterizado porque la unidad de control (10) determina la impedancia a la que se somete el elemento de mando (3) basándose en la fuerza que se ejerce sobre el
    30 elemento de mando, la posición en la que el elemento de mando se encuentra con respecto al bastidor (2) y la velocidad a la que se desplaza el elemento de mando con respecto al bastidor, controlando la unidad de control los accionadores (11, 12) basándose en la impedancia a la que se somete el elemento de trabajo (4) y la impedancia a la que se somete el elemento de mando.
    35 4. Instrumento según cualquiera de las reivindicaciones 1 a 3, caracterizado porque por lo menos uno de los sensores de fuerza (6, 8) y/o sensores de posición (7, 9) comprende fibra de vidrio, mediante el que una fuente de luz y un sensor de luz se disponen en la proximidad de un primer extremo de la fibra de vidrio, y mediante el que una superficie reflectora, que se desplaza en función de la posición y/o la fuerza que se va a medir, se dispone a una cierta distancia de un segundo extremo de la fibra de vidrio.
    40
  4. 5. Instrumento según cualquiera de las reivindicaciones anteriores, caracterizado porque un primer sensor de fuerza (6) comprende una fibra de vidrio (16) mediante el que una fuente de luz y un sensor de luz se disponen en la proximidad de un primer extremo de la fibra de vidrio un segundo extremo de la fibra de vidrio se fija en el elemento de trabajo (4), y mediante el que se dispone una superficie reflectora (17) en el elemento de trabajo
    45 (4) a una distancia definida desde el segundo extremo de la fibra de vidrio, cuya superficie reflectora refleja por lo menos una parte de la luz que proviene de la fuente de luz y emerge del segundo extremo de la fibra de vidrio en el segundo extremo de la fibra de vidrio.
  5. 6. Instrumento según cualquiera de las reivindicaciones anteriores, caracterizado porque el primer sensor de
    50 posición (7) comprende una fibra de vidrio (18), por el que una fuente de luz y un sensor de luz se sitúan en las proximidades de un primer extremo de la fibra de vidrio, y un segundo extremo de la fibra de vidrio dispuesto en el bastidor, y mediante el cual una superficie reflectora (17) que se coloca a cierta distancia del segundo extremo de la fibra de vidrio se dispone en el elemento de trabajo (4), cuya superficie reflectora (19) por lo menos en parte refleja la luz que se origina en la fuente de luz y emerge desde el segundo extremo de la fibra
    55 de vidrio en el segundo extremo de la fibra de vidrio.
  6. 7. Instrumento según cualquiera de las reivindicaciones anteriores, caracterizado porque los accionadores (11, 12) son accionadores electromagnéticos lineales.
    60 8. Instrumento según cualquiera de las reivindicaciones anteriores, caracterizado porque el instrumento (1) comprende por lo menos dos partes que se pueden separar entre sí, de las que una parte es apta para reutilizar y la otra parte es apta para un solo uso, pudiendo las dos partes acoplarse entre sí mediante un acoplamiento.
    7
  7. 9. Instrumento según la reivindicación 8, caracterizado porque el acoplamiento comprende un acoplamiento mecánico (14) y un acoplamiento óptico (15).
    5 10. Instrumento según la reivindicación 8 o 9, caracterizado porque la parte que es apta para reutilizar comprende por lo menos los accionadores (11, 12), la unidad de control (10), la fuente de luz, el sensor de luz y el elemento de mando (3), y porque la parte que es apta para un solo uso comprende por lo menos el elemento de trabajo (4) y las fibras de vidrio (16, 18).
    10 11. Instrumento según cualquiera de las reivindicaciones anteriores, caracterizado porque los accionadores (11, 12), la unidad de control (10), las fuentes de luz y/o los sensores de luz se alojan en una carcasa estanca.
  8. 12. Instrumento según cualquiera de las reivindicaciones anteriores, en el que dicho instrumento es un instrumento
    de telecirugía. 15
  9. 13. Combinación de un instrumento quirúrgico según cualquiera de las reivindicaciones 1 a la 12 y un simulador quirúrgico, en el que el simulador quirúrgico comprende un elemento de mando (3) que puede funcionar manualmente, un primer accionador (11) para controlar el elemento de mando por medio de una fuerza y medios de control que están diseñados para controlar el primer acccionador sobre la base de una impedancia
    20 obtenida a partir de datos de un procedimiento quirúrgico real llevado a cabo anteriormente mediante el instrumento quirúrgico.
    8
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PT2281515E (pt) 2015-07-28
ATE488186T1 (de) 2010-12-15
EP2281515A1 (en) 2011-02-09
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US20050021078A1 (en) 2005-01-27
US7300450B2 (en) 2007-11-27
EP1423056B1 (en) 2010-11-17
EP1423056A2 (en) 2004-06-02
PT1423056E (pt) 2011-02-02
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EP2281515B1 (en) 2015-03-25
ES2356121T3 (es) 2011-04-05

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