ES2569342T3 - Conexión de cuchilla/varilla de disparo para instrumento quirúrgico - Google Patents
Conexión de cuchilla/varilla de disparo para instrumento quirúrgico Download PDFInfo
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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
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B2017/00477—Coupling
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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
- A61B2017/07214—Stapler heads
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- 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
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Abstract
Un instrumento quirúrgico, (100) que comprende: un bastidor (110); una parte alargada (140) que se extiende distalmente desde el bastidor y que define un eje longitudinal; una varilla de disparo (320b) dispuesta al menos parcialmente dentro de la parte alargada y que es trasladable con respecto a la parte alargada; un efector final (150) dispuesto en un extremo distal de la parte alargada, el efector final incluye un primer miembro de mordaza y un segundo miembro de mordaza (160), los miembros de mordaza son movibles relativamente entre sí entre una posición de apertura y una posición de aproximación, el primer miembro de mordaza es un cartucho (170) que tiene una cuchilla (400b); y un conector (360) dispuesto adyacente a una parte distal de la varilla de disparo en donde la conector es acoplable con la cuchilla, caracterizado por que el conector se configura para enlazar con la cuchilla por aproximación de los miembros de mordaza.
Description
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DESCRIPCION
Conexion de cuchilla/varilla de disparo para instrumento quirurgico
Antecedentes
Campo tecnico
La presente descripcion esta relacionada con un instrumento quirurgico que tiene mordazas que son movibles entre posiciones de apertura y de cierre, y mas particularmente con un instrumento quirurgico que tiene una barra de cuchilla.
Antecedentes de la tecnica relacionada
Dispositivos quirurgicos en donde en primer lugar se agarra o se sujeta tejido entre estructuras de mordaza opuestas y luego se unen mediante sujetadores quirurgicos se conocen bien en la tecnica. En algunos instrumentos se proporciona una cuchilla para cortar el tejido que ha sido unido por los sujetadores. Los sujetadores tlpicamente son en forma de grapas quirurgicas pero tambien se pueden utilizar sujetadores polimericos de dos piezas.
Instrumentos para esta finalidad pueden incluir dos miembros alargados que se utilizan respectivamente para capturar o sujetar tejido. Tlpicamente, uno de los miembros lleva un cartucho de grapas que aloja una pluralidad de grapas dispuestas en al menos dos filas laterales, mientras que el otro miembro tiene un yunque que define una superficie para formar las patas de grapa a medida que las grapas son impulsadas desde el cartucho de grapas. La operacion de grapado se efectua mediante barras de leva que se desplazan longitudinalmente a traves del cartucho de grapas, con las barras de leva actuando sobre empujadores de grapa para eyectar secuencialmente las grapas desde el cartucho de grapas. El documento US5749893 describe un instrumento quirurgico del tipo en el que se basa el preambulo de la reivindicacion independiente.
Compendio
Segun la invention se proporciona un instrumento quirurgico segun la reivindicacion 1.
Descripcion de los dibujos
Diversas realizaciones del aparato de grapado quirurgico descrito actualmente se describen en esta memoria con referencia a los dibujos, en donde:
La figura 1 ilustra una vista lateral de un instrumento quirurgico segun una realization de la presente descripcion;
La figura 2 ilustra una vista en section transversal parcial de un bastidor del instrumento quirurgico de la figura 1 que muestra un asidero de sujecion en una position de apertura;
La figura 3 ilustra una vista en seccion transversal parcial del bastidor de la figura 2 que muestra un asidero de sujecion en una posicion de aproximacion;
La figura 4 ilustra una vista en seccion transversal parcial del bastidor de la figura 2 con partes del bastidor omitidas;
La figura 5 ilustra una parte distal del instrumento quirurgico de la figura 1 que muestra miembros de mordaza en una posicion de apertura segun una realizacion de la presente descripcion;
La figura 6 ilustra una vista ampliada de la zona de la parte distal del instrumento quirurgico indicada en la figura 5;
La figura 7 ilustra una parte distal del instrumento quirurgico de la figura 1 que muestra los miembros de mordaza en una posicion de aproximacion segun una realizacion de la presente descripcion;
La figura 8 ilustra una vista ampliada de la zona de la parte distal del instrumento quirurgico indicada en la figura 7;
La figura 9 ilustra una vista ampliada en seccion transversal de una parte distal del instrumento quirurgico de la presente descripcion que muestra una conexion de cuchilla en una posicion sin enlace segun una realizacion de la presente descripcion;
La figura 10 ilustra la conexion de cuchilla de la figura 9 en una posicion con enlace;
La figura 11 ilustra una vista en seccion transversal de una conexion de cuchilla en una posicion sin enlace segun una realizacion de la presente invencion;
La figura 12 ilustra la conexion de cuchilla de la figura 11 en una posicion con enlace;
La figura 13 ilustra una vista en seccion transversal de una conexion de cuchilla en una posicion sin enlace segun una realizacion de la presente descripcion;
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La figura 14 ilustra la conexion de cuchilla de la figura 13 en una posicion con enlace;
La figura 15 ilustra una vista en seccion transversal superior de una conexion de cuchilla en una posicion sin enlace segun una realization de la presente description;
La figura 16 ilustra la conexion de cuchilla de la figura 15 en una posicion con enlace;
La figura 17 ilustra una vista lateral de la conexion de cuchilla de la figura 16;
La figura 18 ilustra una vista en despiece ordenado de un conjunto de cartucho segun una realizacion de la presente descripcion; y
La figura 19 ilustra una vista en seccion transversal parcial del conjunto de cartucho de la figura 18.
Descripcion detallada de realizaciones
Realizaciones del instrumento quirurgico descrito actualmente se describen en detalle con referencia a los dibujos en donde numeros semejantes designan elementos identicos o correspondientes en cada una de las varias vistas. Como es comun en la tecnica, el termino “proximal” se refiere a la parte o componente mas cercano al usuario u operador, p. ej., cirujano o facultativo, mientras que el termino “distal” se refiere a la parte o componente mas alejado del usuario.
Haciendo referencia a la figura 1, se ilustra una realizacion de un instrumento quirurgico 100 de la presente descripcion. El instrumento quirurgico 100 de esta realizacion incluye un bastidor 110, un asidero de sujecion 120, un asidero de disparo 130, una parte alargada 140 y un efector final 150. La parte alargada 140 define un eje longitudinal “X-X” para el instrumento quirurgico 100. El bastidor 110 es de un tamano y forma totales convenientes para ser sostenido en la mano. Asidero de sujecion 120 y asidero de disparo 130 se montan ambos de manera pivotante en el bastidor 110 para el accionamiento entre posiciones de apertura y de cierre.
Un ejemplo de diversos aspectos de la presente descripcion, incluyendo bastidor, asidero de sujecion y asidero de disparo, se describe en la patente de Ee.UU. de propiedad conjunta n°. 5.318.221, la descripcion de la cual se incorpora por la presente por referencia en esta memoria, en su totalidad. Ciertos aspectos de la presente descripcion, incluyendo el accionamiento del efector final 150, se describen en la patente de Estados Unidos de propiedad conjunta n° 6.953.139 de Milliman et al.
Como se trata con mayor detalle mas adelante, el efector final 150 incluye dos miembros de mordaza, un yunque 60 y un conjunto de cartucho 170. Yunque 160 y conjunto de cartucho 170 se extienden desde una parte distal de la parte alargada 140. Al menos uno de yunque 160 y conjunto de cartucho 170 es movible de manera pivotable en relation al otro. El yunque 160 incluye una superficie de contacto con tejido con depresiones formadoras de grapa en la misma (no mostradas expllcitamente en las realizaciones ilustradas). El conjunto de cartucho 170 incluye una pluralidad de sujetadores quirurgicos en el mismo (no mostrados expllcitamente en las realizaciones ilustradas), que son eyectables a traves de tejido y adentro del yunque 160.
Un cartucho de grapas (o unidad de carga) sustituible se puede utilizar con el instrumento quirurgico 100 de la figura 1. El cartucho de grapas sustituible puede alojar una pluralidad de grapas dispuestas en al menos dos filas laterales y puedan ser montables en un canal 210 de cartucho del conjunto de cartucho 170. Ejemplos de unidades de carga para uso con un instrumento de grapado quirurgico se describen en la patente de Estados Unidos de propiedad conjunta n° 5.752.644 de Bolanos et al.
Una parte de un conjunto de impulso 300 se ilustra en las figuras 2-4. El conjunto de impulso 300 de esta realizacion incluye una barreta impulsora 310. Al menos un accionamiento parcial del asidero de sujecion 120 se configura para trasladar la barreta impulsora 310 longitudinalmente para aproximar yunque 160 y conjunto de cartucho 170 relativamente entre si. Al menos un accionamiento parcial del asidero de disparo 130 se configura para trasladar una varilla de disparo 320 (tratada en mayor detalle mas adelante) longitudinalmente para eyectar sujetadores quirurgicos (p. ej., grapas) desde el conjunto de cartucho 170 y/o para cortar tejido. La varilla de disparo 320 se dispone en la parte alargada 140 y se conecta a la cuchilla 400 como se trata mas adelante. La varilla de disparo 320 se dispone al lado de, o concentricamente con, la barreta impulsora 310.
Para sujetar tejido, el asidero de sujecion 120 se pivota hacia abajo (en la direction de la flecha "A" en la figura 2) hacia el bastidor 110. El asidero de sujecion 120 se conecta a un enlace 122 de asidero de manera que la barreta impulsora 310 se mueva longitudinalmente cuando el asidero de sujecion 120 se pivota para cerrarse. Este movimiento longitudinal distal provoca que una parte de la barreta impulsora 310 (p. ej., barreta-1 o parte de accionamiento 330) contacte con una superficie de leva 152 del efector final 150 forzando a al menos uno de yunque 60 y conjunto de cartucho 170 hacia el otro. Detalles adicionales del asidero de sujecion 120 y la barreta impulsora 310 se describen en la patente de EE.UU. de propiedad conjunta n°. 5.318.221 de Green et al.
Cuando el cirujano esta preparado para emplazar sujetadores y cortar tejido, se acciona el asidero de disparo 130, lo que traslada la varilla de disparo 320 longitudinalmente (p. ej., distalmente). Una corredera de accionamiento se
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puede colocar distalmente del extremo distal de la varilla de disparo 320 de manera que el movimiento longitudinal distal de la varilla de disparo 320 haga avanzar la corredera de accionamiento en sentido distal. Con el accionamiento, el asidero de disparo 130 se libera y retorna a su posicion original. Detalles adicionales de disparo de sujetadores y de la retraccion del asidero de disparo 130 se describen en la patente de Estados Unidos n° 5.318.221 de Green et al.
Continuando con referencia a las figuras 2-4, se muestran detalles adicionales del asidero de sujecion 120 y piezas internas del bastidor 110 segun una realizacion de la presente descripcion. Aqul, una parte proximal 124 del enlace 122 de asidero (p. ej., un enlace formado monollticamente) se acopla de manera pivotable con el asidero de sujecion 120 (p. ej., una parte proximal del mismo) y una parte distal 126 del enlace 122 de asidero se acopla de manera pivotable con una parte proximal 312 de la barreta impulsora 310. Se ilustra un miembro de predisposicion 180 (vease la figura 4), que se configura para predisponer la barreta impulsora 310 proximalmente (que predispone los miembros de mordaza a una posicion de apertura). Una parte proximal del miembro de predisposicion 180 se dispone en cooperacion mecanica con el bastidor 110 (p. ej., por via del pasador 182) y una parte distal del miembro de predisposicion 180 esta en cooperacion mecanica con la parte proximal 312 de la barreta impulsora 310 (vease la figura 4). Como se puede apreciar, al menos un accionamiento parcial (es decir, movimiento en la direccion de la flecha A”) del asidero de sujecion 120 fuerza a la parte distal 126 del enlace 122 de asidero distalmente, lo que provoca que la barreta impulsora 310 sea trasladada distalmente contra la predisposicion del miembro de predisposicion 180. Como se ha tratado anteriormente, la traslacion distal de la barreta impulsora 310 provoca la aproximacion de los miembros de mordaza para sujetar tejido entre los mismos.
Con referencia especlfica a las figuras 2 y 3, el instrumento quirurgico 100 de esta realizacion incluye una estructura de enganche 190 dispuesta en cooperacion mecanica con al menos uno de bastidor 110 y asidero de sujecion 120. Por ejemplo, la estructura de enganche 190 puede incluir una primera parte 192 dispuesta en el asidero de sujecion 120 y una segunda parte 194 dispuesta en el bastidor 110, de manera que el accionamiento del asidero de sujecion 120 (p. ej., un accionamiento total) provoca que la primera parte 192 se acople con la segunda parte 194 para mantener de manera liberable el asidero de sujecion 120 en una posicion de cierre. Ademas, un mecanismo de liberacion 196 se puede disponer en una parte del instrumento quirurgico 100 (p. ej., asidero de sujecion 120) de manera que aplicar presion al mecanismo de liberacion 196 (p. ej., presion hacia arriba) provoca que el asidero de sujecion 120 sea liberado desde su posicion de cierre. Esto es, la activacion del mecanismo de liberacion 196 provoca que las partes 192, 194 del mecanismo de enganche 190 se desacoplen o desenganchen una de otra.
En una realizacion concebida, el miembro de predisposicion 180 es un resorte que incluye una constante de resorte que se configura para impedir que los miembros de mordaza lleguen a su posicion de aproximacion cuando el tejido entre los mismos supere un grosor predeterminado. Un ejemplo cuando el tejido es “demasiado grueso” es cuando el grosor del tejido entre los miembros de mordaza impedirla sustancialmente un emplazamiento apropiado de sujetadores en el mismo y/o a traves del mismo.
En una realizacion descrita, el accionamiento del asidero de sujecion 120 se configura tambien para proporcionar al usuario retroinformacion tactil. Por ejemplo, la resistencia que experimenta un usuario en respuesta a accionar el asidero de sujecion 120 puede ser proporcional al grosor del tejido que esta sujeto entre los miembros de mordaza. Asl, se proporciona al usuario una retroinformacion (en forma de resistencia) a medida que se acciona el asidero de sujecion 120 para aproximar los miembros de mordaza alrededor de tejido entre los mismos. Esta retroinformacion puede ser directa o indirectamente proporcional al grosor del tejido a sujetar. Se concibe ademas que esta cantidad de fuerza sea suficiente para vencer la resistencia proporcionada por tejido “demasiado grueso” colocado entre los miembros de mordaza, impidiendo asl sustancialmente que un usuario sujete tejido que sea “demasiado grueso”.
Con referencia especlfica a la figura 2, en su posicion de apertura o sin accionar, el asidero de sujecion 120 (incluyendo enlace 122 de asidero y diversos puntos de pivote) se configura para tener una altura relativamente baja desde el eje longitudinal. Una distancia relativamente tan pequena proporciona al instrumento quirurgico total 100 un perfil mas pequeno, que generalmente es una caracterlstica deseable, ya que el instrumento es menos voluminoso y asl mas facil de manejar. Adicionalmente, se concibe que un usuario pueda accionar este asidero de sujecion 120 de “perfil bajo” con el pulgar de la misma mano que el usuario utiliza para accionar el asidero movible 130 para disparar grapas, por ejemplo. Asl, el asidero de sujecion 120 se configura y dimensiona para facilitar un funcionamiento a una mano del instrumento quirurgico 100.
Haciendo referencia ahora a las figuras 5-8, se muestra una realizacion de la presente descripcion relacionada con la aproximacion de miembros de mordaza. En esta realizacion, el efector final 150 incluye un par de superficies de leva 152a y 152b. Las figuras 5 y 6 ilustran los miembros de mordaza en una posicion de apertura (es decir, sin aproximacion). Aqul la parte de accionamiento 330 (p. ej., una parte horizontal superior de una barreta en I) de la barreta impulsora 310 esta en una primera posicion proximal. Como se ha tratado anteriormente en esta memoria, la aproximacion del asidero de sujecion 120 provoca que la parte de accionamiento 330 de la barreta impulsora se traslade distalmente. Con la traslacion distal de la barreta impulsora 310, la parte de accionamiento 330 contacta con la superficie de leva distal 152a, que provoca la aproximacion de los miembros de mordaza (p. ej., conjunto de cartucho 170 se mueve hacia un yunque estacionario 160). Las figuras 7 y 8 ilustran el resultado de un accionamiento al menos parcial del asidero de sujecion 120, es decir, la parte de accionamiento 330 en una posicion distal y los miembros de mordaza en una posicion de aproximacion.
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Una vez que los miembros de mordaza estan aproximados, un usuario puede, por ejemplo, accionar al menos parcialmente el asidero de disparo 130 para hacer avanzar la varilla de disparo y eyectar grapas desde el conjunto de cartucho 170. El asidero de disparo se predispone deseablemente hacia su posicion inicial de modo que, tras disparar, la varilla de disparo y la parte de accionamiento 330 se retraen. Antes de la eyeccion de grapas, el usuario puede subir el asidero de sujecion 120 (p. ej., en la direction sustancial de la flecha “B” en la figura 3) para retraer la barreta impulsora 310 y provocar que la parte de accionamiento 330 se mueva proximalmente y contacte con la superficie de leva proximal 152b. A medida que la parte de accionamiento 330 de la barreta impulsora 310 contacta con la superficie de leva proximal 152b, los miembros de mordaza se abren relativamente entre si (p. ej., el conjunto de cartucho 170 se aleja del yunque 160). Como se muestra, la superficie de leva distal 152a y la superficie de leva proximal 152b pueden estar adyacentes entre si, formando as! una forma semejante a una V.
En la realization ilustrada, el miembro de mordaza movible (p. ej., conjunto de cartucho 170) tambien incluye un labio 154 dispuesto en una parte proximal del mismo. El labio 154 se eleva encima de la superficie de leva 152b y se configura para ayudar a impedir que la parte de accionamiento 330 de la barreta impulsora 310 se traslade demasiado lejos proximalmente.
Adicionalmente, el miembro de mordaza movible se muestra teniendo una superficie sustancialmente llana 156 (es decir, sustancialmente paralela al eje longitudinal cuando los miembros de mordaza se aproximan) adyacente y distalmente a la superficie de leva distal 152a (vease la figura 6). En esta configuration, la parte de accionamiento 330 de la barreta impulsora 310 puede continuar trasladandose distalmente tras contactar con la superficie de leva distal 152a (y despues de que los miembros de mordaza hayan sido aproximados al menos parcialmente) y se puede acoplar a la superficie 156. Se concibe que el acoplamiento entre la parte de accionamiento 330 y la superficie 156 pueda ayudar a mantener los miembros de mordaza en la posicion de aproximacion.
Adicionalmente, aunque no se ilustra expllcitamente en esta memoria, se concibe que el instrumento quirurgico 100 de la presente description no incluya un asidero de sujecion. En una realizacion de este tipo, se puede utilizar un accionamiento parcial del asidero de disparo 130 para aproximar los miembros de mordaza y un accionamiento adicional, mas completo, del asidero de disparo 130 dispara grapas, por ejemplo. El asidero de disparo, en estas realizaciones, tiene una garra que se predispone hasta el acoplamiento con una cremallera dentada conectada a la barreta impulsora. Accionamientos multiples del asidero de disparo se utilizan para hacer avanzar la barreta impulsora. El avance inicial de la barreta impulsora cierra los miembros de mordaza. Con el accionamiento continuo del asidero de disparo, la parte de accionamiento 330 continua desplazandose distalmente, disparando las grapas. El conjunto de cartucho y el yunque incluye una ranura para permitir que la parte de accionamiento 330 se desplace hacia el extremo distal de los miembros de mordaza. Se puede utilizar el conjunto de asidero descrito en la patente de Estados Unidos n° 6.953.139 de Milliman et al. En esta realizacion, la parte de accionamiento 330 se conecta al miembro de cuchilla, que empuja la corredera 650 para disparar las grapas.
Haciendo referencia ahora a las figuras 9-17, se muestran realizaciones de la presente descripcion relacionadas con las diversas conexiones de cuchilla/varilla de disparo. En estas realizaciones, la estructura de una parte de la varilla de disparo 3-20 y/o una parte de una cuchilla 400 se configura para permitir la conexion entre la varilla de disparo 320 y una cuchilla de un solo uso 400, permitiendo as! usar una cuchilla nueva 400 para cada disparo del instrumento quirurgico 100.
Con particular referencia a las figuras 9 y 10, se muestra una primera realizacion de una conexion de cuchilla/varilla de disparo. Especlficamente, la figura 9 ilustra la varilla de disparo 320a en una primera posicion proximal en la que una unidad de carga, o cartucho sustituible, se ha insertado en el conjunto de cartucho, y varilla de disparo 320a y cuchilla 400a no estan enlazadas. La figura 10 ilustra la varilla de disparo 320a en una segunda posicion distal en la que varilla de disparo 320a y cuchilla 400a estan enlazadas. Varilla de disparo 320a y cuchilla 400a de esta realizacion se configuran de manera que el movimiento distal de la varilla de disparo 320a provoca que un extremo distal 322a de la misma enlace con la cuchilla 400a cuando el efector final 150 se acopla con la con parte alargada 140 del instrumento quirurgico 100. Adicionalmente, el movimiento proximal de la varilla de disparo 320a provoca que la cuchilla 400a (que esta enlazada con la misma) se mueva proximalmente. Ademas, la varilla de disparo 320a y la cuchilla 400a se configuran para desenlazarse entre si cuando la varilla de disparo 320a se ha trasladado proximalmente a una posicion predeterminada (p. ej., correspondiente a cuando el asidero de disparo 130 ha sido retraldo de manera sustancialmente total en la direccion de la flecha “C” en la figura 1).
En la posicion sin enlace (es decir, en la que hay una distancia suficiente entre una superficie 401a de la cuchilla 400a y una superficie 323a del extremo distal 322a de la varilla de disparo 320a (vease la figura 9)), un usuario puede sustituir la cuchilla 400a por una cuchilla nueva, por ejemplo sustituyendo el conjunto de cartucho 160. Si bien las realizaciones ilustradas ilustran los miembros de mordaza en la posicion de aproximacion, se concibe que un usuario pueda retirar y/o sustituir la cuchilla 400a cuando los miembros de mordaza esten en una posicion de apertura.
Detalles adicionales de la interaction entre varilla de disparo 320a y cuchilla 400a se describen en esta memoria continuando con referencia a las figuras 9 y 10. A medida que se hace avanzar la varilla de disparo 320a distalmente, al menos un saliente 142 (p. ej., un par de salientes, un saliente dispuesto radialmente, etc.) dispuesto en la parte alargada 140 se configura para mover al menos una parte de la varilla de disparo 320a transversal al eje
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longitudinal (p. ej., en la direccion de la flecha “D” en la figura 10). Por ejemplo, un saliente 143 puede contactar con una rampa 324a de la varilla de disparo 320a. Como se puede apreciar con relacion a las figuras 9 y 10, la combinacion del movimiento distal y el movimiento transversal provoca que el extremo distal 322a (p. ej., con forma de J) de la varilla de disparo 320a se acople (p. ej., enlace) a una parte proximal 402a (p. ej., con forma de J) de la cuchilla 400a. Correspondientemente, a medida que la varilla de disparo 320a se traslada proximalmente, al menos un saliente 142 se configura para mover al menos una parte de la varilla de disparo 320a transversal al eje longitudinal (p. ej., en la direccion de la flecha “E” en la figura 9). Por ejemplo, un saliente 142 puede contactar con una rampa 326a formada en la varilla de disparo 320a. Asl, la combinacion del movimiento proximal y el movimiento transversal provoca que el extremo distal 322a de la varilla de disparo 320a se desacople (p. ej., desenlace) de una parte proximal 402a de la cuchilla 400a.
Con referencia particular a las figuras 11 y 12, se muestra un ejemplo de realization de una conexion de cuchilla/varilla de disparo segun la invention. Especlficamente, la figura 11 ilustra los miembros de mordaza en una position de apertura en la que la cuchilla 400b no esta acoplada o enlazada con un conector 360 dispuesto distalmente y adyacente a la varilla de disparo 320b. La figura 12 ilustra los miembros de mordaza en una posicion de aproximacion en la que la cuchilla 400b esta acoplada o enlazada con el conector 360. Conector 360 y cuchilla 400b se configuran de manera que cuando los miembros de mordaza estan en la posicion de apertura, conector 360 y cuchilla 400b estan desenlazados (figura 11), permitiendo asl que el cartucho (incluyendo la cuchilla 400b) sea retirado. Cuando los miembros de mordaza estan en una posicion de aproximacion (figura 12), una superficie del miembro de mordaza de yunque contacta con la cuchilla 400b, rotando la cuchilla 400b de modo que conector 360 y cuchilla 400b se enlacen, de manera que la traslacion proximal y distal de la varilla de disparo 320 (y asl el conector 360) da como resultado una traslacion proximal y distal de la cuchilla 400b, respectivamente. Cuando los miembros de mordaza se aproximan, el cartucho no se puede retirar del instrumento quirurgico 100, como se puede apreciar con referencia a la figura 12.
En la realizacion mostrada en las figuras 11 y 12, el conector 360 incluye una parte semejante a un gancho que se configura para acoplarse a la parte semejante a un gancho de la cuchilla 400b. El conector 360 se muestra teniendo una forma sustancial de J, pero se pueden utilizar cualesquiera formas adecuadas para cuchilla 400b y conector 360.
Se concibe que el conector 360 sea movible (p. ej., pivotable, giratorio, etc.) con respecto al extremo distal de la varilla de disparo 320. Por ejemplo, cuando los miembros de mordaza se mueven hacia su posicion de apertura, una parte proximal 402b de la cuchilla 400b puede contactar en una parte superior 362 del conector 360 para pivotar/girar la parte superior 362 distalmente, creando asl bastante espacio (o mas espacio) para que la cuchilla 400b sea retirada del instrumento quirurgico 100. Asimismo, cuando los miembros de mordaza se aproximan, la parte superior 362 del conector 360 puede pivotar/girar proximalmente, enlazando asl (o enlazando aun mas) el conector 360 con la cuchilla 400b, no permitiendo asl que la cuchilla 400b sea retirada del mismo. Adicionalmente, se muestra un reborde 370, que se puede configurar para ayudar a mantener el conector 360 en su posicion y/o ayudar a la parte superior 362 del conector 360 a moverse proximalmente.
Otra realizacion de una conexion de cuchilla/varilla de disparo se ilustra en las figuras 13 y 14. Especlficamente, la figura 13 ilustra la varilla de disparo 320c en una primera posicion proximal en la que varilla de disparo 320c y cuchilla 400c estan desenlazadas. La figura 14 ilustra la varilla de disparo 320c en una segunda posicion distal en la que varilla de disparo 320c y cuchilla 400c estan enlazadas. Varilla de disparo 320c y cuchilla 400c de esta realizacion se configuran de manera que el movimiento distal de la varilla de disparo 320c provoca que un extremo distal 322c de la misma enlace con la cuchilla 400c cuando el efector final 150 se acopla con la parte alargada 140 del instrumento quirurgico 100.
Mas especlficamente, esta realizacion de la conexion de cuchilla/varilla de disparo incluye un elemento de resorte 500 (p. ej., un resorte plano) dispuesto en cooperation mecanica con la cuchilla 400c. Una parte proximal 502 (p. ej., que es sustancialmente con forma de J) del elemento de resorte 500 se predispone hacia un eje de cuchilla K-K. Aqul, el movimiento distal de la varilla de disparo 320c fuerza a la parte proximal 502 del elemento de resorte 500 hacia fuera (es decir, alejandose del eje de cuchilla K-K). La varilla de disparo 320 incluye una abertura 321 para recibir el elemento de resorte 500. Por consiguiente, la parte proximal 502 del elemento de resorte 500 se asegura temporalmente a la varilla de disparo 320c. Asl, la traslacion distal continua de la varilla de disparo 320c provoca la traslacion distal de la cuchilla 400c. Ademas, la traslacion proximal de la varilla de disparo 320c provoca la traslacion proximal de la cuchilla 400c hasta que la varilla de disparo 320c llega a una ubicacion predeterminada (p. ej., correspondiente a cuando el asidero de disparo 130 ha sido retraldo de manera sustancialmente total en la direccion de la flecha “C” en la figura 1) en la que la varilla de disparo 320c se desacopla del elemento de resorte 500. Deseablemente, la forma de la abertura 321 y el elemento de resorte 500 (o elementos de resorte 500) son de manera que el elemento de resorte 500 se predispone hacia fuera al retirar el cartucho del dispositivo, desconectando la varilla de disparo 320 de la cuchilla 400.
Con referencia particular a las figuras 15-17, se muestra una cuarta realizacion de una conexion de cuchilla/varilla de disparo. Especlficamente, la figura 15 ilustra la varilla de disparo 320d en una primera posicion proximal en la que varilla de disparo 320d y cuchilla 400d estan desenlazadas. La figura 16 ilustra la varilla de disparo 320d en una segunda posicion distal en la que varilla de disparo 320d y cuchilla 400d estan enlazadas. La figura 17 es una vista
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lateral de la figura 16. Varilla de disparo 320d y cuchilla 400d de esta realizacion se configuran de manera que el movimiento distal de la varilla de disparo 320d provoca que un extremo distal 322d de la misma enlace con la cuchilla 400d cuando el efector final 150 se acopla con la parte alargada 140 del instrumento quirurgico 100. Adicionalmente, el movimiento proximal de la varilla de disparo 320d provoca que la cuchilla 400d (que esta enlazada con la misma) se mueva proximalmente. Ademas, la varilla de disparo 320d y la cuchilla 400d se configuran para desenlazarse entre si cuando la varilla de disparo 320d se ha trasladado proximalmente a una posicion predeterminada (p. ej., correspondiente a cuando el asidero de disparo 130 ha sido retraldo de manera sustancialmente total en la direction de la flecha “C” en la figura 1). El extremo distal 322d y el receptaculo 402d de la cuchilla 400d se conforman de modo que el extremo distal 322d se predispone hacia fuera al retirar el cartucho del dispositivo, desconectando la varilla de disparo 320 de la cuchilla 400.
En la posicion sin enlace (figura 15), un usuario puede sustituir la cuchilla 400d por una cuchilla nueva, por ejemplo sustituyendo el conjunto de cartucho 160. Se concibe que la configuration de efector final y varilla de disparo 320d permita a un usuario retirar y/o sustituir el cartucho cuando los miembros de mordaza estan en una posicion de apertura y/o de aproximacion.
Detalles adicionales de la interaction entre varilla de disparo 320d y cuchilla 400d se describen en esta memoria continuando con referencia a las figuras 15 y 16. La conexion se puede formar a medida que el extremo distal 322d encaja por salto elastico de manera resiliente en el receptaculo 402d. Como alternativa, a medida que se hace avanzar la varilla de disparo 320d distalmente, una pendiente 142d en la parte alargada 140 se configura para mover el extremo distal 322d de la varilla de disparo 320d transversal al eje longitudinal (p. ej., en la direccion de la flecha “F” en la figura 16) hacia un receptaculo 402d en la cuchilla 400d. Adicionalmente o como alternativa, una pendiente en la parte alargada se puede configurar y disponer para apalancar el extremo distal 322 alejandolo del acoplamiento con la cuchilla. Como se puede apreciar con relation a las figuras 15 y 16, la combination del movimiento distal y el movimiento transversal se puede utilizar para provocar que el extremo distal 322d de la varilla de disparo 320d se acople al receptaculo 402d de la cuchilla 400d. La combinacion del movimiento proximal y el movimiento transversal se puede utilizar para provocar que el extremo distal 322d de la varilla de disparo 320d se acople al receptaculo 402d de la cuchilla 400d. Se pueden utilizar disposiciones similares para la conexion entre cuchilla y varilla de disparo mostradas en las figuras 13 y 14.
Adicionalmente, se concibe que el extremo distal 322d de la varilla de disparo 320d se predisponga para alejarse de la cuchilla 400d, es decir, en la direccion sustancial de la flecha “G” en la figura 15. Por lo tanto, a medida que la varilla de disparo 320d se traslada proximalmente de manera que el extremo distal 322d este proximal de la pendiente 142d, el extremo distal 322d se sale del receptaculo 402d de la cuchilla 400d. Asl, esta combinacion de movimiento desenlaza varilla de disparo 320d y cuchilla 400d.
Con referencia a las figuras 18-19, la presente description tambien esta relacionada con un conjunto de cartucho 600 para uso con un instrumento de grapado quirurgico 100. El conjunto de cartucho 600 se configura para impedir que un usuario dispare un cartucho de un solo uso que ya ha sido disparado. Mas especlficamente, el conjunto de cartucho 600 se configura para trabar su cuchilla 640 e impedir la reutilizacion de un cartucho, despues de que el cartucho haya sido disparado.
Una vista de conjunto del conjunto de cartucho 600 se muestra en la figura 18. Como se muestra, el conjunto de cartucho 600 incluye un canal 610, una cubierta 620, un cartucho de grapas 630 y una cuchilla 640. La cubierta 620 se configura para acoplamiento mecanico (p. ej., un encaje por salto elastico conexion) con el canal 610. El cartucho de grapas 630 se configura para acoplamiento mecanico con la cubierta 620 y la cuchilla 640 se configura para la traslacion con respecto a cubierta 620 y cartucho. La figura 18 tambien ilustra una corredera 650, que se configura para la traslacion con respecto a la cubierta 620 (p. ej., para eyectar grapas desde el cartucho de grapas 630).
Como se muestra, el canal 610 incluye un saliente 612 en el mismo para acoplamiento con un miembro de bloqueo 622 (p. ej., dedo flexible) de la cubierta 620. Con el acoplamiento entre canal 610 y cubierta 620, el saliente 612 provoca que el miembro de bloqueo 622 se mueva desde una primera posicion, en la que el miembro de bloqueo 622 esta sustancialmente paralelo a un plano definido por una superficie 624 de la cubierta 620, a una segunda posicion, en la que al menos una parte del miembro de bloqueo 622 (p. ej., una parte proximal 626) esta espaciada del plano de la superficie 624. En su segunda posicion, el miembro de bloqueo 622 se configura para impedir sustancialmente la traslacion distal de la cuchilla 640 despues de que la cuchilla 640 haya sido desplegada para disparar grapas, y entonces se traslada proximalmente pasando una posicion predeterminada (vease la figura 19). Se concibe que el conjunto de cartucho 600 se configure para permitir la traslacion proximal de la cuchilla 640 pasando el miembro de bloqueo 622 cuando el miembro de bloqueo 622 esta en su segunda posicion. Por ejemplo, el miembro de bloqueo 622 se puede formar como un miembro resiliente. En la posicion inicial de la cuchilla, el miembro de bloqueo 622 es oprimido por la cuchilla. Despues de avanzar la cuchilla, empujando la corredera distalmente para disparar grapas, la cuchilla se retrae a la posicion mostrada en la figura 19. El miembro de bloqueo 622 se eleva de manera resiliente, acoplandose a una superficie sobre la cuchilla. Como se puede apreciar, el conjunto de cartucho 600 se puede utilizar con diversas realizaciones del instrumento de grapado quirurgico 100 descritas en esta memoria.
Se entendera que se pueden hacer diversas modificaciones a las diversas realizaciones de la presente description descrita en esta memoria sin apartarse del alcance de la misma. Por ejemplo, el instrumento de grapado quirurgico de la presente descripcion puede incluir un solo asidero movible para realizar todas las funciones (p. ej., aproximar los miembros de mordaza, disparar grapas, cortar tejido, abrir los miembros de mordaza). Se concibe que el asidero 5 movible individual se pueda accionar parcialmente para realizar una primera funcion y un accionamiento continuado realizarla una segunda funcion. Se concibe tambien que un primer accionamiento completo realizarla una primera funcion y un segundo accionamiento total realizarla una segunda funcion.
Ademas, el instrumento de grapado quirurgico descrito puede no incluir asideros movibles; en lugar, el instrumento de grapado quirurgico puede ser alimentado por medios (p. ej., baterla, electricos, etc.) distintos al accionamiento de 10 un asidero o pinza. Adicionalmente, el instrumento de grapado quirurgico de la presente descripcion tambien pueden tener posibilidades de articulation, que pueden mover el efector final entre una primera position en la que un eje del efector final esta paralelo a un eje de la parte alargada, y una segunda posicion en la que el eje del efector final esta con un angulo con respecto al eje de la parte alargada. Por lo tanto, la descripcion anterior no se debe interpretar como limitadora de la divulgation, sino meramente como ejemplificaciones de diversas realizaciones de la misma. 15 Los expertos en la tecnica contemplaran otras modificaciones dentro del alcance de la presente invention tal como se define en las reivindicaciones que se adjuntan.
Claims (5)
- REIVINDICACIONES1. Un instrumento quirurgico, (100) que comprende: un bastidor (110);una parte alargada (140) que se extiende distalmente desde el bastidor y que define un eje longitudinal;5 una varilla de disparo (320b) dispuesta al menos parcialmente dentro de la parte alargada y que es trasladable con respecto a la parte alargada;un efector final (150) dispuesto en un extremo distal de la parte alargada, el efector final incluye un primer miembro de mordaza y un segundo miembro de mordaza (160), los miembros de mordaza son movibles relativamente entre si entre una posicion de apertura y una posicion de aproximacion, el primer miembro de mordaza es un cartucho 10 (170) que tiene una cuchilla (400b); yun conector (360) dispuesto adyacente a una parte distal de la varilla de disparo en donde la conector es acoplable con la cuchilla, caracterizado por que el conector se configura para enlazar con la cuchilla por aproximacion de los miembros de mordaza.
- 2. El instrumento quirurgico de la reivindicacion 1, en donde el conector se configura para girar con respecto a la 15 parte alargada cuando los miembros de mordaza se mueven hacia su posicion de apertura.
- 3. El instrumento quirurgico de la reivindicacion 1, en donde el conector es sustancialmente con forma de J.
- 4. El instrumento quirurgico de la reivindicacion 1, en donde la traslacion distal de la varilla de disparo provoca traslacion distal de la cuchilla.
- 5. El instrumento quirurgico de la reivindicacion 1, que comprende ademas un asidero movible 130 dispuesto en 20 cooperacion mecanica con el bastidor, y en donde al menos un accionamiento parcial del asidero movible efectuatraslacion de la varilla de disparo.
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-
2008
- 2008-06-06 US US12/134,351 patent/US7789283B2/en active Active
-
2009
- 2009-05-06 CA CA002665472A patent/CA2665472A1/en not_active Abandoned
- 2009-05-07 AU AU2009201826A patent/AU2009201826B2/en not_active Ceased
- 2009-05-13 JP JP2009117024A patent/JP5492450B2/ja not_active Expired - Fee Related
- 2009-05-27 ES ES09251401.7T patent/ES2569342T3/es active Active
- 2009-05-27 EP EP09251401.7A patent/EP2130500B1/en active Active
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2010
- 2010-05-14 US US12/780,431 patent/US8074862B2/en active Active
-
2011
- 2011-11-09 US US13/292,270 patent/US8328065B2/en not_active Expired - Fee Related
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2013
- 2013-10-03 JP JP2013208174A patent/JP2014039849A/ja not_active Withdrawn
Also Published As
| Publication number | Publication date |
|---|---|
| EP2130500A1 (en) | 2009-12-09 |
| US20090302091A1 (en) | 2009-12-10 |
| AU2009201826B2 (en) | 2014-07-24 |
| AU2009201826A1 (en) | 2009-12-24 |
| JP2014039849A (ja) | 2014-03-06 |
| US8328065B2 (en) | 2012-12-11 |
| US7789283B2 (en) | 2010-09-07 |
| JP2009291603A (ja) | 2009-12-17 |
| EP2130500B1 (en) | 2016-03-23 |
| US20120048911A1 (en) | 2012-03-01 |
| US20100237133A1 (en) | 2010-09-23 |
| JP5492450B2 (ja) | 2014-05-14 |
| US8074862B2 (en) | 2011-12-13 |
| CA2665472A1 (en) | 2009-12-06 |
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