ES2627617T3 - Aparato para formar cierres quirúrgicos de altura variable - Google Patents

Aparato para formar cierres quirúrgicos de altura variable Download PDF

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ES2627617T3
ES2627617T3 ES08744103.6T ES08744103T ES2627617T3 ES 2627617 T3 ES2627617 T3 ES 2627617T3 ES 08744103 T ES08744103 T ES 08744103T ES 2627617 T3 ES2627617 T3 ES 2627617T3
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jaw
staple
cam
tissue
jaws
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Gregory Sorrentino
Frank J. Viola
Scott Cunningham
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Covidien LP
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • A61B17/0644—Surgical staples, i.e. penetrating the tissue penetrating the tissue, deformable to closed position
    • 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
    • A61B17/0682—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil
    • A61B17/0684—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil having a forming anvil staying above the tissue during stapling
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/0682—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil
    • A61B17/0686—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil having a forming anvil staying below the tissue during stapling
    • 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
    • A61B2017/07228—Arrangement of the staples
    • 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
    • A61B2017/0725—Stapler heads with settable gap between anvil and cartridge, e.g. for different staple heights at different shots
    • 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
    • A61B2017/2932—Transmission of forces to jaw members
    • A61B2017/2944—Translation of jaw members

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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)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

Un aparato quirúrgico que comprende: un alojamiento que incluye un mecanismo de actuación; un miembro tubular alargado que se extiende distalmente del alojamiento; un conjunto de cierre de grapas (100) situado en un extremo distal del miembro tubular alargado, el conjunto de cierre de grapas (100) que incluye una primera mordaza (104) y una segunda mordaza (140), la primera mordaza (104) que incluye una pluralidad de cierres y un conjunto de empuje, la segunda mordaza (140) que incluye un yunque (142); y un mecanismo de operación de mordaza (160), el mecanismo de operación de mordaza (160) acoplado operativamente al mecanismo de actuación de manera que la actuación del mecanismo de actuación mueve una de la primera y segunda mordazas (104, 140) hacia la otra de la primera y segunda mordazas (104, 140), en donde una superficie de contacto con el tejido (122) de la primera mordaza (104) permanece sustancialmente paralela a una superficie de contacto con el tejido (144) de la segunda mordaza (140) a medida que varía una distancia entre las mordazas, el mecanismo de operación de mordaza (160) que está acoplado operativamente con la segunda mordaza (140), el mecanismo de operación de mordaza (160) que incluye una leva (162), caracterizado por que al menos una parte de la leva (162) está en contacto con una superficie exterior de la segunda mordaza (140) de manera que la rotación de la leva (162) empuja la segunda mordaza (140) hacia la primera mordaza, la leva (162) que se bloquea automáticamente después que la leva (162) haya girado una cantidad deseada, de manera que las mordazas (104, 140) son operables para capturar y mantener el tejido en posición.

Description

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DESCRIPCION
Aparato para formar cierres quirurgicos de altura variable Antecedentes
1. Campo tecnico
La presente descripcion se refiere a un aparato de cierre quirurgico. Mas particularmente, la presente descripcion se refiere a un aparato para formar cierres quirurgicos de altura variable para el tejido corporal en procedimientos quirurgicos.
2. Antecedentes de la tecnica relacionada
Los dispositivos quirurgicos en donde el tejido primero se agarra o sujeta entre una estructura de mordazas opuestas y luego se une por medio de cierres quirurgicos son bien conocidos en la tecnica. En algunos instrumentos, se proporciona una cuchilla para cortar el tejido que se ha unido mediante los cierres. Los cierres son tlpicamente en forma de grapas quirurgicas.
Los instrumentos para este proposito pueden incluir dos miembros alargados que se usan respectivamente para capturar o sujetar tejido. Tlpicamente, uno de los miembros transporta un cartucho que aloja una pluralidad de grapas dispuestas en al menos dos filas laterales mientras que el otro miembro incluye un yunque que define una superficie para formar las patas de la grapa a medida que se empujan los cierres desde el cartucho. Generalmente, la operacion de grapado se efectua mediante un empujador que viaja longitudinalmente a traves del miembro de transporte del cartucho, con el empujador actuando sobre las grapas para expulsarlas secuencialmente desde el cartucho. Una cuchilla puede viajar con el empujador entre las filas de grapas para cortar longitudinalmente y/o abrir el tejido grapado entre las filas de grapas.
Una grapadora posterior descrita en la Pat. de EE.UU. N° 3.499.591 aplica una fila doble de grapas en cada lado de la incision. Esto se logra proporcionando un conjunto de cartucho en el que un miembro de leva se mueve a traves de un camino de gula alargado entre dos conjuntos de surcos de transporte de grapas escalonados. Los miembros de empuje de grapas estan situados dentro de los surcos y estan colocados de tal manera para ser contactados por la leva que se mueve longitudinalmente para efectuar la expulsion de las grapas. Otros ejemplos de grapadoras se describen en las Pat. de EE.UU. N° 4.429.695, 5.065.929 y 5.156.614. Ejemplos adicionales de grapadoras se muestran en el documento US 2006/111735, EP 1728475, US 5865361, US 5358506, US 7114642, US 4633874, US 4605001, EP 1728473 y US 2007/045379, en donde el documento US 2006/111735 describe un aparato quirurgico segun el preambulo de la reivindicacion 1.
Compendio
La invencion se describe en la reivindicacion 1 con las realizaciones preferidas descritas en las reivindicaciones dependientes.
Segun la presente invencion se proporciona un aparato quirurgico que comprende un alojamiento que incluye un mecanismo de actuacion, un miembro tubular alargado que se extiende distalmente del alojamiento, un conjunto de cierre de grapas situado en un extremo distal del miembro tubular alargado, el conjunto de cierre de grapas que incluye una primera mordaza y una segunda mordaza, la primera mordaza que incluye una pluralidad de cierres y un conjunto de empuje, la segunda mordaza que incluye un yunque, y un mecanismo de operacion de mordaza, el mecanismo de operacion de mordaza acoplado operativamente al mecanismo de actuacion de manera que la actuacion del mecanismo de actuacion mueve una de la primera y segunda mordazas hacia la otra de la primera y segunda mordazas, en donde una superficie de contacto con el tejido de la primera mordaza permanece sustancialmente paralela a una superficie de contacto con el tejido de la segunda mordaza a medida que varla la distancia entre las mordazas, el mecanismo de operacion de mordaza que esta acoplado operativamente con la segunda mordaza, el mecanismo de operacion de mordaza que incluye una leva, caracterizado por que al menos una parte de la leva esta en contacto con una superficie exterior de la segunda mordaza de manera que la rotacion de la leva empuja a la segunda mordaza hacia la primera mordaza, la leva que se bloquea de manera automatica despues de que la leva haya rotado una cantidad deseada, de manera que las mordazas son operables para capturar y mantener el tejido en posicion.
El conjunto de cierre de grapas incluye una primera y segunda mordazas cooperativas, un mecanismo de operacion de mordaza, y un conjunto de empuje de grapas. Una mordaza es generalmente alargada e incluye un cargador de grapas. El cargador de grapas puede estar unido de manera fija o unido de manera liberable a la mordaza e incluye una pluralidad de grapas dispuestas en al menos una fila. Una primera superficie de contacto con el tejido se define en una cara del cargador de grapas e incluye una pluralidad de ranuras de retention que corresponden al numero de grapas incluidas en el cargador de grapas. Se contempla que se pueden proporcionar y disponer en columnas multiples filas de grapas. Las ranuras de retencion pueden estar alineadas longitudinalmente o desplazadas unas de otras. Cada ranura de retencion esta configurada y adaptada para recibir de manera liberable su respectiva grapa.
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Cada grapa incluye una primera y segunda patas sustancialmente paralelas conectadas por un tramo trasero que forma angulos sustancialmente rectos con cada una de las patas.
La segunda mordaza es generalmente alargada y movil a lo largo de una pluralidad de posiciones entre una posicion abierta y una posicion cerrada. Un miembro de yunque esta dispuesto en la segunda mordaza e incluye una segunda superficie de contacto con el tejido. La segunda superficie de contacto con el tejido incluye una pluralidad de cavidades de grapas en donde el numero y disposicion de las cavidades de grapas corresponde al numero y disposicion de ranuras de retencion en el cartucho de grapas. La segunda superficie de contacto con el tejido esta orientada de manera que esta en yuxtaposicion con la primera superficie de contacto con el tejido y define un hueco de tejido entre las mismas.
Cada cavidad de grapas incluye un par de surcos de formacion de grapas para capturar las patas de cada grapa. Los surcos de formacion de grapas son sustancialmente simetricos alrededor de un punto intermedio y tienen superficies inclinadas opuestas. Una superficie de canalizacion sustancialmente lemniscata esta formada alrededor de un perlmetro de cada cavidad de grapa. Cada surco de formacion de grapa empuja una pata de cada grapa hacia la otra pata al tiempo que mantiene la separation lateral de las patas durante y despues de la formacion de la grapa.
El mecanismo de operation de mordaza esta dispuesto en un alojamiento que esta unido a una parte proximal del conjunto de cierre de grapas. El mecanismo de operacion de mordaza incluye una leva montada giratoriamente al alojamiento, un cable, y un muelle que estan acoplados cooperativamente unos a otros. Un mecanismo de aproximacion en el instrumento quirurgico esta acoplado operativamente al mecanismo de operacion de mordaza para causar un movimiento proximal del muelle. El movimiento proximal del muelle se acopla a la leva a traves del cable. En una realization, la leva tiene una superficie exterior excentrica para mantener el contacto entre al menos una parte de la superficie exterior de la leva y una superficie exterior de la segunda mordaza. La leva puede incluir un conjunto anti marcha atras (es decir, de bloqueo automatico) para permitir una rotation en sentido contrario a las agujas del reloj de la leva al tiempo que inhibe la rotacion en sentido de las agujas del reloj de la leva. Configurada asl, la rotacion en sentido contrario a las agujas del reloj de la leva excentrica empuja continuamente la segunda mordaza hacia la primera mordaza durante un movimiento proximal del muelle. Las dimensiones de la leva y del cable, asl como las dimensiones y el material seleccionados para el muelle, contribuyen a las caracterlsticas de captura del tejido del mecanismo de operacion de mordaza. Es deseable para las mordazas que capturen y sostengan el tejido en posicion al tiempo que minimicen el trauma al tejido. Ventajosamente, la combination de la leva, el cable, y el muelle permite el ajuste automatico del hueco del tejido para acomodar diferentes espesores de tejido durante las operaciones de grapado.
Breve descripcion de los dibujos
Las realizaciones del instrumento quirurgico descrito inmediatamente se describen en la presente memoria con referencia a los dibujos, en donde:
la FIG. 1 es una vista lateral en section transversal de un conjunto de cierre de grapas segun una realizacion de la presente descripcion en una posicion abierta;
la FIG. 2 es una vista lateral en seccion transversal del conjunto de cierre de grapas de la FIG. 1 en una posicion intermedia;
la FIG. 3 es una vista lateral en seccion transversal del conjunto de cierre de grapas de la FIG. 1 en una posicion cerrada;
la FIG. 4 es una vista superior en planta de un cargador de grapas del conjunto de cierre de grapas de la FIG. 1;
la FIG. 5 es una vista en perspectiva de despiece de un conjunto de empuje de grapas que muestra la relation entre los diversos componentes;
la FIG. 6 es una vista inferior en planta de un miembro de yunque; la FIG. 6A es una vista superior en planta de una cavidad de grapa; la FIG. 7A es una vista lateral de una grapa sin forma;
la FIG. 7B es una vista lateral de la grapa de la FIG. 7A formada para una primera configuration presente descripcion;
la FIG. 7C es una vista lateral de la grapa de la FIG. 7A formada para una segunda configuracion presente descripcion;
la FIG. 7D es una vista lateral de la grapa de la FIG. 7A formada para una tercera configuracion presente descripcion;
segun la segun la segun la
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la FIG. 7E es una vista lateral de la grapa de la FIG. 7A formada para una cuarta configuracion segun la presente descri pcion;
la FIG. 7F es una vista en planta de la grapa de la FIG. 7B que muestra un solapamiento entre la primera y la segunda patas de la grapa;
la FIG. 8A es una vista lateral ampliada de una cavidad de grapa, una grapa no formada, un patln de arrastre de grapas y un patln de arrastre de varilla;
la FIG. 8B es una vista lateral ampliada de los componentes de la FIG. 8A que muestra la grapa formada en una primera configuracion; y
la FIG. 8C es una vista lateral ampliada de los componentes de la FIG. 8B que muestra un tramo trasero de la grapa que se hunde mediante la varilla de hendidura.
Descripcion detallada de las realizaciones preferidas
Las realizaciones del instrumento quirurgico descrito inmediatamente se describiran ahora en detalle con referencia a los dibujos, en los que numeros de referencia iguales designan elementos identicos o correspondientes en cada una de las diversas vistas. Como se usa en la presente memoria, el termino “distal” se refiere a aquella parte del instrumento, o componente del mismo que esta mas lejos del usuario mientras que el termino “proximal” se refiere a aquella parte del instrumento o componente del mismo que esta mas cercana al usuario.
Un ejemplo de un aparato de grapado quirurgico se describe en la Patente de EE.UU. N° 5.480.089 de Blewett, de propiedad actual de y asignada a United States Surgical, una division de Tyco Healthcare. Con referencia a la FIG. 1, un conjunto de cierre de grapas, mostrado de manera general como 100, incluye una primera mordaza 104 fija, una segunda mordaza 140 movil, y un mecanismo de operacion de mordaza 160. En una realizacion, el conjunto de cierre de grapas 100 esta adaptado para su uso en conexion con instrumentos de grapado endoscopico o laparoscopico que son conocidos en la tecnica.
La primera mordaza 104 incluye un cargador de grapas 120 que tiene una primera superficie de contacto con el tejido 122. Una pluralidad de ranuras de retencion 124 esta incluida en el cargador de grapas 120, donde estan dispuestas en filas 126 sobre la primera superficie de contacto con el tejido 122 (vease la FIG. 4). Cada fila 126 se extiende generalmente a lo largo de un eje longitudinal de la primera mordaza 104. La primera superficie de contacto con el tejido 122 es generalmente alargada. Cada ranura de retencion 124 esta configurada para recibir una grapa 110 y un conjunto expulsor de grapas. El conjunto expulsor de grapas incluye un expulsor de grapas 132, una varilla de hendidura 138 (vease la FIG. 5), un patln de arrastre de grapas 134 y un patln de arrastre de varilla 136. Se contempla que el cargador de grapas 120 pueda estar unido de forma extralble a la primera mordaza 104. En una configuracion donde el cargador de grapas 120 es una estructura extralble, una vez que se ha gastado su complemento de grapas 110, se puede extraer y un nuevo cargador de grapas 120 se une a la primera mordaza 104. Cada cargador de grapas 120 incluye un complemento completo de grapas 110 y al menos un conjunto de empuje de grapas 130 (mostrado en la Figura 5 y tratado en detalle mas adelante).
El cargador de grapas 120 incluye una pluralidad de canales longitudinales 128 (veanse las FIG. 3 y 4) que estan adaptados para recibir de manera deslizante el patln de arrastre de grapas 134 y el patln de arrastre de varilla 136. El numero de canales 128 corresponde al numero de filas 126 de grapas 110 incluidas en el cargador de grapas 120. En una realizacion, el cargador de grapas 120 incluye al menos dos filas 126 de grapas 110, aunque el procedimiento que se realiza, las caracterlsticas del tejido a ser sujetado, y otras consideraciones son factores en la determinacion del numero de filas 126, as! como el numero de grapas 110, incluido en cada cargador de grapas 120. Cada fila 126 en la pluralidad de filas tiene una cantidad identica de grapas 110.
Con referencia ahora a las FIG. 5 y 8A-8C, conjuntamente con las FIG. 1-3, se muestra el conjunto de empuje de grapas 130 e incluye un expulsor de grapas 132, un patln de arrastre de grapas 134, un patln de arrastre de varilla 136, y una varilla de hendidura 138. Cada patln de arrastre de grapas 134 esta acoplado operativamente a un mecanismo de empuje (no mostrado) del instrumento de grapado quirurgico usando estructuras que son conocidas en la tecnica. Un ejemplo de tal instrumento que incluye un mecanismo de empuje y un mecanismo de actuacion se describe en la Patente de EE.UU. N° 6.669.073 de Milliman et al., de propiedad actual de y asignada a United States Surgical, una division de Tyco Healthcare. En las realizaciones que incluyen una pluralidad de filas 126, los patines de arrastre de grapas 134 estan acoplados operativamente al mecanismo de empuje de tal manera que su recorrido longitudinal se sincroniza para expulsar una columna 127 de grapas 110 (vease la FIG. 4) sustancialmente simultaneamente durante una secuencia de actuacion. La operacion del mecanismo de empuje provoca el movimiento proximal y distal de las levas respectivas en respuesta a la actuacion del mecanismo de actuacion.
El patln de arrastre de grapas 134 es una estructura generalmente alargada que tiene un par de superficies inclinadas 135a, 135b orientadas hacia el extremo distal del cargador de grapas 120. Las superficies inclinadas 135a, 135b estan separadas lateralmente para definir un paso 135c entre las mismas. El paso 135c es sustancialmente plano y esta dimensionado para recibir de manera deslizante el patln de arrastre de varilla 136. El patln de arrastre de varilla 136 es una estructura generalmente inclinada que tiene una inclinacion sustancialmente
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similar a la del patln de arrastre de grapas 134. Mas aun, el expulsor de grapas 132 incluye un par de patas 132a, 132b que estan separadas lateralmente y anguladas en sus extremos distales para acoplarse facilmente con las superficies inclinadas 135a, 135b. Un agujero pasante 132c esta dispuesto centralmente en el cuerpo 132d del expulsor de grapas 132 y esta dimensionado para recibir de manera deslizante la varilla de hendidura 138.
Tras la actuation del mecanismo de actuation, el patln de arrastre de grapas 134 se empuja a traves del cargador de grapas 120 en una direction generalmente distal mediante el mecanismo de empuje. A medida que se traslada a traves del cargador de grapas 120, el patln de arrastre de grapas 134 se acopla secuencialmente con cada expulsor de grapas 132. El patln de arrastre de grapas 134 y el expulsor de grapas 132 tienen superficies de acoplamiento con angulos complementarios de manera que el movimiento horizontal distal del patln de arrastre de grapas 134 provoca un movimiento vertical del expulsor de grapas 132 que, a su vez, mueve la grapa 110 en una direccion generalmente vertical hacia el miembro de yunque 142. Durante el movimiento distal del patln de arrastre de grapas 134, el patln de arrastre de varilla 136 permanece estacionario en una region proximal del cargador. En los casos donde es deseable una altura de grapa de menos de alrededor de 2,5 mm, como se determina por el hueco de tejido 102, el mecanismo de actuacion acciona el mecanismo de empuje y empuja distalmente el patln de arrastre de varilla 136 como se describira en detalle en lo sucesivo.
Con referencia a las FIG. 2 y 3, se dispone un sensor de hueco 106 en una parte proximal del conjunto de cierre de grapas 100. El sensor de hueco 106 es una estructura generalmente alargada que tiene un agujero pasante 109 dispuesto cerca de un extremo. Mas aun, el sensor de hueco 106 se une fijamente a la segunda mordaza 140 y se recibe de manera deslizable en una abertura 105. Una ventana de hendidura 103 esta dispuesta cerca de una parte proximal de la primera mordaza 104 y esta configurada para recibir de manera deslizante un accionador de varilla de hendidura 107. El accionador de varilla de hendidura 107 esta acoplado operativamente al mecanismo de actuacion y se acopla a la leva de hendidura de grapa 136 cuando la ventana de hendidura 103 esta alineada con el accionador de varilla de hendidura 107. El sensor de hueco 106 esta configurado y dimensionado de manera que la ventana de hendidura 103 este alineada con el accionador de varilla de hendidura 107 solamente cuando el hueco de tejido 102 indica que se desea una altura de grapa de menos de alrededor de 2,5 mm.
En una realization que tiene una altura de grapa de menos de alrededor de 2,5 mm, el patln de arrastre de grapas 134 conduce el patln de arrastre de varilla 136 (FIG. 5) durante su recorrido a traves del cargador de grapas 120. A medida que el patln de arrastre de grapas 134 se traslada distalmente a traves del cargador de grapas 120, el patln de arrastre de varilla 136 le sigue despues de un retardo de tiempo predeterminado. El patln de arrastre de varilla 136 se gula a lo largo de su camino por el paso 135c del patln de arrastre de grapas 134. Por lo tanto, el patln de arrastre de grapas 134 expulsa una grapa 110 y la empuja contra el miembro de yunque 142 para formar una grapa que tiene una altura de alrededor de 2,5 mm como se ha tratado anteriormente. Una vez que la grapa 110 ha sido empujada dentro de la cavidad de grapas 150, y antes de que el patln de arrastre de grapas 134 pase el expulsor de grapas 132 (es decir, el retardo entre los patines de arrastre), el patln de arrastre 136 se acopla a la varilla de hendidura 138. A medida que el patln de arrastre de varilla 136 se traslada distalmente con el patln de arrastre de grapas 134, entra en contacto con la varilla de hendidura 138 causando un movimiento vertical de la misma para acoplarse con el tramo trasero 116. El patln de arrastre de varilla 136 empuja la varilla de hendidura 138 de manera que forma una depresion en el centro del tramo trasero 116 y aumentando ademas la resistencia de sujecion de la grapa 110 formada.
Como se muestra en la FIG. 4, el cargador de grapas 120 puede tener una pluralidad de filas 126 donde las ranuras de retention 124 en cada fila 126 pueden estar desplazadas longitudinalmente de las ranuras de retention 124 en una fila adyacente 126. Dado que las ranuras de retencion 124 estan desplazadas longitudinalmente, las levas de engaste de grapas 134 estan dispuestas operativamente y sincronizadas para expulsar la primera grapa 110 de cada fila 126 y avanzar secuencialmente hacia un extremo distal del cargador de grapas 120 y expulsar secuencialmente las grapas 110 de cada fila 126.
Como se muestra en las FIG. 1-3, la segunda mordaza 140 esta separada de la primera mordaza 104 definiendo un hueco de tejido 102 entre las mismas. La segunda mordaza 140 es movil a traves de una pluralidad de posiciones entre una position abierta y una position cerrada. En una realizacion, la primera mordaza 104 y la segunda mordaza 140 son sustancialmente paralelas una de otra a lo largo de la pluralidad de posiciones. Durante la operation, tratada en detalle a continuation, del conjunto de cierre de grapas 100, la segunda mordaza 140 se mueve hacia la primera mordaza 104 mediante el mecanismo de operacion de la mordaza 160 que mantiene una relation sustancialmente paralela entre las mordazas 104 y 140.
Con referencia a la FIG. 1, el mecanismo de operacion de mordaza 160 esta dispuesto en un alojamiento 170 e incluye una leva 162, un cable 164, y un muelle 166. La leva 162, el cable 164 y el muelle 166 estan conectados operativamente unos con otros. Una parte proximal de la segunda mordaza 140 esta dispuesta dentro del alojamiento 170 y asegurada al mismo. En particular, el muelle 166 esta acoplado operativamente a un mecanismo de aproximacion (no mostrado) del instrumento de grapado mediante estructuras que son conocidas en la tecnica. El mecanismo de aproximacion hace al muelle 166 moverse proximalmente. Dado que el cable 164 esta conectado operativamente al muelle 166, este movimiento proximal del muelle 166 provoca el movimiento proximal del cable 164 y la rotation en sentido contrario a las agujas del reloj de la leva 162.
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Al menos una parte de la leva 162 esta en contacto con una superficie exterior 146 de la segunda mordaza 140 y se bloquea automaticamente en la direction de rotation en sentido contrario a las agujas del reloj. La leva 162 tiene un orificio 163 dispuesto centralmente para unirse de forma giratoria al alojamiento 170. Aunque el orificio 163 es sustancialmente circular, la leva 162 tiene una forma generalmente excentrica, particularmente a lo largo de una superficie exterior, de manera que la rotacion en sentido contrario a las agujas del reloj de la leva 162 hace al menos a una parte de la leva 162 mantener el contacto con la superficie exterior 146 empujando por ello la segunda mordaza 140 hacia la primera mordaza 104 durante la rotacion en sentido contrario a las agujas del reloj. Despues de que la leva 162 haya girado una cantidad deseada, se bloquea en position de manera que no es posible una rotacion en el sentido de las agujas del reloj (es decir, bloqueo automatico), pero es posible una rotacion adicional en sentido contrario a las agujas del reloj. Un mecanismo de liberation, como es conocido en la tecnica, acopla operativamente el mecanismo de operation de mordaza 160 al instrumento de grapado quirurgico. Despues de una secuencia de actuation completa, el mecanismo de liberacion se acciona para desbloquear la leva 162 y permitir la rotacion en el sentido de las agujas del reloj de la leva 162. Asl, la segunda mordaza 140 se empuja lejos de la primera mordaza 104 mediante un mecanismo de desviacion como se conoce en la tecnica para separar las mordazas y permitir la extraction del instrumento de grapado quirurgico.
En una realization, la leva 162, el cable 164, y el muelle 166 se seleccionan de manera que el tejido T se capture y se mantenga entre las mordazas 104, 140 usando una cantidad minima de presion aplicada. La combination ventajosa de la leva 162, el cable 164, y el muelle 166 captura diferentes espesores de tejido T (es decir, cada espesor de tejido corresponde a un hueco de tejido 102 particular) mientras que se minimiza el trauma del tejido T a medida que las mordazas 104, 140 capturan el tejido T entre las mismas.
Con referencia ahora a la FIG. 6, se ilustra un miembro de yunque 142. El miembro de yunque 142 es generalmente alargado e incluye una pluralidad de cavidades de grapas 150 (vease la FIG. 6A) dispuestas sobre una segunda superficie de contacto con el tejido 144, donde el numero y la disposition de las cavidades de grapas 150 corresponden al numero y disposicion de las ranuras de retention 124 en la primera superficie de contacto con el tejido 122. Un ejemplo de una cavidad de grapas se describe en la Patente de EE.UU. N° 5.480.089 de Blewett. Con referencia ahora a la FIG. 6A, cada cavidad de grapas 150 tiene un primer surco de formation de patas de grapa 152 y un segundo surco de formacion de patas de grapa 154 para formar las patas 112, 114 respectivas de la grapa 110 (vease la FIG. 7A). Cada surco de formacion de grapas 152, 154 esta dimensionado para acomodar las patas 112, 114, respectivamente.
Los surcos de formacion de patas de grapa 152 y 154 son simetricos alrededor de un punto intermedio 156. Tambien esta formada una superficie de canalization substancialmente lemniscata 158 (curva en forma de figura de ocho) en la segunda superficie de contacto con el tejido 144 alrededor de un perlmetro de la cavidad de grapas 150. Cada superficie de canalizacion 158 forma un angulo 0, con respecto a un plano definido por la segunda superficie de contacto con el tejido 144, en donde 0°<0<90°. Cada surco de formacion de grapas 152, 154 tiene una pendiente diferente de la de la superficie de canalizacion 158 adyacente. Mas particularmente, cada surco de formacion de grapas 152, 154 tiene un extremo inclinado 152a, 154a para dirigir una pata de grapa 112, 114 correspondiente hacia un tramo trasero 116 de la grapa 110. Los extremos inclinados 152a, 154a son longitudinalmente opuestos uno al otro.
Durante una secuencia de actuacion, una grapa 110 se expulsa de la ranura de retencion 124 y se dirige hacia el miembro de yunque 142, empujando por ello las patas 112 y 114 a traves del tejido T para entrar en los surcos de formacion de grapas 152, 154, respectivamente. A medida que la grapa 110 entra en contacto con la cavidad de grapas 150, los surcos de formacion de grapas 152, 154 dirigen las patas 112, 114 una hacia la otra al tiempo que mantienen la separation lateral de las patas 112, 114 de modo que se solapan una a otra como se muestra en la FIG. 7F. En particular, con referencia a las FIG. 7B-7D, durante la formacion de la grapa 110, el surco de formacion de grapas 152, en cooperation con la superficie de canalizacion 158, dirige la pata 112 hacia el tramo trasero 116 a lo largo y sustancialmente paralelo a una parte no formada de la pata 114. Del mismo modo, el surco de formacion de grapas 154, en cooperacion con la superficie de canalizacion 158, dirige la pata 114 hacia el tramo trasero 116 a lo largo y sustancialmente en paralelo a una parte no formada de la pata 112. La cantidad de solapamiento paralelo entre la pata 112 y la parte no formada de la pata 114 es una funcion del hueco de tejido 102. Del mismo modo, la cantidad de solapamiento paralelo entre la pata 114 y la parte no formada de la pata 112 es tambien una funcion del hueco de tejido 102 que esta controlado por el espesor del tejido T y la operacion del mecanismo de operacion de mordaza 160.
Asl, un hueco de tejido 102 mayor provoca una altura de la grapa 110 mayor (por ejemplo, alrededor de 4,8 mm como se muestra en la FIG. 7B) mientras que un hueco de tejido 102 menor produce una altura de la grapa 110 menor (por ejemplo, alrededor de 2,5 mm como se muestra en la FIG. 7D). En una realizacion, el mecanismo de actuacion, en cooperacion con el cargador de grapas 120 y el miembro de yunque 142, forma las grapas 110 que tienen una altura de entre alrededor de 4,8 mm (es decir, la posicion abierta de la segunda mordaza 140) y alrededor de 2,5 mm (es decir, la posicion cerrada de la segunda mordaza 140) como se determina por el espesor del tejido T y el hueco de tejido 102. Se ha de entender que las grapas 110 se pueden formar teniendo cualquier altura que este en el intervalo de alrededor de 4,8 mm y alrededor de 2,5 mm como se determina por el espesor de tejido T (se ilustra un ejemplo en la FIG. 7C). En los casos donde el espesor de tejido T indica una necesidad de una altura de la grapa 110 menor (es decir, menos de alrededor de 2,5 mm o la posicion de hendidura como se ve en FIG. 7E), el
mecanismo de actuacion del instrumento de grapado opera un segundo miembro de empuje que esta acoplado operativamente al patln de arrastre de varilla 136, como se ha tratado anteriormente.
Se entendera que se pueden hacer diversas modificaciones a las realizaciones descritas en la presente memoria. Por lo tanto, la descripcion anterior no se deberla interpretar como limitativa, sino meramente como ejemplificaciones 5 de las realizaciones preferidas. Por ejemplo, la estructura de formacion de grapas descrita en la presente memoria se puede adaptar y configurar para su uso en EEA, TA, y grapadoras endoscopicas con efecto similar.

Claims (4)

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    REIVINDICACIONES
    1. Un aparato quirurgico que comprende:
    un alojamiento que incluye un mecanismo de actuacion;
    un miembro tubular alargado que se extiende distalmente del alojamiento;
    un conjunto de cierre de grapas (100) situado en un extremo distal del miembro tubular alargado, el conjunto de cierre de grapas (100) que incluye una primera mordaza (104) y una segunda mordaza (140), la primera mordaza (104) que incluye una pluralidad de cierres y un conjunto de empuje, la segunda mordaza (140) que incluye un yunque (142);
    y un mecanismo de operacion de mordaza (160), el mecanismo de operacion de mordaza (160) acoplado operativamente al mecanismo de actuacion de manera que la actuacion del mecanismo de actuacion mueve una de la primera y segunda mordazas (104, 140) hacia la otra de la primera y segunda mordazas (104, 140), en donde una superficie de contacto con el tejido (122) de la primera mordaza (104) permanece sustancialmente paralela a una superficie de contacto con el tejido (144) de la segunda mordaza (140) a medida que varla una distancia entre las mordazas,
    el mecanismo de operacion de mordaza (160) que esta acoplado operativamente con la segunda mordaza (140), el mecanismo de operacion de mordaza (160) que incluye una leva (162),
    caracterizado por que al menos una parte de la leva (162) esta en contacto con una superficie exterior de la segunda mordaza (140) de manera que la rotacion de la leva (162) empuja la segunda mordaza (140) hacia la primera mordaza, la leva (162) que se bloquea automaticamente despues que la leva (162) haya girado una cantidad deseada, de manera que las mordazas (104, 140) son operables para capturar y mantener el tejido en posicion.
  2. 2. El aparato quirurgico de la reivindicacion 1, en donde el mecanismo de operacion de mordaza (160) incluye ademas un muelle (166) que acopla operativamente la leva (162) y el mecanismo de actuacion.
  3. 3. El aparato quirurgico de la reivindicacion 2, en donde el movimiento del muelle (166) en una primera direccion rota la leva (162) en una primera direccion y empuja la segunda mordaza (140) hacia la primera mordaza (104).
  4. 4. El aparato quirurgico de la reivindicacion 2 o la reivindicacion 3, en donde el miembro de enlace (164) conecta operativamente la leva (162) y el muelle (162).
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EP2139411B1 (en) 2017-05-03
AU2008231109B2 (en) 2013-01-10
US20130233905A1 (en) 2013-09-12
US8403198B2 (en) 2013-03-26
EP2139411A4 (en) 2013-08-14
CA2681186A1 (en) 2008-10-02
JP5683564B2 (ja) 2015-03-11
US20120145768A1 (en) 2012-06-14
AU2008231109A1 (en) 2008-10-02
WO2008118728A1 (en) 2008-10-02
CA2681186C (en) 2015-07-21
US20100006620A1 (en) 2010-01-14
US9597073B2 (en) 2017-03-21
JP2014144365A (ja) 2014-08-14
US20170143338A1 (en) 2017-05-25
EP3195814A1 (en) 2017-07-26
EP2139411A1 (en) 2010-01-06
JP2010522035A (ja) 2010-07-01
US8205780B2 (en) 2012-06-26
JP2013078621A (ja) 2013-05-02
JP5394265B2 (ja) 2014-01-22
JP5685334B2 (ja) 2015-03-18

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