ES2777889T3 - Instrumento quirúrgico con mecanismo de seguridad - Google Patents
Instrumento quirúrgico con mecanismo de seguridad Download PDFInfo
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- ES2777889T3 ES2777889T3 ES10251240T ES10251240T ES2777889T3 ES 2777889 T3 ES2777889 T3 ES 2777889T3 ES 10251240 T ES10251240 T ES 10251240T ES 10251240 T ES10251240 T ES 10251240T ES 2777889 T3 ES2777889 T3 ES 2777889T3
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- 230000007246 mechanism Effects 0.000 title claims abstract description 73
- 238000010304 firing Methods 0.000 claims abstract description 36
- 230000000717 retained effect Effects 0.000 claims description 5
- 238000006073 displacement reaction Methods 0.000 claims description 4
- 238000009964 serging Methods 0.000 claims 1
- 210000000056 organ Anatomy 0.000 description 11
- 230000003872 anastomosis Effects 0.000 description 9
- 208000014617 hemorrhoid Diseases 0.000 description 8
- 230000004913 activation Effects 0.000 description 7
- 238000000034 method Methods 0.000 description 6
- 238000001356 surgical procedure Methods 0.000 description 5
- 210000000664 rectum Anatomy 0.000 description 3
- 239000004744 fabric Substances 0.000 description 2
- 230000003993 interaction Effects 0.000 description 2
- 238000012986 modification Methods 0.000 description 2
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- 238000007789 sealing Methods 0.000 description 2
- 210000000436 anus Anatomy 0.000 description 1
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- 230000036770 blood supply Effects 0.000 description 1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis, e.g. in a single operation
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis, e.g. in a single operation
- A61B17/1155—Circular staplers comprising a plurality of staples
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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
- A61B2017/2946—Locking means
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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
- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0807—Indication means
- A61B2090/0811—Indication means for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument
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Abstract
Un instrumento de grapado quirúrgico (10), que comprende: un conjunto del mango (12) que incluye un mango estacionario (18), un mecanismo de aproximación (22) y un gatillo de disparo (20); un mecanismo de seguridad (200) dispuesto en cooperación mecánica con el conjunto del mango (12) e incluye una palanca (210), la palanca (210) puede moverse entre una primera posición donde se impide que se active el gatillo de disparo (20), y una segunda posición donde puede accionarse el gatillo de disparo (20); una porción de cuerpo alargado (14) que se extiende distalmente desde el conjunto del mango (12); y una porción de cabeza (16) dispuesta adyacente a un extremo distal de la porción de cuerpo alargado (14) e incluye un primer miembro de mordaza (30) y un segundo miembro de mordaza (31), siendo el primer miembro de mordaza (30) móvil en relación con el segundo miembro de la mordaza (31) entre posiciones separadas y aproximadas; en donde el mecanismo de aproximación (22) mueve el primer miembro de mordaza (30) en relación con el segundo miembro de mordaza (31) entre la posición espaciada y la posición aproximada, en donde el mecanismo de seguridad (200) incluye un pestillo (212), el instrumento caracterizado porque el pestillo está dispuesto en la palanca (210) y el mecanismo de seguridad (200) comprende además un retenedor de pestillo (270) dispuesto en el mango estacionario (18), en donde el pestillo (212) y el retenedor de pestillo (270) se configuran para mantener de forma liberable la palanca (210) en la segunda posición en donde el gatillo de disparo (20) puede ser accionado; porque la palanca (210) está desviada hacia su primera posición, y porque ese movimiento del mecanismo de aproximación (200) para mover el primer miembro de mordaza (30) desde la posición aproximada hacia la posición espaciada hace que el retenedor del pestillo (270) suelte el pestillo (212) para que la palanca se mueva de la segunda posición a la primera posición.
Description
DESCRIPCIÓN
Instrumento quirúrgico con mecanismo de seguridad
La presente descripción se refiere en general a un instrumento quirúrgico para aplicar grapas quirúrgicas al tejido corporal. Más particularmente, la presente descripción se refiere a un instrumento de grapado quirúrgico adecuado para realizar anastomosis circular y/o tratamiento en paredes internas de órganos de tejido hueco.
La anastomosis es la unión quirúrgica de secciones separadas de órganos huecos. Típicamente, un procedimiento de anastomosis sigue a una cirugía en la que se extrae una sección enferma o defectuosa de tejido hueco y deben unirse las secciones finales restantes. En dependencia del procedimiento de anastomosis deseado, las secciones finales pueden unirse mediante métodos de reconstrucción de órganos circulares, de extremo a extremo, de extremo a lado o de lado a lado.
En un procedimiento de anastomosis circular, los dos extremos de las secciones de órganos se unen por medio de un instrumento de grapado que impulsa una matriz circular de grapas a través de la sección final de cada sección de órgano y al mismo tiempo descorazona cualquier interior de tejido de la matriz circular impulsada de grapas para liberar el paso tubular. Ejemplos de instrumentos para realizar anastomosis circulares de órganos huecos se describen en las patentes de los Estados Unidos Núm. 7,303,106, 6,053,390, 5,588,579, 5,119,983, 5,005,749, 4,646,745, 4,576,167, y 4,473,077. Típicamente, estos instrumentos incluyen un eje alargado que tiene una porción del mango en un extremo proximal para accionar el instrumento y un componente de sujeción de grapas dispuesto en un extremo distal. Un conjunto de yunque que incluye una varilla de yunque con cabeza de yunque unida se monta en el extremo distal del instrumento adyacente al componente de sujeción de grapas. Las porciones extremas opuestas de tejido del órgano u órganos huecos a grapar se sujetan entre la cabeza del yunque y el componente de sujeción de grapas. Típicamente, se usa un primer mecanismo de actuación para aproximar la cabeza del yunque y el componente de sujeción de grapas para sujetar el tejido. El tejido sujeto se grapa al extraer una o más grapas del componente de sujeción de grapas, de modo que los extremos de las grapas pasan a través del tejido y se deforman por la cabeza del yunque. Típicamente, se usa un segundo mecanismo de accionamiento para disparar las grapas. También es común que un cuchillo anular se haga avanzar simultáneamente al tejido central dentro del órgano hueco para liberar un paso tubular dentro del órgano.
Además de la anastomosis de los órganos huecos, se han usado instrumentos de grapado quirúrgico para realizar anastomosis circular para tratar las hemorroides internas en el recto. Típicamente, durante el uso de un instrumento de grapado circular para el tratamiento de hemorroides, la cabeza del yunque y el componente de sujeción de grapas del instrumento de grapado quirúrgico se insertan a través del ano y dentro del recto con la cabeza de yunque y el componente de sujeción de grapas en una posición abierta o no aproximada. A partir de entonces, se usa una sutura de cordón para tirar del tejido hemorroidal interno hacia la barra del yunque. A continuación, la cabeza del yunque y el componente de sujeción de grapas se aproximan para sujetar el tejido de hemorroides entre la cabeza del yunque y el componente de sujeción de grapas. El instrumento de grapado se dispara para eliminar el tejido hemorroidal y engrapar el tejido cortado. En otros usos para la cirugía de hemorroides, el instrumento de grapado se usa para eliminar el tejido justo por encima de las hemorroides con el fin de extraer las hemorroides dentro del recto y reducir los síntomas. Las grapas interrumpen el flujo sanguíneo de las ramas arteriales hemorroidales superiores, cortando el suministro de sangre al tejido, haciendo que las hemorroides se encojan.
Algunos instrumentos de grapado quirúrgico incluyen un dispositivo de seguridad que evita que las grapas se disparen antes de la aproximación de la cabeza del yunque y el componente de sujeción de grapas. El lector puede iluminarse más por referencia a las publicaciones de la técnica anterior identificadas como EP0539762 A1, WO 2004/032766 A2, GB 2 141 066 y EP2 160 984. El documento WO 2004/032766 describe un dispositivo de grapado quirúrgico para realizar anastomosis circulares que presentan las características definidas en el preámbulo de la reivindicación 1.
Resumen
La presente invención busca aliviar al menos algunos de los problemas técnicos exhibidos por la técnica anterior mediante la provisión de un instrumento de grapado quirúrgico de acuerdo con la reivindicación 1.
La presente descripción se refiere a un instrumento quirúrgico que comprende un conjunto del mango, un mecanismo de seguridad, una porción de cuerpo alargada y una porción de cabeza. El conjunto del mango incluye un mango estacionario, un mecanismo de aproximación y un gatillo de disparo. Una palanca del mecanismo de seguridad puede moverse entre una primera posición donde se impide que se active el gatillo de disparo, y una segunda posición donde puede activarse el gatillo de disparo. Un mecanismo de aproximación mueve el primer miembro de la mordaza en relación con el segundo miembro de la mordaza desde una posición separada a una posición aproximada, en donde el movimiento del primer miembro de la mordaza en relación con el segundo miembro de la mordaza desde la posición aproximada hacia la posición separada hace que la palanca se mueva desde su segunda posición a su primera posición.
En una modalidad, la palanca está inclinada hacia su primera posición. En una modalidad preferida, el mecanismo de seguridad incluye un pestillo dispuesto en la palanca y un retenedor del pestillo dispuesto en el mango estacionario, en donde el pestillo y el retenedor del pestillo se configuran para mantener de forma liberable la palanca en su segunda
posición. El retenedor del pestillo puede estar sesgado proximalmente. En modalidades preferidas, una cantidad predeterminada de movimiento del primer miembro de mordaza desde la posición aproximada hacia su posición separada provoca un movimiento distal del retenedor del pestillo para liberar el pestillo.
En algunas modalidades, el mecanismo de seguridad incluye una placa dispuesta en cooperación mecánica con el mango estacionario, y la placa está sesgada distalmente. Un labio de la placa impide preferiblemente el movimiento de la palanca hacia su segunda posición.
La palanca está configurada preferiblemente para enganchar mecánicamente el gatillo de disparo cuando la palanca está en su primera posición, el gatillo de disparo dispara una pluralidad de sujetadores desde la primera mordaza en contacto con la segunda mordaza.
La presente descripción proporciona en otro aspecto un instrumento quirúrgico que comprende un conjunto del mango que incluye un mango estacionario, un mecanismo de aproximación y un gatillo de disparo para disparar una pluralidad de sujetadores. Un mecanismo de seguridad está dispuesto en cooperación mecánica con el conjunto del mango y puede moverse entre una primera posición para evitar el disparo de los sujetadores y una segunda posición para permitir el disparo de los sujetadores. El mecanismo de seguridad se retiene en la segunda posición. Una porción de cuerpo alargada se extiende distalmente desde el conjunto del mango. Una porción de cabeza está dispuesta adyacente a un extremo distal de la porción de cuerpo alargado e incluye un primer miembro de mordaza y un segundo miembro de mordaza, siendo el primer miembro de mordaza móvil en relación con el segundo miembro de mordaza entre posiciones separadas y aproximadas. Un mecanismo de aproximación mueve el primer miembro de la mordaza en relación con el segundo miembro de la mordaza desde una posición espaciada a una posición aproximada, en donde el movimiento del primer miembro de la mordaza en relación con el segundo miembro de la mordaza desde la posición aproximada hacia la posición separada antes del disparo de los sujetadores hacen que el mecanismo de seguridad se libere para moverse de su segunda posición a su primera posición.
En algunas modalidades, la pluralidad de sujetadores se retiene en la segunda mordaza.
En modalidades preferidas, el mecanismo de seguridad incluye una palanca retenida por un retenedor de pestillo en la segunda posición. Preferiblemente, una cantidad predeterminada de movimiento del primer miembro de mordaza desde la posición aproximada hacia la posición separada provoca un movimiento distal del retenedor del pestillo para liberar el pestillo.
En algunas modalidades, el mecanismo de seguridad incluye una placa dispuesta en cooperación mecánica con el mango estacionario, la placa se desvía distalmente y se mueve por el movimiento del mecanismo de aproximación. El borde de la placa en algunas modalidades evita el movimiento de la palanca hacia su segunda posición.
Descripción de los dibujos
En la presente descripción se describen diversas modalidades del instrumento de grapado quirúrgico actualmente descrito con referencia a los dibujos, en donde:
La Figura 1 es una vista en perspectiva del instrumento de grapado quirúrgico actualmente descrito que se ilustra en una posición no aproximada, de acuerdo con una modalidad de la presente descripción;
La Figura 2 es una vista en perspectiva del instrumento de grapado quirúrgico de la Figura 1 ilustrado en una posición aproximada;
La Figura 3 es una vista lateral del instrumento de grapado quirúrgico de las Figuras 1 y 2 que se ilustra en una posición disparada; la Figura 4 es una vista en sección transversal longitudinal de una porción del instrumento de grapado quirúrgico en la posición no aproximada y una primera porción de un mecanismo de seguridad en una primera posición; La Figura 5 es una vista en sección transversal longitudinal de una porción del instrumento de grapado quirúrgico en la posición no aproximada y una segunda porción del mecanismo de seguridad en una primera posición;
La Figura 6 es una vista en sección transversal longitudinal de una porción del instrumento de grapado quirúrgico en la posición no aproximada y la primera porción y la segunda porción del mecanismo de seguridad en la primera posición; La Figura 7 es una vista en sección transversal longitudinal de una porción del instrumento de grapado quirúrgico en la posición aproximada y la primera porción del mecanismo de seguridad en una segunda posición;
La Figura 8 es vista en sección transversal longitudinal de una porción del instrumento de grapado quirúrgico en la posición aproximada y la segunda porción del mecanismo de seguridad en una segunda posición;
La Figura 9 es una vista en sección transversal longitudinal de una porción del instrumento de grapado quirúrgico en la posición aproximada y la primera porción y la segunda porción del mecanismo de seguridad en la segunda posición; La Figura 9A es una vista ampliada de una porción del instrumento de grapado quirúrgico de la Figura 9; y
La Figura 10 es una vista en perspectiva de una placa de seguridad y un retenedor de pestillo de la segunda porción del mecanismo de seguridad como se ilustra en las Figuras 5, 6, 8, 9 y 9A.
Descripción detallada
A continuación se describirán en detalle las modalidades del instrumento de grapado quirúrgico actualmente descrito con referencia a los dibujos, en los cuales los números de referencia semejantes designan elementos idénticos o
correspondientes en cada una de las diversas vistas.
A lo largo de esta descripción, el término "proximal" se referirá a la porción del instrumento más cercana al operador y el término "distal" se referirá a la porción del instrumento más alejada del operador.
Las Figuras 1-3 ilustran una modalidad del instrumento de grapado quirúrgico actualmente descrito y generalmente se denomina número de referencia 10. Brevemente, el instrumento de grapado quirúrgico 10 incluye un conjunto del mango 12, una porción de cuerpo alargada 14 que incluye un tubo exterior alargado curvado 14a y una porción de cabeza 16. Alternativamente, en algunos procedimientos quirúrgicos, por ejemplo, el tratamiento de hemorroides, es deseable tener una porción de cuerpo sustancialmente recta. Se contempla en la presente descripción que la longitud, la forma y/o el diámetro de la porción del cuerpo 14 y la porción de cabeza 16 también pueden variarse para adaptarse a un procedimiento quirúrgico particular.
Con referencia continua a las Figuras 1-3, el conjunto del mango 12 incluye un mango estacionario 18, un gatillo de disparo 20 y un mecanismo de aproximación giratorio 22. La porción de cabeza 16 incluye un primer miembro de mordaza (por ejemplo, un conjunto de yunque 30) y un segundo miembro de mordaza (por ejemplo, un conjunto de carcasa 31). El conjunto de yunque 30 es móvil en relación con el conjunto de carcasa 31 entre las posiciones separadas y aproximadas.
Con referencia continua a las Figuras 1-3, en funcionamiento, la rotación del mecanismo de aproximación 22 provoca el movimiento del conjunto de yunque 30 en relación con el conjunto de carcasa 31 entre las posiciones espaciadas (Figura 1) y aproximadas (Figuras 2 y 3), ya que el mecanismo de aproximación 22 se acopla mecánicamente con el retenedor de yunque 38 (Figura 1), que está sujeto al conjunto de yunque 30. Se prevé que la rotación del mecanismo de aproximación 22 en una primera dirección (por ejemplo, en el sentido de las agujas del reloj) provoca el movimiento proximal del conjunto de yunque 30 (es decir, hacia su posición aproximada), y la rotación del mecanismo de aproximación 22 en una segunda dirección opuesta (por ejemplo, en el sentido de las agujas del reloj) provoca un movimiento distal del conjunto de yunque 30 (es decir, hacia su posición separada). Los detalles de la aproximación se describen, por ejemplo, en la Patente de Estados Unidos Núm. 7,303,106.
La activación del gatillo de disparo 20 (es decir, girando en la dirección de la flecha "A" en la Figura 1) hace que se expulsen grapas desde el conjunto de carcasa 31 hacia el conjunto de yunque 30. Es decir, el gatillo de disparo 20 está dispuesto en cooperación mecánica con un empujador (no se muestra explícitamente en las modalidades ilustradas), de modo que la activación del gatillo de disparo 20 provoca el avance del empujador en contacto con las grapas, el cual expulsa las grapas en los bolsillos de deformación de grapas del conjunto de yunque 30. Los detalles del disparo se describen, por ejemplo, en la Patente de Estados Unidos Núm. 7,303,106.
Con referencia ahora a las Figuras 4-9, el mecanismo de aproximación 22 se acopla mecánicamente con un tope de tornillo 40 y el tope de tornillo 40 está en cooperación mecánica con el conjunto de yunque 30 (no mostrado). Aquí, la rotación del mecanismo de aproximación 22 en una primera dirección hace que el tope de tornillo 40 se mueva proximalmente, lo que a su vez provoca el movimiento proximal del conjunto de yunque 30. Cuando el tope de tornillo 40 se mueve proximalmente, una porción 42 del mismo (véase la Figura 9A) impulsa una porción (es decir, una placa 250) del mecanismo de seguridad 200 proximalmente contra la inclinación de un resorte de placa 260, como se discute con más detalle a continuación. Como resultado, una palanca 210 pivotea en la dirección de la flecha "C" en la Figura 6 para permitir el disparo del instrumento de grapado quirúrgico 10. Es decir, cuando la palanca 210 está en su primera posición de bloqueo (Figuras 4-6), se impide la activación del gatillo de disparo 20.
Más particularmente, y con referencia continua a las Figuras 4-9, el mecanismo de seguridad 200 (que se divide en una primera porción 200a (Figuras 4 y 7) y una segunda porción 200b (Figuras 5 y 8), que se discuten en más detalle a continuación, está dispuesto en cooperación mecánica con el conjunto del mango 12 y mantiene el gatillo de disparo 20 en una posición abierta (Figuras 4-6) hasta que se hayan aproximado el conjunto de yunque 30 y el conjunto de carcasa 31. El mecanismo de seguridad 200 también se configura para evitar la activación del gatillo de disparo 20 cuando el conjunto de yunque 30 se mueve con respecto al conjunto de carcasa 31 desde su posición aproximada hacia su posición separada. Es decir, si el conjunto de yunque 30 y el conjunto de carcasa 31 están en su posición aproximada (por ejemplo, el tejido de sujeción) y luego se mueven hacia su posición espaciada (por ejemplo, el tejido de liberación), el mecanismo de seguridad 200 impide la activación del gatillo de disparo 20 hasta que el conjunto de yunque 30 y el conjunto de carcasa 31 vuelvan a su posición aproximada. Por lo tanto, como puede apreciarse, el mecanismo de seguridad 200 ayuda a impedir que las grapas se disparen prematuramente.
Varios componentes del mecanismo de seguridad 200 se muestran en las Figuras 4-9, con varios componentes omitidos en algunas figuras para mayor claridad. Las Figuras 4-6 ilustran el mecanismo de seguridad 200 en su primera posición de bloqueo. Las Figuras 7-9 ilustran el mecanismo de seguridad 200 en su segunda posición desbloqueada. Para facilitar la claridad de visualización, como se indicó anteriormente, el mecanismo de seguridad 200 se ha desglosado en una primera porción 200a (mostrada individualmente en las Figuras 4 y 7) y una segunda porción 200b (mostrada individualmente en las Figuras 5 y 8). Tanto la primera porción 200a como la segunda porción 200b del mecanismo de seguridad 200 se muestran en las Figuras 6 y 9.
Con referencia inicial a las Figuras 4 y 7, la primera porción 200a del mecanismo de seguridad 200 incluye la palanca 210
que tiene un pestillo 212 y un resorte de seguridad 230. La palanca 210 está dispuesta de manera pivotante con respecto al mango estacionario 18. El pestillo 212, que se muestra formado integralmente con la palanca 210, incluye un diente 214 que tiene una superficie en ángulo 216 sobre el mismo. Se define una distancia "d" entre el diente 214 y una superficie 216 de la palanca 210 (véase la Figura 4).
Una porción distal 222 del resorte de seguridad 230 se configura para enganchar mecánicamente (por ejemplo, enganchar de manera pivotante) una abertura 218 de la palanca 210. Una porción proximal 224 del resorte de seguridad 230 engancha (por ejemplo, está fijada a) una porción del mango estacionario 18. El resorte de seguridad 230 se configura para inclinar la palanca 210 en la dirección sustancial de la flecha "B" en la Figura 4.
La segunda porción 200b del mecanismo de seguridad 200 se ilustra en las Figuras 5 y 8. La segunda porción 200b incluye la placa 250 (una vista ampliada de la cual se muestra en la Figura 10), el resorte de placa 260, un retenedor de pestillo 270 y un resorte de retención 280. La placa 250 está dispuesta dentro del mango estacionario 18 y, como se discutió anteriormente, la placa 250 se configura para engancharse por una porción del tope de tornillo 40. Más específicamente, cuando el tope de tornillo 40 se mueve proximalmente, el tope de tornillo 40 contacta con una porción distal 252 de la placa 250 (véanse las Figuras 9A y 10), creando así una fuerza proximal contra la placa 250. El resorte de placa 260, que también está dispuesto dentro del mango estacionario 18, está en cooperación mecánica con una porción proximal 254 de la placa 250 y se configura para inclinar distalmente la placa 250 contra la fuerza proximal ejercida sobre ella por el tope de tornillo 40. Un nervio 44 está dispuesto dentro del mango estacionario 18 y se configura y posiciona para limitar el desplazamiento distal de la placa 250 (véanse las Figuras 5, 8 y 9A). Más específicamente, al menos una de las pestañas 253 (véase la Figura 10) de la placa 250 se configura para enganchar el nervio 44.
Con referencia continua a la segunda porción 200b del mecanismo de seguridad 200 en las Figuras 5 y 8, se ilustran el retenedor de pestillo 270 y el resorte de retención 280. El retenedor de pestillo 270 está dispuesto en cooperación mecánica con la placa 250 y se acopla de manera deslizante con el mismo. El retenedor del pestillo tiene varios retenes para enganchar la abertura de pared adyacente 258 en la placa 250. El resorte de retención 280 está dispuesto con el mango estacionario 18 y se configura para inclinar el retenedor de pestillo 270 proximalmente con respecto a la placa 250. Se prevé que una porción distal 282 del resorte de retención 280 se enganche mecánicamente con una porción 256 de la placa 250 (véase la Figura 10). Como se analiza en detalle a continuación, la interacción entre el retenedor de pestillo 270, el resorte de retención 280 y la placa 250 está configurada para permitir el acoplamiento liberable entre el pestillo 212 y el retenedor de pestillo 270. Una porción proximal 284 del resorte de retención 280 engancha mecánicamente una porción del retenedor de pestillo 270.
En uso, y con referencia a las Figuras 6, 9 y 10, un labio distal 257 de la placa 250 contacta una superficie de bloqueo 220 de la palanca 210 (Figura 5), evitando así la rotación (es decir, en la dirección sustancial de la flecha "C" en la Figura 6 de la palanca 210 hasta la placa 250 se mueve proximalmente una distancia suficiente de manera que el labio distal 257 pasa proximalmente la superficie de bloqueo 220 de la palanca 210. Se prevé que la rotación de la perilla de aproximación 22 sea tal que el conjunto de yunque 30 y el conjunto de carcasa. 31 son aproximados, lo que hace que el tope de tornillo 40 se traslade proximalmente a una distancia suficiente, de modo que la porción de la pestaña 42 hace que el labio distal 257 pase proximalmente a la superficie de bloqueo 220 (contra la inclinación del resorte de placa 260). Es decir, una vez que el conjunto de yunque 30 y el conjunto de carcasa 31 se aproximan (por ejemplo, sujetando el tejido entre ellos), la palanca 210 puede girar libremente (por ejemplo, manualmente) desde su primera posición de bloqueo (Figuras 4-6) a su segunda posición de habilitación (Figuras 7-9) en la dirección sustancial de la flecha "C" (contra la inclinación del resorte de seguridad 230), permitiendo así el accionamiento del gatillo de disparo 20.
Con respecto a la Figura 9A, se muestra una vista ampliada de la interacción entre el pestillo 212 y el retenedor de pestillo 270. Cuando se gira la palanca 210 desde su primera posición de bloqueo a su segunda posición de habilitación, el pestillo 212 se acopla al retenedor de pestillo 270. Más particularmente, la superficie en ángulo 216 del pestillo 212 está configurada para hacer contacto inicial con el retenedor de pestillo 270. La fuerza ejercida por la rotación de la palanca 210 hace que la superficie en ángulo 216 del pestillo 212 traslade distalmente el retenedor de pestillo 270, con respecto a la placa 250, contra la inclinación del resorte de retención 280. Después de que el retenedor de pestillo 270 se traslada distalmente y el diente 214 del pestillo 212 pase por un miembro de seguridad 272 del retenedor de pestillo 270, el retenedor de pestillo 270 se traslada proximalmente a través de la inclinación del resorte de retención 280, de modo que el miembro de seguridad 272 se empuje hacia la distancia "d" entre el diente 214 y la superficie 216 de la palanca 210. En esta posición, el pestillo 212 se retiene de manera liberable por el retenedor de pestillo 270, y se habilita la activación del gatillo de disparo 20.
Si el conjunto de yunque 30 y el conjunto de carcasa 31 se mueven hacia su posición espaciada (por ejemplo, mediante la rotación de la perilla de aproximación 22 en la segunda dirección), de ese modo posiblemente se libera el tejido, el mecanismo de seguridad 200 se configura de tal manera que la palanca 210 se mueve a su primera posición de bloqueo, evitando así el disparo de grapas. En particular, cuando el conjunto de yunque 30 y el conjunto de carcasa 31 se mueven hacia su posición espaciada, el tope de tornillo 40 se mueve distalmente. Por lo tanto, la porción 42 del tope de tornillo 40 que había estado en contacto con la porción distal 252 de la placa 250 y que impulsaba proximalmente, también se mueve distalmente. En consecuencia, la inclinación distal del resorte de placa 260 no se resiste suficientemente y la placa 250 se traslada distalmente. Tras el desplazamiento distal de la placa 250, el retenedor de pestillo 270 y el resorte de retención 280 también se trasladan distalmente (a un punto de liberación, como se discute a continuación) de modo que el retenedor
de pestillo 270 suelte el pestillo 212. La liberación del pestillo 212, en combinación con la inclinación sostenida por el resorte de seguridad 230, hace que la palanca 210 se mueva hacia su primera posición de bloqueo. Por lo tanto, el mecanismo de seguridad 200 evita la activación del gatillo de disparo 30 después de liberar el tejido (es decir, el conjunto de yunque 30 y el conjunto de carcasa 31 se mueven hacia su posición separada (no aproximada).
Como puede apreciarse, las tolerancias de varios componentes del mecanismo de seguridad 200 ayudan a determinar la cantidad de liberación que es suficiente para devolver la palanca 210 a su primera posición de bloqueo. Por ejemplo, el punto de liberación puede depender de una superposición "O" (Figura 9A) entre el pestillo 212 y el miembro de seguridad 272 del retenedor de pestillo 270. Se prevé que la superposición "O" puede estar aproximadamente entre 0,254 mm y aproximadamente 2,032 mm (0,010 pulgadas y aproximadamente 0,080 pulgadas), por ejemplo, en dependencia del efecto deseado. También se contemplan otras distancias. En tal ejemplo, cuanto más pequeña sea la superposición "O", menor será la cantidad de liberación necesaria para hacer que la palanca 210 regrese a su primera posición de bloqueo y viceversa.
La presente descripción también contempla el uso de un mecanismo indicador 100, como se muestra en las Figuras 4-9. En la primera posición, el indicador 102 proporciona una indicación al cirujano de que el instrumento está en una posición abierta, no aproximada. En la segunda posición, el indicador 102 proporciona una indicación al cirujano de que el instrumento ha sido aproximado y ahora está en una posición lista para disparar. En la tercera posición, el indicador 102 proporciona una indicación al cirujano de que el instrumento ha sido disparado. Detalles adicionales del mecanismo indicador se muestran y describen en la patente de los Estados Unidos 7,303,106.
La presente descripción también se refiere a un método para realizar un procedimiento quirúrgico. El método comprende la etapa de proporcionar un instrumento quirúrgico, como se describió anteriormente, al colocar el instrumento quirúrgico adyacente a un sitio quirúrgico y mover el conjunto de yunque 30 con respecto al conjunto de carcasa 31 desde su posición aproximada hacia su posición separada para mover la porción (por ejemplo, palanca 210) del mecanismo de seguridad 200 desde su segunda posición a su primera posición.
Los detalles adicionales de otras características del instrumento quirúrgico 10, tales como el conjunto de aproximación, el conjunto de disparo y el mecanismo de bloqueo se describen en las Patentes de Estados Unidos de propiedad común Núm. 7,168,604 y 7,303,106,
Se comprenderá que pueden realizarse diversas modificaciones a las modalidades descritas en la presente descripción. Por ejemplo, el mecanismo de seguridad descrito puede usarse con otros tipos de instrumentos quirúrgicos para unir tejidos, tales como, por ejemplo, un instrumento de grapado quirúrgico con miembros de mordaza lineal, instrumentos quirúrgicos con miembros de mordaza curvados e instrumentos de sellado de vasos. Los detalles adicionales de un instrumento de grapado quirúrgico lineal se describen en detalle en la Patente de Estados Unidos de propiedad común Núm. 6953 139 de Milliman y otros. Un ejemplo de un instrumento de sellado de vasos de propiedad común se describe en la Patente de Estados Unidos Núm. 7118570. Por lo tanto, la descripción anterior no debe interpretarse como limitativa, sino meramente como ejemplos de las modalidades descritas. Los expertos en la materia prevén otras modificaciones dentro del alcance de la presente reivindicación.
Claims (15)
1. Un instrumento de grapado quirúrgico (10), que comprende:
un conjunto del mango (12) que incluye un mango estacionario (18), un mecanismo de aproximación (22) y un gatillo de disparo (20);
un mecanismo de seguridad (200) dispuesto en cooperación mecánica con el conjunto del mango (12) e incluye una palanca (210), la palanca (210) puede moverse entre una primera posición donde se impide que se active el gatillo de disparo (20), y una segunda posición donde puede accionarse el gatillo de disparo (20);
una porción de cuerpo alargado (14) que se extiende distalmente desde el conjunto del mango (12); y una porción de cabeza (16) dispuesta adyacente a un extremo distal de la porción de cuerpo alargado (14) e incluye un primer miembro de mordaza (30) y un segundo miembro de mordaza (31), siendo el primer miembro de mordaza (30) móvil en relación con el segundo miembro de la mordaza (31) entre posiciones separadas y aproximadas; en donde el mecanismo de aproximación (22) mueve el primer miembro de mordaza (30) en relación con el segundo miembro de mordaza (31) entre la posición espaciada y la posición aproximada, en donde el mecanismo de seguridad (200) incluye un pestillo (212), el instrumento caracterizado porque el pestillo está dispuesto en la palanca (210) y el mecanismo de seguridad (200) comprende además un retenedor de pestillo (270) dispuesto en el mango estacionario (18), en donde el pestillo (212) y el retenedor de pestillo (270) se configuran para mantener de forma liberable la palanca (210) en la segunda posición en donde el gatillo de disparo (20) puede ser accionado; porque la palanca (210) está desviada hacia su primera posición, y porque ese movimiento del mecanismo de aproximación (200) para mover el primer miembro de mordaza (30) desde la posición aproximada hacia la posición espaciada hace que el retenedor del pestillo (270) suelte el pestillo (212) para que la palanca se mueva de la segunda posición a la primera posición.
2. El instrumento de grapado quirúrgico (10) de la Reivindicación 1, en donde el retenedor del pestillo (270) está desviado proximalmente.
3. El instrumento de grapado quirúrgico (10) de la Reivindicación 1 o la Reivindicación 2, en donde el movimiento del mecanismo de aproximación para provocar una cantidad predeterminada de movimiento del primer miembro de mordaza (30) desde la posición aproximada hacia la posición separada provoca un movimiento distal del retenedor del pestillo (270) para liberar el pestillo (212).
4. El instrumento de grapado quirúrgico (10) de la Reivindicación 1 o la Reivindicación 2, en donde el movimiento del mecanismo de aproximación provoca una cantidad predeterminada de movimiento del primer miembro de mordaza (30) desde la posición aproximada hacia su posición separada provoca que el retenedor del pestillo (270) libere el pestillo (212) cuando el pestillo (212) se mantiene de forma liberable con el mismo, y en donde la liberación del pestillo (212) hace que la palanca (210) se mueva a su primera posición.
5. El instrumento de grapado quirúrgico (10) de cualquiera de las Reivindicaciones 1-4, en el que el mecanismo de seguridad (200) incluye una placa (250) dispuesta en cooperación mecánica con el mango estacionario (18), y en donde la placa (250) está desviada distalmente.
6. El instrumento de grapado quirúrgico (10) de la Reivindicación 5, en donde un labio (257) de la placa (250) impide el movimiento de la palanca (210) hacia su segunda posición.
7. El instrumento de grapado quirúrgico (10) de la Reivindicación 6, en donde la aproximación del primer miembro de mordaza (30) y el segundo miembro de mordaza (31) provoca el desplazamiento proximal de la placa (250) de modo que la palanca (210) puede moverse hacia su segunda posición.
8. El instrumento de grapado quirúrgico (10) de la Reivindicación 7, en donde la aproximación del primer miembro de la mordaza (30) y el segundo miembro de mordaza (31) provoca el desplazamiento proximal de la placa (250) de modo que el labio (257) se mueve proximalmente más allá de un porción de la palanca (210) permitiendo así que la palanca (210) se mueva hacia su segunda posición.
9. El instrumento de grapado quirúrgico (10) de cualquiera de las Reivindicaciones 1-8, en donde la palanca (210) está configurada para enganchar mecánicamente el gatillo de disparo (20) cuando la palanca (210) está en su primera posición.
10. El instrumento de grapado quirúrgico (10) de cualquiera de las Reivindicaciones 1-9, en donde el gatillo de disparo (20) dispara una pluralidad de sujetadores desde el primer miembro de mordaza (30) en contacto con el segundo miembro de mordaza (31).
11. El instrumento de grapado quirúrgico (10) de cualquiera de las Reivindicaciones 1-10, en donde una pluralidad de sujetadores se retienen en la segunda mordaza.
12. El instrumento de grapado quirúrgico (10) de la Reivindicación 11, en donde el mecanismo de seguridad (200) incluye la placa (250) está dispuesto en cooperación mecánica con el mango estacionario (18), y en donde la placa
(250) está desviada distalmente y se mueve por el movimiento del mecanismo de aproximación (22).
13. El instrumento de grapado quirúrgico de la reivindicación 5 o 12, en donde el mecanismo de aproximación (22) se acopla mecánicamente con un tope de tornillo (40) y el tope de tornillo (40) está en cooperación mecánica con el conjunto de yunque (30), en donde la rotación del mecanismo de aproximación (22) en una primera dirección está configurado para hacer que el tope del tornillo (40) se mueva proximalmente, lo que a su vez provoca el movimiento proximal del conjunto de yunque (30) y de tal manera que el tope del tornillo (40) se mueva proximalmente, una porción (42) de la misma impulsa la placa 250 del mecanismo de seguridad (200) proximalmente contra la inclinación de un resorte de placa 260 para inclinar la placa distalmente, por lo que la palanca (210) puede pivotear a la segunda posición donde el gatillo de disparo (20) puede accionarse.
14. El instrumento de grapado quirúrgico de la reivindicación 13, en donde un labio distal (257) de la placa (250) contacta una superficie de bloqueo (220) de la palanca (210), evitando así la rotación de la palanca (210) hasta la placa (250) se mueva proximalmente una distancia suficiente tal que el labio distal (257) pasa proximalmente a la superficie de bloqueo 220 de la palanca 210.
15. El instrumento de grapado quirúrgico de la reivindicación 14, en donde la rotación de la perilla de aproximación (22) de modo que el conjunto de yunque (30) y el conjunto de carcasa (31) se aproximan están configurados para hacer que el tope de tornillo (40) se traslade proximalmente a una distancia suficiente de modo que la porción (42) del tope de tornillo hace que el labio distal (257) pase proximalmente por la superficie de bloqueo (220) de modo que cuando el conjunto de yunque (30) y el conjunto de carcasa (31) se aproximen), la palanca (210) es libre de girar desde la primera posición a la segunda posición, permitiendo así que se active el gatillo de disparo (20).
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-
2010
- 2010-05-17 US US12/781,622 patent/US8146790B2/en active Active
- 2010-05-28 AU AU2010202192A patent/AU2010202192B2/en not_active Ceased
- 2010-06-14 CA CA2707560A patent/CA2707560C/en not_active Expired - Fee Related
- 2010-06-25 JP JP2010145679A patent/JP5653085B2/ja not_active Expired - Fee Related
- 2010-07-09 EP EP19218612.0A patent/EP3649967A2/en not_active Withdrawn
- 2010-07-09 EP EP10251240.7A patent/EP2272443B1/en active Active
- 2010-07-09 ES ES10251240T patent/ES2777889T3/es active Active
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2012
- 2012-02-29 US US13/407,972 patent/US8684248B2/en active Active
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2014
- 2014-02-14 US US14/180,654 patent/US8833630B2/en active Active
- 2014-08-13 US US14/458,285 patent/US8931680B2/en active Active
- 2014-09-16 JP JP2014187468A patent/JP2015013200A/ja active Pending
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- 2015-12-25 JP JP2015252907A patent/JP2016040017A/ja active Pending
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| Publication number | Publication date |
|---|---|
| US20140158745A1 (en) | 2014-06-12 |
| EP2272443B1 (en) | 2020-01-01 |
| EP3649967A2 (en) | 2020-05-13 |
| JP5653085B2 (ja) | 2015-01-14 |
| AU2010202192A1 (en) | 2011-01-27 |
| JP2016040017A (ja) | 2016-03-24 |
| US8684248B2 (en) | 2014-04-01 |
| CA2707560A1 (en) | 2011-01-11 |
| JP2015013200A (ja) | 2015-01-22 |
| CA2707560C (en) | 2017-07-11 |
| JP2011015964A (ja) | 2011-01-27 |
| EP2272443A1 (en) | 2011-01-12 |
| US20140353355A1 (en) | 2014-12-04 |
| US8931680B2 (en) | 2015-01-13 |
| US20110006100A1 (en) | 2011-01-13 |
| US8833630B2 (en) | 2014-09-16 |
| US20120153005A1 (en) | 2012-06-21 |
| AU2010202192B2 (en) | 2015-02-19 |
| US8146790B2 (en) | 2012-04-03 |
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