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ES2398459T3 - Conjunto de herramienta para un dispositivo de grapado quirúrgico - Google Patents

Conjunto de herramienta para un dispositivo de grapado quirúrgico Download PDF

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ES2398459T3
ES2398459T3 ES10165409T ES10165409T ES2398459T3 ES 2398459 T3 ES2398459 T3 ES 2398459T3 ES 10165409 T ES10165409 T ES 10165409T ES 10165409 T ES10165409 T ES 10165409T ES 2398459 T3 ES2398459 T3 ES 2398459T3
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cartridge
assembly
tool assembly
retention
anvil
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David C Racenet
Philip Roy
John W Beardsley
Lee Ann Olson
Ralph Stearns
Clifford L Emmons
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Covidien LP
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Tyco Healthcare Group LP
Covidien LP
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/10—Surgical instruments, devices or methods for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
    • A61B17/105—Wound clamp magazines
    • 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
    • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003—Steerable
    • 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
    • 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
    • A61B2017/07257—Stapler heads characterised by its anvil
    • 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
    • A61B2017/07271—Stapler heads characterised by its cartridge
    • 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
    • A61B17/068—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
    • A61B2017/07285—Stapler heads characterised by its cutter
    • 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
    • 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
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • 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
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft
    • 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
    • A61B2017/2939—Details of linkages or pivot points
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B2017/320052—Guides for cutting instruments

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Abstract

Conjunto (12) de herramienta para su uso con una grapadora quirúrgica, comprendiendo el conjunto (12) deherramienta: un yunque (14); un conjunto (16) de cartucho que tiene al menos una grapa y una pluralidad de ranuras (122) de retención, pudiendomoverse el conjunto (16) de cartucho con respecto al yunque (14) entre posiciones separada y aproximada, incluyendoademás el conjunto (16) de cartucho un patín (140) y al menos un elemento (150) empujador asociado con cada al menos una grapa; un elemento (20) de sujeción situado adyacente a un extremo proximal del conjunto de herramienta, pudiendo moverseel elemento de sujeción desde una posición retraída hasta una posición avanzada para mover el yunque y el conjuntode cartucho a la posición aproximada; un elemento (32) de sujeción dinámica situado dentro del conjunto (12) de herramienta y que puede moverse desde unaposición retraída a través del conjunto (12) de herramienta hasta una posición avanzada para expulsar grapas desde elconjunto de cartucho, incluyendo el elemento (32) de sujeción dinámica una parte (36a) de reborde superior que seacopla a una superficie del yunque (14) y una parte (36b) de reborde inferior que se acopla a una superficie del conjunto(16) de cartucho para mantener un intersticio de tejido deseado, estando situado el elemento (32) de sujeción dinámicade manera proximal al patín (140) en acoplamiento con el mismo y de manera que puede trasladarse a través del cartucho(16); en el que el patín (140) tiene cuñas (144) de leva erguidas y puede moverse a lo largo del eje longitudinal; el al menos un elemento (150) empujador tiene una parte (152) de base con un rebaje (154) configurado y adaptado paraacoplarse de manera deslizante con al menos una de las cuñas (144) de leva, estando el elemento (150) empujadoren una relación fija con respecto al eje longitudinal, acoplándose al menos una cuña (144) de leva con el rebaje (154)del elemento (150) empujador; y el movimiento longitudinal del patín (140) transfiere fuerzas motrices longitudinales desde la al menos una cuña (144) deleva al elemento (150) empujador, transfiriendo de ese modo las fuerzas motrices al tramo (162) posterior de la grapa(160) para mover la grapa (160) a través de la ranura (122) de retención.

Description

Conjunto de herramienta para un dispositivo de grapado quirúrgico.
Antecedentes
1. Campo técnico
La presente descripción se refiere a un conjunto de herramienta para tratar tejido. Más particularmente, la presente descripción se refiere a un conjunto de herramienta quirúrgica endoscópica con capacidad de articulación y rotación para tratar tejido.
2. Antecedentes de la técnica relacionada
Las grapadoras quirúrgicas para sujetar tejido entre estructuras de mordaza opuestas de un conjunto de herramienta y después unir el tejido sujetado se conocen ampliamente en la técnica. Estos dispositivos pueden incluir una cuchilla para practicar una incisión en el tejido unido. Las grapadoras de este tipo que tienen configuraciones laparoscópicas o endoscópicas también se conocen ampliamente en la técnica. Ejemplos de estas grapadoras quirúrgicas endoscópicas se describen en las patentes estadounidenses n.os 6.330.965, 6.250.532, 6.241.139, 6.109.500 y 6.079.606. El documento
U.S. 6.330.965 da a conocer en particular un conjunto de accionador axial que comprende un rodillo de leva y un elemento de soporte para acoplar el yunque y el cartucho de grapas respectivamente. Durante el funcionamiento de la grapadora, un patín de actuación se traslada para hacer avanzar cuñas de leva en contacto con empujadores para forzar las grapas desde ranuras en el cartucho.
Normalmente, estas grapadoras incluyen un elemento de herramienta que tiene un cartucho de grapas para alojar una pluralidad de grapas dispuestas en al menos dos filas separadas lateralmente y un yunque que incluye una pluralidad de cavidades de formación de grapa para recibir y dar forma a brazos de grapa de las grapas cuando las grapas se conducen desde el cartucho. Normalmente, el yunque está soportado de manera pivotante adyacente al cartucho y puede pivotar entre posiciones abierta y cerrada.
Durante procedimientos quirúrgicos laparoscópicos o endoscópicos, el acceso al sitio quirúrgico se consigue a través de una pequeña incisión o a través de una cánula estrecha insertada a través de una pequeña entrada practicada en un paciente. Debido al área limitada para acceder al sitio quirúrgico, muchas grapadoras endoscópicas incluyen mecanismos para rotar la parte de cuerpo endoscópica del dispositivo o articular el conjunto de herramienta del dispositivo. Normalmente, cada mecanismo se controla mediante un actuador que debe manipular un cirujano para orientar correctamente el conjunto de herramienta con respecto al tejido que va a tratarse. Tales manipulaciones llevan tiempo y pueden no dar como resultado la orientación exacta del conjunto de herramienta deseada por el cirujano.
Por consiguiente, existe la necesidad de un dispositivo de grapado quirúrgico endoscópico mejorado que incluya un mecanismo para ajustar la orientación de un conjunto de herramienta que sea fácil de manipular y que pueda posicionar un conjunto de herramienta en cualquier orientación deseada.
El documento US 5.738.474 da a conocer un elemento de accionamiento que está configurado para forzar una pluralidad de grapas quirúrgicas desde un cartucho de grapas a través de empujadores de grapa. El ángulo “E” entre el borde de contacto de una leva de empujador y la dirección longitudinal de desplazamiento “L” del elemento de accionamiento se seleccionan para permitir la rotación del elemento de accionamiento con respecto a la leva en un sentido opuesto al de la rotación inducida por la leva de empujador. Además, se sitúan placas de empujador en la parte proximal del elemento de accionamiento para contrarrestar un posible momento torsor.
Sumario
La presente invención se refiere a un conjunto (12) de herramienta para su uso con una grapadora quirúrgica, comprendiendo el conjunto (12) de herramienta:
un yunque (14);
un conjunto (16) de cartucho que tiene al menos una grapa y una pluralidad de ranuras (122) de retención, pudiendo moverse el conjunto (16) de cartucho con respecto al yunque (14) entre posiciones separada y aproximada, incluyendo además el conjunto (16) de cartucho un patín (140) y al menos un elemento (150) empujador asociado con cada al menos una grapa;
un elemento (20) de sujeción situado adyacente a un extremo proximal del conjunto de herramienta, pudiendo moverse el elemento de sujeción desde una posición retraída hasta una posición avanzada para mover el yunque y el conjunto de cartucho a la posición aproximada;
un elemento (32) de sujeción dinámica situado dentro del conjunto (12) de herramienta y que puede moverse desde una posición retraída a través del conjunto (12) de herramienta hasta una posición avanzada para expulsar grapas desde el conjunto de cartucho, incluyendo el elemento (32) de sujeción dinámica una parte (36a) de reborde superior que se acopla a una superficie del yunque (14) y una parte (36b) de reborde inferior que se acopla a una superficie del conjunto
(16) de cartucho para mantener un intersticio de tejido deseado, estando situado el elemento (32) de sujeción dinámica de manera proximal al patín (140) en acoplamiento con el mismo y de manera que puede trasladarse a través del cartucho (16);
en el que el patín (140) tiene cuñas (144) de leva erguidas y puede moverse a lo largo del eje longitudinal;
el al menos un elemento (150) empujador tiene una parte (152) de base con una rebaje (154) configurado y adaptado para acoplarse de manera deslizante con al menos una de las cuñas (144) de leva, estando el elemento (150) empujador en una relación fija con respecto al eje longitudinal, acoplándose al menos una cuña (144) de leva con el rebaje
(154) del elemento (150) empujador; y
el movimiento longitudinal del patín (140) transfiere fuerzas motrices longitudinales desde la al menos una cuña (144) de leva al elemento (150) empujador, transfiriendo de ese modo las fuerzas motrices al tramo (162) posterior de la grapa
(160) para mover la grapa (160) a través de la ranura (122) de retención.
Según la presente descripción, se da a conocer un instrumento quirúrgico que incluye un conjunto de herramienta que tiene un par de mordazas. El conjunto de herramienta incluye un yunque y un conjunto de cartucho que tiene una pluralidad de fijaciones soportadas en el mismo. El conjunto de cartucho puede moverse con respecto al yunque entre una posición separada y una posición aproximada. Un elemento de sujeción puede moverse desde una posición retraída hasta una posición avanzada para mover el conjunto de cartucho con respecto al yunque desde la posición separada hasta la posición aproximada. Un elemento de sujeción dinámica está situado de manera que puede moverse con respecto al yunque y el conjunto de cartucho desde una posición retraída hasta una avanzada para expulsar la pluralidad de fijaciones desde el conjunto de cartucho. Un elemento de accionamiento formado a partir de un cable flexible está conectado de manera operativa al elemento de sujeción y al elemento de sujeción dinámica y puede moverse para mover el elemento de sujeción y el elemento de sujeción dinámica entre sus posiciones retraída y avanzada.
La presente invención también se refiere un conjunto (12) de herramienta para su uso con una grapadora quirúrgica, comprendiendo el conjunto (12) de herramienta:
un yunque (14);
un conjunto (16) de cartucho que tiene al menos una grapa y una pluralidad de ranuras (122) de retención, pudiendo moverse el conjunto (16) de cartucho con respecto al yunque (14) entre posiciones separada y aproximada, incluyendo además el conjunto (16) de cartucho un patín (140a) y al menos un elemento (150a) empujador asociado con cada al menos una grapa;
un elemento (20) de sujeción situado adyacente a un extremo proximal del conjunto de herramienta, pudiendo moverse el elemento de sujeción desde una posición retraída hasta una posición avanzada para mover el yunque y el conjunto de cartucho a la posición aproximada;
un elemento (32) de sujeción dinámica situado dentro del conjunto (12) de herramienta y que puede moverse desde una posición retraída a través del conjunto (12) de herramienta hasta una posición avanzada para expulsar grapas desde el conjunto de cartucho, incluyendo el elemento (32) de sujeción dinámica una parte (36a) de reborde superior que se acopla a una superficie del yunque (14) y una parte (36b) de reborde inferior que se acopla a una superficie del conjunto
(16) de cartucho para mantener un intersticio de tejido deseado, estando situado el elemento (32) de sujeción dinámica de manera proximal al patín (140) en acoplamiento con el mismo y de manera que puede trasladarse a través del cartucho (16);
en el que el patín (140a) tiene cuñas (144a) de leva erguidas y puede moverse a lo largo del eje longitudinal, definiendo las cuñas (144a) de leva erguidas un espacio (146a);
el al menos un elemento (150a) empujador tiene una parte (152a) de base configurada para residir en el espacio (146a) del patín (140a) y para acoplarse de manera deslizante a las cuñas de leva (144a), estando el elemento (150a) empujador en una relación fija con respecto al eje longitudinal; y
el movimiento longitudinal del patín (140a) transfiere fuerzas motrices longitudinales desde la al menos una cuña (144a) de leva al elemento (150a) empujador, transfiriendo de ese modo las fuerzas motrices al tramo (162) posterior de la grapa (160) para mover la grapa (160) a través de la ranura (122) de retención.
Preferiblemente, el elemento de accionamiento incluye un cable coaxial que incluye una funda exterior y una barra central. La barra central puede moverse axialmente y girar con respecto a la funda exterior. La funda exterior está conectada de manera operativa al elemento de sujeción y la barra central está conectada operativamente al elemento de cierre.
Preferiblemente, un collar está fijado de manera pivotante a una parte de cuerpo de un dispositivo de grapado. La parte de cuerpo puede formar el extremo distal de un dispositivo de grapado quirúrgico o el extremo proximal de una unidad de carga desechable.
Preferiblemente, el conjunto de herramienta está montado de manera giratoria en el elemento de collar. En una realización preferida, la barra central del cable coaxial está conectada al dispositivo de sujeción dinámica de manera que la rotación de la barra central provoca la rotación del elemento de cierre para provocar la rotación del conjunto de herramienta con respecto al elemento de collar para facilitar una rotación independiente del conjunto de herramienta.
En una realización preferida, el elemento de sujeción dinámica incluye una primera parte de reborde situada para acoplarse a una superficie del yunque y una segunda parte de reborde situada para acoplarse a una superficie del conjunto de cartucho. Las partes de reborde primera y segunda, juntas, definen un intersticio de tejido máximo entre el yunque y conjunto de cartucho.
Breve descripción de los dibujos
Varias realizaciones preferidas del dispositivo de grapado quirúrgico dado a conocer actualmente se dan a conocer en el presente documento con referencia a los dibujos, en los que: la figura 1 es una vista en perspectiva lateral de una realización preferida del dispositivo de grapado quirúrgico dado a
conocer actualmente con el yunque y conjunto de cartucho en la posición separada;
la figura 1A es una vista en perspectiva lateral del extremo proximal del yunque, el collar de rotación y el adaptador del dispositivo de grapado quirúrgico mostrado en la figura 1; la figura 2 es una vista lateral del dispositivo de grapado quirúrgico mostrado en la figura 1; la figura 3 es una vista desde arriba con los componentes internos en línea discontinua del dispositivo de grapado
quirúrgico mostrado en la figura 2;
la figura 4 es una vista en sección transversal del dispositivo de grapado quirúrgico mostrado en la figura 2 tomada a lo largo de un eje longitudinal del dispositivo a través del conjunto de cartucho; la figura 5 es una vista en sección transversal del dispositivo de grapado quirúrgico mostrado en la figura 3 tomada a lo
largo de un eje transversal a través del elemento de sujeción dinámica con el elemento de herramienta aproximado;
la figura 6 es una vista en sección transversal del dispositivo de grapado quirúrgico mostrado en la figura 3 tomada a lo largo de un eje transversal del conjunto de herramienta a través del conjunto de cartucho y el yunque; la figura 7 es una vista desde arriba en perspectiva del elemento de sujeción dinámica del dispositivo de grapado quirúr
gico mostrado en la figura 1;
la figura 8 es una vista desde arriba en perspectiva del elemento de sujeción del dispositivo de grapado quirúrgico mostrado en la figura 1; la figura 9 es una vista desde arriba en perspectiva del collar de accionamiento del dispositivo de grapado quirúrgico
mostrado en la figura 1;
la figura 10 es una vista lateral en perspectiva en despiece ordenado del conjunto de herramienta del dispositivo de grapado quirúrgico mostrado en la figura 1; la figura 11 es una vista ampliada del extremo proximal del conjunto de herramienta mostrado en la figura 10; la figura 12 es una vista lateral en perspectiva en despiece ordenado de la parte de cuerpo endoscópica del dispositivo
de grapado quirúrgico mostrado en la figura 1; la figura 13 es una vista lateral en sección transversal del dispositivo de grapado quirúrgico mostrado en la figura 1; la figura 14 es otra realización del elemento de cierre según la presente descripción; la figura 15 es una vista en planta desde arriba del alojamiento del cartucho de la presente descripción; las figuras 16A y 16B son vistas en perspectiva del patín y elementos empujadores de la presente descripción;
la figura 17A es una vista de extremo en sección transversal de una parte del conjunto de cartucho de la figura 16B, tomada a lo largo de las líneas 17A, que ilustra la disposición del patín, el elemento empujador y la grapa según una realización de la presente descripción; y
la figura 17B es una vista de extremo en sección transversal de una parte del conjunto de cartucho que ilustra la disposición del patín, el elemento empujador y la grapa según otra realización de la presente descripción.
Descripción detallada de las realizaciones preferidas
Se describirán ahora en detalle realizaciones preferidas del dispositivo de grapado quirúrgico dado a conocer actualmente con referencia a los dibujos en los que números de referencia iguales designan elementos idénticos o correspondientes en cada una de las diversas vistas.
Las figuras 1-13 ilustran una realización preferida del dispositivo de grapado quirúrgico dado a conocer actualmente mostrado generalmente como 10. El dispositivo 10 de grapado incluye un conjunto 12 de herramienta que tiene un yunque 14 y un conjunto 16 de cartucho, una parte 18 de cuerpo endoscópica, un elemento 20 de sujeción y un collar 22 de rotación. El conjunto 12 de herramienta está soportado de manera pivotante en el extremo distal de la parte 18 de cuerpo endoscópica alrededor de un elemento 24 de pivote. Un adaptador 26 está fijado al extremo distal de la parte 18 de cuerpo e incluye extensiones 28 superior e inferior. Un separador 18a (figura 12) puede colocarse dentro de la parte 18 de cuerpo para mantener el posicionamiento de los componentes internos del dispositivo. Alternativamente, el adaptador 26 puede formarse de manera monolítica con la parte 18 de cuerpo endoscópica. El elemento 24 de pivote se extiende entre las extensiones 28 superior e inferior y una parte 22a proximal (figura 1A) del collar 22 de rotación de tal manera que el conjunto 12 de herramienta puede articularse con respecto al eje longitudinal de la parte 18 endoscópica aproximadamente 90º. Se prevé que una variedad de diferentes tipos de junta de articulación, por ejemplo, de rótula esférica, acoplamiento flexible, junta universal, etc., puedan proporcionarse para permitir mayores grados de articulación,
El conjunto 16 de cartucho incluye un cartucho 16a que aloja una pluralidad de grapas (no mostradas), una parte 30 de canal que define un rebaje para alojar el cartucho 16a, un elemento 32 de sujeción dinámica (figura 7) y un patín 31. El elemento 32 de sujeción dinámica preferiblemente está situado de manera proximal al patín 31 dentro del cartucho 16a. Una hoja 34 de cuchilla está preferiblemente situada en una parte 32a de cuerpo intermedia, preferiblemente central del elemento 32 de sujeción dinámica para practicar una incisión en el tejido unido. La hoja 34 de cuchilla puede mecanizarse directamente en el elemento de sujeción dinámica o puede fijarse de manera fija o retirable al mismo. Alternativamente, la hoja 34 de cuchilla puede formarse en o fijarse de manera fija, retirable o pivotante al patín. El patín 31 está situado de manera deslizante para trasladarse a través del cartucho 16a para expulsar grapas desde el cartucho de manera conocida. El elemento 32 de sujeción dinámica incluye rebordes 36a y 36b superior e inferior. Tal como se muestra en la figura 5, el reborde 36a está situado dentro de una ranura o rebaje 38 formado en el cartucho 16a y el reborde 36b está situado dentro de un rebaje 40 formado en el yunque 14. Alternativamente, los rebordes 36a y 36b no tienen que estar situados de manera deslizante en rebajes sino que, más bien, sólo tienen que acoplarse a una superficie de apoyo superior en el yunque 14 y una superficie de apoyo inferior en el conjunto 16 de cartucho. Tal como se ilustra en la figura 7, los rebordes 36a y 36b preferiblemente son arqueados o semicirculares para minimizar la deflexión y mantener la alineación del yunque y/o el cartucho durante el funcionamiento de la grapadora. El elemento 32 de sujeción dinámica está situado de manera proximal al patín en acoplamiento con el mismo y puede trasladarse a través del cartucho. El elemento 32 de cierre proporciona, restaura y/o mantiene un intersticio de tejido deseado, preferiblemente uniforme, en el área del conjunto 12 de herramienta adyacente al patín 31 durante el disparo del dispositivo 10. El movimiento del elemento 32 de sujeción dinámica a través del conjunto 16 de cartucho hace avanzar el patín a través del conjunto de cartucho.
Se prevé que el yunque y/o el elemento de sujeción dinámica, preferiblemente ambos, estén formados de un material y tengan tal grosor o calibre que se minimice la deflexión del respectivo yunque y/o elemento de sujeción dinámica durante la sujeción, translación a través de, y disparo del dispositivo. Tales materiales incluyen acero inoxidable de calidad quirúrgica. Preferiblemente, el yunque está formado como una unidad de una pieza maciza. Alternativamente, tal como se conoce en la técnica, el yunque puede formarse de un ensamblaje de piezas entre las que se incluyen un cuerpo de yunque y una plancha de yunque que tiene una pluralidad de huecos de formación de grapa. Se desea que el yunque sea lo más fuerte posible dentro de lo razonable y necesario para minimizar la distorsión, por ejemplo, que el extremo distal del yunque se curve hacia arriba durante la sujeción o sujeción previa y/o durante el disparo de grapas.
En referencia a la figura 1A, el extremo proximal del yunque 14 incluye una parte 14a cilíndrica que tiene un rebaje 14b anular. La parte 14a cilíndrica está dimensionada para alojarse dentro de una perforación 22a del collar 22. Al menos un pasador 23 de pivote (figura 1) se extiende a través del collar 22 hasta el interior del rebaje 14b para fijar axialmente el extremo proximal del yunque 14 dentro de la perforación 22a. Puesto que el pasador 23 está situado dentro del rebaje 14b anular, el yunque 14 puede rotar dentro del collar 22. Se prevé que puedan proporcionarse otros medios para unir de manera giratoria el yunque 14 al collar 22. Un segundo pasador 25 (figura 1) se extiende a través del collar 22 para fijar el collar 22 a un extremo distal de la varilla 52 de articulación tal como se describirá más adelante.
Aunque no se muestra, de manera conocida el extremo proximal de la parte 30 de canal del conjunto 16 de cartucho incluye un rebaje para alojar un elemento de pivote, por ejemplo, una lengüeta o pasador, formado en o unido al extremo proximal de yunque 14. Los extremos proximales del yunque 14 y el cartucho 16 están confinados dentro del collar 22 para evitar que el elemento de pivote del yunque se desacople del rebaje en la parte 30 de canal del conjunto 16 de cartucho. Alternativamente, otras disposiciones mecánicas conocidas en la técnica pueden usarse para fijar de manera pivotante el yunque 14 al conjunto 16 de cartucho. Se observa que, puesto que el conjunto 16 de cartucho está unido de manera pivotante al yunque 14, ambos son giratorios con respecto al collar 22.
En referencia a las figuras 1 y 4, se proporciona un mecanismo de articulación para articular el conjunto 12 de herramienta con respecto a la parte 18 de cuerpo endoscópica. El mecanismo de articulación incluye una varilla 50 de articulación proximal y una varilla 52 de articulación distal. La varilla 50 de articulación proximal tiene un primer extremo 50a que se extiende desde el extremo proximal de la parte 18 de cuerpo endoscópica y un segundo extremo 50b situado dentro de la parte 18 de cuerpo y conectado de manera pivotante a un primer extremo 52a de la segunda varilla 52 de articulación. Un segundo extremo 52b de la varilla 52 de articulación está conectado de manera pivotante al collar 22 de rotación mediante el pasador 25 (figura 1) en un punto desplazado con respecto al elemento 24 de pivote, es decir, el eje de pivote del conjunto 12 de herramienta. La varilla 52 de articulación está confinada en una ranura 54 formada en la parte 18 de cuerpo endoscópica. Debido al confinamiento, el mecanismo de articulación sólo puede articular el conjunto 12 de herramienta a lo largo de un arco en un lado del eje longitudinal del dispositivo. Preferiblemente, cada una de las conexiones de pivote identificadas anteriormente incluye un pasador de pivote. Alternativamente, los elementos de pivote pueden estar formados solidariamente con los componentes anteriores o pueden usarse elementos de pivote que no incluyen pasadores. También se contemplan otros tipos de varillas de articulación.
En uso, cuando el eje longitudinal del conjunto 12 de herramienta está alineado con el eje longitudinal de la parte 18 de cuerpo y la varilla 50 de articulación proximal está retraída en la dirección indicada mediante la flecha “A” en la figura 4, la varilla 50 retrae la varilla 52 para efectuar la articulación del conjunto 12 de herramienta alrededor del elemento 24 de pivote en la dirección indicada por la flecha “B” en la figura 4. El conjunto 12 de herramienta puede devolverse a una posición no articulada haciendo avanzar la varilla 50 en la dirección indicada por la flecha “C”. El mecanismo para controlar el movimiento del mecanismo de articulación se comentará más adelante.
En referencia a las figuras 3-9, se proporciona un mecanismo de accionamiento para aproximar el yunque 14 y el conjunto 16 de cartucho, disparar las grapas y rotar el conjunto 12 de herramienta con respecto al collar 22. El mecanismo de accionamiento incluye un cable coaxial o elemento 60 de accionamiento (figura 3) que tiene una barra 62 central y una funda 64 exterior, un collar 66 de accionamiento (figura 9), un elemento de sujeción, mostrado en este caso como anillo 20 de sujeción, y un elemento 32 de sujeción dinámica. La barra 62 central es o incluye un elemento flexible que tiene una fuerza de compresión adecuada para empujar el elemento 32 de sujeción dinámica a través del cartucho 16a. Preferiblemente, barra 62 central incluye un cable flexible enrollado a izquierdas o derechas. Alternativamente, también pueden usarse otros materiales que tengan características de fuerza adecuadas, por ejemplo, Nitinol™. El diámetro de la barra 62 central debe ser lo suficientemente pequeño para situarse dentro del espacio disponible dentro del cartucho 16a. La funda 64 exterior está situada alrededor de la barra 62 central y en parte funciona para estabilizar y evitar el combado de la barra 62 central mientras se encuentra en compresión. Preferiblemente, la funda 62 exterior también es un cable flexible formado a partir de una malla de acero, reforzada con plástico o una aleación de níquel-titanio tal como Nitinol™ También se prevé que puedan usarse otros materiales adecuados que tengan los requisitos de fuerza entre los que se incluyen un material de poliparafenilentereftalamida tal como Kevlar™ comercialmente disponible de DuPont, para formar la funda exterior.
La barra 62 central está situada de manera deslizante dentro de la funda 64 exterior e incluye un primer extremo 62a proximal (figura 4) que se extiende preferiblemente desde el extremo proximal de la parte 18 de cuerpo endoscópica y un segundo extremo 62b unido al elemento 32 de sujeción dinámica. El elemento 32 de sujeción dinámica preferiblemente incluye un rebaje 68 (figura 7) formado en el mismo para alojar el segundo extremo 62b de la barra 62 central. El segundo extremo 62b puede fijarse al elemento 32 de sujeción dinámica mediante engarzado, soldadura como en la figura 4, soldadura fuerte, pasadores, etc. dentro de o utilizando por ejemplo el rebaje 68 y también puede mecanizarse para adaptarse a la forma del rebaje 68.
La funda 64 exterior tiene un primer extremo 64a proximal que se extiende preferiblemente desde el extremo proximal de la parte 18 de cuerpo alargada y un segundo extremo 64b distal conectado de manera fija al collar 66 de accionamiento. El collar 66 de accionamiento (figura 9) preferiblemente incluye una perforación 70 central para alojar la funda 64 exterior y que proporciona un canal para el paso del a barra 62 central a través de la misma. La superficie exterior del collar 66 de accionamiento preferiblemente incluye una estructura de acoplamiento, por ejemplo, muescas 72, para acoplar un elemento de sujeción o anillo 20 en una relación fija de manera giratoria. El anillo 20 de sujeción también incluye una estructura de acoplamiento, por ejemplo, venas o salientes 74, para coincidir con la estructura de acoplamiento del collar 66 de accionamiento para fijar de manera giratoria el collar 66 de accionamiento al anillo 20 de sujeción de modo que puedan girar juntos. El extremo 20a distal del anillo 20 de sujeción incluye un par de recortes 76 configurados para alojar y acoplar partes 36a y 36b de reborde del elemento 32 de sujeción dinámica.
En uso, la barra 62 central y la funda 64 exterior pueden moverse juntas desde una posición retraída hasta una posición parcialmente avanzada para hacer avanzar el collar 66 de accionamiento, el anillo 20 de sujeción y el elemento 32 de sujeción dinámica hasta una primera posición avanzada. El anillo 20 de sujeción, preferiblemente, está situado alrededor del extremo proximal del yunque 14 y el conjunto 16 de cartucho. El conjunto 16 de cartucho incluye una superficie 80 de leva (figura 2) formada en una superficie externa del mismo. A medida que el elemento 32 de sujeción dinámica se mueve desde la posición retraída hasta la primera posición avanzada, el reborde 36b del elemento 32 de sujeción dinámica se acopla a la superficie 80 de leva del conjunto 16 de cartucho para hacer pivotar el conjunto 16 de cartucho desde la posición abierta hasta la posición cerrada o sujeta. El anillo 20 de sujeción también se mueve distalmente desde la primera posición avanzada hasta una posición que rodea las partes proximales del yunque 14 y el conjunto 16 de cartucho. En esta posición, el anillo 20 de sujeción evita que el intersticio entre las partes proximales del yunque 14 y el conjunto 16 de cartucho supere una distancia predeterminada.
Después de que la barra 62 central y la funda 64 exterior se hayan movido a la primera posición avanzada para mover el conjunto 16 de cartucho y, por consiguiente, el yunque 14 a la posición sujeta, la barra 62 central puede hacerse avanzar independientemente de la funda 64 exterior a una segunda posición avanzada para mover el elemento 32 de sujeción dinámica a través del cartucho 16a para expulsar grapas desde el conjunto de cartucho y practicar una incisión en tejido mediante el uso de la hoja 34 de cuchilla del elemento 32 de cierre. Se contempla que, alternativamente, los rebordes 36a y 36b del elemento 32 de cierre puedan acoplarse a una superficie de leva en el yunque 14 y/o conjunto 16 de cartucho para hacer pivotar uno o ambos para proporcionar sujeción de tejido. En referencia a las figuras 5 y 6, un canal 82 está formado en el cartucho 16a para proporcionar soporte lateral a la barra 62 central para evitar que la barra 62 central se combe durante el movimiento de la barra 62 central desde la posición retraída hasta la segunda posición avanzada.
Como se comentó anteriormente, el yunque 14 está fijado de manera giratoria al collar 22, la barra 62 central está unida fijamente al elemento 32 de sujeción dinámica y la funda 64 exterior está unida fijamente al collar 66 de accionamiento. Cuando se hace rotar el elemento 60 coaxial, todo el conjunto de herramienta rota alrededor del eje central del collar 22. Más específicamente, puesto que el elemento 32 de sujeción dinámica está confinado dentro del yunque 14 y el conjunto 16 de cartucho, cualquier momento torsor aplicado a la barra 62 central se transfiere a través del elemento 32 de sujeción dinámica al conjunto 12 de herramienta. Por tanto el elemento 60 coaxial puede hacerse rotar para rotar el conjunto 12 de herramienta alrededor del eje longitudinal del collar 22.
El conjunto de herramienta anteriormente descrito puede ser, modificarse para que sea, o puede incorporarse en una unidad de carga desechable tal como se da a conocer en la patente estadounidense n.º 6.330.965 o unirse directamente al extremo distal de cualquier dispositivo de grapado quirúrgico conocido. Aunque no se ha dado a conocer específicamente un conjunto de mango para accionar el elemento de articulación y los mecanismos de aproximación o sujeción, disparo y rotación de herramienta en el presente documento, ha de entenderse que se prevé el uso de una amplia variedad de diferentes mecanismos de actuación y configuraciones de mango, entre los que se incluyen palancas acodadas, botones giratorios y deslizantes, palancas o gatillos pivotantes, empuñaduras de pistola, mangos en línea, sistemas operados de manera remota y cualquier combinación de los mismos. Por ejemplo, tal como se muestra en la figura 13A, el conjunto de mango puede incluir uno de tipo pistola 200 que incluye un botón 210 de rotación de conjunto de herramienta, una palanca 212 de articulación y un botón 214 de rotación de cuerpo. El uso de un conjunto de herramienta anteriormente descrito como parte de un sistema robótico también está previsto.
Se prevé que la utilización de un material de mayor calibre para el conjunto de yunque solo, y preferiblemente también para el elemento de cierre y el anillo de sujeción proporciona una presión de sujeción mejorada a lo largo de la longitud del tejido que, a su vez, proporciona un intersticio de tejido más uniforme entre las respectivas superficies del yunque y el cartucho adyacentes a y por delante de donde se forman las grapas a través del tejido. Además, utilizar el anillo de sujeción para sujetar previamente el tejido, es decir, sujetar el tejido antes de la deformación de las grapas, tiende a forzar algo de fluido tisular distal y radialmente hacia fuera lo que reduce la probabilidad de desplazar hidráulicamente las grapas durante su deformación. El uso de un elemento de cierre o similar que sujeta a medida que se traslada a lo largo del elemento de herramienta ayuda a compensar el flujo de fluido y/o desde el interior del tejido y/o el curvado hacia fuera del extremo distal del yunque y mantener de este modo el intersticio de tejido deseado entre el yunque y el conjunto de cartucho.
En otra realización preferida tal como se muestra en la figura 14, el elemento 132 de cierre incluye rebordes 136a, 136b superior e inferior separados y unidos a una parte 132a intermedia. Como en la realización anterior, el elemento 132 de cierre está situado preferiblemente de manera proximal al patín 140 parcialmente dentro de un cartucho 118 del conjunto 116 de cartucho. Una hoja 134 de cuchilla está situada preferiblemente en la parte 132a intermedia del elemento 132 de cierre para practicar una incisión en el tejido unido. La hoja 134 de cuchilla puede mecanizarse directamente en una sección de la parte 132a intermedia o puede unirse fijamente o de manera retirable a la parte 132a intermedia. Alternativamente, la hoja 134 de cuchilla puede formarse como parte del patín 140 o puede fijarse de manera fija o retirable al patín 140. Los rebordes 136a, 136b superior o inferior son generalmente estructuras arqueadas con curvaturas sustancialmente idénticas. Alternativamente, la curvatura de los rebordes 136a, 136b superior e inferior pueden diferir para proporcionar un soporte de estructura mayor o menor. Cada reborde 136a, 136b incluye además una superficie 135a, 135b interna y una superficie 137a, 137b externa. Preferiblemente, el elemento 132 de cierre está construido de modo que las superficies 135a, 135b internas estén enfrentadas la una a la otra. Los rebordes 136a, 136b superior e inferior funcionan para definir el intersticio de tejido máximo entre las superficies del yunque y el cartucho.
El conjunto 116 de cartucho incluye una pluralidad de ranuras 122 de retención dispuestas a lo largo de un eje longitudinal de alojamiento del cartucho 118. Tal como se muestra en la figura 15, las ranuras 122 de retención están dispuestas para formar grupos 124, 126 primero y segundo. Preferiblemente, cada grupo 124, 126 incluye tres filas de ranuras 122 de retención configuradas de tal manera que al menos una de la filas está desplazada longitudinalmente respecto a las demás filas. Se prefiere además que se dispongan al menos dos filas de ranuras 122 de retención en cada grupo 124, 128 del conjunto 118 de cartucho de tal manera que cada ranura 122 de retención de una fila interior esté en alineación longitudinal sustancial con una correspondiente ranura 122 de retención en la fila exterior y la fila intermedia de ranuras 122 de retención está desplazada longitudinalmente respecto a las filas interior y exterior. Así, las filas interior y exterior de ranuras 122 de retención están alineadas longitudinalmente desde la ubicación más proximal a la ubicación más distal del alojamiento 118 del cartucho. Preferiblemente, una ranura 122 de retención en las filas interior y exterior define la ranura de retención más proximal y más distal. El posicionamiento ventajoso de las ranuras 122 de retención según se ha descrito mejora la unión del tejido y minimiza el sangrado.
En referencia a las figuras 16A-17B se ilustran realizaciones del patín 140 y el elemento 150 empujador. El elemento 150 empujador incluye una parte 152 de base. En las figuras 16A, el patín 140 se ha hecho avanzar longitudinalmente en el alojamiento 118 del cartucho y comienza a acoplarse a la base 152 del elemento 150 empujador. A medida que el patín 140 se hace avanzar adicionalmente en una dirección longitudinal (figura 16B), la base 152 del elemento 150 empujador se acopla a cuñas 144 de leva erguidas del patín 140. El movimiento longitudinal del patín 140 transfiere las fuerzas motrices longitudinales a lo largo de las cuñas 144 de leva y de este modo a los elementos 150 empujadores. Preferiblemente, los elementos 150 empujadores están en una relación fija respecto al movimiento longitudinal del patín 140 y se mueven de manera sustancialmente ortogonal al eje longitudinal del conjunto 118 de cartucho, transfiriendo de ese modo las fuerzas motrices al tramo 162 posterior de la grapa 160 para mover la grapa 160 a través de la ranura 122 de retención. En una realización preferida, tal como se ilustra en la figura 17A, las cuñas 144 de leva del patín 140 se acoplan al rebaje 154 en el elemento 122 empujador. El rebaje 154 está configurado y adaptado para acoplarse de manera deslizante a la cuña 144 de leva. Una vez que la cuña 144 de leva se acopla al rebaje 154, el movimiento longitudinal adicional del patín 140 actúa para mantener el elemento 150 empujador en alineación sustancial vertical con el eje longitudinal. Configurado de este modo, una vez acoplado por el patín 140, el elemento 150 empujador mantiene su relación sustancialmente ortogonal al eje longitudinal a medida que se mueve a través de la ranura 122 de retención. Alternativamente, el elemento 50a empujador puede estar configurado para residir con un espacio 146a entre cuñas 144a de leva del patín 140a tal como se muestra en la figura 17B. Como en la realización anterior, la base 152a del elemento 50a empujador está configurada y adaptada para acoplarse de manera deslizante al espacio 146a del patín 140a. Además, a medida que el elemento 50a empujador se acopla a la cuña 144a de leva del patín 140a, el elemento 50a empujador mantiene su relación sustancialmente ortogonal al eje longitudinal a medida que se mueve a través de la ranura 122 de retención.
Se entenderá que pueden realizarse diversas modificaciones a las realizaciones dadas a conocer en el presente documento. Por tanto, la descripción anterior no ha de interpretarse como limitativa, sino meramente como ejemplificaciones de realizaciones preferidas. Los expertos en la técnica concebirán otras modificaciones dentro del alcance de las reivindicaciones adjuntas al presente documento.

Claims (14)

  1. REIVINDICACIONES
    1. Conjunto (12) de herramienta para su uso con una grapadora quirúrgica, comprendiendo el conjunto (12) de herramienta:
    un yunque (14);
    un conjunto (16) de cartucho que tiene al menos una grapa y una pluralidad de ranuras (122) de retención, pudiendo moverse el conjunto (16) de cartucho con respecto al yunque (14) entre posiciones separada y aproximada, incluyendo además el conjunto (16) de cartucho un patín (140) y al menos un elemento (150) empujador asociado con cada al menos una grapa;
    un elemento (20) de sujeción situado adyacente a un extremo proximal del conjunto de herramienta, pudiendo moverse el elemento de sujeción desde una posición retraída hasta una posición avanzada para mover el yunque y el conjunto de cartucho a la posición aproximada;
    un elemento (32) de sujeción dinámica situado dentro del conjunto (12) de herramienta y que puede moverse desde una posición retraída a través del conjunto (12) de herramienta hasta una posición avanzada para expulsar grapas desde el conjunto de cartucho, incluyendo el elemento (32) de sujeción dinámica una parte (36a) de reborde superior que se acopla a una superficie del yunque (14) y una parte (36b) de reborde inferior que se acopla a una superficie del conjunto
    (16) de cartucho para mantener un intersticio de tejido deseado, estando situado el elemento (32) de sujeción dinámica de manera proximal al patín (140) en acoplamiento con el mismo y de manera que puede trasladarse a través del cartucho (16);
    en el que el patín (140) tiene cuñas (144) de leva erguidas y puede moverse a lo largo del eje longitudinal;
    el al menos un elemento (150) empujador tiene una parte (152) de base con un rebaje (154) configurado y adaptado para acoplarse de manera deslizante con al menos una de las cuñas (144) de leva, estando el elemento (150) empujador en una relación fija con respecto al eje longitudinal, acoplándose al menos una cuña (144) de leva con el rebaje (154) del elemento (150) empujador; y
    el movimiento longitudinal del patín (140) transfiere fuerzas motrices longitudinales desde la al menos una cuña (144) de leva al elemento (150) empujador, transfiriendo de ese modo las fuerzas motrices al tramo (162) posterior de la grapa
    (160) para mover la grapa (160) a través de la ranura (122) de retención.
  2. 2.
    Conjunto (12) de herramienta según la reivindicación 1, en el que las ranuras (122) de retención incluyen tres filas de ranuras de retención.
  3. 3.
    Conjunto (12) de herramienta según la reivindicación 2, en el que al menos una de las tres filas está desplazada longitudinalmente respecto a las demás filas.
  4. 4.
    Conjunto (12) de herramienta según la reivindicación 2, en el que las tres filas de ranuras (122) de retención incluyen una fila interior y una fila exterior de ranuras de retención, estando cada ranura (122) de retención de la fila interior en alineación longitudinal sustancial con una ranura correspondiente de las ranuras (122) de retención en la fila exterior.
  5. 5.
    Conjunto (12) de herramienta según la reivindicación 4, en el que una fila intermedia de ranuras (122) de retención está desplazada longitudinalmente respecto a la fila interior y la fila exterior.
  6. 6.
    Conjunto (12) de herramienta según la reivindicación 5, en el que una ranura (122) de retención en la fila interior y una ranura de retención en la fila exterior definen las ranuras de retención más proximal y más distal del cartucho de grapas.
  7. 7.
    Conjunto (12) de herramienta según una cualquiera de las reivindicaciones anteriores, en el que las ranuras
    (122) de retención están dispuestas para formar un primer grupo (124) y un segundo grupo (126) de ranuras de retención.
  8. 8. Conjunto (12) de herramienta para su uso con una grapadora quirúrgica, comprendiendo el conjunto (12) de herramienta:
    un yunque (14);
    un conjunto (16) de cartucho que tiene al menos una grapa y una pluralidad de ranuras (122) de retención, pudiendo moverse el conjunto (16) de cartucho con respecto al yunque (14) entre posiciones separada y aproximada, incluyendo además el conjunto (16) de cartucho un patín (140a) y al menos un elemento (150a) empujador asociado con cada al menos una grapa;
    un elemento (20) de sujeción situado adyacente a un extremo proximal del conjunto de herramienta, pudiendo moverse el elemento de sujeción desde una posición retraída hasta una posición avanzada para mover el yunque y el conjunto de cartucho a la posición aproximada;
    un elemento (32) de sujeción dinámica situado dentro del conjunto (12) de herramienta y que puede moverse desde una posición retraída a través del conjunto (12) de herramienta hasta una posición avanzada para expulsar grapas desde el conjunto de cartucho, incluyendo el elemento (32) de sujeción dinámica una parte (36a) de reborde superior que se acopla a una superficie del yunque (14) y una parte (36b) de reborde inferior que se acopla a una superficie del conjunto
    (16) de cartucho para mantener un intersticio de tejido deseado, estando situado el elemento (32) de sujeción dinámica de manera proximal al patín (140) en acoplamiento con el mismo y de manera que puede trasladarse a través del cartucho (16);
    en el que el patín (140a) tiene cuñas (144a) de leva erguidas y puede moverse a lo largo del eje longitudinal, definiendo las cuñas (144a) de leva erguidas un espacio (146a);
    el al menos un elemento (150a) empujador tiene una parte (152a) de base configurada para residir en el espacio (146a) del patín (140a) y para acoplarse de manera deslizante a las cuñas de leva (144a), estando el elemento (150a) empujador en una relación fija con respecto al eje longitudinal; y
    el movimiento longitudinal del patín (140a) transfiere fuerzas motrices longitudinales desde la al menos una cuña (144a) de leva al elemento (150a) empujador, transfiriendo de ese modo las fuerzas motrices al tramo (162) posterior de la grapa (160) para mover la grapa (160) a través de la ranura (122) de retención.
  9. 9.
    Conjunto (12) de herramienta según la reivindicación 8, en el que las ranuras (122) de retención incluyen tres filas de ranuras de retención.
  10. 10.
    Conjunto (12) de herramienta según la reivindicación 9, en el que al menos una de las tres filas está desplazada longitudinalmente respecto a las demás filas.
  11. 11.
    Conjunto (12) de herramienta según la reivindicación 9, en el que las tres filas de ranuras (122) de retención incluyen una fila interior y una fila exterior de ranuras de retención, estando cada ranura (122) de retención de la fila interior en alineación longitudinal sustancial con una ranura correspondiente de las ranuras (122) de retención en la fila exterior.
  12. 12.
    Conjunto (12) de herramienta según la reivindicación 11, en el que una fila intermedia de ranuras (122) de retención está desplazada longitudinalmente respecto a la fila interior y la fila exterior.
  13. 13.
    Conjunto (12) de herramienta según la reivindicación 12, en el que una ranura (122) de retención en la fila interior y una ranura de retención en la fila exterior definen las ranuras de retención más proximal y más distal del cartucho de grapas.
  14. 14.
    Conjunto (12) de herramienta según una cualquiera de las reivindicaciones 8 a 13, en el que las ranuras (122) de retención están dispuestas para formar un primer grupo (124) y un segundo grupo (126) de ranuras de retención.
ES10165409T 2002-10-04 2003-10-06 Conjunto de herramienta para un dispositivo de grapado quirúrgico Expired - Lifetime ES2398459T3 (es)

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ES09013099T Expired - Lifetime ES2380101T3 (es) 2002-10-04 2003-10-06 Conjunto de instrumento para un dispositivo de grapado quirúrgico.
ES10006453T Expired - Lifetime ES2414857T3 (es) 2002-10-04 2003-10-06 Conjunto de instrumento para un dispositivo de grapado quirúrgico
ES08003414T Expired - Lifetime ES2348273T3 (es) 2002-10-04 2003-10-06 Dispositivo de grapado quirurgico.
ES10009127T Expired - Lifetime ES2377813T5 (es) 2002-10-04 2003-10-06 Conjunto de herramienta para un dispositivo de grapado quirúrgico
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ES09013099T Expired - Lifetime ES2380101T3 (es) 2002-10-04 2003-10-06 Conjunto de instrumento para un dispositivo de grapado quirúrgico.
ES10006453T Expired - Lifetime ES2414857T3 (es) 2002-10-04 2003-10-06 Conjunto de instrumento para un dispositivo de grapado quirúrgico
ES08003414T Expired - Lifetime ES2348273T3 (es) 2002-10-04 2003-10-06 Dispositivo de grapado quirurgico.
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