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ES2414857T3 - Conjunto de instrumento para un dispositivo de grapado quirúrgico - Google Patents

Conjunto de instrumento para un dispositivo de grapado quirúrgico Download PDF

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ES2414857T3
ES2414857T3 ES10006453T ES10006453T ES2414857T3 ES 2414857 T3 ES2414857 T3 ES 2414857T3 ES 10006453 T ES10006453 T ES 10006453T ES 10006453 T ES10006453 T ES 10006453T ES 2414857 T3 ES2414857 T3 ES 2414857T3
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Prior art keywords
clamping member
anvil
cartridge assembly
dynamic clamping
stapling device
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David C. Racenet
Lee Ann Olson
Phillip Roy
John W. Beardsley
Ralph A. Stearns
Clifford L. Emmons
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Covidien LP
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Tyco Healthcare Group LP
Covidien LP
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—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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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
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  • Surgical Instruments (AREA)

Abstract

Un dispositivo de grapado quirúrgico (10), que comprende: un yunque (14); un conjunto de cartucho (16), teniendo el conjunto de cartucho (16) una pluralidad de elementos de sujeción y estando montado para moverse de modo pivotable desde una posición abierta hasta una posición apretada; un miembro de apriete (20), que es desplazable desde una posición retraída hasta una posición avanzada, para desplazar el conjunto de cartucho (16) con relación al yunque desde la posición separada hasta la posición apretada y para impedir que el espacio entre las partes proximales del yunque y del conjunto de cartucho exceda una distancia predeterminada; un miembro de apriete dinámico (32) situado de modo que pueda moverse con relación al yunque (14) y al conjunto de cartucho (16), siendo desplazable el miembro de apriete dinámico (32), desde una posición retraída hasta una posición avanzada, para expulsar la pluralidad de elementos de sujeción desde el conjunto de cartucho (16), y en el que el miembro de apriete dinámico (32) incluye una primera parte de pestaña situada para aplicarse a una superficie del yunque (14) y una segunda parte de pestaña situada para aplicarse a una superficie del conjunto de cartucho (16), estando situadas las partes de pestaña primera y segunda para definir un espacio máximo del tejido durante el movimiento del miembro de apriete dinámico (32) desde su posición retraída hasta su posición avanzada; un miembro de accionamiento (60) que está conectado de manera operativa al miembro de apriete (20) y al miembro de apriete dinámico (32), estando formado el miembro de accionamiento (60) a partir de una funda exterior (64) situada alrededor del miembro de apriete (20) y de una varilla central (62) conectada al miembro de apriete dinámico (32), y una parte de cuerpo (18), en el que el yunque (14), el conjunto de cartucho (16), el miembro de apriete (20) y el miembro de apriete dinámico (32) son parte de un conjunto de instrumento (12) asegurado a pivotamiento a la parte de cuerpo (18); y en el que el conjunto de instrumento (12) está montado a rotación en un miembro de collarín (22) asegurado a pivotamiento a la parte de cuerpo (18).

Description

Conjunto de instrumento para un dispositivo de grapado quirúrgico
Antecedentes
1.
Campo técnico.
La presente invención se refiere a un conjunto de instrumento para tratar tejido. Más particularmente, la presente invención se refiere a un conjunto de instrumento quirúrgico endoscópico capaz de realizar movimientos de articulación y rotación para tratar tejido.
2.
Antecedentes de la técnica relacionada.
Son bien conocidas en la técnica las grapadoras quirúrgicas para apretar tejido entre estructuras de mordaza opuestas de un conjunto de instrumento y sujetar, después de ello, el tejido apretado. Estos dispositivos pueden incluir un bisturí para hacer incisiones en el tejido sujetado. Asimismo, son bien conocidas en la técnica las grapadoras del tipo que tienen configuraciones laparoscópicas o endoscópicas. En las patentes de EE.UU. números 6.330.965, 6.250.532, 6.241.139, 6.109.500 y 6.079.606 se describen ejemplos de dichas grapadoras quirúrgicas endoscópicas.
El documento US 6.109.500 describe, en particular, una grapadora quirúrgica que tiene un miembro de apriete dinámico formado por un rodillo de leva y un miembro de soporte.
El documento EP 0 640 317 describe un dispositivo electroquirúrgico que tiene un miembro de apriete formado como una funda eléctricamente conductora.
Típicamente, estas grapadoras incluyen un miembro de instrumento que tiene un cartucho de grapas para alojar una pluralidad de grapas dispuestas, al menos, en dos filas separadas lateralmente y un yunque que incluye una pluralidad de cavidades de formación de grapas, para recibir y formar las patas de las grapas a medida que dichas grapas son accionadas desde el cartucho. Típicamente, el yunque está soportado a pivotamiento, adyacente al cartucho, y puede pivotar entre unas posiciones abierta y cerrada.
Durante los procedimientos quirúrgicos laparoscópicos o endoscópicos, se consigue el acceso a una zona quirúrgica a través de una pequeña incisión o a través de una estrecha cánula introducida en un paciente por una herida de entrada reducida. Debido al área limitada para acceder a la zona quirúrgica, muchas grapadoras endoscópicas incluyen mecanismos para hacer girar la parte de cuerpo endoscópica del dispositivo o articular el conjunto de instrumento del dispositivo. Típicamente, cada mecanismo está controlado por un accionador que tiene que manipular un cirujano para orientar apropiadamente el conjunto de instrumento con relación al tejido a tratar. Las manipulaciones de este tipo consumen tiempo y puede que no den como resultado la orientación exacta del conjunto de instrumento deseada por el cirujano.
En consecuencia, existe la necesidad de un dispositivo mejorado de grapado quirúrgico endoscópico que incluya un mecanismo para ajustar la orientación de un conjunto de instrumento, que sea fácil de accionar y sea capaz de situar dicho conjunto con cualquier orientación deseada.
Sumario
Los aspectos y las realizaciones de la presente invención se exponen en las reivindicaciones que se acompañan.
Se ha descrito asimismo un instrumento quirúrgico que incluye un conjunto de instrumento que tiene un par de mordazas. El conjunto de instrumento incluye un yunque y un conjunto de cartucho, que soporta una pluralidad de elementos de sujeción. El conjunto de cartucho es desplazable con relación al yunque entre una posición separada y una posición acercada. Un miembro de apriete puede moverse desde una posición retraída hasta una posición avanzada, para desplazar el conjunto de cartucho con relación al yunque desde la posición separada hasta la posición acercada. Un miembro de apriete dinámico está situado de modo que pueda moverse con relación al yunque y al conjunto de cartucho desde una posición retraída hasta una avanzada, para expulsar la pluralidad de elementos de sujeción desde el conjunto de cartucho. Un miembro de accionamiento formado a partir de un cable flexible está conectado de manera operativa al miembro de apriete y al miembro de apriete dinámico y puede moverse para desplazar el miembro de apriete y el miembro de apriete dinámico entre sus posiciones retraída y avanzada.
Preferentemente, el miembro de accionamiento incluye un cable coaxial que tiene una funda exterior y una varilla central. La varilla central es desplazable axialmente y giratoria con relación a la funda exterior. La funda exterior está conectada de manera operativa al miembro de apriete y la varilla central está conectada de manera operativa al miembro de cierre.
Preferentemente, un collarín está asegurado a pivotamiento 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 desechable de carga.
Preferentemente, el conjunto de instrumento está montado a rotación en el miembro de collarín. En una realización preferente, la varilla central del cable coaxial está conectada al dispositivo de apriete dinámico de manera que la rotación de dicha varilla central efectúa la rotación del miembro de cierre para llevar a cabo la rotación del conjunto de instrumento con relación al miembro de collarín a efectos de facilitar la rotación independiente del conjunto de instrumento.
En una realización preferente, el miembro de apriete dinámico incluye una primera parte de pestaña situada para aplicarse a una superficie del yunque y una segunda parte de pestaña situada para aplicarse a una superficie del conjunto de cartucho. Las partes de pestaña primera y segunda definen juntas un espacio máximo del tejido entre el yunque y el conjunto de cartucho.
Breve descripción de los dibujos
En esta memoria se describen diversas realizaciones preferentes del dispositivo de grapado quirúrgico, ya dado a conocer, con referencia a los dibujos, en los que:
la figura 1 es una vista, en perspectiva lateral, de una realización preferente del dispositivo de grapado quirúrgico, ya dado a conocer, con el yunque y el conjunto de cartucho en la posición separada;
la figura 1A es una vista, en perspectiva lateral, del extremo proximal del yunque, del collarín de rotación y del 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 superior con los componentes internos en líneas a trazos 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 según 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 según un eje transversal a través del miembro de apriete dinámico, con el miembro de instrumento acercado;
la figura 6 es una vista, en sección transversal, del dispositivo de grapado quirúrgico mostrado en la figura 3 según un eje transversal del conjunto de instrumento a través del conjunto de cartucho y del yunque;
la figura 7 es una vista, en perspectiva superior, del miembro de apriete dinámico del dispositivo de grapado quirúrgico mostrado en la figura 1;
la figura 8 es una vista, en perspectiva superior, del miembro de apriete del dispositivo de grapado quirúrgico mostrado en la figura 1;
la figura 9 es una vista, en perspectiva superior, del collarín de accionamiento del dispositivo de grapado quirúrgico mostrado en la figura 1;
la figura 10 es una vista lateral, en perspectiva y en despiece ordenado, del conjunto de instrumento del dispositivo de grapado quirúrgico mostrado en la figura 1;
la figura 11 es una vista a escala ampliada del extremo proximal del conjunto de instrumento mostrado en la figura 10;
la figura 12 es una vista lateral, en perspectiva y 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 miembro de cierre según la presente invención;
la figura 15 es una vista, en planta superior, del alojamiento del cartucho de la presente invención;
las figuras 16A y 16B son vistas en perspectiva de los miembros de corredera y empujador de la presente invención;
la figura 17A es una vista desde un extremo, en sección transversal, de una parte del conjunto de cartucho de la figura 16B, según las líneas 17A, que ilustra la disposición de la corredera, del miembro empujador y de la grapa según una realización de la presente invención; y
la figura 17B es una vista desde un extremo, en sección transversal, de una parte del conjunto de cartucho que ilustra la disposición de la corredera, del miembro empujador y de la grapa según otra realización de la presente invención.
Descripción detallada de realizaciones preferentes
A continuación se describirán con detalle realizaciones preferentes del dispositivo de grapado quirúrgico, ya dado a conocer, con referencia a los dibujos, en los que números de referencia semejantes designan elementos idénticos o correspondientes en cada una de las diversas vistas.
Las figuras 1-13 ilustran una realización preferente del dispositivo de grapado quirúrgico, ya dado a conocer, mostrado generalmente como 10. El dispositivo de grapado 10 incluye un conjunto de instrumento 12 que tiene un yunque 14 y un conjunto de cartucho 16, una parte de cuerpo endoscópica 18, un miembro de apriete 20 y un collarín de rotación 22. El conjunto de instrumento 12 está soportado a pivotamiento en el extremo distal de la parte de cuerpo endoscópica 18, alrededor de un miembro de pivotamiento 24. Un adaptador 26 está asegurado al extremo distal de la parte de cuerpo 18 e incluye unas prolongaciones superior e inferior 28. Un separador 18a (figura 12) puede estar situado dentro de la parte anterior de cuerpo 8 para mantener el posicionamiento de los componentes internos del dispositivo. Alternativamente, el adaptador 26 puede estar formado de modo monolítico con la parte de cuerpo endoscópica 18. El miembro de pivotamiento 24 se extiende entre las prolongaciones superior e inferior 28 y una parte proximal 22a (figura 1A) del collarín de rotación 22 de manera que el conjunto de instrumento 12 puede articularse con relación al eje longitudinal de la parte endoscópica 18 aproximadamente 90o. Se prevé que una variedad de diferentes tipos de juntas articuladas, por ejemplo, de rótula, de acoplamiento flexible, de junta universal, etc., pueden estar dispuestas para permitir mayores grados de articulación.
El conjunto de cartucho 16 incluye un cartucho 16a que aloja una pluralidad de grapas (no mostradas), una parte de canal 30 que define un rebaje para recibir el cartucho 16a, un miembro de apriete dinámico 32 (figura 7) y una corredera 31. El miembro de apriete dinámico 32 está situado preferentemente de modo proximal a la corredera 31 dentro del cartucho 16a. Una cuchilla de bisturí 34 está situada preferentemente sobre una parte de cuerpo intermedia 32a, preferentemente central, del miembro de apriete dinámico 32, para hacer incisiones en el tejido sujetado. La cuchilla de bisturí 34 puede estar mecanizada directamente en el miembro de apriete dinámico o puede estar asegurada de modo fijo o desmontable al mismo. Alternativamente, la cuchilla de bisturí 34 puede estar formada sobre la corredera o fijada, asegurada de modo desmontable o a pivotamiento a la misma. La corredera 31 está situada de modo deslizante para trasladarse a través del cartucho 16a a efectos de expulsar grapas desde el mismo de manera conocida. El miembro de apriete dinámico 32 incluye unas pestañas superior e inferior 36a y 36b. Como se muestra en la figura 5, la pestaña 36a está situada dentro de una ranura o rebaje 38 formado en el cartucho 16a y la pestaña 36b está situada dentro de un rebaje 40 formado en el yunque 14. Alternativamente, las pestañas 36a y 36b no tienen que estar situadas de modo deslizante en rebajes, sino más bien solamente tienen que aplicarse a una superficie superior de apoyo en el yunque 14 y a una superficie inferior de apoyo en el conjunto de cartucho 16. Como se ilustra en la figura 7, las pestañas 36a y 36b son preferentemente arqueadas o semicirculares para minimizar la desviación y mantener la alineación del yunque y/o del cartucho durante el accionamiento de la grapadora. El miembro de apriete dinámico 32 está situado de modo proximal a la corredera en aplicación con la misma y es desplazable a través del cartucho. El miembro de cierre 32 proporciona, recupera y/o mantiene un espacio deseado del tejido, preferentemente uniforme, en la zona del conjunto de instrumento 12 adyacente a la corredera 31 durante la descarga del dispositivo 10. El movimiento del miembro de apriete dinámico 32, a través del conjunto de cartucho 16, hace avanzar la corredera por dicho conjunto.
Se prevé que el yunque y/o el miembro de apriete dinámico, preferentemente ambos, estén formados por un material y sean de un grosor o calibre tales como para minimizar la desviación del yunque y/o el miembro de apriete dinámico respectivos durante el apriete, la traslación y la descarga del dispositivo. Tales materiales incluyen acero inoxidable de calidad quirúrgica. Preferentemente, el yunque está formado como una unidad maciza de una pieza. Alternativamente, como es conocido en la técnica, el yunque puede estar formado por un conjunto de partes que incluye un cuerpo de yunque y una placa de yunque que tiene una pluralidad de cavidades de formación de grapas. Se desea que el yunque sea tan resistente como lo razonablemente posible y necesario para minimizar la deformación, por ejemplo, el extremo distal del yunque arqueándose hacia arriba durante el apriete o el apriete previo y/o durante la descarga de grapas.
Haciendo referencia a la figura 1A, el extremo proximal del yunque 14 incluye una parte cilíndrica 14a que tiene un rebaje anular 14b. La parte cilíndrica 14a está dimensionada para ser recibida dentro del orificio 22a del collarín 22. Al menos un pasador de pivotamiento 23 (figura 1) se extiende a través del collarín 22 entrando en el rebaje 14b para fijar axialmente el extremo proximal del yunque 14 dentro del orificio 22a. Ya que el pasador 23 está situado dentro del rebaje anular 14b, el yunque 14 se puede hacer girar dentro del collarín 22. Se prevé que otros medios pueden estar dispuestos para fijar a rotación el yunque 14 al collarín 22. Un segundo pasador 25 (figura 1) se extiende a través del collarín 22 para asegurar dicho collarín 22 a un extremo distal de una barra de articulación 52, como se describirá a continuación.
Aunque no se muestra, de manera conocida, el extremo proximal de la parte de canal 30 del conjunto de cartucho 16 incluye un rebaje para recibir un miembro de pivotamiento, por ejemplo, una patilla o un pasador, formado en el extremo proximal del yunque 14 o fijado a dicho extremo. Los extremos proximales del yunque 14 y del cartucho 16 están confinados dentro del collarín 22 para impedir que el miembro de pivotamiento del yunque llegue a desaplicarse del rebaje en la parte de canal 30 del conjunto de cartucho 16. Alternativamente, otras disposiciones mecánicas conocidas en la técnica pueden utilizarse para asegurar a pivotamiento el yunque 14 al conjunto de cartucho 16. Se señala que, ya que el conjunto de cartucho 16 está fijado de modo pivotable al yunque 14, ambos pueden girar con relación al collarín 22.
Haciendo referencia a las figuras 1 y 4, un mecanismo de articulación está dispuesto para articular el conjunto de instrumento 12 con relación a la parte de cuerpo endoscópica 18. El mecanismo de articulación incluye una barra proximal de articulación 50 y una barra distal de articulación 52. La barra proximal de articulación 50 tiene un primer extremo 50a que se extiende desde el extremo proximal de la parte de cuerpo endoscópica 18 y un segundo extremo 50b situado dentro de la parte de cuerpo 18 y conectado a pivotamiento a un primer extremo 52a de la segunda barra de articulación 52. Un segundo extremo 52b de la barra de articulación 52 está conectado a pivotamiento al collarín de rotación 22 mediante el pasador 25 (figura 1) en un punto desplazado respecto al miembro de pivotamiento 24, es decir, el eje de pivotamiento del conjunto de instrumento 12. La barra de articulación 52 está confinada en una ranura 54 formada en la parte de cuerpo endoscópica 18. Debido a este confinamiento, el mecanismo de articulación solamente es capaz de articular el conjunto de instrumento 12 por un arco en un lado del eje longitudinal del dispositivo. Preferentemente, cada una de las conexiones pivotantes identificadas anteriormente incluye un pasador de pivotamiento. Alternativamente, unos miembros de pivotamiento pueden estar formados integralmente con los componentes anteriores o pueden utilizarse miembros de pivotamiento que no incluyen pasadores. Asimismo, se contemplan otros tipos de barras de articulación.
Durante su utilización, cuando el eje longitudinal del conjunto de instrumento 12 está alineado con el eje longitudinal
de la parte de cuerpo 18 y la barra proximal de articulación 50 está retraída en la dirección indicada por la flecha “A”
en la figura 4, dicha barra 50 hace retraerse a la barra 52 para efectuar la articulación del conjunto de instrumento 12
alrededor del miembro de pivotamiento 24 en la dirección indicada por la flecha “B” en la figura 4. Se puede devolver
el conjunto de instrumento 12 a una posición no articulada haciendo avanzar la barra 50 en la dirección indicada por
la flecha “C”. Se describirá a continuación el mecanismo para controlar el movimiento del mecanismo de articulación.
Haciendo referencia a las figuras 3-9, se proporciona un mecanismo de accionamiento para acercar el yunque 14 y el conjunto de cartucho 16, descargar las grapas y hacer girar el conjunto de instrumento 12 con relación al collarín
22. El mecanismo de accionamiento incluye un cable o miembro de accionamiento coaxial 60 (figura 3) que tiene una varilla central 62 y una funda exterior 64, un collarín de accionamiento 66 (figura 9), un miembro de apriete, mostrado en este caso como anillo de apriete 20, y un miembro de apriete dinámico 32. La varilla central 62 es o incluye un miembro flexible que tiene una resistencia a la compresión adecuada para empujar el miembro de apriete dinámico 32 a través del cartucho 16a. Preferentemente, la varilla central 62 incluye un cable flexible enrollado hacia la izquierda o hacia la derecha. Alternativamente, pueden utilizarse asimismo otros materiales que tienen características de resistencia adecuadas, por ejemplo, NitinolTM. El diámetro de la varilla central 62 debe ser suficientemente pequeño como para poder estar situada dentro de un espacio disponible en el cartucho 16a. La funda exterior 64 está situada alrededor de la varilla central 62 y funciona, en parte, para estabilizar e impedir el pandeo de la varilla central 62 cuando la misma está en compresión. Preferentemente, la funda exterior 64 es asimismo un cable flexible formado a partir de una malla de acero, de plástico reforzado o una aleación de níquel y titanio, tal como NitinolTM. Se prevé asimismo que para formar la funda exterior pueden utilizarse otros materiales adecuados con los requisitos de resistencia requeridos incluyendo un material de poli parafenilenotereftalamida, tal como KevlarTM, disponible comercialmente de la firma DuPont.
La varilla central 62 está situada de modo deslizante dentro de la funda exterior 64 e incluye un primer extremo proximal 62a (figura 4) que se extiende preferentemente desde el extremo proximal de la parte de cuerpo endoscópica 18 y un segundo extremo 62b fijado al miembro de apriete dinámico 32. El miembro de apriete dinámico 32 incluye preferentemente un rebaje 68 (figura 7) formado en el mismo para recibir el segundo extremo 62b de la varilla central 62. El segundo extremo 62b puede asegurarse al miembro de apriete dinámico 32 mediante plegado, soldadura, como en la figura 4, soldadura fuerte, pasadores, etc. dentro, por ejemplo, del rebaje 68, o utilizando el mismo, y puede estar mecanizado también para adaptarse a la forma de dicho rebaje 68.
La funda exterior 64 tiene un primer extremo proximal 64a que se extiende preferentemente desde el extremo proximal de la parte de cuerpo alargada 18 y un segundo extremo distal 64b conectado fijamente al collarín de accionamiento 66. El collarín de accionamiento 66 (figura 9) incluye preferentemente un orificio central 70 para recibir la funda exterior 64 y proporcionar un canal para el paso de la varilla central 62 a su través. La superficie exterior del collarín de accionamiento 66 incluye preferentemente una estructura de aplicación, por ejemplo, unas entallas 72, para aplicarse al miembro o anillo de apriete 20 en una relación fija a rotación. El anillo de apriete 20 incluye asimismo una estructura de aplicación, por ejemplo, unos nervios o salientes 74, para coincidir con la estructura de aplicación del collarín de accionamiento 66 a efectos de asegurar a rotación el collarín de accionamiento 66 al anillo de apriete 20 de manera que giren unidos. El extremo distal 20a del anillo de apriete 20 incluye un par de zonas recortadas 76 configuradas para recibir partes de las pestañas 36a y 36b del miembro de apriete dinámico 32 y aplicarse a las mismas.
Durante su utilización, la varilla central 62 y la funda exterior 64 pueden desplazarse juntas desde una posición retraída hasta una posición parcialmente avanzada, para hacer avanzar el collarín de accionamiento 66, el anillo de apriete 20 y el miembro de apriete dinámico 32 hasta una primera posición avanzada. El anillo de apriete 20, preferentemente, está situado alrededor del extremo proximal del yunque 14 y del conjunto de cartucho 16. El conjunto de cartucho 16 incluye una superficie de leva 80 (figura 2) formada sobre una superficie externa del mismo. A medida que el miembro de apriete dinámico 32 se mueve desde la posición retraída hasta la primera posición avanzada, la pestaña 36b del miembro de apriete dinámico 32 se aplica a la superficie de leva 80 del conjunto de cartucho 16 para hacer pivotar dicho conjunto 16 desde la posición abierta hasta la posición cerrada o apretada. El anillo de apriete 20 es desplazado asimismo de modo distal desde la primera posición avanzada hasta una posición que rodea las partes proximales del yunque 14 y del conjunto de cartucho 16. En esta posición, el anillo de apriete 20 impide que el espacio entre las partes proximales del yunque 14 y del conjunto de cartucho 16 exceda una distancia predeterminada.
Después de que la varilla central 62 y la funda exterior 64 han sido desplazadas hasta la primera posición avanzada para llevar el conjunto de cartucho 16 y, en consecuencia, el yunque 14 hasta la posición apretada, se puede hacer avanzar la varilla central 62 independientemente de la funda exterior 64 hasta una segunda posición avanzada para desplazar el miembro de apriete dinámico 32 a través del cartucho 16a a efectos de expulsar grapas desde el conjunto de cartucho y cortar tejido utilizando la cuchilla de bisturí 34 del miembro de cierre 32. Se contempla que, alternativamente, las pestañas 36a y 36b del miembro de cierre 32 podrían aplicarse a una superficie de leva en el yunque 14 y/o en el conjunto de cartucho 16 para hacer pivotar uno, o ambos, a efectos de proporcionar apriete del tejido. Haciendo referencia a las figuras 5 y 6, un canal 82 está formado en el cartucho 16a para proporcionar soporte lateral a la varilla central 62 a efectos de impedir que dicha varilla central 62 pandee durante el movimiento de la varilla central 62 desde la posición retraída hasta la segunda posición avanzada.
Como se ha descrito anteriormente, el yunque 14 está asegurado a rotación al collarín 22, la varilla central 62 está unida fijamente al miembro de apriete dinámico 32 y la funda exterior 64 está unida fijamente al collarín de accionamiento 66. Cuando se hace girar el miembro coaxial 60, todo el conjunto de instrumento gira alrededor del eje central del collarín 22. Más específicamente, ya que el miembro de apriete dinámico 32 está confinado dentro del yunque 14 y del conjunto de cartucho 16, cualquier par aplicado a la varilla central 62 se transfiere al conjunto de instrumento 12 a través del miembro de apriete dinámico 32. Así, se puede hacer girar el miembro coaxial 60 para hacer que el conjunto de instrumento 12 gire alrededor del eje longitudinal del collarín 22.
El conjunto de instrumento anteriormente descrito puede modificarse para ser una unidad desechable de carga, tal como la descrita en la patente de EE.UU. número 6.330.965, o puede estar incorporado dentro de la misma, o estar fijado directamente al extremo distal de cualquier dispositivo conocido de grapado quirúrgico. Aunque no se han descrito específicamente en esta memoria un conjunto de mango para accionar el miembro de articulación y los mecanismos de aproximación o apriete, descarga y rotación del instrumento, se debe comprender que se prevé la utilización de una amplia variedad de diferentes mecanismos de accionamiento y configuraciones de mango, incluyendo palancas acodadas, mandos giratorios y deslizables, palancas o mecanismos activadores pivotables, empuñaduras de pistola, mangos alineados, sistemas accionados a distancia y cualquier combinación de los mismos. Por ejemplo, como se muestra en la figura 13A, el conjunto de mango puede incluir uno de tipo pistola 200 que tiene un mando de rotación 210 del conjunto de instrumento, una palanca de articulación 212 y un mando de rotación 214 del cuerpo. Se prevé asimismo la utilización de un conjunto de instrumento anteriormente descrito como parte de un sistema robótico.
Se prevé que la utilización de un material de calibre más pesado para el conjunto de yunque únicamente, y preferentemente asimismo para el miembro de cierre y el anillo de apriete, proporciona una presión de apriete mejorada por la longitud del tejido que, a su vez, proporciona un espacio más uniforme del tejido entre las respectivas superficies del yunque y el cartucho adyacentes al lugar en el que se forman las grapas a través del tejido y por delante de dicho lugar. Además, utilizando el anillo de apriete para apretar previamente el tejido, es decir, apretar el tejido antes de la deformación de las grapas, se tiende a forzar a que parte del fluido intersticial a salir de modo distal y radial, lo que reduce la probabilidad de desplazar hidráulicamente las grapas durante su deformación. La utilización de un miembro de cierre o similar, que aprieta mientras se traslada a lo largo del miembro de instrumento, ayuda a compensar el flujo de fluido y/o desde dentro del tejido y/o el arqueo hacia fuera del extremo distal del yunque y a mantener por ello el espacio deseado del tejido entre el yunque y el conjunto de cartucho.
En otra realización preferente como la que se muestra en la figura 14, un miembro de cierre 132 incluye unas pestañas superior e inferior 136a, 136b separadas y fijadas a una parte intermedia 132a. Como en la realización anterior, el miembro de cierre 132 está situado preferentemente de modo proximal a la corredera 140 parcialmente dentro de un cartucho 118 del conjunto de cartucho 116. Una cuchilla de bisturí 134 está situada preferentemente sobre la parte intermedia 132a del miembro de cierre 132 para hacer incisiones en el tejido sujetado. La cuchilla de bisturí 134 puede estar mecanizada directamente en una sección de la parte intermedia 132a o puede estar unida de modo fijo o desmontable a dicha parte intermedia 132a. Alternativamente, la cuchilla de bisturí 134 puede estar formada como parte de la corredera 140 o puede estar asegurada de modo fijo o desmontable a dicha corredera
140. Las pestañas superior e inferior 136a, 136b son estructuras generalmente arqueadas con curvaturas sustancialmente idénticas. Alternativamente, la curvatura de las pestañas superior e inferior 136a, 136b puede diferir para proporcionar mayor o menor soporte a la estructura. Cada pestaña 136a, 136b incluye además una superficie interior 135a, 135b y una superficie exterior 137a, 137b. Preferentemente, el miembro de cierre 132 está construido de manera que las superficies interiores 135a, 135b están enfrentadas entre sí. Las pestañas superior e inferior 136a, 136b funcionan para definir el máximo espacio del tejido entre las superficies del yunque y del cartucho.
En un realización preferente, el conjunto de cartucho 116 incluye una pluralidad de ranuras de retención 122 dispuestas a lo largo de un eje longitudinal del alojamiento 118 del cartucho. Como se muestra en la figura 15, las ranuras de retención 122 están dispuestas para formar grupos primero y segundo 124, 126. Preferentemente, cada grupo 124, 126 incluye tres filas de ranuras de retención 122 configuradas de manera que, al menos, una de las filas está desplazada longitudinalmente con respecto a las filas restantes. Se prefiere además que, al menos, dos filas de ranuras de retención 122 estén dispuestas en cada grupo 124, 126 del conjunto de cartucho 118 de manera que cada ranura de retención 122 de una fila interior esté en alineación sustancialmente longitudinal con una ranura de retención 122 correspondiente en la fila exterior y la fila intermedia de ranuras de retención 122 esté desplazada longitudinalmente con respecto a las filas interior y exterior. De esta manera, las filas interior y exterior de las ranuras de retención 122 están alineadas longitudinalmente desde la posición más proximal hasta la posición más distal del alojamiento 118 del cartucho. Preferentemente, una ranura de retención 122 en las filas interior y exterior define la ranura de retención más proximal y más distal. El posicionamiento ventajoso de las ranuras de retención 122, como se ha descrito, mejora la sujeción del tejido y minimiza el sangrado.
Haciendo referencia a las figuras 16A-17B, se ilustran realizaciones adicionales de la corredera 140 y del miembro empujador 150. El miembro empujador 150 incluye una parte de base 152. En la figura 16A, se ha hecho avanzar la corredera 140 longitudinalmente en el alojamiento 118 del cartucho y empieza a aplicarse a la base 152 del miembro empujador 150. A medida que se hace avanzar más la corredera 140 en una dirección longitudinal (figura 16B), la base 152 del miembro empujador 150 se aplica a unas cuñas de leva verticales 144 de dicha corredera 140. El movimiento longitudinal de la corredera 140 transfiere las fuerzas motrices longitudinales a lo largo de las cuñas de leva 144 y, por ello, a los miembros empujadores 150. Preferentemente, los miembros empujadores 150 están en una relación fija respecto al movimiento longitudinal de la corredera 140 y se mueven sustancialmente ortogonales al eje longitudinal del conjunto de cartucho 118, transfiriendo por ello las fuerzas motrices a la separación posterior 162 de la grapa 160 para desplazar dicha grapa 160 a través de la ranura de retención 122. En una realización preferente, como se ilustra en la figura 17A, las cuñas de leva 144 de la corredera 140 se aplican a un rebaje 154 en el miembro empujador 122. El rebaje 154 está configurado y adaptado para la aplicación deslizante de la cuña de leva 144. Una vez que la cuña de leva 144 se aplica al rebaje 154, un movimiento longitudinal adicional de la corredera 140 actúa para mantener el miembro empujador 150 en alineación sustancialmente vertical con el eje longitudinal. Configurado de esta manera, una vez que la corredera 140 se aplica al mismo, el miembro empujador 150 mantiene su relación sustancialmente ortogonal con respecto al eje longitudinal mientras se mueve a través de la ranura de retención 122. Alternativamente, el miembro empujador 150a puede estar configurado para permanecer con un espacio 146a entre las cuñas de leva 144a de la corredera 140a, como se muestra en la figura 17B. Como en la realización anterior, la base 152a del miembro empujador 150a está configurada y adaptada para la aplicación deslizante con el espacio 146a de la corredera 140a. Además, cuando el miembro empujador 150a se aplica a la cuña de leva 144a de la corredera 140a, el miembro empujador 150a mantiene su relación sustancialmente ortogonal con respecto al eje longitudinal mientras se mueve a través de la ranura de retención 122.
Se entenderá que pueden realizarse diversas modificaciones en las realizaciones descritas en esta memoria. Por ejemplo, aunque el conjunto de instrumento se describe exclusivamente como un dispositivo de grapado, puede ser útil aplicar elementos de sujeción distintos de grapas, incluyendo elementos de sujeción en dos piezas. Por lo tanto, la descripción anterior no debe interpretarse como limitativa, sino simplemente como una serie de ejemplificaciones de realizaciones preferentes. Los expertos en la técnica serán capaces de prever otras modificaciones dentro del alcance de las reivindicaciones adjuntas a dicha descripción.

Claims (8)

  1. REIVINDICACIONES
    1. Un dispositivo de grapado quirúrgico (10), que comprende:
    un yunque (14);
    un conjunto de cartucho (16), teniendo el conjunto de cartucho (16) una pluralidad de elementos de sujeción y estando montado para moverse de modo pivotable desde una posición abierta hasta una posición apretada;
    un miembro de apriete (20), que es desplazable desde una posición retraída hasta una posición avanzada, para desplazar el conjunto de cartucho (16) con relación al yunque desde la posición separada hasta la posición apretada y para impedir que el espacio entre las partes proximales del yunque y del conjunto de cartucho exceda una distancia predeterminada;
    un miembro de apriete dinámico (32) situado de modo que pueda moverse con relación al yunque (14) y al conjunto de cartucho (16), siendo desplazable el miembro de apriete dinámico (32), desde una posición retraída hasta una posición avanzada, para expulsar la pluralidad de elementos de sujeción desde el conjunto de cartucho (16), y en el que el miembro de apriete dinámico (32) incluye una primera parte de pestaña situada para aplicarse a una superficie del yunque (14) y una segunda parte de pestaña situada para aplicarse a una superficie del conjunto de cartucho (16), estando situadas las partes de pestaña primera y segunda para definir un espacio máximo del tejido durante el movimiento del miembro de apriete dinámico (32) desde su posición retraída hasta su posición avanzada;
    un miembro de accionamiento (60) que está conectado de manera operativa al miembro de apriete (20) y al miembro de apriete dinámico (32), estando formado el miembro de accionamiento (60) a partir de una funda exterior (64) situada alrededor del miembro de apriete (20) y de una varilla central (62) conectada al miembro de apriete dinámico (32), y
    una parte de cuerpo (18),
    en el que el yunque (14), el conjunto de cartucho (16), el miembro de apriete (20) y el miembro de apriete dinámico
    (32) son parte de un conjunto de instrumento (12) asegurado a pivotamiento a la parte de cuerpo (18); y
    en el que el conjunto de instrumento (12) está montado a rotación en un miembro de collarín (22) asegurado a pivotamiento a la parte de cuerpo (18).
  2. 2.
    El dispositivo de grapado quirúrgico (10) según la reivindicación 1, en el que el yunque (14) está formado por un material y tiene un grosor tales como para minimizar la desviación.
  3. 3.
    El dispositivo de grapado quirúrgico (10) según la reivindicación 1 o la reivindicación 2, en el que el miembro de apriete dinámico (32) está formado por un material y tiene un grosor tales como para minimizar la desviación.
  4. 4.
    El dispositivo de grapado quirúrgico (10) según cualquiera de las reivindicaciones anteriores, en el que la varilla central (62) es desplazable con relación a la funda exterior (64).
  5. 5.
    El dispositivo de grapado quirúrgico (10) según la reivindicación 4, en el que la varilla central (62) es giratoria con relación a la funda exterior (64).
  6. 6.
    El dispositivo de grapado quirúrgico (10) según la reivindicación 1, en el que la varilla central (62) del miembro de accionamiento (60) está conectada de manera operativa al miembro de apriete dinámico (32) de manera que la rotación de dicha varilla central (62) efectúa la rotación de dicho miembro de apriete dinámico (32), que efectúa la rotación del conjunto de instrumento (12).
  7. 7.
    El dispositivo de grapado quirúrgico (10) según cualquiera de las reivindicaciones anteriores, que incluye además una cuchilla de bisturí (34) asociada con el miembro de apriete dinámico (32).
  8. 8.
    El dispositivo de grapado quirúrgico (10) según la reivindicación 1, en el que una cuchilla de bisturí (134) está dispuesta sobre una parte central de cuerpo, entre las pestañas superior e inferior.
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ES09013099T Expired - Lifetime ES2380101T3 (es) 2002-10-04 2003-10-06 Conjunto de instrumento para un dispositivo de grapado quirúrgico.
ES03773180T Expired - Lifetime ES2337248T3 (es) 2002-10-04 2003-10-06 Conjunto de herramienta para un dispositivo de grapado quirurgico.
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