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BRPI1008186B1 - aparelho de fecho cirúrgico - Google Patents

aparelho de fecho cirúrgico Download PDF

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Publication number
BRPI1008186B1
BRPI1008186B1 BRPI1008186A BRPI1008186A BRPI1008186B1 BR PI1008186 B1 BRPI1008186 B1 BR PI1008186B1 BR PI1008186 A BRPI1008186 A BR PI1008186A BR PI1008186 A BRPI1008186 A BR PI1008186A BR PI1008186 B1 BRPI1008186 B1 BR PI1008186B1
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Prior art keywords
end effector
cartridge
instrument
surgical
trigger
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BRPI1008186A
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English (en)
Inventor
E Shelton Frederick Iv
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Ethicon Endo Surgery Inc
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Publication of BRPI1008186A2 publication Critical patent/BRPI1008186A2/pt
Publication of BRPI1008186B1 publication Critical patent/BRPI1008186B1/pt
Publication of BRPI1008186B8 publication Critical patent/BRPI1008186B8/pt

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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
    • A61B2017/00017—Electrical control of surgical instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00681—Aspects not otherwise provided for
    • A61B2017/00734—Aspects not otherwise provided for battery operated
    • 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
    • A61B2017/07242—Stapler heads achieving different staple heights during the same shot, e.g. using an anvil anvil having different heights or staples of different sizes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/0725—Stapler heads with settable gap between anvil and cartridge, e.g. for different staple heights at different shots

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

aparelho de fecho cirúrgico a presente invenção refere-se a um aparelho de fecho cirúrgico que tem um cabo, uma haste alongada tendo uma extremidade proximal ligada ao cabo e uma extremidade distal que se estende do mesmo. um efetor de extremidade que inclui um par de garrasque giram em uma extremidade proximal do mesmo e que são móveis entre uma posição aberta e uma posição fechada. um cartucho que contém uma pluralidade de fechos cirúrgicos, o cartucho sendo fixado ao efetor de extremidade. um atuador acionado eletricamente para implantação dos fechos cirúrgicos, o atuador incluindo uma fonte de alimentação e um motor. meios para ajustar eletricamente a quantidade de espaço entre as ditas garras quando o dito efetor de extremidade está na dita posição fechada.

Description

Relatório Descritivo da Patente de Invenção para APARELHO DE FECHO CIRÚRGICO.
Referência Cruzada a Pedidos Cruzados [1] Este pedido reivindica o benefício do pedido provisório U.S. número de série 61/150.387 intitulado Motor-Driven Surgical Stapler Improvements a Frederick E. Shelton, IV, depositado em 6 de fevereiro de 2009.
Antecedentes [2] A presente invenção refere-se a um exemplo de um grampeador cirúrgico adequado para aplicações endoscópicas que está descrito na Patente U.S. n° 5.465.895 (que está incorporada por referência no presente documento), que apresenta um bisturi endoscópico com ações de fechamento e disparo distintas. Um exemplo de um grampeador cirúrgico acionado por motor está na publicação U.S. n° 2007/0175.958 (que está incorporada por referência no presente documento) na qual excertos são apresentados aqui para detalhar as funções de base, aprimoramentos, antecedentes e componentes da mesma. Ao final, aperfeiçoamentos adicionais para o sistemas são descritos.
[3] Em uma citação dos antecedentes e sumário da invenção da patente U.S. n° 2007015958 - Um clínico com o uso deste dispositivo é capaz de fechar os elementos de garra no tecido para posicionar o tecido antes do disparo. Uma vez que o clínico tiver determinado que os elementos de garra estejam prendendo o tecido adequadamente, ele pode então disparar o grampeador cirúrgico com um único tempo de disparo ou com vários tempos de disparo, dependendo do dispositivo. O disparo do grampeador cirúrgico causa o corte e o grampeamento dos tecidos. O uso de seccionamento e grampeamento simultâneos evita complicações que podem surgir durante a realização sequencial dessas ações com diferentes
Petição 870190072444, de 29/07/2019, pág. 4/23
2/15 instrumentos cirúrgicos que, respectivamente, apenas seccionam ou grampeiam o tecido.
[4] Uma vantagem específica de ser capaz de fechar sobre o tecido antes de disparar é a que o clínico pode verificar via um endoscópio que a localização desejada para o corte foi alcançada, incluindo uma quantidade suficiente de tecido que foi capturada entre garras opostas. De outra maneira, as garras opostas podem ser puxadas muito próximas uma da outra, especificamente pinçando as extremidades distais das mesmas, e dessa forma não formando efetivamente grampos fechados no tecido separado. No outro extremo, uma quantidade excessiva de tecido preso pode causar ligação e um disparo incompleto.
[5] Grampeadores/cortadores endoscópicos continuam a aumentar em complexidade e função com cada geração. Uma das principais razões para isso é a busca por menor força-de-disparo (FTF) para um nível que todos ou a maior parte dos cirurgiões possa lidar. Uma solução conhecida para baixar FTF é o uso de C02 ou motores elétricos. Estes dispositivos não mostraram-se muito melhores do que dispositivos manuais tradicionais, porém por motivos diferentes. Cirurgiões tipicamente preferem experimentar distribuição de força proporcional àquela sendo experimentada pelo efetor de extremidade na formação do grampo para se assegurarem que o ciclo de corte/grampeamento está terminado, com o limite superior dentro das capacidades de muitos cirurgiões (normalmente cerca de 66,7 a 133,4 N (15 a 30 Ibs)). Os mesmos também querem tipicamente manter o controle para implantar o grampo e serem capazes de interrompê-lo a qualquer momento se as forças percebidas no cabo do dispositivo forem muito grandes ou por outro motivo clínico. Estes efeitos de realimentação do usuário não são realizáveis adequadamente em bisturis endoscópicos acionados por motor atuais. Como
Petição 870190072444, de 29/07/2019, pág. 5/23
3/15 resultado, há uma falta de aceitação generalizada por médicos de bisturis endoscópicos acionados por motor em que a operação de corte/grampeamento é ativada ao meramente apertar um botão. Sumário [6] Em um aspecto geral, a presente invenção é direcionada à um instrumento cirúrgico motorizado de corte e fixação que fornece retroinformação ao usuário em relação a posição, força e/ou implantação do efetor de extremidade. O instrumento, em várias modalidades, também permite que o operador controle o efetor de extremidade, incluindo a capacidade de parar a implantação se assim desejar. O instrumento pode incluir dois gatilhos no cabo do mesmo -- um gatilho de fechamento e um gatilho de disparo -- com movimentos de atuação separados. Quando um operador do instrumento retrai o gatilho de fechamento, o tecido posicionado no efetor de extremidade pode ser fixado pelo efetor de extremidade. Então, quando o operador retrai o gatilho de disparo, um motor pode acionar, via trens de acionamento de engrenagens, um conjunto de eixos de acionamento principal rotacional, o que faz com que o instrumento de corte no efetor de extremidade corte o tecido preso.
[7] Em várias modalidades, o instrumento pode compreender um sistema de assistência de acionamento com retroinformação de força de carregamento e controle para reduzir a força de disparo necessária para ser exercida pelo operador a fim de terminar a operação de corte. Em tais modalidades, o gatilho de disparo pode ser engrenado ao trem de acionamento de engrenagens do conjunto do eixo de acionamento principal. Desta forma, o operador pode experimentar retroinformação em relação à força que é aplicada ao instrumento de corte. Isto é, a força de carregamento no gatilho de disparo pode ser relacionada a força de carregamento experimentada pelo instrumento de corte. Além disso, em tais modalidades, como o
Petição 870190072444, de 29/07/2019, pág. 6/23
4/15 gatilho de disparo é engrenado ao trem de acionamento da engrenagem, a força aplicada pelo operador pode ser adicionada à força aplicada ao motor.
[8] De acordo com várias modalidades, quando o gatilho de disparo é retraído em uma quantidade adequada (por exemplo, cinco graus), um comutador para ligar e desligar pode ser ativado, que envia um sinal ao motor para girar a uma taxa específica, dessa forma iniciando a atuação do conjunto de eixos de acionamento e do efetor de extremidade. De acordo com outras modalidades, um sensor proporcional pode ser usado. O sensor proporcional pode enviar um sinal ao motor para girar a uma taxa proporcional à força aplicada ao gatilho de disparo pelo operador. Desta forma, a posição rotacional do gatilho de disparo é, em geral, proporcional ao local em que o instrumento de corte está no efetor de extremidade (por exemplo, completamente distribuído ou completamente retraído). Mais ainda, o operador poderia parar a retração do gatilho de disparo em algum momento no percurso para parar o motor, e por meio disso parar os movimentos de corte. Além disso, sensores podem ser usados para detectar o início do percurso do efetor de extremidade (por exemplo, posição completamente retraída) e o final do percurso (por exemplo, posição completamente distribuída), respectivamente. Consequentemente, os sensores podem proporcionar um sistema de controle adaptável para controlar a implantação do efetor de extremidade que está do lado de fora do sistema de circuito fechado do motor, trem de acionamento de engrenagem, e efetor de extremidade.
[9] Em outras modalidades, o disparador do gatilho pode não ser diretamente engrenado no trem de acionamento de engrenagem usado para atuar no efetor de extremidade. Em tais modalidades, um segundo motor pode ser usado para aplicar forças ao gatilho de disparo para simular a implantação do instrumento de corte no efetor
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5/15 de extremidade. O segundo motor pode ser controlado à base de rotações adicionais do conjunto de eixo de acionamento principal, que pode ser medido por um codificador giratório. Em tais modalidades, a posição da posição rotacional do gatilho de disparo pode ser relacionado à posição do instrumento de corte no efetor de extremidade. Adicionalmente, um comutador para ligar e desligar ou um comutador proporcional pode ser usado para controlar o motor principal (isto é, o motor que aciona o eixo de acionamento principal).
[10] Em várias implementações, o efetor de extremidade pode usar um parafuso helicoidal na base do efetor de extremidade para acionar o instrumento de corte (por exemplo, facas). Além disso, o efetor de extremidade pode incluir um cartucho de grampos para grampeamento do tecido separado. De acordo com outras modalidades, outros meios para fixação (ou vedação) do tecido separado podem ser usados, incluindo energia de RF e adesivos.
[11] Ademais, o instrumento pode incluir um sistema de fechamento mecânico. O sistema de fechamento mecânico pode incluir um canal alongado que tem um membro de fixação, como uma bigorna, conectada de maneira rotatória no canal para o tecido fixado posicionado no efetor de extremidade. O usuário pode ativar a ação de fixação do efetor de extremidade ao retrair o gatilho mais próximo, que, através de um sistema de fechamento mecânico, faz com que a ação de fixação do efetor de extremidade. Uma vez que o membro de fixação esteja preso no lugar, o operador pode ativar a operação de corte ao retrair o gatilho de disparo separado. Isto pode fazer com que o instrumento de corte mover-se longitudinalmente ao longo do canal a fim de cortar o tecido preso pelo efetor de extremidade.
[12] Em várias implementações, o instrumento pode incluir um conjunto de eixo de acionamento principal rotacional para acionar o efetor de extremidade. Além disto, o eixo de acionamento principal pode
Petição 870190072444, de 29/07/2019, pág. 8/23
6/15 compreender uma junta de articulação de maneira que o efetor de extremidade possa ser articulado. A junta de articulação pode compreender, por exemplo, um conjunto de engrenagem de chanfro, uma junta universal, ou um cabo de torção flexível capaz de transmitir força de torção para o efetor de extremidade.
[13] Outros aspectos da presente invenção são direcionados para vários mecanismos para travar o gatilho de fechamento em uma porção de pistola, inferior, do cabo. Tais modalidades liberam espaço no cabo diretamente acima e atrás dos gatilhos para outros componentes do instrumento, incluindo componentes do trem de acionamento de engrenagem e o sistema de fechamento mecânico.
[14] As descrições da presente invenção mostram como uma pessoa poderia incorporar um dispositivo de grampeamento endoscópico autocontido acionado por engrenagem alimentada por bateria.
Descrição dos Desenhos [15] A figura1 é uma vista em perspectiva da extremidade distal de um grampeador cirúrgico, de acordo com a presente invenção.
[16] A figura 2 é uma vista em perspectiva da extremidade distal de um grampeador cirúrgico de acordo com a presente invenção com o cartucho removido do canal.
[17] A figura 3 é uma vista de uma extremidade distal de um grampeador cirúrgico de acordo com a presente invenção, similar à figura 1, mostrando um indicador travado.
[18] A figura 4 é uma vista em perspectiva de uma extremidade proximal de um grampeador cirúrgico de acordo com a presente invenção.
Descrição Detalhada da Invenção [19] Métodos de iluminação do efetor de extremidade/iluminação de sítios cirúrgicos com um bisturi equipado com motor
Petição 870190072444, de 29/07/2019, pág. 9/23
7/15 endoscópico: atualmente, quando o efetor de extremidade está em ou próximo a posição implantação do mesmo, pode ser difícil para o cirurgião visualizar o local de tratamento pois há sombras lançadas por estruturas adjacentes assim como o efetor de extremidade pode até mesmo estar inteiramente atrás de uma estrutura. Uma extremidade distal 3 de um grampeador cirúrgico 1 de acordo com a presente invenção é mostrada na figura 1, incluindo a bigorna 11, o corpo do cartucho 7 e a canaleta 13. Como visto nessa figura, uma fonte de luz 5 adicional pode ser posicionada na extremidade do corpo do cartucho 7 para iluminar o tecido 9. Esta fonte de luz pode ser qualquer combinação de meios práticos para converter energia elétrica em luz incluindo, mas não se limitando a semicondutores (como LED), uma lâmpada convencional incandescente ou de filamentos, eletroluminescente ou laser. Isto permitiria o cirurgião a não apenas iluminar diretamente o local de tratamento, como também permitiria a iluminação de fundo de estruturas para ver os componentes internos como vasculaturas ou com um ponteiro a laser permitir que o cirurgião destaque áreas de interesse a outros através do escopo tradicional.
[20] Isto seria muito fácil de fazer ao permitir um ou mais contatos 21 na parte traseira do cartucho 7 que iria engatar contatos 23 dentro do canal. Isto permitiria ao cirurgião energizar as luzes conforme necessário ao energizar o contato ajustado via um comutador posicionado no cabo 31. Este comutador pode até mesmo ter intensidade variável, como um descrito anteriormente poderia controlar a velocidade de atuação do dispositivo principal.
[21] Conforme indicado acima, a publicação U.S. n° 2007/0.175.949 descreve, ainda, nas figuras 45 a 47 visores de saída que poderiam mostrar, entre outras coisas, retroinformação da posição do efetor de extremidade, situação do travamento, quantidade de disparos, etc. Isto minimizaria uma das mais difíceis questões para o
Petição 870190072444, de 29/07/2019, pág. 10/23
8/15 usuário, que é a identificação da situação de um dispositivo, especificamente as situação do travamento do dispositivo sem ativar o dispositivo. Uma retroinformação adicional que seria de muita ajuda ao usuário seria retroinformação imediata sobre a situação do cartucho quando o mesmo está carregado. Assim como na aplicação acima, o mesmo poderia ser enrolado na indicação de travamento no cabo 31. Um indicador 33 (como um LED, lâmpada de vidro, LCD, enunciador sônico, vibrador, etc.) poderia ser unicamente associado à situação de um meio de travamento do cartucho ou mecanismo de tal maneira que o mesmo forneça esta informação ao cirurgião. Este LED poderia ser localizado no cabo. Alternativamente, um indicador 35 poderia ser localizado próximo a extremidade distal 3 que iria fornecer informação imediata para o cirurgião e carregador se o cartucho está pronto para uso ou não. Isto pode ser alcançado com um comutador ou conjunto de contatos associados diretamente com o travamento mecânico. O comutador ou contatos completam um circuito de tal maneira que o indicador fornece informações adequadas. Este ajuste de contato completo poderia se dar através de um elemento condutivo dentro do suporte deslizante (parte 33 na publicação n° 20070175958) e os dois contatos poderiam estar na posição proximal do canal (parte 22). Outra maneira de detectar a situação do travamento é indiretamente através da situação do instrumento (Exemplo 1: cartucho carregado e nenhuma tentativa de disparar indicaria que o travamento não está engatado; Exemplo 2: instrumento disparado e nenhum cartucho novo instalado indicaria que o travamento está engatado; etc.) Outra modalidade seria a de colocar o LED ou indicação visual no próprio cartucho. Quando o cartucho é encaixado no lugar o mesmo cria um contato que fornece acionamento ao cartucho. Caso o cartucho seja disparado, não apenas o travamento mecânico para o avanço da facas, como o circuito do cartucho ilumina o LED no cartucho
Petição 870190072444, de 29/07/2019, pág. 11/23
9/15 informando ao cirurgião no monitor de escopo que o cartucho está travado. Isto poderia ser mais expandido ao colocar uma pequena bateria ou outro acumulador de carga dentro do próprio cartucho para eliminar a necessidade de uma conexão de acionamento com o dispositivo principal. Além disso, o circuito do cartucho poderia ser ajustado para iluminar a luz de travamento sempre que o dispositivo estiver fechado para informar o usuário que há um cartucho gasto no dispositivo.
[22] Retroinformação indicativa para articulação equipada com motor e cor de cartucho: indicar o tipo de cartucho instalado (cor) e o ângulo da articulação é considerado útil para o cirurgião. A indicação de ângulo de articulação poderia ser indicada de várias formas incluindo numericamente ou graficamente como em um arco de LEDs. A localização desta indicação poderia ser no cabo em um local conveniente ou no eixo do dispositivo mais proximal ao efetor de extremidade. A retroinformação do efetor de extremidade poderia ser passiva ou ativa. A ativa acenderia LEDs adicionais para mostrar o ângulo. A passiva poderia simplesmente mostrar uma meia circunferência acesa de maneira que o cirurgião poderia intuir o quão articulado o efetor de extremidade está. Conforme explora-se mais a fundo os procedimentos cirúrgicos, os mesmos tornam-se mais e mais óbvios para o fato de que os olhos do cirurgião precisam estar focados nos sítios cirúrgicos e não no cabo do instrumento. Também começase a perceber a necessidade do cirurgião de retroinformações completas da situação pelo dispositivo. O ângulo de articulação poderia ser iluminado como parte da própria junta de articulação. Com luzes, LEDs, etc. denotando os ângulos divergentes ou mesmo um pequeno LCD denotando os ângulos em graus. Isto permitiria ao cirurgião ter alguma retroinformação sobre os ângulos fora da reta de maneira que o mesmo possa facilmente navegar de volta ao ângulo
Petição 870190072444, de 29/07/2019, pág. 12/23
10/15 correto após a remoção e reinserção. Outra questão é a óbvia indicação de qual cor de cartucho está no dispositivo. Isto pode ser alcançado através de um arranjo de luzes por cor codificado em cada efetor de extremidade ou no cartucho. Esta informação poderia ser também transmitida de volta para o cabo para exibir um visor redundante para assegurar que há confusão mínima quanto a qual cartucho está nas garras. Outro aprimoramento poderia incluir um pequeno contato de feixe de molas conectado a plataforma proximal do cartucho que indica se uma pressão de tecido mínima foi alcançada entre as garras. Esta pressão mínima iria, no mínimo, indicar se um cartucho de tecido espesso está sendo usado em aplicações de tecido fino, pois o mesmo não acenderia se pressão de tecido insuficiente na plataforma estiver presente.
[23] Avanço e retração automáticos de um bisturi elétrico endoscópico: há várias etapas dentro da função de um grampeador que deve ser concluída em uma ordem estabelecida. Uma vez que o gatilho de fechamento estiver fixado, atuação do ciclo de disparo será a próxima etapa necessária. Após a atuação, a retração do sistema é a próxima etapa sequencial. Com a inclusão de uma fonte de alimentação além do usuário (isto é, baterias ou pneumáticos) a habilidade de reduzir as etapas iniciadas pelo usuário (e, portanto, a complexidade do dispositivo) o próprio sistemas pode começar a completar estas etapas por si só. Comutadores ou circuitos internos poderiam ser adicionados para permitir que estas etapas sejam automaticamente iniciadas. O próximo desafio é permitir que o usuário seja capaz de, intuitivamente, retardar, diminuir ou parar as atuações automáticas. Por exemplo, o mesmo botão de atuação que permitiria o início do disparo em um dispositivo de retroinformação tátil como o 11/344.035 poderia ser usado para diminuir ou parar um sistema de retorno automático pelo usuário comprimindo o botão durante a
Petição 870190072444, de 29/07/2019, pág. 13/23
11/15 retração. Uma vez que a pressão é removida do botão, o autorretorno recomeçaria. O mesmo poderia ser dito para disparo automático, onde, se o sistema não precisar de um botão para disparar, mas um controle é fornecido para mover com os movimentos de faca que o usuário poderia deprimir, o mesmo iria parar ou diminuir sua implantação, mas seria desnecessário se o sistema estiver em funcionamento corretamente.
[24] Prevenção de atuação acidental para um bisturi endoscópico equipado com motor: com a introdução de sistemas equipados com motor que não mais limitam a função do dispositivo nas capacidades de força do usuário, iniciação inadvertida do ciclo de disparo pode tornar-se uma questão muito mais prevalente. Será mais fácil impactar o controle de ativação e fazer com que o instrumento inicie o disparo, impedindo, portanto, o travamento do cartucho ou mesmo congestionando o mesmo no tecido, pois o usuário não percebeu que o mesmo já começou os disparos. A fim de eliminar esta questão, comutadores ou botões ativadores de destravamento secundários poderiam ser usados para destravar o mecanismo de disparo. Isto é muito parecido com os dois sistemas comutadores usados na indústria de serras elétricas, assim como na indústria bélica para proteger contra atuação acidental. O comutador secundário pode tanto liberar a trava no gatilho de disparo quanto meramente energizar o acionamento no controle.
[25] O uso de uma bateria não estéril dentro de um dispositivo estéril I A embalagem como uma barreira de esterilidade para a reutilização de baterias: há a possível necessidade de um método para a introdução de baterias não estéreis (possivelmente com os eletrônicos integrais com as baterias se a lógica programável tornar-se uma necessidade-chave para o cliente). Já existe uma patente dentro da indústria de broca ortopédica para a inserção de baterias não
Petição 870190072444, de 29/07/2019, pág. 14/23
12/15 estéreis dentro de um dispositivo esterilizado reutilizável separadamente. Esta inovação é prevista para otimizar este conceito ao utilizar a embalagem estéril de dispositivo descartável para proteger a esterilidade do instrumento durante a inserção de baterias não estéreis. Um outro aprimoramento seria a inclusão de uma porta de incubação projetada dentro do instrumento e que pode ser fechada após o pacote ter sido inserido mas antes do dispositivo ser removido da embalagem estéril final. Esta incubação poderia então conter a bateria não estéril que poderia contaminar o campo cirúrgico estéril. Os métodos da presente invenção poderiam incluir uma camada adicional de embalagem que teria uma área perfurada em que a bateria poderia ser empurrada através, tanto rompendo a camada extra e permitindo que a bateria atravessada quanto indo com o conjunto de eletrodos da bateria apenas para serem rompidos pelas pontas de pino expostas da bateria na inserção completa. Uma alternativa para isto seria os terminais internos da pistola (profundamente dentro da cavidade de proteção da bateria) romperem a barreira estéril e assentarem dentro dos orifícios de pinos nas baterias. A incubação poderia então ser fechada através do pacote estéril que veda o sistema. A pistola poderia então ser utilizada no campo estéril normalmente, assim como qualquer outro dispositivo estéril.
[26] Modalidades localizadoras de posição I codificador linear e controle de carga de parâmetro do motor: as patentes 6.646.307 e 6.716.223 apresentam os mecanismos para a medição de rotação e torque relacionado para controlar parâmetro do motor e otimização dos parâmetros baseados na identificação de configurações e carregamento de efetor de extremidade. A publicação U.S. n° 2007.0175.958 mostra um método, através do uso de um comprimento rosqueado do eixo primário, nas figuras 8 a 13 como estes tipos de controle de movimento linear poderia ser usado para controle dos locais de
Petição 870190072444, de 29/07/2019, pág. 15/23
13/15 gatilhos. O mesmo tipo de método poderia ser usado para métodos de controle linear eletrônico. O efetor de extremidade poderia identificar o comprimento e tipos mecanicamente ao comprimir pelo menos um êmbolo ativado por mola, que poderia identificar para o cabo o tipo e comprimento, o mesmo permitiria ao motor para funcionar. A rotação do motor poderia ser convertida de movimentos rotatórios para armação linear ou movimentos de cabo, que poderia então ser usado para ajustar a tensão do motor, corrente, e velocidade a fim de afetar o movimento linear desejado da lâmina de controle. A lâmina de controle poderia então ser diretamente acoplada aos movimento acionador de faca. Esta lâmina de controle poderia ter locais de parada descontínuos ou contínuos que o êmbolo identificador marca conforme o deslocamento linear ir para máximo antes da retração.
[27] A identificação de recargas modulares com acionamento linear: um recurso útil para um instrumento cirúrgico é a habilidade de identificar qual efetor de extremidade foi fixado no instrumento. No caso de um grampeador cirúrgico equipado com motor, vários tipos diferentes de efetor de extremidade poderiam ser fixados. Adicionalmente, um tipo de efetor de extremidade pode ter pelo menos uma função e/ou recurso que é seletivamente utilizado ou habilitado. Os meios para identificação de efetor de extremidade aqui apresentados estão anexados. Nota-se que o tipo de efetor de extremidade referido abaixo não se limita a atuadores de extremidades mecânico, pneumático ou hidraulicamente acoplados. O instrumento pode tomar diferentes ações, parâmetros de operação de ajuste, indicação de funções disponíveis etc., como resultado da detecção deste efetor de extremidade.
[28] O efetor de extremidade tem uma conexão elétrica que é feita quando o mesmo é anexado no instrumento. O instrumento comunica-se com o efetor de extremidade e lê pelo menos um de
Petição 870190072444, de 29/07/2019, pág. 16/23
14/15 vários tipos de sinais. Uma posição de comutador ou posição de contato indica qual tipo de efetor de extremidade está presente. Um elemento passivo é medido por impedância e o resultado indica qual tipo de efetor de extremidade está presente.
[29] O efetor de extremidade tem uma ligação de frequência de rádio com o instrumento e dados são transferidos em pelo menos uma direção entre o efetor de extremidade e o instrumento.
[30] O efetor de extremidade tem uma ligação acústica com o instrumento e dados são transferidos em pelo menos uma direção entre o efetor de extremidade e o instrumento.
[31] O efetor de extremidade tem uma ligação ótica com o instrumento e dados são transferidos em pelo menos uma direção entre o efetor de extremidade e o instrumento.
[32] O efetor de extremidade tem uma ligação mecânica que engata elementos (como comutadores ou contatos) no instrumento que o identifica e por meio disso dados são transferidos em pelo menos uma direção entre o efetor de extremidade e o instrumento.
[33] A altura de grampo ajustável ativa para um bisturi endoscópico equipado com motor: a altura de grampo que é ajustável à espessura e tipo do tecido tem sido procurada por muitos anos. Mais recentemente 11/231.456 e 11/540.735 são em torno de um membro ou suportes de acoplamento flexível que permitiriam que o vão do instrumento aumentasse com cargas induzidas pelo tecido mais espesso no dispositivo. Esta altura de grampo variável passiva permite que a espessura do tecido crie formas de grampo maiores. Com a introdução da fonte de alimentação dentro do instrumento, o mesmo permite o uso de eletricidade para alterar a altura de um elemento interno dentro do elemento de acoplamento dinâmico que alteraria a altura do grampo ativamente pelo cirurgião ou configurar o instrumento na altura desejada. Este elemento interno poderia ser um
Petição 870190072444, de 29/07/2019, pág. 17/23
15/15 material com memória de forma e a eletricidade altera a temperatura do mesmo e, portanto, permite que o mesmo altere sua altura física devido a presente configuração. Outro método viável seria a inclusão de um polímero eletroativo (EAP) que através da introdução de um campo elétrico permite que o mesmo altere sua altura e largura. Ainda assim, uma terceira modalidade seria a utilização de um elemento escalonador linear tradicional elétrico que pode submeter à catraca elemento de rosca ajustável pequeno dentro da trave de acoplamento que iria ajustar sua altura.

Claims (1)

  1. REIVINDICAÇÃO
    1. Aparelho de fecho cirúrgico (1), compreendendo:
    a) um cabo (31), uma haste alongada tendo uma extremidade proximal ligada ao cabo (31) e uma extremidade distal (3) que se estende do mesmo, um efetor de extremidade que compreende um par de garras (11, 13) que giram em uma extremidade proximal do mesmo e que são móveis entre uma posição aberta e uma posição fechada, e um cartucho (7) contendo uma pluralidade de fechos cirúrgicos, o cartucho (7) sendo fixado ao efetor de extremidade;
    b) um atuador acionado eletricamente para implantação dos fechos cirúrgicos, o atuador compreendendo uma fonte de alimentação e um motor;
    caracterizado pelo fato de que compreende ainda:
    c) meios para ajustar eletricamente a quantidade de espaço entre as garras (11, 13) quando o efetor de extremidade está na posição fechada.
BRPI1008186A 2009-02-06 2010-01-28 aparelho de fecho cirúrgico BRPI1008186B8 (pt)

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BRPI1008186B8 (pt) 2021-06-22
AU2010210796B2 (en) 2013-11-28
CN102368957A (zh) 2012-03-07
RU2546958C2 (ru) 2015-04-10
EP2393431B1 (en) 2013-05-15
CA2751665C (en) 2017-06-06
BRPI1008186A2 (pt) 2016-03-01
RU2011136854A (ru) 2013-03-20
WO2010090941A1 (en) 2010-08-12
CA2751665A1 (en) 2010-08-12
JP5726761B2 (ja) 2015-06-03
EP2393431A1 (en) 2011-12-14
US20110024478A1 (en) 2011-02-03
JP2012517288A (ja) 2012-08-02

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