medical instrument and medical instrument controller

专利摘要:
MEDICAL INSTRUMENT. A medical instrument must have: (A) a first joint that includes a first and a second limb, the first configured to be repositioned in relation to the second limb, according to the XY plane; (B) a second joint operatively coupled to the first joint. This second joint must comprise a third and a fourth member, the third configured to be repositioned in relation to the fourth member, according to the YZ plane perpendicular to the XY plane; and (C) a controller must include a first control configured to direct the replacement of at least one first and second member, and a second control configured to direct the replacement of at least one of the third and fourth members.
公开号:BR112014003655B1
申请号:R112014003655-1
申请日:2012-08-15
公开日:2021-02-09
发明作者:James David Hughett；Keith Edward Martin；Salvatore Privitera
申请人:Atricure, Inc.；
IPC主号:

专利说明:

Cross-reference for related orders
[001] The present application claims the benefit of the US Provisional Patent Application, Series no. 61 / 523,805, entitled "LAPAROSCOPIC DEVICE," which was presented on August 15, 2011, the description of which is incorporated herein, through this reference. Related technique Field of the Invention
[002] The present invention is directed to surgical equipment and, more specifically, to those that can be used in minimal invasion surgeries. The description also refers to surgical equipment that facilitates the positioning and use of an atrial appendage occlusion device. In addition, the description refers to surgical equipment that adapts to fix or work in conjunction with flexible endoscopes. Introduction to the invention
[003] In PCT patent application W02004 / 112618 a medical forceps implantation instrument is known which comprises a housing with a plurality of controls, a repositionable mechanism comprising first and second repositionable members, in relation to each other, in an XY plane attached to the repositionable mechanism of third and fourth members and a terminal effector in which a clamp is removably mounted, in which the controls include a passive control that has a first position that allows the free movement of the first joint and, therefore, of the effector terminal in the XY plane and a second position that stops said movement, a second control that controls the movement of the second joint and, therefore, of the terminal effector in the XY plane, and a third control to implant the clamp.
[004] The examples of procedures described here include one or more active or passive repositioning mechanisms. As will be detailed below, an active repositioning mechanism provides infinite adjustments, since the user is physically operating a control to directly manipulate the positioning of a terminal effector. On the other hand, a passive repositioning mechanism can be thought of as acting in a similar way to a light switch, which can be turned off or on. In this way, the passive repositioning mechanism allows or not the repositioning of the end effector, but it is not responsible for the active manipulation of the position of the end effector. In other words, the passive repositioning system allows the freedom of movement of the terminal effector, within the range of its movement, when the mechanism is in the "on" position, but blocks the movements of the terminal effector, within the range of its movement, when the mechanism is in the "off" position. As an example, a laparoscopic device may incorporate a repositioning mechanism, both active and passive, to control movements in different directions, such as head and yaw.
[005] Examples of procedures also include active repositioning mechanisms that provide some movement conversion. In other words, a 90 ° movement in the position of the controller could result in a 45 ° change in the position of the terminal effector. As described here, certain parameters can be changed to provide the conversion of different movements, depending on the final application and the user's preference.
[006] It is a first aspect of the present invention to provide a medical instrument that has: (a) a first joint that includes a first and a second member, the first configured to be repositioned in relation to the second member, within the XY plane; (b) a second joint operatively coupled to the first joint. This second articulation must comprise a third and a fourth member, the third configured to be repositioned in relation to the fourth member, within the YZ plane perpendicular to the XY plane; and (c) a controller operatively coupled with the first and second hinge. In addition, the controller must include a first control configured to direct the replacement of at least one first and second member, and a second control configured to direct the replacement of at least one of the third and fourth members.
[007] In a more detailed procedure of the first aspect, where the first control comprises a passive control configured to be repositioned in a first position, which allows free movement between the first and the second member, within the X-Y plane; and a second position that slows down the movement between the first and the second member, within the X-Y plane. The second control comprises an active control configured to be repositioned among an infinite number of positions, where each one directs the third member, regarding the fourth, in a different position, within the Y-Z plane. In yet another more detailed procedure, passive control includes a repositioned lever mounted in a controller cabinet. The lever is coupled to a passive control line and said line is also coupled to a movable connector configured to connect at least one of the first and second members, in order to delay the movement between them, within the X-Y plane. In another detailed procedure, using a spring, the movable connector is inclined to delay the movement between the first and the second member, within the X-Y plane; and the lever is configured to be repositioned and to tension the passive control line, thus correcting the slope of the spring and allowing movement between the first and second members, within the X-Y plane. In yet another detailed procedure, the instrument also includes a longitudinal duct that extends between the controller and the first joint, where at least a portion of the passive control line extends through the longitudinal duct. In another example, the instrument also includes a longitudinal conduit that extends between the controller and the first joint, where the first member is mounted on the controller and the second is repositioned and mounted on the first member. In a more detailed procedure, the first member is elongated and includes an internal cavity that encapsulates at least one movable connector to delay movement between the first and second members, within the X-Y plane; and at least one, between the first member and the longitudinal conduit encapsulates a spring by tilting the movable connector in order to delay the movement between the first and the second member, within the X-Y plane. In another more detailed procedure, at least one, between the first and the second member includes a protrusion; and at least one, between the first and the second member includes a cavity configured to receive the protrusion. The cavity is defined, in part, by a support surface and the projection is configured to have contact with the support surface when movement occurs between the first and the second member, within the X-Y plane. In another example of procedure, the first member includes the cavity, the second includes the protrusion, the movable connector includes at least one external tooth. The second member includes at least one external tooth configured to engage at least one of the teeth of the movable connector and thus delay movement between the first and second members, within the X-Y plane. Continuing, in another detailed procedure, the cavity comprises a first and a second cavity, spaced and arranged separately in front of each other. The projection comprises a first and a second projection, spaced and arranged separately in front of each other. The first cavity is configured to receive the first protrusion and the second cavity is configured to receive the second protrusion.
[008] In yet another more detailed procedure of the first aspect, the first member comprises a cuff and the second comprises a pelvis. In another example of procedure, the first control comprises a passive control configured to be repositioned in a first position that allows free movement between the first and the second member, within the X-Y plane; and a second position that slows down the movement between the first and the second member, within the X-Y plane. The clamp includes an internal cavity that at least partially receives a movable connector and an inclined spring. The movable connector comprises a part of the first control. The first control also includes a mobile drive mounted on the controller and the first control also includes a cord together with the drive and mobile connector. In another also detailed procedure, the pelvis includes a first half of the pelvis and a second half of the pelvis. The first half and the second half of the pelvis are identical. In yet another detailed procedure, the active control includes a mobile drive mounted in the controller cabinet. The drive is operatively coupled to an active control line and the active control line is coupled to at least one, between the third and fourth member, in order to control the movement between the third and fourth member, within of the YZ plan. In a more detailed procedure, the drive includes a wheel and a connection plate. The wheel includes a spiral cavity and the connecting plate includes a projection configured to be received inside the spiral cavity of the wheel. In a more detailed procedure, the drive includes a wheel and a connection plate. The connection plate includes a spiral cavity and the wheel includes a projection configured to be received inside the spiral cavity of the connection plate. In another procedure, the drive includes a wheel and a connection plate. The connection plate includes a spiral cavity and the wheel includes a spiral projection configured to be received inside the connection plate cavity. In yet another more detailed procedure, the drive includes a wheel and a connection plate. The wheel includes a cavity and the connecting plate includes a spiral protrusion configured to be received inside the wheel cavity.
[009] In a more detailed procedure of the first aspect, the second control comprises an active control configured to be repositioned among an infinite number of positions, where each one directs the third member, regarding the fourth, in a different position, inside of the YZ plan. The second member is mounted on the third member and it is repositioned and mounted on the fourth member. In yet another more detailed procedure, the fourth member is elongated and includes an internal cavity that encapsulates, at least partially, a movable thrust connection; and the fourth member includes a channel configured to receive at least part of the active control line. In another detailed procedure, the channel includes a first and a second arcuate segment. The active control line includes a first and a second active control line. The first arcuate segment is configured to receive the first active line of control. The second arcuate segment is configured to receive the second active control line. At least part of the first active control line is attached to the fourth member and at least part of the second active control line is attached to the fourth member. In yet another detailed procedure, at least one of the third and fourth members includes a ledge. At least one, between the third and the fourth member, includes a cavity configured to receive the protrusion. The cavity is defined, at least partially, by a support surface and the projection is configured to have contact with the support surface when movement occurs between the third and the fourth member, within the Y-Z plane. In a more detailed procedure, the fourth member includes the cavity and the third includes the protrusion. In a more detailed procedure, the cavity comprises a first and a second cavity, spaced and arranged separately in front of each other. The projection comprises a first and a second projection, spaced and arranged separately in front of each other. The first cavity is configured to receive the first protrusion and the second cavity is configured to receive the second protrusion. In another more detailed procedure, the second control comprises an active control configured to be repositioned among an infinite number of positions, where each one directs the third member, regarding the fourth, in a different position, within the Y-Z plane. The third member comprises a pelvis and the fourth comprises a joint. In yet another more detailed procedure, the active control includes a mobile drive mounted in the controller cabinet. The drive is operatively coupled to a first and a second active control line. The joint includes an internal cavity that receives, at least partially, a movable push connection and also includes a first channel configured to receive at least a part of the first active control line and a second configured to receive at least one part of the second active line of control. At least part of the first and second active control lines are attached to the joint. In yet another more detailed procedure, the second and third members are assembled together and cooperate to form a pelvis.
[0010] In yet another more detailed procedure of the first aspect, the drive includes a first wheel, a first connection plate, a second wheel and a second connection plate. Each of the wheels (first and second) includes a spiral cavity. Each of the connecting plates (first and second) includes a projection configured to be received inside a spiral cavity of the wheels, of the first and second respectively. The first active control line is attached to the first link plate and the second active control line is attached to the second link plate. In yet another more detailed procedure, the first wheel is a mirror image of the second wheel. In another procedure, the spiral cavity of each wheel (first and second) includes an arcuate wall that describes the spiral cavity. The projection of each of the connecting plates (first and second) includes a curved surface that is configured to have contact with the arched wall of the respective spiral cavity. In yet another detailed procedure, the first control comprises a first passive control configured to be repositioned in a first position that allows free movement between the first and the second member, within the X-Y plane; and a second position that prevents movement between the first and second members, within the X-Y plane. The second control comprises a second passive control configured to be repositioned in a first position that allows free movement between the third and fourth members, within the Y-Z plane; and a second position that prevents movement between the third and fourth members, within the Y-Z plane. In a more detailed procedure, the first passive control includes a drive mounted in the controller cabinet. The drive is coupled to a first passive control line and said line is also coupled to at least one of the first and second members, in order to delay the movement between the first and second members, within the X-Y plane. In a more detailed procedure, the drive is configured to be repositioned and to allow movement between the first and second members, within the X-Y plane. In yet another more detailed procedure, the first member is elongated and includes an internal cavity that encapsulates, at least partially, a movable connector to retard movement between the first and the second member, within the X-Y plane; and at least one, between the first member and the longitudinal duct, encapsulates a spring that slopes over the movable connector to delay movement between the first and second members, within the X-Y plane.
[0011] In a more detailed procedure of the first aspect, at least one, between the first and the second member includes a boss. At least one, between the first and the second member includes a cavity configured to receive the protrusion. The cavity is defined, at least partially, by a support surface. The projection is configured to have contact with the support surface when movement occurs between the first and second members, within the X-Y plane. In yet another more detailed procedure, the first member includes the cavity, the second includes the projection, the movable connector includes at least one external projection. The second member includes at least one external projection configured to engage at least one of the projections of the movable connector in order to delay movement between the first and the second member, within the X-Y plane. In another detailed procedure, the cavity comprises a first and a second cavity, spaced apart and facing each other. The projection comprises a first and a second projection, spaced apart and facing each other. The first cavity is configured to receive the first protrusion and the second cavity is configured to receive the second protrusion. In yet another detailed procedure, the first member comprises a cuff and the second comprises a pelvis. In a more detailed procedure, the clamp includes an internal cavity that, at least partially, receives a movable connector and an inclined spring. The movable connector comprises a part of the first control. The first control also includes a mobile drive mounted on the controller and also includes a cord together with the drive and mobile connector. In a more detailed procedure, the pelvis includes a first half of the pelvis and a second half of the pelvis. The first and second half of the pelvis are identical. In another more detailed procedure, the second control includes a mobile drive mounted in the controller cabinet, the drive is operatively coupled to the passive control line. The passive control line is coupled to at least one, between the third and the fourth member, in order to control the movement between said members, within the Y-Z plane. In yet another more detailed procedure, the drive includes a pressable button that extends through the controller cabinet which is configured to be engaged with a receiver. The drive includes at least one external tooth and the receiver includes at least one external tooth configured to selectively engage at least one external tooth of the drive. In yet another more detailed procedure, the mobile drive is mounted in the controller cabinet and said drive comprises a part of the first and the second control. The first passive control includes a first mobile receiver mounted in the controller cabinet. The first receiver is operatively coupled to a first line mounted at least on the first and second members. The second passive control includes a second mobile receiver mounted on the controller cabinet and said second receiver is operatively coupled to the second line mounted on at least one, between the third and the fourth member.
[0012] In yet another more detailed procedure of the first aspect, the actuation has a pressable button that tilts through a spring. The drive is configured to be repositioned between a first and a second position, allowing the first position to move freely between the first and the second member, within the X-Y plane; allowing free movement between the third and fourth members, within the Y-Z plane; and slowing free movement between the first and second members to the second position, within the X-Y plane; and delaying free movement between the third and fourth members, within the Y-Z plane. The drive can be locked in the first position. The drive will not engage the first or second receiver in the first position, but will engage the first and second receiver in the second position. In yet another more detailed procedure, the drive has a pressable button that tilts through a spring to engage the first and second receivers. The first and second receivers are rotationally repositioned along a coil that extends internally inside the controller when not engaged with the pushbutton. The first and second receivers are not rotationally repositioned along the coil when engaged with the pushbutton. In another detailed procedure, the instrument also includes a terminal effector operatively coupled with the first and second articulation. In yet another detailed procedure, the terminal effector includes at least one of a surgical dissector, an ablation tip, an occlusion clamp, an occlusion clamp applicator, surgical forceps, surgical jaws, a linear cutter, an ablation clamp and an ablation route. In a more detailed procedure, the controller includes a third control operatively coupled to the terminal effector. In a more detailed procedure, the end effector includes a device used as a clamp and the third control includes a connection that extends from the controller to the end effector to control the repositioning of at least part of the device used as a clamp. In another more detailed procedure, the device used as a forceps includes removable opposing jaws attached to an occlusion forceps. The connection is configured to be repositioned and remove the occlusion clamp and be attached to the opposite jaws. In yet another more detailed procedure, each of the opposing jaws includes an orifice through which a cord extends. The cord is attached to the occlusion clamp, and the connection attached to the cord is removed.
[0013] In yet another more detailed procedure of the first aspect, the cord comprises a suture loop and the connection interposes between the suture loop and the occlusion forceps. In yet another aspect of the invention, the end effector includes a device used as a clamp and the third control includes a connection that extends from the controller to the end effector in order to control the repositioning of at least part of the device used as a clamp . In addition, in another detailed procedure, the second articulation includes a channel along which an impulse connection for the passage is configured. The impulse connection is operatively coupled to the third control and to the device used as a clamp. The device used as a clamp includes at least two connecting clamps operatively coupled to the push connection. Each of the two connecting clamps has a non-circular flesh that extends from the flesh surface of at least one of the two jaws. At least two connecting clamps are configured to rotate the two jaws until the interaction between the meat and the meat surface inhibits the rotation.
[0014] It is a second aspect of the present invention to provide a medical instrument that has: (a) a controller that, at least partially, encapsulates a plurality of controls; (b) an elongated conduit operatively coupled to the controller of a first and a second joint; (c) a first joint that includes a first and a second member, the first configured to be repositioned in relation to the second member, in the X-Y plane; (d) a second joint operatively coupled to the first joint. This second joint must comprise a third and a fourth member, the third configured to be repositioned in relation to the fourth member, on the Y-Z plane perpendicular to the X-Y plane; and (e) a terminal effector operatively coupled to the first and second joints, where the plurality of controls include a first control operably coupled to the first joint to control the movement of the first member in relation to the second member, in the X-Y plane. A second control operatively coupled to the second joint to control the movement of the third member in relation to the fourth member, in the Y-Z plane. A third control operatively coupled to the movement control of the end effector of at least a part of the end effector.
[0015] In a more detailed procedure of the second aspect, the instrument also includes a removable occlusion clamp mounted on the end effector, where the plurality of controls includes a fourth control to disassemble the occlusion clamp from the end effector. In yet another more detailed procedure, the first control comprises a passive control configured to be repositioned in a first position, which allows free movement between the first and the second member, within the X-Y plane; and a second position that slows down the movement between the first and the second member, within the X-Y plane. The second control comprises an active control configured to be repositioned among an infinite number of positions, where each one directs the third member, regarding the fourth, in a different position, within the Y-Z plane. In another detailed procedure, the third control comprises a second active control configured to be repositioned between an infinite number of positions, where each one directs the terminal effector in a different position. In yet another detailed procedure, the instrument also includes a removable occlusion clamp mounted on the end effector, where the plurality of controls includes a fourth control to disconnect the occlusion clamp from the end effector. The fourth control includes a passive control configured, either to disconnect or retain a connection between the end effector and the occlusion clamp. In a more detailed procedure, the first control comprises a first passive control configured to be repositioned in a first position, which allows free movement between the first and the second member, within the X-Y plane; and a second position that slows down the movement between the first and the second member, within the X-Y plane. The second control comprises a second control configured to be repositioned between a first position, which allows free movement between the third and fourth members, within the Y-Z plane; and a second position that slows down the movement between the third and fourth members, within the Y-Z plane. In a more detailed procedure, the third control comprises an active control configured to be repositioned among an infinite number of positions, where each one directs the terminal effector in a different position.
[0016] In yet another more detailed procedure of the second aspect, the first control comprises a first passive control configured to be repositioned in a first position, which allows free movement between the first and the second member, within at least 90 ° in the XY plane; and a second position that slows down the movement between the first and the second member, within the X-Y plane. The second control comprises a second control configured to be repositioned between a first position, which allows free movement between the third and the fourth member, within at least 90 ° in the Y-Z plane; and a second position that slows down the movement between the third and fourth members, within the Y-Z plane. In yet another more detailed procedure, the first control comprises a passive control configured to be repositioned in a first position, which allows free movement between the first and the second member, within at least 90 ° in the X-Y plane; and a second position that slows down the movement between the first and the second member, within the X-Y plane. The second control comprises an active control configured to be repositioned between an infinite number of positions, within at least 90 ° in the YZ plane, where each one directs the third member, regarding the fourth, in a different position, within the YZ plan. In another detailed procedure, the active control includes two wheels (first and second) that also comprise two spiral cavities (first and second), respectively formed in the same control. The two spiral cavities (first and second) are mirror images of each other and the active control also includes a first connection plate coupled to a first connection line and a second connection plate attached to a second connection line. The first connection plate includes a first protrusion configured to be received inside the first spiral cavity. The second connection plate includes a second protrusion configured to be received inside the second spiral cavity. The first and second wheels are coupled together, so that the rotation of one wheel causes the corresponding rotation of the other, and the rotation in a first direction causes tension in the first line and not in the second connecting line. However, rotation in a second direction opposite to the first, causes tension in the second line and not in the first connecting line. The tension in the first connecting line causes movement in a positive X direction within the YZ plane, while the tension in the second connecting line causes movement in a negative X direction within the Y-Z plane. In yet another detailed procedure, the terminal effector includes at least one of a surgical dissector, an ablation tip, an occlusion clamp, an occlusion clamp applicator, surgical forceps, surgical jaws, a linear cutter, an ablation clamp and an ablation route. Brief description of the graphics
[0017] FIG. 1 is an elevated perspective view of the example of a laparoscopic device, in accordance with the present description.
[0018] FIG. 2 is an enlarged view of the example in FIG. 1, showing a proximal end of the laparoscopic device.
[0019] FIG. 3 is an elevated perspective view of the example in FIG. 2, which shows a proximal end of the laparoscopic device without the left side cabinet.
[0020] FIG. 4 is an elevated perspective view of the example in FIG. 2, which shows a proximal end of the laparoscopic device without the right side cabinet.
[0021] FIG. 5 is an elevated perspective view of the right and left side cabinets mounted together.
[0022] FIG. 6 is a perspective view under the right and left side cabinets mounted together.
[0023] FIG. 7 is an elevated perspective view of the example in FIG. 1, showing a wheel of the laparoscopic device.
[0024] FIG. 8 is a profile view of the wheel of the example of FIG. 7.
[0025] FIG. 9 is a perspective view under the wheel of the example of FIG. 7.
[0026] FIG. 10 is a bottom view of the wheel, from the example of FIG. 7.
[0027] FIG. 11 is an elevated perspective view of the example in FIG. 1, showing the right side of a laparoscopic device connection plate.
[0028] FIG. 12 is an elevated perspective view of the example in FIG. 11, which shows the left side of the connection plate.
[0029] FIG. 13 is an elevated perspective view of the example of FIG. 11, which shows the front part of the connection plate.
[0030] FIG. 14 is an enlarged view of the profile with the right side cabinet removed, showing the interaction between a wheel and a connection plate, in a first position.
[0031] FIG. 15 is an enlarged view of the profile with the right side cabinet removed, showing the interaction between a wheel and a connection plate, in a second position.
[0032] FIG. 16 is an enlarged profile view of a wheel and a connecting plate with the right side cabinet removed, showing the interaction between the wheel and the connecting tray, in a third position.
[0033] FIG. 17A is a profile view showing three vertical positions of the terminal effector, obtained using an active repositioning mechanism.
[0034] FIG. 17B is an overview showing three horizontal positions of the terminal effector (illustration using changes in the position of the semi-rigid conduit, in relation to the terminal effector), obtained using a passive repositioning mechanism.
[0035] FIG. 18 is an enlarged profile view with the right side cabinet removed, showing an angle θ between the connector and the cavity.
[0036] FIG. 19 is an elevated perspective view of the example in FIG. 1, which shows the outside of the right side cabinet of the laparoscopic device.
[0037] FIG. 20 is an elevated perspective view of the example in FIG. 1, showing the inside of the right side cabinet of the laparoscopic device.
[0038] FIG. 21 is an elevated perspective view of the example in FIG. 1, showing the outside of a lever of the laparoscopic device.
[0039] FIG. 22 is a profile view of the lever of the example of FIG. 21.
[0040] FIG. 23 is an elevated perspective view of the example in FIG. 21, showing the inside of the lever.
[0041] FIG. 24 is an elevated perspective view of the example in FIG. 1, showing the outside of the left side cabinet of the laparoscopic device.
[0042] FIG. 25 is an elevated perspective view of the example in FIG. 1, showing the inside of the right side cabinet of the laparoscopic device.
[0043] FIG. 26 is an enlarged profile view of the interior of a proximal part of the controller of the laparoscopic device of FIG. 1, with the left side cabinet removed.
[0044] FIG. TJ is an enlarged profile view of the interior of a proximal part of the controller of the example of FIG. 1, with the right side cabinet removed.
[0045] FIG. 28 is an elevated perspective view of the example in FIG. 1, which shows a mechanism for manipulating the laparoscopic device.
[0046] FIG. 29 is a perspective view under the manipulation mechanism of the example of FIG. 28.
[0047] FIG. 30 is an elevated perspective view of the example in FIG. 1, showing the interior of the controller and the proximal portion of the laparoscopic device conduit with the left side cabinet removed.
[0048] FIG. 31 is an elevated perspective view of the example of FIG. 1, showing the interior of the controller and the proximal part of the laparoscopic device conduit with the right side cabinet removed and an example cover installed.
[0049] FIG. 32 is an elevated perspective view of the example of FIG. 1, showing the interior of the controller and the proximal part of the laparoscopic device conduit with the right side cabinet removed and an example cover removed.
[0050] FIG. 33 is a longitudinal cross-sectional view of an alternative conduit of the example used with the laparoscopic device of FIG. 1.
[0051] FIG. 34 is an enlarged view of the example in FIG. 1, showing the distal end of the laparoscopic device.
[0052] FIG. 35 is an elevated perspective view of the example of FIG. 1, showing a clamp of the laparoscopic device.
[0053] FIG. 36 is an elevated perspective view of a clamp in the example of FIG. 35, without the upper cabinet.
[0054] FIG. 37 is a clamp overview of the example of FIG. 36.
[0055] FIG. 38 is an elevated perspective view of the example in FIG. 35, which shows the lower clamp cabinet.
[0056] FIG. 39 is an elevated perspective view of the example in FIG. 1, showing a gear receiver of the laparoscopic device.
[0057] FIG. 40 is a front view of the example in FIG. 39, which shows the profile of the gear receiver.
[0058] FIG. 41 is a rear view of the example in FIG. 39, which shows the profile of the gear receiver.
[0059] FIG. 42 is an elevated perspective view of the example of FIG. 35, which shows a clamp without the upper cabinet and with a pair of gear plates and pelvis halves.
[0060] FIG. 43 is an elevated perspective view of the example in FIG. 35, which shows a clamp without the upper case and with a simple gear plate and half of a single pelvis.
[0061] FIG. 44 is an elevated perspective view of the example in FIG. 1, showing a gear plate of the laparoscopic device.
[0062] FIG. 45 is an external profile view of the example of FIG. 1, showing the pelvis half of the laparoscopic device.
[0063] FIG. 46 is a front profile view showing the assembled pelvis halves of FIG. 42.
[0064] FIG. 47 is an overview of the pelvis halves of the example of FIG. 46.
[0065] FIG. 48 is an elevated perspective view of the example in FIG. 1, showing the inside of a pelvis half of the laparoscopic device.
[0066] FIG. 49 is an elevated perspective view of the example in FIG. 1, which shows the repositioning of the laparoscopic device assembly clamps.
[0067] FIG. 50 is an elevated perspective view of the example of FIG. 1, showing a push and joint connection of the laparoscopic device.
[0068] FIG. 51 is an elevated perspective view of the example in FIG. 50, which shows the proximal end of the drive.
[0069] FIG. 52 is a horizontal cross-sectional view of the push and seal connection of the example of FIG. 50.
[0070] FIG. 53 is a horizontal cross-sectional view of the joint in the example of FIG. 50.
[0071] FIG. 54 is an elevated perspective view of the push connection of FIG. 50.
[0072] FIG. 55 is a horizontal cross-sectional view of the thrust connection and joint of the example coupled to the connection plates and connection clamps.
[0073] FIG. 56 is an elevated perspective view of the impulse connection of the example coupled to the connection plates and connection clamps.
[0074] FIG. 57 is an elevated perspective view of the example in FIG. 56, which shows the connection plates of the example coupled to the connection clamps.
[0075] FIG. 58 is an external perspective view of the example in FIG. 1, showing the left mandible of the laparoscopic device.
[0076] FIG. 59 is a perspective view of the example of FIG. 58, which shows the inside of the left lateral jaw.
[0077] FIG. 60 is an overview of the example of FIG. 1, which shows the position of the mandibles and other diverse components of the distal end of the laparoscopic device, in a broader, more compact direction.
[0078] FIG. 61 is an enlarged overview of the connecting jaws and clamps of FIG. 60.
[0079] FIG. 62 is an overview of the example of FIG. 1, which shows the position of the mandibles and other diverse components of the distal end of the laparoscopic device, since the impulse connection initially moves proximally.
[0080] FIG. 63 is an enlarged overview of the connecting jaws and clamps of FIG. 62.
[0081] FIG. 64 is an overview of the example of FIG. 1, which shows the position of the mandibles and other miscellaneous components of the distal end of the laparoscopic device, since the drive connection moves farther, proximally, than in FIG. 62.
[0082] FIG. 65 is an enlarged overview of the connecting jaws and clamps of FIG. 64.
[0083] FIG. 66 is an overview of the example in FIG. 1, which shows the position of the mandibles or other miscellaneous components of the distal end of the laparoscopic device, since the impulse connection moves to its most proximal position to fully open the mandibles.
[0084] FIG. 67 is an overview showing the position of the jaws and other miscellaneous components of the distal end if the laparoscopic device of the example of FIG. 1 does not include a pivot point between the jaws and the connecting clamps.
[0085] FIG. 68 is a perspective view of a clamp in an open position that can be used with the laparoscopic device in the example of FIG. 1.
[0086] FIG. 69 is a perspective view of the example of FIG. 68, which shows a clamp in a closed position.
[0087] FIG. 70 is a cross-sectional view of the example clamp of FIG. 68, in its open configuration, showing the cable member, rigid tubular members and the pusher members.
[0088] FIG. 71 is a cross-sectional view of the example clamp of FIG. 69, in its closed configuration, showing the cable member, rigid tubular members and the pusher members.
[0089] FIG. 72 is a perspective view of the claims of the example of FIG. 68-71, which shows the closing capacity in a non-parallel way.
[0090] FIG. 73 is a perspective view of the first stage of assembly of an alternative clamp procedure, showing a cable member surrounded by rigid tubular members.
[0091] FIG. 74 is a perspective view of the second assembly stage of the clamp of FIG. 73, in which the plates were added to the rigid tubular members.
[0092] FIG. 75 is a perspective view of the clips in the example of FIG. 73 and 74, since the outer fabric cover has been eliminated over the entire surface of the clamp.
[0093] FIG. 76 is an elevated perspective view of an alternative controller of the example that can be used with the laparoscopic device of FIG. 1.
[0094] FIG. 77 is an elevated perspective view of the example in FIG. 76, which shows the alternate controller displayed without the left side enclosure.
[0095] FIG. 78 is an enlarged perspective view of the interior of a distal portion of an alternative controller of the example of FIG. 76.
[0096] FIG. 79 is a profile view of the structure shown in FIG. 78 with the button displayed in its highest vertical position.
[0097] FIG. 80 is a profile view of the structure shown in FIG. 78 with the displayed button pressed in its lowest vertical position.
[0098] FIG. 81 is an enlarged perspective view of the interior of a distal part of the alternative controller of the example of FIG. 76, shown without the button and the first gear assembly.
[0099] FIG. 82 is an enlarged perspective view of the interior of a distal part of the alternative controller of the example of FIG. 76, displayed without the button. Detailed Description
[00100] The procedures of the example in this description are detailed and illustrated below and refer to surgical equipment and, more specifically, to those that can be used in minimally invasive surgeries. The description also refers to surgical equipment that facilitates the positioning and use of an atrial appendage occlusion device. In addition, the description refers to surgical equipment that adapts to fix or work in conjunction with flexible endoscopes. Of course, it is evident to those skilled in the art, that the procedures described below are examples in nature and can be reconfigured without departing from the scope and spirit of the present description. However, for reasons of clarity and precision, such procedures described below may include optional phases, as well as methods and characteristics that persons of ordinary skill will recognize that are not required to be within the scope of this description.
[00101] FIGURES 1-6 in reference show a laparoscopic device of example 100 which comprises a controller 110 mounted on a proximal part of a semi-rigid conduit 112 which is relatively linear. Controller 110 includes several controls in order to manipulate a repositioning mechanism 116 operatively coupled to a terminal effector 118, where the repositioned mechanism is mounted on a distal part of conduit 112. In this example procedure, repositioned mechanism 116 is coupled to a terminal effector comprising a device used as a clamp 118. But, as will be described in subsequent procedures, terminal effector 118 can comprise any number of devices. They can be forceps, ablation routes, jaws, linear cutters, ablation tips, ablation supports, illuminated dissectors and non-illuminated dissectors.
[00102] The repositioned mechanism of example 116 incorporates an active and a passive mechanism. It should be noted that the active mechanism works to control the header (up and down) of the end effector 118, while the passive mechanism works to control the yaw (from side to side) of the end effector. However, as will be evident from the description below, the repositioned mechanism 116 in an alternative procedure of the example can comprise only active or passive mechanisms. On the other hand, the repositioned mechanism 116 in other alternative procedures of the example, can be used as a passive mechanism to control the header (up and down) of the end effector 118, while an active mechanism works to control the yaw (from a side to side) of the terminal effector. Those skilled in the art will understand that the following description is one of a plurality of configurations that include active and passive mechanisms for controlling the movement of a terminal effector 118 in two planes.
[00103] Controller 110 comprises a right side cabinet 130 and a left side cabinet 132 that cooperatively define an internal cavity and corresponding openings to trigger the performance of certain controls. The first of these openings is a back opening 134 that drives the performance of a pair of wheels 136, 138 that is repositioned along the side axles.
[00104] With reference to FIGURES 7-10, each wheel 136, 138 includes a contact face 140 adapted to have contact and be actuated by a user, in order to rotate the wheel. The contact face 140 includes a series of distributed peripheral depressions 142 interposed by a series of protrusions 144 to facilitate adhesion between the user and the wheel 136, 138. Each protrusion 144 is angled to match the contour of the wheel 136, 138, which decreases from a maximum where the contact face 140 borders with an inner face 146. Radially inserted in the depressions 142 and in the protuberances 144 there is a flat surface of the ring 148, which peripherally describes the external limit of an outer cavity ring-shaped 152. A pair of inclined surfaces 154, 156 inserted from the surface of the ring 148 and spaced axially from each other, works to restrict the diameter of the cavity 152 when moving in the direction of the axis, even more deeply in the cavity. The cavity 152 is also partly bounded by a hollow shaft 158 that extends from the center of each wheel 136, 138. This shaft 158 is peripherally surrounded at its base by a landing 162, where the shaft and the landing cooperate to increase gradually the radial dimension of the ring-shaped cavity 152. An interior of the axis 158 defines a cylindrical cavity 166 that continues like this until it reaches an interior medial point where the cavity takes the semicircular shape and extends across the inner surface 146. One semicircular protrusion 170 adjacent to cavity 166 generally projects perpendicularly out of the inner surface 146. The inner surface 146 also includes a spiral cavity 172, it is distributed approximately at 220 ° around the protrusion 170. In this way, the distance radial between the cavity 172 and the protrusion 170 changes gradually until reaching a maximum and a minimum at the ends of the cavity.
[00105] With reference to FIGURES 11-13, the wheels 136, 138 are operatively coupled to the repositioning mechanism 116 and work to monitor the passage of that mechanism. In order to monitor the passage of the repositioned mechanism 116 each wheel 136, 138 is coupled to a connection plate 180, which converts the rotational movement of the wheel into longitudinal movement along the longitudinal axis that extends along the length of the duct 112 In particular, each connection plate 180 comprises a key shape that has a flat section 182 and a plurality of stamped openings 184, 186, 188. The first of these stamped openings 184 is horseshoe-shaped and creates a projection protruding into the interior. opening. This projection is then deformed by folding, approximately 90 °, to create a tongue 190 that extends perpendicularly out of the flat section 182. The second opening 186 has an oval shape with generally circular ends and is provided in order to reduce the weight of the connection plate 180 and provide a complementary opening for the semicircular projection 170 of a corresponding wheel 136, 138 (See FIGURES 8-10). The third opening 188 has a width that is substantially less than the vertical dimension, to create an elongated opening, generally rectangular, with rounded edges. This third opening 188 provides performance for a cable connection 194 and cooperates with a medium curve 196 to secure the cable connection to the connection plate 180. In particular, the end of the flat section 182 is deformed to create the medium curve 196, where the cable connection 194 is within (that is, the concave aspect of the medium curve) the medium curve and extends through the third opening 188. In this example procedure, the cable connection 194 includes a cylindrical sleeve 198 which is attached to the cable to prevent lateral movement between the sleeve and the cable. The sleeve 198 is dimensioned to allow the production of the sleeve and the connection of the cable 194 through the third opening 188. In particular, after the production of the sleeve 198 and the connecting cable 194 through the third opening 188, the sleeve 198 is positioned longitudinally against the connection plate 180 and limits with the average curve 196. Specifically, the sleeve 198 is dimensioned so that it cannot pass through the medium curve 196 when positioned longitudinally against the connection plate 180. In this way, the repositioning of the cable connection 194 can be carried out by repositioning the connection plate 180 to put the connection cable 194 in tension. Each connecting plate 180 also includes a spacer flange 200 that extends over the second opening 186. The spacer flange 200 comprises an S-shaped longitudinal spacer fold, which is applied to the upper part of the key shape. This flange 200 cooperates with a flange 200 corresponding to another connection plate 180 to fix the appropriate spacing between the adjacent connection plates.
[00106] With reference to FIGURES 2, 3 and 7-17, the assembly of the wheels 136, 138 and the connecting plates 180 provide a means to move the repositioning mechanism 116 upwards or downwards, simply by rotating the wheels in the direction clockwise or counterclockwise. In particular, the connecting plates 180 are mounted at the rear, with one of the connecting plates 180 inverted, so that the flanges 200 are inside facing each other. In this way, the flange 200 of a first connection plate 180 is limited with the flat surface 182, while the flange of the second connection plate 200 is limited with the flat surface 182 of the first connection plate. In this orientation, the connectors on each connection plate 180 extend outwardly, away from each other. More specifically, the connectors 190 (and a portion of the connecting plates 180) attach between the inner faces 146 of the wheels 136, 138 and are received within a spiral cavity 172 of the respective adjacent wheel 136, 138. However, when the inner faces 146 approach, the semicircular projections 170 of the wheels 136, 138 are aligned so that the flat surfaces of the projections are limited to each other. In this way, forming a cylindrical projection that projects through both second openings 186 of the connection plates 180.
[00107] Referring specifically to FIGURES 14-17A, the rotation of the wheels 136, 138, together, works to change the vertical direction of the repositioning mechanism 116. For example, starting at position A, as shown in FIG. 17A, the rotation of the wheels 136, 138 from the top, moving distally and downwards, works to push the first connection plate 180 proximally, while the second connection plate is pushed distally. In other words, the rotation movement of the wheels 136, 138 through the interface between the spiral cavity 172 and the connectors 190, is transformed into a horizontal movement of the connection plates 180. More specifically, the connector 190 of the first connection plate 180 is limited to one end of the spiral cavity 172 of the first wheel 136, which works to limit the vertical travel of the repositioning mechanism 116. In this example procedure, the vertical travel is limited so that the maximum deflection angle is -60 ° horizontal. In order to bring the repositioning mechanism 116 upwards, the wheels 136, 138 rotate clockwise, thus changing the position of the spiral cavity 172 in relation to the connector 190. As an example, the connector 190 moves in a spiral 172 inside the spiral cavity and is kept in a constant horizontal direction in relation to the cavity because of the tension of the connection cable 194 which pushes the connection plate 180 proximally. But as the wheels 136, 138 rotate clockwise from position A, the distance from the center of the wheels to the spiral cavity 172 occupied by the connectors 190 decreases, thus repositioning the first connection plate 180 proximally to the wheels. The continuous rotation of the wheels 136, 138 clockwise (about 1/2 turn) works to raise the repositioning mechanism 116 and reach position B (see FIG. 17A), where the repositioning mechanism has an angle of 0o (zero) degree) horizontal. Increased clockwise rotation of the wheels 136, 138, (about Vi turn) works to raise the repositioned mechanism 116, to reach position C (see FIG. 17A), where the repositioning mechanism has an angle of 60 ° horizontal. On the other hand, the rotation of the wheels 136, 138 from the top, moving proximally and downwards, works to push the first connection plate 180 distally, while pushing the second connection plate proximally, decreasing thus the repositioning mechanism 116 by means of connection cables 194.
[00108] The rotation of the wheels 136, 138 is proportional to the turning movement of the repositioning mechanism 116. It should be noted that the position C corresponds to the connector 190 adjacent to the opposite end of the spiral cavity 172, which works to fix the limit of the vertical travel of 60 ° in relation to the horizontal. Simply by rotating the wheels 136, 138 approximately 360 °, the repositioning mechanism works to move 120 °. Accordingly, wheels 136, 138 function to convert 3rd (three degrees) of rotational motion into Io (one degree) of rotational motion. And the spiral shape of the cavity 172 can be modified to increase or decrease the conversion between the rotation movement of the wheels 136, 138 to the turning movement of the repositioning mechanism 116. For example, the passage of the spiral cavity 172 can be configured to that two full rotations of the wheels 136, 138 are necessary to move from one end to the opposite end of the cavity. In this example, the conversion would be 6o (six degrees) of rotation movement resulting in Io (one degree) of rotation movement (assuming that the maximum rotation range is 120 °). In other words, two full rotations of the wheels 136, 138 would be needed to move between the turning ends of the repositioning mechanism 116. In contrast, the spiral passage can be adjusted to extend around one third of the wheels 136, 138, so that the conversion is 1 in 1 (that is, 1 ° (one degree) of rotation movement resulting in Io (one degree) of rotation movement).
[00109] The spiral cavity 172 can also be adjusted to have variable rates according to the rotation of the wheels 136, 138. In other words, the change in the distance from the center of the wheels 136, 138 to the cavity 172 is not constant along of all 360 °. For example, the medial section of cavity 172 may have a passage that correlates with 2 ° (two degrees) of rotation and can be converted into 1 ° (1 degree) of rotating movement of the repositioning mechanism 116, within ± 20 °, in relation to the horizontal (that is, 0o). Beyond this point, the passage of cavity 172 is reduced so that the last 40 ° of movement (between 20 ° to 60 ° and -60 ° to -20 °) are obtained by retracting the wheels 3 ° (three degrees) to reach 1 ° (one degree) of turning motion. Those skilled in the art will understand that various combinations can be obtained by altering the passage of cavity 172 and having one or more sections of the cavity with different steps.
[00110] With reference to FIGURE 18, the passage (i.e., angle 0) of the spiral cavity 172 also influences in case the repositioning mechanism 116 closes by itself. In the context of the present description, "closed by itself" refers to automatically preventing movement. As an example, as the angle 0 of the spiral cavity 172 increases (and the conversion of degrees of rotation to degrees of rotation decreases), the resistance to movement of the connector 190 inside the cavity 172 decreases. As an example, when the 0 angle between the connector and the cavity is 90 ° the resistance will be maximized. In contrast, when the 0 angle between the connector and the cavity is 0o (zero) the resistance will be minimized. At some angle 0 between 0 ° and 90 °, the resistance will be sufficiently greater to provide an automatic closing feature. In other words, to achieve an automatic closing feature, the resistance to movement of connector 190 inside cavity 172 must be greater than the tension force T in connection cable 194. The more spiral curves you understand cavity 172, the greater will be the angle 0. The less spiral curves the cavity 172 understands, the smaller the angle 0 and the greater the possibility of a rear load causing the wheels 136, 138 to rotate. In one example, the spiral cavity 172 has an angle of approximately 80 ° -85 °. This angle is sufficient to provide an automatic closing feature, so that a rear load (force applied directly to the repositioning mechanism 116 that is transmitted along the connection cable 194) does not work to activate the rotation of the wheels 136, 138, preventing thus the turning movement of the repositioning mechanism. However, it is advisable to avoid an automatic closing feature, at which point the shape of connector 190 and cavity 172 can be changed to decrease friction between them, including decreasing spiral turns to decrease angle 0.
[00111] As described above, the wheels 136, 138 are pruned and act as meat to reposition the connection plates 180, which in turn reposition the connection cables 194. As described in more detail below, the connection cables 194 they are mounted on connection 614 which rotates on the ply halves 594, 596, in order to provide an infinite number of positions within the range of movement allowed by the spiral cavity 172 of the wheels 136, 138. For the purposes of the present description, this mechanism it refers to an active repositioning mechanism because it is the affirmative rotation of the wheels that directly triggers a proportional movement of the connection 614 on the pelves halves 594, 596. In addition, a user of the wheels 136, 138 works to close the position of the end effector 118 simply by interrupting the rotation of the wheels. As an example, the rotation resistance of the wheels 136, 138 is the result of the angle between the limits of the cavity 172 and the connector 190 of the connection plates 180. Based on the structure of the present mechanism, a user of the wheels 136, 138 actively controls the position of terminal effector 118.
[00112] In an example of an alternative procedure, the active mechanism can be remotely controlled so that a user does not physically touch the wheels 136, 138, but instead activates a remote controller of them. The controller is communicatively coupled to an operating motor or propellant to drive the wheels in the desired direction, thus allowing remote control of the wheels.
[00113] In another example of alternative procedure, the active mechanism is removed from controller 110 and is repositioned at the distal end of conduit 112, close to terminal effector 118. In this procedure, the active mechanism is exposed and available to be manipulated by a robotic appendix, thus repositioning the terminal effector in place (in relation to controller 110). More specifically, the wheels will be divided by the robotic appendix, in order to reposition the end effector 118.
[00114] As described in more detail below, this active mechanism contrasts with another liability that has the function "on" and "off", allowing or not a certain movement of the terminal effector 118. At present the mechanism is referred to as passive, given that the mechanism does not affirmatively allow increased control of the movement of terminal effector 118, but only functions to enable or prevent movement.
[00115] With reference to FIGURES 1-5 and 19-23, the right side cabinet 130 of controller 110 also includes an outer depression 230 and a pair of finished openings 232, 234 to adapt the movable lever 236, which is part of the mechanism passive. As described in more detail below, the movable lever 236 can be manipulated to open and close the repositioning mechanism 116, in order to provide or stop the lateral adjustment of the end effector 118. The first finished opening 232 is defined by a cylindrical load 238 that protrudes perpendicularly out of the capsule 130. The load 238 includes an outer circular load surface 240 and an inner circular load surface 242 which are found through lever 236. Thus, lever 236 rotates around of the outer load surface 240 and route within the inner load surface 242. Lever 236 includes a narrow appendage 248 integrally formed by a hollow shell 250. An interior of the hollow shell 250 is lowered to define an inner cavity 252 outlined by a wall peripheral 254 having a generally circular shape at one end and an arcuate (but not rounded) shape at the other. A cylindrical straight protrusion 256 projects perpendicularly out of the interior of the hollow casing 250 and is generally separated, equidistantly, from the circular part of the peripheral wall 254, but extends along the height of the peripheral wall. A second cylindrical straight protrusion 258 is formed at a corner of the arcuate end of the peripheral wall 254. This second cylindrical projection 258 projects perpendicularly out of the interior of the hollow casing 250 (and parallel to the first cylindrical protrusion 256), and also extends along the height of the first cylindrical projection 256. The first cylindrical projection 256 is received inside the first finished opening 232 of the cylindrical load 238, while the second cylindrical projection 258 is received inside the second finished opening 234. The cross section circular of the first cylindrical projection 256, the first finished opening 232 and the dimensions of each allow the rotation of the first cylindrical projection inside the first finished opening without significant radial movement that would otherwise cause the lever 236 to not rotate, consistently, around a simple axis of rotation. On the other hand, the second finished opening 234 is elongated and takes an arcuate path, following the movement of the second cylindrical projection 258. More specifically, the second finished opening 234 includes rounded ends that generally correspond to the curvature and dimensions of the second projection 258, however, allow movement between the limits of the opening and the projection, so that it can move within the opening. At the same time, the height of the second finished opening 234 is slightly greater than the diameter of the second projection 258, while the arcuate path through the finished opening follows the position of the second projection, since the lever 236 rotates around the capsule 130. The limits or terminal ends of opening 234 provide a limit on the repositioning of rotation of lever 236. As described in more detail below, the limits provide a closed and an open position that corresponds to the closed or free lateral adjustment of terminal effector 118. More specific The lever 236 is coupled to a connection cable 261 by winding the connection cable around the first cylindrical projection 256. The remaining outer surface 260 of the right side capsule 130 is convex and includes a number of additional features. specific to FIGURES 2, 19 and 20, additional features include an elongated section 264, close to the distal end ai 262, which is rounded at the bottom. This elongated section 264 is reduced proximally and distally until the transition in a close neck 266 and a distal flange 268. Distal flange 268 is interposed with the elongated part 264 and a semicircular adapter 270. As described in more detail below, adapter 270 includes a pair of tongues 272 that engage the semi-rigid duct 112 in order to prevent longitudinal movement of the duct in relation to controller 110. Both tongues 272 extend parallel to each other and project from a peripheral surface 278 of adapter 270, which communicates with an outer part of semi-rigid duct 112. The outer part of adapter 270 is smooth and semicircular to receive a cylindrical cap 282 that circumscribes the outer part of adapter 270.
[00116] With reference to FIGURES 5 and 6, the outer surface 260 of the right side cabinet 130 also includes an inclined dorsal surface 284 (inclined downwards, distal to proximal) that connects in an arcuate manner to a sculpted hollow 286, and to a sloping middle surface 288, both of which link to a relatively flat ventral surface 290. As described in more detail below, the ventral surface 290 of the right side cabinet 130 cooperates with a corresponding ventral surface 294 of the left side cabinet 132, to delineate partially a port of the manipulation mechanism 296 and a port of manipulation retention 298. Both ports 296, 298 are open into the respective cabinets 130, 132. Surfaces 284, 288, 290 converge at the proximal end to partially define a proximal port 300, which is also open to the interior of cabinet 130.
[00117] Referring again to FIG. 20, the interior of the right side cabinet includes a series of hollow cylinders 304, which generally extend perpendicularly to the interior surface and are generally parallel to each other. Each cylinder 304 is dimensioned to receive a threaded fastener in order to mount the respective cabinets 130, 132 to each other. As an example, two of the hollow cylinders 304 are placed apart from each other by a cross member 306 which has a semicircular cutout. Extending proximally from these hollow cylinders 304, there is a pair of reinforcement ribs 308 that partially interpose by a projection 310 that has a corresponding shape defining the outer depression 230. At the proximal end of the projection 310 there is another pair of cylinders hollow 304. These hollow cylinders 304 are followed by another pair of reinforcement ribs 308 that interpose with a third set of hollow cylinders 304. These two hollow cylinders 304, which comprise the third set, are placed apart from each other by an element transverse 312 which includes an elongated protrusion 314 extending from proximal to distal. As described below, the elongated protrusion 314 is hollow and includes a corresponding cavity 316 that receives a part of the manipulation mechanism 320 (see FIG. 26). Finally, a proximal reinforcement rib 308 receives the third set of cylinders and a simple proximal cylinder 304. A part of the perimeter of the inner surface of the right side cabinet 130 includes an embedded shelf 322 which is within the corresponding channel 324 (see FIG. 25 ) of the left side cabinet 132 in order to arrange the cabinets 130-132. The interior of the right side cabinet also includes a tongue 326 that extends to the manipulation holding port 298 and is used to hold the manipulation mechanism in a clamping position.
[00118] With reference to FIGURES 5, 6, 24, and 25, the left side cabinet 132 is similar to that of the right side cabinet 130 and includes a convex outer surface 340 and a concave inner surface 342. The inner and outer surfaces 340- 342 converge to partially define the dorsal opening 134, the manipulation mechanism port 296, the manipulation holding port 298 and the proximal port 300.
[00119] The left side cabinet 132 of controller 110 includes an elongated section 354, close to distal end 352 which is rounded at its bottom. This elongated section 354 is reduced proximally and distally until it links the proximal neck 356 and a distal flange 358. The distal flange 358 is interposed between the elongated part 354 and a semicircular adapter 360. The exterior of the adapter 360 is smooth and semicircular to receive the cylindrical cover 282 that circumscribes the outside of the adapter 360.
[00120] The outer surface 340 of the left side cabinet 132 also includes an inclined dorsal surface 364 (inclined downwards, distal to proximal) that arches in an arcuate manner to a sculpted hollow 366 and to an inclined lateral surface 368, in which both link to a relatively flat ventral surface 294. The inclined side surface 368 includes a plurality of finished holes 370 which are partially connected by means of the corresponding hollow cylinders 372 which extend inside the left side cabinet 132. These cylinders 372 are adapted to be aligned with the hollow cylinders 304 of the right side cabinet 130 and receive the corresponding fasteners (not shown) to fix the cabinets together. In addition, the ventral surfaces 290, 294 of the enclosures 130, 132 cooperate to delineate the handling mechanism port 296 and the handling retention port 298. Surfaces 364, 368, 294 converge at the proximal end to partially define the proximal port 300 which is also open to the interior of cabinet 132.
[00121] The interior of the left side cabinet 132 includes several hollow cylinders 372, which generally extend perpendicularly from the inner surface 342 and are generally parallel to each other. As an example, two of the hollow cylinders 372 closest to the distal end are placed apart from each other and are generally of the same height. Extending proximally from these hollow cylinders 372, there are a pair of reinforcement ribs 378 that partially interpose by means of a cylindrical protrusion 380 that has a hollow inner cavity 382 and an approximate longitudinal height at the height of the cables. Extending proximally from the reinforcement ribs 378, there are a pair of hollow cylinders 372 which are placed apart from each other by an L-shaped transverse element 383. It should be noted that the dorsal cylinder 372 has a relatively equal height at the height of the total part of the transverse element, while the ventral cylinder has a height relatively equal to the height of the bottom of the transverse element. In addition, continuing the proximal path of the L-shaped cross member 383, a larger hollow cylinder 384 crosses a reinforcement rib 379 which has a cutout notch to mount the L-shaped cross member. , the larger cylinder 384 is an L-shaped cross member 385, followed by a pair of hollow cylinders 372 comprising a third set placed apart by a cross member 386, which includes an elongated protrusion 388 projecting proximally for distant. As described below, the elongated protrusion 388 is hollow and includes a corresponding cavity 390 which receives a part of the manipulation mechanism 320. Finally, a proximal reinforcement rib 392 is interposed with the third set of cylinders and a simple proximal cylinder 394. A part of the perimeter of the inner surface 340 of the left side cabinet 132 includes channels 324 that receive the fitted shelf 322 of the right side cabinet 130.
[00122] With reference to FIGURES 2 and 26 to 29, the handling mechanism 320 comprises a movable handle 400, a drive connection 402, a return spring 404 and a retracted plate 406. As described in more detail below, the plate retracted 406 is attached to a retracted cable 408, operatively attached to the device used as clamp 118 to selectively open and close an occlusion clamp 1160 (see FIG. 75), as well as during a surgical procedure using the occlusion clamp appendix atrial. A more detailed explanation of the respective components of the manipulation mechanism 320 is written below.
[00123] The movable handle 400 includes an arch, a ventral adhesion surface 414 that has a series of convex protuberances 416 placed longitudinally apart to facilitate grasping by the user. At the same time, the adherence of the ventral surface 414 reduces the medial to lateral direction, to a maximum between the proximal and distal ends. Opposite the ventral adhesion surface 414 is a corresponding interior surface 418 from which extends a pair of separate and parallel vertical walls 420-422. The vertical walls 420, 422 are also connected to each other, through a plurality of transverse walls 424. The proximal cross wall is also connected to a straight loop 428 which provides a through opening 430 in the medium to lateral direction. Extending distally from loop 428, the walls 420, 422 gradually increase in height and extend distally beyond the ventral adhesion surface 414. In particular, the most separate part of the walls 420, 422 each includes a rounded, dorsal end with circular opening 434 that extends in the middle to lateral direction. A distal wall 436 extends between the walls 420, 422 at the distal end and connects to the ventral adhesion surface 414. The circular openings 434 of the walls 420, 422 are aligned laterally, just like two other pairs of circular openings 440, 442 extending through the walls in the medial to lateral direction. Both the paired openings 440, 442 are smaller in diameter than the distal openings 434, and each is adapted to receive a pin 444 in order to mount the repositioning in the drive connection 402 to the handle 400. Although only one of the paired openings 440, 442 will be occupied by pin 444, the other unoccupied opening may be used, depending on the spring range, the return spring 404 and the device (e.g., device used as clamp 118) comprising the end effector 118.
[00124] A drive connection of example 402 comprises a U-shaped plate, which extends longitudinally, the size of which fits between the walls 420, 422 of the handle 400. A distal end of the plate 402 includes a U-shaped bend and a pair of finished openings (extending in a medial to lateral direction) receiving pin 444. A proximal end of plate 402 includes respective legs parallel to each other and each having a finished opening. Each of the legs of plate 402 is angled by the return spring with thread 404, which is in contact with the rounded end of each leg. In this example procedure, the return spring 404 is not rigidly coupled to the drive connection 402, but is inclined in relation to the drive connection and held in position by the inclination of the return spring that pushes it against the respective reinforcing ribs of the cabinets 130, 132 and the proximal ends of the plate 402. The finished openings in the legs receive a second pin 450, which is also received together, inside the cavity 390 of the elongated projection 388 and inside the cavity 316 of the elongated projection 314, which it is coupled to the drive connection 402 for the retracted plate 406.
[00125] The retracted plate 406 comprises a substantially straight and flat substrate that has three openings 460, 462 and 464 that extend in the medial to lateral direction. The first opening 460 receives a second pin 450 to mount the drive connection for the retracted plate 406. The second opening 462 comprises a rectangular opening with rounded corners, while the third opening 464 comprises a smaller rectangular opening with rounded corners that has a dimension proximal to distal which is smaller than the dorsal to ventral dimension. A strip of the retracted plate 406 is interposed with the openings 462, 464 and deformed to create a lateral loop half 468, laterally concave and convex in the middle. A second strip of the retracted plate 406 at the distal end is also deformed to create a half loop in the middle 470 laterally convex and concave in the middle. It should be noted that the half loop side 468 is deeper than the half loop side 470. Therefore, the half loop side 468 is dimensioned to fit the sleeve 474 that circumscribes a proximal part of the retracted cable 408. This sleeve 474 is not quickly repositioned longitudinally along the retracted cable 408. Therefore, the repositioning of the sleeve 474 while the retracted cable 408 is in tension, causes the retracted cable to be repositioned in the corresponding way.
[00126] The mobile handle 400 is adapted to be activated by a user and repositioned from a holding position to a free position. In the holding position (see FIG. 26), loop 428 of handle 400 engages tongue 326 of the right side cabinet 130 in order to retain the handle adjacent to cabinets 130, 132. When a user wishes to release handle 400 from tongue 326 , the user must slide the handle laterally out of the tongue and out of the engagement with the tongue. From then on, the inclination of the spring 404 works to push against the guide plate 402, which also pushes against the handle 400 to force it out of the cabinets 130, 132. At the same time, the connection plate 406 also is repositioned. When the handle 400 engages the tab 326, the guide plate will be fully retracted in a more proximal position. As described in more detail below, the more proximal position of the conduit plate 406 will cause the conduit cable 408, which is also mounted on the push connection 764, to be pushed proximally to open the occlusion clamp 1160. On the other hand, when the handle 400 disengages the tab 326 and moves out of the cabinets 130, 132 the guide plate will be repositioned in a distal direction. Eventually, if the handle 400 is repositioned in the maximum path out of the cabinets 130 and 132, the driving plate 406 is placed in a more distal position. As described in more detail below, the furthest position from the conduction plate 406 will cause the conduction cable 408 to be repositioned distally to close the occlusion clamp 1160.
[00127] With reference to FIGURES 2-4, controller 110 also includes a removable rod 490 which is leaning against the proximal port 300 of cabinets 130, 132. Removable rod 490 is coupled to one or more clamp disconnect cables 492 (in this case, two clamp disconnect cables) that act to disconnect an occlusion clamp from the device used as clamp 118. In this way, the rod can be removed from the proximal end of controller 110, thus retracting the disconnect cable (s) proximally and disconnecting the occlusion clamp from the device used as clamp 118. In this procedure example, stem 490 is attached to the inside of the proximal port 300 that is frictionally attached and can be corrected by the user by applying pressure to the stem to move it proximally, in relation to controller 110. But it is also within the scope of the description, to use tongues or other affirmative disconnecting mechanisms to release the stem 490 from controller 110.
[00128] Referring once again to FIGURES 2-32, mounting the controller 110 includes mounting the wheels 136, 138 to each other, so that the inner face 146 of the wheels captures the connecting plates 180 between them. A detailed description on the assembly of wheels 136, 138 and connection plates 180, has already been provided and will not be repeated for the sake of brevity. Thereafter, the wheels 136, 138 are directed so that the axles 158 face each other in opposite directions and are, respectively, received within the cylindrical projections 380 of the left side cabinet 132 and within the circular support surface 242 of the side cabinet right 130. In addition, the drive connection 402 is mounted on the right and left side cabinets 130, 132, by means of pins 450, received together inside the cavities 316, 390 of the elongated projections 314, 388. In the example, the connection drive 402 and the right side cabinet 130 surround the guide plate 406 between them. At the same time, the drive connection 402 is mounted on the handle 400, while the circular opening 434 of the handle receives a cylinder 304 from the right side cabinet 130 for swivel the handle on the cabinet. In addition, the spring 404 is inserted into the right side cabinet 130, so that the spring is interposed with the proximal reinforcement rib 308 and the drive connection 402. Finally, the removable stem 490 is inserted between the cabinets 130, 132 and the thereafter, cabinets 130, 132 are mounted together to close the controller. At this time, the conduit cable 408, the clamp disconnect cables 492, the connection cables 194 and the connection cable 261, all extend through the distal end 262 of cabinets 130, 132.
[00129] With reference to FIGURES 20 and 30-32, the controller 110 is mounted in a semi-rigid duct 112, which is relatively linear and has a relatively constant circular cross section. In this example procedure, conduit 112 is made of stainless steel and includes a circular proximal opening and a circular distal opening. The circular proximal opening provides access between the interior of conduit 112 and the interior of controller 110. More specifically, the hollow interior of conduit 112 is completely attached to the conduit cable 408, to the clamp disconnect cables 492, to the connection cables. connection 194, and connection cable 261. Conduit 112 includes a proximal section that has a pair of rectangular, arcuate cutouts 500. These cutouts 500 provide respective openings for the tabs 272 of adapter 270 to occupy and assemble conduit 112 to the cabinets 130, 132.
[00130] Furthermore, as shown in FIG. 33, the semi-rigid conduit 112 can be relatively linear, but includes two additional orifices 504, 506 that can be fitted to a separate conduit 508 adapted to provide a separate alternative route for an exploratory tool 510. The exploratory tools in the example used in the semi-rigid conduits of the present include, for example, forceps, ablation pathways, jaws, linear cutters, ablation tips, ablation clamp, illuminated dissectors and non-illuminated dissectors. The exploratory tool of example 510 can be used in combination with the terminal effector, which is manipulated through the repositioning mechanism 116.
[00131] With reference to FIGURES 34-38, a distal part of the repositioning mechanism of example 116 comprises a clamp 514 comprising ventral and dorsal clamp cabinets 516, 518. Each cabinet 516, 518 is a mirror image of the other and includes a convex, semi-cylindrical proximal section 522 that has a partially encapsulated semicircular end 524, with the exception of a notch 526. Extending longitudinally distally, the outer surface of the proximal semi-cylindrical section 522 includes a pair of finished holes 530 that extend into the cabinet and which are generally arranged longitudinally and placed to be along the apex of the proximal cylindrical part 522. Extending longitudinally in a distal direction beyond the finished holes 530, there is a semi-cylindrical neck 532, which works to increase the diameter of the cabinet 516, 518 compared to the cylindrical proximal part 522, which generally has a diameter the constant. Projecting distally from the neck 532 is a projection 536. The projection 536 includes a generally flat outer surface 538, which is connected to a sloped perimeter surface 540, incorporating parallel sides with a rounded proximal end 542. The perimeter surface is limited by a substantially flat inner surface 544 and parallel to the flat outer surface 538. The inner surface 544 includes a circular depression 546 and includes a circular peripheral surface 548 that extends between the inner surface and a lower flat surface 550 of the depression. The inner surface also includes a portion of a rectangular depression 552 that continues distally into a concave, semi-cylindrical interior surface 554 of the neck 532. It should be noted that the semi-cylindrical interior surface 554 of the neck 532 has the same dimensions as the semi-cylindrical interior surface of the neck. cylindrical proximal section 522. However, the semi-cylindrical inner surface 554 of the cylindrical proximal section 522 includes a distal cable 558, generally having the same shape as the partially attached semicircular distal end 524. Similar to the semicircular distal end 524, the distal cable 558 also includes a notch 560, which is longitudinally aligned with the other notch 526, so that the notches generally have the same dimensions. When cabinets 516, 518 come together, distal cables 558 are aligned with each other, so that notches 560, 526 cooperate to provide a pair of finished openings. At the same time, the distal ends 524 of the enclosures also align to create an internal cavity that encapsulates an inclined spring 564 and a gear receiver 566 as part of the clamp 514.
[00132] With reference to FIGURES 36, 37 and 39-41, the gear receiver 566 includes a cylindrical proximal section 568 that has a uniform circular cross section and extends substantially in a linear fashion. The uniform circular cross section is arranged to receive the inclined spring 564 for assembly. The proximal cylindrical part 568 is hollow and includes a circular proximal end wall 570, which has a pair of circular openings 572, each adapted to fit the arrangement of connecting cables 194. A larger elongated opening 574 is interposed with the circular openings 572 and adapted to fit the conduction cable 408 and the clamp disconnection cables 492. Extending distally from the cylindrical part 568, there is a gear receiving head 576 that has M (middle) and L (lateral) sections, which extend medially and laterally from the cylindrical part. Interposing the middle and side sections is a cylindrical cavity 577 aligned with the hollow cavity of the proximal cylindrical part 568. Each section of the gear receiving head 576 includes a generally rectangular cross section, but by a series of distal teeth 578. Specifically, the teeth 578 have a serrated appearance and are formed to extend in the medium to lateral direction (perpendicular to the longitudinal axis that extends through the cylindrical part 568). In this example procedure, teeth 578 are arranged to receive respective teeth 580 from a pair of gear plates 582.
[00133] With reference to FIGURES 42-44, the gear plates 582 also form part of the clamp 514 and each gear plate 582 comprises a disc, generally flat. Approximately 225 ° of the plate has a circular peripheral surface 584. But the remaining 135 ° of the peripheral surface is formed to include a series of teeth 580. As described above, teeth 580 are arranged to be received between teeth 578 of the receiver gear 566. There is a finished opening 586 in the center of each gear plate 582, outlined by parallel, linear sides 588 and arcuate ends 590. These finished openings 586 adapt to receive a respective pelvis half 594 to allow or prevent movement side of the pelvis half.
[00134] Referring again to FIG. 35-37, mounting the clamp 514 includes inserting the proximal cylindrical portion 568 of the gear receiver 566 into the cylindrical cavity described by the spiral shape of the inclined spring 564. Mounting the clamp 514 also includes aligning the clamp 516, 518 ventral and dorsal enclosures so that the ends where the outer and inner surfaces meet, coincide with the upper part and overlap. The ends can be welded or bonded using conventional techniques. The structure resulting from the assembly of the cabinets 516, 518 creates a distal cylindrical cavity 598 and a proximal cylindrical cavity 600 which are interposed through a circular wall that has a finished opening. As previously described, the circular wall is formed by joining the distal cables 558 of the cabinets 516, 518, while the opening is formed by joining the notches 560. The distal cylindrical cavity 598 is arranged to adapt the gear receiver 566 inserted in the inclined spring 564, so that the end of the inclined spring opposite the gear receiver is in contact with the circular wall to provide a stop against which the spring can be compressed. At the same time, the distal end 524 is closed, except for the opening formed by the attached notches 526. As mentioned above, the connection cable 261 is operatively coupled to the lever 236. This cable 261 also projects through the semi-rigid conduit 112 and through the openings until you reach the gear receiver 566, where the cable is mounted on that receiver to facilitate its repositioning.
[00135] With reference to FIGURES 35-48, the clamp 514 is coupled to the universal joint 610. This universal joint 610 comprises a first half of the pelvis 594 coupled to a second half of the pelvis 596. To provide lateral repositioning, the halves of pelvis 594, 596 are coupled to clamp 514. In particular, the pelvis halves 594, 596 are identical to each other, so a detailed description of only one of them is made in the interest of brevity.
[00136] Each pelvis half 594, 596 includes a distal blade 624 that has a substantially flat interior surface 626 that surrounds a straight rim 628. An opening 630 extends through rim 628 and through blade 624, but is partially covered by a convex outer cover 634 formed integrally by the blade. The cap 634 includes a V-shaped groove 636 that extends into the opening 630 on one side and a channel 638 that extends on the opposite side of the opening. The channel 638 extends proximally beyond the cap 634 and takes an arcuate direction to partially surround around the proximal end 640 of the pelvis half and ends near an integrated platform 642 which has a circular profile. A semicircular inner surface 646 of platform 642 is substantially flat and includes a radial groove 648 with arched side walls and a rounded end that extends to the center of the platform. The arched side walls work to increase the width of the groove 648 as the distance from the inner surface 646 increases. The radial groove 648 also extends outward through a circular peripheral surface 650. The peripheral surface 650 defines the outer limits of a flat, outer ring-shaped surface 652 that circumscribes a straight protrusion 656. This straight protrusion 656 protrudes through the opening 586 of a corresponding gear plate 582 in order to mount that plate in the middle of the joint 620 (see FIG. 42). In this example, the straight protrusion 656 projects perpendicularly out of the ring-shaped surface 652 and includes a pair of parallel straight faces 658 which are interposed by a pair of arched sides 660 which together define an upper part of the landing 662.
[00137] As an example, the distal blade 624 includes a circular peripheral surface 664 that connects to a throat 666 to connect the distal blade 624 to the integrated platform 642. The throat 666 also includes an arched wall 668, adapted to match the contour of the circular peripheral surface 650 of an opposite pelvis half 594, 596. The throat 666 also includes a centered block 672 which has a flat surface 674 parallel to the inner surface 646 of platform 642. This flat surface 674 has a partially elevated portion 678 which it has arched sides and an exposed rounded end. The arched sides work to decrease the width of the peninsula 678, as the distance from the flat surface 674 increases. As described in more detail below, the dimensions of the peninsula 678 are generally the same as the dimensions of the radial groove 648, so that a peninsula of a first pelvis half 594, 596 is received within a radial groove of a second pelvis half to align the pelvis halves when assembled. Block 672 includes a portion of channel 638 on one side, and also includes a channel 682 that has a semicircular cross section that extends substantially in a straight line, except for a proximal slope. Channel 682 is generally centered and extends radially towards the inner surface 626 of distal blade 624. As an example, linear channel 682 interposes with the peninsula 678 and radial groove 648 which are generally parallel to each other and in a horizontally compensated position.
[00138] Referring again to FIGURES 42, 43 and 45-48, the assembly of the universal joint 610 includes directing the pelvis halves 594, 596 so that the inner surfaces 626 of the blades 624 face each other . In addition, the throats 666 of the pelvis halves 594, 596 are placed adjacent to each other, so that the peninsula 678 of the first pelvis half 594 is received into the groove 648 of the second pelvis half 596, so that the inner surface 646 of platform 642 of the second pelvis half, contact the flat surface of the first pelvis half. In this sense, the pelvis halves 594, 596 move with each other (see FIG. 46) to define a peripherally limited finished opening 688. After the pelvis halves 594, 596 are assembled together, as described above, they assemble the respective gear plates 582 are attached to each of the pelvis halves. As an example, each gear plate 582 is directed so that the opening 586 is in line with the straight projection 656. Specifically, the parallel sides 658 of the straight projection 656 are aligned and inserted in relation to the parallel sides 588 that define the opening 586 While the arched sides 660 of the straight protrusion are aligned and inserted in relation to the arched ends 590 that define the opening. Thereafter, the ventral and dorsal armband enclosures 516, 518 are repositioned to contain the pelvis halves 594, 596. Specifically, the circular depression 546 of each enclosure receives a respective 656 straight protrusion of a pelvis half 594, 596. The circular limit of the depression 546 is slightly larger in diameter than the distance between the arched sides 660 of the ridges, thus allowing the ridges to rotate within the depressions. It should be noted that the arch on the sides 660 is more pronounced than that of the wall 548 that defines the protrusion, but not so much, so that the movement is considerably present. Simultaneously, as the pelvis halves 594, 596 are closed by the ventral and dorsal clamp cabinets, both gear plates 582 are directed so that at least one tooth 580 is received within a space between the teeth 578 of the receiver. gear 566. When the teeth 580 of the gear plates 582 are engaged with the teeth 578 of the gear receiver 566, the pivoting movement of the pelvis halves 594, 596 (angular variations in the horizontal plane), in relation to the ventral and dorsal clamp 516, 518. Conversely, when teeth 580 of gear plates 582 do not engage teeth 578 of gear receiver 566, the pelvis halves 594, 596 can rotate relative to the ventral and dorsal enclosures of the clamp 516, 518. The default position of the gear receiver 566 creates an engagement between the respective teeth 578, 580 based on the inclination exerted by the gear receiver by means of the spring 564. tilt can be corrected by pushing the gear receiver 566 proximally, using the connection cable 261 coupled together with the gear receiver and the movable lever 236. In particular, to close the angular position of the pelvis halves 594, 596 in relation to the cabinets ventral and dorsal clamps 516, 518, lever 236 is rotated distally to allow the tilt of spring 564 to push gear receiver 566 engaged with gear plates 582. To open the pelvis halves 594, 596 in relation to the cabinets ventral and dorsal clamps 516, 518, lever 236 is rotated proximally to correct the inclination of the spring 564, thereby compressing the spring and pushing the gear receiver 566 out of the engagement of the gear plates 582. When this happens, the halves of pelvis 594, 596, as a whole, are able to change their angular, horizontal direction with respect to the ventral and dorsal cabinets of the clamp 516, 518 and have an adjustment range 160 ° angle. This angular adjustment and the corresponding angular direction are carried out from the pelvis halves 594, 596 to a joint 614.
[00139] In an example form, clamp 514 (cabinets 516, 518, spring 564 and gear receiver 566), gear plates 582 and pelvis halves 594, 596 cooperate to form the distal part of the passive mechanism. This passive mechanism allows or prevents the yoke (from side to side) of the end effector 118 depending on whether the gear receiver 566 is distally inclined by the spring 564 engaged the gear plates 582. As the gear receiver 566 is, whether engaged or disengaged, in relation to the gear plates 582, thus the mechanism is considered passive. In other words, unlike the active mechanism described earlier, this passive mechanism does not work for the repositioning of the terminal effector from side to side. In addition, this passive mechanism provides complete freedom to move laterally within the range of movement between the clamp 514 and the pelvis halves 594, 596 when the gear receiver 566 is not engaged with the gear plates 582. In an example form , it is expected that a robotic instrument (not shown) or an anatomical accessory (that is, the heart itself) in cooperation with the pressure applied at the distal end of the semi-rigid conduit 112, will laterally reposition the terminal effector (as shown in the example , with three positions illustrated in FIG. 17B) since controller 110 (specifically, lever 236) is manipulated to disengage gear receiver 566 from gear plates 582. As gear receiver 566 is disengaged from plates of gear 582, the end effector 118 can be repositioned (that is, it is not closed laterally in place). But when the lever 236 is pressed so that the spring force 564 is dominant and the gear receiver 566 engages the gear plates 582, the lateral repositioning of the end effector 118 is prevented.
[00140] With reference to FIGURES 49-52, the joint 614 comprises a cylindrical proximal end 690, integrally coupled to the floor 692 and the ceiling 694 and which are formed in an identical manner. More specifically and as described in more detail below, the cylindrical proximal end 690 includes a finished cavity 696 that extends into an open space 698 between the floor 692 and the ceiling 694 in order to adapt certain parts of the repositioning mechanism 116.
[00141] In an example form, the cylindrical proximal end 690 includes a circular groove 702 operative to fork the proximal cylindrical end into a pair of discs 704. Each disc 704 is a mirror image of the other and includes a rounded circular surface 706 , which has a generally constant amplitude and which defines the outer limits of a substantially flat lateral surface 708 which is generally perpendicular to the peripheral surface. This side surface 708 is generally ring-shaped to define a cylindrical depression 710 that does not extend entirely across the disc 704, and is spaced evenly with respect to the edge of the peripheral surface 706. As an example, the depression cylindrical 710 is defined by an upper bevelled ring 714, followed by a ring of constant diameter 716, followed by a second beveled ring 718 which is connected to a substantially flat lower surface 720, parallel with the side surface 708.
[00142] The circular groove 702 between the disks 704 extends in a semicircular path and is crossed through a hole 722, extending through the floor 692 and the ceiling 694. Opposite the finished hole 722, at the proximal end of the groove 702 , a V-shaped opening forms part of the finished cavity 696, where the distal tip of the opening is defined by a rectangular contour 724, which is adjacent to the circular wall 726 which defines a cylindrical part of the finished cavity. The ventral and dorsal parts of the groove 702 receive a corresponding connection cable 194, where each connection cable is threaded within a part of the groove, so that when pushing the first connection cable, the joint 614 moves upwards (ie , ventrally), but when pushing the second connecting cable the joint moves downwards (that is, dorsally). More specifically, the connecting cables 194 are partially intertwined around the joint 614, abutting within a part of the groove 702 and terminating in a cavity where the connecting cable 194 is secured in place.
[00143] Extending distally from the disks 704 are the roof 694 and the floor 692. Both the roof 694 and the floor 692 comprise a rounded protrusion which has a relatively flat outer surface 732 which is connected to a sloping circular surface 734 which, in turn, is connected to a vertical circular surface 736 which is perpendicular to the outer surface. It should be noted that the vertical thickness of the ceiling 694 is greater than that of the floor 692, but leaving aside this difference in thickness, the ceiling and floor are identical. The vertical circular surface 736 defines the outer limit of the multi-stepped inner surface 738. In particular, the inner surface 738 is partially defined by a raised disc 740 having a relatively flat end surface 742 connected to a relatively flat vertical side 744 which it is compensated with a joint line 614. Attached to the side 744 is a relatively flat horizontal wall 746, which is connected by a block to the U-shaped groove 748. The disc 740, the side 744, the horizontal wall 746 and the U-shaped groove 748 cooperate to create a cross-section of consecutive passage. But the U-shaped groove does not extend distally along side blade 744 and horizontal wall 746 because said groove ends in a proximal wall 752 which is distal to the ends of the side blade and the horizontal wall ending in a rear wall 754 Near rear wall 754, both ceiling 694 and floor 692 include a pair of finished vertical openings correspondingly aligned through the openings and receive a pair of billets 758. As described in more detail below, the billets are assembled together on the ceiling 694 and on the floor 692, as well as in the assembly of the mobile jaw 760.
[00144] With reference to FIGURES 49, 50 and 52-54, the assembly of the movable jaw 760 includes a push connection 764 operatively coupled to the connection cable 194 at its proximal end and, together, coupled to the right connection plates and left 766, 768 at this distal end. In this example procedure, the push connection 764 comprises a hollow cylinder 770 mounted on the miniature clamp 772. In particular, the hollow cylinder 770 is mounted to extend perpendicularly out of the base of the clamp 772 and adapted to receive the connection 194. More specifically, connection cable 194 is attached to the interior of the hollow cylinder 770, so that tensioning the connection cable in the proximal direction works to reposition the push connection 764 proximally. This proximal repositioning also works to reposition the ends of the connecting plates 766, 768 mounted on the clamp 772. As an example, the clamp 772 includes a pair of straight, disposed arms 774 that have a generally constant thickness and a height along their length longitudinal. Each straight arm 774 ends in a hollow ring 776, which is generally the same height as the straight arms, but a thickness that is greater than that of the straight arms. The thickness of both rings 776 is generally the same and is made to fit between the respective vertical walls 744 of the floor 692 and the ceiling 694 to ensure that the movement of the clamp 772 in relation to the joint 614 is linear.
[00145] With reference to FIGURES 55-57, the joint 614 has also mounted a pair of right and left clamps 780, 782 that are mounted together on the connection plates 766, 768. As an example, the right connection clamps and left 780, 782 are mirror images of each other and each includes a finished proximal hole 786 that receives a billet 758 from joint 614 for mounting by rotating the right and left connecting clamps to the joint. At the same time, the right and left connection clamps 780, 782 include a second finished hole 788, distal to the proximal hole 786, which receives a billet 790, which is received together through an opening 792 at the ends of the connection plates 766, 768 The openings 792 at the ends of the connection plates 766, 768 are larger in diameter than the diameter of the billet 790, so that the connection plates are repositioned by rotating around the billet. In contrast, the second finished hole 788 generally has the same diameter as the diameter of the billet 790, thereby trapping the billet within the second finished hole through the friction fitting. Opposite the ends of the connection plates 766, 768 there is a finished internal hole 794 that has a diameter larger than a billet 796 that is received by friction within the rings 776 of the clamp 772. In this way, the connection plates 766, 768 are repositioned rotating on the billet 796 and the clamp 772. At a distal end of each right and left connecting clamp 780, 782 there is a rounded, flat head 798 that circumscribes a distal opening 800 that is three-quarter moon shaped. In particular, the distal head 798 is dimensioned so that the width of the head is greater than the width of the rest of the connecting clamps 780, 782. More specifically, the distal head 798 is rounded to extend into the assembly of the movable jaw 760. As described in more detail below, the rounded profile of the distal head coincides with a cylindrical profile of a corresponding jaw 806, 808.
[00146] Once assembled, the hollow rings 776 of the clamp 772 interpose at the ends of the connection plates 766, 768. The opposite ends of the connection plates 766, 768 interpose the respective right and left connection clamps 780, 782. For therefore, the left link clamp 782 directly overlaps and is arranged separately by the thickness of the left link plate 768 and an associated operative space to provide movement between the left link plate and the left link clamp. In addition, the right link clamp 780 directly overlaps and is arranged separately by the thickness of the right link plate 766 and an associated operative space to provide movement between the right link plate and the right link clamps. At the same time, the distance between the ceiling 694 and the floor 692, near the disk 740 on the right side is slightly greater than the cumulative thicknesses of the right connection clamps 780 and the right connection plate 766. Likewise, the distance between the ceiling 694 and the floor 692, near the disk 740 on the left side, it is slightly larger than the cumulative thicknesses of the left connection clamps 782 and the left connection plate 768. With the assembly, the connection plates 766, 768 are rotated repositioned in relation to the clamp 772 and the right and left connection clamps 780, 782. While the right and left connection clamps are rotated in relation to the connection plates and billets 758 of the joint 614. As described in more detail below, the retraction of the clamp 772 proximally (see FIG. 49) inside the joint 614 works to enlarge the space between the rounded ends 798 of the right and left connection clamps 780, 782. On the contrary, repos positioning the clamp 772 distally from the joint 614 works to decrease the space between the rounded ends 798 of the right and left clamps 780, 782. In this way, the repositioning of the clamp 772 works, indirectly, in the repositioning of the right and left jaws 806, 808.
[00147] With reference to FIGURES 49, 58 and 59, the right and left jaws 806, 808 are mirror images of each other and are mounted on the right and left connecting clamps 780, 782, respectively. Therefore, in the interest of brevity, only the left jaw will be described in relation to FIGURES 58 and 59. Each jaw 806, 808 includes a clamp at the proximal end 810 comprising a rounded upper shelf 814 placed separately from a rounded lower shelf 816. Each shelf 812, 814 includes a finished opening 818 that works to receive a cylindrical billet in the shape of a half moon 820. This billet 820, while being coupled together within the finished openings 818 of the shelves 812, 814, is also coupled within the opening 800 from a pair of connecting clamps 780, 782, respectively. As an example, the billet 820 fits by friction within the finished openings 818 so that the billet is not repositioned by turning inside the finished opening. In contrast, the half moon shape of billet 820 does not occupy the entire area of the three-quarter moon shape of distal openings 800. Thus, there is a movement between the walls that define the distal opening and billet 820 so that the the dowel is repositioned by rotating in relation to the respective connecting clamps 780, 782. To further stabilize the connection between the respective jaw 806, 808 and the respective connecting clamps 780, 782, each jaw includes a projection 824 that protrudes proximally from of a vertical wall 826 that connects the shelves 812, 814 at their respective distal ends. The thickness of the protrusion 824 approximates the space between the respective overlapping connecting clips 780, 782 to inhibit compression of the distal ends 798 of the connecting clips between them. Instead, because of the protrusion 824, the compression is reduced and as this happens, the superimposed connecting clamps 780, 782 compress against the protrusion, instead of compressing each other.
[00148] Extending distally from the proximal end of the clamp 810 there is an elongated guide 830 which has a convex outer longitudinal profile and a concave inner longitudinal profile. The elongated guide 830 has a dominant longitudinal dimension and a vertical dimension, which approaches and extends beyond the thickness of a fixing part 1162, 1164 (see FIG. 75). As an example, the distal end 832 of the guide 830 is rounded. Interposing the distal end 832 and the proximal end of the clamp 810 is a pair of finished side holes 836, 838 that receive sutures 840 to mount the jaw 806, 808 on a respective fixing part 1162, 1164. An outer side 844 of the guide 830 includes a longitudinal channel 846 extending from the distal end 832, crossing each of the finished holes 836, 838, proximally, through the vertical wall 826 and ending adjacent to the projection 824. This channel 846 receives a respective clamp disconnect cable 492 which is coupled to the removable stem 490 of controller 110. As an example, suture 840 wraps together (in a loop) the clip disconnect cable 492 and the respective clip segment. Thus, when the clamp is ready for use, the removable rod 490 is repositioned proximally to the rest of the controller 110, thereby pushing the clamp disconnect cables 492 proximally. Initially, the end of the clamp disconnection cables 492 completely crosses distal suture 840, followed by complete passage through proximal suture 840, thus releasing the clamp of the guides 830 and the rest of the laparoscopic device 100.
[00149] With reference to FIGURES 44, 60 and 61, the assembly of the mobile jaw 760 works to dispose linearly and fit through the trocar for anatomical use. Initially, as shown in FIGURES 60 and 61, the assembly of the movable jaw 760 is arranged linearly and along a compact position. In this position, a first face 850 of each billet 820 of both jaws 806, 808 is brought into contact with a face 852 which defines a part of the opening in the form of three quarters of a moon 800.
[00150] With reference to FIGURES 44 and 62-66, to open the jaws 806, 808 the push connection 764 is pushed proximally through the connection cable 194. The proximal movement of the push connection 764 causes the ends of the plates left and right link 766, 768 are coupled to the push link, to be repositioned proximally by rotating around the billet 796 extending through the push link. As the opposite ends of the connection plates 766, 768 are coupled by rotating the right and left connection clamps 780, 782 through the billets 790, the movement of the push connection works to extend the distal ends to the connection clamps with each other. As described above, the three-quarter moon opening 800 allows limited turning movement of the billet 820 of a respective jaw 806, 808, in relation to the connecting clamps 780, 782. Thus, the pivoting movement between the clamps connection 780, 782 and the jaws 806, 808 causes the distal ends of the jaws 806, 808 to initially move closer together, while the proximal ends of the jaws move away from each other, as shown in FIG. 62. While the connection plates 766, 768 rotate in relation to the connection clamps 780, 782, said clamps also work to rotate the jaws 806, 808, as evidenced by the first face 850 of the billet 820 moving away from the first face 852 of the clamps connection, as shown in FIG. 63. The continuous proximal movement of the push connection 764 results in the distal ends of the connecting clamps 780, 782 being moved further away from each other, as shown in FIG. 64. In this position, as shown in FIG. 65, a greater turning action between the jaws 806, 808 and the connecting clamps 780, 782 is inhibited by the second face 854 of the billet 820, coming into contact with the second face 856 of the connecting clamps that defines a part of the opening in three-quarter moon shape 800. In other words, the faces 852, 856 of the connecting clamps 780, 782 provide a range of motion limits for the billet 820, so that it rotates. When the second faces come into contact with each other, the maximum angle between the clamps 780, 782 and the jaws 806, 808 is reached. From then on, the continuous proximal movement of the push connection 764 to an end maximum final proximal (that is, a path limit), causes the distal ends of the connecting clamps 780, 782 to reach a maximum spacing, which corresponds to the distal ends of the jaws 806, 808 moving apart from each other, as shown in FIG. 66. As an example, when the push connection 764 reaches the maximum proximal end point, the jaws 806, 808 will reach a parallel position. This parallel position, otherwise, would not be achieved without some rotating movement between the jaws 806, 808 and the connecting clamps 780, 782. As shown in FIG. 67, without the pivoting action between connecting clamps 780, 782 and jaws 806, 808, the latter would take the angular direction of the connecting clamps and would never reach a parallel position when arranged apart from each other and when the push connection 764 reach its proximal end point.
[00151] FIGURES 68 and 70 show a procedure of an occlusion clamp of the left atrial appendage 1110, in an open position with separate rigid fixation parts 1102, 1104, and resistant or elastic pusher members 1106, 1108 at opposite ends in each fastening part 1102, 1104. Fastening parts 1102,1104 may be tubular and both fastening parts 1102, 1104 may be at least substantially parallel to each other when stopped. That is, when they are not being used to fix the fabric. Fixing parts 1102, 1104 may also be substantially the same or different in length, and each may have a larger outside diameter than the cable used to form each pusher member 1106, 1108. In this regard, the cable that forms pusher members 1106, 1108 can extend through the hollow interiors of the fastening parts 1102, 1104. In this illustrative example, the pusher members 1106, 1108 are each formed as a loop. The planes defined by the interlaced configuration of each pusher member 1106, 1108 can be substantially parallel to each other, and in turn, substantially perpendicular to each other, in the attachment parts 1102, 1104. Of course, other angular directions are also possible.
[00152] FIGURES 69 and 71 show the same clamp 1110 as FIGURES 68 and 70, with fixing parts 1102, 1104 in their normally inclined and joined positions. As shown, the contact between the fastening parts 1102, 1104 may initially occur along its entire parallel length. Of course, when the fastening parts 1102, 1104 are covered with a cloth or other material, as described below, contact may occur between the cloth or other material in its place. In FIGURES 6871, only the structure and relative positions of rigid members 1102, 1104 and pusher members 1106, 1108 are shown. The final assembly is illustrated in FIGURES 72-74 and, although they describe a slightly different procedure, they show the general phases in the construction of each procedure. The fixing parts 1102, 1104 can be of rigid tubes 1112, 1114, of a rigid metal such as titanium disposed on a member of the cable 1116. In this procedure, titanium is used for its compatibility with the Magnetic Resonance Image (MRI) , its biocompatibility and its galvanic compatibility with the cable member 1116 when this member is formed of highly elastic materials, such as nickel titanium alloys. This and other procedures described here can use a material with a lot of elasticity, such as a nickel titanium alloy, to form the pusher members 1106, 1108. The properties of the elasticity allow the material to be extended, mainly, to open the parts clamp 1106, 1108 of clamp 1110, without permanently deforming the material. These highly elastic materials can also be compatible with the MRI image and easily tolerated as an implant material in the body. The rigid tubular members 1112, 1114 of this procedure are mechanically fitted to the underlying cable member 1116, preferably by mechanically stamping the titanium tubes 1112,1114 to the cable members 1116. While showing a single, continuous cable member directed through both the fastening parts 1102, 1104 and pusher members 1106, 1108, stapling 1110 of this procedure can also be carried out with two or more cables, or with any other suitable component.
[00153] As shown in FIG. 72, in addition to being able to close the tissue or anatomical structure in a parallel way, the clamp 1110 can also apply a force to the anatomical fixation structure in a non-parallel way. This allows the clamp 1110 to adapt to a non-uniform fabric thickness over the length of the fastening parts 1102, 1104. In addition, with separate pusher members 1106, 1108 at opposite ends of the fastening parts 1102, 1104, the fastening does not parallel can be originated on each side of the 1110 clamp. The non-parallel fixation method of this procedure allows the 1110 clamp to adapt to a wide range of hollow anatomical structures with varying wall thicknesses along its entire length and width. For example, some anatomical structures such as the atrial appendages of the heart have internal structures called trabeculae, which are not uniform and often cause variable thickness over one or more dimensions. Therefore, non-uniform fixation can be advantageous in this application for this or other reasons.
[00154] FIG. 73 shows an alternative procedure for a clamp 1160, including two pusher members 1166, 1168 formed to look like a letter "U", instead of the more circular loop configuration of the procedure in FIGURES 68-71. As is the case with In the first clamp 1110, the U-shaped pusher members 1166, 1168 of the clamp 1160 can also be in planes generally parallel to each other and perpendicular to the axes of the fastening parts 1162, 1164. A potential use of the procedure of FIG. 73 may reside in the smallest force exerted by the U-shaped pusher members 1166, 1168 on the fixing parts 1162, 1164 in relation to the force exerted by the loop-shaped pusher members 1106, 1108 of the clamp 1110 in FIGURES 68-71, making it the most suitable for fixing anatomical structures that do not require a relatively high clamping force. The U-shaped configuration of the pusher members 1166, 1168 generally requires less space in the direction perpendicular to the axes of the fixing parts 1162, 1164. FIG. 73 shows a first stage of assembly of the clamp 1160, where the rigid tubular members 1163, 1165 are attached to the cable member with great elasticity 1161. In this procedure, mechanical stamping is used to join the tubular members 1163, 1165 to the cable 1161. However , adhesives or laser welding or other joining methods can be used. Similarly, rigid tubular members 1163, 1165 are considered not to need to be attached to cable member 1161 at all. For example, rigid tubular members 1163, 1165 can be relied upon, so that their diameters internal, simply and carefully, fit the cable 1161. In addition, the rigid tubular members 1163, 1165 can take many different cross-sectional shapes. The cross-sectional, oval, triangular or rectangular shapes with rounded edges may be preferred, and the added plates that propagate charge 1167, 1169 shown in FIG. 74, since these alternative forms can provide a wide area of contact against the anatomical structure to be engaged by clamp 1150. As the different anatomical structures vary, to a large extent, from individual to individual, it is advantageous to have a method of preparation in that the length 1171 of the clamp 1160 can easily vary. When cutting the rigid members 1163, 1165 different lengths and different mounting sizes can be configured.
[00155] FIG. 74 shows the next stage in assembling the clamp. Platforms that propagate cargo 1167, 1169 of plastic or other biocompatible material, such as being urethane, can be slid over titanium or other suitable channeling material. In this way, the rigid tubular members 1163, 1165 provide a resistant surface 1173 in order to spread the load out over a larger surface area. Thus, the source charge of the fabric stitch which would otherwise result in cutting the fabric before having had the opportunity to be internally fused is avoided. The plates 1167, 1169 can be mounted and applied to the rigid tubular members 1163, 1165 before the stamping phase. Or also, the plates 1167, 1169 can alternatively be prepared so that they have a longitudinal slit that allows the material to be opened and to fit in the rigid tubular members 1163, 1165.
[00156] FIG. 75 shows clip 1160 after a fabric wrapping material 1174 made, for example, of polyester, is sewn around the fastening parts 1162, 1164 and pusher members 1166, 1168. This material or any other material is considered to be Similar material can be used as a total or partial enclosure in any of the described procedures. Such material is preferably suitable for engaging the tissue of the anatomical structure to be fixed, as well as those of the surrounding areas. Preferably, material 1174 is a circular sewn fabric tube, with a diameter of about 4 to 5 mm and is made of a combination of 4/100, 2/100 and 1/100 of textured polyester. 1174 material can also be heat treated to cause a velvet effect. The fabric or other material 1174 is also sewn or otherwise applied to the pusher members 1166, 1168. In addition, pieces of fabric 1177 can be joined at the respective opposite ends of the fixing parts 1162, 1164 to prevent any part of the anatomical structure engaged, it drains out of the annular occlusion area between the fixing parts 1162, 1164. In other words, the fabric pieces 1177 act as fabric blocking members or barriers at the opposite ends of the clamp. This or another form of tissue block can also be implemented in any other procedure. This is convenient because it minimizes the likelihood of inadvertently leaving any part of the anatomical structure engaged without support. Material 1177 and material 1174 can also promote developing fabric.
[00157] With reference to FIGURES 76-82, an alternative controller of example 1210 can be used, instead of the previous controller 110, with the laparoscopic device of example 100. In the same way as the first controller 110, this alternative controller of example 1210 can be coupled to semi-rigid conduit 112 to manipulate a repositioning mechanism (not shown) operatively coupled to terminal effector 118. But, as described in more detail below, this example 1210 controller incorporates a dual passive mechanism to control the header (up and down) and yaw (from side to side) of the end effector. As an example, unlike the first controller in illustration 110, this alternate controller in example 1210 does not include an active mechanism to handle the header of the end effector 118, but instead uses a passive system that works to close the end effector in one position of heading among a predetermined number of those positions.
[00158] Controller 1210 comprises a right side cabinet 1230 and a left side cabinet 1232 that, cooperatively, define an internal cavity and corresponding openings to trigger the performance of certain controls. The first of these openings is a back opening 1234 that triggers the performance of a vertically adjustable position button 1236. As described in more detail below, the vertically adjustable button 1236 can be manipulated to open and close the repositioning mechanism 116 to provide or stop the lateral and vertical adjustment of the end effector 118.
[00159] The adjustable button 1236 comprises a proximal upper arch to distal 1238 that includes protrusions and a proximal roughness to cause a user's thumb to be positioned at the top of the button. The median to lateral width of the upper part is arched 1238 and, in general, overlaps with a flat vertical appendage 1242 that extends from the lower side of the upper arched part. This vertical appendix 1242 has a relatively constant and minimal medium to lateral dimension, but includes a proximal to lateral dimension that decreases by a maximum, where the appendix extends from the arched upper part to a minimum where the appendix ends. At the end of Appendix 1242, a pair of gear receivers 1246 extend outward in the middle and lateral directions of the opposite sides of the Appendix. Each of the gear receivers 1246 includes a series of longitudinal pyramidal shapes 1248 that are parallel and radially arranged, to define a plurality of corresponding longitudinal pyramidal cavities 1250. At the medial end of the medial gear receiver 1246 and at the side end of the gear receiver lateral 1246, there is a cylindrical protrusion 1252 which is received inside the corresponding vertical elongated grooves 1254 inside the enclosures 1230, 1232. These grooves 1254 inhibit the significant medial to lateral and proximal displacement to the distal of the gear receivers 1246 they are already vertically repositioned. In other words, as the button 1236 is pressed vertically, the gear receivers 1246 are correspondingly repositioned vertically. In this way, the movement of the gear receivers 1246 is directly attributed to the movement of the button 1236 since the gear receivers are mounted indirectly on the button via appendix 1242.
[00160] Button 1236 is tilted vertically to its highest vertical position shown in FIG. 79. To achieve this inclination, cabinets 1230, 1232 include parallel walls 1258 that cooperate to form a medial to lateral cavity where at least one spring 1260 has support. The spring 1260 is classified as having a sufficient spring force to correct the weight of the button 1236 and the appendix 1242, the gear receivers 1246 and the cylindrical projections 1252 to force the button to its highest vertical position. But the force of the spring is not big enough to need a lot of force on a user's thumb in order to press the button 1236 and correct the inclination of the spring 1260.
[00161] An axis 1264 extends in the medial to lateral direction inside the cooperative cavity defined by cabinets 1230, 1232. This axis 1264 is cylindrical in shape and includes a constant longitudinal diameter, thus giving the axis a circular contour. As an example, the middle and lateral ends of the 1264 shaft are received inside the corresponding cylindrical cavities (not shown) inside the cabinets. The depth of these cavities is not big enough to cover most of the 1264 shaft. The exposed cylindrical part of the 1264 shaft works to receive a pair of gear assemblies 1268, 1270 that are interposed with the appendix 1242, it includes a hole vertical, elongated (not shown) to drive the axis performance and the vertical displacement of the appendix in relation to the axis, which has a fixed direction. As an example, gear assemblies 1268, 1270 include a finished cylindrical bore 1272 allowing them to rotate on the outside of the shaft.
[00162] Each of the gear assemblies 1268, 1270 are identical to each other. Therefore, and for short, a description that would be redundant of the second gear assembly has been omitted. Gear assemblies 1268, 1270 include a wheel 1276 that has peripherally distributed teeth 1278 of a size that can be engaged with respective gear receivers 1246 and received within longitudinal pyramidal cavities 1250 when the gear receivers are in position elevated vertical (see FIG. 79). The wheel 1276 has a generally uniform width except for a pair of rods 1280, 1282. The first rod 1280 is generally centered radially in relation to the wheel and partially defines the finished hole 1272, receiving the axle 1264. This first rod 1280 is semicircular and medially extends from the wheel 1276 and includes a corresponding upper and lower arched surface 1284, 1286, which are radially inserted in relation to the wheel. These arcuate surfaces 1284, 1286 act as cam surfaces for the respective connecting cables 1288, 1290 extending from the second rod 1282. The first rod 1280 also includes a pair of vertical flanges 1294 extending from the arcuate surfaces 1284, 1286 and cooperate with the peripheral ends of the wheels to provide middle and side guides for the connecting cables 1288, 1290, so that the connecting cables remain between them. The second rod 1282 is directed proximally to the first rod 1280 and includes a rectangular profile with a pair of L-shaped walls 1292 and a floor 1296, cooperating to define an internal cavity. An opening (not shown) extends across the floor and into the cavity. This opening receives a fastener (for example, a screw) 1300 around which the connection cables 1288, 1290 are threaded and fixed in place. The fastener 1300 is also recessed inside the cavity, so that the walls are shaped like L 1292 extend laterally beyond the end of the fastener. Therefore, the connecting cables 1288, 1290 extending from the fastener are threaded through the space between the L-shaped walls 1292, with one of the cables threaded into the upper arcuate surface 1284, while the second cable is threaded under the lower arcuate surface 1286. Thereafter, cables 1288, 1290 extend distally and shorten, to extend through a respective ring-shaped opening at the proximal end of conduit 112.
[00163] Each of the gear assemblies 1268, 1270 is independently rotated in relation to them. The first gear assembly 1268 works to provide part of a passive repositioning mechanism to control the header (up and down) of the end effector 118, while the second gear assembly 1270 works to provide part of a passive repositioning mechanism for control the yaw (from side to side) of the end effector. As an example, when button 1236 is not pressed, spring 1260 works to tilt gear receivers 1246 and engage teeth 1278 of gear assemblies 1268, 1270, thereby inhibiting rotation of gear assemblies about axis 1264. When the gear assemblies 1268, 1279 are closed in position (see FIG. 79) the end effector 118 cannot be repositioned in the vertical direction (that is, affecting the heading) or in the middle to lateral direction (that is, affecting the yaw) . Thus, when gear assemblies 1268, 1279 are closed in position (see FIG. 79), then the end effector 118 is also closed in position.
[00164] To change the vertical or middle position to the side of the end effector 118, a user must press the button 1236. When pressing the button 1236, the gear receivers 1246 work to further compress the spring 1260 and disengage the gear assemblies 1268 , 1270. More specifically, the longitudinal pyramidal shapes 1248 and the corresponding longitudinal pyramidal cavities 1250 no longer engage the teeth 1278 of the gear assemblies 1268, 1270, thus allowing the rotation of the gear assemblies around the axis 1264. By allowing free rotation of gear assemblies 1268, 1270 around axis 1264, connection cables 1288, 1290 connecting terminal effector 118 and gear assemblies can be repositioned. This will allow the end effector to be freely repositioned in the vertical direction (that is, affecting the heading) and in the medial to lateral direction (that is, affecting the yaw). After reaching the respective vertical position and measuring to the side of the end effector 118, the user will no longer press the button 1236 to close the respective vertical and mediation positions to the side. To close the positions, spring 1260 forces gear receivers 1246 upward to engage gear assemblies 1268, 1270. Like gear assemblies 1268, 1270 include teeth 1278 that engage longitudinal pyramidal shapes 1248 of gear receivers 1246, the spring 1260 will direct said receivers upwards and cause the gear assemblies to rotate, if possible, slightly around the axis 1264, so that the teeth are fully received inside the longitudinal pyramidal cavities 1250. If the position of the end effector 118 is such that the teeth 1278 are aligned with the longitudinal pyramidal cavities 1250, then precisely the vertical and medial to lateral positions will be maintained due to the tension in the connection cables 1288, 1290. But if the position of the end effector 118 is such causing slightly misplaced teeth 1278 with respect to longitudinal pyramidal cavities 1250, then the vertical and medial positions for side will be changed as the gear assemblies 1268, 1270 rotate slightly around the axis 1264, so that the teeth are fully received inside the longitudinal pyramidal cavities 1250. After the teeth 1278 are aligned and received inside the cavities longitudinal pyramids 1250, the vertical and medial to lateral positions will be precisely maintained due to the tension of the connecting cables 1288, 1290.
[00165] In order to maintain the direction of the semi-rigid conduit (which takes the connection cables 1288, 1290) in relation to the cabinets 1230, 1232 a distal part of the right side cabinet 1230 includes a pair of tabs 1302 that engage the semi-conduit rigid 112. These tabs 1302 inhibit the longitudinal movement of conduit 112 in relation to controller 1210. Both tabs 1302 extend parallel to each other and from an inner circular surface of the right side cabinet 1230.
[00166] The right and left side cabinets 1230, 1232 cooperate to describe a port of the manipulation mechanism 1310 and a proximal port 1312 open to the interior of the respective cabinets. The port of the handling mechanism 1310 drives the performance of a part of the handling mechanism 1318 which comprises a movable handle 1320, a conductive plate 1322, a return spring 1324 and a cable clamp 1326. As described in more detail below, the The cable holder is coupled together with a retracted cable 1328 and the conductive plate 1322, so that the movement of the handle 1320 works to open and close an occlusion clamp 1160 (see FIG. 75), as well as use during a surgical procedure of the atrial appendage of the occlusion clamp. A more detailed explanation of the respective components of the 1318 manipulation mechanism is written below.
[00167] The movable handle 1320 includes an arcuate ventral adhesion surface, which may include a series of convex protuberances placed longitudinally apart to facilitate grasping by the user. Opposite a ventral adhesion surface there is a corresponding interior surface from which a pair of vertical walls 1330, 1332 extend, separated and parallel. The vertical walls 1330, 1332 are also connected to each other through a plurality of cross walls 1334. Each of the vertical walls 1330, 1332 includes a vertical distal loop 1338 that provides a through opening in the middle to lateral direction to receive an axis 1340 , extending from the right side cabinet 1230 around which the handle 1320 rotates. Extending distally from loop 1338, walls 1330, 1332 include a circular opening that extends in the middle to lateral direction and which receives a pin 1344 to mount the conductive plate 1322 repositioned on the handle 1320.
[00168] The conductive plate of example 1322 comprises a flat arcuate plate, dimensioned to fit between the walls 1330, 1332 of the handle 1320. A distal end of the plate 1322 includes an opening to receive the pin 1344. Extending proximally from the opening there is an elongated, arched opening 1346 adapted to receive a billet 1348 extended from the inside of the right side cabinet 1230. In this way, billet 1348 is repositioned in relation to opening 1346 and the handle 1324 is repositioned in relation to the conductive plate 1322. As an example , the opening is partially defined by a fold 1350 which acts to retain the billet 1348 in a static position after the handle 1320 is fully closed. Simultaneously, the proximal end of the conductive plate 1322 includes an orifice 1352 which receives a part of the spring 1324 for tilting the handle 1320 to an open position, as shown in FIG. 77. The opposite end of the spring 1324 is mounted on the billet 1354 which extends from the inside of the right side cabinet 1320.
[00169] Controller 1210 also includes a removable rod 1360 that is leaning against the proximal port 1312 of cabinets 1230, 1232. Removable rod 1360 is coupled to one or more 492 clip disconnect cables (in this case, two clamp disconnect) that act to disconnect an occlusion clamp from the device used as clamp 118. In this way, stem 1360 can be removed from the proximal end of controller 1210, thus retracting the disconnect cable or cables proximally and disconnecting the occlusion clamp of the device used as clamp 118. In this example procedure, the stem 1360 is attached to the inside of the proximal port 1312 that is frictionally fitted and that can be corrected by the user by applying pressure to the stem to move it proximally, in relation to the 1210 controller. it is also within the scope of the description, to use tongues or other affirmative disconnection mechanisms to release the rod 1360 of the controller 1210.
[00170] Furthermore, continuing with the previous description and the summaries of the invention, for those skilled in the art it is evident that the methods and equipment described herein constitute examples of procedures of the present invention. Although it is not limited to the above described and changes can be made to the aforementioned procedures without departing from the scope of the invention, as defined in the claims. Furthermore, it should not be understood that the invention is defined by the claims and that it is not intended that any limitation or element that describes the examples of procedures specified herein be incorporated into the interpretation of any claim element, except that that limitation or element explicitly mentioned. It should also be understood that it is not necessary to meet any or all of the identified advantages or objects of the invention, described herein, to be within the scope of any claim. The invention is defined by the claims and, consequently, there may be inherent and / or unforeseen advantages of the present invention although they have not been explicitly described here.

权利要求:
Claims (51)
[0001]
1. Medical instrument, characterized by the fact that it comprises: at least one controller (1210) that partially encapsulates a plurality of controls (1236, 1268, 1270, 1318, 1360); a repositionable mechanism (116); an elongated duct (112) operatively coupled to the controller, to the repositionable mechanism; a terminal effector (118) operatively coupled with the first and second hinge; and an occlusion clamp (1160) removably mounted on the end effector, wherein the plurality of controls includes a fourth control (1360) for disconnecting or retaining a connection between the occlusion clip and the end effector; wherein the repositionable mechanism comprises a first operable part to control a step of the end effector relative to the controller and a second operable part to control a yaw of the final effector relative to the controller, and where the plurality of controls includes a first control (1236 , 1268) configured to be repositionable between a first position, which allows the end effector to be freely repositionable in a predetermined number of step positions and a second position which blocks the movement of the repositionable mechanism between the predetermined number of step positions; a second control (1236, 1270) operatively coupled to the second joint; and the third control (1318) operatively coupled to the movement control of the terminal effector of at least a portion of the terminal effector.
[0002]
2. Medical instrument, according to claim 1, characterized by the fact that: the second control is configured to be repositioned between a first position, which allows the end effector to be freely positioned through a predetermined number of heading positions and one second position that blocks the movement of the repositionable mechanism between the predetermined number of heading positions.
[0003]
3. Medical instrument, according to claim 2, characterized by the fact that the third control comprises the second active control configured to be repositioned between an infinite number of positions, where each of the infinite positions directs the terminal effector in a different position .
[0004]
4. Medical instrument according to claim 1, characterized in that the end effector comprises at least one, among a surgical dissector, an ablation tip, an occlusion clamp, an occlusion clamp applicator, surgical forceps, jaws surgical instruments, a linear cutter, an ablation clamp and an ablation route.
[0005]
5. Medical instrument according to claim 1, characterized in that the third control is configured to be repositionable between an infinite number of positions, each of the infinite number of positions orienting the terminal effector in a different position.
[0006]
6. Medical instrument, characterized by that it comprises: a controller, at least partially, housing a plurality of controls; an elongated duct operatively coupling the controller to a first joint and a second joint; a first joint comprising a first member and a second member, the first member configured to be repositionable with respect to the second member on an X-Y plane; a second joint operatively coupled to the first joint, the second joint comprising a third member and a fourth member, the third member configured to be repositionable with respect to the fourth member on a Y-Z plane perpendicular to the X-Y plane; and, a terminal effector for implanting occlusion clamps operatively coupled to the first and second joints; wherein the plurality of controls includes a first control operatively coupled to the first joint to control the movement of the first member in relation to the second member in the XY plane, a second control operably coupled to the second joint to control the movement of the third member with respect to the fourth member in the YZ plane, a third control operationally coupled to the final effector of occlusion forceps implantation to control the movement of at least a portion of the final effector of occlusion forceps implantation, also comprising a closed ring occlusion clip assembled from removable shape in the terminal effector of implantation of occlusion clip, in which the plurality of controls includes a fourth control to disassemble the closed ring occlusion forceps from the terminal effector of implantation of occlusion forceps.
[0007]
7. Medical instrument, according to claim 6, characterized in that: the first control comprises a passive control configured to be repositionable between a first position, which allows free movement between the first member and the second member within the XY plane , and a second position that slows down the movement between the first member and the second member within the XY Plan; and, the second control comprises an active control configured to be repositionable among an infinite number of positions, each of the infinite number of positions orienting the third member with respect to the fourth member in a different position within the Y-Z plane.
[0008]
8. Medical instrument, according to claim 7, characterized by the fact that the third control comprises a second active control configured to be repositionable between an infinite number of positions, in which each of the infinite number of positions guides the final deployment of the occlusion forceps in a different position.
[0009]
9. Medical instrument, according to claim 8, characterized by the fact that the fourth control comprises a passive control configured to disassemble or retain a connection between the terminal effector of the occlusion clamp and the closed ring occlusion clamp.
[0010]
10. Medical instrument, according to claim 6, characterized by the fact that: the first control comprises a first passive control configured to be repositionable between a first position, which allows free movement between the first member and the second member within the plane XY, and a second position that slows down the movement between the first member and the second member within the XY plane; and, the second control comprises a second passive control configured to be repositionable between a first position, which allows free movement between the third member and the fourth member within the YZ plane, and a second position which delays the movement between the third member and the fourth member inside the YZ plane.
[0011]
11. Medical instrument, according to claim 10, characterized by the fact that the third control comprises an active control configured to be repositionable between an infinite number of positions, in which each of the infinite number of positions guides the end effector of the clamp occlusion in a different position.
[0012]
12. Medical instrument according to claim 11, characterized by the fact that the fourth control comprises a passive control configured to disassemble or retain a connection between the terminal effector of the occlusion clamp and the closed ring occlusion clamp.
[0013]
13. Medical instrument, according to claim 6, characterized by the fact that: the first control comprises a first passive control configured to be repositionable between a first position, which allows free movement between the first limb and the second limb minus ninety degrees from the XY plane and a second position that slows down the movement between the first member and the second member within the XY plane; and, the second control comprises a second passive control configured to be repositionable between a first position, which allows free movement between the third member and the fourth member at least ninety degrees from the YZ plane and a second position that delays the movement between the third member and fourth member within the YZ plan.
[0014]
14. Medical instrument, according to claim 6, characterized by the fact that: the first control comprises a passive control configured to be repositionable between a first position, which allows free movement between the first limb and the second limb at least ninety degrees of the XY plane and a second position that slows down the movement between the first member and the second member within the XY plane; and, the second control comprises an active control configured to be repositionable between an infinite number of positions at least ninety degrees from the YZ plane, where each of the infinite number of positions orients the third member in relation to the fourth member in a different position. inside the YZ plane.
[0015]
15. Medical instrument according to claim 14, characterized by the fact that: the active control includes a first wheel having a first spiral cavity formed therein and a second wheel having a second spiral cavity formed therein, the first and second cavities formed spirals being mirror images of each other; the active control also includes a first connection plate coupled to a first connection line and a second connection site coupled to a second connection line; the first connection plate includes a first projection configured to be received within the first spiral cavity; the second connection plate includes a second projection configured to be received within the second spiral cavity; the first wheel and the second wheel are coupled to each other, so that the rotation of one wheel results in the corresponding rotation of the other wheel, where rotation in a first direction causes tension in the first connecting line and not in the second connecting line. connection, but rotation in a second direction, opposite the first direction, causes tension in the second connection line and not in the first connection line; and, the tension in the first connecting line causes movement in a positive X direction within the Y-Z plane, while the tension in the second connecting line causes movement in a negative X direction within the Y-Z plane.
[0016]
16. Medical instrument characterized by comprising: a manual control that houses at least partially a plurality of controls; a first joint, including the first components of the joint that are repositionable in relation to each other, within a first degree of freedom; a second joint operatively coupled to the first joint, the second joint including the components of the second joint which are repositionable with respect to each other within a second degree of freedom, the second degree of freedom being different from the first degree of freedom; an elongated conduit that operatively couples the portable control to at least one of the first joint and the second joint; and, a terminal effector of implantation of occlusion forceps removably coupled to a closed ring occlusion forceps; wherein the plurality of controls comprises a first passive control configured to control the repositioning of the first joint between a first position that allows free movement of the first joint through a predetermined range of movement and a second position that blocks a position of the first joint within the predetermined range of motion; and, wherein the plurality of controls comprises a second control configured to control the repositioning of the second joint.
[0017]
17. Medical instrument according to claim 16, characterized by the fact that the first joint comprises a mandible and a pelvis.
[0018]
18. Medical instrument according to claim 16, characterized by the fact that the second control comprises a second passive control configured to control the repositioning of the second joint between a free position that allows the free movement of the second joint through a predetermined range of motion and a restricted position that blocks a position of the second joint within the predetermined range of motion.
[0019]
19. Medical instrument, according to claim 18, characterized by the fact that: the first passive control includes a propeller mounted in a repositionable way on the portable control and configured to allow the repositioning of the first joint, the propeller operationally coupled to a first line passive control; and, the first passive control line is operationally coupled to the first joint to allow the repositioning of the first joint between the first position and the second position.
[0020]
20. Medical instrument, according to claim 19, characterized by the fact that: the second control includes a thruster mounted repositioned on the portable control and configured to allow the repositioning of the second joint, the thruster operationally coupled to a second passive control line ; and, the second passive control line is operationally coupled to the second joint to allow the repositioning of the second joint between the free position and the restricted position.
[0021]
21. Medical instrument according to claim 20, characterized by the fact that: the propellant includes a pressable button that extends through the hand control that is configured to engage a receiver; the propellant includes at least one tooth; and, the receiver includes at least one tooth configured to selectively engage at least one propeller tooth.
[0022]
22. Medical instrument, according to claim 20, characterized by the fact that: the propellant comprises a pressable button pressed by a spring, the propellant is configured to be repositionable between a first position of the button and a second position of the button, the first position of the button corresponds to the first position of the first passive control, the second position of the button corresponds to the second position of the first passive control; the thruster can be locked in at least one of the positions of the first button and the second position of the button.
[0023]
23. Medical instrument, according to claim 16, characterized by the fact that the plurality of controls includes a third control configured to disengage the closed ring occlusion clamp from the terminal effector of implantation of the occlusion clamp.
[0024]
24. Medical instrument according to claim 23, characterized by the fact that the third control includes a link that extends from the portable control to the terminal effector of implantation of the occlusion clamp to control the disengagement of the closed ring occlusion clamp of the terminal effector of the occlusion clamp implant.
[0025]
25. Medical instrument according to claim 24, characterized by the fact that: the terminal effector of implantation of the occlusion forceps includes opposing forceps removably coupled to the closed ring occlusion forceps; and, the link is configured to be repositioned to disengage the closed ring occlusion clamp from the opposing jaws.
[0026]
26. Medical instrument according to claim 25, characterized by the fact that: the opposite clamps each include a hole through which a rope extends; the cords are attached to the closed ring occlusion forceps; and, the link is removably coupled to the cords.
[0027]
27. Medical instrument according to claim 26, characterized by the fact that: the string comprises a suture loop; and, the link interposes the suture loop and the closed ring occlusion forceps.
[0028]
28. Medical instrument according to claim 25, characterized by the fact that: at least one, of the first joint and the second joint, includes a channel along which a traction link is configured to pass through; the traction link is operationally coupled to a fourth control of the plurality of controls and to the final effector of implantation of the occlusion clamp; and, in which the repositioning of the traction link in relation to the portable control is configured to cause the opening of the opposite claws and the closed ring occlusion clamp.
[0029]
29. Medical instrument characterized by comprising: a manual control that houses at least partially a plurality of controls; a first joint, including the first components of the joint that are repositionable in relation to each other, within a first degree of freedom; a second joint operatively coupled to the first joint, the second joint including the components of the second joint which are repositionable with respect to each other within a second degree of freedom, the second degree of freedom being different from the first degree of freedom; an elongated conduit that operatively couples the portable control to at least one of the first joint and the second joint; and, a terminal effector for implanting the occlusion clamp includes a pair of parallel guides removably coupled to an occlusion clamp; wherein the plurality of controls comprises a first passive control configured to control the repositioning of the first joint between a first position that allows free movement of the first joint through a predetermined range of movement and a second position that blocks a position of the first joint within the predetermined range of motion; wherein the plurality of controls comprises a second control configured to control the repositioning of the second joint; wherein the plurality of controls includes a third control, including a connection that extends from the handheld control to the occlusion clamp implant end effector and is configured to be repositioned to disengage the occlusion clip end effector occlusion clamp ; wherein the pair of parallel guides each includes a hole through which a rope extends; in which the cords are coupled to the occlusion clamp; and, in which the connection is removably coupled to the strings.
[0030]
30. Medical instrument according to claim 29, characterized by the fact that: the string comprises a suture loop; and, the connection interposes the suture loop and the closed ring occlusion forceps.
[0031]
31. Medical instrument according to claim 29, characterized by the fact that: at least one of the first joint and the second joint include a channel along which a traction link is configured to pass through; the traction link is operationally coupled to a fourth control of the plurality of controls and to the terminal effector of implantation of the occlusion clamp; and, in which the repositioning of the traction link in relation to the portable control is configured to cause the opening of the pair of parallel guides and the occlusion loop.
[0032]
32. Medical instrument controller, characterized by the fact that it comprises: a portable control including a plurality of controls at least partially received within a housing; the plurality of controls comprise a first wheel rotatably repositionable around an axis mounted in the housing, the first wheel is operationally coupled to a first wire and a second wire extending beyond the housing, so that the rotation of the first wheel on a first direction increases a length of the first wire within the housing and decreases a length of the second wire within the housing and therefore the rotation of the first wheel in a second direction, opposite the first direction, decreases the length of the first wire within the housing and decreases the length of the second wire inside the housing; and, the plurality of controls comprise a handle repositioned in the housing, the handle being coupled to a drive link that is operationally coupled to a third wire that extends beyond the housing, so that the repositioning of the repositionable handle in relation to the housing cause the third wire to be repositioned in relation to the box.
[0033]
33. Medical instrument controller, according to claim 32, characterized by the fact that the plurality of controls comprises a repositionable lock configured to inhibit the repositioning of the first wheel in relation to the axle.
[0034]
34. Medical instrument controller according to claim 32, characterized by the fact that: the first wheel includes a first arcuate surface in contact with the first wire; the first wheel includes a second arcuate surface in contact with the second wire; and, a first fastener operatively couples the first wheel to the first and second wires.
[0035]
35. Medical instrument controller, according to claim 32, characterized by the fact that: the first wheel includes a first arcuate surface in contact with the first wire; the first wheel includes a second arcuate surface in contact with the second wire; the first wheel includes a first vertical flange to retain the first wire in contact with the first arcuate surface; and, the first wheel includes a second vertical flange to retain the second wire in contact with the second arcuate surface.
[0036]
36. Medical instrument controller according to claim 32, characterized in that the plurality of controls comprises a second wheel rotatable repositionable around the axis mounted in the housing, the second wheel is operationally coupled to a fourth and a fifth wire wire extending beyond the housing, so that the rotation of the second wheel in a first direction increases a length of the fourth wire within the housing and decreases a length of the fifth wire within the housing and, so that the rotation of the second wheel in a second direction, opposite the first direction, decreases the length of the fourth wire within the housing and decreases the length of the fifth wire within the housing.
[0037]
37. Medical instrument controller, according to claim 36, characterized by the fact that: the second wheel includes a third arched surface in contact with the fourth wire; the second wheel includes a fourth arcuate surface in contact with the fifth wire; and, a second fastener operatively couples the second wheel to the fourth and fifth threads.
[0038]
38. Medical instrument controller, according to claim 36, characterized by the fact that: the second wheel includes a third arcuate surface in contact with the fourth wire; the second wheel includes a fourth arcuate surface in contact with the fifth wire; the second wheel includes a third vertical flange for retaining the fourth wire in contact with the third arcuate surface; and, the second wheel includes a fourth vertical flange to retain the fifth thread in contact with the fourth arcuate surface.
[0039]
39. Medical instrument controller, according to claim 36, characterized by the fact that the plurality of controls comprises a repositionable lock configured to inhibit the repositioning of the first and second wheels in relation to the axle.
[0040]
40. Medical instrument controller, according to claim 32, characterized by the fact that the drive link is operationally coupled to a pin received in a repositionable manner within an opening of the housing.
[0041]
41. Medical instrument controller according to claim 32, characterized by the fact that the drive link includes a repositionable opening receiving a pin from the housing.
[0042]
42. Medical instrument controller, characterized by the fact that it comprises: a portable control including a plurality of controls at least partially received within a housing; the plurality of controls comprise a first wheel rotatably repositionable in relation to the housing, the first wheel is operationally coupled to a first wire that extends beyond the housing, so that the rotation of the first wheel in a first direction increases the length of the first wire inside the housing and the rotation of the first wheel in a second direction, opposite the first direction, decreases the length of the first wire inside the housing; the plurality of controls comprise a handle repositioned in the housing, the handle being coupled to a drive link that is operationally coupled to a third wire that extends beyond the housing, so that the repositioning of the repositionable handle in relation to the housing causes the repositioning of the third wire with respect to housing; and, the plurality of controls comprise a rod mounted in a repositionable manner in the housing, operationally coupled to a second wire that extends within and beyond the housing, where the repositioning of the rod in relation to the housing alters a length of the second wire that extends within of the accommodation.
[0043]
43. Medical instrument controller, according to claim 41, characterized by the fact that: the plurality of controls comprises a second wheel rotatable repositionable in relation to the housing, the second wheel is operationally coupled to a third wire that extends beyond the housing, so that the rotation of the second wheel in a first direction increases the length of the third wire within the housing and the rotation of the second wheel in a second direction, opposite the first direction, decreases the length of the third wire within the housing.
[0044]
44. Medical instrument controller, according to claim 43, characterized by the fact that: the first wheel engages a first connection plate that is coupled to the first wire; the second wheel engages a second connection plate which is coupled to the third wire; the first connecting plate engages the first wheel to convert the rotation of the first wheel into longitudinal movement of the first connecting plate; and, a second connecting plate engages a second wheel to convert the rotation of the second wheel into longitudinal movement of the second connecting plate.
[0045]
45. Medical instrument controller, according to claim 44, characterized by the fact that: the first connection plate and the first wheel engage through a first spiral trench that receives a corresponding first projection; and, the second connecting plate and the second wheel engage through a second spiral trench which receives a corresponding second projection.
[0046]
46. Medical instrument controller according to claim 43, characterized by the fact that the first wheel is a mirror image of the second wheel.
[0047]
47. Medical instrument controller according to claim 43, characterized by the fact that the first wheel and the second wheel rotate around a common axis in relation to the housing.
[0048]
48. Medical instrument controller according to claim 43, characterized in that the majority of the first wheel and the majority of the second wheel are covered by the housing, regardless of whether the first and second wheels are rotated or stationary.
[0049]
49. Medical instrument controller, according to claim 42, characterized by the fact that the stem is configured to be removably mounted in the housing.
[0050]
50. Medical instrument controller according to claim 42, characterized by the fact that the handle is repositionable between a longitudinally aligned position and a juxtaposed position in relation to the housing and where the handle is remote from the longitudinally aligned position.
[0051]
51. Medical instrument controller according to claim 42, characterized in that the housing comprises the respective right and left sides which, when mounted together, delineate a first opening through which at least a portion of the first wheel protrudes, a second opening through which at least a portion of the rod protrudes.

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法律状态:
2017-03-28| B15I| Others concerning applications: loss of priority|

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2017-06-13| B12F| Other appeals [chapter 12.6 patent gazette]|

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2018-12-11| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]|

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2019-10-29| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|

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2020-09-08| B06G| Technical and formal requirements: other requirements [chapter 6.7 patent gazette]|

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2020-11-24| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|

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2021-02-09| B16A| Patent or certificate of addition of invention granted [chapter 16.1 patent gazette]|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 15/08/2012, OBSERVADAS AS CONDICOES LEGAIS. |

优先权:

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申请号 | 申请日 | 专利标题

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US201161523805P| true| 2011-08-15|2011-08-15|

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US61/523,805|2011-08-15|

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PCT/US2012/051002|WO2013025841A1|2011-08-15|2012-08-15|Surgical device|

---