• 专利附录
  • 专利说明
  • 权利要求
  • 类似技术
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    • 专利摘要:
    resistive heated surgical clamp cartridge with phase change seal. the present invention relates to an apparatus for endosurgical use which includes an instrument having an end actuator and a clamp cartridge that can be inserted into the end actuator. the staple cartridge includes staples, staple openings, a resistive member and a medical fluid. when coupled to an energy source, the medical fluid is vaporized by the resistive member and expelled through the staple openings over the stapled tissue. the power source may be contained within the instrument. in one configuration, a resistive strip with strip contacts can be electrically coupled to a conductor on the end actuator. the medical fluid can also be divided into a plurality of sealing blocks that correspond to the clamp openings and the medical fluid can be a depolymerizable cyanoacrylate, a sprayable thermoplastic urethane or any vaporizable medication or pharmaceutical product. the clamp drivers can include one or more openings to allow medical fluid to pass through or around the clamp drivers.
    公开号:BR112014005984B1
    申请号:R112014005984-5
    申请日:2012-09-10
    公开日:2020-12-15
    发明作者:Brett E. Swensgard；Dean B. Bruewer；Cory G. Kimball；Katherine J. Schmid；William A. Daunch
    申请人:Ethicon Endo-Surgery, Inc；
    IPC主号:
    专利说明:

    BACKGROUND
    [0001] In some contexts, endoscopic surgical instruments may be preferred over traditional open surgery devices, since a smaller incision can reduce recovery time and complications in the postoperative period. Consequently, some endoscopic surgical instruments may be suitable for placing a distal end actuator in a desired surgical site through the trocar cannula. These distal end actuators can hold the tissue in various ways to achieve a diagnostic or therapeutic effect (for example, cutter, claw, cutter, stapler, clamp applicator, access device, drug delivery / gene therapy device and device for application of energy using ultrasound, RF, laser, etc.). Endoscopic surgical instruments can comprise a rod between the end actuator and a cable portion, which is handled by the physician. This rod can allow insertion to the desired depth and rotation around the longitudinal axis of the rod itself, thus facilitating the positioning of the end actuator on the patient. The positioning of an end actuator can also be facilitated by the inclusion of one or more joints or articulation features, allowing the end actuator to be selectively articulated or even offset in relation to the longitudinal axis of the stem.
    [0002] Examples of endoscopic surgical instruments include surgical staplers. Some of these staplers can be operated to staple layers of fabric, cut through stapled fabric layers, and urge staples through fabric layers to securely join separate layers of fabric near the separate ends of the fabric layers. Surgical staplers for example only are presented in US Patent No. 4,805,823, entitled "Pocket Configuration for Internal Organ Staplers", issued on February 21, 1989; US Patent No. 5,415,334, entitled "Surgical Stapler and Staple Cartridge", issued May 16, 1995; US Patent No. 5,465,895, entitled "Surgical Stapler Instrument", issued November 14, 1995; US Patent No. 5,597,107, entitled "Surgical Stapler Instrument", issued January 28, 1997; US Patent No. 5,632,432, entitled "Surgical Instrument", issued May 27, 1997; US Patent No. 5,673,840, entitled "Surgical Instrument", issued October 7, 1997; US Patent No. 5,704,534, entitled "Articulation Assembly for Surgical Instruments", issued January 6, 1998; US Patent No. 5,814,055, entitled "Surgical Clamping Mechanism", issued September 29, 1998; US Patent No. 6,978,921, entitled "Surgical Stapling Instrument Incorporating an E-Beam Firing Mechanism", issued December 27, 2005; US Patent No. 7,000,818, entitled "Surgical Stapling Instrument Having Separate Distinct Closing and Firing Systems", issued February 21, 2006; US Patent No. 7,143,923, entitled "Surgical Stapling Instrument Having a Firing Lockout for an Unclosed Anvil", issued December 5, 2006; US Patent No. 7,303,108, entitled "Surgical Stapling Instrument Incorporating a Multi-Stroke Firing Mechanism with a Flexible Rack", issued on December 4, 2007; US Patent No. 7,367,485, entitled "Surgical Stapling Instrument Incorporating a Multistroke Firing Mechanism Having a Rotary Transmission", published on May 6, 2008; US Patent No. 7,380,695, entitled "Surgical Stapling Instrument Having a Single Lockout Mechanism for Prevention of Firing", issued on June 3, 2008; US Patent No. 7,380,696, entitled "Articulating Surgical Stapling Instrument Incorporating a Two-Piece E-Beam Firing Mechanism", issued on June 3, 2008; US Patent No. 7,404,508, entitled "Surgical Stapling and Cutting Device", issued July 29, 2008; US Patent No. 7,434,715, entitled "Surgical Stapling Instrument Having Multistroke Firing with Opening Lockout", issued October 14, 2008; and US Patent No. 7,721,930, entitled "Disposable Cartridge with Adhesive for Use with a Stapling Device", issued May 25, 2010. The description of each of the US patents cited above is incorporated into the present invention by reference. Although the aforementioned surgical staplers are described as used in endoscopic procedures, it should be understood that these surgical staplers can also be used in open procedures and / or other non-endoscopic procedures.
    [0003] Although various types of surgical stapling instruments and associated components have been manufactured and used, it is believed that no one before the inventor (s) has manufactured or used the invention described in the embodiments. BRIEF DESCRIPTION OF THE DRAWINGS
    [0004] The attached drawings, which are incorporated into this specification and form part of it, illustrate modalities of the invention and, together with the general description provided above and the detailed description of the modalities provided below, serve to explain the principles of present invention.
    [0005] Figure 1A depicts a perspective view of an articulated surgical instrument with an end actuator in a non-articulated position;
    [0006] figure 1B shows a perspective view of the surgical instrument of figure 1A with an end actuator in an articulated position;
    [0007] figure 2 represents a perspective view of the open end actuator of the surgical instrument of figures 1A to 1B;
    [0008] figure 3A shows a side cross-sectional view of the end actuator in figure 2, taken along line 3-3 in figure 2, with the firing bar in a proximal position;
    [0009] figure 3B shows a side cross-sectional view of the end actuator in figure 2, taken along line 3-3 in figure 2, but showing the firing bar in a distal position;
    [00010] figure 4 shows a cross-sectional view of the end of the end actuator of figure 2, taken along line 4-4 of figure 2;
    [00011] figure 5 shows an exploded perspective view of the end actuator of figure 2;
    [00012] figure 6 shows a perspective view of the end actuator of figure 2, positioned on the fabric and being actuated once on the fabric;
    [00013] figure 7 shows a perspective view of an exemplary staple cartridge;
    [00014] figure 8A shows a partial lateral cross-sectional view of the cartridge of figure 7;
    [00015] figure 8B shows a portion of the side cross-sectional view of figure 8A showing a vertically cam wedge support of a clamp driver;
    [00016] figure 8C shows a portion of the side cross-sectional view of figure 8A showing a resistive strip vaporizing a seal;
    [00017] figure 8D depicts a portion of the side cross-sectional view of figure 8A showing the vaporized seal being expelled through a clip trigger channel;
    [00018] figure 9 depicts a partial lateral cross-sectional view of an exemplary alternative arrangement for a staple cartridge;
    [00019] figure 10 shows a partial lateral cross-sectional view of yet another exemplary arrangement for a staple cartridge;
    [00020] figure 11 shows a partial perspective view of a pair of exemplary channels formed within a clip cartridge body;
    [00021] figure 12 shows a partial perspective view of an exemplary staple cartridge that has channels that are coupled to a lower jaw of the instrument of figures 1A-1B;
    [00022] figure 13 shows a perspective view of an exemplary staple driver that has a staple driver opening;
    [00023] figure 14 shows a perspective view of an alternative exemplary clamp driver that has a pair of notches;
    [00024] figure 15 shows a side cross-sectional view of yet another exemplary clamp driver that has a plurality of resistive strips and integrated seals; and
    [00025] figure 16 shows a partial lateral cross-sectional view of an end actuator of the instrument of figures 1A-1B.
    [00026] In no way are the drawings intended to be limiting and it is envisaged that various embodiments of the invention may be carried out in a variety of other ways, including those not necessarily represented in the drawings. The drawings incorporated in the annex and which form a part of the specification, illustrate various aspects of the present invention and together with the description serve to explain the principles of the invention, it is understood, however, that this invention is not limited to the provisions shown. DETAILED DESCRIPTION
    [00027] The following description of specific examples of the invention should not be used to limit the scope of the present invention. Other examples, characteristics, aspects, modalities and advantages of the invention will become evident to those skilled in the art from the description below, by way of illustration, one of the best ways contemplated for carrying out the invention. As will be understood, the invention can have other different and obvious aspects, all without departing from the invention. Consequently, drawings and descriptions should be considered as illustrative and not restrictive in nature. I. Exemplary surgical stapler
    [00028] Figures 1 to 6 depict an exemplary surgical cutting and stapling instrument 10 that is dimensioned for insertion, in a non-articulated state, as depicted in figure 1A, through a trocar cannula passage to a surgical site in a patient to perform a surgical procedure. The stapling and separation surgical instrument 10 includes a cable portion 20 connected to an implement portion 22, the latter further comprising a stem 23 that ends distally in a hinge mechanism 11 connected distally to the end actuator 12. When the articulation 11 and the distal end actuator 12 are inserted through the canal of the trocar cannula, the articulation mechanism 11 can be remotely articulated, as shown in figure 1B, by the articulation control 13. Thus, the end actuator 12 it can reach behind an organ or approach tissue at a desired angle or for other reasons. It should be understood that terms such as "proximal" and "distal" are used in the present invention with reference to the cable portion 20 of the instrument 10 manipulated by the physician. In this way, the end actuator 12 is distal with respect to the most proximal portion of cable 20. It will also be recognized that, for convenience and clarity, spatial terms such as "vertical" and "horizontal" are used in the present invention in connection with the drawings. However, surgical instruments can be used in many orientations and positions and these terms are not intended to be limiting and absolute.
    [00029] The end actuator 12 of the present example includes a lower claw 16 and an articulated anvil 18. The handle portion 20 includes a pistol grip 24, against which a closing trigger 26 is pivotally pressed by the physician to in order to cause clamping or closing of the anvil 18 against the lower claw 16 of the end actuator 12. This closing of the anvil 18 is achieved by means of an external closing sleeve 32, which moves longitudinally in relation to the cable portion 20 in response to the articulated actuation of the closing trigger 26 against the pistol grip 24. A distal closing ring 33 of the closing sleeve 32 is supported indirectly by the structure 34 of the implement portion 22. In the articulation mechanism 11, a proximal closing tube 35 of the closing sleeve 32 communicates with the distal portion (closing ring) 33. The frame 34 is flexibly connected to the lower claw 16 via the articulation mechanism 11, allowing articulation in a single plane. The structure 34 also supports, in a longitudinal and sliding way, a firing steering member (not shown), which extends through the rod 23 and transmits a firing movement from the firing trigger 28 to the firing bar 14. The firing trigger firing 28 is further from the closing trigger 26, being pressed jointly by the doctor to staple and separate the tissue clamped on the end actuator 12, as will be described in more detail below. Then, release button 30 is released to release tissue from end actuator 12.
    [00030] Figures 2 to 5 show an end actuator 12 that employs an E 14 beam firing bar to perform various functions. As can best be seen in Figures 3A and 3B, the firing bar 14 includes a cross-oriented upper pin 38, a trigger-bar cover 44, a cross-oriented middle pin 46 and a cutting edge in distal position 48. The upper pin 38 is located and can move inside an anvil pocket 40 of the anvil 18. The trigger bar cover 44 slidably engages the bottom surface of the lower claw 16, causing the trigger bar 14 to extend to the along the slot of the channel 45 (shown in figure 3B) that is formed along the lower claw 16. The middle pin 46 slidably engages the top surface of the lower claw16, cooperating with the trigger bar cover 44. In this way, the firing bar 14 positively spaces the end actuator 12 during firing, avoiding mechanical tightening that can occur between the anvil 18 and the lower claw 16 with a minimum amount of pinched tissue and avoiding malfunctions. forming of staples when an excessive amount of tissue is clamped.
    [00031] Figure 2 shows a firing bar 14 positioned proximally and anvil 18 pivoted to an open position, allowing an uns worn staple cartridge 37 to be removably installed in a channel of the lower claw 16. As shown you can see better in figures 4 and 5, the staple cartridge 37 in this example includes the cartridge body 70, which contains an upper platform 72 and is coupled to a lower cartridge tray 74. As can be seen better in figure 2, a vertical slot 49 is formed through part of the staple cartridge 37. Also, as can be seen better in figure 2, three lines of staple openings 51 are formed through the upper platform 70 on one side of the vertical slot 49, with another set of three rows of clip openings 51 formed through the upper platform 70 on the other side of the vertical slot 49. Returning to figures 3 to 5, a wedge-shaped sliding support 41 and a plurality of clip drivers po 43 are captured between the cartridge body 70 and the tray 74, with the wedge-shaped sliding bracket 41 proximal to the clamp actuators 43. The wedge-shaped sliding bracket 41 is movable longitudinally inside the staple cartridge 37, while the clip drivers 43 are movable vertically inside the clip cartridge 37. The clips 47 are also positioned inside the cartridge body 70, above the corresponding clip drivers 43. In particular, each clip 47 is propelled vertically inside the cartridge body 70 by a clamp actuator 43, in order to propel the clamp 47 through an associated clamp opening 51. As can best be seen in figures 3A and 3B and 5, the sliding support wedge 41 features angled cam surfaces that push the clamp actuators 43 upward as the wedge-shaped slide 41 is propelled distally through the staples 37.
    [00032] With the end actuator 12 closed, as shown in figure 3A, the firing bar 14 is advanced engaged with the anvil 18, through the entrance of the upper pin 38 in a longitudinal slot of the anvil 42. A drive block 80 is located at the distal end of the firing bar 14 and is configured to engage with the wedge-shaped sliding bracket 41 so that the wedge-shaped sliding bracket 41 is pushed distally by the drive block 80 as the firing bar 14 is advanced distally through a staple cartridge 37. During this firing, the cutting edge 48 of the firing bar 14 enters the vertical slot 49 of the staple cartridge 37, separating the clamped fabric between the staple cartridge 37 and the anvil 18. As shown in figures 3A and 3B, the middle pin 46 and the propeller block 80, together, activate the staple cartridge 37 by entering a firing slot inside the staple cartridge 37, which takes the sliding form holder the wedge 41 to the upward contact of the cams with the clamp actuators 43, which, in turn, impels the clamps 47, through the clamp openings 51 and to the forming contact with the clamp forming cavities 53 on the inner surface of the anvil 18. Figure 3B represents the firing bar 14 completely translated distally after the separation and stapling of the fabric are completed.
    [00033] Figure 6 shows an end actuator 12 which was actuated through a single motion fabric 90. As shown, the cutting edge 48 cut through the fabric 90, while the clip drivers 43 pushed three alternating rows of clips 47 through of the fabric 90 on both sides of the cutting line produced by the cutting edge 48. The clamps 47 are all oriented substantially parallel to the cutting line in this example, although it should be understood that the clamps 47 can be positioned in any suitable orientations. In the present example, end actuator 12 is removed from the trocar after the first stroke is completed, the staple cartridge 37 is replaced by a new staple cartridge and end actuator 12 is again inserted through the trocar to reach the stapling site for additional cutting and stapling. This process can be repeated until the desired number of cuts and staples 47 has been applied. Anvil 18 may need to be closed to facilitate insertion and removal through the trocar; and the anvil 18 may need to be opened to facilitate replacement of the staple cartridge 37.
    [00034] It should be understood that the cutting edge 48 can separate fabrics substantially at the same time that the clamps 47 are pushed through the fabric during each stroke of actuation. In the present example, the cutting edge 48 closely follows the insertion of the clips 47, so that a clip 47 is pushed through the fabric just before the cutting edge 48 passes through the same region of the fabric, although it should be understood that this order can reversed, or that the cutting edge 48 can be directly synchronized with the adjacent clips. Although figure 6 shows the end actuator 12 being driven in two layers 92, 94 of fabric 90, it should be understood that end actuator 12 can be driven through a single layer of fabric 90 or more than two layers 92, 94 of fabric. It should also be understood that the formation and positioning of staples 47 adjacent to the cutting line produced by the cutting edge 48 can substantially unite the tissue at the cutting line, thereby reducing or preventing bleeding and / or leakage of other body fluids in the cut-line. Various suitable configurations and procedures in which the instrument 10 can be used will be apparent to those skilled in the art in view of the teachings contained herein.
    [00035] It should be understood that instrument 10 can be configured and is operable in accordance with any other teachings of US Patent No. 4,805,823; US patent No. 5,415,334; US patent No. 5,465,895; US patent No. 5,597,107; US patent No. 5,632,432; US patent No. 5,673,840; US patent No. 5,704,534; US patent No. 5,814,055; US patent No. 6,978,921; US patent No. 7,000,818; US patent No. 7,143,923; US patent No. 7,303,108; US patent 7,367,485; US patent 7,380,695; US patent No. 7,380,696; US patent No. 7,404,508; US patent No. 7,434,715; and / or US patent No. 7,721,930. As noted above, the descriptions of each of these patents are incorporated by reference to the present invention. Additional exemplary modifications that can be made to instrument 10 will be described in more detail below. Several suitable ways in which the teachings below can be incorporated into instrument 10 will be apparent to those skilled in the art. Similarly, various ways in which the teachings below can be combined with various teachings of the patents cited herein will be apparent to those skilled in the art. It should also be understood that the teachings below are not limited to the instrument 10 or the devices taught in the patents cited here. The teachings below can be readily applied to several other types of instruments, including instruments that would not be classified as surgical staplers. Various other suitable devices and configurations in which the teachings below can be applied will be apparent to those skilled in the art in view of the teachings contained herein. II. Exemplary alternative staple cartridges
    [00036] Figure 7 depicts an exemplary alternative staple cartridge 100 for use with instrument 10. The cartridge 100 comprises a cartridge body 102, a cartridge tray 104, a vertical slot 106, an upper platform 110 and a plurality of clip openings 112 formed in the upper platform 110. The vertical slot 106 extends longitudinally through the cartridge body 102 and the upper platform 110 so that the firing bar 14 and the cutting edge 48 pass through at least a portion of the body of cartridge 102. It should be understood that the vertical slot 106 can extend longitudinally only partially through the cartridge body 102 or along the entire length of the cartridge body 102. The cartridge 100 of the present example has a proximal end 120 that includes a support portion 122. The support portion 122 additionally includes cartridge contacts 130 in this example, as will be described later in this document then, to electrically couple cartridge 100 to a power source 98 when cartridge 100 is inserted into end actuator 12. As a person of ordinary skill in the art will appreciate, cartridge contacts 130 are not limited to the proximal end 120 of the cartridge 100. In fact, cartridge contacts 130 can be located on the bottom surface of cartridge 100, such as on or through cartridge tray 104, or anywhere on cartridge body 102. Cartridge contacts 130 can be configured alternatively, so that the electrical power is communicated in an inductive, capacitive, and / or any other way. In addition, cartridge contacts 130 are purely optional. A. Exemplary configuration and operation of an alternative staple cartridge that has a conductive and resistive strip
    [00037] Figures 8A to 8D depict a sequential internal view of the example cartridge 100 when inserted in the lower jaw 16 of the end actuator 12 and used to cut and staple the fabric, like the fabric 90 in figure 6. Referring first to 8A, a plurality of clips 114 and clip drivers 180 are shown disposed within the cartridge 100. In the present example, the lower jaw 16 comprises a conductor 150 having a plurality of conductor contacts 152 extending from the surface of top of conductor 150. Conductor 150 may comprise a metal member which has contacts with ridges, a plastic member which has an embedded metal member and a plurality of contacts protruding from the plastic member, a printed circuit board ( or PCB) with thin conductive contacts and channels (eg exposed lines, etc.), or any other suitable components and / or resources to transmit electrical power to the contacts and conductor 152. Conductor contacts 152 are shown as a plurality of raised portions configured to electrically mate with a corresponding plurality of raised portions of strip contacts 162, although other suitable contact configurations will be apparent to a person of ordinary skill in the field. in view of the teachings in this document. A thin resistive strip 160 having strip contacts 162 is coupled to cartridge body 102 so that when cartridge 100 is inserted into the lower jaw 16, strip contacts 162 and conductor contacts 152 are electrically coupled. In an alternative, the strip contacts 162 can extend through the cartridge tray 104 or the resistive strip 160 that has strip contacts 162 can be integrated in the cartridge tray 104. In another merely exemplary alternative, the strip contacts 162 and the conductor contacts 152 can be omitted and the resistive strip 160 and the conductor 150 can be a single piece, inside the cartridge tray 104, inside the cartridge body 102, or in the lower jaw 16. As shown in the present example, a plurality of strip contacts 162 and conductor contacts 152 are each aligned with a respective clamp opening 112 so that when a load is applied to conductor 150, resistive strip 160 heats a corresponding portion of resistive strip 160 below each clamp opening 112. As will be explained further below, alternative configurations for cartridge 100, conductor 150 and resistive strip 160 can be used.
    [00038] A layer of seal 170 is disposed above resistive strip 160. In the present example, seal 170 is a substantially homogeneous continuum disposed within cartridge body 102. It should be understood that seal 170 is not limited to seals instead, a variety of vaporisable items may be used without departing from the scope of this description. For example, sealant 170 may comprise a depolymerizable cyanoacrylate, sprayable thermoplastic urethane, polyurethane prepolymer, medicaments, hemostatic agents, mucoadhesive polymers, poly vinylpyrrolidone (PVP), methyl cellulose (MC), sodium carboxy methyl cellulose (SCMC), propyl cellulose hydroxy (HPC) and other cellulose derivatives, anionic hydrogels, cationic hydrogels, neutral hydrogels (such as carbapol, polyacrylates, chitosan or Eudragits), polyacrylic-polyethylene glycol copolymers (so-called oral adhesives), thrombin lyophilized (such as that used in Surgiflo® by Ethicon, Inc. in Somerville, New Jersey, USA), platelet-poor plasma (PPP) platelet-rich plasma (PRP), mussel-based or derivative adhesives, calcium alginate, fibrin, adhesives, image enhancing agents, necrosis agents, sclerosis agents, coagulants, therapeutic agents, analiseptic agents, anesthesia agents, antidiuretic agents s, analgesic agents, antiseptic agents, antispasmodic agents, cardiac agents, depressant agents, diuretic agents, hormonal agents, sedative agents, stimulant agents, vascular agents, time releasing agents, drugs, absorbable materials, dyes, plasticizers, volume forming agents, buffering agents, thixotropic agents, antibacterial agents, buffers, catalysts, fillers, microparticles, thickeners, solvents, synthetic or natural rubbers, stabilizers, pH modifiers, bioactive agents, crosslinking agents, transfer agents chain, fibrous reinforcements, dyes, preservatives, sequestering or reducing agents of formaldehyde, and / or any other fluid, including liquids, gels, pastes, etc., or any other suitable medical fluid or hemostatic agent as will be apparent to a person of skill common in the art in view of the teachings in this document.
    [00039] Furthermore, sealant 170 can be impregnated with additional materials, such as various remedies (including pain relievers or other suitable remedies), marking materials (such as echogenic or radiopaque fluids and / or markers), or any other suitable material that can be delivered with seal 170. In addition, seal 170 can be a solidified material that can vaporize when subjected to thermal heating from resistive strip 160, or seal 170 can be a liquid or semi-solid. If seal 170 is a liquid or semi-solid, the seal may be contained within a reservoir or channel formed within resistive strip 160 or in an alternative structure located above resistive strip 160, such as a portion of cartridge body 102. This Alternative channel type structure will be discussed below with reference to figure 11.
    [00040] A plurality of clamp drivers 180 is located above seal 170. In the present example, each of the clamp drivers 180 defines a respective clamp trigger channel 182 formed through each clamp driver 180 so that a material vaporized material can pass through the clamp driver 180 once the clamp 114 is ejected through the clamp opening 112. The clamp trigger channel 182 may include an opening formed through the clamp trigger 180, such as the trigger opening 510 shown in figure 13, or can include notches formed on one or more sides of the clip driver 180, such as semicircular notches 610 shown in figure 14, or other configurations suitable for the clip driver channel 182. The clips 114 are located above the drivers clamp 180, and in figure 8A, both clamps 114 and clamp drivers 180 are shown in an unpositioned configuration. The clamps 114 can also be removably attached to the clamp actuators 180, as through an adhesive, to ensure that the clamps 114 remain aligned and above the clamp actuators 180.
    [00041] Referring now to figure 8B, the wedge holder 41 and the firing bar 14 are shown by driving the clamp 114 through the fabric 90 while also cutting the fabric 90. As described above, the anvil 18 compresses the fabric 90 against the upper platform 110 while the clamp driver 180 is cam vertically through the wedge support 41 to guide the clamp 114 through the fabric 90 and into the clamp forming pocket 53. While the clamp 114 is driven through the fabric 90, conductor 150 and resistive strip 160 may remain inactive, although it should be understood that this is merely optional. In fact, in one configuration, the conductors 150 can be activated sequentially right after the cutting edge 48 cuts through the fabric 90. For example, the wedge support 41 and / or the firing bar 14 can comprise a conduction portion that can be electrically couple to conductor 150 and / or resistive strip 160 to supply power from power source 98. Alternatively, conductors 150 and / or resistive strip 160 and seal 170 can be arranged on the side of the clip driver 180 or elsewhere within the cartridge body 102, as will be apparent to a person of ordinary skill in the art in view of the teachings in this document.
    [00042] Referring again to the present example, as shown in figure 8C, while the anvil 18 is still compressing the tissue 90, the energy source 98 is activated and applied to the conductor 150. The energy source 98 can be activated through a toggle switch or button located on the cable portion 20 of the instrument 10 or through another control mechanism, including, but not limited to, a third trigger or an automated system that receives a signal from a sensor that indicates the advance of the firing bar 14. Additionally, the power source 98 can be external to the instrument 10 or the power source 98 can be contained within the instrument 10. A purely exemplary configuration for the instrument 10 that has an internal power source is revealed US Patent No. 7,738,971, entitled "Post-Sterilization Programming of Surgical Instruments," issued June 15, 2010, the disclosure of which is incorporated by reference in this document. to. Alternatively, the power source 98 can be an external power source.
    [00043] When power source 98 sends power to conductor 150, conductor 150 transfers energy to resistive strip 160 through conductor contacts 152 and strip contacts 162. Resistive strip 160 then heats the appropriate portions of the strip resistive 160 and the portions of the seal 170 to vaporize the seal 170 in droplets 172. It should be understood that the seal 170 can be liquefied, atomized, or transformed into any fluid and / or gaseous form so that the seal 170 can be expelled from cartridge 100. In the present example, resistive heating vaporizes seal 170 and produces a rapid pressure wave that expels seal 170 from cartridge 100. This resistive heating can be carried out in a manner similar to inkjet thermal. Alternatively, droplets 172 can be formed through pressure or vibratory mechanisms, such as piezoelectric inkjet technology. As droplets 172 are formed, droplets 172 are expelled through a clip trigger channel 182 and through the clip opening 112, as shown in figure 8D. In the present configuration, the clip driver 180 is shown leaning against the upper platform 110, although it should be understood that the clip driver 180 can alternatively return to rest above seal 170 before vaporizing seal 170. In an alternative configuration, a separate opening can be provided through which droplets 172 can be expelled. After clamp 114 has perforated fabric 90 and is attached to it, droplets 172 of seal 170 can rest on clamp 114 and fabric 90. Droplets 172 then reconstitute on clamp 114 and / or fabric 90. This reconstitution may include repolymerization (as for cyanoacrylate or polyacrylates), addition polymerization (as for polyurethane prepolymer), and / or solidification of a liquid into a solid polymer. Once the droplets 172 are reconstituted, the seal 170 formed on the clamp 114 and the tissue 90 can further assist in sealing the tissue 90. A user of the instrument 10 can delay the release of the anvil 18 until a predetermined time interval so that droplets 172 sufficiently reconstitute seal 170 in fabric 90 and clamp114. As described above, a user can then change cartridges 100 and repeat the process to cut and seal additional portions of fabric 90.
    [00044] Although a merely exemplary construction for cartridge 100 has been described, other alternative constructions suitable for constructions for cartridge 100 having a resistive heating portion will be apparent to a person of ordinary skill in the art, in view of the teachings in the present document. For example, as shown in figure 9, an alternative arrangement for cartridge 100 shows seal 170 divided into a plurality of individual sealing blocks 174. Sealing blocks 174 of the present example are aligned above strip contacts 162 and conductor contacts 152 and below the clip openings 112. Alternatively, conductor 150 having conductor contacts 152 can be located on or inside cartridge tray 104 while resistive strip 160 and strip contacts 162 are located on or within the body of cartridge 102. In addition, a single strip contact 162 can be located in support portion 122 and a single conductor contact 152 can be located in a corresponding portion of lower jaw 16 instead of a plurality of contacts in cartridge 100 and lower jaw 16. In yet another configuration, the lower jaw 16 may comprise a resistive strip 160 coupled to the power source 98 while the carton tray ho 104 and / or cartridge body 102 comprise a plurality of openings having seal 170 contained therein. Therefore, when the cartridge 100 is coupled to the lower jaw 16, a plurality of openings containing seal 170 aligns with the resistive strip portions 160 in order to resistively heat the seal 170 when the resistive strip 160 is coupled to the power source. 98. Furthermore, while the cartridges disclosed in this document have been described with reference to a single-sided stapling cartridge, it should be understood that these cartridges can be modified to include double-sided stapling cartridge. B. Alternative and exemplary resistive assemblies
    [00045] In yet another configuration, shown in figure 10, a plurality of individual resistive assemblies 200 is arranged below each clamp opening 112 formed in the upper platform 110. In this configuration, each of the resistive assemblies 200 comprises a conductor 202, a resistive strip 206, a seal 210, a strip contact 208 and a conductor contact 204. Seal 210 is not limited to a seal, but may include any of the medical fluids and / or other items referred to for seal 170. According to shown in the present example, conductors 202 which have conductor contacts 204 are disposed within cartridge tray 104 while seals 210 and resistive strips 206 which have exposed strip contacts 208 are disposed within cartridge body 102. Therefore, when the cartridge body 102 is coupled to the cartridge tray 104, the strip contacts 208 are electrically coupled to the conductor contacts 204. In an alternative configuration, the conductors 202 can be incorporated into the lower jaw 14 although the seals 210 and resistive strips 206 are inside the cartridge body 102 and / or the cartridge tray 104. Electrical terminals 220 extend from conductors 202 and resistive strips 206 through one or more terminal openings 222 to electrically couple to the power source 98, as described above. Alternatively, electrical terminals 220 can be integrated into the lower jaw structure 16, cartridge tray 104, and / or cartridge body 102 in a similar way to a PCB or in any other suitable way, as will be apparent to a person of common skill in the technique in view of the teachings in this document. C. Exemplifying sealing channels
    [00046] Yet another configuration for a staple cartridge is shown in figure 11. A plurality of channels 300 are formed within the cartridge body 102. Each channel 300 comprises a channel head 302 and a channel body 304. The bodies of channel 304 may extend over several distances so that each channel head 302 corresponds to a clamp opening, such as clamp openings 51, 112, when the clamp openings are distributed in different locations. For example, in the example cartridge 100 shown in figure 7, the clip openings 112 form three rows on both sides of the vertical slot 106 with misaligned clip openings 112. A plurality of channel bodies 304 of the present example are further configured to be in fluid communication with one or more other channel bodies 304 through ports 306. Doors 306 can be used to inject a seal 320 into channels 300 during assembly to distribute seal 320 across a plurality of channels 300 before seal 320 solidify, or, if a liquid or semi-solid seal 320 is used, ports 306 can allow a plurality of channels 300 to extract from a common seal reservoir 320. Seal 320 is not limited to a seal, but can include any of medical fluids and / or other items referred to for seal 170. It should be understood, however, that ports 306 are purely optional and channels 300 may be independent each other, or a plurality of subsets of channels 300 can be connected via ports 306.
    [00047] A resistive channel plate 310 is located inside each channel head 302 so that resistive channel plate 310 can heat and vaporize the seal 320 below a corresponding clamp opening for ejection into the stapled fabric. Resistive channel plate 310 can be configured as a stand-alone assembly, like resistive assemblies 200, or resistive channel plate 310 can comprise only a resistive strip, such as resistive strip 160. If channel plate 310 comprises a resistive strip , one or more channel board connectors 312 can be provided to electrically couple resistive channel boards 310 to a conductor and / or power source. In the present configuration, the 312 card connectors are incorporated within the cartridge body to electrically couple to a single conductor, although it is to be understood that the 312 channel card connectors can be configured in a variety of other ways, as will be apparent for a person of ordinary skill in the art in view of the teachings in this document.
    [00048] For example, plate connectors 312 can be configured in a similar way to strip conductors 162 of figures 8A-8D, 9 and 10 and protrude outward (or are otherwise exposed through) the bottom of the body 102 and / or cartridge tray 104. This configuration is shown in Figure 12. Channels 300 that have resistive plates 310 with plate connectors 312 are shown configured to be inside a cartridge body 402 of a cartridge 400 The cartridge 400 has a construction substantially similar to that of cartridge 100 and cartridge 37 and cartridge 400 comprises a plurality of clip openings 412, an upper platform 410, a cartridge body 402 and a vertical slot 406. Channels 300 are aligned with corresponding clamp openings 412. In the present example, the lower jaw 16 comprises complementary end actuator contacts 420 for electrically coupling to plate connectors 312 when cartridge 400 is inserted into the lower jaw 16. Alternatively, as noted with some of the above deployments, the lower jaw 16 may comprise a single contact to electrically couple to a single contact on cartridge 400. Alternatively, the lower jaw 16 may include a single plate of conductor for electrically coupling to the card connectors 312 or the lower jaw 14 itself may have a portion that electrically attaches to the card connectors 312.
    [00049] Although various configurations for channels 300 and cartridge 400 have been revealed, other suitable configurations will be apparent to a person of ordinary skill in the art, in view of the teachings in this document. D. Exemplary clamp drivers
    [00050] Now, with reference to figures 13 and 14, different clip actuators can be used with the aforementioned configurations to expel the vaporized seals. Figure 13 depicts a clamp driver 500 having a clamp driver body 502 with a driver opening 510 formed therein and a pair of alignment tabs 520. The driver opening 510 extends vertically through the driver body of clamp 502 and is configured to allow the vaporized seal to be expelled out through the clamp openings of a cartridge. The staple alignment tabs 520 extend vertically from the staple actuator body 520 and are configured to align a staple on the staple actuator 500 prior to positioning. The alignment tabs 520 can be further configured to removably retain the clamp, such as through an adhesive or a removable mechanical connection. In another additional configuration, the alignment tabs 520 can be configured to couple with a receiving notch (not shown) formed within an upper platform of a cartridge, such as the upper platform 110, so that the clip driver 500 engage and remain leaning on the upper platform, even when the firing bar 14 is retracted. In this configuration, any of the aforementioned configurations can then be activated to expel a seal through the trigger opening 510. An alternative staple driver 600 is pictured in figure 14. The alternative staple driver 600 has a configuration substantially similar to the staple driver 500, except that the clip driver 600 comprises a pair of semicircular notches 610 formed on the sides of the clip driver body 602 to allow a seal to pass through the notches and beyond the clip driver 600. Obviously, as with other components described herein other configurations suitable for the 500, 600 clamp actuators will be apparent to a person of ordinary skill in the art in view of the teachings in this document.
    [00051] In another additional configuration shown in figure 15, one or more resistive strips 712 and seals 714 are incorporated within a corresponding chamber 710 in the clip driver 700 or attached to the clip driver body 702 of the clip driver 700. The seal 714 is not limited to a seal, but can include any of the medical fluids and / or other items referred to for seal 170. In this configuration, clamp driver 700 has a plurality of clamp driver contacts 708 on the bottom surface of the staple actuator 700, although it should be understood that the staple actuator contacts 708 can be located anywhere on the staple actuator 700. A connector 722 electrically couples the actuator contacts 708 to the resistive strips 712, although it should be understood that this is merely optional and the resistive strips 712 can be integrally coupled to the actuator contacts 708. One or more openings 720 formed within the steel body clamp driver 702 are configured to allow the vaporized seal 716 to be expelled to seal the clamp and fabric. In the present configuration, actuator 708 contacts are configured to be electrically coupled to one or more contacts located on firing bar 14 and / or wedge support 41. When firing bar 14 is fully extended (and therefore the cartridge clamps were expelled through the clamp openings), the power source 98 can be applied to one or more contacts on the firing bar 14, thereby firing the resistive strips 712 to vaporize the seal 714 to be expelled out through the openings 720. Alternatively , if the wedge support 41 comprises the contacts, or if the wedge support 41 comprises the conductive material, the power source 98 can be coupled to the wedge support 41 although the wedge support 41 places the clamp driver 700 vertically in cam. As will be appreciated, this can vaporize the seals 714 while the clamps are being driven through the fabrics. This can reduce the time required for seal 714 to reconstitute to seal staples and fabric. In another additional configuration, the trigger contacts 708 can be on one or more sides of the body of the clip driver 702 to electrically engage the corresponding contacts on the side wall of the pocket through which the clip driver 700 moves.
    [00052] Although various configurations for the 500, 600, 700 clamp actuators have been presented, other suitable configurations will be apparent to a person of ordinary skill in the art in view of the teachings in this document. E. Example configuration for electrical coupling of end actuator
    [00053] Figure 16 shows an end actuator 12 that has one or more electrical contacts 800 coupled to a remote power source, such as power source 98, via connector 810. As noted earlier, power source 98 it can be located inside the cable portion 20 (shown in figures 1A-1B), or the power source 98 can be external to the instrument 10. The electrical contact 800 in the present arrangement is coupled to a corresponding cartridge contact, such as the contacts cartridge 130 of cartridge 100, when a cartridge is inserted into the lower claw 16. Electrical contact 800 can be configured to be used multiple times with multiple clip cartridges during instrument use 10. Although only a single electrical contact 800 is pictured , it should be noted that more than one electrical contact 800 can be used. In fact, it may be useful to provide redundant electrical contacts 800 for cases where blood or other body fluids may interfere with the electrical connection of one or more electrical contacts 800, although it should be understood that this redundancy is merely optional. In addition, although electrical contact 800 is shown located near the proximal end of lower claw 16, other suitable locations for electrical contact 800 on lower claw 16, anvil 18, or firing bar 14 will be apparent to a person of ordinary skill in the art in view of the teachings in this document.
    [00054] It must be understood that any one or more of the teachings, expressions, modalities, examples, etc. described here can be combined with any one or more of the other teachings, expressions, modalities, examples, etc. that are described here. The teachings, expressions, modalities, examples, etc. described below should not be seen in isolation from each other. Various suitable ways in which the teachings of the present invention can be combined will be readily apparent to those skilled in the art in view of the teachings of the present invention. These modifications and variations must be included in the scope of the achievements.
    [00055] Versions of the devices described above may have application in conventional medical treatments and procedures conducted by a medical professional, as well as application in medical treatments and procedures assisted by robotics.
    [00056] Versions of the above can be designed to be discarded after a single use, or they can be designed for use multiple times. The versions can, in either or both cases, be reconditioned for reuse after at least one use. Reconditioning can include any combination of steps to disassemble the device, followed by cleaning or replacing particular parts and subsequent reassembly. In particular, some versions of the device can be disassembled, in any number of particular parts or parts of the device can be selectively replaced or removed in any combination. With the cleaning and / or replacement of particular parts, some versions of the device can be reassembled for subsequent use in a reconditioning facility, or by a user immediately before a surgical procedure. Those skilled in the art will understand that the reconditioning of a device can use a variety of techniques for disassembly, cleaning / replacement and reassembly. The use of such techniques and the resulting reconditioned device are all within the scope of this application.
    [00057] Just as an example, the versions described here can be sterilized before and / or after a procedure. In a sterilization technique, the device is placed in a closed and sealed container, such as a plastic or TYVEK bag. The container and the device can then be placed in a radiation field, such as gamma radiation, X-rays or high-energy electrons, which can penetrate the container. Radiation can kill bacteria on the device and the container. The sterile device can then be stored in a sterile container for later use. The device can also be sterilized using any other known technique, including, but not limited to, beta or gamma radiation, ethylene oxide or water vapor.
    [00058] In view of the presentation and description of various versions in the present disclosure, additional adaptations of the methods and systems described in this document can be made through appropriate modifications made by an element skilled in the art, without departing from the scope of the present invention. Several of these possible modifications have been mentioned and others will be evident to the elements versed in the technique. For example, the examples, versions, geometry, materials, dimensions, proportions, steps and the like discussed above are illustrative only and are not mandatory. Consequently, the scope of the present invention must be considered in accordance with the terms of the embodiments and it is understood that it is not limited to the details of the structure and operation shown and described in the specification and drawings.
    权利要求:
    Claims (15)
    [0001]
    1. Apparatus characterized by the fact that it comprises: (a) an instrument (10) comprising: i. a cable portion (20), ii. an end actuator (12) comprising: (1) a lower claw (16), (2) a pivoting anvil (18); and (b) a staple cartridge (100) that can be inserted into the end actuator (12), the staple cartridge (100) comprising: i. a cartridge body (102) having an upper platform (110), the upper support (110) comprising: (1) a vertical slot (106) formed in the upper platform (110) and extending longitudinally from a proximal end of the upper platform (110), with a cutting edge (48) capable of longitudinal displacement through the vertical slot (106), and (2) a plurality of clip openings (112), ii. one or more clamp drivers (180) that can move vertically with respect to the cartridge body (102), iii. a plurality of clips (114) disposed above one or more clip drivers (180), the plurality of clips (114) being able to move vertically with respect to the cartridge body (102), iv. a resistive heating member (160) disposed within the cartridge body (102), e.g. a medical seal (170) that has at least one portion in thermal communication with the resistive heating member (160), in which an electrical power source (98) is connected to the resistive heating member (160), the member being resistive heating (160) adapted to heat parts of the medical seal (170) to liquefy the seal (170) in droplets (172), vaporize the seal (170), atomize the seal (170), or transform the seal (170) into any fluid or gaseous form so that the seal (170) can be expelled from the cartridge (100).
    [0002]
    2. Apparatus according to claim 1, characterized by the fact that the resistive heating member (160) comprises a resistive strip (160).
    [0003]
    Apparatus according to claim 2, characterized by the fact that the lower jaw (16) comprises a conductor (150), in which the conductor (150) is selectively coupled to a power source (98).
    [0004]
    4. Apparatus according to claim 3, characterized by the fact that the resistive strip (160) comprises strip contacts (162), in which the conductor (150) comprises conductor contacts (152), in which the contact contacts strip (162) are operable to be electrically coupled to the conductor contacts (152).
    [0005]
    Apparatus according to claim 4, characterized by the fact that at least a portion of the strip contacts (162) is in vertical alignment with the plurality of clip openings (112).
    [0006]
    Apparatus according to claim 1, characterized by the fact that the medical seal (170) comprises a plurality of seal blocks (174).
    [0007]
    Apparatus according to claim 6, characterized by the fact that at least a portion of each of the sealing blocks (174) is in vertical alignment with the plurality of clip openings (112).
    [0008]
    Apparatus according to claim 1, characterized by the fact that the one or more clamp actuators (180) comprise an opening that extends vertically through the one or more clamp actuators (180).
    [0009]
    Apparatus according to claim 1, characterized in that the one or more clamp actuators (180) comprise a notch (610) that extends vertically on one side of the one or more clamp actuators (180).
    [0010]
    Apparatus according to claim 1, characterized by the fact that the medical seal (170) comprises a depolymerizable cyanoacrylate or a thermoplastic urethane capable of being sprayed.
    [0011]
    11. Apparatus according to claim 1, characterized by the fact that the medical seal (170) is a vaporizable medicine or pharmaceutical product.
    [0012]
    Apparatus according to claim 1, characterized in that the cartridge body (102) comprises a channel formed in a base portion of the cartridge body (102), wherein the resistive heating member (160) and the medical seal (170) are disposed within the channel.
    [0013]
    13. Apparatus according to claim 1, characterized by the fact that it also comprises a contact (152) coupled to the resistive member and operable to electrically couple the resistive member to a power source (98).
    [0014]
    Apparatus according to claim 13, characterized in that the cartridge body (102) comprises a proximal end having a support portion and in which the contact (152) is located in the support portion.
    [0015]
    15. Apparatus according to claim 13, characterized by the fact that the power source (98) is contained within the instrument (10).
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    同族专利:
    公开号 | 公开日
    JP6072041B2|2017-02-01|
    MX351214B|2017-10-04|
    RU2624332C2|2017-07-03|
    MX2014002975A|2015-03-19|
    CN103930046A|2014-07-16|
    EP2755570B1|2018-12-05|
    IN2014DN01850A|2015-05-15|
    WO2013039818A1|2013-03-21|
    US20130062393A1|2013-03-14|
    RU2014114496A|2015-10-20|
    US8998060B2|2015-04-07|
    EP2755570A1|2014-07-23|
    CN103930046B|2016-12-28|
    BR112014005984A2|2017-04-04|
    JP2014531239A|2014-11-27|
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    法律状态:
    2018-12-11| B06F| Objections, documents and/or translations needed after an examination request according art. 34 industrial property law|
    2019-10-29| B06U| Preliminary requirement: requests with searches performed by other patent offices: suspension of the patent application procedure|
    2020-09-15| B09A| Decision: intention to grant|
    2020-12-15| B16A| Patent or certificate of addition of invention granted|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 10/09/2012, OBSERVADAS AS CONDICOES LEGAIS. |
    优先权:
    申请号 | 申请日 | 专利标题
    US13/230,994|2011-09-13|
    US13/230,994|US8998060B2|2011-09-13|2011-09-13|Resistive heated surgical staple cartridge with phase change sealant|
    PCT/US2012/054397|WO2013039818A1|2011-09-13|2012-09-10|Resistive heated surgical staple cartridge with phase change sealant|
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