surgical instrument comprising beads of glue suspended in a matrix

专利摘要:
FIBRINE BLOCK MATRIX WITH HEAT-ACTIVATED SUSPENDED ADHESIVE MICROSPHERES. The present invention relates to a surgical instrument that includes a cable portion, a rod housing a firing bar, an end actuator comprising an anvil, a lower jaw, and a cutting and stapling assembly that responds to a movement of longitudinal closure produced by the. cable and rod. The lower jaw is configured to receive the cartridge when in an open position. The cartridge includes a housing, a plurality of clips arranged in the housing, and a platform arranged on the plurality of clips. The platform defines openings, with each opening being substantially arranged over each clamp. The cartridge additionally receives a matrix including microspheres of glue suspended in the matrix. The clips are guided through the matrix to attach the matrix to the fabric. The glue microspheres are activated when the matrix is attached to the fabric, such that the activated adhesive further fixes the staple line on the fabric.
公开号:BR112014006319B1
申请号:R112014006319-2
申请日:2012-09-10
公开日:2020-12-22
发明作者:Israel Nur；Yi-Lan Wang；Aron O. Zingman；Matthew C. Miller
申请人:Ethicon Endo-Surgery, Inc；
IPC主号:

专利说明:

BACKGROUND
[001] In some contexts, endoscopic surgical instruments may be preferred over devices for traditional open surgery, since a smaller incision can reduce recovery time and complications in the postoperative period. As a result, 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 obtain a diagnostic or therapeutic effect, for example, cutter, claw, cutter, stapler, clamp applicator, access device, drug delivery device / gene therapy and device for applying energy with the use of ultrasound, RF, laser, etc. The endoscopic surgical instruments may comprise a rod between the end actuator and a portion of the cable, which is handled by the physician. This nail can allow insertion to the desired depth and rotation around the longitudinal axis of the nail itself, thus facilitating the positioning of the extremity actuator in the patient. The positioning of an end actuator can also be facilitated by the inclusion of one or more articulated joints or features, allowing the end actuator to be selectively articulated or even offset in relation to the longitudinal axis of the stem.
[002] Examples of endoscopic surgical instruments include surgical staplers. Some of these staplers can be operated to staple layers of fabric, cut through stapled layers of fabric, and propel staples through fabric layers to firmly attach separate layers of fabric near the separate ends of the fabric layers. Surgical staplers for example only are described: in US Patent No. 4,805,823, entitled "Pocket Configuration for Internal Organ Staplers", granted 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 on November 14, 1995; US Patent No. 5,597,107, entitled "Surgical Stapler Instrument", granted on January 28, 1997; US Patent No. 5,632,432, entitled "Surgical Instrument", issued on May 27, 1997; US Patent No. 5,673,840, entitled "Surgical Instrument", issued on October 7, 1997; US Patent No. 5,704,534, entitled "Articulation Assembly for Surgical Instruments", issued on January 6, 1998; US Patent No. 5,814,055, entitled "Surgical Clamping Mechanism", issued September 29, 1998; US Patent No. 6,964,363, entitled "Surgical Stapling Instrument having Articulation Joint Support Plates for Supporting a Firing Bar", issued on November 15, 2005; US Patent No. 6,978,921, entitled "Surgical Stapling Instrument Incorporating an E-Beam Firing Mechanism", granted December 27, 2005; US patent No. 6,988,649, entitled "Surgical Stapling Instrument Having a Spent Cartridge Lockout", granted on January 24, 2006; US Patent No. 7,000,818, entitled "Surgical Stapling Instrument Having Separate Distinct Closing and Firing Systems", issued on February 21, 2006; US Patent No. 7,111,769, entitled "Surgical Instrument Incorporating an Articulation Mechanism having Rotation about the Longitudinal Axis", granted on September 26, 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 Living a Rotary Transmission", published on May 6, 2008; US Patent No. 7,380,695, entitled "Surgical Stapling Instrument Living a Single Lockout Mechanism for Prevention of Firing", issued on June 3, 2008; US Patent No. 7,380,696, entitled "Arti- culating 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; in US patent No. 7,434,715, entitled "Surgical Stapling Instrument Having Multiple Shooting Courses with Opening Lock", granted on October 14, 2008; US Patent No. 7,721,930, entitled "Disposable Card with Adhesive for Use with a Stapling Device", issued May 25, 2010; and in US Patent No. 7,455,208, entitled "Surgical Instrument with Articulating Shaft with Rigid Firing Bar Supports", granted on November 25, 2008. The description of each of the aforementioned US patents 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.
[003] 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 attached claims. BRIEF DESCRIPTION OF THE DRAWINGS
[004] The attached drawings, which are incorporated into this descriptive report and which 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 the present invention.
[005] Figure 1A represents a perspective view of a surgical instrument of articulation with an end actuator in a non-articulated position;
[006] Figure 1B represents a perspective view of the surgical instrument of Figure 1A with an end actuator in an articulated position;
[007] Figure 2 represents a perspective view of the open end actuator of the surgical instrument of Figures 1A and 1B;
[008] Figure 3A represents a side cross-sectional view of the end actuator of Figure 2, taken along line 3-3 of Figure 2, with the firing bar in a proximal position;
[009] Figure 3B represents a side cross-sectional view of the end actuator of Figure 2, taken along line 3-3 of Figure 2, but showing the firing bar in the distal position;
[0010] Figure 4 represents a cross-sectional view from the end of the end actuator of Figure 2, taken along line 4-4 of Figure 2;
[0011] Figure 5 represents an exploded perspective view of the end actuator of Figure 2;
[0012] Figure 6 represents a perspective view of the end actuator of Figure 2, positioned on the fabric and being actuated once on the fabric;
[0013] Figure 7 represents a perspective view, fragmented of an exemplary cartridge of the Figure 2 end actuator and an exemplary fibrin block matrix disposed above and on an outer top surface of the cartridge;
[0014] Figure 8 represents a cross-sectional view of the fibrin block matrix of Figure 7, the matrix including suspended glue balls activated by heat;
[0015] Figure 9 represents an elevation view of the end actuator of Figure 2 and the fibrin block matrix of Figure 7 arranged on and between an underside of the anvil and the outer top surface of the cartridge; and
[0016] Figure 10 represents a perspective view of an end actuator with the matrix of Figure 9, the end actuator positioned on and driven inside the fabric to release a tissue repair composition from the support and the adhesive of the glue balls on the fabric.
[0017] The drawings are not intended to limit in any way, and it is envisaged that various modalities of the invention can be performed in a variety of other ways, including those not necessarily represented in the drawings. The attached drawings, which form 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
[0018] 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 following description, which uses illustrations, one of the best contemplated ways to carry 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 rather than restrictive. I. Exemplary surgical stapler
[0019] Figures 1 to 6 represent an exemplary surgical stapling and separation instrument 10 that is dimensioned for insertion in a non-articulated state, as shown in Figure 1A, through the canal of the trocar cannula, to a surgical site. - logical in a patient undergoing a surgical procedure The surgical stapling and separation instrument 10 includes a portion of cable 20 connected to an implement portion 22, the latter also comprising a rod 23 that ends distally in a locking mechanism. pivot 11 connected distally to end actuator 12. When pivot mechanism 11 and distal end actuator 12 are inserted via the trocar cannula conduit, pivot mechanism 11 can be pivoted remotely, as shown in Figure 1B , by the control of article 13. Thus, the end actuator 12 can reach behind an organ or approach a tissue with a desired angle or for other reasons the. 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.
[0020] The end actuator 12 of the present example includes a lower jaw 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 doctor in order to cause clamping or closing of the anvil 18 against the lower jaw 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 tube proximal closing 35 of the closing sleeve 32 communicates with the distal portion of the closing ring 33. The structure 34 is flexibly connected to the lower jaw 16 via mechanism articulation 11, allowing articulation in a single plane. Structure 34 also supports, in a longitudinal and sliding way, a triggering member not shown, which extends through the stem 23 and transmits a firing movement from the trigger 28 to the trigger bar 14. The firing trigger 28 is farthest 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.
[0021] Figures 2 to 5 represent the end actuator 12 that employs an electronic beam firing bar 14 to perform a variety of functions As can be seen best in Figures 3A and 3B, the firing bar 14 includes a transverse oriented upper pin 38, a firing bar cover 44, a transverse oriented medium pin 46 and a cutting edge in distal position 48. The upper pin 38 is located and translatable inside an anvil pocket 40 of the anvil 18. The firing bar cover 44 slidably engages the lower surface of the lower jaw 16, causing the firing bar 14 to extend along the groove in the channel 45 shown in Figure 3B which is formed along the jaw lower 16. The middle pin 46 slidably engages the top surface of the lower jaw16, cooperating with the trigger bar cover 44. Thus, the trigger bar 14 positively spaces the end actuator 12 during firing, avoiding mechanical tightening that can occur between the anvil 18 and the lower jaw 16 with a minimum amount of clamped tissue and avoiding the malformation of clamps when an excessive amount of tissue is clamped.
[0022] Figure 2 shows the firing bar 14 positioned proximally and the anvil 18 hinged in an open position, allowing a cartridge of staples 37 not to be installed in the channel of the lower jaw 16 in a removable way. - to better observe 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 clamp 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 drive Staple rings 43 are captured between the body of the cartridge 70 and the tray 74, with the wedge-shaped sliding support 41 located proximal to the clamp actuators 43. The wedge-shaped sliding support 41 is movable longitudinally inside the cartridge staples 37; whereas staple actuators 43 are movable vertically inside the staple cartridge 37. Staples 47 are also positioned inside the cartridge body 70, above the corresponding staple actuators 43. In particular, each staple 47 is propelled vertically inside the cartridge body 70 by a clamp driver 43, in order to propel the clamp 47 through an associated clamp opening 51. As can be seen better in Figures 3A and 3B and 5, the wedge-shaped sliding support 41 has sloping cam surfaces that push the clamp actuators 43 upward as the wedge-shaped sliding support 41 is propelled distally through the clamp cartridge 37.
[0023] 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 block propeller 80 is located at the distal end of the firing bar 14 and is configured to engage the wedge-shaped slide 41 so that the wedge-shaped slide 41 is pushed distally by the propeller block 80 according to the bar trigger 14 is advanced distally through a staple cartridge 37. During this firing, the cutting edge 48 of the trigger bar 14 enters the vertical slot 49 of the staple cartridge 37, separating the clamped tissue 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 entering a firing slot inside the staple cartridge 37, which takes the sliding support and wedge-shaped 41 to the upward contact of 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 distally translated after the separation and stapling of the fabric are completed.
[0024] Figure 6 represents the end actuator 12 driven by a single movement through the fabric 90. As shown, the cutting edge 48 cut through the fabric 90, while the staple actuators 43 pushed three alternating rows of staples 47 through of the fabric 90 on both sides of the cutting line produced by the cutting edge 48. Staples 47 are all oriented substantially parallel to the cutting line in this example, although it should be understood that staples 47 can be positioned in any suitable orientations . In the present example, the end actuator 12 is removed from the trocar after the first stroke is completed, the staple cartridge 37 is replaced with a new staple cartridge, and the end actuator 12 is inserted again. served through the trocar to reach the stapling site for additional cuts 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.
[0025] It should be understood that the cutting edge 48 can separate fabrics substantially at the same time as 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 be inverted, or that the cutting edge 48 can be directly synchronized with the adjacent clamps. 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 the staples 47 adjacent to the cutting line produced by the cutting edge 48 can substantially unite the fabric on the cutting line, thereby reducing or preventing bleeding and / or leakage. other body fluids on 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.
[0026] 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. 6,964,363; US patent No. 6,978,921; US patent No. 6,988,649; US patent No. 7,000,818; US patent No. 7,111,769; 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; US patent No. 7,721,930; and / or US patent No. 7,455,208. 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 with 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 cartridge and matrix set
[0027] Figure 7 shows an exemplary cartridge and matrix assembly 100 in which cartridge 37 includes fasteners, such as hooks 102, that cling to support or matrix 104. Hooks 102 and matrix 104 can provide a relationship fixation, such as a hook and loop fixation relationship in which the hooks 102 connect to the loops formed inside the matrix material 104. The matrix 104 can be, for example, a fibrin block matrix including suspended microspheres of heat-activated glue 106. As shown in Figure 8, glue balls 106 are suspended in the fibrin block matrix 104. Each glue ball 106 includes a compartment 108 that is heat sensitive to release glue 110 after initial activation with fabric 90 which has a body temperature measurement. The glue ball 106 is heated to a temperature sufficient to start activation when the glue ball 106 is heated by exposure to body temperature, for example. In addition, or alternatively, glue spheres 106 can be activated by body fluids at the surgical site. The glue balls 106 are positioned substantially along the clamps 47 such that when the clamps 47 are driven into the fabric 90, the clamps 47 will pass through the glue balls 47 and release the material into the fabric90. Staples 47 can be produced from a material selected from iron, nickel-titanium alloy, stainless steel and / or titanium. Of course, any other suitable materials can be used.
[0028] Referring again to the Figure. 7, the matrix 104 includes a portion of the cartridge 112, the anvil portion 114, and an intermediate portion 116 disposed between the proximal ends of the cartridge portion 112 and the anvil portion 114. The anvil portion 114 includes a flap 118 that surrounds the upper surface 120 of the anvil 18, as shown in the figure. 9. The flap 118, for example, defines an unrepresented pocket sized to receive the distal end of the anvil 18, thus fixing part of the anvil 114 of the matrix 104 to the anvil 18. The intermediate portion 116 of the matrix 104 can include a pre-formed curve to facilitate the loading of cartridge 37 in the lower jaw and insertion of anvil 18 in the pocket defined by flap 118.
[0029] In use, cartridge 37 with matrix 104 is removably received in the lower jaw 16 of end actuator 12, as shown in Figure 9. When end actuator 12, including cartridge 37 and the matrix 104, is used, as shown in Figure 10, the clamps 47 are driven into the fabric 90, simultaneously or just before the firing bar 14 fires into the fabric 90, while cutting through the matrix 104. Thus, glue balls 106 are guided to fabric 90 by firing staples 47 onto fabric 90. Staples 47 capture the glue balls and release material on fabric 90, as described above. In addition, staples 47 can capture parts of the fibrin block matrix 104 and embed those portions in tissues 90 or, at least, attach the fibrin block matrix 104 to tissue 90. The firing bar 14 cuts through the die 104 while cutting the fabric 90 in use, applying matrix material 104 over the cut fabric. The matrix forming material 104 may comprise a biodegradable polymer that can function to assist with tissue repair, for example, as described below. The material cut by the firing bar 14 can be deposited on fabric 90 slightly after the glue ball material 106 is deposited on the fabric 90. As it can take some time for the heat of the fabric 90 to sufficiently heat up and activate the glue 106 to release glue 110 from compartment 108, glue 110 initially released from glue balls 106 is substantially prevented from attaching and restricting the movement of the firing bar 14 when the firing bar 14 cuts through the matrix 104.
[0030] When surgical clamp 47 is inserted into the tissue by a surgical instrument, such as instrument 10 in the manner shown above, surgical clamp 47 will compress, connect and support such layers of tissue as shown in Figure 10. Glue 108 of the glue spheres 106 will be in contact with the compressed and retained tissue and can be released into the tissue to assist in tissue repair, for example, acting as an adhesive to bond the tissue, while helping to reduce the amount of bleeding at the surgical site.
[0031] The material for matrix 104 may comprise, in addition to fibrin, for example, other auxiliary compounds or hemostatic agents such as thrombin, which can help to clot the blood and reduce the amount of hemorrhage at the surgical site. The hematic capacities of these auxiliary compounds can also contribute to the use of these auxiliary compounds as adhesives and sealants. Agents can help to clot blood at the surgical site, which allows the tissue surrounding the blood to remain joined and can prevent leaks along the stapled tissue site, for example. Other auxiliary compounds or reagents that can be incorporated into matrix 104 and / or glue beads 106 may still include, but are not limited to, medical fluid or matrix components. By way of example only, the matrix 104 and / or glue spheres 106 may include naturally or genetically modified absorbable polymers or synthetic absorbable polymers, or mixtures thereof. Merely illustrative examples of natural or genetically modified polymers are proteins, polysaccharides and combinations thereof. Merely illustrative examples of proteins that can be used include prothrombin, thrombin, fibrinogen, fibrin, fibronectin, heparinase, factor X / Xa, factor VII / VIa, factor IX / IXa, factor XI / XIa, factor XII / XIIa, factor tissue, batroxobin, ancrod, ecarina, von Willebrand factor, collagen, elastin, albumin, gelatin, platelet surface glycoproteins, vasopressin and vasopressin analogs, epinephrine, selectin, procoagulant poison, plasminogen activator inhibitor, platelet activating agents, peptides that have hemostatic activity, and / or a combination thereof. Polysaccharides include, but are not limited to, cellulose, alkyl cellulose, for example, methyl cellulose, alkyl hydroxy alkyl cellulose, hydroxy alkyl cellulose, cellulose sulfate, methyl cellulose carboxy salts, methyl cellulose carboxy, ethyl carboxy cellulose, chitin, carboxy methyl chitin, hyaluronic acid, hyaluronic acid salts, alginate, alginic acid, propylene glycol alginate, glycogen, dextran, dextran sulfate, curdlan, pectin, pullulan, xanthan, chondroitin, chondroitin sulfates, carboxy methyl dextran, carboxy methyl chitosan, chitosan, heparin, heparin sulfate, heparan, heparan sulfate, dermatan sulfate, keratan sulfate, carrageenans, chitosan, starch, amylose, amylopectin, poly-N-glucosamine, polymanuronic acid, polyglucuronic acid, polyguluronic acid, and derivatives of any of these. Examples of synthetic absorbable polymers are polymers of aliphatic polyester, copolymers, and / or combinations thereof. Aliphatic polyesters are typically synthesized in a ring opening polymerization of monomers that include, but are not limited to, lactic acid, lactide (L-, D-, meso and mixtures of D and L), glycolic acid , glycolide, ε-caprolactone, p-dioxanone (1,4-dioxan-2-one) and trimethylene carbonate (1,3-dioxan-2-one). Other components, materials, substances etc. suitable materials that can be used in a medical fluid or matrix will be apparent to those skilled in the art in view of the teachings contained herein.
[0032] In some versions, a medical fluid can be suspended in a biocompatible vehicle. Suitable vehicles may include, for example, a physiological buffer solution, a high flow gel solution, saline, and water. In the case of gel solutions, the tissue repair composition may be in a high-flow gel form prior to release to the target site, or it may form a gel and remain in place after release to the target site. High-flow gel solutions may comprise one or more gelling materials with or without the addition of water, saline, or buffer solution. Exemplifying gelling materials include proteins, polysaccharides, polynucleotides, and other materials, such as alginate, cross-linked alginate, poly (N-isopropylacrylamide), poly (oxyalkylene), poly (ethylene oxide) -polymer polymers (propylene oxide ), poly (vinyl alcohol), polyacrylate, or monostearoyl glycerol co-succinate / polyethylene glycol (MGSA / PEG), copolymers and combinations of any of the above.
[0033] Matrix (104) may alternatively comprise a fibrous block, foam, mesh, or other structure capable of containing an adhesive or other type of medicinal fluid. As an example only, matrix 104 can be built according to the teachings of the US App. Publication number 2009/0120994, entitled "Surgical Fastening Device with Initiator Impregnation of a Matrix or Buttress to Improve Adhesive Application" , published on May 14, 2009, the description of which is incorporated by reference in the present invention. The matrix may comprise, for example, a biocompatible material that is a surgical plate, a matrix with a plurality of openings, an open cell foam, a closed cell foam and / or a tissue dressing. The material can include porosities that induce absorption by capillary effect to the addition of the adhesive to the material and ensure that the openings remain free of the adhesive allowing the growth of tissue through the openings after application to the fabric. Other suitable materials and compositions that can be used to form the matrix 104 will be apparent to those skilled in the art in view of the teachings of the present invention.
[0034] Glue spheres 106 can be freeze-dried prior to suspension in matrix 104 and can be comprised of an adhesive, such as, but not limited to, polymerizable and / or crosslinkable materials, such as an adhesive. cyanoacrylate. The adhesive, for example, can be a monomeric adhesive composition including prepolymeric, a polymeric adhesive composition, or any other compound that can adhere to the fabric. In embodiments, the monomer can be a 1,1-disubstituted ethylene monomer, for example, an alpha-cyanoacrylate. When crosslinked or polymerized, cyanoacrylate can change from a liquid to a solid. Polymerized adhesives, for example, can be formulated to be flexible to rigid and could be spongy. If desired, the adhesive can be single-part or double-part adhesive, and / or it can contain additives such as alternative compounds. The polymerization of the adhesive can occur from, but not limited to, exposure to moisture, heating, and / or adhesion initiators such as those described in the US App. Publication No. 2009/0120994, the description of which being incorporated by reference above. Other suitable materials and compositions that can be used to form glue ball 106 will be apparent to those skilled in the art in view of the teachings of the present invention.
[0035] It must be understood that any one or more of the teachings, expressions, modalities, examples, etc. described here can be combined with any or more of the other teachings, expressions, modalities, examples, etc. which are described here. The teachings, expressions, modalities, examples, etc. The following descriptions 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 are intended to be included in the scope of the attached claims.
[0036] 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.
[0037] 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 the disassembly steps of 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 refurbished device are all within the scope of the present application.
[0038] 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.
[0039] In view of the presentation and description of several versions in this disclosure, additional adaptations of the methods and systems described in this document can be made through appropriate modifications made by an element versed in the technique, without departing from the scope of this 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 following claims and it is understood that it is not limited to the details of the structure and operation shown and described in the specification and in the drawings.

权利要求:
Claims (15)
[0001]
1. Surgical instrument (10) comprising: (a) a portion of handle (20); (b) a rod (23) housing a firing bar (14); (c) an end actuator (12) comprising an anvil (18), a lower jaw (16), and a cutting and stapling assembly that responds to a longitudinal closing movement produced by the cable portion (20) and the rod (23); and (d) a cartridge (100), in which the lower jaw (16) is configured to receive the cartridge (100) when the end actuator (12) is in an open position, where the cartridge (100) comprises: (i) a compartment (70), (ii) a plurality of clips (47) arranged in the compartment (70), (iii) a platform (72) arranged on the plurality of clips (47), the platform (72 ) defining openings (51), each opening (51) being substantially arranged over each clamp (47), and (iv) a matrix (104), said surgical instrument being characterized by the fact that: the matrix includes glue balls (106 ) suspended in the matrix (104), where the glue spheres (106) are not spheres with a total diameter between 0.01 mm and 3.0 mm formed from a polymeric coating filled with a hemostat.
[0002]
2. Surgical instrument according to claim 1, characterized by the fact that each glue ball (106) comprises glue (110) and a compartment (108), in which the compartment (108) of each of the glue balls (106) comprises a solid material, where the glue (110) is arranged in the solid compartment (108).
[0003]
3. Surgical instrument, according to claim 1, characterized by the fact that the glue balls (106) in suspension are freeze-dried.
[0004]
4. Surgical instrument, according to claim 1, characterized by the fact that the glue balls (106) comprise an adhesive that is selected from the group consisting of the following: polymerizable monomer, a monomer of 1.1 - polymerizable disubstituted ethylene, and a cyanoacrylate formulation.
[0005]
5. Surgical instrument, according to claim 1, characterized by the fact that the matrix (104) comprises a biocompatible material, or in which the matrix (104) comprises one of fibrin or thrombin.
[0006]
6. Surgical instrument according to claim 1, characterized by the fact that at least one respective glue ball (106) is substantially arranged over at least one respective opening (51) of the platform (72).
[0007]
7. Surgical instrument according to claim 1, characterized by the fact that the matrix (104) comprises a cartridge portion (112), an anvil portion (114), and an intermediate portion (116) arranged between the same, the anvil portion (114) including a flap (118) that defines a pocket configured to receive a distal end of the anvil (18).
[0008]
8. Surgical instrument according to claim 7, characterized in that the cartridge portion (112) of the matrix (104) includes one or more loops, wherein the platform (72) of the cartridge (100) includes one or more plus hooks (102), where the hooks are configured to receive the loops to attach the die (104) to the platform (72) of the cartridge (100).
[0009]
9. Surgical instrument, according to claim 7, characterized by the fact that the intermediate portion (116) comprises a preformed fold.
[0010]
10. Surgical instrument, according to claim 1, characterized by the fact that the matrix (104) comprises at least one of a hemostatic agent, a sealant or an adhesive.
[0011]
11. Surgical instrument, according to claim 1, characterized by the fact that the clamps (47) comprise a material selected from at least one of the following materials: iron, nickel-titanium alloy, stainless steel and titanium.
[0012]
12. Surgical instrument, according to claim 1, characterized by the fact that the matrix (104) comprises a biocompatible material selected from a group consisting of at least one of the following materials: glycolide epsilon-caprolactone, bovine pericardium, acid polylactic, polyglycolic acid, polyglactin, poly-dioxanone, polyglycolate, whey protein, cellulose gum, starch, gelatin, silk, nylon, polypropylene, braided polyester, polyester, polyethylene and polyetheretherketones.
[0013]
13. Surgical instrument according to claim 1, characterized by the fact that the matrix (104) comprises a biocompatible material selected from a group consisting of at least one of the following: a support, a matrix having a plurality of openings, an open cell foam, a closed cell foam, and a tissue block.
[0014]
14. Surgical instrument, according to claim 1, characterized by the fact that the matrix (104) includes at least one absorption resource.
[0015]
15. Surgical instrument, according to claim 1, characterized by the fact that: the end actuator (12) is connected to the rod (23); the cartridge (100) is received in the lower jaw (16); the anvil (18) is configured to form the clamps (47) in response to a longitudinal closing movement when the end actuator (12) is in a closed position; the matrix (104) comprises a biocompatible material containing the beads of glue (106) suspended in the matrix (104); the biocompatible material is removably connected to the cartridge (100) and the anvil (18); and the clamps (47) are operable to be guided through the biocompatible material.

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同族专利:

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公开号 | 公开日

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BR112014006319A2|2017-04-04|

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RU2612824C2|2017-03-13|

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CN103930053A|2014-07-16|

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JP6482873B2|2019-03-13|

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CN103930053B|2016-11-02|

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JP2015502762A|2015-01-29|

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MX2014003172A|2014-09-15|

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US20130068820A1|2013-03-21|

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RU2014114839A|2015-10-20|

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US8814025B2|2014-08-26|

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EP2755577B1|2018-04-25|

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WO2013039822A1|2013-03-21|

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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|

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2019-10-29| B06U| Preliminary requirement: requests with searches performed by other patent offices: suspension of the patent application procedure|

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2020-09-15| B09A| Decision: intention to grant|

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2020-12-22| 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:

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申请号 | 申请日 | 专利标题

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US13/233,633|2011-09-15|

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PCT/US2012/054407|WO2013039822A1|2011-09-15|2012-09-10|Fibrin pad matrix with suspended heat activated beads of adhesive|

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