• 专利附录
  • 专利说明
  • 权利要求
  • 类似技术
  • 同族专利
  • 引用文献
  • 法律状态
  • 优先权
    • 专利摘要:
    SURGICAL INSTRUMENT WITH CLAMP FOR REINFORCEMENT OF THE CLAMP. An apparatus is presented which comprises a surgical instrument having a cutter and a stapler. The cutter is intended to cut a portion of fabric. The apparatus additionally comprises a plurality of staples, the purpose of the stapler being to introduce the plurality of staples into the fabric, to form a stapling line. The device additionally comprises a reinforcement clip. The reinforcement clip is intended to be in selective communication with the stapling line. The reinforcement clip comprises a crown, a leg portion and a teeth portion. In some versions, the leg portion has an operable width to cover the area defined by the staple line. In some versions, the tooth portion is configured to anchor to the tissue.
    公开号:BR112014006383B1
    申请号:R112014006383-4
    申请日:2012-09-10
    公开日:2020-12-22
    发明作者:Jeffrey S. Swayze；Thomas W. Huitema；Julianne M. Siegel；Wendy A. Kerr；Steven G. Hall
    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 achieve 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 using ultrasound, RF, laser, etc.). Endoscopic surgical instruments can comprise a stem 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 work to staple layers of fabric, cut through stapled layers of fabric, and push staples through layers of fabric to firmly join separate layers of fabric close to the separate ends of the layers of fabric. Merely exemplary surgical staplers are presented in US Patent No. 4,805,823, entitled "Pocket Configuration for Internal Organ Staplers", issued on February 21, 1989, in US Patent No. 5,415,334, entitled "Surgical Stapler and Staple Cartridge ", granted on May 16, 1995, in US patent No. 5,465,895, entitled" Surgical Stapler Instrument ", granted on November 14, 1995, in US patent No. 5,597,107, entitled" Surgical Stapler Instrument ", granted on January 28, 1997, in US patent No. 5,632,432, entitled" Surgical Instrument ", granted on May 27, 1997, in US patent No. 5,673,840, entitled "Surgical Instrument", granted on October 7, 1997, in US patent No. 5,704,534, entitled "Articulation Assembly for Surgical Instruments", granted on January 6, 1998, in US patent No. 5,814,055 , entitled "Surgical Clamping Mechanism", granted on September 29, 1998, in US patent No. 6,978,921, entitled "Surgical Stapling Instrument Incorporating on E-Beam Firing Mechanism ", granted December 27, 2005, in US patent No. 7,000,818, entitled" Surgical Stapling Instrument Having Separate Distinct Closing and Firing Systems ", granted on February 21, 2006 , in US Patent No. 7,143,923, entitled "Surgical Stapling Instrument Having a Firing Lockout for an Unclosed Anvil", issued on December 5, 2006, in US Patent No. 7,303,108, entitled "Surgical Stapling Instrument Incorporating a Multi -Stroke Screw ring Mechanism with a Flexible Rack ", granted on December 4, 2007, in US patent No. 7,367,485, entitled" Surgical Stapling Instrument Incorporating a Multistroke Firing Mechanism Having a Rotary Transmission ", published on 06 May 2008, in US patent No. 7,380,695, entitled "Surgical Stapling Instrument Having a Single Lockout Mechanism for Prevention of Firing", granted on June 3, 2008, in US patent No. 7,380,696, entitled "Articulating Surgic al Stapling Instrument Incorporating a Two-Piece E-Beam Firing Mechanism ", granted on June 3, 2008, in US patent No. 7,404,508, entitled" Surgical Stapling and Cutting Device ", granted on July 29, 2008, in US patent No. 7,434,715, entitled "Surgical Stapling Instrument Having Multiple Shooting Courses with Opening Latch", granted on October 14, 2008, and in 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 above-mentioned 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 embodiments. 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 an articulated surgical instrument with an end actuator in a non-articulated position,
    [006] Figure 1B represents a perspective view of the surgical instrument in Figure 1A, with an end actuator in an articulated position,
    [007] Figure 2 represents a perspective view of an open end actuator of the surgical instrument of Figures 1A to 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 at the top 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 having been activated once on said fabric,
    [0013] Figure 7 represents a perspective view of an exemplary reinforcement clip, which has a resilient structure,
    [0014] Figure 8 represents a side view of the reinforcement clip of Figure 7,
    [0015] Figure 9A represents a side view of an exemplary alternative reinforcement clip, which has a malleable structure with an applicator,
    [0016] Figure 9B represents a side view of the reinforcement clip of Figure 9A, with the applicator flattening the reinforcement clip,
    [0017] Figure 10A represents a side view of an exemplary alternative reinforcement clip, which has a flexible structure with a locking clip,
    [0018] Figure 10B represents a side view of the reinforcement clip of Figure 10A, with the locking clip applied to the clip,
    [0019] Figure 11 represents a side view of an exemplary alternative reinforcement clip, with a ratchet feature,
    [0020] Figure 12 represents a perspective view of a reinforcement clip with an end actuator, the reinforcement clip being applied to a fabric, and
    [0021] Figure 13 represents a perspective view of an exemplary alternative reinforcement clip that has a partially segmented structure.
    [0022] The drawings are not intended to limit in any way, and it is envisaged that various modalities of the invention can be carried out in a variety of other ways, including those not necessarily represented in the drawings. The attached drawings, 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
    [0023] 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. EXEMPLIFYING SURGICAL STAPLER
    [0024] Figures 1 to 6 represent an exemplary surgical cutting and stapling instrument 10 that is sized for insertion, in a non-articulated state as shown in Figure 1A, through the passage of a trocar cannula and up to one surgical site on a patient, to perform a surgical procedure. The surgical cutting and stapling instrument 10 includes a cable portion 20 connected to an implement portion 22, the latter additionally comprising a rod 23 distally terminating in a hinge mechanism 11 and an end actuator 12 connected distally. Once the articulation mechanism 11 and the end actuator 12 are inserted through the passage of the trocar cannula, the articulation mechanism 11 can be remotely articulated, as shown in Figure 1B, through the control of joint 13. Thus, the end actuator 12 can reach behind an organ or approach a 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.
    [0025] 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 closure sleeve 32 communicates with the distal closing ring 33. Structure 34 is flexibly connected to the lower jaw 16 via articulation mechanism 11, allowing articulation in a single plane. The frame 34 also supports, in a longitudinal and sliding way, a triggering member not shown, which extends through the rod 23 and transmits a firing movement from the trigger 28 to the trigger bar 14. The firing trigger 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.
    [0026] Figures 2 to 5 represent the end actuator 12 employing an electron beam firing bar 14 to perform a number of functions. As can best be seen in Figures 3A and 3B, the firing bar 14 includes a top pin transversely oriented 38, a cap of the firing bar 44, a middle pin transversely oriented 46 and a cutting edge in distal position 48 The upper pin 38 is located and is transferable inside an anvil pocket 40 of the anvil 18. The firing bar cover 44 slidably engages the lower surface of the lower jaw 16, making the bar trigger 14 extends along the slot 45 shown in Figure 3B which is formed along the lower jaw 16. The middle pin 46 slidably engages the top surface of the lower jaw16, cooperating with the lid of the lower jaw. firing bar 44. Thus, firing 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 tissue p and avoiding the malformation of staples when an excessive amount of tissue is clamped.
    [0027] Figure 2 shows the firing bar 14 located in a proximal position and the anvil 18 pivoted to an open position, allowing an unexhausted staple cartridge 37 to be installed in a removable way within a lower jaw channel 16 As can be seen best in Figures 4 and 5, the staple cartridge 37 in this example includes the cartridge body 70, which contains an upper plate 72, and is coupled to a lower cartridge tray 74. As shown you can see better in Figure 2, a vertical slot 49 is formed through part of the staple cartridge 37. As can also be seen in Figure 2, three rows of staple openings 51 are formed through the upper platform 72 on one side of the vertical slot 49, with another set of three rows of openings for clamp 51 being formed through the upper platform 72 on the other side of vertical slot 49. Returning to Figures 3 to 5, a sliding wedge-shaped support ha 41 and a plurality of clip drivers 43 are captured between the cartridge body 70 and tray 74, with the wedge-shaped sliding support 41 proximal to the clamp drivers 43. The wedge-shaped sliding support 41 is longitudinally movable inside the staple cartridge 37, while the staple actuators 43 are vertically movable inside the staple cartridge 37. The staples 47 are also positioned inside the cartridge body 70, above the corresponding staple drivers 43 In particular, each clamp 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 wedge-shaped sliding bracket 41 has angled cam surfaces that push the clamp actuators 43 upward, as the sliding bracket wedge 41 is pushed distally through the staple cartridge 37.
    [0028] 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 drive the staple cartridge 37 through the slot 49, inside the staple cartridge 37, inserting the sliding part in wedge 4 1 so that it makes an eccentric contact upwards with the clamp actuators 43 which, in turn, lead the clamps 47 out through the clamp openings 51 and so that they enter into a formation contact with the staple-forming recesses 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.
    [0029] Figure 6 shows the end actuator 12 having been actuated by means of a single touch through the fabric 90. The cutting edge 48 cut through the fabric 90, while the clip drivers 43 led three alternating rows of clips 47 through of the fabric 90, on each side 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 orientation appropriate information. In the present example, end actuator 12 is removed from the trocar after the first stroke is completed, the staple cartridge sent 37 is replaced with a new staple cartridge, and end actuator 12 is inserted again 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 anvil 18 may need to be opened to facilitate replacement of the staple cartridge 37.
    [0030] 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.
    [0031] It should be understood that instrument 10 can be configured and operate in accordance with any other teachings of US Patent No. 4,805,823, US No. 5,415,334, US No. 5,465,895, US No. 5,597,107, US No. 5,632,432, US No. 5,673,840, US No. 5,704,534, US No. 5,814,055, US No. 6,978,921, US No. 7,000,818, US No. 7,143 .923, US No. 7,303,108, US No. 7,367,485, US No. 7,380,695, US No. 7,380,696, US No. 7,404,508, US No. 7,434,715 and / or US No. 7,721,930.
    [0032] 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 the 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 here 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. RESILIENT CLAMP FOR REINFORCING EXAMPLE CLAMPS
    [0033] Figure 7 shows an exemplary reinforcement clip 100. It should be understood that, once the clamps 47 are inserted in the surgical site, the reinforcement clip 100 can be applied along the cut tissue 192, in a position adjacent to the implanted clamps 47, to reinforce the closure of the tissue provided by the clamps 47. However, it should be understood that the reinforcement clip 100 can be used in several other ways, as would be evident to the person skilled in the art in view of the teachings contained herein.
    [0034] Reinforcement clip 100 comprises a crown 102, a leg portion 104 and teeth 106. In the present example, reinforcement clip 100 has a rounded rectangular cross section. In other purely exemplary versions, the reinforcement clip 100 may have a C-shaped cross section. Other formats suitable for the reinforcement clip 100 may be used, as would be evident to the person skilled in the art in view of the teachings contained herein. As seen in the illustrated version of Figure 7, leg portion 104 is long enough to cover staples 47 and a portion of tissue 90 that is affected by a surgical procedure. For example, during a surgical procedure, the user can use instrument 10 to apply staples 47 to tissue 90 adjacent to the edges of tissue 192 cut by instrument 10. Once staples 47 are placed on tissue 90, the user can then , apply the reinforcement clip 100 for an additional fixation of the tissue coupling provided by staples 47. The reinforcement clip 100 could be fed through a separate trocar so that, finally, two trocars would be used in the procedure, being one for inserting the instrument 10 to staple a portion of tissue 90, and the other for inserting tweezers or any suitable instrument to hold and apply the reinforcement clip 100. Alternatively, the instrument 10 and the reinforcement clip 100 can be inserted through a single trocar, large enough to hold reinforcement clip 100 and instrument 10. Other suitable ways of positioning reinforcement clip 10 0 and instrument 10 at the surgical site will be evident to those skilled in the art, in view of the teachings contained herein.
    [0035] In the present example, the reinforcement clip 100 has a width that extends approximately along the fabric portion 90, where the clips 47 are applied along the cut fabric 192. In other exemplary versions, the reinforcement clip reinforcement 100 may have a width significantly greater than that of fabric 90 in which staples 47 are inserted. Of course, any suitable sizes or widths for reinforcement clip 100 can be used, as would be evident to those skilled in the art in view of the teachings contained herein.
    [0036] The reinforcement clip 100 of the present example comprises a soluble material, such as polydioxanone PDS, so that once applied, the reinforcement clip 100 dissolves over time, without having to be removed by the user. Other suitable materials can be used for the reinforcement clip, such as polycaprolactone PCL, polyglycolide PGA, polylactic acid PLA, polylactic-co-glycolic acid PLLA, or any other suitable material as would be evident to the person skilled in the art in view of the teachings here contained. It should also be understood that the reinforcement clip 100 can be removable after implantation in a patient. In addition, it must be understood that the reinforcement clip 100 can be constructed from any suitable material, as would be evident to the person skilled in the art in view of the teachings contained herein. In the present example, reinforcement clip 100 is constructed from a resilient material, so that reinforcement clip 100 is forced to maintain the position shown generically in Figures 7 through 8. In this way, the user can use tweezers or any other instruments suitable for opening and releasing the leg portions 104 thus allowing the reinforcement clip 100 to close on the tissue 90. In other exemplary versions, the reinforcement clip 100 can be slid over the surgical site using sliding it in a direction parallel to the edges 192 of the cut fabric.
    [0037] Crown 102 works in order to keep leg portion 104 sufficiently clamped, with sufficient pressure so that said leg portion 104, together with teeth 106, works in order to close around the tissue 90 in position adjacent to that to which clamps 47 are applied. In other exemplary versions, however, crown 102 may comprise a living joint or any other suitable structure, which will be described in more detail below. In the present example, crown 102 comprises resilient material. In other exemplary versions, any suitable structure for crown 102 can be used, as would be evident to the person skilled in the art in view of the teachings contained herein.
    [0038] Teeth 106 are shaped to have a non-perforating edge, which presses against tissue 90 as shown in Figure 7, without necessarily perforating or penetrating tissue 90. In some versions, teeth 106 may be coated with a material therapeutic, for example, a coagulant, etc. As seen in Figures 7 to 8, teeth 106 are pressed against the surface of tissue 90 to secure the reinforcement clip 100 around tissue 90. In other examples only , the teeth 106 may comprise a sharp point, so that the teeth 106 are anchored within the fabric 90. As seen in the illustrated version, as they are pressed against each other, the teeth 106 apply opposite pressure against the fabric 90. It should be understood that, as a result of this opposing pressure, the portion of tissue 90 pinched within the reinforcement clip 100 can be substantially isolated from the opposing forces that could otherwise tend to separating the tissue layers 90 from one another. As a result, the clamps 47 may be less likely to tear the tissue 90 contained in the reinforcement clip 100. It should also be understood that the clamping forces offered by the teeth 106 can help to provide hemostasis at the location of clamps 470 and at the cut edges 192. III. MALEABLE CLIP FOR EXAMPLE CLAMPING REINFORCEMENT
    [0039] Figures 9A and 9B show an exemplifying reinforcement clip 200 that has malleable properties, as it is applied to fabric 90. Figure 9A shows fabric 90 that has already been stapled and cut, leaving a cut edge 192. A reinforcement clip 200 is being positioned on the fabric 90 in Figure 9A, so that the leg portion 204 covers the clips 47. The reinforcement clip 200 additionally comprises crown 202 and teeth 206. reinforcement clip 200 is malleable , so that an applicator 250 having jaws 252, connected to the stem 254, can be used to flatten the reinforcement clip 200 around the clips 47, where the fabric 90 has been cut and stapled.
    [0040] Figure 9B shows jaws 252 closed around the reinforcement clip 200, causing it to flatten around the clips 47 and the cut tissue 192. Once flattened, the reinforcement clip 200 works in a way to retain its flattened shape, so that applicator 250 can be removed at the same time that it leaves reinforcement clip 200 closed around the surgical area. IV. FLEXIBLE CLAMP FOR REINFORCEMENT OF THE EXAMPLE- FICATOR
    [0041] Figures 10A and B show an exemplary reinforcement clip 300, which has a generally flexible feature that is not forced to retain any specific position. In particular, the reinforcement clip 300 of this example comprises a live joint 302 that connects the leg portions 304. The leg portions 304 lead to the teeth 306. The illustrated version also shows a locking feature 350 that can be used to close the reinforcement clip 300 around the fabric 90. The living joint 302 is flexible enough to allow the leg portions 304 to be easily separated to positions on top of the clips 47. After the reinforcement clip 300 has been sufficiently disposed around the clamps 47, the locking feature 350 can be slid over the reinforcement clip 300 as shown in Figure 10B, thus causing it to be locked in a clamped position. In the present example, the locking feature 350 is positioned on the living joint 302, but any suitable location for the locking feature 350 can be used, as would be evident to the person skilled in the art in view of the teachings contained herein. For example, locking feature 350 can be closed around leg portion 304. In the present example, locking feature 350 comprises a U-shaped clip, but any structure suitable for the locking feature can be used. In some merely illustrative versions, the locking feature 350 may comprise a splinter, a lock or any other suitable locking mechanism, as would be evident to the person skilled in the art in view of the teachings contained herein.
    [0042] Figure 11 shows an alternative merely illustrative form that the locking feature 350 can take. In particular, Figure 11 shows a reinforcement clip 400 that includes an integral ratchet feature 450. Reinforcement clip 400 also includes a leg portion 404, a crown 402, and teeth 406. Cap feature 450 comprises an adjustment strap 452 that passes through a one-way door 454. Door 454 is positioned on one leg portion 404, while adjustment strap 452 extends from the other leg portion 404. As adjustment strap 452 is pulled through port 454, reinforcement clip 400 closes more tight and prevents the strap 452 from passing back through said port 454. Therefore, the strap 452 and port 454 function similarly to a sliding clamp, cable clamp or conventional wrap clamp. By controlling the length of the adjustment belt 452, which is finally pulled through port 454, the user can control the degree of tightness of the reinforcement clip 400 and, in this way, adjust the tightness of the reinforcement clip 400 based in the thickness of tissue 90 at the surgical site.
    [0043] Figure 13 shows yet another merely illustrative version of a reinforcement clip 500. The reinforcement clip 500 of this example has a partially segmented structure. Reinforcement clip 500 includes a leg portion 504, a crown 502 and a clamping region 506. Reinforcement clip 500 further comprises a plurality of transversely formed notches 508 spaced along the length of the clip reinforcement 500. In the present example, the notches 508 are evenly spaced along the reinforcement clip 500, but any suitable spacing configuration can be used, as would be evident to the person skilled in the art in view of the teachings herein. From. For example, the notches 508 may be concentrated in one region of the reinforcement clip 500, being more sparse in others. It should be understood that the notches 508 work in order to provide the flexing of the reinforcement clip 500, in a way that follows the movement and / or the contours of any fabric 90 enclosed by the reinforcement clip 500. It must be understood additionally, that the reinforcement clip 500 can function to provide relief in the event of an accumulation of fluid pressure between the reinforcement clip 500 and the fabric 90 being fixed by it. Other suitable ways in which segmentation in a reinforcement clip can be obtained will be evident to those skilled in the art, in view of the teachings contained herein.
    [0044] Figure 12 shows the reinforcement clip 100 having been used inside the fabric 90 to hold a stapling line covered by the reinforcement clip 100. As mentioned above, over time the reinforcement clip 100 can become gradually dissolve or, in other exemplary versions, the reinforcement clip 100 can be removed by the user. In other alternative versions, the reinforcement clip 100 can simply remain inside the patient, without being removed or dissolved. The other clips 200, 300, 400 and 500 described here can also be used as shown in Figure 12.
    [0045] 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 achievements.
    [0046] 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.
    [0047] 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.
    [0048] 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.
    [0049] 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 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) a surgical instrument (10) comprising a cutter and a stapler, the cutter being configured to cut a portion of tissue, (b) a plurality of staples (47 ) in communication with the stapler, the stapler being configured to introduce the plurality of staples (47) into a cut portion of fabric, the stapler being configured to form a stapling line with the plurality of staples (47 ), and (c) a reinforcement clip (100, 200, 300, 400, 500), configured to selectively cover the stapling line, with the reinforcement clip (100, 200, 300, 400, 500) is configured to be applied after the plurality of clips (47) have been inserted into a portion of cut tissue, the reinforcement clip (100, 200, 300, 400, 500) comprising a crown portion (102, 202, 302, 402, 502), a leg portion (104, 204, 304, 404, 504) and a portion of teeth (1 06, 206, 306, 406, 506), with the leg portion (104, 204, 304, 404, 504) having an operable width to cover an area defined by the stapling line, with the teeth portion (106 , 206, 306, 406, 506) is configured to anchor the teeth portion (106, 206, 306, 406, 506) in fabric, and the reinforcement clip (100, 200, 300, 400, 500) is configured to cover the stapling line and the cut fabric portion.
    [0002]
    2. Apparatus according to claim 1, characterized by the fact that the crown portion (102, 202, 302, 402, 502) comprises a living joint (302).
    [0003]
    3. Apparatus according to claim 2, characterized in that the crown portion (102, 202, 302, 402, 502) additionally comprises at least one locking feature (350) operable to lock the live joint (302), thus fixing the live joint (302) in a predetermined position.
    [0004]
    4. Apparatus according to claim 3, characterized by the fact that the at least one locking feature (350) comprises at least one lock.
    [0005]
    5. Apparatus, according to claim 2, characterized by the fact that the living joint (302) comprises a ratchet feature (450), with the ratchet feature (450) being configured so that the live joint (302) can move in only one direction.
    [0006]
    6. Apparatus according to claim 1, characterized by the fact that the reinforcement clip (100, 200, 300, 400, 500) comprises an absorptive material.
    [0007]
    7. Apparatus according to claim 6, characterized by the fact that the absorptive material comprises polydioxanone.
    [0008]
    8. Apparatus according to claim 1, characterized by the fact that the reinforcement clip (100, 200, 300, 400, 500) is configured to form a seal around a cut portion of fabric.
    [0009]
    9. Apparatus according to claim 1, characterized by the fact that the reinforcement clip (100, 200, 300, 400, 500) comprises an elongated C-shaped cross section.
    [0010]
    10. Apparatus according to claim 1, characterized by the fact that the reinforcement clip (100, 200, 300, 400, 500) comprises a deformable material.
    [0011]
    11. Apparatus, according to claim 1, characterized by the fact that the surgical instrument (10) is configured to be activated in order to introduce the staples (47), using the surgical stapler, in a portion of fabric, and the reinforcement clip (100, 200, 300, 400, 500) is configured to cover all the clamps (47) inserted in a single actuation.
    [0012]
    12. Apparatus, according to claim 1, characterized by the fact that it additionally comprises an applicator instrument (250), the applicator instrument (250) being configured to clamp the reinforcement clip (100, 200, 300, 400, 500) on the stapling line.
    [0013]
    13. Apparatus according to claim 12, characterized by the fact that the applicator instrument (250) is additionally configured to clamp with sufficient force to tighten and secure the stapling line.
    [0014]
    14. Apparatus according to claim 1, characterized by the fact that the reinforcement clip (100, 200, 300, 400, 500) comprises an inner portion and an outer portion, the inner portion of which can be positioned around a portion of cut tissue, the tooth portion (106, 206, 306, 406, 506) of the reinforcement clip (100, 200, 300, 400, 500) is configured to clamp with sufficient force so that the inner portion remains mechanically isolated from the outer portion.
    [0015]
    15. Apparatus, according to claim 1, characterized by the fact that the reinforcement clip (100, 200, 300, 400, 500) is configured to end the stapling line without coming into contact with the stapling line .
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    同族专利:
    公开号 | 公开日
    US20130068821A1|2013-03-21|
    EP2755590B1|2018-11-21|
    MX343434B|2016-11-03|
    EP2755590A1|2014-07-23|
    CN103917188A|2014-07-09|
    CN103917188B|2017-02-15|
    EP3461428A1|2019-04-03|
    RU2611916C2|2017-03-01|
    MX2014003170A|2014-09-22|
    US9254180B2|2016-02-09|
    BR112014006383A2|2017-04-04|
    WO2013039821A1|2013-03-21|
    JP2014531241A|2014-11-27|
    IN2014DN01970A|2015-05-15|
    JP6208134B2|2017-10-04|
    RU2014114841A|2015-10-20|
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    法律状态:
    2018-03-27| B15K| Others concerning applications: alteration of classification|Ipc: A61B 90/00 (2016.01), A61B 17/072 (2006.01), A61B |
    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|
    2020-12-22| 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:
    申请号 | 申请日 | 专利标题
    US13/233,681|2011-09-15|
    US13/233,681|US9254180B2|2011-09-15|2011-09-15|Surgical instrument with staple reinforcement clip|
    PCT/US2012/054406|WO2013039821A1|2011-09-15|2012-09-10|Surgical instrument with staple reinforcement clip|
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