• 专利附录
  • 专利说明
  • 权利要求
  • 类似技术
  • 同族专利
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  • 优先权
    • 专利摘要:
    reusable linear stapler device with cartridge for measuring tissue thickness. the present invention relates to a surgical instrument (20) including a frame, a removable insertion element (200), including a measurement indicator (212) and an end actuator (80) positioned at a distal end of the structure. the end actuator has an internal distal surface (204) facing the proximal end of the structure. the end actuator is configured to receive the insert. a drive feature is in communication with the end actuator and the insert element when the insert element is received at the end actuator. the drive feature is configured to advance the insertion element distally towards the inner distal surface of the end actuator. the measurement indicator of the removable insert is configured to determine the thickness of the fabric positioned between the removable insert and the distal inner surface of the end actuator. based on the measured thickness of the fabric, the user selects a cartridge configured to at least staple (and perhaps also cut) the measured fabric. the cartridge is received inside the end actuator.
    公开号:BR112014013793B1
    申请号:R112014013793-5
    申请日:2012-12-03
    公开日:2021-04-27
    发明作者:Venkataramanan Mandakolathur Vasudevan；Steven G. Hall
    申请人:Ethicon Endo-Surgery, Inc.；
    IPC主号:
    专利说明:

    BACKGROUND
    [001] In some scenarios, surgical instruments include distal end actuators for placement in a specific surgical site, such as, for example, a tissue to be cut and / or stapled. These distal end actuators can trap tissue in a variety of ways to achieve a diagnostic or therapeutic effect (for example, endo-cutter, claw, cutter, stapler, clamp applicator, access device, drug / therapy delivery device and device for applying energy using ultrasound, RF, laser, etc.). Such surgical instruments may include a rod between the end actuator and a portion of the cable, 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 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 such surgical instruments include stapling surgical pains. Some of these staplers are capable of attaching layers of fabric, cutting stuck tissue layers and stapling fabric layers to substantially join the separate fabric layers close to the cut ends of the fabric layers. Merely exemplary surgical staplers are presented in US Patent No. 5,271,543, entitled "Surgical Anastomosis Stapling Instrument with Flexible Support Shaft and Anvil Adjusting Mechanism," issued on December 21, 1993, the description of which is incorporated by reference in this document; US patent No. 5,405,073, entitled "Flexible Support Shaft Assembly," issued April 11, 1995, the description of which is incorporated by reference in this document; US Patent No. 5,452,836, entitled "Surgical Stapling Instrument with Improved Jaw Closure and Staple Firing Actuator Mechanism," issued September 26, 1995, the description of which is incorporated by reference in this document; US Patent No. 5,465,894, entitled "Surgical Stapling Instrument with Articulated Stapling Head Assembly on Rotatable and Flexible Support Shaft," issued November 14, 1995, the description of which is incorporated by reference in this document; US Patent No. 5,603,443, entitled "Surgical Stapling Instrument with Articulated Stapling Head Assembly on Rotatable and Flexible Support Shaft," issued February 18, 1997, the description of which is incorporated by reference in this document; US Patent No. 5,605,272, entitled "Trigger Mechanism for Surgical Instruments," issued February 25, 1997, the description of which is incorporated by reference in this document; US Patent No. 5,607,094, entitled "Surgical Stapling Instrument with Articulated Stapling Head Assembly on Rotatable and Flexible Support Shaft," issued March 4, 1997, the description of which is incorporated by reference in this document; US Patent No. 5,697,543, entitled "Linear Stapler with Improved Firing Stroke," issued December 16, 1997, the description of which is incorporated by reference in this document; US Patent No. 5,732,871, entitled "Surgical Stapling Instrument with Articulated Stapling Head Assembly on Rotatable and Flexible Support Shaft," issued March 31, 1998, the description of which is incorporated by reference in this document; US patent No. 6,988,650, entitled "Retaining Pin Lever Advancement Mechanism for a Curved Cutter Stapler," issued on January 24, 2006, the description of which is incorporated by reference in this document; US Patent No. 7,134,587, entitled "Knife Retraction Arm for a Curved Cutter Stapler," issued with No. 7,134,587, the description of which is incorporated by reference in this document; US Patent No. 7,204,404, entitled "Slotted Pins Guiding Knife in a Curved Cutter Stapler," issued April 17, 2007, the description of which is incorporated by reference in this document; US Patent No. 7,207,472, entitled "Cartridge with Locking Knife for a Curved Cutter Stapler," issued April 24, 2007, the description of which is incorporated by reference in this document; and US Patent No. 7,766,207, entitled "Articulating Curved Cutter Stapler," issued on August 3, 2010, the description of which is incorporated by reference in this document.
    [003] Although several systems and methods have been developed and used in surgical instruments, it is believed that no one before the inventors developed or used the invention described in the appended claims. BRIEF DESCRIPTION OF THE DRAWINGS
    [004] Although the specification concludes with claims that specifically indicate and distinctly claim this technology, it is believed that this technology will be better understood from the following description of certain examples taken in conjunction with the accompanying drawings, in which the same numbers reference points identify the same elements and where:
    [005] FIG. 1 shows a perspective view of a linear surgical staple having a cartridge compartment and a cartridge module;
    [006] FIG. 2 shows a perspective view of the linear surgical stapler of FIG. 1 with the cartridge module removed;
    [007] FIG. 3 shows a perspective view of the linear surgical stapler of FIG. 1 with the cartridge compartment moved to an intermediate position;
    [008] FIG. 4 shows a perspective view of the linear surgical stapler of FIG. 1 with the cartridge compartment moved to a closed position;
    [009] FIG. 5 shows a partial cross-sectional view of the linear surgical stapler with a lightly teretrained closing trigger;
    [0010] FIG. 6 shows a partial cross-sectional view of the linear surgical stapler with the closing trigger almost completely retracted;
    [0011] FIG. 7 shows a side elevation view of an exemplary removable cartridge device for measuring tissue thickness;
    [0012] FIG. 8 shows a side elevation view of an alternative exemplary removable cartridge device for measuring tissue thickness; and
    [0013] FIG. 9 shows a side elevation view of another alternative exemplary removable cartridge device for measuring tissue thickness.
    [0014] The drawings are not intended to be limiting in any way, and it is envisaged that various modalities of technology can be performed in a variety of other ways, including those not necessarily represented in the drawings. The attached drawings incorporated and forming a part of the specification illustrate various aspects of the present technology, and together with the description they serve to explain the principles of the technology; it is understood, however, that this technology is not limited precisely to the provisions shown. DETAILED DESCRIPTION
    [0015] The following description of some examples of the technology should not be used to limit its scope. Other examples, elements, aspects, modalities and advantages of the technology will become evident to those skilled in the art with the following description, which is by means of illustrations, one of the best ways contemplated for the realization of the technology. As will be understood, the technology described here is capable of other different and obvious aspects, all without departing from the technology. Consequently, drawings and descriptions should be considered as illustrative rather than restrictive. I. OVERVIEW OF THE EXAMPLE LINEAR SURGICAL STAPLER
    [0016] FIGS. 1 to 6 show an exemplary linear surgical stapler, or a surgical instrument (20) adapted for use in a plurality of body tissue surgical fasteners. The surgical instrument (20) includes a structure having a proximal end and a distal end, a handle (21) positioned at the proximal end and an end actuator (80) positioned at the distal end. The end actuator (80) is shaped and sized to accommodate a cartridge compartment (121) and an anvil (122). The cartridge compartment (121) and the anvil (122) are relatively mobile between a first position in which they are spaced (FIG. 1) and a second position in which they are very close to each other (FIG. 4). The instrument (20) also includes a firing assembly associated with an end actuator (80) and a cartridge compartment (121) for selective actuation of the fasteners. The instrument further includes a retaining pin (125) (see FIG. 3) for the surrounding tissue between the anvil (122) and the cartridge compartment (121). The retaining pin (125) is movable relative to the cartridge compartment (121), controlled by a retaining pin drive assembly (100). The retaining pin drive assembly (100) includes a hook (111) (see FIGS. 5 to 6) pivotally connected to the cable (21) to facilitate manual and automatic advancement of the retaining pin (125) and require manual retraction of the retaining pin (125).
    [0017] Right and left structural plates (34, 35) connect the cable (21) to the end actuator (80) of the instrument (the left side structural plate (35) is not shown in FIG. 1). The cable (21) has a right housing (22) coupled to a left housing (the left housing is not shown in FIG. 1). The handle (21) also has a structural part (23) to enable the handling and handling of the surgical instrument (20) (see Figures 2 to 4).
    [0018] Although the end actuator (80) is curved in this example, the end actuator (80) can alternatively be straight, or have another shape, as presented in accordance with all references cited in this document. The end actuator (80) is a surgical fixation set that includes a cartridge module (120) (see FIG. 2) and a C-shaped support structure (81). The support structure (81) can alternatively be of another format, as is apparent to those skilled in the art, based on the teachings of the present invention, so that the support structure (81) is configured to receive a cartridge module ( 120) corresponding with an alternative format. A distal extremality (30) of a closing element (28) is arranged to engage the cartridge module (120).
    [0019] The cartridge module (120) contains the cartridge compartment (121) coupled to the anvil (122). The cartridge module (120) also includes a retaining pin (125) (see FIG. 3), a knife (not shown), a removable retainer (160) (see FIG. 2), a contact surface with the fabric (127) (see FIG. 1) which includes a plurality of slots containing staples (128) arranged misaligned in one or more rows (i.e., staple lines) on both sides of the knife. Staples (not shown) are discharged from the cartridge compartment (121) against a staple forming surface on the anvil (122), which faces the tissue contact surface (127) of the cartridge compartment (121).
    [0020] A shoulder-shaped rivet (82) extends from the support structure (81) of the end actuator (80). The support structure (81), in turn, is fixed to the right and left structural plates (34, 35) by columns (83), which extend from the support structure (81) and fit into the reception holes defined in the structural plates (34, 35). As an example only, the support structure (81) can be constructed in accordance with the teachings of US Patent No. 6,988,650, entitled "Retention Pin Lever Advancement Mechanism for a Curved Cutter Stapler," granted on January 24, 2006, the description of which is incorporated by reference in this document.
    [0021] The handle (21) of the surgical instrument (20) includes a handle location (24) that the surgeon holds with the palm of the hand (see FIG. 2). The handle (24) consists of a cable jacket on the right side (25) (see FIG. 1) and a cable jacket on the left side (the left cable jacket is not shown in FIG. 1). A closing trigger (26) and a firing trigger (27) extend pivotally from the underside of the cable (21). The surgical instrument (20) illustrated in FIG. 1 is shown with the respective closing and firing triggers (26, 27) in their non-triggered positions with the cartridge module (120) inserted and the retainer (160) (see FIG. 2) removed. Consequently, the cartridge compartment (121) is spaced apart from the anvil (122) for placing tissue between the cartridge compartment (121) and the anvil (122).
    [0022] The cable (21) of the surgical instrument (20) contains the set for activating the tissue retention pin (100). The retaining pin (125) is associated with the retaining pin drive assembly (100) to advance the retaining pin (125) through the cartridge compartment (121) and into the anvil (122) to thereby capture fabric. For example only, the retaining pin (125) is constructed and functional in accordance with the teachings of US Patent No. 6,988,650, the description of which is incorporated by reference above. The fabric retaining pin drive assembly (100) includes a saddle-shaped blade (101) that is positioned on the top surface of the handle (21) and is in communication with the stem (102), as described below. Manual movement of the blade (101) results in distal movement of a rod (102). The rod (102) is coupled via a coupler (not shown) to the retaining pin (125) of the cartridge module (120). The distal movement or proximal retraction of the nail (102) results in a corresponding longitudinal movement of the retaining pin (125). In particular, and as shown in FIGS. 5 and 6, the blade (101) is connected to a column (103) that extends outwardly from the stem driver (104), through slots (105) (see FIG. 2) in the handle (21) . The stem driver (104) is prevented from moving longitudinally along the axis of the surgical instrument (20) by slits (105). The stem driver (104) is connected to the stem (102) by a circumferential groove in the stem (102) that fits into a slot in the stem driver (104). A distal end of the rod (102) contains a circumferential groove that connects internally with a groove at the proximal end of the coupler (not shown) of the cartridge module (120). A distal end of the coupler contains a groove for interconnection with a circumferential slot in the retaining pin (125).
    [0023] As shown in FIGS. 1 and 2, the surgical instrument (20) additionally includes an elongated closing element (28), which has a generally U-shaped cross section. The closing element (28) extends from the handle (21) inwards the end actuator surgical fixation set (80). As an example only, the closing element (28) can be constructed in accordance with the teachings of US Patent No. 6,988,650, the description of which is incorporated above for reference. The closing element (28) contains columns (29) (see FIG. 5) that extend laterally on both sides of the closing element (28) within the cable (21). These columns (29) are slidably connected to an L-shaped slot (110) of a hook (111), which is part of the retaining pin drive assembly (100), as described below. The hook (111) is pivotally mounted on the cable (21) by a pivot pin (112) on the hook (111). The hook (111) contains cam pins or columns (113) positioned to push the cam surfaces (114) onto the stem driver (104).
    [0024] A distal portion of the closing element (28) passes through the walls (84) (see FIG. 2) of the support structure (81). A distal end of the closing element (28) is arranged to receive and secure the cartridge compartment (121) of the cartridge module (120). A central portion of the closing element (28) is positioned between the left and right structural plates (34, 35), respectively. The right and left manual closing connections (36, 37), respectively, are hingedly attached to the right and left proximal ends of the closing element (28) by a first integral closing connection pin (38). At the end opposite the closing connections (36, 37), closing connections (36, 37) are hingedly attached to a second integral closing connection pin (39). The second integral closing connection pin (39) connects the closing connections (36, 37) to a grooved closing arm connection (40). The grooved closing arm connection (40) is pivotally mounted on the structural plates (34, 35) of the surgical instrument (20) on a pivot pin of the closing trigger (41). The closing trigger (26) descends from the grooved closing arm connection (40) for pivoting rotation around the closing trigger pivot pin (41) towards the handle and in the opposite direction of the handle (24). A closing spring (42) (see FIG. 5) housed between the handle (24) of the cable (21) is attached to the connection of the grooved closing arm (40) to provide the desired resistance when the surgeon tightens the closing trigger (26) towards the handle (24), and to tilt the closing trigger (26) towards the open position.
    [0025] The retaining pin actuation assembly (100) is also releasably coupled to the closing trigger (26) on the cable (21), so that the activation of the closing trigger (26) results in distal movement of the retaining pin (125), if it has not yet been manually moved to its most distal position. In particular, during the actuation of the instrument, the closing element (28) moves linearly, rotating the hook (111) which advances the retaining pin (125). As an example only, the hook (111) is constructed and functional in accordance with the teachings of US Patent No. 6,988,650, the description of which has been incorporated by reference above. The hook (111) does not communicate with the blade (101) and, therefore, the hook (111) or the blade (101) can operate separately, as described above, to move the retaining pin (125) distally.
    [0026] Only by way of example, the operation of loading the cartridge module (120) into the end actuator (80) can occur in accordance with the teachings of US Patent No. 6,988,650, the description of which has been incorporated as a reference above. For example, the cartridge compartment (121) connects to a distal end of the closing element (28) via a snap fit connection, so that when the closing element (28) advances distally, as described in more details below, the attached cartridge compartment (121) advances distally, as long as the retainer (160) has been removed and is not restricting the cartridge compartment (121). FIGS. 2 to 4 illustrate what happens when the cartridge module (120) is loaded and the respective closing and firing triggers (26, 27) are tightened sequentially towards the handle (24) to drive the end actuator (80) of the surgical instrument (20). The surgical instrument (20) is loaded with the cartridge module (120), as shown in FIG. 2, and the retainer (160) is removed. The surgical instrument (20) is then ready to receive tissue, as shown in FIG. 1.
    [0027] When the closing trigger (26) is partially squeezed and placed in its first holding position, shown in FIG. 3, the cartridge compartment (121) moves from the fully open position to an intermediate position between the open and closed positions. Simultaneously, the fabric retaining pin drive assembly (100) moves the retaining pin (125) distally forward relative to the cartridge compartment (121) to pierce the trapped tissue and then enter an opening on the anvil (122), thus fixing the perforated and stuck tissue. In that position, the fabric that has been placed between the cartridge compartment (121) and the anvil (122) can be properly positioned, and the attachment of the fabric between the cartridge compartment (121) and the anvil (122) is ensured. Therefore, when the closing trigger (26) is activated in its intermediate position, the cartridge compartment (121) and the anvil (122) are positioned correspondingly in their tissue fixation position.
    [0028] When the closing trigger (26) is fully depressed, so that it is in a position adjacent to the front end of the handle (24), as illustrated in FIG. 4, the tissue contact surface (127) of the cartridge compartment (121) and the staple forming surface of the anvil (122) are in adjacent positions and, consequently, the properly positioned and fixed tissue is completely trapped. Additionally, the trigger trigger (27) rotates counterclockwise towards the handle (24) to enable the surgeon to hold the trigger trigger (27) for unloading staples. Consequently, the trigger trigger (27) is then in position for the surgeon to squeeze and staple and cut the trapped tissue substantially and simultaneously. When the trigger trigger (27) is fully depressed to unload the clamps, the trigger trigger (27) is positioned very close to the closing trigger (26).
    [0029] In operation, when the closing trigger (26) is pulled towards the handle (24), the grooved closing arm connection (40) and the closing connections (36) move distally within a receiving slot (46) of the firing bar (43). As an example only, the firing bar (43) can be constructed and is functional according to the teachings of US patent No. 6,988,650, the description of which has been incorporated by reference above. The distal movement of the grooved closing arm connection (40) and the closing connection (36) causes the closing element (28) to move accordingly. Similarly, the trigger bar (43) moves concomitantly and distally with the closing element (28), since the first integral pin of the closing connection (38) (see FIG. 1), to which the closing connections (36, 37) are fixed, extends through the receiving slot (46) in the firing bar (43).
    [0030] The set that defines an intermediate closing retention position and the release of the closing trigger (26) from a triggered position to its original, non-triggered position will now be described in connection with FIG. 1 and in combination with FIGS. 5 and 6. The top side of the grooved closing arm connection (40) has a sliding surface of the claw (56) showing an intermediate stop (57) and a closing stop (58). A release latch (59) slides on the sliding surface of the claw (56) and can engage the respective intermediate and closing holders (57, 58). The release latch (59) has a locking pin that extends laterally (60) (see FIGS. 1 and 5) at its distal end. The release latch (59) is located on the cable (21) and is integrally attached to a release button (61) located on the outside of the cable (21). The release button (61) has a finger rest (62) (see FIG. 5), and the release button (61) is hingedly attached to the cable (21) by a release sleeve or pivot ( 63). The release button (61) is angled out from the cable (21). In this way, the release latch (59) is forced downward towards the sliding surface of the claw (56) by a release spring (64). The release spring (64) is mounted on the cable (21) by a spring retaining pin (65) and is mounted on the release button (61) by a spring column (66) of the button. The grooved closing arm connection (40) has an arcuate recess (67) located between the respective intermediate and closing holders (57, 58). Located inside this arched recess (67) for rotating movement, there is a left alternator (68) connected integrally to a right alternator (the right alternator is not shown). Each alternator (68) has an alternator arm (69) that engages with a lock pin (60). For example only, the lock pin (60) is constructed and functional in accordance with the teachings of US Patent No. 6,988,650, the description of which has been incorporated by reference above.
    [0031] In FIG. 5, the closing trigger (26) has been partially squeezed from its open, non-actuated position, shown in FIG. 1. When the closing trigger (26) is partially pulled, it rotates around the pivot pin of the closing trigger (41) counterclockwise towards the handle (24). As it rotates, the grooved closing arm connection (40) and the closing plate closing connections (36, 37) move distally forward, consequently moving the closing element (28) and the firing bar (43) distally. As the grooved closing arm connection (40) moves distally, the locking pin (60) of the release latch (59) slides proximally on the sliding surface of the claw (56). The lock pin (60) engages the distal ends of the alternator arms (69) of the alternators (68) and, consequently, rotates the alternators (68) clockwise. As the grooved lock connection on the arm (40) continues to move distally in response to the pivoting movement of the lock trigger (26) towards the handle (24), the lock pin (60) of the release lock (59) eventually it fits into the intermediate holder (57). When positioned on the intermediate stop (57), the closing spring (42) is unable to return the closing trigger (26) to its original position, not actuated. The closing trigger (26) is then in its intermediate position, partially closed, to properly position and secure the tissue between the cartridge compartment (121) and the anvil (122), as shown in FIG. 5. In addition, as the closing element (28) and the firing bar (43) move apart, the apex (52) of an arched connection of the firing trigger (51) slides on a sliding surface (48 ) of the firing bar (43) towards a proximal section of the end of the firing bar (43).
    [0032] The retaining pin drive assembly (100) is activated during the course of closing the open position for intermediate positioning. The forward movement of the closing element (28) moves the integral columns (29) distally. The columns (29) come into contact with the L-shaped slot (110) of the hook (111). Thus, the distal movement of the columns (29) of the L-shaped slot of the cam (110) causes the hook (111) to rotate around the pins (112). The rotation places the bearing columns (113) of the hook (111) in contact with the surfaces of the cam (114) on the rod driver (104). Additional swiveling motion of the hook (111) causes the bearing columns (113) to move the rod driver (104) distally through the cam contact on the surfaces (114). The stem driver (104) comes into contact with the stem (102), moving the stem (102) distally. The rod (102), in turn, moves the coupler and the retaining pin (125) distally. Termination of the closing stroke to the intermediate holding position (57) results in distal movement of the holding pin (125) through the hole (not shown) in the cartridge compartment (121), through the hole (159) that crosses a washer (not shown) and anvil (122) and into a hole (not shown) in the support structure (81). The fabric, which had been arranged between the surface for contact with the fabric (127) of the cartridge compartment (121) and the anvil (122), is then trapped between the retaining pin (125) and the guide pin (124 ).
    [0033] Just as an example, this same result can be obtained before closing through distal movement of the saddle-shaped blade (101), in accordance with the teachings of US Patent No. 6,988,650, the description of which has been incorporated as a reference above.
    [0034] Now with reference specifically to FIG. 6, when the closing trigger (26) is pressed towards the handle (24), from the intermediate holding position (57), the alternator arms (69) of the alternator (68) disengage from the lock pin (60) . Consequently, as the alternator (68) continues to rotate clockwise, the release lock pin (60) moves upward on the alternating arms (69) and, with the continuous movement of the closing trigger (26), fits the closing stop (58). As the release latch (59) moves upward on the alternator arm (69), it rotates the release knob (61) clockwise around the pivot (63). When the release latch pin (60) fits into the closing stop (58), it emits an audible click that alerts the surgeon that the closing position has been reached.
    [0035] In addition, as the firing bar (43) continues to advance distally, the apex (52) of the arched connection of the firing trigger (51) comes into contact with the lateral engaging surface of the proximal end section of the bar trigger (43). Consequently, the trigger trigger (27) moves to a position where it can continue to move the trigger bar (43) distally to unload staples after the fabric has been fully attached. When the apex (52) of the arched trigger trigger connection (51) moves to engage the engagement surface of the proximal end section of the trigger bar (43), the trigger trigger (27) begins to pivot counterclockwise towards the handle (24) in response to the action of a torsion spring on the right side of the trigger (27) (torsion spring not shown). The trigger trigger (27) rotates independently of the pivoting movement of the closing trigger (26), but its pivoting swing is blocked until the trigger bar (43) has moved distally to allow the trigger trigger connection to engage ( 51) with an end engaging surface of the firing bar (43). The unloading of staples can, by way of example only, occur in accordance with the teachings of US Patent No. 6,988,650, the description of which has been incorporated by reference above. Various other suitable ways in which the instrument (20) can be configured and functional will be apparent to those skilled in the art from the teachings of the present invention. aII. REMOVABLE EXEMPLIFIER CARTRIDGE DEVICE FOR TISSUE THICKNESS MEASUREMENT
    [0036] The examples described below are related to connections and uses of removable cartridges with end actuator portions of linear surgical staplers and / or cutting instruments, such as the instrument (20), to measure the thickness of tissues. For example, the tissue thickness measurement cartridges described below can be used to measure the thickness of the fabric that is positioned between the cartridge and the inner surface (204) of the shoulder-shaped rivet (82) by simply pulling the trigger. closing (26) towards the cable (25). Various suitable ways in which the teachings below can be incorporated into an instrument (20) will be apparent to those skilled in the art. Similarly, various suitable ways in which the teachings below can be combined with the various teachings of the references cited in the present invention will be apparent to those skilled in the art. It should also be understood that the teachings below are not limited to the instrument (20) or the devices taught in the references cited in the present invention. The teachings below can be readily applied to several other types of instruments, including instruments that would not be classified as linear surgical stapling instruments. Various other suitable devices and configurations in which the teachings below can be applied will be apparent to those skilled in the art, based on the teachings of the present invention. A. REMOVABLE EXEMPLIFIER CARTRIDGE DEVICE WITH A METAL PLATE ASSEMBLY
    [0037] FIG. 7 shows an exemplary removable cartridge device (200) configured to fit the end actuator (80) of the instrument (20). For example, a cartridge device (200) can be coupled to an end actuator (80) similarly to the entry in the cartridge module (120), in accordance with the teachings of US Patent No. 6,988,650, the description of which was incorporated as a reference above. In the present example, a cartridge device (200) includes a shape similar to the shape of the cartridge compartment (121) of the cartridge module (120), in addition to that shown below. Alternatively, the cartridge device (200) can include any apparent shape for those skilled in the art, based on the teachings of the present invention. The cartridge device (200) can be sterilized, as apparent to those skilled in the art, based on the teachings of the present invention, and can be reused in multiple applications. The cartridge device (200) can be constructed of durable plastic (such as polycarbonate or a liquid crystal polymer), ceramics, metals and / or any other suitable material, as will be apparent to those skilled in the art, based on the teachings of present invention. Other cartridge device configurations (200) will also be apparent to those skilled in the art, based on the teachings of the present invention.
    [0038] The cartridge device (200) will form a snap connection with the distal end of the closing element (28) when loaded on the end actuator (80), similarly to the way the cartridge compartment (121) forms a snap-fit connection to the distal end of the closing element (28). Other configurations for attaching the cartridge device (200) to the closing element (28) will still be apparent to those skilled in the art, based on the teachings of the present invention. The closing element (28) can include a variety of components or features that are operable to removably secure the cartridge device (200) to the end actuator (80).
    [0039] With reference to FIG. 2 in combination with FIG. 7, the rod (102) can be coupled to an upper proximal portion (202) of the cartridge device (200), so that a distal advance of the rod (102), by squeezing the closing trigger (26) in the manner described above in relation to the instrument (20), it will cause the cartridge device (200) to distal towards the inner surface (204) of the shoulder-shaped rivet (82). Additionally, as the distal end of the closing element (28) is connected to the cartridge device (200), when the cartridge device (200) is loaded on the end actuator (80), as described above, a distal advance of the element closing mechanism (28) will also cause the cartridge device (200) to advance towards the inner surface (204) of the end actuator (80).
    [0040] As shown in FIG. 7, the cartridge device (200) includes an upper proximal portion (202) and an opposite distal portion (206). A measurement dial (210) is arranged along a portion of the upper edge (208) between the upper proximal portion (202) and the distal portion (206). Although the present example shows the measurement display (210) including measurements in increments of 0.5 on a graduated scale from 0 to 4.0, it is possible to show other incremental measurement values. The increments can be values or units measurable in inches, centimeters, millimeters, or other apparent units for those skilled in the art, based on the teachings of the present invention. The measurement display (210) is a constituent and connected part of a mechanical meter assembly (212), described below.
    [0041] The mechanical meter set (212) includes a plate (214), springs (216), horizontal connection element (218) that acts as a mechanical transducer, pin (220), connection element slot (221), element pivoting connection (222), slot (223), pin (224) and pin-pivot (225). The plate (214) can comprise metal, plastic or any other suitable material apparent to those skilled in the art, based on the teachings of the present invention. Although the current example includes springs as slope elements, springs (216) may alternatively be other suitable slope elements apparent to those skilled in the art, based on the teachings of the present invention.
    [0042] The plate (214) includes a proximal surface (226) and a distal surface (228). Forced out springs (216) resiliently connect the proximal surface (226) of the plate (214) to a surface (230) of the distal portion (206) of the cartridge device (200). The springs (216) tilt the plate (214) in the opposite direction of the housing (232) of the cartridge device (200). The horizontal connecting element (218) extends proximally to the proximal surface (226) of the plate (214) and includes a pin (220) projecting from a horizontal connecting element of the proximal end (218) in a substantially direction perpendicular to a longitudinal axis of the horizontal connecting element (218). The pin (220) is retained within and is slidable along a horizontal retaining slot (not shown) disposed in the housing (232) of the cartridge device (200). Alternatively, the pin (220) can be arranged within an opening arranged in the compartment (232) and measured and configured to accommodate the pin (220). In the present example, the horizontal retention slot that receives the pin (220) is substantially parallel and aligned with the longitudinal axis of the horizontal connecting element (218). The pin (220) is also received within a slot (221) at a lower end of the pivoting connector (222). The pivot pin (225) is arranged between the upper and lower ends of the pivoting connection element (222), and the pivoting connection element (222) is configured to rotate around the pivot pin (225). In a position of zero pressure, in which pressure has not yet been applied to the distal surface (228) of the plate (214), as described below, the pivoting connection element (222) will be positioned in a position substantially angled with respect to the horizontal connection (218). An upper end of the pivoting connection element (222) will be positioned at a proximal end of the measurement dial (210), indicating zero pressure units and a zero thickness measurement (indicating that there is currently no tissue attached for measurement). At that upper end, the pivoting connector (222) includes a slot (223) that receives the pin (224). The pin (224) is received and slid into a horizontal slot of the measurement display (not shown), covering a longitudinal axis of the measurement display (210).
    [0043] In operation, when the cartridge device (200) is loaded on the end actuator (80), as described above, the fabric (not shown) can be positioned between the distal surface (228) of the plate (214) of the cartridge device (200) and the inner surface (204) of the end actuator (80). The cartridge device (200) can be distally advanced towards the inner surface (204) of the end actuator (80), in the manner described above with respect to the cartridge compartment (121), until the fabric is disposed in the middle and in contact with the distal surface (228) of the plate (214) and the inner surface (204) of the end actuator (80). For example, the retaining pin (125) can pierce and retain fabric between the plate (214) and the inner surface (204) of the end actuator (80) in the manner described above for the cartridge compartment (121).
    [0044] As the cartridge device (200) advances distally against the fabric, the fabric will be compressed against the distal surface (228) of the plate (214), causing the plate (214) to compress the springs (216) in the direction of the arrow (A) towards the surface (230) of the distal portion (206) of the cartridge device (200). This, in turn, moves the horizontal connecting element (218) inwardly proximally, sliding the pin (220) proximally along the horizontal retention slot in the cartridge device (200). As the pin (220) slides horizontally inward along the retaining slot, the pin (220) is concomitantly pressed against the slot that defines the surface (221) of the pivoting connecting element (222), causing the locking element pivoting connection (222) rotate around the pin (220) and the pivot pin (225) counterclockwise. This pivoting motion advances the pin (224) distally along the horizontal slot of the measurement display, covering at least the length of the measurement display (210). The lengths of the slots (221, 223) are sufficient to provide the required height in an adjustable way between the pins (220, 224) in a first position and in a different second position. The action of advancing the pin distally (224) allows an adequate reading of the thickness of the received tissue, since the pin (224) advances to a position of the measurement dial (210) correlated with the thickness measurement, appropriately measuring the thickness of the compressed fabric between the inner surface (204) of the end actuator (80) and the plate (214) of the cartridge device (200). In addition, removing pressure from the plate (214) can cause the pin (224) to move proximally along the horizontal slit of the measurement display, returning towards an initial position of zero pressure (thickness zero tissue).
    [0045] In some versions, the cartridge device (200) may include a locking feature (not shown) that is functional for locking the pin (224) selectively in position in the measured increment along the measurement display (210), so that the pin (224) remains in position after the closing trigger (26) is released. In this way, the surgeon can position the end actuator (80) with the cartridge device (200) on the patient, squeeze the closing trigger (26) towards the handle (25) to measure the thickness of the tissue that is positioned between the cartridge device (200) and the inner surface (204) of the shoulder-shaped rivet (82) and then reposition the end actuator (80) in a location (for example, outside the patient) where it is most easy to see the locked position of the pin (224) on the measurement display (210). In some of these versions, the surgeon can even remove the cartridge device (200) from the end actuator (80) to observe the locked position of the pin (224) on the measurement display (210). Only by way of example, a ratchet locking feature, containing the ratchet teeth, can be arranged along an outer wall of the pivoting connection element (222), along the horizontal connection element (218) and / or somewhere else. As the pivoting connection element (222) rotates around the pivot pin (225), a lock (not shown) can slide between the ratchet teeth. A resilient element can force the latch to engage the teeth, while a button or other feature can be operated to selectively disengage the latch from the teeth. Other suitable ways in which a ratchet assembly can be provided will be apparent to those skilled in the art, based on the teachings of the present invention. Similarly, other suitable ways of selectively locking the position of the pin (224) will be apparent to those skilled in the art, based on the teachings of the present invention.
    [0046] It should be understood that a tissue measurement obtained using a cartridge device (200) can allow the user to select a cartridge module (120) suitably sized to use to sufficiently staple and / or cut the measured fabric in the manner described above in relation to the instrument (20). The properly sized cartridge module (120) can be selected from a plurality of cartridge modules (120) including, for example, clips of different heights. Additionally or alternatively, the plurality of cartridge modules (120) can include compartments of different sizes. The cartridge device (200) allows the surgeon to select the cartridge module (120) having the ideal staple height and / or the size of the compartment to staple a specific tissue. After use, the cartridge device (200) can be removed from the end actuator (80), selected cartridge module (120) can be used, and the removed cartridge device (200) can be reconfigured and reused, as described above, before the next use of another selected cartridge module (120), which can be used to staple and / or cut another measured fabric vapor. B. EXEMPLIFYING REMOVABLE CARTRIDGE DEVICE WITH A MOLDED PLASTIC SPRING ASSEMBLY
    [0047] FIG. 8 shows an alternative exemplary cartridge device (300), which is similar to the cartridge device (200) and includes similar reference numbers. The cartridge device (300) differs from the cartridge device (200) with respect to the plate and the components of the displacement element. As shown in FIG. 8, the cartridge device (300) includes plate (214) and molded resilient elements (316). The resilient elements (316) are molded features of the plate (214) and / or the cartridge device (300). In this way, the plate (214), the horizontal connecting element (218) and the resilient elements (316) form a single, monolithic piece, or a component in a homogeneous continuous material (for example, plastic, etc.). In some versions, the resilient elements (316), the plate (214) and the receiving distal surface (230) form a single monolithic part, or a component in a homogeneous continuous material (for example, plastic etc.). The resilient elements (316) extend between the proximal surface (226) of the plate (214) and the distal surface (230) of the cartridge device (300), tilting the plate (214) in the direction opposite to the distal surface ( 230). The cartridge device (300) can be functional in the same way, as described above for the cartridge device (200). C. SCHEMATIC REPRESENTATION OF AN EXTERNAL EXTERNAL REMOVABLE CARTRIDGE DEVICE
    [0048] FIG. 9 shows another alternative exemplary cartridge device (400), which is similar to cartridge devices (200, 300). The cartridge device (400), however, includes a vertical measurement display (410), shown in the present example, to include measurements in increments of 0.5 on a graduated scale from 0 to 4.0 (although other measurements or increments can be shown). The cartridge device (400) includes a mechanical gauge assembly (412) that communicates with the vertical measurement display (410) through a schematically represented connection (432) for measuring tissue thickness, as described above in relation to the device cartridge (200). In addition to a mechanical gauge set, other apparent indicators for those skilled in the art, based on the teachings of the present invention, can be used to determine the approximate thickness of fabrics positioned between the cartridge device (400) and the internal surface ( 204) of the end actuator (80). Various suitable components and configurations that can be used as transducers to convert the pressure applied to the cartridge device (400) into a measure of tissue thickness will be apparent to those skilled in the art, based on the teachings of the present invention.
    [0049] The vertical measurement dial (410) is oriented along the distal edge portion of the cartridge device (400), in a position substantially parallel to the position against which the tissue is received against a pressure measurement device ( 434) associated with the mechanical meter set (412). The vertical measurement display (410) includes a pin (436). The pin (436) reacts in response to the pressure received against the pressure measuring device (434), which is communicated to the pin (436) via a connection (432), to cause the pin (436) to move at a suitable increment of the measurement display over the vertical measurement display (410). The pin (436), therefore, indicates the thickness of the tissue trapped and measured between the pressure measuring device (434) and the inner surface (204) of the end actuator (80).
    [0050] Although some cartridge device configurations (200, 300, 400) have been described, other suitable cartridge device configurations (200, 300, 400) will still be apparent to those skilled in the art, based on the teachings of present invention.
    [0051] It should 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 described above, expressions, modalities, examples, etc. therefore, they 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 appended claims.
    [0052] 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.
    [0053] Versions of what has been described 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 refurbished device are all within the scope of the present application.
    [0054] 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 exterminate 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.
    [0055] 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 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 should 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 drawings.
    权利要求:
    Claims (11)
    [0001]
    1. Surgical instrument (20), comprising: (a) a structure having a proximal end and a distal end, with a handle (21) positioned at the proximal end; (b) a removable insertion element (200, 300), including a measurement indicator; (c) an end actuator (80) positioned at the distal end of the structure, the end actuator having a distal inner surface (204) facing the proximal end of the structure, and the end actuator being configured to receive the insert removable; and (d) a drive feature (28) in communication with the end actuator and the removable insert element, when the insert element is received at the end actuator, the drive feature being configured to advance the removable insert element distally towards the distal inner surface of the end actuator; wherein the measurement indicator of the removable insert is configured to determine the thickness of the fabric positioned between the removable insert and the distal inner surface of the end actuator; characterized by the fact that the removable insertion element is configured to advance a distance predefined by the drive feature, from a predefined retracted position in which it is not in contact with the fabric, to a predefined advanced position in which it is in contact with the fabric; wherein the measuring gauge comprises a mechanical gauge assembly (212) and a scale of the measuring gauge (210), where the mechanical measuring gauge is in communication with the scale of the measuring gauge, in which the removable insert comprises a proximal end (202) and a distal end (204) and an insertion axis disposed therebetween, in which the mechanical gauge assembly comprises a pressure receiving component disposed perpendicular to the insertion axis, and in which the scale of the dial measurement is oriented perpendicularly to the pressure receiving component; wherein the mechanical gauge assembly further comprises: (i) a horizontal connection (218) coupled to the pressure receiving component and which extends parallel to the measurement display, and (j)) a pivoting connection element (222) having a first end coupled to the horizontal hinge and a second end slidably coupled to the scale of the measurement display at another end through a first pin (224), where the pivoting connector is configured to rotate around a pivot pin ( 225) between the first end and the second end; wherein the mechanical gauge assembly of the removable insert is configured to determine the thickness of the fabric positioned between the removable insert and the distal inner surface of the end actuator when the removable insert is in its predefined forward position, and that the position of the first pin relative to the scale of the measurement display shows the thickness of the fabric determined.
    [0002]
    2. Surgical instrument according to claim 1, characterized by the fact that the pressure-receiving component comprises a resiliently polarized plate (214).
    [0003]
    3. Surgical instrument according to claim 1, characterized by the fact that the scale of the measurement dial comprises a graduated scale, the value of which increases from the proximal end to the distal end of the removable insertion element.
    [0004]
    4. Surgical instrument according to claim 1, characterized by the fact that the mechanical meter assembly comprises a plate (214) and one or more resilient elements (216; 316) arranged between the plate and the receiving surface (230) of the removable insertion element, in which the plate is configured to compress one or more resilient elements by applying pressure.
    [0005]
    5. Surgical instrument, according to claim 4, characterized by the fact that one or more resilient elements comprise springs (216).
    [0006]
    6. Surgical instrument according to claim 4, characterized by the fact that one or more resilient elements comprise integral and monolithic plastic elements (316) with the plate and the receiving surface of the removable insertion element.
    [0007]
    7. Surgical instrument, according to claim 4, characterized by the fact that the plate comprises metal.
    [0008]
    8. Surgical instrument, according to claim 4, characterized by the fact that the plate comprises plastic.
    [0009]
    9. Surgical instrument, according to claim 4, characterized by the fact that the mechanical gauge set still comprises a pivot pin (225) and a second pin (220).
    [0010]
    10. Surgical instrument, according to claim 9, characterized by the fact that the second pin is in communication with the horizontal connecting element and the pivoting connecting element, in which the pivoting connecting element is configured to rotate in around the pivot pin by applying pressure through the horizontal connecting element.
    [0011]
    11. Surgical instrument, according to claim 10, characterized by the fact that the horizontal connecting element is configured to advance proximally in response to pressure applied on the plate, so that the pivoting connecting element rotates around of the pivot pin and the first pin advances distally along the scale of the measurement display.
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    同族专利:
    公开号 | 公开日
    CN103987329A|2014-08-13|
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    MX2014006868A|2014-07-14|
    JP6457033B2|2019-01-23|
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    BR112014013793A8|2017-06-13|
    RU2620900C2|2017-05-30|
    US9125651B2|2015-09-08|
    CN103987329B|2016-08-17|
    JP2017200634A|2017-11-09|
    MX345023B|2017-01-12|
    JP6441078B2|2018-12-19|
    RU2014127518A|2016-02-10|
    JP2015504697A|2015-02-16|
    EP2787899B1|2018-03-28|
    EP2787899A1|2014-10-15|
    WO2013085827A1|2013-06-13|
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    法律状态:
    2018-12-04| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]|
    2019-11-19| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|
    2020-10-27| B06A| Notification to applicant to reply to the report for non-patentability or inadequacy of the application [chapter 6.1 patent gazette]|
    2021-02-23| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|
    2021-04-27| B16A| Patent or certificate of addition of invention granted|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 03/12/2012, OBSERVADAS AS CONDICOES LEGAIS. |
    优先权:
    申请号 | 申请日 | 专利标题
    US13/313,215|US9125651B2|2011-12-07|2011-12-07|Reusable linear stapler cartridge device for tissue thickness measurement|
    US13/313,215|2011-12-07|
    PCT/US2012/067523|WO2013085827A1|2011-12-07|2012-12-03|Reusable linear stapler cartridge device for tissue thickness measurement|
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