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ES2368478T3 - Instrumento de electrodos bipolares con disposición de electrodos separable. - Google Patents

Instrumento de electrodos bipolares con disposición de electrodos separable. Download PDF

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Publication number
ES2368478T3
ES2368478T3 ES09171462T ES09171462T ES2368478T3 ES 2368478 T3 ES2368478 T3 ES 2368478T3 ES 09171462 T ES09171462 T ES 09171462T ES 09171462 T ES09171462 T ES 09171462T ES 2368478 T3 ES2368478 T3 ES 2368478T3
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tissue
pole
distal end
makes contact
tip cover
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James Gilbert Chandler
Randel Alven Frazier
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Covidien AG
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Covidien AG
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/00296—Surgical instruments, devices or methods for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means mounted on an endoscope
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2945—Curved jaws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B2018/1405—Electrodes having a specific shape
    • A61B2018/1425—Needle
    • A61B2018/1432—Needle curved
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B2018/1495—Electrodes being detachable from a support structure

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Otolaryngology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Plasma & Fusion (AREA)
  • Physics & Mathematics (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

Un instrumento bipolar para cerrar tejido herméticamente que comprende: dos miembros alargados (11, 12) que tienen extremos proximal (16) y distal (17) y que definen un plano, siendo los miembros alargados eléctricamente conductores para transmitir electrocirugía de alta frecuencia al tejido dispuesto entre los extremos distales; y un pivote (13) que conecta los dos miembros alargados permitiendo el movimiento similar al de unas tijeras entre ellos, estando curvados los extremos distales para extenderse transversalmente con relación al plano y generalmente paralelos pero espaciados con relación al pivote, siendo el pivote transversal al plano y estando dispuesto lejos de los extremos distales para permitir el movimiento transversal de los extremos distales comprendiendo además el instrumento bipolar: un primer polo (18) que hace contacto con el tejido de una pieza con un miembro alargado y posicionado en un extremo distal del mismo, siendo el primer polo que hace contacto con el tejido eléctricamente conductor para transmitir electrocirugía de alta frecuencia al tejido; una cubierta (19) de la punta aislada para su colocación sobre el miembro alargado en su extremo distal, estando configurada la cubierta de la punta aislada para su unión al otro miembro alargado en relación de ajuste deslizante alrededor del extremo distal para impedir el movimiento longitudinal o transversal entre la cubierta de la punta aislada, el miembro alargado y el otro extremo distal; un segundo polo (22) que hace contacto con el tejido fijado en la cubierta de la punta aislada y posicionado para estar en relación opuesta al primer polo que hace contacto con el tejido cuando el contacto eléctrico está colocado sobre el extremo distal del miembro alargado; dos terminales eléctricos (30, 31) previstos sobre la cubierta de la punta y situados proximales al pivote cuando la cubierta de la punta está colocada sobre el extremo distal del miembro alargado y configurado para recibir energía electroquirúrgica bipolar; un primer conductor (23) llevado en la cubierta de la punta y que conecta un terminal y el primer polo que hace contacto con el tejido cuando la cubierta de la punta está colocada sobre el otro extremo distal; y un segundo conductor (24) que se acopla eléctricamente al otro terminal y al segundo polo que hace contacto con el tejido cuando la cubierta de la punta está colocada sobre el otro extremo distal para proporcionar un circuito para hacer pasar energía electroquirúrgica bipolar desde el primer polo que hace contacto con el tejido hasta el segundo polo que hace contacto con el tejido.

Description

Instrumento de electrodos bipolares con disposición de electrodos separable
CAMPO DEL INVENTO
Este invento se refiere a un instrumento quirúrgico para cerrar permanentemente vasos en un ser humano o en un animal, y más particularmente a un hemostato modificado que fusiona tejido de los vasos usando una combinación de presión y corriente electroquirúrgica.
ANTECEDENTES DE LA DESCRIPCIÓN
Un hemostato es usado comúnmente en procedimientos quirúrgicos para cerrar venas y arterias. Es típicamente un simple útil
o herramienta similar a unos alicates que utiliza una acción mecánica entre sus mordazas para apretar un vaso sin cortarlo. También es típico que tenga un trinquete de interbloqueo entre los mangos o empuñaduras de tal forma que el dispositivo pueda ser sujetado y bloqueado in situ.
Muchos hemostatos son usados en un procedimiento quirúrgico abierto típico. Una vez que una estructura ha sido sujetada, es común que un cirujano ate y suture alrededor de la estructura para cerrarla permanentemente antes de retirar el hemostato. Varios hemostatos pueden ser dejados en el campo quirúrgico hasta que el cirujano tenga la oportunidad de unirlos todos. Sería deseable que los cirujanos fusionen los vasos inmediatamente, y así evitar tener hemostatos que obstruyen el acceso al sitio quirúrgico.
Se conocen en el campo varios fórceps y pinzas electroquirúrgicos bipolares. Todos estos diseños tienen el inconveniente de que no combinan la simplicidad y familiaridad de un hemostato con electrocirugía bipolar. Por ejemplo, la patente Norteamericana nº 5.462.546 describe un fórceps electroquirúrgico bipolar que comprende dos miembros de cuchilla pivotables enfrentados que son pivotables individualmente uno con relación al otro. El movimiento de pivotamiento de los miembros es efectuado por dos vástagos rígidos eléctricamente conductores que se extienden a través de un miembro tubular alargado.
La Patente estadounidense nº 5.827.271 describe un aparato y método para cerrar vasos herméticamente.
La Patente estadounidense nº 5.776.130 describe una herramienta quirúrgica para cerrar vasos herméticamente.
La Patente estadounidense nº 5.116.332 de Lottick describe un hemostato de electrocauterización. El hemostato incluye mangos de plástico sintético de tipo concha con un interruptor incorporado en ellos.
La Patente estadounidense nº 5.026.370 de Lottick describe un instrumento de electrocauterización con un mecanismo de conmutación eléctrica encerrado no desmontable. La Patente Norteamericana nº 4.370.980 describe un instrumento de electrocauterización que puede ser usado como una dispositivo de sujeción y un aparato para cauterizar vasos sanguíneos que sangran durante la cirugía.
La Patente estadounidense nº 5.484.436 de Eggers describe instrumentos electroquirúrgicos bipolares. Los instrumentos bipolares incluyen electrodos de polaridad opuesta aislados por una capa de aislamiento eléctrico depositada y especialmente preparada para reducir las averías eléctricas y aumentar la suavidad.
La Patente estadounidense nº 5.443.464 de Stern y col. describe un fórceps de coagulación que tiene una pluralidad de electrodos y sensores en las mordazas. Los sensores proporcionan una señal de realimentación a un generador electroquirúrgico con el fin de controlar la cantidad de calor en el fórceps.
La Patente estadounidense nº 4.005.714 de Hiltebrandt describe un fórceps de coagulación bipolar en el que los fórceps están diseñados para coagular tanto el tubo de Falopio como el mesosalpinx adyacente.
En la Patente estadounidense nº 5.472.443 de Cordis y col., se ha descrito un aparato electroquirúrgico que emplea una tensión constante. Un fórceps bipolar incluye miembros de soporte opuestos, que están conectados pivotablemente a un pivote. Cada uno de los miembros de soporte tiene un terminal, para estimular partes de electrodo en el extremo distal de los fórceps.
RESUMEN DEL INVENTO
Es el objetivo general de este invento proporcionar un instrumento que puede fusionar estructuras sin la necesidad de una sutura. El instrumento tiene una corriente electroquirúrgica que fluye entre las mordazas de trabajo. La corriente electroquirúrgica pasa a través de la estructura sujetada y forma un cierre hermético permanente.
BREVE DESCRIPCIÓN DE LOS DIBUJOS
La fig. 1 es una vista en perspectiva del hemostato modificado bipolar para entregar electrocirugía.
La fig. 2 es una vista en perspectiva del hemostato modificado de la fig. 1 sin una cubierta de la punta aislante colocada en su lugar, que muestra uno de los miembros alargados que tiene un extremo distal de sección transversal reducida.
La fig. 3 es una vista en perspectiva de la cubierta de la punta aislante como se vería desde arriba.
La fig. 4 es una vista despiezada ordenadamente del cableado para la parte de interruptor de la cubierta de la punta aislada, con la parte de soporte y de aislamiento retirada de la misma.
La fig. 5 es un diagrama de circuito para el interruptor mostrado en la fig. 4.
La fig. 6 es una vista en perspectiva de la cubierta de la punta aislada como se vería desde abajo.
La fig. 7 es una vista en alzado lateral de la cubierta de la punta aislada de la fig. 3.
La fig. 8 es una vista en sección transversal de la cubierta de la punta aislada de la fig. 7 como se vería a lo largo de las líneas 8-8 de la misma.
La fig. 9 es una vista en sección transversal de la cubierta de la punta aislada de la fig. 7 como se vería a lo largo de las líneas 9-9 de la misma.
La fig. 10 es una vista en sección transversal de la cubierta de la punta aislada de la fig. 7 como se vería a lo largo de las líneas 10-10 de la misma.
DESCRIPCIÓN DETALLADA DE INVENTO
En la realización preferida de un instrumento bipolar, cada uno de los miembros alargados 11 y 12 está formado a partir de un material eléctricamente conductor. Un pivote 13 conecta los dos miembros alargados 11 y 12 de manera que proporcione un movimiento parecido a unas tijeras como en un hemostato modificado 15. El pivote 13 puede ser una espiga simple como en las figs. 1 y 2, o puede ser una parte integral de un conjunto 14 de caja de seguridad. La fig. 1 muestra el instrumento bipolar 10 en una vista superior y la fig. 2 muestra el hemostato modificado 15 en una vista en perspectiva inferior. De una manera bien conocida, el pivote 13 puede estar aislado eléctricamente para impedir el flujo de corriente electroquirúrgica desde uno de los miembros alargados bien 11 o bien 12 al otro. En la realización preferida, el pivote 13 no tiene aislamiento porque no es un trayecto potencial entre los dos polos de energía electroquirúrgica bipolar. El hemostato modificado 15 del instrumento bipolar 10 está hecho mucho más parecido a un hemostato estándar y puede usarse para electrocirugía bipolar y puede ser esterilizado como un hemostato estándar. Es el invento descrito el que permite la conversión de un hemostato estándar para usar con electrocirugía bipolar.
La fig. 1 es una vista en perspectiva del instrumento bipolar 10 basada en el hemostato modificado 15 mostrado en la fig. 2 de modo que la electrocirugía bipolar pueda ser entregada.
El instrumento bipolar 10, como el hemostato modificado 15 en la fig. 2 puede incluir dos miembros alargados 11 y 12. Cada miembro alargado bien 11 o bien 12 tiene preferiblemente un extremo proximal 16 ó 16’ para ser sujetado por el cirujano y un extremo distal 17 ó 17’ para manipulación del tejido o tejido vascular. En las figuras y a través de toda esta descripción el extremo proximal 16 sobre el miembro alargado 11 será denominado como 16 y el extremo distal 17 sobre el miembro alargado 11 será denominado 17. De modo similar, el extremo proximal 16’ sobre el otro miembro alargado 12 será denominado como 16’ y el extremo distal 17’ sobre el otro miembro alargado 12 será denominado 17’. El extremo proximal 16 ó 16’ puede tener características que facilitan que el cirujano lo pueda sujetar, tal como dedales o dedales para los dedos del cirujano.
Un primer polo 18 que contacta con el tejido es de una pieza con un miembro alargado 11 y está situado sobre un extremo distal 16, como se ha visto mejor en la fig. 2. El primer polo 18 que contacta con el tejido es preferiblemente de una pieza con el miembro alargado 11 que está preferiblemente hecho de un material eléctricamente conductor tal como acero inoxidable o aluminio de tal modo que puede conducir electrocirugía bipolar.
El instrumento bipolar 10 tiene una cubierta 19 de la punta aislada para su colocación sobre el otro miembro alargado 12 en su extremo distal 17’. La cubierta 19 de la punta aislada une al otro miembro alargado 12 en relación ajustada deslizante sobre el otro extremo distal 17’ para impedir el movimiento transversal o longitudinal entre la cubierta 19 de la punta aislada, el otro miembro alargado 12 y el otro extremo distal 17’. La fig. 2 es una vista en perspectiva del hemostato modificado de la fig. 1 sin la cubierta 19 de la punta aislada en su lugar, que muestra el otro miembro alargado 12 que tiene una sección transversal reducida en el extremo distal 17’. El extremo distal 17’ tiene una sección transversal reducida para recibir la cubierta 19 de la punta aislada en una relación de ajuste deslizante. La fig. 3 es una vista en perspectiva de la cubierta 19 de la punta aislada como se vería desde arriba. Por consiguiente, la cubierta 19 de la punta aislada incluye una abertura 20 que se extiende en ella en forma de túnel para relación de ajuste deslizante sobre la sección transversal reducida del extremo distal 17. Así se ha impedido el movimiento longitudinal o transversal entre la cubierta 19 de la punta aislada, el otro miembro alargado 12 y su extremo distal 17’. La cubierta 19 de la punta aislada tiene clips o sujeciones 21 para conectar con el otro miembro alargado 12 o sobre él. La cubierta 19 de la punta aislada está diseñada para llevar el sistema de circuitos para conducir la energía electroquirúrgica bipolar a lo largo del otro miembro alargado 12 hasta su segundo polo 22 que hace contacto con el tejido respectivo. Específicamente, el segundo polo 22 que hace contacto con el tejido está en la cubierta 19 de la punta aislada en posición opuesta al primer polo 18 que hace contacto con el tejido de tal forma que la colocación de la cubierta 19 de la punta aislada en el otro extremo distal 17’ causará la alineación precisa del primer y segundo polos 18 y 22 que hacen contacto con el tejido de uno a otro. El primer y segundo polos 18 y 22 que hacen contacto con el tejido están conectados al primer y segundo conductores 23 y 24, respectivamente como se ha comprendido mejor a partir de las figs. 4 y
5.
Un interruptor 25 mostrado de mejor manera en las figs. 4 y 5, en la última esquemáticamente, interrumpe la continuidad del segundo conductor 24 entre el segundo polo 22 que contacta con el tejido y una fuente 26 de electrocirugía bipolar. Una fuente preferida 26 de electrocirugía bipolar es fabricada por Valleylab Inc de Boulder, Colorado, la cesionaria de este invento; específicamente, el generador electroquirúrgico de Fuerza FX que tiene una salida bipolar. Como se ha mostrado en el diagrama esquemático de la fig. 5 hay un circuito 27 entre la fuente 26 de electrocirugía bipolar y las placas de contacto 28 y
29. Las placas de contacto 28 y 29 también se han mostrado en la fig. 5 en que la placa de contacto 28 está simplemente para transferir electrocirugía al hemostato modificado 15 por contacto íntimo de presión. De modo similar la placa de contacto 29 es equivalente al segundo polo 22 que contacta con el tejido en la realización preferida; los expertos en la técnica entenderán que la placa de contacto 29 y el segundo polo 22 que contacta con el tejido pueden ser artículos separados que son acoplados eléctricamente quizás por el montaje de la cubierta 19 de la punta aislada sobre el otro extremo distal 17’. Los terminales 30 y 31 están mostrados en las figs. 3, 4, 5, 6 y 7 para acoplar eléctricamente de forma desmontable y fácil la fuente de electrocirugía bipolar 26 al instrumento bipolar 10 y más particularmente, el primer y segundo conductores 23 y 24, respectivamente como se ha comprendido mejor a partir de la fig. 5 se unen a los terminales 30 y 31. La placa de contacto 28 está así conectada directamente por el primer conductor 31 mientras el segundo conductor 24 está conectado entre el terminal 30 y el interruptor 25. El otro lado del interruptor 25 está acoplado eléctricamente de forma directa al segundo polo 22 que contacta con el tejido por la continuación del primer conductor 24 en la realización preferida. Los terminales 30 y 31 se unen a la salida bipolar de la fuente 26 de electrocirugía bipolar; que está en ambos lados de la salida bipolar. El interruptor 25, en la fig. 5 incluye un control de interruptor manual 32 para activar la fuente 26 de electrocirugía bipolar para suministrar una salida bipolar según sea requerido por el cirujano. Así, cuando el interruptor 25 está cerrado la salida de electrocirugía bipolar es recibida en los terminales 30 y 31 para el paso selectivo controlado de electrocirugía bipolar desde el primer polo 18 que contacta con el tejido hasta el segundo polo 22 que contacta con el tejido. El interruptor 25 está dispuesto preferiblemente en la parte superior del pivote 13 en una posición conveniente para que el cirujano controle el flujo de electrocirugía. La fig. 4 es una vista despiezada ordenadamente del cableado del interruptor 25 de la cubierta 19 de la punta aislada y la fig. 5 es un diagrama de circuito para el interruptor 25 mostrado en la fig. 4. La fig. 6 es una vista en perspectiva de la cubierta 19 de la punta aislada como se vería desde abajo. El hemostato modificado 15 y sus miembros alargados 11 y 12 están construidos a partir de un material eléctricamente conductor, tal como acero inoxidable o aluminio. Por consiguiente la electrocirugía bipolar pasará a través del tejido entre el primer y segundo polos 18 y 22 de contacto cuando el tejido sea cogido entre ellos y el interruptor 25 esté cerrado.
El instrumento bipolar 10 tiene ciertas similitudes al aspecto y sensación de un hemostato estándar de modo que será confortable y resultará familiar para los cirujanos. Sin embargo, el instrumento bipolar 10 tiene la capacidad añadida de ligar vasos y cerrar el tejido vascular herméticamente. La fuente de electrocirugía bipolar 26 está conectada eléctricamente al instrumento bipolar 10 y a los terminales 30 y 31 para proporcionar electrocirugía bipolar de alta frecuencia.
El primer y segundo conductores 23 y 24 están en la realización preferida de la fig. 4 mostrados como cables aislados llevados en la cubierta 19 de la punta aislada a lo largo del otro miembro alargado 12 para transportar corriente de electrocirugía desde los terminales 30 y 31. Los cables aislados pueden ser ajustados por presión, o ser moldeados por inyección como parte de la sobrepinta aislada 19. Así el pivote 13 no necesita estar aislado eléctricamente. La fig. 7 es una vista en alzado lateral de la cubierta 19 de la punta aislada de la fig. 3 que muestra lo ligera y compacta que es. La fig. 8 es una vista en sección transversal de la cubierta 19 de la punta aislada de la fig. 7 como se vería a lo largo de las líneas 8-8 de la misma. La fig. 9 es una vista en sección transversal de la cubierta de la punta aislada de la fig. 7 como se vería a lo largo de las líneas 9-9 de la misma. La fig. 10 es una vista en sección transversal de la cubierta 19 de la punta aislada de la fig. 7 como se vería a lo largo de las líneas 10-10 de la misma. Los clips 21 están mejor mostrados en las figs. 6, 7, 8, 9 y 10 mientras que la cubierta 19 de la punta aislada ensamblada al hemostato modificado 15 está ilustrada en la fig. 1.
Una alternativa, no mostrada pero familiar para los expertos en el diseño y uso de hemostatos es curvar los extremos distales 17 y 17’ más de lo que ya se ha mostrado para que se extiendan transversalmente con relación al plano y generalmente paralelos pero no espaciados del pivote 13. Los hemostatos curvados ofrecen acceso para facilitar la manipulación del cirujano durante algunas cirugías. La cubierta 19 de la punta aislada debería ser lo bastante flexible para ser hecha deslizar fácilmente sobre el extremo distal 17’ de sección transversal reducida. Se prefieren los polímeros que tienen una rigidez dieléctrica elevada, una resistencia a alta temperatura y un coste bajo. De modo similar, el interruptor 25 tiene una placa de circuito impreso para facilitar su fabricación a bajo coste.
Los elementos de retención 33 y 34 están situados sobre cada miembro alargado 11 y 12 preferiblemente de modo proximal al pivote 13. Así en la realización preferida estos elementos de retención 33 y 34 están situados cerca de los extremos proximales 16 y 16’ del instrumento bipolar 10, es decir cerca de los dedales de los dedos. Los elementos de retención 33 y 34 tienen preferiblemente rampas opuestas 35 y topes colindantes 36 para su bien conocida aplicación que conjugan con un deslizamiento. Puede haber previstos al menos tres topes 36 para hacer sucesivamente mayores las fuerzas de cierre entre el primer y segundo polos 18 y 22 que hacen contacto con el tejido. Al menos un tope 36 sobre cada miembro alargado 11 y 12 producirá una pequeña fuerza de cierre entre el primer y segundo polos 18 y 22 que hacen contacto con el tejido para vasos pequeños. Al menos otro tope 36 sobre cada miembro alargado 11 y 12 producirá una gran fuerza de cierre entre el primer y segundo polos 18 y 22 que hacen contacto con el tejido para vasos más grandes. En la realización preferida los elementos de retención 33 y 34 mantendrán la fuerza de cierre contra la energía de tensión de los miembros alargados 11 y 12 que serán desviados ligeramente por la disposición de levas de las rampas opuestas 35 antes de alcanzar la yuxtaposición de cada tope sucesivo 36. Esta acción descrita es común para cualquier hemostato estándar pero representa algo diferente en un hemostato bipolar.
El miembro alargado 11 está unido a una polaridad eléctrica diferente en el circuito electroquirúrgico bipolar 27 que el otro miembro alargado 12 que lleva la cubierta 19 de la punta aislada en su extremo distal. Debido a la cubierta 19 de la punta aislada, el pivote 13 no necesita estar aislado eléctricamente de manera que impida un cortocircuito eléctrico entre los miembros alargados 11 y 12 ya que tienen la misma polaridad en la proximidad del pivote 13. Es así posible usar diseños de hemostato estándar y técnicas de fabricación para hacer el hemostato modificado 15 de la fig. 2 o similar. De manera similar, los elementos de retención 33 y 34 no necesitan estar aislados eléctricamente para impedir un cortocircuito eléctrico en la proximidad de sus rampas 35 y topes. Esto es particularmente bueno ya que la aplicación por fricción de las rampas 35 y de los topes 36 provocarían tensiones en los revestimientos dieléctricos típicos y/o en los intentos de aislamiento.
Los dos terminales eléctricos 30 y 31 están preferiblemente situados hacia el cirujano o los extremos proximales 16 y 16’ están preferiblemente sobre este último. Como se ha explicado, los terminales 30 y 31 son alimentados por la fuente de electrocirugía bipolar 26 con polaridad opuesta. Una espiga 37 conectada a un control de interruptor manual 32 sirve para conmutar como se ha mostrado mejor en la fig. 5. En la realización preferida, los terminales están soportados sobre el otro miembro alargado 12 cerca de su extremo proximal 16’. Para instrumentos bipolares que son reutilizables, los terminales 30 y 31 y la espiga 37 están diseñados para su desconexión rápida de la fuente de electrocirugía bipolar 26 para retirar el hemostato modificado 15.
Un método de montaje de la cubierta 19 de la punta aislada y del hemostato modificado 15 incluye las operaciones de hacer deslizar la cubierta 19 de la punta aislada sobre el otro extremo distal 17’, y a continuación unir la cubierta 19 de la punta aislada al otro miembro alargado 12 para impedir el movimiento longitudinal o transversal entre la cubierta 19 de la punta aislada, el otro miembro alargado 12 y su otro extremo distal 17’.
Corrientemente, dispositivos de agarre comerciales bipolares disponibles, pinzas y similares están diseñados para que puedan ser desechados después de cada operación o si son reutilizables, cada uno debe ser esterilizado y comprobado en cuanto a su seguridad eléctrica, es decir, fugas. El instrumento bipolar 10 descrito se puede separar de los componentes eléctricos de tal forma que solo el último necesita ser desechable, y así se mejora la seguridad y se reduce el coste y se asegura la facilidad de esterilización.
Debe comprenderse que el instrumento bipolar 10 descrito y reivindicado es sólo ilustrativo de una aplicación de los principios del presente invento. Los expertos en la técnica pueden considerar numerosas modificaciones y disposiciones alternativas sin salir del marco del presente invento. Se pretende que las reivindicaciones adjuntas cubran tales modificaciones y disposiciones.

Claims (6)

  1. REIVINDICACIONES
    1.-Un instrumento bipolar para cerrar tejido herméticamente que comprende:
    dos miembros alargados (11, 12) que tienen extremos proximal (16) y distal (17) y que definen un plano, siendo los miembros alargados eléctricamente conductores para transmitir electrocirugía de alta frecuencia al tejido dispuesto entre los extremos distales; y
    un pivote (13) que conecta los dos miembros alargados permitiendo el movimiento similar al de unas tijeras entre ellos, estando curvados los extremos distales para extenderse transversalmente con relación al plano y generalmente paralelos pero espaciados con relación al pivote, siendo el pivote transversal al plano y estando dispuesto lejos de los extremos distales para permitir el movimiento transversal de los extremos distales comprendiendo además el instrumento bipolar:
    un primer polo (18) que hace contacto con el tejido de una pieza con un miembro alargado y posicionado en un extremo distal del mismo, siendo el primer polo que hace contacto con el tejido eléctricamente conductor para transmitir electrocirugía de alta frecuencia al tejido;
    una cubierta (19) de la punta aislada para su colocación sobre el miembro alargado en su extremo distal, estando configurada la cubierta de la punta aislada para su unión al otro miembro alargado en relación de ajuste deslizante alrededor del extremo distal para impedir el movimiento longitudinal o transversal entre la cubierta de la punta aislada, el miembro alargado y el otro extremo distal;
    un segundo polo (22) que hace contacto con el tejido fijado en la cubierta de la punta aislada y posicionado para estar en relación opuesta al primer polo que hace contacto con el tejido cuando el contacto eléctrico está colocado sobre el extremo distal del miembro alargado;
    dos terminales eléctricos (30, 31) previstos sobre la cubierta de la punta y situados proximales al pivote cuando la cubierta de la punta está colocada sobre el extremo distal del miembro alargado y configurado para recibir energía electroquirúrgica bipolar;
    un primer conductor (23) llevado en la cubierta de la punta y que conecta un terminal y el primer polo que hace contacto con el tejido cuando la cubierta de la punta está colocada sobre el otro extremo distal; y un segundo conductor (24) que se acopla eléctricamente al otro terminal y al segundo polo que hace contacto con el tejido cuando la cubierta de la punta está colocada sobre el otro extremo distal para proporcionar un circuito para hacer pasar energía electroquirúrgica bipolar desde el primer polo que hace contacto con el tejido hasta el segundo polo que hace contacto con el tejido.
  2. 2.-El instrumento bipolar según la reivindicación 1, que comprende además elementos de retención (33, 34) que se extienden desde cada miembro alargado para aplicación cooperativa entre ellos, los elementos de retención configurados para mantener una fuerza de sujeción predeterminada entre los extremos distales del miembro alargado.
  3. 3.-El instrumento bipolar según la reivindicación 1, que comprende además un interruptor (25) configurado para impedir el paso selectivo de energía electroquirúrgica bipolar entre el primer polo que hace contacto con el tejido y el segundo polo que hace contacto con el tejido.
  4. 4.-El instrumento bipolar según la reivindicación 3, en el que el interruptor está dispuesto en la parte superior del pivote en posición para que el cirujano controle el flujo de energía electroquirúrgica.
  5. 5.-El instrumento bipolar según la reivindicación 1, en el que el extremo distal del otro miembro incluye una sección transversal reducida para recibir la cubierta de la punta aislada.
  6. 6.-El instrumento bipolar según la reivindicación 1, en el que la cubierta de la punta aislante incluye clips o sujeciones que están configurados para aplicarse al otro miembro alargado.
ES09171462T 1997-09-10 1998-09-08 Instrumento de electrodos bipolares con disposición de electrodos separable. Expired - Lifetime ES2368478T3 (es)

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ES98946876T Expired - Lifetime ES2238768T3 (es) 1997-09-10 1998-09-08 Instrumento bipolar para la fusion de vasos.
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JP4031616B2 (ja) 2008-01-09
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CA2303194A1 (en) 1999-03-18
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EP2130506B1 (en) 2011-06-29
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US6334861B1 (en) 2002-01-01
DE69829480T2 (de) 2006-02-09

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