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ES2377483T3 - Instrumentos quirúrgicos que incluyen sistemas microelectromecánicos (MEMS) - Google Patents

Instrumentos quirúrgicos que incluyen sistemas microelectromecánicos (MEMS) Download PDF

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Publication number
ES2377483T3
ES2377483T3 ES03738882T ES03738882T ES2377483T3 ES 2377483 T3 ES2377483 T3 ES 2377483T3 ES 03738882 T ES03738882 T ES 03738882T ES 03738882 T ES03738882 T ES 03738882T ES 2377483 T3 ES2377483 T3 ES 2377483T3
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tissue
mems
staple cartridge
surgical instrument
anvil
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Russell Heinrich
Douglas J. Cuny
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Covidien LP
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Tyco Healthcare Group LP
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    • A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
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    • A61B17/0686—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil having a forming anvil staying below the tissue during stapling
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    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
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    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
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    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00642—Sensing and controlling the application of energy with feedback, i.e. closed loop control
    • A61B2018/00648—Sensing and controlling the application of energy with feedback, i.e. closed loop control using more than one sensed parameter
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    • A61B2018/00696—Controlled or regulated parameters
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    • A61B90/06—Measuring instruments not otherwise provided for
    • A61B2090/064—Measuring instruments not otherwise provided for for measuring force, pressure or mechanical tension

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  • Engineering & Computer Science (AREA)
  • Veterinary Medicine (AREA)
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  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
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  • Physics & Mathematics (AREA)
  • Reproductive Health (AREA)
  • Vascular Medicine (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Pathology (AREA)
  • Robotics (AREA)
  • Surgical Instruments (AREA)
  • Manipulator (AREA)

Abstract

Una grapadora quirurgica (100, 200), que comprende: un util final (317) configurado y adaptado para enganchar tejido, el util final que incluye un conjunto de cartucho de grapas (318) y un yunque (320) asociado operativamente con el conjunto de cartucho de grapas; y al menos un dispositivo de sistema microelectromecanico (MEMS) ("M") conectado operativamente al util final, cada uno del conjunto de cartucho de grapas y el yunque que definen las superficies de contacto del tejido y el al menos un dispositivo MEMS que se conecta operativamente a al menos una de la superficie de contacto del tejido (318a) del conjunto de cartucho de grapas y la superficie de contacto del tejido (320a) del yunque, el dispositivo MEMS que incluye un sistema electrónico integrado que incluye al menos un sensor para detectar la cantidad de presión aplicada al tejido sujeto entre el conjunto de cartucho de grapas y el yunque y una distancia entre la superficie de contacto del tejido del conjunto de cartucho de grapas y superficie de contacto del tejido del yunque, el dispositivo MEMS que ademas incluye uno o mas circuitos electrónicos para la determinación del espesor del tejido, calculando el espesor del tejido sujeto a partir de la distancia conocida.

Description

Instrumentos quirurgicos que incluyen sistemas microelectromecanicos (MEMS)
Antecedentes
Campo tecnico
La presente descripci6n se refiere a los instrumentos quirurgicos y, mas concretamente a instrumentos y sistemas quirurgicos mecanicos, electromecanicos y basados en energia.
La presente revelaci6n se refiere de manera general a instrumentos y sistemas quirurgicos y, mas concretamente, a instrumentos y sistemas de grapadora quirurgica e instrumentos y sistemas basados en energia, que tienen dispositivos de sistemas microelectromecanicos (MEMS) para detectar, monitorizar, controlar, medir y/o regular las condiciones y/o parametros asociados con el rendimiento de diversos procedimientos quirurgicos.
Antecedentes de la tecnica relacionada
Los instrumentos quirurgicos usados en cirugia abierta y minimamente invasiva se limitan en su capacidad a detectar y/o controlar las condiciones y/o parametros y factores criticos para la operaci6n efectiva. Por ejemplo, los instrumentos quirurgicos convencionales no pueden detectar mensurablemente la cantidad de tejido situado entre las superficies de contacto de tejido de un util final del instrumento quirurgico.
Los sistemas microelectromecanicos (MEMS) son microdispositivos o sistemas integrados que combinan componentes electricos y mecanicos. Se fabrican usando tecnicas de procesamiento de lotes de circuiteria integrada (es decir, IC) y pueden oscilar en tamafo de micr6metros a milimetros. Estos sistemas microelectromecanicos detectan, controlan y/o actuan a micro escala, y funcionan individualmente o en grupos para generar efectos a macro escala.
En general, los dispositivos MEMS son sistemas complejos que incluyen individualmente uno o mas sistemas electricos y/o uno o mas sistemas micro-mecanicos. Los sistemas micro-mecanicos se fabrican usando muchas de las mismas tecnicas de fabricaci6n que tienen los circuitos electr6nicos miniaturizados y han hecho posible la producci6n masiva de pastillas de circuitos integrados de silicio. En particular, los dispositivos MEMS incluyen microestructuras mecanicas, micro-sensores, micro-actuadores y electr6nica integrada en el mismo entorno (es decir, en una pastilla de silicio) usando tecnologia de micro-fabricaci6n. La tecnologia de micro-fabricaci6n permite la fabricaci6n de grandes grupos de dispositivos, que realizan individualmente tareas simples pero en combinaci6n puede consumar funciones complicadas.
Los dispositivos MEMS son ventajosos por muchas razones. En particular, los dispositivos MEMS pueden ser tan pequefos que cientos se pueden encajar en el mismo espacio, los cuales realizan la misma o muchas funciones diferentes, comparado con un macro-dispositivo, que realiza una funci6n simple. Ademas, usando las tecnicas de procesamiento por lotes de IC, cientos de miles de estos dispositivos MEMS se pueden fabricar en una unica oblea de silicio. Esta producci6n masiva reduce mucho el precio de los dispositivos individuales. De esta manera, los dispositivos MEMS son relativamente menos caros que sus contrapartidas del macro-mundo. Ademas, los componentes electricos engorrosos tipicamente no se necesitan con los dispositivos MEMS, dado que la electr6nica se puede situar directamente en el dispositivo MEMS. Esta integraci6n tambien tiene la ventaja de captar menos ruido electrico, mejorando de esta manera la precisi6n y sensibilidad de los sensores. Como se trat6 anteriormente, los dispositivos MEMS proporcionan algo de la funcionalidad de la instrumentaci6n analitica, pero con coste, tamafo, y consumo de potencia enormemente reducidos, y una capacidad de medici6n en tiempo real, en el propio sitio.
Ejemplos de sistemas microelectromecanicos se revelan en la Patente de U.S. N° 6.127.811 de Shenoy y otros; la Patente de U.S. N° 6.288.534 de Starkweather y otros; la Patente de U.S: N° 6.092.422 de Binning y otros; la Solicitud de Patente de U.S. N° US 2001/0020166 PCT clasificada el 30 de abril de 1997; Microelectr6nica en el Cuidado Moderno de la Salud por P. Detemple, W. Ehrfeld, H. Freimuth, R. Pommersheim, y P. Wagler en Tecnologia de Dispositivos Medicos, noviembre de 1998; y Sistemas Microelectromecanicos (MEMS); Tecnologia, Disefo y Aplicaciones, coordinador: Lee, Abraham, Universidad de California, Los Angeles, Departamento de Ingenieria, Sistemas de Informaci6n y Gesti6n Tecnica, Programa de Curso Corto, Ingenieria 823.53, 19-22 de mayo de 1997, los contenidos completos de cada una de los cuales se incorporan aqui por referencia.
Por consiguiente, existe una necesidad de instrumentos quirurgicos que puedan detectar una multitud de parametros y factores, tales como, por ejemplo, la distancia entre el las superficies de contacto del tejido del instrumento quirurgico. Tal instrumento quirurgico puede, de acuerdo con las condiciones detectadas y/o medidas, utilizar, visualizar, grabar y/o controlar automaticamente la posici6n de las superficies de contracto del tejido del instrumento quirurgico o alertar a un cirujano anterior a la operaci6n del instrumento quirurgico.
A la vista de lo anteriormente mencionado, existe la necesidad del uso de sistemas microelectromecanicos en combinaci6n con los instrumentos y sistemas quirurgicos y, en particular en los instrumentos de grapado y los instrumentos quirurgicos basados en energia para la monitorizaci6n, control y regulaci6n de las condiciones y/o parametros asociados con el rendimiento de diversos procedimientos mecanicos, electromecanicos y electroquirurgicos.
La US 6.221.023 revela un sensor para un cateter que incluye una pluralidad de indicadores de tensi6n.
La US 5.395.033 revela un instrumento de grapado quirurgico que tiene un sensor electromagnetico para detectar la distancia entre las mordazas de la grapadora.
Resumen
La presente invenci6n se dirige a los instrumentos quirurgicos que incluyen un util final configurado y adaptado para enganchar el tejido, y al menos un dispositivo de sistema microelectromecanico (MEMS) conectado operativamente al instrumento quirurgico para detectar una condici6n y/o medir un parametro y ademas para controlar la condici6n y/o el parametro adyacente del util final. El al menos un dispositivo MEMS esta conectado operativamente con el util final. El al menos un dispositivo MEMS es al menos uno de un sensor de presi6n, un sensor de tensi6n, un sensor de desplazamiento, un sensor 6ptico, un biosensor, un sensor de temperatura, un sensor de par, un aceler6metro, un sensor de flujo, un sensor electrico y un sensor magnetico para al menos una de detectar, medir y controlar la condici6n y/o el parametro asociado.
Se contempla que el instrumento quirurgico es una grapadora quirurgica de acuerdo con la reivindicaci6n 1 y el util final incluye un conjunto de cartucho de grapas, y un yunque asociado operativamente con el cartucho de grapas, el cartucho de grapas y el yunque que estan conectados m6vilmente el uno con el otro para llevar uno en yuxtaposici6n en relaci6n con el otro. Cada uno del cartucho de grapas y el yunque definen las superficies de contacto del tejido y el al menos un dispositivo MEMS esta conectado operativamente con al menos una de la superficie de contacto del tejido del cartucho de grapas y la superficie de contacto del tejido del yunque. Una pluralidad de dispositivos MEMS estan conectados al instrumento quirurgico, los dispositivos MEMS que estan configurados y adaptados para medir la distancia entre la superficie de contacto del tejido del conjunto de cartucho de grapas y la superficie de contacto del tejido del yunque.
Los dispositivos MEMS se configuran y adaptan para medir la cantidad de presi6n aplicada al tejido sujeto entre la superficie de contacto del tejido del cartucho de grapas y la superficie de contacto del tejido del yunque. Los dispositivos MEMS se configuran y adaptan para medir el espesor del tejido sujeto entre la superficie de contacto del tejido del cartucho de grapas y la superficie de contacto del tejido del yunque.
Se preve que el util final este configurado y adaptado para realizar una anastomosis. El instrumento quirurgico puede ser una grapadora lineal que se adapta para realizar una anastomosis gastrointestinal endosc6pica. Ademas se contempla que el instrumento quirurgico es una grapadora anular que se adapta para realizar una anastomosis extremo a extremo.
Se preve que el util final es un mecanismo de mordaza que incluye un par de miembros de la mordaza acoplados giratoriamente al extremo distal del eje alargado. Se preve ademas que al menos un dispositivo MEMS se proporcione en al menos uno del par de miembros de la mordaza. Los dispositivos MEMS se proporcionan al menos en uno de un extremo proximal, un extremo distal y a lo largo de una longitud de cada uno del par de miembros de la mordaza.
Se preve que el mecanismo de mordaza este configurado y adaptado para realizar una funci6n electroquirurgica. El mecanismo de mordaza se configura y adapta para entregar energia electroquirurgica a un lugar quirurgico objetivo.
Se preve ademas que el instrumento quirurgico este acoplado operativamente a un sistema rob6tico, en el que el util final se configura y adapta para ser operado remotamente por el sistema rob6tico.
Se contempla que el instrumento quirurgico puede incluir una unidad de carga que tiene un extremo proximal y un extremo distal, el extremo proximal que esta conectado selectivamente de manera desmontable con el instrumento quirurgico, el util final esta conectado operativamente a y parte de la unidad de carga, y la unidad de carga incluye el al menos un dispositivo MEMS.
El util final puede ser una grapadora quirurgica que incluye un conjunto de cartucho de grapas, y un yunque asociado operativamente con el conjunto de cartucho de grapas, el conjunto de cartucho de grapas y el yunque que son desmontables y yuxtapuestos uno en relaci6n con el otro. Cada uno del conjunto de cartucho de grapas y el yunque definen las superficies de contacto del tejido y en las que al menos un dispositivo MEMS esta conectado operativamente con la al menos una de la superficie de contacto del tejido del conjunto de cartucho de grapas y la superficie de contacto del tejido del yunque.
Los dispositivos MEMS estan configurados y adaptados para medir la distancia entre la superficie de contacto del tejido del conjunto de cartucho de grapas y la superficie de contacto del tejido del yunque. Los dispositivos MEMS estan configurados y adaptados a medir al menos una de la cantidad de presi6n aplicada al tejido y el espesor del tejido sujeto entre la superficie de contacto del tejido del conjunto de cartucho de grapas y la superficie de contacto de tejido del yunque.
La unidad de carga puede incluir un eje alargado que tiene un extremo distal, el util final que esta conectado operativamente al extremo distal de un eje alargado y el cartucho de grapas y el yunque estan orientados transversalmente con respecto al eje alargado.
Se preve que el util final este configurado y adaptado para realizar una anastomosis. Se preve ademas que el util final es un mecanismo de mordaza que incluye un par de miembros de la mordaza acoplados giratoriamente con el extremo distal del eje alargado. El al menos un dispositivo MEMS se proporciona en al menos uno del par de miembros de la mordaza. Los dispositivos MEMS se pueden proporcionar al menos en uno de un extremo proximal, un extremo distal y a lo largo de una longitud de cada uno del par de miembros de la mordaza.
Se preve que el mecanismo de mordaza este configurado y adaptado para realizar una funci6n electroquirurgica. El mecanismo de mordaza se puede configurar y adaptar para entregar la energia electroquirurgica al lugar quirurgico objetivo.
Se preve que cada uno de la pluralidad de dispositivos MEMS este conectado electricamente con una caja de control a traves de un hilo conductor que se extiende desde la carcasa.
El instrumento quirurgico ademas puede incluir una caja de control conectada electricamente con cada uno de la pluralidad de dispositivos MEMS a traves de un conductor de hilo.
De acuerdo con otro aspecto, hay proporcionado un sistema rob6tico para realizar las tareas quirurgicas que incluye un bastidor, un brazo rob6tico conectado con el bastidor y desmontable en relaci6n con el bastidor, un conjunto de actuaci6n asociado operativamente con el brazo rob6tico para controlar la operaci6n y el movimiento del brazo rob6tico, una unidad de carga que incluye un eje alargado conectado operativamente con el brazo rob6tico, y el util final acoplado operativamente con un extremo distal del eje alargado y configurado para enganchar el tejido, y el al menos un dispositivo de sistema microelectromecanico (MEMS) conectado operativamente a la unidad de carga.
En una realizaci6n el util final incluye un par de miembros de la mordaza acoplados de manera m6vil al extremo distal del eje alargado. Se preve que una pluralidad de dispositivos MEMS se proporcionen en cada uno del par de miembros de la mordaza. Preferentemente, una pluralidad de dispositivos MEMS se proporcionan al menos en uno de un extremo proximal, un extremo distal y a lo largo de una longitud de cada uno del par de miembros de la mordaza.
La unidad de carga se puede conectar al brazo rob6tico a traves de una conexi6n tipo bayoneta.
En otra realizaci6n, el util final esta configurado y adaptado para realizar una funci6n electroquirurgica. Preferentemente, el util final esta configurado y adaptado para entregar energia electroquirurgica al lugar quirurgico objetivo.
Aun en otra realizaci6n, el sistema rob6tico ademas incluye un controlador que tiene un procesador y un receptor para recibir las sefales electricas transmitidas desde el conjunto de actuaci6n y para controlar la operaci6n y el movimiento de la unidad de carga.
El util final puede ser un aplicador de cierre, una grapadora quirurgica, un aplicador de presilla de vaso o un conjunto de sutura vascular.
Como una grapadora quirurgica, el util final incluye un conjunto de cartucho de grapas y un yunque asociados operativamente con el conjunto de cartucho de grapas y en yuxtaposici6n en relaci6n con el conjunto de cartucho de grapas, y en el que al menos un dispositivo MEMS esta conectado operativamente con cada uno del conjunto de cartucho de grapas y el yunque. El conjunto de cartucho de grapas define una superficie de contacto del tejido y en donde al menos un dispositivo MEMS esta conectado operativamente con la superficie de contacto del tejido del conjunto de cartucho de grapas. El yunque define una superficie de contacto del tejido y en donde al menos un dispositivo MEMS esta conectado operativamente a la superficie de contacto del tejido del cartucho de grapas.
Los dispositivos MEMS pueden estar configurados y adaptados a medir la distancia entre la superficie de contacto del tejido del conjunto de cartucho de grapas y la superficie de contacto del tejido del yunque. Alternativamente, los dispositivos MEMS se pueden configurar y adaptar para medir la cantidad de presi6n aplicada al tejido sujeto entre la superficie de contacto del tejido del conjunto de cartucho de grapas y la superficie de contacto del tejido del yunque.
El conjunto de cartucho de grapas y el yunque se orientan deseablemente de manera transversal con respecto al eje alargado. Se preve que el conjunto de cartucho de grapas y el yunque esten conectados giratoriamente con el extremo distal y el eje alargado.
Como un aplicador de presilla de vaso, el util final incluye una parte de cuerpo que tiene un extremo distal y un extremo proximal, en el que el extremo proximal es conectable operativamente al brazo rob6tico, y un conjunto de mordaza conectado operativamente con el extremo distal de la parte del cuerpo, en el que el conjunto de mordaza incluye una primera y una segunda parte de la mordaza. Cada una de la primera y segunda partes de la mordaza incluye al menos un dispositivo MEMS operativamente conectado a las mismas.
Como un conjunto de sutura vascular, el util final incluye un cuerpo alargado que tiene un extremo distal y un extremo proximal, en el que el extremo proximal es conectable operativamente al brazo rob6tico, y un par de mordazas de recepci6n de agujas montadas al extremo distal de la parte del cuerpo alargado, el par de mordazas de recepci6n de agujas que se configura y adapta para pasar una aguja quirurgica y la longitud asociada de material de sutura entre medias. Preferentemente, al menos un componente MEMS esta conectado operativamente con cada una del par de mordazas de recepci6n de agujas
De acuerdo con otro aspecto, el instrumento quirurgico es para usar con una unidad de carga que es acoplable operativamente con el instrumento quirurgico y tiene el util final con un par de mordazas yuxtaponibles para realizar una funci6n quirurgica, el util final que tiene el al menos un dispositivo del sistema microelectromecanico (MEMS) conectado operativamente al mismo. El instrumento quirurgico incluye una carcasa, un eje alargado que se extiende desde la carcasa y tiene un extremo distal acoplable operativamente con una unidad de carga del tipo anterior, un mecanismo de aproximaci6n para aproximar el par de mordazas, un mecanismo de actuaci6n para activar las mordazas para realizar la funci6n quirurgica, y al menos un dispositivo del sistema microelectromecanico (MEMS) conectado operativamente al instrumento quirurgico para al menos una de detectar una condici6n, medir un parametro y controlar la condici6n y/o el parametro adyacente al util final y para la operaci6n cooperativa con el al menos un MEMS del util final.
Es un objeto de la presente revelaci6n proporcionar instrumentos y sistemas quirurgicos mecanicos, electromecanicos y basados en energia que tienen dispositivos microelectromecanicos asociados con ellos para monitorizar, controlar, medir y/o regular las condiciones y los parametros asociados con el rendimiento y la operaci6n del instrumento quirurgico.
Es un objeto adicional de la presente revelaci6n proporcionar instrumentos y sistemas quirurgicos mecanicos, electromecanicos y basados en energia que son mas efectivos, seguros y/o faciles de usar que los instrumentos y sistemas quirurgicos convencionales similares.
Es otro objeto de la presente revelaci6n proporcionar instrumentos y sistemas quirurgicos mecanicos, electromecanicos y basados en energia mejorados los cuales controlan mejor los efectos que tienen en el tejido objetivo y en el paciente.
Estos y otros objetos se ilustraran mas claramente mas adelante mediante la descripci6n de los dibujos y la descripci6n detallada de las realizaciones preferentes.
Breve descripcion de los dibujos
Los dibujos anexos, que se incorporan en y constituyen una parte de esta especificaci6n, ilustran realizaciones de la presente revelaci6n y, junto con la descripci6n detallada de las realizaciones dadas mas adelante, sirven para explicar los principios de la revelaci6n.
La FIG. 1 es una vista en perspectiva de un instrumento de grapado quirurgico que incorpora dispositivos de sistema microelectromecanico, de acuerdo con la presente revelaci6n;
La FIG. 2 es una vista en perspectiva explotada parcialmente de un instrumento de grapado quirurgico alternativo que incorpora dispositivos de sistemas microelectromecanicos de acuerdo con la presente revelaci6n;
La FIG. 3 es una vista en perspectiva de aun otro instrumento de grapado quirurgico alternativo que incorpora dispositivos de sistemas microelectromecanicos de acuerdo con la presente revelaci6n;
La FIG. 3A es una vista en perspectiva alargada de un extremo distal del instrumento de grapado quirurgico de la FIG. 3;
La FIG. 4 es una vista en perspectiva de aun otro instrumento de grapado quirurgico que incorpora dispositivos de sistemas microelectromecanicos de acuerdo con la presente revelaci6n;
La FIG. 5 es una vista en perspectiva de un instrumento de grapado quirurgico para situar presillas en
procedimientos laparosc6picos y endosc6picos que incorporan dispositivos de sistemas microelectromecanicos de acuerdo con la presente revelaci6n;
La FIG. 5A es una vista en perspectiva alargada de la regi6n indicada del instrumento quirurgico representado en la FIG. 5;
La FIG. 6 es una vista en perspectiva de un instrumento quirurgico basado en energia que incorpora dispositivos de sistemas microelectromecanicos de acuerdo con la presente revelaci6n;
La FIG. 6A es una vista en perspectiva alargada de la regi6n indicada del instrumento quirurgico representado en la FIG. 6;
La FIG. 7 es una vista en perspectiva de un sistema rob6tico que emplea dispositivos de sistemas microelectromecanicos de acuerdo con la presente revelaci6n;
La FIG. 8 es un diagrama de bloques que ilustra los componentes de una unidad de carga desechable de acuerdo con la presente revelaci6n;
La FIG. 9 es una vista en perspectiva, con partes separadas, de un sistema rob6tico acoplado a una unidad de carga, que incluye un util final para aplicar grapas quirurgicas;
La FIG. 10 es una vista en perspectiva, con partes separadas, de un sistema rob6tico acoplado a una unidad de carga, que incluye un util final para aplicar energia electroquirurgica;
La FIG. 11 es una vista en perspectiva, con partes separadas, de un sistema rob6tico acoplado a una unidad de carga, que incluye un util final para aplicar presillas de vasos; y
La FIG. 12 es una vista en perspectiva, con partes separadas, de un sistema rob6tico acoplado a una unidad de carga, que incluye un util final para aplicar una sutura vascular.
Descripcion detallada de las realizaciones preferentes
Las realizaciones preferentes de los instrumentos y sistemas quirurgicos revelados actualmente se describiran ahora en detalle con referencia a las figuras de los dibujos en las que numeros de referencia parecidos identifican similares
o identicos elementos. Como se usa aqui dentro y como es tradicional, el termino "distal" se referira a aquella parte que esta mas lejos del usuario mientras que el termino "proximal" se referira a aquella parte que esta mas cercana al usuario.
De acuerdo con la presente revelaci6n, se usa un sistema microelectromecanico (MEMS) para proporcionar dispositivos y/o sistemas MEMS altamente miniaturizados capaces de realizar varias funciones, por ejemplo, detectar, monitorizar, controlar, influir, regular y/o medir varias condiciones y/o parametros de instrumentos y sistemas quirurgicos, tales como, por ejemplo, la distancia entre y/o la presi6n aplicada por las mordazas de un util final. En la presente revelaci6n, por "controlar" se entiende incluir, influir y/o regular. Los dispositivos y/o sistemas MEMS tambien pueden proporcionar realimentaci6n para el control automatico (remoto o manual) de la operaci6n del instrumento quirurgico.
Los dispositivos MEMS tienen el tamafo muy pequefo requerido, los requisitos de baja potencia, y la capacidad de ser integrados facilmente con los sistemas electricos estandar. Estas caracteristicas hacen de los dispositivos MEMS ideales para la incorporaci6n dentro y/o en instrumentos y sistemas quirurgicos. Como se describira en mas detalle mas adelante, los dispositivos MEMS se pueden utilizar en conjunto con, e incorporar dentro y/o en varias partes y elementos estructurales de instrumentos y sistemas quirurgicos.
Los dispositivos y/o sistemas MEMS considerados que estan dentro del alcance de la presente revelaci6n, incluyen, por ejemplo, los sensores y/o dispositivos sensores MEMS, dispositivos MEMS de actuador (motores, hidraulica, bombas, dispositivos ultras6nicos, etc.), componentes de movimiento y mezcla de fluidos, calentadores, y dispositivos MEMS de diagn6stico para medir parametros fisiol6gicos y propiedades del tejido, tales como la integridad de una linea de grapas o de un tejido reparado o unido mediante la medici6n del fluido, por ejemplo, el flujo y/o presencia de sangre, y las sefales electricas o presi6n dentro del tejido grapado.
Tambien considerados dentro del alcance de esta revelaci6n estan: los tipos de dispositivos y/o sistemas MEMS usados para determinar y/o medir la distancia incluyendo los sensores capacitivos, magneticos(sensores de Efecto Hall, para medir la intensidad del campo magnetico dentro de uno o mas imanes), de emisi6n/recepci6n de luz o radiofrecuencia (RF), e interferometricos de fibra 6ptica; los tipos de dispositivos y/o sistemas MEMS usados para determinar y/o medir la cantidad de presi6n aplicada al tejido incluyendo los sensores capacitivos, piezoelectricos, piezorresistivos, resonantes, de emisi6n/recepci6n de luz o RF, e interferometricos de fibra 6ptica; y los tipos de dispositivos y/o sistemas MEMS usados para determinar y/o medir el espesor del tejido, y para determinar o medir la
presi6n y/o proporcionar los datos de presi6n a un procesador que correlaciona los datos de presi6n con el espesor del tejido usando una tabla de busqueda u otra estructura de datos. Conociendo el espesor del tejido, el cirujano entonces puede determinar el tamafo adecuado de las grapas y/o el hueco del tejido entre las superficies de contacto del tejido del yunque y el cartucho de grapas antes de realizar el procedimiento de grapado.
Mientras que los dispositivos y/o sistemas MEMS son preferentes, esta dentro del alcance de la presente revelaci6n y previsto que otros tipos de dispositivos y/o sistemas se puedan usar con o sin dispositivos y/o sistemas MEMS para determinar y/o medir varias condiciones y/o parametros.
En una configuraci6n preferente, el instrumento quirurgico puede incluir uno o mas dispositivos y/o sistemas de entrega MEMS transductores capaces de ser alimentados por una bateria para generar RF u otros tipos de sefales. Estos dispositivos de entrega MEMS transductores estan alineados con los dispositivos de recepci6n MEMS transductores capaces de recibir las sefales generadas. Por consiguiente, la distancia entre los dispositivos de entrega y recepci6n MEMS transductores se puede medir por un procesador que correlaciona el tiempo de transmisi6n de las sefales de RF generadas con la distancia usando una estructura de datos. Conociendo la distancia, el procesador puede calcular entonces el espesor del tejido sujeto por el instrumento quirurgico.
Ademas, cuando los dispositivos de entrega y/o recepci6n MEMS transductores presionan en el tejido sujeto por el instrumento quirurgico, la presi6n del tejido se aplica a los dispositivos y/o sistemas de entrega y/o recepci6n MEMS transductores. Los dispositivos y/o sistemas de entrega y/o recepci6n MEMS transductores a su vez determinan la presi6n aplicada y las sefales de salida.
Alternativamente, uno o mas componentes de entrega y/o recepci6n MEMS transductores, capaces de generar y recibir sefales reflejadas fuera de un objetivo, se pueden proporcionar en el yunque y/o el cartucho de grapas para determinar la distancia entre las superficies de contacto del tejido del yunque y el cartucho de grapas para determinar si el cartucho de grapas se deberia disparar.
Preferentemente, la circuiteria de los dispositivos y/o sistemas MEMS amplifica las sefales, antes de ser transmitidas a los componentes electricos estandar o al procesador, para analisis usando algoritmos convencionales implementados como un conjunto de instrucciones programables. El procesador analiza la lectura para determinar si la lectura esta dentro de los limites deseados para el instrumento quirurgico y/o la aplicaci6n de corriente. El procesador puede usar al menos uno o mas comparadores para comparar el valor de la lectura determinada con los valores almacenados, predeterminados.
Si la lectura determinada esta dentro de los limites deseados para el instrumento quirurgico, entonces el instrumento quirurgico se puede disparar como es usual. No obstante, si la lectura esta fuera de los limites deseados, el instrumento quirurgico y/o el operador puede: (1) impedir el disparo del instrumento quirurgico hasta que la lectura este dentro de los limites deseados; (2) ajustar los componentes del instrumento quirurgico para alterar la lectura segun se necesite; (3) alertar al operador; y/o (4) esperar unos pocos momentos y luego tomar la lectura de nuevo.
Ademas, las lecturas medidas recibidas desde los dispositivos y/o sistemas MEMS tambien se pueden usar para controlar el disparo del instrumento quirurgico. Por ejemplo, si el espesor del tejido es grande, el disparo del instrumento quirurgico se puede ajustar automaticamente o manualmente para que el instrumento quirurgico sea disparado con suficiente potencia para afectar todo el tejido. La lectura del espesor del tejido tambien se puede usar por un cirujano para determinar si la potencia aplicada por el instrumento quirurgico es lo bastante grande para penetrar y afectar todo el tejido.
Los dispositivos y/o sistemas MEMS se situan preferentemente en posiciones opuestas o yuxtapuestas cuando se usan para medir y/o determinar distancias. Los dispositivos MEMS tambien se situan preferentemente en las superficies de contacto del tejido del instrumento quirurgico para medir y/o determinar una distancia entre las superficies de contacto del tejido del instrumento quirurgico segun uno o mas componentes estructurales del instrumento quirurgico se mueve/n uno en relaci6n con el otro. Ademas se preve que los dispositivos y/o sistemas MEMS sean capaces de medir y/o determinar un espesor del tejido sujeto entre las superficies de contacto del tejido del instrumento quirurgico.
Otros tipos de dispositivos y/o sistemas MEMS que se pueden usar dentro del alcance de la presente revelaci6n incluyen sensores de tensi6n, 6pticos, de flujo, electroquimicos y biosensores. Los sensores 6pticos para fluorescencia y absorci6n para determinar, por ejemplo, la presencia de glucosa en sangre, y por lo tanto, la presencia de sangre, requieren conexiones de fibra 6ptica a los fotodetectores y/o tubos fotomultiplicadores que pueden o pueden no estar miniaturizados. Los biosensores se pueden usar para medir las caracteristicas del tejido antes y/o despues del procedimiento de grapado. Es decir, los biosensores se pueden usar para asegurar que el tejido esta en condiciones o es aceptable para el grapado, o segun una comprobaci6n despues de que las grapas se han disparado para asegurar que el tejido esta saludable (es decir, tiene buen flujo de sangre, esta cicatrizando adecuadamente, etc.).
Volviendo ahora a las FIG. 1-4, se muestran realizaciones especificas de varias grapadoras medicas representativas que incluyen dispositivos MEMS "M", de acuerdo con la presente revelaci6n. Como se ve en la FIG. 1, una primera realizaci6n de una grapadora medica, aqui, una grapadora anastom6tica transversal, de acuerdo con la presente revelaci6n, se muestra de manera general como 100. La grapadora quirurgica 100 incluye una carcasa 112 que incluye un mango estacionario 114, una parte de cuerpo de extensi6n de manera distal 116 conectada operativamente con la carcasa 112, una parte del cuerpo transversal 115 conectada operativamente con la parte del cuerpo de extensi6n de manera distal 116. La parte del cuerpo transversal 115 se configura y adapta para recibir operativamente un bastidor de soporte 118 en un extremo distal de la misma
La grapadora quirurgica 100 incluye ademas un yunque 120 fijado a una primera pata 124 o parte distal del bastidor de soporte 118 y que se extiende transversalmente a traves de la parte del cuerpo transversal 115. La grapadora quirurgica 100 ademas incluye un conjunto de cartucho de grapas 122 recibido operativamente dentro del parte del cuerpo transversal 115. Cada uno del yunque 120 y el conjunto de cartucho de grapas 122 incluyen superficies de contacto del tejido yuxtapuestas 120a, 122a, respectivamente. Un actuador de desencadenamiento 134 esta conectado operativamente con el mango 114 y esta configurado y adaptado para avanzar distalmente el conjunto de cartucho de grapas 122 hacia el yunque 120 para disparar la grapadora quirurgica 100.
De acuerdo con la presente revelaci6n, la grapadora quirurgica 100 incluye una pluralidad de dispositivos MEMS "M" proporcionados en ubicaciones especificas de la misma. En particular, a modo de ejemplo solamente y no de manera que sea considerada como limitante, como se ve en la FIG. 1, los dispositivos MEMS "M" se pueden proporcionar preferentemente a lo largo de la longitud de la superficie de contacto del tejido 120a del yunque 120, a lo largo de la superficie de contacto del tejido 122a del conjunto de cartucho de grapas 122 y/o en el conjunto de cartucho de grapas 122 y la parte del cuerpo transversal 115.
Como se describi6 anteriormente, los dispositivos MEMS "M" permiten, por ejemplo, la medici6n de varios parametros de la grapadora quirurgica 100, tales como, por ejemplo, la distancia entre las superficies de contacto del tejido 120a y 122a de la grapadora quirurgica 100, asi como la cantidad de presi6n aplicada al tejido sujeto entre las superficies de contacto del tejido 120a, 122a. Se preve ademas que los dispositivos MEMS "M" son capaces de medir y/o determinar un espesor del tejido sujeto entre las superficies de contacto del tejido 120a, 122a.
Se preve que los dispositivos MEMS "M" puedan transmitir sefales de los parametros medidos y/o detectados a una unidad central de proceso "CPU" (por ejemplo, la caja de control 562 de la FIG. 6) o conjunto de actuaci6n 612 (ver la FIG. 7), a traves de conductores de hilo 560 (ver la FIG. 6) o hilos de transmisi6n "W" (ver la FIG. 7), para procesamiento adicional. Alternativamente, se contempla que los dispositivos MEMS "M" pueden transmitir sefales de realimentaci6n de los parametros medidos y/o detectados a la CPU a traves de transmisiones inalambricas.
Se hace referencia a la Patente de U.S. N° 5.964.394, para una explicaci6n mas detallada del funcionamiento de la grapadora quirurgica 100
Volviendo ahora a la FIG. 2, una realizaci6n alternativa de una grapadora quirurgica, aqui, una grapadora anastom6tica gastrointestinal abierta, de acuerdo con la presente revelaci6n, se muestra de manera general como
200. La grapadora quirurgica 200 incluye una semisecci6n de recepci6n del cartucho 212, una semisecci6n de yunque 214 acoplable operativamente a la semisecci6n de recepci6n del cartucho 212, un conjunto de cartucho de grapas 216 configurado y adaptado para ser montado de manera desmontable dentro de un extremo distal de la semisecci6n de recepci6n del cartucho 212, y un yunque 218 montado operativamente a un extremo distal de la semisecci6n de yunque 214. El conjunto de cartucho de grapas 216 incluye una superficie de contacto del tejido 216a y el yunque incluye una superficie de contacto del tejido 218a yuxtapuesta a la superficie de contacto del tejido 216a del conjunto de cartucho de grapas 216.
De acuerdo con la presente revelaci6n, la grapadora quirurgica 200 incluye una pluralidad de dispositivos MEMS "M" proporcionados en ubicaciones especificas de la misma. En particular, a modo de ejemplo solamente y no en forma que vaya a ser considerada como limitante, como se ve en la FIG. 2, los dispositivos MEMS "M" se pueden proporcionar preferentemente a lo largo de la longitud de o como se muestra, en ubicaciones especificas en la superficie de contacto del tejido 218a del yunque 218, a lo largo de la longitud de la superficie de contacto del tejido 216a del conjunto de cartucho de grapas 216, en las partes del extremo distal de la semisecci6n de recepci6n del cartucho 212 y la semisecci6n del yunque 214.
Como se describi6 anteriormente, los dispositivos MEMS "M" permiten la medici6n de varios parametros de la grapadora quirurgica 200, tales como, por ejemplo, la distancia entre las superficies de contacto del tejido 216a y 218a de la grapadora quirurgica 200, asi como la cantidad de presi6n aplicada al tejido sujeto entre las superficies de contacto del tejido 216a, 218a de la grapadora quirurgica 200.
Se hace referencia a la Patente U.S. N° 6.045.560, la Patente U.S. N° 6.032.849, y la Patente U.S. N° 5.964.394, para una explicaci6n mas detallada del funcionamiento de la grapadora quirurgica 200.
Volviendo ahora a las FIG. 3 y 3A, aun otra realizaci6n de una grapadora quirurgica, aqui, una grapadora anastom6tica gastrointestinal endosc6pica, de acuerdo con la presente revelaci6n, se muestra de manera general como 300. Brevemente, la grapadora quirurgica 300 incluye un conjunto de mango 312 y un cuerpo alargado 314. Una unidad de carga desechable o DLU 316 se asegura de manera liberable a un extremo distal del cuerpo alargado
314. La unidad de carga desechable 316 incluye un util final 317 que tiene un conjunto de cartucho de grapas 318 alojando una pluralidad de grapas quirurgicas (no se muestran) y un yunque 320 asegurado de manera m6vil en relaci6n con el conjunto de cartucho de grapas 318. El conjunto de cartucho de grapas 318 incluye una superficie de contacto del tejido 318a y el yunque 320 incluye una superficie de contacto del tejido 320a yuxtapuesta a la superficie de contacto del tejido 318a del conjunto de cartucho de grapas 318.
El conjunto del mango 312 incluye un miembro de mango estacionario 322, un conjunto de mango m6vil 324 y una parte de tambor 326. Un miembro giratorio 328 se monta preferentemente en el extremo de delante de la parte del tambor 325 para facilitar la rotaci6n del cuerpo alargado 314 con respecto al conjunto de mango 312. Una palanca de articulaci6n 330 tambien se monta preferentemente en el extremo delantero de la parte del tambor 326 adyacente al mando giratorio 328 para facilitar la articulaci6n del util final 317.
De acuerdo con la presente revelaci6n, la grapadora quirurgica 300 incluye una pluralidad de dispositivos MEMS "M" proporcionados en ubicaciones especificas de la misma. En particular, a modo de ejemplo solamente y no en forma que vaya a ser considerada como limitante, como se ve en las FIG. 3 y 3A, los dispositivos MEMS "M" se pueden proporcionar preferentemente a lo largo de la longitud de la superficie de contacto del tejido 320a del yunque 320, a lo largo de la longitud de la superficie de contacto del tejido 318a del conjunto de cartucho de grapas 318, en la unidad de carga desechable 316, en el cuerpo alargado 314 y/o en el conjunto del mango 312.
Como se describi6 anteriormente, los dispositivos MEMS "M" permiten la medici6n de varios parametros de la grapadora quirurgica 300, tales como, por ejemplo, la distancia entre las superficies de contacto del tejido 318a y 320a de la grapadora quirurgica 300, asi como la cantidad de presi6n aplicada al tejido sujeto entre las superficies de contacto del tejido 318a y 320a de la grapadora quirurgica 300.
En otra configuraci6n preferente, como se muestra en las FIG. 3 y 3A, los dispositivos MEMS "M" se situan en la proximidad de un punto de giro del yunque 320 y el conjunto de cartucho de grapas 318 de la grapadora quirurgica
300. Otros dispositivos MEMS "M" se situan remotamente del punto de giro. Se preve que los dispositivos MEMS "M" situados en el yunque 320 y el conjunto de cartucho de grapas 318 pueden ser del tipo capaz de emitir luz desde diodos laser o desde una guia ondas de fibra 6ptica. En particular, un dispositivo MEMS en forma de un sensor/dispositivo de producci6n de luz MEMS (por ejemplo, bicelda o fotodiodo) se situa opuesto a un dispositivo MEMS anteriormente mencionado para detectar cambios en la cantidad de luz que se recibe como resultado del angulo cambiante de rotaci6n entre el yunque 320 y el cartucho de grapas 318.
En consecuencia, en uso, si la cantidad de luz que se recibe es alta, un dispositivo de producci6n de luz MEMS y su dispositivo de detecci6n de luz MEMS correspondiente estan cerca el uno del otro. Por consiguiente, la distancia entre el yunque 320 y el conjunto de cartucho de grapas 318 es pequefa, y, si hay algun tejido sujeto entre el yunque 320 y el conjunto de cartucho de grapas 318, el espesor del tejido es tambien pequefo. Si la cantidad de luz que se recibe es baja, el dispositivo de producci6n de luz MEMS y su correspondiente dispositivo de detecci6n de luz MEMS estan mas lejos el uno del otro. Por consiguiente, la distancia entre el yunque 320 y el conjunto de cartucho de grapas 318 es grande, y, si hay algun tejido sujeto entre el yunque 320 y el conjunto de cartucho de grapas 318, el espesor del tejido es tambien grande.
La distancia y el espesor del tejido tambien se pueden determinar midiendo la duraci6n hasta que el dispositivo de detecci6n de luz MEMS detecta luz una vez que el dispositivo de producci6n de luz MEMS se enciende. Si el dispositivo de detecci6n de luz MEMS detecta luz, por ejemplo, en el tiempo t0 despues de que se enciende el dispositivo de producci6n de luz MEMS, entonces el yunque 320 y el conjunto de cartucho de grapas 318 estan en cercana proximidad o tocandose (espesor de tejido pequefo). Si el dispositivo de detecci6n de luz MEMS detecta luz, por ejemplo, en el momento t0 � t1 despues de que se enciende el dispositivo de producci6n de luz MEMS, entonces el yunque 320 y el conjunto de cartucho de grapas 318 estan a una distancia predeterminada el uno del otro. Tambien, si hay algun tejido sujeto entre el yunque 320 y el conjunto de cartucho de grapas 318, entonces el espesor del tejido es un espesor de tejido predeterminado. La distancia y el espesor del tejido predeterminados se pueden determinar mediante un procesador que accede a una o mas tablas de busqueda u otras estructuras de datos y correlacionando el tiempo medido con la distancia y, entonces correlacionando la distancia con el espesor del tejido.
Se hace referencia a las Patentes de U.S. N° 5.865.361, 6.330.965, y 6.241.139 para una explicaci6n mas detallada del funcionamiento de la grapadora quirurgica 300.
Volviendo ahora a la FIG. 4, una realizaci6n alternativa de una grapadora quirurgica, de acuerdo con la presente revelaci6n, se muestra de manera general como 400. Brevemente, la grapadora quirurgica 400 incluye un conjunto del mango 412 que tiene al menos un miembro de mango de actuaci6n giratoria 414 y un miembro de avance 416
configurados para abrir y cerrar la grapadora quirurgica 400. La grapadora quirurgica 400 ademas incluye una parte de cuerpo tubular 420 que se extiende desde el conjunto de mango 412, un conjunto de cartucho de grapas anular 422 conectado operativamente con un extremo distal de la parte del cuerpo tubular 420, y un yunque anular 426 situado opuesto al conjunto de cartucho de grapas 422 y conectado a la grapadora quirurgica 400 mediante un eje
428. El conjunto de cartucho de grapas 422 incluye una superficie de contacto del tejido 422a y el yunque 426 incluye una superficie de contacto del tejido 426a en yuxtaposici6n en relaci6n con la superficie de contacto del tejido 422a del conjunto de cartucho de grapas 422.
De acuerdo con la presente revelaci6n, la grapadora quirurgica 400 incluye una pluralidad de dispositivos MEMS "M" proporcionados en ubicaciones especificas de la misma. En particular, a modo de ejemplo solamente y no en forma que vaya a ser considerada limitante, como se ve en la FIG. 4, al menos un dispositivo MEMS "M" se puede proporcionar preferentemente en la superficie de contacto del tejido 426a del yunque 426, la superficie de contacto del tejido 422a del conjunto de cartucho de grapas 422, en el eje 428 y/o en el conjunto del mango 412.
Como se describi6 anteriormente, los dispositivos MEMS "M" permiten la medici6n de varios parametros de la grapadora quirurgica 400, tales como, por ejemplo, la distancia entre las superficies de contacto del tejido 422a y 426a de la grapadora quirurgica 400, asi como la cantidad de presi6n aplicada al tejido sujeto entre las superficies de contacto del tejido 422a, 426a de la grapadora quirurgica 400.
Se hace referencia a la Patente U.S. N° 5.915.616, para una explicaci6n mas detallada del funcionamiento de la grapadora quirurgica 400.
Mientras que los dispositivos MEMS para determinar la distancia y/o presi6n se muestran situados en ciertas posiciones discretas en los elementos estructurales de las grapadoras quirurgicas mostradas en las FIG. 1-4, esta dentro del alcance de la presente revelaci6n que los dispositivos MEMS para determinar la distancia y/o presi6n se pueden situar en cualquier sitio en los elementos estructurales de las grapadoras quirurgicas.
En las FIG. 1-4, los dispositivos MEMS "M" se situan meramente en posiciones representativas y no se pretende que sean indicativas de las unicas posiciones donde los dispositivos MEMS "M" se pueden proporcionar o el numero de dispositivos MEMS "M" que se pueden proporcionar. Se preve que un componente de soporte del cartucho de grapas de la grapadora quirurgica, que incluye un cartucho de grapas, se puede alejar automaticamente o manualmente de un yunque si la presi6n aplicada al tejido sujeto esta por encima de un umbral predeterminado. La grapadora quirurgica tambien se puede impedir automaticamente o manualmente que sea disparada en respuesta a la realimentaci6n proporcionada por los dispositivos MEMS "M". La realimentaci6n proporcionada por los dispositivos MEMS "M" podria ser en forma de sefales de realimentaci6n (por ejemplo, audio, visual y/o audiovisual), y/o en forma de realimentaci6n mecanica (por ejemplo, una indicaci6n tactil).
Las grapadoras quirurgicas reveladas aqui dentro se pueden ajustar con grapas quirurgicas de diferentes tamafos (es decir, grapas que tienen patas de longitud que varia) y se pueden adaptar para seleccionar automaticamente las grapas dimensionadas adecuadas para realizar un o el procedimiento quirurgico particular de acuerdo con la informaci6n obtenida por los dispositivos MEMS "M".
Volviendo ahora a las FIG. 5 y 5A, en las que numeros de referencia parecidos identifican elementos similares o identicos, un instrumento quirurgico para situar presillas en procedimientos laparosc6picos o endosc6picos que emplean los nuevos rasgos de la presente revelaci6n se designa de manera general con el numero de referencia
450.
Como se ve en la FIG. 5, el instrumento quirurgico 450 incluye una parte de mango 452 que tiene un mango que gira
o se mueve 454 y el mango estacionario 456. La manipulaci6n de los mangos 454, 456 acciona un conjunto de herramienta, tal como un conjunto de mordaza 458, a traves de un cuerpo alargado 460 que se extiende de manera distal desde la parte del mango 452. El cuerpo alargado 460 es preferentemente giratorio con respecto a la parte del mango 452 girando un mando 459. El conjunto de la mordaza 458 incluye las primera y segunda partes de mordaza yuxtapuestas 462a, 462b, respectivamente, que son m6viles simultaneamente entre una posici6n considerablemente aproximada, en la cual las partes de la mordaza 462a y 462b estan en relaci6n relativamente cercana la una con la otra, y una posici6n separada, en la cual las partes de la mordaza 462a y 462b estan separadas al menos una distancia suficiente para recibir una presilla quirurgica sin forma 464 (ver la FIG. 5A) entre medias.
Se preve que una pluralidad de presillas quirurgicas 464 esten almacenadas en una unidad de carga 466 que se monta de manera liberable al cuerpo alargado 460. En una realizaci6n preferente, la unidad de carga 466 es desechable (es decir, en forma de una unidad de carga desechable o "DLU") posteriormente al agotamiento del suministro de presillas quirurgicas 464 almacenadas alli dentro. El resto del instrumento quirurgico 450 se puede desmontar, volver a esterilizar y reutilizar en combinaci6n con otra unidad de carga que contiene un suministro de presillas quirurgicas 464.
En uso, la aproximaci6n del mango m6vil 454 hacia el mango estacionario 456 provoca el avance de una presilla
quirurgica mas distal 464 a una posici6n entre las partes de la mordaza 462a y 462b. La aproximaci6n adicional de los mangos 454, 456 uno hacia el otro provoca la aproximaci6n de las partes de la mordaza 462a y 462b una hacia la otra para formar la presilla quirurgica dispuesta entre medias.
De acuerdo con la presente revelaci6n, el instrumento quirurgico 450 incluye una pluralidad de dispositivos MEMS "M" proporcionados en ubicaciones especificas del mismo. En particular, a modo de ejemplo solamente y no en forma que vaya a ser considerada limitante, como se ve en las FIG. 5 y 5A, al menos un dispositivo MEMS "M" se puede proporcionar preferentemente en la superficie de contacto del tejido de al menos una, preferentemente cada, parte de la mordaza 462a, 462b del conjunto de la mordaza 458, en la unidad de carga 466 y/o el cuerpo alargado 460, y/o la parte del mango 452.
Como se describi6 anteriormente, los dispositivos MEMS "M" permiten la medici6n de varios parametros del instrumento quirurgico 450, tales como, por ejemplo, la distancia entre las superficies de contacto del tejido de las partes de la mordaza 462a, 462b, asi como la cantidad de presi6n aplicada al tejido sujeto entre las partes de la mordaza 462a, 462b. Se preve ademas que los dispositivos MEMS "M" sean capaces de medir y/o determinar un espesor del tejido sujeto entre las superficies de contacto del tejido de las partes de mordaza 462a, 462b.
Se hace referencia a la Patente de U.S. N° 6.059.799, para una explicaci6n mas detallada del funcionamiento de la grapadora quirurgica 450.
Volviendo ahora a las FIG. 6 y 6A, en las que numeros de referencia parecidos identifican elementos similares o identicos, un instrumento quirurgico que emplea los nuevos rasgos de la presente revelaci6n se designa de manera general con el numero de referencia 500.
Como se ve en la FIG. 6, el instrumento quirurgico 500 incluye una carcasa 521 que tiene una parte de mango fija 514, una parte de mango m6vil 516, un eje alargado 518 que se extiende de manera distal desde la carcasa 512, y un mecanismo de mordaza 522 acoplado operativamente a un extremo distal del eje 518. Como se ve en detalle en la FIG. 6A, el mecanismo de mordaza 522 incluye un par de miembros de mordaza 580, 582 que son giratorios alrededor de un perno 519 para proporcionar la apertura y cierre del mecanismo de la mordaza 522. El instrumento quirurgico 500 esta configurado y adaptado de manera que, en funcionamiento, la manipulaci6n de la parte del mango m6vil 516, distalmente y proximalmente, en relaci6n con la parte del mango fija 514, provoca a los miembros de la mordaza 580, 582 del mecanismo de mordaza 522 abrir y cerrar. Los miembros de la mordaza 580, 582 se muestran como que estan configurados y adaptados para realizar la funci6n electroquirurgica, tal como, por ejemplo, coagulaci6n, cauterizaci6n y similares.
El mecanismo de mordaza 522 se puede configurar para agarrar, grapar, cortar, retraer, coagular y/o cauterizar. Los ejemplos anteriores se pretende que sean meramente ilustrativos de unas pocas de las muchas funciones que se puede configurar el mecanismo de mordaza 522 para consumar y de ninguna manera se pretende que sea un listado exhaustivo de todas las mordazas posibles o similares o las estructuras giratorias.
Como se muestra ademas en la FIG. 6A, el mecanismo de mordaza 522 se dota con una pluralidad de dispositivos microelectroquirurgicos (MEMS) "M" situados en ubicaciones deseadas especificas sobre, en o a lo largo de las superficies de los miembros de la mordaza 580, 582. Por ejemplo, los dispositivos MEMS "M" se pueden situar cerca de un extremo proximal y/o cerca de un extremo distal de los miembros de la mordaza 580, 582, asi como a lo largo de la longitud de los miembros de la mordaza 580, 582.
En una realizaci6n preferente de la presente revelaci6n, los dispositivos MEMS "M" ofrecen una soluci6n para controlar la cantidad de energia entregada, por radiofrecuencia (por ejemplo, monopolar o bipolar), ultras6nica, laser, de haz de arg6n u otros sistemas de energia adecuados, al tejido durante el tratamiento con instrumentos electroquirurgicos basados en energia, por ejemplo, instrumentos quirurgicos de electrocauterizaci6n. En los instrumentos quirurgicos de electrocauterizaci6n el grado de corte, coagulaci6n y dafo del tejido esta influido por el ajuste de la potencia, la fuerza aplicada por el mecanismo de mordaza del instrumento quirurgico de electrocauterizaci6n al tejido, la duraci6n del contacto entre el mecanismo de mordaza del instrumento quirurgico de electrocauterizaci6n y el tejido, asi como otros factores.
Por consiguiente, se contempla que los dispositivos MEMS "M" de detecci6n de energia, capaces de medir y/o detectar energia, sean usados para monitorizar, controlar, medir y/o regular la cantidad de energia entregada por el instrumento quirurgico 500 al tejido. Los dispositivos MEMS "M" de detecci6n de energia pueden proporcionar realimentaci6n a la electr6nica dentro del instrumento de electrocauterizaci6n, por ejemplo, para crear un efecto del tejido deseado mas consistente. En particular, se preve que los dispositivos MEMS "M" esten configurados y adaptados para ser dispositivos MEMS de detecci6n de fuerza y/o presi6n de manera que una presi6n o una fuerza de agarre aplicada al tejido por los miembros de la mordaza 580, 582 se pueda detectar y regular.
Se preve ademas que los dispositivos MEMS "M" se puedan configurar y adaptar para medir temperatura sobre o cerca de una hoja activa (no se muestra) del instrumento quirurgico 500 (es decir, un instrumento de
electrocauterizaci6n, lapiz electroquirurgico, etc.). Estos dispositivos MEMS "M" de detecci6n de temperatura se pueden usar para monitorizar y controlar la temperatura de la hoja activa del instrumento de electrocauterizaci6n, de manera que la hoja activa sea capaz de alcanzar y mantener una temperatura especifica, por ejemplo, teniendo rafagas intermitentes de energia suministradas a la hoja activa o controlando la potencia o energia entregada a la hoja activa siempre que la temperatura de la hoja activa caiga por debajo de un cierto nivel umbral.
En una realizaci6n, se preve que estos dispositivos MEMS de detecci6n de temperatura "M" se puedan termopares situados directamente en una sonda o un instrumento y aislados electricamente y termicamente del mismo para la detecci6n y/o medici6n de la temperatura del tejido situado adyacente a los mismos. Se contempla ademas que, debido a su tamafo y sensibilidades relativamente mas pequefos, los dispositivos MEMS de detecci6n de temperatura "M" se pueden situar y/o encapsular en puntas o elementos conductivos termicamente que podrian ser hilos semirrigidos o hilos hechos de metales con memoria de forma para una aplicaci6n particular que se podria extender fuera de la sonda y en el tejido colindante a una sonda de tratamiento para monitorizar la temperatura del tejido colindante a la sonda de tratamiento.
Se contempla ademas que los dispositivos MEMS "M" seleccionados esten configurados y adaptados para ser dispositivos MEMS de detecci6n de corriente para regular y monitorizar la corriente electrica entregada a la hoja activa y a traves del tejido. Se preve que el flujo o cantidad de corriente se podria regular para detenerse despues de la entrega de una cantidad de energia o despues de alcanzar un valor de corriente especifico.
Ademas, se contempla que los dispositivos MEMS "M" seleccionados se configuren y adapten para controlar el tratamiento de energia detectando la distancia entre elementos m6viles, tales como, por ejemplo, mordazas que tienen electrodos, para mantener las mordazas a una distancia 6ptima para uno o mas aspectos de una aplicaci6n de tratamiento dada. Por ejemplo, los dispositivos MEMS "M" de detecci6n de distancia se pueden emplear para usar haces de luz emitida desde diodos laser y/o guiada a traves de fibra 6ptica en conjunto con un dispositivo de detecci6n, tal como, por ejemplo, una bicelda o un fotodiodo situado directamente en la punta de la sonda o en una ubicaci6n remota adecuada para medir la distancia relativa entre las partes de las mordazas.
En una realizaci6n alternativa de la presente revelaci6n, se preve que los dispositivos MEMS "M" esten configurados y adaptados para ser dispositivos MEMS aceler6metros "M", cuyos aceler6metros detectan frecuencias mediante el desplazamiento de un elemento con voladizo o sintonizado asociado con los dispositivos MEMS "M". En consecuencia, cuando el instrumento quirurgico es un instrumento quirurgico basado en energia, por ejemplo, del tipo de corte o coagulaci6n (por ejemplo, el instrumento electroquirurgico) el cual incluye un mecanismo de mordaza 522 como se describi6 anteriormente, los dispositivos MEMS "M" que emplean sensores adecuados se pueden emplear para medir la aceleraci6n y el desplazamiento de los miembros dela mordaza 580, 582 uno en relaci6n con el otro. En consecuencia, los dispositivos MEMS aceler6metros "M" se pueden situar en componentes individuales, tales como, por ejemplo, cada mordaza 580, 582, para medir su aceleraci6n relativa, en el instrumento quirurgico 500 total o en una hoja fija que realiza las funciones de coagulaci6n y corte, tal como, por ejemplo, un lapiz electroquirurgico para medir la aceleraci6n de los instrumentos en conjunto, o una combinaci6n de los mismos.
Cuando los dispositivos MEMS aceler6metros "M" se emplean e integran adecuadamente como dos o tres conjuntos ortogonales, constituyen de manera efectiva un dispositivo de medici6n de aceleraci6n bidimensional o tridimensional o dispositivo de tipo giroscopio cuando se dota con un punto conocido de origen y un sistema informatico configurado adecuadamente. En esta realizaci6n, los dispositivos MEMS "M" se pueden emplear ventajosamente como un sistema pasivo para hacer el seguimiento de la distancia entre las mordazas, la posici6n del instrumento en relaci6n con la parte del tejido objetivo y la duraci6n del tratamiento.
Una aplicaci6n adicional para los dispositivos MEMS "M" en instrumentos quirurgicos tales como dispositivos de corte o coagulaci6n electroquirurgicos incluye la detecci6n de par. Se contempla que los dispositivos MEMS de detecci6n de par "M" seleccionados se pueden situar adecuadamente en cada miembro de la mordaza 580, 582, en el mecanismo de mordaza 522 o en una combinaci6n de ambos. Los dispositivos MEMS de detecci6n de par "M" se pueden configurar para emplear sensores de tensi6n o sistemas de medici6n 6ptica, por ejemplo. Se preve que, los dispositivos MEMS de detecci6n de par "M" se puedan configurar para detectar la desviaci6n en diferentes puntos a lo largo del elemento o mango del instrumento uno en relaci6n con el otro. En consecuencia, la desviaci6n de las partes del instrumento quirurgico, en puntos y angulos de aplicaci6n predeterminados de los dispositivos MEMS de detecci6n de par "M", podria ser igualada con una fuerza o par aplicado. Los sensores de tensi6n o estructura de guia ondas de fibra 6ptica o integrada en conjunto con un sistema de detecci6n se podria usar para detectar, medir y controlar el grado de fuerza aplicada a o ejercida por componentes mediante la monitorizaci6n de los cambios relativos en la distancia o desviaci6n de las partes del instrumento.
Preferentemente, como se ve en la FIG. 6, los dispositivos MEMS "M" esta acoplados electricamente a una caja de control 562 a traves de conductores de hilo 560 que se extienden desde la carcasa 512. Se preve que los conductores de hilo 560 viajen a traves de la carcasa 512 y eje 518 a los dispositivos MEMS "M". En una realizaci6n preferente, los dispositivos MEMS "M" y la caja de control 562 estan acoplados electricamente a un circuito de
realimentaci6n (no se muestra). El circuito de realimentaci6n monitorizaria continuamente y transmitiria las sefales y parametros entre los dispositivos MEMS "M" y la caja de control 562.
Los dispositivos MEMS "M", tales como aquellos descritos anteriormente, tambien se pueden emplear individualmente o en combinaci6n con los sistemas sensores tradicionales, tales como, por ejemplo, la circuiteria de detecci6n de perdidas entre elementos del instrumento, y se pueden configurar adecuadamente para proporcionar realimentaci6n a un sistema de control electr6nico (por ejemplo, ordenador, microprocesador, controlador de l6gica programable o combinaci6n de los mismos) para hacer el seguimiento cada parametro de realimentaci6n notificado en relaci6n con los criterios predefinidos para el ajuste y control automaticos de la energia entregada por el instrumento para, por ejemplo, medir, determinar, verificar y/o controlar la efectividad del tratamiento y el rendimiento adecuado del instrumento quirurgico. El sistema de control tambien se configuraria preferentemente con l6gica para ponderar las entradas de cada parametro detectado por un dispositivo MEMS "M" y acomodar el funcionamiento manual selectivo de cualquier parametro. De esta manera, los parametros de los dispositivos MEMS "M" se pueden integrar en un sistema de visualizaci6n informatizado unico o monitorizar separadamente, por ejemplo, por el sistema de visualizaci6n o mediante sistemas de advertencia audible, visual o tactil simples. El sistema de control se podria integrar al menos parcialmente en el instrumento o un sistema separado conectado al instrumento.
A modo de ejemplo solamente, de acuerdo con la presente revelaci6n, se preve que los dispositivos MEMS "M" puedan incluir dispositivos de medici6n de presi6n (es decir, capacitivos, piezorresistivos, piezoelectricos, resonantes y/o interferometricos de fibra 6ptica, etc.), dispositivos de medici6n de tensi6n (es decir, piezorresistivos, piezoelectricos y/o de modulaci6n de frecuencia, etc.), dispositivos de medici6n de desplazamiento (es decir, capacitivos, magneticos y/o interferometricos de fibra 6ptica), 6pticos (es decir, fluorescentes, de absorci6n y/o interferometricos de fibra 6ptica), biosensores (para medir, es decir, glucosa, sondas neurales, tactiles, pH, gases en sangre) y/o inmunosensores, sensores de temperatura, sensores de par, aceler6metros, sensores de flujo y sensores electroquimicos y/o electromagneticos, y combinaciones de los anteriores.
De acuerdo con los principios de la presente revelaci6n, como se ve en las FIG. 7-12, se preve que los instrumentos quirurgicos descritos anteriormente, junto con sus dispositivos MEMS incorporados "M" respectivos se puedan emplear con o interconectar directamente con un sistema quirurgico rob6tico 600. Un sistema quirurgico rob6tico ejemplar se revela en la Patente de U.S. N° 6.231.565.
Generalmente, los sistemas quirurgicos rob6ticos incluyen instrumentos o sistemas quirurgicos, o bien alimentados localmente o bien remotamente, que tienen sistemas de control electr6nicos localizados en una consola o distribuidos dentro o a traves del instrumento o sistema quirurgico. Los sistemas de instrumento quirurgico se pueden alimentar o controlar separadamente desde el sistema rob6tico o, en alternativa, los sistemas de potencia y control se pueden integrar o interconectar con el sistema quirurgico rob6tico.
En particular, como se ve en la FIG. 7, el sistema quirurgico rob6tico 600 incluye un conjunto de actuaci6n 612, un monitor 614, un robot 616 y una unidad de carga 618 adjuntas de manera liberable al robot 616 y que tiene al menos un instrumento quirurgico 620 para realizar al menos una tarea quirurgica conectada operativamente al mismo. El robot 616 incluye un tronco 622 que se extiende desde una base 624, un hombro 626 que conecta el tronco 622 con un brazo superior 628, un codo 630 que conecta el brazo superior 628 a un brazo inferior 632, y un mufeca 634 adjunta al brazo inferior 632 desde la cual se extiende un reborde de montaje 636. Preferentemente, el reborde de montaje 636 es capaz de moverse con seis grados de libertad.
Como se usa aqui dentro, la "unidad de carga" se entiende para incluir unidades de carga desechables (por ejemplo, las DLU) y unidades de carga de uso unico (por ejemplo, las SULU). Las SULU incluyen unidades de cartucho desmontables, por ejemplo, para grapadoras de anastomosis gastrointestinal y anastomosis transversal e incluyen unidades desmontables, por ejemplo, aquellas que tienen un eje 316, un conjunto de cartucho 318 y un yunque 317 (ver, por ejemplo, la FIG. 3 presente). Estas ultimas unidades desmontables, que se pueden modificar, se conocen algunas veces como DLU (por ejemplo, ver 618 en la FIG. 7 y 718 en la FIG. 9).
La unidad de carga desechable 618 ademas incluye una parte de cabezal 640 para alojar un conjunto electromecanico (ver la FIG. 8) alli dentro para operar el instrumento quirurgico 620 y una plataforma de fijaci6n 642 para fijar de manera liberable la unidad de carga desechable 618 al robot 616 a traves del reborde de montaje 636. El reborde de montaje 636 preferentemente incluye dos ranuras 635 que inter-enganchan con las protrusiones 638 de la plataforma 642 para conectar el reborde de montaje 636 con la unidad de carga desechable 618. Se contempla ademas que una conexi6n electrica 633 (ver la FIG. 8) sea proporcionada entre las ranuras 635 y las protrusiones 638 para proporcionar alimentaci6n al conjunto electromecanico 619.
La unidad de carga desechable 618, la cual podria ser un instrumento quirurgico como se contempla aqui dentro, se puede desmontar del reborde de montaje 636 y se puede sustituir con otra de tal unidad de carga desechable, o instrumento quirurgico, para realizar un procedimiento quirurgico diferente. A modo de ejemplo solamente y no de forma que vaya a ser considerada como limitante, los instrumentos o sistemas quirurgicos potenciales que pueden interconectar con el sistema rob6tico 600 incluyen varios instrumentos de mano, por ejemplo, agarradores,
retractores, instrumentos de recuperaci6n de muestras, instrumentos endosc6picos y laparosc6picos, instrumentos electroquirurgicos, instrumentos de aplicaci6n de grapas o de cierres, instrumentos de extracci6n de muestras, instrumentos de corte, instrumentos de perforaci6n de agujeros, instrumentos de sutura y/o combinaciones de los mismos. Se preve que cada uno de estos instrumentos sea dotado con al menos uno, preferentemente una pluralidad de dispositivos MEMS "M" como se describi6 anteriormente, para proporcionar realimentaci6n al usuario. Se contempla ademas que los dispositivos MEMS "M" puedan proporcionar realimentaci6n directamente al sistema rob6tico 600 para que el sistema rob6tico 600 responda, por ejemplo, adaptar en respuesta a la realimentaci6n y/o proporcionar notificaci6n al usuario del sistema rob6tico 600. Se preve ademas que una pluralidad de sensores se pueda incorporar dentro, por ejemplo, proporcionada en un instrumento quirurgico basado en energia, cuyo instrumento quirurgico basado en energia tambien se puede interconectar con el sistema rob6tico 600. Por consiguiente, la energia proporcionada al instrumento quirurgico basado en energia se puede entregar y controlar directamente por el sistema rob6tico 600 para interfaces de usuario mejoradas y mejor integraci6n del sistema.
En funcionamiento, el usuario (por ejemplo, el cirujano, la enfermera, el tecnico, etc.) controla el conjunto de actuaci6n 612 para controlar el movimiento y operaci6n del robot 616 y la unidad de carga desechable 618. Dependiendo de la cantidad de giro de los mandos 644 en el conjunto de actuaci6n 612, el conjunto de actuaci6n 612 transmite sefales electricas al robot 616 para operar electromecanicamente las partes m6viles del robot 616, tal como girar el robot 616 alrededor del tronco vertical 622 o avanzar el reborde de montaje 636. El montaje de actuaci6n 612 puede incluir un procesador alli dentro para almacenar los comandos operacionales y para transmitir las sefales digitales al conjunto mecanico 619. El montaje de actuaci6n 612 tambien puede transmitir sefales electricas al reborde de montaje 636 en forma de sefales electricas, por ejemplo, para situar y operar la unidad de carga 618.
El conjunto de actuaci6n 612 preferentemente esta adaptado para transmitir sefales electricas a un conjunto electromecanico 619 alojado dentro de la parte del cabezal 640 de la unidad de carga 618 para accionar el conjunto electromecanico 619 el cual a su vez acciona el instrumento quirurgico 620. El conjunto electromecanico 619 incluye mecanismos para mover y operar el instrumento de herramienta quirurgica 620, tales como, por ejemplo, servomotores para oscilar arm6nicamente un bisturi de un instrumento de corte, o las barras para mover giratoriamente una aguja de sutura situada en un eje de una cubierta longitudinal de un instrumento de sutura.
Como se ve en la FIG. 8, la unidad de carga desechable 618 ademas puede incluir circuiteria integrada para recibir sefales digitales desde el conjunto de actuaci6n 612, tal como, un receptor 621 y un procesador 623. El receptor 621 y el procesador 623 estan incluidos dentro de los medios de control 625 conectados electricamente al conjunto electromecanico 619.
A modo de ejemplo solamente, como se muestra en la FIG. 9, una unidad de carga desechable 718, a continuaci6n algunas veces referida como unidad de carga 718, que incluye un util final de una grapadora quirurgica, similar al util final de la grapadora quirurgica 100 descrita anteriormente, esta conectado operativamente con el robot 616 (ver la FIG. 7) de manera que un grupo de cierres quirurgicos (por ejemplo, grapas) se puede aplicar al tejido del cuerpo. En particular, la unidad de carga 718 incluye una parte del cuerpo que se extiende distalmente 716, una parte del cuerpo transversal 715, y el bastidor de soporte 719 recibido operativamente en un extremo distal de la parte del cuerpo transversal 715. La unidad de carga 718 ademas incluye un yunque 720 y un conjunto de cartucho de grapas 722 recibido operativamente dentro de la parte del cuerpo transversal 715. Cada uno del yunque 720 y el conjunto de cartucho de grapas 722 incluye superficies de contacto del tejido yuxtapuestas 720a, 722a, respectivamente.
Se preve que la unidad de carga 718 incluye un actuador incorporado dentro de una parte de cabezal 792 para realizar el cierre rapido y el avance incremental del conjunto de cartucho de grapas 722 con respecto al yunque 720. Como se describi6 anteriormente, en relaci6n a la grapadora quirurgica 100, los dispositivos MEMS "M" se pueden proporcionar sobre el yunque 720 y el conjunto de cartucho de grapas 722 para proporcionar informaci6n de realimentaci6n al robot 616.
Ejemplos de informaci6n directa que se puede realimentar al robot 616 desde los dispositivos MEMS "M" de la unidad de carga 718 u otros dispositivos MEMS incluyen, por ejemplo, si se han disparado la grapas o, en el caso de un instrumento electroquirurgico, la cantidad de energia entregada. El dispositivo MEMS "M" tambien se puede usar para hacer mediciones indirectas del rendimiento, tales como, por ejemplo, detectar el estado de disparo de la grapa midiendo la posici6n del miembro de montaje responsable de empujar las grapas fuera del cartucho. Alternativamente, los dispositivos MEMS "M" pueden medir un miembro asociado, tal como un desplazamiento de una barra de empuje o un giro de una barra roscada para determinar si las grapas se han disparado o no. En cualquiera de los dos casos, el sistema rob6tico 600 puede aceptar la informaci6n de la unidad de carga 718 y responder en consecuencia, por ejemplo, o bien alterando el rendimiento, haciendo ajustes, notificando al usuario, modificando o deteniendo la operaci6n o bien cualquier combinaci6n de las mismas.
Se hace referencia a la Patente U.S. N° 5.964.394, para una explicaci6n mas detallada del funcionamiento y trabajo interno de los componentes del util final de la grapadora quirurgica acoplado operativamente al extremo distal de la
unidad de carga 718.
Como se ve en la FIG. 10, una unidad de carga que incluye una parte de extremo distal capaz de realizar una funci6n electroquirurgica, similar al instrumento quirurgico 500 anterior, se muestra de manera general como 800. En particular, la unidad de carga 800 incluye una parte de cabezal 802 configurada y adaptada para ser acoplada de manera desmontable al reborde de montaje 636 del robot 616, un eje alargado 818 que se extiende distalmente desde la parte del cabezal 802, y un mecanismo de mordaza 822 acoplado operativamente a un extremo distal del eje 818. El mecanismo de mordaza 822 incluye un par de miembros de la mordaza 880, 882 los cuales son giratorios alrededor de un perno 819 para proporcionar la apertura y el cierre del mecanismo de mordaza 822. Los miembros de la mordaza 880, 882 estan configurados y adaptados preferentemente para realizar una funci6n electroquirurgica, tal como, por ejemplo, coagulaci6n, cauterizaci6n y similares.
La unidad de carga 800 se dota preferentemente ademas con dispositivos MEMS "M" situados cerca de un extremo proximal, un extremo distal, aproximadamente a medio camino y/o en todo lo largo de la longitud de cada miembro de la mordaza 880, 882 para proporcionar informaci6n de realimentaci6n al robot 616. Por consiguiente, en el caso de la unidad de carga 800, los dispositivos MEMS "M" puede realimentar, al robot 616 y al conjunto de actuaci6n 612, la informaci6n con respecto, por ejemplo, a la cantidad de energia entregada, la fuerza de sujeci6n que esta siendo aplicada por los miembros de la mordaza 880, 882, la temperatura en el lugar quirurgico objetivo y similares.
Volviendo ahora a la FIG. 11, una unidad de carga que incluye un util final de aplicaci6n de presilla de vaso, para aplicar presillas quirurgicas al tejido del cuerpo, por ejemplo, para vasos de oclusi6n, se muestra de manera general como 900. La unidad de carga 900 incluye una parte de cabezal 902, una parte de cuerpo 904 que se extiende distalmente desde la parte del cabezal 902, y una pluralidad de presillas quirurgicas (no se muestran) dispuestas dentro de la parte del cuerpo 904. Un conjunto de mordaza 906 se monta adyacente a una parte del extremo distal 908 de la parte del cuerpo 904. El conjunto de mordaza 906 incluye una primera y una segunda parte de la mordaza 901a, 910b, respectivamente, las cuales son m6viles entre una posici6n separada y aproximada una en relaci6n a la otra.
Un empujador de presillas (no se muestra) se proporciona dentro de la parte del cuerpo 904 para avanzar distalmente de manera individual una presilla quirurgica mas distal al conjunto de mordaza 906 mientras que la primera y la segunda partes de la mordaza 910a, 910b estan en la posici6n separada. Un actuador 912, dispuesto dentro de la parte del cuerpo 904, se mueve longitudinalmente en respuesta a la actuaci6n del conjunto electromecanico 619 proporcionado dentro de la parte del cabezal 902. Un miembro de cierre de la mordaza 914 se situa adyacente a la primera y segunda partes de la mordaza 910a, 910b para mover las partes de la mordaza 910a, 910b a la posici6n aproximada. El actuador 912 y el miembro de cierre de la mordaza 914 definen un bloqueo entre medias para producir el movimiento simultaneo del actuador 912 y el miembro de cierre de la mordaza 914 cuando el actuador 912 esta situado adyacente a la parte del extremo distal de la parte del cuerpo 904.
Se preve que la unidad de carga 900 incluya preferentemente al menos un dispositivo MEMS "M" conectado operativamente con cada una de la primera y segunda partes de la mordaza 910a, 910b para proporcionar informaci6n de realimentaci6n al robot 616.
Se hace referencia a la Patente U.S. N° 6.059.799, para una explicaci6n mas detallada del funcionamiento y el trabajo interno de los componentes del util final de aplicaci6n de presillas de vaso de la unidad de carga 900.
Volviendo ahora a la FIG. 12, una unidad de carga que incluye un util final de aplicaci6n de sutura vascular, para suturar las secciones del tejido vascular juntas, se muestra de manera general como 950. La unidad de carga 950 incluye una parte de cabezal 952 y una parte de cuerpo 954 extendida distalmente de alli. Un par de mordazas de recepci6n de agujas 956, 958 se montan giratoriamente en un extremo distal de la parte del cuerpo 954 y se configuran para pasar repetidamente una aguja quirurgica 960 y la longitud asociada de material de sutura entre medias. La unidad de carga 950 ademas incluye la estructura de sujeci6n de la aguja (no se muestra) montada dentro de las mordazas 956 para el movimiento reciproco dentro y fuera de los huecos de sujeci6n de la aguja 962 formados en las mordazas 956, 958. Durante un procedimiento de anastomosis, la unidad de carga 950 respondera ventajosamente a los comandos de movimiento transmitidos desde el conjunto de actuaci6n para aplicar los cierres al tejido.
Se preve que la unidad de carga 950 incluya preferentemente al menos un dispositivo MEMS "M" conectado operativamente a cada una del par de mordazas de recepci6n de agujas 956, 958 para proporcionar informaci6n de realimentaci6n al robot 616. Se contempla que el dispositivo MEMS "M" pueda, por ejemplo, proporcionar informaci6n relativa a la posici6n de las mordazas 956, 958, si y en que aguja 960 de la mordaza esta dispuesta, y la fuerza que se ejerce en la aguja 960.
Se hace referencia a la Patente U.S. N° 5.478.344, para una explicaci6n mas detallada del funcionamiento y el trabajo interno de los componentes del util final de aplicaci6n de sutura vascular de la unidad de carga 950.
Una ventaja de usar dispositivos MEMS en conjunto con los sistemas rob6ticos, similares a aquellos descritos anteriormente, es que las condiciones y fuerzas detectadas por los dispositivos MEMS proporcionados en los utiles finales de las unidades de carga pueden ser sistema de realimentaci6n para los sistemas rob6ticos o transmitidos a una interfaz de usuario.
5 Los sistemas rob6ticos actuales permiten poca a ninguna informaci6n tactil para alcanzar o ser transmitida desde el paciente de vuelta a las manos del usuario (es decir, el cirujano). Por consiguiente, usando dispositivos MEMS, de acuerdo con la presente revelaci6n, en combinaci6n con un sistema de realimentaci6n y control, las condiciones y fuerzas experimentadas por el extremo distal de los utiles finales debidas a la interacci6n del util final con el tejido del paciente se pueden "sentir" y/o monitorizar por el cirujano, mejorando mucho de esta manera la informaci6n del
10 cirujano y, a su vez, la habilidad para realizar procedimientos quirurgicos.
De acuerdo con la presente revelaci6n, se contempla tener realimentaci6n de informaci6n, datos, sefales, condiciones y fuerzas, iniciadas por presi6n y/u otros parametros indicativos de la tarea quirurgica que se realiza por el util final de la unidad de carga desechable y medida y/o detectada por los dispositivos MEMS proporcionados en la unidad de carga, y para transmitir esta realimentaci6n a un sistema de control. Este sistema de control de
15 realimentaci6n permite al sistema rob6tico ser programado, antes de que se realice la tarea quirurgica, con orientaci6n, presi6n, y otros parametros que se pueden monitorizar continuamente para controlar la operaci6n y el movimiento de la unidad de carga y del util final asociado.
Aunque las realizaciones ilustrativas de la presente revelaci6n se han descrito aqui dentro, se entiende que la revelaci6n no esta limitada a esas precisas realizaciones, y que varios otros cambios y modificaciones se pueden
20 efectuar alli dentro por un experto en la tecnica sin salirse del alcance de la revelaci6n. Todos de tales cambios y modificaciones se pretende que esten incluidos dentro del alcance de la revelaci6n.

Claims (12)

  1. REIVINDICACIONES
    1. Una grapadora quirurgica (100, 200), que comprende:
    un util final (317) configurado y adaptado para enganchar tejido, el util final que incluye un conjunto de cartucho de grapas (318) y un yunque (320) asociado operativamente con el conjunto de cartucho de grapas; y
    al menos un dispositivo de sistema microelectromecanico (MEMS) ("M") conectado operativamente al util final, cada uno del conjunto de cartucho de grapas y el yunque que definen las superficies de contacto del tejido y el al menos un dispositivo MEMS que se conecta operativamente a al menos una de la superficie de contacto del tejido (318a) del conjunto de cartucho de grapas y la superficie de contacto del tejido (320a) del yunque, el dispositivo MEMS que incluye un sistema electr6nico integrado que incluye al menos un sensor para detectar la cantidad de presi6n aplicada al tejido sujeto entre el conjunto de cartucho de grapas y el yunque y una distancia entre la superficie de contacto del tejido del conjunto de cartucho de grapas y superficie de contacto del tejido del yunque, el dispositivo MEMS que ademas incluye uno o mas circuitos electr6nicos para la determinaci6n del espesor del tejido, calculando el espesor del tejido sujeto a partir de la distancia conocida.
  2. 2.
    El instrumento quirurgico de acuerdo con la reivindicaci6n 1, en el que el al menos un dispositivo MEMS incluye un transmisor inalambrico.
  3. 3.
    El instrumento quirurgico de acuerdo con la reivindicaci6n 1, en el que el al menos un dispositivo MEMS ademas incluye un sensor seleccionado del grupo que consta de un sensor de presi6n, un sensor de tensi6n, un sensor de desplazamiento, un sensor 6ptico, un biosensor, un sensor de temperatura, un sensor de par, un aceler6metro, un sensor de flujo, un sensor electrico y un sensor magnetico.
  4. 4.
    El instrumento quirurgico de acuerdo con la reivindicaci6n 1, en el que el al menos un dispositivo MEMS incluye un dispositivo de entrega y recepci6n transductor.
  5. 5.
    El instrumento quirurgico de acuerdo con la reivindicaci6n 4, en el que el al menos un dispositivo MEMS incluye dispositivos de entrega y de recepci6n transductores que determinan la distancia entre las superficies de contacto del tejido del cartucho de grapas y el yunque.
  6. 6.
    El instrumento quirurgico de acuerdo con la reivindicaci6n 5, que comprende dispositivos de entrega MEMS transductores alineados con los dispositivos de recepci6n MEMS transductores, los dispositivos de recepci6n que se configuran para recibir una sefal generada por los dispositivos de entrega, y que ademas comprenden un procesador configurado para correlacionar el tiempo de transmisi6n con la distancia usando una estructura de datos.
  7. 7.
    El instrumento quirurgico de acuerdo con la reivindicaci6n 1, en el que el al menos un dispositivo MEMS amplifica una sefal y transmite la sefal a un procesador.
  8. 8.
    El instrumento quirurgico de acuerdo con la reivindicaci6n 1, en el que el al menos un dispositivo MEMS incluye un biosensor configurado para determinar la condici6n del tejido.
  9. 9.
    El instrumento quirurgico de acuerdo con la reivindicaci6n 1, en el que el al menos un dispositivo MEMS incluye un sensor de temperatura.
  10. 10.
    El instrumento quirurgico de acuerdo con la reivindicaci6n 1, en el que el al menos un dispositivo MEMS es un dispositivo MEMS aceler6metro.
  11. 11.
    El instrumento quirurgico de acuerdo con la reivindicaci6n 10, en el que el aceler6metro detecta frecuencias por el desplazamiento de un elemento de voladizo o sintonizado asociado con el dispositivo MEMS.
  12. 12.
    El instrumento quirurgico de acuerdo con la reivindicaci6n 10, en el que el dispositivo MEMS aceler6metro se emplea e integra como dos o tres conjuntos ortogonales que constituyen un dispositivo de medici6n de aceleraci6n bidimensional o tridimensional o dispositivo tipo giroscopio cuando se dota con un punto conocido de origen y el sistema informatico configurado adecuadamente.
ES03738882T 2002-04-25 2003-04-25 Instrumentos quirúrgicos que incluyen sistemas microelectromecánicos (MEMS) Expired - Lifetime ES2377483T3 (es)

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