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ES2412435T3 - Aparato circular para grapar que contiene material de tratamiento de heridas - Google Patents

Aparato circular para grapar que contiene material de tratamiento de heridas Download PDF

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ES2412435T3
ES2412435T3 ES09166705T ES09166705T ES2412435T3 ES 2412435 T3 ES2412435 T3 ES 2412435T3 ES 09166705 T ES09166705 T ES 09166705T ES 09166705 T ES09166705 T ES 09166705T ES 2412435 T3 ES2412435 T3 ES 2412435T3
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staple
anvil
adhesive
treatment material
wound treatment
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Frank J. Viola
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Covidien LP
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Tyco Healthcare Group LP
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B17/115—Staplers for performing anastomosis, e.g. in a single operation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00491—Surgical glue applicators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • 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
    • A61B17/07292—Reinforcements for staple line, e.g. pledgets
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B17/115—Staplers for performing anastomosis, e.g. in a single operation
    • A61B17/1155—Circular staplers comprising a plurality of staples
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00831—Material properties
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00831—Material properties
    • A61B2017/00884—Material properties enhancing wound closure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00831—Material properties
    • A61B2017/00893—Material properties pharmaceutically effective
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • 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
    • A61B2017/07214—Stapler heads
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (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)
  • Materials For Medical Uses (AREA)

Abstract

Un aparato (10) de grapado circular que comprende: un conjunto (26) yunque, comprendiendo el conjunto yunque: una cabeza de yunque, una placa (36) de yunquey un eje (28); estando configurada la cabeza de yunque para soportar la placa de yunque sobre la misma;extendiéndose el eje desde la cabeza de yunque y configurado para acoplarse, de manera selectiva, a unelemento de conexión del aparato de grapado circular; en el que la placa de yunque está conectada, de maneraoperativa, a la cabeza de yunque, definiendo la placa de yunque una pluralidad de cavidades (38) formadorasde grapas en la misma; en el que un conjunto (22) cartucho comprende ranuras (24) de retención de grapasque coincide con las cavidades formadoras de grapas; en el que un material de tratamiento de heridas estáempaquetado dentro de las ranuras de retención de grapas; y en el que el material (W) de tratamiento deheridas está dispuesto dentro de cada cavidad formadora de grapas de la placa de yunque, en el que elmaterial de tratamiento de heridas es un adhesivo, en el que el material de tratamiento de heridas es retenidoen cada cavidad formadora de grapas mediante un revestimiento (40) y el adhesivo incluye al menos uno deentre un adhesivo que se endurece con el contacto con el tejido, un adhesivo que se endurece con laexposición a luz ultravioleta (UV) y un adhesivo que es sensible a la presión.

Description

Aparato circular para grapar que contiene material de tratamiento de heridas
Campo técnico
La presente descripción se refiere a instrumentos y procedimientos quirúrgicos para mejorar las propiedades de un tejido reparado o unido mediante grapas quirúrgicas y, más particularmente, a instrumentos quirúrgicos y una estructura configurados para aplicar elementos de sujeción mecánicos quirúrgicos de manera concomitante con un material de tratamiento de heridas no mecánico, biocompatible, para mejorar las propiedades del tejido reparado o unido en una zona quirúrgica objetivo. Los procedimientos no forman parte de la invención reivindicada en la presente memoria.
Exposición de la técnica relacionada
A lo largo de los años, el campo de la medicina ha utilizado diversas técnicas en un esfuerzo para unir entre sí un tejido del cuerpo. Históricamente, la sutura ha sido la técnica aceptada para unir los tejidos cortados y para cerrar heridas. La sutura se consiguió históricamente con una aguja quirúrgica y un hilo de sutura y, más recientemente, con una diversidad de grapas poliméricas o metálicas, tal como se indicará a continuación. La función prevista de las suturas es para mantener los bordes de una herida o tejido unos contra los otros durante el proceso de cicatrización para reducir el malestar, dolor, cicatrización y el tiempo requerido para la cicatrización.
Recientemente, muchos procedimientos que en el pasado requerían sutura convencional han sido remplazados por sutura con grapas, que implica la aplicación de grapas a los bordes de la herida o tejido con el uso de una grapadora quirúrgica. Se han desarrollado grapadoras quirúrgicas para unir tejidos contiguos, para proporcionar hemostasia de tejidos contiguos y para proporcionar hemostasia en conjunción con el corte de tejidos contiguos. Dichas grapadoras quirúrgicas incluyen configuraciones tanto de tipo lineal como de tipo anular. Una cortadora y grapadora lineal típica incluye filas paralelas de grapas, con una ranura para que unos medios de corte se desplacen entre las filas de grapas.
Las grapadoras de tipo línea típicas se describen en la patente US Nº 6.045.560 de McKean et al., de titularidad compartida, la patente US Nº 6.032.849 de Mastri et al., y la patente US Nº 5.964.394 de Robertson. Una cortadora y grapadora anular típica, que incluye una pluralidad de filas anulares de grapas, típicamente dos, y una cuchilla anular dispuesta en el interior de las filas de grapas, se describe en la patente US Nº 5.799.857 de Robertson et al., de titularidad compartida, y la patente US Nº 5.915.616 de Viola et al.
Estos tipos de grapadoras quirúrgicas aseguran el tejido corporal contiguo para un corte mejorado, la unión de las capas de tejido entre sí y para proporcionar hemostasia mediante la aplicación de filas paralelas o anulares de grapas al tejido circundante conforme los medios de corte realizan un corte entre las filas paralelas o anulares. En consecuencia, al permitir que un cirujano realice todas estas tareas de manera simultánea, las grapadoras quirúrgicas han sido eficaces en la disminución de la cantidad de tiempo que se necesita para sujetar los tejidos, unos a los otros. Para mejorar adicionalmente la unión y la hemostasia en casos en los que la grapadora se usa en un tejido altamente vascularizado, se han usado, con un alto grado de éxito, grapadoras quirúrgicas con múltiples filas de grapas.
Otros procedimientos quirúrgicos utilizan mallas quirúrgicas, soportes u otros tipos de telas y materiales de refuerzo. Típicamente, estos soportes se colocan sobre la superficie de contacto con el tejido del yunque y/o la superficie de contacto con el tejido del cartucho del instrumento de grapado quirúrgico y asegurados contra el tejido objetivo durante el disparo del instrumento de grapado quirúrgico. Puede hacerse referencia a la patente US Nº 5.542.594 para una exposición más detallada del uso de soportes en cooperación con el instrumento de grapado quirúrgico.
Todavía otros procedimientos quirúrgicos implican la etapa de aplicar (por ejemplo, mediante pulverización, cepillado, etc.) un material adhesivo y/o un material de sellado a la superficie externa del sitio quirúrgico objetivo después del procedimiento de grapado quirúrgico.
Otro procedimiento que ha sido desarrollado incluye el uso de adhesivos de tejidos biológicos que se han desarrollado recientemente para la reparación tisular y la creación de anastomosis. Generalmente, los adhesivos biológicos unen entre sí tejidos separados para ayudar en el proceso de cicatrización y para mejorar la resistencia del tejido. Dichos adhesivos pueden usarse en lugar de la sutura y el grapado, por ejemplo, en procedimientos quirúrgicos para la reparación del tejido o la creación de anastomosis.
La aplicación de un adhesivo biocompatible adecuado ofrece muchas ventajas para el paciente y para el cirujano por igual, tales como, por ejemplo, la prevención de la penetración del tejido por agujas y/o grapas, así como el sellado inmediato del tejido bajo tratamiento. Además, el uso de un adhesivo biocompatible tiende a minimizar la reacción a cuerpos extraños y la cicatrización. El documento WO 2003/094746 A1, de Viola, describe un aparato de grapado quirúrgico que incluye un conjunto material de cierre de heridas. El documento WO 02/105698 A2, de Orban y Nolan, describe un anillo con lumen de refuerzo para su uso en conjunción con un instrumento endoscópico de grapado circular. El anillo de refuerzo comprende un depósito con un material de cierre de heridas.
Sumario
Según un aspecto de la presente descripción, que no forma parte de la invención reivindicada en la presente memoria, se describe un conjunto yunque para un aparato de grapado circular. El conjunto yunque incluye una cabeza de yunque configurada para soportar una placa de yunque sobre la misma; un eje que se extiende desde la cabeza de yunque y configurado para acoplarse selectivamente a un elemento de conexión del aparato de grapado circular; una placa de yunque conectada operativamente a la cabeza de yunque, definiendo la placa de yunque una pluralidad de cavidades formadoras de grapas en la misma; y un material de tratamiento de heridas dispuesto en cada cavidad formadora de grapas de la placa de yunque.
El conjunto yunque puede incluir además un revestimiento que cubre la pluralidad de cavidades formadoras de grapas. Idealmente, las cavidades formadoras de grapas están dispuestas en un par de anillos anulares concéntricos separados. Las cavidades formadoras de grapas coinciden con ranuras de retención de grapas respectivas formadas en un conjunto cartucho de grapas del aparato de grapado quirúrgico.
Se prevé que el material de tratamiento de heridas esté contenido en una cápsula. En consecuencia, cada cápsula está configurada para su retención dentro de las cavidades formadoras de grapas.
Según otro aspecto de la presente descripción, que no forma parte de la invención reivindicada en la presente memoria, se describe un aparato de grapado quirúrgico circular para la realización de una anastomosis. El aparato de grapado incluye un conjunto yunque que tiene una cabeza de yunque configurada para soportar una placa de yunque sobre la misma; un eje que se extiende desde la cabeza de yunque y configurado para acoplarse selectivamente a un elemento de conexión del aparato de grapado circular; una placa de yunque conectada operativamente a la cabeza de yunque, definiendo la placa de yunque una pluralidad de cavidades formadoras de grapas en la misma; y un material de tratamiento de heridas dispuesto en cada cavidad formadora de grapas de la placa de yunque.
El aparato de grapado quirúrgico incluye además una parte cuerpo tubular que tiene un elemento de conexión configurado para acoplarse selectivamente al eje del conjunto yunque; y un conjunto cartucho de grapas soportado operativamente en un extremo distal de la parte cuerpo tubular. El conjunto cartucho de grapas incluye una pluralidad de ranuras de retención de grapas coincidentes con las cavidades formadoras de grapas del conjunto yunque; y una grapa dispuesta en cada ranura de retención de grapas.
El conjunto yunque puede incluir un revestimiento que cubre las cavidades formadoras de grapas. Idealmente, el revestimiento es capaz de ser penetrado por las grapas cuando el aparato de grapado quirúrgico es disparado.
Según un aspecto adicional de la presente descripción, que no forma parte de la invención reivindicada en la presente memoria, se describe un procedimiento para la realización de un procedimiento quirúrgico de anastomosis. El procedimiento incluye las etapas de proporcionar un aparato de grapado quirúrgico circular que incluye un conjunto yunque que tiene una cabeza de yunque configurada para soportar una placa de yunque sobre la misma; un eje que se extiende desde la cabeza del yunque y configurado para acoplarse selectivamente a un elemento de conexión del aparato de grapado circular; un placa de yunque conectada operativamente a la cabeza de yunque, definiendo la placa de yunque una pluralidad de cavidades formadoras de grapas en la misma; y un material de tratamiento de heridas dispuesto en cada cavidad formadora de grapas de la placa de yunque. Incluyendo además el aparato de grapado quirúrgico una parte cuerpo tubular que tiene un elemento de conexión configurado para acoplarse selectivamente al eje del conjunto yunque; y un conjunto cartucho de grapas soportado operativamente sobre un extremo distal de la parte cuerpo tubular. El conjunto cartucho de grapas incluye una pluralidad de ranuras de retención de grapas coincidente con las cavidades formadoras de grapas del conjunto yunque; y una grapa dispuesta en cada ranura de retención de grapas.
El procedimiento incluye además las etapas de insertar el conjunto yunque en una primera sección intestinal; insertar el conjunto cartucho de grapas en una segunda sección intestinal; conectar un eje del conjunto yunque al elemento de conexión de la parte cuerpo tubular; aproximar el conjunto yunque hacia el conjunto cartucho de grapas; y disparar el aparato de grapado quirúrgico para impulsar las grapas a través de la primera sección intestinal y la segunda sección intestinal y a las cavidades formadoras de grapas del conjunto yunque. Por consiguiente, cuando las grapas entran en las cavidades formadoras de grapas, las grapas liberan el material de tratamiento de heridas desde las mismas.
El conjunto yunque puede incluir además un revestimiento que cubre las cavidades formadoras de grapas.
Idealmente, el revestimiento es capaz de ser penetrado por las grapas cuando el aparato de grapado quirúrgico es disparado.
Según un aspecto de la presente invención, se proporciona un aparato de grapado quirúrgico que incluye un conjunto yunque configurado para soportar una placa de yunque sobre el mismo y una placa de yunque conectada operativamente al conjunto yunque y que define una pluralidad de cavidades formadoras de grapas en la misma, y un conjunto cartucho que comprende ranuras de retención de grapas coincidentes con las cavidades formadoras de grapas. La mejora incluye la provisión de un material de tratamiento de heridas en cada cavidad formadora de grapas de la placa de yunque y en las ranuras de retención de grapas.
El material de tratamiento de heridas es un adhesivo.
El adhesivo incluye al menos uno de entre un adhesivo que se endurece con el contacto con el tejido, un adhesivo que se endurece tras la exposición a luz ultravioleta (UV) y un adhesivo que es sensible a la presión. Puede incluir también al menos uno de entre un material adhesivo basado en aldehído, derivado de proteína, y un material basado en cianoacrilato.
Breve descripción de los dibujos
Las características anteriores de la presente descripción se harán más evidentes y pueden ser comprendidas con referencia a la descripción detallada siguiente de una realización ilustrada de un instrumento, aparato o estructura quirúrgica, tomada en conjunción con los dibujos adjuntos, en los cuales:
La Fig.1 ilustra una vista en perspectiva de un aparato de grapado quirúrgico según una realización de la presente descripción;
La Fig. 2 es una vista en perspectiva de un conjunto yunque según una realización de la presente descripción;
La Fig. 3 es una vista en sección transversal del conjunto yunque, tomada a través de 3-3 de la Fig. 2;
La Fig. 4 es una vista en sección transversal de un conjunto yunque alternativo, que no forma parte de la invención, tomada a través de 3-3 de la Fig. 2;
La Fig. 5 es una vista en perspectiva de la zona intestinal de un paciente, que ilustra un procedimiento de posicionamiento del conjunto yunque de las Figs. 2-4 al realizar una anastomosis intestinal;
La Fig. 6 es una vista de detalle, ampliada, del conjunto yunque de las Figs. 2-4 y un conjunto cartucho de grapas del aparato de grapado quirúrgico posicionado en el sitio quirúrgico objetivo inmediatamente antes del disparo del aparato de grapado quirúrgico;
La Fig. 7 es una vista de detalle, ampliada, de la dispensación del material de tratamiento de heridas desde el conjunto yunque tras el disparo del aparato de grapado quirúrgico; y
La Fig. 8 es una vista en detalle del conjunto yunque de las Figs. 2-4 y un conjunto cartucho de grapas de un aparato de grapado quirúrgico según la presente descripción, antes del rellenado del aparato de grapado quirúrgico.
Descripción detallada de la invención
Ahora, las realizaciones del aparato de grapado quirúrgico descrito en la presente memoria se describirán en detalle con referencia a las figuras de los dibujos, en los que los números de referencia similares identifican elementos similares o idénticos. Tal como se usa en la presente memoria y como es tradicional, el término "distal" se refiere a la parte que está más alejada del usuario, mientras que el término "proximal" se refiere a la parte que está más cerca del usuario.
Ahora, con referencia en detalle específico a los dibujos, en los que los números de referencia similares identifican elementos similares o idénticos a lo largo de las diversas vistas, la Fig. 1 muestra un aparato 10 de grapado quirúrgico que emplea la estructura para la aplicación de un adhesivo dispersable según la presente descripción. El aparato 10 incluye un conjunto 12 mango que tiene al menos un elemento 14 mango de accionamiento giratorio, e incluye además medios 16 de avance. Los medios 16 de avance incluyen un elemento 18 de agarre giratorio, cuya función se describe a continuación.
Extendiéndose desde el conjunto 12 mango, hay provista una parte 20 cuerpo tubular que puede estar construida de manera que tenga una forma curvada a lo largo de al menos una parte de su longitud. La parte 20 cuerpo tubular también puede ser recta, o en otras realizaciones, la parte 20 cuerpo tubular puede ser flexible para doblarse a cualquier configuración. La parte 20 cuerpo termina en un conjunto 22 cartucho de grapas. El conjunto 22 cartucho de grapas incluye un conjunto anular de grapas "S". Posicionado opuesto al conjunto 22 cartucho de grapas hay provisto un conjunto 26 yunque que está conectado al aparato 10 por medio del eje 28 en los medios 30 de conexión. El conjunto 26 yunque y el conjunto 22 cartucho de grapas se describen en la patente US Nº 5.119.983, de titularidad compartida, expedida el 9 de Junio 1992.
Aunque se muestra y se describe que el aparato 10 utiliza un conjunto cartucho de grapas que tiene un conjunto anular de grapas posicionado en la parte cuerpo tubular, y que tiene el conjunto yunque posicionado opuesto al conjunto cartucho de grapas para su movimiento acercándose y alejándose del conjunto cartucho de grapas, por supuesto, se contempla que el conjunto yunque pueda estar posicionado en la parte cuerpo tubular y que el conjunto cartucho de grapas y el conjunto de grapas estén posicionados frente al conjunto yunque para su movimiento acercándose y alejándose del conjunto yunque. Debe considerarse que dicha construcción está incluida en el alcance de la presente descripción.
Durante el funcionamiento, el aparato 10 es posicionado dentro de un órgano tubular en el cuerpo del paciente y los extremos del órgano a unir son posicionados en el hueco entre el conjunto 22 cartucho de grapas y el conjunto 26 yunque, de manera que el conjunto 26 yunque esté totalmente extendido. Tal como es convencional, los extremos del órgano pueden ser asegurados sobre el conjunto 26 yunque y el conjunto 22 cartucho de grapas mediante una sutura en bolsa de tabaco antes de la aproximación del conjunto 26 yunque en relación al conjunto 22 cartucho de grapas. Con el conjunto 26 yunque y el conjunto 22 cartucho de grapas suturados en bolsa de tabaco, el vástago 28 del conjunto 26 yunque está acoplado a los medios 30 de conexión dispuestos dentro del conjunto 22 cartucho de grapas.
Con el fin de aproximar el conjunto 26 yunque hacia el conjunto 22 cartucho de grapas, el elemento 18 de agarre se hace girar para desplazar un elemento varilla interior (no mostrado) en una dirección proximal. Esto atrae el conjunto 26 yunque a una posición contigua al conjunto 22 cartucho de grapas y coloca los extremos del tejido entre estos dos elementos.
Una vez establecida la distancia apropiada entre el conjunto 26 yunque y el conjunto 22 cartucho de grapas, los medios 32 de enclavamiento pueden ser liberados y los mangos 14 de accionamiento pueden hacerse pivotar para impulsar las grapas a través del tejido y contra el conjunto 26 yunque para completar la anastomosis circular del órgano tubular. Puede hacerse referencia a la patente US Nº 5.119.983, para una descripción y exposición más detalladas de la estructura y el funcionamiento del aparato 10 de grapado quirúrgico.
Tal como se observa en las Figs. 1-4, el conjunto 26 yunque incluye una cabeza 34 de yunque y un vástago 28 que se extiende desde la cabeza 34 de yunque. La cabeza 34 de yunque está configurada para soportar una placa 36 de yunque en la misma. Tal como se observa en las Figs. 2 y 3, la placa 36 de yunque incluye una pluralidad de cavidades 38 formadoras de grapas en la misma. Idealmente, las cavidades 38 formadoras de grapas están dispuestas en un par de anillos anulares concéntricos separados formados en la placa 36 de yunque.
Tal como se observa en las Figs. 3 y 4, cada cavidad 38 formadora de grapas incluye una cantidad de material “W” de tratamiento de heridas en la misma. Tal como se observa en la Fig. 3, una película o revestimiento 40 está colocada encima o sobre la superficie de la placa 36 de yunque cubriendo, de esta manera, las cavidades 38 formadoras de grapas y reteniendo el material “W” de tratamiento de heridas en las mismas. De manera alternativa, que no forma parte de la invención, tal como se observa en la Fig. 4, el material “W” de tratamiento de heridas puede estar contenido en una cápsula o líquido-gel 42 colocado en cada cavidad 38 formadora de grapas. Idealmente, cada cápsula 42 está adherida a, o si no está contenido de manera fija en, las cavidades 38 formadoras de grapas.
Idealmente, el revestimiento 40 está fabricado en un material que puede ser penetrado o roto por las grapas quirúrgicas "S". Por ejemplo, el revestimiento 40 puede fabricarse en un material polimérico, tal como por ejemplo, polietileno, poliéster, poliuretano y similares. Se contempla que el revestimiento 40 esté fabricado en un material bioabsorbible. De esta manera, en caso de que una parte o la totalidad del revestimiento 40 permanezca en el cuerpo después del procedimiento quirúrgico, esa parte del revestimiento 40 será absorbida en el cuerpo.
El material de tratamiento de heridas es un adhesivo. Idealmente, durante el uso, el componente adhesivo del material “W” de tratamiento de heridas funciona para asegurar los tejidos aproximados entre sí.
Se contempla que el adhesivo incluya, y no se limite a, adhesivos que se endurecen en contacto con el tejido, que se endurecen con la exposición a los rayos ultravioleta (UV), que son sensibles a la presión, que son combinaciones de los mismos, o cualquier otro adhesivo adecuado conocido. En una realización, se contempla que pueda usarse un adhesivo que tenga un tiempo de endurecimiento de aproximadamente 10 a 15 segundos. En otra realización, se contempla que se pueda usar un adhesivo que tenga un tiempo de endurecimiento de aproximadamente 30 segundos.
Se prevé que el material “W” de tratamiento de heridas pueda ser un adhesivo endurecido previamente. El adhesivo endurecido previamente reaccionará con la humedad y/o el calor del tejido corporal para activar, de esta manera, las propiedades adhesivas del adhesivo. Se prevé que el adhesivo endurecido previamente pueda ser un hidrogel o similar.
Los ejemplos de adhesivos que pueden ser empleados incluyen materiales adhesivos basados en aldehído, derivados de proteínas, por ejemplo, los materiales de albúmina/glutaraldehído disponibles comercialmente,, comercializados bajo la designación comercial BioGlueTM por Cryolife, Inc., y materiales basados en cianoacrilato, comercializados bajo las designaciones comerciales IndermilTM y Derma BondTM por Tyco Healthcare Group, LP y Ethicon Endosurgery, Inc., respectivamente.
Ahora, con relación a las Figs. 5-7, se ilustra el uso del dispositivo 10 de grapado quirúrgico y el conjunto 100 yunque desmontable en un procedimiento de anastomosis para efectuar la unión de secciones "T1 y T2" intestinales contiguas. Típicamente, el procedimiento de anastomosis se realiza usando técnicas quirúrgicas mínimamente invasivas que incluyen instrumentación y medios de laparoscopia. En el punto en el procedimiento mostrado en la Fig. 5, una sección intestinal enferma ha sido retirada previamente, el conjunto 26 yunque ha sido aplicado al sitio de la operación bien a través de una incisión quirúrgica o bien transanalmente y ha sido posicionado dentro de la primera sección "T1" intestinal, y la parte 20 cuerpo tubular del dispositivo 10 de grapado quirúrgico ha sido insertada transanalmente en la segunda sección "T2" intestinal. Las secciones "T1 y T2" intestinales se muestran también aseguradas temporalmente alrededor de sus respectivos componentes (por ejemplo, el eje 28 del conjunto 26 yunque, y el extremo distal de la parte 20 cuerpo tubular) por medios convencionales, tales como una sutura en bolsa de tabaco (no mostrada).
A continuación, el cirujano maniobra el conjunto 26 yunque hasta que un extremo proximal del eje 28 está conectado operativamente a los medios 30 de conexión de la parte 20 cuerpo tubular. A continuación, el conjunto 26 yunque y la parte 20 cuerpo tubular se aproximan a las secciones "T1 y T2" intestinales próximas.
Ahora, con referencia a la Fig. 6, con el conjunto 26 yunque aproximado hacia el conjunto 22 cartucho de grapas y las secciones "T1 y T2" intestinales sujetadas o capturadas entre los mismos, las cavidades 38 formadoras de grapas del conjunto 26 yunque coinciden con las ranuras 24 de retención de grapas del elemento 22 de sujeción de grapas. En particular, las grapas "S", retenidas en las ranuras 24 de retención de grapas, coinciden con las cavidades 38 formadoras de grapas del conjunto 26 yunque.
Con el conjunto 26 yunque posicionado, de esta manera, en relación con el conjunto 22 cartucho de grapas, el dispositivo 10 de grapado quirúrgico es disparado, grapando y adhiriendo, de esta manera, las secciones "T1 y T2" intestinales entre sí. Tal como se observa en la Fig. 7, tras el disparo del dispositivo 10 de grapado quirúrgico, las grapas "S" son impulsadas desde el conjunto 22 cartucho de grapas e impulsadas a través de las secciones "T1 y T2" intestinales asegurando mecánicamente, de esta manera, las secciones "T1 y T2" intestinales entre sí. Conforme las grapas "S" son impulsadas a través de las secciones "T1 y T2" intestinales, las grapas "S" penetran en el revestimiento 40 y liberan el material “W” de tratamiento de heridas, contenido en las cavidades 38 formadoras de grapas de la placa 36 de yunque sobre el tejido "T2" intestinal. Idealmente, el material “W” de tratamiento de heridas se extiende a lo largo de las grapas "S" a la interfaz entre los tejidos "T1 y T2" intestinales. De esta manera, si el material “W” de tratamiento de heridas contiene un adhesivo, el material “W” de tratamiento de heridas ayuda a adherir las secciones "T1 y T2" intestinales entre sí.
Se prevé además que la filtración de sangre en o sobre el lado yunque de las grapas "S" (por ejemplo, en el primer tejido "T1" intestinal) se reduzca con relación a un aparato quirúrgico que tiene un conjunto yunque sin material de tratamiento de heridas. Durante el uso, conforme las grapas "S" son impulsadas a las cavidades 38 formadoras de grapas del conjunto 26 yunque, el material “W” de tratamiento de heridas es desplazado a la zona que rodea las grapas "S".
Simultáneamente, el cuchillo 50 corta las partes de las secciones "T1 y T2" intestinales situadas radialmente hacia el interior de la cuchilla 50.
Ahora, con relación a la Fig. 8, un material “W” de tratamiento de heridas está dispuesto dentro de (por ejemplo, cargado en, empaquetado en, etc.) las ranuras 24 de retención de grapas. En consecuencia, durante el uso, cuando el aparato 10 de grapado quirúrgico es disparado, el material “W” de tratamiento de heridas es dispensado sobre o si no es extendido sobre el área de la segunda sección "T2" intestinal que rodea un tramo posterior de grapas "S".
Aunque se han ilustrado y descrito diversas formas particulares de conjuntos yunque, y un procedimiento particular de uso de las mismas, en el que el procedimiento no forma parte de la invención reivindicada en la presente memoria, será evidente también que pueden realizarse diversas modificaciones sin apartarse del alcance de las reivindicaciones. Por ejemplo, se contempla y está dentro del alcance de la presente descripción el uso de un material de tratamiento de heridas activado con luz ultravioleta (por ejemplo, adhesivo) en las cavidades 38 formadoras de grapas del conjunto 26 yunque. En consecuencia, durante el uso, antes o después del disparo del dispositivo 10 de grapado quirúrgico, el sitio de la anastomosis es irradiado con luz UV para activar, de esta manera, el adhesivo.
De esta manera, debería entenderse que pueden realizarse diversos cambios en la forma, detalle y aplicación del conjunto yunque de la presente descripción sin apartarse del alcance de las presentes reivindicaciones.

Claims (4)

  1. REIVINDICACIONES
    1.
    Un aparato (10) de grapado circular que comprende:
    un conjunto (26) yunque, comprendiendo el conjunto yunque: una cabeza de yunque, una placa (36) de yunque y un eje (28); estando configurada la cabeza de yunque para soportar la placa de yunque sobre la misma; extendiéndose el eje desde la cabeza de yunque y configurado para acoplarse, de manera selectiva, a un elemento de conexión del aparato de grapado circular; en el que la placa de yunque está conectada, de manera operativa, a la cabeza de yunque, definiendo la placa de yunque una pluralidad de cavidades (38) formadoras de grapas en la misma; en el que un conjunto (22) cartucho comprende ranuras (24) de retención de grapas que coincide con las cavidades formadoras de grapas; en el que un material de tratamiento de heridas está empaquetado dentro de las ranuras de retención de grapas; y en el que el material (W) de tratamiento de heridas está dispuesto dentro de cada cavidad formadora de grapas de la placa de yunque, en el que el material de tratamiento de heridas es un adhesivo, en el que el material de tratamiento de heridas es retenido en cada cavidad formadora de grapas mediante un revestimiento (40) y el adhesivo incluye al menos uno de entre un adhesivo que se endurece con el contacto con el tejido, un adhesivo que se endurece con la exposición a luz ultravioleta (UV) y un adhesivo que es sensible a la presión.
  2. 2.
    Aparato de grapado circular según la reivindicación 1, en el que el adhesivo incluye al menos uno de entre un material adhesivo basado en aldehído, derivado de proteínas, y un material basado en cianoacrilato.
  3. 3.
    Aparato de grapado circular según la reivindicación 1, en el que las cavidades formadoras de grapas están dispuestas en un par de anillos anulares concéntricos separados.
  4. 4.
    Aparato de grapado circular según la reivindicación 1, en el que las cavidades formadoras de grapas coinciden con ranuras (24) de retención de grapas respectivas formadas en un conjunto (22) cartucho de grapas del aparato de grapado quirúrgico.
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