CN101015471A - 具有关节运动端部执行器的外科器械 - Google Patents

具有关节运动端部执行器的外科器械 Download PDF

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CN101015471A
CN101015471A CNA2007100013497A CN200710001349A CN101015471A CN 101015471 A CN101015471 A CN 101015471A CN A2007100013497 A CNA2007100013497 A CN A2007100013497A CN 200710001349 A CN200710001349 A CN 200710001349A CN 101015471 A CN101015471 A CN 101015471A
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end effector
joint motions
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杰弗里·C·休伊尔
约瑟夫·查尔斯·休伊尔
肯尼思·爱德华·霍格
克里斯托弗·刘易斯·吉勒姆
道格拉斯·乔恩·西贝内勒
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Ethicon Endo Surgery Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • 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
    • A61B17/07207—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 the staples being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003—Steerable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B17/2909—Handles
    • A61B2017/2912—Handles transmission of forces to actuating rod or piston
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B17/2909—Handles
    • A61B2017/2912—Handles transmission of forces to actuating rod or piston
    • A61B2017/2919—Handles transmission of forces to actuating rod or piston details of linkages or pivot points
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B2017/320052—Guides for cutting instruments

Abstract

一种关节运动的外科器械，该器械包括轴和端部执行器。该轴具有纵向轴线，该端部执行器在关节运动枢轴处可操作地优选机械地连接到所述轴上。该器械还包括第一带，在一些实施例中还包括第二带，每个带可操作地连接到端部执行器上，并延伸通过轴的至少一部分。关节运动控制器沿着基本上垂直于纵向轴线的方向施加力，所述力在沿第一方向施加时通过第一带平移到端部执行器上，使端部执行器相对于轴围绕关节运动枢轴沿第一方向转动，所述力在沿相反的方向施加时通过第二带平移到端部执行器上，使端部执行器相对于轴围绕关节运动枢轴沿第二方向转动。

Description

具有关节运动端部执行器的外科器械
技术领域
本发明总的涉及外科器械，更具体地说，涉及具有关节运动端部执行器的微创外科器械。
背景技术
内窥镜外科器械和其它微创外科器械通常包括端部执行器和手柄，该端部执行器位于细长轴的远端，该手柄位于细长轴的近端，以便医生操纵端部执行器。在使用中，端部执行器通过插管针的插管被送到手术部位。在手术部位处，端部执行器以多种方式接合组织，达到诊断或治疗的效果。与传统的开放式外科器械相比，内窥镜外科器械通常更受青睐，这是因为内窥镜外科器械需要更小的切口，比传统的开放式手术切口需要更短的术后恢复时间。由于内窥镜手术的这一点以及其他的优点，具有端部执行器的各种内窥镜外科器械已经有了显著的发展，所述端部执行器与组织接合，完成多种手术任务。例如，端部执行器已经被开发用作内切割器、抓钳、切割器、缝合器、夹具施放器、接入装置、药物/基因治疗输送装置、超声波、RF、或激光能量装置和其他外科器械。
图1和2示出了包括端部执行器12的外科缝合和切割器械10的现有技术的例子，该端部执行器12为用于夹紧、切割和缝合组织的内切割器，如美国专利申请公开No.2004/0232196A1所披露的，该专利申请的全部内容通过引用并入本文。外科缝合和切割器械10包括连接到执行部分22上的手柄部分20，执行部分22还包括远侧终止于端部执行器12的轴23。手柄部分20包括手枪式握把24，医生朝着该手枪式握把24枢转地拉动闭合扳机26，以朝着端部执行器12的细长通道16夹紧或者闭合钉砧18。击发扳机28位于闭合扳机26的更外侧，医生枢转地拉动击发扳机28，以缝合和切割夹紧在端部执行器12中的组织。
首先致动闭合扳机26。一旦医生对端部执行器12的定位满意，医生可将闭合扳机26拉回到邻近手枪式握把24的其完全闭合的锁定位置。然后致动击发扳机28。当医生移除压力时击发扳机28弹性地返回。在手柄部分20的近端上按压释放按钮时释放任意锁定的闭合扳机26。
闭合套管32封装有框架34，框架34内装有击发驱动构件36，该击发驱动构件36由击发扳机28定位。框架34将手柄部分20连接到端部执行器12上。如图所示，当通过闭合扳机26将闭合套管32向近侧缩回时，钉砧18打开，枢转离开细长通道16，与闭合套管32一起向近侧平移。细长通道16装纳钉仓37。
具体参照图2，击发杆14包括三个垂直间隔开的销，所述销在击发期间控制端部执行器12的间距。具体地说，上部销38进入钉砧18和细长通道16之间的枢轴附近的钉砧孔40。当钉砧18闭合的情况下击发时，上部销38在纵向钉砧槽42中向远侧推进，钉砧槽42通过钉砧18向远侧延伸。上部销38施加的向下的力克服钉砧的任何微小的向上的偏转。
击发杆14还包括最下部的销，即击发杆帽44，其向上接合细长通道16中的通道狭槽45，由此与上部销38协作，在钉砧18和细长通道16之间夹紧过多组织时将钉砧18和细长通道16稍微拉近。
击发杆14有利地包括中间销46，其穿过形成在钉仓37的下表面和细长通道16的上表面中的击发驱动狭槽47，由此如下所述驱动其中的缝钉。中间销46通过在钉仓37的下表面上滑动，有利地抵抗端部执行器12在其远端夹紧闭合的倾向。
击发杆14上的上部销38和下部销46之间的位于远侧的切割刃48横过钉仓37，以切割夹紧的组织。击发杆14项对于细长通道16和钉砧18的正确定位确保进行有效的切割。
E型梁击发杆14提供的确定的垂直间距适合于尺寸有限的内窥镜装置。另外，E型梁击发杆14允许形成拱形的钉砧18，允许在其远端垂直偏转。拱形钉砧18有助于实现端部执行器12中所需的间隙，即使钉砧18具有较小的厚度，因此更适合于尺寸有限的内窥镜装置。
E型梁击发杆14还具有其它的应用，尤其在于各种结构的钉仓组合使用时。例如，医生可选择产生0.02mm的组织间隙的灰色钉仓，产生0.04mm的组织间隙的白色钉仓，产生0.06mm的组织间隙的蓝色钉仓，产生0.10mm的组织间隙的绿色钉仓。每个相应钉仓的垂直高度与缝钉和一体的楔形滑块50的长度一起预先确定所需的组织厚度，其中钉砧18由E型梁击发杆14适当地垂直间隔开。
对于外科器械10和其它微创器械，端部执行器在手术部位的定位由套管针约束。通常，细长轴23使医生能够将端部执行器插入到所需深度，并使端部执行器围绕轴的纵向轴线旋转。这一定程度上允许端部执行器定位在手术部位。例如通过另一个套管针正确放置套管针并使用抓钳，定位量通常是足够的。但是，根据手术的性质，可以根据需要调节内窥镜外科器械的端部执行器的定位。具体地说，通常将端部执行器相对于器械的细长轴的纵向轴线成多个角度中的任意一个定向。
端部执行器相对于器械轴成多个角度的运动通常称为“关节运动”。关节运动通过由细长轴中端部执行器附近的枢转(关节运动)接头实现。这允许医生遥控地使端部执行器关节运动到任一侧，以更好地放置缝线，便于组织操纵和定向。关节运动端部执行器允许医生在某些情况下(例如在器官后面)更容易接合组织。另外，关节运动定位有利地允许内窥镜定位在端部执行器后面，不会被细长轴阻挡。
使端部执行器关节运动的方法往往是复杂的，因为用于控制关节运动的机构必需与用于操作端部执行器的机构形成一体。例如，必须在器械轴的小直径的范围内执行闭合套管、驱动构件和用于关节运动的机构。一种通常的设计包括折叠式关节运动机构(“挠性颈”)，选择地通过执行轴拉回两个连接杆中的一个，从而使所述关节运动机构关节运动，每个连接杆分别在轴中心线的相对两侧偏移。连接杆通过一系列的离散位置步进运动。
尽管这些公知的方法成功地使端部执行器围绕关节运动枢轴关节运动，但是需要进一步改进性能。因此，极需一种改进的关节运动外科器械。
发明内容
根据本发明的一个实施例，提供一种关节运动外科器械。该器械包括轴和端部执行器。该轴具有纵向轴线，该端部执行器在关节运动枢轴处可操作地优选机械地连接到所述轴上。该器械还包括第一带，其可操作地连接到端部执行器上，并延伸通过轴的至少一部分。关节运动控制器沿着基本上垂直于纵向轴线的方向施加力。关节运动控制器可操作地连接到第一带上，使得所施加的力通过第一带平移到端部执行器上，使端部执行器相对于轴围绕关节运动枢轴转动。
根据具有如上所述的轴和端部执行器的另一个实施例，第二带可操作地连接到端部执行器上，并延伸通过轴的至少一部分。在该实施例中，关节运动控制器也能够沿着基本上垂直于纵向轴线的第二方向施加力。所述力通过第二带平移到端部执行器上，使端部执行器相对于轴围绕关节运动枢轴沿第二转动方向转动。
在一个实施例中，关节运动控制器能够沿着第一方向运动，以沿着第一横向施加力，使端部执行器相对于轴沿着第一转动方向转动。在该实施例中，关节运动控制器还能够沿着第二方向运动，以沿着与第一横向相反的第二横向施加力，使端部执行器相对于轴沿着第二转动方向转动。
关节运动控制器可包括关节运动滑块，所述关节运动滑块可跨过轴横向地运动到第一、第二和中间位置。当关节运动滑块位于中间位置时，所述关节运动滑块限定了位于纵向轴线附近的狭槽，所述第一带和第二带穿过所述狭槽。当关节运动滑块处于第一或第二位置时，关节运动狭槽与纵向轴线偏移。
在各个实施例中，当没有力施加到关节运动控制器上、关节运动控制器位于中间位置时，第一带和第二带朝着纵向轴线预弯曲。在具有轴和端部执行器的另一个实施例中，第一带具有在与关节运动轴线偏移的点处机械地连接到端部执行器上的第一端部。
根据具有如上所述轴和端部执行器的另一个实施例，器械具有可朝着第一带膨胀的第一液压关节运动囊。液压致动囊流体连接到第一液压关节运动囊上。在各个实施例中，第一致动按钮定位成压缩第一液压致动囊。第一液压致动囊的压缩使得第一液压关节运动囊膨胀。第一液压关节运动囊朝着第一带的膨胀使得第一带弯曲，从而使得端部执行器相对于轴围绕关节运动枢轴沿第一转动方向转动。在该器械的另一个实施例中，可设置由第二液压关节运动囊。第二液压关节运动囊朝着第二带的膨胀使得第二带弯曲，从而使得端部执行器相对于轴围绕关节运动枢轴沿第二转动方向转动。
根据本发明的另一个实施例，提供一种操作该器械的方法。该方法包括如下步骤：沿着与所述轴基本上垂直的方向对所述器械施加力，所述力使第一带弯曲，所述第一带的弯曲使端部执行器相对于所述轴围绕关节运动枢轴沿第一方向枢转。
本发明还涉及如下方面：
(1)一种关节运动的外科器械，包括：
具有纵向轴线的轴；
端部执行器，其在关节运动枢轴处可操作地连接到所述轴上；
第一带，其可操作地连接到所述端部执行器上，并延伸通过所述轴的至少一部分；以及
关节运动控制器，用于沿着基本上垂直于所述纵向轴线的方向施加力，所述关节运动控制器可操作地连接到所述第一带上，使得施加的力通过第一带平移到端部执行器上，从而使端部执行器相对于轴围绕关节运动枢轴转动。
(2)如第(1)项所述的器械，其特征为，所述关节运动控制器能够沿着第一方向运动，以沿着第一横向施加力，使端部执行器相对于轴沿着第一转动方向转动。
(3)如第(2)项所述的器械，其特征为，所述关节运动控制器能够沿着第二方向运动，以沿着与第一横向相反的第二横向施加力，使端部执行器相对于轴沿着第二转动方向转动。
(4)如第(2)项所述的器械，其特征为，还包括第二带，所述第二带可操作地连接到端部执行器上，并从端部执行器延伸通过所述轴的至少一部分，所述关节运动控制器可操作地连接到所述第二带上，使得施加的力通过第二带平移到端部执行器上，从而使端部执行器相对于轴沿着第二转动方向转动。
(5)如第(4)项所述的器械，其特征为，所述关节运动控制器包括关节运动滑块，所述关节运动滑块可跨过轴横向地运动到第一、第二和中间位置。
(6)如第(5)项所述的器械，其特征为，所述滑块可跨过轴横向地运动到第三和第四位置。
(7)如第(5)项所述的器械，其特征为，当所述关节运动控制器处于中间位置时，所述第一带和第二带朝着纵向轴线预弯曲。
(8)如第(5)项所述的器械，其特征为，当所述关节运动滑块位于中间位置时，所述关节运动滑块限定了位于纵向轴线附近的狭槽，当所述关节运动滑块处于第一和第二位置中的一个时，所述第一带和第二带穿过所述狭槽，并且所述关节运动滑块的位置相对纵向轴线偏移。
(9)如第(1)项所述的器械，其特征为，还包括第一远侧构件，所述第一带从端部执行器绕过第一远侧构件。
(10)如第(9)项所述的器械，其特征为，还包括第二带和第二远侧构件，所述第二带可操作地连接到端部执行器上，并从端部执行器延伸通过所述轴的至少一部分，所述第二带从端部执行器绕过第二远侧构件。
(11)如第(1)项所述的器械，其特征为，所述关节运动控制器包括可沿着与纵向轴线基本上垂直的方向平移的关节运动滑块，在关节运动滑块的至少一部分运动范围期间，所述关节运动滑块与第一带接触。
(12)如第(1)项所述的器械，其特征为，  所述力施加到第一带上。
(13)如第(1)项所述的器械，其特征为，  还包括可朝着第一带膨胀的第一液压关节运动囊。
(14)如第(13)项所述的器械，其特征为，  还包括液压流体源，其能够接收由关节运动控制器施加的力。
(15)如第(14)项所述的器械，其特征为，  所述液压流体源是流体连接到所述第一液压关节运动囊上的液压致动囊。
(16)如第(15)项所述的器械，其特征为，所述关节运动控制器包括第一致动按钮，当力施加到第一按钮上时，第一按钮压缩第一液压致动囊并将液压流体引导到第一液压关节运动囊中，使第一液压关节运动囊膨胀。
(17)如第(13)项所述的器械，其特征为，  所述关节运动控制器还包括第二液压关节运动囊。
(18)如第(17)项所述的器械，其特征为，所述第一液压关节运动囊和第二液压关节运动囊沿着所述轴的同一侧定位。
(19)如第(17)项所述的器械，其特征为，还包括第二带，所述第二带可操作地连接到端部执行器上，并从端部执行器延伸通过所述轴的至少一部分，所述第二液压关节运动囊可朝着所述第二带膨胀。
(20)如第(19)项所述的器械，其特征为，所述第一液压关节运动囊朝着第一带的膨胀使得第一带弯曲，从而使端部执行器相对于所述轴围绕关节运动枢轴沿第一转动方向转动，所述第二液压关节运动囊朝着第二带的膨胀使得第二带弯曲，从而使端部执行器相对于所述轴围绕关节运动枢轴沿第二转动方向转动。
(21)如第(17)项所述的器械，其特征为，所述关节运动控制器能够沿着第一横向或者与第一横向相反的第二横向施加力，使得端部执行器分别沿着第一转动方向或第二转动方向转动。
(22)如第(21)项所述的器械，其特征为，所述第一带在以关节运动枢轴为中心的凸起处机械地连接到端部执行器上，使得通过第一带平移的力平移到所述凸起上，从而使所述凸起围绕关节运动枢轴转动。
(23)如第(21)项所述的器械，其特征为，所述第一带在与关节运动枢轴偏移的第一点处机械地连接到凸起上。
(24)如第(23)项所述的器械，其特征为，还包括第二带，所述第二带可操作地连接到端部执行器上，并从端部执行器延伸通过所述轴的至少一部分，所述关节运动控制器可操作地连接到所述第二带上并且能够沿着第二横向施加力，所述第二带机械地连接到凸起上，使得施加到第二带上的力平移到凸起上，从而使凸起围绕关节运动枢轴转动。
(25)如第(24)项所述的器械，其特征为，所述第二带在与关节运动枢轴偏移并与第一点间隔开的第二点处机械地连接到凸起上。
(26)如第(1)项所述的器械，其特征为，还包括机械地连接到所述轴上的手柄。
(27)如第(1)项所述的器械，其特征为，还包括第二带，所述第二带可操作地连接到端部执行器上，并从端部执行器延伸通过所述轴的至少一部分，所述第二带包括弹簧组件，允许第二带响应于张力伸长。
(28)如第(27)项所述的器械，其特征为，所述第一带还包括弹簧组件，允许第一带响应于张力伸长固定的距离。
(29)如第(27)项所述的器械，其特征为，所述第一带和所述第二带在与所述轴的纵向轴线偏移的点处可操作地连接到关节运动控制器上。
(30)如第(27)项所述的器械，其特征为，所述第二带能够接收沿着与纵向轴线基本上垂直的方向的第二力，第二力通过第二带平移到端部执行器，使端部执行器相对于所述轴围绕关节运动枢轴沿第二方向转动。
(31)一种关节运动外科器械，包括：
具有近端和远端的轴；
端部执行器，其在所述轴的远端的关节运动枢轴处枢转地连接到所述轴上，允许端部执行器相对于所述轴围绕关节运动轴线枢转；以及
第一带，其延伸通过所述轴的至少一部分，所述第一带包括在与关节运动轴线偏移的点处机械地连接到端部执行器上的第一端部。
(32)如第(31)项所述的器械，其特征为，还包括机械地连接到所述轴的近端上的手柄。
(33)如第(31)项所述的器械，其特征为，还包括可朝着第一带滑动的关节运动控制杆。
(34)如第(31)项所述的器械，其特征为，还包括可朝着第一带膨胀的第一关节运动液压囊。
(35)如第(31)项所述的器械，其特征为，还包括位于轴上的远侧构件，所述第一带环绕远侧构件到达端部执行器。
(36)如第(31)项所述的器械，其特征为，还包括第二带，所述第二带延伸通过所述轴的至少一部分，所述第二带包括在与关节运动轴线偏移的第二点处机械地连接到端部执行器上的第一端部。
(37)如第(36)项所述的器械，其特征为，所述第一带和第二带预弯曲。
(38)一种操作外科器械的方法，所述外科器械包括：轴；端部执行器，其在关节运动枢轴处机械地连接到所述轴上，允许端部执行器相对于所述轴围绕关节运动轴线枢转；以及第一带，其延伸通过所述轴的至少一部分，所述第一带包括在与关节运动轴线偏移的点处机械地连接到端部执行器上的第一端部，所述方法包括：
沿着与所述轴基本上垂直的方向对所述器械施加力，所述力使第一带弯曲，所述第一带的弯曲使端部执行器相对于所述轴围绕关节运动枢轴沿第一方向枢转。
(39)如第(38)项所述的方法，其特征为，所述外科器械还包括第二带，所述第二带包括在与关节运动轴线偏移的第二点处机械地连接到端部执行器上的第一端部，所述方法包括：
沿着与所述轴基本上垂直的第二方向对所述器械施加第二力，所述第二力使第二带弯曲，所述第二带的弯曲使端部执行器相对于所述轴围绕关节运动枢轴沿第二方向枢转。
附图说明
结合到说明书中并构成说明书一部分的描述本发明的具体实施例的附图，与上述本发明的总体描述和以下给出的实施例的详细叙述一起，用于阐述本发明的原理。
图1是现有技术的外科器械的部分切除后的侧视图；
图2是现有技术的外科器械的端部执行器沿图1的线2-2的详细的侧面剖视图；
图3是根据本发明的各个实施例的外科器械的三维视图；
图4是根据本发明的各个实施例的外科器械的侧视图；
图5是根据本发明的各个实施例的外科器械的俯视图；
图6是根据本发明的一个实施例的外科器械的端部执行器和细长轴的俯视截面图；
图7是处于中间位置的图6所示外科器械的关节运动枢轴的俯视截面图；
图8是处于中间位置的图6所示外科器械的关节运动控制器的俯视截面图；
图9A是具有如图6所示器械的关节运动枢轴的外科器械的端部执行器和细长轴的分解图；
图9B是图9A所示器械的击发杆的俯视图；
图10是图6所示外科器械的关节运动枢轴的侧面剖视图；
图11是图10所示外科器械的端部执行器和关节运动枢轴的三维视图；
图12是根据本发明的各个实施例的图6所示的外科器械的端部执行器、关节运动枢轴和关节运动控制器的视图，其中端部执行器关节运动到左侧；
图13是图6所示的外科器械的关节运动控制器的俯视截面图，该关节运动控制器被推向左侧，以使图12所示的端部执行器运动；
图14是根据本发明另一个实施例的外科器械的关节运动枢轴的俯视截面图；
图15是具有如图14所示的关节运动枢轴的外科器械的端部执行器和细长轴的分解图；
图16是具有如图14所示的关节运动枢轴的外科器械的关节运动枢轴的另一个实施例的侧面剖视图；
图17是图14-16所示外科器械的端部执行器、关节运动枢轴和关节运动控制器的视图，其中端部执行器处于中间位置；
图18是图14-16所示外科器械的端部执行器、关节运动枢轴和关节运动控制器的视图，其中端部执行器关节运动到左侧；
图19是根据本发明的一个实施例的外科器械俯视截面图；
图20是处于中间位置的图19所示外科器械的关节运动控制器的俯视截面图；
图21是处于中间位置的图19所示外科器械的轴、缆线和弹簧组件的俯视截面图；
图22是关节运动到左侧的图19所示外科器械的关节运动控制器的俯视截面图；
图23是关节运动到左侧的图19所示外科器械的俯视截面图；
图24是关节运动到左侧的图19所示外科器械的轴、缆线和弹簧组件的俯视截面图；
图25是根据本发明的另一个实施例的外科器械的关节运动枢轴的俯视截面图；
图26是图25所示外科器械的关节运动枢轴的侧面剖视图；
图27是具有如图25和26所示的关节运动枢轴的外科器械的端部执行器和细长轴的分解图；
图28是用于图25和26所示的本发明的实施例的外科器械的液压致动的关节运动控制器的视图；
图29是图25-27所示外科器械的端部执行器和关节运动枢轴的视图，其中端部执行器处于中间位置；以及
图30是图25-27所示外科器械的端部执行器和关节运动枢轴的视图，其中端部执行器关节运动到右侧。
具体实施方式
图3-5显示了示例性的外科器械100，其基本上包括手柄103、轴104和在关节运动枢轴110处枢转连接到轴104上的关节运动端部执行器102。关节运动控制器112使端部执行器102围绕关节运动枢轴110转动。所示的端部执行器102用作用于夹紧、切割和缝合组织的内切割器，但是，应当理解，本发明的各个实施例可包括用作其它外科手术装置的端部执行器(未示出)，例如包括抓钳、切割器、缝合器、夹具施放器、接入装置、药物/基因治疗输送装置、超声波、RF或激光能量装置等。
器械100的手柄103可包括用于使端部执行器102关节运动的闭合扳机114和击发扳机116。应当理解，具有针对不同手术人物的端部执行器的器械可具有不同数量或类型的扳机或者其它用于操作端部执行器的合适的控制器。所示的端部执行器102优选由细长轴与手柄103分离。医生可通过利用关节运动控制器112使端部执行器102相对于轴104关节运动。
应当理解的是，如垂直、水平、右侧、左侧等空间术语在此是相对于附图而言，假定外科器械100的纵向轴线与轴104的中心轴线同轴，扳机114、116从手柄103的底部以锐角向下延伸。但是，在实际应用中，外科器械100可以各种角度定向，相对于外科器械100自身使用这些空间术语。另外，近侧用来表示位于手柄103后面的医生的视角，该医生将端部执行器102放置在远侧或者远离其自身。
在此使用的术语“流体连接”是指元件通过适当的管路或其他方式连接在一起以允许其间的加压的流体介质、空气等通过。如在此使用的，“供给管路”、“液压管路”、“回流管路”中使用的术语“管路”指由导管、管件、管道等形成的适当的流动通道，用于从一个部件向另一部件传输加压的液压流体。
在此使用的“液压流体”指适合于在液压系统中使用的任意流体。液压流体的非限制性的例子包括油、空气等。在一个非限制性的实施例中，液压流体可以是包括例如甘油、盐水等的生物相容性流体。
在此使用的短语“基本上垂直于纵向轴线”是指基本上垂直于纵向轴线的方向，  “纵向轴线”是轴的轴线。但是，应当理解的是，与纵向轴线的垂直方向有少量偏离的方向也基本上垂直于纵向轴线。
本发明的各个实施例是针对具有由弯曲的缆线或者带驱动的关节运动枢轴的器械。图6示出了示例性的细长轴104和包括由弯曲的带驱动的关节运动枢轴110的端部执行器102的俯视截面图。在图6所示的非限制性实施例中，带205可包括从凸起206沿着细长轴104延伸并通过关节运动控制器112的带部分202和204。带205和带部分202、204优选具有固定的长度。
图7示出了图6所示的关节运动枢轴110的截面图，其包括凸起206和带205。如图所示，可使用例如包括胶粘、焊接等的任何合适的紧固方法将带205机械连接到凸起206上。在各个实施例中，每个带部分202、204可以是分离的带，每个分离的带的一端连接到凸起206上，另一端通过轴104和关节运动控制器112(图7未示出)延伸。分离的带可以如上所述地连接到凸起206上。
带部分202、204可从凸起206通过关节运动枢轴110沿着细长轴104延伸到关节运动控制器112，如图8所示。关节运动控制器112可包括关节运动滑块208、框架212和外壳218。带部分202、204可通过狭槽210或者其它的开孔穿过关节运动滑块208，但是应当理解的是，带部分202、204可通过任何方式连接到滑块208上。关节运动滑块208可以是如图8所示的一件式部件，或者在一个非限制性实施例中，关节运动滑块208包括两件部件，两件部件之间的界面限定了狭槽210。在一个非限制性实施例中，关节运动滑块208可例如包括多个狭槽，每个狭槽对应于一个带部分202、204。外壳218可覆盖控制器112的各个部件，以防止碎屑进入。
在各个实施例中，带部分202、204可以在位于下挫210近侧的连接点214、216处锚固到框架212上。图8的非限制性实施例显示了带部分202、204从连接点214、216向轴104纵向轴线附近的狭槽210预弯曲。应当理解的是，带部分202、204可以在器械100的任何位于狭槽210的近侧的地方包括手柄103锚固。
图9A-11是包括图7所示的关节运动枢轴110的器械100的端部执行器102和细长轴104的视图。图9A-11所示的端部执行器102用作内切割器。应当理解的是，在各个实施例中，端部执行器102可以进行需要去除、改变或者添加图中所示的部件的其它外科手术任务。另外，应当理解的是，图3-6所示的端部执行器102可以定制，以用于特定的外科应用。例如图3-6和10-12示出了45mm的内切割器端部执行器，而图9A示出了60mm的内切割器端部执行器。
图9A示出了端部执行器102和细长轴104的分解图，包括各个内部元件。端部执行器框架150和轴框架154在关节运动枢轴110处连接。凸起206与端部执行器框架150形成一体，如图所示，带205于凸起206界面连接。轴框架154可包括指向远侧的柄脚302，柄脚302限定有孔304。孔304可定位成与端部执行器框架150中的关节运动销(未示出)界面连接，以允许端部执行器框架150相对于轴框架154枢转，并因此允许端部执行器102相对于轴104枢轴。各个部件在组装在一起时可在图10和11所示的关节运动轴线306处围绕关节运动枢轴110枢转。
图9A还示出了钉砧120。在该非限制实施例中，钉砧120连接到细长通道198上。例如，细长通道198的孔199可装纳钉砧120的销152，允许钉砧120相对于细长通道198和钉仓118从打开位置到关闭位置枢转。弹簧夹具158安装在端部执行器框架150中，作为用于击发杆172的锁定件。形成在端部执行器框架150顶部的远侧和近侧方孔164、168可在其间限定夹具杆170，用于装纳夹具弹簧158的上部臂162，夹具弹簧158的向远侧延伸的下部臂160对击发杆172的凸起部分174施加向下的力，后面将进行描述。应当理解的是，各个实施例可包括其它类型的锁定件，或者根本不包括锁定件。
另外，图9A示出了击发杆172，其能够通过轴框架154、通过挠性闭合和枢转框架关节运动接头110、并通过远侧框架底150中的击发狭槽176平移到端部执行器102中。击发杆172可由实心部分构造，或者在各个实施例中，可包括层压材料，所述层压材料例如包括一叠钢板173，如图9B所示。应当理解的是，由层压材料制成的击发杆172可降低使端部执行器102关节运动所需的力。击发杆172的远侧凸起的端部连接到E型梁178上，E型梁178有助于在钉砧120处于关闭位置时将钉砧120与钉仓118分隔开。E型梁178的锋利的切割刃182还可用于切割组织。
在操作中，E型梁178致动钉仓118。钉仓118包括模制的仓体194，仓体194容纳多个缝钉11，所述缝钉靠在分别向上打开的缝钉孔195中的缝钉驱动器192上。由E型梁178向远侧驱动楔形滑块190，使楔形滑块190在仓盘196上滑动，仓盘196将可替换的钉仓118的各个部件保持在一起。楔形滑块190使缝钉驱动器192向上运动，挤出缝钉191，使其变形并与钉砧120接处，同时E型梁178的切割表面182切割夹紧的组织。
在附图中，所示的击发杆172位于轴104中，当器械100击发时击发杆172通过仓体194。在一个非限制性实施例中，击发杆172位于轴104中，使得在击发期间全部或者部分击发杆172的主体由钉砧120的狭槽(未示出)支撑。由于钉砧120比钉仓118更坚固，来自狭槽的支撑可防止击发杆172弯曲，即使大的载荷施加到击发杆的远端178。在击发杆元件172包括层压板173的实施例中，这点是有用的。
应当理解的是，在击发期间E型梁178的上部销180接合钉砧120，而中间销184和底座186接合仓体194、仓盘196和细长通道198的各个部分。在使用中，仓体194的狭槽193与仓盘196的狭槽197对准，并且与细长通道198的狭槽189对准。E型梁178的前缘通过对准的狭槽193、197、189滑动。如图9A所示，底座186沿着狭槽189的长度接合沿通道198的底面延伸的沟槽。中间销184沿着纵向狭槽197接合仓盘196的顶面。底座186支撑在通道198的底部上，上部销180支撑在钉砧120的底面的沟槽中，防止由于使用中临床医生或者外科医生推进端部执行器时组织的阻力将钉砧120和通道198挤开。之后，击发杆172向近侧缩回，同时也缩回E型梁178，从而允许钉砧120打开，释放两个缝合和切割的组织部分(未示出)。
图9A-11还示出了根据本发明各个实施例的双枢轴闭合套管组件121。应当理解的是，本发明不限于双枢轴闭合套管组件设计，还可以包括任何合适的闭合套管，或者根本不设有闭合套管。具体参照图9A，双枢轴闭合套管组件121包括轴闭合管部分128，其具有远侧凸起的上部和下部柄脚146、148。端部执行器闭合管部分126包括马蹄形孔124和凸起123，用于接合钉砧120上的打开的凸起122。当钉砧120打开时马蹄形孔124和凸起123接合凸起122。所示的闭合管部分126具有近侧凸起的上部柄脚144和下部柄脚(未示出)。上部双枢轴连接件130包括向上凸起的远侧和近侧枢轴销134、136，它们分别接合远侧凸起的上部柄脚144中的远侧上部销孔138和远侧凸起的上部柄脚146中的近侧上部销孔140。下部双枢轴连接件132包括向下凸起的远侧和近侧枢轴销(图9A中未示出，参见图10)，它们分别接合近侧凸起的下部柄脚中的远侧下部销孔和远侧凸起的下部柄脚148中的近侧下部销孔142。
在使用中，闭合套管组件121向远侧平移，以例如响应于闭合扳机114的致动而闭合钉砧120。通过向远侧平移闭合管部分126，由此平移套管组件121，使套管组件121撞击在钉砧120的图9A中位于凸起122左侧的近侧表面上，从而闭合钉砧120。如图10和11中更清楚地显示的，通过向近侧平移管部分126，由此平移闭合组件121，使凸起123和马蹄形孔124接触并推动凸起122，以抬起钉砧120，从而打开钉砧120。在钉砧的打开位置，双枢轴闭合套管组件121运动到其近侧位置。
在操作中，医生可以通过横向推动控制器112使器械100的端部执行器102围绕枢轴110相对于轴104关节运动。参照图6和8，应当理解的是，如果带部分202、204具有固定的长度并且在关节运动期间保持拉紧，随后由关节运动控制器提供的横向力不会导致弯曲，因为当带部分202弯曲时带部分204防止端部执行器102转动。因此，在如图8所示的非限制性实施例中，带205被构造成使带部分202、204稍长于它们需要的长度，从而使端部执行器102关节运动。随后朝着狭槽210预弯曲带部分202、204，当端部执行器102处于中间位置时狭槽210的轴104的纵向轴线成一直线。
从中间位置，医生可通过向控制器112的左侧提供横向力使端部执行器102相对于轴104关节运动到左侧。响应于作用力，可通过如图12和13所示的框架212推动关节运动滑块208。当通过框架212推动滑块208时，狭槽210和带部分204可沿着横向(例如基本上横穿或者垂直于轴104的纵向轴线的方向)平移跨过细长轴104。因此，作用力施加到带部分204上，使得带部分204进一步从其初始预弯曲位置朝着轴104的相对侧弯曲。同时，带部分202从其初始预弯曲位置松弛。带部分204的进一步弯曲，加上带部分202的变直，使得逆时针的转动力施加在凸起206上，这又使凸起206和端部执行器102围绕关节运动枢轴110枢转到左侧，相对于轴104的轴线成所需的角度，如图12所示。带部分202的松弛减小了该带部分上的张力，允许带部分204使端部执行器102关节运动，不会受到来自带部分202的干扰。应当理解的是，医生也可以通过对控制器112的右侧提供侧向力，从而将端部执行器102相对于轴104关节运动到右侧。这会使带部分202弯曲，从而使顺时针的力作用在凸起206上，使得凸起206和端部执行器围绕关节运动枢轴110枢转到右侧。
图14-18显示出了用根据各个实施例的弯曲带使端部执行器102关节运动的另一实施例。应当理解的是，任意种类的端部执行器102可以与图14-18所示的实施例一起使用。例如，图14和16-18示出了全部或部分45mm的内切割器端部执行器，图15示出了60mm的内切割器端部执行器。图14示出了包括带401、403和凸起406的关节运动枢轴110。带401、403可如图所示朝着关节运动枢轴110向远侧延伸。带401可通过轴104沿着其左侧延伸，其中带401围绕带构件402，跨到轴104的右侧。带401可例如在连接点408处机械连接到凸起406上。同样，带403可通过轴104沿着其右侧延伸，其中带403围绕带构件404，跨到轴104的左侧。带403可例如在连接点410处机械连接到凸起406上。
图16示出了枢轴110的侧视截面图。根据一个非限制性实施例，所示的带401和403相互偏移，防止运动中干扰。例如，所示的带401处于比带403更低的位置。在另一个非限制性实施例中，可以倒转带401和403的垂直定位。图15示出了端部执行器102和轴104的分解图，包括内部元件。图15所示的端部执行器102用作内切割器，用于夹紧、缝合和切割组织，但是，应当理解的是，各个实施例可以利用针对与其他手术任务的端部执行器(未示出)。所示的带构件402、404连接到轴框架柄脚302上。另外，如图所示，凸起406可包括连接点408、410。各个部件在组装在一起时可围绕如图16所示的关节运动轴线306处的关节运动枢轴110枢转。
在使用中，图14的实施例可具有图17所示的未关节运动位置。所示的关节运动控制器112和带401、403位于中央位置，大致在轴104的纵向轴线处。因此，端部执行器102处于中间或者未关节运动位置。在图18中，示出了关节运动控制器112，其中通过关节运动框架滑块208被推到轴104的右侧。因此，带401、403朝着轴104的右侧弯曲。由此可知，带401向右侧弯曲队从凸起406的枢转点偏移的凸起406施加侧向力。偏移力使得凸起406围绕关节运动枢轴110转动，这又使得端部执行器102如图所示枢转到右侧。应当理解的是，将关节运动滑块推动到轴104的左侧可对带401、403施加侧向力，使得带401、403朝着轴104的左侧弯曲。带403的弯曲随后使在凸起406上施加侧向力，该凸起406如上所述从凸起406的枢转点偏移。这又使得凸起406围绕关节运动枢轴转动，从而使端部执行器102枢转到左侧。
图19-24示出了使端部执行器102关节运动的另一实施例，其中带252、254定向成在从轴104的纵向轴线偏移的点与关节运动控制器112连接。因此，带252、254基本上比分别如图6和17所示的带部分202、204和带401、403在轴104中相对于彼此更加平行。图19示出了根据图19-24所示的实施例的示例性轴104、端部执行器102和关节运动控制器112的俯视截面图。所示的带252、254从凸起256通过轴104延伸到关节运动控制器112。弹簧组件258和260沿着带252、254的长度设置，从而允许带延长。应当理解的是，带252、254可以是例如类似于图14-18所示的带401、403的分离的带，或者是类似于图6-13所示的带205和带部分202、204的一个具有两部分的带。同样，应当理解的是，带252、254可以从凸起256围绕类似于图14-48所示的带构件402、404的带构件(未示出)经过。
图20示出了根据实施例19-24的轴104和关节运动控制器112的示例性连接界面的俯视截面图。带252、254可延伸通过轴104，并在连接垫214、216处锚固到关节运动控制器112上之前在关节运动滑块280的滑块开口262处与关节运动控制器112界面连接。带252、254可在滑块开口262和连接点214、216之间预弯曲。但应当理解的是，由于带252、254在从轴104偏移的点处与关节运动控制器112界面连接，因此带252、254的预弯曲程度与如图8所示的带部分202或204不同。
图21示出了弹簧组件258、260的特定的截面图。弹簧组件258、260允许带252、254在低的张力下伸长，但防止带252、254在高的张力下伸长。相对于弹簧组件258、260，活塞272位于壳体270内。弹簧274连接到活塞272和壳体270上。当带252或254处于较低的张力下时，弹簧272稍微伸长，允许活塞272朝着壳体270的开口271运动。当带252或254处于更大的张力下时，活塞272运动成在开口271附近与壳体270接触，防止弹簧组件258或260进一步伸长。
图22示出了图20的关节运动控制器112，其中关节运动滑块280从左侧跨过轴104的纵向轴线推到右侧。因此，带252朝着轴104的右侧弯曲，同时带254通过挡块282保持在其原始位置。参照图24，当最初关节运动控制器112使带252开始弯曲时，弹簧组件258的弹簧274伸长，直到活塞272接触壳体270，弹簧组件258不再伸长。此时，带252的继续弯曲在凸起256上产生逆时针的转动力。当凸起256开始响应于转动力旋转时，其在未弯曲的带254上施加张力。因此，弹簧组件260的弹簧274可以伸长，从而使带254伸长，并允许凸起256沿着逆时针方向转动。凸起256的转动使得端部执行器102向左侧转动方向枢转，如图23所示。应当理解的是，带254的张力较低，足以使弹簧组件260在端部执行器102在所需的范围内运动其间不会到达其最大伸长位置。
与图22-24所示的状态相反，使关节运动滑块280从右侧向左侧滑过轴104，从而使得带254弯曲、凸起256顺时针转动、端部执行器102向右关节运动，其中带252、254的作用与上面描述的相反。此外，应当理解的是，在各种不同的应用中，端部执行器102可能只需要相对于轴沿一个转动方向枢转。因此，可以仅将一个弹簧组件定位在与所需的关节运动方向相反的带上，从而实施图19-24所示的实施例。在这种情况下，弹簧组件可以是任意的弹簧，例如包括适当的带的弹性部分。
图25-30示出了用根据各个实施例的弯曲的缆线或带使端部执行器102液压关节运动的实施例。应当理解的是，任何种类的端部执行器102可以与图25-30所示的实施例一起使用。例如，图25-26和29-30示出了45mm的全部或部分内切割器端部执行器，图27示出了60mm的内切割器端部执行器。参照图25，所示的构件508连接到端部执行器102上。构件508在销522处枢转地连接到轴104上，允许端部执行器102和构件508围绕销522枢转。在各个实施例中，销522位于关节运动轴线306处(如图26所示)。
带502、504可例如分别在连接点507、509处连接到构件508上。应当理解的是，在各个非限制性实施例中，带502、504可以用一根围绕构件508延伸的例如与如图7所示的实施例类似的带(未示出)代替。回到图25，带502、504可从构件508分别延伸到位于轴104右侧的连接点513、511。每根带502、504还被定位成分别与所示的液压囊510、512有效地接触。
囊510、512在例如通过液压管路514、516供应有加压液压流体时可向近侧膨胀。囊510、512在膨胀时在带502、504上施加近侧弯曲力。例如，囊510在膨胀时在带504上施加弯曲力，这又在偏移构件508的枢转点的力，从而使端部执行器102围绕关节运动轴线(如图26所示)转动。在图25-27和29-30所示的实施例中，囊510、512都定位在轴104的右侧。但应当理解的是，在其它非限制性的实施例中，囊可以位于轴104的左侧，或者囊510、512位于轴104的不同侧上。囊510、512在加压下的膨胀可以沿任何方向，只要该膨胀能够在带502或504上施加力，使得囊与带502或504有效地接触，从而将转动力施加在构件508和端部执行器102上。
图26-27是根据图25的实施例的端部执行器102和轴104的其它视图。图27是端部执行器102和轴104的部件的分解视图。在各个非限制性实施例中，构件508可以是端部执行器框架150的一体的部分。所示的轴框架526包括销孔520。销522可接合由构件508限定的销孔518，由此将构件508紧固到轴框架526上，允许构件508和端部执行器102围绕销522转动。所示的框架526还包括液压囊壳540和542，分别用于封装液压囊510、512。
可以用图28所示的关节运动控制器501操作液压囊510、512。包括在关节运动控制器501中的左侧和右侧致动囊528、530在被致动时对液压管路514、516提供加压的液压流体。致动囊528、530可以封装在包括顶部532和底部534的框架组件中。包括在框架组件中的左侧和右侧按钮536、538允许医生液压囊528、530中的一个或另一个，由此致动液压囊528或530，从而迫使液压流体从囊分别经过相关联的液压管路514、516到达囊512或510，使端部执行器102转动。
图29-30是图25所示实施例使用时的截面图。在图29中，囊510和囊512均未膨胀。因此，所示的端部执行器102处于中间位置，即未关节运动位置。相反，图30示出了处于膨胀状态的囊510。囊510例如响应于通过管路516提供的加压液压流体膨胀。在其膨胀状态下，囊510能够对带504提供弯曲力。带504施加偏移构件508的枢转点的力，使构件508沿顺时针方向转动，从而使端部执行器102如图所示关节运动到右侧。
尽管已经通过各个实施例的描述示例性示出了本发明，尽管已经相当详细地描述了这些示例性实施例，当时申请人并不意图将后附权利要求书的范围局限或者以任何方式限制到这些细节。本领域技术人员了解其它优点和变型。
例如，尽管上述实施例能够用于内窥镜外科切割和缝合器械100，类似的实施例可以用于其它临床手术。普遍接受的是，内窥镜手术比腹腔镜手术更常见。因此，本发明仅针对内窥镜手术和设备进行了描述。但是，如“内窥镜”的术语的使用不应该理解为将本发明的外科器械限制成仅仅与内窥镜管(即套管针)联用。相反，应当认为本发明适用于任何需要通过小切口进入的手术，包括但不限于腹腔镜手术和开放手术。
作为另一个例子，尽管所描述的示例性手柄部分103响应于来自医生的输入进行机械操作，但是，根据本发明，手柄部分的部分或者全部功能可以通过其它方式(例如，气动、机电、超声波、液压等)提供能量。另外，可以通过手动或者遥控(例如无线电遥控、自动远程控制台等)控制实现手柄部分上的每个这些功能。
通过引用而全部或者部分并入本文中的任何专利、公开出版物或者其它公开的材料，仅限于不会与在本申请中公开的定义、陈述或者其它公开的材料相矛盾的部分。如此一来，必要时这里明显阐述的公开内容替代任何通过引用而并入本文中的相矛盾的材料。

Claims (10)

1、一种关节运动的外科器械，包括：
具有纵向轴线的轴；
端部执行器，其在关节运动枢轴处可操作地连接到所述轴上；
第一带，其可操作地连接到所述端部执行器上，并延伸通过所述轴的至少一部分；以及
关节运动控制器，用于沿着基本上垂直于所述纵向轴线的方向施加力，所述关节运动控制器可操作地连接到所述第一带上，使得施加的力通过第一带平移到端部执行器上，从而使端部执行器相对于轴围绕关节运动枢轴转动。
2、如权利要求1所述的器械，其特征为，所述关节运动控制器能够沿着第一方向运动，以沿着第一横向施加力，使端部执行器相对于轴沿着第一转动方向转动。
3、如权利要求2所述的器械，其特征为，所述关节运动控制器能够沿着第二方向运动，以沿着与第一横向相反的第二横向施加力，使端部执行器相对于轴沿着第二转动方向转动。
4、如权利要求2所述的器械，其特征为，还包括第二带，所述第二带可操作地连接到端部执行器上，并从端部执行器延伸通过所述轴的至少一部分，所述关节运动控制器可操作地连接到所述第二带上，使得施加的力通过第二带平移到端部执行器上，从而使端部执行器相对于轴沿着第二转动方向转动。
5、如权利要求4所述的器械，其特征为，所述关节运动控制器包括关节运动滑块，所述关节运动滑块可跨过轴横向地运动到第一、第二和中间位置。
6、如权利要求5所述的器械，其特征为，所述滑块可跨过轴横向地运动到第三和第四位置。
7、如权利要求5所述的器械，其特征为，当所述关节运动控制器处于中间位置时，所述第一带和第二带朝着纵向轴线预弯曲。
8、如权利要求5所述的器械，其特征为，当所述关节运动滑块位于中间位置时，所述关节运动滑块限定了位于纵向轴线附近的狭槽，当所述关节运动滑块处于第一和第二位置中的一个时，所述第一带和第二带穿过所述狭槽，并且所述关节运动滑块的位置相对纵向轴线偏移。
9、如权利要求1所述的器械，其特征为，还包括第一远侧构件，所述第一带从端部执行器绕过第一远侧构件。
10、如权利要求9所述的器械，其特征为，还包括第二带和第二远侧构件，所述第二带可操作地连接到端部执行器上，并从端部执行器延伸通过所述轴的至少一部分，所述第二带从端部执行器绕过第二远侧构件。
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US7670334B2 (en) 2010-03-02
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