CN101152098B - 用于圆形缝合器的基于电活化聚合物的关节运动机构 - Google Patents

用于圆形缝合器的基于电活化聚合物的关节运动机构 Download PDF

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CN101152098B
CN101152098B CN2006101463773A CN200610146377A CN101152098B CN 101152098 B CN101152098 B CN 101152098B CN 2006101463773 A CN2006101463773 A CN 2006101463773A CN 200610146377 A CN200610146377 A CN 200610146377A CN 101152098 B CN101152098 B CN 101152098B
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马克·S·奥尔蒂斯
弗雷德里克·E·谢尔顿四世
约瑟夫·C·休伊尔
杰弗里·S·斯韦兹
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Ethicon Endo Surgery Inc
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    • 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
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    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
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Abstract

本发明提供用于致动圆形缝合器和/或使之进行关节运动的方法和装置。在一个示范性实施例中，提供一种具有细长轴的圆形缝合器，该细长轴具有与其联接的缝合装置。可采用例如电活化聚合物致动器的可电扩张和收缩致动器，以便通过向电活化聚合物致动器输送能量来枢转地或成角度地调整缝合装置相对于细长轴的位置。在另一个实施例中，可采用电活化聚合物致动器致动缝合装置，由此优选以大致弯曲的图式驱动一个或多个钉进入组织。该致动器可有选择地或额外地向远侧驱动刀，以切割被缝合的组织。

Description

用于圆形缝合器的基于电活化聚合物的关节运动机构
相关申请的交互参考
本申请是于2005年3月17日提交的、发明名称为“SurgicalInstrument Incorporating an Electrically Actuated ArticulationMechanism”的美国专利申请No.11/082,495的部分继续申请，该美国专利申请要求于2004年7月28日提交的、发明名称为“SurgicalInstrument Incorporating an Electrically Actuated ArticulationMechnism”的美国临时申请No.60/591,694的优先权。这些申请的全部内容在此通过引用接合入本文。
技术领域
本发明广义上涉及外科装置，尤其涉及使如圆形缝合器一类的外科工具上的端部执行器进行关节运动和/或致动端部执行器的方法和装置。
背景技术
内窥镜外科器械通常比传统的开放式外科装置更受到偏爱，这是因为较小的切口易于减少术后恢复时间和并发症。因此，在适合于将远端执行器通过套管针的插管精确地设置在所需手术部位的内窥镜外科器械领域中已经有了显著发展。这些远端执行器以多种方式接合组织以达到诊断或治疗效果(例如，内切割器、抓钳、切割器、缝合器、夹具施放器、接触装置、药物/基因治疗输送装置和使用超声波、RF、激光等的能量装置)。
吻合术是对分离的组织部分进行外科手术接合。典型地，吻合过程是在外科手术之后进行，在该外科手术中，去除中空组织的有病变或有缺陷的部分，并将其余的端部部分接合在一起，当然，也可吻合直肠或其它组织。基于所需要的吻合操作，端部部分可通过圆形、对端或对边器官重建方法进行接合。
在圆形吻合操作中，通过缝合器械将组织片断的两端接合在一起，该缝合器械驱动钉的圆形阵列穿过每个组织片断并同时将被驱动的钉的圆形阵列内部的任何组织挖除以形成管状通道。已知的圆形缝合器典型地包括位于钉保持部件附近的砧座头。待缝合的组织的相对端部分被夹钳在砧座头和钉保持部件之间，并且通过从钉保持部件驱动一个或多个钉来缝合被夹钳的组织，从而使钉的端部穿过组织并受砧座头作用产生变形。可同时或随后推进环形刀具挖出中心组织以形成管状通道。
目前的圆形缝合装置的一个缺点是，需要较大的力来实现击发，而且该力在击发冲程的整个过程中发生改变。目前大多数圆形缝合装置利用一个手握触发器。在击发早期阶段期间，当钉被推出钉仓并刺入组织时，负荷较低。一旦钉进入砧座凹槽，当钉腿弯曲时，阻力和负载就会很快升高。而后，阻力和负载降低并在形成缝合时再次升高。相反，操作者在击发冲程早期和中期阶段具有最大的力量，而该力量在闭合的最后阶段最小。实现击发所需要的较大力以及该力的变化经常会超过外科医生的手的力量，并可潜在地导致当需要未料想到的较大力时会出现束缚或其它故障。
实现击发所需要的较大力还会与轴的挠性或适应性相冲突。目前，钉保持部件可枢转地与轴相联，或者轴可以是挠性的以允许轴穿过弯曲的路径。力从手柄到钉保持部件的传递必然妨碍轴的枢转或弯曲取向，潜在地导致其变直。
因此，需要用于使圆形缝合器致动和/或进行关节运动的方法和装置，尤其是需要以较低的力来实现圆形缝合器的致动和/或关节运动的方法和装置。
发明内容
本发明提供缝合组织的各种装置和方法。在一个实施例中，提供一种圆形缝合器，该圆形缝合器包括具有缝合装置的细长轴，该缝合装置联接至细长轴的远端并适于以大致弯曲的图式将钉送入组织。虽然缝合装置可具有各种结构，在一个实施例中，缝合装置包括钉施放组件和砧座，所述砧座联接至该钉施放组件并可在张开的组织接收位置和闭合的钉施放位置之间运动。在一个示范性实施例中，该装置还包括一个或多个用于实现缝合装置的关节运动和/或致动的致动器。该装置还可包括在细长轴的近端上形成的手柄，且该手柄具有用于有选择地向致动器输送能量的控制机构。
在一个实施例中，可采用电活化聚合物致动器实现该装置的致动，该电活化聚合物致动器联接至钉施放组件并适于驱动一个或多个钉进入位于钉施放组件和砧座之间的组织。例如，钉施放组件可包括驱动器，该驱动器适于向远侧运动，以向着砧座驱动钉穿过钉施放组件。电活化聚合物致动器可联接至驱动器和钉施放组件，且其可适于当向电活化聚合物输送能量时向远侧运动驱动器。虽然电活化聚合物致动器可具有各种结构，在一个示范性实施例中，电活化聚合物致动器可以是一个或多个电活化聚合物索的形式，其适于当向其输送能量时沿轴向收缩，以在钉施放组件内向远侧拉动所述驱动器。
在另一个实施例中，缝合装置可包括电活化聚合物致动器，该电活化聚合物致动器联接至砧座且适于当向其输送能量时使砧座从张开的组织接收位置向闭合的钉施放位置运动。在一个示范性实施例中，电活化聚合物致动器是电活化聚合物索的形式，当向其输送能量时，其轴向收缩以将砧座拉向钉施放组件。
本发明还提供缝合组织的方法。在一个实施例中，该方法可包括将圆形缝合器插入体腔内，将要缝合的组织设置在砧座和位于圆形缝合器远端上的钉施放组件之间，向联接至钉施放组件的电活化聚合物致动器输送能量以驱动多个钉穿过钉施放组件并抵住砧座，从而用定位成大致弯曲图式的钉缝合位于其间的组织。在一个实施例中，向电活化聚合物致动器输送能量能够有效地运动设置在钉施放组件内的驱动器以驱动钉穿过其中并抵住砧座。在一个示范性实施例中，当向其输送能量时，电活化聚合物致动器可轴向收缩以运动驱动器穿过钉施放组件。在另一个实施例中，电活化聚合物致动器可联接至砧座且向电活化聚合物致动器输送的能量可将砧座拉向钉施放组件。
在另一个实施例中，可采用电活化聚合物致动器实现圆形缝合装置的端部执行器的关节运动。例如，该装置可包括细长轴和端部执行器，该端部执行器通过关节运动接头可动地联接到细长轴的远端。端部执行器可适于以大致弯曲的图式将钉送入组织。该装置还可包括电活化聚合物致动器，其联接至关节运动接头并适于当向电活化聚合物致动器输送能量时，使端部执行器绕关节运动接头相对于细长轴运动。
虽然可采用各种技术来运动关节运动接头，从而使用端部执行器，在一个实施例中，细长轴可包括延伸穿过其中并具有联接至关节运动接头的远端的滑棒。电活化聚合物致动器可设置成沿侧向运动该滑棒以实现端部致动器的运动。例如，电活化聚合物致动器可包括设置在滑棒相对侧上的第一和第二电活化聚合物致动器。滑棒可包括在其远端上形成的并适于与在关节运动接头上形成的相应齿轮啮合的齿轮。在另一个实施例中，关节运动接头可以是枢轴接头的形式，且电活化聚合物致动器可包括在端部执行器的第一侧和细长轴的第一侧之间延伸的第一电活化聚合物致动器，和在端部执行器的第二相对侧和细长轴的第二相对侧之间延伸的第二电活化聚合物致动器。在又一个实施例中，关节运动接头可以是在细长轴和端部执行器之间形成的挠性部分的形式。电活化聚合物致动器可包括在不同位置处联接至该挠性部分的多个电活化聚合物致动器，多个电活化聚合物致动器的每一个设置成当向其输送能量时改变取向，以使挠性部分挠曲。
本发明还提供一种固定组织的方法，在一个实施例中该方法包括：将圆形缝合装置的细长轴插入体腔内，以将可动地联接至细长轴远端的端部执行器定位在手术部位附近；向电活化聚合物致动器输送能量，使端部执行器相对于细长轴成角度地定位；以及同时推动多个钉穿过端部执行器以缝合设置在端部执行器附近的组织。向电活化聚合物致动器输送能量可导致电活化聚合物致动器沿径向扩张，以沿侧向运动滑棒，从而实现端部执行器的枢转运动，所述滑棒延伸穿过细长轴并联接至在细长轴和端部执行器之间形成的关节运动接头。可选择地，向电活化聚合物致动器输送能量可导致电活化聚合物致动器沿轴向收缩，以沿侧向运动滑棒，从而实现端部执行器的枢转运动，所述滑棒延伸穿过细长轴并联接至在细长轴和端部执行器之间形成的关节运动接头。在其它实施例中，可向第一电活化聚合物致动器输送能量以沿第一方向运动端部执行器，并可向第二电活化聚合物致动器输送能量以沿相反的第二方向运动端部执行器。向每个电活化聚合物致动器输送的能量量值可对应于端部执行器的运动程度。在又一个实施例中，向电活化聚合物致动器输送能量可通过使细长轴和端部执行器之间的挠性部分挠曲来使端部执行器相对于细长轴以一定角度定位。在其它实施例中，在同时推进多个钉之前，组织可接合在端部执行器的钉施放组件和砧座之间。例如，可向电活化聚合物致动器输送能量以使砧座向钉施放组件运动。在又一个实施例中，同时推进多个钉可包括向联接至推进钉的电活化聚合物致动器输送能量以同时推进多个钉穿过端部执行器，从而缝合设置在端部执行器附近的组织。
更具体地说，本发明涉及如下内容：
(1)一种圆形缝合装置，包括：
具有近端和远端的细长轴；
钉施放组件，其联接至细长轴的远端且适于以大致弯曲的图式将钉输送进组织；
砧座，其联接至钉施放组件并可在张开的组织接收位置和闭合的钉施放位置之间运动；和
电活化聚合物致动器，其联接至钉施放组件并适于从钉施放组件驱动一个或多个钉进入位于钉施放组件和砧座之间的组织。
(2)如第(1)项所述的装置，还包括驱动器，该驱动器位于钉施放组件内并适于向远侧运动以向着砧座驱动钉穿过钉施放组件，电活化聚合物致动器联接至驱动器并适于当向该电活化聚合物致动器输送能量时使驱动器向远侧运动。
(3)如第(2)项所述的装置，其中，所述驱动器包括形成于其上并适于切割被缝合组织的刀。
(4)如第(2)项所述的装置，其中，所述电活化聚合物致动器包括联接至钉施放组件的一部分的第一端，以及联接至所述驱动器的第二端。
(5)如第(4)项所述的装置，其中，所述第一端位于电活化聚合物致动器的第二端的远侧。
(6)如第(5)项所述的装置，其中，所述电活化聚合物致动器包括至少一个电活化聚合物索，该电活化聚合物索适于当向其输送能量时沿轴向收缩以向远侧拉动驱动器。
(7)如第(1)项所述的装置，还包括手柄，该手柄形成于细长轴的近端上并包括适于有选择地向电活化聚合物致动器输送能量的控制机构。
(8)如第(1)项所述的装置，还包括第二电活化聚合物致动器，该第二电活化聚合物致动器联接至砧座并适于当向该第二电活化聚合物致动器输送能量时使砧座从张开的组织接收位置向闭合的钉施放位置运动。
(9)如第(1)项所述的装置，其中，可相对于细长轴的远端成角度地调整钉施放组件，且其中该装置还包括第二电活化聚合物致动器，该第二电活化聚合物致动器联接在钉施放组件和细长轴之间并适于当向该第二电活化聚合物致动器输送能量时成角度地调整钉施放组件相对于细长轴的位置。
(10)一种缝合组织的方法，包括：
将圆形缝合器插入体腔内；
将待缝合的组织定位在位于圆形缝合器远端上的砧座和钉施放组件之间；和
向联接至钉施放组件的电活化聚合物致动器输送能量以驱动多个钉穿过钉施放组件并抵住砧座，从而用以大致弯曲的图式定位的钉缝合位于其间的组织。
(11)如第(10)项所述的方法，其中，向电活化聚合物致动器输送能量有效地运动设置在钉施放组件内的驱动器，以驱动钉穿过其中并抵住砧座。
(12)如第(11)项所述的方法，其中，当向电活化聚合物致动器输送能量时，该电活化聚合物致动器沿轴向收缩以拉动驱动器穿过钉施放组件。
(13)如第(10)项所述的方法，其中，将待缝合的组织定位在砧座和钉施放组件之间包括将组织拉进在砧座和钉施放组件之间形成的缝隙，并且使砧座向钉施放组件运动以接合在其间的组织。
(14)如第(13)项所述的方法，其中，使砧座向钉施放组件运动包括向联接至砧座的第二电活化聚合物致动器输送能量以使该电活化聚合物致动器将砧座拉向钉施放组件。
(15)如第(10)项所述的方法，还包括切除一部分被缝合的组织。
(16)如第(10)项所述的方法，还包括在定位组织之前，成角度地调整钉施放组件和砧座的位置。
(17)如第(16)项所述的方法，其中，通过向联接至钉施放组件的第二电活化聚合物致动器输送能量来成角度地调整钉施放组件和砧座。
附图说明
从下面结合附图进行的详细描述将获得本发明的更全面的理解，附图中：
图1A是现有技术的纤维束类型的EAP致动器的剖视图；
图1B是图1A中所示现有技术的致动器的沿径向的剖视图；
图2A是具有多个EAP复合层的现有技术的层压型EAP致动器的剖视图；
图2B是图2A所示现有技术的致动器的其中一个复合层的透视图；
图3A是圆形缝合器的一个示范性实施例的部分剖视图，该圆形缝合器具有在其远端上形成的缝合装置，所述缝合装置具有砧座和钉施放组件；
图3B是图3A的圆形缝合器的远侧部分的部分剖视图，示出用于致动钉施放组件的电活化聚合物致动器的一个示范性实施例；
图3C是圆形缝合器的远侧部分的另一个实施例的剖视图，该圆形缝合器具有用于驱动钉穿过钉施放组件的电活化聚合物致动器；
图4A是圆形缝合器一个示范性实施例的远侧部分的剖视图，示出用于实现钉施放组件关节运动的处于非致动结构的EAP致动器；
图4B是图4A所示圆形缝合器的远侧部分的剖视图，示出其中一个EAP致动器被电致动，以使钉施放组件进行关节运动；
图5A是钉施放组件的另一实施例的剖视图，该钉施放组件可动地联接至细长轴的远侧部分并具有用于使钉施放组件进行关节运动的EAP致动器；
图5B是图5A所示钉施放组件和细长轴的部分剖视图，示出其中一个EAP致动器被电致动，以使钉施放组件进行关节运动；
图6是钉施放组件的另一个实施例的部分剖视图，该钉施放组件可动地联接至细长轴的远侧部分并具有用于使钉施放组件进行关节运动的EAP致动器；
图7A是钉施放组件的另一实施例的部分剖视图，该钉施放组件可动地联接至细长轴的远侧部分并具有用于使钉施放组件进行关节运动的EAP致动器；
图7B是图7A所示钉施放组件和细长轴的部分剖视图，示出其中一个EAP致动器被电致动，以使钉施放组件进行关节运动；
图8A是钉施放组件的又一实施例的部分剖视图，该钉施放组件可动地联接至细长轴的远侧部分并具有用于使钉施放组件进行关节运动的EAP致动器；
图8B是图8A所示钉施放组件和细长轴的部分剖视图，示出其中一个EAP致动器被电致动，以使钉施放组件进行关节运动；
图9是钉施放组件的又一实施例的透视图，该钉施放组件通过挠性部分可动地联接至细长轴的远侧部分并具有用于使钉施放组件进行关节运动的EAP致动器；
图10是钉施放组件的又一实施例的透视图，该钉施放组件通过挠性部分可动地联接至细长轴的远侧部分并具有用于使钉施放组件进行关节运动的EAP致动器；
图11A处于未致动位置的锁定机构的一个示范性实施例的透视图，其用于锁定图4A-10任一个中的钉施放组件和细长轴之间的可动接头；和
图11B是图11A的锁定机构的透视图，致动该锁定机构以将可动接头锁定在固定位置；
具体实施方式
现在将描述一些示范性实施例，以提供在此公开的装置和方法的结构、功能、制造和使用的原则的全面理解。在附图中示出了这些实施例的一个或多个实例。本领域技术人员将会意识到，在此具体描述和在附图中示出的装置和方法是非限制性的示范性实施例，而本发明的范围仅由权利要求书限定。就一个示范性实施例示出或描述的特征可与其它实施例的特征相结合。这种修改和改变应包括在本发明的范围内。
本发明总的提供用于实现圆形缝合器的一个或多个部件的运动的方法和装置。在一个示范性实施例中，提供一种圆形缝合器，该缝合器具有细长轴，该细长轴具有联接至其上的端部执行器或钉施放组件。可采用可电扩张和收缩致动器(如电活化聚合物致动器)来致动钉施放组件，从而驱动一个或多个钉、优选基本上为弯曲图式的多个钉钉进组织。还可任选采用可电扩张和收缩致动器使砧座向钉施放组件运动。在另一个实施例中，提供具有缝合装置的圆形缝合器，该缝合装置可动地联接至细长轴的远端。可采用可电扩张和收缩电动机，如电活化聚合物致动器，通过向电活化聚合物致动器输送能量来枢转地或成角度地调整缝合装置相对于细长轴的位置。本领域技术人员将会意识到，该圆形缝合器可具有各种结构，而且一个或多个电活化聚合物致动器可联接至圆形缝合器的一个或多个部件以实现运动。
电活化聚合物
电活化聚合物(EAPs)(也称为人造肌肉)是响应电或机械场呈现压电、热电或电致伸缩特性的材料。具体地，EAPs是一组当施放电压时改变形状的导电掺杂质聚合物。该导电聚合物可与一些形式的离子流体或凝胶和电极配对，并且离子从流体/凝胶流入或流出导电聚合物可导致聚合物形状的变化。典型地，可基于具体所使用的聚合物和离子流体或凝胶使用范围在约1V至4kV的电势。重要的是要注意到，当受到激发时，EAPs不会改变体积，而是只在一个方向上扩张并且横向上收缩。
EAPs的一个主要优点是它们的性能和特性能够受电控制和微调。可通过穿过EAP施放外部电压来使EAPs反复变形，而且当反转所施放的电压极性时，EAPs能够快速恢复其原始结构。可选择特定的聚合物来形成不同种类的运动结构，包括扩张、线性运动和弯曲结构。EAPs还可与机械机构(如弹簧或挠性板)配对，以改变当施放电压时所导致的效果。
存在两种基本类型的EAPs并且每种类型具有多种结构。第一种类型是可由许多纤维绑束在一起协同工作而组成的纤维束。这些纤维典型地具有约30-50微米的尺寸。这些纤维可以类似编织品那样被编织成束，且其通常被称为EAP纱。使用时，EAP的机械结构决定EAP的致动器及其运动能力。例如，EAP可以形成长绞股并且缠绕在单个中央电极周围。挠性的外部护套将形成致动器的另一个电极，并且该护套用于容纳装置功能所必需的离子流。当向其施放电压时，EAP将胀大，导致绞股收缩或变短。这些纤维可有选择地构造成扩张或加长。可从商业渠道获得的纤维EAP材料的一个实例是由Santa Fe Scienceand Technology制造的，作为PANIONTM纤维出售，其在美国专利No.6,667,825中有所描述，该专利的全部内容通过引用结合入本文。
图1A-1B示出了由纤维束形成的EAP致动器100的一个示范性实施例。如所示，致动器100通常包括挠性导电外护套102，该外护套102成其上具有端盖102a、102b的细长圆筒件形式。然而，外护套102可基于不同的用途具有各种其它形状和尺寸。如所进一步示出的，外护套102联接到能量输送电极108a和回流电极108b。在所示出的实施例中，能量输送电极108a延伸穿过一个端盖(如端盖102a)，穿过导电外护套102的内腔并进入相对的端盖(例如端盖102b)。能量输送电极108a可以是例如铂阴极导线，并且其可以与外护套102的任何部分联接。导电外护套102还可包括设置在其内的离子流体或凝胶106，用于从能量输送电极108a向设置在外护套102内的EAP纤维104传送能量。具体地，数个EAP纤维104平行布置并在每个端盖102a、102b之间延伸且穿进每个端盖102a、102b。如上所述，纤维104可布置成不同取向以提供所需的结果，例如，径向扩张或收缩或者弯曲运动。使用时，通过有源能量输送电极106a向致动器100输送能量。该能量导致离子流体内的离子进入EAP纤维104，从而导致纤维104向一个方向(例如径向)扩张，从而每个纤维104的外径增加，并沿横向方向(例如轴向)收缩，从而纤维的长度减小。结果，端盖102a、102b将会被拉向彼此，从而使挠性外护套102的长度收缩和减小。
EAP的另一种类型是层压结构，其由一层或多层EAP组成，在每层EAP之间设置有一层离子凝胶或流体，并且将一个或多个挠性板附着到该结构上。当施加电压时，层压结构沿一个方向扩张并沿横向或垂直方向收缩，从而导致与其联接的挠性板变短或加长，或者弯曲或挠曲，这取决于EAP相对于挠性板的结构。可由商业渠道获得层压EAP材料的一个实例是由作为SRI Laboratories的一个部门的Artificial Muscle Inc制造的。板状EAP材料也可从日本的EAMEX获得，该材料被称为薄膜EAP。
图2A-2B示出由层压件形成的EAP致动器200的示范性结构。首先参见图2A，致动器200可包括多层(例如，所示出的五层210、210a、210b、210c、210d)层压EAP复合物，这些层通过设置在其间的粘合层103a、103b、103c、103d彼此粘合在一起。在图2B中更详细地示出所述层中的一层，即，层210，如所示，层210包括第一挠性导电板212a、EAP层214、离子凝胶层216和第二挠性导电板212b，所有这些层均彼此附着在一起形成层压复合物。该复合物还可包括与挠性导电板212a、212b联接的能量输送电极218a和回流电极218b，如图2B所进一步示出的。使用时，可通过有源能量输送电极218a向致动器200输送能量。该能量将导致离子凝胶层216内的离子进入EAP层214，从而导致层214沿一个方向扩张并沿横向方向收缩。结果，将迫使挠性板212a、212b挠曲或弯曲，或者随EAP层214改变形状。
圆形缝合器
如前所述，在一个示范性实施例中，提供圆形缝合方法和装置，其利用可电扩张和收缩致动器(如EAP致动器)来实现该装置各种部件的关节运动和/或致动。在此公开的用于实现关节运动和致动的各种方法和装置可实际结合到任何现有技术已知的圆形缝合器中，且该圆形缝合器可包括各种其它现有技术已知但未在此公开的特征。图3A-3C示出示范性的圆形缝合器，其可包括一个或多个EAP致动器，用于实现关节运动和/或致动。本领域技术人员将会意识到，虽然各种实施例描述成具有用于在无机械辅助情况下影响关节运动和/或致动的EAP致动器，这些致动器可有选择地设置成补充机械关节运动和/或致动。
通常，缝合器10包括细长轴12，该细长轴12具有联接到其近端12a的手柄14以及联接到其远端12b的缝合装置11。缝合装置11包括适于在其间接纳组织的钉施放组件16和砧座18。钉施放组件适于容纳钉仓44，钉仓44具有设置在其中并设置成受撞针或驱动器42驱动钉入组织的多个钉，而砧座18适于使钉变形。使用时，组织位于砧座18和钉施放组件16之间，而后砧座18从张开位置运动到闭合位置，以接合砧座18和钉施放组件16之间的组织。缝合装置11可任选地相对于细长轴12枢转以有利于定位其中的组织。一旦将组织接合在砧座18和钉施放组件16之间，就致动钉施放组件16来驱动一个或多个钉穿过组织并抵住砧座18，砧座18使钉腿变形。在一个示范性实施例中，以基本上圆形图式向组织施放多个钉。圆形缝合器10尤其适用于内窥镜和腹腔镜手术，因为细长轴12相对较小的直径使其适于穿过小的入口或路径。然而，缝合器可适用于各种医疗操作。
为使缝合装置相对于细长轴12进行关节运动(即，成角度地定位缝合装置)，闭合砧座18，和/或致动(击发)钉施放组件16，装置10可包括触发器、旋钮、手柄、开关或其它在手柄14上形成的机构。在一个示范性实施例中，如图3A所示，手柄14包括形成于其上用于闭合该缝合装置11、也就是用于使砧座18向钉施放组件16运动的第一开关13。手柄14还可包括与其联接的第二开关15，用于击发钉施放组件16内的钉仓44以将一个或多个钉输送进组织。第二开关15还可有效地向远侧推动刀穿过钉施放组件16以切割被缝合的组织。本领域技术人员将会意识到，虽然所示出的是开关13，15，但可采用触发器、旋钮、杆、滑动钮或其它机构使缝合装置11相对于细长轴16进行关节运动、使砧座18向着钉施放组件16运动和/或致动钉施放组件16。
致动
如上所述，本发明提供用于致动圆形缝合器上的缝合装置的示范性方法和装置，包括击发钉和任选地驱动刀具或刀穿过钉施放组件以切割被缝合的组织。图3B更详细地示出图3A圆形缝合器10的一部分，示出用于采用一个或多个EAP致动器击发钉施放组件16和/或驱动刀穿过钉施放组件16以切割被缝合组织的技术的一个示范性实施例。本领域技术人员将会意识到，缝合装置可具有各种结构，且EAP致动器可以结合到各种其它钉施放组件内来实现击发和/或切割。
如所示，细长轴12包括设置在其中且适于在近侧位置和远侧位置之间运动的撞针42a。撞针42a可形成钉驱动器，或其可联接至钉驱动器42b，如所示，以向远侧推动钉驱动器42b，从而驱动钉穿过钉施放组件16并移向砧座18和/或切割由缝合装置11接合的组织。如图3B所进一步示出的，撞针42a联接至多个EAP致动器索，该多个EAP致动器索有效地使撞针42a在近侧和远侧位置之间沿轴向运动。具体地，撞针42a的近端可包括在其周围形成的圆盘或凸缘49，且多个EAP致动器索60可联接至凸缘49以使撞针42a相对于细长轴12运动。在所示出的实施例中，细长轴12包括固定地联接到其内侧壁上的基盘47，该基盘47可用作EAP致动器索60的基底。基盘47定位在撞针42a上形成的凸缘49的远侧，且多个EAP致动器索60在基盘47和凸缘49之间延伸。当向EAP致动器索60输送能量时，索60将会轴向收缩或缩短，从而将凸缘49和撞针42a沿远侧方向拉向基盘47。结果，撞针42a将会向远侧推进，将钉驱动器42b向远侧推动以驱动钉穿过钉施放组件16内的钉仓。可终止能量输送，以便使致动器索60沿轴向扩张并返回其初始位置，从而使撞针42a向近侧运动。撞针42a还可或有选择地联接至刀具驱动器43，该刀具驱动器43可有效地向远侧驱动刀41以切割组织。在其它实施例中，独立的电活化聚合物致动器组件可联接至刀具驱动器43以允许驱动刀与钉驱动器42b分离。本领域技术人员将会意识到，现有技术已知的各种驱动器和/或切割刀都可与缝合装置11一起使用，而且一个或多个电活化聚合物致动器可联接至各种结构的驱动器和/或切割刀，以致动驱动器和/或切割刀。
图3C示出了致动圆形缝合器的钉施放组件的技术的另一个实施例。在该实施例中，代替采用轴向收缩的电活化聚合物致动器向远侧拉动撞针或驱动器，可沿轴向推动撞针或驱动器以驱动钉穿过钉施放组件。具体地，图3C示出了圆形缝合器的细长轴82的远侧部分。驱动器84可滑动地设置在细长轴82内且其适于在近侧位置和远侧位置之间运动，其中驱动器84驱动钉穿过设置在钉施放组件88内的钉仓86并向使钉变形的砧座98运动。电活化聚合物致动器94设置在驱动器84的近侧部分84a和驱动器的远侧部分84b之间。这可例如采用层压或复合型的电活化聚合物致动器实现，所述电活化聚合物致动器附着到近侧部分84a和远侧部分84b的每一个，以将这些部分连接起来。使用时，可通过电极向电活化聚合物致动器94输送能量，所述电极联接至设置在该装置手柄内或与该装置手柄配合的电源上。该能量将会导致电活化聚合物致动器沿轴向扩张，从而将驱动器84的远侧部分84b推向钉施放组件88，以驱动钉穿过钉仓86并移向砧座98。能量输送的终止将会导致电活化聚合物致动器沿轴向收缩，从而将驱动器的远侧部分84b向近侧拉至其初始位置。本领域技术人员将会意识到，可采用各种其它技术来采用电活化聚合物致动器使圆形缝合器的驱动器或撞针运动。
关节运动
如前所示，本发明还提供使圆形缝合器的缝合装置进行关节运动的示范性方法和装置。图4A-11B示出用于实现关节运动的关节运动接头和电活体聚合物致动器的各种示范性实施例。
首先参见图4A-4B，细长轴612的远端612b示出为通过枢轴接头616联接至缝合装置611的近端，从而缝合装置611可相对于轴612绕枢轴接头616枢转。该装置还包括滑棒624，滑棒624延伸穿过细长轴612并具有远端624d，远端624d具有形成于其上且适于与缝合装置611上形成的相应轮齿616t啮合的轮齿624t。该装置还可包括一个或多个可电扩张和收缩致动器(如EAP致动器)，用于运动滑棒624，以使滑棒624上的轮齿624t运动缝合装置611上的轮齿624t，从而使缝合装置611相对于细长轴612枢转。虽然EAP致动器可采用各种技术实现滑棒624的运动，在一个示范性实施例中，EAP致动器设置成使滑棒624沿侧向运动。具体地，第一EAP致动器626a可延伸穿过细长轴612邻近滑棒624第一侧面的至少一部分，而第二EAP致动器626b可延伸穿过细长轴612邻近滑棒624的相对的第二侧面的至少一部分，如图4A-4B所示。可以采用任何一种类型的EAP致动器，但在一个示范性实施例中，EAP致动器626a、626b是层压型的EAP致动器，当向该EAP致动器输送能量时，其适于沿侧向扩张。图4A示出两个EAP致动器626a、626b处于未扩张未致动的结构，此时不向任何一个致动器626a、626b输送能量。图4B示出第一EAP致动器626a沿侧向扩张以使滑棒624沿侧向向第二EAP致动器626a运动，从而导致滑棒624使缝合装置611沿与滑棒624的运动方向相反的方向枢转。可通过电极向致动器626a、626b输送能量，所述电极延伸穿过轴612并可联接至设置在该装置的手柄内或联接至该装置的手柄的能量源，例如电池电源或电源插座或其它能量源。手柄还可包括与其联接并适于控制向每个致动器626a、626b输送的能量量大小的控制机构，如滑杆、旋钮或拨盘。向每个致动器626a、626b输送的能量大小由致动器626a、626b的扩张量决定，从而允许有选择地调整缝合装置611的枢转运动量。
本领域技术人员将会意识到，虽然图4A-4B示出了带有侧向扩张EAP致动器626a、626b的侧向运动滑棒624，滑棒624和致动器626a、626b可具有各种其它结构。例如，纤维束形式的多个EAP致动器可在细长轴612的内表面和滑棒624之间侧向延伸。当向致动器输送能量时，致动器的长度可收缩或缩短，以将滑棒624拉向细长轴612，从而使滑棒624沿侧向运动。可选择地，滑棒624可设置成沿纵向运动，以实现缝合装置611的运动，并且可采用EAP来实现滑棒624的纵向运动。在其它实施例中，滑棒自身或至少滑棒的一部分可由EAP致动器形成，该EAP致动器适于沿所需的方向轴向扩张，以使滑棒沿侧向运动。
图5A-5B示出用于使圆形缝合器进行关节运动的技术的另一个实施例。在该实施例中，缝合装置711通过联接至细长轴712的相对侧的相对的第一臂790a和第二臂790b枢转地联接至细长轴712。第一EAP致动器726a和第三EAP致动器726c连接到第一臂790a的终端的相对侧并从该相对侧延伸出，且第二EAP致动器726b和第四EAP致动器726d连接到第二臂790b的终端的相对侧并从相对侧延伸出。每个EAP致动器726a-d的远端在连接点(示出了第一、第二和第三连接点792a、792b、792c)处联接至细长轴712的内侧壁上。结果，第一致动器726a和第二致动器726b连接到细长轴712的一侧上，而第三致动器726c和第四致动器726d连接到细长轴712的相对侧上。使用时，向第一EAP致动器726a和第二EAP致动器726b输送能量以使致动器726a、726b沿轴向收缩或缩短，从而将第一臂790a和第二臂790b沿侧向拉向第一连接点792a和第二连接点792b。结果，缝合装置711沿第一方向枢转。当终止能量输送时，第一致动器726a和第二致动器726b将沿轴向扩张，返回其初始结构，从而使缝合装置711运动回其初始位置，在该初始位置处，缝合装置711与细长轴712对准。可向第三致动器726c和第四致动器726d输送能量以类似地使缝合装置711沿相反方向运动。如前面所讨论的，可控制所输送能量的大小以控制缝合装置711的枢转运动量。如图5B所示，该装置还可包括围绕在枢轴框架组件757的至少一部分上以向其提供支撑的覆盖件799。
图6示出用于使圆形缝合器进行关节运动的技术的又一个实施例。在该实施例中，一个或多个致动件结合到作为枢转框架组件857一部分的滑轮898内。滑轮898可整个由EAP致动器制成，或者可选择地，EAP致动器可连接到滑轮898的近端和远端。在所示出的实施例中，第一EAP致动器826a和第二EAP致动器826b连接到滑轮898的近端和远端。EAP致动器826a、826b锚固至细长轴812上以推或拉动缝合装置811来实现关节运动。具体地，向其中一个EAP致动器(例如第一EAP致动器826a)输送能量，使得第一EAP致动器826a沿轴向收缩或缩短，以使滑轮898沿第一方向运动，从而使缝合装置811沿第一方向枢转。相反地，向第二EAP致动器826b输送能量使得第二EAP致动器沿轴向收缩或缩短，以使滑轮898向相反的第二方向运动，从而使缝合装置811沿相反的第二方向枢转。再一次，可控制能量输送以控制缝合装置811的运动量。
图7A-7B示出用于使缝合装置相对于圆形缝合器的细长轴进行关节运动的技术的另一个实施例。在该实施例中，细长轴912包括延伸穿过其中的滑棒924，且滑棒924具有在其远端上形成的球924t，并且该球924t容纳于在缝合装置911近端上形成的相应凹槽916s内。滑棒924还包括在其上形成的凸轮表面925a、925b，其优选位于邻近细长轴912的远端处。凸轮表面925a、925b可具有各种形状和尺寸，但在一个示范性实施例中，如所示，凸轮表面925a、925b从滑棒924的相对侧向外伸出且其为宽度沿从近到远方向逐渐增加的楔状件。该装置还包括第一致动件926a和第二致动件926b，其延伸穿过细长轴912且位于滑棒924的相对侧上。每个致动件926a、926b包括形成在其上的凸轮表面927a、927b，所述凸轮表面927a、927b适于抵接在滑棒924上形成的凸轮表面925a、925b。结果，第一致动件926a向远侧的运动将会导致形成于其上的凸轮表面927a滑动抵住在滑棒924上形成的凸轮表面925a，从而使滑棒924沿侧向从第一致动件926a移开。滑棒924侧向运动的结果是，球924t将会使缝合装置911相对于细长轴912枢转。相反地，第二致动件926b向远侧的运动将会导致形成于其上的凸轮表面927b滑动抵住在滑棒924上形成的凸轮表面925b，从而使滑棒924沿侧向从第二致动件926b移开，因而使缝合装置911向相反的方向枢转。可在滑棒924的每一侧上设置偏压元件(未示出)，如弹簧，以将滑棒924偏压至如图7A所示的中央静止位置，从而当致动件926a、926b向近侧运动时允许滑棒924返回到静止位置。
在一个示范性实施例中，每个致动件926a、926b的运动可采用联接到其上的EAP致动器来实现。如图7A-7B所示，优选为纤维束型致动器形式的EAP致动器索928a、928b在每个致动件926a、926b的远端和轴912的远端之间延伸。当有选择地向EAP致动索中的一个(如第一致动索928a)输送能量时，索928a将会轴向收缩或缩短，如图7B所示，从而将联接至被致动的EAP索928a的致动件926a沿远侧方向拉动。致动件926a上的凸轮表面927a将抵接滑棒924上的凸轮表面925a，以使滑棒924向第二致动件926b沿侧向运动。结果，滑棒924远端上的球924t将使缝合装置911进行关节运动或绕其枢转。
本领域技术人员将会意识到，EAP致动器可具有各种其它结构，且它们可采用各种其它技术实现滑棒的运动。例如，当向EAP致动索928a、928b输送能量时，不是向远侧拉动滑棒924，而是可使EAP致动器联接至滑棒924的近端且它们可适于向远端推动滑棒924。在其它实施例中，在每个致动件926a、926b上形成的凸轮表面927a、927b可由EAP致动器形成，从而输送到凸轮表面927a、927b的能量使凸轮表面927a、927b向滑棒924扩张，由此使滑棒924沿所需的方向运动，以使缝合装置911进行关节运动。每个致动件926a、926b的运动量以及缝合装置911的关节运动量还可通过控制输送到每个EAP致动器的能量大小来进行控制。
图8A-8B示出用于使圆形缝合器的缝合装置进行关节运动的技术的又一个实施例。在该实施例中，不是采用滑棒来使缝合装置枢转，而是使两个致动件26a、26b直接联接至缝合装置412的相对侧以推或拉动缝合装置412来实现关节运动。具体地，每个致动件26a、26b的远端通过枢轴接头联接至缝合装置412的近端，从而第一致动件26a向近侧的运动使缝合装置412绕第二致动件26b枢转，并且第二致动件26b向近侧的运动使缝合装置412绕第一致动件26a枢转。可采用各种技术使致动件26a、26b运动。例如，每个致动件26a、26b的全部或部分可由适于沿轴向扩张的EAP形成，或者致动件26a、26b可联接至EAP致动器以使致动件26a、26b向近侧和远侧运动，从而使缝合装置412进行关节运动。
图9示出使圆形缝合器的缝合装置进行关节运动的技术的另一个实施例。在该实施例中，细长轴20包括由在细长轴20的相对侧上形成多个切除部分22、24、26、28、30、32、34、36、38、40(此后写为22-40)而形成的挠性部分。所述切除部分允许细长轴20绕其挠曲。一个或多个EAP致动器可相对于切除部分定位以实现缝合装置(未示出)相对于细长轴20的枢转或弯曲运动。图9示出了多个EAP致动器索46、48、50、52、54、56、58(此后写为46-58)，它们沿纵向延伸穿过其上形成有切除部分的细长轴20。EAP致动器索46-58彼此平行地纵向延伸，且它们在正好最接近切除部分22-40的第一端处和在正好最远离切除部分22-40的第二端处联接至细长轴20。使用时，可有选择地向EAP致动器索46-58的任何一个或任何组合输送能量以使切除部分22-40挠曲，从而使缝合装置沿所需方向进行关节运动。例如，可向第一EAP致动器索46输送能量，以使第一致动器索46沿轴向收缩或缩短，从而将索46的相对端拉向相彼此。由于第一致动器索46的两端在切除部分的相对端处连接到细长轴20，而且由于第一EAP致动器索46偏离细长轴20的中心轴线，第一EAP致动器索46将会使细长轴20沿第一方向弯曲。因此，可有选择地致动一个或多个致动器索46-58，即，可有选择地向其输送能量，以实现缝合装置沿所需方向的运动。本领域技术人员将会意识到，可采用各种其它技术使切除部分弯曲。
图10示出用于采用在缝合装置和细长轴12”’之间形成的挠性部分12p”’使缝合装置进行关节运动的技术的又一个实施例。在该实施例中，一个或多个EAP致动器可在各种位置定位在细长轴12”’的挠性部分12p”’内、之上或围绕其定位，且EAP致动器可设置成当向致动器输送能量时使挠性部分12p”’挠曲，从而使缝合装置进行关节运动。图10示出沿细长轴12”’的挠性部分12p”’的不同部分沿轴向延伸的多个EAP致动器261、262、263、264、265。虽然未示出，多个EAP致动器可定位于挠性部分12p”’外周周围各种其它位置处。使用时，例如，向第一致动器261输送能量可使第一致动器261沿轴向收缩，从而使挠性部分12p”’的一部分弯曲。用户从而可有选择地向一个或多个致动器输送能量，以使缝合装置按照需要进行关节运动和定位。
本领域技术人员将会意识到，任何上述实施例可包括当终止向EAP致动器输送能量时允许该装置保持其关节运动位置的锁定元件。具体地，当终止向能量输送时，EAP致动器沿轴向扩张，以使缝合装置返回其初始位置，在该位置处，缝合装置沿纵向与细长轴对准。因而在终止向EAP致动器输送能量前可采用锁定机构将缝合装置锁定在所需的关节运动位置。
虽然锁定机构可具有各种结构，图11A-11B示出了结合在枢转关节运动接头62内的关节运动锁70的一个示范性实施例。如所示，关节运动接头62包括旋转结构72，旋转结构72具有多个适于接纳撞针以防止关节运动接头62进行旋转运动的孔64a、64b、64c、64d、64e。在该装置的细长轴61内形成一止动件且该止动件位于旋转结构72的近侧，该止动件在一个实施例中可以是弹簧加载撞针66。撞针66还联接至EAP致动器(未示出)，当受能量致动时，EAP致动器实现撞针66的运动，从而允许关节运动接头62运动。具体地，如图11A所示，当该装置处于未致动位置时，撞针66静止在旋转结构72的一个孔内(如所示出的孔64e)，从而将缝合装置保持在固定位置。如图11B所示，向EAP致动器输送能量将会将撞针66从孔64e中拉出，以允许关节运动接头62运动到所需的位置。可采用前面描述的各种技术来使缝合装置进行关节运动。一旦使缝合装置运动到所需的关节运动位置，就可使EAP致动器解除致动，即，可终止能量输送，允许弹簧将撞针66偏压进旋转结构72的一个孔内。由此使缝合装置再次保持在固定位置。本领域技术人员将会意识到，各种其它的锁定机构可结合到关节运动接头中，如棘轮和棘齿系统。
基于上述实施例，本领域技术人员将会意识到本发明的进一步的特征和优点。因此，本发明不应受到已具体示出和描述的内容的限制，除非由附加权利要求书所指明的。在此引证的公开内容和参考内容全部清楚地通过参考接合入本文。

Claims (8)

1.一种圆形缝合装置，包括：
具有近端和远端的细长轴；
钉施放组件，其联接至细长轴的远端且适于以大致弯曲的图式将钉输送进组织；
砧座，其联接至钉施放组件并可在张开的组织接收位置和闭合的钉施放位置之间运动；和
电活化聚合物致动器，其联接至钉施放组件并适于从钉施放组件驱动一个或多个钉进入位于钉施放组件和砧座之间的组织；
所述圆形缝合装置还包括驱动器，该驱动器位于钉施放组件内并适于向远侧运动以向着砧座驱动钉穿过钉施放组件，电活化聚合物致动器联接至驱动器并适于当向该电活化聚合物致动器输送能量时使驱动器向远侧运动。
2.根据权利要求1所述的装置，其中，所述驱动器包括形成于其上并适于切割被缝合组织的刀。
3.根据权利要求1所述的装置，其中，所述电活化聚合物致动器包括联接至钉施放组件的一部分的第一端，以及联接至所述驱动器的第二端。
4.根据权利要求3所述的装置，其中，所述第一端位于电活化聚合物致动器的第二端的远侧。
5.根据权利要求4所述的装置，其中，所述电活化聚合物致动器包括至少一个电活化聚合物索，该电活化聚合物索适于当向其输送能量时沿轴向收缩以向远侧拉动驱动器。
6.根据权利要求1所述的装置，还包括手柄，该手柄形成于细长轴的近端上并包括适于有选择地向电活化聚合物致动器输送能量的控制机构。
7.根据权利要求1所述的装置，还包括第二电活化聚合物致动器，该第二电活化聚合物致动器联接至砧座并适于当向该第二电活化聚合物致动器输送能量时使砧座从张开的组织接收位置向闭合的钉施放位置运动。
8.根据权利要求1所述的装置，其中，可相对于细长轴的远端成角度地调整钉施放组件，且其中该装置还包括第二电活化聚合物致动器，该第二电活化聚合物致动器联接在钉施放组件和细长轴之间并适于当向该第二电活化聚合物致动器输送能量时成角度地调整钉施放组件相对于细长轴的位置。
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CN1939229A (zh) 2007-04-04
EP1769753A1 (en) 2007-04-04
CN1939229B (zh) 2010-08-25
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ATE491397T1 (de) 2011-01-15
JP5020590B2 (ja) 2012-09-05
US7410086B2 (en) 2008-08-12
BRPI0604724A (pt) 2007-08-28
JP5208394B2 (ja) 2013-06-12
US20060047307A1 (en) 2006-03-02
EP1769753B1 (en) 2011-03-02
CA2561234A1 (en) 2007-03-30
CN101152098A (zh) 2008-04-02
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JP2007098134A (ja) 2007-04-19
EP1769758B1 (en) 2010-12-15
AU2006222758B2 (en) 2012-11-01
EP1769758A1 (en) 2007-04-04
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US20060047308A1 (en) 2006-03-02
AU2006222758A1 (en) 2007-04-19
US8317074B2 (en) 2012-11-27
JP2007098135A (ja) 2007-04-19
CA2561544A1 (en) 2007-03-30
AU2006222759A1 (en) 2007-04-19
DE602006018840D1 (de) 2011-01-27
CA2561544C (en) 2014-07-22

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