CN101273911A - 具有可手动回缩的击发构件的外科缝合和切割器械 - Google Patents

具有可手动回缩的击发构件的外科缝合和切割器械 Download PDF

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CN101273911A
CN101273911A CNA2008100869492A CN200810086949A CN101273911A CN 101273911 A CN101273911 A CN 101273911A CN A2008100869492 A CNA2008100869492 A CN A2008100869492A CN 200810086949 A CN200810086949 A CN 200810086949A CN 101273911 A CN101273911 A CN 101273911A
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retraction
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C·J·沙尔
C·P·布德罗克斯
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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
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B17/2909—Handles
    • 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
    • A61B2017/2923—Toothed members, e.g. rack and pinion
    • 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
    • A61B2017/2925—Pistol grips
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0807—Indication means
    • A61B2090/0811—Indication means for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument

Abstract

一种具有可手动回缩的击发构件的外科缝合和切割器械，该器械特别适于内镜手术，该器械包括产生单独的闭合和击发动作以致动端部执行器的手柄。具体而言，该手柄产生多个击发冲程以减少击发端部执行器(也就是缝合和切割)所需的力的大小。连接的传输机构减少了所需的手柄纵向长度，同时在被拉直用于击发时实现了刚性的牢固构造。牵引偏压的击发机构避免了在驱动中束缚该拉直的连接齿条。该器械还包括可手动致动的回缩系统，其不需要使用附加的弹簧或其它的机构来产生回缩力，该回缩力在产生击发装置所需的力时必须被克服。在各种实施方式中，回缩系统为外科医生提供了击发进行程度的视觉指示。

Description

具有可手动回缩的击发构件的外科缝合和切割器械
相关申请的交叉引用
本申请与同一日期提交的Chad P.Boudreaux和ChristopherJ.Schall的题为“具有侧安装的回缩构件的外科缝合和切割器械(Surgical Stapling and Cutting Instrument With Side-MountedRetraction Member)”的共有美国专利申请相关，通过引用将其整体包含在这里。
技术领域
本发明整体上涉及内窥镜外科器械，其包括但不限于能够将成排缝钉施加到组织上同时切割这些缝钉排之间的组织的外科缝合器械，更具体而言，本发明涉及与已经具有手动回缩能力的外科缝合器械相关的改进以及对用于形成这种外科缝合器械的各种部件的方法进行的改进。
背景技术
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，这是因为较小的切口易于减少术后恢复时间和并发症。因此，各种内窥镜外科器械已经有了显著的发展，这些器械适于通过套管针的插管将远侧端部执行器精确放置在所需的手术部位。这些远侧端部执行器(例如，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、以及使用超声波、RF、或激光等的能量装置)以各种方式与组织接合，达到诊断或治疗的效果。
已知的外科缝合器包括端部执行器，该端部执行器在组织中形成纵向切口的同时在切口的相对两侧上施加多排缝钉。所述端部执行器包括一对相配合的钳口构件，如果器械用于内窥镜或者腹腔镜应用，这对钳口构件能够穿过插管通道。钳口构件中的一个装纳具有至少两个横向间隔的缝钉排的钉仓。另一个钳口构件限定了具有缝钉成形凹口的砧座，所述凹口与钉仓中的缝钉排对准。该器械通常包括多个往复运动的楔形件，这些楔形件在被向远侧驱动时穿过钉仓中的开口并与支撑缝钉的驱动器接合，向着砧座击发缝钉。
在Brian D.Knodel，Richard P.Nuchols和Warren P.Williamson，IV的美国专利No.5465895中描述了适用于内窥镜应用的外科缝合器的例子，其有利地具有不同的闭合和击发动作。因此，使用该装置的临床医生可在击发之前闭合组织上的钳口构件来定位组织。一旦临床医生确定钳口构件正确地夹持了组织，则临床医生就可用单个击发冲程击发外科缝合器，由此切割和缝合组织。同时切割和缝合避免了在使用分别仅仅进行切割或缝合手术的不同外科工具顺序地进行所述动作时引起的并发症。
可在击发之前在组织上闭合的一个具体的优点在于，临床医生可以通过内窥镜确认到达了需要切割的部位，包括确认已经在相对的夹钳之间捕获了足量的组织。否则，相对的夹钳会被拉得太近，特别是在其远端夹紧，不能在切割的组织中有效形成闭合的缝钉。在另一极端，夹紧过量的组织可导致束缚和不完全的击发。
一般而言，在单击发冲程之前进行的单闭合冲程是进行切割和缝合的方便而有效的方式。但是，在一些情况下，可能需要多击发冲程。例如，医生能够选择具有与需要的切割长度相应的钉仓长度的钳口尺寸的范围。更长的钉仓需要更长的击发冲程。因此，为了进行击发，与更短的钉仓相比，这些更长的钉仓需要手挤压式扳机，以施加更大的力，从而切割更多的组织并驱动更多的钉。可能期望力的大小更小，和更短的钉仓需要的力类似，以便不超过一些医生的手部力量。另外，不熟悉更大的钉仓的一些医生在需要不期望的更高的力时可能担心已经发生束缚或者其它故障。
一种用于降低击发冲程所需的力的方案是使用允许击发扳机被多次动作的棘齿机构，如在美国专利Nos.5762256和6330965中描述的那样，通过引用将其包含在这里。这些已知的带有多冲程击发机构的外科缝合器械不具有分开的闭合和击发动作的优点。
其它的棘齿外科器械公开在2006年8月1日授权给Jeffrey S.Swayze、Frederick E.Shelton IV、Kevin Ross Doll和DouglassB.Hoffman的题为“Multi-stroke Mechanism With Automatic End ofStroke Retraction”的共有美国专利No.7083075中，通过引用将其包含在这里。其中公开的各种实施方式使用能够产生分开的闭合和击发动作来致动端部执行器的手柄。具体而言，该手柄被构造成通过击发扳机的多次致动来产生缝合和切割夹在端部执行器中的组织所需的击发力。该装置还可以使用减少所需手柄长度的连接机构，该连接机构在用于击发时拉直以实现刚性的牢固构造。牵引偏压击发机构利用锁止机构结合防阻塞机构来避免在驱动过程中束缚该拉直的连接齿条，其中该锁止机构能够在击发过程中防止闭合扳机的释放。此外，外部指示器为外科医生提供关于击发已经进行了多远的反馈，并提供手动回缩的能力。这些实施方式一般还使用相对强的弹簧来在端部执行器已经被击发之后自动回缩切割构件。尽管这样的设计非常有效，但是回缩弹簧的使用需要在击发过程中产生附加的击发力来克服相反的弹簧力。当使用关节运动端部执行器时，该问题还可能在一定程度上恶化。具体而言，当使用关节运动端部执行器时，通常必须使用较大的复位弹簧来回缩关节运动击发构件。这种较大弹簧的使用进一步增大了必须产生的击发力的量，以克服弹簧力并击发端部执行器部件。
因此，十分需要一种具有多冲程或其它类型击发机构的外科缝合器械，该击发机构装有可手动致动的回缩机构，并且不使用诸如弹簧之类的能够产生在击发冲程中必须被克服的力的附加回缩装置。
发明内容
在本发明的一个方面中，提供了一种外科器械，其具有手柄组件和用于进行外科手术的端部执行器。所述端部执行器可操作地连接到所述手柄组件上并可操作地支撑击发构件，所述击发构件能够响应于施加于其上的纵向击发动作而从回缩位置移动到击发位置。该器械还可以包括击发驱动器，其由所述手柄组件支撑，并能够基于可操作地连接到所述手柄组件上的击发扳机的致动而选择性地产生所述纵向击发动作。回缩组件可以由所述手柄组件支撑并与所述击发驱动器接合，使得所述回缩组件的手动致动能够使所述击发驱动器产生单独的回缩动作，该单独的回缩动作传递到所述击发构件，以使所述击发构件从所述击发位置运动至所述回缩位置。
在本发明的各种实施方式的另一个总的方面中，提供了一种外科器械，其包括手柄组件，该手柄组件连接到用于进行外科手术的端部执行器上。所述端部执行器可操作支撑击发构件，所述击发构件能够响应于施加于其上的纵向击发动作而从回缩位置运动到击发位置。连接齿条由所述手柄组件可操作地支撑，并且击发杆可以与所述连接齿条和所述端部执行器连通，用于将所述击发动作和所述回缩动作从所述连接齿条传递到所述端部执行器。击发扳机可以由所述手柄组件可操作地支撑，并能够与所述连接齿条接合，使得所述击发扳机的致动使所述连接齿条将所述击发动作施加到所述击发杆上。第一齿轮可以与所述连接齿条啮合，并且回缩杆可以由所述手柄组件可动地支撑，并能够与所述第一齿轮接合，使得所述回缩杆的致动将单独的回缩动作或力施加到所述第一齿轮上，由此所述第一齿轮将所述单独的回缩动作传递到所述连接齿条上。
在本发明的各种实施方式的又一个总的方面中，提供了一种外科器械，其包括手柄组件，该手柄组件与端部执行器相连。所述端部执行器可操作地支撑击发构件，所述击发构件能够响应于施加于其上的纵向击发动作而从回缩位置运动到击发位置。第一连接齿条可以由所述手柄组件可操作地支撑。击发杆可以与所述连接齿条和所述端部执行器连通，用于将所述击发动作和所述回缩动作从所述连接齿条传递到所述端部执行器。击发扳机可以由所述手柄组件可操作地支撑，并能够选择性地与所述连接齿条接合，使得所述击发扳机的致动使所述连接齿条将所述击发动作施加到所述击发杆上。第二齿条可以由所述手柄组件可操作地支撑。驱动齿轮可以与所述第一连接齿条和所述第二齿条啮合。回缩杆可动地连接到所述手柄组件和所述第二齿条上，使得所述回缩杆的致动将单独的回缩动作施加到所述驱动齿轮上，由此将所述单独的回缩动作传递到所述连接齿条上。
具体而言，本发明公开了如下内容：
(1).一种外科器械，包括：
手柄组件；
用于进行外科手术的端部执行器，所述端部执行器可操作地连接到所述手柄组件上并可操作地支撑击发构件，所述击发构件能够响应于施加于其上的纵向击发动作而从回缩位置运动到击发位置；
击发驱动器，其由所述手柄组件支撑，并能够基于可操作地连接到所述手柄组件上的击发扳机的致动而选择性地产生所述纵向击发动作；和
回缩组件，其由所述手柄组件支撑并与所述击发驱动器接合，使得所述回缩组件的手动致动能够使所述击发驱动器产生单独的回缩动作，所述单独的回缩动作传递到所述击发构件，以使所述击发构件从所述击发位置运动至所述回缩位置。
(2).根据第(1)项所述的外科器械，还包括至少一个指示构件，其可操作地支撑在所述手柄组件上并与所述击发驱动器接合，以在向所述端部执行器施加所述击发动作和单独的回缩动作的过程中提供所述击发构件的进程的视觉指示。
(3).根据第(1)项所述的外科器械，还包括：
闭合驱动器，其由所述手柄组件支撑并能够产生闭合动作和打开动作；以及
细长轴组件，其将所述端部执行器连接到所述手柄组件上，并能够将所述打开动作和闭合动作以及所述击发动作和回缩动作传递到其上。
(4).根据第(3)项所述的外科器械，其中，所述端部执行器包括：
细长通道，其与所述细长轴组件相连并且其尺寸适于将钉仓容纳在其中；以及
砧座，其连接到所述细长通道上，并能够响应于来自所述细长轴组件的打开动作和闭合动作而选择性地在打开位置和闭合位置之间运动，并且其中，所述击发构件包括一切割和切断构件，其可操作地支撑在所述细长通道中并能够对来自所述细长轴组件的所述击发动作和回缩动作作出响应。
(5).根据第(3)项所述的外科器械，其中，所述闭合驱动器包括：
锁定机构，其用于在所述闭合驱动器已经将所述闭合动作完全施加到所述端部执行器上之后，自动将所述闭合驱动器锁定在锁定位置；以及
释放机构，其与所述锁定机构接合以选择性地向其施加解锁动作。
(6).根据第(5)项所述的外科器械，其中，所述锁定机构与所述击发驱动器接合，使得所述锁定机构防止所述击发驱动器的致动，直到所述闭合驱动器处于所述锁定位置。
(7).根据第(1)项所述的外科器械，其中，所述击发驱动器包括：
连接齿条，其由所述手柄组件可操作地支撑；
击发杆，其与所述连接齿条和所述端部执行器连通，用于向其传递所述击发动作和回缩动作；以及
击发扳机，其由所述手柄组件可操作地支撑，并能够与所述连接齿条相互作用，使得所述击发扳机的致动能够使所述连接齿条将所述击发动作施加到所述击发杆上。
(8).根据第(7)所述的外科器械，其中，所述回缩组件包括由所述手柄组件可操作地支撑的回缩构件，所述回缩构件与所述连接齿条连通，使得所述回缩构件的手动致动能够使所述连接齿条将所述单独的回缩动作施加到所述击发杆上。
(9).根据第(8)项所述的外科器械，还包括至少一个回缩齿轮，其由所述手柄组件可操作地支撑并与所述回缩构件和所述连接齿条接合。
(10).根据第(8)项所述的外科器械，其中，所述回缩构件能够在对应于所述回缩位置的第一位置和对应于所述击发位置的第二位置之间运动，并且其中，当所述击发扳机被致动时，所述回缩构件从所述第一位置移向所述第二位置，在向所述回缩构件施加回缩力时，所述回缩构件从所述第二位置移向所述第一位置。
(11).一种用于处理外科用器械的方法，所述方法包括：
获得如第(1)项所述的外科器械；
对所述外科器械进行消毒；以及
将所述器械储存在无菌容器中。
(12).一种外科器械，包括：
手柄组件；
用于进行外科手术的端部执行器，所述端部执行器可操作地连接到所述手柄组件上并可操作地支撑击发构件，所述击发构件能够响应于施加于其上的纵向击发动作而从回缩位置运动到击发位置，并能够在向其施加回缩动作时从所述击发位置运动到所述回缩位置；
连接齿条，其由所述手柄组件可操作地支撑；
击发杆，其与所述连接齿条和所述端部执行器连通，用于将所述击发动作和回缩动作从所述连接齿条传递到所述端部执行器；
击发扳机，其由所述手柄组件可操作地支撑，并能够与所述连接齿条接合，使得所述击发扳机的致动能够使所述连接齿条将所述击发动作施加到所述击发杆上；
与所述连接齿条啮合的第一齿轮；以及
回缩杆，其由所述手柄组件可动地支撑，并能够与所述第一齿轮接合，使得所述回缩杆的致动将单独的回缩动作施加到所述第一齿轮上，由此所述第一齿轮将所述单独的回缩动作传递到所述连接齿条上。
(13).根据第(12)项所述的外科器械，还包括第二齿轮，其选择性地连接到所述回缩杆上并与所述第一齿轮啮合。
(14).根据第(13)项所述的外科器械，其中，所述回缩杆通过回缩爪选择性地连接到所述第二齿轮上，当所述回缩杆沿第一方向枢转时，所述回缩爪选择性地接合所述第二齿轮的一部分，当所述第二齿轮沿第二方向枢转时，所述回缩爪与所述第二齿轮的所述部分脱离。
(15).根据第(14)项所述的外科器械，还包括：
闭合驱动器，其由所述手柄组件支撑并能够产生闭合动作和打开动作；
细长轴组件，其将所述端部执行器连接到所述手柄组件上，并能够将所述打开动作和闭合动作从所述闭合驱动器传递到所述端部执行器；以及
锁定机构，其用于在所述闭合驱动器已经将所述闭合动作完全施加到所述端部执行器上之后，自动将所述闭合驱动器锁定在锁定位置，所述锁定机构与所述第二齿轮接合，以防止其致动，直到所述闭合驱动器处于所述锁定位置。
(16).一种外科器械，包括：
手柄组件；
用于进行外科手术的端部执行器，所述端部执行器可操作地连接到所述手柄组件上并可操作地支撑击发构件，所述击发构件能够响应于施加于其上的纵向击发动作而从回缩位置运动到击发位置，并能够在向其施加回缩动作时从所述击发位置运动到所述回缩位置；
第一连接齿条，其由所述手柄组件可操作地支撑；
击发杆，其与所述连接齿条和所述端部执行器连通，用于将所述击发动作和回缩动作从所述连接齿条传递到所述端部执行器；
击发扳机，其由所述手柄组件可操作地支撑，并能够选择性地与所述连接齿条接合，使得所述击发扳机的致动能够使所述连接齿条将所述击发动作施加到所述击发杆上；
第二齿条，其由所述手柄组件可操作地支撑；
驱动齿轮，其与所述第一连接齿条和所述第二齿条啮合；以及
回缩杆，其可动地连接到所述手柄组件和所述第二齿条上，使得所述回缩杆的致动将单独的回缩动作施加到所述驱动齿轮上，由此将所述单独的回缩动作传递到所述第一连接齿条上。
(17).根据第(16)项所述的外科器械，还包括：
闭合驱动器，其由所述手柄组件支撑并能够产生闭合动作和打开动作；
细长轴组件，其将所述端部执行器连接到所述手柄组件上，并能够将所述打开动作和闭合动作从所述闭合驱动器传递到所述端部执行器；以及
锁定机构，其用于在所述闭合驱动器已经将所述闭合动作完全施加到所述端部执行器上之后，自动将所述闭合驱动器锁定在锁定位置，所述锁定机构与所述第二齿条接合以将所述第二齿条保持在第二锁定位置，从而防止其致动，直到所述闭合驱动器处于所述锁定位置。
(18).根据第(17)项所述的外科器械，还包括释放机构，其与所述锁定机构接合以向其选择性地施加解锁动作。
(19).根据第(16)项所述的外科器械，其中，所述回缩杆具有握把部分，并且能够从第一位置运动到第二位置，在所述第一位置所述握把部分与所述手柄组件相邻，在所述第二位置所述握把部分远离所述手柄组件。
(20).根据第(17)项所述的外科器械，其中，所述回缩杆具有握把部分，当所述击发机构处于所述回缩位置时所述握把部分与所述手柄组件相邻，当所述击发构件处于所述击发位置时所述握把部分远离所述手柄组件。
本发明的这些以及其它目的和优点将从以下的附图及其描述中变得更加清楚。
附图说明
结合进说明书并成为其一部分的附图示出了本发明的实施方式，并且与本发明上述总的描述和下面给出的实施方式的详细描述一起用于解释本发明的原理，其中：
图1是本发明各种实施方式的外科缝合和切割器械的立体图。
图2是在位于图1的外科缝合器械远侧部分处的端部执行器的纵向截面中沿线2-2截取的左侧正视图。
图3是图2的端部执行器的前侧透视图。
图4是图1的外科缝合和切割器械的执行部分的分解透视图。
图5描绘了图1中外科器械的在图3中所示端部执行器的截面的左侧正视图，该截面基本上是沿图3中的线5-5截取的，从而露出了钉仓部分，而且描绘了沿纵向中心线的击发杆。
图6描绘了在击发杆已完全击发后，图5中的端部执行器的截面的左侧正视图。
图7是图1中的外科缝合和切割器械的手柄的左侧正视图，其中左侧外壳被移除。
图8是图7中手柄的分解透视图。
图9是图1的外科缝合和切割器械的手柄的右侧正视图，其中右侧手柄外壳部分被移除并且闭合扳机处于解锁位置。
图10是图9中击发机构的连接齿条的右侧分解的组装图。
图11是图1的外科缝合和切割器械的手柄的另一个右侧正视图，其中右侧手柄外壳部分被移除并且闭合扳机处于锁定位置。
图12是用在图1的外科缝合和切割器械中的手动回缩组件实施方式的右侧分解的组装图。
图13是图12的手动回缩组件的右侧立体的组装图。
图14是图11和12的手动回缩组件的左侧组装图。
图15是图11-13的手动回缩组件的另一个左侧组装图，其中以剖视图示出第二齿轮。
图16是图12-15的手动回缩组件和手柄外壳的相应部分的左侧正视图，其中手动回缩组件被示出处于高端位置，为了清楚起见，组件的一部分以剖视图示出。
图17是图12-16的手动回缩组件和手柄外壳的相应部分的另一个左侧正视图，其中手动回缩组件被示出处于下方或者被致动的位置，为了清楚起见，组件的一部分以剖视图示出。
图18是根据本发明其它实施方式的另一种外科缝合和切割器械的立体图。
图19是图18所示外科缝合和切割器械的手柄的左侧正视图，其中左侧手柄外壳部分被移除。
图20是图19的手柄的分解透视图。
图21是图18的外科缝合和切割器械的手动回缩组件的左侧组装图。
图22是本发明其它实施方式的又一种外科缝合和切割器械的立体图。
图23是图22的外科缝合和切割器械的手柄的分解透视图。
图24是图12的外科缝合和切割器械的手动回缩组件的分解的组装图。
图25是图24的手动回缩组件的立体图。
图26是图22的外科缝合和切割器械的手柄的左侧正视图，其中左侧手柄外壳部分被移除，并且器械处于未击发的位置。
图27是图22的外科缝合和切割器械的手柄的另一个左侧正视图，其中左侧手柄外壳部分被移除，闭合扳机处于锁定位置并且手动回缩组件处于完全回缩的位置。
具体实施方式
参见附图，其中在所有的附图中相同的附图标记代表相同的组成元件，图1和2中描绘了外科缝合和切割器械10，其能实现本发明独特的优点。该外科缝合和切割器械10可带有端部执行器12，该端部执行器具有与细长通道16可枢转地连接的砧座14，从而形成了相对的钳口，以用于夹紧待切割和缝合的组织。该端部执行器12通过细长轴组件18连接到手柄20上(图1)。由端部执行器12和轴组件18形成的执行部分22的尺寸使得可有利地穿过套管针或小的腹腔镜开口插入，从而在外科医生抓住手柄组件20进行控制时执行内窥镜手术进程。该手柄组件20可以有利地包括允许分开的闭合动作和击发动作部件，以及闭锁部件，从而避免无意地或不当地击发端部执行器，并且能够在给外科医生指示击发程度的同时实现多个击发冲程，以实现端部执行器12的击发(也就是切割和缝合)。此外，如以下将详细描述的，各种实施方式可以使用独特和新颖的可手动致动的回缩机构，用于回缩击发构件而不需要来自回缩弹簧或其它回缩结构的任何辅助，而在击发操作中必须克服回缩弹簧或其它回缩结构的力。
为了这些目的，轴组件18的闭合管24连接在闭合扳机26(图1)和砧座14之间，以使端部执行器12闭合。在闭合管24之中，框架28连接在细长通道16和手柄组件20之间以沿纵向定位并支撑端部执行器12。旋钮30与框架28连接在一起，且这两个元件可相对于绕轴组件18的纵向轴线的旋转运动可旋转地与手柄组件20连接在一起。因此，外科医生能通过转动旋钮30来旋转端部执行器12。闭合管24也可通过旋钮30来旋转，但相对它保持了一定程度的纵向运动，以使端部执行器12闭合。在框架28内设置了击发杆32，用于纵向运动，并将其连接在端部执行器12的砧座14与多冲程击发扳机34之间。该闭合扳机26位于手柄组件20的手枪式握把36的远侧，并且击发扳机34位于手枪式握把36和闭合扳机26的远侧。
在内窥镜操作中，一旦执行部分22插入病人体内进入手术部位，外科医生参照内窥镜或其它诊断成像装置来将组织定位在砧座14与细长通道16之间。外科医生抓住闭合扳机26和手枪式握把36以可重复地抓住及定位组织。一旦对组织相对于端部执行器12的位置以及其中的组织量都满意的话，外科医生朝向手枪式握把36完全压下闭合扳机26，从而在端部执行器12中夹紧组织并将闭合扳机26锁定在这一夹紧(闭合)位置。如果对这一位置不满意，外科医生可通过压下闭合释放按钮38来释放闭合扳机26并随后重复夹紧组织的过程。
如果夹紧是正确的，外科医生可继续进行外科缝合和切割器械10的击发。具体地说，外科医生抓住击发扳机34和手枪式握把36，以预定次数按压击发扳机34。所需的击发冲程的数量是基于下述因素以人机工程学的方式确定的，即，手的最大尺寸、每次击发冲程期间施加给器械的最大力，以及击发期间需要通过击发杆32传输至端部执行器12的纵向距离和力。
在这些冲程期间，外科医生可以参考指示器，该指示器描绘为指示旋钮40，其响应于多击发冲程来定位旋转。另外，指示旋钮40的定位可在击发扳机34的进一步旋转遇到阻力时确定已发生完全击发。需要理解的是，各种标记和指示可以添加到手柄组件20上以增强由指示旋钮40的旋转所提供的指示。
应当理解的是，在这里使用的术语“近侧”和“远侧”是参照临床医生握住器械的手柄而言。因此，端部执行器12相对于更近侧的手柄组件20而言位于远侧。类似的术语例如“前”和“后”也类似地分别对应于远侧和近侧。还需要理解的是，为了方便和清楚，这里使用的空间术语例如“竖直”和“水平”是相对于附图而言。然而，外科器械应用于许多方位和位置，且这些术语并不是用于限制也不是绝对的。
本发明是就内窥镜手术及装置来进行讨论的。然而，这里使用的术语例如“内窥镜”，并不能解释为将本发明限制为仅与内窥镜管(也就是套管针)一同使用的外科缝合和切割器械。相反，可以相信本发明可以应用于各种手术中，这些手术的入口限制为小的切口，包括但并不局限于腹腔镜手术，以及开放式手术。
E形梁击发构件
能提供多冲程击发动作的手柄组件20的好处是可应用于带有一个图2-6中描绘的端部执行器12的各种器械。特别参考图4，端部执行器12首先通过包括连接到砧座近端52上的砧座表面50(图2，4，6)响应于来自手柄组件20(未示于图2-6)的闭合运动，该砧座近端52包括一对沿横向凸出的砧座枢销54，其在竖直凸出的砧座部件56(图4)的近侧。该砧座枢销54在细长通道16中的卵形开口58内平移，以相对于细长通道16开启及闭合砧座14。砧座部件56与在闭合管24的远端62上的翼片孔60中向内延伸的翼片59(图2，4，6)接合，闭合管24在远侧终止于压靠砧座表面50的远侧边缘64。因此，当闭合管24从其开放位置向近侧运动时，闭合管24的翼片59向近侧拉动砧座部件56，且砧座枢销54随着细长通道16的卵形开口58而运动，从而导致砧座14同时向近侧平移并向上旋转至开放位置。当闭合管24向远侧运动时，翼片孔60中的翼片59从砧座部件56处解除，且远侧边缘64推压在砧座表面50上，从而闭合砧座14。
仍参考图4，执行部分22还包括对应于击发杆32的击发动作的组成元件。特别地，击发杆32与具有纵向凹槽68的击发凹槽构件66可旋转地接合。击发凹槽构件66直接响应于击发杆32的纵向运动而在框架28内沿纵向运动。闭合管24中的纵向槽70可操作地与旋钮30(未示于图2-6)接合。闭合管24中的纵向槽70的长度足够长，从而允许通过旋钮30来实现相对纵向运动，以分别实现击发和闭合动作，旋钮30的接合通过框架28中的纵向槽72传递以可滑动地接合框架凹槽构件66内的纵向凹槽68。
框架凹槽构件66的远端连接到击发杆76的近端，该击发杆76在框架28内运动，特别是在其中的导向件78内运动，以将E形梁击发构件80向远侧伸出到端部执行器12中。该端部执行器12包括钉仓82，该钉仓由E形梁80致动。该钉仓82具有托架84，托架84保持钉仓体86、楔形滑板驱动器88、缝钉驱动器90以及缝钉92。需要理解的是，楔形滑板驱动器88在位于仓托架84与仓体86之间的击发凹槽94(图2)内沿纵向运动。该楔形滑板驱动器88呈凸轮状表面，该表面与缝钉驱动器90相接触并使其向上升起，从钉孔96(图3)向上驱动缝钉92，使其与砧座14的缝钉成形槽98(图3)接触，成形“B”形缝钉，例如图6中的附图标记100处所表示的。特别参考图3，钉仓体86还包括近侧开口、竖直槽102，用于E形梁80通过。特别地，沿E形梁80的远端设置切割表面104，以在组织缝合之后切割组织。
在图2、5、6中，端部执行器12分别按照开放(即，初始)状态、夹紧和未击发状态或位置以及完全击发状态或位置的顺序被描绘出。特别描述了E形梁80的便于端部执行器12的击发的特征。在图2中，该楔形滑板驱动器88完全处于其近侧位置，表明未击发钉仓82。对准中间销106以进入钉仓82中的击发凹槽94，用于向远侧驱动楔形滑板驱动器88。E形梁80的底部销或帽108沿细长通道16的底面滑动，因此该中间销106及底部销108与细长通道16滑动地接合。在图2的开放且非击发状态下，E形梁80的顶部销110已进入并位于砧座14的砧座凹口112内，因而不会阻碍砧座14的反复开启和闭合。
在图5中描绘出的端部执行器12夹紧并准备击发。该E形梁80的顶部销110与砧座14中的砧座槽114对准，该砧座槽位于砧座凹口112远侧并与之连通。在图6中，E形梁80已完全击发，并且上部销110在砧座槽114下平移，从而当切割表面104切割被夹钳的组织时确定地将砧座14与细长通道16间隔开。同时，中间销106已如前所述地致动钉仓82。之后，E形梁80在打开端部执行器12及替换钉仓82之前被回缩，以用于其它操作。
示例性的端部执行器12在四篇共同拥有的美国专利和专利申请中有更详细的描述，每一篇所公开的全部内容在这里被引入作为参考：(1)2006年5月16日授权给Frederick E.Shelton IV、MichaelE.Setser、William B.Weisenburgh II的题为“Surgical StaplingInstrument Having a Single Lockout Mechanism For Preventionof Firing”的美国专利No.7044352；(2)2006年2月21日授权给Frederick E.Shelton IV，Michael E.Setser，Brian J.Hemmelgarn II的题为“Surgical Stapling Instrument HavingSeparate Distinct Closing and Firing Systems”的美国专利No.7000818；(3)2006年1月24日授权给Frederick E.SheltonIV，Michael E.Setser，William B.Weisenburgh II的题为“SurgicalStapling Instrument Having A Spent Cartridge Lockout”的美国专利No.6988649；(4)2006年12月5日授权给Frederick E.Shelton IV，Michael E.Setser，William B.Weisenburgh II的题为“Surgical Stapling Instrument Having A Firing Lockout ForAn Unclosed Anvil”的美国专利No.7143923；以及(5)题为“SurgicalStapling Instrument Incorporating an E-Beam FiringMechanism”，由Frederick E.Shelton IV，Michael E.Setser，William B.Weisenburgh II于2003年6月20日提交的美国专利申请No.10/443,617。但是，本发明的各种实施方式的独特和新颖的特征可以应用于不同类型的端部执行器而不脱离本发明的精神和范围。
需要理解的是，虽然在这里示出的是非关节运动轴组件18，但本发明的应用可包括能关节运动的器械，例如三篇共同拥有的美国专利和两篇共同拥有的美国专利申请中所描述的那样，其中每一篇所公开的全部内容在这里被引入作为参考：(1)2006年9月26日授权给Kenneth S.Wales，Douglas B.Hoffman，Frederick E.Shelton IV，Jeffrey S.Swayze的题为“Surgical InstrumentIncorporating An Articulation Mechanism Having Rotation Aboutthe Longitudinal Axis”的美国专利No.7111769；(2)2006年1月3日授权给Kenneth S.Wales的题为“Surgical Instrument WithA Lateral-Moving Articulation Control”的美国专利No.6981628；(3)2006年6月6日授权给Frederick E.Shelton IV，MichaelE.Setser，William B.Weisenburgh II的题为“Surgical StaplingInstrument Incorporating A Tapered Firing Bar For IncreasedFlexibility Around The Articulation Joint”的美国专利No.7055731；(4)Kenneth S.Wales和Joseph Charles Hueil于2003年7月9日提交的题为“Surgical Stapling Instrument HavingArticulation Joint Support Plates For Supporting A FiringBar”、序列号为No.10/615971的美国专利申请，公开好为No.2005/0006429；以及(5)Brian J.Hemmelgarn于2003年7月9日提交的题为“Surgical Stapling Instrument Incorporating AnArticulation Joint For a Firing Bar Track”的美国专利申请No.10/615962。但是，本领域技术人员应当理解，本发明的各种实施方式的独特和新颖的特征可以与其它类型的关节运动外科器械结合使用而不脱离本发明的精神和范围。
参考图7-9，细长轴组件18具有可纵向往复运动的闭合管24作为其外部结构，闭合管24响应于手柄组件20的闭合扳机26的向近侧下压来使砧座14(图1和2)枢转以实现闭合。细长通道18通过位于闭合管24内部的框架28连接到手柄组件20上。框架28可旋转地接合到手柄组件20上，使得通过扭转旋钮30来实现执行部分22的转动。具体参考图8，旋钮30的每半外壳30a、30b包括向内的突起31，突起31进入闭合管24中相应的较长侧开口70，并向内以与框架28接合，框架28确定了执行部分22的旋转位置。较长开口70的纵向长度足够长，以在闭合操作中辅助闭合管24沿纵向运动。
闭合系统
在各种实施方式中，闭合管24的操作由包括闭合扳机26的闭合驱动器23控制。闭合扳机26具有上部160，上部160构造成经由闭合连接件164致动闭合轭形件162。闭合连接件164在其远端处通过闭合轭形销166可枢转地连接到闭合轭形件162上，并在其近端处通过闭合连接销168可枢转地连接到闭合扳机26上。如图7所示，通过闭合扳机拉伸弹簧246来致动闭合扳机26至打开位置，闭合扳机拉伸弹簧246向近侧连接到闭合扳机26的上部160以及由右半外壳和左半外壳156、158形成的手柄外壳154。
闭合扳机26的上部160还包括近侧冠部170，近侧冠部170中形成有后部凹口171。参见图7和8。在各种实施方式中，闭合释放按钮38经由枢轴杆结构174可枢转地连接到手柄外壳154。如图8所示，锁定臂172从闭合释放按钮38突出，并且如下进一步的详细描述，其被构造成锁定地接合闭合扳机26的上部160。在闭合释放按钮38和手柄外壳154之间使用压缩弹簧180，以偏压闭合释放按钮绕枢轴杆组件174远离外壳154。图7描述了处于未致动位置的闭合扳机26。如图所示，当处于该位置时，枢轴锁定臂172靠在近侧冠部170上。锁定臂172的这种动作使得克服螺旋弹簧180的力朝向手柄外壳154拉动闭合释放按钮38。当闭合扳机26到达其完全压下位置时，枢轴锁定臂172在压缩弹簧180的驱动下落入到位于锁定扳机26的上部中的后部凹口171中。当处于该位置时，闭合扳机被锁定在该位置。此外，如下进一步的详细描述，当锁定臂172处于该锁定位置时，可以致动击发扳机34以致动击发机构150。当击发机构150处于回缩的位置时，闭合释放按钮38的手动下压将向上转动枢轴锁定臂172，使其脱离与位于闭合扳机26的上部中的后部凹口171的接合，并由此解锁闭合扳机26。
击发系统
在本发明的各种实施方式中，如下专利中公开类型的连接传输击发驱动器150可以用于伸出和回缩击发杆32：2006年8月1日授权给Jeffrey S.Swayze，Frederick E.Shelton，IV，Kevin R.Doll和Douglas B.Hoffman的题为“Multi-Stroke Mechanism WithAutomatic End of Stroke Retraction”的美国专利No.7083075，如下进一步的详细描述。对于回缩并被完全压下的闭合扳机26，击发扳机34被解锁并可以被朝向手枪式握把36压下多次以实现端部执行器12的击发。如图8所示，击发扳机34绕击发扳机销202枢转，击发扳机销202横向穿过并连接到右半外壳和左半外壳156、158。
当击发扳机34朝手枪式握把36压下时，击发扳机34的上部204绕击发扳机销202向远侧运动，从而拉伸连接在击发扳机34的上部204与外壳154之间的近侧放置的击发扳机拉伸弹簧206。参见图7和8。击发扳机34的上部204在每次击发冲程中通过弹簧偏压的侧爪机构210与连接齿条200形式的击发机构150接合，该弹簧偏压的侧爪机构210在击发扳机34释放时也松开。
连接齿条
如图8和10所示，每个连接件196a-d销接到相邻的连接件196a-d上，用于向下、向近侧旋转到手枪式握把36中。尽管可以在该方向上弯曲，但是当克服柱形载荷特别是以其它方式驱动远侧连接件196a-d向上弯曲的载荷时，连接齿条200形成刚性构造。具体而言，每个连接件196a-c的近侧终止于延伸部300中，延伸部300具有位于其下部上的横向通孔302。类似地，每个连接件196b-d的远侧终止于延伸部300a中，延伸部300a具有贯穿其的横向孔302a。如图10所示，孔300、300a对齐以容纳通过其的相应枢销310，从而以线性的方式将连接件196a-d铰链连接在一起。
每个前端连接件196a-d在其近端处具有平表面312，该平表面基本上垂直于来自击发杆32的柱形载荷的方向。每个尾端连接件196a-d在其远端处具有接触表面314，该接触表面也基本上垂直于柱形载荷的方向。横向通孔302充分地间隔开，使得凹口316形成在相邻的平表面312和接触表面314的下部之间，以提供用于使尾端连接件196a-d相对于前端连接件196a-d向下枢转的间隙。但是，当前端和尾端连接件196a-d沿纵向对齐时，相邻的平表面312和接触表面314的上部抵接，由此阻止了进一步向上偏转。
当相邻连接件196a-d为水平对齐时，孔302和销310定位于击发杆32的动作线之下。如下进一步的详细描述，当向击发扳机34施加载荷时，牵引偏压机构210沿动作线施加推压载荷并一起偏压连续的水平连接件196a-d。因此，使击发力的动作线处于枢销310之上使得将保持任一前端连接件196a-d处于刚性平直构造。应当理解，尽管已经有利地描述了连接件196a-d之间的销接，但是也可以使用其它弹性或者柔性的连接结构。此外，描述了四个连接件196a-d，但是可以根据击发行程、曲率半径等选择各种数量和长度的连接件。
还如图10所示，各个连接件196a-d的左侧304包括带齿上表面222。此外，各个连接件196a-c的右侧306具有倾斜的右侧轨道282，该右侧轨道282是通过面向近侧且面向右侧的斜面284形成的。前侧连接件196a的远端被构造用于连接到击发杆32的近端上。如图8所示，弓形带192可以用于在击发机构150被致动时支撑击发机构150。在各种实施方式中，带由钢或其它金属制成。但是，带192可以由其它合适的材料制成。如图8所示，带192的远侧布置的端部194连接到前侧连接件196a上的连接部件195上。在各种实施方式中，小弹簧400可以连接到连接件196d的近端和带192的近端(图8和9)，以将连接件196a-d拉成与弓形带192相容接合。本领域技术人员应当理解，连接件196a-d与带192基本上作为一体移动。由此，无论如何，弹簧400不向击发杆32施加任何回缩力。
侧爪机构
在各种实施方式中，在各个击发扳机下压过程中，击发扳机34的上部204通过弹簧偏压的侧爪机构210接合连接齿条200，当击发扳机34释放时该侧爪机构210也松开。具体而言，当击发扳机34被压下时，各个连接件1196a-1196d中由面向近侧且面向右侧的斜面284形成的倾斜的右侧轨道282通过侧爪组件285接合。回到图8，可以成功使用的侧爪组件285的一种形式包括爪滑动件270，其被构造有右侧和左侧下引导件272。一个引导件272在形成于位于齿条通道291之下的闭合轭形件162中的左侧轨道274中滑动，另一个引导件272在平行于齿条通道291的闭合轭形导轨276中的右侧轨道275中滑动。如图8所示，闭合轭形导轨276连接到齿条通道盖277上或与其形成一体，齿条通道盖277连接到闭合轭形件162上以包围齿条通道291。压缩弹簧278连接在位于闭合轭形导轨276的顶部近侧位置上的钩279和位于爪滑动件270的远端右侧上的钩280之间，这保持被向近侧拉动的爪滑动件270与击发扳机34的上部204接触。
参考图8和11，爪阻挡件318位于爪滑动件270上并通过竖直的后部销320可枢转地连接到其上，后部销320穿过爪阻挡件318的左侧、近侧角部和爪滑动件270。反冲阻挡件凹槽322形成在阻挡件318的顶表面的远侧部分上，以容纳通过竖直销326可枢转地销接到其上的反冲阻挡件324，竖直销326的底部尖端延伸到位于爪滑动件270的顶表面上的爪弹簧凹槽328中。爪弹簧凹槽328中的爪弹簧330(图8)延伸到竖直前部销326的右侧，当从上部观察时，竖直前部销326驱动爪阻挡件318逆时针方向旋转，以与倾斜的右侧轨道282接合。当从上面观察时，反冲阻挡件凹槽322中的小螺旋弹簧332(图8)驱动反冲阻挡件324沿顺时针方向转动，其近端被驱动成与形成为位于齿条通道291上方的闭合轭形件162中的轮廓唇缘334接触。
当击发扳机34被完全压下并开始被释放时，反冲阻挡件324随着爪滑动件270的回缩而遇到轮廓唇缘334中的脊部336，当从上方观察时，这迫使反冲阻挡件324沿顺时针方向旋转，由此从与连接齿条200的接合中反冲出爪阻挡件318。反冲阻挡件凹槽322的形状使得反冲阻挡件324的顺时针旋转停止到与轮廓唇缘334垂直的方向，以在完全回缩的过程中保持断开并由此消除棘齿噪音。
回缩系统
图7-17中描述的实施方式包括回缩组件500，回缩组件500被构造成使外科医生能够手动回缩击发杆32而不需要来自弹簧或其它回缩结构的任何其它辅助，其中，这些弹簧或其它回缩结构用于在击发系统上施加拖拉，并且其最终需要产生更高的击发力来致动击发机构。如图16和17最具体地示出，在这些实施方式中，第一齿轮220可操作地安装以与连接齿条200的带齿的左上表面222啮合。第一齿轮220还与第二齿轮230接合，第二齿轮230上具有更小的右侧棘轮231。第一齿轮220和第二车轮230两者分别设在前轴232和后轴234上可旋转地连接到手柄外壳154上。后轴234的一端延伸穿过各自的右半外壳156，并连接到指示器轮40形式的右侧指示构件上。类似地，后轴234的另一端延伸穿过左半外壳158并连接到左侧指示器轮41上。因为后轴232在手柄外壳154中自由旋转并与第二齿轮230键合，指示器轮40、41与第二齿轮230一起旋转。连接齿条200、第一齿轮220和第二齿轮230之间的齿轮关系可以有利地选择为使得带齿的上表面222的齿尺寸适当牢固并且第二齿轮230在连接传输击发机构150的整个击发行程中的转动不会超过一圈。
第二齿轮230的较小的右侧棘轮231延伸到手动回缩构件的套节506中，该手动回缩构件是回缩杆42的形式，其特别地与平分套节506的竖直的纵向对齐槽508(图12和15)对齐。套节506的横向通孔510与上部凹槽512连通。见图12。前部514的形状适于容纳向近侧指向的回缩爪516，爪516绕形成于上部凹槽512的远端中的向右的横向销518枢转。后部520的形状适于容纳L形的弹簧翼片522，翼片522向下驱动回缩爪516与右侧的较小棘轮231接合。支持结构524(图16和17)从右半外壳156突出到上部凹槽512中，用于在手动回缩杆42向上时支撑并防止回缩爪516与较小的右侧棘轮231接合(图16)。弹簧525(图8)将手动回缩杆42驱动到高端位置。
在击发过程完成以后，临床医生能够使用手动回缩杆42来将击发杆32回缩到未被致动的位置。这可以通过抓持手枪式握把36并按顺序下压和释放手动回缩杆42来实现。当手动回缩杆42被压下时(图17)，锁定爪516沿顺时针转动，并且不再由支持结构524支持，并与较小的右侧棘轮231接合，当从左侧观察时，使第二齿轮230顺时针转动。因为第二齿轮230与前向惰轮220啮合，第二齿轮230的顺时针转动导致前向惰轮220沿逆时针方向转动。当前向惰轮220沿逆时针方向转动时，其向近侧方向驱动连接齿条。由此，手动回缩杆42的连续的棘齿动作(图17中的箭头A)将使得连接齿条200回缩(箭头B)，并将击发杆32拉到完全回缩的位置。
在各种实施方式中，本发明构造有用于为外科医生提供击发杆32已经前进和回缩多长距离的指示的装置。在这些实施方式中，指示器齿轮230枢轴连接于其上的轴234连接到可以从外部观察到的指示器轮40、41上。见图8。在这种结构中，外科医生能够通过观察指示器轮40、41的位置来确定击发机构150的相对位置，并由此确定击发扳机34需要多少行程来完成击发。例如，完全的击发行程可以需要三个完全的击发冲程，并由此在每个冲程，指示器轮40、41最多旋转三分之一圈。连接齿条200、第一齿轮220和第二齿轮230之间的齿轮关系可以有利地选择为使得带齿的上表面222的齿尺寸适当牢固并且第二齿轮230在连接传输击发机构150的整个击发行程中的转动不会超过一圈。
闭合系统和击发系统之间的相互作用
当连接齿条200完全回缩并且扳机26、34两者都如图7和9所示打开时，第二齿轮230左侧上的圆形脊部242中的开口240出现在锁定臂172的上表面244上。见图7。锁定臂172通过与闭合扳机26的接触被偏压到开口240中，闭合扳机26又被闭合拉伸弹簧246驱动到打开位置。如图7所示，当锁定臂172的一部分延伸到圆形脊部242中的开口240中时，第二齿轮230不能旋转。由此，当锁定扳机26处于解锁位置时，击发机构150不能被致动。
图18至21图示了本发明的另一个外科缝合和切割器械10’。如图20所示，本实施方式使用与上述器械10相同的元件，除了侧安装并被可旋转地支撑的手动回缩和指示杆642以及相关的部件。更具体而言，参考图19和20，器械10’包括第一齿轮620，其被可操作地安装以与连接齿条200的带齿的左上表面222啮合。第一齿轮620还接合带毂的后部齿轮630。第一齿轮620和后部齿轮630两者分别在前部惰轮轴232和后部惰轮轴234上可旋转地连接到手柄外壳154’上。后轴234的一端延伸穿过相应的右半外壳156’并连接到右侧指示器轮40上。后轴234的另一端延伸穿过相应的左半外壳158’并连接到手动回缩指示杆642上。因为后轴234在手柄外壳154’中自由旋转并与第二齿轮630键合，手动回缩和指示杆642与第二齿轮630一起旋转。
当外科医生通过以上详细描述的方式防止击发手柄34倒转来向远侧推进击发杆32时，连接件196a-d的带齿部分222使第一齿轮620旋转(图19中的方向“C”)，通过与第二齿轮630的啮合，这可以使得第二齿轮630和手动回缩和指示杆642旋转(图19中的方向“D”)。图18和19图示了手动回缩和指示杆642的位置处于未击发和完全击发的位置。连接齿条200、第一齿轮620和第二齿轮630之间的齿轮关系可以有利地选择为使得带齿的上表面222的齿尺寸适当牢固并且第二齿轮630在连接传输击发机构150的整个击发行程中的转动不会超过一圈。由此，外科医生能够通过监测手动回缩和指示杆642的位置来确定击发过程已经进行了多远。
在击发过程完成以后，临床医生能够使用手动回缩杆642来将击发杆32回缩到未被致动(回缩)的位置。这可以通过抓持手动回缩杆642并使其顺时针转动(图18中的箭头“E”)来实现。当手动回缩杆642在该方向旋转时，其使第二齿轮630也在该方向上旋转。因为第二齿轮630与第一齿轮620啮合，第一齿轮620在图18中沿顺时针方向旋转，这在近侧方向上拉动连接齿条直到其到达开始不击发的位置。此外，该实施方式不使用任何弹簧或其它回缩构件，这些弹簧或回缩构件向击发系统施加的回缩力在击发过程中必须被克服。连接齿条200、第一齿轮620和第二齿轮630之间的齿轮关系可以有利地选择为使得带齿的上表面222的齿尺寸适当牢固并且第二齿轮630在连接传输击发机构150的整个击发行程中的转动不会超过一圈。
图22至27图示了本发明的又一个外科缝合和切割器械10”。如图23所示，本实施方式使用与上述器械10相同的元件。从图23-27可以最具体地看出，该实施方式使用手动回缩组件700用于手动回缩击发杆32。在各种实施方式中，手动回缩组件700包括驱动齿轮720，其被可操作地安装以与连接齿条200的带齿的左上表面222啮合。驱动齿轮720可旋转地支撑在手柄外壳154”中并位于轴232上，轴232被支撑在手柄外壳部分156”和158”之间。手动回缩组件700还可以包括第二齿条800，第二齿条800可动地支撑在形成于手柄外壳154”中的齿条通道820中。如图23所示，轨道部分822形成于右壳体部分156中，轨道部分824形成于左壳体部分158中。当壳体部分156、158彼此连接在一起以形成手柄外壳154”时，轨道部分822、824彼此协作以形成齿条通道820。齿条通道820的尺寸相对于第二齿条800进行调整，使得第二齿条800能够在手柄外壳154”中沿轴向来回移动(图26中的箭头“F”)。第二齿条800可动地支撑在齿条通道820中，并与驱动齿轮720啮合。
如图24和25所示，第二齿条800通过手柄轭形件910连接到回缩手柄900上，手柄轭形件910通过销912销接到第二齿条800上，并且通过销914销接到回缩手柄900上。回缩手柄900可以构造有一对枢转腿部902、904，用于与手柄外壳154”枢转连接。具体而言，腿部902可以通过销906销接到右壳体部分156”上，腿部904可以通过销908可枢转地销接到左壳体部分158”上。见图23。
当外科医生通过以上述详细描述的方式防止击发扳机34倒转来向远侧推进击发杆32时，连接件196a-d的带齿部分222使驱动齿轮720顺时针旋转(图26和27中的方向“G”)，通过与第二齿条800的啮合，这可以使得第二齿条800向近侧方向(图27中的方向“H”)移动。图27图示了第二齿条800和手动回缩手柄900的位置处于击发冲程完成的位置(也就是其中击发杆32已经移动到其最远侧位置的位置)。如图所示，回缩手柄的握把部分930远离手柄外壳154。为了回缩击发杆32，外科医生在“H”方向上简单地推动回缩手柄，直到第二齿条800到达图26所示的位置，其中握把部分930靠近手柄外壳154。本领域技术人员应当理解，外科医生能够在继续防止击发扳机34倒转的同时通过观测回缩手柄900的位置来监测击发冲程的进展。此外，本实施方式没有使用任何弹簧或其它回缩构件，这些弹簧或回缩构件向击发系统施加了在击发过程中必须被克服的回缩力。
在各种实施方式中，闭合扳机26具有上部160，上部160被构造成经由闭合连接件164致动闭合轭形件162。闭合连接件164在其远端处通过闭合轭形销166可枢转地连接到闭合轭形件162上，并在其近端处通过闭合连接销168可枢转地连接。如图26所示，通过闭合扳机拉伸弹簧246来致动闭合扳机26至打开位置，闭合扳机拉伸弹簧246向近侧连接到闭合扳机26的上部160以及手柄外壳154”上。
闭合扳机26的上部160包括近侧冠部170，近侧冠部170中形成有后部凹口171。参见图23和26。闭合释放按钮38和枢轴锁定臂172”经由中间横向枢轴174连接。压缩弹簧180向近侧偏压闭合释放按钮38(从右侧观察时是绕中间横向枢轴174顺时针方向)。如图26所示，当闭合扳机26被释放时，上部160后退，枢轴锁定臂172”靠在近侧冠部170上，近侧冠部170在闭合释放按钮38中拉动。如图26所示，枢轴锁定臂172”的上端173”被构造成延伸到第二齿条800中的凹槽802中，以由此防止齿条800的致动并从而击发器械10”。当闭合扳机26到达其完全压下的位置时，应当理解，后部凹口171出现在枢轴锁定臂172”之下，枢轴锁定臂172”在压缩弹簧180的驱动下落入后部凹口171并锁靠该凹口。当枢轴锁定臂172”脱离与第二齿条800的接合时，然后齿条800可以被沿轴向推进。在击发部件回缩时，闭合释放按钮38的手动下压将使枢轴锁定臂172”向上转动，从而松开闭合扳机26。
虽然本发明已由对一些实施例的描述作出示例说明，并且虽然这些示例性实施例已经得到了相当详细的描述，但是申请人并不企图将后附的权利要求书限制或以任何方式限定到这些细节。其它的优点和修改对于本领域技术人员来说是显而易见的。
例如，虽然在这里描述了外科缝合和切割器械10，但其有利地具有单独和不同的闭合和击发致动，提供了临床的弹性。然而，需要理解的是，与本发明相一致的应用可包括手柄，其将单个使用者致动转换为闭合及击发该器械的击发动作。
另外，虽然描述了手动致动手柄，但机动化的或其它动力手柄可得益于结合如这里描述的连接齿条，从而允许手柄尺寸的缩小或其它优点。例如，尽管部分地填充连接齿条到手枪式握把中是很方便的，应当理解的是，连接件之间的枢轴连接允许填充平行于由手柄的轴和筒体限定的直线部的连接件。此外，各种实施方式使用独特且新颖的回缩组件，其使得外科医生能够手动回缩击发杆，并且由此手动回缩端部执行器击发杆，而不需要可以用于向击发驱动器施加回缩力的弹簧或其它力产生构件的辅助。这种附加的力产生装置在回缩击发杆时是有帮助的，但是它们需要器械产生击发力，这些击发力必须克服由这种附加的回缩力产生构件所产生的力。由此，这里公开的各种回缩系统能产生“单独的”回缩动作或力。这意味着回缩动作/力通过外科医生对各个回缩构件的操作来产生，而不需要所附加的弹簧或力产生构件的辅助。
尽管已经描述了本发明的若干实施方式，但是很明显，本领域技术人员可以对这些实施方式进行各种变型、改变和修改，以获得本发明的一些或全部优点。例如，根据各种实施方式，单个部件可以被多个部件代替，多个部件也可以用单个部件代替，以进行给定的一个或多个功能。因此，本申请意图覆盖所有这些变型、改变和修改，而不脱离由所附权利要求限定的本发明的范围和精神。
这里公开的装置可以被设计成一次性使用的，或者它们可以被设计成多次使用。然而，在任一情况中，在至少一次使用之后装置可以被整修以供再使用。整修可以包括以下步骤的任何组合：拆卸装置，然后清洁或替换特殊零件，随后再组装。具体而言，装置可以被拆卸，并且装置的许多特殊零件或部分可以在任何组合中选择性地被替换或去除。一旦清洁和/或替换特殊部分，在外科手术将要开始之前装置可以在整修设备处或者由手术团队再组装供随后使用。本领域的技术人员将会理解装置的整修可以利用拆卸、清洁和/或替换和再组装的多种技术。这些技术的使用以及形成的整修的装置都在本申请的范围内。
优选地，这里描述的发明的各种实施方式可在外科手术之前进行。首先，得到新的或者使用过的器械并且在需要的时候对其进行清洁。器械然后可被灭菌。在一种灭菌技术中，器械被设置在闭合和密封容器中，诸如塑料或者TYVEK
Figure A20081008694900321
包中。容器和器械然后设置在可穿透容器的辐射场中，诸如γ辐射、x射线或者高能电子束。辐射杀死器械和容器中的细菌。灭菌的器械然后可存储在无菌容器中。密封的容器保持器械无菌直到其在医疗场合被打开。
通过引用包含在这里的任何专利、公开或者其它公开材料整体或部分地包含在这里，但是这些包含的材料不与现有的定义、描述或者本公开中提出的其它公开材料相矛盾。由此，在必要的方面，这里清楚描述的公开代替通过引用包含在其中的相矛盾的材料。通过引用包含在这里的与现有定义、描述或者这里提出的公开材料相矛盾的任何材料或者其一部分将仅被包含到使得所包含的材料与现有的公开材料之间不存在矛盾的程度。
意图保护的本发明不应当被限制为这里公开的具体实施方式。
因此，实施方式应当被认为是示例性的而非限制性的。在不背离本发明的精神的前提下，可以进行各种变化和变型。由此，很明显，所有这些等同物、变型和变化都落在由权利要求限定的本发明的精神和范围内。

Claims (10)

1.一种外科器械，包括：
手柄组件；
用于进行外科手术的端部执行器，所述端部执行器可操作地连接到所述手柄组件上并可操作地支撑击发构件，所述击发构件能够响应于施加于其上的纵向击发动作而从回缩位置运动到击发位置；
击发驱动器，其由所述手柄组件支撑，并能够基于可操作地连接到所述手柄组件上的击发扳机的致动而选择性地产生所述纵向击发动作；和
回缩组件，其由所述手柄组件支撑并与所述击发驱动器接合，使得所述回缩组件的手动致动能够使所述击发驱动器产生单独的回缩动作，所述单独的回缩动作传递到所述击发构件，以使所述击发构件从所述击发位置运动至所述回缩位置。
2.根据权利要求1所述的外科器械，还包括至少一个指示构件，其可操作地支撑在所述手柄组件上并与所述击发驱动器接合，以在向所述端部执行器施加所述击发动作和单独的回缩动作的过程中提供所述击发构件的进程的视觉指示。
3.根据权利要求1所述的外科器械，还包括：
闭合驱动器，其由所述手柄组件支撑并能够产生闭合动作和打开动作；以及
细长轴组件，其将所述端部执行器连接到所述手柄组件上，并能够将所述打开动作和闭合动作以及所述击发动作和回缩动作传递到其上。
4.根据权利要求3所述的外科器械，其中，所述端部执行器包括：
细长通道，其与所述细长轴组件相连并且其尺寸适于将钉仓容纳在其中；以及
砧座，其连接到所述细长通道上，并能够响应于来自所述细长轴组件的打开动作和闭合动作而选择性地在打开位置和闭合位置之间运动，并且其中，所述击发构件包括一用于切割和切断的构件，其可操作地支撑在所述细长通道中并能够对来自所述细长轴组件的所述击发动作和回缩动作作出响应。
5.根据权利要求3所述的外科器械，其中，所述闭合驱动器包括：
锁定机构，其用于在所述闭合驱动器已经将所述闭合动作完全施加到所述端部执行器上之后，自动将所述闭合驱动器锁定在锁定位置；以及
释放机构，其与所述锁定机构接合以选择性地向其施加解锁动作。
6.根据权利要求5所述的外科器械，其中，所述锁定机构与所述击发驱动器接合，使得所述锁定机构防止所述击发驱动器的致动，直到所述闭合驱动器处于所述锁定位置。
7.根据权利要求1所述的外科器械，其中，所述击发驱动器包括：
连接齿条，其由所述手柄组件可操作地支撑；
击发杆，其与所述连接齿条和所述端部执行器连通，用于向其传递所述击发动作和回缩动作；以及
击发扳机，其由所述手柄组件可操作地支撑，并能够与所述连接齿条相互作用，使得所述击发扳机的致动能够使所述连接齿条将所述击发动作施加到所述击发杆上。
8.根据权利要求7所述的外科器械，其中，所述回缩组件包括由所述手柄组件可操作地支撑的回缩构件，所述回缩构件与所述连接齿条连通，使得所述回缩构件的手动致动能够使所述连接齿条将所述单独的回缩动作施加到所述击发杆上。
9.根据权利要求8所述的外科器械，还包括至少一个回缩齿轮，其由所述手柄组件可操作地支撑并与所述回缩构件和所述连接齿条接合。
10.根据权利要求8所述的外科器械，其中，所述回缩构件能够在对应于所述回缩位置的第一位置和对应于所述击发位置的第二位置之间运动，并且其中，当所述击发扳机被致动时，所述回缩构件从所述第一位置移向所述第二位置，在向所述回缩构件施加回缩力时，所述回缩构件从所述第二位置移向所述第一位置。
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WO2024017217A1 (zh) * 2022-07-18 2024-01-25 天臣国际医疗科技股份有限公司 闭合机构及吻合器

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