CN101495045B - 外科器械的导引设备 - Google Patents
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Abstract
本发明涉及一种器械导引设备,所述器械导引设备包括细长导引轴,所述导引轴具有近端和远端并且包括器械内腔,所述器械内腔用于接收穿过所述器械内腔的、具有器械轴的手动操作器械。远侧可弯曲元件设置在导引轴的远端并且近侧可弯曲元件设置在导引轴的近端。致动装置在远侧和近侧可弯曲元件之间延伸并且提供由近侧可弯曲元件进行控制的远侧可弯曲元件的弯曲动作。近侧可弯曲元件由手动操作器械控制,以使所述远侧可弯曲元件产生相应弯曲。
Description
相关申请
本申请要求早先提交的美国临时申请60/700,776的优先权,其提交日为2005年7月20日。本发明还涉及到2004年4月12日提交的序列号为10/822,081的早先提交的美国申请,该申请又要求2003年10月30日提交的序列号为60/515,560的美国临时申请的优先权,并且,本发明还涉及到2005年7月20日提交的序列号为11/185,911的美国申请,该申请又要求2005年4月14日提交的序列号为60/671,189的美国临时申请的优先权。所有上述申请的内容通过引用而全部并入本申请。
技术领域
本发明大体涉及外科器械,更具体地,涉及打算用于微创手术或其他形式的外科程序或技术中的手动操作外科器械。进一步更具体地,本发明涉及医疗器械的导引装置。这里所述的器械可以用于腹腔镜程序,然而,应当理解本发明的器械和导引装置可以用于各种各样的其他程序,包括管腔内程序。
背景技术
目前在市场上可获得的内窥镜和腹腔镜器械极难学会操作和使用,主要是因为在它们的使用中缺少灵巧性。例如,在手术期间当使用典型的腹腔镜器械时,器械的工具的定向只受目标和切口的位置支配。这些器械通常通过支点效应工作,使用患者自身的切口区域作为支点。结果,普通任务例如缝合、打结和精细解剖对于医师来说变得复杂。数年来开发了各种一般通过提供额外的铰接装置而克服该缺陷的腹腔镜器械,所述铰接装置通常由单独设置的用于进行附加控制的控制元件进行控制。然而,即使如此,这些器械仍然不能提供足够的灵巧性以允许外科医生执行普通任务,例如缝合,特别是在任意选择的方位处。
上面介绍的本人的相关早先申请描述了一种改进的器械,其采用位于器械自身上的可弯曲部分。
本发明的一个目的是提供一种导引设备或装置,其可以与常规的或以上介绍的用于腹腔镜、内窥镜或其他外科程序的器械一起使用并且允许外科医生以更大的灵巧性容易地操纵外科器械的工具或工作端。
本发明的另一目的是提供一种改进的外科器械和导引装置,其具有各种各样的应用,包括但不限于:经切口、经自然身体孔口或管腔内延伸。
发明内容
为了实现本发明的上述和其他目的、特征和优点,提供了一种器械导引设备,其包括细长导引轴,所述导引轴具有近端和远端并且包括器械内腔,所述器械内腔用于接收穿过所述内腔的、具有器械轴和手柄的手动操作器械。远侧可弯曲元件设置在导引轴的远端,并且近侧可弯曲元件设置在导引轴的近端。致动装置在远侧和近侧可弯曲元件之间延伸并且提供由近侧可弯曲元件进行控制的远侧可弯曲元件的弯曲动作。近侧可弯曲元件由手动操作器械控制,从而导致远侧可弯曲元件产生相应弯曲。
根据本发明的其他方面,提供了一种器械导引设备,其中,致动装置构造和设置成使得近侧可弯曲元件的弯曲导致远侧可弯曲元件产生相同方向的弯曲,或者替代地,致动装置构造和设置成使得近侧可弯曲元件的弯曲导致远侧可弯曲元件产生相反方向的弯曲。近侧可弯曲元件优选地可沿任何方向移动。把手可以设置在近侧可弯曲元件和器械的手柄之间,并且构造和设置成具有器械轴延伸穿过其中的通道。把手可以形成为包括把手部分和旋钮的两个部件,并且把手部分和旋钮部分支撑成可在它们之间进行相对旋转。可以设置用于将器械手柄固定到把手的装置。可弯曲元件均可以包括一体开槽结构,所述一体开槽结构具有由狭槽分隔开的多个圆盘。导引轴可以是刚性,挠性或部分挠性。器械导引设备可以包括多个近侧可弯曲元件和多个远侧可弯曲元件。致动装置可以包括互连近侧和远侧可弯曲元件的多个缆线。导引轴可以具有至少两个用于分别容纳单独器械轴的内腔。插入导引设备中的器械可以具有器械近侧和远侧可弯曲元件。
在本发明的另一实施方式中,提供了一种外科器械组件,其包括:具有近端和远端的细长器械轴;通过器械轴的远端耦联的工作元件;设置在器械轴的近端的控制手柄;以及用于接收器械轴的导引元件。导引元件包括:导引轴;位于导引轴的远端的远侧运动装置;位于导引轴的近端的近侧运动装置;以及在远侧和近侧运动装置之间延伸的致动装置。在手术部位,工作元件延伸超出导引轴的远端。近侧运动装置的任何偏转导致远侧运动装置产生相应偏转,以便对工作元件进行控制。
根据本发明的另外其他方面,提供了一种外科器械组件,其中,远侧运动装置包括远侧可弯曲元件,并且近侧运动装置包括可沿任何方向移动的近侧可弯曲元件。把手可以设置在近侧可弯曲元件和器械的手柄之间,并且构造和设置成具有器械轴延伸穿过其中的通道。把手可以形成为包括把手部分和旋钮的两个部分,并且把手部分和旋钮部分支撑成可在它们之间进行相对旋转。近侧可弯曲元件可以包括一体开槽结构,所述一体开槽结构具有由狭槽分隔开的多个圆盘并且进一步包括互连相邻圆盘的多个肋条,所述肋条以绕着所述元件呈小于90度间距的方式设置。
在本发明的另一实施方式中,提供了一种外科器械,其由具有近端和远端的细长器械轴、设置在器械轴的远端的工作元件以及设置在器械轴的近端的控制手柄组成。工作元件通过远侧运动元件耦联到细长器械轴的远端。控制手柄通过近侧可弯曲元件耦联到细长器械轴的近端。致动装置在远侧和近侧元件之间延伸,由此,控制手柄相对于细长器械轴的任何偏转均导致远侧运动元件产生相应弯曲,以便对工作元件进行控制。至少近侧可弯曲元件包括一体开槽结构,所述一体开槽结构具有由狭槽分隔开的多个圆盘。
根据本发明的另外其他方面,提供了一种器械导引设备,其中,远侧运动元件也包括形成为一体开槽结构的可弯曲元件,所述一体开槽结构具有由狭槽分隔开的多个圆盘。近侧可弯曲元件可以包括互连相邻圆盘的多个肋条,所述肋条以绕着所述元件呈小于90度间距的方式设置。所述肋条可以以大约60度的间距设置。
附图说明
应当理解,提供附图仅仅是为了图解而非想要限定公开的范围。结合附图参考以下具体描述部分,文中所述的实施方式的上述和其他目的和优点将变得现而易见,所述附图为:
图1是外科器械和采用刚性导引管轴的导引设备的第一实施方式的侧视分解图;
图2是沿着图1中的线2-2观察所得的图1中的导引设备的近端的视图;
图3是处于在切口处经患者皮肤插入时的使用状态中的器械和导引组件的示意性侧视图;
图4是图3中的组件的局部放大的侧视截面图;
图5是沿着图4中的线5-5观察所得的近侧可弯曲元件的截面图;
图6是图1-5中所示的导引装置或设备的立体分解图;
图7是示出图4中的组件的弯曲动作的示意性侧视截面图;
图8是示出替代性弯曲动作的示意性侧视截面图;
图9是类似于图4中所示的局部侧视截面图,但是示出了具有附加旋转特征的导引组件的第二实施方式;
图10是与图1中的钳口式末端执行器一起使用的图9中的导引组件的示意性侧视图;
图11是在导引设备中采用挠性主轴的导引组件或设备的第三实施方式的示意性侧视图;
图12是与外科器械的第二实施方式一起使用的导引设备的第四实施方式的侧视分解图;
图13是沿着图12中的线13-13观察所得的图12中的导引设备的近端的视图;
图14是处于使用状态下的图12中的器械和导引组件的示意性侧视图;
图15是导引设备的第五实施方式与外科器械的第三实施方式的侧视分解图;
图16是沿着图15中的线16-16观察所得的图15中的导引设备的近端的视图;
图17是处于在切口处经患者皮肤插入时的使用状态下的图15中的器械和导引组件的示意性侧视图;
图18是导引设备的第六实施方式和外科器械的第四实施方式的侧视分解图;
图19是处于在切口处经患者皮肤插入时的使用状态下的图18中的器械和导引组件的示意性侧视图;
图20是导引设备的第五实施方式与外科器械的第五实施方式一起使用时的侧视分解图;
图21是处于在切口处经患者皮肤插入时的使用状态下的图20中的器械和导引组件的示意性侧视图;
图22是导引设备的第六实施方式与外科器械的第六实施方式一起使用时的侧视分解图;
图23是处于在切口处经患者皮肤插入时的使用状态下的图22中的器械和导引组件的示意性侧视图;
图24是能够与两个或更多器械一起使用的导引设备的另一实施方式的立体图;以及
图25是在导引元件上的近侧和远侧都使用多个可弯曲元件的本发明的又一实施方式的侧视图。
具体实施方式
本发明的器械和导引元件可以用于执行微创程序或实质上任何其他类型的外科或医疗程序。“微创程序”在这里指的是外科医生经过小缺口或切口操作的外科程序,小切口用于进入到手术部位。在一个实施方式中,切口长度范围在直径上介于1mm到20mm,优选地在直径上介于5mm到10mm。该程序与需要大切口进入到手术部位的那些程序形成对比。因此,器械组件优选地用于经过这样的小切口和/或经过自然身体管腔或空腔插入,从而将器械定位在内部目标部位以进行特定外科或医疗程序。外科器械组件引入到解剖组织内也可以通过经皮或外科进入管腔或血管方式进行,或者通过经由解剖组织中的自然孔口引入。而且,尽管器械组件优选地用于MIS手术,它也可以用于开放手术或任何其他外科或医疗程序。
除了用于腹腔镜程序之外,本发明的器械和导引装置可以用于各种其他医疗或外科程序,包括但不限于结肠镜、上胃肠道(upper GI)、关节镜、窦、胸腔、经阴道和心脏程序。取决于特定程序,器械轴可以是刚性,半刚性或挠性。
尽管这里参考的是外科器械和导引装置,但是可以预料本发明的原理也可应用于不必非得用在手术中的其他医疗器械,包括但不限于这样的其他器具:例如导管、内窥镜、光学器件以及诊断和治疗器械和器具。
本发明的外科导引器械的又一方面是具有使器械和导引装置适应各种各样医疗程序的性能。包括但不限于:例如经切口进入身体空腔或者例如经自然身体孔口进入到身体管腔的管腔内使用。器械引入到解剖组织内也可以通过经皮或外科进入管腔、空腔或血管方式进行,或者通过经由解剖组织中的自然孔口引入。
本发明的概念涉及手动可控导引元件或设备的使用,常规器械轴或新式器械均可以穿过所述导引元件或设备插入,例如先前介绍的本人的相关未决申请中所描述的新式器械。使用本发明的导引元件,使用者可以穿过导引元件插入器械轴,然后使用导引元件的可弯曲元件控制器械的操作。因此,通过偏转已定位在导引元件中的器械,,则导致在近侧可弯曲元件处产生偏转或弯曲,所述偏转或弯曲传递到远侧可弯曲元件(通常通过缆索),从而控制远侧工具的定位。导引元件处的所述弯曲控制优选为沿所有方向。
应当注意,在远侧弯曲元件产生的导引元件的弯曲运动的量由近侧可弯曲元件与远侧可弯曲元件的尺寸对比决定。在公开的实施方式中,近侧可弯曲元件可以是远侧可弯曲元件的直径的大约三倍,因此,在远侧可弯曲元件产生的运动是近侧可弯曲元件处的运动的幅度的大约三倍。尽管图3仅仅示出了其中只示出俯仰运动的侧视图,应当理解近侧可弯曲元件可以沿任意方向弯曲,从而控制远侧可弯曲元件在相同平面内沿相同或相反方向弯曲。因此,如图3所示,只需通过近侧可弯曲元件处的转动动作,外科医生便能够在任何方位使器械的工具绕着其纵向轴线转动,所述近侧可弯曲元件处的转动动作主要通过操纵支承在导引元件上的已插入的器械的手柄进行控制。
在本描述部分中,所参考的是可弯曲元件。这些元件也可以称为可转动元件或挠性元件。在文中所给出的描述部分中,诸如可弯曲部分、可弯曲节段、可弯曲运动元件或可转动元件等术语指的是与在接头处进行枢转的元件形成对比的、导引器械中的能够以可控方式产生弯曲的元件。通过采用单一的一体或单体结构,本发明的可弯曲元件便能够使弯曲沿任何方向进行,而不具有任何奇异点,并且,其进一步的特征在于沿任何方向弯曲的备妥性能(ready capability)。这些可弯曲运动元件的定义是:一种导引元件,其形成为控制装置或受控装置,并且能够由张力或压缩力限制,以从直线状态偏转到弯曲构形而不具有任何锐断点或奇异点。
在图1-6中示出了第一实施方式。导引元件或器械10具有近侧可弯曲元件20和远侧可弯曲元件22并且在器械12的插入位置接收例如图3中所示的器械12,从而显示为组装器械系统14。器械12可以是常规器械并且固定在导引元件10中,使得器械手柄40处的运动基本上通过导引元件10进行传递,以控制末端执行器的定位。换句话说,手柄40的偏转导致近侧可弯曲元件20的弯曲(如图3所示),这转而弯曲远侧可弯曲元件22以控制工具或末端执行器的放置。该第一实施方式还包括在手柄40和近侧可弯曲元件20之间提供接口的把手16。在该特定实施方式中,把手16是单部件结构,因此器械的旋转通过旋转整个器械和导引元件才可进行。器械12锁定到导引元件10,因此不存在器械相对于导引元件的线性运动。
参考图1,外科器械12可以视为常规设计并且由器械近端处的手柄40、细长挠性器械轴36和设置在外科器械12的远端的工具或末端执行器38组成。在公开的实施方式中,器械轴36优选地构造成至少呈部分挠性或可弯曲,以充分地随着导引元件10的可弯曲元件的弯曲而弯曲。工具38显示为包括固定钳口54和活动钳口52。工具38借助致动缆线50而被致动,所述致动缆线延伸穿过器械轴36并且由滑动件46和复位弹簧48控制。控制杆42通过连杆或传动杆44操作滑动件46。闭合控制杆42则牵引缆线50从而闭合钳口52、54。
图中示出一组钳口,然而,其他工具或设备可以容易地适用于本发明的器械,包括但不限于照相机、检测器、光学器件、观测装置、流体输送设备、注射器等。工具则可以包括各种铰接工具,例如钳口、剪刀、抓紧器、持针器、微型解剖器、卡钉施用器、敲钉器(tacker)、抽吸冲洗工具和夹子施用器。另外,工具可以包括非铰接工具,例如切割刀片,探针,冲洗器,导管或抽吸孔口。
在图1-6中,导引元件或导引器械10在图1中相对于外科器械12单独绘制。在图3中,示出器械已插入和穿过导引元件10的组装系统14。在图3中,应当注意导引元件的轴18延伸穿过患者皮肤4的插入部位6处的插管8。末端执行器或工具38在图3中显示为延伸自远侧可弯曲元件22。图3还示出可以绕着远侧弯曲元件22延伸的保护鞘24。
除了包括导引轴18之外,导引元件10还包括近侧挠性或可弯曲元件20和远侧挠性或可弯曲元件22。转接盖套26绕着近侧可弯曲元件20的一部分设置。转接盖26包括漏斗或圆锥形部分96(参见图6)以用于接收近侧可弯曲元件20和导引轴18的末端。导引元件10的把手16接收近侧可弯曲元件20的另一端。把手16优选为单部件结构,其具有空腔28以用于接收常规器械12的凸部30。凸部30也可以设置有凹槽32以用于接收穿过把手16延伸到空腔28和凹槽32内的锁定螺钉34。锁定螺钉34的使用使得器械12固定在导引元件10内。器械的运动因此直接传递到把手进而传递到近侧可弯曲元件20。导引元件的长度选择成使得器械的工具延伸超出导引元件的末端,如图3所示。
该第一实施方式还公开了近侧和远侧可弯曲元件20和22的细节,特别在图4-6中。近侧可弯曲元件20具有器械轴36可以延伸穿过其中的中心通道56。图4也示出了由导引轴18限定的、器械轴36延伸穿过其中的内腔58。类似地,远侧可弯曲元件22包括通道60以用于接收器械轴36。在图4中导引轴18显示成刚性,但是也可以是部分刚性或挠性。导引轴18可以由轻质金属材料或塑料制成。
把手16包括空腔62(参见图6)以用于接收近侧可弯曲元件20的一端。该可弯曲元件20就座于把手16的端壁64。壁64具有锥形或圆锥形通道66以用于接收器械轴36。如图6所示,还设置有用于缆索的几个通道68。把手16还包括用于锚固件86和弹簧88的空腔70。包括多个近侧锚固件86和相关弹簧88。弹簧88用于张紧关联缆线76-82。远侧可弯曲元件22包括延伸端94以用于接收对致动缆线76-82的远端进行固定的远侧锚固件84。优选地,把手16还包括益于抓握导引把手16的凸起唇边72。凸起唇边72优选地具有间隔指槽74。
近侧和远侧可弯曲元件之间的控制主要借助在这些可弯曲元件之间延伸的一组缆线来实现。近侧可弯曲元件处的弯曲导致一个或多个缆线受到牵引,而相对的其他缆线则松弛,从而导致在远侧可弯曲元件处发生相应的弯曲动作。所使用的缆索包括在近侧和远侧可弯曲元件之间延伸的挠性缆线76,78,80和82。多个远侧锚固件84用在缆索的远端。缆线通道90设置在近侧可弯曲元件20中,并且缆线通道92设置在远侧可弯曲元件22中。通道90和92容纳这些缆线。而且,导引圆盘(未图示)可以沿着缆线设置,具体地,设置在导引轴18内,因此保证当缆线从导引轴的一端延伸到另一端时使缆线保持就位。
近侧可弯曲元件20由在其间限定出空隙或狭槽100的一系列相邻圆盘98组成。连接肋条102在相邻圆盘98之间延伸。图5示出肋条102的位置。以类似方式,远侧可弯曲元件22包括在其间限定出狭槽或空隙106的一系列圆盘104。肋条108在相邻圆盘104之间延伸。关于可弯曲元件以及圆盘、狭槽和肋条之间的优选关系的更多细节,参考2005年7月20日提交的序列号为11/185,911的申请,该申请的内容通过引用而并入本申请。
图7和8示出器械插入其中的导引元件并且还示出取决于对弯曲动作进行控制的控制缆线的位置而发生的各种运动。在图7中,近侧可弯曲元件20的向下运动导致远侧可弯曲元件22向上运动。替代地,在图8中,近侧可弯曲元件20的向下运动导致远侧可弯曲元件22向下运动。这一点全是依靠在操纵近侧可弯曲元件时缆索伸出或缩回来实现。通过如图7所示使缆索成直线或如图8所示使其交叉180度而产生不同方向的弯曲。在图7和8中,器械手柄显示成固定到把手部分16,从而通过操纵手柄而导致能对把手部分进行直接操纵,进而能控制近侧可弯曲元件处的弯曲。近侧可弯曲元件处的弯曲进而控制远侧可弯曲元件和末端执行器的定位。
在图9和10中示出本发明的第二实施方式。该实施方式使用带有旋钮112的双部件式把手116。该实施方式通过近侧和远侧可弯曲元件而允许进行与第一实施方式中相同的弯曲动作,但是附加地,允许使用者相对于把手部分116旋转导引元件。该旋转动作导致可弯曲元件20、22和导引轴36绕其轴线旋转。
图9和10中的实施方式还示出了固定支撑于把手116的器械手柄。在该特定实施方式中,设置同样也包括旋钮112的基本为双部件的把手而非设置单部件式把手。凸部114设置在旋钮112上,且终止于旋钮112的端壁118。把手116设置有空腔120以用于接收凸部114。固位装置122(环形向内延伸肋条)从把手116延伸到环形狭槽内。由此,旋钮112与把手116接合但是可相对于把手116自由旋转。图10还示出了指示出器械手柄12相对于旋钮112的旋转的箭头111。箭头113指示出末端执行器38的相应旋转。尽管将部件112称为旋钮,但是应当理解,当把手116例如如图10中的箭头111、113所示相对于其旋转时,旋钮112可以保持不旋转。
在图1-10所示的本发明的前两个实施方式中,导引轴自身可以是刚性、挠性或半挠性,但是基本上显示为刚性。器械轴自身优选为至少呈部分挠性,使得当操作近侧和远侧元件时所述器械轴可以挠曲。
在图11中示出了本发明的第三实施方式,图中示出了挠性或部分挠性导引轴或管126。在前两个实施方式中,导引轴可以是刚性或部分挠性并且器械轴应当是至少部分挠性,从而当可弯曲元件活动时所述导引轴发生挠曲。图11中所示的实施方式旨在使用挠性或半挠性导引管126,其显示成穿过位于患者皮肤4的插入部位6处的插管8而得以放置,例如供腹腔镜使用。图11还示意性地示出了器械手柄12、把手以及近侧和远侧可弯曲元件20和22。除了导引轴126之外,导引元件的其余部分可以大致与图1-8或9和10中所述的相同。该特定实施方式还使得能够在管腔内使用器械和导引组件,例如经过切口或自然身体孔口。末端执行器可以位于管腔中,或者,器械可以定位成使得末端执行器位于体腔中或经过身体管腔或血管而延伸到空腔。
该第三实施方式也可以将常规内窥镜容纳在导引元件内。将内窥镜插入到导引元件中。这样的内窥镜可以具有用于仪器、用于光学器件或用于例如冲洗等其他目的通道。在该情况下,本发明的导引元件可以用于使内窥镜转向。这一点将会相当有益,特别是对于管腔内应用,在所述管腔内应用中,内窥镜需要沿组织管腔中的较大弯曲部分穿行。
在图12-14中示出了第四实施方式,该实施方式使用了允许导引元件能够相对于器械手柄进行旋转的单部件式把手。图12是与外科器械的第二实施方式---即包括位于器械和导引元件之间的互锁装置的实施方式---一起使用的导引设备的该第四实施方式的侧视分解图。图13是沿着图12中的线13-13观察所得的图12中的导引设备的近端的视图。图14是图12中的、处于经过切口的使用状态中的器械和导引组件的示意性侧视图。图12-14的实施方式可以视为一种通过使用锁扣的快速脱离装置,所述快速脱离装置容易地使得器械与导引元件能够连接和脱离。
如图14中所示,手柄或把手均可以旋转。图12-14中所示的实施方式使用单部件式把手130,该把手130在一端具有带锁扣133的凸出唇边132,所述锁扣延伸到空腔134内。把手130可以大致与图1-6中所示的把手相同。手柄40上的凸部138具有环形凹槽139。一旦器械插入到导引元件128内,锁扣133就接合在环形凹槽139内。在图12-14的实施方式中,导引元件128以这样的方式与器械连接,使得导引元件128可以相对于器械旋转,反之亦然。这一点依靠锁扣133能够容易地在器械手柄的凹槽139内进行旋转来实现。实质上,可以旋转把手130以使整个导引元件旋转,或者,器械的手柄自身可以旋转。这两个不同的旋转以图14中的单独箭头121、123以及器械远端处的相应箭头125、127示出。与手柄关联的旋转箭头121控制由远侧箭头127所示的旋转。与把手关联的旋转箭头123则控制由远侧箭头125所示的旋转。
在图14中,应当注意导引元件轴18延伸穿过患者皮肤4的插入部位6处的插管8。末端执行器或工具38在图14中显示为延伸自远侧可弯曲元件22。保护鞘可以绕着远侧挠曲元件22延伸。
也可以使锁定设备或机构与图14中的器械组件关联,在该情况下,近侧和远侧可弯曲元件20、22之间的缆索被夹紧,从而使可弯曲元件保持在固定的弯曲方位。参考2004年4月12日提交的序列号为10/822,081的共同未决申请---该申请全文通过引用而并入本申请,可得到对于锁定机构---特别示出在图27中---的说明。所述锁定机构描述为将缆线锁定在特定位置,从而固定可弯曲元件的方位。在具有该装置的情况下,如果导引元件随着弯曲的元件20、22旋转,则弧形远侧可弯曲元件产生旋转,从而使末端执行器发生位移并且为其提供附加控制度。该附加控制度可以提供给本申请中所述的几个实施方式。器械自身的旋转使末端执行器在导引元件内旋转。
在图15-17中示出了第五实施方式,其中,导引元件如前面那样工作,但是附加特征是器械的支撑方式,所述支撑方式允许器械在导引元件内进行滑动动作以及允许器械旋转。当器械与导引元件接合时,弯曲运动可以如先前的实施方式那样进行传递。另外,使用者可以在导引元件内线性移进移出器械,并且可以在导引元件内旋转器械。该实施方式特别有利于器械组件进行管腔内使用,对于管腔内使用来说,理想的会是具有在体腔内线性移动器械的性能。
图15是导引设备的第五实施方式与外科器械的第三实施方式的侧视分解图。图16是沿着图15中的线16-16观察所得的图15中的导引设备的近端的视图。图17是图15中的、处于在切口处经患者皮肤插入时的使用状态中的器械和导引组件的示意性侧视图。如前面所述,也可以在管腔内使用器械组件,在该情况下,器械和导引轴两者沿着它们各自的长度方向均呈挠性。
在图15-17的实施方式中,应当注意把手142具有与之关联的旋钮144。把手和旋钮可以按例如先前图4中所示的方式进行支撑。在所示实施方式中,把手部分和旋钮优选为单部件结构。把手部分142包括端壁146和用于接收器械轴36的锥形通道148。轴36的极近端141可以就座在锥形通道148中。由于外科器械自身并未固定到把手内,因此能够沿例如图17中箭头145的方向线性移动外科器械,从而使得末端执行器能够沿图17中所示的箭头147的方向进行相应的线性平移。除了该线性移动之外,当然也存在如在先前实施方式中所发生的、导引管的近侧和远侧可弯曲元件之间的弯曲动作。
在图15-17的实施方式中,也能够使器械旋转。图17中的箭头指示出手柄的旋转和近侧可弯曲元件的偏转。相应的箭头则指示出器械组件的远端处的运动。箭头151指示出近侧可弯曲元件20处的弯曲,而箭头153则指示出远侧可弯曲元件22处的相应弯曲。箭头155指示出器械手柄处的旋转,而箭头157则指示出末端执行器处的相应旋转。在图17中,器械轴被显示成具有一定长度,但是应当理解,其长度可以取决于特定医疗用途而变化。
图18是导引设备的第六实施方式和外科器械的第四实施方式的分解侧视图。图19是图18中的、处于在切口处经患者皮肤插入时的使用状态中的器械和导引组件的示意性侧视图。图18和19中所示的第六实施方式使用包括把手部分142和旋钮部分144的单部件式把手。器械自身具有旋钮156,所述旋钮156带有凸部158,所述凸部158延伸到手柄40的空腔160内。图18还示出了器械轴162。还示出了器械轴的极远端处的末端执行器38。推拉缆线164延伸穿过器械轴162并且固定在位于滑动件168内的可旋转筒166。末端执行器的致动通过控制杆167进行。图19中的视图示出了已插入到导引元件内的器械。在组件的近端,设置有导引元件的一个可弯曲元件20、位于导引元件上的旋钮和把手、以及器械手柄的旋钮156。在器械的远端,设置有导引元件的远侧可弯曲元件22。图18和19的实施方式允许近侧可弯曲元件产生弯曲,并且也允许旋钮156进行旋转。位于联接件170的环形狭槽172中的锁扣176防止器械相对于导引元件进行任何线性平移,但是允许器械手柄进行相对旋转。联接件170适于配合在导引元件的圆锥形空腔174内。
在图18和19的实施方式中,由于所使用的可弯曲元件以及由于所述允许进行的旋转,因此存在几个允许的运动度。这些运动中的一些运动借助相应箭头在图19中示出。箭头171指示出器械的旋转,而箭头173则指示出器械末端执行器处的相应旋转。箭头175指示出把手142处的导引元件的旋转,而箭头177则指示出导引元件的远端处的相应旋转。箭头179指示出可弯曲部分20处的弯曲,而箭头181则指示出远侧可弯曲元件22处的相应弯曲。
现在参考2004年4月12日提交的序列号为10/822,081和2005年7月20日提交的序列号为11/185,911的相关申请,上述申请通过引用而并入本申请并且视为本申请的公开的一部分。这些申请的主题包含位于器械自身内的近侧和远侧可弯曲元件。该类型的器械也可以与本发明的导引元件关联使用,所述导引元件也包括近侧和远侧可弯曲部分或元件。现在描述在器械和导引元件中都包含可弯曲元件的实施方式。
在图20和21中示出了第七实施方式。该实施方式利用非常规器械,例如在2005年7月20日提交的序列号为11/185,911的共同未决申请中所描述的器械,所述器械使用了器械的近侧和远侧可弯曲部分。因此,组合在一起的组件实际上具有两个近侧可弯曲元件和两个远侧可弯曲元件,从而提供末端执行器的更大控制度。一个近侧可弯曲元件位于导引元件上,而另一个则位于器械自身上。一个远侧可弯曲元件位于导引元件上,而另一个则位于器械自身上。
图20是导引设备的第五实施方式与外科器械的第五实施方式一起使用时的侧视分解图。图21是图20中的、处于在切口处经患者皮肤插入时的使用状态中的器械和导引组件的示意性侧视图。图20和21的实施方式与图18和19的实施方式的区别主要在于:前者具有在导引元件内线性平移器械的性能。图21示出了组件的如箭头所示的各种运动。
因此,在图20和21的实施方式中提供了一种器械,其具有旋钮的旋钮182,所述旋钮182带有凸部184,所述凸台184延伸到手柄40的空腔186内。图20还示出了器械轴162、近侧可弯曲元件188和远侧可弯曲元件190。还示出了器械轴的极远端处的末端执行器38。推拉缆线164延伸穿过器械轴162并且固定在位于滑动件168内的可旋转筒166。关于如图20所示的器械的更多细节,参考序列号为10/822,081和11/185,911的申请,特别是序列号为11/185,911的申请中的图8。
图20和21中的实施方式还包括先前结合图15-17进行描述的把手部分142和旋钮144。在图20中,导引元件140还包括近侧可弯曲元件20、远侧可弯曲元件22和导引轴18。联接件26连接近侧可弯曲元件与导引轴。
图21中的视图示出了已插入到导引元件内的器械。在组件的近端,设置有两个可弯曲元件,即:分别与把手142和器械手柄40关联的近侧可弯曲元件20和188。在器械的远端,设置有分别与导引轴18和器械轴162关联的远侧可弯曲元件22和190。如图21所示的方案也可以使器械能够在导引装置内进行线性平移。图21中的箭头示出了各种运动。
在图20和21所示的实施方式中,由于所使用的几个可弯曲元件以及由于所述允许进行的旋转,因此存在几个允许的运动度。这些运动中的一些运动借助相应箭头在图21中示出。箭头171指示出器械在旋钮182处的旋转,而箭头173则指示出器械末端执行器处的相应旋转。箭头175指示出导引元件在把手142处的旋转,而箭头177则指示出在导引元件的远端处的相应旋转。箭头179指示出可弯曲部分20处的弯曲,而箭头181则指示出远侧可弯曲元件22处的相应弯曲。箭头183指示出可弯曲部分188处的弯曲,而箭头185则指示出远侧可弯曲元件190处的相应弯曲。
在图22和23中示出了本发明的第八实施方式。该实施方式非常类似于图20和21中所示的实施方式,原因在于前者使用两对协同操作的可弯曲部分,一对在器械上而另一对则在导引元件上。然而,在该实施方式中,利用了带有锁扣176的单部件式把手部分,所述锁扣176用于将器械固定到把手部分内,与此同时允许进行旋转但是不允许进行线性平移。关于导引元件的把手部分的更多细节参考图12-14。
图22是导引设备的第六实施方式与外科器械的第六实施方式一起使用时的侧视分解图。图23是图22中的、处于在切口处经患者皮肤插入时的使用状态的器械和导引组件的示意性侧视图。在图22中,导引元件142具有圆锥形空腔174,锁扣176可以延伸到所述空腔174内以与器械主体接合。该啮合允许进行相对旋转但是不允许进行线性平移。
因此,在如图22和23所示的实施方式中,提供了一种器械194,其具有旋钮182,所述旋钮182带有凸部184,所述凸部184延伸到手柄40的空腔186内。图22还示出了器械轴162、近侧可弯曲元件188和远侧可弯曲元件190。还示出了器械轴的极远端处的末端执行器38。推拉缆线164延伸穿过器械轴162并且固定在位于滑动件168内的可旋转筒166。关于图22中所示的器械的更多细节,参考序列号为10/822,081和11/185,911的申请,特别是序列号为11/185,911的申请中的图8。
图22和23中的实施方式还包括具有盖套或联接件192的器械,所述盖套或联接件连接近侧可弯曲元件188与导引轴162。联接件192具有环形凹槽196,该环形凹槽196适于接收锁扣176的自由端。该锁扣/凹槽装置允许在器械和导引元件之间进行旋转。联接件192的圆锥形表面与把手142中的圆锥形空腔174配合。图23示出了完全地和可操作地与导引元件接合的器械。
在如图22和23所示的实施方式中,由于所使用的几个可弯曲元件以及由于所述允许进行的旋转,因此存在几个允许的运动度。这些运动中的一些运动借助相应箭头在图23中示出。箭头171指示出器械在旋钮182处的旋转,而箭头173则指示出器械末端执行器处的相应旋转。箭头175指示出导引元件在把手142处的旋转,而箭头177则指示出导引元件的远端处的相应旋转。箭头179指示出可弯曲部分20处的弯曲,而箭头181则指示出远侧可弯曲元件22处的相应弯曲。箭头183指示出可弯曲部分188处的弯曲,而箭头185则指示出远侧可弯曲元件190处的相应弯曲。
在图24中示出了本发明的第九实施方式,其中,导引元件容纳多个器械以及其他可能的仪器。先前示出的各种器械中的任何一种可以用在该实施方式中。图24示出了例如可以用于冲洗目的或用于光学器件的通道。图24是这样的实施方式,其中,导引轴具有多个通道以用于接收多个器械或其他设备,并且可以是挠性、刚性或半挠性。图24示出了耦联到可以用于光学器件或其他目的的导管或其他管状设备214的近端的连接器216。管214延伸穿过导引元件200内的内腔之一。图24中所示的两个器械可以视为与先前如图20或22所示的类型相同。这些器械中的每一个均显示为控制各自的末端执行器38。
在如图24所示的实施方式中,提供了单部件式把手202,该单部件式把手202具有可以由使用者抓握的凸出唇边204。在替代性实施方式中,可以使用双部件式把手。导引元件具有近侧可弯曲元件206和远侧可弯曲元件208。缆索以与先前针对只具有一个内腔的导引元件所述的相同方式连接在这些可弯曲元件之间。导引元件200可以视为具有三个单独内腔;两个内腔210容纳各自的器械180而另一个内腔212则用于接收导管、管或轴214。在该实施方式中,由于之前已经描述了器械,因此这里不再进行详细描述。参考图19-23。每个器械包括近侧可弯曲部分188和远侧可弯曲部分190。同样每个器械还包括控制钮182。
在如图24所示的实施方式中,由于所使用的几个可弯曲元件以及由于所述允许进行的旋转,因此存在几个允许的运动度。这些运动中的一些运动借助相应箭头在图24中示出。箭头171指示出器械在旋钮182处的旋转,而箭头173则指示出器械末端执行器处的相应旋转。箭头175指示出导引元件在把手142处的旋转,而箭头177则指示出导引元件的远端处的相应旋转。箭头179指示出可弯曲部分20处的弯曲,而箭头181则指示出远侧可弯曲元件22处的相应弯曲。箭头183指示出可弯曲部分188处的弯曲,而箭头185则指示出远侧可弯曲元件190处的相应弯曲。
现在参考图25中所示的本发明的另一实施方式,其中,导引元件接收一个或更多器械,但是,代替在导引轴的每端上具有单一可弯曲元件,而是,在每端上设有两个或更多可弯曲元件或部分。第一近侧可弯曲元件控制第一远侧可弯曲元件并且第二近侧可弯曲元件控制第二远侧可弯曲元件。控制借助在相应的第一可弯曲元件之间延伸的第一缆索和借助在相应的第二可弯曲元件之间延伸的单独的第二缆索进行。由此,依靠通过多个近侧可弯曲元件对相应的多个远侧可弯曲元件进行控制而具有的附加控制度,插入到导引元件内的器械具有增强的控制性能。
图25示出了包含多个可弯曲元件概念的器械导引元件。该导引元件220可以类似于先前在图1中所述的导引元件,但其在导引元件的两端均包括多个可弯曲部分。尽管在导引元件的每端只示出了两个可弯曲元件,应当理解,在导引设备220中可以包含两个以上的可弯曲元件。导引元件220可以接收器械,例如在图1中公开的器械,但是也可以接收其他器械型式,例如文中或文中所提到的相关申请中所公开的其他器械型式。图1中的特定器械借助锁定螺钉224而锁定到导引元件220的把手部分222。当器械完全插入到导引元件中时末端执行器(未图示)从导引元件220的极远端伸出。图25中的导引装置也可以如同图24中的那样容纳多个器械。
在图25中,独立于图1中的外科器械示出了导引元件或导引器械220。而组装系统则具有插入并穿过导引元件220的器械。导引元件220包括导引轴226,该导引轴226可以延伸穿过患者的插入部位处的插管,从而将近侧可弯曲元件设置在患者外部,并且将远侧可弯曲元件设置在患者内,使其邻近手术部位。末端执行器或工具从导引元件的极远端伸出。保护鞘可以绕着远侧挠性或可弯曲元件的之一或两者延伸。
除了包括导引轴226之外,导引元件220还包括第一近侧挠性或可弯曲元件228A和第二近侧挠性或可弯曲元件228B。转接盖套232绕着近侧可弯曲元件228B的一部分设置。转接盖套232包括漏斗或圆锥形部分或空腔234(参见图6中的空腔96)以用于分别接收近侧可弯曲元件228B和导引轴226的末端。近侧可弯曲元件228B的更近端保持在中间元件236中,所述中间元件取决于特定医学应用可以具有各种长度。中间部分236可以是刚性、挠性或半挠性,但是优选则是刚性。中间元件236还保持近侧可弯曲元件228A的更远端。因此,可弯曲元件228A和228B单独安装并且可以由器械手柄的动作单独控制。
导引元件220的把手222接收近侧可弯曲元件228A的另一端。把手222优选为单部件结构,其具有空腔238以用于接收器械的凸部,如图1中所示。凸部还可以设置有凹槽以用于接收穿过把手222延伸到空腔238和器械的凹槽内的锁定螺钉224。锁定螺钉224的使用使得器械固定在导引元件222内。器械的运动因此直接传递到把手222和两个近侧可弯曲元件。导引元件的长度选择成使得器械工具延伸超出导引元件的末端,如图3中所示。
图25中的实施方式还公开了近侧和远侧可弯曲元件228和230的细节。每个元件可以如同先前图4-6中所示的那样进行构造。所有这些可弯曲元件均具有器械轴可以延伸穿过其中的中心通道。图25还示出了由导引轴226限定的、器械轴可以延伸穿过其中的内腔240。类似地,远侧可弯曲元件包括居中设置的通道以用于接收器械轴的更远端。在图25中,导引轴226显示为刚性,但是也可以是部分挠性或挠性。导引轴226可以由轻质金属材料或塑料制成。
把手222包括空腔(参见图6)以用于接收近侧可弯曲元件228A的一端。把手222也优选地包括益于抓握导引把手222的凸起唇边。凸起唇边优选地具有间隔指槽。该可弯曲元件228A就座于把手222的端壁。该壁可以具有锥形或圆锥形通道以用于接收器械轴。如图6中所示,还提供了用于缆索的几个通道。把手222也可以包括用于锚固件和弹簧的空腔,如文中的第一实施方式所示。包括多个近侧锚固件和相关弹簧。弹簧用于张紧关联缆线。对于近侧可弯曲元件228B来说,锚固件和弹簧可以设置在中间元件236中。与近侧可弯曲元件228A关联的缆索穿过中间元件236。
导引元件220在其远端处包括一对由中间元件244分隔开的间隔设置的远侧可弯曲元件230A和230B。远侧可弯曲元件230A和230B可以包括延伸端242以用于接收对致动缆线的远端进行固定的远侧锚固件。与远侧可弯曲元件230A关联的致动缆线可以设置在远侧可弯曲元件230A、230B之间的中间部分244中。近侧和远侧可弯曲元件之间的控制主要借助在这些可弯曲元件之间延伸的一组缆线来实现。近侧可弯曲元件处的弯曲导致一个或更多缆线受到牵引,而相对的其他缆线则松弛,从而导致在远侧可弯曲元件处发生相应的弯曲动作。取决于预期弯曲方向,可以以图7或图8的布置方式设置缆索。
所使用的缆索包括在近侧和远侧可弯曲元件之间延伸的挠性缆线。参考图1。多个远侧锚固件用在缆索的每端。缆线通道设置在近侧可弯曲元件和远侧可弯曲元件中。通道容纳这些缆线。而且,导引圆盘(未图示)可以沿着缆线设置,具体地,设置在导引轴内,从而保证当缆线从导引轴的一端延伸到另一端时使缆线保持就位。
近侧可弯曲元件均由在其间限定出空隙或狭槽的一系列相邻圆盘组成,如图4-6中所示。连接肋条在相邻圆盘之间延伸。图5示出了肋条的位置。以类似方式,远侧可弯曲元件均包括在其间限定出狭槽或空隙的一系列圆盘。肋条在相邻圆盘之间延伸。关于可弯曲元件以及圆盘、狭槽和肋条之间的优选关系的更多细节,参考2005年7月20日提交的序列号为11/185,911的申请,该申请的内容通过引用而并入本申请。
现在,在如图25所示的实施方式中,缆索优选地连接成使得在近侧可弯曲元件228A和远侧可弯曲元件230B之间具有四个缆线,并且同样地,在近侧可弯曲元件228B和远侧可弯曲元件230A之间具有四个缆线。在替代性布置方式中,引自近侧可弯曲元件228A的缆索可以控制远侧可弯曲元件230A,并且引自近侧可弯曲元件228B的缆索可以控制远侧可弯曲元件230B。而且,可以使用其数量或多或少的缆线在近侧和远侧可弯曲元件之间进行控制。
器械系统的使用者可以抓握器械手柄、使器械与导引装置接合,如图3中所示,并且,基本上通过操纵固定到导引把手222的器械手柄而操纵导引元件。例如,近侧可弯曲元件228A的偏转导致缆线张紧和松弛,从而导致远侧可弯曲元件230B发生相应的偏转。该偏转可以沿相同方向或相反方向。参见图7和8。类似地,近侧可弯曲元件228B的偏转导致缆线张紧和松弛,从而导致远侧可弯曲元件230A发生相应的偏转。
已经描述了本发明的一个实施方式,至此,本领域的技术人员应当清楚,可以预料得到落入由所附权利要求书限定的本发明的范围内的众多其他实施方式及其改型。
Claims (10)
1.一种器械导引设备,用在包括控制端和工作端的手动操作器械中,所述器械导引设备用于接收所述手动操作器械,所述器械导引设备包括:
细长导引轴,其具有近端和远端并且包括器械内腔,所述器械内腔用于以穿过其中的方式接收所述手动操作器械;
远侧可弯曲元件,其设置在所述导引轴的所述远端;
近侧可弯曲元件,其设置在所述导引轴的所述近端;
致动装置,其在所述远侧和近侧可弯曲元件之间延伸并且提供由所述近侧可弯曲元件进行控制的所述远侧可弯曲元件的弯曲动作;
由此,所述近侧可弯曲元件由所述手动操作器械以下列方式控制,以使所述远侧可弯曲元件产生相应弯曲,即,通过偏转已定位在所述器械导引设备中的所述手动操作器械的控制端,导致在所述近侧可弯曲元件处产生偏转或弯曲,所述偏转或弯曲经由所述致动装置被传递到所述远侧可弯曲元件,从而控制所述手动操作器械的所述工作端的定位。
2.根据权利要求1所述的器械导引设备,其中,所述近侧可弯曲元件能够沿任何方向移动。
3.根据权利要求1所述的器械导引设备,其包括:把手,所述把手设置在所述近侧可弯曲元件和所述手动操作器械的手柄之间,并且构造和设置成具有手动操作器械轴延伸穿过其中的通道。
4.根据权利要求3所述的器械导引设备,其中,所述把手形成为包括把手部分和旋钮的两个部件,并且所述把手部分和旋钮支撑成能够在它们之间进行相对旋转。
5.根据权利要求1所述的器械导引设备,其中,所述可弯曲元件各自包括一体开槽结构,所述一体开槽结构具有由狭槽分隔开的多个圆盘。
6.根据权利要求1所述的器械导引设备,其中,所述致动装置包括互连近侧和远侧可弯曲元件的多个缆线。
7.根据权利要求1所述的器械导引设备,其中,所述导引轴具有至少两个用于分别容纳单独器械轴的内腔。
8.根据权利要求1所述的器械导引设备,其中,所述手动操作器械具有近侧可弯曲元件和远侧可弯曲元件。
9.根据权利要求8所述的器械导引设备,其包括:在所述手动操作器械的近侧可弯曲元件和远侧可弯曲元件之间延伸的缆索。
10.根据权利要求1所述的器械导引装置,其中,所述近侧可弯曲元件包括一体开槽结构,所述一体开槽结构具有由狭槽分隔开的多个圆盘并且进一步包括互连相邻圆盘的多个肋条,所述肋条以绕着所述元件呈小于90度间距的方式设置。
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- 2006-07-10 WO PCT/US2006/026784 patent/WO2007018898A2/en active Application Filing
- 2006-07-10 AU AU2006276773A patent/AU2006276773A1/en not_active Abandoned
- 2006-07-10 KR KR1020087001525A patent/KR20080036993A/ko active IP Right Grant
- 2006-07-10 CN CN2006800303205A patent/CN101495045B/zh not_active Expired - Fee Related
- 2006-07-10 CA CA002615782A patent/CA2615782A1/en not_active Abandoned
- 2006-07-10 JP JP2008522815A patent/JP5139979B2/ja not_active Expired - Fee Related
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2008
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US20160354114A1 (en) | 2016-12-08 |
JP5139979B2 (ja) | 2013-02-06 |
HK1131875A1 (en) | 2010-02-12 |
US20170196546A1 (en) | 2017-07-13 |
WO2007018898A2 (en) | 2007-02-15 |
US7842028B2 (en) | 2010-11-30 |
JP2009505688A (ja) | 2009-02-12 |
CN101495045A (zh) | 2009-07-29 |
US20090023995A1 (en) | 2009-01-22 |
AU2006276773A1 (en) | 2007-02-15 |
US8926597B2 (en) | 2015-01-06 |
US9427256B2 (en) | 2016-08-30 |
WO2007018898A3 (en) | 2009-04-23 |
US10188372B2 (en) | 2019-01-29 |
EP1912569A2 (en) | 2008-04-23 |
AU2006276773A2 (en) | 2008-08-14 |
US20150105625A1 (en) | 2015-04-16 |
US20070021737A1 (en) | 2007-01-25 |
US20080269727A1 (en) | 2008-10-30 |
KR20080036993A (ko) | 2008-04-29 |
CA2615782A1 (en) | 2007-02-15 |
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