CN101534726B - 具有用于控制缝钉高度的可塌缩部件的外科缝合器械 - Google Patents
具有用于控制缝钉高度的可塌缩部件的外科缝合器械 Download PDFInfo
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- 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
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- A61B90/03—Automatic limiting or abutting means, e.g. for safety
Abstract
一种用于经内窥镜或经腹腔镜插入到手术部位中用于同时缝合和切断组织的外科器械，该外科器械包括在上钳口(砧座)与下钳口(接合到细长缝钉通道的钉仓)之间的力调节间隔，使得缝钉成形高度对应于组织的厚度，但不会超过缝钉的长度可以适应的高度范围。特别地，可塌缩缝钉驱动器可以支撑在钉仓中，用于驱动支撑在其上的一个或多个缝钉，使缝钉与连接到器械的砧座的下侧成形接触。在缝钉接触砧座时，驱动器可以压缩或塌缩，以基于在缝合过程中驱动器承受的压缩力的大小控制一个或多个缝钉的总的成形高度。
Description
相关申请的交叉引用
本申请是2005年9月21日提交的题为“Surgical StaplingInstrument Having Force Controlled Spacing End Effector”、序列号为No.11/231,456的美国专利申请的部分继续申请，上述申请的公开内容全文被引用于此作为参考。该申请也涉及与此同时提交并且被引用于此作为参考的以下美国专利申请：Surgical Stapling InstrumentsHaving Flexible Channel and Anvil Features For A djustable StapleHeights，发明人：Frederick E.Shelton，IV，Jerome R.Morgan，MichaelA.Murray，Richard W.Timm，James T.Spivey，James W.Voegele，Leslie M.Fugikawa和Eugene L.Timperman(K&LNG律师卷号为No.060500CIP1/END5706USCIP1)。
技术领域
本发明大体涉及外科缝合器械，其能够将缝钉线施加到组织，同时切割在那些缝钉线之间的组织，并且尤其涉及关于缝合器械的改进和用于形成这样的缝合器械的各种部件的过程的改进，包括将枕垫材料加入被切断和被缝合的组织。
背景技术
内窥镜和腹腔镜外科器械常常优于传统的开放式外科装置，原因是较小的切口倾向于缩短术后恢复时间并减少并发症。腹腔镜和内窥镜外科手术的利用相对普及并且提供了进一步发展所述外科手术的附加诱因。在腹腔镜手术中，通过小切口在腹部的内部执行手术。类似地，在内窥镜手术中，通过经由皮肤中的小进入伤口插入的窄的内窥镜管在身体的任何中空内脏中执行手术。
腹腔镜和内窥镜手术通常需要手术区域被吹气。因此，插入身体中的任何仪器必须被密封以保证气体不会通过切口进入或离开身体。而且，腹腔镜和内窥镜手术常常需要外科医生远离切口作用于器官、组织和/或脉管。因此，用于这样的手术中的器械典型地长且窄，同时在功能上可从器械的近端进行控制。
在适合于通过套管针的插管在预期手术部位精确放置远端执行器的内窥镜外科器械的领域得到了显著发展。这些远端执行器以许多方式接合组织以获得诊断或治疗效果(例如内切割器，抓紧器，切割器，缝合器，夹子施放器，进入装置，药物/基因治疗输送装置，和使用超声、RF、激光的能量装置，等等)。
已知的外科缝合器包括端部执行器，所述端部执行器同时在组织中制造纵向切口和在所述切口的相对侧施加缝钉线。端部执行器包括一对协同操作的钳口构件，如果该器械打算供内窥镜或腹腔镜应用，所述钳口构件能够穿过插管通道。钳口构件中的一个接收钉仓，所述钉仓具有至少两个横向间隔的缝钉排。另一个钳口构件限定砧座，所述砧座具有与钉仓中的缝钉排对准的缝钉成形凹坑。该器械包括多个往复楔形件，当朝远侧驱动时，所述往复楔形件穿过钉仓中的开口并且接合支撑缝钉的驱动器以实现缝钉朝着砧座的击发。
近来，描述了一种用于外科缝合和切割器械的改进的“E形梁”击发杆，其有利地包括在形成于上钳口(砧座)中的内狭槽内滑动的顶销并且具有在端部执行器或更特别地缝钉施放组件的下钳口的相对侧滑动的中销和底部足部。在中销的远侧，接触表面致动保持在形成下钳口的细长缝钉通道内的钉仓。在接触表面与顶销之间，切割表面或刀具切断夹在砧座与下钳口的钉仓之间的组织。由于两个钳口因此由E形梁接合，E形梁保持钳口之间的预期间隔以保证正确的缝钉成形。因此，如果较少量的组织被夹紧，E形梁支撑砧座以保证足够的间隔供缝钉抵靠砧座的底表面正确地成形。另外，如果较大量的组织被夹紧，E形梁下拉砧座以保证间隔不会超过缝钉的长度使得每个缝钉的端部不充分弯曲以获得预期固位程度。这样的E形梁击发杆在2003年5月20日提交的、题为“Surgical StaplingInstrument Incorporating an E-Beam Firing Mechanism”的美国专利申请No.10/443,617，即现在于2005年12月27日公告的美国专利No.6,978,921中被描述，上述专利的公开内容全文被引用于此作为参考。
尽管E形梁击发杆具有用于外科缝合和切割器械的许多优点，常常希望切断和缝合各种厚度的组织。组织的薄层可以导致仅仅松散成形的缝钉，可能要求需要枕垫材料。组织的厚层可以导致对被捕获组织施加强压缩力的成形缝钉，可能导致坏死、出血或缝钉成形/固位不良。不同于限制适合于指定外科缝合和切割器械的组织厚度的范围，期望的是用相同的外科缝合和切割器械适应更广范围的组织厚度。
因此，非常需要一种改进的外科缝合和切割器械，其包含调节被夹紧的组织量的缝钉施放组件(端部执行器)。
另外，通常用于现有的缝钉施放组件的缝钉驱动器传统上被制造成尽可能刚劲以保证正确的“B”形缝钉高度。由于该刚劲构造，这些驱动器并不提供任何挠性以用于使缝钉的成形高度适应夹在组件内的组织的特定厚度。
因此，另外非常需要缝钉驱动器，其能够便于响应组织厚度的变化来调节缝钉的成形高度。
发明内容
本发明通过提供一种外科器械克服了现有技术的上述和其他缺陷，所述外科器械包含平移通过缝钉施放组件的击发杆，所述缝钉施放组件具有下钳口和枢转连接的上钳口，所述钳口彼此接合以帮助保持在其间压缩组织的内表面之间的预期间隔。有利地，两个钳口之间的距离允许稍稍挠曲分开以允许被压缩组织的更大厚度，而击发杆防止将超过装置的限度的过度挠曲以通过被压缩组织成形缝钉。由此，用适合于更大范围的外科程序或适应患者人群的变化的相同外科器械获得了增强的临床灵活性。
在本发明的一个方面中，一种外科器械具有下钳口，所述下钳口包括接收钉仓的细长缝钉通道，所述细长缝钉通道具有在其中形成的纵向通道狭槽。钉仓中的缝钉具有的缝钉长度尺寸被确定成用于成形在组织厚度的范围之间的闭合缝钉。击发杆具有穿过枢转地连接到细长缝钉通道的砧座中的纵向砧座狭槽的竖直部分并且穿过形成于细长缝钉通道中的纵向通道狭槽。从所述竖直部分延伸的上侧向表面在击发平移期间对砧座施加向内压缩力并且从所述竖直部分延伸的下侧向表面在击发平移期间对细长缝钉通道施加向内压缩力。击发杆通过包括弹性部分有利地适应有效缝钉成形的范围，所述弹性部分在高度上在砧座的缝钉成形底表面与钉仓的上表面之间变化。
在本发明的另一方面中，一种外科器械具有砧座，所述砧座枢转地连接到细长缝钉通道并且包括在内部形成的砧座通道。特别地，竖直狭槽沿着砧座的纵向轴线向内打开并且具有左侧和右侧矩形棱柱状凹窝，所述凹窝与所述竖直狭槽连通，由所述竖直狭槽截开，并且横向于所述竖直狭槽，其中所述左侧和右侧矩形棱柱状凹窝基本沿着所述竖直狭槽的纵向长度延伸。包括用于切断组织的在远侧的切割刃的击发装置纵向地被接收在细长缝钉通道与砧座的砧座通道的竖直狭槽之间。击发装置的上部元件具有左侧和右侧横向上销，所述左侧和右侧横向上销的尺寸被确定成滑动地接合砧座通道的左侧和右侧矩形凹窝的上和下内表面。击发装置的下部元件接合细长钉仓中的通道狭槽。击发装置的中部元件通过朝远侧平移钉仓的楔形元件致动钉仓。击发装置在纵向击发行程期间正接合细长缝钉通道和砧座以提供其间的间隔供缝钉成形。击发期间击发装置的接合保持细长缝钉通道与砧座之间的竖直间隔，防止由于被夹紧组织不足而捏挤和由于被夹紧组织量过度而部分打开。通过在击发装置中包含弹性部分，该确定间隔有利地在钉仓的缝钉长度的有效范围内变化，所述弹性部分允许一定的挠曲以适应由于被夹紧组织的较厚层产生的压缩负荷增加。
在本发明的又一方面中，所述外科器械有利地通过带有上和下钳口的闭合端部执行器的细长轴操作，所述细长轴的尺寸适宜地被确定成通过套管针的插管插入吹气体腔或身体内腔。
在本发明的另一方面中公开了一种外科器械，其包括细长通道，所述细长通道被构造成在其中可操作地支撑钉仓。砧座可枢转地连接到细长通道并且可在打开位置和闭合位置之间选择性地枢转，其中响应于施加到砧座的闭合运动它的缝钉成形底表面与支撑在细长通道内的钉仓的上表面成面对关系并且响应于施加到砧座的打开运动从闭合位置运动到打开位置。击发构件相对于细长通道可操作地被支撑并且响应于施加到击发构件的击发力在缝钉击发运动中选择性地可从未击发位置纵向平移通过细长通道和响应于施加到击发构件的缩回力缩回到未击发位置。在各种实施方式中，细长通道和砧座中的至少一个具有弹性结构，所述弹性结构被构造成在缝钉击发运动期间与击发构件挠性地相互作用以允许砧座的缝钉成形底表面与钉仓的上表面之间的距离相对于在砧座的缝钉成形底表面与钉仓的上表面之间被夹紧的组织的厚度变化。
在本发明的另一个总的方面中公开了一种外科器械，其包括细长缝钉通道，所述细长缝钉通道具有第一挠性部分和与第一挠性部分间隔开以在其间限定纵向通道狭槽的第二挠性部分。钉仓可操作地支撑在细长缝钉通道内并且细长轴可操作地连接到细长缝钉通道。砧座枢转地连接到细长缝钉通道并且可在闭合位置和打开位置之间选择性地枢转，在闭合位置中它的缝钉成形底表面与钉仓的上表面成面对关系，在打开位置中砧座的远端与钉仓的上表面间隔开。砧座进一步在其中具有纵向砧座狭槽。控制手柄组件通过细长轴在近侧可操作地连接以向砧座选择性地施加打开和闭合运动。击发构件通过细长轴可操作地连接到控制手柄组件以用于在细长缝钉通道中进行选择性纵向往复运动，使得击发构件的一个部分延伸通过纵向砧座狭槽并且击发构件的另一部分延伸通过第一和第二挠性部分之间的纵向通道狭槽。
在本发明的又一个总的方面中公开了一种外科器械，其包括具有纵向通道狭槽的细长缝钉通道。钉仓可操作地支撑在细长缝钉通道内。细长轴可操作地连接到细长缝钉通道。砧座枢转地连接到细长缝钉通道并且可在闭合位置和打开位置之间选择性地枢转，在闭合位置中它的缝钉成形底表面与钉仓的上表面成面对关系，在打开位置中砧座的远端与钉仓的上表面间隔开。砧座进一步具有第一弹性砧座部分和与第一弹性砧座部分间隔开以在其间限定细长砧座狭槽的一部分的第二弹性砧座部分。控制手柄组件通过细长轴在近侧可操作地连接以向砧座选择性地施加打开和闭合运动。击发构件通过细长轴可操作地连接到控制手柄组件以用于在细长缝钉通道中进行选择性纵向往复运动，使得击发构件的一个部分延伸通过第一和第二弹性砧座部分之间的砧座狭槽并且击发构件的另一部分延伸通过纵向通道狭槽。
本发明的另一个总的方面包括一种用于外科钉仓的可塌缩缝钉驱动器。在各种实施方式中，所述可塌缩缝钉驱动器包括：基座部分，其能够由所述外科钉仓可操作地支撑；缝钉支撑部分，其能够可操作地支撑在所述外科钉仓中且靠近所述基座部分。还提供了阻力连接结构，其与所述基座部分和所述缝钉支撑部分共同作用，以将所述缝钉支撑部分相对于所述基座部分支撑在第一位置，所述阻力连接结构能够允许所述缝钉支撑部分响应于在缝钉击发操作过程中施加到所述缝钉支撑部分和所述基座部分上的压缩力朝向所述基座部分运动。
本发明的又一个总的方面包括一种外科缝合器械，其可以包括细长通道和支撑在所述细长通道中的钉仓。钉仓可操作地支撑位于其中的多个可塌缩缝钉支撑驱动器。砧座可枢转地连接到细长通道并且在打开位置和闭合位置之间可选择地枢转，其中，所述砧座的缝钉成形底表面与钉仓的上表面成面对关系。驱动器构件相对于细长通道被可操作地支撑，并且可以从未击发位置选择性地纵向移动通过细长通道，其中，驱动器构件在砧座处于闭合位置时响应于施加到驱动器构件的击发力朝向砧座的缝钉成形底表面驱动可塌缩缝钉驱动器。
本发明的又一个总的方面涉及一种外科缝合器械，该外科缝合器械包括钉仓和用于支撑钉仓的部件。砧座可以相对于用于支撑的部件被可枢转地支撑，使得砧座可以从打开位置运动到闭合位置，其中，砧座的缝钉成形底表面与钉仓的上表面成面对关系。在钉仓中提供有多个缝钉支撑部件，用于支撑位于其中的多个缝钉。在砧座处于闭合位置时，每个缝钉支撑部件在被朝向砧座的缝钉成形底表面驱动时可以塌缩。每个缝钉支撑部件上可以支撑至少一个缝钉。器械还可以包括部件，该部件在砧座处于闭合位置时响应于施加到用于选择性地驱动的部件上的击发力朝向砧座选择性地驱动缝钉支撑部件。
通过附图及其描述，本发明的这些和其他目的和优点将变得清楚。
附图说明
包含在该说明书中并且构成它的一部分的附图示出了本发明的实施方式，并且与上面给出的本发明的概述以及下面给出的实施方式的详述一起用于解释本发明的各种原理。
图1是带有打开式端部执行器(缝钉施放组件)的外科缝合和切割器械的左侧正视图，其中轴部分地被切除以暴露由机架底引导并且由闭合套筒包围的近侧击发杆和远侧击发杆的击发构件。
图2是闭合式端部执行器(缝钉施放组件)的左侧视图，其中示出了图1的外科缝合和切割器械的根据本发明的缩回力调节高度击发杆沿着线2-2截取的纵向竖直截面视图。
图3是图2的力调节(顺应)高度击发杆的左侧等轴视图。
图4是图2的力调节高度击发杆的第一型式的远侧部分(“E形梁”)的左侧视图，所述远侧部分具有分别形成于顶销与切割表面之间和中销与切割表面之间的水平狭缝以增强竖直挠曲。
图5是图2的力调节高度击发杆的第二型式的远侧部分(“E形梁”)的左下等轴视图，所述远侧部分具有上销的凹陷下部区域以增强竖直挠曲。
图6是沿着线6-6通过上销的竖直和横向截面截取的图5的E形梁的上部部分的正视前视图。
图7是沿着线6-6的竖直和横向截面截取的图5的E形梁的第三型式的上部部分的前视图，但是进一步包括用于增强竖直挠曲的顶销的凹陷上部根部连接件。
图8是沿着线6-6的竖直和横向截面截取的图5的E形梁的第四型式的上部部分的前视图，但是包括内部竖直弹性叠层而不是用于增强竖直挠曲的顶销的凹陷底表面。
图9是沿着线6-6的竖直和横向截面截取的图5的E形梁的第五型式的上部部分的前视图，但是包括由弹性材料形成的上销而不是用于增强竖直挠曲的顶销的凹陷底表面。
图10是图2的力调节击发杆的第六型式的远侧部分(“E形梁”)的左上等轴视图，所述远侧部分具有在底部足部上的弹性材料以增强竖直挠曲。
图11是沿着通过图1的外科缝合和切割器械的端部执行器(缝钉施放组件)的填塞下方足部的竖直和横向截面截取的正视前视图。
图12是图2的力调节击发杆的第七型式的远侧部分(“E形梁”)的正视左视图，所述远侧部分具有附连到下足的朝近侧和向上延伸的弹性臂以增强竖直挠曲。
图13是图2的力调节击发杆的第八型式的远侧部分(“E形梁”)的左上等轴视图，所述远侧部分具有包围下方足部的弹性垫圈以增强竖直挠曲。
图14是处于夹紧或闭合位置的本发明的另一缝钉施放组件或端部执行器的剖视端视图。
图15是图14的缝钉施放组件的部分透视图，其中它的一些元件在剖视图中被显示。
图16是处于夹紧或闭合位置的本发明的另一缝钉施放组件或端部执行器的剖视端视图。
图17是图16的缝钉施放组件的部分透视图，其中它的一些元件在剖视图中被显示。
图18是夹紧已被部分切割和缝合的一块组织的本发明的缝钉施放组件的部分透视图。
图19是本发明的砧座实施方式的仰视图。
图20是利用图19中所示的砧座实施方式的缝钉施放组件的纵向剖视图。
图21是沿着图20中的线21-21截取的图20的缝钉施放组件的剖视端视图，为了清楚起见以实体形式显示了一些元件。
图22是在其中夹紧一块组织的图20和21的缝钉施放组件的另一局部纵向剖视图，其中组织具有变化的横截面厚度。
图23是在其中夹紧另一块组织的图20-22的缝钉施放组件的另一局部纵向剖视图。
图24是在其中夹紧另一块组织的图20-23的缝钉施放组件的另一局部纵向剖视图。
图25是处于夹紧位置的本发明的另一缝钉施放组件的剖视端视图。
图26是本发明的另一缝钉施放组件的纵向剖视图。
图27是在其中带有被夹紧和缝合的一块组织的本发明的另一缝钉施放组件的一部分的剖视图。
图28是本发明的偏压板实施方式的一部分的俯视图。
图29是沿着图28中的线29-29截取的图28的偏压板的一部分的剖视图。
图30是本发明的另一缝钉施放组件的剖视端视图，为了清楚起见以实体形式显示了一些元件。
图30A是本发明的另一缝钉施放组件的剖视端视图，为了清楚起见以实体形式显示了一些元件。
图31是在其中带有被夹紧和缝合的组织的图30的缝钉施放组件的纵向剖视图。
图32是在其中带有被夹紧和缝合的组织的另一部分的图31的缝钉施放组件的另一纵向剖视图。
图33是图30-32的缝钉施放组件的另一纵向剖视图，所述缝钉施放组件流体地连接到由本发明的各种实施方式的手柄组件支撑的流体容器。
图34是本发明的其他实施方式的缝钉施放组件的纵向剖视图，其中厚度变化的组织被夹紧在其中。
图35是图34的缝钉施放组件的一部分的放大剖视图。
图36是本发明的可塌缩缝钉驱动器实施方式的分解透视图。
图37是处于第一(未塌缩)位置的图36的可塌缩缝钉驱动器实施方式的剖视图。
图38是本发明的另一可塌缩缝钉驱动器实施方式的分解透视图。
图39是处于第一(未塌缩)位置的图38的可塌缩缝钉驱动器实施方式的剖视图。
图40是处于第一(未塌缩)位置的本发明的另一可塌缩缝钉驱动器实施方式的透视图。
图41是图40的可塌缩缝钉驱动器实施方式的分解透视图。
图42是处于第一(未塌缩)位置的图40和41的可塌缩缝钉驱动器实施方式的剖视图。
图43是在压缩力被施加到可塌缩缝钉驱动器之后图40-42的可塌缩缝钉驱动器实施方式的另一剖视图。
图44是本发明的另一可塌缩缝钉驱动器实施方式的分解透视图。
图45是处于第一(未塌缩)位置的图44的可塌缩缝钉驱动器实施方式的剖视图。
图46是图44和45的可塌缩缝钉驱动器实施方式的分解透视图，其中它的一些元件在剖视图中被显示。
图47是本发明的另一可塌缩缝钉驱动器实施方式的分解前视图。
图48是处于第一(未塌缩)位置的图47的可塌缩缝钉驱动器的另一前视图。
图49是在缝钉驱动器被压缩到完全塌缩位置之后图47和48的缝钉驱动器的另一前视图。
图50是本发明的另一可塌缩缝钉驱动器实施方式的分解组装图。
图51是图50的可塌缩缝钉驱动器实施方式的分解前视图。
图52是在可塌缩缝钉驱动器被压缩到完全塌缩位置之后图50和51的可塌缩缝钉驱动器实施方式的另一前视图。
图53是本发明的另一可塌缩缝钉驱动器实施方式的透视图。
图54是处于第一(未塌缩)位置的图53的可塌缩缝钉驱动器的侧视正视图。
图55是在可塌缩缝钉驱动器被压缩到完全塌缩位置之后图53和54的可塌缩缝钉驱动器的另一侧视正视图。
具体实施方式
参照附图，其中在所有几个视图中相同的附图标记表示相同的部件，在图1中，外科缝合和切割器械10包括手柄部分12，所述手柄部分被操纵以定位包括紧固端部执行器的执行部分14，所述端部执行器被显示成缝钉施放组件16，在远侧连接到细长轴18。执行部分14的尺寸被确定成穿过用于内窥镜或腹腔镜外科手术的套管针(未显示)的插管插入，并且缝钉施放组件16的上钳口(砧座)20和下钳口22通过朝着手柄部分12的手枪式把手26按压闭合触发器24而被闭合，这推进细长轴18的外部闭合套筒28以枢转关闭砧座20。
一旦被插入到吹气体腔或内腔中，外科医生可以通过扭转轴旋转旋钮30使执行部分14围绕其纵向轴线旋转，所述轴旋转旋钮跨接接合手柄12的远端和细长轴18的近端。这样定位时，闭合触发器24可以被释放，打开砧座20从而可以抓紧和定位组织。一旦满意保持在缝钉施放组件16中的组织，外科医生按压闭合触发器24直到锁靠在手枪式把手26上，从而夹紧缝钉施放组件16内侧的组织。
然后击发触发器32被按压，朝着闭合触发器24和手枪式把手26牵引，由此向击发构件施加击发力或运动以使击发构件从未击发位置朝远侧行进。击发构件被显示成包括连接到远侧击发杆36的近侧击发杆34，其被支撑在将手柄部分12连接到缝钉施放组件16的机架底38内。在缝钉击发运动期间，击发杆36接合细长缝钉通道40并且致动包含在其中的钉仓42，两者形成下钳口22。击发杆36也接合闭合砧座20。在释放击发触发器32以向击发杆36施加缩回力或运动之后，按压闭合释放按钮44松开闭合触发器24使得闭合套筒28可以缩回以枢转和打开砧座20，从而从缝钉施放组件16释放被切割和缝合的组织。
应当理解的是，空间术语例如竖直、水平、右侧、左侧等在这里参考附图给出，假设外科器械10的纵向轴线与细长轴18的中心轴线共轴，并且触发器24，32从手柄组件12的底部成锐角向下延伸。然而在实际应用中，外科器械10可以成各种角度被定向，并且同样地，这些空间术语相对于外科器械10自身被使用。进一步地，“近侧”用于表示在手柄组件12后面的临床医生的视角，临床医生将执行部分14放置在他或她的远侧，或远离他或她。
在图2中，缝钉施放组件16闭合在被压缩组织46上。在图2-3中，击发杆36具有连接到远侧E形梁50的近侧部分48，所述远侧E形梁在缝钉施放组件16内平移。如图所示随着击发杆36缩回，在新的钉仓42被插入到细长缝钉通道40中之后，E形梁50的竖直部分52基本位于钉仓42的后部。从E形梁50的竖直部分52的上部部分横向延伸的上销54初始位于在砧座20的近侧枢转端附近凹陷的砧座凹坑56内。当E形梁50在缝钉击发运动期间朝远侧被推进时，竖直部分52穿过形成于砧座20的缝钉成形底表面60中的窄的纵向砧座狭槽58(图1，11)、形成于钉仓42中的近侧开放竖直狭槽62和形成于细长缝钉通道40中的底部纵向通道狭槽64。
在图2和11中，窄的纵向砧座狭槽58(图2)向上连通到尺寸被确定成滑动地接收上销54的横向加宽的纵向砧座通道66。纵向通道狭槽64向下连通到接收下方足部70的横向加宽的纵向通道轨道68，所述下方足部的尺寸被确定成在纵向通道轨道68中滑动并且连接在E形梁50的竖直部分52的底部。从E形梁50的竖直部分52延伸的侧向加宽的中销72被定位成沿着钉仓42的底部盘74的顶部表面滑动，所述顶部表面又位于细长缝钉通道40上。形成于底部盘74之上的钉仓42中的纵向击发凹槽75的尺寸被确定成允许中销72平移通过钉仓42。
E形梁50的竖直部分52的远侧驱动表面76被定位成平移通过钉仓42的近侧开放竖直狭槽62并且朝远侧驱动近侧定位在钉仓42中的楔形滑块78。E形梁50的竖直部分52包括在远侧驱动表面76之上和上销54之下沿着远侧边缘的切割表面80，所述切割表面切断被夹紧的组织46与该缝合同时进行。
特别参照图11，应当理解的是，楔形滑块78向上驱动缝钉驱动器82，所述缝钉驱动器又向上将缝钉83驱动到形成于钉仓42的缝钉主体85中的缝钉开孔84之外以抵靠砧座20的底表面60成形，所述底表面相对于钉仓42的上表面43成面对关系(图2)。
在图2，11中，有利地，在上销54之间由箭头86(图2)表示的示例性间隔朝着压缩状态顺应地被偏压，其中0.015英寸的被压缩组织46被包含在缝钉施放组件16中。然而，通过E形梁50的固有挠性允许高达大约0.025英寸的更大量的被压缩组织46。可能高达0.030英寸的过度挠曲被避免，因为缝钉的长度在该附加高度下不能被充分成形。应当理解的是，这些尺寸示例性地用于0.036英寸的缝钉高度。然而这同样适用于每种类型的缝钉。
在图4中，柔顺的E形梁50a的第一型式包括从竖直部分52a的远侧边缘的顶部和底部水平狭缝90，92，所述狭缝可能由电钻机(EDM)形成。竖直部分52a因此包括含有上销54的竖直柔顺的向远侧突出的顶臂94，含有切割表面80的刀具凸缘96，和含有远侧驱动表面76、中销72和下方足部70的下部竖直部分98。水平狭缝90，92通过允许向远侧突出的顶臂94向上枢转而允许顺应竖直间隔，从而调节来自被压缩组织46(未显示)的增加力。
在图5-6中，柔顺的E形梁50b的第二型式包括形成于竖直部分52的每一侧的上销54b中的左侧和右侧下方凹陷区域110，112，从而分别留下左侧和右侧下方支承部114，116。支承部114，116的外侧位置提供长力矩臂以将力施加到挠曲部。应当理解，从本公开来看，在已知缝钉尺寸和其他考虑因素的情况下，凹陷区域110，112的尺寸和柔顺的E形梁50b的材料选择可以被选择以获得预期挠曲程度。
在图7中，柔顺的E形梁50c的第三型式如上面在图5-6中所述，带有由左侧和右侧窄的上方凹陷区域120，122提供的进一步挠曲，所述左侧和右侧窄的上方凹陷区域邻近竖直部分52形成于上销54c的相对的顶部根部表面中。
在图8中，柔顺的E形梁50d的第四型式如图2-3所述，带有复合/叠层竖直部分52d的增加特征，所述增加特征包括夹在分别支撑上销54d的左侧部分和右侧部分136，138的左侧和右侧竖直层132，134之间的中间弹性竖直层130。当左侧部分和右侧部分136，138向上或向下挠曲时，左侧和右侧竖直层132，134产生的弧状弯曲由中间弹性竖直层130的相应压缩或膨胀来适应。
在图9中，柔顺的E形梁50e的第五型式如图2-3所述，带有由挠性更大的材料形成的不连续上销54e的增加特征，所述不连续上销54e被插入通过穿过竖直部分52e的水平开孔140。因此，不连续上销54e的左侧和右侧外端142，144根据负荷力挠曲。
作为将挠曲包含到上销54中的替代方案或附加方案，在图10-11中，如图2-3所述的柔顺的E形梁50f的第六型式还包括连接到底部足部70的上表面152的弹性垫150。弹性垫150根据在底部足部70处受到的压缩力调节上销54的间隔。
在图12中，柔顺的E形梁50g的第七型式如上面图2-3所述，带有底部足部(脚部)70g的增加特征，所述底部足部具有朝后上方延伸的弹性指状部160，所述弹性指状部向下弹性地推动E形梁50g以根据负荷力调节竖直间隔。
在图13中，柔顺的E形梁50h的第八型式如上面图2-3所述，带有位于底部足部70上的卵形弹性垫圈170的增加特征，所述弹性垫圈环绕竖直部分52并且具有向上弧状弯曲的中间部分172，所述向上弧状弯曲的中间部分向下弹性地推动E形梁50h以根据负荷力调节竖直间隔。
对于另一例子，根据本发明的各方面的柔顺的E形梁可以包括与在细长缝钉通道的相对侧上滑动的两个结构的示例性型式中的接合类似的与砧座的接合。类似地，柔顺的E形梁可以通过具有横向加宽部分来接合下钳口，所述横向加宽部分在形成于下钳口结构中的通道内在内部滑动。
作为又一附加例子，在示例性型式中，钉仓42可替换使得缝钉施放组件16的其他部分可以被再使用。应当理解从本公开来看，根据本发明的应用可以包括更大的一次性部分，例如细长轴的远侧部分和带有作为下钳口的一部分被永久接合的钉仓的上钳口和下钳口。
作为又一例子，示例性E形梁有利地确定地使上钳口和下钳口彼此间隔开。因此，E形梁具有向内接合表面，在击发期间在较大量的被压缩组织倾向于张开钳口时所述向内接合表面沿着将钳口牵引到一起的方向拉动钳口。由此E形梁防止由于超过缝钉的有效长度而使缝钉异常成形。另外，E形梁具有向外接合表面，在击发期间在少量组织或器械的其他结构部件倾向于将钳口捏挤在一起从而可以导致缝钉异常成形的情况下所述向外接合表面将钳口推开。任一种或两种功能可以通过根据本发明的各方面的应用被增强，其中E形梁中的固有挠曲调节力以允许一定程度的钳口闭合或钳口打开。
图14是具有本发明的另一实施方式的缝钉施放组件16a的外科器械10a的剖视端视图，其中相同的附图标记用于表示相同的元件，并且其利用用于支撑位于其中的钉仓42的细长通道40a。在各种实施方式中，通道40a具有弹性或挠性特征，所述通道40a被构造成允许缝钉施放组件40a有效地适应组织的不同厚度。图15是缝钉施放组件16a的部分透视图，为了清楚起见在剖视图中显示了一些部件。在图14中可以看到，在该实施方式中，第一纵向延伸凹陷区域180和第二纵向延伸凹陷区域184设在纵向通道40a中。第一纵向延伸凹陷区域180限定第一弹性或挠性通道突出部分182并且第二纵向延伸凹陷区域184限定第二弹性或挠性通道突出部分186。采用E形梁50的形式的击发构件的竖直部分52的上端51延伸通过的细长通道狭槽64形成于挠性突出部分182，186的各自的自由端183，185之间。在图14中进一步可以看到，当E形梁50横穿其中时这样的布置允许E形梁50的下方足部70支承在挠性突出部分182，186上以适应夹在砧座20与下钳口22之间的组织的厚度的变化。将会理解的是，突出部分182，186的厚度188可以被选择成将预期的挠曲量提供给细长通道40a的那些部分。而且，鉴于缝钉尺寸和其他考虑，细长通道40a的材料的选择可以是为了获得预期的挠曲程度。
如上所述的细长通道40a可以与利用常规砧座20的缝钉施放组件结合使用。也就是说，纵向延伸砧座狭槽58可以基本具有“T”形，其尺寸被确定成适应E形梁50的竖直部分52的上端51的上销54。图14和15中所示的实施方式利用砧座20a，该砧座具有弹性或挠性特征以用于进一步适应夹在砧座20a与下钳口22之间的组织厚度的差异。特别地，在图14中可以看到，第三纵向延伸凹陷区域190和第四纵向延伸凹陷区域194可以设在如图所示的砧座20a中。第三纵向延伸凹陷区域190限定第一砧座突出部分192并且第四纵向延伸凹陷区域194限定第二砧座突出部分196，E形梁50的上销54可以支承在该第二砧座突出部分196上。这样的布置将一定程度的挠曲提供给砧座20a以适应夹在砧座20a与下钳口22之间的组织厚度的差异。将会理解的是，突出部分192，196的厚度198可以被选择成将预期的挠曲量提供给砧座20a的那些部分。而且，鉴于缝钉尺寸和其他考虑因素，砧座20a的材料的选择可以是为了获得预期的挠曲程度。砧座20a可以与如图14和15中所示的上述通道布置结合使用或者它可以与常规通道布置一起使用而不脱离本发明的精神和范围。
本领域的普通技术人员也将理解砧座20a和/或通道40a可以成功地与常规E形梁布置或这里所述的任何E形梁布置一起使用。这里公开的E形梁可以由容纳在手柄组件内的控制装置往复地驱动。这样的控制装置的例子在2005年12月27日公告的美国专利No.6,978,921中被公开，上述专利被引用于此作为参考。其他已知的击发构件结构和用于对其施加击发和缩回力或运动的控制装置可以可预料地被利用而不脱离本发明的精神和范围。
图16和17示出了利用通道40b和砧座20b的另一型式的缝钉施放组件16b，所述通道和砧座均具有弹性或挠性部分以适应夹在砧座20b与下钳口22b之间的组织厚度的差异。在那些图中可以看到，上和下纵向延伸凹陷或底切区域202，204的第一对200设在通道40b中以限定第一悬臂式支撑突出部分206并且凹陷或底切区域212，214的第二对210设在通道40b中以限定第二悬臂式支撑突出部分216。第一对凹陷区域202，204将一定程度的挠曲提供给第一支撑突出部分206以允许它如箭头205所示挠曲。类似地，凹陷区域212，214的第二对210将一定程度的挠曲提供给第二支撑突出部分216以允许它如箭头215所示挠曲。与上述实施方式相同，支撑突出部分206和216的厚度208可以被选择成将预期挠曲量提供给细长通道40b的那些部分以适应组织的不同厚度。而且，鉴于缝钉尺寸和其他考虑因素，细长通道40b的材料的选择可以是为了获得预期的挠曲程度。
图16和17进一步示出了具有T形狭槽58b的砧座20b，所述T形狭槽限定第一侧壁部分220和第二侧壁部分222。在各种实施方式中，第一纵向延伸底切区域224设在第一侧壁部分220中以限定弹性或挠性第一突出部分226。类似地，在各种实施方式中，第二纵向延伸底切区域228设在第二侧壁部分222中以限定弹性或挠性第二突出部分230。在图16中可以看到，第一和第二突出部分226，230的各自的端部227，231用于限定砧座狭槽58b的部分59b，E形梁50b的上端部分51延伸通过所述部分59b。这样的布置允许E形梁50b的上销54b可以支承在第一弹性突出部分226和第二弹性突出部分230上以将一定程度的挠曲提供给砧座20ab，从而适应夹在砧座20b与下钳口22b之间的组织厚度的差异。将会理解，突出部分226，230的厚度232可以被选择成向砧座20b提供预期的挠曲量以适应不同的组织厚度。而且，鉴于缝钉尺寸和其他考虑因素，砧座20b的材料的选择可以是为了获得预期的挠曲程度。砧座20a可以与图16和17中所示的上述通道40b结合使用或者它可以与常规通道布置一起使用。本领域的技术人员也将理解，砧座20a和/或通道40bg可以成功地与常规E形梁布置或这里所述的任何E形梁一起使用。
图18示出了用本发明的各种外科切割和缝合器械实施方式中的任何一种的切割和缝合组织240。图18中所示的组织240的一部分242已被切割和缝合。在临床医生切割和缝合第一部分242之后，器械将被收回以允许新的钉仓42被安装。图18示出了在开始第二次切割和缝合过程之前执行部分14的位置。在该图中可以看到，已被缝合的组织240的部分242具有的厚度243小于组织240的其他部分244的厚度245。
图19是可以与本发明的各种实施方式的缝钉施放组件16c一起使用的砧座20c的下侧的视图。砧座20c包括砧座主体21c，所述砧座主体支撑限定不同缝钉区域的可动缝钉成形凹坑。在图19所示的实施方式中，四个左侧缝钉区域252，254，256，258设在砧座狭槽58c的左侧250并且四个右侧缝钉区域262，264，266，268设在砧座主体21c中的砧座狭槽58c的右侧260。第一左侧缝钉区域252由在其中具有一系列缝钉成形凹坑272的第一左侧缝钉成形插入元件270限定。在该实施方式中，缝钉成形凹坑272的三排274，276，278设在插入件270中。在图19中可以看到，凹坑272的中间排276稍稍纵向偏离凹坑272的两个外排274，278并且对应于相应钉仓42中的相应缝钉开孔84的布置。本领域的普通技术人员将理解这样的布置用于导致以如图18中所示的交错方式施加缝钉83。
类似地，第二左侧缝钉区域254可以由在其中具有缝钉成形凹坑272的三排282，284，286的第二左侧缝钉成形插入件280限定。第三左侧缝钉区域256可以由在其中具有缝钉成形凹坑272的三排292，294，296的第三左侧缝钉成形插入件290限定。第四左侧缝钉区域258可以由在其中具有缝钉成形凹坑272的三排302，304，306的第四左侧缝钉成形插入件300限定。第一、第二、第三和第四左侧缝钉成形插入件270，280，290，300在设于砧座狭槽58的左侧250上的砧座20c中的左侧腔251中纵向地被对准。
第一右侧缝钉区域262由在其中具有一系列缝钉成形凹坑272的第一右侧缝钉成形插入元件310限定。在该实施方式中，缝钉成形凹坑272的三排312，314，316设在插入件310中。在图19中可以看到，缝钉成形凹坑272的中间排314稍稍纵向偏离两个外排312，316并且对应于相应钉仓42中的相应缝钉开孔84的布置。这样的布置用于导致缝钉83以交错方式施加在组织切割线的右侧。第二右侧缝钉区域264可以由在其中具有缝钉成形凹坑272的三排322，324，326的第二右侧插入件320限定。第三右侧缝钉区域266可以由在其中具有缝钉成形凹坑272的三排332，334，336的第三右侧缝钉成形插入件330限定。第四右侧缝钉区域268可以由在其中具有缝钉成形凹坑272的三排342，344，346的第四右侧缝钉成形插入件340限定。第一、第二、第三和第四右侧缝钉成形插入件310，320，330，340在设于砧座狭槽58的右侧260上的砧座20c中的右侧腔261中纵向地被对准。在各种实施方式中，缝钉成形插入件可以由不锈钢或比制造缝钉的材料更硬的其他合适的材料制造。例如，插入件可以成功地由其他材料例如钴铬合金、铝、17-4不锈钢、300系列不锈钢、400系列不锈钢、其他沉淀硬化不锈钢等制造。
采用波形弹簧350的形式的至少一个偏压元件或柔顺元件或对应于每个缝钉成形插入件270，280，290，300，310，320，330，340的其他合适的偏压或柔顺介质或元件如图20-23所示设在各个左侧缝钉成形插入件270，280，290，300与左侧腔251的底部之间。波形弹簧350或其他合适的偏压或柔顺介质或元件也设在每个右侧缝钉成形插入件310，320，330，340与右侧腔261的底表面之间。在砧座狭槽58c的左侧的波形弹簧350可以接收在相应弹簧腔253中并且在砧座腔58c的右侧的波形弹簧350可以接收在相应弹簧腔263中。为了将每个插入件270，280，290，300，310，320，330，340偏压地保持在砧座20c中，每个插入件270，280，290，300，310，320，330，340可以通过例如粘合剂或其他紧固件装置连接到它的相应弹簧350或偏压元件。另外，每个弹簧350可以通过例如粘合剂或其他机械紧固件装置连接到砧座20c以将波形弹簧350的一部分保持在它的各个弹簧腔253或263内。这样的弹簧/偏压元件装置用于朝着组织240和缝钉偏压插入件270，280，290，300，310，320，330，340并且基本用作弹性“减震器”以适应组织厚度的差异。该优点在图22-24中被示出。
特别地，在图22中可以看到，夹在缝钉施放组件16c的近端17b中的组织240的部分242具有的第一厚度(箭头243)比夹在缝钉施放组件16c的中间部分17c中的组织240的部分244的厚度(箭头245)更厚。组织部分244的厚度245大于夹在缝钉施放组件16c的远端17a中的组织240的部分246的厚度(箭头247)。因此，由于组织厚度的差异，在缝钉施放组件16c的远侧部分17a中成形的缝钉83比在缝钉施放组件16c的中间部分17c中成形的缝钉83更紧地被成形，在缝钉施放组件16c的中间部分17c中成形的缝钉83比在缝钉施放组件16c的近端17b中成形的那些缝钉83更紧地被成形。图23基于夹在缝钉施放组件16c内的组织的厚度的变化进一步示出了缝钉成形高度的变化。图24示出了一种情况，其中夹在缝钉施放组件16c的中间部分17c中的组织240比夹在缝钉施放组件16c的远端和近端中的组织部分更厚。因此，中间部分17c中的缝钉的成形高度将高于与缝钉施放组件16c的近端17b和远端17a相关联的缝钉的缝钉成形高度。
本领域的普通技术人员将会理解，图19-24中所示的实施方式的独特和新颖特征可以与这样的缝钉施放组件结合使用，所述缝钉施放组件在构造和操作上与上述缝钉施放组件16c基本相同，区别在于缝钉成形插入件270，280，290，300，310，320，330，340可以在其中仅仅具有一排缝钉成形凹坑272或在其中具有两排缝钉成形凹坑272。例如，图25示出了在组织切割线的每一侧仅仅施加两排缝钉的实施方式。在该图中显示的是均仅仅具有两排缝钉成形凹坑272d的缝钉成形插入件270d和310d。
技术人员将会进一步理解，用于砧座狭槽58的每一侧的缝钉成形插入件的数量可以变化。例如单一纵向延伸插入件可以用于砧座狭槽58的每一侧。图26示出了本发明的另一缝钉施放组件16e，所述缝钉施放组件在砧座狭槽的每一侧仅仅使用一个缝钉成形插入件。图26显示了支撑单一左侧缝钉成形插入件380的砧座20e的左侧的剖视图，所述左侧缝钉成形插入件附连到单一波形弹簧350e。也可以利用其他偏压元件或多个波形弹簧或偏压元件。一个偏压元件或多个偏压元件350e被支撑在左侧腔251e中并且以上述各种方式之一附连到砧座20e。类似的右侧插入件(未显示)可以用于砧座狭槽58的右侧。此外，尽管图19-24显示了在砧座狭槽的每一侧使用四个缝钉成形插入件，可以利用更多数量的缝钉成形插入件。
图27-29示出了本发明的另一缝钉施放组件16f，其中独立的可动缝钉成形插入件被提供用于每个缝钉83。特别地，在图27中可以看到，单一缝钉成形插入件400被提供用于每个缝钉83。每个缝钉成形插入件400可以具有形成于它的下侧402的缝钉成形凹坑404以用于成形相应缝钉83的末端。与上述各种实施方式相同，每个插入件400具有与其相关联的偏压元件412。在图27-29所示的例子中，偏压元件412包括偏压板410的冲压部分。偏压板410可以包括一片金属或其他合适的材料，其中每个偏压元件412被冲压或以另外方式被切割和成形以对应于缝钉成形插入件400。偏压板410可以包括支撑在砧座20f中的腔251f内的单一板或多个板410可以用于砧座狭槽的每一侧上。将会理解，类似的布置可以用于砧座狭槽的右侧。每个缝钉成形插入件400可以通过粘合剂或其他合适的紧固件装置附连到它的相应偏压元件412。因此，将会理解，可动缝钉成形插入件的各种不同元件和布置可以被利用而不脱离本发明的精神和范围。特别地，至少一个可动缝钉成形插入件可以用于砧座狭槽的每一侧。
图30-32示出了本发明的其他实施方式的另一缝钉施放组件16g，其中在缝钉成形插入件与砧座之间的偏压或柔顺介质包括至少一个流体囊。更具体而言，在图30中可以看到，左侧囊420被定位在砧座20g中的砧座狭槽58g的左侧的左侧腔253g内。类似地，右侧囊430被定位在砧座20g中的右侧腔263内。左侧缝钉成形插入件270g，280g，290g，300g的系列可以通过合适的粘合剂或其他紧固件装置附连到左侧囊430。类似地，右侧缝钉成形插入件(未显示)可以通过粘合剂或其他合适的紧固件装置附连到右侧囊430。在一个实施方式中，每个囊420，430被密封和部分填充有液体432，例如甘油或盐溶液。本领域的普通技术人员将会理解，这样的布置将允许缝钉成形插入件运动以更好地适应夹在缝钉施放组件16g内的组织的厚度的变化。例如，对于具有相对恒定厚度的组织，液体432将相对均匀地被分布在每个囊420，430内以为缝钉成形插入件提供相对均匀的支撑布置。然而参见图31，当遇到组织的较厚部分时，对应于较厚组织的那些缝钉成形插入件将被压缩到它们各自的砧座腔中，由此迫使囊的该部分中的液体移动到对应于较薄组织部分的囊部分，参见图32。
在一些应用中，临床医生希望能够控制囊420，430内的压力的大小。例如当切割和缝合更精细的组织例如肺组织等时希望有较小压力。当切割和缝合较厚组织例如胃组织、肠组织、肾组织等时希望有较大压力。为了为临床医生提供该附加灵活性，囊420，430均可以由供应管线440或管道流体连接到由器械的手柄部分12支撑的流体容器450。在图33所示的实施方式中，临床医生可以借助于安装到流体容器450的调节机构460增加或减小囊420，430内的流体量和其中的产生的压力。在各种实施方式中，调节机构460可以包括附连到调节螺钉464的活塞462。通过向内调节调节螺钉464，活塞462迫使流体离开容器450进入囊420，430。相反地，通过反转调节螺钉464，活塞462允许更多的流体432返回或保留在容器450内。为了帮助临床医生确定通常被标示为405的该液压系统内的压力的大小，可以利用如图所示的压力计470。因此，对于需要更高的压力大小的那些组织，临床医生可以将囊420，430中的压力预设为有助于成功地夹紧和缝合该特定类型的组织的压力。尽管描述了用于控制液压系统中的压力的活塞/螺钉布置，技术人员将会理解可以成功地利用其他控制机构而不脱离本发明的精神和范围。
图30A示出了本发明的其他实施方式的另一缝钉施放组件16h，其中在缝钉成形插入件与砧座之间的偏压或柔顺介质包括至少一个可压缩聚合物元件。更具体而言，在图30A中可以看到，左侧可压缩聚合物元件420h被定位在砧座20h中的砧座狭槽58h的左侧的左侧腔253h内。类似地，右侧可压缩聚合物元件430h被定位在砧座20h中的右侧腔263h内。左侧缝钉成形插入件270h-300h的系列可以通过合适的粘合剂或其他紧固件装置附连到左侧可压缩聚合物元件420h。类似地，右侧缝钉成形插入件310h-340h可以通过粘合剂或其他合适的紧固件装置附连到右侧可压缩聚合物元件430h。
图34-37显示了一种独特和新颖的可塌缩或可压缩缝钉驱动器装置，其通过响应在击发过程期间驱动器受到的压缩力塌缩或压缩允许各种缝钉驱动器适应不同组织厚度。当在这里使用时，术语“击发过程”指的是朝着砧座的缝钉成形底表面驱动缝钉驱动器的过程。如上所述，现有的缝钉驱动器由刚劲/刚性材料制造，所述材料被设计成当在击发过程期间遇到压缩力时防止偏转和变形。各种这样的驱动器结构是已知的。例如，一些缝钉驱动器被构造成支撑单一缝钉，而其他被设计成支撑多个缝钉。单和双缝钉驱动器和在钉仓内它们怎样可以可操作地被支撑和击发的论述可以在2005年9月9日提交的、题为“Staple Cartridges For Forming Staples Having DifferingFormed Staple Heignt”、序列号为11/216,562的、Frederick E.Shelton，IV的美国专利申请中找到，上述申请的公开内容被引用于此作为参考。
图34显示了包括细长通道40h的缝钉施放组件16h，所述细长通道具有以已知方式可枢转地连接到其上的砧座20h。细长通道40h被构造成在其中可操作地支撑钉仓42h。砧座20h在其上具有缝钉成形底表面60h，当砧座20h被枢转到图34中所示的闭合位置时所述缝钉成形底表面适于面对钉仓42h的上表面43h。缝钉83均被支撑在相应缝钉驱动器500上，下面将更详细地论述所述缝钉驱动器的构造。
每个缝钉驱动器500可以如图34和35中所示可动地支撑在设在钉仓主体85h中的相应缝钉通道87h内。在击发过程期间被定向成用于由E形梁击发构件50接合的驱动元件或楔形滑块78也可操作地支撑在钉仓主体85h内。参见图34，当E形梁击发构件50和楔形滑块78以已知方式朝远侧被驱动通过细长通道40h和钉仓42时，楔形滑块78将缝钉驱动器500向上驱动到钉仓主体85h内。当缝钉驱动器500朝着砧座20h的缝钉成形底表面60h向上被驱动时，它们携带有它们各自的一个缝钉83或多个缝钉，所述缝钉被驱动到与砧座20h的缝钉成形底表面60h中的相应缝钉成形凹坑61h形成接合。当缝钉83的末端88接触成形凹坑61h时，它们弯曲，因此为缝钉83提供稍象“B”的形状。尽管在这里结合E形梁击发构件描述了本发明的各种实施方式，可以预见这些各种实施方式也可以成功地与各种不同击发构件和驱动元件布置一起使用而不脱离本发明的精神和范围。
本发明的一种可塌缩缝钉驱动器实施方式在图36和37中被显示。在这些图中可以看到，可塌缩或可压缩缝钉驱动器500包括基座部分502和缝钉支撑部分520，所述缝钉支撑部分可响应在击发过程期间生成的压缩力从相对于基座部分502的第一未塌缩位置移动。在各种实施方式中，基座部分502可以具有前向支撑柱段504和与前向支撑柱段504间隔开并且与其基本上一体形成的后向支撑柱段508。基座部分502也可以具有直立侧部510，所述直立侧部具有从其自后侧突出的肋512。直立侧部510用于限定基座部分502中的接收突出部分514以用于在其上接收缝钉支撑部分520。本领域的普通技术人员将会理解，当缝钉支撑部分520被接收在突出部分514上时，缝钉驱动器500不能再进一步塌缩或压缩。
缝钉驱动器500的缝钉支撑部分520可以类似地包括前向支撑柱段522和与前向支撑柱段522间隔开的后向支撑柱段524。当缝钉支撑部分520被接收在基座部分502上时，前向支撑柱段504，522用于形成前向柱部分530并且后向支撑柱段508，524形成后向柱部分532。前向缝钉接收凹槽526形成于前向支撑柱段522中并且后向缝钉接收凹槽528形成于后向支撑柱段524中。前向缝钉接收凹槽526和后向缝钉接收凹槽528用于如图35中所示在其中支撑缝钉83。肋512和前向柱530和后向柱532可以与钉仓主体85中的相应通道(未显示)协作以为缝钉驱动器500提供侧向支撑，同时在击发过程期间允许驱动器向上被驱动到钉仓主体85内。
在各种实施方式中，通常被标示为540’的阻力连接结构被提供以在受到击发操作期间的任何压缩力之前将缝钉支撑部分520支撑在相对于基座部分(图37)的第一未压缩或未塌缩取向并且响应缝钉击发操作期间施加到缝钉支撑部分520和基座部分520的压缩力的大小允许缝钉支撑部分520和基座部分朝着彼此移动(塌缩或压缩)。在图36和37中可以看到，各种实施方式中的阻力连接结构540’可以包括一对连接杆540，所述连接杆从缝钉支撑部分520的底部521突出并且对应于基座部分502中的孔或开孔542。杆540相对于孔542的尺寸被确定成并且被成形为在其间建立过盈配合或“轻压配合”(即，大约0.001英寸的过盈)使得当缝钉支撑部分520和基座部分502如下面将更详细地所述在缝钉击发操作期间被压缩在一起时，缝钉支撑部分520和基座部分502可以朝着彼此压缩以相对于在击发过程期间受到的压缩力的大小减小缝钉驱动器500的总高度。在各种实施方式中，例如，缝钉支撑部分520和基座部分502可以由相同材料制造，例如
。在其他实施方式中，基座部分502和缝钉支撑部分520可以由不同材料制造。例如，缝钉支撑部分520可以由
制造，而基座部分502可以由玻璃或矿物填充
制造。然而，也可以利用其他材料。例如，基座部分502可以由尼龙(Nylon)6/6或尼龙6/12制造。
在各种实施方式中，大约0.001英寸的摩擦或过盈配合可以在连接杆540与它们的相应孔542之间被建立。然而，其他程度的过盈配合可以被利用以与当缝合特定类型/厚度的组织时受到的压缩力的大小成比例地获得驱动器压缩的预期量和速度。例如，在一种实施方式中，为了缝合组织，连接杆540与它们各自的孔542之间的过盈配合的程度可以为大约0.002至0.005英寸，其中预期在击发操作期间可以生成大约2至5磅级别的压缩力。
图35示出了当遇到各种厚度的组织时缝钉驱动器500经历的行程和压缩的各种范围。更具体地，图35示出了夹在钉仓42h的上表面43h与砧座20h的缝钉成形底表面60h之间的组织560的一部分。如图35中所示，组织560具有三个厚度。组织的最厚部分被标示为562并且包括在图的右侧的组织部分。组织的次厚部分被标示为564，组织560的最薄部分被标示为566并且在图的左侧。出于说明的目的，与组织部分562相关联的缝钉驱动器被标示为缝钉驱动器500a。与组织部分564相关联的缝钉驱动器被标示为缝钉驱动器500b并且与组织部分566相关联的缝钉驱动器被标示为500c。将会理解，缝钉驱动器500a，500b，500c在构造上可以与如上所述的缝钉驱动器500相同。
首先关注缝钉驱动器500a，当缝钉驱动器500a由楔形滑块(未在图35中被显示)向上朝着砧座20h的缝钉成形底表面60h被驱动时，它遇到阻止缝钉驱动器500a向上运动的厚组织部分562。这样的阻力(由箭头570表示)与由楔形滑块生成的驱动力(由箭头572表示)相反并且用于克服在连接杆540与它们各自的孔542之间建立的过盈量和将杆540更深地推入它们各自的孔542中，由此允许缝钉驱动器500a的缝钉支撑部分520a和基座部分502a朝着彼此运动。在缝钉击发操作期间生成的压缩力下缝钉支撑部分520a和基座部分502a朝着彼此的该运动在这里被称为“塌缩”或“压缩”。当处于完全压缩位置时，其中缝钉支撑部分520a被接收在基座部分502a的突出部分514a上，缝钉支撑部分520a上的缝钉支撑突出部分526a，528a可以优选地将缝钉83的底部交叉元件89支撑在钉仓42h的上表面43h之上以避免当缝钉施放组件16h被收回时钩绊钉仓42h上的缝钉83。缝钉驱动器500a的被压缩高度由图35中的箭头574标示。
接着关注对应于组织部分564的缝钉驱动器500b，由于组织部分564不如组织部分562一样厚，在击发操作期间缝钉驱动器500b受到的阻力570b不如阻力570一样大。所以，缝钉驱动器500b的连接销540b被推进到它们各自的孔542b中不如缝钉驱动器500a的销540被推进到它们各自的孔542中一样远。因此，缝钉驱动器500b的被压缩高度576大于缝钉驱动器500a的被压缩高度574。在图35中可以看到，支撑在缝钉驱动器500b中的缝钉83的底部部分89被支撑在钉仓42h的上表面43h之上。
缝钉驱动器500c与最薄组织部分566相关联。因此，在缝钉击发操作期间缝钉驱动器500c受到的阻力570c小于缝钉驱动器500b受到的阻力570b。因此，缝钉驱动器500c的销540c被推进到它们各自的孔542c中不如缝钉驱动器500b的销540b被推进到它们各自的孔542b中一样远。因此，缝钉驱动器500c的被压缩高度578大于缝钉驱动器500b的被压缩高度576。
在图35中进一步可以看到，由于缝钉驱动器500c的被压缩高度578大于缝钉驱动器500b的被压缩高度576，由缝钉驱动器500c支撑的缝钉83c比由缝钉驱动器500b支撑的缝钉83b被压缩到更大的程度。因此，缝钉83c的成形高度小于缝钉83b的成形高度，缝钉83b的成形高度小于缝钉83a的成形高度，如图35中所示。
本领域的普通技术人员将会理解，连接杆和它们各自的孔的数量、形状、组成和尺寸在实施方式与实施方式之间可以变化而不脱离本发明的精神和范围。连接杆与它们各自的孔之间的这样的相互关系用于在其间建立一定量的摩擦过盈，相对于当夹紧/缝合组织的不同厚度时受到的各种压缩力所述摩擦过盈可以被克服。在一种替代的型式中，连接杆540可以形成于基座部分502上并且所述孔设在缝钉支撑部分520中。
图38和39示出了本发明的另一缝钉驱动器500d实施方式，其在构造和操作上与上述缝钉驱动器500基本相同，区别在于连接杆540d稍稍渐缩或为截头圆锥形。在各种实施方式中，例如，连接杆540d的末端541d相对于孔542的尺寸可以被确定成使得当处于图39中所示的第一未塌缩状态时在其间建立轻压配合。连接杆540d的锥度可以相对于缝钉击发过程期间受到的压缩力的大小适于获得缝钉驱动器压缩的预期量。因此，在这些实施方式中，当缝钉驱动器500d受到将连接杆540d更深地驱动到它们各自的孔542d中的更大压缩力时，连接杆540d与孔542之间的过盈配合的大小增加。在替代实施方式中，连接杆540可以具有圆形并且孔542可以渐缩以与击发操作期间施加到缝钉驱动器上的预期压缩力的大小成比例地获得缝钉驱动器压缩的预期量和速度。在一种替代型式中，连接杆540d可以形成于基座部分502上并且孔542形成于缝钉支撑部分520中。
图40-43示出了本发明的另一缝钉驱动器500e实施方式，其在构造和操作上与上述缝钉驱动器500基本相同，区别在于连接杆540e被构造成或成形为包括附加量的材料，所述材料被定向成当在击发操作期间缝钉驱动器500e受到压缩力时从所述杆的剩余部分被剪切。更具体地并且参考图42，连接杆540e具有接收在相应孔542e内的末端部分541e。末端部分541e相对于孔542e的尺寸可以被确定成使得在其间实现滑动配合，或者在其他实施方式中，当处于第一未塌缩位置时可以在那些部件之间建立小过盈配合。每个连接杆540e的剩余部分543e可以带有或形成有附加量的材料545e，所述材料被设计成当在击发操作期间缝钉驱动器500e受到预期压缩力时从其被剪切。参见图43。附加材料545e可以完全围绕每个连接杆540e的部分543e的周向延伸或者材料543e可以包括围绕连接杆540e的周向定向的一个或多个区段。例如，在图40-43所示的实施方式中，材料543e的两个区段547e如图所示在每个连接杆540e上直径上相对。在各种实施方式中，区段之间的直径距离可以稍大于孔542e的直径，从而当在击发操作期间缝钉驱动器500e受到预期压缩力时导致区段547e从杆540e的至少一部分被剪切或去除。
附加材料543e的部分可以包括连接杆540e的一体化部分或者附加材料543e可以包括第二材料，所述第二材料被应用到连接杆540e并且被设计成当缝钉驱动器500e受到预期压缩力时从那里被剪切。在各种实施方式中，基座部分502可以由比制造连接杆540e和/或附加材料543e的材料更刚性的材料制造，使得当在缝钉击发操作期间缝钉支撑部分520e和基座部分502e被压缩在一起时基座部分502便于附加材料543e的剪切。在一种替代型式中，连接杆540e可以形成于基座部分502上并且孔542e设在缝钉支撑部分520e中。
图44-46示出了本发明的另一缝钉驱动器500f，其在构造和操作上与上述缝钉驱动器500基本相同，区别在于基座部分502f中的孔542f可以为六角形或者可以在其中具有一个或多个表面，所述表面被设计成与连接杆540建立过盈配合或以另外方式阻止连接杆540进一步进入孔542f中。例如，所示的孔542f具有形成于其中的一对平坦表面551f，所述平坦表面用于建立连接杆540f与孔542f之间的过盈配合或一定程度的摩擦阻力，所述摩擦阻力可以由当夹紧/缝合不同厚度的组织时受到的各种压缩力克服。在图44-46所示的实施方式中，连接杆540具有基本圆形的横截面形状并且孔542f具有形成于其中的平坦表面551。然而在替代实施方式中，孔542可以是圆的并且平坦表面可以形成于连接杆540上。在一种替代型式中，连接杆540可以设在基座部分502f上并且孔542f设在缝钉支撑部分520中。
图47-49示出了本发明的另一缝钉驱动器500g，所述缝钉驱动器包括基座部分502g和缝钉支撑部分520g。缝钉支撑部分520g具有形成于其中的缝钉支撑凹槽(未显示)和从它的底表面521g突出的向下突出的柄脚580。柄脚580具有两个渐缩表面582并且被成形为接收在形成于基座部分502g中的相应腔590中。腔590形成有渐缩侧面572并且尺寸被确定成以以下方式在其中接收柄脚580。当缝钉驱动器500g受到在击发操作期间生成的压缩力时，柄脚580被推入腔590中。图49示出了处于完全塌缩或压缩位置的缝钉驱动器500g。缝钉支撑部分520g和/或柄脚580可以由比形成基座部分502g的材料稍稍更柔顺的材料制造，使得柄脚580可以被推入基座部分502g中的腔590中而基本不将基座部分502g扭曲到它将妨碍缝钉驱动器500g被完全驱动到最后击发位置的能力的程度。例如，缝钉支撑部分和/或柄脚580可以由
制造并且基座部分502g可以由玻璃填充尼龙制造，从而当在击发操作期间受到预期压缩力时获得驱动器压缩的预期量。在一种替代型式中，柄脚580可以设在基座部分502g上并且孔590设在缝钉支撑部分520g中。
图50-52示出了本发明的另一缝钉驱动器500h实施方式，其在构造和操作上与上述缝钉驱动器500基本相同，区别在于代替连接杆，缝钉支撑部分520h具有从其突出的两个渐缩柄脚600，所述柄脚被设计成被压缩到形成于基座部分502h中的V形腔610中。在开始击发操作之前，缝钉支撑部分520h被支撑在钉仓内的基座部分502h上。当缝钉支撑部分520h和基座部分502h在击发操作期间被压缩在一起时，渐缩柄脚600如图52中所示被向内推动。柄脚600被压缩到V形腔610中的程度取决于在击发操作期间受到的压缩力的大小。
缝钉支撑部分520h和/或柄脚600可以由比形成基座部分502h的材料稍稍更柔顺的材料制造，使得柄脚600可以被推入基座部分502h中的V形腔610中而基本不将基座部分502h扭曲到它将妨碍缝钉驱动器500h被完全驱动到最后击发位置的能力的程度。例如，缝钉支撑部分和/或柄脚600可以由无填充尼龙制造并且基座部分502h可以由填充玻璃或矿物的
制造，从而当在击发操作期间受到预期压缩力时获得缝钉驱动器压缩的预期量。在一种替代型式中，柄脚600可以设在基座部分502h上并且腔610设在缝钉支撑部分520h中。
图53-55示出了本发明的又一缝钉驱动器500i实施方式，所述缝钉驱动器包括在其中具有V形缝钉支撑凹槽630i，650i的缝钉支撑部分520i。在该实施方式中，缝钉支撑部分520i具有从其突出被定向成压缩到第一V形凹槽或腔630i中的两个渐缩柄脚622i，626i的第一对620i和被定向成压缩到第二V形凹槽或腔650i中的两个渐缩柄脚642i，646i的第二对640i。更具体地并且参考图54，第一柄脚622i具有末端624i，在开始缝钉击发操作之前该末端与第二柄脚626i的末端628i间隔开。当处于图54所示的位置时，末端624i，628i被向外偏压到与第一V形凹槽630i的上侧壁摩擦接触以将缝钉支撑部分520i保持在图54所示的未塌缩位置。尽管未显示，柄脚642i，646i的第二对640i也类似于柄脚622i，626i被构造并且用于以相同方式接合第二V形凹槽650i。
当缝钉支撑部分520i和基座部分502i在击发操作期间被压缩在一起时，第一柄脚622i，626i的末端624i，628i和第二柄脚642i，646i的末端朝着彼此被偏压以允许柄脚更深地被驱动到它们各自的凹槽630i，650i中。图55示出了处于它们的完全压缩状态的柄脚622i，626i的第一对620i，所述完全压缩状态也对应于驱动器500i的完全压缩状态。柄脚被压缩到它们各自的V形凹槽中的程度取决于在击发操作期间受到的压缩力的大小。
缝钉支撑部分520i和/或柄脚622i，626i，642i，646i可以由比形成基座部分502i的材料稍稍更柔顺的材料制造，使得柄脚622i，626i，642i，646i可以被推入基座部分502i中的它们各自的V形凹槽中而基本不将基座部分502i扭曲到它将妨碍驱动器500i被完全驱动到最后击发位置的能力的程度。例如，缝钉支撑部分520i和/或柄脚622i，626i，642i，646i可以由
制造并且基座部分502i可以由填充玻璃或矿物的尼龙制造，从而当在击发操作期间受到预期压缩力时获得驱动器压缩的预期量。在一种替代型式中，柄脚622i，626i，642i，646i可以设在基座部分502i上并且V形凹槽630i，650i可以设在缝钉支撑部分520i中。
上述本发明的各种实施方式和它们各自的等同结构表现出了对现有缝钉施放组件和端部执行器的巨大改进。本发明的各种实施方式为砧座和/或通道提供挠性部分，当组件内的压缩由于组织厚度而增加时所述挠性部分允许缝钉总高度增加。其他实施方式利用具有挠性成形凹坑的砧座布置，响应组织厚度的变化所述挠性成形凹坑可以远离钉仓被压缩。这样做时，成形凹坑与钉仓之间的固有间隙增加，其用于增加缝钉的成形高度。这样的优点可以导致改善的缝钉线一致性并且提供更好的临床结果。
尽管通过几个实施方式的描述举例说明了本发明并且尽管相当详细地描述了示例性实施方式，申请人的目的并不是将后附的权利要求的范围约束或以任何方式限制到这样的细节。本领域的技术人员可以显而易见附加优点和改进。例如，尽管为了清楚起见描述了各种手动操作外科器械，应当理解这样的装置也可以被自动操作。另外，本领域的技术人员将会理解这里公开的实施方式、特征和改进可以容易地与可以在开放式、腹腔镜、内窥镜和/腔内外科程序中得到应用的各种其他已知的外科切割器/缝合器、缝合器等结合使用。特别地，这些独特的且具有新颖性的特征可以与线性缝合器、切割器、成形切割器等在实践中结合使用。因此，给予这里公开的各种实施方式的范围和保护不应当仅仅被限制到内切割器式外科缝合器。
尽管描述了本发明的几个实施方式，然而应当理解，本领域的技术人员可以想到那些实施方式的各种修改、改变和适应，并且可以获得本发明的一些和所有优点。例如，根据各种实施方式，为了执行指定的一个功能或多个功能，单一部件可以由多个部件替换，并且多个部件可以由单一部件替换。该应用所以想要涵盖所有这样的修改、改变和适应而不脱离由后附的权利要求限定的本发明公开的范围和精神。
这里公开的装置可以被设计成在一次性使用后被处置，或者它们可以被设计成多次使用。然而在任一情况下，装置可以在至少一次使用之后被重整供再使用。重整可以包括以下步骤的组合：拆卸装置，之后清洁或替换特定部件，和随后组装。特别地，装置可以被拆卸，并且装置的任何数量的特定部件或部分可以以任何组合选择性地被替换或拆除。当清洁和/或替换特定部分之后，装置可以在重整设施被组装或者在外科程序之前由手术团队立即组装供随后使用。本领域的技术人员将会理解装置的重整可以利用用于拆卸、清洁/替换和组装的各种不同技术。这样的技术的使用和产生的重整装置都在本申请的范围内。
优选地，这里公开的发明将在手术之前被处理。首先新的或用过的器械被获得，并且必要时被清洁。然后该器械可以被消毒。在一个消毒技术中，该器械被放置在闭合和密封容器例如塑料或袋中。所述容器和器械然后被放置在可以穿透容器的辐射场中，例如伽马射线、x射线或高能电子。辐射杀死器械上和容器中的细菌。消毒器械然后被储存在无菌容器中。密封容器保持器械无菌直到它在医疗设施中被打开。
当在这里使用时，术语“流体连接”表示元件与适当管线或其他机构连接在一起以允许其间通过加压气体。当在这里使用时，用于“供应管线”或“返回管线”中的术语“管线”指的是由刚性或挠性管道、管、管路等形成的适当通道，用于将流体从一个部件输送到另一个。
所述全部或部分引用于此作为参考的任何专利、出版物或其他公开资料仅仅在被引用材料不会与现有的定义、声明或在该公开中阐述的其他公开资料冲突的程度上被引用于此。因而，并且必要时，在这里清楚阐述的公开内容代替被引用于此作为参考的任何冲突资料。所述引用于此作为参考，但是与现有的定义、声明或在此阐述的其他公开资料冲突的任何资料或其一部分，将仅仅在被引用资料和现有的公开资料之间不产生冲突的程度上被引用。
希望得到保护的本发明不应当被理解成限制到公开的特定实施方式。所以实施方式应当被看作是示例性的而不是限制性的。他人可以进行变动和变化而不脱离本发明的精神。因此，明确地希望落入如权利要求中限定的本发明的精神和范围内的所有这样的等同物、改变和变化被包含于此。
Claims (9)
1.一种用于外科钉仓(42)的可塌缩缝钉驱动器(500，500d，500e，500f，500g，500h，500i)，所述可塌缩缝钉驱动器(500，500d，500e，500f，500g，500h，500i)包括：
基座部分(502，502f，502g，502h，502i)，其能够由所述外科钉仓(42)可操作地支撑；
缝钉支撑部分(520，520e，520g，520h，520i)，其能够可操作地支撑在所述外科钉仓(42)中且靠近所述基座部分(502，502f，502g，502h，502i)；以及
至少一个连接构件(540，540d，540e，580，600，620i，640i)，其从所述基座部分(502，502f，502g，502h，502i)和所述缝钉支撑部分(520，520e，520g，520h，520i)中的一个突出且容纳在所述基座部分(502，502f，502g，502h，502i)和所述缝钉支撑部分(520，520e，520g，520h，520i)中的另一个中的对应的开孔(542，542e，542f，590，610，630i，650i)内，所述至少一个连接构件中的每一个和与其对应的开孔相对于彼此布置以在其间建立摩擦配合，所述摩擦配合的大小在向所述缝钉支撑部分和基座部分施加压缩力之前将所述缝钉支撑部分保持为相对于所述基座间隔开，并且所述摩擦配合在向所述缝钉支撑部分和基座部分施加所述压缩力时被克服。
2.根据权利要求1所述的可塌缩缝钉驱动器(500)，其中，所述至少一个连接构件(540)中的每一个具有大致圆形的横截面形状并且与所述连接构件(540)对应的开孔(542)包括圆形孔。
3.根据权利要求1所述的可塌缩缝钉驱动器(500d)，其中，所述至少一个连接构件(540d)中的每一个包括渐缩的构件。
4.根据权利要求1所述的可塌缩缝钉驱动器(500e)，其中，在所述至少一个连接构件(540e)中的每一个上具有可剪切部分(545e)，所述可剪切部分(545e)能够在向所述基座部分(502)和所述缝钉支撑部分(520e)施加压缩力的过程中在所述至少一个连接构件(540e)被驱动到与其对应的开孔(542e)中时被从所述至少一个连接构件的至少另外的部分(543e)上剪切掉。
5.根据权利要求1所述的可塌缩缝钉驱动器(500f)，其中，所述至少一个连接构件(540)中的每一个包括具有大致圆形横截面形状的杆，并且与所述连接构件(540)对应的开孔(542f)包括非圆形孔。
6.根据权利要求1所述的可塌缩缝钉驱动器(500g)，其中，所述至少一个连接构件(580)中的每一个包括具有渐缩表面(582)的柄脚，并且与所述连接构件(580)对应的开孔(590)具有与所述柄脚上的所述渐缩表面类似的渐缩表面。
7.根据权利要求1所述的可塌缩缝钉驱动器(500h，500i)，其中，所述至少一个连接构件(600，620i，640i)包括对应于一个所述开孔(610，630i，650i)的至少一对柄脚，所述每对柄脚具有彼此分开的端部，以与所述对应的开孔(610，630i，650i)建立摩擦配合，从而将所述缝钉支撑部分(520h，520i)支撑在第一位置，并且在向所述基座部分(502h，502i)和所述缝钉支撑部分(520h，520i)施加所述压缩力时，所述端部朝向彼此向内运动以允许所述缝钉支撑部分(520h，520i)和所述基座部分(502h，502i)朝向彼此运动。
8.根据权利要求7所述的可塌缩缝钉驱动器(500i)，其中，所述对应的开孔(630i，650i)包括第一凹槽(630i)和第二凹槽(650i)，并且所述至少一对(620i，640i)柄脚包括：
对应于所述第一凹槽(630i)的第一对(620i)柄脚(622i，626i)；以及
对应于所述第二凹槽(650i)的第二对(640i)柄脚(642i，646i)，所述第一对(620i)柄脚(622i，626i)与所述第一凹槽(630i)共同作用并且所述第二对(640i)柄脚(642i，646i)与所述第二凹槽(650i)共同作用，以在向所述缝钉支撑部分(520i)和所述基座部分(502i)施加压缩力之前将所述缝钉支撑部分(520i)保持在所述第一位置，并且在向所述缝钉支撑部分(520i)和所述基座部分(502i)施加压缩力时允许所述缝钉支撑部分(520i)和所述基座部分(502i)朝向彼此运动。
9.根据权利要求1所述的可塌缩缝钉驱动器(500，500d，500e，500f，500g，500h，500i)，其中，所述缝钉支撑部分(520，520e，520g，520h，520i)由第一材料制成，所述基座部分(502，502f，502g，502h，502i)由比所述第一材料刚性更大的第二材料制成。
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| US11/540,735 US7467740B2 (en) | 2005-09-21 | 2006-09-29 | Surgical stapling instruments having flexible channel and anvil features for adjustable staple heights |
| US11/540,734 US7472815B2 (en) | 2005-09-21 | 2006-09-29 | Surgical stapling instruments with collapsible features for controlling staple height |
| US11/540,734 | 2006-09-29 | ||
| PCT/US2007/011309 WO2008042022A1 (en) | 2006-09-29 | 2007-05-10 | Surgical stapling instruments with collapsible features for controlling staple height |
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| CN101534726A CN101534726A (zh) | 2009-09-16 |
| CN101534726B true CN101534726B (zh) | 2011-11-09 |
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| CN2007800412071A Active CN101534726B (zh) | 2006-09-29 | 2007-05-10 | 具有用于控制缝钉高度的可塌缩部件的外科缝合器械 |
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| EP (3) | EP2083711B1 (zh) |
| JP (2) | JP5198453B2 (zh) |
| CN (2) | CN101534727B (zh) |
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2007
- 2007-05-10 JP JP2009530336A patent/JP5198453B2/ja active Active
- 2007-05-10 CN CN2007800412353A patent/CN101534727B/zh active Active
- 2007-05-10 WO PCT/US2007/011275 patent/WO2008042021A1/en active Application Filing
- 2007-05-10 JP JP2009530335A patent/JP5198452B2/ja active Active
- 2007-05-10 CN CN2007800412071A patent/CN101534726B/zh active Active
- 2007-05-10 EP EP07794715.8A patent/EP2083711B1/en active Active
- 2007-05-10 WO PCT/US2007/011309 patent/WO2008042022A1/en active Application Filing
- 2007-05-10 EP EP07794734.9A patent/EP2086425B1/en active Active
- 2007-05-10 EP EP11191999.9A patent/EP2430987B1/en active Active
- 2007-05-10 PL PL07794734T patent/PL2086425T3/pl unknown
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Also Published As
| Publication number | Publication date |
|---|---|
| US7467740B2 (en) | 2008-12-23 |
| EP2083711A1 (en) | 2009-08-05 |
| EP2083711B1 (en) | 2013-07-24 |
| JP2010504810A (ja) | 2010-02-18 |
| US20070073340A1 (en) | 2007-03-29 |
| JP5198452B2 (ja) | 2013-05-15 |
| US20070083234A1 (en) | 2007-04-12 |
| EP2086425B1 (en) | 2017-12-20 |
| EP2430987A3 (en) | 2012-09-05 |
| PL2430987T3 (pl) | 2015-12-31 |
| PL2086425T3 (pl) | 2018-07-31 |
| WO2008042022A1 (en) | 2008-04-10 |
| CN101534727B (zh) | 2012-01-25 |
| EP2430987B1 (en) | 2015-07-15 |
| US7472815B2 (en) | 2009-01-06 |
| JP2010504811A (ja) | 2010-02-18 |
| CN101534726A (zh) | 2009-09-16 |
| EP2086425A1 (en) | 2009-08-12 |
| WO2008042021A1 (en) | 2008-04-10 |
| JP5198453B2 (ja) | 2013-05-15 |
| EP2430987A2 (en) | 2012-03-21 |
| CN101534727A (zh) | 2009-09-16 |
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