CN101627894A - 用于在外科手术过程中保持可见性并提供冲洗和/或抽吸的装置和方法 - Google Patents
用于在外科手术过程中保持可见性并提供冲洗和/或抽吸的装置和方法 Download PDFInfo
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
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- A—HUMAN NECESSITIES
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- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00064—Constructional details of the endoscope body
- A61B1/00071—Insertion part of the endoscope body
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00131—Accessories for endoscopes
- A61B1/00135—Oversleeves mounted on the endoscope prior to insertion
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/12—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor with cooling or rinsing arrangements
- A61B1/126—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor with cooling or rinsing arrangements provided with means for cleaning in-use
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/313—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes
- A61B1/3132—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes for laparoscopy
Abstract
本发明涉及一种用于在外科手术过程中保持可见性并提供冲洗和/或抽吸的装置和方法。通常,所述方法和装置可以允许外科器械利用连接到外科器械的流体管道在外科手术过程中保持可见性。外科装置可以包括护套,该护套具有穿过其延伸的至少一个腔,该腔被构造成允许外科观察器械设置于其中。护套还可以具有穿过其延伸的通道,该通道被构造成允许流体穿过其流动。流体管道可以被构造成在可以允许流体朝着和/或远离外科器械上的观察元件和流体远离观察元件并朝着体腔内的手术区域的可供选择的方向的位置之间运动。
Description
技术领域
本发明涉及用于执行外科手术的装置和方法,具体而言,涉及用于在外科手术过程中保持可见性并提供冲洗和/或抽吸的装置和方法。
背景技术
在腹腔镜手术中,在腹部内形成一个或多个小的切口,并将套管针经由该切口插入以形成进入腹腔的路径。套管针用于将各种器械及工具引入腹腔,还用于提供注气从而将腹壁从器官上提起。在这个过程中,将观测装置,如内窥镜或腹腔镜,经由套管针之一插入使得外科医生能够在与观测装置相连的外部监视器上看到手术的区域。
在一次外科手术过程中,经由套管针通常将观测装置多次插入和取出,并在每次插入和每次取出时观测装置会遇到流体,该流体会黏附到观测装置的镜头上,且完全或部分地妨碍经由该镜头的可见性。在一些外科手术过程中,向外科部位提供流体冲洗,这可以增加能够潜在地妨碍经由镜头的可见性的流体的量。此外,观测装置可将流体从患者身体的内侧或外侧引入套管针,其中流体能被存放在套管针内直到将观测装置或其他器械经由该套管针再次插入。当再次插入时,流体会黏附到观测装置的镜头上。因此,需要清理观测装置的镜头以恢复可见性,通常在一次外科手术过程中需要清理多次。由于接近体内的观测装置受到限制,每次镜头清理需要将观测装置从身体上取出,清理观测装置镜头的流体,然后将观测装置再次引入体内。这种镜头清理方式是一种耗时过程,由于重复插入和取出观测装置还增加了并发症和感染的几率。
因此,需要用于在外科手术过程中向手术部位提供冲洗和/或抽吸并且保持经由观测装置的镜头的清晰可见性的装置以及方法。
发明内容
本发明总的提供了用于在外科手术过程中向手术部位输送冲洗和/或抽吸并且保持经由观测装置的镜头的清晰可见性的装置以及方法。在一种实施方式中,提供了一种外科装置,该外科装置包括环形护套和流体管道,该环形护套被构造成设置在体腔内并且在其腔中容纳外科器械。护套还具有被构造成允许流体穿过其流动的通道,所述通道具有近侧开口和远侧开口。流体管道至少部分位于所述护套的远侧部分中并且被构造成当所述护套设置在体腔内时能够在至少两个位置之间运动以改变所述通道的所述远侧开口的位置。例如,远侧开口的第一位置可以在护套的远端,远侧开口的第二位置可以在护套的远端的近侧。多种外科器械可以设置在护套的腔中,例如在其远端处具有观察元件的观测装置。
流体管道可以具有多种结构。例如,流体管道被可以处于第一位置和第二位置,在该第一位置,其有效地引导流体基本上朝着所述腔流过所述通道,在该第二位置,其引导流体远离所述腔并且基本上朝着手术区域流过所述通道。在另一个例子中,流体管道在至少一个位置可以允许引导流体沿着与所述通道的纵向轴线基本上对准的方向流过所述通道。在一些实施方式中,流体管道可以选择性地允许通过所述通道进行流体冲洗和通过所述通道进行流体抽吸。
在一种示例性的实施方式中,流体管道包括可轴向调节的臂。臂可以具有各种结构。例如,臂能够在第一位置和第二位置之间运动,在该第一位置,所述臂的远端位于所述护套的远端的近侧,在该第二位置,所述臂的远端位于所述护套的远端的远侧。臂可以多种方式运动,例如利用连接到臂的近侧部分的致动器,其中,对致动器的操纵能够有效地使臂在至少两个位置之间运动。在一些实施方式中,外科装置还包括设置在所述护套的远端处的自密封元件,所述臂能够在处于所述自密封元件近侧的位置和处于自密封元件远侧的位置之间运动。
在另一种示例性的实施方式中,流体管道包括设置在所述护套的远侧部分处的可动环。环可以具有各种结构。例如,环可以定位在连接到护套的外科器械的远端的远侧。例如,环在第一旋转位置时可以允许流体朝着所述护套的内腔流过位于所述护套的远端近侧的通道的远侧开口,所述环在第二旋转位置时被构造成允许流体远离所述护套流过位于护套的远端处的通道的远侧开口。在一些实施方式中,环在第一旋转位置时可以阻止流体远离所述护套的远端流过所述通道的远侧开口,环在第二旋转位置时被构造成阻止流体流过位于所述护套的远端近侧的通道的远侧开口。
在另一种实施方式中,一种外科装置包括流体管道和环形护套,环形护套具有穿过其延伸的第一和第二通道。第一通道可以容纳外科器械,第二通道可以允许流体穿过其流动。流体管道可以在第一位置和第二位置之间运动,在该第一位置,其允许所述第二通道的远侧开口基本上指向设置在所述第一通道中的外科器械的远端,在该第二位置,其允许所述第二通道的远侧开口基本上背向所述护套的远端并进入体腔。在一些实施方式中,流体管道至少部分地位于所述护套的远侧部分的近侧。
在其它方面,提供了一种外科方法。该方法包括将其腔中设置有外科器械并具有穿过其延伸的流体通道的护套通入体腔内。所述外科器械的远端位于所述护套的远端的近侧,并且至少部分位于所述护套的远侧部分中的流体管道被构造成能够在至少两个位置之间运动以改变所述流体通道的远侧开口的位置。该方法可以具有任何数量的变型。例如,将所述护套通入体腔内可以包括使所述护套穿过具有延伸到体腔内的工作通道的引导装置。在一些实施方式中,流体管道能够运动以暴露流体通道的远侧开口,从而有效用于选择性地冲洗并抽吸所述护套的远侧部位。在另一个例子中,流体管道能够运动以暴露所述流体通道的远侧开口,从而有效用于选择性地冲洗并抽吸设置在所述护套的内腔中的外科器械的远端。
附图说明
通过以下结合附图的详细描述,将能更充分地理解本发明,其中:
图1是外科装置的一种实施方式的局部剖视图,该外科装置包括手持件和延伸到体腔中的护套,并具有设置在护套中且定位在第一位置的可调节的臂;
图2是图1中的护套位于体腔外侧部分的剖视图;
图3是图2的护套的远侧部分的剖视图;
图4是图1中的外科装置的局部剖视图,其中,可调节的臂设置在护套中并定位在第二位置;
图5是图1的手持件的示意图;
图6是外科装置的一种实施方式的局部剖视图,该外科装置包括手持件和延伸到体腔中的护套,并具有设置在护套中的可调节的臂和保护性镜;
图7是外科装置的另一种实施方式的远侧部分的局部剖视图,该外科装置包括护套并具有设置在护套中的可调节的臂;
图8是外科装置的一种实施方式的远侧部分的局部剖视图,该外科装置包括具有可动歧管的护套,并具有设置在护套中的可调节的臂;
图9是外科装置的又一种实施方式的局部剖视图,该外科装置包括手持件和护套,并具有设置在护套中且位于第一位置的可调节的臂;
图10是图9中的外科装置的局部剖视图,其中,可调节的臂设置在护套中并定位在第二位置;
图11是外科装置的一种实施方式的远侧部分的局部剖视图,该外科装置包括护套并具有设置在护套中的多个可调节的臂,所述臂位于第一位置;
图12是图11中的外科装置的局部剖视图,其中,可调节的臂设置在护套中并位于第二位置;
图13是图11中的外科装置的远端的局部透视图;
图14是图11中的外科装置的透视图;
图15是图14中的外科装置的侧视图;
图16是外科装置的一种实施方式的透视图,该外科装置包括护套并具有至少部分位于所述护套的远侧部分的可动环;
图17是图16中的外科装置的侧视图;
图18是图16中的外科装置的远端的局部透视图,其中,环位于第一位置;
图19是图16中的外科装置的远端的局部剖视图,其中,环位于第一位置;
图20是图16中的外科装置的远端的局部透视图,其中,环位于第二位置;
图21是图16中的外科装置的远端的局部剖视图,其中,环位于第二位置;
图22是外科装置的一种实施方式的远侧部分的局部透视图,该外科装置包括护套并具有至少部分位于护套的远侧部分的可动环,其中,该环位于第一位置;
图23是图22中的外科装置的局部剖视图;
图24是图22中的外科装置的局部透视图,其中,环处于旋转状态;
图25是图24中的外科装置的局部透视图,其中,环运动到第二位置;以及
图26是图25的外科装置的局部剖视图。
具体实施方式
接下来将描述一些示例性的实施方式以提供对这里公开的装置和方法的结构、功能、制造和使用的原理的全面理解。这些实施方式的一个或多个例子在附图中示出。本领域普通技术人员可以理解在这里具体描述且在附图中示出的装置和方法是非限制性的示例性的实施方式并且本发明的保护范围仅仅由权利要求书来限定。结合一种示例性实施方式示出并描述的特征可以与其它实施方式的特征相结合。这些变型和改变意于包括在本发明的范围内。
本领域普通技术人员可以理解,虽然装置和方法是结合内窥镜手术进行描述的,但这里公开的装置和方法可以用于多种外科手术并与多种外科器械一起使用。作为非限制性的例子,装置可以用于腹腔镜手术,其中,该装置是经皮引入的。装置和方法也可以用在开放式外科手术中。此外,本领域普通技术人员可以理解,这里公开的装置和方法可以结合多种刚性和/或挠性的外科器械使用。作为非限制性的例子,外科器械可以是观测装置,例如内窥镜、腹腔镜、结肠镜、关节镜、胃镜等,并且可以是任何其它类型的外科装置,该外科装置的远端可以设置在体腔内,该外科装置具有被构造成允许观察图像、例如监视器上的或者通过目镜观察的静止或影像图像的观察元件。
本领域普通技术人员可以理解,这里使用的术语“流体”意于包括当位于外科器械上时能够不利地影响器械的功能性或外科医生使用器械的能力的任何物质。流体包括任何类型的体液,例如血液,并包括在外科手术中引入的任何类型的清洁流体,例如生理盐水或空气。流体也包括流体/固体混合物或在其中悬浮或存在颗粒物(例如组织片断)的流体,以及粘性材料和气体。本领域普通技术人员也可以理解,这里使用的术语“观察元件”意于包括被构造成允许通过静止、活动或其它可视图像来进行任何类型显示的任何一种或多种元件(例如,镜头、传感器等),这里使用的术语“体腔”意于包括任何身内区域、例如腹腔、口腔、身体内腔等。本领域普通技术人员还可以理解,这里讨论的清洁外科器械的远端意于包括清洁设置在护套中的外科器械的远端的至少一部分和/或设置在外科器械的远端处的观察元件。
提供各种示例性的方法和装置来在外科手术过程中提供对手术部位的冲洗和/或抽吸并且保持穿过观测装置的镜头的清晰可见性。在一种示例性的实施方式中,装置和方法可以允许外科器械在外科手术过程中利用连接到外科器械的流体管道保持可见性。通常,外科装置可以包括具有至少一个穿过其延伸的腔的护套,至少一个腔被构造成允许外科观察器械可移除地或固定地设置在其中。护套也可以具有穿过其延伸的通道,通道被构造成允许流体穿过其流动。流体管道能够可移除地连接到护套或者一体地形成在护套中,该护套围绕外科器械设置,使得流体管道能够与设置在护套中的外科器械同时插入到体腔内和从体腔内收回。流体管道可以被构造成能够在允许流体沿着朝向外科器械上的观察元件和/或远离外科器械上的观察元件的可供选择方向流动的位置之间运动,以帮助清洁观察元件,并且允许流体远离观察元件并朝着体腔内的手术区域流动,以帮助清洁手术区域。
因此,流体管道能够有助于清洁观察元件和/或有助于从其中设置有外科器械观察元件的体腔冲走流体,由此有助于保持穿过观察元件的可接受的视觉清晰度。因此,不需要将外科器械从体内收回来用另一个清洁的外科器械进行替换和/或清洁或替换观察元件。这样,外科手术不会被中断一次或多次以处理视觉上受阻碍的观察元件,由此减少外科手术用的时间。通过在外科器械设置于体内时清洁外科器械的远端,外科器械能够基本上保持在靠近所感兴趣的患者组织附近的期望位置,并且外科医生不必花费另外的时间来操纵外科器械使其在被清洁和/或由另一个外科器械替换之后回到期望的位置。不需要例如通过用于将外科器械引入体腔内或从体腔移出的引导装置来将外科器械从身体移出,也可以减小外科器械将流体抽吸到引导装置中的几率,在观察元件通过引导装置的过程中和/或在外科器械重新插入(或其它外科器械插入)到引导装置中时,如果外科器械将流体抽吸到引导装置中则会使观察元件的观察路径模糊。此外,流体管道在其可供选择的位置中的一处或两处时可以将流体例如体腔内的烟尘或烟雾抽离观察元件或抽离观察元件远侧之外的手术部位,这可以有助于移除可能阻挡穿过观察元件的可见性或可能不利地影响外科手术的流体。利用同一护套和与外科器械相关联的流体管道系统提供流体抽吸和流体冲洗也可以有助于减少在外科手术过程中所需的器械的数量。
图1至5示出了外科装置10的一种示例性的实施方式,该外科装置10包括连接到环形护套12上的流体管道、例如可延伸的臂44。外科装置10可以由任何类型的材料和材料的任何组合、优选为不能渗透流体的、优选为刚性和/或半刚性的、并且优选为生物相容性材料形成。外科装置10可以构造有如下所述的流体管道,或者构造成类似于以下文献中描述的外科装置:2006年10月3日提交的题为“Apparatus For Cleaning A Distal Scope End Of A Medical ViewingScope”的美国专利公开文献No.2008/0081948和2008年3月13日提交的题为“Apparatus For Keeping Clean A Distal Scope End Of AMedical Viewing Scope”的美国专利公开文献No.12/047474(代理人卷号为No.END6345USNP),上述专利公开文献的全部内容通过引用合并在此。通常,外科装置10可以包括环形护套12,环形护套12具有近侧部分16和远侧部分18并且具有穿过其延伸的腔14,腔14具有开放的近端14a和远端14b。腔14可以被构造成容纳至少部分设置于其中的外科器械、例如内窥镜20。护套12可以被构造成在内窥镜20已设置在腔14中之前和/或之后直接插入到患者22体内或者通过延伸到患者体腔50内的引导装置、例如套管针60的工作通道插入到患者22体内。
内窥镜20可以固定地连接到护套12,或者内窥镜20能够例如通过将内窥镜20、首先是其远端42穿过护套的近侧部分16可滑动地设置在腔14内而可移除地连接到护套12。内窥镜的远端42具有外径。管状壁24在护套的远侧部分18处的内径可以小于内窥镜的远端42的外径,以帮助将内窥镜20保持在腔14内并且帮助阻止内窥镜20向远侧滑出护套的远端40。如图1和4所示,内窥镜的远端42可以与护套12在护套的远侧部分18处压配合。压配合可以本领域普通技术人员理解的任何方式来实现、例如通过改变腔14的直径,使得管状壁24的内径从护套的近端52到护套的远端40变小或者沿着其任何部分变小。内窥镜20可以本领域普通技术人员理解的任何方式、例如通过利用弹性护套、压缩配合件、弹性O形环连接到护套12来实现,其中,弹性护套、压缩配合件、弹性O形环接近护套的远端40连接到护套12并且被构造成连接地接合已被插入到护套的近端52等中的内窥镜20。
如上所述,护套12具有管状壁24,该管状壁24具有内径和外径并且在内径和外径之间包含通道26。管状壁24的内径由腔14的直径限定,而管状壁24的外径由护套12的外径限定。通道26具有被构造成允许流体穿过其流动的开放的近侧部分28和远侧部分30。至少在近侧部分28和远侧部分30之间,通道26可以与护套12的纵向轴线A2基本上对准。通道26的近侧部分28具有可以与如下进一步说明的流体冲洗源32和流体真空源34中的至少一个流体连通。通道26的远侧部分30具有至少两个开口,所述开口能够替代地用作通过如下进一步说明的流体管道调节的通道26的远端开口。
护套12的远侧部分18具有环形歧管36,如图3所示,该环形歧管36包括至少一个近侧孔口38,近侧孔口38位于护套12的远侧部分18中且位于护套12的远端40的近侧,并且优选为基本上指向腔14、并且更优选为基本上指向设置在腔14中的内窥镜20的远端42的位置。这样,至少一些时间、流过通道26的流体可以与腔14流体连通和/或与腔14中的内窥镜的远端42流体连通。这样,流出近侧孔口38的流体(例如,沿着远侧方向流过通道26)能够清洁腔14的内侧和/或清洁内窥镜的远端42,并且也由此能够清洁位于内窥镜的远端42处的观察元件。类似地,允许流体流入近侧孔口38(例如沿着近侧方向流过通道26)能够抽吸流体远离腔14的内侧和/或从内窥镜的远端42抽吸流体。图1、2和4中示出了两个近侧孔口38,图3中示出了四个近侧孔口38,虽然通道26可以具有任意数量的近侧孔口,每个近侧孔口可选择地包括多个沿周向间隔开的孔口。环形歧管36的体积可以大于歧管36和每个近侧孔口38之间的通道37的总体积。通道37是通道26延伸到近侧孔口38的部分,从而通道37是当臂44处于第二、远侧位置时通道26的阻止流体流入其内的部分。多个近侧孔口38可以沿着护套12的截面轴线A1基本上轴向对准,如图1、2和4所示,或者一个或多个近侧孔口38可以与任何其它的一个或多个近侧孔口38基本上非轴向地对准,使得至少两个孔口38与护套12的不同的截面轴线沿轴向对准。虽然每个通道37可以是线性的或非线性的(与任何其它通道37相同或不同),通道37优选地与截面轴线A1基本上平行。护套的远侧部分18可以具有包含近侧孔口38的沿周向的内表面54。流体倾向于粘附到沿周向的内表面54,由此辅助保持流体不接近并且远离内窥镜的远端42并且在位于内窥镜远端42处的观察元件的观察路径之外。护套的远侧部分18的沿周向的内表面54可以从护套的远端40沿纵向延伸到内窥镜的远端42,如图1所示。
通道26可以被构造成容纳设置于其中的流体管道,例如可延伸的臂44,流体可以穿过该流体管道流动。臂44的外径小于通道26的直径,使得臂44能够在通道26内滑动。臂44可以是刚性的和/或挠性的,但臂44优选具有足够的刚性以辅助使臂44运动穿过通道26并且辅助穿刺密封件62,如以下将要讨论的。但是,臂44也优选地具有足够的挠性,以辅助臂44穿行于通道26中的任何弯曲部、折弯部、扭曲部等。臂44至少在臂44的流体承载部分内优选具有恒定的横截面积,臂44的流体承载部分被构造成可设置在通道26中,以辅助减少流动损耗并为流过臂44的流体提供更好的响应时间。臂44也优选地具有基本上与通道的截面形状匹配的截面形状,例如圆形、椭圆形、月牙形等,以辅助使臂44平滑地穿过通道26。
当臂44处于图1所示的第一近侧位置时,可延伸的臂44的开放的远端46位于通道的近侧孔口38的近侧,使得流过臂的远端46的流体与近侧孔口38流体连通,从而流体可以流过通道26和近侧孔口38。臂44可以沿轴向调节,例如与纵向轴线A2基本上平行地调节。向远侧推进臂44可以推进包括至少臂的远端46的至少一部分臂44穿过位于近侧孔口38和护套远端40之间的密封件62。臂的远端46可以是基本上线性的,如图1和4所示,或者远端46可以是非线性的,例如弯曲的、锥形的等,以辅助臂44使密封件62“破裂”和/或辅助增加向远侧流过远端46的流体的速率或压力。当臂44向远侧行进穿过密封件62并且位于如图4所示的第二远侧位置时,臂的远端46位于近侧孔口38的远侧,从而阻止流体流过近侧孔口38并且替代地可以流过臂的远端46并流过护套12中的至少一个远侧孔口48。与上述关于近侧孔口38讨论的类似,通道26可以包括任何数量的远侧孔口,并且每个远侧孔口可选地包括多个沿周向间隔开的孔口。在第二远侧位置,臂44的至少一部分可以向远侧延伸超出护套的远端40,使得流过通道26的流体可以流过臂44并且不会接触通道的内壁,如图4所示。替代地,臂44可以穿过密封件62行进一段距离,这允许密封件62“破裂”或者被穿透,但这保持臂的远端46包含在护套12内(例如位于护套的远侧孔口48的近侧并且在密封件62和护套的远端40之间)。
护套12在其远侧部分18可以包括止动元件,以有助于防止臂44向远侧行进超出护套的远端40并且有助于减小臂44与护套远端40外的手术部位相干扰的几率。止动元件的非限制性的例子包括设置在护套的远侧孔口48上方的可流体渗透的网、围绕护套的远侧孔口的唇部,通道26的位于密封件62的远侧的至少一部分通道26的直径小于臂44的直径,这类似于上面关于腔14中的内窥镜20等的描述。但是,在一些外科手术中,理想的是允许臂44延伸超出护套的远端40,如图4中的第二位置所示,从而流体可以更加直接地冲洗手术部位或从手术部位抽吸。远侧孔口48优选地形成在护套的远端40中,以使流体超出护套的远端40的流动最大化,但远侧孔口48可以位于护套12中的任何位置处,只要该位置可以允许流过通道26的流体与体腔50流体连通,其中,护套12的远侧部分18的至少一部分例如设置在护套12的一侧。
密封件62可以包括本领域技术人员可以想到的单独的任何一种或多种流体密封件或者它们的组合。密封件62可以包括零封密封件(zero-closure)和/或器械密封件,例如鸭嘴密封件、舌形阀、挡板门、凝胶垫密封件、重叠多层密封件等。优选地,密封件62被构造成自密封的,使得臂44可以向远侧穿过密封件62行进以穿透密封件62并且可以向近侧穿过密封件62运动以使密封件62“再密封”。在一些实施方式中,密封件62可以被构造成一次性使用的,使得向远侧推进臂44能够刺破密封件62,并且臂44向近侧运动到密封件62近侧的位置不会使密封件62“再密封”。
在一些实施方式中,臂44可以被构造成例如通过在通道26的内表面上和臂44的外表面上具有相应的配合螺纹、沟槽或其它接合机构来接合通道26。这种接合机构可以有助于将臂44保持在通道26中的期望位置和/或有助于将臂44平滑地引导穿过通道26。替代地或另外地,臂44可以优选地在其近端58处包括锁定机构,在其近端58处臂44可以在患者22体外操纵,锁定机构被构造成将臂44保持在通道26中的期望位置。锁定机构的非限制性例子包括在护套12和臂44上的翼片、对应的凹陷和凸起等,从而允许臂44位于通道26中的连续的位置。
臂44可以多种方式在第一和第二位置之间运动。在一种示例性的实施方式中,臂44可以通过手动地操纵位于臂的近端58处的手柄56来运动。手柄56可以具有任何尺寸、形状和结构,并且优选地被构造成当护套12的至少一部分设置在患者的体腔50中时至少部分地延伸到患者22体外。手柄56可以被向远侧推动以向远侧推动臂44,由此使臂44从第一位置运动到第二位置。相应地,手柄56可以被向近侧拉动,以向近侧缩回臂44,由此使臂44从第二位置运动到第一位置。本领域技术人员可以想到臂44在第一和第二位置之前和/或之后可以在任何数量的位置之间运动。手柄56可以包括机械和/或电气部件。手柄56可以被构造成抵接护套12的近端52,以有助于防止臂44完全地设置在通道26中。例如,手柄56的最大直径可以大于通道26至少在第二腔的近侧部分28处的直径,使得手柄56的远侧表面能够抵接护套的近侧部分28而不会滑动到通道26中。在其它实施方式中,臂44可以被构造成以另外的方式运动,例如通过操纵按钮、杆和/或与臂44机械和/或电气联通的其它控制件,使得臂44可以在例如以推动、拉动、转换等方式操纵控制件时运动。
装置10还可以包括被构造成向护套12、更具体地向流体通道26和设置在通道26中的臂44提供流体冲洗源和/或流体抽空源的流体系统64。通常,在一种示例性的实施方式中,流体系统64可以包括冲洗源32、真空源34、具有流体出口68的手持件66和具有近侧和远侧管端72、74的挠性流体流动管70。远侧管端74可以连接到护套12以与通道26的近侧部分28、更具体地与通道26的近侧部分28中的臂44流体连通。这样,流过通道26中的臂44的流体能够流过管70,反之亦然。臂44可以通过护套12的侧壁连接到管70,如图1和4所示。替代地,臂44可以例如通过臂的手柄56连接到位于护套12的近端52的近侧的管70。近侧管端48可以连接到手持件66以与流体出口68流体连通。手持件66包括第一和第二流体入口76、78,其中,第一流体入口76例如经由第一管道80流体连接到冲洗源32,第二流体入口78例如经由第二管道82流体连接到真空源34。冲洗源32可以包括任意一种或多种类型的流体(液体和/或气体)。真空源34可以提供高真空、局部真空和吸气中的任意一种或多种。无论远侧开口位于近侧孔口38处或远侧孔口48处,由真空源34提供的真空是相对于通道26的远侧开口处的压力而言的。在一些实施方式中,当通道的远侧开口暴露于例如患者的注气腹部中的更高压力下时,真空源34可以是周围的室内空气。本领域技术人员可以理解的是,在一些实施方式中,一种或多种添加剂、例如抗雾剂(如表面活化剂)可以被添加到一种或多种源32、34中的流体中、添加到流过一个或两个管道80、82和/或流过管70的流体中。仅仅作为非限制性的例子,冲洗源32可以包括手术室的生理盐水袋,第一管道80流体连接到该袋,并且真空源34可以包括手术室的抽吸罐,第二管道82流体连接到罐。囊可选地放置在生理盐水袋周围,以增加冲洗流体的压力。
手持件66可以被构造成例如通过使用第一和第二阀按钮84、86而在冲洗源32和真空源34之间替代地转换。这样,流体可以向近侧或远侧流过通道26,以便分别提供流体抽吸和冲洗。推动或者以其它方式致动第一阀按钮84可以使第一流体入口76与流体出口68流体连接,并且推动或以其它方式致动第二阀按钮86可以使第二流体入口78与流体出口46流体连接。虽然本领域技术人员可以想到其它转换装置,但在图5所示的一种示例性的实施方式中,“Y”通道88可以将第一和第二流体入口76、78流体连接到流体出口68。第一阀按钮84可操作地连接到设置在“Y”通道88的第一臂92中的第一阀90。第二阀按钮86可操作地连接到设置在“Y”通道88的第二臂96中的第二阀94。例如“Y”通道结构可以允许可由使用者选择的流体流动结构,这允许流体出口68在任意给定时间与流体入口76、78中的一个流体连通但不与另一个(或者不与任何一个流体入口76、78)流体连通。美国专利公开文献No.2008/0081948和美国专利申请No.12/047/474(均在上述被提及)中更加具体地描述了各种阀结构。
图6示出了可以用于冲洗和/或抽吸内窥镜20′的远端42′和/或体腔50′的外科装置10′的另一种实施方式。内窥镜20′设置在护套12′的腔14′内。设置在腔14′中的还有保护性镜头100,该保护性镜头可以连接到护套12′,优选为固定地连接到护套12′,但其也可以可拆卸地连接到护套12′。镜头100通过有效地封闭腔的远端14b′近侧的腔14′来封闭护套的远端40′近侧的护套12′。内窥镜20′可以通过使其远端42′靠近镜100设置而插入到护套的近侧部分16′中。在所示实施方式中,腔14′是渐缩的,并且给定设置在其中的内窥镜20′的尺寸,内窥镜20′被阻止接触镜头100,但设置在腔14′中的另一个外科器械可以被构造成接触镜头100的近侧表面104。这样,镜头100的远侧表面102有助于保护内窥镜的远端42′并且与流体通道26′的近侧孔口38′流体连通,使得当近侧孔口38′基于设置在通道26′中的臂44′的位置限定通道26′的远侧开口时,流过近侧孔口38′的流体可以有助于清洁镜头100的远侧表面102。镜头100可以是光学上透明(clear)的且可以是非放大或放大镜。
图7示出了环形护套110的另一种实施方式,该环形护套具有穿过其中延伸的腔112,外科器械(未示出)可以设置在腔112中。护套110也具有形成在护套的管状壁122中的流体通道114,流体可以穿过护套的管状壁122在通道(未示出)的近侧开口和通道114的远侧开口之间流动。远侧开口可以包括近侧孔口116或者远侧孔口118,该近侧孔口116基本上指向腔112的远端124处,在该处外科器械的远端可以设置在腔112中,该远侧孔口118基本上指向超出护套110的远端120。因此,根据设置在通道114中的可延伸的臂(未示出)的位置,近侧孔口116或远侧孔口118可选择地选为通道114的远侧开口。护套通道114和近侧孔口116之间的近侧孔口通道126可以是渐缩的,如图7所示,以有助于当流体沿箭头128所示的远侧方向流动时增大流出近侧孔口116的流体的速率和/或压力,但近侧孔口通道126可以具有任何结构。近侧孔口116具有抵接腔的远端124的部分和与腔的远端124隔开的部分。管状壁122的一部分限定腔112的远端124,使得管状壁122形成可以接触设置在腔112中的外科器械的远侧表面的唇部或支架形式的止动元件并且阻止外科器械穿过护套110的进一步远侧运动。管状壁122可以包括上述的环形歧管,并且止动元件可以是歧管的一部分。因此,腔112和管状壁122被构造成允许设置在腔112中的外科器械的远端接触腔的远端124并且抵接管状壁122的一部分。这样,当流体能够流过近侧孔口116时,流体基本上可以冲洗外科器械的远端或者从外科器械的远端抽吸流体。
图8示出了包括近侧部分132和远侧部分134的环形护套130的另一种实施方式。远侧部分134连接到近侧部分132并且可以相对于护套130的近侧部分132手动地展开和转动,但在其它实施方式中,转动和/或展开可以被机械地和/或电子地致动。在一种示例性的实施方式中,近侧部分132和远侧部分134与可旋转的舌形部136(围绕中心纵向轴线144可旋转)和至少部分环形的槽138装置相连。形成在近侧部分132和远侧部分134的每一个上的至少一个锁定翼片140可以在远侧部分134相对于近侧部分132伸展的过程中彼此抵接,以有助于防止远侧部分134与近侧部分132分离。密封构件135可以连接到近侧部分132和远侧部分134并且设置在护套130的流体通道137中,以有助于在远侧部分134伸展的过程中流体地密封通道137,从而流体可以在近侧部分132和远侧部分134之间流过通道137。在一些实施方式中,设置在护套130的腔146中的外科器械的远端可以是倾斜的以便改善侧向观察,远侧部分可以相应地是倾斜的,并且可旋转部件可以允许倾斜的远侧部分与外科器械的倾斜的远端转动对准。在本实施方式中,在腔146的远端处的止动元件142被示出为远侧部分134的一部分。外科器械的长度可以少量改变(例如1英寸),并且可展开和可回缩的远侧部分134可以允许改变长度的外科器械克服止动元件142完全插入到护套130中。
图9和10示出了包括设置在环形护套156的通道154中的可延伸臂152形式的流体管道的外科装置150的另一种示例性的实施方式。图9示出了处于第一远侧位置的臂152,在该第一远侧位置,臂的远端158设置在通道154中的密封件160的近侧,使得流体可以流过近侧孔口162。图10示出了处于第二近侧位置的臂152,在该第二近侧位置,臂152已经被向远侧推动,从而臂的远端158向远侧穿出密封件160,使得流体可以流过臂的远端158并且超出护套的远端164。无论臂152是处于第一或第二位置,流经臂152的流体的流动可以通过操纵喇叭型阀166来控制。喇叭型阀166可以连接到护套156的近侧部分168,以有助于允许在装置150的至少一部分设置在患者体内时在患者体外操纵喇叭型阀166。如本领域人员可以理解的,喇叭型阀166可以利用被构造成控制流经喇叭型阀的手柄170并因此也流经通道154的流体的流动的按钮168来致动。
图11-15示出了包括多个流体管道,例如多个可延伸的臂的外科装置180的一种示例性的实施方式。提供多个可延伸的臂可以允许装置180向较大的区域提供流体冲洗和/或流体抽吸。如图11和12中所示,环形护套182包括被构造成分别接收可延伸的第一臂186a和可延伸的第二臂186b的第一和第二通道184a、184b。虽然在护套182中示出了两个通道,但护套182可以包括任何数量的通道。护套182还包括穿过其延伸的腔192,外科器械194可以设置在该腔192中。图11示出了处于第一远侧位置的臂186a、186b,其中,流体可以流过第一臂186a和第二臂186b并且分别流过形成在护套远端196的近侧的护套182中的近侧孔口200a、200b。图12示出了处于第二近侧位置的臂186a、186b,在该第二近侧位置,臂186a、186b的远端188a、188b已经刺破各自的密封件190a、190b并且延伸超出护套182的远端196。护套的远端196可以包括形成在其中的第一远侧孔198a和第二远侧孔198b,如图13和14所示,第一臂186a和第二臂186b当处于第二位置时可以分别延伸穿过第一远侧孔198a和第二远侧孔198b或者如果臂186a、186b没有向远侧行进足够远处于第二位置以穿过孔198a、198b,那么流体可以直接流过。孔198a、198b和臂186a、186b在该实施方式中围绕护套的远侧圆周等距离地分隔开,但孔198a、198b和臂186a、186b在护套中可以任意间距相间隔。
第一臂186a和第二臂186b每个可以被构造用于流体冲洗和流体抽吸,或者臂186a、186b可以各自是专用的,使得一个臂可以被构造用于流体冲洗,而另一个臂可以被构造用于流体抽吸。如果臂186a、186b被构造成每个提供流体冲洗和流体抽吸,那么臂186a、186b可以被构造成例如使用单个手柄或控制两个臂186a、186b的其它运动致动器的操纵而同时运动,或者它们可以被构造成单独操纵。如果臂186a、186b被构造成每个提供流体冲洗和流体抽吸,那么臂186a、186b可以流体地连接到相同的流体冲洗源和相同的流体真空源,或者臂186a、186b中的每个可以具有其专用的冲洗源和/或真空源。如果臂186a、186b各自是专用的,那么臂中的一个可以流体连接到流体冲洗源而另一个臂可以流体连接到流体真空源。各自专用的臂186a、186b可以有助于减小用于冲洗的流体包含任何不期望的之前被抽吸的流体的几率,因为任何之前被抽吸的流体并不在用于提供流体冲洗的臂中并且因此不会不期望地混合到冲洗流体中。各自专用的臂186a、186b还可以允许流体清洗期望的区域并且快速吸气来同时流体冲洗和流体抽吸。
图16-21示出了包括连接到环形护套214的流体管道、例如可旋转的环或可调节的帽212的外科装置210的另一种示例性的实施方式。外科装置210类似于上述外科装置,并且在这里讨论的各种实施方式中的类似命名的元件可以被类似地构造。通常,护套214具有近侧部分216和远侧部分218,并且具有穿过其延伸的腔220,该腔220被构造成接收设置在其中的外科器械,例如内窥镜222。护套214还具有穿过其延伸的至少一个通道,该通道形成在护套的管状壁226中并构造成允许流体穿过其流过。在该实施方式中示出了第一通道224a和第二通道224b,但护套214可以具有两个或任何其它数量的通道。通道224a、224b中的每一个的近侧部分可以如上述的穿过连接到护套214的一个或多个管236流体连接到流体冲洗源和流体真空源中的至少一个,使得流体可以向近侧和/或向远侧流过通道224a、224b。
帽212可以设置在护套的远侧部分218处,优选地从护套的远端228向近侧延伸一段距离,并且固定或者可拆卸地连接到护套214。帽的形状基本上符合护套214的形状,但帽212可以具有任何形状并且帽212可以具有任何尺寸。帽212可以被构造成在至少两个位置之间运动,以改变通道224a、224b的远侧开口的位置。当帽212处于第一近侧位置时,如图18和19所示,第一通道224a和第二通道224b的远侧开口包括近侧孔口226,使得流过第一通道224a和第二通道224b的流体可以与近侧孔口226流体连通。虽然在本实施方式中示出了四个近侧孔口226,但护套214可以包括任何数量的近侧孔口。近侧孔口226位于护套的远端228的近侧并且优选地基本上指向腔220,并且更优选地基本上指向设置在腔220中的内窥镜222的远端230的位置。帽212可以在第一近侧位置和图20和21所示的第二远侧位置之间运动。在第二远侧位置,帽212覆盖近侧孔口226,使得近侧孔口226被流体密封,并且允许第一通道224a和第二通道224b的远侧开口包括护套214中的至少一个远侧孔口232,使得流过第一通道224a和第二通道224b的流体不能流过近侧孔口226而是替代地与远侧孔口232流体连通。类似地,当帽212处于第一位置时,帽212覆盖远侧孔口232但不覆盖近侧孔口226。虽然在本实施方式中示出了两个远侧孔口232,但护套214可以包括任何数量的远侧孔口。此外,每个远侧孔口可选地包括多个沿周向间隔开的孔口。第一位置优选地是帽的默认初始位置,但第一位置或第二位置都可以是帽的默认初始位置。
帽212可以多种方式在第一位置和第二位置之间运动。当护套214的至少远侧部分218设置在患者体内时,帽的运动优选地从帽212近侧的位置并且更优选地从患者体外的位置开始。如本实施方式所示,帽212可以基本上围绕帽212的中心纵向轴线234在顺时针方向和/或逆时针方向至少部分地旋转。如本领域技术人员可以理解的,除了帽212能够旋转或替代帽212能够旋转,帽212可以任意一种或多种其它方式,例如通过基本上平行于帽的中心轴线234的线性运动而在多处位置之间运动。如本领域技术人员可以理解的,帽的旋转可以通过手动、电动或以其它方式实现。使帽212沿着一个方向、例如顺时针方向旋转可以使近侧孔口226暴露于通道224a、224b以在其间形成流体连通,并且可以覆盖远侧孔口232以阻止远侧孔口232和通道224a、224b之间的流体连通,而使帽212沿相反的方向例如逆时针方向旋转可以使远侧孔口232暴露于通道224a、224b并且覆盖近侧孔口226。优选地,使帽212沿特定的方向尽可能远地旋转完全地暴露期望的孔口并且完全覆盖其它的不期望的孔口,使得当由于帽沿那个方向的旋转运动停止而造成帽212处于期望位置时能够更容易地暴露通道224a、224b的期望的远侧开口。替代地,帽212可以沿顺时针方向和逆时针方向中的一个或两个旋转并且具有至少两个在旋转运动范围内的锁定位置。至少一个锁定位置可以对应于第一远侧位置,并且至少一个锁定位置可以对应于第二近侧位置。形成在护套214上或其中的一个或多个止动元件,例如槽、翼片、对应的凸起和凹陷等可以被构造成与帽212接合,使得帽212可以在其旋转过程中“捕获”止动元件,以有助于将帽212暂时锁定在第一和第二位置中的一处并且使得帽212可以从止动元件释放以运动到另外的位置。但是,帽212可以在多个位置之间运动,使帽212运动以选择性地暴露和覆盖护套的远侧部分218中的孔口,这可以有助于在一个或多个孔口附近形成洗刷效果,因为帽212的固体表面在孔口上方的运动可以有助于擦洗或清除在之前的穿过孔口的流体冲洗和/或抽吸过程中在孔口处堆积的流体。
图22-26示出了具有可调节的帽252形式的流体管道的外科装置250的另一种示例性的实施方式,帽252可以选择性地暴露和覆盖四个近侧孔口254和四个远侧孔口256。在图22和23中帽252被示出为处于第一近侧位置,在该处流体可以流过通道258,通道258在近侧孔口254处具有其远侧开口。在本实施方式中通道258被示出为形成在装置的环形护套260中的单个通道,使得帽252用作允许流体流过形成在帽252中的多个远侧开口的歧管。帽252可以被构造成例如沿着图24中的方向箭头所示的顺时针方向旋转,以通过利用运动到图24和25中所示的第二远侧位置的帽252覆盖近侧孔口254并暴露远侧孔口256来重新引导流体流过通道258。当帽252在第一位置和第二位置之间运动时,近侧孔口254和远侧孔口256都可以至少部分地暴露,如图24所示。在第一位置和第二位置之间的中间位置中,帽252可以被构造成允许流体流过通道258和两个远侧开口254、256,以允许流体在护套的远侧部分262处和护套的远侧部分262之外进行多向流动。但是,优选地,近侧孔口254和远侧孔口256以及可以暴露近侧孔口254和远侧孔口256的帽252中的相应的开口在其间具有足够的空间,以阻止近侧孔口254在远侧孔口256被暴露时被暴露,反之亦然。
此处公开的装置还可被设计为在使用一次后被处置,或者其可被设计为多次使用。然而,无论哪种情况,装置可在至少一次使用后被修复用于重新使用。修复可包括拆解装置,紧跟的特殊部分的清理或替换以及重新组装这些步骤的任意组合。尤其是,装置可以是可拆解的,并且装置的任何数量的特殊部分或部件可选择地以任何组合的方式被替换或移除。一旦清理和/或替换特殊部件,装置可在修复设备上或者在即将进行手术程序之前通过外科手术团队重新组装以便以后使用。本领域技术人员应理解为,装置的修复可利用用于拆解、清理/替换、以及重装的各种技术。这种技术的使用以及产生的修复的装置都是在本发明应用的范围内。
本领域技术人员基于上述的实施方式可以理解本发明的其它特征以及优势。因此,本发明除了受后附的权利要求书指明的内容限制之外,并不受特别地显示以及介绍的内容的限制。本文中引用的所有公开文献及参考文献在此明确地通过全文引用结合入本文。
Claims (10)
1.一种外科装置,包括:
环形护套,其能够设置在体腔内并且在其腔中容纳外科器械,所述护套还具有能够允许流体穿过其流动的通道,所述通道具有近侧开口和远侧开口;以及
流体管道,其至少部分位于所述护套的远侧部分中并且能够当所述护套设置在体腔内时能够在至少两个位置之间运动以改变所述通道的所述远侧开口的位置。
2.根据权利要求1所述的装置,其中,所述远侧开口的第一位置处于所述护套的远端,所述远侧开口的第二位置处于所述护套的所述远端的近侧。
3.根据权利要求1所述的装置,其中,所述流体管道能够处于第一位置和第二位置,在所述第一位置,其有效地引导流体基本上朝着所述腔流过所述通道,在所述第二位置,其引导流体远离所述腔并且基本上朝着手术区域流过所述通道。
4.根据权利要求1所述的装置,其中,所述流体管道能够选择性地允许通过所述通道进行流体冲洗和通过所述通道进行流体抽吸。
5.根据权利要求1所述的装置,其中,所述外科器械包括观测装置,所述观测装置具有位于观测装置的远端处的观察元件。
6.根据权利要求1所述的装置,其中,所述流体管道在至少一个位置允许引导流体沿着与所述通道的纵向轴线基本上对准的方向流过所述通道。
7.根据权利要求1所述的装置,其中,所述流体管道包括可轴向调节的臂。
8.根据权利要求7所述的装置,其中,所述臂能够在第一位置和第二位置之间运动,在所述第一位置,所述臂的远端位于所述护套的远端的近侧,在所述第二位置,所述臂的远端位于所述护套的远端的远侧。
9.根据权利要求7所述的装置,还包括设置在所述护套的远端处的自密封元件,所述臂能够在处于所述自密封元件近侧的位置和处于自密封元件远侧的位置之间运动。
10.根据权利要求7所述的装置,还包括连接到所述臂的近侧部分的致动器,对所述致动器的操纵能够有效地使所述臂在至少两个位置之间运动。
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Also Published As
Publication number | Publication date |
---|---|
US20100010310A1 (en) | 2010-01-14 |
JP2010017559A (ja) | 2010-01-28 |
JP5399149B2 (ja) | 2014-01-29 |
CA2671694C (en) | 2018-01-02 |
EP2145578A1 (en) | 2010-01-20 |
US8915842B2 (en) | 2014-12-23 |
EP2145578B1 (en) | 2012-05-02 |
CA2671694A1 (en) | 2010-01-14 |
CN101627894B (zh) | 2013-08-07 |
ATE555713T1 (de) | 2012-05-15 |
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