CN101658437A - 手术施夹器以及组装方法 - Google Patents
手术施夹器以及组装方法 Download PDFInfo
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/128—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/08—Wound clamps or clips, i.e. not or only partly penetrating the tissue ; Devices for bringing together the edges of a wound
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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
- A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
- A61B17/105—Wound clamp magazines
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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
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
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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
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/122—Clamps or clips, e.g. for the umbilical cord
- A61B17/1222—Packages or dispensers therefor
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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
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/128—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
- A61B17/1285—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips for minimally invasive surgery
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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
- A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
- A61B2017/00407—Ratchet means
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- A—HUMAN NECESSITIES
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- 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
- A61B90/03—Automatic limiting or abutting means, e.g. for safety
- A61B2090/038—Automatic limiting or abutting means, e.g. for safety during shipment
Abstract
本发明提供一种手术施夹器,其包括:从壳体向远侧延伸的通道组件;布置在所述通道组件中并且限定其中的通道和多个窗口的夹子载体;可滑动地布置在所述夹子载体的所述通道中的多个夹子;可往复运动地布置在所述通道组件中的楔形板,所述楔形板可操作地连接到所述手柄并且包括沿其长度形成的多个孔;以及可滑动地布置在所述夹子载体的所述通道中并且布置在所述多个夹子的近侧的夹子输出器,所述夹子输出器被构造为和适于选择性接合所述夹子载体的所述窗口和所述楔形板的所述孔。夹子输出器被构造为合适于当所述楔形板往复运动时在相对于所述夹子载体的远侧方向上推动所述多个夹子。
Description
相关申请的交叉引用
[0001]本申请要求于2008年8月25日提交的序列号为61/091,467的美国临时申请的优先权利益,其全部内容通过引用合并于此。
技术领域
[0002]本申请涉及手术器械以及它们的组装方法,并且尤其涉及具有多个夹子以在手术操作期间将夹子施加到体组织和脉管上的手术施夹器以及它们的组装方法。
背景技术
[0003]手术施夹器在本领域中是公知的并且通过提供对体组织和脉管的传统缝合的选择方法已经在外科医生之间更加流行。在格林(Green)等人的专利号为5,030,226的美国专利和伯班克三世(Burbank III)等人的专利号为5,431,668的美国专利中公开了典型的器械。这些器械通常设置多个夹子,这些夹子存储在器械中并且在器械的近端处打开和闭合手柄时,这些夹子相继地进给到在器械的远端处的钳口机构中。随着手柄闭合,钳口闭合以使定位在钳口构件之间的夹子变形,并且随着钳口打开以松开变形的夹子,新的夹子从序列中进给到钳口之间的位置。重复此过程直到在夹子序列中的所有夹子已经得到了应用。
[0004]典型地,可以使用相对小、相对中等到相对大的范围内的不同尺寸和/或比例的手术施夹器。通常地,每个特殊尺寸的手术施夹器包括不同的部件。同样地,组装不同尺寸的手术施夹器的方法从一种尺寸到另一种尺寸也有所不同。
[0005]因此,必须要教会技术人员不同的程序和操作以组装不同尺寸的手术施夹器。因此,当技术人员错误地将一种尺寸的手术施夹器的组装操作用于另一种尺寸的手术施夹器的组装操作时,在组装不同尺寸的手术施夹器中发生错误的程度可能提高。
[0006]因此,需要存在一族不同尺寸的用于施加手术夹子的器械,所述器械从一种尺寸到另一种尺寸以相同的方式组装。
[0007]同样,为了提高生产效率,需要存在组装每个不同尺寸的器械的统一的方法。
发明内容
[0008]本申请涉及具有多个夹子并且用于在手术操作期间将夹子施加到体组织和脉管上的手术施夹器以及它们的组装方法。
[0009]根据本公开的方案,设置了一种手术施夹器,所述手术施夹器包括:壳体;至少一个手柄,其可枢转地连接到所述壳体;通道组件,其从所述壳体延伸出;夹子载体(clip carrier),其设置在所述通道组件中并限定其中的通道和多个窗口;多个夹子,其可滑动地设置在所述夹子载体的所述通道中;楔形板,其可往复运动地设置在所述通道组件中,所述楔形板可操作地连接到所述手柄上并包括沿其长度形成的多个孔;以及夹子输出器(clipfollower),其可滑动地设置在所述夹子载体的所述通道中并位于所述多个夹子的近侧位置处,所述夹子输出器被构造并适于选择性地接合所述夹子载体的所述窗口和所述楔形板的所述孔。夹子输出器被构造并适于当所述楔形板往复运动时相对于所述夹子载体向远侧推动所述多个夹子。
[0010]夹子输出器可以被构造为接合楔形板并在楔形板向远侧平移时向远侧运动,并且可以被构造为接合夹子载体并在楔形板向近侧平移时停止其向近侧运动。
[0011]施夹器可以进一步包括钳口组件,所述钳口组件包括从所述通道组件的与所述壳体相反的一端延伸出的一对钳口。钳口组件可适于容纳夹子于其中并且可操作以响应于所述手柄的运动实现夹子的形成。
[0012]施夹器可以进一步包括可往复运动地定位在所述壳体和所述通道组件的至少一个中的夹子推杆(clip pusher bar)。推杆可以具有可操作地连接到所述至少一个手柄的第一端和限定推动器(pusher)的第二端。推杆可以随着所述至少一个手柄在第一方向上运动初始量而朝所述钳口运动以便移动所述钳口之间的最远侧夹子。推杆可以被构造并适于随着所述至少一个手柄在所述第一方向上运动额外量而朝所述壳体运动以便移动在所述多个夹子中的最远侧夹子之后的所述推动器。
[0013]施夹器可以进一步包括运动放大系统(motion multiplier system),所述运动放大系统被构造为在手柄最初致动时使推杆向远侧运动增加量,并被构造为紧接在手柄的最初致动之后,向近侧移动推杆和楔形板。
[0014]施夹器还可以进一步包括可平移地且可滑动地设置在所述壳体和所述通道组件的至少一个中的驱动通道。驱动通道可以具有,可操作地连接到所述手柄中的至少一个的第一端和被构造并定尺寸为选择性地接合所述一对钳口以实现所述一对钳口的闭合的第二端。驱动通道可以随着所述手柄在第一方向上被致动而朝所述钳口组件运动以便对着所述钳口移动其所述第二端来闭合所述钳口。驱动通道随着所述手柄在第二方向上运动而远离所述钳口以使其所述第二端远离所述钳口而允许所述钳口打开。
[0015]施夹器可以进一步包括可操作地连接到所述楔形板和所述驱动通道的枢转臂。在所述驱动通道的远侧运动期间,所述枢转臂的转动可以导致所述楔形板的近侧运动。
[0016]施夹器可以进一步包括运动放大系统,运动放大系统包括:钟形曲柄齿轮(bell crank gear),其可枢转地支撑在壳体中并且可枢转地连接到推杆;加速齿条(accelarator rack),其可滑动地支撑在壳体中并且可操作地连接到钟形曲柄齿轮;以及偏置构件,其使得驱动通道和加速齿条互相连接。驱动通道的远侧平移可以经由偏置构件引起加速齿条的远侧平移。加速齿条的远侧平移可以引起钟形曲柄齿轮的第一转动和推杆的远侧平移。
[0017]钟形曲柄齿轮可以包括从其沿径向地延伸出的臂和在臂中形成的细长狭槽,其中细长狭槽可滑动地容纳与推杆可操作地相关的凸台(boss)。
[0018]施夹器可以进一步包括运动反向机构(motion reversingmechanism),运动反向机构可操作地连接到所述驱动通道和所述楔形板并且可以与所述推杆选择性地接合。在所述驱动通道的所述远侧平移期间,所述运动反向机构的转动可以导致所述楔形板和所述推杆的近侧运动。
[0019]施夹器可以进一步包括棘轮机构,所述棘轮机构包括:齿条,其具有多个棘齿并且与所述驱动通道关联;以及棘轮爪,其具有至少一个齿并且被布置在选择性地接合所述齿条的位置处。棘轮爪可以被偏置到与所述齿条接合。随着所述驱动通道纵向地往复运动,所述多个齿可以越过所述棘轮爪。棘轮爪可以防止所述驱动通道在所述至少一个手柄完全致动之前非故意的返回。
[0020]施夹器可以进一步包括设置在所述通道组件的远端中的闭锁器(lockout)。闭锁器在最后的夹子从所述施夹器排出时可以由所述夹子输出器致动。闭锁器可以由所述夹子输出器推动以延伸越过所述驱动通道的路径,从而防止所述驱动通道向远侧运动。
[0021]施夹器可以进一步包括支撑在所述壳体和所述通道组件的至少一个中的计数机构。计数机构可以被构造并适于显示所述手柄每次致动时在所述施夹器中的变化。
[0022]驱动通道可以被构造并定尺寸为至少部分地环绕所述钳口和所述楔形板。驱动通道可以包括贯穿其远端用于将所述钳口和所述楔形板保持在所述驱动通道中的带箍(strap)。
[0023]根据本公开的又一方案,设置了手术施夹器,所述手术施夹器包括:壳体;至少一个手柄,其可枢转地连接到壳体的相反侧;通道组件,其固定到壳体并从壳体延伸出;一对钳口,其支撑在通道组件的远端上并从通道组件的远端延伸出;夹子载体,其设置在所述通道组件中并限定通道;多个夹子,其可滑动地设置在所述夹子载体的所述通道中;夹子输出器,其在所述多个夹子的近侧位置处可滑动地设置在所述夹子载体的所述通道中;驱动通道,其可平移地设置在所述壳体和所述通道组件的至少一个中,所述驱动通道具有第一端和第二端,所述第一端可操作地连接到所述手柄中的至少一个上,所述第二端被构造并定尺寸为选择性地接合所述一对钳口以实现钳口的闭合;推杆,其可平移地设置在所述壳体和所述通道组件的至少一个中,所述推杆经由运动放大系统连接到所述驱动通道上,所述推杆的远端被构造为接合多个夹子中的最远侧夹子;楔形板,其可往复运动地布置在所述壳体和所述通道组件的至少一个中,其中所述楔形板的远端选择性地插入在所述一对钳口之间;以及运动反向机构,其包括连接到所述驱动通道的第一端和连接到所述楔形板并可由所述推杆接合的第二端。在使用中,所述驱动通道的远侧平移经由所述运动放大系统使得所述推杆向远侧平移;并且所述驱动通道的远侧平移经由所述运动反向机构使得所述推杆和所述楔形板在停歇期(dwell period)之后向近侧平移。
[0024]楔形板可以限定沿其长度形成的多个孔。夹子载体可以限定沿其长度形成的多个窗口(window)。夹子输出器可以被构造并适于选择性地接合所述夹子载体的所述窗口和所述楔形板的所述孔。夹子输出器可以被构造并适于在所述楔形板远侧推进时相对于所述夹子载体向远侧增量地推动所述多个夹子。
[0025]施夹器可以进一步包括指示器,所述指示器被构造为在满足将夹子装载到所述一对钳口中和由所述一对钳口形成夹子中的至少一个时,产生听觉指示和触觉指示中的至少一个。
[0026]运动放大系统可以包括具有一组齿的加速齿条,并且钟形曲柄齿轮可以包括与加速齿条的齿接合的一组齿。加速齿条的轴向平移可以导致钟形曲柄齿轮的转动和推杆的轴向平移。
[0027]加速齿条可以经由偏置构件连接到驱动通道。
[0028]根据本公开的另一个方案,提供了一种可操作地输送至少相对较小、中等和较大的手术夹子的手术施夹机构,所述手术施夹机构被设置并包括:驱动通道,其能够可平移地运动;一对钳口,其可通过驱动通道的远端接合,其中一对钳口在驱动通道向远侧平移时靠近;楔形板,其能够相对于驱动通道往复平移,其中楔形板的远端选择性地定位在一对钳口之间,楔形板限定沿其长度形成的多个孔;夹子载体,其相对于驱动通道而固定地定位,夹子载体限定通道和沿其长度形成的多个窗口;多个夹子,其可滑动地设置在所述夹子载体的所述通道中;夹子输出器,其在所述多个夹子的近侧位置处可滑动地设置在所述夹子载体的所述通道中;推杆,其能够相对于驱动通道往复平移,其中推杆的远端被构造为接合多个夹子中的最远侧夹子;运动放大系统,其包括钟形曲柄齿轮和加速齿条,加速齿条经由偏置构件连接到驱动通道,钟形曲柄齿轮经由互补轮齿连接到加速齿条,并且钟形曲柄齿轮连接到推杆,其中驱动通道的远侧平移引起加速齿条向远侧平移,引起钟形曲柄齿轮转动,引起推杆向远侧平移;以及枢转臂,其包括连接到驱动通道的第一端和连接到楔形板并可由推杆接合的第二端。在使用中,驱动通道的远侧平移引起枢转臂的第一端向远侧平移,引起枢转臂的第二端在近侧方向上平移,从而引起楔形板在近侧方向上平移;并且推杆的远侧平移在推杆与枢转臂的第二端接触时停止。
[0029]枢转臂的第二端在近侧方向上的进一步平移可以使得推杆在近侧方向上平移。枢转臂通过驱动通道的致动可能在停歇期之后发生。
附图说明
[0030]当结合附图考虑时,从下面的详细描述中将更加全面的认识并更容易理解本公开的施夹器,其中:
[0031]图1为根据本公开的实施例的手术施夹器的立体图;
[0032]图1A为图1所示的手术施夹器的后视立体图,显示了运送楔(shipping wedge)在适当的位置的情况;
[0033]图1B为沿图1A的1B-1B所截取的截面图;
[0034]图1C为沿图1A的1C-1C所截取的截面图;
[0035]图2为图1的手术施夹器的顶视平面图;
[0036]图3为图1和图2的手术施夹器的侧视正视图;
[0037]图4为图1-3的手术施夹器的分解立体图;
[0038]图4A为图1-4的手术施夹器的钟形曲柄齿轮和加速齿条组件的分解立体图;
[0039]图4B为图1-4的手术施夹器的加速齿条的立体图;
[0040]图4C为图1-4的手术施夹器的钟形曲柄齿轮的立体图;
[0041]图4D为图1-4的手术施夹器的枢转臂的顶视立体图;
[0042]图4E为图4D的枢转臂的底视立体图;
[0043]图4F为图1-4的手术施夹器的夹子输出器的顶视立体图;
[0044]图4G为图1-4的手术施夹器的听觉/触觉指示器的立体图;
[0045]图4H为图1-4的手术施夹器的齿条构件(rack member)的立体图;
[0046]图5为图1-4的手术施夹器的纵向截面图,图示了在未致动情况下的手术施夹器;
[0047]图6为图5的细节表示区域的放大视图;
[0048]图7为图5的细节表示区域的放大视图;
[0049]图8为图5的细节表示区域的放大视图;
[0050]图9为沿图8的9-9所截取的图1-4的手术施夹器的截面图;
[0051]图10为图1-4的手术施夹器的立体图,图示了上半壳体从其中移走的情况;
[0052]图11为如图10所示的图1-4的手术施夹器的放大视图;
[0053]图12为图1-4的手术施夹器的通道组件的远端在盖子从其中移走的情况下的顶视立体图;
[0054]图13为图1-4的手术施夹器的顶视立体图,图示了上半壳体和推杆从其中移走的情况;
[0055]图14为图12的通道组件的远端在盖子和推杆从其中移走的情况下的顶视立体图;
[0056]图15为图12的通道组件的远端在盖子、推杆和夹子载体从其中移走的情况下的顶视立体图;
[0057]图16为图12的通道组件的远端在盖子、推杆、夹子载体、手术夹子和夹子输出器从其中移走的情况下的顶视立体图;
[0058]图17为图16的细节表示区域的放大视图;
[0059]图18为图1-4的手术施夹器的顶视立体图,图示了在上半壳体、推杆和楔形板从其中移走的情况;
[0060]图19为图12的通道组件的远端在盖子、推杆、夹子载体、手术夹子、夹子输出器和楔形板从其中移走的情况下的顶视立体图,;
[0061]图20为图1-4的手术施夹器的顶视立体图,图示了在上半壳体、推杆、楔形板和驱动通道从其中移走的情况;
[0062]图21为图1-4的手术施夹器的底视立体图,图示了下半壳体、驱动通道和楔形板从其中移走的情况;
[0063]图22为图1-4的手术施夹器在上半壳体从其中移走并在未致动的情况下所示的顶视平面图;
[0064]图23为图22的细节表示区域的放大视图;
[0065]图24为图22的细节表示区域的放大视图;
[0066]图25为图1-4的手术施夹器在上半壳体从其中移走并在其最初致动期间所示的顶视平面图;
[0067]图26为图25的细节表示区域的放大视图;
[0068]图27为图27的细节表示区域的放大视图;
[0069]图28为在手术施夹器最初致动期间的通道组件的远端的放大纵向截面图;
[0070]图29为沿图27的29-29所截取的截面图;
[0071]图30为在手术施夹器的进一步最初致动期间的通道组件的远端的放大纵向截面图;
[0072]图31为图示了图1-4的手术施夹器的棘轮组件和加速齿条的操作的放大视图;
[0073]图32和图33为放大视图,图示了在图1-4的手术施夹器的相应的最初和进一步致动期间听觉/触觉指示器的操作;
[0074]图34为图1-4的手术施夹器在上半壳体从其中移走并在手术施夹器的最后致动期间所示的顶视平面图;
[0075]图35为图34的细节表示区域的放大视图;
[0076]图36为放大截面图,图示了图1-4的手术施夹器的计数机构的致动;
[0077]图37为在图1-4的手术施夹器的最后致动期间所示的棘轮机构的放大视图;
[0078]图38为通道组件的放大截面图,图示了在图1-4的手术施夹器的最后致动期间的夹子输出器;
[0079]图39和图40为放大立体图,图示了图1-4的手术施夹器的最后致动期间的通道组件的远端;
[0080]图41为图1-4的手术施夹器在上半壳体从其中移走并在手术施夹器致动之后的最后情况下所示的顶视平面图;
[0081]图42为图41的细节表示区域的放大视图;
[0082]图43为图示了在图1-4的手术施夹器的致动之后听觉/触觉指示器的位置的放大视图;
[0083]图44为钳口组件的顶视平面图,图示了图1-4的手术施夹器致动之后钳口组件的位置;
[0084]图45为体脉管的立体图,包括所示的施加到其上的手术施夹器的夹子;
[0085]图46为图34和图41的细节的表示区域的放大视图,图示了手术施夹器在完成其致动之后的打开或松开期间枢转臂的操作;
[0086]图47为在图1-4的手术施夹器的打开或松开期间所示的棘轮机构的放大视图;
[0087]图48为图示了在图1-4的手术施夹器的打开或松开期间听觉/触觉指示器的操作的放大视图;
[0088]图49和图50为通道组件的纵向截面视图,图示了图1-4的手术施夹器的打开或松开期间夹子输出器的运动;
[0089]图51和图52为通道组件的远端的纵向截面图,图示了在图1-4的手术施夹器的打开或松开期间推杆和楔形板的运动;
[0090]图53为通道组件的远端的纵向截面图,图示了最后的手术夹子从其中发射之后在闭锁情况下的图1-4的手术施夹器;
[0091]图54为驱动通道的立体图,包括根据本公开的可选实施例的整体式齿条;
[0092]图55-57为包括图54的驱动通道的手术施夹器的棘轮机构的操作的放大示意图;
[0093]图58为根据本公开的又一实施例的手术施夹器的分解立体图;
[0094]图59为图58的手术施夹器的听觉/触觉指示器的立体图;
[0095]图60为图58的手术施夹器的加速齿条的立体图;
[0096]图61为图58的手术施夹器的枢转臂的立体图;
[0097]图62为图58的手术施夹器的第一臂连杆的立体图;
[0098]图63为图58的手术施夹器的第二臂连杆的立体图;
[0099]图64-66为在手术施夹器的手柄完全挤压期间,图58的手术施夹器的听觉/触觉指示器和加速齿条的相继操作的立体图;
[00100]图67-69为在手术施夹器的手柄完全挤压期间,图58的手术施夹器的枢转臂和臂连杆的相继操作的立体图;
[00101]图70为根据本公开的又一实施例的手术施夹器的分解立体图;
[00102]图71为图70的手术施夹器的齿轮构件的放大立体图;
[00103]图72为图70的手术施夹器的驱动通道齿条的放大立体图;
[00104]图73为图70的手术施夹器的推动器齿条的放大立体图;
[00105]图74为图70的手术施夹器的推杆的近端的放大立体图;
[00106]图75为在壳体的半部分从其中移走并在最初未挤压情况下所示的图70的手术施夹器的手柄组件的立体图;
[00107]图76为在推杆也从其中移走的情况下所示的图75的手柄组件的立体图;
[00108]图77为图76的手柄组件的平面图;
[00109]图78为在扳机的最初挤压期间所示的如图75图示的手柄组件的立体图;
[00110]图79为图78的手柄组件的平面图;
[00111]图80为在壳体的半部分从其中移走并在进一步挤压扳机期间所示的图70的手术施夹器的手柄组件的立体图;
[00112]图81为在推杆也从其中移走的情况下所示的图80的手柄组件的立体图;
[00113]图82为图81的手柄组件的平面图;
[00114]图83为在壳体的半部分从其中移走并仍进一步挤压扳机期间所示的图70的手术施夹器的手柄组件的立体图;
[00115]图84为图83的手柄组件的平面图;
[00116]图85为在壳体的半部分从其中移走并仍在扳机最后挤压期间所示的图70的手术施夹器的手柄组件的立体图;
[00117]图86为图85的手柄组件的平面图;以及
[00118]图87-110图示了组装图1-57的手术施夹器的方法。
具体实施方式
[00119]现在将结合附图详细描述依照本公开的手术施夹器的实施例,其中相似的附图标记表示相似或相同的结构元件。如附图所示和整个下列的描述所述,依照惯例,当提到手术器械上的相对定位时,术语“近侧”表示装置的更靠近用户的端部,而术语“远侧”表示装置的更远离用户的端部。
[00120]现在结合图1-5,依照本公开的实施例的手术施夹器通常标示为100。手术施夹器100通常包括手柄组件102,手柄组件102包括壳体104,壳体104具有上半壳体104a和下半壳体104b。手柄组件102进一步包括可枢转地紧固到壳体104上并从其向外延伸的一对手柄106。通道组件108固定地紧固到壳体104上并从其向外延伸,在钳口组件110中终止。
[00121]见图1-4,施夹器100的半壳体104a和104b通过彼此卡合固定接合而固定在一起。壳体104限定形成在下半壳体104b中以支撑并显示计数机构的窗口104c,正如在下面将更详细地描述。壳体104由合适的塑料材料形成。
[00122]见图4,手柄106由手柄枢转柱(handle pivot post)104d紧固到壳体104上,手柄枢转柱104d从下半壳体104b延伸出并进入到在手柄106中形成的各个孔106a中。手柄组件102包括连杆构件122,连杆构件122在形成在各个手柄106中的枢转点106b处可枢转地连接到每个手柄106上。每个连杆构件122的远端122a经由驱动销124可枢转地连接到形成在驱动通道140中的枢转点140a上。驱动销124的每个端部可滑动地容纳在细长通道104e中,细长通道104e形成在各个上半壳体104a和下半壳体104b中。在使用中,如在下面将更加详细地描述的,随着手柄106被挤压,连杆构件122经由驱动销124向远侧推动驱动通道140。
[00123]通道组件108包括通道或筒形盖(cartridge cover)130以及外或下通道132,通道或筒形盖130以及外或下通道132中的每个具有保持在壳体组件102中的近端并位于上半壳体104a和下半壳体104b之间。筒形盖130包括至少一个保持元件(retention element)130a,保持元件130a被构造并适于以卡合固定接合方式选择性地接合设置在外通道132上的互补或对应保持元件132a。
[00124]见图4和图6-12,施夹器100包括可滑动地设置在筒形盖130以下的夹子推杆160。推杆160包括限定推动器160c的远端160a,推动器160c被构造并适于选择性地接合/运动存储在手术施夹器100中的最远侧夹子“C1”。推杆160进一步包括近端160b,近端160b限定其中的近侧窗口160d以可滑动地容纳驱动销124于其中。推杆160进一步限定其中的远侧窗口160e以与稳定器162操作地接合,正如在下面将更详细地描述的。推杆160还包括从其侧边缘凸出并位于相对靠近近侧窗口160d的近侧的翼片(fin)160f。
[00125]施夹器100进一步包括被构造为叠加在推杆160上并接合推杆160的稳定器162。稳定器162包括构造为接合推杆160的远侧窗口160e的远侧凸起162a;在与形成在推杆160中的近侧窗口160d基本上叠加并对齐的位置处限定其中的细长窗口162b。稳定器162进一步包括在细长窗口162b的近侧位置处从稳定器162的底面延伸出的凸节(nub)162c,凸节162c被构造并定尺寸为容纳在形成在推杆160中的最近侧孔160g中。见图4和图6,稳定器162进一步包括在近侧和远侧位置处从其顶表面延伸出的一对凸起162e,凸起162e被构造并定尺寸为容纳在形成在上半壳体104a中的相应的通道中。
[00126]见图4和图4A-4C,施夹器100进一步包括运动放大系统,运动放大系统具有可枢转地支撑在壳体104中的钟形曲柄齿轮154和可滑动地支撑在壳体104中的加速器壳体156。钟形曲柄齿轮154包括构造为可枢转连接到壳体104上的枢销154a、支撑在枢销154a上的盘状体154b、从盘状体154b径向地延伸出的臂154c和支撑在枢销154a上或与之整体地形成并邻近盘状体154b定位的正齿轮154d。钟形曲柄齿轮154限定形成在盘状体154b的侧边缘中的制动器或凹槽154e(见图24)和形成在臂154c中的纵向定向的狭槽154f。钟形曲柄齿轮154的正齿轮154d限定形成在其侧边缘中的多个轮齿154g并可以是正如图4C最佳示出的扇形齿轮。
[00127]钟形曲柄齿轮154为用于每个较小,中等和大比例施夹器100的通用部分。形成在钟形曲柄齿轮154的盘状体154b的侧边缘中的凹槽154e设置用于组装较大比例的施夹器。较大比例的施夹器需要较大推动器行程并因此需要钟形曲柄齿轮154转动较大的度数。由于钟形曲柄齿轮154较大的转动,盘状体154b将接触从加速齿条156延伸出的凸起156e(见图4A和图4B)。在组装期间,钟形曲柄齿轮154转动直到凹槽154e接触加速齿条156的凸起156e。
[00128]继续参考图4和图4A-4C,运动放大系统的加速齿条156包括基壁(base wall)156a,基壁156a限定形成其中的、细长的、纵向延伸的狭槽156b,用于可滑动地容纳钟形曲柄齿轮154的枢销154a。加速齿条156包括在相反方向上从基壁156a的侧边缘凸出的侧壁156c和形成在侧壁156c中并与基壁156a的狭槽156b对齐或对准的齿条156d。齿条156d被构造为与钟形曲柄齿轮154的正齿轮154d的轮齿154g接合。
[00129]施夹器100进一步包括使加速齿条156和驱动通道140互相连接的偏置构件158。
[00130]见图6,钟形曲柄齿轮154的臂154c的狭槽154f被构造并定尺寸为可滑动和可转动地容纳稳定器162的凸节162d于其中。在使用中,随着驱动通道140向远侧平移,使驱动通道140和加速齿条156互相连接的偏置构件158相继地向远侧运动加速齿条156。随着加速齿条156向远侧运动,由于稳定器162的凸节162d在钟形曲柄齿轮154的臂154c的狭槽154f中行进,加速齿条156引起钟形曲柄齿轮154转动并推动稳定器162,并依次向远侧推动推杆160。
[00131]施夹器100进一步包括设置在通道组件108中并在推杆160之下的夹子载体170。夹子载体170通常为盒状结构,其具有上壁170a、一对侧壁170b和限定通过其中的通道170d的下壁170c。夹子载体170包括形成在上壁170a中并沿其长度纵向地延伸的多个间隔开的窗口172。夹子载体170包括形成在下壁170c中并沿其长度纵向地延伸的细长窗口170e(见图9)。
[00132]见图4、图9和图14,一队列手术夹子“C”以与之滑动和/或沿其滑动的方式被装载和/或保持在夹子载体170的通道170d中。通道170d被构造并定尺寸为以尖对尾的方式将一队列或多个手术夹子“C”可滑动地保持在其中。
[00133]见图12和图14,夹子载体170的远端包括一对间隔开的弹性柄脚(tang)171。柄脚171被构造并适于选择性地接合保持在载体170中的手术夹子“C”队列的最远侧手术夹子“C1”的后跨部(backspan)。
[00134]见图4、图4F、图7和图15,施夹器100进一步包括可滑动地设置在夹子载体170的通道170d中的夹子输出器174。如下面将更详细地描述的,夹子输出器174定位在手术夹子“C”队列之后并设置为在施夹器100的致动期间向前推动夹子“C”队列。如下面将更详细地描述的,夹子输出器174通过楔形板180向前和向后的往复运动而致动。
[00135]见图4F和图7,夹子输出器174包括限定了平面的主体部174a、从主体部174a基本向上和向后延伸的远侧凸起175和从主体部174a基本向下和向后延伸的近侧凸起176。远侧凸起175包括在由主体部174a限定的平面之下向下延伸的远侧部分175a和在由主体部174a限定的平面之上向上延伸的近侧部分175b。
[00136]远侧凸起175的近侧部分175b被构造并定尺寸为选择性地接合形成在夹子载体170的上壁170a中的窗口172。在使用中,夹子输出器174的远侧凸起175的近侧部分175b在形成在夹子载体170的上壁170a中窗口172中的接合防止了夹子输出器在近侧方向上行进或运动。
[00137]近侧凸起176被构造并定尺寸为选择性地接合形成在楔形板180中的窗口180b。在使用中,夹子输出器174的近侧凸起176在形成在楔形板180中的窗口180b中的接合允许夹子输出器174在楔形板180的远侧运动时向远侧推进或运动。
[00138]见图4、图7-9、图16和图17,施夹器100进一步包括可滑动地设置在手柄组件102和通道组件108中的楔形板180。楔形板180定位或设置在夹子载体170之下。楔形板180包括以选择性地操作地插入在钳口120之间的基本上锥形的远端180a。楔形板180限定了沿其长度纵向地延伸并形成在其凸起段的多个间隔开的窗口或孔180b、位于孔180b的远侧的远侧窗口或孔180c以及位于孔180c的近侧的最近侧横向定向狭槽180d。
[00139]见图4、图8、图16和图17,施夹器100包括由筒形盖130支撑的远侧闭锁器178。远侧闭锁器178包括尾状物或凸起178a,尾状物或凸起178a基本上向后和向下延伸并被构造和定尺寸为容纳在楔形板180中的远侧窗口或孔180c中。
[00140]见图4、图4D、图4E、图6、图11、图13、图18和图20,施夹器100包括以枢转臂179的形式的楔形板运动反向机构,其可枢转地支撑在壳体104的下半壳体104b上以将驱动通道140的平移传输到楔形板180的反向平移。枢转臂179包括构造为可枢转地连接到壳体104上的枢转凸台179a、设置在枢转臂179的一端上并在与枢转凸台179a相反的方向上延伸的第一杆或指部179b,以及设置在枢转臂179的第二端上并在与枢转凸台179a相反的方向上延伸的第二杆或指部179c。第一杆或指部179b被构造并适于接合楔形板180的最近侧狭槽180d。第二杆或指部179c被构造为接合形成在驱动通道140中的狭槽140g,并连接在限定于驱动通道140中的窗口140g中。狭槽140g包括其轴向地并横向地彼此偏移的纵向延伸远侧部分和纵向延伸近侧部分,以及互相连接远侧和近侧部分的横向部分。
[00141]在使用中,如下面将更详细地描述的,随着驱动通道140向远侧运动,第二杆或指部179c在停歇期之后(即,驱动通道140的狭槽140g的纵向延伸的远侧部分的长度)在远侧方向上运动,转动枢转臂179并从而在第二方向上运动第一杆或指部179b。随着第一杆或指部179b在第二方向上运动,第一杆或指部179b将楔形板180从钳口120之间拉出来,推进同时又向近侧推进或推动推动器160的翼片160f以在近侧方向上运动推动器160,以使得其推杆160c从钳口120之间移出,反之亦然。随着楔形板180在远侧方向上运动,见图17,楔形板180的远端180a对着钳口120的内表面凸转从而保持钳口120彼此间隔开。
[00142]见图4、图6-11、图13、图18和图19,施夹器100包括可往复运动地支撑在手柄组件102的壳体104和通道组件108中并在其间延伸的驱动通道140。驱动通道140的近端支撑在壳体104的上半壳体104a和下半壳体104b之间并且驱动通道140的远端在楔形板180下面位置处支撑在通道组件108的筒形盖130和外通道132之间。
[00143]驱动通道140的远端为基本U形通道,包括一对间隔开的侧壁140b,所述侧壁140b在离开外通道132并朝向筒形盖130的方向上从其后跨部140c延伸出。驱动通道140进一步限定形成在后跨部140c中的驱动销凹部140a以枢转地容纳通过其中的驱动销124。驱动通道140进一步限定在驱动销凹部140a的远侧位置处从后跨部140c凸出的肋状物140e。驱动通道140进一步限定在狭槽140e的远侧位置处在后跨部140c中形成的往复限定槽140f。
[00144]见图4、图8、图9、图12、图14-16和图19,施夹器100包括紧固到驱动通道140中的驱动通道带箍(drive channel strap)143。带箍143紧固到驱动通道140的直立部140b上以便横跨其延伸。带箍143在往复限定槽140f的远侧位置处紧固到驱动通道140上。带箍143紧固到驱动通道140上以使得楔形板180在带箍143之下和钳口120之上延伸。
[00145]见图4、图4G、图6、图10和图21,施夹器100进一步包括经由驱动销124连接到驱动通道140上的听觉/触觉指示器148。指示器148包括弹性指部148a和一对凸台148b。在使用中,如下面将更加详细地描述,随着施夹器100被致动和驱动通道140往复运动,指示器148的第一弹性指部148a与设置在施夹器100中的对应互补结构或凸耳(ledge)149互相作用以向用户产生听觉和/或触觉反馈。指示器148的凸台148b在形成于上半壳体104a的通道104e中行进并向指示器148提供支撑以防止指示器148转动。
[00146]见图4、图6、图10、图11、图13、图18和图20,施夹器100进一步包括以拉力弹簧形式的偏置构件146,其可操作地紧固到驱动通道140的近端和壳体104上并位于驱动通道140的近端和壳体104之间,往往是将驱动通道140保持在缩回或最近侧位置。偏置构件146起到在定位在钳口120之间的夹子“C”形成之后缩回或有助于缩回驱动通道140的作用。
[00147]见图4、图4H、图11、图13、图18和图20,驱动通道140的近端包括齿条构件141,其紧固到驱动销124上并且可与驱动通道140一起运动。齿条构件141被构造并适于与支撑在壳体104中的棘轮爪142接合。齿条构件141和棘轮爪142限定棘轮机构144。在使用中,随着驱动通道140被轴向地移动,齿条构件141也移动。齿条构件141限定具有这样的长度的一组齿条齿141a:随着驱动通道140到达最近侧或最远侧位置,当齿条构件141在近侧运动和远侧运动之间变化时,其允许棘轮爪142反向并在齿条构件141上返回。
[00148]在棘轮爪142与齿条构件141基本操作地接合的位置处,棘轮爪142可枢转地由棘轮爪销147连接到下半壳体104b上。棘轮爪142可与齿条构件141接合以限制齿条构件141的纵向运动,并依次限制驱动通道140的纵向运动。棘轮机构144进一步包括爪簧145,其被构造且被定位为将棘轮爪142偏置为操作地与齿条构件141接合。爪簧145用于保持棘轮爪142的齿与齿条构件141的齿141a接合以及使棘轮爪142保持在转动或斜置的位置。
[00149]见图1-4、图8、图10、图12、图14-17和图19,施夹器100包括安装在通道组件108的远端上或在通道组件108的远端处并且可由手柄组件102的手柄106致动的一对钳口120。钳口120由诸如适合的生物顺应性材料形成,例如,不锈钢或钛。
[00150]钳口120经由铆钉122等安装在驱动通道140的远端,铆钉122等贯穿驱动通道140的往复限定槽140f以使得钳口120相对于外通道132和驱动通道140纵向地固定。见图12、图14、图17和图19,钳口120限定通道120a于其间以容纳手术夹子“C1”于其中。
[00151]见图1-4、图6、图11、图13和图20,施夹器100进一步包括支撑在手柄组件102的壳体104中的计数机构190。计数机构190包括显示器192、处理器194以及以电池等形式的能源198。显示器192为液晶显示器,其向外科医生显示施夹器100的一个或多个操作参数。显示的操作参数可以是剩余夹子的量或数目、已经使用的夹子的数目、位置参数、使用的手术时间或操作的其他任意参数。
[00152]计数机构190包括凸片192a,凸片192a由PVC制成并设置在电池或能源198和处理器194的接触件194a之间或处理器194的接触件194a之间以防止电池或能源198在存储期间被放电。见图1A和图1B,为了允许用于从其中容易地移除凸片,凸片192a延伸出施夹器100的壳体104。一旦凸片192a被移除,电池或能源198与处理器194的接触件194a电接触或在处理器194的接触件194a之间电接触。
[00153]计数机构190由形成在驱动通道140中的凸节140e致动。在使用中,见图36,随着驱动通道140向前驱动,其凸节140e接合接触件194a,使得接触件194a完成回路并使得触发处理器194实现功能(例如,将出现在显示器192上的数字减少给定增量或值)。
[00154]见图1A和图1C,施夹器100包括支撑在壳体104上并插入在手柄106之间的运送楔200。运送楔200起到在施夹器100的运送和/或存储期间保持手柄106间隔开或未挤压的作用。运送楔200连接到计数机构190的凸片192a上,从而为了终端用户使用施夹器100,终端用户必须移出运送楔200从而也移出凸片192a来激活计数机构190。
[00155]见图1A和图1C,运送楔200包括以凸边的形式的主体部202,其限定通道204,通道204被构造并定尺寸为容纳壳体104的一部分于其中。运送楔200包括从主体部202的两侧向外延伸并被构造为容纳手柄106于其中的直立部206。运送楔200进一步包括从直立部206的相反侧向内延伸的凸起208。运送楔200的凸起208被构造并定尺寸为当运送楔200适当地紧固到施夹器100上时与手柄106接合。
[00156]结合图22-53,提供了CovidienSURGICLIPTM的施夹器100的操作。在施夹器100的手柄106任意最初挤压之前,见图22-24,驱动销124位于最近侧位置,棘轮爪142位于驱动通道140的齿条140d的远侧,枢转臂179的第二指部179c位于在驱动通道140的窗口140g远侧部分中的最远侧位置处以使得楔形板180位于最远侧位置,并且没有夹子“C”定位在钳口120中。由于驱动销124在最近侧位置,推杆160、稳定器162和驱动通道140也在最近侧位置。
[00157]在驱动通道140和推杆160位于最近侧位置的情况下,加速齿条156位于最近侧位置处,并且指示器148的第二弹性指部148b设置在边缘149的近侧。同样,在施夹器100的手柄106最初挤压之前,在楔形板180位于最远侧位置的情况下,其远端180a插入在钳口120之间。
[00158]同样在最初挤压之前,没有夹子“C”出现在钳口120中。在手柄106的最初挤压期间,夹子“C”首先被装载到钳口120中。见图25-33,在手柄106的最初挤压期间,使得连杆构件122的远端122a相对于壳体104向远侧运动。随着连杆构件122的远端122a向远侧运动,使得驱动销124向远侧运动从而将远侧轴向运动传输到驱动通道140。
[00159]随着驱动通道140向远侧运动,偏置构件158与之向远侧运动。随着偏置构件158向远侧运动,偏置构件158在远侧方向上牵引加速齿条156。随着加速齿条156在远侧方向上被牵引,加速齿条156使得钟形曲柄齿轮154绕枢销154a转动并将远侧轴向运动传输到稳定器162的凸节162d,稳定器162的凸节162d依次将远侧轴向运动传输到推杆160。随着驱动通道140向远侧运动,偏置构件146被拉伸或延伸。
[00160]见图25、图32和图33,在手柄106的最初挤压期间,指示器148连同驱动通道140的远侧运动向远侧运动。在使用中,指示器148起到产生听觉响声和/或触觉振动的作用,从而指示用户手术施夹器100的手柄106已经穿过至少部分行程。特别地,见图32和图33,随着手柄106被致动,听觉/触觉指示器148的第一弹性臂148a在凸耳149上方和/或沿着凸耳149行进,所述凸耳149形成在上半壳体104a和下半壳体104b中的至少一个中并因此弯曲。随着听觉/触觉指示器148的臂148a到达凸耳149的近端,弹性臂148a卡合在凸耳149的近端之上并且与凸耳149的表面149a接触,随着弹性臂148a与凸耳149的表面149a接触,从而产生第一听觉声音和触觉振动。听觉/触觉指示器148的第一指示指示用户夹子“C”已经被适当地装载。
[00161]如图28和图30所示,同样在手柄106的最初挤压期间,随着推杆160在远侧方向上运动,其推动器160c接合最远侧夹子“C1”的后跨部并且开始将最远侧夹子“C1”向远侧运动或推动出夹子载体170并且进入钳口120。随着最远侧夹子“C1”向远侧运动,夹子载体170的柄脚171被偏转或者由凸轮带动地脱离与最远侧夹子“C1”的接合并且返回其未偏转或者未被凸轮带动的状态以抓取夹子“C”队列中随后的夹子。在手柄106的最初挤压期间,推杆160被推进了足以将最远侧夹子“C1”放置在钳口120的通道120a中的量。
[00162]如图27和图31所示,同样在手柄106的最初挤压期间,随着驱动通道140在远侧方向上运动,棘轮机构144的齿条构件141被向远侧运动,引起齿条构件141的齿141a运动到与棘轮爪142的齿接合并且运动越过或者跨过棘轮爪142的齿。当棘轮机构144的齿条构件141运动到与棘轮爪142接合时,驱动通道140不能返回原始位置或者最近侧位置,直到齿条构件141已经离开棘轮爪142。
[00163]在手柄106的最初挤压期间,如图25-33所示,驱动通道140被向远侧运动直到枢转臂179的指部179c由驱动通道140的狭槽140g的横向部分接合(即,停歇)。当狭槽140g的横向部分与枢转臂179的指部179c邻接时(即,在已经停歇完成之后),驱动通道140的进一步远侧运动引起指部179c运动并且转动枢转臂179。枢转臂179的转动引起其指部179b的运动,这依次引起楔形板180在近侧方向上被拉动,从而从钳口120之间撤回其远端180a并且允许钳口120最终闭合或者接近,并且推动推杆160的翼片160f以在近侧方向上推动推杆160,使得其远端推动器构件160c也从钳口120之间运动从而允许钳口120最终闭合或者接近。
[00164]当达到枢转臂179的所需转动时,枢转臂179随着枢转臂179的指部179c行进通过驱动通道140的狭槽140g的近侧部分而停止转动。枢转臂179的指部179c保持在驱动通道140的狭槽140g的近侧部分中直到完成驱动通道140的行程。
[00165]如图38所示,随着楔形板180在近侧方向上运动,楔形板180相对于夹子输出器174向近侧运动从而将其窗口180b相对于夹子输出器174的近侧凸起176向近侧运动。
[00166]如图28和图30所示,在手柄106的最初挤压期间,如上所述,推杆160与驱动通道140一起向远侧运动,直到加速齿条156紧靠壳体104的下壳体104b中的肋状物,这时加速齿条156的远侧推进被停止。阻止了加速齿条156的进一步远侧推进,如图32所示,随着驱动通道140进一步向远侧推进,驱动通道140拉动或者弯曲指示器148的弹性指部148a越过凸耳149的近端。这样,产生向使用者指示手术夹子“C”已经被适当地装载的第一指示(即,听觉的和/或触觉的)。同样,由于阻止了加速齿条156进一步的远侧推进,所以阻止了钟形曲柄154转动从而阻止了推杆160进一步的远侧推进。
[00167]现在参考图34-40,在手柄106的进一步挤压期间,引起连杆构件122的远端122a相对于壳体104进一步向远侧运动。随着连杆构件122的远端122a进一步向远侧运动,引起驱动销124进一步向远侧运动从而将远侧轴向运动传递给驱动通道140。
[00168]如图34-40所示,随着驱动通道140被进一步向远侧运动,通过紧靠形成在壳体104的下壳体104b中的肋状物的加速齿条156来防止推杆160的进一步远侧推进。由于加速齿条156的远侧推进被停止,钟形曲柄齿轮154的进一步转动被停止,这依次使稳定器160的远侧推进停止,并且依次使推杆160的远侧推进停止。
[00169]另外,如图44所示,由于楔形板180的远端180a从钳口120之间移出,随着驱动通道140被进一步向远侧运动,驱动通道140和/或驱动通道带箍143的远侧边缘接合钳口120的凸轮表面120b,从而引起钳口120朝彼此靠近并且形成(form)插在其间的手术夹子“C1”。由于驱动通道带箍143固定在驱动通道140上并且与其一起运动,所以驱动通道带箍143用于覆盖驱动通道140使得在钳口120靠近期间将钳口120保持在驱动通道140中,并且在施夹器100的操作过程中将楔形板180保持在驱动通道140中。
[00170]如图45所示,手术夹子“C1”可以形成或者卷曲在脉管“V”或者其他任意生物组织上。
[00171]由于指示器148的凸台148b平移通过推杆160的狭槽160d,所以允许驱动通道140相对于推杆160向远侧运动。
[00172]此外,随着驱动通道140被完全地向远侧推进,如图37所示,棘轮机构144的齿条构件141被向远侧运动到超出棘轮爪142的位置使得齿条构件141的齿141a被向棘轮爪142的齿的远侧运动从而使得齿条构件141和棘轮爪142彼此脱离。这样,允许驱动通道140自由返回原始位置或者最近侧位置。
[00173]如图32和33所示,随着驱动通道140被向远侧运动,听觉/触觉指示器148的弹性臂148a卡合(snap over)在凸耳149的远端之上并且接触凸耳149的表面149a,从而产生听觉声响和/或触觉振动。这种听觉声响和/或触觉振动与手术夹子“C”的装载一致。
[00174]如图43所示,随着驱动通道140被进一步向远侧运动,听觉/触觉指示器148的弹性臂148a卡合在凸耳149的远端上从而产生进一步的听觉声响和/或触觉振动。这种听觉声响和/或触觉振动与手术夹子“C”的完全形成一致。
[00175]继续参考图35-40,在手柄106的进一步挤压期间,由于凸片192a从计数机构190移出,随着驱动通道140被向远侧推进,其凸节140e接合处理器194的接触件194a,从而完成电路并且使得处理器194如上所述起作用。
[00176]现在参考图41-45,显示了在手柄106的整个行程或者挤压之后以及在手柄106打开期间的施夹器100。在这种情况下,驱动通道140在远侧位置处,推杆160在远侧位置处,楔形板180在近侧位置处,加速器156与驱动通道140隔开一定距离,每个偏置构件146和158被拉伸,并且棘轮爪142位于齿条140d的近侧。
[00177]如图46-52所示,在手柄106的打开或者释放期间,使得连杆构件122的远端122a相对于壳体104向近侧运动。随着连杆构件122的远端122a向近侧运动,使得驱动销124向近侧运动从而将近侧轴向运动传递到驱动通道140,并且依次传递给推杆160。偏置构件146的收缩促进了驱动通道140的近侧运动。可选择性,手柄106的释放导致偏置构件146在近侧方向上撤回驱动通道140。
[00178]随着驱动通道140被向近侧运动,驱动通道140的远侧边缘和/或驱动通道带箍143从钳口120的凸轮表面120b脱离,从而使钳口120彼此分开以使楔形板180的远端180a重新插在钳口120之间,并且将另一个手术夹子“C”容纳在钳口120之间。特别地,随着驱动通道140向近侧运动,狭槽140g的横向部分作用在指部179c上以引起枢转臂179转动并且引起枢转臂179的指部179b向远侧推动楔形板180。随着楔形板180在远侧方向上运动,如图51和图52所示,楔形板180的远端180a被重新插入或者重新引入到钳口120中,从而使钳口120张开。
[00179]如图49和图50所示,随着楔形板180向远侧运动,夹子输出器174的近侧凸起176接合在楔形板180的窗口180b中并且从而向远侧被推动给定的距离。随着夹子输出器174向远侧被推动,夹子“C”队列也向远侧被推动。如图50所示,当楔形板180达到最远侧位置时,夹子通道(clipchannel)170邻接、接合、推动或者以别的方式由凸轮带到远侧凸起175的近侧部分175b直到楔形板180的网状物(web)180f基本上位于远侧凸起175的远侧部分175a的下方。在这么做的过程中,远侧凸起175的近侧部分175b运动以延伸到夹子通道170的增加量的更远侧的窗口172中。
[00180]如图51和图52所示,随着夹子输出器174被向前推动,向前运动夹子“C”队列,最远侧夹子“C1”在推杆160的推动器160c的下方用齿轮带动来运动推动器160c的远端,直到最远侧夹子“C1”被施夹器170的柄脚171抓取。
[00181]暂时返回图48,随着驱动通道140在近侧方向上运动,听觉/触觉指示器148的臂148a卡合回到凸耳149上并且重新设置听觉/触觉指示器148以用于手柄106的下一个发射行程或者挤压。
[00182]随着驱动通道140进一步在近侧方向上运动,驱动通道140接合加速齿条156,引起加速齿条156在近侧方向上运动。加速齿条156在近侧方向的运动导致钟形曲柄齿轮154环绕枢销152a转动从而在近侧方向运动推杆160。另外,随着驱动通道140在近侧方向上运动,其凸节140e脱离处理器194的接触件194a。
[00183]现在回到图53,显示了在手柄106的整个行程或者完全挤压之后以及在最后一个夹子已经从其中排出之后的施夹器100的远端。在最后一个夹子发射之后,如图53中所示,夹子输出器的近侧凸起176布置在楔形板180的孔180b中的最远侧孔或者窗口中。这样,随着楔形板180在夹子发射后向远侧运动,夹子输出器174也以如上所述的方式向远侧运动。因此,随着夹子输出器174向远侧运动,其远侧凸起175运动到夹子载体170的窗口172中的最远侧窗口的远端。这样,远侧凸起175的近侧部分175b接合夹子载体170的顶壁的内表面并且向下被凸轮带动或者推动。
[00184]随着远侧凸起175的近侧部分175b向下被凸轮带动或者推动,远侧凸起175的远侧部分175a接合闭锁器178的凸起178a的上表面并且向下凸轮带动或者推动闭锁器178的凸起178a,跨过被支撑在驱动通道140上的带箍143的路径,并且进入楔形板180的远侧窗口180c中。这样,如果驱动通道140向远侧被推进,带箍143将以如上所述的方式紧靠闭锁器178的凸起178a并且阻止或者阻碍带箍143向远侧运动,并且依次,阻止或者阻碍驱动通道140向远侧运动。目前,棘轮爪142位于停歇处,即齿条140d的远端,并且手柄106布置在完全打开的位置并且因此不能更大程度地打开。在该构造中,施夹器被闭锁而不能再使用。
[00185]取决于手术夹子的尺寸,施夹器100的部件的尺寸将相应地定比例(scaled)。大多数不同尺寸施夹器的部件将基本上彼此相同。与夹子的宽度相关的部件尺寸,诸如钳口120和楔形板180,或者与夹子长度相关的部件尺寸,诸如推杆160、钟形曲柄齿轮154和枢转臂179相应地被调节。这样,具有不同尺寸的每个施夹器将以基本相同的方式被组装,并且其内部机构将以基本相同的方式操作。
[00186]例如,施夹器100可以以相对小、中等和大的比例设置,其中每种尺寸的施夹器存储和发射相对小、中等或者大的手术夹子。基于手术夹子的相对尺寸,对应的施夹器和它们对应的部件必须适当地定比例。然而,根据本公开,各种尺寸施夹器中的每一个包括相同的部件并且可以以彼此相同的顺序组装。这样,组装施夹器的技术人员将仅需要学习组装一种尺寸施夹器所需的顺序和/或步骤,并且依次能够等同地组装其他尺寸的施夹器,而不需学习新的组装顺序或步骤。
[00187]因此,用于相对小、中等或者大的施夹器的组装方法和/或步骤彼此基本上相同。
[00188]至少下述部件或者零件基于施夹器的相对尺寸或者比例改变形状,即,枢转臂179的臂的长度、加速齿条156在其中平移的狭槽的长度;以及钟形曲柄齿轮154的转动度。
[00189]许多其他剩余的部件或者零件是相同的或者在特征尺寸或比例中具有较小的变化。然而,如果需要,可以修改下列零件的形状以达到相同的结果,即,钟形曲柄齿轮154的狭槽154f的长度,和/或形成在加速齿条156的基壁156a中的狭槽156b的长度。
[00190]考虑到对于相对小比例的施夹器,给定相对小比例的钟形曲柄齿轮154的大约45°的转动将导致相对小比例的推杆160大约0.345英寸的轴向位移,以使相对小尺寸的夹子装载到钳口120中。类似地,考虑到对于相对中等比例的施夹器,给定相对中等比例的钟形曲柄齿轮154的大约70°的转动将导致相对中等比例的推杆160大约0.485英寸轴向位移,以使相对中等尺寸的夹子装载到钳口120中。同样地,考虑到对于相对大比例的施夹器,给定相对大比例的钟形曲柄齿轮154的大约90°的转动将导致相对大比例的推杆160大约0.710英寸轴向位移,以使相对大尺寸的夹子装载到钳口120中。
[00191]在可选实施例中,如图54-57所示,考虑到驱动通道140的近端可以包括或者限定与其形成一整体并且被构造为和适于接合棘轮爪142的齿条140d。棘轮机构244的使用和操作基本上与棘轮机构144相同,因此这里将不再详细讨论。
[00192]在另一个实施例中,如上面图4所示,施夹器100可以设置有构造为将能源198固定到壳体104上的带箍196。
[00193]在一个实施例中,同样考虑到随着驱动通道140向远侧运动,并且随着听觉/触觉指示器148的弹性臂148a卡合在凸耳149的远侧边缘上,弹性臂148a可以撞击或者接触形成在壳体104中的表面从而将进一步或者再次放大视觉声响和/或触觉振动。
[00194]现在转到图58-69,根据本公开的可选实施例,手术施夹器一般标示为300。手术施夹器300基本上与手术施夹器100相同,因此这里仅详细讨论到为了识别其构造和操作的不同所必要的程度。
[00195]如图58、60和64-66所示,施夹器300包括具有钟形曲柄齿轮154的运动放大系统,以及可滑动地支撑在壳体104中的加速齿条356。加速齿条356包括基壁356a,基壁356a限定形成在其中的细长、纵向延伸的狭槽356b以用于可滑动地容纳钟形曲柄齿轮154的枢销154a。加速齿条356包括从基壁356a的侧边缘在相反方向上突出的侧壁356c,以及形成在侧壁356c中并且与基壁356a的狭槽356b重合或对准的齿条356d。齿条356d被构造为与钟形曲柄齿轮154的正齿轮154d的轮齿154g接合。加速齿条356进一步包括从基壁356a的远侧边缘突出的凸轮构件356e,以及从侧壁356c的远侧边缘突出的凸节356f。
[00196]加速齿条356的基壁356a的狭槽356b的长度将取决于施夹器300的尺寸改变。对于相对较小的施夹器(例如,施加相对较小夹子的施夹器),加速齿条356的狭槽356b的长度将相对较短,而对于相对较大的施夹器(例如,施加较大夹子的施夹器),加速齿条356的狭槽356b的长度将相对较长。
[00197]使用中,正如下面将详细描述的,随着加速齿条356被轴向地运动或者平移,加速齿条356的齿条356d与钟形曲柄齿轮154的正齿轮154d的轮齿154g接合以引起钟形曲柄齿轮154环绕枢销154a转动或者枢转。
[00198]如图58、61和67-69所示,施夹器300包括运动反向机构,运动反向机构具有枢转地支撑在壳体104的下半壳体104b中的楔形板枢转臂379的用于将楔形板180的平移传递给驱动通道140的平移。枢转臂379包括构造为可枢转地连接到壳体104上的枢转凸台379a、设置在枢转臂379的一端并且在与枢转凸台379a相反的方向上延伸的第一杆或指部379b,以及设置在枢转臂379的另一端并且在与枢转凸台379a相同的方向延伸的第二杆或指部379c。第一杆或指部379b被构造为和适于接合在楔形板180的最近侧狭槽180d中。第二杆或指部379c被构造为接合在形成于臂连杆358中的狭槽358b中(图62),所述臂连杆358连接到限定在驱动通道140中的窗口140h中。
[00199]使用中,正如下面将详细讨论的,随驱动通道140向远侧运动,在停歇期过后,臂连杆358推动枢转臂379的第二杆或指部379c以在第一或远侧方向上运动从而使第一杆或指部379b在第二或近侧方向上运动并且引起楔形板180在第二方向上运动,反之亦然。随着楔形板180在远侧方向上运动,正如下面将讨论的,楔形板180凸轮带动钳口120的内表面从而保持钳口120彼此分开。
[00200]施夹器300进一步包括以拉力弹簧的形式的偏置构件384,其可操作地被固定到并且在楔形板180的近端和壳体104之间,趋于将楔形板180保持在被推进或者最远侧位置。偏置构件384用于在位于钳口120之间的夹子“C”形成之后推进或促进楔形板180的前进。
[00201]如图58、59和64-66所示,施夹器300进一步包括支撑在驱动通道140上的听觉/触觉指示器348。指示器348包括第一弹性指部348a和第二弹性指部348b。使用中,如下面将更详细描述的,随着施夹器300被致动并且驱动通道140往复运动,指示器348的第一弹性指部348a与设置在施夹器300中的相应互补结构互相作用以向用户产生听觉和/或触觉反馈,并且指示器348的第二弹性指部348b与加速齿条356的凸轮构件356e互相作用以为不同尺寸的施夹器300调节施夹器300的行程。
[00202]如图58、62和67-69所示,施夹器300进一步包括臂连杆358,臂连杆358可滑动地布置在壳体104中并且可操作地连接到驱动通道140中以与驱动通道140一起平移。臂连杆358包括限定了其中的狭槽358b的主体部358a、从主体部358a的上表面突出的导壁358c以及从主体部358a的近侧边缘在向上方向上延伸的杆358d。臂连杆358的狭槽358b被构造为可滑动地容纳枢转臂379的第二杆或指部379c。臂连杆358的导壁358c定尺寸为在驱动通道140的表面行进。臂连杆358的杆358d被定尺寸为可滑动地容纳在形成于驱动通道140中的窗口140h中。驱动通道140的窗口140h被定尺寸为限定在驱动通道140向远侧运动的时和臂连杆358致动枢转臂379的时其间的停歇时间段。
[00203]参考图64-69,描述手术施夹器300的操作与手术施夹器100相比的不同。在施夹器300的手柄106的任何最初挤压之前,如图64和图67所示,驱动销124位于最近侧位置,棘轮爪142位于驱动通道140的齿条140d的远侧,臂连杆358位于相对于壳体104的最近侧位置和驱动通道140的窗口140h的最远侧位置,并且没有夹子“C”位于钳口106中。由于驱动销124在最近侧位置,所以推杆160、稳定器162和驱动通道140也在最近侧位置。由于推杆160位于最近侧位置,加速齿条356位于最近侧位置,而指示器348的第二弹性指部348b布置在加速齿条356的凸轮构件356e的近侧。同样,在施夹器300的手柄106的最初挤压之前,楔形板180位于最远侧位置使得楔形板180的远端180a插在钳口120之间。
[00204]随着驱动通道140向远侧运动,如图65和图68所示,指示器348与其一起向远侧运动。随着指示器348向远侧运动,其第二弹性指部348b在远侧方向上牵引加速齿条356。随着加速齿条356在远侧方向上被牵引,加速齿条356引起钟形曲柄齿轮154环绕枢销154a转动并且将远侧轴向运动传递到稳定器162的凸节162c,这依次将远侧轴向运动传递给推杆160。随着驱动通道140被向远侧运动,偏置构件146被拉伸或者延伸。
[00205]在手柄106的最初挤压期间,如图67和图68所示,驱动通道140被向远侧运动直到臂连杆358的杆358d由驱动通道140的窗口140h的端壁接合(即,停歇)。当窗口140h的端壁与臂连杆358的杆358d邻接时(即,在已经离开停歇处后),如图69中所示,驱动通道140的进一步的远侧运动导致臂连杆358的远侧运动。随着臂连杆358向远侧运动,臂连杆358的狭槽358b的横向部分将引起枢转臂379转动,这依次引起楔形板380在近侧方向上运动,从而从钳口120之间撤回其远端180a并且允许钳口120最终闭合或者接近。当达到枢转臂379的所需转动时,枢转臂379随着枢转臂379的指部379c行进通过臂连杆358的L形狭槽358b的纵向部分而停止转动。枢转臂379的指部379c保持在臂连杆358的L形狭槽358b的纵向部分中,直到完成驱动通道140的行程。
[00206]如图64和图65所示,在手柄106的最初挤压期间,如上所述,推杆160与驱动通道140一起向远侧运动,直到加速齿条356的凸节356f紧靠形成在壳体104中的凸耳,这时加速齿条356的远侧推进被停止。由于阻止了加速齿条356的进一步远侧推进,如图66所示,随着驱动通道140向远侧进一步推进,驱动通道140从加速齿条356的凸轮构件356e后面拉动或弯曲指示器348的第二弹性指部348b,以允许推杆160在近侧方向运动到原始位置。推杆160通过具有固定到推杆160上的第一端和固定到壳体上的第二端的复位弹簧359而缩回其原始位置。
[00207]在手柄106的整个行程或挤压之后和手柄106的打开期间,驱动通道140在近侧方向上运动。在操作中,随着驱动通道140向近侧运动,驱动通道140的窗口140h的前端壁作用在臂连杆358的杆358d上以在近侧方向上拉动臂连杆358。随着臂连杆358被向近侧运动,臂连杆358使得枢转臂379转动,这依次引起楔形板180在远侧方向上运动。随着楔形板180在远侧方向上运动,楔形板180的远端180a重新插入或者重新引入钳口120中,从而使钳口120张开。
[00208]随着驱动通道140进一步在近侧方向上运动,指示器348的第二弹性指部348b接合加速齿条356的凸轮构件356e,引起加速齿条356在近侧方向上运动。加速齿条356在近侧方向上的运动导致钟形曲柄齿轮152环绕枢销152a转动,从而在近侧方向上运动推杆160和稳定器162。随着驱动通道140在近侧方向上进一步运动,指示器348的第二弹性指部348b在凸轮构件356e的后面用凸轮带动、弯曲或者卡合以重新与加速齿条356接合。
[00209]现在转到图70-88,根据本公开的可选实施例的手术施夹器一般标示为400。手术施夹器400基本上与手术施夹器100相同,因此这里将仅仅详细讨论到为了识别其构造和操作的不同所必要的程度。
[00210]如图70、71和75-77所示,施夹器400包括运动放大系统,运动放大系统具有可转动地支撑在手柄组件402的壳体404中的齿轮构件454。齿轮构件454包括限定转动轴的主体板454a、支撑在主体板454a上并且与转动轴同轴的齿轮454b,以及形成在主体板454a的外边缘处的齿轮段(gearsection)454c。
[00211]如图70、72和75-77所示,施夹器400进一步包括支撑或者以其他方式连接在驱动通道440上的驱动通道齿条442。驱动通道齿条442限定形成在其侧边缘中的多个轮齿442a。驱动通道齿条442被构造和定尺寸为使得其轮齿442a可与齿轮构件454的齿轮454b接合。使用中,随着驱动通道440被平移,驱动通道齿条442与其一起平移,反之亦然。
[00212]如图70、73和75-77所示,施夹器400的运动放大系统还包括支撑或者以其他方式连接在推杆460上的推杆齿条462。推杆齿条462限定形成在其侧边缘中的多个齿462a,以及从其向近侧延伸的杆462b。推杆齿条462被构造和定尺寸为使得其轮齿462a可与齿轮构件454的齿节454c接合。使用中,随着推杆460被平移,推杆齿条462与其一起平移,反之亦然。
[00213]如图70、74和75所示,施夹器400包括推杆460,所述推杆460具有从其表面突出的弹性指部460c。当手柄组件404处于未挤压状态时,如图75所示,推杆460的弹性指部460c布置在从驱动通道440延伸的驱动块(drive block)440a的远侧(图75-77)。同样,在最初未挤压状态中,没有夹子“C”位于钳口106中。
[00214]参考图75-86,描述手术施夹器400的操作与手术施夹器100相比的不同。在施夹器400的手柄106的任何最初挤压之前,如图75-77所示,驱动销124位于最近侧位置,棘轮爪142位于驱动通道440的齿条140d的远侧,驱动通道齿条442和推杆齿条462中的每一个位于相对于壳体104的最近侧位置并且齿轮构件454没有被转动。由于驱动销124在最近侧位置,所以驱动杆440和推杆460也分别位于最近侧位置。同样,在施夹器400的手柄106的最初挤压之前,驱动通道440的驱动块440a布置在推杆460的弹性指部460c的近侧。
[00215]随着驱动通道440向远侧运动,如图78和图79所示,驱动通道440向远侧运动。这样,驱动通道440的驱动块440a接合推杆460的弹性指部460c从而使得推杆460也向远侧被推进。随着驱动通道440和推杆460向远侧运动,推杆460运动推杆齿条462直到推杆齿条462的齿462a接合齿轮构件454的齿节454c。
[00216]现在转到图80-82,随着手柄106进一步被致动,从而进一步向远侧运动驱动通道440,推杆460向远侧运动足以使推杆齿条462向远侧运动并且脱离齿轮构件454的齿节454c的量。同样,这时驱动通道齿条442的齿442a与齿轮构件454的齿轮454b接合,从而防止齿轮构件454返回原始位置。
[00217]在这个阶段,夹子(未示出)已经被推杆460完全输送到钳口中。另外,在这个阶段,棘轮爪142已经由驱动通道440的齿条140d接合。这样,驱动通道440可能不会返回原始位置直到驱动通道440已经完成其远侧行程。
[00218]如图83和图84所示,随着驱动通道440进一步向远侧运动,驱动通道440的驱动块440a卡合推杆460的弹性指部460c上,从而允许拉力弹簧464将推杆460撤回到原始位置。
[00219]如图85和图86所示,当推杆460在原始位置中保持静止时,驱动通道440可以继续向远侧运动以完全致动施夹器400并且形成布置在钳口中的手术夹子。在这个阶段,驱动通道440的齿条140d已经向远侧运动并超出棘轮爪142,从而允许驱动通道440返回原始位置。
[00220]与施夹器的相应尺寸无关,不同尺寸施夹器100-400中的每一个的组装以基本上相同的步骤顺序完成。这样,如上所述,组装施夹器的技术人员将仅仅需要学习组装一种尺寸的施夹器所需的顺序和/或步骤,并且依次,能够等同地组装其他尺寸的施夹器,而不需学习新的组装顺序或者步骤。
[00221]现在转到图87-110,图示了组装相对小、中等和/或大的施夹器100的示例性方法。如图87和图88所示,在组装期间,设置了下半壳体104b并且电池或者能源198放置于下半壳体104b中。另外,包含凸片192b的处理器192放置于下半壳体104b的窗口104c中,使得凸片192b向下半壳体104b的外侧延伸。在将处理器192和电池198放置在下半壳体104b中之前或者之后,爪簧145和爪销147被固定或者插入下半壳体104b中,并且棘轮爪142被插入到爪销147之上并且运动到与爪簧145接合。
[00222]如图91和图92所示,对应尺寸的枢转臂179(例如,尺寸对应于手术夹子的长度和/或宽度的枢转臂179)经由枢转凸台179a可枢转地连接到或者安放在下半壳体104b中。另外,如图91和图92所示,齿条构件141可滑动地位于下半壳体104b中,使得齿条构件141的齿141a与棘轮爪142的齿可操作地关联。另外,齿条构件141的远侧开口141b与限定在下半壳体104b中的细长通道104e重叠,并且齿条构件141的突出部(projection)141c可滑动地位于由下半壳体104b限定的互补狭槽中。
[00223]现在转到图93和图94,通道组件108连接到下半壳体104b上。通道组件108包括下通道132、可滑动地布置在下通道132中的驱动通道140、固定地连接到下通道132上的钳口120以及固定在驱动通道140的远端附近的通道带箍143。当通道组件108连接到下半壳体104b上时,驱动销凹部140a与齿条构件141的开口141b对准。同样,枢转臂179的第二指部179c可滑动地布置在驱动通道140的窗口140g中。
[00224]如图93和图94所示,对应尺寸的楔形板180(例如,尺寸与手术夹子的长度和/或宽度对应的楔形板180)可滑动地位于驱动通道140之上以便楔形板180的远端180a插在通道带箍143和钳口120之间,并且楔形板180的近端连接到枢转臂179的第一指部179b上。
[00225]另外,如图93和图94所示,偏置构件146被设置并且具有连接到驱动通道140的第一端和固定到下半壳体104b的第二端。
[00226]现在转到图95和图96,加速齿条156可滑动地位于下半壳体104b中,并且对应尺寸的钟形曲柄齿轮154(例如,尺寸对应于手术夹子的长度和/或宽度的钟形曲柄齿轮154)经由枢销154a可枢转地连接到下半壳体104b,其中枢销154a贯穿加速齿条156。当适当地定位的钟形曲柄齿轮154的正齿轮154d接合加速齿条156的齿条156d时(见图4A-4C),偏置构件158被设置并且在驱动通道140和加速齿条156之间互相连接。
[00227]接下来,如图97和图98所示,一对手柄106连接到下半壳体104b。特别地,每个手柄106的远侧孔106a可枢转地布置在下半壳体104b的相应枢转柱104d上。同样,连杆构件122被设置,其可枢转地连接到相应的手柄106并且从手柄106伸出使得连杆构件122的远端122a与驱动通道140的枢转点140a重叠。
[00228]现在转到图99和图100,在前述步骤之前、之中或者之后,夹子“C”队列被插入夹子载体170的通道170d中。同样,夹子输出器174在夹子“C”队列的近侧的位置布置在夹子载体170的通道170d中。在一个实施例中,22个夹子“C”可以装载在夹子载体170中。取决于待装载到夹子载体170中的夹子“C”的尺寸(例如,宽度和/或长度),提供或者选择对应尺寸的夹子载体170和夹子输出器174。
[00229]如图101和图102所示,对应尺寸的推杆160(例如,尺寸对应于手术夹子的长度和/或宽度的推杆160)可滑动地布置在筒形盖130中,并且被装载的夹子载体170固定地放置在筒形盖130中以覆盖推杆160的远端。
[00230]现在转到图103和图104,闭锁器178固定到筒形盖130的远端附近。特别地,闭锁器178的凸起178a定向为在近侧方向延伸。同样如图103和图104所示,稳定器162连接到推杆160的近端。特别地,稳定器162的远侧凸起162a插入到推杆160的远侧窗口160e中,并且稳定器162的细长窗口162b与推杆160的近侧窗口160d对准。如图103和图104所示,稳定器162的凸节162d贯穿推杆160。
[00231]现在转到图105和图106,在推杆160、夹子载体170连接到筒形盖130的情况下,筒形盖130连接到外通道132使得推杆160的近端与下半壳体104b重叠。特别地,推杆160的近侧窗口160d位于连杆构件122的远端122a之上并且在驱动通道140的枢销140a之上。当推杆160位于下半壳体104b之中时,稳定器162的凸节162d位于钟形曲柄齿轮154的臂154c的狭槽154f中(见图4C)。
[00232]如图107和图108所示,驱动销124插入推杆160的近侧窗口160d、连杆构件122的每个远端122a、驱动通道140的枢转点140a(见图97和图98)、齿条构件141的开口141b(见图91和图92)并且插入到限定在下半壳体104b中的细长通道104e中(见图91和图92)。
[00233]继续参考图107和图108,听觉/触觉指示器148连接到驱动销124以与其一起运动。接下来,上半壳体104a固定到下半壳体104b上。
[00234]如图109和图110所示,运送楔200被引入手柄106之间并且连接到壳体104。另外,凸片192b的远端或自由端连接到运送楔200,使得当从壳体104拆下运送楔200时导致凸片192b移出并激活计数机构。
[00235]应当理解,前面的描述仅仅是本公开的示例。本领域技术人员可以想出不背离本公开的各种可选方案和修改。因此,本公开旨在涵盖所有这些可选方案、修改和变化。参考附图描述的实施例仅仅呈现为证明本公开的特定实例。与上述和/或随附的权利要求中的那些非基本上不同的其他元件、步骤、方法和技术也被认为包含在本公开的范围内。
Claims (35)
1、一种手术施夹器,包括:
壳体;
至少一个手柄,其可枢转地连接到所述壳体;
通道组件,其从所述壳体向远侧延伸;
夹子载体,其布置在所述通道组件中并且限定其中的通道和多个窗口;
多个夹子,其可滑动地布置在所述夹子载体的所述通道中;
楔形板,其可往复运动地布置在所述通道组件中,所述楔形板可操作地连接到所述手柄并且包含沿其长度形成的多个孔;以及
夹子输出器,其可滑动地布置在所述夹子载体的所述通道中并且布置在所述多个夹子的近侧,所述夹子输出器被构造为且适于选择性接合所述夹子载体的所述窗口和所述楔形板的所述孔,其中所述夹子输出器被构造为且适于当所述楔形板往复运动时相对于所述夹子载体在向远侧的方向上推动所述多个夹子。
2、根据权利要求1所述的施夹器,其中所述夹子输出器被构造为接合所述楔形板并且当所述楔形板向远侧平移时向远侧运动,并且被构造为接合夹子载体并且当所述楔形板向近侧平移时停止其向近侧运动。
3、根据权利要求1所述的施夹器,进一步包括钳口组件,所述钳口组件包括从所述通道组件的与所述壳体相反的一端伸出的一对钳口,所述钳口组件适于将夹子容纳于其中并且可操作以响应于所述手柄的运动来实现夹子的形成。
4、根据权利要求3所述的施夹器,进一步包括可往复运动地位于所述壳体和所述通道组件中的至少一个中的夹子推杆,所述推杆具有可操作地连接到所述手柄中的至少一个上的第一端和限定推动器的第二端,所述推杆能够随着所述手柄在第一方向上以初始量接近而朝所述钳口运动以便移动在所述钳口之间的最远侧夹子,并且所述推杆被构造为且适于随着所述手柄在所述第一方向以额外量接近而朝所述壳体运动以便移动在所述多个夹子中的最远侧夹子后面的推动器。
5、根据权利要求4所述的施夹器,进一步包括运动放大系统,所述运动放大系统被构造为当手柄最初致动时使推杆向远侧运动增加量,并且被构造为在手柄的最初致动之后向近侧移动推杆和楔形板。
6、根据权利要求4所述的施夹器,进一步包括可平移且可滑动地布置在所述壳体和所述通道组件中的至少一个中的驱动通道,所述驱动通道具有可操作地连接到所述至少一个手柄上的第一端和被构造且被定尺寸为选择性地接合所述一对钳口以实现所述一对钳口的闭合的第二端,所述驱动通道随着所述至少一个手柄在第一方向运动致动而朝所述钳口组件运动,以对着所述钳口而移动其所述第二端来闭合所述钳口,所述驱动通道随着所述至少一个手柄运动第二个量而远离所述钳口以使其所述第二端远离所述钳口而允许所述钳口打开。
7、根据权利要求6所述的施夹器,进一步包括可操作地连接到所述楔形板和所述驱动通道的运动反向机构,其中在所述驱动通道的远侧运动期间,所述运动反向机构的转动导致所述楔形板的近侧运动。
8、根据权利要求6所述的施夹器,其中所述运动放大系统包括:
钟形曲柄齿轮,其枢转地支撑在所述壳体中并且枢转地连接到所述推杆;
加速齿条,其可滑动地支撑在所述壳体中并且可操作地连接到所述钟形曲柄齿轮;以及
偏置构件,其使所述驱动通道和加速齿条互相连接,
其中所述驱动通道的远侧平移经由偏置构件引起加速齿条的远侧平移,并且其中加速齿条的远侧平移引起所述钟形曲柄齿轮的第一转动和所述推杆的远侧平移。
9、根据权利要求8所述的施夹器,其中所述钟形曲柄齿轮包括从其沿径向地延伸出的臂和形成在所述臂中的细长狭槽,其中所述细长狭槽可滑动地容纳与所述推杆可操作地相关联的凸台。
10、根据权利要求8所述的施夹器,进一步包括运动反向机构,所述运动反向机构可操作地连接到所述驱动通道和所述楔形板并且选择性地与所述推杆接合,其中在所述驱动通道的所述远侧平移期间,所述运动反向机构的转动导致所述楔形板和所述推杆的近侧运动。
11、根据权利要求6所述的施夹器,进一步包括棘轮机构,所述棘轮机构包括:
齿条,其具有多个棘齿并且与所述驱动通道相关联;以及
棘轮爪,其具有至少一个齿并且被布置在选择性地接合所述齿条的位置,其中所述棘轮爪被偏置到与所述齿条接合,其中随着所述驱动通道被纵向地往复运动,所述多个齿越过所述棘轮爪,并且其中所述棘轮爪防止所述驱动通道在所述至少一个手柄完全致动之前非故意的返回。
12、根据权利要求1所述的施夹器,进一步包括布置在所述通道组件的远端的闭锁器。
13、根据权利要求12所述的施夹器,其中所述闭锁器在最后一个夹子从所述夹子载体排出时由所述夹子输出器致动。
14、根据权利要求13所述的施夹器,其中所述闭锁器由所述夹子输出器推动以延伸越过所述驱动通道的路径,从而防止所述驱动通道向远侧运动。
15、根据权利要求1所述的施夹器,进一步包括被支撑在所述壳体和所述通道组件中的至少一个中的计数显示机构,其中所述计数显示机构被构造为且适于显示当所述至少一个手柄每次致动时所述施夹器的状态的变化。
16、根据权利要求6所述的施夹器,其中所述驱动通道被构造且被定尺寸为至少部分地环绕所述钳口和所述楔形板,其中所述驱动通道包括延伸越过其远端用于将所述钳口和所述楔形板保持在所述驱动通道中的带箍。
17、一种手术施夹器,包括:
壳体;
至少一个手柄,其可枢转地连接到所述壳体的相反侧;
通道组件,其固定到所述壳体并且从其伸出;
一对钳口,其被支撑在所述通道组件的远端并且从所述通道组件的远端伸出;
夹子载体,其布置在所述通道组件中并且限定通道;
多个夹子,其可滑动地布置在所述夹子载体的所述通道中;
夹子输出器,其在所述多个夹子的近侧位置处可滑动地布置在所述夹子载体的所述通道中;
驱动通道,其可平移地布置在所述壳体和所述通道组件中的至少一个中,所述驱动通道具有可操作地连接到所述手柄的至少一个的第一端和构造且定尺寸为选择性地接合所述一对钳口以实现所述钳口的闭合的第二端;
推杆,其可平移地布置在所述壳体和所述通道组件中的至少一个中,所述推杆经由运动放大系统连接到所述驱动通道,所述推杆的远端被构造为接合所述多个夹子中的最远侧夹子;
楔形板,其可往复运动地布置在所述壳体和所述通道组件中的至少一个中,其中所述楔形板的远端选择性地可插在所述一对钳口之间;以及
运动反向机构,其包括连接到所述驱动通道的第一端和连接到所述楔形板并且可由所述推杆接合的第二端,
其中所述驱动通道的远侧平移经由所述运动放大系统引起所述推杆向远侧平移;并且
其中所述驱动通道的远侧平移经由所述运动反向机构引起所述推杆和所述楔形板在停歇期之后向近侧平移。
18、根据权利要求17所述的施夹器,进一步包括布置在所述通道组件的远端中的闭锁器,其中在最后一个夹子从所述施夹器中排出之后所述闭锁器由所述夹子输出器致动,其中所述闭锁器由所述夹子输出器推动以延伸越过所述驱动通道的路径,从而防止所述驱动通道向远侧运动。
19、根据权利要求18所述的施夹器,其中所述楔形板限定沿其长度形成的多个孔,其中所述夹子载体限定沿其长度形成的多个窗口,其中所述夹子输出器被构造为且适于选择性地与所述夹子载体的所述窗口和所述楔形板的所述孔接合,其中所述夹子输出器被构造为且适于在所述楔形板向远侧推进时相对于所述夹子载体向远侧递增地推动所述多个夹子。
20、根据权利要求19所述的施夹器,其中所述一对钳口适于将夹子容纳在其中并且响应于所述驱动通道的远侧平移可操作以实现夹子的形成。
21、根据权利要求20所述的施夹器,进一步包括指示器,所述指示器被构造为在满足将夹子装载到所述一对钳口中和由所述一对钳口形成夹子中的至少一个时,产生听觉指示和触觉指示中的至少一个。
22、根据权利要求17所述的施夹器,其中所述运动放大系统包括钟形曲柄齿轮,所述钟形曲柄齿轮具有从其沿径向延伸出的臂和形成在所述臂中的细长狭槽,其中所述细长狭槽可滑动地容纳与所述推杆可操作地相关联的凸台。
23、根据权利要求22所述的施夹器,其中所述运动放大系统包括具有一组齿的加速齿条,并且所述钟形曲柄齿轮包括与所述加速齿条的齿啮合的一组齿,其中所述加速齿条的轴向平移导致所述钟形曲柄齿轮的转动和所述推杆的轴向平移。
24、根据权利要求23所述的施夹器,其中所述加速齿条经由偏置构件连接到所述驱动通道。
25、根据权利要求17所述的施夹器,进一步包括棘轮机构,所述棘轮机构包括:
齿条,其具有多个棘齿并且与所述驱动通道关联;以及
棘轮爪,其具有至少一个齿并且被布置在选择性地接合所述齿条的位置,其中所述棘轮爪被偏置到与所述齿条接合,其中随着所述驱动通道被纵向地往复运动,所述多个齿越过所述棘轮爪,并且其中所述棘轮爪防止所述驱动通道在所述至少一个手柄完全致动之前非故意的返回。
26、根据权利要求17所述的施夹器,其中所述驱动通道被构造且被定尺寸为至少部分地环绕所述钳口和所述楔形板,其中所述驱动通道包括延伸越过其远端用于将所述钳口和所述楔形板保持在所述驱动通道中的带箍。
27、根据权利要求17所述的施夹器,进一步包括计数机构,其中所述计数机构可以根据所述施夹器的一个发射次序而被致动,并且其中所述计数机构指示所述施夹器中少了一个夹子。
28、一种可操作以输送至少相对小、中等和大的手术夹子的手术施夹机构,所述手术施夹机构包括;
驱动通道,其能够可平移地运动;
一对钳口,其可由所述驱动通道的远端接合,其中所述一对钳口在所述驱动通道向远侧平移时靠近;
楔形板,其能够相对于所述驱动通道往复平移,其中所述楔形板的远端选择性地可位于一对钳口之间,所述楔形板限定沿其长度形成的多个孔;
夹子载体,其相对于所述驱动通道而固定地定位,所述夹子载体限定沿其长度形成的通道和多个窗口;
多个夹子,其可滑动地布置在所述夹子载体的所述通道中;
夹子输出器,其在所述多个夹子的近侧位置处可滑动地布置在所述夹子载体的所述通道中;
推杆,其能够相对于所述驱动通道往复平移,其中所述推杆的远端被构造为接合所述多个夹子中的最远侧夹子;
运动放大系统,其包括钟形曲柄齿轮和加速齿条,所述加速齿条经由偏置构件连接到所述驱动通道,所述钟形曲柄齿轮经由互补轮齿连接到所述加速齿条,并且所述钟形曲柄齿轮连接到所述推杆,
其中所述驱动通道的远侧平移引起所述加速齿条向远侧平移,引起所述钟形曲柄齿轮转动,引起所述推杆向远侧平移;以及
运动反向机构,其包括连接到所述驱动通道的第一端和连接到所述楔形板并且可由所述推杆接合的第二端,
其中所述驱动通道的远侧平移引起所述枢转臂的第一端向远侧平移,引起所述枢转臂的第二端在近侧方向平移,从而引起所述楔形板在近侧方向上平移;而且
其中所述推杆的远侧平移在所述推杆与所述运动反向机构的第二端接触时停止。
29、根据权利要求28所述的手术施夹机构,其中所述枢转臂的第二端在近侧方向上的进一步平移引起所述推杆在近侧方向上平移。
30、根据权利要求28所述的手术施夹机构,其中所述枢转臂通过所述驱动通道的致动在停歇期之后发生。
31、根据权利要求28所述的手术施夹机构,进一步包括指示器,所述指示器被构造为在满足由所述推杆将夹子装载到所述一对钳口中和由所述一对钳口形成夹子中的至少一个时,产生听觉指示和触觉指示中的至少一个。
32、根据权利要求28所述的手术施夹机构,进一步包括棘轮机构,所述棘轮机构包括:
齿条,其具有多个棘齿并且与所述驱动通道关联;以及
棘轮爪,其具有至少一个齿并且被布置在选择性地接合所述齿条的位置,其中所述棘轮爪被偏置到与所述齿条接合,其中随着所述驱动通道被往复地平移,所述齿条的多个齿越过所述棘轮爪,并且其中所述棘轮爪防止所述驱动通道在其完全远侧平移之前返回。
33、根据权利要求28所述的手术施夹机构,其中所述驱动通道被构造且被定尺寸为至少部分地环绕所述一对钳口和楔形板,其中带箍延伸越过所述驱动通道的远端用于将所述一对钳口和楔形板保持在所述驱动通道内。
34、根据权利要求28所述的手术施夹机构,进一步包括计数机构,其中所述计数机构可根据所述施夹机构的一个发射次序而被致动,并且其中所述计数机构指示少了一个夹子。
35、根据权利要求28所述的手术施夹机构,进一步包括接近所述驱动通道的远端布置的闭锁器,其中所述闭锁器在最后一个夹子被排出时由所述夹子输出器致动,其中所述闭锁器由所述夹子输出器推动以延伸越过所述驱动通道的路径从而防止所述驱动通道向远侧运动。
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-
2009
- 2009-08-13 US US12/540,475 patent/US8465502B2/en active Active
- 2009-08-21 CA CA2676309A patent/CA2676309C/en active Active
- 2009-08-24 AU AU2009212771A patent/AU2009212771B2/en not_active Ceased
- 2009-08-24 JP JP2009193533A patent/JP5478150B2/ja not_active Expired - Fee Related
- 2009-08-25 CN CN200910167569.6A patent/CN101658437B/zh active Active
- 2009-08-25 EP EP11002681.2A patent/EP2343017B1/en active Active
- 2009-08-25 EP EP09252052.7A patent/EP2158850B1/en active Active
- 2009-08-25 EP EP10005058.2A patent/EP2218410B1/en active Active
-
2013
- 2013-05-09 US US13/890,580 patent/US9549741B2/en active Active
- 2013-11-13 JP JP2013234623A patent/JP5748239B2/ja not_active Expired - Fee Related
-
2014
- 2014-11-17 JP JP2014232352A patent/JP2015062689A/ja active Pending
-
2016
- 2016-12-12 US US15/375,212 patent/US10542999B2/en not_active Expired - Fee Related
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2019
- 2019-12-16 US US16/715,539 patent/US11510682B2/en active Active
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Also Published As
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JP2014111112A (ja) | 2014-06-19 |
US11510682B2 (en) | 2022-11-29 |
EP2343017B1 (en) | 2013-11-06 |
EP2218410B1 (en) | 2013-11-27 |
EP2218410A1 (en) | 2010-08-18 |
EP2158850B1 (en) | 2015-10-21 |
CA2676309C (en) | 2017-07-04 |
US9549741B2 (en) | 2017-01-24 |
US20200113569A1 (en) | 2020-04-16 |
AU2009212771A1 (en) | 2010-03-11 |
CA2676309A1 (en) | 2010-02-25 |
US20170086850A1 (en) | 2017-03-30 |
US10542999B2 (en) | 2020-01-28 |
EP2343017A1 (en) | 2011-07-13 |
EP2158850A1 (en) | 2010-03-03 |
CN101658437B (zh) | 2014-06-04 |
US20100049216A1 (en) | 2010-02-25 |
JP2015062689A (ja) | 2015-04-09 |
US20130253541A1 (en) | 2013-09-26 |
JP5478150B2 (ja) | 2014-04-23 |
AU2009212771B2 (en) | 2014-11-13 |
JP2010046489A (ja) | 2010-03-04 |
US8465502B2 (en) | 2013-06-18 |
JP5748239B2 (ja) | 2015-07-15 |
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