CN101683279B - 用于外科切割和缝合器械的端部执行器 - Google Patents
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07271—Stapler heads characterised by its cartridge
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0807—Indication means
- A61B2090/0811—Indication means for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument
Abstract
本发明涉及一种用于外科切割和缝合器械的端部执行器。在各种实施方式中，端部执行器可包括细长通道，其能够支撑位于其中的钉仓并也与外科切割和缝合器械可操作连接。砧座可相对于细长通道可动地支撑，用于在打开位置和闭合位置之间选择性地运动，其中在所述闭合位置，响应于从所述外科切割和缝合器械对其施加的闭合动作，组织被夹紧在所述砧座和支撑在所述细长通道内的钉仓之间。至少一个光源可设置于钉仓和细长通道的至少一个上。该光源可与砧座交接以提供通过砧座一部分的可看到的视觉指示，来指示被夹紧在砧座和钉仓之间的组织的位置。
Description
技术领域
本发明总的涉及内窥镜式外科器械，其能够在操作组织并对组织施加缝合线的同时切割这些缝合线之间的组织，更具体地，本发明涉及关于这些器械用端部执行器的改进。
背景技术
在现有技术中，已经利用外科缝合器来同时在组织中形成纵向切口和在该切口相对侧上施加缝合线。这种器械通常包括一对相互配合的钳口构件，该钳口构件在器械被用于内窥镜或者腹腔镜应用时能够通过套管通道。钳口构件中的一个能够容纳配备有侧向间隔开的缝钉排的钉仓。另一个钳口构件通常包括砧座，砧座内形成有与钉仓中的缝钉排对准的缝钉成形凹窝。各种钉仓具有楔形件，当被向远侧驱动通过钉仓时，楔形件能够与支撑缝钉的驱动器接合以实现朝向砧座击发缝钉。
使用时，在击发之前，医生打开和闭合缝合器的钳口构件来定位和夹紧钳口构件中的组织。一旦医生已经确定组织被合适地夹紧在钳口构件中，就致动或者“击发”器械从而切割组织并同时将组织缝合在切口的每一侧上。这种同时的切断和缝合避免了当分别利用仅用于切割和缝合的不同外科工具顺次执行这种动作时会引发的并发症。
然而，当采用这种切割和切断器械时，医生必须在击发装置之前将待切割的组织适当地定位在端部执行器内。该任务可能由于体腔内的组织位置和/或端部执行器位置而变得复杂。
因此，迫切需要一种改进的端部执行器，其能够为医生提供端部执行器内的组织位置的指示。
发明内容
根据本发明的各种实施方式，提供一种用于外科切割和缝合器械的端部执行器。该端部执行器可包括细长通道，细长通道能够支撑位于其中的钉仓并与外科切割和缝合器械可操作地连接。砧座可相对于细长通道可动地支撑，用于在打开位置和闭合位置之间选择性地运动。响应于从所述外科切割和缝合器械对其施加的闭合动作，组织被夹紧在所述砧座和支撑在所述细长通道内的钉仓之间。至少一个光源可设置于钉仓和细长通道的至少一个上。该光源可与砧座交接以提供砧座和钉仓之间的组织位置的视觉指示。
根据本发明的另一种实施方式，提供一种用于外科切割和缝合器械的钉仓。在各种实施方式中，钉仓可以包括钉仓主体，钉仓主体中具有多个钉仓容纳通道。每个钉仓容纳通道可操作地支撑位于其中的至少一个外科缝钉。多个光源可支撑在钉仓主体内，用于在钉仓可操作地支撑在其中且外科切割和缝合器械的砧座部分定向在组织夹紧位置时朝着砧座部分发射光。
根据本发明的另一种实施方式，提供一种用于其中具有至少一个光源的外科切割和缝合器械的钉仓。各种实施方式可包括其中具有多个钉仓容纳通道的钉仓主体。每个钉仓容纳通道可操作地支撑其中的至少一个外科缝钉。多个光发射开口可在多个位置处延伸通过钉仓主体，使得在钉仓可操作地支撑在其中且外科切割和缝合器械的砧座部分定向在组织夹紧位置时，能够从光源朝向砧座部分发射光。
根据本发明的另一种实施方式，提供一种外科切割和缝合器械，其可包括手柄组件和与所述手柄组件可操作连接的细长轴。细长通道可操作地连接到细长轴并能够操作地支撑其中的钉仓。砧座可相对于细长通道可动地支撑，用于在打开位置和闭合位置之间选择性地运动，其中在闭合位置，响应于从细长轴对其施加的打开和闭合动作，组织被夹紧在砧座和支撑在细长通道内的钉仓之间。至少一个光源可位于钉仓和细长通道的至少一个上。该光源与砧座交接以提供通过砧座一部分的可看到的视觉指示，来指示被夹紧在砧座和钉仓之间的组织的位置。
本发明具体公开了以下内容：
(1).一种用于外科切割和缝合器械的端部执行器，所述端部执行器包括：
细长通道，其能够支撑位于其中的钉仓并与所述外科切割和缝合器械可操作地联接；
砧座，其相对于所述细长通道可动地支撑，用于在打开位置和闭合位置之间选择性地运动，其中在所述闭合位置，响应于从所述外科切割和缝合器械对其施加的闭合动作，组织被夹紧在所述砧座和支撑在所述细长通道内的钉仓之间；
至少一个光源，其位于所述钉仓和所述细长通道的至少一个上，所述至少一个光源与所述砧座交接以提供通过所述砧座的一部分的可看到的视觉指示，来指示被夹紧在所述砧座和所述钉仓之间的组织的位置。
(2).如第(1)项所述的端部执行器，其中，所述砧座具有贯穿砧座的多个光观察开口，通过所述光观察开口，所述至少一个光源在所述砧座处于所述闭合位置时能够发射。
(3).如第(1)项所述的端部执行器，其中，所述至少一个光源包括多个处于所述钉仓中的发光二极管。
(4).如第(1)项所述的端部执行器，其中，所述砧座上具有至少一个组织定位件。
(5).如第(1)项所述的端部执行器，其中，所述至少一个光源与由所述外科切割和缝合器械支撑的电能源电连接。
(6).如第(1)项所述的端部执行器，其中，所述细长通道连接到所述外科器械的细长框架，该细长框架支撑位于其中的所述电能源。
(7).如第(1)项所述的端部执行器，其中，所述至少一个光源包括支撑在所述细长通道内且可操作地与支撑在所述细长通道和所述外科切割和缝合器械中的一个内的光源通信的至少一个光纤构件。
(8).如第(1)项所述的端部执行器，其中，所述细长通道与所述外科切割和缝合器械的支撑所述光源的细长框架可操作地连接。
(9).如第(8)项所述的端部执行器，其中，所述细长框架与所述外科切割和缝合器械的支撑所述光源的手柄组件可操作地连接。
(10).一种处理用于外科手术的端部执行器的方法，所述方法包括：
获取如第(1)项所述的端部执行器；
为所述端部执行器灭菌；以及
将所述端部执行器储存在灭菌容器中。
(11).一种用于外科切割和缝合器械的钉仓，所述钉仓包括：
钉仓主体，所述钉仓主体中具有多个钉仓容纳通道，每个所述钉仓容纳通道可操作地支撑位于其中的至少一个外科缝钉；和
多个光源，其支撑在所述钉仓主体内，用于在所述钉仓可操作地支撑在其中且所述外科切割和缝合器械的砧座部分定向在组织夹紧位置时朝着所述砧座部分发射光。
(12).如第(11)项所述的钉仓，其中，所述多个光源包括多个发光二极管。
(13.如第(12)项所述的钉仓，其中，所述发光二极管在所述钉仓主体可操作地与其连接时电连接到所述外科切割和缝合器械中的电能源。
(14).一种用于具有至少一个光源的外科切割和缝合器械的钉仓，所述钉仓包括：
钉仓主体，所述钉仓主体中具有多个钉仓容纳通道，每个所述钉仓容纳通道可操作地支撑位于其中的至少一个外科缝钉；和
多个光发射开口，其在多个位置处延伸通过所述钉仓主体，使得在所述钉仓可操作地支撑在其中且所述外科切割和缝合器械的砧座部分定向在组织夹紧位置时，能够从所述光源朝所述砧座部分发射光。
(15).一种外科切割和缝合器械，包括：
手柄组件；
细长轴，其与所述手柄组件可操作地连接；
细长通道，其可操作地连接到所述细长轴并能够操作地支撑位于其中的钉仓；
砧座，其相对于所述细长通道可动地支撑，用于在打开位置和闭合位置之间选择性地运动，其中在所述闭合位置，响应于从所述细长轴对其施加的打开和闭合动作，组织被夹紧在所述砧座和支撑在所述细长通道内的钉仓之间；
至少一个光源，其位于所述钉仓和所述细长通道中的至少一个上，所述至少一个光源与所述砧座交接以提供通过所述砧座的一部分的可看到的视觉指示，来指示被夹紧在所述砧座和所述钉仓之间的组织的位置。
(16).如第(15)项所述的外科切割和缝合器械，其中，所述砧座具有贯穿砧座的多个光接收通道，通过所述光接收通道，所述至少一个光源在所述砧座处于所述闭合位置时能够发射。
(17).如第(15)所述的外科切割和缝合器械，其中，所述至少一个光源包括：
至少一个发光构件，其支撑在所述细长轴和所述手柄组件中的一个内；以及
至少一个光纤电缆，其支撑在可操作地连接到所述至少一个光源以从其接收光的所述细长通道内。
(18).如第(15)项所述的外科切割和缝合器械，其中，所述至少一个光源包括所述钉仓中的多个由电供能的光源，且所述外科切割和缝合器械还包括支撑在所述细长通道中并与电能源电连接的至少一个电触点，使得当所述钉仓可操作地支撑在所述细长通道内时，所述至少一个电触点与所述钉仓中相应的至少一个电触点交接以将电能输送至其中的多个光源。
(19).如第(18)项所述的外科切割和缝合器械，其中，所述多个由电供能的光源包括多个发光二极管。
(20).如第(19)项所述的外科切割和缝合器械，其中，所述多个发光二极管设置至少两种不同颜色。
因此，本发明的各种实施方式针对用于夹紧和/或操作组织的其它端部执行器以及被设计成切割和缝合组织的那些端部执行器的缺点提供了解决方案。然而，本领域普通技术人员将理解，随着以下详细描述的开展，这些和其它细节、特征和优点将变得更加清楚。
附图说明
包含于并构成本说明书一部分的附图与上面给出的本发明的总体描述以及下面给出的实施方式的详细描述一起用来解释本发明的原理，其中，附图示出了本发明的实施方式。
图1描绘了处于打开位置的本发明的一种实施方式的外科切割和缝合器械的局部剖切的侧视图；
图2描绘了沿着图1的端部执行器的线2-2剖切的详细侧视图；
图3是图2的端部执行器的剖视图，其中，端部执行器的砧座处于闭合位置；
图4描绘了图1的外科切割和缝合器械的近端的手柄部分的侧视图，其中去掉了左侧以暴露出处于未夹紧、未击发(“起始”)位置的内部零件；
图5描绘了图1的外科切割和缝合器械的近端的手柄部分的分解透视图；
图6描绘了图1的外科切割和缝合器械的近端的手柄部分的侧视图，其中去掉了左侧以暴露出处于闭合(“夹紧”)位置的内部零件；
图7描绘了图1的外科切割和缝合器械的近端的手柄部分的侧视图，其中去掉了左侧以暴露出处于缝合且切断(“击发”)位置的内部零件；
图8是本发明的图1的端部执行器实施方式的透视图，其将一部分组织“T”夹紧在砧座和钉仓之间；
图9是图8的端部执行器的透视图，为了清楚起见去掉了砧座；
图10是图9中描绘的钉仓的一部分的透视图；
图11是图1的外科切割和缝合器械的执行部分的分解等轴测图；
图12描绘了处于打开位置的本发明的另一种实施方式的外科切割和缝合器械的局部剖切的侧视图；
图13是图12的端部执行器的剖视图，其中砧座处于闭合位置；
图14是本发明的另一种端部执行器实施方式的透视图，其将一部分组织“T”夹紧在砧座和钉仓之间；
图15是图14的端部执行器的透视图，为了清楚起见去掉了砧座；
图16是图15中描绘的钉仓的一部分的透视图；
图17是图14-16的端部执行器的剖视图，其中砧座处于闭合位置。
具体实施方式
参照附图，其中，在附图中相同的标号表示相同的部件。图1和图2描绘了能够实践本发明独特好处的外科缝合和切割器械10的一种实施方式。然而，随着该详细描述的开展，读者将认识到在不脱离本发明的精神和范围的条件下，本发明的独特和新颖方面可有利地结合各种其他缝钉器、缝合器械甚至组织抓取器械来采用。因此，对本发明的各种实施方式给予的保护范围不应当局限于仅结合这里描述的外科切割和缝合器械的特定类型来使用。
图1和图2示出了一种形式的外科切割和缝合器械，其总体上标示为10并可以有效地结合本发明的各种实施方式中采用。如从这些图中可以看出的，外科切割和缝合器械10可包括与执行部分22连接的手柄组件20，执行部分22还包括向远侧终止于端部执行器12的细长轴23。手柄组件20可包括手枪式握把24，闭合扳机26可由医生可枢转地朝向手枪式握把拉动以引起砧座18朝着端部执行器12的细长通道16夹紧或者闭合。击发扳机28可操作地安装在闭合扳机26外侧的较远处并能够由医生可枢转地拉动以引起缝合和切断夹紧在端部执行器12中的组织。
应当理解，本文使用的术语“近侧”和“远侧”是以抓握器械手柄的医生为参照的。因此，端部执行器12相对于更加近侧的手柄组件20处于远侧。还应当理解，为了方便和清楚，本文使用的例如“竖直的”和“水平的”等空间术语是以附图为参照的。然而，外科器械用在很多定向和位置，因此这些术语不能被认为是限制性和绝对的。
器械10的各种实施方式还可包括可动地安装在框架34上的闭合套筒32。框架34可包围由击发扳机28致动的击发驱动构件36。框架34将手柄组件20连接到端部执行器12。具体来说，框架34的远端联接到端部执行器12的细长通道16，该细长通道16能够可移除地支撑钉仓300。
如图3中可以看到的，钉仓300具有延伸通过钉仓的细长竖直槽49，以使击发杆14通过钉仓。击发杆14上具有用于切断被夹紧组织的切割刃48。已知各种类型和构造的击发杆。例如，可有效采用2005年12月27日授予的美国专利No.6978921中公开的那些击发杆，该专利的公开内容全部通过引用结合入本文。然而，外科切割和缝合器械10也可利用其它击发杆布置。
参照图4-7，手柄组件20可包括第一基本部分50和第二基本部分52，其可以由例如玻璃填充的聚碳酸酯的聚合材料模制而成。第一基本部分50可设有多个圆柱形销54。第二基本部分52可包括多个延伸构件56。每个延伸构件具有六边形开口58。圆柱形销54可容纳在六边形开口58内并摩擦地保持在其中用于维持第一和第二基本部分50和52处于组装状态
各种实施方式还可以包括具有钻孔62的旋转旋钮60，钻孔62完全延伸通过旋转旋钮60用于接合执行部分22并使执行部分22绕着其纵向轴线旋转。旋转旋钮60可包括沿着钻孔62的至少一部分延伸的向内突出的凸起64。突出的凸起64可容纳于形成在闭合套筒32的近侧部分处的纵向槽66内，使得旋转旋钮60的旋转引起闭合套筒32旋转。凸起64可进一步延伸通过框架34与击发驱动构件36的一部分接触，同样引起它们旋转。因此，端部执行器12(在图4-7中未示出)可与旋转旋钮60一起旋转。
框架34的近端68可向近侧通过旋转旋钮60并可进一步具有圆周槽口70，该圆周槽口70与分别从基本部分50和52延伸的相对的通道固定构件72接合。仅示出了第二基本部分52的通道固定构件72。从基本部分50、52延伸的通道固定构件72用来将框架34固定到手柄组件20，从而使框架34不会相对于手柄组件20纵向移动。
闭合扳机26可具有手柄部分74、齿轮节段部分76和中间部分78。钻孔80可延伸通过中间部分78。圆柱形支撑构件82可从第二基本部分52延伸并通过钻孔80，用于将闭合扳机26可枢转地安装到手柄组件20上。从第二基本部分52延伸的第二圆柱形支撑构件83可通过击发扳机28的钻孔81，用于可枢转地安装在手柄组件20上。六边形开口84可设置在圆柱形支撑构件83中，用于接收从第一基本部分50延伸的固定销(未示出)。
闭合轭86可容纳在手柄组件20内用于在其中进行往复运动并用来将运动从闭合扳机26传递到闭合套筒32。从第二基本部分52延伸的支撑构件88和延伸通过轭86中的凹陷89的固定构件72可将轭86支撑在手柄组件20内。闭合套筒32的近端90可设有凸缘92，其扣合到形成于轭86的远端96中的接收凹陷94中。轭86的近端98可具有与闭合扳机26的齿轮节段部分76接合的齿条100。当闭合扳机26朝手柄组件20的手枪式握把24移动时，轭86及由此闭合套筒32向远侧移动，压缩向近侧偏压轭86的弹簧102。闭合套筒32的远侧移动引起砧座18朝端部执行器12的细长通道16枢转平移，近侧运动实现打开，如下面讨论的。
闭合扳机26可由与击发扳机28的接合表面128相互作用的前表面130向前偏压至打开位置。使止动件绕着销106枢转至手柄组件20后部的第一钩104可限制击发扳机28朝手枪式握把24的运动，直到闭合扳机26被夹紧在其闭合位置。钩104可通过接合击发扳机28中的锁定销107限制击发扳机28运动。钩104也可与闭合扳机26接触。具体来说，钩104的前向突起108可与闭合扳机26的中间部分78上的构件110接合，构件110在钻孔80外侧朝向手柄部分74。钩104可被向着与闭合扳机26的构件110接触偏压并由释放弹簧112与击发扳机28中的锁定销107接合。随着压迫闭合扳机26，钩104从顶部到后部运动，压缩被捕获在钩104上的后向突起114和释放按钮30上的前向突起116之间的释放弹簧112。
随着轭86响应闭合扳机26的近侧运动而向远侧运动，释放按钮30的上栓锁臂118沿着轭86上的上表面120运动，直到落入轭86的近侧下部中向上存在的凹陷122中。释放弹簧112向外推动释放按钮30，这使上栓锁臂118向下枢转成与向上存在的凹陷122接合，由此将闭合扳机26锁定在组织夹紧位置，如图6中所描绘的。
栓锁臂118能够运动出凹陷122以通过向内推动释放按钮30而释放砧座18。具体来说，上栓锁臂118绕着第二基本部分52的销123向上枢转。然后允许轭86响应闭合扳机26的返回运动而向近侧移动。可以在手柄组件20内设置击发扳机回复弹簧124，其一端连接到第二基本部分52的销106，另一端连接到击发扳机28上的销126。击发扳机回复弹簧124对销126施加回复力，用于沿着远离手柄组件20的手枪式握把24的方向偏压击发扳机28。闭合扳机26也被击发扳机28的偏压闭合扳机26的前表面130的接合表面128远离手枪式握把24偏压。
随着闭合扳机26朝手枪式握把24移动，其前表面130与击发扳机28上的接合表面128接合，使击发扳机28运动到其“击发”位置。当处于其击发位置时，击发扳机28可被定位在与手枪式握把24成大约45°的角度。在缝钉击发后，弹簧124引起击发扳机28回到其初始位置。在击发扳机28的返回过程中，其接合表面128推抵闭合扳机26的前表面130，使闭合扳机26回到其初始位置。止动构件132可从第二基本部分52延伸以防止闭合扳机26旋转超过其初始位置。
外科缝合和切割器械10另外包括往复部分134、放大机构136和驱动构件138。往复部分134包括执行部分22中的楔形滑架(在图4-7中未示出)和金属驱动杆140。驱动构件138可包括第一和第二齿条141和142。第一槽口144可设置在驱动构件138上并介于第一和第二齿条141、142之间。在击发扳机28的返回运动过程中，击发扳机28上的齿146与第一槽口144接合，用于使驱动构件138在缝钉击发后返回其初始位置。可以在金属驱动杆140的近端处设置第二槽口148，用于将金属驱动杆140锁定到处于未击发位置的释放按钮30的上栓锁臂118。
放大机构136包括一体的第一和第二小齿轮150和152。一体的第一小齿轮150可与设置在金属驱动杆140上的第一齿条154接合。一体的第二小齿轮152可与设置在驱动构件138上的第一齿条141接合。一体的第一小齿轮150可具有第一直径，一体的第二小齿轮152可具有比第一直径小的第二直径。
图4、6和7分别描绘了处于起始位置(打开且未击发)、夹紧位置(闭合且未击发)以及击发位置的手柄组件20。击发扳机28可设有齿轮节段部分156。齿轮节段部分156可与驱动构件138上的第二齿条142接合，使得击发扳机28的运动引起驱动构件138在图8中所示的第一驱动位置和图9中所示的第二驱动位置之间来回运动。为了防止在夹紧组织之前击发缝钉，释放按钮30上的上栓锁臂118可与驱动构件138上的第二槽口148接合，从而将金属驱动杆140锁定在其最近位置，如图4所示。当上栓锁臂118落入凹陷122中时，上栓锁臂118与第二槽口148脱离接合以允许金属驱动杆140向远侧运动，如图7所示。
由于驱动构件138上的第一齿条141和金属驱动杆140上的齿条154与放大机构136接合，因此，击发扳机28的运动引起金属驱动杆140在图8所示的第一往复位置和图7所示的第二往复位置之间往复运动。因为第一小齿轮150的直径大于第二小齿轮152的直径，所以放大机构136使往复部分134运动的距离比击发扳机28使驱动构件138运动的距离更大。可以改变第一和第二小齿轮150和152的直径以允许击发扳机28的行程长度和使其运动需要的力发生改变。可以理解，手柄组件20是示意性的，可以采用其它致动机构。例如，可以用自动装置来产生闭合和击发动作。
图3和图8-10中描绘了外科切割和缝合器械10的端部执行器12的一种实施方式。如上面描述的，手柄组件12可产生致动端部执行器12的单独且不同的闭合和击发动作。端部执行器12可有利地维持这种单独且不同的闭合和击发(即，缝合和切断)的临床灵活性。图9描绘了本发明的钉仓实施方式300，其安装在端部执行器12的细长通道16中，且击发杆14处于其未击发、近侧位置。钉仓300具有由细长槽310隔开的钉仓主体302，钉仓主体302从钉仓300的近端304朝变细的外末端306延伸。钉仓主体302内形成多个缝钉容纳通道320a-320f。在举例的各种实施方式中，缝钉容纳通道320a-320f可布置在6个侧向间隔开的纵向排中，细长槽310的每一侧上有3排。缝钉222设置在缝钉容纳通道320a-320f内并且如已知的支撑在可动驱动器330上。例如，可采用例如题为“Staple CartridgesFor Forming Staples Having Differing Formed Staple Heights”、公开号为No.2007/0045379的共有美国专利申请中描述的那些缝钉驱动装置，该专利申请的公开内容全部通过引用结合在此。然而，可以有效采用其它类型的缝钉和缝钉驱动器布置，也不脱离本发明的精神和范围。
砧座18可以各种已知的布置可动地连接到细长通道16的近端，使得随着例如由闭合套筒32施加到砧座18的打开和闭合动作，砧座18能够在打开和闭合位置之间运动。砧座18可具有主体部分200，主体部分具有多个缝钉形成表面202，缝钉形成表面中具有与设置在钉仓300中的缝钉通道320a、320b、320c、320d、320e和320f相符的缝钉成形凹窝(未示出)。砧座还具有顶部或者外表面204。例如，砧座18由支在细长通道16的近端的槽230中的耳轴232可枢转地联接到细长通道的近端(图11)，使得当处于打开位置时，砧座18的缝钉形成表面202与安装在细长通道16内的钉仓300间隔开，并且当由闭合套筒32向砧座18施加闭合动作时，引起砧座18的缝钉形成表面202与钉仓300成面对关系以使组织“T”能够被夹紧在其间，如图8所示。然而，砧座18可利用各种不同的已知砧座连接布置而相对于钉仓300可动地支撑。
如可从图3和11中看到的，钉仓主体302可安装在仓盘224内。如图3所示，钉仓主体302可形成有两个内部纵向延伸槽390和两个外部纵向延伸槽392。槽390和392从钉仓的近端304延伸到其变细的外末端306。这种钉仓实施方式300还包括可滑动地支撑在仓盘224上的楔形滑架400。一种楔形滑架400实施方式包括一对内部滑架凸轮410，其中，一个内部滑架凸轮410对应于一个内部纵向延伸槽390，另一个内部滑架凸轮410对应于另一个内部纵向延伸槽390，见图3。楔形滑架400还可包括一对外部滑架凸轮420，其中，一个外部滑架凸轮420对应于一个外部纵向延伸槽392，另一个外部滑架凸轮420对应于另一个外部纵向延伸槽392，如图19所示。当组装好时，仓盘224将楔形滑架400和驱动器330保持在钉仓主体302内部。
如从图11可看到的，细长通道16可具有近侧地放置的连接腔226用于接收通道锚固构件228，通道锚固构件228位于框架34的远端上用于将端部执行器12连接到手柄组件20。可环绕框架34的闭合套筒32包括位于远侧的翼片234，其与近侧但却在砧座18上的砧座枢轴232远侧的砧座部件236接合，由此实现砧座18的打开和闭合。击发驱动构件36被显示出由通过销240连接到击发连接件238的击发杆14组装，击发连接件238又旋转地且在近侧地连接到金属驱动杆140。击发杆14在框架的远端处由插入在其中的槽式引导件239引导。
回到图3和8-10，在本发明的各种实施方式中的至少一种中，优选地多个光源500支撑在细长通道16内。例如在一种实施方式中，光源500可包括通过延伸通过细长通道16和框架34的导体602与手柄组件20(图1)内安装的电能源600电连接的发光二极管(LED)。例如，在各种实施方式中，电能源可包括一个或多个电池。然而，在另一些实施方式中，光源500可由交流电(AC)供电。更具体地，手柄组件20可配备有可插入AC插座的电源线(未示出)。在又一些实施方式中，电能源可包括可操作地支撑在框架34内的一个或多个电池。
如可从图3看到的，每个光源500可安装在设置于细长通道16中的光接收端口510内。仓盘224和钉仓主体302可分别设有与每个光源500对应的光接收开口或者通道228、520，从而允许每个光源500发出的光竖直地通过光接收通道228、520并通过钉仓主体302。因此，当医生在夹紧其中的组织之前最初抓取、移动并操作组织“T”时，通过钉仓主体302的光可帮助照亮该区域和周围组织。
然而，如可从图3和8中最显著地看到的，本发明的各种实施方式还可具有延伸通过砧座主体200的光接收通道530。每个光接收通道530与钉仓主体302中的光接收通道520对应，使得当砧座18处于如图3所示的闭合位置时，光将从钉仓主体302中的光接收通道520通过砧座主体200中的对应光接收通道530。由此，当如图8中所示的医生夹紧砧座18和钉仓300之间的组织“T”时，那些由组织“T”阻挡的光接收通道228、520将不从它们的对应光源500接收光。然而，光将通过没有被组织“T”阻挡的那些通道228、520、530。因此，通过注意哪个通道530正在发光，医生就能够确认夹紧在端部执行器12中的组织“T”的位置。在各种实施方式中，砧座18还可以配备有至少一个，优选为两个向下延伸的组织定位件19，用来帮助将组织“T”定位在端部执行器12内。
图12和13示出了一种替代的外科切割和缝合器械10’，其具有替代的端部执行器实施方式12’，该端部执行器12’除了下面讨论的区别之外与上面描述的端部执行器12大体相同。例如，在这种端部执行器实施方式12’中，至少一个、优选至少两个光纤电缆700安装于设置在细长通道602中的通道702内，如图13所示。光纤电缆700可与安装在手柄组件20或者框架34中的至少一个光源800相互配合。该至少一个光源800可包括一个或多个发光二极管等。光纤电缆700用于将光源800发射的光传输到仓盘224中的相应光接收通道228中和钉仓主体302中的光接收通道520中用于从砧座主体200中的光接收通道530排出。
图14-17示出了另一种替代的端部执行器12”实施方式，其除了下面讨论的区别之外与上面描述的端部执行器12大体相同。例如，在这种端部执行器实施方式12”中，多个光源800安装在钉仓主体302中。在各种实施方式中，光源800包括发光二极管，其通过相应的导体802电联接至安装在钉仓主体302的下表面中的触点804并延伸通过仓盘224，见图17。当钉仓300安装在细长通道16内时，第一触点被限制与安装在细长通道16中的相应的第二触点电接触，并与例如安装在框架34或者手柄组件20中的一个或多个电池的电能源电接触。因此，当钉仓300安装在细长通道16中时，光源800通过相应的第一和第二触点804、806之间的相互电连接供电。
在这里公开的各种端部执行器实施方式中，可采用不同颜色的发光二极管例如用来区别端部执行器的不同部分，以进一步帮助医生确定组织在端部执行器内的位置。例如，端部执行器的远端部分可配置有红灯。端部执行器的中间部分可具有绿灯且端部执行器的近端部分可具有黄灯等。
使用时，如图1-2中描述的使用外科缝合和切割器械10。在图1-2中，器械10处于其起始位置，未击发、完全装载的钉仓300扣合到细长通道16的远端中。扳机26、28都向前且端部执行器12打开，如端部执行器12通过套管针或者其它开口插入到体腔中之后的典型形态。然后医生操作器械10使得待缝合和切断的组织“T”被定位在钉仓300和砧座18之间，如图8和14所示。然后医生向近侧移动闭合扳机26直到其被定位成紧挨手枪式握把24，将手柄组件20锁定到闭合且夹紧位置。端部执行器12中缩回的击发杆14不阻止端部执行器12的选择性打开和闭合，而是停驻在砧座凹窝40内。在砧座18闭合且夹紧的情况下，击发杆14对准用于通过端部执行器12击发。在已经夹紧组织后，医生向近侧移动击发扳机28，引起击发杆14向远侧移动到端部执行器12中。医生继续移动击发扳机28直到其接近闭合扳机26和手枪式握把24。由此，缝钉222与砧座18的接合造成它们的所有端部弯曲。切割刃48完全横过组织。通过释放击发扳机28并然后压迫释放按钮30且同时挤压闭合扳机26来打开端部执行器12而完成该过程。
尽管已经通过若干实施方式示出了本发明且所示的实施方式已经描述得相当详细了，但申请人并不意于将后附权利要求的范围局限于这样的细节。本领域的技术人员可以想到其它优点和变型。本发明的各种实施方式表现出对现有的端部执行器的巨大进步。
相应地，本发明按照内窥镜式过程和设备进行讨论的。然而，这里使用的术语例如“内窥镜式”不应当被解释为将本发明限制于仅结合内窥镜管(即，套管针)使用的外科缝合和切割器械。相反，相信本发明可以应用于接近被限制于小切口的任何手术，包括但不限于腹腔镜式手术以及开放式手术。而且，本发明的各种端部执行器实施方式的独特和新颖方面可在结合其它形式的端部执行器和缝合设备使用时找到应用，同样不脱离本发明的精神和范围。例如，本发明的各种实施方式的各种独特和新颖特征可有效地采用在其它形式的组织抓取和组织操作端部执行器中。因此，如这里所使用的，术语“端部执行器”不应当被局限于切割和缝合端部执行器。另外，这里所公开的各种端部执行器被设计成与包括外科切割和缝合装置的一部分并不在用过钉仓后就丢弃的可重复利用击发杆/刀装置一起使用。但是，本领域的普通技术人员将会理解，本发明的各种实施方式的独特和新颖优点和特征也可以结合本领域已知的“一次性装载单元”或者例如刀杆在用过钉仓就丢弃的单元的端部执行器采用。因此，这里使用的术语“端部执行器”也被用于包含这样的一次性装载单元。
而且，这里公开的装置可设计成在一次使用后丢弃，或者可设计成多次使用。然而，在任一种情况下，装置可在至少一次使用后修复以备再次使用。修复可包括装置的拆卸、接着清洗或更换特定部件和随后的重新组装这些步骤的任意组合。特别地，该装置可以被拆卸，任何数量的特定部件或零件可以有选择地以任意组合被更换或去除。在清洗和/或替换特定部件之后，该装置可在修复设备中或在即将进行手术程序之前由手术队进行重新组装以便以后使用。本领域普通技术人员将会理解对该装置的修复可利用用于拆卸、清洗/替换、和重新组装的各种技术。这些技术的使用以及产生的修复好的装置也全都在本申请的保护范围内。
优选地，本文中公开的本发明将在外科手术前被处理。首先，获取新的或者使用过的器械并在需要的情况下对其进行清洁。该器械然后进行灭菌。在一种灭菌工艺中，器械被放置在闭合且密封的容器中，诸如塑料袋或高密度聚乙烯合成纸袋(bag)。容器和器械然后被放置在可穿透容器的辐射场中，诸如γ射线、x射线或者高能电子。辐射杀死器械上以及容器中的细菌。灭菌后的器械然后可被储存在无菌容器中。密封的容器保持器械处于无菌状态，直到其在医学场合下被打开。
被声称通过引用而全部或者部分并入本文中的任何专利、公开出版物或者其它公开材料，仅限于被并入的材料不会与本申请中公开的定义、陈述或者其它公开的材料相矛盾的部分。如此一来，必要时这里明显阐述的公开内容替代任何通过引用而并入本文中的相矛盾的材料。被声称通过引用并入本文中但是与本发明公开的定义、陈述或者其它公开的材料矛盾的任何材料或其部分将只并入不会使得所并入的材料与本发明公开的材料相矛盾的部分。
意于得到保护的本发明不能被解释为局限于公开的特定实施方式。因此，实施方式应被认为是示意性的而不是限制性的。在不脱离本发明的精神的情况下，其他人可进行变型和修改。因此，明确指出所有落入如权利要求书限定的本发明的精神和范围的这些等同方式、变型和修改都包含在本发明的范围内。
Claims (8)
1.一种用于外科切割和缝合器械的端部执行器，所述端部执行器包括：
细长通道，其能够支撑位于其中的钉仓并与所述外科切割和缝合器械可操作地联接；
砧座，其相对于所述细长通道可动地支撑，用于在打开位置和闭合位置之间选择性地运动，其中在所述闭合位置，响应于从所述外科切割和缝合器械对其施加的闭合动作，组织被夹紧在所述砧座和支撑在所述细长通道内的钉仓之间；
至少一个光源，其位于所述钉仓和所述细长通道的至少一个上，所述至少一个光源与所述砧座交接以提供通过所述砧座的一部分的可看到的视觉指示，来指示被夹紧在所述砧座和所述钉仓之间的组织的位置，其中，所述砧座具有贯穿砧座的多个光观察开口，通过所述光观察开口，所述至少一个光源在所述砧座处于所述闭合位置时能够发射，当组织被夹紧在所述砧座和所述钉仓之间时其阻挡至少一个光观察开口。
2.如权利要求1所述的端部执行器，其中，所述至少一个光源包括多个处于所述钉仓中的发光二极管。
3.如权利要求1所述的端部执行器，其中，所述砧座上具有至少一个组织定位件。
4.如权利要求1所述的端部执行器，其中，所述至少一个光源与由所述外科切割和缝合器械支撑的电能源电连接。
5.如权利要求4所述的端部执行器，其中，所述细长通道连接到所述外科切割和缝合器械的细长框架，该细长框架支撑位于其中的所述电能源。
6.如权利要求1所述的端部执行器，其中，所述至少一个光源包括支撑在所述细长通道内且可操作地与支撑在所述细长通道和所述外科切割和缝合器械中的一个内的光源通信的至少一个光纤构件。
7.如权利要求1所述的端部执行器，其中，所述细长通道与所述外科切割和缝合器械的支撑所述光源的细长框架可操作地连接。
8.如权利要求7所述的端部执行器，其中，所述细长框架与所述外科切割和缝合器械的支撑所述光源的手柄组件可操作地连接。
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- 2009-09-17 PL PL09252214T patent/PL2165654T3/pl unknown
- 2009-09-17 EP EP09252214.3A patent/EP2165654B1/en active Active
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- 2009-09-18 CN CN200910171921.3A patent/CN101683279B/zh not_active Expired - Fee Related
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| Publication number | Priority date | Publication date | Assignee | Title |
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| CN200991268Y (zh) * | 2006-12-22 | 2007-12-19 | 苏州天臣国际医疗科技有限公司 | 可照明圆管型外科手术装订仪 |
| CN201012100Y (zh) * | 2007-01-05 | 2008-01-30 | 苏州天臣国际医疗科技有限公司 | 可视圆管型外科手术装订仪 |
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| US20100065605A1 (en) | 2010-03-18 |
| BRPI0904474B1 (pt) | 2019-07-02 |
| CA2679226A1 (en) | 2010-03-18 |
| EP2165654A1 (en) | 2010-03-24 |
| BRPI0904474A2 (pt) | 2010-09-21 |
| JP2010069304A (ja) | 2010-04-02 |
| US8083120B2 (en) | 2011-12-27 |
| CN101683279A (zh) | 2010-03-31 |
| PL2165654T3 (pl) | 2018-05-30 |
| RU2009134906A (ru) | 2011-03-27 |
| CA2679226C (en) | 2016-12-20 |
| RU2508910C2 (ru) | 2014-03-10 |
| EP2165654B1 (en) | 2017-12-13 |
| JP5465498B2 (ja) | 2014-04-09 |
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