CN101940483A - 抓紧钳机构 - Google Patents

抓紧钳机构 Download PDF

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CN101940483A
CN101940483A CN2010102929404A CN201010292940A CN101940483A CN 101940483 A CN101940483 A CN 101940483A CN 2010102929404 A CN2010102929404 A CN 2010102929404A CN 201010292940 A CN201010292940 A CN 201010292940A CN 101940483 A CN101940483 A CN 101940483A
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actuator shaft
flexible handle
surgical device
model selection
selection mechanism
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CN101940483B (zh
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保罗·A·西里卡
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Covidien LP
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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
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • 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
    • 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
    • A61B17/0682—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil
    • A61B17/0686—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil having a forming anvil staying below the tissue during stapling
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B17/2909—Handles
    • A61B2017/2912—Handles transmission of forces to actuating rod or piston
    • A61B2017/2919—Handles transmission of forces to actuating rod or piston details of linkages or pivot points
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft

Abstract

本发明公开一种抓紧钳机构。本发明的外科装置包括手柄组件，手柄组件包括限定固定手柄、活动手柄、致动轴和支承于壳体内的模式选择机构的壳体，所述模式选择机构从与所述致动轴接合的第一位置运动到从所述致动轴脱离的第二位置，所述活动手柄与所述致动轴关联操作，致使所述活动手柄的运动影响所述致动轴的轴向运动，其中当所述模式选择机构处于其第一位置时，所述致动轴沿着第一轴往复运动。利用本发明的结构，内窥镜或腹腔镜外科装置可以具有在不同操作模式之间能够快速且容易操作的工具组件。

Description

抓紧钳机构
本申请是申请日为2007年10月8日、申请号为200710162804.1、发明名称为“抓紧钳机构”的专利申请的分案申请。
技术领域
本公开涉及外科缝合装置，尤其涉及制造成以独立于夹紧和/或弹射模式的抓紧模式来操作工具组件的内窥镜外科缝合装置。
背景技术
首先在对置的钳结构之间抓紧或者夹紧组织，然后用外科紧固件连接的外科装置是本领域所熟知的。该紧固件的典型形式是外科缝合钉，但是也可以利用两部分的聚合紧固件。
实现该目的的器械可以包括具有分别用于抓紧或者夹紧组织的两个细长部件的工具组件。典型的，该部件中的一个携带缝合钉钉仓，该钉仓容置例如至少两侧排排列的多个缝合钉，而另一个部件具有当缝合钉从缝合钉钉仓被驱出时用于限定形成缝合钉腿部的表面的砧座。在某些缝合器中，缝合操作是通过纵向穿过缝合钉钉仓的凸轮连杆作用的，并且该凸轮连杆作用于缝合钉推动器上用于从缝合钉钉仓中顺序弹出缝合钉。刀可以在缝合钉排之间穿行，用于纵向切割缝合钉排之间缝合的组织。这种缝合器已在专利号为6,250,532和6,241,139的美国专利中公开，所述专利文献当前都为Tyco医疗健康集团所有，并且将其全部内部引用于此作为参考。
在内窥镜或者腹腔镜程序中，外科是通过小切口或者通过插入穿过皮肤中的小射入伤口的小口径插管来执行的。当器械穿过皮肤定位时由于其运动的有限程度，外科医生很难在身体组织周围操作该器械的工具组件以接近和/或夹紧组织位置。具有可转动内窥镜主体部和可转动和\或可活动的工具组件的器械已经被研发以克服该问题，并且是可购买到的。尽管这些器械在内窥镜工具领域提供了显著的改善，但仍需要对其进一步改进以减少外科过程所需的时间且允许其更容易接近组织位置。
因此，对具有在不同操作模式之间能够快速且容易操作的工具组件的内窥镜或腹腔镜外科装置的需求持续存在。
发明内容
根据本公开，提供一种外科缝合装置，其包括具有活动手柄的手柄组件、细长部件和一次性装载部件(DLU)。所述DLU包括定位在远端具有砧座组件和钉仓组件的工具组件。所述细长部件可转动地固定在所述手柄组件上。所述工具组件是缝合装置，并且所述手柄组件包括抓紧掣子(grasping pawl)，所述抓紧掣子可向里运动与致动轴啮合以允许以抓紧模式操作所述工具组件。更准确地说，所述抓紧掣子由可滑动地定位在所述手柄组件的相对侧上的一对滑钮操作，且选择性地向里运动与致动轴啮合，以允许致动轴运动一距离，根据所述活动手柄的操作，所述距离将影响所述工具组件的钉仓和砧座组件的靠近，但不会影响钉的弹射。
本公开的另一方案，旋转控制部件可转动安装在所述手柄组件的前端以便于细长部件相对所述手柄组件的转动。
本公开的再一方案，联接杆邻近所述旋转控制部件安装以便于所述工具组件的联接。
附图说明
在此接合附图公开本公开的外科缝合装置的实施方式，其中：
图1是本公开的外科缝合装置的侧视立体图；
图2是图1所示表示细节区域的放大视图；
图3图1所示的部件分解的外科缝合装置近端的侧视立体图；
图4是沿图1的剖切线4-4的横截面后视立体图；
图5是图3所示表示细节区域的放大视图；
图6是图5的弹簧支座的立体图；
图7是图5的上升掣子的立体图；
图8是图5的锁闭凸轮的立体图；
图9是图3所示表示细节区域的放大视图；
图10是图3的齿条的仰视立体图；
图11是抓紧掣子臂从图9所描述的角度旋转90°的侧视立体图；
图12是图1所示外科缝合装置的侧视图；
图13是图12所示表示细节区域的放大视图；
图14是图1的手柄组件的侧视横截面图；
图15是图14所示表示细节区域的放大视图，表示手柄组件处于夹紧/弹射模式；
图16是沿图4的剖切线16-16的侧视横截面图；
图17是图1所示外科缝合装置的手柄组件的部分拆除的侧视立体图，除去壳体；
图18表示啮合齿条的图15的抓紧掣子；
图19是表示活动手柄朝固定手柄枢转的侧视横截面图；
图20是表示上升掣子通过锁闭凸轮偏压至下降位置的侧视横截面图；
图21是表示活动手柄从固定手柄偏离开的侧视横截面图；
图22是表示致动轴在缩回位置的侧视横截面图；
图23是表示上升掣子处于上升位置和滑钮处于上升位置引起抓紧掣子啮合齿条的侧视横截面图。
具体实施方式
下面将参照附图详细地描述本公开的抓紧钳机构的实施方式，其中每个图中相同的附图标记表示相同或相应的构件。
贯穿本说明书，术语“近侧”指距操作者最近的装置部分，而术语“远侧”指距操作者最远的装置部分。
图1表示总体上用10表示的本公开外科缝合装置的一实施方式。外科缝合装置10包括手柄组件13，从手柄组件13远侧延伸的细长部件14和可释放地固定在细长部件14的远端的一次性装载部件(DLU)16。DLU16包括形成细长部件14的延伸部分的近侧主体部29和包含钉仓组件26和砧座组件28的远侧工具组件27。钉仓组件26和砧座组件28还限定一对钳。工具组件27关于与细长部件14的纵轴基本垂直的轴枢转地连接于主体部29。钉仓组件26容置多个缝合钉。在从钉仓组件26间隔开的打开位置和与钉仓组件26并排对准的靠近或夹紧位置之间砧座组件28可相对钉仓组件26运动。工具组件27可选择性地布置为：钉仓组件26可以相对砧座组件28运动。DLU 16被制成应用测得长度大约30mm到大约60mm的线型排的缝合钉。也可以想像到DLU的具有其它长度如45mm的线型排的缝合钉。
手柄组件13包括固定手柄18，活动手柄20和套管部19。旋转控制部件22可旋转安装在套管部19的前端，以利于细长部件14相对手柄组件13的转动。旋转控制部件22由注塑半成面(half-section)12a和12b形成，当然可以想像到用诸如金属的其它材料和制造方法。联接杆24也邻近旋转控制部件22安装在套管部19的前端，以便于工具组件30的联接。Milliman等人的，为TYCO医疗健康集团所有的专利号为5,865,361的美国专利，描述了用于外科缝合装置的旋转控制组件和联接组件，且在此将其全部内容引入作为参考。
一对牵引器旋钮15可动地沿着套管部19定位以将装置10返回到缩回位置，下文将对其进行详细的说明(见图1)。在活动手柄20的相对侧面中的一对凹槽42和48(见图2)，分别用于可滑动地容纳滑钮40和45(见图3)。滑钮40与滑钮45关联操作，即其一的运动影响另一个的运动。滑钮40和45被制成使装置10在“抓紧”模式和“弹射”或夹紧模式之间切换。在抓紧模式中，工具组件27被制成作为抓紧钳机构操作，即，砧座组件28在打开和靠近位置之间相对钉仓组件26前后运动以在抓紧其间的组织。在夹紧模式中，工具组件27被制成作为夹紧机构操作，即，砧座组件28相对钉仓组件26可运动以抓紧其间的组织且应用线排的缝合钉。夹紧模式中，使用者可以缩回牵引器旋钮15以打开工具组件27且释放组织。滑钮40与45各自分别包括上升面(raised surface)40a和45a。上升面40a和45a被制成与外科医生的手指接合以分别在凹槽42和48内移动滑钮40与滑钮45。为便于理解，对于滑钮40与45也可以考虑在旋钮，杆，按钮，套柄，板机组件等中选择。
手柄组件13包括由一对模制的半成面12a和12b形成的壳体12，所述壳体形成手柄组件13的固定手柄18和套管部19。半成面12a和12b由诸如聚碳酸酯(polycarbonate)的热塑性材料制成。可选地，可以应用具有必需强度要求的诸如外科级金属的其它材料来形成壳体12。壳体12半成面12a和12b使用公知的诸如胶粘，焊接，联锁结构，螺杆等的紧固技术彼此固定。可选地，可以用其它紧固技术。
参照图3，活动手柄20关于圆柱部件(未示出)可转动地支承在壳体半成面12a和12b之间，所述圆柱部件容纳于活动手柄20内的开口31内。诸如扭转弹簧的偏压部件(未示出)可被包括，以促使活动手柄20远离固定手柄18至非压缩位置。活动手柄20包括一对大小可容纳枢转部件34的通孔33。提升掣子(advancement pawl)35可转动地支承在枢转部件34上，并受弹簧36偏压朝向致动轴90。
致动轴90可滑动地支承于壳体12的套管部19内的缩回和提升位置之间，并包括限定被制成可转动地容纳控制杆95的近端97的凹槽94的远端。致动轴90包括齿条92。提升掣子35具有受弹簧36偏压朝向致动轴90的齿条92的接合指35a。当致动活动手柄20时，即逆着扭转弹簧(未示出)的偏压朝着固定手柄18枢转时，掣子35的接合指35a接合致动轴90的齿条92以提升远端的致动轴90和控制杆95。
参照图3和图5-8，上升掣子120可滑动地定位于限定在壳体半成面12a和12b之间的狭槽121(见图15)里。上升掣子120从上升掣子120的尖端125接合形成在致动轴90远端的切口93的延伸的或上升位置运动到上升掣子120的尖端125从致动轴90间隔开的缩回或下降位置。支承于壳体半成面12a和12b之间的弹簧130被定位，以偏压上升掣子120至延伸位置。在延伸位置，上升掣子120防止致动轴90的提升以防止装置10的弹射。
柱塞30可往复地支承于形成在壳体半成面12a和12b中的间隔的圆柱沟槽(未示出)之间。柱塞30包括凸轮部件32。可以将弹簧(未示出)定位在间隔的圆柱沟槽(未示出)内的柱塞30的各端上，以将柱塞30推进到使凸轮部件32中心定位在形成于上升掣子120上的一对凸轮面122之间(见图7)的位置。各凸轮面122具有形成于其中的凹槽124以可释放地容纳柱塞30的凸轮部件32。
柱塞30的各端30a延伸穿过固定手柄18，且被压在偏压弹簧(未示出)上，以迫使凸轮部件32与上升掣子120上的相应的一个凸轮面122接合。当向里移动凸轮部件32与凸轮面122中相应的一个接合时，上升掣子120从延伸位置被推到缩回位置以将上升掣子120的尖端125移出致动轴90的切口93(见图19-23)。凸轮部件32在相应凸轮面122的凹槽124里的定位保持上升掣子120在缩回位置。
参照图3和图5，锁闭凸轮组件107支承在壳体12的套管部19内的缩回和提升位置之间(见图1)，并且包括弹簧支座110和具有尖端102和近侧表面100a的凸轮部件100。如图3和图5所示，柱塞30容纳于环形凹槽112内，其被限定在弹簧支座110的底侧以使弹簧支座110保持在壳体半成面12a和12b之间。凸轮部件100可滑动地容纳于限定在弹簧支座110中的狭槽115中。凸轮部件100从凸轮部件100的尖端102啮合上升掣子120的尖端125的延伸或远侧位置移动到凸轮部件100的尖端102从上升掣子120间隔开的缩回或近侧位置。在缩回位置，凸轮部件100的表面100a与弹簧支座110间隔开。凸轮部件100近侧受弹簧105的偏压，所述弹簧105一端固定于在凸轮部件100的远端中确定的凹槽104且相对端被制成接合由弹簧支座110中的狭槽115形成的延伸部114。在延伸或远侧位置，凸轮部件100的尖端102与上升掣子120的尖端125a接合以保持上升掣子120在缩回位置。
参照图3，图9和图11，活动手柄20包括与滑钮40和45关联操作的抓紧掣子组件67。抓紧掣子组件67被制成关于响应于滑钮40和45的操作而进行运动。抓紧掣子组件67包括具有限定在掣子臂50顶端的外凸出部52上的斜面55的掣子臂50和可枢转地支承在掣子臂50的外凸出部52内的抓紧掣子60。滑钮45的顶端包括具有限定凹进槽48的延伸部48a的内弯部46。凹进槽48被量度和制成可滑动地容纳由掣子臂50底端中的凹进槽58限定的延伸部58a。相互地，掣子臂50中的凹进槽58被量度和制成可滑动地容纳滑钮45的延伸部48a。滑钮45的底端包括被制成容纳从其中穿过的连接器销钉44的开孔41a。圆柱插筒40b从滑钮40的内表面向外延伸，且其被量度和制成在形成于活动手柄20的凹槽42中的纵向狭槽42a内平动。连接器销钉44被加工成一定大小，以便可被容纳在插筒40b内，以将滑钮45固定到滑钮40上。突出部47设置在滑钮45的侧面上，所述滑钮45被制成以搭扣配合的方式容纳于被限定在活动手柄20内的一对棘爪108a和108b内(见图4)，如下文将进一步详细地讨论的。
掣子臂50的外凸出部52包括凹进槽53，所述凹进槽53具有一对大小可滑动地容纳枢转销钉56的通孔57。偏压弹簧64在一端被制成其中可插入地容纳枢转销钉62且其在另一端可插入地容纳于凹进槽53内。抓紧掣子60包括一对限定凹槽60a的侧向延伸部60b和60c。枢转销钉56容纳于抓紧掣子60底端的开孔61。枢转销钉62可枢转地容纳于凹槽60a内，从而抓紧掣子60相对掣子臂50以关于枢转销钉62的近端向(proximal direction)枢转。凹进槽53被加工成一定大小以在如沿着掣子臂50纵轴的平面位置和接近或向后位置之间容纳抓紧掣子60的枢转运动。侧向延伸部60b被制成与凹进槽53的表面53a接触，以使抓紧掣子60的枢转运动相对于掣子臂50受到平面位置的近侧方向限制。侧向延伸部60c被制成通过在外凸出部52中的槽53枢转以允许抓紧掣子60枢转运动至近侧或向后位置。在近侧或向后位置，侧向延伸部60c在限定于外凸出部52中的孔63内挤压枢转销钉62，进而挤压弹簧64(见图23)。
参照图17，手柄组件13(见图1)还包括被制成使装置10返回到默认抓紧模式的轭80，这样使得滑钮40和45返回到上升位置以推进抓紧掣子60使其与齿条92的远端部中的狭槽啮合，如在下文详细讨论的。轭80关于容纳于轭80的开孔82内的圆柱部件(未示出)旋转支承在固定手柄18内。一对臂80a和80b从开孔82侧向延伸。基于活动手柄20在箭头“A”表示的方向(见图19)上的运动，即朝固定手柄18枢转，滑钮40和45从抓紧掣子60接合在致动轴90的齿条92中的狭槽92b的上升位置运动到抓紧掣子60从致动轴90的齿条92间隔开的下降位置。当抓紧掣子60定位在狭槽92b内时，基于活动手柄20的操作，致动轴90将仅发生有限地提升和缩回，从而允许装置10以抓紧模式运行。在上升位置，滑钮45上的突出部47定位在棘爪108a内。滑钮45的向下运动引起突出部47从棘爪108a向下运动至棘爪108b，如图4所示。在棘爪108a和棘爪108b内容纳突出部47为外科医生提供指示滑钮40和45的位置/模式变化的听觉和/或触觉反应。活动手柄20在以箭头“C”表示的方向(见图21)上的运动过程中，即朝向其从固定手柄18间隔开的初始位置运动，形成在臂80a的远端的凸轮部件84可滑动地啮合限定在影响轭80顺时针转动的活动手柄20的近侧边上的凸轮面25，使轭80的臂80b接合形成在滑钮45顶端上的柱43，以在图18中由箭头“E”表示的方向上推进滑钮40和45到上升位置。如图23所示，抓紧掣子60通过致动轴90的齿条92中的狭槽92a向下运动。
包括牵引器旋钮15(见图1)的缩回机构通过联接杆96与致动轴90的近端连接。联接杆96包括左、右接合部96a和96b，所述左、右接合部96a和96b贯穿形成于壳体半成面12a和12b中的细长槽17，并且所述接合部96a和96b被制成以容纳牵引器旋钮15。联接杆96的中部96c被量度和制成可滑动地容纳于形成于一对相对的狭槽98内，所述狭槽98形成在与致动轴90近端相邻的致动轴90中。释放板70通过一对间隔设置的销钉91(见图3)被支承在致动轴90的一侧。销钉91从致动轴90的侧面向外延伸以与一对穿透释放板70形成的成角度的凸轮槽71接合。以这种方式，释放板70与致动轴90关联操作，且其被安装以关于对牵引器旋钮15的操作的响应而运动。
使用中，当向后或向近侧拉牵引器旋钮15时，在联接杆96在致动轴90的狭槽98中滑动的情况下，联接杆96最初相对致动轴90向后移动释放板70。当发生此情况时，释放板70通过销钉91相对致动轴90向下运动，从而覆盖齿条92以使提升掣子35的接合指35a从齿条92脱离。一旦联接杆96到达其与狭槽98的近端接合的位置，牵引器旋钮15的额外的向后运动将引起致动轴90的缩回进而控制杆95向后缩回。致动轴90近侧受弹簧64的偏压，所述弹簧64在一端通过连接器75固定于联接杆部96c，并且在另一端固定于致动轴90上的柱77。
外科缝合装置10最初处于抓紧模式。参照图19，操作活动手柄20以便在往复的方式上前后地打开和靠近钉仓组件26和砧座组件28。活动手柄20以箭头“A”表示的方向运动完成抓紧行程，其中活动手柄20逆着扭转弹簧(未显示)的偏压朝向固定手柄18枢转，以将提升掣子35的接合指35a移动至与形成在致动轴90上的凸台99接合。活动手柄20随后的运动使掣子臂50逆时针方向旋转而完成抓紧行程。掣子臂50的逆时针的旋转导致掣子臂50的外凸出部52的斜面55与凸轮部件100的近侧面100a接合，将凸轮部件100偏压至延伸或远侧位置。在延伸或远侧位置，凸轮部件100的尖端102与上升掣子120的尖端125a接合以保持上升掣子120在缩回位置(见图20)。在缩回位置，上升掣子120与致动轴90间隔开，基于活动手柄20在箭头“C”表示的方向上的后续运动，其允许致动轴90返回到缩回位置。
参照图21，当活动手柄20被使用者释放后，偏压部件(未示出)在箭头“C”表示的方向上将活动手柄20返回到其初始位置。当活动手柄20返回到其初始位置时，轭80的臂80b向上滑动滑钮40、45，以使装置10保持在抓紧模式。向下滑动滑钮40、45以将装置10的模式改变至夹紧模式，这样使活动手柄20在“A”方向上的后续运动夹紧钉仓组件26和砧座组件28至组织上，以使钉仓组件26和砧座组件28在活动手柄20释放后仍保持靠近。上升掣子120移动至与致动轴90中的切口93接合以将致动轴90锁定在适当位置。当向壳体半成面12a和12b内压入柱塞30时，柱塞30的凸轮部件32接合上升掣子120的凸轮面122，以使凸轮部件32可释放地容纳于凹槽124中，以便将上升掣子120在图22中箭头“D”表示的方向上推到其缩回位置。在缩回位置，上升掣子120的尖端125在致动轴90的切口93的外面。通过在柱塞30的凸轮部件32与上升掣子120的凸轮面122上的凹槽124之间的接合，上升掣子120保持在缩回位置。
活动手柄20返回到其初始位置且推动轭80顺时针方向转动。轭80的顺时针转动驱使轭80的臂80b接合滑钮45上的柱43以将滑钮40和45推进到上升位置。在上升位置，当齿条92被提升时，则通过齿条92的槽92a取代槽92b向下枢转地偏压抓紧掣子60(见图23)。现在，装置10处于弹射就绪模式。通过在“A”方向移动活动手柄来致动活动手柄20以提升致动轴90，从钉仓组件26里调配(deploying)钉。活动手柄20在图19中箭头“A”表示的方向上移动完成第二弹射行程，在该过程中，提升掣子35接合致动轴90的齿条92，以便远侧地提升致动轴90和控制杆95。再参照图19，当致动轴90远侧地运动时，形成在致动轴90上的凸台99接合上升掣子120以向下移动上升掣子120，从而使柱塞30的凸轮部件32从上升掣子120的凸轮面122脱离，且允许弹簧(未示出)将柱塞30返回到诸如非压缩位置的中性位置。活动手柄20在图21中箭头“C”表示的方向上的后续运动进一步提升齿条92。牵引器旋钮15被用于缩回致动轴90进而向后缩回控制杆95，在齿条92的狭槽92b内重新对准抓紧掣子60。当轭80将滑钮45保持在上升位置时，装置10处于抓紧就绪模式。
在内窥镜检查程序中，在执行夹紧和缝合前，组织经常必须被操作或拉到一边以允许外科医生接近和/或观察组织部位。本公开提供的可选操作模式理解为允许外科医生在将装置10轻易切换到工具组件27被制成夹紧组织和应用钉的操作的夹紧模式前，得益于在通过操作活动手柄20来操作工具组件27以抓紧和操作组织的抓紧模式下操作装置10。
图14表示装置10的缩回机构操作。使用中，当由外科医生向后拉牵引器旋钮15时，在联接杆96在致动轴90的狭槽98中滑动时，联接杆96首先相对致动轴90向后移动释放板70，以使销钉91向下将释放板70运动到覆盖致动轴90的齿条92并使掣子120的指125从齿条92脱离的位置。当将联接杆96向后拉至使其接合狭槽98后端的位置时，牵引器旋钮15额外的向后运动将影响致动轴90和控制杆95的近侧运动。
在可选的实施方式中，外科缝合装置10可以具有抓紧模式，但没有柱塞30。在该实施方式中，除去了上升掣子120和锁闭凸轮组件107。
图19和图20中装置10起始于抓紧模式。当抓紧掣子60接合在狭槽92b中时，活动手柄20可以前后运动以打开和关闭工具组件27的钳子。在该实施方式中，除去了上升掣子120和锁闭凸轮组件107。
滑下滑钮40，45将抓紧掣子60从狭槽92b移开。当操作活动手柄20以夹紧组织时，抓紧掣子60移进狭槽92a。当进一步操作活动手柄20时，提升掣子35提升齿条92并弹射缝合钉。随着提升掣子35反复接合和脱离齿条92，活动手柄20的多次行程被用于提升齿条92。弹射过程中轭80保持滑钮40，45在上升位置。当牵引器旋钮15被用于缩回齿条92后，抓紧掣子60对准狭槽92b，并且装置10再次处于抓紧模式。
可以理解，可以对本文公开的实施方式进行各种修改。例如，可以想像到本公开的外科缝合装置可与诸如夹子供应器，解剖器，电外科密封装置等的其它外科装置结合使用。另外，该装置也可以包括不同于缝合器或那些喷射诸如密封装置(电外科和非电外科的)等的紧固件的装置的工具组件。对本装置而言，用于改变装置操作模式的按钮或其他的致动器可以设置在手柄组件的一侧或两侧。因此，上面的描述不应理解为限定，而仅是优选实施方式的示例。本领域技术人员可以想到在所附权利要求的范围和宗旨内的其它修改。

Claims (14)

1.一种外科装置，包括：
手柄组件，包括限定固定手柄、活动手柄、致动轴和支承于壳体内的模式选择机构的壳体，所述模式选择机构从与所述致动轴接合的第一位置运动到从所述致动轴脱离的第二位置，所述活动手柄与所述致动轴关联操作，致使所述活动手柄的运动影响所述致动轴的轴向运动，其中当所述模式选择机构处于其第一位置时，所述致动轴沿着第一轴往复运动。
2.根据权利要求1所述的外科装置，其中当所述模式选择机构处于其第二位置时，致动轴提升机构在远侧方向提升所述致动轴。
3.根据权利要求2所述的外科装置，其中所述致动轴具有齿，并且所述致动轴提升机构是以交替方式接合和脱离所述齿的掣子。
4.根据权利要求3所述的外科装置，其中所述掣子连接于所述活动手柄且当所述活动手柄朝向所述固定手柄运动时接合所述齿。
5.根据权利要求1所述的外科装置，其中所述模式选择机构包括安装在所述活动手柄上的可滑动按钮。
6.根据权利要求2所述的外科装置，其中所述模式选择机构包括当所述模式选择机构在所述第一位置时与限定在所述致动轴中的第一狭槽接合的抓紧掣子。
7.根据权利要求6所述的外科装置，其中所述致动轴具有设置在第一狭槽近侧的第二狭槽，当所述模式选择机构处于其第二位置时，所述抓紧掣子被设置在所述第二狭槽中。
8.根据权利要求1所述的外科装置，其中所述模式选择机构包括可滑动按钮和可枢转的轭，所述可枢转的轭设置在所述手柄组件中且具有接合所述活动手柄的第一臂和接合所述可滑动按钮的第二臂，当所述可滑动手柄从所述固定手柄移开时，所述轭将所述可滑动按钮维持在所述第一位置。
9.一种外科装置，包括：
手柄组件，包括限定固定手柄、活动手柄、轴和支承于壳体中的模式选择机构的壳体，所述模式选择机构与可滑动地支承于所述活动手柄上的至少一个滑钮关联操作，所述至少一个滑钮从第一位置运动到第二位置，所述第一位置与所述装置的第一操作模式相关，并且所述第二位置与第二操作模式相关，其中所述轴在第一操作模式中与所述模式选择机构接合，并且在所述第二操作模式中与所述模式选择机构脱离。
10.一种外科装置，包括：
具有活动手柄的手柄组件，所述活动手柄具有模式选择机构，所述模式选择机构包括可滑动支承于所述手柄组件上的滑钮，以使所述滑钮从所述手柄组件的任一侧都可接近；
从所述手柄组件远侧延伸的细长部件；及
安装在所述细长部件的远端部的工具组件。
11.一种致动外科装置的方法，包括步骤：
操作外科装置的活动手柄，以使所述外科装置的致动轴以往复运动的方式运动，所述活动手柄连接到与所述致动轴接合的接合部件；
致动按钮以便使所述接合部件远离所述致动轴；及
操作所述活动手柄，以使提升部件接合所述致动轴且在远侧方向提升所述致动轴。
12.根据权利要求11所述的方法，其中所述致动轴以往复运动的方式运动以打开和开闭所述外科装置的一对钳子。
13.根据权利要求12所述的方法，其中所述提升部件以多于一次的所述活动手柄的行程接合和脱离所述致动轴，以提升所述致动轴。
14.根据权利要求13所述的方法，其中所述提升部件接合所述致动轴以关闭所述一对钳子，然后接合所述致动轴以从所述外科装置的至少一个钳子处弹射缝合钉。
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