CN102076270A - 具有自动可重构关节运动端部执行器的外科手术器械 - Google Patents
具有自动可重构关节运动端部执行器的外科手术器械 Download PDFInfo
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- 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
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00022—Sensing or detecting at the treatment site
- A61B2017/00026—Conductivity or impedance, e.g. of tissue
- A61B2017/0003—Conductivity or impedance, e.g. of tissue of parts of the instruments
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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
- A61B2017/00535—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
- A61B2017/00539—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated hydraulically
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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
- A61B17/28—Surgical forceps
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- 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
- A61B90/06—Measuring instruments not otherwise provided for
- A61B2090/067—Measuring instruments not otherwise provided for for measuring angles
Abstract
本发明公开了一种具有能够自动作关节运动的端部执行器的外科手术器械,例如外科手术切割和紧固器械。所述外科手术器械可包括端部执行器、轴和连接在所述端部执行器和所述轴之间的可关节运动的接头组件。所述接头组件包括用于使所述端部执行器相对于所述轴进行关节运动的至少一个马达。所述接头组件包括用于感测所述端部执行器相对于所述轴的关节运动的至少一个关节运动传感器。所述器械还包括与所述关节运动传感器和所述马达通信的控制单元。控制单元包括用于存储来自所述至少一个关节运动传感器的关节运动数据的至少一个存储器单元。当被启动时,所述控制单元将控制信号发送到所述接头组件的马达,以使所述端部执行器基于存储在控制单元的存储器单元中的来自关节运动传感器的关节运动数据而自动地关节运动至期望位置。
Description
发明人:Frederick E.Shelton,IV、David C.Yates和Richard C.Smith
背景技术
手术缝合器已在现有技术中使用,以同时在组织中切开纵向切口和将成排的缝合钉施加到切口的相对两侧。这种器械常常包括具有一对协同工作的钳口构件的端部执行器,如果意图将所述器械用于内窥镜式或腹腔镜式应用,则所述钳口构件能够穿过套管通道。钳口构件之一容纳有钉仓,钉仓具有横向间隔的至少两行缝合钉,每一行位于刀槽的一侧。另一钳口构件限定砧,所述砧具有与钉仓中的成行的缝合钉对齐的缝合钉成形凹陷部。器械具有多个往复式楔形件,当朝远端驱动时,所述多个往复式楔形件穿过钉仓的开口并且与支撑缝合钉的驱动器接合,以使得缝合钉朝着砧击发。同时,切割器械(或刀)沿着钳口构件朝远端拉动,使得夹住的组织同时被切割和紧固(例如,被缝合)。
在标题为“Surgical stapling instrument having separate distinct closing and firing systems”(具有分离的不同关闭和击发系统的手术缝合器械)的美国专利No.7,000,818 B2中描述了适于内窥镜式应用的手术缝合器的实例,该专利的公开内容全文以引用的方式并入本文。在使用中,临床医生能够在组织上关闭缝合器的钳口构件,以在击发之前将组织定位。一旦临床医生确定钳口构件正确地抓住组织时,临床医生可随后击发手术缝合器,从而切断和缝合组织。同时切断和缝合组织的行为避免了当利用分别仅切断或缝合的不同的外科手术工具按次序执行这些行为时可能产生的并发症。
现有技术也包括具有可关节运动的端部执行器的内切割器,例如在公布的美国专利申请公开No.2007/0175959中的描述,该申请全文以引用方式并入本文中。这种器械包括允许用户(例如,手术外科医生)影响端部执行器绕关节运动枢轴旋转的关节运动控制器。
通常,需要使用这种内切割器的手术需要操作者在患者体内的一般通常位置进行几次切割/紧固冲程(stroke)。因此,在器械的每次切割/紧固冲程之后,临床医生必须将所述器械从套管中抽出,并更换端部执行器中的已用空的钉仓。然后临床医生必须将器械向回再插入穿过套管进入患者体内并再次定位端部执行器,包括使端部执行器关节运动返回至其在先前的切割/紧固冲程中所处的相同的一般位置。
发明内容
在一个总体方面,本发明涉及一种具有能够自动作关节运动的端部执行器的外科手术器械,例如外科手术切割和紧固器械。根据各实施例,所述外科手术器械可包括端部执行器、轴和连接在所述端部执行器和所述轴之间的可关节运动的接头组件。接头组件包括用于使端部执行器相对于轴进行关节运动的至少一个马达。接头组件还包括用于感测端部执行器相对于轴的关节运动的至少一个关节运动传感器。
器械还包括与关节运动传感器和马达通信的控制单元。控制单元包括用于存储来自至少一个关节运动传感器的关节运动数据的至少一个存储器单元。此外,当被启动时,控制单元将控制信号发送到接头组件的马达,以基于存储在控制单元的存储器单元中的来自关节运动传感器的关节运动数据而使端部执行器自动地关节运动至期望位置(或关节运动状态)。例如,控制单元可致使端部执行器关节运动至关节运动的先前状态(例如当器械上一次被击发时的关节运动状态)或一些其它的关节运动状态。控制单元还能够致使端部执行器自动地关节运动返回至其初始的或未经关节运动的状态。这样,临床医生可执行以下动作:(i)将端部执行器通过套管插入患者体内;(ii)使端部执行器自动关节运动至期望位置;(iii)击发器械;(iv)使端部执行器再关节运动返回至其初始位置;从而(v)将其通过套管从患者体内抽出;以及(vi)更换钉仓,从而可重复所述过程。在再定位端部执行器的过程中,这应当往往会取得更高的准确性和可重复性,这在需要端部执行器被定位到相同的大致位置以进行重复击发的手术过程中很重要。
根据各具体实施,外科手术器械可为外科手术切割和紧固器械,例如内切割器。这样,端部执行器可包括两个对置的、枢转连接的钳口构件。一个钳口构件可承载用于切断夹持在两个钳口构件之间的组织的切割器械。其还可包括装有多个缝合钉的可更换的钉仓,从而当器械被击发时,缝合钉被迫穿过夹持的组织并被用作砧的另一钳口构件扭转。
在另一总体方面,本发明涉及一种执行外科手术的方法。在一个实施例中,所述方法包括:(a)将可关节运动的端部执行器通过套管插入到患者体内,同时,端部执行器处于第一关节运动状态;(b)在步骤(a)之后,启动外科手术器械上的输入装置,致使端部执行器自动地关节运动至不同于第一关节运动状态的第二关节运动状态;(c)在步骤(b)之后,击发外科手术器械以切断和紧固夹持在端部执行器中的组织;(d)在步骤(c)之后,启动输入装置,以致使端部执行器自动地关节运动至第一关节运动状态;以及(e)在步骤(d)之后,通过套管从患者体内抽出端部执行器。
本发明的这些和其它有益效果将从以下描述中变得显而易见。
附图说明
本文通过实例结合以下附图的方式描述本发明的各实施例,其中:
图1和图2示出了根据本发明的各实施例的具有可关节运动的端部执行器的外科手术器械;
图3是根据本发明的各实施例的图1和图2的外科手术器械的端部执行器的分解图;
图4是示出根据本发明的各实施例的外科手术用控制单元和传感器的框图;
图5是根据本发明的各实施例的外科手术器械的接头关节运动组件的示意图。
具体实施方式
图1和图2示出了根据本发明的各实施例的具有能够自动作关节运动的端部执行器的外科手术切割和紧固器械10。图示实施例是内窥镜式外科手术器械10,通常,本文描述的器械10的实施例是内窥镜式外科手术切割和紧固器械。但是,应该指出的是,根据本发明的其它实施例,器械10可为具有能够自动作关节运动的端部执行器的非内窥镜式外科手术切割器械,例如腹腔镜式器械。
图1和图2示出的外科手术器械10包括手柄6、轴8和在关节运动枢轴14处可枢转地连接至轴8的关节运动端部执行器12。关节运动控制器16可被设置为与手柄6相邻,以使得端部执行器12能够绕关节运动枢轴14的旋转。在图示实施例中,端部执行器12被构造为充当内切割器以夹持、切断和缝合组织,但是在其它实施例中,可使用不同类型的端部执行器,例如用于其它类型的外科手术装置(例如,抓紧器、切割器、缝合器、夹置放器、进入装置、药物/基因理疗装置、超声波、RF或激光装置等)的端部执行器。
器械10的手柄6可包括用于使端部执行器12关节运动的关闭触发器18和击发触发器20。应当理解,具有涉及不同外科手术任务的端部执行器的器械可具有用于操纵端部执行器12的不同数量或类型的触发器或其它合适的控制器。端部执行器12被显示为优选地通过细长轴8与手柄6分离。在一个实施例中,器械10的临床医生或操作者可通过利用关节运动控制器16使端部执行器12相对于轴8进行关节运动。一种类型的合适的关节运动控制器在标题为“Surgical Instrument Having An Articulating End Effector”(具有关节运动端部执行器的外科手术器械)的公布的美国专利申请公开No.2007/0158385 A1(Geoffrey C.Hueil等人)中有所描述,该专利的全文以引用方式并入本文中。
在该实例中,除了别的以外,端部执行器12包括缝合钉槽22和可枢转运动的夹持构件,例如砧24,其保持在能够确保有效地缝合和切断被夹持在端部执行器12中的组织的距离处。手柄6包括手枪式握把26,由临床医生将关闭触发器18枢转拉向手枪式握把26,以致使砧24朝着端部执行器12的缝合钉槽22夹持或关闭,从而夹持住置于砧24和槽22之间的组织。在图示实施例中,击发触发器20在关闭触发器18的更远的外侧。根据该实施例,一旦关闭触发器18被锁定在关闭位置,击发触发器20就可朝着手枪式握把26稍微旋转以使得其可由操作者用一只手接触到。然后,操作者可将击发触发器20朝着手枪式握把26枢转地拉动以缝合和切断在端部执行器12中夹持的组织。在其它实施例中,可使用除砧24之外的不同类型的夹持构件,例如,对置的颚等等。
应当理解,本文使用的术语“近端”和“远端”是相对于握住器械10的手柄6的外科医生而言的。因此,端部执行器12相对于更近端的手柄6为远端。还应当理解,为简洁和清楚起见,本文可以结合附图使用诸如“垂直”和“水平”之类的空间术语。然而,外科手术器械在多个取向和位置使用,并且这些术语并非意图进行限制,也并非绝对。
在使用中,关闭触发器18可被首先致动。一旦临床医生对于端部执行器12的定位感到满意,则临床医生可将关闭触发器18拉回至其邻近手枪式握把26的完全关闭的、锁定的位置。然后,可致动击发触发器20。当临床医生去除压力时,击发触发器20返回至打开位置(图1和图2所示)。当压迫手柄6上的释放按钮时,可释放被锁定的关闭触发器18。
如图1-2所示,手柄6可包括一个或多个外部用户输入选择装置90、92,它们可为(例如)推入式按钮开关、拨动开关、拨号盘、膜开关、麦克风、触摸屏、跟踪球或任何其它合适类型的开关或用户输入装置,其允许器械10的操作者使端部执行器12自动地关节运动至关节运动的先前状态和返回至其初始/正常状态(例如,未经关节运动的状态)。以下提供关于该特征的更多细节。
图3是根据各实施例的端部执行器12的分解图。如图示实施例所示,除了先前提到的槽22和砧24之外,端部执行器12可包括切割器械32、滑块33、可拆卸地安装在槽22中的钉仓34和螺旋形螺杆轴36。例如,切割器械32可为刀。砧24可在连接至槽22的近端端部的枢转点25枢转打开和关闭。砧24还可包括位于其近端端部的凸块27,所述凸块27插入机械关闭系统的组件中以打开和关闭砧24。当致动(即通过器械10的用户拉动)关闭触发器18时,砧24可绕枢转点25枢转至被夹持或关闭的位置。如果端部执行器12的夹持令人满意,则操作者可致动击发触发器20,致使刀32和滑块33沿着槽22纵向行进,从而切割夹持于端部执行器12中的组织。滑块33沿着槽22的运动致使钉仓34的缝合钉被驱动穿过被切断的组织并且抵靠着关闭的砧24,砧24扭转缝合钉以紧固被切断的组织。在各种实施例中,滑块33可为钉仓34的一体组件。全文以引用方式并入本文的、标题为“Surgical stapling instrument incorporating an E-beam firing mechanism”(包含电子束击发机构的外科手术缝合器械)的美国专利No.6,978,921提供了关于这种两冲程切割和紧固器械的更多细节。滑块33可为钉仓34的一部分,使得当刀32在切割操作之后收回时滑块33并不收回。
应该指出的是,虽然本文描述的器械10的实施例使用缝合切断的组织的端部执行器12,但是在其它实施例中,可使用用于紧固或密封切断的组织的不同技术。例如,也可使用利用RF能或粘合剂来紧固切断的组织的端部执行器。全文以引用方式并入本文的、标题为“ELECTROSURGICAL HEMOSTATIC DEVICE”(电外科手术止血装置)的美国专利No.5,709,680(Yates等人)和标题为“ELECTROSURGICAL HEMOSTATIC DEVICE WITH RECESSED AND/OR OFFSET ELECTRODES”(具有内陷式和/或偏心式电极的电外科手术止血装置)的美国专利No.5,688,270(Yates等人)公开了使用RF能来密封切断的组织的内窥镜式切割器械。同样,全文以引用方式并入本文的、标题为“Surgical stapling instruments structured for delivery of medical agents”(被结构化为用于递送药剂的外科手术缝合器械)的公布的美国专利申请公开No.2007/0102453(Jerome R.Morgan等人)和标题为“Surgical stapling instruments structured for pump-assisted delivery of medical agents”(被结构化为用于泵辅助递送药剂的外科手术缝合器械)的公布的美国专利申请公开No.2007/0102452(Frederick E.Shelton,IV等人)公开了使用粘合剂来紧固切断的组织的内窥镜式切割器械。因此,虽然本文的描述通常涉及切割/缝合操纵等,但是应当理解这是示例性实施例,并且不意味着是限制性的。也可使用其它组织紧固技术。
关于合适的端部执行器、用于所述端部执行器的关闭触发器锁定机构和机械关闭系统的更多细节可在标题为“Motor-driven surgical cutting and fastening instrument with user feedback system”(具有用户反馈系统的马达驱动的外科手术切割和紧固器械)的公布的美国专利公开No.2007/0175958 A1(Shelton等人)中找到,该申请的全文以引用方式并入本文。
器械10还可包括用于为端部执行器12供电的马达。在前文段落中提到的公布的美国专利申请No.2007/0175958 A1公开了一种具有用于为端部执行器供电的马达的内切割器。在该实施例中,可通过手柄中的电池(或电池组)供电的马达通过传动系为端部执行器的相关切割和紧固操作供电。
器械10还可包括感测关于器械10的各状态的多个传感器。例如,如以上提及的公布的美国专利申请No.2007/0175958 A1中所述,器械10可包括用于感测通过端部执行器中的切割器械执行的切割冲程的结束的冲程末传感器和用于感测通过所述切割器械执行的切割冲程的开始的冲程始传感器。例如,来自这些传感器的信号可用于控制马达。
此外,参照图4,器械10可包括:关闭触发器传感器50,其用于感测关闭触发器18的收回;砧关闭传感器52,其用于感测砧24的关闭;砧关闭负载传感器54,其用于感测由于砧24的关闭而通过钉仓22施加在传感器54上的力,传感器54可置于钉仓22的底表面内侧;击发触发器传感器56,其用于感测击发触发器20的收回;刀位置传感器58,其用于感测刀(即,切割器械)沿着端部执行器12的槽22的纵向位置;钉仓存在传感器60,其用于感测在端部执行器12中是否存在钉仓34;钉仓状态传感器62,其用于感测钉仓34的状态(例如,钉仓是否被用空)。
传感器50-62可与控制单元64通信,其优选地位于器械的手柄6内。控制单元64可包括处理器70、只读存储器单元72和读写存储器单元74。控制单元64还可包括用于与传感器50-62通信的模数转换器(ADC)和数模转换器(DAC)(未示出)。只读存储器单元72可包括EPROM和/或闪速EEPROM存储器单元。读写存储器单元74可包括易失性存储器单元,例如随机存取存储器(RAM)单元。控制单元64的各组件可以是分立的或它们可集成于一个或几个组件中。例如,在一个实施例中,处理器70、ROM 72、RAM 74、DAC和ADC可为微控制器或单片计算机的一部分。
控制单元64可通过电源76(例如,电池)供电。对于具有用于为端部执行器供电的DC马达的器械10来说,为控制单元64供电的电源76可以是为马达供电的同一电源,或者可使用不同的电源为控制单元64和马达供电。
来自各传感器的输出可以数字形式被存储至存储器单元72、74中的一个或二者中。全文以引用方式并入本文的公布的美国专利申请No.2007/0175964 A1公开了一种具有用于存储和记录传感器数据的存储器装置的内切割器。来自上述传感器的一些的输出可为模拟形式。对于这些类型的传感器,ADC可用于将模拟传感器信号转换为数字形式,以存储在存储器单元72、74中。另外,传感器可通过有线和/或无线通信联接件连接到控制单元64。对于传感器与控制单元64无线通信的实施例,传感器可包括与控制单元64的收发机(未示出)通信的转发器。
根据各种实施例,器械10可包括机动化关节运动枢轴。图5公开了根据这种实施例的关节运动枢转接头组件2400。从图5中可看出,远端管片段2410具有近端端部2414和远端轴线H″-H″。虽然在图5中没有示出,但是远端管片段2410具有机械地结合到端部执行器12上的远端端部。根据采用的砧关闭布置,远端端部可以非可动地或者通过线缆、柔性构件或可枢转构件附着到端部执行器主体。远端管片段2410可部分中空,其近端端部2414为实心的,并且软管/导线容纳通道2416从中穿过。通道2416可具有锥形形状部分2417。接头组件2400还包括近端管片段2450,其具有远端端部2454和近端轴线I″-I ″。虽然在图5中未示出,但是近端管片段2450具有附着到手柄组件6上的近端端部。
在一个实施例中,远端管片段2410通过球形接头组件2460枢转地结合到近端管片段2450上。在一个实施例中,球形接头组件2460包括安装到或形成在近端管片段2450的远端端部2454上的球形构件2462。球形构件2462包括具有扩张或扩大的端部2465的中空通道2464,使得球形构件2462能够与通道部分2416、2417连通,从而不管球形构件2462的位置如何,延伸穿过其中的软管480和/或导线都将不被夹挤或损坏。球形构件2462被容纳在设置在远端管片段2410的近端端部2414中的承窝2458中,使得球形构件2462在其中自由旋转。
在一个实施例中,采用一般指定为2500的致动组件来使远端管片段2410相对于近端管片段2450进行关节运动。在图5中可看出,在一个非限制性实施例中,采用了两个柔性蜗杆线缆2510、2520。第一柔性蜗杆线缆2510适于驱动性地与形成在球形构件2462中的第一齿轮通道2465中的蜗齿、螺纹等(未示出)啮合。第一柔性蜗杆线缆2510结合至安装在远端管片段2410中的第一马达2512。相似地,在该非限制性实施例中,第二柔性蜗杆线缆2520适于驱动性地与形成在球形构件2462中的第二齿轮通道2467中的齿轮齿、螺纹等啮合,在第二齿轮通道2467中形成有蜗齿、螺纹等2469。第二柔性蜗杆线缆2520结合至安装在远端管片段2410中的第二马达2522。虽然在本文中描述为“柔性蜗杆线缆”,但是应该理解,该术语意味着涵盖不必要在其上采用蜗杆型齿的所有类型的柔性从动线缆或驱动器布置。
第一马达2512和第二马达2522可通过电池(例如,局部电池或手柄6中的电池包)或通过交流电供电,或者通过液压流体或空气供电。在一个实施例中,马达2512、2522是电动的并且通过手柄组件6上的一个或多个开关或按钮操作。通过控制第一柔性蜗杆线缆2510和第二柔性蜗杆线缆2520的旋转量和旋转方向,使得球形构件2462在承窝2458中旋转,从而使远端管片段2410(和附着到其上的端部执行器12)相对于近端管片段2450进行关节运动。读者将会知道,这种布置有利于如图5所示的左向关节运动和右向关节运动(未示出)。再者,然而读者将会知道虽然以上描述了两个柔性蜗杆线缆/马达布置,但是如果仅需要或期望单自由度的关节运动,则本发明的其它实施例可仅采用一个柔性蜗杆线缆布置。另外,虽然已经描述了球形构件2462非可动地安装到近端管片段2450中,同时承窝2458设置在远端管片段2410中,但是本领域普通技术人员将会理解,在不脱离本发明的精神和范围的情况下,在其它非限制性实施例中,球形构件2462可以非可动地附着至远端管片段2410,同时承窝2458设置在近端管片段2450中。
接头组件2400可包括用于感测关节运动枢轴14的关节运动的一个或多个传感器66(见图4)。来自传感器66的输出被记录在控制单元64的存储器装置72、74中的一个或二者中。例如,传感器66可包括用于直接或间接地总体感测端部执行器12的关节运动的光学或磁致旋转传感器(例如,霍尔效应传感器)和/或加速计。例如,传感器66可直接感测端部执行器的关节运动/旋转。在另一个实施例中,传感器66可感测蜗杆线缆2510、2520的旋转和方向,从而间接感测端部执行器12的关节运动。控制单元64可存储和记录来自关节运动传感器66的信息,其有利于器械10的用户在器械的后续使用过程中重复准确或近似的关节运动,如以下进一步的描述。传感器66可通过有线和/或无线通信联接件与控制单元64通信。另外,来自传感器66的输出可为模拟信号,其通过控制单元64的ADC转换为数字形式。
以标题为“Hydraulically and electrically actuated articulation joints for surgical instruments”(用于外科手术器械的液力和电致动的关节运动接头)公布的美国专利申请公开No.2007/0106317 A1(Shelton等人)更详细地描述了机动化关节运动枢轴。该申请还提供机动化关节运动枢轴的其它实施例。该申请还描述了液力供电的关节运动枢轴。对于具有液压式关节运动枢轴的器械来说,关节运动传感器66可包括用于直接或间接地感测端部执行器12的关节运动的加速计或其它合适的传感器。
根据各实施例,选择装置90(见图1-2)可为多状态或单状态装置。对于多状态装置来说,器械的用户可启动开关以使得其关节运动至上一次击发器械10时的关节运动的先前状态(例如,关节运动的紧前一个状态)。用户可随后再次启动开关以使端部执行器12回复到其正常的、未经关节运动的状态。当临床医生将端部执行器置于所需状态时,用户还可启动装置90以将关节运动数据记录至控制单元64中。在另一个实施例中,每当器械10击发和/或夹持时,关节运动传感器数据可被自动记录。这样,除了击发器械(例如,按压装置90)之外,临床医生不需要采取积极的动作来将来自关节运动传感器66的关节运动数据记录到控制单元的存储器单元72、74中。
对于具有多个单状态输入装置90、92的实施例来说,用户可利用一个输入装置90来使端部执行器自动地关节运动至先前状态,并且利用第二输入装置92使端部执行器12回复到其正常的、未经关节运动的状态。输入装置90、92可与控制单元64通信。还可以有第三输入装置(未示出),用户可启动第三输入装置来致使关节运动数据被记录在控制单元64中。作为另外一种选择,每当器械10被击发和/或夹持时,关节运动传感器数据可被自动记录下来。
当用户启动选择装置90时,为了使端部执行器自动地关节运动,控制单元64可将信号发送到关节运动枢轴14的接头组件2400中的马达2512、2522(或者,对于具有液压式致动器的接头组件来说,控制单元64可将信号发送到液压式致动器)。基于从关节运动传感器66接收的传感器数据,发送到马达2512、2522的信号可基于端部执行器的关节运动的先前状态(例如,端部执行器12相对于轴的旋转和方向),所述先前状态被存储在存储器单元72、74中的一者或二者中。这样,通过启动选择装置90,器械10的用户可致使端部执行器12自动地关节运动至先前使用中的相同的关节运动状态(例如,当器械10上一次被击发时的关节运动状态)。对于临床医生必须在患者的相同的大致位置处进行重复的切割/紧固冲程的手术来说,这可以是有利的。与必须每次使端部执行器12关节运动至相同的大致位置的情况相反,外科医生可通过启动选择装置90使端部执行器12自动关节运动至其上一次的位置。
以下描述了如何使用器械10的一个实例。在该实例中,假设了多状态用户输入选择装置90的情况,应当认识到,该实例可容易地延伸至具有两个或更多个输入装置的实施例。在该实例中,临床医生可将端部执行器12穿过套管插入。然后,临床医生通过利用手动关节运动控制器16可使端部执行器12关节运动至期望位置,即,临床医生期望同时执行切割器械10的切割和紧固行为的位置。在临床医生使端部执行器12关节运动至期望位置之后,临床医生可将关闭触发器收回至其锁定位置,从而锁定端部执行器12的对置的颚22和24之间的组织。然后,临床医生可收回击发触发器20,致使切割器械32能够进行如下行为:(1)纵向穿越端部执行器12的槽22,从而切割夹持在端部执行器12中的组织;和(2)使得钉仓34中的缝合钉被迫向上穿过夹持的组织并被砧24扭转,从而缝合切割器械32切开的切口的每一侧上的被夹持的组织。在击发之前或之后,或者在夹持之前或之后,用户可启动输入装置90(或一些其它输入装置)致使控制单元64记录指示端部执行器12相对于轴8的关节运动状态的来自关节运动传感器66的关节运动数据。在另一个实施例中,当器械被击发或当端部执行器夹持时,关节运动数据被记录。
然后,临床医生可通过按压用户选择输入装置90(这是针对单输入、2状态装置的实施例,或者,对于2输入装置的实施例来说,按压用户选择输入装置92)使端部执行器12自动地反关节运动(dearticulate)至其正常的、未经关节运动的状态(例如,直的状态),从而临床医生可将其通过套管往回抽出。然后,临床医生可用新的钉仓(例如,具有缝合钉的钉仓)来更换用空的钉仓34,并将端部执行器12穿过套管插回到患者体内。然后,基于存储在控制单元64中的上一次击发的关节运动传感器输出,临床医生通过按压或启动用户输入选择装置90,可使得端部执行器12自动地关节运动至当器械10上一次击发时的相同的关节运动位置。这样,临床医生可使端部执行器12自动地关节运动返回到上一次击发的相同的大致位置,而不用手动使端部执行器12进行关节运动。在再定位端部执行器12的过程中,当将端部执行器再定位到与先前击发的相同的大致位置很重要时,这应当往往会取得更高的准确性和可重复性。
在器械10的第二次击发之后,临床医生可使器械自动地反关节运动至未经关节运动的位置,将其抽出套管,并且(如果必要的话)再次更换钉仓并再插入端部执行器,从而在端部执行器自动关节运动至其先前击发时的关节运动状态的情况下进行下一次击发。对于用户启动用户输入装置以记录关节运动数据的器械来说,用户可仅记录首次击发时的关节运动状态,从而对于后续的击发,端部执行器12将会自动地关节运动至与首次击发相同的大致位置。作为另外一种选择,用户可记录每次击发的关节运动状态,从而端部执行器可自动地关节运动至与前一次击发的相同的大致位置。
本文公开的装置可被设计为在一次手术(其可包含多次击发)之后丢弃,或者它们可被设计为用于多次手术中。然而,无论在哪种情况下,都可对该器械进行再处理,以便在至少一次手术后再使用。再处理可包括以下步骤的任何组合:拆卸装置,然后清洗或更换特定零件,以及后续的再组装。具体地讲,可拆卸该装置,并且可以任何组合选择性地更换或移除装置的任何数量的特定零件或部件。清洗和/或更换特定部件时,可在再处理设施处或在即将进行外科手术操作前由外科手术小组再装配装置,以供后续使用。本领域的技术人员应当知道,器械的再处理可利用多种技术进行拆卸、清洗/更换和再组装。此类技术的使用以及所得再处理后的装置均在本发明的范围内。
优选地,在外科手术之前将对本文所述的发明的各实施例进行处理。首先,获取新的或用过的器械,并根据需要进行清洗。然后可对器械进行消毒。在一种消毒技术中,器械被布置在关闭和密封的容器内,例如由一层TYVEK覆盖的热成形塑料外壳。然后将容器和器械置于可穿透该容器的辐射场,诸如γ辐射、x射线或高能电子。辐射将杀死器械上和容器中的细菌。然后可将消毒后的器械保存在消毒容器中。该密封容器在医疗设施中被打开之前使器械保持在无菌状态。
器械优选地经过消毒。这可通过本领域技术人员已知的任何数量的方法完成,包括β辐射或γ辐射、环氧乙烷、蒸汽以及其它方法。
虽然已经通过描述几个实施例显示了本发明,虽然已经相当详细地描述了示例性实施例,但是申请人的意图不在于将权利要求的范围约束或以任何方式限制到这些细节中。本领域技术人员可容易看出其它优点和修改形式。本发明的各实施例表示了相对于现有缝合方法的巨大改进,所述现有缝合方法需要使用一个钉仓中的不同尺寸的缝合钉以实现具有不同成形(最终)高度的缝合。
因此,本发明对内窥镜式手术和设备进行了讨论。但是,本文使用的术语,例如“内窥镜式”不应被理解为将本发明限于仅结合内窥镜式管(即,套管或套管针)使用的外科手术缝合和切断器械。相反,应该相信本发明可用于进入受限的任何手术中,包括(但不限于)腹腔镜式手术以及开腹手术。此外,在不脱离本发明的精神和范围的情况下,本发明的各种钉仓的实施例的独特和新颖的方面当与其它形式的缝合设备结合使用时具有效用。
Claims (20)
1.一种外科手术器械,包括:
端部执行器;
轴;
可关节运动的接头组件,其连接在所述端部执行器和所述轴之间,以使所述端部执行器相对于所述轴进行关节运动,其中能够自动作关节运动的所述接头组件包括:
至少一个关节运动传感器,其用于感测能够自动作关节运动的所述接头组件的关节运动;
至少一个马达,其用于使所述端部执行器相对于所述轴自动地关节运动;
控制单元,其与所述至少一个关节运动传感器进行通信,其中所述控制单元包括用于存储来自所述至少一个关节运动传感器的关节运动数据的至少一个存储器单元,其中所述控制单元与所述可关节运动的接头组件的所述至少一个马达通信。
2.根据权利要求1所述的外科手术器械,其中所述控制单元用于控制所述可关节运动的接头组件中的所述至少一个马达,从而致使所述马达基于存储在所述至少一个存储器单元中的关节运动数据使所述端部执行器关节运动至一位置。
3.根据权利要求2所述的外科手术器械,其中所述至少一个马达包括电动机。
4.根据权利要求2所述的外科手术器械,其中所述至少一个马达包括液压式马达。
5.根据权利要求2所述的外科手术器械,还包括连接至所述轴的手柄,其中所述控制单元位于所述手柄中。
6.根据权利要求2所述的外科手术器械,其中所述端部执行器包括:
第一钳口构件;以及
可枢转地连接至所述第一钳口构件的第二钳口构件。
7.根据权利要求6所述的外科手术器械,其中所述控制单元包括与所述至少一个存储器单元通信的处理器。
8.根据权利要求7所述的外科手术器械,还包括与所述控制单元通信的至少一个用户输入装置,当第一次被启动时,所述用户输入装置致使所述控制单元基于存储在所述控制单元的所述至少一个存储器单元中的关节运动数据控制所述可关节运动的接头组件的所述马达,致使所述可关节运动的接头组件关节运动至关节运动状态。
9.根据权利要求8所述的外科手术器械,其中所述至少一个用户输入装置位于所述手柄上。
10.根据权利要求8所述的外科手术器械,其中当第二次启动所述用户输入装置时,所述控制单元致使所述可关节运动的接头组件的所述马达使所述可关节运动的接头组件关节运动至未经关节运动的状态。
11.根据权利要求8所述的外科手术器械,其中所述关节运动状态基于所述端部执行器的先前的一次关节运动。
12.根据权利要求11所述的外科手术器械,其中所述先前的一次包括此前击发所述器械的一次。
13.一种外科手术切割和紧固器械,其包括:
端部执行器,其包括:
可动的切割器械,其用于切割位于所述端部执行器中的物体;
第一钳口构件,其包括用于承载所述切割器械的细长槽;以及
第二钳口构件,其可枢转地连接至所述第一钳口构件并与所述第一钳口构件对置;
轴;
可关节运动的接头组件,其连接在所述端部执行器和所述轴之间,以使所述端部执行器相对于所述轴进行关节运动,其中能够自动作关节运动的所述接头组件包括:
至少一个关节运动传感器,其用于感测能够自动作关节运动的所述接头组件的关节运动;以及
至少一个马达,其用于使所述端部执行器相对于所述轴自动地关节运动;
手柄,其连接至所述轴,其中所述手柄包括:
控制单元,其与所述至少一个关节运动传感器进行通信,其中所述控制单元包括用于存储来自所述至少一个关节运动传感器的关节运动数据的至少一个存储器单元,其中所述控制单元与所述可关节运动的接头组件的所述至少一个马达通信,以基于存储在所述至少一个存储器单元中的关节运动数据控制所述至少一个马达,从而致使所述马达使所述端部执行器关节运动至一位置;以及
至少一个用户输入装置,其与所述控制单元通信,当第一次被启动时,所述用户输入装置致使所述控制单元基于存储在所述控制单元的所述至少一个存储器单元中的关节运动数据控制所述可关节运动的接头组件的马达,以使得所述可关节运动的接头组件关节运动至关节运动状态。
14.根据权利要求13所述的外科手术器械,其中当第二次启动所述用户输入装置时,所述控制单元致使所述可关节运动的接头组件的所述马达使所述可关节运动的接头组件关节运动至未经关节运动的状态。
15.根据权利要求13所述的外科手术器械,其中所述关节运动状态基于所述端部执行器的先前的一次关节运动。
16.根据权利要求13所述的外科手术器械,其中所述先前的一次包括此前击发所述器械的一次。
17.一种在患者身上执行医疗手术的方法,所述方法包括:
(a)将外科手术切割和紧固器械的可关节运动的端部执行器通过套管插入到患者体内,其中当所述端部执行器通过所述套管插入时,所述端部执行器处于第一关节运动状态;
(b)在步骤(a)之后,启动所述外科手术切割和紧固器械上的输入装置,致使所述端部执行器自动地关节运动至不同于所述第一关节运动状态的第二关节运动状态;
(c)在步骤(b)之后,击发所述外科手术切割和紧固器械以切断和紧固夹持在所述端部执行器中的组织;
(d)在步骤(c)之后,启动所述输入装置,以致使所述端部执行器自动地关节运动至所述第一关节运动状态;以及
(e)在步骤(d)之后,通过所述套管从患者体内抽出所述端部执行器。
18.根据权利要求17所述的方法,还包括:
(f)在步骤(e)之后,更换所述端部执行器上的钉仓;以及(g)重复步骤(a)至(e)。
19.根据权利要求17所述的方法,在步骤(a)之前还包括:
(h)将所述可关节运动的端部执行器通过所述套管插入到患者体内,其中当所述端部执行器穿过所述套管插入时,所述端部执行器处于所述第一关节运动状态;
(i)在步骤(h)之后,手动地使所述端部执行器关节运动至所述第二关节运动状态;
(j)在步骤(i)之后,击发所述外科手术切割和紧固器械,以切断和紧固夹持在所述端部执行器中的组织;
(k)在步骤(j)之后,启动所述输入装置,以致使所述端部执行器自动地关节运动至所述第一关节运动状态;以及
(l)在步骤(k)之后,通过所述套管从所述患者体内抽出所述端部执行器。
20.根据权利要求19所述的方法,还包括:
(m)在步骤(e)之后,更换所述端部执行器上的钉仓;以及(n)重复步骤(a)至(e)。
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CN103037779A (zh) * | 2010-07-29 | 2013-04-10 | 伊西康内外科公司 | 具有切割构件换向机构的马达驱动外科紧固件装置 |
CN103037779B (zh) * | 2010-07-29 | 2015-12-16 | 伊西康内外科公司 | 具有切割构件换向机构的马达驱动外科紧固件装置 |
CN104042280A (zh) * | 2013-03-14 | 2014-09-17 | 伊西康内外科公司 | 可关节运动的外科器械的关节运动控制系统 |
CN104042280B (zh) * | 2013-03-14 | 2018-02-02 | 伊西康内外科公司 | 可关节运动的外科器械的关节运动控制系统 |
CN109069151A (zh) * | 2016-04-20 | 2018-12-21 | 伊西康有限责任公司 | 具有液压钉部署的外科钉仓 |
CN109069151B (zh) * | 2016-04-20 | 2021-10-15 | 伊西康有限责任公司 | 具有液压钉部署的外科钉仓 |
WO2018027788A1 (en) * | 2016-08-11 | 2018-02-15 | Covidien Lp | Endoscopic surgical clip applier and clip applying systems |
US10806464B2 (en) | 2016-08-11 | 2020-10-20 | Covidien Lp | Endoscopic surgical clip applier and clip applying systems |
TWI705314B (zh) * | 2018-08-22 | 2020-09-21 | 新世代機器人暨人工智慧股份有限公司 | 自動控制方法以及自動控制裝置 |
Also Published As
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BRPI0913095B8 (pt) | 2021-06-22 |
WO2009143092A1 (en) | 2009-11-26 |
US20090289096A1 (en) | 2009-11-26 |
EP2296559A1 (en) | 2011-03-23 |
EP2296559B1 (en) | 2016-08-03 |
US7922061B2 (en) | 2011-04-12 |
CA2724511C (en) | 2017-07-04 |
CN102076270B (zh) | 2014-06-11 |
RU2497468C2 (ru) | 2013-11-10 |
EP2296559B8 (en) | 2016-10-12 |
PL2296559T3 (pl) | 2017-05-31 |
CA2724511A1 (en) | 2009-11-26 |
JP2011520564A (ja) | 2011-07-21 |
JP5512659B2 (ja) | 2014-06-04 |
RU2010152241A (ru) | 2012-06-27 |
BRPI0913095A2 (pt) | 2020-08-18 |
BRPI0913095B1 (pt) | 2020-12-29 |
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