CN102232854B - 带有能进行关节运动的端部执行器的手术缝合器械 - Google Patents
带有能进行关节运动的端部执行器的手术缝合器械 Download PDFInfo
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Abstract
本发明公开了一种外科器械,所述外科器械可包括能够支撑钉仓的通道,此外还包括可相对于所述通道在打开和关闭位置之间枢转的钉砧。所述外科器械还包括切割构件,所述切割构件能够切割夹在所述钉仓和所述钉砧之间的组织,此外还包括用于将所述切割构件阻挡在远端基准之前的装置,其中所述远端基准可通过所述钉仓中的最远侧缝钉腔体限定。在此类实施例中,所述组织内的切口可不延伸到所述组织被钉住的部分之外。
Description
相关专利申请交叉引用
本专利申请是一项部分继续申请,依据美国法典第35篇第120条之规定,要求2008年1月10日提交的名称为“SURGICALSTAPLING INSTRUMENT WITH A FIRING RETURN MECHANISM”(带有击发返回机构的手术缝合器械)的共同未决的美国专利申请No.12/008,266的优先权,该专利申请是2007年6月22日提交的名称为“SURGICAL STAPLING INSTRUMENTS”(手术缝合器械)的美国专利申请No.11/821,277的部分继续申请,所述专利申请全部公开内容以引用方式并入本文中。
背景技术
1.技术领域
本发明整体涉及手术缝合器械,更具体地讲,涉及具有用于闭合端部执行器的闭合系统和用于布置缝钉的击发系统的手术缝合器。
2.相关领域描述
如本领域已知的,手术缝合器通常用于将缝钉布置到软组织中以减少或消除软组织出血,例如尤其是对组织进行切断操作的情况。手术缝合器(例如直线切割闭合器(endocutter))可以包括可相对于细长轴组件移动或关节运动的端部执行器。端部执行器通常被构造成将软组织固定在第一和第二夹具构件之间,其中第一夹具构件通常包括钉仓,其被构造成可拆卸地将缝钉储存于其中,并且第二夹具构件通常包括钉砧。此类手术缝合器可包括用于使钉砧相对于钉仓枢转的闭合系统。然而,在夹具构件都已闭合后,这些闭合系统不会阻止端部执行器相对于轴组件进行关节运动。因此,当端部执行器发生关节运动时,端部执行器可将剪切力施加于夹在夹具构件之间的软组织上。
如上所述,手术缝合器可以被构造成使端部执行器的钉砧相对于钉仓枢转,以便将软组织夹于其间。在多种情形下,钉砧可以被构造成将夹持力施加于软组织,以便将软组织牢牢保持在钉砧和钉仓之间。然而,如果外科医生对端部执行器的位置不满意,外科医生通常必须启动手术缝合器上的释放机构,以使钉砧枢转到打开位置中,进而重新定位端部执行器。随后,通常用驱动器从钉仓布置缝钉,该驱动器横穿过钉仓中的通道,使缝钉抵靠在钉砧上而变形并使各层软组织紧固在一起。如本领域已知的,通常将缝钉布置成几排或几行缝钉,以便将各层组织更牢靠地固定在一起。端部执行器还可包括切割构件(例如小刀),在各层软组织缝合在一起之后,切割构件在两行缝钉之间行进而将软组织切除。
发明内容
在至少一种形式中,手术缝合器可包括被构造成接纳钉仓的通道,该钉仓包括可拆卸地储存于其中的缝钉,其中通道包括远端、近端部分和阻挡件。手术缝合器还可包括被构造成使从钉仓射出的缝钉变形的钉砧,其中钉砧包括远端和近端部分,其中钉砧的近端部分可枢转地连接到通道的近端部分,并且其中钉砧可在打开位置和关闭位置之间旋转。手术缝合器还可包括可在第一位置和第二位置之间移动的闭合构件,其中闭合构件被构造成当闭合构件在第一位置和第二位置之间移动时使钉砧在打开位置和关闭位置之间移动,并且其中闭合构件包括主体、从主体朝向通道远端延伸第一距离的第一凸轮部分以及从主体朝向通道远端延伸第二距离的第二凸轮部分,其中第一距离大于第二距离,其中第一凸轮部分被构造成当闭合构件处于第二位置时其至少部分地布置在钉砧周围,并且其中第二凸轮部分被构造成当所述闭合构件处于第二位置时其至少部分地布置在通道周围并邻近阻挡件。
在至少一种形式中,外科器械可包括具有传动杆和第一导槽的轴以及可围绕枢转接头枢转地连接到轴的端部执行器,其中第一导槽被构造成接纳传动杆的至少一部分,并且端部执行器可沿第一方向和第二方向围绕枢转接头旋转。端部执行器还可包括被构造成接纳钉仓的钉仓附连部分、被构造成接纳传动杆的至少一部分的第二导槽、布置在第二导槽的第一侧面上的第一凹陷,以及布置在所述第二导槽第二侧面上的第二凹陷。手术缝合器还可包括被构造成独立于轴和端部执行器移动的引导构件,该引导构件包括被构造成接纳传动杆的至少一部分的第三导槽、布置在第三导槽第一侧面上的第一扣件,以及布置在第三导槽第二侧面上的第二扣件,其中第一扣件被构造成当端部执行器沿第一方向旋转时其被接纳于端部执行器的第一凹陷内,并且其中第二扣件被构造成当端部执行器沿第二方向旋转时其被接纳于端部执行器的第二凹陷内。
在至少一种形式中,外科器械可包括具有传动杆和第一导槽的轴以及可围绕枢转接头枢转地连接到轴的端部执行器,其中第一导槽被构造成接纳传动杆的至少一部分。端部执行器可沿第一方向和第二方向围绕枢转接头旋转,端部执行器包括被构造成接纳钉仓的钉仓附连部分。该外科器械还可包括被构造成独立于轴和端部执行器移动的引导构件以及凸起,其中该引导构件可包括被构造成接纳传动杆的至少一部分的第二导槽,其中该轴包括被构造成接纳凸起的凹陷,其中该端部执行器被构造成当端部执行器沿第一方向或第二方向移动时其将引导构件推向轴并将凸起布置在凹陷内,并且其中该凹陷包括被构造成限制凸起相对于凹陷和轴运动的侧壁。
在至少一种形式中,外科器械可包括具有外壳的轴、位于外壳内的第一导槽,以及可在第一位置和第二位置之间移动的传动杆,其中第一导槽被构造成接纳传动杆的至少一部分。该外科器械还可包括可围绕枢转接头枢转地连接到轴的端部执行器,其中端部执行器可围绕枢转接头旋转,并且其中端部执行器包括被构造成接纳钉仓的钉仓附连部分。该外科器械还可包括被构造成相对于轴和端部执行器移动的引导构件,该引导构件包括被构造成接纳传动杆的至少一部分的第二导槽、被构造成与端部执行器接触的端部,以及基准部分。传动杆还可包括轴、传动部分和阻挡件,其中的传动部分被构造成当传动杆在第一位置和第二位置之间移动时其可操作地接合切割构件并使切割构件在端部执行器内移动,而其中的阻挡件被构造成接合引导构件的基准部分以限制传动杆相对于端部执行器运动。
在至少一种形式中,外科器械可包括柄部、从柄部延伸的轴以及可围绕枢转接头枢转地连接到轴的端部执行器,其中轴包括外壳、可相对于外壳移动的击发构件,以及可操作地连接到击发构件的切割构件,并且其中端部执行器可围绕枢转接头旋转。端部执行器还可包括被构造成接纳钉仓的钉仓附连部分、以及回缩阻挡件。该外科器械还可包括回缩装置以及传动装置,其中回缩装置用于使击发构件和切割构件沿第一方向相对于钉仓附连部分移动并用于使切割构件紧靠回缩阻挡件定位,并且其中传动装置用于使击发构件和切割构件沿与第一方向相反的方向相对于钉仓附连部分移动距回缩阻挡件的预定距离。
具体地,本发明涉及以下内容:
(1)一种外科器械,包括:
轴,其包括:
外壳;
位于所述外壳内的第一导槽;以及
能够在第一位置和第二位置之间移动的传动杆,其中所述第一导槽能够接纳所述传动杆的至少一部分;
端部执行器,其围绕枢转接头能够枢转地连接到所述轴,其中所述端部执行器能够围绕所述枢转接头旋转,并且其中所述端部执行器包括能够接纳钉仓的钉仓附连部分;以及
引导构件,其能够相对于所述轴和所述端部执行器移动,所述引导构件包括:
能够接纳所述传动杆的至少一部分的第二导槽;
能够与所述端部执行器接触的端部部分;以及
基准部分,
其中所述传动杆还包括:
轴;
传动部分,当所述传动杆在所述第一位置和所述第二位置之间移动时,所述传动部分能够可操作地接合切割构件并使所述切割构件在所述端部执行器内移动;以及
阻挡件,所述阻挡件能够接合所述引导构件的所述基准部分以限制所述传动杆相对于所述端部执行器的运动。
(2)根据第(1)项所述的外科器械,其中所述端部执行器能够沿第一方向和第二方向围绕所述枢轴旋转,并且其中所述端部执行器沿所述第一方向或所述第二方向的所述旋转能够将所述引导构件朝所述轴部分移动。
(3)根据第(1)项所述的外科器械,其中所述传动杆还包括所述切割构件,其中所述切割构件包括切割刃,并且其中在所述切割刃和所述阻挡件之间限定预定距离。
(4)根据第(3)项所述的外科器械,还包括所述钉仓,其中所述钉仓包括能够接纳所述切割刃的切割狭槽,其中所述切割狭槽包括末端,其中当所述传动杆从所述第一位置移动到所述第二位置时,所述传动杆能够朝所述末端移动所述切割刃,其中所述端部执行器能够在第一取向、第二取向以及所述第一取向和所述第二取向中间的中心取向之间旋转,其中当所述端部执行器处于所述第一取向时,在所述末端和所述基准部分之间限定第一距离,其中当所述端部执行器处于所述第二取向时,所述末端和所述基准部分之间限定第二距离,其中当所述端部执行器处于所述中心取向时,所述末端和所述基准部分之间限定第三距离,其中所述第一距离和所述第二距离短于所述第三距离,并且其中所述预定距离短于所述第一距离、所述第二距离和所述第三距离。
(5)根据第(3)项所述的外科器械,还包括所述钉仓,其中所述钉仓包括能够接纳所述切割刃的切割狭槽,其中所述切割狭槽和所述第二导槽限定了所述传动杆的导向路径,其中当所述传动杆从所述第一位置移动到所述第二位置时,所述传动杆能够朝所述末端移动所述切割刃,其中所述端部执行器能够在第一取向、第二取向以及所述第一取向和所述第二取向中间的中心取向之间旋转,其中当所述端部执行器处于所述第一取向时,所述导向路径由第一距离限定,其中当所述端部执行器处于所述第二取向时,所述导向路径由第二距离限定,其中当所述端部执行器处于所述中心取向时,所述导向路径由第三距离限定,其中所述第一距离和所述第二距离短于所述第三距离,并且其中所述预定距离短于所述第一距离、所述第二距离和所述第三距离。
(6)根据第(1)项所述的外科器械,其中所述传动杆还包括所述切割构件,其中所述切割构件包括切割刃,其中所述外科器械还包括所述钉仓,其中所述钉仓包括:
能够接纳所述切割刃的切割狭槽,其中所述切割狭槽包括末端,其中当所述传动杆从所述第一位置移动到所述第二位置时,所述传动杆能够朝所述末端移动所述切割刃;以及
多个缝钉腔体,所述缝钉腔体包括设置在邻近所述切割狭槽的所述末端的末端缝钉腔体,其中所述末端缝钉腔体限定了末端基准;
其中所述端部执行器能够在第一取向、第二取向以及所述第一取向和所述第二取向中间的一系列中间取向之间旋转,并且其中所述传动杆的所述阻挡件能够接触所述引导构件的所述基准部分,使得不论所述端部执行器处于所述第一取向、所述第二取向还是所述中间取向,所述切割刃均不会穿过所述末端基准。
(7)根据第(1)项所述的外科器械,其中所述传动杆还包括所述切割构件,其中所述切割构件包括切割刃,其中所述外科器械还包括所述钉仓,其中所述钉仓包括:
能够接纳所述切割刃的切割狭槽,其中所述切割狭槽包括末端,其中当所述传动杆从所述第一位置移动到所述第二位置时,所述传动杆能够朝所述末端移动所述切割刃;以及
多个缝钉腔体,所述缝钉腔体包括设置在邻近所述切割狭槽的所述末端的基准缝钉腔体,其中所述基准缝钉腔体限定了切割停止基准;
其中所述端部执行器能够在第一取向、第二取向以及所述第一取向和所述第二取向中间的一系列中间取向之间旋转,并且其中所述传动杆的所述阻挡件能够接触所述引导构件的所述基准部分,使得所述切割刃不会穿过所述切割停止基准。
(8)一种外科器械,包括:
柄部;
从所述柄部延伸的轴,其中所述轴包括外壳;
能够相对于所述外壳移动的击发构件;
能够操作地连接到所述击发构件的切割构件;
围绕枢转接头能够枢转地连接到所述轴的端部执行器,其中所述端部执行器能够绕所述枢转接头旋转,并且其中所述端部执行器包括:
能够接纳钉仓的钉仓附连部分;以及
回缩阻挡件;
回缩装置,所述回缩装置用于使所述击发构件和所述切割构件沿第一方向相对于所述钉仓附连部分移动并用于使所述切割构件紧靠所述回缩阻挡件定位;以及
传动装置,所述传动装置用于使所述击发构件和所述切割构件沿与所述第一方向相反的方向相对于所述钉仓附连部分移动距离所述回缩阻挡件的预定距离。
(9)根据第(8)项所述的外科器械,其中所述击发构件包括第一部分和第二部分,其中所述第一部分包括狭槽,所述狭槽包括第一端壁和第二端壁,其中所述第二部分包括延伸进所述狭槽的凸起,并且其中所述第一端壁和所述第二端壁之间的距离大于所述凸起的宽度。
(10)根据第(9)项所述的外科器械,其中当所述击发构件沿所述第一方向移动时,所述第一端壁能够接合所述凸起,并且其中当所述击发构件沿所述相反方向移动时,所述第二端壁能够接合所述凸起。
(11)根据第(8)项所述的外科器械,其中所述端部执行器能够围绕所述枢轴在第一位置、第二位置以及所述第一位置和所述第二位置中间的中心位置之间旋转,其中当所述端部执行器位于所述第一位置、所述第二位置和所述中心位置时,所述传动装置能够将所述切割构件移动所述预定距离。
(12)根据第(8)项所述的外科器械,其中所述端部执行器能够围绕所述枢轴旋转通过一系列端部执行器位置,其中不论所述端部执行器处于所述一系列端部执行器位置中的何种位置,所述传动装置都能够将所述切割构件移动所述预定距离。
(13)根据第(8)项所述的外科器械,还包括所述钉仓,其中所述切割构件包括刀刃,其中所述钉仓包括:
能够接纳所述刀刃的刀狭槽;以及
多个缝钉腔体,所述缝钉腔体包括基准缝钉腔体,其中所述刀刃和所述基准缝钉腔体之间的距离限定了当所述切割构件紧靠所述回缩阻挡件定位时的基准距离;
其中所述外科器械还包括用于确定所述基准距离的检测装置,并且其中所述传动装置能够限制所述切割构件的行进,使得预定距离小于所述基准距离。
附图说明
通过结合附图参考本发明实施例的以下说明,本发明的上述和其他特征及优点及其获取方法将会变得更加明显,并可更好地理解发明本身,其中:
图1是根据本发明实施例的外科器械的正视图;
图2是图1该外科器械柄部的正视图;
图3是图1外科器械的端部执行器的正视图;
图4是图3端部执行器的顶视图;
图5是图1外科器械的关节接头的透视图,图中移除了该外科器械的一些元件;
图6是图1外科器械的细长轴组件和关节接头的透视图,图中移除了该外科器械的一些元件;
图7是图1外科器械的柄部和细长轴组件的局部透视图,图中移除了该外科器械的一些元件;
图8是图2柄部的正视图,图中移除了该外科器械的一些元件;
图9是图2柄部的正视图,图中移除了该外科器械的附加元件;
图10是根据本发明可供选择的实施例的外科器械中的关节锁定机构致动器和端部执行器闭合系统的正视图,图中移除了该外科器械的一些元件;
图11是图10外科器械的正视图,图中示出了处于未锁定位置的关节锁定机构致动器以及开放构型的端部执行器闭合系统;
图12是图10外科器械的正视图,图中示出了处于未锁定位置的关节锁定机构致动器以及部分封闭构型的端部执行器闭合系统;
图13是图10外科器械的正视图,图中示出了处于锁定位置的关节锁定机构致动器以及封闭构型的端部执行器闭合系统;
图14是图1外科器械的端部执行器闭合系统的闭合触发器的正视图;
图15是图15闭合触发器的局部透视图;
图16是图15闭合触发器的局部正视图;
图17是图1外科器械的触发器锁的透视图,;
图18是图17触发器锁的正视图,;
图19是图1外科器械的击发驱动的细部图,图中移除了该外科器械的一些元件;
图20是图19击发驱动的透视图;
图21是图19击发驱动中的击发触发器、制转杆和倾斜机构的局部细部图;
图22是图19击发驱动中的制转杆、倾斜机构和制转杆复位弹簧的正视图;
图23是图22制转杆的正视图;
图24是图19击发驱动的细部图,图中示出了制转杆,其已枢转到位以接合击发驱动的击发连杆;
图25是图22倾斜机构的透视图;
图26是图1外科器械的框架的透视图;
图27是根据本发明可供选择的实施例的外科器械中击发驱动的细部图,图中移除了该外科器械的一些元件;
图28是图27击发驱动的细部图,图中示出了与击发连杆脱离的击发驱动制转杆;
图29是权利要求1所述外科器械中返回机构的透视图,图中示出了处于未致动位置的击发触发器,其中移除了该外科器械的一些元件;
图30是图29返回机构的局部透视图,图中示出了处于致动位置的击发触发器,其中移除了该返回机构的一些元件;
图31是图29返回机构的正视图,该返回机构被布置成图30中所示的构型;
图32是图29返回机构的正视图,图中示出了处于致动位置的返回机构的返回滑架;
图33是图29返回机构的局部透视图,图中移除了该返回机构的一些元件;
图34是图19击发驱动中制转杆和击发销的透视图;
图35是图29返回机构的透视图,图中示出了处于致动位置的返回滑架以及返回到其未致动位置的击发触发器;
图36是图29返回机构的局部透视图,该返回机构被布置成图35中所示的构型,图中示出了返回机构中可操作地接合击发触发器的回程销;
图37是图29返回机构的局部透视图,图中示出了在旋转回程销之后处于致动位置的击发触发器;
图38是图29返回机构的附加局部透视图,该返回机构被布置成图37中所示的构型;
图39是图29返回机构的局部透视图,图中示出了返回到其未致动位置的击发触发器;
图40是图29返回机构的透视图,图中示出了返回到其未致动位置的返回滑架;
图41是图29返回机构的透视图,该返回机构被布置成图40的构型,图中示出了返回机构中的偏置弹簧和回程销之间的相对关系,其中移除了该返回机构的一些元件。
图42是图29返回机构的透视图,该返回机构被布置成图40的构型,图中示出了返回滑架可操作地接合击发驱动中的击发销和返回机构中的回程销以便使击发驱动和返回机构复位到它们的初始构型;
图43是图29返回机构中卷轴的细部图,图中示出了返回机构的回位带与图26的缝合器框架之间的相对关系;
图44是图43卷轴的细部图,图中示出了回位带与图26缝合器框架的可供选择的实施例之间的相对关系;
图45是根据本发明可供选择的实施例的外科器械中返回机构的透视图,该返回机构具有止退棘轮机构;
图46是图45返回机构的正视图,该返回机构具有处于未致动位置的返回滑架;
图47是图45返回机构的透视图,图中移除了该外科器械的一些元件;
图48是图45棘轮机构的回行齿轮、回程销和止退制转杆的透视图;
图49是图45返回机构的另一正视图,;
图50是图5关节接头的透视图;
图51是图5关节接头的透视图,图中移除了该外科器械的一些元件;
图52是图5关节接头的透视图,图中移除了该外科器械的附加元件;
图53是图3端部执行器中锁构件的透视图;
图54是图53端部执行器锁构件的另一透视图;
图55是图53端部执行器锁构件的底视图;
图56是图53端部执行器锁构件的正视图;
图57是之前外科器械中关节接头的局部透视图;
图58是图5关节接头的透视图,图中移除了端部执行器和细长轴组件的一些元件;
图59是图5关节接头的另一透视图,图中移除了端部执行器和细长轴组件的一些元件;
图60是图53所示端部执行器锁构件可操作地接合细长轴组件锁构件的透视图;
图61是图60轴组件锁构件的透视图;
图62是图53所示端部执行器锁构件可操作地接合图60轴组件锁构件的底视图;
图63是根据本发明可供选择的实施例的外科器械中关节接头的细部图,图中移除了该外科器械的一些元件;
图64是端部执行器锁构件可操作地接合图63所示外科器械的轴组件锁构件的顶视图;
图65是端部执行器锁构件可操作地接合图64所示轴组件锁构件的透视图;
图66是图64端部执行器锁构件的透视图;
图67是图64端部执行器锁构件的正视图;
图68是根据本发明实施例的外科器械的正视图,图中移除了该外科器械的一些元件;
图69是图68外科器械的正视图,图中示出了处于致动位置的闭合触发器;
图70是图68外科器械的正视图,图中示出了击发触发器第一次致动后处于致动位置的击发触发器;
图71是图68外科器械中反向机构的齿轮系的透视图,该齿轮系用于回缩击发构件;
图72是图68外科器械的正视图,图中示出了在第一次致动释放后处于未致动位置的击发触发器;
图73是图68外科器械的正视图,图中示出了击发触发器第二次致动后处于致动位置的击发触发器;
图74是图68外科器械的正视图,图中示出了在第二次致动释放后处于未致动位置的击发触发器;
图75是图68外科器械的正视图,图中示出了击发触发器第三次致动后处于致动位置的击发触发器;
图76是图68外科器械的另一正视图,图中示出了向下旋转到致动位置后的反向机构的返回滑架;
图77是图71反向机构齿轮系中的触发器齿轮、键齿轮和回程销的透视图;
图78是图68外科器械的横截面图,图中示出了图77回程销可操作地接合图71反向机构的触发器齿轮和键齿轮;
图79是图77回程销的透视图,;
图80是图76所示返回滑架处于致动位置时的另一正视图,;
图81是与图68外科器械中击发驱动的制转杆接合的击发销的透视图;
图82是图68外科器械中处于致动位置的返回滑架以及可操作地接合击发构件的反向机构的正视图;
图83是图68外科器械的正视图,图中示出了在第四次致动使击发构件回缩后处于致动位置的击发触发器;
图84是图76反向机构的透视图,图中移除了一些元件;
图85是图68外科器械的正视图,图中示出了在第四次致动释放后处于未致动位置的击发触发器;
图86是图68外科器械的正视图,图中示出了向上旋转到未致动位置的图76返回滑架,并且还示出了处于未致动位置的闭合触发器;
图87是根据本发明可供选择的实施例的外科器械的透视图,图中移除了该外科器械的一些元件;
图88是图87外科器械中包括齿轮系的反向机构的透视图,图中示出了当推进外科器械的击发构件时齿轮系中齿轮可旋转的方向;
图89是图88反向机构中的触发器齿轮和回程销的透视图,图中示出了触发器齿轮的横截面;
图90是图89的触发器齿轮和回程销的另一透视图,图中示出了未与触发器齿轮可操作地接合的回程销;
图91是图89的触发器齿轮和回程销的透视图,图中示出了与触发器齿轮重新接合的回程销;
图92是图88反向机构的透视图,图中示出了当击发构件回缩时齿轮系的齿轮旋转方向;
图93是图88反向机构的另一透视图,;
图94是图87外科器械的透视图,图中除示出了触发器以外,还示出了被构造成接合图88反向机构中的齿轮的触发器锁;
图95是根据本发明可供选择的实施例的外科器械中反向机构的正视图,图中示出了处于未致动位置的返回滑架,其中移除了该外科器械的一些元件;
图96是图95反向机构的透视图,图中示出了具有棘轮表面的触发器齿轮以及具有棘轮表面的键齿轮,其中移除了该外科器械的一些附加元件;
图97是呈现图96构型的图95反向机构的横截面图;
图98是图95反向机构中回程销的透视图;
图99是图95反向机构的正视图,图中示出了处于致动位置的返回滑架;
图100是图95反向机构的透视图,其中触发器的棘轮表面与键齿轮彼此接合;
图101是根据本发明可供选择的实施例的外科器械的正视图,该外科器械包括图68外科器械的击发驱动和反向驱动,图中移除了该外科器械的一些元件,其中击发驱动的制转杆被示出为当其相对于击发构件回缩时会显现出来;
图102是图101外科器械的正视图,图中示出了可操作地接合击发构件的制转杆;
图103是图101外科器械的正视图,图中示出了当击发构件非有意地相对于其预期位置后退时击发构件中的制转杆和凹陷之间未对准;
图104是根据本发明可供选择的实施例的外科器械(包括止退机构)的正视图,图中移除了该外科器械的一些元件;
图105是图104止退机构中回程销的透视图;
图106是从图105回程销延伸的键的细部图;
图107是图104止退机构中分度元件的透视图;
图108是可操作地接合图107分度元件的图105回程销的透视图;
图109是回程销和分度元件的透视图,图中示出了布置在分度元件第一孔内的回程销键;
图110a是图109的回程销键和分度元件的另一透视图;
图110b是当回程销键从分度元件第一孔移动到第二孔时压下分度元件中回程销键的透视图;
图110c是布置在分度元件第二孔内的回程销的键部分的透视图;
图110d是当回程销键从分度元件第二孔移动到第三孔时压下分度元件中回程销键的透视图;
图110e是布置在分度元件第三孔内的回程销的键部分的透视图;
图110f是当回程销键从分度元件第三孔移动到第四孔时压下分度元件中回程销键的透视图;
图110g是布置在分度元件第四孔内的回程销的键部分的透视图;
图111是图107分度元件的横截面图;
图112是根据本发明可供选择的实施例的分度元件以及可操作地接合分度元件的复位弹簧的透视图;
图113是图112分度元件的横截面图;
图114是根据本发明另一个可供选择的实施例的分度元件的透视图;
图115是根据本发明可供选择的实施例的外科器械(包括止退机构)的局部透视图,图中移除了该外科器械的一些元件;
图116是图115止退机构的横截面图;
图117是图115外科器械的透视图,图中示出了处于致动位置的反向机构的返回滑架;
图118是当图117的返回滑架处于致动位置时图115止退机构的横截面图;
图119是根据本发明可供选择的实施例的外科器械的透视图,图中移除了该外科器械的一些元件以便示出用于致动该外科器械反向驱动的开关;
图120是根据本发明另一个可供选择的实施例的外科器械的局部正视图,图中移除了该外科器械的一些元件以便示出用于致动该外科器械反向驱动的开关;
图121是图120外科器械的局部正视图,图中示出了处于致动位置的开关的第一部分;
图122是图120外科器械的局部正视图,图中示出了开关的第二部分,用来将开关的第一部分定位在致动位置;以及
图123是可使外科器械的端部执行器旋转连接到轴的关节接头的透视图;
图124是手术缝合器械的端部执行器的正视图,图中示出了处于打开位置的钉砧;
图125是图124端部执行器的闭合管的细部图,该闭合管将端部执行器的钉砧固定在关闭位置;
图126是根据可供选择的实施例的闭合管的透视图;
图127是图126闭合管的正视图,该闭合管接合图123的钉砧,以将钉砧定位在部分关闭位置;
图128是图124闭合管的正视图,该闭合管将图124钉砧固定在完全关闭位置;
图129是手术缝合器械中的轴和端部执行器之间的关节接头的顶视图,图中移除了一些元件,该关节接头还包括可相对于轴和端部执行器移动的引导构件;
图130是图129关节接头的远端部分顶视图;
图131是手术缝合器械可供选择的实施例中轴和端部执行器之间的关节接头的顶视图,图中移除了一些元件,该关节接头还包括可相对于轴和端部执行器移动的引导构件;
图132是图131关节接头的透视图,图中移除了一些元件;
图133是图131关节接头的顶视图,其中移除了一些元件,该图示出了处于平直或居中位置的端部执行器;
图134是图131关节接头的顶视图,图中示出了处于关节运动位置的端部执行器;
图135是位于图133所示方向的图131关节接头的正视图;
图136是传动杆的正视图,该传动杆包括被构造用于切割组织的切割构件以及被构造用于从钉仓布置缝钉的驱动器;
图137是图136传动杆的平面图;
图138是手术缝合器钉仓的部分平面图;
图139是切割构件和该刀杆所连接刀杆的正视图,该刀杆包括止动表面,该止动表面被构造成将切割构件的行进范围限制在外科器械的端部执行器内;
图140是图131关节接头的横截面图,图中示出了图139刀杆、端部执行器被布置成平直或居中构型,并且止动表面与图131的引导构件接合;
图141是图131关节接头的横截面图,图中示出了图139刀杆、端部执行器被布置成关节运动构型,并且止动表面与图131的引导构件接合;
图142是手术缝合器械的击发驱动的示意图,其中击发驱动包括马达、可通过马达驱动的齿条齿轮系统,以及可操作地接合齿条的击发杆,其中马达运行时可推进和/或回缩击发杆
图143是紧靠回缩阻挡件布置的图138钉仓内切割构件的正视图;
图144是击发杆和刀杆之间连接件的细部图,该连接件被构造成使图142切割构件在图138钉仓内运动;
图145是描述如图143所示那样当切割构件在回缩阻挡件作用下反向回缩时可在编码器内部产生的编码器误差的坐标图;
图146a是在端部执行器为平直或居中构型情况下在切割构件紧靠回缩阻挡件设置后的图144连接件的细部图;
图146b是在端部执行器为关节运动构型情况下在切割构件紧靠回缩阻挡件设置后的图144连接件的细部图;
图147是与端部执行器中锁构件接合的锁的顶视图;以及
图图148是图147的锁和锁构件的横截面图;
在所有这几个视图中,对应的参考符号指示对应的部分。本文示出的范例(以一种形式)示出本发明的优选实施例,不应将这种范例理解为是以任何方式限制本发明的范围。
具体实施方式
现在描述某些示例性实施例,以得到对本文所公开的装置和方法的结构、功能、制造和使用的原理的全面理解。这些实施例的一个或多个实例在附图中示出。本领域的普通技术人员将会理解,本文特别描述和在附图中示出的器械和方法为非限制性的示例性实施例,并且本发明多个实施例的范围仅由权利要求书限定。结合一个示例性实施例示出或描述的特征可以与其他实施例的特征组合。这些修改形式和变型形式旨在包含于本发明的范围内。
例如,在各种实施例中,根据本发明的外科器械可被构造成将手术缝钉插入到软组织中。在至少一个实施例中,参见图1-4,外科器械100可包括柄部102、细长轴组件104和端部执行器106。在各种实施例中,参见图3和4,端部执行器106可包括钉仓通道108和钉仓110,其中钉仓110可被构造成可拆卸地将缝钉储存于其中。在至少一个实施例中,端部执行器106还可包括钉砧112,该钉砧可枢转地连接到钉仓通道108并且可通过端部执行器闭合系统在打开和关闭位置之间枢转。为了从钉仓110布置缝钉,外科器械100还可包括被构造成横穿过钉仓110的缝钉驱动器和被构造成推进钉仓内缝钉驱动器的击发驱动。在各种实施例中,钉砧112可被构造成当缝钉从钉仓布置时使缝钉的至少一部分变形。虽然端部执行器闭合系统和击发驱动的各种实施例将在下文更详细地描述,但端部执行器闭合系统和击发驱动的几个实施例公开于以下专利中:公布于2005年6月14日的名称为“SURGICAL STAPLING INSTRUMENT INCORPORATING A FIRINGMECHANISM HAVING A LINKED RACK TRANSMISSION”(装配有带连接齿条传动的击发机构的手术缝合器械)的美国专利No.6,905,057以及公布于2006年5月16日的名称为“SURGICALSTAPLING INSTRUMENT HAVING A SINGLE LOCKOUTMECHAMISN FOR PERVENTION OF FIRING”(具有用于防止击发的单个锁闭机构的手术缝合器械)的美国专利No.7,044,352,所述专利全部公开内容据此以引用方式并入本文中。全文以引用方式并入本文中的还有名称为“SURGICAL STAPLING INSTRUMENT WITH ANARTICULATABLE END EFFECTOR”(带有能进行关节运动的端部执行器的手术缝合器械)的、共同拥有的、同时提交的美国专利申请代理人案卷号END6608USNP/090238的公开内容。
在各种实施例中,根据本发明的外科器械可包括用于使外科器械的端部执行器相对于细长轴组件移动或关节运动的系统。在至少一个实施例中,参见图3-7,外科器械100可包括关节接头114,该关节接头可移动地连接端部执行器106和细长轴组件104。在各种实施例中,关节接头114可允许端部执行器106在单个平面内或作为另外一种选择在多个平面内相对于轴组件104移动。无论哪一种情况,关节接头114都可包括一条或多条枢轴线116(图5),端部执行器106可绕该枢轴线作关节运动。在各种实施例中,参见图5和6,外科器械100还可包括锁定机构118,该锁定机构可使端部执行器106和细长轴组件104之间相对固定或锁定。在至少一个实施例中,锁定机构118可包括锁构件120,该锁构件可相对于端部执行器106滑动并可接合端部执行器106以便防止或至少部分地抑制端部执行器106与轴组件104之间的相对运动。在至少一个实施例中,锁构件120可被构造成接合端部执行器106的至少一个齿312(图5和6),使得锁构件120与齿312之间的交互作用可防止或至少部分地抑制端部执行器106围绕轴线116旋转,如下文更详细的描述。
在各种实施例中,参见图7-9,锁定机构118还可包括致动器122,该致动器可操作地连接到锁构件120。在至少一个实施例中,致动器122可包括销124,该销可被接纳于锁构件120的狭槽121内,使得当致动器122相对于柄部102滑动时,销124可邻接狭槽121的侧壁并可相对于端部执行器106推进锁构件120。在至少一个实施例中,可将致动器122拉离端部执行器106,即,向近侧拉动,从而使锁构件120脱离端部执行器106。尽管未举例说明,但还可设想其他实施例,在这些实施例中,致动器122可向远侧移动或甚至旋转,从而使锁构件120脱离端部执行器106。无论哪一种情况,锁定机构118还可包括复位弹簧126(图6),该复位弹簧可被构造成使锁构件120朝向端部执行器106移动,即向远侧移动,从而在致动器122释放后使锁构件120与端部执行器106接合。其他锁定机构公开于以下专利申请中:2005年4月7日提交的名称为“SURGICAL INSTRUMENT WITHARTICULATING SHAFT WITH SINGLE PIVOT CLOSURE ANDDOUBLE PIVOT FRAME GROUND”(具有带单枢轴闭合器和双枢轴框架底的关节运动轴的外科器械)的美国专利申请No.11/100,772,2005年9月29日提交的名称为“SURGICAL INSTRUMENT WITHARTICULATING SHAFT WITH RIGID FIRING BAR SUPPORTS”(具有带刚性击发杆支撑件的关节运动轴的外科器械)的美国专利申请No.11/238,358,以及2006年7月24日提交的名称为“SURGICALSTAPLING AND CUTTING DEVICE AND METHOD FOR USING THEDEVICE”(手术缝合与切割装置及其使用方法)的美国专利申请No.11/491,626,所述专利申请全部公开内容据此以引用方式并入本文中。
在各种实施例中,参见图1和2,致动器122的轮廓可形成为使得外科医生能够抓握致动器122的外表面并如上所述那样向近侧拉动致动器122。为移动致动器122,在至少一个实施例中,例如,外科医生可以将一只手放在手柄127上,并将其另一只手放在致动器122上,使得外科医生可以相对于手柄127移动致动器122。在其他各种实施例中,参见图10-13,致动器122’可被构造成使得外科医生只需一只手来操作该外科器械。更具体地讲,在至少一个实施例中,致动器122’可包括从其延伸出的吊钩或凸起115,该吊钩或凸起可允许外科医生用一只手握住手柄127,向远侧伸展这只手的至少一根手指以抓住至少一个凸起115以及如上所述那样向近侧拉动致动器122’。虽然本文描述的致动器122’具有凸起115,但是致动器122或任何其他合适的致动器也可包括凸起115和/或任何其他可帮助外科医生用一只手操作外科器械100的合适结构。在至少一个实施例中,凸起115可至少部分地由弹性或“柔软触感”的材料构成或者涂布,这种材料可以增强外科医生对凸起115的抓握性,并且可以为外科医生提供其他人类工程学有益效果。在各种实施例中,致动器122’(例如)可操作地接合轴组件104,使得端部执行器106和轴组件104在致动器122’作用下可围绕纵向轴线旋转。在此类实施例中,外科医生可如上所述那样通过端部执行器106的关节运动和/或将端部执行器106旋转到位而将端部执行器106定位于手术部位。在至少一个实施例中,外科医生可通过将手指紧靠其中一个凸起115放置并向其施加力来旋转致动器122’。在各种实施例中,外科医生可通过将手指紧靠凸起115放置并抵抗致动器122’和相应的端部执行器106的任何非预期运动来将致动器122’固定到位。
在各种实施例中,根据本发明的外科器械可包括例如用于使端部执行器关闭或夹在软组织上的系统。在至少一个实施例中,参见图2、5、8和9,外科器械100可包括闭合触发器128、驱动连杆130、驱动器132和闭合管134。在各种实施例中,在闭合触发器128致动后,闭合触发器128可被构造成使驱动连杆130、驱动器132和闭合管134向远侧发生位移。更具体地讲,在至少一个实施例中,驱动连杆130可包括可枢转连接到触发器128的第一末端和可枢转连接到驱动器132的第二末端,使得触发器128朝向手柄127的旋转可向前驱动连杆130并沿驱动器导引装置136限定的轴线滑动驱动器132(图8)。在各种实施例中,驱动器132可包括从其延伸出的凸起133,该凸起可通过滑动方式接纳于驱动器导引装置136的狭槽135内,使得当驱动器132移动时狭槽135可限定该驱动器的路径。在各种实施例中,闭合管134可操作地接合驱动器132,使得当驱动器132如上所述向远侧移动时,闭合管134可接合钉砧112并使钉砧112向下枢转。主要参见图5,闭合管134可被构造成在关节接头114上滑动并使钉砧112相对于钉仓110枢转。在至少一个实施例中,如图9所示,闭合管134可包括具有从其延伸出的凸起135的近端,该凸起被接纳于驱动器132的狭槽131内,使得驱动器132的位移带动闭合管134。
在各种实施例中,如上所述,锁定机构118可防止或至少部分地抑制端部执行器106和轴组件104之间的相对运动。例如,在软组织夹在钉砧112和钉仓110之间的情况下,端部执行器106和轴组件104之间的相对运动可将剪切力施加于夹在其间的软组织上进而使软组织损伤。在各种实施例中,参见图10-13,为了在端部执行器106闭合时防止或至少减少端部执行器106和轴组件104之间的相对运动,端部执行器闭合系统可被构造成接合锁定机构118,以防止致动器122’移动到其未锁定位置。事实上,在至少一个实施例中,闭合触发器128的致动不仅可以闭合端部执行器106,而且还可以防止锁定机构118解锁。在各种实施例中,参见图10-13,外科器械100’可包括驱动器132,该驱动器可被构造成当驱动器132在触发器128作用下向远侧移动时其邻接致动器122’或紧邻致动器122’布置,从而防止致动器122’如上所述那样相对于致动器122向近侧移动。更具体地讲,在触发器132致动前,如图10和11所示,致动器122’可向近侧滑动,以便使锁构件120相对于端部执行器106滑动并使关节接头114解锁。然而,在触发器132致动后,参见图13,驱动器132可被构造成邻接致动器122’或邻近致动器122’布置,使得致动器122’不会朝向近侧移动,从而使锁构件120脱离端部执行器106。因此,端部执行器闭合系统可防止端部执行器106在闭合后发生关节运动,从而使剪切力传递到夹在其间的软组织上的可能性降低。
就以上所述而言,端部执行器闭合系统可向外科医生提供反馈告知端部执行器已经闭合,如果外科医生要使端部执行器解锁并做关节运动,则外科医生必须首先至少部分地重新开启端部执行器才能使端部执行器做关节运动。更具体地讲,由于在端部执行器106闭合时驱动器132和致动器122’的交互作用,当外科医生试图朝向近侧拉动致动器122’以使关节接头114解锁时,驱动器132可基本防止致动器122’移动,进而将信号发送给外科医生,告知端部执行器106是闭合的,必须首先开启端部执行器106才能移动致动器122’并使关节接头解锁。在各种实施例中,此类端部执行器闭合系统可防止外科医生损坏该外科器械和/或损伤夹在端部执行器之间或端部执行器周围的组织。更具体地讲,在至少一个实施例中,当如上所述那样推进闭合管134以闭合钉砧112时,闭合管134可将力施加于钉砧112上,从而将钉砧112保持在关闭位置,并且在多种情形下,该力在关节接头114内可形成摩擦力,这些摩擦力可抑制(如果不能防止的话)端部执行器106围绕关节接头114旋转。在未使用如上所述的端部执行器闭合系统的实施例中,如果外科医生试图在不首先至少部分地开启端部执行器的情况下克服这些摩擦力,则可能例如弄弯或折断该外科器械的一个或多个元件。然而,在本发明的各种实施例中,驱动器132例如可防止外科医生如上所述那样释放关节锁120,因此外科医生没有机会使关节接头114解锁,更不必说使端部执行器106发生关节运动。
在各种实施例中,根据本发明的外科器械可包括端部执行器闭合系统,该系统可将钉砧112定位在例如打开位置、关闭位置和部分关闭位置。在至少一个实施例中,在钉砧112移动到其关闭位置前,外科医生可将钉砧112移动到部分关闭位置中,并评价端部执行器应该进行重新定位还是进行关节运动。在此类实施例中,钉砧112可相对于软组织移动,软组织布置在钉砧112和钉仓110之间,在钉砧112完全关闭之前没有剪切力或至少没有大量的剪切力施加到软组织。在至少一个实施例中,钉砧112可被构造成使得当其处于部分关闭位置时不会夹住布置在钉砧112和钉仓110之间的软组织。作为另外一种选择,钉砧112可被构造成当钉砧112处于部分关闭位置时将较弱的夹持力施加于软组织,然后当其移动到关闭位置时施加较强的夹持力。在至少一个这样的实施例中,外科器械可包括触发器,该触发器可在第一位置(图11)(对应于钉砧112的打开位置)、第二位置(图12)(对应于钉砧112的部分关闭位置)和第三位置(图13)(对应于钉砧112的关闭位置)之间移动。在各种实施例中,参见图8和9,触发器128可枢转地安装在柄部102的外壳103上,使得触发器128可围绕销129在其第一、第二和第三位置之间旋转。在各种实施例中,参见图8、9、17和18,外科器械100还可包括触发器锁148,该触发器锁可被构造成接合触发器128并将触发器128选择性锁定在上述第一、第二和第三位置的至少一者中。在至少一个实施例中,触发器128可包括枢轴末端138,该枢轴末端包括凸轮表面140、第一凹口142和第二凹口144,其中触发器锁148可被构造成接合第一凹口142和第二凹口144。更具体地讲,参见图8和9,外科器械100还可包括触发器锁弹簧150,该弹簧被构造成使触发器锁148的从动件部分149相对凸轮表面140偏置,使得当第一凹口142或第二凹口144与从动件部分149对准时,触发器锁弹簧150可将从动件部分149分别推进到第一凹口142或第二凹口144。在至少一个实施例中,主要参见图8和9,触发器锁148可通过销151枢转地安装到柄部102的外壳103上。在各种实施例中,触发器锁弹簧150可压缩在触发器锁148的按钮部分152和外壳103之间,使得触发器锁弹簧150可围绕销151旋转触发器锁148并使触发器锁148相对触发器128的凸轮表面140向下偏置。
就以上所述而言,在至少一个实施例中,当触发器132移动到其第二位置并且钉砧112移动到其部分关闭位置时,第一凹口142可与从动件部分149对准。在各种实施例中,从动件部分149可牢固地保持在第一凹口142内,使得可能需要手动使触发器锁148与触发器132脱离,才能将触发器132移动到其第三位置和/或返回到其第一位置。在至少一个实施例中,参见图8和9,外科医生可压下锁构件148的按钮部分152,使得锁构件148围绕销151旋转并且从动件部分149向上提升而脱离触发器128。在其他各种实施例中,第一凹口142可被构造成使得在力施加于触发器132后从动件部分149可滑出第一凹口142。无论哪一种情况,在从动件部分149脱离第一凹口142后,外科医生可选择性地将触发器132移动到其第三位置或释放触发器132,并允许触发器弹簧(例如)将触发器132返回到其第一位置。在至少一个可供选择的实施例中,第一凹口142和从动件部分149可被构造成使得在触发器132已移动到其第二位置后,触发器132必须在返回到其第一位置前移动到其第三位置。无论哪一种情况,在至少一个实施例中,当触发器132移动到其第三位置并且钉砧112移动到其部分关闭位置时,触发器132的第二凹口144可与从动件部分149对准。与第一凹口142类似地,第二凹口144可被构造成将从动件部分149保持在其中直到锁构件148脱离触发器132和/或将足够的力施加于触发器132上以使从动件部分149与第二凹口144分离。然后,在各种实施例中,触发器弹簧可将触发器132从其第三位置移动到其第二位置,其中与上述类似地,可能需要外科医生使从动件部分149与第一凹口142脱离。在至少一个可供选择的实施例中,第一凹口142可被构造成使得从动件部分149可滑过第一凹口142并允许触发器132从其第三位置移动到其第一位置,而无需外科医生使从动件部分149与第一凹口142分离。
就以上所述而言,虽然未举例说明,但是当闭合触发器128处于其第一位置时,锁构件148的按钮部分152可凹进(例如)外科器械外壳103内。在可供选择的实施例中,按钮部分152可与外壳103齐平地布置,或者可从外壳103稍微延伸。无论哪一种情况,在至少一个实施例中,当闭合触发器128移动到其第二位置时,按钮部分152可相对于外壳103向外移动。此类移动可向外科医生提供视觉反馈,告知外科器械的针砧处于其部分关闭位置。此外,按钮部分152的移动还伴有听觉和/或触觉反馈。无论哪一种情况,外科医生都可以在按钮部分152向外移动之后触动按钮部分152,使得锁构件148可如上所述那样与触发器128脱离。在各种实施例中,当触发器128从其第二位置移动到其第三位置时,按钮部分152可向外移动甚至更远距离。与上述类似地,此类移动可向外科医生提供视觉提示,告知针砧现在处于其关闭位置,并且如上所述那样可伴有听觉和/或触觉反馈。虽然以上将按钮152描述成当触发器128在其第一和第三位置之间行进时该按钮向外移动,但是本发明不受此限制。相反地,按钮152或任何其他合适的指示器可以任何合适的方式向外科医生提供反馈。
在可供选择的实施例中,虽然未举例说明,但是钉砧112可固定或保持于不止上述三个位置,即,其打开位置、关闭位置或部分关闭位置。在至少一个实施例中,钉砧112可保持在打开位置、关闭位置和两个或更多个中间位置。在此类实施例中,钉砧112可穿过这些中间位置行进,并且钉砧112在朝向其关闭位置移动时可对夹在端部执行器106中的软组织施加逐渐增大的力。在至少一个实施例中,与上述类似地,触发器132可以包括对应于钉砧112各个中间位置的多个凹口。在各种可供选择的实施例中,虽然未举例说明,但是端部执行器闭合系统可以包括棘轮组件,该棘轮组件可允许触发器132和相应的钉砧112固定在多个位置。在此类实施例中,钉砧112和触发器132可以通过制转杆固定在位,该制转杆可枢转地接合棘轮,而该棘轮可操作地接合触发器132。
在各种实施例中,参见图10-13,如上所述,可以对致动器122’和柄部102’之间的相对运动进行限制,以便控制锁构件120位移的范围。更具体地讲,参见图10和11,致动器122’的远端部分可以包括从其延伸的凸起123,该凸起可以被接纳于腔体125内,其中致动器122’的位移可以通过腔体125的近端壁117和远端壁119进行限制。在至少一个实施例中,当触发器128处于其第一位置时,如图10和11所示,致动器122可以从远侧位置(其中凸起123可邻接远侧壁119,如图10所示)移动到更近侧位置(其中凸起123不邻接远侧壁119,如图11所示)。在此更远侧位置中,如上所述,锁构件120可以脱离端部执行器106并且端部执行器106可以相对于轴组件104旋转。当触发器128处于其第二位置时,参见图12,驱动器132可以限制致动器122’的运动范围,使得凸起123不会紧靠近侧壁117布置。然而,在至少一个实施例中,致动器122’可以朝向近侧移动一段足够的距离,以使锁构件120脱离端部执行器106。在这些情形中,例如即使针砧112可能部分地闭合到软组织上,外科医生也可以重新定位端部执行器106。当触发器128处于其第三位置时,如图13所示,驱动器132可以朝向远侧推动致动器122’,使得凸起132邻接远侧壁119或邻近远侧壁119布置,并且致动器122’不会移动到足以使关节接头114解锁的距离。
在各种实施例中,根据本发明的外科器械可以包括击发驱动,该击发驱动被构造成如上所述那样推进端部执行器内的切割构件和/或缝钉驱动器。在至少一个实施例中,参见图8、9和19-25,外科器械100的击发驱动可以包括击发触发器160、第一击发连杆162、第二击发连杆164和击发构件166。在各种实施例中,击发触发器160能够可操作地接合击发构件166以及击发连杆162和164中的至少一者,以便推进细长轴组件104内的刀杆168。在至少一个实施例中,刀杆168能够可操作地接合端部执行器106内的切割构件(未示出)和缝钉驱动器(未示出),其中切割构件可以被构造成(例如)切割组织并且缝钉驱动器可以被构造成从钉仓110布置缝钉。切割构件和缝钉驱动器在美国专利No.6,905,057和7,044,352中已充分公开,这些专利在以前已以引用方式并入本专利申请中,因此这些装置未在本文中更详细描述。其他切割构件和缝钉驱动器在以下专利申请中公开:2006年9月29日提交的名称为“SURGICAL STAPLES HAVINGCOMPRESSIBLE OR CRUSHABLE MEMBERS FOR SECURINGTISSUE THEREIN AND STAPLING INSTRUMENTS FOR DEPLOYINGTHE SAME”(具有用于将组织固定于其中的可压缩或可变形构件的手术缝钉及其布置用的缝合器械)的美国专利申请No.11/541,123以及2007年1月11日提交的名称为“SURGICAL STAPLING DEVICEWITH A CURVED CUTTING MEMBER”(具有弯曲切割构件的手术缝合器)的美国专利申请No.11/652,169,所述专利申请全部公开内容据此以引用方式并入本文中。
在各种实施例中,主要参见图19和20,击发触发器160可通过销161枢转地连接到外科器械外壳103(图8和9)。在使用中,在至少一个实施例中,击发触发器160可围绕销161枢转,以便朝向远侧推进击发构件166以及击发连杆162和164。在各种实施例中,击发触发器160可包括狭槽159,其中狭槽159可被构造成接纳击发销172。在各种实施例中,当击发触发器160从图2所示的位置致动或旋转到邻近手柄127的位置时,狭槽159的侧壁可被构造成接合击发销172并朝向远侧推进该击发销。在至少一个实施例中,参见图23,击发驱动还可包括制转杆170,其中制转杆170可包括孔171。在各种实施例中,孔171可被构造成接纳击发销172的至少一部分,使得当击发销172在触发器160作用下朝向远侧推进时,击发销172也可朝向远侧推进制转杆170。在各种实施例中,参见图24,制转杆170可包括齿174,击发构件166可包括凹陷167,其中凹陷167可被构造成接纳齿174。在使用中,当制转杆170在击发销172作用下朝向远侧推进并且齿174接合凹陷167的侧壁时,制转杆170也可朝向远侧推进击发构件166。在各种实施例中,制转杆170可在击发销172作用下沿基本线性的路径向远侧推进。在此类实施例中,狭槽159可包括弓形轮廓,其可以协同击发销172将击发触发器160的旋转运动转换成制转杆170的平移运动。在至少一个实施例中,可以将施加于制转杆170的力大体上(如果不是完全的话)导向远侧方向。因此,在此类实施例中,可减少制转杆170被束缚或卡在缝合器框架184上的可能性。
在各种实施例中,制转杆170可在第一位置(其中制转杆170可操作地与击发构件166脱离)与第二位置之间枢转,参见图19和20,在第二位置中制转杆170可操作地与击发构件166接合。主要参见图21-25,击发驱动还可以包括倾斜机构178,该机构可被构造成用于使制转杆170在其第一位置和第二位置之间枢转。在使用中,当击发触发器160被致动时,制转杆170至少在最初阶段可相对于倾斜机构178移动,使得制转杆170的至少一部分可以邻接倾斜机构178,并使制转杆170向上枢转,与击发构件166形成可操作的接合。在至少一个实施例中,制转杆170可以包括(主要参见图23)凹槽175,该凹槽可被构造成用于接纳从倾斜机构178的中部延伸出的凸起179(图25)。在至少一个实施例中,当制转杆170被向远侧推进时,凹槽175的近侧壁176可以接触凸起179上的凸轮表面,并由于枢转销172向制转杆170施加的力,制转杆170可以向上枢转或旋转,使得齿174可以如上所述设置在击发构件166的凹陷167中。制转杆170进行枢转后,制转杆170朝端部执行器106推进时可以向远侧拖曳倾斜机构178。更具体地讲,在至少一个实施例中,倾斜机构178可以包括可变形的构件180,该构件可被接纳在缝合器框架184的狭槽182中,使得可变形的构件180和缝合器框架184间的相互作用至少部分地抑制倾斜机构178相对于缝合器框架184的移动。换句话来讲,由于可变形的构件180与狭槽182侧壁之间存在静摩擦力,必须向倾斜机构178施加足够的力以克服这些摩擦力,然后倾斜机构178才能相对于缝合器框架184被“拖曳”。
在击发触发器160被致动并且击发构件166被推进后,可以释放触发器160使其返回未致动位置(如图2中所示),制转杆170可从击发构件166脱离并回缩至其起始位置(如图19所示)。更具体地讲,在至少一个实施例中,外科器械100可进一步包括可操作地与触发器160和外壳103接合的触发器弹簧(未示出),例如,其中触发器弹簧可被构造成用于绕销161旋转触发器160,以及在制转杆170从击发构件166脱离后向近侧驱动击发销172。在各种实施例中,制转杆170通过倾斜机构178从其第二位置(如图24所示)枢转到第一位置(如上文所述)时,其可与击发构件166脱离。在此类实施例中,制转杆170至少在最初阶段可以相对于倾斜机构178移动,使得凹槽175的远侧壁177可以接触凸起179上的第二凸轮表面,并且由于触发器160或复位弹簧186向击发销172施加的力,可使制转杆170向下旋转,以使得制转杆170的齿174可从击发构件166中的凹陷167脱离。之后,触发器160和/或复位弹簧186可以相对于击发构件166拉伸或回缩制转杆170。在各种实施例中,与上文所述类似,制转杆170可被构造成用于在狭槽182内向近侧拖曳倾斜机构178。由于以上原因,制转杆170无须偏置到其第一位置或第二位置。在各种情况下,制转杆170可以自由地在其第一位置和第二位置间旋转,而不必克服由偏置弹簧施加的力。实际上,在各种实施例中,使制转杆170在其第一位置和的第二位置间移动的力只需克服制转杆170的重力以及制转杆170与该外科器械周围组件之间的摩擦力。
制转杆170返回至其初始位置后,在至少一个实施例中,制转杆170的齿174可能不再与击发构件166中的凹陷167对齐。相反地,通常参见图19和20,制转杆170的齿174可以与第一击发连杆162中的凹陷163对齐。更具体地讲,第一击发连杆162能够可枢转地连接至击发构件166,使得在向远侧推进击发构件166时(如上文所述),击发构件166可以拉伸第一击发连杆162进入击发构件166之前占据的位置。因此,一旦第二次致动击发触发器160,制转杆170就可以从其第一位置枢转入其第二位置,使得齿174可操作地与凹陷163接合,并且制转杆170可向远侧推进击发连杆162。在至少一个实施例中,击发连杆162可向远侧推动击发构件166和刀杆168,从而相应地在端部执行器106中向远侧推进切割构件和缝钉驱动器。然后制转杆170可以再次从其第二位置枢转至其第一位置,并可相对于第一击发连杆162回缩。制转杆170第二次返回至其初始位置后,制转杆170的齿174可能不再与第一击发连杆162的凹陷163对齐。相反地,与上文所述类似,齿174可以与第二击发连杆164中的凹陷165对齐,并可重复上述过程。
尽管图中并未示出,但根据本发明的外科器械可以包括2个以上或少于2个的击发连杆,以便在端部执行器106中推进切割构件和缝钉驱动器至期望的位置。在各种实施例中,如下文更详细地描述,击发构件166可以包括1个以上的凹陷167,使得制转杆170可朝向端部执行器106多次直接推进击发构件166。在至少一个这样的实施例中,制转杆170可在向远侧推进击发构件166后回缩(如上所述),使得当制转杆170再一次向上倾斜时,制转杆170可以接合击发构件166中的另一个凹陷167,并再一次朝向端部执行器106推进击发构件166。因此在至少一个实施例中,可能并不需要击发连杆162和164。
在各种实施例中,外科器械可包括一个或多个弹簧构件,该弹簧构件被构造成用于将制转杆170移动进入其第一位置和第二位置中的至少一者。在至少一个实施例中,参见图27和28,击发驱动可包括制转杆170’、击发销172和倾斜机构178’,其中类似于上文,倾斜机构178’可被构造成用于在制转杆170’被向远侧推进时向上枢转制转杆170’。击发驱动还可以包括枢转弹簧188,该弹簧能够可操作地连接至制转杆170’,使得当制转杆170’向上枢转入其第二位置(如图27所示)时,制转杆170’可以挠曲或有弹性地弯曲枢转弹簧188。制转杆170’被推进后,制转杆170’可被枢转弹簧188向下枢转入其第一位置(如图28所示)。更具体地讲,由于枢转弹簧188被挠曲时存储的势能,一旦制转杆170’不再被倾斜机构178’和击发销172固定在其第二位置后,弹簧188便可向下移动制转杆170’。然后如上文所述,制转杆170’可相对于击发构件166和/或击发连杆162和164回缩。在各种实施例中,倾斜机构178’可不包括用于枢转制转杆170进入其第一位置的第二凸轮表面。在此类实施例中,制转杆170’可通过如上所述施加给击发销172的力回缩。在各种可供选择的实施例中,尽管图中并未示出,但是倾斜机构178’和制转杆170’也可以包括用于向下枢转制转杆170’进入其第一位置的协作结构。
在各种实施例中,参见图19和20,外科器械100还可以包括带190,该带可被构造成用于相对于端部执行器106移动击发构件166和击发连杆162和164。在至少一个实施例中,带190的第一末端可被连接至击发构件166,(例如)使得当击发构件166被向远侧推进时,带190也可以被向远侧拉伸。在各种可供选择的实施例中,带190可连接至第一击发连杆162和/或第二击发连杆164。在至少一个实施例中,带190可以设置围绕卷轴或线轴192的至少一部分,使得当击发构件166拉伸带190时,带190可从卷轴192上展开或退绕。在至少一个实施例中,带190的第二末端可连接至卷轴192,使得带190在外科器械100的正常操作条件下不易从卷轴192上脱离。无论在什么情况下,当击发构件166拉伸带190时,卷轴192可以顺时针或逆时针方向(取决于带190以何种方式设置在卷轴192上)进行旋转。为回缩击发构件166,卷轴192可以相反的方向旋转以向近侧移动击发构件166,以及击发连杆162和164,并使带190卷绕在卷轴192上。
在各种实施例中,带190可围绕卷轴192进行缠绕,使得带190卷绕在卷轴192的基本上成圆柱体的表面上。在至少一个实施例中,卷轴192的旋转轴与圆柱体表面之间的距离基本上等于卷轴192的周长。在这些实施例中,当带190如上文所述被向近侧拉伸时,卷轴192的机械效益可基本保持不变,并且卷轴192向带190施加拉力的能力可基本保持相同。然而在可供选择的实施例中,卷轴192可被构造成用于提供可变的机械效益。在至少一个实施例中,卷轴192可包括非圆柱体表面(带190可卷绕在该表面上),使得卷轴192的旋转轴与非圆柱体表面之间的距离不等于卷轴192的周长。因此在这些实施例中,当带190卷绕在卷轴192上时,卷轴192向带190施加拉力的能力可能会改变。在至少一个实施例中,卷轴192可用作凸轮并包括可进行优化以便在带190首次回缩时向其提供附加力的形状,即该力回缩切割构件时(例如)可达到其最大值。
在各种实施例中,参见图29-42,击发触发器160可选择性地与外科器械100的返回机构接合。在至少一个实施例中,当击发触发器160通过制转杆170可操作地与击发构件166接合时,如上文所述,致动击发触发器160可向远侧推进击发构件166,而当击发触发器160通过带190可操作地与击发构件166接合时,致动击发触发器160可向近侧回缩击发构件166。在各种实施例中,可以手动致动返回机构使击发触发器160从击发构件166中脱离,以及使击发触发器160与卷轴192可操作地接合。在至少一个实施例中,返回机构可包括返回滑架194,该滑架能够可枢转地安装在外科器械外壳103中,使得返回滑架194可在第一(或未致动)位置(如图29所示)和第二(或致动)位置(如图32所示)之间枢转。在至少一个此类实施例中,返回滑架194可包括按钮部分195,当向其上施加外力时,该部分可被构造成用于将返回滑架194从其未致动位置移动至致动位置。
当返回滑架194设置在其未致动位置(如图29-31所示)时,击发触发器160可如上文所述被构造成用于推进击发构件166,而触发器160的齿轮部分158能够可操作地与触发器齿轮196接合。在各种实施例中,齿轮部分158和触发器齿轮196能够可操作地接合,使得触发器160围绕销161旋转时可以驱动触发器齿轮196围绕由回程销198限定的轴线移动。在至少一个实施例中,当返回滑架194处于其未致动位置时,触发器齿轮196可被构造成用于围绕回程销198自由旋转,使得触发器齿轮196的旋转不传递(或至少基本上不传递)至回程销198。更具体地讲,参见图30,回程销198的键199可偏置到脱离与触发器齿轮196的接合,使得触发器齿轮196的旋转不传递至键齿轮206和卷轴192。因此当返回滑架194位于其非致动位置时,致动触发器齿轮196不会使卷轴192旋转,或至少基本上不使其旋转。
在切割构件和缝钉驱动器在端部执行器106内被推进之后,返回滑架194可移动到致动位置。在各种实施例中,参见图30,卷轴192可包括从其延伸的凸轮构件202,该构件可接触返回滑架194并向下旋转返回滑架194。在至少一个实施例中,凸轮构件202可在触发器160的最终致动过程中接触返回滑架194,其中触发器160在此致动过程中将在端部执行器106中推进切割构件和缝钉驱动器。在至少一个这样的实施例中,凸轮构件202可在击发触发器160的第三次致动后接触返回滑架194。在各种实施例中,参见图32-35,当齿轮滑架194移动到致动位置时,返回滑架194可被构造成用于可操作地接合触发器齿轮196与卷轴192。在至少一个实施例中,参见图33和35,返回滑架194可包括偏置弹簧200,其中当返回滑架194处于其未致动位置时,弹簧200可位于如图33中所示的位置,并且当返回滑架194移动入其致动位置(如图35所示),弹簧200可接触回程销198并朝向触发器齿轮196偏置回程销198。在至少一个实施例中,参见图31,触发器齿轮196可包括位于其中的D形腔体197,该腔体在如下文所述的某些情况下可接纳从回程销198延伸的键199,并使触发器齿轮196与键齿轮206和卷轴192可操作地接合。在各种实施例中,返回滑架194移动到致动位置可伴随有听觉和/或触觉反馈,以提示外科医生该外科器械的返回机构已与触发器160接合。
就以上所述而言,当回程销198滑向触发器齿轮196时,D形腔体197可被定位使得键199不立即进入腔体197。相反地,参见图31,弹簧200可偏置回程销198使得键199首先邻接触发器齿轮196的表面204。但在触发器160被释放并返回至其未致动位置后,D形腔体197可旋转并与键199对齐,使得弹簧200可偏置键199使其进入腔体197(如图36中所示)。在至少一个实施例中,参见图31,当回程销198滑向触发器齿轮196时,回程销198的末端可接纳在返回滑架194的狭槽193中(如图32所示)。在键199插入腔体197后,触发器160的后续致动可使得D形腔体197的驱动表面210邻接键199并使回程销198旋转至如图37和38所示的位置。实际上,在至少一个实施例中,触发器160的致动可使键199旋转大约半圈,使得最初基本向下延伸的键199(图36)可以旋转从而使键199基本向上延伸(图37)。然后,触发器160可以被释放,而触发器齿轮194可相对于键199旋转,其中键199可保持基本向上的取向(如图39-41所示)。
在各种实施例中,主要参见图38,键齿轮206能够可操作地与回程销198接合,使得回程销198的旋转可被传递至键齿轮206。在至少一个实施例中,键齿轮206可包括匙形孔212,该孔可被构造成用于可滑动地接纳回程销198的键199。在至少一个这样的实施例中,当回程销198与触发器齿轮196接合时,键199能够可操作地与触发器齿轮196的凹陷197和键齿轮206的孔212接合。在各种可供选择的实施例中,键齿轮206可以固定地安装到回程销198上。在此类实施例中,当回程销198相对于触发器齿轮196滑动时,键齿轮206也可以相对于触发器齿轮196滑动。在各种实施例中,通常参见图38,卷轴192可以包括安装在其上的直齿轮216,其中直齿轮216能够可操作地与键齿轮206接合,使得键齿轮206的旋转可被传递至卷轴192上。在至少一个实施例中,当键齿轮206如上文所述滑向触发器齿轮196时,它可以滑入与卷轴192的可操作接合中。在可供选择的实施例中,直齿轮216可被构造成使得无论键齿轮206是否已偏向触发器齿轮196,键齿轮206都处于可操作接合中。
由于以上原因,当返回滑架194设置在其致动位置(如图32中所示)时,触发器160的致动可以旋转卷轴192并使带190卷绕在其至少一部分上。在返回滑架194被致动,键199无法与触发器齿轮196可操作地接合的情况下,可以手动旋转卷轴192以回缩带190。在至少一个这样的实施例中,参见图33和37,螺栓或紧固件218能够可操作地与卷轴192接合,使得螺栓218的转动可以影响卷轴192的旋转。在各种实施例中,外科医生可以插入螺栓218穿过外科器械外壳103中的开口,并使螺栓218与卷轴192接合。在至少一个实施例中,外科器械100可进一步包括计数机构(未示出),该机构可对触发器160的致动进行计数,并且在至少一个这样的实施例中,螺栓218(例如)能够可操作地与计数机构接合以便旋转卷轴192。因此在各种实施例中,该外科器械可以包括用于卷绕卷轴192的第一(或主)致动器,以及可被构造成用于代替第一致动器卷绕卷轴192的第二致动器。
在各种实施例中,如上文所述,卷轴192可被构造成用于向近侧拉伸带190以及回缩击发构件166和击发连杆162、164。更具体地讲,如上文所述,击发构件166和击发连杆162、164可相对于制转杆170回缩,以便将击发构件166和击发连杆162、164重新定位在它们的起始位置中。在此类实施例中,特别是在如上文所述制转杆170可枢转的实施例中,外科器械100的返回机构可进一步被构造成用于在击发构件166和击发连杆162、164相对于制转杆170移动时,将制转杆170固定,使之脱离与这些部件的可操作接合。更具体地讲,当返回滑架194移动到致动位置(如图35所示)时,返回滑架194可被构造成用于接触击发销172的末端,并使击发销172滑向制转杆170,使得击发销172接合制转杆170并防止制转杆170向上枢转。更具体地讲,参见图34,击发销172可包括第一末端220,该末端可包括斜表面和/或圆形表面,(例如)其中当返回滑架194接触第一末端220时,返回滑架194可将击发销172推向制转杆170。在至少一个实施例中,制转杆170可包括凹陷173,该凹陷可被构造成用于在击发销172移向制转杆170时接纳从击发销172延伸的键222。当键222和凹陷173可操作地接合时,击发销172可防止制转杆170向上枢转进入与击发构件166和击发连杆162、164的接合。
在击发构件166和击发连杆162、164回缩后,可将新的钉仓110固定在端部执行器106中,而外科器械100则可复位使得其可再次用于切割和缝合软组织。在各种实施例中,参见图39-42,返回滑架194可从其致动位置(如图32所示)移动至其未致动位置(如图40所示)。在至少一个实施例中,当向按钮部分195施加外力时,返回滑架194可向上旋转或枢转。或者,返回滑架194可在(参见图29)触发器锁148向上旋转以使从动件部分149与闭合触发器128脱离以便重新打开端部执行器106(如上文所述)时向上移动。更具体地讲,向触发器锁148的按钮部分152施加力时,触发器锁148可向上旋转使得从其上延伸出的凸起147可以接触返回滑架194并向上移动返回滑架194。无论在什么情况下,参见图42,当返回滑架194向上移动进入其未致动位置时,返回滑架194可使击发销172与制转杆170脱离,此外还使回程销198与触发器齿轮196脱离。更具体地讲,返回滑架194可被构造成邻接击发销172的倾斜或圆形末端221,使得当返回滑架194向上旋转时,返回滑架194可使回程销172滑离制转杆170,并使键222从凹陷173中脱离。相似地,当返回滑架194向上移动时,狭槽193的侧壁可被构造成接触回程销198的末端,并使回程销198滑离触发器齿轮196以将键199从D形凹陷197中脱离。简单地说,至少在示出的实施例中,当锁定构件148的按钮部分152被压下,并且返回滑架194向上移动后,该外科器械可以复位并再次重复使用。
尽管上文所述的外科器械可在切割构件和缝钉驱动器在端部执行器106中被完全推进后复位,但是返回滑架194的按钮部分195(例如)仍可在切割构件和缝钉驱动器在端部执行器106中仅部分推进后被压下。在各种实施例中,返回滑架194还可以包括在返回滑架194的相对侧之间延伸的导向销191。在至少一个这样的实施例中,导向销191能够可滑动地接纳在框架184中的导槽185(图31)内,使得导槽185和导向销191可为返回滑架194限定路径。在各种实施例中,导向销191和导槽185可被构造成用于在返回滑架194从其致动位置移动至未致动位置(如上文所述)时,确保返回滑架194接合击发销172和回程销198并复位该外科器械。
在各种实施例中,外科器械100还可以包括制动器用于防止或至少部分抑制击发驱动(例如)在端部执行器106中推进和/或回缩切割构件和缝钉驱动器。在至少一个实施例中,参见图43,框架184可以包括制动器表面187,其中制动器表面187可被构造成向带190施加制动力。更具体地讲,当带190如上文所述被向近侧和/或远侧拉动时,框架184可被构造成使得带190在制动器表面187上滑动,并在此之间产生摩擦力。在各种实施例中,参见图44,制动器表面187’可被构造成使得击发构件166和卷轴192之间的带190的路径被制动器表面187’中断,并且可向带190施加显著的法向力。
在至少一个实施例中,当带190处于静止状态时,带190可与制动器表面187’接合,使得向带190施加拉力时,带190与制动器表面187’之间的静摩擦力可(至少在最初阶段)防止带190相对于制动器表面187’移动。当向带190施加的拉力超过该静摩擦力时,带190可相对于制动器表面187’移动。此类实施例在触发器160被致动多次用于推进端部执行器106中的切割构件和/或缝钉驱动器时可能尤其有用。更具体地讲,致动触发器160后,制转杆170可如上文所述相对于击发构件166回缩,并在各种实施例中,当制转杆170回缩时,带190与制动器表面187’之间的摩擦力可防止(或至少部分抑制)击发构件166和/或击发连杆162、164向近侧移动和/或向远侧移动。由于以上原因,当制转杆170相对于击发构件和击发连杆移动时,制转杆170的齿174与击发构件166和击发连杆162、164中凹陷之间的对齐可保持不变。
相似地,在至少一个实施例中,带190的硬度也可有助于保持击发构件166和击发连杆162、164的位置。更具体地讲,为实现击发构件166的“倒退”或向近侧移动,击发构件166将必须向近侧推动带190,从而使带190卷绕在卷轴192上。在各种实施例中,带190的硬度可使得需要较大的力才能将带190卷绕到卷轴192上,因此可将击发构件166固定到位。为进一步增加将带190卷绕到卷轴192上所需的力,参见图44,可对带190的路径进行控制使其并不以切线方向卷绕到卷轴192上。更具体地讲,如果带190的路径使得其以非切线方向卷绕到卷轴192上,则通过带190传递的一部分力将丢失,从而导致用于卷绕卷轴192的机械效益不良。
在各种实施例中,外科器械100可包括制动器,该制动器能够与卷轴192或击发驱动的任何其他合适组件接合,以(例如)防止击发构件166和/或击发连杆162、164的意外回缩。在至少一个实施例中,尽管并未示出,但是制动器可在第一位置和第二位置之间移动,其中(例如)当制动器处于第一位置时,制动器可向带190施加第一制动力。在至少一个这样的实施例中,该制动器可在(例如)其位于第二位置时向带190施加第二制动力,该力可大于或小于第一致动力。在各种可供选择的实施例中,当该制动器处于第二位置时,可能不与带190或击发驱动的任何其他部分接合。在各种实施例中,尽管并未示出,但是外科器械100可包括棘爪机构,该机构可向卷轴192和/或带190施加制动力。在至少一个此类的实施例中,该棘爪机构可包括球形棘爪和用于使球形棘爪与卷轴192和/或带190偏置地接合的弹簧构件。
在各种实施例中,外科器械100可包括棘轮,该棘轮可使卷轴192以第一方向转动,但在各种情况下可防止卷轴192以与第一方向相反的方向转动。在至少一个实施例中,参见图45-49,外科器械100可包括棘轮组件230,其中棘轮组件230可包括棘轮232和棘轮爪234。在各种实施例中,棘轮232可以基本上相同于键齿轮206的方式(如上所述)工作,不同的是(主要参见图47和48)棘轮232可包括棘轮齿236,由于与棘轮爪234形成的棘轮效应接合,该棘轮齿可在(例如)返回滑架194’位于其未致动位置(图47)时防止棘轮232以顺时针方向转动。更具体地讲,每颗棘轮齿236均可包括平坦表面240,其中参见图48,平坦表面240中的至少一个可邻接爪234的边缘235,并由此防止棘轮232以顺时针方向旋转。
每颗棘轮齿236还可以包括斜面238,其中斜面238可被构造成用于在棘轮232以逆时针方向转动时从下方滑过爪234。由于以上原因,棘轮组件230可允许通过击发构件166向远侧拉动带190,(例如)但至少在返回滑架194’处于其未致动位置时,防止或至少基本上抑制带190向近侧移动。当返回滑架194’如上文所述参照返回滑架194向下枢转入其致动位置时,棘轮232可滑向触发器齿轮196’并脱离与棘轮爪234的可操作接合。因此,在之后,棘轮232可以顺指针或逆时针方向旋转,而不受或至少基本上不受棘轮爪234的干扰。在棘轮232不滑向触发器齿轮196’的各种可供选择的实施例中,棘轮爪234可在返回滑架194’移动到致动位置时向下移动并脱离与棘轮齿236的可操作接合。无论在什么情况下,当返回滑架194’位于其致动位置时,触发器齿轮196’和回程销198’都可旋转棘轮232和凸轮192’以回缩带190和击发构件166。
在各种实施例中,参见图68-86,外科器械400可包括:用于关闭端部执行器的钉砧的闭合系统;用于在端部执行器中推进击发杆、切割构件和/或缝钉驱动器的击发驱动;以及用于相对于端部执行器回缩击发杆、切割构件和/或缝钉驱动器中至少一者的齿轮传动的反向驱动。在至少一个实施例中,参见图68,该闭合系统可包括闭合触发器428、驱动连杆130和驱动器132,其中类似于上文所述,闭合触发器428可被构造成当闭合触发器428从其未致动位置(如图68所示)移动至其致动位置(如图69中所示)时使驱动连杆130和驱动器132发生位移。在各种实施例中,致动闭合触发器428可解锁击发驱动。在至少一个实施例中,击发驱动可包括击发触发器460,该触发器可在闭合触发器428转向柄部427时在锁定位置(如图68中所示)和未锁定位置(如图69所示)之间移动。在至少一个这样的实施例中,闭合触发器428可包括狭槽或凹槽128a,该槽可接纳从击发触发器460延伸的销或凸起160a,其中凹槽128a的侧壁可被构造成当闭合触发器428处于其未致动位置(如图68中所示)时,防止销160a和击发触发器460相对于闭合触发器428移动或至少防止明显的移动。当闭合触发器428被致动或闭合时,狭槽128a的侧壁可邻接销160a并使击发触发器460在其锁定位置(如图68中所示)和未锁定位置(如图69中所示)之间移动。在这样的未锁定位置下,凹槽128a可被取向以使销160a在狭槽128a中移动,从而使击发触发器460能构相对于闭合触发器428移动并推进击发驱动(如下文更详细地描述)。
在各种实施例中,参见图68,击发驱动可包括击发触发器460、击发销172和制转杆170,其中击发触发器460可通过制转杆170和击发销172可操作地与击发杆或构件466接合,以便在端部执行器中推进切割构件和缝钉驱动器。在至少一个这样的实施例中,与上文类似,制转杆170可向上枢转进入与击发构件466的接合,使得当击发触发器460被致动时,参见图70,击发触发器460可向远侧推进击发销172、制转杆170和击发构件466。然后,参见图101,制转杆170可向下枢转离开与击发构件466形成的接合,使得制转杆170可在击发触发器460被释放或返回至其未致动和未锁定位置(如图72中所示)时,相对于击发构件466向近侧回缩。对比图69和72时,可明显看出击发驱动的第一循环已向远侧移动了击发构件466,也已重新定位了制转杆170、击发销172和击发触发器460,使得击发触发器460可第二次致动以进一步推进击发构件466。在此类情况下,参见图102,制转杆170可向上枢转与击发构件466形成可操作接合,并通过再次致动击发触发器460向远侧推进。
在各种实施例中,参见图101和102,击发构件466可包括多个凹陷467,这些凹陷每个都可接纳制转杆170的至少一部分,使得制转杆170可连续地接合凹陷467以便如上文所述多次推进击发构件466。更具体地讲,在至少一个实施例中,击发构件466可包括三个凹陷467,这些凹陷可允许击发构件466被触发器460推进至少三次。以举例的方式,图73示出了第二次致动触发器460时的击发驱动,图74示出了触发器460在其第二次致动后返回至其未致动位置之后的击发驱动,图75示出了第三次致动触发器460时的击发驱动,图82示出了触发器460在其第三次致动后返回至其未致动位置之后的击发驱动。此时,如下文更详细地描述,击发驱动可与击发构件466脱离,而反向驱动能够可操作地与击发构件466接合,使得在各种实施例中,击发构件466可相对于端部执行器回缩,而该外科器械可复位。尽管在所示的示例性实施例中,击发触发器460被致动三次以便完全地推进击发构件466,但也可设想其他实施例,它们可利用多于或少于三次的击发触发器冲程或致动。
在各种实施例中,如上所述,外科器械400还可以包括齿轮传动的反向驱动或机构,该驱动或机构可被构造成相对于外科器械的端部执行器回缩击发构件466、切割构件和/或缝钉驱动器。在至少一个实施例中,反向机构能够可操作地与击发构件466或击发驱动的任何其他合适部分接合,以向近侧移动击发构件466。在至少一个这样的实施例中,参见图71,反向驱动可包括(例如)具有触发器齿轮496、键齿轮406、主动齿轮401、中间齿轮403和直齿轮416的齿轮系。在各种实施例中,参见图84,反向驱动还可包括从击发触发器460延伸的齿轮部分158,该部分可被构造成使得当击发触发器460绕销161旋转时(与上文相似),齿轮部分158可使触发器齿轮496绕回程销498限定的轴线旋转。在至少一个实施例中,齿轮部分158和触发器齿轮496可包括齿和/或凹陷,这些齿和/或凹陷可被构造成彼此协作以及在其间传递旋转运动。
参见图77,也与上文类似,触发器齿轮496和回程销498可被构造成使得它们能够选择性地与彼此接合和脱离。在至少一个这样的实施例中,当击发构件466被击发驱动推进时,触发器齿轮496能够可操作地与回程销498脱离。换句话说,触发器齿轮496可被构造成使得当击发构件466如上文所述被击发驱动推进时,该触发器齿轮不或至少基本上不将旋转运动传递至回程销498。此外,在至少一个这样的实施例中,参见图77和79,回程销498可包括从其延伸的键499,其中键499可被固定在与触发器齿轮496中D形腔体497的可操作接合之外,直至反向驱动如下文更详细地描述可操作地与击发构件466接合。为将键499固定在与触发器齿轮496的可操作接合之外,参见图84,回程销498可包括末端498a,该末端可通过返回滑架494发生位移和/或被固定到位,使得键499定位在D形腔体497之外。
在触发器齿轮496和回程销498如上文所述进行可操作接合之前,反向驱动的主动齿轮401(参见图71)能够可操作地与击发构件466的齿条部分405接合,使得当击发构件466被击发驱动向远侧推进(如上文所述)时,齿条部分405可使主动齿轮401绕轮轴407限定的轴线进行旋转。在各种实施例中,齿条405可包括多颗齿和/或凹槽,这些齿和/或凹槽可被构造成将击发构件466的平移运动转换成主动齿轮401的旋转运动。在各种实施例中,可将中间齿轮403安装到主动齿轮401上或与主动齿轮401整体形成,使得击发构件466的平移也可使中间齿轮403发生旋转。在至少一个实施例中,中间齿轮403和键齿轮406可包括齿和/或凹陷,这些齿和/或凹陷可被构造成彼此协作以及在其间传递旋转运动。相似地,直齿轮416可包括齿和/或凹陷,这些齿和/或凹陷可被构造成与键齿轮406的齿和/或凹陷协作,并在其间传递旋转运动。因此,根据上文所述,击发构件466的推进可使齿轮系的齿轮401、403、406和416旋转。
在至少一个实施例中,参见图71和84,直齿轮416可被安装到指示齿轮492上或与指示齿轮492整体形成,使得当直齿轮416通过键齿轮406进行旋转(如上所述)时,指示齿轮492可通过直齿轮416进行旋转。因此,在至少一个这样的实施例中,向前推进击发构件466可使指示齿轮492绕孔407限定的轴线旋转。在各种实施例中,指示齿轮492上可包括至少一个标记,例如字母、数字和/或任何其他合适的符号,(例如)用于显示击发触发器460被致动的次数。在至少一个这样的实施例中,外科器械的外壳中可包括窗口或孔,其中在第一次致动击发触发器460之后,(例如)指示齿轮492上的数字“1”可与该窗口对齐。相似地,在第二次致动击发触发器后,(例如)指示齿轮492上的数字“2”可与该窗口对齐,而在第三次致动后(例如)数字“3”相应地可与该窗口对齐。作为另外一种选择,在至少一个实施例中,指示齿轮492可包括其上的标记,这些标记可与相对于端部执行器完全推进击发构件466、切割构件和/或缝钉驱动器所需的剩余致动次数相对应。
在击发构件466相对于端部执行器被完全推进,或至少被适当地推进后,返回滑架494可向下旋转(参见图76和82)以便使反向驱动、击发触发器460和击发构件466可操作地连接。在各种实施例中,返回滑架494可绕销494a旋转,使得返回滑架494不再接触或至少基本上不接触回程销498。然后,参见图77和78,弹簧400可使回程销498滑向或移向触发器齿轮496并将键499的至少一部分定位在腔体497中。在至少一个这样的实施例中,参见图78,弹簧400可被定位在框架484和回程销498的键499中间,使得当返回滑架494不再接触末端498a时,弹簧400可伸展并将键499移入腔体497。在各种实施例中,参见图80,当返回滑架494如上文所述向下旋转时,返回滑架494也能够使击发驱动可操作地与击发构件466脱离。更具体地讲,参见图81,返回滑架494可接触击发销172的末端220,使得击发销172可滑向制转杆170,并且也如上文所述,击发销172可包括从其延伸的键222,该键可接合制转杆170中的凹陷173以防止制转杆170向下枢转接合击发构件466。因此,当制转杆170被阻止可操作地接合击发构件466时,击发驱动可能不再接合击发构件466并且反向驱动可回缩击发构件466而不受击发驱动的干扰。
就以上所述而言,在各种实施例中,(例如)返回滑架494可由外科医生或另一名临床医生手动向下旋转。在各种实施例中,通常参见图68和82,外科医生可向按钮部分495施加外力,使得返回滑架494可绕销494a限定的轴线向下枢转。尽管此力可在击发触发器的预定次致动后施加,但在各种实施例中,此力可在达到击发触发器的预定次致动之前施加。除上文所述外或代替上文所述,反向机构的至少一个齿轮可被构造成当击发触发器460的预定次致动后接触返回滑架494。在各种实施例中,参见图76,指示齿轮492可包括凸轮402,该凸轮可被构造成接触返回滑架494的一部分,并在击发触发器460第三次致动时向其上施力。在至少一个这样的实施例中,击发构件466的推进可使指示齿轮492在触发器460每次致动时进行预定程度的旋转,使得凸轮402可在触发器460推进击发构件466的第三次或最后一次冲程后接触滑架494。实际上,指示齿轮492或反向机构的任何其他合适的齿轮可被构造成在将外科器械从“推进”操作模式切换至“反向”操作模式之前旋转预定程度。
当回程销498已可操作地与触发器齿轮496接合,而击发销172已与制转杆170接合以便防止制转杆170可操作地接合击发构件466(如上文所述)后,击发触发器460则可再次致动以便回缩击发构件466。在至少一个这样的实施例中,击发触发器466的后续致动可旋转触发器齿轮492,并由于触发器齿轮492与回程销498之间的可操作接合,触发器齿轮492可旋转键齿轮406。更具体地讲,参见图71、77和78,除了键齿轮406中腔体406a的侧壁外,回程销键499还能够可操作地与触发器齿轮492的驱动表面410接合,使得触发器齿轮496的旋转通过回程销498传递至键齿轮406。在各种实施例中,再次参见图71,键齿轮406的旋转可使中间齿轮403和主动齿轮401旋转以便向近侧驱动或回缩击发构件466。实际上,当触发器460可操作地与反向驱动接合时,主动齿轮401的旋转方向可与其在击发触发器460可操作地与击发驱动接合时的旋转方向相反。在各种实施例中,例如,可对齿轮401、403、406、492、496和触发器齿轮460的齿轮部分158的尺寸或节半径进行选择,使得击发构件466通过一次触发器460的一次致动即可返回(尽管可以设想其他实施例,它们可使用多于或少于一次的触发器460致动)。
在击发构件466被回缩后,返回滑架494可向上枢转到未致动位置以便使外科器械复位。在各种实施例中,参见图85和86,外科医生或临床医生可向触发器锁448的按钮部分452施加外力,使得触发器锁448可向上旋转并邻接返回滑架494。在此类情况下,触发器锁448也可使返回滑架494向上旋转并将滑架494设置在其未致动位置。如此,返回滑架494就可接合击发销172的末端221,以便使击发销172滑离制转杆170并使键222与制转杆170中的凹陷173脱离,从而使制转杆170能够在后续击发触发器460致动时重新接合击发构件466。返回滑架494也可在其向上旋转以便使键499滑离触发器齿轮496时重新接合回程销498的末端498a,从而使回程销498与触发器齿轮496可操作地脱离,并相应地使反向驱动与击发构件466可操作地脱离。然后,可从外科器械中拆下用过的钉仓,并用新的钉仓进行更换,使得外科器械可再次使用。
在各种可供选择的实施例中,外科器械可包括离合器,该离合器被构造成使反向驱动与击发构件进行可操作的接合和脱离。在至少一个实施例中,参见图87-94,类似于外科器械400的外科器械500(例如)可包括击发触发器560,该触发器可被构造成用于驱动击发销和击发驱动的制转杆,以便相对于端部执行器推进击发构件566、切割构件和/或缝钉驱动器。在各种实施例中,也与上文相似,外科器械还可包括具有主动齿轮501、中间齿轮503、键齿轮506和直齿轮516的反向驱动。在至少一个这样的实施例中,由于击发构件496的齿条部分505与主动齿轮501之间的可操作接合,推进击发构件466可旋转齿轮501、503、506和516,如下文更详细地描述。在各种实施例中,可将回程销或键销598安装到键齿轮506上或与键齿轮506整体形成,使得旋转运动可在其间传递。在至少一个这样的实施例中,参见图89,例如,回程销598的至少一部分可包括具有平坦部分598b的非圆形横截面,该平坦部分能够可滑动地接纳在键齿轮506中相应形状的孔506b内(参见图92)。也与上文类似,击发触发器560可包括齿轮部分558,该齿轮部分能够可操作地与触发器齿轮596接合,使得齿轮部分558可使触发器齿轮596绕键销598限定的轴线旋转,如下文更详细地描述。
在使用中,第一次致动击发触发器560后,击发触发器560可类似于上文所述使触发器齿轮596绕键销598旋转,而不直接将旋转运动通过触发器齿轮596传递至键销598。参见图88,击发触发器560的第一次致动可使触发器齿轮596以箭头“A”所示的方向(为使讨论更加清楚,即以顺时针方向)旋转。同样在第一次致动击发触发器560后,击发构件566可使主动齿轮501和中间齿轮503以箭头“B”所示的方向旋转,键齿轮506以箭头“C”所示的方向旋转,而直齿轮516和指示齿轮592则以箭头“D”所示的方向旋转。在各种实施例中,如图88中所示,触发器齿轮596和键齿轮506在触发器560第一次致动过程中可以相反的方向旋转,并且可能无法与彼此可操作地接合,直到触发器560如下文所述的第一次致动之后。当触发器560在其第一次致动之后被释放或返回其未致动位置时,(例如)击发驱动的制转杆可与击发构件566脱离,使得(例如)在触发器560返回其起始或未致动位置时,主动齿轮501和键齿轮506不旋转,或至少基本上不旋转。但当触发器560返回其未致动位置时,触发器齿轮596可由击发触发器560旋转,因此触发器齿轮596可相对于键齿轮506旋转(如图89中所示)。当触发器560返回其未致动位置时(如上文所述),触发器齿轮596的斜面509可接触键销598的离合器爪599并使键销598离开触发器齿轮596(如图90中所示)。然后,触发器齿轮596还可由击发触发器560旋转直至斜面509完全通过离合器爪599,并且弹簧500可将离合器爪599偏置入驱动表面510后方的位置(如图91中所示)。此时,击发触发器560可处于其未致动位置。
第二次致动击发触发器560后,击发驱动的制转杆可保持与击发构件566中脱离的状态,尽管击发触发器560的第二次致动能够再次使触发器齿轮596以箭头A所示的方向旋转,参见图92。由于爪599的位置位于触发器齿轮596的驱动表面510后方,触发器齿轮596的转动可使键销598和键齿轮506以箭头A所示的顺时针方向(即与箭头C相反的方向)旋转。相应地,键齿轮506可使主动齿轮501和中间齿轮503以箭头E所示的方向(即与箭头B相反的方向)旋转,并使指示齿轮592以箭头F所示的方向(即与箭头D相反的方向)旋转。由于主动齿轮501在触发器560的第二次致动过程中以相反的方向旋转,因此主动齿轮501可相对于端部执行器回缩击发构件566,并将击发构件566重新定位(或至少基本上重新定位)于其起始或未致动位置。然后,击发触发器566可被释放并返回至其未致动位置。在此类情况下,触发器齿轮596的驱动表面510可旋转离开离合器爪599,而击发驱动的制转杆可仍保持与击发构件566可操作脱离的状态,键销598和键齿轮596可保持不动。为使外科器械复位,击发驱动的制转杆可被释放使得其可在触发器560的下一次致动后重新接合击发构件566。在此类实施例中,可对用过的钉仓进行更换,以使外科器械可再次使用。
在各种实施例中,参见图94,外科器械500还可包括类似于上文所述的触发器锁148的触发器锁548,该触发器锁可用于固定闭合触发器的位置。在至少一个实施例中,触发器锁548可在致动位置和未致动位置之间旋转,以分别实现闭合触发器(例如闭合触发器428)的锁定和解锁(图68)。在至少一个这样的实施例中,当触发器锁548处于其未致动位置时,触发器锁548的部分548a可被定位于指示器592的凹陷592a中,以防止或至少基本上防止齿轮系和击发构件566的意外促动。换句话说,当部分548a被定位于凹陷592a中时,可使得如上文所述的击发驱动和反向驱动基本失效,并因此可使击发构件566基本上无法移动。当触发器锁548移动进入其致动位置以将闭合触发器固定或锁定到位时,触发器锁548的部分548a可移出或旋出凹陷592a,使得如上文所述的击发驱动和反向驱动可进行操作。
在各种可供选择的实施例中,外科器械可包括棘轮,该棘轮被构造成使反向驱动与击发构件进行可操作的接合和脱离。在至少一个实施例中,参见图95-100,外科器械600可包括(例如)击发触发器660,该触发器可被构造成用于驱动击发销以及击发驱动的制转杆,以便相对于端部执行器推进击发构件666、切割构件和/或缝钉驱动器(与上文类似)。在各种实施例中,也与上文类似,外科器械还可包括具有主动齿轮601、键齿轮606和直齿轮616的反向机构,其中推进击发构件666可通过击发构件696的齿条部分605与主动齿轮601之间的可操作接合而使齿轮601、606和616旋转。在各种实施例中,可将回程销或键销698安装到键齿轮606上或与键齿轮606整体形成,使得旋转运动可在其间传递。也与上文类似,击发触发器660可包括齿轮部分658,该齿轮部分能够可操作地与触发器齿轮696接合,使得齿轮部分658可使触发器齿轮696绕键销698限定的轴线旋转。
在使用中,第一次致动击发触发器660后,击发触发器660可使触发器齿轮696绕键销698旋转,而不直接将旋转运动传递至键销698和键齿轮606。更具体地讲,参见图97,触发器齿轮696可包括孔696a,该孔可被构造成使得键销698与孔696a的侧壁之间存在间隙配合,并因此使得键销698可在其中旋转。此外,参见图96,键齿轮606可包括棘轮表面606c,而触发器齿轮696可包括棘轮表面696c,当击发构件666被击发驱动推进时,这些表面能够可操作地与彼此脱离或分离,使得旋转运动不在它们之间传递。在击发构件666被充分推进后,与上文类似,(例如)返回滑架694可绕销694a向下旋转,使得返回滑架694(参见图99)可与回程销698的末端698a脱离。在此类情况下,如下文更详细地描述,回程销698能够可操作地与触发器齿轮696接合,并可使击发构件666回缩。
在各种实施例中,就以上所述而言,返回滑架694可通过手动方式在其未致动位置(如图95中所示)与其致动位置(如图99中所示)之间移动,与返回滑架494类似。除上文所述外或代替上文所述,齿轮系中的至少一个齿轮(例如指示齿轮692)可包括凸轮(例如凸轮602),该凸轮可在击发触发器660的预定次致动后接触返回滑架694并使其向下旋转。然后,无论在什么情况下,键齿轮606都可通过弹簧600的作用滑向触发器齿轮696。更具体地讲,参见图100,(例如)弹簧600可被定位或压缩在键齿轮606与外科器械框架中间,使得一旦返回滑架694与回程销698的末端698a脱离后,弹簧600即可伸展以使键齿轮606滑向触发器齿轮696。此外,在至少一个实施例中,可将回程销698安装到键齿轮606上或与键齿轮606整体形成,使得回程销698可与键齿轮606一起滑向触发器齿轮696。在至少一个实施例中,参见图97,回程销698可包括套圈698b,其中键齿轮606可邻接回程销698并将回程销698推向触发器齿轮696。
在各种实施例中,由于以上原因,当返回滑架694向下旋转进入其致动位置(如图100中所示)时,棘轮表面606c和696c可通过弹簧600设置为彼此相对。在至少一个实施例中,参见图97,棘轮表面606c和696c可各自包括从其中延伸的齿,这些齿能够协作以便在其间传递旋转运动。在使用中,后续致动击发触发器660时,击发触发器660可使触发器齿轮696和键齿轮606以箭头A所示的顺时针方向旋转,参见图99,其中键齿轮606可使主动齿轮601以箭头E所示的方向旋转。由于主动齿轮601与击发构件666的齿条部分605之间的可操作接合,例如,主动齿轮601可相对于端部执行器回缩击发构件666、切割构件和/或缝钉驱动器(与上文类似)。在至少一个实施例中,齿轮601、606和696以及齿轮部分658可被构造成使得击发构件666可通过触发器460的一次致动即完全回缩。
然后,击发触发器460可被释放和/或返回至其未致动位置。在至少一个这样的实施例中,棘轮表面606c和696c可包括斜面,该斜面可使棘轮表面606c和696c在触发器660返回未致动位置时能够相对于其旋转。在此类情况下,触发器齿轮696可以逆时针方向,即与箭头A指示相反的方向旋转。在至少一个实施例中,棘轮表面606c和696c可相对于彼此进行旋转,即使在这些棘轮表面彼此接触时。然后,返回滑架694可向上旋转使得其可接触回程销698的末端698a,并使回程销698和键齿轮606滑离触发器齿轮696。在此类情况下,因此,棘轮表面606c可脱离棘轮表面696c,使得它们彼此不再可操作地接合。在至少一个这样的实施例中,返回滑架694可向回程销698的末端698a施加力,其中该力可通过套圈698b传递至键齿轮606以便使键齿轮606离开触发器齿轮696。
如上所述,根据本发明的外科器械可包括具有制转杆的击发驱动,该制转杆可被构造成用于相对于端部执行器推进击发构件。在各种实施例中,如上所述,(例如)制转杆170可向上枢转以接合击发构件466中的凹陷467,并向远侧推进击发构件466。然后,再次参见图101和102,制转杆170可相对于击发构件466向下枢转并向近侧回缩,以便重新定位制转杆170,使得制转杆170可再次向上枢转以接合另一个凹陷467,并进一步推进击发构件466。但在各种情况下,当制转杆170如图103中所示向上枢转时,其可能无法接合凹陷467。此类情况可能在(例如)击发构件466因通过外科器械的各种机构传递和/或储存在这些机构中的力或能量而发生意外移动时出现。如果制转杆无法重新接合击发构件,则可能使得该外科器械无法运行,并因此可能必须对外科器械进行手动复位。为了改善此情况,根据本发明中各实施例的外科器械可包括止退机构,该机构可将击发构件保持或至少基本上保持在适当的位置。
在各种实施例中,参见图104,例如,止退机构可被构造成当制转杆170相对于击发构件466缩回时将击发驱动和/或反向驱动的至少一部分固定到位。在至少一个实施例中,止退机构可包括分度机构或板711,其可被构造成当击发构件466被推进时允许回程销798以箭头B所示的逆时针方向旋转(如上所述),而禁止或至少基本上禁止回程销798以顺时针方向(即箭头B的相反方向)旋转。实际上,当回程销798与键齿轮406可旋转地接合,并且键齿轮406通过中间齿轮403和主动齿轮401可操作地与击发构件466接合时,分度机构711还可防止或至少基本上防止击发构件466向近侧缩回。此外,如下文更详细地描述,分度机构711还可抑制击发构件466被意外地向远侧推进。
为了防止回程销798如上文所述发生意外旋转,分度元件711可包括位于其中的一个或多个凹陷和/或孔,以将回程销798固定到位。在各种实施例中,参见图104、107和111,分度机构711可包括具有夹持端711a的片簧,夹持端可被保持在框架784的凹陷784a内,使得分度机构711可相对于框架784的支点784b挠曲和/或旋转。在至少一个实施例中,参见图105和106,回程销798可包括从其延伸的键799,其中键799可被构造成与分度机构711接合。更具体地讲,在至少一个这样的实施例中,分度机构711可包括多个凹陷或孔713a-d(参见图107和108),它们均可被构造成将从键799延伸的凸起799a保持在其中,并因此将回程销798固定到位,如下文更详细地描述。
在使用中,例如,可将外科器械的端部执行器靠到患者的软组织上,之后,如上所述,可通过击发驱动推进外科器械的击发构件。在击发构件推进前,回程销798的凸起799a可被接纳在分度元件711的第一孔713a中,如图110a中所示。在各种实施例中,参见图106和109,键799可进一步包括斜面或坡面799b,其可被构造成使得在触发器460的第一致动下当回程销798被击发构件466、主动齿轮401、中间齿轮403和键齿轮406作用以箭头B所示的方向旋转时,坡面799b可接触孔713a的边缘,并向下挠曲和/或旋转分度机构711,如图110b中所示。值得注意的是,可能需要一定的力来挠曲和/或旋转分度机构711,并因此可减小回程销798相对于凹陷713发生意外位移的可能性。更具体地讲,例如,在不存在施加到击发构件766上的大的拉力的情况下,分度元件中的凹陷能够将回程销798的键799保持在其中,并相应地也可减小击发构件466可能被意外推进的可能性。
在击发触发器460的第一致动结束时,键799可被设置在分度机构711的第二孔713b内,如图110c中所示。在此位置下,由于止动表面799c的作用,可防止键799向后运动到孔713a中。更具体地讲,参见图108,例如,键799可进一步包括止动表面799c,其被构造成邻接孔713b的周边,由于止动表面799c的构造,孔713b和止动表面799c可被构造成防止键799在凹陷715内向下挠曲或旋转分度机构711(图111),并允许回程销798以箭头B的相反方向旋转。在至少一个这样的实施例中,止动表面799c和孔713b的周边可包括彼此平行的表面。在其他各种实施例中,邻接表面可包括至少部分倾斜的部分,其可被构造成使得当止动表面799c被压在孔713b的边缘上时,键799还可被进一步拉入孔713b中,而不是被拉出孔。不管怎样,由于如上所述的回程销798、齿轮系的齿轮和击发构件466之间的合作关系,击发构件466可通过分度构件711防止或至少基本上防止意外地向近侧回缩。因此,在此类实施例中,例如当制转杆170相对于击发构件466回缩时,制转杆170相对于击发构件466内的凹陷467可能发生错位的可能性可得以降低。
在击发触发器460的第二致动下,击发构件466可再次旋转齿轮401、403和406,使得回程销798以箭头B所示的方向旋转。因此,在各个实施例中,坡面799b可接触第二孔713b的边缘并向下挠曲和/或旋转分度机构711,如图110d中所示。在击发触发器460的第二致动结束时,键799可被设置在分度机构711的第三孔713c内,如图110e中所示。在此位置下,键799可因止动表面799c的作用而避免向后运动到第二孔713b中,这与上文类似。此外,在击发触发器460的第三致动下,击发构件466可再次以箭头B所示的方向旋转回程销798,并因此使得坡面799b可接触第三孔713c的边缘并向下挠曲和/或旋转分度机构711,如图110f中所示。在击发触发器460的第三致动结束时,键799可被设置在分度机构711的第四孔713d内,如图110g中所示。在此位置下,与上文类似,键799可因止动表面799c的作用而避免向后运动到第三孔713c中。
在此时,为了可操作地让反向驱动与击发构件接合,与上文类似,可使回程销798和键799朝触发器齿轮496运动,以便可操作地使键齿轮406与触发器齿轮496接合。因此,在各种实施例中,可使凸起799a远离分度构件711,并从第四孔713d中退出。之后,在击发触发器460的回程下,可使击发构件466回缩,并使回程销798以顺时针方向(即箭头B的相反方向)旋转。此时,击发构件466和制转杆170均已回到了它们的起始位置,回程销798发生了旋转使得其与第一孔713a重新对齐,并且回程销798可以脱离触发器齿轮496使得键499滑入接合第一孔713a。因此,在之后,外科器械又可再次使用。
在各种可供选择的实施例中,参见图112和113,止退机构可包括分度元件或板811,其被可旋转地安装在框架884的凹陷884a内,使得铰链端811a可旋转地安装到销轴部分884b上。在至少一个实施例中,与上文类似,分度元件811可相对于销轴811b旋转和/或挠曲。在各种实施例中,止退机构可在凹陷815内进一步包括至少一个弹簧元件或复位弹簧811b,它们可被构造成将分度构件811偏置到如图112和113中所示的位置。类似地,复位弹簧811b可被进一步构造成将分度元件在如上所述被键799挠曲后恢复到此位置。在各种实施例中,例如,该至少一个复位弹簧可被设置在分度元件811与凹陷815的侧壁中间。在各种可供选择的实施例中,参见图114,止退机构可包括分度元件911,与上文类似,它可被安装到框架984的凹陷984a内。在至少一个这样的实施例中,框架984可进一步包括安装凸起984b,它们可以被构造成压力配合在分度元件911中的孔911a内,使得分度元件911可相对于框架984弯曲和/或旋转。
在各种可供选择的实施例中,根据本发明至少一个实施例的止退机构可包括用于防止或至少限制击发构件和/或齿轮系发生不期望运动的棘轮机构。在各种实施例中,参见图115-118,棘轮机构可包括制转杆,它被构造成当被击发构件(例如击发构件466)驱动时允许齿轮系的齿轮(例如指示齿轮492和直齿轮416)以第一方向旋转,而在击发驱动的制转杆(例如制转杆170)相对于击发构件回缩时禁止或至少限制齿轮以相反的方向旋转。在至少一个实施例中,参见图116,棘轮机构可包括片簧或制转杆1011,其可限制直齿轮416旋转,如下文更详细地描述。
就以上所述而言,例如,当击发构件466被击发触发器460推进时,例如击发构件466可以箭头D所示的方向(图116)旋转直齿轮416,这归因于如上所述的主动齿轮401、中间齿轮403、键齿轮406和直齿轮416的可操作接合。当直齿轮416以方向D旋转时,在至少一个实施例中,齿轮416的齿轮齿416a可被构造成接触并挠曲制转杆1011,从而使得齿轮齿416a可以通过。然而,在击发构件466意外回缩和/或直齿轮416以箭头H所示的方向旋转的情况下,制转杆1011可被构造成使得其至少一部分可被设置在两颗相邻的齿轮齿416a中间,并防止或至少限制直齿轮416以方向H旋转。在各种实施例中,参见图116,可将制转杆1011的至少一部分楔入齿轮齿416a之间或“咬”入齿轮416,使得齿轮416基本上无法以H方向旋转,至少在外科器械的反向驱动与击发构件可操作地接合前不能以H方向旋转,如下文更详细地描述。
在各种实施例中,外科器械可包括可在未致动位置(如图115和116所示)与致动位置(如图117和118所示)之间运动的返回滑架,以将外科器械设置到其反向或缩回操作模式。与返回滑架494相似,在至少一个实施例中,返回滑架1094可相对于框架484围绕销轴1094a旋转。在各种实施例中,参见图118,制转杆1011可被安装到返回滑架1094上,使得当返回滑架1094向下旋入其致动位置时,制转杆1011可脱离与直齿轮416的可操作接合。在这些情况下,当外科器械被置于其反向模式时,可允许直齿轮416以箭头H所示的方向旋转。当允许直齿轮416以H方向旋转时,可允许齿轮系从止退机构无干扰或至少基本上无干扰地旋转,使得击发构件可如上所述缩回。在击发构件充分缩回后,可使返回滑架1094向上旋入其未致动位置,并可使制转杆1011可操作地与直齿轮416再次接合。
在各种情况下,可防止外科器械的反向驱动与外科器械的击发构件正确接合。在至少一个实施例中,例如,反向驱动的返回滑架(例如返回滑架494和1094)可能无法正确地接触并促动击发销172和/或回程销498。更具体地讲,返回滑架可能无法正确地使击发销172和/或回程销498发生位移,使得键齿轮406与触发器496可操作地接合,此外,还使得可防止制转杆170与击发构件466可操作地接合。在各种实施例中,如上所述,返回滑架可包括按钮部分,其被构造成当向其施加力时可向下手动旋转返回滑架。然而,在各种情况下,该力的作用可能不足以移动返回滑架,尤其是例如当返回滑架和/或销轴172和498之一被卡住时。
在本发明的各种实施例中,外科器械可包括开关,其可更优地被构造成使外科器械的反向驱动与击发构件在手动操作下接合。在至少一个实施例中,参见图119,开关可包括第一部分和第二部分,其中例如第一部分1194可相对于框架1184可移动地连接,并且其中第二部分1118也可相对于框架1184可移动地连接。在各种实施例中,第一开关部分1194可被可枢转地连到框架1184上,使得例如当第一开关部分1194通过凸轮(类似于凸轮402)向下枢转时,第一部分1194可被构造成脱离回程销498并允许回程销498的键部分499如上所述与触发器齿轮496接合。在各种实施例中,虽然并未在图119中示出,但是返回滑架1194可包括从其上延伸的臂1194d,它可以远离回程销498的末端498a,使得弹簧(例如)可以偏置回程销498,使之与触发器齿轮496可操作地接合。
除上之外,第一开关部分1194在向下枢转时可被构造成接触回程销172,并使回程销172的键222可操作地与制转杆170接合,使得制转杆170无法向上枢转,也如上文所述。实际上,在至少一个这样的实施例中,第一开关部分1194可包括凸轮,它可被致动以使击发驱动从击发构件可操作地脱离,并使反向驱动与击发构件可操作地接合。在各种情况下,可以只需对第一部分1194进行操作,就可使外科器械在其推进和反向操作模式间切换。然而,在反向驱动的凸轮(例如凸轮402)无法正确定位或致动第一开关部分1194的情况下,可利用开关的第二部分1118来致动第一开关部分1194,如下文更详细地描述。
就以上所述而言,可通过致动第二开关部分1118来致动第一开关部分1194。在各种实施例中,再次参见119,第二开关部分1118可包括柄部1118b,其可被构造为例如被外科医生抓住使得可向其施加力并围绕枢轴1118a旋转开关部分1118。在至少一个实施例中,第二开关部分1118可被构造为接触第一开关部分1184,并在图119所示的未致动位置与如上所述的致动位置之间移动第一部分1184。在各种实施例中,实际上,第二开关部分1118可包括凸轮,其可接触第一部分1194并向下驱动第一部分1194,使得第一部分1194接触击发销172和回程销498。在至少一个这样的实施例中,参见图119,第二开关部分1118可包括接触表面1118c,其可被构造为接触第一开关部分1194的表面1194c。在各种实施例中,可将接触表面1118c设置在接触表面1194c的正上方,使得可以对齐表面1118c和1194c,并可减小第二开关部分1118不与第一开关部分1194接触的可能性。
在各种实施例中,就以上所述而言,可将接触表面1118c和1194c设置和排列为使得施加到柄部1198b的力F2具有足够的机械效益,以将第一开关部分1194移动到其致动位置。在至少一个实施例中,柄部的作用力F2可作为传动力F3通过第二开关部分1118的主体并经由接触表面1118c和1194c传递到第一开关部分1194。值得注意的是,在各种实施例中,传动力F3可与柄部作用力F2不同。就以这一点而言,参见图119,为了最初移动第一开关部分1194,与柄部作用力F2和传动力F3相关的扭矩可基本上相同,即距离Da与力F2的乘积可基本上等于距离Db与力F3的乘积,其中距离Da可表示枢轴1118a与施加的力F2之间的距离,并且其中距离Db可表示枢轴1118a与传动力F3之间的距离。因此,当距离Da小于距离Db时,如图119所示,力F2可大于力F3。因此,为了使力F3基本上等于力F2,当向柄部1118b施加力F2时柄部1118b将必须大致设置在表面1118c和1194c的上方。
在各种实施例中,就以上所述而言,传动力F3可作为位移力F1通过第一开关部分1194的主体传递到击发销172上。与上文类似,位移力F1可与传动力F3不同。就以这一点而言,再次参见图119,如上所述,为了最初使击发销172朝向制转杆170发生位移,与位移力F1和传动力F3相关的扭矩可基本上相同,即距离Dc与力F1的乘积可基本上等于距离Dd与力F3的乘积,其中距离Dc可表示枢轴1194a与施加的力F3之间的距离,并且其中距离Dd可表示枢轴1194a与传动力F3之间的距离。因此,当距离Dc小于距离Dd时,如图119所示,力F1可大于力F3。实际上,可使用较小的传动力F3来向击发销172施加较大的位移力F1,这取决于距离Da、Db、Dc和Dd的选择。因此,在各种实施例中,开关的第一和第二部分可被构造为使得由(例如)外科医生提供的力F2可足以通过开关的第二部分手动地将开关的第一部分设置到其致动位置,并因此操纵外科器械从推进操作模式切换到反向操作模式,如上文详述。为了使外科器械回到其推进操作模式,例如第一开关部分1194可向上旋转,使得第二开关部分1118也可向上旋转,从而使开关组件复住。
在另一个示例性实施例中,参见图120-122,外科器械可包括下述开关组件,其具有围绕枢轴1294a可枢转地安装到框架1284上的第一部分1294以及围绕枢轴1218a可枢转地安装到框架1284上的第二部分1218。虽然第一和第二开关部分可被可枢转地安装到框架1284上,但是开关部分也可以可枢转地安装到外科器械的任何其他合适的部分上。在各种实施例中,与上文类似,可操作第一开关部分1294,以使外科器械在推进和反向操作模式之间切换。在至少一个实施例中,第一开关部分1294可在如图120中所示的未致动位置与如图121中所示的致动位置之间旋转。与上文类似,第二开关部分1218可在施加到柄部1218b的力的作用下向下运动,以将第一部分1294向下移动到其致动位置。
在各种实施例中,例如,如果击发触发器不处于其未致动位置,则第二开关部分1218和外科器械的击发触发器(例如击发触发器460)可被构造为使得可防止或至少基本上防止第二部分1218向下旋转。通过在让开关被操作前要求击发触发器处于其未致动位置,当第一部分1294向下旋转时,反向机构的第一开关部分1294可与击发驱动的击发销(例如击发销172)正确地对齐。在各种实施例中,外科器械可被构造为使得击发销被设置在预定的范围内,使得击发销可被第一开关部分1294接触并与击发驱动的制转杆(例如制转杆170)滑入接合。
在各种实施例中,参见图50,外科器械100可包括端部执行器106和细长轴组件104,其中端部执行器106和轴组件104可通过关节接头114可枢转地连接。如上所述,关节接头114可允许端部执行器106围绕轴线116相对于轴组件106活动或作关节运动。在各种情况下,外科医生可使端部执行器106作关节运动,以更容易地接近患者体内的手术部位。更具体地讲,外科医生可通过至少部分地插入患者体内的套管插入端部执行器106和轴组件104,并且在端部执行器106通过了套管后,它就可以发生枢转或作关节运动,以便将端部执行器106相对于软组织(例如需要缝合和/或切割的手术部位中的软组织)定位。在将端部执行器106设置好后,端部执行器106与轴组件104之间的相对关系可被锁定机构固定或锁定,如下文更详细地描述。
在至少一个实施例中,参见图51和52,关节接头114可包括端部执行器锁构件300和枢轴302。在各种实施例中,参见图53-56,端部执行器锁构件300可包括连接器部分320,它可以将锁构件300固定到端部执行器106上,并且参见图52,轴组件104可包括枢轴连接器342,其中枢轴连接器342可包括从其延伸的枢轴302。在各种实施例中,锁构件300可包括孔301,可选择其大小和构造,以使其将枢轴302的至少一部分接纳在其中。在至少一个实施例中,枢轴302和孔301可被构造为使得端部执行器106可绕轴线116自由旋转。在其他各种实施例中,枢轴302和孔301可被构造为使得枢轴302与孔301之间的摩擦可抵抗(然而也允许)端部执行器106与轴组件104之间的相对运动。虽然未示出,但是关节接头114可包括不止一条端部执行器106可绕之旋转的轴线或枢轴。
在各种实施例中,例如,外科医生可通过向围绕手术部位的腔体侧壁推动端部执行器106,以及向轴组件104施加外力使得端部执行器106绕轴线116枢转,而使端部执行器106相对于轴组件104作关节运动。之后,如果外科医生需要端部执行器106回到中心位置,即,使端部执行器106和轴组件104沿一条线取向,那么外科医生可(例如)将端部执行器106再次抵靠在腔体侧壁上,并如上所述向轴组件104施加外力。在各种实施例中,参见图51和52,外科器械100可包括重新定心机构,它可以自动地使端部执行器106相对于轴组件104重新回到或至少基本上重新回到中心位置。在各种实施例中,端部执行器锁构件300可包括定心表面316,并且细长轴组件104可包括定心轴328和偏置构件330,其中偏置构件330可被构造为将定心轴328偏向定心表面316。在至少一个这样的实施例中,定心表面316可被设置在轴线116基本上相对的两侧上,使得定心轴328可向锁构件300施加基本上相等的扭矩或力矩,并在不存在附加的驱动力下,将端部执行器106保持在基本上居中的位置。当如上所述端部执行器106在这样的驱动力作用下发生关节运动时,锁构件300可被构造为使定心轴328之一向近侧发生位移并压缩与之可操作地接合的偏置构件330。更具体地讲,偏置构件330可被设置在导向装置331与从定心轴328延伸的至少一个凸起329之间,使得当凸起329在轴328的作用下向近侧运动时,偏置构件330被压缩在两者之间。在撤去驱动力后,被压缩的偏置构件330可伸展开来,并通过定心轴328将锁构件300旋转到其中心位置,或旋转到由偏置构件330施加的扭矩基本上被平衡的位置。虽然偏置构件330以卷簧的形式示出,但是偏置构件330可包括任何合适的弹性构件。
在各种实施例中,即便在撤去驱动力后,也可使用锁定机构将端部执行器106保持在其关节运动位置。在至少一个实施例中,参见图53-56,端部执行器锁构件300可包括具有第一表面308的第一部分、具有第二表面304的第二部分、齿312以及限定在齿312之间的凹陷314,其中,如下文更具体地描述,齿312和凹陷314可被构造为可操作地与轴组件锁构件接合,以便固定或锁定端部执行器106与轴组件104之间的相对关系。在各种实施例中,齿312和凹陷314可被设置在第一表面308与第二表面304中间。在至少一个实施例中,第一表面308可从孔301延伸到第一周边310,而第二表面304可从孔301延伸到第二周边306。在各种实施例中,第一周边310可限定第一平面,第二周边306可限定第二平面,其中齿312和凹陷314可被设置在第一和第二平面中间。在其中第一周边310与第二周边306不同的实施例中,齿312可以一定的角度或倾斜度在两者之间延伸。在各种实施例中,齿312可在某一点与第一周边310交叉,该点比齿312与第二周边306发生交叉的点更远离轴线116。在至少一个实施例中,至少一颗齿312可限定第一轴线313,该第一轴线可在第一表面308与第二表面304之间以不垂直于第一表面308和/或旋转轴116的方向延伸。在此类实施例中,齿312可在软组织(例如靠近关节接头114设置的软组织)上滑动。换句话来讲,由于齿112的成角或倾斜表面,当端部执行器106作关节运动时,齿112抓住或冲击关节接头114周围的软组织的可能性可得以降低。在至少一个实施例中,齿312可以不延伸到第一周边310之外,使得例如在第一周边310的至少一部分与软组织接触的情况下,第一周边310和齿312可如上所述轻松地相对于软组织滑动。
就以上所述而言,本发明的实施例可提供优于之前的外科器械的显著优点。更具体地讲,参见图57,之前的端部执行器的关节接头包括锁构件,例如锁构件299,而锁构件包括从其周边向外延伸的齿298。这样一来,当端部执行器相对于外科器械的轴组件作关节运动时,齿298会抓住或冲击周围的软组织并可能对其造成创伤。在各种情况下,组织会被抓在相邻的齿298之间,使得当端部执行器作关节运动时,软组织会被拉入关节接头之间,并被接头的相对运动部件夹伤。如上所述并如图58所示,在其中锁构件的齿成一定角度或倾斜度的本发明的实施例中,软组织可更容易地在齿上流动,并降低软组织被拉入关节接头中的可能性。
如上所述,参见图59-62,外科器械100可进一步包括锁构件120,其可相对于端部执行器106滑动并可与端部执行器106可操作地接合,以防止或至少限制在轴组件104与端部执行器106之间的相对运动。在至少一个实施例中,锁构件120可被构造为可与至少一颗齿312接合,以使得防止端部执行器106相对于锁构件120发生运动。更具体地讲,锁构件120可包括端部338和轴部340,其中端部338可包括凹陷336,凹陷被构造为以紧密配合甚或过盈配合的关系接纳锁构件300的齿312。在各种可供选择的实施例中,与上类似,锁定部分338可以紧密配合或过盈配合的关系被接纳在至少一个凹陷314内。不管怎样,外科器械100可进一步包括弹簧126,其可被构造为偏置锁构件120,使之与端部执行器锁构件300接合。在凹陷336未与齿312对齐的情况下,在至少一个实施例中,通过弹簧126施加到锁构件120上的偏置力会导致锁构件120接触端部执行器锁构件300并使之相对于轴线116旋转,直到齿312的其中一颗与凹陷336对齐。在各种实施例中,弹簧126可包括任何合适的偏置构件,包括盘簧、片簧或其他偏置材料。
在各种可供选择的实施例中,参见图63-67,外科器械可包括端部执行器锁构件350,后者包括孔301、具有第一表面358的第一部分、具有第二表面354的第二部分(图67)以及连接器部分320。端部执行器锁构件350还可以包括齿362和限定在齿362之间的凹陷364,其中,在至少一个实施例中,齿362和凹陷364可被设置在第一表面358与第二表面354中间。在各种实施例中,参见图65-67,齿362可不延伸到第一表面358的第一周边357和/或第二表面354的第二周边353之外。在至少一个这样的实施例中,齿362可被完全地设置在或包含在第一表面358与第二表面354之间。在至少一个可供选择的实施例中,齿362可部分地从第一周边357和/或第二周边353伸出。在各种实施例中,第一周边357和第二周边353可在其间限定一个外表面,其中凹陷364可被限定在该外表面中。借助上述特征,端部执行器锁构件350可相对于靠近关节接头设置的软组织滑动而不会冲击软组织。在各种实施例中,可将齿362钝化或倒圆,以进一步有利于上述相对滑动。在至少一个实施例中,参见图63-65,锁定机构可被构造为接合至少一颗齿362和凹陷364,并可包括具有端部388和轴部390的锁构件382。在至少一个实施例中,与上文类似,端部388可包括凹陷394,其可被构造为例如接合齿362中的至少一颗。
在各种实施例中,现在参见图123,与上文类似,外科器械1300可包括围绕关节接头1315可旋转地连到轴1304上的端部执行器1306。也与上文类似,外科器械1300可包括用于相对于钉仓通道1308开关钉砧1312的装置,此外,还包括使端部执行器1306围绕关节接头1315的轴线1316作关节运动的装置。对用于开关钉砧1312的装置而言,外科器械1300可包括具有远侧管组件1334a和近侧管组件1334b的闭管,当向远侧(即以箭头Z所示的方向)推进时,它可以接合钉砧1312并朝向钉仓通道1308向下凸轮驱动或旋转钉砧1312。相应地,当闭管以与箭头Z相反的方向缩回时,远侧管组件1334a可向上凸轮驱动钉砧1312使之远离钉仓通道1308,和/或允许弹簧偏置钉砧1312进入打开位置。
在各种实施例中,现在参见图124和125,远侧管组件1334a可向远侧推进,使得其至少部分地包围钉砧1312和钉仓通道1308。在至少一个实施例中,远侧管部1334a可包括凸轮部1335,其可被构造为接触钉砧1312并在钉砧1312的外表面1337上滑动。此外,凸轮部1335可被构造为在钉仓通道1318的外表面1319上滑动,使得远侧管部1334a可包围钉砧1312的整个周边或至少大部分周边。在至少一个实施例中,凸轮部1335可包括连续的成圆形或至少基本上成圆形的材料环,它限定了一个孔,该孔被构造为控制钉砧1312相对于钉仓通道1318的位置,以及控制钉砧1312与设置在钉仓通道1318内的钉仓之间的间隙(如果有的话)。在某些实施例中,可将至少一个弹簧或偏置构件设置在钉砧1312与钉仓通道1318中间,其中该弹簧可被构造为向远侧管部1334a孔的内周边偏置钉砧1312和/或钉仓通道1318。
在各种实施例中,再次参见图125,远侧管部1334a可包括远边1333,它可以限定与钉砧1312和钉仓通道1318接触的凸轮部1335的最远部分。在某些实施例中,例如钉仓通道1318可包括向前阻挡件(例如阻挡件1331),它被构造为限制远侧管部1334a向远侧运动。在至少一个这样的实施例中,远边1333可接触阻挡件1331,从而限制凸轮部1335可在钉砧1312上滑动的距离。然而,在某些情况下,对凸轮部1335可在钉砧1312上滑动的距离进行的限制,会限制钉砧1312可施加到组织(位于钉砧1312与钉仓通道1318内的钉仓中间)上的夹持力或作用力的大小。
在各种可供选择的实施例中,现在参见图126-128,远侧管部1334a’可包括被构造为接合钉砧1312的第一凸轮部1335a’,此外,还包括被构造为接合钉仓通道1318的第二凸轮部1335b’。与远侧管部1334a很相似,远侧管部1334a’可包围或至少基本上包围由钉砧1312和钉仓通道1318限定的端部执行器1306的一部分或周边。然而,在各种实施例中,凸轮部1335a’可向远侧延伸的距离比凸轮部1335b’长。因此,在至少一个这样的实施例中,凸轮部1335a’在钉砧1312上或其周围延伸的距离可比凸轮部1335b’在钉仓通道1308下或其周围延伸的距离长。如图127所示,远侧管部1334a’可包括远边1333a’,其相对于远边1333b’向远侧设置,使得(参见图128)凸轮部1335a’可在钉砧1312上延伸更长的距离并与远侧管部1334a的凸轮部1335相比提供更大的夹持力或作用力。因此,在各种情况下,在凸轮部1335b’接触阻挡件1331前,凸轮部1335a’可在钉砧1312上延伸更长的距离。
在各种实施例中,再次参见图126,凸轮部1335a’的内周边可包括弓形或至少部分成圆形的内部轮廓,它与钉砧1312的弓形或至少部分成圆形的外部轮廓匹配、或至少基本上匹配。在至少一个这样的实施例中,凸轮部1335a’的内部轮廓可被构造为与钉砧1312的外部轮廓形成紧密配合,使得在其之间存在极小的(如果有的话)相对横向或径向运动,而被构造为当远侧管部1334a’以箭头Z的方向向远侧运动时,允许凸轮部1335a’相对于钉砧1312滑动。与上文类似,凸轮部1335b’的内周边可包括弓形或至少部分成圆形的内部轮廓,其与钉仓通道1308的弓形或至少部分成圆形的外部轮廓匹配、或至少基本上匹配。在至少一个这样的实施例中,凸轮部1335b’的内部轮廓可被构造为与钉仓通道1308的外部轮廓形成紧密配合,使得在其之间存在极小的(如果有的话)相对横向或径向运动,而被构造为当远侧管部1334a’以箭头Z的方向向远侧运动时,允许凸轮部1335b’相对于钉砧1312滑动。
如上所述,再次参见图123,端部执行器1306可相对于轴1304围绕关节接头1315旋转。在各种实施例中,具有远侧管部1334a和近侧管部1334b的闭管可包括一个或多个铰接,例如铰接1301a和1301b,它们可允许当端部执行器1306相对于轴1304旋转时远侧管部1334a相对于近侧管部1334b旋转。在至少一个实施例中,铰接1301a和/或铰接1301b可包括(例如)凸起1303,其被设置在(例如)管部1334a和1334b中的孔内,使得铰接1301a和1301b可相对于近侧管部1334b枢转并使得远侧管部1334a可相对于铰接1301a和1301b旋转。在各种其他实施例中,铰接1301a、1301b和闭管部1334a、1334b可包括凸起和孔的任何合适的组合,以允许可在其间产生关节运动。不管怎样,铰接1301a和1301b可在远侧管部1334a与近侧管部1334b之间提供一种以上的自由度。更具体地讲,铰接1301a和1301b可提供至少两种自由度,即近侧管部1334b与铰接1301a、1301b之间的第一自由度以及铰接1301a、1301b与远侧管部1334a之间的第二自由度。
在使用中,如上所述,可使端部执行器1306相对于轴1304围绕轴线1316作关节运动,然后通过锁被锁定到位。现在参见图129,关节接头1315的枢轴线1316可由从轴通道部1342延伸的枢轴1302限定,其中枢轴1302可被设置在钉仓通道1308的锁部1305的孔内。当锁脱离锁部1305时,可使端部执行器1306围绕轴线1316旋转或枢转到所需的位置,然后通过锁与锁部1305的再次接合锁定到位。在各种实施例中,端部执行器1306围绕枢轴1302以第一和第二或向左和向右方向运动。与上述实施例类似,锁可以接合至少一颗锁齿1312和/或位于锁齿1312中间的至少一个凹陷1314。无论端部执行器1306是处于居中位置还是关节位置,轴1304的闭管1334都可以向远侧推进,以便关闭钉砧1312,如上所述。尽管端部执行器1306可相对于(例如)轴1304作关节运动,但是当闭管1334向远侧推进后,由于在各种情况下由铰接1301a和1301b提供的多种自由度(如上所述),铰接1301a和1301b可相对于轴线1316和关节接头1315滑动。
一旦推进闭管1334并关闭钉砧1312后,即可在轴1304和端部执行器1306内推进传动杆,例如传动杆1390(图136)。在各种实施例中,参见图136和137,传动杆1390可包括杆部1391,其被构造为将力从(例如)外科器械柄部(图1)的触发器传递到切割构件1392和/或缝钉驱动器1393,使得切割构件1392可切割位于端部执行器1306内的组织和/或使得缝钉驱动器1393可(例如)从位于钉仓通道1308的钉仓(例如图138中的钉仓1380)中射出缝钉,例如缝钉1381(在图136中以虚线示出)。现在转到图129,端部执行器1306的锁部1305可包括被构造为接纳传动杆1390的导杆部1391的导槽1321。此外,轴1304可进一步包括框架或脊1345(图131和132),它包括也被构造为用于接纳传动杆1390的导杆部1391的导槽1341,其中当驱动器1390向远侧推进和/或向近侧缩回时传动杆1390可在导槽1321和1341内滑动。
在各种实施例中,现在参见图129和130,外科器械1300可进一步包括引导构件1370,后者可包括被构造为接纳传动杆1390至少一部分的导槽。在至少一个实施例中,引导构件1370内的导槽可包括第一侧壁1371和第二侧壁1372,它们可被构造为当传动杆1390相对于关节接头1315运动时用于支持杆部1391(在图129中以虚线示出)。更具体地讲,如图129所示,当端部执行器1306以第一或向左方向作关节运动时,第一侧壁1371可被构造为当传动杆1390的杆部1391相对于其滑动时为杆部1391提供支持。在各种实施例中,杆部1391可以足够柔韧,能够发生几何变化,从而配合导槽1341和导槽1321并在其内运动。在各种情况下,引导构件1970可被构造成有助于防止杆1391在施加到其上的负荷下弯折。与上文类似,第二侧壁1372可被构造为当端部执行器1306以第二或向右方向作关节运动时支持杆部1391。
在各种实施例中,再次参见图129-130,引导构件1370可独立于轴1304和/或端部执行器1306运动。更具体地讲,在至少一个实施例中,包括当端部执行器1306相对于轴1304作关节运动时,引导构件1370可被构造为相对于端部执行器1306的锁部1305和轴1304的框架1341(图131和132)浮动或变化其自身的位置。在某些实施例中,引导构件1370可包括允许(然而也限制)引导构件1370之间发生相对运动的装置。在至少一个这样的实施例中,引导构件1370可包括从其延伸的第一凸起或突出1376,它可被设置在轴通道部1342中的第一突出狭槽1343内,其中突出狭槽1343的侧壁彼此相距足够远,以允许引导构件1370的末端1378相对于轴1304运动,然而又限制它们之间的运动范围。类似地,引导构件1370可进一步包括从其延伸的第二凸起或突出1377,它可被设置在锁部1305的第二突出狭槽1322内,其中突出狭槽1345的侧壁彼此相距足够远,以允许引导构件1370的末端1379相对于轴1304运动,然而又限制它们之间的运动范围。在各种可供选择的实施例中,引导构件1370可包括第一和第二突出狭槽,轴通道部1342和锁部1305可包括从其延伸的突出。
在各种实施例中,就以上所述而言,轴通道部1342的第一突出狭槽1343和引导构件1370的第一突出1376可被构造为保持引导构件1370狭槽的近端1378与轴1304内的导槽1341对齐或至少基本上对齐。类似地,引导构件1370的第二突出1377以及锁部1305的第二突出狭槽1322可被构造为保持引导构件1370中导槽的远端1379与端部执行器1306中的导槽1321对齐或至少基本上对齐。在各种实施例中,就以上所述而言,例如锁部1305可包括凹陷1323a和1323b,它们被构造为例如当端部执行器1306和锁部1305相对于轴1304作关节运动时可接纳和适应引导构件1370的远角或末端。在至少一个实施例中,主要参见图130,凹陷1323a和1323b可被构造为在凹陷1323a和1323b的侧壁与引导构件1370的末端之间提供空隙。
在各种可供选择的实施例中,现在参见图133和134,端部执行器1306可包括锁部1305的可供选择的实施例,即锁部1305’。锁部1305’可包括凹陷1323a’和1323b’,它们可被构造为接纳和支持引导构件1370的远端,如下文更详细地描述。参见图133,示出了与轴1304成直线或至少基本上成直线对齐的端部执行器1306,其中在引导构件1370和锁部1305的中间存在间隙1329,此外,在引导构件1370和框架或脊1345中间也存在间隙1349。在这样的位置下,导槽1341、引导构件1370中的导槽以及处于锁定位置1305的导槽1321可沿着共轴彼此对齐或至少基本上对齐。在此类情况下,刀杆1390在使用中可经受沿着轴线1394的轴向负荷,然而它也可以经受横向于轴线1394的少量横向负荷(如果有的话),并因此可能要求导槽的侧壁为传动杆191的侧面提供少量的横向支持(如果有的话)。
现在参见图134,示出了与轴1304关节对齐的端部执行器1306,如由锁部1305’的旋转所示。如图134中另外所示,引导构件1370已响应端部执行器1306的关节运动发生了移动。在各种实施例中,端部执行器1306和锁部1305’的运动会导致锁部1305’接触引导构件1370以及出现以下两种情况中的至少一者:(1)以端部执行器1306旋转的相同方向旋转引导构件1370,(2)朝向轴1304的框架1345向近侧推动引导构件1370。如图134所示,位于引导构件1370的远端与锁部1305之间的间隙1329消除或明显减小。也如图134所示,引导构件1370的至少一部分可被设置在第一凹陷1323a’内,使得可防止或至少基本上抑制引导构件1370的远端与锁部1305之间的相对运动。更具体地讲,在至少一个实施例中,可将从引导构件1370延伸的扣件1373a设置在第一凹陷1323内,使得防止或至少限制扣件1373a与锁部1305之间的相对运动,以及使得第一侧壁1371与导槽1321的第一侧壁1321之间的所需对齐可得以基本上维持。由于间隙1329的消除或减小以及第一侧壁1371与第一侧壁1321a之间的对齐或至少基本上对齐,传动杆1391可得到支持,以便消除或至少降低传动杆1391例如以横向弯折的可能性。
在各种情况下,就以上所述而言,端部执行器1306例如可以第二方向或与第一方向相反的方向旋转。在这类情况下,与上文类似,引导构件1370可响应端部执行器1306的关节运动而发生移动。在各种实施例中,端部执行器1306和锁部1305’的运动会导致锁部1305’接触引导构件1370以及出现以下两种情况中的至少一者:(1)以端部执行器1306旋转的相同方向旋转引导构件1370,(2)朝向轴1304的框架1345向近侧推动引导构件1370。在这类情况下,也与上文类似,引导构件1370的远端与锁部1305之间的间隙1329可消除或明显减小,引导构件1370的至少一部分可被设置在第二凹陷1323b’内,使得引导构件1370的远端与锁部1305之间的相对运动可被阻止或至少基本上被抑制。更具体地讲,在至少一个实施例中,可将从引导构件1370延伸的扣件1373b设置在第二凹陷1323b’内,使得阻止或至少限制扣件1373a与锁部1305之间的相对运动,以及使得第二侧壁1372与导槽1321的第二侧壁1321a之间的所需对齐可基本上得以维持。由于间隙1329的消除或减小以及第二侧壁1372与第二侧壁1321b之间的对齐或至少基本上对齐,传动杆1391可得到支持,以便消除或至少降低传动杆1391例如以横向弯折的可能性。
在各种实施例中,就以上所述而言,从引导构件1370延伸的第二突出1377可被构造为与扣件1373a或1373b协同,以防止或至少基本上抑制引导构件1370的远端与锁部1305’之间的相对运动。更具体地讲,在至少一个实施例中,可将第二突出1377和第二突出狭槽1322构造为使得当第一扣件1373a位于第一凹陷1323a’内时第二突出1377与第二突出狭槽1322的侧壁接触。鉴于上述原因,引导构件1370的远端相对于锁部1305’的横移和/或旋转可被阻止或至少被抑制。在各种情况下,第一扣件1373a可被设置在第一凹陷1323a’内,而第二突出1377不与第二突出狭槽1322的侧壁接触。在至少一种这样的情况下,传动杆1390的位移会导致引导构件1370相对于锁部1305’旋转,以及导致第二突出1377抵靠在第二突出狭槽1322的侧壁上。
当端部执行器1306以其第二方向旋转时,与上文类似,第二突出1377和第二突出狭槽1322可被构造为使得当第二扣件1373b位于第二凹陷1323b’内时,第二突出1377与第二突出狭槽1322的侧壁接触。鉴于上述原因,引导构件1370的远端相对于锁部1305’的横移和/或旋转可被阻止或至少抑制。在各种情况下,第二扣件1373b可被设置在第二凹陷1323b’内,而第二突出1377不与第二突出狭槽1322的侧壁接触。在至少一种这样的情况下,传动杆1390的位移会导致引导构件1370相对于锁部1305’旋转,以及导致第二突出1377抵靠在第二突出狭槽1322的侧壁上。
如上所述,端部执行器1306可相对于轴1304在一定的关节角度范围内旋转。例如,端部执行器1306可在如图133所示的直线或居中对齐与如图134所示的关节对齐之间旋转。在图134的关节对齐中,端部执行器1306可例如从直线或居中对齐旋转大约45度。在其他情况下,现在参见图131和132,端部执行器1306可例如从直线或居中对齐旋转大约75度。如上所述,当端部执行器1306旋转时,在各种实施例中,锁部1305’可使引导构件1370旋转,这归因于引导构件1370的第一扣件1373a与锁部1305’的第一凹陷1323a’之间的可操作接合。此外,也如上文所述,锁部1305’的旋转可朝向框架1345向近侧推动引导构件1370。在各种实施例中,引导构件1370可包括近侧凸起或扣件1375,它被构造为当引导构件1370被向近侧推动时在轴1304的凹陷内滑动。在至少一个这样的实施例中,可将近侧扣件1375滑入限定在框架1345与近侧轴部1341中间的凹陷1349内。在此类情况下,可防止或至少抑制引导构件1370的近端1375相对于框架1345向上提起。此外,在至少一个实施例中,第一突出1376和第一突出狭槽1343可与近侧扣件1375和轴1304中的扣件狭槽1349协同,以便防止或至少限制引导构件1370的近端相对于轴1304之间的相对平移和/或旋转。
如上所述,可使端部执行器1306相对于轴1304围绕轴线1316在一定的位置或取向范围内作关节运动。当端部执行器1306处于如图133中所示的直线或居中取向时,导槽1341远端(即基准1330)与导槽1321近端(即基准1331)之间的距离可由第一距离1332a限定。当端部执行器1306处于如图134中所示的关节取向时,基准1330与基准1331之间的距离可由第二距离1332b限定。由于端部执行器1306的关节运动以及基准1331朝基准1330的运动,第二距离1332b短于第一距离1332a。类似地,当端部执行器1306进一步作关节运动,到达图131中所示的取向时,基准1330与基准1331之间的距离可由第三距离1332c限定,它比第一距离1332a和第二距离1332b都短。无论如何,读者都将理解图131、133和134中示出的端部执行器1306的特定关节活动程度都是示例性的,端部执行器1306可发生关节运动到达任何其他合适的取向,其中,在此类其他取向下,基准1330和基准1331之间的距离可以不同。
在各种情况下,当端部执行器1306处于其直线和/或其关节取向时,可将切割构件1392设置在钉仓1380(图138)内。当端部执行器1306处于其直线取向时,可将切割构件1392设置在相对于钉仓1380的远端1382和/或切割刀槽1383的远端1384的第一位置。当端部执行器1306相对于轴1304作关节运动时,如上所述,切割构件1392和钉仓1380之一可相对于彼此运动,从而将切割构件1392置于相对于钉仓1380的远端1382和切割刀槽1383的远端1384的第二位置。在各种情况下,该第二位置可比第一位置更靠近远端1382和远端1384。在此类情况下,取决于关节运动的程度,当切割构件1392被传动杆1390向远侧推进时,切割构件1392可具有更靠近远端1382和远端1384的起始位置。这些不同的起始位置可由以下两种情况产生:(1)切割构件1392被传动杆1390的硬度固定到位或至少部分固定到位,使得当端部执行器1306作关节运动时切割构件1392在钉仓1380内滑动;(2)基准1330与1331之间的距离(1332a、1332b和1332c)随端部执行器1306的关节运动而变化,如上所述。
就以上所述而言,在某些情况下,在端部执行器1306的镜像取向上,切割构件1392的初始位置和远端1382、1384之间的距离可能相同,或至少基本上相同。更具体地讲,(例如)当端部执行器相比以45度角向中心取向右方进行关节运动、以45度角向中心取向左方进行关节运动时,切割构件1392的初始位置和远端1382、1384之间的距离可能相同。在多个实施例中,当端部执行器在左方或右方位于其最大关节运动角度时,切割构件1392的初始位置可能最接近于远端1382、1384。在某些实施例中,当端部执行器1306按直线或中心取向时,切割构件1392的初始位置可能最为远离端部1382、1384。
如上所述,在使用中,传动杆1390可朝远侧行进,以便切割设置在端部执行器1306内的组织和/或发射设置在钉仓1380内的缝钉(图138)。在一些实施例中,可将手术缝合器械构造为使得传动杆1390在使用期间通过外科器械的触发机构或击发机构被推进预定或设定的距离。换言之,在多个实施例中,此类外科器械可被构造为将切割构件1392推进预定或设定的距离,而不考虑端部执行器1306是否做关节运动和/或不考虑端部执行器1306的关节运动程度。然而,在各种情况下,切割构件1392可能因为切割构件1392的起始位置不同而停止在钉仓1380内的不同远侧位置处。更具体地讲,参见图137和138,当端部执行器1306按直线取向时(图133),切割构件1392的切割刃1396可被推进到位置1389a,而当端部执行器处于完全关节运动或几乎完全关节运动的取向时(图131),尽管切割构件1392已被推进相同的预定或设定距离,切割刃仍然可被推进到不同的更为远侧的位置1389c。
在各种情况下,切割构件1392和切割刃1396的最终位置不同可能是由切割构件1392在钉仓1380内的起始位置不同导致的。如上所述,切割构件1392的起始位置不同可能是由端部执行器1306的关节运动、传动杆1391的硬度、以及(例如)当端部执行器1306按直线取向(图133)和关节运动取向(图131)时,存在的基准1330和1331之间的不同距离如距离1332a和1332c导致的。在各种情况下,因为距离1323c短于距离1323a,所以在向切割构件1392施加预定或设定的位移之前,切割构件1392可设置在钉仓1380内更为远侧的初始位置(相比当端部执行器1306按直线取向时它的位置),并且在各种情况下,切割刃1396可被推进到钉仓1380内更为远侧的位置1389c。相应地,因为距离1323a长于距离1323c,所以在向切割构件1392施加预定或设定的位移之前,切割构件1392可设置在钉仓1380内更为近侧的位置(相比当端部执行器1306处于完全关节运动的取向时它的位置),并且在各种情况下,切割刃1396仅可被推进到位置1389a。与上述类似,当端部执行器1306仅处于部分关节运动的取向时(图134),切割刃1396可推进到位置1323a和位置1323c中间的位置。
再次参见图138,钉仓1380可包括多个缝钉腔体(例如缝钉腔体1385),和(例如)设置在缝钉腔体1385中的缝钉(诸如缝钉1381(图137))。在多个实施例中,每个缝钉1381可包括一个或多个钉腿,诸如钉腿1381p和1381d,例如在至少一个实施例中,其中每个缝钉腔体1385可被构造为容纳一枚缝钉1381,使得其钉腿1381d设置在缝钉腔体1385的远端1385d内,并使得其钉腿1381p设置在缝钉腔体1385的近端1385p内。在多个实施例中,可能期望在切割构件1392的切割刃1396穿过末端基准之前将其阻挡,在某些实施例中,其中末端基准1386可被最远侧缝钉例如1381的最远侧钉腿1381d限定并延伸通过此处。在其他多个实施例中,末端基准1386可被(例如)最远侧缝钉腔体1385的任意部分限定并延伸通过此处。在某些实施例中,末端基准1386可被设置在最远侧缝钉腔体1385内的最近侧钉腿1381p限定并延伸通过此处。在任何情况下,当切割刃1396在末端基准1386之前停止下来时,切割刃1396可不横切被缝钉1381钉住以外的组织。在多个实施例中,可能期望切割刃1396被阻挡在不及末端基准1386的至少3mm处。在某些实施例中,可能期望切割刃1396被阻挡在不及末端基准1386的大约3mm至大约7mm的范围内。在某些其他实施例中,可能期望较窄的范围。本文所述为用于控制或限制切割构件1392和切割刃1396在钉仓1380内前进的装置和实施例。
如上所述,再次参见图131、133和134,虽然引导构件1370可相对于锁定部分1305’和轴1304移动,但是在各种情况下,引导构件1370的远端可由锁定部分1305’捕获和/或抵靠设置在锁定部分1305’上。现在参见图140,(例如)传动杆(诸如传动杆1390’)可包括(例如)阻挡件(诸如阻挡件1395’),其可被构造为接触引导构件1370,使得传动杆1390’和切割构件1392的远侧推进可受限于引导构件1370。更具体地讲,在多个实施例中,阻挡件1395’可被构造为接触(例如)引导构件1370近端上的停止基准(诸如停止基准1399),使得当阻挡件1395’接触停止基准1399时,传动杆1390’不再能够或至少不能明显地沿进入钉仓1380的远侧方向前进。当阻挡件1395’接触基准1399、并且引导构件1370接触锁定部分1305’时,切割刃1396最终的最远侧位置可主要取决于止动表面1395’和切割刃1396之间的预定或设定距离1397’,在下文中还将对其进行更为详细的描述。在多个实施例中,阻挡件1395’可包括向下悬置的凸块或凸起,这些凸块或凸起可包括(例如)被构造为接合(例如)停止基准1399相应垂直肩部的垂直肩部。
就以上所述而言,在至少一个实施例中,当传动杆1390’的止动表面1395’接触引导构件1370、而引导构件1370接触端部执行器1306的停止部分1305’时,切割刃1396相对于刀狭槽1383末端1384的最终最远侧位置可取决于预定距离1397’、引导构件1370中导槽的长度、以及基准1331和刀狭槽1383远端1384之间的距离。在多个实施例中,引导构件1370可由刚度足够大的材料和几何形状构成,使得在使用期间引导构件1370的导槽内部仅出现极小的(如果有的话)挠曲或变形。相似地,端部执行器1306可由刚度足够大的材料和几何形状构成,使得在使用期间刀狭槽1383内部仅出现极小的(如果有的话)挠曲或变形。因而在某些实施例中,引导构件1370内的导槽和刀狭槽1383可限定这样的导向路径,不论端部执行器1306如何取向,所述导向路径的长度几乎不发生变化。然而,在至少一些实施例中,所述导向路径的长度可存在一些变化。更具体地讲,虽然引导构件1370可抵靠设置在停止部分1305’上,但是在端部执行器1306的不同取向中,引导构件1370中导槽和锁定部分1305’中导槽1321之间的相对对齐可有所不同,从而导致不同的或至少略微不同的导向路径长度,下文将对其进行更为详细的讨论。
如上所述,端部执行器1306的取向可影响引导构件1370和端部执行器1306之间的相对对齐。参见图134,该图示出了(例如)以大约45度取向的端部执行器1306,并且即使引导构件1370与锁定部分1305’接触,在引导构件1370的远端和锁定部分1305’之间仍可存在小的间隙1389。当端部执行器1306做甚至更进一步的关节运动时,如图131中所示,端部执行器1306以大约75度取向,虽然引导构件1370仍然与锁定部分1305’接触,但是引导构件1370和锁定部分1305’之间的间隙1389可变得更大(即使程度轻微)。此类间隙1389尺寸的改变可导致导向路径(包括引导构件1370中的导槽和刀狭槽1383)的长度改变。虽然可发生此类导向路径长度的改变,但是停止基准1399可提供让传动杆1390’撞到其上而停止远侧推进的可靠基准,以及用于无论端部执行器1306如何取向均在钉仓1380内的一致位置和/或较窄的位置范围内阻挡切割刃1396的可靠装置。在某些情况下,传动杆1391的阻挡件1395’可接触引导构件1370,并将引导构件1370定位于抵靠锁定部分1305’的位置。例如当端部执行器1306按直线或至少基本上为直线取向时,可出现此类情况,参见图133。
就以上所述而言,现在参见图140和141,传动杆1391的阻挡件1395’可邻接引导构件1370的基准1399,以便在端部执行器1306的任何取向下阻挡传动杆1391的远侧推进。更具体地讲,参见图140,当端部执行器1306按直线取向时,止动表面1395’可邻接基准1399,并且类似地,现在参见图141,例如当端部执行器1306以大约66度取向时,传动杆1391的止动表面1395’也可以邻接基准1399。就以上所述而言,正如读者将注意到的那样,在将图140和141进行比较时,引导构件1370可通过端部执行器1306的关节运动而向近侧推进。当引导构件1370向近侧推进时,基准1399也可向近侧推进,从而可缩短传动杆1391能够向远侧移动的距离。相应地,当端部执行器1306按直线取向时,传动杆1391能够向远侧移动的距离可变得较长。在多个实施例中,作为上述的结果,随着端部执行器1306关节运动的角度增大,传动杆1391可向远侧位移的距离可缩短。概括地说,当端部执行器1306处于关节运动位置时,切割构件1392可具有更为远侧的起始位置;然而,此类更为远侧的起始位置可被向近侧移动的基准1399所抵消,所述向近侧移动的基准1399可限制切割构件1392的远侧位移,使得切割构件1392最终的最远侧位置与当端部执行器1306按直线取向时的切割构件1392最终的最远侧位置相同或非常接近。同样,当端部执行器1306按直线取向时,切割构件1392可具有更为近侧的起始位置;然而,此类更为近侧的起始位置可被更为远侧的基准1399所抵消,所述更为远侧的基准1399可使切割构件1392的远侧位移更大,从而使得切割构件1392最终的最远侧位置与当端部执行器1306处于关节运动取向时的切割构件1392最终的最远侧位置相同或非常接近。
如上所述,再次参见图138,可能期望的是将切割构件1392的刀刃1396阻挡在不及末端基准1386处。在多个实施例中,现在参见图142,例如,手术缝合器械诸如外科器械1400可包括由(例如)马达(诸如马达1410)驱动的击发系统。在使用时,可开动马达1410以便(例如)通过端部执行器(诸如端部执行器1306)将切割构件(诸如切割构件1392)推进至端部执行器1306内部的相同或至少大致相同的最终远侧位置,使得无论端部执行器1306处于何种关节运动角度,刀刃1396均被阻挡在不及末端基准1398处。就以上所述而言,在某些实施例中,马达1410可设置在(例如)外科器械1400的柄部内部。外科器械1400还可包括设置在(例如)外科器械柄部上和/或与外科器械柄部可操作地连接的击发开关或触发器,其中可开动所述开关或触发器以便(例如)使马达1410可操作地与电源(诸如电池)连接,其中该电源也可设置在柄部内部。在使用时,如下文更详细的描述,可开动所述击发开关或触发器以从电源将电能供应至马达1410,从而推进和/或回缩击发杆1466、传动杆1390和切割构件1392。
就以上所述而言,在多个实施例中,马达1410可包括与主动齿轮1412可操作地连接的传动轴1411,其中马达1410可被构造为使传动轴1411和主动齿轮1412按第一方向或顺时针方向、和/或按第二方向或逆时针方向旋转。再次参见图142,主动齿轮1412可与齿条1413可操作地连接,其中主动齿轮1412的旋转可根据主动齿轮1412的旋转方向而沿着远侧方向D和/或近侧方向P驱动齿条1413。在多个实施例中,主动齿轮1412和齿条1413可各自包括齿,这些齿可彼此合作,以将齿轮1412的旋转运动传送到齿条1413的直线运动或至少大致为直线的运动。如图142另外所示,击发驱动还可包括可操作地与齿条1413连接的击发杆1466,并且如下文进一步详述,传动杆1390可以与击发杆1466可操作地连接,使得齿条1413的运动可被传送到击发杆1466和传动杆1390。与上述类似,现在参见图143,传动杆1390可以与切割构件1392可操作地连接,使得齿条1413的远侧运动可向远侧移动切割构件1392,并且相应地,齿条1413的近侧运动可向近侧移动切割构件1392。
就以上所述而言,在使用时,外科医生可通过(例如)操纵位于外科器械柄部上的击发开关或触发器而运行外科器械1400,以便推进切割构件1392从而最终推进缝钉和/或切割设置在外科器械端部执行器内的组织。在多个实施例中,外科器械1400还可包括计算机,该计算机可包括一个或多个输入端,其中至少一个此类输入端可以与击发开关可操作地连接,使得计算机可检测到击发开关的运行。在某些实施例中,计算机可设置在(例如)外科器械的柄部内部。在至少一个实施例中,开关的运行可闭合电路,响应于此,计算机可以命令马达1410朝着将齿条1413向近侧方向(即,方向P)移动的方向旋转。更具体地讲,所述计算机可以响应开关输入,从而闭合电路,使得电势可通过电池施加到马达1410上,其结果是可使马达1410旋转轴1411和主动齿轮1412。在任何情况下,当切割构件1392被齿条1413拉向近侧时,切割构件1392可与基准(诸如位于端部执行器1306中的基准阻挡件或基准1398)发生接触。一旦切割构件1392接触基准阻挡件1398,和/或一旦外科器械1400的计算机检测到切割构件1392与基准1398发生接触,则在至少一个实施例中,计算机可断开电源和马达1410之间的电路,使得马达1410不再旋转主动齿轮1412,并使得主动齿轮1412不再向近侧驱动齿条1413。
就以上所述而言,在多个实施例中,外科器械1400还可包括编码器系统,此编码器系统可检测到切割构件1392何时与基准1398接触。在至少一个实施例中,齿条1413可包括多个排列在设置于其上和/或其中的线性阵列中的可检测元件1414,其中编码器系统还可包括编码器传感器1415,所述编码器传感器1415被构造为当可检测元件1414经过编码器传感器1415时将其检测出来。在一些实施例中,可检测元件1414可包含铁,当元件1414在传感器1415前方经过时,其中含有的铁可以扰乱磁场,从而被编码器传感器1415检测到。在某些实施例中,可检测元件1414可包括(例如)可被编码器传感器1415检测到的明显的分界线,诸如凸起、凹陷和/或有色线条。在任何情况下,编码器传感器1415可以与计算机可操作地连接,使得计算机可以在齿条1413回缩或朝着近侧方向P移动时对被传感器1415检测到的可检测元件1414进行计数。更具体地讲,在至少一个实施例中,编码器传感器1415可以与至少一个计算机输入端可操作地连接,使得计算机可以接收来自编码器传感器1415的一个或多个信号。在任何情况下,在多个实施例中,可检测元件1414可设置为彼此相距预定或设定的距离,使得对连续可检测元件1414的检测可提示计算机齿条1413已移动一段或一个单位的距离。在至少一个实施例中,此类一段或一个单位的距离可包括(例如)1mm。在某些实施例中,马达可包括编码器马达,其包括整体复合在其中的编码器系统,其中所述编码器可(例如)测量到马达轴1411的旋转,并基于主动齿轮1412的尺寸和构型,估计齿条1413的近侧和/或远侧运动。
在任何情况下,外科器械1400的计算机可被构造为将传送至马达1410的输出命令与从编码器传感器1415接收的输入信号进行比较,以便确定齿条1413的预期位置和实际位置、以及相应的切割构件1392的预期位置和实际位置之间是否存在差异。图145以举例的方式提供了计算机可以检测的内容(即,第一范围1416a和第二范围1416b)的图形表示,其中第一范围1416a指示齿条1413正在朝着基准阻挡件1398回缩,而第二范围1416b指示切割构件1392与基准阻挡件1398接触和/或因为(例如)基准阻挡件1398和/或切割构件1392的变形而仅略微移动。再次参见图145,外科器械1400的计算机可将基于传送至马达1410的命令或输出的齿条1413预期移动(如线条1417所示)与基于编码器传感器1415输入的齿条1413的检测到的移动(如线条1418所示)进行比较,并且当齿条1413的预期移动和实际移动之间存在明显差异时,计算机能够可操作地让马达1410与电源断开和/或命令马达1410停止旋转主动齿轮1412。此时,外科器械1400的计算机可记录齿条1413和切割构件1392的位置,如处于“基准位置”。在多个实施例中,计算机可包括(例如)存储器,诸如非易失性随机存取存储器(NVRAM)芯片,其可被构造为存储此类信息,和/或在外科器械运行期间的任何其他时刻的任何其他有关齿条1413和切割构件1392位置的信息。
一旦切割构件1392与基准阻挡件1398接触,计算机就可以指令马达1410朝着相反方向旋转主动齿轮1412,以便向远侧(即,朝着方向D)推进齿条1413。在至少一个实施例中,计算机可以颠倒施加到马达1410上的电压的极性,从而朝着相反方向旋转主动齿轮1412。在任何情况下,计算机可以指令马达1410将切割构件1392相对于基准阻挡件1398推进预定或设定的距离。在至少一个这样的实施例中,计算机可允许电源将预定或设定的电压和/或电流施加到马达1410上并持续预定或设定的一段时间,这样可以在各种情况下将切割构件1392推进预定的距离。在某些实施例中,施加到马达1410上的电压和/或电流的(例如)大小和/或持续时间可根据提供给计算机的反馈进行调节。就以上所述而言,在至少一个实施例中,编码器传感器1415可被构造为将齿条1413的实际或至少有所知的位移和位置转达计算机,使得计算机可将齿条1413的实际位置与其预期位置进行比较,并且相应地将刀刃1396的实际位置与预期位置进行比较。在计算机确定刀刃1396的位置(例如)落后于其预期位置的情况下,计算机可以增大施加到马达1410上的功率的持续时间和/或大小,使得刀刃1396抵达其预期位置、或至少大致与其预期位置接近。作为另外一种选择,在计算机确定刀刃1396的位置领先其预期位置的情况下,计算机可以缩短施加到马达1410上的功率的持续时间和/或减小其大小,使得刀刃1396不超过、或至少基本上不超过其预期位置。
就以上所述而言,在多个实施例中,不论端部执行器1306为何关节运动角度(如果有的话),切割构件1392相对于基准阻挡件1398推进的预定或设定距离可为相同的、或至少大致相同的距离。其结果是,在各种情况下,刀刃1396可被阻挡在不及末端基准1386的相同、或至少大致相同的位置。正如读者将注意到的那样,参见图138和143,基准阻挡件1398和末端基准1386均设置在相对于外科器械的关节接头的远侧,其结果为,关节接头元件(诸如上述的引导构件1370)的潜在转变可能不会影响基准1386和1398的相对排列。在至少一个示例性实施例中,基准阻挡件1398可设置在端部执行器1306的钉仓通道内,而末端基准1398可如上述的那样通过设置在钉仓通道内的钉仓1380的某些特征来确定。在某些其他实施例中,基准阻挡件1398和末端基准1386均可由钉仓的特征来限定,而在一些实施例中,基准1398和1386可由(例如)钉仓通道的特征来限定。在任何情况下,当切割构件1392设置在抵靠基准阻挡件1398的位置、并随后向远侧推进预定的距离时,切割构件1392和刀刃1396可相对于末端基准1386牢靠地设置、或至少基本上牢靠地设置。
在多个实施例中,现在参见图144,击发杆1466的远端和传动杆1390的近端之间的相互连接可允许在其间的相对运动。在至少一个实施例中,传动杆1390的传动杆部1391可包括从该处悬置的凸缘或凸块1369,该凸缘或凸块(例如)可设置在击发杆1466的狭槽或凹槽1467内。如图144所示,狭槽1467的宽度W2宽于凸块1369的宽度W1,使得凸块1369可在(例如)狭槽1467内向近侧和/或远侧滑动。其结果是,在某些实施例中,凸块1369的侧面1369p和1369d与狭槽1467的侧面1467p和1467d之间可存在一个或多个间隙。在各种情况下,此类间隙可(例如)通过允许击发杆1466和传动杆1390之间的至少一些相对运动从而避免或至少降低传动杆1390不可取地扣紧的可能性和/或传动杆1390不可取地抵抗端部执行器1306的关节运动的可能性,而有利于端部执行器1306的关节运动。更具体地讲,在至少一些情况下,传动杆1390可在端部执行器1306的关节运动期间向近侧移动,而在至少一个实施例中,可选择狭槽1467的大小和构造,以使其适应传动杆1390的此类近侧移动。如上进一步所述,传动杆1390向近侧移动的距离可与端部执行器1306的关节运动程度成正比,即,端部执行器1306较大的关节运动可导致传动杆1390较大的近侧移动(图146b),而相应地,端部执行器1306较小的关节运动可导致传动杆1390较小的近侧移动(图146a)。在至少一个实施例中,狭槽1467的宽度W2可使得凸块1369的近侧1369p不与狭槽1467的近侧壁1467p发生接触。在任何情况下,在多个实施例中,上述的外科器械1400的击发驱动可抵消或生成(例如)凸块1369和狭槽1467之间的任何间隙,以便将切割构件1392设置在相对于末端基准1386的所需位置处。
下面提供根据上述的一些实施例运行外科器械的示例性次序。在使用时,外科医生可以解锁端部执行器1306,然后通过将其定位于抵靠手术部位内的组织并朝着沿轴1304的轴线的远侧方向施加力从而让端部执行器1306进行关节运动,使得端部执行器1306相对于轴1304枢转。一旦端部执行器1306进行了合适的关节运动,端部执行器1306即可被锁定就位,可设置端部执行器1306,使得组织定位于钉仓1380和钉砧1312的中间,然后关闭钉砧1312以便夹紧组织。作为端部执行器1306关节运动的结果,正如下文将详细讨论的那样,传动杆1390可向近侧移动,其结果是凸块1369的侧面1369d和狭槽1467的侧面1467d之间会生成间隙。一旦外科医生对闭合端部执行器1306内的组织的位置感到满意,外科医生便可启动击发开关或触发器,该操作可被外科器械的计算机检测到。如上所述,计算机可指令马达1410向近侧回缩齿条1413。在各种情况下,计算机可利用脉宽调制,目的在于限制供应到马达1410的功率、并缓慢拉动齿条1413。当齿条1413向近侧移动时,齿条1413可将击发杆1466向近侧拉动,使得狭槽1467的侧面1467d与凸块1369的侧面1369d发生接触,从而消除侧面1467d和侧面1369d之间的间隙。一旦侧面1467d与侧面1369d接触,齿条1413和击发杆1466即可将切割构件1392向近侧拉动,直到切割构件1392接触基准阻挡件1398为止。在多个实施例中,可以校准施加到马达1410上的脉宽调制,使得通过马达1410施加到齿条1413上的力不会超过确定的最大力或峰值力,诸如大约30磅力和/或40磅力。在至少一个实施例中,通过设定该最大力,可避免(例如)齿条1413、击发杆1466、传动杆1390和切割构件1392发生损坏。在任何情况下,上述外科器械的编码器系统和计算机可以检测到切割构件1392何时与基准阻挡件1398发生接触,然后断开供应到马达1410的功率。就以上所述而言,在某些实施例中,编码器系统和计算机可以确定切割构件1392是否正在自由地朝着基准阻挡件1398移动、或切割构件1392是否已与停止基准1398发生接触,并确定某些元件(诸如停止基准1398和切割构件1392)已开始弹性变形或塑性变形中的至少一种。在该参考位置处,切割构件1392与基准阻挡件1398(图143)接触,而狭槽1467的侧面1467p和凸块1369的侧面1369p之间存在间隙1469。在多个实施例中,计算机可指令马达1410朝着远侧方向D推动齿条1413,使得狭槽1467的侧面1467p与凸块1369的侧面1369p发生接触。在至少一个这样的实施例中,齿条1413可向远侧推进预定或设定的距离,诸如大约0.15″,(例如)以便消除间隙1469,并可能推进额外的距离,诸如大约0.025″,(例如)以便确保间隙1469得以消除,并且在至少一个实施例中,(例如)以便确保切割构件1392已至少略微地与基准阻挡件1398分离。这个新位置可被计算机记录为另一个参考位置,并被称为“原位”。在多个实施例中,马达1410可以在原位处暂停切割构件1392的移动、和/或以连续方式通过其预定距离继续向远侧移动切割构件1392。如上所述,不论端部执行器1306为何关节运动角度(如果有的话),齿条1413和切割构件1392均可相对于基准阻挡件1398和/或切割构件1392的原位向远侧移动相同的距离。因此,例如切割构件1392及其刀刃1396可移动到相对于末端基准1398和/或刀狭槽1383远端1384的相同最终远侧位置处。在任何情况下,在切割构件1392已推进到其最远侧位置处后,计算机可指令马达1410向近侧回缩齿条1413和切割构件1392,使得钉砧1312可以重新开启。在某些实施例中,可操纵(例如)外科器械的击发开关或触发器,使得计算机指令马达1410将切割构件1392停止在不到其最终远侧位置处。
在多个实施例中,如上所述,切割构件1392相对于在钉仓通道或钉仓1380近端的基准阻挡件1398的位置可通过上述的方法确定或测试。在某些实施例中,可确定或测试(例如)切割构件1392相对于另一个基准(例如,在钉仓通道和/或钉仓1380远端的基准)的位置。在至少一个这样的实施例中,可通过将切割构件1392从(例如)基准阻挡件1398和/或原位向远侧推进、直到切割构件1392接触钉仓通道的远端,而确定基准阻挡件1398和钉仓通道远端之间的距离。一旦在该参考位置处,计算机就可将该位置储存在其存储器中,并根据此类信息计算切割构件1392的可能最大切割长度,并调整所期望的在使用时切割构件1392的预定或设定移动距离。此类测试可以在(例如)将钉仓设置在钉仓通道内之前、以及将端部执行器设置在病人体内之前进行。
如上文所述,外科器械可包括可相对于外科器械的轴做关节运动的端部执行器。还如上文所述,端部执行器可以有选择地相对于轴锁定就位。现在参见图147和148,外科器械可包括端部执行器,该端部执行器包括可绕枢轴1502做关节运动的端部执行器锁构件1500。与端部执行器锁构件300类似,端部执行器锁构件1500可包括围绕锁构件1500的周长设置的多个齿1512和多个凹陷1514,当端部执行器做关节运动时,它们可以绕枢轴1502旋转。在至少一个这样的实施例中,每个凹陷1514可设置在两个齿1512的中间。在多个实施例中,外科器械还可包括这样的锁构件1538,其可包括被构造为插入端部执行器锁构件1500中的凹陷1514之一的齿1536。在使用时,齿1536可以脱离凹陷1514,以允许端部执行器(包括锁构件1500)旋转到所期望的位置,其中锁构件1538随后可以向远侧推进,使得齿1536插入凹陷1514并与之接合。在某些情况下,当锁构件1538向远侧推进时,锁齿1536可能不与凹陷1514对准。在某些实施例中,锁齿1536和/或端部执行器锁齿1512可包括一个或多个坡面或倾斜表面,所述坡面或倾斜表面可被构造为引起端部执行器锁构件1500略微旋转、或分度至凹陷1514与锁齿1536对准的位置。
本文所公开的装置可设计成单次使用后丢弃,也可以设计成多次使用。然而,在任一种情况下,该装置在至少使用一次后都可被修复以重复利用。修复可包括以下步骤的任何组合:拆卸装置,然后清洗或替换特定零件,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替换或移除装置的任何数量的特定零件或部件。清洗和/或替换特定部件时,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/替换和再组装。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。
优选的是,本文所述的发明将在外科手术前进行处理。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,将器械置于闭合并密封的容器中,诸如塑料袋或TYVEK袋。然后将容器和器械置于可穿透该容器的辐射场中,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无菌容器中。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。
尽管已经将本发明作为示例性设计进行了描述,但还可以在本公开的精神和范围内对本发明进行修改。因此本发明旨在涵盖采用本发明一般原理的任何变型形式、用途或适应形式。此外,本发明旨在涵盖本发明之外但在本发明所属领域的已知或惯有实践范围内的偏差形式。
Claims (7)
1.一种外科器械,包括:
轴,其包括:
外壳;
位于所述外壳内的第一导槽;以及
能够在第一位置和第二位置之间移动的传动杆,其中所述第一导槽能够接纳所述传动杆的至少一部分;
端部执行器,其围绕枢转接头能够枢转地连接到所述轴,其中所述端部执行器能够围绕所述枢转接头旋转,并且其中所述端部执行器包括能够接纳钉仓的钉仓附连部分;以及
引导构件,其能够相对于所述轴和所述端部执行器移动,所述引导构件包括:
能够接纳所述传动杆的至少一部分的第二导槽;
能够与所述端部执行器接触的端部部分;以及
基准部分,
其中所述传动杆还包括:
杆部;
传动部分,当所述传动杆在所述第一位置和所述第二位置之间移动时,所述传动部分能够可操作地接合切割构件并使所述切割构件在所述端部执行器内移动;以及
阻挡件,所述阻挡件能够接合所述引导构件的所述基准部分以限制所述传动杆相对于所述端部执行器的运动。
2.根据权利要求1所述的外科器械,其中所述端部执行器能够沿第一方向和第二方向围绕枢轴旋转,并且其中所述端部执行器沿所述第一方向或所述第二方向的所述旋转能够将所述引导构件朝所述杆部移动。
3.根据权利要求1所述的外科器械,其中所述传动杆还包括所述切割构件,其中所述切割构件包括切割刃,并且其中在所述切割刃和所述阻挡件之间限定预定距离。
4.根据权利要求3所述的外科器械,还包括所述钉仓,其中所述钉仓包括能够接纳所述切割刃的切割狭槽,其中所述切割狭槽包括末端,其中当所述传动杆从所述第一位置移动到所述第二位置时,所述传动杆能够朝所述末端移动所述切割刃,其中所述端部执行器能够在第一取向、第二取向以及所述第一取向和所述第二取向中间的中心取向之间旋转,其中当所述端部执行器处于所述第一取向时,在所述末端和所述基准部分之间限定第一距离,其中当所述端部执行器处于所述第二取向时,所述末端和所述基准部分之间限定第二距离,其中当所述端部执行器处于所述中心取向时,所述末端和所述基准部分之间限定第三距离,其中所述第一距离和所述第二距离短于所述第三距离,并且其中所述预定距离短于所述第一距离、所述第二距离和所述第三距离。
5.根据权利要求3所述的外科器械,还包括所述钉仓,其中所述钉仓包括能够接纳所述切割刃的切割狭槽,其中所述切割狭槽包括末端,其中所述切割狭槽和所述第二导槽限定了所述传动杆的导向路径,其中当所述传动杆从所述第一位置移动到所述第二位置时,所述传动杆能够朝所述末端移动所述切割刃,其中所述端部执行器能够在第一取向、第二取向以及所述第一取向和所述第二取向中间的中心取向之间旋转,其中当所述端部执行器处于所述第一取向时,所述导向路径由第一距离限定,其中当所述端部执行器处于所述第二取向时,所述导向路径由第二距离限定,其中当所述端部执行器处于所述中心取向时,所述导向路径由第三距离限定,其中所述第一距离和所述第二距离短于所述第三距离,并且其中所述预定距离短于所述第一距离、所述第二距离和所述第三距离。
6.根据权利要求1所述的外科器械,其中所述传动杆还包括所述切割构件,其中所述切割构件包括切割刃,其中所述外科器械还包括所述钉仓,其中所述钉仓包括:
能够接纳所述切割刃的切割狭槽,其中所述切割狭槽包括末端,其中当所述传动杆从所述第一位置移动到所述第二位置时,所述传动杆能够朝所述末端移动所述切割刃;以及
多个缝钉腔体,所述缝钉腔体包括设置在邻近所述切割狭槽的所述末端的末端缝钉腔体,其中所述末端缝钉腔体限定了末端基准;
其中所述端部执行器能够在第一取向、第二取向以及所述第一取向和所述第二取向中间的一系列中间取向之间旋转,并且其中所述传动杆的所述阻挡件能够接触所述引导构件的所述基准部分,使得不论所述端部执行器处于所述第一取向、所述第二取向还是所述中间取向,所述切割刃均不会穿过所述末端基准。
7.根据权利要求1所述的外科器械,其中所述传动杆还包括所述切割构件,其中所述切割构件包括切割刃,其中所述外科器械还包括所述钉仓,其中所述钉仓包括:
能够接纳所述切割刃的切割狭槽,其中所述切割狭槽包括末端,其中当所述传动杆从所述第一位置移动到所述第二位置时,所述传动杆能够朝所述末端移动所述切割刃;以及
多个缝钉腔体,所述缝钉腔体包括设置在邻近所述切割狭槽的所述末端的基准缝钉腔体,其中所述基准缝钉腔体限定了切割停止基准;
其中所述端部执行器能够在第一取向、第二取向以及所述第一取向和所述第二取向中间的一系列中间取向之间旋转,并且其中所述传动杆的所述阻挡件能够接触所述引导构件的所述基准部分,使得所述切割刃不会穿过所述切割停止基准。
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US12/765,330 US8308040B2 (en) | 2007-06-22 | 2010-04-22 | Surgical stapling instrument with an articulatable end effector |
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