CN102793571A - 手术器械 - Google Patents

手术器械 Download PDF

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CN102793571A
CN102793571A CN2012102795837A CN201210279583A CN102793571A CN 102793571 A CN102793571 A CN 102793571A CN 2012102795837 A CN2012102795837 A CN 2012102795837A CN 201210279583 A CN201210279583 A CN 201210279583A CN 102793571 A CN102793571 A CN 102793571A
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clamp
gear
drive shaft
rotatable drive
rotation
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CN102793571B (zh
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迈克尔·P·惠特曼
唐纳德·马利诺思卡斯
彼得·达特库克
戴维·尼古拉斯
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Covidien LP
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical 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
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, 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
    • A61B90/90Identification means for patients or instruments, e.g. tags
    • A61B90/98Identification means for patients or instruments, e.g. tags using electromagnetic means, e.g. transponders
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017Electrical control of surgical instruments
    • A61B2017/00199Electrical control of surgical instruments with a console, e.g. a control panel with a display
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00367Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • A61B2017/00398Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0046Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
    • A61B2017/00464Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable for use with different instruments
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00681Aspects not otherwise provided for
    • A61B2017/00734Aspects not otherwise provided for battery operated
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214Stapler heads
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B17/2909Handles
    • A61B2017/2912Handles transmission of forces to actuating rod or piston
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B17/2909Handles
    • A61B2017/2912Handles transmission of forces to actuating rod or piston
    • A61B2017/2923Toothed members, e.g. rack and pinion
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2926Details of heads or jaws
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2926Details of heads or jaws
    • A61B2017/2932Transmission of forces to jaw members
    • A61B2017/2943Toothed members, e.g. rack and pinion

Abstract

本发明提供了一种手术器械,包括:钳夹部,其具有与第二钳夹相对的第一钳夹和包括手术构件的第二钳夹;轴部,其联接到钳夹部的近侧端;限定了纵轴线的手柄,其包括第一可旋转驱动轴和第二可旋转驱动轴;以及至少一个马达,其被配置为使得所述手术器械的轴部相对于所述手柄旋转,使所述钳夹部相对于所述轴部移动,使所述第一钳夹相对于所述第二钳夹移动并且使所述手术构件在所述第二钳夹内移动;其中所述第一可旋转驱动轴与选择器轴机械配合以引起所述选择器轴的旋转运动,并且所述第二可旋转驱动轴与功能轴机械配合以引起所述功能轴的旋转运动。

Description

手术器械
本申请是申请号为200880108278.3、申请日为2008年9月22日、发明名称为“手术器械”的专利申请的分案申请。
相关申请的引用
本申请要求于2007年9月21日提交的美国临时申请第60/974,267号的权益,其全部内容通过引用合并于此。
引用合并
在此通过引用将下述每份专利文献的全部内容明确地纳入到本申请中:于2005年7月27日提交的美国专利申请第11/191,851号;于2003年6月11日提交的美国专利申请第10/460,291号;于2002年3月15日提交的美国专利申请第10/099,634号;于2001年11月30日提交的美国专利申请第09/999,546号;于2001年6月22日提交的美国专利申请第09/887,789号并于2006年4月25日公布的美国专利第7,032,798号;于2001年4月17日提交的美国专利申请第09/836,781号并于2006年1月3日公布的美国专利第6,981,941号;于2000年11月28日提交的美国专利申请第09/723,715号并于2004年9月21日公布的美国专利第6,793,652号;于1999年6月2日提交的美国专利申请第09/324,451号并于2001年11月13日公布的美国专利第6,315,184号;于1999年6月2日提交的美国专利申请第09/324,452号并于2002年9月3日公布的美国专利第6,443,973号;于1999年7月12日提交的美国专利申请第09/351,534号并于2001年7月24日公布的美国专利第6,264,087号;于2000年2月22日提交的美国专利申请第09/510,923号并于2003年2月11日公布的美国专利第6,517,565号;于2000年2月22日提交的美国专利申请第09/510,927号并于2004年4月6日公布的美国专利第6,716,233号。
技术领域
本发明涉及一种手术器械。更具体地,本发明涉及一种用于夹紧、切割以及缝合组织的动力旋转和/或铰接器械。
背景技术
一种类型的手术器械是线性夹紧、切割及缝合器械。这种器械可用于手术程序中以切除胃肠道中的癌性或异常组织。图1中示出一种常规的线性夹紧、切割及缝合设备。该器械包括具有长形轴的手枪握把型结构和远侧部分。远侧部分包括一对剪刀型夹持元件,所述夹持元件将结肠开启的端部夹紧而使其闭合。在该器械中,两个剪刀型夹持元件中一个-例如钉砧部分-相对于整体结构移动或枢转,而另一个夹持元件相对于整体结构保持固定。该剪切装置的致动(钉砧部分的枢转)由保持在手柄上的夹持触发器控制。
除了剪切装置,远侧部分还包括缝合机构。该剪切机构的固定夹持元件包括缝钉筒接收区域和另一机构,该另一机构用于对着钉砧部分向上驱动缝钉穿过被夹紧的组织端部从而密封之前张开的端部。剪切元件可以与轴一体地形成或者是可拆卸的,从而使各种剪切元件和缝合元件能够互换。
上述手术器械-特别是诸如图1中示出的上述线性夹紧、切割及缝合器械存在的一个问题是,难于在患者体内灵活操作相对的钳夹。外科医生可能需要在各种角度之间移动所述相对的钳夹以使得将期望的组织定位在所述相对的钳夹之间。然而,通常来说还期望在患者体内切割尽可能小的切口,小尺寸的切口限制了可以灵活操作所述相对钳夹的程度。
上述手术器械-特别是诸如图1中示出的上述线性夹紧、切割及缝合器械存在的另一个问题是,所述相对的钳夹可能无法充分止血。具体而言,上述手术器械的相对的钳夹无法以足量的力来夹紧,从而降低了手术器械的有效性。上述手术器械-特别是诸如图1中示出的上述线性夹紧、切割及缝合器械还存在的另一个问题是,切割和/或缝合部件不是以足量的转矩被驱动,从而降低了手术器械的效率。
因此,有人认为需要提高夹紧、切割及缝合器械的可灵活操作性。另外,还有人认为需要提供附加夹紧、切割及缝合力的夹紧、切割及缝合器械。
发明内容
依照本发明的示例性实施例,提供了一种手术器械,手术器械包括:第一驱动器,用于执行第一移动功能;第二驱动器,用于执行第二移动功能;第一可旋转驱动轴,其被配置为当致动时使得第一和第二驱动器中的一个与第二可旋转驱动轴选择地接合,其中第二可旋转驱动轴被配置为驱动第一和第二驱动器中选择地结合的一个。
在一个实施例中,手术器械还包括第三驱动器,用于执行第三移动功能,其中第一可旋转驱动轴被配置为当致动时使得第一、第二和第三驱动器中的一个与第二可旋转驱动轴选择地接合,并且其中第二可旋转驱动轴被配置为驱动第一、第二和第三驱动器中选择地接合的一个。而且,手术器械可包括第四驱动器,用于执行第三移动功能,其中第一可旋转驱动轴被配置为,当致动时使得第一、第二、第三和第四驱动器中的一个与第二可旋转驱动轴选择地接合,并且其中第二可旋转驱动轴被配置为驱动第一、第二、第三和第四驱动器中选择地接合的一个。
可由手术器械来执行各种移动功能。例如,手术器械可包括联接到手柄的轴部,手柄限定了纵轴线。第一和第二移动功能中的至少一个可包括,当致动第二可旋转驱动轴时,使手术器械的轴部相对于手术器械的手柄并绕手柄的纵轴线旋转。在第一旋转方向上致动第二可旋转驱动轴可使得轴部在第一旋转方向上相对于手柄并绕手柄的纵轴线作枢转移动,而在第二旋转方向上致动第二可旋转驱动轴可使得轴部在与第一旋转方向相反的第二旋转方向上相对于手柄并绕手柄的纵轴线作枢转移动。第一或第二驱动器可包括至少一个齿轮,当第一可旋转驱动轴使功能部件移动到对应于第一和第二移动功能中的至少一个的位置上时,所述齿轮通过第二可旋转驱动轴选择地接合。
在可由手术器械实现的另一移动功能中,手术器械可包括联接到轴部的钳夹部,并且第一或第二移动功能可包括,当致动第二可旋转驱动轴时,使手术器械的钳夹部相对于手术器械的轴部移动。在第一旋转方向上致动第二可旋转驱动轴可使得钳夹部在第一旋转方向上相对于轴部作枢转移动,而在第二旋转方向上致动第二可旋转驱动轴可使得钳夹部在与第一旋转方向相反的第二旋转方向上相对于轴部作枢转移动。钳夹部和轴部可限定相应的纵轴,并且钳夹部可绕与钳夹部和轴部的纵轴垂直的纵轴线相对于轴部枢转。第一或第二驱动器可包括至少一个齿轮,当第一可旋转驱动轴使功能部件移动到对应于第一和第二移动功能中的至少一个的位置上时,所述齿轮通过第二可旋转驱动轴选择地接合。
在可由手术器械实现的另一移动功能中,手术器械可包括钳夹部,所述钳夹部包括彼此相对的第一钳夹和第二钳夹,并且第一或第二移动功能可包括当致动第二可旋转驱动轴时,使第一钳夹相对于第二钳夹移动。在第一旋转方向上致动第二可旋转驱动轴可使得第一钳夹在第一旋转方向上相对于第二钳夹移动,而在第二旋转方向上致动第二可旋转驱动轴可使得第一钳夹在与第一旋转方向相反的第二旋转方向上相对于第二钳夹作枢转移动。第一或第二钳夹可限定相应的纵轴,并且第一钳夹可绕与第一和第二钳夹的纵轴垂直的纵轴线相对于第二钳夹枢转。第一或第二驱动器可包括至少一个齿轮,当第一可旋转驱动轴使功能部件移动到对应于第一和第二移动功能中的至少一个的位置上时,所述齿轮通过第二可旋转驱动轴选择地接合。
在可由手术器械实现的另一移动功能中,手术器械可包括第一钳夹和与第一钳夹相对的第二钳夹,第二钳夹包括手术构件。第一和第二移动功能中的至少一个可包括当致动第二可旋转驱动轴时,在第二钳夹内驱动手术构件。在第一旋转方向上致动第二可旋转驱动轴可使得手术构件在第一方向上在第二钳夹内移动,而在第二旋转方向上致动第二可旋转驱动轴可使得手术构件在第二钳夹内在与第一方向相反的第二方向上移动。手术构件可包括切割元件和缝合元件中的至少一个。第一或第二驱动器可包括至少一个齿轮,当第一可旋转驱动轴使功能部件移动到对应于第一和第二移动功能中的至少一个的位置上时,所述齿轮通过第二可旋转驱动轴选择地接合。
在一个实施例中,第一和第二可旋转驱动轴可联接到机-电驱动器的相应的驱动联接件。可选择地,手术器械可还包括至少一个马达,该至少一个马达被配置为使第一和第二可旋转驱动轴旋转。
在另一实施例中,设置了一种手术系统,其包括机-电驱动器单元和手术附件,所述机-电驱动器单元包括至少一个马达单元,所述手术附件包括:第一驱动器,用于执行第一移动功能;第二驱动器,用于执行第二移动功能;第一可旋转驱动轴,可联接到至少一个马达单元,并被配置为当通过至少一个马达单元来致动时,使得第一和第二驱动器中的一个与第二可旋转驱动轴选择地接合,其中第二可旋转驱动轴可联接到至少一个马达单元,并被配置为经由至少一个马达单元驱动第一和第二驱动器中选择地接合的一个。
而且,手术系统的手术附件可进一步包括第三驱动器,用于执行第三移动功能,其中第一可旋转驱动轴被配置为当致动时,使得第一、第二和第三驱动器中的一个与第二可旋转驱动轴选择地接合,并且其中第二可旋转驱动轴被配置为驱动选择地接合的第一、第二和第三驱动器中的一个。此外,手术附件可还包括第四驱动器,用于执行第三移动功能,其中第一可旋转驱动轴被配置为当致动时,使得第一、第二、第三和第四驱动器中的一个与第二可旋转驱动轴选择地接合,并且其中第二可旋转驱动轴被配置为驱动选择地接合的第一、第二、第三和第四驱动器中的一个。
在一个实施例中,手术系统的手术附件包括联接到手柄的轴部,手柄限定了纵轴线,其中第一和第二移动功能中的至少一个包括,当致动第二可旋转驱动轴时,使得手术器械的轴部相对于手术器械的手柄并绕手柄的纵轴线旋转。经由第二可旋转驱动轴的至少一个马达单元在第一旋转方向上的致动,可使得轴部在第一旋转方向上相对于手柄并绕手柄的纵轴线作枢转移动,而经由第二可旋转驱动轴的至少一个马达单元在第二旋转方向上的致动,可使得轴部在与第一旋转方向相反的第二旋转方向上相对于手柄并绕手柄的纵轴线作枢转移动。第一或第二驱动器可包括至少一个齿轮,当第一可旋转驱动轴使功能部件移动到对应于第一和第二移动功能中的至少一个的位置上时,所述齿轮通过第二可旋转驱动轴选择地接合。
在一个实施例中,手术系统的手术附件包括联接到轴部的钳夹部,其中第一和第二移动功能中的至少一个包括,当经由第二可旋转驱动轴的至少一个马达单元致动时,使手术器械的钳夹部相对于手术器械的轴部移动。经由第二可旋转驱动轴的至少一个马达单元在第一旋转方向上的致动可使得钳夹部在第一旋转方向上相对于轴部作枢转移动,而经由第二可旋转驱动轴的至少一个马达单元在第二旋转方向上的致动可使得钳夹部在与第一旋转方向相反的第二旋转方向上相对于轴部作枢转移动。钳夹部和轴部可限定相应的纵轴线,并且钳夹部可绕与钳夹部和轴部的纵轴线垂直的纵轴线相对于轴部枢转。第一或第二驱动器可包括至少一个齿轮,当第一可旋转驱动轴使功能部件移动到对应于第一和第二移动功能中的至少一个的位置上时,所述齿轮通过第二可旋转驱动轴选择地接合。
在一个实施例中,手术系统的手术附件可包括钳夹部,所述钳夹部包括彼此相对的第一钳夹和第二钳夹,并且第一或第二移动功能可包括,当经由第二可旋转驱动轴的至少一个马达单元致动时,使第一钳夹相对于第二钳夹移动。经由第二可旋转驱动轴的至少一个马达单元在第一旋转方向上的致动可使得第一钳夹在第一旋转方向上相对于第二钳夹移动,经由第二可旋转驱动轴的至少一个马达单元在第二旋转方向上的致动可使得第一钳夹在与第一旋转方向相反的第二旋转方向上相对于第二钳夹作枢转移动。第一和第二钳夹限定了相应的纵轴线,并且第一钳夹可绕与第一和第二钳夹的纵轴线垂直的纵轴线相对于第二钳夹枢转。第一或第二驱动器可包括至少一个齿轮,当第一可旋转驱动轴使功能部件移动到对应于第一和第二移动功能中的至少一个的位置上时,所述齿轮通过第二可旋转驱动轴选择地接合。
在一个实施例中,手术系统的手术附件包括第一钳夹和与第一钳夹相对的第二钳夹,第二钳夹包括手术构件,其中第一和第二移动功能中的至少一个包括,当经由第二可旋转驱动轴的至少一个马达单元致动时,在第二钳夹内驱动手术构件。经由第二可旋转驱动轴的至少一个马达单元在第一旋转方向上的致动可使得手术构件在第一方向上在第二钳夹内移动,而经由第二可旋转驱动轴的至少一个马达单元在第二旋转方向上致动可使得手术构件在与第一方向相反的第二方向上在第二钳夹内移动。手术构件可包括切割元件和缝合元件中的至少一个。第一或第二驱动器可包括至少一个齿轮,当第一可旋转驱动轴使功能部件移动到对应于第一和第二移动功能中的至少一个的位置上时,所述齿轮通过第二可旋转驱动轴选择地接合。
在一个实施例中,手术系统的手术系统可还包括被配置为控制马达单元的控制系统。控制系统可布置在壳体内。而且,控制系统可包括安装在手术附件上的至少一个控制器械,并且控制器械可包括无线遥控单元。手术附件可包括与可通过第一可旋转驱动轴移动的功能部件对应的位置传感器,传感器输出与功能部件的位置对应的信号。第二可旋转驱动轴可被配置为根据功能部件的位置与第一和/或第二驱动器选择地接合。
在另一实施例中,设置了一种手术器械,其包括:钳夹部,其具有与第二钳夹相对的第一钳夹和包括手术构件的第二钳夹;联接到钳夹部的近侧端的轴部;以及限定了纵轴线的手柄。手术器械还可包括:第一驱动器,用于使手术器械的轴部相对于手柄并绕手柄的纵轴线旋转;第二驱动器,用于使钳夹部相对于轴部移动;第三驱动器,用于使第一钳夹相对于第二钳夹移动;以及第四驱动器,用于使手术构件在第二钳夹内移动。此外,手术器械可还包括第一可旋转驱动轴,所述第一可旋转驱动轴被配置为当致动时,使得第一、第二、第三和第四驱动器中的至少一个与第二可旋转驱动轴选择地接合,其中第二可旋转驱动轴被配置为驱动选择地接合的第一、第二、第三和第四驱动器中的一个。
在这种实施例中,手术器械可被布置为使得,当第一可旋转驱动轴使得第一驱动器与第二可旋转驱动轴接合时,第二可旋转驱动轴在第一旋转方向上的致动使得轴部在第一旋转方向上相对于手柄并绕手柄的纵轴线作枢转移动,而第二可旋转驱动轴在第二旋转方向上的致动使得轴部在与第一旋转方向相反的第二旋转方向上相对于手柄并绕手柄的纵轴线作枢转移动。而且,手术器械可被布置为使得,当第一可旋转驱动轴使得第二驱动器与第二可旋转驱动轴接合时,第二可旋转驱动轴在第一旋转方向上的致动使得钳夹部在第一旋转方向上相对于轴部作枢转移动,而第二可旋转驱动轴在第二旋转方向上的致动使得钳夹部在与第一旋转方向相反的第二旋转方向上相对于轴部作枢转移动。此外,手术器械可被布置为使得钳夹部和轴部限定相应的纵轴线,并且其中钳夹部绕与钳夹部和轴部的纵轴线垂直的纵轴线相对于轴部枢转。
手术器械也可被布置为使得,当第一可旋转驱动轴使得第三驱动器与第二可旋转驱动轴接合时,第二可旋转驱动轴在第一旋转方向上的致动使得第一钳夹在第一旋转方向上相对于第二钳夹移动,而第二可旋转驱动轴在第二旋转方向上的致动使得第一钳夹在与第一旋转方向相反的第二旋转方向上相对于第二钳夹作枢转移动。在这样的布置中,第一和第二钳夹可限定相应的纵轴线,并第一钳夹可绕与第一和第二钳夹的纵轴线垂直的纵轴线相对于第二钳夹枢转。
而且,手术器械可被布置为使得,当第一可旋转驱动轴使得第三驱动器与第二可旋转驱动轴接合时,第二可旋转驱动轴在第一旋转方向上的致动使得手术构件在第一方向上在第二钳夹内移动,而第二可旋转驱动轴在第二旋转方向上的致动使得手术构件在与第一方向相反的第二方向上在第二钳夹内移动。
在一个实施例中,第一和第二可旋转驱动轴可联接到机-电驱动器的相应的驱动联接件。可选择地,手术器械可包括至少一个马达,该至少一个马达被配置为使第一和第二可旋转驱动轴旋转。
附图说明
图1是常规的线性夹紧、切割及缝合器械的立体图;
图2(a)是根据本发明的机-电驱动器部件的示例性实施例的立体图;
图2(b)是示出根据本发明示例性实施例的手术器械的一些部件的示意图;
图2(c)为图示了根据本发明的另一个示例性实施例的手术器械的一些部件的示意图;
图3(a)是根据本发明示例性实施例的手术器械的立体图;
图3(b)为图示了根据本发明的一个实施例的手术器械的手柄的侧视图,该图的一部分是截面图;
图3(c)为图示了根据图3(b)所示的实施例的手术器械的手柄的附加特征的侧视立体图,该图的一部分是截面图;
图3(d)和图3(e)为图示了根据本发明的一个实施例的手术器械的手柄进一步的特征的侧视立体图,该图的一部分是截面图;
图3(f)为根据本发明的一个实施例的手术器械的远侧组件的侧视立体图;
图4(a)为图示了根据图3(f)所示的实施例的远侧组件的近侧部分的分解立体图;
图4(b)为图示了根据图3(f)所示的实施例的远侧组件的中间部分的分解立体图;
图4(c)为图示了根据图3(f)所示的实施例的远侧组件的远侧部分的分解立体图;
图4(d)为根据图3(f)所示的实施例的远侧组件的中间部分的侧视立体图,该图的一部分是截面图
图4(e)为图示了根据本发明的一个实施例的可更换缝钉筒的分解立体图;
图4(f)为根据本发明的一个实施例的第一钳夹的钉砧的底视图;
图5(a)为根据图3(a)至图3(e)所示的实施例的手术器械的手柄部的侧视立体图,并且特别是用作使轴部相对于并绕手柄的纵轴线移动(例如旋转)的手柄部的部件,该图的一部分是截面图;
图5(b)为根据图3(a)至图3(e)所示的实施例的手术器械的手柄部的侧视立体图,特别是用作使钳夹部相对于轴部移动(例如铰接)的手柄部的部件,该图的一部分是截面图;
图5(c)为根据图3(a)至图3(e)所示的实施例的手术器械的手柄部的侧视立体图,特别是用作使第一钳夹相对于第二钳夹移动(例如通过打开和闭合使第一钳夹相对于第二钳夹夹紧)的手柄部的部件,该图的一部分是截面图;
图5(d)为根据图3(a)至图3(e)所示的实施例的手术器械的手柄部的侧视立体图,并且特别是用作使切割和/或缝合元件移动(例如驱动缝钉推动元件和/或切割刀片通过一段组织)的手柄部的部件,该图的一部分是截面图;
图5(e)为根据本发明的一个实施例的手术器械11的切割和/或缝合元件的横截面图;
图6(a)为根据图3(f)和图4(d)所示的实施例的手术器械的远侧部的中间部分的侧视立体图,并且特别是当轴部相对于并绕手柄的纵轴线旋转时被移动(例如被旋转)的中间部分的部件,该图的一部分是截面图;
图6(b)为根据图3(f)和图4(d)所示的实施例的手术器械的远侧部的中间部分的侧视立体图,并且特别是用作使钳夹部相对于轴部移动(例如铰接)的中间部分的部件,该图的一部分是截面图;
图6(c)为根据图3(f)和图4(d)所示的实施例的手术器械的远侧部的中间部分的侧视立体图,并且特别是用作使钳夹部相对于轴部移动(例如通过打开和闭合使钳夹部相对于轴部夹紧)的中间部分的部件,该图的一部分是截面图;
图6(d)为根据图3(f)和图4(d)所示的实施例的手术器械的远侧部的中间部分的侧视立体图,并且特别是用作使切割和/或缝合元件移动(例如驱动缝钉推动元件和/或切割刀片通过一段组织)的中间部分的部件,该图的一部分是截面图;
图7示出根据本发明另一示例性实施例的柔性轴的侧视图,该图的一部分是截面图;
图8是该柔性轴沿图7中示出的线8-8的截面图;
图9示出根据本发明示例性实施例的第一联接件的后视端面图;
图10中能够观察到根据本发明示例性实施例的柔性轴的第二联接件的主视端面图;
图11示意性地示出根据本发明示例性实施例的马达的布局;
图12示出根据本发明示例性实施例的机-电驱动器部件的示意图;
图13是根据本发明示例性实施例的编码器的示意图;
图14示意性地示出根据本发明示例性实施例的存储模块;
图15中能够观察到根据本发明示例性实施例的无线RCU的示意图;
图16中能够观察到根据本发明示例性实施例的有线RCU的示意图;
图17(a)为根据本发明的一个示例性实施例的手术器械的侧视立体图;
图17(b)为图17(a)的手术器械的局部剖视图,示出了手柄的内部部件的另外的细节;
图17(c)为图17(a)的手术器械的局部剖切的顶视立体图,图示了驱动机构的另外的细节;
图18(a)为选择器变速箱组件的分解立体图;
图18(b)为图18(a)的选择器变速箱组件的横截面图;
图18(c)为图18(a)的选择器变速箱组件的立体图;以及
图18(d)为图18(a)的选择器变速箱组件的前视图。
具体实施方式
图2(b)为示出了根据本发明示例性实施例的手术器械11的一些部件的示意图。手术器械11被配置为特别适于例如经由套管(未图示)插入患者体内。在所示实施例中,手术器械11是夹紧、切割及缝合器械。手术器械11包括通过铰链部分11c以可枢转方式联接到轴部11b的钳夹部11a。钳夹部11a包括第一钳夹50和第二钳夹80,第一钳夹50具有远侧端50a和近侧端50b,第二钳夹80具有远侧端80a和近侧端80b。第一钳夹50和第二钳夹80在它们相应的近侧端50b、80b处或附近相互可枢转地联接。如所示,第一钳夹50和第二钳夹80相对于彼此绕枢轴线A可枢转。在所示的示例性实施例中,枢轴线A垂直于页面定向。在这种布置中,钳夹被配置为使得当相对于第二钳夹80打开和闭合第一钳夹50并且在第一钳夹50相对于第二钳夹80移动时,第一钳夹50和第二钳夹80(例如它们的纵轴)都保持在由页面限定的平面内。然而,应当理解的是,手术器械11可代替地被配置为使得第一钳夹50和第二钳夹80可相对于彼此绕不垂直于页面定向的枢轴线枢转,在这种情况下,第一钳夹50和第二钳夹80可由除了所述页面所限定的平面外的一平面或多个平面内移动。
如上所述,钳夹部11a通过铰链部分11c以可枢转方式联接到轴部11b。具体而言,钳夹部11a可绕枢轴线B相对于轴部11b枢转,枢轴线B可以定位在钳夹部11a和轴部11b上或钳夹部11a和轴部11b之间的任何位置处,并且可以相对于钳夹部11a和轴部11b定位在任何周向位置处。在所示的示例性实施例中,枢轴线B在所示附图中定位成垂直的并且位于页面内。在这种布置中,钳夹部11a和轴部l1b被配置为:当相对于轴部11b铰接钳夹部11a并且在钳夹部11a相对于轴部11b移动的任一点,钳夹部11a和轴部11b保持在与枢轴线B垂直的平面内。应当认识到,在其它示例性实施例中,枢轴线B可具有不同的方位,从而使钳夹部11a能够在不同的平面内枢转。钳夹部11a可相对于轴部11b枢转到任何角度以及在相对于轴部11b的任何角度之间枢转,从而使得能够在使用过程中根据需要选择性地对钳夹部11a进行定位。
而且,手术器械11可使得各种部件绕手术器械11的纵轴线旋转。例如,在各种实施例中,钳夹部11a和/或轴部11b可相对于手柄1103(下文将更详细地描述)绕手柄1103的纵轴线D(例如在手柄1103与轴部11b汇合处的手柄1103的纵轴线D)旋转,所述手柄1103、连接到轴部11b的近侧端。
轴部11b可包括远侧部1101a和近侧部1101b,钳夹部11a连接到远侧部1101a上,近侧部1101b可连接到手柄1103上。为了清晰起见,在图2(b)中示意地示出了手柄1103;根据本发明的各种实施例的手柄1103的进一步的细节将结合例如图5(a)至5(d)进行阐述。通常,手柄1103提供了这样一种器械,用户可以使用该器械握持并操作手术器械11。手柄1103具有近侧部1102。在近侧部1102处,手柄1103可包括用于连接到柔性轴(下文将更详细的描述)的连接元件1104,例如速接联接件。
第二钳夹80包括夹紧表面106。第二钳夹80还包括切割及缝合元件104,切割及缝合元件104可形成第二钳夹80的夹紧表面106的至少一部分。第一钳夹50包括与第二钳夹80相对的砧构件700。砧构件700包括夹紧表面108,夹紧表面108与第二钳夹80的夹紧表面106一起夹紧组织的待切割和缝合的部分。如下文将更详细解释的,切割及缝合元件104被配置为当第一钳夹50和第二钳夹80处于闭合位置(例如完全闭合位置)时切割并缝合组织部分。下文将例如结合图3(f)和3(g)来说明并描述根据一种实施例的切割及缝合元件104的附加特征,另外,如上所述,2001年11月30日提交的美国专利申请第09/999,546号以及2003年6月11日提交的美国专利申请第10/460,291号都说明和描述了切割及缝合元件104的附加特征,每个所述专利申请的全部内容都通过引用明确地结合到本文中。
可采用各种驱动器驱动手术器械11移动,例如使第一钳夹50相对于第二钳夹80枢转、启动缝钉筒、使钳夹部11a相对于轴部11b枢转、使钳夹部11a和轴部11b或其某些部分绕轴部11b的纵轴线旋转等。根据本发明的一种实施例,这些功能通过将手术器械11连接到具有两个可旋转驱动轴的柔性轴来实现,但是应当认识到,在其它实施例中可采用不同类型和/或不同数目的驱动部件。
图2(b)示意地示出,手柄1103包括功能选择器模块1110。将在下面阐述功能选择器模块1110的更详细的细节。通常,功能选择器模块1110可通过第一可旋转驱动轴1110a致动,以使得在多个不同的功能位置之间移动。在所示的实施例中,功能选择器模块1110可通过第一可旋转驱动轴1110a在四种不同的功能位置之间致动,下面将更加全面地阐述四种不同功能位置中的每种功能位置。功能选择器模块1110被配置为使得,在每个不同的功能位置,功能选择器模块1110使得第二可旋转驱动轴1110b与手术器械11的所选择的各种驱动器88、98、201、202中的一个接合。如下文所述,每个驱动器88、98、201、202被配置为当与第二可旋转驱动轴1110b接合并操作时,实现手术器械11的特殊功能。
如上所述,在图2(b)所示的实施例中,手柄1103包括连接元件1104,连接元件1104使得第一可旋转驱动轴1110a经由第一驱动凹座654联接到第三可旋转驱动轴94。然后,第三可旋转驱动轴94被联接到或可联接到第一马达96。以这种方式,使第三可旋转驱动轴94、第一驱动凹座654和第一可旋转驱动轴1110a旋转的第一马达96的操作可致动功能选择模块1110。
而且,在图2(b)所示的实施例中,手柄1103的连接元件1104可使得第二可旋转驱动轴1110b经由第二驱动凹座694联接到第四可旋转驱动轴102。然后,第四可旋转驱动轴102被联接到或可联接到第二马达100。以这种方式,使第四可旋转驱动轴102、第二驱动凹座694和第二可旋转驱动轴1110b旋转的第二马达100的操作可驱动之前已经通过功能选择模块1110的操作选择出的特殊的驱动器机构。
在一个实施例中,可由手术器械11执行的第一功能为使轴部11b绕纵轴线D相对于手柄1103旋转,例如,操作手柄1103内的旋转齿轮以便使轴部11b绕纵轴线D相对于手柄1103旋转。为了实现该功能,功能选择模块1110可通过由第一马达96致动第一可旋转驱动轴1110a(并通过接合在其间的第三可旋转驱动轴94和第一驱动凹座654的旋转)首先定位在第一选择位置。一旦功能选择模块1110定位在第一选择位置,功能选择模块1110使得旋转驱动器202与第二马达100接合(经由接合在其间的第四可旋转驱动轴102和第二驱动凹座694),以使得第二马达100的操作致动旋转驱动器202。在此所述的实施例中,当旋转驱动器202由第二马达100(经由接合在其间的第四可旋转驱动轴102和第二驱动凹座694)致动时,除了执行手术器械11的其它操作之外,旋转驱动器202可操作以使轴部11b绕纵轴线D相对于手柄1103旋转,例如,操作手柄1103内的旋转齿轮以使得轴部11b绕纵轴线D相对于手柄1103旋转。旋转驱动器202可包括能够使轴部11b绕纵轴线D相对于手柄1103旋转(例如,能够操作手柄1103内的旋转齿轮以便使轴部11b绕纵轴线D相对于手柄1103旋转)的任意类型的驱动机构。旋转驱动器202可位于手柄1103的远侧部内并可接合轴部11b,用于使轴部11b相对于手柄1103移动。下面更详细地阐述依照本发明的示例性实施例的旋转驱动器202的另外的细节。
在一个实施例中,可由手术器械11执行的第二功能为使钳夹部11a相对于轴部11b移动,例如使钳夹部11a绕轴线B相对于轴部11b枢转。为了实现该功能,功能选择模块1110可通过由第一马达96致动第一可旋转驱动轴1110a(并通过接合在其间的第三可旋转驱动轴94和第一驱动凹座654的旋转)首先定位在第二选择位置。一旦功能选择模块1110定位在第二选择位置中,功能选择模块1110使得铰接驱动器201与第二马达100(经由接合在其间的第四可旋转驱动轴102和第二驱动凹座694)接合,以使得第二马达100的操作致动铰接驱动器201。在此所述的实施例中,当铰接驱动器201由第二马达100(经由接合在其间的第四可旋转驱动轴102和第二驱动凹座694)致动时,除了执行手术器械11的其它操作之外,铰接驱动器201可操作以使钳夹部11a相对于轴部11b移动,例如使钳夹部11a绕轴线B相对于轴部11b枢转。铰接驱动器201可包括能够使钳夹部11a相对于轴部11b移动(例如使钳夹部11a绕轴线B相对于轴部11b枢转)的任意类型的驱动机构。铰接驱动器201可位于轴部11b的远侧部1101a中并可接合钳夹部11a,用于使钳夹部11a相对于轴部11b移动。下面更详细地阐述依照本发明的示例性实施例的铰接驱动器201的另外的细节。
在一个实施例中,可由手术器械11执行的第三功能为使第一钳夹50相对于第二钳夹80移动,例如,通过枢转或任意其它可想象到的相对移动使第一钳夹50相对于第二钳夹80打开和闭合。为了实现该功能,功能选择模块1110可通过由第一马达96致动第一可旋转驱动轴1110a(并通过接合在其间的第三可旋转驱动轴94和第一驱动凹座654的旋转)首先定位在第三选择位置。一旦功能选择模块1110定位在第三选择位置中,功能选择模块1110使得夹紧驱动器88与第二马达100(经由接合在其间的第四可旋转驱动轴102和第二驱动凹座694)接合,以使得第二马达100的操作致动夹紧驱动器88。在此所述的实施例中,当夹紧驱动器88由第二马达100(经由接合在其间的第四可旋转驱动轴102和第二驱动凹座694)致动时,除了执行手术器械11的其它操作以外,夹紧驱动器88可操作以使第一钳夹50相对于第二钳夹80移动,例如,打开和闭合。夹紧驱动器88可包括能够使第一钳夹50和第二钳夹80相对于彼此移动的任意其它类型的驱动机构。为了相对于第二钳夹80打开和闭合第一钳夹50,夹紧驱动器88可至少部分地位于第二钳夹80的近侧端80b中并可连接到第一钳夹50的近侧端50b上,以便接合第一钳夹50的近侧端50b。下面更详细地阐述依照本发明的示例性实施例的夹紧驱动器88的另外的细节。
在一个实施例中,可由手术器械11执行的第四功为使切割和/或缝合元件移动,例如,诸如通过转动切割和缝合元件104的螺纹驱动轴来驱动缝钉推动元件和/或切割刀片通过一段组织。为了实现该功能,功能选择模块1110可通过由第一马达96致动第一可旋转驱动轴1110a(并通过接合在其间的第三可旋转驱动轴94和第一驱动凹座654的旋转)首先定位在第四选择位置中。一旦功能选择模块1110定位在第四选择位置,功能选择模块1110使得启动驱动器98与第二马达100(经由接合在其间的第四可旋转驱动轴102和第二驱动凹座694)接合,以使得第二马达100的操作致动第二驱动器88。在此所述的实施例中,当第二驱动器88由第二马达100(经由接合在其间的第四可旋转驱动轴102和第二驱动凹座694)致动时,除了执行手术器械11的其它操作以外,第二驱动器88可操作以使切割和/或缝合元件移动,例如,驱动缝钉推动元件和/或切割刀片通过一段组织。启动驱动器98可包括能够使切割和/或缝合元件移动(例如驱动缝钉推动元件和/或切割刀片通过一段组织)的任意类型的驱动机构。启动驱动器88可位于第二钳夹80的近侧端80b和远侧端80a之间,以切割和/或缝合布置在第一钳夹50和第二钳夹80之间的一段组织。下面更详细地阐述依照本发明的示例性实施例的启动驱动器98的另外的细节。
应当认识到,当两个驱动凹座(例如:第一驱动凹座654和第二驱动凹座694)以及两个相应的驱动轴(例如:第一驱动轴94和第二驱动轴102)被图示为手术器械11的部件,并作为用于例如使手术器械11的特定部件相对于其它部件移动和定位和/或夹紧、切割并缝合一段组织的目的时,能够设置任意适当数量的驱动凹座和驱动轴。例如,可设置单个驱动轴或两个以上的驱动轴以执行手术器械11的上述功能。
驱动轴(例如:第一和第二可旋转驱动轴94和102以及任意其它的驱动轴)可以容纳在柔性驱动轴内,所述柔性驱动轴诸如图2(a)所示的柔性驱动轴1620。也可采用其它类型的柔性驱动轴。例如,驱动轴可容纳在2006年7月27日提交的申请号为60/703,227、题目为“Flexible Shaft for anElectro-Mechanical Surgical Device(用于机-电手术器械的柔性轴)”的美国临时申请所描述和图示类型的柔性驱动轴中,该申请的全部内容通过引用合并于此。
结合图2(b),手术器械11还可包括存储模块6041。在一个实施例中,存储模块6041连接到切割和缝合元件104或与切割和缝合元件104一体形成。存储模块6041通过数据传输线缆1278连接到数据连接器1272。下文将结合图3(f)和图7说明这些部件的附加特征。
而且,图2(b)还示出连接元件1104。连接元件1104可包括速接套筒713,速接套筒713具有与柔性驱动轴1620的互补速接元件1664接合的速接凹槽713a,下文将对此进行更详细的描述。为了将柔性驱动轴1620的速接元件1664保持在速接套筒713的速接凹槽713a中,连接元件1104也可包括弹簧。
而且,应当认识到,用来驱动第一可旋转驱动轴1110a和第二可旋转驱动轴1110b的马达可与手术器械11一体形成。例如,图2(c)为图示了根据本发明另一个示例性实施例的手术器械11的可选择的布置的示意图。在该实施例中,第一马达961和第二马达1001布置在手柄1103内,以使得第一可旋转驱动轴1110a和第二可旋转驱动轴1110b分别连接到第一马达961和第二马达1001。
根据本发明的示例性实施例,手术器械11可以被配置为诸如具有图2(a)中示出的马达系统的机-电驱动器部件1610的机-电手术系统的附件,或者可以与所述机-电手术系统一体地设置。应当理解的是,在该示例性实施例中,可设置任何合适数目的马达,并且所述马达可借助电池电源、线路电流、DC电源、电子控制DC电源等运转。还应当理解的是,所述马达可连接到DC电源,该DC电源又连接到线路电流并给所述马达提供工作电流。在另一示例性实施例中,该手术器械可以是机械驱动器系统的附件或者可以与机械驱动器系统一体地设置。
图3(a)是根据本发明一种实施例的手术器械11的立体图。如上所述,图3(a)至3(e)示出本发明的一种实施例,其中,两根驱动轴被配置为用于使轴部11b相对于手柄1103并围绕手柄1103的纵轴线移动;使钳夹部11a相对于轴部11b移动(例如,铰接);使第一钳夹50相对于第二钳夹80移动(例如,打开或闭合);以及启动缝合及切割筒。在图3(a)中示出的位置中,钳夹部11a定位成相对于轴部11b大约成60度角。可以根据患者身上的切口以及期望夹紧、切割及缝合的组织的位置来对钳夹部11a进行适当地定位。
如上所述,图3(b)为图示了根据本发明的一个实施例的手术器械的手柄1103的侧视图,该图的一部分是截面图。图3(c)为图示了根据图3(b)所示的实施例的手术器械的手柄附加特征的侧视立体图,该图的一部分是截面图。图3(d)和3(e)为仍进一步图示了根据本发明的一个实施例的手术器械的手柄的特征的侧视立体图,该图的一部分是截面图。
现在结合图3(b),图示了手柄1103包括从手柄1103的近侧端向内延伸的第一可旋转驱动轴1110a。第一可旋转驱动轴1110a具有纵向布置的孔,选择器轴601的近侧端布置在该孔中。有利的是,第一可旋转驱动轴1110a的纵向布置的孔和选择器轴601的近侧端对应地定尺寸和形状,以使得在被接合时,第一可旋转驱动轴1110a的旋转使得选择器轴601旋转。此外,选择器轴601的近侧端通过弹簧603插入并保持在选择器轴601的纵向挡块和第一可旋转驱动轴1110a之间的位置上。弹簧603用来使第一可旋转驱动轴1110a在近侧方向上偏置。
选择器轴601的最远侧端可旋转地安装在手柄的固定内壁605的孔口内,手柄1103的固定内壁605垂直于选择器轴601的纵轴线。选择器轴601沿着邻近其最远侧端的长度还包括螺纹部607。功能选择器块609具有从其纵向延伸的螺纹孔。选择器轴601的螺纹部607延伸穿过功能选择器块609的螺纹孔以使得功能选择器块609安装在其上。功能选择器块609用键连接到手柄的内表面上,以使得当选择器轴601旋转时,在功能选择器块609的螺纹孔内的选择器轴601的螺纹部607的螺纹接合使得功能选择器块609沿着选择器轴601向远侧和近侧移动。
图3(b)还图示了手柄1103包括从手柄1103的近侧端向内延伸的第二可旋转驱动轴1110b。第二可旋转驱动轴1110b具有纵向布置的孔,功能轴611的近侧端布置到该孔中。有利的是,第二可旋转驱动轴1110b的纵向布置的孔和功能轴611的近侧端对应地定尺寸和形状,以使得在接合时,第二可旋转驱动轴1110b的旋转使得功能轴611旋转。此外,功能轴611的近侧端通过弹簧613插入并保持在功能轴611的纵向挡块和第二可旋转驱动轴1110b之间的位置上。弹簧613用来使第二可旋转驱动轴1110b在近侧方向上偏置。
功能轴611的最远侧端可旋转地安装在手柄的固定内壁615的孔口中,手柄1103的固定内壁615垂直于功能轴611的纵轴线。功能轴611沿着邻近其最远侧端的长度还包括启动正齿轮617。沿功能轴611相对于启动正齿轮617位于远侧位置上的是输入正齿轮619。启动正齿轮617和输入正齿轮619每个具有相应的外周齿轮齿6171、6191。也可旋转地安装在手柄的固定内壁615的孔口内的是次级启动正齿轮618。次级启动正齿轮618具有与启动正齿轮619的外周齿轮齿6191啮合的外周齿轮齿6181。
从功能选择器块609向远侧延伸的是齿轮轴621。沿齿轮轴621布置在变化的纵向位置处的是各种齿轮。例如,最邻近功能选择器块609的沿着齿轮轴621的纵向位置处是旋转正齿轮623。旋转正齿轮623包括外周齿轮齿6231。外周齿轮齿6231接合输入正齿轮619的外周齿轮齿6191。在一个实施例中,旋转正齿轮623和输入正齿轮619相对于彼此提供4:1的传动比。当然,应当认识到,可采用任意适当的传动比。而且,在相对于旋转正齿轮623位于远侧的沿着齿轮轴621的纵向位置处是启动正齿轮625。启动正齿轮625包括外周齿轮齿6251。启动正齿轮625的外周齿轮齿6251接合启动正齿轮617的外周齿轮齿6171。此外,在相对于启动正齿轮625位于远侧的沿着齿轮轴621的纵向位置处是夹紧正齿轮627。夹紧正齿轮627包括外周齿轮齿6271。在相对于夹紧正齿轮627位于远侧的沿着齿轮轴621的纵向位置处为铰接正齿轮629。铰接正齿轮629包括外周齿轮齿6291。此外,在相对于铰接正齿轮629位于远侧的沿着齿轮轴621纵向位置处为旋转正齿轮631。旋转正齿轮631包括外周齿轮齿6311。
手柄1103还包括旋转齿轮轴633。旋转齿轮轴633的近侧端可旋转地安装在手柄1103的固定内壁635的孔口中,手柄1103的固定内壁635通常垂直于旋转齿轮轴633的纵轴线。旋转齿轮轴633的远侧端可旋转地安装在手柄1103的固定内壁637的孔口中,手柄1103的固定内壁637也大体垂直于旋转齿轮轴633的纵轴线。旋转齿轮轴633沿着邻近其近侧端的长度包括旋转正齿轮639。旋转正齿轮639具有外周齿轮齿6391。旋转齿轮轴633沿着邻近其远侧端的长度还包括旋转蜗杆齿轮641。旋转蜗杆齿轮641具有外周蜗杆齿轮齿6411。
旋转齿轮643可旋转地安装到手柄1103的固定内壁645上。有利的是,旋转齿轮643绕与旋转齿轮轴633的纵轴线垂直的枢轴线可旋转地安装。旋转齿轮643具有与旋转蜗杆齿轮641的外周蜗杆齿轮齿6411啮合的外周齿轮齿6431。在一个实施例中,旋转齿轮643和旋转蜗杆齿轮641相对于彼此提供45:1的传动比。当然,应当认识到,可采用任意适当的传动比。安装到旋转齿轮643的表面上并被配置为与其旋转的是旋转等径伞齿轮644。旋转等径伞齿轮644具有等径伞齿轮齿6441。
手柄1103还包括第二旋转齿轮轴665。第二旋转齿轮轴665通过通道667保持在手柄1103中,第二旋转齿轮轴665沿纵向并可旋转地保持在通道667中。第二旋转齿轮轴665的近侧端包括旋转等径伞齿轮669。旋转等径伞齿轮669具有等径伞齿轮齿6691。旋转等径伞齿轮669的等径伞齿轮齿6691与等径伞齿轮644的等径伞齿轮齿6441啮合。
第二旋转齿轮轴665的远侧端可旋转地安装在手柄1103的固定内壁671的孔口中,手柄1103的固定内壁671通常垂直于第二夹紧齿轮轴665的纵轴线。第二旋转齿轮轴665沿着邻近其远侧端的长度还包括旋转正齿轮673。旋转正齿轮673具有外周齿轮齿6731。
在手柄1103的最远侧端处安装在口部675内的是旋转管677。纵向挡块使旋转管677沿纵向保持在口部675内。旋转管677的远侧端延伸到管壳体523中。旋转管677的近侧端包括旋转管状正齿轮679。旋转管状正齿轮679具有外周齿轮齿6791。旋转管状正齿轮679的外周齿轮齿6791与旋转正齿轮673的外周齿轮齿6731啮合。在一个实施例中,旋转正齿轮673和旋转管状正齿轮679相对于彼此提供了1.4:1的传动比。当然,应当认识到,可采用任意适当的传动比。
图5(b)图示了与在图3(b)中提供的侧视图相反的侧视立体图,该图的一部分是截面图。图5(b)图示了从图3(b)的视图中隐藏的手柄1103的另外的部件。现在结合图5(b),示出了铰接齿轮轴685。铰接齿轮轴685的近侧端可旋转地安装在手柄1103的固定内壁孔口中(虚线所示),手柄1103的固定内壁通常垂直于铰接齿轮轴685的纵轴线。铰接齿轮轴685的远侧端可旋转地安装在手柄1103的另一固定内壁的孔口中(也以虚线示出),手柄1103的该固定内壁也通常垂直于铰接齿轮轴685的纵轴线。铰接齿轮轴685沿着邻近其近侧端的长度包括铰接正齿轮687。铰接正齿轮687具有外周齿轮齿6871。铰接正齿轮687的外周齿轮齿6871与铰接正齿轮629的外周齿轮齿6291啮合。铰接齿轮轴685沿着邻近其远侧端的长度还包括铰接蜗杆齿轮689。铰接蜗杆齿轮689具有外周蜗杆齿轮齿6891。
铰接齿轮691可旋转地安装到手柄1103的固定内壁693上。有利的是,铰接齿轮691绕与铰接齿轮轴685的纵轴线垂直的枢轴线可旋转地安装。铰接齿轮691具有与铰接蜗杆齿轮689的外周蜗杆齿轮齿6891啮合的外周齿轮齿6911。在一个实施例中,铰接齿轮691和铰接蜗杆齿轮689相对于彼此提供了11.25:1的传动比。当然,应当认识到,可采用任意适当的传动比。
返回到图3(b),示出了具有铰接功能的手柄1103的附加特征。例如,安装到铰接齿轮691的表面上并被配置为与其旋转的是第一铰接等径伞齿轮692。第一铰接等径伞齿轮692具有等径伞齿轮齿6921。
手柄1103还包括第二铰接齿轮轴693。第二铰接齿轮轴693通过通道694可旋转地保持在手柄1103内。第二铰接齿轮轴693的近侧端形成螺杆695。安装在螺杆695上的是第二铰接等径伞齿轮696,其通过铰接等径伞齿轮支撑件697安装在手柄696内。第二铰接等径伞齿轮696具有等径伞齿轮齿6961。第二铰接等径伞齿轮696的等径伞齿轮齿6961与第一铰接等径伞齿轮692的等径伞齿轮齿6921啮合。铰接齿轮支撑件697在手柄1103内保持第二铰接等径伞齿轮696的纵向和径向位置,同时允许第二铰接等径伞齿轮696绕其纵轴线旋转。第二铰接等径伞齿轮696限定了纵向布置的螺纹孔,第二铰接齿轮轴693的螺杆695接合第二铰接等径伞齿轮696的纵向布置的螺纹孔。
第二铰接齿轮轴693的远侧端通过旋转管状正齿轮679的中间区延伸穿过沿纵向限定的开口,并穿过在手柄1103的口部675处的旋转管677,以便最后形成铰接轴525(如图4(a)所示)。借助于第二铰接齿轮轴693的螺杆695和第二铰接等径伞齿轮696的纵向布置的螺纹孔之间的螺纹接合,第二铰接等径伞齿轮696的旋转使得在第二铰接齿轮轴693相对于手柄1103在远侧或近侧方向上选择地移动。
结合图3(b),手柄1103还包括夹紧齿轮轴651。夹紧齿轮轴651的近侧端可旋转地安装在手柄1103的固定内壁653的孔口中,手柄1103的固定内壁653通常垂直于夹紧齿轮轴651的纵轴线。夹紧齿轮轴651沿着邻近其远侧端的长度包括夹紧正齿轮655。夹紧正齿轮655具有外周齿轮齿6551。夹紧齿轮轴651在其远侧端还包括第一夹紧等径伞齿轮657。第一夹紧等径伞齿轮657具有等径伞齿轮齿6571。
第二夹紧等径伞齿轮659可旋转地安装到手柄1103的固定内壁663上。有利的是,第二夹紧等径伞齿轮659绕与夹紧齿轮轴651的纵轴线垂直的枢轴线可旋转地安装。第二夹紧等径伞齿轮659具有与第一夹紧等径伞齿轮657的等径伞齿轮齿6571啮合的等径伞齿轮齿6591。
而且,手柄1103包括第二夹紧齿轮轴681。第二夹紧齿轮轴681的近侧端包括第三夹紧等径伞齿轮661。第三夹紧等径伞齿轮661具有等径伞齿轮齿6611,等径伞齿轮齿6611与第二夹紧等径伞齿轮659的等径伞齿轮齿6591啮合。第二夹紧齿轮轴681的远侧端通过旋转管状正齿轮679的中间区延伸穿过沿纵向限定的开口,并在手柄1103的口部675处穿过旋转管677以便最后形成夹紧轴527(如图4(a)所示)。
结合图3(b),手柄1103还包括启动齿轮轴604。启动齿轮轴604邻近其近侧端可旋转地安装在手柄1103的固定内部支撑件606的孔口中,手柄1103的固定内部支撑件604包括作为其远侧表面的固定内壁606,功能轴611的远侧端可旋转地安装到固定内壁606中。启动齿轮轴604在其近侧端包括启动正齿轮608。启动正齿轮608具有外周齿轮齿6081。启动正齿轮608的外周齿轮齿6081与启动正齿轮617的外周齿轮齿6171啮合。
图5(d)图示了与图3(b)中提供的侧视图相反的侧视立体图,该图的一部分是截面图。图5(d)图示了从图3(b)的视图中隐藏的手柄1103的另外的部件。现在结合图5(d),启动齿轮轴604在其远侧端包括第一启动等径伞齿轮610。第一启动等径伞齿轮610具有等径伞齿轮齿6101。
第二启动等径伞齿轮612可旋转地安装到手柄1103的固定内壁616上。有利的是,第二启动等径伞齿轮612绕与启动齿轮轴604的纵轴线垂直的枢轴线可旋转地安装。第二启动等径伞齿轮612具有与第一启动等径伞齿轮610的等径伞齿轮齿6101啮合的等径伞齿轮齿6121。
而且,手柄1103包括第二启动齿轮轴618。第二启动齿轮轴618的近侧端包括第三启动等径伞齿轮614。第三启动等径伞齿轮614具有与第二启动等径伞齿轮612的等径伞齿轮齿6121啮合的等径伞齿轮齿6141。第二启动齿轮轴618的远侧端通过旋转管状正齿轮679的中间区延伸穿过沿纵向限定的开口,并在手柄1103的口部675处穿过旋转管677以便最终形成启动轴529(如图4(a)所示)。
图3(b)依照本发明的实施例还图示了手术器械11可包括光学功能传感器3001、3002、3003和3004。这些光学传感器3001、3002、3003和3004可分别包括例如LED的二极管,所述二极管提供从壁3005的相应的孔出来的光。经由选择器轴601的螺纹部607的功能选择器块609的移动选择性地阻挡光从传感器3001、3002、3003和3004的二极管中的一个传输。这种阻挡光的传输使得手术器械11确定功能选择器块609位于四个上述功能位置中的哪一个中,并因此相应地控制手术器械11的操作。换句话讲,根据功能选择器块609的位置,到达光学传感器3001、3002、3003和3004中的各个视觉传感器和从其中出来的相应的信号被阻挡,由此当手术器械11令人满意地位于四个上述功能位置中的一个时,提供了带有指示的适当的控制器,所述功能位置例如为钳夹部相对于彼此旋转、铰接、打开/闭合以及启动切割和/或缝合机构。
依照本发明的实施例,图3(b)还图示了手术器械11可包括旋转/铰接控制器械3006。在一个实施例中,旋转/铰接控制器械3006可为适当定位在例如手柄1103的顶表面上的操纵杆型器械,并被定尺为使得当操作者握持手柄1103时,可由操作者的拇指致动。而且,依照本发明的实施例,图3(b)图示了手术器械11可包括打开/闭合/启动控制器械3007。在一个实施例中,打开/闭合/启动控制器械3007可为适当定位在例如手柄1103的底表面上的触发器型器械,并被定尺寸为使得当操作者握持手柄1103时,可由操作者的食指致动。在下面将详细描述旋转/铰接控制器械3006和打开/闭合/启动控制器械3007的操作。
图3(f)、图4(a)至图4(c)和图4(d)共同图示了相对于手柄1103位于远侧的手术器械的部件。例如,图3(f)为根据本发明的一个实施例的当装配时的手术器械11的远侧组件的侧视立体图。图4(a)为图示了根据图3(f)所示的实施例的该远侧组件的近侧部分的分解立体图。
例如,图4(a)图示了具有一对纵向布置的孔口的近侧枢转壳体503,每一个纵向布置的孔口被配置为容纳一对螺杆501a、501b中相应的一个。近侧枢转壳体503还容纳一对输入斜齿轮505a、505b,每个斜齿轮被配置为插入到一对滚珠轴承507a、507b中相应的一个。相对于近侧枢转壳体503向近侧布置的是管壳523。
一对输入斜齿轮505a、505b中的每一个在其近侧端包括纵向布置的孔口。相对于第一滚珠轴承507a向近侧布置的是斜推块509。斜推块509具有通过其纵向布置的孔。夹具轴527的远侧端被配置为延伸穿过管壳523的纵向布置的开口、穿过斜推块509的纵向布置的孔、穿过滚珠轴承507a的纵向布置的孔,并在输入斜齿轮505a近侧端处接合纵向布置的孔口。有利的是,夹具轴527的远侧端和在输入斜齿轮505a的近侧端处纵向布置的孔口被相应地定尺寸和形状为使得,在被接合时,夹具轴527的旋转使得输入斜齿轮505a旋转。
而且,相对于第二滚珠轴承507b向近侧布置的是斜推块511。斜推块511的外周表面包括圆形切口5111,其被配置为使得铰接推力销513置于其中。近侧铰接齿轮515具有中央孔口,铰接推力销513被配置为从下面插入到中央孔口中。斜推块511还具有穿过其纵向布置的孔。启动轴529的远侧端被配置为延伸穿过管壳523的纵向布置的开口、穿过斜推块511的纵向布置的孔,并在输入斜齿轮505b的近侧端处接合纵向布置的孔口。有利的是,启动轴529的远侧端和在输入斜齿轮505b的近侧端处的纵向布置的孔口被相应地定尺寸和形状为使得,在被接合时,启动轴529的旋转使得输入斜齿轮505b旋转。
管壳503在其远侧端具有一对垂直对齐的孔5031。此外,管壳503在其远侧端具有适当形状的凹槽以容纳一部分近侧铰接齿轮515。除了被配置为从下方插入到近侧铰接齿轮515的中央孔口的铰接推力销513之外,铰接齿轮515的中央孔口也适当地定尺寸和形状为使得从上方容纳齿轮519。齿轮519的齿被配置为接合齿条517。齿条517延伸穿过管壳513中的对应形状的纵向布置的开口。在齿条517的近侧端的孔口被配置为容纳铰接轴525的远侧端并通过夹子521保持在相对其的位置上。
如上所述,图4(b)为图示了根据图3(f)所示的实施例的远侧组件的铰接组件部分的分解立体图。图4(b)图示了被配置为接合启动输入斜齿轮533的启动弹簧531。启动输入斜齿轮533被配置为延伸穿过筒壳联接件535中纵向布置的开口并在其近侧端具有斜齿轮5331。此外,夹紧螺丝轴537也延伸穿过筒壳联接件535中纵向布置的开口。相对于夹紧螺丝轴537向近侧布置的是外空转齿轮539。外空转齿轮539包括纵向布置的孔,夹紧螺丝轴537的近侧端被配置为延伸穿过该纵向布置的孔。外空转齿轮539还包括外周齿轮齿。
图4(b)还图示了组合斜/正齿轮部件541。组合斜/正齿轮部件541被配置为在筒壳联接件535中对应的定尺寸和形状的孔口中可旋转地安装在其远侧端5411处。此外,组合斜/正齿轮部件541沿着其中间区包括具有外周齿的正齿轮5412。外空转齿轮539的外周齿被配置为与组合斜/正齿轮部件541的正齿轮5412的外周齿啮合。而且,组合斜/正齿轮部件541在其近侧端包括斜齿轮5413。
图4(b)还图示了远侧枢转壳体543。远侧枢转壳体543在其近侧端具有一对垂直对齐的孔5431。而且,在组合斜/正齿轮部件541的远侧端处的斜齿轮5413、外空转齿轮539和在启动输入斜部件533的远侧端处的斜齿轮5331分别被配置为存在于远侧枢转壳体543的相应的纵向布置的孔口中。此外,远侧枢转壳体543包括一对纵向布置的孔口,每个纵向布置的孔口被配置为容纳一对螺杆545a、545b中相应的一个。
远侧枢转壳体543在其远侧端具有适当形状的凹槽以容纳一部分远侧铰接齿轮547。远侧铰接齿轮547限定了中央孔口和外周齿轮齿,中央孔口和外周齿轮齿绕远侧铰接齿轮547的至少一部分外周延伸。一对空转斜齿轮549a、549b被布置在远侧铰接齿轮的相应的相反上和下表面上。一对空转斜齿轮549a、549b中的每一个包括中央布置的孔口,该孔口被配置为与远侧铰接齿轮547的中央布置的孔口对齐。铰链销551被配置为容纳于近侧枢转壳体503的远侧端处的一对垂直对齐的孔5031中、远侧枢转壳体543的近侧端处的一对垂直对齐的孔5431中、一对空转斜齿轮549a、549b中的每一个的相应的中央布置的孔口中以及远侧铰接齿轮547的中央布置的孔口中。
如上所述,图4(c)为图示了根据图3(f)所示的实施例的远侧组件的远侧部分的分解立体图。图4(c)图示了第一钳夹50和第二钳夹80。第一钳夹50的近侧部包括沿着第一钳夹50的近侧部的侧表面延伸的第一凹槽552。而且,第一钳夹50的近侧部包括沿着第一钳夹50的近侧部的顶表面延伸的第二凹槽556。此外,第二钳夹80的近侧部被定尺寸和形状为使得第二钳夹的近侧部可配合在第一钳夹50的第二凹槽556内,以使得第二钳夹80的近侧部存在于第一钳夹50的近侧部内。此外,第二钳夹的近侧部包括凹槽554。
内部轴555被配置为配合在第一钳夹50的第一凹槽552和第二钳夹80的凹槽554内并在相对于第一钳夹50的第一凹槽552和第二钳夹80的凹槽554在大体远侧和近侧方向上可移动。内部轴555包括螺纹孔,该螺纹孔从第一圆周表面通过其径向地延伸到相反的圆周表面上。夹紧螺丝559被配置为容纳于第二钳夹80的近侧端的纵向布置的孔口内。内部轴555的螺纹孔被配置为容纳夹紧螺丝559的螺纹远侧端。夹紧螺丝559在其近侧端还包括纵向布置的孔口,该孔口被适当地定尺寸和形状为使得容纳对应尺寸和形状的夹紧螺丝轴537的远侧端。
图4(c)还图示了启动轴557。启动轴557的远侧端包括纵向布置的孔口,该孔口被适当地定尺寸和形状为使得容纳对应尺寸和形状的例如从第二钳夹80的近侧端向远侧端延伸的切割和缝合元件104的螺纹驱动轴(未图示)的近侧端。启动轴557的近侧端比其远侧端具有更小的直径,并被配置为沿纵向容纳于弹簧531内。而且,启动轴557的近侧端具有横截面尺寸和形状,其适合于在启动输入斜齿轮533的远侧端处容纳于对应尺寸和形状的纵向布置的孔中。一对螺母563a、563b被配置为接合螺杆545a,545b中相应的一个,每个螺杆延伸穿过远侧枢转壳体543的一对纵向布置的孔口中相应的一个,并穿过第二钳夹80的一对纵向布置的孔口中相应的一个。
图4(d)为装配时的手术器械11的远侧组件的侧视立体图,该图的一部分是截面图,其示出了根据图3(f)所示的实施例的手术器械11被配置为铰接的区域的另外的细节。例如,图4(d)图示了通过铰链销551连接到远侧枢转壳体543(虚线)的近侧枢转壳体503(也为虚线),该铰链销551延伸穿过远侧枢转壳体503的垂直对齐的孔口5031和远侧枢转壳体543的垂直对齐的孔口5431。铰链销551也插入穿过远侧铰接齿轮547的中央孔口,并穿过布置在远侧铰接齿轮547的相应的相反上和下表面上的一对空转斜齿轮549a、549b的中央布置的孔口。
夹具轴527向远侧延伸并延伸穿过管壳523的纵向布置的开口、穿过斜推块509和滚珠轴承507a的纵向布置的孔,并接合输入斜齿轮505a的近侧端处的纵向布置的孔口。输入斜齿轮505a的齿轮齿与上空转斜齿轮549a的齿轮齿啮合。也与上空转斜齿轮549a的齿轮齿啮合的是组合斜/正齿轮部件541的斜齿轮5413的齿轮齿。组合斜/正齿轮部件541在其远侧端5411处可旋转地安装。此外,组合斜/正齿轮部件541的正齿轮5412的外周齿与安装在夹紧螺丝轴537上的外空转齿轮539的外周齿啮合。
启动轴529向远侧延伸并延伸穿过管壳523的纵向布置的开口、穿过斜推块511和滚珠轴承507b的纵向布置的孔,并接合输入斜齿轮505b的近侧端处的纵向布置的孔口。输入斜齿轮505b的齿轮齿与下空转斜齿轮549b的齿轮齿啮合。也与下空转斜齿轮549b的齿轮齿啮合的是启动输入斜齿轮533的斜齿轮5331的齿轮齿。启动输入斜齿轮533向远侧延伸到启动轴557。
铰接轴525也向远侧延伸并延伸穿过管壳523的纵向布置的开口。通过夹子521安装到铰接轴525的远侧端的是齿条537,齿条537的齿与齿轮519的外周齿接合。齿轮519被定位在近侧铰接齿轮515的上表面上,并且可旋转地安装在铰接推力销513上。近侧铰接齿轮515的外周齿轮齿与远侧铰接齿轮547的外周齿轮齿啮合。远侧铰接齿轮547相对于远侧枢转壳体543可旋转地固定。
如上所述,手术器械11还可包括切割及缝合元件104。在一种实施例中,切割及缝合元件104是缝钉筒。图4(e)是可更换缝钉筒2600的分解图。可更换缝钉筒2600是一种缝合/切割装置,该缝合/切割装置可用作例如图3(a)至3(e)中示出的本发明示例性实施例中的切割及缝合元件104。可更换缝钉筒2600包括缝钉盘2604。缝钉盘2604具有位于其近侧端2604d处的凹槽2604i,存储模块6041由存储模块保持器6042保持在凹槽2604i中。存储模块6041可以存储例如以下专利文献中所述的信息:2000年11月28日提交的美国专利申请第09/723,715号-已于2004年9月21日公布为美国专利第6,793,652号、2001年4月17日提交的美国专利申请第09/836,781号、2001年6月22日提交的美国专利申请第09/887,789号以及2002年3月15日提交的美国专利申请第10/099,634号,每份所述专利文献的全部内容通过引用明确地结合到本文中。楔件驱动器2605被配置为以可旋转方式穿过缝钉盘2604的中央通道2604e。具体而言,楔件驱动器2605具有远侧端2605a,远侧端2605a被配置为以可旋转方式安装在缝钉盘2604的远侧孔口2604a内。楔件驱动器2605还包括外螺纹区域2605b、以可旋转方式延伸穿过缝钉盘2604的近侧端2604b中的近侧孔口2604b的非螺纹部分2605c、以及位于楔件驱动器2605最近侧端处的朝向近侧的开口2605d,朝向近侧的开口2605d用于容纳夹紧螺丝559的远侧端。朝向近侧的开口2605d和夹紧螺丝559的远侧端适于当夹紧螺丝559的远侧端容纳于-例如插入在朝向近侧的开口2605d内时以不可旋转的方式相互联接。
可更换缝钉筒2600还包括具有内螺纹孔2603a的楔件2603。楔件驱动器2605的外螺纹区域2605b被配置为延伸穿过楔件2603的内螺纹孔2603a。楔件2603的内螺纹孔2603a的螺纹与楔件驱动器2605的外螺纹区域2605b的螺纹相匹配。如下文将要论述的,当楔件驱动器2605旋转时,楔件2603在缝钉盘2604的远侧端2604c与缝钉盘2604的近侧端2604d之间移动穿过中央通道2604e。
缝钉盘2604还包括位于中央通道2604e的相对壁2604g上的竖向设置的多个凹槽2604f。在中央通道2604e的每一侧上,缝钉推动器2607被配置为以可滑动方式设置在凹槽2604f内。更具体地,每个缝钉推动器2607具有沿纵向在缝钉推动指2607c的两行2607b之间行进的顶表面2607a。缝钉推动指2607c被配置为使得抵靠缝钉盘2604的壁2604g的行2607b中的每个缝钉推动指2607c保持在壁2604g的相应的凹槽2604f内,从而能够在凹槽2604f中沿竖向滑动。缝钉推动指2607c定位在缝钉盘2604中的凹槽2604h上方。缝钉盘2604中的凹槽2604h容纳多个紧固件-例如缝钉2606。每个缝钉2606包括根部2606a和一对延伸部2606b。
楔件2603还包括以可滑动方式与缝钉推动器2607的相应的顶表面2607a接合的一对倾斜边缘2603b。当楔件2603从缝钉盘2604的远侧端2604c到缝钉盘2604的近侧端2604d移动穿过中央通道2604e时,楔件2603的该对倾斜边缘2603b被配置为以可滑动方式接合缝钉推动器2607的相应的顶表面2607a,以使得连续推动缝钉推动器2607的缝钉推动指2607c进入缝钉盘2604中的凹槽2604h中并因此将缝钉2606从缝钉盘2604上的凹槽2604h中推出。筒顶2611被配置为配合在缝钉盘2604的中央通道2604a上方,而缝钉保持器2610被配置为覆盖缝钉盘2604的夹紧表面106。下文将结合图3(g)描述缝钉筒2600的附加特征-例如刀片51,这些特征将在手术器械11工作的过程中描述。
图4(f)为第一钳夹50的仰视图。第一钳夹50包括具有沿纵向设置的凹槽2701的砧构件2700,凹槽2701从砧构件2700的远侧端延伸到近侧端。凹槽2701与第二钳夹80的刀片51对齐,从而刀片51延伸到凹槽2701内并且当刀片从第二钳夹80的远侧端80a移动到近侧端80b时沿凹槽701行进。砧构件2700还包括缝钉导向件2703的多个行2702。缝钉导向件2703被配置为接收缝钉2606的延伸部2606b并使延伸部2606b弯曲从而使缝钉2606闭合。当手术器械11处于闭合位置时,缝钉导向件2703的行2702与第二钳夹80中的缝钉盘2604的凹槽2604h对齐。
如上所述,依照其各个实施例的本发明的手术器械11可被配置为在手术过程期间选择并且之后执行不同的功能。下面说明的是可采用手术器械11的示例性过程。
在操作过程中,钳夹部11a保持在初始位置,在初始位置处钳夹部11a与轴部11b沿轴向对齐,例如图3(b)中示出的位置。在该位置时,手术器械11可以例如通过套管针插入手术部位。根据切口以及待夹紧、缝合和切割的组织的位置,使用者随后可以操作手术器械11。
一旦手术器械11已经插入在患者内,轴部11b可被旋转,例如,轴部11b可相对于并绕手柄1103的纵轴线D旋转。当然,应当认识到,在此处所述的实施例中,轴部11b相对于手柄1103的旋转也使得相对于轴部11b布置在远侧的钳夹部11a旋转。在其它的实施例中,旋转可通过钳夹部11a相对于并绕轴部11b的纵轴线旋转来获得,或者,在钳夹部11a直接联接到手柄1103的一个实施例中,通过钳夹部11a相对于并绕手柄1103的纵轴线旋转来获得。为了本申请的目的,"轴部"是指相对于手柄位于远侧的手术器械的部件的任意部分。
为了实现该第一功能,手术器械11可被操作为使得功能选择器模块1110移动到第一功能位置。如上所述,在该第一功能位置,功能选择器模块1110使得第二可旋转驱动轴1110b与旋转驱动器202接合。图5(a)为手术器械的手柄1103的侧视立体图,该图的一部分是截面图。特别是,图5(a)图示了根据图3(a)至3(e)所示的实施例的手柄1103的一些部件,其形成旋转驱动器202并用来使手术器械11的轴部相对于并绕手柄1103的纵轴线旋转。
现在参照图5(a)所示,例如通过马达96(如图2(b)所示)等使得第一可旋转驱动轴1110a在如逆时针的方向旋转,(为了简化,这里所有关于旋转方向的标记,如,顺时针或者逆时针,除非另外指出的,指的是从手术器械的近侧端到手术器械11的远侧端的视图;另外,应该理解的是,虽然在下文的内容中对于手术器械11的每个部件包括了不同的旋转方向标记,以执行特定的功能,但由于某些部件可被构造得不同,所以这些方向仅仅是示意性的,例如,螺纹部分可能具有与左侧螺纹相对的右侧螺纹等,以致这里所阐释的旋转方向可能被倒转,以执行相同的下述功能)。由于第一可旋转驱动轴1110a的纵向布置的孔和选择器轴601的近侧端的形状和大小是相对应的,所以第一可旋转驱动轴1110a的逆时针方向旋转使得选择器轴601在逆时针方向旋转。依靠功能选择器块609的螺纹孔内的选择器轴601的螺纹部607的螺纹接合,选择器轴601的逆时针方向旋转使得功能选择器块609移动到最远侧端,如,手柄1103的专用齿轮互相接合的第一位置。要理解的是,虽然通过选择器轴601的旋转可使功能选择器块609移动到例如第一位置的该最远侧端,但在其它各种实施例中,手术器械11可被配置为使功能选择器块609最初处于该第一位置上。
一旦功能选择器块609移动到第一位置,例如马达100(如图2(b)所示)等使得第二可旋转驱动轴1110b在如逆时针的方向旋转。由于第二可旋转驱动轴1110b的纵向布置的孔和功能轴611的近侧端的形状和大小是相对应的,所以第二可旋转驱动轴1110b的逆时针方向旋转使得功能轴611逆时针方向旋转。第二可旋转驱动轴1110b的输入正齿轮619也旋转。由于输入正齿轮619的外周齿轮齿6191与旋转正齿轮623的外周齿轮齿6231之间的接合,输入正齿轮619的逆时针方向旋转使得旋转正齿轮623顺时针方向旋转。
当功能选择器块609处于第一位置时,旋转正齿轮623和旋转正齿轮631与齿轮轴621相接合,使得旋转正齿轮623的顺时针方向旋转引起齿轮轴621的顺时针方向旋转,以及旋转正齿轮631的顺时针方向旋转。依靠旋转正齿轮631的外周齿轮齿6311和旋转正齿轮639的外周齿轮齿6391之间的啮合接合,旋转正齿轮631的顺时针方向旋转使得旋转正齿轮639逆时针方向旋转。
安装在旋转齿轮轴633的末端上的旋转正齿轮639的逆时针方向旋转使得旋转齿轮轴633逆时针方向旋转,以及同样安装在其上的旋转蜗杆齿轮641的逆时针方向旋转。由于旋转蜗杆齿轮641的外周蜗轮齿6411和旋转齿轮643的外周齿轮齿6431之间的接合,旋转蜗杆齿轮641的逆时针方向旋转使得旋转齿轮643绕着垂直于旋转齿轮轴633的纵轴线的枢转轴线顺时针方向旋转(当向纸页中看时)。同样地,旋转齿轮643的顺时针方向旋转使得安装于其上的旋转等径伞齿轮644顺时针方向旋转。旋转等径伞齿轮644的等径伞齿轮齿6441与旋转等径伞齿轮669的等径伞齿轮齿6691接合,以使旋转等径伞齿轮644的顺时针方向旋转引起旋转等径伞齿轮669逆时针方向旋转。
旋转等径伞齿轮669安装在第二旋转齿轮轴665上,以使旋转等径伞齿轮669的逆时针方向旋转引起第二旋转齿轮轴665的逆时针方向旋转,以及旋转正齿轮673的逆时针方向旋转。由于旋转正齿轮673的外周齿轮齿6731与旋转管状正齿轮679的外周齿轮齿6791相接合,旋转正齿轮673的逆时针方向旋转使得旋转管状正齿轮679顺时针方向旋转,以及安装于其上的旋转管677的顺时针旋转。手柄1103的最远侧端的口部675内的旋转管677的旋转提供了移动的第一上述功能,如,使轴部11b绕手柄1103的纵轴线旋转。当然,移动,如,在相反方向上的旋转,也可以通过倒转上述齿轮旋转的方向来完成。
图6(a)是手术器械11的远侧部的另外一个部分的侧视立体图,其中一部分是截面图。特别地,图6(a)示出了根据本发明的一个实施例,手术器械11的轴部11b绕着手柄1103的纵轴线的旋转。
一旦轴部11b已相对于手柄1103旋转,则可以采用手术器械11相对轴部11b移动钳夹部11a,如,使钳夹部11a相对于轴部11b绕轴线B枢转。为了执行这个第二功能,可操作手术器械11以将功能选择器模块1110移动到第二功能位置。如上所述,在这个第二功能位置,功能选择器模块1110使得第二可旋转驱动轴1110b与铰接驱动器201接合。图5(b)是侧视图,部分地剖视出了手术器械的手柄1103。特别地,图5(b)示出了组成铰接驱动器201的手柄1103的一些部件,根据图3(a)到图3(e)所示出的实施例,这些部件行使相对于轴部11b移动(如,铰接)钳夹部11a的功能。图5(b)加粗地示出了铰接驱动器201的一些部件。
参阅图5(b),通过例如马达96(如图2(b)所示)等再次驱动第一可旋转驱动轴1110a在如顺时针的方向旋转。由于第一可旋转驱动轴1110a的纵向布置的孔和选择器轴601的近侧端的形状和大小是相对应的,所以第一可旋转驱动轴1110a的顺时针方向旋转使得选择器轴601在顺时针方向旋转。依靠功能选择器块609的螺纹孔内的选择器轴601的螺纹部607的螺纹接合,选择器轴601的旋转使得功能选择器块609最近地移动到,如,手柄1103的专用齿轮互相接合的第二位置。
一旦将功能选择器块609移动到第二位置,通过例如马达100(如图2(b)所示)等使得第二可旋转驱动轴1110b在如逆时针的方向旋转。由于第二可旋转驱动轴1110b的纵向布置的孔和功能轴611的近侧端的形状和大小是相对应的,所以第二可旋转驱动轴1110b的逆时针方向旋转使得功能轴611逆时针方向旋转。并使得第二可旋转驱动轴1110b的启动正齿轮617也逆时针旋转。依靠输入正齿轮619的外周齿轮齿6191与铰接正齿轮623的外周齿轮齿6231之间的接合,输入正齿轮619的逆时针方向旋转使得铰接正齿轮623顺时针方向旋转。
当功能选择器块609处于第二位置时,旋转正齿轮623和铰接正齿轮629与齿轮轴621相接合,使得旋转正齿轮623的顺时针方向旋转引起齿轮轴621的顺时针方向旋转,以及铰接正齿轮629的顺时针方向旋转。依靠铰接正齿轮629的外周齿轮齿6291和铰接正齿轮687的外周齿轮齿6871之间的啮合,铰接正齿轮629的顺时针方向旋转使得铰接正齿轮687逆时针方向旋转。
安装在铰接齿轮轴685的末端上的铰接正齿轮687的逆时针方向旋转使得铰接齿轮轴685逆时针方向旋转,以及同样安装在其上的铰接蜗杆齿轮689的逆时针方向旋转。依靠铰接蜗杆齿轮689的外周蜗杆齿轮齿6891和铰接齿轮691的外周齿轮齿6911之间的接合,铰接蜗杆齿轮689的逆时针方向旋转使得铰接齿轮691绕着垂直于铰接齿轮轴685的纵轴线的枢轴逆时针方向旋转(当向纸页中看时)。同样地,铰接齿轮691的逆时针方向旋转使得安装于其上的铰接等径伞齿轮692逆时针方向旋转。铰接等径伞齿轮692的等径伞齿轮齿6921与铰接等径伞齿轮696的等径伞齿轮齿6961接合,以使铰接等径伞齿轮692的逆时针方向旋转引起铰接等径伞齿轮696逆时针方向旋转。
铰接等径伞齿轮696安装在第二铰接齿轮轴693上。依靠第二铰接齿轮轴693的螺杆部695与铰接等径伞齿轮696的内螺纹孔之间的螺纹接合,铰接等径伞齿轮696的逆时针方向旋转使得第二铰接齿轮轴693移动,如,向远侧端移动(取决于第二铰接齿轮轴693的螺纹的方向)。
图6(b)是手术器械11的远侧部的另外一个部分的侧视图,其中一部分是截面图。特别地,图6(b)示出了根据图3(f)和图4(d)所示的实施例,手术装置11的附加部件,上述附加部件执行了相对于轴部11b移动(例如,以铰接方式)移动钳夹部11a。图6(b)以粗线示出了一些铰接驱动器201的部件。
如图6(b)所示,铰接轴525向远侧方向移动使得齿条517也向远侧方向移动。依靠齿条517的齿与齿轮519的齿之间的接合,齿条517向远侧方向移动使得齿轮519和近侧端铰接齿轮515顺时针方向旋转(当从上看时)。另外,依靠近侧铰接齿轮515的外周齿与远侧铰接齿轮547的外周齿之间的接合,近侧铰接齿轮515顺时针方向旋转使得远侧铰接齿轮547逆时针方向旋转。由于远侧铰接齿轮547相对于远侧枢轴壳体543旋转地固定,所以远侧铰接齿轮547的逆时针方向旋转使得钳夹部11a绕铰接销551相对于轴部11b在逆时针方向(当从上方看时)移动,例如,以铰接方式移动,在这个示例性实施例中,铰接销551限定图2(b)中的轴线B。当然,在相反方向的移动,例如,以铰接方式移动,也可以通过倒转上述齿轮被旋转的方向来完成。
一旦钳夹部11a相对于轴部11b绕轴线B以铰接方式移动,钳夹部50、钳夹部80可以被移动(例如打开),从而使得组织的一部分位于钳夹部50和钳夹部80之间。为了执行这个第三功能,可以操作手术器械11从而将功能选择器模块1110移动到第三功能位置。如上所述,在这个第三功能位置,功能选择器模块1110使得第二可旋转驱动轴1110b与夹紧驱动器88接合。图5(c)是侧视图,部分地剖视出了手术器械11的手柄1103。特别地,图5(c)示出了组成夹紧驱动器88的手柄1103的一些部件,根据图3(a)到图3(e)所示出的实施例,这些部件行使相对于第二钳夹80移动(如,打开)第一钳夹50的功能。图5(c)以粗线示出了夹紧驱动器88的这些部件。
参阅图5(c),通过例如马达96(如图2(b)所示)等再次驱动第一可旋转驱动轴1110a在如顺时针的方向旋转。由于第一可旋转驱动轴1110a的纵向布置的孔和选择器轴601的近侧端的形状和大小是相对应的,所以第一可旋转驱动轴1110a的顺时针方向旋转使得选择器轴601在顺时针方向旋转。依靠功能选择器块609的螺纹孔内的选择器轴601的螺纹部607的螺纹接合,选择轴601的旋转使得功能选择器块609向近侧端方向移动到,如,手柄1103的专用齿轮互相接合的第三位置。
一旦将功能选择器块609移动到第三位置,通过例如马达100(如图2(b)所示)等使得第二可旋转驱动轴1110b在如逆时针的方向旋转。由于第二可旋转驱动轴1110b的纵向布置的孔和功能轴611的近侧端的形状和大小是相对应的,所以第二可旋转驱动轴1110b的逆时针方向旋转使得功能轴611逆时针方向旋转。并使得第二可旋转驱动轴1110b的输入正齿轮619也逆时针旋转。由于输入正齿轮619的外周齿轮齿6191与旋转正齿轮623的外周齿轮齿6231之间的接合,输入正齿轮619的逆时针方向旋转使得旋转正齿轮623顺时针方向旋转。
当功能选择器块609处于第三位置时,旋转正齿轮623和夹紧正齿轮627与齿轮轴621相接合,使得旋转正齿轮623的顺时针方向旋转引起齿轮轴621的顺时针方向旋转,以及夹紧正齿轮627的顺时针方向旋转。依靠夹紧正齿轮627的外周齿轮齿6271和夹紧正齿轮655的外周齿轮齿6551之间的啮合,夹紧正齿轮627的顺时针方向旋转使得夹紧正齿轮655逆时针方向旋转。夹紧正齿轮655安装在夹紧齿轮轴651的一个末端,夹紧齿轮轴651的另一个末端上安装有第一夹紧等径伞齿轮657,以使夹紧正齿轮655的逆时针方向旋转也引起夹紧齿轮轴651逆时针方向旋转以及第一夹紧等径伞齿轮657的逆时针方向旋转。
第一夹紧等径伞齿轮657的等径伞齿轮齿6571和第二夹紧等径伞齿轮659的等径伞齿轮齿6591接合,使得第一夹紧等径伞齿轮657的逆时针方向旋转引起第二夹紧等径伞齿轮659绕着垂直于夹紧齿轮轴651的纵轴线的轴逆时针方向旋转(当向纸页中看时)。同样地,第二夹紧等径伞齿轮659的等径伞齿轮齿6591与第三夹紧等径伞齿轮661的等径伞齿轮齿6611接合,使得第二夹紧等径伞齿轮659的逆时针方向旋转引起第三夹紧等径伞齿轮661的顺时针方向旋转。第三夹紧等径伞齿轮661安装在第二夹紧齿轮轴681的近侧端,使得第三夹紧等径伞齿轮661的顺时针方向旋转引起第二夹紧齿轮轴681顺时针方向旋转。
图6(c)是手术器械11的远侧部的另外一个部分的侧视立体图,其中一部分是截面图。特别地,图6(c)示出了根据图3(f)和图4(d)所示的实施例的手术装置11的附加部件,上述附加部件执行了相对于第二钳夹部80移动(例如,打开)第一钳夹部50。图6(c)以粗线示出了这些夹紧驱动器88的部件。
如上所述,第二夹紧齿轮轴681向远侧延伸穿过旋转管677,最终形成夹紧轴527。夹紧轴527的顺时针方向旋转使得输入斜齿轮505a顺时针方向旋转。依靠输入斜齿轮505a的齿轮齿与上空转斜齿轮549a的齿轮齿之间的接合,输入斜齿轮505a绕夹紧轴527的纵轴线的顺时针方向旋转使得上空转斜齿轮549a顺时针方向旋转(当从上看时)。同样地,依靠上空转斜齿轮549a的齿轮齿与组合斜/正齿轮部件541的斜齿轮5413的齿轮齿之间的啮合,上空转斜齿轮549a绕铰接销551的纵轴线的顺时针方向旋转使得组合斜/正齿轮部件541的斜齿轮5413随着安装在组合斜/正齿轮部件541上的正齿轮的逆时针方向旋转而逆时针方向旋转。由于组合斜/正齿轮部件541的正齿轮的外周齿轮齿与外空转齿轮539的外周齿轮齿相啮合,组合斜/正齿轮部件541的正齿轮的逆时针方向旋转使得外空转齿轮539顺时针方向旋转以及夹紧螺杆轴537的逆时针方向旋转,外空转齿轮539安装在夹紧螺杆轴537上。
参阅图4(c),安装在夹紧螺杆轴537的远侧端上的夹紧螺钉559,也沿逆时针方向转动。内轴555与夹紧螺钉559的外螺纹螺纹接合,使得夹紧螺钉559的逆时针方向旋转引起内轴555分别在第一钳夹50和第二钳夹80的凹槽552和554内在近侧方向上移动。内轴555的这个近侧移动允许第一钳夹和第二钳夹相对于彼此移动,例如打开。在例如2005年7月27日提交的公布号为11/191,851,名称为“手术器械”的美国专利公布中可以找到这种夹紧机构的其它细节,将上述文献的全部内容并入到此处作为引用。
一旦第一钳夹50和第二钳夹80相对于彼此打开到期望的位置,并一旦待操作的一部分组织被满意地置于手术器械11的第一钳夹50和第二钳夹80之间,闭合第一钳夹50和第二钳夹80以夹紧其间的部分组织。
为了使第一钳夹50和第二钳夹80相对于彼此闭合,功能选择器模块1110可以保持在第三功能位置。如上所述,在这个第三功能位置,功能选择器模块1110使得第二可旋转驱动轴1110b与夹紧驱动器88接合。
参阅图5(c),借助于在第三位置上的功能选择器块609,通过例如马达100(如图2(b)所示)等使得第二可旋转驱动轴1110b在如顺时针的方向旋转。由于第二可旋转驱动轴1110b的纵向布置的孔和功能轴611的近侧端的形状和大小是相对应的,所以第二可旋转驱动轴1110b的顺时针方向旋转使得功能轴611顺时针方向旋转。并使得第二可旋转驱动轴1110b的输入正齿轮619也顺时针旋转。由于输入正齿轮619的外周齿轮齿6191与旋转正齿轮623的外周齿轮齿6231之间的接合,输入正齿轮619的顺时针方向旋转使得旋转正齿轮623逆时针方向旋转。
此外,当功能选择器块609处于第三位置,旋转正齿轮623和夹紧正齿轮627与齿轮轴621相接合,使得旋转正齿轮623的逆时针方向旋转引起齿轮轴621的逆时针方向旋转,以及夹紧正齿轮627的逆时针方向旋转。依靠夹紧正齿轮627的外周齿轮齿6271和夹紧正齿轮655的外周齿轮齿6551之间的啮合,夹紧正齿轮627的逆时针方向旋转使得夹紧正齿轮655顺时针方向旋转。夹紧正齿轮655安装在夹紧齿轮轴651的一个末端,夹紧齿轮轴651的另一个末端上安装有第一夹紧等径伞齿轮657,以使夹紧正齿轮655的顺时针方向旋转也引起夹紧齿轮轴651顺时针方向旋转以及第一夹紧等径伞齿轮657的顺时针方向旋转。
第一夹紧等径伞齿轮657的等径伞齿轮齿6571和第二夹紧等径伞齿轮659的等径伞齿轮齿6591接合,使得第一夹紧等径伞齿轮657的顺时针方向旋转引起第二夹紧等径伞齿轮659绕着垂直于夹紧齿轮轴651的纵轴线的轴顺时针方向旋转(当向纸页中看时)。同样地,第二夹紧等径伞齿轮659的等径伞齿轮齿6591与第三夹紧等径伞齿轮661的等径伞齿轮齿6611接合,使得第二夹紧等径伞齿轮659的顺时针方向旋转引起第三夹紧等径伞齿轮661的逆时针方向旋转。第三夹紧等径伞齿轮661安装在第二夹紧齿轮轴681的近侧端,使得第三夹紧等径伞齿轮661的逆时针方向旋转引起第二夹紧齿轮轴681逆时针方向旋转。
接下来参阅图6(c),夹紧轴527的逆时针方向旋转使得输入斜齿轮505a逆时针方向旋转。依靠输入斜齿轮505a的齿轮齿与上空转斜齿轮549a的齿轮齿之间的啮合,输入斜齿轮505a绕夹紧轴527的纵轴线的逆时针方向旋转使得上空转斜齿轮549a逆时针方向旋转(当从上看时)。同样地,依靠上空转斜齿轮549a的齿轮齿与组合斜/正齿轮部件541的斜齿轮5413的齿轮齿之间的啮合,上空转斜齿轮549a绕铰接销551的纵轴线的逆时针方向旋转使得组合斜/正齿轮部件541的斜齿轮5413随着安装在组合斜/正齿轮部件541上的正齿轮的顺时针方向旋转而顺时针方向旋转。由于组合斜/正齿轮部件541的正齿轮的外周齿轮齿与外空转齿轮539的外周齿轮齿相啮合,组合斜/正齿轮部件541的正齿轮的顺时针方向旋转使得外空转齿轮539逆时针方向旋转以及夹紧螺杆轴537的逆时针方向旋转,外空转齿轮539安装在夹紧螺杆轴537上。
现在参阅图4(c),安装在夹紧螺杆轴537远侧端上的夹紧螺钉559,也沿逆时针方向转动。内轴555与夹紧螺钉559的外螺纹螺纹接合,使得夹紧螺钉559的逆时针方向旋转引起内轴555分别在第一钳夹50和第二钳夹80的凹槽552和554内在远侧方向上移动。内轴555的这个远侧移动允许第一钳夹50和第二钳夹80相对于彼此移动,例如闭合。
一旦一部分组织被夹紧在第一钳夹50和第二钳夹80之间,这部分组织可以被切割和/或缝合。应当认识到,虽然本发明举例为同时使用切割和缝合元件,但手术器械11可仅采用一种元件,或者可以采用另一种类型的手术器具。
在将手术器械11插入患者体内之前,在第二钳夹80内设置了缝钉筒578。在一个实施例中,手术器械11是一次使用器械,在手术器械11中缝钉筒与第二钳夹80整体形成。替代性地,手术器械11可具有可更换的缝钉筒,例如,图4(e)中所示出的可更换缝钉筒600,从而允许手术器械11多次与不同的缝钉筒结合使用。在这个实施例中,如果手术器械11是被首次使用,则在制造和组装手术器械11的过程中,可预先安装缝钉筒600,或者在使用手术器械11之前由用户安装。如果第二次或更多次使用手术器械11,则在使用手术器械11之前可以由用户安装。当缝钉筒600插入第二钳夹80中,启动轴557的远侧端被接收在楔件驱动器605的面向近侧的开口605d内。
为了说明手术器械11的切割/缝合操作,首先参照图5(d)。借助安装在手术器械11的第二钳夹80内的缝钉筒600,可以操作手术器械11以将功能选择器模块1110移动到第四功能位置。如上所述,在这个第四位置,功能选择器模块1110使得第二可旋转驱动轴1110b与启动驱动器98接合。图5(d)是侧视图,部分剖视出了手术器械11的手柄1103。特别地,图5(d)示出了根据图3(a)到图3(e)所示的实施例中,形成启动驱动器98的手柄1103的一些部件,所述部件行使移动切割和/或缝合元件的功能,如驱动缝钉推动元件和/或切割刀片通过组织部分。图5(d)以粗线示出了启动驱动器98的这些组成部件中的一些。
参阅图5(d),通过例如马达96(如图2(b)所示)等再次驱动第一可旋转驱动轴1110a在如顺时针的方向旋转。由于第一可旋转驱动轴1110a的纵向布置的孔和选择器轴601的近侧末端的形状和大小是相对应的,所以第一可旋转驱动轴1110a的顺时针方向旋转使得选择器轴601在顺时针方向旋转。依靠功能选择器块609的螺纹孔内的选择器轴601的螺纹部607的螺纹接合,选择器轴601的顺时针方向旋转使得功能选择器块609向近侧端方向移动到,如,手柄1103的专用齿轮互相接合的第四位置。
一旦移动功能选择器块609到第四位置,通过例如马达100(如图2(b)所示)等使得第二可旋转驱动轴1110b在如逆时针的方向旋转。由于第二可旋转驱动轴1110b的纵向布置的孔和功能轴611的近侧端的形状和大小是相对应的,所以第二可旋转驱动轴1110b的逆时针方向旋转使得功能轴611逆时针方向旋转。并使得第二可旋转驱动轴1110b的输入正齿轮619和启动正齿轮617也沿逆时针方向旋转。由于启动正齿轮617的外周齿轮齿6171与启动正齿轮625的外周齿轮齿6251之间的接合,启动正齿轮617的逆时针方向旋转使得启动正齿轮625顺时针方向旋转。同样地,由于输入正齿轮619的外周齿轮齿6191与旋转正齿轮623的外周齿轮齿6231之间的接合,输入正齿轮619的逆时针方向旋转使得旋转正齿轮623顺时针方向旋转。此外,由于启动正齿轮617的外周齿轮齿6171与启动正齿轮608的外周齿轮齿6081之间的接合,启动正齿轮617的逆时针方向旋转使得启动正齿轮608顺时针方向旋转。
启动正齿轮608安装在启动齿轮轴604的一个末端,启动齿轮轴604的另一个末端上安装有第一启动等径伞齿轮610,以使启动正齿轮608的顺时针方向旋转也引起启动齿轮轴604顺时针方向旋转以及第一启动等径伞齿轮610的顺时针方向旋转。
第一启动等径伞齿轮610的等径伞齿轮齿6101和第二启动等径伞齿轮612的等径伞齿轮齿6121接合,使得第一启动等径伞齿轮610的顺时针方向旋转引起第二启动等径伞齿轮612绕着垂直于启动齿轮轴604的纵轴线的轴顺时针方向旋转(当向纸页中看时)。同样地,第二启动等径伞齿轮612的等径伞齿轮齿6121与第三启动等径伞齿轮614的等径伞齿轮齿6141接合,使得第二启动等径伞齿轮612的顺时针方向旋转引起第三启动等径伞齿轮614的逆时针方向旋转。第三启动等径伞齿轮614安装在第二启动齿轮轴618的近侧端,使得第三启动等径伞齿轮614的逆时针方向旋转引起第二启动齿轮轴618逆时针方向旋转。
图6(d)是手术器械11的远侧端的另外一部分的侧视图,其中一部分是截面图。特别地,图6(d)示出了根据图3(f)和图4(d)所示的实施例手术器械11的其它部件,上述部件行使移动切割和/或缝合元件的功能,如驱动缝钉推动元件和/或切割刀片通过组织部分。图6(d)以粗线示出了启动驱动器98的这些组成部件中的一些。
如上所述,第二启动齿轮轴618向远侧端延伸穿过旋转管677,最终形成启动轴529。启动轴527的逆时针方向旋转使得输入斜齿轮505b逆时针方向旋转。依靠输入斜齿轮505b的齿轮齿与下空转斜齿轮549b的齿轮齿之间的啮合,输入斜齿轮505b绕启动轴529的纵轴线的逆时针方向旋转使得下空转斜齿轮549b绕铰接销551的纵轴线顺时针方向旋转(当从上看时)。同样地,依靠下空转斜齿轮549b的齿轮齿与启动输入斜齿轮533的齿轮齿之间的啮合,下空转斜齿轮549b绕铰接销551的纵轴线的顺时针方向旋转使得启动输入斜齿轮533顺时针方向旋转。由于启动输入斜齿轮533不可旋转地接合到启动轴557的近侧端,启动输入斜齿轮533的顺时针方向旋转使得启动轴557顺时针方向旋转。
为了进一步示出手术器械11的切割/缝合操作,接下来参阅图5(e)。图5(e)是根据本发明一种实施方式的手术器械11处于完全闭合位置的截面图。在图5(e)中,手术器械11示出为第一钳夹50和第二钳夹80的夹紧表面106、108之间不存在组织部分。
如图5(e)所示,手术器械11设置在第二钳夹80内,并且切割及缝合元件104包括图5(e)中的可更换缝钉筒2600,可更换缝钉筒2600能够以可更换方式安装在第二钳夹80内。可更换缝钉筒2600在图4(e)中以分解图示出,在图5(e)中示出为组装起来并安装在第二钳夹80内。
如图5(e)所示,楔件2603上设置有具有切割边缘51a的刀片51。替代性地,切割及缝合元件可单独设置。在图5(e)中示出的示例性实施方式中,刀片51具有尾部区域2654,尾部区域2654具有接触面2653。刀片51绕销51b以可旋转方式联接到楔件2603,以使刀片51能够在第一位置和第二位置之间旋转。图5(e)示出当楔件2603和刀片51从缝钉盘2604的远侧端2604c移动到近侧端2604d时处于若干位置的楔件2603和刀片51,所述位置标示为位置A至E。
在标示为A的位置处,楔件2603和刀片51位于缝钉盘2604的远侧端2604c处。在标示为A的位置处,楔件2603和刀片51容纳在壳体2615内,并且刀片51相对于楔件2603旋转以便处于缩回位置-例如切割边缘51a面向上并且不暴露在外。接触面2653最初面向缝钉盘2604的近侧端2604d。
在操作中,楔件驱动器2605的顺时针方向旋转(由楔件驱动器2605与启动轴557的远侧端之间的接合所引起,在上文描述中启动轴557也是顺时针方向旋转)使得楔件2603和刀片51推进到标示为B的位置上。在标示为B的位置处,楔件2603和刀片51相对于缝钉盘2604的远侧端2604c位于近侧。具体而言,在标示为B的位置处,楔件2603和刀片51定位成使得刀片51的接触面2653开始接触壳体2615的致动唇缘2615a。当刀片51的接触面2653开始接触壳体2615的致动唇缘615a时,刀片51开始相对于楔件2603旋转。
经由启动轴557的远侧端,楔件驱动器2605的进一步旋转使得楔件2603和刀片51推进到标示为C的位置上。在标示为C的位置处,楔件2603和刀片51仍然相对于缝钉盘2604的远侧端2604c位于近侧。具体而言,在标示为C的位置处,楔件2603和刀片51定位成使得刀片51的接触面2653充分接触壳体2615的致动唇缘2615a。当刀片51的接触面2653充分接触壳体2615的致动唇缘2615a时,刀片51相对于楔件2603充分旋转,从而使得刀片51的切割边缘51a处于伸展位置-例如切割边缘51a面向缝钉盘2604的近侧端2604d。
经由启动轴557的远侧端,楔件驱动器2605的进一步旋转使得楔件2603和刀片51推进到标示为D的位置上。在标示为D的位置处,楔件2603和刀片51大致位于缝钉盘2604的远侧端2604c和近侧端2604d之间的中间点处。在标示为D的位置处,刀片51被保持在伸展位置,在该伸展位置处切割边缘51a面向缝钉盘2604的近侧端2604d,以便切割夹紧在第一钳夹50和第二钳夹80之间的组织部分(未图示)。
经由启动轴557的远侧端,楔件驱动器2605的进一步旋转使得楔件2603和刀片51推进到标示为E的位置上。在标示为E的位置处,楔件2603和刀片51位于缝钉盘2604的近侧端2604d处。在标示为E的位置处,刀片51仍然保持在伸展位置,切割边缘51a面向缝钉盘2604的近侧端2604d。然而,在此位置,刀片51被包容在壳体2616内,从而使切割边缘51a不暴露在外。
可以在刀片51从第二钳夹80的近侧端80b移动到远侧端80a的同时启动容纳在缝钉盘2604内的缝钉2606。例如,经由启动轴557的远侧端,楔件驱动器2605的旋转使得楔件2603移动穿过缝钉盘2604的中央通道2604e。当楔件2603从缝钉盘2604的远侧端2604c移动到近侧端2604d而穿过中央通道2604e时,楔件2603的一对倾斜边缘2603b以可滑动方式接合缝钉推动器2607的相应的顶表面2607a,并且连续推动缝钉推动器2607的缝钉推动指2607c进入缝钉盘2604中的凹槽2604h并因此将缝钉2606从缝钉盘2604中的凹槽2604h中推出。当手术器械11处于闭合位置时,缝钉导向件2703的行2702与第二钳夹80中的缝钉盘2604的凹槽2604h对齐,从而由缝钉推动器2607的缝钉推动指2607c将保持在缝钉盘2604的凹槽2604h中的缝钉2606推入砧构件2700的相应的缝钉导向件2703内,并由砧构件2700的相应的缝钉导向件2703闭合。当启动手术器械11时,缝钉导向件2703容纳缝钉2606的延伸部2606b并弯折延伸部2606b以便闭合缝钉2606,从而缝合该部分组织。
应当认识到,根据本发明的各种实施例,刀片51和楔件2603可以向近侧或远侧方向移动,以便切割和/或缝合位于第一钳夹50和第二钳夹80之间的组织部分。再者,应当认识到,根据本发明的各种实施例,可以采用构造成使刀片51和楔件2603移动以便切割和/或缝合位于第一钳夹50和第二钳夹80之间的组织部分的任何机械装置。
一旦部分组织可以被切割和/或夹紧,可以采用手术器械11使刀片51和楔件2603回复到其初始位置。当手术器械11采用可更换缝钉筒,例如,如图4(e)所示的可更换缝钉筒600,从而允许手术器械11配合不同缝钉筒而被多次使用时,以上会特别地令人满意。一旦刀片51和楔件2603被移动到其初始位置,就可以第二次或者多次使用手术器械11。为了这样做,用户可以移除使用过的缝钉筒600,并在手术器械11中插入新的缝钉筒600,启动轴557的远侧端容纳于新缝钉筒600的楔件驱动器2605的面向近侧端的开口2605d内。当然,应当认识到,这个使刀片51和楔件2603回复到其初始位置的步骤可以在从患者体内移除手术器械11之前或者之后进行。
为了使楔件2603和刀片51回复到其初始位置,并如图5(d)所示,功能选择器块609可保持在第四位置,在第四位置上手柄1103的专用齿轮互相接合。当功能选择器块609位于第四位置,通过例如马达100(如图2(b)所示)等使得第二可旋转驱动轴1110b在如顺时针的方向旋转。第二可旋转驱动轴1110b的顺时针方向旋转使得功能轴611顺时针方向旋转。并使得第二可旋转驱动轴1110b的输入正齿轮619和启动正齿轮617也顺时针旋转。由于启动正齿轮617的外周齿轮齿6171与启动正齿轮625的外周齿轮齿6251之间的接合,启动正齿轮617的顺时针方向旋转使得启动正齿轮625逆时针方向旋转。同样地,由于输入正齿轮619的外周齿轮齿6191与旋转正齿轮623的外周齿轮齿6231之间的接合,输入正齿轮619的顺时针方向旋转使得旋转正齿轮623逆时针方向旋转。此外,由于启动正齿轮617的外周齿轮齿6171与启动正齿轮608的外周齿轮齿6081之间的接合,启动正齿轮617的顺时针方向旋转使得启动正齿轮608逆时针方向旋转。
启动正齿轮608安装在启动齿轮轴604的一个末端,启动齿轮轴604的另一个末端上安装有第一启动等径伞齿轮610,以使启动正齿轮608的逆时针方向旋转也引起启动齿轮轴604以及第一启动等径伞齿轮610中的每一个逆时针方向旋转。
第一启动等径伞齿轮610的等径伞齿轮齿6101和第二启动等径伞齿轮612的等径伞齿轮齿6121接合,使得第一启动等径伞齿轮610的逆时针方向旋转引起第二启动等径伞齿轮612绕着垂直于启动齿轮轴604的纵轴线的轴逆时针方向旋转(当向纸页中看时)。同样地,第二启动等径伞齿轮612的等径伞齿轮齿6121与第三启动等径伞齿轮614的等径伞齿轮齿6141接合,使得第二启动等径伞齿轮612的逆时针方向旋转引起第三启动等径伞齿轮614的顺时针方向旋转。第三启动等径伞齿轮614安装在第二启动齿轮轴618的近侧端,使得第三启动等径伞齿轮614的顺时针方向旋转引起第二启动齿轮轴618顺时针方向旋转。
参阅图6(d),第二启动齿轮轴618向远侧端延伸穿过旋转管677,最终形成启动轴529。启动轴527的顺时针方向旋转使得输入斜齿轮505b顺时针方向旋转。依靠输入斜齿轮505b的齿轮齿与下空转斜齿轮549b的齿轮齿之间的接合,输入斜齿轮505b绕启动轴529的纵轴线的顺时针方向旋转使得下空转斜齿轮549a绕铰接销551的纵轴线逆时针方向旋转(当从上看时)。同样地,依靠下空转斜齿轮549b的齿轮齿与启动输入斜齿轮533的齿轮齿之间的啮合,下空转斜齿轮549b绕铰接销551的纵轴线的逆时针方向旋转使得启动输入斜齿轮533逆时针方向旋转。由于启动输入斜齿轮533不可旋转地接合到启动轴557的近侧端,启动输入斜齿轮533的逆时针方向旋转使得启动轴557逆时针方向旋转。
参阅图5(e),启动轴557的旋转使得楔件驱动器2605逆时针方向旋转,以使楔件2603和刀片51从缝钉盘2604的近侧端2604d行进到远侧端2604c,直至,当楔件2603和刀片51位于缝钉盘2604的远侧端2604c,例如,标示为位置A的位置,楔件2603和刀片51被再次安放在壳体2615内,刀片51相对于楔件2603旋转,从而处于缩进位置上,例如,切割边缘51a面向上方,刀片不会暴露在外。
一旦楔件2603和刀片51到其初始位置,就可以采用手术器械11使钳夹部11a相对于轴部11b移动,例如,使钳夹部11a相对于轴部11b绕轴线B枢转,以回到其初始的对齐位置,从而达到简化从患者切口移除手术器械的目的。为了执行这个功能,可以操作手术器械11以将功能选择器模块1110回复到第二功能位置。如上所述,在这个第二功能位置上,功能选择器模块1110使得第二可旋转驱动轴1110b与铰接驱动器201接合。
参阅图5(b),通过例如马达96(如图2(b)所示)等再次驱动第一可旋转驱动轴1110a在如逆时针的方向旋转。由于第一可旋转驱动轴1110a的纵向布置的孔和选择器轴601的近侧端的形状和大小是相对应的,所以第一可旋转驱动轴1110a的逆时针方向旋转使得选择器轴601逆时针方向旋转。依靠功能选择器块609的螺纹孔内的选择器轴601的螺纹部607的螺纹接合,选择器轴601的旋转使得功能选择器块609向远侧移动到,如,手柄1103的专用齿轮互相接合的第二位置。
一旦功能选择器块609回到第二位置,则通过例如马达100(如图2(b)所示)等使得第二可旋转驱动轴1110b在如顺时针的方向旋转。由于第二可旋转驱动轴1110b的纵向布置的孔和功能轴611的近侧端的形状和大小是相对应的,所以第二可旋转驱动轴1110b的顺时针方向旋转使得功能轴611顺时针方向旋转。并使得第二可旋转驱动轴1110b的启动正齿轮617也顺时针方向旋转。由于输入正齿轮619的外周齿轮齿6191与铰接正齿轮623的外周齿轮齿6231之间的接合,输入正齿轮619的顺时针方向旋转使得铰接正齿轮623逆时针方向旋转。
当功能选择器块609处于第二位置时,旋转正齿轮623和铰接正齿轮629与齿轮轴621相接合,使得旋转正齿轮623的逆时针方向旋转引起齿轮轴621的逆时针方向旋转,以及铰接正齿轮629的逆时针方向旋转。依靠铰接正齿轮629的外周齿轮齿6291和铰接正齿轮687的外周齿轮齿6871之间的啮合,铰接正齿轮629的逆时针方向旋转使得铰接正齿轮687顺时针方向旋转。
安装在铰接齿轮轴685的末端上的铰接正齿轮687的顺时针方向旋转使得铰接齿轮轴685顺时针方向旋转,以及同样安装在其上的铰接蜗杆齿轮689的顺时针方向旋转。依靠铰接蜗杆齿轮689的外周蜗轮齿6891和铰接齿轮691的外周齿轮齿6911之间的接合,铰接蜗杆齿轮689的顺时针方向旋转使得铰接齿轮691绕着垂直于铰接齿轮轴685的纵轴线的枢轴顺时针方向旋转(当向纸页中看时)。同样地,铰接齿轮691的顺时针方向旋转使得安装于其上的铰接等径伞齿轮692顺时针方向旋转。铰接等径伞齿轮692的铰接等径伞齿轮齿6921与铰接等径伞齿轮696的铰接等径伞齿轮齿6961接合,以使铰接等径伞齿轮692的顺时针方向旋转引起铰接等径伞齿轮696顺时针方向旋转。
铰接等径伞齿轮696安装在第二铰接齿轮轴693上。依靠第二铰接齿轮轴693的螺杆695与铰接等径伞齿轮696的内螺纹孔之间的螺纹接合,铰接等径伞齿轮696的顺时针方向旋转使得第二铰接齿轮轴693移动,如,向近侧端移动(取决于第二铰接齿轮轴693的螺纹的方向)。
如图6(b)所示,第二铰接齿轮轴693和其最终形成的铰接轴525向近侧方向移动使得齿条517也向近侧方向移动。依靠齿条517的齿与齿轮519的齿之间的接合,齿条517向近侧方向移动使得齿轮519和近侧铰接齿轮515逆时针方向旋转(当从上看时)。另外,依靠近侧铰接齿轮515的外周齿与远侧铰接齿轮547的外周齿之间的接合,近侧铰接齿轮515的逆时针方向旋转使得远侧铰接齿轮547顺时针方向旋转。由于远侧铰接齿轮547相对于远侧枢轴壳体543被旋转地固定,远侧铰接齿轮547的顺时针方向旋转使得钳夹部11a绕铰接销551相对于轴部11b顺时针方向(当从上方看时)移动,例如,以铰接方式移动。钳夹部11a相对于相对于轴部11b的这个移动,例如,以铰接方式移动,可持续到钳夹部11a和轴部11b的纵轴线被对齐,从而使从患者切口处移除手术器械11容易。
一旦钳夹部11a和轴部11b的纵轴线被对齐时,可以采用手术器械11使轴部11b相对于手柄1103回复到其初始位置,例如,通过使轴部11b相对于手柄1103绕手柄1103的纵轴线D旋转,直至轴部11b和手柄1103处于其初始位置,例如,相对于彼此对齐的位置。再次地,当手术器械11采用可更换缝钉筒,例如,在图4(e)中示出的可更换缝钉筒600,从而使手术器械11恢复到允许具有不同缝钉筒的手术器械11被多次使用的状况时,以上会特别地令人满意。一旦轴部11b相对于手柄1103被旋转回到其初始位置时,可以第二次或者多次使用手术器械11。当然,应当认识到,这个特别的步骤可以在从患者身体移除手术器械11之前或者之后进行。
为了使轴部11b相对于手柄1103绕手柄1103的纵轴线D旋转,直至轴部11b和手柄1103相对于彼此处于其初始位置,并如图5(d)所示,可以操作手术器械11以使功能选择器模块1110回复到第一功能位置。如上所述,在这个第一功能位置,功能选择器模块1110使得第二可旋转驱动轴1110b与旋转驱动器202接合。
现在参阅图5(a),通过例如马达96(如图2(b)所示)等使得第一可旋转驱动轴1110a在如顺时针的方向旋转。由于第一可旋转驱动轴1110a的纵向布置的孔和选择器轴601的近侧端的形状和大小是相对应的,第一可旋转驱动轴1110a的顺时针方向旋转使得选择器轴601在顺时针方向旋转。依靠功能选择器块609的螺纹孔内的选择器轴601的螺纹部607的螺纹接合,选择器轴601的顺时针方向旋转使得功能选择器块609移动到最远侧端,如,手柄1103的专用齿轮互相接合的第一位置。
一旦功能选择器块609回复到第一位置,通过例如马达100(如图2(b)所示)等使得第二可旋转驱动轴1110b在如顺时针的方向旋转。由于第二可旋转驱动轴1110b的纵向布置的孔和功能轴611的近侧端的形状和大小是相对应的,第二可旋转驱动轴1110b的顺时针方向旋转使得功能轴611顺时针方向旋转。第二可旋转驱动轴1110b的输入正齿轮619也顺时针方向旋转。依靠输入正齿轮619的外周齿轮齿6191与旋转正齿轮623的外周齿轮齿6231之间的接合,输入正齿轮619的顺时针方向旋转使得旋转正齿轮623逆时针方向旋转。
当功能选择器块609处于第一位置时,旋转正齿轮623和旋转正齿轮631与齿轮轴621相接合,使得旋转正齿轮623的逆时针方向旋转引起齿轮轴621的逆时针方向旋转,以及旋转正齿轮631的逆时针方向旋转。依靠旋转正齿轮631的外周齿轮齿6311和旋转正齿轮639的外周齿轮齿6391之间的啮合接合,旋转正齿轮631的逆时针方向旋转使得旋转正齿轮639顺时针方向旋转。
安装在旋转齿轮轴633的末端上的旋转正齿轮639的顺时针方向旋转使得旋转齿轮轴633顺时针方向旋转,以及同样安装于其上的旋转蜗杆齿轮641的顺时针方向旋转。依靠旋转蜗杆齿轮641的外周蜗杆齿轮齿6411和旋转齿轮643的外周齿轮齿6431之间的接合,旋转蜗杆齿轮641的顺时针方向旋转使得旋转齿轮643绕着垂直于旋转齿轮轴633的纵轴线的枢转轴逆时针方向旋转(当向纸页中看时)。同样地,旋转齿轮643的逆时针方向旋转使得安装于其上的旋转等径伞齿轮644逆时针方向旋转。旋转等径伞齿轮644的等径伞齿轮齿6441与旋转等径伞齿轮669的等径伞齿轮齿6691接合,以使旋转等径伞齿轮644的逆时针方向旋转引起旋转等径伞齿轮669顺时针方向旋转。
旋转等径伞齿轮669安装在第二旋转齿轮轴665上,以使旋转等径伞齿轮669的顺时针方向旋转引起第二旋转齿轮轴665的顺时针方向旋转,以及旋转正齿轮673的顺时针方向旋转。依靠旋转正齿轮673的外周齿轮齿6731与旋转管状正齿轮679的外周齿轮齿6791之间的啮合,旋转正齿轮673沿顺时针方向旋转使得旋转管状正齿轮679沿逆时针方向旋转,以及安装于其上的旋转管677沿逆时针旋转。手柄1103的最远侧端的口部675内的旋转管677的逆时针方向旋转可持续到轴部11b和手柄1103相对于彼此处于其初始位置。
如上所述,根据本发明的一个示例性实施例,如在图1中所示的,手术器械11可以被配置成纯机械器械驱动系统的附件,或者与之整体形成。替代性地,在本发明的另外一个示例性实施例中,手术器械11可以是被配置为独立的机-电器械,例如,在一个完整的装置中包含了各种马达、驱动轴、控制系统等,以省略了独立的机-电手术系统的附件。在图2(c)中示意性地示出了这种装置,并且可能包括手术器械11不是在使用之前连接到单独设置的驱动系统的优势。在这个实施例中,第一马达961和第二马达1001设置在手柄1103内,以使得第一可旋转驱动轴1110a和第二可旋转驱动轴1110b分别连接到第一马达961和第二马达1001,并分别为之所驱动。此外,虽然手术器械11可以是非独立的机-电器械,而是整体地包含一个或者多个马达、驱动轴、控制系统等,但是仍然可以联接到包括其它一些马达、驱动轴、控制系统等的独立机-电手术系统。
在另外一个实施例中,手术器械11可以被配置成机-电手术系统的附件,或者与之整体形成,例如图2(a)中所示的机-电驱动系统1610。图3(a)到图6(d)示出了具有这种装置的手术器械11的一个示意性实施例,例如,手术器械11可以通过柔性轴(具有包含于其内的各种可旋转驱动轴)联接到包含于其内的独立驱动单元(具有用于旋转可旋转驱动轴的马达的装置)。例如,图2(b)示出了手术器械11可包括连接元件1104,连接元件1104包括具有速接凹槽713a的速接套筒713,速接套筒713接合柔性驱动轴1620的互补速接元件1664,下文将更加详细地描述(见,例如,图10)。
根据本发明的一个示例性实施例,图2(a)是机-电驱动部件1610的立体图,结合图3(a)到图6(d)示出和描述的手术器械11可连接到手术器械11上。这种机-电手术系统例如在2000年11月28日提交的美国专利申请第09/723,715号并于2004年9月21日公布的美国专利第6,793,652号、2001年4月17日提交的美国专利申请第09/836,781号、2001年6月22日提交的美国专利申请第09/887,789号以及2002年3月15日提交的美国专利申请第10/099,634号中有所描述,所述专利文献的全部内容通过引用明确地结合到本文中。机-电驱动器部件1610可包括例如远程动力控制台1612,远程动力控制台1612包括具有前面板1615的外壳1614。显示器装置1616和指示器1618a、1618b安装在前面板1615上。柔性轴1620从外壳1614延伸并借助第一联接件1622以可拆卸方式附连到外壳1614。柔性轴1620的远侧端1624可包括第二联接件1626,第二联接件1626适于以可拆卸方式将例如上述手术器械11联接到柔性轴1620的远侧端1624。第二联接件1626也适于以可拆卸方式附连不同的手术设备或附件。在另一示例性实施方式中,柔性轴1620的远侧端1624可永久性地连接到手术设备或与手术设备一体地设置。
可以采用轴(例如,柔性轴或者其它轴)以及联接件的任意适当组合以将手术器械11连接到机-电驱动部件1610的装置。例如,图7至图10示出另一种可以将手术器械11附连到机-电动力控制台1610的装置。参阅图7,图中示出柔性轴1620的侧视图,其中一部分是截面图。根据一种示例性实施例,柔性轴1620包括管状外套1628,管状外套1628可包括构造成在其内部通道1640和外界环境之间提供流体密封的包层或其它密封装置。外套1628可以由与组织兼容且可消毒的弹性材料制成。外套1628还可以由耐高压加热的材料形成。第一可旋转驱动轴94、第二可旋转驱动轴102、第一转向线缆1634、第二转向线缆1635、第三转向线缆1636、第四转向线缆1637(应该注意的是,在本发明的各种实施例中,因为可以认为手术器械11无需这些特定转向线缆的转向能力而提供足够的可操作性,所以可以去除这种转向线缆1634、1635、1636和1637)以及数据传输线缆1638可设置在柔性轴1620的内部通道1640内并沿其整个长度延伸。图8是柔性轴1620沿图7中示出的线8-8的截面图,并且该图中进一步示出所述若干线缆94、102、1634、1635、1636、1637以及1638。转向线缆1634、1635、1636、1637中每个的远侧端附接到柔性轴1620的远侧端1624。所述若干线缆94、102、1634、1635、1636、1637以及1638中的每个都可以容置在相应外套内。
第一可旋转驱动轴94和第二可旋转驱动轴102可以构造成例如高柔性驱动轴,例如编织的或螺旋状的驱动线缆。应当理解的是,这种高柔性驱动线缆可能具有有限的扭矩传输特性和能力。还应当理解的是,手术器械11或者连接到柔性轴1620的其它附件可能需要比驱动轴94、102能够传输的扭矩更高的扭矩输入。因此驱动轴94、102可以构造成传输高速/低扭矩,高速/低扭矩可以通过例如设置在手术设备或附件中和/或远程动力控制台1612中的驱动柔性轴1620的远侧端和/或近侧端处的齿轮装置转化成低速/高扭矩。应当理解的是,这种齿轮装置可沿设置在外壳1614中的马达与附连到柔性轴1620的手术设备或其它附件之间的传动系设置在任何合适位置。这种齿轮装置可包括例如正齿轮装置、行星齿轮装置、谐波齿轮装置、摆线驱动装置、周转齿轮装置等。上文中从图3(a)到图6(d)所示的手术器械11提供了各种齿轮装置,齿轮装置提供了上述转换,即速度和/或扭矩转换。
现在参阅图9,其示出了第一联接件1622的后视端面图。第一联接件1622包括第一连接器1644、第二连接器1648、第三连接器1652以及第四连接器1656,每个所述连接器都以可旋转方式紧固到第一联接件1622。各连接器1644、1648、1652、1656包括相应的凹部1646、1650、1654、1658。如图9所示,每个凹部1646、1650、1654、1658可以是六边形的。然而,应当理解的是,凹部1646、1650、1654、1658可以具有任何适于将连接器1644、1648、1652、1656以不可旋转方式联接以及以刚性方式附连到容置在外壳1614内的马达装置的相应驱动轴的形状和构造。应当理解的是,可以在马达装置的相应驱动轴上设置互补的凸起以驱动柔性轴1620的驱动元件。还应当理解的是,所述凹部可以设置在驱动轴上,而互补的凸起可以设置在连接器1644、1648、1652、1656上。可以设置构造成以不可旋转方式及可释放方式联接连接器1644、1648、1652、1656和马达装置的驱动轴的任何其它联接装置。
连接器1644、1648、1652、1656中的一个以不可旋转方式紧固到第一驱动轴94,连接器1644、1648、1652、1656中另一个以不可旋转方式紧固到第二驱动轴102。连接器1644、1648、1652、1656中剩余的两个与构造成给转向线缆1634、1635、1636、1637上施加张力从而使柔性轴1620的远侧端1624转向的传动元件相接合。数据传输线缆1638电连接并逻辑地连接到数据连接器1660。数据连接器1660包括例如电触点1662,电触点1662对应于容置在数据线缆1638中的独立导线并与容置在数据线缆1638中的独立导线的数目相等。第一联接件1622包括键结构1642,键结构1642构造成使第一联接件1622适当地定向到设置在外壳1612上的匹配和互补的联接装置。键结构1642可以设置在第一联接件1622和设置于外壳1612上的匹配和互补的联接装置中任一个上或者在两个上都设置。第一联接件1622可包括通过简单的推动即可使第一联接件1622接合到外壳1612的速接型连接器。可以与所述若干连接器1644、1648、1652、1656、1660中任一个结合设置密封件以便在第一联接件1622的内部和外界环境之间提供流体密封。
现在参阅图10,图中示出柔性轴1620的第二联接件1626的主视端面图。在该示例性实施例中,第二联接件1626包括第一连接器1666和第二连接器1668,每个所述连接器以可旋转方式紧固到第二联接件1626,并且每个所述连接器以不可旋转方式紧固到第一驱动轴94和第二驱动轴102中相应的一个的远侧端。速接型配合件1664设置在第二联接件1626上从而以可拆卸方式将器械11紧固到第二联接件1626上。速接型配合件1664可以是例如旋转速接型配合件、卡合型配合件等,并且速接型配合件1664可以是与图2(b)中示出的速接套筒713互补的配合件。可以在第二联接件1626上设置键结构1674,并且该键结构1674可以构造成使手术器械11与第二联接件1626以适当方式对齐。构造成使手术器械11与柔性轴1620以适当方式对齐的键结构或其它装置可以设置在第二联接件1626和手术器械11中任一个上或者在两个上都设置。另外,键结构可设置在器械11上,如图2(b)中所示,作为速接套筒713的凹槽713a。具有电触点1672的数据连接器1670也设置在第二联接件1626中。像第一联接件1622的数据连接器1660一样,第二联接件1626的数据连接器1670包括触点1672,触点1672电连接并逻辑连接到数据传输线缆1638的相应的导线和数据连接器1660的触点1662。可以与连接器1666、1668、1670结合设置密封件,以便在第二联接件1626的内部和外界环境之间提供流体密封。
机-电驱动器元件设置在远程动力控制台1612的外壳1614内,并且构造成驱动所述驱动轴94、102和转向线缆1634、1635、1636、1637从而使机-电驱动器部件1610和附连到第二联接件1626的手术器械11运转。在图11中示意性示出的示例性实施例中,5个电动马达96、100、1684、1690、1696中每个都借助电源运转,所述5个电动马达可设置在远程动力控制台1612中。然而,应当理解的是,可以设置任何合适数目的马达,并且所述马达可以借助电池电源、线路电流、DC电源、电子控制DC电源等运转。还应当理解的是,所述马达可以连接到DC电源,DC电源又连接到线路电流并给所述马达提供工作电流。
图11示意性地示出一种可行的马达布置。当第一联接件1622与外壳1614接合并因此使柔性轴1620与外壳1614接合以驱动第一驱动轴94和第二联接件1626的第一连接器1666时,第一马达96的输出轴1678与第一联接件1622的第一连接器1644接合。相似地,当第一联接件1622与外壳1614接合并因此使柔性轴1620与外壳1614接合以驱动第二驱动轴102和第二联接件1626的第二连接器1668时,第二马达100的输出轴1682与第一联接件1622的第二连接器1648接合。当第一联接件1622与外壳1614接合并因此使柔性轴1620与外壳1614接合以借助第一滑轮装置1688驱动第一转向线缆1634和第二转向线缆1635时,第三马达1684的输出轴1686与第一联接件1622的第三连接器1652接合。当第一联接件1622与外壳1614接合并因此使柔性轴1620与外壳1614接合以借助第二滑轮装置1694驱动第三转向线缆1636和第四转向线缆1637时,第四马达1690的输出轴1692与第一联接件1622的第四连接器1656接合。第三马达1684和第四马达1690可以紧固在支架1100上,支架1100能够借助第五马达1696的输出轴1698选择性地在第一位置和第二位置之间移动,从而选择性地使第三马达1684和第四马达1690与相应的滑轮装置1688、1694接合和断开,进而根据需要允许柔性轴1620变得张紧且可转向或者变得松弛。应当理解的是,其它机械、电力和/或机-电机构等也可用于选择性地接合和断开该转向机构。所述马达可以如名称为“A Carriage Assembly for Controlling a Steering Wire MechanismWithin a Flexible Shaft(用于控制柔性轴内的操纵线机构的托架组件)”的美国专利申请第09/510,923号所述的方式设置和构造,该申请的全部内容通过引用明确地结合到本文中。还应当理解的是,根据本发明的其它实施方式,该转向机构可以根本不存在,手术器械11在钳夹部11a和轴部11b之间提供铰接移动以便在手术部位内灵活操作手术器械11。
应当理解的是,马达96、100、1684、1690、1696中任一个或多个可以是例如高速/低扭矩马达、低速/高扭矩马达等。如上所述,第一可旋转驱动轴94和第二可旋转驱动轴102可构造成传递高速和低扭矩。因此,第一马达96和第二马达100可构造成高速/低扭矩马达。替代性地,第一马达96和第二马达100可构造成低速/高扭矩马达,同时在第一马达96和第二马达100与第一可旋转驱动轴94和第二可旋转驱动轴102中相应的一个之间设置减小扭矩/增加转速的齿轮装置。这种减小扭矩/增加转速的齿轮装置可包括例如正齿轮装置、行星齿轮装置、谐波齿轮装置、摆线驱动装置、周转齿轮装置等。应当理解的是,任一种此类齿轮装置可以设置在远程动力控制台1612内或者设置在柔性轴1620的近侧端中-例如设置在第一联接件1622中。应当理解的是,所述齿轮装置可以设置在第一可旋转驱动轴94和/或第二可旋转驱动轴102的远侧端和/或近侧端处以防止扭振和断裂。如上所述,上文所描述的示例性实施例包括各种用以提供适当的速度/扭矩功能的这种齿轮装置。
现在参阅图12,其中示出机-电驱动器部件1610的示意图。控制器1122设置在远程动力控制台1612的外壳1614中,并且构造成控制机-电驱动器部件1610和线性夹紧、切割及缝合器械11或者其它手术设备或附连到柔性轴1620的附件的所有功能和操作。设置存储单元1130,存储单元1130可包括诸如ROM部件1132、RAM部件1134之类的存储装置。ROM部件1132经由线路1136与控制器1122电连接并逻辑地联通,RAM部件1134经由线路1138与控制器1122电连接并逻辑地联通。RAM部件1134可包括诸如磁存储装置、光存储装置、光磁存储装置、电子存储装置之类的任何类型的随机存取存储器。相似地,ROM部件1132可包括任何类型的只读存储器,例如PC卡或PCMCIA型装置之类的可移动存储装置。应当理解的是,ROM部件1132和RAM部件1134可以构造成单个单元或者可以是独立的单元,并且ROM部件1132和/或RAM部件1134可以PC卡或PCMCIA型装置的形式设置。
控制器1122进一步连接到外壳1614的前面板1615-更具体地,经由线路1154连接到显示器装置1616并经由相应的线路1156、1158连接到指示器1618a、1618b。线路1116、1118、1124、1126、1128将控制器1122分别电连接并逻辑连接到第一马达96、第二马达100、第三马达1684、第四马达1690和第五马达1696。有线远程控制单元(“RCU”)1150经由线路1152电连接其并逻辑地连接到控制器1122。还设置了无线RCU1148,无线RCU1148经由无线链路1160与接收/发送单元1146联通,接收/发送单元1146经由线路1144连接到收发器1140。收发器1140经由线路1142电连接并逻辑地连接到控制器1122。无线链路1160可以是诸如红外链路之类的光学链路、无线电链路或任何其它形式的无线通信链路。
开关装置1186可包括例如一排DIP开关,开关装置1186可经由线路1188连接到控制器1122。开关装置1186可构造成例如选择用于在显示器装置1616上显示信息以及提示符的多种语言之一。所述信息和提示符可能涉及例如机-电驱动器部件1610和/或附连到其上的手术器械11的操作和/或状态。
根据本发明的示例性实施例,第一编码器1106设置在第二联接件1626内,并且构造成响应于并且根据第一驱动轴94的旋转来输出信号。第二编码器1108也设置在第二联接件626内,并且构造成响应于并且根据第二驱动轴102的旋转来输出信号。由各编码器1106、1108输出的信号可表示相应的驱动轴94、102的旋转位置及其旋转方向。这些编码器可以是例如LED之类的光源装置以及例如图6(e)中示出的光导纤维。替代性地,这种编码器1106、1108可包括例如霍尔效应装置、光学装置等。虽然编码器1106、1108被描述成设置在第二联接件1626内,但是应当理解的是,编码器1106、1108可以设置在马达系统和手术器械11之间的任何位置处。应当理解的是,将编码器1106、1108设置在第二联接件1626内或设置在柔性轴1620的远侧端处可以准确地确定驱动轴的旋转。如果编码器1106、1108设置在柔性轴1620的近侧端处,则第一可旋转驱动轴94和第二可旋转驱动轴102的扭振可能导致测量误差。
图13是包括霍尔效应装置的编码器1106、1108的示意图。具有北极1242和南极1244的磁体1240以不可旋转方式安装在驱动轴94、102上。编码器1106、1108还包括第一传感器1246和第二传感器1248,第一传感器1246和第二传感器1248设置成相对于驱动轴94、102的纵轴线或旋转轴线大致成90°。传感器1246、1248的输出是持续的并且作为传感器检测范围中的磁场的磁极变化的函数而改变其状态。因此,基于来自编码器1106、1108的输出信号,可以在1/4转内确定驱动轴94、102的角位置并且可以确定驱动轴94、102的旋转方向。各编码器1106、1108的输出经由数据传输线缆1638的相应线路1110、1112传送到控制器1122。通过基于来自编码器1106、1108的输出信号,通过追踪驱动轴94、102的角位置和旋转方向,控制器1122可以确定连接到机-电驱动器部件1610的手术器械的部件的位置和/或状态。也就是说,通过统计驱动轴94、102的转动次数,控制器1122可以确定连接到机-电驱动器部件1610的手术器械的部件的位置和/或状态。
例如,第一钳夹50相对于第二钳夹80的进给距离以及楔件2603的进给距离可以是相应的驱动轴94、102的旋转情况的函数并且能够基于相应的驱动轴94、102的旋转情况来确定。通过确定一个时间点时第一钳夹50和楔件2603的绝对位置,基于来自编码器1106、1108的输出信号以及楔件驱动器2605的夹紧螺丝559的已知螺距,在之后所有时间第一钳夹50和楔件2603的相对位移均可用于确定第一钳夹50和楔件2603的绝对位置。第一钳夹50和楔件2603的绝对位置可以是固定的,并在手术器械11最初联接到柔性轴1620时确定。替代性地,第一钳夹50和楔件603相对于例如第二钳夹80的位置可基于来自编码器1106、1108的输出信号来确定。
另外,手术器械11可包括光学传感器3001、3002、3003和3004,例如,图3(b)所示。这些光学传感器3001、3002、3003和3004可以结合功能选择器块609进行操作。根据功能选择器块609的位置,到达和来自各个光学传感器3001、3002、3003和3004的相应的信号被阻断,从而当手术器械11处于上述四个功能位置之一时,如,旋转、铰接、相对于彼此开启/闭合钳夹和启动切割和/或缝合机构时,提供具有指示器的适当控制器。
如上文结合图2(b)和图10所述,手术器械11可包括数据连接器1272,数据连接器1272的尺寸和构造适于电连接并逻辑地连接到第二联接件1626的连接器1670。在该示例性实施例中,数据连接器1272包括在数量上与连接器1670的触点1672相等的触点1276。存储模块6041电连接并逻辑地连接到数据连接器1272。存储模块6041可以是例如EEPROM、EPROM等形式的,并且存储模块6041可以容置在例如手术器械11的第二钳夹80中的可更换缝钉筒600的缝钉盘604内,如图3(f)所示。
图14示意性地示出存储模块6041。如在图14中所观察到的,数据连接器1272包括触点1276,每个触点1276经由相应的线路-例如柔性数据线缆1278电连接并逻辑地连接到存储模块6041。存储模块6041可构造成存储例如序列号数据1180、附件类型识别器(ID)数据1182和使用数据1184。存储模块6041另外还存储其它数据。序列号数据1180和ID数据1182可构造成只读数据。序列号数据1180和/或ID数据1182可存储在存储模块6041的只读区段中。在该示例性实施例中,序列号数据1180可以是专门识别特定手术器械的数据,而ID数据1182可以是识别诸如用于附连其它类型的手术设备或附件的机-电驱动器部件1610的附件类型的数据。使用数据1184表示特定附件的使用情况,例如,手术器械11的第一钳夹50已经开启和闭合的次数或者手术器械11的楔件603已经进给的次数。使用数据1184可以存储在存储模块6041的读/写区段中。
应当理解的是,能够附连到柔性轴1620的远侧端1624的附件-例如手术器械11可以设计并构造成一次使用的或多次使用的。所述附件也可以设计并构造成可使用预定次数。相应地,使用数据1184可用于确定手术器械11是否已被使用以及使用次数是否超过最大允许使用次数。如下文将更全面地描述地,在达到最大允许使用次数之后试图使用该附件将产生错误(ERROR)状况。
再次参阅图12,控制器1122构造成当手术器械11最初连接到柔性轴1620时从手术器械11的存储模块6041读取ID数据1182。存储模块6041经由数据传输线缆1638的线路1120电连接并逻辑地连接到控制器1122。基于所读取的ID数据1182,控制器1122构造成从存储单元1130读取或选择与连接到柔性轴1620的手术设备或附件的类型对应的操作程序或算法。存储单元1130构造成为每个现有类型的手术设备或附件储存操作程序或算法,控制器1122根据从所附连的手术设备或附件的存储模块6041读取的ID数据1182从存储单元1130选择和/或读取操作程序或算法。如上所示,存储单元1130可包括可移动ROM部件1132和/或RAM部件1134。因此,储存在存储单元1130中的操作程序或算法可以根据需要被更新、增加、删除、改进或以其它方式修改。储存在存储单元1130中的操作程序或算法能够基于例如使用者的特殊需要而专门设计。数据输入装置-例如键盘、鼠标、定点装置、触摸屏等可以经由例如数据连接器端口等连接到存储单元1130,以便于对操作程序或算法进行专门设计。替代性地或附加地,所述操作程序或算法可以以远程方式从机-电驱动器部件1610专门设计并预先编程到存储单元1130中。应当理解的是,序列号数据1180和/或使用数据1184也可用于确定从存储单元1130中读取或选择多个操作程序或算法中的哪一个。应当理解的是,操作程序或算法可以替代性地储存在手术器械11的存储模块6041中,并经由数据传输线缆1638传输到控制器1122。一旦控制器1122读取或选择了合适的操作程序或算法或者合适的操作程序或算法传送到控制器1122,控制器1122便根据使用者借助有线RCU1150和/或无线RCU1148实施的操作来执行所述操作程序或算法。如上所示,控制器1122经由相应的线路1116、1118、1124、1126、1128电连接并逻辑地连接到第一马达96、第二马达100、第三马达1684、第四马达1690以及第五马达1696,并且控制器1122构造成根据经由相应的线路1116、1118、1124、1126、1128所读取、选择或传送的操作程序或算法来控制这些马达96、100、1684、1690、1696。
现在参阅图15,图中示出无线RCU1148的示意图。无线RCU1148包括转向控制器1300,转向控制器1300具有设置在四路摇杆1310下方的多个开关1302、1304、1306、1308。借助摇杆1310操作开关1302、1304便可借助第三马达1684控制第一转向线缆1634和第二转向线缆1635的操作。相似地,借助摇杆1310操作开关1306、1308便可借助第四马达1692控制第三转向线缆1636和第四转向线缆1637的操作。应当理解的是,摇杆1310和开关1302、1304、1306、1308设置成使得开关1302、1304的操作使柔性轴1620沿南-北方向转向,并且开关1306、1308的操作使柔性轴1620沿东-西方向转向。本文中引用的北、南、东和西是就相对坐标系而言的。替代性地,可设置数字操纵杆、模拟操纵杆等,用于替代摇杆1310和开关1302、1304、1306、1308。也可用电位计或任何其它类型的致动器来代替开关1302、1304、1306、1308。
无线RCU1148还包括转向接合/断开开关1312,操作该开关即可控制第五马达696的运转,从而选择性地接合及断开转向机构。无线RCU1148还包括具有可操作的第一开关1316和第二开关1318的二路摇杆1314。操作这些开关1316、1318即可根据与附连的器械对应的操作程序或算法,来控制机-电驱动器部件1610以及诸如手术器械11之类附连到柔性轴1620的任何手术设备或附件的某些功能。例如,操作二路摇杆1314可控制手术器械11的第一钳夹50和第二钳夹80的开启和闭合。无线RCU1148还设置有另一个开关1320,操作该开关即可根据与附连的器械对应的操作程序或算法来进一步控制机-电驱动器部件1610以及附连到柔性轴1620的器械的操作。例如,操作开关1320可以开始进给手术器械11的楔件603。
无线RCU1148包括控制器1322,控制器1322经由线路1324电连接并逻辑地连接到开关1302、1304、1306、1308;经由线路1326电连接并逻辑地连接到开关1316、1318;经由线路1328电连接并逻辑地连接到开关1312;并且经由线路1330电连接并逻辑地连接到开关1320。无线RCU1148可包括指示器1618a’、1618b’和显示器装置1616’,指示器1618a’、1618b’对应于前面板1615的指示器1618a、1618b,显示器装置1616’对应于前面板1615的显示器装置1616。如果设置了指示器1618a’、1618b’和显示器装置1616’,则指示器1618a’、1618b’经由相应的线路1332、1334电连接并逻辑地连接到控制器1322,并且显示器装置1616’经由线路1336电连接并逻辑地连接到控制器1322。控制器1322经由线路1340电连接并逻辑地连接到收发器1338,收发器1338经由线路1344电连接并逻辑地连接到接收器/发送器1342。可以在无线RCU1148中设置诸如电池之类的电源,以便为无线RCU1148供电。因此,无线RCU1148可用于经由无线链路1160控制机-电驱动器部件1610和附连到柔性轴1620的器械11的操作。
无线RCU1148可包括经由线路1348连接到控制器1322的开关1346。操作开关1346即可经由无线链路1160将数据信号传送到发送器/接收器1146。该数据信号包括专门识别无线RCU1148的识别数据。控制器1122用该识别数据来防止对机-电驱动器部件1610进行未经授权的操作,并防止与另一无线RCU对机-电驱动器部件610进行的操作相互冲突。无线RCU1148与机-电手术器械610之间随后每次进行的通信都包括识别数据。因此,控制器1122可以在多个无线RCU之间进行区分,从而仅允许单个、可识别的无线RCU1148来控制机-电驱动器部件1610和附连到柔性轴1620的手术器械11的操作。
基于根据来自编码器1106、1108的输出信号确定的附连到柔性轴1620的手术器械的部件的位置,控制器1122可以选择性地使机-电驱动器部件1610的由与所附连器械对应的操作程序或算法限定的功能生效或失效。例如,对于手术器械11来说,除非已确定第一钳夹50和第二钳夹80之间的空间或间隙在可接受的范围内,否则可以使通过操作开关1320来控制的启动功能失效。
现在参阅图16,图中示出有线RCU1150的示意图。在该示例性实施例中,有线RCU1150包括大体上与无线RCU1148相同的控制元件,在此省略对这些元件的描述。同样的元件在图16中以原标号加上上标来标示。应当理解的是,机-电驱动器部件1610和附连到柔性轴1620的器械(例如,手术器械11)的功能可以由有线RCU1150和/或无线RCU1148来控制。在例如无线RCU1148中的电池产生故障的情况下,有线RCU1150可用于控制机-电驱动器部件1610和附连到柔性轴1620的器械的功能。
如上所述,外壳1614的前面板1615包括显示器装置1616和指示器1618a、1618b。显示器装置1616可包括诸如LCD显示器装置之类的字母数字显示器装置。显示器装置1616也可包括诸如扬声器、蜂鸣器之类的音频输出器件。根据与附连到柔性轴1620的器械-例如手术器械11对应的操作程序或算法,控制器1122来操作和控制显示器装置1616。如果没有手术设备或附件附连到柔性轴1620,则控制器1122可以读取或选择默认的操作程序或算法或者默认的操作程序或算法可以被传送到控制器1122,从而使得控制器能够控制显示器装置1616的操作以及机-电驱动器部件1610的其它方面和功能。如果手术器械11附连到柔性轴1620,则显示器装置1616可以显示例如指示根据编码器1106、1108的输出信号确定的第一钳夹50和第二钳夹80之间的间隙的数据,如上文更全面地描述的。
相似地,控制器1122根据与附连到柔性轴1620的器械-例如手术器械11对应的操作程序或算法来操作和控制指示器1618a、1618b。指示器1618a和/或指示器1618b可包括诸如扬声器、蜂鸣器之类的音频输出装置和/或诸如LED、指示灯、照明灯之类的视觉指示器装置。如果手术器械11附连到柔性轴1620,则指示器1618a可以指示例如机-电驱动器部件1610的电源处于开启状态,并且指示器1618b可以指示例如所确定的第一钳夹50和第二钳夹80之间的间隙是否处于可接受的范围内。应当理解的是,虽然描述了两个指示器1618a、1618b,但是可以根据需要另外设置任意数目的指示器。另外,应当理解的是,虽然描述了单个显示器装置1616,但是可以根据需要另外设置任意数目的显示器装置。
有线RCU1150的显示器装置1616’和指示器1618a’、1618b’以及无线RCU1148的显示器装置1616’’和指示器1618a’’、1618b’’由相应的控制器1322、1322’根据附连到柔性轴1620的器械的操作程序或算法以相似方式操作和控制。
图15和图16分别是无线RCU和有线RCU的示意图,无线RCU和有线RCU被配置为在由操作者致动时,控制由手术器械11执行的各种功能,例如,旋转、铰接、相对于彼此开启/闭合钳夹和启动切割和/或缝合机构。如上所述,手术器械11也可以包括其它各种用于控制这些功能的执行的装置。例如,图3(b)示出了,根据本发明的一个实施例,手术器械11可包括旋转/铰接控制器械3006和/或开启/闭合/启动控制器械3007。
在示出的实施例中,旋转/铰接控制器械3006是操纵杆型器械,其被定位在手柄1103的上表面,从而当操作者握住手柄1103时,可以被操作者的拇指所致动。旋转/铰接控制器械3006可以起到与上述无线RCU 1148的四路摇杆1310相似的作用,当手术器械11处于旋转模式,例如,当功能选择器块609被定位在第一功能位置时,旋转/铰接控制器械3006在南-北方向的移动可以控制旋转驱动器202的操作。例如,当旋转/铰接控制器械3006被操作者在北向上移动时,如,通过向远侧推动旋转/铰接控制器械3006,旋转驱动器202可以被致动,从而使得第二可旋转驱动轴1110b在适于引起轴部11b相对于手柄1103顺时针方向旋转的方向上旋转。类似地,当旋转/铰接控制器械3006被操作者在南向上移动时,例如,通过向近侧推动旋转/铰接控制器械3006,旋转驱动器202可以被致动,从而使得第二可旋转驱动轴1110b在适于引起轴部11b相对于手柄1103逆时针方向旋转的方向上旋转。手术器械11可以被配置为使,如果功能选择器块609不是被定位在第一功能位置时,例如,不是处于旋转模式,旋转驱动器202可以被锁住,例如,被防止移动,借此,旋转/铰接控制器械3006在南向或者北向的任何一个方向上的移动都不会引起旋转驱动器202的致动。
旋转/铰接控制器械3006也可以起到与上述无线RCU 1148的四路摇杆1310相似的作用,当手术器械11处于铰接模式时,例如,当功能选择器块609被定位在第二功能位置时,旋转/铰接控制器械3006在东-西方向的移动中可以控制铰接驱动器201的操作。例如,当旋转/铰接控制器械3006被操作者在西向上移动时,例如,通过向左推动旋转/铰接控制器械3006,铰接驱动器201可以被致动,从而使得第二可旋转驱动轴1110b在适于引起钳夹部11a相对于轴部11b顺时针方向旋转的方向上旋转。类似地,当旋转/铰接控制器械3006被操作者在东向上移动时,例如,通过向右推动旋转/铰接控制器械3006,铰接驱动器201可以被致动,从而使得第二可旋转驱动轴1110b在适于引起钳夹部11a相对于轴部11b逆时针方向旋转的方向上旋转。手术器械11可以被配置为使,如果功能选择器块609不是被定位在第二功能位置时,例如,不是处于铰接模式时,铰接驱动器201可以被锁住,例如,被防止移动,借此,旋转/铰接控制器械3006在东向或者西向的任何一个方向上的移动都不会引起铰接驱动器201的致动。
而且,在示出的实施例中,开启/闭合/启动控制器械3007是触发型器械,其被适当地定位在,例如,手柄1103的底表面上并被定形,从而当操作者握住手柄1103时,可以被操作者的食指所驱动。开启/闭合/启动控制器械3007可以起到与上述无线RCU 1148的二路摇杆1314相似的作用,当手术器械11处于夹紧模式,例如,当功能选择器块609被定位在第三功能位置时,开启/闭合/启动控制器械3007在第一方向和第二方向的移动可以控制夹紧驱动器88的操作。例如,当开启/闭合/启动控制器械3007被操作者在第一方向上移动时,例如,通过按压开启/闭合/启动控制器械3007的顶部,夹紧驱动器88可以被致动,从而使得第二可旋转驱动轴1110b在适于引起第一钳夹相对于第二钳夹80开启的方向上旋转。类似地,当开启/闭合/启动控制器械3007被操作者在第二方向上移动时,例如,通过按压开启/闭合/启动控制器械3007的底部,夹紧驱动器88可以被致动,从而使得第二可旋转驱动轴1110b在适于引起第一钳夹相对于第二钳夹80闭合的方向上旋转。手术器械11可以被配置为使,如果功能选择器块609不是被定位在第三功能位置时,例如,不是处于夹紧模式,夹紧驱动器88可以被锁住,例如,被防止移动,借此,开启/闭合/启动控制器械3007在第一方向或者第二方向的任何一个方向上的移动都不会引起夹紧驱动器88的致动。
开启/闭合/启动控制器械3007也可以起到与上述无线RCU 1148的上述开关1320相似的作用,当手术器械11处于启动模式,例如,当功能选择器块609被定位在第四功能位置时,开启/闭合/启动控制器械3007在第一方向和第二方向的移动可以控制启动驱动器98的操作。例如,当开启/闭合/启动控制器械3007被操作者移动到第一位置时,例如,通过按压开启/闭合/启动控制器械3007的顶部,启动驱动器98可以被致动,从而使得第二可旋转驱动轴1110b在适于引起启动轴557和楔件驱动器2605顺时针旋转的方向上旋转,借此驱动楔件2603和/或刀片51穿过组织部分。类似地,当开启/闭合/启动控制器械3007被操作者在第二方向上移动时,例如,通过按压开启/闭合/启动控制器械3007的底部,启动驱动器98可以被致动,从而使得启动轴557和楔件驱动器2605在逆时针方向上旋转,借此驱动楔件2603和/或刀片51缩回进入其初始位置。手术器械11可以被配置为使,如果功能选择器块609不是被定位在第四功能位置时,例如,不是处于启动模式时,启动驱动器98可以被锁住,例如,被防止移动,从而,开启/闭合/启动控制器械3007在第一方向或者第二方向的任何一个方向上的移动都不会引起启动驱动器98的致动。
从旋转/铰接控制器械3006和/或开启/闭合/启动控制器械3007到适当的控制器的信号传送可以由有线连接或者无线传送,使用类似于那些分别在图15和图16中示出的通信装置来执行。
本发明的手术器械11也可以采用成像装置,例如,摄像机。在这种装置中,成像装置可以被定位在手术器械11的合适位置上,从而向操作者提供与手术位置对应的成像数据。有利地,成像装置可以沿着钳夹部11a铰接,以使得无论钳夹部11a相对于轴部11b被顺时针旋转或者逆时针旋转,都可以向操作者提供适当的成像数据。
如上所述,常规手术器械-特别是诸如图1中示出的常规线性夹紧、切割及缝合器械所存在的一个问题是,难于在患者体内灵活操作相对的钳夹。外科医生可能需要在各种角度之间移动所述相对的钳夹,以便将期望的组织定位在所述相对的钳夹之间。然而,也可能期望在患者体内切割尽可能小的切口,小尺寸的切口限制了可以灵活操作所述相对钳夹的程度。本发明的示例性实施例提供的手术器械-例如手术器械11能够以更高的灵活性在患者体内操作。
常规手术器械-特别是诸如图1中示出的上述线性夹紧、切割及缝合器械所存在的另一个问题是,所述相对的钳夹可能无法充分止血。具体而言,上述手术器械的相对的钳夹可能无法以足量的力来夹紧,从而降低了手术器械的有效性。本发明的示例性实施例可以更好地夹紧例如手术器械11之类手术器械的钳夹之间的组织部分,从而更充分地为被夹紧的组织部分提供止血条件。
如上所述,本发明的手术器械可以采用马达以驱动第一可旋转驱动轴1110a和第二可旋转驱动轴1110b,其中马达是与手术器械11一体设置的。例如,图2(c)是根据本发明的一个实施例,示出了手术器械11的设置的示意图,其中第一马达961和第二马达1001设置在手柄1103内,以使得第一可旋转驱动轴1110a和第二可旋转驱动轴1110b分别连接到第一马达961和第二马达1001。图17(a)到图18(d)提供了这个实施例的附加细节,特别是,其中各种部件(例如,马达、电源等)与器械一体形成的装置的附加细节。
图17(a)是根据本发明的一个示例性实施例的这种手术器械的侧视立体图。现参阅图17(a),示出了手术器械800,其可以被配置为独立的,例如,在一个整体装置中包含了各种马达、驱动轴、控制系统等,从而省略了独立的机-电手术系统的附件。这种装置可能包括手术器械800不是在使用之前连接到分开-设置的驱动系统的优势。手术器械800被配置成特别适于经由套管(未示出)插入患者体内。在示出的实施例中,手术器械800是夹紧、切割和缝合器械。手术器械800包括通过铰链部分811c以可枢转方式联接到轴部811b的钳夹部811a。钳夹部811a包括第一钳夹850和第二钳夹880,第一钳夹850具有远侧端和近侧端,第二钳夹880具有远侧端和近侧端。第一钳夹850和第二钳夹880在它们相应的近侧端处或附近以可枢转方式相互联接。如图所示,第一钳夹850和第二钳夹880绕枢轴线A相对于彼此枢转。在这个装置中,钳夹部被配置为使得,在第一钳夹850相对于第二钳夹880开启和闭合以及第一钳夹850相对于第二钳夹880移动的过程中,第一钳夹850和第二钳夹880,例如,它们的纵轴线保持在一个平面内。但是,应当理解,手术器械800可以替代性地被配置为,使得第一钳夹850和第二钳夹880可以绕与示出的枢轴线定向不同的枢轴线相对于彼此枢转
如上所述,钳夹部811a通过铰链部分811c以可枢转方式联接到轴部811b。具体而言,钳夹部811a可绕枢轴线B相对于轴部811b枢转,枢轴线B可以定位在钳夹部811a和轴部811b上或钳夹部811a和轴部811b之间的任何位置处,并且可以相对于钳夹部811a和轴部811b定位在任何周向位置处。在所示的示例性实施例中,在所示附图中枢轴线B定位成垂直的,并且在页面内。在这个装置中,钳夹部811a和轴部811b被配置为使得,在钳夹部811a相对于轴部811b铰接以及钳夹部811a相对于轴部811b移动的过程中,钳夹部811a和轴部811b保持在垂直于枢轴B的平面内。应当认识到,在其它示例性实施例中,枢轴线B可具有不同的方位,从而使钳夹部811a能够在不同的平面内枢转。钳夹部811a可相对于轴部811b枢转到任何角度以及在相对于轴部811b的任何角度之间枢转,从而使得能够在使用过程中根据需要选择性地对钳夹部811a进行定位。
而且,手术器械800可以提供各个部件绕着手术器械800的纵轴线的旋转。例如,在各种实施例中,钳夹部811a和/或轴部811b可以绕着手柄8103的纵轴线D,例如,在手柄8103与轴部811b相接的点上的手柄8103的纵轴线D,相对于附连到轴部811b的近侧端的手柄8103(下文更加详细描述)旋转。轴部811b可包括远侧部分8101a和近侧端8101b,钳夹部811a连接到远侧部分8101a上,手柄8103连接到近侧端8101b上。
通常地,操作者可以握住手柄8103以操作手术器械800。手柄8103具有在示出的实施例中形成基座的近侧部分8102。另外,手柄8103具有中间部分,其包括多个由手指驱动的控制按钮8107、8108和摇杆器械8117、8118。此外,手柄8103具有连接到轴部811b的远侧部8105。
图17(b)是手术器械800的部分剖视图,示出了手柄8103内部部件的其它细节。如图所示,手柄8103的近侧部分8102提供了容置电源(例如电池8106)的壳体。电池8106可以被配置为向手术器械800的任何部件提供电源。如上所述,这个装置相对其它手术器械提供了一个优势,在于可以省略手术器械800的附连到单独机-电手术系统的电源上的附件。
类似地,手柄8103的中间部分8104提供了容置电路板8109的壳体。如下文详细描述的,电路板8109可以被配置为控制手术器械800的各种操作。如上所述,这个装置相对其它手术器械提供了一个优势,在于可以省略手术器械800的附连到单独机-电手术系统的控制系统(例如,软件或者类似的等)上的附件。
控制按钮8107、8108和摇杆器械8117、8118位于手柄8103的中间部分的近侧端上。每个控制按钮8107、8108和摇杆器械8117、8118都包括相应的磁体,磁体由操作者的致动所移动。此外,对于每个控制按钮8107、8108和摇杆器械8117、8118,电路板8109包括相应的由控制按钮8107、8108和摇杆器械8117、8118内的磁体的移动所致动的霍尔-效应开关。例如,霍尔-效应开关刚好位于控制按钮8107的近侧,当操作者致动控制按钮8107时,上述霍尔-效应开关由控制按钮8107内的磁体的移动所致动。霍尔-效应开关的致动使得电路板8109提供适当的信号到功能选择器块8210和输入驱动部件8310(下文进一步解释),以相对于第二钳夹880闭合第一钳夹850,和/或启动第二钳夹880内的缝合/切割筒。
而且,霍尔-效应开关刚好位于摇杆器械8117的近侧,当操作者致动摇杆器械8117时,上述霍尔-效应开关由摇杆器械8117内的磁体的移动所致动。霍尔-效应开关的致动使得电路板8109提供适当的信号到功能选择器块8210和输入驱动部件8310,以使钳夹部811a相对于轴部811b以铰接方式移动。有利地,摇杆器械8117在第一方向上的移动可以使得钳夹部811a相对于轴部811b在第一方向上铰接,而摇杆器械8117在相反的方向(如第二方向上)的移动可以使得钳夹部811a相对于轴部811b在相反的方向(如第二方向上)铰接。
此外,霍尔-效应开关刚好位于控制按钮8108的近侧,当操作者致动控制按钮8108时,上述霍尔-效应开关由控制按钮8108内的磁体的移动所致动。霍尔-效应开关的致动使得电路板8109提供适当的信号到功能选择器块8210和输入驱动部件8310,以相对于第二钳夹880开启第一钳夹850。
另外,霍尔-效应开关刚好位于摇杆器械8118的近侧,当操作者致动摇杆器械8118时,上述霍尔-效应开关由摇杆器械8118内的磁体的移动所致动。霍尔-效应开关的致动使得电路板8109提供适当的信号到功能选择器块8210和输入驱动部件8310,以使轴部811b,或者至少是其一部分,相对于手柄8103旋转。有利地,摇杆器械8118在第一方向上的移动可以使得轴部811b,或者至少是其一部分,相对于手柄8103在第一方向上旋转,而摇杆器械8118在相反的方向(如第二方向上)的移动可以使得轴部811b,或者至少是其一部分,相对于手柄8103在相反的方向(如第二方向上)旋转。
进一步地,手柄8103的远侧部分8105提供了容置驱动机构8110的壳体。如上所述,驱动机构8110可以被配置为驱动轴和/或齿轮部件,从而执行手术器械800的各种功能。例如,驱动机构8110可以被配置为驱动轴和/或齿轮部件,从而使钳夹部811a相对于轴部811b移动,以选择性地使得轴部811b(或者是手术器械800的远侧部)相对于手柄8103绕着纵轴线D旋转,以相对于第二钳夹880移动第一钳夹850,和/或启动第二钳夹880内的缝合和切割筒。如上所述,这个装置相对其它手术器械提供了一个优势,在于可以省略手术器械800的附连到单独机-电手术系统的驱动系统(例如,马达等)上的附件。
图17(c)是部分剖视手术器械800的俯视立体图,示出了驱动机构8110的附加细节。如图17(c)所示,驱动机构8110可以包括相对于轴部811刚好位于近侧的选择器变速箱组件850。位于选择器变速箱组件850近侧的是功能旋转模块8210,其功能是选择性地在选择器变速箱组件850内移动齿轮元件,以与输入驱动组件8310接合。
图18(a)到图18(d)示出了选择器变速箱组件850的各个示图。具体而言,图18(a)是选择器变速箱组件850的分解立体图。参阅图18(a),sga 850包括一对螺钉8101和8202。这对螺钉8101和8202的每个都容纳于相应的近侧壳体826的开口内。此外,轴承801置于近侧壳体826的相应形成的凹部内。近侧壳体826在其远侧表面上也具有一对邻接并重叠的凹部8261、8262。第一凹部8261被配置为接收在其外周附近具有齿轮齿的正齿轮839。此外,正齿轮839具有延伸穿过其的设置在中央的孔口8391,设置在中央的孔口8391界定了具有拉长狭缝形状的开口。第二凹部8262被配置为接收在其外周附近具有轮齿的正齿轮840。此外,正齿轮840具有延伸穿过其的设置在中央的孔口8401,设置在中央的孔口8401界定了非圆形的开口。正齿轮839的齿轮齿与正齿轮840的齿轮齿相啮合。相对于正齿轮839、840位于远侧的是隔离元件883。
相对于隔离元件883位于远侧的是在其外周附近具有齿轮齿的正齿轮836。此外,正齿轮836具有延伸穿过其的设置在中央的孔口8361。设置在中央的孔口8361界定了具有纵向延伸、沿着其内周表面定位在各个间隔上狭缝的开口。选择器变速箱组件850也包括在其外周附近具有轮齿的正齿轮838。此外,正齿轮838具有延伸穿过其设置在中央的孔口8381,设置在中央的孔口8381界定了非圆形的开口。正齿轮836的齿轮齿与正齿轮838的齿轮齿相啮合。相对于正齿轮838位于远侧的是轴承802。轴承802和正齿轮836、838被保持在第一中间壳体825的相应凹槽内。
相对于第一中间壳体825位于远侧的是在其外周附近具有齿轮齿的正齿轮837。此外,正齿轮837具有延伸穿过其设置在中央的孔口8371。设置在中央的孔口8371界定了具有纵向延伸、沿着其内周表面定位在各个间隔上狭缝的开口。选择器变速箱组件850也包括在其外周附近具有齿轮齿的正齿轮834。此外,正齿轮834具有延伸穿过其设置在中央的孔口8341,设置在中央的孔口8341界定了非圆形的开口。正齿轮837的齿轮齿与正齿轮834的齿轮齿相啮合。相对于正齿轮834、837位于远侧的是隔离件882。
相对于隔离元件882位于远侧的是在其外周附近具有齿轮齿的正齿轮896。此外,正齿轮896具有延伸穿过其设置在中央的孔口8961。设置在中央的孔口8961界定了具有纵向延伸、沿着其内周表面定位在各个间隔上狭缝的开口。选择器变速箱组件850也包括在其外周附近具有齿轮齿的正齿轮895。此外,正齿轮895具有延伸穿过其设置在中央的孔口8951,设置在中央的孔口8951界定了非圆形的开口。正齿轮896的齿轮齿与正齿轮895的齿轮齿相啮合。相对于正齿轮895、896位于远侧的是轴承8031、8032。轴承8031、8032和正齿轮895、896被保持在第二中间壳体824的相应凹部内。
第二中间壳体824在其远侧表面上也具有一对邻接并重叠的凹部8241、8242。第一凹部8241被配置为接收在其外周附近具有齿轮齿的正齿轮876。此外,正齿轮876具有延伸穿过其设置在中央的孔口8761,设置在中央的孔口8761界定了具有纵向延伸、沿着其内周表面定位在各个间隔上狭缝的开口。第二凹部8242被配置为接收在其外周附近具有轮齿的正齿轮875。此外,正齿轮875具有延伸穿过其设置在中央的孔口8751,设置在中央的孔口8401界定了非圆形的开口。正齿轮876的齿轮齿与正齿轮875的齿轮齿相啮合。
相对于正齿轮875、876位于远侧的是轴承804、8051和8052。轴承804、8051和8052被保持在远侧壳体823的相应凹部内。近侧壳体826、第一中间壳体825、第二中间壳体824和远侧端823经由螺钉8101和8102从选择器变速箱组件850的近侧端互相附连,并经由螺钉8111和8112(分别保持在套筒内)从其远侧端互相附连。
选择器变速箱组件850也可以包括选择器杆827。选择器杆827在其近侧端具有头部8271。头部8271被配置为接合功能选择器块8210的轴8211。另外,选择器杆827包括近侧部分8272。近侧部分8272沿其外周围具有相对设置的平面部分8273。近侧部分8272存在于正齿轮839的开口8391内,平面部分8273被键接于其内,以将选择器杆827锁进与正齿轮839的可旋转接合。选择器杆827也包括在其轴向中点附近的相对设置的小块828。小块828从选择器杆827的外周围径向向外延伸。
在操作中,钳夹部811a被保持在初始位置,在初始位置上钳夹部811a与轴部811b轴向对齐,比如与图3(b)所示的近似的位置。在这个位置上,手术器械800可以被,例如,通过套管针,插入手术位置。根据切口和待夹紧、缝合和切割的组织部分的位置,用户就可以操作手术器械800。
一旦将手术器械800插入患者体内,轴部811b或者至少是其一部分可能被旋转,例如,轴部811b可以相对于手柄8103并绕着其纵轴线D被旋转。当然,应当认识到,在这里描述的示例性实施例中,轴部811b相对于手柄8103的旋转也使得相对于轴部811b设置在远侧端的钳夹部811a旋转。在其它实施例中,旋转可以通过钳夹部811a相对于轴部811b并绕着其纵轴线的旋转而获得,或者在一个实施例中,钳夹部811a通过钳夹部811a相对于手柄8103并绕着其纵轴线的旋转而被直接联接到手柄8103上。对于该申请的目的,“轴部”是用来指相对于手柄位于远侧的手术器械的部件的任何部分。
一旦轴部811b被相对于手柄8103旋转,可以采用手术器械800来使钳夹部811a相对于轴部811b移动,例如,使钳夹部811a相对于轴部811b绕轴线B枢转。为了执行这个铰接功能,可以操作手术器械800以使功能选择器模块8210移动到铰接功能位置。如上所述,在这个铰接功能位置,功能选择器模块8210使得主马达驱动部件8310的主驱动轴8311与选择器变速箱组件850的适当齿轮相啮合,如下文更加充分阐释的。
通常,功能选择器模块8210被致动,以使得轴8211将选择器杆827移动到铰接位置。在示出的实施例中,铰接功能位置是选择器杆827被移动到其最近侧位置的位置。借助这里的选择器杆827,选择器杆827的小块828定位在纵向凹槽内,纵向凹槽位于正齿轮836的开口8361的内周围表面上。
借助这样定位的选择器杆827,主马达驱动部件被致动。具体而言,操作者可以在第一方向移动手指致动摇杆器械8117。刚好位于摇杆器械8117近侧的相应的霍尔-效应开关感应到摇杆器械8117内的磁体的移动,并产生适当地信号,传送到主马达驱动部件8310,并由之接收。主马达驱动部件8310响应于接收到的信号转动轴8311。在示例性实施例中,主马达驱动部件8310可以顺时针方向转动轴8311(如之前所解释的,为了简化,这里所有旋转方向的标记,如,顺时针或者逆时针,除非另外指出的,指的是从手术器械800的近侧端到手术器械800的远侧端的视图;另外,应当认识到,虽然在下文的内容中对于手术器械800的每个部件,包括了不同的旋转方向的标记,以执行特定的功能,由于某些部件可被构造得不同,这些方向仅仅是示意性的,例如,螺纹部分可能具有与左侧螺纹相对的右侧螺纹,等,使得这里所阐释的旋转方向可能被倒转,以执行相同的下文描述的功能)。
轴8311的远侧端被键接到正齿轮840的非圆形开口8401上,以使得轴8311的顺时针旋转引起正齿轮840顺时针方向旋转。由于正齿轮840的外周围上的齿轮齿与正齿轮839的外周围上的齿轮齿相啮合,正齿轮840的顺时针旋转引起正齿轮839逆时针方向旋转。如上所述,选择器杆827的近侧部分8272被键接入正齿轮839的非圆形开口8391内,以使得正齿轮839的逆时针旋转引起选择器杆827逆时针方向旋转。而且,由于选择器杆827处于轴向位置上,在这个位置选择器杆827的小块828定位在纵向凹槽内,纵向凹槽位于正齿轮836的开口8361的内周围表面上,选择器杆827的逆时针旋转引起正齿轮836逆时针方向旋转。
由于正齿轮836的外周围上的齿轮齿与正齿轮838的外周围上的齿轮齿相啮合,正齿轮836的逆时针旋转引起正齿轮838顺时针方向旋转。正齿轮838的非圆形开口8381被键接到轴,比如,在图4(d)中所示出的轴525,以使得正齿轮838的顺时针旋转引起钳夹部811a相对于轴部811b绕轴线B在第一方向(例如,逆时针方向(当从上看时))以上文描述的方式或者其它方式铰接。当然,在相反方向上的移动,例如,铰接,也可以通过倒转使得上述齿轮被旋转的方向来实现。
一旦钳夹部811a相对于轴部811b绕轴线B铰接,则钳夹部850、钳夹部880可以被移动,例如被开启,从而使得组织部分位于钳夹部850和钳夹部880之间。为了执行这个开启功能,可以操作手术器械800从而将功能选择器模块8210移动到开启功能位置。如上所述,在这个开启功能位置,功能选择器模块8210使得主马达驱动部件8310的主驱动轴8311与选择器变速箱组件850的适当齿轮相啮合,如下文更加充分阐释的。
通常,功能选择器模块8210被致动,以使得轴8211将选择器杆827移动到夹紧位置。在示出的实施例中,夹紧功能位置是选择器杆827被移动到选择器杆827的小块828定位于纵向凹槽内,操作位于正齿轮896的开口8961的内周围表面上的轴向位置的位置上。
借助这样定位的选择器杆827,主马达驱动部件8310被致动。具体而言,操作者可以移动手指致动控制按钮8108。刚好位于控制按钮8108近侧的相应的霍尔-效应开关感应到控制按钮8108内的磁体的移动,并产生适当地信号,传送到主马达驱动部件8310,并由之接收。主马达驱动部件8310响应于接收到的信号转动轴8311。在示例性实施例中,主马达驱动部件8310可以顺时针方向转动轴8311。
由于轴8311的远侧端被键接到正齿轮840的非圆形开口8401上,轴8311的顺时针旋转引起正齿轮840顺时针方向旋转。而且,由于正齿轮840的外周围上的齿轮齿与正齿轮839的外周围上的齿轮齿相啮合,正齿轮840的顺时针旋转使得正齿轮839逆时针方向旋转。如上所述,选择器杆827的近侧部分8272被键接入正齿轮896的非圆形开口8961内,以使得正齿轮839的逆时针旋转引起选择器杆827逆时针方向旋转。而且,由于选择器杆827处于轴向位置上,在这个位置选择器杆827的小块828定位在纵向凹槽内,纵向凹槽位于正齿轮896的开口8961的内周围表面上,选择器杆827的逆时针旋转使得正齿轮896逆时针方向旋转。
由于正齿轮896的外周围上的齿轮齿与正齿轮895的外周围上的齿轮齿相啮合,正齿轮896的逆时针旋转引起正齿轮895顺时针方向旋转。正齿轮895的非圆形开口8951被键接到轴,比如在图4(d)中所示出的轴527,以使得正齿轮895的顺时针旋转引起第一钳夹850相对于第二钳夹880以上文描述的方式或者其它方式移动,例如,被开启。
一旦第一钳夹850和第二钳夹880相对于彼此被开启到期望的位置,并且一旦待操作的一部分组织被满意地置于手术器械800的第一钳夹850和第二钳夹880之间,则闭合第一钳夹850和第二钳夹880以夹紧其间的部分组织。
为了使第一钳夹50和第二钳夹80相对于彼此闭合,功能选择器模块8210可以保持在夹紧功能位置。如上所述,在这个夹紧功能位置,选择器杆827位于使选择器杆827的小块828定位在纵向凹槽内,纵向凹槽位于正齿轮896的开口8961的内周围表面上。
借助这样定位的选择器杆827,主马达驱动部件8310就在与上述相反的方向上被致动。具体而言,操作者可以移动手指致动控制按钮8107。刚好位于控制按钮8107近侧的相应的霍尔-效应开关感应到控制按钮8107内的磁体的移动,并产生适当地信号,传送到主马达驱动部件8310,并由之接收。主马达驱动部件8310响应于接收到的信号来转动轴8311。在这个示例性实施例中,主马达驱动部件8310可以逆时针方向转动轴8311。
由于轴8311的远侧端被键接到正齿轮840的非圆形开口8401上,轴8311的逆时针旋转引起正齿轮840逆时针方向旋转。而且,由于正齿轮840的外周围上的齿轮齿与正齿轮839的外周围上的齿轮齿相啮合,正齿轮840的逆时针旋转使得正齿轮839顺时针方向旋转。如上所述,选择器杆827的近侧部分8272被键接入正齿轮839的非圆形开口8391内,以使得正齿轮839的顺时针旋转引起选择器杆827顺时针方向旋转。而且,由于选择器杆827处于轴向位置上,在这个位置选择器杆827的小块828定位在纵向凹槽内,纵向凹槽位于正齿轮896的开口8961的内周围表面上,选择器杆827的顺时针旋转使得正齿轮896顺时针方向旋转。
由于正齿轮896的外周围上的齿轮齿与正齿轮895的外周围上的齿轮齿相啮合,所以正齿轮896的顺时针旋转引起正齿轮895逆时针方向旋转。正齿轮895的非圆形开口8951被键接到轴,比如,在图4(d)中所示出的轴527,以使得正齿轮895的逆时针旋转使得第一钳夹850相对于第二钳夹880以上文描述的方式或者其它方式移动,例如,被闭合,从而夹紧位于第一钳夹850和第二钳夹880之间的组织部分。
一旦部分组织被夹紧在第一钳夹850和第二钳夹880之间时,这部分组织可以被切割和/或缝合。应当认识到,虽然本发明举例为同时使用切割和缝合元件,但手术器械800可仅采用一种元件,或者可以采用另一种类型的手术器具。
在将手术器械800插入患者体内之前,在第二钳夹880内设置了缝钉筒578。在一个实施例中,手术器械800是一次使用器械,在手术器械800中缝钉筒与第二钳夹80整体形成。替代性地,手术器械800可具有可更换的缝钉筒,例如,图4(e)中所示出的可更换缝钉筒600,从而允许手术器械800多次与不同的缝钉筒结合使用。在这个实施例中,如果手术器械800是被首次使用,则在制造和组装手术器械800的过程中,可预先安装缝钉筒600,或者在使用手术器械800之前由用户安装。如果手术器械800是第二次或更多次使用,则可以在使用手术器械800之前由使用者安装缝钉筒600。当缝钉筒600插入第二钳夹880内时,启动轴557的远侧端容纳于楔件驱动器605的朝向近侧的开口605d内。
借助于安装在手术器械800的第二钳夹80内的缝钉筒600,可以操作手术器械800以将功能选择器模块8210移动到启动功能位置。如上所述,在这个启动功能位置,选择器杆827被定位在使选择器杆827的小块828定位于纵向凹槽内,该纵向凹槽位于正齿轮837的开口8371的内周围表面上。
借助这样定位的选择器杆827,主马达驱动部件8310被致动。具体而言,操作者可以再次移动手指致动控制按钮8107。刚好位于控制按钮8107近侧的相应的霍尔-效应开关感应到控制按钮8107内的磁体的移动,并产生适当地信号,传送到主马达驱动部件8310,并由之接收。主马达驱动部件8310响应于接收到的信号,转动轴8311。在这个示例性实施例中,主马达驱动部件8310可以逆时针方向转动轴8311。
由于轴8311的远侧端被键接到正齿轮840的非圆形开口8401上,所以轴8311的逆时针旋转引起正齿轮840逆时针方向旋转。而且,由于正齿轮840的外周围上的齿轮齿与正齿轮839的外周围上的齿轮齿相啮合,正齿轮840的逆时针旋转使得正齿轮839顺时针方向旋转。如上所述,选择器杆827的近侧部分8272被键接入正齿轮839的非圆形开口8391内,以使得正齿轮839的顺时针旋转引起选择器杆827顺时针方向旋转。而且,由于选择器杆827处于轴向位置上,在这个位置选择器杆827的小块828定位在纵向凹槽内,该纵向凹槽位于正齿轮837的开口8371的内周围表面上,选择器杆827的顺时针旋转使得正齿轮837顺时针方向旋转。
由于正齿轮837的外周围上的齿轮齿与正齿轮834的外周围上的齿轮齿相啮合,所以正齿轮837的顺时针旋转引起正齿轮834逆时针方向旋转。正齿轮834的非圆形开口8341被键接到轴,比如,在图4(d)等中所示出的轴529,以使得正齿轮834的逆时针旋转使得以上文描述的方式或者其它方式切割和/或缝合组织部分,例如,通过驱动缝钉推动元件和/或切割刀片穿过组织部分。
一旦部分组织被切割和/或夹紧,就可以采用手术器械800使刀片51和楔件2603回复到其初始位置。当手术器械800采用可更换缝钉筒,例如,如图4(e)所示的可更换缝钉筒600,从而允许手术器械800结合不同缝钉筒被多次使用时,以上会特别地令人满意。一旦刀片51和楔件2603被移动到其初始位置,就可以第二次或者多次使用手术器械800。为了这样做,用户可以移除使用过的缝钉筒600,并在手术器械800中插入新的缝钉筒600,启动轴557的远侧端容纳于新缝钉筒2600的楔件驱动器2605的面向近侧端的开口2605d内。当然,应当认识到,使刀片51和楔件2603回复到其初始位置的这个步骤可以在从患者体内移除手术器械800之前或者之后进行。
为了使楔件2603和刀片51回复到其初始位置,功能选择器模块8210可保持在启动功能位置。如上所述,在这个启动功能位置,选择器杆827被定位在使选择器杆827的小块828定位于纵向凹槽内,该纵向凹槽位于正齿轮837的开口8371的内周围表面上。
借助这样定位的选择器杆827,主马达驱动部件8310就在与上述相反的方向上被致动。具体而言,操作者可以再次移动手指致动控制按钮8107。刚好位于控制按钮8107近侧的相应的霍尔-效应开关感应到控制按钮8107内的磁体的移动,并产生适当的信号,传送到主马达驱动部件8310,并由之接收。主马达驱动部件8310响应于接收到的信号来转动轴8311。在这个示例性实施例中,主马达驱动部件8310可以顺时针方向转动轴8311。
由于轴8311的远侧端被键接到正齿轮840的非圆形开口8401上,所以轴8311的顺时针旋转引起正齿轮840顺时针方向旋转。而且,由于正齿轮840的外周围上的齿轮齿与正齿轮839的外周围上的齿轮齿相啮合,所以正齿轮840的顺时针旋转使得正齿轮839逆时针方向旋转。如上所述,选择器杆827的近侧部分8272被键接入正齿轮839的非圆形开口8391内,以使得正齿轮839的逆时针旋转引起选择器杆827逆时针方向旋转。而且,由于选择器杆827处于轴向位置上,在这个位置选择器杆827的小块828定位在纵向凹槽内,该纵向凹槽位于正齿轮837的开口8371的内周围表面上,选择器杆827的逆时针旋转使得正齿轮837逆时针方向旋转。
由于正齿轮837的外周围上的齿轮齿与正齿轮834的外周围上的齿轮齿相啮合,所以正齿轮837的逆时针旋转引起正齿轮834顺时针方向旋转。正齿轮834的非圆形开口8341被键接到轴,比如,在图4(d)中所示出的轴529,以使得正齿轮834的顺时针旋转使得切割和/或缝合元件,例如,楔件2603和刀片51,以上文描述的方式或者其它方式返回到其初始位置上。
一旦楔件2603和刀片51到其初始位置上,就可以采用手术器械800相对于轴部811b移动钳夹部811a,例如,使钳夹部811a相对于轴部811b绕轴线B枢转,回到其初始对齐位置,从而便于从患者切口移除手术器械。为了执行这个功能,可以操作手术器械800以将功能选择器模块8210返回到铰接功能位置。如上所述,在这个铰接功能位置,功能选择器模块8210使得主马达驱动部件8310的主驱动轴8311与选择器变速箱组件850的适当齿轮相啮合,如下文更加充分阐释的。
通常,功能选择器模块8210被致动,以使得轴8211将选择器杆827移动回到铰接功能位置,在该铰接功能位置处,选择器杆827的小块828定位在纵向凹槽内,该纵向凹槽位于正齿轮836的开口8361的内周围表面上。
借助这样定位的选择器杆827,主马达驱动部件就在与上述相反的方向上被致动。具体而言,操作者可以在第二方向移动手指致动摇杆器械8117。刚好位于摇杆器械8117近侧的相应的霍尔-效应开关感应到摇杆器械8117内的磁体的移动,并产生适当地信号,传送到主马达驱动部件8310,并由之接收。主马达驱动部件8310响应于接收到的信号来转动轴8311。在示例性实施例中,主马达驱动部件8310可以逆时针方向转动轴8311。轴8311的远侧端被键接到正齿轮840的非圆形开口8401上,从而轴8311的逆时针旋转引起正齿轮840逆时针方向旋转。由于正齿轮840的外周围上的齿轮齿与正齿轮839的外周围上的齿轮齿相啮合,所以正齿轮840的逆时针旋转使得正齿轮839顺时针方向旋转。如上所述,选择器杆827的近侧部分8272被键接入正齿轮839的非圆形开口8391内,以使得正齿轮839的顺时针旋转引起选择器杆827顺时针方向旋转。而且,由于选择器杆827处于轴向位置上,在这个位置选择器杆827的小块828定位在纵向凹槽内,该纵向凹槽位于正齿轮836的开口8361的内周围表面上,选择器杆827的顺时针旋转使得正齿轮836顺时针方向旋转。
由于正齿轮836的外周围上的齿轮齿与正齿轮838的外周围上的齿轮齿相啮合,所以正齿轮836的顺时针旋转引起正齿轮838逆时针方向旋转。正齿轮838的非圆形开口8381被键接到轴,比如,在图4(d)中所示出的轴525,以使得正齿轮838的逆时针旋转使得钳夹部811a相对于轴部811b绕轴B在第二方向(例如,顺时针方向(当从上看时)),以上文描述的方式或者其它方式铰接。当然,在相反方向上的移动,例如,铰接,也可以通过倒转使得上述齿轮被旋转的方向来实现。
一旦钳夹部811a和轴部811b的纵轴线对齐,就可以采用手术器械800使轴部811b相对于手柄8103回复到其初始位置,例如,通过使轴部811b相对于手柄8103绕手柄8103的纵轴线D旋转直至轴部811b和手柄8103相对于彼此处于初始位置,例如,对齐位置。再次地,当手术器械800采用可更换缝钉筒,例如,如图4(e)所示的可更换缝钉筒600,从而使手术器械800回到允许其结合不同的缝钉筒被多次使用的状态时,以上会特别地令人满意。一旦轴部811b相对于手柄8103已旋转回其初始位置,则可以第二次或者多次使用手术器械800。当然,应当认识到,这个特别的步骤可以在从患者体内移除手术器械800之前或者之后进行。
本领域的技术人员应当理解的是,在不偏离本发明的精神和范围的情况下,可以做出上述示例性实施方式的多种改型。虽然已经详细描述并公开了本发明的示例性实施方式,但是应当理解的是,本发明并不限于所述示例性实施方式。

Claims (22)

1.一种手术器械,包括:
钳夹部,其具有与第二钳夹相对的第一钳夹和包括手术构件的第二钳夹;
轴部,其联接到所述钳夹部的近侧端;
限定了纵轴线的手柄,所述手柄包括第一可旋转驱动轴和第二可旋转驱动轴;以及
至少一个马达,其被配置为使得所述手术器械的轴部相对于所述手柄旋转,使所述钳夹部相对于所述轴部移动,使所述第一钳夹相对于所述第二钳夹移动并且使所述手术构件在所述第二钳夹内移动;
其中所述第一可旋转驱动轴与选择器轴机械配合以引起所述选择器轴的旋转运动,并且所述第二可旋转驱动轴与功能轴机械配合以引起所述功能轴的旋转运动。
2.根据权利要求1所述的手术器械,其中所述至少一个马达安装在所述手柄内。
3.根据权利要求2所述的手术器械,进一步包括:
远程壳体,其中所述至少一个马达安装在所述远程壳体内。
4.根据权利要求3所述的手术器械,进一步包括:
用于将所述手术器械联接到所述远程壳体内的所述至少一个马达上的柔性轴。
5.根据权利要求4所述的手术器械,其中所述柔性轴包括能够联接到所述手柄中的第一可旋转驱动轴的第一可旋转驱动轴,以及能够联接到所述手柄中的第二可旋转驱动轴的第二可旋转驱动轴。
6.根据权利要求5所述的手术器械,其中所述手柄中的第一可旋转驱动轴被配置为使得所选择的驱动器与所述第二可旋转驱动轴接合。
7.根据权利要求6所述的手术器械,其中所选择的驱动器被配置为:当经由手柄中的第二可旋转驱动轴的旋转和经由所述至少一个马达单元的柔性轴中的第二可旋转驱动轴的旋转而致动驱动器时,使所述手术器械的轴部相对于所述手柄旋转,使所述钳夹部相对于所述轴部移动,使所述第一钳夹相对于所述第二钳夹移动并且在所述第二钳夹内移动手术构件。
8.根据权利要求1所述的手术器械,其中所述选择器轴的近侧端通过弹簧插入并保持在所述选择器轴的纵向挡块和所述第一可旋转驱动轴之间的位置上。
9.根据权利要求8所述的手术器械,其中所述选择器轴的远侧端可旋转地安装在所述手柄的固定内壁的孔口内。
10.根据权利要求1所述的手术器械,其中所述功能轴的近侧端通过弹簧插入并保持在所述功能轴的纵向挡块和第二可旋转驱动轴之间的位置上。
11.根据权利要求10所述的手术器械,其中所述功能轴的远侧端可旋转地安装在所述手柄的固定内壁的孔口中。
12.一种手术器械,包括:
钳夹部,其具有与第二钳夹相对的第一钳夹和包括手术构件的第二钳夹;
轴部,其联接到所述钳夹部的近侧端;
手柄,其限定了纵轴线;
第一驱动器,用于使所述手术器械的轴部相对于所述手柄并绕所述手柄的纵轴线旋转;
第二驱动器,用于使所述钳夹部相对于所述轴部移动;
第三驱动器,用于使所述第一钳夹相对于所述第二钳夹移动;
第四驱动器,用于使所述手术构件在所述第二钳夹内移动;以及
第一可旋转驱动轴,其被配置为当致动时,使得第一、第二、第三和第四驱动器中的至少一个与第二可旋转驱动轴选择地接合,其中所述第二可旋转驱动轴被配置为驱动所述第一、第二、第三和第四驱动器中的选择地接合的一个。
13.根据权利要求12所述的手术器械,其中,当所述第一可旋转驱动轴使得所述第一驱动器与所述第二可旋转驱动轴接合时,所述第二可旋转驱动轴在第一旋转方向上的致动使得所述轴部在第一旋转方向上相对于所述手柄并绕所述手柄的纵轴线作枢转移动,并且所述第二可旋转驱动轴在第二旋转方向上的致动使得所述轴部在与所述第一旋转方向相反的第二旋转方向上相对于所述手柄并绕所述手柄的纵轴线作枢转移动。
14.根据权利要求12所述的手术器械,其中,当所述第一可旋转驱动轴使得所述第二驱动器与所述第二可旋转驱动轴接合时,所述第二可旋转驱动轴在第一旋转方向上的致动使得所述钳夹部在第一旋转方向上相对于所述轴部作枢转移动,并且所述第二可旋转驱动轴在第二旋转方向上的致动使得所述钳夹部在与所述第一旋转方向相反的第二旋转方向上相对于所述轴部作枢转移动。
15.根据权利要求14所述的手术器械,其中,所述钳夹部和所述轴部限定相应的纵轴线,并且其中所述钳夹部绕与所述钳夹部和所述轴部的纵轴线垂直的纵轴线相对于所述轴部枢转。
16.根据权利要求15所述的手术器械,其中,所述第一钳夹和第二钳夹限定相应的纵轴线,并且其中所述第一钳夹绕与所述第一钳夹和第二钳夹的纵轴线垂直的纵轴线相对于所述第二钳夹枢转。
17.根据权利要求12所述的手术器械,其中,当所述第一可旋转驱动轴使得所述第三驱动器与所述第二可旋转驱动轴接合时,所述第二可旋转驱动轴在第一旋转方向上的致动使得所述手术构件在第一方向上在所述第二钳夹内移动,并且所述第二可旋转驱动轴在第二旋转方向上的致动使得所述手术构件在与所述第一方向相反的第二方向上在所述第二钳夹内移动。
18.根据权利要求12所述的手术器械,其中,所述第一可旋转驱动轴和第二可旋转驱动轴能够联接到机-电驱动器的相应的驱动联接件。
19.根据权利要求12所述的手术器械,进一步包括至少一个马达,所述至少一个马达被配置为使所述第一可旋转驱动轴和第二可旋转驱动轴旋转。
20.一种手术系统,包括:
机-电驱动器单元,其包括至少一个马达单元;和
手术附件,其包括:
第一驱动器,用于执行第一移动功能;
第二驱动器,用于执行第二移动功能;以及
第一可旋转驱动轴,其能够联接到所述至少一个马达单元,并被配置为使得所述第一驱动器和第二驱动器中的被选择的一个与第二可旋转驱动轴接合,其中所述第二可旋转驱动轴能够联接到所述至少一个马达单元,并被配置为经由所述至少一个马达单元驱动所述第一驱动器和第二驱动器中的所述被选择的一个;
其中所述手术附件进一步包括:
第三驱动器,其被布置为执行第三移动功能,
其中所述第一可旋转驱动轴被配置为,使得第一、第二和第三驱动器中的被选择的一个与所述第二可旋转驱动轴接合,并且其中所述第二可旋转驱动轴被配置为驱动第一、第二和第三驱动器中的所述被选择的一个。
21.根据权利要求20所述的手术系统,其中所述手术附件进一步包括:
第四驱动器,其用于执行第四移动功能,
其中所述第一可旋转驱动轴被配置为,使得所述第一、第二、第三和第四驱动器中的被选择的一个与所述第二可旋转驱动轴接合,并且其中所述第二可旋转驱动轴被配置为驱动所述第一、第二、第三和第四驱动器中的所述被选择的一个。
22.根据权利要求20所述的手术系统,其中所述手术附件进一步包括:
钳夹部,其具有与第二钳夹相对的第一钳夹和包括手术构件的第二钳夹;
轴部,其联接到所述钳夹部的近侧端;
手柄,其限定了纵轴线;其中
所述第一、第二、第三和第四驱动器中的至少一个布置为使手术器械的所述轴部相对于所述手柄并绕所述手柄的纵轴线旋转;
所述第一、第二、第三和第四驱动器中的至少一个布置为使所述钳夹部相对于所述轴部移动;
所述第一、第二、第三和第四驱动器中的至少一个布置为使所述第一钳夹相对于所述第二钳夹移动;并且
所述第一、第二、第三和第四驱动器中的至少一个布置为使所述手术构件在所述第二钳夹内移动。
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US20110192883A1 (en) 2011-08-11
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US20160183938A1 (en) 2016-06-30
EP3111854A1 (en) 2017-01-04
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US20200000463A1 (en) 2020-01-02
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