CN102946816A - 外科器械及其端部执行器 - Google Patents
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Abstract
本发明公开了多种形式的外科器械。在多种实施例中,具有可操作和可关闭钳口的端部执行器附接到细长轴的远端,以使得所述钳口的部分从所述细长轴轴向偏移。其他钳口实施例连接到致动装置,所述致动装置允许所述钳口的部分移动脱离与所述细长轴的轴向对准。其他钳口实施例能够有利于组织解剖。本发明还公开了电外科器械。一个实施例采用可贴合组织的柔性电极。
Description
背景技术
多种实施例涉及可用于(例如)开放式和微创外科环境中的外科器械。
在多种情况下,外科器械可被构造成向组织施加能量,以便处理和/或破坏该组织。在某些情形中,外科器械可包括一个或多个电极,该电极可靠着组织布置和/或相对于组织布置,使得电流可从一个电极流过组织而流到另一个电极。外科器械可包括电气输入端、与电极电连接的供电导体、和/或返回导体,所述返回导体可被构造成例如允许电流从电气输入端流过供电导体,流过电极和组织,然后流过返回导体而流到例如电气输出端。作为另外一种选择,外科器械可包括电气输入端、与电极电连接的供体、和/或返回导体,所述返回导体可被构造成允许电流从电气输入端流过供电导体,流过有源电极和组织,并且流过返回电极通过返回导体而流到电气输出端。在多种情形中,可通过流过组织的电流产生热,其中所述热可使得在组织内和/或组织之间形成一个或多个止血密封。例如,这样的实施例可特别用于密封血管。该外科器械还可包括切割构件,该切割构件可相对于组织和电极运动,以便离断组织。
以举例的方式,由外科器械施加的能量可为射频(“RF”)能量的形式。RF能量为可在300千赫兹(kHz)至1兆赫兹(MHz)频率范围内的电能形式。在应用中,RF外科器械通过电极发射低频无线电波,所述无线电波引起离子搅动或摩擦(实际上为阻抗加热),从而提高组织的温度。因为在受影响的组织与围绕的组织之间形成明显的边界,所以外科医生能够以高水平的精确度和控制进行操作,而不需要太多地牺牲相邻的正常组织。RF能量的低操作温度允许外科医生对软组织进行去除、收缩或造型,而同时密封血管。RF能量尤其奏效地适用于结缔组织,所述结缔组织主要由胶原构成并且在接触热时收缩。
另外,在多种开放式和腹腔镜式外科手术中,需要凝结、密封或熔合组织。组织密封的一种优选方式需要将电能施加到捕获的组织上,以在组织内产生密封所需的热效应。已经为此类目的开发了多种单极和双极RF钳口结构。通常,将射频能量递送至捕获的组织块会升高组织温度,从而至少部分地使组织内的蛋白质变性。当蛋白质变性或形成新交联时,使得这些蛋白质(包括胶原)变性形成混杂和熔合在一起的顽固性混合物。当处理部位随时间愈合时,这种生物“焊缝”在身体的伤口愈合过程中被重新吸收。
在双极射频(RF)钳口的典型布置中,每个钳口的表面都具有电极。射频电流流过两个相对的钳口中的电极之间的被捕获组织。大多数市售的双极钳口可提供低强度的组织熔接立即后处理。
在一些手术期间,通常需要进入靶组织,这需要端部执行器的若干操作。在这些应用中,期望具有弯曲和/或可联接的端部执行器装置以改善外科区域相对外科医生的可触及性和可见性。
上述讨论仅仅为了举例说明本发明技术领域中相关技术目前的各个方面,而不应当视为对权利要求范围的否定。
发明内容
根据多种非限制性实施例,本发明提供了包括细长轴的电外科器械,所述细长轴具有远端并且限定第一纵向轴线。端部执行器可操作地连接到细长轴的远端。端部执行器可包括具有第一细长部分和第一弯曲远端的第一钳口。端部执行器还可包括具有第二细长部分和第二弯曲远端的第二钳口。第一钳口的第一细长部分可运动地连接到第二钳口的第二细长部分。第一和第二细长部分可限定从第一纵向轴线偏移的第二轴线。
根据本发明的多种其他非限制性实施例,本发明提供了可包括细长轴的外科器械,所述细长轴限定纵向轴线。外科器械还可包括可操作地支承在细长轴的远端处的端部执行器。端部执行器可包括第一钳口,所述第一钳口具有与细长轴同轴对准的第一近端部分。端部执行器可包括第二钳口,所述第二钳口具有与细长轴同轴对准的第二近端部分。第一和第二钳口可在打开和关闭位置之间选择性地运动。所述器械还可包括致动系统,所述致动系统与第一和第二钳口接合以用于选择性地移动第一钳口的至少一个其他部分和第二钳口的至少一个其他部分从而脱离与细长轴的轴向对准。
根据本发明的其他多种非限制性实施例,本发明提供了可包括具有第一倾斜远端部分的第一钳口的电外科器械。所述器械还可包括具有第二倾斜远端部分的第二钳口,其中第一和第二钳口可在打开和关闭位置之间选择性地运动,并且其中当第一和第二钳口处于关闭位置时,第一倾斜末端和第二倾斜末端会聚以形成基本上锥形的端部执行器顶端。所述器械还可包括可轴向平移的往复构件,所述可轴向平移的往复构件被支承以用于在第一和第二钳口内进行轴向往复移动。可轴向平移的往复构件可包括第一凸缘,所述第一凸缘被构造成可轴向运动地接合所述第一钳口。第一凸缘可具有第一最远端边缘。所述器械还可包括第二凸缘,所述第二凸缘通过中心腹板部分连接到第一凸缘。第二凸缘可被构造成可轴向运动地接合第二钳口。第二凸缘还可具有第二最远端边缘,所述第二最远端边缘朝远侧突出到第一凸缘的所述第一最远端边缘之外。切割边缘可在从第二最远端边缘延伸到第一最远端边缘的中心腹板的远端上形成。
根据本发明的其他多种非限制性实施例,本发明提供了包括柄部和细长轴的外科器械,所述细长轴连接到所述柄部以使得所述细长轴的至少一部分可沿两个以上的方向上选择性地运动。端部执行器可连接到细长轴。
根据本发明的其他非限制性实施例,本发明提供了可包括细长轴和柔性电极组件的电外科器械,所述柔性电极组件可运动地连接到细长轴的远端。
附图说明
本文所述的实施例的各个特征在所附权利要求书中进行了详细描述。然而,根据结合如下附图的以下描述,可理解各种实施例(对手术的组织和方法来说皆是如此)及其优点。
图1为根据本发明的一个非限制性实施例的电外科器械的透视图;
图2为图1所示的柄部的侧视图,其中柄部壳体的一部分被省去以示出各个柄部元件;
图3为根据本发明的一个非限制性实施例的端部执行器的顶视图;
图4为处于打开位置的图3所示的端部执行器实施例的局部透视图;
图5为根据本发明的一个非限制性实施例的可平移构件的一部分的局部透视图,其中替代挠曲位置以虚线示出;
图6为根据本发明的另一个非限制性实施例的可平移构件的一部分的透视图;
图7为根据本发明的另一个非限制性实施例的可平移构件的局部横截面透视图;
图8为根据本发明的另一个非限制性实施例的电外科器械的透视图;
图9为根据本发明的另一个非限制性实施例的处于打开位置的端部执行器的局部透视图;
图10为处于关闭位置的图9的端部执行器的另一个局部透视图;
图11为图10的端部执行器沿图10的线11-11截取的剖视图;
图12为图9和10的端部执行器的顶部概略图,其中替代挠曲位置以虚线示出;
图13为根据本发明的另一个非限制性实施例的电外科器械的透视图;
图14为图13所示的柄部的侧视图,其中柄部壳体的一部分被省去以示出各个柄部元件;
图15为根据本发明的另一个非限制性实施例的具有处于关闭位置的钳口构件的端部执行器的侧正视图;
图16为处于打开位置的图15的端部执行器的局部透视图;
图17为图15和16的端部执行器的顶部概略图,其中替代挠曲位置以虚线示出;
图18为根据本发明的另一个非限制性实施例的另一个端部执行器的一部分的透视图;
图19为根据本发明的另一个非限制性实施例的另一个端部执行器的一部分的透视图;
图20为根据本发明的另一个非限制性实施例的另一个端部执行器的一部分的透视图;
图21为正用于解剖组织的图20的端部执行器实施例的侧视图;
图22为根据本发明的另一个非限制性实施例的电外科器械的透视图;
图23为处于关闭位置的图22所示的端部执行器的剖视图;
图24为处于部分联接位置的图23的端部执行器的下钳口的顶部剖视图;
图25为处于直立位置的图24的下钳口的另一个顶部剖视图;
图26为根据本发明的另一个非限制性实施例的端部执行器的局部透视图,其中可平移构件的一部分以虚线示出;
图27为图26所示的可平移构件的一部分的侧正视图,其中端部执行器钳口部分以虚线示出;
图28为根据本发明的另一个非限制性实施例的电外科器械的透视图;
图29为根据本发明的另一个非限制性实施例的关节可联接的细长轴的一部分的局部透视图;
图30为根据本发明的实施例的脊柱形区段的透视图;
图31为图30的脊柱形区段的剖视图;
图32为附接到端部执行器的图29-31所示的关节可联接的细长轴的局部侧正视图;
图33为根据本发明的另一个非限制性实施例的电外科器械的侧正视图;
图34为图33所示的端部执行器的侧正视图,其中替代位置以虚线示出;
图35为接合组织的图34的端部执行器的另一个侧正视图;
图36为根据本发明的另一个实施例的端部执行器的透视图;并且
图37为图36的端部执行器的一部分沿图36的线37-37截取的剖视图。
对应的参考符号表明贯穿若干视图的对应部分。本文示出的范例(以一种形式)示出了本发明的各种实施例,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
各种实施例涉及用于处理组织的设备、系统和方法。示出了许多特定的细节,从而得到对说明书中所述和附图中所示的实施例的整体结构、功能、制造和用途的彻底理解。然而,本领域技术人员将会理解,可在没有这样的特定细节的情况下实施该实施例。在其他实例中,已描述了熟知的操作、组件和元件,以免使说明书中描述的实施例模糊不清。本领域普通技术人员将会理解,本文所述和所示的实施例为非限制性实例,从而可认识到,本文所公开的特定结构和功能细节可为代表性和示例性的。在不脱离权利要求的范围的情况下可对这些实施例进行变型和改变。
本说明书通篇引用的“各种实施例”、“一些实施例”、“一个实施例”或“实施例”等,是指结合所述实施例描述的具体特征、结构或特性包括在至少一个实施例中。因此,本说明书通篇出现的短语“在各种实施例中”、“在一些实施例中”、“在一个实施例中”或“在实施例中”等并不一定都指相同的实施例。此外,在一个或多个实施例中,具体特征、结构或特性可以任何合适的方式结合。因此,在没有限制的情况下,结合一个实施例示出或描述的具体特征、结构或特性可全部或部分地与一个或多个其他实施例的特征、结构或特性结合。
应当理解,可结合临床医生操纵用来治疗患者的器械的一端在说明书中通篇使用术语“近端”和“远端”。术语“近端”是指器械最靠近临床医生的部分,术语“远端”是指离临床医生最远的部分。还应当理解,为简明和清楚起见,本文可参考所示实施例使用诸如“竖直”、“水平”、“上”和“下”之类的空间术语。然而,外科手术器械可在许多方向和位置中使用,并且这些术语并非意图是进行限制的和绝对的。
本发明的系统和方法的多个实施例涉及在自然组织块内形成热“焊缝”或“熔合”。组织“焊接”和组织“熔合”的替代术语在本文中可互换使用,以描述对目标组织块进行热处理,从而产生基本上均匀的熔合在一起的组织块,在(例如)焊接的血管内处理后立即表现出较强的破裂强度。这种焊缝的强度尤其可用于(I)在血管离断手术中永久性地密封血管;(ii)在切除手术中焊接器官边缘;(iii)焊接其中需要永久性闭合的其他解剖管道;并且另外(iv)可用于进行血管吻合术、血管闭合术或者将解剖结构或其部分接合在一起的其他手术。如本文所公开的组织的焊接或熔合有别于“凝结”、“止血”和通常涉及阻塞小血管或血管化组织内的血流的其他类似的描述性术语。例如,任何表面施加热能都可能导致凝结或止血,但却不属于本文所用术语“焊接”的范畴。这类表面凝结不会产生提供处理的组织任何显著强度的焊缝。
在分子水平,如本文所公开的真正“焊接”组织的现象可能源自于由热引起的目标组织块中胶原和其它蛋白质分子的变性,以形成瞬态液态或凝胶状顽固性混合物。在目标组织内提供所选能量密度,可导致胶原和其他蛋白质内的分子内和分子间氢键交联的水热分解。在可为非常短的所选时间间隔内将变性的蛋白质混合物保持在所选的水合程度(不脱水)。保持目标组织块处于所选极高程度的机械压实状态,以确保解链的变性蛋白质彼此接近,以使其进行交织和缠结。热驰豫之后,随着再交联和复性的发生,混杂的蛋白质混合物会导致蛋白质缠结,从而产生均匀熔合在一起的块。
本文所公开的多种实施例提供了电外科钳口结构,所述电外科钳口结构适于离断钳口之间的捕获组织,并且适于通过可控地施加RF能量而同时焊接所捕获组织的边缘。某些实施例的钳口结构可包括第一和第二相对钳口,所述第一和第二相对钳口带有正温度系数(PTC)或阻抗主体以用于调节递送至所接合组织的RF能量。
图1示出了根据本发明的非限制性实施例的电外科器械100。电外科器械100包括近端柄部105、远端端部执行器200和设置在这两者间的插入件或细长轴构件106。在多种实施例中,端部执行器200包括一组可操作-可关闭的钳口220A和220B。端部执行器200可适于(例如)捕获、焊接和离断组织。第一钳口220A和第二钳口220B可由此捕获或接合两者间的组织。第一钳口220A和第二钳口220B还可对组织施加压缩。在可供选择的实施例中,端部执行器可由一个或两个活动钳口构成。
现在转到图2,其示出了柄部105的侧视图,其中第一柄部主体106A(参见图1)的一半被去除以示出第二柄部主体106B内的一些元件。柄部105可包括杠杆臂128,所述杠杆臂128可沿着路径129牵拉。杠杆臂128可通过往复运动件146连接到设置在细长轴106内的可平移构件140,所述往复运动件146可操作地接合到杠杆臂128的延伸件127。往复运动件146还可连接到偏置装置,例如弹簧141。弹簧141还可连接到第二柄部主体106B,以沿近端方向偏置往复运动件146,因此偏置可平移构件140,从而将钳口220A和220B推动到打开位置,如图1所示。另外,参见图1和2,锁定构件131(参见图2)可通过锁定开关130(参见图1)在锁定位置和解锁位置之间运动,如图所示,在所述锁定位置处,基本上防止往复运动件146朝远侧运动,在所述解锁位置处,可允许往复运动件146自由地沿远端方向朝细长轴106运动。柄部105可为任何类型的手枪式握把或者本领域中已知的其它类型的柄部,其能够承载致动器杆件、触发器或滑动件,以用于致动第一钳口220A和第二钳口220B。细长轴106可具有圆柱形或矩形横截面,并且可包括从柄部105延伸的薄壁管状套筒。细长轴106可具有贯穿延伸的膛孔,以承载用于致动钳口220A、220B的致动器机构如(例如)可平移构件140和承载将电能递送到端部执行器200的电外科元件的电引线。
在一些实施例中,细长轴构件106以及第一钳口220A和第二钳口220B可相对柄部105沿着顺时针或逆时针方向(如通过箭头117所示(图1))连续地旋转(例如,通过三重接触件)。第一钳口220A和第二钳口220B能够在旋转时保持为可操作-可关闭和可打开的。第一钳口220A和第二钳口220B可通过缆线152中的电引线连接到电源145和控制器150以用作具有正极性(+)和负极性(-)的成对双极电极,或者作为另外一种选择用作具有正极性(+)的单电极电极和具有负极性(-)的远程接地垫。
第一钳口220A可具有第一细长部分221A,所述第一细长部分221A通过销轴、锁栓(grunions)、或其他已知附接装置可枢转地连接到第二钳口220B的第二细长部分221B,以使得第一钳口220A可朝向和远离第二钳口220B进行枢转,如通过图4中的箭头251所示。另外,第一钳口220A和第二钳口220B可各自具有设置在第一钳口220A和第二钳口220B的内部部分上的组织夹持元件,例如齿状物243。第一钳口220A可包括第一钳口主体231A,所述第一钳口主体231A具有第一面向外表面232A和第一能量递送表面235A。第二钳口220B可包括第二钳口主体231B,所述第二钳口主体231B具有第二面向外表面232B和第二能量递送表面235B。第一能量递送表面235A和第二能量递送表面235B均可(例如)以“U”形围绕工作端200的远端延伸。
如图1和3可见,细长轴106限定第一纵向轴线A-A。在多种非限制性实施例中,第一和第二钳口220A、220B的第一和第二细长部分221A、221B分别沿着从第一轴线A-A偏移的第二轴线B-B对准。如在图4中进一步可见,第一钳口主体231A可具有弯曲远端部分222A并且第二钳口主体231B可具有弯曲远端部分222B。图3为端部执行器200的顶视图并且示出了其中第一钳口220A和第二钳口220B具有基本上匹配的形状的实施例。如本文所用,术语“基本上”和“基本上相同”是指原本相同、但因制造这些元件时通常经受普通制造公差的特征或元件。如在图3中进一步可见,钳口主体231A的远端顶端部分224A以及第二钳口主体231B的远端顶端部分224B优选地位于细长轴106的直径“D”或“占有面积FP”(对于不具有圆形横截面形状的细长轴106而言)内,以使得端部执行器200可通过能够容纳细长轴106的开口嵌入。相比于其中钳口与细长轴106轴向对准的其他钳口实施例,端部执行器200的偏移性质允许钳口220A、220B设置有弯曲相对更剧烈的弯曲或不规则部分。应当理解,钳口220A、220B可具有多个弯曲部分,前提条件是钳口220A、220B中没有任何部分横向向外突出到细长轴106的直径“D”或占有面积FP之外的一定距离,否则可阻止通过内腔(例如套管针等)的嵌入,除非其可挠曲以由此允许穿过这种内腔的嵌入。
图3-5示出了可平移、往复式构件或往复式“I形横梁”构件240的一部分。柄部105的杠杆臂128可适于致动可平移构件240,所述可平移构件240也用作钳口关闭机构。例如,当沿路径129朝近侧牵拉杠杆臂128时,可朝远侧推压可平移构件240。可平移构件240的远端包括带凸缘的“I”形横梁,所述“I”形横梁能够在钳口220A和220B中的狭槽242内滑动。参见图4。可平移构件240在狭槽242内滑动,以打开和关闭第一钳口220A和第二钳口220B。如在图5中最具体可见,可平移构件240的远端包括由腹板部分248隔开的上凸缘244和下凸缘246,所述腹板部分248具有用于切割组织的尖锐远端250。在多种实施例中,可平移构件240可由(例如)不锈钢或类似弹性材料或者作为另外一种选择可由超弹性材料类型(例如镍钛诺等)制成。在多种实施例中,可平移构件240的上凸缘244和下凸缘246可各自任选地设置有切口部分252。切口252可为基本上V形的,其中它们的最窄部分邻近腹板248且它们的最宽部分开口于凸缘的侧边缘,如图5所示。上凸缘244中的切口252可与下凸缘246中的类似切口252基本上对准。为了有利于可平移构件240的相对紧密弯曲(如图5中的虚线所示),切口252可彼此相对靠近地进行取向。这种可平移构件装置允许可平移构件围绕第一和第二钳口220A、220B中的弯曲狭槽242挠曲。因此,当通过致动杠杆128朝远侧推动可平移构件240时,上凸缘部分244和下凸缘部分246接合第一钳口220A和第二钳口220B以将钳口220A、220B凸轮式地压制在一起,由此夹持和切割两者间的组织。
图6示出了另一个可平移构件240’,所述可平移构件240’类似于上文所述的可平移构件240,不同的是组织切割线材260设置在上凸缘和下凸缘之间以用于组织切割目的。线材260可由(例如)不锈钢等制成并且可在受力情况下安装于上凸缘244和下凸缘246之间。线材260也可与凸缘244、246中不具有切口252的可平移构件240结合使用。在可供选择的实施例中,可将线材260直接或间接地连接到RF电源以进行电力地切割。
在多种实施例中,可平移构件240可设置有上文所述的切口252并且可由(例如)相对柔性或超弹性的材料或合金(例如镍钛诺、NiTi、或具有类似特性的其他合金)制成。在其他实施例中,可平移构件可由镍钛诺、NiTi、或类似材料制成并且可具有如下形状:凸缘中不存在切口252的I形横梁形状。参见图7。
图8-11示出了采用本发明的另一个非限制性端部执行器实施例400的另一个电外科器械300。除了下述差异之外,电外科器械300可具有与电外科器械100相同的构造和操作。转到图9和10,可看出端部执行器400包括第一钳口420A和第二钳口420B。第一钳口420A可枢转地连接到第二钳口420B以允许第一钳口420A在打开位置(图9)和关闭位置(图10)之间枢转。第一钳口420A可包括上部第一钳口主体431A,所述上部第一钳口主体431A由一系列竖直层合的材料层432A形成。在多种实施例中,层合的层432A可由包括热和/或电绝缘体(例如,例如,锆、部分稳定的锆、氧化铝、氮化硅、氧化铝-氧化铬、羟基磷灰石、其他非导电玻璃材料、或其他非导电陶瓷材料)的材料制成。也可采用其他非导电玻璃-陶瓷材料。可通过电测材料434A(例如聚异戊二烯、硅氧烷等)将层432A竖直地层合在一起。参见图11。层合的层432A可用于限定狭槽442A以按上文所述的方式来容纳可平移构件240或240’。第一钳口主体431A具有上部第一面向外表面433A和上部第一能量递送表面435A。如本文所用,术语“竖直层合的”是指垂直于能量递送表面所在平面延伸的材料层。第二钳口420B可包括下部第二钳口主体431B,所述下部第二钳口主体431B由另一系列竖直层合的层432B形成,所述层432B可由上文所述的各种材料制成并进行层合。第二钳口主体431B可具有下部第二面向外表面433B和下部第二能量递送表面435B。第一能量递送表面435A和第二能量递送表面435B均可以“U”形围绕端部执行器200的远端延伸。
如图11中可见,可通过第一能量递送表面435A和第二能量递送表面435B之间的电流通路477来递送电外科能量。可平移构件240可包括绝缘层,以防止构件240用作递送电流的导电通路。相对的第一和第二能量递送表面435A和435B可装载可变电阻正温度系数(PTC)主体或基质,所述主体或基质连接到串联和并联电路元件内的电源145和控制器150。第一能量递送表面435A和相应的PTC主体可具有负极性(-)而第二能量递送表面435B和相应的PTC主体可具有正极性(+)。一旦超过选定断路温度时,则PTC材料将“断路”并且变为高度阻抗的或非导电的。第一能量递送表面435A和第二能量递送表面435B可带有以下专利中所公开的PTC基质和电极元件中的任何一者:名称为“Electrosurgical Jaw Structure for Controlled Energy Delivery”(用于可控能量递送的电外科钳口结构)的美国专利No.6,929,644和名称为“Electrosurgical Jaw Structure for Controlled Energy Delivery”(用于可控能量递送的电外科钳口结构)的美国专利No.6,770,072,这些专利的相应公开内容全文分别以引用方式并入本文。PTC材料在电外科器械中的用途也描述于以下专利中:名称为“Electrosurgical Jaw Structurefor Controlled Energy Delivery”(用于可控能量递送的电外科钳口结构)美国专利No.7,112,201、名称为“Electrosurgical Jaw Structure forControlled Energy Delivery”(用于可控能量递送的电外科钳口结构)的美国专利No.6,929,622、以及名称为“Electrosurgical Instrument JawStructure With Cutting Tip”(具有切割头的电外科器械钳口结构)的美国专利申请公开No.US 2010/0036370A1,这些专利的相应公开内容全文分别以引用方式并入本文。然而,在多种实施例中,第一能量递送表面435A和第二能量递送表面435B各自由通过(例如)粘合剂或机械方式层合在一起的层制成。
图12为端部执行器400和致动系统491的顶部概略图,所述致动系统491可用于在图中所示的三个位置之间挠曲端部执行器400。如在此图中可见,致动系统491可包括附接到所述第一和第二钳口420A、420B中的每一个的至少一个“第一”缆线492。即,至少一个第一缆线492附接到第一钳口420A并且至少一个其他第一缆线492附接到第二钳口420B。同样,至少一个“第二”缆线496附接到第一钳口420A和第二钳口420B中的每一个。也就是说,至少一个第二缆线496附接到第一钳口420A并且至少一个其他第二缆线496附接到第二钳口420B。这种致动系统491允许临床医生“牵拉”第一钳口420A的部分和第二钳口420B的部分从而脱离与细长轴106的轴向对准。也就是说,例如,第一缆线492可用于将第一和第二钳口420A、420B的部分牵拉至轴线125的左侧,并且第二缆线496可用于将第一和第二钳口420A、420B的部分牵拉至轴线125的右侧。第一缆线492可延伸穿过中空细长轴106以连接到由柄部105可操作地支承的第一致动构件494。参见图12。类似地,第二缆线496可延伸穿过中空细长轴106以连接到由柄部105可操作地支承的左侧致动构件498。例如,每个致动构件494、498可包括杠杆臂、按钮等,也就是说,每个致动构件可运动地支承在柄部105上并且连接到相应的缆线492、496,以使得致动构件494沿一个方向的运动对缆线492施加张力,以引起端部执行器挠曲至轴线125的一侧。致动构件494、498沿其他方向的运动允许缆线492、496实现定位,其中端部执行器400可实现相对细长轴构件106的相对轴向取向以允许通过将接纳中空细长轴构件106的内腔来嵌入端部执行器400。类似地,致动构件498沿一个方向的运动对缆线496施加张力以将端部执行器400挠曲至轴线125的另一侧。可利用已知的锁定装置将致动构件494、498选择性地锁定在多个位置。在其他实施例中,可使用一个或多个马达对缆线施加张力以及从缆线释放张力,以实现端部执行器400的所需挠曲或弯曲。应当理解,端部执行器400可另外以本文所公开的多种方式进行操作并且可平移构件240或240’的独特和新颖设计可挠曲或弯曲以移动通过相应狭槽442A、442B。
图13-17示出了根据本发明的另一个非限制性实施例的电外科器械500。此实施例可采用柄部105’,所述柄部105’在一定程度上类似于上文所述的柄部105。然而,电外科器械500不采用能够切割组织和关闭端部执行器510的钳口520A和520B的可平移构件。在此实施例中,第二钳口520B连接到延伸穿过中空细长管106并且附接到柄部105’的脊柱形构件530。中空细长管106的近端接合往复运动构件146,所述往复运动构件146可运动地支承在柄部105’中并且接合杠杆128,以使得杠杆臂128沿路径129的运动将导致往复运动件146和细长管106相对于柄部105’和脊柱形构件530轴向地运动,如通过箭头523所示。参见图14和图15。这种闭合装置通常在与其他形式的外科器械(例如,内切割器等)相关的领域中为已知的。参见(例如)名称为“Surgical Cutting Instrument With Improved Closure System”(具有改善的闭合系统的外科切割器械)的美国专利No.7,588,176和名称为“Surgical Cutting and Stapling Device With Closure Apparatus ForLimiting Maximum Tissue Compression Force”(具有用于限制最大组织压缩力的闭合装置的外科切割和缝合装置)的美国专利No.7,665,647,这些专利的公开内容全文以引用方式并入本文。
现在参见图15,第一钳口520A可枢转地连接到第二钳口520B,以用于在细长轴106进行轴向运动(由箭头523示出)时实现相对于第二钳口520B可选择性枢转移动(由箭头521示出)。第一钳口520A可包括由一系列竖直层合的层532A形成的上部第一钳口主体531A。参见图16。在多种实施例中,层合的层532A可由包括热和/或电绝缘体(例如,例如,锆、部分稳定的锆、氧化铝、氮化硅、氧化铝-氧化铬、羟基磷灰石、其他非导电玻璃材料、或其他非导电陶瓷材料)的材料制成。可采用其他非导电玻璃-陶瓷材料。可通过弹性体材料(例如聚异戊二烯、硅氧烷等)将层532A层合在一起。第一钳口主体531A具有上部第一面向外表面533A和上部第一能量递送表面535A。第二钳口520B可包括下部第二钳口主体531B,所述下部第二钳口主体531B由另一系列层合的层532B形成,所述层532B可由上文所述的各种材料制成并进行层合。第二钳口主体531B可具有下部第二面向外表面533B和下部第二能量递送表面535B。第一能量递送表面535A和第二能量递送表面535B均可以“U”形围绕端部执行器510的远端延伸并且可包括竖直层合的材料层。如上文所述,可通过第一能量递送表面535A和第二能量递送表面535B之间的电流通路来递送电外科能量。第一能量递送表面535A和第二能量递送表面535B可被构造成接触组织并且将适于密封或焊接组织的电外科能量递送至接合的组织。相对的第一和第二能量递送表面535A和535B可带有可变电阻正温度系数(PTC)层540,所述层540连接到串联和并联电路元件内的电源145和控制器150。第一能量递送表面535A和相应的PTC层540可具有负极性(-)而第二能量递送表面535B和相应的PTC主体540可具有正极性(+)。一旦超过选定断路温度时,则PTC材料将“断路”并且变为显著更高阻抗的或非导电的。第一能量递送表面535A和第二能量递送表面435B可带有层合装置中的PTC基质和电极元件的任何一种。控制器150可调节电源145递送的电能,继而向第一能量递送表面535A和第二能量递送表面535B递送电外科能量。可通过启动按钮124来开始能量递送,所述启动按钮124与杠杆臂128可操作地接合并且经由缆线152与控制器150电气连通。如上所述,由电源145递送的电外科能量可包括射频“RF”能量。
为了有利于端部执行器510以(例如)图17所示的方式进行灵活的移动,可采用上文所述类型的致动装置600。具体地讲,致动装置可包括左侧缆线602和右侧缆线606,所述左侧缆线602和右侧缆线606附接到第一钳口520A和第二钳口520B以基本上允许临床医生将第一钳口520A和第二钳口520B“牵拉”至轴线125的左侧和右侧。右侧缆线606可延伸穿过中空脊柱形构件530以连接到由柄部105’可操作地支承的右侧致动构件608。参见图13和图17。类似地,左侧缆线602可延伸穿过中空脊柱形构件530以连接到由柄部105’可操作地支承的左侧致动构件604。例如,每个致动构件604、608可包括杠杆臂、按钮等,也就是说,每个致动构件可运动地支承在柄部105’上并且连接到相应的缆线602、606,以使得致动构件604、608沿一个方向的运动对缆线602、606施加张力并且使得致动构件604、608沿另一个方向的运动允许缆线602、606实现定位,其中端部执行器510可实现相对细长构件106的相对轴向取向以允许通过将接纳中空细长构件106的内腔来嵌入端部执行器510。可利用已知的锁定装置将致动构件604、608选择性地锁定在多个位置。在其他实施例中,可使用一个或多个马达对缆线施加张力以及从缆线释放张力,以实现端部执行器510的所需挠曲。
图18示出了根据本发明的另一个非限制性实施例的端部执行器700。端部执行器700可包括上文所述类型的柔性端部执行器或者其可为基本刚性的。端部执行器700具有相对于第二钳口720B可运动地支承的第一钳口720A。在多种非限制性实施例中,例如,第一钳口720A可枢转地连接到第二钳口720B或者可另外利用细长管106以上文所述的各种方式进行轴向移位而相对第二钳口720B枢转。如同上文所述的多种其他实施例,第一钳口720A具有宽度为“W”的第一钳口主体731A、上部第一面向外表面733A、上部第一能量递送表面735A和远端737A。第二钳口720B可包括另外具有宽度为“W’”的下部第二钳口主体731B,所述宽度“W’”与第一钳口主体731A的宽度“W”可相同或不同,并且因此允许端部执行器700通过套管针或其他内腔方便地嵌入。第二钳口主体731B可具有第二面向外表面733B、第二能量递送表面735B和第二远端737B。第一能量递送表面735A和第二能量递送表面735B均可以“U”形围绕端部执行器700的远端延伸。能量递送表面735A、735B可另外以上文所述的各种方式进行工作。在此实施例中,为了有助于外科医生解剖待烧灼的靶组织,可将远端延伸的圆钝顶端760设置在第一和第二钳口735A、735B中的一者或两者上。圆钝顶端760可为相对平滑的,或者在其他实施例中,圆钝顶端760可涂布有或者说是设置有纤维结构761以允许较好的非电动解剖。如在图18中可见,钝头尖端760可具有小于宽度“W”、“W’的直径或宽度“D”以允许顶端760更容易地插入其中钳口720A、720B原本不能进入的区域内。在其他实施例中,可在顶端760中设置电极(未示出)以使得其能够用作单极解剖器或作为另外一种选择用作双极解剖器。
在其他非限制性实施例中,端部执行器700’可具有圆钝顶端部分760’,所述圆钝顶端部分760’可枢转地连接到从第一和第二钳口720A、720B中的一者或两者突出的延伸件764。参见图19。圆钝顶端部分760’通过铰链766可枢转地连接到延伸件764,所述铰链766将圆钝顶端部分760’摩擦性地保持在所需联接位置中。例如,外科医生可使圆钝顶端部分760’接触组织或其他结构以将圆钝顶端部分760’围绕竖直轴线VA-VA(其基本上垂直于纵向轴线LA-LA)枢转至所需位置。可通过铰链766的元件之间的摩擦来将圆钝顶端部分760’保持在此位置。尽管图19示出圆钝顶端部分附接到延伸件764以用于围绕竖直轴线的枢转移动,但圆钝顶端部分760’可附接到延伸件764以用于围绕水平轴线(未示出)选择性枢转移动。在其他非限制性实施例中,圆钝顶端部分760’可通过“通用”铰链装置可运动地连接到延伸件,所述“通用”铰链装置有利于圆钝顶端部分760’围绕水平轴线和竖直轴线的枢转布置并且此后通过摩擦将圆钝顶端部分760’保持在这种所需位置。在其他非限制性实施例中,圆钝顶端部分760可通过多个铰链和中间顶端部分附接到延伸件764以进一步地允许圆钝顶端部分布置在用于解剖目的的所需方向上。作为另外一种选择,圆钝顶端部分可形成在钳口构件上并且可由延展性材料构成,所述延展性材料允许用户在嵌入患者内之前或者在与所使用的另一种器械一起嵌入之后来预切形状。
图20和21示出了本发明的另一个非限制性实施例的端部执行器800,除了下述差异之外,所述端部执行器800可与端部执行器700相同。端部执行器800可包括上文所述类型的柔性端部执行器或者其可为基本刚性的(不能挠曲以脱离与细长管106的轴向对准)。端部执行器800具有第一钳口820A,所述第一钳口820A可枢转地连接到第二钳口820B或者可另外通过细长管106以上文所述的各种方式进行轴向移位而相对第二钳口820B枢转。如同上文所述的多种其他非限制性实施例,第一钳口820A具有第一钳口主体831A,所述第一钳口主体831A具有第一面向外表面833A和第一能量递送表面835A。第二钳口820B可包括下部第二钳口主体831B,所述下部第二钳口主体831B具有第二面向外表面833B和第二能量递送表面835B。第一能量递送表面835A和第二能量递送表面835B均可以“U”形围绕端部执行器800的远端延伸。能量递送表面835A、835B另外可以上文所述的各种方式进行工作。在此实施例中,为了有助于外科医生解剖或换句话讲分离待烧灼的靶组织,可将朝远侧延伸的第一顶端860A设置在第一钳口820A并且可将朝远侧延伸的第二顶端860B设置在第二钳口820B上。第一顶端860A可具有倾斜的面向外表面861A和相对平坦的面向内表面862A。组织夹持凹槽865A或凸块或者其他结构可设置在面向外表面861A和/或面向内表面862A上。类似地,第二顶端860B可具有倾斜的面向外表面861B和相对平坦的面向内表面862B。组织夹持凹槽865B或凸块或者其他结构可设置在面向外表面861B和/或面向内表面862B上。
在多种非限制性实施例中,第一和第二顶端860A、860B为非电动的。然而,在其他非限制性实施例中,顶端860A包括第一能量递送表面835A的一部分或换句话讲其中具有电极。同时,第二顶端860B包括第二能量递送表面835B的一部分或换句话讲其中具有电极。当供电时,可将能量以双极构型从顶端递送至顶端或者以单极构型从顶端递送至组织。图21示出了用于分离或解剖组织“T”的端部执行器800的一种可能性用途。
图22-25示出了根据本发明的另一个非限制性实施例的电外科器械900。此非限制性实施例可采用柄部105’,所述柄部105’在一定程度上类似于上文所述的柄部105。然而,电外科器械900不采用能够切割组织和关闭端部执行器910的钳口920A和920B的可平移构件。在此实施例中,第二钳口920B连接到脊柱形构件930(图23),所述脊柱形构件930延伸穿过中空细长管106并且以上文所述的方式附接到柄部105’。细长管106的轴向移动导致第一钳口920A相对第二钳口920B枢转。也可采用其他钳口关闭机构。
第一钳口920A可包括一系列可枢转地互连的第一主体区段922A,如图23-25所示。第一主体区段922A通过承窝形接头装置923A连接在一起,以使得它们可相对彼此来围绕如图23所示的竖直轴线VA-VA进行枢转。每个第一主体区段922A可由(例如)热和/或电绝缘体制成。例如,可采用锆、部分稳定的锆、氧化铝、氮化硅、氧化铝-氧化铬、羟基磷灰石、其他非导电玻璃材料、其他非导电陶瓷材料、以及其他非导电玻璃-陶瓷材料。每个第一主体区段922B还具有安装于其中的第一能量递送电极935A。
类似地,第二钳口920B可包括一系列可枢转地互连的第二主体区段922B,所述第二主体区段922B通过承窝形接头装置923B连接在一起,如图24和25所示。将第二主体区段922B连接在一起以使得它们可相对彼此围绕如图23所示的竖直轴线VA-VA进行枢转。每个第二主体区段922B对应于第一主体区段922A并且可由(例如)构成对应第一主体区段922A的相同或不同材料制成。每个第二主体区段922B还具有安装于其中的第二能量递送电极935B,所述第二能量递送电极935B对应于并且基本上竖直对准相应第一主体区段922A的第一能量递送电极935A。第一能量递送电极935A和第二能量递送电极935B可被构造成接触组织并且将适于密封或焊接组织的电外科能量递送至接合的组织。相对的第一和第二能量递送电极935A和935B可连接到串联和并联电路元件中的电源145和控制器150。第一能量递送电极935A和第一主体区段922A可具有负极性(-)而第二能量递送表面935B和相应第二主体区段922B可具有正极性(+),反之亦然。一旦超过选定断路温度时,则第一和第二主体区段922A、922B材料就可“断路”并且变为阻抗的或非导电的。控制器150可调节电源145递送的电能,继而向第一能量递送电极935A和第二能量递送电极9353B递送电外科能量。可通过启动按钮124开始能量递送,所述启动按钮124与杠杆臂128可操作地接合并且经由缆线152与控制器150电气连通。如上文所述,由电源145递送的电外科能量可包括射频“RF”能量并且在性质上可为单极或双极的。
在多种非限制性实施例中,一旦第一主体区段922A相对彼此取向为所需方向时,则承窝元件923A之间的摩擦力用于将第一主体区段922A保持在该位置。类似地,一旦第二主体区段922B相对彼此取向为所需方向时,则承窝元件923B之间的摩擦力用于将第二主体区段922B保持在该位置。任选的是,第一锁定缆线929A可从柄部105’上的锁定机构通过每个第一主体区段922A而延伸到最远端主体区段922A。一旦主体区段922A已运动至所需方向时,外科医生就可通过锁定机构对第一锁定缆线929A施加张力以共同牵拉第一主体区段922A,由此将它们锁定在适当位置。同样,第二锁定缆线929B可从柄部105’上的锁定机构940或另一个锁定机构通过每个主体区段922B而延伸至最远端主体区段922B。一旦主体区段922B已运动至所需方向时,外科医生就可对第二锁定缆线929B施加张力以共同牵拉第二主体区段922B,由此将它们锁定在适当位置。
图26和27示出了根据本发明的另一个非限制性实施例的包括第一钳口1020A和第二钳口1020B的端部执行器1000的一部分。第一钳口1020A可具有第一倾斜远端部分1021A和第二钳口1020B可具有第二倾斜远端部分1021B,所述第二倾斜远端部分1021B与第一倾斜远端部分1021A会聚以形成尤其充分有利于解剖目的的基本上锥形的端部执行器顶端1022。此实施例还可包括往复式I形横梁构件1040,所述往复式I形横梁构件1040可与上文所述的I形横梁构件具有相同的构造和操作,不同的是存在下述差异。更具体地讲,如在图27中可见,I形横梁构件1040具有通过中心腹板部分1046互连的上凸缘1042和下凸缘1044。中心腹板部分1046以上文所述的方式延伸穿过第一钳口构件1020A和第二钳口构件1020B中的对准狭槽(未示出)。上凸缘1042可骑压在第一钳口构件1020A内的凹槽、狭槽、或凹进区域中并且下凸缘1044可骑压在第二钳口构件1020B内的凹槽、狭槽、或凹进区域中,以使得当I形横梁构件1040通过第一和第二钳口构件1020A、1020B朝远侧推进时,上凸缘和下凸缘1042、1044以上文所述的方式来共同枢转第一和第二钳口1020A、1020B。如在图27中最具体可见,下凸缘1044在远端方向上比上凸缘1042突出地更远。中心腹板1046中从下凸缘1044的最远端边缘延伸到上凸缘1042的最远端边缘的部分上具有形成的切割边缘1047。在多种实施例中,切割边缘1047从侧面观察时可具有弓形轮廓。参见(例如)图27。这种“凹进”I形横梁装置以及弓形切割表面与端部执行器的倾斜远端顶端相结合可允许第一和第二钳口1020A、1020B的某些压缩且不会离断夹持在第一和第二钳口1020A、1020B之间的组织。以另一种方式讲,当I形横梁在端部执行器内朝远侧推进时,突出到第二钳口1020B中的狭槽之外的切割表面部分位于推进穿过第二钳口1020B的I形横梁部分的最远端的近端。在多种应用中,可致动钳口以对(例如)设置在下钳口的延伸部分上的组织的切割操作增加表面凝结操作。在其他非限制性实施例中,腹板的远侧边缘(即,边缘1047)可具有“C”形或“U”形。以另一种方式讲,当从侧面观察时,边缘1047可形成基本上水平的“U”形。这种独特的I形横梁有利于压缩钳口之间的组织,由此用于从组织中逐出水分。然后将电流施加至压缩组织,之后利用推进的切割边缘来进行最终的切割。因此,通过获得较稳固的密封。
图28-31示出了根据本发明的另一个非限制性实施例的电外科器械1100。电外科器械1100包括近端柄部端105”、远端端部执行器1200和设置在这两者间的插入件或细长轴构件1106。然而,在此非限制性实施例中,细长轴构件1106包括包封在柔性中空鞘管1112中的柔性脊柱形组件1110。
图29-31示出了多种脊柱形组件元件。具体地讲,在至少一个非限制性实施例中,脊柱形组件1110可由多个互连的脊柱形区段1120制成。如在图30和31中可见,每个脊柱形区段1120具有略似圆柱形形状的中空主体1122。中空主体1122的一端上具有形成的外凸球构件1124。主体1122的另一端具有承窝1126,所述承窝1126具有合适的尺寸以在其中可旋转地接纳和保持相邻区段1120的球构件1124。在多种实施例中,最近端区段1122可不动地附接到可旋转地支承在柄部105”上的致动器轮107。参见图28。因此,致动器轮107的旋转将导致脊柱形组件1110围绕轴线125旋转。最远端脊柱形区段1120附接到端部执行器1200。在一个实施例中,端部执行器1200可包括一组可操作-可关闭的钳口1220A和1220B。端部执行器1200可适于捕获、焊接和离断组织。第一钳口1220A和第二钳口1220B可靠近以由此捕获或接合两者间的组织。第一钳口1220A和第二钳口1220B还可对组织施加压缩。第二钳口1220B可附接到最远端脊柱形区段1120并且第一钳口1220A可枢转地或者说是可运动地连接到第二钳口1220B。在一个实施例中,例如,端部执行器1200可与上文详述的端部执行器200具有相同的构造和操作。
电外科器械1110也可采用可平移、往复式构件或往复式“I形横梁”构件240。柄部105”的杠杆臂128可适于致动柔性可平移构件240,所述柔性可平移构件240也用作钳口关闭机构。例如,当沿路径129朝近侧牵拉杠杆臂128时,可朝远侧推动可平移构件240。可平移构件240的远端包括柔性的具有凸缘的“I”形横梁,所述“I”形横梁能够以上文所述的方式接合第一和第二钳口构件1220A、1220B。柔性可平移构件240延伸穿过内腔1130,所述内腔1130是通过每个脊柱形区段1120提供的。参见图31。柔性可平移构件240的远端以上文所述的方式接合第一和第二钳口1220A、1220B。用于为端部执行器1200供电的线材也可延伸穿过内腔1130或延伸穿过脊柱形区段1120中的其他通道(未示出)。脊柱形组件1110的独特和新颖方面也可结合大量其他的端部执行器装置进行使用。例如,脊柱形区段1120中的内腔1130可容纳可用于控制和致动端部执行器的多种不同的致动器装置、线材、缆线等。
通过大致被设计为1300的控制组件可使脊柱形组件1110沿两个以上的方向(所述方向中的一些在图29中由箭头1111示出)上进行有效的挠曲。在多种实施例中,例如,控制组件1300可包括至少一个致动构件1310,所述致动构件1310延伸穿过在每个脊柱形区段1120的中空主体1122周边上形成的相应对准的中空凸缘1130。在图示实施例中,致动构件1310包括四个控制缆线。然而,在可供选择的实施例中,可采用三个控制缆线以基本上实现利用四个缆线达到的相同程度的运动。名称为“ENDOSCOPIC TRANSLUMENALARTICULATABLE STEERABLE OVERTUBE”(内窥镜式经腔道可关节联接的易操纵上球管)的待审的美国专利公开No.US2010/0010299A1公开了可采用的其他易操纵管状装置,该专利的公开内容以引用方式并入本文。在可供选择的实施例中,控制构件1310还可包括导电体,所述导电体与RF源连通以将RF能量传送至端部执行器。
在示出的非限制性实施例中,每个脊柱形区段1122上具有形成的四个沿直径的相对凸缘1130。控制缆线1310中的每一个延伸穿过中空鞘管1106并且进入柄部105”以接合关节控制机构1400。在图示实施例中,关节控制机构1400包括由柄部105”可操作地支承的操纵杆装置1402。因此,操纵杆装置1402的运动将对缆线1310中的一个或多个施加张力以由此导致脊柱形组件1110进行关节式运动。也可采用其他缆线控制装置。
图33-35示出了根据本发明的另一个非限制性实施例的单极电外科器械1500。电外科器械1500包括近端柄部105、远端端部执行器1600和设置在这两者间的插入件或细长轴构件106。端部执行器1600与返回垫(未示出)相结合可适于巴雷特(Barrett)食道、肝脏、或子宫内膜异位症手术中的可控表面烧蚀。如将在下文中更详细所述,端部执行器1600可相对于细长轴106运动,这使其尤其适用于腹腔镜式或开放式手术应用。
柄部105可包括杠杆臂128,所述杠杆臂128可沿着路径129牵拉。柄部105可为任何类型的手枪式握把或者本领域中已知的其它类型的柄部,其能够承载致动器杠杆、触发器等。细长轴106可具有圆柱形或矩形横截面并且可包括从柄部105延伸的薄壁管状套筒。细长轴106可由(例如)金属(例如不锈钢)或塑料(例如或等)制成。在其他实施例中,细长轴106可包括聚烯烃热收缩管并且具有贯穿延伸的膛孔以用于承载致动器缆线或构件以及用于承载将电能递送至端部执行器1600的电外科元件的电引线。在一些实施例中,细长轴构件106以及端部执行器1600通过(例如)三重接触件可相对柄部105且围绕轴线125旋转完整的360°。
端部执行器1600可包括垫支撑件1602,所述垫支撑件1602销接或换句话讲可运动地连接到细长轴106的远端107。在多种实施例中,垫支撑件1602可由相对柔性的材料(例如聚碳酸酯)或相对高硬度的硅氧烷弹性体制成。然而,可采用其他材料。将导体或电极元件1604以及由正温度系数(PTC)材料制成的柔性垫构件1606附接到柔性垫支撑件1602。例如,柔性垫构件1604可由公开于名称为“ElectrosurgicalJaw Structure For Controlled Energy Delivery”(用于可控能量递送的电外科钳口结构)的美国专利No.6,770,072中的PTC材料制成,该专利的公开内容全文以引用方式并入本文。导体或电极元件1604可由(例如)金属(例如不锈钢或铜)制成并且可通过缆线152中的电引线连接到RF源145和控制器150。这种端部执行器1600包括有利于向组织施加可控能量的致动控制按钮131。可通过启动按钮131来开始能量递送,所述启动按钮131经由缆线152与控制器150电气连通。如上文所述,由电源145递送的电外科能量可包括射频“RF”。杠杆128可相对细长轴106来提供垫支撑件1602的控制以将垫1602较好地对准和逼近组织。作为另外一种选择,杠杆128可控制细长轴107远端附近的细长轴的关节式运动。
本发明的此实施例提供了如下能力,即将电流/功率在预定临界温度水平下提供至靶组织。这是通过如下方式实现的:当施加至组织的RF能量到达时间点时,PTC垫1606被加热至其选定开关范围。其后,从导电电极1604流过柔性垫1606的电流将因PTC阻抗的指数增加而被中断,由此提供RF能量的瞬态和自动降低。因此,端部执行器1600可在有源RF加热和无源导热之间自动地调节施加至组织的能量,以保持靶温度水平。在多种实施例中,PTC垫1606被设计为在超过材料的特定温度时具有急剧增加的阻抗。将能量递送电极1604施用至患者体内。施用至患者体外的接地垫使得形成完整电路。一旦超过选定断路温度时,则PTC材料1606将“断路”并且变为阻抗的或非导电的。如图35中所见,端部执行器元件的柔性特性允许端部执行器在一定程度上适形于不规则组织“T”。上述各种实施例可用于通过向组织施加射频来治疗组织,例如,肝组织、肺组织、心脏组织、前列腺组织、乳腺组织、血管组织等。所述装置可被构造成用于腹腔镜式或开放式手术。柔性端部执行器可被设计成允许进入穿过进入端口(例如套管针)。此外,端部执行器能够将可控能量有效地施用至组织。术语“可控的”是指在预定临界温度水平下将电流/功率提供至到靶组织的能力。这可通过如下方式实现:当施加至组织的RF能量到达时间点时,PTC材料被加热至其选定开关范围。其后,从导电电极流过柔性接合表面的电流可因PTC阻抗的指数增加而被中断,由此提供RF能量的瞬态和自动降低。因此,柔性端部执行器可在有源RF加热和无源导热之间自动地调节施加至组织的能量,以保持靶温度水平。
图36和37示出了另一个端部执行器1600’,所述端部执行器1600’类似于上文所述的端部执行器1600,不同的是存在下述差异。如在图36中可见,细长轴106附接到托架109。细长轴106可由绝缘材料(例如Vectra等)或导电材料(例如不锈钢)制成。在其他实施例中,例如,细长轴106可由聚烯烃热收缩管制成。托架109可由弹性体(例如聚氨酯)或收缩材料(例如聚烯烃、聚氯乙烯(PVC)、或氯丁橡胶)制成。托架109可枢转地附接到刚性垫部分1620,所述刚性垫部分1620可由(例如)聚碳酸酯或高硬度硅氧烷弹性体制成。刚性垫部分1620通过(例如)弹性体粘合剂或包覆成型方法附接到柔性垫部分1622。柔性垫部分1622可由聚异戊二烯或硅氧烷制成。柔性垫部分1622也可由闭孔或开孔氯丁橡胶或硅氧烷泡沫制成。在图36所示的实施例中,将由不锈钢、铜等制成的两个(导电)电极1630通过(例如)弹性体粘合剂附接到柔性垫部分1622并且通过延伸穿过细长轴106和柄部的缆线附接到控制器和RF能量源。在一个非限制性实施例中,如在双极性器械中,两个电极1630可用作源极电路和返回电路。在另一个非限制性实施例中,如在单极器械中,两个电极可进行电连接并且用作单个源电极且具有位于病人体外的返回电极。在其他实施例中,可采用可与柔性垫部分基本上共延的单个导电电极。柔性PTC构件1640可通过(例如)粘合剂或机械附接方式附接到电极1630。此实施例可以上文所述的方式进行操作。
本文所公开的装置可被设计成单次使用后处理掉,也可被设计成多次使用。然而在任一种情况下,该器械均可重新恢复,从而在至少一次使用后再次使用。重新恢复可包括以下步骤的组合:拆卸装置、然后清洗或更换特定部件以及后续重新组装。具体来讲,该装置可拆卸,并且可以任意组合对装置的任意数目的重新特定部件或零件进行选择性地更换或移除。清洗和/或置换特定部分后,该装置可在重新恢复设施处重新组装以随后使用,或者在即将进行外科手术前由外科团队重新组装。本领域普通技术人员将会知道,重新恢复装置时可采用多种不同技术来拆卸、清洗/更换和重新组装。这种技术的使用以及所得重新恢复器械均在本专利申请的范围内。
优选地,在外科手术之前将对本文所述的装置的各种实施例进行处理。首先,获取新的或用过的装置,并在必要时对装置进行清洁。然后对装置进行消毒。在一种灭菌技术中,将器械置于封闭并密封的容器中,例如塑料或口袋中。然后将容器和装置置于能够穿透该容器的辐射区,例如γ辐射、x-射线或高能电子。辐射将装置上和容器中的细菌杀死。然后将灭菌后的装置保存在消毒容器中。该密封容器将器械保持无菌,直到在医疗设备中打开该容器。其他消毒技术可通过本领域技术人员已知的任何多种方式进行,包括β辐射、γ辐射、环氧乙烷和/或蒸汽。
以引用方式全文或部分地并入本文的任何专利、公布或其它公开材料都仅在所并入的材料不与本发明所述的现有定义、陈述或其它公开材料相冲突的范围内并入本文。由此,在必要的程度下,本文所明确阐述的公开内容将取代以引用方式并入本文的任何冲突材料。如果据述以引用方式并入本文但与本文所述的现有定义、陈述或其它公开材料相冲突的任何材料或其部分,仅在所并入的材料和现有的公开材料之间不产生冲突的程度下并入本文。
Claims (28)
1.一种电外科器械,包括:
细长轴,所述细长轴具有远端并且限定第一纵向轴线;
端部执行器,所述端部执行器能够操作地连接到所述细长轴的所述远端,所述端部执行器包括:
第一钳口,所述第一钳口具有第一细长部分和第一弯曲远端;以及
第二钳口,所述第二钳口具有第二细长部分和第二弯曲远端,其中所述第一钳口的所述第一细长部分能够运动地连接到所述第二钳口的所述第二细长部分,并且其中所述第一细长部分和第二细长部分限定从所述第一纵向轴线偏移的第二轴线。
2.根据权利要求1所述的电外科器械,其中所述细长轴限定细长的占有面积,并且其中所述第一钳口和第二钳口不横向突出到所述占有面积之外。
3.根据权利要求1所述的电外科器械,还包括能够轴向平移的往复构件,所述能够轴向平移的往复构件被构造成能够操作地接合所述第一钳口和第二钳口,以在打开位置和关闭位置之间枢转所述第一钳口和第二钳口。
4.根据权利要求3所述的电外科器械,其中所述能够轴向平移的往复构件由弹性合金制成。
5.根据权利要求3所述的电外科器械,其中所述能够轴向平移的往复构件包括:
中心腹板部分,所述中心腹板部分具有远端;
第一凸缘,所述第一凸缘附接到所述中心腹板部分;以及
第二凸缘,所述第二凸缘附接到远离所述第一凸缘的所述中心腹板部分。
6.根据权利要求5所述的电外科器械,还包括位于所述第一凸缘和第二凸缘中的每一个内的多个切口部分。
7.根据权利要求5所述的电外科器械,还包括位于所述能够轴向平移的往复构件的远端上的组织切割部分。
8.根据权利要求7所述的电外科器械,其中所述组织切割部分包括在所述第一凸缘和第二凸缘之间延伸的线材。
9.一种外科器械,包括:
细长轴,所述细长轴限定纵向轴线;以及
端部执行器,所述端部执行器能够操作地支承在所述细长轴的远端处,所述端部执行器包括:
第一钳口,所述第一钳口具有与所述细长轴同轴对准的第一近端部分;
第二钳口,所述第二钳口具有与所述细长轴同轴对准的第二近端部分,并且其中所述第一钳口和第二钳口在打开位置和关闭位置之间能够选择性地运动;以及
致动系统,所述致动系统与所述第一钳口和第二钳口接合以用于选择性地运动所述第一钳口的至少一个其他部分和所述第二钳口的至少一个其他部分从而脱离与所述细长轴的轴向对准。
10.根据权利要求9所述的外科器械,其中所述第一钳口由层合在一起的多个第一材料层形成,并且其中所述第二钳口由层合在一起的相同材料的另外的多个第二材料层形成。
11.根据权利要求10所述的外科器械,其中所述第一钳口具有至少一个第一能量递送表面,并且其中所述第二钳口具有至少一个第二能量递送表面。
12.根据权利要求9所述的外科器械,其中所述致动系统包括:
至少一个第一缆线,所述至少一个第一缆线对应于所述第一钳口和第二钳口中的每一个以用于向其施加第一牵拉运动,由此导致所述第一钳口的所述至少一个其他部分和所述第二钳口的所述至少一个其他部分沿第一方向运动从而脱离与所述细长轴的轴向对准;以及
至少一个第二缆线,所述至少一个第二缆线对应于所述第一钳口和第二钳口中的每一个以用于向其施加第二牵拉运动,由此导致所述第一钳口的所述至少一个其他部分和所述第二钳口的所述至少一个其他部分沿第二方向运动从而脱离与所述细长轴的轴向对准。
13.根据权利要求9所述的电外科器械,还包括能够轴向平移的往复构件,所述能够轴向平移的往复构件被构造成能够操作地接合所述第一钳口和第二钳口,以在打开位置和关闭位置之间枢转所述第一钳口和第二钳口。
14.根据权利要求9所述的外科器械,其中所述第一钳口包括多个能够运动地互连的第一主体区段,其中每个所述互连的第一主体区段内具有第一能量递送电极,并且其中所述第二钳口包括多个能够运动地互连的第二主体区段,其中每个所述互连的第二主体区段内具有第二能量递送电极。
15.一种电外科器械,包括:
具有第一钳口主体的第一钳口,所述第一钳口主体具有第一宽度和第一远端,所述第一钳口具有第一导电性组织接合表面;
具有第二钳口主体的第二钳口,所述第二钳口主体具有第二宽度和第二远端,所述第二钳口具有第二导电性组织接合表面;以及
远端顶端构件,所述远端顶端构件具有小于所述第一宽度和第二宽度的顶端宽度并且从所述第一远端和第二远端中的至少一者朝远侧突出。
16.根据权利要求15所述的电外科器械,其中所述远端顶端构件包括:
从所述第一远端朝远侧突出的第一远端顶端构件;以及
从所述第二远端朝远侧突出的第二远端顶端构件。
17.根据权利要求15所述的电外科器械,其中所述远端顶端构件能够运动地连接到所述第一远端和第二远端中的所述至少一者。
18.根据权利要求15所述的电外科器械,其中所述至少一个远端顶端构件上具有纤维材料。
19.一种电外科器械,包括:
第一钳口,所述第一钳口具有第一倾斜远端部分和第一导电性组织接合表面;
第二钳口,所述第二钳口具有第二倾斜远端部分,其中所述第一钳口和第二钳口在打开位置和关闭位置之间能够选择性地运动,并且其中当所述第一钳口和第二钳口处于关闭位置时所述第一倾斜末端和所述第二倾斜末端会聚以形成基本上锥形的端部执行器顶端,所述第二钳口具有第二导电性组织接合表面;以及
能够轴向平移的往复构件,所述能够轴向平移的往复构件被支承以用于在所述第一钳口和第二钳口内进行轴向往复移动,所述能够轴向平移的往复构件包括:
第一凸缘,所述第一凸缘被构造成能够轴向运动地接合所述第一钳口,所述第一凸缘具有第一最远端边缘;
第二凸缘,所述第二凸缘通过中心腹板部分连接到所述第一凸缘,所述第二凸缘被构造成能够轴向运动地接合所述第二钳口并且具有第二最远端边缘,所述第二最远端边缘朝远侧突出到第一凸缘的所述第一最远端边缘之外;以及
切割边缘,所述切割边缘在从所述第二最远端边缘延伸到所述第一最远端边缘的所述中心腹板的远端上形成。
20.根据权利要求19所述的电外科器械,其中所述切割边缘从其侧面观察时具有弓形轮廓。
21.一种外科器械,包括:
柄部;
连接到所述柄部的细长轴,其中所述细长轴的至少一部分沿两个以上的方向能够选择性地运动;以及
连接到所述细长轴的端部执行器。
22.根据权利要求21所述的外科器械,其中所述细长轴的所述至少一部分包括两个以上能够枢转地互连的脊柱形区段。
23.根据权利要求22所述的外科器械,还包括多个致动构件,所述致动构件连接到所述细长轴的所述至少一部分,以向其选择性地施加致动运动,从而沿两个以上的方向运动所述细长轴的所述至少一部分。
24.根据权利要求23所述的外科器械,其中所述致动构件中的至少两个包括电导体以用于将射频能量从射频能量源传输到所述端部执行器。
25.一种电外科器械,包括:
细长轴;以及
柔性电极组件,所述柔性电极组件能够运动地连接到所述细长轴的远端。
26.根据权利要求25所述的电外科器械,其中所述柔性电极组件包括:
垫支撑件,所述垫支撑件能够枢转地附接到所述细长轴的远端;以及
柔性电极垫构件,所述柔性电极垫构件附接到所述垫支撑件并且与电能源连通。
27.根据权利要求25所述的电外科器械,其中所述电极组件包含正温度系数材料。
28.根据权利要求26所述的电外科器械,其中所述电极垫构件包含正温度系数材料。
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CN105705103A (zh) * | 2013-11-08 | 2016-06-22 | 伊西康内外科有限责任公司 | 电外科装置 |
CN105828734A (zh) * | 2013-12-18 | 2016-08-03 | 柯惠Lp公司 | 电外科末端执行器 |
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CN105705103A (zh) * | 2013-11-08 | 2016-06-22 | 伊西康内外科有限责任公司 | 电外科装置 |
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CN110719758A (zh) * | 2017-03-31 | 2020-01-21 | 爱惜康有限责任公司 | 用于减少粘附的rf电极上的图案化涂层的面积比率 |
CN108969105B (zh) * | 2017-10-06 | 2023-06-20 | 爱惜康有限责任公司 | 电外科器械的电绝缘 |
CN108969105A (zh) * | 2017-10-06 | 2018-12-11 | 伊西康有限责任公司 | 电外科器械的电绝缘 |
CN110051426A (zh) * | 2019-05-15 | 2019-07-26 | 成都五义医疗器械有限公司 | 一种用于微创手术的细长轴组件 |
CN110025359A (zh) * | 2019-05-15 | 2019-07-19 | 成都五义医疗器械有限公司 | 一种用于微创手术的细长轴组件和手术器械 |
CN110025359B (zh) * | 2019-05-15 | 2021-11-23 | 成都五义医疗科技有限公司 | 一种用于微创手术的细长轴组件和手术器械 |
CN110051426B (zh) * | 2019-05-15 | 2021-11-23 | 成都五义医疗科技有限公司 | 一种用于微创手术的细长轴组件 |
Also Published As
Publication number | Publication date |
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CA2799508A1 (en) | 2011-11-24 |
WO2011146377A3 (en) | 2012-01-12 |
CA2799508C (en) | 2019-07-09 |
JP2013526370A (ja) | 2013-06-24 |
AU2011256421A1 (en) | 2012-11-29 |
US20180125571A1 (en) | 2018-05-10 |
US8685020B2 (en) | 2014-04-01 |
EP2571440B1 (en) | 2014-08-13 |
US20110282339A1 (en) | 2011-11-17 |
JP5784714B2 (ja) | 2015-09-24 |
US20170105787A1 (en) | 2017-04-20 |
US20140148806A1 (en) | 2014-05-29 |
WO2011146377A2 (en) | 2011-11-24 |
US9456864B2 (en) | 2016-10-04 |
CN102946816B (zh) | 2016-03-16 |
EP2571440A2 (en) | 2013-03-27 |
WO2011146377A8 (en) | 2012-12-20 |
AU2011256421B2 (en) | 2016-07-07 |
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