CN103118616B - 具有可有选择地铰接的端部执行器的外科器械 - Google Patents

具有可有选择地铰接的端部执行器的外科器械 Download PDF

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CN103118616B
CN103118616B CN201180046065.4A CN201180046065A CN103118616B CN 103118616 B CN103118616 B CN 103118616B CN 201180046065 A CN201180046065 A CN 201180046065A CN 103118616 B CN103118616 B CN 103118616B
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assembly
hinged
end effector
shank
hinge strip
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CN103118616A (zh
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K·J·施米德
C·O·巴克斯特三世
T·W·阿伦霍尔特
J·E·杨
F·E·谢尔顿四世
B·C·沃雷尔
M·C·米勒
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Ethicon Endo Surgery Inc
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14Probes or electrodes therefor
    • 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
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B17/295Forceps for use in minimally invasive surgery combined with cutting implements
    • 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
    • A61B2017/00371Multiple actuation, e.g. pushing of two buttons, or two working tips becoming operational
    • A61B2017/0038Simultaneous actuation of two tools by pushing one button or the like
    • 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
    • A61B2017/2901Details of shaft
    • A61B2017/2908Multiple segments connected by articulations
    • 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
    • A61B2017/2927Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • 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
    • A61B2017/2946Locking means

Abstract

本发明公开了一种具有可铰接的端部执行器的外科器械。所述器械包括铰接系统,所述铰接系统具有与铰接传动装置交接的可旋转致动器构件。致动器构件围绕致动轴线在第一旋转方向上的旋转导致至少一个铰接构件在第一铰接方向上铰接外科端部执行器,并且致动器构件在第二旋转方向上的旋转导致至少一个铰接构件以第二铰接方向铰接外科端部执行器。

Description

具有可有选择地铰接的端部执行器的外科器械
相关专利申请的交叉引用
该非临时性专利申请要求提交于2010年9月24日的美国临时申请No.61/386,094的优先权,该专利申请的全部公开内容以引用的方式并入本文。
技术领域
本发明涉及外科器械,并且在多个实施例中涉及手动致动的外科切割和缝合器械。
背景技术
内窥镜式外科器械常常优于传统的开放式外科器件,因为较小的切口往往会降低术后恢复时间和并发症。因此,适用于精确地将远端执行器穿过套管针科部位处的内窥镜式外科器械已经有了显著发展。这些远端执行器以多种方式与组织接合,以实现诊断或治疗效果(例如,腔内切割缝合器、抓紧器、切割器、缝合器、施夹器、进入装置、药物/基因治疗递送装置以及利用超声波、RF、激光等的能量装置)。
在许多内窥镜式外科应用中,希望利用仅具有完成具体外科手术所需大小的端部执行器。更小的端部执行器可提供更好的外科部位可视化效果。更小的端部执行器还可更好地进入狭小空间并在狭小空间内更好地进行操纵。此类端部执行器的设计者在试图开发小端部执行器时面临许多挑战。制造小端部执行器的能力,更具体地讲制造为切割和缝合组织而设计的小腔内切割缝合器的能力受到形成缝合线和切割组织通常所需的致动力大小限制。此类致动力还可随被处理组织的厚度和组成而变化。例如,切割和缝合较厚的组织通常需要更大的致动力。然而,切割和缝合更薄的组织所需的致动力大小通常更小。因此,许多现有腔内切割缝合器通常使用稳固的砧座闭合系统和缝钉驱动系统,它们能够适应具体范围的组织厚度。然而,此类装置通常不适于处理较薄的组织。
由于在组织内切口的每侧上驱动缝钉并形成缝合,现有腔内切割缝合器装置通常还切割组织。虽然此类装置对于需要切割和紧固组织的那些手术非常有效,但外科医生不能使用它们在不切割组织的情况下安装紧固件。同样,虽然已开发出使腔内切割缝合器铰接的不同形式以改善进入,但此类装置中常用的组件必须足够牢固,以适应特定结构,该结构可生成足够的击发力和闭合力并将这些力从装置柄部传播到端部执行器。因此,此类端部执行器通常太大,因而无法有效进入体内的狭小空间。另外,需要可以单手有效操作的端部执行器。还需要可以应对上述一个或多个挑战的外科器械,该外科器械还可有选择地使端部执行器铰接。
因此,需要应对上述许多挑战的外科切割和缝合器械以及钉仓结构。
上述讨论仅仅为了举例说明本技术领域内目前存在的一些不足之处,而不应看作是对权利要求范围的否定。
发明内容
根据一个一般形式,提供包括柄部组件和细长轴组件的外科器械,该细长轴组件与柄部组件能操作地交接并限定纵向轴线。外科端部执行器能操作地联接到细长轴组件,并且能够在对其施加致动运动后切割和缝合组织。外科器械还包括至少一个铰接构件,该铰接构件由细长轴组件和铰接系统能操作地支撑。在不同形式中,铰接系统包括铰接传动装置,该铰接传动装置由柄部组件能操作地支撑并且能操作地交接至少一个铰接构件。将致动器构件可旋转地支撑在柄部构件上,从而使其有选择地围绕不与纵向轴线横向相交的致动轴线旋转。致动器构件与铰接传动装置连接,使得致动器构件围绕致动轴线沿第一旋转方向的旋转导致至少一个铰接构件相对于纵向轴线以第一铰接方向使外科端部执行器铰接,并且致动器构件围绕致动轴线沿第二旋转方向的旋转导致至少一个铰接构件相对于纵向轴线以相对于纵向轴线的第二铰接方向使外科端部执行器铰接。
根据另一个一般形式,提供外科切割和紧固器械,该器械包括能操作地支撑外科钉仓的细长通道。砧座相对于细长通道可运动地支撑在打开位置和关闭位置之间。刀杆被支撑以在对刀杆施加击发运动时所述刀杆能够运动地从细长通道近端行进到细长通道远端。柄部组件具有与其联接的细长轴组件,该细长轴组件还联接到细长通道。柄部组件能操作地支撑刀杆的至少一部分。细长轴组件限定纵向轴线并且能够对刀杆施加击发运动。将触发组件能操作地支撑在柄部组件上,并且能够对细长轴组件施加击发运动。外科器械还包括铰接系统,该铰接系统包括铰接传动装置,该铰接传动装置由柄部组件能操作地支撑并且与细长轴组件能操作地交接。将致动器构件可旋转地支撑在柄部构件上,从而使其有选择地围绕不与纵向轴线相交的致动轴线旋转。致动器构件与铰接传动装置连接,使得致动器构件围绕致动轴线沿第一旋转方向的旋转导致细长轴组件使外科端部执行器相对于纵向轴线以第一铰接方向铰接,并且致动器构件围绕致动轴线沿第二旋转方向的旋转导致细长轴组件使外科端部执行器相对于纵向轴线以相对于纵向轴线的第二铰接方向铰接。
根据又一个一般形式,提供外科切割和紧固器械。在至少一个形式中,该器械包括具有通道的端部执行器,该通道在其中能够能操作地支撑钉仓。相对于该通道可运动地支撑砧座。该器械还包括细长轴组件,该细长轴组件限定纵向轴线并且包括基本上刚性的近侧轴区段。基本上柔性的铰接区段联接到基本上刚性的远侧轴部分和端部执行器的通道。细长轴组件还包括刀杆,该刀杆具有与基本上柔性的铰接区段相符合的基本上柔性部分,并且具有在其远端形成的组织切割头。刀管与刀杆能操作地交接,用于施加致动运动。第一铰接带组件由基本上刚性的近侧轴区段能操作地支撑,并且在纵向轴线的第一侧上联接到基本上柔性的铰接接头和通道中的一者。第二铰接带组件由基本上刚性的近侧轴区段能操作地支撑,并且在纵向轴线的第二侧上联接到基本上柔性的铰接接头区段和细长通道中的一者。在至少一个形式中,外科切割和紧固器械还包括柄部组件,该柄部组件能操作地联接到基本上刚性的近侧轴区段。将致动器轮可旋转地支撑在柄部组件上。将第一铰接盘可运动地支撑在柄部组件内,并与致动器轮和第一铰接带组件连接。将第二铰接盘可运动地支撑在柄部组件内,并与致动器轮和第二铰接带组件连接。第一铰接盘和第二铰接盘能够使得致动器轮沿第一旋转方向的旋转导致第一铰接盘和第二铰接盘朝向彼此轴向运动,从而以第一轴向对第一铰接带组件施加铰接运动,并以相对于第一轴向的第二轴向对第二铰接带组件施加另一个铰接运动。将击发触发器能操作地支撑在柄部组件上,并与刀管连接,使得对击发触发器施加致动运动导致将该致动运动施加到刀管上。
附图说明
通过结合附图参考本发明实施例的以下说明,本发明的上述和其他特征及优点及其实现方法将会变得更加明显,并可更好地理解发明本身,其中:
图1为本发明的一个外科器械实施例的透视图;
图2为图1的外科器械的另一个透视图,该外科器械的柄部壳体已从柄部组件移除;
图3为图1和2的外科器械实施例的分解组件图;
图4为图1-3所描绘的外科器械实施例的轴组件和端部执行器的一部分的分解组件图;
图5为图4的轴组件和端部执行器的另一个部分的另一个分解组件图;
图6为本发明的端部执行器和轴组件实施例部分的部分横截面图;
图7为图6的端部执行器和轴组件的一部分的部分横截面透视图;
图8为图1-3的外科器械的另一个透视图,为清楚起见,已移除柄部壳体和外部轴构件;
图9为图8的外科器械的一部分处于非铰接位置的俯视图;
图10为图9的外科器械的一部分处于第一铰接位置的另一个俯视图;
图11为图9和10的外科器械的一部分处于第二非铰接位置的另一个俯视图;
图12为图8的外科器械实施例的右侧视图,已移除左侧柄部壳体并且其端部执行器处于打开位置;
图13为图12的外科器械实施例的左侧视图,已移除右侧柄部壳体;
图14为图13的外科器械实施例的部分后部透视图;
图15为图13和14的外科器械实施例的另一个部分后部透视图;
图16为图12-15的外科器械实施例的右侧视图,已移除左侧柄部壳体,并示出用于关闭端部执行器的其触发组件的首次致动;
图17为图16的外科器械实施例的左侧视图,已移除右侧柄部壳体;
图18为图17的外科器械实施例的部分后部透视图;
图19为图17和18的外科器械实施例的另一个部分后部透视图;
图20为图12-19的外科器械实施例的右侧视图,已移除左侧柄部壳体并示出锁定在关闭位置的端部执行器;
图21为图20的外科器械实施例的左侧视图,已移除右侧壳体;
图22为图21的外科器械实施例的部分后部透视图;
图23为图21和22的外科器械实施例的另一个部分后部透视图;
图24为图12-23的外科器械实施例的右侧视图,已移除左侧柄部壳体并示出触发组件,示出了用于对端部执行器施加第二致动运动的触发组件的第二致动;
图25为图24的外科器械实施例的左侧视图,已移除右侧壳体;
图26为图25的外科器械实施例的部分后部透视图;
图27为图25和26的外科器械实施例的另一个部分后部透视图;
图28为图12-27的外科器械实施例的另一个右侧视图,已移除左侧柄部壳体并示出触发组件,外科医生已在对端部执行器施加第二致动运动后移除该触发组件;
图29为图28的外科器械实施例的左侧视图,已移除右侧壳体;
图30为图29的外科器械实施例的部分后部透视图;
图31为图29和30的外科器械实施例的另一个部分后部透视图;
图32为图12-31的外科器械实施例的另一个右侧视图,已移除左侧柄部壳体,并示出了触发组件在第二触发之后已回到其初始位置;
图33为图32的外科器械实施例的左侧视图,已移除右侧壳体;
图34为本发明的另一个外科器械实施例的透视图;
图35为图34的外科器械的另一个透视图,为清楚起见,已移除柄部壳体;
图36为图34和35的外科器械的分解组件透视图;
图37为本发明的不同外科器械实施例的端部执行器和细长轴组件实施例部分的部分分解透视图;
图38为本发明的外科器械实施例的侧正视图,为清楚起见省略了柄部外壳的一部分,并且示出了其处于打开位置的端部执行器;
图39为图38的外科器械实施例的另一个侧正视图,为清楚起见省略了柄部外壳的一部分,并且示出了对击发触发器首次施加致动力后的端部执行器;
图40为图38和39的外科器械实施例的另一个侧正视图,为清楚起见省略了柄部外壳的一部分,并且示出了对击发触发器再次施加致动力后的端部执行器;
图41为图38-40的外科器械实施例的另一个侧正视图,为清楚起见省略了柄部外壳的一部分,并且示出了致动锁定触发器后的端部执行器;
图42为图38-41的外科器械实施例的另一个侧正视图,为清楚起见省略了柄部外壳的一部分,并且示出了完成击发触发器的致动后的端部执行器;
图43为本发明的外科器械实施例处于中立铰接位置的俯视剖视图;
图44为图43的外科器械的侧正视图,为清楚起见省略了柄部外壳的一部分;
图45为图43和44的外科器械实施例的俯视剖视图,其端部执行器相对于纵向轴线以第一铰接方向铰接;
图46为图45的外科器械的侧正视图,为清楚起见省略了柄部外壳的一部分;
图47为图43-46的外科器械实施例的俯视剖视图,其端部执行器相对于纵向轴线以第二铰接方向铰接;以及
图48为图47的外科器械的侧正视图,为清楚起见省略了柄部外壳的一部分。
在所述这些图式中,对应的参考符号均表示对应的部件。本文示出的范例以一种形式示出本发明的优选实施例,不应将这种范例理解为是以任何方式限制本发明的范围。
具体实施方式
本申请的申请人还拥有以下的美国专利申请,这些专利申请与本申请同一天提交,并且每个都以引用的方式各自整体并入本文:
美国专利申请No._________,名称为“Surgical Instrument With TriggerAssembly For Generating Multiple Actuation Motions”,代理人案卷号为END6888USNP3/110378;
美国专利申请No._________,名称为“Surgical Stapler With StationaryStaple Drivers”,代理人案卷号为END7013USNP/110377;
美国专利申请No._________,名称为“Surgical Stapler With FloatingAnvil”,代理人案卷号为END6841USCIP2/100526CIP2;
美国专利申请No._________,名称为“Staple Cartridge IncludingCollapsible Deck Arrangement”,代理人案卷号为END7019USNP/110375;
美国专利申请No._________,名称为“Staple Cartridge IncludingCollapsible Deck”,代理人案卷号为END7020USNP/110374;以及
美国专利申请No._________,名称为“Curved End Effector For A StaplingInstrument”,代理人案卷号为END6841USCIP3/100526CIP3。
现在将描述某些示例性实施例,以从整体上理解本文所公开的装置和方法的结构、功能、制造和用途。这些实施例的一个或多个例子在附图中示出。本领域的普通技术人员将会理解,在本文中具体描述并示出于附图中的装置和方法为非限制性的示例性实施例,并且本发明的多个实施例的范围仅由权利要求书限定。就一个示例性实施例进行图解说明或描述的特征,可与其他实施例的特征进行组合。这种修改形式和变化形式旨在包括在本发明的范围之内。
本说明书通篇引用的“多个实施例”、“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“在多个实施例中”、“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、结构或特性可按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。这种修改形式和变化形式旨在包括在本发明的范围之内。
本文所用术语“近侧”和“远侧”是相对于操纵外科器械柄部的临床医生而言的。术语“近侧”是指最靠近临床医生的部分,并且术语“远侧”是指远离临床医生的部分。还应当理解,为简洁和清楚起见,本文可以结合附图使用诸如“竖直”、“水平”、“上”和“下”之类的空间术语。然而,外科器械在许多方向和位置中使用,并且这些术语并非限制性的和/或绝对的。
提供了多种示例性装置和方法,用于进行腹腔镜检查和微创外科手术操作。然而,本领域普通技术人员将容易认识到,本文所公开的多种方法和装置可用于许多外科手术和应用中,包括例如与开放性外科手术相关的外科手术和应用。随着本发明的详细说明继续,本领域普通技术人员还将认识到,本文所公开的多种器械可以按任何方式插入体内,例如通过自然腔道、通过组织中形成的切口或穿孔等。器械的工作部分或端部执行器部分可直接插入患者体内,或者可通过进入装置插入,该进入装置具有工作通道,外科器械的端部执行器和细长轴可通过该工作通道推进。
转到附图,其中在若干图中,类似的数字代表类似的组件,图1示出了外科器械10,其能够实践本发明的若干独特有益效果。外科器械10设计用于操纵和/或致动多种形式和尺寸的端部执行器12,该端部执行器能操作地附接到外科器械。在示出的实施例中,例如,端部执行器12包括外科缝合装置,其具有可打开和可关闭的钳口13和15。更具体地讲,端部执行器12包括细长通道14,该通道形成端部执行器12的下钳口13。细长通道14能够支撑钉仓30并且还可运动地支撑砧座20,该砧座用作端部执行器12的上钳口15。端部执行器12可以包括例如以下专利申请中所公开类型的端部执行器:共同未决的美国专利申请No._________,名称为“Curved End Effector For A Stapling Instrument”,代理人案卷号为END6841USCIP3/100526CIP3;美国专利申请No._________,名称为“Surgical StaplerWith Floating Anvil”,代理人案卷号为END6841USCIP2/100526CIP2;以及美国专利申请No._________,名称为“Surgical Stapler With Stationary Staple Drivers”,代理人案卷号为END7013USNP/110377,每个专利申请的全部公开内容以引用的方式并入本文。然而,可以想到,外科器械10可用于激活多种不同的外科端部执行器,所述端部执行器需要至少两个致动运动以进行一种或多种外科活动/动作。例如,多个实施例的独特新型特征可以结合端部执行器成功地应用,所述端部执行器能够对夹在或接合在其中的组织施加射频“RF”能量。因此,本文所公开的外科器械的多个实施例不应限于单独地结合附图中所示类型和形式的端部执行器使用。
在多个具体实施中,端部执行器12能够能操作地联接到细长轴组件100,该细长轴组件从柄部组件400突起。端部执行器12(关闭时)和细长轴组件100可以具有类似的横截面形状,并且其尺寸使其能操作地穿过套管针管或另一种形式的进入器械中的工作通道。如本文所用,术语“能操作地穿过”是指端部执行器12和细长轴组件100的至少一部分通过通道或管开口插入或进入,并且可按完成外科手术所需在其中进行操纵。在一些实施例中,端部执行器12的钳口13和15在关闭位置时可以为端部执行器提供大致圆形的横截面形状,该横截面形状便于其穿过圆形通道/开口。然而,本发明多个实施例的端部执行器以及细长轴组件实施例可具有其他横截面形状,使其可穿过具有非圆形横截面形状的进入通道和开口。因此,关闭的端部执行器的横截面的总体尺寸将与其预期穿过的通道或开口的尺寸相关。因此,例如一个端部执行器可以称为“5mm”端部执行器,这意味着其能操作地穿过直径为至少大约5mm的开口。
在多个实施例中,细长轴组件100可以具有与处于关闭位置的端部执行器12的外径基本相等的外径。例如,5mm端部执行器可以联接到具有5mm横截面直径的细长轴组件100。然而,随着本发明的详细说明继续,将显而易见的是,本发明的多个实施例可以结合不同尺寸的端部执行器有效地使用。例如,10mm端部执行器可以附接到具有5mm横截面直径的细长轴。相反,对于其中提供10mm或更大进入开口或通道的那些应用,细长轴组件100可以具有10mm(或更大)横截面直径,但还可以致动5mm或10mm端部执行器。因此,细长轴组件100的外径可以和与其附接的关闭的端部执行器12的外径相同或不同。
细长轴组件100的构造可以与授予Huitema的美国专利No.5,713,505和授予Huitema等人的美国专利No.5,704,534中所述的那些可铰接的轴结构类似,所述专利的全部公开内容各自以其相应全文以引用的方式并入本文。参见图1和2,在至少一个形式中,外科器械10具有将细长轴组件100联接到柄部组件300的铰接传动装置200。然而,随着本发明的详细说明继续,本领域的技术人员将理解到,本发明的各种独特和新型特征可以结合不可铰接的细长轴组件结构应用。
致动铰接传动装置组件200时,导致端部执行器12相对于细长轴组件100所限定的纵向轴线L-L远程铰接。在至少一个形式中,细长轴组件100包括柔性颈杆组件110。提交于2010年9月24日的美国临时专利申请No.61/386,117中公开了多个柔性颈杆组件,该专利申请的全部公开内容以引用的方式并入本文。柔性颈杆组件110可以由Dow ChemicalCompany以ISOPLAST2510级市售的刚性热塑性聚氨酯构成。柔性颈杆组件110具有柔性颈杆区段111,该部分包括第一柔性颈杆部分112和第二柔性颈杆部分114。这些颈杆部分112、114通过中央纵向肋状物116分开。颈杆部分112、114各自具有多个颈杆肋状物118,该肋状物被基本构造成半圆形盘,它们一起大致形成圆柱形构造。侧狭槽120延伸穿过颈杆肋状物118的每一个,从而提供贯穿第一柔性颈杆部分112和第二柔性颈杆部分114的通道,用于容纳柔性传输带组件150、170。参见(例如)图7。以类似的方式,分隔第一柔性颈杆部分112和第二柔性颈杆部分114的中央纵向肋状物116具有中央纵向狭槽122,用于提供容纳刀杆180的通道。
第一支撑导轨面124和第二支撑导轨面126从柔性颈杆区段111朝近侧延伸,用于支撑柔性传输带组件150、170的往复式运动。如图4中可见,导槽128从柔性颈杆区段111的远端延伸,用于引导刀杆180的往复式运动,如下文将进一步详细讨论。
如图3中可见,第一传输带组件150包括第一传输带152,并且第二传输带组件170包括第二传输带172。此外,第一传输带150具有第一细长结构部分154,并且第二传输带170具有第二细长结构部分174。在器械组装过程中,使第一传输带150和第二传输带170彼此接触时,它们形成细长圆柱体,其具有同心延伸穿过自身的纵向腔体160,用于能操作地容纳穿过腔体的击发杆530。第一传输带152的第一结构部分154具有在其上形成的第一铰接齿条156,并且第二传输带172的第二结构部分174具有在其上形成的第二铰接齿条176,如下文将进一步详细讨论,它们与铰接传动装置组件200驱动性连接。
此外在不同形式中,第一传输带152具有从第一结构部分156朝远侧延伸的第一外部增强带部分157。参见图3。同样,第二传输带172具有从第二结构部分176朝远侧延伸的第二外部增强带部分177。每个外部增强带部分157、177具有多个附接柄162,用于将第一和第二内部铰接带固定到其自身。例如,第一传输带152具有附接到其自身的第一内部铰接带158,并且第二传输带172具有附接到其自身的第二内部铰接带178。第一传输带152和第二传输带172可以由塑料构成,尤其是由EMS-American Grilon以商品名Grivory GV-6H市售的玻璃纤维强化的无定形聚酰胺构成。相反,传输带组件的内部铰接带158、178可以由金属构成,有利地由全硬301不锈钢或其等同物构成。传输带152、172的外部增强带部分157、177上的附接柄162分别被容纳并固定到对应内部铰接带158、178上的多个柄孔164中。参见图3。
在至少一个实施例中,细长仓盒通道14的近端具有一对带连接器耳50。将这些带连接器耳50分别插入并穿过内部铰接带158、178的远端上的连接器环159、179。这样,将能操作地支撑钉仓30的仓盒通道14联接到柔性颈杆组件110的内部铰接带158、178。具体地讲,第一柔性传输带组件150和第二柔性传输带组件170的相对方向的往复运动导致内部铰接带158、178被容纳在柔性颈杆区段111上的颈杆肋状物118的侧狭槽120中,从而使其以类似方式往复运动。在内部铰接带158、178往复运动时,具体地讲当第一带158朝近侧运动然后第二带178朝远侧运动时,由于第一柔性颈杆部分114的颈杆肋状物118朝向彼此运动并且第二柔性颈杆部分116的颈杆肋状物118同时远离彼此运动,第一柔性颈杆部分114和第二柔性颈杆部分116将弯曲。将内部铰接带158、178分别联接到传输带152、172的外部增强带部分157、177可防止内部铰接带158、178在相邻的颈杆肋状物之间扣紧。
通过铰接传动装置200控制第一传输带152和第二传输带172的运动。图3示出了铰接传动装置组件200的一种形式的组成部件。组件200包括致动器210、铰接主体220和喷嘴250。致动器210的旋转运动导致喷嘴250内的铰接主体220产生对应旋转。因此,第一细长传输带152和第二细长传输带172以平行于细长轴组件100的纵向轴线L-L的相对方向轴向往复运动,从而促使端部执行器12远程铰接。
在多个实施例中,铰接主体220具有平台222,该平台由空间上隔开的第一半圆形平台半部224和第二半圆形平台半部226组成。平台半部彼此相对并且基本代表彼此的镜像。第一平台半部224和第二平台半部226分别具有从它们的表面突起的彼此相对的第一制动器225和第二制动器227。每个平台半部224、226具有一组平台齿228,其与另一个平台半部上的一组平台齿间隔约180度。铰接主体220具有从其表面向下延伸的一对旋转阻挡件230以及一对指状凹槽232。传动齿轮240从铰接主体22向下延伸而来。传动齿轮240具有穿过其自身的扩张开口242以及下部枢轴244。在传动齿轮240的扩张开口242中,存在击发杆孔口(未示出),用于容纳穿过其中的击发杆550,从而实现对端部执行器12施加击发运动。传动齿轮240能够分别与第一传动齿条156和第二传动齿条176互相啮合,从而实现第一传输带152和第二传输带172的所需的往复式运动。
铰接传动装置组件200的喷嘴250包括喷嘴主体252。喷嘴主体252具有贯穿其中的轴向孔254,该孔便于第一传输带组件150和第二传输带组件170以及击发杆530和器械10的其他有效组件穿过。喷嘴主体252还具有框架凹槽256和凸缘258,用于将喷嘴主体252紧固到柄部组件300(参见图8)。在不同形式中,制动器外壳260包括喷嘴主体252的一部分。制动器外壳260内形成了环形阵列的制动器齿262。制动器外壳基底264与制动器齿262间隔开。基底264具有一对壁架266,它们在铰接主体220的旋转阻挡件230内互相作用,从而限制旋转程度。将铰接主体220插入制动器外壳260时,铰接主体220的基座支撑在制动器外壳260的基底264上,并且第一平台半部224和第二平台半部226的平台齿228对齐,从而与制动器外壳260的制动器齿262啮合。将弹簧构件268支撑在铰接主体内,用于偏置平台齿228,使其与制动器齿262啮合。
在不同形式中,致动器210由杠杆臂212、顶盖214和一对保持指状物216组成。杠杆臂212安装在顶盖214的顶部。这对保持指状物216从顶盖214的下侧向下延伸而得。每个保持指状物216具有保持夹。将保持指状物216容纳到铰接主体220的指状凹槽232内。将铰接主体的平台半部的第一制动器225和第二制动器227插入圆形顶盖214下侧的狭槽凹陷。有利的是,铰接传动装置组件的三个显著组件的每一个,即致动器、铰接主体和喷嘴可以是注塑成型组件。例如,此类组件可以由EMS--American Grilon以商品名Grivory GV-4H市售的玻璃纤维强化的无定形聚酰胺制成。150。
图3结合图9-11示出了铰接传动装置组件200的致动。致动器210的棘轮旋转导致端部执行器12在多个分立位置与内窥镜式轴组件100的纵向轴线L-L成角度的铰接。图9示出了处于非铰接位置的端部执行器12。在图10中,已旋转铰接传动装置200的铰接主体220上的传动齿轮240,从而以“DD”方向朝远侧驱动第一传输带组件150并以近侧方向“PD”朝近侧驱动第二传输带组件170,这导致端部执行器12相对于纵向轴线L-L以第一方向“FD”铰接。在图11中,已旋转铰接传动装置200的铰接主体220上的传动齿轮240,从而以远侧方向“DD”驱动第二铰接带组件170并以近侧方向“PD”驱动第一铰接带组件150,从而导致端部执行器12相对于纵向轴线L-L以第二方向“SD”枢转。
如图3-7中可见,细长轴组件100还包括远侧闭合管区段190,该区段在柔性颈杆组件110的导槽128上滑动。远侧闭合管区段190的近端191中具有一对直径相对的狭槽192,用于容纳朝远侧突起的柄113,该柄从柔性颈杆部分111突起,以防止远侧闭合管区段190相对于柔性颈杆部分111旋转。在多个实施例中,在导槽128中提供了紧固件孔129。通过保持凸块193将远侧闭合管区段190保持在导槽128上,该凸块延伸进入紧固件孔129。参见图6和图7。此类结构导致闭合管区段190与柔性颈杆组件110轴向运动。闭合管区段190朝远侧运动到与砧座20接触导致砧座20运动到关闭位置,如以下专利中进一步详细描述:共同未决的美国专利申请No._________,名称为“Surgical Stapler With Floating Anvil”,代理人案卷号为END6841USCIP2/100526CIP2,该专利申请的全部公开内容以引用方式并入本文。
如上述专利申请进一步详细描述,砧座20具有从其近端21突起的安装部分22。安装部分22上具有一对支承耳轴24,其能够可枢转地容纳到细长通道14的对应支架15中。参见图5-7。出于组装目的,远侧闭合管区段190具有底部狭缝195。为将砧座20组装到细长通道14,将支承耳轴24设置在细长通道14的对应支架15内,然后将远侧闭合管区段190扣到导槽128上。此类结构用于将砧座20可运动地保持在细长通道14上,并且有利于其相对于钉仓30运动。在不同具体实施中,通过以远侧方向“DD”轴向推进远侧闭合管区段190,以使闭合管区段190的远端196接触砧座20的近端21,砧座20可以朝向外科钉仓30运动。在击发(朝远侧推进)刀杆180前,通过以近侧方向“PD”轴向推进远侧闭合管区段190,可以将砧座20枢转到打开位置(图6),如下文将进一步详细讨论。通过远侧闭合管区段190上的远侧凸块196完成砧座20的此类致动,所述区段延伸进入砧座安装部分22中的细长狭槽25。随着远侧凸块196被朝近侧牵引到狭槽25中,其最终接触狭槽25的近端壁并导致砧座20运动到打开位置。
如图3和6中可见,细长轴组件100还包括附接到柔性颈杆组件110的近侧外部轴区段300。近侧外部轴区段300为基本上刚性的,并且可以通过例如压力配合、粘合剂或其他合适的紧固件结构附接到柔性颈杆组件110的柔性颈杆部分111。如图3中可见,在至少一个实施例中,近侧外部轴区段300的远端302中具有一对相对的凹痕304,该凹痕能够容纳从柔性颈杆部分111突起的对应柄115,使得近侧外部轴区段300的旋转导致柔性颈杆组件110旋转并最终导致端部执行器12旋转。
在至少一个实施例中,近侧外部轴区段300具有近端306,该近端具有狭槽308,用于容纳穿过其中的传动齿轮240,使得近侧外部轴区段300可以相对于该狭槽轴向运动。此外,近侧外部轴区段300的近端306具有在其上形成的凸缘310,这有利于旋转附接到能操作地支撑在柄部组件400内的致动系统410的闭合仓盒420。在多个实施例中,闭合仓盒420可以包括两个仓盒区段422,它们通过粘合剂、按扣结构、螺钉等互连在一起。如图3中可见,在至少一个形式中,闭合仓盒420具有远端424,该远端具有凹槽结构426,其能够容纳近侧外部轴区段300的带凸缘的端部310。此类结构用于将近侧外部轴区段300的近端306附接到闭合仓盒420,同时有利于近侧外部轴区段300相对于闭合仓盒420有选择地旋转。因此,细长轴组件100和能操作地联接到其上的端部执行器12可以有选择地围绕相对于柄部组件400的纵向轴线L-L旋转。
在多个实施例中,柄部组件400包括手枪形外壳,出于组装目的,该外壳可以由两个或更多个零件加工而成。例如,如图所示柄部组件400包括右侧壳体构件402和左侧壳体构件404(图1),所述壳体构件由聚合物或塑料模塑或制造而成,并且设计为配对。此类壳体构件402和404可以通过在其中模塑或形成的按扣结构、钉和承窝和/或通过粘合剂、螺钉等附接到一起。组装时,柄部组件400可运动地支撑闭合仓盒420,用于在其中有选择地轴向行进,从而响应于触发组件(通常标记为430)的致动运动。
在至少一个实施例中,触发组件430包括主要触发器440和次要触发器460。主要触发器440和次要触发器460可枢转地穿在柄部组件400中形成的枢轴销组件430上,使得触发器440和460基本可以相对于彼此运动。此类结构使得触发组件430可相对于柄部组件400围绕枢轴PA-PA枢转。参见图3。主要触发器440具有细长的可抓握的主要触发器桨叶442,该桨叶从主要驱动部分444突起,该主要驱动部分具有在其上形成的击发齿条446。在一个实施例中,次要触发器460具有从次要驱动部分464突起的次要触发器桨叶462,该次要触发器可枢转地穿在枢轴销组件430上。主要驱动部分444具有狭槽448,随着主要触发器桨叶442朝向柄部组件400的手枪式握把部分406枢转,该狭槽能够将次要触发器460的次要驱动部分464容纳到其中。在致动过程中,此类结构基本使得次要触发器460“嵌套”在主要触发器440内。如下文将详细讨论,通过枢转主要触发器440可枢转地致动次要触发器460。因此,在其他实施例中,次要触发器460可以没有次要触发器桨叶442。在不同形式中,通过触发弹簧432(图3、8、12和13中所示)将触发组件430偏置到图1、2、8和12-15中所示未致动位置。
如图3和13中可见,次要触发器460的次要驱动部分464具有在其上形成的闭合齿轮区段466,该区段能够用于与闭合仓盒420下侧上形成的仓盒齿轮齿条423啮合。因此,将次要触发器460朝向手枪式握把406枢转时,以远侧方向“DD”驱动闭合仓盒420。
在多个实施例中,致动系统410还包括致动杆470。致动杆470具有在其上形成的第一致动齿条472,该齿条能够与主要触发器440上的主要齿轮区段446啮合。因此,当主要齿轮区段446与第一致动齿条472啮合时,并且主要触发器440朝向手枪式握把406枢转时,以远侧方向“DD”驱动致动杆470。如图3、8和12中还可见,致动杆470具有在其上形成的第二致动齿条474,该齿条能够与离合器组件480的离合器轴482上的离合器齿484啮合。在多个实施例中,将离合器轴482可旋转地支撑在柄部组件400内,并且还可以在其中横向运动。离合器轴482具有轮毂部分486,该轮毂部分具有多个间隔的齿488,所述齿能够驱动地接合可旋转地支撑在离合器轴482上的传动齿轮490中的齿开口492。传动齿轮490在其周围的一部分上具有传动齿轮区段494,该区段能够与可运动地支撑在柄部组件400中的击发齿条500啮合。
离合器组件480的多个实施例还包括离合器板510,该离合器板可滑动地穿在主要触发器440的主要驱动部分444上的离合器销449上。如图13和15中可见,例如,将离合器销449可运动地容纳到离合器板510的竖直狭槽512内。离合器板510还具有朝远侧延伸的离合器臂514,该离合器臂能够致动地接合离合器轴482上形成的斜板489。此外,使用离合器弹簧520横向地偏置离合器轴480,使得离合器轴482上的齿488与传动齿轮490中的齿开口492啮合。
如图3中可见,击发齿条500联接到击发杆530,该击发杆附接到刀杆180的近端。在多个实施例中,刀杆180可以具有层合构造,从而使其能够在使端部执行器12铰接时弯曲,同时保留足够的刚性,以通过轴组件100朝远侧驱动。在所示实施例中,刀杆180停在电子束切割头182中,该切割头上具有组织切割表面184。已知多种形式的切割头构型,并且可以根据所用端部执行器的具体构型进行应用。例如,所示实施例包括上部导流片186,该导流片能够进入砧座20中的对应狭槽,从而在缝合形成与切断过程中检验砧座20是否处于关闭状态并协助将砧座20保持在关闭状态。还可以通过切割头182保持细长通道14和砧座20之间的间距,方法为切割头182上的中部销187沿细长通道14的一部分滑动,而切割头182上形成的底足188以已知方式沿细长通道14的下表面相对地滑动。上部导流片186和中部销187之间的远侧存在的组织切割表面184切断夹住的组织,同时导致钉仓30内的缝钉对端部执行器12内夹住的组织形成缝合。刀杆180的近端具有近侧承窝189,该承窝能够容纳击发杆530的远端部分532。如下文将进一步详细讨论,击发杆530有利于通过致动系统410对刀杆180施加击发和回缩动作。在不同结构中,击发杆530延伸穿过安装在柄部组件400内的闭合轴衬540。在至少一个形式中,一对安装螺柱407从柄部壳体402、404突起并且延伸穿过闭合仓盒420中的对应狭槽,从而容纳到轴衬540中的保持狭槽中。附接到保持夹552的闭合弹簧550穿在闭合轴衬540上。闭合弹簧550在喷嘴主体252和闭合仓盒420的内壁425之间延伸。因此,闭合弹簧550用于以近侧方向“PD”偏置闭合仓盒420。
多个实施例还包括可脱开的闭合锁定组件560,该组件与闭合仓盒420连接,用于将闭合仓盒420有选择地保持在其最远侧关闭位置或夹住位置。在至少一个形式中,闭合锁定组件560包括锁定按钮562,该按钮可枢转地支撑在柄部组件400中。锁定按钮562具有锁臂564,该锁臂能够在按钮562位于锁定位置时,邻接闭合仓盒420上形成的闭锁横档426。此外,锁臂564具有在其上形成的扣件566,该扣件能够以可脱开的方式锁闭击发齿条500近端上的锁定插销502。锁定弹簧568用于将锁定按钮562偏置到锁定位置。参见图16。
现在将结合图12-33描述外科器械10的操作。图12和13示出了端部执行器12的处于打开位置的钳口13和15。如图12中可见,当器械100位于打开位置时,将锁臂564设置在闭合仓盒420上形成的闭锁横档426的顶部,使得锁臂564的扣件566保持与击发齿条500上的锁定插销502接合。因此,处于该初始位置时,不能无意地致动刀杆180。图13-15还示出了处于初始未致动位置的外科器械10。如那些图中可见,离合器板510位于最近侧未致动位置。此外,闭合仓盒420位于其最近侧初始位置或未致动位置。处于该位置时,离合器轴482上的离合器传动斜边489与闭合仓盒420的一部分接触,这防止了离合器轴482在离合器弹簧520的偏置下横向运动到与传动齿轮490啮合。
图16-19示出了已对触发组件430施加第一行程后的外科器械10。也就是说,触发组件430已朝向手枪式握把406初始地枢转。此类枢转动作用于通过次要触发器460上的闭合齿轮区段466和闭合仓盒420下侧形成的仓盒齿条423之间的啮合,而以远侧方向“DD”驱动闭合仓盒420。此类闭合仓盒420的远侧运动还以远侧方向“DD”轴向推进近侧外部轴区段300和远侧闭合管区段190。当远侧闭合管区段190朝远侧运动时,其远端196接触砧座20的近端21,从而使砧座20朝向外科钉仓30运动。如果外科医生希望只是在将组织夹在砧座20和外科钉仓30间之前抓紧和操纵组织,可以枢转触发组件430以打开和关闭砧座20,而无需触发组件430完全枢转到图16所示完全关闭位置。
本领域普通技术人员将理解到,朝向手枪式握把406枢转触发组件430时,也必然将通过主要触发器440上的主要齿轮区段446和致动杆470上的第一致动齿条472之间的啮合,朝远侧驱动致动杆470。致动杆470的远侧运动还将通过离合器轴482上的离合器齿484和致动杆470上的第二致动齿条474之间的啮合,对离合器轴482施加旋转致动运动。然而,不对传动齿轮490施加此类旋转运动,因为离合器板510的离合器臂514与离合器轴482上的离合器传动斜边489接触,防止了离合器轴482轴向运动到与传动齿轮490啮合。因此,离合器轴482相对于传动齿轮490自由地旋转。因此,在触发组件430的初始致动过程中,离合器组件480自动地阻止击发齿条500的激活。
一旦将触发组件430初始地完全压入关闭位置(图16),砧座20将通过闭合锁定组件560保持在锁定位置或夹合位置,这防止了闭合仓盒420的近侧运动。更具体地讲,如图16中可见,将触发组件430初始地枢转到关闭位置时,锁定按钮562的锁臂564枢转离开闭合仓盒420上形成的闭锁横档426,并由此防止闭合仓盒420在闭合弹簧550的偏置下以近侧方向“PD”运动。因此,当外科医生释放触发组件430时,闭合仓盒420和端部执行器12保持在锁定位置或夹紧位置。外科医生释放触发组件430后,主要触发器440在触发弹簧432的偏置力下回到其初始位置。次要触发器460通过次要触发器460上的闭合齿条466和闭合仓盒420下侧形成的仓盒齿条423之间的啮合,保持在其锁定位置。现在致动系统410准备好对端部执行器12施加第二致动运动,用于切割和缝合夹在其中的组织。
图20-23示出了处于其“准备击发”位置的外科器械10。如图20所示,处于准备击发位置时,锁臂564上的扣件566已脱离击发齿条500的锁定插销502。如图21中可见,将闭合仓盒420推进到其最远侧关闭位置时,其不再接触离合器轴482上的离合器传动斜边489。当外科医生释放触发组件430时,弹簧432导致主要触发器440回到其未致动的初始位置。随着主要触发器440枢转到初始位置,离合器销449通过滑动接合到离合器板510中的狭槽512中,导致离合器板510以近侧方向“PD”运动。随着离合器臂514朝近侧运动,轴臂514中的弧形凸起516与离合器传动斜边489重叠,由此允许离合器弹簧520将离合器轴482横向偏置到与传动齿轮490啮合。参见图22和图23。一旦离合器轴482与传动齿轮490啮合,主要触发器440的再次致动将导致朝远侧驱动击发齿条500。
图24-27示出了器械10的击发。具体地讲,要朝远侧驱动刀杆180穿过夹在端部执行器12中的组织,外科医生朝向柄部组件400的手枪式握把406再次枢转主要触发器440。枢转主要触发器440时,以远侧方向“DD”驱动击发齿条500、击发杆530和刀杆180。驱动刀杆180穿过夹在端部执行器12中的组织后,外科医生释放主要触发器440,由此允许主要触发器440在击发弹簧432的偏置下枢转到其未致动位置。随着主要触发器440枢转回到初始位置,将击发齿条500、击发杆530和刀杆180朝近侧牵引回到其相应初始位置。端部执行器12保持在其如图28-31所示的夹紧位置。随着主要触发器440枢转回到初始位置,离合器销449运动离合器板510,从而再次使离合器板510的轴臂514中的凸起516与离合器传动斜边489对齐,如图29-31所示。闭合仓盒420保持在锁定位置。
要对闭合仓盒420和次要触发器460解锁,外科医生将按压锁定按钮562。按压锁定按钮562时,枢转锁定臂564,使其脱离与闭合仓盒420上的闭锁横档426的邻接接合,如图32所示。此类动作允许通过闭合弹簧550以近侧方向“PD”偏置闭合仓盒420。随着闭合仓盒420以近侧方向“PD”运动,将次要触发器460驱动到初始位置。随着闭合仓盒420朝近侧运动,其上的斜面421接触离合器传动斜边489并横向偏置离合器传动轴482,使其脱离与传动齿轮490的啮合。处于如图33所示初始位置时,闭合仓盒420保持离合器传动轴482脱离与传动齿轮490的啮合。随着闭合仓盒420朝近侧运动,将近侧外部轴区段300、柔性颈杆组件110和远侧闭合管区段190朝近侧牵引。随着远侧闭合管区段190朝近侧运动,其上的远侧凸块196接触砧座组件20中狭槽25的近端壁,并导致砧座组件20枢转到所示打开位置。
因此,如从上文可理解到,本发明的至少一个外科器械实施例可通过连续致动触发组件而手动致动。也就是说,本文所公开的至少一种形式的外科器械应用了致动系统,该致动系统能够在连续致动器械的触发组件后,对联接到致动系统的端部执行器施加至少两次致动运动。致动运动中的一者包括施加到闭合仓盒和近侧外部轴区段的第一轴向闭合动作,该区段最终导致端部执行器钳口闭合。第二致动运动包括在触发组件施加第二致动(“行程”)后对端部执行器施加的另一个轴向运动。在至少一种形式中,对刀杆施加第二轴向运动,轴向驱动刀杆穿过端部执行器,从而切割组织并击发能操作地支撑在端部执行器中的缝钉。虽然已结合能够用于切割和缝合组织的端部执行器的使用和致动对本文所公开的外科器械的多个实施例进行描述,但本领域普通技术人员将理解到,本文所公开的各种外科器械及其等同结构可以结合其他外科端部执行器有效应用,所述端部执行器可通过对其施加至少一次轴向致动运动而致动。
图34-48示出了另一个外科器械实施例610。外科器械610设计用于操纵和/或致动多种形式和尺寸的端部执行器612,所述端部执行器能操作地附接到外科器械。在示出的实施例中,例如,端部执行器612包括外科缝合装置,其具有可打开和可关闭的钳口613和615。更具体地讲,端部执行器612包括细长通道614,该通道形成端部执行器612的下钳口613。细长通道614能够支撑能压缩钉仓630,所述钉仓可以具有如下专利申请中所公开的类型和构造:共同未决的美国专利申请No._________,名称为“Staple Cartridge IncludingCollapsible Deck”,代理人案卷号为END7020USNP/110374,以及美国专利申请No._________,名称为“Staple Cartridge Including Collapsible Deck Arrangement”,代理人案卷号为END7019USNP/110375,以及美国专利申请No.12/894,351,名称为“Surgical Cutting and Fastening Instruments With Separate and DistinctFastener Deployment and Tissue Cutting Systems”,所述专利申请的公开内容各自以其相应全文以引用的方式并入本文。然而,可以想到,外科器械610可用于激活多种不同的外科端部执行器。例如,多个实施例的独特新型特征可以结合端部执行器成功地应用,所述端部执行器能够对夹在或接合在其中的组织施加射频“RF”能量。因此,本文所公开的外科器械的多个实施例不应限于单独地结合附图中所示类型和形式的端部执行器使用。
在各种具体实施中,端部执行器612能够能操作地联接到细长轴组件700,该细长轴组件从柄部组件900突起。端部执行器612(关闭时)和细长轴组件700可以具有类似的横截面形状,并且其尺寸使其能操作地穿过套管针管或另一种形式的进入器械中的工作通道。如本文所用,术语“能操作地穿过”是指端部执行器612和细长轴组件700的至少一部分通过通道或管开口插入或进入,并且可按完成外科手术所需进行操纵。在一些实施例中,端部执行器612的钳口613和615在关闭位置时可以为端部执行器提供大致圆形的横截面形状,该横截面形状便于其穿过圆形通道/开口。然而,本发明多个实施例的端部执行器以及细长轴组件实施例可具有其他横截面形状,使其可穿过具有非圆形横截面形状的进入通道和开口。因此,关闭的端部执行器的横截面的总体尺寸将与其预期穿过的通道或开口的尺寸相关。因此,例如一个端部执行器可以称为“5mm”端部执行器,这意味着其能操作地穿过直径为至少大约5mm的开口。
在多个实施例中,细长轴组件700可以具有与关闭位置的端部执行器612的外径基本相等的外径。例如,5mm端部执行器可以联接到具有5mm横截面直径的细长轴组件100。然而,随着本发明的详细说明继续,将显而易见的是,本发明的多个实施例可以结合不同尺寸的端部执行器有效地使用。例如,10mm端部执行器可以附接到具有5mm横截面直径的细长轴。相反,对于其中提供10mm或更大进入开口或通道的那些应用,细长轴组件700可以具有10mm(或更大)横截面直径,但还可以致动5mm或10mm端部执行器。因此,细长轴组件700的外径可以和附接到其上的关闭的端部执行器612的外径相同或不同。
如图34-37中所示,在至少一个实施例中,细长轴组件700包括柔性的铰接接头区段720。在多个实施例中,柔性的铰接接头区段720包括有孔的轴,出于组装目的,该轴由两个零件制成。也就是说,柔性的铰接接头区段720包括有孔的上部接头区段730和有孔的下部接头区段740,它们通过按扣结构、粘合剂、紧固件等互连。柔性的铰接接头区段720可以由例如Dow Chemical Company以ISOPLAST2510级市售的刚性热塑性聚氨酯构成。如图37可见,在至少一个实施例中,上部接头区段730具有柔性上部颈杆区段731,该区段包括第一上部柔性颈杆部分732和第二上部柔性颈杆部分733。这些上部颈杆部分732、733通过中央纵向上部肋状物734分开。同样,下部接头区段740具有柔性下部颈杆区段741,该区段包括第一下部柔性颈杆部分742和第二下部柔性颈杆部分743。这些下部颈杆部分742、743通过中央纵向下部肋状物744分开。上部颈杆部分732、734各自具有多个上部颈杆肋状物735。下部颈杆部分742和743各自具有多个下部颈杆肋状物745。上部颈杆肋状物735和下部颈杆肋状物745被基本构造为半圆形盘,当上部接头区段730与下部接头区段740接合时,所述半圆形盘一起大致形成圆柱体构型。
在多个实施例中,上部接头区段730还具有上部管状部分736,并且下部接头区段740具有下部管状部分746。接合在一起时,上部管状部分736和下部管状部分746用于将两个远侧突起的附接臂616容纳到其中,所述附接臂从细长通道614朝近侧突起。附接臂616上具有附接凸块618,其接合上部管状部分736,从而将细长通道614附连到细长轴组件700。还可以使用其他方法将细长通道614附接到细长轴组件700。
在至少一个实施例中,细长轴组件700包括基本上刚性的近侧外部轴区段760,该区段具有远端762,该远端通过例如销或舌状物以及凹槽狭槽结构联接到柔性的铰接接头720。近侧外部轴区段760还具有近端764,该近端不可旋转地联接到喷嘴组件770,该喷嘴组件可旋转地支撑到柄部组件900上。在多个实施例中,柄部组件900包括手枪形外壳902,出于组装目的,该外壳可以由两个或更多个零件制成。例如,如图所示柄部组件900包括右侧壳体构件904和左侧壳体构件906(图34),所述壳体构件由聚合物或塑料模塑或制造而成,并且设计为配对。此类壳体构件904和906可以通过在其中模塑或形成的按扣结构、针和承窝和/或通过粘合剂、螺钉等附接到一起,并与手枪式握把部分908形成柄部组件。
在多个实施例中,喷嘴组件770包括喷嘴构件772,该喷嘴构件通过例如焊接、胶合、压力配合等不可旋转地附接到喷嘴轴衬774。在至少一个形式中,喷嘴轴衬774具有一对凸缘,这对凸缘可旋转地支撑到设置在外壳900中的对应腔体中。此类结构允许喷嘴构件772相对于柄部外壳902有选择地旋转。外部轴区段760的近端764延伸穿过喷嘴构件772和喷嘴轴衬774,并且通过例如焊接、胶合、压力配合等附接到这两者。此类结构允许外科医生通过相对于柄部外壳902旋转喷嘴构件772,从而围绕纵向轴线L-L旋转端部执行器612。
此外,柔性的铰接接头区段720的上部730和下部740接合在一起时形成容纳刀杆组件780的通道750。在不同形式中,刀杆组件780包括远侧刀杆部分782,该部分可以具有层合构造,从而确保其弯曲穿过柔性的铰接接头区段720。在所示实施例中,远侧刀杆部分782停在切割头784中,该切割头上具有组织切割表面786。
端部执行器612的多个实施例包括具有一对耳轴622的砧座620,该耳轴能够可运动地容纳到细长通道614中的腔体619中。在所示实施例中,切割头784能够能操作地保持砧座620与细长通道614活动接合。例如,在至少一个实施例中,切割头784包括上部导流片787,该导流片能够延伸进入形成于砧座620中的囊袋623中,并且用于将砧座620保持在细长通道614上。通过刀杆组件780在远侧方向“DD”上的轴向运动,使砧座620在打开位置(图38)和关闭位置(图39-41)之间枢转。切割头784还具有在其上形成的下部导流片787,使得朝远侧驱动切割头784时,砧座620被压入能操作地支撑在细长通道614上的可压碎能植入仓盒630中。随着砧座620被压入仓盒630中,支撑在仓盒内的缝钉被压入夹在端部执行器612中的组织中,并在组织切割线的两侧形成缝合。在切割组织并形成缝合后,切割头784以近侧方向“PD”回缩到初始位置,其中切割头784与砧座620互相作用,使砧座620运动到如图38所示打开位置。
如下文将进一步详细讨论,在至少一个实施例中,通过人工激活能操作地支撑在柄部组件900上的击发触发器,控制刀杆组件780的轴向推进和回缩。如图36中可见,连接器构件790联接到远侧刀杆部分782的近端787。在至少一个实施例中,例如,连接器构件790通过销固定到远侧刀杆部分782的近端787,并且具有朝近侧突起的附接结构792,该附接结构能够联接到中空刀管800的远端802。中空刀管800延伸穿过外部轴区段760并进入柄部外壳902,并且附接到仓盒组件810。在多个实施例中,例如,仓盒组件810包括有凸缘的仓盒轴衬812,该仓盒轴衬压力配合到刀管800的一部分上。仓盒组件810还包括击发仓盒814,其具有在其中形成的鞍,该鞍能够延伸越过轴衬凸缘813之间的仓盒轴衬812。在至少一个形式中,击发仓盒814还具有一对横向延伸部分816,其各自具有在其上形成的支撑凸块818。支撑凸块818能够可滑动地容纳到柄部外壳902中形成的对应滑动通道中(未示出)。此类结构允许击发仓盒814在柄部组件900内轴向运动,并由此对刀管800施加轴向致动运动,同时允许刀管800随着喷嘴组件770旋转,相对于击发仓盒824围绕纵向轴线L-L旋转。
在至少一个实施例中,通过可枢转地支撑到柄部组件900上的击发触发组件820,可以对击发仓盒814手动施加致动运动。击发触发组件820包括具有附接板824的击发触发器822,该附接板能够与一对致动板826能操作地交接。如图36中可见,附接板824位于致动板826之间,并且通过第一枢轴销828可枢转地通过销固定到致动板,该第一枢轴销延伸穿过致动板826中的狭槽830和附接板824中的孔825。通过安装柄将第二枢轴销832容纳或支撑到柄部壳体904、906中,并且在致动板826中的孔834之间延伸。致动板826的每一个具有延伸进入击发仓盒814的对应囊袋或开口815的柄836。此类结构有利于通过相对于柄部外壳902枢转击发触发器822,对刀管800施加轴向致动运动。朝向柄部外壳902的手枪式握把部分908枢转击发触发器822时,以远侧方向“DD”驱动击发仓盒814。远离柄部外壳902的手枪式握把部分908枢转击发触发器822时,击发仓盒814以近侧方向“PD”牵引刀管800。
外科器械610的多个实施例还包括锁定系统840,其包括可枢转地联接到柄部外壳902的锁定触发器842。锁定触发器842包括锁定杆部分844,其能够能操作地接合锁定构件846,该锁定构件通过销849可枢转地附接到击发触发器822的附接板824。当锁定触发器842位于未致动位置时,锁定杆842防止锁定构件846枢转超过图40中所示点。
现在将结合图37-42对端部执行器612的致动进行阐释。图37示出了处于未击发位置的外科器械610,其具有处于打开位置的端部执行器612。握住柄部组件900的手枪式握把部分908时,外科医生可以通过对如图39所示击发触发器822施加致动力“F”,对端部执行器612的砧座620施加关闭动作。此类动作导致致动板826对击发仓盒814施加致动运动,最终导致刀管800以远侧方向“DD”轴向位移。以远侧方向“DD”推进刀管800时,同样以远侧方向“DD”驱动刀杆组件780。以远侧方向“DD”驱动刀杆组件780、更具体地讲切割头784时,切割头784向前移出砧座620中的囊袋623,并接触砧座620上的斜面结构625,从而开始对砧座620施加关闭动作。对击发触发器822再次施加致动力“F”导致如图40所示刀管800和切割头784进一步轴向位移。此类动作使砧座620进一步朝向细长通道614运动。击发触发器822朝向柄部组件900的手枪式握把部分908枢转时,锁定构件848也围绕销849以逆时针“CCW”方向枢转。这时,通过锁定系统840防止切割头784以远侧方向“DD”继续运动。更具体地讲,如图40中可见,通过锁定触发器842的锁定杆部分844防止锁定构件848的远端围绕销849以逆时针“CCW”方向继续枢转。因此,外科医生可以运动砧座620,以捕获和操纵端部执行器612中的组织,而不必冒险真的“击发”端部执行器612(即,或切割组织和形成缝合)。
一旦外科医生需要切割组织和形成缝合,即对锁定触发器842施加第二致动力“F’”,如图41所示。如该图中可见,当压下锁定触发器842时,锁定杆部分844枢转到向前位置,由此允许锁定构件848在外科医生继续对触发器822施加致动力“F”时继续以逆时针方向枢转。击发触发器822的此类致动导致切割头784穿过砧座620的轴向位移。切割头784朝远侧运动穿过端部执行器612时,切割表面786切割组织,并且砧座620被片787、788压入仓盒630内。随着砧座620被压入仓盒630内,支撑在其中的缝钉在组织切割线每侧上的组织内形成缝合。
完成切割和缝合过程后,可以释放击发触发器822。附接到击发触发器822的回位弹簧(未示出)将击发触发器822返回到未致动位置。或者,如果不使用弹簧,用户可使用触发器的吊钩结构“拉”开触发器。击发触发器822以顺时针“CW”方向运动时,击发仓盒814以近侧方向“PD”运动,这也使得刀杆组件780以近侧方向“PD”运动。切割头784再次进入砧座620中的囊袋623时,砧座620再次枢转到打开位置。
本发明的多个形式还使用独特新型的铰接系统(通常标记为1000)使端部执行器612围绕柔性的铰接接头720铰接。在至少一个实施例中,铰接系统1000包括第一铰接带组件1010和第二铰接带组件1020。然而,应当理解的是,在可供替代的实施例中,仅使用一个铰接带组件。在至少一个实施例中,第一铰接带组件1010包括柔性的第一远侧区段1012,该区段由例如弹簧钢、420不锈钢、钛、400或300等级不锈钢制成,并且具有在其远端形成的第一吊钩1014。第一吊钩1014能够钩状接合纵向轴线L-L第一侧上的柔性的铰接接头720的下部管状部分746中形成的第一吊钩容纳结构748。第一铰接带组件1010还包括附接到(如通过销固定到)第一远侧区段1012的第一结构带部分1016。第一结构带部分1016可以由例如弹簧钢、420不锈钢、钛制成。同样,第二铰接带组件1020包括柔性的第二远侧区段1022,该区段由例如弹簧钢、420不锈钢、钛制成,并且具有在其远端形成的第二吊钩1024。参见图36。第二吊钩1024能够钩状接合纵向轴线L-L第二侧上的柔性的铰接接头720的下部管状部分746中形成的第二吊钩容纳结构749。第二铰接带组件还包括附接到(如通过销固定到)第二远侧区段1022的第二结构带部分1026。第二结构带部分1026可以由例如400或300等级不锈钢制成。
铰接系统1000的多个实施例包括支撑在柄部组件900内的新型铰接传动装置1030,用于对第一铰接带组件1010和第二连铰接带组件1020施加铰接运动。在不同形式中,铰接传动装置1030包括致动器轮1040,该致动器轮可旋转地支撑在柄部组件900上,用于有选择地围绕致动轴线旋转。在至少一个实施例中,致动轴线与纵向轴线L-L重叠或基本上同轴。因此致动轴线不与纵向轴线横向相交。在其他实施例中,致动轴线可以基本上平行于纵向轴线。为便于组装和制造,致动器轮1040由两个零件1040A、1040B制成,它们可以通过螺钉、按扣结构、粘合剂等附接到一起。组装时,致动器轮1040具有第一组致动器螺纹1042,其被构造为第一方向,用于螺纹接合第一螺母组件1060。此外,致动器轮还具有第二组致动器螺纹1044,其被构造为不同于第一方向的第二方向。例如,第一螺纹1042可以包括“右旋”螺纹,并且第二螺纹1044可以包括“左旋”螺纹,或者两者相反。第二螺纹1044能够通过螺纹接合第二螺母组件1070。
在多个实施例中,第一螺母组件1060包括第一盘1062,该第一盘具有在其上形成的第一螺纹1064。第一盘1062通过第一轴承衬套1066支撑在刀管800上。第一轴承衬套1066有利于第一盘1062相对于刀管800运动。相似地,第二螺母组件1070包括第二盘1072,该第二盘具有在其上形成的第二螺纹1074。第二盘1072通过第二轴承衬套1076支撑在刀管800上,该第二轴承衬套有利于第二盘1072相对于刀管800运动。第一盘1062和第二盘1072同样可运动地支撑在上部螺母轨道1050和下部螺母导轨1052上,所述螺母导轨安装到柄部壳体904、906中模塑的六角隔离柱905。参见图36。上部螺母导轨1050和下部螺母导轨1052用于防止第一盘1062和第二盘1072相对于柄部外壳902旋转,因此,相对于柄部外壳902旋转致动器轮1040时,第一轴承衬套1066和第二轴承衬套1076在刀管800上以不同方向轴向运动。
通过相对于柄部外壳902旋转致动器轮1040,控制第一带组件1010和第二带组件1020。为便于施加此类控制动作,第一结构带部分1016具有第一扣件构件,该第一扣件构件能够固定地接合第一轴承衬套1066,并且第二结构带部分1026具有第二扣件构件,该第二扣件构件能够固定地接合第二轴承衬套1076。此外,至少一个形式的铰接系统1000包括细长支撑梁1080,该支撑梁在刀管800内纵向延伸,从而为刀管800内的第一结构带部分1016和第二结构带部分1026提供侧向支撑。支撑梁1080可以由例如400或300等级不锈钢制成,并且能够有利于第一结构带部分1016和第二结构带部分1026轴向运动,同时对其提供侧向支撑。
结合图43-48可以理解铰接系统1000的操作。图43和44示出了处于非铰接活动的位置的外科器械610。也就是说,端部执行器612处于非铰接活动的位置时,基本上在纵向轴线L-L上轴向对齐,如图43所示。处于该“中立”位置时,第一盘1062和第二盘1072在图44所示位置处彼此间隔开。为了给外科医生提供铰接系统1000已停在中性位置的时间指示,将制动器组件1090安装在柄部外壳902内。制动器组件1090在外壳902内,并且能够接合致动器轮1040的轮毂部分1041中的凹槽(未示出)。参见图36。制动器组件902能够在致动器轮1040位于中性位置时接合凹槽。当制动器1090接合凹槽时,外科医生可以接收触觉和/或听觉指示。
图45和46示出了端部执行器612相对于纵向轴线L-L以第一铰接方向“FAD”铰接。铰接系统1000使端部执行器612以如下方式围绕柔性的铰接接头720铰接。首先,外科医生以第一方向旋转铰接致动器轮1040,这导致第一盘1062和第二盘1072朝向彼此运动到图46所示位置。当第一盘1062以近侧方向“PD”运动时,通过联接到第一轴承衬套1066的第一扣件结构1017,以近侧方向“PD”牵引第一铰接带组件1010。同样,当第二盘1072以远侧方向“DD”运动时,通过联接到第二轴承衬套1076的第二扣件结构1027,以远侧方向“DD”推动第二铰接带组件1020。第一铰接带组件1010和第二铰接带组件1020的此类动作导致端部执行器612通过与联接到端部执行器612的柔性的铰接接头720的下部管状部分746互连的第一铰接带1010和第二铰接带1020,以第一铰接方向“FAD”铰接。
图47和48示出了端部执行器612相对于纵向轴线L-L以第二铰接方向“SAD”铰接。铰接系统1000使端部执行器612以如下方式围绕柔性的铰接接头720铰接。首先,外科医生以第二方向旋转铰接致动器轮1040,这导致第一盘1062和第二盘1072远离彼此运动到图48所示位置。当第一盘1062以远侧方向“DD”运动时,通过联接到第一轴承衬套1066的第一扣件结构1017,以远侧方向“PD”推动第一铰接带组件1010。同样,当第二盘1072以近侧方向“PD”运动时,通过联接到第二轴承衬套1076的第二扣件结构1027,以近侧方向“PD”牵引第二铰接带组件1020。第一铰接带组件1010和第二铰接带组件1020的此类动作导致端部执行器612通过与联接到端部执行器612的柔性的铰接接头720的下部管状部分746互连的第一铰接带1010和第二铰接带1020,以第二铰接方向“SAD”铰接。
可将本发明所公开的装置设计为单次使用后即进行处理,或者可将它们设计为可多次使用。然而,在任一种情况下,所述装置均可进行修复,以在至少一次使用后再次使用。修复可包括如下步骤的任意组合:拆卸该装置、然后清洗或置换某些部分以及随后组装。特别是,所述装置可以拆卸,而且可以任意组合有选择地置换或移除该装置任意数目的特定零件或部件。清洗和/或置换特定部件后,该装置可以在修复设施处重新组装以便随后使用,或者在即将进行外科手术前由外科手术队重新组装。本领域的技术人员将会知道,装置的修复可利用多种用于拆卸、清洗/置换和重新组装的技术。这些技术的使用以及所得的修复装置均在本发明的范围内。
优选的是,在手术前处理本文所述的装置。首先,获取新的或用过的器械,并在必要时对装置进行清洁。然后对器械进行消毒。在一种消毒技术中,将该器械置于闭合并密封的容器中,例如塑料或TYVEK袋中。然后将容器和器械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。辐射将器械上和容器中的细菌杀死。然后将灭菌后的器械保存在消毒容器中。该密封容器将器械保持无菌,直到在医疗设备中打开该器械。
以引用方式全文或部分地并入本文的任何专利、公布或其他公开材料均仅在所并入的材料不与本发明所述的现有定义、陈述或其他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相冲突材料。如果据述以引用方式并入本文但与本文所述的现有定义、陈述或其他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。
尽管已经将本发明作为示例性设计进行了描述,但还可以在本公开的精神和范围内对本发明进行修改。因此本专利申请旨在涵盖采用本发明一般原理的任何变型型式、用途或修改型式。此外,本专利申请旨在涵盖本发明所属领域中属于已知或惯有实践范围内的与本公开不同的型式。

Claims (7)

1.一种外科器械,包括:
柄部组件;
与所述柄部组件能操作地交接并且限定纵向轴线的细长轴组件;
外科端部执行器,所述外科端部执行器能操作地联接到所述细长轴组件,并且能够在对其施加致动运动时切割和缝合组织;
由所述细长轴组件能操作地支撑的至少一个铰接构件;和
铰接系统,所述铰接系统包括:
铰接传动装置,所述铰接传动装置由所述柄部组件能操作地支撑并且与所述至少一个铰接构件能操作地交接;和
致动器构件,所述致动器构件能够旋转地支撑在所述柄部组件上,用于围绕与所述纵向轴线基本上共轴的致动轴线选择性旋转,所述致动器构件与所述铰接传动装置交接,使得所述致动器构件围绕所述致动轴线在第一旋转方向上的旋转导致所述至少一个铰接构件相对于所述纵向轴线在第一铰接方向上铰接所述外科端部执行器,并且所述致动器构件围绕所述致动轴线在第二旋转方向上的旋转导致所述至少一个铰接构件相对于所述纵向轴线在相对于所述纵向轴线的第二铰接方向上铰接所述外科端部执行器;
其中所述至少一个铰接构件包括:
第一铰接带组件,所述第一铰接带组件由所述细长轴组件能操作地支撑并且在所述纵向轴线的第一侧上联接到所述基本上柔性的铰接接头区段的一部分,所述第一铰接带组件与所述铰接传动装置能操作地交接;和
第二铰接带组件,所述第二铰接带组件由所述细长轴组件能操作地支撑并且在所述纵向轴线的第二侧上联接到所述基本上柔性的铰接接头区段的所述部分,所述第二铰接带组件与所述铰接传动装置能操作地交接;
其中所述铰接传动装置包括:
第一铰接盘,所述第一铰接盘能够运动地支撑在所述柄部组件内并与所述致动器构件和所述第一铰接带组件交接,使得所述致动器构件在第一旋转方向上旋转时导致所述第一铰接带组件在第一轴向上运动;和
第二铰接盘,所述第二铰接盘能够运动地支撑在所述柄部组件内并与所述致动器构件和所述第二铰接带组件交接,使得所述致动器构件在所述第一旋转方向上旋转时导致所述第二铰接盘在与所述第一轴向相对的第二轴向上运动。
2.根据权利要求1所述的外科器械,其中所述细长轴组件中具有基本上柔性的铰接接头区段,所述区段联接到所述外科端部执行器。
3.根据权利要求1所述的外科器械,其中所述第一铰接盘与所述致动器构件能操作地交接,使得所述致动器构件在第二旋转方向上旋转时导致所述第一铰接带组件在所述第二轴向上运动并且所述第二铰接带组件在所述第一轴向上运动。
4.根据权利要求1所述的外科器械,其中所述第一铰接盘和第二铰接盘与所述致动器构件螺纹接合。
5.根据权利要求4所述的外科器械,其中所述致动器构件包括致动器轮,该致动器轮能够旋转地支撑在所述柄部组件上以相对于所述柄部组件围绕所述致动轴线选择性旋转,所述致动器轮具有与所述第一铰接盘螺纹接合的第一螺纹以及与所述第二铰接盘螺纹接合的第二螺纹,所述第一螺纹具有第一螺纹方向并且所述第二螺纹具有与所述第一螺纹方向相对的第二螺纹方向。
6.根据权利要求1所述的外科器械,其中所述外科端部执行器能够在其中支撑能植入钉仓。
7.根据权利要求1所述的外科器械,还包括:
由所述细长轴组件能操作地支撑的刀杆;
由所述柄部组件能操作地支撑的击发传动装置;和
击发触发器,所述击发触发器由所述柄部组件能操作地支撑并且能够对所述击发传动装置施加致动运动,从而导致在远侧方向上驱动所述刀杆穿过所述外科端部执行器。
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