CN103118618A - 用于铰接外科装置的铰接接头结构 - Google Patents

用于铰接外科装置的铰接接头结构 Download PDF

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CN103118618A
CN103118618A CN201180046071XA CN201180046071A CN103118618A CN 103118618 A CN103118618 A CN 103118618A CN 201180046071X A CN201180046071X A CN 201180046071XA CN 201180046071 A CN201180046071 A CN 201180046071A CN 103118618 A CN103118618 A CN 103118618A
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hinge portion
jaw
end effector
surgical device
electro
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CN103118618B (zh
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B·C·沃雷尔
D·K·诺维尔
C·J·沙伊布
F·E·谢尔顿四世
G·S·斯特罗布尔
J·S·斯韦兹
G·A·特里斯
J·E·泽克勒
K·M·蒙戈马利
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Ethicon Endo Surgery Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical 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
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
    • A61B18/1447—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod wherein sliding surfaces cause opening/closing of the end effectors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B17/295—Forceps for use in minimally invasive surgery combined with cutting implements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical 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
    • A61B18/14—Probes or electrodes therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical 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
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003—Steerable
    • A61B2017/00305—Constructional details of the flexible means
    • A61B2017/00314—Separate linked members
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00601—Cutting
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/0063—Sealing
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical 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
    • A61B18/1206—Generators therefor
    • A61B2018/1246—Generators therefor characterised by the output polarity
    • A61B2018/126—Generators therefor characterised by the output polarity bipolar
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical 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
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B2018/1452—Probes having pivoting end effectors, e.g. forceps including means for cutting
    • A61B2018/1455—Probes having pivoting end effectors, e.g. forceps including means for cutting having a moving blade for cutting tissue grasped by the jaws

Abstract

一种电外科装置包括主体、端部执行器、切割构件、和轴。端部执行器包括可操作成将RF能量递送到夹在钳口之间的组织的一对钳口。切割构件可操作成切断夹在钳口之间的组织。轴在主体与端部执行器之间延伸。轴包括铰接部分，该铰接部分可操作成将端部执行器有选择地定位在相对于轴的纵向轴线的非平行位置处。一些版本包括在铰接部分的远侧的旋转部分。旋转部分可操作成使端部执行器相对于铰接部分旋转。

Description

用于铰接外科装置的铰接接头结构
优先权
本申请要求2010年9月24日提交的名称为“Articulating SurgicalDevice”的美国临时申请序列号61/386,117的优先权，该专利的公开内容以引用方式并入本文。
背景技术
多种外科器械包括组织切割元件以及将RF能量传输到组织（例如，以凝聚或密封组织）的一个或多个元件。这种装置的一个例子是由EthiconEndo-Surgery,Inc.（Cincinnati,Ohio）制造的
Figure BDA00002959299600011
组织密封装置。这种装置的其他例子以及相关理念公开于下列专利中：2002年12月31公布的名称为“Electrosurgical Systems and Techniques for Sealing Tissue”的美国专利No.6,500,176，该专利的公开内容以引用方式并入本文；2006年9月26日公布的名称为“Electrosurgical Instrument and Method of Use”的美国专利No.7,112,201，该专利的公开内容以引用方式并入本文；2006年10月24日公布的名称为“Electrosurgical Working End for Controlled Energy Delivery”的美国专利No.7,125,409，该专利的公开内容以引用方式并入本文；2007年1月30日公布的名称为“Electrosurgical Probe and Method of Use”的美国专利No.7,169,146，该专利的公开内容以引用方式并入本文；2007年3月6日公布的名称为“Electrosurgical Jaw Structure for Controlled EnergyDelivery”的美国专利No.7,186,253，该专利的公开内容以引用方式并入本文；2007年3月13日公布的名称为“Electrosurgical Instrument”的美国专利No.7,189,233，该专利的公开内容以引用方式并入本文；2007年5月22日公布的名称为“Surgical Sealing Surfaces and Methods of Use”的美国专利No.7,220,951，该专利的公开内容以引用方式并入本文；2007年12月18日公布的名称为“Polymer Compositions Exhibiting a PTC Property and Methodsof Fabrication”的美国专利No.7,309,849，该专利的公开内容以引用方式并入本文；2007年12月25日公布的名称为“Electrosurgical Instrument andMethod of Use”的美国专利No.7,311,709，该专利的公开内容以引用方式并入本文；2008年4月8日公布的名称为“Electrosurgical Instrument andMethod of Use”的美国专利No.7,354,440，该专利的公开内容以引用方式并入本文；2008年6月3日公布的名称为“Electrosurgical Instrument”的美国专利No.7,381,209，该专利的公开内容以引用方式并入本文；2011年4月14日公布的名称为“Surgical Instrument Comprising First and Second DriveSystems Actuatable by a Common Trigger Mechanism”的美国公布No.2011/0087218，该公布的公开内容以引用方式并入本文；以及2011年6月2日提交的名称为“Motor Driven Electrosurgical Device with Mechanical andElectrical Feedback”的美国专利申请No.13/151,181，该专利申请的公开内容以引用方式并入本文。
此外，多种外科器械包括具有铰接部分的轴，从而为定位在轴的铰接部分的远侧的端部执行器提供增强的定位能力。这种装置的例子包括由Ethicon Endo-Surgery,Inc.（Cincinnati,Ohio）制造的各种型号的
Figure BDA00002959299600021
内切割器。这种装置的其他例子以及相关理念公开于以下专利中：2008年6月3日公布的名称为“Articulating Surgical Stapling InstrumentIncorporating a Two-Piece E-Beam Firing Mechanism”的美国专利No.7,380,696，该专利的公开内容以引用方式并入本文；2008年7月29日公布的名称为“Surgical Stapling and Cutting Device”的美国专利No.7,404,508，该专利的公开内容以引用方式并入本文；2008年11月25日公布的名称为“Surgical Instrument with Articulating Shaft with Rigid Firing Bar Supports”的美国专利No.7,455,208，该专利的公开内容以引用方式并入本文；2009年3月24日公布的名称为“Surgical Instrument Incorporating an ElectricallyActuated Articulation Mechanism”的美国专利No.7,506,790，该专利的公开内容以引用方式并入本文；2009年6月23日公布的名称为“SurgicalStapling Instrument with an Articulating End Effector”的美国专利No.7,549,564，该专利的公开内容以引用方式并入本文；2009年7月14日公布的名称为“Surgical Instrument Incorporating a Fluid Transfer ControlledArticulation Mechanism”的美国专利No.7,559,450，该专利的公开内容以引用方式并入本文；2010年2月2日公布的名称为“Surgical Instrument withGuided Laterally Moving Articulation Member”的美国专利No.7,654,431，该专利的公开内容以引用方式并入本文；2010年8月24日公布的名称为“Surgical Instrument with Laterally Moved Shaft Actuator Coupled to PivotingArticulation Joint”的美国专利No.7,780,054，该专利的公开内容以引用方式并入本文；2010年8月31日公布的名称为“Surgical Instrument withArticulating Shaft with Single Pivot Closure and Double Pivot Frame Ground”的美国专利No.7,784,662，该专利的公开内容以引用方式并入本文；以及2010年9月21日公布的名称为“Surgical Instrument Articulation JointCover”的美国专利No.7,798,386，该专利的公开内容以引用方式并入本文。
尽管已研制和使用了若干医疗装置，但据信在本发明人之前还无人研制出或使用所附权利要求中描述的发明。
附图说明
虽然在说明书之后提供了特别指出和清楚地要求保护本技术的权利要求书，但是据信通过对下面某些实施例的描述并结合附图可以更好地理解本技术，附图中类似的参考标号表示相同元件，其中：
图1示出了示例性电外科医疗装置的侧正视图；
图2示出了处于开口构型的图1的装置的端部执行器的透视图；
图3示出了处于开口构型的图1的装置的端部执行器的另一个透视图；
图4示出了处于闭合构型并且具有处于远侧位置的刀片的图2的端部执行器的横截面端视图；
图5示出了用于图1的装置的轴的示例性铰接部分的透视图；
图6示出了沿图5的线6-6截取的图5的铰接部分的横截面端视图；
图7示出了用于图1的装置的轴的另一个示例性铰接部分的俯视透视图；
图8示出了图7的另一个铰接部分的仰视透视图；
图9示出了图7的铰接部分的俯视平面图；
图10示出了用于图1的装置的轴的另一个示例性铰接部分的透视图；
图11示出了图10的铰接部分的分解图；
图12示出了用于图1的装置的轴的另一个铰接部分的分解图；
图13示出了图12的铰接部分的平面图；
图14示出了用于图1的装置的轴的另一个示例性铰接部分的透视图；
图15示出了图14的铰接部分的珠节元件的透视图；
图16示出了图15的珠节元件的俯视平面图；
图17示出了图14的铰接部分的横截面侧视图；
图18示出了图14的铰接部分的远端部分的局部透视图；
图19示出了与图14的铰接部分相关联的远侧旋转结构的上部的局部透视图；以及
图20示出了图19的远侧旋转结构的下部的局部透视图。
附图并非意在以任何方式进行限制，并且可以预期本技术的各种实施例能够以多种其他方式来执行，包括那些未必在附图中示出的方式。附图并入本说明书中并构成其一部分，示出了本技术的若干方面，并与具体实施方式一起用于说明本技术的原理；然而，应当理解，本技术不限于所示出的明确布置方式。
具体实施方式
本技术的某些实例的下述描述不应用于限制其范围。通过以下举例说明设想用于实施本技术的最佳方式之一的描述，本技术的其他实例、特征、方面、实施例和优点对于本领域技术人员将变得显而易见。应当认识到，本文所述的技术包括不脱离本技术的所有其他的不同和明显方面。因此，附图和具体实施方式应被视为实质上是示例性的，而非限制性的。
另外应当理解，本文所述的教导内容、表达方式、实施例、实例等中的任何一个或多个可与本文所述的其他教导内容、表达方式、实施例、实例等中的任何一个或多个相结合。因此下述教导内容、表达方式、实施例、实例等不应视为彼此隔离。根据本文的教导内容，其中本文的教导内容可结合的各种合适方式对于本领域普通技术人员将是显而易见的。这种修改形式和变化形式旨在包括在权利要求书的范围之内。
I.具有铰接结构的示例性电外科装置
图1-4示出了示例性电外科器械10，示例性电外科器械10根据以下专利的教导中的至少一些建造并且可根据以下专利的教导中的至少一些操作：美国专利No.6,500,176、美国专利No.7,112,201、美国专利No.7,125,409、美国专利No.7,169,146、美国专利No.7,186,253、美国专利No.7,189,233、美国专利No.7,220,951、美国专利No.7,309,849、美国专利No.7,311,709、美国专利No.7,354,440、美国专利No.7,381,209、美国公布No.2011/0087218、和/或美国专利申请No.13/151,181。如本文中所描述的并且如将在下文更详细地描述的，电外科器械10可操作成基本同时切割组织并且密封或接合组织（例如，血管等）。换句话讲，电外科器械10与内切割器类型的缝合器类似地操作，不同的是电外科器械10通过应用双极性RF能量而不是提供缝钉线以连接组织来提供组织接合。还应当理解，电外科器械10可以具有与由Ethicon Endo-Surgery,Inc.（Cincinnati,Ohio）制造的组织密封装置相似的各种结构和功能。此外，电外科器械10可以具有与以引用方式举出和并入本文的其它参考文件中的任何参考文件中所教导的装置相似的各种结构和功能。在本文所举出的参考文献的教导内容、由Ethicon Endo-Surgery,Inc.（Cincinnati,Ohio）制造的
Figure BDA00002959299600052
组织密封装置、以及下文涉及电外科器械10的教导之间存在一定程度的重复的范围内，不期望将本文的描述中的任何描述假定为得到承认的现有技术。下文的若干教导内容实际上将超出本文所举出的参考文献的教导内容以及由Ethicon Endo-Surgery,Inc.（Cincinnati,Ohio）制造的
Figure BDA00002959299600053
组织密封装置的范围。
A.示例性手持件和轴
本例的电外科器械10包括手持件20、从手持件20朝远侧延伸的轴30、以及布置在轴30的远端处的端部执行器40。本例的手持件20包括手枪式握把22、枢转触发器24、激活按钮26、以及铰接控制器28。触发器24可朝着和远离手枪式握把22枢转，以如将在下文更详细的描述地有选择地致动端部执行器40。激活按钮26可操作成有选择地激活与端部执行器40导通的RF电路，如也将在下文更详细地描述的。在一些版本中，激活按钮26还用作相对于触发器24的机械锁定件，使得除非按钮26被同时按下，否则不能完全致动触发器24。本文所举出的参考文献中的一个或多个中公开了可以如何提供这种锁定件的例子。应当理解，可以以任何合适的方式对手枪式握把22、触发器24、和按钮26进行改进、替代、补充等，并且本文对这种元件的描述仅仅是示例性的。本例的铰接控制器28可操作成有选择地控制轴30的铰接部分36，将在下文更详细地描述铰接部分36。还将在下文进更详细地描述铰接控制器28可以采用的形式的各种例子，然而考虑到本文的教导内容，进一步的例子对于本领域普通技术人员而言将显而易见。
本例的轴30包括外护套32和铰接部分36。铰接部分36可操作成相对于由护套32所限定的纵向轴向将端部执行器40有选择地定位成各种角度。将在下文更详细地描述铰接部分36以及轴30的其它元件可以采用的形式的各种例子，然而考虑到本文的教导内容，进一步的例子对于本领域普通技术人员而言将显而易见。例如，应当理解，可操作成致动铰接部分36的各种元件可以延伸穿过护套32的内部。在一些版本中，轴30也可通过旋钮34相对于手持件20围绕由护套32所限定的纵向轴线旋转。这种旋转可以整体提供端部执行器40和轴30的旋转。在一些其它的版本中，旋钮34可操作成使端部执行器40旋转而不使在铰接部分36近侧的轴30的任何部分旋转。作为另一个仅仅是示例性的例子，电外科器械10可以包括：一个旋转控制器，该旋转控制器提供轴30和端部执行器40作为一个单元的可旋转性；以及另一个旋转控制器，该旋转控制器提供端部执行器40的可旋转性而不使在铰接部分36近侧的轴30的任何部分旋转。考虑到本文的教导内容，其它合适的旋转方案对于本领域普通技术人员而言将显而易见。当然，如果需要，可以仅仅省略可旋转结构。
B.示例性端部执行器
本例的端部执行器40包括第一钳口42和第二钳口44。在本例中，第二钳口44相对于轴30基本固定；而第一钳口42朝着和远离第二钳口42相对于轴30枢转。在一些版本中，例如杆或电缆等的致动器可以延伸穿过护套32并且在枢转联接件43处与第一钳口42连接，使得致动器杆/电缆等穿过轴30的纵向移动提供第一钳口42相对于轴30并且相对于第二钳口44的枢转。当然，钳口42，44可以相反地具有任何其它合适类型的移动并且可以以任何其它合适的方式被致动。仅以举例的方式，并且如将在下文更详细地描述的，钳口42，44可以通过击发梁60的纵向平移而致动并且因此而闭合，使得在一些版本中可以仅仅去除致动器杆/电缆等。
如在图2-4中最佳可见的，第一钳口42限定了沿纵向延伸的细长狭槽46；而第二钳口44也限定了沿纵向延伸的细长狭槽48。此外，第一钳口42的顶侧提供了第一电极表面50；而第二钳口44的下侧提供了第二电极表面52。电极表面50，52通过沿轴30的长度延伸的一个或多个导体（未示出）与电源80导通。电源80可操作成将RF能量递送到处于第一极性的第一电极表面50并且递送到处于第二（相反）极性的第二电极表面52，使得RF电流在电极表面50，52之间流动并且由此穿过捕集在钳口42，44之间的组织。在一些版本中，击发梁60用作与电极表面50，52相配合的电导体（例如，用作地回路），以用于递送捕集在钳口42，44之间的双极性RF能量。电源80可以位于电外科器械10的外部或者可以与电外科器械10整体形成（例如，位于手持件20等中），如在本文所举出的一个或多个参考文献中或者以其它方式描述的。控制器82调节从电源80递送到电极表面50，52的电力。控制器82可以位于电外科器械10的外部或者可以与电外科器械10整体形成（例如，位于手持件20等中），如在本文所举出的一个或多个参考文献中或者以其它方式描述的。还应当理解，可以以多种备选的位置、构型、以及关系来设置电极表面50，52。
如图4中最佳可见，第一钳口42的下侧包括邻近狭槽46沿纵向延伸的凹槽58；而第二钳口44的上侧包括邻近狭槽48沿纵向延伸的凹槽58。图2示出了包括多个锯齿部46的第一钳口42的上侧。应当理解，第二钳口44的下侧可以包括互补的锯齿部，所述互补的锯齿部与锯齿部46相嵌套，以增强对捕集在钳口42，44之间的组织的抓持而不必撕裂组织。图3将第一钳口42中的锯齿部46的例子主要示为凹槽；其中第二钳口44中的锯齿部48主要示为突起。当然，锯齿部46，48可以采用任何其它合适的形式或者可以仅仅一起省略。还应当理解，锯齿部46，48可以由非导电、或绝缘的材料（例如塑料、玻璃、和/或陶瓷）形成，并且可以包括处理方式（例如聚四氟乙烯、润滑剂、或者基本防止组织被钳口42，44卡住的一些其它的处理方式）。
当钳口42，44处于闭合位置时，轴30和端部执行器40所具有的尺寸和构型能够配合穿过具有多种内径的套管针，使得电外科器械10在微创手术方面是有用的，但是当然，如果需要，电外科器械10也能够用于开放式手术中。仅以举例的方式，当钳口42，44处于闭合位置时，轴30和端部执行器40可以具有大约5mm的外径。备选地，轴30和端部执行器40可以提供任何其它合适的外径（例如，处于大约2mm至大约20mm之间等）。
作为另一个仅仅是示例性的变型，钳口42，44中的任何一个或者钳口42，44中的两个都可以包括可操作成从外科手术部位抽取蒸汽、烟气、以及/或者其它的气体、蒸汽等的至少一个端口、通路、管道、以及/或者其它结构。这种结构可以与吸力源（例如位于手持件20外部的源或者位于手持件20内的源等）导通。此外，端部执行器40可以包括当激活电极表面50，52时降低由端部执行器40所造成的热传播的程度或范围的一个或多个组织冷却结构（未示出）。考虑到本文的教导内容，这种冷却结构可以采用的各种合适的形式对于本领域普通技术人员而言将显而易见。
在一些版本中，端部执行器40包括能够在端部执行器40处感测多个参数（其中包括但不限于相邻组织的温度、相邻组织的电阻或阻抗、跨过相邻组织的电压、由相邻组织施加在钳口42，44上的力等）的一个或多个传感器（未示出）。仅以举例的方式，端部执行器40可以包括定位成邻近电极50，52以及/或者其它位置处的一个或多个正温度系数（PTC）热敏电阻器主体54，56（例如，PTC聚合物等）。来自传感器的数据可以传送到控制器82。控制器82可以以多种方式处理这种数据。仅以举例的方式，控制器82可以至少部分地基于从位于端部执行器40处的一个或多个传感器所获得的数据来调节或者以其它方式改变被递送到电极表面50，52的RF能量。除此之外或者备选地，控制器82可以至少部分地基于从位于端部执行器40处的一个或多个传感器所获得的数据来通过声音和/或视觉反馈装置（例如，扬声器、光、显示屏等）提示使用者一种或多种状况。还应当理解，一些类型的传感器不必与控制器82导通，并且可以在端部执行器40处仅仅提供纯粹的局部效果。例如，位于端部执行器40处的PTC热敏电阻器主体54，56可以随着组织和/或端部执行器40的温度升高而自动降低电极表面50，52处的能量递送，由此降低过热的可能性。在一些这种版本中，PTC热敏电阻器元件与电源80和电极表面50，52串联；并且PTC热敏电阻器响应于超过阈值的温度而提供增大的阻抗（从而降低电流）。此外，应当理解，电极表面50，52可以用作传感器（例如，以感测组织阻抗等）。考虑到本文的教导内容，可以结合到电外科器械10中的各种类型的传感器对于本领域普通技术人员而言将显而易见。类似地，考虑到本文的教导内容，能够由控制器82或者以其它方式通过来自传感器的数据完成的各种事情对于本领域普通技术人员而言将显而易见。考虑到本文的教导内容，端部执行器40的其它合适的变型对于本领域普通技术人员而言将显而易见。
C.示例性击发梁
如图2-4中最佳可见，本例的电外科器械10包括击发梁60，击发梁60可沿端部执行器40的长度的一部分纵向移动。击发梁60共轴地定位在轴30内、沿轴30的长度延伸、并且在轴30内沿纵向平移（其中包括本例中的铰接部分36），但是应当理解，击发梁60和轴30可以具有任何其它合适的关系。击发梁60包括锋利的远侧刀片64、上部凸缘62、以及下部凸缘66。如图4中最佳可见的，远侧刀片64延伸穿过钳口42，44的狭槽46，48，其中上部凸缘62在凹槽59中定位在钳口44的上方，并且下部凸缘66在凹槽58中定位在钳口42的下方。远侧刀片64以及凸缘62，66的构型在击发梁60的远端处提供“工字梁”型横截面。尽管凸缘62，66在本例中仅沿击发梁60的长度的一小部分沿纵向延伸，但是应当理解，凸缘62，66可以沿击发梁60的任何合适的长度纵向延伸。此外，尽管凸缘62，66沿钳口42，44的外部定位，但是凸缘62，66可以备选地布置在形成于钳口42，44内的相应的狭槽中。例如，每一个钳口42，44都可以限定“T”形狭槽，其中远侧刀片64的一部分布置在每一个“T”形狭槽的一个竖直部分中并且凸缘62，66布置在“T”形狭槽的水平部分中。考虑到本文的教导内容，各种其它合适的构型和关系对于本领域普通技术人员而言将显而易见。
远侧刀片64是基本锋利的，使得远侧刀片将易于切断捕集在钳口42，44之间的组织。远侧刀片64在本例中也电接地，从而如本文中其它部分所描述地提供用于RF能量的返回路径。在一些其它的版本中，远侧刀片64用作有源电极。除此之外或者备选地，可以通过超声能量（例如，大约55.5kHz的简谐振动等）有选择地为远侧刀片64提供能量。
击发梁60的“工字梁”型构造使钳口42，44随着击发梁60朝远侧前进而闭合。特别是，随着击发梁60通过支承于形成在钳口44中的凹槽59而从近侧位置（图1-3）前进到远侧位置（图4），凸缘62朝着钳口42可枢转地推动钳口44。通过击发梁60在钳口42，44上所产生的该闭合效果可以在远侧刀片64到达捕集在钳口42，44之间的组织之前发生。击发梁60遇到的这种分段可以使挤压握把24以致动击发梁60通过完全击发冲程所需的力减小。换句话讲，在一些这种版本中，击发梁60可能在遇到来自捕集在钳口42，44之间的组织的阻力之前就已克服了在组织上基本闭合钳口42，44所需的初始阻力。当然，可以提供任何其它合适的分段。
在本例中，凸缘62能够相对于位于钳口44的近端处的斜坡结构进行凸轮运动，以在击发梁60缩回到近侧位置时打开钳口42并且当击发梁60停留在近侧位置时保持钳口42打开。该凸轮运动能力可以有利于例如通过迫使钳口42，44离开闭合位置来使用端部执行器40分离组织层，以执行钝性分离等。在一些其它的版本中，钳口42，44通过弹簧或其它类型的弹性结构弹性偏置到打开位置。尽管在本例中，钳口42，44随着击发梁60平移而闭合或打开，但是应当理解，其它的版本可以提供钳口42，44以及击发梁60的独立移动。仅以举例的方式，一个或多个电缆、杆、梁、或者其它结构可以延伸穿过轴30，以独立于击发梁60有选择地致动钳口42，44。这种钳口42，44致动结构可以由手持件20的专用结构单独控制。备选地，除了使触发器24控制击发梁60,这种钳口致动结构也可以由触发器24控制。还应当理解，击发梁60可以弹性偏置到近侧位置，使得当使用者释放其对触发器24的抓握时，击发梁60朝近侧缩回。
D.示例性操作
在示例性使用中，端部执行器40通过套管针插入到患者体内。当端部执行器40和轴30的一部分插入穿过套管针时，铰接部分36成基本直线。铰接控制器28可以接着被操纵成使轴30的铰接部分36枢转或折曲，以便将端部执行器40定位在相对于患者体内的解剖结构的期望的位置和取向处。接着通过朝着手枪式握把22挤压触发器24来将解剖结构的两层组织捕集在钳口42，44之间。这种组织层可以是患者体内限定解剖结构的同一个天然内腔的一部分（例如，血管、胃肠道的一部分、生殖系统的一部分等）。例如，一个组织层可以沿血管长度的同一区域包括血管的顶部而另一个组织层可以包括血管的底部（例如，使得在使用电外科器械10之前穿过血管的流体路径与由端部执行器40所限定的纵向轴线垂直等）。换句话讲，钳口42，44的长度可以定向成与血管的长度垂直（或者至少大体横向于血管的长度）。如上所述，凸缘62，66产生凸轮运动动作，以在通过朝着手枪式握把22挤压触发器24而朝远侧致动击发梁60时使钳口42朝着钳口44枢转。
随着组织层捕集在钳口42，44之间，通过使用者朝着手枪式握把22挤压触发器24来使击发梁60继续朝远侧前进。随着击发梁60朝远侧前进，远侧刀片64同时切断被夹住的组织层，从而使得分离的上层部分与相应的分离的下层部分对合。在一些版本中，这致使血管沿大体横向于血管的长度的方向被切割。应当理解，分别存在于钳口42，44正上方和正下方的凸缘62，66可以有助于将钳口42，44保持在闭合和夹紧位置。特别是，凸缘62，66可以有助于保持钳口42，44之间显著的压缩力。随着切断的组织层部分被压缩在钳口42，44之间，由使用者按下激活按钮26而通过双极性RF能量激活电极表面50，52。在一些版本中，电极50，52与电源80有选择地联接（例如，通过使用者按下按钮26等），使得钳口42，44的电极表面50，52通过公共的第一极性激活而击发梁60在与第一极性相反的第二极性下激活。因此，双极性RF电流在击发梁60与钳口42，44的电极表面50，52之间流过切断的组织层部分的压缩区域。在一些其它的版本中，电极表面50具有一种极性，而电极表面52和击发梁60都具有另一种极性。在任何一种版本中（以及至少一些其它的版本），由电源80递送的双极性RF能量最终在击发梁60的一侧上将组织层部分热接合在一起并且在击发梁60的另一侧上将组织层部分热接合在一起。
在某些情况下，由激活的电极表面50，52所产生的热能够使组织层内的胶原变性，并且配合由钳口42，44所提供的夹紧压力，变性胶原能够在组织层部分内形成密封。因此，限定解剖结构的天然内腔的切断端部止血密封闭合，使得切断的端部将不会泄漏体液。在一些版本中，甚至可以在击发梁60开始朝远侧平移之前并且因此甚至在组织被切断之前通过双极性RF能量激活电极表面50，52。例如，可以在按钮26除了用作电源80与电极表面50，52之间的开关之外还用作相对于触发器24的机械锁定件的版本中提供这种时序。
尽管将下文的教导内容中的若干教导内容描述成电外科器械10的变型，但是应当理解，下文的各种教导内容也可以结合到各种其它类型的装置中。仅以举例的方式，除了易于结合到电外科器械10中，下文的各种教导内容还可以易于结合到本文所举出的参考文献中的任何参考文献中所教导的装置、其它类型的电外科装置、手术缝合器、外科夹子施加器、和组织抓取器、以及各种其它的装置中。考虑到本文的教导内容，可结合下述教导内容的其它的合适装置对于本领域普通技术人员而言将显而易见。
II.示例性铰接接头构型
如上所述，一些版本的轴30包括铰接部分36，铰接部分36可操作成相对于由护套32所限定的纵向轴线将端部执行器40有选择地定位成各种角度。将在下文更详细地描述铰接部分36以及轴30的其它元件可以采用的形式的若干例子，然而考虑到本文的教导内容，进一步的例子对于本领域普通技术人员而言将显而易见。仅以举例的方式，与本申请同一天提交的名称为“Articulation Joint Features for Articulating Surgical Device”的美国专利申请No.[代理人案卷号END6889USNP1]中公开了铰接部分36的一些仅仅是示例性的备选例子，该专利的公开内容以引用方式并入本文。
A.具有平行支承导轨的示例性铰接部分
图5-6示出了布置在刚性轴部分102与端部执行器104之间的示例性铰接部分100。应当理解，这些结构可以易于结合到上文所述的电外科器械10中，其中轴部分102与轴30相对应并且端部执行器104与端部执行器40相对应。本例的铰接部分100包括模塑构件110，模塑构件110限定了多个狭槽112，114，116以及一对凹槽118。模塑构件110可以包括多种材料，其中包括但不限于Vectra、Isoplast、高密度聚乙烯、以及/或者各种其它材料。在某些情况下，形成模塑构件110的材料向模塑构件110提供弹性偏置，以呈现基本直线取向。考虑到本文的教导内容，用于模塑构件110的其它合适的选择和特性对于本领域普通技术人员而言将显而易见。类似地，尽管在本例中，模塑构件110通过模塑工艺形成，但是应当理解，可以使用多种其它的工艺，其中包括但不限于挤出等。
狭槽112，114沿模塑构件110的长度纵向延伸、在模塑构件110的顶部开口并且终止于模塑构件110的底部内。狭槽112沿模塑构件110的轴线延伸，而狭槽114相对于该轴线横向偏移。狭槽116相对于模塑构件110的轴线横向定向。类似的狭槽112，114、狭槽116也在模塑构件110的顶部开口，而终止于模塑构件110的底部内。狭槽116能够有利于模塑构件110的折曲。狭槽112能够滑动容纳击发梁160。击发梁160等同于上文所讨论的击发梁60。因此，应当理解，击发梁160可操作成在狭槽112内纵向平移。还应当理解，击发梁160具有足够柔性，以使得击发梁能够在铰接部分处于弯曲、铰接构型时沿弯曲路径平移。可以将形成模塑构件110的材料以及/或者模塑构件110上的涂层选择成使击发梁160与模塑构件110之间的摩擦最小化。仅以举例的方式，模塑构件110可以包括焙烤有机硅（baked on silicone）和/或硬脂酸钠和/或各种其它材料。
凹槽118能够容纳铰接带140，142。铰接带140，142的远端固定到铰接部分100的远端。铰接带140，142的近端与例如铰接控制器28的控制器导通。在一些版本中，铰接控制器28可操作成有选择地使一个带140，142前进或缩回，同时保持另一个带140，142的位置基本恒定，由此致使铰接部分100弯曲。在一些其它的版本中，铰接控制器28可操作成在有选择地使带140前进时同时缩回带142；以及/或者在有选择地缩回带140时使带142同时前进。当然，可以通过电缆以及/或者各种其它类型的元件替代带140，142。柔性护套或包裹物可以围绕铰接部分100定位，以有助于相对于模塑构件110保持带140，142。除此之外或者备选地，模塑构件110可以包括竖直延伸的狭槽以及/或者相对于模塑构件110（其中包括当铰接部分100处于弯曲构型时）保持带140，142的其它类型的结构。
狭槽114能够容纳弹簧梁150。在一些版本中，弹簧梁150弹性偏置，以将模塑构件110定向成基本直线构型。当击发梁160平移穿过处于弯曲构型的铰接部分100时，该弹性偏置还可以降低击发梁160上的结合负载。弹簧梁150也能够例如通过在击发梁160平移穿过处于弯曲构型的铰接部分100时提供对击发梁160的横向屈曲或爆裂的阻力来增强铰接部分100的结构完整性。由于弹簧梁150定位在与用于击发梁160的狭槽112分开的狭槽114中，因此弹簧梁150并不在铰接部分100操作期间以及/或者在击发梁160操作期间与击发梁160相接触。该间隔也可以降低弹簧梁150在击发梁160上的夹紧负载。
在一些版本中，每一个弹簧梁150的两端都未固定到任何结构，使得弹簧梁150在铰接部分100内自由浮动。在一些其它的版本中，每一个弹簧梁150的一端相对于铰接部分100固定，而每一个弹簧梁150的另一端自由浮动。考虑到本文的教导内容，其它合适的元件、构型、布置、和关系对于本领域普通技术人员而言将显而易见。还应当理解，狭槽112，114，116中的任何狭槽以及/或者铰接部分110的一些其它的元件可以在端部执行器104与电源之间提供电导通的一根或多根线材。
B.由模塑接头形成的示例性铰接部分
图7-9示出了布置在刚性轴部分202与端部执行器204之间的另一个示例性铰接部分200。应当理解，这些结构可以易于结合到上文所述的电外科器械10中，其中轴部分202与轴30相对应并且端部执行器204与端部执行器40相对应。本例的铰接部分200包括模塑构件210，模塑构件210限定了多个狭槽212，216、内腔214、以及一对凹槽218。模塑构件210可以包括多种材料，其中包括但不限于Vectra、Isoplast、高密度聚乙烯、以及/或者各种其它材料。在某些情况下，形成模塑构件210的材料向模塑构件210提供弹性偏置，以呈现基本直线取向。考虑到本文的教导内容，用于模塑构件210的其它合适的选择和特性对于本领域普通技术人员而言将显而易见。类似地，尽管在本例中，模塑构件210通过模塑工艺形成，但是应当理解，可以使用多种其它的工艺。
如在图8-9中最佳可见的，狭槽212和内腔214均沿模塑构件110的长度纵向延伸。狭槽212能够容纳一根或多根线材，所述一根或多根线材在端部执行器204与电源之间提供电导通。内腔214能够滑动容纳击发梁（未示出），与如上文所述的容纳击发梁160的狭槽112非常相似。因此，无论铰接部分200处于基本直线构型还是弯曲构型，击发梁都可以平移穿过模塑构件210。狭槽216相对于模塑构件210的轴线横向定向。狭槽216能够有利于模塑构件210的折曲。在本例中，如在图9中最佳可见的，狭槽216沿模塑构件210的长度在其相对间隔中交错。这种构型可以有利于模塑构件210的弯曲。在一些其它的版本中，狭槽216相对地定位而不是交错。
凹槽218能够容纳铰接带240，242。铰接带240，242的远端固定到铰接部分200的远端。铰接带240，242的近端与例如铰接控制器28的控制器导通。在一些版本中，铰接控制器28可操作成有选择地使一个带240，242前进或缩回，同时保持另一个带240，242的位置基本恒定，由此致使铰接部分200弯曲。在一些其它的版本中，铰接控制器28可操作成在有选择地使带240前进时同时缩回带242；以及/或者在有选择地缩回带240时使带242同时前进。作为又一个仅仅是示例性的例子，铰接控制器28可操作成有选择地使带240前进同时使带242保持松弛/自由；以及/或者有选择地缩回带240，同时使带242保持松弛/自由。当然，可以通过电缆以及/或者各种其它类型的元件替代带240，242；并且可通过各种其它方式操作。
柔性护套或包裹物可以围绕铰接部分200定位，以有助于相对于模塑构件210保持带240，242。除此之外或者备选地，模塑构件210可以包括竖直延伸的狭槽以及/或者相对于模塑构件210（其中包括当铰接部分200处于弯曲构型时）保持带240，242的其它类型的结构。
图10-11示出了布置在刚性轴部分302与端部执行器304之间的另一个示例性铰接部分300。应当理解，这些结构可以易于结合到上文所述的电外科器械10中，其中轴部分302与轴30相对应并且端部执行器304与端部执行器40相对应。本例的铰接部分300包括一对模塑构件310，311。每一个模塑构件310，311都可以包括多种材料，其中包括但不限于Vectra、Isoplast、高密度聚乙烯、以及/或者各种其它材料。在某些情况下，形成模塑构件310，311的材料向模塑构件310，311提供弹性偏置，以呈现基本直线取向。考虑到本文的教导内容，用于模塑构件310，311的其它合适的选择和特性对于本领域普通技术人员而言将显而易见。类似地，尽管在本例中，模塑构件310，311通过模塑工艺形成，但是应当理解，可以使用多种其它的工艺。模塑构件310，311能够对合地连接在一起，以形成铰接部分300，如图10中所示。模塑构件310，311可以通过多种方式固定在一起，其中包括但不限于粘结剂、超声焊接、卡扣配合、夹钳、夹具、外护套等。
如在图11中最佳可见的，模塑构件310包括多个凹槽312，314，316，318以及多个肋320。凹槽312，314，316，318全部沿模塑构件310的长度纵向延伸。凹槽312定位在模塑构件310的上侧上，而凹槽314，316，318定位在模塑构件310的下侧上。肋320从模塑构件310横向延伸，并且沿模塑构件的长度等距地间隔开。凹槽312能够容纳一根或多根线材，所述一根或多根线材在端部执行器304与电源之间提供电导通。
模塑构件311也包括多个凹槽313，315，317，319以及多个肋321。凹槽313，315，317，319全部沿模塑构件311的长度纵向延伸。凹槽313定位在模塑构件311的上侧上，而凹槽315，317，319定位在模塑构件311的下侧上。肋321从模塑构件310横向延伸，并且沿模塑构件的长度等距地间隔开。凹槽313能够容纳一根或多根线材，所述一根或多根线材在端部执行器304与电源之间提供电导通。在一些版本中，凹槽312或凹槽313容纳这种线材，而另一根线材312，313并不容纳线材。在一些其它的版本中，每一个凹槽312，313都容纳至少一根相应的线材。
当模塑构件310，311如图10中所示地连接在一起时，凹槽314，315对准并且配合以形成通道，击发梁（未示出）可以可滑动地布置在该通道中。因此，该通道的功能与上文所述的内腔214类似。此外，凹槽316，317对齐并且配合以形成通道从而容纳第一铰接电缆（未示出），而凹槽318，319对齐并且配合以形成通道从而在模塑构件310，311连接在一起时容纳第二铰接电缆（未示出）。这种铰接电缆可以与上文所述的用于铰接带140，142的类似的方式操作。在一些其它的版本中，凹槽316，317，318，319能够形成通道，所述通道容纳带而不是电缆。考虑到本文的教导内容，可以用于使铰接部分300铰接的其它合适的结构对于本领域普通技术人员而言将显而易见。如在图10中最佳可见的，肋320，321能够当模塑构件310，311连接在一起时彼此交错。然而，应当理解，如果需要，肋320，321可以相反地彼此对准。还应当理解，无论肋320，321对准还是交错，肋320，321都允许铰接部分300相对于其纵向轴线弯曲。在一些版本中，外部包裹物或收缩管材被设置成围绕模塑构件310，311的外部，但这仅仅是任选的。这种包裹物或管材可以有助于将模塑构件310，311保持在一起。
图12-13示出了基本是上文所述的铰接部分300的变型的又一个示例性铰接部分400。铰接部分400由一对对合的模塑构件410，411形成。每一个模塑构件410，411都可以包括多种材料，其中包括但不限于Vectra、Isoplast、高密度聚乙烯、以及/或者各种其它材料。在某些情况下，形成模塑构件410，411的材料具有弹性特性并且由此使模塑构件410，411偏置以呈现基本直线取向。换句话讲，模塑构件410，411可以具有向基本直线的构型提供偏置的形状记忆。考虑到本文的教导内容，用于模塑构件410，411的其它合适的选择和特性对于本领域普通技术人员而言将显而易见。类似地，尽管在本例中，模塑构件410，411通过模塑工艺形成，但是应当理解，可以使用多种其它的工艺。
模塑构件410包括多个凹槽414，416，418以及多个肋420。凹槽414，416，418基本等同于上文所述的凹槽314，316，318，因此将不会对凹槽414，416，418进行详细描述。还应当理解，模塑构件410可以包括凹槽，该凹槽与上文所述的凹槽312类似。同样地，模塑构件411包括多个凹槽415，417，419以及多个肋421，其中凹槽415，417，419基本等同于上文所述的凹槽315，317，319。模塑构件411还可以包括凹槽，该凹槽与上文所述的凹槽313类似。
与模塑构件310不同，模塑构件410包括多个柱430，所述多个柱430从模塑构件410的下侧向下延伸。模塑构件410的肋420也包括多个凹槽422。与模塑构件311不同，模塑构件411包括多个开口431，所述多个开口431能够在模塑构件410，411连接在一起时容纳柱430。模塑构件411的肋421包括多个突起423，所述多个突起423在模塑构件410，411连接在一起时被容纳在模塑构件410的相应的肋420的凹槽422中。因此，与模塑构件310，311的肋320，321不同，肋420，421在模塑构件410，411连接在一起时彼此对准。
图13示出了模塑构件410，411与模塑构件310，311之间的另一个差异。特别是，图13示出了模塑构件410，411的脊状部分440的厚度如何沿铰接部分400的长度减小。应当理解，图13的左手侧与铰接部分400的远端相对应，而图13的右手侧与铰接部分400的近端相对应。如图所示，脊状部分440的近侧区域442具有宽度“W1”，宽度“W1”大于脊状部分440的远侧区域444的宽度“W2”。这种构型可以降低相对于由铰接部分400所限定的纵向轴线使铰接部分400的远端弯曲所需的力的量。换句话讲，沿铰接部分400的长度逐渐降低脊状部分440的宽度可以有利于铰接部分400的铰接。当然，可以使用任何其它合适的结构或构型。在一些版本中，外部包裹物或收缩管材被设置成围绕模塑构件410，411的外部，但这仅仅是任选的。这种包裹物或管材可以有助于将模塑构件410，411保持在一起。
C.示例性分节铰接部分
图14-20示出了布置在刚性轴部分502与端部执行器504之间的又一个示例性铰接部分500。如将在下文更详细地描述的，端部执行器504与旋转部分580相联接，旋转部分580定位在铰接部分500的远侧。应当理解，这些结构可以易于结合到上文所述的电外科器械10中，其中轴部分502与轴30相对应并且端部执行器504与端部执行器40相对应。然而，如将在下文更详细地描述的，在一些版本中，端部执行器504可相对于轴部分502并且相对于铰接部分500旋转。本例的铰接部分500包括多个共轴对准的珠节510。如在图15-16中最佳可见的，每一个珠节510都包括第一面512和第二面514。每一个面512，514都具有凸状构型。通过珠节510定位成彼此相邻，面512，514的凸状构型可以有利于铰接部分520的铰接。例如，一个珠节510的面512可以在铰接期间仅仅相对于相邻珠节510的面514滚动。
每一个珠节510的外周边还包括从面512延伸到面514的凹槽520，522，524。在本例中，珠节510全部类似地能够使得相邻珠节510的相应的凹槽520，522，524可以易于彼此对准。如图14以及18-20所示，凹槽520，522容纳相应的铰接电缆540，542。铰接电缆540，542可以与上文所述的用于铰接带140，142的类似的方式操作。当然，电缆540，542可以由带以及/或者各种其它类型的结构替代。凹槽524能够容纳线材544，如图20中所示。如将在下文中更详细地描述的，线材544能够提供端部执行器504与电源之间的电导通。应当理解，像本文提到的其它线材一样，线材544可以易于在铰接部分500铰接时与铰接部分500一起弯曲。
每一个珠节510都还包括从面512延伸到面514的中心孔530。所有珠节510的孔530都在铰接部分500处于基本直线构型时全部基本共轴对准。如在图17中最佳可见的，击发驱动电缆560延伸穿过孔530。本例的驱动电缆560包括具有足够的抗拉强度的多股线构造，以支承通过驱动电缆560的远侧驱动力和近侧驱动力。驱动电缆560的构造还允许驱动电缆560用于沿任何一个方向旋转驱动端部执行器504，如将在下文更详细地描述的。如在图17中最佳可见的，每一个孔530都具有锥形构型，从而可以有利于在铰接部分500处于铰接构型时使驱动电缆560折曲穿过铰接部分500。孔530所具有的尺寸也允许驱动电缆560在珠节510内旋转，如将在下文更详细地描述的。在一些版本中，外部包裹物或收缩管材被设置成围绕珠节510的外部，但这仅仅是任选的。这种包裹物或管材可以有助于将珠节510保持在一起。
驱动电缆560在铰接部分500的远侧区域中通过衔接子561固定到击发杆562。击发杆562基本等同于上文所述的击发杆60。特别是，击发杆562包括远侧刀片564以及一对凸缘566，所述一对凸缘566能够在击发杆562朝远侧前进时闭合钳口506，508；以及在击发杆562朝近侧缩回时打开钳口506，508。驱动电缆560可操作成通过使驱动电缆560朝远侧或朝近侧平移而朝远侧或朝近侧驱动击发杆562。驱动电缆560可以通过致动触发器24以及/或者以任何其它合适的方式平移。
考虑到本文的教导内容，用于上文所述的铰接部分100，200，300，400，500的其它合适的元件、结构、构型、以及可操作性对于本领域普通技术人员而言见将显而易见。
III.示例性铰接控制器构型
铰接控制器28可以采用多种形式。仅以举例的方式，可以根据与本申请同一日提交的名称为“Control Features for Articulating Surgical Device”的美国专利申请No.[代理人案卷号END6888USNP]的一个或多个教导内容来构造铰接控制器28，该专利的公开内容以引用方式并入本文。作为另一个仅仅是示例性的例子，可以根据与本申请同一日提交的名称为“ControlFeatures for Articulating Surgical Device”的美国专利申请No.[代理人案卷号END6888USNP1]的一个或多个教导内容来构造铰接控制器28，该专利的公开内容以引用方式并入本文。此外，可以根据本文所举出的参考文献中的至少另一个的教导内容来构造铰接部分。考虑到本文的教导内容，铰接控制器28可以采用的各种其它合适的形式对于本领域普通技术人员而言将显而易见。
IV.其它示例性结构
应当理解，本文所述的电外科器械10的版本中的任何版本都可以包括除了上文所述的或者代替上文所述的那些各种其它结构。仅以举例的方式，图14以及17-20示出了远侧旋转部分580的例子，远侧旋转部分580可以用于提供端部执行器504在铰接部分500的远侧区域中的可旋转性。换句话讲，旋转部分580和端部执行器504可以一起旋转，而铰接部分500和轴部分502保持基本固定。应当理解，无论铰接部分500处于基本直线构型还是弯曲/铰接构型，旋转部分580和端部执行器504都可以一起旋转。
在本例中，旋转部分580和端部执行器504通过使驱动电缆560旋转而旋转。例如，在一些版本中，手持件20包括旋钮或者可操作成使驱动电缆560旋转的其它结构。在一些其它的版本中，省略了手持件20，并且旋转部分580和端部执行器504作为机器人系统的一部分由马达、螺线管、以及/或者一些其它的结构驱动。考虑到本文的教导内容，用于驱动旋转系统的其它合适的元件、构型、和技术以及端部执行器504对于本领域普通技术人员而言将显而易见。还应当理解，电外科器械10可以同时提供两种旋转形式。例如，一种旋转形式可以包括使轴部分502、铰接部分500、旋转部分580、以及端部执行器504同时旋转（无论铰接部分500处于直线构型还是弯曲构型）；而另一种旋转形式可以包括仅使旋转部分580和端部执行器504旋转，其中轴部分502和铰接部分500保持旋转固定（同样无论铰接部分500处于直线构型还是弯曲构型）。
如上所述，线材544通过铰接部分500，以提供端部执行器504与靠近轴502的电源之间的电导通。在本例的一些情况下，旋转部分580能够允许电功率从线材544传送至端部执行器504，而不使线材544在端部执行器504相对于铰接部分500旋转时缠绕或扭曲。特别是，并且如在图19-20中最佳可见的，线材544固定到滑环586的插针584。滑环586定位并且弹性偏置成与套囊590相接触，套囊590包括朝远侧延伸的臂594。插针584、滑环586、套囊590、以及延伸臂594均包括导电材料。这些元件全部容纳在护套582内。臂594与钳口506，508中的一个或两个电导通，以如上文所述地并且如以本文所举出的各种参考文献中所述地通过钳口506，508中的任何一个或两个提供双极性RF能量。
套囊590固定到旋转部分580内的主体592。套囊590和主体592与端部执行器504一起旋转。即使在套囊590与端部执行器504一起旋转而滑环586和铰接部分500保持旋转固定时，滑环586与套囊590之间的关系仍然提供滑环586与套囊590之间的电连续性。应当理解，一个或多个轴承表面或结构也可以设置在铰接部分500与旋转部分580之间，以进一步有利于旋转部分580相对于铰接部分580旋转。
尽管在铰接部分500的背景下提供了图14以及17-20中所示的例子，但是应当理解，旋转部分580也可以易于结合到本文所述的其它版本的铰接部分或者电外科器械10中的任何版本中。还应当理解，旋转部分580也可以易于结合到各种其它类型的器械中，其中包括但不限于本文所述以及/或者本文所举出的各种参考文献中所述的各种类型的器械。考虑到本文的教导内容，可以结合旋转部分580的进一步其它合适的器械对于本领域普通技术人员而言将显而易见。
应当理解，本文的装置中的任何装置还可以包括以下专利申请中所公开的各种结构中的一个或多个：与本申请同一天提交的名称为“ControlFeatures for Articulating Surgical Device”的美国专利申请No.[代理人案卷号END6888USNP]，该专利的公开内容以引用方式并入本文；与本申请同一天提交的名称为“Articulation Joint Features for Articulating Surgical Device”的美国专利申请No.[代理人案卷号END6888USNP1]，该专利的公开内容以引用方式并入本文；以及/或者与本申请同一天提交的名称为“ControlFeatures for Articulating Surgical Device”的美国专利申请No.[代理人案卷号END6889USNP1]，该专利的公开内容以引用方式并入本文。
还应当理解，本文所述的装置中的任何装置可以改进，以包括马达或其它电动装置，从而驱动以其它方式手动移动的元件。1011年6月2日提交的名称为“Motor Driven Electrosurgical Device with Mechanical andElectrical Feedback”的美国专利申请No.13/151,481中描述了这种改进的各种例子，该专利的公开内容以引用方式并入本文。考虑到本文的教导内容，马达或其它电动装置可以结合到本文的装置中的任何装置中的各种其它合适的方式对于本领域普通技术人员而言将显而易见。
此外，应当理解，本文所述的装置中的任何装置都可以改进，以在医疗装置本身内包括所需元件中的大部分（如果不是全部的话）。更具体地讲，本文所述的装置能够使用内部或可附接的电源，而不是需要通过电缆插入至外部电源中的装置。医疗装置能够如何包括便携式电源的各种例子公开于2010年11月5日提交的名称为“Energy-Based SurgicalInstruments”的美国临时专利申请序列号61/410,603中，该专利的公开内容以引用方式并入本文。考虑到本文的教导内容，电源可以结合到本文的装置中的任何装置中的各种其它合适的方式对于本领域普通技术人员而言将显而易见。
VI.其他方面
尽管主要在电外科器械的背景下描述了本文的例子，但是应当理解，本文的教导内容可以易于应用于多种其它类型的医疗器械。仅以举例的方式，本文的教导内容可以易于应用于组织抓取器、组织恢复囊配置器械、手术缝合器、超声外科器械等。还应当理解，本文的教导内容可以易于应用于本文所举出的参考文献中的任何参考文献中所述的器械中的任何器械，使得本文的教导内容可以易于以多种方式与本文所举出的参考文献中的任何参考文献的教导内容相结合。可结合本文的教导内容的其它类型的器械对于本领域普通技术人员而言将显而易见。
应当理解，所述以引用方式并入本文中的任何专利、出版物或其他公开材料，无论是全文或部分，仅在并入的材料与本公开中给出的定义、陈述或其他公开材料不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。
本发明的一些实施例可在传统的内窥镜检查和开放性手术器械以及机器人辅助手术中得到应用。例如，本领域普通技术人员将认识到，本文的各种教导内容可易于与2004年8月31日公布的名称为“Robotic SurgicalTool with Ultrasound Cauterizing and Cutting Instrument”的美国专利No.6,783,524的各种教导内容相结合，该专利的公开内容以引用方式并入本文。
本文所公开的实施例装置可设计为使用一次后丢弃，也可设计为供多次使用。在上述任一或两种情况下，都可对这些实施例进行修复，以便在使用至少一次后重复使用。修复可包括以下步骤的任意组合：拆卸装置、然后清洗或更换特定部件和随后进行重新组装。具体地讲，可以拆卸装置的实施例，并且可有选择地以任何组合形式来更换或拆除装置的任意数量的特定部件或零件。在清洗和/或更换特定零件时，装置的实施例可在修复设施中重新组装或者在即将进行外科手术前由外科手术团队重新组装，以供随后使用。本领域的技术人员将会知道，修复装置时可利用多种技术进行拆卸、清洗/更换和重新组装。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。
可对本文所述的实施例在外科手术前进行处理，以下仅通过举例的方式说明。首先，可获取新的或用过的器械，并根据需要进行清洗。然后可对器械进行消毒。在一种消毒技术中，将该装置置于闭合并密封的容器中，例如塑料或TYVEK袋中。然后可将容器和器械置于可穿透该容器的辐射场，例如γ辐射、X射线或高能电子。辐射可将器械上和容器中的细菌杀死。然后可将消毒后的器械保存在消毒容器中。该密封容器可将器械保持在无菌状态，直到在医疗设施中打开该容器。还可使用本领域已知的任何其他技术对装置消毒，所述技术包括（但不限于）β辐射或γ辐射、环氧乙烷或蒸汽消毒。
已经示出和描述了本发明的多个实施方案，可由本领域普通技术人员进行适当修改来实现本文描述的方法和系统的进一步改进而不偏离本发明的范围。已经提及了若干此类潜在的修改形式，并且其他修改形式对于本领域的技术人员而言将显而易见。例如，上面讨论的例子、实施例、几何形状、材料、尺寸、比率、步骤等均是示例性的而非必需的。因此，本发明的范围应以下面的权利要求书考虑，并且应理解为不限于说明书和附图中示出和描述的结构和操作细节。

Claims (20)

1.一种电外科装置，包括：
(a)主体；
(b)端部执行器，所述端部执行器包括：
(i)第一钳口，其中所述第一钳口包括第一电极，和
(ii)第二钳口，其中所述第二钳口包括第二电极，
其中所述第一钳口能够朝着所述第二钳口运动，以夹住所述第一钳口和第二钳口之间的组织，
其中所述第一电极和第二电极能够操作以将RF能量递送至夹在所述第一钳口和第二钳口之间的组织；
(c)能够操作以切割夹在所述第一钳口和所述第二钳口之间的组织的切割构件；和
(d)在所述主体与所述端部执行器之间延伸的轴，其中所述轴限定纵向轴线，其中所述轴包括铰接部分，其中所述铰接部分能够操作以将所述端部执行器有选择地定位在相对于所述轴的所述纵向轴线的非平行位置处。
2.根据权利要求1所述的电外科装置，其中所述铰接部分包括模塑塑料件。
3.根据权利要求2所述的电外科装置，其中所述铰接部分包括并置在一起的一对互补的模塑塑料件。
4.根据权利要求1所述的电外科装置，其中所述铰接部分包括多个凹槽，其中所述切割构件的一部分设置在所述凹槽中的一个中。
5.根据权利要求4所述的电外科装置，还包括设置在所述多个凹槽中的另一个凹槽中的弹性梁。
6.根据权利要求5所述的电外科装置，其中所述弹性梁与所述切割构件的设置在所述凹槽中的一个中的所述部分平行。
7.根据权利要求1所述的电外科装置，其中所述铰接部分包括一个或多个铰接梁，所述一个或多个铰接梁能够操作以朝着或远离所述轴的所述纵向轴线有选择地驱动所述端部执行器，从而铰接所述端部执行器。
8.根据权利要求1所述的电外科装置，其中所述铰接部分提供将定位在所述铰接部分的两个横向侧面上的多个横向延伸的肋分开的多个横向凹槽，其中定位在所述铰接部分的第一横向侧面上的所述肋相对于定位在所述铰接部分的第二横向侧面上的所述肋纵向偏移。
9.根据权利要求1所述的电外科装置，其中所述铰接部分限定凹槽，所述凹槽能够容纳线材以向所述端部执行器提供电力。
10.根据权利要求1所述的电外科装置，其中所述铰接部分提供将定位在所述铰接部分的两个横向侧面上的多个横向延伸的肋分开的多个横向凹槽，其中第一组肋也定位在所述铰接部分的上半部上，其中第二组肋定位在所述铰接部分的下半部上，其中所述第一组肋与所述第二组肋交错。
11.根据权利要求1所述的电外科装置，其中所述铰接部分提供将定位在所述铰接部分的两个横向侧面上的多个横向延伸的肋分开的多个横向凹槽，其中所述铰接部分还包括将所述铰接部分的两个横向侧面分开的脊状部分，其中近侧脊状部分在所述铰接部分的近侧区域处具有第一宽度，其中远侧脊状部分在所述铰接部分的远侧区域处具有第二宽度。
12.根据权利要求11所述的电外科装置，其中所述第二宽度小于所述第一宽度。
13.根据权利要求12所述的电外科装置，其中所述脊状部分的所述宽度经过每一对肋从近侧的一对肋向远侧的一对肋连续减小。
14.根据权利要求1所述的电外科装置，其中所述铰接部分包括外部收缩管材。
15.根据权利要求1所述的电外科装置，其中所述铰接部分包括多个珠节。
16.根据权利要求15所述的电外科装置，其中所述珠节各自包括凸状远侧面以及凸状近侧面。
17.根据权利要求1所述的电外科装置，其中所述轴还包括旋转部分，其中所述旋转部分在所述铰接部分的远侧，其中所述旋转部分能够操作以使所述端部执行器相对于所述铰接部分旋转。
18.根据权利要求1所述的电外科装置，其中所述主体包括手持件。
19.一种电外科装置，包括：
(a)主体；
(b)端部执行器，所述端部执行器包括：
(i)第一钳口，和
(ii)第二钳口，
其中所述第一钳口能够朝着所述第二钳口运动，以夹住所述第一钳口和第二钳口之间的组织，
其中所述钳口中的至少一个包括至少一个电极，
其中所述至少一个电极能够操作以将RF能量递送至夹在所述第一钳口和第二钳口之间的组织；
(c)能够操作以切割夹在所述第一钳口和所述第二钳口之间的组织的切割构件；和
(d)在所述主体和所述端部执行器之间延伸的轴，其中所述轴限定纵向轴线，其中所述轴包括铰接部分，其中所述铰接部分能够操作以将所述端部执行器有选择地定位在相对于所述轴的所述纵向轴线的非平行位置处，其中所述铰接部分包括：
(i)通路，其中所述切割构件的一部分能够滑动地设置在所述通路中，
(ii)第一铰接构件，和
(iii)第二铰接构件，
其中所述第一铰接构件和所述第二铰接构件能够操作以有选择地使所述端部执行器偏转远离所述轴的所述纵向轴线。
20.一种电外科装置，包括：
(a)主体；
(b)端部执行器，所述端部执行器包括：
(i)第一钳口，和
(ii)第二钳口，
其中所述第一钳口能够朝着所述第二钳口运动，以夹住所述第一钳口和第二钳口之间的组织，
其中所述钳口中的至少一个包括至少一个电极，
其中所述至少一个电极能够操作以将RF能量递送至夹在所述第一钳口和第二钳口之间的组织；
(c)能够操作以切割夹在所述第一钳口和所述第二钳口之间的组织的切割构件；和
(d)在所述主体与所述端部执行器之间延伸的轴，其中所述轴限定纵向轴线，其中所述轴包括：
(i)近侧部分，
(ii)铰接部分，其中所述铰接部分在所述铰接部分的远侧，其中所述铰接部分能够操作以将所述端部执行器有选择地定位在相对于所述轴的所述纵向轴线的非平行位置处，和
(iii)旋转部分，其中所述旋转部分在所述铰接部分的远侧，其中所述旋转部分能够操作以有选择地使所述端部执行器相对于所述铰接部分旋转。
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