CN103281983A - 具有传感器和动力控制的外科器械 - Google Patents

具有传感器和动力控制的外科器械 Download PDF

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CN103281983A
CN103281983A CN2011800641486A CN201180064148A CN103281983A CN 103281983 A CN103281983 A CN 103281983A CN 2011800641486 A CN2011800641486 A CN 2011800641486A CN 201180064148 A CN201180064148 A CN 201180064148A CN 103281983 A CN103281983 A CN 103281983A
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control unit
attached
sensor
surgical instruments
end effector
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CN103281983B (zh
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K·L·豪泽
F·B·斯图伦
W·D·丹纳尔
F·E·谢尔顿四世
G·S·斯特罗布尔
A·C·沃格勒
T·P·莱塞克
G·M·蒙森
B·C·沃雷尔
H·杰恩
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Ethicon Endo Surgery Inc
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Abstract

本发明公开了一种外科器械，所述外科器械包括温度传感器和控制单元，所述控制单元能够操作以停用外科器械的端部执行器。在一些型式中，温度传感器检测换能器的温度；而在其他型式中，温度传感器检测端部执行器的温度。外科器械还可包括触发器和触发器位置传感器。可包括力传感器或位置传感器以确定传输组件的力和/或位置。端部执行器还可包括力传感器或微线圈。外科系统中可包括具有传感器的外科器械，所述外科系统包括控制单元和远程控制器。在某些情况下，远程控制器可具有一个或多个力反馈部件。另外，可包括装置界面和外科医生界面以远程调整控制单元的设置。

Description

具有传感器和动力控制的外科器械
优先权
本专利申请为2011年6月2日提交的名称为“Motor DrivenElectrosurgical Device with Mechanical and Electrical Feedback”的美国专利申请序列号13/151,481的部分继续申请，其公开内容以引用方式并入本文。
本专利申请要求2011年10月20日提交的名称为“SURGICALINSTRUMENT WITH SENSOR AND POWERED CONTROL”的美国非临时申请序列号13/277,328的优先权，其公开内容以引用方式并入本文。
本专利申请还要求2010年11月5日提交的名称为“Energy-BasedSurgical Instruments”的美国临时申请序列号61/410,603的优先权，其公开内容以引用方式并入本文。
本专利申请还要求2011年5月19日提交的名称为“Energy-BasedSurgical Instruments”的美国临时申请序列号61/487,846的优先权，其公开内容以引用方式并入本文。
背景技术
在一些情况下，内窥镜式外科器械可优于传统的开放式外科装置，因为较小的切口可减少术后恢复时间和并发症。因此，一些内窥镜式外科器械可适于将远侧端部执行器通过套管针的插管设置在期望的手术部位处。这些远侧端部执行器（例如，直线切割器、抓紧器、切割器、缝合器、施夹钳、进入装置、药物/基因治疗递送装置、以及使用超声、射频、激光等的能量递送装置）可以多种方式接合组织，以达到诊断或治疗的效果。内窥镜式外科器械可包括轴，所述轴位于端部执行器和由临床医生操纵的柄部之间。这种轴可允许插入到期望的深度并围绕轴的纵向轴线旋转，由此有利于将端部执行器定位在患者体内。
内窥镜式外科器械的例子包括公开于下述专利中的那些：2006年4月13日公布的名称为“Tissue Pad Use with an Ultrasonic Surgical Instrument”的美国专利公布2006/0079874，其公开内容以引用方式并入本文；2007年8月16日公布的名称为“Ultrasonic Device for Cutting and Coagulating”的美国专利公布2007/0191713，其公开内容以引用方式并入本文；2007年12月6日公布的名称为“Ultrasonic Waveguide and Blade”的美国专利公布2007/0282333，其公开内容以引用方式并入本文；2008年8月21日公布的名称为“Ultrasonic Device for Cutting and Coagulating”的美国专利公布2008/0200940，其公开内容以引用方式并入本文；2011年1月20日公布的名称为“Rotating Transducer Mount for Ultrasonic Surgical Instruments”的美国专利公布2011/0015660，其公开内容以引用方式并入本文；2002年12月31日公布的名称为“Electrosurgical Systems and Techniques for SealingTissue”的美国专利6,500,176，其公开内容以引用方式并入本文；以及2011年4月14日公布的名称为“Surgical Instrument Comprising First andSecond Drive Systems Actuatable by a Common Trigger Mechanism”的美国专利公布2011/0087218，其公开内容以引用方式并入本文。另外，这些外科工具可包括无线换能器，例如公开于2009年6月4日公布的名称为“Cordless Hand-held Ultrasonic Cautery Cutting Device”的美国专利公布2009/0143797中的无线换能器，所述专利公布的公开内容以引用方式并入本文。
另外，外科器械可用于或者可适用于机器人辅助外科装置，例如公开于2004年8月31日公布的名称为“Robotic Surgical Tool with UltrasoundCauterizing and Cutting Instrument”的美国专利6,783,524中的机器人辅助外科装置，所述专利公布的公开内容以引用方式并入本文。
尽管已研制出多种系统和方法并用于外科器械，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
本说明书后附的权利要求书特别指出并明确主张本技术，但据信从下面结合附图对某些例子所作的描述将会更好地理解本技术，附图中类似的参考标号表示相同元件，其中：
图1示出了包括外科器械和发生器的示例性超声外科系统的透视图；
图2示出了在其中具有换能器和多个传感器的示例性柄部组件的侧透视图；
图3A示出了具有多个传感器的示例性超声端部执行器的分解透视图，其中端部执行器显示处于闭合位置；
图3B示出了图3A所示端部执行器的分解透视图，所述端部执行器显示处于打开位置；
图4示出了示例性射频外科器械的柄部组件的侧剖面图，所述射频外科器械具有联接至控制单元的触发器位置传感器；
图5A示出了具有多个传感器的示例性射频端部执行器的侧正视图，其中端部执行器显示处于打开位置；
图5B示出了图5A所示端部执行器的侧正视图，所述端部执行器显示处于闭合位置；
图6示出了其中具有力传感器和位置传感器的示例性柄部组件的透视图；
图7示出了其中具有一对马达的示例性柄部组件的侧正视图；
图8示出了示例性远程控制器、外科医生界面、装置界面、以及附加输入装置的图解视图；
图9示出了具有自适应触发器组件的示例性柄部组件的侧正视图；并且
图10示出了具有示例性微线圈的端部执行器的侧正视图。
附图并非旨在以任何方式进行限制，并且预期本技术的各种实施例可以多种其他方式执行，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，示出了本技术的多个方面，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
本技术的某些例子的下述描述不应当用于限制其范围。通过以下举例说明（被认为是用于实施本技术的最佳方式之一），本技术的其他例子、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。正如将会意识到的，本文所述的技术包括其他不同且明显的方面，这些都未脱离本技术。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。
I.示例性超声外科系统概述
图1示出了示例性超声外科系统10，其包括超声外科器械50、发生器20和缆线30，该缆线能够操作以将发生器20联接至外科器械50。合适的发生器20为由Ethicon Endo-Surgery,Inc.（Cincinnati,Ohio）出售的GEN300。在一些型式中，发生器20是根据2011年4月14日公布的名称为“Surgical Generator for Ultrasonic and Electrosurgical Devices”的美国公布2011/0087212的教导内容中的至少一些教导内容进行构造，所述美国公布的公开内容以引用方式并入本文。应该指出的是，将参照超声外科器械来描述外科器械50；然而，如根据本文的教导内容对于本领域的普通技术人员而言显而易见的是，下文所述的技术可用于多种外科器械，包括但不限于直线切割器、抓紧器、切割器、缝合器、施夹钳、进入装置、药物/基因治疗递送装置、以及使用超声、射频、激光等的能量递送装置、和/或它们的任何组合。此外，尽管本例将参照缆线连接的外科器械50进行描述，但应当理解，外科器械50可适于无线操作，例如公开于2009年6月4日公布的名称为“Cordless Hand-held Ultrasonic Cautery Cutting Device”的美国专利公布2009/0143797中的无线操作，所述美国专利公布的公开内容以引用方式并入本文。此外，外科器械50也可用于或适用于机器人辅助的外科场景，例如公开于2004年8月31日公布的名称为“Robotic Surgical Tool withUltrasound Cauterizing and Cutting Instrument”的美国专利6,783,524中的机器人辅助的外科场景。
本例的外科器械50包括多部件柄部组件60、细长的传输组件70和换能器100。传输组件70在传输组件70的近端处联接至多部件柄部组件60并且从多部件柄部组件60朝远侧延伸。在本例中，传输组件70能够为细长的、细管状组件以用于内窥镜式用途，但应当理解，作为另外一种选择，传输组件70可为短组件，例如公开于2007年12月6日公布的名称为“Ultrasonic Waveguide and Blade”的美国专利公布2007/0282333以及2008年8月21日公布的名称为“Ultrasonic Device for Cutting and Coagulating”的美国专利公布2008/0200940中的那些，这些公布的公开内容以引用方式并入本文。本例的传输组件70包括外部护套72、内部管状致动构件（未示出）、波导（未示出）、以及位于传输组件70的远端上的端部执行器80。在本例中，端部执行器80包括联接至波导的刀82、能够操作以在传输组件70的近端处枢转的夹持臂84、以及任选的可联接至夹持臂84的一个或多个夹持垫86。另外应当理解，夹持臂84以及相关联的结构可根据1999年11月9日公布的名称为“Ultrasonic Clamp Coagulator Apparatus HavingImproved Clamp Arm Pivot Mount”的美国专利5,980,510的教导内容中的至少一些教导内容进行构造和操作，所述美国专利的公开内容以引用方式并入本文。
能够将超声能量从换能器100传输到刀82的波导可以为柔性、半柔性或刚性的。一种仅为示例性的超声换能器100为由Ethicon Endo-Surgery,Inc.（Cincinnati,Ohio）出售的型号HP054。如本领域中所熟知，波导也能够将通过波导传输到刀82的机械振动放大。波导还可具有用于控制沿波导的纵向振动的增益的结构，并且具有用于将波导调谐至系统的共振频率的结构。
在本例中，刀82的远端被设置在波腹附近，以便在声学组件未被组织承载时将所述声学组件调谐至优选的共振频率fo。当换能器100通电时，刀82的远端能够在例如大约10至500微米峰间范围内，并且优选地在约20至约200微米的范围内，以例如55.5kHz的预定振动频率fo纵向运动。当本例的换能器100启动时，这些机械振荡通过波导被传输到端部执行器80。在本例中，联接至波导的刀82在超声频率下振荡。因此，当将组织固定在刀82与夹持臂84之间时，刀82的超声振荡可同时切断组织并且使相邻组织细胞中的蛋白质变性，由此提供具有相对较少热扩散的促凝效果。也可通过刀82和夹持臂84提供电流以另外烧灼组织。尽管已描述出传输组件70和换能器100的一些构型，但根据本文的教导内容，传输组件70和换能器100的另一些其他合适构型对于本领域的普通技术人员而言是显而易见的。
本例的多部件柄部组件60包括配对外壳部分62和下部64。配对外壳部分62能够在配对外壳部分62的近端容纳换能器100并且在配对外壳部分62的远端容纳传输组件70的近端。在配对外壳部分62的远端上设有孔以用于插入各种传输组件70。在本例中示出了用于旋转传输组件70和/或换能器100的旋转旋钮66，但应当理解，旋转旋钮66仅为任选的。多部件柄部组件60的下部64包括触发器68并且能够供使用者使用单手抓紧。下部64的一个仅为示例性的替代构型示出于2011年1月20日公布的名称为“Rotating Transducer Mount for Ultrasonic Surgical Instruments”的美国专利公布2011/0015660的图1中，所述美国专利公布的公开内容以引用方式并入本文。
触发按钮（未示出）可位于下部64的远侧表面上并且能够操作以利用发生器20来启动不同操作水平下的换能器100。例如，第一触发按钮可启动最大能量水平下的换能器100，而第二触发按钮可启动最小、非零能量水平下的换能器100。当然，如根据本文的教导内容对于本领域的普通技术人员而言显而易见的是，触发按钮能够用于除最大和/或最小能量水平之外的能量水平。此外，触发按钮可位于多部件柄部组件60上、换能器100上、和/或远离外科器械50的任何其他位置，并且可提供任意数量的触发按钮。
尽管已参照两个不同部分62,64来描述多部件柄部组件60，但应当理解，多部件柄部组件60可为两个部分62,64结合在一起的一体组件。作为另外一种选择，多部件柄部组件60可分成多个分立元器件，例如单独的触发器部分（可通过使用者的手或脚来操作）和单独的配对外壳部分62。触发器部分能够操作以启动换能器100并且可远离配对外壳部分62。多部件柄部组件60可由耐用塑料（例如聚碳酸酯或液晶聚合物）、陶瓷、和/或金属、或者如根据本文的教导内容对于本领域的普通技术人员而言显而易见的任何其他合适的材料进行构造。根据本文的教导内容，多部件柄部组件60的另一些其他构型对于本领域的普通技术人员而言将是显而易见的。例如，器械50可作为机器人系统的一部分进行操作。根据本文的教导内容，多部件柄部组件60的其他构型对于本领域的普通技术人员而言也将是显而易见的。仅以举例的方式，外科器械50可根据下述专利的教导内容中的至少一些教导内容进行构造：美国专利公布2006/0079874、美国专利公布2007/0191713、美国专利公布2007/0282333、美国专利公布2008/0200940、美国专利公布2011/0015660、美国专利6,500,176、美国专利公布2011/0087218、和/或美国专利公布2009/0143797。
外科器械50的附加构型可在2011年10月10日提交的名称为“Ultrasonic Surgical Instrument with Modular End Effector”的美国专利申请序列号13/269,899中有更详细描述，其公开内容以引用方式并入本文。
A.具有传感器的示例性超声外科器械柄部组件
在一些型式中，包括传感器以监视外科器械50和/或其中的元件的状态可为有益的。例如，使用者可能期望监视换能器100和/或端部执行器80的温度。另外，使用者可能期望监视端部执行器80相对于一个或多个预定位置的位置和/或取向。此种位置和/或取向监视可允许使用者远程（例如在监视器上以图表形式或以其他方式）监视其对外科器械50的使用或可允许装置根据外科器械50的位置和/或取向信息而向使用者提供反馈。作为另外一种选择，此种位置和/或取向监视可由机器人装置使用以监视外科器械50的运动或由远程控制外科器械50的使用者使用。因此，将在本文中说明用于外科器械的各种传感器。
图2示出了具有多部件柄部组件160、细长的传输组件170和换能器180的外科器械150。多部件柄部组件160、细长的传输组件170和换能器180可根据上述多部件柄部组件60、传输组件70、和/或换能器100的教导内容中的至少一些教导内容进行构造。在本例中，换能器温度传感器190在基本上接近换能器180的位置处联接至壳体162的内表面。在其他型式中，换能器温度传感器190联接至换能器180或容纳在换能器180的壳体上或内。换能器温度传感器190能够操作以测量换能器180的温度或换能器180附近的大气温度。例如，换能器温度传感器190可包括热电偶或电热调节器。在一些型式中，换能器温度传感器190能够具有正温度系数（PTC），而在其他型式中，换能器温度传感器190能够具有负温度系数（NTC）。当然，根据本文的教导内容，换能器温度传感器190的其他构型对于本领域的普通技术人员而言将是显而易见的。本例的换能器温度传感器190以通信方式联接至控制单元1000，使得换能器温度传感器190可将温度信号传送至控制单元1000，如下文所详述。
本例的外科器械150还包括联接至壳体162的触发器位置传感器192。本例的触发器位置传感器192包括光学二极管开关，但也可使用其他位置传感器，诸如光学编码器、磁性编码器、电阻编码器等。触发器位置传感器192能够操作以确定触发器168相对于壳体162的位置。触发器位置传感器192也以通信方式联接至控制单元1000，使得触发器位置传感器192可传送用于表示触发器168的位置的信号。当然，根据本文的教导内容，触发器位置传感器192的其他构型对于本领域的普通技术人员而言将是显而易见的。例如，可包括多个触发器位置传感器192以进一步改进对触发器168相对于壳体162的位置的确定。仅以举例的方式，可使用多个光学二极管开关，使得当触发器168枢转时，一系列光学开关被断开。
在本例中，触发器168能够当触发器168被使用者致动时纵向致动轭172。轭172联接至内部管状致动构件（未示出），所述内部管状致动构件致动端部执行器（未示出）的夹持臂（未示出）。将参考图3A-3B更详细说明内部管状致动构件、夹持臂和端部执行器。本例的轭172还包括轭传感器194。轭传感器194包括应变仪，所述应变仪能够操作以确定轭172正施加至内部管状致动构件的力。应变仪可在联接至轭172之前根据已知标准进行校准。在所示的例子中，轭传感器194联接至轭172的一侧，但在其他型式中，轭传感器194可位于轭172的远端上或位于轭172与内部管状致动构件的接合轭172的部分之间。轭传感器194也以通信方式联接至控制单元1000，使得轭传感器194可将用于表示轭172上的力的信号传送至控制单元1000。当然，根据本文的教导内容，轭传感器194的其他构型对于本领域的普通技术人员而言将是显而易见的。
控制单元1000包括集成电路或微控制器，所述集成电路或微控制器能够从一个或多个传感器接收输入并将控制指令输出至一个或多个元件和/或装置，但输出仅为任选的（例如控制单元1000可仅为用于接收信息的诊断工具或元件和/或装置可与控制单元1000整合在一起，使得控制单元1000可直接启动或停用元件和/或装置）。在一些型式中，控制单元1000还包括EEPROM以在其上储存数据。例如，EEPROM可储存机器可读代码以控制外科器械150的各种元件或EEPROM可包含存储在数据表中的一个或多个操作设置和/或模式。当然，根据本文的教导内容，EEPROM的其他机器可读代码和/或构型对于本领域的普通技术人员而言将是显而易见的。在一些型式中，控制单元1000被整合到发生器20（示于图1中）中，但这仅为任选的。在其他型式中，控制单元1000被整合到外科器械150中（诸如图6-7所示的控制单元1000），或者控制单元1000可为独立的装置。
在本例中，换能器温度传感器190将指示换能器180的温度的信号传送至控制单元1000。控制单元1000能够当换能器温度传感器190指示某一预定温度时停用换能器180。在一些型式中，控制单元1000使换能器180与发生器20电分离，或使换能器180与缆线30电分离。此种电分离可通过电控制的开关实现。控制单元1000还能够以听觉方式警示使用者已达到或即将达到停用温度，但这仅为任选的。可在外科器械150上或内包括扬声器（未示出）以发出听觉警示。作为另外一种选择，可使用视觉信号（例如指示器或显示器上的弹出式警示）。因此，换能器温度传感器190和控制单元1000可用于监视换能器180的温度、停用换能器180（如果需要）、和/或向使用者提供警示。在一些型式中，当换能器180的温度超过阈值时（例如当传感器190包括热电偶/电热调节器时等），传感器190可直接停用和/或去耦换能器180，而无需由/通过控制单元1000执行切换。
除此之外或作为另外一种选择，控制单元1000和/或换能器温度传感器190能够连续地输出温度信号以供使用者观察或使另一装置监视并控制外科器械150。例如，发生器20和/或控制单元1000可包括显示屏（未示出），所述显示屏显示从换能器温度传感器190输出的温度信号。温度信号的显示可为视觉的（诸如图或多个彩色LED）、用数字表示的、或采用其他方式。在其他型式中，显示屏可安装至外科器械150。
如先前所述，触发器位置传感器192也以通信方式联接至控制单元1000。在本例中，来自触发器位置传感器192的位置信号被传送至控制单元1000以监视触发器168的位置。在一种型式中，控制单元1000可将换能器180维持在停用状态，直到触发器位置传感器192指示触发器168的某一位置。如先前参考图1类似地说明的，触发器168控制夹持臂（未示出），所述夹持臂抵靠刀（未示出）夹持组织。因此，控制单元1000可阻止换能器180的启动，直到达到触发器168的某一位置。在另一型式中，如果在换能器180被启动时触发器168的某一预定位置未被保持，则控制单元1000能够停用换能器180。如果触发器位置传感器192指示触发器168已被释放，则控制单元1000停用换能器180。在另一型式中，控制单元1000可根据从触发器位置传感器192接收到的位置信号而改变换能器180的功率。例如，如果触发器位置传感器192指示触发器168尚未被致动大的距离（诸如如果使用者抓住大量的组织），则控制单元1000能够以第一预定水平启动换能器180。作为另外一种选择，如果触发器位置传感器192指示触发器168已被完全致动或基本上被致动（诸如如果使用者抓住少量的组织或根本未抓住组织），则控制单元1000能够以第二预定水平启动换能器180。当然，换能器180的启动并不限于第一预定水平或第二预定水平，而是可在外科器械150的操作期间改变。
应当理解，触发器位置传感器192的输出可结合一个或多个其他传感器的输出来使用，使得控制单元1000可根据所感测条件的各种组合而针对外科器械150的各种元件提供适当的控制指令和/或启动或停用指令。仅以举例的方式，应变仪输出（诸如来自图3A-3B所示的应变仪286）和/或力输出（诸如来自图2所示的轭传感器194、图3A-3B所示的远侧垫传感器226、和/或近侧垫传感器236）可被传送至控制单元1000并用于确定被夹持在端部执行器内的组织的量、大小、类型等。可与控制单元1000一起使用的一些仅为示例性的传感器、使用者输入、和/或反馈在2011年6月2日提交的名称为“Motor Driven Electrosurgical Device with Mechanical andElectrical Feedback”的美国专利申请序列号13/151,481中有所公开，其公开内容以引用方式并入本文。
在本例中，轭传感器194将力信号输出至控制单元1000以指示由轭172施加至内部管状致动构件的力（以及因此指示端部执行器的夹持臂上的力）。如果轭传感器194指示大的力，而触发器位置传感器192指示触发器尚未被致动大的距离，则控制单元1000能够确定大片组织被夹持在端部执行器内。因此，控制单元1000以第一预定水平启动换能器180以切断组织。此种启动可为自动的或响应于使用者的选择（例如使用者持续按压触发按钮）。如果轭传感器194指示小的力或没有力，而触发器位置传感器192指示触发器尚未被致动大的距离，则控制单元1000能够确定小片组织或没有组织被夹持在端部执行器内。作为响应，控制单元1000能够操作以甚至当使用者试图启动换能器180时也能将换能器180维持在停用状态。如果轭传感器194指示存在的力很小或不存在力，并且触发器位置传感器192指示触发器已被完全致动或基本上致动，则控制单元1000能够确定薄的组织被夹持在端部执行器内或没有组织被夹持在端部执行器内。作为响应，控制单元1000能够操作以第二预定水平启动换能器180以切断组织。此种启动可为自动的或响应于使用者的选择（例如使用者持续按压触发按钮）。如果轭传感器194指示大的力，并且触发器位置传感器192指示触发器已被完全致动或基本上致动，则控制单元1000能够确定致密的组织被夹持在端部执行器内。作为响应，控制单元1000能够操作以第三预定水平启动换能器180以切断致密的组织。此种启动可为自动的或响应于使用者的选择（例如使用者持续按压触发按钮）。当然，使用控制单元1000、轭传感器194和触发器位置传感器192的上述系统仅为示例性的，并且根据本文的教导内容，其他构型和/或响应于传感器输入而从控制单元1000的输出对于本领域的普通技术人员而言将是显而易见的。
除此之外或作为另外一种选择，触发器位置传感器192的输出可用于启动一个或多个马达（未示出）以致动外科器械150和/或其他外科器械的元件。将参考图6来显示并描述此种机动化的外科器械的一个例子。
还应当理解，尽管已参考超声外科器械150描述了前述换能器温度传感器190、触发器位置传感器192、和轭传感器194，然而换能器温度传感器190、触发器位置传感器192、和轭传感器194可结合到其他外科器械中，包括直线切割器、抓紧器、切割器、缝合器、施夹钳、进入装置、药物/基因治疗递送装置、以及使用射频、激光等的能量递送装置。
B.用于具有传感器的超声外科器械的示例性端部执行器
图3A-3B示出了示例性端部执行器200的分解图，所述端部执行器在图3A中被显示处于闭合位置，在图3B中显示处于打开位置。在本例中，端部执行器200包括刀210、远侧夹持垫220、近侧夹持垫230、和夹持臂240。内部管状致动构件260和外部护套280为从柄部组件朝远侧延伸的传输组件的部件，诸如上述传输组件70和柄部组件60。刀210可根据上述刀82的教导内容中的至少一些教导内容或根据美国专利公布2006/0079874、美国专利公布2007/0191713、美国专利公布2007/0282333、美国专利公布2008/0200940、美国专利公布2011/0015660、和/或美国专利公布2009/0143797的教导内容中的至少一些教导内容进行构造，每一所述专利公布的公开内容均以引用方式并入本文。在本例中，刀210能够联接至换能器（诸如换能器100,180），并以超声频率振荡。刀210与换能器的此种联接可通过波导（未示出）实现。当将组织固定在刀210和夹持臂240之间时，刀210的超声振荡可同时切断组织并且使相邻组织细胞中的蛋白质变性，由此提供具有相对较少热扩散的促凝效果。也可通过刀210和夹持臂240提供电流以烧灼组织。如图所示，刀210包括圆柱形主体部分212和位于刀210的远端处的弯曲部分214。仅以举例的方式，刀210包括具有弯曲的矩形体末端的实心钛杆。应当理解，刀210可为基本上直的和/或刀210可具有其他几何形状，包括锥形末端、三棱柱末端、圆柱形末端、基本上平的末端、矩形体主体、和/或如根据本文的教导内容对于本领域的普通技术人员而言显而易见的任何其他几何形状。进一步，刀210可包括除钛之外的材料，包括铝、钢、铁、复合物、合金等。当然，根据本文的教导内容，刀210的其他构型对于本领域的普通技术人员而言将是显而易见的。
i.具有传感器的示例性远侧夹持垫
本例的远侧夹持垫220包括E.I.du Pont de Nemours and Company（Wilmington,Delaware）的
Figure BDA00003462643600131
但如根据本文的教导内容对于本领域的普通技术人员而言显而易见的是，可使用其他低摩擦材料。远侧夹持垫220通过T形构件222安装到夹持臂240上，所述T形构件从远侧夹持垫220延伸并可插入夹持臂240的T形凹口（未示出）中。远侧夹持垫220可枢转至基本上平行于并接触刀210的位置。因此，当夹持臂240被致动至闭合位置（显示于图3A中）时，组织被压缩并夹持在远侧夹持垫220与刀210之间。如图所示，远侧夹持垫220包括非平滑表面224（诸如锯齿状构型）以增强远侧夹持垫220对组织的夹持。锯齿状构型或齿提供用于对抗组织相对于刀210的运动的牵引力。如本领域的普通技术人员所理解的那样，锯齿状构型仅为可用于防止组织相对于刀210的移动而移动的多种组织接合表面中的一个例子。其他示例性例子包括凸起、交织图案、踏板图案、喷丸或喷砂表面等。在所示例子中，远侧夹持垫220可在远端处插入夹持臂240中并设置在近侧夹持垫230的远侧。
远侧夹持垫220还包括远侧夹持传感器226。本例的远侧夹持传感器226包括应变仪或力敏电阻器，当触发器168将夹持臂240致动至闭合位置时，所述应变仪或力敏电阻器能够操作以确定施加到远侧夹持垫220上的力。应变仪或力敏电阻器可在联接至远侧夹持垫220之前根据已知标准进行校准。远侧夹持传感器226也以通信方式联接至控制单元1000。在本例中，垫触点228位于T形构件222上以电联接至夹持臂240上的互补触点（未示出）。因此，用于表示施加至远侧夹持垫220的力的力信号可从远侧夹持传感器226传送至控制单元1000。因此，远侧夹持传感器226可由控制单元1000使用以确定远侧夹持垫220与刀210之间存在或不存在组织。此外，远侧夹持传感器226也可结合其他传感器使用以确定组织的大小和/或密度。例如，如果远侧夹持传感器226输出用于指示力被施加的信号且倾斜仪246（将于下文说明）和/或轭传感器196指示夹持臂240基本上未被致动，控制单元1000能够确定在夹持臂240与刀210之间存在大量组织。因此，控制单元1000可自动地或通过使用者触发触发按钮而输出指令以第一预定水平启动换能器180。如果远侧夹持传感器226输出用于指示大的力的信号且倾斜仪246和/或轭传感器196指示夹持臂240完全或基本上被致动，控制单元1000能够确定在夹持臂240与刀210之间存在薄的致密的组织。因此，控制单元1000可自动地或通过使用者触发触发按钮而输出指令以第二预定水平启动换能器180。如果远侧夹持传感器226输出用于指示小的力被施加的信号且倾斜仪246和/或轭传感器196指示夹持臂240完全或基本上被致动，控制单元1000能够确定在夹持臂240与刀210之间存在薄的不太致密的组织。因此，控制单元1000可自动地或通过使用者触发触发按钮而输出指令以第三预定水平启动换能器180。如果远侧夹持传感器226输出用于指示没有力被施加的信号，则控制单元1000能够停用换能器180或阻止使用者启动换能器180。当然，根据本文的教导内容，远侧夹持传感器226的其他用途和/或构型对于本领域的普通技术人员而言将是显而易见的。
ii.具有传感器的示例性近侧夹持垫
近侧夹持垫230包括基本上平坦的夹持垫，所述夹持垫包括E.I.duPont de Nemours and Company（Wilmington,Delaware）的但如根据本文的教导内容对于本领域的普通技术人员而言显而易见的是，可使用其他低摩擦材料。近侧夹持垫230通过鸠尾状构件232安装到夹持臂240上，所述鸠尾状构件从近侧夹持垫230延伸并可插入夹持臂240的鸠尾状凹口（未示出）中。近侧夹持垫230也可枢转至基本上平行于并接触刀210的位置。因此，当夹持臂240被致动至闭合位置（显示于图3A中）时，组织被压缩在近侧夹持垫230与刀210之间。当然，由于远侧夹持垫220和近侧夹持垫230为不同的元件，因而用于远侧夹持垫220和近侧夹持垫230的材料可不同。远侧夹持垫220和/或近侧夹持垫230可进一步根据2006年4月13日公布的名称为“Tissue Pad for Use with an Ultrasonic SurgicalInstrument”的美国专利公布2006/0079874的教导内容中的至少一些教导内容进行构造，其公开内容以引用方式并入本文。
近侧夹持垫230还包括近侧夹持传感器236。本例的近侧夹持传感器236包括应变仪或力敏电阻器。当触发器168将夹持臂240致动至闭合位置时，所述应变仪或力敏电阻器能够确定施加到近侧夹持垫230上的力。应变仪或力敏电阻器可在联接至近侧夹持垫传感器236之前根据已知标准进行校准。近侧夹持传感器236也以通信方式联接至控制单元1000。在本例中，垫触点238位于鸠尾状构件232上以电联接至夹持臂240上的互补触点（未示出）。因此，用于表示施加至近侧夹持垫230的力的力信号可从近侧夹持传感器236传送至控制单元1000。因此，近侧夹持传感器236可由控制单元1000使用以确定近侧夹持垫230与刀210之间存在或不存在组织。此外，近侧夹持传感器236也可结合其他传感器使用以确定组织的大小和/或密度。在一些型式中，如果组织容纳在近侧夹持垫230与刀210之间，控制单元1000能够阻止换能器180的启动，但这仅为任选的。除此之外或作为另外一种选择，如果远侧夹持传感器226输出用于指示存在组织的信号且近侧夹持传感器236并不输出用于指示存在组织的信号，则控制单元1000能够以第一预定水平启动换能器180。如果远侧夹持传感器226与近侧夹持传感器236两者均输出用于指示存在组织的信号，则控制单元1000能够以第二预定水平启动换能器180。当然，前述仅为示例性的且可使用除远侧夹持传感器226和近侧夹持传感器236之外更多或更少的传感器。此外，控制单元1000可响应于从远侧夹持传感器226和/或近侧夹持传感器236接收到的各种信号而具有其他构型和/或设置。当然，根据本文的教导内容，近侧夹持传感器236的其他用途和/或构型对于本领域的普通技术人员而言将是显而易见的。
iii.示例性内部管状致动构件
本例的内部管状致动构件260为中空的圆柱形构件，所述圆柱形构件能够当刀210纵向延伸通过内部管状致动构件260时在外部护套280内纵向致动。内部管状致动构件260的近端联接至触发器（诸如触发器68,168），所述触发器能够在触发器被按压时朝近侧致动内部管状致动构件260。当触发器被释放时，内部管状致动构件260朝远侧致动。内部管状致动构件260的远端262包括一对致动孔264，所述致动孔设置在内部管状致动构件260的相对侧上并能够容纳夹持臂240的一对下部销252。因此，当夹持臂240通过致动孔264和下部销252联接至内部管状致动构件260时，内部管状致动构件260的纵向运动使夹持臂240围绕夹持臂240的一对上部销254枢转。当然，根据本文的教导内容，内部管状致动构件260的其他构型和联接机制对于本领域的普通技术人员而言将是显而易见的。例如，内部管状致动构件260可包括活动铰链，并可根据于__________提交的名称为“Surgical Instrument with Modular Clamp Pad”的美国专利申请序列号[代理人案卷号END6895USNP19.0587843]的教导内容中的至少一些教导内容进行构造，所述美国专利申请的公开内容以引用方式并入本文。
iv.具有传感器的示例性外部护套
本例的外部护套280也为中空的圆柱形构件，其能够当刀210、和内部管状致动构件260、以及与刀210相关联的波导纵向延伸穿过其中时在外部护套280的近端（未示出）处联接至柄部组件的壳体。外部护套280具有远端282，所述远端包括一对上部孔284，所述上部孔设置在外部护套280的相对侧上并能够容纳夹持臂240的一对上部销254。对于本领域的普通技术人员而言显而易见的是，上部孔284提供枢转点，夹持臂240可围绕所述枢转点枢转。外部护套280还能够相对于内部管状致动构件260纵向固定。因此，当内部管状致动构件260纵向致动时，外部护套280提供机械基础以使夹持臂240能够枢转。当然，外部护套280不一定需要相对于内部管状致动构件260固定。仅以举例的方式，内部管状致动构件260可为固定的且外部护套280可为可致动的，或者在其他型式中，内部管状致动构件260与外部护套280两者均可为可致动的。当然，根据本文的教导内容，外部护套280的其他构型对于本领域的普通技术人员而言将是显而易见的。例如，外部护套280可包括活动铰链，并可根据于________提交的名称为“Surgical Instrument with Modular Clamp Pad”的美国专利申请序列号[代理人案卷号END6895USNP19.0587843]的教导内容中的至少一些教导内容进行构造，所述美国专利申请的公开内容以引用方式并入本文。
在本例中，外部护套280包括应变仪286，所述应变仪被安装至外部护套280的一部分。应变仪286以通信方式联接至控制单元1000并且能够操作以测量端部执行器200上的被施加至外部护套280的力。应变仪286可在联接至外部护套280之前根据已知标准进行校准。当夹持臂240被致动以抵靠刀210夹持组织时，图3A-3B所示的应变仪286测量被施加至外部护套280的力。因此，应变仪286所产生的力信号可指示组织的密度和/或大小。例如，如果存在致密的组织，则当夹持臂240被致动闭合时，应变仪286可产生用于指示大的力的信号。作为另外一种选择，如果存在薄的组织或不存在组织，则当夹持臂240被致动闭合时，应变仪286可产生用于指示存在小的力或不存在力的信号。因此，控制单元1000能够响应于从应变仪286所传送的力信号而调整换能器180和/或其他元件的设置。当然，来自应变仪286的输出信号也可与其他传感器信号一起由控制单元1000使用。此外，尽管应变仪286被显示成位于外部护套280上，然而应当理解，应变仪286可位于其他位置，包括位于内部管状致动构件260上或位于夹持臂240上。此外，可采用多个应变仪286来测量多个力方向和/或力位置。根据本文的教导内容，应变仪286的另一些其他构型对于本领域的普通技术人员而言将是显而易见的。此外，其他传感器可结合应变仪286或替代应变仪286而联接至外部护套280。例如，热电偶、电热调节器、倾斜仪等可位于外部护套280上。一个此类附加传感器为倾斜仪246，将于下文中对所述倾斜仪进行更详细说明。
v.具有传感器的示例性夹持臂
夹持臂240包括接合部分242和位于接合部分242近侧的附接部分248。本例的接合部分242包括具有基本上平坦的底面的弯曲构件，所述弯曲构件包括T形凹口，所述T形凹口能够容纳远侧夹持垫220的T形构件222。T形凹口包括互补触点以电联接至远侧垫传感器226的垫触点228。接合部分242所具有的曲率基本上类似于本例的刀210的曲率。当然，如果刀210为直的，则接合部分242也可为直的。接合部分242还能够围绕刀210的各侧向下弯曲，使得接合部分242形成槽，刀210可将组织压缩到所述槽中并切断组织。附接部分248包括主体构件250、一对下部销252、和一对上部销254。主体构件250包括鸠尾状凹口（未示出），所述鸠尾状凹口能够容纳近侧夹持垫230的鸠尾状构件232。鸠尾状凹口包括互补触点以电联接至近侧垫传感器226的垫触点238。如上所述，下部销252可插入内部管状致动构件260的致动孔264中且上部销254可插入外部护套280的上部孔284中。因此，当销252,254被插入孔264,284中时，夹持臂240联接至外部护套280和内部管状致动构件260，并且夹持臂240可相对于刀210枢转。当然，根据本文的教导内容，夹持臂240的其他构型对于本领域的普通技术人员而言将是显而易见的。在一些型式中，销252,254可为可插入穿过形成于主体构件232中的孔的单独的销。在一些其他型式中，夹持臂240可包括活动铰链，并可根据于__________提交的名称为“SurgicalInstrument with Modular Clamp Pad”的美国专利申请序列号[代理人案卷号END6895USNP19.0587843]的教导内容中的至少一些教导内容进行构造，所述美国专利申请的公开内容以引用方式并入本文。
本例的夹持臂240还包括夹持臂传感器244和倾斜仪246。本例的夹持臂传感器244包括热电偶或电热调节器，所述热电偶或电热调节器能够确定夹持臂240的温度。在本例中，夹持臂传感器244被安装至夹持臂240的顶面，但应当理解，根据本文的教导内容，夹持臂传感器244的其他位置和/或取向对于本领域的普通技术人员而言将是显而易见的。仅为示例性的替代位置包括位于夹持臂240的底部上、嵌入远侧夹持垫220中、嵌入近侧夹持垫230中、位于内部管状致动构件260上、和/或位于外部护套280上。在一些型式中，夹持臂传感器244能够具有正温度系数（PTC），而在其他型式中，夹持臂传感器244能够具有负温度系数（NTC）。当然，根据本文的教导内容，夹持臂传感器244的其他构型对于本领域的普通技术人员而言将是显而易见的。
夹持臂传感器244也以通信方式联接至控制单元1000。在本例中，夹持臂传感器244将用于表示夹持臂240的温度的信号传送至控制单元1000。当夹持臂传感器244指示预定温度传感器值时，控制单元1000能够停用换能器180。例如，控制单元1000能够操作以在发生器20处将供应至换能器180的电力解耦或使缆线30自换能器180分离。控制单元1000还能够以听觉方式和/或以视觉方式警示使用者停用温度已达到或即将达到，如上文所详述。因此，夹持臂传感器244和控制单元1000可用于监视夹持臂240的温度以及间接地围绕夹持臂240的组织的温度。
除此之外或作为另外一种选择，控制单元1000和/或夹持臂传感器244能够连续地输出温度信号以供使用者观察。例如，发生器20和/或控制单元1000可包括显示屏（未示出），所述显示屏显示温度信号。温度信号的显示可为视觉的（诸如图或多个彩色LED）、用数字表示的、或采用其他方式。在其他型式中，显示器可安装至外科器械150或被容纳在外科器械150内。因此，使用者能够在手术期间监视夹持臂240的温度。
当然，尽管已参考超声端部执行器说明了夹持臂传感器244，然而夹持臂传感器244可与其他外科器械和/或端部执行器一起使用。例如，直线切割器、抓紧器、切割器、缝合器、施夹钳、进入装置、药物/基因治疗递送装置、以及使用射频、激光等的能量递送装置。还应当理解，夹持臂传感器244无需一定为温度测量传感器，相反可为任何其他类型的传感器。例如，相反，夹持臂传感器244可为应变仪、倾斜仪、光学传感器等。
夹持臂240还包括联接至夹持臂240的纵向取向的第一倾斜仪246，所述第一倾斜仪能够操作以测量夹持臂240相对于预定取向（例如相对于水平面、相对于垂直面、相对于刀210等）的间距。第一倾斜仪246也以通信方式联接至控制单元1000，使得第一倾斜仪246所产生的倾斜信号被传送至控制单元1000。在一些型式中，倾斜仪246可结合其他传感器（诸如触发器位置传感器192和/或第二倾斜仪246）使用以确定夹持臂240和/或刀210的取向。例如，第一倾斜仪246可指示夹持臂240相对于水平面的位置且触发器位置传感器192可指示触发器168的位置。因此，控制单元1000可根据来自第一倾斜仪246和触发器位置传感器192的信号而确定夹持臂240和刀210相对于水平面的取向（即间距）。
除此之外或作为另外一种选择，第一倾斜仪246可指示夹持臂240相对于水平面的取向，并且位于外部护套280上且相对于第一倾斜仪246垂直取向的第二倾斜仪246也可指示外部护套280相对于水平面的辊取向。因此，当第一倾斜仪246和第二倾斜仪246以通信方式联接至控制单元1000时，控制单元1000可确定夹持臂240和/或刀210相对于两个平面的取向（即间距和辊取向）。
作为另外一种选择或除上述之外，固态罗盘（未示出）可包括在外科器械中（例如在柄部组件中，在外部护套280中或上等）并能够指示外部护套280的方位角。因此，当第一倾斜仪246、第二倾斜仪246、和固态罗盘以通信方式联接至控制单元1000时，控制单元1000可确定夹持臂240和/或刀210相对于三个平面的取向（即倾角、测滚度和偏转角）。在另一构型中，GPS接收器和/或其他位置电子器件可整合到外科器械中。利用此种位置和/或取向信息，控制单元1000可在显示器上指示夹持臂240和/或刀210是否被取向为适于组织的最佳切割。例如，可在外科手术之前（或与外科手术同时地）对外科路径进行塑造，并且关于是否基本上根据所塑造的外科路径而进行组织的切断，控制单元1000可向使用者提供反馈。作为另外一种选择，此种取向反馈可用于机器人外科手术场景中。当然，根据本文的教导内容，倾斜仪246的另一些其他构型和/或用途对于本领域的普通技术人员而言将是显而易见的。
尽管在本文已说明了仅为示例性的端部执行器200，然而也可使用其他端部执行器。例如，可从端部执行器200省去夹持臂240、远侧夹持垫220、近侧夹持垫230、内部管状致动构件260、和/或外部护套280中的一者或多者。省去了近侧夹持垫230、内部管状致动构件260、和外部护套280的一个仅为示例性的端部执行器在2007年8月16日公布的名称为“Ultrasonic Device for Cutting and Coagulating”的美国专利公布2007/0191713中有所描述，其公开内容以引用方式并入本文。省去了夹持臂240、远侧夹持垫220、近侧夹持垫230、和内部管状致动构件260的另一仅为示例性的端部执行器在2007年8月21日公布的名称为“UltrasonicDevice for Cutting and Coagulating”的美国专利公布2008/0200940中有所描述，其公开内容以引用方式并入本文。根据本文的教导内容，端部执行器200的另一些其他构型对于本领域的普通技术人员而言将是显而易见的。
II.示例性射频（RF）外科器械的概述
虽然某些外科器械能够使用超声能量在组织上进行操作，但是其他外科器械（诸如图4-5B所示的外科器械300）能够向患者的组织提供能量，诸如电能和/或热能。外科器械300包括柄部组件302、传输组件320、以及联接至传输组件320的远端的端部执行器400（显示于图5A-5B中）。如下文所详述，柄部组件302可包括一个或多个开关和/或触发器以将电能供应至端部执行器400和/或在端部执行器400内推进刀或切割构件410（也显示于图5A-5B中）以横切位于端部执行器400内的组织。
A.具有传感器的示例性柄部组件
重新参考图4，柄部组件302包括一个或多个电输入端310，所述电输入端能够操作地与电源（未示出）联接，所述电源诸如发生器20和/或任何其他电源，包括例如容纳在柄部组件302内的电源。传输组件320从柄部组件302朝远侧延伸并包括联接至传输组件320的远端的端部执行器400。电源将电流提供至外科器械300，并且电源能够操作以控制电流的大小、持续时间、波形、和/或频率以向外科器械300提供所需量的能量。本例的柄部组件302包括柄部主体304，所述柄部主体能够支撑开关或触发器306以选择性地使电输入端310与延伸穿过传输组件320的第一导体420电联接，使得被供应至输入端310的电流可被传送至端部执行器400。本例的触发器306还包括触发器位置传感器192，所述触发器位置传感器产生并传送信号至控制单元1000以指示触发器306相对于柄部主体304的位置。触发器位置传感器192可进一步根据上文关于图2对触发器位置传感器192所作的描述而进行构造和/或配置。柄部主体304包括两个纵向二等分的部分，所述部分组装在一起形成柄部主体304。如图4所示，已省去一个部分以显示柄部组件302的各种内部元件中的一些。在各种实施例中，如根据本文的教导内容对于本领域的普通技术人员而言显而易见的是，柄部主体304的半部可扣合、压合、焊接、黏附在一起、和/或彼此扣紧。进一步，柄部组件302可为一体部件而非两个分立的半部。在另一选择中，所述部分可并非为半部，而是仅为分立的可耦合的元件，诸如具有可移除的顶部和/或侧部的柄部主体304。根据本文的教导内容，柄部主体304的另一些其他构型对于本领域的普通技术人员而言将是显而易见的。
第一导体420包括导线（诸如绝缘导线），所述导线延伸于触发器306与端部执行器400中的第一电极430（显示于图5A-5B中）之间并且还延伸于触发器306与输入端310之间。在本例中，第一导体420联接至上钳口406中的第一电极430和下钳口408中的第一电极430，但应当理解，第一电极430可只在上钳口406中或只在下钳口408中。第一滑环326将第一导体420的延伸穿过传输组件320的一部分电联接至第一导体320的容纳在柄部组件302内的一部分。柄部组件302还包括第二导体422，所述第二导体也通过输入端310电联接至电源，并延伸穿过传输组件320至端部执行器400并到达第二电极432。在本例中，第二导体422联接至上钳口406中的第二电极432和下钳口408中的第二电极432，但应当理解，第二电极432可只在上钳口406中或只在下钳口408中。传输组件320包括外部护套322，所述外部护套与轴324同轴且围绕所述轴设置，使得轴324被容纳在外部护套322中。第二导体422包括具有绝缘塑料外壳或护套的导线以使第二导体422相对于第一导体420、轴324、和/或第一电极430绝缘。第二滑环328能够将第二导体422的延伸穿过传输组件320的一部分电联接至第二导体422的容纳在柄部组件302中的一部分。本例的滑环326,328分别包括圆形或至少半圆形触点，所述触点安装在柄部主体304内并与安装至传输组件320的一部分的对应的圆形或至少半圆形触点保持接触。滑环326,328因此允许传输组件320相对于柄部组件302旋转，并同时仍通过传输组件320为第一导体420和第二导体422提供电性路径。
当然，柄部组件302和外科器械300可包括其他构型。例如，柄部组件302和/或外科器械300可包括组织切割元件和用于将双极性射频能量传送至组织（例如以凝结或密封组织）的一个或多个元件。这种装置的例子是由Ethicon Endo-Surgery,Inc.（Cincinnati,Ohio）制造的
Figure BDA00003462643600221
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美国专利中：2002年12月31公布的名称为“Electrosurgical Systems and Techniques for SealingTissue”的美国专利6,500,176，其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7,112,201，其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7,125,409，其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7,169,146，其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 Energy Delivery”的美国专利7,186,253，其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7,189,233，其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 andMethods of Use”的美国专利7,220,951，其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 PTCProperty and Methods of Fabrication”的美国专利7,309,849，其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“ElectrosurgicalInstrument and Method of Use”的美国专利7,311,709，其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7,354,440，其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7,381,209，其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 Drive Systems Actuatableby a Common Trigger Mechanism”的美国公布2011/0087218，其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 DrivenElectrosurgical Device with Mechanical and Electrical Feedback”的美国专利申请13/151,181，其公开内容以引用方式并入本文。
B.示例性射频端部执行器
本例的端部执行器400包括上钳口406和下钳口408。上钳口406可相对于下钳口408枢转且能够操作以通过轴324的致动而将组织夹持在上钳口406与下钳口408之间。轴324的致动可经由触发器306的致动、通过第二触发器、通过按钮、通过马达、通过螺线管、和/或通过任何其他适宜的方法来实现。本例的上钳口406和下钳口408均包括第一电极430，所述第一电极延伸于端部执行器400的近端402与远端404之间，显示于图5A-5B中。本例的第一电极430包括沿上钳口406和下钳口408的第一侧延伸的第一侧面部分、沿上钳口406和下钳口408的第二侧延伸的第二侧面部分、以及连接上钳口406和下钳口408的第一侧面部分和第二侧面部分的横向端部，由此在上钳口406和下钳口408中形成U形纵向电极。本例的上钳口406和下钳口408还包括第二电极432，所述第二电极具有与第一电极430相似的形状，但与第一电极430绝缘且从第一电极430插入。在某些情况下，上钳口406仅包括第一电极430且下钳口408仅包括第二电极432，反之亦然。在另一构型中，第二电极432可与切割构件410一起致动。上钳口406和下钳口408均包括纵向槽（未示出），所述纵向槽能够允许切割构件410在其中纵向平移。端部执行器400的另一些其他构型公开于美国专利6,500,176、美国专利7,112,201、美国专利7,125,409、美国专利7,169,146、美国专利7,186,253、美国专利7,189,233、美国专利7,220,951、美国专利7,309,849、美国专利7,311,709、美国专利7,354,440、美国专利7,381,209、美国专利公布2011/0087218、和/或2011年6月2日提交的名称为“Motor Driven Electrosurgical Device with Mechanical and ElectricalFeedback”的美国专利申请13/151,181中，其公开内容以引用方式并入本文。
仍参见图5A-5B，本例的端部执行器400还包括上钳口传感器442和倾斜仪440。本例的上钳口传感器442包括热电偶或电热调节器，所述热电偶或电热调节器能够确定上钳口406的温度。在本例中，上钳口传感器442安装至上钳口406，但应当理解，根据本文的教导内容，上钳口传感器442的其他位置和/或取向对于本领域的普通技术人员而言将是显而易见的。仅为示例性的替代位置包括下钳口408、轴324、和/或外部护套322。在一些型式中，上钳口传感器442能够具有正温度系数（PTC），而在其他型式中，上钳口传感器442能够具有负温度系数（NTC）。当然，根据本文的教导内容，上钳口传感器442的其他构型对于本领域的普通技术人员而言将是显而易见的。
上钳口传感器442也以通信方式联接至控制单元1000。在本例中，上钳口传感器442将用于表示上钳口406的温度的信号传送至控制单元1000。当上钳口传感器442指示某一温度时，控制单元1000能够停用外科器械300。控制单元1000还能够以听觉方式警示使用者停用温度已达到或即将达到。因此，上钳口传感器442和控制单元1000可用于监视上钳口406的温度并据此控制外科器械300。
除此之外或作为另外一种选择，控制单元1000和/或上钳口传感器442能够连续地输出温度信号以供使用者观察。例如，发生器（诸如发生器20）和/或控制单元1000可包括显示屏（未示出），所述显示屏显示温度信号。温度信号的显示可为视觉的（诸如图或多个彩色LED）、用数字表示的、或采用其他方式。在其他型式中，显示器可安装至外科器械150或容纳在外科器械150内。因此，使用者能够在手术期间监视上钳口406的温度。
当然，尽管已参考射频端部执行器说明了上钳口传感器442，然而上钳口传感器442可与其他外科器械和/或端部执行器一起使用。例如，直线切割器、抓紧器、切割器、缝合器、施夹钳、进入装置、药物/基因治疗递送装置、以及使用超声、激光等的能量递送装置。还应当理解，上钳口传感器442无需一定为温度测量传感器，相反可为安装至上钳口406的任何其他类型的传感器。例如，相反，上钳口传感器442可为应变仪、倾斜仪、光学传感器等。
本例的倾斜仪440安装至轴324并位于切割构件410的近侧。类似于关于图3A-3B所示和所述的倾斜仪246，倾斜仪440能够测量轴324相对于预定取向（例如相对于水平面、相对于垂直面等）的间距。倾斜仪440也以通信方式联接至控制单元1000，使得倾斜仪440所产生的信号被传送至控制单元1000，以指示轴324相对于预定取向的倾斜度。此种取向信息可用于在抵靠下钳口408闭合上钳口406和致动切割构件410之前确保切穿组织的最佳角度。在一些型式中，倾斜仪440可结合其他传感器（诸如触发器位置传感器192、安装至上钳口406的第二倾斜仪440、固态罗盘、GPS接收器、和/或其他位置传感器）使用以确定切割构件410和/或上钳口406的取向。
在本例中，触发器306（显示于图4中）能够操作以将组织夹持在上钳口406与下钳口408之间并选择性地将能量从电源经由第一导体420供应至第一电极430。当电源联接至电输入端310时，第二电极432可经由第二导体422保持恒定地联接至电源或者，在一些型式中，第二触发器和/或按钮可选择性地将电力供应至第二电极432。因此，当触发器306致动时，电流从第一电极430流动至第二电极432以烧灼所述第一电极和第二电极之间的组织。此种热可使组织内的胶原蛋白变性，并且与端部执行器400的钳口406,408所提供的夹紧压力配合，变性的胶原蛋白可在组织内形成密封。在一些型式中，触发器306向发生器提供指示以将电流提供至电极。因此，在这些型式中，触发器306并不只是根据电流的开关，所述开关能够操作以选择性地中断电流。
本例的上钳口传感器442用于监视当电流在第一电极430与第二电极432之间流动时在端部执行器400处产生的温度。在一些型式中，上钳口传感器442可用于监视最小温度和最大温度以确定何时组织被充分密封但不变得过热。尽管本示例性端部执行器400能够使用双极性射频能量来密封组织，然而，应当理解，其他型式可使用单极性射频能量和/或其他发热元件。电极430,432的第一横向侧能够在组织内形成第一侧向密封，并且电极430,432的第二横向侧能够在组织内形成第二侧向密封。当然，其他构型可包括多个电极、和/或多个电极部分，所述多个电极、和/或多个电极部分可在组织内以任何取向形成任何适宜数目的密封。当组织在上钳口406和下钳口408的纵向槽的任一端上被密封时，切割构件410朝远侧致动以切断组织的两个横向密封的部分。活性射频能量可有助于此种切断（除密封组织之外）。切割构件410可通过第二触发器（未示出）致动，或者在一个替代性型式中通过触发器306的进一步致动而致动。在本例中，切割构件410包括位于刀的相对端上的上法兰和下法兰，由此形成I形构件。当切割构件410朝远侧致动时，法兰有助于抵靠下钳口408压缩上钳口406。
当然，端部执行器400和/或外科器械300可包括如根据本文的教导内容对于本领域的普通技术人员而言显而易见的其他构型。
III.具有力和位置传感器的示例性的替代性柄部组件
在某些情况下，使用者在使用外科器械的同时可期望获得反馈。例如，如果外科器械300正切断敏感组织，推进切割构件410所需的力可为重要的。另外，切割构件410被推进穿过组织的速度对于使用者而言也可以是重要的。因此，对于一些使用者而言，监视并向使用者提供与切割构件410和/或轴326的力和速度相关的反馈的能力是可取的。在替代性装置中，施加至内部管状致动构件260的力可对应于夹持臂240所施加的夹持力。因此，监视内部管状致动构件260上的力的能力可允许使用者监视组织上的夹持力。此外，以视觉方式指示力和/或速度测量的相对值的能力对于使用者而言也可以是可取的，使得使用者可改变其对装置的使用。因此，以下例子描述一个此类示例性的柄部组件。应当理解，以下说明可应用于各种外科器械，而并非旨在限于本文所述的装置和/或端部执行器。
图6示出了包括力传感器510和位置传感器520的替代性柄部组件500。在本例中，为清晰起见，已省去柄部组件500的一些元件，但应当理解，柄部组件500可根据本文所述柄部组件302,160,60的教导内容中的至少一些教导内容和/或根据美国专利6,500,176、美国专利6,783,524、美国专利7,416,101、美国专利7,738,971、美国专利6,783,524、美国公布2006/0079874、美国公布2007/0191713、美国公布2007/0282333、美国公布2008/0200940、美国公布2009/0209990、美国公布2009/043797、美国公布2010/0069940、和/或美国临时申请序列号61/410,603的教导内容中的至少一些教导内容进行构造。如图6所示，柄部组件500包括触发器502，所述触发器联接至轴504并还联接至力传感器510。触发器502能够操作以相对于柄部组件500纵向致动所述轴504。轴504可根据图4-5B所示的轴324的教导内容中的至少一些教导内容进行构造，或者在一些型式中，轴504可根据图3A-3B所示的内部管状致动构件260的教导内容中的至少一些教导内容进行构造。力传感器510联接至触发器502和轴504，并且能够测量从触发器502传送至轴504的力。在本例中，力传感器510包括力换能器，但如根据本文的教导内容对于本领域的普通技术人员而言显而易见的是，可使用其他力测量传感器。力传感器510以通信方式联接至控制单元1000，并且能够操作以传送用于指示被施加至轴504的力的信号。
位置传感器520联接至轴504，并且能够测量轴504相对于初始预定位置的纵向位移。在本例中，位置传感器520包括线性电位差计，但应当理解，可使用其他位置传感器（例如线性编码器、线性排列的光学传感器等）。仅以举例的方式，初始预定位置可对应于在由触发器502致动之前轴504的位置。因此，当使用者致动触发器502时，轴504被纵向致动，并且位置传感器520测量所述轴504的纵向位移。位置传感器520也以通信方式联接至控制单元1000并且能够操作以传送用于表示轴504的线性位移的信号。
本例的控制单元1000位于柄部组件500内，但这仅为任选的。甚至，如先前所述，控制单元1000可整合到发生器（诸如发生器20）中，或者控制单元1000可为单独的装置。在本例中，控制单元1000能够接收来自力传感器510的力测量和来自位置传感器510的位置测量。利用这些测量，控制单元1000能够确定被施加至轴324的力和轴324的推进速度。控制单元1000可被进一步构造成比较上述值与预定力和/或推进速度值。控制单元1000可接着确定施加至组织的力的量是太多、太少还是适当。另外，控制单元1000还可确定轴324朝远侧推进的速度是太快、太慢、还是适当。在一些型式中，诸如在机器人外科环境中，控制单元1000能够响应于相对力和/或速度确定结果而将经调节的控制信号输出至致动器和/或能够操作外科器械的其他元件。在其他型式中，诸如在其中使用者正操作外科器械的型式中，可提供感观指示器以向使用者提供反馈。仅为示例性的感观反馈可呈视觉、听觉、触觉等形式。
在本例中，多个指示器530安装至柄部组件500且联接至控制单元1000，使得控制单元1000能够操作以调控指示器530。本例的指示器530包括多个LED，但可使用其他指示器。仅为示例性的替代性指示器530包括动态图像显示器、听觉音响、联接至触发器502的力反馈机构等。如图6所示，五个指示器530联接至控制单元1000。当然，可使用任何数目的指示器530，包括1个、2个、3个、4个、6个、7个或更多个。在本例中，中心指示器530对应于来自控制单元1000的输出，所述输出指示适当的速度和/或力正被施加至轴324。远侧指示器530指示来自控制单元1000的对应于预定值的输出，所述输出指示轴324推进太快和/或施加至轴324的力太大。近侧指示器530指示来自控制单元1000的对应于两个不同预定值的输出，所述输出指示轴324推进太慢和/或施加至轴324的力太小。作为另外一种选择，指示器530可具有各种颜色，使得不同的颜色对应于正反馈和/或负反馈。当然，根据本文的教导内容，控制单元1000和/或指示器530的其他构型对于本领域的普通技术人员而言将是显而易见的。
在一些型式中，多组指示器530可指示来自控制单元1000的多个不同输出。例如，一组指示器530可指示如由控制单元1000所确定的轴324的相对速度（太快/太慢/适当），而第二组指示器530可指示如由控制单元1000所确定的轴324上的相对力（太大/太小/适当）。这些组指示器530可排列成LED的平行线。在一些替代性型式中，所述两组指示器530可排列成彼此垂直（诸如呈L形状、T形状、或呈十字形）。根据本文的教导内容，指示器530的另一些其他布置形式对于本领域的普通技术人员而言将是显而易见的。
本例还包括触发开关540，所述触发开关以通信方式联接至控制单元1000。本例的触发开关540包括对应于多个预定设置的多个位置。仅以举例的方式，触发开关540能够针对不同类型的组织（例如，又厚又软的组织、又厚又硬的组织、又薄又硬的组织、又薄又软的组织等）调整控制单元1000，但应当理解，可使用触发开关540和/或控制单元1000的其他构型。例如，触发开关540可针对各种类型的端部执行器、轴长度等而包括对应于多个预定设置的多个位置。响应于触发开关540的运动，本例的控制单元1000能够针对所选的组织类型而使用力和/或位置的预定值的对应表格。因此，使用者可在使用外科器械之前利用触发开关540为控制单元1000选择适当的值。一旦使用者开始使用外科器械，控制单元1000便接收来自力传感器510和位置传感器520的信号并对值与由触发开关540所选的预定值进行比较。然后，控制单元1000将适当的信号输出至指示器530以指示使用者是否以适当的速度和/或利用适当的力推进轴。因此，使用者可根据由指示器530所提供的指示而调整其对外科器械的使用。当然，触发开关540仅为任选的且可省去。
在一些设置中，指示器530所提供的反馈可用于在对有生命的人或生物体使用之前训练外科器械的使用者。例如，医学学生可在首次将装置用于有生命的人或生物体之前使用具有指示器530的外科器械来对外科器械进行练习。作为另外一种选择，此种反馈可由使用者使用以指示外科器械的最佳使用以实现止血。进一步，可使用（由使用者使用或由控制单元1000使用）反馈来监视外科器械的使用以防止由于不适当使用而造成损坏。根据本文的教导内容，柄部组件500的另一些其他构型和/或使用对于本领域的普通技术人员而言将是显而易见的。
IV.具有马达的示例性柄部组件
在一些设置中，使用者可较喜欢具有机械辅助或机动化元件。此种控制可允许具有各种体型特征的各种使用者以基本上相同的方式控制外科器械。例如，一些使用者的手力可大于或小于其他使用者的手力。此外，在一些情况下，机动化控制可允许使用者远程操作外科器械。此外，此种机动化控制可允许控制单元1000控制某些动作执行的顺序（例如在启动换能器100,180之前夹持组织、在推进切割构件410之前密封组织、在推进切割构件410之前网装固定组织、等等）。因此，以下将描述柄部组件的各种构造，所述构造实现马达和/或对柄部组件的各种元件的马达辅助。
A.具有马达驱动的刀轴和夹紧轴的柄部组件
图7示出了示例性柄部组件600，其具有壳体602、可相对于壳体602枢转的触发器604、触发器位置传感器606、一对触发按钮608,609、可纵向致动的刀轴610、第一马达620、可致动的夹紧轴630和第二马达640。本例的触发器604可从第一打开位置（显示于图7中）枢转至第二闭合位置（未示出）。如图7所示，触发器604能够枢转地联接至触发器位置传感器606，但应当理解，这仅为任选的。因此，应当理解，触发器604除触发器位置传感器606和壳体602之外并不接合柄部组件600的任何其他元件。因此，使用者旋转触发器604所需的力可基本上减小至仅来自触发器位置传感器606和/或壳体602的摩擦阻力。当然，可提供弹簧或其他弹性构件以将触发器604偏置至打开位置。在一些型式中，反馈机构（诸如马达或线性致动器（未示出））可联接至触发器604以向触发器604提供力反馈。在其他型式中，触发器604可以能够枢转地联接至壳体602或完全省去（例如在机器人控制的外科器械或远程操作的装置中）。在下文中将更详细地说明具有任选力反馈机构的此种远程操作的装置。
本例的触发器位置传感器606联接至壳体602和触发器604且能够操作以测量触发器604相对于第一预定位置（诸如图7所示的打开位置）的旋转位移。触发器位置传感器606可包括电位差计、编码器、光学传感器、和/或如根据本文的教导内容对于本领域的普通技术人员而言显而易见的任何其他旋转和/或位置测量传感器。触发器位置传感器606也以通信方式联接至控制单元1000，使得触发器位置传感器606所产生的信号可传送至控制单元1000。尽管本例的控制单元1000被显示为位于柄部组件600内，然而应当理解，控制单元1000可整合到电源（诸如图1所示的发生器20）中，或者控制单元1000可为独立的装置。
第一马达620能够操作以相对于壳体602纵向推进刀轴610。在本例中，马达620包括具有小齿轮622的旋转马达，所述小齿轮能够操作以接合并致动刀轴610上的齿条612。本例的刀轴610联接至端部执行器并能够操作以推进切割构件以切断被夹持在端部执行器内的组织。在一些型式中，刀轴610能够操作以夹紧端部执行器并切断组织，诸如在图5A-5B所示的端部执行器400的切割构件410中。作为另外一种选择，刀轴610可联接至端部执行器的其他元件，诸如联接至图3A-3B所示端部执行器200的夹持臂240。根据本文的教导内容，刀轴610的另一些其他构型对于本领域的普通技术人员而言将是显而易见的。在一些型式中，齿轮箱（未示出）可设置在刀轴610的齿条612与马达620上的齿轮622之间以增大或减小齿轮齿数比。马达620可包括伺服马达、压电马达、步进马达、有刷马达、无刷马达、短轴型马达、和/或如根据本文的教导内容对于本领域的普通技术人员而言显而易见的任何其他马达。在一些其他型式中，可省去马达620，并且线性致动器、气压缸、压电致动器、液压缸、和/或任何其他致动装置可联接至刀轴610以向刀轴610提供运动。本例的马达620也以通信方式联接至控制单元1000且能够操作以从控制单元1000接收输出控制信号。根据本文的教导内容，马达620和/或刀轴610的另一些其他构型对于本领域的普通技术人员而言将是显而易见的。
本例的第二马达640能够操作以相对于壳体602纵向推进夹紧轴630。在本例中，马达640包括具有小齿轮642的旋转马达，所述小齿轮能够操作以接合夹紧轴630上的齿条632。本例的夹紧轴630联接至端部执行器的上钳口，并且夹紧轴630能够操作以枢转上钳口以抵靠下钳口（未示出）夹持组织。端部执行器、上钳口、和/或下钳口可根据上述端部执行器400、上钳口406、和/或下钳口408的教导内容中的至少一些教导内容进行构造。应当理解，如根据本文的教导内容对于本领域的普通技术人员而言显而易见的是，夹紧轴630可联接至其他元件和/或端部执行器。在一些型式中，齿轮箱（未示出）可设置在夹紧轴630的齿条632与马达640的齿轮642之间以增大或减小齿轮齿数比。马达640可包括伺服机、压电马达、步进马达、有刷马达、无刷马达、短轴型马达、和/或如根据本文的教导内容对于本领域的普通技术人员而言显而易见的任何其他旋转马达。在一些型式中，可省去马达640，并且线性致动器、气压缸、压电致动器、液压缸、和/或任何其他线性致动装置可联接至夹紧轴630以提供线性运动。本例的马达640也以通信方式联接至控制单元1000且马达640能够操作以从控制单元1000接收输出控制信号。根据本文的教导内容，马达640和/或夹紧轴630的另一些其他构型对于本领域的普通技术人员而言将是显而易见的。
触发按钮608,609以通信方式联接至控制单元1000且能够启动外科器械的一个或多个功能方面。在本例中，第一触发按钮608能够启动端部执行器的射频元件（诸如上述第一电极230和第二电极232）以凝结或密封被端部执行器夹持的组织。除此之外或作为另外一种选择，第一触发按钮608可启动第二马达640以推进上述夹紧轴630。进一步，在其他外科器械中，第一触发按钮608可致动滑动件以将缝钉驱动出钉仓。在另一构型中，第一触发按钮608可启动超声换能器。当然，根据本文的教导内容，第一触发按钮608的另一些其他构型和可操作用途对于本领域的普通技术人员而言将是显而易见的。本例的第二触发按钮609能够启动第一马达620以朝远侧推进刀轴610。如根据本文的教导内容对于本领域的普通技术人员而言显而易见的是，第二触发按钮609可启动外科器械的其他结构。
本例的控制单元1000能够操作以从触发按钮608,609和触发器位置传感器606接收输入并将控制信号输出至第一马达620和/或第二马达640。控制单元1000还能够启动联接至柄部组件600的端部执行器的射频元件，但应当理解，控制单元1000并不限于与射频端部执行器一起使用。此外，应当理解，触发按钮608,609、触发器604、以及触发器位置传感器606仅为任选的并且可省去。甚至，如下文所述，可使用远程装置将适当的输入信号传送至控制单元1000以控制第一马达620、第二马达640以及任何附加元件以使用联接至柄部组件600的端部执行器。
在本例中，控制单元1000能够操作以响应于使用者对触发器604的枢转而启动并控制第二马达640。控制单元1000从触发器位置传感器606接收输出并将控制信号输出至第二马达640。因此，当使用者旋转触发器604时，触发器位置传感器606将位置信号传送至控制单元1000。控制单元1000然后将对应的输出信号传送至第二马达640，使得第二马达640致动夹紧轴630对应于触发器604旋转的预定距离。仅以举例的方式，控制单元1000可将脉冲宽度调节信号输出至伺服马达以使伺服马达旋转至期望的位置。当然，根据本文的教导内容，其他输出和/或马达组合对于本领域的普通技术人员而言将是显而易见的。由于使用者并不直接施加力以致动夹紧轴630，因而在马达640提供力以致动夹持臂轴630的同时，具有不同力量的使用者均可旋转触发器604。在一些型式中，可省去触发器606，并且可使用远程装置（诸如操纵杆）来为控制单元1000提供输入，如下文所详述。除此之外或作为另外一种选择，计算机程序和/或指令可为控制单元1000提供输入值以操作第二马达640。当然，根据本文的教导内容，第二马达640和控制单元1000的其他构型对于本领域的普通技术人员而言将是显而易见的。
控制单元1000还能够操作以响应于使用者启动第一触发按钮608而启动端部执行器的一个或多个元件。如先前所述，控制单元1000可启动端部执行器的射频元件（诸如上述第一电极230和第二电极232）以凝结被夹持在端部执行器内的组织。当然，控制单元1000可响应于使用者启动第一触发按钮608而启动其他端部执行器的其他元件。
在本例中，控制单元1000还能够操作以将控制信号输出至第一马达620，使得可通过控制单元1000来控制刀轴610的致动。仅以举例的方式，控制单元1000可将脉冲宽度调节信号输出至伺服马达以使伺服马达旋转至期望的位置。当然，根据本文的教导内容，其他输出和/或马达组合对于本领域的普通技术人员而言将是显而易见的。在本例中，第二触发按钮609能够启动控制单元1000以启动第二马达620，由此推进刀轴610并切断被夹持和密封在端部执行器内的组织。
尽管上述说明详述了用于控制并致动具有柄部组件600的外科器械的各种元件的控制单元1000的某些基本功能，然而控制单元1000还可用于控制由端部执行器执行的夹持、凝结和切割动作的先后顺序和时序。应当理解，上述夹持、凝结和切割动作仅为示例性的且控制单元1000也可控制其他动作，诸如启动超声换能器、将缝钉驱动出钉仓、等等。
在本例中，当使用者期望利用联接至柄部组件600的端部执行器夹持、凝结并切断组织时，首先使用者将组织定位在端部执行器的上钳口与下钳口之间。然后使用者通过致动触发器604而开始夹持组织。如上所述，触发器604能够枢转地联接至触发器位置传感器606。触发器位置传感器606将信号传送至控制单元1000以指示触发器604的旋转位置。响应于触发器位置传感器604所传送的新位置信号，控制单元1000启动第二马达640以将夹紧轴630致动至期望的位置。当触发器604处于打开位置时，如图7所示，控制单元1000能够将控制信号提供至第二马达640，使得端部执行器的夹持臂或上钳口处于打开位置（诸如图3B和图5A所示的那些）。当使用者将触发器604旋转至闭合位置时，控制单元1000将控制信号提供至第二马达640以致动夹紧轴630，使得端部执行器的夹持臂或上钳口朝闭合位置旋转（诸如图3A和图5B所示的那些）。当然，如上所述，触发器604仅为任选的且可使用用于将信号输入至控制单元1000的其他源来代替柄部组件600的触发器604和触发器位置传感器606。
一旦触发器位置传感器606指示触发器604已枢转至闭合位置，使用者便可启动端部执行器。在本例中，使用者启动第一触发按钮608，由此命令控制单元1000启动端部执行器的射频元件。当然，第一触发按钮608可启动具有其他元件的其他端部执行器。在一些型式中，控制单元1000可停用第一触发按钮608，直到触发器位置传感器606指示触发器604枢转至闭合位置。第一触发按钮608的此种停用可防止在将组织夹持在端部执行器内之前使用者意外启动端部执行器的元件。一旦触发器位置传感器606指示触发器604枢转至闭合位置，控制单元1000便可启用第一触发按钮608以允许使用者启动第一触发按钮608。如先前所述，第一触发按钮608的启动使控制单元1000启动端部执行器的射频元件。在其他型式中，在触发器位置传感器606指示触发器604枢转至闭合位置之后，控制单元1000可自动启动端部执行器的射频元件。在一些型式中，控制单元1000也可命令第二马达640暂停在闭合位置，直到被控制单元1000提示返回至打开位置。即使使用者释放触发器604，此种暂停也可在夹持、凝结并切割组织期间将端部执行器维持在闭合位置。当然，根据本文的教导内容，第一触发按钮608和控制单元1000的其他构型和控制对于本领域的普通技术人员而言将是显而易见的。
在本例中，控制单元1000联接至一个或多个传感器以监视组织的温度。例如，端部执行器可包括上述上钳口传感器442以监视端部执行器的温度（以及间接地监视附近组织的温度）。当然，其他传感器可整合到端部执行器中以监视组织的凝结。在一些替代性型式中，控制单元1000能够阻止任何其他动作，直到预定暂停时间达到。此种暂停时间可用于允许端部执行器对组织进行适当凝结。一旦预定时间过去和/或所述一个或多个传感器指示组织被适当凝结，控制单元1000能够停用端部执行器的射频元件并允许推进刀轴610，使得切割构件可切断被端部执行器夹持的组织。在本例中，控制单元1000阻止刀轴610致动，直到组织被适当凝结和密封。在一些型式中，一旦组织被适当凝结和密封，控制单元1000便可自动将控制指令输出至第一马达620以致动刀轴610。在其他型式中，控制单元1000可等待，直到使用者命令控制单元1000致动刀轴610（诸如通过使用者启动第二触发按钮609）。一旦使用者启动第二触发按钮609，控制单元1000便命令第一马达620推进刀轴610，由此切断端部执行器内的组织。
当组织被切断时，控制单元1000可自动缩回刀轴610并致动夹紧轴630以打开端部执行器以释放被凝结并切断的组织。在一些型式中，在刀轴610缩回且端部执行器打开之前，控制单元1000可等待，直到使用者将触发器604枢转至打开位置。当然，用于夹持、凝结并切断组织的上述步骤的各种部分可省去和/或与本文所述的各种其他部分组合。仅以举例的方式，一旦使用者将触发器604枢转至闭合位置，组织的凝结、切断和释放便可全部由控制单元1000自动地且依序执行。因此，使用者可仅需执行一个动作—将触发器604枢转至闭合位置—以启动外科器械以夹持、凝结并切断组织。此种自动动作可提供被凝结并切断的组织的更均匀图案。在另一型式中，控制单元1000可在每一阶段（例如在夹持、凝结并切断组织之后）等待使用者输入。当然，根据本文的教导内容，其他构型和顺序对于本领域的普通技术人员而言将是显而易见的。
在利用同一致动轴（诸如图5A-5B中所示的端部执行器400）夹持并切断组织的一些外科器械中，控制单元1000可利用马达620致动轴短的距离以初始地将组织夹持在端部执行器内。组织然后由使用者启动第一触发按钮608在初始化之后凝结或由控制单元1000自动地凝结。一旦组织被充分凝结，控制单元1000便接着进一步推进轴以切断端部执行器内的组织。根据本文的教导内容，控制单元1000的另一些其他构型对于本领域的普通技术人员而言将是显而易见的。此外，应当理解，控制单元1000可与非机动化外科器械一起使用。仅以举例的方式，控制单元1000可控制锁定结构，所述锁定结构防止在指示组织被适当凝结之前使用者推进刀轴610。如先前所述，此种指示可通过一个或多个传感器或根据预定停留时间提供。当然，也可为其他外科装置的其他人工启动部分提供此种锁定结构。
进一步，控制单元1000可监视外科器械的时间和使用以提供关于外科器械和/或端部执行器的诊断信息以防止外科器械和/或端部执行器的过度使用。例如，对于具有换能器的外科器械，控制单元1000可监视启动次数、换能器被启动的持续时间、以及总体时间以确定换能器是否可过热。参考本例，控制单元1000可监视启动次数、射频元件被启动的持续时间、以及总体时间以确定端部执行器是否可超过预定温度值。
B.具有力反馈和可调式设置的示例性远程控制器
如先前所述，在一些型式中，可省去触发器604、触发器位置传感器606、和触发按钮608,609，并且可使用图8所示的远程控制器2000来向控制单元1000提供所需输入。远程控制器2000通过有线连接或通过无线连接以通信方式联接至控制单元1000，使得来自远程控制器2000的命令可传送至控制单元1000。在一些型式中，反馈可从控制单元1000传送至远程控制器2000以指示外科器械的一个或多个条件。远程控制器2000可包括一个或多个操纵杆、一个或多个方向垫、一个或多个触发器、一个或多个按钮、和/或任何其他适用于使用者的输入装置。仅以举例的方式，图8所示的远程控制器2000包括一对操纵杆2010、夹持触发器2020、端部执行器启动按钮2030、以及刀致动按钮2040。所述一对操纵杆2010能够将指令输出至控制单元1000以通过一个或多个马达控制端部执行器和/或柄部组件600的深度、旋转、垂直位置、水平位置、间距、和/或偏转角，所述一个或多个马达能够操作以调整柄部组件600的位置和/或取向。夹持触发器2020包括传感器，所述传感器能够以与触发器位置传感器606基本上相同的方式感测夹持触发器2020的旋转位置。因此，当使用者枢转夹持触发器2020时，远程控制器2000将指令传送至控制单元1000以使端部执行器的夹持闭合。在柄部组件600的例子中，控制单元1000命令第二马达640旋转夹紧轴630并使其朝近侧或朝远侧平移。端部执行器启动按钮2030和刀致动按钮2040以与先前所述例子的触发按钮608,609基本上相同的方式提供输入信号。因此，当使用者启动端部执行器启动按钮2030时，远程控制器2000将指令传送至控制单元1000以启动端部执行器的一个或多个元件。可启动的仅为示例性的元件包括用于凝结并密封组织的射频元件、用于使刀振荡以切断组织的换能器、用于使滑动件平移以将缝钉驱动出仓盒的轴、和/或端部执行器的任何其他元件。当使用者启动刀致动按钮2040时，远程控制器2000将指令传送至控制单元1000以推进切割构件（诸如切割构件410）以切断被夹持在端部执行器内的组织。因此，使用者可通过使用远程控制器2000而远程控制外科器械和/或端部执行器。
在本例中，装置界面2100夹设在远程控制器2000与控制单元1000之间。装置界面2100包括集成电路或微控制器，所述集成电路或微控制器能够交接控制单元1000、远程控制器2000、外科医生界面2200、以及一个或多个装置输入端2300。在本例中，装置界面2100能够接收来自外科医生界面2200、一个或多个附加输入装置2300和控制单元1000的与组织条件、操作参数、外科医生偏好等有关的输入。本例的外科医生界面2200包括集成电路或微控制器，所述集成电路或微控制器能够从使用者接收输入并将期望的设置输出至装置界面2100。仅以举例的方式，外科医生界面2200可包括物理使用者界面（例如，触发按钮、开关等）或外科医生界面2200可包括软件使用者界面（例如，具有可由使用者调节的多种设置的软件）。来自外科医生界面2200的仅为示例性的输出可包括组织类型、组织大小、组织厚度、操作条件、最大或最小端部执行器温度、最大或最小夹持力、使用时间最大值、抽吸冲洗设置、换能器的能量水平、切割或凝结模式、和/或如根据本文的教导内容对于本领域的普通技术人员而言显而易见的任何其他输出。因此，外科医生可根据使用者的经验和确定而为装置界面2100提供各种设置以作为输入。利用此种输入，装置界面2100还能够响应于集体条件和设置而调整来自远程控制器2000的控制指令。例如，对于软组织，即使使用者在使用远程控制器2000的同时提供矛盾的指令，装置界面2100也可限制或减小夹持力和切割构件的推进速度。又如，对于又硬又厚的组织，装置界面2100可增大夹持力以确保端部执行器适当地抓紧组织。当然，根据本文的教导内容，外科医生界面2200和/或装置界面2100的其他构型对于本领域的普通技术人员而言将是显而易见的。
在本例中，一个或多个附加输入装置2300以通信方式联接至装置界面2100以提供输入。此种附加输入装置2300可提供与组织条件和/或其他操作参数相关的输入。仅以举例的方式，此种附加输入装置2300可包括图像处理装置、内窥镜式系统、用于外科器械的外部和/或内部传感器、供外科助理输入附加信息的输入装置等。因此，装置界面2100也可利用这些附加输入来修改来自远程控制器2000的控制指令或者，在一些替代形式中，确认从外科医生界面2200接收到的输入。装置界面2100接着将调整过的控制指令输出至控制单元1000。在一些型式中，来自装置界面2100的输出可缩减至一个或多个表参考文献，使得控制单元1000根据在机器可读永久介质中的存储在控制单元1000上的预定指令表（例如存储在控制单元1000的EEPROM上的设置数据表）来修改外科装置的一个或多个方面。当然，其他附加输入装置2300可与装置界面2100一起使用以提供附加输入。
在一些型式中，装置界面2100还可从控制单元1000接收传感器输入并将指令输出至远程控制器2000的力反馈部件，使得所述一对操纵杆2010和/或夹持触发器2020向使用者提供触觉反馈。仅以举例的方式，一个或多个传感器可联接至柄部组件600以监视端部执行器和/或外科器械的其他元件所遭遇的力。可与外科器械一起使用的仅为示例性的传感器包括但不限于上述轭传感器194和应变仪286。此种传感器可将反馈提供至控制单元1000以传送至远程控制器2000的一个或多个力反馈部件。远程控制器2000的此种力反馈部件可包括一个或多个致动装置（诸如马达、线性致动等），以对使用者对远程控制器2000的控制器件的移动提供阻力。这些抗力是基于端部执行器和/或外科器械的其他元件所遭遇的力。作为另外一种选择，或除力反馈之外，控制单元1000能够将触觉反馈信号传送至装置界面2100以即刻启动远程控制器2000的所述一个或多个致动装置。此种触觉反馈可指示某一步骤的完成（例如，组织凝结的完成或组织切断的完成）。作为另外一种选择，远程控制器2000还能够提供视觉、听觉、触觉、和/或其他感观反馈以指示控制单元1000已完成一个或多个序列步骤。仅为示例性的所完成的步骤（远程控制器2000可为其提供感观反馈）包括适当地凝结组织、将夹持组织的端部执行器完全闭合、和/或完全朝远侧致动切割构件以切断组织。当然，根据本文的教导内容，控制单元1000和/或远程控制器2000的其他构型对于本领域的普通技术人员而言将是显而易见的。
C.示例性自适应触发器控制
在某些情况下，当致动外科装置的触发器时，使用者可较喜欢具有可变的控制和/或反馈。例如，如果夹持运动和/或切割构件通过夹持和/或切割运动在中途遭遇困难项目，使用者可较喜欢停止夹持和/或切割并可能松开端部执行器和/或缩回切割工具。因此，对机动化柄部组件进行自适应控制是优选的。
图9示出了具有自适应触发器组件750的示例性柄部组件700。在本例中，柄部组件700包括壳体702、从壳体702朝远侧延伸的传输组件710、以及马达组件720。本例的传输组件710包括外部护套712和可在外部护套712内纵向致动的致动构件714。端部执行器（未示出）联接至外部护套712和致动构件714的远端。致动构件714能够操作以致动端部执行器中的一个或多个元件。例如，如果图3A-3B所示的端部执行器200联接至传输组件710的远端，致动构件714能够操作以枢转夹持臂240。作为另外一种选择，如果端部执行器400联接至传输组件710的远端，则致动构件714能够操作以朝远侧推进切割构件410以抵靠下钳口408夹持上钳口406并切断组织。根据本文的教导内容，端部执行器和致动构件714的另一些其他构型对于本领域的普通技术人员而言将是显而易见的。
致动构件714联接至传送构件716。传送构件716包括联动装置，所述联动装置在第一末端处能够枢转地联接至致动构件714并在第二末端处能够枢转地联接至马达组件720的滑架构件726。传送构件716还在中点处能够枢转地联接至壳体704。因此，当滑架构件726朝远侧或朝近侧推进时，传送构件716朝近侧或朝远侧（与滑架构件726的运动方向相反）致动所述致动构件714。
马达组件720包括马达722、联接至马达722的螺旋齿轮724、和滑架构件726。马达722安装在壳体702内并能够操作以旋转螺旋齿轮724。螺旋齿轮724在壳体702内沿纵向并基本上平行于致动构件714的轴线延伸。在本例中，滑架构件726包括内部螺纹，所述内部螺纹补充螺旋齿轮724的螺纹，并且滑架构件726承载于螺旋齿轮724上。如根据本文的教导内容对于本领域的普通技术人员而言显而易见的是，当马达722旋转螺旋齿轮724时，滑架构件726由于联接至传送构件716而受到旋转限制，从而相对于壳体702平移。因此，马达722能够操作以通过滑架构件726和传送构件714致动该致动构件714。在本例中，电阻器滑架760（将在下文更详细说明）也由螺旋齿轮724承载且可通过马达722对螺旋齿轮724的旋转而平移，但这仅为任选的。
触发器组件750包括能够枢转地安装至壳体702的触发器752和电阻器滑架760。本例的电阻器滑架760包括主体762、远侧力敏电阻器764、和近侧力敏电阻器766。在本例中，远侧力敏电阻器764和近侧力敏电阻器766能够使得当力被施加至远侧力敏电阻器764或近侧力敏电阻器766时，电阻减小。因此，使用者在对应方向上施加至触发器752的力越大，则远侧力敏电阻器764或近侧力敏电阻器766中的电阻越小。在本例中，当触发器752朝闭合位置枢转时，触发器752接触远侧力敏电阻器764，由此减小远侧力敏电阻器764的电阻。当触发器752朝打开位置枢转时，触发器752接触近侧力敏电阻器766，由此减小近侧力敏电阻器766的电阻。当未对触发器752施加力时，触发器752不会对远侧力敏电阻器764或近侧力敏电阻器766施加任何力。因此，当电源（未示出）电联接至远侧力敏电阻器764、近侧力敏电阻器766和马达720时，使用者对触发器752的致动会使马达722朝近侧或朝远侧旋转螺旋齿轮724。
如先前所述，电阻器滑架760是由螺旋齿轮724承载，使得当触发器752枢转时，电阻器滑架760致动。因此，触发器752的运动与致动构件714的运动连接。使用者拉动触发器752越用力，则马达722运行得越快并且电阻器滑架760在螺旋齿轮724上平移得越快。在一些型式中，触发器752可朝打开位置弹性偏置。因此，如果使用者释放触发器752，则触发器752能够接触近侧力敏电阻器以朝远侧致动该致动构件714，由此打开端部执行器。除此之外或作为另外一种选择，当使用者致动触发器752时，力反馈装置可联接至触发器752以提供电阻性反馈力。此种反馈可根据来自一个或多个传感器的输出而改变，所述传感器诸如轭传感器194、应变仪286、和/或用于指示通过致动构件714所施加的力的任何其他传感器。进一步，马达组件720可由可滑动的构件（未示出）承载，使得使用者可利用触发器752而手动致动该致动构件714越过大的距离并同时将远侧力敏电阻器764和/或近侧力敏电阻器766与马达722一起使用以实现更细致的运动。在另一型式中，触发器752可联接至致动构件714且远侧力敏电阻器764和/或近侧力敏电阻器766启动马达722以提供附加电力以致动该致动构件714。此种电力辅助操作可通过壳体702上的一个或多个增益旋钮（未示出）调整。当然，根据本文的教导内容，触发器组件750的另一些其他构型对于本领域的普通技术人员而言将是显而易见的。例如，触发器组件750可根据2010年8月10日公布的名称为“Motor-Driven Surgical Cuttingand Fastening Instrument with Adaptive User Feedback”的美国专利7,770,775的教导内容中的至少一些教导内容进行构造，所述美国专利的公开内容以引用方式并入本文。
V.具有微线圈的示例性端部执行器
在某些情况下，检测金属物件是否接近端部执行器对于使用者而言是有用的。例如，利用端部执行器夹持到或试图切穿金属物件（诸如缝钉、销、牵引器的部分等）是不可取的。此外，对于通过端部执行器中的一个或多个元件传送电力的装置而言，与金属物件接触可造成短路，由此可能损坏装置或危害手术部位的手术完整性。在这些情况下，在夹持到组织上和/或试图切穿金属物件之前检测此种物件的存在是优选的。因此，在端部执行器的末端上或附近提供微涡流线圈可允许使用者检测此种金属物件。
图10示出了具有微线圈810的示例性端部执行器800，所述微线圈位于端部执行器800的远端处。在本例中，微线圈810位于端部执行器800的上钳口802的远端处，但应当理解，作为另外一种选择，微线圈810可位于下钳口804的远端处或端部执行器800内或上的任何其他位置。另外，微线圈810可选择性地联接至端部执行器800，使得如果操作无需使用微线圈810，则使用者可卸下微线圈810。在一些型式中，微线圈810容纳在聚乙烯末端内以相对于端部执行器800的其他元件隔绝微线圈810，但这仅为任选的。实际上，在一些型式中，微线圈810可嵌入端部执行器800的非导电材料中。仅以举例的方式，微线圈810可嵌入夹持垫（诸如上述远侧夹持垫220）中。本例的微线圈810也以通信方式联接至控制单元（未示出）（诸如上述控制单元1000，使得电力可被供应至微线圈810且控制单元可监视通过微线圈810的电压。微线圈810可运作的频率的范围可为从500Hz（包括500Hz在内）至大于500kHz。例如，微线圈810可在700MHz至3kHz之间运作。当然，根据本文的教导内容，微线圈810可运作的其他频率对于本领域的普通技术人员而言将是显而易见的。
在本例中，施加至微线圈810的电压在端部执行器800的远端处产生从微线圈810向外延伸的磁场。当在微线圈810所产生的磁场内存在金属物件时，磁场（以及因此电压）会受到干扰。当初始启动外科器械时，可对基线磁场和/或电压读数进行测试并将其存储在控制单元内。此种基线读数将由端部执行器800的其他金属元件所产生的磁场干扰考虑在内。因此，在端部执行器800使用的同时，控制单元监视微线圈810以确定是否已相对于基线读数发生任何变化。如果端部执行器800和微线圈810遭遇金属物件，则控制单元会检测到干扰。如果遭遇预定电压偏移，则控制单元能够启动指示器以警告使用者存在金属物件。此种指示器可包括视觉显示器（例如，警示灯、显示屏幕上的弹出式警示等）、听觉音响、触觉反馈等。控制单元还可将时间、电压偏移和其他信息记录在控制单元的EEPROM上以用于稍后外科器械的诊断测试和/或用于记录目的。当然，根据本文的教导内容，微线圈810和端部执行器800的另一些其他构型对于本领域的普通技术人员而言将是显而易见的。
对于前述例子，应当理解，柄部组件和/或端部执行器可以是可重复使用的、耐高压灭菌的和/或一次性的。例如，前述端部执行器可以是一次性的，而柄部组件是可重复使用的和/或耐高压灭菌的。此外，如果内部电源与前述柄部组件一起使用，那么内部电源可以是可充电的。例如，可通过移出电池和对电池再充电、通过感应、和/或通过如根据本文的教导内容对于本领域的普通技术人员而言显而易见的任何其他方法，利用再充电插头对柄部组件进行再充电。此外，可以包括对准结构或引导件，以帮助端部执行器与柄部组件的对准和联接。这样的引导件可能有助于在外科器械的组装期间防止对端部执行器和/或柄部组件的损坏。
尽管已描述出示例性外科器械的某些构型，但根据本文的教导内容，可构造外科器械的各种其他方式对于本领域的普通技术人员而言将是显而易见的。仅以举例的方式，本文提及的外科器械可根据下述专利的教导内容中的至少一些教导内容进行构造：美国专利6,500,176、美国专利6,783,524、美国专利7,416,101、美国专利7,738,971、美国专利6,783,524、美国公布2006/0079874、美国公布2007/0191713、美国公布2007/0282333、美国公布2008/0200940、美国公布2009/0209990、美国公布2009/043797、美国公布2010/0069940、和/或美国临时申请序列号61/410,603，所述专利的公开内容以引用方式并入本文。
应当理解，所述以引用方式并入本文中的任何专利、公布或其他公开材料，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的材料。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。
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的手术中得到应用。例如，本领域的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“RoboticSurgical Tool with Ultrasound Cauterizing and Cutting Instrument”的美国专利6,783,524的各种教导内容相结合，其公开内容以引用方式并入本文。
仅以举例的方式，可对本文所述的实施例在外科手术前进行处理。首先，可获取新的或用过的器械，并根据需要进行清洁。然后可对器械进行消毒。在一种消毒技术中，将器械置于闭合并密封的容器中，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）中。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存储在无菌容器中。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。
本文所公开的装置的实施例可在至少一次使用之后进行修复以供再使用。修复可包括以下步骤的任意组合：拆卸装置、然后清洁或更换特定部件和随后进行重新组装。具体地讲，可对本文所公开的装置的实施例进行拆卸，并且可选择性地、以任何组合更换或拆除装置的任意数量的具体部件或零件。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、清洁/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。
已经示出和描述了本发明的多个实施例，可由本领域的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。已经提及了多种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)

1.一种外科器械，包括：
(a)主体部分；
(b)传输部分，所述传输部分从所述主体部分朝远侧延伸；
(c)端部执行器，所述端部执行器联接至所述传输部分的远端；
(d)控制单元；和
(e)一个或多个传感器，所述一个或多个传感器以通信方式联接至所述控制单元；
其中所述一个或多个传感器中的至少一个传感器能够操作以输出指示温度的信号，其中所述温度与所述外科器械相关联；并且
其中所述控制单元能够操作以响应于来自所述至少一个传感器的数据而选择性地停用所述端部执行器的至少一部分。
2.根据权利要求1所述的外科器械，还包括换能器，其中所述至少一个传感器安装在所述主体部分内，并且其中所述至少一个传感器能够操作以输出指示所述换能器的温度的信号。
3.根据权利要求2所述的外科器械，其中所述控制单元能够操作以选择性地停用所述换能器。
4.根据权利要求1所述的外科器械，其中所述至少一个传感器联接至所述端部执行器，并且其中所述至少一个传感器能够操作以输出指示所述端部执行器的温度的信号。
5.根据权利要求1所述的外科器械，还包括能够枢转地安装至所述主体部分的触发器和联接至所述触发器的触发器位置传感器，其中所述触发器位置传感器以通信方式联接至所述控制单元，并且其中所述触发器位置传感器能够操作以输出指示所述触发器相对于所述主体部分的旋转位置的信号。
6.根据权利要求1所述的外科器械，还包括联接至所述传输组件的力传感器，其中所述力传感器以通信方式联接至所述控制单元，并且其中所述力传感器能够操作以输出指示被施加至所述传输组件的力的信号。
7.根据权利要求6所述的外科器械，其中柄部部分包括指示器，其中所述指示器电联接至所述控制单元，其中所述控制单元能够操作以响应于从所述力传感器输出的信号而启动所述指示器。
8.根据权利要求1所述的外科器械，其中所述传输组件还包括致动构件和联接至所述致动构件的位置传感器，其中所述位置传感器以通信方式联接至所述控制单元，并且其中所述位置传感器能够操作以输出指示致动构件相对于所述主体部分的位置的信号。
9.根据权利要求8所述的外科器械，其中所述柄部包括指示器，其中所述指示器电联接至所述控制单元，其中所述控制单元能够操作以响应于从所述位置传感器输出的信号而启动所述指示器。
10.根据权利要求1所述的外科器械，其中所述端部执行器包括：
i.上钳口，所述上钳口能够枢转地联接至所述传输组件的远端，
ii.夹持垫，和
iii.力传感器，
其中所述力传感器以通信方式联接至所述控制单元，并且其中所述力传感器能够操作以输出指示被施加至所述上钳口的力的信号。
11.根据权利要求10所述的外科器械，其中所述力传感器联接至所述夹持垫。
12.根据权利要求10所述的外科器械，其中所述力传感器联接至所述上钳口。
13.根据权利要求10所述的外科器械，其中所述力传感器包括力敏电阻器。
14.根据权利要求1所述的外科器械，其中所述端部执行器包括微线圈。
15.根据权利要求14所述的外科器械，其中所述微线圈联接至所述控制单元，其中所述控制单元能够操作以将电压施加至所述微线圈，并且其中所述控制单元还能够操作以监视被施加至所述微线圈的电压。
16.一种外科系统，包括：
(a)控制单元；
(b)外科器械，所述外科器械包括：
i.主体部分，
ii.传输部分，所述传输部分具有能够平移的切割构件，
iii.端部执行器，
iv.一个或多个传感器，所述一个或多个传感器以通信方式联接至所述控制单元，和
v.一个或多个马达，所述一个或多个马达以通信方式联接至所述控制单元，
其中所述一个或多个马达中的至少一个马达能够操作以使所述切割构件相对于所述主体部分平移；和
(c)远程控制器，所述远程控制器以通信方式联接至所述控制单元；
其中所述控制单元能够操作以从所述一个或多个传感器接收输入信号；其中所述控制单元能够操作以向所述一个或多个马达输出一个或多个信号；其中所述控制单元能够操作以向所述远程控制器输出一个或多个信号；并且其中所述远程控制器能够操作以向所述控制单元输出一个或多个信号。
17.根据权利要求16所述的外科系统，其中所述远程控制器包括一个或多个力反馈部件，并且其中所述控制单元能够操作以启动所述一个或多个力反馈部件。
18.根据权利要求16所述的外科系统，还包括装置界面和外科医生界面，其中所述装置界面以通信方式联接至所述远程控制器、所述控制单元和所述外科医生界面，其中所述控制单元包括一个或多个可选择的设置，并且其中所述装置界面能够操作以响应于来自所述外科医生界面的输入而改变所述控制单元的一个或多个可选择的设置。
19.一种外科器械，包括：
(a)主体部分，其中所述主体部分包括：
i.马达组件，和
ii.触发器组件，其中所述触发器组件包括：
(1)触发器，所述触发器能够枢转地安装至所述主体部分，
(2)主体构件，所述主体构件联接至所述马达组件，
(3)远侧力敏电阻器，所述远侧力敏电阻器联接至所述主体构件，和
(4)近侧力敏电阻器，所述近侧力敏电阻器联接至所述主体构件；和
(b)致动构件，所述致动构件联接至所述马达组件；
其中所述马达组件能够操作以使所述致动构件平移。
20.根据权利要求19所述的外科器械，其中所述马达组件包括：
(1)马达，
(2)螺旋齿轮，所述螺旋齿轮联接至所述马达，和
(3)滑架构件，所述滑架构件由所述螺旋齿轮承载，
其中所述滑架构件能够操作以使所述致动构件平移。
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