CN103298425A - 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 PDFInfo
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- 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
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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
- 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
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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
- A61B18/14—Probes or electrodes therefor
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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
- 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
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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
- 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
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- 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
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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
- A61B18/1206—Generators therefor
- A61B2018/1246—Generators therefor characterised by the output polarity
- A61B2018/126—Generators therefor characterised by the output polarity bipolar
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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
- 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、以及在主体与端部执行器之间延伸的轴。端部执行器包括一对钳口以及可操作成将RF能量递送到夹在钳口之间的组织的至少一个电极。切割构件可操作成切割夹在所述钳口之间的组织。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。铰接部分可以包括珠节、区段、不对称结构、预制弯曲结构、整体铰链、螺旋形切口或弹簧、U型结构、成角度接头、珠节的致动键合部、以及/或者偏移枢轴和一些其它结构。该装置还可以包括卷曲切割构件、逆动切割构件、双枢转钳口、以及/或者线材拉伸组件。
Description
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)制造的组织密封装置。这种装置的进一步的例子以及相关理念公开于以下专利申请中: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 ControlledEnergy 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 andMethod 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 forControlled Energy Delivery”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“ElectrosurgicalInstrument”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 andMethods 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 CompositionsExhibiting a PTC Property and Methods of 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 and Method 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 and Method 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“SurgicalInstrument Comprising First and Second Drive Systems Actuatable by a CommonTrigger 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 DrivenElectrosurgical Device with Mechanical and Electrical Feedback”的美国专利申请No.13/151,181,该专利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,从而为定位成远离轴的铰接部分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)制造的各种型号的内切割器。这种装置的进一步的例子以及相关理念公开于以下专利申请中:2008年6月3日公布的名称为“Articulating Surgical StaplingInstrument Incorporating 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 BarSupports”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 anElectrically Actuated 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“Surgical Stapling 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示出了图5的铰接部分的珠节(bead)的透视图;
图7示出了沿图6的线7-7截取的图6的珠节的横截面图;
图8示出了用于图5的铰接部分的示例性备选珠节的透视图;
图9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俯视图;
图10示出了图9的铰接部分的透视仰视图;
图11示出了图9的铰接部分的互锁珠节的局部透视图;
图12示出了图9的铰接部分的珠节的透视图;
图13示出了用于图1的装置的轴的另一个示例性铰接部分的局部横截面图;
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局部横截面图;
图15示出了用于图1的装置的轴的另一个示例性铰接部分的局部横截面图;
图16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17示出了图16的铰接部分的仰视平面图;
图18示出了沿图16的线18-18截取的图16的铰接部分的珠节的横截面图;
图19示出了用于图1的装置的轴的另一个示例性铰接部分的局部横截面俯视图;
图20示出了图19的铰接部分的分解透视图;
图21示出了图19的铰接部分的横截面端视图;
图22示出了用于图19的铰接部分的端部执行器驱动组件的横截面端视图;
图23示出了用于图19的铰接部分的另一个示例性端部执行器驱动组件的横截面端视图;
图24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25示出了图24的铰接部分的横截面侧视图;
图26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27示出了用于图1的装置的轴的另一个示例性铰接部分的局部横截面侧视图;
图28示出了用于图1的装置的轴的另一个示例性铰接部分的示意图;
图29示出了沿图28的线29-29截取的图28的铰接部分的轴部分的横截面图;
图30示出了沿图29的线30-30截取的图28的铰接部分的端部执行器部分的横截面图;
图31A示出了处于基本直线构型的用于图1的装置的轴的另一个示例性铰接部分的侧正视图;
图31B示出了处于铰接构型的图31A的铰接部分的侧正视图;
图32示出了处于铰接构型的用于图1的装置的轴的另一个示例性铰接部分的横截面图;
图33示出了处于基本直线构型的图32的铰接部分的横截面图;
图34示出了用于图1的装置的轴的另一个示例性铰接部分的横截面图;
图35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36示出了图35的铰接部分的另一个透视图;
图37示出了用于图1的装置的轴与端部执行器之间的示例性备选联接件的透视图;
图38A示出了用于结合到图1的装置中的示例性备选端部执行器的局部透视图,其中切割构件定位在近侧位置处;
图38B示出了图38A的端部执行器的局部透视图,其中切割构件定位在远侧位置处;
图39A示出了用于结合到图1的装置中的另一个示例性备选端部执行器的侧正视图,其中切割构件定位在近侧位置处;
图39B示出了图39A的端部执行器的侧正视图,其中切割构件定位在远侧位置处;
图40示出了用于结合到图1的装置中的具有线材拉伸结构的示例性轴组件的透视图;
图41示出了图40的拉伸结构的透视图;
图42A示出了用于结合到图1的装置中的示例性卷曲切割构件的俯视平面图,其中切割构件处于基本卷曲构型;
图42B示出了处于基本直线构型的图42A的卷曲切割构件的俯视平面图;以及
图43示出了用于结合到图1的装置中的示例性铰接部分的横截面图,其中包括图42A的卷曲切割构件。
附图并非意在以任何方式构成限制,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旋转而不使靠近铰接部分36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的可旋转性而不使靠近铰接部分36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,例如杆或缆线等的致动器可以延伸穿过护套32并且在可枢转联接件43处与第一钳口42连接,使得致动器杆/缆线等穿过轴30的纵向运动提供第一钳口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/缆线等。
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运动。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,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”型构型使钳口42,44随着击发梁60朝远侧行进而闭合。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)行进到远侧位置(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,一个或多个缆线、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44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继续朝远侧行进。随着击发梁60朝远侧行进,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.[代理人案号END6889USNP]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.具有相邻珠节的示例性铰接部分
图5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包括多个同轴对准的珠节110。如在图6-7中最佳可见的,每一个珠节110都包括第一面112和第二面114。每一个面112,114都具有凸状构型。通过珠节110定位成彼此相邻,面112,114的凸状构型可以有利于铰接部分100的铰接。例如,一个珠节110的面112可以在铰接期间仅仅相对于相邻珠节110的面114滚动。
如图6中所示,每一个珠节110的外周边还包括从面112延伸到面114的凹槽120,122,124。在本例中,珠节110全部类似地能够使得相邻珠节110的相应的凹槽120,122,124可以易于彼此对准。如图5中所示,凹槽120,122容纳相应的铰接带140。铰接带140的远端固定到铰接部分100的远端。铰接带140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行进或缩回,同时保持另一个带140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一个带140行进时同时缩回另一个带140;以及/或者在有选择地缩回带140时使另一个带140同时行进。当然,可以通过缆线以及/或者各种其它类型的元件替代带140。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。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的其它类型的部件。作为又一个仅仅是示例性的例子,带140可以暴露在外并且可以在铰接期间自由地横向移动远离铰接部分100。例如,当带140被拉动并且铰接部分100弯曲时,被拉动的带140可以在铰接部分弯曲的同时趋于基本保持直线,从而产生弓弦型效应。允许这样的效应发生可以改进带140的机械优点,由此减少使用者遇到的铰接负载。
凹槽124能够容纳线材(未示出)。这种线材能够提供端部执行器104与电源之间的电连通。应当理解,像本文提到的其它线材一样,这种线材可以易于在铰接部分100铰接时与铰接部分100一起弯曲。每一个珠节110都还包括从面112延伸到面114的中心孔130。所有珠节110的孔130都在铰接部分100成基本直线构型时全部基本同轴对准。应当理解,击发梁160可以延伸穿过孔130。击发梁160是足够柔性的,以在铰接部分100处于弯曲构型时沿由孔130所限定的弯曲路径弯曲和平移。因此,无论铰接部分100处于直线构型还是弯曲构型,击发梁160都可以用于以上文所述的方式致动端部执行器104。如在图7中最佳可见的,每一个孔130都具有沙漏形构型,从而可以有利于在铰接部分100处于铰接构型时使击发梁160折曲穿过铰接部分100。例如,孔130的沙漏形构型可以限制击发梁160上的弯曲应力。除此之外或者备选地,当击发梁160受到负载时(例如,当击发梁160使刀行进穿过组织而铰接部分100处于铰接构型时等),孔130的沙漏形构型可以限制用于击发梁160的屈曲空间。
图8示出了珠节110的仅仅是示例性的变型。特别是,图8示出了能够容纳套囊190的示例性备选珠节150。铰接部分中的一个、多于一个、或者所有的珠节150都可以包括相应的套囊190。套囊190能够通过与由珠节150所提供的脊152相接合而卡扣配合到珠节上。套囊190还能够相对于珠节110将铰接带140基本保持在凹槽120,122中。此外,套囊190能够将线材基本保持在凹槽124中。套囊190还可以保护邻近铰接部分的组织,例如通过防止带140被拉离珠节150并且被该组织挂住。珠节150在其它方面的构造与本例中的珠节110基本相同。应当理解,铰接部分中的每一个珠节150都可以具有相应的套囊190。还应当理解,存在于珠节150上的套囊190不必以任何方式干扰这种铰接部分的铰接。考虑到本文的教导内容,珠节110,150以及用于铰接部分100的其它元件的进一步其它的合适变型对于本领域普通技术人员而言将显而易见。还应当理解,珠节110,150的数量可以增加或减少,以允许端部执行器104更多或更少的铰接以及/或者调节击发梁160上的应力。
B.具有互锁珠节的示例性铰接部分
图9-11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包括多个同轴对准的珠节210。如在图11-12中最佳可见的,每一个珠节210都包括第一面212和第二面214。第一面212形成一定角度,使得第一面212与第二面214不平行。因此,当珠节210定位成直线时,一个珠节210的第一面212与相邻珠节210的第二面214形成缝隙。这些缝隙提供用于珠节210链弯曲的间隙,由此使铰接部分200铰接。这种缝隙还可以有助于通过铰接部分200使摩擦最小化,由此有利于端部执行器204的铰接。
本例的每一个珠节210还包括多个凹槽220,222,224,226、柱230、以及柱通路232。柱230可以包括珠节210的整体形成的结构、插入销、以及/或者任何其它合适的结构。柱230和柱通路232彼此互补,使得一个珠节210的柱230可以插入到另一个珠节210的柱通路232中。可以因此而形成珠节210的互锁链以提供铰接部分200,其中相互配合的柱230和通路232用作交替偏移的铰链。应当理解,本例的珠节210能够使得链中的每一个珠节210的竖直取向都沿链的长度相反。换句话讲,第一珠节210可以具有第一竖直取向,而下一个相邻的珠节210具有相反的竖直取向,再下一个相邻的珠节210具有第一竖直取向等。还应当理解,珠节210的一部分与链中相邻的珠节210的相应部分竖直重叠。
当珠节210连接在一起并且对准时,凹槽220,222,224,226彼此对准。凹槽220,222能够容纳相应的铰接缆线(未示出)。这种铰接缆线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220,222能够形成通道,所述通道容纳带而不是缆线。考虑到本文的教导内容,可以用于使铰接部分200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。凹槽224能够容纳线材(未示出)。这种线材能够提供端部执行器204与电源之间的电连通。应当理解,像本文提到的其它线材一样,这种线材可以易于在铰接部分200铰接时与铰接部分200一起弯曲。
当珠节210连接在一起时,相邻珠节210的凹槽226对准并且配合以形成通道,击发梁260穿过该通道布置。像上文所述的铰接部分100一样,铰接部分200可以包括外部收缩管、一些其它类型的盖、用于珠节210的套囊等。考虑到本文的教导内容,珠节210以及用于铰接部分200的其它元件的进一步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。还应当理解,珠节210的数量可以增加或减少,以允许端部执行器204更多或更少的铰接以及/或者调节击发梁260上的应力。
C.具有互锁区段的示例性铰接部分
图13示出了可以定位在刚性轴部分(例如上文提到的任何刚性轴部分)与端部执行器(例如上文提到的任何端部执行器)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。本例的铰接部分300包括一系列互锁区段310,所述一系列互锁区段310以与铠装缆线的铠装类似的方式共同构造。每一个区段都包括相应的远侧锁定结构312和近侧锁定结构314。每一个区段310的远侧锁定结构312都能够与相邻区段310的近侧锁定结构314相接合,使得区段310可以卡扣配合在一起以形成铰接部分300。
区段310能够在所述区段彼此连接时相对于彼此有选择地移动。例如根据本文的教导内容中的任何教导内容,可以致动一个或多个缆线、带、轴等以使铰接部分300弯曲。在一些版本中,在铰接部分300内以及中性平面外侧推动或拉动元件可以最终迫使区段310在铰接部分300的一侧上变得更加紧凑并且在铰接部分300的相对侧上延伸,从而造成弯曲。当受迫沿任何一个方向移动到极限位置(例如,最小弯曲半径)时,致动部分300可以由于区段310的构型而最终自然变成刚性。用于组装的区段310的数量可以确定铰接部分300所获得的最大角度。区段310的几何形状可以确定铰接部分300的弯曲半径。
D.具有整体开关的示例性铰接部分
图14示出了可以定位在刚性轴部分(例如上文提到的任何刚性轴部分)与端部执行器404之间的另一个示例性铰接部分400。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,其中端部执行器404与端部执行器40相对应。本例的铰接部分400包括一系列区段410和柱430。区段410均包括第一面412和第二面414。面412,414成角度从而形成间隙,以用于使一系列珠节410弯曲,由此使铰接部分400铰接。区段410也包括通道420,422,铰接缆线440,442穿过通道420,422延伸。这种铰接缆线440,442可以与上文所述的用于铰接带140,142类似的方式操作。在一些其它的版本中,通道420,422容纳带而不是缆线440,442。考虑到本文的教导内容,可以用于使铰接部分400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。
区段410和柱430也均限定了击发杆通道424,434,击发杆460延伸穿过击发杆通道424,434。在一些版本中,击发杆通道424,434电绝缘。区段410还包括靠近柱430的导电凹槽450。柱430也是导电的,使得柱430和凹槽450共同形成当铰接部分400的所有柱430与铰接部分400的所有相应的凹槽450相接触时用于通过铰接部分400的电连续性的路径。该电路径可以最终将端部执行器404与电源联接。
成对的弹簧470定位在相邻区段410之间,以使区段410弹性偏置远离彼此。因此,弹簧470能够甚至在铰接部分400处于弯曲构型时仍能促进由铰接部分400所提供的电路径的断开。然而,铰接部分400能够使得当缆线440,442都被同时拉动时,柱430将与凹槽450相接触,从而克服由弹簧470所提供的偏置以提供通过铰接部分400的电连续性。应当理解,当缆线440,442被同时拉动时,铰接部分400可以仍然保持弯曲构型。考虑到本文的教导内容,可以同时拉动缆线440,442的各种合适的方式对于本领域普通技术人员而言将显而易见。还应当理解,同时拉动缆线440,442可以与击发杆460朝远侧的行进机械相关联,使得这些动作全部同时进行。此外,依靠这种结构来完成与端部执行器404的电路可以消除对单独的激活按钮的需要。
图15示出了区段410的示例性备选形式。特别是,图15示出了一系列备选区段480,所述一系列备选区段480包括导电突起482,以嵌套在相邻区段480的导电凹槽484中。因此,突起482在本例中用作柱430的功能替代物。弹簧486使区段480偏置分开,以使通过区段480的电连续性中断,但是区段480可以聚集在一起以建立通过区段480的电连续性。因此,除了突起482对柱430的替代,本例的区段480与区段410类似。考虑到本文的教导内容,区段410,480以及铰接部分400的其它元件的进一步其它的合适变型对于本领域普通技术人员而言将显而易见。
E.具有单侧铰接的示例性铰接部分
图16-18示出了布置在刚性轴部分502与端部执行器504之间的另一个示例性铰接部分500。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。本例的铰接部分500包括多个同轴对准的珠节510。如在图17中最佳可见的,每一个珠节510都包括第一面512和第二面514。每一个第一面512的一侧凸起地弯曲,而第一面512的另一侧是基本平坦的。类似地,每一个第二面514的一侧凸起地弯曲,而第二面514的另一侧是基本平坦的。因此,当珠节510定位成直线时,面512,514的弯曲区域限定缝隙;而当珠节510定位成直线时,面512,514的平坦区域彼此邻接。这种构型允许铰接部分500沿一个方向(即,在具有缝隙的一侧上)弯曲,同时防止铰接部分500沿另一个方向(即,在不具有缝隙的一侧上)弯曲。应当理解,除了成弯曲的,弯曲区域也可以相反地成角度。还应当理解,使相邻珠节510的弯曲区域彼此邻接可以提供基本横向的挺度(例如,当铰接部分500处于或靠近最大铰接程度时)。
如图18中所示,铰接部分500也包括与击发梁560平行地延伸的多个支承梁550,击发梁560延伸穿过铰接部分500的中心。如也能够在图18中可见的,铰接缆线520和锚定缆线522延伸穿过铰接部分500。锚定缆线522的纵向位置是固定的,而铰接缆线520能够平移。特别是,铰接缆线520可以朝近侧被拉动,以使铰接部分500铰接。
在一些版本中,支承梁550弹性偏置,以将铰接部分500定向成基本直线构型。该弹性偏置可以足以在释放铰接缆线520时使铰接部分500基本变直。当击发梁560平移穿过处于弯曲构型的铰接部分500时,弹性偏置还可以降低击发梁560上的结合负载。梁550也能够例如通过在击发梁560平移穿过处于弯曲构型的铰接部分500时提供对击发梁560的屈曲或爆裂的阻力来增强铰接部分500的结构完整性。由于梁550与击发梁560分离,因此梁550并不在铰接部分500操作期间以及/或者击发梁560操作期间与击发梁560相接触。该间隔也可以降低梁550在击发梁560上的夹紧负载。在一些其它的版本中,支承梁550弹性偏置,以将铰接部分500定向成基本弯曲构型。除此之外或者备选地,击发梁560可以弹性偏置,以通过铰接部分500呈现弯曲构型。
图19-23涉及可以定位在刚性轴部分(例如上文提到的任何刚性轴部分)与端部执行器(例如上文提到的任何端部执行器)之间的又一个示例性铰接部分600。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。本例的铰接部分600包括上部主体610和下部主体620。主体610,620能够连接在一起,如图21中最佳可见的。本例的主体610由高硬度弹性材料形成,该高硬度弹性材料能够弹性呈现补充图19中所示的曲度的弯曲形状。主体620由柔性塑料形成,例如尼龙、聚乙烯、isoplast、聚丙烯、以及/或者各种其它的材料。然而,主体620可以成半刚性。此外,主体620模塑成呈现图19中所示的弯曲构型。如在图19-20中最佳可见的,主体620包括伸展侧622和棱纹侧624。棱纹侧624包括多个间隔开的翅片626,所述多个间隔开的翅片626能够适应主体620的弯曲构型。应当理解,如果需要,伸展侧622也可以包括翅片626以及/或者各种其它的结构。
主体610还包括沿主体610的长度延伸的多个凹槽630,632,634。主体620还包括沿主体620的长度延伸的多个凹槽631,633,634。凹槽630,631能够形成通道,当主体610,620组装在一起时,该通道容纳支承带640。支承带640沿铰接部分600的长度的至少一部分延伸。在一些版本中,支承带640的一端或两端相对于铰接部分600固定。在一些其它的版本中,支承带640的两端可以相对于铰接部分600移动。还应当理解,支承带640可以形成为主体610的整体结构,使得凹槽630得以去除。在本例中,支承带640的近端642固定到靠近铰接部分600的刚性轴部分;而支承带640的远端644固定到远离铰接部分600的端部执行器。
凹槽632,622能够形成通道,当主体610,620组装在一起时,该通道容纳致动杆660,下文将更详细地描述致动杆660。应当理解,致动杆660可以在铰接部分600内平移并且在铰接部分600内旋转。凹槽634,635能够形成通道,当主体610,620组装在一起时,该通道容纳铰接带650。应当理解,铰接带650的至少一部分可以在铰接部分600内平移。在本例中,铰接带650的近端652固定到靠近铰接部分600的轴部分的平移构件;而铰接带650的远端654固定到远离铰接部分600的端部执行器。当铰接带650被朝近侧拉动时,根据铰接带650被拉动的程度,铰接部分600从弯曲/铰接构型过渡到直线构型。在一些版本中,铰接带650可以被拉动地更远,使得铰接部分600移动通过直线构型并且开始沿与其初始弯曲/铰链相反的方向弯曲/铰接。
图22更详细地示出了致动杆660。致动杆660可操作成使击发梁、刀、以及/或者远离铰接部分600的端部执行器的其它结构平移。除此之外或者备选地,致动杆660可操作成使这种端部执行器的至少一部分(如果不是整个端部执行器)相对于铰接部分600旋转。在本例中,致动杆660包括平移部分662、机械地部分664、以及绝缘部分666。平移部分662和机械部分664具有相对的“C”形形状,其中绝缘部分666插入在平移部分662与机械部分664之间。平移部分662可操作成在铰接部分600内平移,以使击发梁、刀、以及/或者远离铰接部分600的端部执行器的其它结构平移;而机械地部分664保持固定,从而提供机械地,该机械地用作对远离铰接部分600的端部执行器进行结构性支承的脊状部。绝缘部分666提供部分662,664之间的电隔离。此外,线材668延伸穿过致动杆660的中心,以提供端部执行器与电源之间的电连通。线材668也可以相对于部分662,664绝缘。
图23示出了致动杆660的仅仅是示例性的变型。本例的致动杆670包括平移部分672、机械地部分674、以及绝缘部分676。在本例中,部分672,674具有相对的平面,而不是具有“C”形构型的部分662,664。此外,本例的绝缘部分676包括平板。致动杆670不具有线材668。例如,线材可以相反地延伸穿过铰接部分600的不同部分。致动杆670在其它方面与致动杆660基本相同。考虑到本文的教导内容,用于致动杆660的其它合适的元件、结构、和构型对本领域普通技术人员而言将显而易见。
F.示例性铰链铰接部分
图24-25示出了可以用于连接刚性轴部分702与端部执行器的示例性铰接部分700。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702与轴30相对应并且端部执行器与端部执行器40相对应。本例的铰接部分700包括远侧铰链套囊720,远侧铰链套囊720与轴部分702铰链联接。特别是,套囊720包括朝近侧突出的插针722,插针722被容纳在形成于轴部分702的远端处的横向开口712中。插针722因此与轴部分702形成枢转铰链联接的套囊720。套囊720固定到端部执行器的近侧部分(未示出),使得端部执行器将相对于轴部分702与套囊720一起枢转。
柔性构件730从轴部分702跨越到套囊720。柔性构件730可以容纳击发梁,以致动端部执行器的一部分。柔性构件730也可以容纳一个或多个铰接带、缆线、或者可操作成使套囊720铰接的其它结构。考虑到本文的教导内容,柔性构件730以及相关元件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。
如在图25中最佳可见的,轴部分702的远端包括成角度的边缘724。此外,套囊720的近端包括成角度的边缘724。边缘714,724的角度和取向能够适应套囊720远离和越过轴部分702的纵向轴线的枢转。在一些其它的版本中,仅有一个边缘714,724成角度,而另一个边缘714,724与轴部分702的纵向轴线基本垂直。作为另一个仅仅是示例性的变型,边缘714,724都可以与轴部分702的纵向轴线基本垂直。在一些这种版本中,套囊720仅能够枢转远离轴部分702的纵向轴线,而不能也在轴部分702的纵向轴线上方并且通过轴部分702的纵向轴线枢转。考虑到本文的教导内容,用于使部分700枢转的进一步其它的合适的元件、结构、构型、和可操作性对于本领域普通技术人员而言将显而易见。
G.具有螺旋形构型的示例性铰接部分
图26示出了可以定位在刚性轴部分(例如上文提到的任何刚性轴部分)与端部执行器(例如上文提到的任何端部执行器)之间的另一个示例性铰接部分800。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。本例的铰接部分800包括管构件802,管构件802具有形成在其中的螺旋形切口804。螺旋形切口804可以有利于管构件802的弯曲,由此有利于定位成远离管构件802的端部执行器的铰接。例如击发杆、铰接带/缆线等、线材等的各种元件可以通过管构件802。还应当理解,柔性收缩包裹物或其它元件可以围绕螺旋形切口804定位(例如,以防止组织在铰接期间被夹住)。管构件802可以由任何合适的柔性材料形成,并且可以弹性偏置以呈现基本直线构型。螺旋形切口804可以使用任何合适的技术形成,其中包括但不限于模铸或加工(例如,激光切割、线材EDM、铣削等)。还应当理解,管构件802可以仅仅是完全延伸至手持件或者器械的其它类型的主体部分的刚性轴构件的整体的远侧部分。
图27示出了另一个螺旋构造的铰接部分900,铰接部分900布置在刚性轴部分902与端部执行器904之间。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902与轴30相对应并且端部执行器904与端部执行器40相对应。本例的铰接部分900包括卷簧910。仅以举例的方式,卷簧910可以包括焊接到刚性轴部分902和端部执行器904的通过传统方式形成的金属卷簧。当然,可以使用任何其它合适的材料,并且可以使用用于联接卷簧910的任何其它合适的技术。卷簧910可以相对于由刚性轴部分902所限定的纵向轴线有选择地弯曲,由此有利于端部执行器904的铰接。卷簧910可以弹性偏置,以呈现基本直线构型。例如击发杆、铰接带/缆线等、线材等的各种元件可以通过卷簧910。还应当理解,柔性收缩包裹物或其它元件可以围绕卷簧910定位(例如,以防止组织在铰接期间被夹住)。考虑到本文的教导内容,用于螺旋构造的铰接部分的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。
H.具有单个枢轴的示例性铰接部分
图28示出了铰接接头1000,铰接接头1000用于将刚性轴部分1002与端部执行器1004可枢转地联接。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1002与轴30相对应并且端部执行器1004与端部执行器40相对应。本例的铰接接头1000由一对U形结构1012,1014形成,所述一对U形结构1012,1014通过一对销1016连接。特别是,刚性轴部分1002的远端包括U形结构1012,而端部执行器1014的近端也包括U形结构1014。U形结构1014配合在U形结构1012内,使得U形结构1012交搭并且围绕U形结构1014。当然,可以使用任何其它合适的关系。U形结构1012,1014均包括相应的上部舌状物和下部舌状物。上部销1016将U形结构1012,1014的上部舌状物可枢转地联接在一起,而下部销(未示出)将U形结构1012,1014的的下部舌状物可枢转地联接在一起。因此,U形结构1012,1014和销1016使得端部执行器1004能够相对于轴部分1002枢转。使销1016分离(例如,而不是使单个销通过刚性轴部分1002与端部执行器1004的整个直径等)有利于使元件如下文所述地通过铰接接头1000。
本例的刚性轴部分1002包括推杆1020,如在图29中最佳可见的。推杆1020能够在刚性轴部分1002内沿纵向平移。推杆1020包括沿纵向延伸的凹槽,所述沿纵向延伸的凹槽能够容纳一对铰接缆线1030,1032以及线材1034。推杆1020能够保持缆线1030,1032与线材1034相对于彼此间隔开,同时使得缆线1030,1032和线材1034能够独立于彼此在轴部分1002内平移。根据本文的教导内容,铰接缆线1030,1032可操作成有选择地使端部执行器1004铰接。根据本文的教导内容,线材1034可操作成将来自电源的电力传送至端部执行器1004。本例的推杆1020还保持缆线1030,1034与线材1034电隔离。本例的推杆1020由塑性挤出形成,但是应当理解,可以使用任何其它合适的材料和/或工艺。
推杆1020与击发梁1060相联接,击发梁1060延伸穿过端部执行器1004并且根据上文所述的击发梁60构造且可根据上文所述的击发梁60操作。击发梁1060通过螺纹联接件1026固定到推杆1020,如图28中所示,但是应当理解,可以使用任何其它合适类型的联接件。还应当理解,推杆1020可以在刚性轴部分1002内往复运动,以便使击发梁1060在端部执行器1004内往复运动。
本例的端部执行器1004还包括插入件1040,如图30中最佳可见的。插入件1040包括通路,以容纳击发梁1060、缆线1030,1032、以及线材1034。在本例中,插入件1040固定在端部执行器1004内。然而,插入件能够使得击发梁1060能够平移穿过插入件1040。在一些版本中,缆线1030,1032中的一个或两个也可平移穿过插入件1040,但是应当理解,缆线1030,1032中的一个或两个可以牢固地固定到插入件1040。类似地,线材1034可以相对于插入件1040牢固地固定或者可以相对于插入件1040平移。在这些情况中的每一种情况下,插入件1040都能够保持击发梁1060、缆线1030,1032、以及线材1034彼此间隔开。本例的插入件1040还保持缆线1030,1034、击发梁1060、以及线材1034彼此电隔离。本例的插入件1040由塑性挤出形成,但是应当理解,可以使用任何其它合适的材料和/或工艺。
本例的线材1034形成为弹性线圈。该卷绕构型使得线材1034在端部执行器1004相对于刚性轴部分1002铰接时以有效长度延伸,其中线材1034在端部执行器1004移回至与刚性轴部分1002基本对准的位置时缩回至较短的有效长度。
I.具有成角度接头的示例性铰接部分
图31A-31B示出了铰接接头1100,铰接接头1100用于将刚性轴部分1102与端部执行器1104可枢转地联接。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1102与轴30相对应并且端部执行器1104与端部执行器40相对应。本例的铰接接头1100由互补的成角度的边缘1120,1140形成,所述互补的成角度的边缘1120,1140分别形成于刚性轴部分1102的远端和端部执行器1104的近端处。如能够从图31A至图31B的过渡可见的,这些边缘1120,1140的凸轮运动关系在端部执行器1104相对于刚性轴部分1102旋转时使端部执行器1104铰接。考虑到本文的教导内容,端部执行器1104可以相对于刚性轴部分1102旋转的各种合适的方式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,元件可以通过铰接接头1100并且在端部执行器1104相对于刚性轴部分1102旋转和铰接时仍然正确起作用的各种合适的方式对于本领域普通技术人员而言将显而易见。尽管边缘1120,1140在本例中处于大约45°的角度处,但是应当理解,可以使用任何其它合适的角度。
在一些版本中,击发梁(未示出,但是与击发梁60类似)用于在调节端部执行器1104的铰接角度时使端部执行器1104的远端稳定。例如,刚性轴部分1102和端部执行器1104能够有选择地彼此分离,以有利于铰接。通过边缘1120,1140彼此分离但是击发梁仍然保持端部执行器1140与手持件或者其它类型的器械主体相联接,刚性轴部分1102可以旋转以改变边缘1120的位置。一旦边缘1120已达到与期望的铰接角度相对应的位置,端部执行器1104就可以朝着刚性轴部分1102朝近侧被拉动,直到边缘1120,1140相接合。该接合将致使端部执行器1104以铰接方式挠曲。接着,使用者可以相对于刚性轴部分1102固定端部执行器1104的纵向位置,以保持期望的铰接角度。还应当理解,边缘1120,1140可以包括互补的电触点,所述互补的电触点可以用于将来自电源的电力传送至端部执行器1104。考虑到本文的教导内容,成角度接头1100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。
J.具有预制弯头的示例性铰接部分
图32-33示出了可以定位在刚性轴部分(例如上文提到的任何刚性轴部分)与端部执行器(例如上文提到的任何端部执行器)之间的另一个示例性铰接部分1200。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。本例的铰接部分1200包括护套1210、插入件1230、以及往复运动杆1240。护套1210由易于在图32中所示的弯曲构型与图33中所示的基本直线构型之间过渡的柔性材料形成。插入件1230由弹性和半刚性材料形成,所述弹性和半刚性材料偏置,以呈现图32中所示的弯曲构型。例如,插入件1230可以模塑或者以其它方式预制,以形成图32中所示的弯曲构型。插入件1230包括通过凹槽1234间隔开的多个肋构件1232。将肋构件1232的侧壁的角度选择成限制铰接部分1200的最大铰接角度。特别是,当侧壁或每一个肋构件1232与相邻肋构件1232的侧壁完全接触时,铰接角度可以处于最大值。
每一个肋构件1232都包括通路1236,通路1236能够滑动容纳杆1240。在本例中,通路1236沿由插入件1230形成的弯曲部的内径定位,但是应当理解,通路1236可以以其它方式定位。杆1240是基本刚性构件,该基本刚性构件能够随着杆1240插入穿过肋构件1232而使插入件1230基本变直。因此,当杆1240处于如图32中所示的近侧位置时,端部执行器相对于刚性轴部分铰接;而当杆1240处于如图33中所示的远侧位置时,端部执行器与刚性轴部分基本对准。端部执行器可以基于杆1240的纵向定位(例如,杆1240定位在最近侧位置与最远侧位置之间的任何位置处等)以任何合适的铰接程度有选择地定位。仅以举例的方式,铰接部分1200能够使得端部执行器能够相对于刚性轴部分扫描通过大约0°至大约130°之间的铰接角度的范围。作为另一个仅仅是示例性的例子,最大铰接角度可以达到大约160°。考虑到本文的教导内容,其它合适的角度和范围对于本领域普通技术人员而言将显而易见。
可以有选择地固定杆1240的纵向位置,从而有选择地固定端部执行器的铰接角度。考虑到本文的教导内容,使杆1240平移和固定的各种合适的结构对于本领域普通技术人员而言将显而易见。还应当理解,通路1236可以均具有锥形构型(例如,近侧比远侧宽),以有利于杆1240随着杆1240朝远侧行进而插入通路1236中。插入件1230还可以包括通路,以容纳例如一根或多根线材、击发梁等的其它结构。此外,护套1210可以包括整体弹性体带1212以及/或者由插入件1230形成的弯曲部的内径处的其它结构,以有助于使铰接部分1200的铰接角度稳定。
图34示出了可以用于通过预弯曲的铰接部分1300致动击发梁的示例性元件和构造。在本例中,铰接部分1300包括护套1310,护套1310预制成包括将端部执行器1304定位成相对于刚性轴部分1302成一定角度的一对弯头。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1302与轴30相对应并且端部执行器1304与端部执行器40相对应。在一些版本1310中,护套1310弹性偏置,以呈现图34中所示的构型,但是可以有选择地变直,从而通过套管针或其它套管,以便以微创方式到达患者的体内。
在图34中所示的例子中,推杆1320可滑动地定位在护套1310的近侧部分内。多个轴承1330定位成远离推杆1320在护套1310内彼此相邻。线材1340通过轴承1330,使得轴承1330通过线材1340拴系在一起。线材1340能够将来自电源的电力传送到端部执行器1304。轴承1330能够在护套1310内平移,并且因此可操作成使远侧平移运动从推杆1320过渡至击发梁1360。击发梁1360由此可根据如上所述的击发梁60操作。在本例中,轴承1330沿由护套1310形成的弯曲路径平移,而不会使护套在轴承1330朝远侧行进时变直。线材1340可结构性联接到击发梁1360和推杆1320,使得线材1340可操作成在推杆1320朝近侧缩回时将击发梁1360朝近侧缩回。因此,端部执行器1340可以通过缩回推杆而打开。在本例中,一组轴承1350用于支承击发梁1360,但是应当理解,可以使用各种备选结构。
K.具有偏移铰链的示例性铰接部分
图35-36示出了铰接接头1400,铰接接头1400用于将刚性轴部分1402与端部执行器1404可枢转地联接。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1402与轴30相对应并且端部执行器1404与端部执行器40相对应。本例的铰接接头1400包括枢轴1410,枢轴1410相对于刚性轴部分1402的纵向轴线横向偏移地设置在刚性轴部分1402的远端处。端部执行器1404通过销1412在枢轴1410处与刚性轴部分1402可枢转地联接。
刚性、细长的铰接构件1420可滑动地布置在轴部分1402内。铰接构件1420与枢轴1410的偏移位置基本相对地相对于刚性轴部分1402的纵向轴线横向偏移。铰接构件1420的远端包括枢轴1422。键合部1430通过销1424在枢轴1422处与铰接构件1420可枢转地联接。铰接构件1420和键合部1430能够使得键合部1430将响应于铰接构件1420的近侧平移和远侧平移而移动。考虑到本文的教导内容,可以用于使铰接构件1420铰接的各种合适的结构对于本领域普通技术人员而言将显而易见。
键合部1430的远端还包括枢轴1432。特别是,键合部1430通过销1434在枢轴1432处与端部执行器1404可枢转地联接。键合部1430和端部执行器1404能够使得端部执行器将响应于键合部1430的移动而围绕枢轴1410枢转。由于键合部1430也与铰接构件1420相联接,因此应当理解,端部执行器1404将由此响应于铰接构件1420的纵向运动。特别是,当铰接构件1420朝远侧行进时,端部执行器1404将围绕枢轴1410沿一个方向枢转;而当铰接构件1420朝近侧缩回时,端部执行器1404将围绕枢轴1410沿相反方向枢转。如能够在图35-36中看到的,轴1402的远端包括狭槽1440,狭槽1440能够当铰接构件缩回到近侧位置时容纳键合部1430。如能够在图35-36中最佳可见的,当端部执行器1404沿任何一个方向铰接时,击发梁1460可以易于从轴1402折曲至端部执行器1404。铰接接头1400可以包括用于击发梁1460的弯曲通道,以在铰接接头1400处于铰接构型时易于允许击发梁1460的弯曲半径。这种弯曲通道也能够当击发梁1460被致动而铰接接头1400处于铰接构型时基本防止击发梁1460屈曲穿过铰接接头1400。
在一些其它的版本中,键合部1430被省略。例如,铰接构件1420可以在枢轴1420处与端部执行器1410直接可枢转地联接。考虑到本文的教导内容,可以提供具有偏移枢轴的铰接接头的进一步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。
L.具有多个位置的联接结构的示例性端部执行器
图37示出了使得端部执行器1540能够在相对于轴部分1520的多个位置处有选择铰接的又一个构型1500。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。在本例中,端部执行器1540包括整体联接件1542,整体联接件1542提供处于多个位置和取向的多个联接通道1544。线材1546从联接件1542延伸并且可操作成将来自电源的电力传输至端部执行器1540。通道1544能够有选择地容纳轴部分1520的远端。当联接件1542固定到轴部分1520时,本例的轴部分1520向端部执行器1540提供结构性支承。
在一些版本中,轴部分1520包括可操作成朝远侧和朝近侧驱动端部执行器1540的击发杆1560的一个或多个结构。考虑到本文的教导内容,可以用于联接件1542和轴部分1520内以将这种驱动从轴部分1520的元件传输到击发杆1560的各种合适的结构对于本领域普通技术人员而言将显而易见。除此之外或者备选地,联接件1542可以包括可操作成驱动击发杆1560的一个或多个结构,使得轴部分1520不必具有任何移动部件。
在一些版本中,线材1546提供用于端部执行器1540的所有的电连通,使得轴部分1520总是电被动。在一些其它的版本中,线材1546提供电路的一部分,而轴部分1520提供电路的另一部分,使得当联接件1542与轴部分1520联接时,电路至少基本完整。仅以举例的方式,通道1544和轴部分1520的远端可以包括在联接件1542与轴部分1520联接时相接合的互补触点。考虑到本文的教导内容,可以用于电联接轴部分1520与端部执行器1540的各种合适的元件、结构、和构型对于本领域普通技术人员而言将显而易见。
在示例性使用中,端部执行器1540和轴部分1520通过分离的通道插入到患者体内,并且在端部执行器1540和轴部分1520都处于患者体内之后连接在一起。例如,端部执行器1540可以通过一个套管针插入到患者体内,而轴部分1520通过另一个套管针插入到患者体内。作为另一个仅仅是示例性的例子,端部执行器1540可以通过一个套管针插入到患者体内,而轴部分1520经由皮肤插入到患者体内(例如,不使用套管针)。仅以举例的方式,在这种版本中,轴部分1520可以具有大约3mm的外径。当然,可以使用任何其它合适的尺寸。
应当理解,多种备选结构可以用于有选择地联接端部执行器1540与轴部分1520。一些这种结构可能需要端部执行器1540和轴部分1520保持基本对准,使得所述结构并不允许将端部执行器1540安装在相对于轴部分1520的纵向轴线成多个角度处。作为一个仅仅是示例性的备选方式,轴部分1520可以包括舌状物结构,该舌状物结构插入到端部执行器1540的下部瞬膜1541的中空内部中。考虑到本文的教导内容,用于提供端部执行器1540在患者体内与轴部分1520的有选择联接的进一步其它合适的结构和构型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,用于上文所述的铰接部分100,200,300,400,500,600,700,800,900,1000,1100,1200,1300,1400,1500的其它合适的元件、结构、构型、以及可操作性的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。尽管考虑到本文的教导内容,其它结构对于本领域普通技术人员而言将显而易见,但是下文描述了这种其它结构的若干例子。
A.示例性的备选切割构件致动
在上文所述的例子中,通过使击发杆60朝远侧行进,刀片64朝远侧行进穿过端部执行器40。在图38A-38B中所示的例子中,通过朝近侧缩回击发带1660而使刀片1664朝远侧行进。在本例中,刀片1664由刀片构件1668朝远侧提供,刀片构件1668包括上部凸缘构件1662并且固定至击发带1660的远端。刀片构件1668沿形成在端部执行器组件的下部钳口1644中的狭槽1646纵向行进。刀片构件1668还包括下部凸缘构件(未示出),下部凸缘构件布置在下部钳口1644的下方。仅以举例的方式,电外科器械10的下部钳口44可以易于改进,从而包括本例中所描述的下部钳口1644的结构。
下部钳口1644的远端包括柱1670。击发带1660包裹围绕柱1670,使得柱1670将击发带1660的纵向运动重新导向大约180°。击发带1660具有足够柔性以提供这种移动,但是也具有足够抗拉强度以随着刀片1664切断组织而承受刀片构件1668上的显著负载。在一些版本中,柱1670包括衬套或轴承,衬套或轴承能够有利于击发带1660围绕柱1670移动。如能够从图38A与图38B之间的过渡看到的,刀片构件1668响应于击发带1660朝近侧的移动沿通道1646从近侧位置朝远侧行进到远侧位置。在一些版本中,击发带1660还可以朝远侧行进,以使刀片构件1668从远侧位置返回近侧位置。例如,下部钳口1644可以包括导槽,导槽引导击发带1660并且防止击发带1660随着击发带1660朝远侧行进而屈曲。考虑到本文的教导内容,击发带1660可以朝远侧和/或朝近侧平移的各种合适的方式对于本领域普通技术人员而言将显而易见。还应当理解,在一些版本中,如果击发梁60朝远侧行进以使刀片构件通过铰接的端部执行器40行进,那么通过在端部执行器铰接时朝近侧拉动击发带1660而使刀片构件1668朝远侧行进可以比以其它方式使刀片构件1668行进相对更容易。换句话讲,击发带1660可以有利于具有比由使用朝远侧行进的击发梁60的装置所提供的那些更大的铰接角度的构型。
应当理解,击发带1660可以用于不具有铰接部分36的电外科装置10的版本中。还应当理解,就像本文所述的各种其它元件一样,击发带1660可以用于除了电外科装置之外的多种其它类型的装置中,其中包括但不限于内切割器外科缝合装置。考虑到本文的教导内容,其它合适的实施方式对于本领域普通技术人员而言将显而易见。
B.示例性双枢转钳口
图39A-39B示出了可以结合到本文所述的任何版本的电外科装置10中的双枢转钳口组件1700。在图1-4中所示的例子中,下部钳口44相对于枢转联接件43基本保持固定,使得当钳口42,44打开和闭合时仅有上部钳口42移动。相比之下,在图39A-39B的钳口组件1700中,上部钳口1742和下部钳口1744都相对于枢转联接件1743枢转。枢转联接件1743布置在轴组件1730的远端处。与击发梁60类似,本例中的击发梁1760包括锋利的远侧刀片1764、上部凸缘1762、以及下部凸缘1766。同样与击发梁60类似,击发梁1760可操作成相对于轴组件30纵向平移。
每一个钳口1742,1744都包括相应的近侧突出1746,1748。上部钳口1742的近侧突出1746能够与上部凸缘1762相互作用;而下部钳口1744的近侧突出1748能够与下部凸缘1766相互作用。特别是,如图39A中所示,上部凸缘1762相对于近侧突出1746做凸轮运动,以在击发梁1760处于近侧位置时将上部钳口1742布置在打开位置。同样地,下部凸缘1766相对于近侧突出1748做凸轮运动,以在击发梁1760处于近侧位置时将下部钳口1744布置在打开位置。随着击发梁1760朝远侧平移,凸缘1762,1764相对于钳口1742,1744的外部做凸轮运动,以同时一起闭合钳口1742,1744。应当理解,对比由一个钳口的枢转位置固定时钳口组件所提供的可见性,使得无论钳口组件1700的旋转取向如何,钳口1742,1744都能够同时枢转远离由钳口组件1700所限定的纵向轴线可以提供外科手术部位处更好的可见性。
应当理解,双枢转钳口组件1700可以用于不具有铰接部分36的电外科装置10的版本中。还应当理解,就像本文所述的各种其它元件一样,双枢转钳口组件1700可以用于除了电外科装置之外的多种其它类型的装置中,其中包括但不限于内切割器外科缝合装置。考虑到本文的教导内容,其它合适的实施方式对于本领域普通技术人员而言将显而易见。
C.示例性线材拉伸结构
在本文所述的一个或多个例子中,线材可以以需要线材延伸其有效长度的方式或者以通过其它方式在线材通过其中的铰接部分铰接时拉动线材的方式通过铰接部分。因此,在一些情况下,可能期望允许线材在铰接部分处于弯曲/铰接构型的同时被拉动穿过轴并且穿过铰接部分。然而,可能还期望防止这种线材在铰接部分处于基本直线构型(当线材不必具有有效长度)时聚集、夹住、或者干扰其它元件。图40-41示出了一个仅仅是示例性的线材拉伸组件1800,线材拉伸组件1800可以用于保持线材1810中的张力,同时还允许线材1810在铰接部分1836铰接到弯曲构型时增加其有效长度。在本例中,拉伸组件1800定位成靠近位于轴组件1830的近端处的旋钮1834。轴组件1830的远端包括铰接部分1836和端部执行器1840。旋钮1834可操作成使轴组件1830围绕由轴组件1830所限定的纵向轴线相对于手持件或者其它类型的主体旋转。铰接部分1836可以根据本文所述的任何铰接部分建造并且可根据本文所述的任何铰接部分操作。备选地,铰接部分1836可以具有任何其它合适的构型。类似地,端部执行器1840可以根据本文所述的端部执行器建造并且可根据本文所述的端部执行器操作;或者可以具有任何其它合适的构型。
根据本文的教导内容或者以其它方式,线材1810能够将来自电源的电力递送至端部执行器1840。因此,线材1810的远端远离铰接部分1836与端部执行器1840相联接。线材1810朝近侧延伸穿过轴组件1830。在一些版本中,轴组件1830包括内部元件,该内部元件提供槽、通路、或者基本容纳线材1840的其它结构,同时允许线材1840在轴组件1830内平移。
线材拉伸组件1800包括导电锚定件1812以及与主体部分1816相联接的卷簧1814。线材1810通过形成在主体部分1816中的狭槽1818并且被重新导向大约180°,使得线材1810的近端固定到导电锚定件1812。导电锚定件1812与手持件中的互补结构或者其它类型的主体部分相联接,以将来自电源的电力传送至线材1810。卷簧1814朝近侧弹性支撑在线材1810上,以保持线材1810拉伸,如在图41中最佳可见的。当响应于铰接部分1836的弯曲需要线材1810的额外长度时,卷簧1814压缩并且线材1810行进穿过狭槽1818以提供这种额外长度。当不再需要线材1810的额外长度时(例如,当铰接部分1836变直时),卷簧1814膨胀并且拉动线材1810穿过狭槽1818以收紧松弛部分。如同样能够在图40-41中看到的,击发梁1860通过主体部分1816并且穿过其中往复运动而不会干扰线材1810。考虑到本文的教导内容,可以用于拉伸组件1800的其它合适的元件、结构、和构型对于本领域普通技术人员而言将显而易见。
D.示例性备选切割构件
图42A-43示出了可用于代替本文所述的任何击发梁的示例性卷曲击发梁1900。在本例中,击发梁1900包括近侧直线部分1910、远侧直线部分1912、以及定位在直线部分1910,1912之间的卷曲部分1914。卷曲部分1914能够使得击发梁1900能够在如图42A中所示的压缩构型与如图42B中所示的延展构型之间过渡。卷曲部分1914弹性偏置,以呈现本例中的压缩构型。如图43中所示,卷曲部分1914定位成延伸穿过铰接部分1936,铰接部分1936定位在刚性轴部分1902与端部执行器1904之间。应当理解,铰接部分1936、刚性轴部分1902、以及端部执行器1904可以根据本文的这种元件的教导内容中的任何教导内容建造并操作。
如在上文对线材1810和线材拉伸组件1800的讨论中所注意到的,对通过铰接部分1936的元件的长度要求可以基于铰接部分1936铰接的程度而改变。例如,当铰接部分1936处于弯曲构型时,这可能需要来自通过铰接部分1936的击发梁1900的额外长度。卷曲部分1936可以通过在铰接部分1936弯曲时延伸而提供该额外长度。当铰接部分1936变直时,卷曲部分1936可以收缩。应当理解,卷曲部分能够就在其膨胀(图42B)以及当其压缩(图42A)时传输纵向负载,以使得能够满意地闭合端部执行器1904的钳口并且还使得能够通过位于直线部分1912的远端处的刀片切断夹在端部执行器1904的钳口之间的组织。因此,无论铰接部分1936处于弯曲构型还是基本直线构型,位于直线部分1912的远端处的刀片都将最终穿过端部执行器1904行进相同的距离。
应当理解,就像本文所述的各种其它元件一样,卷曲的击发梁1900可以用于除了电外科装置之外的多种其它类型的装置中,其中包括但不限于内切割器外科缝合装置。考虑到本文的教导内容,其它合适的实施方式对于本领域普通技术人员而言将显而易见。
本文所述的各种例子包括穿过铰接部分延伸至端部执行器的元件以及可以由导电材料形成的元件,其中包括但不限于各种击发梁、击发带、支承梁、铰接梁、铰接缆线等。任何这种元件都可以用于向端部执行器的元件提供电连通。仅以举例的方式,这种元件可以用于将来自电源的电力传送至端部执行器,以提供接地返回路径,从而将信号传送至端部执行器或从端部执行器传送信号等。当然,这种元件还可以根据需要或期望包括适当的隔离。考虑到本文的教导内容,这种元件可以用于传送电力、信号等穿过铰接部分的各种合适的方式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END6889USNP],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,而不是需要通过缆线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,和
(ii)第二钳口,
其中所述第一钳口能够朝所述第二钳口运动,以夹住所述第一钳口与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与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与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多个珠节,其中所述珠节被定位成彼此相邻。
3.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,其中所述珠节包括互补的柱和通路,其中每个珠节的所述柱都定位在另一个珠节的所述通路中,使得所述珠节通过所述柱枢转地键合在一起。
4.根据权利要求1所述的电外科装置,其中所述铰接部分由多个互锁区段形成,其中所述互锁区段能够操作以将所述铰接部分有选择地锁定成铰接构型。
5.根据权利要求1所述的电外科装置,其中所述铰接部分由多个区段形成,其中所述区段包括能够提供穿过所述铰接部分的电连通的电触点,其中所述铰接部分还包括一个或多个偏置以迫使所述触点彼此分离的弹性构件。
6.根据权利要求1所述的电外科装置,其中所述铰接部分具有当所述铰接部分处于直线位置时围绕由所述铰接部分限定的纵向轴线不对称的构型,其中所述铰接部分由多个不对称珠节形成。
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被预制成呈现弯曲构型的弹性构件。
8.根据权利要求7所述的电外科装置,其中所述铰接部分包括能够运动的梁,其中所述能够运动的梁为能够缩回的以使所述弹性构件基本上变直。
9.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第一管部分和第二管部分,其中所述第一管部分包括整体铰链突出,其中所述第二管包括铰链开口,其中所述铰链突出设置在所述铰链开口中以形成铰链,使得所述第一管部分能够在所述铰链处相对于所述第二管部分枢转。
10.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形成在所述轴中的螺旋形切口。
11.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与所述轴同轴对准的卷簧。
12.根据权利要求1所述的电外科装置,其中所述轴包括U形结构,其中所述端部执行器包括U形结构,其中所述轴的所述U形结构与所述端部执行器的所述U形结构枢转地连接,以形成所述铰接部分。
13.根据权利要求12所述的电外科装置,其中所述切割构件一对致动缆线,以及完全穿过所述铰接部分的线材。
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:
(i)预制成呈现弯曲构型的弹性构件,和
(ii)杆,所述杆能够在所述弹性构件内运动以基于所述杆在所述弹性构件内的纵向位置使所述弹性构件基本上变直。
15.根据权利要求1所述的电外科装置,其中所述铰接部分被预制成呈现非直线构型,其中所述切割构件包括延伸穿过所述铰接部分的珠节的键合件,其中所述珠节的键合件能够通过所述铰接部分传送纵向运动。
16.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被设置成横向并且垂直于所述轴的所述纵向轴线的偏移枢轴,其中所述端部执行器能够围绕所述偏移枢轴枢转。
17.根据权利要求1所述的电外科装置,其中所述端部执行器能够从所述轴移除,其中所述端部执行器能够以相对于所述轴的两个或多个选择的角度与所述轴有选择地联接。
18.根据权利要求1所述的电外科装置,其中所述切割构件包括卷曲部分。
19.一种外科器械,所述器械包括:
(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;
(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;
其中所述外科器械还包括以下中的一者或两者:
(i)与所述切割构件连通的击发带,其中所述第二钳口包括能够对所述击发带重新导向的结构,使得所述击发带能够操作以响应于向近侧拉动所述击发带使所述切割构件向远侧行进,或者
(ii)在所述端部执行器处的枢轴结构,其中所述第一钳口和所述第二钳口都能够相对于所述枢轴结构枢转,使得所述第一钳口和所述第二钳口能够围绕所述枢轴结构朝着和远离彼此枢转。
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能量递送到夹在所述第一钳口和第二钳口之间的组织;
(c)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;
(d)延伸穿过所述铰接部分的线材,其中所述线材能够操作以将电力连通至所述至少一个电极;和
(e)拉伸组件,其中所述拉伸组件能够操作以弹性地保持所述线材中的张力。
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