CN103747748B - 用于制备具有不同长度的成形钉的机器人控制的外科缝合装置 - Google Patents
用于制备具有不同长度的成形钉的机器人控制的外科缝合装置 Download PDFInfo
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Abstract
本发明提供了一种外科缝合装置,所述外科缝合装置包括能够接收来自机器人系统的多种控制运动的端部执行器。
Description
相关专利申请的交叉引用
本专利申请是授予Joseph C.Hueil、Jeffrey S.Swayze和Frederick E.Shelton,IV的提交于2007年2月28日的名称为“Surgical Stapling devices That Produce FormedStaples Having Different Lengths”的美国专利申请序列号11/711,979(美国专利申请公开US2007/0194081A1)的部分继续申请并且要求其权益,美国专利申请序列号11/711,979是根据美国专利法35U.S.C.§120的由F.Shelton在2005年8月31日提交的名称为“Staple Cartridges For Forming Staples Having Differing Formed StapleHeights”的美国专利申请序列号11/216,562(现在的美国专利7,669,746,公开于2010年3月2日)的部分继续申请并且要求其权益,专利申请的公开内容全文以引用的方式并入本文。
本专利申请还与以下同时提交的美国专利申请相关,其以引用的方式并入本文:
(1)J.Swayze等人的“Surgical Stapling Device With Staple Driver ThatSupports Multiple Wire Diameter Staples”,美国专利申请序列号11/711,977,现在的美国专利7,673,781;
(2)J.Morgan等人的“Surgical Stapling Device With Anvil Having StapleForming Pockets Of Varying Depth”,美国专利申请序列号11/714,049,现在的美国专利公布2007/0194082;
(3)J.Hueil等人的“Surgical Stapling Device With Multiple StackedActuator Wedge Cams For Driving Staple Drivers”,美国专利申请序列号11/712,315,现在的美国专利7,500,979;
(4)J.Hueil等人的“Surgical Stapling Device With Staple Drivers OfDifferent Height”,美国专利申请序列号11/711,975,现在的美国专利公布2007/0194079;和
(5)F.Shelton,IV的“Staple Cartridges For Forming Staples HavingDiffering Formed Staple Heights”,美国专利申请序列号12/695,359,现在的美国专利公布2010/0127042。
技术领域
本发明整体涉及能够施加成排钉的缝合器械,更具体地讲,涉及关于与外科缝合器械一起使用的钉仓的改进,该外科缝合器械能够在对组织进行切割的同时将具有不同成形钉高度的成排钉施加到组织。
背景技术
外科缝合器已在现有技术中使用,以同时在组织中切开纵向切口和将成排的钉施加到切口的相对两侧。此类器械通常包括一对协同工作的钳口构件,如果意图将所述器械用于内窥镜式或腹腔镜式应用,则所述钳口构件能够穿过插管通道。钳口构件之一容纳钉仓,该钉仓具有横向间隔开的至少两排钉。另一钳口构件限定砧座,所述砧座具有与钉仓中的钉排对齐的钉成形凹坑。器械包括多个往复式楔形件,当朝远侧驱动时,所述多个往复式楔形件穿过钉仓中的开口并且接合支撑钉的驱动器,以使钉朝着砧座击发。
在美国专利申请US2004/0232196A1中描述了适用于内窥镜式应用的外科缝合器的例子,该专利的公开内容全文以引用的方式并入本文。在使用中,临床医生能够在组织上闭合缝合器的钳口构件,以在击发之前定位组织。一旦临床医生已确定钳口构件正在正确地抓持组织,则临床医生可接着击发外科缝合器,从而切断和缝合组织。同时进行切割及缝合避免了当利用分别仅用于切割或缝合的不同外科工具依次执行此类动作时可能产生的并发症。
每当穿过不同的组织组合物的区域横切组织时,最接近切割线的钉具有小于离切割线最远的那些钉的成形高度的成形高度将是有利的。在实施过程中,内侧钉排用于提供止血屏障,而具有较大成形高度的外侧钉排提供系紧效果,其中组织从紧密压缩的止血部分过渡到非压缩的相邻部分。在其他应用中,在单行钉中的钉具有不同的成形高度是有用的。授予Pruitt的美国专利4,941,623和5,027,834公开了外科缝合器和钉仓布置,该钉仓布置采用具有不同插脚长度的钉以最终实现具有不同成形高度的成排的钉。同样,WO2003/094747A1公开了外科缝合器和钉仓,该钉仓具有六排钉,其中外侧的两排钉包括比内侧的两排钉和中间的钉排更大的钉。因此,所有这些方法均需要在同一钉仓中使用不同尺寸的钉。
发明内容
在一个总的方面,本发明涉及能够制备不同成形长度的钉的外科缝合装置。例如,在还能够切割被缝合的组织的此类装置中,最靠近纵向切口线的内侧钉排可具有小于外侧钉排的成形高度的成形高度。这样,内侧钉排可以提供止血屏障,而具有较大成形高度的外侧钉排可以提供系紧效果,其中组织从紧密压缩的止血部分过渡到非压缩的相邻部分。
根据不同的具体实施,钉仓可具有不同高度的钉驱动器,从而形成具有不同成形长度的钉。由较短的钉驱动器驱动的钉将具有较长的成形长度(假定不存在会影响钉的成形高度的其他不同之处)。另外,砧座中的钉成形凹坑可具有不同的深度。在较深凹坑中形成的钉往往比在较浅凹坑中形成的钉长。此外,一些钉成形凹坑可形成于砧座的柔顺材料部分中。在此类凹坑中形成的钉往往比在砧座的非柔顺(或较不柔顺)的部分中形成的钉长。另外,通道可具有内部台阶,其将形成具有不同成形高度的钉。在较低的台阶处开始的由钉驱动器形成的钉将比在较高的台阶处开始的由钉驱动器形成的钉具有更长的成形长度。另外,可使用具有不同线径的钉。较粗的钉将易于形成具有较长成形长度的钉。就此而言,本发明的实施例涉及可以适应具有不同线材厚度的钉的钉推动器。另外,可使用不同材料的钉。由更坚固但较不柔顺的材料制成的钉将易于形成较长的成形钉。
根据其他实施例,外科缝合装置可包括多个堆叠的楔形带组。每个堆叠的楔形带组可包括多个彼此堆叠的楔形带。可连续致动楔形带以按连续的步骤驱动钉。即,例如,在堆叠件中具有三个楔形带的实施例中,可首先致动第一楔形带以部分地部署钉,然后可致动堆叠件中的第二楔形带以开始形成钉,并且可最后致动堆叠件中的第三楔形带以完成钉的成形。为了形成具有不同成形高度的钉,例如,堆叠件的高度(对应于堆叠件中楔形带的累计高度)可以不同。
用于形成不同高度的成形钉的技术可用于多种不同的外科缝合装置中。例如,缝合装置可以是切割被夹紧的组织的装置或不包括切割器械的装置。例如,外科缝合器可以是直线切割器、开放式直线型缝合器装置或圆形缝合器。
根据本发明的各种实施例的其他整体方面,提供了与具有机器人控制的致动器和砧座部分的缝合装置一起使用的钉仓,所述致动器可选择性地在轴向上致动,所述砧座部分可选择性地在打开位置和闭合位置之间运动。在各种实施例中,钉仓包括仓体,其可支撑于缝合装置中以用于当处于闭合位置时选择性地与缝合装置的砧座部分呈面对关系。仓体能够将动态致动构件轴向容纳于其中,该动态致动构件响应于由机器人控制的致动器施加至其上的控制运动。至少一个第一钉驱动器可运动地支撑于仓体中以由动态致动构件接触,使得当由机器人控制的的致动器向所述动态致动构件施加第一控制运动时,随着动态致动构件轴向推进穿过仓体,第一钉驱动器当砧座处于闭合位置时沿着朝向砧座的方向驱动。每个第一钉驱动器限定用于将钉支撑于其上的第一钉支撑支架。第一钉支撑支架与闭合砧座的相应部分相距第一钉成形距离处定位。至少一个第二钉驱动器可运动地支撑于仓体中以由动态致动构件接触,使得随着动态致动构件轴向推进穿过仓体时,第二钉驱动器沿着朝向闭合砧座的方向驱动。每个第二钉驱动器限定用于将另一个钉支撑于其上的第二钉支撑支架。第二钉支撑支架与闭合砧座的另一部分相距第二钉成形距离处定位,其中第二钉成形距离不同于第一钉成形距离。
根据本发明的各种实施例的其他整体方面,提供了包括机器人系统的外科缝合装置,该机器人系统能够操作以产生击发运动和闭合运动。装置还包括响应于来自机器人系统的击发运动和闭合运动的工具部分。在各种形式中,工具部分包括细长通道,该细长通道可操作地联接到机器人系统的一部分并能够在其中支撑钉仓。砧座可运动地联接到细长通道并且其中具有砧座通道。当机器人系统向砧座施加闭合运动时,砧座可从打开位置运动到闭合位置。各种实施例还包括击发装置,该击发装置包括远侧设置的切刃,当机器人系统向所述击发装置施加击发运动时,该击发装置在细长通道和砧座内从起始位置纵向运动到结束位置。击发装置具有在击发的远侧运动过程中用于接合砧座通道的上部和用于接合细长通道的下部。各种形式的钉仓均包括仓体,所述仓体的尺寸设定成支撑在细长通道内。仓体具有在其中纵向延伸的狭槽,以用于将击发装置容纳于其中。仓体具有非平面的平台表面,当砧座处于闭合位置时,该平台表面能够面对其中具有钉成形凹坑的砧座的钉成形部分。多个第一内侧钉驱动器在仓体的一部分中轴向排列成第一排内侧钉驱动器,所述第一排内侧钉驱动器与纵向延伸的狭槽的第一侧面相邻。多个第二内侧钉驱动器仓体的另一部分中轴向排列成第二排内侧钉驱动器,所述第二排内侧钉驱动器与纵向延伸的狭槽的第二侧面相邻。内侧钉驱动器可运动地支撑在仓体中,以在砧座处于闭合位置时朝砧座选择性地运动。每个内侧钉驱动器限定用于将第一钉支撑于其上的支撑支架。当砧座处于闭合位置时,每个第一钉支撑支架与砧座的相应部分相距第一钉成形距离处定位。多个第一外侧钉驱动器轴向排列成邻近第一排内侧钉驱动器的第一排外侧钉驱动器。多个第二外侧钉驱动器轴向排列成第二排外侧钉驱动器并邻近第二排内侧钉驱动器。每个外侧钉驱动器可运动地支撑在仓体中,以在砧座处于闭合位置时朝砧座选择性地进行驱动运动。每个外侧钉驱动器限定用于将另一个钉支撑于其上的第二钉支撑支架。当砧座处于闭合位置时,每个第二钉支撑支架与砧座的另一个相应部分相距第二钉成形距离处定位。第二钉成形距离在量级上不同于第一钉成形距离。楔形滑动件支撑在仓体中,以通过击发装置驱动接触并致动接触多个第一内侧钉驱动器和多个第二内侧钉驱动器以及多个第一外侧钉驱动器和多个第二外侧钉驱动器,使得随着击发装置响应于来自机器人系统的击发运动而沿着第一轴向在仓体中的细长狭槽中运动,楔形滑动件朝砧座驱动每个内侧驱动器和外侧驱动器,以当砧座处于闭合位置时使支撑在内侧驱动器和外侧驱动器上的钉与砧座成形接触。
附图说明
并入本文中并且构成本说明书一部分的附图以举例的方式示出了本发明的实施例,并且与上面所给出的概述和下面所给出的具体实施方式一起用于解释本发明的原理,其中:
图1示出了根据本发明的各种实施例的处于打开位置的外科缝合和切断器械的部分切除的侧正视图;
图2示出了根据本发明的各种实施例的外科缝合和切断器械的端部执行器的沿着图1中的线2-2截取的横截面侧正视细部图;
图3示出了根据本发明的各种实施例的图2的外科缝合和切断器械的击发杆的放大侧正视图;
图4示出了根据本发明的各种实施例的图2的外科缝合和切断器械的击发杆的放大的前视图;
图5示出了根据本发明的各种实施例的用于图1的外科缝合和切断器械的可供选择的端部执行器的横截面侧正视细部图,其中采用了击发杆,该击发杆没有用于防止端部执行器夹紧的中间销;
图6示出了根据本发明的各种实施例的图1的外科缝合和切断器械的近端的柄部部分的侧正视图,其中左侧被移除以暴露处于未夹紧、未击发(“起始”)位置的内部部件;
图7示出了根据本发明的各种实施例的图1的外科缝合和切断器械的近端的柄部部分的透视分解图;
图8示出了根据本发明的各种实施例的图1的外科缝合和切断器械的近端的柄部部分的侧正视图,其中左侧被移除以暴露处于闭合(“夹紧”)位置的内部部件;
图9示出了根据本发明的各种实施例的图1的外科缝合和切断器械的近端的柄部部分的侧正视图,其中左侧被移除以暴露处于缝合和切断(“击发”)位置的内部部件;
图10示出了根据本发明的各种实施例的安装在端部执行器中的钉仓的平面图;
图11为根据本发明的各种实施例的钉仓的一部分的放大的平面图;
图12为可在本发明的各种实施例中采用的钉的侧视图;
图13为根据本发明的各种实施例的其上支撑两个钉的一个内侧双驱动器的前正视图;
图14为根据本发明的各种实施例的图13的内侧双驱动器和钉的平面图;
图14A为根据本发明的各种实施例位于安装在端部执行器中的钉仓的一部分中的图13的内侧双驱动器的正视图,并且还示出了处于闭合位置的砧座的相应部分;
图15为根据本发明的各种实施例的图13和14的内侧双驱动器和钉的右侧正视图;
图15A为根据本发明的各种实施例的图15的内侧双驱动器的另一个侧正视图,其中以虚线表示仓托盘和砧座的相应部分以显示两者间的关系;
图16为根据本发明的各种实施例的其上支撑钉的一个外侧单驱动器的前正视图;
图16A为根据本发明的各种实施例的图16的外侧单驱动器的另一个前视图,其中示出了仓托盘和砧座的部分以显示两者间的关系;
图17为根据本发明的各种实施例的图16的外侧单驱动器和钉的平面图;
图18为根据本发明的各种实施例的图1的外科缝合和切断器械的工具部分的等轴分解图;
图19为根据本发明的各种实施例沿着图10的线19-19截取的剖视图,示出了击发杆、细长通道、楔形滑动件、钉驱动器、钉和钉仓之间的剖视关系;
图19A为根据本发明的各种实施例的端部执行器的另一个剖视图,示出了击发杆、细长通道、楔形滑动件、钉驱动器、钉、钉仓和砧座之间的剖视关系;
图20为根据本发明的各种实施例的一个楔形滑动件的透视图;
图21为根据本发明的各种实施例的图20中示出的楔形滑动件的内侧滑动件凸轮的侧正视图;
图22为根据本发明的各种实施例的图20中示出的楔形滑动件的外侧滑动件凸轮的侧正视图;
图23为根据本发明的各种实施例的位于图1的外科缝合和切断器械的远端处的端部执行器的等轴视图,其中砧座处于向上或打开位置,仓大部分被移除,以暴露示例性的单钉驱动器和双钉驱动器,以及抵靠击发杆的中间销位于其起始位置的楔形滑动件;
图24为根据本发明的各种实施例的位于图1的外科缝合和切断器械的远端处的端部执行器的等轴视图,其中砧座处于向上或打开位置以暴露钉仓和击发杆的切刃;
图25为根据本发明的各种实施例的位于图1的外科缝合和切断器械的远端的等轴视图,其中砧座处于向上或打开位置,钉仓完全被移除,并移除细长通道的一部分以暴露击发杆的最下面的销;
图26为根据本发明的各种实施例示出了在图1的外科缝合和切断器械的的砧座、细长通道和处于闭合位置的钉仓之间的机械关系的截面的侧正视图,截面通常沿着图24的线26-26截取以暴露楔形滑动件、钉驱动器和钉,而且示出沿着纵向中心线的击发杆;
图27为根据本发明的各种实施例的钉仓的一部分的剖视图,其中楔形件的外侧凸轮邻近外侧单驱动器;
图28为根据本发明的各种实施例的钉仓的一部分的剖视图,其中楔形滑动件的外侧凸轮接合三个外侧单驱动器;
图29为使用根据本发明的各种实施例的外科缝合和切断器械安装在切割线的每一侧上的成排钉的图解示意图;
图30示出了由根据本发明的各种实施例的一个内侧驱动器形成的钉;
图31示出了由根据本发明的各种实施例的一个外侧驱动器形成的另一个钉;
图32为使用根据本发明的各种实施例的外科缝合和切断器械安装在切割线的每一侧上的成排钉的图解示意图;
图33为使用根据本发明的各种实施例的外科缝合和切断器械安装在切割线的每一侧上的成排钉的图解示意图;
图34为使用根据本发明的各种实施例的外科缝合和切断器械安装在切割线的每一侧上的成排钉的图解示意图;
图35为根据本发明的各种实施例的沿着处于部分闭合但未夹紧位置的夹持组织的端部执行器的纵向中心线截取的图1的外科缝合和切断器械的侧正视横截面图;
图36示出了根据本发明的各种实施例的处于闭合或夹紧位置的图1的外科缝合和切断器械的部分切除的侧正视图;
图37示出了根据本发明的各种实施例的处于闭合或夹紧位置的图1的外科缝合和切断器械的侧正视图,其中组织被适当压缩;
图38示出了根据本发明的各种实施例的处于局部击发位置的图1的外科缝合和切断器械的远端沿着中心线的截面的视图;
图39示出了根据本发明的各种实施例的处于局部击发位置的图1的外科缝合和切断器械的部分切除的侧正视图;
图40示出了根据本发明的各种实施例的处于完全击发位置的图1的外科缝合和切断器械的远端沿着中心线的截面的视图;
图41为根据本发明的各种实施例的处于完全击发位置的图1的外科缝合和切断器械的部分切除的侧正视图;
图42-44示出了根据本发明的各种实施例的具有滑动件的端部执行器的各个方面,该滑动件具有多个滑动件凸轮,其中一个滑动件凸轮高于另一个滑动件凸轮;
图45示出了根据本发明的各种实施例的具有变化深度的钉成形凹坑的端部执行器的各个方面;
图46-47示出了根据本发明的各种实施例的具有不同预成形长度的钉的双钉驱动器;
图48示出了根据本发明的各种实施例的具有双钉驱动器的端部执行器的侧视图,该双钉驱动器具有不同的钉驱动器高度;
图49-50示出了根据本发明的各种实施例的具有变化深度的钉成形凹坑的端部执行器的侧视图;
图51-62示出了根据本发明的各种实施例的具有堆叠的可致动楔形带的外科缝合装置的各个方面;
图63-69示出了根据本发明的各种实施例的开放式直线型外科缝合装置的各个方面;
图70-77示出了根据本发明的各种实施例的端部执行器的横截面正视图;
图78-83示出了根据本发明的各种实施例的可容纳具有不同线径的钉的钉驱动器;
图84-89示出了根据本发明的各种实施例的圆形外科缝合装置;
图90-95示出了根据本发明的实施例的另一个外科缝合装置;
图96为一个机器人控制器实施例的透视图;
图97为可操作地支撑本发明的多个外科工具实施例的机器人系统的一个机器人外科臂车/操纵器的透视图;
图98为图97中示出的机器人外科臂车/操纵器的侧视图;
图99为具有用于可操作地支撑机器人操纵器的定位连杆的示例性的臂车结构的透视图,该机器人操纵器可与本发明的各种外科工具实施例一起使用;
图100为本发明的外科工具实施例的透视图;
图101为用于将各种外科工具实施例附接到机器人系统的适配器和工具架装置的分解组件视图;
图102为图101中示出的适配器的侧视图;
图103为图101中示出的适配器的底视图;
图104为图101和图102的适配器的顶视图;
图105为图100的外科工具实施例的部分底部透视图;
图106为本发明的可进行关节运动的外科端部执行器实施例的一部分的局部分解图;
图107为移除了工具安装外壳的图105的外科工具实施例的透视图;
图108为移除了工具安装外壳的图105的外科工具实施例的后部透视图;
图109为移除了工具安装外壳的图105的外科工具实施例的前透视图;
图110为图105的外科工具实施例的部分分解透视图;
图111为图105的外科工具实施例的部分横截面侧视图;
图112为图111中示出的外科工具的一部分的放大剖视图;
图113为图105中示出的外科工具实施例的工具安装部分的一部分的分解透视图;
图114为图113的工具安装部分的一部分的放大分解透视图;
图115为图105的外科工具的细长轴组件的一部分的局部剖视图;
图116为本发明的外科工具实施例的闭合螺母实施例的半部分的侧视图;
图117为本发明的另一个外科工具实施例的透视图;
图118为图117的外科工具实施例的外科端部执行器和细长轴组件的一部分的横截面侧视图,其中砧座处于打开位置并且闭合离合器组件处于中间位置;
图119为图118中示出的外科端部执行器和细长轴组件的另一个横截面侧视图,其中离合器组件接合于闭合位置;
图120为图118中示出的外科端部执行器和细长轴组件的另一个横截面侧视图,其中离合器组件接合于击发位置;
图121是本发明的工具安装部分实施例的一部分的平面图;
图122为本发明的另一个外科工具实施例的透视图;
图123为图122的外科工具实施例的外科端部执行器和细长轴组件的一部分的横截面侧视图,其中砧座处于打开位置;
图124为图122的外科工具实施例的外科端部执行器和细长轴组件的一部分的另一个横截面侧视图,其中砧座处于闭合位置;
图125为本发明的闭合驱动螺母和部分刀杆实施例的透视图;
图126是本发明的另一个工具安装部分实施例的平面图;
图127为本发明的另一个外科工具实施例的透视图;
图128为图127的外科工具实施例的外科端部执行器和细长轴组件的一部分的横截面侧视图,其中砧座处于打开位置;
图129为图128的外科工具实施例的外科端部执行器和细长轴组件的一部分的另一个横截面侧视图,其中砧座处于闭合位置;
图130为本发明的外科工具实施例的安装衬圈实施例的剖视图,示出了闭合驱动轴的刀杆和远端部分;
图131为图130的安装衬圈实施例的剖视图;
图132为本发明的另一个外科工具实施例的另一个工具安装部分实施例的平面图;
图132A为本发明的另一个外科工具实施例的齿轮装置的一部分的分解透视图;
图132B为图132A中示出的齿轮装置的横截面透视图;
图133为采用了压力传感器装置的本发明的另一个外科工具实施例的外科端部执行器和细长轴组件的一部分的横截面侧视图,其中砧座处于打开位置;
图134为图133的外科工具实施例的外科端部执行器和细长轴组件的一部分的另一个横截面侧视图,其中砧座处于闭合位置;
图135为与机器人系统的工具架部分相关的本发明的另一个外科工具实施例的一部分的侧视图,其一些部件以横截面示出;
图136为与机器人系统的工具架部分相关的本发明的另一个外科工具实施例的一部分的侧视图,其一些部件以横截面示出;
图137为本发明的另一个外科工具实施例的一部分的侧视图,其一些部件以横截面示出;
图138为本发明的外科工具实施例的一部分的另一个外科端部执行器的一部分的侧视图,其一些部件以横截面示出;
图139为本发明的外科工具实施例的一部分的另一个外科端部执行器的一部分的侧视图,其一些部件以横截面示出;
图140为本发明的外科工具实施例的一部分的另一个外科端部执行器的一部分的侧视图,其一些部件以横截面示出;
图141为图140的端部执行器的一部分的放大剖视图;
图142为图140和141的端部执行器的一部分的另一个剖视图;
图143为本发明的另一个外科工具实施例的外科端部执行器和细长轴组件的一部分的横截面侧视图,其中砧座处于打开位置;
图144为图143的外科工具实施例的外科端部执行器和细长轴组件的一部分的放大横截面侧视图;
图145为图143和144的外科端部执行器和细长轴组件的一部分的另一个横截面侧视图,其中砧座处于闭合位置;
图146为图143至145的外科工具实施例的外科端部执行器和细长轴组件的一部分的放大横截面侧视图;
图147为本发明的外科工具实施例的工具安装部分实施例的平面图;
图148为本发明的另一个外科工具实施例的透视组件视图;
图149为可与本发明的各种外科工具实施例一起使用的一次性加载单元装置的前透视图;
图150为图149的一次性加载单元的后部透视图;
图151为图149和150的一次性加载单元的底部透视图;
图152为可与本发明的各种外科工具实施例一起使用的另一个一次性加载单元装置的底部透视图;
图153为图149至151中示出的一次性加载单元的安装部分的分解透视图;
图154为本发明的外科工具实施例的一次性加载单元和细长轴组件实施例的一部分的透视图,其中一次性加载单元处于第一位置;
图155为图154的一次性加载单元和细长轴组件的一部分的另一个透视图,其中一次性加载单元位于第二位置;
图156为图154和154中一次性加载单元和细长轴组件实施例的一部分的剖视图;
图157为图154至156中示出的一次性加载单元和细长轴组件实施例的另一个剖视图;
图158为本发明的外科工具实施例的另一个一次性加载单元实施例的一部分和细长轴组件实施例的局部分解透视图;
图159为本发明的外科工具实施例的另一个一次性加载单元实施例的一部分和细长轴组件实施例的局部分解透视图;
图160为图159的一次性加载单元实施例和细长轴组件实施例的另一个局部分解透视图;
图161为本发明的外科工具实施例的另一个工具安装部分实施例的平面图;
图162为本发明的另一个外科工具实施例的侧视图,其一些部件以横截面示出并与机器人系统的机器人工具架相关;
图163为可结合本发明的各种外科工具实施例使用的外科端部执行器实施例的分解组件视图;
图164为用于驱动在本发明的各种外科端部执行器实施例中使用的切割器械的缆线驱动系统的一部分的侧视图;
图165为图164的缆线驱动系统和切割器械的平面图;
图166为处于闭合位置的本发明的缆线驱动传动装置实施例的平面图;
图167为处于中间位置的图166的缆线驱动传动装置实施例的另一个平面图;
图168为处于击发位置的图166和167的缆线驱动传动装置实施例的另一个平面图;
图169为处于图166中示出的位置的缆线驱动传动装置实施例的透视图;
图170为处于图167中示出的位置的缆线驱动传动装置实施例的透视图;
图171为处于图168中示出的位置的缆线驱动传动装置实施例的透视图;
图172为本发明的另一个外科工具实施例的透视图;
图173为用于驱动在本发明的各种外科端部执行器实施例中使用的切割器械的另一个缆线驱动系统实施例的一部分的侧视图;
图174为图173的缆线驱动系统实施例的平面图;
图175为本发明的另一个外科工具实施例的工具安装部分实施例的平面图;
图176是本发明的另一个外科工具实施例的俯视剖视图;
图177为本发明的外科工具实施例的外科端部执行器实施例的一部分的剖视图;
图178为图177的外科端部执行器沿着图177中的线178-178截取的横截面端视图;
图179为部分以横截面示出的图177和178的外科端部执行器的透视图;
图180为图177至179的外科端部执行器的一部分的侧视图;
图181为本发明的各种外科工具实施例的滑动件组件实施例的透视图;
图182为图181的滑动件组件实施例和图180的细长通道的一部分的剖视图;
图183至188以图解法示出了在本发明的外科工具实施例中的钉的顺序击发;
图189为本发明的外科端部执行器实施例的一部分的局部透视图;
图190为本发明的外科工具实施例的外科端部执行器实施例的一部分的局部横截面透视图;
图191为滑动件组件轴向推进穿过其中的图190的外科端部执行器实施例的另一个局部横截面透视图;
图192为本发明的另一个外科工具实施例的另一个滑动件组件实施例的透视图;
图193为滑动件组件轴向推进穿过其中的图190和191中示出的外科端部执行器实施例的一部分的局部平面图;
图194为图193的外科端部执行器实施例的另一个局部平面图,为了清楚起见,已移除外科钉仓的顶部表面;
图195为图190和191中示出的外科端部执行器的旋转驱动器实施例和钉推动器实施例的局部横截面侧视图;
图196为本发明的自动重新加载系统实施例的透视图,其中外科端部执行器与其提取系统以提取方式接合;
图197为图196中示出的自动重新加载系统实施例的另一个透视图;
图198为图196和197中示出的自动重新加载系统实施例的横截面正视图;
图199为图196至198中示出的自动重新加载系统实施例的另一个横截面正视图,其中其提取系统从外科端部执行器中移除用过的外科钉仓;
图200为图196至199中示出的自动重新加载系统实施例的另一个横截面正视图,示出了将新的外科钉仓加载到外科端部执行器中;
图201为本发明的另一个自动重新加载系统实施例的透视图,其一些部件以横截面示出;
图202为图201的自动重新加载系统实施例的一部分的分解透视图;
图203为图202中示出的部分自动重新加载系统实施例的另一个分解透视图;
图204为图201至203的自动重新加载系统实施例的横截面正视图;
图205为支撑其中的一次性加载单元的取向管实施例的剖视图;
图206为本发明的另一个外科工具实施例的透视图;
图207为本发明的外科工具实施例的关节运动接头实施例的局部透视图;
图208为本发明的外科工具实施例的闭合管实施例的透视图;
图209为组装在图207的关节运动接头实施例上的图208的闭合管实施例的透视图;
图210为本发明的外科工具实施例的工具安装部分实施例的一部分的平面图;
图211为图210的工具安装部分实施例中采用的关节运动驱动组件实施例的透视图;
图212为本发明的另一个外科工具实施例的透视图;并且
图213为本发明的另一个外科工具实施例的透视图。
具体实施方式
本专利申请的申请人还拥有与本专利同一日期提交的以下专利申请,这些专利申请各自的全部内容均以引用方式并入本文:
-名称为“Surgical Instrument With Wireless Communication Between aControl Unit of a Robotic System and Remote Sensor”的美国专利申请序列号____________,代理人案卷号END5924USCIP2/060339CIP2;
-名称为“Robotically-Controlled Disposable Motor Driven Loading Unit”的美国专利申请序列号__________,代理人案卷号END6213USCIP1/070330CIP1;
-名称为“Robotically-Controlled Endoscopic Accessory Channel”的美国专利申请序列号________,代理人案卷号END5568USCIP2/100809CIP2;
-名称为“Robotically-Controlled Motorized Surgical Instrument”的美国专利申请序列号__________,代理人案卷号END6416USCIP1/080205CIP1;
-名称为“Robotically-Controlled Motorized Cutting and FasteningInstrument”的美国专利申请序列号_________,代理人案卷号END6269USCIP1/070391CIP1;
-名称为“Robotically-Controlled Shaft Based Rotary Drive Systems ForSurgical Instruments”的美国专利申请序列号___________,代理人案卷号END6089USCIP1/070059CIP1;
-名称为“Robotically-Controlled Surgical Instrument Having RecordingCapabilities”的美国专利申请序列号_______________,代理人案卷号END5773USCIP4/050698CIP4;
-名称为“Robotically-Controlled Surgical Instrument With ForceFeedback Capabilities”的美国专利申请序列号__________,代理人案卷号END5773USCIP5/050698CIP5;
-名称为“Robotically-Driven Surgical Instrument With E-Beam Driver”的美国专利申请序列号__________,代理人案卷号END0908USCIP2/100810CIP2;
-名称为“Surgical Stapling Instruments With Rotatable StapleDeployment Arrangements”的美国专利申请序列号__________,代理人案卷号END7002USNP/110262。
现在将描述某些示例性实施例,以从整体上理解本文所公开的装置和方法的结构、功能、制造和用途。这些实施例的一个或多个实例在附图中示出。本领域的普通技术人员将会理解,本文特别描述和在附图中示出的装置和方法为非限制性的示例性实施例,并且本发明各种实施例的范围仅由权利要求书限定。就一个示例性实施例进行图解说明或描述的特征,可与其他实施例的特征进行组合。这种修改形式和变化形式旨在包括在本发明的范围之内。
因此,本说明书通篇使用的短语“在各种实施例中”、“在一些实施例中”、“在一个实施例中”或“在实施例中”等并不一定都指相同的实施例。此外,在一个或多个其他实施例中,可按照任何合适的方式组合一个或多个实施例的具体特征、结构或特性。这种修改形式和变化形式旨在包括在本发明的范围之内。
参见附图,其中贯穿多个视图的类似的数字代表类似的部件,图1和2示出了能够实践本发明独特的有益效果的外科缝合和切断器械10的一个实施例。然而,应当认识到,在不脱离本发明精神和范围的情况下,可有利地结合多种其他缝合器和缝合器械应用本发明的独特和新颖方面。因此,不应将给予本发明多个实施例的保护范围限制于仅用于本文所述的特定类型的外科缝合和切断器械。
如图1和2所示,外科缝合和切断器械10包括具有致动器或电子束击发机构(“击发杆”)14的端部执行器12,该致动器或电子束击发机构有利地控制端部执行器12的间距。具体地讲,细长通道16和可枢转地平移的砧座18保持在确保有效缝合和切断的间距处。避免了与端部执行器12中捕获的组织的变化量有关的问题。
应当理解,本文使用的术语“近侧”和“远侧”是以握持器械的柄部的外科医生为参照的。因此,端部执行器12相对于更近侧的柄部部分20为远侧。还应当理解,为方便和清楚起见,本文可结合附图使用空间术语例如“垂直”和“水平”。然而,外科器械在多个取向和位置中使用,并且这些术语并非意图进行限制,也并非绝对。
外科缝合和切断器械10包括与工具部分22连接的柄部部分20,该工具部分还包括远侧终止于端部执行器12中的轴23。柄部部分20包括手枪式握把24,由临床医生将闭合触发器26枢转地拉向手枪式握把,以使砧座18朝向端部执行器12的细长通道16夹紧或闭合。击发触发器28在闭合触发器26的更外侧,并且被临床医生枢转地牵拉,以使夹持的组织在端部执行器12中被缝合和切断。
在实施过程中,首先致动闭合触发器26。一旦临床医生对于端部执行器12的定位感到满意,临床医生即可将闭合触发器26拉回至其紧邻手枪式握把24的完全闭合的锁定位置。接着,击发触发器28被致动。当临床医生移除压力时,击发触发器28以弹簧形式返回。当被按压在柄部部分20的近端上时,释放按钮30释放任何锁定的闭合触发器26。
闭合套管32包封框架34,该框架继而包封由击发触发器28定位的击发驱动构件36。框架34将柄部部分20连接至端部执行器12。如图所示,随着闭合套管32通过闭合触发器26朝近侧撤回,砧座18以弹簧形式打开,从而远离细长通道16枢转并且与闭合套管32一起朝近侧平移。细长通道16容纳钉仓37。
具体参见图2-4,击发杆14包括三个竖直间隔开的销,所述销在击发期间控制端部执行器12的间距。具体地讲,上部销38为分段的以进入枢轴附近的砧座凹坑40,所述枢轴介于砧座18与细长通道16之间。当随着砧座18闭合而被击发时,上部销38在纵向砧座狭槽42内朝远侧推进,所述纵向砧座狭槽朝远侧延伸穿过砧座18。在砧座18中任何微量的向上偏转均可通过由上部销38施加的朝下的力来克服。击发杆14还包括最下部的销或击发杆顶盖44,所述最下部的销或击发杆顶盖向上地接合细长通道16中的通道狭槽45,从而与上部销38协作,以在过多的组织被夹紧在其间的情况下将砧座18与细长通道16略微拉近到一起。击发杆14有利地包括中间销46,所述中间销穿过在仓300的下表面和细长通道16的上表面中形成的击发驱动狭槽47从而驱动其中的钉,如下所述。通过抵靠细长通道16滑动,中间销46有利地抵抗端部执行器12在其远端处被夹紧关闭的任何趋势。为了示出中间销46的优点,图5示出了在击发杆14’上没有中间销的另一端部执行器12’。在该图示中,允许端部执行器12’在其远端处被夹紧关闭,这往往损害期望的钉成形。
回到图2-4,在击发杆14上的上部销38和中间销46之间远侧设置的切刃48横向穿过仓37中近侧存在的竖直狭槽49以切断夹持的组织。击发杆14相对于细长通道16和砧座18的明确定位确保进行有效切割。由电子束击发杆14提供的明确的竖直间隔适用于内窥镜式装置的有限尺寸。此外,电子束击发杆14使砧座15能够加工成形有在其远端处(类似于图5中示出的位置)赋予竖直偏转的曲度。该曲面砧座15有利地帮助在端部执行器12中获得所需的间隙,即使砧座15具有减缩厚度,这更适合于内窥镜式装置的尺寸限制。
结合图6-9,柄部部分20由第一基座部分50和第二基座部分52构成,所述第一基座部分和第二基座部分可由聚合材料(例如玻璃填充的聚碳酸酯)模制而成。第一基座部分50设有多个圆柱形销54。第二基座部分52包括多个延伸构件56,每个延伸构件具有六边形开口58。圆柱形销54容纳于六边形开口58中,并通过摩擦保持于其中,以将第一基座部分50和第二基座部分52保持在组件中。
旋转旋钮60具有完全延伸穿过其中的镗孔62,以用于围绕其纵向轴线接合和旋转工具部分22。旋转旋钮60包括向内突起的毂64,所述毂沿镗孔62的至少一部分延伸。突起毂64被容纳在形成于闭合套管32的近侧部分处的纵向狭槽66内,使得旋转旋钮60的旋转使闭合套管32旋转。应当理解,毂64还延伸穿过框架34并延伸至与击发驱动构件36的一部分接触以同样使其旋转。因此,端部执行器12(图6-9中未示出)随着旋转旋钮60旋转。
框架34的近端68朝近侧穿过旋转旋钮60并且设有周边凹口70,所述周边凹口由分别从基座部分50和52延伸的相对的通道固定构件72接合。仅示出了第二基座部分52的通道固定构件72。从基座部分50,52延伸的通道固定构件72用于将框架34固定到柄部部分20,使得框架34不能相对于柄部部分20纵向运动。
闭合触发器26具有柄部部分74、齿轮段部分76和中间部分78。镗孔80延伸穿过中间部分78。从第二基座部分52延伸的圆柱形支撑构件82穿过镗孔80以将闭合触发器26枢转地安装到柄部部分20上。从第二基座部分52延伸的圆柱形支撑构件83穿过击发触发器28的镗孔81以枢转地安装到柄部部分20上。将六边形开口84设置在圆柱形支撑构件83中以容纳从第一基座部分50延伸的固定销(未示出)。
闭合轭86被容纳在柄部部分20内,以用于在其内进行往复运动并用来将运动从闭合触发器26传送至闭合套管32。从第二基座部分52延伸的支撑构件88和延伸穿过轭86中的凹槽89的固定构件72将轭86支撑于柄部部分20中。
闭合套管32的近端90设有凸缘92,所述凸缘被搭扣配合到形成于轭86的远端96中的容纳凹槽94中。轭86的近端98具有由闭合触发器26的齿轮段部分76接合的齿轮齿条100。当闭合触发器26向柄部部分20的手枪式握把24运动时,轭86朝远侧运动并因此使闭合套管32朝远侧运动,从而压缩朝近侧偏置轭86的弹簧102。闭合套管32的远侧运动使砧座18朝远侧并朝向端部执行器12的细长通道16进行枢转平移运动,并且闭合套管的近侧运动使砧座闭合,如下所述。
通过与击发触发器28的接合表面128相互作用的前表面130来使闭合触发器26向前偏置至打开位置。在柄部部分20中围绕销106从顶部枢转到后部的夹具第一钩104限制击发触发器28向着手枪式握把24运动,直到闭合触发器26被夹持到其闭合位置。钩104通过与击发触发器28中的锁定销107结合来限制击发触发器28的运动。钩104还与闭合触发器26接触。具体地讲,钩104的向前突出108与闭合触发器26的中间部分78上的构件110结合,构件100朝向柄部部分74置于镗孔80的外面。朝着与闭合触发器26的构件110接触的方向偏置钩104,并通过释放弹簧112与击发触发器28中的锁定销107接合。当压下闭合触发器26时,钩104从顶部运动至后部,从而压下捕获在钩104上的向后突出114和释放按钮30上的向前突出116之间的释放弹簧112。当轭86响应于闭合触发器26的近侧运动而向远侧运动时,释放按钮30的上锁臂118沿着轭86的上表面120运动,直到落入在轭86的近侧下部中向上存在的凹槽122中。释放弹簧112向外推压释放按钮30,该释放按钮将上锁臂118向下枢转成与向上存在的凹槽122接合,从而将闭合触发器26锁定在组织夹紧位置中,例如图8中所示。
可通过向内推动释放按钮30将锁臂118移出凹槽122,从而释放砧座18。具体地,上锁臂118围绕第二基座部分52的销123向上枢转。然后允许轭86响应于闭合触发器26的返回运动向近侧运动。
击发触发器返回弹簧124位于柄部部分20中,其一端附接到第二基座部分52的销106,并且另一端附接到击发触发器28上的销126。击发返回弹簧124将返回力施加到销126,以使击发触发器28沿着远离柄部部分20的手枪式握把24的方向偏置。还通过与偏置闭合触发器26的前表面130的击发触发器28的表面128结合使闭合触发器26偏离手枪式握把24。
当闭合触发器26朝手枪式握把24运动时,其前表面130与击发触发器28上的接合表面128接合,从而使击发触发器28运动至其“击发”位置。当处于其击发位置时,击发触发器28以大约45°的角度相对于手枪式握把24定位。在钉击发后,弹簧124使击发触发器28返回至其初始位置。在击发触发器28的返回运动过程中,其接合表面128推压闭合触发器26的前表面130,从而使闭合触发器26返回至其初始位置。止动构件132从第二基座部分52延伸以防止闭合触发器26旋转越过其初始位置。
外科缝合和切断器械10另外包括往复运动部分134、倍增器136和驱动构件138。往复运动部分134包括工具部分22中的楔形滑动件(在图6-9中未示出)和金属驱动杆140。驱动构件138包括第一齿轮齿条141和第二齿轮齿条142。第一凹口144设置在第一齿轮齿条141和第二齿轮齿条142中间的驱动构件138上。在击发触发器28的返回运动期间,在钉击发之后,击发触发器28上的齿146与第一凹口144接合以使驱动构件138返回至其初始位置。第二凹口148位于金属驱动杆140的近端,用于将金属驱动杆140锁定在处于其未击发位置的释放按钮30的上锁臂118上。倍增器136包括第一集成小齿轮150和第二集成小齿轮152。第一集成小齿轮150与设置在金属驱动杆140上的第一齿轮齿条154接合。第二集成小齿轮152与在驱动构件138上的第一齿轮齿条141接合。第一集成小齿轮150具有第一直径,第二集成小齿轮152具有小于第一直径的第二直径。
图6、8和9分别示出了处于起始位置(打开并且未击发)、夹紧位置(闭合并且未击发)以及击发位置的柄部部分20。击发触发器28设有齿轮段部分156。齿轮段部分156与驱动构件138上的第二齿轮齿条142结合,使得击发触发器28的运动引起驱动构件138在图8示出的第一驱动位置和图9示出的第二驱动位置之间来回运动。为了防止在组织夹紧发生之前击发钉,释放按钮39上的上锁臂118与驱动构件138上的第二凹口148结合,使得金属驱动杆140锁定在最近侧的位置,如图6所示。当上锁臂118落入凹槽122中时,上锁臂118脱离第二凹口148以允许金属驱动杆140向远侧运动,如图9所示。
因为驱动构件138上的第一齿轮齿条141和金属驱动杆140上的齿轮齿条154与倍增器136结合,击发触发器28的运动使金属驱动杆140在图8中示出的第一往复位置和图9中示出的第二往复位置之间往复运动。因为第一小齿轮150的直径大于第二小齿轮152的直径,倍增器136使往复运动部分134运动的距离比击发触发器28使驱动构件138运动的距离更大。可改变第一小齿轮150和第二小齿轮152的直径以使得击发触发器28的冲程长度和使其运动所需的力被改变。应当理解,柄部部分20是示例性的,并且可采用其他致动机构。例如,可通过自动装置产生闭合和击发运动。
外科缝合和切断器械10的端部执行器12的一个实施例在图18、19和23-26中进一步详细地示出。如上所述,柄部部分20产生致动端部执行器12的单独的并且不同的闭合和击发运动。端部执行器12有利地保持该单独的并且不同的闭合和击发(即,缝合和切断)的临床灵活性。另外,端部执行器12引入上述能力以在临床医生定位和夹持组织之后明确地保持击发期间的闭合间距。这些特征例如在另外的夹持的组织不足量的情况下通过确保足够的间隔,以及在另外的夹持的组织过量的情况下通过增强夹持在方法上和结构上增强了外科缝合和切断器械10的能力。
图10示出了安装在端部执行器12中的本发明的钉仓实施例300,其中击发杆14处于其未击发的近侧位置。钉仓300具有被细长狭槽310分隔的仓体302,所述细长狭槽从仓300的近端304朝锥形的外部尖端306延伸。多个钉容纳槽320a-320f在钉仓体302中形成,并且排列成六个横向间隔开的纵向排500,502,504,506,508,510,在细长狭槽310的每一侧上有三排。钉222定位在钉容纳槽320a-320f内。参见图10和11。
仓300还包括四个横向间隔的纵向排钉驱动器330a,330b,370a和370b,如图11中所示。“第一”内侧钉驱动器330a可滑动地安装在相应的槽320b和320c中,使得每个驱动器330a支撑两个钉222,一个位于槽320b中并且一个位于槽320c中。同样,“第二”内侧钉驱动器330b可滑动地安装在相应的槽320d和320e中,使得每个驱动器330b支撑两个钉222,一个位于槽320d中并且一个位于槽320e中。“外侧”驱动器370a和370b分别可滑动地安装在钉容纳槽320a和320f中。每个外侧驱动器370a和370b支撑单个钉222。驱动器370a在本文中称为“第一”外侧驱动器并且驱动器370b在本文中称为“第二”外侧驱动器。
图12示出了可与本发明的多个实施例结合使用的钉222。钉222包括主要部分223和两个插脚225。插脚225均具有长度“P”并且主要部分具有宽度“W”。读者应当理解,可使用各种不同类型的钉。例如,对于血管钉来说,“P”可为大约0.102英寸;对于常规钉来说,“P”可为大约0.134英寸;以及对于粗的组织钉来说,“P”可为大约0.160英寸。“W”可为大约0.012英寸。可以下文中讨论的方式使用其他尺寸的钉222。
位于细长狭槽310的一侧上的内侧钉驱动器330a在本文中被称为“第一”内侧钉驱动器,以及位于细长狭槽310的另一侧上的内侧钉驱动器330b在本文中被称为“第二”内侧钉驱动器。如将在下文中进一步详细讨论,在一个实施例中,除了在仓体302中的各自的槽中的取向不同之外,第二内侧钉驱动器330b与第一内侧钉驱动器330a相同。
图13-15示出了用于支撑和驱动钉222的“第一”内侧双驱动器330a的一个实施例。如那些图中所示,钉驱动器330a具有主驱动器部分340和通过中心基座构件360与第一主部分340连接的次驱动器部分350。主驱动器部分340具有主驱动器基座342,所述主驱动器基座在其中具有沟槽343,所述沟槽适于与仓体302中相应的竖直延伸的舌状物(未示出)配合,以用于当驱动器330a在其各自的槽内运动时引导和稳定驱动器330a。主驱动器部分340还具有从第一驱动器基座342向上突起的第一向前支撑柱344和第一向后支撑柱346。第一向前支撑柱344在其中具有第一向前钉容纳沟槽345并且第一向后支撑柱346在其中具有第一向后钉容纳沟槽347。参见图13-15。第一向前支撑柱344和第一向后支撑柱346彼此间隔并且共同形成第一钉支架348,以用于将其中的钉222的主要部分223支撑在竖直位置(即,插脚面向砧座)。相似地,次驱动器部分350具有次驱动器基座352以及从次驱动器基座352伸出的次向前支撑柱354和次向后支撑柱356。次向前支撑柱354在其中具有次向前钉容纳沟槽355并且次向后支撑柱356在其中具有次向后钉容纳沟槽357。次向前支撑柱354和次向后支撑柱356彼此间隔并且共同形成次钉支架358,以用于支撑其中的另一个钉222的主体部分223。
如图13和15所示,中心基座构件360具有能够由相应的滑动件凸轮接合的倾斜的向后边缘362,如将在下文中进一步详细描述。如图13和14所示,在该实施例中,次驱动器部分的次向前支撑柱354相对于第一向后支撑柱346取向,使得支撑在次钉支架358中的钉222与第一钉支架348中的钉222纵向错开。读者应当理解,第一内侧驱动器330a均以一个取向安装到位于仓体302中细长狭槽310的一侧上的相应的一对槽320b和320c中。第二内侧钉驱动器330b(位于细长狭槽310的与第一内侧钉驱动器330a相对的侧面上)包括旋转180度的内侧驱动器330a,以使其各自的倾斜表面363面向仓300的近端304,从而使它们能够被安装在成对的相应槽320d和320e中。因此,在该实施例中,仅采用一个内侧驱动器构型,从而不需要用于细长狭槽310的每一侧上的槽的两种不同的内侧钉驱动器构型。
图16和17示出了“第一”外侧钉驱动器370a的一个实施例。如那些图中所示,第一外侧钉驱动器370a具有第二基座372,所述第二基座具有倾斜的向后部分374。其中具有第二向前钉容纳沟槽376的第二向前支撑柱375从第二基座372向上突起。第二向后支撑柱377也从第二基座372向上突起,并且相对于第二向前支撑柱375呈空间上隔开的关系。第二向后支撑柱377在其中具有第二向后钉容纳沟槽378。支撑柱375,377共同形成第二钉支架379,所述第二钉支架能够将钉222支撑在竖直位置,如图16和17所示。钉驱动器370a还具有横向突起的肋371,所述肋容纳在仓体302中的相应的沟槽中(未示出),以用于当驱动器370a在各自的槽中运动时导引和稳定驱动器370a。
读者应当理解,第一外侧驱动器370a以一个取向安装到位于细长狭槽310的一侧上的相应槽320a中。第二外侧钉驱动器370b(位于细长狭槽310的与第一外部钉驱动器370a相对的侧面上)包括旋转180度的外侧驱动器370a,使得其上的倾斜表面374’面向仓300的近端304,从而使其能够被安装在仓体302中的相应槽320f中。因此,在该实施例中,仅采用一个外侧钉驱动器构型,从而不需要用于细长狭槽310的每一侧上的槽的两种不同的外侧钉驱动器构型。图19和19A示出了安装在一种类型的端部执行器12中的本发明的钉仓的一个实施例的横截面。在该实施例中,端部执行器12采用图23-25中示出的“阶梯式”砧座18的类型。然而,在其他实施例中,砧座的底部表面是平的并且不是阶梯式的。如图19A和23-25所示,砧座18具有与两个横向侧部21,23错开或不共面的中心部分19。因此,在该实施例中,仓300的上表面306设有凹陷的中心部分307和两个横向侧部309,当砧座18处于闭合位置时,中心部分307和两个横向侧部309能够分别与砧座18的相应部分19,21,23紧密配合。参见图19A。
如图24所示,在该实施例中,砧座18的下表面200设有一系列的成形凹坑202,所述一系列的成形凹坑可与仓300中的通道排对应地成排设置。即,凹坑202的排205可对应于通道排500。凹坑的排207可对应于通道排502。凹坑202的排209可对应于通道排504。凹坑202的排211可对应于通道排506。凹坑202的排213可对应于通道排508。凹坑202的排215可对应于通道排510。每个凹坑202中具有至少一个成形表面203,所述成形表面能够与在其中被驱动的钉插脚225的末端接触,从而使插脚225向内朝彼此弯曲。在一个实施例中,每个凹坑202具有如图14A中所示取向的两个相交的弓形成形表面203。每个弓形成形表面具有限定最大凹坑深度“Z”的顶点203’。然而,可采用其他成形凹坑构型。
回到图18和19,可以看出,在一个实施例中,仓体302安装在仓托盘224中。如图19中所示,仓体302由两个内侧纵向延伸的狭槽390和两个外侧纵向延伸的狭槽392形成。狭槽390和392从仓的近端304延伸至其锥形的外侧尖端306(在图10中示出)。该实施例还包括可滑动地支撑在仓托盘224上的楔形滑动件400。一个楔形滑动件实施例400包括一对内侧滑动件凸轮410,其中一个内侧滑动件凸轮410对应于一个内侧纵向延伸的狭槽390,并且其中另一个内侧滑动件凸轮410对应于另一个内侧纵向延伸的狭槽390。参见图19。楔形滑动件400还包括一对外侧滑动件凸轮420,其中一个外侧滑动件凸轮420对应于一个外侧纵向延伸的狭槽392,并且另一个外侧滑动件凸轮420对应于另一个外侧纵向延伸的狭槽392,如图19所示。当进行装配时,仓托盘224将楔形滑动件400和驱动器330a,330b,370a,370b保持在仓体302内。
如图18所示,细长通道16具有朝近侧放置的附接腔体226,所述附接腔体容纳框架34的远端上的通道锚定构件228,以用于将端部执行器12附接到柄部部分20。细长通道16还具有砧座凸轮狭槽230,所述砧座凸轮狭槽可枢转地容纳砧座18的砧座枢轴232。包围框架34的闭合套管32包括远侧设置的突出部234,所述突出部接合紧邻砧座18上的砧座枢轴232但在所述砧座枢轴的远侧的砧座结构236,以使砧座18打开和闭合。击发驱动构件36被示为由击发杆14装配而成,所述击发杆通过销240附接到击发连接器238,其继而旋转地并朝近侧附接到金属驱动杆140。击发杆14在框架的远端处由插入其中的开槽引导件239导向。
图20-23示出了本发明的楔形滑动件400的一个实施例。如图20和23所示,楔形滑动件400包括在内侧滑动件凸轮410之间延伸的中心间隔部分402。推块404形成于中心间隔部分402上以用于与击发杆14的中间销46接合。内侧滑动件凸轮410的一个实施例的侧面轮廓在图21中示出。如图所示,内侧滑动件凸轮410具有底部表面412和与底部表面412形成角度“G”的第一凸轮表面414以及延伸至顶部表面416的第二凸轮表面415。在一个实施例中,例如,角度“G”可以为35度,并且角度“G”可以为20度。将内侧滑动件凸轮410的高度(介于底部表面412和顶部表面416之间的距离)表示为“第一”滑动件凸轮高度“H”。在一个实施例中,距离“H”为大约0.173英寸,并且顶部表面416的长度在实施例之间可以不同。继续参阅本具体实施方式将更加明显的是,第一滑动件凸轮高度表示在操作期间内侧滑动件凸轮410将朝砧座18驱动相应的内侧驱动器330a,330b的垂直距离。
楔形滑动件400还包括在内侧滑动件凸轮410和外侧滑动件凸轮420之间延伸的横向间隔部分406,如图20和23所示。外侧滑动件凸轮420的一个实施例的侧面轮廓在图22中示出。在此实施例中,外侧滑动件凸轮420具有底部表面422和相对于底部表面422形成角度“I”的第一凸轮表面424以及延伸至顶部表面426的第二凸轮表面425。在一个实施例中,角度“I”可以为大约35度,并且角度“I”可以为大约20度。将外侧滑动件凸轮420的高度(介于底部表面412和顶部表面416之间的距离)表示为“第二”滑动件凸轮高度“J”。在一个实施例中,距离“J”为大约0.163英寸。第二滑动件凸轮高度表示在操作期间外侧滑动件凸轮420将朝砧座18驱动相应的外侧驱动器370a,370b的垂直距离。读者应当理解,上述尺寸是一个实施例的例子,并且对于其他实施例而言可以是不同的。
具体参见图23,移除钉仓300的一部分以暴露出细长通道16的一部分例如凹槽212,214,以及暴露出钉仓300的处于其未击发位置的一些部件。具体地讲,已移除了仓体302(示出于图18中)。楔形滑动件400被显示为在其近侧未击发位置具有推块404,所述推块接触击发杆14的中间销46(图23中未示出)。楔形滑动件400沿着纵向滑动接触仓托盘224,并且包括楔形滑动件凸轮410,420,所述楔形滑动件凸轮在楔形滑动件400朝远侧运动时向上推动双驱动器330a,330b和单驱动器370b,370bb。停靠在驱动器330a,330b,370a,370b上的钉222(图23中未示出)因此也被向上驱动至与砧座18中的砧座成形凹坑202接触以形成闭合钉。还描绘了细长通道16中的通道狭槽45,所述通道狭槽与钉仓300中的细长狭槽310对齐。
图24示出了端部执行器12,其通过回缩的闭合套管32处于打开位置,并且钉仓300安装在细长通道16中。击发杆14处于其近侧位置,并且上部销38以非干扰性方式与砧座凹坑40对齐。砧座凹坑40显示为与砧座18中的纵向砧座狭槽42连通。击发杆14的远侧设置的切刃48与钉仓300中的竖直狭槽49对齐并且向近侧从其中移除,从而允许移除用过的仓并插入可“扣合”到细长通道16中的未击发的仓。具体地,在该实施例中,钉仓300的延伸结构316,318分别接合细长通道16中的凹槽212,214(示于图23中)。
图25描绘了图23的端部执行器12,其中移除了全部的钉仓300以显示击发杆14的中间销46,并且移除了细长通道16的邻近通道狭槽45的部分以暴露出击发杆顶盖44。此外,还移除了轴23的多个部分以暴露出击发杆14的近侧部分。一对相对的组织止挡件244从靠近枢轴的砧座18向下突起,其用于防止组织在夹持期间被定位成过度往上进入端部执行器12中。图26示出了处于闭合位置的端部执行器12,其中击发杆14处于未击发位置。上部销38位于砧座凹坑40中,并且与砧座狭槽42竖直地对齐以用于击发杆14在击发期间的远侧纵向运动。中间销46定位成朝远侧推动楔形滑动件400,使得滑动件凸轮410,420分别接触并提升双驱动器330a,330b和单驱动器370a,370b,从而朝砧座18将其向上驱动。
如参见图14A、15A和19A可以理解,在本发明的一个实施例中,当砧座18处于闭合位置并且当内侧驱动器330a,330b被支撑在仓托盘224上时,介于形成第一钉支架349的第一钉容纳沟槽345,347的底部和砧座18的相应成形凹坑202的成形表面203的顶端203’之间的距离在本文中称为第一钉成形距离“A”。当砧座18处于闭合位置并且当内侧驱动器330a,330b被支撑在仓托盘224上时,介于形成次钉支架349的次钉容纳沟槽345,347的底部和砧座18中的相应成形凹坑202的成形表面203的顶端203’之间的距离在本文中称为次钉成形距离“B”。在一个实施例中,第一钉成形距离“A”和次钉成形距离“B”基本上彼此相同。在其他实施例中,那些距离“A”和“B”可彼此不同。
如图16A和19A中所示,当砧座18处于闭合位置并且当外侧驱动器370a,370b被支撑在仓托盘224上时,介于形成第二钉支架379的第二钉容纳沟槽376,378的底部和砧座18中的相应成形凹坑202的成形表面203的顶端203’之间的距离在本文中称为“第二”钉成形距离“C”。
图27和28示出了支撑在一些第一外侧驱动器370a上的钉的成形。在图27中,楔形滑动件400的外侧滑动件凸轮420中的一个首先与外侧驱动器370a中的一个接触。当楔形滑动件400在由图28中的箭头“K”表示的驱动方向上继续时,外侧滑动件凸轮420使得外侧驱动器370a驱动所支撑的钉222进入砧座18中的钉成形凹坑202中。同样,当楔形滑动件400在驱动方向“K”上被驱动时,内侧滑动件凸轮410与内侧驱动器330a,330b接触,并使得它们驱动所支撑的钉222进入砧座18中的相应的钉成形凹坑202中。
如上所述,在涉及不同的组织组合物的区域的一些应用中,可能理想的是形成钉排,其中在距离切割线最远的行中的钉的成形(最终)高度大于在距离切割线最近的行中的那些钉的成形(最终)高度。在其他应用中,可能理想的是,对于单排钉的成形高度在钉间增加(或减少)。另一个临床的有益效果是使在最外侧排中的钉的成形高度大于在内侧排中的钉的成形高度。虽然在所有排中采用相同的钉,但本主题发明的各种实施例可提供这些结果。
在以下的描述中,在最外侧排520,530钉中的那些钉222(使用外侧钉驱动器370a,370b成形的那些钉)在下文中将称为钉222’,并且在最内侧排522,524,526,528钉中的那些钉(使用内侧驱动器330a,330b成形的那些钉)在下文中将称为钉222”。然而,应当理解,在通过本发明的各种实施例成形之前,钉222’和222”彼此相同。即,钉222’和222”均具有相同的插脚长度“P”和宽度“W”。
回到图14A-16A和21以及22,可通过改变相对于彼此的钉成形距离“A”、“B”和“C”和/或滑动件凸轮高度“H”和“J”获得上述所需的效果。例如,在本主题发明的一个实施例中,每个内侧滑动件凸轮410的高度“H”基本上等于每个外侧滑动件凸轮420的滑动件高度“J”。参见图21和22。在该实施例中,钉成形距离“A”和“B”基本上彼此相等,但是距离“A”和“B”小于钉成形距离“C”。介于第一钉容纳沟槽345,347的底部与主驱动器基座342的底部表面342’之间的距离“D”基本上与介于次钉容纳沟槽356,357的底部与次驱动器基座部分352的底部表面352’之间的距离“E”相等。参见图15。仍在该实施例中,介于第二钉容纳沟槽376和378的底部与外侧驱动器370a,370b(图16)的第三基座372的底部表面373之间的距离“F”小于距离“D”和“E”(图15)。因为成形距离“C”大于成形距离“A”和“B”,由外侧驱动器370a,370b支撑并形成的钉222被压缩得不如由内侧驱动器330a,330b支撑并形成的钉被压缩得多。应当理解,可通过使用相同设置和尺寸的内侧驱动器330b和外侧驱动器370b在细长狭槽310的相对侧和在组织中形成的切割线600上获得类似的结果。在可供选择的实施例中,可以通过改变与驱动器330a和370b对应的成形凹坑202的深度使得成形距离“C”大于成形距离“A”和“B”来获得相同的结果。即,与外侧驱动器370a,370b对应的成形凹坑202的深度(在图16A中的距离“Z”)可大于与内侧驱动器330a、330b对应的成形凹坑202的深度(在图14A中的距离“Z”)。
图29示出了利用本发明的该实施例在切割线600的每一侧上形成的成行钉,其中成形距离“A”和“B”彼此相等,并且成形距离“C”大于成形距离“A”和“B”。例如,如果成形距离“C”比成形距离“A”和“B”大0.020英寸,排520和530中的外侧钉222’的成形高度(图30中表示为尺寸“L”)将比排522,524,526,528中的内侧钉222”的成形高度(图31中表示为尺寸“M”)大0.020英寸。
可以通过利用本发明的另一个实施例获得相同的结果,其中成形距离“A”、“B”和“C”基本上相等。然而,在该实施例中,每个内侧滑动件凸轮410的高度(图21中的距离“H”)大于每个外侧滑动件凸轮420的高度(图22中的距离“J”)。从而,由于内侧滑动件凸轮410的高度“H”大于外侧滑动件凸轮420的高度“J”,与外侧滑动件凸轮420驱动相应的外侧驱动器370a,370b相比,内侧滑动件凸轮410朝砧座将相应的内侧驱动器330a,330b驱动得更远。此类驱动动作将使得由内侧驱动器330a,330b支撑的钉比由外侧驱动器370a,370b支撑的那些钉更大程度地压缩。
例如,如果距离“H”比距离“J”大0.020英寸,在排520,530中的钉222’的成形高度将比在行522,524,526,528中的钉222”的成形高度大0.020英寸。
当采用本发明的另一个实施例时,钉222’的外侧排520,530和钉222”的内侧排522,528可被成形为具有比内侧排524,526中的钉222”的成形高度大的高度。参见图32。可通过使成形距离“C”大于成形距离“A”并且使成形距离“A”大于次成形距离“B”获得此结果。
本发明的另一个实施例可用于期望单排中钉的成形高度有差别的地方安装钉。在图33中示出了一个此类设置。如图33所示,当分别从每排520,530的近端521,531分别运动至每排520,530的远端523,533时,在外侧排520,530中的钉222’的成形高度增加。可通过减少用于每个后续驱动器370a,370b的成形距离“C”来实现该结果。即,最接近仓300的近端的驱动器370a的尺寸将设定成形成比通过相邻驱动器370a得到的成形距离“C”更大的成形距离“C”,以此类推,以实现如下状况:其中每个后续钉222’(在从仓300的近端至远端的方向上运动)将具有较大的成形高度。还可通过相似地改变由每个驱动器330a,330b获得的成形距离“A”和/或“B”而在排522,524,526,528中的钉222”中获得此结果。同样,当分别从每排520,530的近端521,531分别运动至每排520,530的远端523,533时,可使在外侧排520,530中的钉222’的成形高度降低。可通过增加每个后续驱动器370a,370b的成形距离获得该结果。即,最接近仓300的近端的驱动器370a可具有比邻近驱动器370a的成形距离“C”更小的成形距离“C”,以此类推,以实现如下状况:其中每个后续钉222’(在从仓的近端至远端的方向上运动)将具有更小的成形高度。参见图34。
在使用中,外科缝合和切断器械10如图1-2和35-41中所示使用。在图1-2中,器械10处于其起始位置,其中未击发的满负荷钉仓300被搭扣配合到细长通道16的远端中。两个触发器26,28是向前的并且端部执行器12是打开的,例如通常在将端部执行器12通过套管针或其它开口插入体腔中后。然后临床医生操作器械10以使得待缝合和切断的组织248被定位在钉仓300和砧座18之间,如图35所示。参见图36和37,然后临床医生朝近侧运动闭合触发器26直到直接邻近手枪式握把24定位,并且将柄部部分20锁定到闭合和夹紧位置。端部执行器12中的回缩击发杆14不会阻止端部执行器12选择性地打开和闭合,而是驻留在砧座凹坑40内。在闭合和夹紧砧座18的情况下,可使电子束击发杆14对齐以用于击发穿过端部执行器12。具体地讲,上部销38与砧座狭槽42对齐并且细长通道16由中间销46和击发杆顶盖44围绕通道狭槽45明确地接合。
参见图38和39,在组织被夹紧后,临床医生使击发触发器28朝近侧运动,从而使击发杆14朝远侧运动到端部执行器12中。具体地讲,中间销46穿过击发驱动狭槽47进入钉仓300,以通过楔形滑动件400影响钉222(图38和39中未示出)朝砧座18的击发。最下面的销或击发杆顶盖44与中间销46协作以滑动地定位击发杆14的切刃48以切断组织。两个销44,46还将击发杆14的上部销38定位在砧座18的纵向砧座狭槽42中,从而在其远侧击发运动期间明确地保持砧座18与细长通道16之间的间隔。
参见图40和41,临床医生继续运动击发触发器28直到临近闭合触发器26和手枪式握把24。从而,由于钉222与砧座18接合,所有钉的末端被弯折。击发杆顶盖44抵靠朝向通道狭槽45的远端突起的击发杆止挡件250被止动。切刃48已完全地横切穿过组织。通过释放击发触发器28,然后压下释放按钮30,同时挤压闭合触发器26以打开端部执行器12来完成该过程。
图42-43示出了具有不同高度的滑动件400的内侧滑动件凸轮410和外侧滑动件凸轮420,使得钉在成形时可具有不同的成形高度。具体地讲,如图42中所示,外侧滑动件凸轮420可以矮于内侧滑动件凸轮410。那样,外侧钉可具有比内侧钉更大的成形高度。图42为针对内侧滑动件凸轮410和外侧滑动件凸轮420的具有不同高度的滑动件400的透视图。图43为端部执行器12的侧视图,示出了使用滑动件400驱动钉222的各个阶段,针对内侧滑动件凸轮410和外侧滑动件凸轮420,滑动件400具有不同的高度。如图43所示,成形钉222b可具有比成形钉222a更大的成形高度,因为钉222b由外侧滑动件凸轮420驱动,并且钉222a由较高的内侧滑动件凸轮410驱动。
在另一个实施例中,如图44中所示,双驱动器330的驱动器部分342,352的高度可不同,使得钉在成形时可具有不同的高度。具体地讲,如图44中所示,次驱动器部分352(具有高度“E”)可短于主驱动器部分342(具有高度“D”)。那样,由次驱动器部分352驱动的钉222a可具有比由主驱动器部分342驱动的钉222b更大的成形高度。在各种实施例中,内侧双驱动器330中的一些或全部可具有不同高度的主驱动器部分和次驱动器部分342。另外,高度差不必全部相同。不同的内侧双驱动器330可具有不同的高度差。
另外,主驱动器部分342和次驱动器部分352的高度可与外侧钉驱动器370的驱动器部分372的高度相同或不同。即,在各种实施例中,外侧钉驱动器部分372的驱动器高度可以(1)当驱动器部分342,352具有相同的高度时,与内侧双驱动器330的两个驱动器部分342,352的高度不同,(2)当它们具有不同的高度时,与两个驱动器部分342,352的高度不同,或(3)当驱动器部分342,352具有不同高度时,与驱动器部分342,352中的一者的高度相同。另外,外侧钉驱动器370的驱动器部分372的高度不必全部相同。不同的外侧钉驱动器370可具有不同的高度。
图45示出了具有不同高度的驱动器(例如,主驱动器部分342高于次驱动器部分352)和具有不同深度砧座凹坑202的实施例。砧座凹坑202的不同深度也可以影响成形钉的高度。在同等条件下,较深的凹坑能够形成较长的成形钉。在图示实施例中,对应于主驱动器部分342的凹坑202比对应于次驱动器部分352的凹坑202更深。用于每个钉排500-510的凹坑202中的一些或全部可以更深。另外,深度差不必全部相同。多个不同的深度可以用于单排500-510中或用于所有排500-510中。
另外,如图46中所示,可以使用具有不同预成形插脚高度(“P”)的钉222。在图示实施例中,与由主驱动器部分342驱动的钉222b相比,较长的钉222a与内侧双驱动器330的较短的次驱动器部分352一起使用。预成形的钉插脚长度可以在钉排500-510或整个钉排中变化。即,例如,在内侧行504-506中的所有钉可具有相同的预成形插脚长度x,在中间排502,508中的所有钉可以较长(例如,长度为1.10x),以及在外侧排500,510中的所有钉可以更加长(例如,长度为1.20x)。如图47中所示,砧座凹坑202可以具有相同的深度。在其他实施例中,可以使用不同的砧座凹坑深度。
图48为在外侧钉驱动器370具有不同高度的实施例中的端部执行器12的侧视图。具体地讲,在图示实施例中,第一钉驱动器370’高于第二钉驱动器370”。在图示实施例中,钉222具有相同的预成形插脚长度,并且相应的砧座凹坑202具有相同的深度。由此,由第二外侧钉驱动器370”形成的成形钉222”长于由第一外侧钉驱动器370’形成的成形钉222’。
图49为端部执行器12的侧视图,其中对于由内侧双驱动器330驱动的钉222,砧座18具有不同深度的凹坑202。在图示实施例中,对应于主驱动器部分342的凹坑202比对应于次驱动器部分352的凹坑202更深。在该实施例中,主驱动器部分342和次驱动器部分352具有相同的高度,并且钉222具有相同的预成形插脚长度。介于主驱动器部分342的顶部和相应的砧座凹坑202的顶部之间的距离为高度“A”,以及用于次部分352的相应高度为高度“B”,其中“A”比“B”大高度差“h”。对于主驱动器部分342,这将形成较长的成形钉,如图50中所示。
图51和60示出了根据可用于制备不同成形长度的钉的其他实施例的端部执行器12的各个方面。在图示实施例中,通过在多个楔形带组710,712,714远端的多个致动器楔形凸轮709分阶段驱动钉驱动器330,370。在图示实施例中,每个楔形带组包括四个楔形带(在图56中最好地示出);两个楔形带720用于致动内侧驱动器330a,b,以及两个楔形带722用于致动外侧驱动器370a,b。楔形带组710,712,714的楔形带可以连续地致动,并能够以堆叠的方式位于彼此的顶部,从而以连续的阶段驱动钉驱动器330a,b和370a,b(并因此驱动钉222)。例如,最下面的致动器楔形带组710的楔形带可以被首先击发(或致动),并可局部部署钉222。如图53-56中所示,靠在最下面楔形带组710顶部上的中间楔形带组712可随后启动,其可具有开始形成钉222的效果。然后,可启动靠在中间楔形带组712上的最上面的楔形带组714,其完成了钉222的成形。图56示出了该操作。在图56中,最下面的楔形带组710已经被击发,中间楔形带组712已经被部分击发,并且最上面的楔形带组714还未被击发。因此,此类实施例可包括多个(在这种情况下为四个)堆叠的楔形带组,每个堆叠件包括最下面的楔形带组710、中间楔形带组712和最上面的楔形带组714。
然后,可击发具有电子束击发机构14的击发杆716以切割由端部执行器12夹持的组织。可在横杆719处连接到框架34的压紧弹簧718可接合并向下推进击发杆716。
如图54和56最好地所示,内侧排的楔形带堆叠件720的累积高度可大于外侧排的楔形带堆叠件722的累积高度(高度差h’)。那样,外侧钉排可具有比内侧成形钉排更大的成形长度,如图55的实例所示,其中外侧钉222a排具有比内侧钉222b排更大的成形长度。如图61的实例所示,根据一个实施例,最下面的楔形带组710和中间的楔形带组712的楔形带可具有相同的高度,并且外侧排楔形带722的最上面的楔形带组714的高度可小于内侧排楔形带720的最上面的楔形带组714的高度,以对于不同楔形带堆叠件提供高度差。
在该实施例中的端部执行器12还可包括滑动件400,但不具有滑动件凸轮410、420,以使击发机构14不被锁定在通道中(参见图3-4和相关文本)。
内侧楔形带堆叠件720和外侧楔形带堆叠件722可在框架34中紧密地间隔。因此,端部执行器12还可包括致动器楔形带各自的导向件702以用于当它们进入端部执行器12以与钉驱动器330,370对齐时展开楔形带堆叠件720,722。楔形带导向件702可包括用于每个内侧楔形带堆叠件720和外侧楔形带堆叠件722的楔形带通道。即,在图示实施例中,楔形带导向件702可包括四个楔形带通道,用于内侧排720的两个和用于外侧排722的两个。图58-60更详细地示出了楔形带导向件702的一个侧面。如图60中所示,楔形带通道730,732可以在楔形带堆叠件720,722进入端部执行器12中时迫使楔形带堆叠件720,722向外。内侧楔形带通道730可引导内侧楔形带堆叠件720使得内侧楔形带堆叠件720与内侧钉驱动器330对齐,外侧楔形带通道732可引导外侧行楔形带堆叠件722使得外侧楔形带堆叠件与外侧钉驱动器370对齐。在图示实施例中,通道730,732是直的。在其他实施例中,通道730,732中的一者或两者可包括弯曲部分。
图62为根据该实施例的轴组件10的剖视图。如图62中所示,每个楔形带组710-714可具有其自身的致动(或击发)杆。最下面的致动杆740可致动最下面的楔形带组710的楔形带,中间致动杆742可致动中间楔形带组712的楔形带,并且最上面的致动杆744可致动最上面的楔形带组714的楔形带。用于致动切割器械14的击发杆716可连接到最上面的楔形带组714,使得用最上面的(最后的)楔形带组714致动切割器械14。在其他实施例中,击发杆716可具有其自身的致动机构,使其可被单独地致动。
在实施过程中,临床医生可在致动击发杆716以切割组织之前选择(或选定)致动少于所有楔形带组710-714,从而对待成形的钉的长度进行一些选择。例如,在各种实施例中,临床医生可在切割之前选择致动最下面的和中间的楔形带组710,712,而并非最上面的楔形带组714。
图63-69示出了开放式直线型缝合和切割装置800的实施例,所示开放式缝合和切割装置可使用多个堆叠的楔形带组以制备不同成形长度的钉。在图示实施例中,砧座810位于通道809之下。由此,作为缝合操作的一部分,向下驱动钉穿过夹持在端部执行器12中的组织。
装置800可包括上部主体件802和下部主体件804。上部主体件802可包括其中插入钉仓809的通道806。砧座810可连接到下部主体件804并面对钉仓809,使得钉222可抵靠砧座810的钉成形表面812而成形。当临床医生对介于仓809和砧座810之间的组织位置感到满意时,临床医生可使用连接到上部主体件802的夹紧杠杆组件816的夹紧杠杆814来锁定装置800。
可使用多阶段楔形带堆叠件来分阶段致动仓809中的钉驱动器820。因为在该实施例中钉222被向下驱动,所以最上面楔形带组822的楔形带可首先被致动以局部部署钉222。然后,可致动跨置在最上面的楔形带组822上的中间楔形带组824的楔形带以开始形成钉222。然后,可致动跨置在中间楔形带组824上的最下面的楔形带组826的楔形带,其完成了钉222的成形。
在图示实施例中,刀830位于其远端的击发杆828连接到最下面的楔形带组826,并用最下面的楔形带组826击发。压紧弹簧832可接合并向上推进击发杆828。刀保持器834可用最下面的楔形带组826保持击发杆828。
如在图67-68中最好的示出,临床医生可使用三件式致动滑动条840致动楔形带组。上部件842可致动最上面的(初始的)楔形带组822。中间件844可致动中间的楔形带组824。下部件846可致动最下面的(最后的)楔形带组826。
为了形成不同成形高度的钉,钉推动器820可具有不同的高度。例如,如图66中所示,一组钉推动器820a可短于另一组钉推动器820b。由此,由较短的钉推动器820a制备的成形钉222a比由较长的钉推动器820b制成的成形钉222b具有更长的成形长度。在其他实施例中,钉222可具有不同的长度或线径以形成不同长度的成形钉,和/或砧座810中的凹坑202可具有不同的深度以形成不同长度的成形钉。另外,楔形带堆叠件的累积高度可不同。
根据本发明的各种实施例,钉驱动器可具有允许使用不同线径的钉的钉/驱动器接口。例如,如图78-83的实施例所示,外侧钉驱动器370a,b可在其上表面上具有凸起的凹坑构型以用于支撑具有不同线径的钉。如在图示实施例中所示,凹坑构型可包括内侧的两组外凸的凹坑(或凸块)620a,b和外侧的两组凹坑622a,b。每组凹坑限定了钉222可位于竖直位置的容纳区域,如图81-83中所示。内侧组凹坑620a,b可大于外侧组凹坑622a,b,使得内侧组凹坑620a,b的容纳区域小于外侧组凹坑622a,b的容纳区域。然而,由于凹坑的凸出特性,可容纳不同线材厚度的钉222,如图82和83中所示。例如,可将凹坑配置成使得钉驱动器370能够容纳线径为0.006英寸至0.012英寸的钉,或线径为一些其他范围例如0.004英寸至0.008英寸或0.006英寸至0.008英寸等的钉。如此,不同线材厚度的钉可用于单个仓306中。在所有其他因素都相同的情况下(例如,相同的驱动/挤压距离、相同的凹坑深度等),不同的线径将形成不同的成形钉高度。另外,如在图78中最好地示出,用于内侧驱动器330的钉支架可包括可损伤正被缝合的组织的锋利的尖端624。外侧钉驱动器370上的凹坑构型没有此类锋利的尖端,这往往将使被缝合组织的创伤最小化。
在图示实施例中,外侧钉驱动器370a,b具有凸起的凹坑构型,以容纳不同线径的钉,并且内侧钉驱动器342,352的钉支架仅能够支撑一种通用线径的竖直钉。在其他实施例中,内侧钉驱动器342,352中的一者或两者也可以或作为另外一种选择具有凸起的凹坑构型。另外,除了使用凸起的凹坑构型,可以使用V形钉通道349,379。此类V形通道也可容纳具有不同线径的钉。另外,具有容纳不同钉线径的钉接口的钉推动器可以与除图78-83中示出的内侧双钉驱动器和外侧单钉驱动器之外的其他类型的钉驱动器一起使用。
图70-77为根据本发明的各种实施例的端部执行器12的横截面正视图。在图70示出的实施例中,砧座18是阶梯式的,其具有相对于两个横向侧部21,23偏移(或不共面)的中心部分19。另外,仓300的上表面306具有凹陷的中心部分307和两个横向侧部309(参见图19A)。所有的钉222具有相同的预成形插脚高度,并且相应的砧座凹坑202具有相同的深度。然而,由于砧座18的阶梯式特性,在砧座18的两个横向侧部21,23上的凹坑202与在砧座的中心部分19中的凹坑错开。偏移钉成形凹坑202的竖直位置可以影响成形钉222的长度。在其他条件都相同的情况下,通过提高的钉成形凹坑所形成的钉将比用未提高的凹坑所形成的钉具有更长的成形长度。另外在该实施例中,双内侧驱动器330a,b的主驱动器部分342和次驱动器部分352具有相同的高度,并且外侧钉驱动器370a,b的驱动器部分372的高度大于双内侧钉驱动器330a,b的驱动器部分342,352的高度。另外,在该实施例中,内侧滑动件凸轮410和外侧滑动件凸轮4120具有相同的高度。
图71示出了其中端部执行器12在仓300的底部具有阶梯式仓托盘224以匹配通道16中的阶梯的实施例。具体地讲,在图示实施例中,仓托盘224具有其上设置有双内侧钉驱动器330a,b的中心部分602和其上设置有外侧钉驱动器370a,b的外侧横向部分604。如图71所示,仓托盘224的中心部分602可提升到外侧横向部分604之上。如此,滑动件400可配置成使得外侧滑动件凸轮420被定位成低于内侧滑动件凸轮410,使得外侧滑动凸轮420能够接合下部外侧驱动器部分370a、b。
图72中示出的实施例与图71中示出的实施例类似,不同的是在图72中仓300不包括仓托盘224。相反,钉驱动器330,370直接设置在通道16上。该实施例可能是有利的,因为与具有仓托盘224的类似的实施例(例如图71中所示)相比,其可允许在点A和B处在通道16中具有更多的材料(例如,金属)。
图73中示出的实施例类似于图71中示出的实施例,与图71中示出的实施例相比,不同的是在图73中仓托盘224相对于通道16的底部略微凸起。与图71中示出的实施例相比,该实施例还可允许在点A和B处在通道16中具有更多的材料(例如,金属)。根据其他实施例,可减少砧座18的高度以允许在点A和B处在通道16中具有更多的材料。
图74的实施例与图73中使用的实施例类似,不同的是图74的实施例中不包括仓托盘224。
图75的实施例与图70的实施例类似,不同的是在图75中,外侧行的凹坑202形成于砧座18的柔顺材料部分610中。柔顺材料部分610可由比砧座18的其余部分更为柔顺的材料制成。例如,柔顺材料部分610可以由塑性或塑性复合材料制成,并且凹坑的其余部分可限定在砧座18的较不柔顺的材料,例如不锈钢中。较不柔顺的砧座部分在本文中有时称为“非柔顺部分”以使其区别于柔顺材料部分610,但应当认识到所谓的非柔顺材料部分可以具有一定程度的柔顺性,只是不如柔顺材料部分610柔顺。在其他条件都相同的情况下,由形成于砧座18的柔顺材料部分610中的外侧凹坑202成形的钉将长于在砧座18的非柔顺(例如,金属)部分中形成的钉,因为柔顺材料部分610将在钉成形过程中压缩更多。
图76和77共同示出了另一个实施例。在该实施例中,通道16包括在外侧驱动器370下面的柔顺材料部分612。例如,柔顺材料部分612可以是塑料或复合塑料。内侧驱动器330可以位于较不柔顺(或“非柔顺”)的通道16上,所述通道可以由金属(如,不锈钢)制成。当形成与通道16上的内侧驱动器330相关的钉时,外侧滑动件凸轮420可以轻微压缩在外侧驱动器370下面的柔顺材料部分612,从而在外侧排形成稍长的钉。在其他实施例中,如果期望使内侧钉具有更大的成形长度,柔顺材料部分612可以位于内侧驱动器330的下面。
根据其他实施例,不同材料的钉可以用于制备不同成形长度的钉。不同的材料可以具有不同的弹性模量,使得它们在给定的相同驱动力下不同地成形。具有较高弹性模量的钉在给定的相同驱动力下往往变形较小,从而易于制备具有较长成形长度的钉。用于钉222的不同材料可以包括钛、不锈钢、合金等。
本发明还涉及能够形成不同高度的成形钉的其他类型外科切割装置。例如,图84-89示出了能够形成不同成形高度的钉的圆形缝合器900。如图84中所示,圆形缝合器900包括头部902、砧座904、调节旋钮组件906和触发器908。头部902通过弓形轴组件912连接到柄部组件910。触发器908被柄部组件910可枢转地支撑,并用于在安全机构(未示出)被释放时操作缝合器900。当触发器908被致动时,击发机构(图84中未示出)在轴组件912中运行,使得钉914从头部902排出以与砧座904成形接触。同时,可操作地支撑在头部902中的刀916用于切割在头部902和砧座904之间夹持的组织。然后将缝合器900牵拉穿过组织,将被缝合的组织保持在原位。
图85和图86示出了可结合本主题发明的多个实施例使用的砧座904和头部902的一种形式。如这些图所示,砧座904可具有圆形主体部分920,该圆形主体部分具有用于将套管针(未示出)附接到其上的砧座轴922。砧座主体920上具有钉成形表面924,并且还可具有附接到其远端的护罩926。砧座904还可设置有一对套管针保持夹片或叶片式弹簧928,其用于以可释放的方式使套管针与砧座轴922保持接合。塑性刀板930可安装到砧座主体904中的腔体932中。
头部902可包括壳体构件940,该壳体构件用来支撑其中的圆形钉驱动器组件942形式的钉仓支撑组件,所述钉驱动器适于与圆形钉仓944交接并驱动支撑在其中的钉914,以使其与砧座904的钉成形表面924成形接触。圆形刀构件916也居中设置于钉驱动器组件942中。壳体构件940的近端可通过远端套圈构件948联接到弓形轴组件912的外部管状护罩946上。有关圆形钉的更多细节参见F.Shelton等人在2006年9月29日提交的名称为“Surgical Cutting and Stapling Device with Closure Apparatus for LimitingMaximum Tissue Compression Force”的美国专利申请11/541,151,该专利申请以引用的方式并入本文。
如图85-89所示,钉驱动器组件942可包括外环钉驱动器950和内环钉驱动器952。相应地,砧座904可包括钉成形凹坑202的两个同心环。柄部组件910的击发触发器908的致动使得轴组件912的压缩轴(未示出)向远端运动,从而向远侧驱动钉驱动器组件942以击发钉914,并与砧座904的钉成形表面924成形接触。因此,当外侧钉驱动器950被缝合器900的驱动机构致动时,其将外环钉914驱动至夹持的组织中并且通过砧座904的表面成形表面924成形。相似地,当内侧钉驱动器952被缝合器900的驱动机构致动时,其将外环钉914驱动至夹持的组织中并且通过砧座904的表面成形表面924成形。
钉驱动器950,952可具有不同的高度,从而形成不同长度的成形钉(在其他条件都相同的情况下)。例如,如图示实施例中所示,外侧钉驱动器950可短于内侧钉驱动器952,使得外侧成形钉长于内侧成形钉,如图88中所示。当然,在其他实施例中,内侧钉驱动器952可短于外侧钉驱动器950。另外,外侧钉驱动器950可以不是一致的高度;在外侧钉驱动器950中可存在高度变化。相似地,在内侧钉驱动器952中可存在高度变化。
另外,可使用具有不同预成形插脚高度的钉。另外,砧座904的表面成形表面924中的钉成形凹坑202可具有不同的深度从而改变成形钉的长度。另外,如上所述,钉驱动器950,952中的一些或全部可以在其与钉914的接口处具有凸起构型以容纳不同线径的钉,或容纳不同线径的钉的一些其他构型(如,V形钉通道)。另外,砧座1006中的一些凹坑202可形成于砧座1006的柔顺材料部分中。另外,钉914可由具有不同弹性模量的材料制成。
在其他实施例中,如图90-95中所示,本发明涉及能够形成不同高度的钉的直线型缝合器1000。图90-95集中于用于该直线型缝合器1000的端部执行器1002。端部执行器1002可包括可替换的钉仓1004和直线型砧座1006。仓1004包括钉,当致动装置1000时,所述钉被驱动至砧座1006中并且由其成形。与之前所述的直线切割器不同,砧座1006在直线型缝合器1000中可以是不可旋转的。为了将组织夹持在端部执行器1002中,使用者可紧握夹持触发器(未示出),这使得仓1004从打开位置朝砧座1006向远侧滑动至闭合位置。有关直线型缝合器的操作和部件的更多细节可以参见M.Burdorff的名称为“Linear Stapler WithImproved Firing Stroke”的美国专利5,697,543(“‘543专利”),该专利以引用的方式并入本文。通常,此类直线型缝合器不包括切割器械。
图92-93示出了仓1004的外部覆盖件被移除的端部执行器1002。如这些图所示,钉仓1004可包括钉驱动器组件1010,所示钉驱动器组件包括一排内侧钉驱动器1012和一排外侧钉驱动器1014。钉驱动器1012,1014可具有不同的高度,从而形成不同长度的成形钉(在其他条件都相同的情况下)。例如,如图示实施例中所示,外侧钉驱动器1014可短于内侧钉驱动器1012,使得外侧成形钉222b长于内侧成形钉222a,如图94-95中所示。当然,在其他实施例中,内侧钉驱动器1012可短于外侧钉驱动器1014。另外,外侧钉驱动器1014可以不是一致的高度;在外侧钉驱动器1014中可存在高度变化。相似地,在内侧钉驱动器1012中可存在高度变化。另外,仓1004可包括例如三排钉,其中外侧的两排具有较短的钉驱动器,内侧的一排具有较长的钉驱动器。
另外,可使用具有不同预成形插脚高度的钉1008。另外,砧座1006的表面成形表面1016中的钉成形凹坑202可具有不同的深度从而改变成形钉的长度。另外,如上所述,钉驱动器1012,1014中的一些或全部可以在其与钉1008的接口处具有凸起构型以容纳不同线径的钉,或容纳不同线径的钉的一些其他构型(如,V形钉通道)。另外,砧座1006中的一些凹坑202可形成于砧座1006的柔顺材料部分中。另外,可使用不同材料的钉1008。
在操作中,如‘543专利中更详细地描述,当使用者使夹持触发器回缩时,使砧座1006朝钉仓1004向近侧滑动至闭合位置以将组织夹持在端部执行器102中。仓1004可包括向远侧延伸的组织定位销1020,当端部执行器1002处于闭合位置时,所述组织定位销接合砧座中的开口1022以将组织保持在仓1004和砧座1002之间。当临床医生使分开的击发触发器(未示出)回缩时,致动朝远侧延伸的击发杆(未示出),从而致动钉驱动器1010以驱动钉1008。
在另一个实施例中,可将直线型缝合器1000配置成使得当夹持触发器被致动时使钉仓1004朝砧座向远侧滑动。
应当认识到,根据本发明的缝合装置可结合本文所述的一些特征以用于形成不同成形长度的钉。例如,对于具有不同钉挤压距离的实施例而言,钉全都可具有相同的预成形插脚长度,或一些钉可具有不同的预成形插脚长度。另外,所有钉可由相同的材料制成,或可使用由具有不同弹性模量的不同材料制成的钉。另外,钉的线径可全部相同或其中一些可以是不同的。
可将本发明所公开的装置设计为单次使用后即进行处理,或者可将它们设计为可多次使用。然而,在任一种情况下,所述装置均可进行修复,以在至少一次使用后再次使用。重新修复可包括如下步骤的任意组合:拆卸该装置、然后清洗或置换某些部分以及随后组装。特别是,所述装置可以拆卸,而且可以任意组合选择性地置换或移除该装置任意数目的特定零件或部分。清洗和/或置换特定部分后,该装置可以在修复设施处重新组装以便随后使用,或者在即将进行外科手术前由外科手术队重新组装。本领域的技术人员将会知道,装置的修复可利用多种用于拆卸、清洗/置换和重新组装的技术。这些技术的使用以及所得的修复装置均在本发明的范围内。
优选地,在外科手术之前将对本文所述的发明的各种实施例进行处理。首先,获取新的或用过的装置,并在必要时对装置进行清洁。然后对装置进行消毒。在一种消毒技术中,将该装置置于闭合并密封的容器中,例如塑料或TYVEK袋中。然后将容器和装置置于能够穿透该容器的辐射区,例如γ辐射、x-射线或高能电子。辐射将装置上和容器中的细菌杀死。然后将灭菌后的装置保存在消毒容器中。该密封容器将器械保持无菌,直到在医疗设备中打开该容器。
器械优选地经过消毒。这可以通过任意数目的本领域技术人员已知的方式来进行,包括β辐射、γ辐射、环氧乙烷、蒸汽。
虽然已经通过描述几个实施例举例说明了本发明并且已经相当详细地描述了示例性实施例,但是申请人不旨在将权利要求的范围约束或以任何方式限制到这些细节中。本领域的技术人员可容易看出其它优点和修改形式。本发明的各种实施例表示了相对于现有缝合方法的巨大改进,所述现有缝合方法需要使用单个仓中的不同尺寸的钉以实现具有不同成形(最终)高度的钉。
因此,本发明对内窥镜式手术和设备进行了讨论。但是,本文使用的术语,例如“内窥镜式”不应被理解为将本发明限于仅结合内窥镜式管(即,套管针)使用的外科缝合切断器械。与此相反,本发明据认为可用于进入受限于小切口的任何手术中,包括但不限于腹腔镜式手术以及开腹手术。此外,在不脱离本发明的实质和范围的情况下,本发明的各种钉仓的实施例的独特和新颖的方面当与其它形式的缝合设备结合使用时具有效用。
多年以来,已经开发出多种微创机器人(或“远距离外科手术”)系统以增加外科手术的灵活性,并允许外科医生以直观的方式对患者进行手术。多个此类系统公开在以下美国专利中,所述各个美国专利全文以引用的方式并入本文:名称为“Articulated SurgicalInstrument For Performing Minimally Invasive Surgery With Enhanced Dexterityand Sensitivity”的美国专利5,792,135、名称为“Robotic Arm DLUS For PerformingSurgical Tasks”的美国专利6,231,565、名称为“Robotic Surgical Tool WithUltrasound Cauterizing and Cutting Instrument”的美国专利6,783,524、名称为“Alignment of Master and Slave In a Minimally Invasive Surgical Apparatus”的美国专利6,364,888、名称为“Mechanical Actuator Interface System For RoboticSurgical Tools”的美国专利7,524,320、名称为“Platform Link Wrist Mechanism”的美国专利7,691,098、名称为“Repositioning and Reorientation of Master/SlaveRelationship in Minimally Invasive Telesurgery”的美国专利7,806,891以及名称为“Surgical Tool With Writed Monopolar Electrosurgical End Effectors”的美国专利7,824,401。然而,过去的多个此类系统已不能生成有效切割和紧固组织所需量级的力。
图96示出了可结合图96中示出的从属机械臂车11100类型使用的主控制器11001的一个型式。主控制器11001和从属机械臂车11100以及它们各自的部件和控制系统在本文中统称为机器人系统11000。此类系统和装置的实例公开于美国专利7,524,320中,所述专利以引用的方式并入本文。因而,除了可能必要的理解本发明的多种实施例和形式以外,本文将不详细地描述此类装置的各个细节。众所周知,主控制器11001通常包括如下主控制器(在图96中一般表示为11003):在外科医生通过立体显示器11002观察手术的同时,所述主控制器由外科医生抓持并在空中操控。主控制器11001通常包括手动输入装置,所述手动输入装置优选地以多个自由度运动并通常还具有用于致动工具(例如,用于闭合抓持锯、施加电势到电极等)的致动手柄。
如图97所示,在一种形式中,机械臂车11100能够致动多个外科工具,一般称为11200。使用主控制器和机械臂车装置的各种机器人外科系统和方法公开于名称为“Multi-Component Telepresence System and Method”的美国专利6,132,368中,该专利的全部公开内容以引用的方式并入本文。在各种形式中,机械臂车11100包括基座11002,在图示实施例中,所述基座支撑有三个外科工具11200。在各种形式中,外科工具11200均由一系列手动关节运动的连杆(一般称为装置接头11104)和机器人操纵器11106支撑。本文示出的这些结构具有在机器人连杆的大部分之上延伸的护盖。这些护盖可以是任选的,并且可在尺寸有所限制或在一些实施例中完全消除,以使用于操纵此类装置的伺服机构遇到的惯性最小化、限制运动部件的体积以避免碰撞并且限制车11100的总重量。车11100将通常具有适于在手术室之间搬运车11100的尺寸。车11100可配置成通常适于穿过标准的手术室门并放置到标准的医院电梯上。在各种形式中,车11100可优选地具有重量并包括轮(或其他运输)系统,所述轮系统允许由单个维护人员将车1100设置在邻近手术台。
现在参见图98,在至少一种形式中,机器人操纵器11106可包括限制外科工具11200的运动的连杆11108。在各种实施例中,连杆11108包括由旋转接头以平行四边形布置方式连接在一起的刚性连接件,使得外科工具11200围绕空间11110中的某一点旋转,如在公布的美国专利5,817,084中更完整地描述,所述专利的全部公开内容以引用的方式并入本文。平行四边形布置方式将旋转限制为围绕轴11112a(有时称为俯仰轴)枢转。支撑平行四边形连杆的连接件可枢转地安装到装置接头11104(图97)上,使得外科工具11200进一步围绕轴11112b(有时称为偏航轴)旋转。俯仰轴11112a和偏航轴11112b在远程中心11114处相交,所述远程中心沿着外科工具11200的轴11208对齐。当由操纵器11106支撑时,外科工具11200可具有另外的从动自由度,包括外科工具11200沿着纵向工具轴线“LT-LT”的滑动运动。当外科工具11200沿着工具轴线LT-LT相对于操纵器11106(箭头11112c)滑动时,远程中心11114相对于操纵器11106的基座11116保持固定。从而,使整个操纵器总体上发生移动以重新定位远程中心11114。操纵器11106的连杆11108由一系列的马达11120驱动。这些马达响应于控制系统处理器的命令而主动移动连杆11108。如将在下文中进一步详细描述,马达11120还用于调控外科工具11200。
图99中示出了可供选择的装置接头结构。在该实施例中,外科工具11200由两个组织操纵工具之间的可供选择的操纵器结构11106'支撑。本领域的普通技术人员将会知道本发明的各种实施例可以包括多种可供选择的机器人结构,包括描述于名称为“AutomatedEndoscope System For Optimal Positioning”的美国专利5,878,193中的那些,该专利的全部内容以引用的方式并入本文。另外,虽然结合外科工具11200和主控制器11001之间的通信在本文中初步描述了机器人部件和机器人外科系统的处理器之间的数据通信,应当理解,类似的通信可发生在操纵器、装置接头、内窥镜或其他图像捕获装置等的电路和机器人外科系统的处理器之间,所述机器人外科系统的处理器用于部件兼容性确认、部件类型识别、部件校正(例如偏移等)通信、部件与机器人外科系统的连接确认等。
图100中示出了非常适于与机器人系统11000一起使用的示例性的非限制性外科工具11200,所述机器人系统具有可操作地联接到主控制器11001的工具驱动组件11010(图101),所述主控制器可通过操作者(即,外科医生)的输入来运行。如图所示,外科工具11200包括外科端部执行器12012,所述端部执行器包括直线切割器。在至少一种形式中,外科工具11200通常包括细长轴组件12008,所述细长轴组件具有通过关节运动接头12011联接在一起的近侧闭合管12040和远侧闭合管12042。外科工具11200通过工具安装部分(一般称为11300)可操作地联接到操纵器。外科工具11200还包括将工具安装部分11300机械地且电力地联接到操纵器的接口11230。接口11230的一种形式在图101-105中示出。在各种实施例中,工具安装部分11300包括工具安装板11302,所述工具安装板可操作地支撑多个(图105中示出了四个)可旋转主体部分、从动盘或从动元件11304,所述每个从动盘或从动元件均包括从从动元件11304的表面延伸的一对销11306。一个销11306比相同从动元件11304上的其他销11306更靠近每个从动元件11304的旋转轴,这有助于确保从动元件11304的正向角对齐。接口11230包括能够与安装板11302以安装方式接合的适配器部分11240,如将在下文中进一步描述。适配器部分11240可包括一系列电连接销11242(图103),所述电连接销可通过工具安装部分11300中的电路板连接到存储器结构。虽然结合机械耦合元件、电耦合元件和磁力耦合元件在本文描述了接口11230,应当理解,可使用多种遥测形式,包括红外、电感耦合等。
如图101-104所示,适配器部分11240通常包括工具侧11244和夹持器侧11246。在各种形式中,将多个可旋转主体11250安装到浮动板11248,所述浮动板相对于垂直于适配器11240主表面的周围适配器结构具有限定的运动范围。当沿着工具安装部分外壳11301的侧面致动杠杆11303时(参见图100),浮动板11248的轴向运动有助于使可旋转主体11250从工具安装部分11300脱离。可采用其他机构/装置以可释放的方式将工具安装部分11300联接到适配器11240。在至少一种形式中,通过弹性径向构件将可旋转主体11250弹性地安装到浮动板11248,所述弹性径向构件围绕可旋转主体11250延伸到周边凹痕中。可旋转主体11250可通过偏转这些弹性结构相对于板11248轴向运动。当设置在第一轴向位置(朝工具侧11244)时,可旋转主体11250自由旋转而没有角度限制。然而,当可旋转主体11250朝工具侧11244轴向运动时,突出部11252(从可旋转主体11250径向延伸)横向接合浮动板上的闭锁装置以便限制可旋转主体11250围绕其轴线的角旋转。当驱动销11272将可旋转主体11250推动到受限的旋转位置直到销11234与开口11256’对齐(并滑动到其中)时,可使用该受限的旋转以有助于可旋转主体11250与机器人系统11000的对应工具架部分11270的驱动销11272驱动接合。可旋转主体11250的工具侧11244上的开口11256和夹持器侧11246上的开口11256’能够使工具安装部分11300的从动元件11304(图105)与工具架11270的驱动元件11271准确对齐。有关从动元件11304的内侧和外侧销11306如上所述,开口11256,11256’位于相距其各自的旋转主体11250的旋转轴线不同的距离处,以确保与之要达到的位置不呈180度对齐。另外,每个开口11256略微径向伸长,以适当地容纳周边方向上的销11306。这使得销11306在开口11256,11256’内径向滑动并适应工具11200和工具架11270之间的一些轴偏差,同时使驱动元件和从动元件之间的任何角偏差和角侧隙最小化。工具侧11244上的开口11256与夹持器侧11246上的开口11256’(以虚线示出)成约90度的偏移,如图104中明显地示出。
各种实施例还可包括位于适配器11240夹持器侧11246上的一系列电连接器销11242,并且适配器11240的工具侧11244可包括狭槽11258(图104)以用于容纳工具安装部分11300的销阵列(未示出)。除了在外科工具11200和工具架11270之间传输电信号之外,可通过适配器11240的电路板将这些电连接器中的至少一些连接到适配器存储器装置11260(图103)。
可使用可拆卸的闩锁装置11239以可释放的方式将适配器11240附连到工具架11270。如本文所用,术语“工具驱动组件”在用于机器人系统11000的上下文中时至少涵盖适配器11240和工具架11270的各种实施例,并且其在图101中一般称为11010。例如,如图101所示,工具架11270可包括第一闩锁销结构11274,所述第一闩锁销结构的尺寸设定成容纳在设置于适配器11240中相应的连接叉狭槽11241中。另外,工具架11270还可包括第二闩锁销11276,所述第二闩锁销的尺寸设定成保持在适配器11240中相应的闩锁连接叉11243中。参见图103。在至少一种形式中,闩锁组件11245可运动地支撑在适配器1240上,并且能够在第一闩锁位置和未闩锁位置之间偏置,在第一闩锁位置中,闩锁销11276保持在各自的闩锁连接叉11243中,在未闩锁位置中,第二闩锁销11276可进入闩锁连接叉11243或从中移除。使用弹簧(未示出)以将闩锁组件偏置到闩锁位置。适配器11240工具侧11244上的凸缘可滑动地容纳工具安装外壳11301的横向延伸的突出部。
然后转到图105-112,在至少一个实施例中,外科工具11200包括外科端部执行器12012,在该实例中,所述外科端部执行器此外包括至少一个部件12024,所述部件相对于至少一个其他部件12022在第一位置和第二位置之间响应于施加至其上的各种控制运动而选择性地运动,如将在下文中进一步详细地描述。在各种实施例中,部件12022包括能够可操作地支撑其中的外科钉仓12034的细长通道12022,并且部件12024包括可枢转地平移的夹紧构件,例如砧座12024。外科端部执行器12012的各种实施例能够使砧座12024和细长通道12022保持在确保有效缝合和切断夹持在外科端部执行器12012中的组织的间距处。如图111所示,外科端部执行器12012还包括切割器械12032和滑动件12033。例如,切割器械12032可以为刀。外科钉仓12034可操作地容纳其中支撑在可运动的钉驱动器(未示出)上多个外科钉(未示出)。当切割器械12032朝远侧驱动穿过外科钉仓12034中居中设置的狭槽(未示出)时,其也向远侧推动滑动件12033。当滑动件12033朝远侧驱动时,其“楔形”构型接触可运动的钉驱动器并朝闭合砧座12024垂直驱动钉驱动器。当外科钉被驱动到位于砧座12024下侧的成形表面时,形成外科钉。滑动件12033可以是外科钉仓12034的一部分,使得当切割器械12032在切割操作后回缩时,滑动件12033不会回缩。砧座12024可在位于细长通道12022的近端的枢轴点12025处枢转地打开和闭合。砧座12024还可包括位于其近端的突出部12027,所述突出部与机械闭合系统(下文中进一步描述)的部件相互作用以利于砧座12024的打开。细长通道12022和砧座12024可以由导电材料(例如金属)制成,使得它们可作为与端部执行器中的一个或多个传感器连通的天线的一部分,如上所述。外科钉仓12034可以由非导电材料(例如塑料)制成,并且传感器可连接到或设置在外科钉仓12034中,也如上所述。
如图105-112所示,根据各种实施例,通过细长轴组件12008将外科端部执行器12012附接到工具安装部分11300。如图示实施例所示,轴组件12008包括关节运动接头(通常表示为12011),所述关节运动接头使外科端部执行器12012能够选择性地围绕关节运动轴线AA-AA进行关节运动,所述关节运动轴线AA-AA基本上横向于纵向工具轴线LT-LT。参见图106。在其他实施例中,省略了关节运动接头。在各种实施例中,轴组件12008可包括闭合管组件12009,所述闭合管组件包括通过枢转连接件12044枢转地连接和可操作地支撑在脊组件(一般描述为12049)上的近侧闭合管12040和远侧闭合管12042。在图示实施例中,脊组件12049包括远侧脊部分12050,所述远侧脊部分附接到细长通道12022并且可枢转地连接到近侧脊部分12052。闭合管组件12009能够响应于施加至其上的致动运动在脊组件12049上轴向滑动。远侧闭合管12042包括开口12045,砧座12024上的突出部12027插入到所述开口中以当远侧闭合管12042在近侧方向“PD”上轴向运动时有利于砧座12024的打开。闭合管12040,12042可以由导电材料(例如金属)制成,使其可用作天线的一部分,如上所述。主驱动轴组件(如,驱动轴12048,12050)的部件可以由非导电材料(例如塑料)制成。
在使用中,围绕纵向工具轴线LT-LT旋转外科端部执行器12012可能是有利的。在至少一个实施例中,工具安装部分11300包括旋转的传输组件12069,所述旋转的传输组件能够接收来自机器人系统11000的工具驱动组件11010的对应的旋转输出运动,并将此旋转输出运动转化成旋转控制运动以使细长轴组件12008(和外科端部执行器12012)围绕纵向工具轴线LT-LT旋转。在各种实施例中,例如,近侧闭合管12040的近端12060通过向前的支撑支架11309和同样可运动地支撑在工具安装板11302上的闭合滑动件12100被旋转地支撑在工具安装部分11300的工具安装板11302上。在至少一种形式中,旋转的传输组件12069包括管齿轮段12062,所述管齿轮段形成于(或附接到)近侧闭合管12040的近端12060上,以通过可操作地支撑在工具安装板11302上的旋转齿轮组件12070可操作地接合。如图108所示,在至少一个实施例中,旋转齿轮组件12070包括旋转传动齿轮12072,当工具安装部分11300连接到工具驱动组件11010时,所述旋转传动齿轮连接到工具安装板11302的适配器侧11307上相应的从动盘或从动元件11304中的第一个。参见图105。旋转齿轮组件12070还包括旋转从动齿轮12074,所述旋转从动齿轮与管齿轮段12062和旋转传动齿轮12072啮合,可旋转地支撑在工具安装板11302上。将来自机器人系统11000的工具驱动组件11010的第一旋转输出运动施加到相应的从动元件11304,从而将引起旋转传动齿轮12072的旋转。旋转传动齿轮12072的旋转最终导致细长轴组件12008(和外科端部执行器12012)围绕纵向工具轴线LT-LT(图108中由箭头“R”表示)旋转。应当理解,在一个方向上施加来自工具驱动组件11010的旋转输出运动将引起细长轴组件12008和外科端部执行器12012围绕纵向工具轴线LT-LT在第一方向上旋转,并且在相对的方向上施加旋转输出运动将引起细长轴组件12008和外科端部执行器12012在相对于第一方向的第二方向上旋转。
在至少一个实施例中,通过在脊组件12049上沿着远侧方向“DD”使闭合管组件12009轴向运动来实现砧座12024相对于钉仓12034的闭合。如上所述,在各种实施例中,近侧闭合管12040的近端12060由闭合滑动件12100支撑,所述闭合滑动件包括闭合传动装置(一般描述为12099)的一部分。在至少一种形式中,闭合滑动件12100能够将闭合管12009支撑在工具安装板11320上,使得近侧闭合管12040能够相对于闭合滑动件12100旋转并且随闭合滑动件12100轴向行进。具体地讲,如图113所示,闭合滑动件12100具有直立的突出部12101,所述直立的突出部延伸到近侧闭合管12040的近端部分中的径向沟槽12063中。另外,如图110和113所示,闭合滑动件12100具有延伸穿过工具安装板11302中的狭槽11305的突出部部分12102。突出部部分12102能够保持闭合滑动件12100与工具安装板11302滑动接合。在各种实施例中,闭合滑动件12100具有直立部分12104,所述直立部分具有在其上形成的闭合齿条齿轮12106。闭合齿条齿轮12106能够与闭合齿轮组件12110驱动接合。参见图110。
在各种形式中,闭合齿轮组件12110包括闭合正齿轮12112,所述闭合正齿轮联接到工具安装板11302的适配器侧11307上相应的从动盘或从动元件11304中的第二个。参见图105。因此,当工具安装部分11300联接到工具驱动组件11010时,将来自机器人系统11000的工具驱动组件11010的第二旋转输出运动施加到相应的第二从动元件11304上将引起闭合正齿轮12112的旋转。闭合齿轮组件12110还包括与闭合正齿轮12112以啮合的方式而被支撑的闭合减速齿轮组12114。如图109和110所示,闭合减速齿轮组12114包括与闭合正齿轮12112以啮合的方式而被旋转地支撑的从动齿轮12116。闭合减速齿轮组12114还包括与第二闭合传动齿轮12120啮合的第一闭合传动齿轮12118,所述第二闭合传动齿轮与闭合齿条齿轮12106以啮合的方式而被旋转地支撑在工具安装板11302上。因此,将来自机器人系统11000的工具驱动组件11010的第二旋转输出运动施加到相应的第二从动元件11304将引起闭合正齿轮12112和闭合传动装置12110的旋转,并且最终轴向驱动闭合滑动件12100和闭合管组件12009。闭合管组件12009运动的轴向最终取决于第二从动元件11304旋转的方向。例如,响应于从机器人系统11000的工具驱动组件11010接收的一个旋转输出运动,将在远侧方向“DD”上驱动闭合滑动件12100并且最终在远侧方向上驱动闭合管组件11009。当朝远侧驱动远侧闭合管12042时,闭合管段12042的末端将接合砧座12024的一部分并使砧座12024枢转到闭合位置。施加来自机器人系统11000的工具驱动组件11010的“开口”输出运动时,将在近侧方向“PD”上驱动闭合滑动件12100和轴组件12008。当在近侧方向上驱动远侧闭合管12042时,其中的开口12045与砧座12024上的突出部12027相互作用以利于其打开。在各种实施例中,当将远侧闭合管12042运动至其起始位置时,可使用弹簧(未示出)以将砧座偏置至打开位置。在各种实施例中,闭合齿轮组件12110的各种齿轮的尺寸设定成能够产生所需的必要的闭合力,所述闭合力令人满意地在待由外科端部执行器12012切割和缝合的组织上闭合砧座12024。例如,闭合传动装置12110的齿轮的尺寸设定成能够产生大约70-120磅的力。
在各种实施例中,通过刀杆12200驱动切割器械12032穿过外科端部执行器12012。参见图111和113。在至少一种形式中,刀杆12200可由(例如)不锈钢或其他类似材料制成并且具有大致矩形的横截面形状。此刀杆构型足够刚性以推动切割器械12032穿过夹持在外科端部执行器12012中的组织,同时足够柔性以使外科端部执行器12012相对于近侧闭合管12040和近侧脊部分12052围绕关节运动轴线AA-AA进行关节运动,如将在下文中进一步详细地描述。如图114和115所示,近侧脊部分12052具有延伸穿过其中的矩形通路12054,以在其被轴向推动穿过其中时为刀杆12200提供支撑。近侧脊部分12052具有近端12056,所述近端可旋转地安装到附接到工具安装板11032的脊安装托架12057上。参见图113。此装置允许近侧脊部分12052在近侧闭合管12040内旋转但不轴向运动。
如图111中所示,将刀杆12200的远端12202附接到切割器械12032。刀杆12200的近端12204可旋转地附连到刀齿条齿轮12206上,使得刀杆12200相对于刀齿条齿轮12206自由旋转。参见图113。如图107-112所示,刀齿条齿轮12206可滑动地支撑在附接到工具安装板11302的齿条外壳12210内,使得刀齿条齿轮12206保持与刀齿轮组件12220啮合。更具体地讲并结合图110,在至少一个实施例中,刀齿轮组件12220包括刀正齿轮12222,所述刀正齿轮联接到工具安装板11302的适配器侧11307上相应的从动盘或从动元件11304中的第三个。参见图105。因此,将来自机器人系统11000的另一旋转输出运动通过工具驱动组件11010施加到相应的第三从动元件11304,从而将引起刀正齿轮12222的旋转。刀齿轮组件12220还包括刀减速齿轮组12224,所述刀减速齿轮组包括第一刀从动齿轮12226和第二刀传动齿轮12228。刀减速齿轮组12224可旋转地安装到工具安装板11302上,使得第一刀从动齿轮12226与刀正齿轮12222啮合。同样,第二刀传动齿轮12228与第三刀传动齿轮12230啮合,所述第三刀传动齿轮与刀齿条齿轮12206以啮合的方式而被旋转地支撑在工具安装板11302上。在各种实施例中,刀齿轮组件12220的齿轮的尺寸设定成能够产生如下力:需要所述力以驱动切割元件12032穿过夹持在外科端部执行器12012中的组织并致动其中的钉。例如,刀驱动组件12230的齿轮的尺寸设定成能够产生大约40至100磅的力。应当理解,在一个方向上施加来自工具驱动组件11010的旋转输出运动将引起切割器械12032在远侧方向上轴向运动,并且在相对的方向上施加旋转输出运动将引起切割器械12032在近侧方向上轴向运动。
在各种实施例中,外科工具11200采用包括关节运动接头12011的关节运动系统12007,所述关节运动接头使外科端部执行器12012能够围绕关节运动轴线AA-AA进行关节运动,所述关节运动轴线AA-AA基本上横向于纵向工具轴线LT-LT。在至少一个实施例中,外科工具11200包括第一关节运动杆12250a和第二关节运动杆12250b,所述第一关节运动杆和第二关节运动杆可滑动地支撑在穿过近侧脊部分12052的相应通路12053中。参见图113和115。在至少一种形式中,通过关节运动传动装置(一般称为12249)致动第一关节运动杆12250a和第二关节运动杆12250b,所述关节运动传动装置可操作地支撑在工具安装板11032上。关节运动杆12250a,12250b中的每一个均具有从中伸出导向杆的近端12252,所述导向杆横向延伸穿过近侧脊部分12052的近端部分中的对应狭槽并且进入关节运动螺母12260中的对应弓形狭槽,所述关节运动螺母包括关节运动传动装置的一部分。图114示出了关节运动杆12250a。应当理解,关节运动杆12250b被相似地构造。如图114所示,例如,关节运动杆12250a具有导向杆12254,所述导向杆横向延伸穿过远侧脊部分12050的近端部分12056中的对应狭槽12058并且进入关节运动螺母12260中的对应弓形狭槽12262。另外,关节运动杆12250a具有通过例如销12253a可枢转地联接到远侧脊部分12050的远端12251a,并且关节运动杆12250b具有通过例如销12253b可枢转地联接到远侧脊部分12050的远端12251b。具体地讲,关节运动杆12250a在第一横向上从纵向工具轴线LT-LT横向偏置,并且关节运动杆12250b在第二横向上从纵向工具轴线LT-LT横向偏置。因此,关节运动杆12250a和12250b在相对方向上的轴向运动将使远侧脊部分12050以及附接到其上的外科端部执行器12012能够围绕关节运动轴线AA-AA进行关节运动,如将在下文中进一步详细地描述。
通过围绕纵向工具轴线LT-LT旋转关节运动螺母12260来控制外科端部执行器12012的关节运动。关节运动螺母12260可旋转地接合在远侧脊部分12050的近端部分12056,并且通过关节运动齿轮组件12270可旋转地在远侧脊部分的近端部分上驱动。更具体地讲并结合图108,在至少一个实施例中,关节运动齿轮组件12270包括关节运动正齿轮12272,所述关节运动正齿轮连接到工具安装板11302的适配器侧11307上相应的从动盘或从动元件11304中的第四个。参见图105。因此,当接口11230连接到工具架11270时,穿过工具驱动组件11010将来自机器人系统11000的另一旋转输入运动施加到相应的第四从动元件11304上,从而将引起关节运动正齿轮12272的旋转。关节运动传动齿轮12274旋转地支撑在工具安装板11302上并与关节运动正齿轮12272和如图所示的关节运动螺母12260的齿轮部分12264啮合。如图113和114所示,关节运动螺母12260具有在其上形成的肩部12266,所述肩部限定环形沟槽12267以容纳其中的保持杆12268。将保持杆12268附接到工具安装板11302上,并用于防止关节运动螺母12260在近侧脊部分12052上轴向运动,同时保持相对于其的旋转能力。因此,由于导向杆12254与关节运动齿轮12260中螺旋狭槽12262的相互作用,在第一方向上旋转关节运动螺母12260将导致关节运动杆12250a在远侧方向“DD”上轴向运动以及关节运动杆12250b在近侧方向“PD”上轴向运动。相似地,在与第一方向相对的第二方向上旋转关节运动螺母12260将使关节运动杆12250a在近侧方向“PD”上轴向运动并引起关节运动杆12250b在远侧方向“DD”上轴向运动。因此,可通过同时在远侧方向“DD”上使关节运动杆12250a运动和在近侧方向“PD”上使关节运动杆12250b运动而使外科端部执行器12012在第一方向“FD”上围绕关节运动轴线“AA-AA”选择性地进行关节运动。同样,可通过同时在近侧方向“PD”上使关节运动杆12250a运动和在远侧方向“DD”上使关节运动杆12250b运动而使外科端部执行器12012在第二方向“SD”上围绕关节运动轴线“AA-AA”选择性地进行关节运动。参见图106。
上述工具实施例采用了交接装置,所述交接装置尤其适于将机器人控制的的医疗工具安装到至少一种形式的机械臂装置上,所述机械臂装置产生至少四种不同的旋转控制运动。本领域的普通技术人员将会知道可通过机器人系统/控制器经由可编程控制系统来选择性地控制此类旋转输出运动。例如,上述工具装置可很好地适于与由IntuitiveSurgical,Inc.(Sunnyvale,California,U.S.A.)制造的那些机器人系统一起使用,其中许多可以在以引用的方式并入本文的各种专利中详细描述。本发明的各种实施例的独特的和新型的方面用来利用由机器人系统提供的旋转输出运动以生成特定的控制运动,所述控制运动具有使端部执行器切割和缝合组织的足够量级。因此,本发明的各种实施例的独特装置和原则可以使本文所公开和受权利要求保护的多种不同形式的工具系统结合提供程序化的旋转或其他输出运动的其他类型和形式的机器人系统有效地使用。另外,随着继续参阅本具体实施方式将变得更加明显,利用由机器人系统产生的一种或多种控制运动还可以有效地致动需要其他形式的致动运动的本发明的各种端部执行器实施例。
图117-121示出了可结合具有工具驱动组件的机器人系统11000有效使用的另一种外科工具12300,所述工具驱动组件可操作地联接到通过操作者的输入运行的机器人系统的控制器,并且其配置成向支撑在工具驱动组件上的至少一个旋转主体部分提供至少一种旋转输出运动。在各种形式中,外科工具12300包括外科端部执行器12312,所述外科端部执行器包括细长通道12322和可枢转平移的夹紧构件,例如砧12324,所述细长通道和可枢转平移的夹紧构件保持在确保有效地缝合和切断被夹持在外科端部执行器12312中的组织的间距处。如图示实施例中所示,外科端部执行器12312可包括除了前述细长通道12322和砧座12324之外的具有在其上形成的滑动件部分12333的切割器械12332、位于细长通道12322中的外科钉仓12334和具有在其上形成的螺旋形螺纹的旋转端部执行器驱动轴12336。例如,切割器械12332可以为刀。如将在下文中进一步详细地描述,旋转端部执行器驱动轴12336将使切割器械12332和滑动件部分12333轴向行进穿过外科钉仓12334以在起始位置和结束位置之间运动。切割器械12332轴向行进的方向取决于端部执行器驱动轴12336旋转的方向。砧座12324可在连接至细长通道12322的近端的枢轴点12325处可枢转地打开和闭合。砧板12324还可包括位于其近端的突出部12327,所述突出部可操作地与机械闭合系统(以下进一步描述)的部件交接以打开和闭合砧板12324。当旋转端部执行器12336时,切割器械12332和滑动件12333将穿过外科钉仓12334从起始位置纵向行进至结束位置,从而切割夹持在外科端部执行器12312中的组织。滑动件12333穿过外科钉仓12334的运动使得其中的钉被驱动穿过被切断的组织并且抵靠闭合的砧座12324,所述砧座转动钉以紧固被切断的组织。在一种形式中,细长通道12322和砧座12324可以由导电材料(例如金属)制成,使得它们可作为与端部执行器中的一个或多个传感器连通的天线的一部分,如上所述。外科钉仓12334可以由非导电材料(例如塑料)制成,并且传感器可以连接到或设置在外科钉仓12334中,如上所述。
应该指出的是,虽然本文描述的外科工具12300的实施例使用对切断的组织进行缝合的外科端部执行器12312,但是在其它实施例中,可使用用于对切断的组织进行紧固或密封的不同技术。例如,也可使用利用射频能量或粘合剂来紧固被切断的组织的端部执行器。授予Yates等人的名称为“Electrosurgical Hemostatic Device”的美国专利5,709,680以及授予Yates等人的名称为“Electrosurgical Hemostatic Device With RecessedAnd/Or Offset Electrodes”的美国专利5,688,270公开了使用射频能量来紧固被切断的组织的切割器械,该专利以引用的方式并入本文。授予Morgan等人的美国专利申请序列号11/267,811以及授予Shelton等人的美国专利申请序列号11/267,363公开了使用粘合剂来紧固被切断的组织的切割器械,该专利也以引用的方式并入本文。因此,虽然本文的描述涉及切割/缝合操作等,但是应当认识到,这仅是示例性实施例,并不旨在进行限制。也可以使用其它组织紧固技术。
在图示实施例中,外科端部执行器12312联接到细长轴组件12308,所述细长轴组件联接到工具安装部分12460并限定纵向工具轴线LT-LT。在该实施例中,细长轴组件12308不包括关节运动接头。本领域的普通技术人员将会理解其他实施例中可具有关节运动接头。在至少一个实施例中,细长轴组件12308包括中空的外管12340,所述中空的外管可旋转地支撑在工具安装部分12460的工具安装盘12462上,如将在下文中进一步详细地描述。在各种实施例中,细长轴组件12308还包括远侧脊轴12350。远侧脊轴12350具有远端部分12354,所述远端部分连接到远侧固定基座部分12360或与其一体化形成,该远侧固定基座部分固定连接到通道12322。参见图118-120。
如图115中所示,远侧脊轴12350具有滑动地容纳在近侧脊轴12353中的狭槽12355内的近端部分12351,所述近侧脊轴通过至少一个支撑衬圈12357不可移除地支撑在中空外管12340内。如图118和119进一步所示,外科工具12300包括闭合管12370,所述闭合管被限制为相对于远侧固定基座部分12360仅进行轴向运动。闭合管12370具有近端12372,所述近端具有在其中形成并且与传动装置螺纹接合的内螺纹12374,所述传动装置(一般描述为12375)可操作地支撑在工具安装板12462上。在各种形式中,传动装置12375包括旋转驱动轴组件(一般称为12381)。当旋转时,旋转驱动轴组件12381将促使闭合管12370轴向运动,如将在下文中进一步详细地描述。在至少一种形式中,旋转驱动轴组件12381包括闭合离合器组件(一般称为12380)的闭合驱动螺母12382。更具体地讲,闭合驱动螺母12382具有近端部分12384,所述近端部分相对于外管12340可旋转地支撑并与闭合管12370螺纹接合。出于组装目的,近端部分12384可通过螺纹附接到保持环12386。与闭合驱动螺母12382的末端12387协作的保持环12386限定环状狭槽12388,锁定衬圈12390的肩部12392延伸到所述环状狭槽中。锁定衬圈12390不可移除地附接(例如,焊接、胶粘等)到外管12340的末端。此装置用于将闭合驱动螺母12382附连到外管12340上,同时使闭合驱动螺母12382相对于外管12340旋转。闭合驱动螺母12382还具有远端12383,所述远端具有螺纹部分12385,所述螺纹部分与闭合管12370的内螺纹12374通过螺纹接合。因此,闭合驱动螺母12382的旋转将使闭合管12370轴向运动,如图119中的箭头“D”所示。
通过由中空驱动套管12400传输的控制运动实现砧座12324的闭合和切割器械12332的致动。如图118和119所示,中空驱动套管12400可旋转地并且可滑动地容纳在远侧脊轴12350上。驱动套管12400具有可旋转地安装到近侧脊轴12353上的近端部分12401,所述近侧脊轴从工具安装部分12460突出使得驱动套管12400可相对于近侧脊轴旋转。参见图118。如图118-120所示,驱动套管12400通过驱动轴12440围绕纵向工具轴线“LT-LT”旋转。驱动轴12440具有附接到其远端12442并与附接到驱动套管12400的从动齿轮12450啮合的传动齿轮12444。
驱动套管12400还具有远端部分12402,所述远端部分联接到闭合离合器组件12380的闭合离合器12410部分,所述闭合离合器组件具有近侧面12412和远侧面12414。近侧面12412具有在其上形成的一系列近侧齿状物12416,所述近侧齿状物适于与形成于闭合驱动螺母12382的近端部分12384中的相应的近侧齿状物腔体12418选择性地接合。因此,当近侧齿状物12416与闭合驱动螺母12382中的近侧齿状物腔体12418啮合时,驱动套管12400的旋转将引起闭合驱动螺母12382的旋转,并且最终引起闭合管12370轴向运动,如将在下文中进一步详细地描述。
尤其如图118和119所示,驱动离合器部分12410的远侧面12414具有形成于其上的一系列远侧齿状物12415,所述远侧齿状物适于与形成于刀驱动轴组件12420的面板部分12424中的相应的远侧齿状物腔体12426选择性地接合。在各种实施例中,刀驱动轴组件12420包括中空的刀轴段12430,所述中空的刀轴段可旋转地容纳在远侧脊轴12350的对应部分上,所述远侧脊轴的对应部分附接到固定基座12360或从固定基座12360突出。当闭合离合器部分12410的远侧齿状物12415与面板部分12424中的远侧齿状物腔体12426啮合时,驱动套管12400的旋转将引起驱动轴段12430围绕固定轴12350旋转。如图118-120所示,将刀传动齿轮12432附接到驱动轴段12430,并与附接到端部执行器驱动轴12336的驱动刀齿轮12434啮合。因此,驱动轴段12430的旋转将引起端部执行器驱动轴12336的旋转,从而朝远侧驱动切割器械12332和滑动件12333穿过外科钉仓12334,以切割和缝合夹持在外科端部执行器12312中的组织。滑动件12333可由例如塑料制成,并且可具有倾斜的远侧表面。当滑动件12333穿过细长通道12322时,滑动件12333的前倾表面可向上推动或“驱动”外科钉仓12334中的钉穿过被夹持的组织并抵靠砧座12324。砧座12324使钉弯曲或“成形”,从而缝合切断的组织。如本文所用,术语“击发”是指引发如下动作:需要所述动作以沿远侧方向驱动切割器械和滑动件部分穿过外科钉仓,以切割夹持在外科端部执行器中的组织并驱动钉穿过切断的组织。
在使用中,围绕纵向工具轴线LT-LT旋转外科端部执行器12312可能是有利的。在至少一个实施例中,传动装置12375包括旋转的传输组件12465,所述旋转的传输组件能够接收来自机器人系统11000的工具驱动组件11010的对应的旋转输出运动,并将此旋转输出运动转化成旋转控制运动以使细长轴组件12308(和外科端部执行器12312)围绕纵向工具轴线LT-LT旋转。如图121所示,外管12340的近端12341可旋转地支撑在支架装置12343中,所述支架装置附接到工具安装部分12460的工具安装板12462。旋转齿轮12345形成在细长轴组件12308的外管12340的近端12341上或附接到其,以与可操作地支撑在工具安装板12462上的旋转齿轮组件12470啮合。在至少一个实施例中,当工具安装部分12460连接到工具驱动组件11010时,旋转传动齿轮12472联接到工具安装板12462的适配器侧上相应的从动盘或从动元件11304中的第一个。参见图105和121。旋转驱动组件12470还包括旋转从动齿轮12474,所述旋转从动齿轮可旋转地支撑在工具安装板12462上,与旋转齿轮12345和旋转传动齿轮12472啮合。将来自机器人系统11000的第一旋转输出运动通过工具驱动组件11010施加到相应的从动元件11304,从而将通过可操作地联接至其而引起旋转传动齿轮12472的旋转。旋转传动齿轮12472的旋转最终导致细长轴组件12308(和端部执行器12312)围绕纵向工具轴线LT-LT旋转(主旋转运动)。
通过沿远侧方向“DD”使闭合管12370轴向运动来实现砧座12324相对于钉仓12034的闭合。通过向闭合驱动螺母12382施加旋转控制运动来实现闭合管12370沿远侧方向“DD”的轴向运动。为了向闭合驱动螺母12382施加旋转控制运动,闭合离合器12410必须首先与闭合驱动螺母12382的近端部分12384啮合。在各种实施例中,传动装置12375还包括可操作地支撑在工具安装板12462上的移位器驱动组件12480。更具体地讲并结合图121,可以看出,近侧脊部分12353的近端部分12359延伸穿过旋转齿轮12345并可旋转地连接到移位器齿轮齿条12481,所述移位器齿条穿过狭槽12482可滑动地附连到工具安装板12462。移位器驱动组件12480还包括移位器传动齿轮12483,当工具安装部分12460连接到工具架11270时,所述移位器传动齿轮连接到工具安装板12462的适配器侧上相应的从动盘或从动元件11304中的第二个。参见图105和121。移位器驱动组件12480还包括移位器从动齿轮12478,所述移位器从动齿轮可旋转地支撑在工具安装板12462上,与移位器传动齿轮12483和移位器齿条齿轮12482啮合。将来自机器人系统11000的第二旋转输出运动通过工具驱动组件11010施加到相应的从动元件11304,从而将通过可操作地联接至其而引起移位器传动齿轮12483的旋转。移位器传动齿轮12483的旋转最终引起移位器齿轮齿条12482和近侧脊部分12353以及驱动套管12400和附接至其的闭合离合器12410的轴向运动。闭合离合器12410的轴向行进方向取决于移位器传动齿轮12483通过机器人系统11000旋转的方向。因此,移位器传动齿轮12483在第一旋转方向上的旋转将引起闭合离合器12410沿近侧方向“PD”的轴向运动,从而使近侧齿状物12416与闭合驱动螺母12382中的近侧齿状物腔体12418啮合。反之,移位器传动齿轮12483在第二旋转方向(与第一旋转方向相反)上的旋转将引起闭合离合器12410沿远侧方向“DD”的轴向运动,从而使远侧齿状物12415与形成于刀驱动轴组件12420的面板部分12424中的相应的远侧齿状物腔体12426啮合。
一旦使闭合离合器12410与闭合驱动螺母12382啮合,闭合驱动螺母12382通过旋转闭合离合器12410进行旋转。通过向传动装置12375的旋转驱动传输部分12490施加旋转输出运动来控制闭合离合器12410的旋转,所述传动装置可操作地支撑在工具安装板12462上,如图121所示。在至少一个实施例中,旋转驱动传输部分12490包括旋转驱动组件12490’,所述旋转驱动组件包括齿轮12491,当工具安装部分12460联接到工具架11270时,所述齿轮联接到工具安装板12462的适配器侧上相应的从动盘或从动元件11304中的第三个。参见图105和121。旋转驱动传输部分12490还包括第一旋转从动齿轮12492,所述第一旋转从动齿轮可旋转地支撑在工具安装板12462上,与第二旋转从动齿轮12493和旋转传动齿轮12491啮合。第二旋转从动齿轮12493联接到驱动轴12440的近端部分12443。
旋转传动齿轮12491在第一旋转方向上的旋转将引起驱动轴12440在第一方向上的旋转。反之,旋转传动齿轮12491在第二旋转方向(与第一旋转方向相反)上的旋转将引起驱动轴12440在第二方向上的旋转。如上所述,驱动轴12440具有传动齿轮12444,所述传动齿轮附接到其远端12442并与附接到驱动套管12400的从动齿轮12450啮合。因此,驱动轴12440的旋转引起驱动套管12400的旋转。
现将描述操作外科工具12300的方法。一旦工具安装部分12462可操作地联接到机器人系统11000的工具架11270,并定向至邻近待切割和缝合的靶组织的位置,如果砧座12334尚未处于打开位置(图118),机器人系统11000可向移位器传动齿轮12483施加第一旋转输出运动,这使闭合离合器12410轴向运动至与闭合驱动螺母12382啮合(如果尚未与其啮合)。参见图119。一旦机器人系统11000的控制器11001确定闭合离合器12410与闭合驱动螺母12382啮合(例如,通过外科端部执行器12312中与机器人控制系统连通的一个或多个传感器),则机器人控制器11001可向旋转传动齿轮12492施加第二旋转输出运动,如上所述,这将最终引起旋转驱动螺母12382在第一方向上的旋转,从而引起闭合管12370在远侧方向“DD”上的轴向运动。当闭合管12370在远侧方向上运动时,其接触砧座12323的一部分并使砧座12324枢转至闭合位置,从而夹持介于砧座12324和外科钉仓12334之间的靶组织。一旦机器人控制器11001确定砧座12334已通过外科端部执行器12312中与之连通的相应的一个或多个传感器枢转至闭合位置,则机器人系统11000停止向旋转传动齿轮12491施加第二旋转输出运动。机器人控制器11001还可以为外科医生提供砧座12334已完全闭合的指示。然后外科医生可引发击发过程。在可供选择的实施例中,击发过程可由机器人控制器11001自动引发。然后,机器人控制器11001向移位器传动齿轮12483施加主旋转控制运动12483,这使闭合离合器12410轴向运动至与刀驱动轴组件12420的面板部分12424啮合。参见图120。一旦机器人系统11000的控制器11001确定闭合离合器12410与面板部分12424啮合(通过端部执行器12312中与机器人控制器11001连通的一个或多个传感器),则机器人控制器11001向旋转传动齿轮12492施加第二旋转输出运动,如上所述,这最终使切割器械12332和滑动件部分12333沿远侧方向“DD”轴向运动穿过外科钉仓12334。当切割器械12332朝远侧运动穿过外科钉仓12334时,切断夹持在其中的组织。当滑动件部分12333朝远侧驱动时,其驱动外科钉仓中的钉穿过切断的组织,从而与砧座12324成形接触。一旦机器人控制器11001确定切割器械12324已到达外科钉仓12334中的结束位置(通过端部执行器12312中与机器人控制器11001连通的一个或多个传感器),则机器人控制器11001停止向旋转传动齿轮12491施加第二旋转输出运动。然后,机器人控制器11001向旋转传动齿轮12491施加次旋转输出运动,这最终使切割器械12332和滑动件部分12333沿近侧方向“PD”轴向运动至起始位置。一旦机器人控制器11001通过外科端部执行器12312中与机器人控制器11001连通的一个或多个传感器确定切割器械12324已到达起始位置,则机器人控制器11001停止向旋转传动齿轮12491施加次旋转输出运动。然后,机器人控制器11001向移位器传动齿轮12483施加主旋转输出运动,从而使闭合离合器12410运动至与旋转驱动螺母12382接合。一旦闭合离合器12410已运动至与旋转驱动螺母12382啮合,则机器人控制器11001向旋转传动齿轮12491施加次输出运动,这最终引起旋转驱动螺母12382在第二方向上旋转,从而使闭合管12370在近侧方向“PD”上运动。如图118-120所示,闭合管12370中具有开口12345,所述开口接合砧座12324上的突出部12327以使砧座12324枢转至打开位置。在可供选择的实施例中,当闭合管12370回到起始位置时(图118),可使用弹簧以将砧座12324枢转至打开位置。
图122-126示出了可结合机器人系统11000有效使用的另一个外科工具12500。在各种形式中,外科工具12500包括外科端部执行器12512,所述外科端部执行器包括细长通道12522形式的“第一部分”和可枢转地平移的夹紧构件(例如砧座12524)形式的“第二可运动部分”,所述第一部分和第二可运动部分保持在确保有效缝合和切断夹持在外科端部执行器12512中的组织的间距处。如图示实施例中所示,外科端部执行器12512可包括除了前述细长通道12522和砧座12524之外的切割器械12532形式的“第三部分”、滑动件(未示出)和可移除地位于细长通道12522中的外科钉仓12534。例如,切割器械12532可以为刀。砧座12524可在连接至细长通道12522的近端的枢轴点12525处可枢转地打开和闭合。砧座12524还可包括位于其近端的突出部12527,所述突出部能够与机械闭合系统(以下进一步描述)的部件可操作地交接以打开和闭合砧板12524。当致动时,刀12532和滑动件沿着细长通道12522纵向行进,从而切割夹持在外科端部执行器12512中的组织。滑动件沿着细长通道12522的运动使得外科钉仓12534的钉被驱动穿过切断的组织并且抵靠闭合的砧座12524,砧座转动钉以紧固被切断的组织。在一种形式中,细长通道12522和砧座12524可以由导电材料(例如金属)制成,使得它们可以作为与外科端部执行器中的一个或多个传感器连通的天线的一部分,如上所述。外科钉仓12534可以由非导电材料(例如塑料)制成,并且传感器可以连接到或设置在外科钉仓12534中,如上所述。
应该指出的是,虽然本文描述的外科工具12500的实施例使用对切断的组织进行缝合的外科端部执行器12512,但是在其它实施例中,可使用用于对切断的组织进行紧固或密封的不同技术。例如,也可使用如下端部执行器,其利用射频能量或粘合剂来紧固被切断的组织。授予Yates等人的名称为“Electrosurgical Hemostatic Device”的美国专利5,709,680以及授予Yates等人的名称为“Electrosurgical Hemostatic Device WithRecessed And/Or Offset Electrodes”的美国专利5,688,270公开了使用射频能量来紧固被切断的组织的切割器械,该专利以引用的方式并入本文。授予Morgan等人的美国专利申请序列号11/267,811以及授予Shelton等人的美国专利申请序列号11/267,363公开了使用粘合剂来紧固被切断的组织的切割器械,该专利也以引用的方式并入本文。因此,虽然本文的描述涉及切割/缝合操作等,但是应当认识到,这仅是示例性实施例,并不旨在进行限制。也可使用其它组织紧固技术。
在图示实施例中,外科端部执行器12512的细长通道12522联接到细长轴组件12508,所述细长轴组件连接到工具安装部分12600。在至少一个实施例中,细长轴组件12508包括中空的脊管12540,所述中空的脊管不可移除地联接到工具安装部分12600的工具安装板12602。如图123和124所示,细长通道12522的近端12523包括能够附接到脊管12540的远端12541的中空的管状结构。在一个实施例中,例如,将细长通道12522的近端12523焊接或胶粘到脊管12540的远端。
如图123和124进一步所示,在至少一个非限制性实施例中,外科工具12500还包括闭合管12550形式的可轴向运动的致动构件,所述闭合管被限制为相对于细长通道12522和脊管12540进行轴向运动。闭合管12550具有近端12552,所述近端具有形成于其中的内螺纹12554,所述内螺纹与闭合驱动螺母12560形式的可旋转运动的部分进行螺纹接合。更具体地讲,闭合驱动螺母12560具有相对于细长通道12522和脊管12540旋转支撑的近端部分12562。出于组装目的,近端部分12562螺纹附接到保持环12570。保持环12570容纳在沟槽12529中,所述沟槽在细长通道12522的近端12523上的肩部12527和脊管12540的远端12541之间形成。此装置用于将闭合驱动螺母12560可旋转地支撑在细长通道12522内。闭合驱动螺母12560的旋转将引起闭合管12550轴向运动,如图123中的箭头“D”所示。
驱动构件延伸穿过脊管12540和闭合驱动螺母12560,在至少一个实施例中,所述驱动构件包括具有远端部分12582的刀杆12580,所述远端部分可旋转地联接到切割器械12532,使得刀杆12580可相对于切割器械12582旋转。如图123-125所示,闭合驱动螺母12560中具有狭槽12564,刀杆12580可滑动地延伸穿过所述狭槽。此装置允许刀杆12580相对于闭合驱动螺母12560轴向运动。然而,刀杆12580围绕纵向工具轴线LT-LT的旋转还将引起闭合驱动螺母12560的旋转。闭合管12550运动的轴向最终取决于刀杆12580和闭合驱动螺母12560旋转的方向。当朝远侧驱动闭合管12550时,其远端将接触砧座12524并使砧座12524枢转至闭合位置。当施加来自机器人系统11000的开放式旋转输出运动时,闭合管12550将沿近侧方向“PD”被驱动,并且凭借突出部12527与闭合管12550中的开口12555的接合而将砧座12524枢转至打开位置。
在使用中,围绕纵向工具轴线LT-LT旋转外科端部执行器12512可能是有利的。在至少一个实施例中,工具安装部分12600能够接收来自机器人系统11000的相应的第一旋转输出运动,并将此旋转输出运动转化成旋转控制运动以使细长轴组件12508围绕纵向工具轴线LT-LT旋转。如图121所示,中空的脊管12540的近端12542可旋转地支撑在支架装置12603中,所述支架装置附接到工具安装部分12600的工具安装板12602。外科工具12500的各种实施例还包括可操作地支撑在工具安装板12602上的传动装置,一般描述为12605。在各种形式中,传动装置12605包括旋转齿轮12544,所述旋转齿轮形成于或附接到脊管12540的近端12542,以与可操作地支撑在工具安装板12602上的旋转驱动组件12610啮合。在至少一个实施例中,当工具安装部分12600联接到工具架11270时,旋转传动齿轮12612联接到工具安装板12602的适配器侧上相应的旋转主体、从动盘或从动元件11304中的第一个。参见图105和126。旋转驱动组件12610还包括旋转从动齿轮12614,所述旋转从动齿轮可旋转地支撑在工具安装板12602上,与旋转齿轮12544和旋转传动齿轮12612啮合。将来自机器人系统11000的第一旋转输出运动通过工具驱动组件11010施加到相应的从动旋转主体11304,从而将通过可操作地联接至其而引起旋转传动齿轮12612的旋转。旋转传动齿轮12612的旋转最终使细长轴组件12508(和端部执行器12512)围绕纵向工具轴线LT-LT旋转。
通过在远侧方向“DD”上轴向运动闭合管12550来实现砧座12524相对于外科钉仓12534的闭合。通过向闭合驱动螺母12382施加旋转控制运动来实现闭合管12550在远侧方向“DD”上的轴向运动。在各种实施例中,通过向刀杆12580施加旋转输出运动来转动闭合驱动螺母12560。通过向旋转闭合系统12620施加旋转输出运动来控制刀杆12580的旋转,所述旋转闭合系统可操作地支撑在工具安装板12602上,如图126所示。在至少一个实施例中,旋转闭合系统12620包括闭合传动齿轮12622,当工具安装部分12600联接到工具架11270时,所述闭合传动齿轮联接到工具安装板12462的适配器侧上相应的旋转主体部分、从动盘或从动元件11304中的第二个。参见图105和126。在至少一个实施例中,闭合传动齿轮12622与闭合齿轮系(一般描述为12623)驱动啮合。闭合齿轮驱动系12623包括可旋转地支撑在工具安装板12602上的第一从动闭合齿轮12624。通过驱动轴12628将第一闭合从动齿轮12624附接到第二闭合从动齿轮12626。第二闭合从动齿轮12626与可旋转地支撑在工具安装板12602上的第三闭合从动齿轮12630啮合。闭合传动齿轮12622在第二旋转方向上的旋转将引起第三闭合从动齿轮12630在第二方向上的旋转。反之,闭合传动齿轮12483在次旋转方向(与第二旋转方向相反)上的旋转将引起第三闭合从动齿轮12630在次旋转方向上的旋转。
如图126所示,将驱动轴组件12640联接到刀杆12580的近端。在各种实施例中,驱动轴组件12640包括具有正方形横截面形状的近侧部分12642。近侧部分12642能够与第三从动齿轮12630中相应的成形孔滑动地接合。当第三从动齿轮12630旋转时,此装置引起驱动轴组件12640(和刀杆12580)的旋转。驱动轴组件12640通过刀驱动组件12650在远侧和近侧方向上被轴向推进。一种形式的刀驱动组件12650包括旋转传动齿轮12652,当工具安装部分12600联接到工具架11270时,所述旋转传动齿轮联接到工具安装板12462的适配器侧上相应的旋转主体部分、从动盘或从动元件11304中的第三个。参见图105和126。旋转从动齿轮12652与齿轮系(一般描述为12653)驱动啮合。在至少一种形式中,齿轮系12653还包括可旋转地支撑在工具安装板12602上的第一旋转从动齿轮组件12654。第一旋转从动齿轮组件12654与第三旋转从动齿轮组件12656啮合,所述第三旋转从动齿轮组件可旋转地支撑在工具安装板12602上并且与第四旋转从动齿轮组件12658啮合,所述第四旋转从动齿轮组件与驱动轴组件12640的螺纹部分12644啮合。旋转传动齿轮12652在第三旋转方向上的旋转将引起驱动轴组件12640和刀杆12580在远侧方向“DD”上的轴向行进。相反,旋转传动齿轮12652在三级旋转方向(与第三旋转方向相反)上的旋转将引起驱动轴组件12640和刀杆12580在近侧方向上的运动。
现将描述操作外科工具12500的方法。一旦工具安装部分12600可操作地联接到机器人系统11000的工具架11270,则机器人系统11000可将外科端部执行器12512定位在邻近待切割和缝合的靶组织的位置。如果砧座12524尚未处于打开位置(图123),机器人系统11000可向闭合传动齿轮12622施加第二旋转输出运动,这引起刀杆12580在第二方向上的旋转。刀杆12580在第二方向上的旋转引起闭合驱动螺母12560在第二方向上的旋转。当闭合驱动螺母12560在第二方向上旋转时,闭合管12550在近侧方向“PD”上运动。当闭合管12550在近侧方向“PD”上运动时,砧座12524上的突出部12527与闭合管12550中的开口12555交接并使砧座12524枢转至打开位置。除此之外或在可供选择的实施例中,当闭合管12550回到起始位置时(图123),可使用弹簧(未示出)以将砧座12354枢转至打开位置。然后,可通过机器人系统11000操纵打开的外科端部执行器12512以将靶组织定位在打开的砧座12524和外科钉仓12534之间。然后,外科医生可通过致动机器人控制系统11000以向闭合传动齿轮12622施加第二旋转输出运动来引发闭合过程,如上所述,这最终引起闭合驱动螺母12382在第二方向上的旋转,从而引起闭合管12250在远侧方向“DD”上的轴向行进。当闭合管12550在远侧方向上运动时,其接触砧座12524的一部分并使砧座12524枢转至闭合位置,从而夹持砧座12524和钉仓12534之间的靶组织。一旦机器人控制器11001确定砧座12524已通过端部执行器12512中与之连通的相应的一个或多个传感器枢转至闭合位置,则机器人控制器11001停止向闭合传动齿轮12622施加第二旋转输出运动。机器人控制器11001还可为外科医生提供砧座12524已完全闭合的指示。然后外科医生可引发击发过程。在可供选择的实施例中,击发过程可以由机器人控制器11001自动引发。
在机器人控制器11001确定砧座12524处于闭合位置之后,然后机器人控制器11001向旋转传动齿轮12652施加第三旋转输出运动,这引起驱动轴组件12640和刀杆12580在远侧方向“DD”上的轴向运动。当切割器械12532朝远侧运动穿过外科钉仓12534时,切断夹持在其中的组织。当滑动件部分(未示出)朝远侧驱动时,其驱动外科钉仓12534中的钉穿过切断的组织,从而与砧座12524成形接触。一旦机器人控制器11001通过外科端部执行器12512中与机器人控制器11001连通的一个或多个传感器确定切割器械12532已到达外科钉仓12534内的结束位置,则机器人控制器11001停止向旋转传动齿轮12652施加第二旋转输出运动。然后,机器人控制器11001向旋转传动齿轮12652施加次旋转控制运动,这最终使切割器械12532和滑动件部分在近侧方向“PD”上轴向运动至起始位置。一旦机器人控制器1001通过端部执行器12512中与机器人控制器11001连通的一个或多个传感器确定切割器械12524已到达起始位置,则机器人控制器11001停止向旋转传动齿轮12652施加次旋转输出运动。然后,机器人控制器11001可向闭合传动齿轮12622施加次旋转输出运动,这引起刀杆12580在次方向上的旋转。刀杆12580在次方向上的旋转引起闭合驱动螺母12560在次方向上的旋转。当闭合驱动螺母12560在次方向上旋转时,闭合管12550在近侧方向“PD”上运动至打开位置。
图127-132B示出了可结合机器人系统11000有效使用的另一个外科工具12700。在各种形式中,外科工具12700包括外科端部执行器12712,所述外科端部执行器包括细长通道12722形式的“第一部分”和包括可枢转地平移的夹紧构件(例如砧座12724)形式的“第二可运动部分”,所述第一部分和第二可运动部分保持在确保有效缝合和切断夹持在外科端部执行器12712中的组织的间距处。如图示实施例中所示,外科端部执行器12712可包括除了前述通道12722和砧座12724之外的切割器械12732形式的“第三部分”、滑动件(未示出)和可移除地位于细长通道12722中的外科钉仓12734。例如,切割器械12732可以为刀。砧座12724可在连接至细长通道12722的近端的枢轴点12725处可枢转地打开和闭合。砧板12724还可包括位于其近端的突出部12727,所述突出部与机械闭合系统(以下进一步描述)的部件交接以打开和闭合砧板12724。当致动时,刀12732和滑动件沿着细长通道12722纵向行进,从而切割夹持在外科端部执行器12712中的组织。滑动件沿着细长通道12722的运动使得外科钉仓12734的钉被驱动穿过被切断的组织并且抵靠闭合的砧座12724,砧座转动钉以紧固被切断的组织。在一种形式中,细长通道12722和砧座12724可以由导电材料(诸如金属)制成,使得它们可以作为与外科端部执行器中的一个或多个传感器连通的天线的一部分,如上所述。外科钉仓12734可以由非导电材料(例如塑料)制成,并且传感器可以连接到或设置在外科钉仓12734中,如上所述。
应该指出的是,虽然本文描述的外科工具12500的实施例使用对切断的组织进行缝合的外科端部执行器12712,但是在其它实施例中,可使用用于对切断的组织进行紧固或密封的不同技术。例如,也可使用如下端部执行器,其利用射频能量或粘合剂来紧固被切断的组织。授予Yates等人的名称为“Electrosurgical Hemostatic Device”的美国专利5,709,680以及授予Yates等人的名称为“Electrosurgical Hemostatic Device WithRecessed And/Or Offset Electrodes”的美国专利5,688,270公开了使用射频能量来紧固被切断的组织的切割器械,该专利以引用的方式并入本文。授予Morgan等人的美国专利申请序列号11/267,811以及授予Shelton等人的美国专利申请序列号11/267,363公开了使用粘合剂来紧固被切断的组织的切割器械,该专利也以引用的方式并入本文。因此,虽然本文的描述涉及切割/缝合操作等,但是应当认识到,这仅是示例性实施例,并不旨在进行限制。也可以使用其它组织紧固技术。
在图示实施例中,外科端部执行器12712的细长通道12722联接到细长轴组件12708,所述细长轴组件连接到工具安装部分12900。虽然未示出,细长轴组件12708可包括关节运动接头以允许外科端部执行器12712围绕基本上横向于工具轴线LT-LT的轴线选择性地进行关节运动。在至少一个实施例中,细长轴组件12708包括中空的脊管12740,所述中空的脊管不可移除地联接到工具安装部分12900的工具安装板12902。如图128和129所示,细长通道12722的近端12723包括通过安装衬圈12790附接到脊管12740的中空的管状结构。图130中示出了安装衬圈12790的剖视图。在各种实施例中,安装衬圈12790具有能够附接至脊管12740的远端的近侧凸缘末端12791。在至少一个实施例中,例如,将安装衬圈12790的近侧凸缘末端12791焊接或胶粘到脊管12740的远端。如图128和129所示,安装衬圈12790还具有安装毂部分12792,所述安装毂部分的尺寸设定成能够容纳其上的细长通道12722的近端12723。细长通道12722的近端12723通过例如焊接、粘结等不可移除地附接到安装毂部分12792。
如图128和129所示,外科工具12700还包括闭合管12750形式的可轴向运动的致动构件,所述闭合管被限制为相对于细长通道12722进行轴向运动。闭合管12750具有近端12752,所述近端具有形成于其中的内螺纹12754,所述内螺纹与闭合驱动螺母12760形式的可旋转运动的部分螺纹接合。更具体地讲,闭合驱动螺母12760具有相对于细长通道12722和脊管12740旋转支撑的近端部分12762。出于组装目的,近端部分12762螺纹附接到保持环12770。保持环12770容纳在沟槽12729中,所述沟槽在通道12722的近端12723上的肩部12727和安装衬圈12790的安装毂12729之间形成。此装置用于将闭合驱动螺母12760旋转地支撑在通道12722内。闭合驱动螺母12760的旋转将引起闭合管12750轴向运动,如图128中的箭头“D”所示。
驱动构件延伸穿过脊管12740、安装衬圈12790和闭合驱动螺母12760,在至少一个实施例中,所述驱动构件包括具有连接到切割器械12732的远端部分12782的刀杆12780。如图128和129所示,安装衬圈12790具有穿过其中的通路12793以允许刀杆12780滑动地穿过其中。相似地,闭合驱动螺母12760中具有狭槽12764,刀杆12780可滑动地延伸穿过所述狭槽。此装置允许刀杆12780相对于闭合驱动螺母12760进行轴向运动。
通过旋转从动闭合轴12800来控制砧座12724的致动。如图128和129所示,闭合驱动轴12800的远端部分12802延伸穿过安装衬圈12790中的通路12794,并且闭合齿轮12804附接至其。闭合齿轮12804能够与闭合驱动螺母12760的内表面12761驱动接合。因此,闭合轴12800的旋转也将引起闭合驱动螺母12760的旋转。闭合管12750运动的轴向最终取决于闭合轴12800和闭合驱动螺母12760旋转的方向。例如,响应于接收自机器人系统11000的一个旋转闭合运动,将在远侧方向“DD”上驱动闭合管12750。当闭合管12750朝远侧驱动时,开口12745将接合砧座12724上的突出部12727并使砧座12724枢转至闭合位置。当施加来自机器人系统11000的开放式旋转输出运动时,闭合管12750将在近侧方向“PD”上被驱动并且将砧座12724枢转至打开位置。在各种实施例中,可使用弹簧(未示出)以将砧座12724偏置至打开位置(图128)。
在使用中,围绕纵向工具轴线LT-LT旋转外科端部执行器12712可能是有利的。在至少一个实施例中,工具安装部分12900能够接收来自机器人系统11000的相应的第一旋转输出运动以使细长轴组件12708围绕纵向工具轴线LT-LT旋转。如图132所示,中空的脊管12740的近端12742可旋转地支撑在支架装置12903和轴承组件12904中,所述支架装置和轴承组件附接到工具安装部分12900的工具安装板12902。旋转齿轮12744形成于或附接到脊管12740的近端12742,以与可操作地支撑在工具安装板12902上的旋转驱动组件12910啮合。在至少一个实施例中,当工具安装部分12600联接到工具架11270时,旋转传动齿轮12912连接到工具安装板12602的适配器侧上相应的从动盘或从动元件11304中的第一个。参见图105和132。旋转驱动组件12910还包括旋转从动齿轮12914,所述旋转从动齿轮可旋转地支撑在工具安装板12902上,与旋转齿轮12744和旋转传动齿轮12912啮合。将来自机器人系统11000的第一旋转控制运动通过工具架11270和适配器11240施加到相应的从动元件11304,从而将通过可操作地联接至其而引起旋转传动齿轮12912的旋转。旋转传动齿轮12912的旋转最终导致细长轴组件12708(和端部执行器2712)围绕纵向工具轴线LT-LT旋转(主旋转运动)。
通过在远侧方向“DD”上使闭合管12750轴向运动来实现砧座12724相对于钉仓12734的闭合。通过向闭合驱动螺母12760施加旋转控制运动来实现闭合管12750在远侧方向“DD”上的轴向运动。在各种实施例中,通过施加旋转输出运动到闭合驱动轴12800来转动闭合驱动螺母12760。如图132所示,闭合驱动轴12800的近端部分12806上具有与闭合驱动组件12920啮合的从动齿轮12808。在各种实施例中,闭合驱动系统12920包括闭合传动齿轮12922,当工具安装部分12900联接到工具架11270时,所述闭合传动齿轮联接到工具安装板12462的适配器侧上相应的从动旋转主体或从动元件11304中的第二个。参见图105和132。闭合传动齿轮12922以与闭合齿轮系(一般描述为12923)啮合的方式被支撑。在至少一种形式中,闭合齿轮系12923包括可旋转地支撑在工具安装板12902上的第一从动闭合齿轮12924。通过驱动轴12928将第一闭合从动齿轮12924附接到第二闭合从动齿轮12926。第二闭合从动齿轮12926与行星齿轮组件12930啮合。在各种实施例中,行星齿轮组件12930包括可旋转地支撑在轴承组件12904中的从动行星闭合齿轮12932,所述轴承组件安装在工具安装板12902上。如图132和132B所示,闭合驱动轴12800的近端部分12806可旋转地支撑在脊管12740的近端部分12742中,使得从动齿轮12808与行星齿轮12932上形成的中心齿轮齿12934啮合。如图132A所示,两个另外的支撑齿轮12936附接到或旋转地支撑在脊管12740的近端部分12742以向其提供轴承支撑。此具有行星齿轮组件12930的装置用于通过旋转驱动组件12910适应脊轴12740的旋转,同时允许闭合从动齿轮12808与闭合驱动系统12920保持啮合。另外,闭合传动齿轮12922在第一方向上的旋转将最终引起闭合驱动轴12800和闭合驱动螺母12760的旋转,这将最终导致砧座12724闭合,如上所述。反之,闭合传动齿轮12922在第二相反方向上的旋转将最终引起闭合驱动螺母12760在相反方向上的旋转,这将使砧座12724打开。
如图126所示,刀杆12780的近端12784具有与之附接并与刀驱动组件12940驱动接合的螺纹轴部分12786。在各种实施例中,螺纹轴部分12786通过附接到工具安装板12902的轴承12906旋转地支撑。此装置允许螺纹轴部分12786相对于工具安装板12902旋转和轴向运动。刀杆12780通过刀驱动组件12940在远侧和近侧方向上轴向推进。一种形式的刀驱动组件12940包括旋转传动齿轮12942,当工具安装部分12900联接到工具架11270时,所述旋转传动齿轮联接到工具安装板12902的适配器侧上相应的旋转主体、从动盘或从动元件11304中的第三个。参见图105和132。旋转传动齿轮12942与刀齿轮系(一般描述为12943)啮合。在各种实施例中,刀齿轮系12943包括可旋转地支撑在工具安装板12902上的第一旋转从动齿轮组件12944。第一旋转从动齿轮组件12944与第三旋转从动齿轮组件12946啮合,所述第三旋转从动齿轮组件可旋转地支撑在工具安装板12902上并且与第四旋转从动齿轮组件12948啮合,所述第四旋转从动齿轮组件与刀杆12780的螺纹部分12786啮合。旋转传动齿轮12942在一个方向上的旋转将引起刀杆12780在远侧方向“DD”上的轴向推进。相反,旋转传动齿轮12942在相反方向上的旋转将引起刀杆12780在近侧方向上的运动。否则,可使用工具12700,如上所述。
图133和134示出了基本上与上文详细描述的工具12700相同的外科工具实施例12700’。然而,工具12700’包括压力传感器12950,所述压力传感器能够向机器人控制器11001提供关于砧座12724受到的夹紧压力的量的反馈。在各种实施例中,例如,压力传感器可包括弹簧偏置的接触开关。对于连续信号而言,可使用其上具有应变计的悬臂梁或内部有应变计的圆顶按钮盖。另一种产品形式可包括仅以已知的所需负载接触的断路开关。此装置可包括基座上的圆顶,其中该圆顶为一个电极并且基座为另一个电极。此装置允许机器人控制器11001通过调节施加到砧座12724的闭合压力的量来调节施加到外科端部执行器12712内组织的夹紧压力的量。本领域的普通技术人员将会理解,此压力传感器装置可与本文所述的若干外科工具实施例以及它们的等价结构一起有效地使用。
图135示出了可结合机器人系统11000有效使用的另一个外科工具13000的一部分。外科工具13003采用一个或多个机载马达以为外科端部执行器切割器械的各种部件提供动力。在至少一个非限制性的实施例中,例如,外科工具13000包括直线切割器(未示出)形式的外科端部执行器,其具有上述类型和构造的砧座(未示出)和外科钉仓装置(未示出)。外科工具13000还包括上述类型的细长轴(未示出)和砧座闭合装置(未示出)。因而,除了必须理解外科工具13000的各种实施例的独特和新颖属性之外,此部分的具体实施方式将不重复对那些部件的描述。
在所示的实施例中,端部执行器包括联接到刀杆13003的切割器械13002。如图135可见,外科工具13000包括工具安装部分13010,所述工具安装部分包括能够与适配器部分11240’以安装方式交接的工具安装板13012,所述适配器部分以上述各种方式联接到机器人系统11000。工具安装部分13010能够可操作地将传动装置13013支撑于其上。在至少一个实施例中,适配器部分11240’在适配器11240没有采用动力旋转主体和盘构件的情况下可能与上文中详细描述的适配器部分11240相同。在其他实施例中,适配器部分11240’可能与适配器部分11240相同。被视为在本发明的各种形式的精神和范围内的其他修改形式可以采用一种或多种来自工具架部分11270(如在上文中所述)的机械运动(即,旋转运动)以激活/致动传动装置13013,同时还使用一个或多个在工具安装部分13010内的马达以为外科端部执行器的其他部件提供动力。另外,虽然所示实施例的端部执行器包括直线切割器,但是本领域的普通技术人员将会知道,在不脱离本发明的各种形式的实质和范围的情况下可结合其他类型的外科端部执行器有效地使用所示实施例的独特和新颖属性。
在各种实施例中,工具安装板13012能够至少容纳第一击发马达13011以为刀杆13003提供击发和回缩运动,所述刀杆连接到切割器械13002或与切割器械13002可操作地交接。工具安装板13012具有一系列电连接销13014,所述电连接销能够与适配器11240’中的狭槽11258(图104)交接。此装置允许机器人系统11000的控制器11001为外科工具13000的电子控制电路13020提供控制信号。虽然结合机械耦合元件、电耦合元件和磁力耦合元件在本文中描述了接口,应当理解,可使用多种遥测形式,包括红外、电感耦合等。
控制电路13020在图135中以图解示意图的形式示出。在一种形式或实施例中,控制电路13020包括电池13022形式的电源,所述电池连接到通断螺线管电源开关13024。控制电路13020还包括连接到双极开关13028的通断击发螺线管13026以用于控制马达13011的旋转方向。因而,当机器人系统11000的控制器11001提供适当的控制信号时,开关13024将允许电池13022为双极开关13028提供电力。机器人系统11000的控制器11001还将为双极开关13028提供适当的信号,从而为马达13011提供电力。当期望击发外科端部执行器(即,朝远侧驱动切割器械13002穿过夹持在外科端部执行器中的组织)时,双极开关13028将处于第一位置。当期望将切割器械13002回缩至起始位置时,双极开关13028将通过控制器11001运动至第二位置。
外科工具13000的各种实施例还采用尺寸设定成与击发齿轮系13031结合的齿轮箱13030,在至少一个非限制性实施例中,所述击发齿轮系包括击发传动齿轮13032,所述击发传动齿轮与击发从动齿轮13034啮合以生成所需量的驱动力,从而驱动切割器械13002穿过组织并以本文所述的各种方式驱动和形成钉。在图135中示出的实施例中,从动齿轮13034连接到与螺母装置13038螺纹接合的螺杆轴13036,限制所述螺母装置进行轴向运动(由箭头“D”表示)。将螺母装置13038附接到击发杆13003。因而,通过在第一方向上旋转螺杆轴13036在远侧方向“DD”上驱动切割器械13002,并通过在相反的第二方向上旋转螺杆轴可以在近侧方向“PD”上回缩切割器械13002。
图136示出了另一个基本上与上述工具13000相同的外科工具13000’的一部分,不同的是从动齿轮13034附接到驱动轴13040。将驱动轴13040附接到与第三从动齿轮13044啮合的第二传动齿轮13042,所述第三从动齿轮与连接到击发杆13003的螺钉13046啮合。
图137示出了可结合机器人系统11000有效使用的另一个外科工具13200。在该实施例中,外科工具13200包括非限制性形式的外科端部执行器13212,所述外科端部执行器包括相对于至少一个其他端部执行器部件部分在第一位置和第二位置之间选择性运动的部件部分。如将在下文中进一步详细地描述,外科工具13200采用机载马达以为传动装置13305的各种部件提供动力。外科端部执行器13212包括可操作地支撑外科钉仓13234的细长通道13222。细长通道13222具有可滑动地延伸到中空的细长轴组件13208中的近端13223,所述中空的细长轴组件连接到工具安装部分13300。另外,外科端部执行器13212包括通过一对耳轴13225可枢转地连接到细长通道13222的砧座13224,所述耳轴容纳在细长通道13222中相应的开口13229内。轴组件13208的远端部分13209包括开口13245,当细长通道13222相对于轴组件13208的远端部分13209在近侧方向“PD”上轴向运动时,砧座13224上的突出部13227插入到所述开口中以打开砧座13224。在各种实施例中,可以使用弹簧(未示出)以将砧座13224偏置至打开位置。
如上所述,外科工具13200包括工具安装部分13300,所述工具安装部分包括配置成可操作地支撑传动装置13305并与适配器部分11240’安装连接的工具安装板13302,所述适配器部分以上述各种方式连接到机器人系统11000。在至少一个实施例中,适配器部分11240’在没有适配器11240采用的动力盘构件的情况下可能与上文中详细描述的适配器部分11240相同。在其他实施例中,适配器部分11240’可能与适配器部分11240相同。然而,在此实施例中,因为外科端部执行器13212的各种部件全部由工具安装部分13300中的马达提供电力,外科工具13200将不采用或需要来自工具架部分11270的任何机械(即,非电力的)致动运动以为外科端部执行器13200部件提供动力。被视为在本发明的各种形式的精神和范围内的其他修改形式可以采用一种或多种来自工具架部分11270(如在上文中所述)的机械运动以激活/致动一个或多个外科端部执行器部件,同时还使用一个或多个在工具安装部分内的马达以为外科端部执行器的其他部件提供动力。
在各种实施例中,工具安装板13302配置成支撑第一击发马达13310以用于为传动装置13305提供将击发和回缩运动,从而驱动连接到上述类型的切割器械13332的刀杆13335。如图137所示,工具安装板13212具有一系列电连接销13014,所述电连接销配置成与适配器11240’中的狭槽11258(图104)连接。此装置允许机器人系统11000的控制器11001为外科工具13200的电子控制电路13320、13340提供控制信号。虽然结合机械耦合元件、电耦合元件和磁力耦合元件在本文中描述了接口,应当理解,可以使用多种遥测形式,包括红外的、电感耦合等。
在一种形式或实施例中,第一控制电路13320包括第一电池13322形式的第一电源,所述第一电池连接到第一通断螺线管电源开关13324。第一击发控制电路13320还包括第一通断击发螺线管13326,所述第一通断击发螺线管联接到第一双极开关13328以控制第一击发马达13310的旋转方向。因而,当机器人控制器11001提供适当的控制信号时,第一开关13324将允许第一电池13322为第一双极开关13328提供电力。机器人控制器11001还将为第一双极开关13328提供适当的信号,从而为第一击发马达13310提供电力。当期望击发外科端部执行器(即,朝远侧驱动切割器械13232穿过夹持在端部执行器13212中的组织)时,第一开关13328将通过机器人控制器11001设置在第一位置。当期望将切割器械13232回缩至起始位置时,机器人控制器11001将发送适当的控制信号以使第一开关13328运动至第二位置。
外科工具13200的各种实施例还采用尺寸设定成与附接的击发传动齿轮13332结合的第一齿轮箱13330,所述击发传动齿轮可操作地与击发齿轮系13333交接。在至少一个非限制性实施例中,击发齿轮系13333包括击发从动齿轮13334,所述击发从动齿轮与传动齿轮13332啮合以生成所需量的驱动力,从而驱动切割器械13232穿过组织并以本文中所述的各种方式驱动和形成钉。在图137示出的实施例中,从动齿轮13334联接到驱动轴13335,所述驱动轴具有与之联接的第二从动齿轮13336。第二从动齿轮13336以与第三从动齿轮13337啮合的方式被支撑,所述第三从动齿轮与第四从动齿轮13338啮合。第四从动齿轮13338与刀杆13235的螺纹近侧部分13339啮合,限制所述刀杆进行轴向运动。因而,通过在第一方向上旋转驱动轴13335,在远侧方向“DD”上驱动切割器械13232并在相反的第二方向上旋转驱动轴13335,切割器械13232可在近侧方向“PD”上回缩。
如上所述,通过相对于细长轴组件13208使细长通道13222轴向运动来控制砧座13224的打开和闭合。细长通道13222的轴向运动由闭合控制系统13339控制。在各种实施例中,闭合控制系统13339包括闭合轴13340,所述闭合轴具有与螺纹闭合杆13342通过螺纹接合的中空的螺纹端部13341。螺纹端部13341可旋转地支撑在脊轴13343中,所述脊轴可操作地与工具安装部分13300交接并延伸穿过轴组件13208的一部分,如图所示。闭合系统13339还包括闭合控制电路13350,所述闭合控制电路包括第二电池13352形式的第二电源,所述第二电池联接到第二通断螺线管电源开关13354。闭合控制电路13350还包括第二通断击发螺线管13356,所述第二通断击发螺线管连接到第二双极开关13358以控制第二闭合马达13360的旋转。因而,当机器人控制器11001提供适当的控制信号时,第二开关13354将允许第二电池13352为第二双极开关13354提供电力。机器人控制器11001还将为第二双极开关13358提供适当的信号,从而为第二马达13360提供电力。当期望闭合砧座13224时,第二开关13348将处于第一位置。当期望打开砧座13224时,第二开关13348将运动至第二位置。
工具安装部分13300的各种实施例还采用联接到闭合传动齿轮13364的第二齿轮箱13362。闭合传动齿轮13364与闭合齿轮系13363啮合。在各种非限制性形式中,闭合齿轮系13363包括附接到闭合驱动轴13366的闭合从动齿轮13365。与附接到闭合轴13340的闭合轴齿轮13360啮合的闭合传动齿轮13367也附接到闭合驱动轴13366。图137示出了处于打开位置的端部执行器13212。如上所述,当螺纹闭合杆13342处于图137中示出的位置时,弹簧(未示出)将砧座13224偏置至打开位置。当期望闭合砧座13224时,机器人控制器11001将启动第二马达13360以旋转闭合轴13340,从而在近侧方向‘PD’上牵拉螺纹闭合杆13342和通道13222。当砧座13224与轴13208的远端部分13209接触时,砧座13224枢转至闭合位置。
现将描述操作外科工具13200的方法。一旦工具安装部分13302可操作地联接到机器人系统11000的工具架11270,机器人系统11000可将端部执行器13212定位在邻近待切割和缝合的靶组织的位置。如果砧座13224尚未处于打开位置,则机器人控制器11001可启动第二闭合马达13360以在远侧方向上将通道13222驱动至图137中示出的位置。一旦机器人控制器11001通过在端部执行器和/或工具安装部分13300中的一个或多个传感器确定外科端部执行器13212已处于打开位置,则机器人控制器11001可为外科医生提供信号,从而通知外科医生随后可闭合砧座13224。一旦靶组织定位在打开的砧座13224和外科钉仓13234之间,则外科医生可通过启动机器人控制器11001以向第二闭合马达13360施加闭合控制信号来开始闭合过程。第二闭合马达13360向闭合轴13340施加旋转运动,以在近侧方向“PD”上牵拉通道13222直到砧座13224枢转至闭合位置。一旦机器人控制器11001通过在端部执行器13212和/或与机器人控制系统连通的工具安装部分13300中的一个或多个传感器确定砧座13224已运动至闭合位置,则马达13360可被停止。然后,可通过外科医生启动控制器11001上的触发器、按钮等手动开始击发过程,或控制器11001可自动地开始击发过程。
为了开始击发过程,机器人控制器11001启动击发马达13310以在远侧方向“DD”上驱动击发杆13235和切割器械13232。一旦机器人控制器11001通过在外科端部执行器13212和/或马达驱动部分13300中的传感器确定切割器械13232已运动至外科钉仓13234中的结束位置,则机器人控制器11001可为外科医生提供指示信号。然后,外科医生可手动启动第一马达13310以回缩切割器械13232至起始位置,或机器人控制器11001可自动地启动第一马达13310以回缩切割元件13232。
图137中示出的实施例不包括关节运动接头。图138和139示出了分别具有端部执行器13212’,13212”的外科工具13200’和13200,所述端部执行器可与具有本文所公开的各种类型的关节运动接头的细长轴实施例一起使用。例如,如图138所示,螺纹闭合轴13342通过柔性缆线或其他柔性构件13345联接到细长通道13222的近端13223。关节运动接头(未示出)在细长轴组件13208中的位置将与柔性构件13345一致,从而使柔性构件13345适应此关节运动。另外,在上述的实施例中,柔性构件13345可旋转地附连到细长通道13222的近端部分13223以使柔性构件13345相对于其旋转,从而防止柔性构件13229相对于通道13222“卷绕”。虽然未示出,可通过刀杆以上述方式中的一者来驱动切割元件,所述刀杆也可适应细长通道组件的关节运动。图139示出了基本上与上述外科端部执行器13212相同的外科端部执行器13212”,不同的是螺纹闭合杆13342附接到闭合螺母13347,限制所述闭合螺母仅在细长轴组件13208内进行轴向运动。将柔性构件13345附接到闭合螺母13347。此装置还防止螺纹闭合杆13342卷绕柔性构件13345。可采用柔性刀杆13235’以利于外科端部执行器13212”的关节运动。
上述外科工具13200,13200’和13200”也可采用本文所述的切割器械实施例中的任何一个。如上所述,通过牵拉细长通道至与细长轴组件的远端接触来闭合这些工具的每个端部执行器的砧座。因此,一旦靶组织位于钉仓13234和砧座13224之间,机器人控制器11001可开始向内牵拉通道13222至轴组件13208中。然而,在各种实施例中,为了防止端部执行器13212,13212’,13212”在该闭合过程中使靶组织随着端部执行器运动,控制器11001可同时使工具架运动并最终使工具运动以补偿细长通道13222的运动,从而使靶组织实际上被夹持在砧座和细长通道之间而不被移动。
图140-142示出了除了下文描述的差异之外基本上与上述外科工具13200”相同的另一个外科工具实施例13201。在该实施例中,螺纹闭合杆13342’具有可变节距的沟槽。更具体地讲,如图141所示,闭合杆13342’具有远侧沟槽部分13380和近侧沟槽部分13382。远侧沟槽部分13380和近侧沟槽部分13382能够与支撑在中空的螺纹端部13341’中的凸耳13390相接合。如图141所示,远侧沟槽部分13380具有比近侧沟槽部分13382更细小的节距。因此,此可变节距装置通过凸耳13390和近侧沟槽部分13382之间的接合而允许细长通道13222以第一速度或速率被牵拉到轴13208中。当凸耳13390接合远侧沟槽部分时,通道13222将以第二速度或速率被牵拉到轴13208中。因为近侧沟槽部分13382比远侧沟槽部分13380更粗糙,第一速度将大于第二速度。此装置用于加速端部执行器的初始闭合以用于操纵组织,然后在将组织准确地定位在其中之后,生成适当夹持组织以对组织进行切割和缝合的闭合力的大小。因此,砧座13234最初以较小的力快速闭合,然后随着砧座更慢闭合而施加更大的闭合力。
在将组织完全夹持在所需位置以对齐进行切割和缝合之前,可利用外科端部执行器打开和闭合运动以允许使用者使用端部执行器抓持和操纵组织。例如,使用者可在该过程中多次打开和闭合外科端部执行器以将端部执行器定位在使组织被保持在所需位置的适当的位置。因此,在至少一些实施例中,为了生成用于击发的高负载,细牙螺纹可能需要多达5至10次完全旋转以生成必要的负载。在一些情况下,例如,该动作可能花费长达2至5秒。如果在定位/组织操纵过程中每次也花费等长的时间打开和闭合端部执行器,则定位端部执行器可能花费过长的时间。如果出现这种情况,使用者可能放弃使用端部执行器以使用常规的抓紧器装置。使用抓紧器等可不利地增加与完成外科手术相关的成本。
上述实施例采用一个或多个电池以为用于驱动端部执行器部件的马达提供电力。通过机器人系统11000控制马达的启动。在可供选择的实施例中,电源可包括由机器人系统11000为马达提供的交流电“AC”。即,交流电可由通过工具架和适配器为机器人系统11000提供电力的系统供给。在其他实施例中,电源线或绳可附接到工具安装部分13300以提供所需的来自单独的交流电源或直流电源的电能。
在使用中,控制器11001施加主旋转运动至闭合轴13340(图137)以向内轴向牵拉细长通道13222至细长轴组件13208中,并以第一速率使砧座从第一位置运动至中间位置,所述中间位置对应于其中远侧沟槽部分13380过渡到近侧沟槽部分13382的点。进一步将旋转运动施加到闭合轴13340将使砧座相对于外科钉仓从中间位置运动至闭合位置。当处于闭合位置时,待切割和缝合的组织被适当地夹持在砧座和外科钉仓之间。
图143-147示出本发明的另一个外科工具实施例13400。该实施例包括从工具安装部分13500延伸的细长轴组件13408。细长轴组件13408包括可旋转的近侧闭合管段13410,所述可旋转的近侧闭合管段可旋转地连接在近侧脊构件13420上,该近侧脊构件刚性地联接到工具安装部分13500的工具安装板13502。近侧脊构件13420具有远端13422,所述远端联接到外科端部执行器13412的细长通道部分13522。例如,在至少一个实施例中,细长通道部分13522具有端部分13523,所述端部分“以钩的形式接合”脊构件13420的远端13422。细长通道13522能够支撑其中的外科钉仓13534。该实施例可使用本文所公开的各种切割器械实施例中的一个来切断夹持在外科端部执行器13412中的组织,并将钉仓13534中的钉击发至切断的组织中。
外科端部执行器13412具有通过一对耳轴13525可枢转地连接到细长通道13522的砧座13524,所述耳轴容纳在细长通道13522中相应的开口13529内。砧座13524通过远侧闭合管段13430在打开位置(图143)和闭合位置(图144-146)之间运动。远侧闭合管段13430的远端部分13432包括开口13445,当远侧闭合管段13430相对于其进行轴向运动时,砧座13524上的突出部13527插入到所述开口中以打开和闭合砧座13524。在各种实施例中,将开口13445成形以使得当闭合管段13430在近侧方向上运动时,闭合管段13430使砧座13524枢转至打开位置。除此之外或作为另外一种选择,可使用弹簧(未示出)以将砧座13524偏置至打开位置。
如图143-146所示,远侧闭合管段13430包括凸耳13442,所述凸耳从其远端13440延伸至与可旋转的近侧闭合管段13410的远端13412中形成的可变节距沟槽/螺纹13414进行螺纹接合。可变节距沟槽/螺纹13414具有远侧部分13416和近侧部分13418。远侧沟槽/螺纹部分13416的节距小于近侧沟槽/螺纹部分13418的节距。如图143-146所示,通过轴向保持器销13450限制远侧闭合管段13430相对于脊构件13420进行轴向运动,所述轴向保持器销容纳在脊构件13420的远端中的轴向狭槽13424中。
如上所述,通过旋转近侧闭合管段13410打开和闭合砧座12524。可变节距螺纹装置通过凸耳13442和近侧沟槽/螺纹部分13418之间的接合而允许以第一速度或速率在远侧方向“DD”上驱动远侧闭合管段13430。当凸耳13442接合远侧沟槽/螺纹部分13416时,将以第二速度或速率在远侧方向上驱动远侧闭合管段13430。因为近侧沟槽/螺纹部分13418比远侧沟槽/螺纹部分13416更粗糙,第一速度将大于第二速度。
在至少一个实施例中,工具安装部分13500能够接收来自机器人控制器11001的相应的第一旋转运动,并将该第一旋转运动转化成主旋转运动,以使可旋转的近侧闭合管段13410围绕纵向工具轴线LT-LT旋转。如图147所示,近侧闭合管段13410的近端13460可旋转地支撑在附接到工具安装部分13500的工具安装板13502的支架装置13504中。旋转齿轮13462形成于或附接到闭合管段13410的近端13460,以与可操作地支撑在工具安装板13502上的旋转驱动组件13470啮合。在至少一个实施例中,当工具安装部分13500连接到工具架11270时,旋转传动齿轮13472联接到工具安装板13502的适配器侧上相应的从动盘或从动元件11304中的第一个。参见图105和146。旋转驱动组件13470还包括旋转从动齿轮13474,所述旋转从动齿轮可旋转地支撑在工具安装板13502上,与旋转齿轮13462和旋转传动齿轮13472啮合。将来自机器人控制器11001的第一旋转控制运动通过工具架11270和适配器11240施加到相应的从动元件11304,从而将通过可操作地联接至其而引起旋转传动齿轮13472的旋转。旋转传动齿轮13472的旋转最终引起闭合管段13410的旋转,从而打开和闭合砧座13524,如上所述。
如上所述,外科端部执行器13412采用上述类型和构造的切割器械。图147示出了用于轴向推进刀杆13492的刀驱动组件13480的一种形式,所述刀杆附接到该切割器械。一种形式的刀驱动组件13480包括旋转传动齿轮13482,当工具驱动部分13500联接到工具架11270时,所述旋转传动齿轮联接到工具安装板13502的适配器侧上相应的从动盘或从动元件11304中的第三个。参见图105和147。刀驱动组件13480还包括可旋转地支撑在工具安装板15200上的第一旋转从动齿轮组件13484。第一旋转从动齿轮组件13484与第三旋转从动齿轮组件13486啮合,所述第三旋转从动齿轮组件可旋转地支撑在工具安装板13502上并与第四旋转从动齿轮组件13488啮合,所述第四旋转从动齿轮组件与联接到刀杆13492的驱动轴组件13490的螺纹部分13494啮合。旋转传动齿轮13482在第二旋转方向上的旋转将引起驱动轴组件13490和刀杆13492在远侧方向“DD”上的轴向行进。相反,旋转传动齿轮13482在次旋转方向(与第二旋转方向相反)上的旋转将引起驱动轴组件13490和刀杆13492在近侧方向上的运动。
图148-157示出了可结合机器人系统11000使用的本发明的另一个外科工具13600实施例。如图148所示,工具13600包括一次性加载单元13612形式的端部执行器。可结合工具13600使用的一次性加载单元的各种形式在例如名称为“End Effector ArrangementsFor a Surgical Cutting and Stapling Instrument”的美国专利申请公布US2009/0206131A1中公开,该专利的公开内容全文以引用的方式并入本文。
在至少一种形式中,一次性加载单元13612包括砧座组件13620,所述砧座组件被支撑以相对于可操作地支撑其中的钉仓13640的载体13630而枢转行进。安装组件13650可枢转地联接到仓载体13630,以使载体13630围绕关节运动轴线AA-AA相对于纵向工具轴线LT-LT枢转。参见图153,安装组件13650包括上部安装部分13652和下部安装部分13654。每个安装部分包括在其每个侧面上的螺纹镗孔13656,所述螺纹镗孔的尺寸设定成能够容纳螺栓(未示出)以固定载体13630的近端。一对中心定位的枢转构件13658通过一对联接构件13660在上部安装部分和下部安装部分之间延伸,所述联接构件与外壳部分13662的远端接合。每个联接构件13660均包括互锁近侧部分13664,所述互锁近侧部分能够容纳于在外壳部分13662的近端中形成的凹槽13666中,从而使安装组件13650和外壳部分13662保持在相对于其的纵向固定位置。
在各种形式中,一次性加载单元13614的外壳部分13662包括包含在外部壳体13674内的上半部外壳13670和下半部外壳13672。上半部外壳13670的近端包括用于以可释放的方式接合细长轴13700和插入尖端13678的接合块13676。接合块13676与细长轴13700的远端形成卡口型的联接,这将在下文中进一步详细地描述。外壳半部13670,13672限定用于可滑动地容纳轴向驱动组件13680的通道13674。第二关节运动连接件13690的尺寸设定成可滑动地定位于在外壳半部13670,13672之间形成的狭槽13679中。将一对防爆板13691设置在邻近与轴向驱动组件13680的远端相邻的外壳部分13662的远端,以防止在载体13630的关节运动过程中驱动组件13680向外凸出。
在各种实施例中,第二关节运动连接件13690包括至少一个细长金属板。优选地,堆叠两个或更多个金属板以形成连接件13690。关节运动连接件13690的近端包括钩部分13692,所述钩部分能够接合延伸穿过细长轴13700的第一关节运动连接件13710。第二关节运动连接件13690的远端包括套环13694,所述套环的尺寸设定成能够接合安装组件13650上形成的凸起。凸起与枢轴销13658横向错开,使得第二关节运动连接件13690的线性运动促使安装组件13650围绕枢轴销13658枢转,从而使载体13630进行关节运动。
在各种形式中,轴向驱动组件13680包括细长的驱动横梁13682,所述细长的驱动横梁包括远侧工作头13684和近侧接合部分13685。驱动横梁13682可由单个材料片或优选地多个堆叠的片材制成。接合部分13685包括一对接合指状物,所述接合指状物的尺寸设定成并配置成以安装方式接合驱动构件13686中形成的一对相应的保持狭槽。驱动构件13686包括近侧通道口13687,当一次性加载单元13614的近端与外科工具13600的细长轴13700接合时,所述近侧通道口能够容纳控制杆12720的远端13722(参见图157)。
参见图148和155-157,为了使用外科工具13600,首先将一次性加载单元13612固定到细长轴13700的远端。应当理解,外科工具13600可包括关节运动或非关节运动的一次性加载单元。为了将一次性加载单元13612固定到细长轴13700,将控制杆13720的远端13722插入到一次性加载单元13612的插入尖端13678中,并且插入尖端13678在图155中箭头“A”示出的方向上纵向滑动到细长轴13700的远端,使得第二关节运动连接件13690的钩部分13692在细长轴13700中的通道13702内滑动。每个接合块13676将在细长轴13700各自的通道(未示出)中对齐。当钩部分13692接合通道13702的近侧壁13704时,一次性加载单元13612在图154和157中箭头“B”示出的方向上旋转以使第二关节运动连接件13690的钩部分13692运动至与第一关节运动连接件13710的指状物13712接合。接合块13676还在细长轴13700中的环形通道13703内形成“卡口式”联接。在加载单元13612的旋转过程中,接合块13676接合挡板13730的凸轮表面13732(图155),以首先在图155中箭头“C”示出的方向上移动板13730以便将接合构件13734锁定在控制杆13720的凹槽13721中,从而防止控制杆13720在一次性加载单元13612的附接过程中纵向运动。在最终程度的旋转过程中,接合块13676从凸轮表面13732脱离以允许挡板13730在图154和157中箭头“D”示出的方向上从接合构件13734的后面运动,从而再次允许控制杆13720纵向运动。虽然上述附接方法反映了相对于细长轴13700操纵一次性加载单元13612,但是本领域的普通技术人员将会知道,一次性加载单元13612可支撑在固定位置,并且机器人系统11000可相对于一次性加载单元13612操纵细长轴部分13700,从而实现上述连接过程。
图158示出了可附接在具有细长轴13700’的卡口式装置中的另一个一次性加载单元13612’,所述细长轴除了下文所述差异之外基本上与轴13700相同。如图158所示,细长轴13700’具有延伸其至少一部分的狭槽13705,并且所述狭槽能够容纳其中的接合块13676。在各种实施例中,一次性加载单元13612’包括从其延伸的臂13677,在一次性加载单元13612’旋转之前,所述臂可与从外壳部分13662延伸的接合块13676对齐或至少基本上对齐。在至少一个实施例中,例如,当一次性加载单元13612’插入到细长轴13700’中时,臂13677和接合块13676可插入到细长轴13700’中的狭槽13705中。当一次性加载单元13612’旋转时,可将臂13677充分地限制在狭槽13705内,使得狭槽13705可将臂保持在适当的位置,然而接合块13676可被定位为使得其不被限制在狭槽13705内并可相对于臂13677旋转。当旋转时,关节运动连接件13690的钩部分13692与延伸穿过细长轴13700’的第一关节运动连接件13710接合。
可使用将一次性加载单元联接到细长轴的末端的其他方法。例如,如图159和160所示,一次性加载单元13612”可包括能够与细长轴13700”的连接器部分13740接合的连接器部分13613。在至少一个实施例中,连接器部分13613可包括可与连接器部分13740的至少一个突出和/或沟槽配合的至少一个突出和/或沟槽。在至少一个此类实施例中,连接器部分可包括协作的燕尾部分。在各种实施例中,连接器部分能够彼此互锁,并且防止(或至少抑制)一次性加载单元13612”沿着轴线13741进行远侧和/或近侧运动。在至少一个实施例中,轴向驱动组件13680’的远端可包括小孔13681,所述小孔能够容纳从控制杆13720’延伸的突出13721。在各种实施例中,此装置可允许一次性加载单元13612”在不与轴线13741共线或平行的方向上组装到细长轴13700。虽然未示出,轴向驱动组件13680’和控制杆13720可包括任何其他合适的突出和小孔装置以可操作地彼此连接。另外在该实施例中,第一关节运动连接件13710可操作地与第二关节运动连接件13690接合。
如图148和161所示,外科工具13600包括工具安装部分13750。工具安装部分13750包括能够连接至工具驱动组件11010的工具安装板13751。工具安装部分可操作地将传动装置13752支撑于其上。在使用中,围绕由细长轴13700限定的纵向工具轴线旋转一次性加载单元13612可能是有利的。在至少一个实施例中,传动装置13752包括旋转的传输组件13753,所述旋转的传输组件能够接收来自机器人系统11000的工具驱动组件11010的对应的旋转输出运动,并将此旋转输出运动转化成旋转控制运动以使细长轴13700(和一次性加载单元13612)围绕纵向工具轴线LT-LT旋转。如图161所示,细长轴13700的近端13701可旋转地支撑在支架装置13754中,所述支架装置附接到工具安装部分13750的工具安装板13751。旋转齿轮13755形成于或附接到细长轴13700的近端13701,以与可操作地支撑在工具安装板13751上的旋转齿轮组件13756啮合。在至少一个实施例中,当工具安装部分13750联接到工具驱动组件11010时,旋转传动齿轮13757驱动地联接到工具安装板13751的适配器侧上相应的从动盘或从动元件11304中的第一个。旋转的传输组件13753还包括旋转从动齿轮13758,所述旋转从动齿轮以与旋转齿轮13755和旋转传动齿轮13757啮合的方式可旋转地支撑在工具安装板13751上。将来自机器人系统11000的第一旋转输出运动通过工具驱动组件11010施加到相应的从动元件11304,从而将通过可操作地联接至其而引起旋转传动齿轮13757的旋转。旋转传动齿轮13757的旋转最终致使细长轴组件13700(和一次性加载单元13612)围绕纵向工具轴线LT-LT旋转(主旋转运动)。
如图161所示,将驱动轴组件13760联接到控制杆12720的近端。在各种实施例中,控制杆12720通过刀/闭合驱动传动装置13762在远侧和近侧方向上轴向行进。一种形式的刀/闭合驱动组件13762包括旋转传动齿轮13763,当工具安装部分13750联接到工具架11270时,所述旋转传动齿轮联接到工具安装板13751的适配器侧上相应的从动旋转主体部分、盘或元件11304中的第二个。旋转从动齿轮13763与齿轮系(一般描述为13764)驱动啮合。在至少一种形式中,齿轮系13764还包括可旋转地支撑在工具安装板13751上的第一旋转从动齿轮组件13765。第一旋转从动齿轮组件13765与第二旋转从动齿轮组件13766啮合,所述第二旋转从动齿轮组件可旋转地支撑在工具安装板13751上并且与第三旋转从动齿轮组件13767啮合,所述第三旋转从动齿轮组件与驱动轴组件13760的螺纹部分13768啮合。旋转传动齿轮13763在第二旋转方向上的旋转将引起驱动轴组件13760和控制杆12720在远侧方向“DD”上轴向行进。相反,旋转传动齿轮13763在与第二旋转方向相反的次旋转方向上的旋转将引起驱动轴组件13760和控制杆12720在近侧方向上运动。当控制杆12720在远侧方向上运动时,其朝远侧驱动其驱动横梁13682和工作头13684穿过外科钉仓13640。当工作头13684朝远侧驱动时,其可操作地接合砧座13620以将砧座枢转至闭合位置。
可通过施加轴向关节运动控制运动至第一关节运动连接件13710和第二关节运动连接件13690来使仓载体13630围绕关节运动轴线AA-AA选择性地进行关节运动。在各种实施例中,传动装置13752还包括可操作地支撑在工具安装板13751上的关节运动驱动器13770。更具体地讲并结合图161可看出,能够可操作地与第一关节运动连接件13710接合的关节运动驱动轴13771的近端部分13772延伸穿过旋转齿轮13755并可旋转地联接到移位器齿条齿轮13774,所述移位器齿条齿轮穿过狭槽13775可滑动地附连到工具安装板13751。关节运动驱动器13770还包括移位器传动齿轮13776,当工具安装部分13750联接到工具架11270时,所述移位器传动齿轮联接到工具安装板13751的适配器侧上相应的从动盘或从动元件11304中的第三个。关节运动驱动组件13770,13220还包括移位器从动齿轮13778,所述移位器从动齿轮可旋转地支撑在工具安装板13751上并与移位器传动齿轮13776和移位器齿条齿轮13774啮合。将来自机器人系统11000的第三旋转输出运动通过工具驱动组件11010施加到相应的从动元件11304,从而将通过可操作地联接至其而引起移位器传动齿轮13776的旋转。移位器传动齿轮13776的旋转最终引起移位器齿轮齿条13774和关节运动驱动轴13771的轴向运动。关节运动驱动轴13771的轴向行进的方向取决于移位器传动齿轮13776通过机器人系统11000旋转的方向。因此,移位器传动齿轮13776在第一旋转方向上的旋转将引起关节运动驱动轴13771在近侧方向“PD”上的轴向运动并引起仓载体13630围绕关节运动轴线AA-AA在第一方向上枢转。反之,移位器传动齿轮13776在第二旋转方向(与第一旋转方向相反)上的旋转将引起关节运动驱动轴13771在远侧方向“DD”上的轴向运动,从而引起仓载体13630围绕关节运动轴线AA-AA在相反方向上枢转。
图162示出了可结合机器人系统11000使用的本发明的另一个外科工具13800实施例。如图162所示,外科工具13800包括直线切割器13814形式的外科端部执行器13812,所述直线切割器采用各种缆线驱动的部件。各种形式的缆线驱动的直线切割器在例如名称为“Surgical Stapler With Universal Articulation and Tissue Pre-Clamp”的美国专利7,726,537和名称为“Cable Driven Surgical Stapling and Cutting Instrument WithImproved Cable Attachment Arrangements”的美国专利公开US2008/0308603A1中公开,所述专利的公开内容全文均以引用的方式并入本文。此类直线切割器13814可以被称为“一次性加载单元”,因为其被设计为在单次使用后被丢弃。然而,本发明的各种实施例的各种独特和新颖的装置也可结合可重复使用的缆线驱动的端部执行器使用。
如图163所示,在至少一种形式中,直线切割器13814包括可操作地支撑其中的外科钉仓13834的细长通道13822。砧座13824被可枢转地支撑以相对于外科钉仓13834运动。砧座13824具有能够与预夹紧衬圈13840相互作用的凸轮表面13825,所述预夹紧衬圈被支撑以相对于凸轮表面进行轴向运动。将端部执行器13814与附接到工具安装部分13900的细长轴组件13808连接。在各种实施例中,可采用闭合缆线13850以使预夹紧衬圈13840朝远侧运动到凸轮表面13825及其上方,以相对于外科钉仓13834闭合砧座13824并压缩其间的组织。优选地,闭合缆线13850在点13841处或靠近点13841附接到预夹紧衬圈13840,并馈通砧座13824(或在砧座13824的近侧部分的下方)中的通道并朝近侧馈通轴13808。闭合缆线13850在近侧方向“PD”上的致动迫使预夹紧衬圈13840朝远侧抵靠凸轮表面13825以相对于钉仓组件13834闭合砧座13824。可采用返回机构,例如,弹簧、缆线系统等以将预夹紧衬圈13840返回至重新打开砧座13824的预夹紧方向。
细长轴组件13808的形状可以是圆柱形的,并且限定通道13811,所述通道的尺寸可被设计为能够容纳管适配器13870。参见图163。在各种实施例中,管适配器13870可与细长轴13808的内部通道以摩擦配合接合的方式而被滑动容纳。管适配器13870的外表面还可包括至少一个机械接口,例如,切口或凹口13871,所述切口或凹口被取向为与设置在内部通道13811的内周边上的相应的机械接口,例如径向向内延伸的凸起或棘爪(未示出)配合,以将管适配器13870锁定到细长轴13808。在各种实施例中,管适配器13870的远端可包括一对相对的凸缘13872a和13872b,它们限定了用于在其中枢转地容纳枢轴块13873的腔体。每个凸缘13872a和13872b可包括小孔13874a和13874b,所述小孔被取向为容纳延伸穿过枢轴块13873中的小孔的枢轴销13875,以允许枢轴块13873围绕与纵向工具轴线“LT-LT”垂直的轴线而枢转运动。通道13822可由两个向上延伸的凸缘13823a,13823b构成,所述向上延伸的凸缘中具有尺寸设定成能够容纳枢轴销13827的小孔。继而,枢轴销13875穿过枢轴块13873中的小孔安装,以允许外科端部执行器13814在给定的外科手术过程中当需要时围绕“Y”轴旋转。枢轴块13873沿着“Z”轴围绕销13875的旋转使外科端部执行器13814围绕“Z”轴旋转。参见图163。在不脱离本发明的实质和范围的情况下,可有效采用将细长通道13822紧固到枢轴块13873上的其他方法。
在制备或组装过程中外科钉仓13834可被组装并安装在细长通道13822内,并作为外科端部执行器13812的一部分出售,或在需要时外科钉仓13834可被设计为选择性地安装在细长通道13822内并单独出售,例如作为单次使用的置换件、可替换的或一次性的钉仓组件。例如,外科端部执行器13812可枢转地、操作地或一体地附接到一次性外科缝合器的细长轴组件13808的远端13809上是在本公开范围内的。众所周知,使用的或用过的一次性加载单元13814可从细长轴组件13808中移除并用未使用的一次性单元替换。一旦将未耗费的或未使用的钉仓13834安装在细长通道13822中,则直线切割器13814还可优选地包括致动器、优选地动态夹紧构件13860、滑动件13862以及钉推动器(未示出)和钉(未示出)。参见图163。
在各种实施例中,动态夹紧构件13860与滑动件13862相连,例如,安装和靠在滑动件上、或与其相连或一体结合和/或靠在其后面。据设想,动态夹紧构件13860可具有与其连接的或一体成型的凸轮楔形件或凸轮表面,或由凸轮楔形件或凸轮表面的远侧前表面推动。在各种实施例中,动态夹紧构件13860可包括具有横向小孔13864(销13865可安装或安装在其中)的上部13863、中央支撑件或向上的延伸部分13866和基本上为T形的底部凸缘13867,所述各部分配合以在滑动件13862的纵向远侧运动过程中沿着理想的切割路径滑动地保持动态夹紧构件13860。前切刃13868(这里为刀片13869)的尺寸设定成靠在钉仓组件13834的狭槽13835中,并且一旦缝合就使组织分离。如本文所用,术语“刀组件”可以包括上述动态夹紧构件13860、刀13869和滑动件13862或其他其刀/横梁/滑动件驱动装置和切割器械装置。另外,本发明的各种实施例可采用刀组件/切割器械装置,所述刀组件/切割器械装置可完全支撑在钉仓13834中或局部支撑在钉仓13834和细长通道13822中或全部支撑在细长通道13822中。
在各种实施例中,可通过缆线驱动组件13870在近侧和远侧方向上驱动动态夹紧构件13860。在一个非限制性形式中,缆线驱动组件包括一对推进缆线13880,13882和击发缆线13884。图164和165示出了图表形式的缆线13880,13882,13884。如那些图所示,第一推进缆线13880可操作地支撑在第一远侧缆线过渡支撑体13885和第一近侧缆线过渡支撑体13886上,所述第一远侧缆线过渡支撑体包括附接到细长通道13822的远端的例如皮带轮、杆、绞盘等,所述第一近侧缆线过渡支撑体包括由细长通道13822可操作地支撑的例如皮带轮、杆、绞盘等。第一推进缆线13880的远端13881附连到动态夹紧组件13860。第二推进缆线13882可操作地支撑在第二远侧缆线过渡支撑体13887和第二近侧缆线过渡支撑体13888上,所述第二远侧缆线过渡支撑体包括安装到细长通道13822的远端的例如皮带轮、杆、绞盘等,所述第二近侧缆线过渡支撑体包括安装到细长通道13822的近端的例如皮带轮、杆、绞盘等。第二推进缆线13882的近端13883可附接到动态夹紧组件13860。另外,在这些实施例中,采用环状击发缆线13884并将其连接在支撑体13889上,所述支撑体包括安装在细长轴13808中的皮带轮、杆、绞盘等。在一个实施例中,回缩缆线13884可在套环中形成并联接到连接器13889’,所述连接器固定地附接到第一推进缆线13880和第二推进缆线13882。
本发明的各种非限制性实施例包括可操作地支撑在工具安装部分13900的工具安装板13902上的缆线驱动传动装置13920。工具安装部分13900具有一系列电连接销13904,所述电连接销能够与适配器11240’中的狭槽11258(图104)交接。此装置允许机器人系统11000为工具13800的控制电路13910提供控制信号。虽然结合机械耦合元件、电耦合元件和磁力耦合元件在本文中描述了接口,应当理解,可以使用多种遥测形式,包括红外、电感耦合等。
控制电路13910在图162中以图解示意图的形式示出。在一种形式或实施例中,控制电路13910包括电池13912形式的电源,所述电池连接到通断螺线管电源开关13914。然而,在其他实施例中,电源可包括交流电源。控制电路13910还包括通断螺线管13916,所述螺线管联接到双极开关13918以控制马达旋转方向。因此,当机器人系统11000提供适当的控制信号时,开关13914将允许电池13912为双极开关13918提供电力。机器人系统11000还为双极开关13918提供适当的信号以为移位器马达13922提供电力。
转到图166-171,缆线驱动传动装置13920的至少一个实施例包括可操作地安装到驱动轴13932的驱动皮带轮13930,所述驱动轴与上述类型和构造的从动元件11304附接,所述从动元件被设计为与适配器11240的相应的驱动元件11250交接。参见图104和169。因此,当工具安装部分13900可操作地联接到工具架11270时,机器人系统11000可在所需方向上施加旋转运动到驱动皮带轮13930。第一驱动构件或皮带13934驱动接合驱动皮带轮13930,并且可旋转地支撑在移位器轭13940上的第二驱动轴13936。移位器轭13940可操作地联接到移位器马达13922,使得移位器马达13922的轴13923在第一方向上的旋转将在第一方向“FD”上偏移移位器轭,并且移位器马达轴13923在第二方向上的旋转将在第二方向“SD”上偏移移位器轭13940。本发明的其他实施例可采用移位器螺线管装置,以在所述的第一方向和第二方向上偏移移位器轭。
如图166-169所示,闭合传动齿轮13950安装到第二驱动轴13936,并能够与闭合驱动组件(一般称为13951)选择性地啮合。同样,击发传动齿轮13960也安装到第二驱动轴13936,并能够与击发驱动组件(一般称为13961)选择性地啮合。第二驱动轴13936的旋转引起闭合传动齿轮13950和击发传动齿轮13960旋转。在一个非限制性实施例中,闭合驱动组件13951包括闭合从动齿轮13952,所述闭合从动齿轮联接到可旋转地支撑在第三驱动轴13956上的第一闭合皮带轮13954。闭合缆线13850驱动地容纳在第一闭合皮带轮13954上,使得闭合从动齿轮13952的旋转将驱动闭合缆线13850。同样,击发驱动组件13961包括击发从动齿轮13962,所述击发从动齿轮联接到可旋转地支撑在第三驱动轴13956上的第一击发皮带轮13964。第一驱动皮带轮13954和第二驱动皮带轮13964在第三驱动轴13956上独立地旋转。击发缆线13884驱动地容纳在第一击发皮带轮13964上,使得击发从动齿轮13962的旋转将驱动击发缆线13884。
另外在各种实施例中,缆线驱动传动装置13920还包括制动组件13970。例如,在至少一个实施例中,制动组件13970包括闭合制动器13972,所述闭合制动器包括附接到传动装置外壳13971的一部分的弹簧臂13973。闭合制动器13972具有齿轮凸耳13974,所述齿轮凸耳的尺寸设定成能够接合闭合从动齿轮13952的齿状物,如将在下文中进一步详细地描述。制动组件13970还包括击发制动器13976,所述击发制动器包括附接到传动装置外壳13971的另一部分的弹簧臂13977。击发制动器13976具有齿轮凸耳13978,所述齿轮凸耳的尺寸设定成能够接合击发从动齿轮13962的齿状物。
外科工具13800的至少一个实施例可按如下使用。工具安装部分13900可操作地联接到机器人系统11000的接口11240。操作机器人系统的控制器或控制单元,以将待切割和缝合的组织定位在打开的砧座13824和钉仓13834之间。当位于初始位置时,制动组件13970已锁定了闭合从动齿轮13952和击发从动齿轮13962,使得它们不能旋转。即,如图167所示,齿轮凸耳13974与闭合从动齿轮13952锁定接合,并且齿轮凸耳13978与击发从动齿轮13962锁定接合。一旦外科端部执行器13814已被适当地定位,机器人系统11000的控制器11001将为移位器马达13922(或移位器螺线管)提供控制信号,从而在第一方向上运动移位器轭13940。当移位器轭13940在第一方向上运动时,当闭合传动齿轮13950运动至与闭合从动齿轮13952啮合时,闭合传动齿轮使齿轮凸耳13974运动至与闭合从动齿轮13952脱离。如图166所示,当处于该位置时,齿轮凸耳13978保持与击发从动齿轮13962锁定接合,从而防止击发系统的致动。然后,机器人控制器11001穿过从动元件11304和工具架11240的对应部件之间的接口而为驱动皮带轮13930提供第一旋转致动运动。当驱动皮带轮13930在第一方向上旋转时,闭合缆线13850被旋转以将预夹紧衬圈13840驱动至与砧座13824的凸轮表面13825闭合接合,以便使其运动至闭合位置,从而夹紧砧座13824和钉仓13834之间的靶组织。参见图162。一旦砧座13824已运动至闭合位置,机器人控制器11001停止施加第一旋转运动至驱动皮带轮13930。然后,机器人控制器11001可通过发送另一控制信号至移位器马达13922(或移位器螺线管)来使移位器轭在第二方向“SD”上运动而开始击发过程,如图168所示。当移位器轭13940在第二方向上运动时,当击发传动齿轮13960运动至与击发从动齿轮13962啮合时,击发传动齿轮使齿轮凸耳13978与击发从动齿轮13962脱离。如图168所示,当处于该位置时,齿轮凸耳13974保持与闭合从动齿轮13952锁定接合,从而防止闭合系统的致动。然后,穿过从动元件11304和工具架11240的对应部件之间的接口来致动机器人控制器11001,以为驱动皮带轮13930提供第一旋转致动运动。当驱动皮带轮13930在第一方向上旋转时,击发缆线13884被旋转以在远侧方向“DD”上驱动动态夹紧构件13860,从而击发钉并切割夹持在端部执行器13814中的组织。一旦机器人系统11000通过传感器或通过监测施加到驱动皮带轮13930的旋转输入的量来确定动态夹紧构件13860已到达其最远侧位置,则控制器11001可向驱动皮带轮13930施加第二旋转运动以在相反方向上转动闭合缆线13850,从而在近侧方向“PD”上回缩动态夹紧构件13860。一旦动态夹紧构件回缩至起始位置,停止向驱动皮带轮13930施加第二旋转运动。然后,移位器马达13922(或移位器螺线管)通电,以将移位器轭13940运动到闭合位置(图166)。一旦闭合传动齿轮13950与闭合从动齿轮13952啮合,则机器人控制器11001可再次向驱动皮带轮13930施加第二旋转运动。驱动皮带轮13930在第二方向上的旋转使闭合缆线13850将预夹紧衬圈13840回缩至与砧座13824的凸轮表面13825脱离,以允许砧座13824运动至打开位置(通过弹簧或其他装置),从而从外科端部执行器13814释放被缝合的组织。
图172示出了采用如图173-175中示出的齿轮从动击发杆14092的外科工具14000。该实施例包括从工具安装部分14100延伸的细长轴组件14008。工具安装部分14100包括可操作地将传动装置14103支撑于其上的工具安装板14102。细长轴组件14008包括可旋转的近侧闭合管14010,所述可旋转的近侧闭合管可旋转地连接在近侧脊构件14020上,所述近侧脊构件刚性联接到工具安装板14102。近侧脊构件14020具有联接到外科端部执行器14012的细长通道部分14022的远端。外科端部执行器14012可基本上类似于上述外科端部执行器13412。另外,可通过与近侧闭合管14010可操作地交接的远侧闭合管14030打开和闭合外科端部执行器14012的砧座14024。远侧闭合管14030与上述远侧闭合管13430相同。相似地,近侧闭合管14010与上述近侧闭合管段13410相同。
通过以上述方式相对于远侧闭合管13410旋转近侧闭合管14010来打开和闭合砧座14024。在至少一个实施例中,传动装置包括闭合传动装置(一般称为14011)。如将在下文中进一步描述,闭合传动装置14011能够接收来自机器人系统11000的相应的第一旋转运动,并将此第一旋转运动转化成主旋转运动,以使可旋转的近侧闭合管14010围绕纵向工具轴线LT-LT旋转。如图175所示,近侧闭合管14010的近端14060可旋转地支撑在支架装置14104中,所述支架装置附接到工具安装部分14100的工具安装板14102。旋转齿轮14062形成于或附接到闭合管段14010的近端14060,以与可操作地支撑在工具安装板14102上的旋转驱动组件14070啮合。在至少一个实施例中,当工具安装部分14100联接到工具架11270时,旋转传动齿轮14072连接到工具安装板14102的适配器侧上相应的从动盘或从动元件11304中的第一个。参见图105和175。旋转驱动组件14070还包括旋转从动齿轮14074,所述旋转从动齿轮以与旋转齿轮14062和旋转传动齿轮14072啮合的方式可旋转地支撑在工具安装板14102上。将来自机器人系统11000的第一旋转控制运动通过工具架11270和适配器11240施加到相应的从动元件11304将从而通过可操作地联接至其而引起旋转传动齿轮14072的旋转。旋转传动齿轮14072的旋转最终引起闭合管段14010的旋转,从而打开和闭合砧座14024,如上所述。
如上所述,端部执行器14012采用如图173和174中示出的切割元件13860。在至少一个非限制性实施例中,传动装置14103还包括刀驱动传动装置,所述刀驱动传动装置包括刀驱动组件14080。图175示出了用于轴向推进刀杆14092的刀驱动组件14080的一种形式,所述刀杆使用上述缆线相对于外科工具13800附接到此切割元件。具体地讲,刀杆14092替代外科工具13800的实施例中采用的击发缆线13884。一种形式的刀驱动组件14080包括旋转传动齿轮14082,当工具安装部分14100联接到工具架11270时,所述旋转传动齿轮联接到工具安装板14102的适配器侧上相应的从动盘或从动元件11304中的第二个。参见图105和175。刀驱动组件14080还包括可旋转地支撑在工具安装板14102上的第一旋转从动齿轮组件14084。第一旋转从动齿轮组件14084与第三旋转从动齿轮组件14086啮合,所述第三旋转从动齿轮组件可旋转地支撑在工具安装板14102上并与第四旋转从动齿轮组件14088啮合,所述第四旋转从动齿轮组件与连接到刀杆14092的驱动轴组件14090的螺纹部分14094啮合。旋转传动齿轮14082在第二旋转方向上的旋转将引起驱动轴组件14090和刀杆14092在远侧方向“DD”上的轴向推进。相反,旋转传动齿轮14082在次旋转方向(与第二旋转方向相反)上的旋转将引起驱动轴组件14090和刀杆14092在近侧方向上运动。击发杆14092在近侧方向“PD”上的运动将在远侧方向“DD”上驱动切割元件31860。反之,击发杆14092在远侧方向“DD”上的运动将引起切割元件13860在近侧方向“PD”上运动。
图176-182示出了可结合机器人系统11000有效使用的另一个外科工具15000。在各种形式中,外科工具15000包括外科缝合器械形式的外科端部执行器15012,所述外科缝合器械包括细长通道15020和可枢转平移的夹紧构件(例如砧座15070),所述细长通道和可枢转平移的夹紧构件保持在确保有效缝合和切断夹持在外科端部执行器15012中的组织的间距处。如图178所示,细长通道15020的横截面可以是大致U形的,并且由例如钛、203不锈钢、304不锈钢、416不锈钢、17-4不锈钢、17-7不锈钢、6061或7075铝、铬钢、陶瓷等制成。大致U形的金属通道盘15022可支撑在细长通道15020的底部,如图所示。
各种实施例包括滑动件组件15030形式的致动构件,所述滑动件组件可操作地支撑在外科端部执行器15012中,并响应于施加至其上的控制运动在起始位置和结束位置之间轴向运动。在一些形式中,金属通道盘15022具有居中设置的狭槽15024以可运动地容纳滑动件组件15030的基座部分15032。基座部分15032包括支脚15034,所述底部的尺寸设定成可滑动地容纳在细长通道15020中的狭槽15021中。参见图178。如图177、178、181和182所示,滑动件组件15030的基座部分15032包括能够通过螺纹容纳在螺纹驱动轴15130上的轴向延伸的螺纹镗孔15036,如将在下文中进一步详细地描述。另外,滑动件组件15030包括支撑组织切割刀片或组织切割器械15040的直立支撑部分15038。直立支撑部分15038终止于顶部15042,所述顶部具有从其中突起的横向延伸的一对保持翅片15044。如图178所示,翅片15044被定位成容纳在砧座15070中相应的狭槽15072内。当滑动件组件15030朝远侧驱动穿过夹持在外科端部执行器15014中的组织时,翅片15044和支脚15034用于将砧座15070保持在所需的间隔开的闭合位置处。另外如图180和182所示,滑动件组件15030还包括往复或顺序致动的驱动组件15050,以朝闭合砧座15070驱动钉推动器。
更具体地讲并结合图178和179,细长通道15020能够可操作地支撑其中的外科钉仓15080。在至少一种形式中,外科钉仓15080包括主体部分15082,所述主体部分可由例如维克特拉(Vectra)、尼龙(6/6或6/12)制成并包括居中设置的狭槽15084,以容纳滑动件组件15030的直立支撑部分15038。参见图178。这些材料还可用10%-40%的玻璃、碳或矿物质填充。外科钉仓15080还包括多个腔体15086以用于可运动地支撑其中成行的或成排的钉支撑推动器15088。腔体15086可排列在间隔开的纵向延伸的行或排15090,15092,15094,15096中。例如,排15090在本文中可被称为第一外侧排。排15092在本文中可被称为第一内侧排。排15094可被称为第二内侧排以及排15096可被称为第二外侧排。第一内侧排15090和第一外侧排15092位于纵向狭槽15084的第一横向侧上,第二内侧排15094和第二外侧排15096位于纵向狭槽15084的第二横向侧上。第一内侧排15092中的第一钉推动器15088相对于第一外侧排15090中的第一钉推动器15088交错排列。相似地,第二外侧排15096中的第二钉推动器15088相对于第二内侧排15094中的第二推动器15088交错排列。每个推动器15088可操作地将外科钉15098支撑于其上。
在各种实施例中,顺序致动或往复致动的驱动组件15050包括附接到公共轴15056的一对外侧驱动器15052和一对内侧驱动器15054,所述公共轴可旋转地安装在滑动件组件15030的基座15032中。外侧驱动器15052被取向为与设置在通道盘15022中的相应的多个外侧激活腔体15026顺序或往复地接合。同样,内侧驱动器15054被取向为与设置在通道盘15022中的相应的多个内侧激活腔体15028顺序或往复地接合。内侧激活腔体15028相对于邻近的外侧激活腔体15026交错排列。参见图179。如图179和181所示,在至少一个实施例中,滑动件组件15030还包括位于镗孔15036的每个侧面上的远侧楔形件段15060和中间楔形件段15062,以当滑动件组件15030在远侧方向“DD”上朝远侧驱动时与推动器15088接合。如上所述,滑动件组件15030通过螺纹容纳在驱动轴15130的螺纹部分15132上,所述驱动轴可旋转地支撑在端部执行器15012中。例如,在各种实施例中,驱动轴15130具有支撑在远侧轴承15136中的远端15134,所述远侧轴承安装在外科端部执行器15012中。参见图178和179。
在各种实施例中,外科端部执行器15012通过细长轴组件15108联接到工具安装部分15200。在至少一个实施例中,工具安装部分15200可操作地支撑传动装置(一般称为15204),所述传动装置能够接收来自机器人系统的旋转输出运动。细长轴组件15108包括可在脊构件15120上旋转和轴向运动的外部闭合管15110,所述脊构件刚性联接到工具安装部分15200的工具安装板15201。脊构件15120还具有联接到外科端部执行器15012的细长通道部分15020的远端15122。
在使用中,围绕由细长轴组件15008限定的纵向工具轴线LT-LT来旋转外科端部执行器15012可能是有利的。在各种实施例中,外部闭合管15110具有近端15112,所述近端通过向前的支撑支架15203可旋转地支撑在工具驱动部分15200的工具安装板15201上。外部闭合管15110的近端15112能够可操作地与传动装置15204的旋转传动部分15206交接。在各种实施例中,外部闭合管15110的近端15112也支撑在闭合滑动件15140上,所述闭合滑动件也可运动地支撑在工具安装板15201上。闭合管齿轮段15114形成在外部闭合管15110的近端15112上,以与旋转传动装置15206的旋转驱动组件15150啮合。如图176所示,在至少一个实施例中,旋转驱动组件15150包括旋转传动齿轮15152,当工具驱动部分15200联接到工具架11270时,所述旋转传动齿轮连接到工具安装板15201的适配器侧11307上相应的从动盘或从动元件11304中的第一个。旋转驱动组件15150还包括旋转从动齿轮15154,所述旋转从动齿轮以与闭合管齿轮段15114和旋转传动齿轮15152啮合的方式可旋转地支撑在工具安装板15201上。将来自机器人系统11000的第一旋转控制运动通过工具架11270和适配器11240施加到相应的从动元件11304以引起旋转传动齿轮15152的旋转。旋转传动齿轮15152的旋转最终引起细长轴组件15108(和端部执行器15012)围绕纵向工具轴线LT-LT(图176中由箭头“R”表示)旋转。
通过在远侧方向“DD”上使外部闭合管15110轴向运动来实现砧座15070相对于外科钉仓15080的闭合。外部闭合管15110的轴向运动可通过传动装置15204的闭合传动部分15144实现。如上所述,在各种实施例中,外部闭合管15110的近端15112由闭合滑动件15140支撑,所述闭合滑动件使近端15112相对于其进行旋转,但是随着闭合滑动件15140轴向行进。具体地讲,如图176所示,闭合滑动件15140具有直立的突出部15141,所述直立的突出部延伸到外部闭合管15110的近端部分15112中的径向沟槽15115中。另外,如上所述,闭合滑动件15140可滑动地安装到工具安装板15201。在各种实施例中,闭合滑动件15140具有直立部分15142,所述直立部分具有在其上形成的闭合齿条齿轮15143。闭合齿条齿轮15143能够与闭合传动装置15144驱动接合。
在各种形式中,闭合传动装置15144包括闭合正齿轮15145,所述闭合正齿轮联接到工具安装板15201的适配器侧11307上相应的从动盘或从动元件11304中的第二个。因此,当接口11230联接到工具安装部分15200时,将来自机器人系统11000的第二旋转输出运动通过工具固定器11270和适配器11240施加到相应的第二从动元件11304上将引起闭合正齿轮15145的旋转。闭合传动装置15144还包括以与闭合正齿轮15145和闭合齿条齿轮15143啮合的方式而被支撑的从动闭合齿轮组15146。因此,将来自机器人系统11000的第二旋转输出运动通过工具架11270和适配器11240施加到相应的第二从动元件11304将引起闭合正齿轮15145的旋转,并最终轴向驱动闭合滑动件15140和外部闭合管15110。闭合管15110运动的轴向最终取决于第二从动元件11304旋转的方向。例如,响应于接收自机器人系统11000的一个旋转闭合运动,闭合滑动件15140将在远侧方向“DD”上被驱动,并且外部闭合管15110最终也将在远侧方向上被驱动。外部闭合管15110具有远端15116中的开口15117,所述远端能够以上述方式与砧座15070上的突出部15071接合。当朝远侧驱动外部闭合管15110时,闭合管15110的近端15116将接触砧座15070并将其枢转闭合。当施加来自机器人系统11000的“开口”旋转运动时,将在近侧方向“PD”上驱动闭合滑动件15140和外部闭合管15110,并且以上述方式将砧座15070枢转至打开位置。
在至少一个实施例中,驱动轴15130具有近端15137,所述近端具有与之附接的近侧轴齿轮15138。近侧轴齿轮15138以与附接到旋转驱动杆15160的远侧传动齿轮15162啮合的方式而被支撑,使用脊构件15120可旋转地支撑所述旋转驱动杆。通过旋转刀传动装置15207来控制旋转驱动杆15160和最终旋转驱动轴15130的旋转,所述旋转刀传动装置包括支撑在工具安装板15210上的传动装置15204的一部分。在各种实施例中,旋转刀传动装置15207包括可操作地支撑在工具安装板15201上的旋转刀驱动系统15170。在各种实施例中,刀驱动系统15170包括旋转传动齿轮15172,当工具驱动部分15200联接到工具架11270时,所述旋转传动齿轮联接到工具安装板15201的适配器侧上相应的从动盘或从动元件11304中的第三个。刀驱动系统15170还包括第一旋转从动齿轮15174,所述第一旋转从动齿轮以与第二旋转从动齿轮15176和旋转传动齿轮15172啮合的方式可旋转地支撑在工具安装板15201上。将第二旋转从动齿轮15176联接到旋转驱动杆15160的近端部分15164。
旋转传动齿轮15172在第一旋转方向上的旋转将引起旋转驱动杆15160和旋转驱动轴15130在第一方向上的旋转。反之,旋转传动齿轮15172在第二旋转方向(与第一旋转方向相反)上的旋转将引起旋转驱动杆15160和旋转驱动轴15130在第二方向上的旋转。
现将描述操作外科工具15000的方法。工具驱动器15200可操作地联接到机器人系统11000的接口11240。操作机器人系统11000的控制器11001以将待切割和缝合的组织定位在打开的砧座15070和外科钉仓15080之间。一旦通过机器人系统11000定位外科端部执行器15012而使得靶组织位于砧座15070和外科钉仓15080之间,则可启动机器人系统11000的控制器11001以向与闭合正齿轮15145连接的第二从动元件11304施加第二旋转输出运动,以在远侧方向上轴向驱动闭合滑动件15140和外部闭合管15110,从而以上述方式枢转闭合砧座15070。一旦机器人控制器11001通过例如外科端部执行器15012和/或工具驱动部分15200中的传感器确定砧座15070已闭合,则机器人控制器11001系统可为外科医生提供表明砧座闭合的指示。此类指示可以是例如光和/或可听见的声音、控制构件上的触觉反馈等形式。然后外科医生可引发击发过程。然而,在可供选择的实施例中,机器人控制器11001可自动开始击发过程。
为了开始击发过程,机器人控制器将第三旋转输出运动施加到与旋转传动齿轮15172联接的第三从动盘或从动元件11304。旋转传动齿轮15172的旋转使旋转驱动杆15160和旋转驱动轴15130以上述方式旋转。可以结合图177、179和180最好地理解外科钉15098的击发和成形。当滑动件组件15030在远侧方向“DD”上驱动穿过外科钉仓15080时,远侧楔形件段15060首先接触钉推动器15088并开始使其朝闭合砧座15070运动。当滑动件组件15030继续朝远侧运动时,外侧驱动器15052将落入通道盘15022中的相应的激活腔体15026中。然后,每个外侧驱动器15052的相对端将接触相应的外侧推动器15088,所述外侧推动器将远侧楔形件段15060和中间楔形件段15062向上运动。滑动件组件15030的进一步远侧运动使外侧驱动器15052旋转并朝砧座15070驱动相应的推动器15088,从而当推动器驱动至砧座15070中时使支撑在其上的钉15098成形。应当理解,当滑动件组件15030朝远侧运动时,刀片15040切断夹持在砧座和钉仓之间的组织。因为内侧驱动器15054和外侧驱动器15052附接到相同的轴15056并且内侧驱动器15054与外侧驱动器15052在轴15056上径向错开,当外侧驱动器15052朝砧座15070驱动其相应的推动器15088时,内侧驱动器15054落入其下一个相应的激活腔体15028中,从而使它们以相同的方式朝闭合砧座15070可旋转地或往复地驱动相应的内侧推动器15088。因此,当滑动件组件15030朝远侧被驱动时,在居中设置的狭槽15084的每一侧上的横向对应的外侧钉15098同时一起成形,并且在狭槽15084的每一侧上的横向对应的内侧钉15098同时一起成形。一旦机器人控制器11001通过传感器或通过监测施加到驱动轴15130和/或旋转驱动杆15160的旋转输出量来确定滑动件组件15030已到达其最远侧位置,则控制器11001可将第三旋转输出运动施加到驱动轴15130以在相反方向上旋转驱动轴15130,从而将滑动件组件15030回缩至其起始位置。一旦滑动件组件15030回缩至起始位置(如通过端部执行器15012和/或工具驱动部分15200中的传感器发送信号),则停止向驱动轴15130施加第二旋转运动。然后,外科医生可手动启动砧座打开过程或可通过机器人控制器11001自动开始。为了打开砧座15070,将第二旋转输出运动施加到闭合正齿轮15145,以在近侧方向上轴向驱动闭合滑动件15140和外部闭合管15110。当闭合管15110朝近侧运动时,在闭合管15110远端15116中的开口15117接触砧座15070上的突出部15071,以将砧座15070枢转至打开位置。当闭合管15116返回至起始位置时,也可使用弹簧将砧座15070偏置至打开位置。此外,外科端部执行器15012和/或工具安装部分15200中的传感器可为机器人控制器11001提供表明砧座15070现已打开的信号。然后,外科端部执行器15012可从外科手术部位撤回。
图183-188以图表示出了外科工具组件15000’中钉的顺序击发,所述外科工具组件基本上类似于上述外科工具组件15000。在该实施例中,内侧驱动器15052’和外侧驱动器15054’具有凸轮形状,其具有如图183-189中示出的凸轮表面15053和致动器凸起15055。驱动器15052’,15054’连接在由滑动件组件15030’可旋转地支撑的相同的轴15056’上。在该实施例中,滑动件组件15030’具有用于接合推动器15088的远侧楔形件段15060’。图183示出了当滑动件组件15030’在远侧方向“DD”上被驱动时两个内侧或外侧驱动器15052’,15054’的初始位置。如图所示,推动器15088a向上推进楔形件段15060’并接触驱动器15052’,15054’。滑动件组件15030’在远侧方向上的进一步行进促使驱动器15052’,15054’在“P”方向(图184)上枢转,直到致动器部分15055接触激活腔体15026,15028的端壁15029a,如图185所示。滑动件组件15030’在远侧方向“DD”上的继续推进促使驱动器15052’,15054’在“D”方向上旋转,如图186所示。当驱动器15052’,15054’旋转时,推动器15088a向上推动凸轮表面15053至图187中示出的最终竖直位置。当推动器15088a到达图187和188中示出的最终竖直位置时,将支撑在其上的钉(未示出)驱动至砧座的钉成形表面以形成钉。
图190-195示出了例如可结合上文详细描述的工具安装部分11300和轴12008使用的外科端部执行器15312。在各种形式中,外科端部执行器15312包括细长通道15322,所述细长通道如上所述能够支撑其中的外科钉仓15330。外科钉仓15330包括主体部分15332,所述主体部分包括用于容纳滑动件组件15380的竖直支撑部分15386的居中设置的狭槽15334。参见图190-192。外科钉仓体部分15332还包括多个腔体15336以用于可运动地支撑其中的钉支撑推动器15350。腔体15336可排列在间隔开的纵向延伸的排15340,15342,15344,15346中。排15340,15342位于纵向狭槽15334的一个横向侧上,并且排15344,15346位于纵向狭槽15334的另一个横向侧上。在至少一个实施例中,推动器15350能够将两个外科钉15352支撑于其上。具体地讲,位于细长狭槽15334的一侧上的每个推动器15350支撑处于交错取向的排15340中的一个钉15352和排15342中的一个钉15352。同样,位于细长狭槽15334的另一侧上的每个推动器15350支撑处于交错取向的排15344中的一个外科钉15352和排15346中的另一个外科钉15352。因此,每个推动器15350支撑两个外科钉15352。
如图190、191进一步所示,外科钉仓15330包括多个旋转驱动器15360。更具体地讲,在细长狭槽15334的一侧上的旋转驱动器15360排列在单行15370中并且与行15340,15342中的推动器15350相对应。另外,在细长狭槽15334的另一侧上的旋转驱动器15360排列在单行15372中并且与行15344,15346中的推动器15350相对应。如图190所示,每个旋转驱动器15360可旋转地支撑在钉仓体15332内。更具体地讲,每个旋转驱动器15360可旋转地容纳在相应的驱动器轴15362上。每个驱动器15360具有在其上形成的弓形斜坡部分15364,所述弓形斜坡部分配置成接合在每个推动器15350上形成的弓形下表面15354上。参见图195。另外,每个驱动器15360具有底部支撑部分15366,所述底部支撑部分从驱动器延伸以滑动地支撑通道15322上的推动器15360。每个驱动器15360具有能够与滑动件组件15380接合的向下延伸的致动杆15368。
如图192所示,在至少一个实施例中,滑动件组件15380包括基座部分15382,所述基座部分具有支脚部分15384,所述支脚部分的尺寸设定成可滑动地容纳在通道15322中的狭槽15333中。参见图190。滑动件组件15380包括支撑组织切割刀片或组织切割器械15388的直立支撑部分15386。直立支撑部分15386终止于顶部15390中,所述顶部具有从其突起的横向延伸的一对保持翅片15392。将翅片15392定位成容纳于砧座(未示出)中相应的狭槽(未示出)内。正如上述实施例,当滑动件组件15380朝远侧被驱动穿过夹持在外科端部执行器15312中的组织时,翅片15392和支脚部分15384用于将砧座(未示出)保持在所需的间隔开的闭合位置。直立支撑部分15386能够附接到刀杆12200(图111)。滑动件组件15380还具有水平延伸的致动器板15394,将所述水平延伸的致动器板成形为用于与推动器15360上的每个致动杆15368致动接合。
现将结合图190和191描述外科端部执行器15312的操作。当在远侧方向“DD”上驱动滑动件组件15380穿过钉仓15330时,致动器板15394顺序接触推动器15360上的致动杆15368。当滑动件组件15380继续朝远侧运动时,致动器板15394顺序接触细长狭槽15334的每一侧上的驱动器15360的致动器杆15368。此动作使驱动器15360从第一未致动位置旋转至致动部分,在该致动部分中,推动器15350朝闭合砧座被驱动。当推动器15350朝砧座被驱动时,其上的外科钉15352被驱动至与砧座的下侧成形接触。一旦机器人系统11000通过传感器或其他装置确定滑动件组件15080已到达其最远侧位置时,则机器人系统11000的控制系统可将刀杆和滑动件组件15380回缩至起始位置。然后,机器人控制系统可启动用于将砧座返回至打开位置以释放被缝合的组织的过程。
图196-200示出了本发明的自动重新加载系统实施例的一种形式,一般称为15500。在一种形式中,自动重新加载系统15500能够用“新的”外科端部执行器部件替换机器人外科系统的可操纵的外科工具部分中“用过的”外科端部执行器部件。如本文所用,术语“外科端部执行器部件”可包括例如外科钉仓、一次性加载单元、或使用时被用过并且必须用新的部件替换的其他端部执行器部件。此外,术语“用过的”是指端部执行器部件已被启动并且在当前状态下不再可用于所需目的。例如,在外科钉仓或一次性加载单元的上下文中,术语“用过的”是指之前支撑在其中的至少一些未成形的钉已从其“击发”。如本文所用,术语“新的”外科端部执行器部件是指在预期用途条件下的端部执行器部件。在外科钉仓或一次性加载单元的上下文中,例如,术语“新的”是指其中具有未成形的钉并且准备好使用的此类部件。
在各种实施例中,自动重新加载系统15500包括基座部分15502,所述基座部分可在战略上位于机器人系统11000的机械臂车11100(图97)的工作区域11109内。如本文所用,术语“可操纵的外科工具部分”总体上是指本文所公开的各种类型的外科工具和可操作地附接到例如机械臂车11100或类似装置的其他形式的外科机器人致动的工具,所述机械臂车11100或类似装置能够自动地操纵和致动外科工具。本文所用的术语“工作区域”是指机器人系统的可操纵的外科工具部分的运动的范围。图97总体上示出了可包括机械臂车11100的工作区域的区域。本领域的普通技术人员将会知道在此示出的工作区域的形状和尺寸仅为示例性的。工作区域的最后尺寸、形状和位置将最终取决于可操纵的外科工具部分的构造、行进限制的范围和位置。因此,本文所用的术语“工作区域”旨在涵盖多种不同尺寸和形状的工作区域,并且不应限制于图97中示出的样品工作区域的具体尺寸和形状。
如图196所示,基座部分15502包括新的部件支撑部分或装置15510,所述新的部件支撑部分或装置能够在“加载取向”上可操作地支撑至少一个新的外科端部执行器部件。如本文所用,术语“加载取向”是指以此方式支撑新的端部执行器,以允许可操纵的外科工具部分的相应的部件支撑部分在除了必须启动机器人系统之外没有人为干预的情况下,与新的端部执行器部件(或使新的端部执行器部件与可操纵的外科工具部分的相应的部件支撑部分加载接合)加载接合(即,可操作地位于或可操作地附接到新的端部执行器部件)。继续参阅本具体实施方式将进一步理解,在至少一个实施例中,准备护士将在外科手术之前用完成外科手术所需的适当长度和颜色的钉仓(一些外科钉仓可支撑某些尺寸的钉,其尺寸可由仓体的颜色指示)来加载新的部件支撑部分。然而,在外科手术过程中,不需要直接的人机互动来重新加载机器人直线切割器。在一种形式中,外科端部执行器部件包括钉仓12034,所述钉仓能够可操作地设置于上述各种其他端部执行器装置的任何部件支撑部分(细长通道)中。出于解释目的,将新的(未使用的)钉仓指定位“12034a”并且将用过的钉仓指定位“12034b”。该图示出了被设计为与包括通道12022和砧座12024的外科端部执行器12012一起使用的仓12034a,12034b,所述通道和砧座的构造和操作在上文中已详细地描述。仓12034a,12034b与上述仓12034相同。在各种实施例中,仓12034a,12034b能够扣合保持(即,加载接合)在外科端部执行器12012的通道12022中。然而,继续参阅本具体实施方式,本领域的普通技术人员将会知道在不脱离本发明的实质和范围的情况下,可结合其他仓装置的自动移除和安装而有效地利用自动的仓重新加载系统15500的独特且新颖的特性。
在示出的实施例中,术语“加载取向”是指将新的外科钉仓12034a的远侧末端部分12035a插入到新的仓支撑部分15510的相应的支撑腔体15512中,使得新的外科钉仓12034a的近端部分12037a处于方便的取向,以使臂车11100操纵外科端部执行器12012至如下位置:在该位置,新的仓12034a可自动地加载到外科端部执行器12012的通道12022中。在各种实施例中,基座15502包括至少一个传感器15504,所述传感器与机器人控制器11001的控制系统11003连通,以为控制系统11003提供基座15502的位置和/或每个分段的或新的仓12034a的重新加载长度和颜色。
另外如图所示,基座15502还包括能够收集用过的仓12034b的收集容器15520,所述用过的仓已从可操作地附接到机器人系统11000的外科端部执行器12012中移除或脱离。另外,在一种形式中,自动重新加载系统15500包括提取系统15530,在除了必须的启动机器人系统之外无需特定的人为干预的情况下,所述提取系统用于将用过的端部执行器部件从端部执行器或可操纵的外科工具部分的相应的支撑部分中自动地移除。在各种实施例中,提取系统15530包括提取钩构件15532。在一种形式中,例如,提取钩构件15532刚性地支撑在基座部分15502上。在一个实施例中,提取钩构件具有在其上形成的至少一个钩5534,当其支撑在外科端部执行器12012的细长通道12022中时,所述钩能够与用过的仓12034b的远端12035以钩的形式接合。在各种形式中,提取钩构件15532便利地位于收集容器15520的一部分中,使得当用过的端部执行器部件(仓12034b)与提取钩构件15532以提取方式接合时,用过的端部执行器部件(仓12034b)从相应的部件支撑部分(细长通道12022)移除并落入收集容器15020中。因此,为了使用该实施例,可操纵的外科工具部分对附接至其的端部执行器进行操纵,以使其中用过的仓12034b的远端12035与钩15534以钩的形式接合,然后以此方式运动端部执行器,以将用过的仓12034b从细长通道12022中分离。
在其他装置中,提取钩构件15532包括旋转的轮构型,所述旋转的轮构型具有从其突起的一对沿直径相对的钩15334。参见图196和199。提取钩构件15532可旋转地支撑在收集容器15520中,并连接到由机器人系统的控制器11001所控制的提取马达15540。该形式的自动重新加载系统15500可按如下使用。图198示出了可操作地附接到可操纵的外科工具部分11200的外科端部执行器12012的引入。如图所示,机器人系统11000的臂车11100将外科端部执行器12012置于所示的位置,其中提取构件15532的钩端部15534与外科端部执行器12012中用过的仓12034b的远端12035以钩的形式接合。外科端部执行器12012的砧座12024处于打开位置。用过的仓12034b的远端12035与钩端部15532接合后,提取马达15540被致动以旋转提取轮15532,从而使用过的仓12034从通道12022中脱离。为了有助于用过的仓12034b从通道12022中脱离(或如果提取构件15530是固定的),机器人系统11000可在向上的方向上(图199中的箭头“U”)运动外科端部执行器12012。随着用过的仓12034b从通道12022中分离,用过的仓12034b落入收集容器15520中。一旦用过的仓12034b从外科端部执行器12012中移除,则机器人系统11000将外科端部执行器12012运动至图200中示出的位置。
在各种实施例中,传感器装置15533邻近提取构件15532定位,所述提取构件与机器人系统11000的控制器11001连通。传感器装置15533可包括传感器,当远侧末端部分12035b与提取构件15532接合时,所述传感器能够感测外科端部执行器12012的存在,更具体地感测用过的外科钉仓12034b的顶端12035b的存在。在一些实施例中,传感器装置15533可包括例如光幕装置。然而,可采用其他形式的接近传感器。在此装置中,当具有用过的外科钉仓12034b的外科端部执行器12012与提取构件15532以提取方式接合时,传感器感测外科钉仓12034b的远侧末端12035b(如光幕被损坏)。当提取构件15532旋转并且松散地弹出外科钉仓12034b并落入收集容器15520中时,光幕又一次未被损坏。因为在此过程中未移动外科端部执行器12012,所以机器人控制器11001确定用过的外科钉仓12034b已从中移除。也可成功地采用其他传感器装置以为机器人控制器11001提供用过的外科钉仓12034b已从外科端部执行器12012中移除的指示。
如图200所示,外科端部执行器12012被定位成抓持通道12022和砧座12024之间新的外科钉仓12034a。更具体地讲,如图197和200所示,每个腔体11512具有与之相关的相应的直立的压垫15514。定位外科端部执行器12012使得压垫15514位于新的仓12034a和砧座12024之间。一旦处于该位置,机器人系统11000将砧座12024闭合到压垫15514上,所述压垫用于推动新的仓12034a至与外科端部执行器12012的通道12022扣合。一旦新的仓12034a已在细长通道12022中扣合到位,则机器人系统11000从自动的仓重新加载系统15500中撤出外科端部执行器12012,以与进行另一个外科手术结合使用。
图201-205示出了另一个自动重新加载系统15600,其可用于从可操纵的外科工具装置13600(图148-161)中移除用过的一次性加载单元13612并重新加载新的一次性加载单元13612,所述可操纵的外科工具装置可操作地附接到臂车11100或机器人系统11000的其他部分。如图201和202所示,一种形式的自动重新加载系统15600包括外壳15610外壳15610,所述外壳具有支撑在其上的旋转转盘顶板15620形式的可运动的支撑组件,所述旋转转盘顶板与外壳15610配合形成中空的封闭区15612。自动重新加载系统15600能够可操作地支撑在机器人系统的可操纵的外科工具部分的工作区域中,如上所述。在各种实施例中,旋转转盘板15620具有用于支撑其中的多个取向管15660的多个孔15622。如图202和203所示,旋转转盘板15620附连到芯轴15624上。芯轴15624居中设置在封闭区15612内并具有附接至其的芯轴齿轮15626。芯轴齿轮15626与联接到转盘驱动马达15630的转盘传动齿轮15628啮合,所述转盘驱动马达与机器人系统11000的机器人控制器11001可操作地连通。
自动重新加载系统15600的各种实施例还可包括转盘锁定组件,一般称为15640。在各种形式中,转盘锁定组件15640包括附连到芯轴15624上的凸轮盘15642。芯轴齿轮15626可附接到凸轮盘15642的下侧,并且凸轮盘15642可键锁到芯轴15624。在可供选择的装置中,芯轴齿轮15626和凸轮盘15642可独立地非旋转地附连到芯轴15624。如图202和203所示,多个凹口15644围绕凸轮盘15642的周边间隔开。锁定臂15648可枢转地安装到外壳15610中,并通过锁定弹簧15649被偏置到与凸轮盘15642的周边接合。如图201所示,凸轮盘15642的外周边是圆形的以有利于相对于锁定臂15648旋转凸轮盘15642。每个凹口15644的边缘也是圆形的,使得当凸轮盘15642旋转时,通过凸轮盘15642的周边使锁定臂15648与凹口15644脱离。
各种形式的自动重新加载系统15600能够支撑便携式/可替换的托盘组件15650,所述托盘组件能够在单个取向管15660中支撑多个一次性加载单元13612。更具体地讲并结合图202和203,可替换的托盘组件15650包括具有从其底侧突起的居中设置的定位芯轴15654的托盘15652。定位芯轴15654的尺寸设定成能够容纳在芯轴15624的中空端部15625中。托盘15652中具有能够支撑其中的取向管15660的多个孔15656。每个取向管15660在期望方向上通过取向管15660上的定位翅片15666被定位在可替换的托盘组件15650中的对应孔15656中,所述取向管被设计为容纳在托盘组件15650中相应的定位狭槽15658中。在至少一个实施例中,定位翅片15666具有大致V形的横截面形状,所述横截面形状的尺寸设定成适合在V形定位狭槽15658中。此装置用于在所需的起始位置处定位取向管15660,同时当向其施加旋转运动时,使其在孔15656中旋转。即,当向取向管15660施加旋转运动时,V形定位翅片15666将从其相应的定位狭槽中弹出,从而使管15660相对于托盘15652旋转,如将在下文中进一步详细地描述。另外如图201-203所示,可替换的托盘15652可设有一个或多个柄部部分15653,以当加载有取向管15660时有利于托盘组件15652的传输。
如图205所示,每个取向管15660包括具有凸缘式开口端15664的主体部分15662。主体部分15662限定腔体15668,所述腔体的尺寸设定成能够在其中容纳一次性加载单元13612的一部分。为了对一次性加载单元13612在取向管15660中进行正确取向,腔体15668具有在其中形成的平坦的定位表面15670。如图205所示,平坦的定位表面15670能够有利于在所需的或预定的非旋转方向上将一次性加载单元插入到腔体15668中。另外,腔体15668的端部15669可包括泡沫或缓冲材料15672,所述泡沫或缓冲材料被设计为缓冲腔体15668内的一次性加载单元13612的远端。另外,定位表面的长度可与一次性加载单元13612的轴向驱动组件13680的滑动支撑构件13689配合,以进一步在所需的方向上将一次性加载单元13612定位在取向管15660中。
取向管15660可由尼龙、聚碳酸酯、聚乙烯、液晶聚合物、6061或7075铝、钛、300或400系列不锈钢、涂布的或涂漆钢、电镀钢等制成,并且当加载到可替换的托盘15662并且定位芯轴15654插入到芯轴15624的中空端部15625中时,取向管15660延伸穿过转盘顶板15620中相应的孔15662。每个可替换的托盘15662配备有与机器人系统11000的控制器11001的控制系统11003连通的位置传感器15663。传感器15663用于确定重新加载系统的位置,以及容纳在托盘中的每个重新加载件的数量、长度、颜色和击发状态。另外,与机器人控制器11001连通的光学传感器或传感器15665可用于感测加载到托盘15662中的一次性加载单元的类型/尺寸/长度。
自动重新加载系统15600的各种实施例还包括用于将旋转运动施加到取向管15660的驱动组件15680,从而将一次性加载单元13612保持附接到外科工具13600(总体上为“可操纵的外科工具部分”)的轴13700,所述外科工具可操作地联接到机器人系统。驱动组件15680包括附接到锁定臂15648的支撑轭15682。因此,支撑轭15682随着锁定臂15648枢转。支撑轭15682可旋转地支撑管惰轮15684和管驱动轮15686,所述管驱动轮由附接至其的管马达15688驱动。管马达15688与控制系统11003连通并受其控制。管惰轮15684和管驱动轮15686由例如天然橡胶、三都平(sanoprene)、热塑性聚氨酯树脂(isoplast)等制成,使得其外表面生成足够量的摩擦力,以在管马达15688致动时使与之接触的取向管15660旋转。惰轮15684和管驱动轮15686相对于彼此取向,以在两者间形成支架区域15687以用于容纳其中驱动接合的取向管15060。
在使用中,加载到自动重新加载系统15600中的一个或多个取向管15660是空的,同时其他取向管15660可操作地支撑其中相应的新的一次性加载单元13612。如将在下文中进一步详细地描述,使用空的取向管15660容纳其中用过的一次性加载单元13612。
在系统15600定位在机器人系统的可操纵的外科工具部分的工作区域内之后,可按如下使用自动重新加载系统15600。如果可操纵的外科工具部分具有可操作地与之连接的用过的一次性加载单元13612,则支撑在可替换的托盘15662上的取向管15660中的一个是空的,以容纳其中用过的一次性加载单元13612。然而,如果可操纵的外科工具部分不具有可操作地与之连接的一次性加载单元13612,则每个取向管15660可设有适当取向的新的一次性加载单元13612。
如上所述,一次性加载单元13612采用旋转的“卡口式”连接装置,以将一次性加载单元13612可操作地联接到可操纵的外科工具部分的对应部分。即,为了将一次性加载单元13612附接到可操纵的外科工具部分(13700-参见图154、155)的对应部分,当那些部件已运动至彼此加载接合时,必须将旋转安装运动施加到一次性加载单元13612和/或可操纵的外科工具部分的对应部分。此类安装运动统称为“加载运动”。同样,为了将用过的一次性加载单元13612从可操纵的外科工具的相应部分中分离,必须施加旋转分离运动到用过的一次性加载单元13612和/或可操纵的外科工具部分的相应部分,同时移动用过的一次性加载单元和可操纵的外科工具的相应部分使之彼此远离。此类分离运动统称为“提取运动”。
为了开始加载过程,启动机器人系统11000以操纵可操纵的外科工具部分和/或自动重新加载系统15600以使可操纵的外科工具部分与新的一次性加载单元13612加载接合,所述新的一次性加载单元支撑在与驱动组件15680驱动接合的取向管15660中。一旦机器人控制系统11000的机器人控制器11001(图96)将可操纵的外科工具部分定位成与新的一次性加载单元13612加载接合,机器人控制器11001致动驱动组件15680以施加加载运动到其中支撑有新的一次性加载单元13612的取向管15660,和/或施加另一个旋转加载运动到可操纵的外科工具部分的相应部分。在施加此类旋转加载运动时,机器人控制器11001还使可操纵的外科工具部分的相应部分朝新的一次性加载单元13612运动至与之加载接合。一旦一次性加载单元13612与可操纵的工具部分的相应部分加载接合,加载运动中止并且可使可操纵的外科工具部分运动远离自动重新加载系统15600,所述自动重新加载系统附带有与之可操作地附接的新的一次性加载单元13612。
为了将用过的一次性加载单元13612从相应的可操纵的外科工具部分中分离,机器人系统的机器人控制器11001操纵可操纵的外科工具部分,以将用过的一次性加载单元13612的远端插入到空的取向管15660中,所述取向管与驱动组件15680保持驱动接合。然后,机器人控制器11001启动驱动组件15680,以施加旋转提取运动到其中支撑有用过的一次性加载单元13612的取向管15660和/或施加旋转提取运动到可操纵的外科工具部分的相应部分。机器人控制器11001还使可操纵的外科工具部分从用过的旋转的一次性加载单元13612中撤离。然后,停止旋转提取运动。
用过的一次性加载单元13612从可操纵的外科工具部分中移除之后,机器人控制器11001可启动转盘驱动马达15630,以导引转盘顶板15620使另一个取向管15660与驱动组件15680驱动接合,所述另一个取向管支撑其中的新的一次性加载单元13612。然后,可重复加载过程,以将其中新的一次性加载单元13612附接到可操纵的外科工具部分的相应部分。机器人控制器11001可记录已从特定的可替换托盘15652中使用的一次性加载单元的数量。一旦控制器11001确定了从此托盘中使用的所有新的一次性加载单元13612,则控制器11001可为外科医生提供如下信号(可视的和/或可听的),所述信号表明支撑所有用过的一次性加载单元13612的托盘15652必须被容纳新的一次性加载单元13612的新的托盘15652所替换。
图206-211示出了非常适于与具有工具驱动组件11010(图101)的机器人系统11000一起使用的本发明的外科工具16000的另一个非限制性实施例,所述工具驱动组件可操作地联接到通过操作者(即,外科医生)的输入而运行的主控制器11001。如图206所示,外科工具16000包括外科端部执行器16012,所述端部执行器包括直线切割器。在至少一种形式中,外科工具16000通常包括细长轴组件16008,所述细长轴组件具有通过关节运动接头16100连接在一起的近侧闭合管16040和远侧闭合管16042。外科工具16000通过工具安装部分(一般称为16200)可操作地联接到操纵器。外科工具16000还包括接口16030,所述接口可以上述详细描述的各种方式将工具安装部分16200机械地和电力地连接到操纵器。
在至少一个实施例中,外科工具16000包括外科端部执行器16012,所述外科端部执行器此外包括至少一个部件16024,所述部件相对于至少一个其他部分16022在第一位置和第二位置之间响应于施加到部件16024的各种控制运动而选择性地运动,如将在下文中进一步详细地描述,从而进行外科手术。在各种实施例中,部件16022包括能够可操作地支撑其中的外科钉仓16034的细长通道16022,并且部件16024包括可枢转地平移的夹紧构件,例如,砧座16024。外科端部执行器16012的各种实施例能够将砧座16024和细长通道16022保持在确保有效缝合和切断夹持在外科端部执行器16012中的组织的间距处。除非另外说明,端部执行器16012类似于上述外科端部执行器12012并包括切割器械(未示出)和滑动件(未示出)。砧座16024可包括位于其近端的突出部16027,所述突出部与机械闭合系统(下文中进一步描述)的部件相互作用以利于砧座16024的打开。细长通道16022和砧座16024可以由导电材料(诸如金属)制成,使得它们可以作为与端部执行器中的一个或多个传感器连通的天线的一部分,如上所述。外科钉仓16034可以由非导电材料(例如塑料)制成,并且传感器可以连接到或设置在外科钉仓16034中,也如上所述。
如图206所示,根据各种实施例,通过细长轴组件16008将外科端部执行器16012附接到工具安装部分16200。如图示实施例中所示,细长轴组件16008包括关节运动接头(一般称为16100),所述关节运动接头使外科端部执行器16012围绕基本上横向于纵向工具轴线LT-LT的第一工具关节运动轴线AA1-AA1和基本上横向于纵向工具轴线LT-LT以及第一关节运动轴线AA1-AA1的第二工具关节运动轴线AA2-AA2选择性地进行关节运动。参见图207。在各种实施例中,细长轴组件16008包括闭合管组件16009,所述闭合管组件包括通过枢转连接件16044和16046枢转地连接的近侧闭合管16040和远侧闭合管16042。闭合管组件16009可运动地支撑在脊组件上(一般称为16102)。
如图208所示,近侧闭合管16040通过上部枢转连接件16044U和下部枢转连接件16044L可枢转地连接到中间闭合管接头16043,使得中间闭合管接头16043围绕第一闭合轴线CA1-CA1和第二闭合轴线CA2-CA2相对于近侧闭合管16040枢转。在各种实施例中,第一闭合轴线CA1-CA1基本上平行于第二闭合轴线CA2-CA2,并且两根闭合轴线CA1-CA1,CA2-CA2基本上横向于纵向工具轴线LT-LT。如图208中进一步所示,中间闭合管接头16043通过左侧枢转连接件16046L和右侧枢转连接件16046R可枢转地连接到远侧闭合管16042,使得中间闭合管接头16043围绕第三闭合轴线CA3-CA3和第四闭合轴线CA4-CA4相对于远侧闭合管16042枢转。在各种实施例中,第三闭合轴线CA3-CA3基本上平行于第四闭合轴线CA4-CA4,并且两根闭合轴线CA3-CA3,CA4-CA4基本上横向于第一闭合轴线CA1-CA1和第二闭合轴线CA2-CA2以及纵向工具轴线LT-LT。
闭合管组件16009能够响应于施加至其上的致动运动在脊组件16102上轴向滑动。远侧闭合管16042包括开口16045,所述开口与砧座16024上的突出部16027连接以便当远侧闭合管16042在近侧方向“PD”上轴向运动时有利于砧座16024的打开。闭合管16040、16042可以由导电材料(例如金属)制成,使其可以用作天线的一部分,如上所述。脊组件16102的部件可以由非导电材料(例如塑料)制成。
如上所述,外科工具16000包括工具安装部分16200,所述工具安装部分能够以上文详细描述的方式可操作地附接到机器人系统11000的工具安装组件11010。如图210所示,工具安装部分16200包括可操作地将传动装置16204支撑于其上的工具安装板16202。在各种实施例中,传动结构16204包括关节运动传动装置16142,所述关节运动传动装置包括关节运动系统16140的一部分,以围绕第一工具关节运动轴线TA1-TA1和第二工具关节运动轴线TA2-TA2使外科端部执行器16012进行关节运动。第一工具关节运动轴线TA1-TA1基本上横向于第二工具关节运动轴线TA2-TA2,第一工具关节运动轴线和第二工具关节运动轴线均基本上横向于纵向工具轴线LT-LT。参见图207。
为了有利于使外科端部执行器16012围绕第一工具关节运动轴线TA1-TA1和第二工具关节运动轴线TA2-TA2选择性地进行关节运动,脊组件16102包括近侧脊部分16110,所述近侧脊部分通过枢轴销16122可枢转地联接到远侧脊部分16120以围绕TA1-TA1选择性地枢转行进。相似地,远侧脊部分16120通过枢轴销16124可枢转地附接到外科端部执行器16012的细长通道16022,以使外科端部执行器16012围绕第二工具轴线TA2-TA2相对于远侧脊部分16120选择性地枢转。
在各种实施例中,关节运动系统16140还包括可操作地与外科端部执行器16012交接的多个关节运动元件,以及可操作地支撑在工具安装构件16200中的关节运动控制装置16160,如将在下文中进一步详细地描述。在至少一个实施例中,关节运动元件包括第一对第一关节运动缆线16144和16146。第一关节运动缆线位于纵向工具轴线的第一或右侧上。因此,第一关节运动缆线在本文中称为右上部缆线16144和右下部缆线16146。右上部缆线16144和右下部缆线16146沿着近侧脊部分16110的右侧分别延伸穿过相应的通路16147,16148。参见图211。关节运动系统16140还包括第二对第二关节运动缆线16150,16152。第二关节运动缆线位于纵向工具轴线的第二或左侧上。因此,第二关节运动缆线在本文中称为左上部关节运动缆线16150和左下部关节运动缆线16152。左上部关节运动缆线16150和左下部关节运动缆线16152在近侧脊部分16110中分别延伸穿过通道路16153,16154。
如图207所示,右上部缆线16144围绕上部枢转接头16123延伸并且在左侧枢转接头16125处附接到细长通道16022的左上侧。右下部缆线16146围绕下部枢转接头16126延伸并且在左侧枢转接头16125处附接到细长通道16022的左下侧。左上部缆线16150围绕上部枢转接头16123延伸并且在右侧枢转接头16127处附接到细长通道16022的右上侧。左下部缆线16152围绕下部枢转接头16126延伸并且在右侧枢转接头16127处附接到细长通道16022的右下侧。因此,为了围绕第一工具关节运动轴线TA1-TA1将外科端部执行器16012向左(箭头“L”)枢转,必须在近侧方向“PD”上牵拉右上部缆线16144和右下部缆线16146。为了围绕第一工具关节运动轴线TA1-TA1使外科端部执行器16012向右进行关节运动,必须在近侧方向“PD”上牵拉左上部缆线16150和左下部缆线16152。为了在向上的方向(箭头“U”)上围绕第二工具关节运动轴线TA2-TA2使外科端部执行器16012进行关节运动,必须在近侧方向“PD”上牵拉右上部缆线16144和左上部缆线16150。为了在向下的方向(箭头“DW”)上围绕第二工具关节运动轴线TA2-TA2使外科端部执行器16012进行关节运动,必须在近侧方向“PD”上牵拉右下部缆线16146和左下部缆线16152。
关节运动缆线16144,16146,16150,16152的近端联接到包括球形接头组件的关节运动控制装置16160,所述球形接头组件是关节运动传动装置16142的一部分。更具体地讲并结合图211,球形接头组件16160包括在近侧脊16110的近侧部分形成的球形构件16162。关节运动控制环16164可运动地支撑在球形构件16162上。如图211进一步所示,关节运动缆线16144,16146,16150,16152的近端通过相应的球形接头装置16166联接到关节运动控制环16164。关节运动控制环16164由关节运动驱动组件16170控制。尤其如图211所示,将第一关节运动缆线16144,16146的近端在位于平面16159上的相应间隔开的第一点16149,16151处附接到关节运动控制环16164。同样,将第二关节运动缆线16150,16152的近端在沿着平面16159设置的相应间隔开的第二点16153,16155处附接到关节运动控制环16164。继续参阅本具体实施方式,本领域的普通技术人员将会知道,当关节运动控制环16164由关节运动驱动组件16170操纵时,关节运动控制环16164上的此类缆线附接装置有利于所需范围内的关节运动动作。
在各种形式中,关节运动驱动组件16170包括水平关节运动组件(一般称为16171)。在至少一种形式中,水平关节运动组件16171包括附接到水平齿轮装置16180的水平推动缆线16172。关节运动驱动组件16170还包括竖直关节运动组件(一般称为16173)。在至少一种形式中,竖直关节运动组件16173包括附接到竖直齿轮装置16190的竖直推动缆线16174。如图210和211所示,水平推动缆线16172延伸穿过附接到近侧脊部分16110的支撑板16167。水平推动缆线16174的远端通过相应的球形/枢转接头16168附接到关节运动控制环16164。竖直推动缆线16174延伸穿过支撑板16167,并且其远端通过相应的球形/枢转接头16169附接到关节运动控制环16164。
水平齿轮装置16180包括枢转地安装到水平轴16181上的水平从动齿轮16182,所述水平轴附接到近侧脊部分16110的近侧部分。水平推动缆线16172的近端可枢转地附接到水平从动齿轮16182,使得当水平从动齿轮16172围绕水平枢转轴线HA旋转时,水平推动缆线16172施加第一枢转运动到关节运动控制环16164。同样,竖直齿轮装置16190包括竖直从动齿轮16192,所述竖直从动齿轮可枢转地支撑在与近侧脊部分16110的近侧部分附接的竖直轴16191上,以便围绕竖直枢转轴线VA枢转行进。竖直推动缆线16174的近端可枢转地附接到竖直从动齿轮16192,使得当竖直从动齿轮16192围绕竖直枢转轴线VA旋转时,竖直推动缆线16174施加第二枢转运动到关节运动控制环16164。
水平从动齿轮16182和竖直从动齿轮16192通过可操作地与关节运动移位器组件16320交接的关节运动齿轮系16300驱动。在至少一种形式中,关节运动移位器组件包括关节运动传动齿轮16322,所述关节运动传动齿轮联接到工具安装板16202的适配器侧11307上相应的从动盘或从动元件11304中的一个。参见图210。因此,当接口11230联接到工具架11270时,将来自机器人系统11000的旋转输入运动通过工具驱动组件11010施加到相应的从动元件11304上,从而将引起关节运动传动齿轮16322的旋转。将关节运动从动齿轮16324附接到可旋转地支撑在工具安装板16202上的花键式移位器轴16330。关节运动从动齿轮16324与关节运动传动齿轮16322啮合,如图所示。因此,关节运动传动齿轮16322的旋转将引起轴16330的旋转。在各种形式中,移位器从动齿轮组件16340可运动地支撑在移位器轴16330的花键部分16332上。
在各种实施例中,移位器从动齿轮组件16340包括附接到移位器板16344的从动移位器齿轮16342。移位器板16344与移位器螺线管组件16350可操作地交接。移位器螺线管组件16350通过导体16352联接至相应的销16352。参见图210。将销16352取向为与适配器11240的工具侧11244上的狭槽11258(图104)电连通。此装置用于将移位器螺线管组件16350电联接到机器人控制器11001。因此,移位器螺线管16350的致动将如图210和211中的箭头“S”所示使移位器轴16330的花键部分16332上的移位器从动齿轮组件16340发生偏移。关节运动齿轮系16300的各种实施例还包括水平齿轮组件16360,所述水平齿轮组件包括安装在可旋转地附接到工具安装板16202的轴16361上的第一水平传动齿轮16362。第一水平传动齿轮16362以与第二水平传动齿轮16364啮合的方式而支撑。如图211所示,水平从动齿轮16182与第二水平从动齿轮16364的远侧面部分16365啮合。
关节运动齿轮系16300的各种实施例还包括竖直齿轮组件16370,所述竖直齿轮组件包括安装在可旋转地支撑在工具安装板16202上的轴16371上的第一竖直传动齿轮16372。第一竖直传动齿轮16372以与第二竖直传动齿轮16374啮合的方式而支撑,第二水平传动齿轮16364与所述第二竖直传动齿轮被同心地支撑。第二竖直传动齿轮16374可旋转地支撑在近侧脊部分16110上以绕其行进。第二水平传动齿轮16364可旋转地支撑在所述第二竖直传动齿轮16374的一部分上以独立地在其上旋转行进。如图211所示,竖直从动齿轮16192与第二竖直从动齿轮16374的远侧面部分16375啮合。
在各种形式中,第一水平传动齿轮16362具有第一直径并且第一竖直传动齿轮16372具有第二直径。如图210和211所示,轴16361与轴16371不在公共轴线上。即,第一水平从动齿轮16362和第一竖直从动齿轮16372不围绕公共轴线旋转。因此,当移位器齿轮16342设置在中心“锁定”位置使得移位器齿轮16342与第一水平从动齿轮16362和第一竖直传动齿轮16372啮合时,关节运动系统16140的部件被锁定就位。因此,可运动的移位器齿轮16342和第一水平和竖直传动齿轮16362,16372的装置以及关节运动移位器组件16320可统称为关节运动锁定系统(一般称为16380)。
在使用中,机器人系统11000的机器人控制器11001可按如下控制关节运动系统16140。为了围绕第一工具关节运动轴线TA1-TA1使端部执行器16012向左进行关节运动,机器人控制器11001致动移位器螺线管组件16350,以使移位器齿轮16342与第一水平传动齿轮16362啮合。然后,控制器11001施加第一旋转输出运动到关节运动传动齿轮16322,以在第一方向上驱动移位器齿轮,从而最终在另一个第一方向上驱动水平从动齿轮16182。驱动水平从动齿轮16182以使球形部分16162上的关节运动环16164枢转,从而在近侧方向“PD”上牵拉右上部缆线16144和右下部缆线16146。为了围绕第一工具关节运动轴线TA1-TA1使端部执行器16012向右进行关节运动,机器人控制器11001致动移位器螺线管组件16350,以使移位器齿轮16342与第一水平传动齿轮16362啮合。然后,控制器11001在相反方向上施加第一旋转输出运动到关节运动传动齿轮16322,以在第二方向上驱动移位器齿轮16342,从而最终在另一个第二方向上驱动水平从动齿轮16182。此动作使关节运动控制环16164以此方式运动,以在近侧方向“PD”上牵拉左上部缆线16150和左下部缆线16152。在各种实施例中,当致动水平齿轮组件16360时,在竖直齿轮组件16370的齿轮之间产生的齿轮齿数比和摩擦力用于防止竖直从动齿轮16192的旋转。
为了围绕第二工具关节运动轴线TA2-TA2在向上的方向上使端部执行器16012进行关节运动,机器人控制器11001致动移位器螺线管组件16350,以使移位器齿轮16342与第一竖直传动齿轮16372啮合。然后,控制器11001施加第一旋转输出运动到关节运动传动齿轮16322,以在第一方向上驱动移位器齿轮16342,从而最终在另一个第一方向上驱动竖直从动齿轮16192。驱动竖直从动齿轮16192以使近侧脊部分16110的球形部分16162上的关节运动环16164枢转,从而在近侧方向“PD”上牵拉右上部缆线16144和左上部缆线16150。为了围绕第二工具关节运动轴线TA2-TA2在向下方向上使端部执行器16012进行关节运动,机器人控制器11001致动移位器螺线管组件16350,以使移位器齿轮16342与第一竖直传动齿轮16372啮合。然后,控制器11001在相反方向上施加第一旋转输出运动到关节运动传动齿轮16322,以在第二方向上驱动移位器齿轮16342,从而最终在另一个第二方向上驱动竖直从动齿轮16192。从而此动作使关节运动控制环16164在近侧方向“PD”上牵拉右下部缆线16146和左下部缆线16152。在各种实施例中,当致动竖直齿轮组件16370时,在水平齿轮组件16360的齿轮之间产生的齿轮齿数比和摩擦力用于防止水平从动齿轮16182的旋转。
在各种实施例中,多个传感器可以与机器人控制器11001连通,以确定端部执行器16012的关节运动位置。例如,此类传感器可与关节运动接头16100连接或位于工具安装部分16200中。例如,可以使用传感器以检测近侧脊部分16110的球形部分16162上的关节运动控制环16164的位置。来自传感器至控制器11001的此类反馈允许控制器11001调节关节运动传动齿轮16322的旋转量和旋转输出的方向。另外,如上所述,当移位器传动齿轮16342居中设置成与第一水平传动齿轮16362和第一竖直传动齿轮16372啮合时,端部执行器16012被锁定在关节运动位置。因此,获得所需的关节运动量之后,控制器11001可致动移位器螺线管组件16350,以使移位器齿轮16342与第一水平传动齿轮16362和第一竖直传动齿轮16372啮合。在可供选择的实施例中,可将移位器螺线管组件16350弹簧致动至中心锁定位置。
在使用中,围绕纵向工具轴线LT-LT旋转外科端部执行器16012可能是有利的。在至少一个实施例中,工具安装部分上的传动装置16204包括旋转的传输组件16400,所述旋转的传输组件能够接收来自机器人系统11000的工具驱动组件11010的相应的旋转输出运动,并将此旋转输出运动转化成旋转控制运动,以使细长轴组件16008(和外科端部执行器16012)围绕纵向工具轴线LT-LT旋转。在各种实施例中,例如,近侧闭合管16040的近端部分16041通过向前的支撑支架16205以及也可运动地支撑在工具安装板16202上的闭合滑动件16510而旋转地支撑在工具安装部分16200的工具安装板16202上。在至少一种形式中,旋转的传输组件16400包括管齿轮段16402,所述管齿轮段形成于(或附接到)近侧闭合管16040的近端16041上,以通过可操作地支撑在工具安装板16202上的旋转齿轮组件16410可操作地接合。如图210所示,在至少一个实施例中,旋转齿轮组件16410包括旋转传动齿轮16412,当工具安装部分16200连接到工具驱动组件11010时,所述旋转传动齿轮连接到工具安装板16202的适配器侧11307上相应的从动盘或从动元件11304中的第二个。参见图105。旋转齿轮组件16410还包括第一旋转从动齿轮16414,所述第一旋转从动齿轮与旋转传动齿轮16412啮合可旋转地支撑在工具安装板16202上。第一旋转从动齿轮16414附接到可旋转地支撑在工具安装板16202上的驱动轴16416。第二旋转从动齿轮16418附接到驱动轴16416,并与在近侧闭合管16040上的管齿轮段16402啮合。将来自机器人系统11000的工具驱动组件11010的第二旋转输出运动施加到相应的从动元件11304,从而将引起旋转传动齿轮16412的旋转。旋转传动齿轮16412的旋转最终导致细长轴组件16008(和外科端部执行器16012)围绕纵向工具轴线LT-LT旋转。应当理解,在一个方向上施加来自工具驱动组件11010的旋转输出运动将引起细长轴组件16008和外科端部执行器16012围绕纵向工具轴线LT-LT在第一方向上旋转,并且在相对的方向上施加旋转输出运动将引起细长轴组件16008和外科端部执行器16012在相对于第一方向的第二方向上旋转。
在至少一个实施例中,通过在脊组件12049上沿着远侧方向“DD”使细长轴组件12008的闭合部分轴向运动来实现砧座12024相对于钉仓12034的闭合。如上所述,在各种实施例中,近侧闭合管16040的近端部分16041由闭合滑动件16510支撑,所述闭合滑动件包括闭合传动装置(一般描述为16512)的一部分。如图210所示,近侧闭合管部分16040的近端部分16041具有在其上形成的衬圈6048。闭合滑动件16510通过与衬圈16048中的环形沟槽16049接合的轭16514与衬圈16048连接。此装置用于使衬圈16048在保持与闭合传动装置16512联接的同时围绕纵向工具轴线LT-LT旋转。在各种实施例中,闭合滑动件16510具有直立部分16516,所述直立部分具有在其上形成的闭合齿条齿轮16518。闭合齿条齿轮16518能够与闭合齿轮组件16520驱动接合。参见图210。
在各种形式中,闭合齿轮组件16520包括闭合正齿轮16522,所述闭合正齿轮联接到工具安装板16202的适配器侧11307上相应从动盘或从动元件11304中的第二个个。参见图210。因此,当工具安装部分16202联接到工具驱动组件11010时,将来自机器人系统11000的工具驱动组件11010的第三旋转输出运动施加到相应的第二从动元件11304上将引起闭合正齿轮16522的旋转。闭合齿轮组件16520还包括以与闭合正齿轮16522和闭合齿条齿轮12106啮合的方式而被支撑的闭合减速齿轮组16524。因此,将来自机器人系统11000的工具驱动组件11010的第三旋转输出运动施加到相应的第二从动元件11304将引起闭合正齿轮16522和闭合传动件16512的旋转,并且最终在近侧脊部分16110上轴向驱动闭合滑动件16510和近侧闭合管16040。近侧闭合管16040运动的轴向最终取决于第三从动元件11304旋转的方向。例如,响应于接收自机器人系统11000的工具驱动组件11010的一次旋转输出运动,将在远侧方向“DD”上驱动闭合滑动件16510并最终在远侧方向“DD”上驱动近侧闭合管16040。当近侧闭合管16040朝远侧被驱动时,远侧闭合管16042由于其与近侧闭合管16040的连接也朝远侧被驱动。当朝远侧驱动远侧闭合管16042时,闭合管16042的端部将接合砧座16024的一部分并使砧座16024枢转到闭合位置。当施加来自机器人系统11000的工具驱动组件11010的“开口”输出运动时,将在近侧脊部分16110上沿着近侧方向“PD”驱动闭合滑动件16510和近侧闭合管16040。当在近侧方向“PD”上驱动近侧闭合管16040时,还将在近侧方向“PD”上驱动远侧闭合管16042。当在近侧方向“PD”上驱动远侧闭合管16042时,其中的开口16045与砧座16024上的突出部16027相互作用以利于砧座打开。在各种实施例中,当远侧闭合管16042运动至其起始位置时,可使用弹簧(未示出)以将砧座16024偏置至打开位置。在各种实施例中,闭合齿轮组件16520的各种齿轮的尺寸设定成能够产生所需的必要的闭合力,该闭合力满意地在待由外科端部执行器16012切割和缝合的组织上闭合砧座16024。例如,闭合传动装置16520的齿轮的尺寸设定成能够产生大约70-120磅的闭合力。
在各种实施例中,通过刀杆16530驱动切割器械穿过外科端部执行器16012。参见图210。在至少一种形式中,刀杆16530由接头装置(未示出)制成和/或由如下材料制成:所述材料在保持足够的刚性的同时可适应外科端部执行器16102围绕第一工具关节运动轴线和第二工具关节运动轴线而进行的关节运动,以推动切割器械穿过夹持在外科端部执行器16012中的组织。刀杆16530延伸穿过近侧脊部分16110中的中空通道16532。
在各种实施例中,刀杆16530的近端16534可旋转地附连到刀齿条齿轮16540上,使得刀杆16530相对于刀齿条齿轮16540自由旋转。刀杆16530的远端以上述各种方式附接到切割器械。如图210所示,刀齿条齿轮16540可滑动地支撑在附接到工具安装板16202的齿条外壳16542内,使得刀齿条齿轮16540保持与传动装置16204的刀驱动传动装置部分16550啮合。在各种实施例中,刀驱动传动装置部分16550包括刀齿轮组件16560。更具体地讲并结合图210,在至少一个实施例中,刀齿轮组件16560包括刀正齿轮16562,所述刀正齿轮联接到工具安装板16202的适配器侧11307上相应的从动盘或从动元件11304中的第四个。参见图105。因此,将来自机器人系统11000的另一旋转输出运动通过工具驱动组件11010施加到相应的第四从动元件11304将引起刀正齿轮16562的旋转。刀齿轮组件16560还包括刀减速齿轮组16564,所述刀减速齿轮组包括第一刀从动齿轮16566和第二刀传动齿轮16568。刀减速齿轮组16564可旋转地安装到工具安装板16202上,使得第一刀从动齿轮16566与刀正齿轮16562啮合。同样,第二刀传动齿轮16568与第三刀传动齿轮组件16570啮合。如图210所示,第二刀从动齿轮16568与第三刀传动齿轮组件16570的第四刀从动齿轮16572啮合。第四刀从动齿轮16572与第五刀从动齿轮组件16574啮合,所述第五刀从动齿轮组件与刀齿条齿轮16540啮合。在各种实施例中,刀齿轮组件16560的齿轮的尺寸设定成能够产生驱动切割器械穿过夹持在外科端部执行器16012中的组织并致动其中的钉所需的力。例如,刀齿轮组件16560的齿轮的尺寸可设定成能够产生大约40-100磅的驱动力。应当理解,在一个方向上施加来自工具驱动组件11010的旋转输出运动将引起切割器械在远侧方向上轴向运动,并且在相对的方向上施加旋转输出运动将引起切割器械在近侧方向上轴向运动。
通过上述说明可以理解,外科工具16000代表对现有机器人工具装置的大幅改进。外科工具16000采用的独特的和新颖的传动装置,使该工具可操作地联接到仅具有四个旋转的输出主体的机器人系统的工具架部分11010,另外从其获得旋转输出运动以:(i)围绕基本上彼此横向的以及横向于纵向工具轴线的两条不同的关节运动轴线使端部执行器进行关节运动;(ii)围绕纵向工具轴线旋转端部执行器16012;(iii)相对于外科钉仓16034不同程度地闭合砧座16024,以使端部执行器16012能够用于操纵组织,然后将其夹紧以对其进行切割和缝合;以及(iv)击发切割器械以切割夹持在端部执行器16012中的组织。上述本发明的各种实施例的独特的和新颖的移位器装置使得两种不同的关节运动动作从机器人系统的单个旋转主体部分获得动力。
以上已经结合切割型外科器械对本发明的各种实施例进行了描述。然而,应该指出的是,在其它实施例中,本文公开的本发明的外科器械不必为切割型外科器械,而是可被用于包括遥感器转发器的任何类型的外科器械中。例如,其可为非切割内窥镜式器械、抓紧器、缝合器、施加器、进入装置、药物/基因治疗递送装置、利用超声波、射频、激光等的能量装置。此外,本发明例如可为腹腔镜式器械。本发明也可在传统的内窥镜式和开放式外科器械以及机器人辅助的手术中得到应用。
图211示出了结合具有超声动力的端部执行器17012的外科工具17000使用本发明的某些实施例的各个方面。端部执行器17012通过细长轴组件17008可操作地附接到工具安装部分17100。工具安装部分17100可基本上类似于上述各种工具安装部分。在一个实施例中,端部执行器17012包括超声动力的钳口部分17014,所述超声动力的钳口部分由交流电或直流电以已知方式提供动力。此类超声动力的装置在例如名称为“Robotic SurgicalTool With Ultrasound Cauterizing and Cutting Instrument”的美国专利6,783,524中公开,该专利的全部公开内容以引用的方式并入本文。在图示实施例中,示出了单独的电源线17020。然而,应当理解,可通过工具安装部分17100从机器人控制器1001对其提供动力。外科端部执行器17012还包括可用于将组织夹持到超声钳口部分17014上的可运动钳口17016。可以本文所述的各种方式中的任意一种通过机器人控制器11001选择性地致动可运动的钳口部分17016穿过工具安装部分17100。
图213示出了结合具有包括直线型缝合装置的端部执行器18012的外科工具18000使用本发明的某些实施例的各种方面。端部执行器18012通过上述类型和构造的细长轴组件13700可操作地附接到工具安装部分18100。然而,端部执行器18012可通过本文所述的各种其他细长轴组件附接到工具安装部分18100。在一个实施例中,工具安装部分18100可基本上类似于工具安装部分13750。然而,还可使用本文详细描述的各种其他工具安装部分和它们各自的传动装置。此类线性缝合压头部分也在例如名称为“Surgical StaplingDevice With Staple Driver That Supports Multiple Wire Diameter Staples”的美国专利7,673,781中公开,该专利的全部公开内容以引用的方式并入本文。
在授予Shelton,IV等人的美国专利公开2011/0062212A1中公开的各种传感器实施例可以与本文所公开的许多外科工具实施例一起使用,该专利的公开内容全文以引用的方式并入本文。如上所述,主控制器11001通常包括主控制器(一般表示为11003),在外科医生通过立体显示器11002观察手术的同时,所述主控制器由外科医生抓持并在空中操控。参见图96。主控制器11001是手动输入装置,其优选地以多个自由度运动,并且通常还具有用于致动外科工具的致动手柄。本文所公开的一些外科工具实施例在其工具驱动部分中采用一个或多个马达,以为工具端部执行器提供各种控制运动。此类实施例也可从机器人系统部件中所采用的马达装置中获得另外的控制运动。本文中所公开的其他实施例从机器人系统内的马达装置中获得全部的控制运动。
在不脱离本发明的实质和范围的情况下,此类马达动力装置可采用各种传感器装置,所述传感器装置在上述引用的美国专利申请中公布以为外科医生提供多种形式的反馈。例如,采用手动致动击发触发器的那些主控制器装置11003可使用马达运转传感器以为外科医生提供与施加到切割构件或由其承受的力的大小相关的反馈。马达运转传感器能够与击发触发器部分连通,以检测击发触发器部分何时致动而由端部执行器开始切割/缝合操作。马达运转传感器可以为比例传感器,例如变阻器或可变电阻器。当击发触发器被拉近时,传感器检测此运动,并发送电信号,所述电信号指示提供给相应电机的电压(或功率)。当传感器为可变电阻器等时,马达的转速可与击发触发器的运动量大致成比例。即,如果操作者仅少量牵拉或者闭合击发触发器,则马达的转速相对较低。当完全拉近击发触发器(或者处于完全闭合位置)时,马达的转速为其最大值。换句话讲,外科医生越用力牵拉击发触发器,则施加到马达上的电压就越大,从而转速就越大。其他装置可为外科医生提供反馈计11005和力的大小的视觉指示,所述反馈计可通过显示器1002观察,并且所述力的大小为施加到切割器械或动态夹紧构件的力的大小。其他传感器装置可用于为主控制器11001提供指示,以指示钉仓是否已加载到端部执行器中、砧座是否在击发之前已运动至闭合位置等。
在可供选择的实施例中,可结合控制器11001使用马达控制的接口,所述控制器根据外科端部执行器承受的负载(如,夹紧力、切割力等)来限制最大的触发器牵拉力。例如,越难驱动切割器械穿过夹持在端部执行器中的组织,则越难牵拉/致动击发触发器。在其他实施例中,将控制器11001上的触发器布置成使得触发器牵拉位置与端部执行器位置/状态相当。例如,仅当完全击发端部执行器时完全按下触发器。
可将本发明所公开的装置设计为单次使用后即进行处理,或者可将它们设计为可多次使用。然而,在任一种情况下,所述装置均可进行修复,以在至少一次使用后再次使用。重新恢复可包括如下步骤的任意组合:拆卸该装置、然后清洗或置换某些部分以及随后组装。特别是,所述装置可以拆卸,而且可以任意组合选择性地置换或移除该装置任意数目的特定零件或部分。清洗和/或置换特定部分后,该装置可以在修复设施处重新组装以便随后使用,或者在即将进行外科手术前由外科手术队重新组装。本领域的技术人员将会知道,装置的修复可利用多种用于拆卸、清洗/置换和重新组装的技术。这些技术的使用以及所得的修复装置均在本发明的范围内。
尽管本文已经结合某些公开的实施例描述了本发明,但是可对那些实施例进行多种修改和变型。例如,可采用不同类型的端部执行器。另外,凡是公开了用于某些部件的材料的情形均可使用其它材料。上述描述和以下权利要求旨在涵盖所有这类修改形式和变型。
以引用方式全文或部分地并入本文的任何专利、公布或其他公开材料均仅在所并入的材料不与本发明所述的现有定义、陈述或其他公开材料相冲突的范围内并入本文。由此,在必要的程度下,本文所明确阐述的公开内容将取代以引用方式并入本文的任何相冲突的材料。如果据述以引用方式并入本文但与本文所述的现有定义、陈述或其它公开材料相冲突的任何材料或其部分,仅在所并入的材料和现有的公开材料之间不产生冲突的程度下并入本文。
Claims (18)
1.一种外科缝合装置,包括:
机器人系统,其能够操作以生成击发运动和闭合运动并且具有联接至该机器人系统的适配器部分;
工具部分,其响应于来自所述机器人系统的击发运动和闭合运动,所述工具部分包括:
工具安装部分,其包括能够与所述适配器部分以安装方式交接的工具安装板,并支撑该工具安装部分上的传动装置,其中,所述传动装置包括安置在所述工具安装板上的第一闭合马达和安置在该工具安装板上的第一击发马达;
细长通道,其联接到所述机器人系统并且能够在其中支撑钉仓;
砧座,其可运动地联接到所述细长通道并且在其中具有砧座通道,所述砧座能够响应于由所述第一闭合马达和所述机器人系统施加至其上的所述闭合运动而在打开位置和闭合位置之间运动;
击发装置,其包括远侧设置的切刃,所述击发装置能够响应于由所述第一击发马达和所述机器人系统施加至其上的所述击发运动而在所述细长通道内纵向运动;
位于所述击发装置上的上部构件,其能够接合到所述砧座通道;以及下部,其在用于击发的远侧运动过程中纵向接合所述细长通道,并且其中所述钉仓包括:
能够支撑在所述细长通道内的仓体,所述仓体具有非平面的平台表面,当所述砧座处于所述闭合位置时,所述非平面的平台表面能够面对其中的所述砧座钉成形凹坑的钉成形部分;
多个第一钉驱动器,其可运动地支撑在所述仓体中,并且所述多个第一钉驱动器在与所述击发装置顺序地相互作用时能够相继从未致动位置运动至致动位置,每个所述第一钉驱动器在其中限定第一钉支撑支架以用于将钉支撑于其上,每个所述第一钉支撑支架与所述闭合砧座的所述钉成形部分的相应部分相距第一钉成形距离定位;和
多个第二钉驱动器,其可运动地支撑在所述仓体中并且与所述第一钉驱动器横向地间隔开,每个所述第二钉驱动器在与所述击发装置顺序地相互作用时能够相继从另一个未致动位置运动至另一个致动位置,每个所述第二钉驱动器在其中限定第二钉支撑支架以用于将另一个钉支撑于其上,每个所述第二钉支撑支架与对应于所述第二钉支撑支架的所述闭合砧座的所述钉成形部分的另一个相应部分相距第二钉成形距离定位,并且其中所述第二钉成形距离在量级上不同于所述第一钉成形距离。
2.根据权利要求1所述的外科缝合装置,其中每个所述第一钉驱动器将所述钉中的至少两个支撑于其上。
3.根据权利要求2所述的外科缝合装置,其中所述第一钉支撑支架位于所述第一钉驱动器的主驱动器部分中,并且其中每个所述第一钉驱动器还包括附接到所述主驱动器部分并且限定次钉支撑支架的次驱动器部分,当所述砧座处于闭合位置时,所述次钉支撑支架与所述砧座的另一个相应部分相距次钉成形距离定位,所述次支撑支架将所述钉中的另一个支撑于其上。
4.根据权利要求3所述的外科缝合装置,其中所述次钉成形距离基本上等于所述第一钉成形距离。
5.根据权利要求3所述的外科缝合装置,其中所述次钉成形距离在量级上不同于所述第一钉成形距离和所述第二钉成形距离。
6.根据权利要求1所述的外科缝合装置,其中所述多个第一钉驱动器轴向排列成第一排第一钉驱动器,并且其中所述多个第二钉驱动器排列成第二排所述第二钉驱动器。
7.根据权利要求6所述的外科缝合装置,其中所述第一排所述第一钉驱动器中的一个所述第一钉驱动器的所述第一钉成形距离在量级上不同于所述第一排第一钉驱动器中的另一个所述第一钉驱动器的所述第一钉成形距离。
8.根据权利要求7所述的外科缝合装置,其中所述第二排所述第二钉驱动器中的一个所述第二钉驱动器的所述第二钉成形距离在量级上不同于所述第二排所述第二钉驱动器中的另一个所述第二钉驱动器的所述第二钉成形距离。
9.一种外科缝合装置,包括:
机器人系统,其能够操作以生成击发运动和闭合运动并且具有联接至该机器人系统的适配器部分;
工具部分,其响应于来自所述机器人系统的击发运动和闭合运动,所述工具部分包括:
工具安装部分,其包括能够与所述适配器部分以安装方式交接的工具安装板,并支撑该工具安装部分上的传动装置,其中,所述传动装置包括安置在所述工具安装板上的第一闭合马达和安置在该工具安装板上的第一击发马达;
细长通道,其可操作地联接到所述机器人系统的一部分并且能够在其中支撑钉仓;
砧座,其可运动地联接到所述细长通道并且其中具有砧座通道,当向所述砧座施加来自所述第一闭合马达和所述机器人系统的所述闭合运动时,所述砧座能够从打开位置运动至闭合位置;
击发装置,其包括远侧设置的切刃,当向所述击发装置施加来自所述第一击发马达和所述机器人系统的所述击发运动时,所述击发装置能够在所述细长通道和所述砧座中从起始位置纵向运动至结束位置,所述击发装置具有在用于击发的远侧运动过程中用于接合所述砧座通道的上部以及用于接合所述细长通道的下部,并且其中所述钉仓包括:
仓体,所述仓体的尺寸设定成支撑在所述细长通道内,所述仓体中具有纵向延伸的狭槽,以用于将所述击发装置容纳于其中,所述仓体具有非平面的平台表面,当所述砧座处于所述闭合位置时,所述非平面的平台表面能够面对其中具有钉成形凹坑的所述砧座的钉成形部分;
多个第一内侧钉驱动器,其在邻近所述纵向延伸的狭槽的第一侧面的所述仓体的一部分中轴向排列成第一排内侧钉驱动器;和多个第二内侧钉驱动器,其在邻近所述纵向延伸的狭槽的第二侧面的所述仓体的另一部分中轴向排列成第二排内侧钉驱动器,当所述砧座处于闭合位置时,所述内侧钉驱动器可运动地支撑在所述仓体内以朝所述砧座选择性地运动,每个所述内侧钉驱动器限定用于将钉支撑于其上的第一钉支撑支架,当所述砧座处于闭合位置时,每个所述第一钉支撑支架与所述砧座的相应部分相距第一钉成形距离定位;
多个第一外侧钉驱动器,其邻近所述第一排所述内侧钉驱动器轴向排列成第一排外侧钉驱动器;和多个第二外侧钉驱动器,其邻近所述第二排内侧钉驱动器轴向排列成第二排外侧钉驱动器,当所述砧座处于所述闭合位置时,每个所述外侧钉驱动器可运动地支撑在所述仓体内以朝所述砧座选择性地进行驱动运动,每个所述外侧钉驱动器限定用于将另一个钉支撑于其上的第二钉支撑支架,当所述砧座处于所述闭合位置时,每个所述第二钉支撑支架与所述砧座的另一个相应部分相距第二钉成形距离定位,所述第二钉成形距离在量级上不同于所述第一钉成形距离;和
楔形滑动件,其支撑在所述仓体中,以通过所述击发装置驱动接触并致动接触所述多个第一所述内侧钉驱动器和多个第二所述内侧钉驱动器以及所述多个第一所述外侧钉驱动器和多个第二所述外侧钉驱动器,使得随着所述击发装置响应于来自所述机器人系统的击发运动沿第一轴向在所述仓体中的所述细长狭槽内运动,所述楔形滑动件朝所述砧座驱动所述内侧驱动器和外侧驱动器中的每一个,以当所述砧座处于所述闭合位置时使支撑在所述内侧驱动器和外侧驱动器上的所述钉与所述砧座成形接触。
10.根据权利要求9所述的外科缝合装置,其中所述内侧钉驱动器中的每一个将所述钉中的两个支撑于其上。
11.根据权利要求10所述的外科缝合装置,其中支撑在至少一个所述内侧钉驱动器上的所述两个钉彼此纵向错开。
12.根据权利要求10所述的外科缝合装置,其中所述第一钉支撑支架位于所述内侧驱动器的主驱动器部分中,并且其中每个所述内侧驱动器还包括附接到所述主驱动器部分的次驱动器部分,所述次驱动器部分在其中限定次钉支撑支架,当所述砧座处于闭合位置时,所述次钉支撑支架与所述砧座的另一个相应部分相距次钉成形距离定位,每个所述次钉支撑支架将所述钉中的一个支撑于其上。
13.根据权利要求12所述的外科缝合装置,其中所述次钉成形距离基本上等于所述第一钉成形距离。
14.根据权利要求12所述的外科缝合装置,其中所述次钉成形距离在量级上不同于所述第一钉成形距离和所述第二钉成形距离。
15.根据权利要求10所述的外科缝合装置,其中所述第一排所述第一外侧钉驱动器中的至少一个所述外侧钉驱动器的所述第二钉成形距离在量级上不同于所述第一排所述外侧钉驱动器中的至少一个其他的所述外侧钉驱动器的所述第二钉成形距离。
16.根据权利要求15所述的外科钉仓,其中所述第二排所述外侧钉驱动器中的至少一个所述外侧钉驱动器的所述第二钉成形距离在量级上不同于所述第二排所述外侧钉驱动器中的至少一个其他的所述外侧钉驱动器的所述第二钉成形距离。
17.根据权利要求9所述的外科缝合装置,其中所述第一排所述内侧钉驱动器中的至少一个所述第一钉驱动器的所述第一钉成形距离在量级上不同于所述第一排所述内侧钉驱动器中的至少一个其他的所述内侧钉驱动器的所述第一钉成形距离。
18.根据权利要求15所述的外科缝合装置,其中所述第二排所述内侧钉驱动器中的至少一个所述内侧钉驱动器的所述第一钉成形距离在量级上不同于所述第二排所述内侧钉驱动器中的至少一个其他的所述内侧钉驱动器的所述第一钉成形距离。
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CN107625541A (zh) | 2018-01-26 |
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