CN103976771A - 手术施夹器 - Google Patents

手术施夹器 Download PDF

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CN103976771A
CN103976771A CN201410008877.5A CN201410008877A CN103976771A CN 103976771 A CN103976771 A CN 103976771A CN 201410008877 A CN201410008877 A CN 201410008877A CN 103976771 A CN103976771 A CN 103976771A
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passage
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雅罗斯洛娃·T·马尔科夫斯基
布赖恩·罗克罗尔
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Covidien LP
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/128—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/128—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
    • A61B17/1285—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • A61B2017/00407—Ratchet means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2932—Transmission of forces to jaw members
    • A61B2017/2943—Toothed members, e.g. rack and pinion

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Abstract

本发明提供了一种手术施夹器，并且包括：棘轮机构，其具有连接到驱动通道的齿条构件，使得驱动通道的轴向平移引起齿条构件的轴向平移，所述齿条构件限定有沿其第一侧的第一套齿以及沿其第二侧的第二套齿。所述棘轮机构包括：第一爪和第二爪，其各自可倾斜地支撑在壳体中并且分别布置在齿条构件的相对侧上；以及变弯弹簧，其介于第一爪和第二爪之间并且该变弯弹簧被约束在齿条构件中形成的槽中，其中所述变弯弹簧被定尺寸为在近侧方向和远侧方向的其中一个方向上弯曲。

Description

手术施夹器
技术领域
本申请涉及手术器械，并且更特别地，本申请涉及具有多个夹子的手术施夹器，该手术施夹器用于在手术操作中将夹子施加到体组织和血管。
背景技术
手术施夹器在本领域中是已知的，并且手术施夹器因提供对体组织和血管的传统缝合的替代而在外科医生中日益流行。在授予格林(Green)等人的第5,030,226号美国专利以及授予伯班克三世（BurbankIII）等人的第5,431,668号美国专利中公开了典型的器械。通常，这些器械提供了多个夹子，这些夹子被存储在器械中并且在打开和闭合器械近侧端处的手柄时向器械的远侧端处的钳夹机构被顺序地供给。随着手柄闭合，钳夹闭合从而使得定位于钳夹构件之间的夹子变形，并且随着打开钳夹以释放已变形的夹子，从序列中将新的夹子供给到钳夹之间的位置。重复该过程直到夹子序列中的所有夹子都已被使用。
不可避免地，这些器械趋向相对复杂，包括许多的部件，这些部件中的许多部件相互移动和相互协作。
因此，鉴于卫生保健以及手术费用的增长，存在控制手术操作中使用的设备等的成本的需求。
于是，存在对具有更少的部件并且制造起来更经济的改良施夹器的需求。
发明内容
本申请涉及具有多个夹子的手术施夹器以及其使用方法，该手术施夹器用于在手术操作期间将夹子应用到体组织和血管。
根据本公开的一个方案，提供了一种手术施夹器，所述手术施夹器包括：壳体；至少一个手柄，其可枢转地连接到所述壳体；通道组件，其从所述壳体向远侧延伸出；夹子承载器，其布置在通道组件内并且限定了通道；多个夹子，其装载在所述夹子承载器的通道中；驱动通道，其可平移地支撑在所述壳体和所述通道组件中，所述驱动通道在所述至少一个手柄致动时被平移；以及棘轮机构，其布置在所述壳体中。所述棘轮机构包括：齿条构件，其连接到驱动通道，使得驱动通道的轴向平移引起齿条构件的轴向平移，所述齿条构件限定有沿其第一侧的第一套齿以及沿其第二侧的第二套齿；第一爪和第二爪，其各自可倾斜地支撑在壳体中并且分别布置在齿条构件的相对侧上；以及变弯弹簧，其介于第一爪和第二爪之间并且所述变弯弹簧被约束在齿条构件中形成的槽中，其中所述变弯弹簧被定尺寸为在近侧方向和远侧方向的其中一个方向上弯曲。
使用中，当所述变弯弹簧在近侧方向上弯曲时，所述第一爪和所述第二爪与所述齿条构件接合以准许驱动通道在远侧方向上移动；并且，当所述变弯弹簧在所述远侧方向上弯曲时，所述第一爪和所述第二爪与所述齿条构件接合以准许驱动通道在近侧方向上移动。
所述手术施夹器可以进一步包括夹子输出器，其可滑动地布置在所述夹子承载器的通道内并且布置在所述多个夹子的近侧，所述夹子输出器被配置为且适用于通过所述夹子承载器的通道和通过所述通道组件进行选择性增量推进，其中所述夹子输出器被配置为且适用于在所述多个夹子的最远侧夹子装载入一对钳夹中之后，相对于所述夹子承载器在远侧方向上驱使所述多个夹子。
所述夹子输出器可以通过偏置构件在远侧方向上被驱使。所述偏置构件可以是等拉力弹簧。所述等拉力弹簧可以包括被紧固以防止在手术施夹器中移动的远侧端，以及盘绕在自身上的近侧端。所述等拉力弹簧的盘绕近侧端可以连接至所述夹子输出器以在盘绕所述等拉力弹簧的盘绕近侧端时将所述夹子输出器向远侧拉动。
所述手术施夹器可以进一步包括夹子推杆，所述夹子推杆往复运动地定位在所述壳体和所述通道组件中的至少一个内。所述推杆可以具有第一端和第二端，所述第一端可操作地连接到所述至少一个手柄，所述第二端限定有推动器。随着所述至少一个手柄被致动，所述推动器可以远离所述一对钳夹移动从而使所述推动器在存储在所述夹子承载器的通道中的最远侧夹子的后方移动。所述推杆可以被配置为且适用于随着所述至少一个手柄返回到未致动位置而朝向钳夹移动，以使所述最远侧夹子在所述一对钳夹之间移动。
所述夹子输出器可以包括头部，所述头部被配置并定尺寸为在一叠夹子的最后的夹子装载入所述手术施夹器的一对钳夹中之后，接合处于缩回位置时的所述夹子推杆的推动器。
使用中，在所述夹子输出器的所述头部与所述夹子推杆的推动器接合之后，所述夹子推杆的远侧推进可以使所述夹子输出器向远侧推进，使得所述夹子输出器的所述头部被定位在所述一对钳夹之间。
使用中，当所述夹子输出器的所述头部被定位在所述一对钳夹之间时，所述夹子输出器的所述头部可以阻止所述一对钳夹闭合从而防止所述至少一个手柄完全地致动。
所述手术施夹器可以进一步包括钳夹组件，所述钳夹组件包括一对钳夹，所述一对钳夹从所述通道组件的与所述壳体相对的一端延伸出，所述钳夹组件适用于在其中容纳夹子并且所述钳夹组件能够根据所述至少一个手柄的移动而操作以实现夹子的成形。
所述驱动通道可以包括第一端和第二端，所述第一端操作地连接到所述至少一个手柄，所述第二端被配置和定尺寸为环绕并且选择性地使所述一对钳夹接合以实现所述一对钳夹的闭合。随着所述至少一个手柄在第一方向上移动，所述驱动通道可以朝向所述钳夹组件移动以使所述驱动通道的第二端靠近所述一对钳夹移动从而闭合所述一对钳夹。随着所述至少一个手柄在与所述第一方向相反的第二方向上移动，所述驱动通道可以远离所述钳夹组件移动，以使所述驱动通道的第二端远离所述钳夹组件移动从而允许所述一对钳夹打开。
所述驱动通道的第二端可以包括在一对钳夹之间延伸的舌状件。
使用中，在所述驱动通道布置在最近侧位置处，变弯弹簧在近侧方向上弯曲，并且所述第一爪和所述第二爪与所述齿条构件接合以便准许驱动通道在远侧方向上移运的状态下，当所述驱动通道被推进至最远侧位置时，向近侧弯曲的变弯弹簧可以被作用并且被引起在远侧方向上弯曲，由此所述驱动通道被准许在近侧方向上移动。
使用中，在所述驱动通道布置在最远侧位置处，变弯弹簧在远侧方向上弯曲，并且所述第一爪和所述第二爪与所述齿条构件接合以便准许驱动通道在近侧方向上移动的状态下，当所述驱动通道缩回到最近侧位置时，向远侧弯曲的变弯弹簧可以被作用并且被引起在近侧方向上弯曲，由此所述驱动通道被准许在远侧方向上移动。
所述驱动通道可以包括在朝向所述夹子输出器的方向上从所述驱动通道突出的停止挡块，并且其中所述夹子输出器在其中限定有窗口。使用中，当所述夹子输出器在最远侧位置并且其头部布置在所述一对钳夹之间，并且当所述驱动通道在最近侧位置时，所述驱动通道的所述停止挡块可以布置在所述夹子输出器的所述窗口中。
所述夹子输出器可以包括：具有远侧端和近侧端的细长主体，其中所述头部被支撑在所述细长主体的远侧端处；以及具有远侧端和近侧端的尾部，其中所述尾部的近侧端与所述细长主体的近侧端相连接，使得所述尾部和所述细长主体相互远离偏置。
被配置为接纳所述驱动通道的停止挡块的所述夹子输出器的窗口可以形成在尾部中。
可以通过等拉力弹簧在远侧方向上驱使所述夹子输出器。所述等拉力弹簧可以包括被紧固以防止在手术施夹器中移动的远侧端，以及盘绕在自身上的近侧端，所述近侧端至少部分地布置在所述夹子输出器的尾部的窗口中。在所述多个夹子的最远侧夹子装载入所述手术施夹器的一对钳夹中之后盘绕所述等拉力弹簧的盘绕近侧端时，所述等拉力弹簧的盘绕近侧端可以将所述夹子输出器向远侧拉动。
使用中，当所述变弯弹簧被引起发生变弯以便从近侧方向弯向远侧方向以及从远侧方向弯向近侧方向时，所述一对爪可以被引起绕枢转点弹起并且产生听觉反馈和触觉反馈中的至少一种反馈。
所述通道组件可以包括一对相对的近侧侧壁，其中所述通道组件的各近侧侧壁可以限定有大致V形通道，并且其中各爪可以被可枢转地布置在通道组件的相应V形通道中。
各V形通道可以包括突出到通道中的肋件。V形通道的肋件可以被接纳在限定在各爪中的凹口中，其中各爪在V形凹口中的轴向位置被保持。
所述驱动通道可以包括从其近侧端向近侧延伸的尾部。所述驱动通道的尾部可以在第一爪和第二爪之间延伸，并且其中所述棘轮机构的所述齿条构件可以形成在所述驱动通道的尾部上。
附图说明
当结合下面的附图考虑时，由于通过下面的详细说明将更好地理解本发明的施夹器，所以本发明的施夹器将得到更加全面地了解，在附图中：
图1为根据本公开一实施例的手术施夹器的立体图；
图2为图1的手术施夹器的俯视平面图；
图3为图1和图2的手术施夹器的侧视图；
图4为图1至图3的手术施夹器的分解立体图；
图5为图1至图3的手术施夹器的夹子通道的立体图；
图6为图1至图3的手术施夹器的推杆的远侧端的放大立体图；
图7为图1至图3的手术施夹器的夹子输出器的立体图；
图8为图7的细节指示区域的放大视图；
图9为夹子输出器的近侧端的放大视图，图示出了与其相关联的偏置构件；
图10为图1至图3的手术施夹器的远侧端的立体图；
图11为图1至图3的手术施夹器的一对钳夹以及驱动通道的远侧端的部件分开的立体图；
图12为图1至图3的手术施夹器的立体图，其中从手术施夹器移除了壳体半部；
图13为图12中图示出的手术施夹器的局部放大视图；
图14为图13的细节指示区域的放大视图；
图15为图1至图3的手术施夹器的远侧端的立体图；
图16为图1至图3的手术施夹器的远侧端的立体图，其中从手术施夹器中移除了夹子通道；
图17为图13的细节指示区域的放大视图；
图18为图13的细节指示区域的放大视图；
图19为图13中图示出的手术施夹器的局部放大图，其中移除了一叠夹子和联接机构；
图20为图19的细节指示区域的放大视图；
图21为图13中图示出的手术施夹器的局部放大视图，其中移除了一叠夹子、联接机构以及推杆；
图22为图21的细节指示区域的放大视图；
图23为图1至图3的手术施夹器的立体图，其中从手术施夹器中移除了壳体半部并且图示出了处于未致动状态的手术施夹器；
图24为图23的细节指示区域的放大视图；
图25为图23的细节指示区域的放大视图；
图26为图24的细节指示区域的放大视图；
图27为图23中图示出的手术施夹器的纵向剖视图；
图28为图27的细节指示区域的放大视图；
图29为图27的细节指示区域的放大视图；
图30为图29的细节指示区域的放大视图；
图31为图27的细节指示区域的放大视图；
图32为图1至图3的手术施夹器的平面图，其中从手术施夹器中移除了壳体并且示出了处于未致动状态的手术施夹器；
图33为图32的细节指示区域的放大视图；
图34为图32图示出的手术施夹器的一对钳夹以及驱动通道的俯视平面图；
图35为通过图34的35-35所截取的剖视图；
图36为图32的细节指示区域的放大视图；
图37为图1至图3的手术施夹器的立体图，其中从手术施夹器中移除了壳体并且图示出了其初始致动期间的手术施夹器；
图38为图37的细节指示区域的放大视图；
图39为图37的细节指示区域的放大视图；
图40为图37中图示出的手术施夹器的纵向剖视图；
图41为图40的细节指示区域的放大视图；
图42为图37中图示出的手术施夹器的一对钳夹以及驱动通道的俯视平面图；
图43为通过图40的43-43所截取的剖视图；
图44为图1至图3的手术施夹器的俯视平面图，其中从手术施夹器中移除了壳体并且示出了处于完全致动状态的手术施夹器；
图45为图44的细节指示区域的放大视图；
图46为当手术施夹器处于完全致动状态时，图44的手术施夹器的联接机构以及棘轮机构的俯视平面图；
图47为当手术施夹器处于完全致动状态时，图44的手术施夹器的一对钳夹以及驱动通道的俯视平面图；
图48为图47的手术施夹器的一对钳夹以及驱动通道的底部立体图；
图49为当手术施夹器处于完全致动状态时，图1-3的手术施夹器的一对钳夹、驱动通道、夹子通道以及一叠夹子的俯视立体图；
图50为当手术施夹器处于完全致动状态时，图1-3的手术施夹器的一对钳夹、驱动通道以及夹子通道的俯视立体图；
图51为图44中图示出的手术施夹器的远侧端的纵向剖视图；
图52为体血管的立体图，包括示出被应用至体血管的手术施夹器的夹子；
图53为图示出在图1至图3的手术施夹器的打开期间的联接机构的俯视平面图；
图54为图示出在手术施夹器打开期间，图1至图3的手术施夹器的远侧端的纵向剖视图；
图55为图示出在锁定状态下，图1至图3的手术施夹器的通道组件的纵向剖视图；
图56为图55的细节指示区域的放大视图；
图57为图1至图3的手术施夹器的通道组件的纵向剖视图，图示出了手术施夹器的锁定；
图58为图55的细节指示区域的放大视图；
图59为根据本公开另一个实施例的手术施夹器的手柄组件的后端的立体图，其中从手术施夹器移除了壳体半部，图示出了根据本公开另一个实施例的棘轮机构；
图60为图59中图示出的棘轮机构的俯视平面图；
图61为图59和图60中图示出的手术施夹器的下通道、驱动通道以及棘轮机构的部件分开的立体图；
图62为图61的细节指示区域的放大视图；
图63为手术施夹器的俯视立体图，其中从手术施夹器移除了盖以及壳体半部，且图示出根据本公开另一个实施例的夹子输出器；
图64为图63的细节指示区域的放大视图；
图65为图示出根据本公开另一个实施例的图63的夹子输出器以及等拉力弹簧的部件分开的立体图；
图66为图示出图63至图66的等拉力弹簧与钉仓盖连接的放大立体图；
图67为图63至图65的夹子输出器的后仰视立体图；
图68为图63至图65的夹子输出器的主俯视立体图；
图69为图63至图66中图示出的施夹器的立体纵向剖视图；并且
图70为图63至图66中图示出的施夹器的正视纵向剖视图。
具体实施方式
现在，将参照附图详细地描述根据本公开的手术施夹器的实施例，其中，相似的附图标记表示相似或相同的结构元件。如附图中所示和在整个以下说明中描述的，按照惯例，当涉及手术器械上的相对定位时，术语“近侧”是指装置的较靠近用户的端部，而术语“远侧”是指装置的较远离用户的端部。
首先转至图1至图3，在开放式手术操作期间以封闭为目的能够对选定的组织应用多个止血夹子的手术器械主要被表示为100。
施夹器100包括手柄组件102，手柄组件102包括壳体104，壳体104具有上壳体半部104a和下壳体半部104b。手柄组件102进一步包括一对手柄106，一对手柄106可枢转地紧固到壳体104并且从壳体104向外延伸出。通道组件108固定地紧固到壳体104并且从壳体104向外延伸出，在钳夹组件110中终止并且支撑钳夹组件110。
如图4所示，施夹器100的壳体半部104a和壳体半部104b利用相互搭扣配合式接合而装配在一起。壳体104由合适的塑性材料制成。
手柄106通过从上壳体半部104a和下壳体半部104b延伸出来的互补的两部件式手柄枢轴柱104d紧固到壳体104，当壳体半部104a、壳体半部104b相互连接或搭扣时，互补的两部件式手柄枢轴柱104d相互联结。枢轴柱104d被接纳到在手柄106中形成的相应远侧孔106a中。手柄组件102包括连杆构件122，在相应手柄106中形成的枢转点106b处，连杆构件122在其第一端122a处枢转地连接到各手柄106。各连杆构件122的第二端122b枢转地连接到在驱动通道140的侧壁140b中限定的相应的枢转点140b1、枢转点140b2。
通道组件108包括通道或者钉仓盖130以及外通道或下通道132，其在上壳体半部104a和下壳体半部104b之间分别具有保持在手柄组件102中的近侧端。钉仓盖130包括至少一个固持元件，该至少一个固持元件被配置为且适用于以搭扣配合式接合选择性地接合在外通道132上设置的互补或相应的固持元件。
如图4和图11、图21以及图22所示，施夹器100包括驱动通道140，驱动通道140被往复运动地支撑在手柄组件102的壳体104和通道组件108中并且在手柄组件102的壳体104和通道组件108之间延伸。驱动通道140的近侧端被支撑在壳体104的上壳体半部104a和下壳体半部104b之间，并且驱动通道140的远侧端被支撑在通道组件108的钉仓盖130和外通道132之间。
如图11和图26至图28所示，驱动通道140的远侧端为大致盒形管道，其包括使顶壁140a与底壁140c相互连接的一对隔开的侧壁140b。驱动通道140的最远侧端包括舌状件140e，其布置在侧壁140b之间并且从底壁140c延伸出且在顶壁140a和底壁140c之间延伸以限定一对面向远侧的开口140e1、140e2。
驱动通道140的近侧端限定了细长销槽140d，细长销槽140d形成在驱动通道140的底壁140c中用于销124沿细长销槽滑动的通过。销124沿通道组件108的中心纵向轴线而定位。
如图4和图12所示，施夹器100进一步包括呈压缩弹簧形式的偏置构件146，该偏置构件146布置在壳体104内以便可操作地环绕驱动通道140的中间部分并且以便紧靠壳体104的内部远侧表面。偏置构件146起到主要维持驱动通道140在缩回位置或最近侧位置的作用。特别地，偏置构件146起到在定位于钳夹120之间的夹子“C”成形之后以及在释放手柄106之后使驱动通道140缩回或便于驱动通道140缩回的作用。
如图23和图25所示，驱动通道140的近侧端支撑棘轮齿条构件141并且棘轮齿条构件141紧固到驱动通道140的近侧端，其中棘轮齿条构件141可与驱动通道140一起运动。棘轮齿条构件141限定了被配置为且适用于接合第一棘轮爪142a的第一套齿141a，以及被配置为且适用于接合第二棘轮爪142b的第二套齿141b，其中第一套齿141a与第二套齿141b布置在齿条构件141的相对侧上。第一棘轮爪142a和第二棘轮爪142b分别被支撑在壳体104中，其中第一棘轮爪142a和第二棘轮爪142b布置在棘轮齿条构件141的相对侧上。齿条构件141和爪142a、爪142b限定了棘轮机构144。在使用中，随着驱动通道140轴向移动，齿条构件141也与驱动通道140一起轴向移动。在操作中，如将在下文中更加详细描述的，当在齿条构件141中形成的纵向延伸槽的远侧端/近侧端撞击弹锁棘轮弹簧143时，棘轮爪142a、142b反转其方向，使得棘轮弹簧143弹起，并且依次，使得棘轮爪142a、142b弹起或反转其方向。
在各棘轮爪142a、142b分别与齿条构件141的齿条齿141a、齿条齿141b处于基本上操作的接合的位置处，各棘轮爪142a、142b被可枢转地支撑在上壳体半部104a和下壳体半部104b中。棘轮爪142a、棘轮爪142b能够与齿条构件141接合以限制齿条构件141的纵向移动并依次限制驱动通道140的纵向移动。
此外，如图25所示，各棘轮爪142a、142b具有大致三角形的外形，其中各棘轮爪142a、142b的远角142a1、142b1远离齿条构件141延伸，并且各棘轮爪142a、142b的远角142a1、142b1位于在上壳体半部104a和下壳体半部104b中限定的一对壁104c1、104c2的内角104c3内。各棘轮爪142a、142b的远角142a1、142b1和一对壁104c1、104c2的内角104c3的交界面限定了用于棘轮爪142a、142b的枢转点。
棘轮机构144包括呈螺旋弹簧形式的弹锁棘轮弹簧143，弹锁棘轮弹簧143介于棘轮爪142a、142b之间并且延伸通过和横跨齿条构件141。随着齿条构件141轴向地平移，弹锁棘轮弹簧143起到维持棘轮爪142a、142b的齿与齿条构件141的齿条齿141a、141b分别相接合的作用。如图36和图43所示，当棘轮爪142a、142b在第一位置（准许驱动通道140在远侧方向上移动）上时，弹锁棘轮弹簧143在近侧方向上凸出或变弯，并且如图46所示，当棘轮爪142a、142b在第二位置（准许驱动通道140在近侧方向上移动）上时，弹锁棘轮弹簧143在远侧方向上凸出或变弯。
在操作中，当驱动通道140移动到最远侧位置时，齿条构件141的表面接合在远侧上凸出的弹锁棘轮弹簧143从而反转其变弯方向，因而反转或改变棘轮爪142a、142b的定向。此外，当驱动通道140运动到最近侧位置并且齿条构件141的齿条齿141a、141b已经再一次不接触（cleared）棘轮爪142a、142b时，齿条构件141的另一表面接合在近侧上凸出的弹锁棘轮弹簧143以再次反转其变弯方向，因而再次反转或改变棘轮爪142a、142b的定向。
当棘轮爪142a、142b在驱动通道140的行程的任一端处被弹起时，施夹器100提供有听觉/触觉的提示或反馈。特别地，当棘轮爪142a、142b弹起时，棘轮爪142a、142b通过弹锁棘轮弹簧143加速并且对着壳体104的一对壁104c1、104c2敲击，从而为用户提供已经到达行程末端的反馈。
如图1至图4以及图10、图34和图35所示，施夹器100包括一对钳夹120，该一对钳夹120安装在通道组件108的远侧端上或远侧端处并且能够由手柄组件102的手柄106致动。该一对钳夹120由合适的生物相容性材料例如不锈钢或钛制成。
该一对钳夹120经由延伸穿过驱动通道140的往复运动限制槽140d的销或铆钉124而安装在外通道132的远侧端上，使得钳夹120相对于外通道132和驱动通道140在纵向上固定。一对钳夹120包括第一钳夹构件121a和第二钳夹构件121b，其中第一钳夹构件121a延伸通过驱动通道140的第一面向远侧开口140e1，并且其中第二钳夹构件121b延伸通过驱动通道140的第一面向远侧开口140e2。以这种方式，驱动通道140的舌状件140e在第一钳夹构件121a和第二钳夹构件121b之间延伸。
如图4所示，一对钳夹120在其间限定了用于在其中接纳手术夹子“C1”的通道120a。
如图3所示，各钳夹构件121a、121b的远侧端相对于通道组件108的纵向轴线成大约在15°-22.5°之间的角度以通过将最终用户的视线改变到一对钳夹120的钳夹构件121a、121b使得最终用户能够更好地看见在一对钳夹120中布置的手术夹子。以这种方式，当手术夹子被放置在血管上或血管上方时，最终用户可以更好地看见和证实手术夹子在一对钳夹120中的存在。
如图4以及图6、图15、图16、图19和图20所示，施夹器100包括夹子推杆160，夹子推杆160在驱动通道140和钉仓盖130之间的位置处抵靠驱动通道140可滑动地布置。推杆160包括远侧端160a，远侧端160a限定有被配置为且适用于选择性地接合/移动存储在手术施夹器100中的最远侧手术夹子“C1”的推动器160c。推杆160进一步包括可操作地连接至驱动通道140的近侧端160b。如将在下文中更加详细地描述的，推杆160进一步在其中限定了细长窗口160d用于在其中操作的接纳等拉力弹簧176的近侧端。
如图4以及图13、图18、图31和图32所示，施夹器100进一步包括联接机构150，联接机构150具有远侧从动连杆臂154，该远侧从动连杆臂154具有枢转地连接到推杆160的近侧端160b的第一远侧端154a。联接机构150进一步包括近侧主动（driver）连杆臂152，近侧主动连杆臂152具有枢转地连接到从动连杆臂154的第二近侧端154b的第一远侧端152a，以及限定了被配置为可滑动地接纳驱动通道140的凸出部140f的弓形槽152c的第二近侧端152b。如将在下文中更加详细地描述的，弓形槽152c是末端开口的并且在其远侧和近侧平移的选择部分中仅与驱动通道140的凸出部140f接合。主动连杆臂152限定了中心孔眼152c用于枢转连接到销126，使得主动连杆臂152相对于壳体104轴向地固定。
如图4和图5所示，施夹器100进一步包括在推杆160和钉仓盖130之间的位置处固定地布置在通道组件108内并且抵靠推杆160布置的夹子承载器170。夹子承载器170通常为U型通道结构，其具有下壁170a和在下壁170a和钉仓盖130之间限定了通道170c的一对侧壁170b。
如图4和图33所示，一叠手术夹子“C”以便于在通道170c内滑动和/或沿通道170c滑动的方式被装载和/或保留在由夹子承载器170和钉仓盖130限定的通道170c内。夹子承载器170被配置和定尺寸为使一叠或多个手术夹子“C”以头尾相接的方式可滑动地保留在其内。
如图5和图14所示，夹子承载器170的远侧端包括弹性中心柄脚171。柄脚171被配置为且适用于选择性地接合保留在承载器170内的一叠手术夹子“C”的最远侧手术夹子“Cd”的后跨部（backspan）从而阻挡夹子承载器170的通道170c内的一叠手术夹子“C”。
如图4以及图7至图9和图29所示，施夹器100进一步包括夹子输出器174，夹子输出器174至少部分地可滑动地布置在夹子承载器170的通道170c内。如下文中将更加详细地描述的，夹子输出器174定位在一叠手术夹子“C”之后并且设置为在施夹器100的致动期间驱使一叠手术夹子“C”向前。如下文中也将更加详细地描述的，在施夹器100发射期间，在最远侧的手术夹子“Cd”通过推杆160向远侧越过夹子承载器170的柄脚171而推进时，由等拉力弹簧176来致动夹子输出器174。
夹子输出器174包括细长主体174a，细长主体174a具有被配置和定尺寸为穿过夹子承载器170的通道170c的远侧端部174b。夹子输出器174的远侧端部174b被配置为坐靠一叠手术夹子“C”的最近侧夹子“Cp”的后跨部。
夹子输出器174包括近侧端部174c，其在自身上折叠以限定尾部174d使得近侧端部174c呈叶片弹簧的形式。近侧端部174c限定了形成在细长主体174a的近侧部中的上窗口174a1，以及形成在尾部174d中并且叠加在上窗口174a1上或与上窗口174a1配准的下窗口174d1。夹子输出器174包括在细长主体174a和尾部174d之间延伸的凸出部174e。
夹子输出器174由弹力金属构成以使得夹子输出器174的尾部174d抵靠驱动通道140的表面而稍微地弹簧偏置。
现在转向图63至图70，显示并将描述替换实施例的夹子输出器274。夹子输出器274基本类似于夹子输出器174，因此在此将仅详细地描述到描述其结构和功能上的区别所必要的范围内。如图63至图65和图67至70所示，夹子输出器274包括近侧翼片274d，近侧翼片274d从近侧端部274c横向地突出。近侧翼片274d限定了近侧表面274d1，近侧表面274d1具有被配置为接纳等拉力弹簧176的盘绕或缠绕部176c并且与等拉力弹簧176的盘绕或缠绕部176c一起安装的凹弓形外形。
现在转向图4、图5和图9并且如图4、图5和图9所示，施夹器100包括等拉力弹簧176，等拉力弹簧176被支撑在手柄组件104和通道组件108中。等拉力弹簧176呈带状形式，包括具有远侧端176b的主体部176a和自我盘绕以形成卷轴（spool）的近侧端176c。
等拉力弹簧176的主体部176a和远侧端176b布置在形成于钉仓盖130的下侧中的通道内，其中等拉力弹簧176的主体部176a和远侧端176b介于钉仓盖130和夹子输出器174的细长主体174a之间。如下文所描述的，等拉力弹簧176的远侧端176b被紧固到夹子承载器170的尖头170e上。特别地，如图17和图30所示，等拉力弹簧176的远侧端176b限定了开口176b1（见图5），开口176b1滑过夹子通道170的向远侧延伸的尖头170e。以这种方式，夹子通道170的尖头170e防止等拉力弹簧176的远侧端176b向近侧移动。
现在暂时转向图63至图66以及图69至图70，在替换实施例中，可以设想的是，等拉力弹簧176的远侧端176b可以被钩在从钉仓盖130的内表面向远侧和向内突出的钩子或尖头130a上。
等拉力弹簧176的近侧盘绕或缠绕端176c布置在输出器174的下窗口174a1和上窗口174d1内，其中近侧盘绕或缠绕端176c介于输出器174的凸出部174e和输出器174的近侧末端的壁之间。由于等拉力弹簧176的记忆，其近侧盘绕或缠绕端176c趋向于想要沿主体部176a卷起。
等拉力弹簧176是由弹簧材料制成的预应力平条，其形成为实际等半径圈，其中如上文所述，等拉力弹簧176的远侧端176b被紧固到夹子通道170，并且如上文所述，其中等拉力弹簧176的近侧盘绕或缠绕端176c布置在夹子输出器174的近侧端部174c内。
等拉力弹簧176起到对一叠手术夹子“C”保持恒定压力或远侧力的作用，使得一叠手术夹子“C”抵靠夹子承载器170的弹性中心柄脚171而被挤压。以这种方式，在操作中，如将在下文中更加详细描述的，随着最远侧的手术夹子“Cd”被推杆160推过弹性中心柄脚171，一叠手术夹子“C”按要求向远侧推进。
如图24、图57和图58所示，施夹器100包括锁定件用于在应用了一叠手术夹子“C”的最后一个手术夹子之后防止一对钳夹120的致动。锁定件包括形成在夹子输出器174的向远侧定向的尾部174d中的停止挡块或隆起174d2，以及紧接驱动通道140的近侧端突出的停止挡块或隆起140g。将在下文中更加详细地描述锁定件的操作。
参照图1至图58，并且特别参照图37至图58，提供了柯惠（Covidien）施夹器100的操作。在任何初始的捏挤施夹器100的手柄106之前（其中施夹器100包括满的一叠手术夹子“C”），如图12至图36所示，驱动通道140被定位在最近侧位置处，推杆160被定位在最远侧位置处，并且夹子输出器174被定位在最近侧位置处。当推杆160被定位在最远侧位置处时，其推动器160c支撑布置在一对钳夹120之间的任意手术夹子。
当驱动通道140被定位在最近侧位置处并且推杆160被定位在最远侧位置处时，联接机构150处于未致动位置，其中从动连杆臂154基本与通道组件108的纵向轴线对齐。
而且在初始的捏挤之前，如果没有手术夹子“C”存在于一对钳夹120内，则在初始捏挤手柄106或施夹器100的装填（priming）期间将一手术夹子“C”首先装载到一对钳夹120中（以将初始的手术夹子装载入一对钳夹120中）。
如图37至图43以及特别是图37和图38所示，在初始捏挤手柄106或装填施夹器100的第一阶段期间，导致连杆构件122的第二端122b相对于壳体104向远侧移动。随着连杆构件122的第二端122b向远侧移动，连杆构件122作用于驱动通道140上以将远侧轴向移动传送到驱动通道140。
如图38和图43以及图42所示，随着驱动通道140向远侧移动，在初始捏挤手柄106的第二阶段期间，在初始的停留（dwell）时段之后，在进一步捏挤手柄106时，驱动通道140的凸出部140f进入主动连杆臂152的弓形槽152c并且作用于主动连杆臂152上以使主动连杆臂152绕销126旋转。
随着主动连杆臂152绕销126旋转，主动连杆臂152的远侧端152a作用于从动连杆臂154的近侧端154b上以在近侧方向上拉动从动连杆臂154。
如图39至图41所示，随着从动连杆臂154在近侧方向上被拉动，从动连杆臂154的远侧端154a作用于推杆160上以在近侧方向上缩回推杆160。主动连杆臂152的弓形槽152c的相对尺寸和配置、主动连杆臂152的远侧端152a和近侧端152b的旋转半径以及从动连杆臂154的相对长度确定推杆160何时缩回足够量使得推动器160c布置在最远侧手术夹子“C1”的近侧。
在推杆160缩回的量足够使得推动器160c布置在最远侧手术夹子“C1”的近侧之后，驱动通道140的凸出部140f退出主动连杆臂152的弓形槽152c使得推杆160的近侧移动停止而驱动通道140的远侧移动继续。
在初始捏挤手柄106期间，棘轮爪142a、142b起到产生听觉上的喀嗒声和/或触觉上震动的作用，从而向用户指示手术施夹器100的手柄106已经经过了行程的至少一部分。此外，钉仓盖130由透明材料制成，允许用户可以清楚地看到一叠夹子中的夹子“C”。
如上文所描述的，通过棘轮爪142a、142b的第一听觉/触觉提示，向用户指示手术夹子“C”已经被适当地装载。
如图43所示，还是在初始捏挤手柄106的第一阶段期间，随着驱动通道140在远侧方向上移动，棘轮机构144的齿条构件141向远侧移动，导致齿条构件141的齿141a移动到与每个棘轮爪142a、142b的齿接合并且越过或跨过每个棘轮爪142a、棘轮爪142b的齿。一旦棘轮机构144的齿条构件141移动到与各棘轮爪142a、142b接合，则直到齿条构件141已经不接触棘轮爪142a、棘轮爪142b，驱动通道140才能返回到原位置或最近侧位置。
在初始捏挤手柄106的第二阶段期间，如图44至图51所示，驱动通道140向远侧移动直到驱动通道140的侧壁140b的远侧边缘抵靠一对钳夹120的外凸轮表面120b接合，从而引起一对钳夹120相互接近（并且，如果手术夹子存在，则介于一对钳夹120之间的手术夹子“C1”成形）。
此外，在初始捏挤手柄106的第二阶段期间，随着手柄106被捏挤以向远侧推进驱动通道140，驱动通道140和/或连杆构件122作用于偏置构件146上以抵靠壳体104压缩偏置构件146。
参照图44至图51，图示出了在手柄106的整个初始行程或者捏挤之后并且在打开手柄106期间的施夹器100。在此状态下，驱动通道140处于最远侧位置处，推杆160处于最近侧位置处，偏置构件146处于压缩状态下，并且各棘轮爪142a、142b定位于齿条构件141的近侧。
在使用时，手柄106可以由手打开，或移除趋向保持手柄106闭合的闭合力，由此被压缩的偏置构件146可以展开。随着被压缩的偏置构件146展开，偏置构件146作用于连杆臂122和/或驱动通道140上以协助手柄106的打开以及协助施夹器100返回至打开或初始状态。
如图53至图54所示，在手柄106打开期间，引起了连杆构件122的第二端122b相对于壳体104向近侧移动。随着连杆构件122的第二端122b向近侧移动，连杆构件122作用于驱动通道140上以向驱动通道140传送近侧轴向移动。
随着驱动通道140向近侧移动，在初始的停留时段之后，驱动通道140的凸出部140f再次进入主动连杆臂152的弓形槽152c中并且作用于主动连杆臂152上以使主动连杆臂152绕销126在相反方向上旋转。
随着主动连杆臂152绕销126（在相反的方向上）旋转，主动连杆臂152的远侧端152a作用于从动连杆臂154的近侧端154b上以在远侧方向上推动从动连杆臂154。
如图53和图54所示，随着从动连杆臂154在远侧方向上被推动，从动连杆臂154的远侧端154a作用于推杆160上以在远侧方向上推进推杆160。主动连杆臂152的弓形槽152c的相对尺寸和配置、主动连杆臂152的远侧端152a和近侧端152b的旋转半径以及从动连杆臂154的相对长度确定推杆160何时被推进足够量以使得推杆160的推动器160c将一叠手术夹子“C”的最远侧手术夹子“C1”装载进一对钳夹120中。
特别地，随着推杆160在远侧方向上被推进，其推动器160c与最远侧夹子“C1”的后跨部接合并且开始使最远侧夹子“C1”向远侧移动或驱使出夹子承载器170并且进入一对钳夹120中。随着最远侧夹子“C1”向远侧移动，夹子承载器170的中心柄脚171暂时偏转退出或凸轮运动退出与最远侧夹子“C1”的接合并且返回到它的未偏转或未凸轮运动状态以便抓住一叠手术夹子“C”的随后的手术夹子。在手柄106打开期间，推杆160被推进足够量以把最远侧手术夹子“C1”放置在一对钳夹120的通道120a中。
随着推杆160的推动器160c把最远侧手术夹子“C1”推进到一对钳夹120中，剩余的一叠手术夹子“C”由于通过夹子输出器174作用于一叠手术夹子“C”上的推进力而被向远侧推进。如上文所述，特别地，当移除了最远侧手术夹子“C1”时，等拉力弹簧176的近侧盘绕端176c继续盘绕在自身上，从而由于等拉力弹簧176的远侧端176b锚固至夹子承载器所以缩短了主体部176a的长度。
随着等拉力弹簧176的近侧盘绕端176c盘绕在自身上，近侧盘绕端176c作用于夹子输出器174的凸出部174e上以在夹子输出器174上施加远侧力并且向远侧推进夹子输出器174。夹子输出器174向远侧被推进，直到一叠手术夹子“C”因夹子承载器170的中心柄脚171而停止为止。
在推杆160返回至最远侧位置之后，驱动通道140的凸出部140f退出主动连杆臂152的弓形槽152c，使得推杆160的远侧移动停止而驱动通道140的近侧移动继续。
当推杆160处于最远侧位置时，推杆160的推动器160c保持抵靠被装载入一对钳夹120中的最远侧手术夹子“C1”的后跨部。以这种方式，当一对钳夹120在目标血管上方被推进时，推杆160的推动器160c支撑最远侧手术夹子“C1”的后跨部以抑制最远侧手术夹子“C1”退出一对钳夹120。
在手柄106完全打开期间，驱动通道140的最近侧定位引起棘轮爪142a、142b弹起和发出吧嗒声，产生听觉喀哒声和/或触觉震动，从而指示给用户手术施夹器100的手柄106已经完全打开并且手术施夹器100已经经历了一个完整的周期。
如图46所示，也是在手柄106打开期间，随着驱动通道140在近侧方向上移动，棘轮机构144的齿条构件141向近侧移动，引起齿条构件141的齿141a移回到与各棘轮爪142a、142b的齿接合并且越过或跨过各棘轮爪142a、142b的齿。一旦棘轮机构144的齿条构件141移回到接合各棘轮爪142a、142b，则直到齿条构件141已经又不接触棘轮爪142a、142b，驱动通道140才能再向远侧推进到前面的位置或最远侧位置。
在手柄106打开期间，如图26所示，驱动通道140向近侧移动使得并且直到驱动通道140的舌状件140e抵靠一对钳夹120的内凸轮表面120c接合为止，因而协助和/或引起一对钳夹120相互分离到完全打开状态（如果一对钳夹120因一些外部的压力或力而被保持在接近的状态下）。
在施夹器100的初始装填之后，如图52所示，手柄106的任何进一步捏挤将会引起施夹器100的发射以把手术夹子“C1”应用到血管“V”或任何其他生物组织上。
在再次捏挤手柄106期间，如上文所述，随着驱动通道140向远侧移动并且推杆160向近侧移动，当手术夹子“C1”被装载入一对钳夹120中时，随着驱动通道140的侧壁140b的远侧边缘抵靠一对钳夹120的外凸轮表面120b接合，一对钳夹120朝向彼此接近以使手术夹子“C1”成形。
如图52所示，手术夹子“C1”可以成形或折叠（crimped）到血管“V”或任何其他生物组织上。在特定情况下，外科医生可以决定或需要发射手术夹子“C1”到缝合处上以代替在缝合处打结。
现在转到图55-图56和图57-图58，如上文所述，图示出了在手柄106的整个行程或捏挤之后并且在最后的手术夹子已经从夹子承载器170中驱使出且装载入一对钳夹120之后的施夹器100的远侧端。如上文所述，在最后的手术夹子装载入一对钳夹120之后，夹子输出器174通过等拉力弹簧176而向最远侧位置推进。
当最后的夹子装载入一对钳夹120时，通过捏挤手柄106，随着施夹器100再一次发射以发射最后一个夹子，推杆160在近侧方向上移动（如上文所述）使得推动器160c（见图6）凸轮运动越过夹子输出器174的远侧端部174b并且在夹子输出器174的远侧端部174b（见图7）的近侧。然后，随着手柄106被打开，推杆160向远侧方向上移动（如上文所述）。随着推杆160在远侧方向上移动，推动器160c作用于夹子输出器174的远侧端部174b上以向远侧驱使夹子输出器174，直到（1）夹子输出器174的远侧端部174b布置在一对钳夹120之间，并且（2）夹子输出器174的尾部174d的下窗口174d1（见图7）的前边缘174d3布置在驱动通道140的停止挡块140g的远侧为止。
此时，在一对钳夹120中不存在夹子，并且夹子输出器174上的锁定尾部174d与驱动通道140上的停止挡块140g相接合。同样地，如果用户此时尝试发射施夹器100，则驱动通道140对着一对钳夹120驱动夹子输出器174的锁定尾部174d，同时夹子输出器174的远侧端部174b布置在一对钳夹120之间，所以施夹器100不能使一对钳夹120闭合。
此外，在驱动通道140的停止挡块140g布置在夹子输出器174的尾部174d的下窗口174d1的前边缘174d3的近侧时，如图58所示，任何再次致动施夹器100的尝试（从而驱动通道140被向远侧推进），将会导致驱动通道140的停止挡块140g紧靠夹子输出器174的尾部174d的下窗口174d1的前边缘174d3，从而防止驱动通道140的远侧移动。
现在转向图59至图62，根据本公开的另一个实施例的下通道，主要被表示为232。下通道232与下通道132基本相似，因此在此将仅详细地描述到描述其结构和操作上的区别所必要的范围。如图59至图62所示，下通道232包括一对相对的、直立近侧侧壁232a、232b。各侧壁232a、232b限定有大致V形的通道232c、232d，其中各V形通道232c、232d在与下通道232的纵向轴线正交的方向上延伸。肋件232e、232f分别延伸到各V形通道232c、232d中。
继续参照图59至图62，根据本公开的另一个实施例的驱动通道，主要被表示为240。驱动通道240与驱动通道140基本相似，因此在此将仅详细地描述到描述其结构和操作上的区别所必要的范围内。如图59至图62所示，驱动通道240的相对侧壁240b在驱动通道240的近侧端处连结在一起以形成尾部或棘轮齿条构件241。棘轮齿条构件241包括：在棘轮齿条构件241的第一侧上的第一套齿241a，其被配置为且适用于接合第一棘轮爪242a；以及在棘轮齿条构件241的第二侧上的第二套齿241b，其被配置为且适用于接合第二棘轮爪242b。
驱动通道240的棘轮齿条构件241在下通道230的侧壁232a、侧壁232b之间延伸并且延伸通过在壳体104中形成的槽104e。此外，第一棘轮爪242a介于下通道230的侧壁232a和驱动通道240的棘轮齿条构件241之间，并且第二棘轮爪242b介于下通道230的侧壁232b和驱动通道240的棘轮齿条构件241之间。
齿条构件241和棘轮爪242a、棘轮爪242b限定了棘轮机构244。在使用时，随着驱动通道240轴向移动，引起齿条构件241相对于第一棘轮爪242a和第二棘轮爪242b移动。在这种情况下，齿条齿241a、241b系列具有这样的长度：当驱动通道240到达最近侧或最远侧位置时，在齿条构件241在近侧移动和远侧移动之间变换时，该长度允许各棘轮爪242a、棘轮爪242b反转和回推越过齿条构件241。
在各棘轮爪242a、242b分别与齿条构件241的齿条齿241a、241b处于基本上操作的接合的位置处，各棘轮爪242a、242b被可枢转地支撑在下通道230中。棘轮爪242a、棘轮爪242b能够与齿条构件241接合以限制齿条构件241的纵向移动，并且依次限制驱动通道240的纵向移动。
各棘轮爪242a、242b具有大致三角形的外形，其中各棘轮爪242a、242b的远角242a1、242b1远离齿条构件241延伸，并且棘轮爪242a、242b的远角242a1、242b1位于下通道230的相应V形通道232c、232d的内角内。各棘轮爪242a、242b的远角242a1、242b1和下通道230的相应V形通道232c、232d的交界面限定了用于棘轮爪242a、棘轮爪242b的枢转点。各棘轮爪242a、242b的枢转范围受棘轮爪242a、242b的相对形状和尺寸以及下通道230的相应V形通道232c、232d的相对角定向所限制。
此外，如图62所示，各棘轮爪242a、242b的远角242a1、242b1限定了在其中形成的各凹口242a2、242b2。各棘轮爪242a、242b的凹口242a2、242b2被配置为接纳下通道230的V形通道232c、232d的相应肋件232e、232f以使棘轮爪242a、242b与V形通道232c、232d以及齿条构件241保持轴向配准。
与棘轮机构144相似，棘轮机构244包括呈螺旋弹簧形式的弹锁弹簧143，其介于棘轮爪242a、242b之间并且延伸越过和横跨限定在齿条构件241中的槽。弹锁弹簧143具有足够的长度以驱使各棘轮爪242a、242b进入下通道230的相应V形通道232c、232d中。
随着齿条构件241轴向地平移，弹锁弹簧143起到保持棘轮爪242a、棘轮爪242b的齿与齿条构件241的相应齿条齿241a、241b接合的作用。当棘轮爪242a、棘轮爪242b处于第一位置（准许驱动通道240在远侧方向上移动）时，弹锁弹簧243在近侧方向上突出，并且当棘轮爪242a、棘轮爪242b处于第二位置（准许驱动通道240在近侧方向上移动）时，弹锁弹簧143在远侧方向上突出。
在操作中，当驱动通道240移动至最远侧位置时，齿条构件241的向远侧定向的表面与在远侧上突出的弹锁弹簧143接合以使弹锁弹簧143的变弯方向反转，因此反转或改变棘轮爪242a、棘轮爪242b的定向。此外，当驱动通道240移动到最近侧位置时，齿条构件241的向近侧定向的表面与在近侧上突出的弹锁弹簧143接合以使弹锁弹簧143的变弯方向再次反转，因此再次反转或改变棘轮爪242a、棘轮爪242b的定向。
当棘轮爪242a、棘轮爪242b在驱动通道240的行程的任一端处被弹起时，施夹器100还可以包括利用下通道230和棘轮爪242a、242b的听觉/触觉提示或反馈。特别地，当棘轮爪242a、棘轮爪242b弹起时，棘轮爪242a、棘轮爪242b通过弹锁弹簧243加速并且对着下通道230的相应V形通道232c、232d的壁敲击，从而为用户提供已经到达行程末端的反馈。
应当理解的是，上述描述仅仅是对本公开的阐述。本领域的技术人员能够想出各种替换和改进而不偏离本公开。
例如，可以设想的是，可以这样的方式将等拉力弹簧176的盘绕或缠绕端176c附接或紧固到施夹器100中：盘绕或缠绕端176c在一对钳夹120附近保持不动，而等拉力弹簧176的自由端（即，176b）被附接至输出器174。在此实施例中，等拉力弹簧176的盘绕或缠绕端176c将不需要沿施夹器100的轴平移。
因此，本公开旨在包含所有的这种替换、改进和变型。示出的参照附图描述的实施例仅用来阐释本发明的某些特定实例。与上文描述的和/或所附权利要求书中的那些内容无实质上不同的其它元件、步骤、方法和技术也旨在包括在本公开的范围内。

Claims (22)

1.一种手术施夹器，包括：
壳体；
至少一个手柄，其可枢转地连接到所述壳体；
通道组件，其从所述壳体向远侧延伸出；
夹子承载器，其布置在所述通道组件内并且限定了通道；
多个夹子，其装载在所述夹子承载器的通道中；
驱动通道，其可平移地支撑在所述壳体和所述通道组件中，所述驱动通道在所述至少一个手柄致动时被平移；以及
棘轮机构，其布置在所述壳体内，所述棘轮机构包括：
齿条构件，其连接到所述驱动通道，使得所述驱动通道的轴向平移引起所述齿条构件的轴向平移，所述齿条构件限定有沿其第一侧的第一套齿以及沿其第二侧的第二套齿；
第一爪和第二爪，其各自可倾斜地支撑在所述壳体中并且分别布置在所述齿条构件的相对侧上；以及
变弯弹簧，其介于所述第一爪和所述第二爪之间并且被约束在所述齿条构件中形成的槽中，其中所述变弯弹簧被定尺寸为以便在近侧方向和远侧方向的其中一个方向上弯曲；
其中，当所述变弯弹簧在所述近侧方向上弯曲时，所述第一爪和所述第二爪与所述齿条构件接合以准许所述驱动通道在远侧方向上移动；并且
其中，当所述变弯弹簧在所述远侧方向上弯曲时，所述第一爪和所述第二爪与所述齿条构件接合以准许所述驱动通道在近侧方向上移动。
2.根据权利要求1所述的手术施夹器，进一步包括：
夹子输出器，其可滑动地布置在所述夹子承载器的通道内并且布置在所述多个夹子的近侧，所述夹子输出器被配置为且适用于通过所述夹子承载器的通道和通过所述通道组件进行选择性增量推进，其中所述夹子输出器被配置为且适用于在将所述多个夹子的最远侧夹子装载入一对钳夹中之后，相对于所述夹子承载器在远侧方向上驱使所述多个夹子。
3.根据权利要求2所述的手术施夹器，其中，所述夹子输出器通过偏置构件在远侧方向上被驱使。
4.根据权利要求3所述的手术施夹器，其中，所述偏置构件是等拉力弹簧。
5.根据权利要求4所述的手术施夹器，其中，所述等拉力弹簧包括被紧固以防止在所述手术施夹器中移动的远侧端，以及盘绕在自身上的近侧端，其中，所述等拉力弹簧的盘绕近侧端连接至所述夹子输出器以在盘绕所述等拉力弹簧的盘绕近侧端时将所述夹子输出器向远侧拉动。
6.根据权利要求3所述的手术施夹器，进一步包括夹子推杆，所述夹子推杆往复运动地定位在所述壳体和所述通道组件中的至少一个内，所述推杆具有第一端和第二端，所述第一端可操作地连接到所述至少一个手柄，所述第二端限定有推动器，随着所述至少一个手柄被致动，所述推杆能够远离所述一对钳夹移动从而使所述推动器在存储在所述夹子承载器的通道中的最远侧夹子的后方移动，并且所述推杆被配置为且适用于随着所述至少一个手柄返回到未致动位置而朝向钳夹移动，以使所述最远侧夹子在所述一对钳夹之间移动。
7.根据权利要求6所述的手术施夹器，所述夹子输出器包括头部，所述头部被配置并定尺寸为在一叠夹子的最后的夹子装载入所述手术施夹器的一对钳夹中之后，接合处于缩回位置时的所述夹子推杆的推动器。
8.根据权利要求7所述的手术施夹器，其中，在所述夹子输出器的所述头部与所述夹子推杆的推动器接合之后，所述夹子推杆的远侧推进将使所述夹子输出器向远侧推进，使得所述夹子输出器的所述头部被定位在所述一对钳夹之间。
9.根据权利要求8所述的手术施夹器，其中，当所述夹子输出器的所述头部被定位在所述一对钳夹之间时，所述夹子输出器的所述头部阻止所述一对钳夹闭合从而防止所述至少一个手柄完全地致动。
10.根据权利要求9所述的手术施夹器，进一步包括钳夹组件，所述钳夹组件包括一对钳夹，所述一对钳夹从所述通道组件的与所述壳体相对的一端延伸出，所述钳夹组件适用于在其中容纳夹子并且所述钳夹组件能够根据所述至少一个手柄的移动而操作以实现夹子的成形。
11.根据权利要求10所述的手术施夹器，其中，所述驱动通道包括第一端和第二端，所述第一端操作地连接到所述至少一个手柄，所述第二端被配置和定尺寸为环绕并且选择性地使所述一对钳夹接合以实现所述一对钳夹的闭合；
随着所述至少一个手柄在第一方向上移动，所述驱动通道朝向所述钳夹组件移动以使所述驱动通道的所述第二端靠近所述一对钳夹移动从而闭合所述一对钳夹；
随着所述至少一个手柄在与所述第一方向相反的第二方向上移动，所述驱动通道远离所述钳夹组件移动，以使得所述驱动通道的所述第二端远离所述钳夹组件移动从而允许所述一对钳夹打开。
12.根据权利要求11所述的手术施夹器，其中，所述驱动通道的所述第二端包括在一对钳夹之间延伸的舌状件。
13.根据权利要求11所述的手术施夹器，其中，在所述驱动通道布置在最近侧位置处，所述变弯弹簧在近侧方向上弯曲，并且所述第一爪和所述第二爪与所述齿条构件接合以便准许所述驱动通道在远侧方向上移动的状态下，当所述驱动通道被推进至最远侧位置时，向近侧弯曲的变弯弹簧被作用并且被引起在远侧方向上弯曲，由此所述驱动通道被准许在近侧方向上移动。
14.根据权利要求13所述的手术施夹器，其中，在所述驱动通道布置在最远侧位置处，所述变弯弹簧在远侧方向上弯曲，并且所述第一爪和所述第二爪与所述齿条构件接合以便准许所述驱动通道在近侧方向上移动的状态下，当所述驱动通道缩回到所述最近侧位置时，向远侧弯曲的变弯弹簧被作用并且被引起在近侧方向上弯曲，由此所述驱动通道被准许在远侧方向上移动。
15.根据权利要求11所述的施夹器，其中，所述驱动通道包括在朝向所述夹子输出器的方向上从所述驱动通道突出的停止挡块，并且其中所述夹子输出器在其中限定有窗口，
其中，当所述夹子输出器在最远侧位置并且其头部布置在所述一对钳夹之间，并且当所述驱动通道处于最近侧位置时，所述驱动通道的所述停止挡块布置在所述夹子输出器的所述窗口中。
16.根据权利要求15所述的手术施夹器，其中，所述夹子输出器包括：
具有远侧端和近侧端的细长主体，其中所述头部被支撑在所述细长主体的远侧端处；以及
具有远侧端和近侧端的尾部，其中所述尾部的近侧端与所述细长主体的近侧端相连接，使得所述尾部和所述细长主体相互远离偏置。
17.根据权利要求16所述的手术施夹器，其中，被配置为接纳所述驱动通道的停止挡块的所述夹子输出器的窗口形成在所述尾部中。
18.根据权利要求17所述的手术施夹器，其中，通过等拉力弹簧在远侧方向上驱使所述夹子输出器，其中所述等拉力弹簧包括被紧固以防止在所述手术施夹器中移动的远侧端，以及盘绕在自身上的近侧端，所述近侧端至少部分地布置在所述夹子输出器的尾部的窗口中，其中在所述多个夹子的最远侧夹子装载入所述手术施夹器的一对钳夹中之后盘绕所述等拉力弹簧的盘绕近侧端时，所述等拉力弹簧的盘绕近侧端将所述夹子输出器向远侧拉动。
19.根据权利要求1所述的手术施夹器，其中，当所述变弯弹簧被引起发生变弯以便从近侧方向弯向远侧方向以及从远侧方向弯向近侧方向时，所述一对爪被引起绕枢转点弹起并且产生听觉反馈和触觉反馈中的至少一种反馈。
20.根据权利要求1所述的手术施夹器，其中，所述通道组件包括一对相对的近侧侧壁，其中所述通道组件的各近侧侧壁限定有大致V形通道，并且其中各爪可枢转地布置在所述通道组件的相应V形通道中。
21.根据权利要求20所述的手术施夹器，其中，各V形通道包括突出到通道中的肋件，其中所述V形通道的肋件被接纳在限定在各爪中的凹口中，其中各爪在V形凹口中的轴向位置被保持。
22.根据权利要求20所述的手术施夹器，其中，所述驱动通道包括从其近侧端向近侧延伸的尾部，其中所述驱动通道的尾部在第一爪和第二爪之间延伸，并且其中所述棘轮机构的所述齿条构件形成在所述驱动通道的尾部上。
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US9848886B2 (en) 2017-12-26
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