CN104582606A - 用于电外科装置的封闭反馈控制 - Google Patents
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Abstract
本发明涉及用于机器人式受控的电外科器械的封闭反馈控制的系统和方法的多种示例性实施例。在一个实施例中,所述方法包括将至少一个电外科信号施加到机器人式受控的外科器械的电外科端部执行器。反馈信号可由所述电外科端部执行器生成并提供至控制逻辑部件。所述控制逻辑部件能够基于从所述电外科端部执行器接收的所述反馈信号来确定目标组织的阻抗的变化速率。所述控制逻辑部件能够控制或修改所述至少一个电外科信号,使得通过所述反馈信号确定的所述阻抗变化速率保持在预先确定的速率或预先确定的范围内。
Description
相关申请的交叉引用
本申请涉及下列同时提交的美国专利申请,这些美国专利申请全文以引用方式并入本文:
美国专利申请序列号_________________,名称为“Haptic FeedbackDevices for Surgical Robot”,代理人案卷号END7042USNP/110388;
美国专利申请序列号_________________,名称为“Lockout Mechanismfor Use with Robotic Electrosurgical Device”,代理人案卷号END7043USNP/110389;
美国专利申请序列号_________________,名称为“Surgical Instrumentswith Articulating Shafts”,代理人案卷号END6423USNP/110392;
美国专利申请序列号_________________,名称为“Ultrasonic SurgicalInstruments with Distally Positioned Transducers”,代理人案卷号END6819USNP/110393;
美国专利申请序列号_________________,名称为“Surgical Instrumentswith Articulating Shafts”,代理人案卷号END7047USNP/110394;
美国专利申请序列号_________________,名称为“Ultrasonic SurgicalInstruments with Distally Positioned Jaw Assemblies”,代理人案卷号END7048USNP/110395;
美国专利申请序列号_________________,名称为“Surgical Instrumentswith Articulating Shafts”,代理人案卷号END7049USNP/110396;
美国专利申请序列号_________________,名称为“Ultrasonic SurgicalInstruments with Control Mechanisms”,代理人案卷号END7050USNP/110397;和
美国专利申请序列号_________________,名称为“Surgical Instrumentswith Fluid Management System”,代理人案卷号为END7051USNP/110399。
背景技术
本公开整体涉及机器人外科手术领域。具体地,本公开并不唯一地涉及电外科器械。更具体地讲,本公开并不唯一地涉及用于电外科装置的反馈控制。
超声外科装置(诸如超声刀)因其独特的性能特性而用于外科手术的多种应用中。根据具体的装置构型和操作参数,超声外科装置能够基本上同时进行组织的横切和通过凝结作用的止血,从而有利地最大程度减轻患者创伤。超声外科装置包括定位在近侧的超声换能器和联接到超声换能器的器械,该器械具有安装在远侧的端部执行器,该端部执行器包括超声刀以切割和密封组织。端部执行器通常经由轴联接到柄部和/或机器人外科工具。刀经由延伸穿过轴的波导而在声学上联接到换能器。具有该性质的超声外科装置能够用于开放性外科用途、腹腔镜式或内窥镜式外科手术,包括机器人辅助的手术。
超声能量使用比用在电外科手术中的温度低的温度来切割和凝结组织。通过高频振动(例如每秒55,500次),超声刀使组织中的蛋白质变性以形成粘性凝结物。由刀表面施加在组织上的压力使血管塌缩并且允许所述凝结物形成止血密封。外科医生能够通过由端部执行器施加至组织的力、施加该力的时间、以及端部执行器的选定偏移水平来控制切割速度和凝结。
电外科装置还用于多种外科应用。电外科装置向组织施加电能以便对组织进行处理。电外科装置可包括具有安装在远侧的端部执行器的器械,该端部执行器包括一个或多个电极。端部执行器可抵靠组织定位,使得电流被引入到组织中。电外科装置能够用于双极或单极操作。在双极操作期间,电流分别通过端部执行器的有源电极和返回电极被引入组织中并从组织返回。在单极操作期间,电流通过端部执行器的有源电极被引入组织中,并通过返回电极(例如,接地垫)返回,该有源电极与返回电极分开地位于患者的身体上。通过组织的电流所生成的热可在组织内和/或在组织之间形成止血密封,并且因此可尤其适用于例如密封血管。电外科装置的端部执行器有时还包括可相对于组织和电极移动的切割构件以用于横切组织。
由电外科装置施加的电能可通过发生器传递至器械。电能可以是射频(“RF”)能量的形式。射频能量为可在300kHz至1MHz频率范围内的电能形式。在其操作期间,电外科装置可将低频射频能量传递通过组织,这会引起离子振荡或摩擦,实际上造成电阻性加热,从而升高组织的温度。由于可在受影响的组织和周围组织之间形成明显的边界,因此外科医生能够以高精确度进行操作和控制,而不损伤相邻的非目标组织。射频能量的低操作温度可适用于在密封血管的同时移除、收缩软组织,或对软组织塑形。射频能量可尤其良好地适用于结缔组织,该结缔组织主要包含胶原,并在接触热时收缩。
发明内容
各种示例性实施例涉及用于机器人式受控的电外科器械的封闭反馈控制的系统和方法。在一个实施例中,该方法包括将至少一个电外科信号施加到以机器人方式控制的外科器械的电外科端部执行器。反馈信号可由电外科端部执行器生成并提供给控制逻辑部件。控制逻辑部件能够基于从电外科端部执行器接收的反馈信号来确定目标组织的阻抗的变化速率。控制逻辑部件能够控制或修改至少一个电外科信号使得从反馈信号确定的阻抗变化速率保持在预先确定的速率或预先确定的范围内。
附图说明
多个实施例的特征结构在所附权利要求书中进行了详细描述。然而,参考结合如下附图的下列描述可最好地理解多个实施例(有关手术的组织和方法两者)及其优点:
图1示出包括外科器械和超声发生器的外科系统的一个实施例。
图2示出图1所示外科器械的一个实施例。
图3示出超声端部执行器的一个实施例。
图4示出超声端部执行器的另一个实施例。
图5示出图1所示的外科器械的一个实施例的分解图。
图6示出图1所示的外科器械的一个实施例的剖视图。
图7示出图1所示的外科器械的一个示例性实施例的各种内部部件。
图8示出包括外科器械和超声发生器的外科系统的一个实施例的顶视图。
图9示出图1的外科器械的一个示例性实施例中包括的旋转组件的一个实施例。
图10示出包括外科器械的外科系统的一个实施例,该外科器械具有单元件端部执行器。
图11是电能外科器械的一个实施例的透视图。
图12是图11的外科器械的一个实施例的柄部的侧视图,其中移除了柄部主体的一半以示出其中的一些部件。
图13示出图11的外科器械的端部执行器的一个实施例的透视图,其中钳口打开并且可轴向运动的构件的远侧端部处于回缩位置。
图14示出图11的外科器械的端部执行器的一个实施例的透视图,其中钳口闭合并且可轴向运动的构件的远侧端部处于部分推进的位置。
图15示出图1的外科器械的可轴向运动的构件的一个实施例的透视图。
图16示出图1的外科器械的端部执行器的一个实施例的截面图。
图17示出无绳的电能外科器械的一个实施例的透视图的一部分。
图18A示出图17的外科器械的一个实施例的柄部的侧视图,其中移除了柄部主体的一半以示出其中的各种部件。
图18B示出根据一个实施例的射频驱动和控制电路。
图18C示出根据一个实施例的控制器的主要部件。
图19示出机器人外科系统的一个实例实施例的框图。
图20示出机械臂车的一个实施例。
图21示出图20的机械臂车的机器人操纵器的一个实施例。
图22示出具有另选的装置接头结构的机械臂车的一个实施例。
图23示出可与机械臂车(诸如图19-图22的机械臂车)结合使用的控制器的一个实施例。
图24示出适于与机器人系统一起使用的超声外科器械的一个实施例。
图25示出适于与机器人系统一起使用的电外科器械的一个实施例。
图26示出器械驱动组件的一个实施例,该器械驱动组件可联接到外科操纵器以接收和控制图24所示的外科器械。
图27示出包括图26的外科工具的图24的器械驱动组件实施例的另一个视图。
图28示出包括图26的电外科工具的图25的器械驱动组件的另一个视图。
图29-图31示出图26的器械驱动组件的适配器部分的另外视图。
图32-图34示出图24-图25的器械安装部分的一个实施例,显示用于将从动元件的运动转化成外科器械的运动的部件。
图35-图37示出图24-图25的器械安装部分的另选实施例,显示用于将从动元件的旋转转化成围绕轴的轴线的旋转运动的另选示例性机构,以及用于生成一个或多个构件沿轴538的轴线的往复式平移的另选示例性机构。
图38-图42示出图24-图25的器械安装部分的另选实施例,显示用于将从动元件的旋转转化成围绕轴的轴线的旋转运动的另一个另选示例性机构。
图43-图46A示出器械安装部分的另选实施例,显示用于使构件沿轴的轴线进行微分平移(例如,用于进行关节运动)的另选示例性机构。
图46B-图46C示出包括内部功率源和能量源的器械安装部分的一个实施例。
图48示出与封闭反馈控制方法一起使用的电外科端部执行器的一个实施例。
图49示出用于封闭反馈控制的方法的一个实施例。
图50示出用于封闭反馈控制的方法的可供选择的实施例。
具体实施方式
各种示例性实施例涉及用于机器人式受控的电外科器械的封闭反馈控制的系统和方法。在一个实施例中,该方法包括将至少一个电外科信号施加到机器人式受控的外科器械的电外科端部执行器。反馈信号可由电外科端部执行器生成并提供至控制逻辑部件。控制逻辑部件能够基于从电外科端部执行器接收的反馈信号来确定目标组织的阻抗的变化速率。控制逻辑部件能够控制或修改至少一个电外科信号使得从反馈信号确定的阻抗变化速率保持在预先确定的速率或预先确定的范围内。
各种示例性实施例涉及修改电外科驱动信号。驱动信号能够控制电外科刀沿电外科端部执行器的纵向轴线的运动。驱动信号可由控制逻辑部件控制以调整电外科刀的速度。通过改变电外科刀的速度,控制器可将目标组织的阻抗的增加速率保持在预先确定的速率或预先确定的范围内。
其他示例性实施例涉及修改递送至电外科端部执行器以用于处理目标组织的电外科信号。递送至电外科端部执行器的电外科信号可包括超声信号或射频(RF)信号。在一个实施例中,超声信号被施加到电外科刀以赋予电外科刀超声运动。在另一个实施例中,射频信号被施加到位于电外科端部执行器上的第一电极和第二电极以将射频信号传递到目标组织,以引起目标组织的接合(welding)。在另一个实施例中,超声能量和射频能量都可被施加到电外科端部执行器。电外科信号可由控制逻辑部件修改以将目标组织的阻抗的增加速率保持在预先确定的速率或预先确定的范围内。
现在将详细提及若干实施例,包括显示具有端部执行器的手动和机器人外科器械的示例性具体实施的实施例,所述端部执行器包括超声元件和/或电外科元件。只要可行,相似或相同的参考编号可用于多个附图并可指示相似或相同的功能。附图仅出于举例说明的目的描绘了所公开的外科器械和/或使用方法的示例性实施例。本领域的技术人员将通过以下描述容易地认识到:可在不脱离本文所述原理的情况下采用本文所示的结构和方法的另选的示例性实施例。
图1为超声外科器械10的一个实施例的右侧视图。在该例示的实施例中,超声外科器械10可用于各种外科手术,包括内窥镜式外科手术或传统的开放式外科手术。在一个示例性实施例中,超声外科器械10包括柄部组件12、细长轴组件14和超声换能器16。柄部组件12包括触发器组件24、远侧旋转组件13和开关组件28。细长轴组件14包括端部执行器组件26,该端部执行器组件包括用于解剖组织或相互抓紧、切割并凝结血管和/或组织的元件,以及用于致动端部执行器组件26的致动元件。柄部组件12适于在近侧端部接收超声换能器16。超声换能器16机械地接合到端部执行器组件26的多个部分和细长轴组件14。超声换能器16经由缆线22电联接到发生器20。虽然大部分附图描绘了结合腹腔镜式外科手术使用的多端部执行器组件26,但是超声外科器械10可用于更传统的开放式外科手术中。出于本文的目的,从内窥镜式器械的角度来描述超声外科器械10;然而,可以设想,超声外科器械10的开放式和/或腹腔镜式形式也可包括如本文所述的相同或相似的操作部件和特征结构。
在各种实施例中,发生器20包括若干功能性元件,诸如模块和/或块。不同的功能性元件或模块能够用于驱动不同种类的外科装置。例如,超声发生器模块21可以驱动超声装置,诸如超声外科器械10。在一些示例性实施例中,发生器20还包括用于驱动电外科装置(或超声外科器械10的电外科实施例)的电外科手术/射频发生器模块23。在各种实施例中,发生器20可在柄部组件12内一体地形成。在此类具体实施中,电池将协同定位在柄部组件12内以充当能量源。图18A和附随的公开内容提供了此类具体实施的一个示例。
在一些实施例中,电外科手术/射频发生器模块23能够生成治疗和/或亚治疗能级。在图1所示的示例性实施例中,发生器20包括与发生器20成一体的控制系统25,以及经由缆线27连接至发生器的脚踏开关29。发生器20还可包括用于激活外科器械(诸如器械10)的触发机构。触发机构可包括电源开关(未示出)以及脚踏开关29。当由脚踏开关29激活时,发生器20可提供能量以驱动外科器械10的声学组件并以预先确定的偏移水平来驱动端部执行器18。发生器20以声学组件的任何合适的共振频率来驱动或激发声学组件,以及/或者形成治疗/亚治疗电磁/射频能量。
在一个实施例中,电外科/射频发生器模块23可作为电外科手术单元(ESU)实施,该电外科手术单元能够利用射频(RF)能量来提供足以来执行双极电外科手术的功率。在一个实施例中,ESU可以是由ERBE USA,Inc.(Marietta,Ga.)销售的双极ERBE ICC 350。如此前所论述,在双极电外科手术应用中,可以使用具有有源电极和返回电极的外科器械,其中有源电极和返回电极可抵靠或邻近待处理的组织定位,使得电流可从有源电极通过组织流至返回电极。因此,电外科/射频发生器模块23能够通过将足以处理组织T(例如,烧灼)的电能施加到组织而用于治疗目的。
在一个实施例中,电外科/射频发生器模块23能够递送亚治疗射频信号,以实施组织阻抗测量模块。在一个实施例中,电外科/射频发生器模块23包括如下文所详述的双极射频发生器。在一个实施例中,电外科/射频发生器模块12能够监控组织T的电阻抗Z,并通过在端部执行器组件26的夹持构件上提供的返回电极来控制基于组织T的时间和功率电平属性。因此,电外科/射频发生器模块23可出于亚治疗目的能够用于测量组织T的阻抗或其他电特性。用于测量组织T的阻抗或其他电特性的技术和电路配置在共同转让的名称为“Electrosurgical Generator for Ultrasonic Surgical Instruments”的美国专利公布No.2011/0015631中有更详细的讨论,该美国专利公布的公开内容全文以引用方式并入本文。
合适的超声发生器模块21能够在功能上以与Ethicon Endo-Surgery,Inc.(Cincinnati,Ohio)销售的GEN300相似的方式运作,如在以下美国专利中的一者或多者中所公开,所有这些专利均以引用方式并入本文:美国专利6,480,796(“Method for Improving the Start Up of an Ultrasonic System UnderZero Load Conditions”);美国专利6,537,291(“Method for Detecting BladeBreakage Using Rate and/or Impedance Information”);美国专利6,662,127(“Method for Detecting Presence of a Blade in an Ultrasonic System”);美国专利6,678,899(“Method for Detecting Transverse Vibrations in an UltrasonicSurgical System”);美国专利6,977,495(“Detection Circuitry for SurgicalHandpiece System”);美国专利7,077,853(“Method for CalculatingTransducer Capacitance to Determine Transducer Temperature”);美国专利7,179,271(“Method for Driving an Ultrasonic System to Improve Acquisition ofBlade Resonance Frequency at Startup”);以及美国专利7,273,483(“Apparatus and Method for Alerting Generator Function in an UltrasonicSurgical System”)。
应当理解,在各种实施例中,发生器20能够以若干模式来操作。在一种模式中,发生器20能够使得超声发生器模块21和电外科/射频发生器模块23可被独立地操作。
例如,可将超声发生器模块21激活以向端部执行器组件26施加超声能量,并且随后,可通过电外科/射频发生器模块23向端部执行器组件26施加治疗或亚治疗射频能量。如此前所论述,可向夹持在端部执行器组件26的受权利要求保护元件之间的组织施加亚治疗电外科/射频能量,以测量用于控制超声发生器模块21的激活或改变其激活的组织阻抗。由施加亚治疗能量获得的组织阻抗反馈还可用于激活电外科/射频发生器模块23的治疗电平,从而将夹持在端部执行器组件26的受权利要求保护元件之间的组织(例如,血管)密封。
在另一个实施例中,超声发生器模块21和电外科/射频发生器模块23可被同时激活。在一个示例中,超声发生器模块21与用于测量组织阻抗的亚治疗射频能级被同时激活,与此同时,端部执行器组件26的超声刀切割并凝结夹持在端部执行器组件26的夹持元件之间的组织(或血管)。此类反馈可用于例如修改超声发生器模块21的驱动输出。在另一个示例中,超声发生器模块21可与电外科/射频发生器模块23被同时驱动,使得在将端部执行器组件26的超声刀部分用于切割受损组织的同时,电外科/射频能量被施加到端部执行器夹持组件26的电极部分以便将组织(或血管)密封。
当发生器20经由触发机构激活时,在一个实施例中,电能由发生器20连续地施加到声学组件的换能器叠堆件或组件上。在另一个实施例中,电能由发生器20以间歇方式施加(例如,为脉冲的)。发生器20的控制系统中的锁相环路可监控来自声学组件的反馈。锁相环路调节由发生器20发送的电能的频率,使其与声学组件的选定纵向振动模式的共振频率匹配。此外,控制系统25中的第二反馈回路将提供给声学组件的电流维持在预选的恒定水平,以便在声学组件的端部执行器18处实现基本上恒定的偏移。在另一个实施例中,控制系统25中的第三反馈回路监控位于端部执行器组件26中的电极之间的阻抗。虽然图1-图9示出手动操作的超声外科器械,但是应当理解,超声外科器械还可以用于(例如)如本文所述的机器人应用中,以及手动应用和机器人应用的组合中。
在超声操作模式下,提供给声学组件的电信号可使端部执行器18的远侧端部在例如大约20kHz至250kHz的范围内纵向振动。根据各种实施例,刀22可在约54kHz至56kHz的范围内振动,例如以约55.5kHz振动。在其他实施例中,刀22可以其他频率振动,包括例如约31kHz或约80kHz。可通过例如控制由发生器20施加到声学组件的换能器组件的电信号的振幅来控制刀的振动偏移。如上所述,发生器20的触发机构允许使用者激活发生器20,以使得可将电能连续地或间歇地提供给声学组件。发生器20还具有电源线以便插入电外科单元或常规电源插座。据设想,还可以通过直流(DC)源诸如电池来对发生器20供电。发生器20可包括任何合适的发生器,诸如可得自Ethicon Endo-Surgery,Inc的GEN04型和/或GEN11型发生器。
图2是超声外科器械10的一个示例性实施例的左侧透视图,显示柄部组件12、远侧旋转组件13、细长轴组件14和端部执行器组件26。在该例示的实施例中,细长轴组件14包括尺寸被设计为机械地接合端部执行器组件26的远侧端部52,以及机械地接合柄部组件12和远侧旋转组件13的近侧端部50。细长内窥镜式轴组件14的近侧端部50接收在柄部组件12和远侧旋转组件13内。关于细长轴组件14、柄部组件12和远侧旋转组件13之间的连接的更多细节在图5和图7的描述中提供。
在该例示的实施例中,触发器组件24包括与固定柄部34结合操作的触发器32。固定柄部34和触发器32以符合人体工程学的方式形成,并且适于与使用者舒适地交接。固定柄部34与柄部组件12整体地相关联。触发器32可相对于固定柄部34可枢转地运动,如在下文相对于超声外科器械10的操作更详细地解释。当使用者施加相对于触发器32的挤压力时,触发器32可沿朝着固定柄部34的方向33A可枢转地运动。当使用者释放相对于触发器32的挤压力时,弹簧元件98(图5)致使触发器32沿方向33B可枢转地运动。
在一个示例性实施例中,触发器32包括细长触发器钩36,其在细长触发器钩36和触发器32之间限定孔38。孔38的大小被设计成适于接收使用者的从中穿过的一根或多根手指。触发器32还可包括在触发器32基底的上方模塑的弹性部分32a。形成重叠注塑的弹性部分32a,从而得到更加舒适的接触表面,用于沿向外方向33B控制触发器32。在一个示例性实施例中,可在细长触发器钩36的一部分的上方提供重叠注塑的弹性部分32a。细长触发器钩32的近侧表面保持未涂布状态或涂布有非弹性基材,以使使用者能够轻易地将其手指滑入和滑出孔38。在另一个实施例中,触发器的几何结构形成完全闭合的套环,其限定大小被设计成适于接收使用者的从中穿过的一根或多根手指的孔。完全闭合的套环触发器还可包括在触发器基底的上方模塑的弹性部分。
在一个示例性实施例中,固定柄部34包括近侧接触表面40和握持锚定件或鞍形表面42。鞍形表面42倚靠在手上拇指和食指结合的指蹼上。近侧接触表面40具有手枪式握把轮廓,其在没有环或孔的普通手枪式握把上接收手掌。近侧接触表面40的轮廓曲线可为波状外形的以适应或接收手掌。稳定性尾部44朝向柄部组件12的更近侧的部分定位。稳定性尾部44可以与手的位于拇指和食指之间的最上方指蹼部分接触,以稳定柄部组件12并使柄部组件12更易于控制。
在一个示例性实施例中,开关组件28可包括拨动开关30。拨动开关30可以作为位于柄部组件12内部的具有中心枢轴304的单个部件来实施,以消除同时激活的可能性。在一个示例性实施例中,拨动开关30包括第一突出旋钮30a和第二突出旋钮30b,用于将超声换能器16的功率设置设定在最小功率电平(例如,MIN)和最大功率电平(例如,MAX)之间。在另一个实施例中,摇臂开关可在标准设置和特殊设置之间枢转。特殊设置可允许由装置执行一个或多个特殊程序。当第一突出旋钮30a和第二突出旋钮30b被致动时,拨动开关30围绕中心枢轴旋转。一个或多个突出旋钮30a,30b联接到一个或多个臂,所述一个或多个臂运动通过一小段弧并且致使电触点根据第一突出旋钮30a或第二突出旋钮30b的启动情况来闭合或断开电路从而以电气方式为超声换能器16供能或使超声换能器16去能。拨动开关30联接到发生器20以控制超声换能器16的启动。拨动开关30包括用于启动超声换能器16的一个或多个电功率设置开关,旨在为超声换能器16设定一项或多项功率设置。启动拨动开关30所需的力被导向为大致朝向鞍形点42,由此避免了在启动拨动开关30时器械在手中旋转的任何趋势。
在一个示例性实施例中,第一突出旋钮30a和第二突出旋钮30b位于柄部组件12的远侧端部上,使得它们能被使用者轻易地触及,从而在最低程度或基本上无需重新定位握把的情况下激活电源,因此适于在启动拨动开关30的同时维持控制并将注意力集中在手术部位(例如,腹腔镜手术中的监视器)上。突出旋钮30a,30b能够卷绕柄部组件12的侧面至一定程度,以便更易于被不同长度的手指触及,并且在不顺手位置或针对较短的手指允许较大的触及自由度来启动突出旋钮。
在该例示的实施例中,第一突出旋钮30a包括多个触觉元件30c,例如该例示的实施例中的纹理突出部或“凸耳”,以允许使用者区分第一突出旋钮30a和第二突出旋钮30b。本领域的技术人员应当理解,可将若干人体工程学特征结构结合到柄部组件12中。此类人体工程学特征结构在名称为“Ergonomic Surgical Instruments”的美国专利申请公布No.2009/0105750中有所描述,该专利申请公布全文以引用方式并入本文。
在一个示例性实施例中,拨动开关30可以由使用者的手操作。使用者可以在任何点轻易地触及第一突出旋钮30a和第二突出旋钮30b,同时还避免在任何时间意外或无意启动。拨动开关30可以易于用手指操作以控制传输至超声组件16和/或超声组件16的功率。例如,食指可用于启动第一接触部分30a以将超声组件16接通到最大(MAX)功率电平。食指可用于启动第二接触部分30b以将超声组件16接通到最小(MIN)功率电平。在另一个实施例中,摇臂开关可使器械10在标准设置和特殊设置之间枢转。特殊设置可允许由器械10执行一个或多个特殊程序。使用者无需观察第一突出旋钮30a或第二突出旋钮30b便可以操作拨动开关30。例如,第一突出旋钮30a或第二突出旋钮30b可以包括纹理部或突出,因而无需观察便可以触觉方式区分第一突出旋钮30a和第二突出旋钮30b。
在其他实施例中,触发器32和/或拨动开关30可以单独地用于或与超声发生器模块21的激活相结合地用于致动电外科/射频发生器模块23。
在一个示例性实施例中,远侧旋转组件13可绕纵向轴线“T”在任一方向上不受限制地旋转。远侧旋转组件13机械地接合到细长轴组件14。远侧旋转组件13位于柄部组件12的远侧端部上。远侧旋转组件13包括圆柱形毂46以及在毂46的上方形成的旋钮48。毂46机械地接合细长轴组件14。旋钮48可包括有凹槽的聚合物特征结构,并且可以用手指(例如,食指)接合以旋转细长轴组件14。毂46可包括在主结构的上方模塑的用于形成旋钮48的材料。旋钮48可在毂46上方重叠注塑。毂46包括在远侧端部露出的端盖部分46a。在腹腔镜式手术期间,毂46的端盖部分46a可以接触套管针的表面。毂46可以由硬质耐用塑料诸如聚碳酸酯形成,用于缓解端盖部分46a和套管针之间可能出现的任何摩擦。旋钮48可以包括由突肋48a形成的“扇形凹口”或凹槽以及位于肋48a之间的凹面部分48b,从而提供更加精确的旋转握持。在一个示例性实施例中,旋钮48可以包括多个凹槽(例如,三个或更多个凹槽)。在其他实施例中,可以采用任何合适数量的凹槽。旋钮48可以由在硬质塑性材料上重叠注塑的较软聚合材料形成。例如,旋钮48可以由柔韧的、有弹性的、柔性的聚合材料(包括例如GLS公司制造的TPE合金)形成。这种较软的重叠注塑材料可以提供更好的握持,以及对旋钮48的运动的更加精确的控制。应当理解,任何提供充分地耐受灭菌处理、具有生物相容性且提供对外科手套提供足够摩擦阻力的材料都可以用于形成旋钮48。
在一个示例性实施例中,柄部组件12由包括第一部分12a和第二部分12b的两(2)个外壳部分或护罩形成。从使用者的角度由远侧端部朝近侧端部观察柄部组件12,第一部分12a被视为右侧部分,并且第二部分12b被视为左侧部分。第一部分12a和第二部分12b中的每个包括多个接合部69(图5),接合部的尺寸被设计为彼此机械地对准并接合以形成柄部组件12并且封闭其内部工作部件。与柄部组件12整体地相关联的固定柄部34在组装柄部组件12的第一部分12a和第二部分12b后成形。可以在柄部组件12的第一部分12a和第二部分12b的周边周围的多个点处设置多个另外的接合部(未示出),例如能量方向点/挠曲点,以用于超声焊接的目的。可以按本领域已知的任何方式将第一部分12a和第二部分12b(以及下文所述的其他部件)组装在一起。例如,定位销、按扣型接合部、舌状物接合部和沟槽接合部、锁定接片、粘结口可以单独或组合用于组装目的。
在一个示例性实施例中,细长内窥镜式轴组件14包括适于机械地接合柄部组件12和远侧旋转组件13的近侧端部50;以及适于机械地接合端部执行器组件26的远侧端部52。细长轴组件14包括外部管状护套56和位于外部管状护套56内的往复式管状致动构件58。管状往复式管状致动构件58的近侧端部机械地接合到柄部组件12的触发器32,以响应于触发器32的致动和/或释放而沿方向60A或60B运动。可枢转地运动的触发器32可以生成沿纵向轴线“T”的往复式运动。这种运动可用于例如致动端部执行器组件26的钳口或夹紧机构。一系列连杆将触发器32的枢转旋转转化成联接到致动机构的轭的轴向运动,该轴向运动控制端部执行器组件26的夹紧机构的钳口的打开和闭合。管状往复式管状致动构件58的远侧端部机械地接合到端部执行器组件26。在该例示的实施例中,管状往复式管状致动构件58的远侧端部机械地接合到可绕枢转点70枢转的夹持臂组件64,以响应于触发器32的致动和/或释放而打开和闭合夹持臂组件64。例如,在该例示的实施例中,当沿方向33A挤压触发器32时,夹持臂组件64可绕枢转点70沿方向62A从打开位置运动到闭合位置。当沿方向33B释放触发器32或使其向外接触时,夹持臂组件64可绕枢转点70沿方向62B从闭合位置运动到打开位置。
在一个示例性实施例中,端部执行器组件26附接在细长轴组件14的远侧端部52处,并且包括夹持臂组件64和刀66。端部执行器组件26的夹紧机构的钳口由夹持臂组件64和刀66形成。刀66可超声致动并在声学上联接到超声换能器16。柄部组件12上的触发器32最终连接至驱动组件,它们一起机械地配合以影响夹持臂组件64的运动。沿方向33A挤压触发器32使夹持臂组件64沿方向62A从打开位置运动到夹持或闭合位置,在打开位置,夹持臂组件64和刀66相对于彼此以间隔关系设置,在夹持或闭合位置,夹持臂组件64和刀66配合以夹持其间的组织。夹持臂组件64可以包括夹持垫69以接合刀66和夹持臂64之间的组织。沿方向33B释放触发器32使夹持臂组件64沿方向62B从闭合关系运动到打开位置,在打开位置,夹持臂组件64和刀66相对于彼此以间隔关系设置。
柄部组件12的近侧部分包括用于接收超声组件16的远侧端部的近侧开口68。超声组件16插入近侧开口68中并且机械地接合到细长轴组件14。
在一个示例性实施例中,触发器32的细长触发器钩36部分提供具有较短的跨度和旋转行程的较长的触发器杠杆。细长触发器钩36的较长杠杆允许使用者在孔38内使用多根手指来操作细长触发器钩36,并且使触发器32沿方向33B枢转以打开端部执行器组件26的钳口。例如,使用者可以将三根手指(例如,中指、无名指和小指)插入孔38中。多根手指允许外科医生可在触发器32和细长触发器钩36上施加较大的输入力来启动端部执行器组件26。当沿方向33A闭合或挤压触发器32或沿方向33B通过向外开启运动来开启触发器32时,较短的跨度和旋转行程产生更舒适的握持,从而减少进一步向外伸出手指的需求。这将显著减轻与触发器32沿方向33B的向外开启运动相关联的手部疲劳和紧张。触发器的向外开启运动可以由弹簧元件98(图5)弹簧协助以有助于缓解疲劳。开启弹簧力足以协助轻易地开启,但不足以在展开解剖期间对组织张力的触觉反馈造成不利影响。
例如,在外科手术期间,任意食指可用于控制细长轴组件14的旋转,以在合适的取向上来定位端部执行器组件26的钳口。中指和/或其他较短手指可用于挤压触发器32和抓握钳口内的组织。一旦钳口位于所期望的位置并且钳口夹持住组织,食指就可用于启动拨动开关30,从而调整超声换能器16的用于处理组织的功率电平。一旦已经处理了组织,使用者就可以使用中指和/或较短手指抵靠细长触发器钩36沿远侧方向向外推动来释放触发器32,从而打开端部执行器组件26的钳口。使用者不必调整其对柄部组件12的握持即可执行此基本过程。
图3-图4示出细长内窥镜式轴组件14相对于端部执行器组件26的连接。如前所述,在该例示的实施例中,端部执行器组件26包括夹持臂组件64和刀66以形成夹紧机构的钳口。刀66可以是在声学上联接到超声换能器16的可超声致动的刀。触发器32机械地连接至驱动组件。触发器32和驱动组件机械地共同配合以使夹持臂组件64沿方向62A运动到打开位置,其中夹持臂组件64和刀66相对于彼此以间隔关系设置,并且使夹持臂组件64沿方向62B运动到夹持或闭合位置,在该位置夹持臂组件64和刀66配合以夹持其间的组织。夹持臂组件64可以包括夹持垫69以接合刀66和夹持臂64之间的组织。管状往复式管状致动构件58的远侧端部机械地接合到端部执行器组件26。在该例示的实施例中,管状往复式管状致动构件58的远侧端部机械地接合到可绕枢转点70枢转的夹持臂组件64,以响应于触发器32的致动和/或释放而打开和闭合夹持臂组件64。例如,在该例示的实施例中,当沿方向33A挤压触发器32时,夹持臂组件64可绕枢转点70沿方向62B从打开位置运动到闭合位置。当沿方向33B释放触发器32或使其向外接触时,夹持臂组件64可绕枢转点70沿62B方向从闭合位置运动到打开位置。
如此前所论述,夹持臂组件64可包括电联接到电外科/射频发生器模块23以接收治疗和/或亚治疗能量的电极,其中电外科/射频能量可在或不在超声能量施加至刀66的同时被施加到电极。此类能量激活可以任何合适的组合施加,以便与算法或其他控制逻辑部件相配合而实现所期望的组织效应。
图5为图2所示的超声外科器械10的分解图。在该例示的实施例中,分解图显示柄部组件12的内部元件、柄部组件12、远侧旋转组件13、开关组件28和细长轴组件14。在该例示的实施例中,第一部分12a和第二部分12b配合形成柄部组件12。第一部分12a和第二部分12b各自包括多个接合部69,接合部的尺寸被设计为彼此机械地对准并接合以形成柄部组件12并且封闭超声外科器械10的内部工作部件。旋钮48机械地接合到外部管状护套56,使得其可以沿圆形方向54旋转最多360°。外部管状护套56位于往复式管状致动构件58之上,该往复式管状致动构件经由多个联接元件72机械地接合到柄部组件12并保持在其中。联接元件72可包括O形环72a、管套环帽72b、远侧垫圈72c、近侧垫圈72d和螺纹管套环72e。往复式管状致动构件58位于往复式轭84内,该往复式轭保持在柄部组件12的第一部分12a和第二部分12b之间。轭84是往复式轭组件88的一部分。一系列连杆将细长触发器钩32的枢转旋转转化成往复式轭84的轴向运动,该轴向运动控制超声外科器械10远侧端部处的端部执行器组件26的夹紧机构的钳口的打开和闭合。在一个示例性实施例中,四联接件设计提供例如在相对短的旋转跨度方面的机械优势。
在一个示例性实施例中,超声传输波导78设置在往复式管状致动构件58的内部。超声传输波导78的远侧端部52在声学上联接(例如,直接或间接机械联接)到刀66,并且超声传输波导78的近侧端部50被接收在柄部组件12内。超声传输波导78的近侧端部50适于在声学上联接到超声换能器16的远侧端部,如下文更详细地讨论。超声传输波导78通过保护护套80和多个隔离元件82(诸如硅胶环)与细长轴组件14的其他元件隔离。外部管状护套56、往复式管状致动构件58和超声传输波导78通过销74机械地接合。开关组件28包括拨动开关30和电气元件86a,b,用于根据第一突出旋钮30a或第二突出旋钮30b的启动来以电气方式为超声换能器16供能。
在一个示例性实施例中,外部管状护套56将使用者或患者与超声传输波导78的超声振动隔离。外部管状护套56通常包括毂76。外部管状护套56通过螺纹连接到柄部组件12的远侧端部上。超声传输波导78延伸穿过外部管状护套56的开口,而隔离元件82将超声传输波导24与外部管状护套56隔离。外部管状护套56可使用销74附接到波导78。波导78中用于接收销74的孔穴可以标称地出现在位移波节处。波导78可通过螺栓螺纹连接或卡合到手持式柄部组件12中。毂76上的平坦部分可以允许组件扭转至所需的程度。在一个示例性实施例中,外部管状护套56的毂76部分优选地由塑料构造,并且外部管状护套56的管状细长部分由不锈钢制成。作为另外一种选择,超声传输波导78可以包括围绕在其周围的聚合材料,以隔离其与外部接触。
在一个示例性实施例中,超声传输波导78的远侧端部可以通过内部螺纹连接而联接到刀66的近侧端部,优选地位于或靠近波腹。据设想,刀66可通过任何合适的手段诸如焊接接头等附接到超声传输波导78。虽然刀66可以与超声传输波导78分离,但另据设想,单元件端部执行器(例如,刀66)和超声传输波导78可形成为单个一体件。
在一个示例性实施例中,触发器32联接到连杆机构以将触发器32沿方向33A和33B的旋转运动转化为往复式管状致动构件58沿相应方向60A和60B的线性运动。触发器32包括其中形成有开口以接收第一轭销92a的第一组凸缘98。第一轭销92a还定位成穿过在轭84的远侧端部处形成的一组开口。触发器32还包括用于接收联接件92的第一端部92a的第二组凸缘96。触发器销90接收在形成于联接件92和第二组凸缘96中的开口内。触发器销90接收在形成于联接件92和第二组凸缘96中的开口内,并且适于联接到柄部组件12的第一部分12a和第二部分12b以形成触发器32的触发器枢转点。联接件92的第二端部92b接收在形成于轭84的近侧端部中的狭槽384内,并通过第二轭销94b保持在其中。随着触发器32绕由触发器销90形成的枢转点190以枢转方式旋转,轭在箭头60A,B指示的方向上沿纵向轴线“T”水平平移。
图8示出超声外科器械10的一个示例性实施例。在该例示的实施例中,在柄部组件12的局部剖面图内显示超声换能器16的剖视图。超声外科器械10的一个示例性实施例包括:联接到超声换能器16的超声信号发生器20,该超声换能器16包括手持式外壳99;以及可超声致动的单元件或多元件端部执行器组件26。如此前所论述,端部执行器组件26包括可超声致动的刀66和夹持臂64。超声换能器16(被称为“Langevin叠堆件”)通常包括换能部分100、第一共振器部分或端罩102、第二共振器部分或前罩104、以及辅助部件。这些部件的总体构造是共振器。超声换能器16的长度优选地为整数个系统半波长(nλ/2;其中“n”为任何正整数;例如,n=1、2、3……),如下文将更详细地描述。声学组件106包括超声换能器16、鼻部锥108、速度变换器118和表面110。
在一个示例性实施例中,端罩102的远侧端部连接至换能部分100的近侧端部,而前罩104的近侧端部连接至换能部分100的远侧端部。前罩104和端罩102的长度由多个变量确定,这些变量包括换能部分100的厚度、用于制造端罩102和前罩22的材料的密度和弹性模量、以及超声换能器16的共振频率。前罩104可以与速度变换器118一样,从其近侧端部到其远侧端部向内成锥形以放大超声振动振幅,另选地,可以不具有放大作用。合适的振动频率范围可以为约20Hz至32Hz,并且非常合适的振动频率范围可以为约30-10kHz。例如,合适的工作振动频率可以为大约55.5kHz。
在一个示例性实施例中,压电元件112可由诸如锆钛酸铅、间铌酸铅、钛酸铅、钛酸钡或其他压电陶瓷材料等任何合适的材料制成。正电极114、负电极116和压电元件112中的每个都具有延伸穿过中心的镗孔。正电极114和负电极116分别电联接到电线120和122。电线120和122封闭在缆线22内,并且可电连接到超声信号发生器20。
声学组件106的超声换能器16将来自超声信号发生器20的电信号转化为机械能,该机械能主要致使超声换能器16以及端部执行器组件26的刀66部分出现以超声频率纵向振动运动的声学驻波。在另一个实施例中,超声换能器的振动运动可以在不同的方向起作用。例如,振动运动可包括细长轴组件14的顶端的更复杂运动的局部纵向分量。合适的发生器为得自EthiconEndo-Surgery,Inc.(Cincinnati,Ohio)的GEN11型发生器。当声学组件106被供能时,振动运动驻波通过声学组件106生成。超声外科器械10被设计为在共振下操作,使得产生预先确定的振幅的声学驻波图案。沿声学组件106的任何点处的振动运动振幅取决于沿声学组件106用于测量振动运动的位置。振动运动驻波的最小或零交点通常称为波节(即纵向运动最小的位置),驻波的局部最大绝对值或峰值通常称为波腹(即局部运动最大的位置)。波腹与距其最近的波节之间的距离为四分之一波长(λ/4)。
线120和122将电信号从超声信号发生器20传输到正电极114和负电极116。由超声信号发生器20响应于致动器224(诸如脚踏开关)而提供的电信号来激励压电元件112,从而在声学组件106中产生声学驻波。电信号在压电元件112中产生反复小位移形式的扰动,导致材料内出现较大的交替压缩力和张力。反复的小位移使压电元件112沿电压梯度的轴线以连续方式伸展和收缩,从而生成超声能量的纵波。通过细长轴组件14的传输部件或超声传输波导部分78将超声能量通过声学组件106传输至端部执行器组件26的刀66部分。
在一个示例性实施例中,为了使声学组件106能够向端部执行器组件26的刀66部分递送能量,声学组件106的所有部件必须在声学上联接到刀66。超声换能器16的远侧端部可以在表面110处通过螺纹连接件(诸如螺柱124)在声学上联接到超声传输波导78的近侧端部。
在一个示例性实施例中,优选地对声学组件106的部件进行声学调谐,使得任何组件的长度均为整数个半波长(nλ/2),其中波长λ是声学组件106的预选或操作的纵向振动驱动频率fd的波长。另据设想,声学组件106可以结合任何合适的声学元件布置方式。
在一个示例性实施例中,刀66的长度可基本上等于系统半波长的整数倍(nλ/2)。刀66的远侧端部可设置在波腹附近,以便提供远侧端部的最大纵向偏移。当换能器组件被供能时,刀66的远侧端部能够以例如55kHz的预先确定的振动频率在例如大约10至500微米峰到峰的范围内运动,并且优选地在约30至64微米的范围内运动。
在一个示例性实施例中,刀66可联接到超声传输波导78。所示的刀66和超声传输波导78由适于传输超声能量的材料形成为单个单元构造。此类材料的示例包括Ti6Al4V(含有铝和钒的钛合金)、铝、不锈钢、或其他合适的材料。另选地,刀66可以与超声传输波导78分开(并且由不同的组合物制成),并且通过例如螺柱、焊接件、胶水、快速连接或其他合适的已知方法联接这两个部件。超声传输波导78的长度可基本上等于例如整数个半波长(nλ/2)。超声传输波导78可以优选地由使用适合高效传播超声能量的材料(诸如上述钛合金(即,Ti6Al4V)、或任何合适的铝合金、或其他合金)构造的实芯轴制成。
在一个示例性实施例中,超声传输波导78包括在近侧端部处的纵向突出的附接柱,用于通过螺纹连接诸如螺柱124来联接到超声传输波导78的表面110。超声传输波导78可包括定位在多个波节处的多个起稳定作用的硅氧烷环或适形支撑件82(图5)。硅氧烷环82抑制不可取的振动并将超声能量与外部保护护套80(图5)隔离,以确保纵向的超声能量流以最大的效率到达刀66的远侧端部。
图9示出近侧旋转组件128的一个示例性实施例。在该例示的实施例中,近侧旋转组件128包括插在圆柱形毂135上的近侧旋钮134。近侧旋钮134包括多个径向突出部138,这些突出部被接收在形成于圆柱形毂135的近侧端部上的相应狭槽130中。近侧旋钮134限定用于接收超声换能器16的远侧端部的开口142。径向突出部138由柔软的聚合材料形成,并且限定了尺寸相对比超声换能器16的外径较小的直径,以便在超声换能器16的远侧端部时形成摩擦过盈配合。聚合物径向突出部138径向地突起到开口142中,以形成牢牢地抓住超声换能器16的外壳的“抓具”肋。因此,近侧旋钮134牢固地抓住超声换能器16。
圆柱形毂135的远侧端部包括周边唇缘132和周边支承表面140。周边唇缘与形成于外壳12中的沟槽接合,周边支承表面140则与外壳12接合。这样,圆柱形毂135便机械地保持在外壳12的两个外壳部分(未示出)内。圆柱形毂135的周边唇缘132位于或“被捕获”在第一外壳部分12a和第二外壳部分12b之间,并且可在沟槽内适当地自由旋转。周边支承表面140倚靠着外壳的内部部分,以协助正确的旋转。这样,圆柱形毂135便可在外壳内适当地自由旋转。使用者利用其手指或拇指接合在近侧旋钮134上形成的凹槽136,以旋转外壳12内的圆柱形毂135。
在一个示例性实施例中,圆柱形毂135可以由耐用塑料诸如聚碳酸酯形成。在一个示例性实施例中,圆柱形毂135可以由硅化聚碳酸酯材料形成。在一个示例性实施例中,近侧旋钮134可以由柔韧的、有弹性的、柔性的聚合材料(包括例如GLS公司制造的TPE合金)形成。例如,近侧旋钮134可以由弹性体材料、被称为的热塑性橡胶、其他热塑性硫化橡胶(TPV)、或弹性体形成。然而,实施例并不限于此背景中。
图10示出包括外科器械210的外科系统200的一个示例性实施例,该外科器械210具有单元件端部执行器278。系统200可包括联接到端部执行器278的换能器组件216,以及围绕如图所示的端部执行器278的近侧部分定位的护套256。换能器组件216和端部执行器278可以与上述换能器组件16和端部执行器18相似的方式工作,从而产生可通过刀226'传输至组织的超声能量。
图11-图18C示出了外科器械的各种实施例,这些外科器械利用治疗和/或亚治疗电能来处理和/或破坏组织,或向发生器(例如,电外科器械)提供反馈。图11-图18C的实施例适于以手动或用手操作的方式使用,但电外科器械也可用于机器人应用中。图11为包括电能外科器械310的外科器械系统300的一个示例性实施例的透视图。电外科器械310可包括近侧柄部312、远侧工作端部或端部执行器326,以及设置在它们之间的导引器或细长轴314。
电外科系统300能够独立地或者同时地向患者的组织提供诸如电能、超声能量、热能或它们的任意组合的能量,如结合例如图1所述。在一个示例性实施例中,电外科系统300包括与电外科器械310电连通的发生器320。发生器320经由合适的传输介质(诸如缆线322)连接到电外科器械310。在一个示例性实施例中,发生器320联接到控制器,诸如控制单元325。在各种实施例中,控制单元325可与发生器320一体地形成,或可作为电耦合到发生器320的单独电路模块或装置提供(以虚线显示,以示出这种选择)。虽然在本发明所公开的实施例中,发生器320被显示为与电外科器械310分开,但在一个示例性实施例中,发生器320(和/或控制单元325)可与电外科器械310一体地形成以形成一体的电外科系统300,在该情况下,位于电外科器械310内的电池为能量源,而联接到电池的电路产生合适的电能、超声能量或热能。一个此类示例在下文结合图17-图18C进行描述。
发生器320可包括位于发生器320控制台的前面板上的输入装置335。输入装置335可包括生成适于对发生器320的操作进行编程的信号的任何合适的装置,诸如键盘或输入端口。在一个示例性实施例中,第一钳口364A和第二钳口364B中的各种电极可联接至发生器320。缆线322可包括多个电导体,用于将电能施加到电外科器械310的正(+)电极和负(-)电极。控制单元325可用于激活可充当电源的发生器320。在各种实施例中,发生器320可包括例如可被独立地或同时地激活的射频源、超声源、直流电源、和/或任何其他合适类型的电能量源。
在各种实施例中,电外科系统300可包括至少一个供给导体331和至少一个返回导体333,其中电流能够经由供给导体331供给电外科器械300并且其中电流能够经由返回导体333流回发生器320。在各种实施例中,供给导体331和返回导体333可包括绝缘线和/或任何其他合适类型的导体。在某些实施例中,如下文所述,供给导体331和返回导体333可容纳在缆线322内和/或可包括:在发生器320与电外科器械310的端部执行器326之间或至少部分地在它们之间延伸的缆线。在任何情况下,发生器320都能够在供给导体331与返回导体333之间施加足够的电压差,使得可将足够的电流提供至端部执行器110。
图12为外科器械310的柄部312的一个示例性实施例的侧视图。在图12中,显示柄部312,其中第一柄部主体312A(参见图12)的一半被移除以示出第二柄部主体312B内的各种部件。柄部312可以包括杠杆臂321(例如,触发器),该杠杆臂321可以沿路径33被牵拉。杠杆臂321可通过往复运动件384联接到设置在伸长轴314内的可轴向运动构件378(图13-图16),该往复运动件可操作地接合到杠杆臂321的延伸件398。往复运动件384还可以连接到偏置装置,诸如弹簧388,以沿近侧方向偏置往复运动件384并因而沿近侧方向偏置可轴向运动的构件378,由此将钳口364A和364B推压到打开位置,如图11中所见,其中该偏置装置还可以连接至第二柄部主体312B。另外,参见图11-图12,锁定构件190(参见图12)可通过锁定开关328(参见图12)在锁定位置和解锁位置之间运动,在锁定位置,基本上防止往复运动件384朝远侧运动,如图所示;在解锁位置,可允许往复运动件384自由地沿远侧方向朝细长轴314运动。柄部312可以是任何类型的手枪式握把或本领域中已知的其他类型的柄部,其能够承载用于致动第一钳口364A和第二钳口364B的致动器杠杆、触发器或滑动件。细长轴314可具有例如圆柱形或矩形横截面,并且可包括从柄部312延伸的薄壁管状套筒。细长轴314可包括贯穿其延伸的镗孔,用于承载用于致动钳口的致动器机构(例如,可轴向运动的构件378),以及用于承载将电能递送到端部执行器326的电外科部件的电引线。
端部执行器326可以适于捕获并横切组织,并且适于同时通过能量(例如,射频能量)的受控施加而接合(welding)所捕获的组织。第一钳口364A和第二钳口364B可以闭合,由此围绕由可轴向运动的构件378限定的纵向轴线“T”来捕获或接合组织。第一钳口364A和第二钳口364B还可对组织施加压缩。在一些实施例中,细长轴314连同第一钳口364A和第二钳口364B一起能够相对于柄部312旋转完整的360°,如箭头196(参见图11)所示。例如,旋钮348可绕轴314的纵向轴线旋转,并且可联接到轴314以使得旋钮348的旋转导致轴314的相应旋转。第一钳口364A和第二钳口364B能够在旋转的同时保持为可打开和/或可闭合的。
图13显示钳口364A,364B打开的端部执行器326的一个示例性实施例的透视图,而图13显示钳口364A,364B闭合的端部执行器326的一个示例性实施例的透视图。如上所述,端部执行器326可以包括上部第一钳口364A和下部第二钳口364B,它们可以是直的或弯曲的。第一钳口364A和第二钳口364B各自可以分别包括沿它们的相应中间部分向外设置的细长狭槽或通道362A和362B。另外,第一钳口364A和第二钳口364B各自可以具有设置在第一钳口364A和第二钳口364B的内部部分上的组织夹持元件,诸如齿状物363。第一钳口364A可以包括上部第一钳口主体200A,该上部第一钳口主体具有上部第一向外表面202A和上部第一能量递送表面365A。第二钳口364B可以包括下部第二钳口主体200B,该下部第二钳口主体具有下部第二向外表面202B和下部第二能量递送表面365B。第一能量递送表面365A和第二能量递送表面365B均可围绕端部执行器326的远侧端部以“U”形延伸。
柄部312的杠杆臂321(图12)可适于致动可轴向运动的构件378,该可轴向运动的构件还可以充当钳口闭合机构。例如,当沿路径33朝近侧牵拉杠杆臂321时,可经由往复运动件384朝远侧推动可轴向运动的构件378,如图12所示且如上所述。图15是外科器械310的可轴向运动的构件378的一个示例性实施例的透视图。可轴向运动的构件378可以包括一个或若干个零件,但是在任何情况下,其均可以相对于细长轴314和/或钳口364A,364B运动或平移。另外,在至少一个示例性实施例中,可轴向运动的构件378可以由17-4沉淀硬化不锈钢制成。可轴向运动的构件378的远侧端部可以包括带凸缘的“I”形梁,该“I”形梁能够在钳口364A和364B中的通道362A和362B内滑动。可轴向运动的构件378可在通道362A,362B内滑动,以打开和闭合第一钳口364A和第二钳口364B。可轴向运动的构件378的远侧端部还可以包括上部凸缘或“c”形部分378A和下部凸缘或“c”形部分378B。凸缘378A和378B分别限定内部凸轮表面367A和367B,用于与第一钳口364A和第二钳口364B的向外表面接合。钳口364A和364B的打开和闭合可以使用凸轮机构在组织上施加非常高的压缩力,凸轮机构可以包括可运动的“I形梁”、可轴向运动的构件378以及钳口364A,364B的向外表面369A,369B。
更具体地,现在参见图13-图15,可轴向运动的构件378的远侧端部的内部凸轮表面367A和367B可共同地适于分别可滑动地接合第一钳口364A的第一向外表面369A和第二钳口364B的第二向外表面369B。第一钳口364A内的通道362A和第二钳口364B内的通道362B的大小可被设计成且能够适应可轴向运动的构件378的移动,该可轴向运动的构件可包括组织切割元件371,例如,包括锐利的远侧边缘。图14例如显示了至少部分地推进穿过通道362A和362B(图13)的可轴向运动的构件378的远侧端部。可轴向运动的构件378的推进可以将端部执行器326从图13所示的打开构型闭合。由图14所示的闭合位置中,上部第一钳口364A和下部第二钳口364B分别限定第一钳口364A的第一能量递送表面365A和第二钳口364B的第二能量递送表面365B之间的间隙或尺寸D。在各种实施例中,尺寸D可例如等于约0.0005英寸至约0.040英寸,并且在一些实施例中,例如介于约0.001英寸至约0.010英寸之间。另外,第一能量递送表面365A和第二能量递送表面365B的边缘可以被倒圆以防止将组织切开。
图16是外科器械310的端部执行器326的一个示例性实施例的截面图。下部钳口364B的接合表面或组织接触表面365B适于至少部分地通过导电-电阻基质(诸如可变电阻正温度系数(PTC)主体)向组织递送能量,如下文更详细地讨论。上部钳口364A和下部钳口364B中的至少一者可以承载至少一个能够将能量从发生器320递送到捕获组织的电极373。上部钳口364A的接合表面或组织接触表面365A可承载类似的导电-电阻基质(即,PTC材料),或者在一些实施例中,该表面可为例如导电电极或绝缘层。另选地,钳口的接合表面可以承载2001年10月22日提交的名称为“ELECTROSURGICAL JAW STRUCTURE FOR CONTROLLED ENERGYDELIVERY”的美国专利6,773,409中所公开的任何能量递送部件,该专利的全部公开内容以引用方式并入本文。
第一能量递送表面365A和第二能量递送表面365B各自可以与发生器320电连通。第一能量递送表面365A和第二能量递送表面365B能够接触组织并且能够将适于密封或接合(weld)所述组织的电外科能量递送至捕获的组织。控制单元325调控由电发生器320递送的电能,继而向第一能量递送表面365A和第二能量递送表面365B递送电外科能量。可通过激活按钮328(图12)来发起能量递送,该激活按钮与杠杆臂321可操作地接合并经由缆线322与发生器320电连通。在一个示例性实施例中,电外科器械310可通过脚踏开关216(图11)由发生器320供能。当被致动时,例如脚踏开关329触发发生器320,以将电能递送至端部执行器326。控制单元325可在激活期间对由发生器320生成的功率进行调控。尽管脚踏开关329可能适用于许多情况,但可以使用其他合适类型的开关。
如上文所提及,由电发生器320递送并由控制单元325调控或者说是控制的电外科能量可包括射频(RF)能量或其他合适形式的电能。另外,相对的第一能量递送表面365A和第二能量递送表面365B可以承载可变电阻正温度系数(PTC)主体,该主体与发生器320和控制单元325电连通。有关电外科端部执行器、钳口闭合机构、以及电外科能量递送表面的另外的细节在以下美国专利和已公布的专利申请中有所描述:美国专利7,087,054、7,083,619、7,070,597、7,041,102、7,011,657、6,929,644、6,926,716、6,913,579、6,905,497、6,802,843、6,770,072、6,656,177、6,533,784和6,500,312,以及美国专利申请公布No.2010/0036370和2009/0076506,所有这些专利和专利申请公布均全文以引用方式并入本文并构成本说明书的一部分。
在一个示例性实施例中,发生器320可被实施为电外科单元(ESU),该电外科单元能够利用射频(RF)能量来提供足以执行双极电外科的功率。在一个示例性实施例中,ESU可以是ERBE USA,Inc.(Marietta,Georgia)销售的双极ERBE ICC 350。在一些实施例中,诸如对于双极电外科应用,可以利用具有有源电极和返回电极的外科器械,其中有源电极和返回电极可以抵靠、邻近待处理的组织定位以及/或者被定位成与待处理的组织电连通,使得电流能够从有源电极通过正温度系数(PTC)主体并通过组织而流至返回电极。因此,在各种实施例中,电外科系统300可包括供应路径和返回路径,其中正被处理的所捕获的组织使电路结束或将该电路闭合。在一个示例性实施例中,发生器320可以是单极射频ESU并且电外科器械310可以包括单极端部执行器326,在该单极端部执行器326中整合了一个或多个有源电极。对于此类系统,发生器320可能需要在远离手术部位的位置处与患者紧密接触的返回垫和/或其他合适的返回路径。返回垫可经由缆线连接到发生器320。在其他实施例中,操作员20可提供亚治疗射频能级以用于在电外科系统300中评估组织状态以及提供反馈的目的。可使用此类反馈来控制电外科器械310的治疗性射频能量输出。
在电外科器械300的操作过程中,使用者通常抓紧组织,向捕获的组织提供能量以形成接合或密封(例如,通过致动按钮328和/或踏板216),并且然后驱动位于可轴向运动的构件378远侧端部处的组织切割元件371穿过捕获的组织。根据各种实施例,可放缓(paced)或以其他方式控制可轴向运动的构件378的轴向运动的平移,从而有助于以合适的行进速率驱动可轴向运动的构件378。通过控制行进速率,提高了在用切割元件371横切之前适当地且功能性地密封所捕获组织的可能性。
图17为包括无绳电能外科器械410的外科器械系统的一个示例性实施例的透视图。该电外科系统与电外科系统300类似。该电外科系统250能够独立地或同时地向患者的组织提供能量诸如电能、超声能量、热能或它们的任意组合,如结合例如图1和图11所述。该电外科器械可利用本文结合无绳近侧柄部412所述的端部执行器326和细长轴314。在一个示例性实施例中,柄部412包括发生器电路420(参见图18A)。发生器电路420执行基本上与发生器320的该电路类似的功能。在一个示例性实施例中,发生器电路420联接到控制器,诸如控制电路。在该例示的实施例中,控制电路整合到发生器电路420中。在其他实施例中,控制电路可与发生器电路420分开。
在一个示例性实施例中,端部执行器326(包括其钳口364A,364B)中的各种电极可以联接到发生器电路420。控制电路可用于激活可充当电源的发生器420。在各种实施例中,发生器420可包括例如射频源、超声波源、直流电源、和/或任何其他合适类型的电能量源。在一个示例性实施例中,可提供按钮328,用于激活发生器电路420从而向端部执行器326,326提供能量。
图18A为无绳外科器械410的柄部412的一个示例性实施例的侧视图。在图18A中,显示柄部412,其中第一柄部主体的一半被移除以示出第二柄部主体434内的各种部件。柄部412可以包括杠杆臂424(例如,触发器),该杠杆臂424可以沿路径33围绕枢转点被牵拉。杠杆臂424可以通过往复运动件联接到设置在细长轴314内的可轴向运动的构件478,该往复运动件可操作地接合到杠杆臂424的延伸部。在一个示例性实施例中,杠杆臂424限定包括远侧构件424a和近侧构件424b的牧羊杖钩形状。
在一个示例性实施例中,无绳电外科器械包括电池437。电池437向发生器电路420提供电能。电池437可以是适于以所需的能级驱动发生器电路420的任何电池。在一个示例性实施例中,电池437为100mAh三芯锂离子聚合物电池。该电池可在用于外科手术之前充满电,并且可保持约12.6V的电压。电池437可具有装配到无绳电外科器械410的两条保险丝,它们被布置成符合每个电池端子。在一个示例性实施例中,提供用于将电池437连接到直流电源(未示出)的充电端口439。
发生器电路420可以任何合适的方式配置。在一些实施例中,发生器电路包括射频驱动和控制电路440以及控制器电路482。图18B示出根据一个实施例的射频驱动和控制电路440。图18B是示出用于该实施例中以生成和控制提供给端部执行器326的射频电能的射频驱动和控制电路440的局部示意框图。如下文将更详细地解释,在该实施例中,驱动电路440是包括关于射频放大器输出的并联谐振网络的谐振模式射频放大器,而控制电路工作以控制驱动信号的工作频率以使得其保持在驱动电路的谐振频率下,继而控制提供给端部执行器326的功率的量。根据以下说明,实现这点的方式将是显而易见的。
如图18B中所示,射频驱动和控制电路440包括上述电池437,在该示例中其被布置成提供约0V和约12V的导轨。输入电容器(Cin)442连接在0V与12V之间,用于提供低源阻抗。一对FET开关443-1和443-2(在该实施例中,此二者均为N型通道以减少功率损耗)串联连接在0V导轨与12V导轨之间。提供生成两个驱动信号的FET栅极驱动电路805,这两个驱动信号中的一个用于驱动所述两个FET 443中的每一个。该FET栅极驱动电路445生成驱动信号,其在下部FET(443-2)关闭时使得上部FET(443-1)接通,反之亦然。这使得节点447交替地连接到12V导轨(当FET 443-1接通时)和0V导轨(当FET 443-2接通时)。图18B还显示相应FET 443的内部寄生二极管448-1和448-2,它们在FET 443接通的任意期间导电。
如图18B所示,节点447连接到由电感器Ls 452和电感器Lm 454形成的电感器-电感器谐振电路450。FET栅极驱动电路445被布置成以驱动频率(fd)生成驱动信号,该驱动信号以并联谐振电路450的谐振频率接通和关闭FET开关443。由于谐振电路450的谐振特性,在节点447处的方波电压将使得在驱动频率(fd)下的基本上呈正弦的电流在谐振电路450内流动。如图18B所示,电感器Lm 454是变压器455的主线圈,该变压器455的次级线圈由电感器Lsec 456形成。变压器455次级线圈的电感器Lsec 456连接到通过电感器L2458、电容器C4460和电容器C2462形成的电感器-电容器-电容器并联谐振电路457。变压器455将电感器Lm 454两端的驱动电压(Vd)升压转换成施加到输出并联谐振电路457的电压。负载电压(VL)由并联谐振电路457输出,并施加到与由镊子的钳口和由端部执行器326所夹持的任何组织或血管的阻抗对应的负载(在图18B中由负载电阻R负载459表示)。如图18B所示,提供了一对直流阻塞电容器CbI 480-1和480-2以阻止任何直流电信号施加到负载459。
在一个实施例中,变压器455可由符合以下规格的芯径(mm)、线径(mm)、以及次级线圈之间的间隙实施:
芯径,D(mm)
D=19.9×10-3
22AWG线的线径,W(mm)
W=7.366×10-4
次级线圈之间的间隙,间隙=0.125
G=间隙/25.4
在该实施例中,通过改变用于切换FET 443的转换信号的频率而对提供给端部执行器326的电量进行控制。这是可行的,因为谐振电路450充当频率相依性(较少损耗)衰减器。驱动信号越接近谐振电路450的谐振频率,驱动信号衰减得就越少。相似地,随着驱动信号的频率从电路450的谐振频率移除,该驱动信号衰减得就越多,因此提供给负载的功率减少。在该实施例中,基于将递送到负载459的所期望功率和由常规电压感测电路483和电流感测电路485获得的负载电压(VL)和负载电流(IL)的测量值,由控制器481对FET栅极驱动电路445所生成的转换信号的频率进行控制。控制器481运行的方式将在下文中更详细地描述。
在一个实施例中,电压感测电路485和电流感测电路483可以用高带宽、高速轨到轨放大器(例如,由National Semiconductor制造的LMH6643)实施。然而,此类放大器在其工作时消耗相对高的电流。因此,可提供节电电路以降低放大器在不用于电压感测电路485和电流感测电路483中时的供电电压。在一个实施例中,节电电路可使用降压稳压器(例如,由Linear Technologies制造的LT3502)来降低轨到轨放大器的供电电压并且因此延长电池437的寿命。
图18C示出根据一个实施例的控制器481的主要部件。在图18C所示的实施例中,控制器481是基于微处理器的控制器,因此图16中所示的大部分部件为基于软件的部件。然而,也可以使用基于硬件的控制器481。如图所示,控制器481包括同步I,Q取样电路491,其从感测电路483和485接收所感测到的电压和电流信号,并且获得传送到功率、Vrms和Irms计算模块493的相应样本。计算模块493使用接收到的样本计算施加到负载459(图18B;端部执行器326及因而夹持的组织/血管)的RMS电压和RMS电流,并通过它们计算目前正施加给负载459的功率。然后将确定值传送到频率控制模块495和医疗装置控制模块497。医疗装置控制模块497使用该值来确定负载459的当前阻抗,并且基于该确定的阻抗和预定义的算法,确定应当将何种设定点功率(P设定)施加到频率控制模块495。医疗装置控制模块497继而由从使用者输入模块499接收的信号来控制,使用者输入模块从使用者接收输入(例如,按下按钮或启动柄部104上的控制杠杆114,110),并且还经由使用者输出模块461来控制柄部104上的输出装置(灯、显示器、扬声器等)。
频率控制模块495使用从计算模块493获得的值和从医疗装置控制模块497获得的设定点功率(P设定)以及预定义的系统限制(将在下文中阐释)来确定是否要提高或降低所施加的频率。然后,将该决定的结果传送到方波发生模块463,其在该实施例中根据接收到的决定将自身生成的方波信号的频率提高或降低1kHz。如本领域的技术人员将会知道的那样,在另选的实施例中,频率控制模块495可不仅确定是否要提高或降低频率,还确定所需的频率变化的量。在这种情况下,方波发生模块463将生成与期望的频移对应的方波信号。在该实施例中,将由方波发生模块463生成的方波信号输出到FET栅极驱动电路445,该FET栅极驱动电路将该信号放大然后将其施加到FET 443-1。该FET栅极驱动电路445还转换施加到FET 443-1的信号并且将所转换的信号施加到FET 443-2。
电外科器械410可包括如相对于电外科系统300所讨论的另外的特征结构。本领域的技术人员将认识到,电外科器械410可包括旋钮348、细长轴314和端部执行器326。这些元件以与上文相对于电外科系统300所讨论的那些方式基本上类似的方式发挥作用。在一个示例性实施例中,无绳电外科器械410可包括视觉指示器435。视觉指示器435可向操作员提供视觉指示信号。在一个示例性实施例中,视觉指示信号可警示操作员装置已开启,或者装置正在向端部执行器施加能量。本领域的技术人员将认识到,视觉指示器435能够提供关于装置的多种状态的信息。
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。机器人外科系统可以与许多不同类型的外科器械一起使用,这些外科器械包括例如超声或电外科器械,如本文所述。示例性机器人系统包括由IntuitiveSurgical,Inc.(Sunnyvale,California,U.S.A)制造的那些。此类系统以及得自其他制造商的机器人系统在以下美国专利中进行了公开,这些美国专利各自全文以引用方式并入本文:名称为“Articulated Surgical Instrument ForPerforming Minimally Invasive Surgery With Enhanced Dexterity andSensitivity”的美国专利5,792,135、名称为“Robotic Arm DLUS ForPerforming Surgical Tasks”的美国专利6,231,565、名称为“Robotic SurgicalTool With Ultrasound Cauterizing and Cutting Instrument”的美国专利6,783,524、名称为“Alignment of Master and Slave In a Minimally InvasiveSurgical Apparatus”的美国专利6,364,888、名称为“Mechanical ActuatorInterface System For Robotic Surgical 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/Slave Relationship in MinimallyInvasive Telesurgery”的美国专利7,806,891以及名称为“Surgical Tool WithWrited Monopolar Electrosurgical End Effectors”的美国专利7,824,401。然而,许多此类系统在过去尚未能生成有效切割和紧固组织所需量级的力。
图19-46示出与所公开的机器人外科控制系统兼容的机器人外科系统的示例性实施例。在一些实施例中,所公开的机器人外科系统可以利用本文所述的超声或电外科器械。本领域的技术人员将会知道,所示的机器人外科系统不仅仅限于本文所述的那些器械,而是可以利用任何兼容的外科器械。本领域的技术人员还将认识到,虽然本文所述的各种实施例可以与所述的机器人外科系统一起使用,但是公开内容并不如此受到限制,而是可以与任何兼容的机器人外科系统一起使用。
图19-图25示出若干示例性机器人外科系统及其部件的结构和操作。图19示出示例性机器人外科系统1000的框图。系统1000包括至少一个控制器508和至少一个臂车510。臂车510可机械地联接到一个或多个由方框512指示的机器人操纵器或机械臂。机械臂512中的每个可以包括一个或多个外科器械514,用于对患者504执行各种手术任务。臂车510(包括臂512和器械514)的操作可由临床医生502从控制器508进行指导。在一些实施例中,由第二临床医生502'操作的第二控制器508'也可与第一临床医生502'协力指挥臂车510的操作。例如,临床医生502,502'中的每一位可以控制臂车的不同臂512,或在一些情况下,可在临床医生502,502'之间传递对臂车510的完全控制。在一些实施例中,可将另外的臂车(未示出)用于患者504。这些另外的臂车可由控制器508,508'中的一个或多个控制。臂车510和控制器508,508'可经由通信链路516彼此通信,该通信链路可以是根据任何合适的通信协议承载任何合适类型的信号(例如,电信号、光信号、红外信号等)的任何合适类型的有线或无线通信链路。机器人外科系统(诸如系统1000)的示例性具体实施在已经以引用方式并入本文的美国专利7,524,320中有所公开。因而,本文将不详细描述此类装置的各个细节,除了理解受权利要求书保护的装置的各种实施例可能必需的细节外。
图20示出机械臂车520的一个示例性实施例。机械臂车520能够致动多个外科器械或器械,它们在工作包封空间519内一般被指定为522。名称为“Multi-Component Telepresence System and Method”的美国专利6,132,368中公开了使用主控制器和机械臂车布置结构的各种机器人外科系统和方法,该专利的全部公开内容以引用方式并入本文。在各种形式中,机械臂车520包括基座524,在该例示的实施例中,该基座支撑有三个外科器械522。在各种形式中,外科器械522各自由一系列可在手动操作下进行关节运动的连杆(一般称为装置接头526)和机器人操纵器528支撑。本文示出的这些结构具有在机械连杆的大部分之上延伸的护盖。这些护盖可以是任选的,并且可在尺寸上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、限制移动部件的体积以避免碰撞、并且限制车520的总重量。车520将通常具有适于在手术室之间搬运车520的尺寸。车520能够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520将优选地具有一定的重量并且包括轮(或其他运输)系统,该轮系统使得车520可被单个维护人员定位在邻近手术台的位置。
图21示出机械臂车520的机器人操纵器528的一个示例性实施例。在图21所示的示例中,机器人操纵器528可包括约束外科器械522的运动的连杆530。在各种实施例中,连杆530包括由旋转接头以平行四边形布置方式联接在一起的刚性联接件,使得外科器械522围绕空间532中的某一点旋转,如在已公布的美国专利5,817,084中更完整地描述,该专利的全部公开内容以引用方式并入本文。平行四边形布置方式将旋转约束为围绕轴线534a(有时称为俯仰轴)枢转。支撑平行四边形连杆的连接件以枢转方式安装到装置接头526(图20),使得外科器械522还围绕轴线534b(有时称为偏航轴)旋转。俯仰轴线534a和偏航轴线534b在远程中心536处相交,该远程中心沿外科器械522的轴538对齐。当由操纵器540支撑时,外科器械522可具有另外的从动自由度,包括外科器械522沿着纵向器械轴线“LT-LT”的滑动运动。当外科器械522沿着器械轴线LT-LT相对于操纵器540滑动时(箭头534c),远程中心536相对于操纵器540的基座542保持固定。因此,整个操纵器540通常运动,从而使远程中心536重新定位。操纵器540的连杆530由一系列马达544驱动。这些马达544响应于控制系统处理器的命令而主动使连杆530运动。如将在下文中进一步详细论述,马达544还用于操纵外科器械522。
图22示出具有另选的装置接头结构的机械臂车520'的一个示例性实施例。在该示例性实施例中,外科器械522由位于两个组织操纵器械之间的另选的操纵器结构528'支撑。本领域的普通技术人员将会知道,受权利要求书保护的装置的各种实施例可以包括多种另选的机器人结构,包括在美国专利5,878,193中描述的那些结构,该专利的全部公开内容以引用方式并入本文。另外,虽然本文参考外科器械522和控制器之间的通信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,但应当理解,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,该机器人外科系统的处理器用于部件兼容性验证、部件类型识别、部件校准(诸如偏移等)通信、部件与机器人外科系统的联接确认等。
图23示出控制器518的一个示例性实施例,该控制器可以与机械臂车(诸如在图20-图22中描绘的机械臂车520,520')结合使用。控制器518通常包括主控制器(在图23中一般表示为519),在临床医生通过立体显示器521观察手术的同时,该主控制器由临床医生抓持并在空间操纵。外科医生反馈计515可通过显示器521来观察并为外科医生提供正施加于切割器械或动态夹紧构件的力的大小的视觉指示。主控制器519通常包括手动输入装置,该手动输入装置优选地以多个自由度运动,并且通常还具有用于致动器械(例如,用于闭合抓持锯、施加电势到电极等)的柄部或触发器。
图24示出适于与机器人外科系统一起使用的超声外科器械522的一个示例性实施例。例如,外科器械522可以联接到上文所述的外科操纵器528,528'中的一个。如在图24中可以看出,外科器械522包括外科端部执行器548,该外科端部执行器包括超声刀550和夹持臂552,该外科端部执行器可联接到细长轴组件554,在一些实施例中,该细长轴组件可包括关节运动接头556。图25示出用电外科器械523替代超声外科器械522的另一个示例性实施例。外科器械523包括外科端部执行器548,该外科端部执行器包括可闭合的钳口551A,551B,它们具有能量递送表面553A,553B,用于接合钳口551A,551B之间的组织并向该组织提供电能。组织切割元件或刀555可定位在可轴向运动的构件557的远侧端部处,该可轴向运动的构件可延伸穿过细长轴组件554到达器械安装部分558。图26示出器械驱动组件546的一个示例性实施例,该器械驱动组件可联接到用于接收和控制外科器械522,523的外科操纵器528,528'中的一个。器械驱动组件546还可以可操作地联接到控制器518,用于接收临床医生的输入而对器械522,523进行控制。例如,夹持臂552的致动(即,打开和闭合)、钳口551A,551B的致动(即,打开和闭合)、超声刀550的致动、刀555的延伸、以及能量递送表面553A,553B的致动等可通过器械驱动组件546基于由临床医生通过控制器518提供的输入而加以控制。外科器械522通过器械安装部分(一般称为558)可操作地联接到操纵器。外科器械522还包括将器械安装部分558以机械方式和电气方式联接到操纵器的接合部560。
图27示出包括超声外科器械522的图26的器械驱动组件的另一个视图。图28示出包括电外科器械523的图26的器械驱动组件的另一个视图。器械安装部分558包括器械安装板562,该器械安装板可操作地支撑多个(图26中示出了四个)可旋转主体部分、从动盘或从动元件564,每个从动盘或从动元件均包括自从动元件564的表面延伸的一对销566。一个销566比同一个从动元件564上的另一个销566更靠近每个从动元件564的旋转轴线,这有助于确保从动元件564的正向角对准。从动元件564和销566可定位在器械安装板562的适配器侧567上。
接合部560还包括能够与安装板562以安装方式接合的适配器部分568,如将在下文中进一步论述。适配器部分568可包括一系列电连接销570,这些电连接销可通过器械安装部分558内的电路板而联接到存储器结构。虽然参考机械联接元件、电耦接元件和磁力耦接元件在本文中描述了接合部560,但是应当理解,可以使用多种遥测形式,包括红外、电感耦接等。
图29-图31示出图26的器械驱动组件546的适配器部分568的另外视图。适配器部分568通常包括器械侧572和保持器侧574(图29)。在各种实施例中,将多个可旋转主体576安装到浮动板578,该浮动板相对于垂直于适配器568主表面的周围适配器结构具有受限的运动范围。当沿器械安装部分外壳582的侧面的杠杆580被致动时(参见图24和图25),浮动板578的轴向运动有助于使可旋转主体576从器械安装部分558脱离。可采用其他机构/布置结构以可释放的方式将器械安装部分558联接到适配器568。在至少一种形式中,通过弹性径向构件将可旋转主体576弹性地安装到浮动板578,该弹性径向构件围绕可旋转主体576延伸到周边凹痕中。可旋转主体576可通过这些弹性结构的挠曲而相对于板578轴向运动。当可旋转主体576设置在第一轴向位置(朝器械侧572)时,可旋转主体576自由旋转而无角度限制。然而,当可旋转主体576朝器械侧572轴向运动时,突片584(从可旋转主体576径向延伸)侧向接合浮动板上的棘爪以便限制可旋转主体576围绕其轴线的角旋转。当驱动销586将可旋转主体576推动至受限的旋转位置直到销586与开口590对准(并滑动到其中)时,可使用该受限的旋转来帮助可旋转主体576与机器人系统的对应器械架部分588的驱动销586驱动接合。
可旋转主体576的器械侧572上的开口590以及夹持器侧574上的开口590能够将器械安装部分558的从动元件564(图27、图28)与器械保持器588的驱动元件592准确对准。如上文关于从动元件564的内部和外部销566所述,开口590位于相距其各自的可旋转主体576的旋转轴线不同的距离处,以便确保与之要达到的位置不呈33度对准。另外,每个开口590可能略微径向伸长,以便适当地接收周边方向上的销566。这允许销566在开口590内径向滑动并适应器械522,523和器械保持器588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。器械侧572上的开口590可与保持器侧574上的开口590(以虚线示出)偏置成约90度,如在图31中可以最清楚地看到。
各种实施例还可以包括位于适配器568的夹持器侧574上的电连接销570阵列,并且适配器568的器械侧572可包括狭槽594(图31),用于接收器械安装部分558的销阵列(未示出)。除了在外科器械522,523和器械架588之间传输电信号外,可通过适配器568的电路板将这些电连接件中的至少一些联接到适配器存储器装置596(图30)。
可采用可拆卸的闩锁布置结构598以可释放的方式将适配器568附连到器械保持器588。如本文所用,术语“器械驱动组件”在用于机器人系统的上下文中时,至少涵盖适配器568和器械保持器588的各种实施例,并且其在图26中一般称为546。例如,如在图26中可以看出,器械保持器588可包括第一闩锁销布置结构600,该第一闩锁销布置结构的大小被设计成接收在适配器568中提供的相应的连接叉狭槽602中。另外,器械保持器588还可以具有第二闩锁销604,该第二闩锁销的尺寸被设计成保持在适配器568中相应的闩锁连接叉606中。参见图30。在至少一种形式中,闩锁组件608被活动地支撑在适配器568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600保持在它们各自的闩锁连接叉606中,在未闩锁位置中,第二闩锁销604可进入闩锁连接叉606或从闩锁连接叉606中移除。使用一个或多个弹簧(未示出)以将闩锁组件偏置到闩锁位置中。适配器568的器械侧572上的唇缘可以可滑动地接收器械安装外壳582的侧向延伸的突片。
如前所述,从动元件564可与器械保持器588的驱动元件592对准,使得驱动元件592的旋转运动导致从动元件564的相应旋转运动。驱动元件592和从动元件564的旋转可(例如)响应于经由控制器508从临床医生502接收的指令而经由机械臂612来电子控制。器械安装部分558可将从动元件564的旋转转化成外科器械522,523的运动。
图32-图34示出器械安装部分558的一个示例性实施例,显示用于将从动元件564的运动转化成外科器械522,523的运动的部件。图32-图34示出具有轴538的器械安装部分,该轴在其远侧端部处具有外科端部执行器610。端部执行器610可以是用于对患者执行外科任务的任何合适类型的端部执行器。例如,端部执行器能够向手术部位处的组织提供射频和/或超声能量。轴538可旋转地联接到器械安装部分558并在轴538的联轴器650处由顶部轴保持器646和底部轴保持器648固定。
在一个示例性实施例中,器械安装部分558包括用于将各种从动元件564的旋转转化成轴538的旋转、构件沿轴的轴线的微分平移(例如,用于进行关节运动)、以及一个或多个构件沿轴538的轴线的往复式平移(例如,用于延伸和缩回组织切割元件诸如555、外套管和/或其他部件)的机构。在一个示例性实施例中,可旋转主体612(例如,可旋转卷轴)联接到从动元件564。可旋转主体612可与从动元件564一体地形成。在一些实施例中,可旋转主体612可独立于从动元件564形成,前提是可旋转主体612和从动元件564固定地联接以使得驱动从动元件564致使可旋转主体612旋转。可旋转主体612中的每个联接到齿轮系或齿轮机构,用于提供轴的关节运动和旋转、夹持钳口的打开/闭合、以及刀致动。
在一个示例性实施例中,器械安装部分558包括用于引起两个或更多个构件沿轴538的轴线发生微分平移的机构。在图32-图34提供的示例中,该运动用于操纵关节运动接头556。在该例示的实施例中,例如,器械安装部分558包括齿条与小齿轮传动机构以提供微分平移并因而提供轴关节运动功能。在一个示例性实施例中,齿条与小齿轮传动机构包括联接到可旋转主体612的第一小齿轮传动装置614,使得相应从动元件564的旋转导致第一小齿轮传动装置614旋转。轴承616联接到可旋转主体612并提供于从动元件564和第一小齿轮传动装置614之间。第一小齿轮传动装置614啮合到第一齿条传动装置618以将第一小齿轮传动装置614的旋转运动转化成第一齿条传动装置618的线性运动,从而控制轴组件538的关节运动段556沿向左方向620L的关节运动。第一齿条传动装置618附接到第一关节运动带622(图32),使得第一齿条传动装置618沿远侧方向的线性运动导致轴组件538的关节运动段556沿向左方向620L进行关节运动。第二小齿轮传动装置626联接到另一个可旋转主体612,使得相应从动元件564的旋转导致第二小齿轮传动装置626旋转。轴承616联接到可旋转主体612并提供于从动元件564与第二小齿轮传动装置626之间。第二小齿轮传动装置626啮合到第二齿条传动装置628以将第二小齿轮传动装置626的旋转运动转化成第二齿条传动装置628的线性运动,从而控制关节运动段556沿向右方向620R的关节运动。第二齿条传动装置628附接到第二关节运动带624(图33),使得第二齿条传动装置628沿远侧方向的线性运动导致轴组件538的关节运动段556沿向右方向620R进行关节运动。可以在可旋转主体和相应齿轮之间提供另外的轴承。可以提供任何合适的轴承以支撑和稳定安装,并且减小例如轴和齿轮的旋转摩擦。
在一个示例性实施例中,器械安装部分558还包括用于将从动元件564的旋转转化成围绕轴538的轴线的旋转运动的机构。例如,旋转运动可以是轴538自身的旋转。在该例示的实施例中,第一螺旋蜗轮630联接到可旋转主体612,并且第二螺旋蜗轮632联接到轴组件538。轴承616(图17)联接到可旋转主体612并提供于从动元件564和第一螺旋蜗轮630之间。第一螺旋蜗轮630啮合到第二螺旋蜗轮632,后者可联接到轴组件538和/或器械522,523的需要其纵向旋转的另一个部件。旋转可基于第一螺旋蜗轮630和第二螺旋蜗轮632的旋转方向而沿顺时针方向(CW)和逆时针方向(CCW)进行。因此,第一螺旋蜗轮630绕第一轴线的旋转被转换为第二螺旋蜗轮632绕第二轴线的旋转,第二轴线与第一轴线正交。如图32-图33所示,例如,第二螺旋蜗轮632的顺时针旋转导致轴组件538沿634CW所指示的方向顺时针旋转。第二螺旋蜗轮632的逆时针旋转导致轴组件538沿634CCW所指示的方向逆时针旋转。可以在可旋转主体和相应齿轮之间提供另外的轴承。可以提供任何合适的轴承以支撑和稳定安装,并且减小例如轴和齿轮的旋转摩擦。
在一个示例性实施例中,器械安装部分558包括用于生成一个或多个构件沿轴538的轴线的往复式平移的机构。这种平移可用于例如驱动组织切割元件诸如555、驱动外套管以使端部执行器610闭合以及/或者进行关节运动等。在该例示的实施例中,例如,齿条与小齿轮传动机构可提供往复式平移。第一齿轮636联接到可旋转主体612,使得相应从动元件564的旋转导致第一齿轮636沿第一方向旋转。第二齿轮638围绕在器械安装板562中形成的柱640自由旋转。第一齿轮636啮合到第二齿轮638,使得第二齿轮638沿与第一齿轮636相反的方向旋转。在一个示例性实施例中,第二齿轮638是啮合到沿线性方向运动的齿条642的小齿轮。齿条642联接到平移块644,该平移块可与齿条642一起朝远侧和近侧平移。平移块644可联接到轴组件538和/或端部执行器610的任何合适的部件以便提供往复式纵向运动。例如,平移块644可机械地联接到射频外科装置523的组织切割元件555。在一些实施例中,平移块644可以联接到外套管,或端部执行器610或轴538的另一个部件。
图35-图37示出器械安装部分558的另选实施例,显示用于将从动元件564的旋转转化成围绕轴538的轴线的旋转运动的另选示例性机构,以及用于生成一个或多个构件沿轴538的轴线的往复式平移的另选示例性机构。现在参见另选旋转机构,第一螺旋蜗轮652联接到第二螺旋蜗轮654,后者联接到第三螺旋蜗轮656。可出于各种原因提供这样的布置,这些原因包括维持与现有机器人系统1000的兼容以及/或者实际情况是空间可能有限。第一螺旋蜗轮652联接到可旋转主体612。第三螺旋蜗轮656与联接到轴组件538的第四螺旋蜗轮658啮合。轴承760联接到可旋转主体612并提供于从动元件564和第一螺旋蜗轮738之间。另一个轴承760联接到可旋转主体612并提供于从动元件564和第三螺旋蜗轮652之间。第三螺旋蜗轮652啮合到第四螺旋蜗轮658,后者可联接到轴组件538和/或器械522,523的需要其纵向旋转的另一个部件。旋转可基于螺旋蜗轮656,658的旋转方向而沿顺时针方向和逆时针方向进行。因此,第三螺旋蜗轮656绕第一轴线的旋转被转换为第四螺旋蜗轮658绕第二轴线的旋转,该第二轴线与第一轴线正交。如图36和图37所示,例如,第四螺旋蜗轮658联接到轴538,并且第四螺旋蜗轮658的顺时针旋转导致轴组件538沿634CW所指示的方向顺时针旋转。第四螺旋蜗轮658的逆时针旋转导致轴组件538沿634CCW所指示的方向逆时针旋转。可以在可旋转主体和相应齿轮之间提供另外的轴承。可以提供任何合适的轴承以支撑和稳定安装,并且减小例如轴和齿轮的旋转摩擦。
现在参见用于生成一个或多个构件沿轴538的轴线的往复式平移的另选示例性机构,器械安装部分558包括齿条与小齿轮传动机构以提供沿轴538的轴线的往复式平移(例如,射频外科装置523的组织切割元件555的平移)。在一个示例性实施例中,第三小齿轮传动装置660联接到可旋转主体612,使得相应从动元件564的旋转导致第三小齿轮传动装置660沿第一方向旋转。第三小齿轮传动装置660啮合到沿线性方向运动的齿条传动装置662。齿条传动装置662联接到平移块664。平移块664可联接到装置522,523的部件,诸如,射频外科装置的组织切割元件555和/或外套管或期望其纵向平移的其他部件。
图38-图42示出器械安装部分558的另选实施例,显示用于将从动元件564的旋转转化成围绕轴538的轴线的旋转运动的另一个另选示例性机构。在图38-图42中,轴538经由联接器676和轴衬678联接到安装部分558的其余部分。联接到可旋转主体612的第一齿轮666、包括第一开口和第二开口672的固定柱668、联接到轴组件的第一可旋转销和第二可旋转销674、以及缆线670(或绳索)。缆线缠绕在可旋转主体612周围。缆线670的一个端部定位成穿过固定柱668的顶部开口672并固定地联接到顶部可旋转销674。缆线670的另一个端部定位成穿过固定柱668的底部开口672并固定地联接到底部旋转销674。出于各种原因提供此类布置,这些原因包括维持与现有机器人系统1000的兼容以及/或者实际情况是空间可能有限。因此,可旋转主体612的旋转基于可旋转主体612的旋转方向导致围绕轴组件538沿顺时针和逆时针方向旋转(例如,轴538自身的旋转)。因此,可旋转主体612绕第一轴线的旋转被转换为轴组件538绕第二轴线的旋转,该第二轴线与第一轴线正交。如图38-图39所示,例如,可旋转主体612的顺时针旋转导致轴组件538沿634CW所指示的方向顺时针旋转。可旋转主体612的逆时针旋转导致轴组件538沿634CCW所指示的方向逆时针旋转。可以在可旋转主体和相应齿轮之间提供另外的轴承。可以提供任何合适的轴承以支撑和稳定安装,并且减小例如轴和齿轮的旋转摩擦。
图43-图46A示出器械安装部分558的另选实施例,显示用于使构件沿轴538的轴线发生微分平移(例如,用于进行关节运动)的另选示例性机构。例如,如图43-图46A所示,器械安装部分558包括双凸轮机构680以提供轴关节运动功能。在一个示例性实施例中,双凸轮机构680包括第一凸轮部分680A和第二凸轮部分680B。第一从动件悬臂682和第二从动件悬臂684可枢转地联接到相应的枢转卷轴686。当联接到双凸轮机构680的可旋转主体612旋转时,第一凸轮部分680A作用于第一从动件悬臂682,而第二凸轮部分680B作用于第二从动件悬臂684。当凸轮机构680旋转时,从动件悬臂682,684绕枢转卷轴686枢转。第一从动件悬臂682可附接到待发生微分平移的第一构件(例如,第一关节运动带622)。第二从动件悬臂684附接到待发生微分平移的第二构件(例如,第二关节运动带624)。当顶部凸轮部分680A作用于第一从动件悬臂682时,第一构件和第二构件发生微分平移。在第一构件和第二构件为相应的关节运动带622和624的示例性实施例中,轴组件538沿向左方向620L进行关节运动。当底部凸轮部分680B作用于第二从动件悬臂684时,轴组件538沿向右方向620R进行关节运动。在一些示例性实施例中,两个单独的轴衬688,690安装在相应的第一从动件悬臂682和第二从动件悬臂684之下,以允许轴在不影响第一从动件悬臂682和第二从动件悬臂684的关节运动位置的情况下旋转。对于关节运动动作,这些轴衬与第一从动件悬臂682和第二从动件悬臂684一起进行往复运动,而不影响钳口902的旋转位置。图46A示出轴衬688,690和双凸轮组件680,该双凸轮组件包括第一凸轮部分680B和第二凸轮部分680B,并且第一从动件悬臂682和第二从动件悬臂684被移除以提供更详细且更清楚的视图。
在各种实施例中,器械安装部分558可另外包括内部能量源,用于驱动电子器件并向外科工具提供所需的超声和/或射频频率信号。图46B-图46C示出包括内部功率源和能量源的器械安装部分558'的一个实施例。例如,利用器械安装部分558'安装的外科器械(例如,器械522,523)不需要用线材连接到外部发生器或其他功率源。相反,本文所述的各种发生器20,320的功能可在安装部分558上实施。
如图46B-图46C所示,器械安装部分558'可包括远侧部分702。远侧部分702可包括用于将驱动元件612的旋转耦合到例如如上文所述的各种外科器械522,523的端部执行器的各种机构。在远侧部分702的近侧,器械安装部分558'包括内部直流(DC)能量源以及内部驱动和控制电路704。在该例示的实施例中,能量源包括第一电池706和第二电池708。在其他方面,器械安装部分558'与上文所述的器械安装部分558的各种实施例类似。
在一个实施例中,可对电外科端部执行器进行控制以在操作期间确保目标组织的正确密封。图47示出能够实施用于控制电外科端部执行器722的方法的电外科器械700的一个示例性实施例。在一个实施例中,电外科端部执行器722包括马达驱动的可滑动刀724、用于夹持其间的目标组织707的第一钳口构件705a和第二钳口构件705b。第一钳口构件705a和第二钳口构件705b分别包括第一电极709a和第二电极709b,用于将治疗和/或亚治疗能量传导至目标组织707。在一个实施例中,射频能量的治疗电平可足以密封目标组织707。应当理解,术语“目标组织”适用于在第一钳口构件705a和第二钳口构件705b之间夹持的那部分组织或血管。刀724可由马达714驱动。马达714连接到马达控制逻辑部件712,该马达控制逻辑部件可改变马达714的速度,从而改变刀724的往复式运动。在一个实施例中,马达714可以是伺服马达。在一个实施例中,一旦目标组织707被密封,刀724就会被马达714推进以切割密封的目标组织707。
电外科器械700可与图19-图46所示的机器人外科系统整合。电外科器械700能够以图19-46所示构型中的任一种操作。在一个实施例中,马达控制逻辑部件712和控制逻辑部件726可与电外科器械700整合并且位于器械安装部分内,诸如器械安装部分758(在图47中以虚线显示)。在另一个实施例中,控制逻辑部件726和马达控制逻辑部件712可与机器人外科系统整合,例如,机器人外科系统500(在图47中以虚线显示)。在又一个实施例中,可将控制逻辑部件726和马达控制逻辑部件712结合到机器人外科控制系统的一个或多个控制器中。
在一个实施例中,控制逻辑部件726联接到马达控制逻辑部件712和电外科端部执行器722。在一个实施例中,控制逻辑部件726能够修改施加到电外科端部执行器722的一个或多个信号。例如,控制逻辑部件726可将控制信号提供给马达控制逻辑部件712以调节马达714的速度。作为另一个示例,控制逻辑部件726可联接到发生器以控制由发生器生成且被施加到电外科端部执行器722的超声信号或射频信号。控制逻辑部件726可在任何合适的数字逻辑电路中实施,诸如(例如),处理器、数字信号处理器、由现场可编程门阵列(FPGA)实施的状态机、或任何其他合适的逻辑电路。控制逻辑部件726可在硬件、软件或它们的任何组合中实施。
在一个实施例中,第一电极709a和第二电极709b接收电外科信号728,诸如射频信号。射频信号可以是治疗或亚治疗射频信号。电外科信号728可由发生器生成,例如,在图11中示出并结合该图描述的发生器320。在该例示实施例中,电外科信号728可由控制逻辑部件726控制。在一个实施例中,控制逻辑部件726通过控制电外科发生器的功能来启用电外科信号728的递送。在另一个实施例中,控制逻辑部件726可通过控制信号和一个或多个控制块来启用电外科信号728的递送。
在一个实施例中,第一反馈信号710通过使能量传导通过目标组织707而生成并且被传输至控制逻辑部件726。在一个实施例中,由目标组织707为了操作第一反馈信号710而传导的能量可以是治疗的、亚治疗的或它们的组合。在一个实施例中,反馈信号710可以是对目标组织707的阻抗的测量。当目标组织707被切割和密封时,目标组织707的阻抗成比例增大。通过测量阻抗的增大,控制逻辑部件726可确定电外科端部执行器722是否正确地密封和切割目标组织707并且响应于此而施加任何合适的控制信号。控制逻辑部件726可调整刀724的往复式运动速度、电外科信号728的能级、或它们的任何组合,以便确保目标组织707被适当地密封。
在一个实施例中,马达714可包括伺服马达。伺服马达是形成伺服机构的一部分的马达。在一个实施例中,编码器位于伺服马达的轴上,以将反馈信号提供给马达控制逻辑部件712。编码器可以是与伺服马达一起使用的任何合适的编码器,诸如(例如)可提供用于指示旋转位置的信号的旋转编码器。在一个实施例中,伺服马达的轴的旋转可对应于刀724的运动。例如,旋转编码器可设置在伺服马达的轴上。伺服马达的每个旋转度可对应于刀724的具体远侧运动距离。马达控制逻辑部件712可从编码器接收信号,并可基于轴的旋转和刀724的远侧运动之间的已知比率而将该信号转换成刀724的位置。
在另一个实施例中,马达714可包括步进马达。步进马达为无刷直流马达,其将马达的整个旋转分成多个相等的步长。马达的位置可由脉冲直流信号控制,该信号使马达每个脉冲前进一定步长数。在一个实施例中,步进马达的单个步长可对应于刀724的已知远侧运动距离。刀724的位置可通过将脉冲控制信号施加到步进马达来精确控制。在一个实施例中,马达控制逻辑部件712可基于来自控制逻辑部件726的输入、从端部执行器接收的一个或多个反馈信号710,710’或它们的任何组合,为步进马达生成脉冲直流控制信号。
在一个实施例中,控制逻辑部件726可通过改变马达714的速度来保持阻抗的增加速率。控制逻辑部件726可将控制信号提供至马达控制逻辑部件712。马达控制逻辑部件712可改变提供至马达714的输出信号,以增大或减小刀724的纵向速度,从而确保目标组织707的正确切割和密封。马达控制逻辑部件712可以是任何合适的马达控制器,诸如,速度可调驱动器或智能马达控制器。速度可调驱动器是可改变提供给马达的输出电压或电流从而导致马达以与电压成比例的更快或更慢的速度运行的控制电路。智能马达控制器是可控制提供至马达的电压、电流或其他输出以增大或减小纵向速度的逻辑电路。马达控制逻辑部件712可以在任何合适的数字逻辑电路中实施,诸如(例如),处理器、数字信号处理器、由现场可编程门阵列(FPGA)实施的状态机、或任何其他合适的逻辑电路。马达控制逻辑部件712可在硬件、软件或它们的任何组合中实施。
控制逻辑部件726和马达控制逻辑部件712可包括用于转换或生成控制信号的一个或多个电路部件。在一个实施例中,马达控制逻辑部件712可包括数模转换器(DAC),用于将来自控制逻辑部件726的数字控制信号转换成用于马达714的模拟输入信号。在其他实施例中,控制逻辑部件726或马达控制逻辑部件712可包括用于生成脉冲宽度调制信号以控制马达714的一个或多个部件,包括但不限于晶体振荡器、一个或多个锁存器、或用于生成合适的控制信号的任何其他数字或模拟部件。
在一个实施例中,控制逻辑部件726可将至少一个电外科信号728施加到电外科器械700。在各种实施例中,电外科信号728可包括用于马达控制逻辑部件712的驱动信号716、施加到在相应的第一钳口构件705a和第二钳口构件705b中的第一电极709a和第二电极709b以用于目标组织707的电外科处理的射频信号、或用于赋予刀724超声运动的超声驱动信号。控制逻辑部件726能够改变至少一个电外科信号708中的一个或多个以保持目标组织707的阻抗的预先确定的变化速率。
在一个实施例中,目标组织707的阻抗可在组织治疗过程期间增加,该过程可包括例如独立地或同时地密封和切割目标组织707的操作。当刀724沿纵向轴线平移时,组织阻抗通常可响应于目标组织707的凝结、组织接合和/或切割而增加。在一些实施例中,组织阻抗可显示指示成功凝结(密封)的急剧的阻抗增加。阻抗的增加可能是由于组织中的生理变化、正温度系数(PTC)材料达到触发阈值等,并可发生在组织处理过程期间的任意时间点。阻抗的变化(逐步的或急剧的)可由控制逻辑部件726监控,该控制逻辑部件可调制一个或多个电外科信号以将阻抗的变化速率保持在预先确定的水平或预先确定的范围内。术语“调制”旨在涵盖任何合适形式的信号调制,例如但不限于,振幅调制、频率调制、相位调制或它们的任何组合。保持阻抗的预先确定的变化速率所需的能量的量、刀724的行进时间、或此两者的组合可能与目标组织707的热质量有关。任何给定的目标组织707的热质量继而可能与位于目标组织707处的组织的类型和量有关。
反馈信号710可用于计算在处理过程期间目标组织707的阻抗的变化速率。在一个实施例中,反馈信号710可指示电外科端部执行器722或目标组织707的一个或多个特性,诸如(例如),在目标组织707上的电压降、通过目标组织707以及相应的第一钳口构件705a和第二钳口构件705b的第一电极709a和第二电极709b的电流、或它们的任何组合。反馈信号710将所述一个或多个特性的测量值提供给控制逻辑部件726,该控制逻辑部件可接着计算在目标组织707的部位处的阻抗。可以在控制逻辑部件726的一个或多个时钟周期内对反馈信号710进行比较以生成阻抗的变化速率。阻抗的变化速率可由控制逻辑部件726在目标组织707的处理期间监控,并且一个或多个电外科信号708可由控制逻辑部件726调制以将阻抗的变化速率保持在预先确定的速率或预先确定的范围内。该预先确定的速率或预先确定的范围可基于施加到目标组织707的处理来确定。例如,第一预先确定的速率可用于在目标部位处的目标组织707的凝结和切割,第二预先确定的速率可用于在目标部位处的目标组织707的接合和切割,并且第三预先确定的速率可用于包括凝结和接合两者的治疗的组合。
在另一个实施例中,第二反馈信号710’可由马达控制逻辑部件712提供给控制逻辑部件726。马达714能够在刀724运动期间提供用于指示马达714上的负载的信号。如果刀724正在目标部位处横切包括较厚组织类型的目标组织707,那么马达714上的负载可大于在目标部位处包括较薄组织类型的目标组织707。马达控制电路712可监控马达714上的负载并生成用于指示该负载的第二反馈信号710’。第二反馈信号710’可被施加到控制逻辑部件726,该控制逻辑部件可以响应于由马达控制逻辑部件712生成的第二反馈信号710’而改变一个或多个电外科信号708。
在一个实施例中,电外科器械700能够单独地或组合地响应于第一反馈信号710和第二反馈信号710’来控制刀724的运动速度。例如,控制逻辑部件726可调制施加到马达控制逻辑部件712的驱动控制信号716以调整马达714的速度。驱动控制信号716可以任何合适的方式被调制。例如,可调制驱动控制信号716的电压和/或电流。在各种实施例中,调制可基于振幅、频率、相位或它们的任何组合、基于电压和电流测量值。在各种实施例中,驱动控制信号716可以是脉冲信号。在此类实施例中,控制逻辑部件726可通过改变驱动信号的脉冲宽度、占空比等来调制驱动控制信号716。通过调制驱动控制信号716,控制逻辑部件726可通过增大或减小刀724的速度以允许能量向目标组织707的更长或更短施加而确保目标组织707的正确处理。
在一个实施例中,电外科器械700能够响应于第一反馈信号710、第二反馈信号710’或它们的组合来控制递送至电外科端部执行器722的超声能量或射频能量。在一个实施例中,超声能量或射频能量可被递送至电外科端部执行器722。在另一个实施例中,射频能量可被递送至位于相应的第一钳口构件705a和第二钳口构件705b上的第一电极709a和第二电极709b。在另一个实施例中,刀724可作为超声刀来实施,在这种情况下,超声能量可被施加到超声刀以用于切割目标组织707。控制逻辑部件726可电耦合至发生器(未示出)以生成超声或射频能量。控制逻辑部件726可调制施加到发生器的发生器控制信号以调整发生器的输出信号。通过调整发生器的输出信号,控制逻辑部件726可增加或减少递送至目标组织707的能量。如上文所讨论,随着目标组织707的凝结、密封或接合增加,目标组织707的阻抗也增加。通过调制递送至目标组织707的能量,控制逻辑部件726可减少充分凝结、密封或接合目标组织所需的时间量,从而增加组织阻抗的变化速率。
图48示出端部执行器722的一个实施例。端部执行器722可包括第一钳口构件705a和第二钳口构件705b、第一电极709a和第二电极709b、马达驱动的可滑动刀724、以及致动器718。在一个实施例中,致动器718可联接到刀724以控制刀724沿纵向轴线(显示为箭头“A”)的运动。在另一个实施例中,致动器718能够控制第一钳口构件705a和第二钳口构件705b的打开和闭合运动。如图47所示,电外科信号728可被施加到端部执行器722以通过电外科方式处理目标组织707。在图48所示的实施例中,射频信号被施加到第一电极709a和第二电极709b以形成目标组织707的电外科接合。结合向第一电极709a和第二电极709b施加射频能量以密封目标组织707或在此之后,刀724可以在远侧方向上沿纵向轴线可滑动地平移以切割目标组织707。如上所述,控制逻辑部件726可控制射频能量的能级、刀724的运动速度或这两者,以在处理和切割过程期间确保目标组织的正确治疗或加热(cooking)。
图49是由控制逻辑部件726施加到端部执行器722的电外科能量信号的图形表示。现在参照图47-图49,描述用于基于反馈信号控制端部执行器的方法的一个实施例。根据图47-图48所示实施例并且借助于曲线图800,组织707处理部位位于端部执行器722的第一钳口构件705a和第二钳口构件705b之间。更具体地讲,组织707位于相应的第一钳口构件705a和第二钳口构件705b的第一电极709a和第二电极709b之间。驱动控制信号716和电外科能量信号808由控制逻辑部件726递送至端部执行器722。阻抗反馈信号810被施加到控制逻辑部件726。驱动控制信号816被施加以使刀724在远侧方向上沿端部执行器的纵向轴线前进。刀724具有可通过调制驱动控制信号816来调整的刀速度。组织707阻抗反馈信号810在端部执行器722处生成并且由控制逻辑部件726监控。在时间“A”,诸如足以引起组织焊接的射频波形的电外科能量信号808通过端部执行器722的第一电极709a和第二电极709b被施加到目标组织707。从时间“A”至时间“B”,在测量阻抗反馈信号810的同时,刀724的速度和电外科能量信号808保持恒定。在从时间“A”至时间“B”的时间段内,目标组织707的阻抗的变化速率保持在预先确定的范围内。
在时间“B”,刀速度816响应于由组织阻抗反馈信号810的变化指示的目标组织707的阻抗的减少而增加。从时间“B”至时间“C”,刀速度816由控制逻辑部件726保持恒定速率。在从“B”至“C”的时间段内,控制逻辑部件726响应于由组织707阻抗反馈信号810指示的组织707阻抗的变化速率来调制电外科能量信号808。如在该例示实施例中所示,在从“B”至“C”的时间段内调制电外科能量信号808以增加或减少所施加的电外科能量信号808的脉冲宽度或脉冲时间,以便将组织707阻抗的变化速率保持在预先确定的速率。
在该例示实施例中,刀724在时间“C”达到最远侧位移,从而导致行程结束算法激活并使刀724的方向反向。因此,刀724返回至端部执行器722内的最近侧或起始位置。在刀724的近侧移动期间,一个或多个终止脉冲(例如,四个终止脉冲)可由控制逻辑部件726施加到端部执行器722。终止脉冲可以是与组织707阻抗反馈信号810无关的预先确定的脉冲图案。虽然已参照图49描述了用于响应于反馈信号810而调制一个或多个信号716,808的方法,但本领域的技术人员将认识到任何合适的波形、调制或信号都可以使用并且在所附权利要求书的范围内。
图50示出了描绘用于控制电外科端部执行器722的方法的一个实施例的逻辑流程图900。在一个实施例中,至少一个电外科信号被施加902到电外科端部执行器,诸如例如,电外科端部执行器722。电外科端部执行器722基于电外科端部执行器722的一个或多个状况生成反馈信号。反馈信号由控制逻辑部件接收904。在一个实施例中,控制逻辑部件可与电外科端部执行器722整体地形成。在另一个实施例中,控制逻辑部件可位于外科机器人内或外科机器人的控制器内。
在一个实施例中,控制逻辑部件使用反馈信号来确定906处理部位的阻抗的变化速率。控制逻辑部件可以控制908所述一个或多个电外科信号以将阻抗的变化速率保持在预先确定的速率或预先确定的范围内。在一个实施例中,该预先确定的范围是等于或大于阈值的阻抗的变化速率。控制逻辑部件可以在整个处理期间监控反馈信号并修改至少一个电外科信号以在该处理期间保持阻抗的预先确定的变化速率。
图51示出图47-图48所示端部执行器722的控制逻辑部件1006的一个实施例。现在参照图47-图48和图51,控制逻辑部件1006创建用于递送至端部执行器722的第一电极709和第二电极709b的射频信号1008。控制逻辑部件1006是灵活的,并且可以在所需的频率和功率电平设置下创建射频信号1008,以产生治疗射频信号、亚治疗射频信号或它们的组合。在各种实施例中,控制逻辑部件1006可控制一个或多个发生器,诸如例如,图1和图11所示的发生器20,320,以产生射频信号1008。在各种实施例中,发生器可包括若干单独的功能性元件,诸如模块和/或块。尽管可通过举例说明某些模块和/或块,但可理解,可使用更多或更少的模块和/或块,并仍在实施例的范围内。此外,尽管各种实施例可按照模块和/或块的形式描述以有利于说明,然而这些模块和/或块可通过一个或多个硬件部件和/或软件部件和/或硬件部件和软件部件的组合加以实施,所述硬件部件为例如处理器、数字信号处理器(DSP)、可编程逻辑装置(PLD)、专用集成电路(ASIC)、电路、寄存器,所述软件部件为例如程序、子程序、逻辑。
在一个实施例中,控制逻辑部件1006可包括用固件、软件、硬件或它们的任意组合实现的一个或多个嵌入式应用程序。控制逻辑部件1006可包括各种可执行模块,诸如软件、程序、数据、驱动器、应用程序接合部(API)等。所述固件可存储在非易失性存储器(NVM),诸如位屏蔽只读存储器(ROM)或闪速存储器中。在各种具体实施中,将固件存储在ROM中可保护闪速存储器。NVM可包括其他类型的存储器,包括例如可编程ROM(PROM)、可擦除可编程ROM(EEPROM)、或电池支持的随机存取存储器(RAM),例如动态RAM(DRAM)、双数据RAM(DDRAM)和/或同步DRAM(SDRAM)。
在一个实施例中,控制逻辑部件1006包括作为处理器1100实施的硬件部件,用于执行程序指令,以监控电外科器械700的各种可测量特性并生成输出信号以将治疗射频信号、亚治疗射频信号或组合射频信号递送至第一电极709a和第二电极709b。本领域的技术人员将理解,控制逻辑部件1006可包括更多或更少的部件,并且为了简明和清楚起见,本文仅描述了简化版本的控制逻辑部件1006。在各种实施例中,如此前所论述,硬件部件可作为DSP、PLD、ASIC、电路和/或寄存器实施。在一个实施例中,处理器1100能够存储和执行计算机软件程序指令,以生成用于驱动超声外科器械700的各种部件(例如,第一电极709a和第二电极709b、马达控制逻辑部件712、马达714或刀724)的输出信号。
在一个实施例中,在一个或多个软件程序例程的控制下,处理器1100执行根据所述实施例的方法以产生阶跃函数,所述阶跃函数由包括电流(I)、电压(V)和/或针对各种时间间隔或时间段(T)的频率(f)的射频信号的阶梯式波形形成。射频信号的阶梯式波形可通过在多个时间间隔内形成常值函数的分段线性组合而生成,所述常值函数通过射频发生器模块驱动信号例如输出电流(I)、电压(V)和/或频率(f)的阶跃而创建。时间间隔或时间段(T)可为预先确定的(例如固定的和/或通过使用者编程的)或可为可变的。可变时间间隔可通过以下方法限定:将射频信号设定为第一值,并将射频信号保持为该值,直至在监控的特性中检测到变化。所监控特性的实例可包括例如组织阻抗、组织发热、组织横切、组织凝结等等。由控制逻辑部件1006生成的射频信号包括但不限于治疗射频信号、亚治疗射频信号、以及组合射频信号。
在一个实施例中,可执行模块包括存储在存储器中的一个或多个阶跃函数算法1102,当执行这些算法时,致使处理器1100生成由射频信号的阶梯式波形形成的阶跃函数,射频信号包括在各种时间间隔或时间段(T)内的电流(I)、电压(V)和/或频率(f)。射频信号的阶梯式波形可通过在两个或更多个时间间隔内形成常值函数的分段线性组合而生成,所述常值函数通过发生器的输出驱动电流(I)、电压(V)和/或频率(f)的阶跃而创建。根据一个或多个阶跃输出算法1102,可在预先确定的固定时间间隔或时间段(T)内或可变时间间隔或时间段内生成射频信号。在处理器1100的控制下,控制逻辑部件1006以特定分辨率向上或向下阶跃(例如,递增或递减)电流(I)、电压(V)和/或频率(f)持续预先确定的时间段(T)或直到检测到预先确定的条件,所述预先确定的条件例如为所监控特性(例如,组织阻抗)的改变。在经编程的递增或递减中,所述阶跃可以变化。如果需要其他阶跃,则控制逻辑部件1006可适应性地基于测量到的系统特性增加或减少阶跃。
在各种实施例中,输出指示器1112可为外科医生提供视觉、听觉和/或触觉反馈,以指示外科手术的状态,诸如例如,基于测量到的电外科器械700的特性(如组织阻抗)或随后描述的其他测量来确定组织密封和切割何时完成。以举例而非限制的方式,视觉反馈包括任何类型的视觉指示装置,其包括白炽灯或发光二极管(LED)、图形用户界面、显示器、模拟指示器、数字指示器、柱状图显示器、数字字母显示器。以举例而非限制的方式,听觉反馈包括任何类型的蜂鸣器、计算机生成的音调、计算机化语音、通过声音/语音平台与计算机相互作用的声音用户界面(VUI)。以举例而非限制的方式,触觉反馈包括通过机器人控制器提供的任何类型的振动反馈。
在一个实施例中,处理器1100可被配置或编程为生成数字电流信号1114和数字频率信号1118。这些信号1114,1118被施加到直接数字合成器(DDS)电路1120,以调整提供至第一电极709a和第二电极709b的电流输出信号1116的振幅和频率(f)。DDS电路1120的输出被施加到放大器1122,所述放大器的输出被施加到变压器1124。变压器1124的输出是施加到第一电极709a和第二电极709b的信号1116。
在一个实施例中,控制逻辑部件1006包括一个或多个测量模块或部件,其能够监测电外科器械700的可测量特性。在图51所示的实施例中,可采用处理器1100来监控和计算系统特性。如图所示,处理器1100通过监控提供至组织部位707的电流和施加到组织部位707的电压来测量组织部位707的阻抗Z。在一个实施例中,采用电流感测电路1126来感测通过组织部位707的电流,并且采用电压感测电路1128来感测施加到该组织部位的输出电压。这些信号可经由模拟多路复用器1130电路或开关电路布置施加到模数转换器1132(ADC)。模拟多路复用器1130将合适的模拟信号沿特定路线发送至ADC 1132,以用于转换。在其他实施例中,针对每个测量的特性,可采用多个ADC 1132来替代多路复用器1130电路。处理器1100接收ADC 1132的数字输出1133,并基于电流和电压的测量值计算组织阻抗Z。处理器1100调节输出驱动信号1116,使得所述驱动信号可生成期望的功率与负载的曲线关系。根据经编程的阶跃函数算法1102,处理器1100可响应于组织阻抗Z以任何合适的增量或减量使射频信号1116(例如,电流或频率)阶跃。
控制逻辑部件1006的操作可被编程以提供各种输出驱动信号,以例如基于位于第一钳口构件705a和第二钳口构件705b之间的组织来测量与组织部位707以及处于治疗、亚治疗或组合状态的第一电极709a和第二电极709b相关联的电流、电压、功率、阻抗和频率的电气性质。当组织部位为较薄组织类型时,输出可以例如以第一序列被阶跃。当组织部位为较厚组织类型时,输出可以以第二序列被阶跃,该第二序列将较高的电压、电流或时间间隔递送至组织部位707。
本领域技术人员将理解,电流阶跃函数设定点(如I1、I2、I3)和针对上述阶跃函数设定点中的每一个的持续时间内的时间间隔或时间段(如T1、T2)不限于本文所述的值并可调节为给定外科手术集所需的任何合适值。如根据给定设计特性或性能约束集的需要,可选择更多或更少的电流设定点和持续时间的周期。如此前所述,周期能够通过编程进行预先确定或可根据可测量的系统特性进行改变。然而,实施例并不限于此背景中。
外科系统700的各种实施例的操作性细节已经描述,但可根据采用外科器械密封和切割血管的过程来进一步地描述上述外科系统700的操作,所述外科器械包括参照图51描述的控制逻辑部件1006和组织阻抗测量能力。虽然结合操作细节描述了具体过程,但可以理解所述过程仅提供了如何通过外科系统700实施本文所述的一般功能的示例。此外,除非另外指明,否则给定的过程不一定按照本文呈现的顺序执行。如此前所论述,可采用控制逻辑部件1006对提供至第一电极709a和第二电极709b的阶跃输出(例如,电流、电压、频率)进行编程。
因此,一种用于密封和切割血管的技术包括将目标组织夹持在第一钳口构件705a和第二钳口构件705b之间。应当理解,第一钳口构件705a和第二钳口构件705b可包括用于抓持和密封组织的一种或多种类型的钳口,诸如例如桨式钳口构件、锯齿状钳口构件,并且可包括一个或多个枢转钳口构件,用于将压力施加到位于第一钳口构件705a和第二钳口构件705b之间的组织部位707。在一个实施例中,第一钳口构件705a和第二钳口构件705b可包括钝性分离部分。
在一个实施例中,第一射频信号可被施加到第一电极709a和第二电极709b以密封位于第一钳口构件705a和第二钳口构件705b之间的组织部位707。以举例而非限制的方式,并且根据控制逻辑部件726的一个具体实施,对控制逻辑部件1006进行编程以输出第一射频能量信号f1持续第一时间段T1,以引起组织部位707的治疗性处理。在一个实施例中,第一时间段T1可通过测量组织部位707的一个或多个特性(诸如,组织阻抗)来确定。如上文相对于图51所讨论,控制逻辑部件1006可监控提供至组织部位707的电流和施加到组织部位707的电压以计算组织部位707的阻抗。
在一个实施例中,第二射频信号可被施加到第一电极709a和第二电极709b。第二射频信号可以是亚治疗射频信号。在第二时间段T2内将第二射频信号施加到组织部位707。由第二射频信号施加到组织部位707的电流和电压可被监控并用于计算组织部位707的阻抗。
在一个实施例中,组织/血管密封和切割过程可通过感测组织部位707的阻抗Z特性来自动进行,以检测组织/血管的密封何时发生。阻抗Z可与组织部位707的密封和血管的横切/密封相关,以便为处理器1100提供触发器,从而为马达控制逻辑部件712提供驱动信号以使得刀724横切组织。如此前参照图51所讨论,在组织707以及第一电极709a和第二电极709b处于一定负载下时,组织707的阻抗Z可由处理器1100基于通过组织707的电流和施加到组织707的电压进行计算。由于组织707的阻抗Z与组织707的密封状态成比例,随着组织707的密封状态增强,组织707的阻抗Z增加。因此,可对组织707的阻抗Z进行监控以检测组织707的密封并确定何时可以安全使用刀724横切组织。
在一个实施例中,控制逻辑部件1006可将控制信号提供给马达控制逻辑部件712。控制信号可基于组织707的阻抗Z而生成。例如,在一个实施例中,一定的组织阻抗Z可指示已通过将治疗射频能量施加到组织部位707而将组织成功密封。控制逻辑部件1006可将控制信号发送至马达控制逻辑部件712,指示组织阻抗Z已达到预先确定的水平。接着,马达控制逻辑部件712可推进刀724以横切位于第一钳口构件705a和第二钳口构件705b之间的组织707。
在一个实施例中,电外科器械700可响应于组织阻抗Z而根据所编程的阶跃函数算法进行操作。在一个实施例中,频率阶跃函数输出可基于组织阻抗Z与一个或多个预先确定的阈值的比较而开始,所述一个或多个预先确定的阈值与组织707密封状态相关。当组织阻抗Z转变为高于或低于(如越过)阈值时,处理器1100将数字频率信号1118施加到DDS电路1120,以响应于组织阻抗Z根据阶跃函数算法1102以预先确定的阶跃改变驱动信号1116的频率。
现在参照图47和图52,在一个实施例中,控制逻辑部件1006包括信号发生器模块。在一个实施例中,信号发生器模块可作为组织阻抗模块1202实施。虽然在本发明所公开的实施例中,控制逻辑部件1206被显示为与电外科器械分离,但在一个实施例中,控制逻辑部件1206可与电外科器械整体地形成,如图47中以虚线所示。在一个实施例中,信号发生器模块能够监控组织707的电阻抗Zt以基于组织T的阻抗Zt来控制时间和功率电平等特性。在一个实施例中,如此前所讨论,通过将亚治疗射频(RF)信号施加到组织T并借助于第一电极709a和第二电极709b测量通过组织T的电流,可以确定组织阻抗Zt。在图52所示的示意图中,端部执行器722包括设置在相应的第一钳口构件705a和第二钳口构件705b上的第一电极709a和第二电极709b。组织阻抗模块1202通过合适的传输介质(诸如缆线)联接到第一电极709a和第二电极709b。缆线包括多个电导体,用于将电压施加到组织707并且提供用于使通过组织707的电流返回至阻抗模块1202的返回路径。在各种实施例中,组织阻抗模块1202可与器械安装部分、机器人外科系统、机器人外科系统的控制系统整体地形成,或者可以作为联接到机器人外科系统的单独电路而提供。
仍然参照图52,如图所示,信号发生器模块被配置为组织阻抗模块1202。在一个实施例中,整合的发生器模块可生成超声电驱动信号以驱动联接到刀724的超声换能器。在一个实施例中,组织阻抗模块1202能够测量在第一钳口构件705a和第二钳口构件705b之间夹持的组织707的阻抗Zt。组织阻抗模块1202包括射频振荡器1206、电压感测电路128和电流感测电路1210。电压感测电路1208和电流感测电路1210响应于施加到第一电极709a和第二电极709b的射频电压vrf以及通过第一电极709a、组织和第二电极709b的射频电流irf。所感测到的电压vrf和电流irf经由模拟多路复用器1130通过ADC 1132转换成数字形式。处理器1100接收ADC 1132的数字化输出1133,并通过计算由电压感测电路1208和电流感测电路1210测量的射频电压vrf与电流irf的比率来确定组织阻抗Zt。在一个实施例中,组织707的密封可通过感测组织阻抗Zt来确定。因此,组织阻抗Zt的检测可与自动化过程集成以用于在由刀724横切组织之前密封组织。
图53是控制逻辑部件1006的示意图,该控制逻辑部件被配置为联接到第一电极709a和第二电极709b的组织阻抗模块1202,其中组织707部位位于两电极之间。现在参照图47和图51-图53,控制逻辑部件1006包括配置为组织阻抗模块1202的信号发生器模块,该组织阻抗模块被配置用于在组织密封和切割过程期间监控位于第一电极709a和第二电极709b之间的组织T的阻抗Zt。组织阻抗模块1202可借助于缆线联接到电外科器械700。缆线包括连接到第一电极709a的第一“激励”导体和连接到第二电极709b(例如,负[-]电极)的第二“返回”导体。在一个实施例中,射频电压vrf被施加到第一电极709a,以使射频电流irf流过组织707。第二电极709b提供用于使电流irf返回至组织阻抗模块1202的返回路径。第二电极709b的远侧端部连接到传导护套,使得电流irf可从刀第一电极709a流过定位在第一钳口构件705a和第二钳口构件705b中间的组织707以及第二电极709b。阻抗模块1202通过第一电极709a和第二电极709b连接在电路中。在一个实施例中,施加到组织707以用于测量组织阻抗Zt的射频能量可以是对于组织707的处理没有显著贡献或完全无贡献的低电平亚治疗信号。在另一个实施例中,施加到组织707的射频能量是用于处理组织707的治疗信号。
非限制性实例
在一个实施例中,提供了一种机器人外科系统。该机器人外科系统包括外科工具,该外科工具包括:端部执行器,其包括第一钳口构件、第二钳口构件和刀,其中第一钳口构件和第二钳口构件包括相应的第一电极和第二电极,该端部执行器能够接收至少一个信号;致动器,其用于使刀沿纵向轴线往复式运动;和控制电路,其用于控制致动器,其中控制电路:将至少一个信号提供给端部执行器;接收用于指示与端部执行器接触的组织的组织阻抗的反馈信号;基于反馈信号来确定组织阻抗的变化速率;控制至少一个信号以保持组织阻抗的预先确定的变化速率。
在一个实施例中,提供了一种外科工具。该外科工具包括:端部执行器,其包括第一钳口构件、第二钳口构件和刀,其中第一钳口构件和第二钳口构件包括相应的第一电极和第二电极,该端部执行器能够接收至少一个信号;致动器,其用于使刀沿纵向轴线往复式运动;和控制电路,其用于控制致动器,其中控制电路:将至少一个信号提供给端部执行器;接收用于指示与端部执行器接触的组织的组织阻抗的反馈信号;基于反馈信号来确定组织阻抗的变化速率;控制至少一个信号以保持组织阻抗的预先确定的变化速率。
申请人还拥有以下专利申请,这些专利申请各自以其相应全文以引用的方式并入:
2012年6月28日提交并且名称为“Flexible Drive Member”(代理人案卷号END7131USNP/120135)的美国专利申请序列号13/536,271;
2012年6月28日提交并且名称为“Multi-Functional Powered SurgicalDevice with External Dissection Features”(代理人案卷号END7132USNP/120136)的美国专利申请序列号13/536,288;
2012年6月28日提交并且名称为“Rotary Actuatable ClosureArrangement for Surgical End Effector”(代理人案卷号END7134USNP/120138)的美国专利申请序列号13/536,295;
2012年6月28日提交并且名称为“Surgical End Effectors HavingAngled Tissue-Contacting Surfaces”(代理人案卷号END7135USNP/120139)的美国专利申请序列号13/536,326;
2012年6月28日提交并且名称为“Interchangeable End EffectorCoupling Arrangement”(代理人案卷号END7136USNP/120140)的美国专利申请序列号13/536,303;
2012年6月28日提交并且名称为“Surgical End Effector Jaw andElectrode Configurations”(代理人案卷号END7137USNP/120141)的美国专利申请序列号13/536,393;
2012年6月28日提交并且名称为“Multi-Axis Articulating and RotatingSurgical Tools”(代理人案卷号END7138USNP/120142)的美国专利申请序列号13/536,362;以及
2012年6月28日提交并且名称为“Electrode Connections for RotaryDriven Surgical Tools”(代理人案卷号END7149USNP/120153)的美国专利申请序列号13/536,417。
应当理解,根据操纵用来治疗患者的器械的一端的临床医生来在说明书中通篇使用术语“近侧”和“远侧”。术语“近侧”是指器械的最靠近临床医生的部分,术语“远侧”是指离临床医生最远的部分。还应当理解,为简明和清楚起见,本文可以参考所示实施例使用诸如“竖直”、“水平”、“上”或“下”之类的空间术语。然而,外科器械可以在许多取向和位置使用,并且这些术语并非意图是限制的或绝对的。
本文描述了外科器械和机器人外科系统的各种实施例。本领域的技术人员应当理解,本文所述的各种实施例可以与所述的外科器械和机器人外科系统一起使用。提供的说明只是为了举例,本领域的技术人员应当理解,所公开的实施例不只是限于本文所公开的装置,而是可以与任何兼容的外科器械或机器人外科系统一起使用。
本说明书通篇提及的“各种实施例”、“一些实施例”、“一个示例性实施例”或“实施例”意味着结合所述实施例描述的具体特征、结构或特性包括在至少一个示例性实施例中。因此,在整篇说明书中出现的短语“在各种实施例中”、“在一些实施例中”、“在一个示例性实施例中”或“在实施例中”并不一定都指相同的实施例。此外,在没有限制的情况下,结合一个示例性实施例示出或描述的具体特征、结构或特性可全部或部分地与一个或多个其他实施例的特征、结构或特性组合。
虽然已经通过描述若干实施例来例示了本文的各种实施例,并且虽然已经相当详细地描述了例示性实施例,但是申请人的意图不在于将所附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另外的优点和修改形式。例如,普遍认为,内窥镜式手术比腹腔镜式手术更常用。因此,本发明对内窥镜式手术和设备进行了讨论。然而,本文使用的诸如“内窥镜式”的术语不应被理解为将本发明限于仅结合内窥镜式管(例如,套管针)使用的器械。与此相反,据信本发明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放式手术。
应当理解,本文的附图和描述中的至少一些已被简化以示出适于清楚地理解本公开的元件,同时为清晰起见移除了其他元件。然而,本领域的普通技术人员将认识到,这些和其他元件可为所需的。然而,由于此类元件为本领域所熟知并且由于它们不利于较好地理解本公开,因此本文未提供对这些元件的论述。
虽然已经描述了若干实施例,但应当知道,本领域技术人员在掌握了本公开的一些或全部优点之后可能对这些实施例作出各种修改、改变和改型。例如,根据各种实施例,单个部件可替换为多个部件,并且多个部件也可替换为单个部件,以执行给定的一种或多种功能。因此,在不脱离所附权利要求书限定的本公开的范围和实质的情况下,本专利申请旨在涵盖所有此类修改、变型和改型形式。
以引用方式全文或部分地并入本文的任何专利、专利公布或其他公开材料均仅在所并入的材料不与本公开所述的现有定义、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、陈述或其他公开材料相冲突的任何材料或其部分,仅在所并入的材料和现有的公开材料之间不产生冲突的程度下并入本文。
Claims (20)
1.一种控制机器人外科系统中的端部执行器的方法,所述方法包括:
由所述机器人外科系统将至少一个信号施加到外科装置的端部执行器;
由所述机器人外科系统接收反馈信号,所述反馈信号指示与所述端部执行器接触的组织的组织阻抗;
由所述机器人外科系统基于所述反馈信号来确定所述组织阻抗的变化速率;
由所述机器人外科系统基于所述反馈信号来控制所述至少一个信号,以保持组织阻抗的预先确定的变化速率。
2.根据权利要求1所述的方法,包括由所述机器人外科系统将组织阻抗的所述预先确定的变化速率保持为至少等于预先确定的值。
3.根据权利要求1所述的方法,包括利用驱动信号来控制所述端部执行器的刀的远侧运动速率。
4.根据权利要求1所述的方法,包括将超声能量信号递送至所述刀。
5.根据权利要求1所述的方法,包括将射频能量信号递送至所述端部执行器的至少一个电极。
6.根据权利要求1所述的方法,其中组织阻抗的所述变化速率与所述组织的密封状态成比例。
7.一种机器人外科系统,包括:
外科工具,所述外科工具包括:
端部执行器,所述端部执行器包括第一钳口构件、第二钳口构件和刀,所述第一钳口构件和所述第二钳口构件包括相应的第一电极和第二电极,所述端部执行器能够接收至少一个信号;
致动器,所述致动器用于使所述刀沿纵向轴线进行往复运动;和
控制电路,所述控制电路用于控制所述致动器,其中所述控制电路:
将所述至少一个信号提供给所述端部执行器;
接收反馈信号,所述反馈信号指示与所述端部执行器接触的组织的组织阻抗;
基于所述反馈信号来确定所述组织阻抗的变化速率;
控制所述至少一个信号以保持所述组织阻抗的预先确定的变化速率。
8.根据权利要求7所述的机器人外科系统,包括:
马达,所述马达联接到所述致动器;
马达控制逻辑部件,所述马达控制逻辑部件联接到所述马达,所述马达控制逻辑部件用于控制与至少一个电外科信号成比例的所述刀的远侧运动速度。
9.根据权利要求7所述的机器人外科系统,其中所述至少一个信号包括递送至所述第一钳口电极和所述第二钳口电极的射频能量信号。
10.根据权利要求7所述的机器人外科系统,包括将超声能量信号递送至所述刀以赋予所述刀超声运动。
11.根据权利要求7所述的机器人外科系统,所述控制电路包括处理器,其中所述处理器能够运行用于控制所述至少一个信号的一个或多个软件线程。
12.根据权利要求7所述的机器人外科系统,包括:
发生器,所述发生器用于生成所述至少一个信号,所述发生器从所述控制逻辑部件接收控制信号,并且其中所述发生器基于从所述控制逻辑部件接收的所述控制信号来控制所述至少一个信号。
13.根据权利要求7所述的机器人外科系统,其中所述组织阻抗的所述变化速率与所述组织的密封状态成比例。
14.一种外科工具,包括:
端部执行器,所述端部执行器包括第一钳口构件、第二钳口构件和刀,所述第一钳口构件和所述第二钳口构件包括相应的第一电极和第二电极,所述端部执行器能够接收至少一个信号;
致动器,所述致动器用于使所述刀沿纵向轴线进行往复运动;和
控制电路,所述控制电路用于控制所述致动器,其中所述控制电路:
将所述至少一个信号提供给所述端部执行器;
接收反馈信号,所述反馈信号指示与所述端部执行器接触的组织的组织阻抗;
基于所述反馈信号来确定所述组织阻抗的变化速率;
控制所述至少一个信号以保持所述组织阻抗的预先确定的变化速率。
15.根据权利要求14所述的外科器械,包括:
马达,所述马达联接到所述致动器;
马达控制逻辑部件,所述马达控制逻辑部件联接到所述马达,所述马达控制逻辑部件用于控制与至少一个电外科信号成比例的所述刀的远侧运动速度。
16.根据权利要求14所述的外科器械,其中所述至少一个信号包括递送至所述第一钳口电极和所述第二钳口电极的射频能量信号。
17.根据权利要求14所述的外科器械,包括将超声能量信号递送至所述刀以赋予所述刀超声运动。
18.根据权利要求7所述的机器人外科系统,所述控制电路包括处理器,其中所述处理器能够运行用于控制所述至少一个信号的一个或多个软件线程。
19.根据权利要求14所述的外科器械,包括:
发生器,所述发生器用于生成所述至少一个信号,所述发生器从所述控制逻辑部件接收控制信号,并且其中所述发生器基于从所述控制逻辑部件接收的所述控制信号来控制所述至少一个信号。
20.根据权利要求14所述的外科器械,其中所述组织阻抗的所述变化速率与所述组织的密封状态成比例。
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JP2015521900A (ja) | 2015-08-03 |
BR112014032904B1 (pt) | 2022-04-19 |
EP2866700B1 (en) | 2020-04-29 |
US11096752B2 (en) | 2021-08-24 |
BR112014032904A2 (pt) | 2017-06-27 |
CN104582606B (zh) | 2017-05-24 |
JP6312663B2 (ja) | 2018-04-18 |
US20220039891A1 (en) | 2022-02-10 |
US20200222135A1 (en) | 2020-07-16 |
EP2866700A1 (en) | 2015-05-06 |
US20170348064A1 (en) | 2017-12-07 |
US20160192999A1 (en) | 2016-07-07 |
US9226767B2 (en) | 2016-01-05 |
US10524872B2 (en) | 2020-01-07 |
WO2014004116A1 (en) | 2014-01-03 |
US20140005667A1 (en) | 2014-01-02 |
US9713507B2 (en) | 2017-07-25 |
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