CN104918564A - 包括控制环的具有可选择的机动和手动控制的圆形钉合器 - Google Patents

包括控制环的具有可选择的机动和手动控制的圆形钉合器 Download PDF

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CN104918564A
CN104918564A CN201380066186.4A CN201380066186A CN104918564A CN 104918564 A CN104918564 A CN 104918564A CN 201380066186 A CN201380066186 A CN 201380066186A CN 104918564 A CN104918564 A CN 104918564A
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head assembly
assembly
operate
stitching
stitching head
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CN104918564B (zh
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J.S.斯韦泽
C.O.巴克特三世
F.E.舍顿
G.W.约翰逊
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Ethicon Endo Surgery Inc
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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
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/115—Staplers for performing anastomosis in a single operation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/115—Staplers for performing anastomosis in a single operation
    • A61B17/1155—Circular staplers comprising a plurality of staples
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00115—Electrical control of surgical instruments with audible or visual output
    • 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
    • A61B2017/00389—Button or wheel for performing multiple functions, e.g. rotation of shaft and end effector
    • A61B2017/00393—Button or wheel for performing multiple functions, e.g. rotation of shaft and end effector with means for switching between functions
    • 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
    • A61B2017/00398—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00681—Aspects not otherwise provided for
    • A61B2017/00734—Aspects not otherwise provided for battery operated
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0807—Indication means
    • A61B2090/0811—Indication means for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument

Abstract

本发明公开了一种用于钉合组织的设备(210)，该设备包括钉合头部组件(220)、旋转驱动轴(264)、以及模式选择器。所述钉合头部组件包括闭合组件和击发组件。所述闭合组件能够操作以抵靠砧座夹持组织。所述击发组件能够操作以朝向所述砧座将至少一个钉驱动穿过组织。所述模式选择器能够操作以在组织夹持模式和击发模式之间进行选择。所述旋转驱动轴能够操作以响应于选择所述组织夹持模式而促动所述闭合组件。所述旋转驱动轴能够操作以响应于选择所述击发模式而促动所述击发组件。所述模式选择器可使所述旋转驱动轴在第一纵向位置和第二纵向位置之间平移以在所述组织夹持模式和所述击发模式之间进行选择。所述模式选择器可包括滑动环(252)。

Description

包括控制环的具有可选择的机动和手动控制的圆形钉合器
背景技术
在一些背景下，外科医生可能希望将外科器械穿过患者的腔道口而定位，并且使用该器械来调整、定位、附接患者体内的组织和/或以其他方式与患者体内的组织相互作用。例如，在一些外科手术中，可切割并移除胃肠道的部分以清除不需要的组织，或者出于其他原因而切割和移除。一旦移除了期望的组织，则剩余的部分可能需要重新联接在一起。一种用于完成这些吻合手术的此类工具是穿过患者的腔道口插入的圆形钉合器。
圆形外科钉合器的实例描述于：1993年4月27公布的名称为“Surgical Anastomosis Stapling Instrument”的美国专利5,205,459；1993年12月21日公布的名称为“Surgical Anastomosis Stapling Instrument”的美国专利5,271,544；1994年1月4日公布的名称为“Surgical AnastomosisStapling Instrument”的美国专利5,275,322；1994年2月15日公布的名称为“Surgical Anastomosis Stapling Instrument”的美国专利5,285,945；1994年3月8日公布的名称为“Surgical Anastomosis Stapling Instrument”的美国专利5,292,053；1994年8月2日公布的名称为“Surgical Anastomosis StaplingInstrument”的美国专利5,333,773；1994年9月27日公布的名称为“Surgical Anastomosis Stapling Instrument”的美国专利5,350,104；以及1996年7月9日公布的名称为“Surgical Anastomosis Stapling Instrument”的美国专利5,533,661。上文所引用的美国专利中的每个中的公开内容均以引用方式并入本文。一些此类钉合器能够操作以向下夹持在组织层上，切割穿过夹持的组织层，并驱动钉穿过组织层，以在组织层的被切断的端附近将切断的组织层基本上密封在一起，从而接合解剖内腔的两个切断的端。
仅作为示例性的附加的其他外科钉合器在以下美国专利中有所公开：1989年2月21日公布的名称为“Pocket Configuration for Internal OrganStaplers”美国专利4,805,823；1995年5月16日公布的名称为“SurgicalStapler and Staple Cartridge”的美国专利5,415,334；1995年11月14日公布的名称为“Surgical Stapler Instrument”的美国专利5,465,895；1997年1月28日公布的名称为“Surgical Stapler Instrument”的美国专利5,597,107；1997年5月27日公布的名称为“Surgical Instrument”的美国专利5,632,432；1997年10月7日公布的名称为“Surgical Instrument”的美国专利5,673,840；1998年1月6日公布的名称为“Articulation Assembly forSurgical Instruments”的美国专利5,704,534；1998年9月29日公布的名称为“Surgical Clamping Mechanism”的美国专利5,814,055；2005年12月27日公布的名称为“Surgical Stapling Instrument Incorporating an E-Beam FiringMechanism”的美国专利6,978,921；2006年2月21日公布的名称为“Surgical Stapling Instrument Having Separate Distinct Closing and FiringSystems”的美国专利7,000,818；2006年12月5日公布的名称为“SurgicalStapling Instrument having a Firing Lockout for an Unclosed Anvil”的美国专利7,143,923；2007年12月4日公布的名称为“Surgical Stapling InstrumentIncorporating a Multi-Stroke Firing Mechanism with a Flexible Rack”的美国专利7,303,108；2008年5月6日公布的名称为“Surgical Stapling InstrumentIncorporating a Multistroke Firing Mechanism Having a Rotary Transmission”的美国专利7,367,485；2008年6月3日公布的名称为“Surgical StaplingInstrument Having a Single Lockout Mechanism for Prevention of Firing”的美国专利7,380,695；2008年6月3日公布的名称为“Articulating SurgicalStapling Instrument Incorporating a Two-Piece E-Beam Firing Mechanism”的美国专利7,380,696；2008年7月29日公布的名称为“Surgical Stapling andCutting Device”的美国专利7,404,508；2008年10月14日公布的名称为“Surgical Stapling Instrument Having Multistroke Firing with OpeningLockout”的美国专利7,434,715；以及2010年5月25日公布的名称为“Disposable Cartridge with Adhesive for Use with a Stapling Device”的美国专利7,721,930。上文所引用的美国专利中的每个中的公开内容均以引用方式并入本文。虽然上文所涉及的外科钉合器被描述为用于内窥镜式手术，但应理解，此类外科钉合器也可用于开腹手术和/或其它非内窥镜式手术。
虽然已制造并使用各种类型的外科钉合器械，但是据信，在本发明人之前还无人研制出或使用所附权利要求书中所描述的发明。
附图说明
本说明书后附的权利要求书特别指出并明确主张本技术，但据信从下面结合附图对某些实例所作的描述将会更好地理解本技术，附图中类似的参考标号表示相同元件，其中：
图1示出了示例性圆形钉合外科器械的侧正视图；
图2A示出了图1的器械的示例性钉合头部组件的放大纵向剖面图，其示出了处于打开位置的示例性砧座；
图2B示出了图2A的钉合头部组件的放大纵向剖面图，其示出了处于闭合位置的砧座；
图2C示出了图2A的钉合头部组件的放大纵向剖面图，其示出了处于击发位置的示例性钉驱动器和刀；
图3示出了抵靠砧座而形成的示例性钉的放大局部剖面图；
图4A示出了图1的外科器械的示例性促动器柄部组件的放大侧正视图，其中主体的一部分被移除，其示出了处于未击发位置的触发器和处于锁定位置的锁定特征结构；
图4B示出了图4A的促动器柄部组件的放大侧正视图，其示出了处于击发位置的触发器和处于解锁位置的锁定特征结构；
图5示出了图1的外科器械的示例性指示器组件的放大局部透视图，其示出了指示器窗口和指示器杠杆；
图6示出了图5的指示器窗口的图解视图，其示出了示例性指示器条和示例性对应钉表示；
图7示出了另一个示例性圆形钉合外科器械的透视图；
图8示出了图7的器械的柄部组件和轴组件的分解图；
图9示出了图7的器械的柄部组件的剖视图；
图10示出了图7的马达组件和电池组件的放大局部剖视图；
图11A示出了图7的器械的操作模式选择组件的侧正视图，其中第一齿轮与第二齿轮断开；
图11B示出了图11A的操作模式选择组件的侧正视图，其中第一齿轮与第二齿轮啮合；
图12示出了图11A的操作模式选择组件的第一齿轮的前正视图；
图13示出了图11A的操作模式选择组件的第二齿轮的透视图；
图14示出了图7的器械的柄部组件的放大局部透视图；
图15A示出了其中选择了机动操作模式的图7的器械的剖视图，其示出了砧座联接到套管针；
图15B示出了其中选择了机动操作模式的图7的器械的剖视图，所述器械处于组织夹持位置；
图15C示出了其中选择了机动操作模式的图7的器械的剖视图，所述器械处于击发位置；
图16示出了图7的器械的柄部组件的剖视图，其示出选择了手动操作模式；
图17A示出了其中选择了手动操作模式的图7的器械的剖视图，其示出了砧座联接到套管针；
图17B示出了其中选择了手动操作模式的图7的器械的剖视图，所述器械处于组织夹持位置；
图17C示出了其中选择了手动操作模式的图7的器械的剖视图，所述器械处于击发位置；
图18示出了与图7的器械一起使用的示例性控制组件的示意图；
图19示出了另一个示例性操作模式选择组件的局部透视图；和
图20示出了图19的操作模式选择组件的前视图。
附图并非旨在以任何方式进行限制，并且预期本技术的各种实施例可以多种其他方式进行，包括在附图中不一定示出的那些方式。并入本说明书中并形成其一部分的附图示出了本技术的若干方面，并连同说明书用于解释本技术的原理；然而，应当理解，本技术不限于所示出的精确布置方式。
具体实施方式
本技术的某些示例的下述描述不应用于限制其范围。通过以下举例说明(被认为是用于实施本技术的最佳方式之一)，本技术的其他实例、特征、方面、实施例和优点对于本领域技术人员将变得显而易见。正如将会意识到的，本文所述的技术包括其他不同且明显的方面，这些都未脱离本技术。因此，附图和具体实施方式应被视为实质上是示例性而非限制性的。
I.示例性圆形钉合外科器械概述
图1-6示出了示例性圆形外科钉合器械10，其具有钉合头部组件20、轴组件60和促动器柄部组件70，其中的每一个将在下文中更详细地描述。轴组件60从促动器柄部组件70朝远侧延伸，并且钉合头部组件20联接到轴组件60的远侧端部。简而言之，促动器柄部组件70能够操作以促动钉合头部组件20的钉驱动器24，从而将多个钉66从钉合头部组件20中驱动出来。钉66由附接在器械10的远侧端部处的砧座40弯曲以形成完整的钉。因此，可使用器械10来钉合图2A-2C中示出的组织2。
在该实例中，器械10包括闭合系统和击发系统。闭合系统包括套管针38、套管针促动器39和旋钮98。砧座40可联接到套管针38的远侧端部。旋钮98能够操作以相对于钉合头部组件20纵向地平移套管针38，从而当砧座40联接到套管针38时平移砧座40以将组织夹持在砧座40与钉合头部组件20之间。击发系统包括触发器74、触发器促动组件84、驱动器促动器64和钉驱动器24。钉驱动器24包括刀片36，当钉驱动器24被纵向地促动时，所述刀能够切断组织。此外，钉66被定位在钉驱动器24的多个钉驱动构件30的远侧，使得当钉驱动器24被纵向地促动时钉驱动器24还朝远侧驱动钉66。因此，当触发器74被促动并且触发器促动组件84经由驱动器促动器64促动钉驱动器24时，刀片36和构件30基本上同时切断组织2并且相对于钉合头部组件20朝远侧驱动钉66进入组织中。现在将更详细地描述闭合系统和击发系统的部件和功能。
A.示例性砧座
如图1-2C所示，砧座40可选择性地联接到器械10以提供如下表面：钉66可抵靠该表面弯曲以钉合容纳在钉合头部组件20与砧座40之间的材料。该实例的砧座40可选择性地联接到相对于钉合头部组件20朝远侧延伸的套管针或尖杆38。参见图2A-2C，砧座40经由砧座40的近侧轴42的联接可选择性地联接到套管针38的远侧末端。砧座40包括大致圆形的砧座头48和从砧座头48朝近侧延伸的近侧轴42。在示出的实例中，近侧轴42包括管状构件44，该管状构件具有弹性偏置保持夹具46以选择性地将砧座40联接到套管针38，虽然这仅为可选的，但是应当理解还可使用其他用于将砧座40联接到套管针38的保持特征结构。例如，可使用C形夹具、夹钳、手术线、销、粘合剂等将砧座40联接到套管针38。此外，虽然砧座40被描述为可选择性地联接到套管针38，但是在一些型式中，近侧轴42可包括单向联接结构使得砧座40一旦附接，砧座40便无法从套管针38移除。仅为示例性的单向特征结构包括倒钩、单向按扣、筒夹、箍、突片、束带等。当然，参考本文的教导内容，用于将砧座40联接到套管针38的另一些其他构型对于本领域的普通技术人员而言将是显而易见的。例如，套管针38可替换为中空轴，并且近侧轴42可包括能够插入中空轴中的尖锐杆。
该实例的砧座头48包括形成于砧座头48的近侧面50中的多个钉成形凹坑52。因此，如图2C所示，当砧座40处于闭合位置并且钉66从钉合头部组件20中被驱动出来进入钉成形凹坑52中时，钉66的腿部68被弯曲以形成完整的钉。
在砧座40作为独立部件的情况下，应当理解，砧座40在联接到钉合头部组件20之前可被插入并且固定到组织2的一部分。仅以举例的方式，砧座40可被插入并且固定到组织2的第一管状部分，而器械10被插入并且固定到组织2的第二管状部分。例如，组织2的第一管状部分可钉合到砧座40的一部分或者围绕砧座40的一部分钉合，而组织2的第二管状部分可钉合到套管针38或者围绕套管针38钉合。
如图2A所示，砧座40然后联接到套管针38。该实例的套管针38示出处于最远侧促动位置。套管针38的此类延伸位置可在砧座40附接之前提供组织2可联接的更大区域。此外，套管针38的延伸位置还可提供砧座40到套管针38的更容易的附接。套管针38还包括渐缩的远侧末端。此类末端能够穿刺入组织和/或有助于砧座40插入到套管针38上，但是该渐缩的远侧末端仅为可选的。例如，在其他型式中，套管针38可具有钝的末端。除此之外或另选地，套管针38可包括磁性部分(未示出)，所述磁性部分可吸引砧座40朝向套管针38。当然，参考本文的教导内容，砧座40和套管针38的另一些构型和布置方式对于本领域的普通技术人员而言将是显而易见的。
当砧座40联接到套管针38时，砧座40的近侧面与钉合头部组件20的远侧面之间的距离限定间隙距离d。该实例的套管针38能够经由位于促动器柄部组件70的近侧端部处的调节旋钮98而相对于钉合头部组件20纵向平移，如将在下文更详细地进行描述。因此，当砧座40联接到套管针38时，调节旋钮98的旋转通过相对于钉合头部组件20促动砧座40来扩大或减小间隙距离d。例如，如图2A-2B依次所示，砧座40被示为相对于促动器柄部组件70从初始打开位置朝近侧促动到闭合位置，从而减小间隙距离d以及待接合的组织2的两部分之间的距离。如图2C所示，一旦间隙距离d进入预定范围之内，钉合头部组件20便可被击发以钉合并切断位于砧座40与钉合头部组件20之间的组织2。钉合头部组件20能够操作以通过使用者枢转促动器柄部组件70的触发器74来钉合并切断组织2，如将在下文更详细地进行描述。
如上所述，间隙距离d对应于砧座40与钉合头部组件20之间的距离。当器械10被插入到患者中时，该间隙距离d可能不容易看到。因此，示于图5-6的可运动指示器条110被设置为通过定位成与触发器74相对的指示器窗口120可见。指示器条110能够操作以响应于调节旋钮98的旋转而运动，使得指示器条110的位置代表间隙距离d。如图6所示，指示器窗口120还包括指示砧座间隙处于期望的操作范围(例如绿色区域或“绿区”)内的标尺130，以及在标尺130的每个端部处的对应的钉压缩表示。仅以举例的方式，如图6所示，第一钉图像132示出了大的钉高度，而第二钉图像134示出了小的钉高度。因此，使用者可经由指示器条110和标尺130来观察所联接的砧座40相对于钉合头部组件20的位置。因此，使用者可随后经由调节旋钮98来调整砧座40的定位。
重新参见图2A-2C，使用者围绕管状构件44钉合组织2的一部分，使得砧座头48位于待钉合的组织2的一部分内。当组织2附接到砧座40时，保持夹具46和管状构件44的一部分从组织2突出，使得使用者可将砧座40联接到套管针38。在组织2联接到套管针38和/或钉合头部组件20的另一部分的情况下，使用者将砧座40附接到套管针38，并且朝向钉合头部组件20朝近侧促动砧座40以减小间隙距离d。一旦器械10处于操作范围内，使用者然后便将组织2的端部钉合在一起，从而形成组织2的基本上连续的管状部分。
砧座40可根据以下专利的至少一些教导内容来进一步构造：美国专利5,205,459；美国专利5,271,544；美国专利5,275,322；美国专利5,285,945；美国专利5,292,053；美国专利5,333,773；美国专利5,350,104；美国专利5,533,661，所述专利的公开内容均以引用的方式并入本文；和/或参考本文的教导内容，根据对于本领域的普通技术人员而言将是显而易见的其他构型来进一步构造。
B.示例性钉合头部组件
该实例的钉合头部组件20联接到轴组件60的远侧端部，并且包括容纳可滑动钉驱动器24的管状壳体22和容纳在钉凹坑32内的多个钉66。钉66和钉凹坑32以圆形阵列围绕管状壳体22设置。在该实例中，钉66和钉凹坑32被设置成一对同心的环形的钉排66和钉凹坑32。钉驱动器24能够操作以响应于促动器柄部组件70的触发器74的旋转而在管状壳体22内纵向地促动。如图2A-2C所示，钉驱动器24包括具有套管针开口26、中央凹槽28、以及围绕中央凹槽28周向地设置的多个构件30，并相对于轴组件60朝远侧延伸的扩张圆柱形构件。每个构件30能够接触和接合钉凹坑32内的多个钉66的对应钉66。因此，当钉驱动器24相对于促动器柄部组件70朝远侧促动时，每个构件30将对应的钉66穿过形成于管状壳体22的远侧端部的钉孔34来从其钉凹坑32中驱动出来。因为每个构件30从钉驱动器24延伸，多个钉66基本上同时被从钉合头部组件20中驱动出来。当砧座40处于闭合位置时，钉66被驱动进入钉成形凹坑52以弯曲钉66的腿部68，从而钉合位于砧座40与钉合头部组件20之间的材料。图3示出了一个仅为示例性的钉66，该钉由构件30驱动进入砧座40的钉成形凹坑32中以弯曲腿部68。
钉驱动器24还包括圆柱形刀片36，所述圆柱形刀与套管针开口26同轴并且从钉凹坑32插入。在该实例中，圆柱形刀片36被设置在中央凹槽28内以利用钉驱动器24朝远侧平移。如上所述，当砧座40被固定到套管针38时，砧座头48提供表面，圆柱形刀片36抵靠该表面切割容纳在砧座40与钉合头部组件20之间的材料。在一些型式中，砧座头48可包括用于圆柱形刀片36的凹槽(未示出)以有助于切割材料(例如，通过提供协作剪切边缘)。除此之外或另选地，砧座头48可包括与圆柱形刀片36偏置的一个或多个相对的圆柱形刀(未示出)，使得可提供剪刀型切割动作。参考本文的教导内容，另一些其他构型对于本领域的普通技术人员而言将是显而易见的。因此，钉合头部组件20能够操作以响应于通过促动器柄部组件70的促动而基本上同时钉合和切割组织2。
当然钉合头部组件20可根据以下专利的至少一些教导内容来进一步构造：美国专利5,205,459；美国专利5,271,544；美国专利5,275,322；美国专利5,285,945；美国专利5,292,053；美国专利5,333,773；美国专利5,350,104；美国专利5,533,661，所述专利的公开内容均以引用的方式并入本文；和/或参考本文的教导内容，根据对于本领域的普通技术人员而言将是显而易见的其他构型来进一步构造。
如前文所述，钉驱动器24包括套管针开口26。套管针开口26能够允许套管针38相对于钉合头部组件20和/或轴组件60纵向滑动。如图2A-2C所示，套管针38联接到套管针促动器39，使得套管针38可经由旋钮98的旋转被纵向地促动，如将参考促动器柄部组件70在下文更详细地进行描述。在该实例中，套管针促动器39包括联接到套管针38的细长的、相对刚性的轴，但是这仅为可选的。在一些型式中，促动器39可包括纵向刚性材料同时允许侧向弯曲，使得器械10的部分在使用期间可选择性地弯曲或弯折；或者器械10可包括预置的弯曲轴组件60。一种仅为示例性的材料是镍钛诺。当砧座40联接到套管针38时，套管针38和砧座40能够经由促动器39平移以调整砧座40与钉合头部组件20之间的间隙距离d。参考本文的教导内容，用于促动器39以纵向地促动套管针38的另一些构型对于本领域的普通技术人员而言将是显而易见的。
C.示例性轴组件
如图2A-2C所示，钉合头部组件20和套管针38被定位在轴组件60的远侧端部处。该实例的轴组件60包括外部管状构件62和驱动器促动器64。外部管状构件62联接到钉合头部组件20的管状壳体22和促动器柄部组件70的主体72，从而为其中的促动部件提供机械接地。驱动器促动器64的近侧端部联接到促动器柄部组件70的触发器促动组件84，如下所述。驱动器促动器64的远侧端部联接到钉驱动器24，使得触发器74的旋转纵向地促动钉驱动器24。如图2A-2C所示，驱动器促动器64包括具有开放纵向轴线的管状构件，使得联接到套管针38的促动器39可在驱动器促动器64内且相对于驱动器促动器64纵向地促动。当然，应当理解，参考本文的教导内容，可如对于本领域的普通技术人员而言将显而易见地一样将其他部件设置在驱动器促动器64内。
轴组件60可根据以下专利的至少一些教导内容来进一步构造：美国专利5,205,459；美国专利5,271,544；美国专利5,275,322；美国专利5,285,945；美国专利5,292,053；美国专利5,333,773；美国专利5,350,104；美国专利5,533,661，所述专利的公开内容均以引用的方式并入本文；和/或参考本文的教导内容，根据对于本领域的普通技术人员而言将是显而易见的其他构型来进一步构造。
D.示例性促动器柄部组件
现在参见图4A-5，促动器柄部组件70包括主体72、触发器74、锁定结构82、触发器促动组件84和套管针促动组件90。该实例的触发器74以能够枢转的方式安装到主体72，并且联接到触发器促动组件84，使得触发器74从未击发位置(示于图4A)到击发位置(示于图4B)的旋转促动上文所述的驱动器促动器64。弹簧78联接到主体72和触发器74以朝向未击发位置来偏置触发器74。锁定结构82是联接到主体72的可枢转构件。在第一锁定位置中，锁定结构82向上枢转并远离主体72，使得锁定结构82接合触发器74并且通过使用者来机械抵抗触发器74的促动。在第二解锁位置中，例如图1和4B所示，锁定结构82向下枢转，使得触发器74可被使用者促动。因此，在锁定结构82处于第二位置的情况下，触发器74可接合触发器促动组件84以击发器械10。
如图4A-4B所示，该实例的触发器促动组件84包括与驱动器促动器64的近侧端部接合的可滑动触发器滑架86。滑架86包括在滑架86的近侧端部上的一组突片88以保持并接合从触发器74延伸的一对触发器臂76。因此，当触发器74被枢转时，滑架86被纵向地促动并将纵向运动传递至驱动器促动器64。在示出的实例中，滑架86固定地联接到驱动器促动器64的近侧端部，但是这仅为可选的。实际上，在一个仅为示例性的替代方案中，滑架86可仅邻接驱动器促动器64，同时远侧弹簧(未示出)相对于促动器柄部组件70朝近侧偏置驱动器促动器64。
触发器促动组件84可根据以下专利的至少一些教导内容来进一步构造：美国专利5,205,459；美国专利5,271,544；美国专利5,275,322；美国专利5,285,945；美国专利5,292,053；美国专利5,333,773；美国专利5,350,104；美国专利5,533,661，所述专利的公开内容均以引用的方式并入本文；和/或参考本文的教导内容，根据对于本领域的普通技术人员而言将是显而易见的其他构型来进一步构造。
主体72还容纳套管针促动组件90，所述套管针促动组件能够响应于调节旋钮98的旋转而纵向地促动套管针38。如图4A-5最佳显示，该实例的套管针促动组件90包括调节旋钮98、沟槽状柄94和套管92。该实例的沟槽状柄94位于套管针促动器39的远侧端部处，但是应当理解，沟槽状柄94和套管针促动器39可以另选地为接合以传递纵向运动的独立部件。调节旋钮98由主体72的近侧端部可旋转地支撑，并且能够操作以经由内部突片(未示出)使与沟槽状柄94接合的套管92旋转。该实例的沟槽状柄94包括形成于沟槽状柄94的外表面中的连续的沟槽96。因此，当调节旋钮98旋转时，内部突片搭乘在沟槽96内，并且沟槽状柄94相对于套管92被纵向地促动。由于沟槽状柄94位于套管针促动器39的远侧端部处，因此沿第一方向旋转调节旋钮98将相对于促动器柄部组件70朝远侧推进套管针促动器39。因此，砧座40与钉合头部组件20之间的间隙距离d增加。通过在相反的方向上旋转调节旋钮98，套管针促动器39相对于促动器柄部组件70被朝近侧促动，以减小砧座40与钉合头部组件20之间的间隙距离d。因此，套管针促动组件90能够操作以响应于旋转调节旋钮98而促动套管针38。当然，参考本文的教导内容，套管针促动组件90的其他构型对于本领域的普通技术人员而言将是显而易见的。
该实例的沟槽96包括多个不同部分96A,96B,96C，所述不同部分每轴向距离具有不同的节距或不同数目的沟槽。本发明的沟槽96被分成远侧部分96A、中间部分96B和近侧部分96C。如图5所示，远侧部分96A包括细节距或在沟槽状柄94的短的轴向距离上的很多沟槽，使得需要调节旋钮98的大量旋转来横穿短的轴向距离。中间部分96B包括每轴向距离具有相比之下较粗节距或较少沟槽的部分，使得需要相对较少的旋转来横穿长的轴向距离。因此，间隙距离d可通过调节旋钮98相对较少的旋转而快速减小。该实例的近侧部分96C基本上类似于远侧部分96A，并且包括细节距或在沟槽状柄94的短的轴向距离上的很多沟槽，使得需要大量旋转来横穿短的轴向距离。当砧座40基本上靠近钉合头部组件20时，该实例的近侧部分96C被定位在套管92内，使得指示器条110在指示器窗口120内沿着标尺130运动以指示砧座间隙处于期望的操作范围内，如将在下文进行更详细的描述。因此，当突片位于沟槽96的近侧部分96C内时，调节旋钮98的每次旋转可少量减小间隙距离d以提供微调。
套管针运动组件90可根据以下专利的至少一些教导内容来进一步构造：美国专利5,205,459；美国专利5,271,544；美国专利5,275,322；美国专利5,285,945；美国专利5,292,053；美国专利5,333,773；美国专利5,350,104；美国专利5,533,661，所述专利的公开内容均以引用的方式并入本文；和/或参考本文的教导内容，根据对于本领域的普通技术人员而言将是显而易见的其他构型来进一步构造。
在示于图4A-4B的实例中，U形夹具100附接到位于沟槽状柄94远侧的套管针促动器39的中间部分。在本实例中，套管针促动器39的延伸部接合柄部组件70的外壳中的狭槽以防止当调节旋钮98旋转时套管针促动器39围绕其轴线旋转。在一些其它型式中，U形夹具100与主体72的一部分接合以基本上防止当调节旋钮98旋转时套管针促动器39围绕其轴线旋转。本实例的U形夹具100还包括位于其相对侧的每一侧上的用于接收附接构件(诸如螺钉、螺栓、销、夹具等)的细长狭槽102，从而出于相对于标尺130校准指示器条110的目的而选择性地调整U形夹具100的细长狭槽102相对于套管针促动器39的纵向位置。
如图5所示，促动器柄部组件70还包括能够接合并枢转指示器104的指示器托架140。该实例的指示器托架140可相对于主体72沿着形成于主体72上的一对狭槽滑动。指示器托架140包括矩形板144、指示器臂146和成角度凸缘142。成角度凸缘142形成在矩形板144的近侧端部处，并且包括孔(未示出)以可滑动地安装到套管针促动器39和/或沟槽状柄94上。螺旋弹簧150插置在凸缘142与凸出部152之间，以便抵靠U形夹具100来偏置凸缘142。因此，当U形夹具100利用套管针促动器39和/或沟槽状柄94朝远侧促动时，螺旋弹簧150推动指示器托架140与U形夹具100一起朝远侧行进。此外，当套管针促动器39和/或沟槽状柄94朝近侧平移时，U形夹具100将指示器托架140相对于凸出部152朝近侧推动，从而压缩螺旋弹簧150。当然，应当理解，在一些型式中，指示器托架140可固定地附接到套管针促动器39和/或沟槽状柄94。
在该实例中，当指示器托架140处于不对应于当砧座间隙在期望的操作范围(例如绿色区域或“绿区”)内的纵向位置时，锁定结构82的一部分邻接指示器托架140的表面141。当砧座间隙在期望的操作范围(例如绿色区域或“绿区”)内时，指示器托架140变窄以在指示器臂146的任一侧上提供一对间隙145，该指示器臂允许锁定结构82枢转，从而释放触发器74。因此，锁定结构82和指示器托架140可基本上防止使用者释放和操作触发器74，直至砧座40处于预定操作范围内。当然，应当理解，锁定结构82在一些型式中可以全部省去。
如上文所简要描述的，该操作范围可经由抵靠标尺130所示的指示器104的指示器条110从视觉上传达给使用者。朝远侧突出的指示器臂146位于指示器托架140的远侧端部处，该指示器臂终止在侧向突出的指状件148处以用于控制指示器104的运动。如图5最佳显示，指示器臂146和指状件148能够接合指示器104的突片106，使得当指示器托架140被纵向地促动时指示器104被枢转。在该实例中，指示器104在指示器104的第一末端处以能够枢转的方式联接到主体72，但是这仅为可选的，并且参考本文的教导内容，指示器104的其他枢转点对于本领域的普通技术人员而言将是显而易见的。指示器条110被定位在指示器104的第二端部上，使得指示器条110响应于指示器托架140的促动而运动。因此，如上所述，指示器条110通过指示器窗口120抵靠标尺130(示于图6中)而显示，以示出砧座40与钉合头部组件20之间的相对间隙距离d。
当然指示器托架140、指示器104、和/或促动器柄部组件70可根据以下专利的至少一些教导内容来进一步构造：美国专利5,205,459；美国专利5,271,544；美国专利5,275,322；美国专利5,285,945；美国专利5,292,053；美国专利5,333,773；美国专利5,350,104；美国专利5,533,661，所述专利的公开内容均以引用的方式并入本文；和/或参考本文的教导内容，根据对于本领域的普通技术人员而言将是显而易见的其他构型来进一步构造。
II.具有可选择的控制件的示例性机动圆形钉合外科器械
在一些情况下，可能需要提供对器械10的机动控制。还可能需要使得使用者能够在圆形外科钉合器械10的机动型式的机动控制或手动控制之间选择。例如，器械10可包括操作模式选择组件，所述操作模式选择组件允许使用者断开自动化机动旋转促动系统并且提供对该系统的手动促动。还可能需要提供开关组件，所述开关组件用于使单个旋转驱动装置的模式在组织夹持模式和组织切割/钉合模式之间改变。换句话讲，此类开关组件可使得单个旋转驱动器能够促动砧座40夹持特征结构或促动器械10的刀片36和钉驱动结构。下面的实例包括器械10的仅示例性型式，其中可使用单个马达经由单个旋转驱动装置来控制对组织的夹持和切割/钉合两者；其中操作者可在机动操作和手动操作之间进行选择；和在机动操作和手动操作中响应于单个旋转驱动装置的钉合头仓组件。
A.示例性操作模式选择组件
图7示出了作为器械10的选择性机动变型的另一个示例性圆形钉合器械210。此实例的器械210包括钉合头部组件220、砧座240、轴组件260和柄部组件270。钉合头部组件220与钉合头组合20的相似之处在于钉合头部组件220与砧座240选择性地联接。钉合头部组件220能够操作以将组织夹持在钉凹坑32和砧座240的钉成型凹坑52之间。钉合头部组件220包括圆柱形刀片36，所述刀能够操作以切断捕获在钉合头部组件220和砧座240之间的组织。钉合头部组件220将钉66驱动穿过捕获在钉合头部组件220和砧座240之间的组织。钉合器械210可用于在患者胃肠道内或其它地方形成固定吻合(例如，端对端吻合)。
钉合头部组件220与钉合头部组件20的不同之处在于钉合头部组件220能够操作以完全响应于经由轴组件260传输的单个旋转输入而夹持组织，切断组织，并且钉合组织。因此，钉合头部组件220不需要线性平移穿过轴组件260的促动输入，但钉合头部组件220可包括平移离合器结构。仅以举例的方式，钉合头部组件220的至少一部分可根据下述专利的教导内容中的至少一些来配置：与本案同一日提交的名称为“Motor DrivenRotary Input Circular Stapler with Modular End Effector”的美国专利申请[代理人案卷号END7161USNP.0597922]，其公开内容以引用方式并入本文。参考本文的教导内容，钉合头部组件220的其它合适的构型对于本领域的普通技术人员而言将是显而易见的。
轴组件260与轴组件60的类似之处在于轴组件260将柄部组件270与钉合头部组件220联接。轴组件260与轴组件60的不同之处在于轴组件260包括单个促动结构(即，图8所示的旋转驱动器促动器264)。驱动器促动器264能够操作以驱动钉合头部组件220以夹持组织，切断组织，并且钉合组织。因此，不需要通过轴组件260的线性促动，但旋转驱动器促动器264可纵向平移以在组织夹持模式和组织切割/钉合模式之间切换。例如，驱动器促动器264可从第一纵向位置平移到第二纵向位置，在所述第一纵向位置，驱动器促动器264的旋转提供在钉合头部组件220处对组织的夹持，在所述第二纵向位置，驱动器促动器264的旋转提供在钉合头部组件220处对组织的切割和钉合。轴组件260的一些型式可包括一个或多个柔性部分。配置有柔性部分且可结合到轴组件260中的轴组件的实例公开于下述专利中：与本案同一日提交的名称为“Motor Driven Rotary InputCircular Stapler with Lockable Flexible Shaft”的美国专利申请[代理人案卷号END7163USNP.0597933]，其公开内容以引用方式并入本文。另选地，轴组件260可沿着轴组件260的长度为刚性的或具有以其它方式配置的一个或多个柔性部分。
柄部组件270示于图8-10中。柄部组件270包括柄部外壳272、马达外壳274、马达280、电池281、旋钮298、操作模式选择组件(其示于图11A-11B中)和击发环252。马达外壳274定位在柄部外壳272内。柄部外壳272包括肋255,256,257，所述肋向内延伸到柄部外壳272中以支撑马达外壳274，如图9所示。电池281邻近马达280定位在马达外壳274内。电池281可从马达外壳274移除以更换、废弃或再充电。如在图10中最为显见，电池281包括从电池281朝远侧延伸的电触点231,232。马达280包括从马达280朝近侧延伸的电触点233,234。电池电触点232和马达电触点234经由导电金属带242联接。螺钉243将带242联接到马达外壳274以使带242的位置相对于马达外壳274固定。因此，带242能够不断地联接电池电触点232和马达电触点234。
如图10所示，电池电触点231联接到导电金属带245。金属带245经由导电螺钉247固定到马达外壳274。马达电触点233联接到导电金属带244。金属带244经由导电螺钉246固定到马达外壳274。马达外壳274由电绝缘材料(例如，塑料)形成并且包括环绕马达外壳274的环形触点284,286。螺钉246,247各自与相应的环形触点284,286联接以分别将电池电触点231和马达电触点233与环形触点284,286电联接。
另一个导电金属带282固定到柄部外壳272。金属带282的每个端部形成相应的弹簧触点283,285。马达外壳274相对于柄部外壳272朝近侧和/或朝远侧平移以选择性地将弹簧触点283,285与环形触点284,286联接和/或脱离。具体地讲，当马达外壳274处于远侧位置(图15A)时，弹簧触点283接合环形触点284并且弹簧触点285接合环形触点286以将电池281与马达280联接并且向马达280提供动力。应当理解，由于弹簧触点283,285为同一导电金属带282的一部分，并且由于触点232,234已经由带242联接，故弹簧触点283,285与环形触点284,286之间的接合使电池281与马达280之间的电路完整。此定位用于提供如下文将更详细描述的对钉合头部组件220的机动促动。当马达外壳274处于近侧位置(图17A)时，弹簧触点283,285与环形触点284,286脱离，使得电池281与马达280脱离并且马达280不接收动力。此定位用于提供如下文将更详细描述的对钉合头部组件220的手动促动。环形触点284,286的环形形状实现弹簧触点283,285与环形触点284,286之间的适当接触，而不管马达外壳274在柄部外壳272内的角位置如何。在一些型式中，带282可包括断路器，所述断路器与外部开关联接，使得使用者可促动所述外部开关以便在马达外壳274处于远侧位置之后使电池281与马达280之间的联接完整。
马达外壳274的近侧端部固定地固定到旋钮298，如图8所示。旋钮298从柄部外壳272朝近侧突出并且包括从旋钮298朝远侧延伸的花键296。柄部外壳272包括对应的齿251以选择性地接合花键296。牵拉和/或推动旋钮298以使马达外壳274在柄部外壳272内平移。当旋钮298处于近侧位置(图17A)时，花键296与柄部外壳272断开，使得旋钮298和马达外壳274相对于柄部外壳272自由地旋转。此定位用于提供如下文将更详细描述的对钉合头部组件220的手动促动。当旋钮298处于远侧位置(图15A)时，花键296接合柄部外壳272中的对应的齿251以锁定旋钮298和马达外壳274使其不能相对于柄部外壳272旋转。花键296和齿251因此提供马达外壳274相对于柄部外壳272的机械接地。此定位用于提供如下文将更详细描述的对钉合头部组件220的机动促动。旋钮298由柄部外壳272中的弹性构件279偏置至远侧位置。具体地讲，弹性构件279从柄部外壳272的肋255朝远侧延伸到第一齿轮278，所述齿轮一体地固定到马达外壳274的远侧端部。当旋钮298处于近侧位置时，弹性构件279在第一齿轮278和肋255之间压缩以使柄部外壳272弹性偏置至远侧位置。
操作模式选择组件远离马达外壳274定位在柄部外壳272内。如图11-13所示，操作模式选择组件包括第一齿轮278和第二齿轮276，其中第一齿轮278同轴地且以能够滑动的方式围绕第二齿轮276设置。第一齿轮278包括围绕第一齿轮278的内开口对齐的方形齿277，如图12所示。齿277限定沿周边间隔的凹槽阵列。第二齿轮276包括轴273、花键275和环形凸缘258，如图13所示。轴273具有远侧呈现开口259。远侧呈现开口259为六边形以接收同样为六边形的驱动器促动器264的近侧端部263(图8)。轴273还具有近侧呈现开口(未示出)，所述近侧呈现开口为半圆形以与从马达280朝远侧延伸的驱动轴287互补并接收所述驱动轴。也可使用轴263,287的其它合适的形状和构型来将第二齿轮276与轴263,287联接。
第二齿轮276的花键275定位在轴273的近侧端部上并且朝远侧延伸。花键275对应于第一齿轮278的齿277，使得花键275能够适配于限定在齿277之间的凹槽内。一对环形凸缘258定位在轴273的远侧端部处并且向外延伸以接合柄部外壳272的向内延伸的环形肋253，从而使第二齿轮276的纵向位置固定在柄部外壳272内。尽管环形肋253使第二齿轮276的纵向位置固定在柄部外壳272内，然而环形肋253允许第二齿轮276相对于柄部外壳272旋转。基于本文的教导内容，用于纵向固定第二齿轮276的其它合适的接合特征结构对于本领域的普通技术人员而言将是显而易见的。
第一齿轮278定位成围绕第二齿轮276，如图11A-11B所示。第一齿轮278固定地联接到马达外壳274的远侧端部，使得第一齿轮278与马达外壳274一体地平移并旋转。当马达外壳274处于如图11B和图17A所示的近侧位置时，马达280和第一齿轮278也处于近侧位置。在此位置中，马达280的驱动轴287与第二齿轮276脱离并且第一齿轮278的齿277接合第二齿轮276的花键275。因此，当旋钮298旋转时，马达外壳274和第一齿轮278也旋转。此定位由此提供如下文将更详细描述的对钉合头部组件220的手动促动。随着第一齿轮278的齿277与花键275接合，旋钮298由此使第二齿轮276相对于马达外壳274旋转。当马达外壳274处于如图11A和图15B所示的远侧位置时，马达280和第一齿轮278也处于远侧位置。马达278经由轴287,273与第二齿轮276接合。第一齿轮278在第二齿轮276的轴273的上方滑动以脱离花键275。马达280的驱动轴287的旋转由此使第二齿轮276旋转。此定位由此提供如下文将更详细描述的对钉合头部组件220的机动促动。换句话讲，当旋钮298和马达外壳274处于如图11A和图15B所示的远侧位置时，马达280使第二齿轮276旋转。当旋钮298和马达外壳274处于如图11B和图17A所示的近侧位置时，旋钮298使第二齿轮276旋转。
重新参见图8-9，第二齿轮276的远侧端部联接到驱动器促动器264，使得第二齿轮276的旋转使驱动器促动器264旋转。驱动器促动器264类似于驱动器促动器64。因此，当第二齿轮276旋转时，驱动器促动器264旋转以调整砧座240和钉合头部组件220之间的间隙距离d。柄部外壳272还包括击发环252和联接构件268。联接构件268围绕驱动器促动器264的凹槽261固定，如图8所示。因此，联接构件268与驱动器促动器264一起平移，但驱动器促动器264在联接构件268内自由地旋转。联接构件268包括向外延伸的突起，所述突起将联接构件268连接到击发环252。联接构件268的突起延伸穿过外壳组件272的狭槽265,266,267，如图14所示。狭槽265围绕柄部组件272的一部分周向地延伸。狭槽266从狭槽265朝近侧延伸。狭槽267从狭槽266横向延伸并基本上平行于狭槽265。击发环252环绕柄部外壳272并且能够相对于柄部外壳272旋转和平移以将联接构件268的突起手动驱动穿过狭槽265,266,267。
当击发环252处于远侧位置时，联接构件268的突起定位在柄部外壳272的狭槽265内。当联接构件268定位在狭槽265内时，联接构件268将驱动器促动器264与钉合头部组件220中的特征结构联接，所述特征结构能够操作以调整砧座240和钉合头部组件220之间的间隙距离d。例如，如果联接构件268在狭槽265内顺时针旋转，则间隙距离d减小以使砧座240相对于钉合头部组件220闭合。如果联接构件268在狭槽265内逆时针旋转，则间隙距离d增大以使砧座240相对于钉合头部组件220打开。弹性构件269定位在联接构件268的近侧以将联接构件268朝远侧偏置(图8)。击发环252的联接构件268然后可朝近侧平移穿过狭槽266到达狭槽267。当击发环252处于近侧位置时，联接构件268的突起定位在狭槽267内。当联接构件268定位在狭槽267内时，联接构件268将驱动器促动器264与钉合头部组件220中的特征结构联接，所述特征结构响应于驱动器促动器264的旋转而驱动刀片36和钉66。例如，如果联接构件268在狭槽267内顺时针旋转，则钉合头部组件220驱动刀片36和钉66。狭槽367的构型防止联接构件268逆时针旋转。参考本文的教导内容，其它合适的联接构件268旋转构型对于本领域的普通技术人员而言将是显而易见的。
如图9所示，开关248定位在柄部外壳272中以与联接构件268对齐。当选择机动操作模式时，开关248能够在开关248被按下时电联接马达280和电池281，并且开关248能够在开关248不被按下时电分离马达280和电池281。联接构件268能够在联接构件268旋转时接合并按下开关248。例如，当联接构件268处于中间位置时(例如，当联接构件268与相应的狭槽266对齐时)，开关248不被按下并且马达280与电池281分离。当联接构件268旋转离开中间位置时，联接构件268接合开关248以按下开关248并且将马达280与电池281联接以操作器械210。应当理解，外壳272可包括三个开关248。例如，一个开关248可定位用于当击发环252在处于近侧位置的同时顺时针旋转(例如，随狭槽267中的联接构件268一起)时启动；而另一个开关248定位用于当击发环252在处于远侧位置的同时顺时针旋转(例如，随狭槽265中的联接构件268一起)时启动；而另一个开关248定位用于当击发环252在处于远侧位置的同时逆时针旋转时启动。控制逻辑部件可与开关248连通，该开关在击发环252处于远侧位置的同时旋转时启动。此类控制逻辑部件可以能够操作以选择性地反转马达280的旋转方向，从而提供对套管针238和砧座240的选择性推进或回缩以根据击发环252旋转的方向来调整间隙距离d。
应当理解，击发环252和联接构件268用作离合器控制件以使驱动器促动器264从砧座夹持模式(当联接构件268处于远侧位置时)变换到切割/钉合模式(当联接构件268处于近侧位置时)。响应于驱动器促动器264定位的此类变化的钉合头部组件220的实例公开于下述专利中：与本案同一日提交的名称为“Motor Driven Rotary Input Circular Stapler withModular End Effector”的美国专利申请[代理人案卷号END7161USNP.0597922]，其公开内容以引用方式并入本文。参考本文的教导内容，钉合头部组件220可采取的其它合适的形式对于本领域的普通技术人员而言将是显而易见的。外管状构件262联接到促动器柄部组件270。外管状构件262类似于外管状构件62以提供钉合头部组件220和柄部组件270之间的机构接地。
1.机动操作
图15A-15C示出了机动操作期间的器械210。图15A示出了砧座240联接到套管针238。砧座240以类似于上文参照砧座40和套管针38所述的方式与套管针238联接。当选择机动操作时，旋钮298处于远侧位置。在远侧位置中，旋钮298的花键296接合柄部外壳272中的对应的齿251以锁定旋钮298使其不能相对于柄部外壳272旋转。当旋钮298处于远侧位置时，马达外壳274也处于远侧位置。当马达外壳274处于远侧位置时，弹簧触点283,285与环形触点284,286对齐以将电池281的电触点231与马达280的电触点233联接。当联接构件268旋转以按下开关248时，从电池281向马达280提供动力。马达280经由轴287,273与第二齿轮276啮合并且第一齿轮278与花键275脱离，从而允许第二齿轮276相对于第一齿轮278、马达外壳274和柄部外壳272旋转。联接构件268的突起朝远侧定位在柄部外壳272的狭槽265内以锁定击发环252和驱动器促动器264的纵向位置。
如图15B所示，击发环252顺时针旋转以使联接构件268在狭槽267内平移。当联接构件268旋转时，开关248被按下以联接马达280和电池281并且向马达280提供动力。马达280因此被启动以使轴287旋转。轴287由此使第二齿轮276旋转。由于第二齿轮276联接到驱动器促动器264，故第二齿轮276的旋转也使驱动器促动器264旋转。驱动器促动器264的此旋转驱动钉合头部组件220中的特征结构以调整砧座240和钉合头部组件220之间的间隙距离d。一旦砧座240相对于钉合头部组件220处于期望的位置，击发环252便逆时针旋转到中间位置以释放开关248，使得马达280与电池281分离。器械210然后可被击发，如图15C所示。击发环252平移以将联接构件268定位在狭槽265外部并定位至狭槽267中的近侧位置。当联接构件268朝近侧平移至狭槽267时，联接构件268也使驱动器促动器264朝近侧平移以将驱动器促动器264与钉合头部组件220中的特征结构联接，所述特征结构能够操作以将刀片36朝远侧驱动并且将钉66驱动至砧座240中以钉合所夹持的组织2,4以形成吻合。击发环252在狭槽267内顺时针旋转以按下开关248，从而再次将电池281与马达280联接以向马达280提供动力。马达280再次与处于近侧位置的联接构件268和驱动器促动器264一起旋转。此旋转经由驱动轴287和第二齿轮276传输至驱动器促动器264，且由此传输至驱动器促动器264以切割并钉合组织2,4。击发环252然后可在狭槽267内逆时针旋转至中间位置以释放开关248并且使马达280与电池281分离。
2.操作模式的选择
如图16所示，器械210从机动操作切换到手动操作。使用者可抓握旋钮298以使旋钮298从远侧位置平移到近侧位置。在近侧位置中，旋钮298的花键296与柄部外壳272中的对应的齿251脱离以允许旋钮298相对于柄部外壳272旋转。此也允许马达外壳274和第一齿轮278相对于柄部外壳272旋转。当旋钮298处于近侧位置时，马达外壳274也处于近侧位置。当马达外壳274处于近侧位置时，弹簧触点283,285与环形触点284,286偏置以使电池281与马达280分离，使得不向马达280提供动力。第一齿轮278朝近侧平移以接合第二齿轮276的花键275。因此，旋钮298的旋转使马达外壳274、第一齿轮278、第二齿轮276和驱动器促动器264旋转。使用者还可将旋钮298朝远侧往回推动以重新选择机动操作。通过使用旋钮298作为促动器以在机动操作和手动操作之间选择，不需要闭锁件或开关同时移除供给马达280的动力。旋钮298因此提供机动操作的“紧急援助”系统，同时允许器械210完全以手动操作模式操作。因此应当理解，即使操作者初始以机动模式使用器械210，操作者也可简单地通过继续牵拉旋钮298而迅速并容易地将器械210转换至手动操作模式，而不牺牲器械210的基本功能。
3.手动操作
图17A-17C示出了在手动操作期间的器械210。图17A示出了砧座240联接到套管针238。旋钮298处于如上所述的近侧位置。如图17B所示，旋钮298旋转以使马达外壳274相对于柄部外壳272旋转。马达外壳274由此使第一齿轮278旋转。第一齿轮278与花键275接合以使第二齿轮276旋转。由于第二齿轮276联接到驱动器促动器264，故第二齿轮276的旋转也使驱动器促动器264旋转。驱动器促动器264的此旋转使钉合头部组件220中的特征结构旋转以调整砧座240和钉合头部组件220之间的间隙距离d。一旦砧座240相对于钉合头部组件220处于期望的位置，则器械210可被击发，如图17C所示。击发环252从远侧位置平移并且离开狭槽265到达狭槽267的近侧位置。当联接构件268朝近侧平移至狭槽267时，联接构件268也使驱动器促动器264朝近侧平移以将驱动器促动器264与钉合头部组件220中的特征结构联接，所述特征结构能够操作以将刀片36朝远侧驱动并且将钉66驱动至砧座240中以钉合所夹持的组织2,4以形成吻合。旋钮298再次与处于近侧位置的联接构件268和驱动器促动器264一起旋转。此旋转经由第一齿轮278和第二齿轮276传输至驱动器促动器264，并且由此传输至驱动器促动器264以切割并钉合组织2,4。
4.控制组件
图18示出了与器械210一起使用的示例性控制组件228。控制组件228包括传感器222、控制模块224和反馈特征结构226。反馈特征结构226可以能够操作以提供视觉、听觉和/或触觉反馈(LED灯、LED显示器、扬声器、振动发生器等)。传感器222联接到器械210并且能够检测器械210的驱动系内的运动。例如，传感器222可包括编码器，所述编码器定位用于检测驱动器促动器264的旋转或驱动系的某一其它旋转分量(例如，旋转但不同样平移的分量)。传感器222与控制模块224联接以向控制模块224提供感测信号。控制模块224能够处理感测信号并且可以确定器械210的选定操作模式、砧座240和钉合头部组件220之间的间隙距离d、和/或刀片36和钉66的击发。在本实例中，控制模块224与器械210和反馈特征结构226联接。然而，控制模块224可与器械210或反馈特征结构226中的任一者联接。控制模块224也可与开关248联接以在开关248被按下时促动马达280。传感器222、控制模块224和反馈特征结构226中的每一者可位于器械210内或远离器械210。
基于感测信号，控制模块224能够操作以促动器械210和/或反馈特征结构226。例如，控制模块224可促动反馈特征结构226以指示器械210的选定操作模式。在一些型式中，反馈特征结构226可具有对应于机动操作模式的第一LED和对应于手动操作模式的第二LED。传感器222可检测旋钮298和/或马达外壳274的近侧位置和/或远侧位置并将该信息提供给控制模块224。控制模块224然后可在传感器222检测到近侧位置的情况下点亮第一LED以指示选择了机动操作模式。控制模块224可在传感器222检测到远侧位置的情况下点亮第二LED以指示选择了手动操作模式。另选地，反馈特征结构226可仅具有一个点亮或不点亮以指示操作模式的LED，或反馈特征结构226可具有扬声器以在操作模式改变时提供声音。
在一些型式中，控制模块224可促动反馈特征结构226以指示钉合组件220的选定模式。反馈特征结构226可具有对应于组织夹持模式的第一LED和对应于击发模式的第二LED。传感器222可检测击发环252、联接构件268和/或驱动器促动器264的近侧位置和/或远侧位置并将该信息提供给控制模块224。控制模块224然后可在传感器222检测到远侧位置的情况下点亮第一LED以指示选择了组织夹持模式。控制模块224可在传感器222检测到近侧位置的情况下点亮第二LED以指示选择了击发模式。另选地，反馈特征结构226可仅具有一个点亮或不点亮以指示钉合头部组件220模式的LED，或反馈特征结构226可具有扬声器以在钉合头部组件220模式改变时提供声音。
除此之外或另选地，控制模块224可促动反馈特征结构226以指示砧座240和钉合头部组件220之间的间隙距离d。传感器222可检测驱动器促动器264的旋转圈数。控制模块224然后可基于感测信号确定间隙距离d，并促动反馈特征结构226。反馈特征结构226可包括单独点亮以指示间隙距离d的多个LED。当间隙距离d增大时，LED可点亮以对应于间隙距离d。当间隙距离d减小时，LED可关掉以对应于间隙距离d。作为另一个仅示例性实例，反馈特征结构226可包括提供间隙距离d的实时指示的LED显示屏。反馈特征结构226还可具有发出在音调和音量上变化的声音以指示对应的间隙距离d的扬声器。另选地，可使用一个LED来指示何时已达到特定间隙距离d，或可在已达到特定间隙距离d时提供声音。
在其中反馈特征结构226包括向操作者提供触觉反馈的能力的型式中，应当理解，各种常规部件可并入柄部组件270中以提供此类触觉反馈。还应当理解，触觉反馈可通过马达280提供。仅以举例的方式，反馈特征结构226可以能够向马达280提供正弦波信号以实质上使驱动轴287稍微顺时针旋转，然后，立即使其稍微逆时针旋转完全相同的量。净结果将是驱动轴287的零旋转位移。当此序列(例如，快速连续地)重复时，驱动轴287的运动可使得柄部组件270振动或以其它方式颤动至足以使操作者通过抓握柄部组件270的手感觉到振动或颤动。由于通过此反馈算法的驱动轴287的零净运动，触觉反馈可不导致头组件220中的任何部件的净促动，而不管驱动器促动器264处于远侧位置还是处于近侧位置。可提供此类触觉反馈以指示钉合行程的结束、指示闭锁件状况、和/或指示其它状况。参考本文的教导内容，可提供听觉、视觉和/或触觉反馈的各种其他合适的方式对本领域的普通技术人员将显而易见。
在一些型式中，控制模块224可促动器械210。传感器222可以能够检测何时已击发刀片36和钉66。控制模块224因此可一旦已击发刀片36和钉66则自动反转马达280。控制模块224也可促动反馈特征结构226以向使用者指示已击发器械210。参考本文的教导内容，可使用传感器222、控制模块224和反馈特征结构226的其它合适的方式对于本领域的普通技术人员而言将是显而易见的。还应当理解，如果需要，可完全省略此类特征结构。
B.示例性开关组件
如上所述，外科钉合器械10,210具有两个子系统，闭合子系统(用于将组织夹持在砧座40,240与钉合头部组件20,220之间)和击发子系统(用于将刀片36和钉66朝向砧座40,240向远侧驱动)，以便形成吻合。可能需要以单个旋转马达来为这两个子系统提供动力以免除另外的马达和传动装置的成本和包装。图19-20示出了能够以单个旋转马达380来为两个子系统提供动力的示例性驱动组件371。尽管器械210以单个旋转驱动轴来提供闭合和击发，但此实例的驱动组件371通过由单个马达380驱动的两个单独的旋转驱动轴来提供闭合和击发。驱动组件371包括马达380、传动轴392、螺线管390、闭合杆364和击发杆362。马达380包括从马达380延伸的轴368和联接到轴368的齿轮370。传动轴392包括与马达380的齿轮370接合的齿轮372。齿轮377定位在传动轴392的相对端上。
枢转摆臂391环绕传动轴392，使得传动轴392可相对于摆臂391自由地旋转，如图18所示。摆臂391从传动轴392延伸并且包括齿轮376。齿轮376固定地固定到摆臂391。销394从摆臂391延伸并且与齿轮376同轴。销394由托架393以能够枢转地方式支撑，使得摆臂391能够响应于齿轮376的旋转而相对于托架393围绕销394枢转。螺线管390包括联接到齿条371的齿轮374。齿条371还联接到接合摆臂391的齿轮376的齿轮375。另选地，螺线管390的齿轮374可直接联接到摆臂391的齿轮376。闭合杆364包括齿轮378。击发杆362邻近并基本上平行于闭合杆364定位。击发杆362包括齿轮379。传动轴392的齿轮377选择性地摆动以接合闭合杆364的齿轮378或击发杆362的齿轮379。
如图19-20所示，传动轴392定位用于接合闭合杆364。因此，当启动马达380时，轴368使齿轮370旋转。齿轮370由此使齿轮372和传动轴392旋转以使齿轮377旋转。由于齿轮377与齿轮378啮合，因此传动轴392由此使闭合杆364旋转。闭合杆364可用于调整砧座40,240与钉合头部组件20,220之间的间隙距离d。如果使用者期望切换到击发子系统，则可促动螺线管390。当促动螺线管390时，螺线管390使齿轮374旋转以使齿条371平移。齿条371然后使摆臂391的齿轮375和齿轮376旋转。齿轮376由此使摆臂391枢转。当摆臂391枢转时，摆臂391使传动轴392平移，使得传动轴392与闭合杆364脱离并接合击发杆362。因此，当启动马达380时，轴368使齿轮370旋转。齿轮370由此使齿轮372和传动轴392旋转以使齿轮377旋转。由于齿轮377此时与齿轮379啮合，因此传动轴392由此使击发杆362旋转。击发杆364可用于将刀片36和钉66朝向砧座40,240向远侧驱动。然后可再次促动螺线管390，使得开关组件371经由摆臂391切换到闭合子系统。
螺线管390可按钮启动或以其它方式手动启动。另选地，切换组件371可结合逻辑，使得螺线管390自动启动。例如，使用者可以通过将使用者输入310输入到控制模块312中来促动驱动组件371，如图19所示。控制模块312联接到马达380和螺线管390以基于使用者输入310来选择性地促动马达380和/或螺线管390。控制模块312可与器械10,210为整体的，或控制模块312可为单独的组件。参考本文的教导内容，合适的控制模块312构型对于本领域的普通技术人员而言将是显而易见的。
III.杂项
应当理解，本文所述教导内容、表达、实施例、实例等中的任何一个或多个可与本文所述其它教导内容、表达、实施例、实例等中的任何一个或多个结合。因此上述教导内容、表达、实施例、实例等不应视为彼此分离。参考本文教导内容，其中本文教导内容可结合的各种合适方式对于本领域的普通技术人员而言将会显而易见。此类修改和变型旨在包括在权利要求书的范围内。
本文的教导内容中的至少一些可易于与下述专利的一个或多个教导内容组合：2010年9月14日公布的名称为“Surgical Staples HavingCompressible or Crushable Members for Securing Tissue Therein and StaplingInstruments for Deploying the Same”的美国专利7,794,475，其公开内容以引用方式并入本文。此类教导内容可被结合的各种合适方式对于本领域的普通技术人员将是显而易见的。
相似地，本文的教导内容中的至少一些可易于与下述专利的一个或多个教导内容组合：2012年12月4日提交的名称为“Trans-Oral CircularAnvil Introduction System with Dilation Feature”的美国专利申请13/693,430，其公开内容以引用方式并入本文。此类教导内容可被结合的各种合适方式对于本领域的普通技术人员将是显而易见的。
相似地，本文的教导内容中的至少一些可易于与下述专利的一个或多个教导内容组合：2012年11月29日提交的名称为“Surgical Staple withIntegral Pledget for Tip Deflection”的美国专利申请13/688,951，其公开内容以引用方式并入本文。此类教导内容可被结合的各种合适方式对于本领域的普通技术人员将是显而易见的。
相似地，本文的教导内容中的至少一些可易于与下述专利的一个或多个教导内容组合：2012年12月6日提交的名称为“Surgical Stapler withVarying Staple Widths Along Different Circumferences”的美国专利申请13/706,827，其公开内容以引用方式并入本文。此类教导内容可被结合的各种合适方式对于本领域的普通技术人员将是显而易见的。
相似地，本文的教导内容中的至少一些可易于与下述专利的一个或多个教导内容组合：2012年11月29日提交的名称为“Pivoting Anvil forSurgical Circular Stapler”的美国专利申请13/688,992，其公开内容以引用方式并入本文。此类教导内容可被结合的各种合适方式对于本领域的普通技术人员将是显而易见的。
相似地，本文的教导内容中的至少一些可易于与下述专利的一个或多个教导内容组合：2012年12月4日提交的名称为“Circular AnvilIntroduction System Alignment with Feature”的美国专利申请13/693,455，其公开内容以引用方式并入本文。此类教导内容可被结合的各种合适方式对于本领域的普通技术人员将是显而易见的。
相似地，本文的教导内容中的至少一些可易于与下述专利的一个或多个教导内容组合：与本案同一日提交的名称为“Circular Stapler withSelectable Motorized and Manual Control”的美国专利申请[代理人案卷号END7159USNP.0597920]，其公开内容以引用方式并入本文。此类教导内容可被结合的各种合适方式对于本领域的普通技术人员将是显而易见的。
相似地，本文的教导内容中的至少一些可易于与下述专利的一个或多个教导内容组合：与本案同一日提交的名称为“Motor Driven Rotary InputCircular Stapler with Modular End Effector”的美国专利申请[代理人案卷号END7161USNP.0597922]，其公开内容以引用方式并入本文。此类教导内容可被结合的各种合适方式对于本领域的普通技术人员将是显而易见的。
相似地，本文的教导内容中的至少一些可易于与下述专利的一个或多个教导内容组合：与本案同一日提交的名称为“Motor Driven Rotary InputCircular Stapler with Lockable Flexible Shaft”的美国专利申请[代理人案卷号END7163USNP.0597933]，其公开内容以引用方式并入本文。此类教导内容可被结合的各种合适方式对于本领域的普通技术人员将是显而易见的。
应当理解，所述以引用的方式并入本文中的任何专利、出版物或其它公开材料，无论是全文或部分，仅在所并入的材料与本公开中给出的定义、陈述或者其它公开材料不冲突的范围内来并入本文。由此，在必要程度下，本文所明确阐述的公开内容将会取代以引用的方式并入本文中的任何相冲突的材料。如果据述以引用的方式并入本文但与本文所述现有定义、陈述或者其它公开材料相冲突的任何材料或其部分，仅在所并入的材料与现有公开材料之间不产生冲突的程度下并入本文。
上文所述装置型式可适用于医学专家所执行的常规医疗处理和手术中，并且可适用于机器人辅助的医疗处理和手术中。仅以举例的方式，本文的各种教导内容可易于结合到诸如由Intuitive Surgical,Inc.(Sunnyvale,California)提供的DAVINCITM系统的机器人外科系统中。相似地，本领域的普通技术人员将认识到，本文的各种教导内容可易于与2004年8月31日公布的名称为“Robotic Surgical Tool with Ultrasound Cauterizing and CuttingInstrument”的美国专利6,783,524的各种教导内容相结合，该专利的公开内容以引用方式并入本文。
上文所述型式可设计为在单次使用后丢弃，或者它们可设计为能够使用多次。在上述任一种或两种情况下，都可针对这些型式进行修复，以便在使用至少一次后重复使用。修复可以包括以下步骤任何组合：拆卸装置，然后清洗或者更换特定部件，并且随后重新组装。具体地讲，可以拆卸所述装置中的一些型式，并可选择性地以任何组合的形式更换或者移除所述装置中任何数量的特定件或部件。在清洗和/或更换特定零件时，所述装置的一些型式可在修复设施中重新组装或在即将进行手术前由用户重新组装以供随后使用。本领域的技术人员将会知道，装置修复可以利用多种技术进行拆卸、清洗/更换以及重新组装。此类技术的使用和所得修复装置全都在本发明的范围内。
仅以举例方式，本文所述型式可在手术之前和/或之后进行消毒。在一种消毒技术中，装置放置在闭合并密封的容器、诸如塑料袋或TYVEK袋中。随后，可将容器和装置放置在可穿透容器的诸如γ辐射、X射线或高能电子等的辐射场中。辐射可以杀死装置上和容器中的细菌。消毒后的装置随后可以存放在无菌容器中，以备以后使用还可使用在本领域中已知的任何其它技术进行装置消毒，所述技术包括但不限于β或γ辐射、环氧乙烷或者蒸汽消毒。
尽管已在本发明中示出并描述了多个型式，但是本领域的普通技术人员可在不脱离本发明的范围的前提下进行适当修改以对本文所述的方法和系统进行进一步地改进。已经提及若干此类潜在修改，并且其它修改对于本领域的技术人员而言将会显而易见。例如，上文所讨论的实例、实施例、几何形状、材料、尺寸、比率、步骤等均是示例性的而非所要求的。因此，本发明的范围应以以下权利要求书作考虑，并且应理解为不限于说明书和附图中示出并描述的结构以及操作细节。

Claims (20)

1.一种用于钉合组织的设备，所述设备包括：
(a)钉合头部组件，其中所述钉合头部组件包括：
(i)闭合组件，所述闭合组件能够操作以抵靠砧座夹持组织，和
(ii)击发组件，所述击发组件能够操作以朝所述砧座将至少一个钉驱动穿过组织；
(b)旋转驱动轴，所述旋转驱动轴与所述钉合头部组件连通；和
(c)主体组件，所述主体组件联接到所述旋转驱动轴，其中所述主体组件包括模式选择器，所述模式选择器能够操作以在组织夹持模式和击发模式之间进行选择，其中所述旋转驱动轴能够操作以响应于选择所述组织夹持模式来促动所述闭合组件，其中所述旋转驱动轴能够操作以响应于选择所述击发模式来促动所述击发组件。
2.根据权利要求1所述的设备，其中所述模式选择器能够操作以使所述旋转驱动轴在第一纵向位置和第二纵向位置之间平移以在所述组织夹持模式和所述击发模式之间进行选择。
3.根据权利要求1所述的设备，其中所述主体组件还包括外壳，其中所述模式选择器包括能够相对于所述主体组件的外壳运动的环形构件。
4.根据权利要求3所述的设备，其中所述主体组件的外壳还限定多个狭槽，其中所述模式选择器还包括从所述环形构件突出的销构件，其中所述销构件能够在所述模式选择器进行模式选择期间横贯所述多个狭槽。
5.根据权利要求1所述的设备，其中所述模式选择器能够在近侧位置和远侧位置之间运动，其中所述近侧位置与所述击发模式相关联，其中所述远侧位置与所述组织夹持模式相关联。
6.根据权利要求5所述的设备，其中所述模式选择器能够沿第一方向旋转以触发所述旋转驱动轴的旋转以相对于所述钉合头部组件闭合所述砧座。
7.根据权利要求6所述的设备，其中所述模式选择器能够沿第二方向旋转以触发所述旋转驱动轴的旋转以相对于所述钉合头部组件打开所述砧座。
8.根据权利要求5所述的设备，其中所述模式选择器能够沿第一方向旋转以触发所述旋转驱动轴的旋转以将至少一个钉从所述钉合头部组件朝向所述砧座驱动穿过组织。
9.根据权利要求1所述的设备，其中所述击发组件还能够操作以将刀片驱动穿过组织。
10.根据权利要求1所述的设备，其中所述主体组件包括开关，其中所述开关能够选择性地启动所述钉合头部组件，其中所述开关被定位成响应于所述模式选择器的旋转而被启动。
11.根据权利要求1所述的设备，还包括马达，其中所述马达能够操作以驱动所述旋转驱动轴。
12.根据权利要求11所述的设备，还包括手动操作选择器，所述手动操作选择器能够操作以使所述马达选择性地脱离所述旋转驱动轴以提供所述旋转驱动轴的手动旋转。
13.根据权利要求11所述的设备，还包括控制组件，其中所述控制组件包括：
(i)传感器，所述传感器能够感测与所述钉合头部组件的操作相关联的一种或多种状况，和
(ii)控制模块，所述控制模块与所述传感器和所述马达连通，其中所述控制模块能够操作以至少部分地基于来自所述传感器的信号来控制所述马达的操作。
14.根据权利要求1所述的设备，还包括：
(a)反馈特征结构，其中所述反馈特征结构能够操作以向操作者提供听觉反馈或视觉反馈中的一者或两者以指示与所述钉合头部组件的操作相关联的状况；和
(b)控制组件，所述控制组件包括：
(i)传感器，所述传感器能够感测与所述钉合头部组件的操作相关联的一种或多种状况，和
(ii)控制模块，所述控制模块与所述传感器和所述反馈特征结构连通，其中所述控制模块能够操作以至少部分地基于来自所述传感器的信号来驱动所述反馈特征结构。
15.根据权利要求14所述的设备，其中所述设备能够在手动操作模式和机动操作模式之间切换，其中所述控制组件能够操作以驱动所述反馈特征结构以指示选择了所述手动操作模式还是所述机动操作模式。
16.根据权利要求14所述的设备，其中所述控制组件能够操作以驱动所述反馈特征结构以指示选择了所述组织夹持模式还是所述击发模式。
17.根据权利要求14所述的设备，其中所述控制组件能够操作以驱动所述反馈特征结构以指示所述砧座和所述钉合头部组件之间的距离。
18.根据权利要求1所述的设备，其中所述主体组件限定柄部。
19.一种用于钉合组织的设备，所述设备包括：
(a)钉合头部组件，其中所述钉合头部组件能够以组织夹持模式或组织钉合模式选择性地操作，其中所述钉合头部组件能够在所述组织夹持模式下操作以驱动砧座夹持组织，其中所述钉合头部组件能够在所述组织钉合模式下操作以钉合组织；
(b)旋转驱动轴，所述旋转驱动轴能够在所述组织夹持模式下操作以驱动所述钉合头部组件，其中所述旋转驱动轴还能够在所述组织钉合模式下操作以驱动所述钉合头部组件；和
(c)主体，所述主体与所述旋转驱动轴联接，其中所述主体包括：
(i)轴旋转特征结构，其中所述轴旋转特征结构能够操作以旋转所述旋转驱动轴，和
(ii)轴平移特征结构，其中所述轴平移特征结构能够操作以使所述旋转驱动轴在第一纵向位置和第二纵向位置之间平移，
其中响应于所述旋转驱动轴处于所述第一纵向位置，所述旋转驱动轴能够在所述组织夹持模式下操作以驱动所述钉合头部组件，
其中响应于所述旋转驱动轴处于所述第二纵向位置，所述旋转驱动轴能够在所述组织钉合模式下操作以驱动所述钉合头部组件。
20.一种用于钉合组织的设备，所述设备包括：
(a)钉合头部组件，所述钉合头部组件能够以组织夹持模式或组织钉合模式选择性地操作；
(b)驱动组件，所述驱动组件能够在所述组织夹持模式下操作以驱动所述钉合头部组件，其中所述驱动组件还能够在所述组织钉合模式下操作以驱动所述钉合头部组件；
(c)模式选择器，所述模式选择器能够操作以使所述钉合头部组件在所述组织夹持模式和所述组织钉合模式之间转换；和
(d)反馈特征结构，所述反馈特征结构能够操作以提供所述模式选择器的模式选择的指示。
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