CN105025815A - 用于外科缝合器的一体式组织定位和钳口对准特征结构 - Google Patents

用于外科缝合器的一体式组织定位和钳口对准特征结构 Download PDF

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CN105025815A
CN105025815A CN201480010840.4A CN201480010840A CN105025815A CN 105025815 A CN105025815 A CN 105025815A CN 201480010840 A CN201480010840 A CN 201480010840A CN 105025815 A CN105025815 A CN 105025815A
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anvil block
storehouse
end effector
constructed
projection
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CN105025815B (zh
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R·J·西姆斯
D·B·霍夫曼
J·E·泽克勒
C·J·沙伊布
J·B·沃尔兹
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Ethicon Endo Surgery Inc
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    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
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    • A61B17/0682—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • 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
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
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    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
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    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07278—Stapler heads characterised by its sled or its staple holder
    • 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
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Abstract

本发明公开了一种设备，其包括主体、与主体连通的轴以及与轴连通的端部执行器。端部执行器能够操作以驱动钉穿过组织。端部执行器包括砧座和仓。砧座能够操作以相对于仓枢转地运动。仓被定位成朝所述砧座向上驱动钉。仓包括能够操作以防止砧座侧向摇动的多个突起。多个突起指向所述砧座。在一些形式中，可在砧座和仓之间使用对准构件和/或侧向稳定构件。

Description

用于外科缝合器的一体式组织定位和钳口对准特征结构
背景技术
在一些情况下，内窥镜式外科器械可优于传统的开放式外科装置，因为较小切口可减少术后恢复时间和并发症。因此，一些内窥镜式外科器械可适于通过套管针的套管将远侧端部执行器放置在期望的手术部位处。这些远侧端部执行器(例如，内切割器、抓紧器、切割器、缝合器、施夹器、进入装置、药物/基因治疗递送装置、以及使用超声、RF、激光等的能量递送装置)可以多种方式接合组织，以达到诊断或治疗的效果。内窥镜式外科器械可包括轴，该轴位于端部执行器和由临床医生操纵的柄部部分之间。此轴可插入期望的深度并围绕轴的纵向轴线旋转，因此有利于端部执行器在患者体内的定位。还可通过添加一个或多个关节运动接头或特征结构而进一步有利于端部执行器的定位，使端部执行器能够选择性地进行关节运动，或者以其它方式相对于轴的纵向轴线偏转。
内窥镜式外科器械的示例包括外科缝合器。一些此类缝合器能够操作以夹紧压制组织的层，切割穿过夹紧的组织的层，并驱动钉穿过组织的层，以在组织的层的被切断的端部附近将切断的组织层基本上密封在一起。仅示例性的外科缝合器公开于：1989年2月21日公布的名称为“PocketConfiguration for Internal Organ Staplers”的美国专利4,805,823；1995年5月16日公布的名称为“Surgical Stapler 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 StaplerInstrument”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 for Surgical 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 StaplingInstrument Incorporating an E-Beam Firing Mechanism”的美国专利6,978,921；2006年2月21日公布的名称为“Surgical Stapling InstrumentHaving Separate Distinct Closing and Firing Systems”的美国专利7,000,818；2006年12月5日公布的名称为“Surgical Stapling Instrument having a FiringLockout 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 Instrument Incorporating a Multi-Stroke FiringMechanism 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 Instrument Incorporating a Multistroke FiringMechanism 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 Stapling Instrument Having a Single LockoutMechanism 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 Surgical Stapling 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 and Cutting Device”的美国专利7,404,508；2008年10月14日公布的名称为“Surgical Stapling Instrument HavingMultistroke Firing with Opening Lockout”的美国专利7,434,715；2010年5月25日公布的名称为“Disposable Cartridge with Adhesive for Use with aStapling Device”的美国专利7,721,930；2010年10月21日公布的名称为“Surgical Stapling Instrument with An Articulatable End Effector”的美国公布2010/0264193；和2012年9月20日公布的名称为“Motor-Driven SurgicalCutting Instrument with Electric Actuator Directional Control Assembly”的美国公布2012/0239012。上面所引用的美国专利和美国专利公布中的每一个的公开内容以引用方式并入本文。
尽管上文所涉及的外科缝合器被描述为用于内窥镜式手术，但应当理解，此类外科缝合器也可用于开腹手术和/或其他非内窥镜式手术。仅以举例的方式，在胸廓外科手术中，外科缝合器可通过胸廓切开术插入，并由此位于患者肋骨之间以到达一个或多个器官，该胸廓外科手术不使用套管针作为缝合器的导管。此手术可包括使用缝合器来切断和闭合通向肺部的血管。例如，在从胸腔移除器官之前，可通过缝合器切断和闭合通向该器官的血管。当然，外科缝合器可用于各种其他情况和手术。
虽然已经制造和使用各种类型的外科缝合器械和相关部件，但据信在本发明人之前还无人制造或使用所附权利要求中描述的发明。
附图说明
并入本说明书并构成其一部分的附图示出了本发明的多个实施例，并且与上文所给出的本发明的一般描述和下文所给出的实施例的详细描述一起用于解释本发明的原理。
图1示出示例性关节运动外科缝合器械的透视图；
图2示出图1的器械的侧正视图；
图3示出图1A的器械中的打开的端部执行器的透视图；
图4A示出图3的端部执行器沿图3的线4-4截取的侧剖面图，其中击发梁处于近侧位置；
图4B示出图3的端部执行器沿图3的线4-4截取的侧剖面图，其中击发梁处于远侧位置；
图5示出图3的端部执行器沿图3的线5-5截取的端部剖面图；
图6示出图3的端部执行器的分解透视图；
图7示出图3的端部执行器的透视图，该端部执行器定位在组织处并且已经在组织中致动一次；
图8示出在图1的器械中使用的示例性控制电路的示意图；
图9示出图1的器械的柄部组件的侧正视图，其中移除了一半外壳；
图10示出图9的柄部组件的驱动组件部件的透视图；
图11示出图10的驱动组件的细长构件的透视图；
图12示出适于结合在图1的器械中的示例性另选形式端部执行器的侧正视图；
图13示出图12的端部执行器的放大的侧正视图，示出侧向分开的向上延伸的突起；
图14示出图12的端部执行器沿图13的线14-14截取的剖面，示出侧向突起；
图15示出图12的端部执行器的图解端部视图，示出砧座的侧向滚动角；
图16示出图12的具有接合沟槽的砧座的放大的透视图；
图17示出图12的具有突起和侧向分开的向上延伸的突起的仓的放大的透视图；
图18示出图12的端部执行器的顶部图解视图，示出砧座的偏转角度；
图19示出端部执行器的另选的示例性形式的侧正视图，该端部执行器具有对准构件和侧向稳定构件；并且
图20示出沿图19的线20-20截取的剖面图，示出侧向稳定构件。
附图并非旨在以任何方式进行限制，并且可以设想本发明的各种实施例能够以多种其他方式来执行，包括那些不必在附图中示出的方式。结合于本说明书并构成其一部分的附图示出了本发明的若干方面，并与具体实施方式一起用于说明本发明的原理；然而，应当理解，本发明不限于所示出的精确布置。
具体实施方式
本发明的某些示例的如下描述不应被用来限制本发明的范围。通过以下举例说明设想用于实施本发明的最佳方式之一的描述，本发明的其它示例、特征、方面、实施例和优点将对本领域的技术人员显而易见。正如将会意识到的，本发明能够具有其它不同且明显的方面，只要不脱离本发明即可。因此，附图和具体实施方式应被视为实质上是示例性的而非限制性的。
I.示例性外科缝合器
图1-7示出示例性外科缝合和切断器械10，在图1中示出的非关节运动的状态下，其尺寸设定成穿过套管针的套管插入患者的手术部位，以便执行外科手术。仅以举例的方式，此类套管针可被插入患者的腹部，位于患者的两个肋骨之间或其他地方。在一些情况下，器械10不使用套管针。例如，器械10可通过胸廓切开术或其他类型切口直接插入。本示例的器械10包括连接到轴22的柄部部分20。轴22在远侧终止于关节运动接头11中，该关节运动接头进一步与端部执行器12耦接。应当理解，本文中使用的术语诸如“近侧”和“远侧”参照临床医生抓握器械10的柄部部分20而言。因此，端部执行器12相对于更近侧的柄部部分20位于远侧。还应当理解，为便利和清楚起见，本文结合附图使用空间术语，例如“竖直”和“水平”。然而，外科器械是在多个取向和位置中使用的，并且这些术语并非旨在进行限制，也并非绝对的。
在一些形式中，轴22是根据如下专利的教导内容中的一些构造的：与本文同一天提交的名称为“Surgical Instrument with Multi-Diameter Shaft”的美国专利申请[代理人案卷号END7181USNP.0599180]，其公开内容以引用方式并入本文。根据本文的教导内容，轴22的其他合适的构型对于本领域普通技术人员而言将是显而易见的。
一旦关节运动接头11和端部执行器12插入穿过套管针的套管通道，关节运动接头11就可以通过关节运动控件13向远处关节运动，如图1中的虚线示出的，使得端部执行器12可从轴22的纵向曲线LA以期望的角度(α)偏转。由此，端部执行器12可以从所需的角度或由于其他原因到达器官的后面或接近组织。在一些形式中，关节运动接头11能够使端部执行器12沿着单个平面偏转。在一些其他形式中，关节运动接头11能够使端部执行器沿着多于一个平面偏转。关节运动接头11和关节运动控件13可根据本文引用的多个参考中的任意参考中的教导内容来构造。另选地，关节运动接头11和/或关节运动控件13可具有任何其它合适的构型。仅以举例的方式，关节运动控件13可代替地构造为旋钮，该旋钮围绕垂直于轴22的纵向轴线LA的轴线旋转。
在一些形式中，关节运动接头11和/或关节运动控件13是根据如下专利的教导内容中的至少一些构造和操作的：与本文同一天提交的名称为“Surgical Instrument End Effector Articulation Drive with Pinion and OpposingRacks”的美国专利申请[代理人案卷号END7174USNP.0599176]，其公开内容以引用方式并入本文。关节运动接头11也可根据如下专利的教导内容中的至少一些来构造和操作：美国专利申请[代理人案卷号END7181USNP.0599180]，其公开内容以引用方式并入本文。考虑到本文的教导内容，关节运动接头11和关节控件13可以采用的各种其它合适的形式对于本领域普通技术人员而言将显而易见。
本示例的端部执行器12包括下钳口16和可枢转砧座18。在一些形式中，下钳口16是根据如下专利的教导内容中的至少一些来构造的：与本文同一天提交的名称为“Installation Features for Surgical Instrument End EffectorCartridge”的美国专利申请[代理人案卷号END7182USNP.0599227]，其公开内容以引用方式并入本文。结合到砧座18中的各种示例性另选的特征结构、构型和可操作性将在下文进行更详细的描述。此外，砧座18可根据如下专利的教导内容中的至少一些来构造：与本文同一天提交的名称为“Staple Forming Features for Surgical Stapling Instrument”的美国专利申请[代理人案卷号END7180USNP.0599175]，其公开内容以引用方式并入本文。考虑到本文的教导内容，下钳口16和砧座18可以采用的各种其它合适的形式对于本领域普通技术人员而言将显而易见。
柄部部分20包括手枪式握把24和闭合触发器26。闭合触发器26能够朝着手枪式握把24枢转，以使得砧座18朝着端部执行器12的下钳口16夹紧或闭合。砧座18的此类闭合是通过闭合管32和闭合环33提供的，这两者响应于闭合触发器26相对于手枪式握把24的枢转而相对于柄部部分20纵向地平移。闭合管32沿着轴22的长度延伸；并且闭合环33在远侧定位到关节运动接头11。关节运动接头11能够操作以将纵向运动从闭合管32传送/传输到闭合环33。
柄部部分20也包括击发触发器28。细长构件136(示于图11中)纵向延伸穿过轴22并响应于击发触发器28的致动而将纵向击发运动从柄部部分20传送至击发梁14。击发梁14的这种远侧平移使得端部执行器12中夹紧的组织被缝合和切断，如下文将更详细地描述的。然后，将触发器26、28释放以从端部执行器12释放该组织。
图3-6示出采用电子束形式的击发梁14来执行多种功能的端部执行器12。应当理解，电子束形式仅是例证性示例。击发梁14可采取任何其他合适形式，包括但不限于非电子束形式。如最佳见于图4A-4B，击发梁14包括横向取向的上部销38、击发梁顶盖44、横向取向的中部销46和在远侧呈现的切割刃48。上部销38被定位在砧座18的纵向砧座狭槽42内，并且能够在所述纵向砧座狭槽内平移。通过使击发梁14延伸穿过下钳口狭槽45(示于图4B中)，击发梁顶盖44以可滑动的方式接合下钳口16的下表面，下钳口狭槽是穿过下钳口16形成的。中部销46以滑动的方式接合下钳口16的顶表面，从而与击发梁顶盖44协作。因此，击发梁14在击发期间必然隔开端部执行器12。
一些非电子束形式的击发梁14可缺少上部销38、中部销46、和/或击发梁顶盖44。器械10的一些此类形式可仅仅依靠于闭合环33或一些其他特征结构，以在击发梁14推进到远侧位置时，将砧座18枢转到闭合位置并将砧座18保持在闭合位置中。仅通过举例的方式，击发梁14和/或相关的闭锁特征结构可根据如下专利的教导内容中的至少一些来构造：与本文同一天提交的名称为“Lockout Feature for Movable Cutting Member of SurgicalInstrument”的美国专利申请[代理人案卷号END7175USNP.0599231]，其公开内容以引用方式并入本文。根据本文的教导内容，击发梁14可以采取的其他合适的形式对于本领域的普通技术人员将是显而易见的。
图3示出本示例的朝近侧定位的击发梁14和枢转到打开位置的砧座18，从而允许未耗尽的钉仓37可移除地安装到下钳口16的通道中。如最佳见于图5-6，本示例的钉仓37包括仓体70，该仓体呈现出上部平台72并与下部仓托盘74联接。如最佳见于图3，竖直狭槽49是穿过钉仓37的一部分形成的。还最佳见于图3，三排钉孔51在竖直狭槽49的一侧上穿过上部平台72形成，其中另一组三排钉孔51在竖直狭槽49的另一侧上穿过上部平台72形成。当然，可提供任何其他合适数量钉排(例如，两排、四排、或其他数量)。重新参见图4A-6，楔形滑动件41和多个钉驱动器43被捕获在仓体70和托盘74之间，其中楔形滑动件41位于钉驱动器43近侧。楔形滑动件41能够在钉仓37内纵向地运动；而钉驱动器43能够在钉仓37内竖直地运动。钉47也被定位在仓体70内，处于对应的钉驱动器43上方。具体地，每个钉47在仓体70内被钉驱动器43竖直地驱动，以将钉47驱动穿出相关的钉孔51。如最佳见于图4A-4B和6，楔形滑动件41存在倾斜凸起表面，当楔形滑动件41朝远侧驱动穿过钉仓37时，该倾斜凸起表面向上推动钉驱动器43。
结合到钉仓37中的各种示例性部件、构型和可操作性将在下文进行更详细的描述。钉仓37也可根据如下专利的教导内容中的至少一些来构造和操作：美国专利申请[代理人案卷号END7182USNP.0599227]，其公开内容以引用方式并入本文。根据本文的教导内容，钉仓37可采取的其他合适的形式对于本领域的普通技术人员将是显而易见的。
在通过朝远侧推进闭合管32和闭合环33以使端部执行器12如图4A-4B所示闭合的情况下，通过使上部销38进入纵向砧座狭槽42，将击发梁14推进至与砧座18接合。推块80(示于图5中)位于击发梁14的远侧端部处，并且被构造为能够接合楔形滑动件41，使得当激发触发器28被致动时，楔形滑动件41随着击发梁14被朝远侧推进穿过钉仓37，而被推块80朝远侧推动。在此类击发期间，击发梁14的切割刃48进入钉仓37的竖直狭槽49，从而切断夹紧在钉仓37和砧座18之间的组织。如图4A-4B所示，中间销46和推块80通过进入钉仓37内的狭槽49中来一起致动钉仓37，从而将楔形滑动件41驱动成与钉驱动器43发生向上顶起接触，继而将钉47向外驱动穿过钉孔51并使钉47与砧座18的内表面上的钉成形凹坑53(示于图3)形成接触。图4B示出在完成切断和缝合组织之后完全朝远侧平移的击发梁14。应当理解，钉成形凹坑53在图4A-4B的视图中被有意省略；但钉成形凹坑53示出于图3中。还应当理解，砧座18在图5中被有意省略。
图7示出端部执行器12，所述端部执行器已通过单个行程而被致动穿过组织90。如图所示，切割刃48(图7中模糊部分)已经切穿组织90，同时在切割刃48形成的切割线的每一侧上，钉驱动器43已经使交替的三排钉47驱动穿过组织90。在该示例中，钉47全部与切割线基本上平行地取向，但应当理解，钉47可被定位成任何适合的取向。在本示例中，在第一行程完成之后，端部执行器12从套管针撤回，用新的钉仓替换耗尽的钉仓37，然后将端部执行器12再次穿过套管针插入，以到达缝合部位用于进一步的切割和缝合。这个过程可以重复，直到提供了期望量的切口和钉47。可能需要将砧座18闭合以有利于通过套管针来插入和撤回；并且可能需要将砧座18打开以有利于替换钉仓37。
应当理解，在每个致动行程期间，切割刃48可在钉47被驱动穿过组织时基本上同时切断组织。在本示例中，切割刃48仅稍微落后于钉47的驱动，使得钉47正好在切割刃48穿过组织之前被驱动穿过该组织的相同区域，但应当理解，这个顺序可以颠倒，或者切割刃48可以直接与相邻的钉同步。虽然图7示出端部执行器12在组织90的两个层92、94中被致动，但应当理解，端部执行器12可被致动穿过组织90的单个层或者组织的多于两个层92、94。还应当理解，与切割刃48产生的切割线相邻的钉47的成形和定位可基本上密封所述切割线处的组织，从而减少或防止切割线处的出血和/或其它体液的渗漏。此外，尽管图7示出端部执行器12在组织的两个基本上平的相反的平面层92、94中致动，但应当理解，端部执行器12也可在管状结构诸如血管、胃肠道的一部分等上致动。因此，不应将图7视为对端部执行器12的设想用途进行任何限制。根据本文的教导内容，可使用器械10的各种适合的情况和程序对于本领域的普通技术人员将是显而易见的。
应当理解，可以根据以下专利的教导内容中的任何内容来构造和操作器械10：美国专利4,805,823；美国专利5,415,334；美国专利5,465,895；美国专利5,597,107；美国专利5,632,432；美国专利5,673,840；美国专利5,704,534；美国专利5,814,055；美国专利6,978,921；美国专利7,000,818；美国专利7,143,923；美国专利7,303,108；美国专利7,367,485；美国专利7,380,695；美国专利7,380,696；美国专利7,404,508；美国专利7,434,715；美国专利7,721,930；美国公布2010/0264193；和/或2012/0239012。如上所述，这些专利中的每一个的公开内容均以引用方式并入本文。可提供用于器械10的附加示例性修改将更详细地描述于下文中。下述教导内容并入器械10中的各种适合方式对本领域的普通技术人员将显而易见。类似地，将下述教导内容与本文引用的专利/公布的各种教导内容进行组合的各种适合方式对本领域的普通技术人员将是显而易见的。还应当理解，下述教导内容并不限于本文引用的专利中所教导的器械10或装置。下述教导内容可容易地施加于各种其他种类的器械，包括未被归类为外科缝合器的器械。根据本文的教导内容，可以应用下述教导内容的各种其它适合装置和情况对于本领域的普通技术人员将是显而易见的。
II.示例性机动化驱动特征结构
在本示例中，器械10提供对击发梁14的机动化控制。图8-11示出可被用来提供对击发梁14的机动化控制的示例性部件。具体地，图8示出示例性控制电路100，该控制电路可被用来从电池组104(同样示于图1-2)使用电力对电动马达102供电。电动马达102能够操作以将击发梁14纵向平移，如将在下文所详述。应当理解，整个控制电路100，包括马达102和电池组104，可被封装在柄部部分20内。图8示出作为打开的开关的击发触发器28，但应当理解，该开关在击发触发器28致动时是闭合的。本示例的电路100包括必须是闭合的以便使电路100完整的安全开关106，但应当理解，安全开关106仅仅是任选的。可通过致动柄部部分20上的分开按钮、滑块、或其他特征结构来使安全开关106闭合。
本示例的电路100还包括闭锁开关108，该闭锁开关默认是闭合的，但是被构造为能够响应于闭锁条件而自动打开。仅以举例的方式，闭锁条件可包括以下中的一者或多者：下钳口16中缺少仓37、下钳口16中存在耗尽的(例如，先前击发的)仓37、未充分闭合的砧座18、确定器械10已被击发很长时间、和/或任何其他合式的条件。根据本文中的教导内容，可以用来检测闭锁条件的各种传感器、算法和其他特征结构对本领域的普通技术人员是显而易见的。类似地，根据本文的教导内容，其他合适种类的闭锁条件对于本领域的普通技术人员将是显而易见的。应当理解，电路100是打开的，因此，当闭合开关108打开时，马达102不能够操作。闭锁指示器110(例如LED等)能够操作以提供对闭锁开关108的状态的视觉指示。仅以举例的方式，闭锁开关108、闭锁指示器110、和相关联的部件/功能可根据下述专利的教导内容中的至少一些来构造：2010年1月12日公布的名称为“Electronic Lockouts and Surgical Instrument Including Same”的美国专利7,644,848，其公开内容以引用方式并入本文；
一旦击发梁14到达最远侧位置(例如，在切割行程的末端)，行程结束开关112自动转换到闭合位置，从而逆转施加到马达102的电压的极性。这逆转马达102的旋转方向，应当理解，操作者在该操作阶段将使击发触发器28释放。在该操作状态下，电流流过反向指示器114(例如LED等)，以向操作者提供马达102方向已逆转的视觉指示。考虑到本文的教导内容，当击发梁14到达最远侧位置时，行程结束开关112可自动切换到闭合位置的各种合适方式对于本领域的普通技术人员而言将显而易见。类似地，考虑到本文的教导内容，反向指示器114可以采用的各种合适的形式对于本领域的普通技术人员而言将显而易见。
本示例的柄部部分20还包括手动返回开关116，其也示于电路100中。手动返回开关116被构造为能够充当“紧急救助”(bailout)特征结构，使操作者在击发行程期间能够快速开始朝近侧回缩击发梁14。换句话讲，当击发梁14仅已被部分地朝远侧推进时，手动返回开关116可手动致动。手动返回开关116可提供与行程结束开关112类似的功能性，即逆转施加到马达102的电压的极性，以由此逆转马达102的旋转方向。同样，该逆转在视觉上可通过反向指示器114来指示。
在一些形式中，开关28、106、108、112、116中的一者或多者为微型开关的形式。根据本文的教导内容，其它合适形式对于本领域的普通技术人员将是显而易见的。除此之外或作为前述的代替，电路100的至少一部分可根据如下专利的教导内容中的至少一些来构造：2012年7月3日提交的名称为“Motor-Driven Surgical Instrument”的美国专利8,210,411，其公开内容以引用方式并入本文。
图9-11示出可被用来提供对击发梁14的机动化控制的各种机械部件。具体地，图9示出封装在柄部部分20的手枪式握把24中的马达102。应当理解，电池组104(示于图1-2中)也可位于手枪式握把24中(例如，在马达102下方)和/或柄部部分20内其他地方。马达102具有与齿轮组件122联接的驱动轴120。齿轮组件122具有外部壳体(未示出)，并且能够操作以驱动上部齿轮126，示于图10中。上部齿轮126与小齿轮128啮合，小齿轮由固定在柄部部分20中的销129可旋转地支撑。因此，应当理解，马达102的激活将最终使小齿轮128在柄部部分20内旋转。
正如还在图9-10中示出，平移齿条130包括齿132，该齿与小齿轮128啮合使得齿条130在小齿轮128旋转时纵向平移。如图11中所示，齿条130与细长构件136联接，该细长构件延伸穿过轴22并包括与击发梁14的近侧端部联接的远侧端部138。细长构件136在轴22内平移，使得细长构件136将齿条130的纵向运动传送到击发梁14。因此，应当理解，马达102的激活将最终使击发梁14在端部执行器12内平移。具体地，马达102可朝远侧驱动击发梁14以切断组织90，以及将钉47驱动到组织90中。开关致动臂134从齿条130侧向延伸，并且定位成当击发梁14到达最远侧位置(例如，在组织90已经被切断且钉47已经被驱动到组织90中后)时接合行程结束开关112。如上所述，与行程结束开关112的接合自动地逆转马达102使击发梁14从最远侧位置返回到近侧位置，使砧座18能够枢转远离下钳口16以释放组织90。
使用术语“枢转”(以及与作为基础的“枢转”类似的术语)不应被解读为必须要求围绕固定轴线进行枢转运动。在一些形式中，砧座18围绕由销(或类似的特征结构)限定的轴线枢转，该销(或类似的特征结构)在砧座18朝下钳口16移动时，沿着细长狭槽或通道滑动。在此类形式中，枢转轴线沿着由狭槽和通道限定的路径平移，而砧座18同时围绕该轴线枢转。此外或另选地，枢转轴线首先可沿着狭槽/通道滑动，然后砧座18在枢转轴线已经沿着狭槽/通道滑动到某距离后围绕该枢转轴线枢转。应当理解，此类滑动/平移枢转运动包含在术语诸如“枢转(pivot/pivots/pivoting)”、“枢转的”、“能够枢转的”等内。当然，一些形式可提供砧座18围绕保持固定且不在狭槽或通道内平移的轴线的枢转运动等。
除此之外或作为前述的代替，可操作以驱动击发梁14的特征结构可根据如下专利的教导内容中的至少一些来构造：美国公布2012/0239012，其公开内容以引用方式并入本文；和/或美国公布2012/0239012，其公开内容以引用方式并入本文。考虑到本文的教导内容，用于提供击发梁14的机动的其它合适的部件、特征结构和构型对本领域普通技术人员而言将显而易见。还应当理解，一些其他形式可提供对击发梁14的手动驱动，使得省略马达。仅以举例的方式，击发梁14可根据本文引用的任何其他专利/公布参考的教导内容中的至少一些进行致动。
III.具有稳定特征结构的示例性端部执行器
在一些情况下，可能期望提供一种机构，该机构用于确保砧座18在将钉47击发到组织90中之前已经直角地抵靠着仓37地夹紧并相对于仓37处于合适的高度。例如，在砧座18和仓37夹紧通常在一个区域中较薄且在另一个区域中较厚的组织的情况下，可能期望使砧座18对准抵靠仓37，即使有不平的组织夹紧在它们之间。在夹紧组织时，还可能期望防止砧座18相对于仓37侧向滚动和/或侧向枢转偏转。
图12示出能够操作以与器械一起使用的示例性端部执行器212，该器械诸如图1中所示的器械10。例如，端部执行器212可用于代替端部执行器12。应当理解，端部执行器212可与关节运动机构11一体式形成或者可分开形成并可移除地连接到关节运动机构11。参考本文的教导内容，其他合适的变型对于本领域的普通技术人员而言将是显而易见的。端部执行器212包括砧座218和下钳口216。下钳口216能够操作以保持钉仓237。一般来讲，砧座218抵靠着仓237地夹紧，以将组织夹紧在它们之间。然后，仓237内的钉可被击发到组织中，并由于钉抵靠砧座218弯曲而锚固在组织中。关于夹紧组织和击发钉，端部执行器212与图1的端部执行器12基本类似。由于砧座218接触仓237，将在下文进一步讨论的特征结构可用来侧向稳定砧座218。因此，钉(诸如钉47)可从仓237击发穿过组织并抵靠砧座218，而不使砧座218相对于仓237侧向倾斜。
图13示出端部执行器212的放大的视图。仓237包括多个侧向分开的向上延伸的突起250。如图14中可见，侧向突起250包括两个侧向隔开的突起250。突起250被隔开，使得当砧座218闭合在仓237上时，砧座218不关于仓237侧向摇动。在示例性形式中，突起250具有浅的倒圆的形状，但应当理解，根据本文的教导内容，可以使用的突起250的任何合适形状对本领域的普通技术人员而言将是显而易见的。例如，突起250可具有尖的或凸起的平台形状。在一些形式中，突起250能够沿着仓237的长度定位。
图15示出端部执行器212的图解端部视图，示出砧座218相对于纵向轴线260的滚动角θ213，该纵向轴线延伸穿过端部执行器212的中心。应当理解，该滚动角θ213表示在砧座218抵靠着仓237地夹紧时，组织90使砧座滚动的从0°角的正的或负的侧向滚动。侧向突起250能够操作以提供砧座218和仓237之间的两个接触点，使得当砧座218接触侧向突起250时，砧座218的滚动角θ213保持大约接近0°。应当理解，由于将组织夹紧在砧座218和仓237之间，滚动角θ213可偏离0°，但由于由突起250提供的双接触点，该偏离仅是轻微的。换句话讲，当砧座218闭合在仓237上，在仓237上的闭合运动期间，砧座218可侧向滚动；然而，砧座218和突起250之间的接触能够操作以纠正砧座218的任何侧向滚动。因此，在击发钉之前，钉成形凹坑253(见图16)与孔251(见图17)对准。此外，突起250一致地形成在将砧座218的预加载施加在仓237的上部平台的地方。尽管该示例性形式示出位于仓237上的突起250，应当理解，此外或者另选地，突起250可定位在砧座218上。根据本文的教导内容，用于侧向稳定砧座218的突起250的其它合适的位置对本领域的普通技术人员而言将是显而易见的。图13进一步示出具有突起219的砧座218，该突起能够操作以接合突起250，由此促进仓237和砧座218之间的进一步接触。突起219被成形为大体平坦的表面，但是根据本文的教导内容，可使用的其他合适的形状对于本领域的普通技术人员而言将是显而易见的。突起219还可见于图16中。
还应理解，在一些情况下，由于砧座218抵靠着仓237地闭合，可能期望防止或纠正砧座218相对于仓237的侧向枢转偏转。
图16示出砧座218的下侧视图，示出接合沟槽270。接合沟槽270被成形为砧座218内的细长半球形沟槽，但应当理解，接合沟槽270可具有接收突起272(示于图17中)的任何合适的形状，这将在下文更详细地讨论。例示的形式中的沟槽270包括直的弯曲部分271和球形的弯曲部分273，该球形的弯曲部分与该直的弯曲部分侧面相接以形成沟槽270。示例性形式的沟槽270沿着砧座218在一侧居中，但是可使用沟槽270的其他合适的位置。在例示的形式中，接合沟槽270定位成使得当砧座218抵靠着仓237地闭合时，接合沟槽270和突起250形成大体三角形形状。当然，该构型仅仅是例示性的示例，并且这些特征结构能够受制于各种合适的另选布置。在本示例中，砧座218被成形为朝着接合沟槽270侧向渐缩，但是根据本文的教导内容，可使用的砧座218的任何合适形状对本领域的普通技术人员而言将是显而易见的。
图17示出具有突起272的端部执行器212的仓237。应当理解，当砧座218抵靠着仓237地闭合时，突起272能够装配在接合沟槽270内。具体地，当砧座218朝仓237按压，突起272可首先接触半球形弯曲部分273，然后滑动到直的弯曲部分271。应当理解，接合沟槽270的尺寸大于突起272的尺寸。因此，突起272不需要与接合沟槽270完全对准以使接合沟槽270抓住突起272。本示例性形式中的仓237朝突起272侧向地和竖直地渐缩以形成窄的顶端，但是应当理解，根据本文的教导内容，可使用的仓237的任何合适的形状对于本领域的普通技术人员而言将是显而易见的。
突起272能够操作以抓住接合沟槽270的一部分，诸如球形的弯曲部分273，其后接合沟槽270的弯曲轮廓使突起272能够滑动到接合沟槽270的更中心的部分中，使得直的弯曲部分271能够装配在突起272和接合沟槽270之间。一旦突起272和接合沟槽270彼此完全接合，则应当理解，砧座218不能够相对于仓237侧向偏转。例如，在示例性形式中，接合沟槽270的宽度与突起272的直径互补，由此防止砧座218的偏转，并促进砧座218和仓237对准。然而，接合沟槽270的长度比突起272的直径长，由此促进突起272和接合狭槽270的结合，并进一步促进突起272滑动到接合沟槽270的直的弯曲部分271中。应当理解，如果砧座218在闭合期间侧向枢转地偏转，则接合沟槽270和突起272协作以将砧座218引导成对准。
图18示出延伸穿过端部执行器212的中心的纵向轴线260。偏转角β262表示纵向轴线260向左或向右偏转的量，在一些情形下，在使用期间，砧座218可经历该偏转。例如，在如下情况可发生砧座218的偏转：在砧座218抵靠着仓237地夹紧时较厚或尤其密的组织被定位在砧座218和仓237之间，或者当砧座218和下钳口216之间的区域中的组织的密度和厚度在砧座218和下钳口216的宽度上变化时。当然，如上讨论，应当理解，通过使接合沟槽270与突起272接合，使砧座218抵抗偏转，由此相对于纵向轴线260将偏转角β262保持在大约0°。应当理解，在一些情况下，可发生轻微偏转，但是一般来讲，突起272和接合沟槽270相对于纵向轴线260将偏转角β262保持在或接近于0°。
此外，如图16中可见，砧座218具有砧座顶端220，其中砧座顶端220具有弯曲的倾斜的形状，朝仓237成角度。应当理解，砧座顶端220的弯曲形状与仓237的形状互补，使得砧座218进一步抵抗相对于仓237的偏转。尽管示例性形式示出砧座顶端220具有弯曲的形状，应当理解，砧座顶端220不必必须具有弯曲形状，并且接合沟槽270和突起272可用于其中砧座顶端220相对于砧座218的其余部分以直的方式取向的情形中。实际上，接合沟槽270和突起272还可与仓237结合使用，该仓为直的而不具有成角度的顶端，例如如图12中所见。
图19示出端部执行器312的另选的示例性形式。应当理解，端部执行器312可用来与图1和12中所见端部执行器12、212交换或代替它们而使用。端部执行器312包括砧座318和下钳口316。下钳口316与仓337连通，该仓能够操作以如图3中所示相对于下钳口16和仓37的基本上类似的方式来保持多个钉。砧座顶端320弯曲成大体与仓237的形状互补，但是应当理解，砧座顶端320可具有其他合适的形状。
端部执行器312还包括远侧定位的砧座对准构件370和侧向稳定构件372。应当理解，对准构件370能够操作以在端部执行器312的远侧端部处限定砧座318和仓337之间的间隔。此外，侧向稳定构件372能够操作以侧向地使砧座318稳定抵靠仓337，这在下文将进一步详细描述。
本示例的对准构件370具有带三角形剖面的楔形形状。应当理解，对准构件370的三角形楔形形状被构造为能够与砧座318和仓337的轮廓互补。例如，在一些情况下，基于放置在砧座318和仓337之间的组织的类型和/或厚度，可能期望保持砧座318和仓337之间的特定距离。对准构件370因此可定位在砧座318的一部分和仓337之间，以防止砧座318比使用者所期望的进一步抵靠着仓337地闭合。此外，不仅对准构件370防止砧座318进一步抵靠着仓337地闭合，而且对准构件370允许砧座318与仓337保持特定距离。此外，对准构件370填充砧座318和仓337之间的空间，使得砧座318的远侧端部和仓337在将对准构件370放置在它们之间的情况下，形成防止损伤的钝的端部，该防止损伤的钝的端部可用来推动端部执行器312穿过组织，使砧座318或仓337在不经意的情况下不抓住组织。在该示例性形式中，砧座318和仓337具有平坦轮廓，在该平坦轮廓处，砧座318和仓337接触对准构件370。然而，应当理解，根据本文的教导内容，砧座318和仓337可具有其他合适的形状，这对于本领域的普通技术人员将是显而易见的。因此，对准构件370也可具有任何合适的形状来与砧座318和仓337互补。应当理解，在一些形式中，对准构件370相对于砧座318或仓337是可移除的，或者与砧座318或仓337一体式形成。在其他示例性形式中，应当理解，对准构件370可被分开，使得一部分连接到砧座318，而另一部分连接到仓337。在一些情况下，端部执行器312可被提供有多个模块化对准构件370，该多个模块化对准构件具有不同的形状和尺寸，使得使用者能够例如在一种类型的组织中使用一种形状的对准构件370，以及在另一种类型的组织中使用另一种形状的对准构件370。
侧向稳定构件372也可见于图19中，并且此外，图20示出侧向稳定构件372的前剖面图。侧向稳定构件372包括多件材料，该多件材料能够操作以提供砧座318和仓337之间的侧向接触。如图20中所能见，侧向稳定构件372包括两个接触构件，其中该两个接触构件之间设置有空间。应当理解，通过将侧向稳定构件372放置在砧座318和仓337的相对的侧面处，当在使用期间砧座318闭合在仓337上时，砧座318与侧向稳定构件372接触。当与侧向稳定构件372接触时，侧向地使砧座318稳定，使得砧座318相对于仓337不左右摇动。具体地，侧向稳定构件372提供沿着侧向稳定构件372的接触表面，以用于砧座318接触。因此，应当理解，当砧座318闭合在仓337上时，即使由于抵靠不同厚度或密度的组织按压而使砧座318可能侧向地滚动，一旦砧座318抵靠着侧向稳定构件372地闭合，则砧座318在侧向上变直。因此，侧向稳定构件372类似于图13中的突起250来起作用。在一些示例性形式中，侧向稳定构件372可定位在砧座318上而不在仓337上。在其他示例性形式中，侧向稳定构件372可放置在砧座318和仓337两者上。根据本文的教导内容，侧向稳定构件372的其他合适形式对本领域普通技术人员将是显而易见的。应当理解，在一些形式中，侧向稳定构件372和/或对准构件370可结合图13中所示的端部执行器212使用，由此提供进一步增加的稳定。
IV.其它方面
应当理解，本文所述的教导内容、表达方式、实施例、示例等中的任何一者或多者可与本文所述的其他教导内容、表达方式、实施例、示例等中的任何一者或多者相结合。上述教导内容、表达方式、实施例、示例等不应视为彼此孤立。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将对本领域的普通技术人员显而易见。此类修改和变型旨在包括在权利要求书的范围内。
应当理解，所述以引用的方式并入本文中的任何专利、出版物或其他公开材料，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、陈述或者其他公开材料不冲突的范围内并入本文。同样并且在必要的程度下，本申请明确阐述的公开内容取代了以引证方式并入本申请的任何冲突材料。以引用方式并入本文但与本文所述的现有定义、陈述或其它公开材料相冲突的任何材料或其部分，仅在所并入的材料和现有的公开材料之间不产生冲突的程度下并入本文。
上文所述的装置的形式可适用于由医疗专业人员进行的常规医疗处理和手术中、以及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机器人外科系统诸如Intuitive Surgical,Inc.(Sunnyvale,California)的DAVINCITM系统中。类似地，本领域的普通技术人员将认识到本文中的各种教导内容可易于结合如下专利中的任何专利的各种教导内容：1998年8月11日公布的名称为“Articulated SurgicalInstrument For Performing Minimally Invasive Surgery With Enhanced Dexterityand Sensitivity”的美国专利5,792,135，其公开内容以引用方式并入本文；1998年10月6日公布的名称为“Remote Center Positioning Device withFlexible Drive”美国专利5,817,084，其公开内容以引用方式并入本文；1999年3月2日公布的名称为“Automated Endoscope System for OptimalPositioning”的美国专利5,878,193，其公开内容以引用方式并入本文；2001年5月15日公布的名称为“Robotic Arm DLUS for Performing SurgicalTasks”的美国专利6,231,565，其公开内容以引用方式并入本文；2004年8月31日公布的名称为“Robotic Surgical Tool with Ultrasound Cauterizing andCutting Instrument”的美国专利6,783,524中，其公开内容以引用方式并入本文；2002年4月2日公布的名称为“Alignment of Master and Slave in aMinimally Invasive Surgical Apparatus”的美国专利6,364,888，其公开内容以引用方式并入本文；2009年4月28日公布的名称为“Mechanical ActuatorInterface System for Robotic Surgical Tools”的美国专利7,524,320，其公开内容以引用方式并入本文；2010年4月6日公布的名称为“Platform LinkWrist Mechanism”的美国专利7,691,098，其公开内容以引用方式并入本文；2010年10月5日公布的名称为“Repositioning and Reorientation ofMaster/Slave Relationship in Minimally Invasive Telesurgery”的美国专利7,806,891，其公开内容以引用方式并入本文；2013年1月10日公布的名称为“Automated End Effector Component Reloading System for Use with aRobotic System”的美国公布2013/0012957，其公开内容以引用方式并入本文；2012年8月9日公布的名称为“Robotically-Controlled SurgicalInstrument with Force-Feedback Capabilities”的美国公布2012/0199630，其公开内容以引用方式并入本文；2012年5月31日公布的名称为“ShiftableDrive Interface for Robotically-Controlled Surgical Tool”的美国公布2012/0132450，其公开内容以引用方式并入本文；2012年8月9日公布的名称为“Surgical Stapling Instruments with Cam-Driven Staple DeploymentArrangements”的美国公布2012/0199633，其公开内容以引用方式并入本文；2012年8月9日公布的名称为“Robotically-Controlled MotorizedSurgical End Effector System with Rotary Actuated Closure Systems HavingVariable Actuation Speeds”的美国公布2012/0199631，其公开内容以引用方式并入本文；2012年8月9日公布的名称为“Robotically-Controlled SurgicalInstrument with Selectively Articulatable End Effector”的美国公布2012/0199632，其公开内容以引用方式并入本文；2012年8月9日公布的名称为“Robotically-Controlled Surgical End Effector System”的美国公布2012/0203247，其公开内容以引用方式并入本文；2012年8月23日公布的名称为“Drive Interface for Operably Coupling a Manipulatable Surgical Tool toa Robot”的美国公布2012/0211546，其公开内容以引用方式并入本文；2012年6月7日公布的名称为“Robotically-Controlled Cable-Based Surgical EndEffectors”的美国公布2012/0138660，其公开内容以引用方式并入本文；和/或2012年8月16日公布的名称为“Robotically-Controlled Surgical EndEffector System with Rotary Actuated Closure Systems”的美国公布2012/0205421，其公开内容以引用方式并入本文。
上文所述的形式可被设计为单次使用后丢弃，或者它们可被设计为可多次使用。在上述任一种或两种情况下，都可对这些形式进行修复，以便在使用至少一次后再使用。修复可包括以下步骤的任意组合：拆卸装置、然后清洗或替换特定部件和随后进行重新组装。具体地，可拆卸所述装置的一些形式，并且可选择性地以任何组合形式来替换或取出所述装置的任意数量的特定部件或零件。在清洗和/或更换特定零件时，所述装置的一些形式可在修复设施中重新组装或者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了解，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。这些技术的用途以及得到的重新修复装置均在本发明的范围内。
仅通过举例的方式，本文描述的形式在手术之前和/或之后可被消毒。在一种消毒技术中，将装置放置在闭合并密封的容器中，例如，塑料袋或TYVEK袋中。然后可将容器和装置放置在可穿透所述容器的辐射场中，诸如γ辐射、X射线或高能电子。辐射可将装置上和容器中的细菌杀死。消毒后的装置随后可存放在无菌容器中，以供以后使用。还可使用本领域已知的任何其他技术对装置消毒，包括但不限于β辐射或γ辐射、环氧乙烷或蒸汽。
上文已经示出和描述了本发明的多个实施例，可由本领域的普通技术人员在不脱离本发明范围的情况下进行适当修改来实现本文描述的方法和系统的进一步改进。已经提及了若干此类潜在修改形式，并且其它修改形式对本领域的技术人员将是显而易见的。例如，上文所讨论的例子、实施例、几何形状、材料、尺寸、比率、步骤等均是示例性的而非所要求的。因此，本发明的范围应根据下面的权利要求书来考虑，并且应理解为不限于说明书和附图中示出和描述的结构和操作细节。

Claims (20)

1.一种设备，所述设备包括：
(a)主体；
(b)与所述主体连通的轴；
(c)与所述轴连通的端部执行器，其中所述端部执行器被构造为能够驱动连续定位的钉穿过组织，其中所述端部执行器包括：
(i)砧座，和
(ii)仓，其中所述砧座能够操作以相对于所述仓运动，其中所述仓被定位成朝所述砧座向上驱动钉，其中所述仓包括被构造为能够防止所述砧座侧向摇动的至少一个突起，其中所述至少一个突起指向所述砧座。
2.根据权利要求1所述的设备，其中所述砧座的远侧部分被成形为朝所述仓弯曲。
3.根据权利要求1所述的设备，其中所述至少一个突起包括定位在所述仓的远侧端部处的一对侧向地间隔开的凸耳。
4.根据权利要求1所述的设备，其中所述砧座包括朝所述仓延伸的至少一个砧座突起，其中所述至少一个砧座突起被构造为能够接合所述仓的所述至少一个突起。
5.根据权利要求4所述的设备，其中所述砧座包括朝所述仓延伸的多个突起，其中所述仓具有朝所述砧座延伸的仅一个突起。
6.根据权利要求1所述的设备，其中所述砧座和所述仓被成形为朝所述端部执行器的远侧端部侧向地渐缩。
7.根据权利要求1所述的设备，其中所述砧座包括接合沟槽。
8.根据权利要求7所述的设备，其中所述接合沟槽具有大于其直径的长度。
9.根据权利要求7所述的设备，其中所述仓包括被构造为能够接合所述接合沟槽的突起。
10.根据权利要求9所述的设备，其中所述接合沟槽具有成轮廓的弯曲形状，所述成轮廓的弯曲形状能够操作以与球形接合件的弯曲部互补。
11.根据权利要求9所述的设备，其中所述接合沟槽具有比球形接合件长的长度。
12.根据权利要求1所述的设备，所述设备还包括被构造为能够接合所述砧座和所述仓的对准构件，其中所述对准构件具有楔形形状。
13.根据权利要求1所述的设备，所述设备还包括被构造为能够接合所述砧座和所述仓的对准构件，其中所述对准构件被构造为能够向所述砧座和所述仓提供平坦接触表面。
14.根据权利要求1所述的设备，所述设备还包括被构造为能够接合所述砧座和所述仓的对准构件，其中所述对准构件被成形为与所述砧座的轮廓和所述仓的轮廓互补。
15.根据权利要求1所述的设备，所述设备还包括在所述砧座和所述仓之间侧向地间隔开的一对侧向稳定构件。
16.一种设备，所述设备包括：
(a)主体；
(b)与所述主体连通的端部执行器，其中所述端部执行器包括砧座和仓，其中所述砧座被构造为能够抵靠着所述仓地闭合，其中所述砧座和所述仓被构造为能够抵靠组织地夹紧；和
(c)定位在所述砧座和所述仓之间的侧向稳定特征结构，其中所述侧向稳定特征结构在所述砧座的中心平面和所述仓的中心平面之间保持平行对准。
17.根据权利要求16所述的设备，其中所述侧向稳定特征结构包括定位在所述砧座和所述仓之间的多个侧向地对准的突起。
18.根据权利要求16所述的设备，其中所述端部执行器限定延伸穿过所述端部执行器的纵向轴线，其中在所述砧座相对于所述纵向轴线侧向滚动时形成滚动角，其中所述侧向稳定特征结构被构造为能够当所述砧座抵靠着组织和所述仓地夹紧时保持基本上为0°的滚动角。
19.根据权利要求18所述的设备，其中所述砧座包括沟槽，其中所述仓包括球形部，所述球形部被成形成能够装配在所述沟槽中，其中所述沟槽和所述球形部被构造为能够接合以防止所述砧座相对于所述纵向轴线侧向枢转偏转。
20.一种设备，所述设备包括：
(a)主体；
(b)与所述主体连通的端部执行器，其中所述端部执行器包括：
(i)砧座，和
(ii)仓，其中所述砧座被构造为能够抵靠所述仓地闭合，其中所述仓包括多个侧向地定位的突起，所述突起被构造为能够当所述砧座抵靠所述仓地闭合时在所述多个侧向地定位的突起中的每个突起处接触所述砧座，其中所述多个侧向地定位的突起被构造为能够抵靠所述仓地侧向稳定所述砧座；和
(c)定位在所述砧座和所述仓之间的对准构件，其中所述对准构件被构造为能够在所述砧座被定位成抵靠所述仓地闭合时同时接合所述砧座的远侧端部和所述仓的远侧端部。
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CN110167465A (zh) * 2016-11-14 2019-08-23 爱惜康有限责任公司 具有凹入平台的圆形外科缝合器
CN110114016A (zh) * 2016-12-21 2019-08-09 爱惜康有限责任公司 具有刀狭槽宽度的砧座
CN110114016B (zh) * 2016-12-21 2022-08-09 爱惜康有限责任公司 具有刀狭槽宽度的砧座
CN110505846A (zh) * 2017-02-17 2019-11-26 爱惜康有限责任公司 具有弯曲砧座末端、成角度的钉仓末端和组织抓持特征部的外科缝合器
CN110505846B (zh) * 2017-02-17 2023-08-08 爱惜康有限责任公司 具有弯曲砧座末端、成角度的钉仓末端和组织抓持特征部的外科缝合器

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