CN105073036A - 具有多个夹紧机构的外科器械 - Google Patents
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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
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
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- A—HUMAN NECESSITIES
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- A61B17/32—Surgical cutting instruments
- A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
- A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
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- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
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- A61B90/03—Automatic limiting or abutting means, e.g. for safety
Abstract
本发明公开了一种用于外科器械的嵌套式触发器组件,其可以大体包括第一触发器和第二触发器,其中第一触发器和第二触发器能够在嵌套式触发器组件的第一行程上一起运动,其中第二触发器能够在第一行程之后和第二行程之前偏置远离第一触发器,并且其中第二触发器能够在第二行程期间向第一触发器运动。一种外科器械可以大体包括:轴,该轴包括近侧端部和远侧端部;柄部,该柄部从近侧端部延伸,其中该柄部包括抓握部分;和从该柄部延伸的嵌套式触发器组件。该嵌套式触发器组件可以包括可分离触发器组件和可分开触发器组件中的一种。
Description
背景技术
1.技术领域
本申请大体涉及医疗装置和方法,并且具体而言,涉及被构造成能够焊接和/或切入组织的外科器械。
2.相关领域的说明
在多种情况下,外科器械能够被构造成向组织施加能量,以便处理和/或破坏该组织。在某些情况下,外科器械可以包括一个或多个电极,该电极可以靠着组织定位和/或相对于组织定位,使得电流可以流过该电极并且流入到组织中。该外科器械还可以包括电气输入端、与电极电气联接的供电导体和/或返回导体,该返回导体可以能够例如允许电流从电气输入端流过供电导体,流过电极和组织,然后流过返回导体而流到电气输出端。在多种情况下,能量能够在被捕捉的组织内产生热,以在该组织内产生一个或多个止血密封。例如,这样的实施例可以特别用于密封血管。该外科器械能够包括超声刀片,该超声刀片连接至超声换能器,以将机械振动耦合到组织并且产生一个或多个止血密封且同时将组织分开。例如,这种实施例特别可以用于密封和分开血管。此外,可以构想其它的能量形式但不限于微波、激光、热和高强度聚焦超声。该外科器械还可以包括切割构件,该切割构件可以相对于组织和电极运动,以便横切组织。
上述讨论仅仅为了举例说明本发明技术领域中相关技术目前的各个方面,而不应当视为对权利要求范围的否定。
发明内容
在各种实施例中,一种外科器械可以大体包括:轴,该轴包括近侧端部和远侧端部;端部执行器,该端部执行器从轴的远侧端部延伸,其中该端部执行器能够操作以夹持组织;柄部,该柄部从近侧端部延伸,其中该柄部包括抓握部分;和触发器组件,该触发器组件从柄部延伸,其中该触发器组件包括触发器,该触发器能够在未致动位置与第一致动位置和第二致动位置之间相对于抓握部分运动,其中该触发器能够操作以控制端部执行器选择性地在触发器处于第一致动位置时以第一压缩力抓持组织,并且在触发器处于第二致动位置时以第二压缩力抓持组织。
在各种实施例中,一种外科器械可以大体包括:轴,该轴包括近侧端部和远侧端部;端部执行器,该端部执行器从轴的远侧端部延伸,其中该端部执行器包括第一钳口、第二钳口和电极,其中第一钳口能够在打开位置与闭合位置之间相对于第二钳口运动,以在处于闭合位置时压缩位于第一钳口和第二钳口中间的组织;柄部,该柄部从近侧端部延伸,其中该柄部包括抓握部分;和触发器组件,该触发器组件从柄部延伸,其中该触发器组件包括触发器,该触发器能能够在从未致动位置到第一致动位置的第一运动范围内相对于所述抓握部分运动,其中该触发器能够在从第一致动位置到第二致动位置的第二运动范围内运动,并且其中该触发器能够在从所述第二致动位置到所述未致动位置的第三运动范围内运动,其中该触发器能够操作以控制端部执行器选择性地在触发器处于第一致动位置时以第一压缩力压缩组织,并且在触发器处于第二致动位置时以第二压缩力压缩组织,其中第一压缩力大于第二压缩力。
在各种实施例中,一种外科器械可以大体包括:轴,该轴包括近侧端部和远侧端部;超声波导,该超声波导至少部分地定位在轴内,该波导具有近侧端部和远侧端部;定位在波导的远侧端部的超声致动刀片;夹持臂组件,该夹持臂组件枢转地连接至轴的远侧端部,其中该夹持臂组件包括旋转地附接到夹持臂的至少两个凸轮构件,其中该夹持臂能够相对于刀片在打开位置与闭合位置之间运动,以在处于闭合位置时压缩位于夹持臂和刀片中间的组织,并且其中当夹持臂在打开位置与闭合位置之间运动时,至少两个凸轮构件相对于夹持臂旋转以分离组织层。
附图说明
本文所述的实施例的各个特征在所附权利要求书中进行了详细描述。然而,根据结合如下附图的以下描述,可以理解各种实施例(对手术的组织和方法来说皆是如此)及其优点。
图1包括根据各种实施例的外科器械的侧正视图。
图2包括根据各种实施例的处于打开构型的图1装置的端部执行器的透视图。
图3包括根据各种实施例的处于打开构型的图1装置的端部执行器的另一个透视图。
图4包括根据各种实施例的处于闭合构型并且刀片处于远侧位置的图2的端部执行器的横截面端视图。
图4A包括根据各种实施例的外科器械,该外科器械包括端部执行器,该端部执行器包括滚子轴承。
图5包括根据各种实施例的外科器械,该外科器械包括处于多个位置的触发器组件。
图6包括根据各种实施例的外科器械,该外科器械包括触发器旁路机构。
图7包括图6中所示的触发器旁路机构。
图8A至图8G包括根据各种实施例的外科器械,该外科器械包括处于多个位置的触发器组件。
图9A至图9G包括根据各种实施例的外科器械,该外科器械包括处于多个位置的触发器组件。
图10A至图10D包括根据各种实施例的外科器械,该外科器械包括处于多个位置的触发器组件。
图11A至图11C包括根据各种实施例的外科器械,该外科器械包括处于多个位置的触发器组件。
图12包括根据各种实施例的外科器械中的后托架销路径的剖视图。
图13包括根据各种实施例的外科器械中的后托架销路径的剖视图。
图14A至图14C包括根据各种实施例的外科器械,该外科器械包括处于多个位置的触发器组件。
图15A至图15K包括根据各种实施例的外科器械,该外科器械包括处于多个位置的触发器组件。
图16包括根据各种实施例的外科器械,该外科器械包括触发器组件。
图17A至图17H包括根据各种实施例的受压缩力的血管的一部分的剖视图。
图18A和图18B包括根据各种实施例的外科器械,该外科器械包括处于多个位置的端部执行器。
图19A和图19B包括根据各种实施例的外科器械的柄部组件的侧正视图,其中移除了外壳的一半。
图20包括根据各种实施例的端部执行器,该端部执行器包括旋转结构。
图21A和图21B包括根据各种实施例的凸轮构件,该凸轮构件包括突起。
贯穿多个视图,对应的参考符号指示对应的部件。本文示出的范例(以一种形式)示出了本发明的各种实施例,不应将这种范例理解为是以任何方式限制本发明的范围。
具体实施方式
各种实施例涉及用于处理组织的设备、系统和方法。示出了许多特定的细节,从而得到对说明书中所述和附图中所示的实施例的整体结构、功能、制造和用途的彻底理解。然而,本领域技术人员将会理解,可以在没有这样的特定细节的情况下实施该实施例。在其它实例中,没有详细描述熟知的操作、部件和元件,以免使说明书中描述的实施例模糊不清。本领域普通技术人员将会理解,本文所述和所示的实施例是非限制性的实例,从而可以认识到,本文所公开的特定结构和功能细节可能是代表性的,并且不必限制实施例的范围,实施例的范围仅仅由所附的权利要求限定。
本说明书通篇引用的“各种实施例”、“一些实施例”、“一个实施例”或“实施例”等,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实施例中。因此,本说明书通篇出现的短语“在各种实施例中”、“在一些实施例中”、“在一个实施例中”或“在实施例中”等并不一定都指相同的实施例。此外,在一个或多个实施例中,具体特征、结构或特性可按任何合适的方式组合。因此,在无限制的情形下,结合一个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它实施例的特征、结构或特性结合。
应当理解,可以结合临床医生操纵用来治疗患者的器械的一端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”和“下”之类的空间术语。然而,外科手术器械可以在许多取向和位置中使用,并且这些术语并非意图是限制的和绝对的。
这些系统和方法的各种实施例涉及在自然组织块内形成热“焊缝”或“熔合”。组织“焊接”和组织“熔合”的替代术语可以在本文中互换使用,以描述对目标组织块进行热处理,从而产生基本上均匀的熔合在一起的组织块,例如,在处理后立即表现出较强的破裂强度的焊接的血管内。这种焊缝的强度尤其可用于(i)在血管离断手术中永久性密封血管;(ii)在切除手术中焊接器官边缘;(iii)焊接需要永久闭合的其它解剖管道;并且也可用于(iv)进行血管吻合、血管闭合或将解剖结构或其一部分连在一起的其它手术。本文所公开的组织的焊接或熔合有别于“凝结”、“止血”和通常涉及减少和阻塞小血管或血管化组织内的血流的其它类似的描述性术语。例如,任何表面施加热能都可能导致凝结或止血,但却不属于本文所用术语“焊接”的范畴。这类表面凝结不会产生提供处理的组织任何显著强度的焊缝。
在分子水平,如本文所公开的真正“焊接”组织的现象可能源自于由热引起的目标组织块中胶原和其它蛋白分子的变性,以形成瞬态液态或凝胶状蛋白质性混合物。在目标组织内提供选定能量密度,可导致胶原和其它蛋白质内的分子内和分子间氢键的水热断裂。在可为非常短的选定时间间隔内将变性的蛋白质混合物保持在选定的水合程度(不脱水)。保持目标组织块处于选定的极高程度的机械压缩状态,以确保解链的变性蛋白质彼此接近,以便进行交织和缠结。热驰豫之后,随着再交联和复性的发生,混杂的蛋白质混合物会导致蛋白质缠结,从而产生均匀熔合在一起的块体。
超声外科器械凭借此类器械独特的性能特征而在外科手术中得到日益广泛的应用。根据具体器械构型和操作参数,超声外科器械能够通过凝结基本上同时进行组织切割和止血,从而有利地使患者创伤最小化。切割动作通常通过位于器械远侧端部的端部执行器或刀片末端完成,该端部执行器将超声能量传输到接触端部执行器的组织。具有这一性质的超声器械可以被构造用于开放性外科用途、腹腔镜检查的或内窥镜检查的手术操作,包括机器人辅助操作。
已开发出包括夹持机构的超声外科器械,以将组织压在端部执行器的刀片上,以便将超声能量耦合到患者的组织。这种装置(有时被称为夹钳凝结器剪(clampcoagulatorshears)或超声切断器)被公开在美国专利5,322,055、5,873,873、和6,325,811中,所述专利的全文以引用方式并入本文。外科医生启动夹持臂,通过挤压手把或柄部,将夹钳垫片压向刀片。
一些目前的超声剪装置利用组织接合垫片或夹钳垫片,该组织接合与刀片的表面接近平行的垫片或夹钳垫片。通过这种构造,组织被抓持在夹钳垫片与刀片之间。该夹钳垫片可以包含低摩擦系数聚合物材料、或任何其它合适的低摩擦材料。尽管这些设计是可用的,但是它们倾向于存在寿命问题,原因是夹钳垫片倾向于随着长时间外科手术而劣化。此外,夹钳凝结器剪的更新的设计增大了刀片振幅(amplitude)以及/或夹钳垫片抵抗组织和刀片的负载,并且超过夹钳垫片材料的承受能力,导致达不到所需的夹钳垫片寿命。夹钳垫片材料限制了可以对组织和刀片施加的力的量,这继而又限制一些目前的夹钳凝结器剪有效地切割和凝结的组织厚度或血管尺寸。
希望提供克服当前超声外科器械的某些缺陷的电外科器械。本文所描述的电外科器械的各种实施例可以克服那些缺陷中的一些缺陷。
可以通过将所接合血管相对侧的外膜层放置成彼此直接接触来实现增强密封血管的能力。阻碍这种直接接触的通常是血管的肌层(内膜层)。可以通过施加足够的压缩力,使肌层在血管内“分裂”,而不会波及外膜。肌层的回缩程度将足以允许直接外膜接触。直接外膜密封表现出较高的破裂压力。在各种实施例中,电外科装置可以提供可变力控制,以允许使用者产生大的压缩力以用于肌肉分离以及较小的压缩力以用于施加超声能量和密封以及切割。
在各种实施例中,电外科器械可以被构造成能够提供多个触发器位置,以向组织递送多级别的压缩力。压缩力通常可以使用两种使用者可选夹持模式中的一种通过柄部确定,以提供可变力控制:一种用于切割和凝结小血管;并且一种用于切割和凝结大血管。大血管凝结模式大体与端部执行器递送短期高压缩力然后前进到压缩力较小的位置的顺序相对应。例如,在各种实施例中,较小的压缩力可以为高压缩力的大约50%到大约70%。高压缩力可以压缩大血管,使得血管的内层(即内膜和中膜)被挤出和分离,并且只有血管的外层(即外膜)留在端部执行器内。
不期望受到任何特定理论的限制,据信外膜最显著地影响超声离断血管的密封强度,并且血管的内层对密封强度的影响非常小且实际上倾向于平复或者在结构上对抗外膜密封。因此,电外科器械可以被构造成能够提供高压缩力,以机械地挤出血管内层以及低压缩力以允许直接外膜接触和外膜-外膜密封。本文所描述的电外科器械的各种实施例可以相对于目前的超声剪装置提供某些优点,其中包括以下所述的一个或多个:以更可控、较低的夹持力来获得密封;以较低的发电机驱动功率来获得密封;较低的发电机功率需求;利用耐久性稍差的夹钳垫片材料;改进大血管密封;改善夹钳垫片寿命;当需要时,仅通过使用高夹持力来改善人体工程学,该高夹持力与高输入力相对应;提高效率;并且促进成本节约。
电外科器械能够例如被构造成向患者的组织提供诸如电能、超声能量、和/或热能之类的能量。例如,本文所公开的各种实施例提供下述电外科钳口结构,所述电外科钳口结构适于离断钳口之间的所捕获的组织,并且适于通过可控地施加射频能量而同时焊接或密封所捕获的组织的边缘。在各种实施例中,电外科钳口结构可以适于凝结所捕集的组织而不是焊接所捕集的组织。电外科器械还可以被构造成能够例如抓持、切断和缝合组织。电外科器械可以被构造成能够提供诸如微波、激光、热、超声和高强度聚焦超声之类的其它能量形式和/或其组合。所有的这些装置和具体实施都旨在属于本公开的范围内。
在各种实施例中,参照图1,电外科器械10可以包括手件20、从手件20朝远侧延伸的轴30、以及设置在轴30的远侧端部的端部执行器40。手件20可以包括手枪式握把22、枢转触发器24、和激活按钮26。触发器24可朝向和远离手枪式握把22枢转以选择性地致动端部执行器40,如下文将更详细地描述的那样。激活按钮26可操作以选择性地激活与端部执行器40连通的射频电路,这一点也将在下文更详细地描述。在一些型式中,激活按钮26还可用作针对触发器24的机械闭锁件,使得如果不同时按下按钮26,就无法完全致动触发器24。本文所举出的参考文献中的一个或多个中公开了可以如何提供这种闭锁件的例子。应当理解,手枪式握把22、触发器24和按钮26可以任何合适的方式改进、替代、补充等,并且本文对此类部件的描述仅仅是例示性的。
轴30可以包括任何合适的横截面,例如圆柱形横截面和/或矩形横截面。轴30可以包括外部护套32,该外部护套32从手件20延伸。轴30的近侧端部可以附接到手件20。在各种实施例中,轴30能够通过旋钮34相对于手件20围绕由护套32限定的纵向轴线旋转。此类旋转可提供端部执行器40和轴30的整体旋转。在各种实施例中,旋钮34可操作以使端部执行器40旋转而不使轴30的任何部分旋转。
在各种实施例中,端部执行器40可以包括第一钳口42和第二钳口44。第二钳口44可以相对于轴30基本固定;而第一钳口42可以朝向和远离第二钳口42相对于轴30枢转。在各种实施例中,致动器、例如棒杆和缆线,可以延伸穿过护套32并与第一钳口42在枢轴联接件43处接合,使得致动器通过轴30的纵向运动提供第一钳口42相对于轴30和相对于第二钳口44的枢转。在各种实施例中,钳口42、44可以包括任何其它合适种类的运动,并可以任何其它合适的方式进行致动。例如,如将在下文更详细地描述的那样,钳口42、44可以通过击发梁60的纵向平移而致动并且因此而闭合,使得在某些实施例中可以直接去除致动器。
在各种实施例中,参照图2至图4,第一钳口42限定了纵向延伸的细长狭槽46,并且第二钳口44限定了纵向延伸的细长狭槽48。第一钳口42的顶侧可以包括第一电极表面50,并且第二钳口44的底侧可以包括第二电极表面52。电极表面50、52可以经由沿轴30的长度延伸的一个或多个导体(未示出)与电源80连通。电源80可操作以向具有第一极性的第一电极表面50和具有第二(相反的)极性的第二电极表面52递送射频能量,使得射频电流在电极表面50、52之间流动,从而穿过被捕集在钳口42、44之间的组织。在各种实施例中,击发梁60可以用作与电极表面50、52相配合的电导体(例如,用作地回路),以用于递送捕集在钳口42、44之间的双极性射频能量。电源80可以位于电外科器械10的外部或者可以与电外科器械10(例如,在手件20中)整体形成。控制器82可以调节电源80递送到电极表面50、52的功率。控制器82可以位于电外科器械10的外部或者可以与电外科器械10(例如,在手件20中)整体形成。还应当理解,电极表面50、52可以以多种可选位置、构型和关系设置。
参照图4,第一钳口42的下侧可以包括邻近狭槽46的纵向延伸的凹处58,并且第二钳口44的上侧可以包括邻近狭槽48的纵向延伸的凹处58。图2示出了包括多个锯齿构造46的第一钳口42的上侧。应当理解,第二钳口44的下侧可包括互补的锯齿,所述互补的锯齿与锯齿46相嵌套,以增强对被捕集在钳口42、44之间的组织的抓握而不必撕裂组织。图3将第一钳口42中的锯齿46的例子主要示为凹处;其中第二钳口44中的锯齿48主要示为突起。当然,锯齿46、48可以采用任何其它合适的形式或者可以直接一起省略。还应当理解,锯齿46、48可以由非导电、或绝缘的材料(例如塑料、玻璃和/或陶瓷)形成,并且可以包括处理(例如聚四氟乙烯、润滑剂、或者一些其它的处理以基本防止组织被钳口42、44卡住)。
当钳口42、44处于闭合位置时,轴30和端部执行器40的尺寸被设定成并且被构造成能够穿过具有各种内径的套管针,使得电外科器械10在微创外科手术中适用,但是当然,如果需要,电外科器械10也可用于开放式和内窥镜式手术中。仅以举例的方式,当钳口42、44处于闭合位置时,轴30和端部执行器40可以具有大约5mm的外径。备选地,轴30和端部执行器40可以具有任何其它合适的外径,例如从大约2mm到大约20mm。
在各种实施例中,钳口42、44中的任何一个或者钳口42、44中的两个都可以包括能够操作以从外科手术部位抽取蒸汽、烟气、和/或其它的气体的至少一个端口、通路、管道、和/或其它结构。这种结构可以与抽吸源(例如外部源或位于手件20内的源)连通。此外,端部执行器40可以包括一个或多个组织冷却结构(未示出),该一个或多个组织冷却结构在电极表面50、52被激活时降低由端部执行器40在相邻组织上所造成的热扩散的程度或范围。考虑到本文的教导内容,这种冷却结构可以采用的各种合适的形式对于本领域普通技术人员而言将显而易见。
在各种实施例中,端部执行器40可以包括一个或多个传感器(未示出),该一个或多个传感器被构造成能够感测端部执行器40处的多个参数,其中包括但不限于钳口位置、相邻组织的温度、相邻组织的电阻或电阻抗、相邻组织之间的电压、由相邻组织施加在钳口42、44上的力。在各种实施例中,端部执行器40可以包括与电极50、52相邻定位和/或其它位置处的一个或多个正温度系数(PTC)热敏电阻器主体54、56,例如PTC聚合物。来自传感器的数据可以传送到控制器82。控制器82可以以多种方式处理这样的数据。在各种实施例中,控制器82可以至少部分地根据从端部执行器40处的一个或多个传感器获得的数据调节或以其它方式改变递送至电极表面50、52的射频能量。在各种实施例中,控制器82可至少部分地根据从端部执行器40处的一个或多个传感器获得的数据通过听觉和/或视觉反馈装置(例如,扬声器、灯、显示屏等)警示使用者一种或多种状况。还应当理解,一些类型的传感器不一定需要与控制器82连通,并且可以只提供端部执行器40处的纯局部效果。在各种实施例中,位于端部执行器40处的PTC热敏电阻器主体54、56可以随着组织和/或端部执行器40的温度升高而自动减少电极表面50、52处的能量递送,由此降低过热的可能性。在各种实施例中,PTC热敏电阻器元件可以与功率源80和电极表面50、52串联;并且PTC热敏电阻器可以提供增大的阻抗,以响应于温度超过阈值而减小电流。此外,应当理解,电极表面50、52可以用作传感器(例如,以感测组织阻抗)。根据本文的教导内容,可结合到电外科器械10中的多种类型的传感器对于本领域的普通技术人员而言将是显而易见的。相似地,根据本文的教导内容,能够利用来自传感器的数据通过控制器82或以其它方式处理的各种问题对于本领域的普通技术人员而言将是显而易见的。根据本文的教导内容,用于端部执行器40的其它合适变型对于本领域的普通技术人员而言将是显而易见的。
在各种实施例中,参照图2至图4,电外科器械可以包括击发梁60,该击发梁60能够沿端部执行器40的长度的一部分纵向地运动。击发梁60可以同轴定位在轴30内、沿轴30的长度延伸并且在轴30内纵向地平移,然而应当理解,击发梁60和轴30可具有任何其它合适的关系。击发梁60可包括锋利的远侧刀片64、上凸缘62、和下凸缘66。如图4中所示,远侧刀片64延伸穿过钳口42、44的狭槽46、48,其中上凸缘62在凹处59中位于钳口44上方,并且下凸缘66在凹处58中位于钳口42下方。远侧刀片64和凸缘62、66的构型在击发梁60的远侧端部提供“I形梁”型横截面。在各种实施例中,凸缘62、66可以沿击发梁60的任何合适的长度纵向地延伸。在各种实施例中,凸缘62、66可以沿钳口42、44的外部定位,或者设置在形成于钳口42、44内的相应的狭槽中。例如,每个钳口42、44可限定“T”形狭槽,其中远侧刀片64的某些部分设置在每个“T“形狭槽的一个竖直部分中,并且凸缘62、66设置在“T”形狭槽的水平部分中。参照图4A,在各种实施例中,远侧刀片64可以包括至少一个滚子轴承38,以压缩组织T和/或断裂形成于血管内或位于该血管外部的钙(fracturecalcium)。滚子轴承38可以包括这样的圆锥柱体:该锥形柱体具有沿远侧刀片64侧向地减小的直径,如图4A中所示。在各种实施例中,滚子轴承38可以包括这样的锥形柱体:该锥形锥柱体具有远离远侧刀片64侧向地增大的直径。在各种实施例中,滚子轴承38可以包括直筒柱体。在各种实施例中,滚子轴承38可以包括曲线横截面形状,例如圆形和椭圆形。如图4A中所示,滚子轴承38可以定位在位于钳口42、44中间的远侧刀片64的相对侧上。在各种实施例中,远侧刀片64可以包括销(未示出),以使滚子轴承38相对于远侧刀片64旋转。在各种实施例中,远侧刀片可以包括竖直狭槽,该竖直狭槽包括销,该销被可滑动地布置在竖直狭槽中,从而相对于远侧刀片64垂直地旋转滚子轴承38和/或运动滚子轴承38。根据本文的教导内容,各种其它合适的构型和关系对于本领域的普通技术人员而言将是显而易见的。
远侧刀片64可以是基本上尖锐的,使得远侧刀片64可容易地切断被捕集在钳口42、44之间的组织。远侧刀片64可以电接地,从而如本文其它段落所述提供射频能量的返回路径。在各种实施例中,远侧刀片64可以用作活动电极。在各种实施例中,可以通过超声能量选择性向远侧刀片64提供能量,例如大约55.5kHz的简谐振动。
在各种实施例中,击发梁60的“I形梁”型构型可以在击发梁60朝远侧行进时提供钳口42、44的闭合。具体而言,在击发梁60通过支承在形成于钳口44中的凹处59从近侧位置(如图1至图3中所示)行进到远侧位置(如图4中所示)时,凸缘62将钳口44枢转地推向钳口42。通过击发梁60在钳口42、44上所产生的该闭合效果可以在远侧刀片64到达被捕集在钳口42、44之间的组织之前发生。通过击发横梁60实现的分段相遇可降低整个击发行程中挤压握把24以致动击发横梁60所需的力。换句话讲,在各种实施例中,击发梁60可在遇到切断钳口42、44之间捕集的组织的阻力之前就已克服了在组织上基本闭合钳口42、44所需的初始阻力。当然,可以提供任何其它合适的分段。
在各种实施例中,凸缘62可以被构造成能够相对于位于钳口44的近侧端部的斜坡结构进行凸轮偏心运动,以在击发梁60缩回到近侧位置时打开钳口42,并且在击发梁60保持在近侧位置时保持钳口42打开。该进行凸轮偏心运动的能力可以有利于使用端部执行器40来分离组织层,以便通过迫使钳口42、44从闭合位置分开来进行钝性分离等。在各种实施例中,钳口42、44可以通过弹簧或其它类型的弹性结构弹性偏置到打开位置。虽然钳口42、44随击发梁60的平移而闭合或打开,但是应当理解,其它实施例可以提供钳口42、44和击发梁60的独立运动。在各种实施例中,一个或多个缆线、棒杆、梁或其它结构可以延伸穿过轴30,以独立于击发梁60选择性地致动钳口42、44。这种钳口42、44致动结构可以由手件20的专用结构分别控制。在各种实施例中,除了通过触发器24来控制击发梁60之外,这样的钳口致动结构也可以由触发器24控制。还应当理解,击发梁60可弹性偏置到近侧位置,使得当使用者松开其对触发器24的抓握时,击发梁60朝近侧缩回。
在各种实施例中,在使用中,端部执行器40可以通过套管针被插入到患者体内相对于患者体内的解剖结构期望的位置和取向处。然后,通过朝手枪式握把22挤压触发器24,解剖结构的两个组织层被捕集在钳口42、44之间。这样的组织层可以是限定患者体内的解剖结构的相同自然管腔的一部分(例如,血管、胃肠道的一部分、生殖系统的一部分等)。在各种实施例中,沿血管长度的相同区域,一个组织层可以包括血管的顶部并且另一个组织层可以包括血管的底部。在各种实施例中,在使用电外科器械10之前,通过血管的流体路径可以与由端部执行器40限定的纵向轴线垂直。钳口42、44的长度可以定向成垂直于(或至少大致横向于)血管的长度。如上所述,当通过朝手枪式握把22挤压触发器24而远侧致动击发梁60时,凸缘62、66像凸轮一样起作用,以使钳口44朝向钳口42枢转。
在各种实施例中,将组织层捕集在钳口42、44之间后,使用者可以通过朝手枪式握把22挤压触发器24使击发梁60继续朝远侧行进。当击发梁60朝远侧行进时,远侧刀片64同时切断被抓持的组织层,从而导致分离的上层部分与相应的分离的下层部分并置。这导致血管在大致横向于血管的长度的方向上被切割。应当理解,凸缘62、66分别紧邻钳口42、44上方和下方可以有助于将钳口42、44保持在闭合和夹紧位置。特别是,凸缘62、66可以有助于保持钳口42、44之间显著的压缩力。当被切断的组织层部分被压缩在钳口42、44之间时,电极表面50、52可以通过使用者按压激活按钮26而由双极性射频能量激活。在各种实施例中,电极50、52可以与功率源80选择性地联接(例如,通过使用者按压按钮26),使得钳口42、44的电极表面50、52以普通的第一极性激活,而击发梁60以与第一极性相反的第二极性激活。因此,双极性射频电流穿过被切断的组织层部分的压缩区域在击发梁60和钳口42、44的电极表面50、52之间流动。在各种实施例中,电极表面50具有一个极性,而电极表面52和击发梁60二者具有另一个极性。可以由功率源80递送双极性射频能量,以在击发梁60的一侧上将组织层部分热焊接在一起,并且在击发梁60的另一侧上将组织层部分热焊接在一起。
在特定情况下,被激活的电极表面50、52所产生的热能够使组织层部分内的胶原变性,并且配合钳口42、44所提供的压缩力,变性胶原能够在组织层部分内形成密封。因此,限定解剖结构的自然内腔的被切断的端部被止血地密封关闭,使得被切断端部将不会泄漏体液。在各种实施例中,可以在击发梁60开始朝远侧平移之前并且因此甚至在组织被切断之前通过双极性射频能量来激活电极表面50、52。例如,可在如下型式中提供此类定时:其中按钮26除了用作功率源80和电极表面50、52之间的开关之外还充当相对于触发器24的机械闭锁件。
尽管将下文的教导内容中的若干描述成电外科器械10的变型,但应当理解,下文的各种教导内容也可以结合到各种其它类型的装置中。仅以举例的方式,除了易于结合到电外科器械10中之外,下文的各种教导内容也可易于结合到本文所引用的参考文献中的任何参考文献中所提出的装置、其它类型的电外科装置、替代的能量形式装置、外科缝合器、外科施夹器和组织夹持器以及各种其它的装置中。参考本文的教导内容,可结合下述教导内容的其它的合适装置对于本领域普通技术人员而言将显而易见。
在各种实施例中,该外科器械可以包括两级夹紧机构,该两级夹紧机构被构造成能够提供较高的夹紧力以将血管的肌层分开以及较低的夹紧力以密封外膜。不期望受到任何特定理论的限制,据信相比较高的夹紧力,较低的夹紧力有利于适当的加热速率,以在外膜层之间产生较高强度的密封。
在各种实施例中,如图5中所示,触发器24能够在未致动位置与一个或多个致动位置之间相对于手件20运动。在各种实施例中,触发器24能够在未致动位置1到第一致动位置2的第一运动范围内运动。在各种实施例中,第一运动范围可从未致动位置1到位置3和/或位置4,以及从位置3和/或位置4到第一致动位置2。在各种实施例中,触发器24能够在第一致动位置2到第二致动位置3的第二运动范围内运动。在各种实施例中,触发器24能够在第二致动位置3到未致动位置1的第三运动范围内运动。在各种实施例中,触发器24能够在未致动位置1到第三致动位置4的第四运动范围内运动。在各种实施例中,触发器24能够在第三致动位置4到未致动位置1的第五运动范围内运动。在各种实施例中,第二致动位置3和第三致动位置4可以是相同或不同的位置。
在各种实施例中,如上所述,钳口42、44可以向被捕集在其间的组织施加压缩力或接合力。在各种实施例中,钳口42、44可以在触发器24处于第一致动位置2时施加第一压缩力,在触发器24处于第二致动位置3时施加第二压缩力,并且在触发器24处于第三致动位置4时施加第三压缩力。在各种实施例中,参照图5,钳口42、44可以处于闭合位置,其特征在于触发器24处于第一致动位置时的第一压缩力。在各种实施例中,钳口42、44可以处于闭合位置,其特征在于触发器24处于第二致动位置时的第二压缩力。在各种实施例中,钳口42、44可以处于闭合位置,其特征在于触发器24处于第三致动位置时的第三压缩力。在各种实施例中,当触发器24处于未致动位置时,钳口42、44可以处于打开位置。
在各种实施例中,第一压缩力、第二压缩力和第三压缩力可以是不同的。在各种实施例中,第一压缩力可以大于第二压缩力。在各种实施例中,第二压缩力可以大于或等于第三压缩力。在各种实施例中,第一压缩力、第二压缩力和第三压缩力可以分别被选择成达到大约10磅每平方英寸(“psi”),例如大约1psi至大约10psi、大约2psi至大约8psi、大约3psi至大约5psi、以及4psi至大约6psi。在各种实施例中,第一压缩力可以为大约4psi至大约6psi,并且第二压缩力可以为大约2psi至大约4psi。在各种实施例中,第一压缩力可以为大约6psi并且第二压缩力可以为大约4psi。在各种实施例中,第一压缩力可以为大约4psi并且第二压缩力可以为大约2psi。在各种实施例中,第一压缩力可以为大约3psi至大约5psi,并且第二压缩力可以为大约1psi至大约3psi。在各种实施例中,第一压缩力可以为大约5psi并且第二压缩力可以为大约3psi。在各种实施例中,第一压缩力可以为大约3psi并且第二压缩力可以为大约1psi。在各种实施例中,当触发器24处于未致动位置时,钳口42、44不可以向组织施加压缩力。
在各种实施例中,电外科器械10可以包括触发器组件,该触发器组件被构造成能够致动端部执行器40,以在触发器24处于第一致动位置、第二致动位置和/或第三致动位置时向被捕集在钳口42、44之间的组织提供可变的压缩力,如下文更详细地描述的那样。在各种实施例中,触发器组件可以被构造成能够在触发器24处于第一致动位置时将压缩力限制在第一压缩力并且在触发器24处于第二致动位置时将压缩力限制在第二压缩力。在各种实施例中,触发器组件可以被构造成能够在触发器24处于第三致动位置时将压缩力限制在第三压缩力。
在各种实施例中,电外科器械10可以包括触发器组件,该触发器组件被构造成能够致动端部执行器40,以通过第一运动范围、第二运动范围和/或第三运动范围向被捕集在钳口42、44之间的组织提供可变的压缩力,如下文更详细地描述的那样。在各种实施例中,触发器组件可以被构造成能够通过第一运动范围将压缩力限制在第一压缩力并且通过第二运动范围将压缩力限制在第二压缩力。在各种实施例中,触发器组件可以被构造成能够通过第四运动范围将压缩力限制在第三压缩力。
在各种实施例中,触发器组件可以包括一个或多个掣子结构和/或其它类型的结构(多个结构),以提供端部执行器关于由护套限定的纵向轴线的角位置的听觉和/或触觉指示。参照图16,在各种实施例中,触发器1024可以枢转地附接到手件1020。触发器1024可以包括活动铰链1054。在各种实施例中,活动铰链可以向使用者提供听觉和/或触觉指示。例如,可以朝手枪式握把1022挤压触发器1024,以致动端部执行器(未示出)。当触发器1024处于致动位置时,活动铰链可以提供听觉和/或触觉指示。包括听觉和/或触觉指示器的装置的多个例子在2010年7月23日提交的名称为“ELECTROSURGICALCUTTINGANDSEALINGINSTRUMENT”(电外科切割和密封器械)的美国专利申请序列12/842,565中有所描述,其公开内容以引用方式并入本文。
在各种实施例中,在使用中,端部执行器40可以通过套管针被插入到患者体内相对于患者体内的解剖结构期望的位置和取向处。在各种实施例中,使用者可以通过第一运动范围来操作触发器24,以在解剖结构具有大于大约3mm的直径时捕集解剖结构42、44的两个组织层。如上所述,凸缘62、66像凸轮一样起作用,以在通过将触发器24从未致动位置挤压到第一致动位置来朝远侧致动击发梁60时,使钳口44朝向钳口42枢转。钳口42、44可以在触发器24处于第一致动位置时向被捕集在其间的组织层施加第一压缩力。在各种实施例中,第一压缩力可以压缩解剖结构使得解剖结构的内层被挤出和分离,并且仅解剖结构的外层位于钳口42、44之间。在各种实施例中,激活按钮26可以用作相对于触发器24的机械闭锁件,使得当触发器24处于第一致动位置时,双极性射频电流不可以流向电极表面50、52。
在各种实施例中,使用者可以通过第二运动范围来操作触发器24以切断被夹紧在钳口42、44之间的组织层并且热焊接被切断的组织层。如上所述,当通过使用者将触发器24从第一致动位置挤压到第二致动位置来使击发梁60继续朝远侧行进时,远侧刀片64切断被夹紧的组织层。钳口42、44可以在触发器24处于第二致动位置时向被捕集在其间的组织层施加第二压缩力。在各种实施例中,第二压缩力可以允许内部被切断的组织层部分直接彼此接触。通过钳口42、44向被切断的组织层部分施加第二压缩力,由使用者按压激活按钮26来通过双极性射频能量激活电极表面50、52。如上所述,双极性射频电流通过被切断的组织层部分的压缩区域在击发梁60与电极表面50、52之间流动,以在击发梁60的一侧上将组织层部分热焊接在一起并且在击发梁60的另一侧上将组织层部分热焊接在一起。在各种实施例中,解剖结构的内部被切断的组织层部分可以彼此热焊接。在各种实施例中,激活按钮26可以用作相对于触发器24的机械闭锁件,使得如果触发器24不处于第二致动位置并且按钮26未被同时按下,双极性射频电流就不可以流向电极表面50、52。
在各种实施例中,在使用中,端部执行器40可以通过套管针被插入到患者体内相对于患者体内的解剖结构期望的位置和取向处。在各种实施例中,使用者可以通过第三运动范围来操作触发器24,以在解剖结构具有达到大约3mm的直径时捕集解剖结构42、44的两个组织层。如上所述,凸缘62、66像凸轮一样起作用,以在通过将触发器24从未致动位置挤压到第三致动位置来朝远侧致动击发梁60时,使钳口44朝向钳口42枢转。使用者可以通过第三运动范围来继续操作触发器24以切断被夹紧在钳口42、44之间的组织层并且热焊接被切断的组织层。如上所述,当通过使用者将触发器24从第一致动位置挤压到第三致动位置来使击发梁60继续朝远侧行进时,远侧刀片64切断被夹紧的组织层。钳口42、44可以在触发器24处于第三致动位置时向被捕集在其间的组织层施加第三压缩力。
通过钳口42、44向被切断的组织层部分施加第三压缩力,由使用者按压激活按钮26来通过双极性射频能量激活电极表面50、52。如上所述,双极性射频电流通过被切断的组织层部分的压缩区域在击发梁60与电极表面50、52之间流动,以在击发梁60的一侧上将组织层部分热焊接在一起,并且在击发梁60的另一侧上将组织层部分热焊接在一起。在各种实施例中,激活按钮26可以用作相对于触发器24的机械闭锁件,使得如果按钮触发器不处于第三致动位置并且按钮26未被同时按下,双极性射频电流就不可以流向电极表面50、52。
如上所述,在各种实施例中,电外科器械10可以包括触发器组件,该触发器组件能够操作以控制钳口44、42,由此以各种压缩力选择性地压缩位于钳口42、44之间的组织。下文更详细地描述了触发器组件以及手件20的其它部件的各种实施例,而根据本文的教导内容,进一步的例子对于本领域的普通技术人员而言将是显而易见的。
如上所述,在各种实施例中,可以通过朝手枪式握把22将触发器24挤压到致动位置来使击发梁60朝远侧行进;同时可以通过释放触发器24以及/或者通过使触发器24远离手枪式握把22主动地运动到未致动位置来使击发梁60朝近侧缩回。在各种实施例中,触发器组件可以包括托架,以将触发器24联接到击发梁60。在各种实施例中,触发器组件还可以包括联接臂,以将触发器24联接到击发梁60。当然,可以任何其它合适的方式运动击发梁60。
在各种实施例中,电外科器械可以大体包括:轴,该轴包括近侧端部和远侧端部;端部执行器,该端部执行器从轴的远侧端部延伸,其中该端部执行器能够操作以抓持组织;手件,该手件从近侧端部延伸,其中该手件包括手枪式握把和触发器组件,该触发器组件从手件延伸,其中该触发器组件包括触发器,该触发器能够在未致动位置与第一致动位置和第二致动位置之间相对于手枪式握把运动,其中该触发器能够操作以控制端部执行器选择性地在触发器处于第一致动位置时以第一压缩力抓持组织,并且在触发器处于第二致动位置时以第二压缩力抓持组织。
在各种实施例中,参照图6和图7,电外科器械110可以大体包括旁路闩锁或偏心自锁机构(over-centermechanism),该旁路闩锁或偏心自锁机构被构造成能够限定触发器124的旁路路径113。在各种实施例中,手件120包括手枪式握把122、旁路闩锁片簧111和触发器组件,该触发器组件包括枢转地附接到托架138的触发器124。触发器124可以包括延伸臂125,该延伸臂125包括限定了旁路路径的狭槽113。旁路闩锁片簧111的一个端部可以固定地附接到手件120,并且旁路闩锁片簧111的自由端部可以设置在狭槽113中。如图7所示,旁路闩锁片簧111的自由端部在触发器124处于未致动位置1时与狭槽113的第一部分相接合,在触发器124处于第一致动位置2时与狭槽113的第二部分相接合,并且在触发器124处于第二致动位置3时与狭槽113的第三部分相接合。
在使用中,对于具有大的直径或厚度的组织而言,旁路闩锁片簧111可以被构造成能够在电外科器械110被激活以密封钳口(未示出)之间的组织时通过第一致动位置2并且释放到或靠近第二致动位置3。通过该方式,使用者在第一致动位置2处压碎组织,使得在端部执行器(未示出)被激活以在第二致动位置3处切割并且凝结外部组织层之前侧向地挤出内部组织层。在使用中,对于具有小的直径的组织而言,旁路闩锁片簧111可以被构造成能够在电外科器械110被激活以捕集、切割和/或密封钳口(未示出)之间的组织时直接通向第三致动位置4。不期望受到任何特定理论的限制,据信根据本公开的电外科器械可以利用基本类似的功率和夹持力,以在当前的超声剪装置用于凝结较小血管时凝结较大血管。
在各种实施例中,参照图8A至图8G,手件220可以大体包括:托架238,该托架238能够相对于手件220纵向地滑动;触发器224,该触发器224可滑动地附接到托架238并且旋转地附接到手件220;和联接臂236,该联接臂236固定地附接到托架238并且旋转地附接到手件220。联接臂236可以包括狭槽233。触发器224可以通过触发器销216联接到联接臂236。触发器销216的一个端部可以设置在狭槽233中。在各种实施例中,狭槽233可以包括径向结构,该径向结构被构造成能够用作凸轮并且触发器销216可以被构造成能够用作凸轮从动件。在各种实施例中,狭槽233可以包括第一部分和第二部分。在各种实施例中,狭槽233的第一部分可以包括径向结构并且狭槽233的第二部分可以包括纵向结构。例如,如图8A中所示,狭槽233可以包括L形,其中狭槽233的第一部分从包括手件220的纵向轴线的平面朝近侧并且径向地延伸,并且狭槽233的第一部分与包括手件220的纵向轴线的平面平行地延伸。
在使用中,参照图8A至图8G,当触发器224从未致动位置(图8A)通过第一运动范围(图8B、8C)运动到第一致动位置(图8C)时,触发器销216沿狭槽233的第一部分滑动,以将触发器224的运动转化成托架238的近侧线性运动。当触发器销216沿狭槽233的第二部分滑动时,触发器224可以继续通过第二运动范围(图8D)从第一致动位置运动到第二致动位置(图8D),以将触发器224的运动转化成托架238的近侧线性运动。在各种实施例中,托架238可以通过第一运动范围行进第一距离并且通过第二运动范围行进第二距离。在各种实施例中,第一距离可以大于或等于第二距离。在各种实施例中,第一距离与第二距离之间的差值可以使施加于捕集组织的压缩力从第一压缩力减小到第二压缩力。
参照图8D至图8G,当触发器224从第二致动位置(图8D)通过第三运动范围(图8E至图8G)运动到未致动位置时,弹簧(未示出)可以使触发器224返回未致动位置,在该未致动位置处,触发器224远离纵向轴线枢转。在各种实施例中,参照图8E,触发器224能够关于枢转点枢转,该枢转点相对于手件220固定。当触发器224远离纵向轴线旋转时,触发器销216沿狭槽233的第二部分滑动到狭槽233的第一部分。如图8F中所示,当触发器224继续远离纵向轴线旋转时,触发器销216沿狭槽233的第一部分滑动,以将触发器224的运动转化成托架238的近侧线性运动。未致动位置示于图8G中。
在各种实施例中,在接近其返回行程的终点时,触发器组件可以包括对触发器24的机械附件。在各种实施例中,可能还期望在整个运动范围内向挤压触发器的使用者提供基本恒定量的阻力,使得使用者所遇到的阻力在击发行程和返回行程的特定阶段期间不显著增大。
在各种实施例中,参照图9A至图9G,手件320可以大体包括:托架338,该托架338能够相对于手件320纵向地滑动;触发器324,该触发器324滑动地附接到托架338并且旋转地附接到手件320;和联接臂336,该联接臂336枢转地附接到托架338并且旋转地附接到触发器324。触发器324可以通过触发器销316联接到联接臂336,如上文所述。在各种实施例中,触发器324可以被构造成能够用作凸轮,并且狭槽333和联接件336可以包括突出部,该突出部被构造成能够用作凸轮从动件337。在各种实施例中,联接件336可以包括突出部337,以与包括触发器销316的触发器324的部分325相接合。在各种实施例中,在触发器324处于第一致动位置时,突出部337可以与触发器324的第一部分相接合,并且在触发器324处于第二致动位置时与触发器324的第二部分相接合。在各种实施例中,突出部337可以包括成角表面。例如,如图9A中所示,突出部337可以包括五边形形状,该五边形形状包括成角表面337a。在各种实施例中,在触发器324处于第一致动位置时,突出部337的成角表面337a可以与触发器324的第一部分325相接合,并且在触发器324处于第二致动位置时与触发器324的第二部分326相接合。
在使用中,参照图9A至图9G,当触发器324从未致动位置(图9A)通过第一运动范围运动到第一致动位置(图9B)时,突出部337的成角表面337a的第一部分与触发器324的第一部分相接合,以将触发器324的运动转化成托架338的近侧线性运动。当突出部337的成角表面337a的第二部分与触发器324的第二部分相接合时,触发器324可以通过第二运动范围(图9C)继续从第一致动位置运动到第二致动位置(图9D),以将触发器324的运动转化成托架338的远侧线性运动。如图9C中所示,在各种实施例中,成角表面337a的第二部分可以包括与触发器324的第二部分互补的角度。当触发器324通过第二运动范围从第一致动位置运动到第二致动位置时,触发器324的互补表面可以与突出部337a的互补表面接触。如上所述,在各种实施例中,托架338可以通过第一运动范围行进第一距离并且通过第二运动范围行进第二距离,使得第一距离与第二距离之间的差值可以使施加于捕集组织的压缩力从第一压缩力减小到第二压缩力。如上所述,使用者可以释放触发器324,并且弹簧(未示出)可以使触发器324返回未致动位置。当触发器324从第二致动位置(图9E)通过第三运动范围(图9F)运动到未致动位置(图9G)时,在各种实施例中,触发器324可以通过设置在狭槽333中的触发器销316联接到联接臂336,以防止触发器324过度行进和锁定。
在各种实施例中,参照图10A至图10D,手件420可以大体包括:托架438,该托架438能够相对于手件420纵向地滑动;触发器424,该触发器424可枢转地附接到托架338;和联接臂436,该联接臂436枢转地附接到托架438。触发器424可以通过设置在触发器狭槽417中的触发器销416联接到联接臂436。触发器424可以包括这样的表面:该表面包括释放凹口425,该释放凹口425被构造成能够用作凸轮,并且联接臂436可以包括突出部437,该突出部437被构造成能够用作凸轮从动件。复位弹簧(未示出)可以通过销(未示出)联接到托架438,该销被构造成能够使托架438朝远侧弹性地偏置并且使联接臂436的突出部437与触发器424的表面接触。在各种实施例中,当触发器424处于第一致动位置时,联接臂436的突出部437可以与不具有释放凹口425的触发器424的表面相接合,并且在触发器424处于第二致动位置时与释放凹口425相接合。在各种实施例中,联接臂438的突出部437可以包括与释放凹口425互补的形状。例如,如图10D中所示,联接臂438的突出部437可以包括与释放凹口425互补的形状。
在使用中,参照图10A至图10D,当触发器424从未致动位置(图10A)通过第一运动范围运动到第一致动位置(图10B和图10C)时,联接臂438的突出部437与不具有释放凹口425的触发器424的表面相接合,以压缩复位弹簧(未示出)并且将触发器424的运动转化成托架438的近侧线性运动。当联接臂438的突出部437与释放凹口425相接合时,触发器424可以继续通过第二运动范围从第一致动位置运动到第二致动位置(图10D),以将复位弹簧(未示出)解压缩,并且将触发器424的运动转化成托架438的远侧线性运动。在各种实施例中,当触发器424处于第一致动位置时,触发器销417可以与触发器狭槽417的第一部分接触。当触发器423处于第二致动位置时,触发器销417可以通过第二运动范围沿触发器狭槽417滑动至触发器狭槽417的第二部分。如上所述,在各种实施例中,托架438可以通过第一运动范围行进第一距离并且通过第二运动范围行进第二距离,使得第一距离与第二距离之间的差值可以使施加于捕集组织的压缩力从第一压缩力减小到第二压缩力。在各种实施例中,如图10D中所示,第二距离可以与释放凹口425的深度和/或触发器狭槽417的长度相关。如上所述,使用者可以释放触发器424,并且触发器销416可以沿触发器狭槽417滑动到触发器狭槽417的第一部分,并且联接臂438的突出部437可以旋转到释放凹口425之外,以使触发器324返回到未致动位置。
在各种实施例中,参照图11A至图11C,手件520可以大体包括托架538,该托架538能够相对于手件520纵向地滑动;触发器524,该触发器524枢转地附接到托架538;和联接臂536,该联接臂536枢转地附接到托架538。在各种实施例中,手件520可以包括柄部护罩狭槽544。触发器524可以通过设置在触发器狭槽517中的触发器销516联接到联接臂536。联接臂537可以包括突出部,该突出部包括联接销537。联接销537可以设置在柄部护罩狭槽544中。在各种实施例中,联接销537可以沿柄部护罩狭槽544滑动。如上文所讨论的那样,复位弹簧(未示出)可以通过销(未示出)联接到托架538,该销被构造成能够使托架538朝远侧弹性地偏置。在各种实施例中,当触发器524处于第一致动位置时,联接销537可以与柄部护罩狭槽544的第一部分接触,并且在触发器524处于第二致动位置时与柄部护罩狭槽544的第二部分接触。
在使用中,参照图11A至图11C,当触发器524从未致动位置(图11A)通过第一运动范围运动到第一致动位置(图11B)时,联接销537沿狭槽544滑动,以压缩复位弹簧(未示出)并且将触发器524的运动转化成托架538的近侧线性运动。如图11B中所示,当触发器524处于第一致动位置时,联接销537可以与狭槽544的第一部分相接合。当联接销537继续沿狭槽544行进时,触发器524可以通过第二运动范围继续从第一致动位置运动到第二致动位置(图11C),以将复位弹簧(未示出)解压缩,并且将触发器524的运动转化成托架538的远侧线性运动。如图11B中所示,当触发器524处于第二致动位置时,联接销537可以与狭槽544的第二部分相接合。如上所述,在各种实施例中,托架538可以通过第一运动范围行进第一距离并且通过第二运动范围行进第二距离,使得第一距离与第二距离之间的差值可以使施加于捕集组织的压缩力从第一压缩力减小到第二压缩力。在各种实施例中,如图11C中所示,第二距离可以与狭槽544的构型和/或触发器狭槽517的长度相关。如上所述,使用者可以释放触发器524,并且触发器销516可以沿触发器狭槽517滑动,联接销537可以沿狭槽544滑动到狭槽544的第一部分,以使触发器524返回到未致动位置。在各种实施例中,狭槽544可以防止触发器524过度行进和锁定。
在各种实施例中,参照图14A至图14C,手件620可以大体包括:托架638,该托架638能够相对于手件620纵向地滑动;触发器624,该触发器624可滑动地附接到托架638并且枢转地附接到手件620;和联接臂636,该联接臂636枢转地附接到托架638和触发器624。在各种实施例中,参照图12和图13,手件620可以包括狭槽644,该狭槽644包括第一部分644a和第二部分644b,并且托架638可以包括凹口617,该凹口617包括第一部分617a和第二部分617b。后托架销618可以联接手件620、联接臂636和托架638。后托架销618的第一端部可以设置在狭槽644中,并且后托架销的第二端部可以设置在凹口617中。在各种实施例中,当触发器处于第一致动位置时,后托架销的第一端部可以与狭槽644的第一部分644a相接合,当触发器通过第二运动范围运动时,该第一端部可以与位于第一部分644a与第二部分644b之间的狭槽644的上行台阶相接合,并且当触发器处于第二致动位置时,该第一端部可以与狭槽644的第二部分644b相接合。在各种实施例中,上行台阶可以包括狭槽644的第一部分644a的成角度部分。在各种实施例中,当触发器处于第一致动位置时,后托架销的第二端部可以与凹口617的第一部分617a相接合,并且当触发器处于第二致动位置时,该第二端部可以与第二部分617b相接合。
在使用中,参照图14A至图14C,当触发器624从未致动位置(图14A)通过第一运动范围运动到第一致动位置(图14B)时,后托架销的第一端部可以沿狭槽644的第一部分644a滑动,以将触发器624的运动转化成托架638的近侧线性运动。当触发器通过第一运动范围从未致动位置运动到第一致动位置时,后托架销的第二端部可以位于凹口617的第一部分617a中。第一致动位置示于图14B中。当后托架销的第一端部沿狭槽644的上行台阶滑动到狭槽644的第二部分644b时,触发器624可以通过第二运动范围继续从第一致动位置运动到第二致动位置(图14C),并且后托架销的第二端部可以从凹口617的第一部分617a运动到第二部分617b,以将触发器624的运动转化成托架638的远侧运动。在各种实施例中,当后托架销的第一端部沿狭槽644的上行台阶滑动时,托架638可以上行朝远侧方向行进,并且当后托架销的第一端部沿狭槽644的第二部分644b滑动时,该托架638可以沿线性朝远侧方向行进。在各种实施例中,第二运动范围期间托架638相对于纵向轴线沿狭槽644的角运动和/或后托架销在凹口617中的运动可以向使用者提供触发器(未示出)处于第二致动位置的听觉和/或触觉指示。如上文所讨论的那样,复位弹簧(未示出)可以通过销(未示出)联接到托架638,该销被构造成能够使托架638朝远侧弹性地偏置。如上所述,使用者可以释放触发器,并且后托架销的第一端部可以沿狭槽644从狭槽644的第二部分644b滑动到第一部分644a,并且后托架销的第二端部可以从凹口617的第二部分617b运动到第一部分617a,以使触发器返回未致动位置。在各种实施例中,狭槽644可以防止触发器过度行进和锁定。
在各种实施例中,参照图15A至图4,手件720可以大体包括:托架738,该托架738能够相对于手件720纵向地滑动;触发器724,该触发器724枢转地附接到托架738;和联接臂736,该联接臂736固定地附接到托架738。联接臂736可以包括狭槽733。触发器724可以包括触发器狭槽717。触发器724可以通过触发器销716联接到联接臂736。触发器销716可以设置在联接销732中。触发器销716的一个端部可以设置在触发器狭槽717中。联接销732的一个端部可以设置在触发器狭槽717中,并且联接销732的另一个端部可以设置在狭槽733中。在各种实施例中,狭槽717、733可以被构造成能够用作凸轮并且触发器销716和联接销732可以被构造成能够用作凸轮从动件。在各种实施例中,狭槽716、733可以各自包括第一部分和第二部分。在各种实施例中,狭槽733的第一部分可以包括成角结构并且狭槽733的第二部分可以包括相对于纵向轴线的竖直结构。例如,如图15A中所示,狭槽733的第一部分可以从包括手件220的纵向轴线的平面朝远侧并且竖直地延伸,并且狭槽733的第二部分可以与包括手件220的纵向轴线的平面平行地延伸。
在使用中,参照图15A至图15K,当触发器724从未致动位置(图15A)通过第一运动范围(图15B、15C)运动到第一致动位置时,联接销732沿狭槽733的第一部分滑动,以将触发器724的运动转化成托架738的近侧线性运动。在各种实施例中,当触发器724处于未致动位置和第一致动位置时,联接销732可以与触发器狭槽717的第一部分接触。在各种实施例中,当触发器724通过第一运动范围运动时,触发器销717不可以在触发器狭槽716中运动。第一致动位置示于图15D中。当触发器销716沿狭槽717、733的第二部分滑动时,触发器724可以通过第二运动范围(图15E、图15F)继续从第一致动位置运动到第二致动位置,以将触发器724的运动转化成托架738的远侧线性运动。第二致动位置示于图15G中。如上所述,在各种实施例中,托架738可以通过第一运动范围行进第一距离并且通过第二运动范围行进第二距离,使得第一距离与第二距离之间的差值可以使施加于捕集组织的压缩力从第一压缩力减小到第二压缩力。在各种实施例中,如图15D、15G中所示,第二距离可以与触发器狭槽717的长度相关。
参照图15G至图15K,当触发器724从第二致动位置(图15G)通过第三运动范围(图15H至图15J)运动到未致动位置(图15K)时,弹簧(未示出)可以使触发器724返回未致动位置,在该未致动位置处,触发器724远离纵向轴线枢转。在各种实施例中,参照图15H和图15I,使用者可以释放触发器724,并且触发器销716可以沿狭槽733的第二部分向狭槽733的第一部分滑动,同时仍然在触发器狭槽717的第二部分中保持静止。参照图15J,当触发器销716与狭槽733的第一部分接触时,触发器销716可以沿触发器狭槽717的第二部分滑动到狭槽717的第一部分。当触发器724继续远离纵向轴线旋转时,联接销732沿狭槽733的第一部分滑动,以将触发器724的运动转化成托架738的远侧线性运动。未致动位置示于图15K中。在各种实施例中,狭槽717、733中的至少一个可以防止触发器724过度行进和锁定。
在各种实施例中,外科器械可以被构造成能够向被捕集的组织施加压缩力。如上所述,例如,钳口可以向被捕集在其间的组织施加压缩力。在各种实施例中,参照图17A至图17H,压缩力可以包括相对压缩力和/或滚动压缩力。如图17A至图17D中所示,当经受相对压缩力的作用并且将能量施加于组织时,血管的内层和外层可以保持粘合。外膜层可以在受热条件下回缩,从而使内肌层粘结。相比外膜-外膜粘结,内肌层粘结可能较弱。在各种实施例中,钳口可以施加相对压缩力和滚动压缩力,以在钳口闭合时使血管内层和外层分离。如图17E至图17H中所示,当经受相对压缩力和滚动压缩力作用时,血管的内层和外层可以分离。分离的内肌层可以在外膜层之前回缩,并且因此,外膜-外膜粘结可以在将能量施加于组织时形成。内肌层的分离可以通过允许内肌层随着开始积累热量而在血管内侧回缩来降低密封期间外膜层回缩的发生率。在各种实施例中,密封和/或焊接压缩的和滚动的组织层可以相对于密封和/或焊接被压缩的组织层形成更强的外膜-外膜粘结。
参照图18A和图18B,在各种实施例中,端部执行器840可以包括第一钳口842和第二钳口844。第二钳口844能够相对于轴830纵向地滑动;而第一钳口842朝向和远离第二钳口844相对于轴830枢转。第一钳口842和第二钳口844可以包括多个锯齿构造846。锯齿构造846可以允许组织被抓持、控制、凝结和/或切割而不在钳口842、844之间滑移。在各种实施例中,手件820可以包括连接器基部835,该连接器基部835被构造成能够使第二钳口844相对于轴830缩回。参照图19A和图19B,连接器基部835和第二钳口844可以通过弹簧838弹性偏置到远侧位置。如图19A中的插图中所示,钳口842可以不延伸至钳口844的尖端。连接器基部被构造成能够相对于手件820中的斜坡结构进行凸轮偏心运动,以在击发梁缩回到近侧位置时使第二钳口844相对于轴830缩回。手件820可以包括止动构件880,该止动构件880定位成接近连接器基部835和弹簧838。如图19B中所示,止动构件880被构造成能够在击发梁朝远侧行进以闭合钳口842、844时与连接器基部835的近侧面相接合。该进行凸轮偏心运动的能力可以有利于使用端部执行器840来分离组织层,例如血管的外膜层和内肌层。如图19B中的插图中所示,钳口844可以朝近侧运动,以与处于闭合位置的钳口842的尖端接触。在各种实施例中,致动器的纵向运动可以提供第一钳口842相对于轴830并且相对于第二钳口844的枢转以及第二钳口844相对于轴830的缩回。
在各种实施例中,外科器械可以大体包括:轴,该轴包括近侧端部和远侧端部;和超声波导,该超声波导至少部分地定位在轴内,该波导具有近侧端部和远侧端部;定位在波导的远侧端部的超声致动刀片;夹持臂组件,该夹持臂组件枢转地连接至轴的远侧端部,其中该夹持臂组件包括旋转地附接到夹持臂的至少两个凸轮构件,其中夹持臂能够相对于刀片在打开位置与闭合位置之间运动,以在处于闭合位置时压缩位于夹持臂与刀片中间的组织,并且其中在夹持臂从打开位置运动至闭合位置时所述至少两个凸轮构件沿相反方向旋转。在各种实施例中,所述至少两个凸轮构件可以选择性地在凸轮构件的第一部分与组织接触时以第一压缩力压缩组织,并且在凸轮构件的第二部分与组织接触时以第二压缩力压缩组织。在各种实施例中,第一压缩力可以与第二压缩力不同。在各种实施例中,第一压缩力可以大于或等于第二压缩力。能够构想到将上述构型与如本说明书前述的替代的能量形式及其组合结合在一起。
在各种实施例中,参照图20,端部执行器910可以包括夹持臂组件941,以抓握组织并且/或者相对于超声刀片964压缩组织。夹持臂组件941可以通过枢转销943枢转地附接到轴930的远侧端部。在各种实施例中,夹持臂组件941朝向并远离刀片964相对于刀片964枢转。如上所述,致动器(未示出)可以延伸穿过护套932并且与夹持臂941且在枢轴联接件943处联接,使得致动器通过轴930的纵向运动提供夹持臂941相对于轴930并且相对于刀片964的枢转。当然,夹持臂941还可以具有任何其它合适种类的运动,并可以任何其它合适的方式被致动。在各种实施例中,夹持臂组件可以包括旋转地附接到夹持臂941的至少一个凸轮构件942、944。当夹持臂941从打开位置运动到闭合位置时,凸轮构件942、944中的每一个都可以相对于轴930和刀片964沿顺时针方向或逆时针方向独立地旋转。在各种实施例中,凸轮构件942、944可以沿相反方向旋转。在各种实施例中,凸轮构件942、944可以沿相同方向旋转。在各种实施例中,凸轮构件942、944可以同时旋转。在各种实施例中,凸轮构件942、944可以单独旋转。
在各种实施例中,夹持臂941可以包括致动销917,以用于使凸轮构件944相对于波导964旋转。致动销917可以定位在凸轮构件944的近侧端部。当夹持臂941枢转以使凸轮构件944旋转时,致动销917可以与轴930的凹口916可操作地相接合。例如,当夹持臂941朝向刀片964枢转以使凸轮构件944逆时针旋转时,致动销917可以与凹口916相接合。当夹持臂941远离刀片964枢转以使凸轮构件944顺时针旋转时,致动销917可以与凹口916相接合。在各种实施例中,每个凸轮构件942、944都可以包括致动销,以分别与轴930中相应的凹口相接合。在各种实施例中,凸轮构件944可以包括致动销917,以与轴930的凹口916和齿轮(未示出)相接合,以与至少另一个凸轮构件942、944的齿轮(未示出)操作性地相接合,使得凸轮构件944的旋转运动使凸轮构件942旋转。当然,凸轮构件942、944还可以具有任何其它合适种类的运动,并可以任何其它合适的方式被致动。
在各种实施例中,凸轮构件可以选择性地在凸轮构件的第一部分与组织接触时以第一压缩力压缩组织并且在凸轮构件的第二部分与组织接触时以第二压缩力压缩组织,其中第一压缩力与第二压缩力不同。在各种实施例中,第一压缩力大于第二压缩力。在各种实施例中,参照图21A和图21B,凸轮构件942、944可以包括接触大体上为周边组织T的表面,该表面包括至少一个突起942a、944a。突起942a、944a可以分别在凸轮构件942、944的表面之上延伸。在各种实施例中,突起942a、944a可以包括大体逗号形状的弯曲部分。在各种实施例中,凸轮构件942、944可以选择性地在包括突起942a、944a的凸轮构件942、944的第一部分与组织T接触时以第一压缩力压缩组织T,并且在不具有突起的凸轮构件942、944的第二部分与组织T接触时以第二压缩力压缩组织T。在各种实施例中,凸轮构件942、944可以与组织T接触并且与组织T旋转地相接合,以剪切和/或刮擦组织T的外部和/或内部表面上的任何钙化。
尽管上文所描述的各种实施例包括手枪式握把,但是应当理解,前述教导内容可以易于被应用于具有各种其它类型的抓握部的装置。仅以举例的方式,可以在具有剪刀式抓握部的装置中根据上文的教导内容提供触发器和凸轮杠杆的变型。包括剪刀式抓握部的装置的各种例子在2012年3月21日提交的名称为“ENERGY-BASEDSCISSORSDEVICE”(基于能量的剪刀式装置)的美国专利申请序列13/426,084中有所描述,该专利的公开内容以引用方式并入本文。可以与上文的教导内容相结合的其它种类的抓握部对于本领域的普通技术人员而言将是显而易见的。此外,触发器和凸轮杠杆的变型可以易于结合到这样的装置中:所述装置具有各种其它种类的端部执行器,其中包括但不限于组织抓持器、组织取回袋部署器械、外科缝合器、超声外科器械等。
还应当理解,本文所述的装置中的任何装置可以改进,以包括马达或其它电动装置,从而驱动以其它方式手动运动的元件。此类改进的各种示例在2012年5月10日公布的名称为“MotorDrivenElectrosurgicalDevicewithMechanicalandElectricalFeedback”(带有机械和电反馈的马达驱动的电外科装置)的美国公布2012/0116379中有所描述,其公开内容以引用方式并入本文。考虑到本文的教导内容,马达或其它电动装置可以结合到本文的装置中的任何装置中的各种其它合适的方式对于本领域普通技术人员而言将是显而易见的。
还应当理解,可修改本文所述的任何装置以包含医疗装置自身内的大部分(如果不是全部)所需部件。更具体地讲,本文所述的装置能够使用内部或可附接的电源,而不是需要通过缆线插入至外部电源中的装置。医疗装置可以如何适于包括便携式功率源的各种例子公开于2010年11月5日提交的名称为“Energy-BasedSurgicalInstruments”(基于能量的外科器械)的美国临时申请序列61/410,603中,该专利的公开内容以引用方式并入本文。考虑到本文的教导内容,电源可以结合到本文的装置中的任何装置中的各种其它合适的方式对于本领域普通技术人员而言将是显而易见的。
本文所公开的装置可设计成单次使用后处理掉,也可以设计成多次使用。然而在任一种情况下,该器械均可重新恢复,从而在至少一次使用后再次使用。重新恢复可包括以下步骤的组合:拆卸装置、然后清洗或更换特定部件以及后续重新组装。具体来讲,该装置可以拆卸,并且可以任意组合对装置的任意数目的重新特定部件或零件进行选择性地更换或移除。清洗和/或置换特定部分后,该装置可以在重新恢复设施处重新组装以随后使用,或者在即将进行外科手术前由外科团队重新组装。本领域普通技术人员将会知道,重新恢复装置时可以采用多种不同技术来拆卸、清洗/更换和重新组装。这种技术的使用以及所得重新恢复器械均在本专利申请的范围内。
优选地,在外科手术之前将对本文所述的装置的各种实施例进行处理。首先,获取新的或用过的装置,并在必要时对装置进行清洁。然后对装置进行消毒。在一种消毒技术中,将器械置于闭合并密封的容器中,例如塑料或袋中。然后将容器和装置置于能够穿透该容器的辐射区,例如γ辐射、x-射线或高能电子。辐射将装置上和容器中的细菌杀死。然后将灭菌后的装置保存在消毒容器中。该密封容器将器械保持无菌,直到在医疗设备中打开该容器。其它消毒技术可通过本领域技术人员已知的任何多种方式进行,包括β辐射、γ辐射、环氧乙烷和/或蒸汽。
虽然文中结合某些公开的实施例对装置的多种实施例作了描述,但这些实施例的许多修改和变化形式也可被实现。例如,可采用不同类型的端部执行器。另外,凡是公开了用于某些元件的材料的,均可使用其它材料。此外,根据多种实施例,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。上述描述和以下权利要求旨在涵盖所有这类修改形式和变型。
以引用方式全文或部分地并入本文的任何专利、公布或其它公开材料均仅在所并入的材料不与本发明所述的现有定义、陈述或其它公开材料相冲突的范围内并入本文。由此,在必要的程度下,本文所明确阐述的公开内容将取代以引用方式并入本文的任何相冲突的材料。如果据述以引用方式并入本文但与本文所述的现有定义、陈述或其它公开材料相冲突的任何材料或其部分,仅在所并入的材料和现有的公开材料之间不产生冲突的程度下并入本文。
Claims (25)
1.一种外科器械,包括:
轴,所述轴包括近侧端部和远侧端部;
端部执行器,所述端部执行器从所述轴的所述远侧端部延伸,其中所述端部执行器能够操作以抓持组织;
柄部,所述柄部从所述近侧端部延伸,其中所述柄部包括抓握部分;和
触发器组件,所述触发器组件从所述柄部延伸,其中所述触发器组件包括触发器,所述触发器能够在未致动位置与第一致动位置和第二致动位置之间相对于所述抓握部分运动,其中所述触发器能够操作以控制所述端部执行器选择性地在所述触发器处于所述第一致动位置时以第一压缩力抓持组织并且在所述触发器处于所述第二致动位置时以第二压缩力抓持组织。
2.根据权利要求1所述的外科器械,其中所述第一压缩力大于所述第二压缩力。
3.根据权利要求1所述的外科器械,其中所述第一压缩力和所述第二压缩力独立地选自1psi至10psi。
4.根据权利要求1所述的外科器械,其中所述触发器组件包括:
杠杆臂,所述杠杆臂从所述触发器朝远侧延伸,其中所述杠杆臂包括狭槽;和
片簧,所述片簧包括设置在所述狭槽中的自由端部;
其中当所述触发器处于所述第一致动位置时,所述片簧的自由端部与所述狭槽的第一部分相接合,并且当所述触发器处于所述第二致动位置时,所述片簧的自由端部与所述狭槽的第二部分相接合。
5.根据权利要求1所述的外科器械,其中所述触发器组件包括:
托架,所述托架能够相对于所述柄部纵向地滑动并与所述触发器纵向地相接合;
联接臂,所述联接臂包括狭槽;和
触发器销,所述触发器销设置在所述狭槽中,其中所述触发器销联接所述触发器和所述联接臂;
其中当所述触发器处于所述第一致动位置时,所述触发器销与所述狭槽的第一部分相接合,并且当所述触发器处于所述第二致动位置时,所述触发器销与所述狭槽的第二部分相接合。
6.根据权利要求1所述的外科器械,其中所述触发器组件包括:
托架,所述托架能够相对于所述柄部纵向地滑动并与所述触发器纵向地相接合,其中所述触发器包括凸轮结构;和
联接臂,所述联接臂枢转地附接到托架,其中所述联接臂包括凸轮从动件以与所述凸轮结构相接合;
其中当所述触发器处于所述第一致动位置时,所述凸轮从动件与所述凸轮结构的第一部分相接合,并且当所述触发器处于所述第二致动位置时,所述凸轮从动件与所述凸轮结构的第二部分相接合。
7.根据权利要求1所述的外科器械,其中所述触发器组件包括:
包括触发器狭槽的触发器和包括触发器凹口的凸轮结构;
联接臂,所述联接臂枢转地附接到托架,其中所述联接臂包括凸轮从动件以与所述凸轮结构相接合;以及
触发器销,所述触发器销设置在所述狭槽中,其中所述触发器销联接所述触发器和所述联接臂;
其中当所述触发器处于所述第一致动位置时,所述凸轮从动件与所述凹口的第一部分相接合,并且当所述触发器处于所述第二致动位置时,所述凸轮从动件与所述凹口的第二部分相接合;并且
其中当所述触发器处于所述第一致动位置时,所述触发器销与所述触发器狭槽的第一部分相接合,并且当所述触发器处于所述第二致动位置时,所述触发器销与所述触发器狭槽的第二部分相接合。
8.根据权利要求1所述的外科器械,其中所述触发器组件包括:
柄部,所述柄部包括凸轮结构,所述凸轮结构包括凸轮狭槽;和
联接臂,所述联接臂枢转地附接到托架,其中所述联接臂包括设置在所述凸轮狭槽中的联接销;
触发器,所述触发器包括触发器狭槽;
触发器销,所述触发器销设置在所述触发器狭槽中,其中所述触发器销联接所述触发器和所述联接臂;
其中当所述触发器处于所述第一致动位置时,所述联接销与所述凸轮狭槽的第一部分相接合,并且当所述触发器处于所述第二致动位置时,所述联接销与所述凸轮狭槽的第二部分相接合;并且
其中当所述触发器处于所述第一致动位置时,所述触发器销与所述触发器狭槽的第一部分相接合,并且当所述触发器处于所述第二致动位置时,所述触发器销与所述触发器狭槽的第二部分相接合。
9.根据权利要求1所述的外科器械,其中
所述柄部包括凸轮结构,所述凸轮结构包括狭槽;并且
所述触发器组件包括:
联接臂,所述联接臂枢转地附接到所述触发器;和
托架,所述托架能够相对于所述柄部纵向地滑动并与所述触发器纵向地相接合,其中所述托架包括凸轮结构,所述凸轮结构包括凹口,和
托架销,所述托架销包括设置在所述狭槽中的第一端部和设置在所述凹口中的第二端部;
其中当所述触发器处于所述第一致动位置时,所述托架销的第一端部与所述狭槽的第一部分相接合,并且所述托架销的第二端部与所述凹口的第一部分相接合,并且当所述触发器处于所述第二致动位置时,所述托架销的第一端部与所述狭槽的第二部分相接合,并且所述托架销的第二端部与所述凹口的第二部分相接合。
10.根据权利要求9所述的外科器械,其中当所述联接销接合所述狭槽的第二部分和所述凹口的第二部分中的至少一个时,所述触发器组件提供听觉和/或触觉信号。
11.根据权利要求1所述的外科器械,其中所述触发器组件包括:
托架,所述托架能够相对于所述柄部纵向地滑动;
联接臂,所述联接臂枢转地附接到所述托架并滑动地附接到所述触发器,其中所述联接臂包括凸轮结构,所述凸轮结构包括凸轮狭槽;
触发器销,所述触发器销联接所述触发器和所述联接臂,其中所述触发器销设置在所述凸轮狭槽中;
其中当所述触发器处于所述第一致动位置时,所述触发器销与所述凸轮狭槽的第一部分相接合,并且当所述触发器处于所述第二致动位置时,所述触发器销与所述凸轮狭槽的第二部分相接合。
12.根据权利要求1所述的外科器械,其中所述端部执行器包括:
第一钳口;
第二钳口,其中所述第一钳口和所述第二钳口中的至少一个能够在打开位置与闭合位置之间相对于所述第一钳口和所述第二钳口中的另一个运动;和
至少一个电极,所述至少一个电极施加电外科能量以焊接组织。
13.根据权利要求12所述的外科器械,其中所述至少一个电极联接到射频(Rf)能量源。
14.根据权利要求13所述的外科器械,所述外科器械包括闭锁机构以防止电流从所述能量源流向所述至少一个电极,除非所述触发器处于所述第二致动位置。
15.根据权利要求12所述的电外科器械,其中所述第一钳口和所述第二钳口中的一个能够在第一位置与第二位置之间相对于所述第一钳口和所述第二钳口中的另一个纵向地运动,其中当所述触发器处于所述未致动位置时,所述第一钳口和所述第二钳口中的所述一个处于所述第一位置,并且当所述触发器处于所述第一致动位置时,所述第一钳口和所述第二钳口中的所述一个处于所述第二位置。
16.根据权利要求1所述的外科器械,其中所述端部执行器包括击发梁,所述击发梁能够沿所述端部执行器的至少一部分纵向地运动,其中所述击发梁包括:
用以切断组织的远侧刀片,其中所述远侧刀片包括相对的表面,每个所述相对的表面包括至少一个滚子轴承以压缩组织。
17.一种外科器械,包括:
轴,所述轴包括近侧端部和远侧端部;
端部执行器,所述端部执行器从所述轴的所述远侧端部延伸,其中所述端部执行器包括第一钳口、第二钳口和电极,其中所述第一钳口能够在打开位置与闭合位置之间相对于所述第二钳口运动,以在处于所述闭合位置时压缩位于所述第一钳口和所述第二钳口中间的组织;
柄部,所述柄部从所述近侧端部延伸,其中所述柄部包括抓握部分;和
触发器组件,所述触发器组件从所述柄部延伸,其中所述触发器组件包括触发器,所述触发器能够在从未致动位置到第一致动位置的第一运动范围内相对于所述抓握部分运动,其中所述触发器能够在从第一致动位置到第二致动位置的第二运动范围内运动,并且其中所述触发器能够在从所述第二致动位置到所述未致动位置的第三运动范围内运动,其中所述触发器能够操作以控制所述端部执行器选择性地在所述触发器处于所述第一致动位置时以第一压缩力压缩组织并且在所述触发器处于所述第二致动位置时以第二压缩力压缩组织,其中所述第一压缩力大于所述第二压缩力。
18.根据权利要求17所述的外科器械,所述外科器械包括凸轮结构和与所述凸轮结构相接合的接合构件,其中当所述触发器处于所述第一致动位置时,所述接合构件与所述凸轮结构的第一部分相接合,并且当所述触发器处于所述第二致动位置时,所述接合构件与所述凸轮结构的第二部分相接合。
19.一种外科器械,包括:
轴,所述轴包括近侧端部和远侧端部;
超声波导,所述超声波导至少部分地定位在所述轴内,所述波导具有近侧端部和远侧端部;
超声致动刀片,所述超声致动刀片定位在所述波导的远侧端部处;
夹持臂组件,所述夹持臂组件枢转地连接至所述轴的远侧端部,其中所述夹持臂组件包括旋转地附接到夹持臂的至少两个凸轮构件,其中所述夹持臂能够在打开位置与闭合位置之间相对于所述刀片运动以在处于所述闭合位置时压缩位于所述夹持臂与所述刀片中间的组织,并且其中所述至少两个凸轮构件相对于所述夹持臂旋转,从而当所述夹持臂在所述打开位置与所述闭合位置之间运动时将组织层分离。
20.根据权利要求19所述的外科器械,其中所述至少两个凸轮构件选择性地在所述凸轮构件的第一部分与组织接触时以第一滚动压缩力压缩组织并且在所述凸轮构件的第二部分与组织接触时以第二滚动压缩力压缩组织,其中所述第一滚动压缩力与所述第二滚动压缩力不同。
21.根据权利要求20所述的外科器械,其中所述第一滚动压缩力大于所述第二滚动压缩力。
22.根据权利要求21所述的外科器械,其中所述至少两个凸轮构件各自包括圆周表面,所述圆周表面包括第一部分和第二部分,其中所述第二部分包括突起,并且其中所述突起以所述第一滚动压缩力压缩组织。
23.根据权利要求19所述的外科器械,其中当所述夹持臂在所述打开位置与所述闭合位置之间运动时,所述至少两个凸轮构件相对于彼此独立地旋转。
24.根据权利要求19所述的外科器械,其中当所述夹持臂在所述打开位置与所述闭合位置之间运动时,所述至少两个凸轮构件相对于彼此同时旋转。
25.根据权利要求19所述的外科器械,其中当所述夹持臂在所述打开位置与所述闭合位置之间运动时,所述至少两个凸轮构件沿相同方向或相反方向旋转。
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JP2016511096A (ja) | 2016-04-14 |
US20140276738A1 (en) | 2014-09-18 |
EP2967622A1 (en) | 2016-01-20 |
US9241728B2 (en) | 2016-01-26 |
US20160095617A1 (en) | 2016-04-07 |
WO2014150163A1 (en) | 2014-09-25 |
BR112015023138A2 (pt) | 2017-07-18 |
US9743947B2 (en) | 2017-08-29 |
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