CN105101886A - 外科器械端部执行器的远侧末端特征结构 - Google Patents

外科器械端部执行器的远侧末端特征结构 Download PDF

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CN105101886A
CN105101886A CN201480011027.9A CN201480011027A CN105101886A CN 105101886 A CN105101886 A CN 105101886A CN 201480011027 A CN201480011027 A CN 201480011027A CN 105101886 A CN105101886 A CN 105101886A
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anvil block
storehouse
end effector
equipment according
distal end
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CN105101886B (zh
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R·J·西姆斯
D·B·霍夫曼
R·J·格廷尔
T·S·贝达德
D·L·加纳
G·A·阿姆斯特朗
J·B·沃尔兹
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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
    • A61B17/068—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
    • 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
    • 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
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00681—Aspects not otherwise provided for
    • A61B2017/00738—Aspects not otherwise provided for part of the tool being offset with respect to a main axis, e.g. for better view for the surgeon
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00831—Material properties
    • A61B2017/00858—Material properties high friction, non-slip
    • 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
    • A61B2017/07214—Stapler heads
    • A61B2017/07257—Stapler heads characterised by its anvil
    • 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
    • A61B2017/07214—Stapler heads
    • A61B2017/07271—Stapler heads characterised by its cartridge
    • 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
    • A61B2090/0801—Prevention of accidental cutting or pricking
    • A61B2090/08021—Prevention of accidental cutting or pricking of the patient or his organs
    • 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

Abstract

本发明公开了一种设备，其包括主体、轴和端部执行器，所述端部执行器能够操作以压缩、缝合和切割组织。所述端部执行器包括砧座和仓。当所述砧座处于闭合位置时，纵向轴线与所述砧座的远侧末端相交。所述仓限定从所述仓的第一侧部沿所述仓的远侧表面朝所述砧座延伸的视准线。所述仓的所述第一侧部与所述砧座相对。所述仓的所述远侧表面既不与所述纵向轴线平行，也不与所述纵向轴线垂直。当所述砧座处于所述闭合位置时，所述视准线在所述远侧末端附近与所述纵向轴线相交。所述视准线的一段与所述纵向轴线的一段限定角θ。所述角θ大于90°。

Description

外科器械端部执行器的远侧末端特征结构
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。此轴可使能插入期望的深度并围绕轴的纵向轴线旋转，由此有利于将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，或者以其他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“PocketConfigurationforInternalOrganStaplers”的美国专利4,805,823；1995年5月16日公布的名称为“SurgicalStaplerandStapleCartridge”的美国专利5,415,334；1995年11月14日公布的名称为“SurgicalStaplerInstrument”的美国专利5,465,895；1997年1月28日公布的名称为“SurgicalStaplerInstrument”的美国专利5,597,107；1997年5月27日公布的名称为“SurgicalInstrument”的美国专利5,632,432；1997年10月7日公布的名称为“SurgicalInstrument”的美国专利5,673,840；1998年1月6日公布的名称为“ArticulationAssemblyforSurgicalInstruments”的美国专利5,704,534；1998年9月29日公布的名称为“SurgicalClampingMechanism”的美国专利5,814,055；2005年12月27日公布的名称为“SurgicalStaplingInstrumentIncorporatinganE-BeamFiringMechanism”的美国专利6,978,921；2006年2月21日公布的名称为“SurgicalStaplingInstrumentHavingSeparateDistinctClosingandFiringSystems”的美国专利7,000,818；2006年12月5日公布的名称为“SurgicalStaplingInstrumenthavingaFiringLockoutforanUnclosedAnvil”的美国专利7,143,923；2007年12月4日公布的名称为“SurgicalStaplingInstrumentIncorporatingaMulti-StrokeFiringMechanismwithaFlexibleRack”的美国专利7,303,108；2008年5月6日公布的名称为“SurgicalStaplingInstrumentIncorporatingaMultistrokeFiringMechanismHavingaRotaryTransmission”的美国专利7,367,485；2008年6月3日公布的名称为“SurgicalStaplingInstrumentHavingaSingleLockoutMechanismforPreventionofFiring”的美国专利7,380,695；2008年6月3日公布的名称为“ArticulatingSurgicalStaplingInstrumentIncorporatingaTwo-PieceE-BeamFiringMechanism”的美国专利7,380,696；2008年7月29日公布的名称为“SurgicalStaplingandCuttingDevice”的美国专利7,404,508；2008年10月14日公布的名称为“SurgicalStaplingInstrumentHavingMultistrokeFiringwithOpeningLockout”的美国专利7,434,715；2010年5月25日公布的名称为“DisposableCartridgewithAdhesiveforUsewithaStaplingDevice”的美国公布7,721,930；2010年10月21日公布的名称为“SurgicalStaplingInstrumentwithAnArticulatableEndEffector”的美国公布2010/0264193；和2012年9月20日公布的名称为“Motor-DrivenSurgicalCuttingInstrumentwithElectricActuatorDirectionalControlAssembly”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者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研制出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说明和下文所给出的实施例的详细说明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截取的侧剖面视图，此时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截取的侧剖面视图，此时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截取的端部剖面视图；
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示出具有成角度砧座和成角度仓的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侧视图；
图14示出图12的仓的放大侧视图，图中示出了成角度末端；
图15A示出示例性另选形式端部执行器的侧正视图，该端部执行器具有带球形末端的砧座和带球形末端的仓，此时砧座处于闭合位置；
图15B示出图15A的端部执行器的侧正视图，此时砧座处于打开位置；
图16示出图15A的端部执行器的砧座的侧透视图，图中示出了具有球形沟槽和凹槽的内部部分；
图17示出具有有色部分的示例性另选形式端部执行器的侧正视图；并且
图18示出具有形成于砧座中的开口的示例性另选形式端部执行器的侧透视图。
附图并非意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，应当理解本发明不受限于所示出的确定布置。
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，本发明的其他示例、结构、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，本发明能够具有其他不同且明显的方面，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1A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插管通道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，本申请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，并且这些术语并非意图进行限制，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“SurgicalInstrumentwithMulti-DiameterShaft”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插入穿过套管针的管道通道，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(α)偏转。由此，端部执行器12可以从所需的角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使端部执行器12能够沿着单个平面偏转。在一些其他形式中，关节运动接头11使端部执行器能够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被构造。另选地，关节运动接头11和/或关节运动控件13可具有任何其他合适的构型。仅以举例的方式，关节运动控件13可代替地被构造为旋钮，该旋钮围绕与轴22的纵向轴线LA垂直的轴线旋转。
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“SurgicalInstrumentEndEffectorArticulationDrivewithPinionandOpposingRacks”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可以采用的各种其他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“InstallationFeaturesforSurgicalInstrumentEndEffectorCartridge”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。砧座18可以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“IntegratedTissuePositioningandJawAlignmentFeaturesforSurgicalStapler”的美国专利申请[代理人案卷号END7176USNP.0599177]，其公开内容以引用方式并入本文；与本文同一天提交的名称为“JawClosureFeatureforEndEffectorofSurgicalInstrument”的美国专利申请[代理人案卷号END7177USNP.0599225]，其公开内容以引用方式并入本文；与本文同一天提交的名称为“StapleFormingFeaturesforSurgicalStaplingInstrument”的美国专利申请[代理人案卷号ENDEND7180USNP.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可以采用的各种其他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，该闭合管32和闭合环33两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，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以能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以能够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推进到远侧位置中时，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“LockoutFeatureforMovableCuttingMemberofSurgicalInstrument”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内纵向地活动；而钉驱动器43能够在钉仓37内竖直地活动。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。
在一些形式中，钉仓37是根据如下专利的教导内容中的至少一些来构造和操作的：美国专利申请[代理人案卷号END7176USNP.0599177]，其公开内容以引用方式并入本文。除此之外或作为另外一种选择，钉仓37可以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中)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/或其他体液的渗漏。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中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。以下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他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100可被用来从电池组104使用电力对电动马达102(同样示于图1-2中)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，但是应当理解安全开关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108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，并因此当闭合开关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“ElectronicLockoutsandSurgicalInstrumentIncludingSame”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被释放。在该操作状态下，电流流过反向指示器114(例如LED)，以提供马达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中的一者或多者是的形式为微型开关。根据本文的教导内容，其他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-DrivenSurgicalInstrument”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128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132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136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。除此之外或作为另外一种选择，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的机动的其他合适的部件、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.具有可视化特征结构和引入端特征结构的示例性端部执行器
应当理解，在一些情况下，可能期望使使用者更清楚地看到端部执行器12。具体地，使用者在将端部执行器12插入手术部位后，可能会在手术期间旋转器械10的轴22。端部执行器12因而也旋转。当端部执行器12旋转时，使用者可能希望看到手术部位。例如，使用者可能想要看到组织90和端部执行器12之间的接触面或接触点。因为端部执行器12可以绕纵向轴线LA相对于柄部部分20旋转，所以应当理解，使用者在观察手术部位时，可能看到端部执行器的下钳口16，而不是砧座18。另选地，可将端部执行器12旋转到这样的位置，即，使用者在观察端部执行器12时，可以看到砧座18。使用者能够看到比使用图1的器械10时所能看到的手术部位范围更大的范围可能是合意的。举例来说，在使用者使用设备做一些涉及切断再缝合有体液及血液流经的脉管的外科手术的情况下，可能期望目视判定砧座18和下钳口16已完全覆盖需要切割的脉管，由此确保致动一次设备就可以完全切割并缝合此脉管。换句话讲，使用者可能希望避免只有一部分脉管被切割缝合的情况。因此，可能合意的是采取一些可视监视和/或反馈的手段，让使用者能够知道端部执行器12已适当定位在手术部位中，接着使用者便可以操纵端部执行器，让砧座18和下钳口16完全夹持住脉管。一种可行的监视手术部位的方式可包括改善与下钳口16和砧座18的远侧末端相邻区域的可见度。此外，应当理解，让使用者在手术过程中能够看到端部执行器12的远侧端部可能还不够。可能还期望将端部执行器12构造成具有这样的特征结构：当端部执行器12在组织中推进时，端部执行器12具有的特征结构能促使端部执行器12平稳光滑地穿过组织，不对组织造成损伤。
图12示出包括砧座218和下钳口216的示例性端部执行器212。应当理解，端部执行器212可与器械10的端部执行器12互换使用。端部执行器212可与器械10一体形成，或作为另外一种选择，可与器械10的端部执行器12互换。
砧座218能操作用于相对下钳口216枢转。在枢转过程中，砧座218和下钳口216能够以类似于图1所示的砧座18和下钳口16所执行的夹紧操作夹紧组织90。端部执行器212还包括与图3所示的仓37类似的仓237，仓237能操作用于放置在下钳口216中。
从图12-13可以看出，砧座218具有伸长的形状，其远侧部分成一角度朝仓237靠拢。砧座218的远侧部分成一角度朝仓237靠拢，使得砧座218的最远侧末端219在纵向上朝远侧延伸超过仓237。然而应当理解，在一些形式中，远侧末端219可能在纵向上延伸到与仓237垂直齐平，或者延伸到相对于仓237的最远侧点近侧的位置。此外，砧座218以平缓的坡度成一角度朝仓237靠拢。仅以举例的方式，图12的砧座218的形状与倒转的滑雪板末端类似。应当理解，具有成角度形状的砧座218可使端部执行器212更容易插入手术部位。例如，具有平缓坡度或倒转的滑雪板末端形状的砧座218在接触组织时，或在组织中移动时，砧座218表面会使组织挠曲，不对组织造成损伤。应当理解，一旦将具有成角度形状的砧座218置于手术部位中，使用者就会发现，他能够更灵活地操纵端部执行器212。本领域的普通技术人员参考本文的教导内容能轻而易举地设想其他合适形式的砧座218。
仓237能操作用于保持住与图4A所示的钉47类似的钉，并驱动这些钉47进入组织。如图13所示，仓237的远侧端部具有三角形轮廓。具体地，仓237的远侧端部包括上部锥形表面239和下部锥形表面238。上部锥形表面239和下部锥形表面238在仓237的最远侧端部合拢。下部锥形表面238限定视准线240。视准线240的用途是，一旦使用者把端部执行器212插入手术部位，就可沿着视准线240观察。我们可以在图14中更清楚地看到，视准线240沿下部锥形表面238的边缘延伸。应当理解，将下部锥形表面238构造成具有平面形状可能是为了允许使用者看到和/或大致看到砧座218的远侧末端219。具体地，视准线240与纵向延伸穿过端部执行器212的纵向轴线LA相交形成视角θ。
应当理解，视角θ可确定使用者对远侧末端219的相对可见度。具体地，使用者可能在远侧末端219前方，沿视角θ范围内穿过视准线240和纵向轴线LA交点的任一条视线观察远侧末端219。例如，随着视角θ增大，使用者从近侧有利位置观察远侧末端219时，会发现远侧末端219正前方区域的能见度变大；然而，随着视角θ减小，使用者从近侧有利位置观察远侧末端219时，会发现远侧末端219前方区域的能见度变小。在一些形式中，视角θ限定比90度大的角。此外，在一些形式中，视角θ限定比135度大的角。本领域的普通技术人员参考本文的教导内容能轻而易举地设想视角θ的其他合适角。在示出的形式中，应当理解，使用者通常沿视准线240或沿视角θ范围内的一些其他视线观察，因此，使用者不仅能观察到沿视准线的区域，还能观察到视角θ范围内的任意区域。远侧末端219的下侧还可以略圆，有助于使用者看到纵向轴线LA和视准线240的交点。
一旦使用者如图13所示那样将组织90夹持在闭合的仓237和砧座218之间，就可沿视准线240或在视角θ范围内的其他位置观察，比如清晰地看到砧座218在何位置夹持住组织90。此外，使用者将能够确定组织是否被完全夹持在砧座218与仓237之间，只有确定组织被完全夹持，才能确保组织不溢出端部执行器212的末端。应当理解，还可能将砧座218和仓237夹持组织90的程度形象地呈现给使用者。应当理解，在一些情况下，可以先旋转端部执行器212再夹持组织90，在旋转端部执行器212的同时夹持组织90，或先夹持组织90再旋转端部执行器212。因此，砧座218的锥形形状还能让使用者更容易观察远侧末端219，或与远侧末端219大体相邻的区域。应当理解，锥形的砧座218与仓237的下部锥形表面238结合起来可进一步促进端部执行器212以无创伤的方式轻松插入组织。此外，由于端部执行器212具有锥形端部，使用者便可以更加容易地将端部执行器212穿过套管针或能操作用于引导端部执行器212的其他设备推送到手术部位中。例如，一旦使用者将远侧末端219装入套管针，下部锥形表面238和锥形的砧座218就可用作引入端，引导端部执行器212的其余部分进入套管针。
图15A示出包括砧座318和下钳口316的示例性另选形式端部执行器312。应当理解，可使用端部执行器312替代图1示出的端部执行器12。在一些形式中，端部执行器312可与轴22一体形成；另选地，可单独形成端部执行器312，然后将其组装到轴22上。砧座318能操作用于相对仓337枢转打开或闭合。例如，图15B示出砧座318处于打开位置，图15A示出砧座318处于闭合位置。砧座318具有成角度的远侧部分320，还在成角度远侧部分320的最远侧部分处具有砧座球形末端319。仓337具有仓球形末端322。应当理解，仓球形末端322与砧座318的下侧适配，这将在下文进一步详细描述。应当理解，砧座318和仓337的远侧锥形改善了端部执行器312远侧端部的可见度，这与图12所示的端部执行器212类似。
图16示出砧座318下侧的放大视图。砧座318除包括砧座球形末端319和成角度的远侧部分320之外，还包括多个横向延伸的凹槽324和一个球形凹坑326。多个凹槽324在成角度的远侧部分320内排成一行。在示出的形式中，多个凹槽324包括三个凹槽，但应当理解，可以使用其他合适数量的凹槽324。例如，可以使用四个、五个、六个或更多个凹槽324。应当理解，多个凹槽324可以等距离地间隔开。此外，多个凹槽324可以已知的距离间隔开。例如，使用者可能知道每个凹槽324与相邻凹槽间隔1mm。因此，在配合使用砧座318和仓337抓牢组织后，组织可能覆盖住一部分凹槽324。由于组织覆盖住凹槽324，使用者用被覆盖住的凹槽324的数量乘以凹槽324的间距，就能够近似确定凹槽324上方组织的长度。另选地，使用者可以估计暴露的凹槽324的数量，然后使用该数量计算从砧座球形末端319到组织的近似距离。此外，应当理解，凹槽324还可用于增大对组织的抓持力度，让砧座318和仓337始终能够更牢固地夹持住组织。示例性形式的砧座318还包括钉孔351和竖直狭槽349。应当理解，钉孔351和竖直狭槽349的作用基本上类似于图3的孔51和竖直狭槽349。
应当理解，球形凹坑326的形状与仓球形末端322的形状互补。尽管本示例的凹坑326和末端322都具有不完全球形的形状，但应当理解，球形凹坑和仓球形末端可具有其他任何合适的形状。在本示例中，由于末端322和凹坑326的构型互补，所以，在砧座318闭合到仓337上之后，仓球形末端322与球形凹坑326接合，不仅促使砧座318与仓337对准，还增强砧座318与仓337的稳定性。尽管该示例性形式示出球形凹坑326定位在一个凹槽324中，但应当理解，球形凹坑326可沿砧座318定位在任何合适的位置。在一些形式中，球形凹坑326或球形末端322可具有抛光和/或上色的表面，目的是在将砧座318插入组织后，球形凹坑326或球形末端322的抛光表面能让使用者更清晰地看到球形凹坑326或球形末端322。因此，使用者便可以更清楚地确定球形末端322或球形凹坑326是否足够靠近目标组织区域。此外，虽然示例性形式示出砧座318具有凹槽324和球形凹坑326，但应当理解，仓337除球形凹坑326之外还可包括类似的球形凹坑或者只包括与球形凹坑326类似的球形凹坑，用于容纳砧座球形末端319，并且仓337还可能具有基本上类似于凹槽324的凹槽。
球形末端322不仅有利于使用者看到砧座218的末端，还可用作钝性分离工具(例如用作钮扣状解剖器)，或用作促使组织在手术部位内四处游走的工具。应当理解，倒圆形状的球形末端322能操作用于提供接合组织的无创伤表面。虽然示例性形式示出球形末端322具有球形形状，但应当理解，可以使用本领域的普通技术人员参考本文教导内容能轻易设想出的任何合适的球形末端322无创伤形状。应当理解，采用这种球形末端322设计后，使用者在推动端部执行器312或以其他方式移动端部执行器312穿过组织时，能够将组织创伤降低到最低限度。
在一些情况下，为端部执行器设计更容易看到的末端可能是合意的，在使用者将端部执行器的远侧端部插入(例如)手术部位时，这种末端能让使用者更清楚地看到该远侧端部。图17和图18示出的端部执行器412和512被设计成有利于使用者更清楚地看到端部执行器412的远侧端部。在图17中，端部执行器412包括砧座418和下钳口416，其中下钳口416固定住仓437。应当理解，砧座418、下钳口416和仓437以基本上类似于图3的砧座18、下钳口16和仓37的方式发挥作用。然而，由于砧座418的远侧端部具有成角度形状且砧座418包括顶盖部分440，所以砧座418与砧座418不同。顶盖部分440包含能操作用于覆盖住砧座418端部的橡胶、塑料或者说合成材料。举例来说，顶盖部分440可包括嵌入物、包覆模制物、涂层；或呈现本领域的普通技术人员参考本文教导内容能轻易设想出的其他任何合适的形式。在示例性形式中，顶盖部分440覆盖住砧座418的下侧。因此，应当理解，当组织被砧座418挤压时，仍可见的顶盖部分440面积可以提示使用者有多少组织已被砧座418夹紧。还应当理解，顶盖部分440可具有能够与组织区分开的对比色。例如，顶盖部分440可具有亮红色、黄色、蓝色、绿色等颜色，这样，一旦使用者将砧座418插入组织，就能够迅速确定砧座418在组织内的位置。虽然在示例性形式中，砧座418包括顶盖部分440，但应当理解，除此之外或作为另外一种选择，仓437也可具有类似的有色部分。此外，虽然示出的形式显示顶盖部分440只覆盖住砧座418的一部分，但在一些形式中，顶盖部分440可以覆盖住整个砧座418。
图18示出另选的示例性端部执行器512，其包括砧座518和下钳口516，其中下钳口516固定住仓537。砧座518在所述砧座518远侧端部处限定开口540。应当理解，开口540完全延伸穿过砧座518，因此，当砧座518在组织上闭合时，使用者可以透过开口540观察，看组织是否可见。如果组织可见，使用者便至少以一种方式确认组织已被夹持在砧座518和仓537之间。应当理解，在一些情况下，使用者可能只想透过开口540瞄一眼，确认组织不可见。如果没有看到组织，使用者就可确认组织已足够深入地定位在砧座518和仓537之间，此时倘若要夹持并切割组织，便能确保击发一次端部执行器512，就可以对砧座518和仓537之间的全部组织执行夹持和切割。譬如在切割脉管期间，使用者可能期望确认组织不可见。此外，应当理解，开口540还干扰了砧座518表面的连续，从而可以增大砧座518对组织的夹持力度。虽然在示例性形式中，砧座518形成了开口540，但应当理解，开口540可以在仓537或端部执行器512的任何其他合适部分上形成，只要适用于让使用者看到砧座518和仓537之间的组织、或促使砧座518和仓537夹紧组织即可。此外，虽然在示出的形式中开口540显示为垂直于砧座518的表面形成的圆形开口，但开口540可以具有任何合适的形状，并可能以有利于使用者透过开口540看到组织的任意合适角穿过砧座518形成。
在一些形式中，端部执行器512可结合端部执行器412使用。具体地，开口540可用作锚固点，能够在其上锚定包覆模制物，或固定另外的特征结构(比如顶盖部分440)。这种包覆模制物或顶盖部分440可由与形成砧座518的材料不同的材料形成。仅以举例的方式，包覆模制物或顶盖部分440可由塑料或其他聚合物形成，而砧座518由金属形成。还应当理解，砧座518和/或端部执行器512的任何其他特征结构可能涂有涂层，或接受过表面处理。虽然示出的形式显示砧座518包括开口540，但应当理解，开口540可定位在端部执行器512远侧端部上的任意位置，用于容纳包覆模制部件比如顶盖部分440。例如，开口540可定位在砧座518的侧部上，或仓537上任意合适位置处。
IV.其他方面
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、陈述或其他公开材料相冲突的任何材料或其部分，仅在所并入的材料和现有的公开材料之间不产生冲突的程度下并入本文。
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IntuitiveSurgical,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“ArticulatedSurgicalInstrumentForPerformingMinimallyInvasiveSurgeryWithEnhancedDexterityandSensitivity”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“RemoteCenterPositioningDevicewithFlexibleDrive”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“AutomatedEndoscopeSystemforOptimalPositioning”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“RoboticArmDLUSforPerformingSurgicalTasks”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“RoboticSurgicalToolwithUltrasoundCauterizingandCuttingInstrument”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“AlignmentofMasterandSlaveinaMinimallyInvasiveSurgicalApparatus”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“MechanicalActuatorInterfaceSystemforRoboticSurgicalTools”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“PlatformLinkWristMechanism”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“RepositioningandReorientationofMaster/SlaveRelationshipinMinimallyInvasiveTelesurgery”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“AutomatedEndEffectorComponentReloadingSystemforUsewithaRoboticSystem”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-ControlledSurgicalInstrumentwithForce-FeedbackCapabilities”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“ShiftableDriveInterfaceforRobotically-ControlledSurgicalTool”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“SurgicalStaplingInstrumentswithCam-DrivenStapleDeploymentArrangements”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-ControlledMotorizedSurgicalEndEffectorSystemwithRotaryActuatedClosureSystemsHavingVariableActuationSpeeds”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-ControlledSurgicalInstrumentwithSelectivelyArticulatableEndEffector”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-ControlledSurgicalEndEffectorSystem”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“DriveInterfaceforOperablyCouplingaManipulatableSurgicalTooltoaRobot”的美国公布2012/0211546；2012年6月7日公布的名称为“Robotically-ControlledCable-BasedSurgicalEndEffectors”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-ControlledSurgicalEndEffectorSystemwithRotaryActuatedClosureSystems”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，所述装置的一些版本可在修复设施中重新组装或者在即将进行手术前由使用者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，并且其他修改形式对本领域的技术人员将是显而易见的。例如，上文所讨论的示例、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)从所述主体延伸的轴；和
(c)与所述轴连通的端部执行器，其中所述端部执行器能够操作以压缩、缝合和切割组织，其中所述端部执行器包括：
(i)砧座，其中所述砧座能够在打开位置和闭合位置之间运动，其中所述砧座具有远侧末端，其中所述端部执行器限定纵向轴线，当所述砧座处于所述闭合位置时，所述纵向轴线与所述砧座的所述远侧末端相交，和
(ii)仓，其中所述仓限定从所述仓的第一侧部沿所述仓的远侧表面朝所述砧座延伸的视准线，其中所述仓的所述第一侧部与所述砧座相对，其中所述仓的所述远侧表面既不与所述纵向轴线平行，也不与所述纵向轴线垂直，其中当所述砧座处于所述闭合位置时，所述视准线在所述远侧末端附近与所述纵向轴线相交，其中所述视准线的一段与所述纵向轴线的一段限定角θ，其中所述视准线的所述一段位于所述纵向轴线的仓侧，其中所述纵向轴线的所述一段位于所述视准线远侧，其中所述角θ大于90°。
2.根据权利要求1所述的设备，其中所述仓包括具有三角形轮廓的末端。
3.根据权利要求1所述的设备，其中所述砧座包括锥形远侧端部。
4.根据权利要求1所述的设备，其中所述砧座的所述远侧末端包括倒圆末端，其中所述远侧末端的下侧部分是倒圆的。
5.根据权利要求1所述的设备，其中所述砧座的所述远侧末端包括球形末端。
6.根据权利要求5所述的设备，其中所述球形末端包括抛光表面。
7.根据权利要求1所述的设备，其中所述砧座包括球形沟槽，其中所述仓的所述远侧末端包括仓球形末端，其中所述仓球形末端的至少一部分被构造为能够适配在所述球形沟槽中。
8.根据权利要求1所述的设备，其中所述砧座限定所述砧座的下侧，其中所述下侧包括多个凹槽。
9.根据权利要求8所述的设备，其中所述多个凹槽中的每一个以等间隔方式间隔分开。
10.根据权利要求1所述的设备，其中所述砧座包括顶盖部分，所述顶盖部分能够操作以覆盖所述砧座的至少一部分。
11.根据权利要求10所述的设备，其中所述顶盖部分限定所述砧座的所述远侧末端。
12.根据权利要求10所述的设备，其中所述砧座包括由第一材料形成的砧座主体，其中所述顶盖部分被固定到所述砧座主体，其中所述顶盖部分由第二材料形成，其中所述第二材料具有对比色，用于在视觉上将所述顶盖部分与所述砧座主体区分开。
13.根据权利要求1所述的设备，其中所述砧座包括由第一材料形成的砧座主体，其中所述砧座的所述远侧末端形成开口，其中由第二材料形成的顶盖被锚固在所述开口中。
14.根据权利要求1所述的设备，其中所述仓在所述仓的所述远侧端部处限定仓末端，其中所述砧座的所述远侧末端朝远侧延伸超过仓末端。
15.根据权利要求1所述的设备，其中所述角θ大于135°。
16.一种设备，所述设备包括：
(a)主体；
(b)从所述主体延伸的轴；和
(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压缩和缝合组织，其中所述端部执行器包括：
(i)砧座，其中所述砧座包括近侧部分和远侧部分，其中所述近侧部分沿平面延伸，其中所述远侧部分不沿所述平面延伸，和
(ii)仓，其中所述仓限定纵向轴线，其中所述仓具有上表面和下表面，其中所述上表面不与所述纵向轴线平行，其中所述下表面不与所述纵向轴线平行，其中所述上表面不与所述下表面平行，其中所述仓的所述上表面和所述下表面朝邻近所述砧座的所述远侧部分的位置延伸，其中所述砧座的所述远侧部分与所述仓的所述上表面互补。
17.根据权利要求16所述的设备，其中所述砧座包括远侧末端，其中下部锥形表面限定延伸到所述远侧末端的视准线。
18.根据权利要求16所述的设备，其中所述砧座包括多个凹槽。
19.根据权利要求16所述的设备，其中所述砧座包括砧座球形末端，其中所述仓包括仓球形末端。
20.一种设备，所述设备包括：
(a)主体；和
(b)与所述主体连通的端部执行器，所述端部执行器包括：
(i)砧座，
(ii)下钳口，其中所述砧座能够朝所述下钳口运动，和
(iii)可移除地接收在所述下钳口中的仓，其中所述仓能够操作以朝所述砧座驱动钉；
其中所述砧座或所述仓中的一者的远侧部分具有突起的末端特征结构，
其中所述砧座或所述仓中的另一者的远侧部分具有凹陷特征结构，所述凹陷特征结构与所述突起的末端特征结构互补，
其中所述突起的末端特征结构被构造为能够适配在所述凹陷特征结构中。
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