CN105682571A - 具有滚转砧座的外科缝合器 - Google Patents

具有滚转砧座的外科缝合器 Download PDF

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CN105682571A
CN105682571A CN201480045172.9A CN201480045172A CN105682571A CN 105682571 A CN105682571 A CN 105682571A CN 201480045172 A CN201480045172 A CN 201480045172A CN 105682571 A CN105682571 A CN 105682571A
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fastener assembly
end effector
assembly component
equipment according
axle
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CN105682571B (zh
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C·J·沙伊布
J·C·加格尔
J·S·斯韦兹
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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
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • A61B17/0644—Surgical staples, i.e. penetrating the tissue penetrating the tissue, deformable to closed position
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • A61B17/0643—Surgical staples, i.e. penetrating the tissue with separate closing member, e.g. for interlocking with staple
    • 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
    • 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
    • A61B17/07292—Reinforcements for staple line, e.g. pledgets
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • 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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    • A—HUMAN NECESSITIES
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    • 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
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    • A61B2017/0647—Surgical staples, i.e. penetrating the tissue having one single leg, e.g. tacks
    • 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
    • A61B2017/07278—Stapler heads characterised by its sled or its staple holder
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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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
    • A61B2017/320093—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw additional movable means performing cutting operation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—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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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • 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
    • A61B2017/320095—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw with sealing or cauterizing means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • 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
    • A61B2017/320097—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw with stapling means

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Abstract

本发明公开了一种设备(10)，所述设备包括轴(23)和端部执行器(12)。所述端部执行器定位在所述轴的远侧端部处并能够操作以形成紧固件组件来固定组织。所述端部执行器包括第一紧固件组件成形特征结构和第二紧固件组件成形特征结构。所述第一紧固件组件成形特征结构(140)可相对于所述轴旋转。所述紧固件组件由第一紧固件组件构件和第二紧固件组件构件形成。所述第一紧固件组件构件包括由所述第一紧固件组件成形特征结构接收的支撑条(160)。所述第二紧固件组件构件包括具有突起部分(174)的线(170)或具有整体突起紧固件(280,380)的紧固件条(270,370)。所述支撑条接收所述突起部分(174)或突起紧固件以将组织固定在所述支撑条与所述线或紧固件条之间。所述端部执行器可横切组织层(92,94)并在横切面的每一侧上将组织层紧固在一起。

Description

具有滚转砧座的外科缝合器
技术领域
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插管将远侧端部执行器放置在期望的外科手术位点处。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、和使用超声、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，所述轴位于端部执行器和由临床医生操纵的柄部部分之间。此轴可使得能够插入期望的深度并围绕轴的纵向轴线旋转，由此有利于端部执行器在患者体内的定位。还可通过包含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，以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。一些这样的缝合器能够操作以夹紧组织层，切割穿过被夹紧的组织层，并驱动钉穿过组织层，以在组织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。仅示例性外科缝合器公开于：1989年2月21日公布的名称为“用于内脏缝合器的凹坑构型(PocketConfigurationforInternalOrganStaplers)”的美国专利第4,805,823号；1995年5月16日公布的名称为“外科缝合器和钉仓(SurgicalStaplerandStapleCartridge)”的美国专利第5,415,334号；1995年11月14日公布的名称为“外科缝合器器械(SurgicalStaplerInstrument)”的美国专利第5,465,895号；1997年1月28日公布的名称为“外科缝合器器械(SurgicalStaplerInstrument)”的美国专利第5,597,107号；1997年5月27日公布的名称为“外科器械(SurgicalInstrument)”的美国专利第5,632,432号；1997年10月7日公布的名称为“外科器械(SurgicalInstrument)”的美国专利第5,673,840号；1998年1月6日公布的名称为“用于外科器械的关节运动组件(ArticulationAssemblyforSurgicalInstruments)”的美国专利第5,704,534号；1998年9月29日公布的名称为“外科夹紧机构(SurgicalClampingMechanism)”的美国专利第5,814,055号；2005年12月27日公布的名称为“结合电子束击发机构的外科缝合器械(SurgicalStaplingInstrumentIncorporatinganE-BeamFiringMechanism)”的美国专利第6,978,921号；2006年2月21日公布的名称为“具有单独的不同关闭系统和击发系统的外科缝合器械(SurgicalStaplingInstrumentHavingSeparateDistinctClosingandFiringSystems)”的美国专利第7,000,818号；2006年12月5日公布的名称为“具有用于打开砧座的击发闭锁件的外科缝合器械(SurgicalStaplingInstrumentHavingaFiringLockoutforanUnclosedAnvil)”的美国专利第7,143,923号；2007年12月4日公布的名称为“结合具有柔性齿条的多行程击发机构的外科缝合器械(SurgicalStaplingInstrumentIncorporatingaMulti-StrokeFiringMechanismwithaFlexibleRack)”的美国专利第7,303,108号；2008年5月6日公布的名称为“结合具有旋转传动器的多行程击发机构的外科缝合器械(SurgicalStaplingInstrumentIncorporatingaMultistrokeFiringMechanismHavingaRotaryTransmission)”的美国专利第7,367,485号；2008年6月3日公布的名称为“具有用于防止击发的单一闭锁机构的外科缝合器械(SurgicalStaplingInstrumentHavingaSingleLockoutMechanismforPreventionofFiring)”的美国专利第7,380,695号；2008年6月3日公布的名称为“结合两件式电子束击发机构的关节运动式外科缝合器械(ArticulatingSurgicalStaplingInstrumentIncorporatingaTwo-PieceE-BeamFiringMechanism)”的美国专利第7,380,696号；2008年7月29日公布的名称为“外科缝合和切割装置(SurgicalStaplingandCuttingDevice)”的美国专利第7,404,508号；2008年10月14日公布的名称为“具有带有开口闭锁件的多行程击发的外科缝合器械(SurgicalStaplingInstrumentHavingMultistrokeFiringwithOpeningLockout)”的美国专利第7,434,715号；2010年5月25日公布的名称为“与缝合装置一起使用的一次性仓和粘合剂(DisposableCartridgewithAdhesiveforUsewithaStaplingDevice)”的美国专利第7,721,930号；2010年10月21日公布的名称为“具有能够关节运动的端部执行器的外科缝合器械(SurgicalStaplingInstrumentwithAnArticulatableEndEffector)”的美国公布第2010/0264193号；和2012年9月20日公布的名称为“具有电致动器定向控制组件的马达驱动外科切割器械(Motor-DrivenSurgicalCuttingInstrumentwithElectricActuatorDirectionalControlAssembly)”的美国公布第2012/0239012号。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。
虽然以上所涉及的外科缝合器被描述为用于内窥镜式手术中，但应当理解，此类外科缝合器也可用于开腹手术和/或其它非内窥镜式手术中。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，并由此位于患者的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，在从胸腔移出器官之前，可通过缝合器切断和闭合通向所述器官的血管。当然，外科缝合器可用于各种其它情况和手术中。
虽然已经制造和使用各种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
并入本说明书中并构成本说明书的一部分的附图例示了本发明的实施例，并且与以上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1A描绘了示例性关节运动式外科缝合器械的透视图，其中端部执行器处于非关节运动的位置；
图1B描绘了图1A的外科器械的透视图，其中端部执行器处于关节运动位置；
图2描绘了图1A至图1B的外科器械的打开的端部执行器的透视图；
图3A描绘了图2的端部执行器沿图2的线3-3截取的侧视剖面图，其中击发杆处于近侧位置；
图3B描绘了图2的端部执行器沿着图2的线3-3截取的侧视剖面图，但示出了击发杆处于远侧位置；
图4描绘了图2的端部执行器沿图2的线4-4截取的端视剖面图；
图5描绘了图2的端部执行器的分解透视图；
图6描绘了图2的端部执行器的透视图，所述端部执行器定位在组织处并已在组织中被致动了一次；
图7描绘了可结合到图1A至图1B的器械中的示例性另选端部执行器和其它部件的示意图；
图8描绘了图7的端部执行器的上钳口的局部透视图；
图9描绘了图7的端部执行器的下钳口的局部透视图；
图10描绘了图9的下钳口沿图9的线10-10截取的侧视剖面图；
图11描绘了图7的端部执行器沿图7的线11-11截取的端视剖面图；
图12描绘了图7的端部执行器沿图11的线12-12截取的侧视剖面图；
图13描绘了可结合到图1A至图1B的器械中的示例性另选端部执行器的端视剖面图；
图14描绘了图13的端部执行器沿图13的线14-14截取的侧视剖面图；
图15描绘了可结合到图1A至图1B的器械中的另一示例性另选端部执行器的侧正视图，所述端部执行器被设置成呈直线构型通过套管针；
图16描绘了图15的被枢转到成角构型的端部执行器的侧正视图；
图17描绘了图15的横切和跟踪组织的端部执行器的透视图；和
图18描绘了图15的端部执行器的侧视剖面图。
图式并非旨在以任何方式进行限制，而是可以设想本发明的各种实施例可以多种其它方式来实施，包括那些不必在图式中描绘的方式。结合在本说明书中并形成本说明书的一部分的附图例示了本发明的若干方面，并与描述一起用于解释本发明的原理；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以下描述不应被用来限制本发明的范围。阅读通过举例说明设想用于实施本发明的最佳方式之一的以下描述，本发明的其它示例、特征结构、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，本发明能够具有其它不同且明显的方面，此皆不脱离本发明。因此，图式和描述应被视为实质上是例示性的而非限制性的。
I.示例性外科缝合器
图1至图6描绘了示例性外科缝合和切断器械10，在如图1A中描绘的非关节运动的状态下，其尺寸被设定成穿过套管针插管通道插入患者体内的外科手术位点，以便执行外科手术。外科缝合和切断器械10包括连接到执行部分22的柄部部分20，所述执行部分还包括轴23，所述轴在远侧终止于关节运动机构11和远侧附接的端部执行器12中。一旦关节运动机构11和端部执行器12插入穿过套管针的插管通道，关节运动机构11便可以通过关节运动控件13进行远程关节运动，如图1B所示。因此，端部执行器12可以从所需的角度或出于其它原因而到达器官的后面或接近组织。应当理解，本文中使用的用语诸如“近侧”和“远侧”是参照临床医生抓握器械10的柄部部分20而言的。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，本文结合图式使用空间用语，诸如“竖直”和“水平”。然而，外科器械用于许多取向和位置中，并且这些用语并非旨在为限制性和绝对化的。
本示例的端部执行器12包括下钳口16和可枢转砧座18。柄部部分20包括手枪式握把24，由临床医生将闭合触发器26以枢转方式朝所述手枪式握把拉动，以使砧座18朝端部执行器12的下钳口16夹紧或闭合。砧座18的此种闭合通过最外部的闭合套管32提供，所述闭合套管响应于闭合触发器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。闭合套管32的远侧闭合环33由执行部分22的框架34间接地支撑。在关节运动机构11处，闭合套管32的近侧闭合管35与远侧闭合环33连通。框架34经由关节运动机构11灵活地附接到下钳口16，从而使得能够在单个平面内进行关节运动。框架34还在纵向上滑动地支撑击发驱动构件(未示出)，所述击发驱动构件延伸穿过轴23并将击发运动从击发触发器28传递到击发杆14。击发触发器28位于闭合触发器26更远的外侧，并可被临床医生枢转地拉动，以使被夹紧的组织在端部执行器12中被缝合和切断，如下文将更详细地描述。然后，按下释放按钮30，以从端部执行器12释放所述组织。
图2至图5描绘了采用电子束击发杆14来执行多个功能的端部执行器12。如图3A至图3B中最佳所见，击发杆14包括横向取向的上部销38、击发杆顶盖44、横向取向的中间销46和存在于远侧的切割刃48。上部销38定位在砧座18的砧座凹坑40内，并可在所述砧座的凹坑内平移。击发杆顶盖44通过使击发杆14延伸穿过通道狭槽45(示出在图3B中)而可滑动地接合下钳口16的下表面，所述通道槽被形成为穿过下钳口16。中间销46滑动地接合下钳口16的顶表面，从而与击发杆顶盖44协作。因此，击发杆14在击发期间肯定与端部执行器12间隔开，以克服在最小量的夹紧组织的情况下在砧座18与下钳口16之间可能出现的挤痛情况，并克服在过量的夹紧组织的情况下出现的钉畸形。
图2示出了朝近侧定位的击发杆14和枢转到打开位置的砧座18，从而允许未空钉仓37可移除地安装到下钳口16的通道中。如在图4至图5中最佳所见，此示例的钉仓37包括仓体70，所述仓体呈现上部平台72并与下部仓托盘74联接。如在图2中最佳所见，竖直狭槽49被形成为穿过钉仓37的一部分。也如在图2中最佳所见，三排钉孔51被形成为在竖直狭槽49的一侧上穿过上部平台72，其中另一组三排钉孔51被形成为在竖直狭槽49的另一侧上穿过上部平台72。重新参见图3至图5，楔形滑动件41和多个钉驱动器43被捕集在仓体70与托盘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可在钉仓37内纵向移动；而钉驱动器43可在钉仓37内竖直移动。钉47也被定位在仓体70内，位于对应的钉驱动器43上方。具体来讲，每个钉47在仓体70内被钉驱动器43竖直地驱动，以将钉47通过相联的钉孔51驱动出。如在图3A至图3B和图5中最佳所见，楔形滑动件41存在倾斜凸轮表面，当楔形滑动件41朝远侧驱动穿过钉仓37时，所述倾斜凸轮表面向上推压钉驱动器43。
在端部执行器12如图3A所示处于闭合的情况下，通过使上部销38进入纵向砧座狭槽42，将击发杆14推进成与砧座18接合。推块80位于击发杆14的远侧端部处，并被构造成能够接合楔形滑动件41，使得当朝远侧推进击发杆14穿过钉仓37时，推块80朝远侧推动楔形滑动件41。在此类击发期间，击发杆14的切割刃48进入钉仓37的竖直狭槽49，以切断钉仓37与砧座18之间夹紧的组织。如图3A至图3B所示，中间销46和推块80通过进入钉仓37内的狭槽49中而一起致动钉仓37，以将楔形滑动件41驱动成与钉驱动器43发生向上顶起接触，并被驱动成与砧座18的内表面上的钉成形凹坑53形成接触，所述钉驱动器继而通过钉孔51将钉47驱动出。图3B描绘了在完成切断和缝合组织之后完全朝远侧平移的击发杆14。
图6示出端部执行器12，所述端部执行器已通过单行程被致动穿过组织90。切割刃48已切穿组织90，同时钉驱动器43已驱动三排交替的钉47穿过由切割刃48产生的切割线的每一侧上的组织90。在此示例中，钉47全部与切割线基本上平行地取向，但应当理解，钉47可被定位成任何合适的取向。在本示例中，在第一行程完成后，端部执行器12从套管针撤回，用新钉仓替换已空钉仓37，然后，端部执行器12再次插入穿过套管针而到达缝合位点以进行进一步的切割和缝合。这个过程可以重复，直到已提供了期望量的切口和钉47。可能需要将砧座18闭合以有利于插入穿过套管针和通过套管针撤回；且可能需要将砧座18打开以有利于替换钉仓37。
应当理解，在每一致动行程期间，切割刃48可基本上与钉47被驱动穿过组织同时切断组织。在本示例中，切割刃48仅稍微落后于钉47的驱动，使得钉47刚好在切割刃48穿过组织的相同区域之前被驱动穿过所述组织，但应当理解，这个顺序可以颠倒，或者切割刃48可直接与相邻的钉同步。虽然图6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的单个层或组织的多于两个层92,94。也应当理解，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，由此减少或防止切割线处的出血和/或其它体液的渗漏。根据本文的教导内容，其中可使用器械10的各种合适的情况和程序将对本领域的普通技术人员显而易见。
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：美国专利第4,805,823号；美国专利第5,415,334号；美国专利第5,465,895号；美国专利第5,597,107号；美国专利第5,632,432号；美国专利第5,673,840号；美国专利第5,704,534号；美国专利第5,814,055号；美国专利第6,978,921号；美国专利第7,000,818号；美国专利第7,143,923号；美国专利第7,303,108号；美国专利第7,367,485号；美国专利第7,380,695号；美国专利第7,380,696号；美国专利第7,404,508号；美国专利第7,434,715号；和/或美国专利第7,721,930号。
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的其它示例性修改将更详细地描述于下文中。其中下文教导内容可并入器械10中的各种合适的方式将对本领域的普通技术人员显而易见。类似地，其中下文教导内容可与本文引用的专利的各种教导内容进行组合的各种合适的方式将对本领域的普通技术人员显而易见。也应当理解，下文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。下文教导内容可容易地应用到各种其它种类的器械，该器械包括将不被归类为外科缝合器的器械。根据本文的教导内容，其中可以应用下文教导内容的各种其它合适的装置和情况将对本领域的普通技术人员显而易见。
II.用于连续缝合的示例性端部执行器
应当理解，在器械10的每一致动行程期间所实现的组织横切的长度是由仓37的长度限制的。如果操作者希望沿着比仓37的长度长的长度横切组织，则操作者将需要以新仓37对器械10进行重新装载。相同的原理将适用于操作者希望横切患者体内的一个位置中的组织并然后横切患者体内的另一位置中的组织的情况—每次操作者希望致动器械10时，操作者将仍需要以新仓37对器械10进行重新装载。在一些型式中，操作者将需要从患者移出端部执行器12以移除已空仓37并装载新仓37；然后将端部执行器12重新插入患者体内。此过程在一些情况下可为冗长乏味的。因此可能期望使得操作者能够沿着比使用仓37可实现的长度长的长度来执行横切(包括沿着横切的每一侧的紧固件)。相似地，可能期望操作者能够使用无需在每一次横切之间从患者移出的器械而在患者体内执行若干次横切(包括沿着每一次横切的每一侧的紧固件)。下文所述的各种示例包括能够操作以提供这些结果的器械10的变型。根据本文的教导内容，其它变型将对本领域的普通技术人员显而易见。
A.利用枢转钳口和线形式紧固件进行连续缝合的示例性端部执行器
图7至图12示出了可并入如同以上所讨论的器械10的器械中的示例性另选端部执行器100。此示例的端部执行器100包括上钳口110、下钳口120和组织切割构件130。上钳口110可相对于下钳口120枢转，以使得钳口110,120可选择性地打开和闭合以捕集组织。根据本文的教导内容，其中上钳口110可相对于下钳口120枢转的各种合适的方式将对本领域的普通技术人员显而易见。如下文将更详细地描述，端部执行器100能够操作以横切组织层92,94，并使用由线170和支撑条160形成的紧固组件在横切线的每一侧上将组织层92,94紧固在一起。因此可以与上述端部执行器12相似的方式使用端部执行器100，其中由线170和支撑条160形成的紧固组件实际上相似于由端部执行器12施加的成形钉47。然而，应当理解，本示例的端部执行器100将不再需要替换仓37的等效物，因此有利于在无需从患者重复移出端部执行器100的情况下在患者体内形成更长的横切线和/或一系列横切面。
如图7所示，上钳口110包括由驱动轴150驱动的一对滚转砧座140。砧座140围绕与端部执行器150的纵向轴线垂直的轴线旋转；而驱动轴150围绕与端部执行器150的纵向轴线平行的轴线旋转。砧座140在相同的方向上同时一起旋转。根据本文的教导内容，可用于将驱动轴150与砧座140联接的各种合适的传动构型将对本领域的普通技术人员显而易见。驱动轴150与旋转驱动源152联接，所述旋转驱动源可包括马达和/或任何其它合适种类的旋转驱动源152。如图8所示，上钳口110限定被构造成能够可滑动地接收组织切割构件130的狭槽112。上钳口110还限定位于狭槽112的每一侧上的一对通道114和开口116。开口116被定位成暴露砧座140的部分。具体来讲，开口116被构造成能够接收线170的突起部分174，以使得砧座140能够如下文将更详细所述形成紧固组件。
如图12所示，每个砧座140包括径向延伸的凸缘142和成形腔室侧壁144，所述成形腔室侧壁协作以围绕砧座140的周边形成一系列成形腔室凹槽146。虽然在本示例中示出了六个凹槽146，但应当理解，可使用任何其它合适数量的凹槽146。如下文将更详细描述，凹槽146被构造成能够接收支撑条160和线170的突起部分174。凹槽146还被构造成能够使线170的突起部分174变形以形成线170的成形部分176。每一砧座140还限定被构造成能够接收轮轴141的镗孔148。轮轴141如上所述由驱动轴150驱动。虽然在本示例中两个砧座140共享共用轮轴141，但一些其它型式可对砧座140提供单独的轮轴141。
本示例的支撑条160如图12所示在砧座140的顶部上方馈送。支撑条160可由任何合适的材料形成，所述材料包括但不限于以下材料：聚谷氨酸(PGA)聚合物；聚乙醇酸：三亚甲基碳酸酯(PGA:TMC)；牛心包；可压缩止血剂材料，诸如例如，氧化再生纤维素(ORC)或可生物吸收泡沫(例如，被压缩成片材形式)；聚二烷酮(PDS)；聚甘油癸二酸酯(PGS)；聚乙醇酸(PGA)；聚己内酯(PCL)；聚乳酸(PLA)；聚羟基脂肪酸酯(PHA)；聚卡普隆(PGCL)；聚乳酸(PLA或PLLA)；聚羟基脂肪酸酯(PHA)；聚己内酯(PCL)；聚氨酯；聚丙烯(PP)；聚乙烯(PE)；聚碳酸酯；聚酰胺，诸如尼龙、聚氯乙烯(PVC)、聚甲基丙烯酸甲酯(PMMA)、聚苯乙烯(PS)、聚酯、聚醚醚酮(PEEK)、聚四氟乙烯(PTFE)、聚三氟氯乙烯(PTFCE)、聚氟乙烯(PVF)、氟化乙烯丙烯(FEP)、聚缩醛、聚砜、硅、和前述材料中任何材料的组合。此外，支撑条160可由发泡弹性体和/或多孔弹性体(诸如例如，有机硅、聚异戊二烯、膨体聚四氟乙烯(ePTFE)、共聚醚酯氨基甲酸酯泡沫和/或任何其它合适的材料)形成。根据本文的教导内容，可用于支撑条160的各种其它合适的材料和构型将对本领域的普通技术人员显而易见。
每个砧座140接收各自的支撑条160。在一些型式中，砧座140包括突起，并且支撑条160包括开口，所述开口与砧座140的所述突起协作以提供牵引馈送构型，以使得当砧座140旋转时，砧座140直接朝远侧牵拉支撑条160。根据本文的教导内容，其中可朝远侧推进支撑条160的其它合适的方式将对本领域的普通技术人员显而易见。在本示例中，每个支撑条160从各自线轴或卷轴162释放。卷轴162可位于如同柄部部分20的柄部部分内和/或位于任何其它合适的位置中。卷轴162可被构造成能够当支撑条160朝远侧牵拉时自由地释放支撑条160和/或卷轴162可包括对支撑条160从卷轴162的释放进行选择性地锁定/解锁的特征结构。在一些型式中，对卷轴162供以动力以旋转并由此积极地馈送支撑条160。
如在图11至图12中最佳所见且如下文将更详细描述，当突起部分174进入凹槽146时，支撑条160被构造成能够接收线170的相应突起部分174。支撑条160可包括有利于突起部分174穿过支撑条160的预成形开口。作为另外一种选择，当突起部分174进入凹槽146时，突起部分174可简单地刺穿或以其它方式穿透支撑条160。
如图9所示，下钳口120限定被构造成能够可滑动地接收组织切割构件130的狭槽122。下钳口120还限定终止于狭槽122的每一侧上的开口126处的一对通道124。开口126被定位成当上钳口110相对于下钳口120处于闭合位置时与上钳口110的开口116对齐。如在图10中最佳所见，通道124的尺寸被设计成接收线170。具体来讲，通道124被构造成能够使得线170通过下钳口120朝远侧连通，而不造成对突起部分174的干扰。通道124还包括重新定向区129，所述重新定向区被构造成能够在线170靠近下钳口120的远侧端部时将线170的行进从远侧方向重新定向到近侧方向。辊125被定位在重新定向区129处并相对于下钳口120自由旋转，由此减少重新定向区129处线170和下钳口120之间的摩擦。当然，辊125仅为任选的。每一通道124的末端包括与开口126相邻的斜坡127。每个斜坡127相对于下钳口120的上部平台表面121限定浅钝角，以使得线170能够沿着几乎平行于下钳口120的上部平台表面121的路径退出开口126。根据本文的教导内容，斜坡127的各种合适的角度将对本领域的普通技术人员显而易见。
如上所述，每条线170包括多个横向突起部分174。突起部分174由线170的基部长度178分开。线170为可塑的，以使得成形部分176一旦被形成便将基本上保持其形状。线170可由各种金属和/或任何其它合适种类的材料形成。突起部分174被构造成能够如图12所示穿透组织层92,94。在一些型式中，突起部分174被锐化以有利于组织穿透，但未必需要此种锐化。虽然线170具有足够的灵活性以使得成形部分176能够由砧座140形成，但线170具有足够的刚性以在突起部分174穿透组织的同时使突起部分174基本上保持其构型。根据本文的教导内容，可用于形成线170的各种合适的材料和构型将对本领域的普通技术人员显而易见。在本示例中，每条线170从各自的线轴或卷轴172释放。卷轴172可位于如同柄部部分20的柄部部分内和/或位于任何其它合适的位置中。卷轴172可被构造成能够当线170朝远侧牵拉时自由地释放线170和/或卷轴172可包括对线170从卷轴172的释放进行选择性地锁定/解锁的特征结构。在一些型式中，对卷轴172供以动力以旋转并由此积极地馈送线170。
组织切割构件130相似于上述击发杆14之处在于，组织切割构件130具有被构造成能够切断捕集在钳口110与120之间的组织的远侧切割刃134。在一些型式中，组织切割构件130能够操作以在组织切割构件130朝远侧推进时将上钳口110朝下钳口120驱动。在一些其它型式中，上钳口110通过单独的特征结构(例如，相似于闭合套管32的特征结构等)而朝下钳口驱动。如在图7中最佳所见，本示例的组织切割构件130包括分别位于远侧切割刃134的顶部和底部处的上凸缘136和下凸缘138。下凸缘138可滑动地设置在如图10所示形成于下钳口120中的通道128中；而上凸缘136可滑动地设置在形成于上钳口110中的通道(未示出)中。远侧切割刃134可滑动地设置在钳口110,120的狭槽112,122中。组织切割构件130与驱动组件132连通，所述驱动组件能够操作以穿过钳口110,120中的狭槽112,122朝远侧驱动组织切割构件。
在本示例中，驱动组件132包括马达。在一些型式中，旋转驱动源152和驱动组件132由相同共用马达驱动。根据本文的教导内容，可用于将马达的启动转换为组织切割构件130的平移的各种合适的特征结构将对本领域的普通技术人员显而易见。在一些其它型式中，驱动组件132可包括由如同上述击发触发器28的用户输入致动的手动机械驱动系。不管组织切割构件130是由马达推进还是手动推进，组织切割构件130的一些型式能够操作以在超声频率(例如，大约55.5kHz)下振动，以同时切断组织并使相邻组织细胞中的蛋白质变性，由此以相对小的热扩散提供凝固效果。因此应当理解，驱动组件132可包括能够操作以将电力转换为超声振动的一个或多个压电元件。作为再一仅例示性示例，组织切割构件130可以RF能量选择性地启动。在一些此种型式中，端部执行器100的一个或多个其它特征结构提供此种RF能量的返回路劲，以使得端部执行器100用作双极性电外科端部执行器。在一些其它型式中，将接地垫放置在患者之上或之下，以使得端部执行器100用作单极性电外科端部执行器。
如图7所示，驱动组件132和旋转驱动源152两者均与控制模块104联接，所述控制模块进一步与电源102联接。控制模块104能够操作以基于用户输入和/或基于其它信息而从电源102选择性地提供电力到驱动组件132和/或旋转驱动源152。仅以举例的方式，控制模块104可包括与用户输入连通的一个或多个开关(例如，击发触发器28等)，所述一个或多个开关因此选择性地完成用户输入、驱动组件132、旋转驱动源152和电源102之间的电路。此外或作为另外一种选择，控制模块104可与一个或多个传感器(例如，编码器轮、簧片开关、组织接触电极等)连通，所述一个或多个传感器能够操作以检测与端部执行器100相关联的运行参数(例如，钳口110与120之间的组织的存在等)并基于此种信息控制旋转驱动源152和/或电源102的启动。根据本文的教导内容，控制模块104的各种合适的构型、可由控制模块104处理的输入和此种处理的结果将对本领域的普通技术人员显而易见。也应当理解，电源102可包括电池(例如，位于柄部部分20内)、外部电源(例如，经由缆线与柄部部分20联接)和/或一些其它种类的电源102。作为另外一种选择，电源102可被除去。例如，端部执行器100的全部操作可由操作者的手手动驱动。
在示例性使用中，操作者可将组织层92,94定位在钳口110与120之间，然后将上钳口110朝下钳口120驱动以夹紧钳口110与120之间的组织层92,94。操作者然后可致动旋转驱动源152以旋转砧座140。砧座140的此旋转朝远侧并围绕砧座140牵拉支撑条160。砧座140的旋转也围绕辊125朝远侧牵拉线170。此动作最终朝近侧驱动支撑条160和线170，其中如在图12中最佳所见当支撑条160被施加成与层92,94的上侧处于并列位置的同时，线170的突起部分174穿透层92,94的下侧。在进一步穿透支撑条160之后，线170的突起部分174遇到砧座140，所述砧座使突起部分174变形以在支撑条160的上侧上形成线170的成形部分176。成形部分176充当铆钉头，以防止线170通过支撑条160和支撑条160下面的组织层92,94被向回牵拉。线170的基部长度178进一步将线170固定到组织层92,94的下侧。因此，成形线170和支撑条160协作以将组织层92,94固定在一起。
在由成形线170和支撑条160固定组织层92,94之前、期间和/或之后，可致动组织切割构件130以切断组织。具体来讲，组织切割构件130可沿着平行于由线170和支撑条160形成的紧固件组件且位于所述紧固件组件之间的路径横切组织层92,94。最终结果可能看起来相似于图7所示的内容，其中由线170和支撑条160形成的紧固件组件邻近由组织切割构件130产生的组织横切而定位。在本示例中，狭槽112,122在远侧终止在开口116,126近侧，以使得组织切割构件130不朝远侧行进到其中组织层92,94被线170和支撑条160紧固的点。这可确保组织层92,94在组织层92,94被横切之前被紧固。此外或作为另外一种选择，驱动组件132可被手动和/或自动控制，以确保对组织切割构件130的致动进行适当定时(例如，与通过线170和支撑条160和/或以其它方式进行的紧固有关)。
应当理解，由线170和支撑条160形成的紧固件组件可提供对组织层92,94的锚固，并也可在由组织切割构件130形成的横切边缘处提供止血。当部署紧固件组件时，如果使用钳口110,120来基本上压缩组织层92,94则可进一步增强止血。也应当理解，可实施并重复以上过程达所期望时间长度，以使得操作者能够创建具有有效不定长度的被固定横切面(例如，尤其在预装载大量支撑条160和线170时)，而无需从患者移出端部执行器100。相似地，可重复以上过程以在患者体内形成若干单独的被固定横切面，而无需从患者移出端部执行器100。在其中操作者从一个横切位点移动到另一横切位点的实例中，操作者可在移动到后一横切位点之前简单地使用传统切割器械来切割线170和/或支撑条160。
在一些变型中，端部执行器100包括能够选择性地调整闭合钳口110与120之间的间隙距离的特征结构，这可有效地改变由线170最终形成的紧固件的高度。可期望此种可调整性来形成不同的组织厚度。根据本文的教导内容，其中可提供对闭合钳口110与120之间的间隙距离的选择性调整的各种合适的方式将对本领域的普通技术人员显而易见。作为再一仅例示性变型，端部执行器100可能够调整轮轴141与上钳口110的下表面之间的距离，这可有效地改变由线170最终形成的紧固件的高度。也应当理解，可能不需要间隙调整和/或紧固件高度调整。根据本文的教导内容，端部执行器100的构造、使用和可操作性的其它变型将对本领域的普通技术人员显而易见。
B.利用枢转钳口和铆钉紧固件进行连续缝合的示例性端部执行器
图13至图14示出可用于替代上述端部执行器100的示例性另选端部执行器200。此示例的端部执行器200包括一对上部滚转砧座240和一对下部滚转导引件225。砧座240和导引件225相对地成对提供，并且每一对定位在组织切割构件230的相对侧上。应当理解，砧座240可位于如同上钳口110的上钳口中；而导引件225可位于如同下钳口120的下钳口中。因此砧座240相似于砧座140，其中导引件225相似于辊125，并且组织切割构件230相似于组织切割构件130。砧座240和/或导引件225可通过相似于驱动轴150的某物等来驱动。组织切割构件230可能够操作以平移来切断组织、在超声频率下振动以切断和凝固组织、和/或将RF能量递送到组织，所有均如以上关于组织切割构件130所述。在本示例中，组织切割构件230被定位成在组织层92,94被下文所述的紧固组件固定之后切割层92,94，但应当理解，组织切割构件230可转而以其它方式进行定位。
本示例的端部执行器200被构造成能够形成具有铆钉条270、铆钉280、和支撑条260的紧固组件。应当理解，支撑条260可被视为上述支撑条160的替代物；而铆钉条270和铆钉280可一起被视为线170的替代物。仅以举例的方式，每个条260,270可由适用于形成支撑条160的以上所列出的各种材料中的任何材料形成。根据本文的教导内容，可用于支撑条260,270的各种其它合适的材料和构型将对本领域的普通技术人员显而易见。也应当理解，支撑条260可由一种材料(或多种材料的组合)形成，而铆钉条270是由不同种类的材料(或多种材料的组合)形成。
支撑条260可从卷轴和一些其它种类的源馈送；同时铆钉条270和铆钉280也可从卷轴和一些其它种类的源馈送。每个铆钉280包括下凸缘282和具有开放式自由端部286的空心轴区段284。铆钉280设置在铆钉条270中，其中下凸缘282定位在铆钉条270下方以防止铆钉280通过铆钉条270被牵拉。铆钉280被构造形成空心轴区段284以穿透组织层92,94并穿过支撑条260。在一些情况下，支撑条260包括被间隔开并被构造成能够接收空心轴区段284的预成形开口。在一些其它情况下，空心轴区段284在支撑条260中形成其自己的开口。
在每一自由端部286穿过支撑条260之后，砧座240使自由端部286变形以在支撑条260的顶部上形成铆钉头，如在图14中最佳所见。具体来讲，砧座240包括尖的突出部242，所述尖的突出部沿径向向外延伸并被间隔开和被构造成能够当紧固组件在滚转砧座240与滚转导引件225之间馈送时进入连续自由端部286。尖形状的突出部242有利于突出部进入自由端部286中，并且还有利于自由端部286向外伸展以形成铆钉头。铆钉280由可塑材料形成，以使得成形自由端部286在由突出部242形成铆钉头之后基本上保持铆钉头构型。仅以举例的方式，铆钉280可由各种金属(例如，微冲压钛、钛基合金等)和/或任何其它合适的材料(例如，可吸收聚卡普隆(PGCL)诸如MONOCRYLbyEhticon,Inc.,ofSomerville,NewJersey等)形成。根据本文的教导内容，可用于形成铆钉280的各种其它合适的材料将对本领域的普通技术人员显而易见。
在形成于自由端部286处的铆钉头位于支撑条260上方且凸缘282位于铆钉条270下方的情况下，应当理解，条260,270和铆钉280将协作以将组织层92,94保持在一起。也应当理解，当铆钉头被形成时组织层92,94可被压缩在砧座240与导引件225之间，以使得条260,270和铆钉280的组件将组织层92,94保持处于被压缩构型。也应当理解，层92,94的此种保持可为组织提供止血，以基本上防止由组织切割构件230形成的横切切口处的组织出血。如上所述，砧座240和/或导引件225可由相似于驱动轴150的某物等驱动。砧座240和/或导引件225的此种驱动运动可进一步相对于组织来驱动条260,270，如图14所示。
端部执行器200可以相似于上述端部执行器100的操作的方式操作。也应当理解，可实施并重复以上过程达所期望时间长度，以使得操作者能够创建具有有效不定长度的被固定横切面(例如，尤其在预装载大量条260,270和铆钉280时)，而无需从患者移出端部执行器200。相似地，可重复以上过程以在患者体内形成若干单独的被固定横切面，而无需从患者移出端部执行器200。在其中操作者从一个横切位点移动到另一横切位点的实例中，操作者可在移动到后一横切位点之前简单地使用传统切割器械来切割条260,270。根据本文的教导内容，可与端部执行器200相关联的再一些其它合适的部件、特征结构、构型、可操作性和变型将对本领域的普通技术人员显而易见。
C.利用枢转头和相对辊进行连续缝合的示例性端部执行器
图15至图18示出相似于上述端部执行器100,200的另一示例性端部执行器300，所述端部执行器可用于提供对组织的横切和连续紧固。此示例的端部执行器300设置在轴302的远侧端部处。端部执行器300包括底盘308，所述底盘通过枢轴销304接合到轴302，以使得端部执行器300被构造成能够相对于轴302围绕枢轴销304枢转，从而在直线构型(图16)与被枢转构型(图17)之间转变。当端部执行器300呈直线构型时，端部执行器300和轴302可通过传统套管针插管400馈送，以微创方式到达患者体内的外科手术位点。一旦端部执行器300已定位在患者体内，端部执行器300便可接着视需要相对于轴302枢转，以基于患者的解剖结构和将被横切/紧固的组织的位置来实现理想取向。所期望的枢转程度可基于各种其它因素而变化。
在本示例中，通过平移延伸穿过轴302并与底盘308联接的带306而选择性地枢转端部执行器300。带306朝近侧牵拉以使端部执行器300从直线构型转变为被枢转构型。应当理解，当端部执行器300呈被枢转构型时，端部执行器300可相对于轴302而被取向为各种角度。在一些型式中，端部执行器300被弹性偏置成呈现直线构型以使得带306被简单地释放以便端部执行器300从被枢转构型转变回直线构型。在一些其它型式中，带306朝远侧积极地推动，以使端部执行器300从被枢转构型转变回直线构型。根据本文的教导内容，其中可致动带306的各种合适的方式将对本领域的普通技术人员显而易见。相似地，根据本文的教导内容，其中端部执行器300可在直线构型与被枢转构型之间转变的各种其它合适的方式将对本领域的普通技术人员显而易见。仅以举例的方式，除带306之外或代替带306，可使用缆线、齿条和小齿轮、链驱动、和/或各种其它合适的特征结构。
端部执行器300还包括一对滚转砧座340和滚转导引件325，所述一对滚转砧座和滚转导引件全部可旋转地固定到底盘308。砧座340和导引件325被布置成相似于如上所述的砧座240和导引件225。具体来讲，砧座340和导引件325相对地成对提供，且每一对定位在组织切割构件330的相对侧上。不同于端部执行器100,200，此示例的端部执行器300没有枢转钳口。在一些型式中，砧座340与导引件325之间的间距是固定的。在一些其它型式中，端部执行器300包括能够操作以改变砧座340与导引件325之间的间距的特征结构。也应当理解，如根据本文的教导内容将对本领域的普通技术人员显而易见，砧座340和/或导引件325可诸如经由驱动轴、经由皮带、经由缆线和/或以任何其它合适的方式相对于底盘308可旋转地驱动。组织切割构件330被构造成能够切割组织并可以固定方式固定到底盘308，或者可能够操作以相对于底盘308移动。仅以举例的方式，组织切割构件330可能够操作以平移来切断组织、在超声频率下振动以切断并凝固组织、和/或将RF能量递送到组织，所有均如以上关于组织切割构件130所述。在本示例中，组织切割构件330被定位成在组织层92,94被下文所述的紧固组件固定之后切割层92,94，但应当理解，组织切割构件330可转而以其它方式进行定位。
本示例的端部执行器300被构造成能够形成具有紧固件条370、紧固件380、和支撑条360的紧固组件。应当理解，支撑条360可被视为上述支撑条160的替代物；而紧固件条370和紧固件380可一起被视为线170的替代物。仅以举例的方式，每个条360,370可由适用于形成支撑条160的以上所列出的各种材料中的任何材料形成。根据本文的教导内容，可用于支撑条360,370的各种其它合适的材料和构型将对本领域的普通技术人员显而易见。也应当理解，支撑条360可由一种材料(或多种材料的组合)形成，而紧固件条370由不同种类的材料(或多种材料的组合)形成。
支撑条360可从卷轴或一些其它种类的源馈送；同时紧固件条370和紧固件380也可从卷轴或一些其它种类的源馈送。每个紧固件380包括下凸缘382和具有带倒钩的自由端部386的轴区段384。紧固件380设置在紧固件条370中，其中下凸缘382定位在紧固件条370下方以防止紧固件380通过紧固件条370牵拉。紧固件380被构造形成带倒钩的自由端部386以穿透组织层92,94并穿过支撑条360。在一些情况下，支撑条360包括被间隔开并被构造成能够接收带倒钩的自由端部386的预成形开口。在一些其它情况下，带倒钩的自由端部386在支撑条360中形成其自己的开口。
每个砧座340包括一对径向延伸的凸缘342和围绕砧座340的周边成角度设置的凹槽346。虽然在本示例中示出八个凹槽346，但应当理解可使用任何其它合适数量的凹槽346。凸缘342被构造成能够相对于砧座340导引并侧向地保持支撑条360；而凹槽346被构造成能够接收紧固件380的带倒钩的自由端部386。具体来讲，凹槽346被构造成能够允许带倒钩的自由端部386穿过支撑条360，且砧座340不提供任何阻力。因此，不同于上述砧座140,240，本示例的砧座340不使紧固件380变形。导引件325包括被构造成能够相对于导引件325导引并侧向地保持凸缘382的凹槽326。凹槽346,326被构造成能够在砧座340和导引件325的旋转期间在组织层92,94的接合部处连续地彼此对齐，如图18所示。应当理解，带倒钩的自由端部386的带倒钩的构型基本上防止带倒钩的自由端部386在带倒钩的自由端部386穿过支撑条360之后通过支撑条360向回牵拉。仅以举例的方式，紧固件380可由各种金属(例如，微冲压钛、钛基合金等)和/或任何其它合适的材料(例如，可吸收聚卡普隆(PGCL)诸如MONOCRYLbyEhticon,Inc.,ofSomerville,NewJersey等)形成。根据本文的教导内容，可用于形成紧固件380的各种其它合适的材料将对本领域的普通技术人员显而易见。
在带倒钩的自由端部386位于支撑条360上方，并且凸缘382位于紧固件条370下方的情况下，应当理解，条360,370和紧固件380将协作以将组织层92,94保持在一起。也应当理解，当带倒钩的自由端部386被驱动穿过组织层92,94时，层92,94可被压缩在砧座340与导引件325之间，以使得条360,370和紧固件380的组件将组织层92,94保持处于被压缩构型。还应当理解，层92,94的此种保持可为组织提供止血，以基本上防止由组织切割构件330形成的横切切口处的组织出血。如上所述，可驱动砧座340和/或导引件325以进行旋转。砧座340和/或导引件325的此种驱动运动可进一步相对于组织驱动条360,370，如图18所示。
端部执行器300可以相似于上述端部执行器100的操作的方式操作。也应当理解，可实施并重复以上过程达所期望的时间长度，以使得操作者能够创建具有有效不定长度的被固定横切面(例如，尤其在预装载大量条360,370和紧固件380时)，而无需从患者移出端部执行器300。相似地，可重复以上过程以在患者体内形成若干单独的被固定横切面，而无需从患者移出端部执行器300。在其中操作者从一个横切位点移动到另一横切位点的实例中，操作者可在移动到后一横切位点之前简单地使用传统切割器械来切割条360,370。根据本文的教导内容，可与端部执行器300相关联的再一些其它合适的部件、特征结构、构型、可操作性和变型将对本领域的普通技术人员显而易见。
III.其它方面
应当理解，本文所述的教导内容、表达、实施例、示例等中的任何一者或多者可与本文所述的其它教导内容、表达、实施例、示例等中的任何一者或多者进行组合。因此，上述教导内容、表达、实施例、示例等不应视为彼此孤立。根据本文的教导内容，其中本文教导内容可进行组合的各种合适的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，据称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所述的定义、陈述或者其它公开材料不冲突的范围内并入本文。因此，并且在必要的程度下，本文明确阐述的公开内容取代以引用方式并入本文的任何冲突材料。据称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。
上文所述装置的型式可应用在由医疗专业人员进行的传统医疗处理和手术中、以及可应用在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IntuitiveSurgical,Inc.,ofSunnyvale,California的DAVINCITM系统的机器人外科系统中。
上文所述型式可被设计成在单次使用后丢弃，或者其可被设计成能够使用多次。在任一种或两种情况下，可对各型式进行修复，以便在至少一次使用后再使用。修复可包括以下步骤的任意组合：拆卸装置、然后清洗或更换特定零件和随后进行重新组装。具体地讲，可拆卸一些型式的所述装置，并且可选择性地以任何组合形式来更换或移除所述装置的任意数量的特定零件或部分。在清洗和/或更换特定部分时，所述装置的一些型式可在修复设施处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理解，修复装置可以利用多种技术进行拆卸、清洗/更换和重新组装。这些技术的使用和所得重新修复的装置均在本申请的范围内。
仅以举例的方式，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，诸如塑料袋或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。经杀菌的装置随后可存储在无菌容器中，以供以后使用。还可使用本领域已知的任何其它技术对装置消毒，所述技术包括但不限于β辐射或γ辐射、环氧乙烷或蒸汽。
已经示出和描述了本发明的各种实施例，可在不脱离本发明的范围的情况下由本领域的普通技术人员进行适当修改来实现本文所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，并且其它修改将对本领域的技术人员显而易见。例如，上文所讨论的示例、实施例、几何形状、材料、尺寸、比率、步骤等均是例示性的而非所要求的。因此，本发明的范围应根据以下权利要求书来考虑，并且应理解为不限于说明书和图式中示出和描述的结构和操作细节。

Claims (20)

1.一种设备，包括：
(a)轴，其中所述轴具有远侧端部；
(b)端部执行器，其中所述端部执行器设置在所述轴的所述远侧端部处，其中所述端部执行器限定被构造成能够接收组织的间隙，其中所述端部执行器包括：
(i)定位在所述间隙的第一侧处的第一紧固件组件成形特征结构，其中所述第一紧固件组件成形特征结构能够相对于所述轴旋转，和
(ii)定位在所述间隙的第二侧处的第二紧固件组件成形特征结构；
(c)第一紧固件组件构件，其中所述第一紧固件组件成形特征结构被构造成能够接收所述第一紧固件组件构件并将所述第一紧固件组件构件定位在所述间隙的所述第一侧处，其中所述第一紧固件组件构件被构造成能够在所述第一紧固件组件成形特征结构的旋转期间通过所述轴朝远侧平移；和
(d)第二紧固件组件构件，其中所述第二紧固件组件成形特征结构被构造成能够接收所述第二紧固件组件构件并将所述第二紧固件组件构件定位在所述间隙的所述第二侧处，其中所述第二紧固件组件构件被构造成能够在所述第一紧固件组件成形特征结构的旋转期间通过所述轴朝远侧平移；
其中所述第一紧固件组件构件和所述第二紧固件组件构件被构造成能够接合在一起并由此形成紧固件组件。
2.根据权利要求1所述的设备，其中所述端部执行器还包括：
(i)第一钳口，和
(ii)第二钳口，
其中所述第一钳口能够相对于所述第二钳口枢转以选择性地改变所述间隙。
3.根据权利要求2所述的设备，其中所述第一紧固件组件成形特征结构设置在所述第一钳口中，其中所述第二紧固件组件成形特征结构设置在所述第二钳口中。
4.根据权利要求3所述的设备，其中所述第一钳口限定被构造成能够朝所述第一紧固件组件成形特征结构导引所述第一紧固件组件构件的第一通道，其中所述第二钳口限定被构造成能够朝所述第二紧固件组件成形特征结构导引所述第二紧固件组件构件的第二通道。
5.根据权利要求4所述的设备，其中所述第二通道限定弯头，所述弯头被构造成能够将所述第二紧固件组件构件的路径从远侧方向重新定向到近侧方向。
6.根据权利要求1所述的设备，其中所述端部执行器还包括能够操作以切割组织的组织切割构件。
7.根据权利要求6所述的设备，其中所述组织切割构件被构造成能够相对于所述第一紧固件组件成形特征结构和所述第二紧固件组件成形特征结构平移。
8.根据权利要求6所述的设备，其中所述组织切割构件相对于所述第一紧固件组件成形特征结构和所述第二紧固件组件成形特征结构朝近侧定位。
9.根据权利要求1所述的设备，其中所述第一紧固件组件成形特征结构包括砧座。
10.根据权利要求9所述的设备，其中所述砧座限定被构造成能够使所述第二紧固件组件构件的部分变形的成角度列阵的凹槽。
11.根据权利要求9所述的设备，其中所述砧座限定被构造成能够使所述第二紧固件组件构件的部分变形的成角度列阵的突起。
12.根据权利要求1所述的设备，其中所述第一紧固件组件构件包括支撑条。
13.根据权利要求1所述的设备，其中所述第二紧固件组件构件包括线，其中所述线包括可塑突起部分，其中所述第一紧固件组件成形特征结构被构造成能够使所述可塑突起部分变形。
14.根据权利要求1所述的设备，其中所述第二紧固件组件构件包括：
(i)条，和
(ii)从所述条横向延伸的多个紧固件，其中所述第一紧固件组件构件被构造成能够接收所述多个紧固件。
15.根据权利要求14所述的设备，其中所述紧固件中的每一个紧固件包括可变形自由端部，其中所述第一紧固件组件成形特征结构被构造成能够使每个自由端部变形为铆钉头构型。
16.根据权利要求14所述的设备，其中所述紧固件中的每一个紧固件包括带倒钩的自由端部，其中所述带倒钩的自由端部被构造成能够锁定到所述第一紧固件组件构件中。
17.根据权利要求1所述的设备，其中所述整个端部执行器能够相对于所述轴枢转。
18.根据权利要求1所述的设备，还包括：
(a)第一卷轴，其中所述第一紧固件组件构件的一部分聚集在所述第一卷轴上；和
(b)第二卷轴，其中所述第二紧固件组件构件的一部分聚集在所述第二卷轴上。
19.一种设备，包括：
(a)轴，其中所述轴具有远侧端部；
(b)端部执行器，其中所述端部执行器设置在所述轴的所述远侧端部处，其中所述端部执行器包括：
(i)具有砧座构件的第一钳口，其中所述砧座构件能够在所述第一钳口内旋转，和
(ii)具有导引构件的第二钳口；
(c)第一紧固件组件构件，其中所述砧座被构造成能够接收所述第一紧固件组件构件；和
(d)第二紧固件组件构件，其中所述导引构件被构造成能够接收所述第二紧固件组件构件；
其中所述第一紧固件组件构件和所述第二紧固件组件构件被构造成能够接合在一起，
其中所述砧座被构造成能够使所述第二紧固件组件构件的一部分变形，以将所述第一紧固件组件构件和所述第二紧固件组件构件固定在一起。
20.一种设备，包括：
(a)轴，其中所述轴具有远侧端部；
(b)端部执行器，其中所述端部执行器设置在所述轴的所述远侧端部处，其中所述端部执行器限定被构造成能够接收组织的间隙，其中所述端部执行器包括：
(i)定位在所述间隙的第一侧处的第一可旋转构件，和
(ii)定位在所述间隙的第二侧处的第二可旋转构件；
(c)支撑条，其中所述第一可旋转构件被构造成能够接收所述支撑条；和
(d)具有多个紧固件的紧固件条，其中所述第二可旋转构件被构造成能够接收所述紧固件条，其中所述支撑条被构造成能够接收所述紧固件以将组织固定在所述支撑条与所述紧固件条之间。
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US20150048143A1 (en) 2015-02-19
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RU2676522C2 (ru) 2018-12-29
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US9561029B2 (en) 2017-02-07
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