CN105705103A - 电外科装置 - Google Patents
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- 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
- A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
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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
- 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
- A61B2017/2926—Details of heads or jaws
- A61B2017/2945—Curved jaws
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00053—Mechanical features of the instrument of device
- A61B2018/00059—Material properties
- A61B2018/00071—Electrical conductivity
- A61B2018/00083—Electrical conductivity low, i.e. electrically insulating
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- 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
- A61B2018/1405—Electrodes having a specific shape
- A61B2018/1425—Needle
- A61B2018/1432—Needle curved
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- 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
- A61B2018/1452—Probes having pivoting end effectors, e.g. forceps including means for cutting
- A61B2018/1455—Probes having pivoting end effectors, e.g. forceps including means for cutting having a moving blade for cutting tissue grasped by the jaws
Abstract
在各种实施方案中，公开了一种外科器械。在一个实施方案中，外科器械包括柄部、从柄部朝远侧延伸的轴组件，以及附接到轴组件的远侧端部的端部执行器。端部执行器包括具有近侧端部和远侧端部的钳口组件。钳口组件包括活动钳口构件和固定钳口构件。活动钳口构件能够相对于固定钳口构件在打开位置和闭合位置之间枢转地移动。在闭合位置，钳口组件限定曲率半径以及从近侧端部到远侧端部的平滑锥形。
Description
相关申请的交叉引用
本申请涉及美国专利申请律师代理人案卷号END7372USNP/130426，其与本申请同时提交并且以引用的方式全文并入本文。
背景技术
本公开整体涉及具有用于夹持和处理组织的各种机构的电外科装置。具体地，本公开涉及具有用于控制弯曲的端部执行器的各种机构的电外科装置。
尽管已研制和使用了若干装置，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装置。
发明内容
在各种实施方案中，公开了一种外科器械。在一个实施方案中，外科器械包括柄部、从柄部朝远侧延伸的轴组件，以及附接到轴组件的远侧端部的端部执行器。端部执行器包括具有近侧端部和远侧端部的钳口组件。钳口组件包括活动钳口构件和固定钳口构件。活动钳口构件能够相对于固定钳口构件在打开位置和闭合位置之间枢转地移动。在闭合位置，钳口组件限定曲率半径以及从近侧端部到远侧端部的平滑锥形。
在各种实施方案中，公开了一种外科端部执行器。在一个实施方案中，外科端部执行器包括具有近侧端部和远侧端部的钳口组件。钳口组件包括活动钳口构件、固定钳口构件，以及联接活动钳口构件和固定钳口构件的枢轴连接部。活动钳口构件能够相对于固定钳口构件在打开位置和闭合位置之间枢转地运动。在闭合位置，钳口组件限定曲率半径以及从近侧端部到远侧端部的平滑锥形。
在各种实施方案中，公开了一种外科器械。在一个实施方案中，外科器械包括柄部、从柄部朝远侧延伸的轴组件，以及附接到轴组件的远侧端部的端部执行器。轴组件包括朝远侧延伸穿过其的杠杆臂。端部执行器包括具有近侧端部和远侧端部的钳口组件。钳口组件包括活动钳口构件和固定钳口构件。活动钳口构件能够相对于固定钳口构件在打开位置和闭合位置之间枢转地移动。杠杆臂在轴组件的中心轴线的第一侧上不对称地联接到活动钳口构件。活动钳口构件和固定钳口构件之间的枢轴连接部偏移到轴组件的中心轴线的第一侧。在闭合位置，钳口组件限定曲率半径以及从近侧端部到远侧端部的平滑锥形。
附图说明
本文所述实施方案的新颖特征在所附权利要求书中进行了详细描述。然而，对组织和操作方法的实施方案而言，皆可以通过结合附图参照以下具体实施方式更好地理解。
图1示出了电外科器械的一个实施方案。
图2示出了图1的电外科器械的侧面透视图。
图3示出了图1的电外科器械的侧视图。
图4示出了图1的电外科器械的透视图，其中左柄部外壳被移除。
图5示出了图1的电外科器械的分解图。
图6示出了包括柄部组件中的钳口闭合系统的图1的电外科器械的侧视图。
图7示出了图6的电外科器械，其中钳口闭合系统处于部分闭合的位置。
图8示出了与切割构件击发机构交接的击发机构锁条。
图9示出了经充分地旋转以使锁条从齿条解锁块脱离接合的闭合触发器。
图10示出了图8的击发机构处于解锁位置。
图11示出了钳口位置传感器的一个实施方案。
图12示出了包括调节螺钉锁簧的钳口位置传感器的一个实施方案。
图13示出了钳口位置传感器的一个实施方案。
图14示出了安装在柄部组件中的钳口位置传感器的一个实施方案。
图15示出了图4的电外科器械的一个实施方案，其中闭合触发器被完全致动。
图16示出了图4的电外科器械，其中闭合触发器锁被接合。
图17示出了图16的电外科器械，其中击发触发器处于致动位置。
图18示出联接到回程阻尼器的钳口闭合系统的托架的一个实施方案。
图19示出了回程阻尼器的一个实施方案。
图20A示出了当端部执行器的钳口处于闭合位置时托架和回程阻尼器之间的接口。
图20B示出了当端部执行器的钳口转变到打开位置时托架和回程阻尼器之间的接口。
图21示出了图4的电外科器械，其中闭合触发器锁被释放并且闭合触发器处于被释放的位置。
图22示出了齿条弹簧垫圈的一个实施方案。
图23示出了钳口闭合弹簧止动件的一个实施方案。
图24示出了包括能量按钮、源线缆和回流线缆的电能系统的一个实施方案。
图25示出了包括预压缩的钳口闭合弹簧的电外科器械的一个实施方案。
图26示出了包括顶部安装刀片的击发齿轮和齿条的电外科器械的一个实施方案。
图27A和图27B示出了包括弯曲形状的电外科端部执行器的一个实施方案。
图28示出了图27A至图27B的电外科端部执行器的一个实施方案，其包括偏移的钳口闭合致动器。
图29示出了包括具有平滑锥形、弯曲形状的第一钳口构件和第二钳口构件的电外科端部执行器的一个实施方案。
图30示出了处于闭合位置的图29的电外科端部执行器的一个实施方案。
图31示出了包括弯曲的纵向切割构件狭槽的图29至图30的电外科端部执行器的下钳口的一个实施方案。
图32示出了说明闭合触发器在各种触发角度处的机械增益的图。
图33示出了说明当没有组织位于钳口内时由钳口递送的力的图。
图34示出了说明当组织切片位于钳口内时由钳口递送的力的图。
图35示出了说明由回程阻尼器提供的对回载的阻尼效应的图。
具体实施方式
在下面的详细描述中，参考构成其一部分的附图。在附图中，类似的符号和参考字符通常指贯穿几个附图中的类似部件，除非上下文另有指示。详细描述、附图以及权利要求书中描述的例示性实施方案并非旨在为限制性的。在不脱离本文所公开的主题的范围的情况下，可利用其他实施方案，并且可做出其他变化。
本技术的某些示例的下述描述不应当用于限制其范围。从下面的描述而言，本技术的其他示例、特征、方面、实施方案和优点对本领域的技术人员而言将是显而易见的，下面的描述以例示的方式进行，这是为实现本技术所设想的最好的方式中的一种。正如将意识到的，本文所述技术能够包括其他不同的和明显的方面，这些均不脱离本发明技术。因此，附图和具体实施方式应被视为实质上是例示性的而非限制性的。
还应当理解，本文所述的教导内容、表达方式、实施方案、示例等中的任何一个或多个可与本文所述的其他教导内容、表达方式、实施方案、示例等中的任何一个或多个相结合。因此，下述教导内容、表达方式、实施方案、示例等不应视为相对于彼此孤立。参考本文的教导内容，其中本文教导内容可结合的各种合适方式对本领域的普通技术人员来说将显而易见。此类修改和变型旨在被包括在权利要求书的范围内。
在详细解释具有近距离关节运动特征结构的多个实施方案之前，应该指出的是，本文所公开的各种实施方案的应用或使用并不局限于附图和具体实施方式中示出的部件的构造和布置的细节。相反，所公开的实施方案可以设置或结合在其他实施方案中，其变型形式和修改形式中可以多种方式实施或进行。因此，本文所公开的具有近距离的关节运动特征结构的外科装置的实施方案实质上是例示性的，而并非旨在限制其范围或应用。此外，除非另外指明，否则本申请所用的术语和表达是为了方便读者描述实施方案的目的而选择的，并非限制其范围。另外，应当理解，本申请所公开的实施方案、实施方案的表达和/或示例中的任何一个或多个可非限制性地与本申请其他公开的实施方案、实施方案的表达和/或示例中的任何一个或多个结合。
另外，在下面的描述中，应当理解，术语诸如前、后、内部、外部、顶部、底部等等是方便型用语，并且不应当理解为是限制性术语。本文所用的术语并非意在限制在本文所述装置或其部分的范围内，而是可以按照其他取向被附接或利用。将参考附图更详细地描述各种实施方案。
现在转向附图，图1示出了电外科器械2的一个实施方案。电外科器械2包括两个触发器的夹持和切割机构。电外科器械2包括柄部组件4、联接到柄部组件4的远侧端部的轴组件12，以及联接到轴组件12的远侧端部的端部执行器10。柄部组件4被配置为手枪式握把，并且包括左柄部外壳罩6a和右柄部外壳罩6b、闭合触发器8、手枪式握持柄部14、击发触发器16、能量按钮18以及可旋转轴旋钮20。电力线缆21在近侧端部处进入柄部组件4。
轴组件12包括钳口致动器、切割构件致动器和外部护套23。钳口致动器操作地联接到柄部组件4的闭合触发器8。在一些实施方案中，外部护套23包括钳口致动器。切割构件致动器操作地联接到柄部组件4的击发触发器16。外部护套23包括在远侧端部上的一个或多个接触电极，其被构造成能够与端部执行器10交接。一个或多个接触电极操作地联接到能量按钮18和能量源(未示出)。
能量源可适于治疗组织处理、组织烧灼/封闭以及亚治疗处理和测量。能量按钮18控制能量到电极的递送。本文在下面提供对这些控制元件中的每一个的详细解释。如贯穿本公开所使用的，按钮是指用于控制加工或过程的某个方面的开关机构。按钮可由硬质材料诸如通常是塑料或金属制成。表面可被形成或成形以容纳人的手指或手，以便被容易地压下或推压。按钮最通常可以是偏置开关，尽管甚至许多未偏置的按钮(由于它们的物理性质)需要弹簧以恢复到它们未被推压的状态。对于按钮的“推压”的术语可包括按压、压下、碾压以及用力按。
在一些实施方案中，端部执行器10联接到轴组件12的远侧端部。端部执行器10包括第一钳口构件22a和第二钳口构件22b。第一钳口构件22a枢转地联接到第二钳口构件22b。第一钳口构件22a能够相对于第二钳口构件22b枢转地移动以抓持这两者间的组织。在一些实施方案中，第二钳口构件22b被固定。在其他实施方案中，第一钳口构件22a和第二钳口构件22b能够枢转地移动。端部执行器10包括至少一个电极92。电极92被构造成能够递送能量。由电极92递送的能量可包括例如射频(RF)能量、亚治疗RF能量、超声波能量和/或其他合适形式的能量。在一些实施方案中，切割构件(未示出)可接收在由第一钳口构件22a和/或第二钳口构件22b限定的纵向狭槽内。切割构件被构造成能够切割在第一钳口构件22a和第二钳口构件22b之间抓持的组织。在一些实施方案中，切割构件包括用于递送能量诸如例如RF和/或超声能量的电极。
图2示出了在图1中所示的电外科器械的侧面透视图。图2示出了右柄部外壳6b。能量按钮18延伸穿过柄部组件4，并且在柄部组件4的两侧上均是能够触及的。闭合触发器8、击发触发器16和能量按钮18包括人体工程学设计。在一些实施方案中，柄部组件4在靠近能量按钮18处较薄，以允许临床医生易于触及能量按钮18。在一些实施方案中，能量按钮18设置在左柄部外壳6a上或右柄部外壳6b上。图3示出了电外科器械2和右柄部外壳6b的侧视图。
图4示出了图1的外科器械2的一个实施方案，其中左柄部6a被移除。柄部组件4包括用于致动外科器械2的多个部件，例如，诸如用于影响端部执行器10的钳口22a、22b的闭合、在端部执行器10内展开切割构件并且/或者将能量递送到联接到端部执行器10的电极92的机构。闭合触发器8被构造成能够将钳口22a、22b从打开位置转变到闭合位置。闭合触发器8连接至夹持臂24。夹持臂24将闭合触发器8联接到托架26。当闭合触发器8朝手枪式握把柄部14被致动时，托架26朝近侧移动并且压缩夹持弹簧28。夹持弹簧28的压缩使钳口致动器诸如例如外部护套23回缩，以将端部执行器10的第一钳口构件22a从打开位置转变到闭合位置。在例示的实施方案中，夹持弹簧28包括未压缩的弹簧。在一些实施方案中，可使用部分预压缩的弹簧(参见图25)。
击发触发器16被构造成能够在端部执行器10内展开切割构件。击发触发器16操作地联接到复合齿轮42。复合齿轮42与齿条44交接。齿条44联接到击发致动器(未示出)。当击发触发器16被致动时，复合齿轮42朝远侧旋转并移动齿条44。齿条44的远侧移动致使击发致动器的远侧移动以及切割构件在端部执行器10内的展开。切割构件从端部执行器10的近侧端部到远侧端部被展开。在一个实施方案中，击发触发器16包括高枢轴，以在击发触发器16的致动期间提供线性感觉。线性感觉向致动击发触发器16的临床医生提供增加的控制和舒适度。
在一些实施方案中，齿条44包括锁定机构。在例示的实施方案中，齿条44包括齿条解锁块40。齿条解锁块40与锁臂38交接，以防止切割构件击发开关16在闭合触发器8的致动之前致动。当闭合触发器8处于打开位置时，锁臂38与齿条解锁块40交接，以锁定齿条44并且防止击发触发器16的致动。当闭合触发器8被致动时，托架26使锁臂38升高远离齿条解锁块40。当对应于端部执行器10的钳口22a、22b处于充分闭合的位置以防止切割构件存在于钳口22a、22b中的狭槽内，闭合触发器8被充分致动时，锁臂38从齿条解锁块40脱离，从而允许击发触发器16的致动。
图5示出了电外科器械2的分解图。如图5中所示，柄部组件4包括左柄部外壳6a和右柄部外壳6b。柄部组件4包括闭合触发器8、击发触发器16和能量按钮18。夹持臂24通过多个销52联接到钳口闭合触发器8和托架26。milmax连接器53位于柄部组件4的近侧端部，以联接到能量源(未示出)。尽管例示的实施方案包括联接到外部能量源的外科器械2，但本领域的技术人员应当认识到，能量源和/或一个或多个驱动电路可位于柄部组件4内。例如，在一个实施方案中，电池和RF生成电路可安装在柄部组件4中，并且联接到能量按钮18。在一些实施方案中，钳口位置传感器34安装在柄部组件4中以指示端部执行器10的钳口22a、22b何时已经闭合超出预定位置。螺钉锁簧36安装到钳口位置传感器34以防止钳口位置传感器34的意外调节。控制板48安装在柄部组件4中。
图6示出了包括柄部组件4中的钳口闭合机构的柄部组件4的侧面透视图。所示闭合触发器8处于对应于钳口22a、22b的打开位置的初始位置。在操作中，临床医生致动闭合触发器8以将钳口22a、22b转变到闭合位置。图7示出了处于部分致动位置的闭合触发器8。如图7所示，当闭合触发器8向近侧朝手枪式握持柄部14旋转时，夹持臂24在近侧方向上移动托架26以压缩夹持弹簧28。夹持弹簧28的压缩致使钳口22a、22b转变到闭合位置，并且将力施加到被抓持在钳口22a、22b之间的组织。例如，在一些实施方案中，在图7中示出的闭合触发器8的位置对应于钳口22a、22b的完全闭合。闭合触发器8的附加致动增加由钳口22a、22b施加到抓持在这两者之间的组织切片的力。在其他实施方案中，当闭合触发器8被完全致动时，发生钳口22a、22b的完全闭合。在闭合触发器8中的孔19允许闭合触发器8被致动而无需与能量按钮18交接。在一些实施方案中，孔19被左柄部外壳6a和右柄部外壳6b覆盖。
图8示出了击发触发器锁定机构33。锁臂38与齿条解锁块40交接，以防止击发触发器16在钳口22a、22b的闭合之前致动。击发触发器锁定机构33通过闭合触发器8的致动被解锁。托架26联接到解锁条41。当托架26通过闭合触发器8的致动朝远侧移动时，锁条41使锁臂38垂直提升远离齿条解锁块40。当锁臂38已经被提升足够的距离时，允许齿条44朝远侧移动，并且击发触发器16是可致动的以在端部执行器10内展开切割构件。图9和图10示出外科器械2的柄部组件4，其中钳口夹持触发器8被充分压缩以从齿条解锁块40释放锁臂38。如在图9中可见，锁臂38被提升足够的距离，以允许击发触发器16在闭合触发器8的完全旋转之前致动。当钳口22a、22b充分闭合时，击发触发器16被解锁，由此使得切割构件不能跳出在端部执行器10中形成的狭槽。例如，在一些实施方案中，当对应于大约2.5度的钳口开口，闭合触发器8被压缩大约8度时，释放锁臂38。在其他实施方案中，锁臂38可在闭合触发器8的较低或较高旋转度数下被释放。
在一些实施方案中，锁簧64联接到锁臂38，以将偏置力施加到锁臂38。偏置力朝齿条解锁块40偏置锁臂38，并且维持锁臂38与齿条解锁块40接触，直到闭合触发器8已经被充分致动。当闭合触发器8被释放并且托架26回到静止位置时，锁簧64将锁臂38偏置回到具有齿条解锁块40的锁定配置中。
图10示出了处于解锁位置的锁臂38。在解锁位置，临床医生可致动击发触发器16，以朝远侧驱动齿条44，并且在端部执行器10内展开切割构件。在一些实施方案中，钳口位置传感器34被构造成能够指示钳口22a、22b何时充分地闭合，以允许切割构件的展开。在一些实施方案中，钳口位置传感器34包括旁路开关。在其他实施方案中，可使用其他类型的开关，诸如例如正常打开的、正常闭合的和/或其他开关类型。
图11示出了钳口位置传感器34的一个实施方案。钳口位置传感器34包括可调节触点77。可调节触点77可机械调节，以调节钳口位置传感器34的钳口感测启动点。通过旋转联接到钳口位置传感器34的螺钉76，调节触点77。对应于闭合触发器8的具体旋转，螺钉76的旋转增加或减小(根据旋转方向)锁臂38的必要高度，其被需要以激活钳口位置传感器34。在一些实施方案中，诸如图12中示出的实施方案中，螺钉锁簧36联接到螺钉76以防止触点77的意外调节。在图12示出的实施方案中，为了调节触点77，在螺钉76旋转之前，螺钉锁簧36必须被压下。调节螺钉76以将螺钉76锁定在适当的位置后，释放螺钉锁簧36。在一些实施方案中，螺钉76包括锁定螺纹。钳口位置传感器34的启动可对应于例如第一钳口22a和第二钳口22b之间大约0.01英寸的距离。
图13示出了钳口位置传感器134的一个实施方案。钳口位置传感器134包括开关170。当开关170的触点177被锁条41压下时，开关170内的电连接打开。开关170的电连接的中断由双位置连接头172检测。连接头172联接到例如控制板38。连接的插座174将连接头172联接到柄部组件4。图14示出安装在柄部组件4中的钳口传感器34。柄部组件4包括多个出入孔79，以允许临床医生压下螺钉锁簧36，并且旋转螺钉76以调节触点77。
图15示出了柄部组件4的一个实施方案，其中闭合触发器8被完全致动。当闭合触发器8被完全致动时，对应于由钳口22a、22b施加的最大力，托架26压缩夹持弹簧28到最大压缩。在一些实施方案中，钳口22a、22b可被构造成能够保持两者间的最小间距，以防止对外科器械2的部件和/或组织切片的损坏。在其他实施方案中，夹持弹簧28的最大压缩对应于钳口22a、22b的完全闭合位置。在一些实施方案中，闭合触发器8的完全致动对应于大约30度的旋转。当闭合触发器8抵靠手枪式握持柄部14被完全旋转时，闭合触发器锁46接合以将闭合触发器8保持在旋转的位置，并且因此将钳口22a、22b保持在闭合位置。如图15所示，在闭合触发器8中的孔19允许闭合触发器8抵靠手枪式握持柄部14被完全旋转而无需与能量按钮18交接。一旦触发器锁46已经接合，临床医生可释放闭合触发器8，并且触发器锁46将闭合触发器8保持在闭合位置，如图16所示。
如图16所示，触发器锁46将闭合触发器8保持在不到完全回缩的位置，以防止由于对钳口22a、22b过度施加的力而造成的对外科器械2的部件的损坏。触发器锁46将闭合触发器8保持在充分旋转的位置，以从齿条解锁块40释放锁臂38，并且接合钳口位置传感器34。例如，在例示的实施方案中，触发器锁46将闭合触发器8保持在大约28度的旋转。在闭合触发器8处于锁定位置的情况下，临床医生可致动击发触发器16，以在端部执行器10内展开切割构件。在一些实施方案中，临床医生可致动能量按钮18，以将能量递送到被抓持在钳口22a、22b之间的组织切片，其在切割构件的展开之前进行或者与切割构件的展开同时进行。
在各种实施方案中，闭合触发器8提供将力从闭合触发器8传送到钳口22a、22b的机械增益。图32是示出闭合触发器8在各种触发角度702处的机械增益704的图表700。如图32所示，随着闭合触发器8的角度增加，例如，通过朝手枪式握持柄部14致动闭合触发器8，由夹持弹簧28递送到钳口22a、22b的机械增益704增加。图33和图34示出当闭合触发器8朝手枪式握持柄部14旋转时由钳口22a、22b提供的力。图33示出了当没有组织位于钳口22a、22b内时由钳口22a、22b递送的力806。图34示出了当大约3mm厚的组织位于钳口22a、22b之间时由钳口22a、22b递送的力906。
如图16所示，击发触发器16联接到与齿条44交接的复合齿轮42。齿条44机械地联接到击发致动器(未示出)，其被构造成能够在端部执行器10内朝远侧展开切割构件。击发触发器16向近侧朝柄部组件4的旋转致使齿条44在柄部组件4内朝远侧推进，并且驱动在端部执行器10内的切割构件。图17示出了柄部组件4，其中击发触发器16处于致动位置。对应于切割构件位于端部执行器10内的最远侧位置处，复合齿轮42已经朝远侧推进齿条44。齿条44在远侧方向上的推进压缩弹簧垫圈58。当临床医生释放击发触发器16时，弹簧垫圈在近侧方向上推动齿条44，从而从端部执行器10抽出切割构件。击发触发器16包括相对于施加到击发触发器16的力调节由切割构件施加的力的机械增益。例如，在一个实施方案中，击发触发器16包括为6的机械增益，由此使得施加到击发触发器16的一磅的力对应于由切割构件施加到被抓持在端部执行器10内的组织切片的0.6磅的力。在一些实施方案中，击发触发器16包括最大旋转，其对应于切割构件位于端部执行器10的最远侧部分。例如，击发触发器16可旋转大约十九度，以在端部执行器10内完全展开切割构件。在一些实施方案中，柄部组件4包括被构造成能够将齿条偏置在近侧位置的齿条偏置弹簧47。闭合触发器锁46被释放以打开钳口22a、22b，并且释放被抓持在其中的组织。
图18示出了联接到托架26以减少夹持弹簧28的回程的力的回程阻尼器32的一个实施方案。当闭合触发器8被释放时，回程阻尼器32抑制托架26的回程。图19示出了回程阻尼器32的一个实施方案。图20A和图20B示出托架26和回程阻尼器32之间的接口。回程阻尼器32包括肘节臂78和阻尼弹簧76。托架26包括阻尼器接口销79。当托架26朝远侧移动时，例如，当钳口22a、22b被释放并且闭合触发器8回到未致动的位置时，接口销79向下推动肘节臂78，从而压缩阻尼弹簧76，并且减少来自闭合触发器8上的闭合弹簧28的负载。一旦接口销79推动肘节臂78靠近中心上方，在托架销79上的负载变成几乎为零，由此使得对于行程的剩余部分的阻尼效应被消除。当闭合触发器8从致动位置被释放时，回程阻尼器32减少闭合弹簧28的力。
图35示出了说明由回程阻尼器32提供的对回载的阻尼效应的图表。图表1000示出了针对施加到闭合触发器8的力1004绘制的闭合触发器8的触发角度1002。如在图35中可见，由钳口22a、22b施加的力在夹持触发器大约18度的旋转处增加到最大点。当夹持触发器8被释放时，阻尼力减小，并且阻尼器肘节78跨越中心点。
图21示出了在闭合触发器8已经被释放并且钳口22a、22b已经假设打开位置之后的柄部组件4。闭合触发器8已经回到相对于手枪式握持柄部14的未致动的位置。夹持弹簧28和齿条44已经回到它们各自的起始位置。当夹持弹簧28处于静止位置时，回程阻尼器32被完全压缩。图22示出当齿条44在远侧方向上被推进时被构造成能够与齿条弹簧59交接的弹簧垫圈158的一个实施方案。如果击发触发器16被释放，则弹簧垫圈158和齿条弹簧59致使齿条44朝近侧移动。图23示出了弹簧止动件162的一个实施方案。弹簧止动件162联接到夹持弹簧28的近侧端部。
图24示出了安装在柄部组件4内的电能系统80的一个实施方案。能量按钮18被构造成能够将能量递送到联接到端部执行器10的电极92。能量按钮18联接到多个电力启动线82。当能量按钮18被压下时，电路完成，从而允许能量递送到电极92。源路径84联接安装在轴组件12的外管23的远侧端部上的电触点。在一些实施方案中，源路径包括外管23。另选地，在一些实施方案中，源路径包括容纳在外管23内的实心或绞合导体。回位路径85起到用于递送到电极的双极RF能量的回路的作用。对于单极RF能量，回位路径可包括联接到患者的接地电极。在一些实施方案中，电力启动线82联接到发生器。控制板48进一步联接到钳口位置开关34和发生器。发生器可防止能量递送到电极92，除非钳口位置传感器34指示钳口22a、22b处于充分闭合位置。
图25示出了包括预压缩闭合弹簧228的电外科器械202的一个实施方案。预压缩闭合弹簧228包括在闭合触发器8的致动之前具有一定预压缩的闭合弹簧。在与未压缩的弹簧进行比较时，预压缩闭合弹簧228需要临床医生向闭合触发器8施加较小的力，以在钳口22a、22b处产生相同量的力。预压缩弹簧228可进一步提供较短的行程，用于将钳口22a、22b压缩到与未压缩的弹簧相同的闭合或力水平。电外科器械204以其他方式类似于针对图1至图24讨论的电外科器械2。例如，通过致动闭合触发器8影响联接到外科器械202的端部执行器的闭合，从而将托架226朝近侧移动以压缩预压缩弹簧228，并且将钳口22a、22b从打开位置转变到闭合位置。
图26示出了包括柄部组件304的外科器械302的一个实施方案，所述柄部组件304具有安装在顶部的复合齿轮342和齿条344。击发触发器316通过多个齿状物343联接到复合齿轮342。击发触发器316的致动在远侧方向上推进齿条344。齿条344联接到击发致动器(未示出)，其在联接到轴312的端部执行器内朝远侧推进切割构件。外科器械302以其他方式类似于在图1至图24中讨论的电外科器械2。例如，通过致动联接到托架326的闭合触发器8影响联接到轴组件312的端部执行器的钳口的闭合，从而压缩闭合弹簧328。
图27A和图27B示出了包括弯曲形状的电外科端部执行器410的一个实施方案。端部执行器410包括第一钳口构件422a和第二钳口构件422b。第一钳口构件422a通过枢轴销479枢转地联接到第二钳口构件。电外科端部执行器410被构造成能够联接到电外科器械，诸如例如在图1至图24中示出的电外科器械2。在一些实施方案中，第一钳口构件422a和第二钳口构件422b是平滑锥形的，其中钳口构件422a,422b的近侧部分是最宽的部分，并且钳口构件422a,422b的远侧端部是钳口构件422a,422b最窄的部分。平滑锥形包括在端部执行器410的曲率平面中并且平行于轴412的中心轴线的锥形。例如，在一些实施方案中，端部执行器410的远侧部分可包括端部执行器410的近侧宽度的大约25％到50％，诸如例如33％。平滑锥形提供更好的解剖，同时保持宽电极通过大部分端部执行器410以便更好的密封。第一钳口构件422a和第二钳口构件422b沿端部执行器410的纵向轴线弯曲。端部执行器410的弯曲包括曲率半径。曲率半径可包括例如大约1.000"到4.000"的半径。
端部执行器410的锥形和曲率增加尖端491的可见性。锥形补偿端部执行器410的更近侧位置上的组织上的力损失，从而在该组织上提供更恒定的压力。沿端部执行器410的纵向轴线的平滑转变和沿端部执行器410的长度的锥形分布偏转降低应力集中，从而允许由端部执行器410施加更大的负载。降低的应力和偏转允许端部执行器410被延长超出非弯曲的、非锥形的端部执行器。例如，在一些实施方案中，端部执行器410包括大约23mm的长度。
在一些实施方案中，端部执行器410包括偏置枢轴486。偏置枢轴486包括从轴412的纵向轴线和端部执行器410偏移的枢轴点。偏置枢轴允许连杆式闭合机构的使用。连杆销488和偏置枢轴486提供对第一钳口构件422a的移动的精确控制。图28示出了包括联接到偏移致动器的偏置枢轴586的端部执行器510的一个实施方案。偏移致动器包括联接到第一钳口构件522a的单个不对称的杠杆臂590。在与传统的两个杠杆臂的端部执行器进行比较时，不对称的杠杆臂590提供围绕枢轴586的附加材料。
图29示出了包括偏置枢轴686和联接到轴612的不对称杠杆臂690的端部执行器610的一个实施方案。端部执行器610包括第一钳口构件622a和第二钳口构件622b。第一钳口构件622a能够相对于第二钳口构件622b枢转地移动。第二钳口构件622b被固定。第一钳口构件622a和第二钳口构件622b包括具有相对于轴612的纵向轴线的曲率半径的弯曲形状。第一钳口构件622a和第二钳口构件622b包括从近侧端部到远侧端部的平滑锥形。远侧尖端690包括比端部执行器610的近侧节段的宽度小的宽度。例如，在一些实施方案中，远侧尖端包括端部执行器610的近侧节段的宽度的大约25％到50％的宽度。在图29中所示端部执行器610处于打开位置。在一些实施方案中，第一钳口构件622a相对于第二钳口构件622b的移动由不对称杠杆臂690和轴612的外护套623之间的连杆式连接实现。低摩擦轴衬698诸如例如润滑金属或塑料包括不对称杠杆臂690和外护套623之间的滑动接口。低摩擦轴衬698设置在不对称杠杆臂690的外径和轴612的内径之间。图30示出了处于闭合位置的图29的端部执行器610。如图30所示，通过朝近侧移动不对称杠杆臂690，端部执行器610转变到闭合位置。例如，通过致动由轴612联接到端部执行器610的柄部组件4的闭合触发器8可影响不对称杠杆臂690的近侧运动。
在一些实施方案中，电极692联接到第二钳口构件622b。电极692通过粘合剂诸如例如硅或环氧树脂粘合剂粘附到第二钳口构件622b。电极692选择性地涂覆有陶瓷涂层，其提供电绝缘以防止电极692和第二钳口构件622b之间的短路。在一些实施方案中，陶瓷涂层和粘合剂包括大约0.5W/(mK)到大约2.0W/(mK)的热导率。当第一钳口构件622a相对于第二钳口构件622b旋转到闭合位置时，电极692接触外管623的远侧端部上的源电极。接触电极在外轴623上的放置确保电极692和能量源之间的良好连接。在一些实施方案中，第一钳口构件622a和/或第二钳口构件622b限定切割构件狭槽。图31示出了包括切割构件狭槽696的第二钳口构件622b的一个实施方案。切割构件狭槽696的近侧端部在通过轴612的中心轴线的平面中开始。切割构件狭槽696偏置到轴612的中心轴线的第一侧，然后越过中心轴线到达被偏置到中心轴线的相对侧的位置，其处于切割构件狭槽696的最远侧部分。切割构件狭槽696的形状最大化切割构件狭槽696的半径，从而减小在切割构件695上的弯曲负载。切割构件狭槽696的几何形状保持在切割构件狭槽696两侧上几乎相等的电极692宽度。在一些实施方案中，切割构件狭槽696的曲率基本上等于端部执行器610的曲率，其基本上等于被横切的解剖结构的曲率。在一些实施方案中，切割构件狭槽696的曲率半径在切割构件狭槽696的长度上从大约2.000"变化到4.000"。在一些实施方案中，切割构件狭槽696以大于0.000"到大约0.065的最大值的距离被偏置到轴612的中心轴线的第一侧和/或第二侧。
尽管主要在电外科器械的背景下描述了本文的示例，但是应当理解，本文的教导内容可以容易地应用于多种其他类型的医疗器械。仅以举例的方式，本文的教导内容可以容易地应用于组织抓取器、组织恢复囊配置器械、手术缝合器、超声外科器械等。还应当理解，本文的教导内容可以容易地应用于本文所举出的参考文献中的任何参考文献中所述的器械中的任何器械，由此使得本文的教导内容可以容易地以多种方式与本文所举出的参考文献中的任何参考文献的教导内容相结合。可结合本文的教导内容的其他类型的器械对于本领域技术人员而言将是显而易见。
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所述的定义、陈述或者其他公开材料不冲突的范围内并入本文。同样地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。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。
本发明所公开的实施方案应用于常规的内窥镜检查和开放式外科器械以及应用于机器人辅助的手术。
本文所公开的装置的实施方案可设计为使用一次后丢弃，也可设计为供多次使用。在上述任一或两种情况下，都可对这些实施方案进行修复，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、然后清洗或更换特定零件和随后进行重新组装。具体地讲，可以拆卸装置的实施方案，并且可选择性地以任何组合形式来更换或移除装置的任意数量的特定零件或部件。在清洁和/或更换特定部件时，所述装置的实施方案可在修复设施中重新组装或在即将进行外科手术前由外科手术团队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，可在外科手术之前对本文所述的实施方案进行处理。首先，可以获取新的或用过的器械，并且根据需要进行清洁。然后，可对器械进行消毒。在一种消毒技术中，将该器械放置在闭合且密封的容器中，例如塑料或TYVEK袋中。然后可将容器和器械置于可穿透该容器的辐射场，诸如γ辐射、X射线或高能电子。辐射可以杀死器械上和容器中的细菌。消毒后的器械随后可被存放在无菌容器中。密封容器可将器械保持处于无菌状态，直至在医疗设施中将该容器打开。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。
值得一提的是，任何对“一个方面(oneaspect)”、“一方面(anaspect)”、“一种实施方案(oneembodiment)”、“一个实施方案(anembodiment)”的提及均意指结合所述方面所述的具体特征、结构或特性包括在至少一个方面中。因此，出现在整篇说明书中的不同位置的短语“在一个方面(inoneaspect)”、“在一方面(inanaspect)”、“在一种实施方案中(inoneembodiment)”或“在一个实施方案中(inanembodiment)”不一定都是指同一方面。此外，具体特征部、结构或者
本领域技术人员将会认识到，本文所述的组成部分(例如，操作)、装置、对象和它们随附的讨论是为了概念清楚起见而用作示例，并且可以设想多种配置修改形式。因此，如本文所用，阐述的具体例子和随附的讨论旨在代表它们更一般的类别。一般来讲，任何具体示例的使用旨在代表其类别，并且具体组成部分(如操作)、装置和对象的未纳入部分不应采取限制。
对于本文中使用的基本上任何复数和/或单数术语，本领域技术人员可从复数转换成单数和/或从单数转换成复数，只要适合于上下文和/或应用就可以。为清楚起见，各种单数/复数置换在本文中没有明确表述。
本文所述的主题有时阐述了包含在其他不同部件中的不同部件或与其他不同部件连接的不同部件。应当理解，此类描述的架构仅是示例，并且事实上可以实施获得相同功能性的许多其他架构。在概念意义上，获得相同功能性的部件的任何布置方式都是有效“相关联的”，从而获得所需的功能性。因此，本文中为获得特定功能性而结合在一起的任何两个组件都可被视为彼此“相关联”，从而获得所需的功能性，而不论架构或中间组件如何。同样，如此相联的任何两个组件也可被视为彼此“操作地连接”或“操作地联接”，以获得所需的功能性，并且能够如此相联的任何两个组件都可被视为彼此“操作地联接”，以获得所需的功能性。可操作地联接的具体示例包括但不限于可物理匹配的和/或物理交互部件，和/或无线交互式，和/或无线交互式部件，和/或逻辑交互式，和/或逻辑交互式部件。
一些方面可以使用表达“联接”和“连接”以及它们的衍生词来描述。应当理解，并不希望这些术语是彼此同义的。例如，某些方面可以利用术语“连接”来描述，以表示两个或更多个元件彼此直接物理接触或电接触。在另一个示例中，一些方面可使用术语“联接”来描述，以表示两个或更多个元件直接物理接触或电接触。然而，术语“联接”还可以指两个或更多个元件彼此不是直接接触，而是彼此配合或相互作用。
在一些情况下，一个或多个部件在本文中可被称为“被构造成能够(configuredto)”、“被构造成能够(configurableto)”、“操作/操作地”、“适合/适于”、“能”、“适应/适合”等。本领域的技术人员将会认识到，除非上下文另有所指，否则“被构造成能够”通常可涵盖活动状态的部件和/或失活状态的部件和/或待机状态的部件。
虽然已经示出并描述了本文所述的本发明主题的特定方面，但是对本领域的技术人员将显而易见的是，基于本文的教导，可在不脱离本文所述的主题的情况下作出改变和变型，并且如在本文所述的主题的真实范围内，其更广泛的方面并因此所附权利要求将所有此类改变和变型包括在其范围内。本领域的技术人员应当理解，一般而言，本文特别是随附权利要求(例如，随附权利要求的正文)中所使用的术语通常旨在为“开放”术语(例如，术语“包括”应解释为“包括但不限于”，术语“具有”应解释为“至少具有”，术语“包含”应解释为“包含但不限于”等)。本领域的技术人员还应当理解，如果所引入权利要求叙述的具体数目为预期的，则这样的意图将在权利要求中明确叙述，并且在不存在这样的叙述的情况下，不存在这样的意图。例如，为帮助理解，下述随附权利要求可含有对介绍性短语“至少一个”和“一个或多个”的使用以引入权利要求叙述。然而，对此类短语的使用不应被视为暗示通过不定冠词“一个”或“一种”引入权利要求叙述将含有此类引入权利要求叙述的任何特定权利要求限制在含有仅一个这样的叙述的权利要求中，甚至当同一权利要求包括介绍性短语“一个或多个”或“至少一个”和诸如“一个”或“一种”(例如，“一个”和/或“一种”通常应解释为意指“至少一个”或“一个或多个”)的不定冠词时；这也适用于对用于引入权利要求叙述的定冠词的使用。
另外，即使明确叙述引入权利要求叙述的特定数目，本领域的技术人员应当认识到，此种叙述通常应解释为意指至少所叙述的数目(例如，在没有其他修饰语的情况下，对“两个叙述”的裸叙述通常意指至少两个叙述、或两个或更多个叙述)。此外，在其中使用类似于“A、B和C中的至少一者等”的惯例的那些情况下，一般而言，这种构造意在具有本领域的技术人员将理解所述惯例的意义(例如，“具有A、B和C中的至少一者的系统”将包括但不限于具有仅A、仅B、仅C、A和B一起、A和C一起、B和C一起和/或A、B和C一起等的系统)。在其中使用类似于“A、B或C中的至少一者等”的惯例的那些情况下，一般而言，这种构造意在具有本领域的技术人员将理解所述惯例的意义(例如，“具有A、B或C中的至少一者的系统”将包括但不限于具有仅A、仅B、仅C、A和B一起、A和C一起、B和C一起和/或A、B和C一起等的系统)。本领域的技术人员还应当理解，通常，除非上下文另有指示，否则无论在具体实施方式、权利要求或附图中呈现两个或更多个替代术语的转折性词语和/或短语应理解为涵盖包括所述术语中的一者、所述术语中的任一个或这两个术语的可能性。例如，短语“A或B”通常将被理解为包括“A”或“B”或“A和B”的可能性。
对于所附的权利要求，本领域的技术人员将会理解，其中列出的操作通常可以任何顺序进行。另外，尽管以一定顺序列出了多个操作流程，但应当理解，可以不同于所示顺序的其他顺序进行所述多种操作，或者可以同时进行所述多种操作。除非上下文另有规定，否则此类替代排序的示例可包括重叠、交错、中断、重新排序、增量、预备、补充、同时、反向，或其他改变的排序。此外，除非上下文另有规定，否则像“响应于”、“相关”这样的术语或其他过去式的形容词通常不旨在排除此类变体。
总之，已经描述了由采用本文所述的概念产生的许多有益效果。为了举例说明和描述的目的，已经提供了一个或多个实施方案的上述说明。所述说明并非意图为详尽的或限定到本发明所公开的精确形式。可以按照上述教导内容对本发明进行修改或变型。所选择和描述的一个或多个实施方案是为了示出本发明的原理和实际用途，从而允许本领域的普通技术人员能够利用多个实施方案，并且在适合设想的具体应用的情况下进行各种修改。与此一同提交的权利要求书旨在限定全部范围。
本文所公开的主题的各个方面在下面编号的条款中被陈述：
1.一种外科器械，所述外科器械包括：柄部；从所述柄部朝远侧延伸的轴组件；联接到轴组件的远侧端部的端部执行器，其中所述端部执行器包括：具有近侧端部和远侧端部的钳口组件，所述钳口组件包括：活动钳口构件；以及固定钳口构件，其中所述活动钳口构件能够相对于所述固定钳口构件在打开位置和闭合位置之间枢转地移动；其中在所述闭合位置，钳口组件限定曲率半径和从所述近侧端部到所述远侧端部的平滑锥形。
2.根据条款1所述的外科器械，其中所述钳口组件的所述远侧端部限定所述钳口组件的近侧端部宽度的大约25％到大约50％之间的宽度。
3.根据条款2所述的外科器械，其中所述平滑锥形被构造成能够从所述钳口组件的近侧端部到远侧端部提供几乎恒定的压力。
4.根据条款1所述的外科器械，其中所述曲率半径为大约1.000"到大约4.000"。
5.根据条款1所述的外科器械，其包括在由所述钳口组件限定的纵向弯曲狭槽内可纵向展开的切割构件，其中所述纵向弯曲狭槽包括与所述轴组件的中心轴线基本上成一直线的近侧部分，并且其中所述纵向弯曲狭槽基本上遵循所述钳口组件的所述曲率半径。
6.根据条款5所述的外科器械，其中所述纵向弯曲狭槽的中心部分在所述轴组件的所述中心轴线的第一侧上以大于0.000"到大约0.065"的距离偏移。
7.根据条款6所述的外科器械，其中所述纵向弯曲狭槽的远侧部分在所述轴组件的所述中心轴线的第二侧上以大于0.000"到大约0.065"的距离偏移。
8.根据条款7所述的外科器械，其中所述曲率半径从大约2.000"变化到大约4.000"。
9.根据条款1所述的外科器械，其包括所述轴组件的中心轴线的第一侧上不对称地联接到所述活动钳口构件的杠杆臂，其中所述杠杆臂被构造成能够将所述活动钳口构件从打开位置枢转到闭合位置。
10.根据条款9所述的外科器械，其中所述活动钳口构件和所述固定钳口构件之间的枢轴连接部偏移到所述轴组件的所述中心轴线的所述第一侧。
11.根据条款10所述的外科器械，其中所述枢轴连接部包括被钉住的连杆滑块。
12.根据条款9所述的外科器械，其中所述杠杆臂纵向延伸穿过所述轴组件，并且其中润滑轴衬位于所述杠杆臂的外径和所述轴组件的内径之间。
13.根据条款12所述的外科器械，其中所述润滑轴衬包含塑性材料。
14.根据条款12所述的外科器械，其中所述润滑轴衬包含异种金属材料。
15.根据条款1所述的外科器械，其包括设置在所述固定钳口构件上的电极，其中所述电极被构造成能够递送电外科射频(RF)信号。
16.根据条款15所述的外科器械，其包括设置在所述电极上的陶瓷涂层，以使所述电极与所述固定钳口构件电隔离。
17.根据条款16所述的外科器械，其中所述陶瓷涂层包含氧化铝或氧化锆中的一种。
18.根据条款15所述的外科器械，其中所述电极通过粘合剂联接到所述固定钳口构件。
19.根据条款18所述的外科器械，其中所述粘合剂的热导率为大约.5W/(mK)到2.0W/(mK)。
20.一种外科端部执行器，所述外科端部执行器包括：具有近侧端部和远侧端部的钳口组件，所述钳口组件包括：活动钳口构件；固定钳口构件；以及联接所述活动钳口构件和所述固定钳口构件的枢轴连接部,其中所述活动钳口构件能够相对于所述固定钳口构件在打开位置和闭合位置之间枢转地移动；其中在所述闭合位置，钳口组件限定曲率半径和从所述近侧端部到所述远侧端部的平滑锥形。
21.根据条款20所述的外科端部执行器，其包括在所述钳口组件的中心轴线的第一侧上不对称地联接到所述第一钳口构件的杠杆臂，其中所述杠杆臂被构造成能够将所述活动钳口构件从所述打开位置枢转到所述闭合位置。
22.根据条款21所述的外科端部执行器，其中所述活动钳口构件和所述固定钳口构件之间的所述枢轴连接部偏移到所述钳口组件的所述中心轴线的所述第一侧。
23.根据条款22所述的外科端部执行器，其中所述枢轴连接部包括被钉住的连杆滑块。
24.根据条款21所述的外科端部执行器，其包括润滑轴衬，其中所述润滑轴衬被构造成能够在所述端部执行器联接到外科器械时位于所述杠杆臂的外径和外轴的内径之间。
25.根据条款24所述的外科端部执行器，其中所述润滑轴衬包含塑性材料。
26.根据条款24所述的外科端部执行器，其中所述润滑轴衬包含异种金属材料。
27.一种外科器械，所述外科器械包括：柄部；从所述柄部朝远侧延伸的轴组件，所述轴组件包括朝远侧从其中延伸穿过的杠杆臂；联接到所述轴组件的远侧端部的端部执行器，其中所述端部执行器包括：具有近侧端部和远侧端部的钳口组件，所述钳口组件包括：活动钳口构件；以及固定钳口构件，其中所述活动钳口构件能够相对于所述固定钳口构件在打开位置和闭合位置之间枢转地移动，其中所述杠杆臂在所述轴组件的中心轴线的第一侧上不对称地联接到所述活动钳口构件，并且其中所述活动钳口构件和所述固定钳口构件之间的枢轴连接部偏移到所述轴组件的所述中心轴线的所述第一侧；并且其中在所述闭合位置，所述钳口组件限定曲率半径和从所述近侧端部到所述远侧端部的平滑锥形。
28.一种外科器械，所述外科器械包括：柄部组件，所述柄部组件包括：限定能量按钮孔的闭合触发器；位于所述能量按钮孔内的能量按钮；击发触发器；以及联接到所述柄部组件的轴组件，所述轴组件包括：外管；操作地联接到所述闭合触发器的闭合致动器；以及操作地联接到所述击发触发器的击发致动器；以及联接到所述轴组件的远侧端部的端部执行器，所述端部执行器包括：具有近侧端部和远侧端部的钳口组件，所述钳口组件包括：第一钳口构件；第二钳口构件，其中所述第一钳口构件和所述第二钳口构件限定纵向狭槽，其中所述闭合致动器联接到所述第一钳口构件，以将所述第一钳口构件相对于所述第二钳口构件从打开位置枢转地移动到闭合位置；以及在所述纵向狭槽内能够展开的切割构件，其中所述切割构件联接到所述击发致动器，以在所述纵向狭槽内朝远侧推进所述切割构件。
29.根据条款28所述的外科器械，其中所述柄部组件包括：联接到所述击发触发器的复合齿轮，所述复合齿轮包括高枢轴；以及联接到所述击发致动器且操作地联接到所述复合齿轮的齿条，其中所述复合齿轮被构造成能够在所述击发触发器致动时旋转，以朝远侧推进所述齿条和击发致动器，从而在所述端部执行器内朝远侧展开所述切割构件。
30.根据条款29所述的外科器械，其中所述击发致动器包括拉管。
31.根据条款29所述的外科器械，其中所述柄部组件包括击发锁，所述击发锁被构造成能够防止所述击发触发器在所述钳口组件的闭合之前致动，其中当所述闭合触发器处于预定的闭合位置时，所述闭合触发器被构造成能够释放所述击发锁，并且其中所述击发锁的释放允许所述击发触发器的致动。
32.根据条款31所述的外科器械，其中所述柄部组件包括切割构件回位弹簧止动件，所述切割构件回位弹簧止动件包括弯皱和垫圈。
33.根据条款28所述的外科器械，其中所述闭合触发器包括与闭合弹簧交接的托架，其中所述闭合弹簧联接到所述闭合致动器，其中所述闭合触发器的致动使所述托架朝近侧滑动以压缩所述闭合弹簧，并且其中所述闭合弹簧的压缩朝近侧移动所述闭合致动器以将所述第一钳口构件旋转到闭合位置。
34.根据条款33所述的外科器械，其中所述钳口闭合弹簧包括预压缩的弹簧。
35.根据条款28所述的外科器械，其中所述闭合致动器包括非对称地联接到所述第一钳口构件的杠杆臂，并且其中所述钳口组件包括偏置枢轴。
36.根据条款28所述的外科器械，其中所述轴组件包括设置在所述外管上的电触点，并且所述端部执行器包括电极，其中所述电触点被构造成能够在所述钳口组件处于闭合位置时将所述电极电联接到能量源。
37.根据条款1所述的外科器械，其中在所述闭合位置，所述钳口组件限定曲率半径和从所述近侧端部到所述远侧端部的平滑锥形。
38.一种外科器械，所述外科器械包括：柄部组件，所述柄部组件包括：限定能量按钮孔的闭合触发器；位于所述能量按钮孔内的能量按钮；以及击发触发器；联接到所述柄部组件的轴组件，所述轴组件包括：外管；操作地联接到所述闭合触发器的闭合致动器；以及操作地联接到所述击发触发器的击发致动器；以及联接到所述轴组件的远侧端部的端部执行器，所述端部执行器包括：具有近侧端部和远侧端部的钳口组件，所述钳口组件包括：活动钳口构件；固定钳口构件，其中所述活动钳口构件能够相对于所述固定钳口构件在打开位置和闭合位置之间枢转地运动，并且其中在所述闭合位置，所述钳口组件限定曲率半径；以及在所述弯曲狭槽内能够部署的切割构件，其中所述切割构件联接到所述击发致动器，以在所述弯曲狭槽内朝远侧推进所述切割构件。
39.根据条款38所述的外科器械，其中所述柄部组件包括：联接到所述击发触发器的复合齿轮，所述复合齿轮包括高枢轴；以及联接到所述击发致动器且操作地联接到所述复合齿轮的齿条，其中所述复合齿轮被构造成能够在所述击发触发器致动时旋转，以朝远侧推进所述齿条和击发致动器，从而在所述端部执行器内朝远侧展开所述切割构件。
40.根据条款38所述的外科器械，其中所述击发致动器包括拉管。
41.根据条款40所述的外科器械，其中所述柄部组件包括击发锁，所述击发锁被构造成能够防止所述击发触发器在所述钳口组件的闭合之前致动，其中所述闭合触发器被构造成能够在所述闭合触发器处于预定的闭合位置时释放所述击发锁，并且其中所述击发锁的释放允许所述击发触发器的致动。
42.根据条款41所述的外科器械，其中所述柄部组件包括切割构件回位弹簧止动件，所述切割构件回位弹簧止动件包括弯皱和垫圈。
43.根据条款38所述的外科器械，其中所述闭合触发器包括与闭合弹簧交接的托架，其中所述闭合弹簧联接到所述闭合致动器，其中所述闭合触发器的致动使所述托架朝近侧滑动以压缩所述闭合弹簧，并且其中所述闭合弹簧的压缩朝近侧移动所述闭合致动器以将所述第一钳口构件旋转到闭合位置。
44.根据条款43所述的外科器械，其中所述钳口闭合弹簧包括预压缩的弹簧。
45.根据条款38所述的外科器械，其中所述轴组件包括设置在所述外管上的电触点，并且所述端部执行器包括电极，其中所述电触点被构造成能够在所述钳口组件处于闭合位置时电联接到所述端部执行器。
46.根据条款38所述的外科器械，其中在所述闭合位置，所述钳口组件包括从所述近侧端部到所述远侧端部的平滑锥形。
47.一种外科器械，所述外科器械包括：柄部组件，所述柄部组件包括：限定能量按钮孔的闭合触发器；位于所述能量按钮孔内的能量按钮；以及击发触发器；联接到所述柄部组件的轴组件，所述轴组件包括：外管；操作地联接到所述闭合触发器的闭合致动器；以及操作地联接到所述击发触发器的击发致动器；以及联接到所述轴组件的远侧端部的端部执行器，所述端部执行器包括：具有近侧端部和远侧端部的钳口组件，所述钳口组件包括：活动钳口构件；以及固定钳口构件，其中所述活动钳口构件能够相对于所述固定钳口构件在打开位置和闭合位置之间枢转地移动，其中所述闭合致动器在所述轴组件的中心轴线的第一侧上不对称地联接到所述活动钳口构件，并且其中所述活动钳口构件和所述固定钳口构件之间的枢轴连接部偏移到所述轴组件的所述中心轴线的所述第一侧；并且其中在所述闭合位置，所述钳口组件限定曲率半径和从所述近侧端部到所述远侧端部的平滑锥形。
Claims (27)
1.一种外科器械，包括：
柄部；
轴组件，所述轴组件从所述柄部朝远侧延伸；
端部执行器，所述端部执行器联接到所述轴组件的远侧端部，其中所述端部执行器包括：
钳口组件，所述钳口组件具有近侧端部和远侧端部，所述钳口组件包括：
活动钳口构件；以及
固定钳口构件，其中所述活动钳口构件能够相对于所述固定钳口构件在打开位置和闭合位置之间枢转地运动；
其中在所述闭合位置，所述钳口组件限定曲率半径和从所述近侧端部到所述远侧端部的平滑锥形。
2.根据权利要求1所述的外科器械，其中所述钳口组件的所述远侧端部限定所述钳口组件的近侧端部宽度的大约25％到大约50％之间的宽度。
3.根据权利要求2所述的外科器械，其中所述平滑锥形被构造成能够从所述钳口组件的近侧端部到远侧端部提供几乎恒定的压力。
4.根据权利要求1所述的外科器械，其中所述曲率半径为大约1.000"到大约4.000"。
5.根据权利要求1所述的外科器械，包括在由所述钳口组件限定的纵向弯曲狭槽内能够纵向部署的切割构件，其中所述纵向弯曲狭槽包括与所述轴组件的中心轴线基本上成一直线的近侧部分，并且其中所述纵向弯曲狭槽基本上遵循所述钳口组件的所述曲率半径。
6.根据权利要求5所述的外科器械，其中所述纵向弯曲狭槽的中心部分在所述轴组件的所述中心轴线的第一侧上以大于0.000"到大约0.065"的距离偏移。
7.根据权利要求6所述的外科器械，其中所述纵向弯曲狭槽的远侧部分在所述轴组件的所述中心轴线的第二侧上以大于0.000"到大约0.065"的距离偏移。
8.根据权利要求7所述的外科器械，其中所述曲率半径从大约2.000"变化到大约4.000"。
9.根据权利要求1所述的外科器械，包括在所述轴组件的中心轴线的第一侧上不对称地联接到所述活动钳口构件的杠杆臂，其中所述杠杆臂被构造成能够将所述活动钳口构件从打开位置枢转到闭合位置。
10.根据权利要求9所述的外科器械，其中所述活动钳口构件和所述固定钳口构件之间的枢轴连接部偏移到所述轴组件的所述轴线的所述第一侧。
11.根据权利要求10所述的外科器械，其中所述枢轴连接部包括被钉住的连杆滑块。
12.根据权利要求9所述的外科器械，其中所述杠杆臂纵向延伸穿过所述轴组件，并且其中润滑轴衬位于所述杠杆臂的外径和所述轴组件的内径之间。
13.根据权利要求12所述的外科器械，其中所述润滑轴衬包含塑性材料。
14.根据权利要求12所述的外科器械，其中所述润滑轴衬包含相异的金属材料。
15.根据权利要求1所述的外科器械，包括设置在所述固定钳口构件上的电极，其中所述电极被构造成能够递送电外科射频(RF)信号。
16.根据权利要求15所述的外科器械，包括设置在所述电极上的陶瓷涂层，以使所述电极与所述固定钳口构件电隔离。
17.根据权利要求16所述的外科器械，其中所述陶瓷涂层包含氧化铝或氧化锆中的一种。
18.根据权利要求15所述的外科器械，其中所述电极通过粘合剂联接到所述固定钳口构件。
19.根据权利要求18所述的外科器械，其中所述粘合剂的热导率为大约.5W/(mK)到2.0W/(mK)。
20.一种外科端部执行器，包括：
钳口组件，所述钳口组件具有近侧端部和远侧端部，所述钳口组件包括：
活动钳口构件；
固定钳口构件；以及
枢轴连接部，所述枢轴连接部联接所述活动钳口构件和所述固定钳口构件，其中所述活动钳口构件能够相对于所述固定钳口构件在打开位置和闭合位置之间枢转地运动；
其中在所述闭合位置，所述钳口组件限定曲率半径和从所述近侧端部到所述远侧端部的平滑锥形。
21.根据权利要求20所述的外科端部执行器，包括在所述钳口组件的中心轴线的第一侧上不对称地联接到所述第一钳口构件的杠杆臂，其中所述杠杆臂被构造成能够将所述活动钳口构件从所述打开位置枢转到所述闭合位置。
22.根据权利要求21所述的外科端部执行器，其中所述活动钳口构件和所述固定钳口构件之间的所述枢轴连接部偏移到所述钳口组件的所述轴线的所述第一侧。
23.根据权利要求22所述的外科端部执行器，其中所述枢轴连接部包括被钉住的连杆滑块。
24.根据权利要求21所述的外科端部执行器，包括润滑轴衬，其中所述润滑轴衬被构造为能够在所述端部执行器联接到外科器械时位于所述杠杆臂的外径和外轴的内径之间。
25.根据权利要求24所述的外科端部执行器，其中所述润滑轴衬包含塑性材料。
26.根据权利要求24所述的外科端部执行器，其中所述润滑轴衬包含相异的金属材料。
27.一种外科器械，包括：
柄部；
轴组件，所述轴组件从所述柄部朝远侧延伸，所述轴组件包括朝远侧延伸穿过其的杠杆臂；
端部执行器，所述端部执行器联接到所述轴组件的远侧端部，其中所述端部执行器包括：
钳口组件，所述钳口组件具有近侧端部和远侧端部，所述钳口组件包括：
活动钳口构件；以及
固定钳口构件，其中所述活动钳口构件能够相对于所述固定钳口构件在打开位置和闭合位置之间枢转地运动，其中所述杠杆臂在所述轴组件的中心轴线的第一侧上不对称地联接到所述活动钳口构件，并且其中所述活动钳口构件和所述固定钳口构件之间的枢轴连接部偏移到所述轴组件的所述中心轴线的所述第一侧；
其中在所述闭合位置，所述钳口组件限定曲率半径和从所述近侧端部到所述远侧端部的平滑锥形。
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| PCT/US2014/064057 WO2015069719A1 (en) | 2013-11-08 | 2014-11-05 | Electrosurgical devices |
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| CN105705103B CN105705103B (zh) | 2019-01-25 |
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| Publication number | Publication date |
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| EP3065653B1 (en) | 2021-08-25 |
| US9526565B2 (en) | 2016-12-27 |
| EP3065653A1 (en) | 2016-09-14 |
| US20150133915A1 (en) | 2015-05-14 |
| CN105705103B (zh) | 2019-01-25 |
| WO2015069719A1 (en) | 2015-05-14 |
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