CN105997195A - 手术钳 - Google Patents

手术钳 Download PDF

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CN105997195A
CN105997195A CN201610300105.8A CN201610300105A CN105997195A CN 105997195 A CN105997195 A CN 105997195A CN 201610300105 A CN201610300105 A CN 201610300105A CN 105997195 A CN105997195 A CN 105997195A
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end effector
effector assembly
tissue
jaw member
energized
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CN105997195B (zh
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T·莫厄
D·N·赫德
J·A·科
J·J·卡普斯
P·M·米勒
R·A·西丽安妮
R·C·阿塔莱
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Covidien LP
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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
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Abstract

本发明涉及一种钳子，所述钳子包括端部执行器组件，所述端部执行器组件包括第一钳口构件和第二钳口构件。所述钳口构件中的一个或两个能够相对于另一个在间隔开的位置和接近位置之间运动，以将组织抓持在钳口构件之间。钳口构件中的一个或两个构造成在钳口构件之间以及通过抓持在钳口构件之间的组织传导能量，以治疗组织。绝缘管状构件能够相对于端部执行器组件在缩回位置和延伸位置之间运动，在所述缩回位置中，绝缘管状构件定位在端部执行器组件的近侧，在所述延伸位置中，绝缘管状构件布置在端部执行器组件周围。单极构件构造成当绝缘管状构件布置在延伸位置中时，将能量施加到组织，以便治疗组织。

Description

手术钳
本分案申请是基于中国发明专利申请号201310237636.3、发明名称“手术钳”、申请日2013年6月17日的专利申请的分案申请。
技术领域
本公开涉及一种手术器械，并且更加具体地，涉及一种包括能够延伸的单极元件的双极手术的钳子。
背景技术
双极电外科钳通常包括两个大体相对的电极，所述电极充电到不同的电势以将能量选择性地施加到组织。双极电外科钳利用机械夹持作用和电能量，以通过加热组织和血管来实现止血，从而凝结和/或烧灼组织。某些外科手术需要更为简单地烧灼组织，而且依赖于夹持压力、精确的电外科能量控制和间隙距离(即，当围绕组织闭合时相对的钳口构件之间的距离)的独特组合来“封闭”组织、血管和特定的脉管束。通常，一旦封闭血管之后，医生必须沿着新形成的组织封闭部精确地切开组织。因此，已经设计了多种钳子，所述钳子结合在形成组织封闭部之后有效切开组织的刀或刀片构件。
另一方面，单极手术器械包括有源电极，并且与远处返回电极(例如，返回垫)组合使用以将能量施加到组织。单极器械能够快速运动通过组织而且剖开窄的组织平面。
在一些外科手术中，有益的是使用双极和单极器械，例如在必须剖开一层或者多层组织以抵达待封闭的下层组织的手术。而且，尤其对于内窥镜手术有益的是提供一种结合双极和单极特征件的单一器械，从而避免需要交替地移除和插入双极和单极器械以有利于彼此。
发明内容
当在此使用时，术语“远侧”指的是描述为更远离用户的部分，而术语“近侧”指的是描述为更靠近用户的部分。而且，为了尽可能的一致，在此描述的方面中的任意一个均可以与在此描述的其它方面中的任意一个组合使用。
根据本公开，设置了一种钳子，所述钳子包括端部执行器组件，所述端部执行器组件包括第一钳口构件和第二钳口构件。所述钳口构件中的一个或两个能够相对于另一个在间隔开的位置和接近位置之间运动，以将组织抓持在钳口构件之间。钳口构件中的一个或两个构造成在钳口构件之间以及通过抓持在钳口构件之间的组织传导能量，以治疗组织。所述钳子还包括绝缘管状构件，所述绝缘管状构件能够相对于端部执行器组件在缩回位置和延伸位置之间运动，在所述缩回位置中，绝缘管状构件定位在端部执行器组件的近侧，在所述延伸位置中，绝缘管状构件布置在端部执行器组件周围。所述钳子还包括单极构件，所述单极构件构造成当绝缘管状构件布置在延伸位置中时，将能量施加到组织，以便治疗组织。
在一个方面中，单极构件包括内管状构件，所述内管状构件布置在绝缘管状构件内并且接合到绝缘管状构件。内管状构件的一部分从绝缘管状构件向远侧延伸，使得在绝缘管状构件的延伸位置中，内管状构件的所述部分从端部执行器组件向远侧延伸，以将能量施加到组织，以便治疗组织。
在另一个方面中，内管状构件的从绝缘管状构件向远侧延伸的所述部分还构造成便于机械剖开组织。
在另一个方面中，内管状构件的从绝缘管状构件向远侧延伸的所述部分包括斜面远端、环形远端、从所述部分向远侧延伸的刀片、以及从所述部分向远侧延伸的钩中的一个。
在再一个方面中，内管状构件包括能够释放地接合的远侧末端。所述能够释放地接合的远侧末端从绝缘管状构件向远侧延伸。另外，能够释放地接合的远侧末端可以选自多个远侧末端，所述多个远侧末端包括以下中的一个或多个：包括斜面远端的第一远侧末端、包括从所述部分向远侧延伸的刀片的第二远侧末端、包括从所述部分向远侧延伸的钩的第三远侧末端、以及包括环形远端的第四远侧末端。
在又一个方面中，所述钳子还包括在轴的远端处联接到端部执行器组件的轴。在这个方面中，绝缘管状构件可以布置在轴周围且能够相对于轴在缩回位置和延伸位置之间滑动。
仍然在又一个方面中，所述钳子还包括滑动组件，所述滑动组件包括滑动捏手。所述滑动捏手联接到绝缘管状构件且能够在第一位置和第二位置之间选择性地运动，以使绝缘管状构件在缩回位置和延伸位置之间运动。
在另一个方面中，所述钳子还包括：第一激活开关，所述第一激活开关用于将能量选择性地供应到钳口构件；和第二激活开关，所述第二激活开关用于将能量选择性地供应到单极构件。而且，当绝缘管状构件分别布置在延伸位置和缩回位置中时，可以防止激活第一激活开关和/或第二激活开关。
在再一个方面中，钳口构件中的一个或两个包括远侧末端部分。钳口构件的远侧末端部分限定了单极构件，以当绝缘管状构件布置在延伸位置中时将能量施加到组织，以便治疗组织。钳口构件的远侧末端部分还可以构造成有助于机械剖开组织。另外，绝缘管状构件可以限定开孔。在该构造中，钳口构件的远侧末端部分可以构造成当绝缘管状构件布置在延伸位置中时延伸通过开孔。
根据本公开的方面设置的另一种钳子包括端部执行器组件，所述端部执行器组件包括第一钳口构件和第二钳口构件。所述钳口构件中的一个或两个能够相对于另一个在间隔开的位置和接近位置之间运动，以将组织抓持在钳口构件之间。钳口构件中的一个或两个构造成在钳口构件之间以及通过抓持在钳口构件之间的组织传导能量，以治疗组织。所述钳子还包括单极组件。所述单极组件包括绝缘管状构件和导电远侧构件，所述导电远侧构件构造成将能量施加到组织以治疗组织。导管远侧构件接合到绝缘管状构件并且从绝缘管状构件向远侧延伸。单极组件能够相对于端部执行器组件在缩回位置和延伸位置之间运动，在所述缩回位置中，单极组件定位在端部执行器组件近侧，在所述延伸位置中，绝缘管状构件基本包围端部执行器组件，且导电远侧构件从端部执行器组件向远侧延伸。
在一个方面中，导电远侧构件包括能够释放地接合的远侧末端，所述能够释放地接合的远侧末端从绝缘管状构件向远侧延伸。能够释放地接合的远侧末端可以选自多个远侧末端，所述多个远侧末端包括：包括斜面远端的第一远侧末端、包括从其向远侧延伸的刀片的第二远侧末端、包括从其向远侧延伸的钩的第三远侧末端、以及包括环形远端的第四远侧末端。
在另一个方面中，所述钳子还包括滑动组件，所述滑动组件包括滑动捏手。所述滑动捏手联接到单极组件且能够在第一位置和第二位置之间选择性地运动，以使单极组件在缩回位置和延伸位置之间运动。
还提供了一种根据本公开的方面的治疗组织的方法。所述方法包括：将组织抓持在第一钳口构件和第二钳口构件之间；将能量施加在第一钳口构件和第二钳口构件之间并且施加至抓持在其间的组织，以便治疗组织；推进单极组件，所述单极组件包括围绕第一钳口构件和第二钳口构件的绝缘管状构件和导电远侧构件，使得绝缘管状构件大体包围第一钳口构件和第二钳口构件，以及导电远侧构件从第一钳口构件和第二钳口构件向远侧延伸；和将能量从导电远侧构件施加到组织，以便治疗组织。
在一个方面中，将能量施加在钳口构件之间的步骤还包括封闭抓持在钳口构件之间的组织，以及从导电远侧构件施加能量的步骤还包括电气剖开组织。
在另一个方面中，导电远侧构件包括可释放接合的远侧末端。在这个方面中，所述方法还包括从多个远侧末端选择所述远侧末端，所述多个远侧末端包括：包括斜面远端的第一远侧末端；包括从其向远侧延伸的刀片的第二远侧末端；包括从其向远侧延伸的钩的第三远侧末端；和包括环形远端的第四远侧末端，并且所述方法还包括将选择的远侧末端接合到导电远侧构件。
附图说明
在此参照附图描述了本公开的多个方面，其中，相同的附图标记表示相似或者相同的元件：
图1是构造成根据本公开使用的内窥镜手术钳的正视立体图；
图2是图1的钳子的端部执行器组件的放大立体图；
图3是图1的钳子的纵向剖视图；
图4A是图2的端部执行器组件的纵向剖视图，其中，端部执行器组件的钳口构件布置在间隔开的位置中；
图4B是图2的端部执行器组件的纵向剖视图，其中，钳口构件布置在接近位置中；
图4C是图2的端部执行器组件的纵向剖视图，其中，钳口构件布置在接近位置中，刀组件布置在部署位置中；
图4D是图2的端部执行器组件的纵向剖视图，其中，单极组件布置在延伸位置中；
图5是图4D的单极组件的远端的纵向剖视图；
图5A-5D是与图4D的单极组件可释放接合的多种远侧末端的纵向剖视图；
图6A是构造成与图1的钳子一起使用的另一个端部执行器组件的侧视立体图，所述钳子包括布置在缩回位置中的单极组件；
图6B是图6A的端部执行器组件的侧视立体图，其中，单极组件布置在延伸位置中；
图6C是构造成与图1的钳子一起使用的另一个端部执行器组件的侧视立体图，所述钳子包括布置在延伸位置中的单极组件；
图6D是构造成与图1的钳子一起使用并且部件分开示出的另一个端部执行器组件的侧视立体图，所述端部执行器组件包括布置在缩回位置中的单极组件；
图6E是构造成与图1的钳子一起使用的另一个端部执行器组件的俯视立体图，所述钳子示出为包括布置在延伸位置中的单极组件；
图6F是图6E的端部执行器组件的仰视立体图，所述端部执行器组件示出为包括布置在缩回位置中的单极组件；
图7A是构造成与图1的钳子一起使用的另一个端部执行器组件的钳口构件的俯视图，其中，单极组件布置在延伸位置中；
图7B是图7A的钳口构件的端视图，其中，单极组件布置在缩回位置中；
图8A是构造成与图1的钳子一起使用的另一个端部执行器组件的纵向剖视图，其中，单极组件布置在缩回位置中；
图8B是图8A的端部执行器组件的纵向剖视图，其中，单极组件布置在延伸位置中；
图9A是构造成与图1的钳子一起使用的另一个端部执行器组件的侧视图，其中，钳口构件布置在间隔开的位置中；
图9B是图9A的端部执行器组件的侧视图，其中，钳口构件布置在接近位置中；
图9C是图9A的端部执行器组件的侧视图，其中，钳口构件布置在接近位置中且包括布置在其周围的绝缘套筒；和
图10是构造成与图1的钳子一起使用的另一个端部执行器组件的侧视图。
具体实施方式
现在参照图1-3，整体用附图标记10表示钳子，所述钳子包括以双极模式(例如，用于抓持、治疗和/或切开组织)和单极模式(例如，用于治疗和/或切开组织)操作的特征件。尽管示出为内窥镜钳子10，但是预期的是，钳子10也构造成用于与传统开放性外科手术结合使用。明显地，不同的电气和机械连接和考虑因素应用于每个具体构造；然而，关于钳子10及其操作特性的新颖方面在开放性构造和内窥镜构造上大体保持一致。
继续参照图1-3，钳子10限定了纵向轴线“X-X”并且包括壳体20、手柄组件30、滑动组件60、旋转组件70、触发器组件80、端部执行器组件100和单极组件200。钳子10还包括轴12，所述轴12具有：远端14，所述远端14构造成机械接合端部执行器组件100；和近端16，所述近端16机械接合壳体20。钳子10还包括电外科线缆2，所述电外科线缆2将钳子10连接到发电机(未示出)或者其它适当的电源，但是钳子10可以替代性地构造成为电池供电的器械。线缆2包括延伸贯通其中的电线2a，所述电线2a的长度长到足以延伸通过轴12，从而例如在激活第一激活开关90时，将电能分别提供给端部执行器组件100的钳口构件110、120的组织封闭板112、122中的至少一个。另一方面，线缆2的电线2b延伸通过壳体20，从而例如在激活第二激活开关95时将电能供给到单极组件200，如将在下文更加详细描述的那样。
继续参照图1-3，手柄组件30包括固定手柄50和可运动手柄40。固定手柄50与壳体联结成一整体，可运动手柄40能够相对于固定手柄50运动。旋转组件70能够围绕纵向轴线“X-X”沿着任一方向旋转，以使得端部执行器100围绕纵向轴线“X-X”旋转。壳体20容置钳子10的内部工作部件。
仍然参照图1-3，示出的端部执行器组件100附接在轴12的远端14处并且包括一对相对的钳口构件110和120。钳口构件110和120中的每一个均包括电绝缘外钳口壳体111、121和由导电板112、122限定的导电组织封闭表面，所述导电板112、122布置在相应的钳口壳体111、121的顶部上，但是可以设想其它构造，例如，钳口构件110、120可以完全由导电材料形成。钳口构件110、120的组织封闭板112、122例如经由电线2a分别适于连接到电源(没有示出)，用于在所述组织封闭板112、122之间以及通过抓持在钳口构件110、120之间的组织传导能量，以治疗组织(例如，封闭组织)。更加具体地，端部执行器组件100限定了双极构造，其中，将组织封闭板112充电到第一电势，而将组织封闭板122充电到不同的第二电势，从而产生电势梯度，以在组织封闭板112、122之间以及通过抓持在其间的组织传导能量，以用于治疗组织(例如封闭组织)。第一激活开关90联接到电线2a，从而允许使用者将能量选择性地施加到端部执行器组件100的封闭板112、122。
端部执行器组件100设计成为单侧组件，即，钳口构件120相对于轴12是固定的，而钳口构件110相对于轴12和固定的钳口构件120是能够运动的。然而，端部执行器组件100可替代地构造成为双侧组件，即，钳口构件110和钳口构件120相对于彼此和相对于轴12皆能够运动。在一些实施例中，刀组件180布置在轴12内，并且刀通道115、125限定在钳口构件110、120中的一个或两个内，以例如通过致动触发器组件80的触发器82来允许刀184穿过其中往复运动。
继续参照图1-3，手柄组件30的可运动手柄40最终连接到驱动组件150，所述手柄组件20和驱动组件150机械配合，以使得钳口构件110和120分别在间隔开的位置(图4A)和接近位置(图4B)之间运动，以将组织抓持在钳口构件110、120的组织封闭板112和122之间。更加具体地，驱动组件150包括驱动套筒155(图3)，所述驱动套筒155可操作地联接到钳口构件110(和/或钳口构件120)，使得驱动套筒155相对于端部执行器组件100通过轴12的纵向平移使得钳口构件110相对于钳口构件120在间隔开位置和接近位置之间枢转，用于将组织抓持在其间。如图1所示，可运动手柄4初始与固定手柄50间隔开，并且对应地，钳口构件110、120布置在间隔开的位置中。可运动手柄40可以从这个初始位置运动至按下位置，以使驱动套筒155相对于端部执行器组件100向近侧平移通过轴12，以将钳口构件110、120运动至接近位置，从而将组织抓持在其间(见图4B)。在释放(或者复位)可运动手柄40时，驱动套筒155在偏压构件158的偏压作用下向远侧平移，以使得钳口构件110、120返回至间隔开的位置。
现在参照图1-4D，钳子10的单极组件200示出为整体包括电绝缘外管状构件210和导电内管状构件220，所述导电内管状构件220作为单极组件200的有源电极。外管状构件210布置在内管状构件220周围并且固定接合到内管状构件220，使得外管状构件210和内管状构件220相互一致地运动，但是外和内管状构件210、220分别可以替代地相对于彼此运动。而且，与外管状构件210相似，第二电绝缘构件(没有明确示出)可以定位在导电内管状构件220内，使得导电内管状构件220夹在一对绝缘管状构件之间，但是也可以设想其它构造。
单极组件200布置在轴12周围，其中，外和内管状构件210、220的近端211、221分别延伸至壳体20中。延伸到壳体20中的外管状构件210的近端211(和/或内管状构件220的近端221)在壳体20内联接到滑动组件60。滑动组件60包括滑动捏手64，所述滑动捏手64从限定在壳体20内的狭槽22延伸并且沿着狭槽22选择性地平移，以使得单极组件200相对于轴12和端部执行器组件100在缩回位置(图4A-4C)和延伸位置(图4D)之间平移，如将在下文更加详细描述的那样。可替代地，轴12可以联接到滑动组件60，并且单极组件200可以固定接合到壳体20，使得在滑动组件60的滑动捏手64沿着狭槽22平移时，轴12和端部执行器组件100相对于单极组件200在缩回位置(图4A-4C)和延伸位置(图4D)之间平移。线缆2的电线2b联接到内管状构件220的近端221，以便将能量供应到内管状构件220。布置在壳体20上的第二激活开关95联接到电线2b，以便允许使用者选择性地控制将能量施加到内管状构件220。
内管状构件220包括主体部分222和远侧末端224。内管状构件220的远侧末端224的至少一部分向远侧延伸越过单极组件200的外管状构件210的远端213，使得至少部分地暴露出导电远侧末端224。因此，如将在下文中更加详细描述的那样，在延伸位置中(图4D)，内管状构件220的导电远侧末端224的暴露出的部分向远侧延伸越过端部执行器组件100，以便于治疗组织(例如机械、电气或者机电地剖开组织)。为了利用单极组件200治疗组织，例如在激活第二激活开关95时，从电线2b供应能量并且沿着内管状构件220将能量传导至其远侧末端224，用于施加到组织。返回垫(未示出)放置在远处，以便接收从单极电极(例如内管状构件220，并且更加具体其远侧末端224)传导通过组织的能量。如将在下文更加详细描述的那样，远侧末端224可释放地与内管状构件220的主体222相接合，使得单极组件200可以根据具体用途呈现多种不同构造。
单极组件200可以被偏压向缩回位置，和/或可以包括锁定组件(未示出)，以将单极组件200选择性地锁定在缩回位置和/或延伸位置中。而且，分别联接到第一和第二激活开关90、95的内电路(没有具体示出)和电线2a、2b设置成在单极组件200布置在延伸位置时阻止组织封闭板112、122通电，和/或在单极组件200布置在缩回位置中时阻止内管状构件220的远侧末端224通电。可替代地或者附加地，用于阻止激活开关90、95激活的机械机构(没有明确示出)还可以设置成用于类似目的。例如，单极组件200的近端可以构造成当处于缩回位置中时与激活开关95相干扰，由此当单极组件200布置在缩回位置中时阻止激活开关95激活。这种特征可以类似地应用到在此描述的其它实施例中的任意一个。
现在转到图4A-4D，结合图1，描述了以双极模式(例如，为了抓持、治疗和/或切割组织)和单极模式(例如，为了电气/机电治疗组织)使用和操作钳子10。首先，关于双极模式，如图4A所示，钳口构件110、120布置在间隔开位置中。在双极模式中，单极组件200保持布置在缩回位置中，如图4A-4C所示，其中，内管状构件220的远侧末端224定位在钳口构件110、120的近侧。在钳口构件110、120布置在间隔开的位置中的情况下，端部执行器组件100可以被操纵就位，使得待被抓持、治疗(例如封闭)和/或切割的组织布置在钳口构件110、120之间。接下来，相对于固定手柄50按压可运动手柄40或者向近侧拉动可运动手柄40，使得钳口构件110相对于钳口构件120从间隔开位置枢转至接近位置，以便将组织抓持在其间，如图4B所示。更加具体地，在致动可运动手柄40时，驱动套筒155(图3)向近侧平移通过轴12，从而拉动钳口构件110相对于钳口构件120从间隔开的位置枢转至接近位置。在这个接近位置中，能够例如通过激活开关90将能量供应至钳口构件110的组织封闭板112和/或钳口构件120的组织封闭板122并且将能量传导通过组织，以便治疗组织，例如实现组织封闭或者其他方式治疗组织。
单极组件200布置在缩回位置(例如，内管状构件220的远侧末端224与端部执行器组件100向近侧间隔开)以及将绝缘外管状构件210定位在内管状构件220周围，这有助于在能量供应到组织封闭板112和/或组织封闭板122以用于组织封闭(或者以其他方式治疗组织)时，阻止组织封闭板112、122和单极组件200的远侧末端224之间的电容耦合，例如有助于防止远侧末端224被加热或者通电。在不使用时将远侧末端224保持在未通电状态有助于保护钳子10周围的组织。
如图4C所示，结合图1，一旦完成组织治疗(或者切割未处理的组织)之后，可以例如通过致动触发器组件80的触发器82使刀组件180的刀184从轴12内部署至钳口构件110、120之间，以便切割抓持在其间的组织。更加具体地，在致动触发器82时，刀184从轴12向远侧被推进，以分别至少部分地延伸通过钳口构件110、120的刀通道115、125，以切割抓持在钳口构件110、120之间的组织。此后，刀184可以返回到轴12内，并且钳口构件110、120可运动回到间隔开的位置(图4A)，以便释放治疗和/或分开的组织。
参照图4B和4D，结合图1，就单极模式而言，首先相对于固定手柄按压可运动手柄40，以使钳口构件110相对于钳口构件120从间隔开的位置枢转至接近位置。在钳口构件110、120布置在接近位置中的情况下，单极组件200可以从缩回位置(图4B)平移到延伸位置(图4D)。更加具体地，为了使得单极组件200从缩回位置(图4B)平移到延伸位置(图4D)，滑动组件60的滑动捏手64沿着限定在壳体20内的狭槽22从狭槽22的近端23向远侧平移到其远端25，使得外和内管状构件210、220分别在轴12上向远侧平移，并且最终分别在钳口构件110、120上平移，直到内管状构件220的远侧末端224从端部执行器组件100向远侧延伸为止。在延伸位置中，单极组件200的外管状构件210完全布置在钳口构件110、120上，并且其部分可以向远侧延伸越过钳口构件110、120。在外和内管状构件210、220相对于彼此能够独立运动的实施例中，多个滑动捏手64可以设置成使得外和内管状构件210、220中的每一个在缩回和延伸位置之间独立于彼此运动。也可以设想其它部署机构。
在单极组件200布置在延伸位置中的情况下，如图4D所示，可以致动第二激活开关95，以便将能量供应到内管状构件220，使得能量沿着内管状构件220被传导至其远侧末端224，并且从远侧末端224传导至待治疗(例如，剖开)的组织。如上文所提及的那样，能量经由远处定位的返回垫(没有明确示出)返回。在将能量施加至远侧末端224期间，钳子10可以相对于组织运动(例如沿着纵向轴线“X-X”纵向运动和/或从其径向运动)，以便有助于机电地治疗组织。可替代地或者附加地，钳子10可以相对于组织运动，以便机械地剖开组织(例如，在组织平面上划痕)，其中远侧末端224不存在施加到远侧末端224的能量。
在将能量施加至远侧末端224期间，外管状构件210使得内管状构件220的主体部分222与周围的组织电绝缘，以便帮助保护周围组织。而且，在钳口构件110、120布置在接近位置中的情况下，绝缘钳口壳体111、121使得相应的组织封闭板112、122与内管状构件220绝缘，以便帮助阻止其之间的电容耦合。如上所述，第二电绝缘构件(没有明确示出)可以定位在导电内管状构件220内，以便当单极组件220布置在缩回位置中时便于组织封闭板112、122与远侧末端224隔离。在任一种构造中，阻止因电容耦合所造成的对周围组织的损伤。
在完成组织治疗(例如，剖开)时，单极组件200可以例如通过使滑动组件60的滑动捏手64沿着狭槽22从近侧平移至其近端23而返回到缩回位置(图4A-4B)。在单极组件200再次处于缩回位置中时，可以操纵端部执行器组件100的钳口构件110、120以用双极模式如上所述地抓持、治疗和/或切割组织。
现在转到图5和图5A-5D，单极组件200示出为包括多个远侧末端224a、224b、224c、224d，所述远侧末端224a、224b、224c、224d构造成用于与其一起使用。如上所述，远侧末端224a、224b、224c、224d可以可释放地接合单极组件200的内管状构件220的主体222。更加具体地，内管状构件220的主体222包括限定在其远端223处的接合特征件(例如，螺纹226)，而远侧末端224a、224b、224c、224d均在其近端处包括互补的接合特征件(例如，互补螺纹228)，用于可释放地接合内管状构件220的主体222的螺纹226。还可以设想其它可释放的接合特征件，例如，摩擦配合、闩锁等。
继续参照图5和5A-5D，示出了远侧末端224a、224b、224c和224d的多种不同构造。远侧末端224a示出为包括斜角远端225a；远侧末端224b示出为包括从其向远侧延伸的大体直线刀片225b；远侧末端224c示出为包括从其向远侧延伸的钩225c；远侧末端224d示出为限定了大体环形的远端225d。还可以提供其它构造。根据具体目的，远侧末端的期望构造可以被选择和接合到内管状构件220的主体222。例如，在期望通过向远侧推进钳子10(图1)来治疗组织的情况下，可以选择远侧末端224a、远侧末端224b或者远侧末端224d(根据待剖开的组织的尺寸和/或成分)。另一方面，在期望通过向近侧移动钳子10来治疗组织的情况下(图1)，可以选择远侧末端224c。
参照图6A-10在下文描述了根据本公开提供并且构造成与钳子10(图1)或者任何其它适当的手术器械一起使用的端部执行器组件和/或单极组件的多种其它实施例。如上所述，这些端部执行器组件和/或单极组件分别与端部执行器组件100和单极组件200相类似(见图1-3)。因此，为了简洁的目的，将在下文仅仅描述不同之处，应当记住的是，端部执行器组件100(图2)、单极组件200(图3)和/或钳子10(图1)的特征中的任意一个或者全部在某种程度上可以类似地分别应用于下文所述的端部执行器组件、单极组件和与此相关的器械。
现在转到图6A-6B，用附图标记300整体示出了根据本公开提供的单极组件的另一个实施例。单极组件300构造成与端部执行器组件100和类似于钳子10(图1)的钳子一起使用，所述钳子与钳子10的不同之处在于钳子的轴12′还包括朝其远端14′安装在其上的绝缘构件(例如，远侧套筒18′)，所述远端14′构造成当单极构件300布置在缩回位置中时将导电单极棒构件320接收在其中，如将在下文中描述的那样。而且，单极组件300与单极组件200类似(图3)，单极组件300不是包括导电内管状构件220(图3)，而是包括具有暴露出的导电部分(例如，远侧末端324)的单极棒构件320。
继续参照图6A-6B，单极组件300包括电绝缘外管状构件310，所述电绝缘外管状构件310布置在轴12′和单极棒构件320周围，所述单极棒构件320延伸通过外管状构件310(毗邻轴12′)并且从其向远侧延伸，从而最后限定了暴露出的导电钩状远侧末端324(但是还可以提供其它构造)。棒构件320、以及更加具体地其远侧末端324作为单极组件300的有源电极。外管状构件310可以固定接合到棒构件320，使得例如在滑动捏手64平移时(图1)，外管状构件310和棒构件320在缩回位置(图6A)和延伸位置(图6B)之间彼此一致地运动。可替代地，外管状构件310和棒构件320可以联接到彼此，以便实现外管状构件310和棒构件320相对于彼此同步但有差别的部署，或者所述外管状构件310和所述棒构件320可以独立于彼此，使得外管状构件310和/或棒构件320可以选择性地独立于彼此进行部署。
在缩回位置中，如图6A所示，单极组件300的远侧末端324布置在绝缘构件(例如轴12′的远侧套筒18′)中，所述绝缘构件朝轴12′的远端14′布置。远侧套筒18′是电绝缘的，使得当布置在缩回位置中时棒构件320的远侧末端324与钳口构件110、120的组织封闭板112、122分别隔离并且与周围的组织隔离，从而防止电容耦合以及对周围组织造成的损害。
在延伸位置中，如图6B所示，外管状构件310布置在端部执行器组件100的钳口构件110、120周围，而棒构件320的远侧末端324从其向远侧延伸。在这个位置中，能够将能量施加到棒构件320的远侧末端324，以治疗组织。定位在远处位置中的返回垫(未示出)用于使从棒构件320的远侧末端324传递的能量返回通过组织。而且，在延伸位置中，单极组件300、以及更加具体地其棒构件320例如通过旋转第二旋转组件(类似于旋转组件70(图1))可以相对于端部执行器组件100旋转，以便相对于组织更好地定位棒构件320的远侧末端324，所述第二旋转组件布置在壳体20内(图1)并且联接到单极组件300。
转到图6C，示出了类似于单极组件300的单极组件400的另一个实施例。单极组件400与单极组件300的不同之处在于，单极组件400的绝缘外管状构件410形成钳子的轴(或固定地布置在钳子的轴周围)并且相对于端部执行器组件100固定就位。单极棒构件420延伸通过外管状构件410并且从外管状构件410向远侧运动，而且能够相对于端部执行器组件100和绝缘外管状构件410在缩回位置和延伸位置之间运动。棒构件420可以包括布置在其主体部分422周围的绝缘套筒或者涂层426，使得远侧钩424是棒构件420的仅暴露出的导电部分。当处于缩回位置中时，棒构件420的远侧钩424接收在限定于从外管状构件410的远端414延伸的远侧套筒418内的凹陷部内，从而有助于保护周围组织。
参照图6D，示出了结合单极组件400′的端部执行器组件100′的另一个实施例。端部执行器组件100′类似于端部执行器组件100(图1-4D)，而单极组件400′类似于单极组件300(图6A-6B)和单极组件400(图6C)。因此，将在下文仅仅详细描述端部执行器组件100′和单极组件400′与在上文描述的先前实施例相比的不同之处。
继续参照图6D，端部执行器组件100′的每个钳口构件110′、120′均包括：远侧钳口部分111′、121′，所述远侧钳口部分111′、121′包括由导电组织封闭板112′和122′所限定的组织封闭表面；和近侧凸缘114′、124′，所述近侧凸缘114′、124′从相应的远侧钳口部分111′、121′向近侧延伸。近侧凸缘114′、124′构造成接收枢转销95′，以便使得钳口构件110′、120′可枢转地相互联接并且可以至少部分地由绝缘材料形成或者至少部分地涂敷有绝缘材料。钳口构件中的一个的近侧凸缘(例如，钳口构件120′的近侧凸缘124′)还限定了延伸通过其中的管腔126′，以及限定在近侧凸缘124′的远侧表面内的凹陷部128′，所述凹陷部128′与管腔126′连通。这种钳口构件120′的近侧凸缘124′的构造允许单极组件400′的棒构件420′的主体422′延伸通过钳口构件120′的近侧凸缘124′(例如延伸通过管腔126′)，而且当单极组件400′布置在缩回位置中时还允许单极组件400′的棒构件420′的远侧钩424′接收在近侧凸缘124′的凹陷部128′内，从而有助于保护周围组织。换言之，当单极组件400′布置在缩回位置中时钳口构件120′不是提供用于保持单极组件400′的绝缘套筒，而是钳口构件120′自身构造成当单极组件400′布置在缩回位置中时将单极组件400′保持在其中。
现在转到图6E-6F，示出了结合单极组件400″的端部执行器组件100″的另一个实施例。端部执行器组件100″与端部执行器组件100′类似(图6D)，而单极组件400″与单极组件400′类似(图6D)，但是端部执行器组件100″和/或单极组件400″可以替代地构造成类似于在此描述的其它端部执行器组件和单极组件中的任意一个。为了简化的目的，将在下文仅仅详细描述端部执行器组件100″和单极组件400″分别与端部执行器组件100′(图6D)和单极组件400′(图6D)相比之间所存在的差异。
继续参照图6E-6F，端部执行器组件100″的每个钳口构件110″、120″均包括：远侧钳口部分111″、121″，所述远侧钳口部分111″、121″具有布置在其上的组织封闭板112″、122″；和近侧凸缘114″、124″，所述近侧凸缘114″、124″从相应的远侧钳口部分111″、121″向近侧延伸。钳口构件中的一个的近侧凸缘(例如，钳口构件120″的近侧凸缘124″)还限定了管腔126″和凹陷部128″，所述凹陷部128″构造成当单极部件400″布置在缩回位置(图6F)中时分别接收单极组件400″的棒构件420″的主体422″和单极组件400″的棒构件420″的远侧钩424″。而且，端部执行器组件100″的钳口构件110″和120″限定了弯曲构造，例如以有助于操纵组织并且针对接近目标组织提供良好的“瞄准线”，但是也可以提供其它构造。更加具体地，钳口构件110″和120″弯向端部执行器组件100″的布置有单极组件400″的一侧，使得端部执行器组件100″的整个宽度尺寸不因存在单极组件400″而增加。
钳口构件中的一个(例如，钳口构件120″)包括通道状开孔129″，所述通道状开孔129″朝向所述远侧钳口部分121″的远端限定在远侧钳口部分121″内。开孔129″构造成允许单极组件400″在缩回位置和延伸位置之间往复运动，在所述缩回位置中，单极组件400″布置在钳口构件120″的近侧凸缘124″内，在所述延伸位置中，单极组件400″的远侧钩424″从端部执行器组件100″向远侧延伸。更加具体地，由于钳口构件110″、120″的弯曲构造，钳口构件120″的远端弯曲到单极组件400″的路径中。开孔129″限定了单极组件400″构造成延伸通过其中的通道，从而允许远侧钩424″向远侧延伸越过端部执行器组件100″而不受到钳口构件120″的干扰，并且引导单极组件400″的延伸/收回。
参照图7A-7B，示出了端部执行器组件500的钳口构件520，所述钳口构件520在其中结合有单极棒构件530。与端部执行器组件100的钳口构件110、120(见图1-3)类似，钳口构件520包括绝缘外钳口壳体521和导电组织封闭板522，所述导电组织封闭板522布置在钳口壳体521顶部上。然而，钳口壳体521还包括：延伸通过钳口壳体的管腔(没有明确示出)，所述管腔构造成可滑动地接收棒构件530的主体532；以及限定在钳口壳体中的成互补形状的凹陷部528，所述凹陷部528与管腔(未明确示出)相连通。凹陷部528限定在钳口构件520的远端523中并且构造成当棒构件530布置在缩回位置中时在其中接收棒构件530的远侧末端534。更加具体地，在缩回位置中，棒构件530完全布置在钳口构件520的钳口壳体521的凹陷部528内，使得棒构件530与组织封闭板522(以及端部执行器组件500的另一个钳口构件(未示出)的组织封闭板)电绝缘。在延伸位置中，棒构件530从凹陷部528和钳口构件520向远侧延伸，以有助于单极组织治疗。如在先前实施例中那样，绝缘管状构件(没有明确示出)可以设置成当棒构件530运动到延伸位置中时，绝缘管状构件在端部执行器组件500上向远侧滑动且使端部执行器组件500与棒构件530电绝缘。棒构件530还能够相对于端部执行器组件500旋转。
参照图8A-8B，示出了与端部执行器组件500(图7A-7B)类似的端部执行器组件600的另一个实施例，其在钳口构件610、620的其中一个(例如钳口构件620)内包括单极电线构件630。更加具体地，钳口构件620包括：管腔626，所述管腔626纵向延伸通过其绝缘钳口壳体621；和导电单极电线构件630，所述导电单极电线构件630可滑动地接收在管腔626内。电线构件630的至少一部分由弹性材料形成或者用其它方式构造成，使得电线构件630的远侧末端634能够相对于电线构件630的主体632呈现大体直线构造，从而允许电线构件630以大体直线构造完全收回到管腔626内。在电线构件630从管腔626延伸时(例如，在电线构件630运动至延伸位置时)，电线构件630的远侧末端634呈现出弯曲的钩状或者其它适当构造，以有助于剖开组织。与上文关于棒构件330的描述(图6A-6B)类似，当处于延伸位置时，电线构件630还可以相对于钳口构件620旋转。而且，与上文关于先前实施例的描述类似，外绝缘套筒(未示出)还可以设置成在单极构件630延伸时包围端部执行器组件600。
现在转到图9A-9B，用附图标记700整体表示根据本公开提供的端部执行器组件的另一个实施例。端部执行器组件700包括第一导电钳口构件710和第二导电钳口构件720(但是钳口构件710、720的一部分可以覆盖有或者由绝缘材料涂覆)，所述第一和第二导电钳口构件710、720能够在间隔开的位置和接近位置之间相对于彼此运动，用于将组织抓持在其间。每个钳口构件710、720均包括大体直线的主体部分712、722，所述大体直线的主体部分712、722分别限定了组织封闭表面713、723。钳口构件710、720中的一个或两个还包括钩状或者弯曲的远侧部分714、724，所述远侧部分714、724分别从其相应的主体部分712、722延伸。钳口构件710、720适于连接到能量源(没有明确示出)，用于在双极和单极模式中的每一个中将能量供应到钳口构件710、720。更加具体地，在双极模式中，钳口构件710充电至第一电势，而钳口构件720充电至不同的第二电势，使得产生了电势梯度，以用于在其间以及通过抓持在其间的组织传导能量，以为了治疗(例如，封闭)组织。
另一方面，在单极模式中，钳口构件710、720接近并且通电至同样的电势，使得能量分别从钳口构件710、720、以及更加具体地其远侧部分714、724传导通过组织至位于远处的返回垫(没有明确示出)，用于治疗(例如，剖开)组织。钳口构件710、720的特殊构造(例如，其中，钳口构件710、720中的任一个或者两个分别包括钩状远侧部分714、724)有助于组织的单极剖开，其中当钳口构件710、720布置在接近位置中时，钩状远侧部分714和/或钩状远侧部分724(单独任意一个或者相互配合)限定了单极有源电极探针730。即，在以单极模式操作中，钳口构件710、720的远侧部分714、724不是提供单独的单极元件，而是作为单极元件。
转到图9C，在一些实施例中，端部执行器组件700还可以包括绝缘管状构件740，所述绝缘管状构件740布置在钳口构件710、720的主体部分712、722周围。绝缘管状构件740包括远侧开孔742，使得当绝缘管状构件740在端部执行器700周围延伸时单极探针730(例如，钳口构件710、720的钩状远侧部分714、724)暴露出，以有助于单极组织治疗。在以单极模式操作期间，这种构造还通过使钳口构件710、720的主体部分712、722分别与周围组织电隔离来保护周围组织。与上文关于先前实施例中的任意一个的描述类似，绝缘管状构件740延伸和收回。
参照图10，用附图标记800整体表示根据本发明设置并且构造成以双极模式和单极模式操作的端部执行器组件的另一个实施例。端部执行器组件800与端部执行器组件700(图9A-9C)类似，不同之处在于钳口构件810、820不是包括大体直线主体部分和钩状远侧部分，而是钳口构件810、820大体沿着其长度限定了互补弯曲的构造。钳口构件810、820的弯曲构造有助于展开和/或分离组织，以提供进入下层组织的途径，用于抓持、治疗(例如封闭)和/或分开下层组织(以双极模式)。而且，与端部执行器组件700(图9A-9C)类似，当钳口构件810、820布置在接近位置中时，单极有源电极探针830通过钳口构件810、820的远端814、824的配合而形成，从而有助于单极组织治疗(以单极模式)。如上文描述并且在一定程度上已知，端部执行器组件700(图9A-9C)的其它特征中的任意一个类似地应用于端部执行器组件800，并且因此在此不再重复描述。
从以上内容并且参照多张附图，本领域的技术人员将理解的是，在不悖离本公开的范围的前提下，还能够针对本公开进行某些修改。尽管已经在附图中示出了本公开的若干实施例，但是并不旨在将本公开局限于此，因为旨在本公开的范围如本领域将允许和说明书所读那样广泛。因此，以上描述不应当理解为限制，而是仅仅作为具体实施例的范例。本领域的技术人员将设想处于随附权利要求的范围和精神内的其它修改方案。

Claims (15)

1.一种手术器械，所述手术器械包括：
壳体；
与壳体间隔开的端部执行器组件，所述端部执行器组件被构造成向组织施加能量以治疗组织；
管状构件，所述管状构件能够相对于端部执行器组件在第一缩回位置和第一延伸位置之间运动，在所述第一缩回位置中，管状构件定位在端部执行器组件的近侧，在所述第一延伸位置中，管状构件围绕端部执行器组件；
可通电元件，所述可通电元件被构造成向组织施加能量以治疗组织，可通电元件能够相对于端部执行器组件在第二缩回位置和第二延伸位置之间运动，其中，在所述第二延伸位置中，可通电元件从端部执行器组件向远侧延伸；以及
致动捏手，所述致动捏手被设置在壳体上并且操作地联接到管状构件和可通电元件，以使得致动捏手的致动将管状构件从第一缩回位置移动到第一延伸位置，以及将可通电元件从第二缩回位置移动到第二延伸位置。
2.根据权利要求1所述的手术器械，其还包括：
第一激活开关，所述第一激活开关被设置在壳体上，并且操作地联接到端部执行器组件，以将能量选择性地供给到端部执行器组件；以及
第二激活开关，所述第二激活开关被设置在壳体上，并且操作地联接到可通电元件，以将能量选择性地供给到可通电元件。
3.根据权利要求1所述的手术器械，其中，管状构件至少部分地由绝缘材料形成。
4.根据权利要求1所述的手术器械，其中，在管状构件的第一延伸位置和可通电元件的第二延伸位置中，管状构件将端部执行器组件与可通电元件电隔离。
5.根据权利要求1所述的手术器械，其中，可通电元件当被设置在第二缩回位置中时被阻止通电。
6.根据权利要求1所述的手术器械，其中，当管状构件和可通电元件被设置在其各自的第一延伸位置和第二延伸位置中时，端部执行器组件被阻止通电。
7.根据权利要求1所述的手术器械，其中，端部执行器组件包括第一钳口构件和第二钳口构件，所述第一钳口构件和第二钳口构件中的至少一个能够相对于另一个在间隔开的位置和接近位置之间运动。
8.根据权利要求7所述的手术器械，还包括联接到壳体和端部执行器组件上的可动手柄，以使得可动手柄的致动将第一钳口构件和第二钳口构件中的所述至少一个从间隔开的位置移动到接近位置。
9.根据权利要求1所述的手术器械，其中，端部执行器组件被构造成向组织施加第一类型的能量，并且其中，可通电元件被构造成向组织施加第二类型的能量。
10.根据权利要求9所述的手术器械，其中，第一类型的能量是双极能量，第二类型的能量是单极能量。
11.根据权利要求1所述的手术器械，还包括将壳体和端部执行器组件互连的轴。
12.一种手术器械，所述手术器械包括：
壳体；
与壳体间隔开的端部执行器组件，所述端部执行器组件被构造成向组织施加双极能量以治疗组织；
单极组件，所述单极组件被构造成向组织施加单极能量以治疗组织，单极组件包括绝缘管状构件和操作地联接到绝缘管状构件的可通电元件，单极组件能够相对于端部执行器组件在缩回位置和延伸位置之间运动，其中，在所述延伸位置中，可通电元件从端部执行器组件向远侧延伸，并且绝缘管状构件围绕端部执行器组件，以将端部执行器组件与可通电元件电隔离；和
致动捏手，所述致动捏手被设置在壳体上，并且操作地联接到单极组件，以使得致动捏手的致动将单极组件相对于端部执行器组件从缩回位置移动到延伸位置。
13.根据权利要求12所述的手术器械，还包括：
第一激活开关，所述第一激活开关被设置在壳体上，并且操作地联接到端部执行器组件，以将双极能量选择性地供给到端部执行器组件；以及
第二激活开关，所述第二激活开关被设置在壳体上，并且操作地联接到可通电元件，以将单极能量选择性地供给到可通电元件。
14.根据权利要求12所述的手术器械，其中：
当单极组件被设置在缩回位置中时，可通电元件被阻止通电；和
当单极组件被设置在延伸位置时，端部执行器组件被阻止通电。
15.根据权利要求12所述的手术器械，其中，端部执行器组件包括第一钳口构件和第二钳口构件，所述第一钳口构件和第二钳口构件中的至少一个能够相对于另一个在间隔开的位置和接近位置之间运动。
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US9918784B2 (en) 2018-03-20
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US9649152B2 (en) 2017-05-16
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