CN1636526A - 结合锥形触发杆以增加绕铰转接头挠曲性的外科钉合器械 - Google Patents
结合锥形触发杆以增加绕铰转接头挠曲性的外科钉合器械 Download PDFInfo
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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
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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
- A61B2017/2901—Details of shaft
- A61B2017/2902—Details of shaft characterized by features of the actuating 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
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
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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
- A61B2017/2932—Transmission of forces to jaw members
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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
- A61B17/32—Surgical cutting instruments
- A61B2017/320052—Guides for cutting instruments
Abstract
一种外科钉合和切断器械,通过一种转化来自把手部分的旋转运动的齿轮式铰转机构,特别适合于将末端受动器进行内窥的铰转。一触发杆在把手部分和末端受动器之间平移。为了将不失真的切断边缘和接合特征提供到末端受动器的相对钳夹,将触发杆加厚。触发杆也有利地包括变薄的或锥形的近端部分,其形式为拐过铰转机构的条或带。
Description
有关申请的对照
本申请涉及四个与本申请日同一天提交的共同未决和共同拥有的申请,各申请的公开整体在此作为参考,这四个申请的名称分别为:
(1)由Kenneth S.Wales,Douglas B.Hoffman,Frederick E.Shelton IV,和JeffSwayzz申请的“结合绕纵轴转动的铰转机构的外科手术器械”;
(2)由Douglas B.Hoffman申请的“结合用于触发杆轨道的铰转接头的外科手术钉合器械”;
(3)由Kenneth S.Wales和Joseph Charles Hueil申请的“具有用于支撑触发杆的铰转接头支撑板的外科手术钉合器械”和
(4)由Kenneth S.Wales申请的“带有侧移铰转控制器的外科手术器械”。
技术领域
本发明总体上涉及能够将钉合线施加于组织同时切断那些钉合线之间组织的外科手术钉合器械,尤为涉及对钉合器械的改进、和对该钉合器械的各个构件包括铰接转动杆(articulating shaft)的成形方法的改进。
背景技术
由于更小的开口有助于减少手术后恢复时间和并发症,通常优选使用优于传统开口外科手术器械的内窥镜外科手术器械。因此,给内窥镜检查外科手术器械领域带来显著的发展,该外科手术器械适合远端(部)受动器在外科手术位置通过套管针套管的精确放置。这些远末端受动器以许多方式啮合组织,以实现诊断和治疗效果(例如,内部刀具、抓紧器、刀具、钳、夹填充器、通道装置、药物/基因治疗传递装置、和使用超声、射频(RF)、激光等的能量装置)。
定位末端受动器受套管针的限制。通常这些内窥镜检查外科手术器械包括末端受动器和由医生操作的把手部分之间的长杆,该长杆能够插到所需深度,并且绕杆的纵轴转动,从而将末端受动器定位到一定角度。随着套管针的明智布局和抓紧器的使用,例如通过另一套管针,通常这种定位的量是足够的。外科钉合和切断器械,例如在美国专利号5,465,895中所述的是通过插入和转动成功定位末端受动器的内窥镜外科手术器械的例子。
更近来,美国专利申请系列号,它由Shelton等人于2003年5月20日申请,描述了用于切断组织和促动钳的改善的“E形杆”触发杆。一些另外的有点包括肯定分隔末端受动器的钳,即使为最佳钳形成很轻微地夹住或夹住两个小组织。此外,E形杆触发杆包括以能够合并几个有利的锁定的方式啮合末端受动器和钳夹头。
依照手术的必然性,有需要进一步调整内窥镜检查外科手术器械的末端受动器的定位,而不仅限于插入和转动。特别是,常常希望将末端受动器定向在一个横向于器械杆纵轴的轴上。末端受动器相对于器械杆的横向移动习惯地称为“铰转-铰接转动(articulation)”。这种铰转定位使医生更容易地在一些情况下接合组织。另外,铰转定位有利地允许内窥镜定位在末端受动器后,而不受器械杆阻碍。
当前述非连接钉合和切断器械具有很大效用,并且可以在许多外科过程中成功使用时,需要提高它们连接末端受动器的能力的操作,从而在它们的使用时提供更大的临床灵活性。
由随着关闭末端受动器的控制一起的整合连接控制连接接近实现钉合和切断,以在内窥镜装置的小直径限制中夹住组织和触发(即,钉合和切断)末端受动器。通常,三个控促动作都通过杆传递为纵向平移。例如,美国申请专利号5,673,840揭示了类似可折叠铰转机构(“弯曲颈”),该机构由分别通过器械杆收回两个连接杆的一个连接,各杆分别在杆的中心线的相反边偏移。
铰转机构纵向控制的另一个例子是美国申请专利号5,865,361,该申请包括连接链从凸轮枢轴偏移,从而推或拉动连接链的纵向平移实现对各自边的连接。类似地,美国申请专利号5,797,537揭示了经过杆的类似的杆以实现连接。
当这些纵向控制铰转机构对外科手术器械,例如用于内窥镜钉合和切断提供确定的优点时,可以相信替换的连接动作将提供附加的设计机动性。特别是,在对照和共同未决的申请中描述的优点的达到,在这些申请中相对杆的纵轴的转动动作传递连接动作到将末端受动器耦合该杆的铰转机构。
还需要的是保持结合转动控制铰转机构的外科钉合和切断器械中的E形杆的触发杆的有点。因此,为该结合触发杆的装置明显的需要存在,该触发杆有利地提供夹住组织,为肯定控制钉合啮合末端受动器的钳,也为通过铰转机构的触发动作耦合。
发明内容
本发明通过提供用于纵向地促动一末端受动器的触发杆克服现有技术的上述以及其它缺陷,并且具有用于弯曲通过一铰转转动杆的锥形近端部分。从而,实现铰转式外科手术器械的临床好处而不破坏末端受动器的连贯操作。
在本发明的一方面,一种外科手术器械具有产生一铰转运动和一触发运动的把手部分,两项运动被传递通过具有纵轴的杆。一铰转机构将该杆连接到一末端受动器,并且响应该铰转运动将末端受动器转离该杆的纵轴。触发机构响应该触发运动,并被连接以移动通过铰连机构和末端受动器。特别是,该触发机构具有一触动部分具有第一厚度并且定位在末端受动器中的促动部分,和向近端连接到该促动部分,并且为了通过铰转机构连接移动具有小于第一厚度的第二厚度的连接部分。从而该触发机构有效用于促动末端受动器和通过该铰转机构连接两者。
在本发明的另一方面,一种外科手术器械具有产生触发运动、关闭运动、和铰转运动的把手部分,分别在杆的传递下转动。末端受动器通过响应铰转运动的铰转机构受到枢转。末端受动器包括耦合到杆,并且包括通道槽的细长通道。砧板绕轴转动地耦合到该杆,响应从该杆的关闭动作,并且包括砧板通道,触发装置具有在该细长通道和该砧板之间纵向接收的远端存在的切断边缘,并且包括通过该铰转机构转换的变薄的条部分。
也在本发明的另一方面,一种外科手术器械具有一把手部分,把手部分可操作地构成为以可产生旋转铰转运动和纵向触发运动的,两项运动通过杆传递。铰转机构响应旋转铰转运动以铰转末端受动器。触发杆响应把手部分的纵向触发动作。该触发杆包括一纵向定位以移动通过铰转机构的伸长条,和具有远端地连接到该伸长条的触发杆头,并且触发杆头被定位以在末端受动器中纵向移动。
本发明的这些和其它目的和优点将通过附图和说明书描述。
附图说明
与说明书结合并且是说明书的一部分,并且同上述本发明的基本描述一起的附图描述了本发明的实施例,并且实施例的详细描述将在下面给出,提供对本发明原理的解释。
图1是处于非铰转位置的铰转式外科手术器械的透视图。
图2是处于铰转位置的铰转式外科手术器械的透视图。
图3是图1-2的铰转式外科手术器械的打开的末端受动器的透视图。
图4示出了图1的外科手术器械的图3的末端受动器的截面侧视图,该截面基本沿图3的线4-4,以揭示钳夹头部分,但是也沿纵向中心线示出了触发杆。
图5示出了在触发杆完全触发后,图4的末端受动器的截面侧视图。
图6示出了包括旋转铰转控制器的图1的外科手术器械的近端部的把手部分的截面侧视图。
图7示出了图1的外科手术器械的近端部的把手部分的透视、分解图。
图8示出了部分地切除以露出旋转铰转控制机构的图1的外科手术器械的把手部分的远端部分的向下、向前和向右的透视图。
图9示出了图8的把手部分的远端部分的向上、向后和向右的透视图,其部分的切除以露出旋转铰转控制机构,并且具有拆卸下来的旋转铰转控制旋钮。
图10示出了去除触发和构架架部分的图1的外科手术器械的正齿轮铰转机构和末端受动器的上部透视详细图。
图11示出了包括正齿轮铰转机构的图1的外科手术器械的执行部分的透视、分解图。
图12示出了图11的正齿轮铰转机构的上部截面图。
具体实施方式
参考附图,在图中相同的附图标记表示相同的构件,图1-3示出了一种外科手术器械,该器械在描述的实施例中更特别的是一种外科钉合和切断器械10,该器械能够实现本发明的独特优点。特别是,该外科钉合和切断器械10大小定为在图1所示的非铰转转动状态下,可穿插通过套管针套管通到达病人的手术部位以进行外科手术程序。一旦铰转机构11和远端连接的末端受动器12穿过套管通道,如图2所示,就可通过一铰转控制器13遥距地铰转转动所述的铰转机构11。从而,末端受动器12就可以到达一器官之后、或以所需角度或为其它理由接近器官。例如,一触发机构(为方便起见指为切断夹住组织的E形杆触发杆14,图3中所示)接合细长通道16和枢转连接的砧板18。
外科钉合和切断器械10包括连接到执行部分22的把手部分20,把手部分20又包括远端端止在铰转机构11和末端受动器12中的杆23。把手部分20包括枪柄24,医生将一闭合扳机26枢转地拉向枪柄24,使砧板18夹向或合向末端受动器12的细长通道16。触发扳机28在闭合扳机26的更外侧,并由医生枢转地拉动以钉合和切断在末端受动器12中夹住的组织。其后,按下释放按钮30以释放夹住的组织。
杆23最外面的闭合套管32响应闭合扳机26纵向地平移,以枢转地闭合砧板18。特别地,涉及铰转机构11的闭合套管32的远端部分或闭合环箍33由执行部分22的构架34(部分可见于铰转机构11)间接地支撑。在铰转机构11上,闭合套管32的近端部分或闭合管35与远端部分(闭合环箍)33相通。构架34通过铰转机构11挠性连接到细长通道16,造成在单一平面中的铰转转动。构架34还纵向滑动地支撑触发驱动部件36,该部件将源自触发扳机28的触发运动传递到触发杆14。图3中仅示出了触发驱动部件36的触发杆14,而针对转动地控制铰转机构11的各种形式,会对触发驱动部件36在下面更详细地描述。
应当意识到,此处所述的“近端”和“远端”是参照握持器械把手的医生而言的。因此,相对于更近端的把手部分20,末端受动器12位于远端。还应当意识到,为了方便和清楚,这里所用的空间概念“竖直”和“水平”是相对于附图而言的。然而,外科手术器械在许多方向和位置被使用,这些用语并非意味着是限制的和绝对的。
E形杆触发杆
图3-5示出了采用E形杆触发杆14以实现数项功能的末端受动器12。在图3中,触发杆14在近端定位,使未用完的钉筒37安装在细长通道16中。特别是,触发杆14的上部栓38位于一描述为砧袋40的凹槽中,使砧板18可重复地打开和闭合。如图4所示,随着末端受动器闭合,通过上部栓38进入纵向的砧槽42,触发杆14前进与砧板18接合。通过触发杆14贯穿通道槽45,最低的栓或触发杆帽44接合细长通道16的下表面。中间栓46滑动地接合细长通道16的上表面,与触发杆帽44共同作用。因此,在触发过程中,触发杆14肯定分隔末端受动器12,克服因夹住极小量的组织产生的痛楚,以及克服因夹住组织过量使钉变形。
在触发过程中,在触发杆的上部栓38和中间栓46之间的、处于远端的切断边缘48进入处于近端的钉筒37的竖直槽49,切断夹在钉筒37和砧板18之间的组织。如图4所示,通过中间栓46进入钉筒37内的一个触发槽促动钉筒37、驱动楔形橇41进入向上的凸轮系统与钉驱动器43接触,接着钉驱动器43将多个钉47从钉筒37中的钉孔51驱动出来,以在砧板18的内表面上形成与钉袋53的接触。图5示出了在完成切断和钉合组织后,触发杆14完全向远端平移。
两轴把手
参考图6-7,把手部分20由第一和第二基底部件50和52组成,这两个基底部件由聚合材料,例如玻璃填充聚碳酸酯模制而成。第一基底部件50配有多个圆柱形栓54。第二基底部件52包括多个伸长部件56,各具有六边形开口58。该圆柱形栓54容纳在六边形开口58中,并且摩擦地保持其中,以装配的形式保持第一和第二基底部件50和52。
壳体帽60具有完全伸过其中的孔62,用于接合执行部分22并使之绕其纵轴转动。壳体帽60包括沿孔62的至少一部分伸展的内突凸台64。该凸台64容纳在一个形成于闭合套管32近端部分处的纵向槽66中,使得壳体帽60的转动影响闭合套管32的转动。可以意识到凸台64进一步伸展通过构架34,并与触发驱动部件36的一部分接触以影响它们的转动。因此,末端受动器12(图3-4中未示出)随壳体帽60转动。
构架34的近端68近端地穿过壳体帽60并设有一圆周槽70,该槽受到分别自基底部件50和52延伸的相对管槽固定部件72接合。图中仅示出了第二基底部件52的管槽固定部件72。从基底部件50、52延伸的管槽固定部件72用于将构架34固定到把手部分20,从而该构架34不会相对把手部分20纵向移动。
闭合扳机26具有把手部件74、扇形齿轮部件76、和中间部件78。孔80贯通中间部件78。为了将闭合扳机26枢转地安装在把手部分20上,从第二基底部件52延伸的圆柱支撑部件82穿过孔80。从第二基底部件52延伸的第二圆柱支撑部件83穿过触发扳机28的孔81,以枢转地安装在把手部分20上。在圆柱支撑部件83中设有六边形开口84,用于容纳从第一基底部件50延伸的固定栓(未示出)。
关闭轭86嵌在把手部分20内,以在其中往复移动,并将来自闭合扳机26的运动转移到闭合套管32。从第二基底部件52延伸的支撑部件88和伸过轭86中的凹槽89的固定部件72将轭86支撑在把手部分20内。
闭合套管32的近端部90设有凸缘92,凸缘卡合在轭86的远端96中形成的接收凹槽94内。轭86的近端部98具有齿轮架100,其通过闭合扳机26的扇形齿轮部件76进行啮合。因此,当闭合扳机26向把手部分20的枪柄24移动时,轭86和闭合套管32向远端移动,压缩近端地偏压轭86的弹簧102。如下所述,闭合套管32的远端运动影响砧板18远端地并朝向末端受动器12的细长通道16的枢转移动,闭合套管的近端移动影响砧板的闭合。
闭合扳机26通过一个与触发扳机28的接合表面128相互作用的前表面130向前偏移到打开位置。绕栓106将顶部枢转到把手部分20中的后部的钳夹第一钩104抑制触发扳机26向枪柄24的移动,直到闭合扳机26夹住到其闭合位置。该钩104通过啮合触发扳机28中的锁定栓107来限制触发扳机28的动作。该钩104也与闭合扳机26接触。特别是,该钩104的向前突出108在闭合扳机26的中间部件78上啮合部件110,该部件110在向把手部件74的孔80外。该钩104向接触闭合扳机26的部件110的方向偏移,并且通过释放弹簧112啮合触发扳机28中的锁定栓107。当压下闭合扳机26时,该钩104从顶部向后面移动,压缩释放弹簧112,该弹簧在该钩104上的向后突出114和释放按钮30上的向前突出116之间捕获。
当轭86响应闭合扳机26的近端移动而向远端移动时,释放按钮30的上卡臂118沿轭86上的上表面120移动,直到落入位于轭86的近端下部中朝上的凹槽122中。释放弹簧112向外逼迫释放按钮30,按钮将上卡臂118向下枢转成与朝上的凹槽122接合,从而将闭合扳机26锁在组织夹住状态。
通过向内推释放按钮30,可将卡臂118移出凹槽122以释放砧板18。特别是,上卡臂118绕第二基底部件52的栓123向上转动。然后,允许轭86响应闭合扳机26的退回移动而向近端移动。
触发扳机退回弹簧124位于把手部分20内,一端连接到第二基底部件52的栓106,另一端连接到触发扳机28上的栓126。为了沿离开把手部分20的枪柄24方向偏移触发扳机28,触发退回弹簧124向栓126施加退回力。通过接合触发扳机28的表面128偏压闭合扳机26的前表面130,闭合扳机26也被偏离开枪柄24。
当闭合扳机26移向枪柄24时,其前表面130与触发扳机28上的接合表面128接合,导致触发扳机28移至其“触发”位置。当其处于触发位置时,触发扳机28相对于枪柄24成大约45°角。在钉触发后,弹簧124导致触发扳机28退回其初始位置。在触发扳机28退回移动期间,其接合表面128推住闭合扳机26的前表面130,导致闭合扳机26退回其初始位置。止动部件132从第二基底部件52延伸,以阻止闭合扳机26转动超过其初始位置。
外科钉合和切断器械10另外包括往复运动部件134、倍增器136和驱动部件138。该往复运动部件134包括一个在执行部分22(图6-7中未示出)中的楔形橇和金属驱动杆140。
驱动部件138包括第一和第二齿条141和142。在第一和第二齿条141、142中间的驱动部件138上设有一第一凹槽槽口144。在触发扳机28退回移动期间,触发扳机28上的齿146与第一凹槽144接合,用于在钉触发后使驱动部件138退回其初始位置。将一第二凹槽148定位在金属驱动杆140的近端,以将金属驱动杆140锁定到释放按钮30的上卡臂118处于其非触发位置。
倍增器136包括第一和第二整体的小齿轮150和152。第一整合小齿轮150与金属驱动杆140上的第一齿条154啮合。第二整合小齿轮152与驱动部件138上的第一齿条141啮合。第一整合小齿轮150具有第一直径,第二整合小齿轮152具有比第一直径小的第二直径。
转动铰转控制器
参考图6-9,把手部分20有利地结合铰转控制器13,两者令到执行部分22绕外科手术器械10的纵轴转动,并将末端受动器12铰转转动至与纵轴成一个角度。一中空铰转驱动管200同心地定位在闭合套管32内,并且可操作地连接到促动杆202,从而促动杆202的转动使管200绕纵轴转动,并且导致闭合环箍250和末端受动器12垂直转动或铰转转动。闭合环箍250的这种铰转转动与医生所观察和操纵的促动杆202转动角度和方向一致。在所述的形式中,这种关系是单对单的,因为促动杆202的转动角度相应于铰转转离杆23纵轴的角度,所以为医生提供一种直观的指示。应当意识到可以选择其它角度关系。
铰转控制器13包括一对连接到壳帽60的镜像对称的铰转转动传递壳204。此外,铰转转动传递壳204包括纵向对齐的外部凸片206,医生扭动凸片以影响铰转转动传递壳204的转动因而也影响末端受动器12绕执行部分22纵轴的转动。促动杆202连接到圆柱铰转体208,该圆柱铰转体位于基本上向上开口的圆柱凹槽210内并垂直于杆23。铰转体208的最低部分包括靠近杆23卡合在铰转转动传递壳208上的开口214中的尖头212,尖头212防止铰转体208抽离圆柱凹槽210。
环向分布的齿轮齿216位于铰转体208的下部并与一铰转轭220上的齿218啮合。铰转轭220跨在于闭合套管32中形成的铰转矩形窗口222上。闭合套管32可在铰转控制器13(沿纵向)内滑动移动,以闭合和打开末端受动器12。铰转驱动管200随闭合套管32相对固定的铰转控制器13纵向移动。窗口222为铰转轭220上向内的凸台224提供间隙,铰转轭220穿过矩形窗口222以接合在铰转驱动管200中的槽226,纵向定位转动运动的铰转驱动管200。中空的铰转驱动管200在闭合套管32内从铰转机构11纵向延伸,并远端地终止于闭合套管32的锁定凸片227之前。凸片227向内弯曲在铰转驱动管200的近端表面之后,从而将铰转驱动管200保持在杆23中。
应当意识到铰转转动传递壳204操作地连接到杆23的关闭管35。通过近端的外径圆形凹槽228,该凹槽在组合基底部件50、52的远端开口处接合圆形向内凸缘230,壳帽60将铰转轭220保持在铰转转动传递壳60中,并将铰转控制器13保持在把手部分20中。
图10和11以正齿轮铰转机构240形式示出了图1-2的齿轮铰转机构11,该齿轮铰转机构与上述的一样,但是在铰转机构240的其它边上带有附加的铰转驱动组件,从而提高性能。铰转机构240具有可转动的中空铰转驱动管242,在其同心地位于关闭管32中,并且该铰转机构240在第一圆周部分246的周围具有远端突出齿轮部件244。齿轮部件244与一正齿轮248啮合,正齿轮248连接到闭合环箍250并自此近端地伸出,该闭合环箍绕贯通第一和第二枢轴点252、260的栓253转动,所述枢轴点从闭合套管32向远端伸出。从而,铰转枢轴穿过第一和第二枢轴点252、260和栓253,可转动地将闭合环箍250连接到闭合套管32。驱动器242的转动啮合齿轮242和248,并且绕第一和第二枢轴点252、260铰转闭合环箍250。
为了增加在中空铰转驱动管242和闭合环箍250之间齿轮接触的有效表面积,中空铰转驱动管242的第二圆周部分254具有凹状远端地突出的齿轮部分256由此伸出。通过由构架34枢转支撑的换向齿轮262,该齿轮部分256可操作地连接到一第二正齿轮258,该正齿轮连接到闭合环箍250的相对侧边并由此近端地突出。换向齿轮262一边啮合两个凹状远端地突出的齿轮部分256,另一边啮合闭合环箍250的第二正齿轮258。
当促动闭合扳机26时,闭合套管32的中空铰转驱动管242和枢转地连接的闭合管250两者远端地移动以闭合砧板18。通过钉到正齿轮248、258中心的枢轴孔264和266的枢轴点252、260,以及伸过那里的构架开口268,闭合套管32的闭合管35自闭合环箍33隔开。构架开口268提供间隙,从而在铰转期间闭合环箍33的近端边缘和闭合套管32的闭合管35的远端边缘不会碰撞。
图11以分解方式示出了执行部分270,该执行部分包括正齿轮铰转机构240。构架272通过其近端上的轴套274可纵向连接到把手部分20(如图1和2所示)以旋转地接合于此。通过一纵向地与构架272中心对齐的开口278形成的构架槽276比在构架槽276内纵向滑动的触发连接器280更长。触发连接器280的近端转动地啮合金属驱动杆140(图6所示)的远端。触发连接器280的远端部包括容纳触发杆14近端的槽282,通过栓284连接其中。触发杆14的更远端部分位于触发杆槽状导向器288上的下部凹槽286中,并与铰转构架部件290和构架272远端地啮合。
铰转构架部件290具有锚定通道部件292,该部件远端地连接到在细长通道16中的近端部分的连接套环294。触发杆14穿过铰转构架部件290中的下部槽295。铰转构架部件290自触发杆槽状导向器288的构架272的远端隔开,并且由此通过弹性连接器296挠性地连接以铰转。弹性连接器296的加宽近端298接合构架272远端中远端地连通的上部凹槽300,并且弹性连接器296的加宽远端部302啮合铰转构架部件290中近端地连通的上部凹槽304。因而,细长通道16连接到把手部分20,尽管其间带有挠性部分。
细长通道16还具有砧板凸轮槽306,该凸轮槽枢转地容纳砧板18的砧板枢轴308。包围铰转构架部件290的闭合环箍250包括远端的凸片310,该凸片啮合一个砧板部分312,砧板部分312接近但离开砧板18上的砧板枢轴308,从而实现打开。当闭合环箍250向前移动时,其远端闭合面314接触坡面的圆柱闭合面316,该面离开砧板18的凸片312。这种凸轮动作向下关闭砧板18,直到闭合环箍250的闭合面314接触砧板18平的圆柱面318。
锥形触发杆
图12示出了沿铰转枢轴的铰转机构240和触发杆14结构,铰转机构240示出杆23和末端受动器12之间的挠性支撑结构,有利地执行切断的触发杆14柔韧的足以铰转。中空铰转驱动管242啮合闭合环箍33的正齿轮248(仅示出了闭合环箍33的正齿轮248)。闭合套管32的近端部或闭合管35从图中省略,该闭合套管纵向定位用于铰转正齿轮248。
在铰转机构240中允许绕铰转枢轴铰转转动的弹性支撑包括一对支撑面板400、402,支撑面板为触发杆的近端部分提供侧向导引,触发杆描述为对齐绕铰转枢轴挠曲的细长锥形触发杆条404。该锥形触发杆条404过渡到较厚的远端部分,示作触发杆头406,远端部分包括切断边缘48、上部栓38、中间栓46和触发杆帽44。触发杆条404的较薄部分比较厚部分406容易弯曲,从而减少压力以铰转末端受动器。在触发期间该较厚触发杆头406增加厚度以阻止来自夹压组织负载的偏转,从而保证钉筒37的有效切断和促动。
操作
外科钉合和切断器械10的闭合的末端受动器12和执行部分22的杆23穿过套管针的套管通道插入到用于内窥镜或腹腔镜检查过程的外科手术位置。铰转控制器13绕杆23的纵轴按所需转动,以实现末端受动器12的相应转动。有利地,铰转控制器13的促动杆202枢转以在铰转驱动管200、242中产生转动铰转转动运动,该运动在铰转机构11、240中的齿轮连接处转换为铰转动作,从而将末端受动器12定位在所需位置。触发杆14前进通过执行部分22以促动末端受动器12,由包括的随减小的阻力弯曲的伸长锥形触发杆条404帮助通过铰转机构11、240。
尽管本发明已经通过对几个实施方式的说明进行了描述,并且尽管已经非常详尽地描述了说明性的实施方式,但是并不意味着将随附的权利要求的范围限定或者以任何方式限制为这样的细节。对本领域的普通技术人员来说,附加的优点和改进可以很容易得看出。
本发明已经在内窥镜检查过程和器械方面进行了讨论。然而,在此使用的术语例如“内窥镜检查”不应当解释为将本发明限定为仅用于与内窥镜管(即,套管)结合的外科钉合和切断器械。正相反,应当相信本发明可以在通道限定为小切口的任何过程中得到应用,包括但不限定在腹腔镜检查过程,也包括开口过程。
另一个例子,虽然E形杆触发杆14对于内窥镜检查采用的外科切断和钉合器械10具有优势,但是类似的E形杆也可以用在其它临床过程中。人们通常接受的是内窥镜检查过程比腹腔镜检查过程更普通。因此,本发明已经在内窥镜检查过程和装置方面进行了讨论。然而,在此使用的术语例如“内窥镜检查”不应当解释为将本发明限定到仅用于与内窥镜管(即,套管)结合的外科钉合和切断器械。正相反,应当相信本发明可以在通道限定到小切口的任何过程中得到应用,包括但不限定在腹腔镜检查过程,也包括开口过程。
另一个例子,虽然在此描述的说明性的把手部分20由医生手动操作,但是动力化(例如气动的、液动的、电机的、超声波等)把手部分的某些或全部功能与本发明的方面也是一致的。此外,对这些功能每一项的控制可以在把手部分上手动进行,也可遥距控制(例如无线遥控、自动遥控台等)。
作为另外的例子,虽然这里有利地描述了同时钉合和切断器械,但是通过其他类型的末端受动器转动地控制铰转转动与本发明的方面也是一致的,如抓紧器、刀具、钉合器、夹填充器、通道装置、药物/基因治疗传递装置以及使用超声、射频(RF)、激光等的能量装置。
例如,尽管这里描述正齿轮铰转机构240,但也可以包括其它铰转机构,例如在前面提到的共同未决申请中所述的装置。
作为另外的例子,对于阻隔杆纵轴的铰转机构,支撑面板和锥形触发杆可以从纵轴偏移。
Claims (13)
1.一种外科手术器械,包括:
一把手部分,可操作地构造成可产生铰转运动和触发运动;
一具有纵轴的杆,连接到把手部分以传递铰转运动和触发运动;
一末端受动器;
一铰转机构,将所述杆连接到末端受动器,并且响应铰转运动以将末端受动器转离杆的纵轴;和
一触发机构,响应触发运动,并受到连接以移动通过铰转机构和末端受动器,该触发机构包括:
促动部分,具有第一厚度并且定位在末端受动器中,和
铰转部分,近端地连接到促动部分并且具有小于第一厚度的第二厚度以铰转移动通过铰转机构。
2.根据权利要求1所述的外科手术器械,其特征在于,末端受动器包括一对用于夹住组织的枢转相对钳夹,触发机构的促动部分包括用于切断所夹组织的远端切割边缘。
3.根据权利要求2所述的外科手术器械,所述末端受动器还包括:
一细长通道,连接到把手部分并包括一通道槽;
一钉筒,由细长通道接收,并结合一经排齐位于近端的楔形部件以朝上凸出支撑钉的驱动器;
一砧板,枢转地连接到细长通道,并且包括一砧板通道;和
触发机构的铰转部分包括纵向容纳在细长通道和砧板之间的远端切割边缘,一个可接合到砧板通道的上部构件、一个接合通道槽的下部构件,和通过远端地平移钉筒的楔形部件可操作的促动钉筒的中间部件。
4.根据权利要求3所述的外科手术器械,其特征在于,所述杆还包括铰转驱动管,铰转驱动管响应来自把手部分的旋转运动并远端地终止在一齿轮部分中,铰转机构包括一个近端地连接到末端受动器并且由齿轮部分啮合的正齿轮。
5.根据权利要求1所述的外科手术器械,其特征在于,所述杆还包括铰转驱动管,铰转驱动管响应来自把手部分的旋转运动并远端地终止在一齿轮部分中,铰转机构包括一个近端地连接到末端受动器并且由齿轮部分啮合的正齿轮。
6.一种外科手术器械,包括:
一把手部分,可操作产生触发运动、闭合运动、和铰转运动;
一个杆,连接到把手部分,可操作分别地传递触发运动、闭合运动、和铰转运动;
一细长通道,连接到所述杆并且包括一通道槽;
一砧板,枢转地连接到细长通道,响应来自所述杆的闭合运动,并且包括一砧板通道;
一触发装置,包括一个纵向地容纳在所述细长通道和砧板之间的远端切割边缘;和
一铰转机构,响应铰转运动将细长通道转离所述杆;
其中,触发装置包括一经过铰转机构的变薄条部。
7.根据权利要求6所述的外科手术器械,其特征在于,所述触发装置被构造成在砧板和细长通道之间纵向移动其间,确定地将砧板从细长通道隔开。
8.根据权利要求6所述的外科手术器械,还包括一钉筒,由细长通道接合并且包括近端地开口槽以容纳触发装置的切割边缘,该钉筒包括多个通过触发装置的远端纵向移动被朝上凸出的钉。
9.根据权利要求8所述的外科手术器械,其特征在于,所述钉筒还包括支撑多个钉的多个驱动器和一楔形橇,楔形橇响应触发机构的远端纵向移动以朝上凸出所述驱动器从而对着砧板形成多个钉。
10.根据权利要求8所述的外科手术器械,其特征在于,所述砧板形成被向内偏向于细长通道,在钉筒促动期间,在砧板和细长通道之间的确定地隔开方面,帮助触发装置。
11.一种外科手术器械,包括:
一把手部分,可操作地构造成可产生旋转铰转运动和纵向触发运动;
一个杆,可操作分别地传递所述旋转铰转运动和纵向触发运动;
一末端受动器,远端地连接到所述杆装置;
一铰转机构,响应所述旋转铰转运动以铰转末端受动器;和
一触发杆,响应把手部分的纵向触发运动,所述触发杆包括:
一纵向定位的细长条,用以移动通过铰转机构,和
一远端地连接到细长条的触发杆头,受到定位以在末端受动器中纵向移动。
12.根据权利要求11所述的外科手术器械,其特征在于,所述把手部分包括用于产生旋转铰转运动和纵向触发运动的把手装置,并且所述杆包括用于分别传递旋转铰转运动和纵向触发运动的杆装置。
13.根据权利要求12所述的外科手术器械,其特征在于,把手部件还包括用于产生纵向闭合运动的装置,并且所述杆装置还包括用于分别传递纵向闭合运动的装置。
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CA2473504A1 (en) | 2005-01-09 |
US20050006431A1 (en) | 2005-01-13 |
JP2005028149A (ja) | 2005-02-03 |
MXPA04006766A (es) | 2005-04-19 |
EP1522264A1 (en) | 2005-04-13 |
PL1522264T3 (pl) | 2017-09-29 |
BRPI0402725A (pt) | 2005-03-15 |
EP1522264B8 (en) | 2017-06-21 |
EP1522264B1 (en) | 2017-04-05 |
US7055731B2 (en) | 2006-06-06 |
BRPI0402725B1 (pt) | 2014-03-04 |
CA2473504C (en) | 2012-09-11 |
AU2011200518B2 (en) | 2012-04-12 |
AU2011200518A1 (en) | 2011-03-03 |
AU2004203121A1 (en) | 2005-01-27 |
JP4642396B2 (ja) | 2011-03-02 |
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