CN1903138B - 具有与枢转关节接头连接的横向运动轴致动器的外科器械 - Google Patents

具有与枢转关节接头连接的横向运动轴致动器的外科器械 Download PDF

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CN1903138B
CN1903138B CN200610106298XA CN200610106298A CN1903138B CN 1903138 B CN1903138 B CN 1903138B CN 200610106298X A CN200610106298X A CN 200610106298XA CN 200610106298 A CN200610106298 A CN 200610106298A CN 1903138 B CN1903138 B CN 1903138B
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肯尼思·S·威尔士
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical 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
    • A61B17/07207Surgical 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
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/005Flexible endoscopes
    • A61B1/0051Flexible endoscopes with controlled bending of insertion part
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00367Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • A61B2017/00398Details 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
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00535Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
    • A61B2017/00557Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated inflatable
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00831Material properties
    • A61B2017/00876Material properties magnetic
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2926Details of heads or jaws
    • A61B2017/2927Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2926Details of heads or jaws
    • A61B2017/2932Transmission of forces to jaw members
    • A61B2017/2933Transmission of forces to jaw members camming or guiding means

Abstract

一种特别适于以内窥方式使用的外科器械,通过包括位于轴的近侧部分中的横向滑动构件使端部执行器进行关节运动,所述轴将端部执行器枢转到所选的一侧。通过在横向滑动构件和轴的框架之间包括导向机构,有差别的相反致动力(例如液压的、流体的、机械的致动力)作用于该横向滑动构件而不会发生束缚。

Description

具有与枢转关节接头连接的横向运动轴致动器的外科器械 
相关申请的交叉引用
本申请要求Kenneth Wales和Chad Boudreaux于2005年2月18日提交的申请号为11/061,908、题为“SURGICAL INSTRUMENTINCORPORATIG A FLUID TRANSFER CONTROLLEDARTICULATION MECHANISM”的共有的美国专利申请的优先权,其内容通过全部引用而包含于本申请中。 
技术领域
本发明总的涉及适合于将端部执行器(例如,内切割器、抓钳、切割器、缝合器、夹具施放器、接触装置、药物/基因治疗输送装置和使用超声波、RF、激光等的能量装置)以可内窥的方式插入到手术部位的外科器械,更具体地说,涉及具有关节连接轴的这种外科器械。 
背景技术
内窥镜外科器械通常比传统的开放式外科装置更受到偏爱,这是因为较小的切口易于减少术后恢复时间和并发症。因此,在内窥镜外科器械的领域中已经有了显著发展,该内窥镜外科器械适合于将远端执行器通过套管针的套管精确地放置在所需的手术部位。这些远端执行器以多种方式接合组织以实现诊断或治疗作用(例如,内切割器、抓钳、切割器、缝合器、夹具施放器、接触装置、药物/基因治疗输送装置和使用超声波、RF、激光等的能量装置)。 
通过套管针限制端部执行器的定位。通常,这些内窥镜外科器械包括在端部执行器和由医生操作的手柄部分之间的长轴。这个长轴能够插入到所需深度并围绕轴的纵向轴线转动,从而将端部执行器定位到一定程度。在正确定位套管针和例如通过另一套管针使用抓钳的条 件下,通常这个定位量是足够的。诸如在美国专利No.5,465,895中描述的外科缝合和切割器械是通过插入和转动成功定位端部执行器的内窥镜外科器械的一个例子。 
更近地,美国专利序列号10/443,617描述了一种改进的用于切割组织和致动缝合的“E形梁”击发杆,该申请由Shelton IV等人于2003年5月20日提交,名称为“SURGICAL STAPLING INSTRUMENTINCORPORATING AN E-BEAM FIRING MECHANISM”,该申请在此全部引入作为参考。一些另外的优点包括即使为了最优化钉的形成而夹住略微过多或过少的组织,也可肯定地分隔端部执行器的钳口,或更具体地说,钉施加组件的钳口。此外,E形梁击发杆以能够采用几个有利的闭锁的方式接合端部执行器和钉仓。 
取决于操作的性质,可能希望进一步调整内窥镜外科器械的端部执行器的定位。特别是,通常希望在横切该器械的轴的纵向轴线的轴线上定向端部执行器。通常将端部执行器相对器械轴的横向运动称为“关节运动”(articulation)。这典型地通过被放置在靠近钉施加组件的伸长的轴中的枢轴(或关节)接合来实现。这允许医生远程致动钉施加组件到任一侧,用于更好的手术放置钉线和更简单的组织操作和定向。这种关节连接定位允许医生在一些情况下更简单地接合组织,例如在器官后。另外,关节连接定位有利地允许将内窥镜定位在端部执行器后方,而不会被器械轴挡住。 
由于将关节运动控制与在内窥镜器械的小直径的限制下闭合端部执行器以夹住组织和击发端部执行器(即,缝合和切割)的控制结合在一起,使外科缝合和切割器械进行关节运动的方法很复杂。通常,将三个控制动作都通过轴转换为纵向平移。例如美国专利No.5,673,840披露了手风琴状的关节运动机构(“柔性颈”),该关节运动机构由有选择地通过执行轴拉回两个连接杆中的一个而进行关节运动,每个杆分别在轴中心线的相对侧处偏移。连接杆通过一系列不连续位置渐进运动。 
关节运动机构的纵向控制的另一例子是美国专利No.5,865,361, 该关节运动机构包括关节运动连接件,其与凸出枢轴偏置,从而推动或拉动关节运动连接件的纵向平移实现向相应侧的关节运动。同样,美国专利No.5,797,537公开了类似的穿过轴以实现关节运动的杆。 
在未审结和共有的美国专利申请序列号10/615,973中使用旋转运动作为替换以将关节运动转换成纵向运动,该申请由Frederick E.Shelton IV等人申请,名称为“SURGICAL INSTRUMENTINCORPORATING AN ARTICULATION MECHNANISM HAVINGROTATION ABOUT THE LONGITUDINAL AXIS”,该申请公开的内容在此全部引入作为参考。 
虽然机械方式连接的关节运动已经成功地使内窥镜外科缝合和切割器械进行关节运动,但发展趋势为进入市场提出多种挑战和阻碍。矛盾的设计目标包括设计这样一种轴,其具有尽可能小的直径以减小手术开口的尺寸,但是具有足够强度以进行几种运动(例如,闭合、击发、关节运动、转动等)。另外,传递足够的力而不会产生束缚以及其它摩擦问题对设计施加了约束,限制了期望的特征和可靠性。 
因此,对于关节运动外科器械存在这样的需要,即:采用关节运动机构,该关节运动机构采用进行关节运动的力,其包含于关节运动机构的封闭边界内,而且不与击发和闭合运动发生干扰。 
发明内容
本发明通过提供如下所述的外科器械克服了现有技术的上述和其它的缺点,该外科器械具有连接在手柄和端部执行器之间的关节连接轴,所述关节连接轴在轴的近侧部分中采用抵抗端部执行器的枢转零件起作用的横向滑动构件。位于横向滑动构件的相对侧上的横向运动致动器控制向每一侧的枢转。该横向运动构件具有可差别的作用在上面的大的纵向表面积,从而在细长轴的封闭边界内有利地获得进行关节运动所需的作用力,该细长轴适于经过套管针的插管插入,以进行内窥镜或者腹腔镜外科手术。
在本发明的一个方面中,外科器械使用定位在靠近作为滑杆的一部分的铁磁靶标的横向槽中的电磁体。控制电路选择性地激励该电磁体来定位滑杆,用于使端部执行器进行关节运动。 
在本发明的另一方面中,外科器械使用关节运动控制器,该关节运动控制器具有位于滑杆每一侧上在细长轴内运动的差别纵向运动构件,所述差别纵向运动构件有差别地抵抗滑杆机械地致动,以对滑杆进行横向定位,并由此引起端部执行器的关节运动。 
更具体地说,本发明涉及了如下内容: 
(1)一种外科器械,其包括: 
端部执行器,其包括近侧凸出表面; 
细长轴,其包括限定了与纵向轴线对准的横槽的框架; 
关节运动接头,其将端部执行器以可枢转的方式连接到所述细长轴的远端; 
滑杆,其位于所述横槽中并具有与端部执行器的近侧凸出表面接合的远端; 
致动器,其定位在所述横槽中所述滑杆的选定横向侧;以及 
手柄部分,其连接到所述细长轴的近端,并在操作上构造为有差别地控制致动器以使滑杆横向运动,由此枢转关节运动接头和端部执行器。 
(2)如第(1)项所述的外科器械,其中,所述致动器包括第一纵向运动构件,第一纵向运动构件邻近定位在滑杆的一个横向运动平面中并包括多个指向内的横向凸出表面,所述滑杆包括对应的多个指向外的横向凸出表面,其中所述第一纵向运动构件以远侧和近侧纵向运动中选定的一个运动能导致滑杆沿横向运动离开,其中第一纵向运动构件沿着与所述选定的一个运动相反方向的运动允许所述滑杆向着第一纵向运动构件运动。 
(3)如第(2)项所述的外科器械,其中,所述致动器包括第二纵向运动构件,第二纵向运动构件邻近定位在滑杆的与第一纵向运动构件相对的横向运动平面中并包括多个指向内的横向凸出表面,所述滑杆包括对应的多个指向外的横向凸出表面,其中第二纵向运动构件以远侧和近侧纵向运动中选定的一个运动能导致滑杆沿横向运动离开,其中第二纵向运动构件沿着与所述选定的一个运动相反方向的运动允许所述滑杆向着第二纵向运动构件运动。 
(4)如第(1)项所述的外科器械,还包括旋转控制构件,该旋转控制构件与所述滑杆平行对准并与其沿径向连接,并且该旋转控制构件的旋转使所述滑杆横向平移。 
(5)如第(1)项所述的外科器械,还包括: 
第一和第二致动器,它们分别包括在所述滑杆的相对横向侧的第一和第二挠曲构件,每个挠曲构件包括至少一个可纵向定位的连接点;以及 
关节运动控制器,其操作上构造为有差别地定位所述第一和第二挠曲构件的至少一个可纵向定位的连接点。 
(6)如第(1)项所述的外科器械,其中,所述右侧和左侧致动器中选定的一个包括横向靠近所述滑杆的第一电磁体,其中所述滑杆包括磁体靶标。 
(7)如第(6)项所述的外科器械,其中,所述右侧和左侧致动器中的另一个包括横向靠近所述滑杆并与所述第一电磁体相对的第二电磁体,所述磁体靶标包括含铁靶标。 
(8)如第(6)项所述的外科器械,其中,所述滑杆包括磁体,所述第一电磁体操作上构造为可选择地产生正和负磁场。 
(9)如第(1)项所述的外科器械,其中,所述端部执行器的近侧表面包括扇形齿轮,并且所述滑杆的远端包括齿轮齿条。 
(10)如第(9)项所述的外科器械,还包括在所述细长轴中的锁定构件,其可选择性地向远侧纵向平移,以接合端部执行器的扇形齿轮,从而锁定关节运动接头。 
(11)如第(10)项所述的外科器械,其中,所述锁定构件被向远侧偏压,并且其包括近侧销,所述关节运动控制器包括带齿表面,该带齿表面在致动期间使近侧销向近侧顶起,并在关节运动控制停止时允许近侧销向远侧运动进入带齿表面的相应齿根处。 
(12)如第(1)项所述的外科器械,其中,所述端部执行器的近侧表面包括指向近侧的凸轮槽,该凸轮槽容纳所述滑杆的远端。 
(13)如第(1)项所述的外科器械,其中,所述端部执行器的近侧凸出表面包括指向近侧的凸轮槽,该凸轮槽容纳所述滑杆的远端。 
(14)如第(1)项所述的外科器械,其中,所述端部执行器的近侧凸出表面包括扇形齿轮,并且所述滑杆的远端包括齿轮齿条。 
(15)一种外科器械,其包括: 
端部执行器; 
细长轴,其与端部执行器连接并包括限定了与纵向轴线对准的横槽的框架; 
关节运动接头,其将端部执行器以可枢转的方式连接于所述细长轴的远端; 
滑杆,其位于所述横槽中并具有与端部执行器的近侧凸出表面接合的远端,还包括铁磁靶标; 
电磁体,其靠近所述铁磁靶标定位在所述横槽中; 
手柄部分,其与所述细长轴的近端连接;以及 
控制电路,其操作上设置为选择性地激励电磁体来定位滑杆,用来使端部执行器进行关节运动。 
(16)如第(15)项所述的外科器械,还包括与所述滑杆接合的定心偏压件,所述铁磁靶标包括磁体,所述控制电路还包括操作上设置为选择电磁体的极性,以抵抗所述定心偏压件以选定方向进行关节运动。 
(17)如第(16)项所述的外科器械,还包括第二电磁体,其定位在滑杆的与第一电磁体相对的一侧,所述控制电路操作上设置为以所需关节运动方向激励选定的电磁体。 
(18)一种外科器械,其包括: 
端部执行器; 
细长轴,其与端部执行器连接并具有限定了与纵向轴线对准的横 槽的框架; 
关节运动接头,其将端部执行器以可枢转的方式连接到所述细长轴的远端; 
滑杆,其位于所述横槽中并具有与端部执行器的近侧凸出表面接合的远端; 
右侧和左侧致动器,它们在横槽中位于滑杆的相应侧; 
手柄部分,其与所述细长轴在近端连接;以及 
关节运动控制器,其包括有差别的纵向运动构件,所述有差别的纵向运动构件使右侧和左侧致动器差别定位,由此使滑杆横向移位。 
(19)如第(18)项所述的外科器械,其中,所述左和右致动器包括挠曲构件。 
(20)如第(18)项所述的外科器械,其中,所述滑杆还包括横向凸出表面,所述左和右致动器还包括定位成与滑杆有差别地接触的相对的凸出构件。 
通过下面的附图和对附图的说明将清楚地了解本发明的这些和其它目的及优点。 
附图说明
包括在该说明书中并构成该说明书的一部分的附图图示出本发明的实施例,并且与上述本发明的概述以及下述实施例的详细说明一起用来解释本发明的原理。 
图1是外科缝合和切割器械的从前侧上部看的透视图,示出了打开的端部执行器或说钉施加组件,其中除去了钉仓。 
图2是图1的外科缝合和切割器械的从前侧上部看的透视图,其中关节运动机构由流体致动控制器致动。 
图3是图1的外科缝合和切割器械的细长轴和关节运动机构的分解透视图。 
图4是图1的外科缝合和切割器械的执行部分的远侧部分的分解透视图,包括钉施加组件和关节运动机构。
图5是图1和图4中的钉施加组件的从前侧上部看的透视图,其中钉仓的侧半部被除去以暴露由击发运动驱动的元件。 
图6是图1的外科器械的执行部分的从前侧看的透视图,其中除去了双枢轴闭合套管组件和端部执行器,暴露出通过流体关节运动机构进行关节运动的单枢轴框架底。 
图7是用于图1的外科器械的替代的关节运动接头的详细透视图,示出了双枢轴闭合套管组件,在近侧位置带有单枢轴框架底。 
图8是图7的替代的关节运动接头的从底部右侧看的分解透视图,包括双枢轴固定壁狗骨型连接件和具有用于横向运动构件(T型杆)的轨道的框架底。 
图9是用于图1的外科器械的另一种替代关节运动接头的从上部左侧看的分解透视图,包括作为替代的实心壁支撑板机构,该实心壁支撑板机构被结合到下部双枢轴连接件中用于支撑击发杆并包括轨道导引的横向运动构件(T型杆)。 
图10是用于图1的外科器械的作为替代的关节运动锁定机构的俯视示意图,其中除去了闭合套管组件,暴露出用于自动关节运动锁定接合和脱离接合的用反向载荷脱开的T型杆。 
图11是用于图1的外科器械的另一种替代关节运动机构的俯视示意图,其中位于T型杆上的弹性偏压齿条带有由于来自端部执行器的反向载荷而接合的锁定零件。 
图12是用于图1所示外科器械的作为替代的T型杆和具有横向导向件的框架底。 
图13是用于图1所示外科器械的又一种作为替代的T型杆和具有横向导向件的框架底。 
图14是用于图1的外科器械的作为替代的关节运动机构的左侧上部看的透视图,该关节运动机构包括双枢轴框架底组件和单枢轴闭合套管组件。 
图15是作为图14的替代的关节运动机构的从左侧底部看的透视图。
图16是横向运动流体关节运动机构的示意图,其中枢转的齿条和扇形齿轮示出为未进行关节运动的状态。 
图17是图16的流体关节运动机构沿着线17-17截取的主剖视图。 
图18是横向运动流体关节运动机构的示意图,其中枢转的齿条和扇形齿轮示出为进行关节运动的状态。 
图19是图18的流体关节运动机构沿着线19-19截取的主剖视图。 
图20是由至少一个纵向运动构件使外科器械进行关节运动的俯视示意图,所述纵向运动构件将滑杆横向顶起,该滑杆又使端部执行器进行关节运动。 
图21是图20的外科器械处于关节运动状态的俯视示意图。 
图22是用于图16或20所示外科器械的作为选择的旋转连接机械控制系统的主剖视图,图示为未进行关节运动的状态,该旋转连接机械控制系统分别使T型杆或者滑杆横向平移。 
图23是处于进行关节运动状态的图22的可旋转连接机械控制系统的一种替代的主剖视图。 
图24是外科器械的俯视示意图,其具有由一对挠曲构件横向定位使端部执行器进行关节运动的滑杆,每个挠曲构件具有可纵向调节的近侧端点。 
图25是图24的外科器械的俯视示意图,图示为进行关节运动的状态。 
图26是具有电磁横向关节运动控制机构的外科器械的俯视示意图。 
图27是处于关节运动状态的图26的外科器械的俯视示意图。 
图28是具有不对称偏压电磁横向关节运动控制机构的外科器械的俯视示意图。 
图29是处于关节运动状态的图28的外科器械的俯视示意图。 
具体实施方式
关节轴概述
参照附图,其中在所有附图中相同的附图标记代表相同的组成构件。图1示出了一种外科器械,更具体地,在解释性方案中为外科缝合和切割器械10,其能够实践本发明的独特优点。特别地,在图1中所示的未进行关节运动的状态下,该外科缝合和切割器械10的大小适于通过套管针的插管通道插入到患者(未显示)体内的手术部位,以进行外科手术。一旦执行部分12经过插管通道插入,该执行部分12的细长轴16的远侧部分中包含的关节运动机构14可通过关节运动控制器18远距离的进行关节运动,如图2所示。端部执行器(在解释性方案中示为钉施加组件20)从远侧与关节运动机构14连接。因此,远距离地使关节运动机构14进行关节运动由此使钉施加组件20相对于细长轴16的纵向轴线进行关节运动。这种带角度的位姿具有如下优点:以所需的角度接近组织以进行切割和缝合,接近那些否则受其它器官和组织阻挡的组织,和/或允许将内窥镜定位在钉施加组件20的后面并与其对准,以确认放置。 
手柄 
外科缝合和切割器械10包括与执行部分12从近侧连接的手柄部分22,用于向该执行部分提供定位、关节运动、闭合和击发运动。该手柄部分22具有手枪式把手24,医生朝着该把手24枢转地向近侧拉动闭合触发器26,导致钉施加组件20的夹紧和闭合。击发触发器28在所述闭合触发器26的外侧,医生以枢转的方式拉动该击发触发器28,使夹钳在钉施加组件20中的组织被缝合和切割。此后,按压闭合释放按钮30释放夹紧的闭合触发器26,并由此释放被夹钳的组织的切割和缝合端部。手柄部分22还包括与细长轴16一起运动的连接的旋钮32,以使轴16和关节连接的钉施加组件20围绕轴16的纵向轴线旋转。手柄部分22还包括击发回缩手柄34,用于在产生束缚时辅助缩回击发机构(在图1-2中未显示),从而使钉施加组件20此后可以打开。 
应当理解,这里使用的术语“近侧”和“远侧”是以握持器械手 柄的医生为参照。因此,钉施加组件20相对于更近侧的手柄部分处于远侧。还应理解,为了方便和清楚起见,这里使用的空间术语,诸如“垂直”和“水平”均相对于附图而言。然而,外科器械可以多种方向和位置使用,这些术语并不是限制性的和绝对的。 
在如下的未审结和共有的美国专利申请中更详细地描述了图1-2中用于外科缝合和切割器械10的示例性多冲程手柄部分22,该申请是Jeffrey S.Swayze等人申请的序列号为11/052,632的名称为“MULTI-STROKE MECHANISM WITH AUTOMATIC END OFSTROKE RETRACTION”的美国专利申请以及Swayze和Shlton IV的序列号为10/674,026、名称为“SURGICAL STAPLINGINSTRUCMENT INCORPORATING A MULTISTROKE FIRINGPOSITION INDICATOR AND RETRACTION MECHANISM”的申请,上述两个申请公开的内容在此全部引入作为参考,附加特征和变化在此进行描述。虽然多冲程手柄部分22有利地支持在长距离上高击发力的应用,但是与本发明一致的应用可以采用单一击发冲程,例如在Frederick E.Shelton IV、Michael E.Setser和Brian J.Hemmelgarn的序列号为10/441,632、名称为“SURGICAL STAPLING INSTRUMENTHAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS”的未审结和共有的美国专利申请中所描述的,该申请的公开内容在此全部引入作为参考。 
执行部分(进行关节运动的细长轴和钉施加组件) 
在图3-5中,有利地,执行部分12包括在适于内窥镜和腹腔镜手术的较小直径内的纵向旋转、关节运动,闭合和击发的多种致动运动。钉施加组件20(“端部执行器”)具有一对可枢转地相对的钳口,图示为一个具有可枢转地连接的砧座42的细长通道40(图1-2,4-5)。砧座42相对于细长通道40的闭合和夹钳通过用可旋转地连接到手柄部分20的框架组件44(图3)、甚至用图2中所示的关节连接的钉施加组件20沿纵向支撑该细长通道40来实现,其中,一个双枢轴闭 合套管组件46在所述框架组件44的上方沿纵向运动,以向砧座42施加分别对应于向远侧和近侧运动的闭合和打开。 
特别参照图3,框架组件44包括一个单枢轴框架底48,其近端与旋钮32接合,并且如图3所示旋钮32上带有右侧半壳50。应当理解,闭合套管组件46的近端、特别是闭合直管52的近端包围框架底48的近端,进一步穿过手柄部分22内部,与使闭合套管组件46纵向平移的闭合构件(未显示)接合。一个位于闭合直管52近端的圆形凸缘54提供了与所述元件的旋转接合。旋钮32的接合元件穿过闭合直管52的近侧部分上的纵向槽56与在框架底48上在近侧定位的孔口58接合。纵向槽56具有足够的长度,以允许闭合套管组件46以由旋钮32为闭合套管组件46和框架底48设定的各种旋转角度沿纵向平移。 
细长轴16通过容纳与手柄部分22(未显示)旋转接合的击发杆60来支持击发运动。击发杆60沿着框架底48的纵向中心线进入近侧开口62。框架底48的远侧部分包括一个沿着其与近侧开口62相通的底部的击发杆槽64。击发杆66在击发杆槽64中纵向平移,并包括一个向上突出的近侧销68,该近侧销与击发杆60的远端70接合。 
细长轴16通过具有矩形容器腔72来支持关节运动,该容器腔72在旋钮32的远侧部分中描绘为横向部分。位于矩形容器腔72中的底部分隔室74具有横向间隔开的左和右挡板76、78。关节运动致动器80在底部分隔室74的上方横向滑动,该关节运动致动器的向下的横向间隔开的左和右凸缘82、84位于挡板76、78外侧,每个凸缘与分别从旋钮32的每个半壳向外伸出的左和右按钮86、88横向相通。抵抗流体关节运动系统94的左和右储存囊90、92而运转,关节运动致动器80的横向运动使左和右凸缘82、84分别更靠近或更远离左和右挡板76、78,每个囊90、92分别向远侧与左和右流体导管或通道96、98连通,该左和右流体导管或通道96、98又分别与左和右致动囊100、102连通。后者(也就是左和右致动囊100、102)相对并横向枢转关节运动机构14的滑杆,图示为T型杆104。
框架组件44通过包括框架底48的顶部和远侧带凹槽的板106来限制这些流体致动,流体通道96、98和致动囊100、102位于所述框架底的所述板106上面。T型杆104在致动囊100、102之间滑动地位于带凹槽的板106上面。在T型杆104的近侧,一个凸出的阻挡肋108与其对准,用于防止流体通道96、98向内膨胀。框架组件44具有一个圆形的顶部框架盖(隔离件)110,其在框架底48的上方滑动,从而防止流体通道96、98和致动囊100、102的垂直膨胀,同时限制T型杆104的任何垂直运动。特别地,框架盖110包括能使其还可提供关节运动的锁定构件111的零件,下面将作为关节运动锁定机构113的一部分进行详细描述。 
T型杆104的远端(“齿条”)112用于使关节运动机构14的关节连接的远侧框架构件114的指向近侧的扇形齿轮115枢转。关节连接的闭合管116包围关节连接的框架构件114,并包括一个与砧座42接合的马蹄形孔口118。在闭合直管52和关节运动闭合环116之间关节运动机构14的上方形成一个双枢轴连接,从而允许即使当关节运动机构14进行关节运动时也可进行纵向闭合运动。特别地,带有销孔122、124的闭合直管52上的顶部和底部向远侧伸出的枢轴翼片119、120分别与具有销孔130、132的关节运动闭合环116上相应的顶部和底部向近侧伸出的枢轴翼片126、128沿纵向间隔开。一个上部双枢轴连接件134具有分别与销孔130、122接合的沿纵向间隔开的向上的远侧和后部销136、138,一个下部双枢轴连接件140具有分别与销孔132、124接合的沿纵向间隔开的向下伸出的远侧和后部销142、144。 
特别参照图4,为了增强可制造性,关节运动闭合环116显示为包括一个短管146,该短管146与包括向近侧伸出的枢轴翼片126、128连接的关节连接卡圈148相连。类似地,闭合直管52由与后部连接卡圈152连接的长闭合管150组装而成,所述连接卡圈152包括向远侧伸出的枢轴翼片119、120。短闭合管146中的马蹄形孔口118与略微靠近横向枢轴销156的向上伸出的砧座零件154接合,所述枢 轴销156与细长通道40中的枢轴槽158接合。 
在图2、6中,在框架底48中形成的竖直的远侧销孔169用于容纳框架枢轴销171,该框架枢轴销171在远侧框架构件114中枢转。 
图4的解释性方案包括狗骨型连接件160,其近侧销157被可枢转地连接到框架底48的框架孔161中,并且其近侧销159与关节运动框架构件114的近侧下表面162刚性连接,从而在各销之间提供可枢转地支撑。狗骨型连接件160的底部纵向刀槽163导引击发杆66的关节运动部分。关节运动框架构件114还包括一个用于导引击发杆66的远侧部分的底部纵槽164。 
钉施加器械(端部执行器) 
参照图4-5,击发杆66在远侧终止于E-形梁165,所述E-形梁165包括上部导销166,该上部导销166插入砧座42中的砧座槽168中,以便在形成钉和切割期间检验并辅助将砧座42保持为闭合状态。细长通道40和砧座42之间的间隔还可通过如下方式来保持,即,E-形梁165具有沿着细长通道40的顶面滑动的中间销170,同时其底脚172由细长通道40中的纵向开口174导引沿着该细长通道40的下表面相对地滑动。位于上部导销166和中间销170之间的E形梁164的在远侧的切割表面176对夹钳的组织进行切割,同时E形梁通过向远侧运动楔形滑动件180致动可拆卸的钉仓178,该楔形滑动件180引起钉驱动器182向上凸出,以驱动钉184向上脱离钉仓体188中的钉孔186,从而抵靠砧座42的钉形成下表面190形成钉。钉仓座192从底部包围钉仓178的其它元件,将它们保持在适当的位置。钉仓座192包括一向后开口的槽194,该槽194覆盖在细长通道40中的纵向开口174上,从而使中间销170穿过钉仓座192的内部。 
钉施加组件20由Frederick E.Shelton IV等共有的于2004年9月30日提交的申请号为10/955,042、名称为“ARTICULATINGSURGICAL STAPLING INSTRUMENT INCORPORATING ATWO-PIECE E-BEAM FIRING MECHANISM”的美国未审结专利申 请中有详细描述,其公开的内容在此全部引入作为参考。 
关节运动锁定机构 
在图3-4和6-8中,有利地包括一个关节运动锁定机构113,以将钉施加组件20保持在预定的关节运动角度。关节运动锁定机构113减小了左和右致动囊100、102上的负载。特别地,压缩弹簧202(图3)在近侧定位于关节锁定构件111的近端204和手柄部分22之间,向远侧偏压关节锁定构件111。特别参照图4,关节锁定构件111远端210上的两个平行的狭槽206、208分别容纳框架底48上的向上伸出的导向肋212、214。导向肋212、214的纵向长度比平行的狭槽206、208的长度短,使其具有相对纵向行程范围。特别参照图8,由此使远侧摩擦表面(示为从关节锁定构件111向远侧伸出的带齿的槽216)的可选抵接接合部分与容纳在关节运动框架构件114的顶部近侧凹槽220中的制动板218中的相应锁定扇形齿轮217接合。制动板218的远侧和近侧孔221、222容纳从顶部近侧凹槽220向上伸出的远侧和近侧销223、224。 
特别参照图6,细长轴16示为处于进行关节运动的位置,其中闭合套管组件46被从框架组件44周围除去,而且没有细长通道40和砧座42。关节运动致动器80显示为横向运动到左侧,以压缩右侧近侧储存囊90,并使远侧右侧致动囊100膨胀,从而将T型杆104向左侧运动到所示位置。因此,如图所示,关节运动致动器80的横向运动使远侧框架114围绕单枢轴框架底48沿顺时针进行关节运动。有利地,关节运动致动器80还自动地与关节运动锁定机构113接合和脱离接合。特别地,沿着关节运动致动器80的近侧上表面的带齿止动表面225容纳从关节锁定构件111的近端204向下伸出的锁定销226。锁定销226在带齿止动表面225根部的接合为关节锁定构件111提供了足够的向远侧的运动,将锁定扇形齿轮217锁定接合于制动板218中。由操作人员造成的关节运动致动器80向近侧的横向运动向近侧推压锁定销226,由此使关节锁定构件111与制动板218脱离接合。 当操作人员释放关节运动致动器80时,锁定销226被压缩弹簧202推压到止动表面225的相邻止动槽中,以使锁定机构111锁定,从而锁定钉施加组件20。 
在图10中,外科器械2004的关节运动机构2002的一种替代的锁定机构2000通常是未锁定的,并通过使横向运动的T型杆2006由于反向载荷而歪斜来启动。一个狭槽2008位于框架底2010中,以容纳并导引从T型杆2006向下伸出的肋2012。如果端部执行器2016受反向载荷,则一个与肋2012成直角连接的细长纵向部分2014偏斜。例如,当端部执行器2016受到如箭头2018所示向右的力,其近侧扇形齿轮2020作用在T型杆2006的齿条2022上,从而施加非垂直的反向驱动力,如箭头2114所示。因此,细长纵向部分2014偏斜,将肋2012旋塞到狭槽2008中。这种旋塞产生了相反的束缚力(如箭头2026、2028所示),将T型杆2006锁定并阻止其继续进行关节运动。当关节运动的致动使横向运动T型杆2006释放时,则解除锁定。此后,肋2016可辅助导引T型杆2006。 
在图11中,显示了外科器械2102的又一种关节运动锁定机构2100,其通常是未锁定的,并通过由端部执行器2106的齿轮齿2104和T型杆2110的齿条齿2108以20度压力角形成的近侧力向量来致动。当端部执行器2106受到反向载荷(如非垂直箭头2112所示)时,压力角的纵向向量(如箭头2114所示)使T型杆2110向近侧运动。该纵向力向量施加到位于T型杆2110的齿条2120后面的牵引弹簧2118上。当弹簧2118随着T型杆2110向近侧运动而偏斜时,从齿条2120向近侧伸出的锁定齿2126开始接合,同时锁定元件2122在底部框架2124上向远侧横向地对准。当通过除去端部执行器2106的反向载荷并且T型杆2110由于弹簧2118的推压向远侧运动使近侧力向量2114减小或消除时,锁定齿2126和锁定构件2122脱离接合。 
双枢轴闭合套管和单枢轴框架底的组合 
参照图3-4和7,有利地,执行部分12包括双枢轴闭合套管组件 46,该双枢轴闭合套管组件46围绕一个单枢轴框架底48并在其上方纵向平移。下面将进一步详细描述这些机构和它们的操作。特别参照图7,关节运动机构14显示为处于进行关节运动的状态,其中闭合套管46向近侧回缩到砧座处于打开状态。在砧座42的打开的情况下,关节运动控制器18的致动引起关节连接的闭合环116分别围绕上部和下部双枢轴闭合连接件134、140的向上的远侧销136和向下的远侧销142枢转。框架底48围绕单个销(图示为连接框架底48与远侧框架构件114的框架枢轴销171(图3))枢转。随着砧座42的打开,框架底48的框架枢轴销171与闭合套管组件46的上部和下部双枢轴连接件134、140的最远位置对准。当砧座42打开时,这样定位很容易使钉施加组件20进行枢转和旋转。当闭合套管组件46向远侧运动来枢转闭合砧座42时,闭合直管52围绕框架底48向远侧运动,并且关节连接的闭合环116由于枢轴连接件134、140的促动沿着关节连接的远侧框架构件114的轴向远侧运动。当所述装置进行关节运动时(未显示),随着它们向着远侧闭合位置的致动,连接件134、140上的双枢轴销136、138以及142、144有利于与闭合直管52和关节连接的闭合环116的接合。在远侧闭合位置,框架枢轴销171在进行完全关节运动时与近侧枢轴销138、144垂直对准,或者当有效运行时落在远侧销136、142和近侧销138、144之间的任一点上。 
实心击发杆支撑件 
在图8中,图7中的关节运动机构14被局部分解并从底部图示,显示图4中的实心壁击发杆支撑设计(狗骨型连接件160),其提供了传统弹性支撑板所不具备的优点。支撑板用于间隙的桥接,并通过单框架底枢轴关节运动接头1801导引并支撑击发杆66。弹性击发杆支撑件是已知的,但是采用实心壁击发杆支撑件(例如图4、8、9中显示的那些)提供了独特的优点。下面参见图8,框架底48包括一个沿着框架底48的底部延伸的框架刀槽1802,和一个沿着进行关节运动的远侧框架构件114的底部延伸用于将击发杆66(未显示)滑动容 纳于其中的远侧刀槽164。如上所述的框架底48还包括一个在框架枢轴销171处与远侧框架构件114的直接单枢轴连接。可旋转地连接于近侧销端部157并可动地连接在远侧销端部159上的固定壁狗骨型连接件160包括左和右横向导向件1818、1820,在这两个导向件之间限定了一个导槽1822,作为击发杆66的滑动通道(图4)。 
因此,为了桥接框架底48和远侧框架构件114之间的间隔,将固定壁枢轴狗骨型连接件160可枢转地连接到框架底48,并与框架构件114滑动连接。枢转的狗骨型连接件160的近侧销157可枢转地容纳于框架底48的孔1824中,使枢转的狗骨型连接件160能够围绕孔1824枢转。远侧销159从枢轴狗骨型连接件160向上伸出,并滑动容纳于远侧框架构件114中的狭槽1826中。钉施加组件20与纵向轴线成例如45度角的关节运动使枢转狗骨型连接件116以其近侧销157为轴在孔1824中枢转,并且远侧销157滑进在远侧框架构件114中形成的狭槽1826中,使击发杆66弯曲成两个分开的角,它们的角度是钉施加组件20的角度的一半。与以前参照的将击发杆66弯曲成45度角的弹性支撑板不同,固定壁枢转狗骨型连接件160将击发杆66弯曲成两个分开的角,例如每个22.5度。将一个或多个弹性击发杆66弯曲成所述角度的一半可以在击发杆66中将弯曲应力减小到传统的关节运动支撑件中的一半。击发杆66中的弯曲应力的减小降低了击发杆中的永久弯曲或设置预定量(placing a set)的可能性,降低了击发阻塞的可能性,确保了较小的击发杆回缩力,并为击发系统提供了更平稳的运行。 
在图9中,外科器械1900包括双闭合枢轴。单框架枢轴关节运动接头1902给出了一种作为替代的实心壁支撑板机构1904,其可替代图8中的下部双枢轴连接件140和狗骨型连接件1812。左和右击发杆支撑件1906、1908从闭合套管组件1912的下部双枢轴连接件1904向上伸出。在框架底1916中提供间隙1914,当闭合套管组件1912向远侧运动闭合砧座42(在图9中未显示)以及向近侧运动打开砧座42时,使击发杆1906、1908能够在该间隙中运动。与上述的枢转狗 骨型连接件160类似,作为替代的下部双枢轴连接件1910也可弯曲并支撑击发杆66(在图9中未显示),从而形成两个分开的弯曲角,其中的每个达到钉施加组件20的弯曲角的一半。 
横向构件导向机构 
继续参照图9,框架底1916上的左和右向上凸缘1918、1920包括远侧和近侧横向销导向件1921、1923,它们横向穿过T型杆1926中的通孔1923、1924,从而辅助将关节运动机构1928中的束缚降到最低。作为另一个例子,在图7中,有利地,T型杆104包括一个燕尾状横向导向件1930,其可在T型杆104中形成的燕尾状通道1932中横向滑动。作为另一个例子,在图12中,一个从框架底1936上的凸出的肋1934容纳于在T型杆1940中形成的矩形狭槽1938中。为了进一步有利于无束缚的横向平移,每个远侧和近侧横向支撑轨道都包括多个滚珠1946、1948。作为又一个例子,在图13中,与T型杆1964中的T型杆横向沟槽1958-1962相对应,在框架底1956中形成多个框架横向沟槽1950-1954。滑动滚柱1966-1970被捕获停留在每对横向沟槽1950/1958、1952/1960、1954/1962中。这些决不意味着对防止T型杆1940不期望的倾斜或旋转的横向导向构件的穷尽列举。 
双枢轴框架底和单枢轴闭合件的组合 
在图14-15中,外科器械2202包括一种替代的框架底和闭合机构2200,该框架底和闭合机构2200包括双枢轴框架组件2204。特别地,框架底2206通过双枢轴框架狗骨型件2210与远侧框架构件2208连接,所述双枢轴框架狗骨型件2210具有一个与框架底2206中的近侧孔2214枢转接合的近侧枢轴销2212和一个与远侧框架构件2208的远侧孔2218接合的远侧枢轴销2216。导向槽2220设置于狗骨型件2210的下侧,以在其中导引击发杆66(在图14-15中未显示)。刀槽2222设置在远侧框架构件2208中。如图所示,闭合套管组件2224的闭合环2230以四十五(45)度角进行关节运动,使远侧框架构件 2208以四十五(45)度角相进行关节运动,并使框架狗骨型件2210以该角度的一半进行关节运动。因此,击发杆66仅受到分开的两个小的半弯曲,并能获得上述列举的优点。 
最外层闭合套管组件2224的不同之处在于,框架组件2204的双枢轴设计中仅有一个枢轴适于纵向闭合运动。如图所示,闭合管轴2226在其远端具有一个叉形头(clevis)2228。叉形头2228与闭合环2230可枢转地接合。闭合环2230在其近端形成有近侧齿轮2232,并且销2234穿过近侧齿轮2232并与叉形头2228的上柄脚2236枢转接合。下臂2238通过定位销2241与叉形头2228的下柄脚2240可枢转地接合。叉形头2228中的孔2242容纳横向导销2243,并且T型杆2244可滑动地连接于其中,以接合闭合环2230的近侧齿轮2232。因此,这种替代机构2200使用与前面描述的机构相反的单/双枢轴替代构想。也就是说,这种作为替代的闭合机构2200具有单枢轴,而作为替代的框架底具有双枢轴,这与前面描述的具有单枢轴框架底的双枢轴闭合机构不同。 
横向运动关节运动机构 
在图16-19中示意性地描绘出了横向运动关节运动机构230,显示出用于执行端部执行器232的关节运动的横向运动。横向运动是至少一个元件向着或离开外科装置234的纵向轴线的运动。这种运动一般与纵向轴线(该纵向轴线是将机构230二等分的水平线)成直角,并不涉及旋转运动或者纵向运动。横向运动关节运动机构可以如图16-19所示地流体致动,也可以如图20-23所示地机械致动。 
横向运动流体关节运动机构 
在图16-19中示意性地显示了横向运动关节运动机构230,其包括流体控制系统235,该流体控制系统235具有流体填充的平行的左和右流体囊236、238,所述流体囊236、238在其间纵向延伸,通过流体242的运动使横向构件或者T型杆240横向运动。所有方向均以 纵向轴线为参照。参见没有进行关节运动的图16、17,位于远侧的端部执行器232围绕销244枢转,并在其近端具有扇形齿轮246。枢轴销244与框架(未显示)连接。位于T型杆240远端的齿条248可操作地与扇形齿轮246接合。T型杆240和齿条248可沿着轴线A-A横向运动。长的左和右流体囊236、238的每个远侧部分位于可横向运动的T型杆240的侧部,并在横向上被限制于闭合套管250中,在垂直方向上由下面的框架252和上面的定位片254限制。特别地,左侧致动流体囊236具有左侧远侧致动囊256、左侧流体通道258以及左侧近侧储存囊260。右侧流体囊238具有右侧远侧致动囊262、右侧流体通道264以及右侧近侧储存囊266。固定的分隔器270从框架252伸出并隔开囊260、266以及流体通道258、264。固定分隔器270和闭合套管250限制该流体通道258、264,防止在囊236、238的流体通道258、264部分的膨胀。可横向运动的“C”形压缩构件272包括于关节运动控制机构273中,用于压缩近侧储存囊260、266中的一个,并用于端部执行器232的关节运动。另外,也可采用其它元件,诸如穿过框架252中的击发杆槽276的击发杆274(图17、19)。 
如图18、19中所示,C形压缩构件272向左侧的横向运动压迫右侧近侧储存囊266,迫使流体242进入右侧流体通道264和右侧远侧致动囊262中。随着右侧远侧致动囊262使T型杆240横向运动到左侧,左侧远侧致动囊256被压缩,端部执行器232被致动到右侧(从图示的顶部顺时针方向观察)。左侧远侧致动囊256的压缩引起流体242经过左侧固定流体通道258向近侧流动,并进入左侧近侧储存囊260中。具体地,与C形压缩构件272相连的右侧壁280向左侧运动,引起右侧近侧储存囊266的压缩。当流体流进膨胀的左侧近侧储存囊260时,与C形压缩构件272相连的左侧壁278的相应的左向运动为来自受压缩的左侧制动器囊256的流体提供了空间。 
该用于关节运动机构230的流体控制系统235提供了至少多个优点。首先,致动囊256、262靠近关节运动接头或者机构230的定向允许在外科装置234中使用长的囊236、238和更长的T型杆240。 作为流体驱动系统,可以两种方式来实现流体控制系统235的输出力的增加。第一种,对于在T型杆240上的固定流体面积,可增大作用在固定面积上的流体压力。第二种,对于固定的流体压力,可增加T型杆240上的流体接触面积。第一种方法使设计更紧凑,系统压力更高。第二种方法导致设计更大,系统压力更小。为了降低成本,简化设置,降低系统应力,并减小囊破裂的风险,示例性方案示出了长的远侧致动囊256、262,它们处于外科装置234中靠近关节运动机构230的有利位置。正是囊256、262的这种设置使囊256、262可以很长,而且对较低的输入压力而言,关节运动的输出力可以很高。 
因此,可以简单地通过增加T型杆240上的远侧致动囊(球囊)256、262的压力接触面积来增大关节运动机构230的输出力(对相同的输入压力而言)。压力接触面积的增大受到高度和长度的限制。由于传统内窥镜外科器械的直径是用于穿过注入口的固定直径,这限制了高度的变化。压力接触面积的长度变化具有最大效果,并使装置的横向输出力可(通过改变长度)有利地调节,以符合系统对各种输出力的需求。 
在横向运动装置中使用的流体既可以是可压缩的,也可以是不可压缩的。如这里所指,术语“流体”包括液体、气体、凝胶、微粒和能够在压力梯度之间流动的任何其它材料。虽然可使用任何流体,特别优选灭菌溶液,诸如盐水、矿物油或者硅氧烷。 
横向运动机械关节运动机构 
尽管上面描述了用流体机构引起横向运动和关节运动,机械机构可实现与流体囊236、238产生的横向运动相同的横向运动。在图20-21中,作为替代的横向运动关节运动机构300采用机械控制系统(具体地说是纵向运动构件)为外科器械301施加横向运动和关节运动。在示例性方案中,特别参考图20,横向运动滑杆302具有至少一对倾斜的左和右凸出表面304、306,它们从滑杆302向细长纵轴308的相对侧横向伸出。在示例性方案中,还可包括另一对近侧左和右倾斜凸出 表面310、312。右侧纵向运动连接件314包括对应的方向向内的远侧和近侧反向倾斜表面316、318,该远侧和近侧反向倾斜表面316、318与远侧和近侧的右侧凸出表面306、312对准并滑动接合,从而使运动连接件312的远侧纵向运动引起滑杆302的左向横向运动。应当理解,这种倾斜接触可颠倒,从而使远侧运动引起向右运动。 
应当理解,在滑杆302上可包括弹性偏压件(未显示),以用于促动滑杆302向右与右侧纵向运动连接件314接合,从而使右侧纵向运动连接件314的反向近侧运动允许滑杆302的向左运动。作为替代,在示例性方案中,左侧纵向运动连接件320包括相应的方向向内的远侧和近侧反向倾斜表面322、324,该远侧和近侧反向倾斜表面322、324与远侧和近侧的右侧凸出表面304、310对准并滑动接合,凸出表面304、310向远侧倾斜,反向倾斜表面322、324向近侧倾斜,从而使左侧纵向运动连接件320的远侧纵向运动引起滑杆302的向右横向运动。应当理解,这种倾斜接触可颠倒,使远侧运动引起向左运动。应当理解,右侧和左侧纵向运动连接件314、320和滑杆302支撑于细长轴308中,这允许纵向运动连接件314、320的这种纵向运动和滑杆302的横向运动。 
图示为窝球(socket ball)328的滑杆302的远端容纳于V形凸轮槽330中,该V形凸轮槽330向近侧设置并靠近侧部执行器334的枢轴销332。因此,在图21中,右侧纵向运动连接件314的近侧运动和左侧纵向运动连接件320的远侧运动引起滑杆302的向右运动以及窝球328的相应的向右运动。这样V形凸轮槽330被向右驱动,其最远端336向左枢转。作为替代,滑杆302的横向运动可通过参见图16-19描述的齿条和扇形齿轮转化成端部执行器334的关节运动。因此,采用纵向运动的机械系统可用于为外科器械301提供横向关节运动。 
可旋转连接件 
在图22和23中,又一种作为替代的关节运动机构400采用可旋转连接件402使图示为横向运动滑杆404的横向构件运动,从而导致 外科器械406进行关节运动。该横向运动滑杆404可操作地在端部执行器(未显示)的近端与上面图16和20中所示的旋转齿轮或者凸轮槽接合。可旋转连接件402可定位在滑杆404的下面,并具有至少一个臂408,所述臂408从该可旋转连接件402的纵向轴线横向地可旋转地伸出,以便接合到滑杆404中的插槽410内。滑杆404在顶部定位片412和底部框架414之间受到垂直限制,该底部框架414具有容纳可旋转连接件402并适于臂408旋转的纵向沟槽416。定位片412和框架414由管状套管418包围。可旋转连接件402的旋转使臂408沿着弧形运动,由此使滑杆404沿着旋转方向横向运动。 
具有相对挠曲的弹性构件的关节运动机构 
在图24中,外科器械500具有沿着细长轴504的纵向轴线对准的滑动构件502,并允许该滑动构件502在左侧挠曲构件506和右侧挠曲构件508之间横向运动且在垂直方向上由框架和定位片(未显示)限制。每个挠曲构件506、508分别具有固定的远侧固定件510、512,和纵向平移近侧连接件514、516。每个左和右弹性构件518、520沿相反的方向抵靠滑杆502向内弯成弓形,并且横向弯入量与它们各自的近侧连接件514、516的远侧纵向运动相关。在图24中显示的未进行关节运动的状态,近侧连接件514、516在位置上没有差别,因此滑动构件502的向远侧伸出的末端522定位在V形凸轮槽524的中央,该V形凸轮槽524相对于端部执行器528的枢轴销526向近侧开放。在图25中,左侧的近侧连接件514已经向远侧行进并且右侧的近侧连接件已516已经向近侧回缩,因而引起滑杆502横向平移到右侧,从而导致向远侧伸出的末端522抵靠V形凸轮槽524的右侧部分进行凸轮运动,结果端部执行器528围绕枢轴销526向左进行关节运动。 
电磁横向关节运动控制机构 
在图26中,外科器械600具有在远侧连接的端部执行器602,其选择性地通过滑杆608的横向运动围绕其枢轴销604相对于细长轴 606沿弧形进行关节运动。特别地,滑杆608的远侧球610与V形凸轮槽612接合,该V形凸轮槽612在靠近枢轴销604处敞开。滑杆608在细长轴606中沿垂直方向由框架和定位片(未显示)限制。向内定向的位于滑杆608的相对横向侧上的左和右压缩弹簧614、616靠近细长轴606的远端618。这些弹簧614、616在滑杆608上提供了定心偏压,并由此在端部执行器602上提供了定心偏压。位于滑杆608的相对侧上的左和右电磁体620、622可选择性地被激励,以便吸引与滑杆608成一体或者固定于其上的含铁靶标(ferrous target)624,从而选择性地使滑杆608横向移位并使端部执行器602进行关节运动,如图27中所示。为了简化起见,图示了纵向对准的线圈,但是应当理解,可对准一个或多个电磁体来产生与滑杆608垂直的磁场,例如多个沿着滑杆608的纵向长度对准的线圈(未显示),并且每个线圈的纵向轴线与滑杆608的横向运动轴线对准。 
不对称横向关节运动控制机构 
在图28中,外科器械700具有在远侧连接的端部执行器702,其选择性地通过滑杆708的横向运动围绕其枢轴销704相对于细长轴706沿弧形进行关节运动。特别地,滑杆708的远侧齿条710与扇形齿轮712接合,该扇形齿轮712位于枢轴销704近侧。滑杆708在细长轴706中沿垂直方向由框架和定位片(未显示)限制。向内定向的位于滑杆708的相对横向侧上的左和右压缩弹簧714、716靠近细长轴706的远端718。这些弹簧714、716提供了在滑杆708上的不对称定心偏压并因此提供了在端部执行器702上的不对称定心偏压。因此位于滑杆708的相对侧的左侧未致动空间720和右侧电磁体722可选择性地形成有可选的左向不对称偏压,通过吸引与滑杆708成一体或者固定于其上的含铁靶标724,从而选择性地使滑杆708横向移位并使端部执行器702进行关节运动,如图29所示。为了简化起见,图示了纵向对准的线圈,但是应当理解,可对准一个或多个电磁体来产生与滑杆708垂直的磁场,例如多个沿着滑杆708的纵向长度对准的 线圈(未显示),并且每个线圈的纵向轴线与滑杆708的横向运动轴线对准。 
除弹簧714的向右偏压之外或者作为替代,滑杆708可包括多个磁体(例如永久磁体、电磁体)732,这样通过使右侧电磁体722的极性相反,使滑杆708可选择性地被吸引或者排斥。因此,当电磁体722去激励时,定心的弹簧714、716可实现对立平衡,从而伸直端部执行器702。 
作为替代,应当理解,在滑杆中放置永磁体,并且在每个横向侧排列永磁体来排斥滑杆中的磁体,这样可有利地采用一个或多个电磁体来克服定心偏压而使滑杆定心。 
还应理解,不对称致动可包括如这里描述的在滑杆一侧上的流体输送、机械凸轮机构、挠曲构件等,并且在另一侧上具有来自于压缩弹簧和/或永久磁体的相对的偏压。而且,这些实施方式还可包括锁定机构。 
作为又一种选择,与上述实时方式类似的,例如具有从端部执行器702向近侧伸出的弧形的扇形齿轮734(其被垂直间隔开以避免与滑杆708相互干扰)可以将端部执行器702相对于细长轴706成角度地锁定。在关节运动期间从细长轴706向远侧伸出的锁定杆736可稍微放到近侧,以与弧形的扇形齿轮734(图28)脱离接合,然后稍微向远侧运动而接合(图29),以所需的关节运动角度锁定。 
通过对多个实施例的描述对本发明进行了解释,这些示例性的实施例描述得非常详细,但申请人并不是想将所附的权利要求书的范围限制或以任何方式限定得如此详细。其它优点和变化对本领域技术人员来说是显而易见的。

Claims (4)

1.一种外科器械,其包括:
端部执行器,其包括近侧凸出表面;
细长轴,其包括限定了与纵向轴线对准的横槽的框架;
关节运动接头,其将端部执行器以可枢转的方式连接到所述细长轴的远端;
滑杆,其位于所述横槽中并具有与端部执行器的近侧凸出表面接合的远端;
致动器,其定位在所述横槽中所述滑杆的选定横向侧;以及
手柄部分,其连接到所述细长轴的近端,并在操作上构造为有差别地控制所述致动器以使滑杆横向运动,由此枢转关节运动接头和端部执行器。
2.如权利要求1所述的外科器械,其中,所述致动器包括第一纵向运动构件,该第一纵向运动构件邻近定位在滑杆的一个横向运动平面中并包括多个指向内的横向凸出表面,所述滑杆包括对应的多个指向外的横向凸出表面,其中所述第一纵向运动构件以远侧和近侧纵向运动中选定的一个运动能导致滑杆沿横向运动离开,其中第一纵向运动构件沿着与所述选定的一个运动相反方向的运动允许所述滑杆向着第一纵向运动构件运动。
3.如权利要求2所述的外科器械,其中,所述致动器包括第二纵向运动构件,该第二纵向运动构件邻近定位在滑杆的与第一纵向运动构件相对的横向运动平面中并包括多个指向内的横向凸出表面,所述滑杆包括对应的多个指向外的横向凸出表面,其中第二纵向运动构件以远侧和近侧纵向运动中选定的一个运动能导致滑杆沿横向运动离开,其中第二纵向运动构件沿着与所述选定的一个运动相反方向的运动允许所述滑杆向着第二纵向运动构件运动。
4.如权利要求1所述的外科器械,还包括旋转控制构件,该旋转控制构件与所述滑杆平行对准并与其沿径向连接,并且该旋转控制构件的旋转使所述滑杆横向平移。
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EP1745748B1 (en) 2009-08-26
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