CN1956684A - 手术器械 - Google Patents

手术器械 Download PDF

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CN1956684A
CN1956684A CNA200580016032XA CN200580016032A CN1956684A CN 1956684 A CN1956684 A CN 1956684A CN A200580016032X A CNA200580016032X A CN A200580016032XA CN 200580016032 A CN200580016032 A CN 200580016032A CN 1956684 A CN1956684 A CN 1956684A
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pipe fitting
electrode
combined apparatus
tissue
pulling
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马修·R·霍尔
马克·G·马歇尔
科林·C·O·戈布尔
弗朗西丝·阿莫阿
凯尔文·J·瓦尼
朱利安·马克·埃巴特
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Gyrus Medical Ltd
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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
    • A61B18/1485—Probes or electrodes therefor having a short rigid shaft for accessing the inner body through natural openings
    • 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
    • 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
    • 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
    • A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
    • 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
    • A61B17/3205—Excision instruments
    • A61B17/32053—Punch like cutting instruments, e.g. using a cylindrical or oval knife
    • 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
    • A61B17/3205—Excision instruments
    • A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
    • A61B17/320758—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions with a rotating cutting instrument, e.g. motor driven
    • A61B2017/320775—Morcellators, impeller or propeller like means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/42—Gynaecological or obstetrical instruments or methods
    • A61B2017/4216—Operations on uterus, e.g. endometrium
    • 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
    • A61B2018/1412—Blade

Abstract

公开了一种切碎患者体腔内的组织的装置，其包括固定管件(8)，其设有远端部分；以及双极电手术电极组件(13)，其位于所述管件的远端上。所述电手术电极组件(13)包括由绝缘构件(15)隔离的第一电极和第二电极(14、16)，所述双极电手术电极组件围绕所述管件(8)的远端边缘的周边延伸。在电手术切割电压施加在所述双极电手术电极组件(13)上并且在所述管件(8)与组织之间初始化相对运动后，离体组织的芯体形成在所述管件中，从而可从所述患者体腔去除所述离体组织。诸如卡爪组件(24)的组织拉出装置(2)可被采用以拉动组织抵靠着管件(8)的远端。

Description

手术器械
本发明涉及在大量去除组织中、如在腹腔镜子宫切除术中所使用的双极电手术器械。
在腹腔镜子宫切除术中，子宫的本体从子宫残端(stump)或子宫底(fundus)被切除，并且然后从手术部位被去除。为了使得子宫可通过受限的手术开口被去除，期望的是将子宫切碎成相对较小块的组织，可容易地去除它们。本发明涉及用于切碎和去除子宫的器械和方法。
美国专利No.5957884、No.6007512和No.6036681示出了切碎装置的实例，其中承载着电极的元件转动，从而使得实现组织的切碎。电极的这种转动需要机械驱动结构，这增加了器械的复杂性。本发明旨在提供用于大量去除组织的简单的并因而更加可靠的结构。
因此，提供了用于切碎患者体腔中的组织的装置与组织拉出装置的组合器械，切碎装置包括固定的管件，其包含远端部分；组织拉出装置可设置在所述管件中，组合器械包括双极电手术电极组件，其包括位于管件的远端上的第一电极和第二电机，它们通过绝缘构件彼此相互隔离，这种结构使得在电手术切割电压施加在电极组件上时，组织拉出装置可移动以拉动组织抵靠着管件的远端，从而在管件中形成离体组织(severed tissue)的芯体，并且进一步移动，以将离体组织从患者的体腔中去除。
方便地，电手术电极组件围绕管件的远端边缘的周边延伸，优选完全围绕周向边缘。
美国专利No.5304124公开了一种将肌瘤从患者的子宫去除的器械，该器械利用了位于筒形构件的端部的烧灼元件。该烧灼元件被描述为一种线圈，或者“Bovie型部件”。由于这种器械是用于去除肌瘤的(完好地留下子宫的剩余部分)，所以烧灼元件将减少来自于子宫的剩余部分的出血，而所述子宫的剩余部分将通过血管连接至患者。与之相反，本发明提供了双极电手术器械，所述双极电手术器械更加适于从子宫去除大量组织，而其已经被切除并且将不再具有血管供应。
双极组件的第二电极优选从第一电极沿管件的纵向轴线沿轴向向回设置。管件本身方便地构成第一电极、第二电极或者绝缘构件。在一种结构中，至少一个电极包括设置在绝缘构件上的导电迹线，例如通过将迹线印制在绝缘构件上。
方便地，第二电极附加地设置在组织拉出装置上，或者由其构成。由于第二电极设置在管件上，所以如果在第二电极与组织拉出装置之间没有电连接，则将可能出现这样的情况，即被拉入管件中的组织与第一电极接触，而不与第二电极接触。在这些情况下，组织的电手术切割将不会完成，直至组织被拉动足够远以至于接触第二电极。通过将第二电极安置在组织拉出装置上，或者通过使得第二电极与组织拉出装置电连接，将通过构造在组织拉出装置与第一电极之间的双极电极组件完成组织的切割。
通过在管件上设置第二电极，并且将组织拉出装置制造用于第二电极，分别将在不同的时间用作为第二电极。在组织首先出现在管件上时，组织拉出装置将用作为第二电极。随后，随着组织被拉入管件中，在位于管件上的第一电极与第二电极之间将实现双极切割。这种结构确保，在第一电极与管件接触时，双极电极组件适于成功点火，并且在越来越多的组织被拉入管件中时，而仍旧继续起作用。
因而，可以看出，双极电极组件被构造成包括位于管件的远端区域中的两个电极，以及附加地位于组织拉出装置上的可选的电极。这些结构的每种结构构成“双极”电极组件，即使组织拉出装置构成附加的电极。双极电极组件包括至少两个电极，它们可在手术部位的中间区域中调整。这与单极或“Bovie型”结构相反，在所述单极或“Bovie型”结构中，固定的回路垫在稍微远离手术部位的位置点附着在患者上。
组织拉出装置优选相对于管件可沿纵向移动。通过利用牵拉装置，管件可被保持固定，并且组织被拉入管件的端部中。因此，无需使管件前进或者将其移动进入将被去除的组织，正如许多现有技术的装置那样。
组织拉出装置优选是一对卡爪构件，它们可在打开与关闭位置之间移动，卡爪构件方便地安装在延伸穿过管件的杆件上。卡爪可围绕组织闭合，并且稳固地抓持组织，并且杆件在管件中缩回，以使得组织在管件的远端由电手术电极组件切断。可选地，组织拉出装置包括螺纹构件，其可相对于管件转动。螺纹构件的转动具有将组织拉入管件中的作用。
管件方便地包括端面，其相对于管件的纵向轴线被斜角，优选地相对于纵向轴线为30度与60度之间的角度，并且大体为45度。该斜角的端面有助于确保，组织与电极组件之间的最初的接触是点接触，因而有助于电极组件的点火而进入切割或汽化模式，并且确保组织的高效分离。
固定管件可选地包括具有波纹形周边部的端面，其大体为堞形或可选地波浪形周向表面。在一种方便的结构中，周边部大致以正弦波形式起伏。这些不同的端部轮廓分别有助于提供一个或多个逐渐发展的接触点，这与在整个端部周边部上的均匀的接触相反，因而有助于组织的电手术切割。
第一电极优选具有远端部分，其包括围绕其周边部设置的多个开口，优选为从管件的端部向回设置的一排或多排开口。各开口方便地为圆形孔，或可选地为细长的槽，并且一排中的开口优选沿径向偏离相邻排中的对应的开口。所述各开口旨在确保，热量并不太快从第一电极的远端周边传导出，因而保持有源电极处于较高的温度，并且减小器械的其余部分的温度上升的速度。
本发明还涉及一种通过腹腔镜的方式去除子宫的方法，所述方法包括以下步骤：
a)从子宫残端切除子宫的本体；
b)通过腹腔镜的方式插入切碎装置，所述切碎装置包括固定管件，其具有远端部分；以及组织拉出装置，其设置在所述管件中，所述切碎装置和/或所述组织拉出装置包括双极电手术电极组件，所述电手术电极组件包括位于所述管件的远端上的第一电极以及第二电极，所述第一电极与所述第二电极通过绝缘构件彼此相互隔离；
c)用所述组织拉出装置抓持组织，并且将其拉动抵靠着所述管件的远端；
d)用电手术切割电压对所述双极电手术电极组件供电；
e)继续用所述组织拉出装置拉动所述组织，以使得组织的芯体形成在管件中；并且
f)从所述管件撤出所述组织的芯体。
最后，本发明还涉及一种用于切碎患者的体腔内的组织的装置，所述装置包括固定的管件，其具有远端部分；以及双极电手术电极组件，其位于所述管件的远端上，所述电手术电极组件包括通过绝缘构件彼此隔离的第一电极和第二电极，所述双极电手术电极组件围绕所述管件的远端边缘的周边延伸，以使得在电手术切割电压施加在所述双极电手术电极组件上并且在所述管件与所述组织之间初始化相对运动后，离体组织的芯体形成在所述管件中，以使得所述离体组织可从患者的体腔被去除。
现在参看附图，仅仅通过示例，更加详细地说明本发明，其中：
图1是根据本发明的切碎系统的、局部剖切的示意性侧视图；
图2是图1的系统的一部分的示意性剖视图；
图3至6是图2的对应部分的可选实施例的示意图；
图7和8是图2的对应部分的远端的其它可选实施例的示意图；
图9和10是用于与图2的对应部分一起使用的电极的示意图；并且
图11是根据本发明构造的切碎系统的可选实施例的示意剖视图。
参看图1，切碎系统包括大体由附图标记1示出的切碎装置，大体由附图标记2示出的组织拉出装置，以及电手术发电机3。发电机3借助于电缆4连接至切碎装置1，并且借助于电缆5连接至组织拉出装置2。发电机3通过脚踏开关6被控制。
如图1和2所示，切碎装置1包括手柄7以及圆柱形管件8。圆柱形管件8是中空的，并且在其中限定了管腔9。管件8的近端10从手柄7延伸，如附图标记11所示，并且管件的远端12设有电手术电极组件13。电手术电极组件13包括有源组织切割电极14，以及绝缘构件15，两者都围绕管件8的周边延伸。绝缘构件15将电极14与管件8的其余部分隔离，所述管件8的其余部分用作为回路电极16。
管件8经由电缆4以及连接器17连接至发电机3的一极。有源电极14围绕管件8的整个周边延伸，并且经由电缆4、连接器17以及附加的引线(未示出)连接至发电机3的另一极。这样，电极14和16构成双极电极组件，在由发电机3供电时，所述双极电极组件适于切割与管件8的远端接触的组织。
组织拉出装置2包括空心轴18，在所述空心轴的远端是剪刀型处理机构19，其包括第一手柄20以及第二手柄21。第二手柄21可绕枢销22相对于第一手柄枢转。
第二手柄21的枢转使得延伸穿过轴18的推杆23纵向移动至其远端。
卡爪组件24位于轴18的远端，所述卡爪组件24设有第一卡爪构件25以及第二卡爪构件26，它们通过推杆23的移动而在打开位置与关闭位置之间移动。组织拉出装置2在切碎装置1的管腔9中以纵向的方式手动平移，而可滑动的引导构件27在管件8中支承组织拉出装置的轴18。卡爪构件25和26电连接至轴18，并且所述轴经由引线5和连接器28与发电机3电连接。轴18连接至与由管件8构成的回路电极16相同的发电机3的那极。
切碎系统的操作如下所述。切碎装置1的管件8大体通过套管针(未示出)插入患者的体内，并且处于邻近将被去除的组织(大体在腹腔镜子宫切除术中的切除的子宫)的位置。组织拉出装置2然后被插入穿过切碎装置1的管腔9。手柄21被操作以打开卡爪组件24，并且组织拉出装置2被调整，从而来自子宫的组织位于卡爪构件25与26之间。手柄21然后被操作，以闭合卡爪组件24，同时将组织抓持在其中。
外科医生操作脚踏开关6以操作发电机3，从而电手术切割电压被供应到组织切割电极14与回路电极16之间。如前所述，推杆23以及卡爪组件24也电连接至与管件8相同的发电机3的那极，并且因此管件与卡爪组件一起构成回路电极16。由于组织稳固地抓持在卡爪组件24中，装置2缓慢地从管件8撤出，同时牵拉组织抵靠着管件的远端以及切割电极14。由于组织接触组织切割电极14，所以其被汽化，允许装置2进一步被撤回到管件8中。这样，组织的圆柱形芯体形成在管件8中，该组织被撤出经过切碎装置1的近端10(其保持在患者的体外)，以便处置。
组织拉出装置2然后可被重新插入管件8中，从而组织的其它芯体可从患者体中去除。通过重复该过程，较大量的组织可以以相对短的时间从患者去除，从而可去除整个子宫，如果必须的话，仍采用腹腔镜法。
在上述器械中，管件8提供回路电极16(或者换句话说，回路电极提供管件的结构整体性)。图3示出了可选实施例，其中，有源电极14提供了管件8的结构元件。管件8的内侧表面由绝缘材料的层40覆盖，所述绝缘材料大体为陶瓷或者诸如尼龙或硅橡胶的聚合物材料。管件8的外侧表面同样地也由绝缘尼龙或硅橡胶材料的层41覆盖。绝缘层40和41正好留出管件8的远端12的一短部分，同时设置出构成暴露的有源电极14的暴露区域42。导电材料的附加的沉积层(例如由诸如金或银的生物相容性材料包覆的铜)构成回路电极16。
参看图1和2，以与上述相同的方式操作器械，而组织拉出装置2抓持组织，并且牵拉组织抵靠着管件8的远端12，在所述管件8的远端12处，所述组织通过在有源组织切割电极14与回路电极16之间流动的电流被汽化。
图4示出了可选实施例，其中，通过绝缘构件15提供管件8的结构整体性。管件8由硬质陶瓷或玻璃强化的尼龙材料形成，并且具有附着在其上的金属插入部43。插入部43具有一个或多个纵向支柱44，所述支柱沿管件8的长度延伸。支柱44用于引导来自发电机3的电手术电流，并且还支承位于管件8的远端12上的周向有源电极结构45。管件8还用诸如铜的金属材料包覆以形成回路电极16。不像相对于图3所示的结构，图4的实施例中的金属涂层提供了离散的回路垫46，以及引线47。回路电极结构可设置在管件8的内侧表面上、外侧表面上、或者内侧和外侧表面这两者上。
操作再次如前所述，组织被牵拉抵靠着管件8的远端12，从而通过有源电极14与回路电极16之间的电流被汽化。
图5示出了可选实施例，其中，设置冷却系统以确保，回路电极16并不达到过高温度。整个结构与图2的结构类似，前述的部件设有相同的附图标记，并且回路电极16构成了管件8的结构整体性。除了管件8，还设有流体入口管道48、流体出口管道49以及冷却套50。冷却套50围绕管件8的远端部分，同时留出最远端部分12暴露，从而有源电极14可接触被拉入管件中的组织。冷却液体被泵送穿过冷却套50，并且将热量传递出回路电极16的远端。这确保了回路电极16的远端并不达到组织粘附于其的温度。
图6示出了管件8的可选实施例，其中，管件的远端12设有斜角的端部，其由附图标记33表示。该斜角的端部33大体具有相对于管件8的纵向轴线的45度的角度，该斜角的端部33有助于提供组织切割电极14与被拉入管件中的组织之间的最初点接触。这有助于确保组织的高效电手术切割。
图7示出了可选的结构，其中，管件8的远端12设有波纹形的周边部。该波纹形的周边部为具有波峰51和波谷52的正弦波形式。尽管图7的结构被示出具有两个波峰51和两个波谷52，但是还可采用具有不同波峰和波谷数目的结构。管件8的端部的波纹形周边部构成了有源组织切割电极14，这确保了有源电极在一个或多个点接触位置接触组织，因而有助于确保高效的组织分离。
图8示出了管件的另一个实施例，其中，管件8的远端为堞形(castellated)形式，设有突出部53和凹部54。进一步，这确保了组织切割电极14在围绕管件8的周边的多个离散的位置与组织接触。
图9示出了有源组织切割电极14的结构。电极的形式为环55，参看图4如前所述，其由两个支柱44支承。环55设有围绕环55沿径向延伸的多个圆孔56。孔56有助于减少由组织切割电极14产生的热量传导至器械的其它近端部件，例如绝缘构件15或回路电极16。这有助于将有源电极14保持在用于切割组织的较高的温度，同时防止回路电极16达到过高的温度，在该过高的温度，组织将开始粘附至该电极。尽管在图8中示出环55设有平滑的圆形周边部，但是孔56可同样设有图7和8中所示的不规则形状的结构。
此外，孔56可由槽57替换，如图10所示。图10示出了采用设有两个交错排的槽57的环55形式的有源电极14。所述排的交错还有助于防止由有源电极14产生的热量沿近端方向通至器械的其它部件。
最后，图11示出了切碎装置1的可选实施例的管件8，其中，组织拉出装置2由螺纹构件29构成。螺纹构件29在其远端通过电极30被可转动地驱动，所述螺纹构件29的远端设有尖锐的端头31。螺纹构件29的端头31接合组织，并且螺纹构件的转动使得组织拉出抵靠着管件8的远端，在那里，如前所述，所述组织通过电手术电极组件13被汽化。组织在螺纹构件29的转动的作用下移动到管件8，直至所述组织从管件的近端10出来，从而通过剥离元件32从螺纹构件去除。这种结构具有这样的优点，可以基于几乎连续的方式完成组织的提取，而无需取出和再插入前图中的组织拉出装置。
本领域技术人员将理解的是，除了上述卡爪构件和螺纹构件以外，可采用用于将组织拉入管件8中的其它装置。双极电手术组件13将适于切割通过任何合适的装置被牵拉成与其接触的组织。

Claims (28)

1.一种组合器械，包括适于切碎患者体腔中的组织的切碎装置以及组织拉出装置，所述切碎装置包括固定的管件，所述固定的管件具有远端部分，所述组织拉出装置适于设置在所述管件中，所述组合器械包括双极电手术电极组件，其包含位于所述管件的远端的第一电极和第二电极，所述第一电极和所述第二电极通过绝缘构件彼此隔离，这种结构设置成使得，在电手术切割电压施加在所述电极组件上时，所述组织拉出装置可移动以将组织牵拉抵靠着所述管件的远端，以在所述管件中形成离体组织的芯体，并且进一步移动，以从患者的体腔去除离体的组织。
2.根据权利要求1所述的组合器械，其特征在于，所述第一电极围绕所述管件的远端边缘的周边部延伸。
3.根据权利要求2所述的组合器械，其特征在于，所述第一电极完全围绕所述固定管件的周边部延伸。
4.根据前述权利要求任一所述的组合器械，其特征在于，所述第二电极沿所述管件的纵向轴线从所述第一电极沿轴向向回设置。
5.根据前述权利要求任一所述的组合器械，其特征在于，所述管件构成所述第一电极。
6.根据权利要求1至4任一所述的组合器械，其特征在于，所述管件构成所述第二电极。
7.根据权利要求1至4任一所述的组合器械，其特征在于，所述管件构成所述绝缘构件。
8.根据权利要求5至7任一所述的组合器械，其特征在于，所述至少一个电极包括设置在所述绝缘构件上的导电迹线。
9.根据权利要求8所述的组合器械，其特征在于，所述导电迹线印制在所述绝缘构件上。
10.根据前述权利要求任一所述的组合器械，其特征在于，所述第二电极设置在所述组织拉出装置上，或者由所述组织拉出装置构成。
11.根据前述权利要求任一所述的组合器械，其特征在于，所述组织拉出装置可相对于所述管件沿纵向移动。
12.根据权利要求11所述的组合器械，其特征在于，所述组织拉出装置包括一对卡爪构件，它们可在打开位置与关闭位置之间移动。
13.根据权利要求12所述的组合器械，其特征在于，所述卡爪构件安装在延伸穿过所述管件的杆件上。
14.根据权利要求1至10任一所述的组合器械，其特征在于，所述组织拉出装置包括可相对于所述管件转动的螺纹构件。
15.根据前述权利要求任一所述的组合器械，其特征在于，所述固定的管件具有端面，所述端面相对于所述管件的纵向轴线斜角设置。
16.根据权利要求15所述的组合器械，其特征在于，所述管件的端面处于相对于所述管件的纵向轴线的30度与60度之间的角度。
17.根据权利要求16所述的组合器械，其特征在于，所述管件的端面处于相对于所述管件的纵向轴线的45度的角度。
18.根据权利要求1至14任一所述的组合器械，其特征在于，所述固定的管件设有具有波纹形周边部的端面。
19.根据权利要求18所述的组合器械，其特征在于，所述端面具有堞形周边部。
20.根据权利要求18所述的组合器械，其特征在于，所述端面设有周边部，其以波纹形式起伏。
21.根据权利要求20所述的组合器械，其特征在于，所述端面设有周边部，其大致以正弦波的形式起伏。
22.根据前述权利要求任一所述的组合器械，其特征在于，所述第一电极设有远端部分，所述远端部分包括围绕其周边设置的多个开口。
23.根据权利要求22所述的组合器械，其特征在于，所述开口为圆形孔的形式。
24.根据权利要求22所述的组合器械，其特征在于，所述开口为细长槽的形式。
25.根据权利要求22至24任一所述的组合器械，其特征在于，所述远端部分包括多排开口。
26.根据权利要求25所述的组合器械，其特征在于，在一排中的所述各开口相对于相邻排中的对应开口沿径向偏离。
27.一种通过腹腔镜的方式去除子宫的方法，所述方法包括以下步骤：
a)从子宫残端切除子宫的本体；
b)通过腹腔镜的方式插入切碎装置，所述切碎装置包括固定的管件，其具有远端部分；以及组织拉出装置，其设置在所述管件中，所述切碎装置和/或所述组织拉出装置包括双极电手术电极组件，所述电手术电极组件包括位于所述管件的远端上的第一电极以及第二电极，所述第一电极与所述第二电极通过绝缘构件彼此相互隔离；
c)用所述组织拉出装置抓持组织，并且将其牵拉抵靠着所述管件的远端；
d)用电手术切割电压对所述双极电手术电极组件供电；
e)继续用所述组织拉出装置拉动所述组织，以使得组织的芯体形成在管件中；并且
f)从所述管件撤出所述组织的芯体。
28.一种用于切碎患者的体腔内的组织的装置，所述装置包括固定的管件，其具有远端部分；以及双极电手术电极组件，其位于所述管件的远端上，所述双极电手术电极组件包括通过绝缘构件彼此隔离的第一电极和第二电极，所述双极电手术电极组件围绕所述管件的远端边缘的周边延伸，以使得在电手术切割电压施加在所述双极电手术电极组件上并且在所述管件与所述组织之间初始化相对运动后，离体组织的芯体形成在所述管件中，以使得所述离体组织可从患者的体腔被去除。
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US10624617B2 (en) 2015-05-27 2020-04-21 Ambu A/S Endoscope
US10617284B2 (en) 2015-05-27 2020-04-14 Ambu A/S Endoscope
CN107809938A (zh) * 2015-05-27 2018-03-16 安布股份有限公司 内窥镜
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US10631716B2 (en) 2015-05-27 2020-04-28 Ambu A/S Endoscope
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US11553113B2 (en) 2015-05-27 2023-01-10 Ambu A/S Endoscope

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WO2005112806A3 (en) 2006-02-23
EP1746949B1 (en) 2012-01-25
AU2005244649B2 (en) 2011-08-11
US7896877B2 (en) 2011-03-01
ATE542485T1 (de) 2012-02-15
US20050261676A1 (en) 2005-11-24
EP1746949A2 (en) 2007-01-31
WO2005112806A2 (en) 2005-12-01
CN1956684B (zh) 2011-06-08
GB0411270D0 (en) 2004-06-23
US20050261677A1 (en) 2005-11-24
GB2414185A (en) 2005-11-23

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