CN1957854B - 锁定机构和具有该锁定机构的外科器械 - Google Patents

锁定机构和具有该锁定机构的外科器械 Download PDF

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CN1957854B
CN1957854B CN2006101437533A CN200610143753A CN1957854B CN 1957854 B CN1957854 B CN 1957854B CN 2006101437533 A CN2006101437533 A CN 2006101437533A CN 200610143753 A CN200610143753 A CN 200610143753A CN 1957854 B CN1957854 B CN 1957854B
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CN1957854A (zh
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马克·S·奥尔蒂斯
查德·保罗·布德罗克斯
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Ethicon Endo Surgery Inc
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    • 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
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00535Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
    • 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
    • A61B2017/07214Stapler heads
    • A61B2017/07285Stapler heads characterised by its cutter
    • 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
    • A61B2017/2943Toothed members, e.g. rack and pinion
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08Accessories or related features not otherwise provided for
    • A61B2090/0814Preventing re-use

Abstract

本发明公开了一种外科器械。该外科器械包括手柄部分、通道、砧座、钉仓、楔形构件、往复运动击发装置以及锁定臂。手柄部分可操作地构造成产生击发运动并与通道部分连接。钉仓由通道接合并包括多个缝钉驱动器,使缝钉朝着与通道枢转连接的砧座突出。楔形构件位于缝钉驱动器的近侧并与其纵向对准,往复运动击发装置响应于击发运动将楔形构件从未击发位置逐渐地驱动到击发位置。锁定臂与通道枢转连接并可操作地构造成基于楔形构件的位置相对于击发装置在锁定位置和未锁定位置之间枢转。

Description

锁定机构和具有该锁定机构的外科器械 
技术领域
本发明在各实施方式中总的涉及外科缝合和切割器械,其结构和布置适于从可多次使用的钉仓对组织施加多排缝钉,同时切割所施加的缝钉排之间的组织。更具体地说,本发明涉及在进行关节运动的外科缝合和切割器械中使用的锁定机构,该锁定机构防止了当钉仓中的缝钉用尽或者在未击发位置没有钉仓时对组织的切割。 
背景技术
外科缝合和切割器械在现有技术中已经被用于在组织中形成纵向切口的同时在切口的相对两侧上施加多排缝钉。所述器械通常包括一对相配合的夹钳构件,如果器械用于内窥镜或者腹腔镜应用,这对夹钳构件能够穿过插管通道。夹钳构件中的一个通常装纳具有至少两个横向间隔的缝钉排的钉仓。另一个夹钳构件限定了具有缝钉形成凹口的砧座,所述凹口与钉仓中的缝钉排对准。该器械包括多个往复运动的楔形件,这些楔形件在被向远侧驱动时穿过钉仓中的开口并与支撑缝钉的驱动器接合,向着砧座击发缝钉。 
在美国专利No.5465895中描述了适用于内窥镜应用的外科缝合器的例子,其有利地提供了不同的闭合和击发动作。因此,临床医生可在击发之前闭合组织上的夹钳构件来定位组织。一旦临床医生确定夹钳构件正确地夹持了组织,则临床医生就可击发外科缝合器。击发将所有缝钉放置到组织中并使刀片行进对组织进行切割。这种同时切割和缝合避免了在使用分别仅仅进行切割或缝合手术的不同外科工具顺序地进行所述动作时引起的并发症。 
形成用于外科缝合器的可多次使用的端部执行器通常是有利的。例如,一个患者可能需要一系列切割和缝合手术。每次手术都 替换整个端部执行器在经济上是效率低下的。对于构建为具有用于反复手术的强度和可靠性的端部执行器尤其如此。为此,在外科缝合器的每次操作之前将钉仓装配到端部执行器中。因此,每次使用后抛弃的外科缝钉量多得多。 
虽然钉仓提供了许多好处,当未击发的钉仓不存在时,仍然需要防止器械无意中击发。否则,可能发生组织的切割,而没有缝钉来减少流血。特别需要防止以没有受到介入性故障的可靠方式完成无意中击发。而且,出于易于制造和组装的目的,还需要使用最少量的元件来实现锁定结构。 
基于刀片的垂直运动的锁定机构是已知的,特别适用于非关节运动的内镜切割刀设计,其中端部执行器位于基本上为刚性的轴的端部。轴能够插入需要的深度并围绕轴的纵向轴线旋转,从而使端部执行器定位到一定程度。授予Bittner等人的美国专利No.5878938公开了一种锁定机构或者锁定件,其在击发操作后用板簧自动升高钉仓的刀片,从而锁定器械,阻止后续的击发操作。同样授予Bittner等人的美国专利No.5673842教导了使用细长构件的锁定机构,当器械被击发时该细长构件自动从第一位置旋转到第二位置。随着锁定臂处于第二位置,刀片向上自由平移并锁定器械。 
这种锁定机构不太适用于关节运动的外科缝合和切割器械设计中,在该设计中端部执行器定位在结合有关节运动机构的轴的端部。授予Hoffman的美国专利No.6786382公开了结合有用于将轴与端部执行器连接的关节运动机构的外科缝合和切割器械。通过穿过关节运动机构延伸的挠性击发机构实现缝钉的击发和组织的切割,该关节运动机构能够以挠曲或者非挠曲状态在其中传送较大的负载。尽管关节运动器械设计通常提供了更大的临床灵活性,在击发机构处于挠曲状态时,击发机构的几何结构和/或物理力的存在能够足以限制其垂直运动,使上述锁定机构不能有效地使用。 
因此,非常需要一种在关节运动外科缝合和切割器械中使用的改进的锁定机构,该锁定机构防止当钉仓中的缝钉用尽或者在未击 发位置没有钉仓时无意中击发(即,切割和缝合)。 
发明内容
本申请公开了一种外科器械,包括手柄部分、通道、砧座、钉仓、楔形构件、往复运动击发装置和锁定臂。手柄部分可操作地构造成产生击发运动并与通道部分连接。钉仓由通道接合并包括多个缝钉驱动器和缝钉。缝钉驱动器构造成使缝钉朝着与通道枢转连接的砧座突出。楔形构件位于缝钉驱动器的近侧并与其纵向对准,往复运动击发装置响应于击发运动将楔形构件从未击发位置逐渐地驱动到击发位置。锁定臂与通道枢转连接并可操作地构造成基于楔形构件的位置相对于击发装置在锁定位置和未锁定位置之间枢转。 
本申请还公开了一种外科器械,包括手柄部分、通道、砧座、钉仓、楔形构件、往复运动击发装置和至少一个锁定组件。手柄部分可操作地构造成产生击发运动并与通道部分连接。钉仓由通道接合并包括多个缝钉驱动器和缝钉。缝钉驱动器构造成使缝钉朝着与通道枢转连接的砧座突出。楔形构件位于缝钉驱动器的近侧并与其纵向对准,往复运动击发装置响应于击发运动将楔形构件从未击发位置逐渐地驱动到击发位置。每个锁定组件包括可动地设置在由通道限定的相应凹槽中的锁定仓。锁定仓基于楔形构件的位置相对于击发装置在锁定位置和未锁定位置之间运动。 
本申请还公开了一种外科器械,包括手柄部分、通道、砧座、钉仓、楔形构件和往复运动击发装置。手柄部分可操作地构造成产生击发运动并与通道部分连接。钉仓由通道接合并包括多个缝钉驱动器和缝钉。缝钉驱动器构造成使缝钉朝着与通道枢转连接的砧座突出。楔形构件位于缝钉驱动器的近侧并与其纵向对准,往复运动击发装置响应于击发运动将楔形构件从未击发位置逐渐地驱动到击发位置。击发装置包括远侧部分、近侧部分和连接近侧部分和远侧才部分的枢转部件。远侧部分基于楔形构件的位置相对于通道在锁定位置和未锁定位置之间枢转。 
本申请还公开了一种用于外科器械的端部执行器,包括通道、往复运动击发装置和锁定臂。通道用于容纳钉仓,击发装置响应于外科器械产生的击发运动将钉仓的楔形构件从未击发位置逐渐地驱动到击发位置。锁定臂与通道枢转连接,并可操作地构造成基于楔形构件的位置相对于击发装置在锁定位置和未锁定位置之间枢转。 
本申请还公开了一种用于外科器械的端部执行器,包括通道、往复运动击发装置和至少一个锁定组件。通道用于容纳钉仓,击发装置响应于外科器械产生的击发运动将钉仓的楔形构件从未击发位置逐渐地驱动到击发位置。每个锁定部件设置于通道中并靠近击发装置的相应侧表面,并且包括可动地设置在由通道限定的相应凹槽中的锁定仓。锁定仓构造成基于楔形构件的位置相对于击发装置在锁定位置和未锁定位置之间运动。 
本申请还公开了一种用于外科器械的端部执行器,包括通道、往复运动击发装置。通道用于容纳钉仓,击发装置响应于外科器械产生的击发运动将钉仓的楔形构件从未击发位置逐渐地驱动到击发位置。击发装置包括远侧部分、近侧部分和连接近侧部分和远侧部分的枢转部件。远侧部分基于楔形构件的位置相对于通道在锁定位置和未锁定位置之间枢转。 
本发明还涉及如下方面: 
(1)一种外科器械,包括: 
手柄部分,操作该手柄部分可产生击发运动; 
与手柄部分连接的通道; 
与通道枢转连接的砧座; 
钉仓,由通道接合并包括多个缝钉驱动器和缝钉,所述缝钉驱动器用于使缝钉朝着砧座突出; 
楔形构件,位于所述缝钉驱动器的近侧并且与所述缝钉驱动器纵向对准; 
往复运动击发装置,响应于击发运动将所述楔形构件从未击发位置逐渐驱动到击发位置;以及 
锁定臂,与通道枢转连接并可操作地构造成基于楔形构件的位置相对于击发装置在锁定位置和未锁定位置之间枢转。 
(2)如第(1)项所述的外科器械,还包括用于连接所述手柄部分和所述通道的轴,该轴包括关节运动机构。 
(3)如第(1)项所述的外科器械,其中,所述锁定臂包括第一端部、第二端部和设置在所述第一端部和所述第二端部之间的枢转部件,所述枢转部件与所述通道相配合。 
(4)如第(3)项所述的外科器械,其中,所述锁定臂限定了具有开放端部的槽,该槽穿过所述第一端部并进入一部分第二端部。 
(5)如第(3)项所述的外科器械,其中,所述锁定臂的第一端部可操作地构造成当处于未击发位置时由所述楔形构件下压接合,使所述锁定臂的第二端部在升高的位置中相对于所述击发装置枢转,所述第一端部的下压接合和所述第二端部的升高对应于所述锁定臂的未锁定位置。 
(6)如第(5)项所述的外科器械,还包括用于施加使所述锁定臂的第一端部升高的力的偏置部件,当所述楔形构件不处于未击发位置中时所述锁定臂的第二端部在下压位置中相对于击发装置枢转,所述第一端部的升高和所述第二端部的下压对应于所述锁定臂的锁定位置。 
(7)如第(6)项所述的外科器械,其中,当所述锁定臂处于锁定位置时,所述锁定臂的第二端部可操作地构造成与击发装置接合,防止击发装置向远侧运动。 
(8)如第(7)项所述的外科器械,其中,所述锁定臂的第二端部包括锁定销,用于当所述锁定臂处于击发位置时接合由所述击发装置限定的凹口。 
(9)一种外科器械,包括: 
手柄部分,操作该手柄部分可产生击发运动; 
与手柄部分连接的通道; 
与通道枢转连接的砧座; 
钉仓,由通道接合并包括多个缝钉驱动器和缝钉,所述缝钉驱动器用于使缝钉朝着砧座突出; 
楔形构件,位于所述缝钉驱动器的近侧并且与所述缝钉驱动器纵向对准; 
往复运动击发装置,响应于击发运动将所述楔形构件从未击发位置逐渐驱动到击发位置;以及 
至少一个锁定组件,定位在所述通道中并靠近所述击发装置的相应侧面,每个锁定组件包括可动地设置在由所述通道限定的相应凹槽中的锁定仓,其中,所述锁定仓基于所述楔形构件的位置相对于所述击发装置在锁定位置和未锁定位置之间运动。 
(10)如第(9)项所述的外科器械,还包括用于连接所述手柄部分和所述通道的轴,该轴包括关节运动机构。 
(11)如第(9)项所述的外科器械,其中,每个锁定组件还包括用于将力施加到所述锁定仓上的偏置部件,使一部分锁定仓在楔形构件不处于未击发位置时从相应的凹槽突出,所述锁定仓从凹槽的突出对应于其锁定位置。 
(12)如第(11)项所述的外科器械,其中,每个锁定组件的偏置部件包括弹簧指状件,所述弹簧指状件具有与所述锁定仓连接的第一端部和与所述通道连接的第二端部。 
(13)如第(12)项所述的外科器械,其中,每个锁定组件的锁定仓包括第一表面,该第一表面在所述锁定仓处于锁定位置时与所述击发装置的相应销接合,防止所述击发装置向远侧运动。 
(14)如第(13)项所述的外科器械,其中,每个锁定组件的锁定仓还包括第二表面,该第二表面在处于未击发位置时由楔形构件接合,使所述锁定仓被下压到相应的凹槽中,锁定仓的下压与其未锁定位置对应。 
(15)如第(14)项所述的外科器械,其中,每个锁定组件的锁定仓还包括第三表面,该第三表面在其进行往复运动期间与所述击发装置上的相应销滑动地接合。 
(16)一种外科器械,包括: 
手柄部分,操作该手柄部分可产生击发运动; 
与手柄部分连接的通道; 
与通道枢转连接的砧座; 
钉仓,由通道接合并包括多个缝钉驱动器和缝钉,所述缝钉驱动器用于使缝钉朝着砧座突出; 
楔形构件,位于所述缝钉驱动器的近侧并且与所述缝钉驱动器纵向对准;以及 
往复运动击发装置,响应于击发运动将楔形构件从未击发位置逐渐地驱动到击发位置,其中,所述击发装置包括远侧部分、近侧部分和连接近侧部分和远侧部分的枢转部件,远侧部分基于楔形构件的位置相对于所述通道在锁定位置和未锁定位置之间枢转。 
(17)如第(16)项所述的外科器械,还包括用于连接所述手柄部分和所述通道的轴,该轴包括关节运动机构。 
(18)如第(16)项所述的外科器械,其中,所述远侧部分可操作地构造成在所述击发装置向远侧运动期间由楔形构件接合,使所述远侧部分相对于所述通道枢转升高,所述远侧部分的枢转升高与其未锁定位置对应。 
(19)如第(18)项所述的外科器械,还包括偏置部件,用于在击发装置向远侧运动期间,在远侧部分不被楔形构件接合时,施加作用力以相对于所述通道推动远侧部分进入下压位置,所述远侧部分的下压位置与其锁定位置对应。 
(20)如第(19)项所述的外科器械,其中,所述击发装置的远侧部分包括至少一个销,所述销在所述远侧部分处于锁定位置时收纳在由通道的底部限定的相应凹槽中,防止击发装置进一步向远侧运动。 
(21)一种用于外科器械的端部执行器,包括: 
通道,用于装纳钉仓; 
往复运动击发装置,响应于由外科器械产生的击发运动将钉仓 的楔形构件从未击发位置逐渐驱动到击发位置;以及 
锁定臂,与通道枢转连接,并可操作地构造成基于楔形构件的位置相对于击发装置在锁定位置和未锁定位置之间枢转。 
(22)一种用于外科器械的端部执行器,包括: 
通道,用于装纳钉仓; 
往复运动击发装置,响应于由外科器械产生的击发运动将钉仓的楔形构件从未击发位置逐渐驱动到击发位置;以及 
至少一个锁定组件,定位在所述通道中并靠近所述击发装置的相应侧面,每个锁定组件包括可动地设置在由所述通道限定的相应凹槽中的锁定仓,其中,所述锁定仓基于所述楔形构件的位置相对于所述击发装置在锁定位置和未锁定位置之间运动。 
(23)一种用于外科器械的端部执行器,包括: 
通道,用于装纳钉仓; 
往复运动击发装置,响应于由外科器械产生的击发运动将钉仓的楔形构件从未击发位置逐渐地驱动到击发位置,其中,所述击发装置包括远侧部分、近侧部分和连接近侧部分和远侧部分的枢转部件,远侧部分基于楔形构件的位置相对于所述通道在锁定位置和未锁定位置之间枢转。 
附图说明
图1是根据各种实施方式的外科缝合和切割器械的前上方透视图,其具有打开的端部执行器或者缝钉施加组件,其中去除了钉仓; 
图2是根据各种实施方式的图1的外科缝合和切割器械的前上方透视图,其中关节运动机构由流体致动控制器致动; 
图3是根据各种实施方式的图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是根据各种实施方式的图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,所述器械包括缝钉施加组件和关节 运动机构; 
图5是根据各种实施方式的图3-4的外科缝合和切割器械的远端处的端部执行器的前上方透视图,其中去除了砧座并仅仅显示钉仓的楔形滑块; 
图6-8是根据各种实施方式的图3-4的端部执行器的横截面侧视图,图6中钉仓处于装载和未击发状态,图7中钉仓处于击发状态的,图8中的钉仓的缝钉耗尽并且击发杆处于回缩状态; 
图9是根据各种实施方式的图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,所述器械包括缝钉施加组件和关节运动机构; 
图10是根据各种实施方式的图9的外科缝合和切割器械的远端处的端部执行器的前上方透视图,其中去除了钉仓和砧座; 
图11-13是根据各种实施方式的图9的端部执行器的横截面视图,图11中钉仓处于装载和未击发状态,图12中钉仓处于击发状态的,图13中的钉仓的缝钉耗尽并且击发杆处于回缩状态; 
图14是根据各种实施方式的图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,所述器械包括缝钉施加组件和关节运动机构; 
图15是根据各种实施方式的图14的外科缝合和切割器械的远端处的端部执行器的前上方透视图,其中去除了砧座并仅仅显示钉仓的楔形滑块; 
图16-18是根据各种实施方式的图14的端部执行器的横截面视图,图16中钉仓处于装载和未击发状态,图17中钉仓处于击发状态,图18中缝钉耗尽的钉仓处于重新击发状态; 
具体实施方式
通过引用而全部或者部分并入本文中的任何专利、公开出版物或者其它公开的材料,仅限于不会与在本申请中公开的定义、陈述或者其它公开的材料相矛盾的部分。如此一来,必要时这里明显阐述 的公开内容替代任何通过引用而并入本文中的相矛盾的材料。被声称通过引用并入本文中但是与本发明公开的定义、陈述或者其它公开的材料矛盾的任何材料或其部分将只并入不会使得所并入的材料与本发明公开的材料相矛盾的部分。 
参照附图,其中相同的附图标记在全部附图中表示相同的元件。图1示出了外科器械,其在示例性方案中更具体地是外科缝合和切割器械10,能够实施本发明的独特优点。特别地,在如图1所示的未进行关节运动的状态下,外科缝合和切割器械10的大小适于经过套管针插管通道插入到患者(未显示)体内的手术部位进行外科手术。如图2中所示,一旦执行部分12经过插管通道插入,包含在执行部分12的细长轴16的远侧部分中的关节运动机构14可通过关节运动控制器18遥控而关节运动。在示例性方案中显示为缝钉施加组件20的端部执行器远侧连接到关节运动机构14上。因此,关节运动机构14的遥控关节运动使缝钉施加组件20从细长轴16的纵向轴线关节运动。这种倾斜的位置在从切割和缝合需要的角度接近组织方面可具有优点(否则其它器官和组织妨碍接近组织),和/或允许内窥镜被定位在缝钉施加组件20后面并与其对准,用于确保就位。 
外科和缝合和切割器械10包括近侧与执行部分12连接的手柄部分22,用于为其提供定位、关节运动、闭合和击发运动。手柄部分22包括手枪式把手24,外科医生向着该手枪式把手24枢转地向近侧拉动闭合扳机26,引起缝钉施加组件20的夹钳或闭合。击发扳机28在闭合扳机26更远的外侧,并由临床医生枢转拉动,引起夹钳在缝钉施加组件20中的夹钳组织的缝合和切割。此后,按压闭合释放按钮30,释放夹钳的闭合扳机26,由此释放切割及缝合的夹钳组织的端部。手柄部分22还包括连接与细长轴16一起运动的旋钮32,使轴16和关节运动的缝钉施加组件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,在发生束缚时帮助回缩击发机构(在图1-2中未显示),使缝钉施加组件20的打开可随后发生。 
应当理解,术语“近侧”和“远侧”以握持器械的手柄的临床医生为参照。因此,相对于更近侧的手柄部分22而言,缝钉施加组件20位于远侧。还应当理解,为了方便和清楚起见,使用的空间术语例如“垂直”和“水平”以图为参照。但是,可以多种方位和位置使用外科器械,这些术语并不意味着限制和绝对化。 
用于图1-2的外科缝合和切割器械10的示例性多冲程手柄部分22在待审的共有美国专利申请“SURGICAL STAPLINGINSTRUMENT INCORPORTATING A MULTISTROKE FIRINGPOSITION INDICATOR AND RETRACTION MECHANISM”中更详细地描述,该申请是Swayze和Shelton IV于2003年9月29日提交,申请号为10/674,026,其公开的全部内容加上其中描述的附加特征和变型通过引用并入本文。尽管多冲程手柄22有利地支持长距离的具有较高击发力的应用,与本发明一致的应用还可包括单击发冲程,诸如在待审的共有美国专利申请“SURGICAL STAPLINGINSTRUMENT HAVING SEPARATE DISTINCT CLOSING ANDFIRING SYSTEMS”中更详细地描述的一样,该申请是Frederick E.Shelton IV、Michael E.Setser和Brian J.Hemmelgarn于2004年11月25日提交,申请号为10/441,632,其公开的全部内容通过引用并入本文。 
在图3-4中,执行部分12有利地包括在适于内窥镜和腹腔镜手术的小直径中的纵向旋转、关节运动、闭合和击发的多种致动运动。缝钉施加组件20(“端部执行器”)具有一对枢转的相对夹钳,图示为具有枢转连接的砧座42(图1-2,4)的细长通道40。通过用框架组件44(图3)支撑细长通道40实现砧座42朝细长通道40的闭合和夹钳,所述框架组件44转动地连接到手柄部分22上,双枢轴闭合套管组件46在手柄部分22上纵向运动,分别将向远侧和近侧运动的闭合和打开施加到砧座42上,甚至如图2中所示缝钉施加组件20关节运动。 
特别参照图3,框架组件44包括单枢轴框架底48,其近端与旋 钮32接合,右半壳50位于其上,如图3所示。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的内部与使闭合套管组件46纵向平移的闭合元件(未显示)接合。闭合直管52的近端处的环形凸缘54提供了与所述元件的旋转接合。旋钮32的接合元件穿过封闭直管52近侧部分上的纵向狭槽56与近侧定位在框架底48上的开孔58接合。纵向狭槽56具有足够的长度,允许闭合套管组件46以通过旋钮32对闭合套管组件46和框架底48设定的各种旋转角度闭合纵向平移。 
细长轴16通过收纳与手柄部分22(未显示)的击发元件旋转接合的击发杆60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的远侧部分包括沿着其底部与近侧开口62连通的击发杆狭槽64。击发杆66在击发杆狭槽64中纵向平移,并包括与击发杆60的远端70接合的向上突起的近侧销68。 
细长轴16通过结合有矩形储存腔72支持关节运动,所示的储存腔72的一个侧部位于旋钮32的远侧。位于矩形储存腔72中的底部室74具有横向间隔设置的左右挡板76、78。关节运动致动器80在底部室74的顶部上横向滑动,在挡板76、78外侧的向下横向间隔设置的凸缘82、84分别与从旋钮32的相应半壳向外伸出的左右推动按钮86、88横向连通。关节运动致动器80的横向运动将左右凸缘82、84拉得更近,分别拉到左右挡板76、78,靠在流体关节运动系统94的左右储存囊90、92上,每个囊90、92分别远侧与左右流体导管或者通道96、98连通,该左右流体导管或者通道96、98分别与左右致动囊100、102连通。左右致动囊100、102相对并使关节运动机构14的T-杆104横向枢转。 
框架组件44通过包括框架底48的顶部且远侧的凹入板106限制这些流体的致动,框架底48上有流体通道96、98和致动囊100、102。T-杆104也滑动地位于致动囊100、102之间的凹入板106上。在T-杆104的近侧,突出的屏障肋108与其对准,用于防止流体通道96、98向内膨胀。框架组件44具有圆形顶部框架盖(隔离片) 110,其在框架底48顶部上滑动,防止流体通道96、98和致动囊100、102垂直膨胀,同时限制T-杆104的任何垂直运动。 
T-杆104的远端(“导轨”)112接合以使关节运动机构14的关节运动的远侧框架构件114的指向近侧的扇形齿轮115枢转。关节运动闭合环116环绕关节运动的框架构件114并包括与砧座42接合的马蹄形开口118。在关节运动机构14上在闭合直管52和关节运动闭合环116之间形成双枢轴连接,甚至在关节运动机构14关节运动时也允许纵向闭合运动。特别地,在具有销孔122、124的闭合直管52上的顶部和底部向远侧突出的枢轴翼片119、120分别与分别具有销孔130、132的关节运动闭合环116上的相应的顶部和底部向近侧突出的枢轴翼片126、128纵向间隔开。上部双枢轴连接件134具有纵向间隔的指向上的远侧后部销136、138,它们分别与销孔130、122接合,下部双枢轴连接件140具有纵向间隔的向下突出的远侧后部销142、144,它们分别与销孔132、124接合。 
特别参照图4,关节运动闭合环116显示为具有增强的可制造性,包括短管146,该短管146与包括向近侧突出的枢轴翼片126、128的关节运动连接套环148连接。类似地,闭合直管52由长闭合管160组装,该长闭合管160与包括向远侧突出的枢轴翼片119、120的后连接套环152连接。短闭合管146中的马蹄形开口118与稍位于横向枢轴销156近侧的向上突出的砧座零件154接合,该横向枢轴销156与细长通道40内部的枢轴凹槽158接合。 
图4的示例性方案包括狗骨连接件160,其近侧销157与框架孔161中的框架底48枢转连接,其远侧销159与关节运动框架构件114的近侧下表面162刚性连接,从而在其间提供枢转支撑。狗骨连接件160中的底部纵向刀片槽163引导击发杆66的关节运动部分。关节运动框架构件114还包括底部纵向槽164,用于引导击发杆66的远侧部分。 
参照图4,击发杆66远侧终止于E-梁165,该E-梁165包括进入砧座42的砧座槽168中的上部导销166,在缝钉形成和切割期间 检验并帮助将砧座42保持为闭合状态。细长通道40和砧座42之间的间隔进一步由E-梁165通过使中间销170沿着细长通道40的顶面滑动,同时底座172相对地沿着细长通道40的下表面滑动,由细长通道40中的纵向开口174的引导。位于上部导销166和中间销170之间的E-梁165的位于远侧的切割表面176切割夹钳的组织,同时E-梁通过向远端移动楔形滑块180致动可替换的钉仓178,该楔形滑块180引起缝钉驱动器182向上突出驱动缝钉184脱离钉仓主体188中的向上打开的缝钉孔186,从而在砧座42的缝钉形成下表面190上成型。钉仓盘192从钉仓178的其它元件的底部围绕,将它们保持在适当的位置。钉仓盘192包括叠在细长通道40中的纵向开口174上的向后打开的槽194。因此,中间销170穿过钉仓盘192的内部。 
缝钉施加组件20的实施例在待审的共有美国专利申请“ARTICULATING SURGICAL STAPLING INSTRUMENTINCORPORATING A TWO-PIECE-BEAM FIRING MECHANISM”中更详细地描述,该申请由Frederick E.Shelton IV于2004年9月30日提交,申请号为10/955,042,其公开的全部内容通过引用并入本文。 
在图3-4中,有利地包含有关节运动锁定机构200,将缝钉施加组件20保持在需要的关节运动角度。关节运动锁定机构200减小了左右致动囊100、102上的负载。特别地,压缩弹簧202(图3)近侧定位于关节运动锁定元件111的近端204和手柄部分22之间,将关节运动锁定元件111向远侧偏置。特别参照图4,位于关节运动锁定元件111的远端210的两个平行的槽206、208分别装纳框架底48上向上突出的导向肋212、214。导向肋212、214的纵向长度比平行槽206、208短,允许相对的纵向运行范围。因此,远侧摩擦表面的选择性抵接接合件,图示为从关节运动锁定元件111向远侧突出的带齿的凹槽216,与装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中的对应的锁定扇形齿轮217接合。制动板218中的远侧和近侧孔221、222装纳从顶部近侧凹槽220向上突出的远侧和近侧销223、224。 
关节运动锁定机构200的实施例在待审的共有美国专利申请“SURGICAL INSTRUMENT INCORPORATING A FLUIDTRANSFER CONTROLLED ARTICULATION MECHANISM”中更详细地描述,该申请由Kenneth S.Wales等人于2005年2月18日提交,申请号为11/061,908,其公开的全部内容通过引用并入本文。 
在图3-4中,执行部分12有利地包括与细长通道40枢转连接的锁定臂226,其被构造成根据楔形滑块180的位置在锁定位置和未锁定位置之间相对于击发杆66枢转。锁定臂226围绕击发杆66的远端定位,并包括相对于E-梁165位于近侧的第一端部228、沿着远离第一端部228的近侧方向并沿着击发杆66延伸的第二端部230、以及定位于第一和第二端部228、230之间用于与细长通道40中形成的相应枢轴凹槽234配合地接合的枢转部件232。如图所示,枢转部件232可以为一对枢轴销232,其在锁定臂226的相对两侧对称形成。锁定臂226限定了具有开放端部的槽236,其穿过第一端部228并进入一部分第二端部230,从而使锁定臂226能够围绕击发杆66以跨式(straddle-like)构造设置,使击发杆66可穿过锁定臂226。 
锁定臂226的第一端部228包括因开放端部的槽236的通过形成的一对对称齿238。当击发杆66处于回缩位置时,每个齿238相对于对应的E-梁的侧面邻近定位,并沿着它向远侧延伸。如图所示,每个齿238具有向下倾斜部分的特征,该向下倾斜部分过渡到具有平的朝上的表面的尖端部分中,当位于未击发位置时,该朝上的表面适于通过楔形滑块180的底面下压接合。第一端部228还包括偏置部件240,用于通过楔形滑块180施加与齿238的下压接合方向相反的指向上的力。因此,当楔形滑块180不位于未击发位置中时,偏置部件240引起锁定臂226的第一端部228被枢转升高。如图所示,偏置部件240可以是一对设置在齿238之间并且与长通道40的底部接触的向下延伸的弹簧指状件240。 
锁定臂226的第二端部230离开第一端部228沿着击发杆66的相对的侧面向近侧延伸,并过渡到具有位于击发杆66上方的平的尖 端部分242的向上倾斜部分中。如图所示,第二端部230可具有适当的轮廓,使器械10的操作期间在锁定臂226和砧座42的砧座销156之间提供足够的间隙。第二端部230包括与尖端部分242连接的锁定销244,其被构造成当第二端部230在下压位置相对于其枢转时与击发杆66限定的凹口246接合。相反,当第二端部230在升高的位置相对于击发杆66枢转时锁定销244与凹口246脱离。提供靠近凹口246并从其向近端倾斜的在击发杆66上形成的倾斜轮廓248,用于在击发杆66的往复运动期间引导锁定销244,如将在下面参照图6-8讨论的一样。 
锁定臂226的第二端部230的位置通过由楔形滑块180接合的第一端部226来确定。特别地,当楔形滑块180处于未击发状态时,齿238被楔形滑块下压接合导致第二端部相对于击发杆66可枢转地升高。因此,引起锁定销244与凹口246脱离接合,从而响应于击发运动允许击发杆66向远侧运动。第一端部228的下压接合和产生的第二端部230的枢转升高与锁定臂226的未锁定位置对应。当楔形滑块180没有处于未击发位置时(例如,在击发操作之后),偏置部件240用于使第一端部228枢转升高,引起第二端部相对于击发杆66被枢转下压。因此,锁定销244与凹口246接合,从而防止击发杆66向远侧运动。第一端部228的升高和所导致的第二端部230的枢转下压与锁定臂226的锁定位置对应。 
图5是位于图3-4的外科缝合和切割器械10的远端的端部执行器20的前上方透视图,其中砧座42被去除,为清楚起见仅仅显示钉仓178的楔形滑块180。击发杆66显示为处于回缩状态,其中锁定臂66相对于其处于未锁定位置中。由楔形滑块180处于未击发位置所导致的齿238的下压接合导致锁定臂226的第二端部230相对于击发杆66的枢转升高。因此,如图5中所示,锁定销244与凹口246脱离,从而使击发杆66能够向远侧运动。重要的是,由于锁定臂226的位置仅仅取决于楔形滑块180的位置,锁定臂66的操作不受由关节运动机构14的致动产生的击发杆66弯曲的影响。 
图6-8示出了当外科缝合和切割器械10被击发时,锁定臂226在图3-4的端部执行器中的顺序操作。在图6中,未击发的钉仓178已经被插入到细长通道40中,其中楔形滑块180与锁定臂226的齿238下压接合。因此,锁定臂226处于未锁定位置,并且锁定销244与击发杆66的槽246脱离。 
在图7中,钉仓178的击发已经开始,其中楔形滑块180向远侧横过锁定臂226的齿238。因此,锁定臂226的第一端部228被偏置部件240枢转升高,引起锁定销244与击发杆66接触。在击发杆66随后的向远侧运动期间,锁定销244持续保持与击发杆66滑动接触并横过其近侧部分,包括成形部分248。 
在图8中,显示了刚回缩的击发杆66。锁定销244沿着相反的方向再次横过击发杆66的近侧部分,其与凹口246垂直对准而终止。由于楔形滑块180不再处于未击发位置,锁定臂66的第二端部230保持在相对于击发杆66的下压位置,导致凹口246被锁定销244接合,如图8中所示。由锁定销244在成形部分248上方向上横过引起的偏置部件240的压缩确保凹口246通过适量的力被锁定销244接合。因此,锁定臂226处于锁定位置,击发杆向远侧的运动被阻止,直到缝钉用尽的钉仓178被替换。 
作为图3-4的锁定臂226的另一种选择,图9的执行部分12的实施例有利地包括至少一个锁定组件250,其安装在细长通道40中并且当击发杆66处于回缩位置时相对于E-梁的相应侧面邻近定位。在优选实施例中,如图9所示,提供两个锁定组件250,尽管可以理解也可利用单个锁定组件250。每个锁定组件250包括可动地设置在由细长通道40的底面限定的相应凹槽254中的锁定仓252,其构造成根据楔形滑块180的位置在锁定位置和未锁定位置之间相对于E-梁165运动。每个锁定组件250还包括用于将指向上的力施加到锁定仓252的偏置部件256,当楔形滑块180没有处于未击发位置时使一部分锁定仓252从相应的凹槽252突出。如图9所示,用于每个锁定仓252的偏置部件256可以是具有与锁定仓252连接的向内延 伸的第一端部258和与细长通道40的侧面连接的向上延伸的第二端部260的弹簧指状件256。当处于放松(即未压缩)状态时,第一端部258向上倾斜,使锁定仓252的一部分适当地从其相应凹槽254突起,最好见下面讨论的图10。优选地,每个弹簧指状件256的第二端部260以平齐的方式(例如,在形成的凹槽中)连接到相应的细长通道40的表面上,使钉仓178可被细长通道40容纳而不需要变化。 
图10是图9的组装的端部执行器20的前上方透视图,其位于外科缝合和切割器械10的远端,其中为清楚起见,钉仓178和砧座42被去除。如图所示,每个锁定仓252包括朝向近侧的侧向第一表面262,当锁定仓252处于锁定位置(即,从细长通道40的凹槽254突出)时,该侧面构造成用于接合E-梁165的相应中间销170。当出于锁定位置时,锁定仓252接合中间销170,从而防止了击发杆66向远侧运动。 
每个锁定仓252还可包括朝向上的第二表面264,其被构造成当处于未击发位置时由楔形滑块180的底面接合。第二表面264以这种方式的接合足以克服由偏置部件256施加到锁定仓252的力。因此,每个锁定仓252都被下压到其相应的凹槽254中,使第一表面与E-梁165的对应中间销170脱离,从而使击发杆66能向远侧运动。每个锁定仓252的下压位置对应于其锁定位置。 
每个锁定仓252还可包括朝向远侧的倾斜第三表面266,其构造成刚好在击发杆66回缩之前与E-梁165的相应中间销170滑动接合。以这种方式的第三表面266的接合操作,瞬间时使每个锁定仓252下压,从而允许击发杆66完全回缩。当击发杆66完全缩回时,引起每个锁定仓252从处于锁定位置中的其相应凹槽254突出,使第一表面262与相应的中间销170接合。重要的是,由于锁定仓252的位置仅仅取决于楔形滑块180的位置,锁定组件的操作不受由关节运动机构14的致动产生的击发杆66弯曲的影响。 
图11-13示出了当外科缝合和切割器械10被击发时,锁定组件 250在图9-10的端部执行器中的顺序操作。在图11中,未击发的钉仓178已经被插入到细长通道40中,其中楔形滑块180与第二表面264接合,使每个锁定仓252被下压到细长通道40中其相应的凹槽254中。因此,每个锁定仓252都保持在未锁定位置,并且第一表面262与E-梁165的相应中间销170脱离。 
在图12中,钉仓178的击发已经开始,其中楔形滑块180(未显示)向远侧横过锁定仓252的第二表面264。因此,由于通过偏置部件256施加于其上的力,使锁定仓252从它们相应的凹槽254突出。 
在图13中,在锁定仓252的第三表面266被相应的中间销170滑动接合后,E-梁165显示处于完全回缩位置。由于楔形滑块180不再处于未击发位置,每个锁定仓252从处于锁定位置的其相应凹槽254突出,使中间销170被第一表面262接合,从而防止击发杆66随后向远侧运动,直到缝钉用尽的钉仓178被替换。 
作为图3-4的锁定臂226和图9-10的锁定组件250的另一种选择,图14的执行部分12的实施例有利地包括两片击发杆268,其包括与近侧部分272枢转连接的远侧部分270。击发杆268的远侧部分270构造成根据楔形滑块180的位置在锁定和未锁定位置之间相对于细长通道40枢转。 
如图14所示,近侧部分272包括在远侧定位在其相对的侧面上的一对枢轴销274。远侧部分270包括一对对称形成的枢转板276,每个具有在其中形成的近侧孔278,用于与近侧部分272的相应枢轴销274配合地接合。远侧部分270还包括与上述E-梁165类似的E-梁280,其具有成形的近侧凹槽282,用于接合由每个枢转板276的远端形成的相对成形的销284,从而能够在其间形成基本上刚性的连接。因此包括E-梁280的击发杆268的远侧部分270允许在垂直平面中相对于其近侧部分272枢转。 
每个枢转板276还包括在其远端底部上形成的向下伸出的销286,该销286包括朝向近侧的成形表面288。当枢转板276被E-梁 280接合时,销286保持对准,从而有效地限定了共同的销。当击发杆268处于完全回缩位置时,销286与靠近纵向开口174的近端的细长通道40的底部接触,从而可支撑地将远侧部分270相对于细长通道40保持在升高的位置。当击发杆268处于与完全回缩位置不同的位置时(例如,在伸出或者缩回期间),销268与纵向槽174对准,不再与细长通道40的底部接触。因此,对于这种位置而言,远侧部分270不由销286支撑。 
E-梁280包括在其远端形成的前端290,其构造成通过近侧部分楔形滑块180可支撑地接合。因此,在由起击发杆268延伸引起的楔形滑块180向远侧运动期间,前端290将E-梁280相对于细长通道40保持在升高的位置(由此保持击发杆268的远侧部分270)。前端290由楔形滑块180的支撑接合,所导致的远侧部分270的升高位置对应于其未锁定位置。 
最好见图15,细长通道40包括一对由其底部限定并对称设置在纵向槽174的相对两侧上的凹槽292。凹槽292被定位成当击发杆268完全回缩时,都位于E-梁280的相应中间销170的下方并略靠前。当楔形滑块180没有处于未击发位置时,在击发杆268延伸期间E-梁280的前端290不被支撑。击发杆268的远侧部分270由此允许相对于细长通道40向下枢转到压缩位置,使中间销170被装纳在相应的凹槽292中。每个凹槽292限定了垂直定向的远侧表面294,用于接合相应中间销170的相对的远侧部分,从而防止击发杆268进一步向远侧运动。如图14所示,偏置部件296,所示为弹簧构件296可包含在执行部分12中,用于将远侧部分270向下推动到锁定位置中。 
再次参见图15,每个凹槽292还限定了倾斜的近侧表面298,用于在击发杆268回缩期间滑动接合相应的中间销170,使远侧部分270向上枢转,从而有利于中间销170从凹槽292中回缩。击发杆268回缩到完全回缩位置引起销286的成形表面288与靠近纵向槽174的近端的细长通道40的底部滑动接合,从而将远侧部分270过 渡到未锁定位置。 
在图15中,所示的击发杆268处于完全回缩状态,其中远侧部分270相对于细长通道40保持在枢转升高的位置(即未锁定位置)。重要的是,由于击发杆268的远侧部分270需要被升高或者下压以在未锁定和锁定位置之间的过渡,锁定机构不受由关节运动机构14的致动产生的近侧部分272的弯曲的影响。 
图16-18示出了当外科缝合和切割器械10被击发时,击发杆268在图14的端部执行器中的顺序操作。在图16中,未击发的钉仓178已经被插入到细长通道40中,其中楔形滑块180可支撑地接合E-梁280的前端290。远侧部分270通过销286支撑在升高(即未锁定)位置,中间销270定位在相应的凹槽292上方。 
在图17中,钉仓178的击发已经开始。尽管远侧部分270不再由销286支撑,前端290被楔形滑块180接合,防止了远侧部分270响应于由偏置部件296施加于其上的力而向下枢转。因此,远侧部分270保持充分升高,使中间销170不被收纳在凹槽292中,允许击发杆268向远侧连续运动。 
在图18中,显示了在完全回缩并再次击发而没有替换刚用过的钉仓178之后的击发杆268。由于楔形滑块180不再存在,E-梁280的前端290由此不再被支撑地接合。偏置部件296从而引起远侧部分270被枢转下压到锁定位置,使中间销170装纳在相应的凹槽292中。中间销170被凹槽292的远侧表面294接合,防止了击发杆268进一步向远侧运动。 
虽然已经通过描述一些实施例对本发明进行了解释,虽然这些示例性实施例已经描述得相当详细,并不意味着申请人将后附权利要求的范围限定或者以任何方式限制得如此详细。本领域技术人员容易想到其它优点和修改。 
例如,应当理解,上述锁定机构的实施例可被包含到具有可通过不同于流体致动控制的关节运动机构(例如齿轮驱动关节运动机构)的关节运动外科缝合和切割器械中。还应当理解,上述锁定机 构的实施例不是将它们的应用限制在关节运动器械设计中,还可有利地包含于非关节运动器械中。 

Claims (4)

1.一种外科器械,包括:
手柄部分,操作该手柄部分可产生击发运动;
与手柄部分连接的通道;
与通道枢转连接的砧座;
钉仓,由通道接合并包括多个缝钉驱动器和缝钉,所述缝钉驱动器用于使缝钉朝着砧座突出;
楔形构件,位于所述缝钉驱动器的近侧并且与所述缝钉驱动器纵向对准;
往复运动击发装置,响应于击发运动将所述楔形构件从未击发位置逐渐驱动到击发位置;以及
锁定臂,与通道枢转连接并可操作地构造成基于楔形构件的位置相对于击发装置在锁定位置和未锁定位置之间枢转;
所述锁定臂包括第一端部、第二端部和设置在所述第一端部和所述第二端部之间的枢转部件,所述枢转部件与所述通道相配合;
所述锁定臂的第一端部可操作地构造成当处于未击发位置时由所述楔形构件下压接合,使所述锁定臂的第二端部在升高的位置中相对于所述击发装置枢转,所述第一端部的下压接合和所述第二端部的升高对应于所述锁定臂的未锁定位置;
所述外科器械还包括用于施加使所述锁定臂的第一端部升高的力的偏置部件,当所述楔形构件不处于未击发位置中时所述锁定臂的第二端部在下压位置中相对于击发装置枢转,所述第一端部的升高和所述第二端部的下压对应于所述锁定臂的锁定位置;
当所述锁定臂处于锁定位置时,所述锁定臂的第二端部可操作地构造成与击发装置接合,防止击发杆向远侧运动。
2.如权利要求1所述的外科器械,还包括用于连接所述手柄部分和所述通道的轴,该轴包括关节运动机构。
3.如权利要求1所述的外科器械,其特征为,所述锁定臂限定 了具有开放端部的槽,该槽穿过所述第一端部并进入一部分第二端部。
4.如权利要求1所述的外科器械,其特征为,所述锁定臂的第二端部包括锁定销,用于当所述锁定臂处于击发位置时接合由所述击发装置限定的凹口。 
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DE602006019805D1 (de) 2011-03-10
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EP1782738B1 (en) 2011-01-26
CA2566668C (en) 2014-08-26
BRPI0604524B8 (pt) 2021-06-22
MXPA06012763A (es) 2007-05-03
US7328828B2 (en) 2008-02-12
BRPI0604524A (pt) 2007-08-28
US20070102475A1 (en) 2007-05-10
EP1782738A3 (en) 2007-07-04
CN1957854A (zh) 2007-05-09
ATE496580T1 (de) 2011-02-15
EP1782738A2 (en) 2007-05-09

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