CN1163558A - 具有可拆卸的端部操作装置的内窥镜仪器 - Google Patents
具有可拆卸的端部操作装置的内窥镜仪器 Download PDFInfo
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Abstract
一有手柄、圆筒和可拆卸端部担任装置的外科仪器。管状圆筒的一端连接于手柄。端部操作装置可分离地连接于圆筒另一端,并具有通过多个连接件连接于在手柄内的或连接于手柄的动力源而可独立地枢转、旋转或操作的钳片。用手柄内的微处理机和多维控制器或电接触操作和控制仪器。实施例中用锁定装置手动控制钳片的闭合,端部操作装置呈是剪刀状,但可以是如抓紧器、夹具、剥离器或针驱动件的其它端部操作装置,可用适当的操作和连接件连接于手柄。
Description
技术领域
本发明总的涉及外科仪器领域。本发明尤其涉及一种用于内窥镜外科过程的外科仪器,特别是带有端部操作装置的仪器可以用一只手来定位和操纵。
发明背景
内窥镜检查(例如腹腔镜检查、胸腔镜检查、关节镜检查等等)是外科检查的一种形式,这种形式包括用一发光的光学仪器、一内窥镜来显影体内的情况以及用外科仪器施行手术的过程。内窥镜和其它外科仪器通过小的穿刺孔进入体内。
内窥镜检查过程一般是从使用一称为套管针的装置开始着手的。套管针包括一套管或套管针套(一具有中心腔的空心护套或套)和一在套管内的锋利的闭塞器(obturator)。用套管针来穿透腹部壁或胸。套管针的内腹部端进入腹腔之后,闭塞器从套管中抽出,在整个外科检查过程中,套管留在腹部壁中,使外科仪器可以进入腹腔。套管针以及套管有各种尺寸以适应各种各种各样的仪器。
传统的腹腔镜类型的内窥镜几乎只用于妇科的外科。但是,专门从事其它领域的内科医生已开始认识到内窥镜的诊断和手术价值。
内窥镜外科的优点包括:各种过程可以在病人体外进行;在不施行剖腹术、即腹壁上没有大切口的情况下,外科医生有机会观察腹内内脏;形成小的穿刺孔或伤口而不是大切口,从而减小外伤;由于缩短了在医院的滞留时间而减少了病人和保险公司需付出的费用;以及能减轻术后病人的难受程度,缩短了病人的恢复时间。
因此,提供专门任务的外科仪器,尤其是适用于现在用内窥镜进行的普通外科过程的外科仪器是很重要的而且是必要的。由于内窥镜检查尤其是腹腔镜检查是普通外科领域内的一项正在发展的专门课题,因此目前市场上的仪器不足以满足用腹腔镜检查的外科医生的需要。
设计成内窥镜检查过程的外科仪器一般采用外科工具的形式(此后程端部操作装置),例如剪刀、剥离器和切割钳片(cutting jaw),用一在细长轴的里面或外面的操纵连接机构把所述外科工具连接到该轴的远端。一连接于轴的相对端即近端的手柄通常有一个相联的手动机构以操纵端部操作装置,并可有一第二手动机构以转动轴和端部操作装置。一般来讲,为了适合通过小直径孔口或切口,为单一的、专门用途设计一仪器。理想的是,外科医生选择仪器是根据他的偏爱以及手中正在进行的步骤。但是,用于使用附加仪器涉及到的费用和取出一种仪器再放进另一种仪器所需的时间,外科医生倾向于用最初使用的仪器来进行工作,即使另外一种仪器更适合于即刻在做的任务。
目前的内窥镜外科仪器仅给外科医生提供有限的,在不必从病人体内取出仪器的情况下再定位端部操作装置的能力。特别重要的是:使现有仪器的端部操作装置相对于它们细长轴的纵向轴线枢转的有限能力。端部操作装置一般是固定地连接于细长轴,因此,无论如何是没有枢转能力的。当使用一没有枢转能力的仪器时,为了直接进入施行对象的组织或内部结构,孔的正确位置就显得至关重要。由于端部操作装置相对于仪器轴的位置往往是固定的,因此就必需增加些附加的腹腔镜孔或切口,以形成一合适的仪器角度和到达要做手术的组织的入口。
授予Zvenyatsky等人的美国专利5,383,888揭示了具有一种装置的内窥镜检查外科仪器,当外科医生在操作时使用这个装置能枢转外科工具,但是,这种枢转能力受到所采用的枢转装置的限制。Zvenyatsky等人发明的仪器的端部操作装置固定地连接于一称为铰接部分(articulating section)的中间件上,该中间件自己又可枢转地连接于仪器的细长轴上。因此,Zvenyatsky等人发明的仪器中的枢转动作包括铰接构件和外科工具的枢转。所以可以看出,在Zvenyatsky等人发明的仪器中的铰接总半径(即枢转半径)等于铰接件的长度加上外科工具的长度。
最好使铰接的半径达到可能的最短程度。至所以如此,是因为外科医生一般只关心外科工具的位置和角度。换句话讲,医生用一枢转头经过一垂直于细长轴的较长的距离到达工作区域的这种情况几乎是没有的。因此,当外科医生枢转外科工具时,该外科医生必需在相反的方向横向移动细长轴一段与铰接的半径成正比的距离。虽然这种移动的本身不难,但该移动被铰接部分的长度所放大,端部操作装置横向离轴近端的精确定位的复杂化又使腹腔镜的摄像机缺乏识别深度的能力。因此可以看到,活动的半径越大,精确定位端部操作装置就越困难。此外,由于在外科手术部位的空间受到限制,使用Zvenyatsky等人发明的仪器的外科医生不可能有足够的空间在一个方向上横向移动细长轴,以便在另一方向枢转外科工具,或类似地,对于要枢转的铰接件和外科工具的总长度来讲不可能有足够的空间。
目前内窥镜外科仪器设计上的另一种限制是端部操作装置的再定位,一外科医生必需用两只手,一只手要手动控制一拇指轮或旋钮以旋转该轴(和端部操作装置),另一只手要握持仪器。这就意味着不得不放掉正在使用的第二只仪器,或者求助内科医生或护士提供帮助。
其次,要求端部操作装置能方便地从细长轴的远端拆下来。这样能使外科医生对于各种不同的外科操作过程使用同一个手柄和细长轴,从而节省了附加的手柄和轴的费用。此外,有了可拆卸的端部操作装置,就能快速而方便地清洁端部操作装置,并把它弄锋利。另外,端部操作装置可被设计成是一次性使用的,而手柄和细长轴可重复使用。
对于具有三维自由度例如旋转、枢转和夹紧的端部操作装置的内窥镜外科仪器来讲,人们不知道有端部操作装置的拆卸机构存在。授予Marlow等人的美国专利5,368,606揭示了一种内窥镜外科工具,在该内窥镜外科工具中的头部工具是可以从细长轴上取下的。连接机构包括一旋入到细长轴的、有螺纹的端部操作装置支承件。端部操作装置支承件的内部是一通过在一球座中的球连接于一在细长轴内延伸的杆的短轴。与此杆联合操作的短轴控制端部操作装置的夹紧动作。但是,采用Marlow等人的拆卸装置的仪器没有可枢转的端部操作装置。可以相信,Marlow等人的拆卸概念不能用来把一仪器的连接机构可操作地与一能枢转以及能旋转和夹紧的端部操作装置连接起来。
因此,本发明的一个目的是提供一种内窥镜外科仪器,这种内窥镜外科仪器能提高外科医生的工作能力和灵巧性,它还需要一极小的内窥镜检查孔。本发明的又一个目的是设计内窥镜仪器通过包括5mm套管针套筒在内的各种尺寸的套管针套筒或内窥镜检查孔,因此允许它在极微侵袭过程中使用。
本发明的另一目的是提供一种具有可旋转的和可枢转的端部操作装置或仪器头的内窥镜外科设备,从而能使外科医生在不必移动或再定位整个仪器的情况下就能到达难以迅速而方便地进入的区域。在这方面,不需要附加的铰接部分的、具有能在位置上旋转、枢转和操纵所选的端部操作装置的能力的一仪器能实现这个目的。一更加特有的目的是端部操作装置的枢转运动的铰接半径达到最小。
本发明的还有一个目的是提供一种适用于接收各种不同类型的端部操作装置的仪器。总的来讲,各种可互换的端部操作装置包括提供所有的切割和夹紧或抓紧的动作的端部操作装置、在该仪器远端提供其它运动的端部操作装置和单叶片的、试探类的端部操作装置。另一个目的是提供这些端部操作装置从仪器的其余部分拆下的易拆卸性。
本发明的再一个目的是提供一种内窥镜仪器,至少是部分地用集成微处理器来控制端部操作装置的定位和操作。
当结合附图和权利要求书研究下面的说明时,本发明的上述和其它目的将变得更清楚和更能理解。发明概要
本发明涉及一种满足上述目的的内窥镜外科仪器。具有本发明特点的内窥镜外科仪器包括一手柄、一管状件(也称圆筒、圆筒管或管状圆筒)和一执行外科任务的端部操作装置。手柄可以用来握持仪器,并且是操纵和控制端部操作装置的动力的来源或管道。圆筒一般是管状的,其一端可旋转地连接于手柄上。端部操作装置可枢转地安装在圆筒的另一端,该仪器包括一可操纵地连接端部操作装置和动力的装置。完成端部操作装置的闭合与端部操作装置叶片的枢转状态无关,因此,使得枢转、旋转和夹紧的运动相互之间是独立的。
在较佳实施例中,端部操作装置包括两个叶片,它们都枢转地连接于圆筒远端上的U形叉。一对齿条和小齿轮机构驱动端部操作装置。在端部操作装置的各叶片近端加工出一个小齿轮,每个小齿轮可枢转地安装在U形叉中。一对直长齿条可滑动地安装该叉内,每一个与各自相应的小齿轮啮合。各齿条齿轮对是独立的,因此,一齿条往远方向运动引起端部操作装置中的一个叶片相对于相邻叶片枢转。往近方向拉齿条引起端部操作装置的叶片往直线方向枢转。往远方向推两个齿条引起端部操作装置(即端部操作装置的两个叶片)枢转,同时拉两齿条引起端部操作装置的两叶片伸直。相对于一齿条推另一齿条使端部操作装置的一个叶片相对于另一叶片打开,而推一齿条同时保持另一齿条不动,使端部操作装置的叶片形成“剪切”动作。通过使圆筒、包括连接件和端部操作装置组件相对于手柄旋转来形成轴线旋转(即绕圆筒纵向轴线的旋转运动)。所述齿条的协调运动是通过两个向后延伸到手柄的长连接杆进行的。该两连接杆在圆筒内是同轴线的,它们受到制约而不能在圆筒内旋转,但它们能在圆筒内沿长度方向运动。每个控制杆的近端有一螺纹部。当控制杆安装到手柄上时,各螺纹部与各自的细长丝杆啮合。手柄内的两驱动丝杆一起旋转,但其中之一的轴向位置受到约束,而第二根丝杆连接于一扳扣状的操纵件,并可在近端运动。所以,当扳扣动作,一齿条相对于另一齿条移动,从而闭合端部操作装置。当作为一对的两丝杆被驱动,则两连接杆在各自的丝杆上螺旋向前时,端部操纵装置枢转。丝杆的旋转以及由此形成的端部操作装置叶片的枢转可由手动也可由小的齿轮电动机来完成。两连接杆的运动以及端部操作装置的一个叶片相对于另一叶片的所产生的闭合可以手动也可以自动进行。在手动的实施例中,一组杠杆和连接件连接于一安装在手枪式握把上的扳扣状臂,并紧握该手柄使其闭合,而使它们被驱动。手动闭合给使用者提供直接的触觉反馈。还为使用者提供一手动扳扣锁,以便抓紧和锁住在组织(tissue)或工具上。
在电驱动或装有动力的实施例中,连接件的运动是通过一齿轮电动机或其它动力源来进行的。电动机可在该设备的手柄里面或外面,一在适当位置的电源开关或多个开关与手柄相连。
分离一组使各控制杆与各自细长控制连接件相连的卡口接头,就可取下包括端部操作装置刀片、齿条和控制杆的组件。使圆筒相对于两在内部的连接件旋转,就可实现分离。
可用诸如蒸汽或浸没的标准程序对本发明装置进行消毒。此外,本发明也适用于电灸,因而有一用于外电灸电源的连接。
在另一实施例中,端部操作装置的叶片可枢转地连接于一U形叉上,并在一支点彼此交叉,各叶片的相对部分构造成在近端方向延伸的杠杆。能在拉伸和压缩下作用的控制缆的护套连接于一叶片的近端。能在护套内滑动的控制缆的缆芯连接于另一叶片,并也能通过拉伸和压缩作用。
包括护套和缆芯的控制缆的另一端进入圆筒内,并适当地与一对向后伸进手柄的细长连接件配合。同时往远方向推护套和缆芯使得一圈护套和缆芯朝端部操作装置推动,从而引起端部操作装置的两叶片相对圆筒枢转。相对于护套推和拉缆芯引起端部操作装置的一个叶片相对于另一叶片打开和闭合。拉控制缆(即同时拉护套和缆芯)使端部操作装置伸直,拉缆芯仅仅使端部操作装置的叶片产生“剪切”动作。这种端部操作装置组件还可以通过上述的卡口配合而可拆卸地安装在手柄上。
本发明的另一个实施例也采用一对长的可滑动的连接件,每一个连接件直接与端部操作装置中的一个叶片接合。正如第二实施例一样,叶片例如刀片在一支点上彼此交叉,并在近端方向延伸,各叶片的相对部分构造成具有细长对角缝隙的杠杆。各连接件的远端有一个与各自端部操作装置的叶片的缝隙接合的整体U形销。两连接件/叶片对工作相同。往远端方向推一连接件使得该销钉沿其缝隙向上朝支点滑动,引起该叶片旋转。当该销钉沿其缝隙向下运动离开支点时,进一步往远端方向推该连接件,则引起连续的旋转。以此方法,往远端方向推两连接件引起枢转,而推一个连接件拉另一个连接件,则引起剪切。如上所述,也可用卡口接头把这种端部操作装置组件可取下地连接于手柄上。
在本发明的另一个实施例中,端部操作装置可以是如上所述的剪刀状,具有枢转连接于圆筒远端的两刀片。剪刀端部操作装置的每一刀片的一钳片端是锋利的,从而当它们彼此相对枢转时能在两刀片之间进行剪切。刀片在一支点彼此交叉,各刀片的相对部分构成在近端方向延伸一段距离(取决于所要求的杠杆作用)的杠杆。在这两杠杆之间有一使杠杆分开的弹簧,因此可打开剪切钳片。在这两杠杆的外侧边缘是围绕杠杆近端上的一半径延伸的凹槽。该凹槽被精加工,其宽度足以容纳可在其内前后自由滑动的抗拉系数较高的缆芯。
在仪器的该实施例中有两根拉伸缆绳,每一根连接于一刀片,并在各自的凹槽内、在相对叶片近端的周围交叉。各缆绳在相反的方向围绕各自在两刀片的相对侧上的滑轮延伸。两缆绳的自由端进入圆筒内,并适当地与和手柄相联的一操作驱动机构配合。这两缆绳通过刀片杠杆端之间的弹簧的作用而保持张力。当拉一缆绳而释放另一缆绳时,引起两刀片的协调的枢转。同时拉两缆绳,引起叶片的协调的闭合。转动圆筒引起刀片与滑轮和缆绳一起轴线旋转。
使用安装在圆筒内的一螺纹轴,就能使两缆绳协调的运动。内轴的远端有一右旋螺纹,接着是一左旋螺纹。两个旋转受到制约但可在圆筒内沿长度方向滑动的螺母(一个是右旋螺纹,另一个是左旋螺纹)旋在该轴上。上述缆绳之一连接于第一螺母(在远端的),而另一根缆绳穿过第一螺母中的孔连接于第二螺母(近端)。在圆筒内既能旋转又能轴向滑动的螺纹轴连接于一手枪式握把内的花键。一圆筒形轴环也位于手柄内,并连接于该轴,使得一扳扣机构形成的连接往近端方向拉与螺母和缆绳一起的轴,从而闭合剪刀的刀片。轴的旋转是通过齿轮啮合花键来形成的,它使得两螺母协调的运动,因此,所述缆绳在任一方向枢转剪刀的刀片。
本发明还有一个特征是端部操作装置顶部的互换性。在一实施例中,圆筒和轴具有一花键部分,以便与手柄内的齿轮传动装置啮合。回缩连接件或杠杆(闭合端部操作装置的两叶片)能够与连接于圆筒内的螺纹轴上的轴环相脱离。压一个按钮或释放一在手柄上的掣子机构就能替换顶部和圆筒,取下一顶部,因而可插入相同类型或不同类型的另一个顶部。
通过使用一公用手柄和驱动机构以及不同的可替换的端部操作装置顶部,每一个该顶部根据需要可迅速而方便地连接于驱动机构,本发明仪器包括一系列的仪器而使本发明具有灵活性。这种互换性使使用者继续利用具有相应的电动机、齿轮和控制件的一公用手柄,能把一种功能的装置迅速而方便地换成另一种功能的装置。它也可使装置中一次性零件是可更换的,而最昂贵零件可重复使用。一个主要优点是:该装置的穿入病人体内腔的端部操作装置工作部分是新的、锋利的,而且保证是消过毒的,而装置的其余部分可以清洁、消毒和再使用。当然,如果整个仪器从费用因素考虑是合算的,则也可以是一次性的。
除了能采用多种端部操作装置顶部、并铰接所选的端部操作装置之外,本发明另外具有几个超过现有内窥镜外科仪器的重要优点。采用电子控制的电动机和离合器使使用者的接口(interface)具有附加的灵活性,外科医生使用这种接口以使该装置在所需方向运动。这种接口可以采用小滑动开关、控制手柄、旋钮或按钮的形式和合并入手柄的逻辑电路,或一由计算机或其它外界装置控制的远程接口。在本发明的仪器中采用微处理器的一个优点是:逻辑电路可保持驱动电动机或其它运动机构、操纵机构的精度及位置控制的可重复性。
根据下面的详细说明并结合所附的附图和权利要求书,本发明的上述和其它特征、目的以及优点将变得更清楚和更能理解。因予以理解的是,叙述和附图仅仅是为了举例说明本发明,而不是用来限定本发明的范围。
附图的简要说明
图1是本发明整个仪器的一个实施例的正视图;
图2A-E是表示使用齿条和小齿轮机构的端部操作装置的一个实施例的、带局部剖面的视图;
图3是本发明可拆卸的端部操作组件的一个实施例的正视图;
图4A是类似于图3的视图,表示在本发明的一端部操作组件和细长的圆筒的一部分之间连接的一个实施例;
图4B是本发明细长的圆筒近端部分的、带局部剖面的视图,表示了端部操作组件的固定机构;
图4C是表示固定端部操作组件的连接机构细节的、带局部剖视的等角立体图;
图5A是本发明手柄的、带局部剖面的视图,表示了电动机和驱动机构,而为清楚起见,取掉了圆筒连接和转动机构的一些部分;
图5B类似于图5A,表示了如何使端部操作组件枢转运动;
图5C是类似于图5A的视图,表示了使端部操作装置夹紧或合拢的连杆的运动;
图5D是类似于图5A的视图,表示了圆筒的轴向转动;
图6是手柄一部分的后视图;
图7是表示在本发明仪器的电子部分内的微处理机集成电路的示意框图;
图8-17是表示本发明微处理机控制实施例操作的流程图,图8(包括图8A和8B)表示了全部主操作,而图9-17表示了子程序;
图18是基本上类似于图2的视图,但表示了一具有剥离钳的端部操作装置;
图19类似于图18,但表示了一鸭嘴夹紧钳;
图20A-C是表示端部操作组件上的一控制缆绳设计的一实施例的带局部剖面的视图,它利用固体柔软管道和一绳芯作为控制缆绳;
图21类似于图20A-C,但表示了控制缆绳中使用的盘绕护套;
图22类似于图3,它带有局部剖面显示了控制缆绳护套和绳芯与各控制杆之间的连接;
图23是本发明另一实施例的局部剖面的视图,其中,具有一对纵向滑动的操作连杆的端部操纵组件。
图24A类似于图23的一端部操作组件的平面图,其中,钳片与圆筒对齐并合拢;
图24B是图23所示的端部操作组件的、带局部剖面的视图,其中,端部操作装置枢转45度;
图25是一用于本发明的、手工操纵的手柄的带局部剖面的视图;
图26A是一手工操纵的手柄的另一实施例的带局部剖面的视图,它使用了一供枢转用的指轮和齿轮机构;
图26B类似于图26A,表示了使端部操作装置合拢的扳机的运动;
图26C是俯视剖面图,表示了使端部操作装置枢转的传动轴的运动;
图26D是类似于图26A的另一实施例的正视图,其中,用第二扳机代替指轮;
图27A是本发明的端部操作组件的另一实施例的正视图;
图27B是类似于图27A的视图,表示了端部操作组件的侧视图;
图27C是类似于图27A的视图,表示了在合拢位置的端部操作装置;
图28A是图27中的端部操作装置用的控制连杆的的正视图;
图28B是类似于图28A的视图,表示了通过移动控制连杆使端部操作装置的刀片合拢;
图28C是类似于图28A的视图,表示了通过转动控制连杆使端部操作装置枢转;
图28D是类似于图28A的视图,表示了端部操作装置和圆筒的转动;
图29A是表示用于本发明手柄的另一实施例的带局部剖面的视图,为清楚起见,取掉了圆筒转动机构;
图29B是类似于图29A的正视图,显示了如何使端部操作装置转动;
图30A是一变更的手柄实施例的局部剖视图,显示了将端部操作装置和圆筒固定在手柄上的一连接机构;
图30B是本发明的控制连杆一部分的正视图;
图31A是本发明另一端部操作组件结构远端的正视图,为清楚起见,部分零件被剖视;
图31B是图31A中的一钳片的立体图;
图31C也是图31B中的钳片的正视图;
图32A是本发明另一种形式的端部操作组件的带局部剖面的正视图,为清楚起见,部分零件被剖视;
图32B是图32A所示的本发明形式的远端的带局部剖面的正视图,为清楚起见,部分零件被剖视;
图32C是类似于图32A的视图,表示了端部操作装置的枢转运动。本发明的详细介绍
参看图1,本发明的一个较佳实施例包括一带有操纵扳机2和控制按钮12的手柄4,一管状件6(还被称作圆筒,管状筒,或者就是筒),一带有端部操作装置8的、可拆卸的端部操作组件9,以及一分离旋钮10。如下面将详细介绍的,手柄4内安装着包括传动和控制机构的驱动装置,电动机和相关的齿轮传动、电池、控制电子线路、驱动器开关和必需的导线。
关于固定、安装、附加或连接本发明的零件以形成一件完整的手术仪器的装置,除非特别指出,它们一般包括传统使用的固定件,诸如螺钉、铆钉、螺母和螺栓、肘节、销钉等。适合于连接零件的其他的固定或连接装置包括粘结、焊接和低温焊接,后者特别与电气系统有关。
除非特别指出,本发明中的电气系统和金属丝导线系统的所有零件均是普通的、市场上可买到的零件。它们包括电子元件和电路、金属丝、保险丝、焊接接头、电路板和微处理元件。
一般来说,除非另外特别指出或说明,形成本发明中的金属零件(如筒管和端部操作装置等)的材料选自诸如不锈钢或金属合金之类的适当材料。而手柄可由各种塑料之类的材料制成。
尽管上面指出,用来形成或制造本发明的手术仪器的零件和材料可从市场上买到,但下面的详细描述显示了用于本发明的具体零件和步骤,虽然本技术领域的技术人员可能认识到和选择等同的零件。
该仪器的管状件6内安装着用来合拢和枢转端部操作装置8的连接装置28,30,70和72(例如,参看图3和4B),并包括(参看图4A和4B)一分离机构,以便将带有端部操作装置8的组件从该仪器的剩余部分上卸下。在图1中,端部操作装置8是一剪刀状的工作端。然而,也可以使用其它形式的端部操作装置,诸如抓紧器、提取器、夹钳、镊子、抽筒器、活组织检查(活检)工具和在手术过程中有用的其它装置。端部装置8可是一次性的或重复使用的。
参看图2A-E,它表示了端部组件9的一个较佳实施例。在图2A中,端部操作装置叶片20和22通过销钉24可枢转地安装在U型拨叉26上,,从而使两端部操作装置叶片可自由地枢转。在端部操作装置叶片22的近端是轮齿36。这些轮齿36与在齿条32上的配对轮齿啮合。齿条32的尾端固定在第一控制杆30上,而第一控制杆30可滑动地安装在U型拨叉26内。参看图2E,端部操作部件20具有独立于端部操作装置叶片22和齿条32的近端轮齿38和齿条34。再参看图2C,齿条34固定在可滑动地安装在控制杆30内的控制杆28上。两对齿条/控制管组件通过叉26的侧面部分27(图2A)可纵向自由滑动,并保持与轮齿啮合,叉26包围了齿条的背面。沿远端方向推动齿条32(见图2A)可使端部操作装置叶片22枢转,从而该刀片相对另一片刀片张开。通过该叉在标号27表示的范围内倾斜角度(可参看图2A)可避免齿条接触细胞组织。小轮齿结构的一个特点是,在轮齿和齿条部分上的拉伸和压缩应力格外地高。因此,轮齿和齿条必需用足够高刚度的合金制造,其破坏应力超过150,000磅/英寸2。
现在参看图2A,端部操作装置8自垂直偏转20度,而端部操作装置叶片20和22略微张开。“剪切”动作是向远端方向拉动齿条32进行的,它使端部操作装置叶片22逆时针枢转,而同时齿条34(这里未画出)保持不动。由此产生的动作是,端部操作装置叶片22向着不运动的端部操作装置叶片20“剪下”。仍参看图2A,端部操作装置8的叶片20和22的同时枢转是通过同时向远端方向推动齿条32和34(该图未画出齿条34)实现的。相反,通过向近端方向拉动齿条32和34(见图2E)可使叶片20、22伸直(图2B显示端部操作装置叶片20和22合拢并伸直)。如上所述,当这对片叶20和22处于离开伸直位置0度到100度的任何角度时,端部操作装置的叶片可以张开和合拢。
图2C是端部操作组件9的视图,它表示了与图2A所示相反的另一侧,并显示端部操作装置已转至它的最大角度(约110度),并最大限度地张开。小销钉23从端部操作装置叶片22上突出,并在端部操作装置合拢时进入端部操作装置叶片20上的小凹槽21内。这销钉23和凹槽21在端部操作部件合拢时防止一端部操作装置叶片越过中心。图2D显示端部操作装置自垂直枢转90度并合拢。
图2E是端部操作装置8的远端视图,其中端部操作部件20和22枢转超过60度并略微张开。在该视图中,可清楚地看到两齿条32和34以及各端部操作装置叶片的轮齿36和38。从图2B可看到,没有一个结构突出圆筒6限定的直径之外。在一个较佳实施例里,该直径是这样的,使仪器可方便地通过5毫米的套筒针套或只有5毫米的腹腔镜孔(套筒和孔未画出)。这样,可在不牺牲只有微小伤害的外科手术所需要的小直径的情况下,实现本发明的端部操作装置的通用性和三维控制。
如上所述,在本发明的较佳实施例里,包括端部操作装置8的组件可从仪器的剩余部分上卸下。图3显示了已从仪器的剩余部分上卸下的这样一种组件。该端部操作组件9包括(1)端部操作装置8;(2)U型拨叉26,它具有旗状缝槽46的卡口连接件40,而该缝槽是这样切割的,使旗朝向逆时针方向(当从近端方向看去时);以及(3)控制杆28和30。可滑动地安装在U型拨叉26内部的中心的控制杆28和30还具有切割在其内的卡口连接48和50。这些旗状缝槽48和50的旗被切割成与U型拨叉卡口连接件40上的缝槽46的旗相反的方向。控制杆28和30的横截面通常是圆的,但以这样的方式连接:即,它们受约束而不能互相相对或相对U型拨叉26转动。在较佳的实施例里,这是通过将齿条32和34连接在控制杆28和30上实现的。控制杆28和30的远端如图2A-2D所示。
现在参看图4A,通过将该组件的近端插入圆筒6的远端(如箭头所示)并沿顺时针方向(如箭头所示)旋转分离旋钮10,可将端部操作组件9固定在圆筒6上。
参看图4B的远端,可看到连接块52,54和56径向伸入圆筒6和控制管70和72内部。这些连接块分别与在图4所示的端部操作组件9上的旗状缝槽46,48和50啮合。分离旋钮10向非锁定位置(从近端看是顺时针)转动时,圆筒随其转动,并使圆筒上的成对的连接块52(只画了一块)与在控制管70和72内的成对的连接块54和56(各只画了一块)对齐。在非锁定位置上,所有成对的连接块52,54和56与端部操作组件9上纵向成对的缝槽46,48和50对齐。连接块52和54的长度是这样的,使它们不与在它们内部的控制管啮合或互相干扰,但仍与它们各自的缝槽46和48完全啮合。当分离旋钮10逆时针(自近端看去)转动时,连接块52首先与缝槽46啮合。然后,继续转动分离旋钮10,使U型拨叉26转动。由于控制杆28和30受约束而不能互相转动和随U型拨叉26转动,U型拨叉26的转动使连接块54与缝槽48啮合,使连接块56与缝槽50啮合,直至所有的连接块完全到底。在该点,分离旋钮10和圆筒6相对控制管70和72扭转锁定,由此阻止端部操作组件松开。可以设想,使用者不试图推动端部操作装置枢转按钮12(见图1)和枢转端部操作装置8,而试图转动分离旋钮10。
再参看图4B,可看到压缩弹簧62。弹簧可使分离旋钮10保持在近端位置上,从而锁定分离旋钮,以防止由于疏忽而引起的端部操作组件9的枢转和分离。当向远端方向推动分离旋钮10时,弹簧62被压缩,并在分离旋钮10转动时保持压缩。这里还显示出,细长的控制管70和72可滑动地安装在圆筒6内,并在驱动管64内延伸。细长的控制管70和72互相同轴心。整个组件同轴心。两控制管70和72具有细长的缝槽58,一销钉60通过该缝槽,并使控制管与驱动管64可转动地连接,当需要端部操作装置8枢转和剪切时还可以平移。
图4C进一步显示了分离旋钮10怎样与控制管70和72锁定和分离的,以允许端部操作装置卸下。在该视图里,分离旋钮10在锁定位置上。分离旋钮10可滑动地安装在筒套65上,而筒套65通过焊接或其它方法固定在圆筒6上。接着,将筒套65同轴心地、可转动地安装在驱动管64上。通过向远端方向推动分离旋钮10并沿逆时针方向(从近端看去)将分离旋钮转动1/4转可使分离旋钮分离。当推动分离旋钮10时,销钉66沿筒套65上的笔直的纵向缝槽63滑动。销钉66也沿驱动管64上的L形缝槽68的纵向部分滑动。当销钉66到达L形缝槽68的转角时,允许分离旋钮沿逆时针方向转动。这将使筒套65和圆筒6相对控制管70和72转动,而控制管70和72与驱动管64连接。除了分离旋钮10外,任何零件没有轴向移动。分离旋钮10的锁定则与上述相反。应该看到,分离旋钮10的推动和转动是相对驱动管64而言的,驱动管提供了转动功能。锁定时,图4A-C中标示的所有零件一起转动。
现在参看图5A,手柄4内安装着驱动装置和操纵机构。在本发明的这个较佳实施例里,端部操作装置是通过后拉扳机2手动进行的。在图4B中所示的分离组件整体一部分的圆筒6自手柄4的远端突出,和手柄4可转动地连接,并与下面将介绍的转动机构的中心线同轴。在上述锁定位置上的、不能相对圆筒6转动的两控制管70和72可在圆筒6内纵向滑动。各控制管70和72通过各自的细长螺杆88和90(见图5B)可轴向移动。螺杆88和90由微型齿轮电动机(未画出)通过挠性联节轴102驱动,由此使端部操作装置枢转。第二电动机74驱动小齿轮75(图5D中所示),该小齿轮使分离旋钮10、圆筒6和控制管70和72转动。而这些电动机由按钮开关12和控制电路76(图5A)控制。
为了使电动机能浸没在在杀菌液或高压消毒蒸锅中经受灭菌操作,将电子回路板、开关(未画出)和电动机74(另一个未画出)装入一密封层里或密封在一气密的隔室(未画出)里。电动机轴必须通过一蒸汽/水汽密封装置108,该密封装置使电子元件保持干燥。电池78给电动机和电路提供电能。它们是可更换的或可再充电的。
仍参看图5A,手柄4还被设计成允许外科医生使用所需的单极电灸。将专用的电插头114设置在手柄底部,以便与一电灸导线连接。使导线路径116通过不导电的手柄到达圆筒6和端部操作装置。圆筒6和U型拨叉26(见图3)上涂有电绝缘材料,以避免在使用电灸时发生意外的电击。
图5B较详细地显示了端部操作装置8是怎样枢转的。在这个较佳实施例里,螺杆88的近端部分92具有六角形或花键形状,它与滑动螺杆90内部的配合结构啮合。该配合形状允许滑动螺杆90相对驱动螺杆88滑动,并与它一起转动。驱动螺杆88通过位于其近端的轴承98而保持在轴向位置上。滑动螺杆90在轴承96上转动,并通过滑动轭架104而保持在轴向位置上。齿轮电动机(未画出)通过挠性联节轴102传动驱动螺杆88。两控制管70和72的近端均设有内螺纹,螺杆88与控制管72上的内螺纹86啮合,螺杆90与控制管70上的内螺纹94啮合。两螺杆/内螺纹对的螺距必须相同,以便两控制管同步滑动;否则,当端部操作装置8枢转时将显而易见地张开或合拢。然而,由于考虑到实际空间,较佳的是使用两不同的螺杆直径。在这个实施例里,驱动螺杆88较小,并与内控制管72连接,而与控制管70在一起的滑动螺杆90在外侧滑动。
由此可看到,揿压按钮盘12上的“伸直转动”钮(图6中的Strt)时,启动使螺杆88和90转动的电动机(未画出),从而使控制管70和72如箭头所示向近端方向缩回。这使齿条32和34缩回,从而使端部操作装置叶片20和22变直(如图2B所示)。
从图5C可更清楚地看到端部操作装置8的夹紧或剪切运动。当拉动扳机2时,轭架104、轴承96、滑动螺杆90和外侧控制管70向近端滑动,接着拉动控制杆30(图3)和齿条32(图2A),由此使端部操作装置叶片22枢转(图2A)。尽管扳机2运动,内侧控制管72仍在圆筒6内保持不动。因此,续后的动作使一端部操作装置叶片22向另一部件20合拢,从而产生剪切或夹紧动作。
外科医生经常需要一锁定机构以使该仪器夹紧细胞组织或一个目标。在本发明里,利用棘轮110和棘爪112可使扳机2在任何位置上锁定,通过在手指圈里向上移动手指可方便地使棘轮110和棘爪112啮合。棘轮110固定在手柄4的下侧,且在扳机2上设置一缝槽,以便供棘轮110通过。一小棘爪112固定在扳机2上,并能够向上弯曲与棘轮110啮合。棘轮110和棘爪112上的齿形是这样设计的,在释放之前使扳机2保持锁定状态。释放是通过再拉动扳机实现的,它使棘爪112向下放出,使棘轮110分离,使扳机2复位。
图5D详细显示了端部操作装置8的旋转运动。端部操作装置8的枢转是通过一单独的齿轮电动机74(图5A)、通过挠性联节轴80转动小齿轮轴82实现的。小齿轮75与驱动管64上的齿轮84啮合。如图4B清楚显示的,驱动管64与分离旋钮10、圆筒6、控制管70和72以及端部操作装置8连接。揿压按钮盘12上的“CCW”钮(见图5A)使整个圆筒组件和端部操作装置8均沿逆时针方向枢转,如箭头所示。两个电动机74(见图5A;另一个电动机在视图后面)并肩安装在手柄4里,并与平行和独立的挠性联节轴80和102配合工作,其中一个在图5B中画出,另一个在图5D中画出。具有被驱动的转动特征的电动机对于外科医生来说是非常有益的。然而,端部操作装置的枢转可通过手柄远端上的一按钮,使圆筒6直接转动,手动完成。
图6显示了控制仪器工作的一种方法;在这种情况下,控制开关12安装在手柄4上。覆盖在开关12上的一小标签显示了揿压控制开关12上各部分在所对应的各方向上的作用。开关12可通过大拇指方便地进行控制,开关12具有下列作用:(1)揿压开关12上的标记“strt”可使端部操作装置8向前笔直位置枢转(图2B);(2)揿压标记“back”可使端部操作装置8向后枢转(图2C);(3)揿压标记“CW”可使分离旋钮10、圆筒6和端部操作装置8同步顺时针转动;以及(4)揿压标记“CCW”可使分离旋钮10、圆筒6和端部操作装置8同步逆时针转动。在这个实施例里,运动是独立的和不成比例的,虽然控制电路(见图7)的较小改变可实现这种成比例控制。
图7是用于本发明的手术仪器的微处理机控制器和相关的电路的示意图。各功能块可以是或不是预定的功能电路。使用者通过开关、可变电阻、编码器或其它装置(一般用标号12,124表示)给微处理机120输入信号。根据使用的元件的类型,微处理机120可能需要一个接口电路122。同样地,状态显示器灯126也可能需要一些外部驱动电路128。电动机或其它驱动器130和132不能由微处理机120直接驱动;各需要一个驱动电路134,以便调整提供给它们的电源78。来自电动机或驱动器130、132的反馈由编码器或限位开关(未画出)提供,并由一反馈电路136控制和决定。在某些情况下,可能最好是避免反馈控制,而是利用正向馈电系统,例如使用步进电动机代替伺服电动机。利用电气开关118提供开关电池连接,可从该装置上去除电源。
本发明可包括带有微处理机功能的一单板计算机,该单板计算机与在内部ROM(只读存贮器)内带有程序设计语言的Motorola(摩托罗拉)68HC11处理机相同。该控制软件可保存在EEPROM(电可擦可编程序只读存贮器)内。68HC11处理机包括在本发明的仪器关闭时用来存储设定值等的一部分EEPROM。单板计算机可与包含运动控制ICs(例如,惠普公司的HCTL-1000)的一伺服传动控制模块连接,它能控制多个驱动电动机130。所选择的微处理机本身可编程,以执行独立的运动控制ICs的伺服控制功能。还可以提供接口电路122,以便对操作者使用的操纵杆或开关12及比例开关124的输出信号进行译码。
现在参看图8-17,用于本发明仪器的软件包括一在该仪器通电时不断工作的主回路390(图8B)和若干对诸如往复、剪切或振动等特定功能进行控制的次回路(图9-17)。主回路390的一个主要目的是询问操纵杆和其它控制开关,以确定是否需要一个操作。如果是的,就调出一个适当的子程序。在仪器通电时,主循环390每20毫秒运行一次,从而可以连续检查系统的工作参数,并不断更新在图8B和17中分别表示的显示。退出主回路390的唯一方法是使该仪器断电。
电动机运动是通过电动机控制芯片实现的,它在位置误差状态下运行。总是保持相对的和绝对的位置,以确保可重复的运动和一绝对的零参考点。绝对的位置是在初始化程序(图9)过程中建立的,其中,电动机在从极限到极限中被驱动,以建立一个绝对的零参考点。各电动机的运动对于编码器来说是相对一目标位置测定的,是微处理机120(图7)计算出来的位置。其速度与一供使用者控制距离灵敏度的放大系数相乘。如果位置误差超过初始化(图9)时由电动机极限值确定的一误差范围,那么主控制回路390指出有一个元件失效,宣布一个误差,并点亮一个适当的灯泡。特定的功能、诸如往复、剪切、振动、自动复零和圆筒分离由独立的程序(图12-16)控制。开关关闭和操纵杆运动是直接进行的。由于运动程序是独立的和不同的,各电动机运动的逻辑线路是互相独立的。然而,由于主回路390是如此快地运行,运动控制ICs将接受指定位置和速率,并且由于电动机具有机械惯性,由此产生的电动机运动在功能上是同时发生的。这将允许在所有的三条坐标轴上同时运动。其它的、操作者可改变的功能,诸如速度、力量和操纵杆灵敏度可通过一组适当的信息标号或专用按钮进行编程。信息可通过显示灯或诸如一液晶显示器之类的一显示装置显示。
本发明仪器的操作由图8A和8B所示的微处理机上的主程序回路的流程图描述。在块400处将动力提供给该仪器。程序通过EEPROM块402进行,如果有一错误状态则在块404处再初始化。其次在块406处初始化硬件和说明变化值以及检查电池。图9中详细地示出了这个操作,用完全初始化块407启动,进行到检查电池块408,圆筒转动控制器块410,枢转控制器块412,和端部操作装置合拢控制器块413。在块414处重置运行状态标志,在块416处消除任何误差。在块418处初始化结束,在该点,程序进入在块419上显示动力。
现在参看图8B,在误差询问块420之后,显示器在块421处被更新,这在图17中有详细描述,它从更新显示器块422开始。首先,在块423处设置误差标志询问,如果答案是“是”,如块424所示,误差灯亮,在块426处目前参数被取消,而在块428处更新显示结束。如果在块423检测不到误差,在块430处动力显示器亮,并在块432询问电池电压。如果电压较低,在块434处低动力显示器亮,且流程图进入显示目前参数(包括诸如速度、力等操作参数)的块436。那时在块428处结束更新显示程序。
再参看图8B,如果没有检测到误差,该仪器的使用可进入通过操作者或程序询问提供的特定的输入信息,诸如操纵杆询问和运动块450和452。参看图10,控制端部操作装置运动的程序流程分别通过由块454和456通常表示的一组询问和比较、以及由块458通常指示的输入操作命令进行了详细的描述。
同样的,在扳机询问块460和462处(图8B所示)监视扳机开关124(图7),由此产生端部操作装置合拢功能块464,465和466。图11分别在块467和468的分解图中表示了端部操作装置合拢和张开的顺序。
图8B显示该程序包括一特定功能询问块470,如果需要一特定功能并被启动,流程进入块472,图12作了进一步的描述。块473启动特定功能流程,然后开始询问各特定功能,包括往复剪切块474,振动块476,自动复零块478,或分离功能块480。关于往复询问,如果答案是肯定的,流程开始进入操作往复剪切块482,详细说明见图13。
参看图13,往复剪切流程在块483处开始,首先在块484处询问该功能是否需要。如果答案是“否”,流程在块486处结束往复。如果答案是“是”,在块488处完全向前驱动电动机。然后,流程在块490开始询问端部操作装置是否完全合拢。如果答案是“否”,程序回到开始处,如果答案是“是”,在块510处询问是否仍旧揿压请求按钮。否定的答复将使流程进入结束往复块486。如果答案是“是”,在块512处电动机驱动,在块514处询问端部操作装置。如果答案是“是”,程序回到开始处,如果答案是“否”,在块516处询问端部操作装置是否完全张开。如果答案是“否”,程序回到启动点,直至到达完全张开状态。
参看图12,在块476处的振动询问将导入振动功能块520,详细说明见图14。在块521处振动要求启动的情况下,流程或是在块522处向前驱动夹紧电动机,或是在块524处向后驱动夹紧电动机。然后,程序在块526处询问是否仍旧揿压该操作的请求的按钮;如果答案是“是”,流程回到开始处,如果是“否”,在块528处结束振动流程。
再参看图12,特定功能在块478处包括自动复零询问。如果答复是肯定的,流程在块530处开始自动复零功能,详细情况如图15所示。如果流程在块531处启动,程序在块532处驱动枢转电动机向前/向后,直至到零值。同样地,在块534和536处,夹紧电动机和转动电动机被驱动,直至分别到零,在块538处,自动复零结束。
回到图12,在分离询问块480处,特定功能的另一询问开始。如果答案是“是”,流程进入块540,并如图16所示分离圆筒。该功能的流程在块541处开始。接着,在块542处驱动夹紧电动机,直至等于分离值。在该点,程序在块544处询问是否仍旧揿压分离按钮,如果答案是“是”,程序回到驱动块542。如果答案是“否”,在块546处夹紧电动机被向前驱动,直至到零值,并且程序进入完全初始化块548,其中,硬件被重新初始化且变化值被说明,在块550处,结束自动复零程序。主程序流程(图8B)还包括周期检查系统功能块560。
图18和19表示了本发明另一个实施例,其中,端部操作装置8,具体地说是钳片或端部操作装置叶片20和22具有不同的形状。图18显示了一剥离端部操作装置,而图19显示了一外伤用夹紧器。这些是各种各样端部操作装置叶片的代表,它们可以固定在端部操作装置上,而它们的操作情况基本上类似于图2A所示的端部操作装置。
图20A-C描述了利用一控制缆绳结构的端部操作机构的另一实施例。两剪切端部操作部件138和139通过枢转销钉141可枢转地安装在叉140上。一细长件、超弹性金属管(例如拉制的镍-钛)、或护套142通过轴销146固定在端部操作装置叶片138的近端。所示的护套142是一拉制管,但是一金属丝卷绕管或具有适当功能的等同物也可使用。护套142作一拉伸和压缩件用。在U型拨叉140内形成有一缝槽,以限定和引导护套142;该缝槽形成一半径,它使管子弯曲成大致垂直于刀片138。在护套142内是另一细长件,它是一小直径的绳芯144,它能在护套142内纵向自由滑动。绳芯144通过轴销143固定在端部操作装置叶片139上,它作拉伸和压缩件用,这样,绳芯144的拉伸和压缩可使端部操作装置叶片138和139互相相对张开和合拢,如图20A和20B所示。端部操作装置叶片138和139在张开和合拢时的同步枢转是通过向远端方向、即向着端部操作装置一起推动护套142和绳芯144实现的。这种推动使护套和绳芯延伸或相对端部操作装置8横向“拖拉”,如图20A和20C所示。一旦在一个角度上定位,如图20C所示,相对圆筒6到达或超过90度,张开或合拢端部操作装置叶片138和139是通过相对护套142推动或拉动绳芯144实现的。拉动外侧护套142将使端部操作装置叶片138和139回到相对仪器的圆筒6向前垂直的位置上,如图20B所示。
仍参看图20A,护套142和绳芯144在端部操作装置叶片138和139上的固定点可以是如图所示的单个点,或者可取细长缝槽的形状,而缆绳连接点可在端部操作装置叶片近端的缝槽里滑动(未画出)。该缝槽和端部操作装置叶片可是笔直的或弯曲的,以便使护套绳芯144获得一直的和顺利的引导,从而使绳芯144在护套内的弯曲和摩擦达到最小程度。此外,该缝槽也可以是有角度的或定向的,以便在张开或合拢时给绳芯144提供增大的杠杆比或机械效益。
如图20A-C所示的本发明的进一步简化是控制缆绳芯144在端部操作装置叶片139和护套142在端部操作装置叶片138上的刚性固定。去掉轴销将减少复杂性和零件数量。绳芯144可用拉制金属线、股绞金属线、或诸如镍-钛的超弹性合金制造。也可使用适当的复合材料。同样地,图20A-C中的柔软的护套142也可由聚合材料或超弹性金属合金制成。
图21显示了用来驱动端部操作装置8的可控制技术的另一个实施例。利用一柔软的金属螺旋卷绕护套148代替图20A-C所示的拉制的镍-钛金属管。本发明的进一步改进是使用一缝槽,其底部是弯曲的,带有一限定的半径,控制缆绳护套在其中纵向滑动。现在参看图22,它描述了绳芯144和护套142对控制杆28和30互相连接的细节。绳芯144的近端在接合处156与控制杆28连接。同样地,护套142的近端在接合处154与控制杆30连接。
图23表示了端部操作装置的另一个实施例。如前面所述,两个端部操作装置叶片180和182通过横向销钉198固定在U型拨叉196上,端部操作装置叶片可环绕销钉自由地枢转。各端部操作装置叶片有一在近端方向突出的“尾”部,作为使端部操作装置叶片枢转的杠杆。端部操作装置叶片180和182的各近端具有一细长的缝槽184和186,它们分别与固定在两纵向的控制杆190和194(在图24B表示了190)远端上的叉杆销钉192和188啮合。两控制杆的几何形状互相对称。再参看图23,向近端方向移动控制杆194将使销钉192沿缝槽184滑动,从而使端部操作部件180逆时针转动。端部操作装置成对向后枢转是通过向远端方向推动控制杆190(见图24B)和194实现的。“剪切”动作是通过推动杆194和拉动相对的190实现的。以远端方向将两杆推到底,销钉188和192将沿缝槽向上朝着枢转销钉方向前进,然后沿缝槽向下离开该销钉,由此使端部操作装置自笔直位置向后枢转超过120度。
在合拢和笔直位置上的端部操作装置如图24A所示。图24B是从仪器远端看过去的圆筒的端视图,它表示了端部操作部件180和182互相略微张开并相对圆筒枢转约20度。本发明的一个重要特征是,控制杆190和194与圆筒6和叉196联锁,从而允许纵向滑动,又防止因销钉192和188施加的偏心负载引起的扭转(见图23)。该实施例的一个优点是,由于控制杆190和194形成管状横截面的大部分,因此它们在轴向负载下的弯曲和刚性方面可能都是坚强的。由此,这种机械连接是非常牢固的,并能抵抗弯曲或弹性。虽然控制杆190和194以及端部操作部件180和182的运动相对角位置是非线性的,但通过调整手柄里的连接可方便地克服这种非线性。
图25表示了本发明一简化的、完全手工操作的手柄。该手柄与连接在其上的圆筒6以及控制件70和72一起可拆卸地固定在图3所示的端部操作组件9上,为表示清楚,图4A-C所示的分离机构已被去掉而未画出。本发明的这个实施例已被简化,因为它不再依靠控制杆70和72的同步移动,它保持着已被固定的控制杆70和72,并通过移动圆筒和U型拨叉而使端部操作部件枢转。
参看图25,手柄200由手指的握持,从而拇指可枢转杠杆202。合拢杠杆202将向远端方向拉动叉杆销钉216。外控制管70可转动地安装在手柄上,由轴环214拴住,从而使其不能轴向滑动。内控制管72可转动地连接于叉杆销钉216上,这样,合拢杠杆202将相对控制管70后拉控制管72,从而合拢图2所示的端部操作装置8。张开过程相反,即不是拉动而是推动控制管72。通过旋转旋钮206可实现枢转,从而向远端方向旋转螺杆208的螺纹部分。螺杆208固定在圆筒6上。向远端方向移动圆筒6将使U型拨叉26(在图2A中)相对两被固定的控制管70和72前进,由此使端部操作装置枢转。销钉210防止螺杆208转动。通过旋转旋钮204可使端部操作装置8转动。销钉210横向通过旋钮204、控制管70和72以及螺杆208。缝槽212通过控制管72和螺杆208,从而允许这些零件相对手柄200和旋钮204滑动。控制管70有一个供销钉210用的孔,从而使它随旋钮204转动,而不会轴向移动。这样,当旋钮204转动时,整个组件(包括圆筒6,控制管70和72,螺杆208,枢转旋钮206和销钉210)一起转动。在手柄200和旋钮204之间有一摩擦装置(未画出),以便操作者枢转旋钮206时不会不当心转动转动旋钮204和转动端部操作装置8。
参看图26A-D,它表示了本发明的另一实施例。在这个实施例里,手柄200完全用手工操作。手柄200由外科医生的手握持,这样,拇指可用来打开和合拢扳机杠杆202,同时让食指自由地拨动指轮辊222和旋钮204。打开和合拢扳机杠杆202可使端部操作装置相应地张开和合拢。利用食指可使指轮辊222来回转动,从而移动圆筒6和枢转端部操作装置。通过食指转动旋钮204可使端部操作装置转动。(这种手柄也可使用图3所示的端部操作组件8,它可从圆筒的远端上卸下;卸下机构未画出。)
现在具体地参看图26A,通过可转动的旋钮204将手柄200可操纵地固定在端部操作装置上。可转动的旋钮204由横向通过圆筒6、内控制管72和外控制管70的销钉210定位,这样,旋钮204的转动将使管子的整个组件转动。由于端部操作装置与管子组件连接,管子组件的转动将使端部操作装置转动。将旋钮204放在适当的位置,就可利用食指方便地使其转动。管子组件的轴向位置是通过控制轴环214保持的,而控制轴环214固定在外控制管70上,并由手柄200夹持,但它可相对手柄200自由转动。
图26B显示了朝着手柄200合拢扳机杠杆202的作用,它使端部操作装置的钳片合拢。沿着箭头方向合拢杠杆202将向远端方向拉动叉杆销钉216,从而相对外控制管70和圆筒6向远端方向拉动内控制管72,由此使端部操作装置8上的一刀片相对另一刀片合拢(如图2B所示)。相对手柄200打开扳机杠杆202将使控制管72相对控制管70和圆筒6向着近端方向被推动,由此使端部操作装置8的一刀片相对另一个刀片张开。
图26C手柄的横剖视俯视图,表示了指轮辊222(图26A)转动的作用。现在参看图26A-C,可看到指轮辊222同轴心地位于小齿轮220上。接着,小齿轮220与齿轮218啮合。齿轮218同轴心地位于小齿轮219上,而小齿轮219与圆筒6上的圆柱形齿条224啮合。在这种结构下,顺时针转动(俯视图)指轮222将使小齿轮220转动,由此使齿轮218和固定的小齿轮219逆时针转动。由于小齿轮219与圆柱形齿条224啮合,小齿轮219的逆时针转动将使圆柱形齿条224向近端方向移动,由此使圆筒6向近端方向移动。参看图2A,可看到,相对两控制管70和72向近端方向移动圆筒6(和U型拨叉26),且控制管被固定(扳机杠杆保持不动),则可使端部操作部件20和22一起枢转。
再参看图26,可看到,端部操作装置的转动和枢转是互相独立的。即,可利用旋钮204使端部操作装置环绕圆筒6的轴线转动而不枢转,同样地,可利用指轮222使端部操作装置环绕垂直于圆筒6的轴线枢转而不转动。圆柱形齿条224的用途是使圆筒6的转动独立于圆筒6的轴向移动和相应的端部操作装置的枢转。即,由于齿条224被制成圆柱形、并完全环绕着圆筒6的远端,因此圆筒6的转动将使小齿轮219和齿条224继续啮合,而不会导致圆筒6相应的纵向移动。这种继续啮合也允许由指轮222产生的圆筒6的直线移动,而与圆筒6的转动位置无关。此外,圆筒6和内控制管72上的缝槽212允许端部操作装置枢转和合拢,而不会影响旋钮204的轴向位置。
图26D表示了图26A所示的仪器的另一个实施例,它利用一扳机来实施端部操作装置的枢转。如上所述,拨动旋钮204可直接使端部操作装置转动。在这个实施例里,一或是滑动或是枢转的附加扳机226可使端部操作装置枢转。扳机226可在一垂直于仪器轴线(未画出)的轴线上枢转,也可环绕着一或是与圆筒轴线平行、或是成任一角度上的轴线枢转。在这个轴线非垂直于仪器轴线的实施例里,扳机运动类似“拍动”运动,而不是传统的扳机“枢转”。如上面所述的其它实施例,这个运动利用指尖很容易实现。
下面将参考图27-30叙述该全部手术仪器的另一替换实施例。这个替换的仪器结构包括端部操作装置8,圆筒6和手柄4,其中每一样将在下面详细描述。
图27A-C显示了替换的仪器结构的剪刀状的端部操作装置8的放大图。在图27A中,剪刀端部操作装置8张开,并相对圆筒6转动45度。象剪刀一样工作的端部操作装置头部8包括通过销钉320可枢转地固定在圆筒6上的两端部操作部件(刀片)316和318。端部操作装置叶片316和318可成对地环绕销钉320转动360度,各端部操作部件316和318可相对另一端部操作部件转动45度,从完全合拢位置(图27C)转动到完全张开位置(图27A)。图27B所示的端部操作部件316和318互相平行,各具有一个相邻的平面,它们在头部8合拢时产生一个尖锐边缘。图27B是该剪刀状的端部操作装置8的横截面图,其中,端部操作部件316和318合拢,且与圆筒6的纵向轴线对齐。由于压缩弹簧322(或扭簧,未画出)的作用,两端部操作部件316和318向张开位置偏移。提供两相同的控制绳324和330(为清楚起见,只画了324),用以相对合拢端部操作部件316和318,或使端部操作部件316和318相对圆筒6枢转。控制绳324沿着圆筒6的纵向轴线延伸,并绕过一可单独环绕销钉320自由转动的滑轮326,再沿着端部操作部件316和318的后端部或近端328延伸。在两端部操作部件316和318的近端328加工一磨光的半径,以便接纳控制绳324,然后该绳跨越一段距离到达另一端部操作部件318,在那里,它卷绕在一与端部操作部件316后端部类似的半径上,并固定在那里。第二控制绳330(图28A-D)以与控制绳324相反的方向同样地安装在端部操作部件上。这样,控制绳330沿着圆筒6的纵向轴线延伸,并绕过一可单独环绕销钉320自由转动的第二滑轮(未画出,但与滑轮326相同),再沿着端部操作部件318的近端后部延伸。控制绳330由在端部操作部件318近端上形成的磨光半径接纳,然后跨越一段距离到达另一端部操作部件316,并卷过一半径,然后结束并固定在适当位置。
图28A-D表示了工作的端部操作装置的剪刀状头部8可实现的三维运动。两控制绳324和330平行于圆筒6的轴线(A线)延伸,并固定在两螺母332和334之一上。螺母332和334用诸如键或花键之类的适当方法进行约束,以防止它们在圆筒6内转动,但允许它们沿着圆筒6的轴线轴向移动。各控制绳324和330固定在各自的螺母332和334上。这样,控制绳330直接与螺母334连接,而控制绳324通过螺母334上的孔与螺母332连接。传动轴336一般相对圆筒6同轴延伸,并在其远端具有螺纹。沿着长度338的螺纹是标准(右旋)螺纹,它超过端部操作装置8从一个极端转动到另一极端时控制绳324和330所需要的总行程。传动轴336上的相等长度338和340具有相反方向的螺纹。传动轴336向一个方向的转动将使螺母332和334相对靠拢,而向另一个、相反方向的转动将使螺母332和334相互分离。
图28B显示了向近端方向拉回传动轴336的情况,由此同步拉动螺母332和334,以及控制绳324和330。端部操作部件316和318相对合拢,但是没有相对圆筒6的转动。这是本发明的一个重要方面,因为它允许操作者将工作的端部操作装置头部8相对圆筒6的轴线保持在一不变的角度,同时仍旧可使端部操作装置8动作。当两端部操作部件316和318如图28B所示合拢并笔直时,整个装置的轮廓在所要求的轮廓内,从而可经过一相当小的腹腔镜手术孔或进入一紧密区域。
图28C显示了由于圆筒6内的传动轴336的转动而引起的端部操作装置8的枢转运动(箭头C)。相对圆筒6转动的传动轴336将使螺母332和334相对靠拢,拉动控制绳330,同时释放完全等量长度的控制绳324。由此使端部操作装置8在圆筒6轴线所在的平面内枢转。可以看到,端部操作装置8的枢转与端部操作部件316和318的合拢程度是无关的。即,端部操作部件316和318的枢转与传动轴336向近端方向收缩多少是无关的。这是有用的,因为它允许外科医生单独地控制端部操作部件316和318的合拢和枢转,这就允许该外科医生可选择地分离或剪切组织。
图28D显示了同时转动传动轴336和圆筒6(箭头D)所产生的端部操作装置8的转动动作。当传动轴336和圆筒6以相同速度向同一方向转动时,螺母332和334不相对圆筒6前进,也没有端部操作装置8的枢转发生。最终结果是圆筒6和端部操作装置8的同时转动(箭头D)。可以看到,端部操作部件316和318的合拢与圆筒6和端部操作装置8的转动程度无关。该机构还具有使系统没有取向的优先选择、以及使控制绳324和330不能纠缠或交叉的优点。这些优点对于可互换的端部操作装置(包括可拆卸的圆筒6和选择的端部操作装置8)是显而易见的,因为重新安装(即,将选定的端部操作组件9插入圆筒,或将圆筒6插入手柄4)不再要求连接结构的特定方向或位置。
参看图29A,它描述了与图27-28所示的另一结构一起使用的手柄4的内部结构的细节。通过用手后拉扳机2使端部操作装置合拢。将圆筒6(它也可以是端部操作组件整体一部分)插入手柄4的一接纳孔,并被约束。圆筒6的近端被分叉,或用一诸如花键之类的适当连接机构安装,产生与驱动管64可靠地扭转啮合。驱动管64使圆筒6环绕着它的纵向轴线可靠地转动。传动轴336的近端342(例如,是方的或刻有花键槽)可与齿轮344啮合,但可滑动通过驱动管64,以允许传动轴336可靠地转动,但与驱动管64和圆筒6无关。传动轴336相对圆筒6向远端方向被偏移。传动轴336延伸通过轴环345并与它可靠连接,由此,向近端方向拉动轴环345将使传动轴336向同一方向移动。轴环345在弹簧346作用下向远端方向被偏压,并通过一叉组件(未画出)与扳机2连接,该叉组件允许传动轴336和花键342自由转动,但也可拉回传动轴336。拉动扳机2将使端部操作部件316和318合拢(见图27A),而合拢程度直接与扳机2的行程成正比。
图29B类似于图5D,表示端部操作装置的转动。齿轮84与在一单独的轴82上的小齿轮75啮合,并通过它自己的挠性传动80和齿轮电动机74被驱动。在这种情况下,齿轮电动机74直接使端部操作装置的圆筒6转动。
参看图29A,它表示了枢转动作。齿轮344与在传动轴352上的小齿轮353啮合,而传动轴352通过电动机100和齿轮箱被驱动。两单独的电动机和齿轮组件允许直接控制端部操作装置8的各单独的运动轴线。这两个电动机并排地安装在手柄里。电动机74和100(也请看图29B)由安装在手柄上的、操作者拇指可很方便地到达的范围内的多位置操纵杆式开关或按钮控制开关12控制。给电动机74和100的动力由一集成的、可再充电的或可拆卸的电池78(图29A所示)提供。端部操作装置的位置由微处理机为基础的控制电路76(图29A)控制,它的功能和操作已在上面参考图7-17进行了说明。参看图30A和30B,它描述了用于另一仪器结构的、将圆筒6固定在手柄4上或从手柄4上卸下圆筒6的机构。具体地说,在图30A中,传动轴336安装在通常是圆柱形的锁定轴环362内,而轴环362可滑动地安装在手柄4内。轴环362可操作地并可滑动地包含一弹簧366、一组安装在轴环上的孔内的制动滚珠364、以及一扳机销钉(未画出)。传动轴336和圆筒6通过滚珠364设置在手柄4里,滚珠364与传动轴336(见图30B,它表示了传动轴336的细节,其中包括它的花键或方形部分)近端靠近的制动环356可释放地啮合,由此将传动轴336轴向地锁定在轴环362上,同时允许传动轴336转动。再参看图30A,向近端方向移动扳机2将使轴环362和传动轴336缩回,由此张开或合拢端部操作装置头部8。
仍参看图30A,向近端方向滑动按钮314将使固定在按钮314上的一掣子滑动,从而通过一组制动槽341进入这样的位置、即允许滚珠364径向向外移动而使制动环356脱离锁定轴环362,从而允许圆筒6和传动轴336从手柄4上卸下。在这种方式里,单个手柄4可使用多种头部组件(包括圆筒6和选定的端部操作装置),并可安全地和可操作地固定在手柄4上。
图31A-C和32A-B显示了图27A-C所示的剪刀状端部操作装置头部8的另一实施例。图31A显示了一类似于图27A所示的端部操作装置,其中,可利用一对绳芯(未画出)、以类似于参考图27A所述的方式使两端部操作部件380和382动作或合拢。如图31A所示,两种结构在工作原理上的不同之处在于,用另一对绳芯384和386(只画了绳芯384)来使端部操作部件380和382张开,以代替用弹簧322迫使它们分离,即张开,而且端部操作部件380和382具有杠杆381和383。绳芯384沿圆筒6轴向延伸,包绕滑轮326周围,沿着在端部操作部件382上的杠杆的后侧延伸,并与端部操作部件380上的杠杆连接。拉动绳芯384将一起拉动杠杆,使端部操作部件380和382张开。其优点是,绳芯384和386(未画出)可以可靠地使端部操作部件380和382张开,由此,与单独使用弹簧相比,可利用更大的力实现张开。
图32A-C显示了另一剪刀状头部的实施例,它提供了类似于图27A-C所示的剪刀状结构提供的优点,然而只使用了较少量的零件。图32A显示了两端部操作部件388和390,它们被磨削成用来相互进行剪切。它们在整体弹簧392的作用下处于张开位置,而弹簧392与端部操作部件388和390连在一起。各端部操作部件388和390具有一弧形凹槽393,销钉394通过该凹槽。通过滑轮396和它的“尾部”397定位端部操作部件或钳片388和390,该尾部向近端方向突出并进入弹簧392的弯曲部。滑轮396和“尾部”397环绕着固定在圆筒6端部上的销钉394一起转动。该转动将使端部操作部件组件环绕着销钉394枢转。绳芯398包绕过一对端部操作部件388和390一侧上的滑轮396周围,并固定在另一侧的端部操作部件390上。同样的,另一绳芯399沿相反方向延伸,包围另一滑轮(396,图32B)周围,并固定在另一端部操作部件388上。正如图27所示,拉动一条绳芯同时释放另一条,将使端部操作部件388和390在那个方向转动。图32C显示了端部操作部件388和390转动了90度(较远的一条绳芯399被掩盖,它固定在端部操作部件388上)。同时拉动绳芯398和399将使端部操作部件388和390合拢,并产生一个切割或剪切动作。这种结构的优点是,使端部操作部件388和390受偏压而张开的弹簧392是端部操作部件388和390整体的一部分,因此,在端部操作装置的这个实施例里只有两个活动零件(除去绳芯398和399)。
本发明的手柄和操作机构实施例的其它变化包括一可自动地张开或合拢端部操作装置头部8的第三伺服电动机,以及提供诸如振动的自动驱动的功能。在这个实施例里,端部操作装置8的两齿条32和34(见图2A-E)可分别固定在两螺母332和334上(图28A-D)。附加的伺服电动机可转动带螺纹的传动轴336,以使端部操作部件张开和合拢。现有的枢转用的电动机可使整条传动轴336滑动,使两齿条一起移动,并使端部操作装置枢转。各电动机将由上面所述的的微处理机120控制。
再参看图30A,第三电动机、齿轮箱和齿轮传动机构与轴环362啮合,轴环362在它外侧的一般是圆柱形表面刻有螺纹,且与一辅助的螺纹齿轮(未画出)啮合。该齿轮由一小齿轮驱动,而小齿轮与一附加的电动机和齿轮箱驱动组件连接。向一个方向驱动齿轮将使轴环362和传动轴336缩回,使端部操作装置头部8合拢。向相反方向驱动齿轮将使轴环362向远端方向移动,推动传动轴336并使端部操作部件张开。
为电动机的连续控制提供一可变位置的开关。在这个实施例里,虽然扳机2实际上与图29A所示的相同,在此实施例中,但它基本上是向远端方向偏压的、一比例开关。完全释放或张开的位置对应于传送给微处理机的一个控制信号,该信号使电动机运动直至端部操作装置头部8完全张开和保持张开。另一个位置、完全合拢、扳机的近端位置、给微处理机提供一个信号,使电动机运转,并使端部操作装置8合拢或保持合拢。中间位置绘出了对应于端部操作装置位置的扳机位置。此外,扳机可以垂直移动,从而提供一“切断”功能,使端部操作装置8在任何位置上停止不动。
通过带有上述电动机和控制装置可增加本发明仪器的操作选择和参数。利用微处理机可使控制辅助电动机和由该电动机提供附加的功能、诸如端部操作装置头部的振动和振荡变得更加方便。当希望包括端部操作装置的电动控制的往复运动、端部操作装置头部的振动、或包含协调工作的其它复杂运动时,这是非常理想的。此外,向一个或几个方向或方位的力的反馈控制可能是一个需要的属性。例如,操作者揿压控制按钮或扳机越重,使端部操作装置头部张开和合拢的力就越大。同样的,操作者揿压开关越重,端部操作装置合拢和张开的速度越快。由于它的适应性和专用控制功能,用微处理机来控制实现这些功能的伺服电动机是非常适当的。在这里所述的任一实施例里,微处理机可用来监视通过驱动电动机的电压和电流,以及监视和调整速度、电动机温度和电池充电情况。
本发明的仪器是为内窥镜,特别是为腹腔镜用途设计的。然而,本发明还可以有许多其它的用途。例如,本发明的可互换的头部和操作的联动装置可与诸如针头夹座、纤维切断机、激光器、或内窥镜等外科仪器配合使用。还可在本发明的较佳实施例里增加电烙功能。此外,可在端部操作装置头部增加一切片摄像机,特别是在指定部位和指定移植结合的部位。
虽然已公开和描述了本发明的具体实施例,但本技术领域的熟练人员将明白,在不脱离本发明的精神和范围的情况下,在形式和细节上还可以作出许多改变。
Claims (75)
1.一种用于内窥镜检查的外科仪器,它包括:
一具有一近端和一远端的管状件;
一枢转地连接于远端的有两叶片的端部操作装置;
一可分离和可旋转地连接于近端的手柄;以及
同时枢转端部操作装置的两叶片、并使端部操作装置的其中一个叶片相对于另一叶片运动、而手柄相对于管状件不动的装置,用来枢转和运动的装置由一与手柄相联系的驱动装置来发动,它包括多个细长的、可操作地把端部操作装置与驱动装置联接在一起的控制件。
2.如权利要求1所述的外科仪器,其特征在于,用来枢转和运动的装置还包括:
一设置在多个细长控制件中的第一控制件上的第一齿条;
一设置在多个细长控制件中的第二控制件上的第二齿条;
一与端部操作装置中一个叶片相联系的、并可与第一齿条啮合的第一齿轮;以及
一与端部操作装置中另一个叶片相联系的、并可与第二齿条啮合的第二齿轮。
3.如权利要求2所述的外科仪器,其特征在于,端部操作装置的两叶片的同时枢转是通过同时往远方向运动第一和第二控制件来实现的,两叶片的闭合是使第一细长控制件和第二细长控制件彼此相对运动来实现的。
4.如权利要求1所述的外科仪器,其特征在于,
管状件包括一第一部分和第二部分,端部操作装置枢转地连接于第二部分的远端,所述两个部分具有用来连接和分离第一部分和第二部分的联接装置;以及
各细长控制件包括一第一分段和一第二分段,端部操作装置可操作地联接于多个第二分段的每一个的远端,每对第一和第二分段具有用来使每对中的第一分段相对于各自的第二分段连接和分离的啮合装置,从而,联接装置和多个啮合装置允许包括端部操作装置的一组件从外科仪器的其余部分拆卸下来并替换它。
5.如权利要求4所述的外科仪器,其特征在于:
多个细长控制件彼此是同轴的,并在管状件内部与其同轴;
联接装置包括一当管状件的第一部分相对于第二部分的旋转时可锁上和可松开的扭锁接头;
多个啮合装置的每一个都包括一当各细长控制件的第一分段相对于各自的第二分段旋转时可锁上和可松开的锁转接头。
6.如权利要求5所述的外科仪器,其特征在于,通过第一部分相对于第二部分在一给定方向旋转,使管状件的第一部分和第二部分联接,以及
通过各第一分段相对于各自第二分段在与所述给定方向相反的方向旋转,使各细长控制件的第一分段与各自的第二分段啮合。
7.如权利要求6所述的外科仪器,其特征在于,
管状件的第一部分的旋转可以独立于各细长控制件的第一分段;以及
迫使各细长控制件的第二分段与管状件的第二部分一起旋转,因此,当第一部分旋转时,使得管状件的第一部分与第二部分彼此联接,这样第一部分的继续旋转导致各细长控制管的第二分段的旋转,从而使第二分段与各自的第一分段啮合。
8.如权利要求7所述的外科仪器,其特征在于,端部操作装置的拆卸装置还包括:
旋转管状件第一部分的装置,该旋转装置与手柄相联系;以及
限制各细长控制管的第一分段的旋转的装置,该限制装置与手柄相联系。
9.如权利要求6所述的外科仪器,其特征在于,管状件的第一部分和各细长控制件的第一分段可旋转地连接,它们的旋转不受其余的细长控制件的第一分段的制约;以及
迫使各细长控制件的第二分段与管状件的第二部分一起旋转,因此,当第一部分和第一分段旋转时,使得管状件的第一部分与第二部分彼此联接,并且也使第一细长控制件的第一分段彼此联接,这样第一部分的继续旋转导致余下的各细长控制管的第二分段的旋转,从而使余下的第二分段与各自的第一分段啮合。
10.如权利要求9所述的外科仪器,其特征在于,端部操作装置的拆卸装置还包括:
旋转管状件第一部分和多个第一分段的第一分段的装置,该旋转装置与手柄相联系;以及
限制余下的各细长控制管的多个第一分段的旋转的装置,该限制装置与手柄相联系。
11.如权利要求5所述的外科仪器,其特征在于,各扭锁接头是卡口类型的结构。
12.如权利要求11所述的外科仪器,其特征在于,卡口接头的缝槽是逐渐变小的,便于连接,并使连接的松动程度达到最小。
13.如权利要求11所述的外科仪器,其特征在于,卡口接头受到弹簧件的偏压,使联接和啮合的配合间隙达到最小。
14.如权利要求5所述的外科仪器,其特征在于,各扭锁接头具有标准的螺旋螺纹。
15.如权利要求1所述的外科仪器,其特征在于,端部操作装置的各个叶片具有锯齿,以形成一解剖器。
16.如权利要求1所述的外科仪器,其特征在于,端部操作装置是一抓紧器。
17.如权利要求1所述的外科仪器,其特征在于,多个细长控制件包括一第一细长控制件和一第二细长控制件,各控制件的近端有一螺纹部分;以及
驱动装置包括可旋转地安装在手柄中的第一丝杆,该第一丝杆容纳第一细长控制件的螺纹部分;以及
驱动装置还包括一可操作地联接于第一丝杆、以便于一起旋转的第二丝杆,通过一附带于手柄的操纵件的运动使该第二丝杆轴向运动,从而引起两细长控制管和端部操作装置的叶片之间的相对运动。
18.如权利要求2所述的外科仪器,其特征在于,驱动装置还包括一与手柄相联系的控制装置,该控制装置包括:
一控制端部操作装置的叶片相对运动的扳扣;以及
一控制端部操作装置的两叶片的旋转和同时枢转的触敏开关操纵件。
19.如权利要求18所述的外科仪器,其特征在于,端部操作装置的两叶片的旋转和同时枢转是由电动机驱动的。
20.如权利要求18所述的外科仪器,其特征在于,该控制装置包括一微处理机。
21.如权利要求20所述的外科仪器,其特征在于,微处理机是一包括连接于微处理机并由该微处理机来控制的驱动电动机的电子线路的一部分。
22.如权利要求21所述的外科仪器,其特征在于,用于旋转、枢转和操作端部操作装置的装置使用电池形式的储存电能。
23.如权利要求17所述的外科仪器,其特征在于,驱动装置用手驱动。
24.如权利要求1所述的外科仪器,它还包括一电灸电线,以便提供一通过手柄和管状件到端部操作装置的导电路径。
25.如权利要求1所述的外科仪器,其特征在于,驱动装置还包括使管状件相对于多个细长控制件运动的装置,以使端部操作装置的两叶片同时枢转。
26.如权利要求25所述的外科仪器,其特征在于,使管状件相对于多个细长控制件运动的装置包括一可旋转的、设置得可被一握持仪器的手的食指转动的滚柱。
27.如权利要求26所述的外科仪器,其特征在于,可旋转的滚柱以约与管状件的轴线和仪器平面成90°设置。
28.如权利要求26所述的外科仪器,其特征在于,使管状件相对于多个细长控制件运动的装置包括:
一连接于管状件的圆筒形齿条;以及
一与此圆筒形齿条啮合的齿轮,其中齿轮的运动使得管状件相对于多个细长控制件运动。
29.如权利要求26所述的外科仪器,其特征在于,驱动装置还包括一附带于手柄的杠杆,该杠杆适用于使端部操作装置的其中一个叶片相对于另一叶片运动。
30.如权利要求29所述的外科仪器,其特征在于,它还包括一附带于手柄的可旋转的旋钮,该可旋转的旋钮适用于使管状件和端部操作装置相对于手柄旋转。
31.如权利要求25所述的外科仪器,其特征在于,使管状件相对于多个细长控制件运动的装置包括一弧形的、设置得当握持仪器时可用食指枢转的扳扣。
32.如权利要求31所述的外科仪器,其特征在于,扳扣的枢转垂直于管状件的轴线。
33.如权利要求31所述的外科仪器,其特征在于,扳扣的枢转平行于管状件的轴线。
34.如权利要求31所述的外科仪器,其特征在于,驱动装置还包括一附带于手柄的杠杆,该杠杆适用于使端部操作装置的其中一个叶片相对于另一叶片运动。
35.如权利要求34所述的外科仪器,其特征在于,还包括一附带于手柄的可旋转的旋钮,该可旋转的旋钮适用于使管状件和端部操作装置相对于手柄旋转。
36.如权利要求1所述的外科仪器,其特征在于,用于枢转的装置还包括:
一围绕并固定地连接于管状件、在管状件近端附近的空心丝杆;以及
一可旋转的设置在空心丝杆周围的枢转旋钮,该枢转旋钮具有与空心丝杆的螺纹配合的内螺纹,由此,枢转旋钮的手动旋转引起管状件相对于多个细长控制件纵向运动,并由此使得端部操作装置枢转。
37.如权利要求36所述的外科仪器,其特征在于,使端部操作装置的其中一叶片相对于另一叶片运动的装置还包括一与手柄相联系的、并连接于一个细长控制件的杠杆件,以便手动操作杠杆件,引起被连接的细长控制件相对于多个细长控制件中的另一个进行纵向运动,由此使端部操作装置的一叶片相对于另一叶片运动。
38.如权利要求37所述的外科仪器,它还包括围绕管状件设置的并可围绕其旋转的旋钮,该旋钮连接于管状件和多个细长控制件,以迫使管状件与旋钮一起转动,还允许管状件和一个控制管纵向运动,因此,旋钮的手动旋转引起端部操作装置绕管状件的纵向轴线转动。
39.如权利要求38所述的外科仪器,其特征在于,管状件包括一第一部分和一第二部分,端部操作装置枢转地连接于第二部分的远端,该两部分具有用来连接和分离第一和第二部分的联接装置;以及
各细长控制件包括一第一分段和一第二分段,端部操作装置可操作地联接于各第二分段的远端,各分段对具有把各第一分段连接于各自的第二分段并把使它们分离的啮合装置,由此联接装置和多个啮合装置允许把包括端部操作装置在内的一组件从该外科仪器的其余部分中拆卸下来和更换。
40.如权利要求39所述的外科仪器,其特征在于,驱动装置还包括:
一附带于手柄的杠杆,该杠杆适用于使端部操作装置的一叶片相对于另一叶片运动;
一附带于手柄的指轮,其设置得一当手握持仪器时可用食指转动它,该指轮适用于同时枢转端部操作装置的两叶片;以及
一附带于手柄的可旋转的旋钮,该可旋转的旋钮的适用于使管状件和端部操作装置相对于手柄转动。
41.一种用于内窥镜检查的外科仪器,它包括:
一管状件;
一两叶片式的、枢转地连接于管状件远端的端部操作装置,各叶片的近端有一齿轮;
一可旋转地连接于管状件近端的手柄;
一对细长控制件,其中一个可滑动地设置在另一个的内侧,且该两个细长控制件可滑动地设置在管状件的内侧,各控制件的远端有一与所述一个齿轮啮合的齿条;
用来使管状件相对于成对的细长控制件轴向移动、以便同时枢转端部操作装置的两叶片的装置;以及
用来使一个细长控制件相对于另一个细长控制件轴向移动、以便使端部操作装置的叶片进行相对运动的装置。
42.如权利要求41所述的外科仪器,其特征在于,与手柄相联系的控制装置包括:
一附带于手柄的杠杆,该杠杆适用于使端部操作装置的一叶片相对于另一叶片运动;
一附带于手柄的指轮,其设置得当一手握持仪器时可用食指转动它,该指轮适用于同时枢转端部操作装置的两叶片;以及
一附带于手柄的可旋转的旋钮,该可旋转的旋钮适用于使管状件和端部操作装置相对于手柄转动。
43.在一种用于内窥镜的外科仪器中包括:一具有近端和远端的管状件;一两叶片式的枢转地连接于远端的端部操作装置;一连接于近端的手柄;和同时枢转端部操作装置的两叶片、并使端部操作装置的其中一叶片相对于另一叶片运动的装置,用来枢转和运动的装置由一与手柄相联系的驱动装置来驱动,所述驱动装置包括多个可操作地把端部操作装置和所述驱动装置联接起来的细长控制件;一端部操作装置的拆卸装置,其特征在于:
管状件包括一第一部分和一第二部分,端部操作装置枢转地连接于第二部分的远端,该两部分具有用来连接和分离第一和第二部分的联接装置;以及
各细长控制件包括一第一分段和一第二分段,端部操作装置可操作地联接于各第二分段的远端,各分段对具有把各第一分段连接于各自的第二分段并把使它们分离的啮合装置,由此联接装置和多个啮合装置允许把包括端部操作装置在内的组件从该外科仪器的其余部分中拆卸下来和更换。
44.如权利要求43所述的端部操作装置拆卸装置,其特征在于:
多个细长控制件彼此是同轴的,并在管状件内部与其同轴;
联接装置包括一当管状件的第一部分相对于第二部分的旋转时可锁上和可松开的扭锁接头;
多个啮合装置,每个包括一当各细长控制件的第一分段相对于各自的第二分段旋转时可锁上和可松开的扭锁接头。
45.如权利要求44所述的端部操作装置拆卸装置,其特征在于:
通过第一部分相对于第二部分在一给定方向旋转,使管状件的第一部分和第二部分联接,以及
通过各第一分段相对于各自第二分段在与所述给定方向的相反方向旋转,使各细长控制件的第一分段与各自的第二分段啮合。
46.如权利要求45所述的端部操作装置拆卸装置,其特征在于,
管状件的第一部分独立于各细长控制件的第一分段进行旋转;以及
迫使各细长控制件的第二分段与管状件的第二部分一起旋转,因此,当第一部分旋转时,使得管状件的第一部分与第二部分彼此联接,这样,第一部分的继续旋转导致各细长控制管的第二分段的旋转,并使第二分段与各自的第一分段啮合。
47.如权利要求46所述的端部操作装置拆卸装置,它还包括:
旋转管状件第一部分的装置,该旋转装置与手柄相联接;以及
限制各细长控制管的第一分段旋转的装置,该限制装置与手柄相联接。
48.如权利要求44所述的端部操作装置拆卸装置,其特征在于,各扭锁接头是卡口型的结构。
49.如权利要求48所述的端部操作装置拆卸装置,其特征在于,卡口接头的缝槽是逐渐变小的,以便于连接,并使连接的松动程度达到最小。
50.如权利要求48所述的端部操作装置拆卸装置,其特征在于,卡口接头受到弹簧件的偏压,使联接和啮合的配合间隙达到最小。
51.如权利要求44所述的端部操作装置拆卸装置,其特征在于,各扭锁接头具有标准的螺旋螺纹。
52.一种用于内窥镜检查的外科仪器,它包括:
一具有一近端和一远端的管状件;
一两叶片式的枢转地连接于远端的端部操作装置;
一可分离地并可旋转地连接于近端的手柄;以及
用来在手柄相对于所述管状件不动的情况下、使端部操作装置的两叶片同时枢转以及使端部操作装置的其中一叶片相对于另一叶片运动的装置,用来枢转和运动的所述装置由一与手柄相联接的驱动装置驱动,所述驱动装置至少包括一可操作地使端部操作装置与驱动装置联接的细长控制件。
53.如权利要求52所述的外科仪器,其特征在于,至少一个细长件包括:
一拉伸压缩件;以及
一对可滑动地容纳在管状件中的轴,各轴有一可操作地联接于手柄的第一端和一可操作地联接于拉伸压缩件的第二端。
54.如权利要求41所述的外科仪器,其特征在于,至少一细长控制件是挠性的。
55.如权利要求53所述的外科仪器,其特征在于,拉伸压缩件是一护套和一可滑动地容纳在护套中的缆芯。
56.如权利要求55所述的外科仪器,其特征在于,护套通常是一具有一内腔的管状体。
57.如权利要求56所述的外科仪器,其特征在于,该管状体由一紧密绕制的线材制成。
58.如权利要求56所述的外科仪器,其特征在于,制成该管状体的材料从包括超弹性金属和金属合金的材料族中选择。
59.如权利要求58所述的外科仪器,其特征在于,管状体由含有镍和钛的超弹性金属材料制成。
60.如权利要求55所述的外科仪器,其特征在于,缆芯是拉伸件,该拉伸件通常由一根线材制成。
61.如权利要求53所述的外科仪器,其特征在于,驱动装置还包括:
一附带于手柄的杠杆,该杠杆适用于使端部操作装置的一叶片相对于另一叶片运动;
一附带于手柄的指轮,其设置得当一手握持仪器时可用食指转动它,该指轮适用于同时枢转端部操作装置的两叶片;以及
一附带于手柄的可旋转的旋钮,该可旋转的旋钮的适用于使管状件和端部操作装置相对于手柄转动。
62.如权利要求52所述的外科仪器,其特征在于,端部操作装置的每一叶片形成一在近端方向延伸的杠杆,此杠杆有一容纳靠近细长控制件远端附加的连接件的开口。
63.如权利要求52或62所述的外科仪器,其特征在于,
至少一细长控制件包括一第一细长控制件和一第二细长控制件,各控制件可滑动地安装在管状件中,旋转受到制约,并具有一靠近细长控制件远端附加的连接件;以及
端部操作装置的各叶片远端有一容纳其中一个连接件的开口。
64.如权利要求63所述的外科仪器,其特征在于:
第一和第二细长控制件的各近端有一螺纹部分;以及
驱动装置包括两细长丝杆,每个细长螺纹用来接纳一个螺纹部分。
65.如权利要求63所述的外科仪器,其特征在于:
一根丝杆可旋转地安装在手柄中;
第二丝杆可操作地联接于第一丝杆以便与之一起运动,并通过附带于手柄的操纵件的运动而轴向运动,以引起轴与端部操作装置的两叶片之间的相对运动。
66.如权利要求63所述的外科仪器,其特征在于,驱动装置还包括:
一附带于手柄的杠杆,该杠杆适用于使端部操作装置的一叶片相对于另一叶片运动;
一附带于手柄的指轮,其设置得当一手握持仪器时可用食指转动它,该指轮适用于同时枢转端部操作装置的两叶片;以及
一附带于手柄的可旋转的旋钮,该可旋转的旋钮适用于使管状件和端部操作装置相对于手柄转动。
67.如权利要求52所述的外科仪器,其特征在于:
至少一细长控制件包括一单一的轴,此所述轴具有一第一端,第一端上有一朝一个方向的部分螺纹和一朝第二方向的相邻部分螺纹,所述轴还有一可分离地和可操作地联接于驱动装置的第二端;以及
至少一细长控制件包括一第一控制缆,所述控制缆有一连接于端部操作装置的第一端和一连接于装在其中一个螺纹部分上的螺母的第二端;以及
至少一细长控制件还包括一第二控制缆,该控制缆具有连接于端部操作装置的第一端和连接于装在另一螺纹部分上的第二螺母的第二端。
68.如权利要求67所述的外科仪器,其特征在于,轴的第二端有一插入部分,用来联接一可滑动地接纳在手柄中的锁定轴环,以及部分驱动装置。
69.如权利要求52所述的外科仪器,其特征在于,用来旋转、枢转和闭合端部操作装置的装置包括两段高抗拉系数的、以协调方式一起工作的缆绳。
70.如权利要求67所述的外科仪器,其特征在于,轴的所述螺纹部分的长度超过拉伸件的行程。
71.如权利要求69所述的外科仪器,其特征在于,端部操作装置的叶片的各近端部分有一槽,以容纳拉伸件。
72.如权利要求71所述的外科仪器,其特征在于,籍两附加的缆绳端部操作装置可打开。
73.如权利要求69所述的外科仪器,其特征在于:
拉其中一个拉伸件而释放另一个拉伸件,同步地枢转端部操作装置的所述叶片;
同时拉诸拉伸件以闭合端部操作装置的所述叶片;以及
管状件相对于手柄的旋转使端部操作装置的叶片和拉伸件转动。
74.如权利要求52所述的外科仪器,其特征在于,端部操作装置包括一单一的叶片,所述单一的叶片包括两从基部延伸的臂,各臂具有一工作部分,基部促使所述臂分开。
75.如权利要求68所述的外科仪器,它还包括一联接结构,所述联接机构有一留给锁定轴环的空腔,使得当轴环容纳在所述腔中时,轴可从轴环中拆卸下来,并当轴环不在所述腔中时,该机构把可旋转的和轴向的力从动力源传递到该轴。
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CN 95195624 Pending CN1163558A (zh) | 1994-10-11 | 1995-10-11 | 具有可拆卸的端部操作装置的内窥镜仪器 |
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US11849944B2 (en) | 2021-03-24 | 2023-12-26 | Cilag Gmbh International | Drivers for fastener cartridge assemblies having rotary drive screws |
US11918217B2 (en) | 2021-05-28 | 2024-03-05 | Cilag Gmbh International | Stapling instrument comprising a staple cartridge insertion stop |
US11826047B2 (en) | 2021-05-28 | 2023-11-28 | Cilag Gmbh International | Stapling instrument comprising jaw mounts |
US11723662B2 (en) | 2021-05-28 | 2023-08-15 | Cilag Gmbh International | Stapling instrument comprising an articulation control display |
US11957337B2 (en) | 2021-10-18 | 2024-04-16 | Cilag Gmbh International | Surgical stapling assembly with offset ramped drive surfaces |
US11877745B2 (en) | 2021-10-18 | 2024-01-23 | Cilag Gmbh International | Surgical stapling assembly having longitudinally-repeating staple leg clusters |
US11980363B2 (en) | 2021-10-18 | 2024-05-14 | Cilag Gmbh International | Row-to-row staple array variations |
US11937816B2 (en) | 2021-10-28 | 2024-03-26 | Cilag Gmbh International | Electrical lead arrangements for surgical instruments |
US11980366B2 (en) | 2022-03-31 | 2024-05-14 | Cilag Gmbh International | Surgical instrument |
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