RU2187249C2 - Хирургический инструмент - Google Patents
Хирургический инструмент Download PDFInfo
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Abstract
Изобретение относится к хирургическим инструментам и предназначено для использования при хирургических операциях и, в частности, при закрытых внутриполостных эндохирургических операциях. Хирургический инструмент в виде ножниц, щипцов или зажимов содержит корпус с подвижными, сменными рабочими частями, которые установлены с возможностью поворота и фиксации, тягу, исполнительные органы и ручки для удерживания инструмента и управления. Инструмент управления механизмом фиксации снабжен рычагом. Рычаг расположен на оси выше петли неподвижной ручки, в пазу которой размещена взаимодействующая с рычагом пружина. Один конец пружины закреплен на оси, а другой конец через пружину взаимосвязан с сухариком, закрепленным на оси. Конец сухарика взаимодействует с зубчатой поверхностью кремальеры, опирающейся на опорную шпильку неподвижной ручки, и осью. Ось соединена с подвижной ручкой. Рычаг может занимать любое из трех положений - среднее, нижнее и верхнее, что соответствует положению: механизм фиксации действует, временно отключен и отключен совсем. В результате исключается случайное закрытие рабочих частей в ходе операции, при этом конструкция позволяет использовать инструмент в свободном, необходимом хирургу режиме, например без механизма фиксации. 2 з.п. ф-лы, 5 ил.
Description
Изобретение относится к хирургическим инструментам и предназначено для использования при хирургических операциях и, в частности, при закрытых внутриполостных эндохирургических операциях.
Известен хирургический инструмент (Журнал фирмы "DUFNER" 1992г.) в виде ножниц, щипцов, захватов и зажимов, содержащий корпус, исполнительный орган с рабочими подвижными частями (лезвия ножниц губки, зажимов, захватов или щипцов) соединенный с ручками для удерживания инструмента и управления подвижными частями, а также механизм фиксации положения рабочих подвижных частей. Простейшим механизмом фиксации положения рабочих подвижных частей в положении только "открыто" служит пружина. В положение "закрыто" они приводятся и удерживаются в нем только рукой хирурга.
Инструмент с механизмом фиксации в виде зубчатых смыкающихся элементов (кремальер) требует больших усилий, грубо и ступеньчато позволяет регулировать положение рабочих подвижных частей, не исключает пережим ткани оперируемого или наоборот недожим пережимаемого, например, сосуда, а при разжиме сцепленных зубьями кремальер требует значительных (явно не женских) усилий для создания перекоса и разведения ручек, при этом происходит произвольное перемещение (дергание) рабочих частей, что может травмировать удерживаемые ими ткани или сосуды оперируемого.
Известен также инструмент с механизмом фиксации подвижных рабочих частей, который не обеспечивает плавную регулировку и надежную фиксацию подвижных частей в любом требуемом хирургу положении, требует также значительных усилий и внимания хирурга к инструменту при освобождении из позиции "зажато", а зубчатая кремальера может самоотключаться при ее случайном задевании, поскольку удерживается в зацеплении только усилием пружины и механически не застрахована от самопроизвольного откидывания, что и мешает использованию инструмента.
Известен инструмент, выбранный в качестве прототипа (см. патент Российской Федерации 2121310, 10.11.1998), в котором механизм управления подвижными рабочими частями и их фиксации выполнен в виде подпружиненной радиусной кремальеры, зубчатая поверхность которой взаимодействует с крючком, управляемым через пружину курком, являющимся частью внутренней поверхности петли ручки инструмента.
Главный недостаток инструмента с таким механизмом управления и фиксирования подвижных рабочих частей заключается в том, что при работе инструментом в положении рабочих частей "зажато" любое перемещение пальца хирурга в ограниченном пространстве петли ручки приведет к случайному нажатию курка, а следовательно, и к раскрытию рабочих частей, что в ходе операции может серьезно осложнить операцию.
Другим недостатком этого инструмента является то, что механизм регулирования не отключается и это не позволяет использовать инструмент в свободном, необходимом хирургу режиме, например в режиме просто щипцов без механизма фиксации, что сужает применимость инструмента.
Суть данного изобретения выражается следующей совокупностью признаков, существенных и обеспечивающих хирургу удобство работы инструментом с возможностью выбора режима; фиксируемого положения подвижных частей, которое осуществляется плавно и с минимальным усилием, или временного, или полного отключения механизма фиксации и свободного манипулирования инструментом. Инструмент надежен и исключает "случайности", поскольку рычаг управления механизмом фиксации размещен выше петли ручки, в зоне, которая защищена самой ручкой, при этом пружина, взаимодействующая через сухарик с кремальерой, размещена в пазу ручки и тем самым также защищена.
Это достигается тем, что предлагаемый хирургический инструмент, выполненный в виде ножниц, щипцов или зажимов, содержит корпус с подвижными рабочими частями, установленными с возможностью поворота и фиксации, толкатель, исполнительные органы и ручки для удерживания инструмента и управления исполнительными органами, снабжен также рычагом, расположенным на оси выше петли ручки, в прорези которой размещена взаимодействующая с рычагом пружина, один конец ее закреплен на оси, а другой конец через пружину взаимосвязан с сухариком на оси, свободный конец которого взаимодействует с зубчатой поверхностью кремальеры, опирающейся на сухарик неподвижной ручки, и осью, соединенной с подвижной ручкой. При этом центр оси рычага имеет разные длины до вершин углов, взаимодействующих с пружиной, что обеспечивает требуемый режим фиксации или отключение механизма фиксации. Такое выполнение улучшает стерилизацию инструмента.
На фиг. 1 показан общий вид инструмента в позиции органов управления, соответствующей положению рабочих подвижных частей: пунктиром -"открыто", а "закрыто" - сплошной линией.
На фиг.2 показан вид разреза А-А, где видно, что кремальера 6 закреплена на оси 5 ручки 4.
На фиг.3 показан вид Б расположения в пазу и крепления на оси 8 пружины 9 неподвижной ручки 7.
На фиг.4 показан вид В положения рычага 10 на оси 11 ручки 7 при взаимодействии с пружиной 9.
Фиг.4.1 соответствует положению, когда механизм фиксации положения рабочих частей 2 отключен совсем при самофиксации рычага 10, отведенного (поднятого) "вверх".
На фиг. 4 среднее положение рычага 10 соответствует рабочему положению механизма фиксации.
Фиг.4.2 соответствует временному отключению механизма фиксации при обязательном удерживании рычага 10 "вниз" пальцем хирурга.
На фиг.5 показан вид Г положения органов механизма фиксации, взаимосвязанных с кремальерой 6.
Предлагаемый хирургический инструмент, по фиг.1-5, состоит из корпуса 1 со сменными рабочими частями 2, тяги 3, подвижной ручки 4 с закрепленной к ней на оси 5 кремальерой 6 (фиг.2, разрез А-А), а также закрепленной неподвижно к корпусу 1 ручки 7, в пазу которой размещена и закреплена на оси 8 пружина 9 (фиг.3), взаимосвязанная с рычагом 10 на оси 11 ручки 7 (фиг.4), при этом пружина 9 через пружину 12 взаимосвязана с сухариком 13, закрепленным на оси 14, а сухарик 13 взаимосвязан с зубчатой поверхностью кремальеры 6, опирающейся на опорную шпильку 15 ручки 7.
Рычаг 10 может занимать одно из трех положений.
Верхнее, при котором механизм фиксации положения рабочих частей отключен.
Среднее, при котором механизм фиксации действует.
Нижнее, в котором рычаг 10 удерживается пальцем хирурга, и механизм фиксации в это время отключен, при снятии пальца рычаг 10 вернется в среднее положение.
Работа хирургического инструмента осуществляется таким образом, чтобы большой палец хирурга располагался в петле ручки 4, средний, безымянный и мизинец - в петле ручки 7. Рычаг 10 находится в среднем, рабочем положении, и на пружину 9 воздействия не оказывает (фиг.4). При сведении ручек, например, щипцов тяга 3 тянет рабочие части 2, и они начинают смыкаться, при этом кремальера 6, одним концом соединенная осью 5 с подвижной ручкой 4, перемещается по опорной шпильке 15 неподвижной ручки 7, при этом сухарик 13, расположенный на оси 14, под действием пружины 12 прижат к кремальере 6, а она - к опорной шпильке 15, и сухарик 13 находится во взаимодействии с зубчатой поверхностью кремальеры 6. При перемещении кремальеры 6 пружина 12 позволяет сухарику 13 отходить (прощелкивать по зубчатой поверхности кремальеры 6) до положения смыкания рабочих частей 2 и надежно фиксирует их в этом положении от обратного хода кремальеры 6 клинящим действием сухарика 13.
Для разведения ручек 4, 7 и раскрытия рабочих частей 2 необходимо указательным пальцем нажать рычаг 10 вниз, при этом рычаг 10 окажет воздействие на пружину 9 своим длинным от оси 11 плечом (фиг.4.2), которая изменит длину и усилие воздействия на сухарик 13, и он выйдет из зацепления с кремальерой 6.
Удерживая рычаг 10, хирург может свободно манипулировать ручками 4 и 7, а следовательно, и рабочими частями 2. При отпускании рычага 10 (палец хирурга убран) рычаг 10 под действием пружины 9 снова займет свое среднее рабочее положение (фиг.4), и механизм фиксации будет включен.
Для полного отключения механизма фиксации рычаг 10 необходимо поднять вверх, при этом рычаг 10 окажет воздействие на пружину 9 (фиг.4.1) своим коротким от оси 11 плечом, и механизм фиксации будет отключен, так как сухарик 13 выйдет из зацепления с кремальерой 6, при этом сам рычаг 10, поднятый вверх, останется в этом положении до его перевода, при необходимости, в другое положение. Полное отключение механизма фиксации позволяет, разобрать инструмент, заменить рабочие части 2 и способствует лучшей сте рилизации инструмента.
Сведение ручек 4 и 7 для смыкания рабочих частей 2 может осуществляться и при отключении механизма фиксации с перемещением рычага 10 из среднего положения вниз или вверх, а разведение ручек 4 и 7, а следовательно, и рабочих частей 2 - только при положениях рычага 10 внизу или вверху, при среднем положении рычага 10 ручки и рабочие части 2 будут фиксироваться.
Claims (3)
1. Хирургический инструмент в виде ножниц, щипцов или зажимов, содержащий корпус с подвижными, сменными рабочими частями, установленными с возможностью поворота и фиксации, толкатель, тягу, исполнительные органы и ручки для удерживания инструмента и управления исполнительными органами, отличающийся тем, что снабжен рычагом управления механизмом фиксации, расположенным на оси выше петли неподвижной ручки, в пазу которой размещена взаимодействующая с рычагом пружина, один конец которой закреплен на оси, а другой конец через пружину взаимосвязан с сухариком, закрепленным на оси, конец которого взаимодействует с зубчатой поверхностью кремальеры, опирающейся на опорную шпильку неподвижной ручки, и осью, соединенной с подвижной ручкой.
2. Инструмент по п.1, отличающийся тем, что рычаг имеет три рабочих положения: нижнее, временно отключающее механизм фиксации, среднее - при работающем механизме фиксации и верхнее с отключением механизма фиксации.
3. Инструмент по пп.1 и 2, отличающийся тем, что центр оси рычага имеет разные расстояния до вершин углов, взаимодействующих с пружиной, расположенной в пазу неподвижной ручки.
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US11826047B2 (en) | 2021-05-28 | 2023-11-28 | Cilag Gmbh International | Stapling instrument comprising jaw mounts |
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