CN100569190C - 外科缝合器械 - Google Patents

外科缝合器械 Download PDF

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CN100569190C
CN100569190C CNB2004800441916A CN200480044191A CN100569190C CN 100569190 C CN100569190 C CN 100569190C CN B2004800441916 A CNB2004800441916 A CN B2004800441916A CN 200480044191 A CN200480044191 A CN 200480044191A CN 100569190 C CN100569190 C CN 100569190C
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CN101043850A (zh
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J·J·库恩斯
M·德阿坎格洛
F·比洛蒂
A·朗戈
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Ethicon Endo Surgery Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments 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
    • A61B1/00131—Accessories for endoscopes
    • A61B1/0014—Fastening element for attaching accessories to the outside of an endoscope, e.g. clips, clamps or bands
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/00296—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means mounted on an endoscope
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical 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
    • A61B2017/07214—Stapler heads
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical 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
    • A61B2017/07214—Stapler heads
    • A61B2017/07221—Stapler heads curved
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical 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
    • A61B2017/07214—Stapler heads
    • A61B2017/0725—Stapler heads with settable gap between anvil and cartridge, e.g. for different staple heights at different shots
    • 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
    • A61B2017/2901—Details of shaft
    • A61B2017/2905—Details of shaft flexible

Abstract

外科缝合器械(1)包括：缝钉紧固组件(2)，其包括弯曲的钉仓装置(10)以及弯曲的钉砧(12)。钉仓装置(10)包括至少一个弯曲的打开的缝钉排，所述缝钉通过钉砧(12)的缝钉成形面成形。钉砧(12)可相对于钉仓装置(10)移动。在该器械的近端区域中的手柄可操作地与缝钉紧固组件(2)连接。挠性支柱，优选为内窥镜(6)，设置在手柄(4)和缝钉紧固组件(2)之间并且引导移动装置和缝钉驱动装置的力传送器(8，9)。

Description

外科缝合器械
技术领域
本发明涉及可用于例如下消化道病理诊断和/或治疗的外科缝合器械。
背景技术
WO 01/91646 A1已经公开了这种外科缝合器械。WO 01/91646A1披露了外科缝合器械，其具有位于该缝合器械的远端区域的缝钉紧固组件、位于该缝合器械的近端区域的刚性轴以及从该轴延伸的手柄。该缝钉紧固组件包括弯曲的钉仓装置，其包括多个具有凹侧和凸侧的弯曲的打开的缝钉排。与钉仓装置相对地设置有弯曲的钉砧。该钉砧具有缝钉成形面并适于与该钉仓装置协作以对从钉仓装置退出的缝钉的端部进行成形。钉砧可相对于钉仓装置从用于定位两者之间的组织的间隔位置移动到用于夹紧组织的闭合位置。并且，在钉仓装置中包含有小刀并且小刀定位于至少一个缝钉排的凹侧并且任选在至少一个缝钉排的凸侧。
在WO 01/91646 A1中公开的外科缝合器械可用于切除例如息肉的组织，并且基本上可立即止血。在外科手术过程中，缝合器械例如导入到肛管中并移动到待切除的组织部位。当钉仓装置和钉砧位于间隔或打开位置时，可通过分离的组织抓取器械将待切除的组织拉入到钉砧和钉仓装置之间的区域中。此后，为了夹紧该组织，将钉砧相对于钉仓装置移动。当钉仓装置和钉砧到达闭合位置时，外科医生可使该器械“击发”，这意味着从钉仓装置中驱动出缝钉，刺穿该组织，在其上通过钉砧弯曲端部，并且为了切除该组织，将小刀朝向钉砧移动。当该器械打开时，完全切除的组织可以随该器械一起或先于该器械安全地从患者体内移出。
在WO 01/91646 A1中公开的外科缝合器械的特别优点在于缝钉紧固组件的形状，其中钉仓装置和钉砧截面为弧状。这允许不受阻碍地观察和到达钉仓装置和钉砧的内凹面。
然而，当探入到例如肛管中时，由WO 01/91646 A1已知的器械的操作范围受到限制，并且因为其有限的轴长，不能用于切除更加远离直肠的组织。
发明内容
本发明的目的在于提供一种外科缝合器械，其具有至少两个主要优点，即比WO 01/91646 A1中公开的缝合器械更大的操作范围，以及由于缝合器械尺寸可显著小于WO 01/91646 A1中公开的缝合器械而可由消化道(例如GI)医生在结肠镜定位中使用。
该技术问题通过具有权利要求1的特征的外科缝合器械得到解决。本发明优选的技术方案由从属权利要求阐明。
根据本发明的外科缝合器械包括在该器械的远端区域中的缝钉紧固组件，该组件包括弯曲的钉仓装置以及与钉仓装置相对的弯曲的钉砧。钉仓装置包括至少一个具有凹侧和凸侧的弯曲的打开的缝钉排。钉砧具有缝钉成形面并适于与钉仓装置协作，以对从钉仓装置中退出的缝钉的端部进行成形。此外，移动装置适于将钉砧相对于钉仓装置以基本平行的关系从用于在其间定位组织的间隔位置移动到用于夹紧该组织的闭合位置。缝钉驱动装置适于将钉仓装置中的缝钉朝向钉砧驱动。在该器械的近端区域中，手柄可操作地与缝钉紧固组件相连并且包括与移动装置和缝钉驱动装置的力传送器连接的致动部件。
任选地，缝合器械包括小刀，其容纳在钉仓装置中并且位于至少一个缝钉排的凹侧。小刀可通过例如优选与缝钉驱动装置连接的刀致动装置朝向钉砧移动，从而在缝钉驱动装置的致动部件致动时，缝钉和小刀可同时前进，小刀跟随缝钉，使得在缝合之后可切割组织。
根据本发明，在手柄和缝钉紧固组件之间设置有挠性支柱。挠性支柱为手柄和缝钉紧固组件之间的一种挠性轴或挠性连接件并可引导移动装置和缝钉驱动装置的力传送器。挠性支柱可以很长。其使得缝合器械可探入到例如肛管中并向前移动相当长的距离，以允许对远离肛门的部位处的组织进行治疗。随着缝合器械的进入，挠性支柱可适应肠道的弯曲。
在本发明的一个优选技术方案中，挠性支柱包括优选可拆卸地安装(即，其可与器械的其它部分分离)的挠性内窥镜。内窥镜通常包括用于观察的光学系统和光源并且可选地包括在其纵向中的工作通道。工作通道可用于将外科工具(例如，将组织拉入到钉仓装置和钉砧之间的空间中的内窥镜抓取器械)放置到外科手术部位。在缝合器械的支柱中应用挠性内窥镜具有可使用标准元件的优点，其对缝合器械既可提供强度又可提供挠性。
缝合器械可适于与形成至少部分挠性支柱的独立的挠性内窥镜一起使用。这意味着根据本发明的缝合器械的配置不带有内窥镜，并且为了使其进入操作状态，独立或分离配置的内窥镜可与该器械的其它部分相连。可选地，挠性内窥镜可以是该缝合器械的元件，甚至形成一体的部件。这些选择许允较大的设计多样性和较高的成本效率。
在本发明的一个优选方案中，移动装置和缝钉驱动装置的力传送器位于内窥镜的外部并且通过多个间隔的支架连接到内窥镜上。如果小刀致动装置在手柄处具有独立的致动部件，小刀致动装置的力传送器也可设置在内窥镜的外部。该设计利用内窥镜作为手柄与缝钉紧固组件之间唯一的结构连接件并且特别简单。
在另一方案中，挠性支柱包括挠性导轨，其沿着内窥镜设置并且容纳移动装置和缝钉驱动装置的力传送器。导轨根据其设计可在结构上连接手柄和缝钉紧固组件。
在本发明的一个优选方案中，移动装置和缝钉驱动装置的至少一个力传送器包括挠性旋转杆，其适于在手柄的相关致动部件致动时围绕其纵向轴线旋转并且适于在缝钉紧固组件处将其旋转运动转变为纵向运动。术语挠性杆应作更加广义地理解；其包括例如挠性并可传送扭矩的紧卷的螺旋线，并且甚至包括连接部件的设计。当力通过旋转运动从手柄处的致动部件传送到缝钉紧固组件时，旋转杆在导轨或护套中旋转的该旋转动作不会影响到挠性支柱的实际弯曲形状。与其相比，在弯曲的挠性轴中的力传送器的平移运动倾向于伸直该轴，这在这种器械的使用中是很大的缺陷。
优选地，至少一个力传送器适于通过由相关的致动部件操作的齿轮传动器而旋转。并且，至少一个力传送器适于通过螺杆传动件将其旋转运动转变为(钉砧相对于钉仓装置相对移动或击发缝钉所要求的)纵向运动。
钉砧的缝钉成形面可基本上为平面，但也可设计例如波浪形的其它形状。
在本发明的一个优选方案中，缝钉紧固组件适于允许没有阻碍地到达钉仓装置和钉砧的内凹面。已由WO 01/91646 A1公开的这样的设计极大地方便了外科手术过程中该缝合器械的应用。
优选地，钉仓装置和钉砧具有基本上为弧状的截面，该弧在10°到350°角的范围内延伸。
在本发明的一个优选方案中，钉砧通过至少一个臂支撑，该臂从钉砧的一端延伸并基本上沿与钉砧相对于钉仓装置相对移动的方向平行地延伸。如果钉砧可相对于固定的钉仓装置移动，该臂可通过移动装置驱动。优选在钉砧的另一端的可选的第二臂提供了额外的强度并方便了钉砧相对于钉仓装置的准确对准，这对于缝钉的端部相对于钉砧的缝钉成形面的精确对准很重要。这种支撑允许钉仓装置与钉砧之间的较大的未阻碍区域。
优选地，钉仓装置与闭合位置中的钉砧之间的距离可以调节。例如，为了防止钉仓装置(或钉砧)移动超出限位位置且夹住组织过紧，移动装置可包括例如在手柄的相关致动部件处的可调节的挡块。或者根据组织的厚度可使用一系列具有不同嵌入组织挡块的钉仓装置。也可设计使用具有适于钉仓装置与闭合位置的钉砧之间的所需距离的一系列不同纵向尺寸的钉仓装置。通过调节钉仓装置与闭合位置的钉砧之间的距离，该器械可匹配待缝合的组织的厚度和类型。
在外科缝合器械的一个优选方案中，钉仓装置包括可更换的包含缝钉的钉仓。这样，如果需要，没有缝钉的已使用的钉仓可用新的替换。这在该器械对于同一患者使用多次时特别有利。
优选地，缝钉紧固组件和/或手柄相对于挠性支柱可拆卸地安装，这允许更方便处理和/或部分地更换缝合器械。
WO 01/91646 A1已公开了以上所讨论的某些技术特征，特别是弧状的钉仓装置和钉砧以及从钉砧一端延伸的支撑臂，这使得例如内窥镜光学系统或辅助的外科器械容易到达手术部位。总的说来，根据本发明的缝合器械可使用于WO 01/91646 A1中公开的所有类型的外科手术，该公开其全部内容通过引用并入本文。然而，本发明的特别优点在于可在更加远离患者身体开口的位置进行这些手术并且使用诸如局部麻醉或镇静的GI技术(例如，非外科手术的)的能力。
这里，所用的术语“缝钉”具有非常概括的含义。其包括金属缝钉或夹子，也包括由合成材料制成的外科紧固件。合成紧固件通常具有设置在钉砧上的配合物(保持器部件)。从该意义来说，术语“钉砧”和“缝钉成形面”也具有广泛的含义，在包括两件式合成紧固件的情况下，包括钉砧状的工具以及保持器部件设置在其处的面，以及类似装置。
附图说明
在下文中，通过实施方式将更详细地描述本发明。其中：
图1为根据本发明第一实施方式的外科缝合器械的总体等轴侧图，其中包括内窥镜、在远端区域的缝钉紧固组件以及在近端区域中的手柄；
图2为图1的缝合器械的远侧部分的等轴侧图；
图3为沿着内窥镜间隔设置的多个支架的其中一个的等轴侧图；
图4为手柄的内部机构的等轴侧图；
图5为手柄的内部机构的侧视图；
图6为去除了缝钉紧固组件的内窥镜的远端的等轴侧图；
图7为由手柄中的机构(即支撑钉砧的臂和用于排出缝钉的推动器底座)驱动的缝钉紧固组件的元件的等轴侧图；
图8为与图7类似并增加缝钉和小刀的等轴侧图；
图9为图8的某些部分在不同视角的等轴侧图；
图10为钉砧的缝钉成形面和用于引导小刀的两个导轨的等轴侧图；
图11为钉砧处于间隔位置的完全组装后的缝钉紧固组件的等轴侧图；
图12为去除了外壳、钉砧位于闭合位置并且刚刚击发缝钉的缝钉紧固组件的等轴侧图；
图13为图12的部分在不同视角的等轴侧图；
图14为与图12相似的、安装有外壳并且包括内窥镜的等轴侧图；
图15为缝钉紧固组件的分解图；
图16为根据本发明第二实施方式的外科缝合器械的等轴侧图，其中包括挠性导杆和内窥镜；以及
图17为图16的实施方式的远端区域的等轴侧图。
具体实施方式
图1为根据第一实施方式的外科缝合器械1的总体等轴侧图。缝合器械1包括在其远端区域中的缝钉紧固组件2以及在其近端区域中的手柄4。手柄4和缝钉紧固组件2通过挠性内窥镜6相连。在该实施方式中，内窥镜6为市场上可得到的内窥镜，其并非为了用于该缝合器械而做出改进。内窥镜6作为挠性支柱并提供结构强度。
如图1和图2所示，从手柄4延伸至缝钉紧固组件2的两个力传送器8和9通过内窥镜6引导。力传送器用于将来自手柄4的力传送至缝钉紧固组件2，以执行缝合器械1的功能。
缝钉紧固组件2的主要元件为钉仓装置10，其包括多个弯曲的打开的缝钉排以及小刀，以及弯曲的钉砧12，其具有缝钉成形面并且适于与钉仓装置协作以在缝合器械1“击发”时对从钉仓装置排出的缝钉的端部进行成形。
钉砧12可相对于钉仓装置10以平行关系移动，即在与内窥镜6的远端部分的纵向轴线平行的方向上移动。如图2所示，钉砧12已完全移动到钉仓装置10。
用于相对钉仓装置10移动钉砧12的缝合器械1的机构和其元件总的称为移动装置，而用于推进缝钉的机构和元件总的称为缝钉驱动装置。
图2示出了钉仓装置10和钉砧2基本上为弧状。这个设计确保容易到达钉仓装置10和钉砧12之间的工作区域。
此外，图2示出了内窥镜6的远端部分和缝钉紧固组件2的设置。内窥镜6的远端面具有两个开口，一个用于观察的光学系统14，一个用于光源15。可选地，内窥镜可包括工作通道，其允许具有挠性轴的外科器械通过内窥镜的工作通道探入到外科手术部位，即缝钉紧固组件2的区域。
在该实施方式中，力传送器8和9通过多个间隔的支架安装在内窥镜6上。图3以放大图示出了一个支架16。各个支架16具有锁17和用于分别容纳力传送器8和9的两个凹槽18和19。为了装配，包括燕尾形突起以及与其配合的槽口的锁17可以打开。由挠性材料制造的支架16允许内窥镜6插入。
内窥镜6与缝钉紧固组件2或手柄4之间的机械连接可完全由支架16和力传送器8和9实现。特别在手柄4的区域，手柄4与内窥镜6并非刚性连接的这种设计的挠性是有利的。在缝合器械1的远端区域，可另外通过例如粘结将内窥镜6固定到缝钉紧固组件2的钉仓装置10上。
图4和图5示出了手柄4的内部机构。手柄4包括设计用于在操作者手掌中握持的把手20和齿轮罩22。
致动部件24为移动装置的一部分。当可旋转地安装的致动装置24向把手20移动时，齿条26在远侧方向移动并旋转齿轮28。旋转轴线的方向通过位于轴承3 0近端的小齿轮29改变90°，轴承3 0支撑移动装置的力传送器8的近端。力传送器8包括旋转杆(见下图)，其近端固定到小齿轮29上。因此，在按压致动部件24时，力传送器8的旋转杆产生围绕纵向轴线的旋转运动。由于齿轮28与小齿轮29的齿轮比，该旋转运动相对较快。
类似地，按压旋转安装的致动部件32以抵抗弹簧33的力(使器械“击发”)时，齿条34在远侧方向移动并且驱动位于轴承38近端的齿轮36和小齿轮37，这导致缝钉驱动装置的力传送器9的旋转杆的相对快速的旋转运动。
为了在缝钉“击发”之后释放(缩回)缝钉驱动装置，需要按压释放按钮40以抵抗弹簧41施加的力。在“击发”之后且按压释放弹簧40之前，锁钩42接合缝钉驱动装置的突起并保持齿条34位于远侧位置。此外，当按压致动部件32时，又通过该机构保持齿条26向前并且就位。按压释放按钮40以抬起锁钩42，这释放了缝钉驱动装置的突起，从而通过弹簧33的动作，齿条34返回到其初始的近侧位置。
安全机构(未详细示出)是由部件44保持的销，直到部件44在致动部件24的致动时退出为止。这确保致动部件32不能先于致动部件24使用。
图6示出了移动装置的力传送器8以及缝钉驱动装置的力传送器9的远端区域，其中包括最远侧的支架16和内窥镜6的远端区域。
力传送器8包括旋转安装在挠性护套中的挠性旋转杆50。在该实施方式中，旋转杆50自始至终为单独的挠性结构。也可设想不同的设计，例如，包括挠性连接的短的刚性部件的结构或紧卷的螺旋结构。旋转杆50在其远端固定到与驱动螺杆53的近端连接的连接器52上。以相似的方式，力传送器9包括旋转杆54，其在护套55中受引导并且末端为固定到驱动螺杆57的连接器56。
图7显示了由螺杆53和57驱动的元件，但仍未显示用于这些元件的引导部件或轨道。螺杆53配合拧入在支撑钉砧外壳62的臂60中沿纵向方向延伸的螺纹孔。相似地，螺杆57配合拧入推动器底座64中的螺纹孔。因此，通过旋转旋转杆50或54，臂60和推动器底座64分别在缝钉紧固组件2的纵向方向上移动。
图8示出了缝钉紧固组件2的辅助元件。螺杆53和57均通过缝钉紧固组件2的弓形底座65中的孔引导。推动器底座64(通过中间部件67)支撑多个推动器指状件68从其中纵向延伸的推动器平台66。每个推动器指状件68支撑缝钉70，从而缝钉70的尖端在远侧方向对准。推动器指状件68和相关的缝钉70在各个形成于钉仓装置10的外壳中的槽(图8中未示出)中受引导。此外，中间部件67支撑具有凹侧(图8中示出)、与凹侧相对的凸侧以及锋利的刀刃73的弓形小刀73。图8还示出了从钉砧外壳62延伸并且与臂60平行的钉砧12的引导臂74。
图9提供了更加清除的缝钉70(图9中未示出但可通过推动器指状件68的位置表示)和小刀72的设置。
钉仓装置10包括三个弯曲的打开的缝钉排，也即，在小刀72的凸侧的两排76和77以及在小刀72的凹侧的一排78。
在图10中示出了安装在钉砧外壳62(见图8)上的缝钉成形面80。缝钉成形面80优选由金属制造并包括三排与缝钉70的尖端对准的缝钉成形凹槽82。并且，图10示出了小刀凹槽84，其与小刀72的锋利刀刃73对准并优选填充作为切割挡块但可由小刀72切割的塑料。
如图10所示，两个导轨86和87固定到缝钉成形面80上，其各具有用于即使当其非常靠近缝钉成形面80时也可精确引导小刀72的横向槽。当钉砧12通过移动装置相对应钉仓装置10移动时，导轨86和87也在纵向方向上移动并且在中间部件67和推动器平台66中设置的孔88和89(见图9)中滑动。这种移动不会影响小刀72的位置，因为小刀72固定到中间部件67上。
图11为与图8相似的视图，但是钉仓装置10已由外壳90封闭。在该实施方式中，外壳90为由医用塑料制成注塑成型的部件。
图11示出了钉砧12已移动到间隔位置的状态，即钉仓装置10与缝钉成形面80之间的距离较大的位置。这对应于图8中驱动螺杆53的较大的暴露区域。在该间隔位置中，患者待切除的组织可以拉入钉砧12的缝钉成形面80与钉仓装置10之间。此后，移动装置的致动部件24朝向把手20按压，这产生旋转杆50和驱动螺杆53的旋转运动，导致钉砧12在近侧方向的移动。这样，钉砧12到达闭合位置并且夹紧该组织。
该过程的下一步骤在图12中示出(其中去除了外壳90)。如所示出的，从驱动螺杆53较小的暴露区域显而易见钉砧12已移动到闭合位置。此外，按压致动部件32，这导致螺杆57的旋转运动以及推动器底座64、中间部件67、推动器平台66、推动器指状件68、缝钉70以及小刀72的远侧方向的纵向运动，其中小刀72的锋利刀刃73跟随缝钉70的尖端。图12示出了缝钉70通过缝钉成形面80成形时的状态。图13显示了相同的状态。
图14示出了在相同状态下的钉仓装置10、钉砧12和内窥镜6的远端区域的完整视图。在该组织缝合之后，通过小刀72切割并切除。这样，留在患者体内的组织可通过小刀72凸侧上的排76和排77的缝钉安全地缝合，这可即时止血，而通过排78的缝钉将要从患者体内去除的部分组织缝合并保持在一起。在缝合之后，按压释放按钮40，从而齿条34和致动部件32通过弹簧33所施加的力返回到它们的初始位置。另外，这产生移动装置的反向运动，增加了钉砧12与钉仓装置10之间的距离，以释放夹紧的组织并且能够将缝合器械1从患者体内移出。该组织的切除部分保留在缝钉紧固组件2中。
图15以分解图的方式示出了至此所述的实施方式的缝钉紧固组件2的元件。螺钉92和93用于将弓形底座65与钉仓装置10的外壳90的部件连接。
图16和图17显示了第二实施方式的外科缝合器械，即缝合器械100。其缝钉紧固组件102和其手柄104具有与第一实施方式的缝钉紧固组件2和手柄4相似的设计。然而，相比较而言，力传送器未暴露于内窥镜106的外周，而是容纳在挠性导轨108中。内窥镜106和挠性导轨108形成缝合器械100的挠性支柱。
在该实施方式中，挠性导轨108由塑料制造并且包括用于引导移动装置和缝钉驱动装置的力传送器的旋转杆的两个纵向轨道。开口的轨道109沿着挠性导轨108的纵向延伸。如图16和17所示，内窥镜106可嵌入在开口轨道109中。
缝合器械100的功能和使用与缝合器械1的相同。

Claims (18)

1、一种外科缝合器械，包括：
在所述器械(1；100)的远端区域中的缝钉紧固组件(2；102)，包括弯曲的钉仓装置(10)以及与所述钉仓装置(10)相对的弯曲的钉砧(12)，所述钉仓装置包括至少一个具有凹侧和凸侧的弯曲的打开的缝钉(70)排(76，77，78)，所述钉砧(12)具有缝钉成形面(80)并能够与所述钉仓装置(10)协作，以对从所述钉仓装置(10)中退出的缝钉(70)的端部进行成形，所述钉仓装置(10)和钉砧(12)具有基本上为弧状的截面，
移动装置(8，24，26，28，29，30，53，60)，其能够将所述钉砧(12)相对于所述钉仓装置(10)以基本平行的关系从用于在其间定位组织的间隔位置相对移动到用于夹紧所述组织的闭合位置，
缝钉驱动装置(9，32，34，36，37，38，57，64)，其能够将所述缝钉(70)朝向所述钉砧(12)从钉仓装置(10)中驱出，
在所述器械(1；100)的近端区域中的手柄(4；104)，所述手柄(4；104)可操作地与所述缝钉紧固组件(2；102)连接并且包括与所述移动装置和缝钉驱动装置的力传送器(8，9)连接的致动部件(24，32)，
其特征在于，在所述手柄(4；104)和所述缝钉紧固组件(2；102)之间设置有挠性支柱(6；106，108)，所述挠性支柱(6；106，108)引导所述移动装置和缝钉驱动装置的力传送器(8，9)，所述缝钉紧固组件(2；102)能够允许没有阻碍地到达所述钉仓装置(10)和钉砧(12)的内凹面。
2、根据权利要求1所述的缝合器械，其特征在于，还包括：
小刀(72)，其容纳在所述钉仓装置(10)中并且位于至少一个缝钉(70)排(76，77)的凹侧，以及
小刀致动装置(9，32，34，36，37，38，57，64)，其能够将所述小刀(72)朝向所述钉砧(12)移动，所述小刀致动装置与所述缝钉驱动装置连接。
3、根据权利要求1或2所述的缝合器械，其特征在于，所述挠性支柱(6；106，108)包括可拆卸地安装的挠性内窥镜(6；106)。
4、根据权利要求1或2所述的缝合器械，其特征在于，所述缝合器械(1；100)能够与形成至少部分所述挠性支柱(6；106，108)的独立的挠性内窥镜(6；106)一起使用。
5、根据权利要求3所述的缝合器械，其特征在于，所述移动装置和所述缝钉驱动装置的力传送器(8，9)位于所述内窥镜(6)的外部并且通过多个间隔的支架(16)连接到所述内窥镜(6)上。
6、根据权利要求4所述的缝合器械，其特征在于，所述移动装置和所述缝钉驱动装置的力传送器(8，9)位于所述内窥镜(6)的外部并且通过多个间隔的支架(16)连接到所述内窥镜(6)上。
7、根据权利要求3所述的缝合器械，其特征在于，所述挠性支柱(106，108)包括挠性导轨(108)，所述挠性导轨沿着所述内窥镜(106)设置并且容纳所述移动装置和所述缝钉驱动装置的力传送器。
8、根据权利要求4所述的缝合器械，其特征在于，所述挠性支柱(106，108)包括挠性导轨(108)，所述挠性导轨沿着所述内窥镜(106)设置并且容纳所述移动装置和所述缝钉驱动装置的力传送器。
9、根据权利要求1所述的缝合器械，其特征在于，所述移动装置和所述缝钉驱动装置的至少一个力传送器(8，9)包括挠性旋转杆(50，54)，所述挠性旋转杆(50，54)能够在所述手柄(4)的相关的致动部件(24，32)致动时围绕其纵向轴线旋转并且能够在所述缝钉紧固组件(2)处将其旋转运动转变为纵向运动。
10、根据权利要求9所述的缝合器械，其特征在于，所述至少一个力传送器(8，9)能够通过由所述相关的致动部件(24，32)操纵的齿轮传动器(26，28，29；34，36，37)而旋转。
11、根据权利要求9或10所述的缝合器械，其特征在于，所述至少一个力传送器(8，9)能够通过螺杆传动件(53，57)将其旋转运动转变为纵向运动。
12、根据权利要求1所述的缝合器械，其特征在于，所述钉砧(12)的所述缝钉成形面(80)基本上为平面。
13、根据权利要求1所述的缝合器械，其特征在于，所述的弧在10°到350°角的范围内延伸。
14、根据权利要求1所述的缝合器械，其特征在于，所述钉砧(12)通过至少一个臂(60，74)支撑，所述臂从所述钉砧(12)的一端延伸并基本上与所述钉砧(12)相对于所述钉仓装置(10)的相对运动的方向平行地延伸。
15、根据权利要求1所述的缝合器械，其特征在于，所述钉仓装置(10)与所述闭合位置中的所述钉砧(12)之间的距离能够调节。
16、根据权利要求1所述的缝合器械，其特征在于，所述钉仓装置包括可更换的包含缝钉的钉仓。
17、根据权利要求1所述的缝合器械，其特征在于，所述缝钉紧固组件被可拆卸地安装。
18、根据权利要求1所述的缝合器械，其特征在于，所述手柄被可拆卸地安装。
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BRPI0419039B8 (pt) 2021-06-22
EP1788954A1 (en) 2007-05-30
US20090236399A1 (en) 2009-09-24
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US20100133320A1 (en) 2010-06-03
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