CN101011275B - 具有可拆卸的电池的外科器械 - Google Patents
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Abstract
一种外科切割器械,包括手柄、电池、马达以及锁定系统。手柄包括主体部分以及握持部分。握持部分可释放地连接到主体部分上。电池位于握持部分中。马达与电池电连接。锁定系统位于手柄中,所述锁定系统被构造和布置成在握持部分与主体部分断开预定次数之后阻断握持部分与主体部分的连接。
Description
相关申请的交叉引用
本发明与下列同时提交的美国专利申请相关,这些专利申请的内容通过引用并入本文:
(1)发明人为Frederick E.Shelton、IV、John Ouwerkerk和Jerome R.Morgan,发明名称为“MOTOR-DRIVEN SURGICALCUTTING AND FASTENING INSTRUMENT WITH USERFEEDBACK SYSTEM”的申请(K&LNG 050519/END5687USNP);
(2)发明人为Frederick E.Shelton、IV、John N.Ouwerkerk、Jerome R.Morgan和Jeffrey S.Swayze,发明名称为“MOTOR-DRIVEN SURGICAL CUTTING AND FASTENINGINSTRUMENT WITH LOADING FORCE FEEDBACK”的申请(K&LNG 050516/END5692USNP);
(3)发明人为Frederick E.Shelton、IV、John N.Ouwerkerk、Jerome R.Morgan和Jeffrey S.Swayze,发明名称为“MOTOR-DRIVEN SURGICAL CUTTING AND FASTENINGINSTRUMENT WITH TACTILE POSITION FEEDBACK”的申请(K&LNG 050515/END5693USNP);
(4)发明人为Frederick E.Shelton、IV、John N.Ouwerkerk和Jerome R.Morgan,发明名称为“MOTOR-DRIVEN SURGICALCUTTING AND FASTENING INSTRUMENT WITH ADAPTIVEUSER FEEDBACK”的申请(K&LNG 050513/END5694USNP);
(5)发明人为Frederick E.Shelton、IV和Christoph L.Gillum发明名称为“MOTOR-DRIVEN SURGICAL CUTTING ANDFASTENING INSTRUMENT WITH ARTICULATABLE ENDEFFECTOR”的申请(K&LNG 050692/END5769USNP);
(6)发明人为Frederick E.Shelton、IV和Christoph L.Gillum发明名称为“MOTOR-DRIVEN SURGICAL CUTTING ANDFASTENING INSTRUMENT WITH MECHANICAL CLOSURESYSTEM”的申请(K&LNG 050693/END5770USNP);
(7)发明人为Frederick E.Shelton、IV和Kevin R.Doll,发明名称为“SURGICAL CUTTING AND FASTENING INSTRUMENTWITH CLOSURE TRIGGER LOCKING MECHANISM”的申请(K&LNG 050694/END5771USNP);
(8)发明人为Frederick E.Shelton、IV、Jeffrey S.Swayze、EugeneL.Timperman,发明名称为“GEARING SELECTOR FOR APOWERED SURGICAL CUTTING AND FASTENING STAPLINGINSTRUMENT”的申请(K&LNG 050697/END5772USNP);
(9)发明人为Frederick E.Shelton、IV、John N.Ouwerkerk和Eugene L.Timperman,发明名称为“SURGICAL INSTRUMENTHAVING RECORDING CAPABILITIES”的申请(K&LNG050698/END5773USNP);
(10)发明人为Jeffrey S.Swayze、Frederick E.Shelton、IV和Kevin R.Doll,发明名称为“ELECTRONIC LOCKOUTS ANDSURGICAL INSTRUMENT INCLUDING SAME”的申请(K&LNG050700/END5775USNP);
(11)发明人为Frederick E.Shelton、IV、Jeffrey S.Swayze、Mark S.Ortiz,和Leslie M.Fugikawa,发明名称为“ENDOSCOPICSURGICAL INSTRUMENT WITH A HANDLE THAT CANARTICULATE WITH RESPECT TO THE SHAFT”的申请(K&LNG050701/END5776USNP);
(12)发明人为Frederick E.Shelton、IV、Stephen J.Balek和Eugene L.Timperman,发明名称为“ELECTRO-MECHANICALSURGICAL CUTTING AND FASTENING INSTRUMENT HAVING AROTARY FIRING AND CLOSURE SYSTEM WITH PARALLELCLOSURE AND ANVIL ALIGNMENT COMPONENTS”的申请(K&LNG 050702/END5777USNP);
(13)发明人为Frederick E.Shelton、IV、Michael S.Cropper、Joshua M.Broehl、Ryan S.Crisp、Jamison J.Float和Eugene L.Timperman,发明名称为“DISPOSABLE STAPLE CARTRIDGEHAVING AN ANVIL WITH TIS SUE LOCATOR FOR USE WITH ASURGICAL CUTTING AND FASTENING INSTRUMENT ANDMODULAR END EFFECTOR SYSTEM THEREFOR”的申请(K&LNG050703/END5778USNP);
(14)发明人为Frederick E.Shelton、IV、Jerome R.Morgan、Kevin R.Doll、Jeffrey S.Swayze和Eugene L.Timperman,发明名称为“SURGICAL INSTRUMENT HAVING A FEEDBACK SYSTEM”的申请(K&LNG 050705/EDN5780USNP)。
技术领域
本申请公开的发明在不同实施例中总的涉及具有可拆卸的电池的马达驱动的外科器械。
背景技术
与传统的开放式外科器械相比,内窥镜外科器械通常更受青睐,这是因为较小的切口易于减少术后恢复时间和并发症。因此,各种内窥镜外科器械已经有了显著的发展,这些器械适于通过套管针的插管将远侧端部执行器精确放置在所需的手术部位。这些远侧端部执行器(例如,内切割器、抓钳、切割器、缝合器、夹具施放器、接入装置、药物/基因治疗输送装置、以及使用超声波、RF、或激光等的能量装置)以各种方式与组织接合,达到诊断或治疗的效果。
已知的外科缝合器包括端部执行器,该端部执行器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。所述端部执行器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成形凹口的砧座,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,其披露了具有不同闭合和击发动作的内切割器。使用该装置的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,则临床医生就可用单个击发冲程击发外科缝合器,由此缝合和切割组织。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。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。
可在击发之前在组织上闭合的一个具体的优点在于,临床医生可以通过内窥镜确认到达了需要切割的部位,包括确认已经在相对的夹钳之间捕获了足量的组织。否则,相对的夹钳会被拉得太近,特别是在其远端夹紧,不能在切割的组织中有效形成闭合的缝钉。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。在另一极端,夹紧过量的组织可导致故障和不完全的击发。
每一代内窥镜缝合器/切割器不断增加复杂性和功能。一个主要的原因是为了满足低击发力(FTF)的要求,使所有或大多数外科医生能够处理。降低FTF的一种已知方案是采用CO2或马达。这些装置比传动的手动功能装置并不具有明显优势,但原因不同。外科医生通常青睐经受适当的力分布,不愿在形成缝钉时由端部执行器承受力,以确保切割/缝合周期完成,上限在大多数外科医生的能力范围内(通常大约15-301bs)。他们通常希望保持控制缝钉的展开,并希望能够在感到装置的手柄中的力太大或因为其他一些临床原因随时停止。在目前的马达驱动的内切割器中不能适当的实现这些用户反馈。因此,在仅仅通过按压按钮来致动切割/缝合操作的情况下,医生很难接受马达驱动的内切割器。
越来越多的马达驱动的外科器械通过一个或多个设置在器械中的电池提供能量。在许多权限下,规定要求每个电池在放置在器械中之前和/或在医疗手术中使用器械之前灭菌。许多权限还要求以不同于放置器械的其它部分的方式放置每个电池。
由于各种原因,马达驱动的外科器械可能需要替换一个或多个电池。外科器械制造商投放大量资金来开发马达驱动的外科器械的高级模型。至少部分取决于制造商对于一个具体模型所卖出的器械的数量,与具体模型相关的一部分开发成本整体上影响每个器械的购买价格。一些马达驱动的外科器械被设计成仅仅使用有限的次数。因此,如果许多器械被使用的次数大于其设计使用的次数,制造商就不能收回与具体模型有关的开发成本。
发明内容
本申请公开了一种外科切割器械。根据不同实施例,该外科器械包括手柄、电池、马达以及锁定系统。手柄包括主体部分以及握持部分。握持部分可释放地连接到主体部分上。电池位于握持部分中。马达与电池电连接。锁定系统位于手柄中,所述锁定系统被构造和布置成在握持部分与主体部分断开预定次数之后阻断握持部分与主体部分的连接。
根据其它实施例,该外科器械包括手柄、电池和马达。手柄包括主体部分以及握持部分。握持部分可释放地连接到主体部分上。所述握持部分的一部分被构造和布置成中断所述握持部分,并且在所述握持部分与所述主体部分断开时保持与所述主体部分接触。电池位于握持部分中。马达与电池电连接。
根据其它实施例,该外科器械包括手柄、电池、马达和计数器。手柄包括主体部分以及握持部分。握持部分可释放地连接到主体部分上。电池位于握持部分中。马达与电池电连接。计数器位于手柄中,所述计数器被构造和布置成用于打开马达联动装置。
本发明还涉及如下方面:
(1)一种外科切割器械,包括:
手柄,其包括主体部分以及可释放地连接到主体部分上的握持部分;
位于握持部分中的电池;
与电池电连接的马达;以及
位于手柄中的锁定系统,所述锁定系统被构造和布置成在握持部分与主体部分断开预定次数之后阻断握持部分与主体部分的连接。
(2)如第(1)项所述的外科器械,其中,所述电池可从所述握持部分拆卸。
(3)如第(1)项所述的外科器械,其中,所述电池是可充电电池。
(4)如第(1)项所述的外科器械,其中,所述锁定系统包括计数器,所述计数器被构造和布置成当所述握持部分与所述主体部分断开时前进。
(5)如第(4)项所述的外科器械,其中,所述计数器包括:
分度轮;以及
连接到分度轮上的偏压构件。
(6)如第(4)项所述的外科器械,其中,所述锁定系统还包括连接到计数器上的阻断组件,所述阻断组件被构造和布置成在所述握持部分与所述主体部分断开预定次数之后阻断所述握持部分与所述主体部分的连接。
(7)如第(6)项所述的外科器械,其中,所述阻断组件包括阻断构件,所述阻断构件被构造和布置成在所述握持部分与所述主体部分断开预定次数之后阻断所述握持部分与所述主体部分的连接。
(8)如第(7)项所述的外科器械,其中,所述阻断组件还包括与所述阻断构件接触的闸构件。
(9)如第(8)项所述的外科器械,其中,所述阻断组件还包括与所述闸构件连接的偏压构件。
(10)如第(4)项所述的外科器械,其中,所述计数器是可重置的计数器。
(11)一种外科切割器械,包括:
手柄,其包括主体部分以及可释放地连接到主体部分上的握持部分,所述握持部分的一部分被构造和布置成中断所述握持部分,并且在所述握持部分与所述主体部分断开时保持与所述主体部分接触;
位于握持部分中的电池;以及
与电池电连接的马达。
(12)如第(11)项所述的外科器械,其中,所述电池可从所述握持部分中拆卸。
(13)如第(11)项所述的外科器械,其中,所述电池是可充电电地。
(14)一种外科切割器械,包括:
手柄,其包括主体部分以及可释放地连接到主体部分上的握持部分;
位于握持部分中的电池;
与电池电连接的马达;以及
位于手柄中的计数器,所述计数器被构造和布置成用于打开马达联动装置。
(15)如第(14)项所述的外科器械,其中,所述电池可从所述握持部分中拆卸。
(16)如第(14)项所述的外科器械,其中,所述电池是可充电电地。
(17)如第(14)项所述的外科器械,其中,所述计数器被构造和布置成在所述电池从所述器械拆卸预定次数之后打开所述马达联动装置。
(18)如第(14)项所述的外科器械,其中,所述计数器被构造和布置成在所述握持部分与所述主体部分断开预定次数之后打开所述马达联动装置。
(19)如第(14)项所述的外科器械,其中,所述计数器被构造和布置成在外科器械的扳机被致动预定次数之后打开所述马达联动装置。
(20)如第(14)项所述的外科器械,其中,所述计数器被构造和布置成在外科器械首次使用之后预定时间打开所述马达联动装置。
附图说明
结合附图通过例子的方式描述本发明的不同实施例,其中:
图1和2是根据不同实施例的外科切割和紧固器械的透视图;
图3-5是根据不同实施例的器械的端部执行器和轴的分解图;
图6是根据不同实施例的端部执行器的侧视图;
图7是根据不同实施例的器械的手柄的分解图;
图8和9是根据不同实施例的手柄的局部透视图;
图10是根据不同实施例的手柄的侧视图;
图11是根据不同实施例的器械中使用的电路的示意图;
图12-13是根据不同实施例的手柄的侧视图;
图14-22示出了用于锁定根据不同实施例的闭合扳机的不同机构;
图23A-B示出了可用在根据不同实施例的器械的关节运动点处的万向接头(“u-接头”);
图24A-B示出了可用在根据不同实施例的器械的关节运动点处的扭转电缆;
图25-31示出了根据不同实施例的具有动力辅助的外科切割和紧固器械;
图32-36示出了根据不同实施例的具有动力辅助的外科切割和紧固器械;
图37-40示出了根据不同实施例的具有触觉反馈的外科切割和紧固器械;
图41-42示出了比例传感器的不同实施例;
图43是根据不同实施例的外科器械的一部分的剖视图;
图44是根据不同实施例的外科器械的一部分的剖视图;
图45是根据不同实施例的外科器械的一部分的剖视图;
图46是根据不同实施例的外科器械的一部分的组合图;
图47是沿着图44的线5-5截取的外科器械的剖视图;
图48是沿着图44的线6-6截取的外科器械的剖视图;
图49是沿着图44的线7-7截取的外科器械的剖视图;
图50-55是根据不同实施例的外科器械的一部分的操作的示意图;
图56是根据不同实施例的外科器械的一部分的剖视图;
图57是根据不同实施例的外科器械的一部分的剖视图;以及
图58是根据不同实施例的外科器械中使用的电路的示意图。
具体实施方式
应当理解,所公开的发明的至少一些附图和说明被简化,示出了与清楚理解本发明相关的元件,同时为了清楚起见,省略了其他元件。但是本领域普通技术人员应当理解,这些和其他元件是有利的。但是,由于这些元件是本领域已知的,并且它们不会有利于更好的理解本发明,因此这里省略了对这些元件的描述。
图1和2示出了根据本发明不同实施例的外科切割和紧固器械10。该示例性实施例是内窥镜器械,总的说来,这里描述的器械10的实施例是内窥镜外科切割和紧固器械。但是应当理解,根据本发明的不同实施例,器械可以非内窥镜外科切割和紧固器械,例如腹腔镜器械。
图1和2示出的外科器械10包括手柄6、轴8、在关节运动枢轴14处连接到轴8上的关节运动端部执行器12。关节运动控制器16可设置在手柄6附近,使端部执行器12围绕关节运动枢轴14转动。在所示的实施例中,端部执行器12能够用作内切割器,用于夹紧、切割和缝合组织,但是在其他实施例中,可以使用其他类型的端部执行器,例如用于其他类型的外科装置的端部执行器,如内切割器、抓钳、切割器、缝合器、夹具施放器、接入装置、药物/基因治疗输送装置、以及使用超声波、RF、或激光等的装置。
器械10的手柄6可包括闭合扳机18和击发扳机20,用于致动端部执行器12。应当理解,具有用于不同手术任务的端部执行器的器械可具有不同数量和类型的扳机或者其他适合的控制器,用于操作端部执行器12。所示的端部执行器12通过优选细长的轴8与手柄6分离。在一个实施例中,器械10的临床医生或者操作者可以通过利用关节运动控制器16使端部执行器12相对于轴8关节运动,如Geoffrey C.Hueil等人2006年1月10日提交的名称为“SurgicalInstrument Having An Articulating End Effector”待审美国专利申请No.11/329020中更详细地描述的一样,该申请通过引用并入本文。
在该实施例中,端部执行器12包括缝钉通道22和可枢转平移的夹紧构件如钉砧24等,它们之间保持确保有效缝合和切割夹紧在端部执行器12中的组织的间距。手柄6包括手枪式握把26,临床医生向着手枪式握把26枢转地拉动闭合扳机18,使钉砧24朝着端部执行器12的缝钉通道22夹紧或者闭合,从而夹紧定位在钉砧24和缝钉通道22之间的组织。击发扳机20在闭合扳机18更远的外侧。一旦闭合扳机18锁定在下面将进一步描述的闭合位置,击发扳机20可朝着手枪式握把26稍微转动,从而操作者可用一只手触及。然后操作者可以向着手枪式握把26枢转地拉动击发扳机20,从而缝合和切割端部执行器12中的夹紧组织。在其他实施例中,可以使用除钉砧24之外的不同类型的夹紧构件,例如,相对的夹钳等。
应当理解,此处使用的术语“近侧”和“远侧”是相对握持手柄6的临床医生而言的。因此,相对于更近侧的手柄6而言,端部执行器12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”是相对附图而言的。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。
可以首先致动闭合扳机18。一旦临床医生对端部执行器12的定位满意,医生可将闭合扳机18拉回到邻近手枪式握把26的其完全闭合的锁定位置。然后致动击发扳机20。当医生移除压力时击发扳机20返回打开位置(图1和2所示),下面将更详细地描述。按压手柄6上的释放按钮时可释放锁定的闭合扳机18。
图3是根据不同实施例的端部执行器12的分解图。如图示实施例所示,除了前面描述的通道22和钉砧24之外,端部执行器12还可包括切割器械32、滑块33、钉仓34以及螺旋轴36,钉仓34可移除地安置于通道22中。切割器械32例如可以是小刀。钉砧24可以在连接到通道22的近端上的枢转点25处可枢转地打开和闭合。钉砧24还可在近端包括突起27,突起27插入机械闭合系统(下面将进一步描述)的部件中,以打开和关闭钉砧24。当致动闭合扳机18时,即当器械10的用户拉动闭合扳机18时,钉砧24可以围绕枢转点25枢转到夹紧或者闭合位置,如果端部执行器12的夹紧是满意的,操作者可致动击发扳机20(下面将更详细地描述),使得刀32和滑块33沿着通道22纵向运动,由此切割夹紧在端部执行器12中的组织。滑块33沿着通道22的运动使得钉仓34的缝钉(未示出)被驱动通过切割的组织,靠在闭合的钉砧24上,使得缝钉密封切割的组织。名称为“Surgical stapling instrument incorporating an E-beam firingmechanism”的美国专利6,978,921更详细地描述了这种双冲程式内窥镜器械,该专利通用引用并入本文。滑块33可以是钉仓34的部件,使得当刀32在切割操作后缩回时,滑块33不会缩回。
应当注意,尽管这里描述的器械10的实施例采用缝合切割的组织的端部执行器12,在其他实施例中可以采用其他技术来闭合或者紧固切割的组织。例如,也可采用利用RF能量或者粘结剂来紧固切割的组织的端部执行器。名称为“Electrosurgical Hemostatic Device”的美国专利No.5,810,811披露了利用RF能量紧固切割的组织的切割器械,该专利通过引用并入本文。名称为“Surgical Stapling InstrumentsStructured For Delivery Of Medical Agents”的美国专利申请No.11/267,811和名称为“Surgical Stapling Instruments Structured ForPump-Assisted Delivery Of Medical Agents”的美国专利申请No.11/267,383公开了采用粘结剂来紧固切割的组织的切割器械,这两篇申请通过引用并入本文。因此,尽管这里的描述涉及切割/缝合操作和下面的类似操作,应当理解,这只是示例性的实施例,并不意味着这限制。可采用其他组织紧固技术。
图4和5是分解图,图6是根据不同实施例的端部执行器12和轴8的侧视图。如图示实施例示出的,轴8可包括由枢转连接件44枢转连接的近侧闭合管40和远侧闭合管42。远侧闭合管42包括开口45,钉砧24上的突起27插入该开口45,以打开和闭合钉砧24,如下面进一步描述的一样。近侧脊管46可设置在闭合管40、42内。主旋转(或近侧)驱动轴48可设置在近侧脊管46内,驱动轴48通过锥齿轮组件52与第二(远侧)驱动轴50连接。第二驱动轴50连接到驱动齿轮54上,驱动齿轮54接合螺旋轴36的近侧驱动齿轮56。当击发扳机20(下面将更详细描述)的致动使得主驱动轴48转动时,锥齿轮组件52a-c使第二驱动轴50转动,由于驱动齿轮54、56的接合,这又使得螺旋螺杆轴36转动,从而使刀/滑块驱动构件32沿着通道22纵向运动,以切割夹紧在端部执行器12中的任何组织。垂直锥齿轮52b可安座于近侧脊管46的远端的开口57中,并可在该开口57中枢转。远侧脊管58可用于装纳第二驱动轴50和驱动齿轮54、56。主驱动轴48、第二驱动轴50和关节运动组件(例如锥齿轮组件52a-c)有时整体称作“主驱动轴组件”。
轴承38拧在螺旋驱动螺杆36上。轴承38还连接到刀32上。当螺旋驱动螺杆36向前转动时,轴承38在螺旋驱动螺杆36上向远侧运动,驱动切割器械32,并在该过程中驱动滑块33,以进行切割/缝合操作。滑块33可例如由塑料制成,并可具有倾斜的远侧表面。当滑块33横过通道22时,倾斜向上的表面可向上推动或驱动钉仓中的缝钉通过夹紧的组织,靠在钉砧24上。钉砧24转动缝钉24,由此缝合切割的组织。当刀32缩回时,刀32和滑块33可脱离接合,由此使滑块33留在通道22的远端。
由于用户缺乏切割/缝合操作的反馈,在仅仅通过按压按钮致动切割/缝合操作的情况下,医生难以接受马达驱动的内切割器。相反,本发明的实施例提供了这样一种马达驱动的切割器,其具有端部执行器中的切割器械的展开、受力和/位置的用户反馈。
图7-10示出了马达驱动的内切割器尤其是其手柄6的一个示例性实施例,该手柄6提供有关端部执行器中的切割器械的展开和加载力的用户反馈。另外,该实施例可采用用户在缩回击发扳机20时提供的能量,以对装置供能(所谓的动力辅助模式)。如该示例性实施例所示,手柄6包括外部下侧件59、60和外部上侧件61、62,它们相互配合整体上形成手柄6的外部。电池64,例如锂离子电池,可设置在手柄6的手枪式握把26中。电池64对设置在手柄6的手枪式握把26的上部中的马达65供电。根据不同实施例,马达65可以是DC电刷驱动马达,其最大转速为大约5000RPM。马达65可驱动包括第一锥齿轮68和第二锥齿轮70的90°的锥齿轮组件66。锥齿轮组件66可驱动行星齿轮组件72。行星齿轮组件72可包括连接到驱动轴76上的小齿轮74。小齿轮74可驱动相配合的环形齿轮78,环形齿轮78通过驱动轴82驱动螺旋齿轮鼓80。环84可拧入螺旋齿轮鼓80。因此,当马达65转动时,通过中间夹设的锥齿轮组件66、行星齿轮组件72和环形齿轮78使环84沿着螺旋齿轮鼓80运动。
手柄6还可包括与击发扳机20连通的运转马达传感器110,当操作者朝着手柄6的手枪式握把26拉近(或者“关闭”)击发扳机20时,运转马达传感器110进行检测,由此通过端部执行器12致动切割/缝合操作。传感器110可以是比例传感器,例如变阻器或者可变电阻器。当拉近击发扳机20时,传感器110检测运动并发出供给马达65的表现为电压(或动力)的电信号。当传感器110时可变电阻器等时,马达65的转速可以与击发扳机20的运动量大致成比例。也就是说,如果操作者仅轻微拉动或者关闭击发扳机20,马达65的转速较低。当完全拉近击发扳机20(或者出于完全关闭位置),马达的转速为其最大值。换句话说,用户越用力拉动击发扳机20,施加到马达65上的电压越多,产生更大的转速。
手柄6可包括位于击发扳机20的上部附近的中间手柄件104。手柄6还可包括偏压弹簧112,其连接在中间手柄件104上的柱和击发扳机20之间。偏压弹簧112可将击发扳机20偏压到其完全打开位置。这样,当操作者释放击发扳机20时,偏压弹簧112将击发扳机20拉动其打开位置,由此释放传感器110的致动,从而停止马达65的转动。此外,借助于偏压弹簧112,每当用户关闭击发扳机20时,用户会感到关闭操作的阻碍,由此提供给用户有关马达65转动量的反馈。另外,操作者可停止缩回击发扳机20,以从传感器110移除力,由此停止马达65。同样,用户可停止展开端部执行器12,由此为操作者提供对切割/密封操作的控制的测量。
螺旋齿轮鼓80的远端包括驱动环形齿轮122的远侧驱动轴120,该环形齿轮122与小齿轮124啮合。小齿轮124连接到主驱动轴组件的主驱动轴48上。这样,马达65的转动使得主驱动轴组件转动,从而致动端部执行器12,如上面所描述的一样。
拧入螺旋齿轮鼓80的环84可包括设置在带槽臂90的槽88中的柱86。带槽臂90的相对端部94具有开口92,装纳连接在手柄外侧件59、60之间的枢轴销96。枢轴销96还穿过通过击发扳机20中的开口100和中间手柄件104中的开口102。
另外,手柄6可包括反转马达(或冲程结束)传感器130和停止马达(冲程开始)传感器142。在不同实施例,反转马达传感器130可以是位于螺旋齿轮鼓80远端的限制开关,使得当环84到达螺旋齿轮鼓80的远端时拧入螺旋齿轮鼓80的环84接触和脱扣反转马达传感器130。反转马达传感器130在启动时对马达65发送信号,以倒转其转动方向,由此在切割操作之后缩回端部执行器12的刀32。
停止马达传感器142例如可以是常闭限制开关。在不同实施例中,停止马达传感器142可以位于螺旋齿轮鼓80的近端,使得当环84到达螺旋齿轮鼓80的近端时环84断开(trip)开关142。
在操作中,当器械10的操作者拉回击发扳机20时,传感器110检测击发扳机20的展开并对马达65发送信号,使得马达65例如以与操作者拉回击发扳机20所用力的程度成比例的速度向前旋转。马达65的向前旋转又使得行星齿轮组件72远端的环形齿轮78旋转,由此使得螺旋齿轮鼓80转动,从而使拧入螺旋齿轮鼓80的环84沿着螺旋齿轮鼓80向远侧运动。螺旋齿轮鼓80的转动还驱动如上所述的主驱动轴组件,这又使得端部执行器12中的刀32展开。也就是说,使得刀32和滑块33纵向运动经过通道22,由此切割夹紧在端部执行器12中的组织。此外,在使用缝合式端部执行器的实施例中使端部执行器12产生缝合操作。
当端部执行器12的切割/缝合操作完成时,螺旋齿轮鼓80上的环84到达螺旋齿轮鼓80的远端,由此使反转马达传感器130断开,对马达65发送信号使马达65倒转其转动方向。这使得刀32缩回,从而使螺旋齿轮鼓80上的环84运动回到螺旋齿轮鼓80的近端。
如图8和9中最清楚地显示的一样,中间手柄件104包括后侧肩部106,后侧肩部106接合带槽臂90。中间手柄件104还具有接合击发扳机20的向前运动挡块107。带槽臂90的运动如上所述受马达65的转动控制。当环84从螺旋齿轮鼓80的近端朝远端运动时,在带槽臂90逆时针转动(CCW)的情况下,中间手柄件104自由逆时针转动。因此,当用户拉近击发扳机20时,击发扳机20接合中间手柄件104的向前运动挡块107,使得中间手柄件104逆时针转动。由于后侧肩部106接合带槽臂90,中间手柄件104仅能够在带槽臂90允许的范围内逆时针转动。这样,如果马达65由于一些原因停止转动,带槽臂90也会停止转动,用户就不能进一步拉近击发扳机20,因为带槽臂90使得中间手柄件104不能自由逆时针转动。
图41和42示例性示出了可用作根据本发明的不同实施例的运转马达传感器110的可变传感器的两种状态。传感器110可包括表面部分280、第一电极(A)282、第二电极(B)284和电极282、284之间的可压缩的电介质材料286(例如EAP)。可以定位传感器110,使得表面部分280接触缩回的击发扳机20。因此,当击发扳机20缩回时,电介质材料286被压缩,如图42所示,使得电极282、284靠得更近。由于电极282、284之间的距离“b”与电极282、284之间的阻抗直接相关,距离越大,阻抗越大,距离越小,阻抗越小。这样,由于击发扳机20的缩回使电介质材料286被压缩的量(图42中表示为“F”)与电极282、284之间的阻抗成比例,可以用来成比例地控制马达65。
图7-10还显示出了用于通过缩回闭合扳机18闭合(夹紧)端部执行器12的钉砧24的示例性闭合系统的部件。在该示例性实施例中,闭合系统包括轭250,其通过销251连接到闭合扳机18上,销251通过闭合扳机18和轭250中对准的开口插入。枢轴销252通过闭合扳机18中的另一个孔插入,该孔偏离销251插入闭合扳机18中的那个孔,闭合扳机18围绕枢轴销252枢转。这样,闭合扳机18的缩回使得闭合扳机18的上部逆时针转动,轭250通过销251连接到闭合扳机18的所述上部上。轭250的远端通过销254连接到第一闭合支架256上。第一闭合支架256连接到第二闭合支架258上。闭合支架256、258整体限定了一个开口,近侧闭合管40(参见图4)的近端安座并保持在该开口中,从而闭合支架256、258的纵向运动使得近侧闭合管40纵向运动。器械10还包括设置在近侧闭合管40内的闭合杆260。闭合杆260可包括窗口261,手柄外部件中的一个(例如该示例性实施例中的外部下侧件59)上的柱263设置在窗口261中,以将闭合杆260固定地连接到手柄6上。这样,近侧闭合管40能够相对于闭合杆260纵向运动。闭合杆260还可包括远侧轴环267,轴环267装配到近侧脊管46的腔269中并通过帽271(参见图4)保持在其中。
在操作中,当由于闭合扳机18缩回使得轭250转动时,闭合支架256、258使近侧闭合管40向远侧(远离器械10的手柄端部)运动,这使得远侧闭合管42向远侧运动,从而使钉砧24围绕枢轴销25转动到夹紧或者闭合位置。当闭合扳机18从锁定位置解锁时,使近侧闭合管40向近侧滑动,这又通过插在远侧闭合管42的开口45中的突起27使得远侧闭合管42向近侧滑动,从而使钉砧24围绕枢轴销25转动到打开或者松开位置。这样,通过缩回和锁定闭合扳机18,操作者可夹紧钉砧24和通道22之间的组织,并且可以在切割/缝合操作之后通过从锁定位置解锁闭合扳机18来松开组织。
图11是根据本发明不同实施例的器械10的电路的示意图。当操作者在锁定闭合扳机18之后首次拉近击发扳机20时,传感器110被启动,允许电流流过。如果常开反转马达传感器开关130打开(意味着没有到达端部执行器冲程的末端),电流流向单极双掷继电器132。由于反转马达传感器开关130没有闭合,继电器132的线圈134不会被供电,使得继电器132处于未供电状态。该电路还包括钉仓锁定传感器136。如果端部执行器12包括钉仓34,则传感器136处于闭合状态,允许电流流过。否则,如果端部执行器12不包括钉仓34,传感器136则打开,由此防止电池64对马达65供电。
当存在钉仓34时,传感器136闭合,使得对单极单掷继电器138供电。当继电器138被供电时,电流借助于双极双掷继电器140经过可变电阻器传感器110流向马达65,由此对马达65供电,允许马达65向前转动。
当端部执行器12到达其冲程末端时,反转马达传感器130被启动,由此关闭开关130并对继电器132供电。这使得继电器132处于供电状态(图11没有示出),从而使电流绕过钉仓锁定传感器136和可变电阻器110,而且使得电流流向常闭双极双掷继电器140并回到马达65,但是电流通过继电器140使马达65倒转其转动方向。
由于停止马达传感器开关142是常闭开关,所以电流流回继电器132,以保持继电器132关闭直到开关142打开。当刀32完全缩回时,停止马达传感器开关142被启动,使得开关142打开,由此将能量从马达65移除。
在其他实施例中,可以使用开-关式传感器而不是比例式传感器110。在这些实施例中,马达65的转动速度与操作者施加的力不成比例。马达65是以恒定的速度转动。但是操作者还是感到力的反馈,因为击发扳机20连接在齿轮传动系统中。
图12是根据另一个实施例的动力辅助马达驱动的内切割器的手柄6的侧视图。图12的实施例类似于图7-10的实施例,只是在图12的实施例中没有连接到拧在螺旋齿轮鼓80上的环84上的带槽臂90。相反,在图12的实施例中,环84包括传感器部分114,当环114在螺旋齿轮鼓80上向下前进(以及回来)时,传感器部分114与环84一起运动。传感器部分114包括凹116。反转马达传感器130可位于凹口116的远端,停止马达传感器142可位于凹口116的近端。当环84在螺旋齿轮鼓80上向下运动(以及回来)时,传感器部分114与环84一起运动。另外,如图12所示,中间手柄件104可以具有伸入凹口116中的臂118。
在操作中,当器械10的操作者朝着手枪式握把26缩回击发扳机20时,运转马达传感器110检测该运动并且发送信号对马达65供电,这使得螺旋齿轮鼓80转动。当螺旋齿轮鼓80转动时,拧在螺旋齿轮鼓80上的环84前进(或者缩回,取决于转动)。此外,由于拉近击发扳机20,与击发扳机20接合的向前运动的挡块107使得中间手柄件104与击发扳机20一起逆时针转动。中间手柄件104的逆时针转动使得臂118与环84的传感器部分114一起逆时针转动,使得臂118保持设置在凹口116中。当环84到达螺旋齿轮鼓80的远端时,臂118接触倒转马达传感器130并由此将其断开。同样,当环84到达螺旋齿轮鼓80的近端时,臂118接触停止马达传感器142,由此将其断开。如上所述,这些动作分别可以倒转和停止马达65。
图13是根据另一个实施例的动力辅助马达驱动的内切割器的手柄6的侧视图。图13所示的实施例类似于图7-10的实施例,只是图13的实施例的臂90没有设置槽。而拧在螺旋齿轮鼓80上的环84包括垂直通道126。臂90包括设置在通道126中的柱128,而不包括槽。当螺旋齿轮鼓80转动时,拧在螺旋齿轮鼓80上的环84前进(或者缩回,取决于转动)。如图13所示,当环84前进时由于柱128设置在通道126中,臂90逆时针转动。
如上所述,在使用双冲程马达驱动的器械时,操作者首先拉回闭合扳机18并将其锁定。图14和15示出了将闭合扳机18锁到手柄6上的手枪式握把26上的方式的一个实施例。在该示例性实施例中,手枪式握把26包括钩状物150,其受扭转弹簧152偏压,以围绕枢转点151逆时针转动。此外,闭合扳机18包括闭合杆154。当操作者拉近闭合扳机18时,闭合杆154接合钩状物150的倾斜部分156,由此使钩状物150向上(或者如图14-15顺时针)转动,直到闭合杆154完全将倾斜部分156送入钩状物150的凹口158中,由此将闭合扳机18锁定就位。操作者可通过下压在手枪式握把26的后侧或相对侧上的滑动释放按钮160来释放闭合扳机18。下压滑动释放按钮160使得钩状物150顺时针转动,从而使闭合杆154从凹口158释放。
图16示出了根据不同实施例的另一个闭合扳机锁定机构。在图16所示的实施例中,闭合扳机18包括具有箭头部分161的楔形件160。通过板簧162向下(或顺时针)偏压箭头部分161。楔形件160和板簧162可例如由模制的塑料制成。当闭合扳机18缩回时,箭头部分161通过手柄6的手枪式握把26中的开口164插入。箭头部分161的下部斜切表面166接合开口164的下部侧壁168,迫使箭头部分161逆时针转动。下部斜切表面166最后完全经过下部侧壁168,由此去除箭头部分161上的逆时针方向的力,从而使下部侧壁168滑入箭头部分161后侧的凹口170中的锁定位置。
为了解锁闭合扳机18,用户可下压闭合扳机18的相对侧上的按钮172,使箭头部分161逆时针转动,并允许箭头部分161滑出开口164。
图17-22示出了根据另一个实施例的闭合扳机锁定机构。如该实施例所示,闭合扳机18包括挠性纵向臂176,挠性纵向臂176包括从其伸出的横向销178。臂176和销178可以例如由模制的塑料制成。手柄6的手枪式握把26包括开口180,横向延伸的楔形件182设置在开口180中。当闭合扳机18缩回时,销178接合楔形件182,并且通过楔形件182的下表面184迫使销178向下运动(即,使臂176顺时针转动),如图17和18所示。当销178完全经过下表面184时,移除臂176上的顺时针方向的力,使得销178逆时针转动,从而销178靠在楔形件182后侧的凹口186中,如图19所示,并由此锁定闭合扳机18。通过从楔形件184延伸的挠性挡块188将销178进一步保持就位于锁定位置中。
为了解锁闭合扳机18,操作者可进一步挤压闭合扳机18,使销178接合开口180的倾斜后壁190,迫使销178向上运动经过挠性挡块188,如图20和21所示。然后销178可在开口180的上部通道192外自由运动,使得闭合扳机18不再锁定到手枪式握把26上,如图22所示。
图23A-B示出了万向接头(“u-接头”)195。u-接头195的第二部件195-2沿着第一部件195-1所处的水平面转动。图23A示出了沿直线(180°)定向的u-接头195,图23B示出了以大致150°定向的u-接头195。可以在主驱动轴组件的关节运动点14处使用u-接头195来使端部执行器12关节运动,而不是使用锥齿轮52a-c(如图4所示)。图24A-B示出了可以代替锥齿轮52a-c和u-接头195的扭转电缆197,用于实现端部执行器12的关节运动。
图25-31示出了具有根据本发明另一个实施例的动力辅助系统的马达驱动的双冲程内窥镜外科器械10的另一个实施例。图25-31的实施例与图6-10的实施例类似,只是图25-31的实施例不使用螺旋齿轮鼓80,而是包括替代的齿轮驱动组件。图25-31的实施例包括齿轮箱组件200,齿轮箱组件200包括多个设置在框架201中的齿轮,这些齿轮在驱动轴48的近端处连接在行星齿轮72和小齿轮124之间。如下面进一步描述的,齿轮箱组件200通过击发扳机20向用户提供关于端部执行器12的展开和加载力的反馈。此外,用户可通过齿轮箱组件200提供动力,以辅助端部执行器12的展开。这样,与上面描述的实施例类似,图25-31所示的实施例是另一种动力辅助的马达驱动的器械10,其向用户提供关于切割器械32所受的加载力的反馈。
在该示例性实施例中,击发扳机20包括两个部件,即主体部分202和加强部分204。主体部分202可以例如由塑料制成,加强部分204可以由更具刚性的材料制成,例如金属。在该示例性实施例中,加强部分204与主体部分202相邻,但是根据其他实施例,加强部分204可以设置在主体部分202内部。枢轴销207可以插入击发扳机部件202、204的开口中,击发扳机20可以围绕枢轴销207枢转。另外,弹簧222可以偏压击发扳机20,使其逆时针转动。弹簧222可具有连接到销224上的远端,销224连接到击发扳机20的部件202、204上。弹簧222的近端可以连接到手柄外部下侧件59、60中的一个上。
在该示例性实施例中,主体部分202和加强部分204在它们的上端部分别包括齿轮部分206、208。如下面所描述的,齿轮部分206、208接合齿轮箱组件200中的齿轮,以驱动主驱动轴组件,并且向用户提供关于端部执行器12的展开的反馈。
在该示例性实施例中,如图所示,齿轮箱组件200可包括六个齿轮。齿轮箱组件200的第一齿轮210接合击发扳机20的齿轮部分206、208。另外,第一齿轮210接合较小的第二齿轮212,较小的第二齿轮212与较大的第三齿轮214同轴。第三齿轮214接合较小的第四齿轮216,较小的第四齿轮216与第五齿轮218同轴。第五齿轮218是90°的锥齿轮,其接合相配合的90°锥齿轮220(如图31最清楚地示出的),锥齿轮220连接到小齿轮124上,小齿轮124驱动主驱动轴48。
在操作中,当用户缩回击发扳机20时,运转马达传感器(未示出)被致动,从而可对马达65提供信号,使其以与操作者缩回击发扳机20的程度或用力的大小成比例的速度转动。这使得马达65以与来自传感器的信号成比例的速度转动。用于该实施例的传感器未示出,但是其可以类似于上述运转马达传感器110。该传感器可以位于手柄6中,从而当击发扳机20缩回时传感器被下压。此外,可以使用开/关式传感器,而不是比例式传感器。
马达65的转动使得锥齿轮66、70转动,这又使得行星齿轮72转动,从而通过驱动轴76使得环形齿轮122转动。环形齿轮122与小齿轮124啮合,小齿轮124连接在主驱动轴48上。这样,小齿轮124的转动驱动主驱动轴48,这使得端部执行器12的切割/缝合操作被致动。
小齿轮124的向前的转动又使得锥齿轮220转动,从而通过齿轮箱组件200中的其他齿轮使得第一齿轮210转动。第一齿轮210接合击发扳机20的齿轮部分206、208,由此当马达65对端部执行器12提供向前的驱动力时,使击发扳机20逆时针转动(并且当马达65反转以缩回端部执行器12时,使击发扳机20顺时针转动)。这样,用户通过握持在击发扳机20上感受到关于端部执行器12的加载力和展开的反馈。因此,当用户缩回击发扳机20时,操作者感受到与由端部执行器12所受的加载力有关的阻力。同样,当操作者在切割/缝合操作后释放击发扳机20时,击发扳机20回到其原始位置,用户可以从击发扳机20感受到顺时针转动力,其与马达65的反转速度基本上成比例。
还应注意,在该实施例中,用户可施加力(代替来自马达65的力或者除了来自马达65的力之外),以通过缩回击发扳机20来致动主驱动轴组件(因此致动端部执行器12的切割/缝合)。也就是说,缩回击发扳机20使得齿轮部分206、208逆时针转动,这使得齿轮箱组件200的齿轮转动,由此使得小齿轮124转动,从而使主驱动轴48转动。
尽管图25-31没有显示,但器械10还可以包括反转马达传感器和停止马达传感器。如上所述,反转马达传感器和停止马达传感器可分别检测切割冲程的结束(刀32和滑块33完全展开)和缩回操作的结束(刀32完全缩回)。可使用与图11所示的电路类似的电路来对马达65适当地供电。
图32-36示出了具有根据另一个实施例的动力辅助系统的双冲程马达驱动的内窥镜外科器械10。图32-36的实施例类似于图25-31的实施例,只是图32-36的实施例中击发扳机20包括下部228和上部230。上部230和下部228都连接到枢转销207上并围绕其枢转,枢转销207穿过每个部分228、230。上部230包括与齿轮箱组件200的第一齿轮210的齿轮部分232。弹簧222连接到上部230上,使得上部230受到偏压,顺时针方向转动。上部230还可包括下部臂234,下部臂234接触击发扳机20的下部228的上表面,从而当上部230顺时针转动时,下部228也顺时针转动,当下部228逆时针转动时,上部230也逆时针转动。同样,下部228包括接合上部230的下侧肩部的转动挡块238。这样,当上部230逆时针转动时,下部228也逆时针转动,当下部228顺时针转动时,上部230也顺时针转动。
该实施例还包括运转马达传感器110,其对马达65发送信号,在不同实施例中,该信号可使马达65以与缩回击发扳机20时操作者施加的力成比例的速度转动。传感器110可以例如是变阻器或者这里描述的其他的可变电阻传感器。此外,器械10可包括反转马达传感器130,传感器130当与击发扳机20的上部230的前表面242接触时断开或者转换。当反转马达传感器130被致动是,会对马达65发送信号,以使其倒转方向。此外,器械10可包括停止马达传感器142,传感器142在与击发扳机20的下部228接触时断开或者致动。停止马达传感器142在被致动时发送信号以停止马达65的反转。
在操作中,当操作者将闭合扳机18缩回到锁定位置时,击发扳机20稍微缩回(通过本领域已知的机构,包括名称为“SurgicalStapling Instrument Incorporating An E-Beam Firing Mechanism”的美国专利No.6,978,921和名称为“Surgical Stapling InstrumentIncorporating A Firing Mechanism Having A Linked RackTransmission”的美国专利No.6,905,057,这两篇专利通过引用并入本文),使得用户可以抓住击发扳机20,以开始切割/缝合操作,如图32和33所示。此时,如图33所示,击发扳机20的上部230的齿轮部分232运动成与齿轮箱组件200的第一齿轮210接合。当操作者缩回击发扳机20时,根据不同实施例,击发扳机20可在断开运转马达传感器110之前少量转动(例如5度),如图34所示。传感器110的启动使得马达65以由操作者施加的缩回力成比例的速度向前转动。如上所述,马达65的向前转动使得主驱动轴48转动,这使得端部执行器12中的刀32展开(例如开始运动经过通道22)。连接到主驱动轴48上的小齿轮124的转动使得齿轮箱组件200中的齿轮210-220转动。由于第一齿轮210与击发扳机20的上部230的齿轮部分232接合,使得上部230逆时针转动,从而使下部228也逆时针转动。
当刀32完全展开(即切割冲程结束时),上部230的前表面242断开反转马达传感器130,发送信号使马达65倒转转动方向。这使得主驱动轴组件倒转转动方向,以缩回刀32。主驱动轴组件的反转使得齿轮箱组件200中的齿轮210-220倒转方向,使得击发扳机20的上部230顺时针转动,从而使得击发扳机20的下部228顺时针转动,直到刀32完全缩回时上部230的前表面242断开或者致动停止马达传感器142,使得马达165停止。这样,用户通过握持在击发扳机20上感受到关于端部执行器12的展开的反馈。因此,当用户缩回击发扳机20时,操作者感受到与端部执行器12的展开有关的阻力,特别是与刀32承受的加载力有关的阻力。同样,当操作者在切割/缝合操作后释放击发扳机20使其回到原始位置时,用户可以从击发扳机20感受到顺时针转动力,其与马达65的反转速度基本上成比例。
还应注意,在该实施例中,用户可施加力(代替来自马达65的力或者除了来自马达65的力之外),以通过缩回击发扳机20来致动主驱动轴组件(因此致动端部执行器12的切割/缝合)。也就是说,缩回击发扳机20使得上部230的齿轮部分232逆时针转动,这使得齿轮箱组件200的齿轮转动,由此使得小齿轮124转动,从而使主驱动轴组件转动。
上述实施例采用了用于双冲程马达驱动内窥镜外科器械的动力辅助用户反馈系统,其具有或者不具有自适应控制功能(例如利用马达、齿轮传动系和端部执行器的闭环控制系统外部的传感器110、130和142)。也就是说,在缩回击发扳机20时由用户施加的力可以借助于连接到马达65和主驱动轴48之间的齿轮传动系上的击发扳机20添加到由马达施加的力上。在本发明的其他实施例中,用户可有关于端部执行器12中的刀32的位置的触觉反馈,但是击发扳机20不连接到齿轮传动系上。图37-40示出了具有这种触觉位置反馈系统的马达驱动的内窥镜外科器械10。
在图37-40所示的示例性实施例中,击发扳机20可具有下部228和上部230,类似于图32-36所示的器械10。但是,与图32-36所示的实施例不同的是,上部230不具有与部分齿轮传动系配合的齿轮部分。器械10而是包括第二马达265,其螺纹杆266拧入其中。当马达265转动时,根据转动方向,螺纹杆266纵向往复运动进入和离开马达265。器械10还包括编码器268,其响应于主驱动轴48的转动,以例如将主驱动轴48(或者主驱动组件的其他部件)的增量角运动转化成对应的数字信号序列。在该示例性实施例中,小齿轮124包括连接到编码器268上的近侧驱动轴270。
器械10还包括可通过使用微控制器或者其他类型的集成电路执行的控制电路(未示出),该控制电路接受来自编码器268的数字信号。根据来自编码器268的数字信号,控制电路可计算端部执行器12中的刀32的展开的阶段。也就是说,控制电路可计算刀32是否完全展开、完全缩回或者处于中间阶段。根据端部执行器12的展开阶段的计算结果,控制电路可对第二马达265发送信号,以控制其转动,由此控制螺纹杆266的往复运动。
在操作中,如图37所示,当闭合扳机18未锁定到夹紧位置时,击发扳机20转动离开手柄6的手枪式握把26,使得击发扳机20的上部230的前表面242不与螺纹杆266的近端接触。当操作者缩回闭合扳机18并将其锁定到夹紧位置时,击发扳机20朝着闭合扳机18稍微转动,使得操作者可以抓住击发扳机20,如图38所示。在该位置,上部230的前表面240接触螺纹杆266的近端。
当用户缩回击发扳机20时,运转马达传感器110在初始转动量(例如旋转5度)之后可以被启动,使得传感器110如上所述对马达65发送信号,使其以与操作者对击发扳机20施加的缩回力的量成比例的速度向前转动。马达65的向前转动通过齿轮传动系使主驱动轴48转动,从而使刀32和滑块33沿着通道22向下运动,并且切割夹紧在端部执行器12中的组织。控制电路接收来自编码器268的关于主驱动轴组件的增量转动的输出信号并且对第二马达265发送信号,使第二马达265转动,从而使螺纹杆266缩回到马达265。这允许击发扳机20的上部230逆时针转动,从而允许击发扳机的下部228也逆时针转动。这样,由于螺纹杆266的往复运动与主驱动轴组件的转动有关,所以器械10的操作者通过他对击发扳机20的握持感受到关于端部执行器12的位置的触觉反馈。但是,操作者施加的缩回力不直接影响主驱动轴组件的驱动,因为该实施例中击发扳机20没有连接到齿轮传动系上。
通过借助于来自编码器268的输出信号跟踪主驱动轴组件的增量转动,控制电路可以计算刀32何时完全展开(即完全伸出)。此时,控制电路可对马达65发送信号,使其倒转方向,从而缩回刀32。马达65的反转使得主驱动轴组件的转动方向也倒转,这也可由编码器268检测到。根据编码器268检测的反转方向,控制电路对第二马达265发送信号,使其倒转转动方向,从而螺纹杆266开始从马达265纵向伸出。该运动迫使击发扳机20的上部230顺时针转动,从而使下部228顺时针转动。这样,操作者可从击发扳机20感受到顺时针方向的力,其向操作者提供了关于端部执行器12中的刀32的缩回位置的反馈。控制电路可确定刀32何时完全缩回。此时,控制电路可对马达65发送信号停止转动。
根据其他实施例,可采用如上所述的反转马达传感器和停止马达传感器,而不具有确定刀32的位置的控制电路。另外,可使用开/关式开关或传感器,而不使用用于控制马达65的转动的比例传感器110。在这种实施例中,操作者不能控制马达65的转速。马达而是以预编程的速度转动。
图43示出了外科器械300的不同实施例。外科器械300可类似于上面描述的外科器械10。在这些实施例中,手柄6包括主体部分302和和可释放地连接到主体部分302上的握持部分304。握持部分304通过适当的布置与主体部分302接合。例如,根据不同实施例,握持部分304与主体部分302的接合通过如图44所示的直线滑动布置实现,要求握持部分304和/或主体部分302的转动来完成接合等。
根据不同实施例,握持部分304包括上面描述的手枪式握把26、一部分外部侧件59和一部分外部侧件60。根据不同实施例,主体部分302可包括手柄6的其它部分。如图48和49所示,握持部分304还包括第一和第二上部滑轨306,以及第一和第二下部滑轨308。如图44所示,第一上部滑轨限定斜面310。图44示出了第一上部滑轨306和第二下部滑轨308之间的关系。
尽管图43所示的电池64位于握持部分304内,但是应当理解,根据其它实施例电池64可位于主体部分302内。根据不同实施例,握持部分304被构造和布置成允许电池64从握持部分304拆卸。例如,握持部分304可包括可拆卸部分,其覆盖大小允许电池64从握持部分304拆卸的开口。作为另一种选择,外部侧件59的一部分可以与外部侧件60的一部分断开,以允许容易地接近电池,进行分离处理。根据不同实施例,电池64可以是可充电电池。
尽管图43所示的马达65位于主体部分302内,但是应当理解,根据其它实施例马达65可以位于握持部分304内。马达65与电池64通过导线314电连接。尽管图43只示出了导线314,如下面将更详细描述的一样,根据不同实施例,电池64和马达65之间的电连接路径还可以包括一个或多个马达联动装置。
外科器械300还可以在手柄6中包括锁定系统316。如图44和47更详细示出的锁定系统316被构造和布置成在握持部分304与主体部分302断开预定的次数之后,阻断握持部分304与主体部分302的连接。所述预定次数可以是任意次数。例如,根据不同实施例,锁定系统316可以在握持部分304与主体部分302断开两次之后阻断握持部分304与主体部分302的连接。尽管示出的锁定系统316主要位于主体部分302中,但是应当理解,根据其它实施例锁定系统316可以主要位于握持部分304中。
如图44所示,锁定系统316包括计数器318和连接到计数器318上的阻断组件320。计数器318被构造和布置成当握持部分304与手柄6的主体部分302断开时前进。计数器318连接到轴322上(如图46和47更清楚地示出的),轴322由连接到主体部分302上的突起323(如图46和47所示)支。计数器318包括连接到轴322上的分度轮324和连接到分度轮324上的偏压构件326。偏压构件326可以例如是扭转弹簧,其沿逆时针方向偏压分度轮324。
分度轮324限定了突起328,突起328与阻断组件320配合,限制分度轮324的前进。突起328中的一个被构造和布置成与阻断组件320配合,在握持部分304与主体部分302断开预定的次数之后阻断握持部分304与主体部分302的连接。尽管所示的分度轮324限定突起328,但是应当理解,根据其它实施例,分度轮324可以限定与阻断组件320配合的凹口,以限制分度轮324的前进,凹口中的一个可以与阻断组件320配合,在握持部分304与主体部分302断开预定的次数之后阻断握持部分304与主体部分302的连接。
轴322被构造和布置成允许分度轮324被重置在原来的位置。例如,轴可以限定六角形开口330,六角形工具可以通过由主体部分302(如图47所示)限定的开口331插入六角形开口330,然后顺时针转动将分度轮324重置到原来的位置。
阻断组件320被构造和布置成在握持部分304与主体部分302断开预定的次数之后阻断握持部分304与主体部分302的连接。如图44所示,阻断组件320包括阻断构件332、阻断构件导向件334、闸构件336和偏压构件338。阻断构件332被构造和布置成在握持部分304与主体部分302断开预定的次数之后阻断握持部分304与主体部分302的连接。阻断构件导向件334连接到主体部分302上(如图46和47更清楚地示出的),与阻断构件332接触,用于引导阻断构件332的运动。闸构件336与阻断构件332接触,可枢转地连接到阻断构件导向件334上,并且与突起328配合,以限制分度轮324的前进。偏压构件338连接到闸构件336上。偏压构件338可以例如是扭转弹簧,其沿顺时针方向偏压闸构件336。下面将参照图50-55更详细描述锁定系统316的操作。
例如如图44、45和47所示,手柄6还包括释放系统340,释放系统340被构造和布置成启动握持部分304与主体部分302的脱离。释放系统340位于主体部分302内并且包括释放按钮342以及连接到释放按钮342上或者与释放按钮342形成一体的第一和第二释放构件344。第一和第二释放构件344每个都限定了释放斜面346。释放系统340还包括:与相应的释放斜面346接触的第一和第二释放销348;与第一和第二释放销348接触的第一和第二锁定弹簧350;与第一和第二下部滑轨308接触的第一和第二排出弹簧352(如图49更清楚地示出的)。
为了启动握持部分304与主体部分302的脱离,推进释放按钮342,从而使第一和第二释放构件344和相应的释放斜面346也前进。当释放斜面346前进时,释放斜面346使第一和第二释放销348改变位置。第一和第二释放销348相应位置的改变使得第一和第二锁定弹簧350改变位置。一当第一和第二锁定弹簧350改变相应位置足以允许第一和第二上部滑轨306经过,则每个第一和第二排出弹簧352释放存储的能量,由此分别在第一和第二下部滑轨308上施加力。所施加的力有助于使握持部分304与主体部分302脱离。应当理解,根据其它实施例,释放系统340可以包括适于启动握持部分304与主体部分302断开的其它部件和/或构造。
图50-55示出了在连接/断开过程中的不同时刻锁定系统316的部件的相对位置。图50示出了握持部分304首次与主体部分302完全接合之前的相对位置。闸构件336与一个突起328接触,由此防止分度轮324前进。
当第一和第二上部滑轨306前进时,由第一上部滑轨306限定的斜面310使阻断构件332朝着分度轮324前进。当阻断构件332朝着分度轮324前进时,阻断构件332使闸构件336离开分度轮324。当第一上部滑轨306和斜面310继续前进时,阻断构件332继续朝着分度轮324前进。当握持部分304完全与主体部分302接合时,阻断构件332与本来和闸构件336接触的突起328接触,由此防止分度轮324如图51所示那样前进。
在启动握持部分304与主体部分302的脱离之后,第一和第二上部滑轨306沿相反方向前进,由第一上部滑轨306限定的斜面310允许阻断构件332前进离开分度轮324。当阻断构件332前进离开分度轮324时,阻断构件332允许闸构件336朝着分度轮324前进经过突起328,如图52所示。当握持部分304与主体部分302断开时,阻断构件332远离分度轮324前进,足以断开与突起328的接触,并允许分度轮324转动,直到第二突起328与闸构件336接触,如图53所示。
此时,计数器318已经前进了一个位置,主体部分302能够重新连接到握持部分304上(或者连接到替换的握持部分上)。可以重复连接/断开循环。当握持部分304与主体部分302完全接合时,阻断构件332与本来和闸构件336接触的突起328接触,由此防止分度轮324如图54所示一样前进。在第二循环结束时,当握持部分304与主体部分302断开时,闸构件336与第三突起328接触,如图55所示。第三突起328被构造和布置成防止闸构件336通过阻断构件332而前进离开分度轮324,由此防止主体部分302重新连接到握持部分304上(或者连接到替换的握持部分上)。因此,根据这些实施例,外科器械10是有效的双用途器械。但是,本领域技术人员应当理解,如果分度轮324限定了更多的突起328或者凹口,可以增加用途的数量。
图56示出了外科器械400的不同实施例。外科器械400类似于外科器械300,但是不包括锁定系统316。外科器械400的不同之处还在于握持部分304的部分402被构造和布置成中断握持部分304并在握持部分304与主体部分302断开时保持与主体部分302接触。在与握持部分304分离之后,中断部分402保持与主体部分302接触,并且自然阻碍握持部分304重新连接(或者替换的握持部分连接)到主体部分302上。因此,外科器械400是有效的单用途器械。尽管图56所示的中断部分402是第一上部滑轨306的一部分,但是根据其它实施例,中断部分402可以是握持部分304的任意部分。
图57示出了外科器械500的不同实施例。外科器械500类似于外科器械300,但是不包括锁定系统316。外科器械500而是包括位于手柄6中的计数器502,计数器502被构造和布置成可以打开马达联动装置504。如图58所示,马达联动装置504位于电池54和马达65的电连接路径中。图58所示的电路类似于图11所示的电路,但是包括与钉仓锁定传感器136串联的马达联动装置504。因此,当马达联动装置504处于打开位置时,继电器138处于非供能状态,由此防止电池64对马达65供电。
根据不同实施例,马达联动装置504包括一部分计数器502。计数器502可以实施为被构造和布置成在计数器502达到预定计算之后打开马达联动装置504的机械计数器、机电计数器或者电计数器。根据不同实施例,对计数器502的输入可以为非电输入。根据其它实施例,计数器502可包括集成电路芯片,该集成电路芯片包括一个或多个马达联动装置504。尽管图58仅仅示出了一个马达联动装置504,应当理解,在电池64和马达65之间的电连接路径中可以有任意个马达联动装置504。
根据不同实施例,计数器502被构造和布置成在电池64从外科器械500拆卸预定次数之后打开马达联动装置504。预定次数可以是任意次数。例如,根据不同实施例,计数器502可以在电池64从器械500拆卸两次之后打开马达联动装置504。
根据其它实施例,计数器502被构造和布置成在握持部分304从主体部分302断开预定次数之后打开马达联动装置504。预定次数可以是任意次数。例如,根据不同实施例,计数器502可以在握持部分304从主体部分302断开两次之后打开马达联动装置504。
根据其它实施例,计数器502被构造和布置成在闭合扳机18和/击发扳机20被致动预定次数之后打开马达联动装置504。预定次数可以是任意次数。例如,根据不同实施例,计数器502可以在击发扳机20被致动两次之后打开马达联动装置504。
根据其它实施例,计数器502被构造和布置成在首次使用外科器械500之后预定时间打开马达联动装置504。对于这些实施例,计数器502可以实施为计时器。可以以对应于外科器械500的使用的方式定义首次使用。例如,首次使用可以对应于握持部分304与主体部分302的连接、闭合扳机18的致动、击发扳机20的致动等。预定的时间可以是任意的时间。
尽管已经对本发明的一些实施例进行了描述,但本领域技术人员在保持本发明的一些或者全部优点的情况下可以对这些实施例进行各种改进、改变和变型。例如,根据不同实施例,单个部件可以用多个部件代替,多个部件可以用单个部件代替,以执行给定的功能。因此本申请旨在覆盖所有这些改进、改变和变型,而不背离由后附权利要求书限定的本发明的范围和精神。
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。
Claims (8)
1.一种外科器械,包括:
手柄,其包括主体部分以及可释放地连接到主体部分上的握持部分;
位于握持部分中的电池;
与电池电连接的马达;以及
位于手柄中的锁定系统,所述锁定系统被构造和布置成在握持部分与主体部分断开预定次数之后阻断握持部分与主体部分的连接,所述锁定系统包括计数器,所述计数器被构造和布置成当所述握持部分与所述主体部分断开时前进,所述计数器包括:
分度轮;以及
连接到分度轮上的偏压构件。
2.如权利要求1所述的外科器械,其特征为,所述电池能从所述握持部分拆卸。
3.如权利要求1所述的外科器械,其特征为,所述电池是可充电电池。
4.如权利要求1所述的外科器械,其特征为,所述锁定系统还包括连接到计数器上的阻断组件,所述阻断组件被构造和布置成在所述握持部分与所述主体部分断开预定次数之后阻断所述握持部分与所述主体部分的连接。
5.如权利要求4所述的外科器械,其特征为,所述阻断组件包括阻断构件,所述阻断构件被构造和布置成在所述握持部分与所述主体部分断开预定次数之后阻断所述握持部分与所述主体部分的连接。
6.如权利要求5所述的外科器械,其特征为,所述阻断组件还包括与所述阻断构件接触的闸构件。
7.如权利要求6所述的外科器械,其特征为,所述阻断组件还包括与所述闸构件连接的偏压构件。
8.如权利要求1所述的外科器械,其特征为,所述计数器是可重置的计数器。
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US7147138B2 (en) * | 2004-07-28 | 2006-12-12 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument having an electroactive polymer actuated buttress deployment mechanism |
US20060025812A1 (en) * | 2004-07-28 | 2006-02-02 | Ethicon Endo-Surgery, Inc. | Surgical instrument incorporating an electrically actuated pivoting articulation mechanism |
US8905977B2 (en) * | 2004-07-28 | 2014-12-09 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument having an electroactive polymer actuated medical substance dispenser |
US8579176B2 (en) * | 2005-07-26 | 2013-11-12 | Ethicon Endo-Surgery, Inc. | Surgical stapling and cutting device and method for using the device |
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-
2006
- 2006-01-31 US US11/344,020 patent/US7464846B2/en active Active
-
2007
- 2007-01-25 AU AU2007200316A patent/AU2007200316B2/en not_active Ceased
- 2007-01-30 CA CA 2576466 patent/CA2576466C/en not_active Expired - Fee Related
- 2007-01-30 RU RU2007103540/14A patent/RU2449745C2/ru not_active IP Right Cessation
- 2007-01-30 SG SG200700735-4A patent/SG134310A1/en unknown
- 2007-01-30 EP EP10177924A patent/EP2305134B1/en active Active
- 2007-01-30 JP JP2007020029A patent/JP5037150B2/ja active Active
- 2007-01-30 PL PL10177924T patent/PL2305134T3/pl unknown
- 2007-01-30 EP EP07250372.5A patent/EP1813200B1/en active Active
- 2007-01-30 ES ES10177924T patent/ES2392331T3/es active Active
- 2007-01-30 PL PL07250372T patent/PL1813200T3/pl unknown
- 2007-01-31 CN CN2007100069492A patent/CN101011275B/zh active Active
- 2007-01-31 BR BRPI0701395A patent/BRPI0701395B8/pt active IP Right Grant
- 2007-01-31 KR KR1020070009924A patent/KR101358130B1/ko active IP Right Grant
- 2007-01-31 MX MX2007001311A patent/MX2007001311A/es active IP Right Grant
- 2007-11-06 HK HK07112053.2A patent/HK1106681A1/zh not_active IP Right Cessation
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US5709334A (en) * | 1993-10-08 | 1998-01-20 | United States Surgical Corporation | Surgical apparatus for applying surgical fasteners |
EP1479346A1 (en) * | 2003-05-20 | 2004-11-24 | Ethicon Endo-Surgery | Surgical stapling instrument incorporating keyed firing mechanism |
Also Published As
Publication number | Publication date |
---|---|
CA2576466C (en) | 2015-03-31 |
KR20070079049A (ko) | 2007-08-03 |
US7464846B2 (en) | 2008-12-16 |
JP5037150B2 (ja) | 2012-09-26 |
BRPI0701395B8 (pt) | 2021-06-22 |
EP1813200B1 (en) | 2014-04-02 |
HK1106681A1 (zh) | 2008-03-20 |
CN101011275A (zh) | 2007-08-08 |
JP2007222615A (ja) | 2007-09-06 |
KR101358130B1 (ko) | 2014-02-06 |
AU2007200316B2 (en) | 2012-06-21 |
US20070175960A1 (en) | 2007-08-02 |
AU2007200316A1 (en) | 2007-08-16 |
BRPI0701395B1 (pt) | 2018-07-17 |
BRPI0701395A (pt) | 2007-10-30 |
PL2305134T3 (pl) | 2013-02-28 |
EP2305134B1 (en) | 2012-08-29 |
PL1813200T3 (pl) | 2014-08-29 |
EP1813200A3 (en) | 2007-09-12 |
RU2007103540A (ru) | 2008-08-10 |
RU2449745C2 (ru) | 2012-05-10 |
SG134310A1 (en) | 2007-08-29 |
EP2305134A3 (en) | 2011-07-20 |
CA2576466A1 (en) | 2007-07-31 |
EP1813200A2 (en) | 2007-08-01 |
EP2305134A2 (en) | 2011-04-06 |
ES2392331T3 (es) | 2012-12-07 |
MX2007001311A (es) | 2008-11-18 |
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