CN101133972B - 电动闭锁装置以及包含该装置的外科器械 - Google Patents
电动闭锁装置以及包含该装置的外科器械 Download PDFInfo
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Abstract
公开了一种外科切割和缝合器械。该器械包括端部执行器和手柄。端部执行器包括通道、可枢转地连接在通道上的钉砧、用于对定位在钉砧和通道之间的物体进行切割的可动切割器械、以及被构造成可取出地由通道收纳的钉仓。钉仓包括在切割冲程过程中与切割器械接合的滑块。手柄包括用于通过主驱动轴组件使切割器械致动的马达。该器械还包括能够根据钉仓的位置引发马达操作的第一联锁电路。
Description
相关申请的交叉引用
本申请涉及以下共同提交的美国专利申请,这些申请在此通过引用并入本文:
(1)具有使用者反馈系统的马达驱动的外科切割和紧固器械(MOTOR-DRIVEN SURGICAL CUTTING AND FASTENINGINSTRUMENT WITH USER FEEDBACK SYSTEM);发明人:Frederick E.Shelton,IV,John Ouwerkerk,以及Jerome R.Morgan(代理案卷No.050519/END5687USNP);
(2)具有负载力反馈的马达驱动的外科切割和紧固器械(MOTOR-DRIVEN SURGICAL CUTTING AND FASTENINGINSTRUMENT WITH LOADING FORCE FEEDBACK);发明人:Frederick E.Shelton,IV,John N.Ouwerkerk,Jerome R.Morgan以及Jeffrey S.Swayze(代理案卷No.050516/END5692USNP);
(3)具有触摸位置反馈的马达驱动的外科切割和紧固器械(MOTOR-DRIVEN SURGICAL CUTTING AND FASTENINGINSTRUMENT WITH TACTILE POSITION FEEDBACK);发明人:Frederick E.Shelton,IV,John N.Ouwerkerk,Jerome R.Morgan以及Jeffrey S.Swayze(代理案卷No.050515/END5693USNP);
(4)具有自适应使用者反馈的马达驱动的外科切割和紧固器械(MOTOR-DRIVEN SURGICAL CUTTING AND FASTENINGINSTRUMENT WITH ADAPTIVE USER FEEDBACK);发明人:Frederick E.Shelton,IV,John Ouwerkerk,以及Jerome R.Morgan(代理案卷No.050513/END5694USNP);
(5)具有可关节运动端部执行器的马达驱动的外科切割和紧固器械(MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITH ARTICULATABLE END EFFECTOR);发明人:Frederick E.Shelton,IV以及Christoph L.Gillum(代理案卷No.050692/END5769USNP);
(6)具有机械闭合系统的马达驱动的外科切割和紧固器械(MOTOR-DRIVEN SURGICAL CUTTING AND FASTENINGINSTRUMENT WITH MECHANICAL CLOSURE SYSTEM);发明人:Frederick E.Shelton,IV以及Christoph L.Gillum(代理案卷No.050693/END5770USNP);
(7)具有闭合扳机锁定机构的外科切割和紧固器械(MOTOR-DRIVE SURGICAL CUTTING AND FASTENINGINSTRUMENT WITH CLOSURE TRIGGER LOCKINGMECHANISM);发明人:Frederick E.Shelton,IV以及Kevin R.Doll(代理案卷No.050694/END5771USNP);
(8)用于动力驱动的外科切割和紧固缝合器械的齿轮传动选择器(GEARING SELECTOR FOR A POWERED SURGICAL CUTTINGAND FASTENING STAPLING INSTRUMENT);发明人:FrederickE.Shelton,IV,Jeffrey S.Swayze以及Eugene L.Timperman(代理案卷No.050697/END5772USNP);
(9)具有记录能力的外科器械(SURGICAL INSTRUMENTHAVING RECORDING CAPABILITIES);发明人:Frederick E.Shelton,IV,John N.Ouwerkerk以及Eugene L.Timperman(代理案卷No.050698/END5773USNP);
(10)具有可拆卸的电池的外科器械(SURGICAL INSTRUMENTHAVING A REMOVABLE BATTERY);发明人:Frederick E.Shelton,IV,Kevin R.Doll,Jeffrey S.Swayze以及Eugene Timperman(代理案卷No.050699/END5774USNP);
(11)具有可以相对于轴关节运动的手柄的内窥镜外科器械(ENDOSCOPIC SURGICAL INSTRUMENT WITH A HANDLETHAT CAN ARTICULATE WITH RESPECT TO THE SHAFT);发明 人:Frederick E.Shelton,IV,Jeffrey S.Swayze,Mark S.Ortiz以及LeslieM.Fugikawa(代理案卷No.050701/END5776USNP);
(12)具有带平行闭合和钉砧排列部件的旋转击发和闭合系统的机电式外科切割和紧固器械(ELECTRO-MECHANICAL SURGICALCUTTING AND FASTENING INSTRUMENT HAVING A ROTARYFIRING AND CLOSURE SYSTEMWITH PARALLEL CLOSUREAND ANVIL ALIGNMENT COMPONENTS);发明人:FrederickE.Shelton,IV,Stephen J.Balek以及Eugene L.Timperman(代理案卷No.050702/END5777USNP);
(13)用于外科切割和紧固器械的具有带组织定位器的钉砧的可置换钉仓及其标准端部执行器;发明人:Frederick E.Shelton,IV,Michael S.Cropper,Joshua M.Broehl,Ryan S.Crisp,Jamison J.Float以及Eugene L.Timperman(代理案卷No.050703/END5778USNP);以及
(14)具有反馈系统的外科器械(SURGICAL INSTRUMENTHAVING A FEEDBACK SYSTEM);发明人:Frederick E.Shelton,IV,Jerome R.Morgan,Kevin R.Doll,Jeffrey S.Swayze以及EugeneTimperman(代理案卷No.050705/END5780USNP)。
技术领域
公开的本发明总体上并以不同实施方式涉及外科缝合和切割器械,该器械被组合并构造成将可重复使用的钉仓中成排的缝钉施放在组织内,同时切割所施放的缝钉排之间的组织。更具体地说,公开的本发明涉及用于机动外科缝合和切割器械的电动联锁装置,其在钉仓未得到安装、未得到正确安装、或者被用完时,或者当外科缝合和切割器械不是处于以安全和/或最佳方式执行缝合和切割操作的状态下时防止切割组织。公开的本发明还涉及用于在缝合和切割操作正在进行的同时,使某些器械特征无效的电动联锁装置。
背景技术
内窥镜外科器械经常比常规的开放式外科装置更得到偏爱,这是因为更小的切口往往可以减少术后的恢复时间和并发症。因而,已经在适于通过套管针的插管在所需手术部位精确放置远侧端部执行器的内窥镜外科器械领域有了显著发展。这些远侧端部执行器以许多方式接合组织,以获得诊断或治疗效果(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/基因治疗供给装置、以及采用超声波、RF、激光等的能量装置)。
已知的外科缝合器包括同时在组织上形成纵向切口和在切口的相对两侧施放成排缝钉的端部执行器。该端部执行器包括一对联动的夹爪元件,如果器械被用于内窥镜或腹腔内窥镜的用途,所述夹爪元件能够穿过套管通道。一个夹爪元件容纳具有横向间隔的至少两排缝钉的钉仓。另一个夹爪限定了具有与盒中的缝钉排对准的缝钉形成容室的钉砧。所述器械包括多个往复的楔形件,它们在被向远侧驱动时,穿过钉仓上的开口并接合支承缝钉的驱动器,以执行向钉砧击发缝钉。
有利的是,端部执行器的设计可以是其可以与外科缝合器一起重复使用。例如,一个患者可以需要一系列的切断和缝合操作。每个操作更换整个端部执行器往往在经济上是低效的,特别是在端部执行器被构造成强度和可靠性满足重复操作的要求。为此,钉仓通常被构造成可更换并在外科手术缝钉的每一操作之前被装配在端部执行器内。
在授予Knodel等人的名称为“SURGICAL STAPLERINSTRUMENT(外科手术缝钉器械)”的美国专利No.5,465,895中描述了适用于内窥镜用途的外科手术缝钉的实例,该文献公开了具有各自不同的闭合和击发动作的内切割器。因此,临床医生能够闭合作用在组织上的夹爪元件以在击发之前使组织定位。一旦临床医生已经确定夹爪元件适当地夹紧组织,则临床医生随后利用取决于装置的单击发冲程或多击发冲程击发外科手术缝钉。击发外科手术缝钉促使组织的切断和缝合。同时进行的切断和缝合避免了在利用各自仅切断和 缝合的不同外科工具依次执行所述操作时可能产生的并发症。
能够在击发之前闭合组织的一个特有的优点是临床医生能够通过内窥镜验证已经达到了所需的切割位置,包括在相对的夹爪之间已经获取了足够量的组织。另外,相对的夹爪可以被拉动得更靠近在一起,特别是收聚在它们的远端,并由此不会在切断的组织上有效地形成闭合的缝钉。在另一极端下,过量夹紧的组织会导致粘连和击发不完全。
由于所需闭合夹爪并同时执行切割和缝合操作的致动力(也就是“用于击发的力”,或者FTF)可能相当大,因此手动产生动力的切割和缝合器械,例如以上所述的器械,不能被在其他方面胜任但不能产生所需FTF的使用者利用。因此,已经开发了动力驱动的切割和缝合器械以降低用于击发的力(FTF)。这种器械通常包括适于补充或取代使用者产生的力以执行切割和缝合操作的马达或其他致动机构。
尽管动力驱动的器械提供许多优点,但在某些状态下需要防止器械无意的击发。例如,在未安装钉仓的情况下使器械击发,或者在具有安装的钉仓但是空的钉仓的情况下使器械击发会导致在没有同时缝合以使出血降至最少的情况下切割组织。另外,在没有完全闭合夹爪的情况下使器械击发会导致切割和击发操作不符合要求和/或导致对器械的损坏。如果夹爪在切割和击发操作正在进行的同时无意中打开也会产生类似的后果。特别要求应该以不会遭受错误动作的介入的可靠方式实现用于防止所述无意中击发和夹爪操纵的联锁特征。而且,为了易于制造和组装,还要求应该以最少数量的部件实现联锁特征。
因而,极大地需要提供用于动力驱动的切割和缝合器械上的电动联锁特征,从而在例如上述状态下防止无意中的击发(也就是切割和缝合)和夹爪操纵。
发明内容
本发明根据不同实施方式公开了一种外科切割和缝合器械。该器 械包括端部执行器和手柄。端部执行器包括通道、可枢转地连接在通道上的钉砧、用于对定位在钉砧和通道之间的物体进行切割的可动切割器械、以及被构造成可取出地由通道收纳的钉仓。钉仓包括在切割冲程过程中与切割器械接合的滑块。手柄包括用于通过主驱动轴组件使切割器械致动的马达。该器械还包括能够根据钉仓的位置引发马达操作的第一联锁电路。
本发明具体涉及:
(1)一种外科切割和缝合器械,包括:
端部执行器,其包括:
通道;
可枢转地连接在通道上的钉砧;
可动切割器械,其用于对定位在钉砧和通道之间的物体进行切割;以及
钉仓,其被构造成由通道可移除地收纳,所述钉仓包括在切割冲程期间与切割器械接合的滑块;
手柄,其包括用于通过主驱动轴组件使切割器械致动的马达;以及
第一联锁电路,其能够根据钉仓的位置引发马达操作。
(2)如权利要求(1)所述的外科器械,还包括第二联锁电路,用于在切割器械运动期间防止钉砧相对于通道枢转运动。
(3)如权利要求(2)所述的外科器械,其中,所述第二联锁电路包括机电致动器,其被构造成在切割器械运动过程中防止钉砧相对于通道打开。
(4)如权利要求(1)所述的外科器械,其中,所述第一联锁电路还能够根据钉砧的位置、滑块在钉仓内的位置、以及器械执行的操作累计次数中的至少一个引发马达操作。
(5)如权利要求(4)所述的外科器械,其中,所述第一联锁电路包括:
第一开关,其被构造成当钉仓处于与其由通道收纳相对应的位置 时,保持第一开关状态;
第二开关,其被构造成当钉砧相对于通道处于闭合位置时保持第二开关状态;
第三开关,其被构造成当滑块位于钉仓内未击发位置时保持第三开关状态;以及
第四开关,其被构造成当操作的累计次数小于预定值时保持第四开关状态;
其中,所述第一、第二、第三、以及第四开关被连接成使得当共同保持相应的第一、第二、第三、以及第四开关状态时,能够引发马达操作。
(6)如权利要求(5)所述的外科器械,其中,所述第一、第二、第三、以及第四开关中的至少一个从接触致动开关和非接触致动开关中选择。
(7)如权利要求(5)所述的外科器械,其中,所述第一开关包括布置在通道内并与通道电绝缘的第一开关触点和第二开关触点,其中,第一和第二开关触点被定位成使得钉仓的一部分在当处于与其由通道收纳相对应的位置时,在第一和第二开关触点之间建立导电通道。
(8)如权利要求(5)所述的外科器械,其中,所述第二开关还能够因钉砧相对于通道处于闭合位置时向第二开关上施加机械力而保持第二开关状态。
(9)如权利要求(5)所述的外科器械,其中,所述第二开关还被构造成响应于电信号而保持第二开关状态,其中,所述电信号表示钉砧处于闭合位置时由钉砧施加的力。
(10)如权利要求(5)所述的外科器械,其中,所述第二开关还被构造成在钉砧已经相对于通道处于闭合位置达预定时间段之后保持第二开关状态。
(11)如权利要求(5)所述的外科器械,其中,所述第三开关还被构造成因位于未击发位置的滑块向第三开关施加的机械力而保 持第三开关状态。
(12)如权利要求(5)所述的外科器械,还包括与第四开关通信的计数器,其中,所述计数器被构造成保存表示操作累计次数的计数并且当所述计数小于预定值时使第四开关保持第四开关状态。
(13)如权利要求(12)所述的外科器械,其中,所述计数器还被构造成根据由此接收的机械输入和电子输入中的一个保存所述计数。
(14)如权利要求(12)所述的外科器械,其中,所述计数器与显示器通信,所述显示器用于指示所保存的计数之一以及预定值和保存的计数之间的差值。
(15)如权利要求(5)所述的外科器械,还包括显示第一、第二、第三以及第四开关中的至少一个的状态的至少一个指示器。
(16)如权利要求(5)所述的外科器械,其中,所述第一、第二和第三开关中的每一个都采用常开开关构造,并且第四开关采用常闭开关构造。
(17)如权利要求(16)所述的外科器械,其中,所述第一、第二、第三和第四开关串联地与马达和马达控制电路中的一个相连,使得当没有保持第一、第二、第三或第四开关状态中的任何状态时防止引发马达操作。
附图说明
在此结合以下附图通过举例描述本发明的不同实施方式,其中:
图1和2是根据本发明不同实施方式的外科切割和紧固器械的透视图;
图3-5是根据本发明不同实施方式的端部执行器和轴的分解视图;
图6是根据本发明不同实施方式的端部执行器的侧视图;
图7是根据本发明不同实施方式的器械手柄的分解视图;
图8和9是根据本发明不同实施方式的手柄的局部透视图;
图10是是根据本发明不同实施方式的手柄的侧视图;
图11是根据本发明不同实施方式的器械中采用的电路的示意图;
图12-13是根据本发明其他实施方式的手柄的侧视图;
图14-22表示根据本发明不同实施方式的用于锁定闭合扳机的不同机构;
图23A-B表示可以在根据本发明不同实施方式的器械的关节运动点采用的万向接头(“U形接头”);
图24A-B表示可以在根据本发明不同实施方式的器械的关节运动点采用的扭转电缆;
图25-31表示根据本发明另一实施方式的具有动力辅助的外科切割和紧固器械;
图32-36表示根据本发明又一实施方式的具有动力辅助的外科切割和紧固器械;
图37-40表示根据本发明实施方式的具有触觉反馈的外科切割和紧固器械;
图41-42表示根据本发明不同实施方式可以采用的比例传感器;以及
图43A-44C表示根据本发明不同实施方式的联锁电路的闭锁传感器开关的安装结构和构造。
具体实施方式
图1和2表示根据本发明不同实施方式的外科切割和紧固器械10。所示的实施方式是内窥镜器械,并且,大体上在此所描述的器械10的实施方式是内窥镜外科切割和紧固器械。然而,应该指出,根据本发明的其他实施方式,所述器械可以是非内窥镜外科切割和紧固器械,例如腹腔镜器械。
在图1和2中示出的外科器械10包括手柄6、轴8、以及在关节运动枢轴14与轴8枢转连接的关节运动端部执行器12。可以靠近手柄6设置关节运动控制件16,以使端部执行器12可以绕关节运动枢 轴14旋转。在所示的实施方式中,端部执行器12被构造成作为用于夹紧、切断和缝合组织的内切割器,尽管如此,在其他实施方式中,可以采用不同类型的端部执行器,例如用于其他类型的外科装置的端部执行器,例如抓钳、切割器、缝合器、夹具施放器、接入装置、药物/基因治疗供给装置、超声波、RF、激光等等。
器械10的手柄6可以包括用于使端部执行器12致动的闭合扳机18和击发扳机20。应当理解,具有用于不同外科任务的端部执行器的器械可以具有用于操作端部执行器12的不同数量或类型的扳机或其他适当的控制件。端部执行器12被示出通过优选细长的轴8与手柄16分隔。在一种实施方式中,临床医生或器械10的操作者可以利用关节运动控制件16相对于轴8关节运动端部执行器12,这一点在授予Hueil等人的名称为“SURGICAL INSTRUMENT HAVING ANARTICULATING END EFFECTOR”的待审美国专利申请No.11/329,020中更详细地得到了描述,该文献在此引入作为参考。
端部执行器12在本实例中尤其包括缝钉通道22和可枢转移动的夹紧元件例如钉砧24,它们保持一定间距以确保有效地缝合和切断夹紧在端部执行器12上的组织。手柄6包括手枪式握把26,闭合扳机18由临床医生向所述手枪式握把26枢转拉动以使钉砧24向端部执行器12的缝钉通道22夹紧或闭合,由此将定位在钉砧24和通道22之间的组织夹紧。击发扳机20在闭合扳机18的更外侧。一旦闭合扳机18如下文进一步描述的那样锁定在闭合位置,则击发扳机20可以略微向手枪式握把26旋转,使得其可以由操作者采用一只手触到。随后操作者可以向手枪式握把26枢转地拉动击发扳机20以缝合并切割夹紧在端部执行器12上的组织。在另一实施方式中,可以采用钉砧24之外的不同类型夹紧元件,例如相对的夹爪等等。
应当理解,在此参照临床医生握持器械10的手柄6采用术语“近端”和“远端”。因此,端部执行器12相对于更近端的手柄16是处于远端。进一步应当理解,为了方便和清晰,在此相对于图采用空间术语例如“垂直”和“水平”。然而,外科器械可以被用在许多定向 和位置上,并且这些术语并不是用于限制和绝对表示。
闭合扳机18可以首先致动。一旦临床医生对端部执行器12的定位满意,临床医生就可以将闭合扳机18拉回到其接近手枪式握把26的完全闭合的、锁定的位置。击发扳机20可以随后致动。但临床医生解除压力时击发扳机20回到打开位置(图1和2所示),这一点将在下文更详尽地进行描述。手柄6上的释放按钮在被压下时可以释放锁定的闭合扳机18。释放按钮可以通过多种形式实现,例如图14所示的滑动释放按钮160,和/或图16所示的按钮172。
图3是根据不同实施方式的端部执行器12的分解视图。如示意性实施方式所示,端部执行器12除了上述的通道22和钉砧24之外还包括切割器械32、滑块33、可取出地落入通道22内的钉仓34、以及螺杆轴36。切割器械32例如可以是刀。钉砧24可以在与通道22近端相连的枢轴点25可枢转地打开和闭合。钉砧24还可以包括在其远端的突舌27,其被插入到机械闭合系统(下文进一步进行描述)的部件内以打开和闭合钉砧24。当闭合扳机18致动时,也就是由器械10的使用者向内拉动时,钉砧24可以绕枢轴点25枢转到夹紧或闭合位置。如果端部执行器12的夹紧满足要求,则操作者可以使击发扳机20致动,这样如下文更详细地说明的那样促使刀32和滑块33沿通道22纵向移动,由此对夹紧在端部执行器12内的组织进行切割。滑块33沿通道22的移动促使钉仓34中的缝钉(未示出)被驱动穿过切断的组织并压靠在闭合的钉砧24上,所述钉砧24又使缝钉弯曲以紧固切断的组织。授予Shelton,IV等人的名称为“包含E形架击发机构的外科缝合器械(SURGICAL STAPLING INSTRUMENTINCORPORATING AN E-BEAM FIRING MECHANI SM)”的美国专利No.6,978,921在此引入作为参考,其更详细地提出了有关这种两冲程切割和紧固器械的内容。滑块33可以是与盒34一体的部件,使得当刀32在切割操作之后缩回时,滑块33不会缩回。
应该指出,尽管在此描述的器械10的实施方式采用端部执行器12缝合切断的组织,但在其他实施方式中可以采用不同技术来紧固或 密封切断的组织。例如,还可以采用利用RF能量或胶粘剂紧固切断的组织的端部执行器。授予Yates等人的名称为“电外科止血剂装置(ELECTROSURGICAL HEMOSTATIC DEVICE)”的美国专利No.5,709,680和授予Yates等人的名称为“具有隐藏式和/或偏心式电极的电外科止血剂装置(ELECTOSURGICAL HEMOSTATICDEVICE WITH RECESSED AND/OR OFFSET ELECTRODES”的美国专利No.5,688,270在此引入作为参考,它们公开了采用RF能量紧固切断的组织的切割器械。授予Morgan等人的名称为“被构造成用于供给药剂的外科缝合器械(SURGICAL STAPLING INSTRUMENTSSTRUCTURED FOR DELIVERY OF MEDICAL AGENTS)”的美国专利申请No.11/267,811和授予Shelton IV等人的名称为“被构造成用于借助泵供给药剂的外科缝合器械(SURGICAL STAPLINGINSTRUMENTS STRUCTURED FOR PUMP-ASSISTED DELIVERYOF MEDICAL AGENTS)”的美国专利申请No.11/267,383也在此引入作为参考,它们公开了采用胶粘剂紧固切断的组织的切割器械。因此,尽管在此描述涉及切割/缝合操作并且下文大同,但应该认识到这是示例性实施方式而并不意味着限制。还可以采用其他组织紧固技术。
图4和5是根据不同实施方式的端部执行器12和轴8的分解视图以及图6是其侧视图。如示意性实施方式所示,轴8可以包括通过枢轴连接件44枢转连接的近端闭合管40和远端闭合管42。远端闭合管42包括开口45,钉砧24上的突舌27插入所述开口45内以打开和闭合钉砧24,这将在下文进一步描述。近端脊状管46可以布置在闭合管40,42内。通过锥齿轮组件52与副(远端)传动轴50相连的主旋转(或近端)传动轴48可以布置在近端脊状管46内。副传动轴50与传动齿轮54相连,该传动齿轮54接合螺杆轴36的近端传动齿轮56。垂直锥齿轮52b可以在近端脊状管46的远端上的开口57内定位并枢转。远端脊状管58可以被用于封装副传动轴50和传动齿轮54,56。总之,主驱动轴48、副传动齿轮50以及关节运动组件(例如锥 齿轮组件52a-c)有时在这里被称为“主驱动轴组件”。
定位在缝钉通道22远端的轴承38容纳传动螺杆36,从而使传动螺杆36可以相对于通道22自由旋转。传动螺杆36可以与刀32的螺纹开口(未示出)接合,使得轴36的旋转会促使刀32穿过缝钉通道22向远端或向近端(取决于旋转方向)平移。因此,当通过击发扳机20的致动(如下文更详细地说明)促使主驱动轴48旋转时,锥齿轮组件52a-c促使副传动轴50旋转,这样由于传动齿轮54,56的接合又会促使螺杆轴36旋转,从而促使刀驱动元件32沿通道22纵向移动以对夹紧在端部执行器12内的任何组织进行切割。滑块33可以由例如塑料制成并且可以具有倾斜的远端面。当滑块33横切通道22时,倾斜前表面可以向上推动或驱动钉仓34内的缝钉穿过夹紧的组织并压靠在钉砧24上。钉砧24使缝钉弯曲,由此缝合切断的组织。当刀32缩回时,刀32和滑块33可以脱离接合,由此将滑块33留在通道22的远端。
由于切割/缝合操作缺少使用者反馈,因此在医生中缺乏对仅由按压按钮引发切割/缝合操作的马达驱动的器械的认可。相比之下,本发明的实施方式提供具有对切割器械在端部执行器中的展开、力和/或位置的使用者反馈的马达驱动的内切割器。
图7-10表示马达驱动的内切割器特别是其手柄6的示例性实施方式,提供了有关切割器械在端部执行器中的展开和负载力的使用者反馈。另外,该实施方式可以采用由使用者在击发扳机20缩回时提供的动力驱动所述装置(所谓的“动力辅助”模式)。如示意性实施方式所示,手柄6包括装配在一起以大体上形成手柄外部的外部下侧部件59,60和外部上侧部件61,62。电池64例如锂离子电池可以设置在手柄6的手枪式握把部分26上。电池64向布置在手柄6的手枪式握把部分26的上部的马达65提供动力。根据不同实施方式,马达65可以是具有大约5000RPM最大旋转的DC电刷驱动马达。马达65可以驱动包括第一锥齿轮68和第二锥齿轮70的90°锥齿轮组件66。锥齿轮组件66可以驱动行星齿轮组件72。行星齿轮组件72可以包括与 传动轴76相连的小齿轮74。小齿轮74可以驱动配合齿圈78,该配合齿圈78通过传动轴82驱动斜齿轮鼓轮80。环84可以通过螺纹接合在斜齿轮鼓轮80上。因此,当马达65旋转时,促使环84通过插入的锥齿轮组件66、行星齿轮组件72以及齿圈78沿斜齿轮鼓轮80移动。
手柄6还可以包括当击发扳机20被操作者向手柄6的手枪式握把26拉动(或“闭合”)时与击发扳机20相连以进行检测的运转马达传感器110,由此通过端部执行器12引发切割/缝合操作。传感器110可以是比例传感器,例如变阻器或可变电阻器。当击发扳机20被向内拉动时,传感器110检测移动并发送表示供给到马达65的电压(或动力)的电信号。当传感器110是可变电阻器或类似元件时,马达65的旋转可以大体上与击发扳机20的移动量成比例。也就是说,如果操作者仅少量地拉动或闭合击发扳机20,马达65的旋转相对较低。当击发扳机20完全被拉入(或处于完全闭合的位置)时,马达65的旋转处于其最大值。换句话说,使用者拉动击发扳机20的程度越大,施加在马达65上的电压越大,导致转速越高。
手柄6可以包括靠近击发扳机20上部的中间手柄部件104。手柄6还可以包括连接在中间手柄部件104和击发扳机20上的柱之间相连的偏压弹簧112。偏压弹簧112可以将击发扳机20偏压到其完全打开的位置。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拉向其打开位置,由此解除传感器110的致动,从而停止马达65的旋转。而且,通过偏压弹簧112,任何时候使用者可以闭合击发扳机20,使用者将会承受闭合操作的阻力,由此使用者具有对马达65施加的旋转量的反馈。此外,操作者可以停止使击发扳机20缩回,由此解除来自传感器100的力并由此使马达65停止。同样,使用者可以停止端部执行器12的展开,由此向操作者提供对切割/紧固操作的控制的测定。
斜齿轮鼓轮80的远端包括驱动齿圈122的远端传动轴120,齿圈122与小齿轮124啮合。小齿轮124与主驱动轴组件的主驱动轴48 相连。这样,如上所述,马达65的旋转促使主驱动轴组件旋转,从而促使端部执行器12的致动。
通过螺纹接合在斜齿轮鼓轮80上的环84可以包括布置在开槽臂90的槽88内的柱86。开槽臂90在其相对端94具有开口92,开口92容纳连接在手柄外部侧部件59,60之间的枢轴销96。枢轴销96还布置成穿过击发扳机20上的开口100和中间手柄部件104上的开口102。
另外,手柄6可以包括反向马达(或冲程结束)传感器130和止动马达(或冲程开始)传感器142。在不同实施方式中,反向马达传感器130可以是位于斜齿轮鼓轮80的远端的限位开关,使得当环84到达斜齿轮鼓轮80的远端时螺纹接合在斜齿轮鼓轮80上的环84与反向马达传感器130接触和脱开。反向马达传感器130在致动时向马达65发送信号以使其旋转方向反向,由此在切割操作之后退出端部执行器12的刀32。
止动马达传感器142可以是例如常闭限位开关。在不同实施方式中,其可以位于斜齿轮鼓轮80的近端,使得当环84到达斜齿轮鼓轮80的近端时环84与开关142脱开。
在操作时,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的展开并向马达65发送信号以促使马达65以例如与操作者拉回击发扳机20的剧烈程度成正比的速率正向旋转。马达65的正向旋转又促使齿圈78在行星齿轮组件72的远端旋转,由此促使斜齿轮鼓轮80旋转,从而促使螺纹接合在斜齿轮鼓轮80上的环84沿斜齿轮80鼓轮向远端移动。如上所述斜齿轮鼓轮80的旋转还驱动主驱动轴组件,这样又促使端部执行器12中的刀32的展开。也就是,促使刀32和滑块33沿纵向横切通道22,由此对夹紧在端部执行器12中的组织进行切割。在使用缝合型端部执行器的实施方式中还进行端部执行器12的缝合操作。
在完成端部执行器12的切割/缝合操作后,斜齿轮鼓轮80上的环84将已经到达斜齿轮鼓轮80的远端,由此促使反向马达传感器130 脱开,从而向马达65发送信号以使马达65的旋转反向。这样又促使刀32缩回,并且还促使斜齿轮鼓轮80上的环84移动回到斜齿轮鼓轮80的近端。
在图8和9中最清楚地示出,中间手柄部件104包括接合开槽臂90的后侧台肩106。中间手柄部件104还具有接合击发扳机20的前进运动止动件107。如以上说明,通过马达65的旋转控制开槽臂90的移动。当开槽臂90随着环84从斜齿轮鼓轮80的近端移动到远端而逆时针(CCW)旋转时,中间手柄部件104将自由地逆时针旋转。因此,当使用者向内拉动击发扳机20时,击发扳机20将接合中间手柄部件104的前进运动止动件107,从而促使中间手柄部件104逆时针旋转。然而,由于后侧台肩106接合开槽臂90,因此中间手柄部件104仅能在开槽臂90的允许下逆时针旋转。这样,如果马达65出于某种原因应该停止旋转时,开槽臂90将停止旋转,并且由于中间手柄部件104因开槽臂90的存在而不能自由地逆时针旋转,因此使用者不能进一步向内拉动击发扳机20。
图41和42表示可以作为根据本发明不同实施方式的运转马达传感器110的变量传感器的两种状态。传感器110可以包括面部280、第一电极(A)282、第二马达(B)284、以及在马达282,284之间的可压缩电介质材料286(例如EAP)。传感器110可以定位成使得面部280接触缩回时的击发扳机20。因此,当击发扳机20缩回时,电介质材料286得到压缩,如图42所示,从而电极282,284更靠近在一起。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,因此距离越大阻抗越大,并且距离越近阻抗越小。这样,电介质材料286因击发扳机20的缩回(在图42中由力“F”表示)而被压缩的量与电极282,284之间的阻抗成比例,这被用于按比例控制马达65。
还在图7-10中示出了用于通过缩回闭合扳机18而闭合(或夹紧)端部执行器12的钉砧24的示例性闭合系统的部件。在所示实施方式中,闭合系统包括通过销251与闭合扳机18相连的轭250,所述销 251穿过闭合扳机18和轭250上的对准孔。使闭合扳机18绕其枢轴的枢轴销252插过闭合扳机18上的另一开口,该开口偏离销251穿过闭合扳机18的位置。因此,闭合扳机18的缩回促使闭合扳机18通过销251连接轭250的上部逆时针旋转。轭250的端缘通过销254与第一闭合托架256相连。第一闭合托架256与第二闭合托架258相连。总之,闭合托架256,258限定了开口,近端闭合管40的近端(参见图4)落入并固定在该开口中,使得闭合托架256,258的纵向移动促使近端闭合管40的纵向运动。器械10还包括布置在近端闭合管40内的闭合杆260。闭合杆260可以包括窗口261,在一个手柄外部部件例如所示实施方式中的外部下侧部件59上的柱263布置在所述窗口261内以使闭合杆260与手柄6固定连接。这样,近端闭合管40能够相对于闭合杆260纵向移动。闭合杆260还可以包括装配在远端脊状管46上的凹腔269内的并通过盖271保持在其中的远端凸缘267(参见图4)。
在操作时,当轭250因闭合扳机18的缩回而旋转时,闭合托架256,258促使近端闭合管40向远端移动(也就是远离器械10的手柄6一端),这样促使远端闭合管42向远端移动,从而促使钉砧24绕枢轴点25旋转到夹紧或闭合位置。当闭合扳机18从锁定位置解锁时,促使近端闭合管40向近端滑动,这样促使远端闭合管42向近端滑动,从而通过插入远端闭合管42的开口45内的突舌27促使钉砧24绕枢轴点25枢转到打开或松开位置。这样,通过缩回并锁定闭合扳机18,操作者可以夹紧钉砧24和通道22之间的组织,并且可以在切割/缝合操作之后通过使闭合扳机18从锁定位置解锁来松开组织。
图11是根据本发明不同实施方式的器械10的电路的原理图。当操作者在锁定闭合扳机18之后首先向内拉动击发扳机时,传感器110致动,使电流从中流过。如果常开反向马达传感器开关130打开(意味着端部执行器的冲程还没有结束),电流将流到单级、双投继电器132。由于反向马达传感器开关130未闭合,因此继电器132的线圈134不会被通电,从而继电器132将处于其断电状态。该电路还包括 共同限定联锁电路137的闭锁传感器开关136a-d,当断电时来自继电器132的电流必须经过联锁电路137以电操作马达65起动。每个联锁传感器开关136a-d被构造成分别响应相应状态的出现或缺少而保持打开(也就是非导电)开关状态或闭合(也就是导电)开关状态。在击发器械10时出现的任何相应状态都会导致不符合要求的切割和缝合操作和/或对器械10的损坏。闭锁传感器开关136a-d可以响应的状态包括例如在通道22中缺少钉仓34、在通道22中出现空(例如之前已击发的)钉仓34、以及钉砧24相对于通道22的打开(或未完全闭合)位置。闭锁传感器开关136a-d可以响应的其他状态例如部件磨损可以根据由器械10产生的击发操作的累计次数量进行推断。因此,如果这些状态中的任何状态存在,相应的闭锁传感器开关136a-d都保持打开开关状态,由此防止所需引起马达65操作的电流通过。仅在所有状态都已经得到纠正之后闭锁传感器136a-d才允许电流通过。应当理解,上述状态仅通过举例的方式提出,可以提出另外的闭锁传感器开关以响应对器械10的操作不利的其他状态。同样应当理解,对不存在或不涉及上述一个或多个状态的实施方式来说,闭锁传感器开关的数量可以比所示更少。
如图11所示,可以采用常开开关构造作为闭锁传感器开关136a,使得当钉仓34处于与其由通道22准确收纳相对应的位置时保持闭合开关状态。当钉仓34未安装在通道22内或安装不准确(例如不对准)时,闭锁传感器开关136a保持打开开关状态。
可以采用常开开关构造作为闭锁传感器开关136b,使得仅当通道22内存在未用完的钉仓34(也就是钉仓34具有处于未击发位置的滑块33)时才保持闭合开关状态。在通道22内存在空钉仓34促使闭锁传感器开关136b保持打开开关状态。
可以采用常开开关构造作为闭锁传感器开关136c,使得当钉砧24相对于通道22处于闭合位置时保持闭合开关状态。如下文进一步详细论述的那样,闭锁传感器开关136c可以根据时间延迟特性得到控制,在所述时间延迟特性中仅在钉砧24处于闭合位置预定时间之 后保持闭合开关状态。
可以采用常闭开关构造作为闭锁传感器开关136d,使得仅当由器械10产生的击发累计次数小于预定值时才保持闭合开关状态。如下文进一步详细描述的那样,闭锁传感器开关136d可以与计数器304相连,该计数器304被构造成保存代表器械执行的击发操作累计次数的计数、并将该计数与预定值进行比较、以及根据比较结果控制闭锁传感器开关136d的开关状态。
根据不同实施方式,联锁电路137可以包括一个或多个器械10的使用者可视的指示器,用于显示至少一个闭锁传感器开关136a-d的状态。如图11所示,例如,每个闭锁传感器开关136a-d可以具有绿色LED139a和与其联合的红色LED139b。联锁电路137可以被构造成使得当相应的闭锁传感器开关136a-d分别保持在闭合和打开开关状态时LED139a,b被通电。应当理解,闭锁传感器开关136a-d可以包括一个或多个辅助开关触点(未示出),该辅助开关触点具有适于以上述方式操作LED139a,b的开关构造。
图43A-44C表示根据本发明不同实施方式的联锁电路137的闭锁传感器开关136a-d的安装结构和构造。如图43A所示,闭锁传感器开关136a可以包括布置在通道22的内壁上并与其电绝缘的第一开关触点288a和第二开关触点288b。第一和第二开关触点288a,b的相应位置被设计成使得钉仓34处于与其由通道22准确收纳相对应的位置,钉仓34的导电或半导电部分290(以钉仓34的金属托盘部分作为示例)接触第一和第二开关触点288a,b以在它们之间形成导电通路。在图43B中最清楚地示出,每个开关触点288a,b可以包括圆形外形,从而当钉仓34被通道22收纳时降低对其的机械阻力并且能够与其导电部分290形成确定的电接触。导电部分290因此起作用以将闭锁传感器开关136a保持在闭合开关状态。尽管开关触点288a,b被示出相邻地定位在通道22的侧壁部分上,但应当理解,每个开关触点288a,b大体上可以位于与导电元件290适当的电接触的通道22内的任何位置。还将认识到可以备选地采用常规接触致动的限位开关作 为闭锁传感器开关136a。根据该实施方式,限位开关可以定位成使得钉仓34当由通道22收纳时通过机械方式使限位开关致动,从而保持闭合开关状态。还应当理解,还可以采用常规非接触致动的限位开关例如磁性簧片限位开关或Hall(霍尔)效应接近开关作为闭锁传感器开关136a。根据该实施方式,钉仓34可以包括磁铁,该磁铁适于在安装钉仓34时促使闭锁传感器开关136a保持在闭合开关状态。
在图43B中最清楚地示出,闭锁传感器开关136b可以安装在通道22的内部下表面上。根据不同实施方式并如图所示,可以采用常规设计的适于检测线性移动的接触致动的限位开关作为闭锁传感器开关136b。闭锁传感器开关136b的定向被设计成使得其致动位置从通道22的内部下表面向上延伸。闭锁传感器开关136b在通道22下表面上的位置被设计成使得当安装未用完的钉仓34时,滑块33的底部通过机械方式使闭锁传感器开关136b致动并使得由此保持闭合开关状态。因此,出现未用完的钉仓34(也就是钉仓具有处于未击发位置的滑块33)能够使电流通过闭锁传感器开关136b。应当理解,可以采用非接触致动的开关(例如磁性簧片限位开关或Hall效应接近开关)代替作为闭锁传感器开关136b。对这种实施方式来说,滑块33可以包括磁化部分,该磁化部分例如在滑块33出现在未击发位置时使闭锁传感器开关136b致动。
如图44A所示,闭锁传感器开关136c定位成靠近由通道22的近端限定的一个枢轴凹槽296的远端以接合钉砧24的相应枢轴点25。根据不同实施方式并如图所示,可以采用常规设计的适于检测线性移动的接触致动的限位开关作为闭锁传感器开关136c。然而,应当理解,可以代替地采用非接触致动的限位开关。闭锁传感器开关136c的定向可以被设计成使得其致动部分略微延伸超过相应枢轴凹槽296的远端。当钉砧24相对于通道22处于(如图44A所示)打开位置时,枢轴点25定位在枢轴凹槽296的近端。钉砧24的闭合促使枢轴点25移动到枢轴凹槽296的远端。枢轴点25与闭锁传感器开关136c的致动部分发生的接触促使闭锁传感器开关136c保持闭合开关状态,由 此使电流能够从中通过。
根据其他实施方式并如图44B所示,闭锁传感器开关136c可以代替地被构造成响应电信号而保持闭合开关状态。电信号可以是例如由布置在通道22的下部内表面上的力传感器298产生的模拟信号,该信号代表钉砧24施加的夹紧力的量级。由此可以在模拟信号的量级足够大的情况下推断钉砧24的闭合位置。因而,可以通过比较电路141接收模拟信号,该比较电路141被构造成确定量级是否超过在其中存储的预定阈值。如果超过阈值,表示钉砧24闭合,则比较电路141促使闭锁传感器开关136c保持闭合开关状态,由此使电流能够从中通过。如果模拟信号的量级小于预定阈值,表示钉砧24没有完全闭合,则比较电路141促使闭锁传感器开关136c保持打开开关状态,由此防止电流从中通过。尽管被示为分开,但应当理解,比较电路141可以与闭锁传感器开关136c一体形成以形成共用装置。还应当理解,可以按照需要调节比较电路141存储的预定阈值以反映代表不同切割和缝合操作下钉砧24闭合的力。
在某些情况,需要或要求在钉砧24闭合之后延迟开始击发操作一段时间。例如在夹紧和击发操作之间引入延迟可以起到提高夹紧组织的稳定性的作用。因此,参照图44C,本发明的实施方式可以包括定时器300,其具有预设时间延迟(例如12秒)并被构造成根据钉砧24基于时间的位置控制闭锁传感器开关136c的开关状态。尽管被示为分开,但应当理解,定时器300可以与闭锁传感器开关136c一体形成以形成共用装置(例如接通延迟定时器)。优选地,定时器300采用电子装置,尽管如此,应当理解,可以代替地采用机械定时器。以与图44A相同的方式构造的常开限开关302可以与定时器300相连,使得当钉砧24相对于通道22处于闭合位置时开始定时。当预设时间延迟到时后,定时器300促使闭锁传感器开关136c保持闭合开关状态,由此使电流能够从中通过。定时器300可以响应限位开关302的转换被预设到打开开关状态(也就是当钉砧24处于打开位置时)。应当理解,可以按照需要(例如采用一体的电位计调节)选择性调整 定时器300的预设时间延迟。
再次参照图11,电路可以包括计数器304,其被构造成保存代表由器械10执行的击发操作类似次数的计数并根据该技术控制闭锁传感器开关136d的开关状态。尽管被示为分开,但应当理解,计数器304可以与闭锁传感器开关136d一体形成以形成共用装置。优选地,计数器304采用电子装置,该装置具有输入以根据为其提供的离散电信号的转换增加保存的计数。应当理解,可以代替地采用被构造成根据机械输入(例如击发扳机20的缩回)保存技术的机械计数器。当采用电子装置时,在电路中存在的将每一击发操作转换一次的任何离散信号都可以被用作计数器304的输入。如图11所示,例如,可以利用由冲程结束传感器130的致动引起的离散电信号。计数器304可以控制闭锁传感器开关136d的开关状态,使得当保存的计数小于存储在计数器304内的预定值时保持闭合开关状态。当保存的计数等于预定值时,计数器304促使闭锁传感器开关136d保持打开状态,由此防止电流从中通过。应当理解,可以按照需要选择性地调节计数器304存储的预定值。根据不同实施方式,计数器304可以与显示器305例如LCD显示器相连,所述显示器与器械10结合成一体以向使用者指示保存的计数或者预定值和保存的计数之间的差值。
当闭锁传感器开关136a-d共同保持闭合开关状态时,单极、单投继电器138被通电。当继电器138被通电时,电流流过继电器138,流过可变电阻器传感器110,并通过双极、双投继电器140到达马达65,由此驱动马达65并使其在正向上旋转。由于一旦通电继电器138的输出会将继电器138保持在通电状态直至继电器132被通电,因此联锁电路137在马达65起动时不会防止其操作,即使是在一个或多个闭锁传感器开关136a-d依次保持打开开关状态。然而,在其他实施方式中,可能需要或要求使联锁电路137与继电器138相连,使得一个或多个闭锁传感器开关136a-d必须保持闭合开关状态以在马达165起动时维持其操作。
马达在正向上的旋转促使换84向远端移动并由此停止止动马达 传感器开关142。由于开关142是常闭的,因此螺线管306被通电。螺线管306可以是常规的推式螺线管,其在被通电时促使柱塞(未示出)沿轴向伸长。如下文结合图14-22所论述的那样,柱塞的伸长可以起到将闭合扳机18保持在缩回位置的作用,由此防止钉砧24在击发操作正在进行的同时(也就是开关142不致动的同时)打开。当螺线管306断电时,柱塞缩回使得可以手动释放闭合扳机18。
当端部执行器12冲程结束时,方向马达传感器130将会致动,由此闭合开关130并使继电器132通电。这样促使继电器132表现出其通电状态(在图11中未示出),从而促使电流绕过联锁电路137和变量电阻器110,并且代替地促使电流流到常闭双极、双投继电器140,但以促使马达65旋转方向反向的方式通过继电器140回到马达65。
由于止动马达传感器开关142是常闭的,因此电流将流回到继电器132以保持其通电,直至开关142打开。当刀32完全缩回时,止动马达传感器开关142致动,从而促使开关142打开,由此消除了来自马达65的动力并停止螺线管306。
在其他实施方式中,可以采用开关式传感器代替比例式传感器110。在这些实施方式中,马达65的旋转速率不会与由操作者施加的力成比例。此外,马达65大体上以恒定速率旋转。但由于击发扳机20连接在齿轮传动系内,因此操作者仍然承受受力反馈。
图12是根据另一实施方式的动力辅助的机动内切割器的手柄6的侧视图。图12的实施方式与图7-10类似,除了在图12的实施方式中,不存在与通过螺纹方式连接在斜齿轮鼓轮80上的环84相连的开槽臂90。代替地,在图12的实施方式中,环84包括传感器部分114,其随着环84在斜齿轮鼓轮80上的向下(和向后)前进而与环84一起移动。传感器部分114包括凹口116。反向马达传感器130可以位于凹口116的远端并且止动马达传感器142可以位于凹口116的近端。当环84沿斜齿轮鼓轮80向下(和向后)移动时,传感器部分与其一起移动。此外,如图12所示,中间部件104可以具有延伸到 凹口116内的臂118。
在操作时,器械10的操作者向手枪式握把26方向拉动击发扳机20,运转马达传感器110检测运动并发出信号以驱动马达65,这样尤其是促使斜齿轮鼓轮80旋转。当斜齿轮鼓轮80旋转时,螺纹接合在斜齿轮鼓轮80上的环84前进(或缩回、取决于旋转)。同样,由于击发扳机20向内拉动,促使中间部件104在接合了击发扳机20的正向运动止动件107的作用下与击发扳机20一起逆时针旋转。中间部件104的逆时针旋转促使臂118与环84的传感器部分114一起逆时针旋转,使得臂118保持布置在凹口116内。当环84到达斜齿轮鼓轮80的远端时,臂118将接触并由此脱开反向马达传感器130。同样,当环84到达斜齿轮鼓轮80的近端,臂118将接触并由此脱开止动马达传感器142。如上所述,该动作会使马达65反向并停止。
图13是根据另一实施方式的动力辅助的机动内切割器的手柄6的侧视图。图13的实施方式与图7-10类似,除了在图13的实施方式在臂90上没有槽。代替地,螺纹连接在斜齿轮鼓轮80上的环84包括垂直通道126。取代槽,臂90包括布置在通道126内的柱128。当斜齿轮鼓轮80旋转时,螺纹接合在斜齿轮鼓轮80上的环84前进(或缩回、取决于旋转)。由于柱128布置在通道126内,因此臂90随着环84的前进而逆时针旋转,如图13所示。
如上所述,采用两冲程机动器械时,操作者首先拉回并锁定闭合扳机18。图14和15表示将闭合扳机18锁定在手柄6的手枪式握把26上的方法的一个实施方式。在所示实施方式中,手枪式握把部分26包括由扭簧152偏压以绕枢轴点151逆时针旋转的钩150。同样,闭合扳机18包括闭合杆154。当操作者向内拉动闭合扳机18时,闭合杆154接合钩150的倾斜部分156,由此使钩150向上(或在图14-15中顺时针)旋转直至闭合杆154使倾斜部分156完全进入钩150的凹入口158内,这样将闭合扳机18锁定在适当位置。操作者可以通过下推手枪式握把部分26后部或相对侧的滑动按钮释放部件160来释放闭合扳机18。下推滑动按钮释放部件160使钩150顺时针旋转,使 得闭合杆154与凹入口158脱开。为了防止钉砧24在击发操作正在进行的同时无意中打开,螺线管306可以定位在手枪式握把26内,使得通电时螺线管306的柱塞308容纳在活动按钮释放部件160的相应开口163内。这样,滑动按钮释放部件160锁定在适当位置,从而防止滑动按钮释放部件160的操作直至完成击发操作时柱塞308从开口163中缩回。
图16表示根据不同实施方式的另一闭合扳机锁定机构。在图16的实施方式中,闭合扳机18包括具有箭头部分161的楔部160。箭头部分161由片簧162向下(或顺时针)偏压。楔部160和片簧162可以由例如模制塑料制成。当闭合扳机18缩回时,箭头部分161穿过手柄6的手枪式握把部分26上的开口164。箭头部分161的下斜切表面166接合开口164的下侧壁168,从而迫使箭头部分161逆时针旋转。最后下斜切表面166完全通过下侧壁168,解除对箭头部分161的逆时针力,从而促使下侧壁168滑入箭头部分161后面的凹口170上的锁定位置。
为了使闭合扳机18解锁,使用者向闭合扳机18的相对一侧按下按钮172,从而促使箭头部分161逆时针旋转并且使箭头部分161可以滑出开口164。为了防止钉砧24在击发操作的正在进行的同时无意中打开,螺线管306可以定位在手枪式握把26内,使得通电时螺线管306的柱塞308容纳在由箭头部分161限定的相应开口173内。当容纳在开口173内时,柱塞308起到防止箭头部分161逆时针旋转的作用。这样,使用者可以防止由使用者造成的按钮172的无意操作,直至击发操作完成时柱塞308从开口173中缩回。
图17-22表示根据另一实施方式的闭合扳机锁定机构。如该实施方式所示,闭合扳机18包括柔性纵向臂176,其包括从中延伸的侧销178。臂176和销178可以由例如模制塑料制成。手柄6的手枪式握把部分26包括开口180,侧向延伸的楔部182布置在其中。当闭合扳机18缩回时,销178接合楔部182,并且销178被楔部182的下表面184迫使向下(也就是臂176顺时针旋转),如图17和18所示。当 销178完全穿过下表面184时,解除对臂176的顺时针力,并且销178逆时针旋转,使得销178停在楔部182后面的凹口186内,如图19所示,由此锁定闭合扳机18。销178进一步通过从楔部184延伸的柔性止动件188适当保持在锁定位置。
为了使闭合扳机18解锁,操作者可以进一步挤压闭合扳机18,促使销178接合开口180的倾斜后壁190,从而迫使销178向上经过柔性止动件188,如图20和21所示。销178随后自由向外移动到开口180的上通道192,使得闭合扳机18不再锁定在手枪式握把部分26上,如图22所示。为了防止钉砧24在击发操作正在进行的同时无意中打开,螺线管306可以定位在手枪式握把26内,使得通电时螺线管306的柱塞308容纳在上通道192内。当容纳在上通道192内时,柱塞308起到防止销178从中通过的作用。这样,防止闭合扳机18解锁直至击发操作完成时柱塞308从上通道192中缩回。
图23A-B表示万向接头(“U形接头”)195。U形接头195的第二部件195-2在第一部件195-1所处的水平平面上旋转。图23A表示U形接头195处于线性(180°)定向并且图23B表示U形接头195处于大致150°的定向。U形接头195可以被用在主驱动轴组件的关节运动点14处代替斜齿轮52a-c(例如参见图4)关节运动端部执行器12。图24A-B表示可以被用于代替斜齿轮52a-c和U形接头195以实现端部执行器12的关节运动的扭转电缆197。
图25-31表示根据本发明另一实施方式的具有动力辅助的机动、两冲程外科切割和紧固器械10的另一实施方式。图25-31的实施方式与图6-10类似,除了代替斜齿轮鼓轮80,图25-31的实施方式包括备选的齿轮传动组件。图25-31的实施方式包括带有布置在框架201内的多个齿轮的变速箱组件200,其中所述齿轮在传动轴48的近端连接在行星齿轮72和小齿轮124之间。如下文进一步说明的那样,变速箱组件200通过击发扳机20向使用者提供有关端部执行器12的展开和负载力的反馈。同时,使用者可以通过变速箱组件200向系统提供动力以有助于端部执行器12的展开。在那方面,与以上所述的实 施方式相同,图25-31的实施方式是另一种动力辅助、机动的器械10,其向使用者提供有关切割器械32承受的负载力的反馈。
在所示实施方式中,击发扳机20包括两部分:主体部分202和加强部分204。主体部分202可以由例如塑料制成并且加强部分204可以由更硬的材料例如金属制成。在所示实施方式中,加强部分204靠近主体部分202,但根据其他实施方式,加强部分204可以布置在主体部分202内部。枢轴销207可以穿过击发扳机部件202,204上的开口,并且可以是使击发扳机20绕其旋转的点。另外,弹簧222可以偏压击发扳机20以使其在逆时针方向上旋转。弹簧222可以具有与销224相连的远端,销224与击发扳机20的部件202,204相连。弹簧222的近端可以与手柄外部下侧部件59,60中的一个相连。
在所示实施方式中,主体部分202和加强部分204包括分别在它们上端部分的齿轮部分206,208。齿轮部分206,208如下文说明的那样接合变速箱组件200内的齿轮,以驱动主驱动轴组件并向使用者提供有关端部执行器12展开的反馈。
变速箱组件200如示意性实施方式所示可以包括六个(6个)齿轮。变速箱组件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接合更小的第二齿轮212,更小的第二齿轮212与大的第三齿轮214同轴。第三齿轮214接合更小的第四齿轮216,更小的第四齿轮216与第五齿轮218同轴。第五齿轮218是接合与之配合的90°斜齿轮220的90°斜齿轮(在图31中最清楚地示出),所述斜齿轮220与驱动主驱动轴48的小齿轮124相连。
在操作时,当使用者使击发扳机20缩回时,运转马达传感器(未示出)致动,向马达65提供信号,使其以与操作缩回击发扳机20的程度或力成比例的速率旋转。这样促使马达65以与来自传感器的信号成比例的速度旋转。在该实施方式中未示出传感器,但其可以与以上所述的运转马达传感器110类似。该传感器可以位于手柄6内,使得当击发扳机20缩回时其被压下。同样,可以采用开/关式传感器代替比例式传感器。
马达65的旋转促使斜齿轮66,70旋转,这样促使行星齿轮72旋转,从而通过传动轴76促使齿圈122旋转。齿圈122与小齿轮124啮合,小齿轮124与主驱动轴48相连。因此,小齿轮124的旋转驱动主驱动轴48,从而促使端部执行器12的切割/缝合操作的执行。
小齿轮124的正向旋转又促使斜齿轮220旋转,这样通过变速箱组件200中的其余齿轮促使第一齿轮210旋转。第一齿轮210接合击发扳机20的齿轮部分206,208,由此促使击发扳机20在马达65对端部执行器12提供正向驱动时逆时针旋转(并且在马达65反向旋转以使端部执行器12缩回时逆时针旋转)。这样,使用者通过使用者握紧在击发扳机20上而承受有关端部执行器12负载力和展开的反馈。因此,当使用者缩回击发扳机20时,操作者将承受与端部执行器12承受的负载力相关的阻力。同样,当操作者在切割/缝合操作之后释放击发扳机20使得其能够回到其初始位置时,使用者将承受来自击发扳机20大体上与马达65的反向速度成比例的CW旋转。
还应该指出,在本实施方式中使用者可以(代替来自马达65的力或在其之外)施加力以通过缩回击发扳机20使主驱动轴组件致动(以及由此引起端部执行器12的切割/缝合操作)。也就是说,缩回击发扳机20促使齿轮部分206,208逆时针旋转,这样促使变速箱组件200中的齿轮旋转,由此促使小齿轮124旋转,进而促使主驱动轴48旋转。
尽管在图25-31中未示出,但器械10还可以包括反向马达和止动马达传感器。如上所述,反向马达和止动马达传感器可以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)。可以采用与以上结合图11所述的电路类似的电路适当地驱动马达65。
图32-36表示根据另一实施方式的具有动力辅助的两冲程、机动的外科切割和紧固器械10。图32-36的实施方式与图25-31类似,除了在图32-36的实施方式中击发扳机20包括下部228和上部230。这两部分228,230与穿过每部分228,230布置的枢轴销207相连并绕 其枢转。上部230包括接合变速箱组件200的第一齿轮210的齿轮部分232。弹簧222与上部230相连,使得上部被偏压在顺时针方向旋转。上部230还可以包括下臂234,其接触击发扳机20的下部228的上表面,使得当促使上部230顺时针旋转时下部228也顺时针旋转,并且当下部228逆时针旋转时上部230也逆时针旋转。类似地,下部228包括接合上部230的下台肩的旋转止动件238。这样,当促使上部230逆时针旋转时下部228也逆时针旋转,并且当下部228顺时针旋转时上部230也顺时针旋转。
所示的实施方式还包括向马达65传送信号的运转马达传感器110,在不同实施方式中该运转马达传感器110可以促使马达65以与缩回击发扳机20时操作者施加的力成比例的速度旋转。如在此说明的那样,该传感器110可以是例如变阻器或一些其他可变电阻传感器。另外,器械10可以包括反向马达传感器130,其在由击发扳机20的上部230的正面242接触时脱开或转换。当致动时反向马达传感器130向马达65发送信号以使方向反向。同时,器械10可以包括止动马达传感器142,其在由击发扳机20的下部228接触时脱开或致动。当致动时止动马达传感器142发送信号以停止马达65的反向旋转。
在操作时,当操作者使闭合扳机18缩入锁定位置时,击发扳机20(通过本领域已知机构,包括授予Swayze等人的名称为“包含具有连接齿条传动的击发机构的外科缝合器械(SURGICAL STAPLINGINSTRUMENT INCORPORATING A FIRING MECHANISM HAVINGA LINKED RACK TRANSMISSION)”的美国专利No.6,905,057,该专利在此引入作为参考)略微缩回,使得操作者可以抓紧击发扳机20以引发切割/缝合操作,如图32和33所示。在那时,如图33所示,击发扳机20的上部230的齿轮部分232移动以与变速箱组件200的第一齿轮210啮合。根据不同实施方式,当操作者缩回击发扳机20时,在脱开运转马达传感器110之前,击发扳机20可以小量旋转例如五度,如图34所示。传感器110的致动促使马达65以与操作者施加的缩回力成正比的速率正向旋转。如上所述,马达65的正向旋转 促使主驱动轴48旋转,这样促使端部执行器12上的刀32展开(也就是开始横切通道22)。与主驱动轴48相连的小齿轮124的旋转促使变速箱组件200中的齿轮210-220旋转。由于第一齿轮210与击发扳机20的上部230的齿轮部分232啮合,因此促使上部230逆时针旋转,从而促使下部228也逆时针旋转。
当刀32完全展开时(也就是切割冲程结束),上部230的正面242脱开反向马达传感器130,从而向马达65发送信号以使旋转方向反向。这样促使主驱动轴组件的旋转方向反向以缩回刀32。主驱动轴组件的反向旋转促使变速箱组件200内的齿轮210-22方向反向,这又促使击发扳机20的上部230顺时针旋转,从而促使击发扳机20的下部228顺时针旋转直至上部230的正面242在刀32完全缩回时脱开或致动止动马达传感器142,这样促使马达65停止。这样,使用者承受与通过使用者抓紧在击发扳机20上而产生的端部执行器12的展开相关的反馈。因此,当使用者缩回击发扳机20时,操作者将承受与端部执行器12的展开以及特别是刀32承受的负载力相关的阻力。类似地,当操作者在切割/缝合操作之后释放击发扳机20使得其回到原始位置时,使用者将承受来自击发扳机20、大体上与马达65的反向速度成比例的顺时针旋转力。
还应该指出,在本实施方式中使用者可以(代替来自马达65的力或在其之外)施加力以通过缩回击发扳机20使主驱动轴组件致动(以及由此引起端部执行器12的切割/缝合操作)。也就是说,缩回击发扳机20促使上部230的齿轮部分232逆时针旋转,这样促使变速箱组件200中的齿轮旋转,由此促使小齿轮124旋转,进而促使主驱动轴组件旋转。
上述实施方式采用动力辅助的使用者反馈系统,具有对两冲程、机动的外科切割和紧固器械的自适应控制(例如采用在马达的闭环系统之外的传感器110,130和142、齿轮传动系、以及端部执行器)。也就是说,可以通过击发扳机20(直接或间接)连接在马达65和主驱动轴48之间的齿轮传动系内使使用者在缩回击发扳机20时施加的 力附加在马达65施加的力上。在本发明的其他实施方式中,使用者可以具有有关端部执行器12中的刀32的位置的触觉反馈,但是在击发扳机20未连接在齿轮传动系内的情况下。图37-40表示具有这种触摸位置反馈系统的机动外科切割和紧固器械10。
在图37-40所示的实施方式中,与图32-36所示的器械10类似,击发扳机20可以具有下部228和上部230。然而,与图32-36的实施方式不同的是,器械10不具有与齿轮传动系的部件啮合的齿轮部分。代替地,器械10包括第二马达265,其具有螺纹连接在其上的螺纹杆266。当马达265旋转时,螺纹杆266根据旋转方向沿纵向往复进入和离开马达265。器械10还包括响应主驱动轴48的旋转以将主驱动轴48(或主传动组件的其他部件)增加的角运动译成例如响应系列的数字信号的编码器268。在所示实施方式中,小齿轮124包括与编码器268相连的近端驱动轴270。
器械10还包括控制电路(未示出),其可以采用从编码器268接收数字信号的微控制器或一些其他类型的集成电路。根据来自编码器268的信号,控制电路可以计算端部执行器12中的刀32的展开阶段。也就是说,控制电路可以计算刀32是否完全展开,完全缩回,或处于中间阶段。根据端部执行器12展开阶段的计算结果,控制电路可以向第二马达265发送信号以控制其旋转,由此控制螺纹杆266的往复移动。
在操作时,如图37所示,当闭合扳机18未锁定在夹紧位置时,击发扳机20旋转远离手柄6的手枪式握把部分26,使得击发扳机20的上部230的正面242不与螺纹杆266的近端接触。当操作者缩回闭合扳机18并将其锁定在夹紧位置时,击发扳机20向闭合扳机18略微旋转,使得操作者可以抓紧击发扳机20,如图38所示。在这一位置,上部230的正面242接触螺纹连接杆266的近端。
当使用者随后缩回击发扳机20时,在初始旋转量(例如旋转5度)之后运转马达传感器110可以致动,使得如上所述传感器110向马达65发送信号以使其以与操作者施加在击发扳机20上的缩回力值 成比例的正向速度旋转。马达65的正向旋转通过齿轮传动系促使主驱动轴48旋转,这样促使刀32和滑块33沿通道22移动并切断夹紧在端部执行器12上的组织。控制电路从编码器268接收有关主驱动轴组件增量旋转的输出信号并向第二马达265发送信号以促使第二马达265旋转,从而促使螺纹杆266缩入马达265内。这样可以使击发扳机20的上部230逆时针旋转,从而使击发扳机的下部228也逆时针旋转。这样,由于螺纹杆266的往复移动与主驱动轴组件的旋转有关,因此器械10的操作者通过他/她紧握在击发扳机20上来承受对端部执行器12的位置的触觉反馈。然而,由于在本实施方式中击发扳机20没有连接在齿轮传动系内,因此操作者施加的缩回力并不直接影响主驱动轴组件的传动。
凭借通过来自编码器268的输出信号跟踪主驱动轴组件的增量旋转,控制电路可以计算出刀32完全展开(也就是完全伸出)的时刻。在这时,控制电路可以向马达65发送信号使方向反向以促使刀32缩回。马达65方向反向促使主驱动轴组件的旋转方向反向,这一点也通过编码器268检测。根据编码器268检测刀的反向旋转,控制电路向第二马达265发送信号以促使其反向旋转,使得螺纹杆266开始从马达265纵向伸出。这种运动迫使击发扳机20的上部230顺时针旋转,从而促使下部228也顺时针旋转。这样,操作者可以承受来自击发扳机20的顺时针力,从而向操作者提供对端部执行器12上的刀32的缩回位置的反馈。控制电路可以确定刀32完全缩回的时刻。在这时,控制电路可以向马达65发送信号以停止旋转。
根据其他实施方式,如上所述,可以采用反向马达和止动马达传感器,而不是具有确定刀32的位置的控制电路。另外,可以采用转换开关或传感器,而不是采用比例传感器110控制马达65的旋转。在这种实施方式中,操作者不能控制马达65的旋转速率。而只能是所述马达以预定编程速率旋转。
以上已经结合切割式外科器械描述了本发明的不同实施方式。然而,应该指出,在其他实施方式中在此公开的本发明的外科器械不需 要是切割式外科器械。例如,其可以是非切割内窥镜器械、抓钳、缝合器、夹具施放器、接入装置、药物/基因治疗供给装置、采用超声波、RF、激光等的能量装置。
尽管在此已经结合某些公开的实施方式描述了本发明,但可以对那些实施方式做出许多修改和变形。例如,可以采用不同类型的端部执行器。同时,对于公开的用于某些部件的材料来说,可以采用其他材料。在前描述和之后的权利要求被用于覆盖所有这样的修改和变形。
就是说在此通过参考总体或部分地引入的任何专利、出版物、或其他公开内容引入在此仅仅是达到所引入的材料不与本申请公开的内容中提出现有定义、陈述或其他公开内容相矛盾的程度。同样,在必要的范围内,在此明确提出的内容替代通过参考在此引入的任何矛盾的内容。就是说在此通过参考引入的、但与在此提出的现有定义、陈述或其他公开内容相矛盾的任何内容或其一部分仅仅被引入达到在引入的内容和现有公开内容之间不会产生任何矛盾的程度。
Claims (9)
1.一种外科切割和缝合器械,包括:
端部执行器,其包括:
通道;
可枢转地连接在通道上的钉砧;
可动切割器械,其用于对定位在钉砧和通道之间的物体进行切割;以及
钉仓,其被构造成由通道可移除地收纳,所述钉仓包括在切割冲程期间与所述可动切割器械接合的滑块;
手柄,其包括用于通过主驱动轴组件使所述可动切割器械致动的马达;以及
第一联锁电路,其能够根据钉仓的位置引发马达操作;
第二联锁电路,其用于在所述可动切割器械运动期间防止钉砧相对于通道枢转运动。
2.如权利要求1所述的外科切割和缝合器械,其特征在于,所述第二联锁电路包括机电致动器,其被构造成在所述可动切割器械运动过程中防止钉砧相对于通道打开。
3.如权利要求1所述的外科切割和缝合器械,其特征在于,所述第一联锁电路还能够根据钉砧的位置、滑块在钉仓内的位置、以及所述外科切割和缝合器械执行的操作累计次数中的至少一个引发马达操作。
4.如权利要求3所述的外科切割和缝合器械,其特征在于,所述第一联锁电路包括:
第一开关,其被构造成当钉仓处于与其由通道收纳相对应的位置时,保持第一开关状态;
第二开关,其被构造成当钉砧相对于通道处于闭合位置时保持第二开关状态;
第三开关,其被构造成当滑块位于钉仓内未击发位置时保持第三开关状态;以及
第四开关,其被构造成当操作的累计次数小于预定值时保持第四开关状态;
其中,所述第一、第二、第三、以及第四开关被连接成使得当共同保持相应的第一、第二、第三、以及第四开关状态时,能够引发马达操作。
5.如权利要求4所述的外科切割和缝合器械,其特征在于,所述第一、第二、第三、以及第四开关中的至少一个从接触致动开关和非接触致动开关中选择。
6.如权利要求4所述的外科切割和缝合器械,其特征在于,所述第一开关包括布置在通道内并与通道电绝缘的第一开关触点和第二开关触点,其中,第一和第二开关触点被定位成使得钉仓的一部分在当处于与其由通道收纳相对应的位置时,在第一和第二开关触点之间建立导电通道。
7.如权利要求4所述的外科切割和缝合器械,其特征在于,所述第二开关还能够因钉砧相对于通道处于闭合位置时向第二开关上施加机械力而保持第二开关状态。
8.如权利要求4所述的外科切割和缝合器械,其特征在于,所述第二开关还被构造成响应于电信号而保持第二开关状态,其中,所述电信号表示钉砧处于闭合位置时由钉砧施加的力。
9.如权利要求4所述的外科切割和缝合器械,其特征在于,所述第二开关还被构造成在钉砧已经相对于通道处于闭合位置达预定时间段之后保持第二开关状态。
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2006
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2007
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RU2447850C2 (ru) | 2012-04-20 |
BRPI0701393B1 (pt) | 2018-07-24 |
BRPI0701393B8 (pt) | 2021-06-22 |
RU2007103538A (ru) | 2008-08-10 |
KR20070079050A (ko) | 2007-08-03 |
US7644848B2 (en) | 2010-01-12 |
HK1106419A1 (en) | 2008-03-14 |
CN101133972A (zh) | 2008-03-05 |
EP1813207B2 (en) | 2020-04-08 |
SG134314A1 (en) | 2007-08-29 |
JP2007203057A (ja) | 2007-08-16 |
EP1813207B1 (en) | 2011-04-20 |
ATE556659T1 (de) | 2012-05-15 |
CA2576470C (en) | 2014-10-28 |
BRPI0701393A (pt) | 2007-12-11 |
US20070175956A1 (en) | 2007-08-02 |
EP2272441B1 (en) | 2012-05-09 |
JP4970067B2 (ja) | 2012-07-04 |
EP1813207A1 (en) | 2007-08-01 |
MX2007001305A (es) | 2008-11-18 |
CA2576470A1 (en) | 2007-07-31 |
AU2007200357B2 (en) | 2012-03-15 |
EP2272441A1 (en) | 2011-01-12 |
DE602007013957D1 (de) | 2011-06-01 |
AU2007200357A1 (en) | 2007-08-16 |
ATE506015T1 (de) | 2011-05-15 |
KR101369236B1 (ko) | 2014-03-04 |
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