CN101273879A - 腹腔镜组织厚度和夹钳载荷测量装置 - Google Patents

腹腔镜组织厚度和夹钳载荷测量装置 Download PDF

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CN101273879A
CN101273879A CNA2008100869473A CN200810086947A CN101273879A CN 101273879 A CN101273879 A CN 101273879A CN A2008100869473 A CNA2008100869473 A CN A2008100869473A CN 200810086947 A CN200810086947 A CN 200810086947A CN 101273879 A CN101273879 A CN 101273879A
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C·P·布德罗克斯
E·L·蒂珀曼
L·M·富吉卡瓦
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Abstract

本发明公开了一种腹腔镜组织厚度和夹钳载荷测量装置。本发明的外科器械具有对置的钳口，能够选择性地在打开位置和闭合位置之间运动。各种实施方式包括用于测量夹钳在对置钳口之间的组织厚度。一些实施方式被构造成在确定组织厚度的同时确定施加到组织的压缩力的大小。组织厚度数据显示在器械自身上和/或远离该器械的显示器上。各种实施方式可包括不同类型的外科器械，诸如外科缝合器和抓钳。本发明还公开了带有钳口的钳口结构，所述钳口的形状适于限定对应于物体横截面形状的托架。产生厚度数据的组成元件可被以电或机械方式致动。

Description

腹腔镜组织厚度和夹钳载荷测量装置
技术领域
本申请总体上涉及腹腔镜和内窥镜外科器械，更具体地说涉及能够使医生测量组织厚度和夹钳载荷的内窥镜外科装置和抓持装置。
背景技术
由于较小切口能够减小术后恢复时间和并发症，内窥镜外科器械通常比传统的开放式外科装置更受青睐。因此，适于通过套管针的套管将远端执行器精确地放置在所需外科手术部位的内窥镜外科器械领域已经有了重大发展。这些远端执行器以各种方式(例如内镜切割器、抓钳、切割器、缝合器、夹具施放器、进入装置、药物/基因治疗输送装置、使用超声、RF、激光等的能量装置)接合组织，以获得诊断或治疗效果。
已知的外科缝合器包括能够同时在组织中形成纵向切口并将成排钉施加在切口的相对侧上的端部执行器。所述端部执行器包括一对协作的钳口构件，如果想要将该器械用于内窥镜或腹腔镜应用，所述钳口构件能够穿过套管通道。其中一个钳口构件容纳具有至少两排横向间隔开的钉的钉仓。另一个钳口构件限定砧座，该砧座具有与钉仓中的成排钉对准的钉成形凹槽。该器械通常包括多个往复运动的楔形件，当向远侧驱动时，这些楔形件穿过钉仓中的开口并接合支撑钉的驱动器来向着砧座对钉实施击发。
当在内窥镜手术过程中使用内镜切割器时，医生通常很难确定他们将要切割的组织的厚度。组织的厚度决定了它们所需的钉仓/钉的类型，以便正确地密封切口。通常，医生必须根据监视器上显示的组织视觉观察来确定厚度，或者如果可能的话，使用他们的手来感觉组织的厚度。
已知在腹腔镜手术过程中通常采用的另一种类型的装置是抓钳。这种抓钳通常具有一对对置的钳口，用于在外科手术过程中抓持组织或其它外科器械的一部分。但是，这种抓持装置也缺少用于确定组织厚度的部件。此外，这类抓钳采用的钳口设置通常不适于有效地抓持和操纵在手术中使用的其它外科器械。
因此，非常需要一种腹腔镜装置，其允许医生精确和重复地测量组织厚度，使医生能够选择正确的钉仓来执行切割。还需要抓钳，其具有组织厚度测量能力和能够在其间有效抓持其它外科器械的钳口。
上述讨论仅仅是用于示出本发明所属技术领域目前存在的一些缺陷，而不应认为是对要求保护的本发明的范围的限制。
发明内容
在本发明的一个方面中，提供了一种外科器械，其包括一对对置的钳口，其中至少一个钳口可响应于施加到其上的打开和闭合动作而相对于另一个钳口可选择地运动，以便可选择地在其间夹钳组织。输出发生器与所述一对对置的钳口相联，并且能够产生表示夹钳在一对对置的钳口之间的组织厚度的组织厚度数据或标记。所述外科器械还包括用于在其上显示组织厚度数据或标记的显示器。在各种实施方式中，组织厚度数据或标记可显示在位于外科器械自身上的显示器上或显示在远离所述外科器械的显示器上。
在本发明的各种实施方式的另一个总的方面，提供了一种外科器械，其包括手柄组件和用于执行外科手术操作的端部执行器。所述端部执行器连接到手柄组件并且具有相对置的钳口构件，所述钳口构件用于响应于施加到其上的打开和闭合动作可选择地在其间夹钳组织。闭合驱动器由所述手柄组件支撑并且被构造成产生用于选择性地施加到端部执行器上的打开和闭合动作。所述端部执行器可包括至少一个信号发生器，用于产生对应于夹钳在所述对置的钳口构件之间的组织厚度的信号。所述器械还包括信号处理器，用于从所述信号发生器接收所述信号并计算组织的厚度。此外，显示器与所述信号处理器连通，用于在其上显示组织厚度。
在本发明的各种实施方式的又一个总的方面，提供了一种用于外科器械的钳口结构，其包括第一钳口，该第一钳口可操作地连接到所述外科器械并具有远端和第一夹钳面以及形成于所述第一夹钳面上的至少一个第一结块。所述结构还包括第二钳口，该第二钳口具有远端和第二夹钳面。至少一个第二结块形成于所述第二夹钳面上。所述第二钳口可相对于第一钳口操作地连接到所述外科器械，在打开或闭合动作从外科器械施加到第一和第二钳口中的至少一个上时第一和第二钳口的第一和第二远端可分别选择性地朝向彼此运动或彼此离开，在第一和第二远端朝向彼此运动时，第一和第二远端以及第一和第二结块协作，在其间限定托架区域，其尺寸被设定成适于在其中紧紧地支撑具有特定横截面形状的物体。
在本发明的另一个方面，提供了一种外科器械，其可包括手柄组件和可操作地连接到所述手柄组件的一对对置的钳口。所述对置的钳口可选择性地在打开位置和闭合位置之间运动，以便在其间夹钳组织。所述外科器械还包括闭合驱动器，其由手柄组件可操作地支撑，用于选择性地将打开和闭合动作施加到所述一对对置的钳口上。输出发生器可与所述闭合驱动器协作，以便显示对应于夹钳在一对对置的钳口之间的组织厚度的参考标记。
具体而言，本发明公开了如下内容：
(1).一种外科器械，包括：
一对对置的钳口，其中至少一个钳口能够响应于施加到其上的打开动作和闭合动作而相对于另一个钳口可选择地运动，以便选择性地将组织夹钳在其间；
输出发生器，其与所述一对对置钳口相联，所述输出发生器产生表示夹钳在所述一对对置的钳口之间的组织的厚度的组织厚度数据；以及
显示器，用于在其上显示所述组织厚度数据。
(2).如第(1)项所述的外科器械，其中，所述输出发生器包括：
至少一个应变仪，用于产生对应于夹钳在所述一对对置的钳口之间的组织的组织厚度的应变信号；
处理器，其与所述至少一个应变仪相连通，用于从所述至少一个应变仪接收所述应变信号并产生与之对应的组织厚度数据，并且将所述组织厚度数据传输到所述显示器。
(3).如第(1)项所述的外科器械，其中，所述一对对置的钳口包括：
第一钳口，其尺寸适于在其中可拆卸地支撑仓；
第二钳口，其可动地连接到所述第一钳口，并且能够响应于施加到其上的打开动作和闭合动作而相对于细长通道选择性地在打开位置和闭合位置之间运动，
其中所述输出发生器包括：
测量仓，其能够拆卸地支撑于所述细长通道中；
应变仪，其与所述测量仓相联，用于产生与夹钳在所述测量仓和所述第二钳口之间的组织的组织厚度相对应的应变信号；以及
处理器，其与所述至少一个应变仪相连通，用于从其接收所述应变信号并计算与所述组织厚度相对应的所述组织厚度数据，并且将所述组织厚度数据传输到所述显示器。
(4).如第(3)项所述的外科器械，其中，所述应变仪由所述测量仓支撑，并且具有用于与所述第二钳口接触的可弯曲部分。
(5).如第(3)项所述的外科器械，其中，所述应变仪包括：
第一应变仪，其由所述细长通道支撑，当所述测量仓由所述细长通道支撑时，所述第一应变仪产生与当组织夹钳于所述测量仓的一部分和所述第二钳口之间时经受的压缩载荷的量相对应的第一应变信号，所述第一应变仪与所述处理器相连通，在收到所述第一应变信号时，所述处理器将对应于所述压缩载荷的数据传输到所述显示器；以及
第二应变仪，其由所述测量仓支撑并具有用于在组织被夹钳在所述测量仓的所述部分和所述第二钳口之间时与所述第二钳口接触的可弯曲部分，所述第二应变仪产生与夹钳在所述第一钳口和第二钳口之间的组织的厚度相对应的第二应变信号，所述第二应变仪与所述处理器相连通，在收到所述第二应变信号时，所述处理器产生对应于组织厚度的所述组织厚度数据，并且将所述组织厚度数据传输到所述显示器。
(6).如第(1)项所述的外科器械，还包括：
手柄组件，其支撑所述显示器；
抓钳杆，其由所述手柄组件可操作地支撑并且连接到所述一对对置的钳口，用于将所述打开动作和闭合动作传递到所述一对对置的钳口上，其中所述输出发生器与所述抓钳杆协作，以在所述显示器上显示与夹钳在所述一对对置的钳口之间的组织的厚度相对应的所述组织厚度数据。
(7).如第(6)项所述的外科器械，其中，只有在所述一对对置的钳口向夹钳于其间的组织施加预定量的压缩力，才能在所述手柄组件上观察到标记。
(8).如第(1)项所述的外科器械，还包括：
手柄组件；
抓钳杆，其由所述手柄组件可操作地支撑并且连接到所述一对对置的钳口，用于在可操作地连接到所述手柄组件上的闭合扳机选择性地致动时将所述打开动作和闭合动作传递到所述一对对置的钳口，
其中所述输出发生器包括：
应变仪，其与所述抓钳杆相联，用于在所述抓钳杆将所述闭合动作施加到所述对置的钳口以便将组织夹钳在其间时产生应变信号；以及
处理器，其与所述应变仪相连通，用于从所述应变仪接收所述应变信号并计算对应于所述组织厚度的所述组织厚度数据，并且将所述组织厚度数据传输到所述显示器。
(9).如第(1)项所述的外科器械，其中，所述对置的钳口的形状使其能够在其间容纳具有特定横截面形状的物体。
(10).如第(9)项所述的外科器械，其中，所述一对对置的钳口中的每个钳口均具有远端和从其夹钳面凸出的至少一个结块，在所述对置的钳口朝着彼此运动时，所述远端和结块在其间限定托架区域，该托架区域的尺寸使其能够将具有特定横截面形状的物体紧紧地支撑于其中。
(11).一种用于处理外科器械的方法，所述方法包括：
获取如第(1)项所述的外科器械；
对所述外科器械进行消毒；并且
将所述器械存储在无菌容器中。
(12).一种外科器械，包括：
一对对置的钳口，其中至少一个钳口能够响应于施加到其上的打开动作和闭合动作而相对于另一个钳口可选择地运动，以便可选择地在其间夹钳组织；
与所述一对对置的钳口协作以用于选择性地向所述一对对置的钳口施加所述打开动作和闭合动作的部件；
用于产生与夹钳在所述一对对置的钳口之间的组织的厚度相对应的信号的部件；
用于将所述信号转换成与夹钳在所述一对对置的钳口之间的组织的厚度相对应的组织厚度数据的部件；以及
用于显示所述组织厚度数据的部件。
(13).如第(12)项所述的外科器械，其中，所述用于选择性地向所述一对对置的钳口施加所述打开动作和闭合动作的部件可操作地连接到所述一对对置的钳口和手柄组件上，并且其中所述用于显示的部件由所述手柄组件支撑。
(14).如第(12)项所述的外科器械，其中，所述用于选择性地向所述一对对置的钳口施加所述打开动作和闭合动作的部件可操作地连接到所述一对对置的钳口和手柄组件上，并且其中所述用于显示的部件处于远离所述手柄组件的位置。
(15).一种外科器械，包括：
手柄组件；
用于执行外科手术操作的端部执行器，所述端部执行器连接到所述手柄组件并且具有对置的钳口构件，所述对置的钳口构件用于响应于施加到钳口构件上的打开和闭合动作选择性地将组织夹钳在其间；
由所述手柄组件支撑的闭合驱动器，其被构造成产生所述打开和闭合动作，以便选择性地施加到所述端部执行器；
位于所述端部执行器中的至少一个信号发生器，用于产生与夹钳在所述对置的钳口构件之间的组织的厚度相对应的信号；
信号处理器，用于从所述信号发生器接收所述信号，并且计算组织的厚度；以及
与所述信号处理器连通的显示器，用于在其上显示所述组织厚度。
(16).如第(15)项所述的外科器械，还包括测量仓，所述测量仓包括：
仓主体，其尺寸使其适于被可拆卸地支撑于所述端部执行器中；以及
应变仪，其由所述仓主体支撑并且被构造成在所述仓主体可拆卸地支撑于所述端部执行器中时与所述信号处理器连通，所述应变仪产生与由所述端部执行器夹钳的组织的厚度相对应的应变信号。
(17).如第(16)项所述的外科器械，其中，还包括支撑于所述端部执行器中并且与所述处理器连通的另一个应变仪，所述另一个应变仪产生与施加到由所述端部执行器夹钳的组织上的压缩载荷的量相对应的另一个应变信号。
(18)一种手术方法，包括：
提供如第(16)项所述的外科器械；
将测量仓安装到端部执行器中；
在端部执行器中夹钳待切割和缝合的组织；
在显示器上观察组织厚度；
将组织从端部执行器松开；
将测量仓从端部执行器移开；
选择钉仓，所述钉仓具有用于基于显示在显示器上的组织厚度来缝合组织的钉；
将钉仓安装在端部执行器中；
将组织再次夹钳在端部执行器中；以及
致动钉仓，以切割和缝合夹钳在端部执行器中的组织。
(19)一种用于外科器械的钳口结构，所述钳口结构包括：
第一钳口，该第一钳口可操作地连接到所述外科器械并具有远端和第一夹钳面以及形成于所述第一夹钳面上的至少一个第一结块；以及
第二钳口，该第二钳口具有远端和第二夹钳面以及形成于所述第二夹钳面上的至少一个第二结块，所述第二钳口以可相对于第一钳口操作的方式连接到所述外科器械，在打开或闭合动作从外科器械施加到第一和第二钳口中的至少一个上时第一和第二钳口的第一和第二远端可分别选择性地朝向彼此运动或彼此离开，在第一和第二远端朝向彼此运动时，第一和第二远端以及第一和第二结块协作以在其间限定一托架区域，其尺寸被设定成能够在其中紧紧地支撑具有特定横截面形状的物体。
(20).如第(19)项所述的钳口结构，其中，所述特定横截面形状为圆形。
(21).一种外科器械，包括：
手柄组件；
可操作地连接到所述手柄组件上的一对对置的钳口，所述对置的钳口选择性地在打开位置和闭合位置之间运动，以便在其间夹钳组织；
闭合驱动器，其由手柄组件可操作地支撑，用于选择性地将打开和闭合动作施加到所述一对对置的钳口上；以及
输出发生器，能够与所述闭合驱动器协作，以便显示与夹钳在所述一对对置的钳口之间的组织的厚度相对应的参考标记。
(22).如第(21)项所述的外科器械，其中，只有在所述一对对置的钳口向组织施加预定大小的夹钳载荷，对应于组织厚度的所述参考标记才能够被观察到。
(23).如第(21)项所述的外科器械，还包括锁定构件，用于选择性地将对置钳口锁定就位。
(24).如第(21)项所述的外科器械，其中，所述输出发生器被机械地致动。
参照附图及其说明，本发明的这些和其他目的以及优点将会非常清楚。
附图说明
包含于本说明书中并构成其一部分的附图解释了本发明的实施方式，并与上面给出的本发明的总体说明和下面给出的实施方式的详细描述一起用于解释本发明的原理。
图1是本发明各种实施方式的外科缝合和切割器械的立体图；
图2是本发明的端部执行器的实施方式的左侧立体图；
图3是图2的端部执行器的剖视图，其中一部分组织夹钳在砧座和组织测量仓之间；
图4是图3的端部执行器沿着图3中的线4-4截取的剖视图；
图5是本发明各种实施方式的应变仪和操作系统设置的示意图；
图6是本发明另一端部执行器的实施方式的剖视图，其中组织夹钳在砧座和组织测量仓之间；
图7是本发明另一实施方式的应变仪和操作系统设置的示意图；
图8是本发明抓钳的实施方式的侧剖视图，其中左侧手柄外壳被移除，以显示出支撑于手柄组件中的各组成元件；
图9是在图8所示抓钳实施方式中采用的抓钳杆设置的一部分的分解组装图；
图10是图8所示抓钳实施方式的各组成元件的示意图，其中其钳口处于打开位置；
图11是图8所示抓钳实施方式的各组成元件的另一示意图，其中在其钳口之间夹钳了一部分组织；
图12是图8所示抓钳实施方式的各组成元件的又一示意图，其中其钳口处于完全闭合位置；
图13是本发明抓钳的另一实施方式的右侧剖视图；
图14是本发明其他实施方式的钳口设置的侧视图；
图15是本发明另一外科器械实施方式的侧视图；
图16是图15所示外科器械的一部分的分解组装图；
图17是图15和16所示外科器械的手柄组件的剖视图，其中为了清楚起见一些组成元件以实线示出；
图18是处于完全闭合并且锁定位置的图15-17的外科器械的剖视图，其中为了清楚起见一些组成元件以实线示出；
图19是处于完全打开位置的图15-18的外科器械的另一剖视图，其中为了清楚起见一些组成元件以实线示出；
图20是处于完全闭合位置的图15-19的外科器械的又一剖视图，其中释放扳机处于完全压下位置，并且为了清楚起见一些组成元件以实线示出；
图21是处于组织夹钳位置的图15-20的外科器械的另一剖视图，其中为了清楚起见一些组成元件以实线示出；
图22是处于医生向组织施加过大夹钳力的位置的图15-21的外科器械的剖视图，其中为了清楚起见一些组成元件以实线示出；以及
图23是处于组织夹钳位置的图15-22的外科器械的另一剖视图，其中使用者能够读取对应于被夹钳组织的厚度“t”的参考标记。
具体实施方式
下面将说明一些示例性实施方式，以提供对在此披露的装置的结构、功能、制造和使用的原理以及方法的原理的全面理解。这些实施方式的一种或多种实例在附图中示出。本领域技术人员将会理解，在此具体描述并且在附图中示出的装置和方法是非限制性的示例性实施方式，并且本发明的各种实施方式的范围仅由权利要求限定。就一种示例性实施方式示出或描述的特征可与其它实施方式的特征结合。这些变型和改变也包括在本发明的范围内。
本发明总体上涉及用于测量在内窥镜和腹腔镜手术过程中被切割或以其他方式操作的组织的厚度的方法和装置。在一种示例性实施方式中，所述测量装置可与用于切割和缝合组织的内镜切割器一起使用。这种内镜切割器通常包括带有对置钳口的端部执行器，所述对置钳口适于在其间接收目标组织。如就一种示例性实施方式描述的那样，端部执行器通过细长轴组件连接到手柄组件。所述手柄组件配备有闭合扳机，其能够使医生可选择地打开或闭合端部执行器的钳口。所述端部执行器还配备有击发驱动系统，用于驱动刀穿过钉仓和夹钳的组织，并且同时驱动容纳在钉仓中的钉与砧座成形接触。另一种示例性实施方式包括一种外科装置，其具有一对对置的钳口，用于简单地操作和抓持组织、其它外科器械等。
随着本具体实施方式部分的继续，本领域技术人员将会理解，此处描述的外科器械可具有多种构造，此处披露的本发明的各种实施方式的多种组织测量特征的一种或多种可成功地用于本领域已知的各种不同的抓持装置/端部执行器，用于抓持/操纵组织或其它物体。因此，此处使用的术语“外科器械”旨在包括具有能够靠拢到一起进行抓持、夹钳、切割、解剖、缝合等的对置的可动钳口的任何装置。
参照附图，其中相同的附图标记在全部附图中表示相同的组成元件，图1和2示出了能够实现本发明的各种独特优点的外科缝合和切割器械10的一种实施方式。所述外科缝合和切割器械10包含有端部执行器12，端部执行器12具有第一钳口14和第二钳口16。在各种实施方式中，第二钳口16可包括细长通道17，并且第一钳口14可包括砧座15，该砧座15可枢转地连接到细长通道17，从而形成相对置的钳口，用于夹钳待切割和缝合的组织。本领域技术人员将会理解，附图中示出的示例性内镜切割器实施方式包括一种本发明各种实施方式可成功地采用的内镜切割器形式。但是，本发明各种实施方式可与多种不同的内镜切割器器械一起使用。例如，本发明各种实施方式可与如下的外科器械一起使用，这些器械公开于Shelton，IV等人的名称为“Surgical Stapling Instrument Incorporatingan E-Beam Firing Mechanism”的美国专利No.6978921，该文献的内容通过引用结合入本文。
如图1所示，端部执行器12可通过细长轴组件18连接到手柄组件20。由端部执行器12和轴组件18形成的执行部分22可具有有利的尺寸，以便通过套管针或小的腹腔镜开口插入，从而在由抓持手柄组件20的医生控制的同时执行内窥镜外科手术。手柄组件20可包括这样一些元件，它们允许分开的闭合动作和击发动作、锁定，以便防止端部执行器的无意中或不当的击发，以及能够进行多击发冲程，以便使端部执行器12击发(即，切割和缝合)同时向医生指示击发程度。
为此，轴组件18的闭合管24可连接到闭合扳机26(图1)和砧座15之间，以使端部执行器12闭合。在闭合管24中，框架28可连接到细长通道17和手柄组件20之间，以便沿纵向定位和支撑端部执行器12。旋钮30可与框架28连接，并且它们都可旋转地连接到手柄组件20。因此，医生可通过使能够引起闭合管24转动的旋钮30旋转来转动端部执行器12。框架28与击发杆32一起延伸穿过闭合管24，击发杆32被定位成用于纵向运动并且可操作地连接到击发扳机34。在图1所示的实施方式中，闭合扳机26位于手柄组件20的手枪式握把36的远侧，并且击发扳机34位于手枪式握把36和闭合扳机26的远侧。
应当理解，此处使用的术语“近侧”和“远侧”是参照抓持器械手柄的医生而言。因此，端部执行器12相对于更近侧的手柄组件20而言位于远侧。功能相同的术语诸如“前侧”和“后侧”类似地分别对应于远侧和近侧。还应当理解的是，为了方便和清楚起见，此处使用的空间术语诸如“竖直”、“水平”、“上”和“下”是参照附图而言。但是，外科器械可以多种方向和位置使用，这些术语并不是限制性的和绝对的。
本发明是就内窥镜手术和设备来讨论的。但是，此处使用的术语诸如“内窥镜”不应被解释为将本发明限制为仅与内窥镜管(即套管针)一起使用的外科缝合和切割器械。相反，应理解，本发明可应用于进入被限制于小切口的任何手术中，包括但不限于腹腔镜手术以及开放式手术。
特别参照图3，砧座15通过一对横向伸出的砧座枢销54可枢转地连接到细长通道17，所述枢销54位于竖直伸出的砧座元件56(图4)近侧。砧座枢销54在细长通道17的肾形开口58中移动，以便相对于细长通道17打开或闭合砧座15。砧座元件56与凸片59(图1)接合，该凸片59在闭合管24的远端62上的凸片孔60中向内延伸。因此，当闭合管24从其打开位置向近侧运动时，闭合管24的凸片59向近侧拉动砧座元件56，并且砧座枢销54随着细长通道17的肾形开口58运动，导致砧座15同时向近侧移动和向上转动到打开位置。当闭合管24向远侧运动时，凸片孔60中的凸片59从砧座元件56松开，并且远侧边缘64推压砧座面50，由此闭合砧座15。
应当理解，尽管此处示出的是非关节运动型轴组件18，但是本发明的应用可包括能够进行关节运动的器械，诸如以下三个共同拥有美国专利和两个共同拥有的美国专利申请中公开的那些器械：(1)于2006年9月26日授权给Kenneth S.Wales，Douglas B.Hoffman，Frederick E.Shelton IV和Jeffrey S.Swayze的名称为“SurgicalInstrument Incorporating An Articulation Mechanism Having RotationAbout the Longitudinal Axis”的美国专利No.7111769；(2)于2006年1月3日授权给Kenneth S.Wales的名称为“Surgical InstrumentWith A Lateral-Moving Articulation Control”的美国专利No.6981628；(3)于2006年6月6日授权给Frederick E.Shelton IV，Michael E.Setser，William B.Weisenburgh II的名称为“Surgical StaplingInstrument Incorporating A Tapered Firing Bar For Increased FlexibilityAround The Articulation Joint”的美国专利No.7055731；(4)由KennethS.Wales和Joseph Charles Hueil于2003年7月9日提交的申请号为No.10/615971、美国专利公开号为No.2005/0006429的名称为“Surgical Stapling Instrument Having Articulation Joint Support PlatesFor Supporting A Firing Bar”的申请；以及(5)由Brain J.Hemmelgarn于2003年7月9日提交的申请号为No.10/615962的名称为“SurgicalStapling Instrument Incorporating An Articulation Joint For A FiringBar Track”的申请。这些文献的全部内容通过引用而结合入本文。但是，本领域技术人员应当理解，在不脱离本发明的精神和范围的情况下，本发明各种特征的独特和新颖的方面可与其他类型的关节运动型外科器械一起使用。
参照图2和3，细长通道17被构造成在其中可拆卸地容纳厚度测量仓100。厚度测量仓100可类似于传统的钉仓。但是，厚度测量仓100没有钉和钉击发驱动器，并且还至少以如下所述的方式不同于传统钉仓。特别是，厚度测量仓100的主体部分102可具有形成于仓100的远端101上的直立的夹钳结块110。所述夹钳结块110可在仓100的远端101上如此定位：当仓100安装在细长通道17中时，夹钳结块110位于安装在细长通道17内的传统的第一应变仪120上方。第一应变仪120的目的将在下面进行详细讨论。
仍然如图2和3所示，厚度测量仓100还可包括安装在仓主体102内的厚度或砧座探头130。更具体地说，如图3所示，砧座探头130可包括第一部分132和可弯曲的第二部分134，所述第一部分132安装在仓主体102内，并且可弯曲的第二部分134从仓主体102向上突出，接触砧座15的下侧19。砧座探头130可由金属或其他适合的材料制造，并且与安装在仓主体102中的第二应变仪140相联。第一应变仪120和第二应变仪140可分别连接到电池或其他的电源150、放大器152、数模转换器154、传统的中央处理单元“CPU”156和显示单元158。电池150、放大器152、转换器154、CPU 156和显示单元158可容纳在手柄组件20内。每个应变仪可以具有自身的放大器。第一应变仪120和第二应变仪140、电源150、放大器152、转换器154、CPU 156可共同形成总体上用附图标记118代表的输出发生器。在替代的实施方式中，CPU 156也可连接到无线信号发生器160，该无线信号发生器160用于将厚度数据传递到远程(即不由手柄组件20支持)监视器162。见图5。测量仓100可形成有销和槽连接件(未显示)，以便第二应变仪140和细长通道17内的导体之间的电联通，所述导体延伸通过轴18并且最终连接到CPU 156和/或电源150。
下面将参照图1、3、4和5说明本发明各种实施方式的厚度测量仓100的操作。在将传统的钉仓安装到细长通道17中之前，医生可首先将厚度测量仓100安装到细长通道17中。厚度测量仓100可设置有常见于传统钉仓的保持元件，以便将厚度测量仓100可拆卸地保持在细长通道17中。当被安装时，销和槽连接器或其他设置可将第二应变仪140连接到电源150和放大器152。
在腹腔镜和内窥镜外科手术中，在患者身体上形成小切口或穿孔，以便为管或套管装置提供进入口。一旦延伸到患者体内，套管允许各种外科器械插入来执行手术。在医生将厚度测量仓100安装在细长通道17中之后，医生可然后将执行部分22插入穿过套管(未显示)，从而使待切割组织“T”的一部分T’定位在砧座15的下侧19和厚度测量仓100之间。见图3。然后医生可使闭合扳机26向着手枪式握把36运动，以便以已知的方式运动闭合管24，从而沿着闭合方向枢转砧座15。随着砧座15沿着闭合方向枢转，待切割组织“T”的一部分被夹钳在结块110和砧座15的下侧19之间。如可从图3和4最清楚看出的，枢轴突起104可以形成于仓主体102的下侧上，靠在细长通道17的底部，从而由此使仓主体102在其上枢转。
当砧座15开始将组织“T”夹钳在结块110和砧座15的下侧19之间时，第一应变仪120置于载荷下并且可用作电阻器，当载荷施加到第一应变仪120上时，第一应变仪120对来自电源150的供电增加或减少一定量的电阻。放大器152放大来自第一应变仪120的信号，并将放大的信号输送到数模转换器154，数模转换器154将原始电流转化成数字数据。然后数字数据被发送到CPU 156，CPU 156编译数字数据并且以数学方法将数据转换成由手柄显示器158显示的第一大小的应变或载荷，和/或发送到无线信号发生器160，其将数据以无线方式传递到远程监视器162。见图5。医生继续闭合砧座15，直到显示器表明位于第一和第二钳口14、16之间的组织“T”已经被以预定大小的夹钳载荷夹紧。例如，预定大小的夹钳载荷或力可以是8克。这种力例如不会损坏组织“T”，但是可提供用于重复性目的的参考点。
当砧座15正在被闭合时，砧座15的下侧19开始向砧座探头130施加载荷，这传递到位于仓100内的第二应变仪140。放大器152放大来自第二应变仪140的输出信号并将放大的信号输送到数模转换器154，将原始电流转化成数字数据。然后数字数据传递到CPU156，CPU 156编译数字数据并且以数学方法将数据转换成由手柄显示器158显示的组织厚度，和/或发送到无线信号发生器160，用于传递到远程监视器162。在医生已经确定待切割组织的厚度“t”时，缩回执行部分22，以便用适当的钉仓替换厚度测量仓100。然后可将厚度测量仓100消毒，用于下一手术或者简单地将之丢弃。
在图6和7所示的替代实施方式中，厚度测量仓100’没有如上所述包括在厚度测量仓100中的结块和第一应变仪。该实施方式可仅配备有应变仪140’。因此，在该实施方式中，输出发生器118’可包括电源150、应变仪140’、放大器152、转换器154和CPU 156。否则，仓100’可与仓100大致相同。图7是应变仪140’和CPU 156之间的接口的示意图。在该实施方式中，CPU 156采用一种算法，在显示器上显示最终载荷读数或计算的组织厚度“t”之前，其比较一段时间内的应变值并且等待直到在期望时间增量δ内的应变不再变化。此外，开关164(机械或电启动)与夹钳扳机26相联，用于检测夹钳扳机26的位置。开关164可与CPU 156通信，使得CPU 156在夹钳扳机26到达预定位置之前不会处理应变载荷。
图8-12示出了抓钳302形式的另一种外科器械300，其可采用本发明各种实施方式的各种独特和新颖特征。这种抓钳302在本领域是已知的，因此在此不再超出全面理解和领会本发明各种实施方式的需要来具体讨论已知的特征。这种装置的例子见Measamer等人的美国专利No.6117158和Measamer等人的美国专利No.5735874，上述文献的内容通过引用结合入本文。
如图8所示，抓钳302包括端部执行器312，端部执行器312具有第一钳口314和第二钳口316，它们可操作地安装到从手柄组件320的远侧伸出的抓钳杆400。如已知的，抓钳杆400的近侧部分402可旋转地支撑在手柄组件320内，并且连接到可旋转地支撑在手柄组件320上的旋钮330。这种设置允许医生相对于手柄组件320转动抓钳杆400(以及钳口314、316)。如图8所示，抓钳杆400延伸穿过闭合管324，闭合管324也从手柄组件320伸出。
如本领域已知的，钳口314和316可枢转地连接到抓钳杆400的远端404，并且可通过弹簧结构(未显示)保持在图8所示的打开位置。随着抓钳杆400响应于连接到手柄组件320的闭合扳机326的致动而沿着近侧方向被拉动，当钳口314和316的相应近端315、317与闭合管324的远端325接触时，钳口314和316闭合。如图8所示，闭合扳机326可枢转地安装在枢轴杆328上，以便选择性地围绕枢轴杆328枢转运动。闭合扳机326具有与之连接的弧形随动臂340，随动臂340受到限制，当闭合扳机326在图8所示的打开位置和其中闭合扳机326的近端327基本上靠近手柄组件320的抓持部分336的闭合位置之间枢转时，随动臂340沿着弧形路径在手柄组件320内枢转。闭合弹簧342支撑于手柄组件320内，并且被布置成与随动臂340的远端接合，以便将闭合扳机326偏压到打开位置。在各种实施方式中，抓钳302还可以包括将闭合扳机326以及最终将钳口314和316锁定在特定夹钳位置的锁定扳机组件350。这种锁定扳机组件350的结构和操作在本领域中是已知的，因此在此不再详细描述。
如图8所示，抓钳302设置有总体上标记为500的输出发生器。在各种实施方式中，输出发生器500可包括弧形臂504形式的第一齿轮502，其具有形成于远端506的一组齿轮齿510。近端508连接到闭合扳机326。齿轮齿510设置成和与曲杆530不可转动连接的闭合或第二齿轮520的齿啮合。第二齿轮520可转动地支撑于手柄壳体320内的第二枢轴杆514上。如图8所示，曲杆530的远端532上形成有一组曲杆齿534，近端536上形成有定位片538。由此，通过朝着抓持部分330枢转闭合扳机326，曲杆530如图8所示沿着顺时针方向“CW”旋转。
还是在本实施方式中，在抓钳杆400的一部分上形成有一组环550。环550位于抓钳杆400上，用于选择性地接合曲杆齿534。还邻近最近侧环550形成凸缘552。如图8和9所示，抓钳杆400的近端410可通过连接臂组件570连接到基准标度臂560。如上所述，医生可能希望相对于手柄组件320旋转抓钳杆400，以便精确地定位钳口314和316。因此，在各种实施方式中，抓钳杆400的近端410可通过总体上标记为580的万向接头型关节组件连接到连接臂组件。如图9所示，万向接头型关节组件580可包括卡圈582，其具有从其凸出的两个周向相对的枢销584、586。卡圈582由抓钳杆400的肩部412接收，并通过螺纹连接到抓钳杆400的近端410上的螺钉414保持在肩部412上，如图所示。本领域技术人员应当理解，这种设置用于允许抓钳杆400在连接到卡圈582上的同时在其中自由地转动。
如图9所示，连接臂组件570可包括可枢转地连接到右枢销584上的右连接臂572和连接到左枢销586上的左连接臂574。右连接臂572的近端573和左连接臂574的近端575可通过枢销590可枢转地连接到标度臂560。因此，这种设置使得抓钳杆400连接到标度臂560，同时允许抓钳杆400相对于标度臂560自由转动。在各种实施方式中，标度臂560的下端562通过枢销564可枢转地连接到手柄外壳321，从而使标度臂560与抓钳杆400同步地枢转。
如图8所示，标度臂560的下端562也可连接到载荷施加组件600上。在各种实施方式中，载荷施加组件包括销610，其尺寸设定成可在形成于手柄外壳321中的腔323内轴向运动。测量弹簧612位于腔323内，用于沿着远侧方向“DD”偏压销610。如下面进一步讨论的，测量弹簧612的尺寸可被设置成施加8克或其它预定载荷，以便在闭合扳机326枢转到一定位置时闭合钳口314和316。销614的远端通过销620可枢转地连接到标度臂560上，其中销620容纳在形成于标度臂下端的细长槽563中。见图10-12。如图所示，基准标度尺566可连接到标度臂560的上端或形成于其上。基准标度尺566可设有参考标记568，其目的将在下面进一步讨论。还是在图8所示的实施方式中，护罩630可从曲杆530伸出。护罩630可具有贯穿的第一参考窗口632。此外，还穿过手柄外壳321设置窗口329，用于使医生读取基准标度尺566上的与窗口对准的参考标记568。见图10。
图10-12示意性地示出了一种操作方法，参照图10-12可进一步了解抓钳302的操作。图10示出了示意性的抓钳302，其中钳口314、316处于完全打开位置。当处于该位置时，闭合弹簧342偏压闭合扳机326离开抓持部分(图10中未示出)。可相对于测量弹簧612设置闭合弹簧342的尺寸，使得闭合弹簧342强于测量弹簧612，从而在抓钳302未被致动时使闭合扳机326枢转到打开位置。在图10中，闭合弹簧342沿着逆时针方向“CCW”偏压闭合扳机326。如图8和10所示，当抓钳杆400处于完全打开位置时，曲杆530上的曲杆齿534均未与抓钳杆400上的任何环550接合，并且曲杆530上的定位片538与抓钳杆400上的凸缘552接触。此外，护罩630的端部在基准标度尺566和手柄外壳321中的观察窗口329之间延伸，从而使医生在透过窗口329观察时只能看到护罩630；在窗口329不能看到任何参考标记568。
图11示出了使用示意性抓钳302测量组织“T”的厚度“t”。如图所示，已经抵抗闭合弹簧342的闭合力沿着逆时针方向CCW拉动闭合扳机326，以便使曲杆530沿着顺时针方向CW旋转，从而使定位片538与抓钳杆400上的凸缘552脱离接合。当定位片538已经与凸缘552脱离接合时，通过标度臂560使抓钳杆400沿着近侧方向“PD”运动。特别的，通过销610使标度臂560的下端562沿着远侧方向运动，这使得标度臂560围绕枢销564枢转，并且沿着近侧方向“PD”拉动抓钳杆400。随着测量弹簧612的膨胀，销610与槽563中的标度臂560的接合位置发生变化——从枢轴杆564运动得更远。因此，随着测量弹簧力的减小(由于测量弹簧612的扩张)，标度臂560的机械利益增加，以保持抓钳钳口314和316的恒定载荷。随着抓钳杆400沿近侧方向“PD”运动，导致钳口314和316闭合在组织“T”上。在各种实施方式中，测量弹簧612的尺寸被设置成将预定大小的夹钳载荷施加到组织“T”上。例如，在一种示例性实施方式中，测量弹簧612的尺寸被设置成向组织“T”施加大约8克的闭合载荷。
当仅仅在测量弹簧612的夹钳载荷下组织“T”已被夹钳在钳口314和316之间时，一个相应的参考标记568将与手柄外壳321的观察窗口329对准。然后医生可定位闭合扳机326，使得曲杆530和护罩630运动到使护罩630的观察窗口632与观察窗口329对准的位置，从而允许医生通过观察窗口632与观察窗口329观察参考标记568，如图11所示。当处于该位置时，曲杆530不影响抓钳杆400的位置。抓钳杆400的位置仅仅由标度臂560上的测量弹簧612以上述方式影响来控制。因此，当处于该位置，并且组织“T”在预定载荷下被夹钳在钳口314、316之间时，医生观察与组织“T”的厚度相关联的参考标记568。本领域技术人员应当理解，测量弹簧和测量杆可被构造/校准，使得参考标记568对应于所述载荷下夹钳的组织“T”的厚度。
图12示出了当医生完全闭合钳口314、316，且其间未夹钳任何组织时各种抓钳组成元件的位置。如图所示，医生已经将闭合扳机326拉动到这样的位置，在该位置，测量弹簧612偏压标度臂560，以便将抓钳杆400沿着近侧方向“PD”拉动很远，足以使钳口314、316完全闭合。当医生松开闭合扳机326时，强于测量弹簧612的闭合弹簧342将闭合扳机326偏压到打开位置。当闭合扳机326转到打开位置时，使得曲杆530沿着图12中的逆时针方向(CCW)枢转，使得定位片538与抓钳杆400上的凸缘552接合，以便沿着远侧方向“DD”驱动抓钳杆400，直到抓钳杆400到达打开位置(图10)。
因此，抓钳302的各种实施方式可以如下方式使用。医生最初闭合钳口314、316，使得执行部分322通过套管或其它开口插入。在将执行部分322插入患者体内后，医生松开闭合扳机326以允许钳口314、316打开。然后医生操作器械，直到目标组织“T”定位在钳口314、316之间。然后通过朝向手柄组件320的抓持部分336压下闭合扳机326来将钳口314、316闭合在目标组织“T”上。随着医生继续压下闭合扳机326，他/她能够观察手柄组件320中的观察窗口329，直到对应于预定夹钳载荷下组织厚度的参考标记568可见。进一步压下闭合扳机326将借助曲杆530上的齿534与抓钳杆400上的一个或多个环550的接合而沿着近侧方向“PD”进一步拉动抓钳杆400，并且由此继续向组织“T”施加夹钳力。但是，在这样做时，曲杆530和护罩630的运动导致护罩630的观察窗口632运动，不与手柄外壳321的观察窗口329对准。因此，在组织“T”置于大于所需预定夹钳载荷的夹钳载荷下时医生不能观察参考标记568。如果医生希望获得厚度读数，他/她必须简单地开始松开闭合扳机326，直到护罩630的观察窗口632再次与手柄外壳的观察窗口329对准，以便允许观察参考标记。
图13示出了抓钳702形式的另一种外科器械700，其可采用本发明各种实施方式的各种独特和新颖特征。在该实施方式中采用了传统抓钳设置。这种抓钳702可包括端部执行器712，端部执行器712具有第一钳口714和第二钳口716，它们可操作地安装到从手柄组件720向远侧伸出的抓钳杆800。如已知的，抓钳杆800的近侧部分802可旋转地支撑在手柄组件720内，并且连接到可旋转地支撑在手柄组件720上的旋钮730。这种设置允许医生相对于手柄组件720转动抓钳杆800。仍如图13所示，抓钳杆800延伸穿过闭合管724，闭合管724也从手柄组件720伸出。
如本领域已知的，钳口714和716可枢转地连接到抓钳杆800的远端804，并且可通过弹簧设置(未显示)保持在图13所示的打开位置。随着抓钳杆800响应于连接到手柄组件720的闭合扳机726的致动而沿着近侧方向被拉动，当钳口714和716的相应近端715、717与闭合管724的远端725接触时，钳口714和716闭合。闭合扳机的结构和操作及其与抓钳杆800的相互作用在本领域中是已知的，因此在此不再详细描述。
但是，在各种实施方式中，应变仪900可被定向，以便与抓钳杆800相互作用，使得在通过压下闭合扳机726而沿着近侧方向“PD”运动抓钳杆时由应变仪900测量抓钳杆800上的应变。如图14所示，应变仪900连接到电池或其他的电源910、放大器912、模数转换器914、传统的中央处理单元“CPU”916和显示单元918。在各种实施方式中，应变仪900、电源910、放大器912、转换器914和CPU916可称作总体上用附图标记930表示的输出发生器。在替代的实施方式中，CPU 916也可连接到无线信号发生器920，该无线信号发生器920用于将厚度数据传递到远程监视器922。
在该实施方式中，CPU 916采用一种算法，在显示器上显示最终载荷读数或计算的组织厚度“t”之前，其比较一段时间内的应变值并且等待直到应变在给定增量δ内不再变化，例如小于1％至2％的变化。这种变化可从原始电压(raw voltage)(应变仪用作电阻器，以根据应变仪所受应力、拉力或压力的大小来修正电压)、数据从电压转化成应变之后的偏差、或者在应变转化成厚度时的组织厚度中测量。此外，开关(机械或电启动)与夹钳扳机相联，用于检测夹钳扳机的位置。开关可与CPU通信，从而CPU在夹钳扳机到达预定位置之前不会处理应变载荷。
在图14中示出了本发明的各种实施方式的另一特征。特别的，图14示出了钳口710、712，它们可与此处描述的任何抓钳实施方式一起使用，或者与其它传统抓钳设置一起使用，所述其它传统抓钳设置可有利地抓持和操纵其它外科器械，诸如内镜切割器等。在图15所示的实施方式中，第一钳口710可具有夹钳面711和向下弯曲的远端712。第二钳口720具有夹钳面721和向上弯曲的远端722。略微弯曲的结块714可形成于第一钳口710的夹钳面711上，并且另一略微弯曲的结块724可形成于第二钳口720的夹钳面721上。在该实施方式中，结块714、724可被定向和成形为与第一钳口710和第二钳口720的相应远端712、722协作，以便形成总体上表示为730的托架，用于接收和支撑大致为圆形横截面的外科器械750的一部分。这种设置用于提供外科器械750在第一钳口710和第二钳口720内的刚性支撑，并且使医生能够使用抓钳精确地操纵器械750。本领域技术人员应当理解，在本发明的其它实施方式中，结块的尺寸、形状和数量可变，和/或钳口的远端可具有不同的形状，以便更好地形成对应于将要抓持在钳口之间的器械的横截面形状的托架。因此，产生这些实施方式的范围和保护不应限于使用如图14所示的具有特定形状的两个结块。
图15-23示出了抓钳1002形式的另一种外科器械1000，其可采用本发明各种实施方式的各种独特和新颖特征。在各种实施方式中，抓钳1002可包括端部执行器1012，端部执行器1012具有第一钳口1014和第二钳口1016，它们可操作地安装到从手柄组件1020向远侧伸出的抓钳杆1100上。见图19。抓钳杆1100轴向地容纳于管1024中，管1024可旋转地连接到手柄组件1020。旋钮1030如图19所示可旋转地连接到手柄组件1020并且连接到管1024，这样旋钮1030相对于手柄组件1020的旋转可导致端部执行器1012相对于手柄组件1020的旋转。钳口1014、1016通过相应的连杆1106、1108可枢转地连接到抓钳杆1100的远端1104。抓钳杆1100沿着远侧方向“DD”的运动将使钳口1014、1016枢转闭合。
在各种实施方式中，抓钳杆1100可通过闭合扳机1026的致动而可选择地运动，其中闭合扳机1026由手柄组件1020可枢转地支撑。更具体地，参照图17和18，抓钳杆1100的近端1102连接到容纳于手柄组件1020内的校准弹簧滑块1200。在各种实施方式中，例如，抓钳杆1100的近端1102可形成有T形部分1103，其被构造成容纳于校准弹簧滑块1200的远端部分1202中的相应形状的腔1204中。校准弹簧滑块1200被构造成可动地容纳于手柄组件1020的细长开口1040中，并具有致动器开口1208，用于接收形成于闭合扳机1026上的杠杆臂1028。杠杆臂1028也可凸出穿过致动器开口1208、进入窗口滑块1210中的相应开口1212，其中所述窗口滑块1210被构造成在形成于手柄组件1020中的窗口滑块腔1040内可滑动地受到支撑。窗口滑块1210上可形成有阻挡部分1214，如将在下面更详细讨论的，该阻挡部分1214用于阻挡形成于手柄组件1020中的相应窗口开口1022。由此，通过朝着手柄组件1020的手枪式握把部分1025枢转闭合扳机1026，杠杆臂1028使校准弹簧滑块1200和窗口滑块1210沿着近侧方向“PD”运动。在各种实施方式中，窗口滑块弹簧1216可由手柄组件1020支撑，以便沿着远侧方向“DD”偏压窗口滑块1210。
如图16-23所示，抓钳1002还可被构造成具有可松开的锁定组件(总体上由附图标记1220表示)。在各种实施方式中，锁定组件1220可包括杠杆锁定臂1222，其连接到闭合扳机1026，或从闭合扳机1026伸出，闭合扳机1026可枢转地轴支在转向销1023上，或者轴支在形成于或以其他方式连接于手柄组件1020上的其它构件上。见图16。变扭弹簧1230也可轴支在转向销1023上，以便将偏压力施加到闭合扳机1026上，将闭合扳机1026偏压到打开位置，如图18所示。在各种实施方式中，杠杆锁定臂1222可包括一片金属或其它合适的材料，其被连接到闭合扳机1026并且被构造成延伸进入形成于手柄组件1020中的锁定腔1027。具有锯齿或带齿端1242的锁定构件延伸进入锁定腔1027，所述带齿端1242被构造成选择性地与杠杆锁定臂1222的一部分接合，并将其保持在锁定腔1027内。如图16-23所示，锁定弹簧1250可支撑于手柄组件1020中，用于将锁定构件1240偏压成与杠杆锁定臂1222的一部分保持接合。为使医生能够选择性地松开锁定构件1240，不再与杠杆锁定臂1222保持接合，可设置释放扳机1260。在各种实施方式中，释放扳机1260可具有近端1262，其可滑动地容纳在手柄组件的扳机腔1029内。释放扳机1260的近端1262也被构造成延伸进入形成于锁定构件1240中的腔1244。朝着手柄组件1020的手枪式握把部分1025压下释放扳机1260导致释放扳机1260的近端1262与腔1244内的斜面1246协作，以便使锁定构件1240抵抗锁定弹簧1250而向下运动，从而使杠杆锁定臂1222从锁定腔1027释放。当杠杆锁定臂1222被释放后，闭合扳机1026在变扭弹簧1230的影响下枢转到打开位置。
各种实施方式还可包括总体上用附图标记1201代表的输出发生器。在各种实施方式中，输出发生器可包括基准刻度盘1270，其可旋转地支撑于刻度盘销1272上，刻度盘销1272形成于手柄组件1020上或者支撑于手柄组件1020内。基准刻度盘1270可设置有参考标记1274，其目的将在下面更详细地说明。此外，输出发生器1201还可包括驱动齿轮1280，其可形成于基准刻度盘1270上或者连接到基准刻度盘1270上，如图16所示。驱动齿轮1280布置成与形成于校准弹簧滑块1200上的齿轮齿1206啮合。还是在各种实施方式中，输出发生器例如可包括设置在校准弹簧滑块1200的远端1202上的校准弹簧1290，该弹簧被容纳在手柄壳体1020中的相应腔1292内。如可从下面讨论的内容理解的那样，各种实施方式中的输出发生器1201可以机械方式致动或供能。此处使用的术语“以机械方式致动”指的是输出发生器在没有任何电生成的输入的情况下致动。
参照图18-23可了解抓钳1002的各种实施方式的操作。图18示出了抓钳1002处于“完全闭合”和锁定位置。当闭合扳机1026处于完全压下的位置时，杠杆臂1028位于校准弹簧滑块1200的杠杆臂腔1208内，以便允许校准弹簧滑块1200在校准弹簧1292产生的偏压力作用下向近侧滑动。当校准弹簧滑块1200向近侧滑动时，其借助齿1206和驱动齿轮1280之间的啮合沿顺时针方向驱动基准刻度盘1270。在各种实施方式中，校准弹簧1292的尺寸可以设定成使得基准刻度盘1270上的“0”与手柄组件1020的窗口开口1022对准。为了回复到完全打开位置(图19)，医生压下释放扳机1260，如图23所示，这释放杠杆锁定臂1222并允许闭合扳机1026在变扭弹簧1230的力作用下回复到打开位置。在闭合扳机1026运动到打开位置时，杠杆臂部分1028在窗口滑块1210的开口1212中沿着逆时针方向枢转，由此允许窗口滑块1210被窗口滑块弹簧1216沿着远侧方向偏压，从而使阻挡部分1214阻挡手柄组件1020的窗口开口1022。此外，杠杆臂部分1028向远侧推动校准弹簧滑块1200，这使抓钳杆1100向远侧运动而打开钳口1014、1016。
如图21所示，当医生需要夹钳位于钳口1014、1016之间的组织“T”时，医生将端部执行器1012运动就位，并压下释放扳机1260，以允许闭合扳机1026开始被压下。当处于该位置时，窗口滑块1210处于其最远侧位置并且其阻挡部分1214不阻碍壳体组件中的窗口开口1022。当闭合扳机1026被压下时，校准弹簧滑块1200向近侧运动，这向近侧拉动抓钳杆1100，并使钳口1014、1016夹钳位于其间的组织“T”(图21)。医生继续压下闭合扳机1026，直到闭合扳机已经枢转到使杠杆臂部分1028将窗口滑块1210向近侧偏压到其中阻挡部分1214阻挡住手柄组件1020中的窗口开口1022的位置。见图22。之后医生轻微松开闭合扳机1026到如下位置，其中基准刻度盘1270上的参考标记1274通过手柄组件1020的窗口1022可见。见图23。本领域技术人员将会理解，参考标记可与组织“T”的特定厚度相关联。例如，基准刻度盘1270上的数字1可表示大约1mm的组织厚度；数字2可表示大约2mm的组织厚度，等等。还应当理解，这种独特和新颖设置使得医生能够获得在预定夹钳载荷(由于校准弹簧1292)下的组织“T”的厚度测量值。例如，校准弹簧1292的尺寸可设置成在抓钳被定位时施加大致8克/mm2的夹钳载荷来指示组织厚度。如果医生“过度夹紧”组织，窗口滑块1210运动到其中阻挡部分1214阻挡窗口1022的位置，由此防止医生读取参考标记1274。
虽然已经通过几种实施方式的说明示例性描述了本发明，并且已经相当详细地描述了示例性的实施方式，但是申请人不是想要将后附权利要求的范围限制或以任何方式限制到这样的细节。其它优点和变化对本领域普通技术人员来说是可以想到的。本领域技术人员将会理解这些不同实施方式提供的不同优点。例如，本发明的各种实施方式能够使医生确定所需目标组织厚度，以便采用正确尺寸的执行装置(钉仓等)。各种实施方式还被构造成能使医生获得在预定压缩载荷下的组织厚度测量值。
虽然已经描述了本发明的几种实施方式，但是，应当清楚，能够获得本发明的一些或全部优点的对这些实施方式的各种变形、变化和改变对本领域技术人员来说是可以想到的。例如，根据各种实施方式，单个元件可由多个元件替换，多个元件可由单个元件替换，以便执行给定一个或多个功能。因此这些应用旨在覆盖所有这些变形、变化和改变，而不背离由所附权利要求限定的本发明的范围和精神。
这里公开的装置也可以被设计成在单次使用后被处置，或者它们可以被设计成多次使用。然而，在任一情况中，在至少一次使用之后设备可以被整修以供再使用。整修可以包括以下步骤的任何组合：拆卸设备，然后清洁或替换特殊零件，随后再组装。特别地，设备可以被拆卸，并且设备的许多特殊零件或部分可以在任何组合中选择性地被替换或去除。一旦清洁和/或替换特殊部分，在外科操作将要开始之前设备可以在整修设备或者由手术团队再组装供随后使用。本领域的技术人员将会理解设备的整修可以利用拆卸、清洁和/或替换和再组装的多种技术。这种技术的使用以及形成的整修的装置都在本申请的范围内。
优选地，这里描述的发明的各种实施方式可在外科手术之前处理。首先，得到新的或者使用过的器械并且在需要的时候对其进行清洁。器械然后可被灭菌。在一种灭菌技术中，器械被设置在闭合和密封容器中，诸如塑料或者TYVEK
Figure A20081008694700321
袋中。容器和器械然后设置在可穿透容器的辐射场中，诸如γ射线或者高能电子束。辐射杀死器械和容器中的细菌。灭菌的器械然后可存储在无菌容器中。密封的容器保持器械无菌直到其在医疗场合被打开。
在此通过引用包含在本申请中的任何专利、公开出版物或者其它公开的材料，全部或者部分，均仅仅包含到所包含的材料不与在本公开内容中阐释的现有定义、陈述或者其它公开材料相矛盾的程度。这样，在本文中作为清楚阐释的所公开内容取代任何通过引用包含在本申请中的矛盾的材料。在此通过引用包含在本申请中但是与此处给出的现有定义、声明或其它公开材料相冲突的任何材料或者其部分仅仅结合到在结合的材料和现有公开材料之间不会引起冲突的程度。
希望保护的本发明不应被解释为限于公开的特定实施方式。因此所述实施方式应被看作是示例性的而不是限制性的。在不背离本发明的精神的情况下可做出变形和改变。因此，落入权利要求书限定的本发明的精神和范围内的所有这些等同物、变型和变化都包括在本发明中。

Claims (10)

1.一种外科器械，包括：
一对对置的钳口，其中至少一个钳口能够响应于施加到其上的打开动作和闭合动作而相对于另一个钳口可选择地运动，以便选择性地将组织夹钳在其间；
输出发生器，其与所述一对对置钳口相联，所述输出发生器产生表示夹钳在所述一对对置的钳口之间的组织的厚度的组织厚度数据；以及
显示器，用于在其上显示所述组织厚度数据。
2.根据权利要求1所述的外科器械，其中，所述输出发生器包括：
至少一个应变仪，用于产生与夹钳在所述一对对置的钳口之间的组织的组织厚度相对应的应变信号；
处理器，其与所述至少一个应变仪相连通，用于从所述至少一个应变仪接收所述应变信号并产生与之对应的组织厚度数据，并且将所述组织厚度数据传输到所述显示器。
3.根据权利要求1所述的外科器械，其中，所述一对对置的钳口包括：
第一钳口，其尺寸适于在其中可拆卸地支撑仓；
第二钳口，其可动地连接到所述第一钳口，并且能够响应于施加到其上的打开动作和闭合动作而相对于细长通道选择性地在打开位置和闭合位置之间运动，
其中所述输出发生器包括：
测量仓，其能够可拆卸地支撑于所述细长通道中；
应变仪，其与所述测量仓相联，用于产生与夹钳在所述测量仓和所述第二钳口之间的组织的组织厚度相对应的应变信号；以及
处理器，其与所述至少一个应变仪相连通，用于从其接收所述应变信号并计算与所述组织厚度相对应的所述组织厚度数据，并且将所述组织厚度数据传输到所述显示器。
4.根据权利要求3所述的外科器械，其中，所述应变仪由所述测量仓支撑，并且具有用于与所述第二钳口接触的可弯曲部分。
5.根据权利要求3所述的外科器械，其中，所述应变仪包括：
第一应变仪，其由所述细长通道支撑，当所述测量仓由所述细长通道支撑时，所述第一应变仪产生与当组织夹钳于所述测量仓的一部分和所述第二钳口之间时经受的压缩载荷的量相对应的第一应变信号，所述第一应变仪与所述处理器相连通，所述处理器在收到所述第一应变信号时将对应于所述压缩载荷的数据传输到所述显示器；以及
第二应变仪，其由所述测量仓支撑并具有用于在组织被夹钳在所述测量仓的所述部分和所述第二钳口之间时与所述第二钳口接触的可弯曲部分，所述第二应变仪产生与夹钳在所述第一钳口和第二钳口之间的组织的厚度相对应的第二应变信号，所述第二应变仪与所述处理器相连通，所述处理器在收到所述第二应变信号时产生对应于组织厚度的所述组织厚度数据，并且将所述组织厚度数据传输到所述显示器。
6.根据权利要求1所述的外科器械，还包括：
手柄组件，其支撑所述显示器；
抓钳杆，其由所述手柄组件可操作地支撑并且连接到所述一对对置的钳口，用于将所述打开动作和闭合动作传递到所述一对对置的钳口上，其中所述输出发生器与所述抓钳杆协作，以在所述显示器上显示与夹钳在所述一对对置的钳口之间的组织的厚度相对应的所述组织厚度数据。
7.根据权利要求6所述的外科器械，其中，只有在所述一对对置的钳口向夹钳于其间的组织施加预定量的压缩力，才能在所述手柄组件上观察到标记。
8.根据权利要求1所述的外科器械，还包括：
手柄组件；
抓钳杆，其由所述手柄组件可操作地支撑并且连接到所述一对对置的钳口，用于在可操作地连接到所述手柄组件上的闭合扳机选择性地致动时将所述打开动作和闭合动作传递到所述一对对置的钳口，
其中所述输出发生器包括：
应变仪，其与所述抓钳杆相联，用于在所述抓钳杆将所述闭合动作施加到所述对置的钳口以便将组织夹钳在其间时产生应变信号；以及
处理器，其与所述应变仪相连通，用于从所述应变仪接收所述应变信号并计算对应于所述组织厚度的所述组织厚度数据，并且将所述组织厚度数据传输到所述显示器。
9.根据权利要求1所述的外科器械，其中，所述对置的钳口的形状使其能够在其间容纳具有特定横截面形状的物体。
10.根据权利要求9所述的外科器械，其中，所述一对对置的钳口中的每个钳口均具有远端和从其夹钳面凸出的至少一个结块，在所述对置的钳口朝着彼此运动时，所述远端和结块在其间限定托架区域，该托架区域的尺寸使其能够将具有特定横截面形状的物体紧紧地支撑于其中。
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US8893946B2 (en) 2014-11-25
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