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CN101327135B - 带阻止索意外脱离设备的索驱动外科缝合和切割器械 - Google Patents

带阻止索意外脱离设备的索驱动外科缝合和切割器械 Download PDF

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CN101327135B
CN101327135B CN 200810109777 CN200810109777A CN101327135B CN 101327135 B CN101327135 B CN 101327135B CN 200810109777 CN200810109777 CN 200810109777 CN 200810109777 A CN200810109777 A CN 200810109777A CN 101327135 B CN101327135 B CN 101327135B
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F·E·谢尔顿四世
R·W·蒂姆
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伊西康内外科公司
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical 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
    • A61B17/07207Surgical 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 the staples being applied sequentially
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0046Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
    • A61B2017/00473Distal part, e.g. tip or head
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00681Aspects not otherwise provided for
    • A61B2017/0069Aspects not otherwise provided for with universal joint, cardan joint
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical 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
    • A61B2017/07214Stapler heads
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical 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
    • A61B2017/07214Stapler heads
    • A61B2017/07278Stapler heads characterised by its sled or its staple holder
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical 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
    • A61B2017/07214Stapler heads
    • A61B2017/07285Stapler heads characterised by its cutter
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B17/2909Handles
    • A61B2017/2912Handles transmission of forces to actuating rod or piston
    • A61B2017/2913Handles transmission of forces to actuating rod or piston cams or guiding means
    • A61B2017/2916Handles transmission of forces to actuating rod or piston cams or guiding means pins in guiding slots
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B17/2909Handles
    • A61B2017/2912Handles transmission of forces to actuating rod or piston
    • A61B2017/2919Handles transmission of forces to actuating rod or piston details of linkages or pivot points
    • A61B2017/292Handles transmission of forces to actuating rod or piston details of linkages or pivot points connection of actuating rod to handle, e.g. ball end in recess
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
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    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2926Details of heads or jaws
    • A61B2017/2927Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2926Details of heads or jaws
    • A61B2017/2932Transmission of forces to jaw members
    • A61B2017/2933Transmission of forces to jaw members camming or guiding means
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B2017/2926Details of heads or jaws
    • A61B2017/2932Transmission of forces to jaw members
    • A61B2017/2933Transmission of forces to jaw members camming or guiding means
    • A61B2017/2934Transmission of forces to jaw members camming or guiding means arcuate shaped guiding means
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2926Details of heads or jaws
    • A61B2017/2932Transmission of forces to jaw members
    • A61B2017/2933Transmission of forces to jaw members camming or guiding means
    • A61B2017/2936Pins in guiding slots
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
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    • A61B2017/2926Details of heads or jaws
    • A61B2017/2932Transmission of forces to jaw members
    • A61B2017/2933Transmission of forces to jaw members camming or guiding means
    • A61B2017/2937Transmission of forces to jaw members camming or guiding means with flexible part
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
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    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2926Details of heads or jaws
    • A61B2017/2932Transmission of forces to jaw members
    • A61B2017/2939Details of linkages or pivot points
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2926Details of heads or jaws
    • A61B2017/2932Transmission of forces to jaw members
    • A61B2017/2939Details of linkages or pivot points
    • A61B2017/294Connection of actuating rod to jaw, e.g. releasable
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2946Locking means
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32Surgical cutting instruments
    • A61B2017/320052Guides for cutting instruments
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/70Manipulators specially adapted for use in surgery
    • A61B34/71Manipulators operated by drive cable mechanisms
    • A61B2034/715Cable tensioning mechanisms for removing slack

Abstract

本发明公开了一种带阻止索意外脱离设备的索驱动外科缝合和切割器械。所述索驱动外科器械包括细长通道组件,其被构造用于可操作地支撑其中的钉仓组件。所述器械可以包括刀组件和至少一个索过渡支架,所述刀组件被定向用于在所述细长通道组件内行进,所述至少一个索过渡支架可操作地安装在所述细长通道组件和所述刀组件中的至少一个上。驱动索可操作地绕所述索过渡支架的至少一部分延伸并且与索驱动系统连接以在所述细长通道组件内驱动所述刀组件。可以包括索保持装置,用于保持所述驱动索围绕所述索过渡支架的至少一部分。

Description

带阻止索意外脱离设备的索驱动外科缝合和切割器械

技术领域

[0001] 本发明总体涉及内窥镜外科器械,包括但不限于适于将成排缝钉施加到组织上同时切割那些缝钉排之间的组织的外科缝合器械,更具体涉及有关其击发和驱动系统的改进。

背景技术

[0002] 本申请涉及如下在同一天申请的共有美国专利申请,它们的公开内容通过引用而整体包含在本申请中:

[0003] (1)题为"Surgical Stapling and Cutting Instrument WithImproved Firing System,,的美国专利申请,发明人为 Richard W. Timm, Frederick Ε. Shelton, IV,Eugene L. Timperman 和 Leslie Μ· Fugikawa,(案卷号 END6094USNP/KLG No. 070064);

[0004] (2)题为"Surgical Stapling and Cutting Instrument With ImprovedClosure System,,的美国专利申请,发明人为 Richard W. Timm, Frederick Ε. Shelton, IV,Eugene L. Timperman 和 Leslie Μ. Fugikawa(档案号:END6095USNP/KLG. No. 070065);

[0005] (3)题 % "Cable Driven Surgical Stapling and Cutting Instrumentffith Improved Cable Attachment Arrangements,,的美国专禾丨J 申请,发明人为 Frederick Ε. Shelton, IV 和 Richard W. Timm,(案卷号 END6097USNP/KLG. No. 070067);

[0006] (4)题为"Surgical Stapling and Cutting Instrument WithImproved Anvil Opening Features” 的美国专利申请,发明人为 RichardW. Timm, Frederick Ε. Shelton, IV 和 Jeffrey S. Swayze,(案卷号 END6098USNP/KLG No. 070068);和

[0007] (5)题为 ‘‘Surgical Stapling and Cutting hstruments” 的美国专利申请, 发明人为 Richard W. Timm, Frederick Ε. Shelton, IV, CharIesJ. Scheib, Christopher J. Schal 1, Glen A. Armstrong, Eugene L. Timperman,禾口 Leslie M. Fugikawa,(案卷号 END6102USNP/KLG. No. 070071)。

[0008] 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,适于通过套管针的插管将远端执行器精确放置在需要进行外科手术部位上的内窥镜器械领域已经有了显著的发展。这些远端执行器 (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、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,以达到诊断或治疗的效果。

[0009] 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钳口构件,如果器械用于内窥镜或者腹腔镜应用,这对钳口构件能够穿过插管通道。钳口构件中的一个容纳有具有至少两个横向间隔的缝钉排的钉仓。另一个钳口构件限定了具有缝钉成形凹槽的砧座,所述凹口与钉仓中的缝钉排对准。该器械通常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承缝钉的驱动器接合,向着砧座击发缝钉。[0010] 所述外科缝合器的一个例子在美国专利申请US2006/001699A1中公开,其公开的内容通过引用而包含在本申请中。其中公开的缝合装置采用一根或多根索,所述索围绕定位在远侧的销或者滑轮定位并固定到刀上。索的端部沿着近侧方向被拉动。但是,这种系统的机械优势较低并趋向于在冲程中需要相对较大的力来拉动刀。

[0011] 因此,需要提供一种用于索驱动外科缝合器的改进的驱动和击发系统。

[0012] 另外,这种索击发外科缝合器系统可能遭遇索意外脱离滑轮系统,这会使装置停止。这种情况可能是在使用或者在使用或装运时遭受其它震动的过程中由机械振动引起的。

[0013] 因此,还需要用来确保用于击发外科缝合装置的一根或多根索不从它们各自的滑轮或驱动元件上脱离的设备、装置和系统。

发明内容

[0014] 在本发明的一个方面,提供了一种外科器械,其包括细长通道组件,所述细长通道组件具有远端和近端并且被构造用于可操作地支撑其中的钉仓组件。所述器械还包括刀组件,其被定向用于在所述细长通道组件内行进。至少一个索过渡支架可操作地安装在所述细长通道组件和所述刀组件中的至少一个上。驱动索可以围绕所述至少一个索过渡支架的至少一部分延伸并且与索驱动系统连接以在所述细长通道内驱动所述刀组件。所述器械还可以包括索保持装置,其用于保持所述驱动索围绕所述索过渡支架的至少一部分。

[0015] 本发明的各种实施方式的另一总的方面,提供了一种外科器械,其包括细长通道组件,所述细长通道组件具有远端和近端并且被构造用于可操作地支撑其中的钉仓。刀组件可以被定向用于在所述细长通道组件内行进。远侧第一和第二索过渡支架可以设在所述细长通道组件的所述远端上。第二索过渡支架可以设在所述刀组件上。驱动索可以围绕所述远侧第一和第二索过渡支架和位于所述刀组件上的所述第二索过渡支架的至少一部分延伸并且与索驱动系统连接以在所述细长通道组件内驱动所述刀组件。可以设置至少一个索保持装置,其用于保持所述驱动索围绕所述远侧第一和第二索过渡支架和所述第二索过渡支架中的至少一个。

[0016] 具体而言,本发明公开了 :

[0017] (1). 一种外科器械,包括:

[0018] 细长通道组件,其能够将钉仓组件可操作地支撑在其中;

[0019] 刀组件,其被定向用于在所述细长通道组件内行进;

[0020] 至少一个索过渡支架,其可操作地安装在所述细长通道组件和所述刀组件中的至少一个上;

[0021] 驱动索,其可操作地围绕所述至少一个索过渡支架的至少一部分延伸并且与索驱动系统连接以在所述细长通道组件内驱动所述刀组件;以及

[0022] 索保持装置,其用于可操作地保持所述驱动索围绕所述索过渡支架的所述至少一部分。

[0023] (2).根据第(1)项所述的外科器械,其中,所述至少一个索过渡支架包括滑轮。

[0024] (3).根据第⑵项所述的外科器械,其中,所述索保持装置包括索保持块,所述索保持块与所述滑轮非常接近。[0025] (4).根据第(3)项所述的外科器械,其中,所述索保持块具有弧形表面,所述弧形表面相对于所述驱动索的在所述滑轮上的部分形状互补,从而防止所述驱动索从所述滑轮上脱离。

[0026] (5).根据第⑴项所述的外科器械,其中,所述至少一个索过渡支架包括块,所述块具有延伸通过其的通道,所述通道形成弧形支承表面,所述驱动索通过所述弧形支承表面。

[0027] (6).根据第(1)项所述的外科器械,其中,所述索保持装置包括连接在所述驱动索上用于保持其张力的索张紧接头。

[0028] (7).根据第(6)项所述的外科器械,其中,所述驱动索具有第一端和第二端,所述索张紧接头包括:

[0029] 第一止动元件,其连接在所述驱动索的所述第一端上;

[0030] 第二止动元件,其连接在所述驱动索的所述第二端上并且具有穿过其的通道,所述通道用于容纳通过其的所述驱动索的一部分,所述第二止动元件能够相对于所述第一止动元件在所述驱动索上移动;

[0031] 第三止动元件,其固定地连接在所述驱动索的一部分上,使得所述第二止动元件可动地容纳在所述第一止动元件和位于所述驱动索的所述部分上的所述第三止动元件之间;

[0032] 张紧弹簧,其连接在所述第二止动元件和所述第三止动元件上。

[0033] (8).根据第(7)项所述的外科器械,其中,所述索驱动系统包括从动滑轮,所述从动滑轮将所述驱动索的一部分驱动地支撑于其上,所述至少一个索过渡支架包括:

[0034] 第一和第二滑轮,其安装在所述细长通道组件的远端上;以及

[0035] 第三滑轮,其安装在所述刀组件上。

[0036] (9).根据第⑶项所述的外科器械,还包括:

[0037] 手柄组件,其可操作地支撑所述从动滑轮;

[0038] 细长轴,其可操作地连接到所述手柄组件和所述细长通道组件上并且将所述驱动索支撑在其中;以及

[0039] 关节运动接头,其位于所述细长轴中,用以使所述细长通道组件能够相对于所述手柄组件进行关节运动。

[0040] (10). 一种用于处理外科器械的方法,所述方法包括:

[0041] 获得如第(1)项所述的外科器械;

[0042] 对所述外科器械进行消毒;并且

[0043] 将所述外科器械存储在无菌容器内。

[0044] (11). 一种外科器械,包括:

[0045] 细长通道组件,其能够将钉仓可操作地支撑于其中;

[0046] 刀组件,其被定向用于在所述细长通道组件内行进;

[0047] 远侧第一和第二索过渡支架,其位于所述细长通道组件的远端上;

[0048] 第二索过渡支架,其位于所述刀组件上;

[0049] 驱动索,其围绕所述远侧第一和第二索过渡支架以及位于所述刀组件上的所述第二索过渡支架的至少一部分延伸并且与索驱动系统连接以在所述细长通道组件内驱动所述刀组件;以及

[0050] 至少一个索保持装置,其用于保持所述驱动索围绕所述远侧第一和第二索过渡支架和所述第二索过渡支架中的至少一个。

[0051] (12).根据第(11)项所述的外科器械,其中,所述远侧第一和第二索过渡支架和所述第二索过渡支架中的至少一个包括滑轮。

[0052] (13).根据第(1¾项所述的外科器械,其中,所述索保持装置包括索保持块,所述索保持块与所述滑轮非常接近。

[0053] (14).根据第(1¾项所述的外科器械,其中,所述索保持块具有弧形表面,所述弧形表面相对于所述驱动索的在所述滑轮上的部分形状互补,从而防止所述驱动索从所述滑轮上脱离。

[0054] (15).根据第(11)项所述的外科器械,其中,所述至少一个索过渡支架包括块,所述块具有穿过其延伸的通道,所述通道形成弧形支承表面,所述驱动索能够通过所述弧形支承表面。

[0055] (16).根据第(11)项所述的外科器械,其中,所述索保持装置包括连接在所述驱动索上用于保持其张力的索张紧接头。

[0056] (17).根据第(16)项所述的外科器械,其中,所述驱动索具有第一端和第二端,所述索张紧接头包括:

[0057] 第一止动元件,其连接在所述驱动索的所述第一端上;

[0058] 第二止动元件,其连接在所述驱动索的所述第二端上并且具有穿过其的通道,所述通道用于容纳通过其的所述驱动索的一部分,所述第二止动元件能够相对于所述第一止动元件在所述驱动索上移动;

[0059] 第三止动元件,其固定地连接在所述驱动索的一部分上,使得所述第二止动元件可动地容纳在所述第一止动元件和位于所述驱动索的所述部分上的所述第三止动元件之间;

[0060] 张紧弹簧,其连接在所述第二止动元件和所述第三止动元件上。

[0061] (18).根据第(17)项所述的外科器械,其中,所述索驱动系统包括从动滑轮,所述从动滑轮将所述驱动索的一部分驱动地支撑在其上。

[0062] (19).根据第(18)项所述的外科器械,还包括:

[0063] 手柄组件,其将所述从动滑轮可操作地支撑在其中;

[0064] 细长轴,其可操作地连接到所述手柄组件和所述细长通道组件上并且将所述驱动索支撑于其中;以及

[0065] 关节运动接头,其位于所述细长轴中,用以使所述细长通道组件能够相对于所述手柄组件作关节运动。

[0066] 00). —种外科器械,包括:

[0067] 细长通道组件,其具有远端和近端,所述细长通道组件被构造用于将钉仓组件可操作地支撑在其中;

[0068] 刀组件,其被定向用于在所述细长通道组件内行进;

[0069] 至少一个索过渡支架,其可操作地安装在所述细长通道组件和所述刀组件中的至少一个上;[0070] 驱动索,其可操作地围绕所述至少一个索过渡支架的至少一部分延伸并且与索驱动系统连接以在所述细长通道组件内驱动所述刀组件;以及

[0071] 用于保持所述驱动索围绕所述索过渡支架的所述至少一部分的装置。

[0072] 通过附图以及对附图的描述,本发明的这些和其它目的和优点将变得清楚。

附图说明

[0073] 包含在本说明书中并构成其一部分、示出本发明的实施方式的附图与上面给出的本发明的一般描述以及下面给出的实施方式的详细描述一道,用于解释本发明的各种原理。

[0074] 图1是本发明的各种实施方式的外科缝合和切割器械的透视图。

[0075] 图2是图1中示出的工具组件的分解透视图。

[0076] 图3是图1的工具组件的从右侧看的透视图,其中该工具组件的一些元件以剖面显不。

[0077] 图4是图2和3中示出的工具组件的左侧部分剖视图。

[0078] 图5是其中一些部分与本发明的各种实施方式的仓组件分离的仰视透视图。

[0079] 图6是本发明的各种实施方式的滑车、缝钉和缝钉推出器的分解组装图。

[0080] 图7是本发明的各种实施方式的砧座组件的透视图。

[0081] 图8是本发明的各种实施方式的动力夹钳元件的透视图。

[0082] 图9是图1-4中示出的工具组件的侧剖视图,其中组织被夹钳在工具组件中。

[0083] 图10是本发明的各种实施方式的细长通道组件的仰视透视图。

[0084] 图11是图10的细长通道组件的近侧部分的透视图。

[0085] 图12是图10和11的细长通道组件的远侧部分的透视图。

[0086] 图13是图10-12的细长通道组件的远侧部分的剖面图,其中动力夹钳元件支撑在其中。

[0087] 图14是图10-13的细长通道组件的另一仰视图。

[0088] 图15是本发明的各种实施方式的击发系统的示意性侧视图。

[0089] 图15A是本发明的各种实施方式的另一种击发系统的示意性侧视图。

[0090] 图16是图15的击发系统的示意性俯视图。

[0091] 图16A是图15A的击发系统的示意图。

[0092] 图17是本发明的各种实施方式的绞盘组件的主透视图。

[0093] 图18是图17的绞盘组件实施方式的后透视图。

[0094] 图19是图17和18的绞盘组件实施方式的右侧图。

[0095] 图20是处于空闲位置的图17-19的绞盘组件实施方式的剖视图。

[0096] 图21是本发明的驱动系统实施方式的透视图。

[0097] 图22是采用关节运动接头的本发明的另一种实施方式的局部剖视图。

[0098] 图23是在图22中示出的关节运动接头的局部放大剖视图。

[0099] 图M是图22中示出的器械的一部分的放大剖视图。

[0100] 图25是本发明的另一细长通道组件的仰视图。

[0101] 图沈是图25的细长通道组件的远端部分的放大图。[0102] 图27是沿着图沈中的线27-27的图沈中的细长通道组件远端的一部分的剖视图。

[0103] 图观是本发明的另一细长通道组件实施方式的远端的一部分的仰视图,其中一些元件以剖面显示。

[0104] 图四是沿着图28中的线四-29的图28中示出的细长通道组件的一部分的剖视图。

[0105] 图30是本发明的各种实施方式的采用索张紧接头的另一索设置的示意性俯视图。

[0106] 图31是图30的索设置的另一示意性俯视图,其中索张紧接头处于完全张开位置。

[0107] 图32是处于进行关节运动位置的图30和31的索设置的另一示意性俯视图。

[0108] 图33是图30-32中示出的索张紧接头的局部放大图。

[0109] 图34是本发明的索实施方式的透视图。

[0110] 图35是本发明的索连接接头实施方式的放大图。

[0111] 图36是与动力夹钳组件连接的本发明的索锚定接头实施方式的剖视图。

[0112] 图37是图36的索锚定接头的透视图。

[0113] 图38是与动力夹钳组件连接的本发明的另一索锚定接头实施方式的剖视图。

[0114] 图39是本发明的另一索连接实施方式的局部视图。

[0115] 图40是本发明的另一索连接实施方式的局部视图。

[0116] 图41是关节运动接头设置的局部透视图。

[0117] 图42是本发明的闭合管接头组件实施方式的透视图。

[0118] 图43是沿着线43-43的图42的闭合管接头组件实施方式的剖视图。

[0119] 图44是安装在图41中示出的关节运动接头上方的图42和43的闭合管接头组件的透视图。

[0120] 图44A是安装在图41的关节运动接头上方的本发明的另一闭合管接头组件实施方式的透视图。

[0121] 图45是本发明的另一砧座组件实施方式的透视图。

[0122] 图46是本发明的手柄组件和闭合管致动设置实施方式的分解透视图。

[0123] 图47是本发明的手柄组件和工具组件实施方式的局部剖视图,其中一些元件以立体方式显示,并且砧座组件处于闭合或者夹钳位置。

[0124] 图48是本发明的闭合管组件和工具组件实施方式的局部剖视图,其中砧座组件处于闭合或夹钳位置。

[0125] 图49是图47的手柄组件和砧座组件的另一局部剖视图,其中其砧座组件处于打开位置。

[0126] 图50是图48的闭合管组件和工具组件的另一局部剖视图,其中其砧座组件处于打开位置。

[0127] 图51是本发明的另一种实施方式的闭合管和闭合环的局部剖视图。

[0128] 图52是本发明的另一种实施方式的万向关节运动接头的局部剖切透视图。

[0129] 图53是图52的工具组件和关节运动接头的剖视图。

[0130] 图M是图53的工具组件和关节运动接头的俯视图。[0131] 图55是本发明的另一种实施方式的另一万向关节运动接头的剖视图。

[0132] 图56是本发明的索控可锁定关节运动接头实施方式的透视图。

[0133] 图57是图56的索控可锁定关节运动接头实施方式的端视图。

[0134] 图58是本发明的另一种实施方式的另一索控可锁定关节运动接头的剖视图。

[0135] 图59是图58的索控可锁定关节运动接头的近侧脊段的局部透视端视图。

[0136] 图60是图59的近侧脊段的端视图。

[0137] 图61是图59和60的近侧脊段的局部侧视图。

[0138] 图62是本发明的另一种实施方式的另一可锁定关节运动接头的剖视图。

[0139] 图63是图62的可锁定关节运动接头的近侧脊段的局部透视端视图。

[0140] 图64是图63的近侧脊段的端视图。

[0141] 图65是本发明的另一种实施方式的另一可锁定关节运动接头的剖视图。

[0142] 图66是图65的可锁定关节运动接头的近侧脊段的局部透视端视图。

[0143] 图67是图66的近侧脊段的端视图。

[0144] 图68是本发明的另一种实施方式的另一可锁定关节运动接头的剖视图。

[0145] 图69是图68的可锁定关节运动接头的近侧脊段的局部透视端视图。

[0146] 图70是图69的近侧脊段的端视图。

[0147] 图71是本发明的另一种实施方式的另一可锁定关节运动接头的剖视图。

[0148] 图72是本发明的另一种实施方式的另一可锁定关节运动接头的剖视图。

[0149] 图73A是本发明的另一种外科器械实施方式的工具组件和关节运动接头的局部剖视图。

[0150] 图7¾是图73A的外科器械的闭合管组件的局部剖视图。

[0151] 图74A是图73A和7¾的外科器械的工具组件和关节运动接头的另一种局部剖视图。

[0152] 图74B是图73A和73B的外科器械的闭合管组件的另一局部剖视图。

[0153] 图75是沿着图74A中的线75_75的图74A中示出的闭合管组件的剖视图。

[0154] 图76是沿着图74B中的线76_76的图74B中示出的闭合管组件的另一剖视图。

[0155] 图77是沿着图74B中的线77_77的图74B中示出的闭合管组件的另一剖视图。

[0156] 图78是本发明实施方式的快速断开接头的局部分解组装视图,其中其元件以剖面显示。

[0157] 图79是图78的快速断开接头的另一局部分解组装视图。

[0158] 图80是图78和79的快速断开接头的另一局部分解组装视图[0159] 图81是图78-80的快速断开接头的另一局部分解组装视图。

[0160] 图82是本发明的另一手柄组件实施方式的剖视图。

[0161] 图83是本发明的各种实施方式的驱动系统的示意性端视图。

[0162] 图84是本发明的各种实施方式的制动释放机构的局部透视图。

[0163] 图85是本发明的各种实施方式的另一关节运动接头实施方式的局部透视图。

[0164] 图86是图85的关节运动接头的分解组装视图。

[0165] 图87是图85和86的关节运动接头的局部侧视图。

[0166] 图88是图87的关节运动接头的俯视图。[0167] 图89是处于进行关节运动位置的图87和88的关节运动接头的另一种俯视图。

[0168] 图90是本发明的各种实施方式的另一工具组件和闭合管设置的局部透视图,其中一部分闭合管以剖面显示。

[0169] 图91是图90的工具组件和闭合管组件设置的剖面图,其中耳轴锁定杆处于将耳轴保持在它们各自的槽中的锁定位置。

[0170] 图92是图91的工具组件和闭合管设置的局部俯视图,其中其部分以剖面显示。

[0171] 图93是图90-92的工具组件和闭合管设置的剖面图,其中耳轴锁定杆处于未锁定位置。

[0172] 图94是图93的工具组件和闭合管设置的局部俯视图,其中其一部分以剖面显示。

[0173] 图95是图90-92的工具组件和闭合管组件设置的剖面图,其中耳轴锁定杆处于未锁定位置并且耳轴从细长通道组件的耳轴槽中运动出来。

[0174] 图96是本发明的各种实施方式的另一动力夹钳组件的侧视图。

[0175] 图97是本发明的各种实施方式的另一动力夹钳组件的侧视图。

[0176] 图98是本发明的各种实施方式的另一动力夹钳组件的侧视图。

[0177] 图99是本发明的各种实施方式的另一动力夹钳组件的侧视图。

[0178] 图100是在槽已经被打开并且销已经被除去后图99的动力夹钳组件的另一侧视图。

[0179] 图101是本发明的各种实施方式的另一动力夹钳组件的侧视图。

[0180] 图102是本发明的各种实施方式的另一动力夹钳组件的侧视图。

[0181] 图103是沿着图102中的线103-103的图102的动力夹钳组件的局部剖视图。

[0182] 图104是本发明的另一种外科器械实施方式的一部分的侧视图,其中闭合环运动到其最远侧位置并且其中其一些元件以剖面显示。

[0183] 图105是图104的外科器械实施方式的侧视图,其中闭合环运动到其最近侧位置并且其一些元件以剖面显示。

具体实施方式

[0184] 现在将描述一些典型实施方式,提供对本文中公开的装置和方法的结构、功能、制造和使用的原理的总体理解。这些实施方式的一个或多个例子在附图中示出。本领域普通技术人员将会理解,在本文中特别描述和在附图中示出的装置和方法是非限制性的典型实施方式,本发明的各种实施方式的范围仅由权利要求书来限定。结合一种典型实施方式示出和描述的特征可与其他实施方式的特征组合。这样的修改和变化也包括在本发明的范围内。

[0185] 转向附图,其中相同的附图标记在一些附图中表示相同的元件,图1示出了能够实践本发明的一些独特优点的外科器械,在典型方案中其具体为外科缝合和切割器械1。器械1可主要包括外科缝合器,其形式和构造在前面引证的美国专利公开US 2006/0011699A1中公开,在此通过全文引用而包含在本申请中,其中一个或多个改进在下面描述。但是,如前面本具体实施方式所说的那样,本领域普通技术人员可以理解,与其他外科缝合器构造有关的在本文中描述的各种实施方式和改进都可被包括,也不脱离本发明的精神和范围。[0186] 如图1所示,器械1可包括分别具有远端4和近端6的外壳3、安装在外壳3上(优选安装在其远端4上)的细长轴20以及总体标记为5的手柄组件。轴20可具有远端20a, 可通过连接机构20b可操作地将一次性加载单元10与其连接。同样如图1所示,一次性加载单元(DLU) 10可包括可枢转并可操作地通过连接器机构C彼此连接的工具组件100和轴连接器部分20c。

[0187] 在本发明公开的范围内,工具组件100例如通过连接机构诸如连接器机构C可枢转、可操作或者整体地永久并直接连接到一次性外科缝合器的轴20的远端20a。如同已知的那样,已使用或者用过的一次性加载单元10可从可重新使用或者一次性的开放式内窥镜或者腹腔镜外科缝合器的轴20上除去,并更换成未使用过的一次性单元。在各种实施方式中,可以想到具有或不具有整体或可拆卸连接的一次性加载单元的轴20可选择性地从外壳3拆卸。

[0188] 轴连接器部分20c包括近端M和远端22。如前所述,近端M可永久或者可拆卸地与手柄或者手动(或者其他,例如机器人或计算机)操作的开放式或者内窥镜外科缝合器1的其他致动组件连接。轴连接器部分20c的远端22可操作地连接到工具组件100。工具组件100通常可包括细长通道组件120、砧座组件110和钉仓组件200。一旦未用尽或未用过的仓200安装在细长通道组件120上,工具组件100还可优选包括致动器(优选为动力夹钳元件150)、滑车160以及缝钉推出器2¾和缝钉350,参见图2、5和6。

[0189] 应当理解,术语“近端”和“远端”在本文中以临床医生握持器械的手柄为参照。因此,工具组件100相对于更近侧的手柄组件5为远侧。还应理解,为了方便和清楚起见,空间术语“垂直”和“水平”在本文中以附图为参考来使用。但是,外科器械可以许多朝向和位置来使用,这些术语并不是限制和绝对化。

[0190] 轴连接器部分20c可以是圆柱形形状并限定了尺寸可设置为容纳管适配器40的内部通道25,见图2。轴连接器部分20c还可接收或容纳用于致动工具组件100的致动器。 工具组件100可安装到轴连接器20c的远端22 (或者轴20的远端20a)上。在各种实施方式中,工具组件100可被安装在具有外部圆柱表面47的管适配器40上,该外部圆柱表面47 可与轴连接器20c (再次地,也可与轴20)的内部通道25摩擦配合接合而被滑动容纳。这里,工具组件100与轴连接器20c的近端连接或附接还可应用到其与轴20的连接。管适配器40的外表面47还可还包括至少一个机械界面,例如切口或者凹口 45,其被定向为与设置在内部通道25的内周上的相应的机械界面例如径向向内延伸的凸起或定位槽(未显示) 配合,以便将管适配器40锁定到轴连接器20c。

[0191] 在各种实施方式中,管适配器40的远端可包括一对相对的翼缘4¾和42b,它们限定了用于枢转地容纳枢轴块50的腔41。每个翼缘4¾和42b可包括被定向为容纳枢轴销 57的孔4½和44b,所述枢轴销延伸通过枢轴块50中的孔,允许枢轴块50围绕与工具组件 100的纵向轴线“X”垂直限定的“Z”轴可枢转地运动,见图3。如同将在下面详细描述的那样,通道组件可形成有两个向上延伸的翼缘121a、121b,它们分别具有孔12h、122b,孔的尺寸设置成可容纳枢轴销59。枢轴销59通过枢轴块50的孔53a、5¾安装,以便在给定外科手术过程中当需要时允许工具组件100围绕“Y”轴旋转。枢轴块50沿着“Z”轴围绕销 57的旋转使工具组件100围绕“Z”轴旋转。在不背离本发明的精神和范围的条件下也可有效采用将通道120紧固到枢轴块和将砧座紧固到通道的其他方法。[0192] 在各种实施方式中,一个或多个致动器(未显示)优选穿过轴连接器部分20c、管适配器40和枢轴块50,并可操作地与工具组件100连接,以便在外科手术过程中当需要时允许外科医生使工具组件100围绕“Y”轴和“Z”轴进行关节运动。另外,可通过旋钮“K” 的旋转使外科缝合器1的轴20能够360°旋转。结果,工具组件100可在所有方向上关节运动至少90°。可被用于完成该任务的各种致动器、手柄组件和枢轴块都是可以想到的,其中一些与美国专利US6250532和US 6330965中的相同,这两分专利的内容通过引用而包含在本申请中。

[0193] 如上所述,在各种实施方式中,工具组件100可包括砧座组件110和细长通道组件120,见图2。细长通道组件120可支撑钉仓组件200、致动器(例如动力夹钳元件150) 和滑车160。这样,当组装时,这些不同组件和它们各自的内部元件在给定外科手术过程中 (将在下面解释)协作,允许工具组件操作、夹持、夹钳、紧固并优选切割组织。细长通道组件120可包括具有向上延伸的侧壁或翼缘121a和121b的底表面128,所述侧壁或翼缘限定了细长支撑通道125,该支撑通道的尺寸又设置成可将钉仓组件200可安装地容纳在其中。 细长通道组件120还可包括多个机械界面127a、127b、127c、127d,它们被定向成容纳设置在钉仓组件200的朝向外面的表面中的相应的多个机械界面23fe、235b、235c和235d。见图2禾口 6。

[0194] 钉仓组件200安装在细长通道组件120中并包括上部组织接触或者朝向表面231, 如同在本具体实施方式中进一步变得清楚的那样,所述表面231与砧座组件110的组织接触或朝向底部的砧座表面114b相对。在制造或组装工程中钉仓组件200可被组装并安装在细长通道组件120中,并作为整体工具组件100的一部分出售,或者在需要时钉仓组件200 可被设计成选择性安装到通道组件120上,并单独出售,例如作为单独使用的替换、可替换或者一次性的钉仓组件200。例如,钉仓组件200可被制造成包括滑车160和动力夹钳元件 150。作为替代,具有刀155的动力夹钳元件150可作为不具有刀片15¾的可替换钉仓组件200的一部分出售(但优选具有刀片155a),以增强和/或确保缝钉成形后精确地切割组织。工具组件100还可作为套件出售,该套件包括各种含有不同尺寸和/或设置成以不同模式射出外科紧固件350的钉仓200,其中任何一种钉仓可与细长通道组件120选择性地接合以便在在特定手术过程中在需要时使用。

[0195] 如图6最清楚显示的,滑车160可包括一对向上延伸的凸轮楔161a和161b,当由用户致动以运动时,其使一系列外科紧固件350或者缝钉进入并穿过组织并且抵靠砧座组件110的缝钉成形凹槽111 (在图9中显示),以便成形紧固件350并紧固组织。动力夹钳元件150与滑车160连接,例如安装并骑设在其上,或者与其相连或者集成在一起和/或骑设在其后面。可以想到,动力夹钳元件150可具有与其连接或者一体形成的凸轮楔或者凸轮表面,或者由凸轮楔或者凸轮表面的远侧前表面推动。

[0196] 在各种实施方式中,动力夹钳元件150可包括具有横向孔154(销159可安装或者安装在其中)的上部157、中央支架或者向上的延伸部分151和大体上为T形的底部翼缘 152,所述各部分协同动作以在滑车160的纵向向远侧运动过程中沿着理想切割路径滑动保持动力夹钳元件150。见图8。前切割边缘155(这里为刀片155a)的尺寸设置成倚靠在钉仓组件200的槽282中,并且一旦缝合就使组织400分离。可以想到,动力夹钳元件150 的前缘153a可以是锯齿状的、倾斜的或者带缺口的,以利于组织切割。在一些实施方式中,例如,上部凸轮运动元件不必是销,而可以是任何一体的或可拆卸的适当向上突出的凸轮表面。同样对于底部翼缘152来说,其可以是任何合适的凸轮运动表面,包括销或者可拆卸的销、按钮,以利于将动力夹钳元件安装到滑车160中或者细长通道组件120中。在本文中使用的术语“刀组件” 170可包括前述动力夹钳元件150、刀155和滑车160或者其他刀/梁 /滑车驱动设置。另外,本发明的各种实施方式可采用刀组件设置,刀组件设置可完全支撑在钉仓中或者部分支撑在钉仓和细长通道组件中或者完全支撑在细长通道组件中。

[0197] 如图10最清楚地显示的,细长通道组件120具有远端123和近端123’。细长通道组件120的底表面1¾还包括细长的纵向槽126,该纵向槽包括切口或者槽口 1¾并以近端与其连通。槽口 1¾的尺寸设置成允许动力夹钳元件150的底部翼缘152穿过其间。 槽126的狭窄部分的尺寸设置成滑动容纳向上的支架或者延伸部分151并允许其从其中穿过。见图13。其他动力夹钳元件150、通道槽和滑车构造也可采用。

[0198] 当组装工具组件100时,滑车160可滑动定位在钉仓组件200和细长通道组件120 之间(参见图幻。滑车160和上面详细描述的钉仓组件200的内部工作元件可操作地协同动作以使缝钉350变形。更具体地,如上所述,滑车160可包括向上延伸的分叉凸轮楔161a 和161b,它们与一系列缝钉推出器288接合并协同动作,以便从钉仓组件200驱动缝钉350 通过槽225,并基于砧座组件100的缝钉成形凹槽11使缝钉变形。各种实施方式的滑车 160、动力夹钳元件150和钉仓组件200的进一步的细节在美国专利公开US2006/0011699A1 中有描述。

[0199] 如图2和7所示,砧座组件110可以是细长的并分别包括近端116、远端118、顶表面IHa和底表面114b。一对耳轴119a和119b可设置在近端116附近并被设计成用于可枢转接合对应的一对槽口 123a和12北,槽口 123a和12¾设置在细长通道组件120的近端附近的侧壁121a和121b中。可以想到,通过常规方式(例如远程致动,例如通过手柄组件 5)致动可引起夹钳卡圈140沿着远侧方向运动并接合砧座组件110的前向凸轮表面115。 这可引起砧座组件110从打开的第一位置枢转到闭合的第二位置,在所述第一位置中细长通道组件120以彼此间隔设置的关系设置,在所述第二位置中砧座组件110和钉仓组件200 协同动作将组织夹钳在其间,即将组织预先夹钳在砧座组件110的组织接合表面114b和钉仓组件200的相对的组织接合表面231之间。但是,其他砧座组件设置也可成功地被采用。

[0200] 在各种实施方式中,砧座组件110可包括细长的十字形或者T形通道或者槽,其总体标记为112,具有悬垂中央部分(cbpendingcentral portion)或者腿11¾和横向上部 112b。见图7。槽112优选从砧座组件110的上部11½的近端113纵向延伸到其远端118。 腿11¾从砧座组件110的近端113开始或者进入其中并延伸到远端118,横向上部112b从近侧凸轮115开始并延伸到远端118。见图7。优选地,上部112b的尺寸设置成滑动容纳横向销159,该横向销159在动力夹钳元件150的中央支架或者延伸部分157的上部157中的孔154内延伸(见图9)。销159的尺寸设置成将动力夹钳元件150的上部157滑动锁定在T形槽112中,使动力夹钳元件150可在槽112中纵向往复运动。

[0201] 在各种实施方式中,在组织紧固之前,预夹钳卡圈140可被设置成围绕通道组件 120和砧座组件110,并将它们夹紧或者预夹紧在接近的夹钳位置中。通过向远侧运动预夹钳卡圈140,用户可从打开的第一位置向着通道组件120致动/运动砧座组件110使钳口即砧座组件110和钉仓200靠近到闭合的第二位置,将组织夹持在其间。滑车160可由用户致动以缝合并随后切断组织。

[0202] 最好见图4、8和9所示,在动力夹钳元件150通过组织400向远侧移动过程中,砧座组件Iio的大尺寸材料以及大致垂直对准的翼缘152、刀片155和凸轮运动销159的组合进行操作,使位于刀15¾的前缘155远侧的运动点处的相对的组织接合表面(即砧座底表面114b和钉仓组件200的朝上表面231)进一步靠近(即进一步夹钳)。相对于移动的动力夹钳元件150向远侧进一步夹钳组织400用来保持相对的表面114b和231之间的最大可接受间隙并从组织400压迫出流体,该流体可增强缝合并降低在变形过程中缝钉350的液压位移的可能性。可以想到,由于砧座组件110的大尺寸材料和上述动力夹钳元件150 一起产生的增强的闭合力的组合,当前缘巧5行进穿过组织400时增强的闭合力的组合允许组织400的相对精确的切割。

[0203] 通过前面的描述部并参照各个附图,本领域技术人员将会理解,也可对本发明公开的内容进行一些改变,也不脱离本发明公开的范围。例如,上述工具组件100可以是一次性加载单元(DLU)诸如在美国专利IS6330965中公开的那些的一部分或者结合到其中,或者直接与任何已知的外科缝合装置的远端连接。用于致动接近元件的手柄组件可选自各种致动机构,包括拉钳、可旋转和滑动的旋钮、可枢转的杆或扳机以及它们的任何组合。上述工具组件100作为机械系统的一部分的使用也是可以想到的。

[0204] 图10-18示出了单一用途的工具组件设置。如同从这些图中可以看到的那样,一对索、绳线、丝线、窄带或者带800、820可由通道组件120支撑。如同从图11和12中看到的那样,第一索800包括锚定段802、致动部分804和运动部分805,锚定段802固定到细长通道组件120的远端123处的底部1¾上的第一连接点803上,致动部分804延伸到定位在外壳部分5中的驱动系统(未示出)。如同特别从图12中看到的那样,第一索800可操作地支撑在远侧第一索过渡支架830上,该远侧第一索过渡支架830例如包括安装到细长通道组件120的远端123的底部1¾上的滑轮、杆、绞盘等。第一索800还可操作地支撑在第二索过渡支架840上,该第二索过渡支架例如可包括安装到刀组件170的双滑轮840。在一种实施方式中,例如,第二索过渡支架安装到动力夹钳元件150的底部翼缘部分152上。 见图12和13。第一索800可经过设置在细长通道组件120的底部128中的纵向延伸的第一槽806。运动部分805可邻近槽1¾来回自由地轴向运动。致动部分804可经过细长通道组件120的底部128中的第一过渡通道808,见图11。

[0205] 同样在该实施方式中,第二索820可具有锚定部分822、延伸到定位在手柄外壳5 中的驱动系统的致动部分拟4和运动部分825,所述锚定部分822在第二连接点803’处固定到细长通道组件120的远端123的底部1¾上。第二索820可操作地支撑在远侧第二索过渡支架850上,该过渡支架例如可以包括与细长通道组件120的远端123连接并且还可操作地支撑在远侧第二索过渡支架850上的第二滑轮、杆、绞盘等。第二索820可通过设置在细长通道组件120的底部128中的纵向延伸的第二槽826。运动部分825可靠近槽126 前后自由地轴向运动。致动部分拟4可经过细长通道组件120的底部128中的第二过渡通道828。见图11。本领域普通技术人员将会理解,所述设置可提供优于现有的索设置的改进的机械优点,由此降低了必须产生使动力夹钳元件150、刀155和滑车160形式的刀组件 170行进以击发缝钉350的击发力的大小。

[0206] 如上所述,刀组件170(即动力夹钳元件150、刀155和滑车160)的前进和回缩由索800、820控制,每个索都具有例如可与索驱动系统连接的近端,所述索驱动系统例如可包括可旋转的卷绕鼓轮(一个或多个)(未显示),其可操作地支撑在手柄5上。一个或多个卷绕鼓轮可机械或手动地旋转或者通过马达提供动力,使索800、820在其上旋转。当索 800、820被卷绕在那些鼓轮上时,刀组件170(动力夹钳组件150/滑车160)从细长通道120 的近端向其远端驱动,完成切割及缝合操作。在各种实施方式中没有提供装置用于将刀组件170回缩到通道120的近端,因而工具组件不能被重新使用。

[0207] 替代的击发系统1300的实施方式在图15-20中公开。如图15_17中可以看到的那样,该实施方式采用了行进索1302和以示意图形式示出的回缩索1330,该行进索1302分叉形成一对行进索部分1310、1320。如同更尤其从图16中可以看到的那样,第一行进索部分1310可操作地支撑在远侧第一索过渡支架1340上,该远侧第一索过渡支架例如可包括与细长通道组件120的远端123连接的滑轮、杆、绞盘等,见上述。第一行进索部分1310的远端1312可固定到刀组件170(动力夹钳组件150)上。第二行进索部分1320可操作地支撑在例如可包括安装到细长通道元件120的远端123上的滑轮、杆、绞盘等的远侧第二索过渡支架1360上。第二行进索部分1320的远端1322与刀组件170 (动力夹钳组件150)连接。同样在这些实施方式中,采用回缩索1330。在一种实施方式中,回缩索1330可形成环, 使远侧成环末端1332固定连接到动力夹钳组件150上。

[0208] 在各种实施方式中,行进索1302和回缩索1330例如可由索驱动系统1000驱动, 所述索驱动系统例如可包括安装在手柄组件5中或者由其支撑的手动致动的绞盘组件 1001。见图17-20。绞盘组件1001例如可包括由手柄组件5枢转支撑的击发扳机1004形式的致动器1002。虽然该实施方式采用可握持扳机1004,本领域普通技术人员将会理解, 在不背离本发明的精神和范围的条件下,致动器1002可包括按钮、杆、滑块等。在图17-20 所示的实施方式中,绞盘组件1001可分别包括支撑在机架组件1012上的传动装置1010、可旋转第一线轴1250和可旋转第二线轴1260。

[0209] 在各种实施方式中,手柄齿轮部分1006可形成或者以其他方式设置在击发扳机 1004上。手柄齿轮部分1006与安装到与离合器组件1050的第一棘齿离合器盘1052连接的轴1042上的初级传动齿轮1040啮合地安装。见图18。第二棘齿离合器盘1060支撑在旋转支撑在手柄组件5中的离合器轴1062上。离合器轴1062可设置有肩部1064并具有通过轴颈连接于其上并与一部分外壳3接触的离合器弹簧1066,将第二棘齿离合器盘1060 偏压成与第一棘齿离合器盘1052啮合。通过图18还可以看出,第二传动齿轮1070可通过轴颈连接在离合器轴1062上并与第三传动齿轮1080啮合,所述第三传动齿轮1080连接到第一传动轴1090上,第一传动轴1090由与由安装在机架组件1012中的第一传动轴承或者套筒1092可旋转支撑。见图18。第一传动轴1090可具有第一小齿轮部分1100和在其上形成的一组第一齿轮齿1102,用于选择性地与轴向地并可旋转运动的轴卷筒1110上的一组初级齿轮齿1112啮合。从图20中可以看出,轴卷筒1110容纳在花键轴1120上,该花键轴可旋转地容纳在第一传动轴1090和第二小齿轮1130中。第二小齿轮1130具有第二小齿轮部分1132和一组第二齿轮齿1134,以便选择性地与轴卷筒1110上的次级齿轮齿1114 啮合。第二小齿轮1130由安装在机架组件1012中第二轴承1136可旋转地支撑,如图所示。 从图18和20中可以看出,反向锥齿轮1140由分别与第一和第二小齿轮1100、1130啮合的机架组件1012支撑。[0210] 从图18和20中还可以看出,轴卷筒1110还具有在其上形成的卡圈部分1150,以便容纳从在切换杆1166的底部上形成的轭形件1160延伸的两个相对的销1162。切换杆 1166可具有轴部分1168,其可枢转地销接到机架组件1012的横杆部分1014上。轴1168 的一部分经过手柄壳体(未显示)中的开口向外突出,并且切换钮1170可与轴1168的端部连接,使用户能够来回轴向移动轴1168,以便使传动装置1010换向(将在下面进一步探讨)。本领域普通技术人员将会理解,轭形件1160的设置使轴卷筒1110能够相对于轭形件 1160自由旋转,同时使轭形件1160能够在花键轴1120上轴向移动轴卷筒1110。

[0211] 如图20所示,切换器输出齿轮1180通过键或其他方式连接到花键轴1120上,以便与花键轴1120 —起旋转。该切换器输出齿轮1180被设置成与第一卷筒齿轮1190啮合, 该第一卷筒齿轮1190被连接到可旋转第一卷筒1250的轴1200上。第一卷筒传动齿轮1220 连接到可旋转第一卷筒轴1200的另一端部上。第一卷筒传动齿轮1220与反向齿轮1230 啮合,该反向齿轮1230与连接到可旋转第二卷筒1260的轴1252上的第二卷筒传动齿轮 1240啮合。见图17。在各种实施方式中,行进索1302可被接收在可旋转第二(底部)卷筒1260上并且回缩索1330被接收在可旋转第一卷筒1250上。

[0212] 现在将参照图17-20描述绞盘1000的操作方法。首先转到图20,在该图中,轴卷筒1110处于空闲位置。因此,击发扳机1004的致动不会导致动力夹钳元件150、刀155或者滑车160的任何运动。为了击发装置(使动力夹钳元件150、刀155和滑车160从细长通道组件120的近端运动到细长通道组件120的远端),临床医生将切换器钮1170切换到图 18中显示的位置。在这样做时,轴卷筒1110的初级齿轮齿1112与第一小齿轮1100的第一齿轮齿1102啮合。在轴卷筒1110已经运动到该位置之后,临床医生可开始拉动/枢转击发扳机1004,引起手柄齿轮部分1006沿着由图18中的箭头“A”表示的方向运动。当击发扳机1004继续枢转时,齿轮部分1006使初级传动齿轮1040和离合器组件1050以及第二传动齿轮1070沿着“B”方向旋转。当第二传动齿轮1070沿着该方向旋转时,第三传动齿轮1080沿着相反的“A”方向旋转,这又引起第一小齿轮1100沿着该方向旋转。由于第一小齿轮1100的第一齿1102与轴卷筒1110的初级齿1112啮合,轴卷筒1110也沿着“A”方向旋转。当轴卷筒1110沿着“A”方向旋转时,花键轴1120和切换器输出齿轮1180也沿着该方向旋转。切换器输出齿轮1180与连接到第一卷筒1250的轴1200连接的第一卷筒齿轮1190啮合。当切换器输出齿轮沿着“A”方向旋转时,第一卷筒齿轮1190沿着“B”方向旋转。第一卷筒传动齿轮1220与轴1200连接并且也沿着“B”方向旋转。当第一卷筒1250 沿着“B”方向旋转时,回缩索1330被第一卷筒1250放出。当第一卷筒1250旋转时,第一卷筒传动齿轮1220沿着相同方向旋转。第一卷筒传动齿轮1220、反向齿轮1230和第二卷筒传动齿轮1240引起第二卷筒1260将行进索1302卷绕于其上。

[0213] 在击发扳机1004已经被下压到其最大可能压缩程度时(到其冲程末端),临床医生释放击发扳机1004,并且由手柄组件5支撑的弹簧(未显示)或者其他合适设置偏压击发扳机1004回到开始位置(未击发位置)。当击发扳机1004恢复到开始位置时,第一离合器盘1052相对于第二离合器盘1060向后旋转(“A”方向),同时第二离合器盘1060保持静止而不运动。用户然后可再次压下击发扳机1004,直到动力夹钳元件150、刀155和滑车 160通过行进索1302已经完全行进到通道组件120中的远端位置。

[0214] 为了回缩(使刀组件170沿着近侧方向“PD”运动到开始位置)动力夹钳元件150、刀155和滑车160,临床医生移动切换器钮1170,使轴卷筒1110的次级齿轮齿1114与第二小齿轮1130上的第二齿轮齿1134啮合。在轴卷筒1110已经运动到该位置之后,临床医生可以上述方式开始拉动/枢转击发扳机1004。当击发扳机1004继续枢转时,齿轮部分1006 沿着“B”方向旋转初级传动齿轮1040以及离合器组件1050和第二传动齿轮1070。当第二传动齿轮1070沿着该方向旋转时,第三传动齿轮1080沿着相反的“A”方向旋转,也引起第一小齿轮1110沿着该方向旋转。当第一小齿轮1100旋转时,其引起反向锥齿轮1140旋转并引起第二小齿轮1130沿着“B”方向旋转。由于轴卷筒1110的次级齿1114与第二小齿轮1130的第二齿1134啮合,轴卷筒1110和花键轴1120沿着“B”方向旋转。切换器输出齿轮1180引起第一卷筒传动齿轮1220沿着“A”方向旋转。当第一卷筒传动齿轮1220沿着“A”方向旋转时,回缩索1330卷绕到第一卷筒1250上。当第一卷筒1250旋转时,第一卷筒传动齿轮1220沿着相同的方向旋转。第一卷筒传动齿轮1220、反向齿轮1230和第二卷筒传动齿轮1240引起第二卷筒1260旋转以从第二卷筒1260松开行进索1302。

[0215] 在击发扳机1004已经被压下到其最大可能压缩程度时(到其冲程末端),临床医生释放击发扳机1004,并且由手柄组件5支撑的弹簧(未显示)或者其他合适设置偏压击发扳机1004回到开始位置(未击发位置)。当击发扳机1004恢复到开始位置时,第一离合器盘1052相对于第二离合器盘1060向后旋转,同时第二离合器盘1060保持静止而不运动。用户然后可再次压下击发扳机1004,直到动力夹钳元件150、刀155和滑车160通过回缩索1330已经完全回缩到细长通道组件120中的开始位置。

[0216] 在图18和20中示出的实施方式中,可旋转第一卷筒1250和可旋转第二卷筒1260 逐渐变细。也就是说,它们沿着各自的轴向方向具有逐渐减小的直径。因此,当绞盘组件 1001张紧索时,绞盘组件1001具有改变机械优点的能力。在该实施方式中,行进索1302与卷筒1260连接并且回缩索1330与卷筒1250连接,使最大张紧力在击发过程开始时产生。 在绞盘组件1001以恒定扭矩转动时,索在卷筒上张紧并且卷筒直径的变化将改变传递到索上的力。当击发过程中必须克服的最大摩擦或者阻力在击发程序开始发生时,这种设置特别有利。但是,如果最大摩擦和阻力预期在接近击发过程结束时遇到,则索1302、1330可与它们各自的卷筒1260、1250的另一端(较小的一端)连接。在又一种其他实施方式中, 如果最大阻力和摩擦力在击发过程的中间遇到时,则每个卷筒1250、1260可具有带有比卷筒的端部更大的直径的中央部分。这种独特新颖的卷筒构造与上面描述的独特新颖的滑轮一道,使装置能够被设计成解决在击发顺序中遇到的不同摩擦和阻力,并代表了对与外科缝合器械结合采用的驱动系统有关的现有索的巨大改进。

[0217] 虽然上述索驱动系统1000包括了可手动致动的驱动系统,但本发明的其他构思实施方式也可采用电池供电的一个或多个马达,交流电供电的一个或多个马达或者气动马达,以便为索驱动系统供电。因此,对本发明的各种实施方式给予的保护不应当仅仅限制为可手动致动的外科器械。

[0218] 图15A、16A和21示出了本发明的另一种改进实施方式的击发系统1300’。从图 15A和16A中可以看出,该实施方式采用了一对行进索1310’、1320’和回缩索1330。图15A 和16A以示意形式示出了索1310’、1320’和回缩索1330。从这些附图中可以看出,第一行进索1310’可操作地支撑在远侧第一索过渡支架1340和近侧第一索过渡支架1350上,如同上面描述的那样,所述远侧第一索过渡支架例如可包括与细长通道组件120的远端123连接的滑轮、杆、绞盘等,所述近侧第一索过渡支架例如可包括可操作地由细长通道组件120 支撑的滑轮、杆、绞盘等。第一行进索1310’的远端1312’固定到刀组件170(动力夹钳组件150)并且第一行进索1310’的近端1314’连接到与可往复运动驱动元件1390连接的连接器1380。如同从图15A和16A中看到的那样,远侧第一索过渡支架1340可被定向成使其旋转轴线大体上与近侧第一索过渡支架1350的旋转轴线垂直。第二行进索1320’可操作地支撑在远侧第二索过渡支架1360和近侧第二索过渡支架1370上,所述远侧第二索过渡支架例如可包括与细长通道组件120的远端123连接的滑轮、杆、绞盘等,所述近侧第二索过渡支架例如可包括例如安装在细长通道组件120的近端的滑轮、杆、绞盘等。第二行进索1320的远端1322,连接刀组件170(动力夹钳组件150)并且近端1324,与连接器1380, 连接。同样在这些实施方式中,采用回缩索1330。在一种实施方式中,回缩索1330可形成环,使远侧环状末端1332固定连接(模压等)到动力夹钳组件150上并且两个近端1334、 1336每个都固定连接(模压等)到连接器1380上。

[0219] 本领域普通技术人员将会理解,当驱动杆1390沿着远侧方向“DD”行进时,动力夹钳元件150、刀155和滑车160也可沿着远侧方向(“DD”)行进。为了沿着近侧方向“PD” 回缩刀,驱动杆1390沿着近侧方向“PD”运动。在各种实施方式中,驱动杆1390可选择性地通过驱动系统1400行进和回缩,所述驱动系统1400在操作上有些类似于绞盘组件1001 的操作,但下面描述的不同除外。特别是,从图21中可以看出,手柄齿轮部分1006可在击发扳机(未显示)上形成或者设置。手柄齿轮部分1006可安装成与初级传动齿轮1040啮合,所述初级传动齿轮安装在与离合器组件1050的第一棘齿离合器盘1052连接的轴(未显示)上。第二棘齿离合器盘1060支撑在可旋转支撑在手柄组件5中的离合器轴1062上。 离合器轴1062可设置有肩部(未显示)并具有通过轴颈连接于其上的离合器弹簧1066,以便将第二棘齿离合器盘1060偏压成与第一棘齿离合器盘1050啮合。

[0220] 第二传动齿轮1070可通过轴颈连接到离合器轴1062上并与第三传动齿轮1080 啮合,所述第三传动齿轮1080与由安装在机架组件1012’中的第一传动轴承或套筒(未显示)可旋转支撑的第一传动轴1090连接。第一传动轴1090具有第一小齿轮部分1100和一组在其上形成的第一齿轮齿1102,以便选择性地与轴向可旋转运动的轴卷筒1110上的一组初级齿轮齿1112啮合。轴卷筒1110容纳在可旋转容纳在第一传动轴1090和第二小齿轮1130中的花键轴1120(未显示)上。第二小齿轮1130具有第二小齿轮部分1132和一组第二齿轮齿1134,用于选择性地与轴卷筒1110上的次级齿轮齿1114啮合。第二小齿轮1130由安装在机架组件1012’中的第二轴承(未显示)可旋转支撑,如图所示。

[0221 ] 反向锥齿轮1140由分别与第一和第二小齿轮1100、1130啮合的机架组件1012’支撑。轴卷筒1110具有在其上形成的卡圈部分1150,以便容纳从切换杆1166的底部上形成的轭形件1160延伸的两个相对的销1162。切换杆1166具有枢转地销接到机架组件1012’ 上的横杆部分1014’的轴1168部分。一部分轴1168经过手柄壳体(未显示)中的开口向外突出,并且切换钮1170可与轴1168的端部连接,使用户可来回轴向移动轴1168,使驱动器1140反向(将在下面进一步探讨)。本领域普通技术人员将会理解,轭形件1160的设置使轴卷筒1110相对于轭形件1160自由旋转,同时使轭形件1160在花键轴1120上轴向移动卷筒1110。

[0222] 切换器输出齿轮1180锁定到花键轴1120上或者与其连接以便与其一起旋转。切换器输出齿轮1180被设置成与连接到传动轴1200’的传动齿轮1190’啮合。与传动轴1200’ 连接的是传动齿轮1410,其与被限制成在机架1012’中形成的两个凸耳1422、14M之间沿着远侧和近侧方向轴向运动的齿条1420啮合。为了将驱动杆1390的近端固定到齿条1420 上,可在齿条1420的远端1425中形成T形槽1似6。但是,也可采用其他连接方法。

[0223] 现在将描述操作驱动系统1400的方法。从图21中可以看出,轴卷筒1110处于空闲位置。因此,击发扳机1004的致动不会导致动力夹钳元件150、刀155或者滑车160的任何运动。为了击发装置(使动力夹钳元件150、刀155或者滑车160沿着远侧方向DD运动),临床医生移动切换器钮1170,使第一小齿轮1100的第一齿轮齿1102与轴卷筒1110的初级齿轮齿1112啮合。在轴卷筒1110已经运动到该位置时,临床医生可开始拉动/枢转击发扳机1004,引起手柄齿轮部分1006运动。当击发扳机1004继续枢转时,齿轮部分1006 使离合器组件1050的初级传动齿轮和第二传动齿轮1070旋转。当第二传动齿轮1070沿着一个方向旋转时,第三传动齿轮1080沿着相反的方向旋转,并且还引起第一小齿轮1100 也沿着该方向旋转。由于第一小齿轮1100的第一齿1102与轴卷筒1110的初级齿1112啮合,轴卷筒1110也沿着该方向旋转。当轴卷筒1110沿着该方向旋转时,花键轴和切换器输出齿轮1180也沿着该方向旋转。切换器输出齿轮1180引起传动齿轮1190’、传动轴1200’ 和传动齿轮1410沿着“B”方向旋转,从而沿着远侧方向DD驱动齿条。

[0224] 在击发扳机1004已经被下压到其最大可能压缩的程度(到其冲程末端)时,临床医生释放击发扳机1004并且弹簧(未显示)或者由手柄组件5支撑的其他合适设置偏压击发扳机1004回到开始位置(未击发位置)。当击发扳机1004返回到开始位置时,第一离合器盘1052相对于第二离合器盘1060向后旋转(A方向),同时第二离合器盘1060保持静止而不运动。临床医生然后可再次压下击发扳机1004,直到刀组件170(动力夹钳元件 150、刀155和滑车160)通过齿条1420和驱动杆1390已经完全行进到通道组件120中的远侧末端位置。

[0225] 为了回缩(沿着近侧方向“PD”运动到开始位置)动力夹钳元件150、刀155和滑车160,临床医生移动切换器钮1170,使轴卷筒1110的次级齿轮齿1114与第二小齿轮1130 上的第二齿轮齿11;34啮合。在轴卷筒1110已经运动到该位置之后,临床医生可以上述方式开始拉动/枢转击发扳机1004。当击发扳机1004继续枢转时,齿轮部分1006沿着“B” 方向旋转初级传动齿轮1040以及离合器组件1050和第二传动齿轮1070。当第二传动齿轮 1070沿着该方向旋转时,第三传动齿轮1080沿着相反的“A”方向旋转,也引起第一小齿轮 1110沿着该方向旋转。当第一小齿轮1100旋转时,其引起反向锥齿轮1140旋转并引起第二小齿轮1130沿着“B”方向旋转。由于轴卷筒1110的次级齿1114与第二小齿轮1130的第二齿1134啮合,轴卷筒1110和花键轴1120沿着“B”方向旋转。切换器输出齿轮1180 引起传动齿轮1190’、传动轴1220’和传动齿轮1410沿着“A”方向旋转,这引起齿条14M 沿着近侧方向“PD”运动。

[0226] 在击发扳机1004已经被下压到其最大可能压缩程度时(到其冲程末端),用户释放击发扳机1004,并且由手柄组件5支撑的弹簧(未显示)或者其他合适设置偏压击发扳机1004回到开始(未击发位置)位置。当击发扳机1004返回到开始位置时,第一离合器盘1052相对于第二离合器盘1060向后旋转(A方向),同时第二离合器盘1060保持静止而不运动。用户然后可再次下压击发扳机1004,直到动力夹钳元件150、刀155和滑车160通过驱动杆1390和导轨14M已经完全回缩到细长通道组件120中的开始位置。本领域技术人员将会理解,传动装置或导轨和小齿轮的传动比的变化可被用于得到改进的机械优点, 以便在细长通道组件120中驱动刀组件170(动力夹钳元件150、刀155和滑车160)。

[0227] 虽然上述索驱动系统1400包括了可手动致动的驱动系统,但本发明的其他构思实施方式也可采用电池供电的一个或多个马达,交流电供电的一个或多个马达或者气动马达,以便为索驱动系统供电。因此,对本发明的各种实施方式给予的保护不应当仅仅限制为可手动致动的外科器械。

[0228] 图22-¾示出了可采用本发明的一些零件的另一种外科缝合器械1500的一部分。 该实施方式采用了从手柄(未显示)延伸到通道组件(未显示)的中空脊或者管1510。在图 22-24示出的实施方式中,中空脊1510与Racenet等人的美国专利公开US 2005/0006432 中公开的类型和构造的关节运动接头1512连接,该文献的内容通过引用而包含在本申请中。在不背离本发明的精神和范围的条件下也可采用其他关节运动接头设置。从图22-24 中可以看出,驱动杆1520延伸穿过中空管1510并具有近端1522,该近端1522可与上述类型的驱动设置的导轨连接并由手柄支撑。过渡块1530可与驱动杆1520的远端15M连接或者在其上形成以便连接从动杆1540。近侧滑轮、杆、绞盘等1560安装在中空管1510中, 如图22和M中所示。

[0229] 索、丝线、窄带、带等1570可操作地支撑在通道组件(未显示)上形成的一个或多个滑轮、杆、绞盘等上,并延伸穿过关节运动接头1512并可操作地支撑在如图22-M中显示的远侧滑轮1560上。索1570可具有行进部分1572和回缩部分1574。回缩部分1574的端部1576可固定连接到从动杆1540的远端巧42,如图22中所示。同样的,索1570的另一端部1578与从动杆1540的远端1542连接。图22示出了当动力夹钳元件(未显示)、 刀(未显示)和滑车(未显示)处于细长通道组件(未显示)的远端时从动杆1540的位置。动力夹钳元件、刀和滑车可通过上述驱动系统(图21)以可引起驱动杆1520和从动杆 1540沿着近侧方向“PD”运动的上述回缩模式操作运动到回缩位置。本领域普通技术人员将会理解,所述设置代表了优于现有索设置的机械优点的巨大改进。还应当理解,当器械进行关节运动时索1570可挠曲。在其他实施方式中,索的端部可与将在下面进一步描述类型的弹簧连接设置连接在一起。

[0230] 如上所述,当使用索驱动的外科切割和缝合器械时可能遇到的一个问题是一根或多根索可与一个或多个索过渡支架诸如滑轮、杆、绞盘等脱离接合或者可使装置丧失能力的类似问题。例如,所述索脱离可由装置的使用过程中的机械振动引起,或者可通过在使用或者运输过程中装置受到震动引起。图25-27示出了采用索止动元件1600的本发明的其他实施方式,该索止动元件例如可包括细长通道组件120上靠近索过渡支架830、850以将索800、820分别保持于其上的索保持块1601。在各种实施方式中,索过渡支架830、850例如可包括滑轮、杆、绞盘等。虽然在各种实施方式中索保持块1610可以各种形状和构造设置,但每个索保持块1601可具有与索800、820弧形形状互补的弧形表面1602,使索800、 820不会与索过渡支架800、820脱离。

[0231] 图28和四示出了另一种索止动元件1700,例如其可包括本发明的其他实施方式的索保持块1701。从这些附图中可以看出,块1701具有穿过其中的通道1702,其形成索 800、820可通过的弧形支撑表面1704。在该实施方式中,在安装过程中索可穿入弧形通道1702并从其中通过。所述设置避免了索从一个或多个滑轮、杆、绞盘等脱开的问题。

[0232] 图30-33以示意形式示出了本发明的另一种实施方式。该实施方式采用具有由索 1800驱动的动力夹钳元件150、刀155和滑车组件160 (在本文中统称为“刀组件170”)的细长通道组件120。特别是,索1800可操作地支撑在一对索过渡支架1802、1804和位于刀组件170上的第三索过渡支架1806上,所述索过渡支架1802、1804例如可包括安装在细长通道组件120的远端123底部的滑轮、柱、绞盘等,所述第三索过渡支架1806例如可包括滑轮、柱、绞盘等。另外,索1800可操作地支撑在由手柄组件5可运动支撑的驱动滑轮1808 上。驱动滑轮1808可通过手柄组件5中的扳机(未显示)或者其它致动器设置(未显示) 选择性地沿着远侧方向“DD”和近侧方向“PD”运动。

[0233] 如图30-33中示出的本发明的其他实施方式采用独特新颖的用于连接索1800的端部的索张紧接头1801,以便保持索1800的张紧,防止索1800从滑轮1802、1804、1806、 1808脱落。特别是,该设置采用弹簧1810形式的张紧元件,其大体上沿着与索加载路径平行的路径定向。从那些附图中可以看出,第一止动元件或者块1820固定(模制、粘合、焊接等)连接到索1800的第一端部1803。索1800的第二端部1805也与第二止动元件或者块1830固定连接(模制、焊接、粘合等)。从图33中可以看出,第二止动元件1830具有穿过其中的通道1832,一部分索1800可滑动通过其中,如该图中的箭头所示。第三止动元件或者块1840与索1800固定连接并且弹簧1810的端部与其连接。弹簧1810的另一端与第二止动元件1830连接。本领域普通技术人员可以理解,当可操作地支撑在例如滑轮、绞盘、 保持块等形式的索过渡支架上时,当张紧弹簧1810未扩张时所述设置允许索1800使距离 “L”(第一和第二止动元件1820、1830之间的距离)变长。还应当理解,当采用如图32中所示的进行关节运动的器械时所述设置特别有利。特别是,索张紧接头1801的使用使索能够延伸或者围绕关节运动接头弯曲,同时保持围绕各种索过渡支架张紧。

[0234] 如上所述,当采用索驱动系统时通常遇到的另一种挑战涉及以确保索有效地将需要的力传递到刀/动力夹钳元件或者其他外科器械元件的方式连接索(驱动元件)的端部。图34和35示出了本发明的各种实施方式的环形索1900。在该实施方式中,例如,环形索1900可包括编织的金属线或者编织的塑性材料元件。为了形成环形索,端部1902的纤维 1903可与端部1904的纤维1905交织形成索环。另一种实施方式是中国式指套(Chinese finger cuff)(图35)方法,其中一个端部插入中空编织索的另一端部形成张得更紧的连接。在各种实施方式中,在组装过程中可采用一些紧固剂/粘接剂以便于所述接头的预张紧。例如,当沿着纵向施加张力时所述设置可允许索1900稍微围绕其纵向轴线“L-L”压缩。 所述编织模式的一个例子在Olsen的美国专利US4817643中公开,其内容通过引用而包含在本申请中。在端部1902、1904如图所示编织在一起之后,索1900形成封闭的环1906。当端部1902、1904编制或者交织在一起时,索可围绕驱动滑轮或者其他元件以及外科器械元件的可运动元件诸如销、滑轮、绞盘或者其他部分成环。

[0235] 图36-38示出了本发明的用于将索与外科器械元件连接的另一种索连接设置 2000。从这些附图中可以看出,索2002可具有大体上为楔形或者大体上为圆锥形的嵌块 (slug) 2010,该嵌块具有在其中延伸的孔2012,用于容纳索2002的端部2004,如图36中所示。嵌块2010可卷曲、模制、粘合、包覆成型、超声焊接等到索端部2012上,如图所示。在各种实施方式中,例如,嵌块2010可由略软的材料诸如铅、铜、黄铜、不锈钢、钛等或者例如热塑性材料诸如尼龙或者聚碳酸酯制成。嵌块2010的尺寸设置成使其能被容纳在例如与动力夹钳元件150连接的外科器械元件中的形状互补的凹口 2020中。凹口 2020的尺寸可设置成当沿着“T”方向向索2002施加张力时使连接变得更紧。也就是说,当索张力增大时, 嵌块2010进一步压缩在索2020的端部2004上。在各种实施方式中,凹口 2020可以至少在其一侧上是开口的,以允许嵌块2010被安装在其中。

[0236] 图39示出了本发明的各种实施方式的另一种索连接设置2100。从该图中可以看出,索2110的端部2112可围绕销2120卷绕,并通过一个或多个夹具2130与索2110的其他部分2114连接,所述夹具可卷绕或者夹紧于其上,以便形成环2140,该环2140用于容纳至少一部分外科器械元件例如诸如滑轮、销、绞盘等。

[0237] 图40示出了本发明的各种实施方式的另一种索连接设置2200。从该图中可以看出,索2210的端部2212可卷绕在销2220上并可焊接或者粘合在索2210的另一相邻部分 2214上以形成环2240,以便容纳至少一部分外科器械元件,例如滑轮、销、绞盘等。

[0238] 在美国专利公开US 2006/0011699A1中公开的内镜切割器采用了两个索系统:一个用于闭合砧座,并且另一个拉动动力夹钳组件、刀和滑车,以切割组织并成形缝钉。在一种设置中,索与夹钳卡圈连接以便在凸轮表面上和上方向远侧拉动夹钳卡圈,以便相对于钉仓组件闭合砧座并压缩组织。该闭合索必须通过关节运动接头回穿到手柄中。当该索的近端被拉动时,与夹钳卡圈连接的索的远端引起夹钳卡圈向远侧运动并闭合砧座。但是,所述设置受到产生夹钳力的能力的限制。

[0239] 图41示出了在上述公开中公开类型的关节运动接头1512。图42和43示出了本发明的各种实施方式的闭合管组件2300的关节运动接头组件2302,这些实施方式可与关节运动接头1512结合使用并不需要用索来闭合砧座110。图44示出了安装在关节运动接头1512上方的闭合管组件2300。如同将在下面进一步详细讨论的那样,在各种实施方式中,闭合管组件2300可操作地靠近细长通道组件120受到支撑,以便当与闭合管组件2300 闭合接触时选择性地将闭合动作施加到砧座组件110。

[0240] 从图42中可以看出,闭合管组件2300的实施方式可包括具有近端2312和远端 2314的远侧闭合管段2310、具有远端2322和近端23¾的中央闭合管段2320和具有近端 2332和远端2334的近侧闭合管段2330。近侧闭合管段2330的近端2332可以不可旋转地连接到闭合管段2340的远端2342。从图43中可以看出,中空闭合管段2340的远端2342中可设置有用于容纳从近侧闭合管段2330的远端2334向近侧突出的翼片2336的凹口 2344。 从图43中还可以看出,近端2332可容纳在中空闭合管段2340的中空远端2342中。近侧闭合管段2330可通过粘接剂、胶水等与闭合管段2340保持连接。本领域普通技术人员应当理解,所述独特新颖的构造帮助促进装置的组装。但是,例如在其他实施方式中,近侧闭合管段2330可与闭合管段2340 —体形成。

[0241] 在各种实施方式中,闭合管组件2300可还包括从近侧闭合管段2330的远端2334 突出的第一上部翼片2350和与第一上部翼片2350成间隔关系的从近侧闭合管段2330的远端2334突出的第一下部翼片2352。第一上部翼片2350具有穿过其中的第一上部枢轴孔 2354并且第一下部翼片2352具有穿过其中的第一下部枢轴孔2356,在各种实施方式中该第一下部枢轴孔与第一上部枢轴孔23M共轴对准。中央闭合管段2320的近端23M具有从其上突出的第二上部翼片23¾和从其上突出并与第二上部翼片23¾成间隔关系的第二下部翼片2328。第二上部翼片23¾具有穿过其中的第二上部枢轴孔2327并且第二下部翼片23¾具有穿过其中的第二下部枢轴孔23¾,该第二下部枢轴孔大体上与第二上部枢轴孔2327共轴对准。

[0242] 从图44中可以看出,中央闭合管段2320的远端2322具有从其上突出的第一侧向翼片2321和第二侧向翼片2323。第一侧向翼片具有穿过其中的第一侧孔(未显示),第二侧向翼片2323具有穿过其中的第二侧孔2325,该第二侧孔与第一侧孔2325共轴对准。另夕卜,远侧闭合管段2310的近端2312具有从其上突出的第三侧向翼片2316和从其上突出并与第三侧向翼片2316成间隔关系的第四侧向翼片2318。第三侧向翼片2316具有穿过其中的第三侧向枢轴孔(未显示),第四侧向翼片2318具有穿过其中的第四侧向枢轴孔2319, 其与第三侧向枢轴孔大体上共轴对准。

[0243] 在各种实施方式中,闭合管接头组件2302还包括具有从其中突出的第一上部销 2362和第二上部销2364的上部双枢轴连接件2360。第一上部销2362的尺寸设置成可枢转地容纳在第一上部枢轴孔23M中,第二上部销2364的尺寸设置成可枢转地容纳在第二上部枢轴孔2327中。上部双枢轴连接件2360可通过关节运动接头组件1512保持在中央闭合管段2320的近端23M和近侧闭合管段2330的远端2334之间的位置中。闭合管接头组件2300可还包括下部双枢轴连接件2370,其具有从其上突出的第一下部销2372和第二下部销2374。见图43。第一下部销2372的尺寸设置成可枢转地容纳在第一下部枢轴孔2356 中,第二下部销2374的尺寸可枢转地容纳在第二下部枢轴孔23¾中。下部双枢轴连接件 2370可通过关节运动接头组件1512保持在中央闭合管段2320的近端23M和中央闭合管段2320的远端2322之间的位置中。

[0244] 当上部双枢轴连接件2360和下部双枢轴连接件2370连接到中央闭合管段2320 的近端23M和近侧闭合管段2330的远端23;34时,第一上部销2362和第一下部销2372沿着第一枢转轴线D-D共轴对准,在各种实施方式中,该第一枢转轴线D-D可大体上与延伸穿过细长闭合管组件1000的细长轴轴线C-C垂直。见图43。同样的,第二上部枢轴销2364 和第二下部枢轴销2374沿着第二枢转轴线E-E共轴对准。在各种实施方式中,第二枢转轴线E-E大体上与细长轴轴线C-C垂直并大体上与第一枢转轴线D-D平行。读者可以理解,这种设置允许中央闭合管段2320围绕枢转轴线D-D和E-E相对于近侧闭合管段2330枢转。

[0245] 在各种实施方式中,闭合管接头组件2302可还包括第一侧向双枢轴连接件2380, 其具有从其上突出的第一上部销(未显示)和第二上部销(未显示)。第一侧销的尺寸设置成可枢转地容纳在第一侧向翼片2321中的第一侧向枢轴孔(未显示)中,第二侧销的尺寸设置成可枢转地容纳在第三侧向翼片2316中的第二侧向枢轴孔(未显示)中。第一侧向双枢轴连接件2380可通过关节运动接头组件1512保持在远侧闭合管段2310的近端2312 和中央闭合管段2320的远端2322之间的位置中。闭合管接头组件2300可还包括第二侧向双枢轴连接件2390,其具有从其上突出的第三侧销2392和第四侧销2394。第三侧销2392 的尺寸设置成可枢转地容纳在第二侧向翼片2323中的第二侧孔2325中,第四侧销2394的尺寸设置成可枢转地容纳在第四侧向翼片2318中的第四侧向枢轴孔2319中。第二侧向双枢轴孔连接件2390可通过关节运动接头组件1512保持在远侧闭合管段2310的近端2312 和中央闭合管段2320的远端2322之间的位置中。

[0246] 当第一侧向双枢轴连接件2380和第二双枢轴连接件2390连接到远侧闭合管段2310的近端2312和中央闭合管段2310的远端2322上时,第一侧销和第三侧销2392沿着第三枢转轴线F-F共轴对准,在各种实施方式中,该第三枢转轴线F-F可大体上横过细长轴轴线C-C或与其垂直。同样的,第二侧向枢轴销和第四侧向枢轴销2394沿着第四枢转轴线 G-G共轴对准。在各种实施方式中,第三枢转轴线F-F大体上横过细长轴轴线C-C、第一轴线D-D和第二轴线E-E或者与其垂直,并且大体上与第四枢转轴线G-G平行。读者可以理解,这种设置允许远侧闭合管段2310围绕枢转轴线G-G和F-F相对于中央闭合管段2320 枢转。因此,所述设置提供了可在接头组件1512上方轴向运动并仍提供了围绕四个轴线进行多个关节运动的闭合管组件。

[0247] 本领域普通技术人员将会理解,当闭合管组件2300沿着远侧方向DD运动(推动) 时,远侧闭合管段2310的远端2314通过与砧座组件110的凸轮表面115 (见图2、4和7) 接触而将闭合动作施加到砧座组件110上,将砧座组件110相对于钉仓组件200闭合。在各种实施方式中,可采用复位机构例如弹簧、索系统或者类似物(未显示),将闭合管组件 2300回复成预夹钳朝向,当闭合管段2310与砧座组件110近端上的反向凸轮表面117接触时引起砧座组件110重新打开。见图2和7。在图45中所示的其他实施方式中,砧座组件 110’可形成直立的致动翼片111’,其尺寸设置成延伸到远侧闭合管段2310的远端2314中的马蹄形开口 2315中。见图44A。因此,当闭合管组件2300沿着远侧方向DD运动时,马蹄形开口 2315接触斜面115并促使砧座组件110’进入闭合位置。当闭合管组件2300沿着近侧方向PD运动时,马蹄形开口 2315拉动翼片111’并引起砧座组件110’枢转到打开位置。

[0248] 本发明的一种闭合管驱动系统在图46中简要图示。但是,其他系统也可被有效地采用,也不脱离本发明的精神和范围。从图46中可以看出,一种形式的闭合管驱动系统 2400包括与闭合扳机18连接的轭形件M02。枢轴销M04经过闭合扳机18和轭形件M02 两者中对准的开口插入。轭形件M02的远端经销M06与闭合托架MlO的第一部分M08 连接。第一闭合托架部分M08与第二闭合托架部分M12连接。整体上,闭合托架MlO限定了开口,闭合管段2340的近端2346可安放并保持在其中,使闭合托架MlO的纵向运动基本上沿着远侧方向DD推动或驱动闭合管段2340 (并最终驱动细长闭合管组件2300)。

[0249] 在操作中,当轭形件M02由于闭合扳机18的回缩而旋转时,闭合托架MlO弓丨起近侧闭合管段2340沿着近侧方向PD运动,这引起远侧闭合管段2310向近侧运动。如果采用砧座组件110’,当远侧闭合管段2310向近侧运动时则翼片111’引起砧座组件110’打开。 当闭合扳机18从锁定位置打开时,近侧闭合管段2340沿着远侧方向DD被推动或者驱动, 引起远侧闭合管段2310向远侧滑动。远侧闭合管段2310通过驱动砧座组件110’向远侧进入斜面115而迫使其闭合。这种闭合系统MOO在共同拥有的申请号为11/343547的美国专利申请中进一步描述,该申请的题目为“Endoscopic SurgicalInstrument Witha Handle That Can Articulate With Respect to theShaft,,,申请人为 Frederick Ε. Shelton, IV 等,其内容通过全文引用而包含在本申请中。但是,也可采用其他闭合系统使闭合管组件 2300沿着近侧和远侧方向轴向运动。

[0250] 图47-50示出了本发明的各种实施方式的另一种独特新颖的闭合系统2500。在这些附图中示出的实施方式中,采用了可手动致动的驱动系统2600。这样的驱动系统设置在共同拥有的申请号为11/47M12的美国专利申请中公开,其申请日为2006年6月27臼,串请人为 Frederick Ε· Shelton 等,题目为“Manually Driven Surgical Cutting and i^steninglnstrument”,该专利申请的全部内容通过引用而包含在本申请中。如前面所进行的详细描述,本领域技术人员将会理解,本发明的闭合系统2500还可有效地与采用一根或多根索来驱动动力夹钳元件、刀和滑车的外科缝合器械结合使用。另外,闭合系统2500 还可有效地与采用马达来驱动动力夹钳元件、刀、滑车等的其他外科缝合器械结合使用。因此,对本文中描述的闭合系统2500所提供的保护不应当仅限于其与图47-50所示出的可手动致动的驱动系统结合使用。

[0251] 如这些附图中所示,击发扳机沈10由手柄组件5可操作地支撑并在其上具有与可操作地连接旋转驱动轴2614的传动齿轮设置(未显示)啮合连接的齿轮齿沈12。旋转传动轴沈14可旋转地支撑在延伸穿过细长中空闭合管2510的脊沈16中。旋转传动轴沈14 可与由脊沈17可操作地支撑的其他传动元件连接,以便将旋转驱动运动传递到工具组件 100’。而且在各种实施方式中,切换器组件沈20与传动齿轮设置连接。切换器组件可包括选择器开关2622,当开关处于一个位置中并且击发扳机沈10在棘轮运动中枢转时,使旋转传动轴沈14沿着第一方向旋转,并最终将旋转运动施加到工具组件100’上,引起动力夹钳元件或者刀组件沿着远侧方向DD运动,并且当选择器开关沈22运动到第二位置时,击发扳机沈10的棘轮运动引起旋转传动轴沈14沿着相反方向旋转,从而将相反的旋转运动施加到工具组件100’,并引起动力夹钳组件或者刀组件沿着近侧方向PD运动。

[0252] 从这些附图中还可以看出,闭合管组件2500可还包括闭合旋钮2520和用于工具组件旋转的旋转组件2550。从图48中更特别能够看出,闭合旋钮2520可支撑在闭合管 2510的近端2512和脊连接管沈18上。出于组装的目的,闭合旋钮2520可设置成通过机械紧固件或者粘接剂互连的半部。在一种实施方式中,脊连接管2618是中空的并具有带凸缘的近端沈19。带凸缘近端沈19可旋转支撑在设置在闭合旋钮2520中的径向槽2522中,使闭合旋钮2520可围绕脊连接管沈18自由旋转。从图48中还可以看出,脊沈16可具有尺寸设置成延伸到脊连接管2618中的近端沈17。但是,也可采用其他设置。从图48中还可以看出,闭合管2510的近端2512可以带凸缘并可被定向成不旋转地保持在闭合旋钮2520 中形成的第二径向槽25M中,使闭合旋钮2520的旋转引起闭合管2510的旋转。

[0253] 各种实施方式还可包括旋转组件2550。从图47、49和50中可以看出,旋转组件 2550可包括可旋转地容纳在手柄组件5中的旋转旋钮2552。如闭合旋钮2520和外科组件 5 一样,旋转旋钮2552可设置成两部分,为了组装它们可通过机械紧固件-螺钉、按扣等或者粘接剂互连。在各种实施方式中,旋转旋钮2552的远端25M具有在其中延伸的孔2556, 其适于将脊管2560容纳在其中,所述脊管具有与旋转旋钮2552的远端25M轴向接合的带键部分2562,使旋转旋钮2550可相对于脊管2560轴向运动,但总是与其带键部分2562接合。从图48中可以看出,脊管2560具有延伸到闭合旋钮2520中并且通过粘接剂或者其他合适的紧固件设置与脊连接管2618不旋转地连接的远端2564。脊管2560的近端2566带有凸缘并适于被容纳在设置在手柄组件5中的环形槽2570中,使带凸缘的近端2566可在其中旋转。

[0254] 从图47和49中还可以看出,外壳组件的远端2580带有凸缘并具有在其上形成的第一径向齿轮2582。外壳组件的带凸缘的远端2580延伸到在旋转旋钮2552中形成的环形腔2567中。环形腔2567通过向内延伸的环形凸缘2568形成,所述环形凸缘2568具有在其上形成的第二径向齿轮2569以便选择性地与第一径向齿轮2582啮合。环形凸缘2568还延伸到在外科组件5中形成的环形弹簧腔2584中。在弹簧腔2584中设置锁定弹簧2590。 将第二径向齿轮2569偏压成与第一径向齿轮2582啮合。如同将在下面详细讨论的那样, 临床医生可解锁脊沈16,从而通过向近侧拉动旋转旋钮2552使第二径向齿轮2569从第一径向齿轮2582脱离,使临床医生能够旋转脊沈16并最终将工具组件100’旋转到将工具组件100,沿着所需的朝向定位,使旋转旋钮2550、脊管2560和脊沈16能够旋转。

[0255] 如图47和48中所示,闭合管2510的远端2514可形成有直径减小部分2515,以便将不能旋转的闭合环2594滑动容纳于其上。在各种实施方式中,一对槽2516设置在其中,被定向成容纳从闭合环2594的壁上向内突出的相应的销2596。在各种实施方式中,采用至少一个销和槽设置。在替代实施方式中,销2596可以在闭合管2510中并且槽2516可设置在闭合环中。图50示出了处于打开位置中的工具组件100’的砧座110’中。为了闭合砧座110’,临床医生简单地沿着第一方向旋转闭合旋钮2520,并同样沿着该方向旋转闭合管2510。闭合管2510借助销2596和槽2516之间的相互作用的旋转引起闭合环2594向远侧运动,与砧座110’的一部分接触,将砧座110’枢转到图47和48中所示的闭合位置。 如图48所示,在闭合环2594的近端2598和闭合管2510的直径减小部分2515的突出部分 2517之间存在距离2599。所述距离2599代表了闭合环2594可利用的轴向行进量。本领域普通技术人员将会理解,通过以相对较低的角度提供槽2516,销2596将易于保持在位置中,由此也将砧座110’保持在闭合位置中。但是,也可采用其他锁定设置。

[0256] 为了打开砧座110’,临床医生再次沿着近侧方向PD运动制动旋钮2552,然后沿着如图49和50所示的第二方向运动闭合旋钮2520(和闭合管2510)。在各种实施方式中, 被夹钳在工具组件100’中的组织引起砧座110’运动到打开位置。在另外的实施方式中, 当闭合环2594已经运动到图49和50所示的位置时,可采用弹簧或者其他偏压元件(未显示)将砧座110’偏压到打开位置。在其他实施方式中,闭合环2594可设置有上述马蹄形开口,并且砧座110’可被构造成具有如图45中所示的翼片111’。因此,在该实施方式中, 当闭合环2594被向近侧拉动时,其将砧座110’拉到打开位置,一旦处于打开位置中,临床医生可释放制动旋钮2552并且定位槽2550将闭合管2510 (和砧座110,)锁定在打开位置中。本领域普通技术人员将会理解,闭合系统2500可有效地与上述闭合管接头组件2302 结合使用。在所述实施方式中,槽2516可设置在远侧闭合管段2310中。所述设置将可以上述相同的方式操作,但是,器械还可围绕多个轴进行关节运动。

[0257] 图51示出了本发明的另一种实施方式,其中闭合管2510的远端2515’上具有螺纹2513,以便与闭合环2594,上的螺纹2597螺纹接合。在该实施方式中,闭合环2594,可被构造成与通道组件120和或脊沈16相互作用,使闭合环2594’可相对于其纵向运动,但不旋转。螺纹2597在闭合环2594,的近端2595中形成,当闭合管2510沿着一个方向旋转时,使闭合环2594’沿着远侧方向DD轴向运动,与砧座110’接触并将砧座110’枢转到夹钳位置。闭合环2594’沿着相反方向的旋转引起闭合环2594’沿着近侧方向PD运动,使待枢转的砧座110’通过夹钳在其中的组织或者通过弹簧或者其他偏压元件打开。多圈螺纹的使用可提供比其他闭合环设置更多的闭合动力。在替代实施方式中,闭合环2594’可设置有马蹄形开口以便与砧座上的闭合翼片相互作用。见图45。闭合管2510’的旋转和锁定可通过闭合系统2500和上述闭合管制动组件2550来控制。该实施方式还可与上述各种关节运动接头结合使用,也不脱离本发明的精神和范围。还应当理解,所述实施方式可有效地用于图47和49所示的手动驱动系统或者其他驱动设置,诸如索驱动设置等。

[0258] 图52-M示出了本发明的另一种索致动闭合系统2700的实施方式。从这些附图中可以看出,各种实施方式包括轴向支撑近侧脊段2720的近侧覆盖管2710。近侧脊段2720 从手柄组件(未显示)延伸并可由此以一些已知设置中任何一种被支撑,也不脱离本发明的精神和范围。

[0259] 在各种实施方式中,近侧脊段2720具有远端2722,所述远端2722具有从其上突出并具有与其连接或者与其一起形成的球形元件2730的颈部2724。从这些图中可以看出,球形元件2730的尺寸设置成可容纳在通道形远侧脊段2740的近端2742中形成的插座2750 中。球形元件2730和插座2750共同形成球形接头,总体标记为2760,为远侧脊段2740提供相对于近侧脊段2720沿着多个方向进行关节运动的能力。在远侧脊段2740的近端2742 和近侧脊段2720的远端2722之间提供足够大小的间隙2748,使远侧脊段2740相对于近侧脊段2720在所需的运动范围中进行关节运动。在各种实施方式中,远侧脊段2740和与砧座110”枢转连接的细长通道组件120”连接。从图52-54中可进一步看出,闭合环2770支撑在远侧脊段2740上以便在其上轴向行进。

[0260] 在各种实施方式中,砧座110’的打开和闭合可通过从手柄组件(未显示)穿过近侧脊段2720和颈部27M中的中空通道27¾的闭合索2780来完成。闭合索2780的近端 (未显示)可与在本文中描述的一个索驱动系统或者其他索控制系统连接以便选择性地将张力施加到索2780。本领域普通技术人员还会理解,也可采用上面描述的各种类型的驱动索系统来驱动动力夹钳元件、刀和滑车。

[0261] 从图52-54中可以看出,闭合环2770可具有安装于其上的第一索过渡支架2790, 其延伸到通道形远侧脊段2740的开口上端,当闭合环2770在其上运动时,使第一索过渡支架2790可在远侧脊段2740中向远侧和轴向来回运动。在各种实施方式中,第一索过渡支架2790可包括选自包括滑轮、杆、绞盘等的支架组的支架。另外,第二索过渡支架2792可沿着图示的朝向安装在远侧脊段2740中,使闭合索2780可操作地支撑在第一和第二索过渡支架2790、2792上。类似地,第二索过渡支架2792可包括选自包括滑轮、杆、绞盘等的支架组的支架。

[0262] 闭合索2780的远端2782可在连接点2744处固定到远侧脊段2740。因此,将张力施加到闭合索2780 (沿着近侧方向PD拉动闭合索2780)引起闭合环2770沿着远侧方向 DD运动与砧座110’接触并以上述方式将其枢转到闭合位置。在各种实施方式中,被夹钳在工具组件100”中的组织引起砧座110’运动到打开位置。在其他实施方式中,当闭合环 2770已经轴向运动到其近侧未夹钳位置时,可采用弹簧或者其他偏压元件(未显示)将砧座110’偏压到打开位置中。这种独特新颖的索致动闭合系统相对于现有技术的索提供动力的闭合系统具有显著的机械优点,同时还提供了相对于器械的其他部分致动工具组件100” 的能力。其他实施方式也可被预期,其中球形元件在远侧脊段2740中形成并且插座在近侧脊段2720中形成。在还有一些其他实施方式中,不采用关节运动接头。也就是说,近侧脊段和远侧脊段包括单个元件。

[0263] 图55-57示出了本发明的各种实施方式的索控可锁定关节运动接头观00,其可连接在细长通道组件120”和近侧脊段观20之间。在各种实施方式中,近侧脊段观20可从手柄组件(未显示)延伸从而可由一些已知设置中的任何一种支撑,都不脱离本发明的精神和范围。近侧脊段2780可具有远端观22,其具有从其上突出并具有与其连接或者与其一起形成的大致球形元件观22的颈部观对。从这些附图中还可以看出,球形元件观30的尺寸可设置成容纳于在远侧脊段观40的近端观42中形成的插座观50中。球形元件观30和插座观50共同形成球接头,总体标记为观00,其为远侧脊段观40提供了相对于近侧脊段 2820沿着多个方向进行关节运动的能力。在远侧脊段观40的近端观42和近侧脊段观20 的远端观22之间提供足够大小的间隙观48,使远侧脊段观40相对于近侧脊段观20在所需的运动范围中进行关节运动。在各种实施方式中,远侧脊段观40与细长通道组件120”连接,砧座与细长通道组件120”枢转连接。

[0264] 在各种实施方式中,一个或多个可径向延伸部分观80可设置在球形元件观30中。 在图55-57中所示的实施方式中,例如设置三个可径向延伸指观80。在各种实施方式中,可径向延伸指观80可围绕球形元件观30等间距(例如以120°为间隔)设置。其他数目的可径向延伸指观80也可成功地被采用。在各种实施方式中,球形元件观30例如可由塑性材料、金属等制成,使可径向延伸指可被拉动或者径向向外驱动一距离,以便以所需的方向将球形元件观30锁定在插座观50中。

[0265] 在各种实施方式中,每个可径向延伸指观80可具有与其连接的索观82,该索观82 延伸到近侧脊段观20的颈部观对附近并穿过近侧脊段观20的远端观22中相应的通道观沈。索观沈可延伸穿过中空近侧脊段观20并到达由手柄(未显示)支撑的控制系统, 以便选择性地将张力施加到索2882。例如,索观82可与锁定扳机或者支撑在手柄中的其他机构连接,所述其他机构可将张力施加到索并可选择性地保持在该位置中,直到需要释放接头,由此所述机构可被打开以释放索观82中的张力。从图55中可以看出,可采用如图所示的中空索环观90将索观82保持在颈部观对附近。

[0266] 为了使用这种实施方式,临床医生将工具组件100定位在患者体内然后通过另一种外科器械将关节运动力施加到工具组件上,或者在将张力施加到锁定索观82之前通过将工具组件100与患者的一部分接触而使工具组件进行关节运动到所需位置。在工具组件 100已经进行关节运动到所需位置后,临床医生将张力施加到锁定索2882,引起可径向延伸指观80沿径向向外延伸并将球形元件观30在插座观50中锁定在该朝向,从而将远侧脊段观40(以及与其连接的工具组件100)保持在该关节运动位置。所述系统采用“被动”关节运动技术。

[0267] 图58-61示出了本发明的各种实施方式的索控可锁定关节运动接头四00。从这些图中可以看出,各种实施方式可包括近侧脊段四20,所述近侧脊段四20可从手柄组件(未显示)延伸从而可由一些已知设置中的任何一种支撑,都不脱离本发明的精神和范围。从图58中可以看出,球形元件四36可在远侧脊段四30的近端四32上形成。球形元件四30 的尺寸可设置成容纳于在近侧脊段四20的远端四22中形成的插座四对中。球形元件四36 和插座四对共同形成球接头,整体标记为四10,其为远侧脊段四30提供了相对于近侧脊段 2920沿着多个方向进行关节运动的能力。在远侧脊段四30的近端四32和近侧脊段四20 的远端四22之间提供足够大小的间隙四48,使远侧脊段四30相对于近侧脊段四20在所需的运动范围中进行关节运动。在各种实施方式中,远侧脊段四30可以连接到与砧座(未显示)枢转连接的细长通道组件(未显示)上。[0268] 在各种实施方式中,近侧脊段四20的远端四22可具有柔性部分四50和束带部分 2960。近侧脊部分例如可由塑性材料、金属等制成。柔性部分四50可由设置在近侧脊段 2920的远端四22中的一组等间距的槽四52限定,形成多个可径向收缩的锁定部分,例如柔性部分的形式,用于将插座四对限定在其间。另外,在周围延伸的槽四56可围绕近侧脊段四20的远端四22的圆周设置。锁定索四70可延伸穿过中空近侧脊段四20并围绕在周向延伸的槽四56中的束带部分四60形成环,如图59和61所示。从这些附图中可以看出,索四70可穿过两个通道四57、2958,使其末端可延伸穿过近侧脊段四20到达支撑在手柄组件(未显示)中的索控制系统(未显示),可用于选择性地将张力施加到索四70。

[0269] 为了使用该实施方式,临床医生将工具组件100定位在患者体内然后使用另一种外科器械将关节运动力施加到工具组件上,或者在将张力施加到锁定索四70之前通过将工具组件100与患者的一部分接触而使工具组件关节运动到所需位置。在工具组件100已经进行关节运动到所需位置后,临床医生将张力施加到锁定索四70,引起柔性部分围绕球形元件四70锁定并防止其相对于近侧脊段四20运动,从而将远侧脊段观40 (以及与其连接的工具组件100)保持在该关节运动位置。所述系统采用“被动”关节运动技术。为了释放球形元件以便允许工具组件进一步进行关节运动,张力从索四70释放。

[0270] 图62-64示出了本发明的各种实施方式的可锁定关节运动接头3000。从这些图中可以看出,各种实施方式可包括近侧脊段3010,所述近侧脊段3010可从手柄组件(未显示)延伸从而可由一些已知设置中的任何一种支撑,都不脱离本发明的精神和范围。近侧脊段3010具有远端3012,其具有从其上突出并具有在其上形成的大体球形元件3016的颈部3014。从图63和64中可以看出,球形元件3016中具有一组槽3018,用于限定一组球形分部3020。如图62中所示,球形元件3016的尺寸可设置成容纳于在远侧脊段3030的近端3032中形成的插座3034中。球形元件3016和插座3034共同形成球接头,整体标记为3040,其为远侧脊段3030提供了相对于近侧脊段3010沿着多个方向进行关节运动的能力。在远侧脊段3030的近端3032和近侧脊段3010的远端3012之间提供足够大小的间隙 3042,使远侧脊段3030相对于近侧脊段3010在所需的运动范围中关节运动。在各种实施方式中,远侧脊段3030可以连接到与砧座(未显示)枢转连接的细长通道组件(未显示) 上。

[0271] 从图62中可以看出,致动元件3050可被用于选择性地径向延伸球形分部3020以便在插座3034中膨胀并锁定球形元件3016。在一种实施方式中(图62-64),致动元件具有中空轴部分3052,其延伸通过近侧脊段3010的颈部3014中的通道3015并且还通过球形元件3016中的通道3017。致动元件3050的远端30M具有大体锥形部分3056,其被容纳在球形元件3016中的锥形关节运动插座3050中,如图所示。当致动元件3050沿着近侧方向PD被拉动时,锥形部分3056引起球形分部3020径向向外延伸并将球形元件3016锁定在插座3034中。也可采用手柄中的各种扳机和锁定设置(未显示),以便选择性地沿着近侧方向PD和远侧方向DD运动致动元件并将致动元件3050锁定在位置中,将球形元件3016 保持为膨胀/锁定状态。

[0272] 为了使用该实施方式,临床医生将工具组件100定位在患者体内然后使用另一种外科器械将关节运动力施加到工具组件上,或者在沿着近侧方向PD拉动致动元件3050之前将工具组件100与患者的一部分接触,使工具组件关节运动到所需位置。在工具组件100已经进行关节运动到所需位置后,临床医生沿着近侧方向拉动致动元件3050,引起球形分部3020径向向外扩张并沿着该朝向将球形元件3016锁定在插座3034中,从而将远侧脊段 3030(以及与其连接的工具组件100)保持在该关节运动位置。所述系统采用“被动”关节运动技术。

[0273] 图65-67示出了本发明的各种实施方式的另一种可锁定关节运动接头3100,其基本上与上述关节运动接头3000的操作相同,但致动元件3150和球形元件3116除外。从这些图中可以看出,球形元件3116具有在其中形成的至少一个并优选三个可径向延伸部分 3120。致动元件3150具有中空轴部分3152,其延伸穿过近侧脊段3010的颈部3014中的通道3015并且还通过球形元件3116中的通道3017。致动元件3150的远端3巧4具有大体锥形楔部3156,其与球形元件3116中的每个可径向延伸部分3120对应,延伸到球形元件 3116中的锥形致动插座3118中,如图所示。当致动元件3150沿着近侧方向PD被拉动时, 锥形楔部3156引起对应的可径向延伸部分3120径向向外膨胀并将球形元件3116锁定在插座3034中。也可采用手柄中各种扳机和锁定设置(未显示),以便选择性地沿着近侧方向PD和远侧方向DD运动致动元件并将元件锁定在位置中,将球形元件3116保持为膨胀/ 锁定状态。

[0274] 为了使用该实施方式,临床医生将工具组件100定位在患者体内使用另一种外科器械将关节运动力施加到工具组件上,或者将工具组件100与患者的一部分接触,在沿着近侧方向PD拉动致动元件3150之前使工具组件沿着近侧方向PD进行关节运动到所需位置。在工具组件100已经进行关节运动到所需位置后,临床医生沿着近侧方向拉动致动元件3150,引起可径向延伸的部分3120径向向外膨胀并沿着该朝向将球形元件3116锁定在插座3034中,从而将远侧脊段3030(以及与其连接的工具组件100)保持在该关节运动位置。所述系统采用“被动”关节运动技术。

[0275] 图68-70示出了本发明的各种实施方式的另一种可锁定关节运动接头3200。从这些图中可以看出,各种实施方式可包括近侧脊段3210,所述近侧脊段3210可从手柄组件 (未显示)延伸从而可由一些已知设置中的任何一种支撑,都不脱离本发明的精神和范围。 近侧脊段3210具有远端3212,其具有多个可径向收缩部分,例如其中限定插座3216的柔性插座指3214的形式。从图68中可以看出,球形元件3310可在远侧脊段3300的近端3312 上形成。球形元件3310可在颈部3308的端部上形成,其尺寸可设置成容纳于在由插座指 3214形成的插座3216中。球形元件3310和插座3216共同形成球接头,整体标记为3320, 其为远侧脊段3300提供了相对于近侧脊段3210沿着多个方向进行关节运动的能力。在远侧脊段3300的近端3304和近侧脊段3210的远端3212之间提供足够大小的间隙3002,使远侧脊段3300相对于近侧脊段3210在所需的运动范围中进行关节运动。在各种实施方式中,远侧脊段3300可以连接到与砧座(未显示)枢转连接的细长通道组件(未显示)上。 另外,中空通道3306可经过球形元件3310和颈部3308设置,以便于索或其他致动器械/ 元件从其中穿过。

[0276] 从图68-70中还可以看出,该实施方式还可包括闭合环3400,其选择性地沿着近侧和远侧方向在近侧脊段3210上滑动并可轴向运动。上述各种系统和元件都可被采用,以便选择性地沿着近侧和远侧方向运动闭合环3400。特别是从图68中可以看出,插座指3214 具有倾斜或者逐渐变细的端表面3215,使闭合环3400的远侧部分3402在其上滑动,并引起插座指3214闭合在球形元件3310上并将其锁定在位置中。

[0277] 为了使用该实施方式,临床医生将工具组件100定位在患者体内使用另一种外科器械将关节运动力施加到工具组件上,或者在向远侧行进闭合环MOO之前通过将工具组件100与患者的一部分接触而使工具组件关节运动到所需位置。在工具组件100已经进行关节运动到所需位置后,临床医生向远侧行进闭合环3400,引起插座指3214闭合在球形元件3310上并将球形元件3310沿着该朝向锁定在插座3216中,从而将远侧脊段3300 (以及与其连接的工具组件100)保持在该关节运动位置。所述系统采用“被动”关节运动技术。

[0278] 图71示出了本发明的各种实施方式的另一种被动关节运动接头3500。从该图中可以看出,各种实施方式可包括近侧脊段3510,所述近侧脊段3510可从手柄组件(未显示)延伸从而可由一些已知设置中的任何一种支撑,都不脱离本发明的精神和范围。近侧脊段3510具有远端3512,其中具有插座3514。从图71中还可以看出,球形元件3530可在远侧脊段3520的近端3522上的颈部3532上形成。球形元件3530和插座3514共同形成球接头,整体标记为邪40,其为远侧脊段3520提供了相对于近侧脊段3510沿着多个方向进行关节运动的能力。在替代实施方式中,插座可在远侧脊段中形成并且球形元件可在近侧脊段中形成。在远侧脊段3520的近端3522和近侧脊段3510的远端3512之间提供足够大小的间隙3542,使远侧脊段3520相对于近侧脊段3510在所需的运动范围中进行关节运动。在各种实施方式中,远侧脊段3520可以连接到与砧座(未显示)枢转连接的细长通道组件(未显示)上。

[0279] 从图71中还可以看出,球形元件3530的近侧朝向面3532具有多个在其中形成的定位槽3534。锁定销3550可操作地支撑在近侧脊段3510中并被定向成与定位槽3534接合。锁定销3550可被弹簧偏置成向着球形元件3530的近侧朝向面3532,当远侧脊段3520 相对于近侧脊段3510进行关节运动时,使锁定销扣合到相应的一个定位槽3534中,将远侧脊段3520保持在该位置中。

[0280] 为了使用该实施方式,临床医生将工具组件100定位在患者体内使用另一种外科器械将关节运动力施加到工具组件上,或者将工具组件100与患者的一部分接触,使工具组件关节运动到所需位置,或者另一个外科工具可被用于将关节运动力施加到工具组件, 引起工具组件100向着所需方向运动。当工具组件进行关节运动时,锁定销的远端3552将扣合到定位槽3534中,直到到达所需的关节运动位置再从其中脱离。所述系统采用“被动” 关节运动技术。

[0281] 图72示出了本发明的各种实施方式的另一种被动关节运动接头3600,其有些类似于上述关节运动接头3500,下面讨论其不同。例如在该实施方式中,球形元件3630可在从近侧脊段3610向远侧突出的颈部3632上形成。近侧脊段3610可从手柄组件(未显示) 延伸从而可由一些已知设置中的任何一种支撑,都不脱离本发明的精神和范围。远侧脊段 3620中具有插座36M。球形元件3630和插座36M共同形成球接头,整体标记为3650,其为远侧脊段3620提供了相对于近侧脊段3610沿着多个方向进行关节运动的能力。在远侧脊段3620的近端3622和近侧脊段3610的远端3612之间提供足够大小的间隙3642,使远侧脊段3620相对于近侧脊段3610在所需的运动范围中进行关节运动。在各种实施方式中, 远侧脊段3620连接到与砧座(未显示)枢转连接的细长通道组件(未显示)。

[0282] 从图72中还可以看出,插座面3636的一部分3638具有多个在其中形成的定位槽3639。锁定销3660可操作地支撑在近侧脊段3610中并被定向成与定位槽3639结合。锁定销3660可被弹簧偏压成向着球形元件3530的面3636,当远侧脊段3620相对于近侧脊段 3610进行关节运动时,使锁定销3660扣合到相应的一个定位槽3639中,将远侧脊段3620

保持在该位置中。

[0283] 为了使用该实施方式,临床医生将工具组件100定位在患者体内然后使用另一种外科器械将关节运动力施加到工具组件上,或者通过将工具组件100与患者的一部分接触而使工具组件进行关节运动到所需位置,或者另一个外科工具可被用于将关节运动力施加到工具组件而引起工具组件100向着所需方向运动。当工具组件进行关节运动时,锁定销 3660的远端3662将扣合到定位槽3639中,直到到达所需的关节运动位置再从其中脱离。 所述系统采用“被动”关节运动技术。

[0284] 本发明的各种外科缝合器械可被设计成适用被设计成单次使用后被抛弃的工具组件。在缝合操作完成后,工具组件被抛弃并且器械可在准备用于另一次手术时重新灭菌。 在所述应用中,因此通常希望采用接头设置,方便将工具组件与器械快速地连接和拆卸。图 73-83示出了外科器械4000,其被构造成与可进行外科手术动作的外科工具组件100”结合使用。在各种实施方式中,工具组件100”被构造成通过上述索提供动力的动力夹钳元件/ 刀设置来切割并缝合组织。在其他实施方式中,可采用不同的驱动设置来驱动动力夹钳元件/刀穿过工具组件100”的细长通道部分。

[0285] 在一些实施方式中,工具组件100”包括一次性重新加载单元4002的一部分。在其他实施方式中,工具组件100”可与器械4000的其他部分永久连接并能够与钉仓组件结合重新使用。一次性重新加载单元4002可还包括用于将一次性重新加载单元4002与器械4000连接的连接器部分4004。在各种实施方式中,工具组件100”可通过关节运动接头 4006相对于连接器部分4004进行关节运动。

[0286] 特别是从图73A中可以看出,一种实施方式的工具组件100”可包括具有与其枢转连接的砧座组件4020的细长通道组件4012。例如,在一种实施方式中,砧座组件4020可具有一对耳轴4022,它们适于被容纳在细长通道组件4012的壁中相应的槽4014中,如图所示。砧座组件4020可被形成为在其近端40¾上具有砧座闭合翼片4(^6,以便选择性地由闭合环4030接触。不旋转的闭合环4030键接到细长通道组件4012和/或砧座组件4020, 使闭合环4030不能相对于细长通道4012旋转。翼片间隙开口 4032可经过闭合环4030设置,当砧座组件4020处于闭合(夹钳)位置时容纳砧座闭合翼片仙沈。一组内螺纹4036 可设置在不旋转的闭合环4030的近端4034,用于螺纹接收远侧闭合管段4040的带螺纹远端4042。如同将在下面进一步详细讨论的那样,当远侧闭合管段4040旋转时,闭合环4030 沿着远侧方向DD轴向驱动。当闭合环4030沿着远侧方向DD运动时,其上到砧座组件4020 的近端的斜面4021上,引起砧座组件4020枢转到闭合位置。这种设置代表了优于其中闭合环由索沿着远侧方向拉动的现有设置的巨大改进。

[0287] 外科器械4000可还包括细长闭合管组件5000,其容纳各种元件并可操作地与手柄组件连接(将在下面进一步详细讨论)。在本发明的各种实施方式中,闭合管组件5000 可包括中间闭合管段5001和近侧闭合管段5020。在一些实施方式中,工具组件100”可通过关节运动接头4006与闭合管组件5000的中间闭合管段5001连接,方便工具组件100” 相对于闭合管组件5000围绕大体上彼此垂直的两个轴线UA-UA和OA-OA的行进(将在下面进一步详细讨论)。而且,各种实施方式可包括用于主动控制工具组件100”、具有被动关节运动能力、同时还具有将工具组件锁定在所需的关节运动位置中的能力的部件。当详细描述本发明时这些独特新颖的特征和优点将进一步变得清楚。

[0288] 例如,在各种实施方式中,远侧闭合管段4040可形成为具有从其上沿着近侧方向突出的一对相对的通用枢转臂4046。中间闭合管段5001的远端5002可形成为具有两个从其上向远侧突出的相对的紧固件臂5004、5006,见图73A和74B。紧固件臂5004具有穿过其中的枢轴孔5008,并且紧固件臂5006具有大体上与枢轴孔5008共轴对准的枢轴孔5010, 限定通用枢转轴线UA-UA。定位在紧固件臂5004和5006之间的是通用环4070,其具有从其上突出的两对销4072、4074,其中每个销可围绕通用环4070的圆周彼此间隔90度(一个销 4074如图73A和74B中虚线所示)。如图73A所示,一个销4072可枢转地容纳在紧固件臂 4006的下部枢轴孔5010中。这种设置使通用环4070能够相对于闭合管组件5000围绕通用轴线UA-UA枢转。从远侧闭合管4040突出的每个相对的通用枢转臂4046中具有可枢转地将一个对应的销容纳在其中的孔4047,使远侧闭合管4040能够围绕垂直轴线OA-OA (在图75中显示)沿着由图73A中的箭头FD所示的第一枢转方向和由图73A中的箭头SD所示的第二枢转方向相对于通用环4070和闭合管组件5000枢转。轴线UA-UA和OA-OA可大体上彼此垂直。

[0289] 因此,本领域普通技术人员将会理解,上述通用环4070设置利于远侧闭合管4040 的关节运动,并最终利于与其连接的工具组件100”相对于闭合管组件5000围绕多个轴线 UA-UA和OA-OA进行关节运动。另外,如同将在下面进一步描述的那样,在各种实施方式中, 闭合管组件5000可由手柄组件旋转地支撑,使其可围绕轴的轴线C-C旋转。由于工具组件 100”固定到闭合管组件5000 (通过关节运动接头4006),工具组件100”也可与其一起旋转。 因此,这种设置提供了工具组件100”,其中可具有索驱动刀组件和具有围绕多个轴被致动的能力的非索驱动的砧座闭合设置。

[0290] 从图73A和74A中还可以看到,该实施方式可还包括远侧脊段4050,其可具有在其上形成的容纳在远侧闭合管4040中的定位槽4044中的环状保持凸缘4052。在各种实施方式中,关节运动接头4006还可包括关节运动锁定组件,整体标记为4007,其利于在工具组件100”已经进行关节运动到所需朝向后关节运动接头4006的锁定。所述锁定组件4007 可包括在远侧脊段4050的颈部40M上形成的球形元件4060。锁定组件4007可还包括带齿插座元件5030,其在定位在连接器部分4004中的中间脊段5020的远端5022上形成。带齿插座元件5030可包括多个可径向收缩指5032,将插座5034限定在它们之间,球形元件 4060可沿着多个方向在其中进行关节运动。带齿插座元件5030安装在通用环4070中。 [0291 ] 在各种实施方式中,插座锁定管5080可共轴容纳在一次性脊段5020上,使其可相对于脊段5020轴向运动(将在下面进一步详细讨论)。锁定管5080的远端5082可逐渐变细,以便当锁定管5080沿着远侧方向DD轴向运动时选择性地与带齿插座元件5030轴向接触,引起带齿指5032径向收缩并围绕球形元件4060闭合,将远侧脊段4050(以及工具组件 100”)相对于细长闭合管组件5000锁定在位置中。

[0292] 本发明的各种实施方式的外科器械4000可还包括主动关节运动系统,整体标记为5090,用于将关节运动主动施加到远侧脊段4050。例如在各种实施方式中,主动关节运动系统5090可包括四个进行关节运动的丝5092,它们可由弹簧钢或者类似物制成,并具有足够的硬度,以便将施加的压缩力传递到其近侧部分而不皱缩。丝5092可围绕带齿插座 5030彼此以90度为间隔设置,并可容纳在可径向收缩指5032的外表面中的对应槽5033 中。每根丝5092的远端5094可与远侧脊段4050的颈部40M连接,并且每根丝5092的近端5096可与容纳在闭合管5000中的远侧丝固定架5100的套节部分5102连接,如图73B 中所示。如同将在下面进一步详细讨论的那样,远侧脊段4050(以及与其连接的工具组件 100”)可通过拉动和推动丝5092主动进行关节运动。

[0293] 而且在各种实施方式中,球形元件4060的近侧朝向部分中可具有大体锥形腔 4062,以容纳一个或多个刀致动索5040,该刀致动索5040与安装在一次性工具组件100”中的动力夹钳元件(未显示)和/或刀(未显示)连接。索5040的近端5042(图73A)可与刀螺母5050连接,该刀螺母5050可螺纹连接在刀螺钉5060上。从图73A和75中可以看出,刀螺母5050具有一对侧向突出的翼片5052,它们轴向容纳在一次性脊段5020中的相应的轴向延伸槽50¾中。本领域普通技术人员将会理解,当刀螺钉5060旋转时这种设置允许刀螺母5050沿着近侧方向PD或远侧方向DD轴向运动。

[0294] 如上所述,各种实施方式中一次性重新加载单元4002可被构造成一次使用后丢弃。为了便于重新加载单元4002的快速拆卸和新的重新加载单元4002的重新连接而无需工具,可采用快速断开接头4008。在本文中,术语“快速断开”指的是不使用工具将一个元件从另一个元件上拆下的能力。快速断开接头4008的各种实施方式的操作和构造可通过图7!3B、74B和76来理解。从图7¾和74B可以看出,闭合管组件5000包括中间闭合管段 5001和近侧闭合管段5120。从图7¾和76中可以看出,中间闭合管段5001的近端具有一组在其上形成的径向齿轮齿5003,当一次性重新加载单元4002与近侧闭合管段5120连接时用于与近侧闭合管段5120(在图76中未显示)的远端5122上的齿轮齿5124(在图76 中未显示)啮合。

[0295] 为了支持一次性重新加载单元4002和近侧闭合管段5120之间的可拆卸互连,可采用连接星轮5150。连接星轮5150可部分容纳在中间闭合管段5001的近端中并从其中突出,当中间闭合管段5001与近侧闭合管段5120连接时,使连接星轮5150的一部分突出到近侧闭合管段5120的远端5122中。在各种实施方式中,连接星轮可通过销钉在或者通过粘接剂或者其他合适的紧固件设置连接在中间闭合管段5001的近端中。见图76。

[0296] 在各种实施方式中,连接星轮5150还可通过轴颈连接在一次性脊段5020上并被构造成容纳从远侧丝固定架5100突出的相应的致动器杆5104。每个致动器杆5104的近端5106可包括锥形的定位槽,以利于多个近侧丝连接器元件5160之间的互连。例如在一种实施方式中,可采用四个近侧丝连接器元件。多个致动器杆5104可设置有定位槽5108, 用于容纳安装在每个近侧丝连接器5160中的锥形孔定位槽5162中的相应连接器球5164。 见图7¾和77。因此,采用四个连接器球5164,每个近侧丝连接器5160—个。从图73B、78 和79中还可以看出,一次性脊段5020的近端5021具有向近侧延伸的连接部分5023,其可具有在其中形成的内卡圈部分5025,以支撑刀螺钉5060的近侧部分5062。另外,向近侧延伸的连接部分5023可具有在其上形成的外部花键50¾,用于容纳在近侧脊段5200的远端 5202中形成的键槽5206中。刀螺钉5060的近端5062可支撑在轴承5064中,并具有带键驱动部分5066,以便不旋转容纳在刀驱动轴5220的远端5222中的带键驱动腔52M中,见图78。[0297] 接着转到图74A和74B,锁定管5080的连接可被理解。从图74A中可以看出,锁定管5080具有从其上向近侧突出的一对致动器制动臂5084。图74B是从图73B中显示的剖面旋转大约45度的剖视图。从图74B中可以看出,每个致动器制动臂5084具有在其中形成的定位槽5085,用于将安装在锥形孔定位槽5166中的连接器球5168容纳在相应近侧致动器制动臂5300中,见图74B和77。为了为致动器制动臂5084提供滑动横向支撑,每个致动器制动臂5084可滑动容纳在一次性脊段5020中的对应槽5027中。见图75和76。

[0298] 从图73B中还可以看出,外部近侧脊段MOO可容纳在近侧闭合管5120中并与其协作来限定用于将闭合管弹簧Mio容纳在其中的弹簧腔M02。近侧闭合管段5120的近端51¾上可具有加大的旋钮部分5128,以便于由临床医生将控制运动施加到其上。插座 5130可在旋钮部分51¾中形成,用于将固定到外部近侧脊段MOO的弹簧挡圈5132容纳在其中。因此,闭合管弹簧MlO用于将近侧闭合管段5120偏压成与一次性闭合管段5000 啮合。从图7¾和78中可以看出,近侧闭合管段5120的远端122具有更大的内径5123,其具有倾斜的表面5125。为了将工具组件100,,从器械4000上拆下,临床医生依靠弹簧MlO 的力沿着近侧方向PD拉动旋钮5128,直到更大的内径部分5123与连接器球5164对准,当用户将除去力施加到工具组件100”、沿着远侧方向DD对其进行拉动时,使连接器球5164能够沿着远侧丝固定架5100的致动器杆5104的近端5106与定位槽5108脱离结合。

[0299] 图78-81示出了将一次性重新加载单元4002连接到器械部分4000。特别参见图 78,临床医生定向单元4002,使刀螺钉5060的带键部分5066与刀驱动轴5220中的内部带键腔52M对准并将带键驱动部分5066的近端插入其中。见图79。此后,临床医生将一次性脊段的近端5021上的花键50¾与近侧脊段5200中的键槽5206对准。见图79和80。 临床医生然后继续将近端5106插入到四个近侧丝连接器5160和近侧脊段5200之间的区域5161中。见图80。临床医生然后可沿着近侧方向运动闭合旋钮5128,当致动器杆5104 的近端5106向近侧被推动到位置中时,使连接器球5164能够径向向外运动。临床医生染后释放旋钮5128,允许近侧闭合管5120向远侧运动,将连接器球5164锁定在远侧丝固定架5100的致动器杆5104中的定位槽5108中,将四个近侧丝连接器5160固定到远侧丝固定架5100,并且还将连接器球5168锁定在致动器制动臂5084中的定位槽5085中。另外, 径向齿轮5003、51M被保持为彼此啮合。

[0300] 图82-84示出了可用于使工具组件100”相对于连接器部分4004进行关节运动并为其提供致动的一种实施方式。从图82中可以看出,器械4000可还包括手柄组件5500,其可由可通过螺钉、扣件、粘接剂等连接在一起的两个外壳部分5510(在图82中仅仅显示一个外壳部分5510)形成。在各种实施方式中,手柄组件5500可采取具有手柄抓持部分5512 的“手枪把手”形外壳。从图82中可以看出,连接凸缘讨04可在外部近侧脊段MOO的近端上形成,用于将外部近侧脊段MOO固定到手柄组件5500上。凸缘M04可通过粘接剂或者其他机械紧固件设置、螺钉、扣件、槽等与手柄外壳阳00连接。同样地,近侧脊段5200的近端5204可具有用于将近侧脊段5200固定到手柄组件5500的凸缘5210。凸缘5210可通过粘接剂或者其他机械紧固件设置、螺钉、扣件、槽等与手柄外壳5500连接。

[0301] 在各种实施方式中,主动关节运动系统5090可还包括关节运动控制系统,整体标记为5600,其由手柄组件5500可操作地支撑并与关节运动丝5092连接。从图82中可以看出,关节运动控制系统5600可包括操纵杆组件5602,每个近侧丝连接器5160的近端与其可枢转连接。例如在一种实施方式中,操纵杆组件5602可包括可旋转地支撑在手柄组件5500 中的插座5520中的关节运动球5610。在各种实施方式中,近侧丝连接器5160的每个近端 5170可具有支撑在其上的球形支架5172,以便容纳支架安装销5612,将近侧丝连接器5160 与关节运动球5610连接。但是,也可采用其他紧固件设置。另外,关节运动旋钮5620可与关节运动球5610连接。

[0302] 因此,为了使工具组件100”相对于连接器部分4004进行关节运动,临床医生可用一只手握持手柄部分5512并用另一只手握持关节运动旋钮5620。通过操纵关节运动旋钮5620,临床医生可将关节运动施加到远侧丝固定架5100,并最终将关节运动施加到与其连接的四根关节运动丝5092,进而将关节运动施加到将引起工具组件100”相对于一次性重新加载单元4002进行关节运动的远侧脊段4050。因此临床医生可通过使用操纵杆组件 5602有效地调整工具组件100”。

[0303] 工具组件100”的位置可通过整体标记为5640的制动控制系统锁定在位置中。从图82和84中可以看出,制动控制系统5640可包括通过轴颈可动地连接在刀驱动轴5220 上的驱动器盘5642,用于选择性地与其一道运动而不妨碍刀驱动轴5220的旋转。从图84 中可以看出,每个近侧致动器制动臂5300具有固定到驱动盘5642的近端5302。制动轭形件5650可通过突出到在驱动器盘5642中形成的沿着圆周延伸的槽5644中的一对销5643 与驱动器盘5642连接。制动轭形件5650由制动轭形件枢轴销5652上的外壳组件5500可枢转支撑。从图84中可以看出,在各种实施方式中,制动扳机56M在制动轭形件5650的下部形成。制动扳机56M可具有从其上突出到外壳组件5500中的开口 5506中的锁定臂 5656。锁定臂5656的下部可具有在其上形成的锁定齿5658,以便与外壳组件5500的锁定壁部分5508接合。

[0304] 本发明的各种实施方式还可采用制动释放机构5660来锁定和解锁制动扳机 5654。从图84中可以看出,一种形式的释放机构5660可包括锁定按钮5662,其具有释放按钮部分5664并可由图84中示出的位置中的手柄组件5500可动地支撑。从该图中可以看出,锁定按钮5664可具有锥形末端部分5666,该锥形末端部分5666具有延伸到释放按钮部分5664的锥形部分(未显示)的颈部。当临床医生沿着第一方向推动释放按钮部分5664 时,锥形部分5666与锁定臂5656接触并将其升高,使其与锁定壁部分5508脱离结合,从而使扳机56M能够枢转。弹簧(未显示)可被用于将锁定按钮5662保持在锁定位置中。一旦扳机56M枢转到所需位置,用户可简单地沿着相反方向推动释放部分5664,使锥形部分 5666运动,与锁定臂5656脱离结合,允许其再次与锁定壁部分5508接合。因此,一旦临床医生已经使工具组件100”运动到所需位置,临床医生可向着手柄组件5500挤压制动扳机 5654。该动作引起制动轭形件5650和驱动器盘5642沿远侧方向DD运动制动臂5300,这沿着远侧方向DD驱动锁定管5080,将指5032锁定在球形元件4060周围。一旦指5032已经被锁定在球形元件4060周围,临床医生就可沿着允许锁定臂5656上的一个齿5658与锁定壁部分5508接合的方向推动锁定按钮,并将制动释放机构保持在锁定位置中。当临床医生需要解锁工具组件100”或许使其再次进行关节运动时,临床医生可简单地推动锁定扳机释放按钮部分,允许扳机56M枢转远离手柄组件5500,由此使致动器臂5300向近侧运动。

[0305] 在本发明的各种实施方式中,可通过整体标记为5700的驱动系统将旋转运动施加到刀驱动轴5220上。从图82和83可以看出,在一种实施方式中,驱动系统5700可包括可枢转或者可致动连接到手柄组件5500的击发手柄5702。例如在一种实施方式中,击发手柄5702通过枢轴销5704可枢转地连接到手柄组件5500。与击发手柄连接的是击发齿轮 5706,其被定向成随着击发手柄5702枢转。击发齿轮5706可与安装在棘轮传动轴5710的棘轮传动齿轮5708啮合。棘轮传动轴5710可与棘轮离合器组件5720连接。

[0306] 在各种实施方式中,棘轮离合器组件5720可包括第一离合器盘5722,其与棘轮轴 5710连接并与安装在输出轴5726的第二棘轮离合器盘5724啮合。第二离合器盘5724可被偏压成通过棘轮弹簧5730与第一离合器盘5722啮合。棘轮输出齿轮5740可与设置成与安装到锥齿传动轴5752上的传动齿轮5750啮合的棘轮输出轴5726连接。输入锥齿轮 5760可被安装到锥齿传动轴5752上并与安装到输出轴5780上的输出锥齿轮5770啮合。 输出齿轮5782被安装到输出轴5780并与连接到刀驱动轴5220的近端5226的刀驱动齿轮 5790啮合。

[0307] 因此,为了旋转刀驱动轴5220并沿着近侧方向PD驱动刀螺母5050,并通过刀致动索5040致动动力夹钳组件(未显示)和刀设置(未显示),临床医生握持手柄组件并向着握持部分5512使手柄组件5702来回棘轮运动。击发手柄5512以该方式的运动将引起驱动系统5700将旋转运动施加到刀驱动轴5220,并最终将旋转运动施加到刀螺钉5060,弓丨起刀螺母5050沿着近侧方向运动。在击发顺序已经完成时,临床医生可拆下重新加载单元 4002并重新连接另一个重新加载单元并重复该过程。在替代实施方式中,刀驱动轴可通过马达和行星齿轮驱动旋转。马达可以由电池供电或者由交流电供电。其他设置也可被采用。

[0308] 图85-89示出了采用主动或者可控关节运动接头设置6010的另一种实施方式的外科器械6000。从图85和86中可以看出,一种实施方式可采用上面描述的类型和构造的闭合管6020。闭合管6020具有可与由手柄组件支撑的各种闭合管控制机构连接的近端(未显示),用于为手柄组件提供致动力。闭合管6020还可与各种上述工具组件之一连接,将打开或者打开与闭合力施加到其砧座组件。而且在该实施方式中,脊元件6030可从手柄组件 (未显示)延伸穿过闭合管6020。再次地,脊元件6030的近端(未显示)可操作地由手柄组件(未显示)以上面描述的各种方式或者其他已知方式支撑。在各种实施方式中,脊元件6030的远端6032可形成有顶部脊臂6034和底部脊臂6036,它们从脊元件6030的远端 6032沿着远侧方向DD突出。顶部脊臂6034具有穿过其中的枢轴孔6037,底部脊臂6036 具有大体上沿着垂直轴线VA-VA与枢轴孔6037共轴对准的枢轴孔6039。

[0309] 各种实施方式还包括延伸穿过脊元件6030的水平锁定管6040。水平锁定管6040 具有近端(未显示),其由手柄组件(未显示)支撑并可与致动设置(未显示)连接以便在脊元件6030中轴向沿着近侧方向PD和远侧方向DD轴向行进水平锁定管6040,并选择性地将水平锁定管6040保持或者锁定在所需轴向位置。另外,用于水平锁定管6040的致动设置还可采用弹簧或者其他设置,以便在水平锁定管6040被解锁之后沿着近侧方向PD偏压水平锁定管6040。从图86中可以看出,水平锁定管6040具有顶部或者第一锁定杆6042, 其具有在其中形成的一组顶部或者第一齿6044。水平锁定杆6040进一步具有底部或者第二锁定杆6046,其具有在其远端形成的底部或者第二齿6048。

[0310] 同样在这些实施方式中,垂直锁定管6050可延伸穿过水平锁定管6040。垂直锁定管6050具有近端(未显示),其由手柄组件(未显示)支撑并可与致动设置(未显示) 连接以便在水平锁定管6040中轴向沿着近侧方向PD和远侧方向DD轴向行进垂直锁定管6050,并选择性地将垂直锁定管6050保持或者锁定在所需轴向位置。另外,用于垂直锁定管6050的致动设置还可采用弹簧或者其他设置,以便在垂直锁定管6050被解锁之后沿着近侧方向PD偏压垂直锁定管6050。例如在各种实施方式中,所采用的致动设置可被构造成同时致动、锁定和释放水平锁定管6040和垂直锁定管6050。

[0311] 从图86中可以看出,例如在各种实施方式中,垂直锁定管6050具有第一垂直锁定尖端6052和第二垂直锁定尖端6054。各种实施方式可采用上面描述类型的使用索驱动动力夹钳元件和/或刀设置的工具组件。垂直锁定管可具有从其中穿过的索通道6056,以容纳穿过工具组件到达手柄组件的驱动索(未显示)。

[0312] 在各种实施方式中,第一和第二垂直锁定尖端6052、6054被定向成与垂直锁定块 6060接合。例如在一种实施方式中,垂直锁定块6060可具有第一侧向锁定柱6062和第二侧向锁定柱6066,第一侧向锁定柱上具有一组第一侧齿6064,第二侧向锁定柱上具有一组第二侧齿6068。第一侧向锁定柱6062和第二侧向锁定柱6066通过上部或者第一侧向横杆6070和底部或者第二侧向横杆6072彼此间隔地设置,两个横杆彼此成间隔设置关系以便在它们之间限定致动器容纳通道6074。在各种实施方式中,垂直锁定块6060可被构造成响应于来自垂直锁定管6050的致动动作相对于关节运动元件或者块6080沿着近侧方向 PD和远侧方向DD轴向行进。垂直锁定块6060可被支撑,以便通过一对延伸到垂直锁定块 6060中的孔6077、6079和关节运动块6080中的孔(未显示)向着和远离致动块6080轴向行进。

[0313] 从图85和86中可以看出,关节运动块6080可具有穿过其中的纵向通道6082,用于容纳驱动索(未显示)。另外,第一垂直销6084容纳在关节运动块中的孔6083中并从其上突出到被容纳在脊元件6030的顶部或者第一上臂6037中的第一枢轴孔6037中。同样地,下部销6089从关节运动块6080的底表面突出成可枢转容纳在脊元件6030的底部或者第二臂6036中的底部或者第二枢轴孔中,使关节运动块6080可选择性地围绕垂直轴线 VA-VA枢转。同样在该实施方式中,可包括一部分工具组件的细长通道组件6090的近端可具有从其上沿着近侧方向延伸的第一夹板部分或者臂6092和第二夹板部分或者臂6094。 第一夹板臂6092的近侧朝向面6096具有在其上形成的第一组水平锁定齿6068,用于选择性地与第一侧向锁定柱6062上相应组的第二水平锁定齿6064结合。同样的,第二夹板臂 6094的近侧朝向面6100具有在其上形成的另一组第一水平锁定齿6102,用于选择性地与垂直锁定块6060上的第二侧向锁定柱6062上另一相应组的第二水平锁定齿6068啮合。第一夹板臂6092可具有穿过其中的第一枢轴孔6093,其适于枢转容纳从关节运动块6080突出的枢轴销6110,第二夹板臂6094可具有穿过其中的第二枢轴孔6095,用于可枢转地容纳从关节运动块6080突出的第二枢轴孔6112,使得通道组件6090可选择性地围绕水平轴线 HA-HA相对于关节运动块6080枢转。

[0314] 从图86中还可以看出,第一水平锁定片6120可与关节运动块6080的上表面6081 连接或者与其一体形成,并具有一组在其中形成的第一垂直锁定齿6122,用于与在顶部或者第一水平锁定杆6042中形成的相应组的第二垂直锁定齿6044接合。同样地,第二水平锁定片6130可与关节运动块6080的底表面6083连接或者与其一体形成,并具有另一组在其中形成的第一垂直锁定齿6132,用于与在第二或者底部锁定杆6046上的相应组的第二垂直锁定齿6048结合。[0315] 为了使用户能够使工具组件(通道组件6090)主动进行关节运动,关节运动接头 6010可设置有水平致动器杆6140和垂直致动器杆6150。水平致动器杆6140例如可由塑性材料、弹簧钢等制成。水平致动器杆6140的远端6142可形成有上面描述的球形轴承设置,并可被销接在关节运动块6080上或者通过其他方式与关节运动块6080连接。水平致动器杆6140的近端(未显示)可以可操作地与上面描述的类型的操纵杆组件连接,该操纵杆组件可支撑在手柄组件中或者其他致动设置中,用于将推拉运动施加到水平致动器杆 6140。从图85和86还可以看出,垂直致动器杆6150的远端6152可与第二夹板臂6094上形成的延伸块6097连接。远端6152可固定连接到延伸块6097,或者具有在其上形成的球形轴承,以便可枢转地与其连接。垂直致动器杆6150的近端(未显示)可以可操作地与上面描述的类型的操纵杆组件连接,该操纵杆组件可支撑在手柄组件中或者其他致动设置中,用于将推拉运动施加到水平致动器杆6140。垂直致动器杆6150的近端(未显示)可以可操作地与上面描述的类型的操纵杆组件连接,该操纵杆组件可支撑在手柄组件中或者其他致动设置中,用于将推拉运动施加到垂直致动器杆6150。在替代实施方式中,垂直致动器杆6150或者水平致动器杆6140可被省略。在那些实施方式中,例如,如果水平致动器杆6140被省略,则可采用垂直致动器杆6150使通道组件6090 (和工具组件)围绕水平轴线HA-HA进行关节运动,并且临床医生可通过释放(解锁)水平锁定管6040并将工具组件与患者身体的一部分或者另一种外科器械接触,将枢转力施加到通道组件(和工具组件), 使通道组件6090 (以及工具组件)围绕垂直轴线HA-HA进行关节运动,引起它们围绕垂直轴线VA-VA枢转,直到它们被锁定在所需位置中(在该时刻水平锁定管6040可被行进到与水平锁定元件6120、6130锁定结合)。类似地,如果垂直致动器杆被省略,则可采用水平致动器杆来使通道组件6090 (和工具组件)围绕垂直轴线VA-VA进行关节运动,并且临床医生可通过释放(解锁)垂直锁定管6050并将工具组件与患者身体的一部分或者另一种外科器械接触,将枢转力施加到通道组件6090 (和工具组件),使通道组件6090 (以及工具组件)围绕水平轴线HA-HA进行关节运动,引起它们围绕水平轴线HA-HA枢转,直到它们被定位在所需位置中(在该时刻垂直锁定管6050可被行进到分别与通道夹板臂6092、6094上的水平锁定齿6068、6102锁定结合)。

[0316] 图90-105示出了本发明的另一种实施方式的外科器械7000,其可在使用后被抛弃。但是,这些实施方式的独特新颖的特征可与上面描述的多个实施方式结合采用,也不脱离本发明的精神和范围。从图90中可以看出,工具组件7002包括砧座组件7010,其可枢转地连接到上面描述的类型和构造的通道组件7020,以便可操作地将钉仓7021容纳在其中。砧座组件7020具有近端7012,该近端7012具有两个从其上突出砧座耳轴7014,它们适于被容纳在通道组件7020的近端7021的壁7022中的相应的端部开口的槽7024中。从图90-95中还可以看出,器械7000还可包括脊元件7030,该脊元件具有可与通道组件7020 的近端7021连接的远端7032。

[0317] 这些实施方式还可采用按照上面描述的方式构建并操作的闭合管7040。例如,远端7042可被构造成用于选择性地与在砧座组件7010中形成的近侧朝向壁架7016轴向接触,使得当闭合管7040沿着远侧方向DD运动时,远端7042与壁架7016接触并引起砧座组件7010枢转到闭合位置(图90-92),同时耳轴7014通过将在下面进一步描述的耳轴锁定杆7050被限制成在它们各自的槽7024中枢转。闭合管7040的近端(未显示)可由手柄组件(未显示)中的上面描述的类型和构造的致动元件支撑,以便选择性地控制闭合管7040 沿着远侧方向DD和近侧方向PD轴向运动。

[0318] 从图90中可以看出,耳轴锁定杆7050可滑动支撑在设置于脊7030中的轴向槽 7034中。耳轴锁定杆7050的近端(未显示)可与手柄组件中的致动元件相互作用,使耳轴锁定杆7050沿着远侧方向DD和近侧方向PD进行运动,并选择性地将杆7050保持在那些位置中。从图92和94中还可以看出,耳轴锁定杆7050的远端7052可具有两个从其上突出的耳轴保持臂7054。

[0319] 图90-92示出了处于锁定位置中的耳轴锁定杆7050,其中耳轴保持臂7054将耳轴保持在通道组件7020中各自的端部开口的槽7024中。从这些附图中可以看出,当处于该位置中时,砧座组件7010可处于闭合(夹钳)位置。在缝合手术已经完成后(例如动力夹钳元件/刀组件已经从工具组件7002的近端7004驱动到工具组件7002的远端7006之后), 临床医生可沿近侧方向回缩闭合管和耳轴锁定杆7050,允许耳轴7014通过每个槽7024的开口端7025弹出,如图95中所示。当砧座组件7010的近端7012处于图95中所示的位置中时,本领域普通技术人员将会理解,被夹钳在砧座组件7010和钉仓7021之间的组织现在就可以从其中被释放。

[0320] 图104和105示出了作为替代实施方式的外科器械4000’,其可具有大体上与上面描述的外科器械4000相同的构造和操作。但是,在图104和105所示的实施方式中,槽 4014,具有开口端,允许耳轴4022,变得与其脱离接合。从图104中可以看出,当闭合环4030 已经行进到其最远侧位置中以闭合砧座组件4020时,闭合环4030可用于通过其在砧座组件4020,的近端部分4024,上的轴承将砧座组件4020,保持在夹钳位置中。当闭合环4030 被行进到其最近侧位置时,如图105中所示,耳轴4022’自由运动,从细长通道组件4012’ 中的端部开口的槽4014’中运动脱离。外科器械400’还可以在上面详细描述的外科器械 4000相同的方式操作。

[0321] 同样在各种实施方式中,为了完全释放砧座组件7010,砧座组件7010可设置有与砧座组件7010的下侧7011连接的弹簧元件7100,如图95所示。从该图还可以看出,被构造成由一个或多个驱动索7110、7112在细长通道组件7020中驱动的动力夹钳元件150可设置有销159,其被定向成可滑动容纳在砧座组件7010中的槽7018中。当动力夹钳组件 150沿着远侧方向DD被驱动经过细长通道组件7010时,销159用于向着细长通道组件7020 拉动砧座组件7010。从图95中可以看出,弹簧元件7120的远端7102向下延伸,以便当动力夹钳组件150已经到达图95中所示的其最远侧位置时与销159接合。此后,沿着近侧方向拉动或者运动动力夹钳组件150可导致弹簧7102将销159从槽7018中释放出来。

[0322] 动力夹钳元件150的各种实施方式在图96-103中示出。从这些附图中可以看出, 动力夹钳元件150可包括上部157、中央支架或者向上的延伸部分151和底部152,在动力夹钳元件150在细长通道组件7020中向远侧纵向运动过程中,这些部分协同动作以沿着理想切割路径滑动保持动力夹钳元件150。前切割边缘155 (这里为刀片155a)的尺寸设置成倚靠在钉仓7021中形成的槽中,并且一旦缝合则将组织分开。可以想到动力夹钳元件150 的前缘可以为齿状、带斜边或者切口,以利于组织切割。动力夹钳元件150可由一根或多根驱动索7100、7112驱动。为了便于所述驱动索7110、7112的连接,动力夹钳元件150可设置有连接孔7130和壁架7132。但是,也可采用其他连接设置和驱动构造。[0323] 转向图96,动力夹钳元件的上部157设置有端部开口的槽7140,用于将销159容纳在其中。一旦销159与弹簧7100接触,则销159可被迫使脱离端部开口的槽7140。图 97的动力夹钳元件实施方式大体上与图96的相同,但上部157具有在其上形成的加强元件 7150。在图98的实施方式中,底切部分7160设置在上部中并且槽7162最初被卷曲闭合。 当销159与弹簧7100接触时,形成槽的底部7164允许向下弯曲以释放销159。在图99所示的实施方式中,支撑销159的槽7170由可弯曲的挡板7172限定,该挡板可弯曲或者变形以便打开槽7170,允许销从其上被除去,如图100所示。图101中示出的实施方式具有与第一销槽7180连通的第二槽7190,使第一销槽7180能够被打开到其中销可从其上被释放的位置。在图96-101所示的实施方式中,销159具有大体为圆形的截面形状。在图102和 103所示的实施方式中,销159’可设置有侧翼或者角板7200,为销159’提供另外的支撑并将当动力夹钳元件150被驱动经过细长通道组件7020时使销弯曲的任何可能最小化。

[0324] 虽然已经描述了本发明的一些实施方式,但可想到的是,本领域技术人员为获得本发明的一些或者所有优点,可对这些实施方式进行各种修改、变化和改变。例如,根据各种实施方式,单个元件可被多个元件代替,多个元件也可被单个元件代替,来执行给定的一种或多种功能。本申请因此覆盖了所有这些修改、改变和变化,都不脱离由所附的权利要求书所限定的本发明的精神和范围。

[0325] 在本文中公开的装置可被设计成在单次使用后可抛弃的,或者它们可被设计成可多次使用的。但在任何一种情况下,在至少一次使用后装置可再生以便重新使用。再生可包括下列步骤的任何组合:装置拆卸,然后清洁并替换特定部件,随后重新组装。特别是, 装置可被拆卸,任意数目的特定部件或者装置的部分可选择性地以任意组合被替换或者除去。当清洁和/或替换特定部分时,装置可在再生工厂或者由外科团队在外科手术前立即重新组装以便后续使用。本领域普通技术人员将会理解,装置的再生可利用用于拆卸、清洁 /替换和重新装配的各种不同技术。所述技术的使用以及产生的再生装置都属于本申请的范围。

[0326] 优选地,在这里所描述的本发明在外科手术前处理。首先得到新的或者使用过的器械,如果可能的话,对其进行清洁。器械然后可被灭菌。在一种灭菌技术中,器械被放置在密闭并密封的容器中,诸如塑料袋或者TYVEK ®袋。容器和器械然后放置在可穿透容器的辐射场所中,诸如Y射线、χ-射线或者高能电子。辐射杀死器械上和容器中的细菌。灭菌的器械然后可存在在灭菌容器中。密封容器保持器械无菌,直到其在医疗场合被打开。

[0327] 声称通过引用而包含在本申请中的任何专利、出版物或者其他形式的公开材料, 全部或部分,在本文中仅仅包含到所包含的材料不与在本申请中阐明的现有定义、陈述或者其他公开材料相矛盾的程度。这样,并且在需要的程度,在本文中明确阐明的公开内容代替了任何通过引用而包含在本申请中的相矛盾的材料。声称通过引用而包含在本申请中但与现有定义、陈述或者其他公开材料相矛盾的的任何材料或者其部分仅仅包含到不引起所包含的材料与现有公开材料不相矛盾的程度。

[0328] 试图保护的本发明不被解释为由所公开的特定实施方式所限定或限制的内容。因此这些实施方式被认为是示意性的而不是限制性的。可在不脱离本发明的精神和范围的情况下对其进行变化和改变。因此,清楚的是落入由权利要求书所限定的本发明的精神和范围内的所有这些等同物、变化和改变由此而被包括。

Claims (6)

1. 一种外科器械,包括:细长通道组件,其能够将钉仓组件可操作地支撑在其中;刀组件,其被定向用于在所述细长通道组件内行进;至少一个索过渡支架,其可操作地安装在所述细长通道组件和所述刀组件中的至少一个上;驱动索,其可操作地围绕所述至少一个索过渡支架的至少一部分延伸并且与索驱动系统连接以在所述细长通道组件内驱动所述刀组件;以及索保持装置,其用于可操作地保持所述驱动索围绕所述索过渡支架的所述至少一部分,其中,所述索保持装置包括连接在所述驱动索上用于保持其张力的索张紧接头。
2.根据权利要求1所述的外科器械,其中,所述至少一个索过渡支架包括滑轮,所述索保持装置还包括索保持块,所述索保持块与所述滑轮非常接近,并且,所述索保持块具有弧形表面,所述弧形表面相对于所述驱动索的在所述滑轮上的部分形状互补,从而防止所述驱动索从所述滑轮上脱离。
3.根据权利要求1所述的外科器械,其中,所述至少一个索过渡支架包括块,所述块具有延伸通过其的通道,所述通道形成弧形支承表面,所述驱动索通过所述弧形支承表面。
4.根据权利要求1所述的外科器械,其中,所述驱动索具有第一端和第二端,所述索张紧接头包括:第一止动元件,其连接在所述驱动索的所述第一端上;第二止动元件,其连接在所述驱动索的所述第二端上并且具有穿过其的通道,所述通道用于容纳通过其的所述驱动索的一部分,所述第二止动元件能够相对于所述第一止动元件在所述驱动索上移动;第三止动元件,其固定地连接在所述驱动索的一部分上,使得所述第二止动元件可动地容纳在所述第一止动元件和位于所述驱动索的该部分上的所述第三止动元件之间;张紧弹簧,其连接在所述第二止动元件和所述第三止动元件上。
5.根据权利要求4所述的外科器械,其中,所述索驱动系统包括从动滑轮,所述从动滑轮将所述驱动索的一部分驱动地支撑于其上,所述至少一个索过渡支架包括:第一和第二滑轮,其安装在所述细长通道组件的远端上;以及第三滑轮,其安装在所述刀组件上。
6.根据权利要求5所述的外科器械,还包括:手柄组件,其可操作地支撑所述从动滑轮;细长轴,其可操作地连接到所述手柄组件和所述细长通道组件上并且将所述驱动索支撑在其中;以及关节运动接头,其位于所述细长轴中,用以使所述细长通道组件能够相对于所述手柄组件进行关节运动。
CN 200810109777 2007-06-18 2008-06-17 带阻止索意外脱离设备的索驱动外科缝合和切割器械 CN101327135B (zh)

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US11820124 US20080308603A1 (en) 2007-06-18 2007-06-18 Cable driven surgical stapling and cutting instrument with improved cable attachment arrangements
US11820161 US7510107B2 (en) 2007-06-18 2007-06-18 Cable driven surgical stapling and cutting instrument with apparatus for preventing inadvertent cable disengagement
US11820077 US7731072B2 (en) 2007-06-18 2007-06-18 Surgical stapling and cutting instrument with improved anvil opening features
US11820119 US7588176B2 (en) 2007-06-18 2007-06-18 Surgical cutting instrument with improved closure system
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