CN101378703A - 显微外科手术器械 - Google Patents

显微外科手术器械 Download PDF

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CN101378703A
CN101378703A CNA2007800046728A CN200780004672A CN101378703A CN 101378703 A CN101378703 A CN 101378703A CN A2007800046728 A CNA2007800046728 A CN A2007800046728A CN 200780004672 A CN200780004672 A CN 200780004672A CN 101378703 A CN101378703 A CN 101378703A
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G·L·基希赫维尔
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Alcon Inc
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32Surgical cutting instruments
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007Methods or devices for eye surgery
    • A61F9/00736Instruments for removal of intra-ocular material or intra-ocular injection, e.g. cataract instruments
    • A61F9/00763Instruments for removal of intra-ocular material or intra-ocular injection, e.g. cataract instruments with rotating or reciprocating cutting elements, e.g. concentric cutting needles
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00535Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
    • A61B2017/00544Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated pneumatically
    • 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
    • A61B2017/2918Handles transmission of forces to actuating rod or piston flexible handles
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/30Surgical pincettes without pivotal connections
    • A61B2017/305Tweezer like handles with tubular extensions, inner slidable actuating members and distal tools, e.g. microsurgical instruments
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03Automatic limiting or abutting means, e.g. for safety
    • A61B2090/033Abutting means, stops, e.g. abutting on tissue or skin
    • A61B2090/034Abutting means, stops, e.g. abutting on tissue or skin abutting on parts of the device itself

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Abstract

显微外科手术器械包括切割件和底座,所述底座具有一驱动机构,该驱动机构提供更有效的切割组织。

Description

显微外科手术器械
技术领域
本发明一般涉及显微外科手术器械。更具体地,但不作为限制,本发明涉及具有用于抽吸和切割组织的口的显微外科手术器械。
背景技术
许多显微外科手术要求精密切割和/或切除各种身体组织。例如,某些眼外科手术要求切割和/或清除玻璃体、充满眼的后段的透明胶状材料。玻璃状体液,或者玻璃体包括许多显微纤维,所述显微纤维常常附着到视网膜上。因此,切割和消除玻璃体必须十分小心地进行,以便避免在视网膜上牵引、视网膜与脉络膜分离、视网膜撕裂、或者在最坏情况下,切割和清除视网膜本身。
在后段眼外科中使用显微外科手术切割探针是众所周知的。这种玻璃体切割术探针通常是通过巩膜中部分平面附近的切口插入。外科医生在后段外科手术期间还可以插入其它显微外科手术器械,如光纤照明器、输注套管、或抽吸探针。外科医生实施手术,而同时在显微镜下观察眼睛。
常规外科手术探针通常包括空心外切割件、空心内切割件、和一口,上述空心内切割件与空心外切割件同轴式安装,并可移动式设置在空心外切割件内,而上述口在空心外切割件远端附近径向上贯穿外切割件。将玻璃状体液抽吸到打开的口中,驱动内切割件,同时关闭口。在关闭口时,在内和外切割件二者上的切割面协同工作,以便切割玻璃体,然后穿过内切割件将切下的玻璃体抽吸走。下列美国专利Nos.4577629(Martinez);5019035(Missirlian等);4909249(Akkas等);5176628(Charles等);5047008(de Juan等);4696298(Higgins等);和5733297(Wang)全都公开了各种类型的玻璃体切割术探针,这些专利当中每个专利都通过参考整体包括在本文中。
常规玻璃体切割术探针包括“侧除刀通管丝(guillotine style)”探针和旋转式探针。侧除刀通管丝探针具有一内切割件,所述内切割件绕它的纵向轴线往复运动。在两种类型探针中,内切割件用各种方法驱动。例如,内切割件可以通过压缩空气的压力从打开口的位置移动到关闭口的位置,上述压缩空气的压力顶着活塞或隔膜组件来克服机械弹簧力。在除去压缩空气压力时,弹簧使内切割件从关闭口的位置移动到打开口的位置。作为另一个例子,内切割件可以用第一压缩气源从打开口的位置移动到关闭口的位置,然后可以用第二压缩气源从关闭口的位置移动到打开口的位置。作为另一个例子,内切割件在打开口的位置和关闭口的位置之间用常规电动机或螺线管用机电法驱动。美国专利No.4577629提供一种侧除刀通管丝、气动活塞/机械弹簧驱动式探针。美国专利Nos.4909249和5019035公开了侧除刀通管丝、气动隔膜/机械弹簧驱动式探针。美国专利5176628表明一种旋转式双压缩空气驱动探针。
在许多常规玻璃体切割术探针中,内切割件的切割行程通过在切割行程的终端处与探针的关闭的远端接触进行限制。这种驱动可能使探针的切割面变钝。在许多常规玻璃体切割术探针中,内切割件的返回行程是通过驱动活塞或隔膜接触止动环进行限制。这种安排减少了在切割行程开始时暴露于驱动压力下的隔膜面积。在常规气动活塞(或隔膜)/机械弹簧驱动式探针中,使用预加载返回弹簧要求较大的驱动压力来开始切割行程。弹簧加载式探针还显示随着切割行程的进展而不断增加弹簧返回力,这要求增加气动压力来完成切割行程。这种限制在具有更高切割速度的现代化探针中加剧,因为弹簧预加载力越大,相应地要求气动压力越大。
因此,需要有一种改进的具有更有效切割的玻璃体切割状探针。这种有效性有助于在探针驱动、在较低气动压力下工作及在较高切割速度下工作期间使消耗的空气总量最少。减少空气的总消耗量对于在通过定期更换的压力钢瓶输送气动压力的地方应用尤其重要。在较高的切割速度下手术减少了切割之间的抽吸时间和切割期间玻璃体和视网膜组织的扰动。
发明内容
在一个方面,本发明是一种显微外科手术器械,所述显微外科手术器械具有切割件和底座。切割件具有管状外切割件和管状内切割件,上述管状外切割件具有一用于接收组织的口,而上述管状内切割件设置在外切割件内。底座具有驱动机构,所述驱动机构用于内切割件的往复驱动,以便内切割件打开和关闭口并切割设置在所述口内的组织。驱动机构包括隔膜室、刚性中心支承件和挠性隔膜,上述隔膜室具有第一壁部分和第二壁部分,上述刚性中心支承件设置在隔膜室中,并具有第一界面和第二界面,而上述挠性隔膜连接到中心支承件和底座上。在驱动内切割件时,第一界面在内切割件的切割行程的终端处接触第一壁部分,而第二界面在内切割件的返回行程的终端处接触第二壁部分。
附图说明
为了更充分理解本发明及其另一些目的和优点,参见下面结合附图所作的说明,其中:
图1是按照本发明的优选实施例所述的显微外科手术器械的透视图;
图2是图1的显微外科手术器械的顶视图;
图3是图1的显微外科手术器械显示操作式连接到显微外科手术系统上的侧剖图;
图4是图1的显微外科手术器械的凸轮件的放大透视图;
图5是图4的凸轮件的剖视图;
图6是图2的圈6中所示的图1显微外科手术器械部分的放大示意局部侧剖图;和
图7是图1的显微外科手术器械的驱动机构中一部分的放大示意局部侧剖图。
具体实施方式
本发明的一些优选实施例及它们的优点通过参见附图的图1-7最好地得以理解,同样的标号用于各附图的同样和对应的部件。
显微外科手术器械10优选的是包括底座12、驱动手柄14、鼻状件16、和切割件18,所述切割件18具有一远端尖头20。如各图中所示,显微外科手术器械10是玻璃体切割术探针。但是,显微外科手术器械10可以是任何显微外科手术切割、抽吸或注入探针。
底座12包括一驱动机构13,所述驱动机构13用于以往复方式驱动切割件18的管状内切割件110。驱动机构13优选的是包括第一气动口22、第二气动口24、隔膜室26、挠性隔膜28和刚性中心支承件30。挠性隔膜28连接到中心支承件30和底座12上。如各附图中所示,挠性隔膜28摩擦式连接到中心支承件30和底座12二者上。可选择地,挠性隔膜28可以摩擦式连接到底座12上和过度模制(over-molded)到中心支承件30上。中心支承件30具有界面31a和31b,所述界面31a和31b分别用于与隔膜室26的壁部分33a和33b接合。底座12还包括抽吸口34和远端部分12a,所述远端部分12a具有孔径12b和远端尖头12c。卡圈36将远端部分12a连接到驱动手柄14上。内切割件110通过O形圈38连接到中心支承件30上及滑动式和流体式连接到底座12上。
驱动手柄14优选的是包括近端底座50、远端底座52和多个挠性附件14a,所述挠性附件14a连接到上述底座50和52二者上。挠性附件14a可以用任何适合的具有记忆的弹性材料如钛、不锈钢或适合的热塑性塑料制造。手柄14环绕底座12的远端部分12a。近端底座50连接到卡圈36上。远端底座52容纳在可滑动的卡圈54内。使用者通过手柄14握紧显微外科手术器械10。当使用者在挠性附件14a上施加向内压力时,挠性附件14a在14b或其附近弯曲,同时使挠性附件14a伸直和伸长,并使卡圈54移向远端尖头20。当这种压力除去时,弹簧55使挠性附件14a返回到图2所示的位置。
鼻状件16优选包括凸轮室70、底座室74、套筒76和出口78,上述凸轮室70用于容纳凸轮件72,上述底座室74用于容纳底座12的远端尖头12c、上述套筒76用于容纳切割件18的内切割件10,及上述出口78用于容纳切割件18的管状外切割件100。凸轮件72通过插入一孔79的每一端的定位销(未示出)旋转式连接到底座12的孔12b内的鼻状件16上。凸轮件72优选的是具有用于与卡圈54接合的第一支承面80、用于与底座12接合的第二支承面82、用于容纳切割件18的内切割件110的余隙槽84、及用于与套筒76接合的凸轮面86。O形圈88滑动式和流体式将鼻状件16密封到内切割件110上。
如上所述,切割件18优选的是包括管状外切割件100和管状内切割件110。外切割件100具有内孔102、闭合端104、用于容纳组织的口106、和切割面108。内切割件具有内孔112、开口端114、和切割面116。
在手术时,玻璃体切割术探针10操作式连接到显微外科手术系统198上。更准确地说,气动口22通过流体管线202流体式连接到压缩空气源200上,气动口24通过流体管线206流体地连接到压缩气源204上,抽吸口34通过流体管线209流体式连接到真空源208上。把外科手术液罐入内孔112和流体管线209。显微外科手术系统198还具有微处理机或计算机210,所述计算机210分别通过接口212和214电连接到压缩气源200和204上。
外科医生用部分平面的插入件将远端尖头20插入眼的后段。外科医生为真空源208选择所希望的真空水平。通过口106将组织抽吸到内孔112中。外科医生用微处理机210和任选地比例控制装置(未示出)如脚控制器为探头10选择所希望的切割速率。更具体地,微处理机210利用加压气源200和204来产生横跨隔膜28的循环压差,以便以所希望的切割速率,用往复方式移动中心支承件30,并因此移动内切割件110。当提供给气动口22的压力大于提供给气动口24的压力时,内切割件110移向远端尖头20直至开口端114经过切割面108为止,如图6中所示。这种驱动将口106关闭,同时使切割面108和116能切割内孔112内的组织。切下的组织通过内孔112、抽吸口34、流体管线209抽吸,并吸入到收集室(未示出)中。当提供给气动口24的压力大于提供给气动口22的压力时,内切割件110移动离开远端尖头20,同时打开口106,并能进一步抽吸组织。
在驱动内切割件110期间,中心支承件30的界面31a接触隔膜室26的壁部分33a,以便精确地结束切割行程。中心支承件30的界面31b接触隔膜室26的壁部分33b,以便精确地结束返回行程。当界面31a接触壁部分33a时,内切割件110的开口端114的切割面116优选的是设置在外切割件100的远端切割面108处或正好通过所述远端切割面108。当界面31b接触壁部分33b时,开口端114优选的是设置在外切割件100的近端切割面108处或其附近。这种驱动内切割件110的精密控制大大增加了探针10的切割效率。
从上述情况可知,本发明提供相当大的优于常规玻璃体切割术探针的好处。本发明在本文中作为例子进行了说明,且该领域的技术人员可以进行各种修改。例如,尽管本发明在上面在玻璃体切割术探针方面进行了说明,但它同等地可适用于抽吸探针、注入探针和其它切割探针。
可以认为,本发明的操作和结构从上述说明显而易见。尽管所表明的上述的设备和方法作为优选实施例表征,但在不脱离如下面权利要求书所述的精神和范围的情况下,本文可以进行各种修改。

Claims (4)

1.一种显微外科手术器械,包括:
切割件,所述切割件具有管状外切割件和管状内切割件,上述管状外切割件具有用于容纳组织的口,而上述管状内切割件设置在上述外切割件内;和
底座,所述底座具有一驱动机构,所述驱动机构用于往复式驱动上述内切割件,以便上述内切割件打开和关闭上述口,并切割设置在上述口中的组织,上述驱动机构包括:
隔膜室,所述隔膜室具有第一壁部分和第二壁部分;
刚性中心支承件,所述刚性中心支承件设置在上述隔膜室中,并具有第一界面和第二界面;和
挠性隔膜,所述挠性隔膜连接到上述中心支承件和底座上;
因而在驱动上述内切割件时,上述第一界面在上述内切割件的切割行程终端处接触上述第一壁部分,而上述第二界面在上述内切割件的返回行程的终端处接触上述第二壁部分。
2.如权利要求1所述的显微外科手术器械,其中当上述内切割件关闭上述口时,上述第一界面接触上述第一壁部分。
3.如权利要求2所述的显微外科手术器械,其中当上述口处于完全打开位置时,上述第二界面接触上述第二壁部分。
4.如权利要求1所述的显微外科手术器械,其中所述器械是玻璃体切割术探针。
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CN104039250B (zh) * 2010-12-22 2016-11-09 爱尔康研究有限公司 液压玻璃体切除术探针
CN102327159A (zh) * 2011-08-18 2012-01-25 杨勋 两用玻璃体切割头
CN102327159B (zh) * 2011-08-18 2013-05-15 杨勋 两用玻璃体切割头
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US20070185512A1 (en) 2007-08-09

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