CN101474086A - 用于体外组织或死亡生物体上的方法 - Google Patents

用于体外组织或死亡生物体上的方法 Download PDF

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CN101474086A
CN101474086A CNA2009100052151A CN200910005215A CN101474086A CN 101474086 A CN101474086 A CN 101474086A CN A2009100052151 A CNA2009100052151 A CN A2009100052151A CN 200910005215 A CN200910005215 A CN 200910005215A CN 101474086 A CN101474086 A CN 101474086A
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迈克尔·P·惠特曼
约翰·E·伯班克
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    • A61B18/14—Probes or electrodes therefor
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    • A61B2018/1455—Probes having pivoting end effectors, e.g. forceps including means for cutting having a moving blade for cutting tissue grasped by the jaws

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Abstract

本发明涉及一种用于体外组织或死亡生物体上的方法，该方法包括：将部分组织定位于与第二爪相对对应放置的第一爪之间，该第二爪在远端对面的近端机械地连接于第一爪；以及启动连接于设置在该第二爪的远端内的切割元件的第一驱动器以便近侧地将所述切割和锁环固定元件从所述远端移向所述第二爪的近端，从而切割位于所述第一爪和所述第二爪之间的部分组织。在切割和锁环固定操作期间，通过将切割和锁环固定元件从装置的远端移动到近端，可以减少在其远端处上爪和下爪之间的距离，可降低切割和锁环固定操作期间所需要的旋力，从而降低外科装置的各种部件所承受的应力。

Description

用于体外组织或死亡生物体上的方法
本申请是申请号为02823832.X、申请日为2002年11月07日、发明名称为“外科装置”的原案申请的分案申请。
相关申请的交叉引用
本申请在此结合以下参考文献：2001年6月22日提交的美国专利申请第09/887,789号；2001年4月17日提交的美国专利申请第09/836,781号；2000年11月28日提交的美国专利申请第09/723,715号；1999年6月2日提交的美国专利申请第09/324,451号；1999年6月2日提交的美国专利申请第09/324,452号；1999年7月12日提交的美国专利申请第09/351,534号并在2001年7月24日公布为美国专利第6,264,087号；2000年2月22日提交的美国专利申请第09/510,923号；以及2000年2月22日提交的美国专利申请第09/510,927号。
技术领域
本发明涉及一种外科装置。更具体地说，本发明涉及一种用于夹紧、切割、和锁环固定组织的线形夹紧、切割、和锁环固定装置。
背景技术
文献中充满着外科装置的描述。申请人的共同未决美国专利申请第09/887,789号列出了这些外科装置的一部分，如授权Sjostrom等人的美国专利第4,705,038号；授权Ams等人的美国专利第4,995,877号；授权Mallaby的美国专利第5,249,583号；授权Hooven的美国专利第5,383,880号；授权Byrne等人的美国专利第5,395,033号；授权Tsuruta等人的美国专利第5,467,911号；均授权Hooven的美国专利第5,518,163、5,518,164、和5,667,517号；授权Young等人的美国专利第5,653,374号；授权Alesi等人的美国专利第5,779,130号；以及授权Viola等人的美国专利第5,954,259号。
一种类型的外科装置是线形夹紧、切割、和锁环固定装置。2001年7月24日公布的美国专利第6,264,087号展示和描述了这类装置的一个实例。这类装置可用于外科手术以从胃肠道切除癌性或异常组织。
相对于如图1所示的传统线形夹紧、切割、和锁环固定仪器的结构特点，该装置包括手枪式握把型结构，具有细长轴和远侧部分。该远侧部分包括一对剪式夹紧元件，其夹住闭合结肠的开口端。在该装置中，两个剪式夹紧元件之一的支点部分相对于整个结构移动或旋转，而另一个夹紧元件相对于整个结构保持不动。这种剪式装置的启动(支点部分的旋转)是由把手维持的夹紧起动器进行控制。
除了剪式装置之外，远侧部分还包括锁环固定装置。剪式装置的固定的夹紧元件包括锁环夹头接受区域和用于相对于支点部分驱动锁环向上通过组织的夹紧端的装置，由此密封先前的开口端。该剪式元件可与轴整体地形成，或可以是可拆卸的，从而各种剪式和锁环固定元件可以互换。
前述外科装置的一个问题，特别是如说明于图1的前述线形夹紧、切割、和锁环固定装置，是夹紧装置的相对爪在切割和锁环固定组织期间倾向于被分开。前述外科装置的另一个问题，特别是如说明于图1的前述线形夹紧、切割、和锁环固定装置，是这些装置难以操纵。由于线形夹紧、切割、和锁环固定装置可在体内使用，例如，在患者体内，因而该装置须足够小以在患者体内使用。传统的如说明于图1的线形夹紧、切割、和锁环固定装置有总长度，其增加了操纵该装置的困难，特别是在患者体内。
前述外科装置的又一个问题，特别是如说明于图1的前述线形夹紧、切割、和锁环固定装置，是切割和锁环固定部分组织所需的旋力太大，从而在装置的各种部件中产生应力。例如，在其它将剪式和锁环固定元件从近端移到远端的线形夹紧、切割、和锁环固定装置中，当剪式和锁环固定元件在远端时需要大的旋力以移动剪式和锁环固定元件。因而，当切割和锁环固定元件已移动到爪的远端时，大的旋力会在剪式和锁环固定元件、以及装置的驱动器中引起应力。
发明内容
根据本发明的一个典型实施例，涉及一种外科装置，其包括第一爪和与第一爪处于相对对应位置的第二爪。第二爪是在远端对面的近端机械地连接于第一爪。具有刀片朝向近端的切割元件位于第二爪内，而第一驱动器成一定构造以从远端向第二爪的近端移动切割元件从而切割第一爪和第二爪之间的部分组织。
根据典型的实施例，该装置可包括设置在第二爪内的锁环固定元件，其中切割元件和锁环固定元件相接触以便限定单个切割和锁环固定元件，如刀片置于其上的楔。当楔从第二爪的远端移到近端时，楔则将锁环推向相对的位于第一爪中的锁环导管以在刀片切割部分组织时用锁环固定部分组织。
在切割和锁环固定操作期间，通过将切割和锁环固定元件从装置的远端移动到近端，该具体实施例可降低装置操作中上爪和下爪的分离倾向。特别地，在切割和锁环固定操作期间，通过将切割和锁环固定元件从装置的远端移动到近端，可以减少在其远端处上爪和下爪之间的距离。
此外，在切割和锁环固定操作期间，通过将切割和锁环固定元件从装置的远端移动到近端，该实施例可降低切割和锁环固定操作期间所需要的旋力，从而降低外科装置的各种部件所承受的应力。通过将切割和锁环固定元件安放在装置的远端，相对于传统的线形夹紧、切割、和锁环固定装置，该实施例也可以降低外科装置的长度，从而改善装置的可操纵性，特别是当使用在患者体内时，并且可以使行程(例如，可被切割和锁环固定的距离)加长从而比传统的线形夹紧、切割、和锁环固定装置夹紧、切割、和锁环固定更大部分的组织。
附图说明
图1是传统的线形夹紧、切割、和锁环固定装置的立体图；
图2是根据本发明的一个具体实施例的机电外科系统的立体图；
图3和图4分别是根据本发明的一个具体实施例的线形夹紧、切割、和锁环固定装置的闭合和打开配置的侧视图；
图5和图6分别是图3和图4所说明的线形夹紧、切割、和锁环固定装置的闭合和打开配置的侧面剖视图；
图5A是图3至图6所说明的线形夹紧、切割、和锁环固定装置的闭合配置的另一剖视图；
图7至图14是图3至图6所说明的线形夹紧、切割、和锁环固定装置的后剖视图；
图15至图19分别是图3至图14所说明的线形夹紧、切割、和锁环固定装置的仰视图、顶剖视图、纵深的顶剖视图、底剖视图、以及顶视图；
图20是图3至图19所说明的线形夹紧、切割、和锁环固定装置的侧面剖视图；
图21是根据本发明的一个具体实施例的机电外科装置的柔性轴的侧面正视图，局部剖视；
图22是沿着图21所示的线22-22获取的柔性轴的截面图；
图23是图21所说明的柔性轴的第一连接的后部视图；
图24是图21所说明的柔性轴的第二连接的前部视图；
图25是图2所说明的机电外科装置的电动机布置的示意图；
图26是图2所说明的机电外科装置的示意图；
图27是图21所说明的柔性轴的编码器的示意图；
图28是根据本发明的一个具体实施例的线形夹紧、切割、和锁环固定装置的存储器的示意图；
图29是图2所说明的机电外科装置的无线遥控器的示意图；
图30是图2所说明的机电外科装置的有线遥控器的示意图；以及
图31至图33是根据本发明的一个具体实施例的线形夹紧、切割、和锁环固定装置的闭合配置的侧面剖视图，说明可拆卸地连接于锁环固定元件的切割元件。
具体实施方式
根据本发明的外科装置的一个具体实施例说明于图3至图20。参照图3和图4，其说明了外科装置11的具体实施例，例如，线形夹紧、切割、和锁环固定装置。在该具体实施例中，装置11包括平行的分离爪系统，具有下爪50，其在上爪80的相对对应位置，而该上爪具有近端100。图3说明处在闭合位置的装置11，其中下爪50和上爪80在其近端和远端均接触。图4说明处在打开位置的装置11，其中下爪50和上爪80分离。仅为了说明起见，图3至图20说明相对的爪50和80，其彼此相对保持平行。在可换替的具体实施例中，相对的爪50和80可以剪式(scissor-like fashion)打开和闭合，其中相对爪50和80的近端是通过铰链或其它可旋转元件进行机械连接，从而上爪50可旋转地连接于下爪80。
图5是处在闭合位置的外科装置11的侧面剖视图，对应于图3所示的视图。另一方面，图6是处于打开位置的外科装置11的侧面剖视图，对应于图4所示的视图。现参照图5或图6，上爪80的近端100包括一对螺纹垂直孔90，通过其延伸相应的一对垂直轴130。垂直孔90的内螺纹92匹配垂直轴130的外螺纹132。垂直轴130在上水平轴151的远端140啮合螺纹上水平轴151。上水平轴151的外螺纹152连结于垂直轴130的外螺纹132。上水平轴151包括在近端170的上驱动套管180。
图5A是根据本发明的一个具体实施例的图3和图4所说明的外科装置11的闭合配置的另一剖视图。图5A说明连接(可拆卸地或永久地)于机电外科系统510的外科装置11。该外科装置11包括第一驱动器261，其通过第一驱动轴532连接于系统510的第一电动机576。如在下面更详细说明的，第一驱动器261，当由系统510连接时，可运转以驱动下爪50内的切割和锁环固定元件。此外，外科装置11包括第二驱动器150，其通过第二驱动轴530连接于系统510的第二电动机580。如在下面更详细说明的，第二驱动器150，当由系统510啮合时，可运转以相对于下爪50打开和闭合上爪80。
再参照图5和图6，外科装置11进一步包括切割元件和锁环固定元件，其包括楔270，有刀片51置于其上。在可替换的具体实施例中，可以将切割和锁环固定元件分别进行设置。在该具体实施例中，刀片51包括刃口51a，其朝向外科装置11的近端170。在下爪50设置有托架220，其是可替换的，安放一个或多个紧固件，例如，锁环230，而在上爪80设置一个或多个对应于锁环230的锁环导管240。每个锁环230包括铰链232，其伸出到托架220的下面而一对支架234延伸到托架220的顶部。外科装置11进一步包括楔形导管或槽250，其在托架220的下面延伸。在槽250内延伸具有外螺纹262的螺纹下水平轴260。当下水平轴260移动楔270时，该楔包括：倾斜顶面280；与槽250同轴的水平螺纹孔290，具有匹配于下水平轴260的外螺纹262的内螺纹292；以及向上延伸的刀片构件51。如前所述，刀片构件51包括刃口51a，其朝向外科装置11的近端170。下水平轴260在近端300具有第二驱动套管310。
在所说明的具体实施例中，外科装置11还包括第一传感电极182，其通过传输导线电连接于第一接触垫片187，而第一接触垫片187又通过，例如，直接接触电连接于第二接触垫片189。第二接触垫片189通过传输导线188a电连接于第一接触节点188。类似地，外科装置11进一步包括第二传感电极184，其通过传输导线电连接于第二接触节点186(说明于图7)。在机电驱动部件510中接触节点186、188电连接于传输导线(未示出)以形成传感电路，因而当上爪80和下爪50夹在一起时，传感电极182、184相接触，传感电路是闭合的，而操作者通过其它电路部件(下面详细讨论)被告知爪50、80的夹紧位置。因此，操作者知道开始切割和锁环固定过程是安全和/或适当的。
图7是图5说明的外科装置11的沿线7-7获得的后剖视图。图7说明第二接触节点186、以及用于啮合第一驱动轴的上驱动套管180和用于啮合第二驱动轴的下驱动套管310。图7还说明连接于数据存储单元1174的数据连接器1272(说明于图5和图6)，其目的和操作会在下面详细讨论。图8是图5说明的外科装置11的沿线8-8获得的后剖视图。图9是图5说明的外科装置11的沿线9-9获得的后剖视图。图10是图5说明的外科装置11的沿线10-10获得的后剖视图。
图11是图中说明的外科装置11的沿线11-11获得的后剖视图。图12是图6说明的外科装置11的沿线12-12获得的后剖视图。图13是图6说明的外科装置11的沿线13-13获得的后视图。图14是图6说明的外科装置11的沿线14-14获得的后视图。
图15是图5和图6说明的外科装置11的沿线15-15获得的仰视图。图16是图5和图6说明的外科装置11的沿线16-16获得的顶剖视图。图17是图5和图6说明的外科装置11的沿线17-17获得的纵深顶剖视图。图18是图5和图6说明的外科装置11的沿线18-18获得的底剖视图。图19是图5和图6说明的外科装置11的沿线19-19获得的顶视图。图20是图5和图6说明的外科装置11的沿线20-20获得的侧面剖视图。
上述的每个具体实施例包括刀片51固定地置于其上的楔270。根据本发明的另一具体实施例，外科装置11包括刀片，其可拆卸地连接或安装于楔，因而该刀片可相对于楔在第一位置和第二位置之间移动。根据一个具体实施例，相对于楔的刀片的第一位置可以处于收缩位置，而相对于楔的刀片的第二位置可以处于可操作位置，例如，其中刀片的刃口朝向外科装置11的下爪50的近端。
图31至图33说明一个具体实施例，其中外科装置11包括可旋转地连接于楔670的刀片651，从而在第一和第二位置之间进行旋转。如图31至图33所示的外科装置11的操作将在下面详细讨论。图31至图33说明定位于下爪50的远端的楔270。刀片651是通过枢轴构件652可旋转地安装于楔270。刀片651包括刃口651a，其起初处于收缩或向下位置，例如，朝向下水平轴260。刀片651还包括尾部区域654，具有启动针接受面653，其起初朝向外科装置11的近端170。邻接位于启动针接受面653的是固定的启动针655，根据此说明的具体实施例其是固定地连接于下爪50。
根据本发明的一个具体实施例，外科装置11可构造成机电外科系统的附件，或者可以与机电外科系统成一整体，如机电外科系统510。在另一具体实施例中，外科装置可构造成纯机械装置驱动系统的附件，或可以与纯机械装置驱动系统成一整体，如图1所说明的外科装置。
图2是根据本发明的机电外科系统510的一个具体实施例的立体图。机电外科系统510可包括，例如，远距离动力控制台512，其包括具有面板515的外罩514。安装于面板515上的是显示装置516和指示器518a、581b，其将在下文更充分地描述。柔性轴520可从外罩514伸出来并可以通过第一连接522可拆卸地固定于其上。柔性轴520的远端524可包括第二连接526，其适合于可拆卸地将，例如，上述的外科装置11固定于柔性轴520的远端524。然而，应注意到，第二连接526也可以适合于可拆卸地固定不同的外科仪器或附件。在另一具体实施例中，柔性轴520的远端524可永久地固定于外科仪器或和外科仪器成一整体。
参照图21，可以看到柔性轴520的局部截面的侧视图。根据一个具体实施例，柔性轴520包括管形护套528，其可包括涂层或其它密封装置以在其内部槽540和环境之间提供不漏流体的密封。护套528可由组织相容、可灭菌的弹性材料制成。护套528也可以由耐高压加热的材料制成。设置在柔性轴520的内部槽540内，并沿着其整个长度延伸的可以是第二可旋转驱动轴530、第一可旋转驱动轴532、第一转向电缆534、第二转向电缆535、第三转向电缆536、第四转向电缆537、以及数据传输电缆538。图22是柔性轴520的沿着图21所示线22-22获得的截面图，进一步说明了几个电缆530、532、534、535、536、537、538。转向电缆534、535、536、537的每个远端是固定于柔性轴520的远端524。几个电缆530、532、534、535、536、537、538的每一个可包含在相应的护套内。
第二可旋转驱动轴530和第一可旋转驱动轴532可构造成，例如，高度柔性的驱动轴，例如，编织或螺旋驱动电缆。应当理解的是，这种高度柔性的驱动电缆具有有限的旋力传递特性和能力。还应当理解的是，外科装置11(或其它连接于柔性轴520的附件)可能需要比由驱动轴530、532传递的旋力更大的旋力输入。因此，驱动轴530、532可成一定构造以传递高速的低旋力，这种高速/低旋力可通过齿轮装置转换成低速/高旋力，该齿轮装置可设置，例如，在驱动柔性轴520的远端和/或近端、在外科仪器或附件中和/或在远距离动力控制台512中。应当知道，这类齿轮装置可提供在沿着传动系的任何适当的位置，其中传动系是在设置于外罩514内的电动机和连接的外科仪器或其它连接于柔性轴520的附件之间。这类齿轮装置可包括，例如，正齿轮装置、行星齿轮装置、谐波齿轮装置、摆线驱动装置、周转传动装置等等。
现参照图23，可以看到第一连接522的后端视图。第一连接522包括第一连接器544、第二连接器548、第三连接器552、以及第四连接器556，每个可旋转地固定于第一连接522。每个连接器544、548、552、556包括相应的凹处546、550、554、558。如图23所示，每个凹处546、550、554、558可以是六角形。然而，应当知道，凹处546、550、554、558可以具有任何形状和构造以将连接器544、548、552、556非旋转地连接和刚性连接于包含在外罩512内的电动机装置的相应的驱动轴，如下面更充分地描述的。应当知道，辅助突出部可设置在电动机装置的相应的驱动轴上，由此驱动柔性轴520的驱动元件，如下所述。还应当知道，这些凹处可设置在驱动轴上而辅助突出部可设置在连接器544、548、552、556上。可以设置任何其它连接装置，其成一定构造以非旋转地和可分离地连接连接器544、548、552、556和电动机装置的驱动轴。
连接器544、548、552、556之一是非旋转地固定于第二驱动轴530，而连接器544、548、552、556中的另一个是非旋转地固定于第一驱动轴532。连接器544、548、552、556中的剩余两个连接于传递元件，其成一定构造以对转向电缆534、535、536、537施加拉力，从而控制柔性轴520的远端524。数据传输电缆538是电和逻辑连接于数据连接器560。数据连接器560包括，例如，电触点562，其对应于并且数目等于包含在数据电缆538内的单个导线的数目。第一连接522包括键结构542以适当地使第一连接522适应于置于外罩512上的配匹的和互补的连接装置。这种键结构542可设置在第一连接522和置于外罩512上的配匹的和互补的连接装置之一或两者上。第一连接522可包括快速连接型连接器，其可以利用，例如，简单的推移来将第一连接522连接于外罩512。可以和几个连接器544、548、552、556、560中的任何连接器一道提供密封，以在第一连接522的内部和环境之间提供不漏流体的密封。
现参照图24，可以看到柔性轴520的第二连接526的前端视图。在该具体实施例中，第二连接526包括第一连接器566和第二连接器568，每个可旋转地固定于第二连接526并且每个非旋转地固定于第一和第二驱动轴532、530的相应一个的远端。快速连接型套筒564设置在第二连接526上用于可拆卸地在其上固定装置11。快速连接型套筒564可以是，例如，旋转快速连接型配件、卡口型配件等等。键结构574设置在第二连接526上用于适当地使装置11和第二连接526成一直线。用于适当地使装置11和柔性轴520成一直线的键结构或其它装置可以设置在第二连接526和装置11之一或两者上。此外，快速连接型配件可设置在装置11上。具有电触点572的数据连接器570也设置在第二连接526中。与第一连接522的数据连接器560一样，第二连接526的数据连接器570包括触点572，电连接和逻辑连接于数据传输电缆538和数据连接器560的触点562的相应的导线。可以与连接器566、568、570一道提供密封以在第二连接526的内部和环境之间提供不漏流体的密封。
设置在远距离动力控制台512的外罩514内的是机电驱动元件，其成一定构造以驱动该驱动轴530、532和转向电缆534、535、536、537，从而操作机电外科系统510和连接于第二连接526的线形夹紧、切割、和锁环固定装置11。在示意说明于图25的具体实施例中，每个通过电源操作的五个电动机576、580、584、590、596可设置在远距离动力控制台512中。然而，应当明白，可以安装任何适当数目的电动机，而电动机可通过电池动力、线路电流、直流电源、电控直流电源等等进行运转。也应当明白，这些电动机可连接于直流电源，其又连接于线路电流并向这些电动机提供工作电流。
图25示意说明电动机的一种可能的配置。当第一连接522和柔性轴520啮合于外罩514时，第一电动机576的输出轴578啮合于第一连接522的第一连接器544，从而驱动第二连接526的第二驱动轴530和第一连接器566。类似地，当第一连接522和柔性轴520啮合于外罩514时，第二电动机580的输出轴582啮合于第一连接522的第二连接器548，从而驱动第二连接526的第一驱动轴532和第二连接器568。当第一连接522和柔性轴520啮合于外罩514时，第三电动机584的输出轴586啮合于第一连接522的第三连接器552，从而通过第一滑轮装置588驱动第一和第二转向电缆534、535。当第一连接522和柔性轴520啮合于外罩514时，第四电动机590的输出轴592啮合于第一连接522的第四连接器556，从而通过第二滑轮装置594驱动第三和第四转向电缆536、537。第三和第四电动机584、590可固定于托架1100上，其通过第五电动机596的输出轴598可选择性地在第一位置和第二位置之间移动，以选择性地将第三和第四电动机584、590与相应的滑轮装置588、594啮合和脱离，从而当必要时允许柔性轴520变得拉紧和易操纵或柔软。应当明白，可以使用其它机械、电子、或机电装置以选择性地啮合和脱离转向装置。这些电动机可如美国专利申请第09/510,923号所述进行排列和构造，该申请的题目是“A CarriageAssembly for Controlling a Steering Wire Mechanism Within a FlexibleShaft”(用于在柔性轴内控制转向导线装置的托架组件)，其全部内容结合于此作为参考。
应当知道，任何一个或多个电动机576、580、584、590、596可以是高速/低旋力电动机或低速/高旋力电动机。如上所述，第二可旋转驱动轴530和第一可旋转驱动轴532可以成一定构造以传递高速和低旋力。因而，第一电动机576和第二电动机580可构造成高速/低旋力电动机。可替换地，第一电动机576和第二电动机580可构造成低速/高旋力电动机并具有旋力降低/速度提高的齿轮装置，其放置在第一电动机576及第二电动机580和第二可旋转驱动轴530及第一可旋转驱动轴532的相应的一个之间。这类旋力降低/速度提高的齿轮装置可包括，例如，正齿轮装置、行星齿轮装置、谐波齿轮装置、摆线驱动装置、周转传动装置等等。应当明白，任何这类齿轮装置可设置在远距离动力控制台512内或在柔性轴520的近端，例如，在第一连接522。应当知道，齿轮装置是设置在第二可旋转驱动轴530和/或第一可旋转驱动轴532的远端和/或近端以防止其缠绕和断裂。
现参照图26，可以看到机电外科系统510的实施例的示意图。控制器1122设置在远距离动力控制台512的外罩514中并成一定构造以控制机电外科系统510和连接于柔性轴520的线形夹紧、切割、和锁环固定装置11的所有功能和操作。提供了存储单元1130，其可以包括存储器件，如ROM部件1132和/或RAM部件1134。ROM部件1132是通过线路1136与控制器1122电和逻辑连接，而RAM部件1134是通过线路1138与控制器1122电和逻辑连接。RAM部件1134可以包括任何类型的随机存取存储器，如，磁性存储器、光学存储器、磁光存储器、电子存储器等等。类似地，ROM部件1132可以包括任何类型的只读存储器，例如，可移动存储器，如PC卡或PCMCIA型装置。应当知道，ROM部件1132和RAM部件1134可以体现为单个单元或可以是分离的单元，并且ROM部件1132和/或RAM部件1134可以PC卡或PCMCIA型装置的形式设置。
控制器1122进一步连接于外罩514的面板515，尤其是通过线路1154连接于显示器516，以及通过相应的线路1156、1158连接于指示器518a、518b。线路1116、1118、1124、1126、1128分别将控制器1122电和逻辑连接于第一、第二、第三、第四、以及第五电动机576、580、584、590、596。有线遥控单元(“RCU”)1150通过线路1152电和逻辑连接于控制器1122。还设置了无线RCU1148并通过无线电线路1160与接收/发送单元1146相联，而接收/发送单元1146通过线路1144连接于无线电收发机1140。无线电收发机1140是通过线路1142电和逻辑连接于控制器1122。无线电线路1160可以是，例如，光学线路，如红外线路，无线电通信线路或任何其它形式的无线通信线路。
开关装置1186，其可以是，例如，DIP开关的阵列，可以通过线路1188连接于控制器1122。开关装置1186可用来，例如，选择多种语言中的一种，其用于在显示器516上显示信息和提示。这些信息和提示可涉及，例如，机电外科系统510和/或连接于其上的外科装置11的操作和/或状态。
根据本发明的具体实施例，第一编码器1106是设置在第二连接526内并成一定构造以响应和依据第二驱动轴530的旋转输出信号。第二编码器1108也是设置在第二连接526内并成一定构造以响应和依据第一驱动轴532的旋转输出信号。由每个编码器1106、1108输出的信号可表示相应驱动轴530、532的旋转位置以及其旋转方向。这种编码器1106、1108可以是，例如，霍尔效应装置、光学装置等等。虽然编码器1106、1108是描述为设置在第二连接526内，但应当知道，编码器1106、1108可以设置在电动机系统和线形夹紧、切割、和锁环固定装置之间的任何位置。应当知道，将编码器1106、1108设置在第二连接526内或在柔性轴520的远端可保证驱动轴旋转的精确测定。如果编码器1106、1108设置在柔性轴520的近端，第一和第二可旋转驱动轴532、530的缠绕可导致测量误差。
图27是编码器1106、1108的示意图，其包括霍尔效应装置。非旋转地安装于驱动轴530、532上的是具有北极1242和南极1244的磁体1240。编码器1106、1108进一步包括第一传感器1246和第二传感器1248，其相对于驱动轴530、532的纵轴或旋转轴大约相隔90°设置。传感器1246、1248的输出是不变的并且作为在传感器的探测范围内磁场极性变化的函数变化其状态。因而，基于来自编码器1106、1108的输出信号，驱动轴530、532的角位可以确定在四分之一转数内，并且可以确定驱动轴530、532的旋转方向。每个编码器1106、1108的输出是通过数据传输电缆538的相应线路1110、1112传输到控制器1122。控制器1122，通过基于来自编码器1106、1108的输出信号跟踪驱动轴530、532的角位和旋转方向，可由此确定线形夹紧、切割、和锁环固定装置的部件的位置和/或状态，其中线形夹紧、切割、和锁环固定装置是连接于机电外科系统510。也就是说，通过计算驱动轴530、532的转数，控制器1122可确定线形夹紧、切割、和锁环固定装置的部件的位置和/或状态，其中线形夹紧、切割、和锁环固定装置是连接于机电外科系统510。
例如，相对于下爪50的上爪80的推进距离以及楔270的推进距离是相应驱动轴530、532的旋转的函数并可基于相应驱动轴530、532的旋转进行确定。通过及时确定爪80和楔270在一点的绝对位置，基于来自编码器1106、1108的输出信号以及垂直驱动轴1132和下水平轴260的已知间距，爪80和楔270的相对位移则可以一直用来确定在其后的爪80和楔270的绝对位置。在外科装置11首次连接于柔性轴520时，可以固定和确定爪80和楔270的绝对位置。可替换地，爪80和楔270相对于，例如，下爪50的位置可基于来自编码器1106、1108的输出信号进行确定。
根据一个具体实施例和如图5所说明的，外科装置11可进一步包括数据连接器1272，其大小和形状适合于电和逻辑连接于第二连接526的连接器570。在该具体实施例中，数据连接器1272包括触点，其数目等于连接器570的引线572数目。包含在外科装置11内的是存储单元1174，其电和逻辑连接于数据连接器1272。存储单元1174可以是，例如，EEPROM、EPROM等的形式并可包含在，例如，外科装置11的下爪50内。
图28示意说明存储单元1174。如在图28中所看到的，数据连接器1272包括触点1276，每个通过相应的线路1278电和逻辑连接于存储单元1174。存储单元1174成一定构造以存储，例如，连续数字数据1180、附着型识别(ID)数据1182、以及应用数据1184。存储单元1174可额外地存储其它数据。连续数字数据1180和ID数据1182均可构造成只读数据。在该具体实施例中，连续数字数据1180是唯一识别特定线形夹紧、切割、和锁环固定装置的数据，而ID数据1182是识别附件类型的数据(当，例如，该装置可以使用其它类型的附件时)。应用数据1184表示特定附件的应用，例如，外科装置11的上爪80已被打开和闭合的次数，或外科装置11的楔270已被推进或触发的次数。
应当知道，可连接于柔性轴520，例如，外科装置11的远端524的附件可以被设计和构造成使用一次或多次。该附件也可以被设计和构造成使用预定次数。相应地，应用数据1184可用来确定外科装置11是否已被使用和使用次数是否已超过允许使用的最大次数。如在下面更充分地描述的，尝试在已达到允许使用的最大次数后使用附件会产生错误状态。
再参照图26，根据本发明的该具体实施例，控制器1122成一定构造以当外科装置11最初连接于柔性轴520时从外科装置11的存储单元1174读取ID数据1182。存储单元1174是通过数据传输电缆538的线路1120电和逻辑连接于控制器1122。基于读取的ID数据1182，控制器1122成一定构造以从存储单元1130读取或选择操作程序或算法，其对应于连接于柔性轴520的外科仪器或附件的类型。存储单元1130成一定构造以存储针对每一种可获得类型的外科仪器或附件的操作程序或算法，根据从连接的外科仪器或附件的存储单元1174读取的ID数据1182，控制器1122从存储单元1130选择和/或读取操作程序或算法。如上所述，存储单元1130可包括可移ROM部件1132和/或RAM部件1134。因此，存储在存储单元1130中的操作程序或算法当必要时可更新、添加、删除、改进、或修订。存储在存储单元1130中的操作程序或算法可基于，例如，用户的特定需要进行定制。数据输入装置，例如，键盘、鼠标、定点设备、触摸屏等等可通过，例如，数据连接端口连接于存储单元1130，以便于操作程序或算法的定制。可替换地或额外地，操作程序或算法可定制和远程地从机电外科系统510预编程进入存储单元1130中。应当知道，连续数字数据1180和/或应用数据1184也可以用来确定从存储单元1130中读取或选择多种操作程序或算法的哪一种。应当知道，操作程序或算法可替换地存储在外科装置11的存储单元1174中并通过数据传输电缆538传输到控制器1122。一旦适当的操作程序或算法由控制器1122读取或选择，或传输到控制器1122，控制器1122则使操作程序或算法依据用户进行的操作执行，其是通过有线RCU 1150(下文描述)和/或无线RCU 1148(下文描述)。如在上文所述，控制器1122是通过相应的线路1116、1118、1124、1126、1128电和逻辑连接于第一、第二、第三、第四、以及第五电动机576、580、584、590、596并通过相应的线路1116、1118、1124、1126、1128依据读取、选择或传输的操作程序或算法控制这种电动机576、580、584、590、596。
现参照图29，可以看到无线RCU 1148的示意图。无线RCU1148包括转向控制器1300，其具有排列在四通摇杆1310下面的多个开关1302、1304、1306、1308。通过摇杆1310，开关1302、1304的操作通过第三电动机584控制第一和第二转向电缆534、535的操作。类似地，通过摇杆1310，开关1306、1308的操作通过第四电动机592控制第三和第四转向电缆536、537的操作。应当知道，摇杆1310和开关1302、1304、1306、1308成一定配置，以便开关1302、1304的操作在南北方向控制柔性轴520而开关1306、1308的操作在东西方向控制柔性轴520。在此参照北、南、东、和西是涉及相对的坐标系。可替换地，可提供数字操纵杆、模拟操纵杆等等来代替摇杆1310和开关1302、1304、1306、1308。电位计或任何其它类型的致动器也可以用来代替开关1302、1304、1306、1308。
无线RCU 1148进一步包括转向啮合/脱离开关1312，其操作控制第五电动机596的操作以选择性地啮合和脱离转向装置。无线RCU 1148还包括两通摇杆1314，其具有由此可操作的第一和第二开关1316、1318。这些开关1316、1318的操作控制机电外科系统510和任何外科仪器或附件的某些功能，如外科装置11，其依据对应于连接的装置11的操作程序或算法连接于柔性轴520。例如，两通摇杆1314的操作可控制外科装置11的上爪和下爪的打开和闭合。无线RCU 1148装有另一开关1320，其操作可根据对应于连接的装置的操作程序或算法进一步控制机电外科系统510和连接于柔性轴520的装置的操作。例如，开关1320的操作可激发外科装置11的楔270的推进、或触发序列。
无线RCU 1148包括控制器1322，其通过线路1324电和逻辑连接于开关1302、1304、1306、1308，通过线路1326连接于开关1316、1318，通过线路1328连接于开关1312，以及通过线路1330连接于开关1320。无线RCU 1148可包括对应于面板515的指示器518a、518b的指示器518a’、518b’，以及对应于面板515的显示器516的显示器516’。如果设置的话，指示器518a’、518b’是通过相应的线路1332、1334电和逻辑连接于控制器1322，而显示器516’是通过线路1336电和逻辑连接于控制器1322。控制器1322通过线路1340电和逻辑连接于无线电收发机1338，而无线电收发机1338通过线路1344电和逻辑连接于接收机/发送机1342。电源(未示出)，例如，电池，可提供在无线RCU 1148中以给其提供动力。因而，无线RCU 1148可用来通过无线电线路1160控制连接于柔性轴520的机电外科系统510和装置11的操作。
无线RCU 1148可包括通过线路1348连接于控制器1322的开关1346。开关1346的操作通过无线电线路1160将数据信号传输到发送机/接收机1146。数据信号包括唯一识别无线RCU 1148的识别数据。控制器1122利用这种识别数据来阻止机电外科系统510的未授权的操作和防止另一无线RCU干扰机电外科系统510的操作。在其后无线RCU 1148和机电外科装置510之间的每次联系可包括识别数据。因而，控制器1122可区别不同的无线RCU并由此仅允许单个的、可识别的无线RCU 1148来控制连接于柔性轴520的机电外科系统510和装置11的操作。
基于连接于柔性轴520的装置的部件的位置，如根据来自编码器1106、1108的输出信号所确定的，控制器1122可选择性地实现或不实现机电外科系统510的功能，如由对应于连接的装置的操作程序或算法所规定的。例如，对于外科装置11来说，由开关1320的操作所控制的触发功能不能实现除非下爪50和上爪80之间的间隔或间隙被确定在可接受的范围内。下爪50和上爪80之间的间隔或间隙的确定是基于来自编码器1106、1108的输出信号，如在上文更充分地描述的。应当知道，在该具体实施例中，开关1320自身仍然是可操作的，但控制器1122并不实现相应的功能除非间隔或间隙被确定在可接受的范围内。
现参照图30，可以看到有线RCU 1150的示意图。在该具体实施例中，有线RCU 1150包括和无线RCU 1148基本上相同的控制元件，因而省略这类元件的进一步描述。在图30中相同的元件用伴随的撇号指示。应当知道，机电外科系统510和连接于柔性轴520的装置(例如，外科装置11)的功能可由有线RCU 1150和/或由无线RCU 1148进行控制。万一发生电池失效，例如，在无线RCU 1148中，有线RCU 1150可用来控制机电外科系统510和连接于柔性轴520的装置的功能。
如上所述，外罩514的面板515包括显示器516和指示器518a、518b。显示器516可包括字母数字显示器，如LCD显示器。显示器516也可以包括声频输出装置，如扬声器、蜂鸣器等等。显示器516是由控制器1122根据相应于连接于柔性轴520的装置(例如，外科装置11)的操作程序或算法来操作和控制。如果没有外科仪器或附件被如此连接，那么默认操作程序或算法可由控制器1122读取或选择，或传输到控制器1122，从而控制显示器516的操作以及机电外科系统510的其它方面和功能。如果外科装置11连接于柔性轴520，显示器516可显示，例如，如根据编码器1106、1108的输出信号所确定的表示下爪50和上爪80之间间隙的数据，如在上文更充分地描述的。
类似地，指示器518a、518b是由控制器1122根据相应于连接于柔性轴520的装置11(例如，外科装置11)的操作程序或算法来操作和控制。指示器518a和/或指示器518b可包括声频输出装置，如扬声器、蜂鸣器等等，和/或视觉指示器，如LED、灯、光线等等。如果外科装置11连接于柔性轴520，指示器518a则可以指示，例如，机电外科系统510是处于动力接通状态，而指示器518b可以，例如，指示是否下爪50和上爪80之间的间隙被确定在可接受的范围内，如在上文更充分描述的。应当知道，虽然仅描述两个指示器518a、518b，但在必要时可设置任意数目的额外的指示器。另外，应当知道，虽然描述了单个的显示器516，但在必要时可提供任意数目的额外的显示器。
有线RCU 1150的显示器516’和指示器518a’、518b’以及无线RCU 1148的显示器516″和指示器518a″、518b″是由相应的控制器1322、1322’根据连接于柔性轴520的装置的操作程序或算法类似地进行操作和控制。
如前所述，外科装置11可用来夹住、切割、和锁环固定部分组织。外科装置11的操作现将和切除患者肠中癌性或异常部分组织一起进行描述，当然，其仅是可利用外科装置11进行的一种类型的组织和一种类型的外科手术。通常，在手术中，在癌性或异常组织已被定位在胃肠道中之后，患者的腹部首先被打开以使肠暴露。利用由机电外科系统510所提供的远程起动，外科装置11的上爪和下爪50、80被驱动进入打开的位置。然后肠管被置于接进于展开的爪之间的癌性组织一侧。再一次，通过远程起动，使第二驱动器相反啮合，并且上爪贴近肠和下爪。一旦将肠充分地夹紧，则啮合第一驱动器，其使楔同时从附件的远端推进到其近端，由此对肠进行切割和锁环固定。然后在癌性组织的另一侧重复该步骤，由此切除包含癌性组织的部分肠，其被锁环固定在任一端以防止肠材料溢出进入打开的腹部。
更具体地说，根据本发明的该具体实施例，将外科装置11连接于机电驱动器部件510的附件套管或连接26，以致上驱动套管180啮合相应的机电驱动器部件510的柔性驱动轴530，而第二驱动套管310连接相应的机电驱动器部件510的柔性驱动轴532。因而，上水平轴151的旋转是由上驱动套管180的旋转来实现，其又是由相应的机电驱动器部件510的柔性驱动轴530的旋转来实现。顺时针或反时针旋转的获得是依赖于电动机580的方向。类似地，下水平轴260的旋转是通过第二驱动套管310的旋转来实现，其是通过机电驱动器部件510的相应的柔性驱动轴532的旋转来实现。再一次，顺时针或反时针旋转的获得是依赖于电动机576的方向。
为了夹住肠的暴露端，启动对应于上柔性驱动轴530的上电动机580，其在上水平轴151的近端170啮合上驱动套管180，由此使上水平轴151作出第一(例如，顺时什)旋转。当外科装置11处于如图5说明的初始闭合状态时，上水平轴151的第一旋转使上水平轴151的外螺纹152啮合垂直轴130的外螺纹132，从而使垂直轴130进行类似的第一(例如，顺时针)旋转。垂直轴130的旋转使垂直轴130的外螺纹132在垂直孔90的内螺纹92内开辟通道，从而使上爪80连续升高(在所说明的具体实施例中，平行对准于固定的下爪50)并开始与下爪50分离。电动机以这种方式的连续操作最后将外科装置11置于打开状态，在上爪80和下爪50之间提供间隔，如图6所说明的。
一旦外科装置11处于这种打开状态，锁环230的托架220则可以进入，并且可检查以确定是否锁环230已准备好操作和/或用更合适的托架220更换托架220。此外，外科装置11的状态可通过控制系统1122来确定，如在上文所述。一旦托架220被确定已准备好并在适当位置，一部分结肠则被放置在上爪80和下爪50之间。其后，上电动机580被换向以实现上水平轴151的第二(例如，反时针)旋转，其又引起垂直轴130的反时针旋转，其又引起上爪80的降低。上电动机580以这种方式的连续操作最后将线形夹紧和锁环固定装置恢复到闭合状态，其中肠的远端是夹在上爪80和下爪50之间。
肠的远端的夹住是根据输出传感器1246和1248或输出电极182、184来确定，如以上所述。在机电外科系统510中的电路部件可提供报警信号以告知开始切割和锁环固定操作是安全和/或适当的。为开始锁环固定和切割操作，则启动对应于下柔性驱动轴532的机电驱动器部件的下电动机576，其在下水平轴260的近端300连接下驱动套管310，从而使下水平轴260作出第一(例如，反时针)旋转。当锁环固定和切割装置处于初始的加载状态时，楔270和与其相联的刀片51是在槽250中，其位置是在远离下水平轴260的近端300(即，在远端)。下水平轴260的反时针旋转使下水平轴260的外螺纹262啮合于楔270的水平螺纹孔290的内螺纹292，从而使楔270在向着下水平轴260的近端300的近侧方向穿过槽250。下电动机576以这种方式的连续操作将移动楔270完全通过槽250。当楔270近侧地移动通过该槽时，安装在楔顶部的刀片51切割通过肠，从而对其进行横切。同时，楔270的倾斜顶面280接触锁环230的突出部分232，由此推进锁环230的支架234通过肠的夹紧远端的组织并顶着锁环导管240，其弯曲并闭合锁环230。当楔270近侧地移动完全通过槽250时，全部锁环230被推进通过托架220并闭合，从而在切割的两侧用锁环固定闭合的肠的远端。
其后，再次启动上电动机580以实现上水平轴151的顺时针旋转，其又引起垂直轴130的顺时针旋转，其又引起上爪80的升高。上电动机580以这种方式的连续操作最后将外科装置11恢复到打开状态。其后，用充满的托架220替换空的托架220并在肠的近端进行相同的夹紧、切割、和锁环固定步骤。应当明白，在安全的夹紧、切割、和锁环固定步骤之前，通过操作下电动机576，刀片51和楔270可恢复到远侧位置。为了完成该项工作，下电动机576被换向以实现下水平轴260的顺时针旋转，其又使楔270离开下水平轴260的近端300。下电动机576以这种方式的连续操作最后将楔270恢复到其在装置远端的初始位置。一旦肠的近端也被夹紧、切割、和锁环固定，附件(即，外科装置11)则可与机电驱动器部件分离并扔掉该附件。
如前所述，图31至图33说明可替换的具体实施例，其中外科装置11包括可旋转地连接于楔270的刀片651，以便在第一和第二位置之间进行旋转。为操作外科装置11的这个可替换的具体实施例所进行的步骤基本上类似于上述的如为操作图5和图6所说明的外科装置11的具体实施例而进行的步骤。现将描述图31至图33说明的可替换具体实施例的外科装置11的一些额外特点的操作。参照图31，并如前所述，在夹紧操作已进行之后但在切割和锁环固定操作开始之前，楔270是位于下爪50的远端。刀片651是通过枢轴构件652可旋转地安装于楔270。刀片651的刃口651a起初是处于收缩或向下位置，例如，朝向下水平轴260。将刀片651的尾部区域654是设置在楔270上，因此启动针接受面653起初朝向外科装置11的近端170并靠近下爪50的固定的启动针655。
图32说明外科装置11，其中切割和锁环固定操作已经开始，例如，通过旋转水平轴260，以便开始将楔270从下爪50的远端移向下爪50的近端。如图32所说明的，位于刀片651的尾部区域654的启动针接受面653啮合固定的启动针655，使刀片651围绕枢轴构件652相对于楔270进行旋转。通过围绕枢轴构件652相对于楔270进行旋转，刀片651的刃口651a移开其起初的朝向下水平轴260的位置并开始向上旋转。
图33说明外科装置11，其中切割和锁环固定操作进一步继续，例如，通过进一步旋转水平轴260，以便继续将楔270从下爪50的远端移向下爪50的近端。如图33所说明的，楔270已近侧地向下爪50的近端移动足够远，以致使在刀片651的尾部区域654的启动针接受面653完成其与固定启动针655的连接。此时，刀片651围绕枢轴构件652相对于楔270进行旋转，以致刀片651的刃口651a朝向下爪50的近端。
如前所述，传统切割和锁环固定装置的一个问题是，在操作期间，装置的相对爪倾向于打开，或被推开。这是因为当倾斜面280接触锁环托架220中的锁环230的突出部分232并推动锁环230的支架234进入相对的锁环导管240中时，由楔270的倾斜顶面280所施加的力具有向上的分量。当支架234接触导管240时，接触的力倾向于分离、或推开上爪和下爪，直到锁环的支架234被导管240弯曲成闭合位置。如果将上爪和下爪分开足够的距离，支架234将不会被导管240充分地弯曲成闭合位置，而组织的不适当锁环固定端可允许其内含物溢入患者打开的腹部，这增加了感染和其它并发症的可能性。
根据本发明的具体实施例，在切割和锁环固定操作期间，切割和锁环固定元件，例如，楔270和刀片51，从外科装置11的远端到近端的移动可在切割和锁环固定操作中降低上爪与下爪分离、或被推开的倾向。特别地，在切割和锁环固定操作期间，通过将切割和锁环固定元件，例如，楔270和刀片51，从外科装置11的远端移到近端，可以减少上爪与下爪之间在其远端的距离。例如，在线形夹紧、切割、和锁环固定装置中，其中在锁环固定和切割操作期间楔/刀片是从近端移到远端，楔所遇到的第一锁环是最靠近近端的锁环。当该楔接触第一锁环的突出部分时，该楔迫使锁环的支架与上爪的对应锁环导管相接触。这种锁环的支架和相对的锁环导管之间的接触使上和下爪之间在其远端的距离增加少许，直到支架已被弯曲和闭合。然而，由于上和下爪是在近端机械地，例如，可在枢轴上转动地，相连，但在远端不受约束，在近端上和下爪之间距离的少量增加变成在远端上和下爪之间距离的相对较大的增加。同时，当刀片正切割夹在上和下爪之间的组织时，刀片的远侧移动也倾向于将夹在上和下爪之间的组织推向爪的远端。因为爪在其远端已被迫使分开，更大数量(即，厚度)的组织可容纳在爪的远端，刀片对组织的推进作用倾向于将更大数量的组织推入在爪远端的空间。一旦额外的组织被容纳在上和下爪的远端之间，该组织则会进一步作用以迫使爪的远端分开。因而，当切割和锁环固定元件已移动到爪的远端时，在远端爪之间的距离可以是不需要的那样大，进而在爪远端之间组织的有效锁环固定可能不是最佳。
相反，根据本发明的具体实施例，楔270遇到的第一锁环230是最靠近下爪50远端的锁环。当楔270接触第一锁环的突出部分232时，楔270迫使锁环230的支架234与在上爪80中的相对的锁环导管240相接触。这种锁环230的支架234和相对的锁环导管240之间的接触可以使上爪80和下爪50之间在其远端的距离增加少许，这是因为上爪80和下爪50在其远端是不受约束的。然而，由于上爪80和下爪50在其近端是机械地相连，因而在其远端上爪80和下爪50之间距离的少量增加不会变成相应的在其近端上爪80和下爪50之间距离的较大增加。此外，在本发明的具体实施例中，当刀片51正切割夹在上爪50和下爪80之间的组织时，刀片51的水平移动倾向于将夹在上爪80和下爪50之间的组织推向爪的近端。然而，由于上爪80和下爪50在其近端没有被迫使分开，因而在爪的近端不可能容纳更大数量(即，厚度)的组织，而刀片51对组织的切割力可能不会倾向于将更大数量的组织推入在爪近端的空间。因而，由于没有额外的组织可以容纳在上爪80和下爪50的近端之间，该组织可能不会进一步作用以迫使爪的近端分开。因此，直到切割和锁环固定元件，例如，刀片51和楔270，已移动到下爪50的近端的时候，在近端下爪50和上爪80之间的距离可保持基本不变，从而保证在锁环固定下和上爪50、80的近端之间的组织时具有最佳效率。同样地，当楔270最后在爪50、80的近端接触锁环230时，下和上爪50、80之间在其近端的距离可增加少许。然而，因为位于远端的组织已经被切割和锁环固定，上爪80和下爪50之间在远端的任何较大的距离在此时是没有关系的。因此，本发明通过减少操作过程中上爪和下爪分离的倾向可使锁环固定得到最佳效率。
本发明的具体实施例还可以降低移动楔270所需要的旋力，并因此可以降低外科装置的各种部件所承受的应力。例如，在线形夹紧、切割、和锁环固定装置中，将楔/刀片从近端移到远端，移动楔/刀片所需要的旋力当楔/刀片从近端移到远端时会增加，因为楔/刀片和装置的近端之间的距离(在此点可旋转驱动轴连接于该装置)会增加。此外，由于额外的组织容纳在装置的远端，移动楔/刀片所需要的旋力当楔/刀片从近端移到远端时也会增加。如上所述，当刀片正切割夹在上和下爪之间的组织时，刀片的远侧移动也倾向于将夹在上和下爪之间的组织推向爪的远端。为了切割更大数量(即，厚度)的容纳在爪远端的组织，则需要更大的旋力以通过水平驱动轴传给楔/刀片。因此，当切割和锁环固定元件已移动到爪的远端时，旋力已经增加，从而在楔/刀片、以及装置的驱动机构中产生应力。
相反，根据本发明的具体实施例，在切割和锁环固定操作过程中，可以降低移动楔270所需要的旋力，从而降低外科装置11的各种部件所承受的应力。例如，在外科装置11中，将楔270和刀片51从远端移到下爪50的近端，移动楔270和刀片51所需要的旋力当楔270和刀片51从远端移到下爪50的近端时会减小，因为楔/刀片和装置的近端之间的距离(在此点可旋转驱动轴连接于该装置)会减小。此外，由于没有额外的组织容纳在爪50和80的近端，移动楔/刀片所需要的旋力当楔/刀片从下爪50的远端移到远端时也会增加。与传统的线形夹紧、切割、和锁环固定装置不同，当外科装置11的刀片51正切割夹在上爪80和下爪50之间的组织时，刀片51的近侧移动并不倾向于将夹在上爪80和下爪50之间的组织推向爪的近端。因此，由于刀片51无需切割通过更大数量(即，厚度)的容纳在爪近端的组织，所以为了切割组织，无需更大的旋力以通过下水平轴260传给楔270和刀片51。当楔270和刀片51已移动到下爪50的近端时，旋力已经减小，从而降低在楔270、刀片51、第一驱动器261等中的应力。
本发明的具体实施例还可以减少线形夹紧、切割、和锁环固定装置的长度，从而改善装置在较小空间内使用的能力。由于线形夹紧、切割、和锁环固定装置可在体内使用，例如，在患者体内，该装置必须足够小以在患者体内操作。在传统的线形夹紧、切割、和锁环固定装置中，将楔/刀片从近端移到远端，为将楔/刀片放置在装置的近端所需要的空间可增加装置的总长度。这种装置长度的增加使该装置更难以在患者体内操作。
相反，根据本发明的具体实施例，外科装置11起初将楔270和刀片51安置在下爪50的远端，其是不受存储单元1174、垂直驱动轴130、以及位于外科装置11的近端的各种其它部件的妨碍。因此，通过起初将楔270和刀片51安置在下爪50的远端，以及通过将楔270和刀片51从下爪50的远端移到近端，则可以减少外科装置11相对于传统的线形夹紧、切割、和锁环固定装置的总长度。当与传统的线形夹紧、切割、和锁环固定装置比较时，这种总长度的减少使外科装置11更容易在患者体内操作。
根据具体实施例，相对于传统的线形夹紧、切割、和锁环固定装置，通过减少外科装置11所需的总长度，外科装置11，当与传统的线形夹紧、切割、和锁环固定装置比较时，还可以提供其行程长度的相应增加(大约30％)，例如，在切割和锁环固定操作期间楔270和刀片51可移动的距离。例如，由于起初放置楔270和刀片51在远端所节省的空间可以减少外科装置11的总长度(相对于传统的线形夹紧、切割、和锁环固定装置的总长度)，而节省的空间也可以增加外科装置11的行程长度。因此，根据一个具体实施例，外科装置11可以成一定构造以比传统的线形夹紧、切割、和锁环固定装置夹紧、切割、和锁环固定更大的部分组织。
说明于图31至图33的具体实施例还可改善外科装置11的安全性，其在于当楔270处于在下爪50远端的起初位置时，刀片651的刃口651a处于收缩状态，例如，未暴露状态。特别地，根据该具体实施例，在待夹紧、切割、和锁环固定的部分组织被放置和夹在外科装置11的上爪80和下爪50之间期间，刀片651的刃口651a处于收缩状态。在操作的定位和夹紧阶段，通过收缩刀片651的刃口651a，可以降低在部分组织被适当夹紧前无意切割部分组织的可能性。此外，通过配置收缩的刀片651可以减少刀片651意外切割，例如，操作者或其它设备。根据该具体实施例，仅在部分组织已被夹紧(并已经确定开始操作的切割和锁环固定阶段是合适的)之后，楔270才被移向下爪50的近端，从而使刀片651的刃口651a被置于切割位置，例如，朝向下爪50的近端。
因此，可最有效地达到本发明的一些前述的目的和优点。对于本领域技术人员来说，可以对上文所述的示范性具体实施例进行许多改进而不偏离本发明的精神和范围。虽然本文已详细描述和披露了本发明的单个具体实施例，但是应当明白，本发明并不因此受到限制。

Claims (15)

1.一种用于体外组织或死亡生物体上的方法，包括以下步骤：
将部分组织定位于与第二爪相对对应放置的第一爪之间，所述第二爪在远端对面的近端机械地连接于所述第一爪；以及
启动连接于设置在所述第二爪的远端内的切割元件的第一驱动器以便近侧地将所述切割和锁环固定元件从所述远端移向所述第二爪的近端，从而切割位于所述第一爪和所述第二爪之间的部分组织。
2.根据权利要求1所述的用于体外组织或死亡生物体上的方法，其中所述切割元件进一步包括锁环固定元件，由此所述第一驱动器的启动同时切割和锁环固定所述部分组织。
3.根据权利要求2所述的用于体外组织或死亡生物体上的方法，进一步包括启动连接于所述第一爪的第二驱动器的步骤以便使所述第一爪接近所述第二爪，从而夹紧所述第一和第二爪之间的所述部分组织。
4 根据权利要求3所述的用于体外组织或死亡生物体上的方法，其中所述第二驱动器进一步包括一对螺纹旋转轴和与所述一对螺纹旋转轴成旋转和啮合关系设置的水平螺纹啮合轴，其中所述第二驱动器启动步骤包括旋转所述水平螺纹啮合轴的子步骤。
5.根据权利要求3所述的用于体外组织或死亡生物体上的方法，其中所述第二驱动器包括至少一个螺纹旋转轴，而其中所述第一爪包括相应的至少一个螺纹孔用于通过其接受所述螺纹旋转轴，所述方法进一步包括在第一旋转方向旋转所述旋转轴的步骤以便在将所述部分组织定位在与第二爪相对对应设置的第一爪之间之前使所述第一爪沿所述旋转轴轴向地移开所述第二爪，而其中所述第二驱动器启动步骤包括在第二旋转方向旋转所述旋转轴的子步骤以便使所述第一爪沿所述旋转轴轴向地移向所述第二爪以夹紧所述部分组织。
6.根据权利要求1所述的用于体外组织或死亡生物体上的方法，其中所述切割和锁环固定元件包括设置于在所述第二爪内形成的楔形导沟中的刀片和楔。
7.根据权利要求1所述的用于体外组织或死亡生物体上的方法，其中所述第二驱动器包括成一定构造以引起所述第一爪移动的第一可旋转轴，所述第一可旋转轴的布置是平行于所述第一和第二爪在闭合位置时的平行对应的轴。
8.根据权利要求7所述的用于体外组织或死亡生物体上的方法，其中所述第二驱动器启动步骤包括下述子步骤：在第一方向旋转所述第一可旋转轴以打开所述爪并在与所述第一方向相反的第二方向旋转所述第一可旋转轴以闭合所述爪。
9.根据权利要求8所述的用于体外组织或死亡生物体上的方法，进一步包括以下步骤：
将所述第一可旋转轴的近端连接于机电驱动装置的第一可旋转驱动轴；以及
通过旋转所述第一可旋转驱动轴旋转所述第一可旋转轴。
10.根据权利要求1所述的用于体外组织或死亡生物体上的方法，其中所述第一驱动器包括围绕纵轴可旋转的第二可旋转轴，所述第二可旋转轴的布置是平行于所述第一爪和所述第二爪在闭合位置时的平行对应的所述轴。
11.根据权利要求3所述的用于体外组织或死亡生物体上的方法，进一步包括以下步骤：
将所述第二驱动器连接于机电驱动装置的第一可旋转驱动轴；以及
将所述第一驱动器连接于机电驱动装置的第二可旋转驱动轴。
12.根据权利要求11所述的用于体外组织或死亡生物体上的方法，进一步包括以下步骤：用所述机电驱动装置的至少一个电动机排列驱动所述第一和第二可旋转驱动轴的每一个。
13.根据权利要求11所述的用于体外组织或死亡生物体上的方法，进一步包括以下步骤：用所述机电驱动装置的第一电动机排列驱动所述第一可旋转驱动轴；以及
用所述机电驱动装置的第二电动机排列驱动所述第二可旋转驱动轴。
14.根据权利要求12所述的用于体外组织或死亡生物体上的方法，进一步包括以下步骤：用机电驱动装置驱动所述第一驱动器和所述第二驱动器的每一个。
15.根据权利要求14所述的用于体外组织或死亡生物体上的方法，其中用机电驱动器驱动所述第一驱动器和所述第二驱动器的步骤进一步包括独立地驱动所述第一驱动器和所述第二驱动器的每一个的子步骤。
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CN106413578B (zh) * 2014-03-26 2019-09-06 伊西康内外科有限责任公司 外科缝合器械系统

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US20030105478A1 (en) 2003-06-05
US8512359B2 (en) 2013-08-20
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US20140257353A1 (en) 2014-09-11
US20110297729A1 (en) 2011-12-08
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WO2003047436A2 (en) 2003-06-12
ATE553704T1 (de) 2012-05-15
CN100496418C (zh) 2009-06-10
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EP2366340A1 (en) 2011-09-21
AU2002340426A1 (en) 2003-06-17
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US20100249816A1 (en) 2010-09-30
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CA2466651A1 (en) 2003-06-12
US9078654B2 (en) 2015-07-14
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US8021373B2 (en) 2011-09-20

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