CN101500493A - 外科手术器械 - Google Patents
外科手术器械 Download PDFInfo
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
- A61B2017/003—Steerable
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2901—Details of shaft
- A61B2017/2905—Details of shaft flexible
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- A—HUMAN NECESSITIES
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- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B17/2909—Handles
- A61B2017/291—Handles the position of the handle being adjustable with respect to the shaft
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B17/2909—Handles
- A61B2017/2912—Handles transmission of forces to actuating rod or piston
- A61B2017/2919—Handles transmission of forces to actuating rod or piston details of linkages or pivot points
- A61B2017/292—Handles 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
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Abstract
该外科手术器械包括远端工具、支承该远端工具的长形轴以及近端手柄或控制构件,在那里,工具和手柄通过远端和近端可弯曲运动构件分别联接到长形轴上的远端和近端。致动装置在所述远端和近端构件之间延伸,因此,所述控制手柄相对于所述长形器械轴的任意偏转都导致所述远端运动构件相应的弯曲,以控制所述工作构件。近端可弯曲构件包括球窝组件,其被支承在手柄和器械轴之间,并且被构造和设置成用于三维运动。
Description
相关申请
本申请根据35 U.S.C.§119(e)要求享有2006年8月16日提交的、共同共有的待审美国临时专利申请No.60/838,059的优先权。在此将前述申请的全部内容引入作为参考。
技术领域
本发明大体上涉及手术器械,更具体地说,本发明涉及意在用于微创手术或其它形式的外科手术或医疗手术或技术的人工操作手术器械。于此描述的器械主要用于腹腔镜手术或内窥镜手术,但是,应当了解,本发明的器械还能够用于包括腔内手术等在内的多种其它手术中。
背景技术
市场上当前可用的内窥镜器械和腹腔镜器械难以学习操作并使用,主要是由于在应用这些器械时缺乏灵活性。例如,当在外科手术过程中使用通常的腹腔镜器械时,器械的工具的定向完全由目标和伤口的位置决定。这些器械一般通过将患者自身的伤口区域用作支点以利用支点作用来运行。因此,例如缝合、打结及精细解剖等常见工作对手术师来说变成棘手的工作。人们已经对各种腹腔镜器械研究了若干年,通常通过提供另外的关节来克服此缺陷,所述关节往往由分开设置的、用于所增控制的控制构件进行控制。但是,即使是这样,这些器械仍不能提供使外科医生能够执行例如缝合之类的常见工作的足够的灵活性,在任何任意选择定向处尤其如此。而且,这种现有的器械并未提供将该器械保持在特定位置中的有效方式。此外,现有器械需要使用双手进行操作以有效地控制该器械。
因此,本发明的目的是提供一种改进的腹腔镜或内窥镜外科手术器械,其使得外科医生可以更灵活地控制外科手术器械的工具端。
本发明的另一目的是提供一种改进的外科手术器械或医疗器械,其穿过伤口、身体上固有的孔或切口,具有广泛的多种应用。
本发明的另一目的是提供一种改进的医疗器械,其特征在于能够将该器械锁定在特定的位置中。
本发明的另一目的是提供一种锁定特征,其为对所述器械的其它控制非常重要的属性,使得外科医生能够一度将所述器械锁定在所需的位置。这使得外科医生在执行该动作之后更容易执行外科手术,而不必在手术的同时将所述器械保持在特定的弯曲构型中。
本发明的另一目的是提供一种改进的医疗器械,使用者能够用一只手有效地控制所述医疗器械。
本发明的另一目的是提供一种改进的医疗器械,其特征在于在能够旋转器械的端部的同时,能够将所述器械的位置锁定在预先选定的位置中。
发明内容
根据本发明,提供了一种医疗器械,其包括:近端控制手柄;远端工作构件;近端可移动构件,其受到来自近端控制手柄的控制;远端可移动构件,其受到来自近端可移动构件的控制,以从近端控制手柄提供远端工作构件的受控运动;器械轴,其将近端可移动构件与远端可移动构件互相联接;以及联接在可移动构件之间的致动装置。近端可移动构件包括球窝组件,该球窝组件被支承在手柄和器械轴之间,并且被构造和设置成用于三维运动。
根据本发明的其它方面,该医疗器械可进一步包括锁定构件,该锁定构件受到来自近端控制手柄的支承,并且具有锁定状态和解锁状态;处于解锁状态中的锁定构件使得能够经由可移动构件从近端控制手柄控制远端工作构件;并且处于所述锁定状态中的锁定构件将可移动构件保持在所需的固定位置中;处于锁定状态中的锁定构件固定近端可移动构件的位置;远端可移动构件可包括单体式结构;球窝组件可包括受到器械轴支承的球、限定在手柄中的窝以及以可旋转的方式被支承在手柄处的锚环;致动装置可包括多根缆线,这些缆线由锚环支承在近端处;球可具有跨接在窝中的槽中的销;旋转控制构件和可联接在手柄和旋转控制构件之间的活塞组件;活塞组件可进一步包括活塞、位于旋转控制构件上的环、以可枢转的方式连接在环和活塞之间的连杆以及用于保持活塞的位置的锁定旋钮;活塞组件可进一步包括由手柄支承并且能够旋转的保持架、由保持架支承的滑动件以及联接在滑动件和旋转控制构件之间的连杆;包括位于手柄上的从动件,并且包括跨接件、用于支承跨接件的球状件以及以可旋转的方式支承在跨接件上的锚环;包括具有裂开的球的锁定构件,以及能够移动到裂开的球中以锁定近端可移动构件的位置的楔形构件;包括靠近近端控制手柄的旋转控制构件,用于控制远端工作构件以围绕远端工作构件轴线旋转;致动装置可包括一组联接在所述可移动构件之间的缆线,并且进一步包括由手柄支承并且用于保持缆线的近端的缆线保持件;手柄可包括手枪握把式手柄,其包括底部及限定球状窝的顶部,球状窝用于支承球,并且同时球支承近端可移动构件;并且近端可移动构件可包括整体式可弯曲构件,并且进一步包括与近端可弯曲构件成一直线的可旋转控制构件。
在本发明的另一实施方式中,设置有一种医疗器械,其具有由用于在内部穿过解剖体的长形器械轴互联的近端控制手柄和远端工具、分别将近端控制手柄和远端工具与器械轴互联的近端和远端可移动构件、布置在所述可移动构件之间的缆线致动装置以及旋转球,并且,其中,控制手柄包括底部和限定了球状窝的顶部,球状窝支承用于在其中三维枢转的旋转球。
根据本发明的其它方面,近端可移动构件可包括由旋转球支承的近端可弯曲构件;可以与所述近端可弯曲构件成一直线的方式支承旋转控制构件,用于控制三维枢转;旋转控制构件可控制三维枢转以及围绕近端可弯曲构件的纵向轴线的旋转,从而控制工具围绕其远端工具轴线的旋转;在所述近端可弯曲构件的近端处的枢转控制构件可控制三维枢转;枢转控制构件还可以控制器械轴的旋转;以及优选地包括锁定装置,锁定装置由使用者手动操作,并且将球锁定在窝中。
根据本发明的另一实施方式,在一种医疗器械中,该医疗器械具有由用于在内部穿过解剖体的长形器械轴互联的近端控制手柄和远端工具、分别将近端控制手柄和远端工具与器械轴互联的近端和远端可移动构件以及设置在可移动构件之间的缆线致动装置,该实施方式提供了一种借助于控制元件从手柄控制工具的方法,包括枢转控制元件从而控制工具沿三维方向的定位,并通过旋转器械轴来控制工具的旋转定向。此方法还可以包括将球窝设置为近端可移动构件的部件,以及控制该控制元件以相对于窝枢转球。
附图说明
应当了解,如下的附图仅出于说明性的目的,而并非意在限定本发明的范围。当结合附图进行理解时,参照如下的详细描述,在此描述的实施方式的前述和其它目的及优点将变得非常明显,图中:
图1是本发明的外科手术器械的第一实施方式的局部剖切侧视示意图;
图2是图1中所示器械的实施方式沿图1中的线2-2剖取的截面图;
图3是图1中所示器械沿图1中的线3-3剖取的截面图;
图4是沿图3的线4-4剖取的截面图;
图4A是用于图1中所示器械中的一部分缆线致动机构的局部立体图;
图4B是用于图4A中的机构中的传递盘装置的立体图;
图5是图1的器械局部剖切侧视示意图,所述器械被手动控制成弯曲并旋转端部受动器;
图6是该器械的另一实施方式的局部截面俯视图;
图7是沿图6的线7-7剖取的截面图;
图8是沿图6的线8-8剖取的截面图;
图9是如图6-8中所示的实施方式的局部分解立体图;
图10是轴和球之间的支承件的替换实施方式的局部截面图;
图11是该器械的另一实施方式的局部截面侧视图;
图11A是沿图11的线11A-11A剖取的局部截面图;
图12是图11的轴承环和活塞组件的示意性立体图;
图13是本发明的另一实施方式的截面侧视图;
图14是沿图13的线14-14剖取的截面端视图;以及
图15是本发明的器械的另一实施方式的截面侧视图。
具体实施方式
本发明的器械可以用于执行微创手术。“微创手术”于此指的是一种外科手术,在这种外科手术中,外科医生通过小的切口或伤口进行手术,这种小伤口被用以达到手术部位。在一个实施方式中,伤口长度的范围为直径1毫米到20毫米,优选为直径5毫米到10毫米。这种手术不同于需要较大的切口才能达到手术部位的那些手术。因而,优选地使用灵活的器械插过这种小切口和/或插过固有的体腔或腔,从而将该器械定位在用于特定外科手术或医疗手术的内部目标部位处。也可以通过经皮的或外科手术的方式到达内腔或脉管,或者通过解剖中固有的孔的引入将外科手术器械引入到解剖中。
除了用于腹腔镜手术之外,本发明的器械还可以用于各种其它医疗或外科手术中,这些手术包括但不限于结肠镜手术、上消化道手术、关节内窥镜手术、鼻窦手术、胸腔手术、阴道手术、矫形手术和心脏手术。根据具体的手术,该器械可以是刚性的、半刚性的或柔性的。
尽管在此参照“外科手术器械”进行,但是,可以设想,本发明的原理同样可以应用于其它医疗器械,而并非必需是用于外科手术的,并且包括但不限于例如导管以及诊断、治疗器械和器具之类的其它器具。
图1是本发明的外科手术器械710的一个实施方式的侧视示意图。在此外科手术器械中,工具和手柄运动构件或可弯曲构件能够沿任意方向弯曲。它们通过缆线互连,以这种方式使得在近端构件处的弯曲动作在远端构件处也提供了相关的弯曲。该器械的使用者通过在旋转控制构件724处的运动、枢转或偏转来控制近端弯曲。换言之,外科医生握紧手枪握把式手柄,并且一旦该器械处于适当的位置中,则在旋钮处的任意运动(偏转)都立即控制近端可弯曲构件718,该近端可弯曲构件718又通过缆线控制远端可弯曲构件720处相应的弯曲或偏转。此动作又控制远端工具716的定位。关于此运动的说明,请参见图1和图5分别示出的位置。
优选地,近端构件718通常比远端构件720大,例如如图1中所示,从而提供增强的人机工程学控制。在根据本发明的一种形式中,可以提供一种弯曲动作,在该弯曲动作中,远端可弯曲构件沿与近端可弯曲构件相同的方向弯曲。在替换实施方式中,可弯曲、可转动或柔性构件可以通过将致动缆线旋转180度而被设置成沿相反的方向弯曲,或者可以受控以根据用于缆线的远端和近端支承点之间的关系,而沿实质上任意其它方向弯曲。
应当注意,在远端弯曲构件处产生的弯曲运动量由近端可弯曲构件的尺寸与远端可弯曲构件的尺寸相比来确定。在所述实施方式中,近端可弯曲构件通常比远端可弯曲构件大,因此,在远端可弯曲构件处产生的运动幅度大于在近端可弯曲构件处的运动幅度。近端可弯曲构件能够沿任意的方向(约360度)弯曲,从而将远端可弯曲构件控制成同时在同一平面中、沿相同或相反的方向弯曲。而且,外科医生能够仅通过转动或旋转轴向旋钮724,绕器械的工具的纵向轴线在任意的方位处弯曲和转动器械的工具。
在此描述中参照可弯曲构件进行。这些构件还可以被称作是可转动构件或柔性构件。在此所作的描述中,例如“可弯曲部”、“可弯曲段”、“可弯曲运动构件”或“可转动构件”之类的术语指的是与在接合处枢转的元件相比,该器械上能够可控地弯曲的元件。本发明的可弯曲元件使得能够优选地全部用单个的整体式或单体式结构来制造器械,这种器械能够沿任意方向弯曲而没有任何死点,并且其进一步的特征在于能够沿任意方向弯曲。“整体式”或“单体式”结构的定义是:仅由单个的整体构件构成的结构,而不是由多个组合的或配合的部件形成一个的结构。
这些可弯曲运动构件的定义是:器械元件,其或者形成为控制装置或者形成为受控装置,并且能够受拉力或压力的约束,以便从直线型改变到弯曲的构型,而不会出现任何急剧的断裂或棱角。可弯曲构件可以呈整体式结构的形式,如于此在图1中所示的那样,或者可以呈如图6-15中所示的其它形式。对于可弯曲构件的其它形式,请参见2006年8月16日提交的序列号为No.11/505,003、2006年9月19日提交的序列号为No.11/523,103以及2006年9月27日提交的序列号为No.11/528,134的共同待审申请,在此将这些申请的全部内容引入作为参考。
图1示出了本发明的器械的第一实施方式。图1描述了如在外科手术的过程中可能会出现的那样,处于适当位置中的外科手术器械710。例如,该器械可以穿过腹壁而用于腹腔镜手术。为此,通常提供有布置插管或套管针的插入部位。器械710的轴714适于穿过伤口,从而将该器械的远端布置在手术部位处。如图1中所示的端部受动器716可以被认为是处于这种手术部位处。图1还描述了利用本发明的器械所能执行的转动。这能够借助于相对于手柄712绕轴线T旋转旋钮724发生。这在图1中通过环形箭头R1示出。当旋钮724旋转时,在任何方向中,这都将导致器械轴714的相应旋转。这在图1中通过旋转的箭头R2示出。该同一运动还导致端部受动器716绕轴线P的旋转,如旋转的箭头R3所示。应当注意,在图1中将该器械设置成处于轴线T和P重合的直线位置中。同样参见图5,在那里示出该器械的末端沿着轴线P延伸成角度B2。在旋转发生于图5中所示的位置中的情况下,则无论是否将该器械锁定或解锁,随后末端(端部受动器)运动都围绕轴线P旋转。
在锁定(或解锁)该器械的同时,旋钮724的任意旋转均将器械末端维持在相同的角度位置处,但是旋转末端(工具)的方位。对于旋转特征的进一步的解释,请参见2005年12月14日提交的序列号为No.11/302,654的共同待审的申请,具体地说是图25-28,在此将该申请的全部内容引入作为参考。
在图1中,将手柄712示出为在中立位置处,在该中立位置中,旋钮724的轴线T与器械轴714的轴线U成一直线。在该位置中,远端可弯曲构件720和端部受动器716也成一直线。另一方面,图5中示出了通过向上偏转、枢转或倾斜旋钮724而弯曲、又控制近端可弯曲构件718的弯曲的器械。在图5中,将旋钮724示出为沿着轴线T相对于器械轴纵向中心轴线U倾斜成角度B1。尽管应当了解该偏转同样能够在纸面内或纸面外进行,但该倾斜、偏转或弯曲可以被认为是在纸面中进行。
借助于缆线700,此动作导致远端可弯曲构件720处相应地弯曲到末端沿着轴线P指向、并且相对于器械轴纵向中心轴线U成角度B2的位置处。外科医生主要通过旋钮的倾斜度控制近端可弯曲构件718处的弯曲,所述旋钮能够上下倾斜或倾斜进或倾斜出图5中的纸面。该操作通过弯曲控制缆线直接控制远端可弯曲构件处的弯曲,所述弯曲控制缆线在它们相反的端部处分别连接到远端可弯曲构件和近端可弯曲构件。
因而,将手柄处的控制用于在近端运动构件处弯曲该器械,以进而控制远端运动构件和工具的定位。工具的“定位”主要通过此弯曲或运动来确定,并且可以被看作是远端运动构件的远端处的坐标定位。实际上,人们会考虑在近端运动构件和远端运动构件二者处以及在器械末端处的坐标轴。这种定位处于三维坐标中。另一方面,工具的“方位”与工具绕所示的远端末端轴线(参见图5中的轴线P)的旋转定位有关。
由此,可将旋钮724看作是具有双重功能:用作用于控制弯曲动作的装置,所述弯曲动作在此被称为用于控制端部受动器的定位的“枢转”;以及用于通过用于绕远端末端轴线定位端部受动器的旋转功能,来控制端部受动器的方位的装置。
在图中示出了一组卡爪,但是,其它的工具或装置也可以方便地适用于与本发明的器械一起使用。这些包括但不限于照相机、检测器、光学器件、观测仪器、流体输送装置、注射器等。该工具可以包括各种组装工具,例如:卡爪、剪刀、抓紧器、持针器、微型解剖器、施钉器、定位搭接器(tacker)、吸入式冲洗工具及施夹器。另外,该工具可以包括非组装工具,例如:刀片、探针、冲洗器、导管或吸入孔。
图1的外科手术器械中示出了根据本发明的外科手术器械710的第一实施方式,其正处于使用中,例如在穿过患者皮肤的插入部位处插过插管或套管针。在此描述的许多部件,例如器械轴714、端部受动器716、远端弯曲构件720以及近端弯曲构件718类似于在2005年7月20提交的序列号为No.11/185,911的共同待审的美国申请中描述的相同器械部件,并且其也以相同的方式相互作用,在此将上述申请的全部内容引入作为参考。并且在此也将2004年4月12日提交的序列号为No.10/822,081的美国专利申请、2005年10月3日提交的序列号为No.11/242,642的美国申请以及2005年12月14日提交的序列号为No.11/302,654的美国申请的全部内容引入作为参考。
在于此所述的第一实施方式中,应当注意,该器械使用手枪握把式的手柄,并且其利用能够在手柄中旋转的轴来支承器械轴714。器械轴的远端支承远端可弯曲构件720和端部受动器716。远端可弯曲构件的控制经由在可弯曲构件之间互连的缆线700来自远端可弯曲构件。近端可弯曲构件718容纳在手柄内,具体地说是在手柄壳体711的球状顶部713内。该手柄壳体的顶部包括球窝装置,其中球715适于旋转支承在手柄窝717中。
与旋钮724一样,近端可弯曲构件718受到球715支承。在此实施方式中,主要通过沿三维方向枢转或偏转球715、而不是指引近端可弯曲构件的动作的手柄来控制近端可弯曲构件。球715的枢转又直接受旋钮724的控制。图1示出了具有处于中间或中立位置处的旋钮的该器械,在该位置中,可弯曲构件基本上彼此成一直线。另一方面,图5示出了已经以所示角度B1上向倾斜或枢转的旋钮。在这种形式下,弯曲控制缆线700(参见图2)通过器械轴互连,使得旋钮向上的运动导致远端可弯曲构件向上弯曲。这通过在缆线从器械轴的一端经过到达另一端的同时,使缆线扭曲180度来实现。如果缆线被连接而不扭曲180度,则旋钮的向上的运动导致远端可弯曲构件的向下运动。当然,也能够控制旋钮724,以使旋钮724运动到纸面内或外,从而控制远端可弯曲构件,使其同样运动到纸面内或外。
如前所述,在此实施方式中,将器械轴内的缆线示出为如图1中所示处于直线构型中,并且在图5中示出为处于弯曲的状态。借助于卡爪致动装置致动端部受动器或工具716,所述卡爪致动装置主要由靠近手枪握把式手柄712的底部709放置的细长杆722组成。杆722在杆枢转销723处受到壳体支承。杆722靠近手柄底部709作用在滑动件728上,滑动件728用来接收工具致动缆线738的最近端。当未致动杆722(与手柄壳体分开)时,这相应于处于完全打开位置中的端部受动器卡爪。当杆722靠近时,如图1中所示,这导致滑动件728向下运动,然后朝靠近的位置移动卡爪744和746。卡爪致动器缆线738在其两端处分别限定于曲拐748和转管(rotation barrel)766(参见图1)。
在可弯曲部或可弯曲构件718和720的每个中,可以设置有塑料管。这包括远端管和近端管。这两根管全都可以由例如聚醚醚酮(PEEK)之类的塑料构成。这些管的材料足够刚性以保持缆线762,并且它还足够柔软以使得它能够随着可弯曲构件718和720的弯曲而容易地弯曲。所述管具有足够的强度以接收和引导缆线,它们还具有足够的柔性,使得它们将不会纽结或扭曲,从而由此保持缆线处于用于致动的适当状态,并且还限定了用于缆线的固定长度。所述管沿纵向是僵直的,但是沿侧向是柔性的。关于这些可弯曲部和管的进一步的细节,请参见前述的序列号为No.11/185,911的共同待审申请。
端部受动器716的控制源于卡爪致动器缆线738处。如前所述,将卡爪致动器缆线738的最近端保持在转管766内。将转管766支承在滑动件728内。滑动件728还设置有从滑动件凹处延伸的槽,并且容纳连杆770。连杆770是用于从杆722致动滑动件728,进而致动致动器缆线738的主要装置。
致动连杆770在一端处借助于枢转销771受到杆722支承。连杆770的相反端支承在于此被称作滑动件销772的另一销处。将销772保持用于滑动件728中的槽(未示出)内的纵向运动。图1和5分别示出了在连杆770的相反端部处的销771和772。图1和5还示意性地示出了被推靠在致动器弹簧776上的滑动件。将弹簧776布置在滑动件728的隔室内。关于杆和滑动件装置的进一步的细节,请参照前述序列号为No.11/185,911的申请。另外,该设置还可以包括复位弹簧。
当朝手柄本体按压杆722时,杆722致动端部受动器716。杆722通过棘轮及棘爪装置进行操作,同时该杆能够被压入到有棘齿的间隙中。此棘轮和棘爪装置包括棘轮786和棘爪788。为了容纳棘轮786,滑动件728可以设置有所提供或切掉的端部。棘爪788由手柄712保持。棘轮786在枢转销790处枢转,并且设置有一系列的棘齿,这些棘齿能够将棘轮保持在与端部受动器的连续的闭合度相对应的连续的位置处。扭转弹簧(未示出)优选地被设置成局部围绕枢轴790,并且促进棘齿与棘爪788形成接触。棘轮和棘爪装置还包括整体释放装置,其通常能够由外科医生的拇指接合。这在图1中用释放按钮796示出。当将力作用在按钮796上时,这随即释放棘轮及棘爪装置,并且将杆722返回到其释放位置,同时卡爪完全打开。对按钮796的按压使棘轮786旋转而脱离开与棘爪788的接合。
图1示出支承在手柄的凸缘708处的器械轴714。此支承包括轴承719,它使得能够相对于器械手柄旋转支承器械轴。图1还在虚线的外形中在721处示出了旋钮的可能的替换位置。在此装置中,旋钮紧紧地附接到器械轴的外部,从而能够手动使其旋转。
现在参照延伸在近端可弯曲构件和远端可弯曲构件之间的缆线。设置此缆线使得将近端可弯曲构件处的任何弯曲都转换成在远端可弯曲构件处相应的弯曲。在此所述的可弯曲构件能够沿所有的方向弯曲。在此所述的优选实施方式中,如图5中所示,远端可弯曲构件的直径大致为近端可弯曲构件的直径的二分之一。但是,如前所述,根据该器械的具体用途及使用该器械的医疗手术,也能够使用其它的直径关系。在一个实施方式中,甚至有可能远端可弯曲构件的直径大于近端可弯曲构件的直径。
可以借助于柔性控制缆线700来实现近端可弯曲构件718和远端柔性构件720之间的控制。可以设置四根这种缆线。在这些缆线的远端处,它们可以连接到远端可弯曲构件的最远端处的簧片。如图2中所示,缆线端部接线片702在缆线700的近端处保持缆线700。在这些端部接线片702和集线器701的壁之间保持四个弹簧704。可以用弹性衬垫替换弹簧。参照图2,图2示出了端部接线片702、弹簧704以及集线器701,集线器701被布置在近端可弯曲构件的最近端处。弹簧704张紧缆线700或占据缆线700上的松弛部分。在可弯曲构件之间,可以借助于间隔物(未示出)中的槽来引导缆线700,可以沿着器械轴的支承管来布置所述间隔物。
两个可弯曲构件的构造都可以是整体式带槽的结构,如图1中所示。关于远端可弯曲构件的更多细节,请参照前述序列号为No.11/185,911的申请,其示出了隔开的盘状件的应用,所述盘状件限定了槽,并且可以通过肋装置互连,所述肋装置在受到弯曲控制缆线的控制时使得可弯曲构件易于沿任意方向弯曲,所述弯曲控制缆线附接到远端可弯曲构件,并且受近端可弯曲构件的控制。
图2中示出了近端可弯曲构件718的局部截面图,其包括限定在槽707之间的隔开的盘状件706。近端可弯曲构件优选地还包括在盘状件之间互连的肋,并且所述肋优选地以60度间隔设置,以提供有效的三维弯曲。
再次参照图1和5,球715基本上呈球状,并且容纳在球状窝717中。为了使得球和手柄壳体之间能够进行组装,手柄可以被制成围绕球715进行组装的两部分。球715还包括锥形的腔725,在腔725中布置有近端可弯曲构件。此锥形的腔725提供了开放空间,近端可弯曲构件718能够在该开放空间中弯曲。在图1中,将近端可弯曲构件718示出为处于锥形腔的中间区域中,而在图5中,将近端可弯曲构件718示出为处于弯曲状况,因而靠近该腔的壁。在图5中所示的位置中,应当注意,锥形的腔725提供了充分的空间,以使近端可弯曲构件718能够弯曲。
球715还包括槽726,该槽726容纳工具致动缆线738。工具致动缆线738布置在护套729内,所述护套729从滑动件728的正上方延伸到邻近工具致动组件750的位置。护套729的两端固定在适当的位置中,当致动工具致动缆线738时,它移动穿过护套729。参照图3,其中,在742处示出了护套729的一端。图3还示出缆线738在749处附接到曲拐748的一条腿的那一端(球形端)。在图3中,箭头A表示出护套729中的缆线738用于致动所述工具、闭合工具卡爪的牵引方向。
现在参照图3和4,这些视图示出曲拐机构748的进一步的细节。此机构用于通过传递盘组件760将缆线致动作用从杆722传递到工具致动缆线762。曲拐机构748包括臂764和轭768。臂和轭布置在枢轴769的两侧。曲拐枢轴769又受到固定于球715的安装轮毂752支承。这样,当将近端可弯曲构件枢转到例如图5中所示的位置时,用于曲拐机构的支承与其一起移动。
在图4A中,在立体图中示出了曲拐机构。轭768具有终止于768A和768B的相反的腿。这些终止端形成了适于推靠传递盘组件760的衬垫。在768A、768B处可以附接单独的弹性衬垫。
传递盘组件760由近端加伸轴753支承。轴753的一端支承在集线器701处或者与集线器701一体成形。旋钮724固定到加伸轴753的另一端,如图2中所示。图2中示出了一组螺栓754,其用于将旋钮724固定到近端加伸轴753。端板755也支承加伸轴753。图2还示出轴承756和757,其分别用于从球状的球715支承端板755和集线器701。这样,旋钮724、传递盘组件760和整个近端可弯曲构件均受到支承,从而相对于球状的球715旋转。
图4B中在单独的立体图中示出了传递盘组件760。此组件包括外盘780和同心设置的内盘782。盘780和782通过四个销784互连。这些销适于跨接在近端加伸轴753中的相应的槽785中,从而使得传递盘组件760能够直线平移。参照图2-4,它们用于描述槽785相对于销784的定位。此槽装置允许传递盘组件760沿近端加伸轴753的纵向直线移动有限的量。图2示出了在槽785的右端处的传递盘组件760。这相应于工具致动杆722的未致动位置。另一方面,图3示出了在槽785的左端处或附近的传递盘组件760,该位置相应于工具致动杆722的致动位置。
图2和3还示出了缆线复位弹簧783。将它布置于形成弹簧座的固定盘787处的一侧处。借助于一个或多个设定螺栓789将盘787维持在近端加伸轴753中的适当位置中。将复位弹簧783的相反端推靠在传递盘组件760的内盘782上。因而,在图3中,复位弹簧783将传递盘组件760向右偏压,以使端部受动器的位置通常处于卡爪打开的位置中。
图3示出已经通过轭768沿箭头A的方向牵引,以将传递盘组件移动到致动位置的致动缆线738。在图3中,箭头B表示出传递盘组件760的直线的运动方向。内盘782具有用于接收工具致动缆线762的中心通道。图3示出减小直径的缆线端球792,所述缆线端球792附接到缆线762,并且接收传递盘组件760中的缆线。当然,传递盘组件760沿箭头B的方向的运动沿着相同的方向移动工具致动缆线762。在图2和3中,将工具致动缆线762示出为被布置在缆线护套794中,缆线护套794也延伸穿过近端可弯曲构件。工具致动缆线762以与序列号为No.11/185,911的美国申请中所述类似的方式致动端部受动器。
图1-5中所示的医疗器械也具有锁定特征。例如,在图1中这由以可枢转的方式安装到手柄壳体的锁定杆795示出。锁定杆795致动摩擦垫797,而摩擦垫797由杆795推动,靠在球状的球715的外球面上。在杆795的一个位置中,如图1中所示,它脱离接合,使得球能够在窝717内容易地旋转。在杆795的另一位置中,如图5中所示,将它推动,靠在摩擦垫797上,摩擦垫797又接合球715的外球面。在此锁定位置中,防止该球在窝717内的任何进一步的旋转,从而将可弯曲构件维持在特定的选定位置中。但是,即使在此锁定位置中,仍然能够通过旋钮724旋转该器械的末端,以改变端部受动器的方位。将旋钮724和近端可弯曲构件718以可旋转的方式支承在手柄中,从而即使在该器械的位置被锁定时也能够进行此旋转。
对于本发明的另一个实施方式,现在参照图6-10。此实施方式略有简化,因为它不需要使用伸缩管或一系列的互连的盘,特别是在该器械的近端处更是如此。在此实施方式中,未公开整个器械,但是应当了解,整个器械将包括整个手柄组件及具有端部受动器的整个远端部。在图6中示出了远端可弯曲构件的一部分。在此实施方式中,远端可弯曲构件是整体式结构。在图6中,与其说该手柄是手枪握把式的,不如说是嵌入式的。
图6是此实施方式的器械的局部截面俯视图,仅示出了部分手柄812、器械轴814和远端可弯曲构件820。关于该器械的远端部分的进一步的细节,请参照序列号为No.11/185,911的美国申请,在此将其全部内容引入作为参考。在图6中示出了缆线800,它延伸穿过器械轴814,并且联接到在图6中未具体示出的端部受动器。在与近端可弯曲构件818的交界处仅在局部视图中示出了手柄的构造。该手柄包括用于致动工具致动缆线838的杆。关于手柄机构和致动杆的进一步的细节,再次参照本申请的图1-5以及序列号为No.11/185,911的美国申请。在图6-10的实施方式中,手柄优选地为直线构造的。
图7是在图6中沿线7-7剖取的截面图。图8是也在图6中沿线8-8剖取的截面图。图9是图6的实施方式的部分机构的分解立体图。图10是示出了用于内轴的支承的另一实施方式的局部截面图。
在图6的实施方式中,将手柄812构造成包括手柄半件812A和812B的两半(参见图9)。正是手柄812相对于适配件826的倾斜控制远端可弯曲构件820处的远端弯曲。作为替代,使用者可以考虑使轴相对于手柄倾斜。旋钮824与适配件826一体成形,并且提供了器械轴的旋转,特别是器械轴的外管832相对于器械轴的内管834的旋转。器械轴的外管832的旋转使得远端可弯曲构件以及支承在其远端处的端部受动器旋转。这提供了在该器械的末端处围绕例如图5中的轴线P的远端末端轴线的旋转。
将外轴管832固定在适配件826内。经由轴承833和835相对于外管832支承内管834。这些轴承使得外管832能够相对于固定位置旋转内管834。轴承833和835优选地设置有用于接收缆线800的通孔或槽,缆线800从所述通孔或槽中穿过。在器械轴814内还可以设置有具有用于缆线800的导引槽的间隔物(未图示)。在图6-10中所示的实施方式中,如图7的截面图中所示设置有四个控制缆线800。在其它实施方式中,可以设置少于或多于四根的缆线。
内管834的最近端836支承球815。球815固定安装在内轴不旋转的端部上。如图6中所示,容纳在柔性护套839中的工具致动缆线838穿过球815。为此,球815设置有略呈锥形的腔817。在图6中,将手柄示出为处于其倾斜位置中,并且,腔817允许工具致动缆线838和护套839在腔817中偏转,而在缆线和球之间不必有任何绑扎。
将球815稳固地附接到内管834的近端836,因而可以被认为基本上是不能旋转的。端部受动器沿三维方向的倾斜通过手柄812实现,所述手柄812同样具有相对于适配件826沿三维方向弯曲或倾斜的能力。为此,将手柄812设置为两个半件的形式,并且在两个半件之间限定有球窝825。同样参照图9,其示出了手柄半件812A和812B,它们通过使用锁定销807互相接合。图9的分解图还示出了球状的球815,以及手柄812中相配的球窝825。球815设置有沿直径布置的销827,这些销827在球窝825处被容纳在手柄中沿直径布置的槽828中。该销和槽装置使得手柄能够相对于球815沿三维方向运动。当在图6中的纸面内移动手柄时,销827可以在槽828内平移。而且,当将手柄移进或移出图6的纸面时,手柄能够相对于销827枢转。这提供了三维定位。
图6还示出旋转锚环840,其相对于手柄812受到支承,并且承载着每根缆线800的最近端。为此,旋转锚环840包括四个彼此成90度布置的孔,它们接收每根缆线800的近端(球841)。图6和7示出缆线锚球841,所述缆线锚球841是用于每根缆线的近端终端。在每个缆线终端和旋转锚环840之间设有弹簧842。在图6中所示的位置处,应当注意,手柄向上倾斜。只要在器械轴内不扭曲缆线800,则手柄的这种倾斜通过远端可弯曲构件820会导致端部受动器相应的向下运动。
还可将近端可弯曲构件818看作是包括保持件844和金属加强环846。金属加强环846将两个手柄半件固定在一起,并且将窝825固定在球815周围。通过使用某种类型的保持装置,或者不使用保持装置,可以将加强环846通过搭扣配合固定在适当的位置中。保持件844靠近金属加强环,并且将旋转锚环840保持在适当的位置中,同时允许相对于手柄812旋转该旋转锚环840。在旋转锚环840和手柄812之间设置有缆线通道847。
如前所述,旋转锚环840表示用于保持缆线800的最近端的装置。而且,旋转锚环840是旋钮824和手柄之间的界面。为此,在环840上设置有沿直径布置的销849,它们容纳在旋钮824中的弓形槽850中,如图6和7中所示。该销和槽装置使得能够旋转旋钮,进而旋转器械轴的外管和端部受动器。不论手柄的位置如何,旋钮824都旋转端部受动器,并且销849在槽850中移动,以使得能够进行此旋转运动。与其它的销和槽装置827、828一样,不论手柄相对于器械轴的位置如何,销849和槽850都使得旋钮824能够进行旋转运动。
图6的截面图还示出锁定机构,该锁定机构与近端可弯曲构件818一起使用。该锁定机构包括套管852,它在一端处支承凸缘853,并在另一端处支承杯状件854。杯状件854设置在座855中。关于接收杯状件854的座855的描述,请参见图9。套管852适于朝球815及远离球815直线平移。在一个位置中,将套管设置成远离该球,并在相反的位置中,将它移动成与该球接触,用于锁定手柄相对于球815的位置。
套管852的平移受到楔形构件856的控制。楔形构件856具有靠在凸缘853上的平面,并且具有接合手柄的锥形壁857的锥形面。楔形构件856还包括长形槽858,它设置有足够的间隙,以使得当楔形构件856在其锁定位置和解锁位置之间移动时,不与工具致动缆线及其相关护套接触。图8的截面图示出了楔形构件856及其相关联的长形槽858。
楔形构件856通过一对按钮进行控制。这包括支承在轴861端部处的锁定按钮860。轴861被固定到楔形构件856。在楔形构件856的相反侧上,如图6中所示,具有释放按钮862,它借助于轴863受到楔形构件支承。同样参照图8的截面图。
当向内朝手柄按下锁定按钮860时,这导致楔形构件856移动抵靠在锥形面857上,由此纵向移动套管852,以使得杯状件854将夹紧压力或力施加在球815上。当这种情况发生时,将手柄812相对于球815保持在固定位置中。换言之,不论按下按钮862时,器械所处的位置如何,均将该器械维持在端部受动器处于特定的相应位置处的状态中。
可以通过按下释放按钮862来释放锁定构件,从而沿相反的方向纵向移动楔形构件856。这释放了套管852上的压力,使得其不再与球815紧密接触。这使得手柄能够相对于适配件826在任意三维位置中运动。偏压装置或制动装置可以与锁定机构相关联。
现在参照图10的局部截面图。图10是替换实施方式的示意图,其中,球815以旋转的方式安装在内轴834的端部上。在图10中,此旋转安装通过轴承808来实现。在此具体实施方式中,不使用图6中示出的轴承833和835,因而,内管832和外管834一起旋转。
图11、11A和12中示出了本发明的另一实施方式。在此实施方式中,未示出整个器械。应当了解,手柄865包括用于致动工具致动缆线的机构。在该器械的远端处,存在经由远端可弯曲构件联接到端部受动器的器械轴。在此实施方式中,所示主要是近端可弯曲构件866。近端可弯曲构件866包括球接头,球接头进一步利用滑动杆或活塞,所述滑动杆或活塞被夹持以将该器械保持和锁定在理想位置中。此杆和活塞装置相对于弯曲动作起到从动件的作用。
图11是本发明的该实施方式的局部截面侧视图。图11A是沿图11的线11A-11A剖取的局部截面图。图12是在图11的实施方式中使用的轴承环和活塞组件的示意性立体图。
在图11的局部截面图中,手柄865与适配件868连接。适配件868可以基本上类似于图6的实施方式中所示的适配件826。同样,图11中所示的器械包括外轴管,它并未示于图11中,但可与图6中所示的相同。图11确实示出了连接到球872的内轴管870。通过使用轴承873,该连接可以与图10中所示出的基本上相同,以使得该器械轴的内管和外管一起旋转。
适配件868已与旋钮874一体成形,该旋钮874可以具有与图7的截面图中所示的基本上相同的结构。适配件868还设置有槽或轨道876,一个设置在如图11中所示的分开的沿直径布置的位置处。该轨道876分别接收锚环880的销878。适配件868还接收轴承环和活塞组件890,它在图12中在示例性立体图中予以示出。为此,在适配器中在其近侧处设置有环形槽,它形成用于轴承899的通道891。卡环882将组件890保持在适配件处适当的位置中。在图11的实施方式中,当操纵手柄以使其将活塞移进及移出时,活塞组件890起到从动件的作用。
在图12中在立体图中示出轴承环和活塞组件890,该轴承环和活塞组件890包括环892和多个围绕环892以90度间隔设置的杆893。在每个杆的各端处都形成有接头。将这些接头中的每个在图12中都描述为球窝接头。但是,应当了解,也可以使用其它类型的限制枢转接头,例如铰链接头或活铰链等。因而,每个杆在其各端处都具有接头894和895。这些接头至少提供了每个杆相对于环892的受限的枢转。图11示出在近端可弯曲构件866的弯曲情况下杆相对于环892的定位。
接头894将所述杆连接到环892,同时接头895将所述杆的相对端连接到各个活塞896。每个活塞896都被容纳在手柄865内的开放式气缸897中。图11示出在气缸897的一端处的顶部活塞896以及在该气缸的相对端处的下部活塞896。每个活塞896均具有长形肋898,肋898延伸穿过壳体中的槽,以使得它能够被弹性构件871接触。弹性构件871的形状优选为环形,并且通过锁定旋钮875保持在适当的位置中。弹性构件871具有倾斜的表面,该表面适于与活塞肋898接触,以将活塞保持在选定的位置中,从而将近端和远端可弯曲构件维持在它们的选定位置中。
环形锁定旋钮875接收弹性构件871,并且包括与手柄865的螺纹接合。这示于图11中的877处。锁定旋钮875的旋转导致旋钮875和弹性构件871之间位于879处的接触面接合并且迫使该弹性构件抵靠活塞肋898以锁定该位置。图11用箭头D示出锁定旋钮875和弹性构件871的平移方向。
图11还示出旋转锚环880,它相对于手柄865受到支承,并且承载每根缆线900的最近端。为此,旋转锚环880包括四个孔,它们相对于彼此以90度布置并且接收每根缆线900的近端。图11示出缆线锚球901,它就是每根缆线的近端终端。在每根缆线终端和旋转锚环880之间设有弹簧902。在图11中所示的位置中,应当注意,近端可弯曲构件相对于手柄865倾斜。根据在器械轴内是否扭曲缆线800,然后手柄和近端可弯曲构件之间的该相对倾斜通过远端可弯曲构件导致端部受动器相应的向下或向上运动。
还可将近端可弯曲构件866看作是包括保持件867和金属加强环869。金属加强环869将两个手柄半件固定在一起,并且将手柄窝固定在球872周围。通过使用某种类型的抑制装置,或者不使用抑制装置,可以将加强环869通过搭扣配合固定在适当的位置中。保持件867被靠近金属加强环布置,并且将旋转锚环880保持在适当的位置中,同时允许旋转锚环880相对于手柄865的延伸而旋转。如前面所指出的那样,在旋转锚环880和手柄865之间设置有通道。
如前所述,旋转锚环880表示用于保持缆线900的最近端的装置。而且,旋转锚环880是旋钮874和手柄865之间的界面。为此,设置有沿直径布置的销878,它们容纳在旋钮874中的弓形槽或轨道876中。该销和槽组件使得旋钮能够旋转,进而旋转器械轴的内管和外管以及端部受动器。不论手柄的位置如何,旋钮874都旋转端部受动器,并且销878在槽876中移动,以使得能够进行此旋转运动。
在图11-12的实施方式中,应当注意,将锚环880附接到手柄,但是能够相对于手柄旋转。正是近端可弯曲构件和手柄之间沿三维方向的相对运动(倾斜)通过缆线900控制远端可弯曲构件的定位。一旦外科医生使该器械处于所需的位置中,并且想要将该器械锁定在该特定的位置中时,而后就沿图11中的箭头D旋动锁定环或旋钮875。螺纹877优选为是粗糙的,以使得不必将旋钮875旋转到任意非常大的程度以锁定器械位置。旋钮875的该旋转推动弹性构件871,弹性构件871又将该构件移动成与活塞肋或滑动件898接合。此相同的动作发生在每个活塞896处,因而紧紧地锁定了近端可弯曲构件的位置,并进而锁定了远端可弯曲构件的位置。通过沿相反的方向旋转旋钮875来释放该锁定动作。可以使用左旋螺纹或右旋螺纹877。
在图13和14中示出了本发明的另一实施方式。在此实施方式中未示出整个器械。应当了解,手柄912包括用于致动工具致动缆线的机构,例如图1的杆装置。在该器械的远端处具有器械轴,它经由远端可弯曲构件联接到端部受动件。在此实施方式中,主要示出了近端可弯曲构件918。近端可弯曲构件918包括球窝装置,结合类似于前面图6中示出的锁定机构,球窝装置进一步采用了滑动和枢转杆或活塞。
图13是本发明的另一实施方式的截面侧视图,它与图11的实施方式的相似之处在于它采用了受限枢转杆或活塞。图14是沿图13的线14-14剖取的截面端视图。
在图13的实施方式中,可将手柄912构造成两个半件,并且优选地为直线结构,但是也可以是手枪握把式的。正是手柄912相对于适配件926的倾斜控制在远端可弯曲构件处的远端弯曲,图13中未示出该远端可弯曲构件,但是它可以为前述类型。旋钮924与适配件926一体成形,并且提供了器械轴914的旋转,特别是器械轴的外管932相对于器械轴的内管934的旋转。器械轴的外管932的旋转使得远端可弯曲构件及支承在其远端处的端部受动器旋转。这提供了该工具围绕其远端工具轴线的旋转。
将外轴管932固定在适配件926内。经由器械轴914的各端处的轴承相对于外管932支承内管934。在图13中仅示出一个轴承933,应当了解,在器械轴的远端处也设置有轴承,如图6中所示。这些轴承使得外管932能够相对于固定位置的内管934旋转。轴支承轴承优选地设置有用于接收缆线910的通孔或槽,缆线910从所述通孔或槽中穿过。在器械轴914内还可以设置有具有用于缆线910的引导槽的间隔物(未图示)。在图13和14中所示的实施方式中,如图14的截面图中所示可以设置有四根控制缆线。在另一实施方式中可以设置少于或多于四根的缆线。
在图13中所示的实施方式中,外管932能够相对于内管934旋转。为此,在内管和外管之间设置有轴承。在替换实施方式中,器械轴的内部和外部可以一起旋转,在这种情况下,轴承处于内管和球之间,如图10中所示。
内管934的最近端936支承球915。球915固定安装在内轴不旋转的端部上。如图13中所示,容纳在柔性护套内的工具致动缆线938穿过球915。为此,球915设置有略呈锥形的腔917。在图13中,将该手柄示出为处于其倾斜位置中,并且腔917允许工具致动缆线938和护套939在腔917中偏转,而在缆线和球之间没有任可绑扎。
将球915稳固地附接到器械轴的内管934的近端,因而可以被认为基本上是不能旋转的。端部受动器沿三维方向的倾斜通过手柄912实现,手柄912同样具有沿三维方向弯曲或倾斜的能力。为此,可将该手柄912设置为两个半件的形式,并且在两个半件之间限定有球窝925。手柄半件可以通过使用对齐的锁定销互锁。将窝925布置在手柄套圈941的终端端部处。球915设置有沿直径布置的销927,销927在球窝925处容纳在手柄中沿直径布置的槽928中。该销和槽装置使得手柄能够相对于球915沿三维方向运动。当在图13中的纸面中移动手柄时,销927可以在槽928中平移。而且,当将手柄移进和移出图13中的纸面时,手柄能够相对于销927枢转。
图13的截面图还示出了锁定机构的一部分,该锁定机构与近端可弯曲构件918一起使用。该机构可以与结合图6的实施方式所示出和前述的那个一样。该锁定机构包括套管952,它在一端处支承凸缘(在图13中未示出),并在另一端处支承杯状件954。杯状件954设置在窝925的座内。套管952适于朝球915及远离球915直线平移。在一个位置中,将套管设置成远离该球,并且在相反的位置中,将它移动成与球接触,用于锁定手柄相对于球915的位置。套管952的平移受到例如图6中所示的楔形装置的控制。套管952沿图13中的箭头F的方向的运动抵靠球915锁定杯状端部954,因而将近端可弯曲构件保持在所需的选定的锁定位置中。
在图13中所示的实施方式中,每个缆线910均由滑动件920、而不是使用用于保持缆线910的端部的锚环所保持。每个滑动件920又由可旋转保持架922保持在相应的滑动件导槽923中。图13示出了轴承921,它相对于手柄912支承保持架922。将保持架922支承为,通过连杆935响应于旋钮924的旋转而旋转。每个滑动件920能够在其相应的导槽923内滑动。每个滑动件920保持相应控制缆线910的端部。为此,每根缆线设置有由滑动件920保持的端部固定接线片943。还示出用于偏置缆线910的弹簧944。图13示出被牵引的顶部缆线910,同时松开相应的底部缆线。
连杆935形成适配件926和器械手柄912之间的平移装置。受限运动接头设置在这些连杆935的相应端部处。因而,每根连杆935具有一个接头937,它使得该连杆能够相对于适配件926进行某些受限的枢转。连杆的另一端支承另一接头931,它同样使得连杆能够相对于滑动件920进行某些受限的枢转。
图13示出具有手柄的器械,其中手柄以一定的角度弯曲到器械轴的纵向中心轴线。这在图13中示出为角度B1。在图13中还将该角的余角示出为B1’,它处于手柄的纵向轴线和通过接头931的线之间。
图15是本发明的另一实施方式的截面侧视图,它与图13中的实施方式的类似之处在于它采用了用于控制缆线的运动杆或连杆。
在图15的实施方式中,可将手柄960构造成两个半件,并且可以具有直线结构或呈手枪握把式。正是手柄960相对于适配件966的倾斜控制图15中未示出的远端可弯曲构件处的远端弯曲,但是也可以是前述类型。旋钮964与适配件966一体成形,并且设置用于器械轴967的旋转,特别是器械轴的外管968连同器械轴的内管969的旋转。器械轴的内管和外管的旋转使远端可弯曲构件及支承在其远端处的端部受动器旋转。图15用箭头R1示出了轴的旋转。
将外轴管968固定在适配件966内。内管969相对于外管968受到支承,从而如图10中所示的实施方式那样一起旋转。该实施方式包括轴承970,它使得内轴管989和球972之间能够相对旋转。在图15中所示的实施方式中,可以设置四根控制缆线973,以提供三维方向的定位。在另一实施方式中可以设置少于或多于四根的缆线。
在图13中所示的实施方式中,外管932能够相对于内管934旋转。为此,在内管和外管之间设置有轴承。但是,在图15的实施方式中,器械轴的内部或外部一起旋转,在这种情况下,轴承位于内管和球之间,如图10和15中所示。
内管969的最近端通过轴承970支承球972。球972位于手柄窝974中。如图15中所示,容纳在柔性护套976中的工具致动缆线975穿过球972。为此,球972设置有略呈锥形的腔977。在图15中,将手柄示出为,相对于近端可弯曲构件处于倾斜位置中,并且腔977允许工具致动缆线975和护套976在腔977中偏转,而在缆线和球之间没有任何绑扎。
球972以可旋转的方式附接到器械轴的内管969的近端,并且能够在手柄窝974中旋转。端部受动器沿三维方向的倾斜通过手柄960实现,所述手柄960同样具有沿三维方向弯曲或倾斜的能力。为此,可将手柄960设置成两个半件的形式,并且进一步包手柄管979,该手柄管979在其远端处具有杯状端部980,在所述杯状端部980处限定有球窝974。手柄半件可以通过使用对齐的锁定销互锁。球972设置有沿直径布置的销982,所述销982在球窝974处容纳在手柄中沿直径布置的槽983中。该销和槽装置使得手柄能够相对于球972沿三维方向运动。当手柄在图15中的纸面内运动时,销982可以在槽983内平移。同样,当将手柄移进和移出图15中的纸面时,手柄能够相对于销982枢转。
图15的实施方式还示出了沿着管979形成的球状件984。球状件984经由跨接件986支承锚环985。保持件987将锚环985保持在适当的位置中。锚环985和跨接件986之间形成有通道。
连杆或销988形成了适配件966和器械手柄960之间的传送装置,并且更具体地是锚环985。在这些连杆988的相应端部处设有受限运动接头。因而,每个连杆988都具有一个接头989,接头989使得连杆能够相对于适配件966进行某些受限的枢转。连杆的另一端支承另一个接头990,所述另一接头990同样使得连杆能够相对于锚环985进行某些受限的枢转。
图15中的截面图还示出了与近端可弯曲构件一起使用的锁定机构。该机构类似于结合图6的实施方式示出及前述的一个机构。该锁定机构包括滑动按钮装置,它控制楔形构件991。楔形构件991通过一对按钮受到控制。这包括支承在轴994的端部处的锁定按钮992。轴994固定于楔形构件991。在楔形构件991的相反侧上,如图15中所示,具有释放按钮993,它借助于轴995受到楔形构件支承。
当向内朝手柄按下锁定按钮992时,这导致楔形构件991移动抵靠在滑动件996的表面上,因而将锥形件997移动到球984中的裂口中。当这种情况发生时,将手柄960相对于近端可弯曲构件和旋钮保持在固定位置中。换言之,不论此时器械的位置如何,均按下按钮992,将该器械维持在该位置中,同时端部受动器处于所需的位置处。锥形件997运动到球中导致球的外表面锁靠在跨接件986上。
可以通过按下释放按钮993来释放锁定构件,从而沿相反的方向移动楔形构件991。这释放了锥形件上的张紧力,以使得其不再处于与球984的紧密接触中。这使得手柄能够相对于适配件966移动到任意的三维位置中。
现在已经描述了本发明的有限数量的实施方式,现在对于所属领域的普通技术人员应该很明显,应将本发明的其它实施方式及其变型看作是落入到本发明的范围内。例如,在此处描述的实施方式已主要使用了四根控制缆线,用于提供运动构件的所有方向的运动。在替换实施方式中,可以设置更少或更多数量的缆线。在最简化的形式中,仅使用两根缆线,从而在可弯曲运动构件处提供单自由度的动作。另一示例是现有的其它实施方式,它们示出了手枪式握把或者嵌入式手柄结构,但是应当理解,所有的实施方式均能够使用任意类型的手柄结构。在所示实施方式中,已使用旋钮来执行旋转远端器械末端的功能。在本发明的替换实施方式中,也可以设置其它装置来实现这种末端旋转。例如,可以使用滑动构件来取代旋钮或者任意其它的可移动构件,该可移动构件控制器械轴及器械末端,用于使端部受动器围绕例如图1中所示的远端工具轴线(轴线P)旋转。同样,例如,在图1-5的实施方式中,旋钮724提供了旋转特征(用于围绕轴线P控制该工具),以及对于弯曲动作的枢转控制。在本发明的替换实施方式中,通过由例如图1中所示的旋钮721之类的旋钮独立控制的旋转,能够将旋钮724仅用于控制弯曲或倾斜。旋钮724还可以被杆装置所取代以控制弯曲。
Claims (25)
1.一种医疗器械,其包括:
近端控制手柄;
远端工作构件;
近端可移动构件,其受到来自所述近端控制手柄的控制;
远端可移动构件,其受到来自所述近端可移动构件的控制,以便从所述近端控制手柄提供所述远端工作构件的受控运动;
器械轴,其将所述近端可移动构件与所述远端可移动构件互相联接;
以及致动装置,其联接在所述可移动构件之间;
所述近端可移动构件包括球窝组件,所述球窝组件被支承在所述手柄和所述器械轴之间,并且被构造和设置成用于三维运动。
2.如权利要求1所述的医疗器械,其进一步包括锁定构件,所述锁定构件受到来自所述近端控制手柄的支承,并且具有锁定状态和解锁状态;处于所述解锁状态中的所述锁定构件使得能够经由所述可移动构件从所述近端控制手柄控制所述远端工作构件;并且处于所述锁定状态中的所述锁定构件将所述可移动构件保持在所需的固定位置中。
3.如权利要求2所述的医疗器械,其中,处于所述锁定状态中的所述锁定构件固定所述近端可移动构件的位置。
4.如权利要求1所述的医疗器械,其中,所述远端可移动构件包括单体式的结构。
5.如权利要求1所述的医疗器械,其中,所述球窝组件包括受到所述器械轴支承的球、限定在所述手柄中的窝以及以可旋转方式被支承在所述手柄处的锚环。
6.如权利要求5所述的医疗器械,其中,所述致动装置包括多根缆线,所述缆线由所述锚环支承在近端处。
7.如权利要求6所述的医疗器械,其中,所述球具有跨接在所述窝中的槽中的销。
8.如权利要求6所述的医疗器械,其包括旋转控制构件和联接在所述手柄和旋转控制构件之间的活塞组件。
9.如权利要求8所述的医疗器械,其中,所述活塞组件进一步包括活塞、位于所述旋转控制构件上的环、以可枢转的方式连接在所述环和活塞之间的连杆以及用于保持所述活塞的位置的锁定旋钮。
10.如权利要求8所述的医疗器械,其中,所述活塞组件进一步包括由所述手柄支承并且能够旋转的保持架、由所述保持架支承的滑动件以及联接在所述滑动件和所述旋转控制构件之间的连杆。
11.如权利要求6所述的医疗器械,其包括位于所述手柄上的从动件,并且包括跨接件、用于支承所述跨接件的球状件以及以可旋转的方式支承在所述跨接件上的锚环。
12.如权利要求11所述的医疗器械,其包括具有裂开的球的锁定构件,以及能够移动到所述裂开的球中以锁定所述近端可移动构件的位置的楔形构件。
13.如权利要求1所述的医疗器械,其包括靠近所述近端控制手柄的旋转控制构件,用于控制所述远端工作构件以围绕远端工作构件轴线旋转。
14.如权利要求1所述的医疗器械,其中,所述致动装置包括一组联接在所述可移动构件之间的缆线,并且进一步包括由所述手柄支承并且用于保持所述缆线的近端的缆线保持件。
15.如权利要求1所述的医疗器械,其中,所述手柄包括手枪握把式手柄,其包括底部及限定支承所述球的球状窝的顶部,所述球支承所述近端可移动构件。
16.如权利要求15所述的医疗器械,其中,所述近端可移动构件包括整体式可弯曲构件,并且进一步包括与所述近端可弯曲构件成一直线的可旋转控制构件。
17.一种医疗器械,其具有由用于在内部穿过解剖体的长形器械轴互联的近端控制手柄和远端工具、分别将所述近端控制手柄和所述远端工具与所述器械轴互联的近端可移动构件和远端可移动构件、布置在所述可移动构件之间的缆线致动装置以及旋转球,并且,其中,所述控制手柄包括底部和限定了球状窝的顶部,所述球状窝支承用于在其中进行三维枢转的所述旋转球。
18.如权利要求17所述的医疗器械,其中,所述近端可移动构件包括由所述旋转球支承的近端可弯曲构件。
19.如权利要求18所述的医疗器械,其进一步包括以与所述近端可弯曲构件成一直线的方式支承的旋转控制构件,用于控制所述三维枢转。
20.如权利要求19所述的医疗器械,其中,所述旋转控制构件控制所述三维枢转以及围绕所述近端可弯曲构件的纵向轴线的旋转,从而控制所述工具围绕其远端工具轴线的旋转。
21.如权利要求18所述的医疗器械,其进一步包括在所述近端可弯曲构件的近端处的枢转控制构件,用于控制所述三维枢转。
22.如权利要求21所述的医疗器械,其中,所述枢转控制构件还控制所述器械轴的旋转。
23.如权利要求18所述的医疗器械,其包括锁定装置,所述锁定装置由使用者手动操作,并且将所述球锁定在所述窝中。
24.在一种医疗器械中,所述医疗器械具有由用于在内部穿过解剖体的长形器械轴互联的近端控制手柄和远端工具、分别将所述近端控制手柄和所述远端工具与所述器械轴互联的近端可移动构件和远端可移动构件,以及布置在所述可移动构件之间的缆线致动装置,一种借助于控制元件从所述手柄控制所述工具的方法,包括枢转所述控制元件,以控制所述工具沿三维方向的定位,并通过旋转所述器械轴来控制所述工具的旋转定向。
25.如权利要求24所述的方法,其包括将球窝设置为近端可移动构件的部件,以及控制所述控制元件以相对于所述窝枢转所述球。
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JP (1) | JP4989724B2 (zh) |
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2006
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-
2007
- 2007-07-24 KR KR1020097003162A patent/KR20090051049A/ko not_active Application Discontinuation
- 2007-07-24 CN CN2007800301613A patent/CN101500493B/zh not_active Expired - Fee Related
- 2007-07-24 JP JP2009524600A patent/JP4989724B2/ja not_active Expired - Fee Related
- 2007-07-24 WO PCT/US2007/016630 patent/WO2008020964A2/en active Application Filing
- 2007-07-24 EP EP07836217A patent/EP2056722A2/en not_active Withdrawn
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2010
- 2010-01-07 HK HK10100094.3A patent/HK1132446A1/xx not_active IP Right Cessation
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Also Published As
Publication number | Publication date |
---|---|
CN101500493B (zh) | 2011-09-28 |
JP4989724B2 (ja) | 2012-08-01 |
EP2056722A2 (en) | 2009-05-13 |
HK1132446A1 (en) | 2010-02-26 |
US20100228235A1 (en) | 2010-09-09 |
US7708758B2 (en) | 2010-05-04 |
US8709037B2 (en) | 2014-04-29 |
KR20090051049A (ko) | 2009-05-20 |
US20080046000A1 (en) | 2008-02-21 |
WO2008020964A2 (en) | 2008-02-21 |
JP2010500149A (ja) | 2010-01-07 |
WO2008020964A3 (en) | 2008-11-20 |
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