CN101511281B - 外科器械以及用于该外科器械的致动运动传递装置 - Google Patents

外科器械以及用于该外科器械的致动运动传递装置 Download PDF

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CN101511281B
CN101511281B CN200780033145XA CN200780033145A CN101511281B CN 101511281 B CN101511281 B CN 101511281B CN 200780033145X A CN200780033145X A CN 200780033145XA CN 200780033145 A CN200780033145 A CN 200780033145A CN 101511281 B CN101511281 B CN 101511281B
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M·达尔坎吉罗
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Abstract

一种外科器械，例如外科缝合器械(1)，包括：用于引入到患者体内的组织操作部分(2)；具有适于产生致动运动的致动机构(7)的手柄部分(3)，以便致动组织操作部分(2)，并且其包括至少一对旋转输出构件(33；40)；和致动传递装置(5、5’；6、6’)，该致动传递装置将手柄部分(3)的致动机构(7)与组织操作部分(2)连接，并包括至少一对旋转杆(17、17’；19、19’ )，所述旋转杆用于将来自所述一对旋转输出构件(33；40)的旋转致动运动传递到组织操作部分(2)。致动机构(7)包括同步部件(31、32、32’；38、39、39’ )，这些同步部件将所述一对旋转输出构件的两个旋转输出构件(33；40)的运动相关联，使它们以大致相同的速度反向旋转。

Description

外科器械以及用于该外科器械的致动运动传递装置
技术领域
本发明总体涉及外科器械，具体涉及可通过内窥镜引入到患者体内的器械，所述器械通过专用运动传递装置与设有致动机构的体外手柄部分连接，该专用运动传递装置能够将致动运动从手柄部分传递到体内的外科器械。
背景技术
特别是关于外科缝合器械，例如在低位胃肠道的病理学诊断和/或治疗中使用的外科缝合器械，存在两种几乎不可调和的一般要求：即，将外科缝合器尽可能深地引入到自然孔道(例如结肠)中以便到达需要被治疗的病理区域的要求，以及在致动过程中(换言之，在手术介入的进行过程中)从体外控制外科器械的位置和运动的要求。
在WO 01/91646A1中公开的已知外科缝合器械，具有位于缝合器械的远端区域中的缝钉紧固组件，刚性轴和在缝合器械的近端区域中从轴延伸出的手柄。该已知的外科缝合器械可被用于切除组织，例如息肉，并立即有效止血。在外科手术中，缝合器械例如被引入到肛管中并运动到待切除的组织部位。当钉仓装置和砧座处于间隔或者打开位置时，待切除的组织可通过单独的组织抓持器械被拉到缝合器的砧座与钉仓装置之间的区域中。此后，砧座向着钉仓装置运动以便夹紧组织。当钉仓装置和砧座已经达到关闭位置时，外科医生可“击发”器械，这意味着驱动缝钉使其离开钉仓装置，穿进组织，于是末端被砧座弯曲，并且使刀或切割边缘向着砧座运动以便切割组织。当器械被打开之后，完全切除的组织可安全地从患者体内与器械本身的移除一同或者在其之前被除去。
由于已知的外科缝合器械的插入轴的刚性和有限长度，已知的外科缝合器械使缝钉紧固组件的位置和运动在致动过程中能够具有极好的稳定性和控制性，但由于同样的原因，外科缝合器械的操作范围被限制到这样的程度，即，其例如不能被用于切除远离直肠的肛管组织。
为了消除与器械的插入和布置有关的这些缺陷，已经提出了一种外科缝合装置(在WO2006/027014中公开)，其中，刚性插入轴已经由柔性轴取代，该柔性轴柔性地连接近侧手柄和远侧缝钉紧固组件。该柔性轴，例如内窥镜，可以相当长，使缝合器械能够被引入到例如肛管中并向前运动相当长的距离，以允许对位于远离肛门的部位的组织进行治疗。在缝合器的引入和行进过程中，柔性轴适应肠的弯曲。
尽管该解决方案允许更深地将外科器械引入到患者体内，但其需要适应弯曲的内窥镜进入路径并且基本上不响应于致动而发生变形或者位移的可弯曲变形的致动运动传递装置。为了满足这些要求，已经提出了使用柔性旋转杆，其可旋转地安装在可弯曲但扭转刚性的护套中，该护套使得能够在致动过程中在一定的限度内保持缝钉紧固装置的位置，并能够防止缝钉紧固装置本身响应于旋转杆的旋转致动运动而自旋。除了笨重并具有大的弯曲半径之外，这些扭转刚性护套需要与缝钉紧固组件刚性连接，从而还增加外科缝合器的纵向尺寸。这导致外科器械的可操作性降低。
发明内容
考虑到现有技术的外科器械以及它们的致动运动传递装置的缺点，本发明的目的在于提供用于外科器械例如内窥镜缝合器械的致动运动传递装置，其改善并稳定了在致动过程中器械的定位，同时消除了笨重的刚性护套及其连接装置。
在本发明的主要目的的总范围内，本发明的另一个的目的在于提供外科器械，特别是装备有本发明的致动运动传递装置的外科缝合装置。
通过一种用于外科器械(例如外科缝合装置)的致动运动传递装置解决了这些和其他问题，该外科器械包括：
用于引入到患者体内的组织操作部分(例如缝钉紧固组件)，和
具有致动机构的手柄部分，该致动机构能够产生致动运动以便致动组织操作部分，
其中，致动传递装置能够将手柄部分的致动机构与组织操作部分连接，并且包括至少一对旋转杆，所述旋转杆用于将来自致动机构的旋转致动运动传递到组织操作部分，
其中，致动传递装置包括同步部件，其将所述一对旋转杆的两个旋转杆的运动相关联，使它们以大致相同的速度反向旋转。
本发明的目的也通过外科器械(例如外科缝合装置)来实现，该器械包括：
用于引入到患者体内的组织操作部分(例如缝钉紧固组件)，和
具有致动机构的手柄部分，该致动机构能够产生致动运动以便致动组织操作部分，并且包括至少一对旋转输出构件；
致动传递装置，该致动传递装置将手柄部分的致动机构与组织操作部分连接，并包括至少一对旋转杆，所述旋转杆用于将来自所述一对旋转输出构件的旋转致动运动传递到组织操作部分，
其中，致动机构包括同步部件，这些同步部件将所述一对旋转输出构件的两个旋转输出构件的运动相关联，使它们以大致相同的速度反向旋转。
本发明的目的还通过一种操作外科器械(例如外科缝合装置)的方法来实现，该外科器械包括：
用于引入到患者体内的组织操作部分(例如缝钉紧固组件)，和
具有致动机构的手柄部分，该致动机构能够产生致动运动以便致动组织操作部分，
致动传递装置，该致动传递装置将手柄部分的致动机构与组织操作部分连接，并包括至少一对旋转杆，所述旋转杆用于将来自致动机构的旋转致动运动传递到组织操作部分，
其中，所述方法包括使所述一对旋转杆的两个旋转杆以同步的方式运动，从而它们以大致相同的速度反向旋转。
由于两个旋转杆沿着相反方向并以大致相同(优选完全相同)的旋转速度同步运动，作用于组织操作部分上的扭矩得到平衡，从而防止了不需要的旋转并消除了笨重的扭转刚性结构。
根据本发明的一个方面，外科器械是外科缝合器械，包括：
位于器械的远端区域中的缝钉紧固组件，该缝钉紧固组件包括弧形钉仓装置和与该钉仓装置相对的弧形砧座，该钉仓装置包括至少一个开放的弧形缝钉排且具有凹侧和凸侧，该砧座具有缝钉成形面并能够与钉仓装置协作以使从钉仓装置离开的缝钉的末端成形，
设置在缝钉紧固组件处的砧座运动装置，其能够使砧座相对于钉仓装置从用于将组织放置在其之间的间隔位置运动到用于夹紧组织的关闭位置，
设置在缝钉紧固组件处的缝钉驱动装置，其能够向着砧座驱动缝钉离开钉仓装置，
设置在器械的近端区域中的手柄部分，该手柄部分可操作地与缝钉紧固组件连接，该手柄部分容纳致动机构，该致动机构能够产生一对第一旋转输出构件的砧座致动运动和一对第二旋转输出构件的缝钉致动运动；
两个第一旋转杆，其与所述两个第一旋转输出构件和砧座运动装置连接，以便将所述砧座致动运动传递到所述砧座运动装置上；
两个第二旋转杆，其与所述两个第二旋转输出构件和缝钉驱动装置连接，以便将所述缝钉致动运动传递到所述缝钉驱动装置上，
其中，同步部件包括：
第一同步部件，其将所述两个第一旋转输出构件的运动相关联，使它们以大致相同的速度反向旋转，
第二同步部件，其将所述两个第二旋转输出构件的运动相关联，使它们以大致相同的速度反向旋转。
根据本发明的一种实施方式，同步部件包括齿轮机构，优选是与两个相对设置的平行传动小齿轮啮合的双面的驱动端面齿轮或者锥齿轮，所述小齿轮在双面驱动齿轮旋转时以相同的速度反向旋转。
在本说明书中，术语“缝钉”被用作非常一般的意义。它包括金属缝钉或者夹子，而且还包括由合成材料制成的外科紧固件及类似紧固件。合成紧固件通常具有保持在砧座处的对应件(保持构件)。在这个意义上，术语“砧座”和“缝钉成形面”也具有广泛含义，在两部分合成材料紧固件的情况下，包括像砧座那样的工具及其用于固定保持构件的表面，以及类似装置。
附图说明
通过附图及其描述，本发明的这些和其他细节和优点将是显而易见的，所述附图及其描述示出本发明的实施方式并与上面给出的一般描述以及下面给出的本发明的详细描述一道用于解释本发明的原理。
图1是根据本发明的一种实施方式的外科缝合器械的等轴测图；
图2是图1中示出的器械的组织操作部分的近侧等轴测图；
图3是图1中示出的器械的组织操作部分的远侧等轴测图；
图4是处于完全关闭构型中的组织操作部分的侧视图；
图5是处于完全打开构型中的组织操作部分的侧视图；
图6是组织操作部分的侧视图，其中外壳被除去以便显示一对砧座运动螺杆；
图7是组织操作部分的侧视图，其中外壳被除去以便显示一对缝钉驱动螺杆；
图8是组织操作部分的近侧端视图，示出了两对致动运动传递装置的输入扭矩的方向；
图9是图1的外科缝合器械的打开的手柄部分和内部致动机构的侧视图；
图10是图1的外科缝合器械的打开的手柄部分和内部致动机构的从侧向看的等轴测图；
图11和12是根据本发明的外科缝合器械的旋转运动同步装置的两种实施方式的示意图；
图13是根据本发明的装置和器械的细节的替代实施方式的示意图。
具体实施方式
转向附图，图1是根据本发明的一种实施方式的外科缝合器械1的总体等轴测图。缝合器械1包括在其远端区域中的缝钉紧固组件2和在其近端区域中的手柄3。手柄3和缝钉紧固组件2通过细长刚性或者优选为柔性的插入轴连接，该插入轴例如为用作柔性骨干并为器械1提供结构强度的内窥镜4。第一对细长致动运动传递装置5、5’和第二对细长致动运动传递装置6、6’将容纳在手柄3中的致动机构7与砧座运动装置8连接并与缝钉紧固组件2的缝钉驱动装置9连接，以便将来自致动机构7的致动运动传递到缝钉紧固组件2，从而执行缝合器械1的功能。
缝钉紧固组件2的主要组成部件是钉仓装置10和砧座11，所述钉仓装置包含一些开放的弧形缝钉排以及刀或切割边缘，所述砧座具有缝钉成形面，并能够与钉仓装置10协作，当缝合器械1被“击发”时使从钉仓装置排出的缝钉末端成形。
砧座11可相对于钉仓装置10以平行关系运动，即沿着与缝钉紧固组件2的纵向轴线X平行的方向运动。在图5和6的视图中，砧座11与钉仓装置10间隔开，而在图4和7中，同一砧座11已经完全向着钉仓装置10运动。如同已经解释的那样，用于使砧座11相对于钉仓装置10运动的机构及其构件总的被称为(砧座)运动装置8，而用于排出缝钉的机构和构件总的被称为(缝钉)驱动装置9。
砧座11包括两个向近侧延伸的平行臂14，它们优选设置在砧座11的两个相对的侧端15上。每个臂14以被导引的方式可滑动地容纳在优选在钉仓装置10的两个相对侧端附近形成的两个导引座16中的一个之中，以便强制地限定砧座11相对于钉仓装置10的运动轨迹。
运动装置8包括第一对两个运动螺杆17、17’，其中的每个都以自由旋转但轴向静止的方式容纳在被限定在缝钉紧固组件2的近侧底座结构18中的相对的座中并分别与两个砧座臂14中的一个轴向对准。运动螺杆17、17’的向远侧延伸的螺纹轴配合在沿纵向延伸到臂14内部的相应螺纹孔中，使运动螺杆17、17’的旋转引起砧座14与砧座11一起沿着运动螺杆17、17’相对于钉仓装置10平移。
类似地，缝钉驱动装置9包括第一对两个运动螺杆19、19’，其中的每个都以自由旋转但轴向静止的方式容纳在被限定在缝钉紧固组件2的近侧底座结构18中的相对的座中并分别与在推进底座20中限定的相应螺纹孔螺纹接合，使驱动螺杆19、19’的旋转引起推进底座20沿着驱动螺杆19、19’(沿着缝钉紧固组件2的纵向X)相对于底座结构18、砧座11和含有缝钉的钉仓21平移。如同已知的那样，直接或间接作用于缝钉上并优选也作用于刀(在附图中未显示或隐藏)上的推进底座20的运动引起缝钉排出以及引起刀向着并抵靠砧座的缝钉形成表面行进。
为了这个目的，推进底座20可(通过中间部件)支撑推进平台，多个推进指从该推进平台纵向延伸出。每个推进指支撑缝钉，使缝钉的尖锐末端都朝着远侧方向对准。推进指和相关的缝钉在形成于钉仓21的外壳中的单独的槽中被导引。此外，中间部件支撑优选为拱形的刀，该刀具有凹侧、与凹侧相对的凸侧以及远侧切割边缘。
设置在砧座11上的缝钉成形面25优选由金属制成，并包括例如三排与缝钉26的尖锐末端对准的缝钉成形凹陷。此外，在砧座11的近侧端面中设有刀凹陷(在图中被隐藏)，该刀凹陷与刀的切割边缘对准并优选填充有塑料材料，塑料材料用作切割垫块(cuttingblock)但可以被刀切穿以指示完全切穿组织的执行情况。
根据一种优选实施方式，第一对的两个运动螺杆17、17’设置在缝钉紧固组件的两个相对的侧端上，并且第二对的两个驱动螺杆19、19’并排设置在运动螺杆17、17’之间的中央位置，并与运动螺杆17、17’一起限定相对于弧形缝钉紧固组件2的纵向中心平面的对称螺杆模式。
由于设置了将在下面描述的同步部件，该对运动螺杆17、17’只可以相同的旋转速度并沿相反的方向旋转，从而在砧座靠近运动期间平衡并补偿作用于缝钉紧固组件2上的扭转输入和旋转惯性效应。
类似地，设有同步部件，它们也将所述一对驱动螺杆19、19’限制成以相同的旋转速度并沿着相反方向旋转，从而平衡并补偿由于器械1的击发而作用于缝钉紧固组件2上的扭转输入和旋转惯性效应。
在示例性实施方式中，刀驱动装置有利地与缝钉驱动装置9连接，但作为替代，可提供不同的刀驱动装置，其可由两个螺杆驱动器驱动，所述两个螺杆驱动器同样优选被限制为以相同的旋转速度但沿相反方向旋转以便平衡在切割过程中作用在缝钉紧固组件上的扭转和旋转惯性效应。
所述第一对运动传递装置5、5’包括一对旋转杆12(图10)，其中的每个旋转杆优选可旋转地安装在柔性护套22中。在该实施方式中，旋转杆12始终是单个柔性结构。不同设计，例如包括柔性连接的短刚性构件的结构或者紧密缠绕的螺旋结构也是可想到的。在它们的远端处，两个旋转杆12的每个分别以扭转传递的方式通过连接器连接到两个(砧座)运动螺杆17、17’的每个的近端上。
以类似的方式，所述第二对运动传递装置6、6’也包括一对旋转杆13(图10)，其中的每个优选可旋转地安装在柔性护套23中。在该实施方式中，旋转杆13始终是单个柔性结构。不同设计，例如包括柔性连接的短刚性构件的结构或者紧密缠绕的螺旋结构也是可想到的。在它们的远端处，两个旋转杆13的每个分别以扭转传递的方式通过连接器连接到两个(缝钉)运动螺杆19、19’的每个的近端上。
上面提到的同步部件直接或者间接作用于第一旋转杆12和第二旋转杆13这两对中的每一对之上，使得第一旋转杆在它们传递砧座向近侧致动运动时以相同的旋转速度并沿相反方向旋转，以及使得第二旋转杆13在它们将来自手柄致动机构的缝钉驱动致动运动传递到缝钉紧固组件2时以相同的速度并沿相反的方向旋转。
在图1中示出的实施方式中，两对运动传递装置5、5’、6、6’通过多个间隔开的固定器24与插入轴(内窥镜4)连接。每个固定器具有用于将具有圆形构造的固定器锁定在插入轴4的周围的锁和用于容纳运动传递装置5、5’、6、6’的凹槽。根据一种实施方式，锁包括燕尾状的突起和与其配合的切口，以便实现固定器的可逆形状锁定。
作为替代，运动传递装置可部分或者全部容纳在柔性或者刚性插入轴之内。
柔性插入轴4与缝钉紧固组件2或者手柄3之间的机械连接可全部通过固定器24和成对的致动运动传递装置5、5’、6、6’来实现。特别是在手柄3的区域中，不将手柄3与内窥镜(用作插入轴)刚性连接的这种设计的灵活性会是有利的。在缝合器械1的远端区域中，内窥镜4可例如通过粘结的方式附加地固定到缝钉紧固组件2的钉仓装置10上。
图9和10示出了手柄3的内部致动机构7。手柄3包括齿轮外壳28和被设计成置于操作人员的手掌中的把手27。
砧座致动构件29是(砧座)运动装置的一部分。当砧座致动构件29(优选为可旋转地安装的杆)向着把手27运动时，齿条30朝着远侧方向移动并通过中间齿轮48使齿轮31旋转。在该实施方式中，齿轮31为具有在其每侧上形成的两个相对的齿排的双面的端面齿轮或者锥齿轮。相对的齿排的每一排与两个平行的小齿轮32、32’之一啮合，从而将旋转轴线的方向改变90°并将两个小齿轮32、32’的运动限制为以相同的速度反向旋转。小齿轮32、32’与一对第一旋转输出构件(旋转杆部分)33可旋转地连接，该对第一旋转输出构件由轴承34支撑，并且可旋转地连接或者可拆卸地且可旋转连接到第一旋转杆12的近端以便引导砧座运动。
因此，当按压砧座致动构件29时，引起第一运动传递装置5、5’的旋转杆12围绕它们的纵向轴线沿着相反方向以相同速度的同步旋转运动。由于由齿轮31和小齿轮32、32’提供的传动比，这种同步的反向旋转运动相当快。
以类似的方式，当抵抗弹簧36的力按压可旋转地安装的缝钉致动构件35(“击发”器械)时，齿条37朝着远侧方向移动并驱动与两个小齿轮39、39’啮合的双面的端面齿轮或者锥齿轮，从而将旋转轴线的方向改变90°并将两个小齿轮39、39’的运动限制为以相同的速度反向旋转。小齿轮39、39’与一对第二旋转输出构件(旋转杆部分)40可旋转地连接(在适于传递旋转的连接的意义上)，该对第二旋转输出构件由轴承41支撑，并且可旋转地连接或可拆卸地且可旋转地连接到第二旋转杆13的近端以便引导缝钉驱动装置。
为了在缝钉已经被施加之后释放(回缩)缝钉驱动装置，释放按钮42必须抵抗由弹簧43施加的力而被按压。在“击发”之后和按压释放按钮42之前，扣件44与缝钉驱动致动机构的突起接合并将齿条37保持在远侧位置。此外，在缝钉致动构件35被按压下，齿条30也由该机构保持向前并保持就位。按压释放按钮42使扣件44升高，释放缝钉驱动致动机构的突起，从而通过弹簧36的作用使齿条37返回到其初始的近侧位置。
根据一种实施方式，安全特征件(未详细示出)包括销，该销由部件45保持，直到当砧座致动构件29被致动时部件45被推离通道。这确保了缝钉致动构件35不能在砧座致动构件29之前被使用。
如同本领域技术人员立即就能理解的那样，与两个平行的小齿轮(图10和11)啮合的双侧端面齿轮或者锥齿轮提供了上面提到的同步部件，这些同步部件分别使成对的旋转杆以及成对的驱动螺杆和运动螺杆的运动同步，从而使它们沿着相反方向以相同旋转速度旋转，由此得到在致动过程作用于缝钉紧固组件上的扭转输入和旋转惯性的平衡。
图12示出了这样的同步部件的其他可能实施方式之一，该实施方式包括与具有相同直径和齿数的一对从动小齿轮47、47’的第一从动小齿轮47啮合的传动(正)齿轮46。第一小齿轮47进而与第二小齿轮47’啮合，当传动正齿轮47旋转时，使所述一对从动小齿轮47、47’以相同的速度但沿着相反方向旋转。当然，发明人并不是想将本发明的范围限制到已作为有利但不是限制性的例子被描述的同步部件的这样的特定实施方式。
在图示的实施方式中，这样的同步部件设置在位于器械的手柄中的致动机构中。类似地，同步部件可设置在致动运动传递装置5、5’、6、6’处并作用于成对的旋转杆12、13上，和/或它们可设置在缝钉紧固组件2上或者与其一体化形成并直接作用于成对的砧座运动螺杆17、17’和/或缝钉驱动螺杆19、19’上。
图4和5与图6和7类似，但钉仓装置10已经装上外壳48而变完整。在该实施方式中，外壳48包括由医疗级塑料材料制成的注射成型件。在图5和6所示的构型中，砧座已经向远侧运动到间隔位置，即运动到钉仓装置10与砧座11的缝钉成形面25之间的距离很大的位置中。这与图6中的(砧座)运动螺杆17、17’的很大暴露区域对应。在该间隔位置中，患者待切除的组织可被拉到砧座11的缝钉成形面25与钉仓装置10之间。此后，运动装置的砧座致动构件29被压向把手29，引起两个第一旋转杆12和两个砧座运动螺杆17、17’以相同的速度反向旋转运动，导致砧座11朝着近侧方向移动，从而平衡并补偿作用于位置保持固定的缝钉紧固组件2上的输入扭矩和旋转惯性力。以这种方式，砧座11到达关闭位置并且组织被夹紧。
手术的下一步骤在图4和7中显示(在图7中外壳48被除去)。如所解释的那样，砧座11已经运动到关闭位置，这可从两个砧座运动螺杆17、17’的很小暴露区域明显地看出。此外，缝钉致动构件35已经被压下，引起两个第二旋转杆13和两个缝钉螺杆19、19’以相同的速度反向旋转运动，导致推进底座20朝着远侧方向纵向运动，从而平衡并补偿作用于位置保持固定的缝钉紧固组件2上的输入扭矩和旋转惯性力。
推进底座20(和，如果设有的话，中间部件，推进平台、推进指)使缝钉26和刀运动，其中，刀的切割边缘沿着缝钉26的尖锐末端。以这种方式，缝钉被驱动离开钉仓抵靠到缝钉成形面25上，按照已知方式使缝钉的尖锐末端成形。
在组织已经被缝合之后，该组织被刀切割并切除。以该方式，保留在患者中的组织在刀的凸侧上由至少一排、优选两排缝钉安全地缝合，立即止血，而从患者体内除去的组织部分由至少一排缝钉缝合并保持在一起。缝合后，按压释放按钮24，使齿条37和致动构件35借助由弹簧36施加的力返回到它们的初始位置。另外，这引起运动装置的反向运动，增加了砧座11与钉仓装置10之间的距离，以便释放被夹组织并能够将缝合器械1从患者中除去。在除去过程中，被切除的组织部分可能遗留在缝钉紧固组件2中。
虽然已经通过描述一些实施方式示出了本发明，同时相当详细地描述的本发明的示例性实施方式，但应当注意这并不是想以任何方式将所附的权利要求书的范围限制得如此详细。其他优点和修改对本领域技术人员来说是显而易见的。
例如，成对的反向旋转运动输出构件、旋转杆、砧座运动螺杆和/或缝钉驱动螺杆不一定必须具体实施为两个平行间隔开的构件，而是可以包括两个共轴设置(例如一个插入到另一个中)的反向旋转构件、杆或螺杆或者螺旋轴，如图13中示意示出的那样。

Claims (10)

1.一种外科器械(1)，该器械包括：
用于引入到患者体内的组织操作部分(2)；
具有致动机构(7)的手柄部分(3)，该致动机构能够产生致动运动，以便致动所述组织操作部分(2)，该致动机构包括至少一对旋转输出构件(33；40)；
致动运动传递装置(5、5’；6、6’)，该致动运动传递装置将所述手柄部分(3)的致动机构(7)与组织操作部分(2)连接，并且包括至少一对旋转杆(12；13)，所述旋转杆用于将来自所述一对旋转输出构件(33；40)的旋转致动运动传递到所述组织操作部分(2)，
其中，所述致动机构(7)包括同步部件(31、32、32’；38、39、39’)，这些同步部件将所述一对旋转输出构件的两个旋转输出构件(33；40)的运动相关联，使它们以大致相同的速度反向旋转。
2.根据权利要求1所述的外科器械(1)，包括：
位于所述器械(1)的远端区域中的缝钉紧固组件(2)，该缝钉紧固组件包括钉仓装置(10)和与该钉仓装置(10)相对的砧座(11)，该钉仓装置包括至少一排缝钉(26)，该砧座具有缝钉成形面(25)且能够与所述钉仓装置(10)协作以使从所述钉仓装置(10)离开的缝钉(26)的末端成形，
设置在所述缝钉紧固组件(2)处的砧座运动装置(8)，该砧座运动装置能够使所述砧座(11)相对于所述钉仓装置(10)从用于将组织放置在所述砧座和所述钉仓装置之间的间隔位置运动到用于夹紧组织的关闭位置，
设置在所述缝钉紧固组件(2)处的缝钉驱动装置(9)，该缝钉驱动装置能够向着所述砧座(11)驱动所述缝钉(26)离开所述钉仓装置(10)，
设置在所述器械(1)的近端区域中的手柄部分(3)，该手柄部分可操作地与所述缝钉紧固组件(2)连接，所述手柄部分(3)容纳所述致动机构(7)，所述致动机构能够产生一对第一旋转输出构件(33)的砧座致动运动和一对第二旋转输出构件(40)的缝钉致动运动；
两个第一旋转杆(12)，其与所述一对第一旋转输出构件(33)和所述砧座运动装置(8)连接，以便将所述砧座致动运动传递到所述砧座运动装置上；
两个第二旋转杆(13)，其与所述一对第二旋转输出构件(40)和所述缝钉驱动装置(9)连接，以便将所述缝钉致动运动传递到所述缝钉驱动装置上，
其中，所述同步部件(31、32、32’；38、39、39’)包括：
第一同步部件(31、32、32’)，其将所述一对第一旋转输出构件(33)的运动相关联，使它们以大致相同的速度反向旋转，
第二同步部件(38、39、39’)，其将所述一对第二旋转输出构件(40)的运动相关联，使它们以大致相同的速度反向旋转。
3.根据权利要求1或2所述的外科器械，其中，所述同步部件(31、32、32’；38、39、39’)包括齿轮机构。
4.根据权利要求2所述的外科器械，其中，所述砧座运动装置(8)包括：
从所述砧座(11)向近侧延伸的两个平行臂(14)，所述两个平行臂可滑动地容纳在所述钉仓装置(10)的两个相应的导引座(16)中；
第一对运动螺杆(17、17’)，它们以自由旋转但轴向静止的方式容纳在所述缝钉紧固组件(2)的近侧底座结构(18)中，其中，所述运动螺杆(17、17’)的向远侧延伸的螺纹轴配合在沿所述砧座的臂(14)内部形成的相应螺纹孔中，使所述运动螺杆(17、17’)的旋转引起所述砧座(11)相对于所述钉仓装置(10)平移，
所述第一对运动螺杆(17、17’)的每一个分别刚性旋转地连接到所述两个第一旋转杆(12)中的一个之上。
5.根据权利要求4所述的外科器械，其中，所述缝钉驱动装置(9)包括：
第二对两个驱动螺杆(19、19’)，这两个驱动螺杆以自由旋转但轴向静止的方式容纳在所述缝钉紧固组件(2)的近侧底座结构(18)中，并且与被限定在推进底座(20)中的相应螺纹孔螺纹接合，使所述驱动螺杆(19、19’)的旋转引起推进底座(20)相对于砧座(11)和含有缝钉的钉仓(21)平移，以向着砧座排出缝钉，
所述两个驱动螺杆(19、19’)的每个分别旋转且刚性地连接到所述两个第二旋转杆(13)的每个上。
6.根据权利要求5所述的外科器械，其中，所述第一对运动螺杆(17、17’)设置在所述缝钉紧固组件(2)的两个相对的侧端上，并且所述两个驱动螺杆(19、19’)并排设置在所述运动螺杆(17、17’)之间的中央位置，并与所述运动螺杆(17、17’)一起限定相对于所述缝钉紧固组件(2)的纵向中心平面的对称螺杆模式，其中，所述缝钉紧固组件(2)是弧形的。
7.根据权利要求1所述的外科器械(1)，其中，所述旋转杆(12、13)容纳在柔性保护护套(22、23)的内部。
8.根据权利要求1所述的外科器械(1)，包括柔性细长插入轴(4)以及将所述致动运动传递装置(5、5’、6、6’)与所述插入轴(4)连接的连接器(24)。
9.根据权利要求2所述的外科器械(1)，包括：
刀，该刀设置在所述钉仓装置(10)内部并沿着至少一排缝钉的一侧放置；
刀致动装置，该刀致动装置能够使所述刀向着所述砧座运动，以切割被夹紧在所述砧座与所述钉仓装置之间的组织，
所述刀致动装置与所述缝钉驱动装置(9)连接。
10.一种用于外科器械(1)的致动运动传递装置(5、5’、6、6’)，该外科器械包括：
用于引入到患者体内的组织操作部分(2)，和
具有致动机构(7)的手柄部分(3)，所述致动机构能够产生致动运动以便致动所述组织操作部分(2)，
其中，所述致动运动传递装置(5、5’、6、6’)能够将所述手柄部分(3)的致动机构(7)与所述组织操作部分(2)连接，并包括至少一对旋转杆(12；13)，所述至少一对旋转杆用于将来自所述致动机构(7)的旋转致动运动传递到所述组织操作部分(2)，
其中，所述致动运动传递装置(5、5’、6、6’)包括同步部件(31、32、32’；38、39、39’)，所述同步部件将所述一对旋转杆的两个旋转杆(12；13)的运动相关联，使它们以大致相同的速度反向旋转。
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CN101511281A (zh) 2009-08-19
JP2010502324A (ja) 2010-01-28
EP1897501A1 (en) 2008-03-12
EP1897501B1 (en) 2009-08-26
US20100038403A1 (en) 2010-02-18
US8499994B2 (en) 2013-08-06
WO2008028700A1 (en) 2008-03-13
ATE440549T1 (de) 2009-09-15
DE602006008783D1 (de) 2009-10-08

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