CN101522120A - 管轴器械 - Google Patents

管轴器械 Download PDF

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CN101522120A
CN101522120A CNA2007800363963A CN200780036396A CN101522120A CN 101522120 A CN101522120 A CN 101522120A CN A2007800363963 A CNA2007800363963 A CN A2007800363963A CN 200780036396 A CN200780036396 A CN 200780036396A CN 101522120 A CN101522120 A CN 101522120A
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tubular shaft
blade
shaft instrument
nozzle component
tissue
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CN101522120B (zh
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迪特尔·哈夫纳
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Erbe Elecktromedizin GmbH
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Erbe Elecktromedizin GmbH
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    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
    • A61B18/1447—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod wherein sliding surfaces cause opening/closing of the end effectors
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    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical 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
    • A61B17/07207—Surgical 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
    • A—HUMAN NECESSITIES
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
    • A61B2017/00473—Distal part, e.g. tip or head
    • A—HUMAN NECESSITIES
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical 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
    • A61B2017/07214—Stapler heads
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical 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
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B2018/1452—Probes having pivoting end effectors, e.g. forceps including means for cutting
    • A61B2018/1457—Probes having pivoting end effectors, e.g. forceps including means for cutting having opposing blades cutting tissue grasped by the jaws, i.e. combined scissors and pliers

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Abstract

本申请涉及一种用于分离组织的管轴器械。在常规管轴器械中，组织的整齐分离成为问题。在实际当中，通常情况是例如刀片磨损导致组织被运动力而非刀片的作用切断。切割边缘也相应地变形。本发明涉及一种确保明显更可靠、更整齐地分离组织的管轴器械。为此，与常规切割装置相比，刀片并不是穿过所固定的组织移位而是在组织上面滑动直至确定完全分离。

Description

管轴器械
技术领域
本发明涉及一种如权利要求1的前序部分所述的管轴器械。
背景技术
在现代医学中，通常力图使对完整组织的损伤保持到最小程度。因此，当情况允许时，微创手术常常是用来进行手术介入的优选方法。对组织的小切口和微创伤使得患者术后痛感低并使患者得以快速恢复和快速活动。这同样适用于在腹腔中实施复杂手术期间的腹腔镜手术。
这种手术以及这种手术所需要的器械给医疗器械制造商提出了特殊的挑战，因为大多数手术步骤是在非常有限的空间中进行的而且没有直接的视觉接触。因此所使用的医疗器械必须不仅能够在最小的空间中操作而且功能必需非常可靠使得无需视觉监控。这种器械优选构造成使得即使没有视觉接触实施手术的外科医生仍然一直获得使他能够对手术进展做出结论的反馈。
这尤其适用于所有适于分离组织的器械。由于具有敞开刀片的手术刀——如果有刀片的话——不适合用于微创手术，(参见DE 44 44 166A1)，因此常常采用剪式或钳式器械，这些器械一方面在插入时遮盖刀片另一方面行使保持待切割的组织的功能。
同样证明在微创手术中有利的是为了防止流血在分离之前进行组织凝结。从现有技术已知提供具有一体结合的凝结装置和切割装置的器械。此处在第一步骤中夹紧固定平面上的组织并使其凝结。在第二步骤中引导具有大体垂直于固定平面在两侧组织上方突出的刀片的手术刀穿过组织。该移位大体平行于固定平面进行。该现有技术出现于例如US 231 99 870 A1、US 6 679 882 B1、EP 717 960 B1、US 221 88 294 A1以及WO 2005/00435 A1。
另一方面，从US 6 626 901 B1已知使类似于比萨饼切刀的刀片而非手术刀在组织上面滚动，从而进行剖切。而最后提及的方法非常复杂并且对器械的设计有特殊要求，另一些方法具有许多的缺点。因此所夹持的组织基本上由于手术刀的移位而被推出嘴部件而所保持的组织中仅部分被分离。在分离过程中，组织上施加有大的单点载荷，进而意味着当刀片磨损时无法保证整齐分离。组织受到压挤直至实际撕裂。存在切割边缘将延伸很远而穿过凝结区域并且已经实现的血管密封将再次被撕开的危险。由于刀片或刀具仅在一点上置于组织上，所以刀具磨损快。
发明内容
从这样的现有技术出发，本发明的目的是提供一种用于分离组织的管轴器械，该管轴器械易于操作并确保在对周围组织的损伤最小的情况下进行可靠的分离。
该目的由根据本权利要求1所述的管轴器械来实现。
具体地，在这样一种用于分离组织的具体为电手术管轴器械的管轴器械的情况下该目的得以实现，该管轴器械包括：
管轴；
第一和第二嘴部件，其具有用于将组织固定在固定平面中的夹紧表面，由此所述嘴部件中的至少一个结合到管轴；
切割装置，其具有用于切割所固定的组织的刀片，能够通过致动装置使切割装置沿切割方向移位，
由此，
刀片以能够大体平行于固定平面移位的方式被引导并由预加载装置预加载成在切割过程中抵靠固定平面。
因此本发明的基本理念是不使刀片穿过固定平面进而穿过组织移位，而是通过引导装置引导所述刀片在固定平面上方或下方移位，由此通过预加载装置将刀片按压成抵靠固定平面。因此刀片以限定的接触压力在组织上进而在固定平面上滑动，优选前后移动，直至组织完全分离。因此，确保组织由于机械压力而被分离并且不被撕开。预加载装置的力基本垂直于固定平面作用。
优选地，预加载装置包括具有弯度的弹性引线，所述线基本刚性地结合到刀片，并且在管轴中以沿固定平面的方向相对于管轴对刀片进行预加载的方式被引导。因此可以通过引线形式的弹性致动元件产生基本垂直于固定平面作用的所述力。施加的力相对于引线在其中被引导的管轴作用。因此在最简单的情况下，引线具有弯折。至少为了力的反作用或支撑，弹性引线使用管轴的一部分。
优选地，预加载装置包括弯折部，弯折部设置在引线中使得在刀片被朝前推动时弯折部向管轴的远端靠近。因此弯折部能够将由刀片压靠切割平面所引起的力传递给管轴。对管轴器械的使用者而言，引线仅用来使刀片在切割装置内移动。在最好的情况下，由于管轴吸收接触压力，因此没有作用于使用者的旋转力。为了对引线进行功能性布置，弯折部和弯曲部基本位于与固定平面垂直的切割平面中。当然，还能够用具有所述垂直于固定平面的弹力性能的导轨替代所述引导装置。同样在这种情况下，可以通过轨道的形状产生预加载。
优选地，两个夹紧部中的至少一个包括沿切割方向延伸的开口，这样形成刀片引导装置。大体椭圆的夹紧部可包括成对形成的侧部件，侧部件具有沿切割方向引导切割装置的通道。
优选地，刀片包括基本平行于固定平面延伸的至少一个部分。还能够想到切割装置具有多个刀片，由此多个刀片部分平行于固定平面延伸。
优选地，刀片弯曲成至少部分是凸形的。因此刀片设计成使得在刀片沿切割方向移位的过程中所述刀片在预加载在固定平面中的组织上面移位。如果待分离的组织很坚韧以致于不能够一刀就被分离，那么这样尤其有利。在这种情况下，刀片的轮廓起类似坡道的作用，其引导刀片进入固定平面上方的位置。其中刀片在组织上面滑动直至所述组织完全分离。预加载装置提供必要的接触压力。
优选地，管轴器械包括特别是坡道形状的刀片引导装置，刀片引导装置设计并设置成其使得刀片通过沿切割方向运动而从离开固定平面一定距离的起始位置到固定平面上。因此优选地，刀片在离开固定平面以及嘴部件的夹紧表面一定距离的起始位置处受到支撑。只有当组织固定于夹紧表面之间时刀片才通过平行于固定平面移位而接近固定平面和夹紧表面。在起始位置刀片被遮挡，能够完好无损地夹取组织。特别是如果管轴器械为具有用于使所保持的组织凝结的电极的电手术器械，则能够防止过早地切伤组织。
优选地，刀片引导装置设计成使刀片能够进入靠近嘴部件的支轴的起始位置，具体地进入管轴中。
优选地，夹紧表面具有用于向所保持的组织提供高频凝结电流的电极。因此能够在切割之前或在切割过程中通过高频凝结电流烧灼所保持的组织，这样确保在切割之前或在切割过程中可靠地封闭血管。
优选地，刀片至少部分带有微齿。
从其它从属权利要求形成其它有利的实施方式。
附图说明
下面将基于将通过附图更加详细地说明的实施方式来描述本发明。附图中：
图1示出用于分离组织的管轴器械；
图2示出图1的管轴器械的工具头，其中工具头包括第一嘴部件和第二嘴部件；
图3示出第二嘴部件的立体侧视图；
图4示出第二嘴部件的俯视图；
图5示出第二嘴部件的侧视图；
图6示出第一嘴部件的立体侧视图；
图7示出第一嘴部件的俯视图；
图8示出第一嘴部件的侧视图；
图9示出两种不同铰接装置的示意图；
图10示出具有切割装置的图2的工具头的剖视图；
图11示出切割装置的示意图；
图12示出位于管轴器械的管轴中的切割装置的示意图；
图13至图15示出切割刀片的三种实施方式；
图16示出切口监控装置的框图；
图17示出处于张开位置的工具头的立体图；
图18示出处于闭合位置的图17的工具头；
图19示出具有张力带的第二嘴部件；以及
图20示出管轴器械的示意性侧视图。
具体实施方式
在以下描述中相同的附图标记用于同样的部件和以同种方式发生效用的部件。
图1提供了根据本发明的管轴器械的实施方式的大致概观。其示出了管轴器械的三个功能性部件：手柄110、稍长的管轴24以及设置在管轴24的远端上的工具头30。工具头30提供管轴器械的实际功能。工具头用于切割和/或凝结组织。手柄110控制工具头30的运动。具体地，可以通过手柄110使嘴部件10、10’(参见图2)闭合和张开以便固定、凝结以及切割组织。
图2示出了根据本发明的工具头30的实施方式，工具头30包括第一嘴部件10和第二嘴部件10’。第一嘴部件10是椭圆体，在其面向管轴24的侧部上具有刚性接合到所述管轴24的适配器25。第二嘴部件10’通过铰接装置40附连到第一嘴部件10并且能够从用于抓持组织的张开位置进入用于固定组织的闭合位置。铰接装置40设计成使得虚拟支轴1或枢轴位于第一嘴部件10和第二嘴部件10’外部。因此，与用于这种器械的常规铰接装置40不同，支轴1不是在管轴24中或嘴部件10、10’相接合的区域中定位地靠近管轴24的纵轴线。示出的铰接装置40的机构表现为使得虚拟支轴1形成在管轴器械的面向第二嘴部件10’的一侧上方。
在图9的示意图的基础上示出了这种重新定位的支轴1的具体优点。左上角中示出的是常规铰接装置，其支轴1大体定位在嘴部件10和10’的纵轴线上。在张开位置，第二嘴部件10’的末端16’相对于第一嘴部件10的末端16朝后偏。然而，图9的另外两幅图中示意性地示出的根据本发明的铰接装置40却不是这种情况。其中支轴1明显位于两个椭圆形嘴部件10、10’的纵轴线上方。即使在张开状态下，在由第一嘴部件10相对于第二嘴部件10’所形成的角度开度相同的情况下，第二嘴部件10’的末端16’仍然基本定位在经过第一嘴部件10的末端16的垂直直线上或前方。因此如果第二嘴部件10’相对于第一嘴部件10张开，那么第二嘴部件10’不仅具有其间第二嘴部件10’相对于第一嘴部件10的相对布置发生改变的旋转位移而且具有向远侧定向的纵向位移，即，沿第一嘴部件10的末端16的方向平行于第一嘴部件10的纵轴线的位移。反之，在嘴部件10、10’的闭合运动过程中，第二嘴部件10’具有沿近侧方向的纵向位移。
因此，最终将位于两个嘴部件10、10’之间的组织拽入工具头30中。此外，在张开角度相同的情况下，根据本发明，第二末端16’的升距——即第一末端16与第二末端16’之间的距离——明显较大(参见图9，右侧)。在一种实施方式中，嘴部件10、10’的长度相对于第一嘴部件10的纵轴线到支轴的距离之比约为10:1。
虽然在图9中为清晰起见而通过竖直地附连在嘴部件10、10’的近端上的延伸部来实现支轴1的重新定位，但是在优选实施方式中支轴1的形成完全是虚拟的。这种虚拟设计由以下基于图3至图8进行说明的槽孔式引导系统来实现。因此，如图3所示，第二嘴部件10’在其与末端16’相反的近端上具有两个弯曲的铰接导轨41、41’。从上面看(参见图4)，这些铰接导轨41、41’基本平行地沿第二嘴部件10’的纵轴线延伸，并且间隔开以形成通道。
从侧面看(参见图5)，第二嘴部件10’具有勺状轮廓。因而，第二嘴部件10’——具体为铰接导轨41、41’——的近端各自在它们的上侧具有与第一嘴部件10接合的凹部43、43’。如图6所示，为此该嘴部件10具有两个铰接导销42、42’，每个铰接导销具有凸起结构部。在嘴部件10、10’张开和闭合运动的过程中，第一铰接导轨41的凹部43在相邻的、第一铰接导销42的凸部上面滑动，而第二铰接导轨41’的凹部43’在相邻的、第二铰接导销42’的凸部上面滑动。两个铰接导轨41、41’的凹部43、43’和铰接导销42、42’的对应部分的曲率决定了虚拟支轴1的位置。与弯曲较不明显的情况相比，在弯曲较明显的情况下支轴1更靠近工具头30。对应于较明显或较不明显的情况产生根据图9所描述的效果。
与仅具有单点连接的铰接装置相比，引导机构或铰接装置40还具有高稳定性的优点。由于凸部和凹部彼此接合，因而形成大面积的接触区域并且与具有单点连接的铰接装置相比铰接装置40能够吸收明显更多的力。为了进一步稳定铰接装置40，第一嘴部件10包括第一铰接导向轴承46和第二铰接导向轴承46’。和铰接导销42、42’相同，铰接轴承46、46’交替地附连在第一嘴部件10的侧壁的内侧。
第一铰接导向轴承46和第一导销42间隔开，使得它们在它们之间的空间中容置第一铰接导轨41。第一铰接导向轴承46具有与第一铰接导轨41的凸部44接合的凹入截面。当张开和闭合工具头30时，第一铰接导轨41由第一导销42和第一铰接导向轴承46引导着绕支轴1旋转。
同样，第二铰接导轨41’由第二导销42’和第二铰接导向轴承46’引导着绕支轴1旋转。为此，第二铰接导轨41’、第二铰接导销42’、第二铰接导向轴承46’以及第二铰接导轨41’的凸部44’与第一铰接导轨41、第一铰接导销42、第一铰接导向轴承46以及第一铰接导轨41的凸部44设计并设置成对称的。
如图10所示，在第二嘴部件10’的近端上附连有张力带27。更准确地，张力带大约附连在铰接导轨41、41’的凸部44、44’的中间。为此，铰接导轨41、41’具有用于形成对接边缘2(图5)的轮廓。优选地，该对接边缘2不是沿平行于支轴1的直线延伸而是设计成半圆形的(参见图19)。由于沿该长形的对接边缘2焊接第二嘴部件10’和张力带27，因此使力均匀地传递到张力带17中并且显著地提高了焊缝的拉伸及弯曲承载能力。在替代实施方式中，能够想到提供可比拟结果的锐角焊缝或具有多个细齿的焊缝。张力带27的平行于支轴1的宽度实质大于其厚度。这确保张力带27在第二嘴部件10’旋转时的弹性和可弯曲性。然而，张力带27在管轴器械的纵向上是相对刚性的，使得还能够产生剪切力。
通过将张力带27的第一端部附连到铰接导轨41、41’的凸部44、44’，确保了通过张力带27施加的张力总是与弯曲的铰接导轨41、41’绕支轴1的圆周运动大体相切地作用。因而确保了力不依赖于张开角度而均匀传递。张力带27的第二端部可操作地连接至手柄110，并且能够通过设置在手柄110上的控制装置移位。如已说明的，由于虚拟支轴1位于嘴部件10、10’的外部和上方，因此支轴1与张力带27的第一端部之间的距离显著大于通过普通铰接装置所得到的距离。因此所述管轴器械的实施方式具有明显较大的杠杆作用，能够借杠杆作用通过张力带27使第二嘴部件10’运动。
两个嘴部件10、10’均具有用于固定组织的夹紧表面12、12’。因而第一嘴部件10在远端部分上具有面朝上的第一夹紧表面12。第一夹紧表面12大体形成为横穿第一嘴部件10的纵轴线的凹面。当工具头30处于闭合状态时，第二嘴部件10’的凸出的第二夹紧表面12’基本平行于该第一夹紧表面12放置。
在所述实施方式中，这些夹紧表面12、12’不仅适于牢靠地固定以后待进行切割的组织，而且还形成用于凝结处理的电极。为此，夹紧表面12、12’的部分是导电的并经由印刷导体连接至同样能够通过手柄110控制的高频电源。因此，可以在切割程序之前将所夹持的组织烧灼至能够在不流血的情况下实现分离的程度。优选地，至少嘴部件10、10’的部分由陶瓷材料通过注塑模制方法制成。因此易于形成铰接装置40的引导元件，具体为铰接导轨41、41’和铰接导销42、42’。陶瓷材料的铰接装置40形成嘴部件10、10’之间——具体是它们的用于进行凝结的电极之间——的电绝缘。
在本实施方式中，实际的机械切割过程发生在凝结之后。为此，切割装置50平行于由夹紧表面12、12’所限定的固定平面x-y运动。除引线52之外，该切割装置50还包括用于分离组织的刀片51，刀片51能够通过引线52沿管轴器械的纵向(x轴)移位。
在切割过程之前，将刀片51朝管轴24向回拉足够远使得不会过早伤到组织。优选地，第一嘴部件10中的刀片处于铰接导销42、42’的层面上。以此为起点，刀片51经由一体结合在第二嘴部件10’中的坡道55(为此参见图4)进到固定平面x-y上。该坡道55位于两个铰接导轨41、41’之间。第二嘴部件10’提供了用于刀片51或刀具进行移位的刀片引导装置53。该刀片引导装置53是沿第二嘴部件10’的纵轴线延伸的椭圆开口。为了将刀片51保持成垂直于固定平面x-y，第二嘴部件10’在其中间区域中具有侧部件60、60’，侧部件以它们形成纵向延伸的通道的方式彼此平行地设置。在该通道中引导刀片51或刀具。
因此，在嘴部件10、10’闭合之后，刀片51从坡道55上面滑出其起始位置并滑入所述通道中，并且可以在所述通道中拉着远离或推着接近组织。相对于固定平面x-y对刀片51进行预加载，从而确保这种移位逐步地将组织分离。预加载装置施加垂直于固定平面x-y的力，从而挤压刀片51抵靠所述平面。该力通过引线52的弹力及其弯曲形成。如图12所示，引线52在由刀片51预加载的平面中垂直于固定平面x-y弯曲。在引线52的前部设置有弯折部56。弯折部56以这种方式一体结合在引线52中，即，使切割装置50处于完全伸出的状态即当刀片52位于嘴部件10、10’的远端时，管轴24中的弯折部同样位于所述轴的远端。弯折部56用于将由于引线52垂直于固定平面x-y弯曲而施加的力的至少一部分传递至管轴24，并且弯折部56具有相应的接触点。引线52的弯曲设置成使得如果引线的近端平行于管轴24延伸，那么未进行附连的引线52的远端向下弯曲并使刀片51至少部分地位于固定平面x-y下方。引线52以使刀片51能够通过手柄110在工具头30中来回运动的方式可操作地连接至手柄110。
就刀片51的设计而言能够想到多种变化的实施方式。以下将基于图13、图14以及图15描述这些实施方式。本发明的一种构思是刀片51具有基本平行于固定平面x-y进而平行于被固定的组织延伸的至少一部分。因此，在切割过程中，刀片51滑动穿过组织直至组织完全分离。因此与常规切割过程中不同，这样能够确保即使当刀片51变钝时组织仍将能够得以分离且不会因机械压力而压伤。切割刀片的平行于固定平面x-y形成的该部分还具有使刀片51并非仅在一点处而是通常在较长的区域范围上置于组织上的优点。因此防止刀片51在某一点处破损。
图13示出了具有凸形弯曲部的半圆形刀片51。刀片51设置在引线52的下侧。刀片51并且具有远离和靠近管轴器械的刀片弯曲部54。
图14示出了包括彼此前后设置的两个半圆部的刀片51。
图15示出了具有远端刀片弯曲部54和垂直于引线52的近端部分的刀片51。
优选地，刀片51是整体带有细齿的。
在替代性实施方式中(例如参见图10)，引线52是轨道。轨道可以以其具有与引线52相同的功能的方式设计。能够通过轨道内在的弹性或通过独立装置(例如，弹簧)实现相对于固定平面x-y的预加载。
尽管到目前为止已经结合有利的铰接形状描述了本发明的有利的切割装置50。然而，还可以将两项发明彼此分开来实施。
因此，例如图17和图18示出了位于工具头30中的切割装置50，由此第二嘴部件10’不是通过槽孔式引导系统与第一嘴部件10操作性地连接。在此支轴1基本位于嘴部件10、10’的纵轴线上。
在根据本发明的一种实施方式中，管轴器械还包括切割监控装置。该切割监控装置判断两个夹紧表面12、12’之间的组织何时完全被分离。在该实施方式中，当组织彻底分离时刀片51搁置在第一夹紧表面12上。由于夹紧表面12包括用于凝结的电极，因此至少其局部是导电的。根据本发明，刀片51的在组织分离时机械接触分离表面12的至少一部分同样由导电材料形成。刀片51与夹紧表面12之间的电接触通过切割监控装置来判断。在经由第二嘴部件10’的末端16’直至坡道55的完整的切割远动的过程中当刀片51与夹紧表面12之间存在连续的电接触时则视为所夹持的组织完全被分离。如图16所示，切割监控装置包括处理单元100、显示装置101、开关103以及用于确定和显示切割过程的进展的行程传感器102。行程传感器102确定刀片51的位置或位移从而有助于限定出优选覆盖完整的刀片运动的观测期。在最简单的情形中，开关103通过导电的刀片51和第一夹紧表面12形成。由于待切割的组织具有一定的导电性，因此只有当夹紧表面12与刀片51之间存在低电阻连接时才认为电开关103是闭合的。在处理单元100的上游连接有相应装置。如果处理单元100确定在整个观测期期间刀片51和夹紧表面12之间存在连续的低电阻接触，那么它通过显示装置101向使用者指示所夹持的组织已经彻底分离。由于刀片51在其与夹紧表面12之间没有组织被夹入的情况下在夹紧表面12上移位会损坏切割装置，因此小心地对待切割装置50。
可替代地，还可以不断地向使用者指示刀片51与夹紧表面12之间是否存在直接的机械接触。由于使用者手动操作刀片51的运动，因此他能够独立地得出组织是否充分分离的结论。
在另一种实施方式中，行程传感器102包括在刀片引导装置53的远端和近端上的两个电接触区域，并且所述两个电接触区域以能够判断刀片51与远接触区域以及刀片51与近接触区域之间的接触的方式设计。于是处理单元100能够确定观测间隔的起点与终点。
图20示出了图1的手柄110的示意性详细视图。手柄110包括手柄体117，在手柄体117下面一体形成有第一手柄杆122。该手柄杆122具有用于容置多个手指——优选为中指、无名指以及小指——的开口。第二手柄杆122’以可旋转的方式靠近第一手柄杆122接合到手柄体117。可以通过使第二手柄杆122’相对于第一手柄杆122靠近和远离的移位来张开和闭合工具头30的嘴部件10、10’。手柄杆122、122’形成手触发器120因而能够抓握在使用者的手中使得能够凭借一只手来操纵整个管轴器械。为此，手环绕手柄杆122、122’的部分。接合在齿条124中的延伸部位于第二手柄杆122’的背对手柄体117的端部上。该齿条124在第一手柄杆122的背对手柄体117的端部上以直角附连到第一手柄杆122的纵轴。齿条24的齿型以这样的方式设计：即，使第二手柄杆122’能够逐步地朝手柄杆122运动并且在不持续施力的情况下相应设定的位置保持不变。为了松开手柄杆122、122’彼此之间的这种紧固，以使齿条124和延伸部125不再啮合的方式按压齿条124远离延伸部125。
另外，手柄110具有同样以可旋转的方式附连到手柄体117的指触发器130。可以通过操作指触发器130使具体为刀片51的切割装置50朝远处移位。手柄体117内部的弹性元件(未示出)使指触发器130在操作后回复至其起始位置，因此使切割装置朝近处移位。以能够在抓握手柄杆122、122’的同时由第一指来操作指触发器130的方式来将指触发器130在远侧处设置在第一手柄杆122前面。
手柄110在手柄体117的近侧具有控制凝结电流的瞬时接触开关116。在替代性实施方式中，能够将瞬时接触开关116替换成提供具有多个致动元件的控制装置，可以通过该控制装置对多种凝结模式进行选择和操作。还能够想到在手柄体117上设置显示装置101。
在根据本发明的一种实施方式中，管轴24和手柄110以管轴24能够以可拆卸的方式插入手柄110中的方式设计。为此，在手柄110的侧部上设置有能够通过罩盖封闭的接收口112。
因此，在操作之前，将具有合适的工具头30和切割装置50的一次性消毒管轴24插入并锁定在可重复使用的手柄110中。不想重复使用管轴24以及相关联装置。手柄体117具有用于机械地连接工具头30、切割装置51以及管轴24的第一耦联元件或耦联元件114、第二耦联元件或耦联元件114’以及第三耦联元件114”或耦联元件。设置在管轴24的近端上的环以使管轴刚性连接至手柄体117的方式与第三耦联元件114’接合。第一内管适配器22通过同样设置在近端上的环与第一耦联元件114接合，第一耦联元件114与第二手柄杆122’操作性地连接。第二手柄杆122’的位移通过设置在手柄体117内部的机构传递至第一耦联元件114进而将该位移传递至第一内管适配器22。该第一内管适配器通过张力带27直接或间接地机械结合到第二嘴部件10’。因此第一内管适配器22相对于管轴24的纵向移位使嘴部件10、10’张开和闭合。
第二内管适配器22’以能够相对于第一内管适配器22的运动的方式设置在所述第一内管适配器22内。该内管适配器22’操作性地连接至引线52并使刀片51移动。管轴24插入手柄体117中使位于第二内管适配器22’的近端上的环与第二耦联元件114’接合，并且将通过指触发器130施加的力或位移传递至切割装置50。
为了使得更容易插入一次性管轴24，在管轴24上设置有可拆除的紧固装置，该紧固装置将内管适配器22、22’相对于管轴保持在预定位置，并且以使环容易插入耦联元件114、114’、114”中的方式设计。
耦联元件114、114’、114”以使管轴24能够相对于手柄110旋转的方式设计。因此能够自由调节工具头30相对于手柄110的对齐。在旋转过程中，内管适配器22、22’和管轴24的环在耦联元件114、114’、114”中旋转从而形成铰接。
附图标记列表
1               支轴
2               对接边缘
10、10’        嘴部件
12、12’        夹紧表面
16、16’        末端
22、22’        内管适配器
24              管轴
25              适配器
27              张力带
30              工具头
40              铰接装置
41、41’        铰接导轨
42、42’        铰接导销
43、43’        铰接导轨的凹部
44、44’        铰接导轨的凸部
46、46’        铰接导向轴承
50              切割装置
51              刀片
52              引线
53              刀片引导装置
54              刀片弯曲部
55                 坡道
56                 弯折部
60、60’           侧部件
100                处理单元
101                显示装置
102                行程传感器
103                开关
110                手柄
112                接收口
114、114’、114”  耦联元件
116                瞬时接触开关
117                手柄体
120                手触发器
122、122’         手柄杆
124                齿条
125                延伸部
130                指触发器
x                  x轴
y                  y轴
z                  z轴

Claims (22)

1.管轴器械，具体为电手术管轴器械，用于分离组织，所述管轴器械包括：
-管轴(24)；
-第一和第二嘴部件(10、10’)，所述第一和第二嘴部件(10、10’)各自具有用于将组织固定在固定平面(x-y)中的至少一个夹紧表面(12、12’)，其中所述嘴部件(10、10’)中的至少一个结合到所述管轴(24)；以及
-切割装置(50)，所述切割装置(50)具有用于切割所固定的组织的刀片(51)，所述切割装置在致动装置的作用下能够沿切割方向(x)移位，
其特征在于，
所述刀片(51)以能够基本平行于所述固定平面(x-y)移位的方式被引导，并且由预加载装置(56)预加载成在切割过程中抵靠所述固定平面(x-y)。
2.如权利要求1所述的管轴器械，其特征在于，
所述预加载装置(56)包括具有弯度的弹性引线(52)，由此所述引线(52)基本刚性地结合到所述刀片(51)，并且以沿所述固定平面(x-y)的方向使所述刀片(51)相对于所述管轴进行预加载的方式在所述管轴(24)中被引导。
3.如前述权利要求中任一项所述的、特别是如权利要求2所述的管轴器械，其特征在于，
所述预加载装置(56)包括弯折部，所述弯折部设置在所述引线(52)中使得在所述刀片(51)被朝前推动时所述弯折部向所述管轴(24)的远端靠近。
4.如前述权利要求中任一项所述的管轴器械，其特征在于，
所述两个嘴部件(10、10’)中的一个包括沿所述切割方向(x)延伸的刀片引导装置(53)。
5.如前述权利要求中任一项所述的管轴器械，其特征在于，
所述刀片(51)包括基本平行于所述固定平面(x-y)延伸的至少一个部分。
6.如前述权利要求中任一项所述的管轴器械，其特征在于，
所述刀片(51)弯曲成至少部分是凸形的。
7.如前述权利要求中任一项所述的管轴器械，其特征在于，包括：
特别是坡道形状的刀片引导装置(53)，所述刀片引导装置(53)设计并设置成其使得所述刀片(51)通过沿所述切割方向(x)运动而从离开所述固定平面(x-y)一定距离的起始位置到所述固定平面(x-y)上。
8.如前述权利要求中任一项所述的管轴器械，其特征在于，
所述嘴部件(10、10’)设置成能够相对于彼此旋转，并且所述刀片引导装置(53)设计成使得所述刀片(51)能够进入靠近所述嘴部件(10、10’)的支轴的起始位置。
9.如前述权利要求中任一项所述的管轴器械，其特征在于，
所述夹紧表面(12、12’)包括用于向所夹持的组织提供高频凝结电流的电极。
10.如前述权利要求中任一项所述的管轴器械，其特征在于，
所述刀片(51)至少部分带有微齿。
11.如前述权利要求中任一项所述的管轴器械，用于夹持和/或凝结和/或分离组织，其特征在于，包括：
至少一个铰接装置(40)，所述铰接装置(40)用于以使所述嘴部件(10、10’)能够从张开位置进入闭合位置从而利用所述夹紧表面(12、12’)固定所述组织的方式可旋转地支撑所述嘴部件(10、10’)，其中，所述铰接装置(40)以所述铰接装置(40)的支轴(1)位于所述嘴部件(10、10’)外部并且至少一个嘴部件(10、10’)的远端能够在张开时远离所述管轴(24)的远端进行移位的方式设计。
12.如前述权利要求中任一项所述的管轴器械，其特征在于，
所述铰接装置(40)包括槽孔式引导系统。
13.如前述权利要求中任一项所述的管轴器械，其特征在于，
所述铰接装置(40)包括位于两个嘴部件(10、10’)中的一个上的铰接引导装置和位于所述两个嘴部件(10、10’)中的另一个上的至少一个轨道或槽。
14.如前述权利要求中任一项所述的管轴器械，其特征在于，
设置有至少两个部分铰接装置(40、40’)，所述部分铰接装置(40、40’)彼此间隔开以形成优选设置于所述部分铰接装置(40、40’)中间的通道。
15.如前述权利要求中任一项所述的管轴器械，其特征在于，
所述两个嘴部件中的一个(10)刚性连接至所述管轴(24)。
16.如前述权利要求中任一项所述的管轴器械，其特征在于，
为了打开和闭合待移位的嘴部件(10’)，设置有能够大体沿直线移位的带，所述带通过弹性的端部附连在待移位的所述嘴部件(10’)上。
17.如前述权利要求中任一项所述的、特别是如权利要求16所述的管轴器械，其特征在于，
所述带设计成张力带(27)，特别是弹簧钢制成的张力带(27)，所述张力带的所述端部固定地附连至所述嘴部件(10’)。
18.如前述权利要求中任一项所述的、特别是如权利要求17所述的管轴器械，其特征在于，
所述带通过焊接附连在所述嘴部件(10’)上，由此焊缝优选相对于所述带的纵轴线不成直角地和/或弯曲地延伸。
19.如前述权利要求中任一项所述的管轴器械，其特征在于，
所述嘴部件(10、10’)中的至少一个包括至少在所述铰接装置(40)的区域中的电绝缘材料，特别是陶瓷材料。
20.如前述权利要求中任一项所述的管轴器械，其特征在于，包括：
可拆卸手柄，所述可拆除手柄包括：
-第一和第二机械致动元件(120、130)；
-第一力传递元件(114、114’)，所述第一力传递元件用于将所述第一致动元件(120)以可拆卸的方式耦联至第一功能单元，具体耦联至所述工具头的所述嘴部件(10、10’)中的至少一个；以及
-第二力传递元件(114)，所述第二力传递元件用于将所述第二致动元件(130)以可拆卸的方式耦联至第二功能单元，具体耦联至所述工具头(30)的切割装置(50)。
21.如前述权利要求中任一项所述的、特别是如权利要求20所述的管轴器械，其特征在于，
所述管轴(24)和所述嘴部件设计成一次性单元并通过所述力传递元件(114、114’)以可更换的方式结合到所述手柄(110)。
22.如前述权利要求中任一项所述的、特别是如权利要求21所述的管轴器械，其特征在于，
所述一次性单元，具体为所述工具头(30)和/或所述嘴部件(10、10’)和/或所述切割装置(50)，在安装之前通过紧固装置以安装好时所述力传递元件(114、114’、114”)能够与对应的匹配部件接合的方式预先定位在所述手柄(110)中。
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CN101522118A (zh) 2009-09-02
CN101516285B (zh) 2011-08-17
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CN101522118B (zh) 2012-10-17
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