CN101530340A - 用于外科器械的可互换工具 - Google Patents
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Abstract
本发明涉及外科工具系统,更具体地涉及用于外科器械的可互换工具。外科工具系统可包括外科器械,该外科器械包括手柄组件,在手柄组件中支撑有驱动系统以通过连接手柄组件的可动手柄部分的致动产生驱动运动。细长主体从手柄组件伸出,在细长主体中可操作地支撑控制杆,控制杆与驱动系统相互作用。外科工具系统还包括从外科工具组中选择的至少两种外科工具,所述外科工具组包括:操纵器,镊子,剪刀,内镜切割器,组织厚度测量装置,钉施放器,夹具施放器,注射器以及烧灼装置,其中在外科工具组中的每个外科工具至少具有外壳和驱动组件,外壳与细长主体可移除地连接,驱动组件与控制杆可移除地连接以从控制杆接收驱动运动。
Description
共同拥有的专利申请
本申请的受让人还共同拥有以下通过引入结合入本文的美国专利申请:
2007年3月28日提交的、题为Laparoscopic Tissue Thickness andClamp Load Measuring Devices、序列号为No.11/729,008的美国专利申请;
2007年1月11日提交的、题为Surgical Stapler With TaperedDistal End、序列号为No.11/652,170的美国专利申请;
Kyle P.Moore等人提交的代理卷号为END6213USNP/070330、题为Disposable Motor Driven Loading Unit For Use With a SurgicalCutting and Stapling Apparatus、序列号为____的美国专利申请;
Jerome R.Morgan等人2008年2月14日提交的、题为Articulatable Loading Units For Surgical Stapling and CuttingInstruments、序列号为No.12/031,001的美国专利申请。
技术领域
本发明总的涉及外科器械,其包括但不限于通常用于一次性切割和缝合单元的外科器械,所述一次性切割和缝合单元能向组织施加钉排并且同时切割这些钉排之间的组织,本发明更具体地涉及与这样的器械一起使用的可互换工具的集合。
背景技术
由于内窥镜外科手术所需的较小切口有助于缩短手术后的康复时间和减少并发症,因此内窥镜手术通常优于传统的开放式外科手术。目前,通过腹腔镜或其他内窥镜技术可实施各种外科手术。这些手术可包括例如肠胃手术(诸如结肠癌的切除、疝修补、胃的缝合、胆囊的切除、妇产科相关手术)以及其它手术(诸如那些涉及对患者的脾、肝脏、肺、心脏等等进行的手术)。
因此,在内窥镜外科器械领域已有了重大的发展,其适于将远端执行器穿过已被插入患者体内的套管针的套管而精确放置在外科手术所需的位置。这些远端执行器通过多种方式与组织接合或相互作用,以获得所需的诊断或治疗效果。这些装置通常构造为实施单个类型的外科手术动作(例如,内镜切割器(endocutter)、抓持器、切割器、缝合器、夹具施放器、进入装置、药物/基因治疗输送装置以及使用超声、RF、激光等的能量装置),这些动作通常需要医生使用多个不同的器械,这些器械的每一个仅适于在单步操作中实施一个动作。例如,美国专利No.5,352,235;美国专利No.5,383,895;以及美国专利No.5,728,121均公开了可用于内窥镜和腹腔镜手术的专用抓持器械。对于那些需要从人体切除组织或样本(例如切除病变的胆囊、阑尾等)的手术,开发出了如美国专利No.6,406,440公开的专用样本取回器械。对于需要切割和切断组织的手术,开发出了如美国专利No.6,168,605公开的那些的专用剪切器械。
对于那些涉及组织的切割和缝合的手术,已经设计出了各种外科缝合装置。这些外科缝合装置一般包括在组织上形成纵向开口的同时将钉排施加到切口相对两侧上的端部执行器。端部执行器包括一对协同操作的钳口构件,如果器械是应用于内窥镜或腹腔镜应用中,则所述钳口构件能穿过套管通道。美国专利No.6,905,057公开了外科切割和缝合装置的一种形式。这些装置具有可重复使用的专用驱动装置和刀梁,并设计为与可更换的钉仓一同使用。构造为测量组织厚度的可拆卸的仓也可设计为与这些器械一起使用,该可拆卸的仓如序列号为No.11/729,008、题为Laparoscopic Tissue Thicknessand Clamp Load Measuring Devices的美国专利申请中公开的那些。另一种弧形的端部执行器装置也具有可重复使用的专用刀和驱动梁装置以便与可拆除/可更换的钉仓一起使用,该可更换的弧形的端部执行器装置如序列号为11/729,008,题为Surgical Stapler WithTapered Distal End的美国专利申请公开的那些。
诸如美国专利No.5,865,361公开的其他类型的外科缝合装置被构造成与一次性装载单元(DLU)一起工作,该一次性装载单元被构造为在其中支撑专用钉仓和刀组件。一旦手术完成,整个DLU被废弃。这样的器械被设计成满足DLU的目的,为器械的每次击发提供“新”刀片的优点。这种外科缝合器械的可重复使用的手柄部分限于与构造为切割和缝合组织的一次性装载单元相关地使用。因此,对于涉及多种动作和过程的手术(例如,抓紧和操纵组织、切割组织、切除组织、施加夹具和/或钉、烧灼组织、输送药物和药剂等),手头需要在过去专门设计用于实施那些动作之一的不同外科器械的集合。
因此,需要可与单个外科器械手持件一起使用的不同类型的可互换的外科工具附件。
发明内容
在本发明的各种实施方式的一个一般方面,提供了一种用于外科器械的外科工具,该外科器械具有在其中可操作地支撑驱动系统的手柄组件,以通过手柄组件的可动手柄部分的致动产生驱动运动。该外科器械还具有细长主体,该细长主体可操作地在其中支撑控制杆以传递驱动运动。该外科工具的各种实施方式包括可移除地与细长主体连接的外壳。驱动组件可操作地支撑在外壳中并可移除地与控制杆连接。一对非钉成形钳口可操作地与驱动组件连接,使得当沿着第一方向将驱动运动施加到驱动组件上时,每个非钉成形钳口可朝向彼此在闭合方向上同时运动,当沿着第二方向施加另一驱动运动时,每个非钉成形钳口可彼此背离地在打开方向上同时运动。
在本发明的各种实施方式的另一个一般方面,提供了一种用于与外科器械一起使用的外科工具,该外科器械具有可操作地在其中支撑驱动系统的手柄组件,以通过手柄组件的可动手柄部分的致动产生驱动运动。该外科器械还可具有细长主体,该细长主体可操作地在其中支撑控制杆以传递驱动运动。该外科工具的各种实施方式可包括承载器,外壳连接在该承载器上。该外壳可动地连接在细长主体上。驱动组件可操作地支撑在外壳和承载器中,并可移除地与控制杆连接。非钉成形砧座可动地支撑在该承载器上,并构造为可操作地与驱动组件相互作用以选择性地将该非钉成形砧座移向承载器和从承载器移开。组织厚度测量仓可支撑在承载器中。该组织厚度测量仓可具有与外壳相互作用的指示器构件,以提供被夹在非钉成形砧座和该组织厚度测量仓之间的组织的厚度范围的指示。
在本发明的各种实施方式的另一个一般方面,提供了一种用于与外科器械一起使用的外科工具,该外科器械具有可操作地在其中支撑驱动系统的手柄组件,以通过手柄组件的可动手柄部分的致动产生驱动运动。该外科器械还可具有细长主体,该细长主体可操作地在其中支撑控制杆以传递驱动运动。在各种实施方式中,该外科工具包括直接连接在该细长主体上的外壳。驱动组件可操作地支撑在外壳和承载器中。该驱动组件可移除地与控制杆连接。一钉成形砧座以不可运动的方式受外壳支撑。多个钉可支撑在外壳的远端中并被定向成在向驱动组件施加驱动运动时被连续地推入钉成形砧座中。
在本发明的各种实施方式的另一个一般方面,提供了一种用于与外科器械一起使用的外科工具,该外科器械具有可操作地在其中支撑驱动系统的手柄组件,以通过手柄组件的可动手柄部分的致动产生驱动运动。该外科器械还可具有细长主体,该细长主体可操作地在其中支撑控制杆以传递驱动运动。在各种实施方式中,该外科工具包括直接连接在该细长主体上的外壳。一对相对的可动钳口可连接于轴上并从该轴延伸。钳口被构造为当钳口位于打开位置时依次在钳口中容纳各个外科夹具。当钳口移向闭合位置时,钳口也可使连续地容纳在其中的各个外科夹具成形。当外壳连接到细长主体时,可动成形机构可移除地与控制杆连接。该成形机构可构造为在控制杆的第一驱动运动的作用下,将钳口从打开位置移向闭合位置,从而对连续地容纳在其中的各个外科夹具成形。该成形机构可进一步构造为在由控制杆对成形机构施加第二驱动运动时,从闭合位置运动至打开位置。进给机构可操作地与可动成形机构相互作用。该进给机构可具有一进给板,其可响应成形机构的运动而运动,并可释放地与进给机构的夹具推动器可释放地连接。在向成形机构施加第一驱动运动时,该夹具推动器可以是固定的并从进给板分开。在向可动成形机构施加第二驱动运动时,该夹具推动器可以是可动的并可操作地与进给板连接,以使得各个外科夹具连续地从轴运动进入钳口中。
与本发明另一个一般方面有关,提供了一种用于与外科器械一起使用的外科工具,该外科器械具有可操作地在其中支撑驱动系统的手柄组件,以通过手柄组件的可动手柄部分的致动产生驱动运动。该外科器械还可具有细长主体,该细长主体可操作地在其中支撑控制杆以传递驱动运动。本发明的外科工具的各种实施方式可包括承载器,一外壳连接于该承载器上。该外壳可移除地连接在细长主体上。驱动组件可操作地支撑在外壳和承载器中,并也可移除地与控制杆连接。钉成形砧座可动地支撑在承载器上,并可操作地与驱动组件相互作用,以选择性地将钉成形砧座移向承载器和从承载器移开。一具有曲率半径的钉支撑仓可支撑在承载器中。该钉支撑仓可具有穿过其的弯曲槽,该弯曲槽限定了在将驱动运动施加于钉支撑仓上时用于容纳驱动组件远端的弯曲通道。
依照本发明的另一个一般方面,提供了一种用于与外科器械一起使用的外科工具,该外科器械具有可操作地在其中支撑驱动系统的手柄组件,以通过手柄组件的可动手柄部分的致动产生驱动运动。一细长主体可操作地在其中支撑控制杆以传递驱动运动。外科工具的各种实施方式可包括外壳,该外壳可移除地与细长主体连接。注射器主体可连接到外壳上。空心针可从注射器主体伸出。驱动组件可操作地支撑在外壳中,并可移除地与控制杆连接。注射器活塞可动地支撑在注射器主体中,并可与驱动组件连接用于随之选择性地运动。
依照本发明的另一个一般方面,提供了一种用于与外科器械一起使用的外科工具,该外科器械具有可操作地在其中支撑驱动系统的手柄组件,以通过手柄组件的可动的手柄部分的驱动产生驱动运动。细长主体可操作地在其中支撑控制杆以传递驱动运动。外科工具的各种实施方式包括外壳,该外壳可移除地与细长主体连接。一非施放钉用的端部执行器可操作地从外壳的远端伸出。该非施放钉用的端部执行器可支撑至少一个电动构件。电池可动地支撑在外壳中,并构造为与至少一个电动构件进行电通信。电池可移除地与控制杆连接,以使得在第一驱动运动作用下,电池向电动构件提供电力,且在第二驱动运动作用下,电池停止向电动构件提供电力。
依照本发明的另一个一般方面,提供了一种包括外科器械的外科工具系统,该外科器械包括具有可操作地在其中支撑驱动系统的手柄组件,以通过可操作地与手柄组件连接的、可动的手柄部分的驱动产生驱动运动。细长主体可从手柄组件伸出,控制杆可操作地支撑在该细长主体中。控制杆与驱动系统连接以从驱动系统接收驱动运动。该系统可进一步包括从外科工具组中选择的至少两种外科工具,包括:操纵器,镊子,剪刀,内镜切割器,组织厚度测量装置,钉施放器,夹具施放器,注射胶/密封剂/药物/药剂施放器和烧灼装置,其中手术工具组中的每个外科工具至少具有外壳以及驱动组件,该外壳与细长主体可移除地连接,所述驱动组件与控制杆可移除地连接以用于从控制杆接收驱动运动。
从附图和说明书中将更明显地得到本发明的这些和其他对象及优点。
更具体地说,本发明涉及如下内容:
(1).一种用于外科器械的外科工具,该外科器械具有手柄组件和细长主体,在所述手柄组件中可操作地支撑有驱动系统,以通过所述手柄组件的可动手柄部分的致动产生驱动运动,在所述细长主体中可操作地支撑有控制杆以传递所述驱动运动,所述外科工具包括:
外壳,其可移除地与所述细长主体连接;
驱动组件,其可操作地支撑在所述外壳中并且可移除地与所述控制杆连接;以及
一对非钉成形钳口,其可操作地与所述驱动组件连接,使得在沿着第一方向将所述驱动运动施加到所述驱动组件上时引起所述一对非钉成形钳口的每个都同时沿着闭合方向朝着彼此运动,并且在沿着第二方向施加另一个所述驱动运动时,所述一对非钉成形钳口的每个都同时沿着打开方向相互远离地运动。
(2).如第(1)项所述的外科工具,其中,所述驱动组件包括:
近侧驱动梁段,其能够可移除地与所述控制杆连接;以及
远侧驱动梁段,其与所述近侧驱动梁段和所述一对非钉成形钳口以可枢转的方式连接。
(3).如第(2)项所述的外科工具,其中,所述远侧驱动梁段通过可操作地支撑在所述外壳中的反向连接组件与所述近侧驱动梁段以可枢转的方式连接,并且所述远侧驱动梁段通过一对枢轴连杆与所述一对非钉成形钳口以可枢转的方式连接。
(4).如第(1)项所述的外科工具,其中,所述非钉成形钳口的每个都包括组织夹紧钳口。
(5).如第(4)项所述的外科工具,其中,至少一个所述组织夹紧钳口具有形成于其中的空腔部分,用以容纳切除的组织。
(6).如第(1)项所述的外科工具,其中,所述非钉成形钳口的每个都包括剪刀钳口。
(7).如第(1)项所述的外科工具,其中,在所述外壳中具有无源关节运动的接头。
(8).一种用于外科器械的外科工具,该外科器械具有手柄组件和细长主体,在所述手柄组件中可操作地支撑有驱动系统,以通过所述手柄组件的可动手柄部分的致动产生驱动运动,在所述细长主体中可操作地支撑一控制杆以传递所述驱动运动,所述外科工具包括:
承载器;
外壳,其与所述承载器连接并且可移除地与所述细长主体连接;
驱动组件,其可操作地支撑在所述外壳和所述承载器中并且可移除地与所述控制杆连接;
非钉成形砧座,其可移除地支撑在所述承载器上并且可操作地与所述驱动组件相互作用,以选择性地使所述非钉成形砧座移向所述承载器和从所述承载器移开;以及
组织厚度测量仓,其能够被支撑在所述承载器中并且具有与所述外壳相互作用的指示器构件,以提供被夹在所述非钉成形砧座和所述组织厚度测量仓之间的组织的厚度范围的指示。
(9).如第(8)项所述的外科工具,其中,所述组织指示器构件能够区别多个不同的组织厚度范围。
(10).如第(8)项所述的外科工具,其中,在所述外壳中具有无源关节运动的接头。
(11).一种用于外科器械的外科工具,该外科器械具有手柄组件和细长主体,在所述手柄组件中可操作地支撑有驱动系统,以通过所述手柄组件的可动手柄部分的致动产生驱动运动,在所述细长主体中可操作地支撑一控制杆以传递所述驱动运动,所述外科工具包括:
外壳,其直接与所述细长主体连接;
驱动组件,其可操作地支撑在所述外壳和承载器中并且可移除地与所述控制杆连接;
钉成形砧座,其由所述外壳以不能运动的方式支撑;以及
多个钉,其支撑在所述外壳的远端中并且在将所述驱动运动施加到所述驱动组件上时定向成被连续地驱动进入所述钉成形砧座中。
(12).如第(11)项所述的外科工具,其中,在所述外壳中具有无源关节运动的接头。
(13).一种用于外科器械的外科工具,该外科器械具有手柄组件和细长主体,在所述手柄组件中可操作地支撑有驱动系统,以通过所述手柄组件的可动手柄部分的致动产生驱动运动,在所述细长主体中可操作地支撑一控制杆以传递所述驱动运动,所述外科工具包括:
外壳,其直接与所述细长主体连接;
轴,其从所述外壳延伸并且在该轴中具有多个外科夹具;
一对相对的可动钳口,其连接到所述轴并且从所述轴延伸,当所述钳口位于打开位置时,所述钳口用于在其中连续地接收所述外科夹具的每一个,当所述钳口运动到闭合位置时,所述钳口用于对连续接收的所述外科夹具的每一个进行成形;
可动成形机构,当所述外壳连接到所述细长主体时,该成形机构可移除地与所述控制杆连接,所述成形机构在来自所述控制杆的第一驱动运动的作用下将所述钳口从所述打开位置运动到所述闭合位置,以使连续接收的所述外科夹具的每个能成形,并且在由所述控制杆向所述成形机构施加第二驱动运动时,所述成形机构使所述钳口从所述闭合位置运动至所述打开位置;以及
进给机构,其可操作地与所述可动成形机构相互作用,所述进给机构具有一进给板,该进给板能响应所述成形机构的运动而运动,并且被可释放地连接到所述进给机构的夹具推动器,其中在将所述第一驱动运动施加到所述成形机构上时,所述夹具推动器是固定的并且从所述进给板分开,在将所述第二驱动运动施加到所述可动成形机构上时,所述夹具推动器是可动的并且被可操作地连接到所述进给板,以使所述外科夹具的每个从所述轴连续地运动进入所述钳口中。
(14).如第(13)项所述的外科工具,其中,所述可动成形机构包括可动成形板,该可动成形板可移除地与所述控制杆连接,所述进给板通过齿轮组件与所述可动成形板可动地连接,从而在将所述第一驱动运动施加到所述可动成形板上时,引起所述可动成形板沿第一方向运动并且同时引起所述进给板沿着与第一方向相反的第二方向运动。
(15).一种用于外科器械的外科工具,该外科器械具有手柄组件和细长主体,在所述手柄组件中可操作地支撑有驱动系统,以通过所述手柄组件的可动手柄部分的致动产生驱动运动,在所述细长主体中可操作地支撑一控制杆以传递所述驱动运动,所述外科工具包括:
承载器;
外壳,其与所述承载器连接并且可移除地与所述细长主体连接;
驱动组件,其可操作地支撑在所述外壳和承载器中并且可移除地与所述控制杆连接;
钉成形砧座,其可移除地支撑在所述承载器上并且可操作地与所述驱动组件相互作用,以选择性地将所述钉成形砧座移向所述承载器和从所述承载器移开;以及
钉支撑仓,其具有曲率半径并且被支撑在所述承载器中,弯曲的槽穿过所述钉支撑仓并限定了用于在将驱动运动施加到所述钉支撑仓时容纳所述驱动组件的远端的弯曲通道。
(16).如第(15)项所述的外科工具,其中,在所述外壳中具有无源关节运动的接头。
(17).一种用于外科器械的外科工具,该外科器械具有手柄组件和细长主体,在所述手柄组件中可操作地支撑有驱动系统,以通过所述手柄组件的可动手柄部分的致动产生驱动运动,在所述细长主体中可操作地支撑一控制杆以传递所述驱动运动,所述外科工具包括:
外壳,其可移除地与所述细长主体连接;
注射器主体,其连接到所述外壳上并且具有从所述注射器主体伸出的空心针;
驱动组件,其可操作地支撑在所述外壳中并且可移除地与所述控制杆连接;以及
注射器活塞,其可动地支撑在所述注射器主体中并且与所述驱动组件连接以便随所述驱动组件选择性地运动。
(18).如第(17)项所述的外科工具,其中,在所述外壳中具有无源关节运动的接头。
(19).一种用于外科器械的外科工具,该外科器械具有手柄组件和细长主体,在所述手柄组件中可操作地支撑有驱动系统,以通过所述手柄组件的可动手柄部分的致动产生驱动运动,在所述细长主体中可操作地支撑一控制杆以传递所述驱动运动,所述外科工具包括:
外壳,其可移除地与所述细长主体连接;
非施放钉用的端部执行器,其可操作地从所述外壳的远端伸出,所述非施放钉用的端部执行器支撑至少一个电动构件;
电池,其可动地支撑在所述外壳内并且与所述至少一个电动构件电通信,所述电池可移除地与所述控制杆连接,使得在将第一所述驱动运动施加到所述电池上时,所述电池向所述电动构件提供电力,且在将第二所述驱动运动施加到所述电池上时,所述电池停止向所述电动构件提供电力。
(20).如第(19)项所述的外科工具,其中,在所述外壳中具有无源关节运动的接头。
(21).一种外科工具系统,包括:
外科器械,该外科器械包括:
手柄组件;
驱动系统,其可操作地支撑在所述手柄组件中,以通过可操作地与所述手柄组件连接的可动手柄部分的致动产生驱动运动;
细长主体,其从所述手柄组件伸出;
控制杆,其可操作地支撑在所述细长主体中并且与所述驱动系统相互作用以从所述驱动系统接收所述驱动运动;以及
从外科工具组中选择的至少两种外科工具,所述外科工具组包括:操纵器,镊子,剪刀,内镜切割器,组织厚度测量装置,钉施放器,夹具施放器,用于施加胶、密封剂、药物或药剂的注射器以及烧灼装置,其中在所述外科工具组中的每种所述外科工具至少具有外壳和驱动组件,所述外壳与所述细长主体可移除地连接,所述驱动组件与所述控制杆可移除地连接以从所述控制杆接收所述驱动运动。
(22).如第(21)项所述的外科工具系统,还包括样本取回工具,该样本取回工具包括:
可移除地与所述细长主体连接的外壳;
在所述外壳的远端上的样本取回袋。
附图说明
结合入说明书并且构成本说明书一部分的附图示出了本发明的实施方式,并同以上给出的本发明各种实施方式的一般描述和下面给出的实施方式的详细描述一起用于解释本发明的各种原理。
图1是现有的外科切割和缝合设备的透视图。
图2是本发明的外科工具实施方式的侧视图。
图3是图2中的外科工具实施方式的截面图,为了清楚起见,其中外科工具的一些组件给出了全视图。
图4是图2和3中的外科工具实施方式在闭合位置时的另一个截面图。
图5是显示了用于从患者体内切除组织而将图2-4中的外科工具实施方式与本发明另一种外科工具实施方式结合使用的一个示例性用法的透视图。
图6是本发明另一种外科工具实施方式的截面图,为了清楚起见,其中外科工具的一些组件给出了全视图。
图7是本发明另一种外科工具实施方式的透视图。
图8是本发明另一种外科工具实施方式的透视图。
图9是图8的外科工具实施方式的截面图。
图10是图8和9的外科工具远端位于预击发位置时的放大截面图。
图11是图8-10的外科工具远端的另一放大截面图,其中钉被射入组织。
图12是图8-11的外科工具远端在第一钉被击发之后的另一放大截面图。
图13是本发明另一种外科工具实施方式的透视图。
图14是图13的外科工具实施方式的截面图,为了清楚起见,其中一些组件给出了全视图。
图15是本发明另一种外科工具实施方式的透视图。
图16是图15的外科工具实施方式的一部分的分解组件图。
图17是图15和16的外科工具实施方式的侧视图,其中砧座组件位于打开位置。
图18是图15和16的外科工具实施方式的另一侧视图,其中一部分以截面示出,砧座组件位于第一闭合位置且没有组织被夹在其中。
图19是图18描述的外科工具实施方式的远端的放大图。
图20是图18的外科工具沿图18中的线20-20截取的截面图。
图21是图20所示的外科工具的远端部分的放大图。
图22是图15-21的外科工具的厚度测量仓部分的分解组件图。
图23是图21的厚度测量仓的部分的另一分解组件图。
图24是图17的外科工具的一部分沿图17中的线24-24截取的截面图。
图25是图17的外科工具的一部分沿图17中的线25-25截取的截面图。
图26是图15-25的外科工具实施方式的侧视图,其中砧座组件位于闭合位置以便在其中夹紧具有第一厚度范围的组织。
图27是图26描述的外科工具实施方式的远端的放大图。
图28是图15-27的外科工具实施方式的侧视图,其中砧座组件位于闭合位置以便在其中夹紧具有第二厚度范围的组织。
图29是图15-28的外科工具实施方式的侧视图,其中砧座组件位于闭合位置以便在其中夹紧具有第三厚度范围的组织。
图30是图15-29的外科工具实施方式的侧视图,其中砧座组件位于闭合位置以便在其中夹紧具有第四厚度范围的组织。
图31是本发明另一种外科工具实施方式的一部分的透视图,其中盖被从其移除。
图32是图31的外科工具的成形板和进给板装置的部分的透视图。
图33是图31的外科工具实施方式的俯视图,为了清晰起见,盖被移除。
图34是图31-33的外科工具的截面图。
图35是图34的外科工具沿图34中的线35-35截取的截面图。
图36是本发明另一种外科工具实施方式的平面图,为了清晰起见,将砧座组件的一部分省略。
图37是本发明另一种外科工具实施方式的平面图,为了清晰起见,将砧座组件的一部分省略。
图38是本发明另一种外科工具实施方式的透视图。
图39是图38的外科工具的一部分外壳的截面图。
图40是本发明一种外科工具实施方式与本发明另一种外科器械实施方式结合使用时的分解组件图。
图41是本发明的替代外壳实施方式的透视图,其中外壳的一部分用虚线表示,用以展示围绕在外壳中形成的关节运动构件的关节运动的能力。
图42是本发明实施方式另一种可选外壳实施方式的透视图。
具体实施方式
转至附图,在多个图中相同的附图标记表示相同的组件,图1描述了现有的外科器械10,其包括外壳组件12和从该外壳组件伸出的细长主体14。图1还示出了现有的一次性装载单元16,其包括用于切割组织并在切口每边施加钉排的一次性内镜切割器。一次性装载单元16包括工具组件17,该工具组件具有容纳大量外科钉的仓组件18和可动地连接到仓组件18上的砧座组件20。在各种实施方式中,传统的外科器械10和一次性装载单元16可包括如在美国专利No.5,865,361中所描述的外科器械和一次性装载单元,该美国专利所公开的内容通过引用结合入本文。因此,在此除了需要描述可以与外科器械10共同使用的本发明各种外科工具的实施方式的操作之外,该具体实施方式部分将不具体地讨论外科器械10和一次性装载单元16的各种组件以及它们的操作。
继续本发明的详细描述,可以理解在这里使用的术语“近侧”和“远侧”是相对于握住与特定外科工具可操作地连接的外科器械10的手柄组件12的医生而言。因此,相对于更近侧的手柄组件12而言,外科工具在“远侧”。进一步可以理解的是,为了更方便和清楚起见,在这里使用的空间术语例如“竖直”、“水平”、“上”、“下”、“左”和“右”是相对于附图而言的。但是,外科工具和器械可用于很多定向和位置,这些术语并不认为是限制的和绝对的。
图2-4描述了本发明一种实施方式的外科工具1000,其可操作地与外科器械10连接,并用于操纵组织、器官等。由这些图可以看出,外科工具1000可包括外壳1010,该外壳1010具有构造为可移除地与外科器械10的细长主体14连接的近端1012。具体地,近端1012可具有形成于其上的接合凸起254,该接合凸起254用于与如在美国专利No.5,865,361中描述的外科缝合装置的细长主体部分14的远端形成卡口式连接。
外科工具1000包括驱动组件1020,该驱动组件1020可包括通过反向连接组件1040与远侧驱动梁段1030连接的近侧驱动梁段1022。驱动梁段1022,1030均可由单层薄片材料或优选为多层叠置的薄片构造。但是,驱动梁段1022,1030可由其他合适的材料和布置而制成。由图3可以看出,近侧驱动梁段1022具有形成于其上的接合部分1024,该接合部分1024可包括一对大小和构造适于与驱动构件1026固定地连接的接合指状物1024a和1024b。驱动构件1026包括近侧孔1028,其构造为当工具附件100的近端1012与外科装置10的细长主体14接合时容纳控制杆52的远端276(见图1)。由图3可以看出,在近端1012中具有空心通道1014,控制杆52的远端276可延伸穿过该空心通道1014。
近侧驱动梁段1022的远端具有远侧突起部分1028,其被销接在反向连接组件1040的连杆1042上。连杆1042通过销1044枢转地与外壳1010连接,并且还与远侧驱动梁段1030的近侧突起部分1032连接。远侧驱动梁段1030的远端1034可通过第一枢轴连杆1052枢转地与非钉成形的上操纵钳口1050连接,并且还通过第二枢轴连杆1062与非钉成形的下操纵钳口1060连接。在此使用的术语“非钉成形”指的是钳口被设计为用于抓紧或操纵组织,而不是被设计为用于成形、支撑或驱动钉,例如,砧座、钉仓或设计用于支撑钉仓的单元部分。
图2和3示出了处于打开定向的上和下操纵钳口1050,1060,图4示出了处于闭合定向的上和下操纵钳口1050,1060。一旦外科工具1000与外科设备10的细长主体14相连接(并且控制杆52的远端276与驱动构件1026相连接),临床医生可以通过操纵外科设备10的可动手柄部分24使上和下操纵钳口1050,1060在打开和闭合位置之间运动。例如,使可动手柄部分24向手柄组件12的固定部分22枢转,可引起控制杆52沿着“第一”远侧方向“DD”移动近侧驱动梁段1022。当近侧驱动梁段1022在第一远侧方向“DD”上运动时,反向连接组件1040沿着“第二”近侧方向“PD”拉动远侧驱动梁段1030,这会导致连杆1052,1062将非钉成形的上和下操纵钳口1050,1060同时彼此相向运动至闭合定向。使可动手柄部分24从固定手柄部分22上移开,会导致非钉成形的上和下操纵钳口1050,1060同时彼此相互远离地运动至打开位置。
本领域的普通技术人员可以理解,非钉成形的上和下操纵钳口1050,1060可以具有不同的形状和尺寸,这不脱离本发明精神和范围。例如,图5示出了本发明的外科工具1000的与从体腔600切除组织等物有关的一种用法。更特别地,图5示出了传统的第一套管针610的用法,使用传统的第一套管针610穿过体壁602进入体腔600内形成第一通道604。本发明的外科工具1000与第一传统外科设备10相连接。外科工具1000随后穿过第一套管针610的套管插入并进入体腔600以抓住和操纵组织606的一部分。
一些医疗手术可能需要将病变的组织或器官的一部分从体腔600中移除。为了方便从体腔600中移除少量的这种组织,可采用本发明的另一种外科工具1100。从图5可以看出,外科工具1100可包括外壳部分1110,该外壳1110的近端1112具有形成于其上的凸起254,以便通过上述的方式与外科设备10’的细长主体部分14相连接。在外壳1110中可具有空心腔,以便于控制杆52在其内的运动。但是,在各种实施方式中,控制杆的远端276并未在外壳内与任何组件直接相连。与外壳1110的远端1114连接的是样本取回袋1120,该样本取回袋可由与柔性袋构件1124相连的可折叠的袋环部分1122形成。可折叠的袋环部分1122可由弹簧臂1226或能使袋环部分1122折叠以使样本取回袋1120能插入传统套管针610的套管或相似物以及从该套管或相似物中收回的类似物制成。
回到图5,还示出了本发明的外科工具1100,其与另一已被插入穿过另一传统套管针610的传统外科器械10’相连。在袋组件1120经过套管针的套管进入体腔600后,可折叠的袋环1122弹开。外科工具1000可用于抓住病变的组织606(例如胆结石等),并将病变的组织606放入随后可穿过第二传统套管针610的套管收回的袋组件1120内。拖绳1121围绕袋环1112延伸,穿过外壳1110以通过细长主体14的一部分,并可从其中邻近手柄组件12的孔穿出。当从体腔移除填充的袋1120时,拖绳1121可用于封闭样本取回袋1120。
一些其他的医疗过程包括切割和移除小部分组织例如切除息肉700或取出小部分组织用于检验。本发明的外科工具实施方式1200可用于实施这些操作。更特别地,参考图6,外科工具1200可包括如上所述的外壳部分1110和驱动梁段1022,1030。外科工具1200以如上所述的方式与细长主体部分14和控制杆52相连接,并通过如上所述将可动手柄部分24移向或远离固定的手柄部分22来进行操作。但是,在各种实施方式中,上组织夹紧钳口1210和下组织夹紧钳口1220分别与连杆1052和1062相连,而不是使上操纵钳口和下操作钳口分别与连杆1052和1062相连。从图6可以看出,上和下组织夹紧钳口1210和1220被设计为夹住被夹在他们之间的组织。上和下夹紧钳口1210,1220至少之一在其中具有腔部分1211,用于取回被夹紧的组织。在图6描述的实施方式中,每个组织夹紧钳口1210,1220均具有形成于其中的腔部分1211,所述腔部分1211在夹紧钳口1210,1220基本闭合时共同形成总体表示为1230的空心接收区域。因此,在通过使夹紧钳口1210,1220闭合而夹紧组织700之后,随后将组织700容纳在空心接收区域1230中以从体内移除。
图7示出了本发明另一种外科工具1300,其包括如上所述的外壳部分1110和驱动组件1020。但是,从图7可以看出,外科工具1300使用了剪刀钳口1310和1320。具体地,上剪刀钳口1310与连杆1052连接,下剪刀钳口1320与连杆1062连接。支撑元件1380从外壳部分1110的远端伸出,并如图所示围绕枢轴销1382枢转地支撑剪刀钳口1310,1320。外科工具1300以如上所述方式与外科器械10的细长主体部分14和控制杆52相连接,并通过如上所述将可动手柄部分24移向和远离固定的手柄部分22来进行操作。因此,剪刀钳口1310,1320可彼此对准以使得外科工具1300能够穿过套管(套管针)插入体腔,并随后通过移动外科器械10的可动手柄部分24致动剪刀钳口以切割组织。
图8-12示出了可与传统外科器械10一同使用的另一外科工具1400。从这些图可以看出,外科工具1400包括用于缝合组织的缝合器。更具体地,参见图8,外科工具1400可包括外壳部分1410,其具有设置为可移除地与外科器械10的细长主体14连接的近端部分1412。特别的,近端部分1412可具有形成于其上的接合凸起254,其用于如上所述与外科器械10的细长主体部分14远端一起形成卡口式连接。外科工具1400可包括驱动组件1420,其包括可由单层薄片材料或优选多层叠置的薄片构造而成的细长驱动梁1422。但是,驱动梁1422可由其他合适的材料和布置制成。从图9可以看出,驱动梁1422具有形成于其上的接合部分1424,该接合部分1424可包括一对尺寸和构造适于与驱动构件1426固定地连接的接合指状物1424a和1424b。驱动构件1426包括近侧孔1428,该近侧孔1428构造为当外科工具1400的近端1412与外科器械10的细长主体14接合时容纳控制杆52的远端276(见图1)。由图9可以看出,近端1412在其内具有空心通道1414,控制杆52的远端276可延伸穿过该空心通道。
从图9-12中还可以看出,外壳1410具有远端部分1416,其可操作地将外科钉1432的排1430容纳于其中。在多种实施方式中,外壳1410可制成多个段以允许将钉1432安装于其中。在单用途的实施方式中,钉1432可在工厂安装,且外壳部分通过粘接剂、卡扣等永久地组装在一起。在其他实施方式中,外壳部分可移除地连接在一起以允许安装另外的钉1432。从图9-12还能看出,钉驱动器1440固定在驱动梁1422的远端。从图10-12可以看到,钉驱动器1440的远端1442可具有形成于其中的钉容纳槽1444。
外科工具1400按如上所述的方式与外科器械10的细长主体部分14和控制杆52相连接,并通过同样如上所述将可动手柄部分24移向和远离固定的手柄部分22来进行操作。复位弹簧1450支撑在外壳1410的壁部分1418和钉驱动器1440上的复位突起部分1446之间,以帮助钉驱动器1440返回其复位位置,如图10所示另一钉1432可落入击发位置。从图10可以看出,当处于击发位置时,钉1432的最远的排1430的底部钉1432已落入与钉驱动器1440中的钉容纳槽1444接合。板簧形式的进给弹簧1470可设置用于将在钉的最远排1430中的每个后续钉1432朝向钉驱动器1440向下偏压。另外,弹簧组件1480(图10-12中以箱型示出)安装在外壳1410的远端部分1416中,以沿着钉驱动器1440上的远侧方向“DD”偏压钉1432的排1430,以使得钉1432的一排用完时,钉1432下一个邻近的排被偏压进入击发位置,如图10所示。
因此,为了使用外科工具1400,外壳部分1410的远端1416被引入与待缝合的组织“T”接合。见图11。从图10-12可以看出,远端部分1416具有倾斜端部1417,在该端部中具有开口1419以露出正在被击发的钉1432。当钉1432通过外科器械10的可动手柄部分24的运动进行击发(即,由钉驱动器1440在远侧方向“DD”上驱动)时,钉在与不可运动地安装在外壳1410内的钉成形砧座1490接触时被成形。图10示出了击发前的外科工具1400。图11示出了将钉1432击发进入组织“T”中。图12示出了钉驱动器1440,其已被缩回以允许另一钉1432落入预备位置。虽然外科工具1400特别地适于内窥镜手术,但本领域普通技术人员可以理解,外科工具1400也可以用于缝合张开的切口而无需将外科工具1400穿过套管插入体腔中。
图13和14示出了可与传统外科器械10一同使用的另一外科工具1500。从这些图中可以看出,外科工具1500包括用于施用例如,胶、密封剂、药物或其它药剂的注射器。更具体地,参见图14,外科工具1500可包括外壳部分1500,其具有构造为可移除地与外科器械10的细长主体14连接的近端部分1512。特别的,近端部分1512可具有形成于其上的接合凸起254,其用于如上所述与外科缝合器械10的细长主体部分14的远端形成卡口式连接。外科工具1500可包括驱动组件1520,该驱动组件包括可由单层薄片材料或优选多层叠置的薄片构成的细长驱动梁1522。但是,驱动梁1522可由任何其他合适的材料或布置制成。从图14可以看出,驱动梁1522具有形成于其上的接合部分1524,该接合部分可包括一对大小和构造适于与驱动构件1526固定地连接的接合指状物1524a和1524b。驱动构件1526包括近侧孔1528,该近侧孔被构造为当外科工具1500的近端1512与外科器械10的细长主体14接合时容纳控制杆52的远端276(见图1)。由图14可以看出,近端1512具有空心通道1514,控制杆52的远端276可延伸穿过该空心通道1514。
从图13和14还可以看出,注射器主体1570通过凸缘1572或其它紧固件装置与远端1516连接。凸缘1572可通过粘接剂或其他合适的装置固定在外壳1510和注射器主体1570上。从图14可以看出,驱动梁1522的远端1523连接于可动地支撑在注射器主体1570内部的注射器活塞1574上。空心针或套管1580可如图所示连接于注射器主体1570的远端。注射器主体1570可通过如下方式填充药物或药剂,即:通过使外科器械10的可动手柄24(见图1)向手柄组件12的固定手柄部分22运动,首先将注射器活塞1574推进到注射器主体1570的远端。随后,针1580的尖端1582可插入胶、密封剂、药物或药剂的小瓶或贮液器(未示出)中。通过将可动的手柄24从手柄组件12的固定手柄部分22移开,使得驱动梁1522和注射器活塞1574沿近侧方向“PD”运动,临床医生随后可通过针1580将贮液器中的物质吸入注射器主体1570。一旦注射器主体1574吸取了所需要的量的药剂或药物,临床医生随后可将外科工具1500通过套管或其他开口插入体腔,并通过再次使可动的手柄24朝着手柄组件12的固定手柄部分22运动,将药剂或药物从注射器主体1570中排出。在注射器主体1570上设有刻度或其他形式的测量标记1590,使得临床医生能够监控从注射器主体1574排出的胶、密封剂、药剂或药物的量。
当外科手术包括组织的缝合时,临床医生必须根据待缝合的组织的厚度来选择要用的适当尺寸的钉。例如,一般用于内窥镜手术的钉通常制成各种尺寸以提供各种成形高度,如0.75mm,1.0mm,1.5mm,2.0mm等等。临床医生必须仔细将钉的尺寸与组织的厚度进行匹配。如果钉太大,组织可能无法适当地保持在一起,或者如果钉太小,组织可能会被钉撕裂。但是,过去,临床医生经常不得不估算组织的厚度,然后期望估算足够准确。因此,需要一种能够与外科器械10一起使用的外科工具,其能够准确测量组织厚度从而可使用适当尺寸的钉。
图15-30描述了本发明的外科工具实施方式1600,其可操作地与外科器械10连接,并用于测量可能需切割和缝合的组织“T”的厚度。从这些图中可以看出,外科工具1600可包括承载器216,外壳1610连接在承载器上。外壳1610可通过卡扣特征件219或其他适合的装置连接于承载器216的直立的壁217。外壳1610具有构造成与外科器械10的细长主体14可动地连接的近端1612。具体的,近端1612可具有形成于其上的接合凸起254,其用于如上所述与外科器械10的细长主体部分14的远端形成卡口式连接。
外科工具1600进一步包括驱动组件1620,该驱动组件包括可由单层薄片材料或优选多层叠置的薄片构成的驱动梁1622。但是,驱动梁1622可由其他合适的材料或布置制成。从图16可以看出,驱动梁1622具有形成于其上的接合部分1624,该接合部分可包括一对大小和构造适于与驱动构件1626固定地连接的接合指状物1624a和1624b。驱动构件1626包括近侧孔(未示出),该近侧孔用于当外科工具1600的近端1612与外科器械10的细长主体14接合时容纳控制杆52的远端276(见图1)。
驱动梁1622的远端1626可具有凸轮销或辊子286(图16),其设置为与非钉成形的砧座组件20的凸轮部分209(图18)接合,其中该砧座组件20与承载器216枢转地连接。一对枢轴构件211形成在砧座组件20上,并定位在形成于承载器216上的槽213内,以在打开和夹紧位置之间引导砧座部分。当通过将可动手柄24移向外科器械10的手柄组件12的固定手柄部分22而使驱动梁1622在远侧方向“DD”上被驱动时,驱动梁1622远端上的凸轮辊子与砧座组件20的凸轮部分209接合,并使得砧座组件20枢转至所给定的可重复的闭合位置,该位置形成用于建立厚度测量的参考表面。
外科工具1600还可包括支撑于承载器216内的组织厚度测量仓1650。从图18-22可以看出,厚度测量仓1650包括安装在承载器216内的主体部分1652,该主体部分1652通过卡扣特征件1654(图22)或其他适合的紧固件装置保持在承载器216中。从图22可以看出,例如,仓主体1652可由通过粘接剂或其他适合的紧固件紧固在一起的两个主体部分1652a,1652b构成。从图22可以进一步看出,仓主体1652可操作地支撑可动的组织测量平台1660。如图22和23所示,组织测量平台1660可设置为具有通过铰链销1664与仓主体部分1652连接的近端部分1662。平台弹簧1666可以轴颈方式支撑在铰链销1664上,以朝向砧座组件20的方向偏压组织测量平台1660(图17和19中箭头“U”所指)。铰链销1664可安装在主体部分1652a,1652b的相应的孔1653中,见图22。从图23和26-30可以看出,组织测量平台1660的远端1668具有朝下突出的齿条部分1669,该齿条部分1669适于与齿轮组件1670驱动地连接。
从图22和23可以看出,齿轮组件1670可包括第一齿条齿轮1672,其通过键连接到可旋转地支撑在主体部分1652a,1652b的孔1682中的第一齿轮轴1680上。第二级齿轮1674也可通过键连接到第一齿轮轴1680上。齿轮组件1670可进一步包括第三传动齿轮1676,其通过键连接到可旋转地支撑在主体部分1652a,1652b的孔1692中的第二齿轮轴1690上,且与第二级齿轮1674啮合。第四输出齿轮1678也可通过键连接到第二齿轮轴1690上并且与可滑动地支撑在承载器216中的指示器构件或基底1700的齿条部分1702啮合。因此,参照图27可以理解,当组织测量平台1660被向下按压(箭头“DW”)时,该齿条部分1669从组织测量平台伸出,使得第一齿条齿轮1672按图27中的逆时针“CCW”旋转,这同样引起第二级齿轮1674也按逆时针方向旋转。第二级齿轮1674与第三传动齿轮1676啮合且产生在图27中的顺时针“CW”方向上转动。当第三传动齿轮1676顺时针转动时,输出齿轮1678也顺时针转动。当输出齿轮1678顺时针(“CW”)转动时,由于输出齿轮1678与指示器齿条1702啮合,该输出齿轮1678在远侧方向“DD”上驱动指示器基底1700。在各种实施方式中,例如,可采用大约30∶1的传动比,从而在约3秒内可达到60mm的线性击发运动。但是,也可以想到使用其他传动比。
更具体地从图23可以看出,指示器基底1700可分叉成两个均终止于直立的指示器板1712的侧指示器腿部分1710。每个指示器板1712上可具有一系列厚度识别器或指示器。特别地,每个指示器板1712可具有对应于第一组织厚度范围“T1”的第一厚度识别器1720。例如,第一组织厚度范围“T1”可表示具有约0.75mm至约1.0mm厚度的组织,其所需的成形钉尺寸为0.75mm。每个指示器板1712可进一步具有对应于第二组织厚度范围“T2”的第二厚度识别器1722。例如,第二组织厚度范围“T2”可表示具有约1.0mm至约1.5mm厚度的组织,其所需的成形钉尺寸例如为1.0mm。每个指示器板1712可进一步具有对应于第三组织厚度范围“T3”的第三组织厚度识别器1724,第三组织厚度范围“T3”对应于组织的第三特定尺寸。例如,第三组织厚度范围“T3”可表示具有约1.5mm至2.0mm厚度的组织,其所需的成形钉尺寸例如为1.5mm。每个指示器板1712可进一步具有对应于第四组织厚度范围“T4”的第四组织厚度识别器1726,该第四组织范围“T4”对应于组织的第四特定尺寸。例如,第四组织厚度范围“T4”可表示具有约2.0mm厚度的组织,其所需的成形钉尺寸例如为2.0mm。组织识别器1720,1722,1724,1726可包括例如数字、字母、颜色等,这些均理解为对应于特定的组织厚度范围。在不同实施方式中,可在仓1652上提供近侧组织止挡部1721,以提供抵接壁将组织定位在仓1652和砧座组件20之间。见图17,22和24。同样在各种实施方式中,如图22所示,可在仓1652上设置组织抓握构件1723来帮助抓握和定位仓1652和砧座组件20之间的组织。
从图25可以看出,可在外壳1610的每个侧面部分提供与组织识别器1720,1722,1724,1726重合的视窗1730,下面将进一步详细讨论。图18和19示出了当没有组织被夹在砧座组件20和组织测量平台1660之间时指示器板1712的位置。从这些图中可以看出,厚度识别器1720,1722,1724,1726的任一个都不能从视窗1730观察到。图26和27示出了当具有组织厚度范围T1的组织被夹在砧座组件20和组织测量平台1660之间时指示器板1712的位置。从这些图中可以看出,第一组织指示器1720可通过相应的视窗1730看到。
图28示出了当具有组织厚度范围T2的组织被夹在砧座组件20和组织测量平台1660之间时指示器板1712的位置。从图中可以看出,第二组织指示器1722可通过相应的视窗1730看到。图29示出了当具有组织厚度范围T3的组织被夹在砧座组件20和组织测量平台1660之间时指示器板1712的位置。从图中可以看出,第三组织指示器1724可通过相应的视窗1730看到。图30示出了当具有组织厚度范围T4的组织被夹在砧座组件20和组织测量平台1660之间时指示器板1712的位置。从图中可以看出,第四组织指示器1726可通过相应的视窗1730看到。因此,通过可操作地将外科工具1600与外科器械10连接,以及在组织测量平台1660和砧座组件20之间夹紧待缝合的一部分目标组织(通过朝向固定手柄部分22致动可动手柄部分24),临床医生可以确定待缝合的组织的厚度,随后选择带有适当尺寸的钉的一次性缝合单元,例如美国专利No.5,865,361公开的类型。临床医生随后只需简单地将外科工具1600从外科器械10上分离,并可操作地将选择的一次性缝合单元连接到外科器械10上,并对其进行操作,如美国专利No.5,865,361中所述。
图31-35示出了另一外科工具实施方式1800,其包括与外科器械10共同使用的夹具施放器,以在人体上施加至少一个外科夹具1801。外科工具1800的各种实施方式可采用美国专利No.5,951,574公开的夹具施放器的各个组件,其公开的内容通过引用结合入本文。在外科技术领域,使用外科夹具1801在体内结扎体内结构,如脉管、导管及组织,是众所周知的。外科工具1800的各种实施方式可具有一对相对的可动钳口1820,当钳口1820打开时,在钳口中依次容纳夹具1801,而当钳口1820闭合时,在其中对依次容纳的夹具1801进行成形,见图33。钳口1820可连接于从外壳组件1840突起的、通常成直角的轴1830的远端。轴1830可具有“U”形结构的外罩1832、透明的上盖1834以及包括其内包含大量夹具(未示出)的夹具库。
外壳组件1840可包括基底部分1842,盖1844连接于所述基底部分1842上,见图34。基底部分1842具有近端1846,该近端设置为与外科器械10的细长主体14和控制杆52可操作地连接。近端部分1846具有空心连接器部分1848,该连接器部分1848包括可释放地与外科器械10的细长主体14接合的接合凸起254。
器械1800可进一步包括击发杆连接器1850,其具有容纳控制杆52的远端276于其中的近侧孔1852。见图34。击发杆连接器1850与成形板1860连接,除了此处讨论的区别外,成形板1860与美国专利No.5,951,574中公开的成形机构85结构相似。从图31-33和35可以看出,在成形板1860上可具有用于与齿轮组件1870啮合的成形齿条1862。齿轮组件1870可转动地支撑在齿轮柱1872上,齿轮柱从基底部分1842伸出并且延伸穿过成形板1860上的细长槽1864。齿轮组件1870可具有与成形齿条1862啮合的成形齿轮部分1874。齿轮组件1870还可包括连接到成形齿轮1874上的进给齿轮1876。进给齿轮1876与形成于进给板1880上的进给齿条1882接合,进给板执行与美国专利No.5,951,574的进给机构100执行相同的功能。在各种实施方式中,齿轮组件1870和齿条1862,1882可具有2∶1的传动比,因此当成形板1860在远侧方向“DD”上被驱动时,进给板1880同时在近侧方向“PD”上仅仅被驱动到成形板1860在远侧方向“DD”上被驱动的距离的一半。
外科工具1800还具有夹具推动器1890(图33),其在经过大量同时发生的动作时能保持大致固定。当控制杆52在近侧方向上移动进给板1880以将夹具1801放入打开的钳口1820中时,夹具推动器1890可释放地与可动进给板1880连接。轴1830内的夹具库为进给板1880和夹具推动器1890提供另外的夹具1801,以将夹具1801连续地放入钳口1802。
通过在远侧方向“DD”上移动控制杆52而将外科工具1800激活,这使钳口1820闭合并使连续容纳于钳口中的每个夹具1801成形。在近侧方向“PD”上移动控制杆52,使得钳口1820打开并释放充分成形的夹具1801,并将未成形的夹具1801连续地进给至打开的钳口1820中。外科工具1800以如前所述的方式与细长主体部分14和控制杆52相连接,并通过如前所述的方式将可动手柄部分24移向和移离固定的手柄部分22来进行操作。所属领域的普通技术人员可以理解,外科工具1800特别适合于在开放手术中使用,从而能拓宽传统外科器械10的用途,在过去传统外科器械10局限于与内窥镜外科手术关联使用。
已设计出与传统外科器械10一起使用的现有一次性装载单元的工具组件,该工具组件被构造成以直线方式施加钉。在各种外科技术中,诸如胃组织的切除,例如通常优选这样的线性施用。在这些技术中,一次性装载单元典型地通过套管插入外科部位,因此,通常需要装载单元的工具组件具有线性构造以在将工具组件插入套管之前与套管的轴线对准。但是,在有些状况下,这些具有线性构造的工具组件在使用上有些困难。更具体地,例如,当工具组件必须邻近或抵靠腔壁例如胸腔壁放置时,医生通常很难将工具组件的钳口放置到接近和/或连接在腔壁上的脆弱的或易碎的组织后面。此外,就算医生能成功地将钳口放到组织后面,由于工具组件的线性结构,医生可能无法看见工具组件的远端。在有些情况下,具有可重复使用的刀片和驱动系统的外科器械已被开发出来,其采用弯曲的端部执行器。这些装置的例子在共同拥有的2007年1月11日提交的、序列号为11/652,170并且题为Surgical Stapler End Effector With aTapered Distal End的美国专利申请中公开,其公开的内容通过引用结合入本文。
图36描绘了可与外科器械10关联使用的本发明另一种外科工具实施方式1900。从该图可以看出,外科工具1900可包括弯曲的承载器1916,外壳构件1910连接于该承载器上。外壳1910可通过卡扣特征件或其他合适的方式连接到承载器部分的直立的壁1917上。外壳构件1610具有近端1912,该近端构造为可移除地与外科器械10的细长主体14连接。特别地,近端1912可具有形成于其上的接合凸起254,其用于如上所述与外科器械10的细长主体部分14的远端形成卡口式连接。
在本发明的多个实施方式中,承载器1916和支撑在其中的钉仓1920是弯曲的。在多个实施方式中,例如,这些部件的曲率设置为基本上与典型的胸腔壁的轮廓相匹配。在这些实施方式中,可以测量并统计分析若干胸腔壁的曲率以确定弯曲的端部执行器的最佳轮廓。该轮廓可以包括多个弓形部分,以及另外多个线性部分。在其他实施方式中,胸腔壁的曲率可由单个曲率半径来逼近。这些实施方式更简单并且制造起来不昂贵。在至少一种实施方式中,该曲率半径是1.2”。在其他多个实施方式中,承载器1916和钉仓1920的曲率可设置为与下直肠、骨盆或下腹部的轮廓相匹配。例如,图37示出了采用承载器1916’的可选外科器械1900’,该承载器1916’具有与承载器1916不同的曲率。也可以使用前述的序列号为No.11/652,170的美国专利申请中公开的其他曲率。
在本发明的多种实施方式中,钉仓1920包括弯曲的槽1922,用于控制轴向的驱动组件1966沿弯曲的路径运动。该弯曲的槽1922可包括多个弓形部分和多个线性部分。在各种实施方式中,弯曲的槽1922可由一个曲率半径来限定。砧座组件1930在其他方面同上述的砧座组件类似,其可具有一与承载器1916和钉仓1920基本上相匹配的弯曲部分(为了清楚起见在图36和37中省略)。在图36和37所示的实施方式中,钉仓1920具有弯曲的槽1922。承载器1916和砧座组件在之中均可具有同样的槽(未示出),其与槽1922连接用于在其中容纳驱动梁1966的相应部分。驱动构件1966的远端可以通过如上所述的关于驱动梁266的方式构造以便于如上所述通过控制杆52的运动进行其驱动致动。驱动梁1966的近端包含刀片(未示出),该刀片可构造为当驱动梁1966通过外科器械10的可动手柄24的运动在远侧方向“DD”上被驱动时,使得驱动梁1966通过由槽1922所限定的弯曲路径。
图38和39描述了本发明的外科工具实施方式2000,其与外科器械10连接并用于在开放外科环境中烧灼组织。从这些图可以看出,外科工具2000可包括外壳2010,该外壳2010具有设置为可移除地与外科器械10的细长主体14连接的近端2011。特别地,近端2011可具有形成于其上的接合凸起254,其用于像如上所述的那样形成与外科器械10的细长主体部分14远端的卡口式连接。
外壳2010还可包括开关部分2013,其中可动地装有电池2030。可动电池2030可以是已被Mark H.Ransick等人于与本申请同一天提交的共同拥有的题为Disposable Motor Driven Loading Unit For UseWith a Surgical Cutting and Stapling Apparatus,代理卷号为END6213USNP/070330的美国专利申请公开,其通过引用结合入本文。更具体地,参见图39,外壳2010的开关部分2013限定了电池舱2032,该电池舱可动地支撑收容电池2030在其中的电池保持器2034。由图39可以看出,第一电池接触器2036以与电池2030电接触的方式受支撑,并从电池保持器2034中伸出以与电池舱2032的内壁2033滑动地接合。相似的,第二电池接触器2038以与电池2030电接触的方式安装,并也从电池保持器2034伸出以沿着电池舱2032的内壁2033滑动。电池保持器2034具有控制杆插口2035,其设置为当外科工具2000的近端2011与外科缝合设备10的细长主体14相接合时,能容纳控制杆52的远端276。从图39中也可以看出,一对接触器2026,2028可在壁2033内定向,以分别与电池接触器2036,2038接触。接触器2026,2028的目的将在下面进一步详细讨论。从图39中也可以看出,偏压元件或开关弹簧2040放置在电池舱2032内,以在近侧方向“PD”上偏压电池保持器2034,从而当外科工具2000未与细长主体14连接时,电池保持器2034被偏压至其最近侧的位置,如图39所示。当通过弹簧2040保留在“使用前”或“断开”位置时,电池接触器2036和2038在电池舱2032内不与它们各自的接触器2026,2028接触,以防止电池2030在没使用时被消耗。
从图38可以看出,外科工具2000可进一步包括非施用钉的端部执行器,其形式为球形端部构件2050,且通过销可枢转地连接到与外壳2010远端连接的轭2052上。在各种实施方式中,端部执行器2050可由传导材料例如不锈钢、钛等制成,且其中具有至少一个电动构件2060。在图38描述的实施方式中,电动构件2060可包括加热元件。所属领域的普通技术人员可以理解,端部执行器2050可以是各种其它形状或结构,其不脱离本发明精神和范围。从图38中可以进一步看出,加热元件2060可通过引线2022,2024分别与接触器2026,2028电连接。
因此,当外科工具2000未与外科器械10的细长主体14连接时,电池2030将被偏压进入未致动的位置(图39),并因此电池不会被消耗。此外,外科工具2000与细长主体14的连接以及控制杆52与电池保持器插口2035的连接不会导致电池2030的工作或消耗。为了使用工具2000,临床医生简单地使可动手柄24向手柄组件(图1)的固定部分22运动以驱动电池接触器2036,2038分别与接触器2026,2028的接触,这随后为端部执行器2050中的加热元件2060提供动力。灯或其他指示器2070可由外壳2010支撑,并由电池2030提供电力以为临床医生提供加热元件2060正在被提供电力的指示。
图40示出了与上述外科工具2000基本上相类似的另一外科工具实施方式2000’。但是,在该实施方式中,外科工具2000’中不具有电池。外科工具2000’构造为与外科器械10’一起使用,该外科器械10’具有由安装在手柄组件12’中的开关2090操作的电池2030’。开关2090与位于细长主体14远端中的接触组件2092通信。当工具2000’与细长主体14连接时,接触组件2092被定向成与安装在工具2000’外壳部分的近端上的接触器2094接触。为了激活端部执行器2050中的加热元件2060,临床医生致动手柄组件12’上的按钮2090。灯2070’也可安装在手柄组件12’上,以提供工具2000’正在被提供电力的指示。
图41和42示出了替代的外壳实施方式2200和2200’,其可用于在使用柔性驱动组件时替代如上所述的各种外壳装置。特别地,当使用的驱动组件能够弯曲或至少具有能够弯曲的部分时,这些外壳2200,2200’至少可与图2-30和36-40所描述的各种实施方式关联使用。图41描述的外壳2200可如图所示构造为具有近端部分2202,该近端部分2202被构造成容纳控制杆52的远端于其中,并且在近端部分上具有凸起254,以便于如上所述与细长主体14连接。然而,在该实施方式中,外壳2200具有形成于其中的无源关节运动的接头构件2300,以便于如图所示围绕外壳2200的纵向轴线L-L进行无源关节运动。无源关节运动的接头构件2300可包括具有联锁肋条2304的柔性导管部分2302,该联锁肋条构造为将无源关节运动的接头构件2300保持在关节运动方向上。
图42示出了另一种连接外壳2200’,其具有通过例如近侧主体凸缘2310与近侧外壳部分2400连接的另一无源关节运动的接头构件2300’,。柔性关节运动构件2300’具有主体部分2301,并包括被肋条2304隔开的多个切口2303。在各种实施方式中,切口2303和肋条2304可沿柔性关节运动构件2300’等距地分布,因此当柔性关节运动构件进行关节运动时形成一连续的弯曲半径。通过在切口2302和肋条2304之间提供的不等间隔,可获得具有多个弯曲半径的柔性关节运动构件2300’。例如,可通过使肋条2304在一端间隔较近并且在另一端间隔较远来得到这种布置。本领域普通技术人员可以理解,切口2302和/或肋条2304的间距的增加会减小具有较大间隔的部分的弯曲半径,从而更接近地逼近枢轴支点弯曲连接。相反地使切口2302和/或肋条2304间隔得更近会导致更缓和的弯曲,从而具有更大的弯曲半径。
在图42示出的实施方式中,切口2302包括至少部分绕柔性关节运动构件2300’周边延伸的环形槽。然而,切口2302优选包括半环形槽,其被沿柔性关节运动构件2300’的纵向轴线L-L向下延伸的中央纵脊2306隔开,使得多个第一肋条2304形成在脊2306的一侧,而多个第二肋条2304形成在脊2306的另一侧。该脊2306有助于为柔性关节运动构件2300’增加刚性,并提供槽(未示出)用于容纳驱动组件穿过其中。纵向的脊2306可贯穿柔性关节运动构件2300’的整个纵向长度。柔性关节运动构件2300’在两侧上也可包括一对穿过每个肋条2304的侧槽(未示出),用于容纳相应的关节运动板(未示出),其在Frederick E.Shelton,IV等人在与本申请同一天提出的共同拥有的题为Articulatable Loading Unit For Surgical Stapling andCutting Instrument,申请号为No.12/031,001的美国专利申请中描述,其通过引用结合入本文。如其中论述的,这些关节运动板可由相对无弹性的材料制成。也就是说,这些板可由这样的材料制成,它们能够保持弯曲后的位置。例如,关节运动板可由例如铅、铜等材料制成。本领域普通技术人员可以理解,支撑在外壳2300或2300’的任一个中的驱动组件的至少柔性部分或另外的可关节运动的部分被设置成与柔性关节运动构件2300,2300’相对应,以便于外科工具的关节运动,而对于延伸穿过关节运动组件的驱动组件的操作没有不利的影响。
因此,由上述可以理解,本发明的各种外科工具实施方式特别适合于与外科器械一起使用,该外科器械专门设计用于与一次性切割和缝合单元联合使用,该一次性切割和缝合单元具有它们专用的切割刀片并构造为在使用一次后丢弃。虽然这些器械通常可以与多个一次性切割和缝合单元联合使用,但是临床医生在操作中不得不用手握住多个其它的专用器械以实施其它手术。本发明的可互换工具系统解决了这个问题。因此,本发明多个实施方式可包括外科工具系统,该外科工具系统可包括外科器械10和至少两种在此公开的各种外科工具。例如,外科工具包括操纵器1000,镊子1200,剪刀1300,一次性内镜切割器16,组织厚度测量装置1600,钉施放器1400,夹具施放器1800,烧灼装置2000以及样本取回装置1100。
尽管描述本发明多种实施方式时,然而本领域技术人员可想到这些实施方式的各种修改、变形和适配并且获得本发明的部分或所有的优点。例如,根据各种实施方式,在执行给定的一个或多个功能时,单个组件可被多个组件替代,并且多个组件也可以被单个组件替代。因此,本发明旨在覆盖不超出如后附权利要求书所限定的本公开发明范围和精神的所有这样的改进、变型和修正。
通过引用结合入本文的任意专利,出版物或其他的公开材料通过引用完全或部分地结合于本文中,其引入范围是结合在本文中的材料并不与本申请中清楚给出的现有定义,陈述或其他公开材料相冲突。同样,在必要的范围中,本文明确给出的公开内容可取代通过引用结合入本文的任何相冲突的材料。对于所述通过引用结合入本文的任何材料或其部分,如果其与本文给出的现有定义、陈述或其他公开材料相冲突,则在不使结合的材料和现有的公开材料冲突的情况下才结合入本文。
意图保护的本发明不限于具体实施方式所限定公开的内容。因此,实施方式应视为示意性的而不是限制的。在不脱离本发明的精神的情况下,可以对其做出变型和改变。因此,其明确指出将落在如权利要求书所限定的本发明的精神和范围内的所有等同物、变型和变化都包含在其中。
Claims (10)
1.一种用于外科器械的外科工具,该外科器械具有手柄组件和细长主体,在所述手柄组件中可操作地支撑驱动系统,以通过所述手柄组件的可动手柄部分的致动产生驱动运动,在所述细长主体中可操作地支撑控制杆以传递所述驱动运动,所述外科工具包括:
外壳,其可移除地与所述细长主体连接;
驱动组件,其可操作地支撑在所述外壳中并且可移除地与所述控制杆连接;以及
一对非钉成形钳口,其可操作地与所述驱动组件连接,使得在沿着第一方向将所述驱动运动施加到所述驱动组件上时引起所述一对非钉成形钳口的每个都同时沿着闭合方向朝着彼此运动,并且在沿着第二方向施加另一个所述驱动运动时,所述一对非钉成形钳口的每个都同时沿着打开方向相互远离地运动。
2.根据权利要求1所述的外科工具,其中,所述驱动组件包括:
近侧驱动梁段,其能够可移除地与所述控制杆连接;以及
远侧驱动梁段,其与所述近侧驱动梁段和所述一对非钉成形钳口以可枢转的方式连接。
3.根据权利要求2所述的外科工具,其中,所述远侧驱动梁段通过可操作地支撑在所述外壳中的反向连接组件与所述近侧驱动梁段以可枢转的方式连接,并且所述远侧驱动梁段通过一对枢轴连杆与所述一对非钉成形钳口以可枢转的方式连接。
4.根据权利要求1所述的外科工具,其中,所述非钉成形钳口的每个都包括组织夹紧钳口。
5.根据权利要求4所述的外科工具,其中,至少一个所述组织夹紧钳口具有形成于其中的空腔部分,用以容纳切除的组织。
6.根据权利要求1所述的外科工具,其中,所述非钉成形钳口的每个都包括剪刀钳口。
7.根据权利要求1所述的外科工具,其中,在所述外壳中具有无源关节运动的接头。
8.一种用于外科器械的外科工具,该外科器械具有手柄组件和细长主体,在所述手柄组件中可操作地支撑驱动系统,以通过所述手柄组件的可动手柄部分的致动产生驱动运动,在所述细长主体中可操作地支撑控制杆以传递所述驱动运动,所述外科工具包括:
承载器;
外壳,其与所述承载器连接并且可移除地与所述细长主体连接;
驱动组件,其可操作地支撑在所述外壳和所述承载器中并且可移除地与所述控制杆连接;
非钉成形砧座,其可移除地支撑在所述承载器上并且可操作地与所述驱动组件相互作用,以选择性地使所述非钉成形砧座移向所述承载器和从所述承载器移开;以及
组织厚度测量仓,其能够被支撑在所述承载器中并且具有与所述外壳相互作用的指示器构件,以提供被夹在所述非钉成形砧座和所述组织厚度测量仓之间的组织的厚度范围的指示。
9.根据权利要求8所述的外科工具,其中,所述组织指示器构件能够区别多个不同的组织厚度范围。
10.根据权利要求8所述的外科工具,其中,在所述外壳中具有无源关节运动的接头。
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- 2009-02-16 CN CN2009101346326A patent/CN101530340B/zh active Active
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2010
- 2010-02-08 HK HK10101408.2A patent/HK1137636A1/zh not_active IP Right Cessation
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2014
- 2014-05-07 US US14/272,197 patent/US20140243865A1/en not_active Abandoned
- 2014-05-12 US US14/275,232 patent/US20140330161A1/en not_active Abandoned
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2017
- 2017-11-06 US US15/804,160 patent/US10743851B2/en active Active
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2020
- 2020-06-30 US US16/916,375 patent/US20200375585A1/en active Pending
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Also Published As
Publication number | Publication date |
---|---|
US20180078248A1 (en) | 2018-03-22 |
US20090209946A1 (en) | 2009-08-20 |
US10743851B2 (en) | 2020-08-18 |
JP2009189830A (ja) | 2009-08-27 |
BRPI0904823A2 (pt) | 2011-03-15 |
US8758391B2 (en) | 2014-06-24 |
US20140243865A1 (en) | 2014-08-28 |
JP5442271B2 (ja) | 2014-03-12 |
PL2098170T3 (pl) | 2016-06-30 |
RU2495637C2 (ru) | 2013-10-20 |
EP2098170A2 (en) | 2009-09-09 |
EP2098170A3 (en) | 2013-06-26 |
EP2098170B1 (en) | 2015-12-16 |
US20200375585A1 (en) | 2020-12-03 |
HK1137636A1 (zh) | 2010-08-06 |
US20140330161A1 (en) | 2014-11-06 |
RU2009105148A (ru) | 2010-08-20 |
CN101530340B (zh) | 2013-08-21 |
BRPI0904823B1 (pt) | 2019-07-02 |
BRPI0904823B8 (pt) | 2021-06-22 |
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