CN101574272A - 具有夹具的手术器械 - Google Patents

具有夹具的手术器械 Download PDF

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CN101574272A
CN101574272A CNA2009101364023A CN200910136402A CN101574272A CN 101574272 A CN101574272 A CN 101574272A CN A2009101364023 A CNA2009101364023 A CN A2009101364023A CN 200910136402 A CN200910136402 A CN 200910136402A CN 101574272 A CN101574272 A CN 101574272A
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anchor clamps
pincers
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CN101574272B (zh
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戴维·法拉肖尼
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Covidien LP
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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
    • A61B17/068—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
    • 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
    • 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
    • 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
    • A61B2017/00353—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery one mechanical instrument performing multiple functions, e.g. cutting and grasping
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • 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
    • 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
    • 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
    • A61B2017/07214—Stapler heads
    • A61B2017/07221—Stapler heads curved
    • 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
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • 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
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2931—Details of heads or jaws with releasable head
    • 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
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2945—Curved jaws
    • 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
    • A61B2018/1405—Electrodes having a specific shape
    • A61B2018/1425—Needle
    • A61B2018/1432—Needle curved

Abstract

本发明公开了一种用于手术地连接组织的手术器械。所述手术器械包括手柄部、内窥镜部、一对钳构件以及夹具。内窥镜部从手柄部向远侧延伸并且限定了第一纵轴。所述一对钳构件邻近内窥镜部的远端布置并且一般从其向远侧延伸。钳构件中的至少一个可在打开位置与接近位置之间相对于另一个移动以接合其间的体组织。夹具邻近钳构件布置并且一般从内窥镜部向远侧延伸。夹具可在打开位置与接近位置之间移动以接合体组织。夹具可相对于钳构件独立地移动。

Description

具有夹具的手术器械
相关申请的交叉引用
[0001]本申请要求于2008年5月5日提交的申请序列号为61/050,282的美国临时专利申请的权益和优先权，其全部内容通过引用合并于此。
技术领域
[0002]本公开一般涉及用于手术地连接组织的器械，并且尤其涉及具有夹具的手术器械。
背景技术
[0003]用于手术地连接组织的各种手术器械在本领域中是公知的，并且通常用于例如横切、切除、吻合中的组织或器官的闭合(closure)、用于胸腹操作中的器官的闭合(occlusion)，并且用于电手术融合或密封组织。
[0004]所述手术器械的一个示例是手术缝合器械，手术缝合器械可以包括砧座组件、用于支撑一排手术缝合钉的钉仓组件、用于接近钉仓和砧座组件的接近机构，以及用于使手术缝合钉从钉仓组件弹射出的发射机构。
[0005]外科医生通常使用手术缝合器械来接近砧座和钉仓组件。接下来，外科医生可以启动(fire)所述器械以将缝合钉安置在组织中。另外，外科医生可以使用同一个器械或分离的器械来切割邻近缝合钉排或在缝合钉排之间的组织。
[0006]本公开的手术器械的其它示例包括电手术(例如，单极或双极的)镊。电手术镊通过加热组织和血管以凝结、烧灼和/或密封组织而利用机械箝位作用和电能影响止血。
发明内容
[0007]本公开涉及一种用于手术地连接组织的手术器械。所述手术器械包括手柄部、伸长部、一对钳构件以及夹具。伸长部从手柄部向远侧延伸并且限定了第一纵轴。所述一对钳构件邻近伸长部的远端布置。钳构件中的至少一个可在打开位置与接近位置之间相对于另一个移动以接合其间的体组织。夹具邻近钳构件布置并且一般从伸长部向远侧延伸。夹具可在打开位置与接近位置之间移动以接合体组织。夹具可相对于钳构件独立地移动。
[0008]在一个公开的实施方式中，夹具包括第一部分和第二部分并且夹具的至少一个部分可围绕布置在夹具的近侧部处的枢轴点相对于另一个部分枢转。在另一个公开的实施方式中，钳构件中的每一个与夹具实质上平行。
[0009]在手术器械的实施方式中，钳构件包括砧座组件以及钉仓组件，或者配置成将电手术能量输送给组织。在公开的实施方式中，钳构件相对于第一纵轴弯曲并且/或者夹具相对于第一纵轴弯曲。在另外公开的实施方式中，钳构件可围绕第一纵轴相对于手柄部旋转。
[0010]在一个公开的实施方式中，钳构件是负载单元的一部分并且负载单元可连接到伸长部上。
[0011]在一个实施方式中，末端执行器限定了第二纵轴。这里，末端执行器可从第一位置移动到至少第二位置：在第一位置处，第二纵轴与第一纵轴实质上排列在一条直线上；在第二位置处，第二纵轴与第一纵轴成一角度布置。
[0012]本公开还涉及一种配置成与手术器械可拆卸地接合的负载单元。所述负载单元包括主体部、一对钳构件，以及夹具。主体部限定了第一纵轴。主体部的近侧部配置成与手术器械的伸长部可拆卸地接合。所述一对钳构件布置在主体部的远侧。钳构件中的至少一个可在打开位置与接近位置之间相对于另一个移动以接合其间的体组织。夹具邻近钳构件布置并且可在打开位置与接近位置之间移动以接合体组织。夹具可相对于钳构件独立地移动。
[0013]在一个公开的实施方式中，负载单元的夹具包括第一部分和第二部分并且夹具的至少一个部分可围绕布置在夹具的近侧部处的枢轴点相对于另一个部分枢转。
[0014]在一个实施方式中，钳构件中的每一个与夹具实质上平行。负载单元的实施方式还包括包含砧座组件以及钉仓组件的钳构件或者配置成将电手术能量输送给组织的钳构件。实施方式还包括相对于第一纵轴弯曲的钳构件和/或相对于第一纵轴弯曲的夹具。
[0015]本公开还涉及一种配置成与手术器械可拆卸地接合的负载单元，所述负载单元包括一对钳构件以及夹具，并且配置成与手术器械的伸长部可拆卸地接合。钳构件中的至少一个可在打开位置与接近位置之间相对于另一个移动以接合其间的体组织。夹具邻近钳构件布置并且可在打开位置与接近位置之间移动以接合体组织。负载单元具有用于致动钳构件的第一机构以及用于夹具的闭合机构。
[0016]在某些实施方式中，闭合机构包括夹具连杆。夹具连杆可以向近侧延伸以在负载单元与手术器械的伸长部接合后就接合手术器械上的器械连杆。在某些实施方式中，第一机构布置成使得钳构件在钳构件的打开与接近位置之间移动。在另一个实施方式中，第一机构布置成从钳构件中的至少一个发射缝合钉。
[0017]本公开还涉及一种用于连接组织的手术器械，其中，所述手术器械包括手柄部；伸长部，其从手柄部向远侧延伸并且限定了纵轴；一对钳构件，其邻近内窥镜部的远端布置，钳构件中的至少一个可在打开位置与接近位置之间相对于钳构件中的另一个移动以接合其间的体组织；以及夹具，其邻近钳构件布置并且可在打开位置与接近位置之间移动以接合体组织，钳构件是弯曲的。
[0018]在某些实施方式中，钳构件是弯曲的并且具有凸起侧和凹入侧，夹具邻近钳构件的凹入侧布置。夹具可以是弯曲的或者具有与弯曲的钳构件相对应的形状。
[0019]本公开还涉及一种手术地连接组织的方法。所述方法包括如下步骤：提供一种手术器械，使得手术器械的夹具从打开位置朝着接近位置的方向移动以接合体组织，使得手术器械的钳构件中的至少一个相对于另一个从打开位置朝着接近位置的方向移动以接合体组织，以及致动钳构件以连接组织。本公开的方法中所使用的手术器械包括手柄部、伸长部、一对钳构件以及夹具。伸长部从手柄部向远侧延伸。一对钳构件邻近伸长部的远端布置并且钳构件中的至少一个可在打开位置与接近位置之间相对于另一个移动以接合其间的体组织。夹具邻近钳构件布置。夹具可相对于钳构件独立地移动。
[0020]本公开的方法中所使用的手术器械的实施方式包括具有钉仓组件以及砧座组件的钳构件。本公开的方法中所使用的手术器械的其它实施方式包括配置成将电手术能量输送给组织的钳构件。
[0021]本公开的方法的实施方式包括鉴别肠组织的将被连接的部分、具有内部的肠组织，用手术器械的夹具夹紧邻近肠组织的被鉴别部分的肠组织，清洗或清洁肠组织的内部以便包括肠组织的被鉴别部分，接近手术器械的钳构件以接合肠组织的被鉴别部分，钳构件邻近夹具布置在手术器械上，从钳构件中的至少一个发射缝合钉。
[0022]在某些实施方式中，通过将超声波或电手术能量输送给组织来连接组织。在连接之后，可以使用布置在手术器械上或布置在分离的器械上的刀片来切割组织。
[0023]在另一个方案中，一种用于手术地连接组织的手术器械包括手柄部；内窥镜部，其从手柄部向远侧延伸并且限定了纵轴；以及一对钳构件，其邻近内窥镜部的远端布置。钳构件中的至少一个可在打开位置与接近位置之间相对于另一个移动以接合其间的体组织。所述一对钳构件相对于纵轴弯曲，所述一对钳构件包括砧座组件以及钉仓组件。钉仓组件容纳布置成朝着砧座组件的方向弹射出的多个手术缝合钉。夹具邻近所述一对钳构件布置，夹具可在打开位置与接近位置之间移动以接合体组织，并且夹具相对于纵轴弯曲。
[0024]在某些实施方式中，夹具沿着一对钳的凹入侧布置。
[0025]手术器械可以具有在横向于纵轴的方向上弹射出的手术缝合钉。在某些实施方式中，夹具包括第一部分和第二部分，并且其中，夹具的至少一个部分可围绕布置在夹具的近侧部处的枢轴点相对于另一个部分枢转。在手术器械中，所述一对钳构件中的每一个可以与夹具实质上平行。
[0026]在某些实施方式中，所述一对钳构件沿纵轴直线地延伸。所述一对钳构件可以配置成将电手术能量输送给组织。
附图说明
[0027]在本文中结合附图公开了本公开的手术器械的各种实施方式，其中：
[0028]图1A为根据本公开的一种手术缝合器械的立体图；
[0029]图1B为根据本公开的一种电手术镊的立体图；
[0030]图2至图4为与图1A和图1B中的手术器械一起使用的负载单元在手术的各个阶段的立体图；
[0031]图5和图6为图示了和夹具一起使用的闭合机构的图2至图4中的负载单元的立体图；
[0032]图7为图5和图6中的负载单元的侧视图；
[0033]图8为图5至图7中的负载单元的仰视图；以及
[0034]图9为图5至图8中的负载单元的另一侧视图。
具体实施方式
[0035]结合附图，对本公开的手术器械的实施方式以及和其一起使用的负载单元进行了详细地描述，其中，相同的附图标记指代各个图中的每一个中的相对应的元件。
[0036]在图1A中，本公开的一种手术缝合器械表示为附图标记100a。在图1B中，本公开的一种电手术镊表示为附图标记100b。在本文中，手术器械100a和100b总称为附图标记100。类似地，对于手术缝合器械100a和电手术镊100b来说共有的若干特征总称为相同的附图标记(例如，内窥镜部110、钳构件220以及夹具230)。
[0037]在图2至图9中示出了和手术器械100一起使用的负载单元(或“DLU”)200a。DLU 200a可连接在手术器械100的伸长部或内窥镜部110上，例如，以允许手术器械100具有较大的多功能性。DLU 200a可以配置成一次性的，并且/或者可以配置成多次使用。为了说明起见，图1A中所图示的手术缝合器械100a显示为具有不同的DLU 200b。根据本公开的一个实施方式，图1B中所图示的电手术镊100b被显示为没有DLU。
[0038]在博拉诺斯(Bolanos)等人共有的专利号为5,752,644的美国专利中公开了和手术缝合器械一起使用的负载单元的示例，所述专利的全部内容通过引用合并于此。在米利曼(Milliman)等人共有的专利号为6,953,139的美国专利中详细地描述了内窥镜手术缝合器械的进一步的细节，所述专利的全部内容通过引用合并于此。在于2003年2月20日提交的题目为血管密封及分割器及其制造方法的申请号为10/369,894的共有专利中描述了电手术镊的进一步的细节，所述专利的全部内容通过引用合并于此。
[0039]现在结合图2至图9，示出了本公开的DLU 200a。DLU 200a包括近侧部210、一对钳构件220，以及夹具230。近侧部210利用诸如卡口接头、闩锁(latch)、棘爪或搭扣配合的各种连接特征而配置成可拆除地连接在手术器械100的伸长部或内窥镜部110上(参见图1A)。
[0040]本公开还涉及具有包括图2至图9所示的特征的远侧部的手术器械100，其中，远侧部(包括钳构件220以及夹具230)固定地连接在内窥镜部(即，非DLU的一部分)上。因此，本文所描述的DLU的特征还可以被包括在没有可拆除或可替换的负载单元的手术缝合器械100a和/或电手术镊100b上。
[0041]当连同手术缝合器械100a使用时，钳构件220包括钉仓组件222以及砧座组件224(为了说明起见，钉仓组件和砧座组件用图2中的附图标记来示出，但是在没有背离本公开的范围的情况下可以位于与所示的相反的位置)。钉仓组件容纳多个缝合钉或紧固件(在图2至图9的实施方式中未明确示出)。钉仓组件222包括用于从其中弹射出缝合钉的多个缝合钉推动器。DLU可以包括多个凸轮杆以与推动器相互作用来部署手术紧固件。例如，在专利号为5,318,221的美国专利中公开的装置具有保持多个凸轮杆和刀具的凸轮杆适配器，所述专利的全部公开通过引用合并于此。通道通过向前驱动凸轮杆和刀具的所述装置的手柄的操作而前进。环绕砧座的近端的夹紧管被推进以将砧座和钉仓夹紧在一起。在另一个示例中，在专利号为5,782,396的美国专利中公开的装置具有致动滑板。伸长的驱动梁通过向前驱动致动滑板的装置的手柄的操作来向远侧前进。驱动梁的远端接合砧座以及随着驱动梁向远侧行进来支撑钉仓的通道，以部署缝合钉并且将砧座和钉仓夹紧在一起。在手术紧固件和/或缝合钉部署以及形成的上述示例中的每一个中，在朝着砧座组件的缝合钉形成袋或凹槽的方向上，在横向于装置的内窥镜轴或内窥镜部的纵轴的方向上驱动缝合钉。
[0042]砧座组件224包括缝合钉袋(在图2至图9的实施方式中未明确示出)，缝合钉袋配置成在它们由钉仓组件222驱动时形成缝合钉。夹具230邻近钉仓组件222和砧座组件224安装并且可相对于近侧部210移动以夹紧组织。夹具230包括第一部分232和第二部分234(参见图5)。夹具230的第一部分232和第二部分234中的至少一个可相对于另一个移动。
[0043]当连同电手术镊100b使用时，钳构件220相互合作以抓取、密封，以及在某些情况下，分割管状血管和维管组织。电手术镊100b可用于各种电手术操作并且一般包括壳体20、手柄组件30、旋转组件80、触发组件70，以及钳构件220。电手术镊100b还包括邻近其钳构件220的夹具230以在接近钳构件之前并且在将能量输送给钳构件之前夹紧血管或组织。另外，电手术镊100b包括将电手术镊100b连接到诸如发电机的电手术能源上的电手术电缆310。
[0044]具体结合图2至图6以及图8，钳构件220相对于由内窥镜部110限定的纵轴A-A弯曲(图1A和图1B)。如图所示，本实施方式的钳构件220一般从内窥镜部向远侧延伸。可以预想到，弯曲的钳构件200可以便于执行某些类型的手术操作。例如，与笔直的钳构件(诸如图1A中所图示的钳构件)相比，弯曲的钳构件200例如在低位前切除(“LAR”)的过程中可以有助于进入下骨盆区。另外，弯曲的钳构件220的包埋可以允许更清楚地看到手术部位并且还给予外科医生更多的空间来用他或她的手操纵目标组织或钳构件220本身。在夹具230和钳220不会聚或彼此叉开的意义上来说，希望夹具230也是弯曲的，或者夹具230和钳220是平行的。如图2所示，钳构件220具有凹入侧220a和凸起侧220b。夹具230弯曲或成形为与钳构件220相对应。夹具邻近钳构件220的凹入侧220a布置。在其它实施方式中，夹具布置在钳构件的凸起侧220b上。钳构件和夹具的其它形状可以用于提高对身体的可进入性，诸如成角度的钳构件和/或夹具。为了允许更灵活地放置钳构件220和夹具230(例如，在下盆腔区内)，手术器械100可以包括旋转特征(例如，图1A中的旋转分度盘120或图1B中的旋转组件80)以有助于钳构件220和夹具230能够相对于手术器械100的手柄部旋转。
[0045]在根据本公开的手术缝合器械中，杆或其它构件通过手柄的操作而向远侧移动以致动DLU并且部署缝合钉。例如，返回结合图1A，活动手柄132相对于固定手柄130的至少部分的致动纵向地平移驱动梁(在图示的实施方式中未明确示出)以相对于另一个钳构件接近至少一个钳构件。另外，活动手柄132的至少部分的致动(例如，连续致动)纵向地平移发射杆(在图示的实施方式中未明确示出)以从钉仓组件170弹射出手术紧固件(例如，缝合钉)和/或使刀具前进以切割组织。还可以预想到，第一手柄使钳构件相对于彼此接近并且第二手柄和/或第三手柄的致动引起紧固件的弹射和刀具的前进。其它类型的手柄可以通过诸如电动机驱动、液压驱动、棘轮效应等来使用。
[0046]继续结合图1A，杠杆140被显示为邻近旋转分度盘120并且可以用来帮助钳构件220的铰接。杠杆140的致动使得钳构件220在第一位置与第二位置之间移动：在第一位置处，钳构件220与纵轴A-A实质上排列在一条直线上；在第二位置处，钳构件220相对于纵轴A-A成一角度布置。可以预想到，移动杠杆140使得铰链连杆(articulation link)纵向地移动，这导致了至少一个钳构件的近侧部向近侧或远侧移动。即，在第一方向上移动杠杆140使得铰链连杆向近侧移动(这在第一方向上铰接钳构件220)而在第二相反的方向上移动杠杆140使得铰链连杆向远侧移动(这在第二方向上铰接钳构件220)。
[0047]在图2至图9中示出了夹具230。在一个公开的实施方式中，夹具230用于将组织压缩在其第一部分232与第二部分234之间。可以预想到，用户可以将夹具230放置在钳构件220(以及随后的缝合线或密封线)的近侧上，这可以便于直肠清洗。
[0048]如图2至图4所示，用户与致动钳构件220分开地致动夹具230。在连同手术缝合器械100a的预期使用中，用户首先将DLU 200a放置在组织附近(夹具230和钳构件220在打开位置，如图2所示)。接下来，用户使得夹具230压缩组织(图3)并且随后闭合钳构件220(图4)。在钳构件220在期望位置闭合之后，用户则可以缝合组织(例如，顺序地)和/或切割组织。
[0049]在连同电手术镊100b的预期使用中，用户首先将钳构件220放置在组织附近(夹具230和钳构件220在打开位置，如图2所示)。接下来，用户使得夹具230压缩组织(图3)并且随后闭合钳构件220(图4)。在钳构件220在期望位置闭合之后，用户则可以压下触发组件70以将能量输送给组织来密封或凝结组织。用户可以在密封/凝结或其后的过程中切割组织。
[0050]可以意识到，存在可以实现手术器械100的各种致动的若干方法。例如，手术器械100可以包括固定手柄、夹紧手柄、第一活动手柄、第二活动手柄以及释放按钮。可以进一步预想到，可以致动释放按钮以释放夹具230(例如，从锁定位置)。一个或多个活动手柄设置在手术器械100上以实现夹具230的闭合、钳构件220的闭合，以及缝合钉的发射或者将能量输送给组织。
[0051]还可以预想到致动手术器械100的其它方法。例如，当DLU 200a和图1a中的手术缝合器械100a一起使用时，活动手柄132的致动可以闭合钳构件220、发射缝合钉和/或切割组织，而杠杆140的致动可以用于操作夹具230。另外，手柄部130可以包括可以多次挤压的单个活动手柄，其中，每次致动可以执行不同的操作。即，活动手柄的第一致动可以致动夹具230，活动手柄的第二致动可以接近钳构件220，而同一个活动手柄的第三致动可以部署缝合钉和/或刀具或者可以将能量输送给组织。
[0052]现在结合图5和图6，示出了用于接近夹具230的闭合机构240。闭合机构240包括销242以及倾斜槽244。销242布置在DLU 200a或手术器械100的夹具连杆(非夹具230的一部分)上。槽244示出为布置在夹具230的第一部分232上。结合图5和图6可以了解，夹具230利用杠杆140的致动使得手术器械100的铰链连杆移动。当DLU 200a连接到器械100上时，铰链连杆连接到夹具连杆上。夹具连杆的移动引起销242与槽244之间的相对移动。即，销242相对于槽244向近侧移动使得夹具230的第一部分232朝着夹具230的第二部分234移动(例如，凸轮带动(cam)、绕枢轴转动(pivot)等)。任意适合的结构可以与手术器械100和/或DLU 200a结合以引起销242与槽244之间的相对移动。例如，手术器械100可以包括在活动手柄/旋钮/等的致动后就可纵向地移动的夹圈(clamp collar)。在所述的一个实施方式中，夹圈的远侧平移可以相对于第二部分234用凸轮带动第一部分232，并且因此来接近夹具230。另外，夹圈的近侧平移可以打开夹具230。另外，如图2至图4所示，闭合机构240可以被包含(或至少部分地包含)在壳体246内，例如以有助于防止组织的不期望的夹痛(pinching)。
[0053]另外，返回结合图2，本公开的一个实施方式包括布置在夹具230上的短小突起250。(例如，在图2中，短小突起250示出在夹具的第二部分234上。)可以预想到，短小突起250配置成在夹具230处于闭合位置时与布置在夹具230的相反部分(例如，第一部分232)上的孔251(在图2中以虚线示出)紧密配合。在使用的过程中，该短小突起250/孔的结合可以有助于使夹具230保持在闭合位置并且还有助于保持夹具230的部分232、234的对准。
[0054]在另一个实施方式中，钳构件和/或夹具枢转地连接到DLU的近侧部210上。DLU包括夹具连杆以及铰链连杆，其每一个均在使手术器械100的伸长部与DLU接合后就接合伸长部中的相对应的连杆。器械100的手柄部包括杠杆、滑块、按钮、可枢转手柄等的任意组合，以分开地致动钳构件、夹具以及使得钳构件和/或夹具相对于手术器械的近侧部210和伸长部枢转(还被公知为铰接)。在米利曼等人共有的专利号为6,953,139的美国专利中公开了一种用于内窥镜手术缝合器的铰接负载单元，所述专利的全部内容通过引用合并于此。
[0055]本公开还涉及一种使用所描述的手术器械100和DLU 200a的方法。如上所述的方法包括提供手术器械100、经由夹具230来夹紧组织、接近钳构件220、发射缝合钉(例如，顺序地)或将能量输送给组织，和/或切割组织(例如，利用布置为与DLU 200a或手术器械100机械合作的刀具，或者使用分离的器械)。在某些实施方式中，致动夹具230，夹紧到肠组织上。然后，清洗或清洁肠组织的内部。然后使用电手术能量来切割和缝合或连接组织。这样，内部的肠组织被彻底清洁到夹具的位置，所述位置包括一旦钳被接近则所述钳将接合将被缝合和/或切割的肠组织的区域。
[0056]虽然以上描述包含了许多细节，但是这些细节不应解释为对本公开的范围的限制，而仅仅是其各种实施方式的说明。因此，以上描述不应理解为限制，而仅仅是各种实施方式的例证。本领域技术人员将预想到在所附的权利要求的范围和精神内的其它改进。

Claims (16)

1、一种用于手术地连接组织的手术缝合器械，包括：
手柄部；
内窥镜部，其从所述手柄部向远侧延伸并且限定了第一纵轴；
一对钳构件，其邻近所述内窥镜部的远端布置并且一般从其向远侧延伸，所述钳构件中的至少一个可在打开位置与接近位置之间相对于另一个移动以接合其间的体组织，所述一对钳构件包括砧座组件以及钉仓组件，所述钉仓组件容纳被布置成将在横向于所述第一纵轴并且朝着所述砧座组件的方向上弹射出的多个手术缝合钉；以及
夹具，其邻近所述钳构件布置并且一般从所述内窥镜部向远侧延伸，所述夹具可在打开位置与接近位置之间移动以接合体组织，并且其中，所述夹具可相对于所述钳构件独立地移动。
2、根据权利要求1所述的手术器械，其中，所述夹具包括第一部分和第二部分，并且其中，所述夹具的至少一个部分可围绕布置在所述夹具的近侧部处的枢轴点相对于另一个部分枢转。
3、根据权利要求1所述的手术器械，其中，所述一对钳构件中的每一个与所述夹具实质上平行。
4、根据权利要求1所述的手术器械，其中，所述一对钳构件沿所述第一纵轴直线地延伸。
5、根据权利要求1所述的手术器械，其中，所述一对钳构件配置成将电手术能量输送给组织。
6、根据权利要求1所述的手术器械，其中，所述一对钳构件相对于所述第一纵轴弯曲。
7、根据权利要求6所述的手术器械，其中，所述夹具相对于所述第一纵轴弯曲。
8、根据权利要求7所述的手术器械，其中，所述夹具沿着所述一对钳的凹入侧布置。
9、根据权利要求1所述的手术器械，其中，所述钳构件是负载单元的一部分，所述负载单元可连接到所述内窥镜部上。
10、根据权利要求1所述的手术器械，其中，所述一对钳构件可相对于所述手柄部旋转。
11、根据权利要求1所述的手术器械，其中，所述一对钳构件限定了第二纵轴，所述一对钳构件可从第一位置移动到至少第二位置：在所述第一位置处，所述第二纵轴与所述第一纵轴实质上排列在一条直线上；在所述第二位置处，所述第二纵轴被布置为与所述第一纵轴成一角度。
12、一种配置成与手术器械可拆卸地接合的负载单元，所述负载单元包括：
主体部，其限定了第一纵轴，所述主体部的近侧部配置成与所述手术器械的内窥镜部可拆卸地接合；
一对钳构件，其布置在所述主体部的远侧，所述钳构件中的至少一个可在打开位置与接近位置之间相对于另一个移动以接合其间的体组织，所述一对钳构件包括砧座组件以及钉仓组件，所述钉仓组件容纳被布置成将在横向于所述纵轴并且朝着所述砧座组件的方向上弹射出的多个手术缝合钉；以及
夹具，其邻近所述钳构件布置，所述夹具可在打开位置与接近位置之间移动以接合体组织，并且其中，所述夹具可相对于所述钳构件独立地移动。
13、根据权利要求12所述的负载单元，其中，所述夹具包括第一部分和第二部分，并且其中，所述夹具的至少一个部分可围绕布置在所述夹具的近侧部处的枢轴点相对于另一个部分枢转。
14、根据权利要求12所述的负载单元，其中，所述一对钳构件沿所述第一纵轴直线地延伸。
15、根据权利要求12所述的负载单元，其中，所述一对钳构件相对于所述第一纵轴弯曲。
16、根据权利要求15所述的负载单元，其中，所述夹具沿着所述一对钳的凹入侧布置。
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US8256653B2 (en) 2012-09-04
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