CN101612053A - 内窥镜缝合装置 - Google Patents
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
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- A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
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- A61B17/0625—Needle manipulators the needle being specially adapted to interact with the manipulator, e.g. being ridged to snap fit in a hole of the manipulator
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- 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
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- A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft
Abstract
本公开涉及通过进入管等用于内窥镜缝合或缝接的装置、系统和方法。提供了一种内窥镜缝合装置,所述内窥镜缝合装置包括手柄组件;由手柄组件支撑并且从手柄组件延伸出来的细长轴;以及被支撑在细长轴的远端上的末端执行器。所述末端执行器包括轴颈组件和一对并置的钳口,所述轴颈组件被配置为并且适于在基本线性构造和离轴构造之间在一个方向上铰接,所述一对并置钳口彼此可枢转地关联。每个钳口限定了形成在其组织接触表面中的缝合针容纳凹槽。
Description
相关申请的交叉引用
[0001]本申请要求享有于2008年6月13日提交的序列号为61/061,136的美国临时专利申请的优先权和利益,该申请的全部内容通过引用合并在此。
技术领域
[0002]本公开涉及用于内窥镜缝合或缝接的装置、系统和方法,尤其涉及通过进入管等用于内窥镜缝合和/或缝接的装置、系统和方法。
背景技术
[0003]随着医疗成本和住院成本的持续增加,外科医生不断努力开发先进的手术技术。手术领域的发展往往与操作技术的发展相关,操作技术涉及微创手术程序和减少整体患者创伤。通过这种方式,可以大大减少住院期的长度,因此也可以减少住院成本和医疗成本。
[0004]近年来,减少手术程序的侵入性的一个真正重大的进展是内窥镜手术。通常,内窥镜手术涉及切穿体壁,例如在卵巢、子宫、胆囊、肠、肾、阑尾等上观察和/或操作。存在许多常用的内窥镜检查性手术操作,包括关节镜检查、腹腔镜检查(盆腔检查)、胃肠镜检查以及喉支气管镜检查等,仅仅列举了几个。典型地,利用套针产生切口,通过切口来实施内窥镜手术。将套针管或套管装置延伸进腹壁中并留在腹壁中适当的位置以提供用于内窥镜手术工具的入口。将照相机或内窥镜通过相对较大直径的通常位于腹部切口(naval incision)处的套针管插入,照相机或内窥镜允许目视检查和放大体腔。然后在诸如手术镊、刀具、涂药器等设计为通过另外的套管安装的专用器械的辅助下,外科医生能够在手术部位处实施诊断和治疗操作。因此,经历内窥镜手术的患者获得了尺寸在5至10毫米之间的更具美观吸引力的切口,而不是切穿大量肌肉的大切口(典型地为12英寸或更大)。因此,和传统手术相比,痊愈的更快并且患者需要较少的麻醉。此外,因为极大地放大了手术区,因此外科医生能够更好地剖割血管及控制失血。由于切口较小,极大地减少了热和水损失。
[0005]在许多手术程序中,包括涉及到内窥镜手术的那些手术程序中,往往需要缝合身体器官或组织。在内窥镜手术期间后者尤其复杂,因为身体器官或组件的缝合必须通过小开口来完成。
[0006]在过去,通过内窥镜手术缝合身体器官或组织是通过使用尖锐的金属缝合针来实现的,该金属缝合针在其一端处连有一定长度的缝合材料。外科医生使缝合针刺穿并且穿过身体组织,拉动缝合材料穿过身体组织。一旦缝合材料被拉过身体组织,外科医生就会在缝合材料中系一个结。缝合材料的打结允许外科医生调节缝合材料的拉力,以适应被缝合的特定组织并控制组织的接近、咬合、连接或其它状态。对于外科医生来说,不管正在进行的手术程序的类型,控制拉力的能力都是极为重要的。
[0007]然而,在内窥镜手术期间,由于需要穿过小的内窥镜开口进行较难的手法和操作,所以缝合材料的打结是费时和麻烦的。
[0008]已经进行了许多尝试来提供一种装置以克服常规缝合的缺点。这种现有技术装置基本上是缝合钉、手术夹、钳或其它紧固件。然而,以上列出的这些装置没有一个能克服与在内窥镜手术期间缝合身体组织关联的上述缺点。
[0009]因此,需要改进缝合装置,该缝合装置可以克服现有技术设备的缺点和不足。
发明内容
[0010]与本发明一致的内窥镜缝合装置包括手柄组件;由手柄组件支撑并且从手柄组件延伸出来的细长轴;以及被支撑在细长轴的远端上的末端执行器,所述末端执行器包括轴颈组件和一对并置的钳口,所述轴颈组件被配置为并且适于在基本线性构造和离轴构造之间在一个方向上铰接,所述一对并置钳口彼此可枢转地关联,其中每个钳口限定了形成在其组织接触表面中的缝合针容纳凹槽。
[0011]在一个实施例中,所述钳口被可旋转地支撑在末端执行器上,用于当末端执行器处于基本线性构造和铰接构造时绕其纵轴作选择性的转动。在另一实施例中,所述手柄组件支撑转动组件,所述转动组件被配置为将致动从手柄组件传递通过细长轴以实现钳口的转动。所述转动组件可以包括一旋钮,所述旋钮被可旋转地支撑在手柄组件的壳体上并且可操纵地连接至中心驱动杆组件,其中所述中心驱动杆组件包括穿过细长轴并且连接至钳口的远端。在一些实施例中,所述中心驱动杆组件的至少一部分是柔性的。在一个实施例中,内窥镜缝合装置包括被平移地支撑在其中的中心驱动杆组件,所述中心驱动杆组件包括可操纵地连接至手柄组件的至少一个手柄的近端和延伸穿过细长轴并且可操纵地连接至钳口的远端,其中所述中心驱动杆组件的轴向平移导致钳口的打开和闭合。在一个实施例中,所述中心驱动杆组件的轴向转动导致所述钳口围绕其纵轴的转动。在一个实施例中,内窥镜缝合装置包括转动组件,所述转动组件被支撑在手柄组件的壳体上并且可操纵地连接至中心驱动杆组件,其中所述转动组件的致动导致中心驱动杆组件和钳口的并行转动。在一个实施例中,所述中心驱动杆组件的至少一部分长度是柔性的,其中所述中心驱动杆组件的柔性部分在末端执行器铰接时将弯曲并且当末端执行器处于铰接状态时能够使钳口转动。
[0012]在一个实施例中,所述末端执行器进一步包括一对沿轴向可平移的针接合刀片,每个针接合刀片可滑动地支撑在一个相应钳口中,每个刀片具有第一位置和第二位置,在第一位置,当缝合针存在于形成在钳口的组织接触表面中的缝合针容纳凹槽中时一部分刀片与缝合针接合,在第二位置,刀片不与缝合针接合。依照一个实施例,每个刀片的近端被可旋转地支撑在一对同轴筒体的相应筒体上,其中刀片在钳口转动时绕筒体转动。
[0013]在一些实施例中,当相应刀片位于第二位置时缝合针能够被加载到限定在钳口中的缝合钉容纳凹槽中。在一个实施例中,装置包括被支撑在手柄组件上并且连接至每个刀片的加载/卸载组件,其中所述加载/卸载组件能够在刀片位于第一位置的第一位置和刀片位于第二位置的第二位置之间移动。所述加载/卸载组件能够在第一方向上致动以将第一刀片移动到第一位置以及将第二刀片移动到第二位置,并且能够在第二方向上致动以在第二方向上移动第一刀片以及在第一方向上移动第二刀片。
[0014]本发明的内窥镜缝合装置还可以包括被支撑在手柄组件上并且能够致动以铰接末端执行器的铰接组件,其中所述铰接组件的致动导致末端执行器在线性构造和离轴构造之间的铰接。在一个实施例中,所述铰接组件包括被支撑在手柄组件的壳体上的铰接凸轮,并且包括第一和第二凸轮盘、第一销和第一滑块以及第二销和第二滑块,所述第一和第二凸轮盘具有限定在其中的对置的相应第一和第二凸轮通道,所述第一销与第一凸轮通道可操作地关联,所述第一滑块被配置为相对于壳体沿纵向平移,所述第二销与第二凸轮通道可操作地关联,所述第二滑块被配置为相对于壳体沿纵向平移,所述第一和第二滑块固定至第一和第二铰接电缆的相应近端,所述远端被固定在轴颈组件的远侧的位置处,并且其中所述铰接电缆被布置在中心驱动杆组件的相对两侧上。所述第一和第二凸轮通道可以被配置为提供与第一和第二凸轮盘的角位移直接成比例的等距线性运动。所述第一和第二凸轮通道具有基本类似于对数螺线的形状。在一些实施例中,每个铰接电缆在其平移时保持基本拉紧。在一个实施例中,所述第一和第二凸轮盘是整体形成的。扭转弹簧与第一和第二凸轮盘可操作地连接。在一些实施例中,铰接组件包括铰接旋钮、铰接套筒、铰接颈圈和铰接电缆,所述铰接旋钮被支撑在手柄组件的壳体上,所述铰接套筒可操纵地连接至铰接旋钮上并且包括一对相反斜向的外螺旋形螺纹,所述铰接颈圈通过螺纹连接至每个螺旋形螺纹并且被配置为允许其轴向平移和防止其转动,所述铰接电缆固定至每个铰接颈圈,其中每个铰接电缆包括固定至相应铰接颈圈的第一端和固定在轴颈组件的远侧的位置处的第二端,并且其中所述铰接电缆被布置在中心驱动杆组件的相对两侧上。
[0015]在一个实施例中,每个铰接电缆与密封件可操作地关联,所述密封件具有穿过其中的第一和第二内腔,并且其中至少一个内腔被配置为以基本密封的关系容纳至少一个铰接电缆。密封件的第一和第二内腔中的至少一个可以具有拱形区域。在一个实施例中,所述第一和第二内腔中的至少一个可以响应于至少一个铰接电缆穿过其中的纵向平移而被重定位通过包括第一位置和第二位置的多个位置。在一个实施例中,密封件的至少一个内腔被偏压朝向第一和第二位置的至少一个。
[0016]在一些实施例中,铰接旋钮的转动导致铰接套筒的转动和铰接颈圈的并行轴向平移,其中所述铰接颈圈的轴向平移导致末端执行器的铰接。在一个实施例中,所述铰接套筒在第一方向上的转动导致铰接颈圈的相对轴向分离以在第一方向上铰接末端执行器,而所述铰接套筒在第二方向上的转动导致铰接颈圈的相对轴向分离以在第二方向上铰接末端执行器。
[0017]在一个实施例中,轴颈组件包括多个彼此可枢转地接触的链环,其中每个链环包括形成在其第一侧的转向节和形成在其第二侧的U形件,其中第一链环的转向节可操纵地连接至相邻链环的U形件。所述转向节和U形件可以被配置为能够使轴颈组件单向铰接。所述转向节和U形件可以被配置为当轴颈组件处于基本线性构造或离轴构造时至少部分彼此重叠。根据本发明的内窥镜缝合装置可以包括手柄组件,所述手柄组件包括一对手柄和中心驱动杆,所述中心驱动杆在第一端连接至手柄而在第二端连接至一对钳口,其中手柄的致动导致中心驱动杆的轴向平移和钳口的并行的打开和闭合。
[0018]与本发明一致的内窥镜缝合装置包括:包括壳体的手柄组件;由壳体支撑并且从壳体延伸出来的细长轴;以及被支撑在细长轴的远端上的末端执行器,所述末端执行器包括轴颈组件和一对并置的钳口,所述轴颈组件被配置为并且适于在基本线性构造和离轴构造之间在一个方向上铰接,所述一对并置钳口彼此可枢转地关联,其中每个钳口限定了形成在其组织接触表面中的缝合针容纳凹槽,并且其中钳口被可旋转地支撑在末端执行器上用于当末端执行器处于基本线性构造和铰接构造时绕其纵轴的选择性转动;被支撑在壳体上并且能够致动以铰接末端执行器的铰接组件,其中所述铰接组件的致动导致末端执行器在线性构造和离轴构造之间的铰接;以及被支撑在壳体上的转动组件,所述转动组件被配置为将致动从手柄组件传递通过细长轴以实现钳口的转动。
[0019]在一个实施例中,铰接组件包括被支撑在手柄组件的壳体上的铰接凸轮,并且包括第一和第二凸轮盘、第一销和第一滑块以及第二销和第二滑块,所述第一和第二凸轮盘具有限定在其中的对置的相应第一和第二凸轮通道,所述第一销与第一凸轮通道可操作地关联,所述第一滑块被配置为相对于壳体沿纵向平移,所述第二销与第二凸轮通道可操作地关联,所述第二滑块被配置为相对于壳体沿纵向平移,所述第一和第二滑块固定至第一和第二铰接电缆的相应近端,所述远端被固定在轴颈组件的远侧的位置处,并且其中所述铰接电缆被布置在中心驱动杆组件的相对两侧上。所述第一和第二凸轮通道被配置为提供与第一和第二凸轮盘的角位移直接成比例的等距线性运动。所述第一和第二凸轮通道可以具有基本类似于对数螺线的形状。在一些实施例中,每个铰接电缆在其平移时保持基本拉紧。在一个实施例中,所述第一和第二凸轮盘是整体形成的。扭转弹簧可以与第一和第二凸轮盘可操作地连接。
[0020]在一个实施例中,转动组件包括一旋钮,所述旋钮被可旋转地支撑在壳体上并且可操纵地连接至中心驱动杆组件,其中所述中心驱动杆组件包括延伸穿过细长轴并且连接至钳口的远端。所述转动组件可以包括与所述旋钮可操纵地关联的锥齿轮组件。所述锥齿轮组件可以被配置为使中心驱动杆组件平移以打开和闭合钳口。所述锥齿轮组件可以被配置为依照至少一个下列比例将转动能量传递至中心驱动杆组件:1∶1、大于1∶1或小于1∶1。在一个实施例中,所述锥齿轮组件包括太阳齿轮以及第一和第二锥齿轮,所述太阳齿轮被布置为与所述旋钮机械协作并且与第一和第二锥齿轮可操纵地关联,所述第一和第二锥齿轮可操纵地彼此关联。所述锥齿轮组件可以进一步包括被布置为与第一锥齿轮和旋钮机械协作的第一锥齿轮固定架。所述第二锥齿轮可以被布置为与中心驱动杆组件机械协作。在一个实施例中,所述中心驱动杆组件的至少穿过轴颈组件的一部分是柔性的。
[0021]在一个实施例中,内窥镜缝合装置包括中心驱动杆组件,所述中心驱动杆组件至少可平移地被支撑在壳体、细长轴和末端执行器中并且至少被可旋转地支撑在细长轴和末端执行器中,所述中心驱动杆组件包括可操纵地连接至手柄组件的至少一个手柄的近端和延伸穿过细长轴并且可操纵地连接至钳口的远端,其中所述中心驱动杆组件的轴向平移导致钳口的打开和闭合。
[0022]在一个实施例中,中心驱动杆组件的至少远侧部的轴向转动导致钳口绕其纵轴转动。在一个实施例中,末端执行器进一步包括一对沿轴向可平移的针接合刀片,每个针接合刀片可滑动地支撑在一个相应钳口中,每个刀片具有第一位置和第二位置,在第一位置,当缝合针存在于形成在钳口的组织接触表面中的缝合针容纳凹槽中时一部分刀片与缝合针接合,在第二位置,刀片不与缝合针接合。每个刀片的近端可以被可旋转地支撑在一对同轴筒体的相应筒体上,其中刀片在钳口转动时绕筒体转动。当相应的刀片位于第二位置时缝合针可以被加载到限定在钳口中的缝合钉容纳凹槽中。
[0023]与本发明一致的内窥镜缝合装置可以具有被支撑在手柄组件上并且连接至每个刀片的加载/卸载组件,其中所述加载/卸载组件能够在刀片位于第一位置的第一位置和刀片位于第二位置的第二位置之间移动。所述加载/卸载组件能够在第一方向上致动以将第一刀片移动到第一位置以及将第二刀片移动到第二位置,并且能够在第二方向上致动以在第二方向上移动第一刀片以及在第一方向上移动第二刀片。
[0024]在一个实施例中,铰接组件包括铰接旋钮、铰接套筒、铰接颈圈和铰接电缆,所述铰接旋钮被支撑在手柄组件的壳体上,所述铰接套筒可操纵地连接至铰接旋钮上并且包括一对相反斜向的外螺旋形螺纹,所述铰接颈圈通过螺纹连接至每个螺旋形螺纹并且被配置为允许其轴向平移和防止其转动,所述铰接电缆固定至每个铰接颈圈,其中每个铰接电缆包括固定至相应铰接颈圈的第一端和固定在轴颈组件的远侧的位置处的第二端,并且其中所述铰接电缆被布置在中心驱动杆组件的相对两侧上。
[0025]在一个实施例中,每个铰接电缆与密封件可操作地关联,所述密封件具有穿过其中的第一和第二内腔,并且其中至少一个内腔被配置为以基本密封的关系容纳至少一个铰接电缆。密封件的所述第一和第二内腔中的至少一个可以具有拱形区域。密封件的所述第一和第二内腔中的至少一个可以响应于至少一个铰接电缆通过其中的纵向平移而可以被重定位通过包括第一位置和第二位置的多个位置。在一个实施例中,密封件的至少一个内腔被偏压朝向第一和第二位置的至少一个。
[0026]在一个实施例中,铰接旋钮的转动导致铰接套筒的转动和铰接颈圈的并行轴向平移,其中所述铰接颈圈的轴向平移导致末端执行器的铰接。在一个实施例中,铰接套筒在第一方向上的转动导致铰接颈圈的相对轴向分离以在第一方向上铰接末端执行器,并且所述铰接套筒在第二方向上的转动导致铰接颈圈的相对轴向分离以在第二方向上铰接末端执行器。
[0027]本发明的内窥镜缝合装置可以具有轴颈组件,所述轴颈组件包括多个彼此可枢转地接触的链环,其中每个链环包括形成在其第一侧的转向节和形成在其第二侧的U形件,其中第一链环的转向节可操纵地连接至相邻链环的U形件。所述转向节和U形件可以被配置为能够使轴颈组件单向铰接。所述转向节和U形件可以被配置为当轴颈组件处于基本线性构造或离轴构造时至少部分彼此重叠。
[0028]在一个实施例中,手柄组件包括:被支撑在壳体上的一对手柄;以及中心驱动杆,所述中心驱动杆在第一端连接至手柄而在第二端连接至一对钳口,其中手柄的致动导致中心驱动杆的轴向平移和钳口的并行的打开和闭合。
附图说明
[0029]通过结合附图阅读以下的说明,本公开的上述目的、特征和优点将变得明显,其中:
[0030]图1是根据本公开的一个实施例的柔性缝合装置的立体图;
[0031]图2是图1的柔性缝合装置的俯视平面图;
[0032]图3是图1和图2的柔性缝合装置的侧视图;
[0033]图4是图1至图3的柔性缝合装置的末端执行器的立体图;
[0034]图5是图1至图3的柔性缝合装置的轴颈组件的立体图;
[0035]图6是图5的轴颈组件沿图5的线6-6所观察到的立体图;
[0036]图7是柔性缝合装置的手柄组件的俯视右侧立体图,示出了半个壳体部从其中移除;
[0037]图8是柔性缝合装置的手柄组件的俯视左侧立体图,示出了半个壳体部从其中移除;
[0038]图9是柔性缝合装置的部件分解的立体图;
[0039]图10是柔性缝合装置的针加载组件和末端执行器铰接组件的部件分解的立体图;
[0040]图11是本公开的缝合针组件的立体图;
[0041]图12是柔性缝合装置的针保持组件的部件分解的立体图;
[0042]图13是图12的针保持组件的部件组装后的立体图;
[0043]图14是图12和图13的针保持组件沿图13的14-14截取的纵向截面图;
[0044]图15是本公开的柔性缝合装置沿图3的15-15截取的纵向截面图;
[0045]图16是本公开的柔性缝合装置沿图15的16-16截取的纵向截面图;
[0046]图17是图15的指示区域的细节的放大图;
[0047]图18是图16的指示区域的细节的放大图;
[0048]图19是图15的指示区域的细节的放大图;
[0049]图20是图16的指示区域的细节的放大图;
[0050]图21是手柄组件沿图20的21-21截取的截面图;
[0051]图22是末端执行器组件的钳口沿图17的22-22截取的截面图;
[0052]图23是柔性缝合装置的手柄组件的截面图,示出了其手柄的初始致动;
[0053]图24是在手柄组件的初始致动期间柔性缝合装置的末端执行器组件的截面图;
[0054]图25是图24的指示区域的细节的放大图;
[0055]图26是末端执行器的钳口的截面图,示出了布置在其中的缝合针组件的针;
[0056]图27是示出了针加载组件在手柄组件的初始致动期间的移动的截面图;
[0057]图28是图27的针加载组件沿图27的28-28截取的截面图;
[0058]图29是柔性缝合装置的半个壳体部的立体图;
[0059]图30是图29的指示区域的细节的放大图;
[0060]图31是柔性缝合装置的手柄组件的截面图,示出了手柄组件的手柄的松开和针保持组件的致动;
[0061]图32是进一步示出了针保持组件的致动的平面图;
[0062]图33是末端执行器组件的纵向截面图,示出了缝合针组件加载到其中;
[0063]图34是末端执行器组件沿图33的34-34截取的截面图;
[0064]图35是末端执行器组件沿图33的35-35截取的截面图;
[0065]图36是柔性缝合装置的手柄组件的截面图,示出了针保持组件的进一步致动;
[0066]图37是末端执行器组件的纵向截面图,示出了缝合针组件的针定位在末端执行器组件的一个相对的钳口中;
[0067]图38是手柄组件沿图8的38-38截取的截面图;
[0068]图39是手柄组件沿图8的39-39截取的截面图;
[0069]图40是手柄组件的纵向截面图,示出了铰接组件的致动;
[0070]图41是柔性缝合装置的轴颈组件的部件分解的立体图;
[0071]图42是图41的轴颈组件的链环的立体图;
[0072]图43是末端执行器的截面图,示出了末端执行器的铰接;
[0073]图44是图43的末端执行器的立体图;
[0074]图45是手柄组件沿图7的45-45截取的截面图,示出了柔性缝合装置的转动组件的操作;
[0075]图46是手柄组件沿图7的46-46截取的截面图,示出了柔性缝合装置的转动组件的另一个操作;
[0076]图47是示出了远侧中心杆和近侧中心杆的连接的立体图,其中包括连接套筒;
[0077]图48是示出了远侧中心杆和近侧中心杆的连接的立体图,其中连接套筒被移除;
[0078]图49是末端执行器组件的轴颈部的远侧链环连接至末端执行器组件的远侧支撑部件的部件分解的立体图;
[0079]图50是图49的指示区域的细节的放大图;
[0080]图51是示出了轴颈组件的远侧链环和远侧支撑部件的连接的纵向截面图;
[0081]图52是图51的指示区域的细节的放大图;
[0082]图53是末端执行器组件的立体图,示出了执行器组件的转动;
[0083]图54是根据本公开的另一实施例的末端执行器转动组件的正视立体图;
[0084]图55是图54的末端执行器转动组件的后视立体图;
[0085]图56是图54和图55的末端执行器转动组件的部件分解的立体图;
[0086]图57是图54至图56的末端执行器转动组件的立体图,示出了末端执行器转动组件的操作;
[0087]图58是根据本公开的又一实施例的末端执行器转动组件的正视立体图;
[0088]图59是图58的末端执行器转动组件沿图58的59-59截取的截面图;
[0089]图60是图58和图59的末端执行器转动组件的部件分解的立体图;
[0090]图61是图58至图60的末端执行器转动组件沿图58的61-61截取的截面图;
[0091]图62是图59的截面图,示出了图58至图61的末端执行器转动组件的操作;
[0092]图63是本公开的柔性缝合装置的远端的另一实施例的纵向截面图,包括在其中的拱形密封件;
[0093]图64是图63的指示区域的细节的放大图,其中示出的拱形密封件位于第一位置;
[0094]图65是图63的拱形密封件的立体图;
[0095]图66是图63至图65的拱形密封件沿图65的66-66截取的立体纵向截面图;
[0096]图67是图63至图66的拱形密封件沿图64的67-67截取的横向截面图;
[0097]图68是图63至图67的拱形密封件的纵向截面图,其中示出的拱形密封件位于第二位置;
[0090]图69是图63至图68的拱形密封件沿图68的69-69截取的横向截面图;
[0099]图70是根据本公开的另一实施例的末端执行器转动组件的纵向截面图;
[00100]图71是图70的末端执行器转动组件的齿轮组件的立体图;
[00101]图72是图70和图71的末端执行器转动组件从图70的72-72截取的截面图;
[00102]图73是柔性缝合装置的手柄组件的另一实施例的立体图,其中包括铰接组件的另一实施例;
[00103]图74是图73的手柄组件的放大立体图,其中壳体被移除以示出铰接组件;
[00104]图75是图73至图74的铰接组件的部件分解的立体图,;
[00105]图76是图73至图75的铰接组件的铰接凸轮的侧视图,其中示出了铰接凸轮在第一位置;
[00106]图77是图76的铰接凸轮的侧视图,其中示出了铰接凸轮在第二位置;
[00107]图78是图76至图77的铰接凸轮的侧视图,其中示出了铰接凸轮在第三位置;
[00108]图79是根据本公开的铰接凸轮的另一实施例的立体图;
[00109]图80是根据本公开的铰接组件的另一实施例的俯视平面示意图;
[00110]图81是根据本公开的铰接组件的另一实施例的俯视平面示意图;
[001111]图82是根据本公开的铰接组件的另一实施例的侧视示意图。
具体实施方式
[00112]本公开涉及用于内窥镜、腹腔镜、腔内和/或经腔缝合的装置、系统和方法。例如,在一个实施例中,这种装置包括手柄、手柄组件或连接至柔性细长主体部的近端的其它合适的致动机构(例如,机械手等)。轴颈组件被可操纵地支撑在柔性细长主体部的远端上,末端执行器被可操纵地支撑在轴颈组件的远端上,轴颈组件允许末端执行器响应于铰接电缆的致动而铰接。末端执行器包括缝合针和一对钳口。在操作中,缝合针从一个钳口到另一个钳口来回穿过组织。该装置适于被放置在柔性内窥镜的内腔中,然后插入患者的自然腔道中,并且通过自然内腔的构造从腔内转到自然内腔内或外部的处理部位上。
[00113]在附图和以下描述中,术语“近侧”将按照惯例指装置最靠近操作者的一端,而术语“远侧”将指装置距操作者最远的一端。
[00114]现在详细结合附图,附图中相似的附图标记指代类似或相同的元件,图1至图3示出了通常以100示出的柔性缝合装置。缝合装置100适于在内窥镜或腹腔镜程序中尤其有用,其中缝合装置的内窥镜部即末端执行器经由套管组件等(未示出)能够插入操作部位。
[00115]如图1至图3所示,缝合装置100包括末端执行器200,末端执行器200能够支撑在手柄组件300和/或细长管状主体部308的远端上,或者从手柄组件300和/或细长管状主体部308的远端延伸出来,其中细长管状主体部308从手柄组件300向远侧延伸。
[00116]如图1至图6、图9、图41和图42所示,末端执行器200包括轴颈组件210以及工具或钳口组件220,其中轴颈组件210被支撑在从手柄组件300延伸出的轴308的远端上,工具或钳口组件220被支撑在轴颈组件210的远端上。轴颈组件210包括多个链环212,每个链环包括一同形成的近侧的转向节212a和远侧的U形件212b。如图41和图42所示,每个转向节212a可操纵地接合相邻链环212的U形件212b。每个链环212限定了形成在其中的中央内腔212c(见图42)以及分别形成在中央内腔212c的两侧的两对对置的内腔212d1、212d2和212e1、212e2。一对铰接电缆340、3422可滑动地穿过链环212的相应内腔212e1、212e2。
[00117]转向节212被配置为能够使末端执行器200在基本线性构造和基本成角度的离轴或铰接构造之间移动。转向节212还被配置为允许末端执行器200在仅单一方向上被铰接。例如,如图5和图6所示,当末端执行器200处于线性状态时,在中央内腔212c的第一侧的转向节和U形件完全坐靠在彼此内,而在中央内腔212c的第二侧上的转向节和U形件不是完全坐靠在彼此内,从而允许末端执行器200在中央内腔212c的不完全坐靠侧的方向上被铰接。此外,转向节和相应U形件的尺寸被确定为:当末端执行器200处于基本线性构造时,在中央内腔212c的不完全坐靠侧的转向节和相应的U形件至少彼此对准或二者至少彼此部分重叠。通过这种方式,降低了组织、血管或其它身体结构被卡在或夹在二者之间的可能性。
[00118]下文将更详细地讨论操作轴颈组件210以使末端执行器200绕其铰接。
[00119]如图1至图4、图9、图49和图50所示,末端执行器200的钳口组件220包括钳口支撑部件222和安装为在钳口支撑部件222上可枢转运动的一对钳口230、232。钳口支撑部件222在其近端限定了内腔224而在其远端限定了一对间隔臂226。如图49所示,内腔224被配置及尺寸被确定为容纳从轴颈组件210的最远侧链环212延伸出的柄212f。
[00120]如图49至图52所示,钳口支撑部件222限定了形成在其内腔224的表面中的环形槽224a,而柄212f限定了形成在其外表面中的环形座圈212f1。当柄212f连接至钳口支撑部件222时,形成在钳口支撑部件222的内腔224的表面中的环形槽224a和形成在柄212f的外表面中的环形座圈212f1彼此对准。环213被布置在形成在钳口支撑部件222的内腔224的表面中的环形槽224a和形成在柄212f的外表面中的环形座圈212f1内,从而维持柄212f连接至钳口支撑部件222并且允许钳口支撑部件222相对于柄212f转动。
[00121]如图4、图17和图18所示,每个钳口230、232分别包括针容纳凹槽230a、232a,针容纳凹槽230a、232a被配置为环绕和保持缝合针组件102的针104的至少一部分,缝合针组件102基本垂直于钳口的组织接合表面而布置在其中。如图11所示,针104包括靠近其各端形成的槽104a。缝合线106可以在槽104a之间的位置处被固定至手术针104上。
[00122]缝合针组件104的缝合线106可以包括单向或带倒刺缝合线,其中缝合线包括细长主体,细长主体具有从其中延伸出的多个倒钩。倒钩以如下方式定位:倒钩使得缝合线抵抗在与倒钩正对的方向相反的方向上的移动。
[00123]与缝合针组件104一起使用的合适的缝合线包括但不限于以下专利中描述和公开的这些缝合线:美国专利3,123,077;美国专利5,931,855;和于2002年9月30日提交的公开号为2004/0060409的美国专利,每个专利的全部内容通过引用合并于此。
[00124]钳口230、232依靠钳口枢转销234被可枢转地安装在支撑部件222上,其中钳口枢转销234穿过形成在支撑部件222的臂226中的孔226a和形成在钳口230、232中的相应枢转孔230b、232b。为了使钳口230、232在打开位置和闭合位置之间移动,设置了能够沿轴向或径向移动的中心驱动杆组件236,中心驱动杆组件236具有安装在中心驱动杆远侧部236a的远端处的凸轮销238。凸轮销238安放于形成在相应的钳口230、232中的斜凸轮狭槽230c、232c中并且与斜凸轮狭槽230c、232c接合,以使中心杆组件236的轴向或纵向移动引起钳口230、232在打开和闭合位置之间做凸轮运动。
[00125]钳口组件220包括驱动组件240,驱动组件240被可滑动地和可旋转地布置在支撑部件222的内腔224内。如图9和图12至图14所示,驱动组件240包括内驱动组件242和外驱动组件244。内驱动组件242包括内筒体或颈圈242a,内筒体或颈圈242a限定了穿过其中的内腔242b。内腔242b被配置为将中心驱动杆组件236的中心驱动杆远侧部236a可滑动地且可旋转地容纳在其中。内驱动组件242进一步包括封套250a和第一刀片250b,封套250a被可滑动地和/或可旋转地支撑在内筒体242a上,而第一刀片250b从封套250a延伸出来。刀片250b在与内筒体242a的内腔242b的中心纵轴基本平行的方向上从封套250a延伸出来。
[00126]如图9和图12至图14所示,外驱动组件244包括外筒体或颈圈244a,外筒体或颈圈244a限定了穿过其中的内腔244b和形成在内腔244b的表面中的环形凹槽244c。内腔244b被配置为将内筒体242a可滑动地且可旋转地容纳在其中,以使内筒体242a套在外筒体244a的内腔244b内。外驱动组件244进一步包括封套252a和第二刀片252b,封套252a被可滑动地和/或可旋转地支撑在环形凹槽244c上,而第二刀片252b从环244d延伸出来。刀片252b在基本平行于外筒体244a的内腔244b的中心纵轴的方向上从封套252a延伸出来。
[00127]钳口组件220进一步包括被布置在支撑部件222的臂226之间的U形件246。U形件246包括从基体246a延伸出的一对间隔臂246b。每个臂246b限定了穿过其中的内腔246c。U形件246限定了形成在基体246a中的中央开口246d。臂246b相隔足够量,而基体246b的中央开口246d的尺寸被确定为以便可滑动地且可旋转地容纳中心杆组件236的远侧部236a穿过其中。
[00128]如上所讨论的,钳口组件220进一步包括一对针接合部件或刀片250b、252b,针接合部件或刀片250b、252b被可滑动地支撑在U形件246的臂246b的相应内腔246c内。每个刀片250b、252b包括可滑动地延伸进入相应钳口230、232的刀片容纳通道230d、232d中的远端(见图17)。每个刀片250b、252b是有弹性的以便随着钳口230、232被打开和闭合而弯曲或折弯并且当钳口230、232处于打开或闭合状态时仍相对于彼此平移。
[00129]在操作中,随着内驱动组件242和外驱动组件244在轴向上相对于彼此被平移,刀片250b、252b也相对于彼此被平移。
[00130]现在转到图1至图3和图7至图10,提供了对手柄组件300的详细讨论。手柄组件300包括壳体302,壳体302具有上半壳体304和下半壳体306。手柄组件300进一步包括一对手柄310,手柄310可枢转地固定在壳体302上并且从壳体302向外延伸。
[00131]柔性缝合装置的半壳体304、306可以通过搭扣配合(snap-fit)接合或通过合适的紧固件(如螺钉)等结合在一起。壳体302限定了分别形成在半壳体304、306中的窗口304a、306a。半壳体304、306的窗口304a、306a的尺寸被确定为容纳铰接组件330并为铰接组件330提供入口。
[00132]如图9所示,手柄310在手柄枢转位置处被固定在壳体302上。手柄组件300包括连杆部件312,连杆部件312具有第一端和第二端,其中第一端在形成于各个手柄310中的枢转点310a处可枢转地连接至每个手柄310,第二端经由驱动销316可枢转地彼此连接并且可枢转地连接至中心驱动杆组件236的近侧部236b。驱动销316的每一端被可滑动地容纳在半壳体304、306的相应细长通道304b、306b中。在使用时,如下文将更详细描述的,随着手柄310被握紧,连杆部件312经由驱动销316向近侧推动中心驱动杆组件236。
[00133]如上文提到的,手柄组件300包括被可平移地支撑在壳体302中的中心驱动杆组件236。手柄组件300包括呈复位弹簧形式的偏置部件318,偏置部件318被支撑在中心驱动杆组件236的近侧部236b上并且被保持在表面306c与保持夹318a之间的适当位置,其中表面306c形成在下半壳体306中,保持夹318a连接至中心驱动杆组件236的近侧部236b。
[00134]如图9、图47和图48所示,中心驱动杆组件236的远端近侧部236b可旋转地连接至中心驱动杆组件236的中间部236c的近端。通过这种方式,中心驱动杆组件236的中间部236c相对于中心驱动杆组件236的近侧部236b可以自由转动。可以设置套筒237来保持中心驱动杆组件236的中间部236c和中心驱动杆组件236的近侧部236b的彼此连接。中心驱动杆组件236的中间部236c连接至中心驱动杆组件236的远侧部236a。在操作中,随着中心驱动杆组件236的近侧部236b在手柄310致动时被平移,所述平移被传递至中心驱动杆组件236的中间部236c和远侧部236a。如上所述,随着中心驱动杆组件236的远侧部236a被平移,安装在中心驱动杆组件236的远侧部236a上的凸轮销238坐靠并接合形成在相应钳口230、232中的斜凸轮狭槽230c、232c,以引起钳口230、232在打开和闭合位置之间做凸轮运动。
[00135]手柄组件300进一步包括被可旋转地支撑在壳体302中的铰接组件330。铰接组件330包括带螺纹的铰接套筒332,铰接套筒332在偏置部件318的远侧的位置处被可旋转地支撑并沿轴向装在中心驱动杆314上。带螺纹的铰接套筒332分别限定了远侧螺纹和近侧螺纹332a、332b。
[00136]如图9、图10、图19和图20所示,铰接组件330进一步包括可操纵地连接至铰接套筒332的相应螺纹332a、332b上的远侧铰接颈圈334a和近侧铰接颈圈334b。每个颈圈334a、334b分别限定了一对沿径向延伸的突出部334a1、334b1,突出部334a1、334b1分别与上下半壳体304、306的细长狭槽304d、306d(见图20)可滑动地接合。铰接套筒332的螺纹332a、332b以及远侧和近侧铰接颈圈334a、334b的相应螺纹被配置为,当铰接套筒332在第一方向上被转动时铰接套筒332的转动导致远侧和近侧铰接颈圈334a、334b相对于彼此接近,或者当铰接套筒332在第二方向上被转动时远侧和近侧铰接颈圈334a、334b相对于彼此分离。可以设想的是,需要的话可以选定铰接套筒332和铰接颈圈334a、334b之间的螺纹的螺距,以实现使颈圈334a、334b相对于彼此接近或分离的预期目的。
[00137]铰接组件330进一步包括铰接盘336,铰接盘336被可旋转地布置在壳体302中并且被用键或以其它方式固定至铰接套筒332。通过这种方式,随着铰接盘336被转动,并行转动被传递至铰接套筒332及远侧和近侧铰接颈圈334a、334b。铰接盘336被用键或以其它方式连接至铰接旋钮338,铰接旋钮338被可旋转地支撑在壳体302中并且通过上下半壳体304、306的窗口304a、306a可以接近铰接旋钮338。在操作中,随着铰接旋钮338被转动,所述转动被传递至铰接盘336。
[00138]铰接组件330进一步包括一对铰接电缆340、342,铰接电缆340、342延伸穿过并且固定至末端执行器200和手柄组件300上。第一铰接电缆340包括第一端和第二端,其中第一端固定至近侧铰接颈圈334b,第二端延伸穿过远侧铰接颈圈334a、铰接盘336中的相应狭槽、链环212的相应内腔212e1,并且固定至最远侧链环212或轴颈部210的柄212f(见图18)。第二铰接电缆342包括第一端和第二端,其中第一端固定至远侧铰接颈圈334a,第二端穿过铰接盘336中的相应狭槽、链环212的相应内腔212e2,并且固定至最远侧链环212或轴颈部210的柄212f(见图18)。
[00139]在操作中,如下文将更详细地描述的,随着铰接旋钮338被转动,转动被传递至铰接盘336和铰接套筒332上。随着铰接套筒332被转动,远侧和近侧铰接颈圈334a、334b相对于彼此接近和/或分离,从而根据铰接旋钮338的转动方向引起第一或第二铰接电缆340、342的收缩。
[00140]铰接组件330进一步包括被支撑在中心驱动杆组件236的中间部236c上的偏置部件346。
[00141]如图1至图3和图7至图14所示,手柄组件300进一步包括被支撑在其上的针加载/保持组件350。针加载/保持组件350包括杠杆352,杠杆352被可枢转地支撑在壳体302中并且具有从其中延伸出的一对臂354a、354b。针加载/保持组件350还包括第一刀片控制杆356a和第二刀片控制杆356b。每个刀片控制杆356a、356b包括在枢转轴的相对两侧处连接至杠杆352的近端。通过这种方式,随着杠杆352在第一方向上被致动或枢转,第一刀片控制杆356a在第一方向上移动而第二刀片控制杆356b在与第一方向相反的第二方向上移动,反之亦然。每个刀片控制杆356a、356b的远端连接至相应的内驱动组件242和外驱动组件244,特别是连接至驱动组件240的相应的内筒体242a和外筒体244a。
[00142]如图12至图14所示,针加载/保持组件350进一步包括弹性可弯杆358a、358b,弹性可弯杆358a、358b使每个刀片控制杆356a、356b的远端与驱动组件240的相应内筒体242a和外筒体244a相互连接。如图13和图14所示,杆359a、359b可以使刀片控制杆356a、356b的相应远端和内外筒体242a、244a相互连接。
[00143]如图9、图10、图20至图22以及图26至图30所示,针加载/保持组件350进一步包括被支撑在壳体302上的一对针加载/卸载按钮360、362。针加载/卸载按钮360、362能够在最远侧位置和最近侧位置之间滑动。当针加载/卸载按钮360、362位于最远侧位置时,刀片250b、252b位于最远侧位置,以使如图22所示形成在其中的相应缺口250c、252c对齐或对准相应钳口230、232的相应的针容纳开口230a、232a。刀片250b、252b位于最远侧位置时,缝合针组件102的针104可以被放入选定的钳口230、232的选定的针容纳开口230a、232a中。当针加载/卸载按钮360、362位于最近侧位置时,刀片250b、252b位于最近侧位置,以使形成在其中的相应缺口250c、252c不对齐或对准相应钳口230、232的相应的针容纳开口230a、232a。刀片250b、252b位于最近侧位置时,由于刀片250b、252b与针104的槽104a接合,使得被放入选定的钳口230、232的选定的针容纳开口230a、232a中的缝合针组件102的针104保持在适当的位置。
[00144]如图9、图20和图21所示,相应的偏置部件360b、362b将每个按钮360、362支撑在相应的偏置柄360a、362a上。如图21和图27至图30所示,柄360a、360b被可滑动地布置在上下半壳体304、306的相应狭槽304e、306e中。每个狭槽304e、306e包括加宽的近端304f、306f,加宽的近端304f、306f被配置为当按钮360、362被移动到近侧位置时将相应柄360a、362a的一部分容纳在其中。为了在远侧方向上移动按钮360、362,一旦柄360a、362a已经位于上下半壳体304、306的狭槽304e、306e的加宽的近端304f、306f中,使用者必须压下按钮360、362以将柄360a、362a移出狭槽304e、306e的加宽的近端304f、306f,从而允许按钮360、362向远侧移动。
[00145]如图9、图10、图20和图27所示,针加载/保持组件350被支撑在框架或支架368上。支架368可以随着杠杆352向远侧和近侧移动,并且支架368被配置为允许中心驱动杆组件236穿过其中。如图27所示,偏置部件346插入支架368和铰接套筒332之间。在使用中,随着按钮360、362在近侧方向上被移动,支架368在近侧方向上移动以压缩偏置部件346。通过这种方式,当按钮360、362被压下以使柄360a、362a从狭槽304e、306e的加宽的近端304f、306f脱离时,允许偏置部件346伸长从而将按钮360、362复位至远侧位置。
[00146]如图1至图3、图7至图10、图45和图46所示,手柄组件300进一步包括末梢转动组件370,末梢转动组件370被支撑在壳体302上用于使末端执行器200绕其纵轴转动。末梢转动组件370包括被支撑在壳体302上的转动旋钮372。转动旋钮372限定了内齿轮齿372a的环形阵列。末梢转动组件370包括被支撑在壳体302中的框架376上的齿轮系统374。齿轮系统374包括至少一个第一齿轮374a、至少一个第二齿轮374b和至少一个第三齿轮374c,其中第一齿轮374a与转动旋钮372的齿轮齿372a可操纵地接合,第二齿轮374b被用键或以其它方式连接至中心驱动杆组件236的中间部236c,第三齿轮374c使第一齿轮374a和第二齿轮374b相互连接,以使转动旋钮372的转动方向导致中心驱动杆组件236的中间部236c和远侧部236a以及依次的末端执行器200的并行转动。随着中心驱动杆组件236的中间部236c和远侧部236a被转动,所述转动被传递至钳口230、232的凸轮销238,因而转动被传递至末端执行器200。由于刀片250b、252b被可旋转地支撑在相应筒体242a、244a上,所以刀片250b、252b也与末端执行器200一起转动。
[00147]现在转到图15至图53,提供了对柔性内窥镜缝合装置100的操作的详细讨论。如图15至图22所示,缝合装置100以针加载/卸载构造示出。当缝合装置100处于针加载/卸载构造时,如图16和图20所示,针加载/保持组件350位于远侧位置,以使刀片250b、252b位于最远侧位置并且如图22所示形成在刀片250b、252b中的相应缺口250c、252c对齐或对准相应钳口230、232的相应的针容纳开口230a、232a。在刀片250b、252b的缺口250c、252c对齐或对准相应钳口230、232的相应的针容纳开口230a、232a时,如图24至图26所示,缝合针组件102的针104可以被放置到或加载到相应钳口230、232的选定的一个针容纳开口230a、232a中。
[00148]如图23至图26所示,一旦针104被加载到相应钳口230、232的任一针容纳开口230a、232a中,则手柄310被致动(例如,紧握)以移动连杆部件312并且依次将中心驱动杆组件236在近侧方向(如图23和图24的箭头“A”所示)上沿轴向移位。如图24和图25所示,随着中心驱动杆组件236在近侧方向上被移动,凸轮销238在近侧方向上被移动以使钳口230、232接近。
[00149]如图27所示,一旦针104被加载到相应钳口230、232的任一针容纳开口230a、232a中,针加载/保持组件350在近侧方向上被移动,从而使刀片250b、252b收缩并且引起每个刀片250b、252b与针104的相应槽104a接合。
[00150]如图31至图35所示,在针104被刀片250b、252b二者接合时,如图31和图32所示,杠杆352被致动或转动,使得如图35所示仅一个刀片250b、252b如刀片252b与针104保持接合,而如图34所示另一个刀片250b与针104脱离。如图33至图35所示,在仅一个刀片如刀片252b与针104接合时,如图31所示手柄310可以被松开,从而使中心驱动杆组件236和凸轮销238在远侧方向上移动以打开钳口230、232。
[00151]由于钳口230、232打开,末端执行器200可以被定位在需要的手术部位,并且手柄310被重新致动以使钳口230、232接近。例如,在钳口230、232位于打开位置并且针104被加载到其中时,钳口230、232可以被定位在目标组织周围或在目标组织上房而手柄310被致动以使钳口230、232接近。随着钳口230、232接近,针104的露出端刺穿目标组织并且进入相对的钳口230、232。如图36所示,在针104位于对置钳口230、232中时,杠杆352被再次致动或转动使得刀片250b、252b被反转。通过这样做,使刀片252b与针104脱离而使刀片250b与针104接合。
[00152]如图37所示,由于针104被刀片250b接合,手柄310可以被松开,从而打开钳口230、232并且拉动针104穿过目标组织。通过这样做,缝合线106也被拉过组织。将针104穿过钳口230、232之间并且将缝合线拉过目标组织的过程重复多次,从而按照需要或期望缝合目标组织。
[00153]在手术程序期间,如果需要或必要时,如图38至图44所示,使用者可以致动铰接组件330的铰接旋钮338以实现末端执行器200的铰接或离轴运动。具体来说,随着铰接旋钮338被转动,转动被传递至铰接盘336和铰接套筒332上。随着铰接套筒332被转动,远侧和近侧铰接颈圈334a、334b相对于彼此从接近状态移动到更分离状态,从而引起第一铰接电缆340的收缩和第二铰接电缆342的拉长。
[00154]如图43和44所示,随着第一铰接电缆340被收缩和第二铰接电缆342被拉长,末端执行器200在轴颈部210处被铰接。随着末端执行器200被铰接,中心驱动杆组件236的中间部236c被弯曲。通过这种方式,末端执行器200仍然能够绕其轴转动,并且钳口230、232仍然能够打开和闭合。
[00155]如图44所示,尽管处于铰接状态,但链环212保持至少部分重叠以抑制组织等进入其间。通过这种方式,当末端执行器200被回复到非铰接或线性状态时,组织将不会被卡在或夹在轴颈部210的链环212之间。
[00156]在手术程序期间,如果需要或必要时,如图45至图53所示,使用者可以致动末梢转动组件370的转动旋钮372以实现末端执行器200沿其纵轴的转动。具体来说,随着转动旋钮372被转动,中心驱动杆组件236的中间部236c和远侧部236a被转动。随着中心驱动杆组件236的中间部236c和远侧部236a被转动,所述转动被传递至钳口230、232的凸轮销238,因而转动被传递至末端执行器200。
[00157]现在转到图54至图57,根据本公开的另一实施例的与缝合装置100一起使用的末梢转动组件通常用470表示。末梢转动组件470包括被支撑在壳体302上的转动旋钮472。旋钮472限定了形成在其后表面中的弓状狭槽472a,并且弓状狭槽472a从旋钮472的中心旋转轴沿径向向外延伸并且绕中心旋转轴延伸约180°。末梢转动组件470包括被用键或以其它方式固定至中心驱动杆组件236的颈圈474。末梢转动组件470进一步包括叉形连杆476,叉形连杆476具有可枢转地连接至颈圈474的第一端476a和可枢转地支撑柱塞478的第二端476b。连杆476的第一端476a绕横向于其枢转轴的轴弯曲,以便限定凹处476c,凹处476c被配置为选择性地将中心驱动杆组件236容纳在其中。销479穿过柱塞478并且将柱塞478连接至弓状狭槽472a。
[00158]转动组件470包括起始位置,在起始位置时销479位于弓状狭槽472a的第一端,在此处弓状狭槽472a距中心驱动杆组件236最远。
[00159]在操作中,为了使末端执行器200绕其纵轴转动,转动旋钮472从起始位置被转动。随着转动旋钮472被转动,销479可滑动地平移通过弓状狭槽472a,使销479接近中心驱动杆组件236。随着销479接近中心驱动杆组件236,叉形连杆476具备了足够的间隙以便叉形连杆476环绕中心驱动杆组件236。这样,旋钮472的转动导致转动力经由柱塞478、叉形连杆476和颈圈474传递至中心驱动杆组件236。
[00160]现在转到图58至图62,根据本公开的另一实施例的与缝合装置100一起使用的末梢转动组件通常用570表示。末梢转动组件570包括被支撑在壳体502上的转动旋钮572。旋钮572限定了形成在其内表面的内螺旋形螺纹572a。末梢转动组件570包括布置在壳体502内的螺母。螺母574包括一对对置的柄574a,柄574a从螺母沿径向延伸出来并穿过形成在壳体502中的相应的纵向延伸狭槽502a。螺母574的柄574a足够长以接合转动旋钮574的螺旋形螺纹574a。螺母574限定了内螺旋形螺纹574b。
[00161]末梢转动组件570还包括被用键或以其它方式连接至中心驱动杆组件236的导螺杆576。导螺杆576包括被配置为与螺母574的内螺旋形螺纹574b可操纵地接合的外螺纹等576a。导螺杆576被进一步沿轴向固定在并可旋转地支撑在形成在壳体502中的托架502b中。
[00162]在操作中,如图62所示,随着转动旋钮572被转动,螺母574的柄574a被转动旋钮572的内螺旋形螺纹572a接合并且引起螺母574沿轴向移动通过壳体502和壳体502的细长狭槽502a。随着螺母574沿轴向移动通过壳体502的狭槽502a,由于导螺杆576被沿轴向固定在壳体502的托架502b中,螺母574的内螺纹574a接合导螺杆576的螺纹576a,引起导螺杆576转动。随着导螺杆576转动,导螺杆576将所述转动传递至中心驱动杆组件236。
[00163]现在参照图63至图69,可以设想的是,每个铰接电缆340、342可以与拱形密封件10可操作地关联,拱形密封件10布置为与中心驱动杆组件236机械协作。拱形密封件10包括布置在中心驱动杆内腔14周围的多个电缆内腔12a至12d(见图65),所有电缆内腔均穿过拱形密封件10。中心驱动杆内腔14被配置为容纳中心驱动杆组件236通过其中。每个电缆内腔12a至12d被配置为以基本密封的关系容纳一个或多个铰接电缆340、342。每个电缆内腔12a至12d可以具有相应的拱形区域16,拱形区域16包括被配置为与一个或多个铰接电缆340、342的表面接合的文氏管部16a,以使拱形密封件10可以与铰接电缆340、342一起移动。
[00164]每个拱形区域16的文氏管部16a能够使每个电缆内腔12a至12d响应于穿过其中的一个或多个铰接电缆340、342的纵向平移而被重定位通过多个位置,所述多个位置包括与轴颈组件210的线性方位对应的第一位置(例如,图66)以及与轴颈组件210的铰接方位对应的第二位置(例如,图68)。通过这种方式,当轴颈组件210处于线性或铰接方位时,总是可以维持拱形密封件10和铰接电缆340、342之间的密封关系。
[00165]现在转到图70至图72,根据本公开的另一实施例的与缝合装置100一起使用的末梢转动组件通常用670表示。末梢转动组件670包括被支撑在壳体302上的转动旋钮672(见图70)和与转动旋钮672可操纵地关联的锥齿轮组件680。锥齿轮组件680包括太阳齿轮682、第一锥齿轮684和第二锥齿轮686,其中太阳齿轮682被布置为与所述旋钮672机械协作,第一锥齿轮684与太阳齿轮682可操纵地关联,第二锥齿轮686与第一锥齿轮684可操纵地关联。第一锥齿轮684可以相对于太阳齿轮682和第二锥齿轮686大致垂直地布置。第二锥齿轮686被布置为与中心驱动杆组件236机械协作以便于转动能量从末梢转动组件670传送至中心驱动杆组件236以打开和闭合钳口230、232。
[00166]末梢转动组件670还包括被布置为与第一锥齿轮684和旋钮672机械协作的第一锥齿轮固定架685。第一锥齿轮固定架685相对于旋钮672可旋转地支撑第一锥齿轮684,特别是使太阳齿轮682和第二锥齿轮606相互连接。
[00167]太阳齿轮682和第二锥齿轮686可以被配置并且尺寸被确定为相对于彼此呈偏移关系来围绕缝合装置100的纵轴转动。第一锥齿轮固定架685被配置为将第一锥齿轮684定位为使得第一锥齿轮684绕横向于缝合装置100的纵轴的轴转动。第二锥齿轮686可以用键或扁平表面来接合中心驱动杆组件236,同时仍允许中心驱动杆组件236相对于第二锥齿轮686的轴向运动。太阳齿轮682、第一锥齿轮684和第二锥齿轮686可以被配置并且尺寸被确定为总共允许仅最小(例如,5度)的转动齿隙。此外,末梢转动组件670的锥齿轮组件680可以被配置并且尺寸被确定为,依照一个或多个下列比例将转动能量传递至中心驱动杆组件236∶1∶1,大于1∶1或小于1∶1。
[00168]在操作中,随着转动旋钮672绕缝合装置100的纵轴被转动(可以是顺时针或逆时针),锥齿轮组件680的太阳齿轮682(用键固定至转动旋钮672)与其同轴转动。太阳齿轮682接合第一锥齿轮684的第一齿轮部684a,引起第一锥齿轮684绕横向于缝合装置100的纵轴的轴转动。第一锥齿轮684的转动引起第一锥齿轮684的第二齿轮部684b接合第二锥齿轮686并且使第二锥齿轮686绕缝合装置100的纵轴转动。第二锥齿轮686的转动引起中心驱动杆组件236转动,从而引起钳口230、232转动。
[00169]现在转到图73至图78,示出了包括另一实施例的铰接组件1000的手柄组件1300。铰接组件1000包括铰接凸轮1010、第一销1020、第二销1030、第一滑块1040、第二滑块1050以及第一和第二铰接电缆340、342。铰接凸轮1010包括第一和第二铰接臂1012、1014和第一和第二凸轮盘1016、1018,第一和第二凸轮盘1016、1018用于定位铰接凸轮1010通过与轴颈组件210的线性和/或成角度方位对应的多个位置,该多个位置包括第一位置(图76)、第二位置(图77)和第三位置(图78)。
[00170]铰接凸轮1010被支撑在手柄组件1300的壳体1302中。第一和第二凸轮盘1016、1018在其中限定了对置的相应第一和第二凸轮通道1016a、1018a。第一和第二凸轮通道1016a、1018a可以具有基本类似于对数螺线的形状,其可以被配置为提供与第一和第二凸轮盘1016、1018的角位移直接成比例的等距线性运动。这样,每个铰接电缆340、342在其相对于壳体1302平移时可以保持基本拉紧。
[00171]再结合图73至图78,第一销1020与第一凸轮盘1016的第一凸轮通道1016a和第一滑块1040可操作地关联。第一滑块1040被配置为在限定于壳体1302中的通道中纵向平移。第二销1030与第二凸轮盘1018的第二凸轮通道1018a和第二滑块1050可操作地关联。第二滑块1050被配置为在限定于壳体1302中的通道中纵向平移。第一和第二滑块1040、1050被固定至第一和第二铰接电缆340、342的相应近端。如上所述,第一和第二铰接电缆340、342的远端被固定在轴颈组件210的远侧的位置处。铰接电缆340、342被布置在中心驱动杆组件236的相对两侧上。
[00172]在操作中,为了铰接轴颈组件210,经由第一和/或第二铰接臂1012、1014使铰接凸轮1010转动。如图73至图78所述,随着铰接凸轮1010被转动,第一和第二销1030、1040平移通过第一和第二凸轮盘1016、1018的相应第一和第二凸轮通道1016a、1018a,并且引起相应第一和第二滑块1040、1050纵向平移。随着第一和第二滑块1040、1050纵向平移,取决于铰接凸轮1010的转动的方向,第一或第二铰接电缆340、342收缩,从而引起轴颈组件210铰接。通过这种方式,一个铰接电缆340、342被收缩,而另一个铰接电缆340、342精确地拉长与另一个铰接电缆缩短的长度相同的长度。铰接电缆340、342的收缩和拉长与第一和第二凸轮盘1016、1018的第一和第二凸轮通道1016a、1018a的曲率成比例。
[00173]换句话说,在铰接轴颈组件210时,与铰接电缆340、342在近侧方向上的平移相比,铰接电缆340、342在远侧方向上的平移必须行进更大的距离。这样,为了补偿在铰接电缆340、342的拉伸时的任何松弛,第一和第二凸轮通道1016a、1018a的形状使得第一和/或第二致动臂1012、1014的转动的程度越大,则铰接电缆340或342的近侧平移越大。
[00174]第一和第二凸轮盘1016、1018可以是整体形成的。如在一般通常指定为2010的铰接凸轮的另一实施例中所示的以及如图79所示,第一和第二凸轮盘2016、2018可以是独立的和不同的以使每个凸轮盘经由第一和第二铰接臂2012、2014可以在相反的转动方向上转动。扭转弹簧2015可以与第一和第二凸轮盘2016、2018可操作地连接,以使扭转弹簧2015的远端和近端被布置为与相应第一和第二凸轮盘2016、2018机械协作。扭转弹簧2015可以被支撑在沿轴向布置在第一和第二凸轮盘2016、2018之间的轴上,以促进每个凸轮盘2016、2018相对于彼此约10度至15度转动。扭转弹簧2015可以被预加载,以使它产生的力足够用于维持铰接电缆340、342的拉伸以精确操作缝合装置100,然而扭转弹簧2015可以被配置为在轴颈组件210的铰接期间限制第一和第二凸轮盘2016、2018相对于彼此的转动。
[00175]如在图80至图82所示的铰接组件3000、4000、5000的其它实施例中所示的,铰接电缆340、342可以直接连接至第一或第二销1030、1040上,其中第一或第二销1030、1040被布置为与相应第一和第二凸轮盘1016、1018、2016、2018机械协作以提供纵向平移。如在图80至图81所示的实施例中所示出的,铰接电缆340、342可以被安装在壳体302、1302的不同位置上的一个或多个辊子“R”重定向。这样,由于辊子“R”取决于其放置可以在任何方向上重定向铰接电缆340、342,所以第一和第二凸轮盘1016、1018、2016、2018可以被定位为与缝合装置的纵轴纵向对齐、横向或其它任何变型。
[00176]尽管已经结合特定的实施例特定地示出和描述了本公开,但本领域的技术人员会理解的是,可以在不超出本发明的范围和精神的情况下在形式和细节上做出各种改进。因此,诸如上述提出的并且不限于此的各种改进被认为是在本发明的范围内。
Claims (65)
1、一种内窥镜缝合装置,包括:
手柄组件;
由所述手柄组件支撑并且从所述手柄组件延伸出来的细长轴;以及
被支撑在所述细长轴的远端上的末端执行器,所述末端执行器包括轴颈组件和一对并置的钳口,所述轴颈组件被配置为并且适于在基本线性构造和离轴构造之间在一个方向上铰接,所述一对并置钳口彼此可枢转地关联,其中每个钳口限定了形成在其组织接触表面中的缝合针容纳凹槽。
2、根据权利要求1所述的内窥镜缝合装置,其中所述钳口被可旋转地支撑在所述末端执行器上,用于当所述末端执行器处于基本线性构造和铰接构造时绕其纵轴选择性地转动。
3、根据权利要求1所述的内窥镜缝合装置,其中所述手柄组件支撑转动组件,所述转动组件被配置为将致动从手柄组件传递通过所述细长轴以实现所述钳口的转动。
4、根据权利要求3所述的内窥镜缝合装置,其中所述转动组件包括旋钮,所述旋钮被可旋转地支撑在所述手柄组件的壳体上并且可操纵地连接至中心驱动杆组件,其中所述中心驱动杆组件包括穿过所述细长轴并且连接至所述钳口的远端。
5、根据权利要求4所述的内窥镜缝合装置,其中所述中心驱动杆组件的至少一部分是柔性的。
6、根据权利要求1所述的内窥镜缝合装置,进一步包括被平移地支撑在其中的中心驱动杆组件,所述中心驱动杆组件包括可操纵地连接至所述手柄组件的至少一个手柄的近端和穿过所述细长轴并且可操纵地连接至所述钳口的远端,其中所述中心驱动杆组件的轴向平移导致所述钳口的打开和闭合。
7、根据权利要求6所述的内窥镜缝合装置,其中所述中心驱动杆组件的轴向转动导致所述钳口绕其纵轴转动。
8、根据权利要求7所述的内窥镜缝合装置,进一步包括转动组件,所述转动组件被支撑在所述手柄组件的壳体上并且可操纵地连接至所述中心驱动杆组件,其中所述转动组件的致动导致所述中心驱动杆组件和钳口的并行转动。
9、根据权利要求8所述的内窥镜缝合装置,其中所述中心驱动杆组件的至少一部分长度是柔性的,其中所述中心驱动杆组件的柔性部分在所述末端执行器铰接时将弯曲并且当所述末端执行器处于铰接状态时能够使所述钳口转动。
10、根据权利要求1所述的内窥镜缝合装置,其中所述末端执行器进一步包括一对沿轴向可平移的针接合刀片,所述针接合刀片的每一个可滑动地支撑在一个相应钳口中,每个刀片具有第一位置和第二位置,在第一位置时,当缝合针存在于形成在所述钳口的组织接触表面中的缝合针容纳凹槽中时一部分刀片与缝合针接合,在第二位置时,所述刀片不与缝合针接合。
11、根据权利要求10所述的内窥镜缝合装置,其中每个刀片的近端被可旋转地支撑在一对同轴筒体的相应筒体上,其中所述刀片在所述钳口转动时绕所述筒体转动。
12、根据权利要求10所述的内窥镜缝合装置,其中当相应的刀片位于所述第二位置时缝合针能够被加载到限定在所述钳口中的缝合钉容纳凹槽中。
13、根据权利要求10所述的内窥镜缝合装置,进一步包括被支撑在所述手柄组件上并且连接至每个刀片的加载/卸载组件,其中所述加载/卸载组件能够在所述刀片位于所述第一位置的第一位置和所述刀片位于所述第二位置的第二位置之间移动。
14、根据权利要求13所述的内窥镜缝合装置,其中所述加载/卸载组件能够在第一方向上致动以将第一刀片移动到所述第一位置以及将第二刀片移动到所述第二位置,以及能够在第二方向上致动以在第二方向上移动所述第一刀片以及在所述第一方向上移动所述第二刀片。
15、根据权利要求1所述的内窥镜缝合装置,进一步包括被支撑在所述手柄组件上并且能够致动以铰接所述末端执行器的铰接组件,其中所述铰接组件的致动导致所述末端执行器在线性构造和离轴构造之间的铰接。
16、根据权利要求15所述的内窥镜缝合装置,其中所述铰接组件包括被支撑在所述手柄组件的壳体上的铰接凸轮,并且所述铰接组件包括第一和第二凸轮盘、第一销和第一滑块以及第二销和第二滑块,所述第一和第二凸轮盘具有限定在其中的对置的相应第一和第二凸轮通道,所述第一销与所述第一凸轮通道可操作地关联,所述第一滑块被配置为相对于所述壳体沿纵向平移,所述第二销与所述第二凸轮通道可操作地关联,所述第二滑块被配置为相对于所述壳体沿纵向平移,所述第一和第二滑块固定至第一和第二铰接电缆的相应近端,所述远端被固定在所述轴颈组件的远侧的位置处,并且其中所述铰接电缆被布置在中心驱动杆组件的相对两侧上。
17、根据权利要求16所述的内窥镜缝合装置,其中所述第一和第二凸轮通道被配置为提供与所述第一和第二凸轮盘的角位移直接成比例的等距线性运动。
18、根据权利要求17所述的内窥镜缝合装置,其中所述第一和第二凸轮通道具有基本类似于对数螺线的形状。
19、根据权利要求16所述的内窥镜缝合装置,其中每个铰接电缆在其平移时保持基本拉紧。
20、根据权利要求16所述的内窥镜缝合装置,其中所述第一和第二凸轮盘是整体形成的。
21、根据权利要求16所述的内窥镜缝合装置,其中扭转弹簧与所述第一和第二凸轮盘可操作地连接。
22、根据权利要求15所述的内窥镜缝合装置,其中所述铰接组件包括铰接旋钮、铰接套筒、铰接颈圈和铰接电缆,所述铰接旋钮被支撑在所述手柄组件的壳体上,所述铰接套筒可操纵地连接至所述铰接旋钮上并且包括一对相反斜向的外螺旋形螺纹,所述铰接颈圈通过螺纹连接至每个螺旋形螺纹并且被配置为允许其轴向平移并防止其转动,所述铰接电缆固定至每个铰接颈圈,其中每个铰接电缆包括固定至相应铰接颈圈的第一端和固定在所述轴颈组件的远侧的位置处的第二端,并且其中所述铰接电缆被布置在中心驱动杆组件的相对两侧上。
23、根据权利要求22所述的内窥镜缝合装置,其中每个铰接电缆与密封件可操作地关联,所述密封件具有穿过其中的第一和第二内腔,并且其中至少一个内腔被配置为以基本密封的关系容纳至少一个铰接电缆。
24、根据权利要求23所述的内窥镜缝合装置,其中所述第一和第二内腔的至少一个具有拱形区域。
25、根据权利要求23所述的内窥镜缝合装置,其中所述第一和第二内腔的至少一个可以响应于至少一个铰接电缆穿过其中的纵向平移而被重定位通过包括第一位置和第二位置的多个位置。
26、根据权利要求25所述的内窥镜缝合装置,其中至少一个内腔被偏压朝向所述第一和第二位置中的至少一个。
27、根据权利要求22所述的内窥镜缝合装置,其中所述铰接旋钮的转动导致所述铰接套筒的转动和所述铰接颈圈的并行轴向平移,其中所述铰接颈圈的轴向平移导致所述末端执行器的铰接。
28、根据权利要求27所述的内窥镜缝合装置,其中所述铰接套筒在第一方向上的转动导致所述铰接颈圈的相对轴向分离以在第一方向上铰接所述末端执行器,而所述铰接套筒在第二方向上的转动导致所述铰接颈圈的相对轴向分离以在第二方向上铰接所述末端执行器。
29、根据权利要求1所述的内窥镜缝合装置,其中所述轴颈组件包括多个彼此可枢转地接触的链环,其中每个链环包括形成在其第一侧的转向节和形成在其第二侧的U形件,其中第一链环的转向节可操纵地连接至相邻链环的U形件。
30、根据权利要求29所述的内窥镜缝合装置,其中所述转向节和U形件被配置为能够使所述轴颈组件单向铰接。
31、根据权利要求29所述的内窥镜缝合装置,其中所述转向节和U形件被配置为当所述轴颈组件处于基本线性构造或离轴构造时至少部分彼此重叠。
32、根据权利要求1所述的内窥镜缝合装置,其中所述手柄组件包括一对手柄和中心驱动杆,所述中心驱动杆在第一端连接至所述手柄而在第二端连接至所述一对钳口,其中所述手柄的致动导致所述中心驱动杆的轴向平移和所述钳口的并行的打开和闭合。
33、一种内窥镜缝合装置,包括:
包括壳体的手柄组件;
由所述壳体支撑并且从所述壳体延伸出来的细长轴;以及
被支撑在所述细长轴的远端上的末端执行器,所述末端执行器包括轴颈组件和一对并置的钳口,所述轴颈组件被配置为并且适于在基本线性构造和离轴构造之间在一个方向上铰接,所述一对并置钳口彼此可枢转地关联,其中每个钳口限定了形成在其组织接触表面中的缝合针容纳凹槽,并且其中所述钳口被可旋转地支撑在所述末端执行器上用于当所述末端执行器处于基本线性构造和铰接构造时绕其纵轴选择性地转动;
被支撑在所述壳体上并且能够致动以铰接所述末端执行器的铰接组件,其中所述铰接组件的致动导致所述末端执行器在线性构造和离轴构造之间的铰接;以及
被支撑在壳体上的转动组件,所述转动组件被配置为将致动从所述手柄组件传递通过所述细长轴以实现所述钳口的转动。
34、根据权利要求33所述的内窥镜缝合装置,其中所述铰接组件包括被支撑在所述手柄组件的壳体上的铰接凸轮,并且所述铰接组件包括第一和第二凸轮盘、第一销和第一滑块以及第二销和第二滑块,所述第一和第二凸轮盘具有限定在其中的对置的相应第一和第二凸轮通道,所述第一销与所述第一凸轮通道可操作地关联,所述第一滑块被配置为相对于所述壳体沿纵向平移,所述第二销与所述第二凸轮通道可操作地关联,所述第二滑块被配置为相对于所述壳体沿纵向平移,所述第一和第二滑块固定至第一和第二铰接电缆的相应近端,所述远端被固定在所述轴颈组件的远侧的位置处,并且其中所述铰接电缆被布置在中心驱动杆组件的相对两侧上。
35、根据权利要求34所述的内窥镜缝合装置,所述第一和第二凸轮通道被配置为提供与所述第一和第二凸轮盘的角位移直接成比例的等距线性运动。
36、根据权利要求35所述的内窥镜缝合装置,其中所述第一和第二凸轮通道具有基本类似于对数螺线的形状。
37、根据权利要求34所述的内窥镜缝合装置,其中每个铰接电缆在其平移时保持基本拉紧。
38、根据权利要求34所述的内窥镜缝合装置,其中所述第一和第二凸轮盘是整体形成的。
39、根据权利要求34所述的内窥镜缝合装置,其中扭转弹簧与所述第一和第二凸轮盘可操作地连接。
40、根据权利要求33所述的内窥镜缝合装置,其中所述转动组件包括旋钮,所述旋钮被可旋转地支撑在所述壳体上并且可操纵地连接至中心驱动杆组件,其中所述中心驱动杆组件包括穿过所述细长轴并且连接至所述钳口的远端。
41、根据权利要求40所述的内窥镜缝合装置,其中所述转动组件包括与所述旋钮可操纵地关联的锥齿轮组件。
42、根据权利要求41所述的内窥镜缝合装置,其中所述锥齿轮组件被配置为使所述中心驱动杆组件平移以打开和闭合所述钳口。
43、根据权利要求41所述的内窥镜缝合装置,其中所述锥齿轮组件被配置为依照至少一个下列比例将转动能量传递至所述中心驱动杆组件:1∶1、大于1∶1或小于1∶1。
44、根据权利要求41所述的内窥镜缝合装置,其中所述锥齿轮组件包括太阳齿轮以及第一和第二锥齿轮,所述所述太阳齿轮被布置为与所述旋钮机械协作以及与所述第一和第二锥齿轮可操纵地关联,所述第一和第二锥齿轮相互可操纵地彼此关联。
45、根据权利要求44所述的内窥镜缝合装置,其中所述锥齿轮组件进一步包括被布置为与所述第一锥齿轮和旋钮机械协作的第一锥齿轮固定架。
46、根据权利要求44所述的内窥镜缝合装置,其中所述第二锥齿轮被布置为与所述中心驱动杆组件机械协作。
47、根据权利要求40所述的内窥镜缝合装置,其中所述中心驱动杆组件的至少穿过所述轴颈组件的一部分是柔性的。
48、根据权利要求33所述的内窥镜缝合装置,进一步包括中心驱动杆组件,所述中心驱动杆组件至少被可平移地支撑在所述壳体、细长轴和末端执行器中并且至少被可旋转地支撑在所述细长轴和末端执行器中,所述中心驱动杆组件包括可操纵地连接至所述手柄组件的至少一个手柄的近端和延伸穿过所述细长轴并且可操纵地连接至所述钳口的远端,其中所述中心驱动杆组件的轴向平移导致所述钳口的打开和闭合。
49、根据权利要求48所述的内窥镜缝合装置,其中所述中心驱动杆组件的至少远侧部的轴向转动导致所述钳口绕其纵轴转动。
50、根据权利要求33所述的内窥镜缝合装置,其中所述末端执行器进一步包括一对沿轴向可平移的针接合刀片,所述针接合刀片的每一个可滑动地支撑在一个相应钳口中,每个刀片具有第一位置和第二位置,在第一位置时,当缝合针存在于形成在所述钳口的组织接触表面中的缝合针容纳凹槽中时一部分刀片与缝合针接合,在第二位置时,所述刀片不与缝合针接合。
51、根据权利要求50所述的内窥镜缝合装置,其中每个刀片的近端被可旋转地支撑在一对同轴筒体的相应筒体上,其中所述刀片在所述钳口转动时绕所述筒体转动。
52、根据权利要求50所述的内窥镜缝合装置,其中当相应的刀片位于所述第二位置时缝合针能够被加载到限定在所述钳口中的缝合钉容纳凹槽中。
53、根据权利要求50所述的内窥镜缝合装置,进一步包括被支撑在所述手柄组件上并且连接至每个刀片的加载/卸载组件,其中所述加载/卸载组件能够在所述刀片位于所述第一位置的第一位置和刀片位于所述第二位置的第二位置之间移动。
54、根据权利要求53所述的内窥镜缝合装置,其中所述加载/卸载组件能够在第一方向上致动以将第一刀片移动到所述第一位置以及将第二刀片移动到所述第二位置,以及能够在第二方向上致动以在第二方向上移动所述第一刀片以及在所述第一方向上移动所述第二刀片。
55、根据权利要求33所述的内窥镜缝合装置,其中所述铰接组件包括铰接旋钮、铰接套筒、铰接颈圈和铰接电缆,所述铰接旋钮被支撑在所述手柄组件的壳体上,所述铰接套筒可操纵地连接至所述铰接旋钮上并且包括一对相反斜向的外螺旋形螺纹,所述铰接颈圈通过螺纹连接至每个螺旋形螺纹并且被配置为允许其轴向平移并防止其转动,所述铰接电缆固定至每个铰接颈圈,其中每个铰接电缆包括固定至相应铰接颈圈的第一端和固定在所述轴颈组件的远侧的位置处的第二端,并且其中所述铰接电缆被布置在中心驱动杆组件的相对两侧上。
56、根据权利要求55所述的内窥镜缝合装置,其中每个铰接电缆与密封件可操作地关联,所述密封件具有穿过其中的第一和第二内腔,并且其中至少一个内腔被配置为以基本密封的关系容纳至少一个铰接电缆。
57、根据权利要求56所述的内窥镜缝合装置,其中所述第一和第二内腔的至少一个具有拱形区域。
58、根据权利要求56所述的内窥镜缝合装置,其中所述第一和第二内腔的至少一个可以响应于至少一个铰接电缆通过其中的纵向平移而被重定位通过包括第一位置和第二位置的多个位置。
59、根据权利要求58所述的内窥镜缝合装置,其中至少一个内腔被偏压朝向第一和第二位置中的至少一个。
60、根据权利要求55所述的内窥镜缝合装置,其中所述铰接旋钮的转动导致所述铰接套筒的转动和所述铰接颈圈的并行轴向平移,其中所述铰接颈圈的轴向平移导致所述末端执行器的铰接。
61、根据权利要求60所述的内窥镜缝合装置,其中所述铰接套筒在第一方向上的转动导致所述铰接颈圈的相对轴向分离以在第一方向上铰接所述末端执行器,而所述铰接套筒在第二方向上的转动导致所述铰接颈圈的相对轴向分离以在第二方向上铰接所述末端执行器。
62、根据权利要求33所述的内窥镜缝合装置,其中所述轴颈组件包括多个彼此可枢转地接触的链环,其中每个链环包括形成在其第一侧的转向节和形成在其第二侧的U形件,其中第一链环的转向节可操纵地连接至相邻链环的U形件。
63、根据权利要求62所述的内窥镜缝合装置,其中所述转向节和U形件被配置为能够使轴颈组件单向铰接。
64、根据权利要求62所述的内窥镜缝合装置,其中所述转向节和U形件被配置为当所述轴颈组件处于基本线性构造或离轴构造时至少部分彼此重叠。
65、根据权利要求62所述的内窥镜缝合装置,其中所述手柄组件包括:
被支撑在所述壳体上的一对手柄;以及
中心驱动杆,所述中心驱动杆在第一端连接至所述手柄而在第二端连接至所述一对钳口,其中所述手柄的致动导致所述中心驱动杆的轴向平移和所述钳口的并行的打开和闭合。
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- 2009-06-12 JP JP2009141065A patent/JP5503194B2/ja not_active Expired - Fee Related
- 2009-06-12 EP EP09251544.4A patent/EP2133028B1/en active Active
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Also Published As
Publication number | Publication date |
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US8628545B2 (en) | 2014-01-14 |
JP5503194B2 (ja) | 2014-05-28 |
AU2009202354A1 (en) | 2010-01-07 |
CN101612053B (zh) | 2013-11-06 |
EP2133028B1 (en) | 2018-04-11 |
EP2133028A3 (en) | 2013-04-03 |
CA2668618A1 (en) | 2009-12-13 |
JP2010005386A (ja) | 2010-01-14 |
CN103284770A (zh) | 2013-09-11 |
CN103284770B (zh) | 2016-06-01 |
CA2668618C (en) | 2017-07-11 |
US20090312773A1 (en) | 2009-12-17 |
AU2009202354B2 (en) | 2014-10-02 |
EP2133028A2 (en) | 2009-12-16 |
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