CN101647720B - 手术用倾斜砧座组件 - Google Patents
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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
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
- A61B17/1152—Staplers for performing anastomosis in a single operation applying the staples on the outside of the lumen
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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
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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
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/1114—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis of the digestive tract, e.g. bowels or oesophagus
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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
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
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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
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
- A61B17/1155—Circular staplers comprising a plurality of staples
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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
- A61B17/0057—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
- A61B2017/00646—Type of implements
- A61B2017/00663—Type of implements the implement being a suture
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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
- A61B2017/07214—Stapler heads
- A61B2017/07257—Stapler heads characterised by its anvil
Abstract
一种包括杆和头组件的手术用倾斜砧座组件,其中头组件包括具有缝合钉变形凹处的砧座盘。所述头组件可枢转地固定在杆上,并且其能够相对于杆在第一倾斜位置、非倾斜位置和第二不同倾斜位置之间枢转。所述头组件从第一倾斜位置出发,穿过非倾斜位置直至第二倾斜位置。
Description
相关申请的交叉引用
本申请要求享有于2008年8月12日提交的第61/088,055号美国临时专利申请的权益和优先权,该临时申请的全部内容通过引用合并于此。
技术领域
本公开主要涉及一种适用于环形吻合手术缝合器的砧座组件。本公开尤其涉及一种具有适用于环形吻合手术缝合器的可倾斜头部的砧座组件。
背景技术
在本领域中,包括具有可倾斜砧座头的砧座组件的环形吻合手术缝合器是公知的。第6,053,390号美国专利就公开了一种具有倾斜的砧座头的砧座组件。在第6,957,758号美国专利中公开了一种联动系统,其用于使手术用缝合器的砧座组件在靠近时从倾斜位置倾斜到非倾斜位置,并且当砧座返回到原来彼此隔开的位置时,其又能将砧座倾斜到倾斜位置。在第7,168,604和7,431,191号美国专利中也已公开并描述了另外的砧座组件,这些砧座组件在靠近时可从倾斜位置枢转到操作位置,而一俟缝合钉发射完就又回到倾斜位置。公开号为2008-0230581的美国专利公开了另一种倾斜砧座组件。砧座头能够移送到倾斜的还原位置(reduced profile position),在砧座被附到器械上时能够倾斜并随后又能靠近至适于发射缝合钉的操作位置,这样的设计尽管具有优点,但仍期望提供一种设计简单且可控性增加的倾斜式砧座。
发明内容
本公开提供了一种手术用倾斜砧座组件。在一个方案中该倾斜砧座组件包括杆和头组件,所述头组件包括具有缝合钉变形凹处的砧座盘。头组件枢转地固定在杆上,并能够相对于杆在第一倾斜位置、非倾斜位置和第二不同倾斜位置之间枢转,其中,头组件从第一倾斜位置经过非倾斜位置到达第二倾斜位置。
头组件可包括支撑构件,该支撑构件可绕支柱从第一位置运动到第二位置,在第一位置中,支撑构件被定位以阻止头组件从非倾斜位置枢转到第二倾斜位置,在第二位置中,支撑构件被定位以允许头组件相对于杆从非倾斜位置枢转到第二位置。
倾斜砧座组件的头组件可以另外包括枢转的凸轮闩锁构件,该凸轮闩锁构件被定位以接合支撑构件,以防止支撑构件从第二位置运动到第一位置。头组件可以围绕枢轴构件枢转地固定到杆上,并且围绕所述枢轴构件可枢转地设置枢转的闩锁构件。当支撑构件处于其第一位置时,所述闩锁构件可被定位以接合支撑构件的内周缘。所述闩锁构件可包括弯曲表面,配置该弯曲表面以在头组件从第一位置运动到第二位置过程中去除所述闩锁构件与支撑构件之间的任何间隙。
倾斜砧座组件可进一步包括柱塞,其由偏置构件推进与所述凸轮闩锁构件接合,进而将凸轮闩锁构件推进至其枢转位置。倾斜砧座组件进一步包括固定器构件,该固定器构件位于头组件中,用于在预定力施加到支撑构件之前阻止支撑构件从第一位置运动到第二位置。该固定器构件可包括可变形构件,该可变形构件设置在头组件内,并且位于托架与支撑构件之间。所述托架以及支柱可限定环形凹陷,而所述固定器组件可被设置在该环形凹陷中。所述固定器构件可包括围绕支柱定位的环形体,以及从该环形体延伸的多个可变形突出物(tab)。
支撑构件可被设置邻接所述固定器构件,这样,在支撑构件从其第一位置向第二位置运动时,所述可变形突出物就变形。支撑构件可包括切割环和支撑盘,所述切割环可被固定在该支撑盘的近端面上。支撑盘可包括至少一个指状物,在支撑构件处于其第一位置时,该指状物被设置为与杆的表面相接合,以阻止头组件相对于杆的枢转运动。所述切割环可用比构成支撑盘的材料更软的材料形成。杆可限定一纵轴,并且头组件的枢转轴可与该中央杆的纵轴相交叉。
在一个优选实施例中,头组件被连接到头组件的拉紧构件保持在第一倾斜位置上。在一个优选实施例中,该拉紧构件是容纳在头组件开口中的缝合线。在头组件的第二开口处可提供第二缝合线,其在与第一缝合线相对的方向上延伸,用于收回砧座组件。
在本公开的另一方案中,提供了一种手术用倾斜砧座组件,其包括杆和可枢转地固定在该杆上的砧座头组件,所述头组件能够相对于杆在第一方向上从用于插入的第一倾斜位置枢转到操作位置,进而相对于杆在第一方向上从操作位置枢转到用于移除的第二倾斜位置。
在一个优选实施例中,从第一倾斜位置到第二倾斜位置,头组件大约要移过140度的弧线。头组件可进一步包括枢转的闩锁构件,其设置用于阻止头组件的支撑构件从第二位置运动到初始位置。在一个优选实施例中,柱塞将头组件从第一倾斜位置运动到操作位置,并从操作位置运动到第二倾斜位置。在一个优选实施例中,缝合线把头组件保持在第一倾斜位置。
在本公开的另一方案中,提供一种手术用砧座组件,其包括杆和头组件,该头组件包括托架、凸轮构件和支撑构件。头组件枢转地固定在杆上,且能够相对于杆在第一方向上从用于插入的第一倾斜位置枢转到操作位置,进而相对于杆在第一方向上从操作位置枢转到与第一倾斜位置不同的第二倾斜位置。在支撑构件被移动到远侧后,凸轮构件阻止该支撑构件的近侧运动。砧座组件可进一步包括柱塞,其由弹簧偏置与凸轮构件接合。
在本公开的另一方案中,提供一种手术用砧座传送系统,其包括砧座组件,该砧座组件包括杆和头组件,以及柔性管和拉紧构件。头组件可枢转地固定在杆上,并从第一倾斜位置运动到非倾斜的操作位置。砧座组件与柔性管相连,拉紧构件连接到头组件上并将头组件保持在第一倾斜位置,这样,松开拉紧构就会使得头组件返回到非倾斜位置。在一个优选实施例中,拉紧构件是缝合线,该缝合线延伸穿过头组件中的小孔并伸进柔性管中的开口中。所述系统可进一步包括第二缝合线,其与头组件相连并在与所述第一缝合线不同的方向上延伸。
在一个优选实施例中,头组件定位到操作非倾斜位置后,能够进一步地枢转到第二倾斜位置,其中,第二倾斜位置不同于第一倾斜位置。砧座组件可进一步包括可旋转的凸轮构件和柱塞,该柱塞由弹簧偏置而与凸轮构件相接触,其中,凸轮构件是可旋转的,并且柱塞可向远侧运动从而可将头组件从第一倾斜位置运动到操作位置,进而可运动地将头组件从操作位置运动到第二不同倾斜位置。为将砧座组件连接到柔性管,可以提供接合器。
在另一方面,本公开提供一种用于枢转手术用砧座组件的砧座头组件的方法,其包括下列步骤:提供包括杆和可枢转地固定到该杆上的头组件的砧座组件,头组件能够从第一倾斜位置运动到非倾斜的操作位置,所述砧座组件连接到柔性管上并被拉紧构件保持在第一倾斜位置中;将砧座组件插入到患者体内,并且拉紧构件将砧座保持在第一倾斜位置;以及切断拉紧构件,使得头组件在第一方向运动,从而回到非倾斜的操作位置。
附图说明
在此,参照附图,公开本公开的倾斜砧座组件的不同实施例,其中:
图1是包括一个根据本公开的砧座组件实施例的手术用缝合钉装置的立体图;
图2是图1所示砧座组件在非倾斜位置上的第一立体侧视图;
图3是图1和图2所示砧座组件的第二立体侧视图;
图4是图1至图3所示的砧座组件的分解侧视图;
图5是图1至图3所示的砧座组件的端视图;
图6是图1至图4所示的倾斜砧座组件的远端沿图5中的6-6线剖切后的剖面侧视图,示出了头组件位于非倾斜的操作位置;
图7是图1至图6所示的砧座组件的远端沿图5中的7-7线剖切后的剖面侧视图,示出了头组件位于非倾斜的操作位置;
图8是图1至图4所示的砧座组件的凸轮闩锁构件的放大侧视图;
图9是支撑在砧座传送系统上的图1至图4所示的砧座组件的顶视图;
图10是图9所示的砧座传送系统的放大分解图;
图11是图9和图10所示的砧座传送系统的放大顶视图,该砧座系统包括图1至图4所示的被缝合线拉紧在第一倾斜位置的砧座组件;
图12是图11所示的砧座组件和砧座传送系统沿图11的12-12线剖切后的剖面侧视图;
图13是图1至图4所示的砧座组件的剖面侧视图(展示了图12的细节区域),图中显示的该砧座组件支撑在图9所示的砧座传送系统上,并处于发射前的倾斜位置;
图14是图13中的标记为14的部分的放大示意图;
图15是图1所示的手术用缝合装置与图9所示的砧座传送系统的图示,图中的砧座传送系统连接有经口腔插入患者体内的砧座组件;
图16是图1和图15所示的手术用缝合装置的远端头部的放大侧视图;
图17是图1和图15所示的手术用缝合装置的远端头部的放大侧视图,图中显示图1至图4所示的砧座组件设置于其上;
图18是图1所示的手术用缝合装置的远端头部的放大剖面侧视图,包括图1至图4所示的连接的砧座组件,该砧座组件位于靠近的发射前的非倾斜操作位置;
图19是图1所示的手术用缝合装置的远端头部的放大剖面侧视图,包括图1至图4所示的连接的砧座组件,该砧座组件位于发射后的非倾斜操作位置;
图20是图1至图4所示的砧座组件位于与图19所示位置相应的发射后的非倾斜位置时的远端的放大剖面侧视图;
图21是图1至图4所示的砧座组件位于发射后的第二倾斜位置时的放大剖面侧视图;
图22是图1至图4所示的砧座组件位于发射后的第二倾斜位置时的放大剖面侧视图(与图21所示位置相应),图中显示该砧座组件支撑在图1所示的手术用缝合装置的砧座固定器上;
图22A是图1至图4所示的砧座组件位于与图22所示砧座组件位置对应的位置时的另一个剖面侧视图;
图23是展示图22A的细节的指定区域的放大视图;以及
图24是图22所示砧座组件的侧视图,该砧座组件支撑在图1所示的手术用缝合装置的砧座固定器上。
具体实施方式
现在,将参照附图,详细描述在此公开的砧座组件的各实施例,在每一不同附图中,相同或相近的元件都用同样的数字标记。在整篇说明书中,术语“近端”指的是装置接近操作者的部分,而术语“远端”指的是装置远离操作者的部分。
图1描绘了被配置为与根据本公开的倾斜砧座组件一起使用的手术用缝合装置的一个实施例。简言之,手术用缝合装置10包括近端手柄组件12、延长的中央基体部14和远端头部16,其中所述基体部包括弯曲延长的外部管14a。可选地,在一些手术程序例如治疗痔疮手术中,适宜采用实质上笔直的、缩短的中央基体部。为配合特定的手术程序,所述基体部14和远端头部16的长度、形状和/或直径也可以改变。
仍然参照图1,手柄组件12包括固定手柄18、发射扳机20、可旋转的接近旋钮22和指示器24。可枢转地安装的扳机锁26被固定在手柄组件12上,其可以手动定位以便防止缝合装置10在无意中发射。指示器24设置在固定手柄18上,包括例如颜色代码和字母-数字标记等的标记,其用于使外科医生识别装置是否已经接近并已经准备好发射。头部16包括砧座组件110和外壳组件31。关于手术用缝合器10的更加详细的论述公开在第7,364,060和7,303,106号美国专利中,此两份专利的全部内容通过引用合并于此。
现在参照图2至图7,图中展示了一般以附图标记110示出的本公开的砧座组件的一个实施例。砧座组件110示出在非倾斜或操作位置,其中缝合钉变形凹处130面向器械的缝合订槽。砧座组件110包括头组件112和中央杆组件114。头组件112包括支柱116,托架118,支持构件或支持盘120,切割环122,切割环护盖123,砧座盘124,间隔片或者垫圈125,凸轮闩锁构件126以及固定器构件127。支柱116与托架118一体形成,并位于托架的中央。可选择地,托架118和支柱116可分离形成,再利用公知的固定技术如焊接法固定到一起。
托架118包括开口119a、119b,其大小和尺寸被设计成能够容纳一个或多个缝合线“S”,对此,将在下面进行深入论述。在使用过程中,第一缝合线“S1”(图11)被贯穿插入开口119a中,其用于在砧座组件110插入患者体内时将头组件112保持在收缩位置或者第一倾斜位置(图11和图12)上。就是说,缝合线“S1”起到将头组件保持在第一倾斜位置的拉紧构件的作用。第二缝合线“S2”贯穿插入开口119b中,其被设置用于使倾斜砧座组件110在期望的时候能从患者体内收回。在砧座组件110经口腔插入时,缝合线“S2”从患者口部延伸,使得砧座组件110能够经过口腔被收回。如图所示,第二缝合线“S2”在与缝合线“S1”的相对方向延伸。
仍然参考图2至图7,砧座盘124支撑在托架118的外部环形凹陷128中,其包括多个用于容纳缝合钉并使之变形的变形凹处130。至少一个突出物124a从砧座盘124上径向向外延伸,并被于托架118外边缘中形成的切口(cutout)132容纳。突出物124a和切口132在托架118的环形凹陷128中将砧座盘124对准或使其正确定位。
对头组件112将特别参照图4、图6和图7进行详细说明。支撑盘120包括中央开口134,该开口围绕支柱116设置在托架118的内部环形凹陷136中,位于支架116和外部环形凹陷128之间。支撑盘120包括凸起的平台120a。切割环122包括开口122a,该开口具有在实质上与平台120a同样的结构。尽管平台120a被示为具有圆形形状,但可以预见其他的诸如方形、矩形、三角形等构造。在一个实施例中,切割环122由聚乙烯形成,并使用例如粘合剂不动地固定到支撑盘120上,以形成支撑盘/切割环组件。支撑盘120由刚性材料例如金属形成。可选地,支撑盘120和切割环122也可以采用其他结构材料。进一步地,在替代方案中,支撑盘120和切割环122可被形成为单个或者整体结构。
仍然参照图6和图7,利用例如粘合剂将切割环护盖123固定到切割环122向外朝向的或者近侧表面上。在一个实施例中,切割环护盖123由硬度比形成切割环的材料更大的一种或多种材料构成,例如聚脂薄膜。在一个实施例中,切割环护盖123包括两层聚酯薄膜(未被显示),采用粘合剂和聚丙烯涂层将所述两层聚酯薄膜联结在一起。另外,切割环122并非必需护盖。切割环122和支撑盘120可滑动地围绕支柱116安装。支撑盘120包括一对向内延伸的指状物138,对该指状物将在下文中进一步地详细阐述。
仍然参照图4、图6和图7,固定器构件127位于支撑盘120和托架118的后壁118a之间的内部环形凹陷136中。在一个实施例中,固定器构件127是环形的,包括多个与支撑盘120的齿轮表面接合的可变形突出物127a。在预定的足以使突出物127a发生形变的力被施加到支撑盘/切割环组件上之前,固定器构件127会阻止支撑盘120和切割环122移动或被推进到托架118的内部环形凹陷136中。所述预定的力可接近但要小于手术用缝合装置的环形切割刀片在与例如砧座组件110的切割环相接合时所施加的力。在一个示范性实施例中,该预定的力在约10磅至约90磅之间,可约为30磅。当达到此预定的力时,例如在切割组织的过程中,支撑盘120就被推进内部环形凹陷136中,进而挤压固定器构件127。可以预见可以用其他的可压扁的、可形变的、可收缩的或者限定运动构件将支撑盘/切割环组件保持在固定的位置中,直到将预定的力施加到该支撑盘/切割环组件上。
如图4所描绘的,砧座中央杆组件114包括中央杆152、柱塞154和柱塞弹簧156。中央杆152的第一末端包括限定空腔159a的一对臂159。每支臂159具有横向贯穿孔158,该横向贯穿孔与中央杆152的中央纵轴对准。可选择的,贯穿孔158可从中央杆152的纵轴偏离。砧座头组件112的支柱116被设置成合适的大小以便能够置入空腔159a中,它也包括横向贯穿孔(未被显示)。枢轴构件162可枢转地将支柱116通过所述贯穿孔固定到中央杆152上,这样,砧座头组件112可被可枢转地安装到砧座中央杆组件114上。
暂时转到图8,凸轮闩锁构件126包括具有贯穿孔126b的基体126a。贯穿孔126b被设置成合适的大小以便能够容纳枢轴构件162,这样,凸轮闩锁构件126就可枢转地围绕枢轴构件162安装在支柱116的横向槽172中(图3)。现在参照图3、图6和图7,凸轮闩锁构件126包括第一基体部126c,其部分地自支柱116的槽172延伸并被定位为与柱塞154的指状物166相接合。第一基体部126c被这样设定,使得第一基体部126c的表面和贯穿孔126b之间的距离围绕凸轮闩锁构件126沿着顺时针方向增加。按照这种方式,柱塞154就能够随着凸轮闩锁构件126沿顺时针方向的转动而向前运动。此外,第一基体部126c的这种结构也使得柱塞154随着凸轮闩锁构件沿逆时针方向旋转而缩进。凸轮闩锁构件126也包括边缘126f,该边缘则包括突出物126g。边缘126f设置有导向部,使得在砧座头112处于非倾斜位置或操作位置时,所述导向部可以通过柱塞154的接合指状物166而与支撑盘120的内周缘120b相接合。突出物126g被这样设置,使得其与托架118的后壁118a相接合,以阻止凸轮闩锁构件126相对于托架118作逆时针旋转。
参照图6,柱塞154可滑动地设置于孔164中,该孔形成在中央杆152的第一末端中。柱塞154包括接合指状物166,其偏离开砧座头组件112的枢轴且倾斜地与凸轮闩锁126的边缘126c相接合。指状物166与凸轮闩锁126的边缘126c的接合就把边缘126f的导向部压向支撑盘120的内周缘,从而将砧座头组件112推进至中央杆152上的操作位置或者非倾斜位置。在此非倾斜位置上,指状物166与砧座组件110的支柱116保持近距离的间隔。
转到图7,在头组件112发射前的操作位置上,例如当头组件112已经枢转到其非倾斜位置上时,形成在支撑盘120上的指状物138与中央杆152的顶面152a相邻的突出部152b相接合,从而阻止头组件112围绕枢轴构件162枢转。
如下面所述的那样,为便于插入,砧座头组件112可通过缝合线“S1”而相对于砧座中央杆组件114倾斜α度角(图13)到达发射前的第一倾斜位置。在一个实施例中,砧座头组件112以小于90度角,优选为约70度角倾斜到其发射前的倾斜位置,然而,应当明白的是,将头组件112作其他角度的倾斜也已被预见到了。砧座头组件112通过缝合线S1相对于砧座中央杆组件114的倾斜迫使位于支撑盘120的内周缘中的凸轮闩锁构件126旋转,从而使凸轮闩锁构件126的基体部126c与柱塞154的指状物166接合。随着凸轮闩锁组件126与砧座头组件112一起逆时针旋转(如图14所示),柱塞154收缩进砧座中央杆组件114的孔164中,从而挤压弹簧156。以这种方式,柱塞154的指状物166在远端偏离凸轮闩锁构件126的基体部126c。
参照图3和图4,中央杆152的第二末端包括由多个可曲臂182限定的孔180。各个可曲臂182都包括开口182a,该开口被构造成合适的大小以容纳形成在外壳组件31(图18)上或者连接在外壳组件31上的凸起。可选地,开口182a可被设置成用于容纳缝合线,从而允许收回砧座组件110。各个可曲臂182的近端包括内肩184,该内肩被设置成合适的大小以便与手术用缝合装置10的外壳组件31可松开地接合,从而将砧座组件110固定到手术用缝合装置上。围绕中央杆152形成有多个齿条186。齿条186起到将砧座组件110与手术用缝合装置的缝合钉保持部对齐的作用。中央杆152还包括环形凹陷部190,其用以帮助外科医生用抓取器抓取砧座组件110。凹陷部190可包括粗糙表面或有节的表面或者过浇铸件,以方便抓取砧座组件110。
现在参照图9至图12,通常将用于在患者体内传送砧座组件110的系统示为砧座传送系统50。砧座传送系统50包括柔性管52和接合器62。柔性管52包括开口端52a。接合器62和砧座组件110被支撑在柔性管52的开口端52a上。柔性管52的开口端52a包括延伸通过其中的贯穿孔53,该贯穿孔被设置为接纳锁销54。开口端52a进一步包括开口55,其在制造过程中用于对准管50上的印花(printing)。柔性管52的封闭端52b被设置成用于经口腔插入患者体内。在柔性管52的全长范围内可包括标记或者其他分级记号56,以便向外科医生显示在插入过程中有多长的柔性管52已经伸入患者体内和/或显示在收回过程中还有多长一部分柔性管52仍留在患者体内。
进一步参照图10,接合器62包括第一末端62a和第二末端62b,第一末端62a被设置成能够容纳于柔性管52的开口端52a内,而第二末端62b被设置成能够容纳于在砧座组件110的中央杆152中形成的孔180内。第一末端62a包括一系列被设置成能够将接合器62的第一末端62a以摩擦的方式保持在柔性管52的开口端52a中的环形圈64。接合器62的第二末端62b包括被设置成容纳于在砧座组件110的中央杆152中形成的可曲臂182之间的纵向导向构件66。此外,接合器62的第二末端62b被构造成合适的大小,以使得砧座组件110的中央杆152能够自由地滑进、滑出接合器62的第二末端62b。接合器62进一步包括形成于中央套节部62c之中的第一贯穿孔70,以及形成于第一末端62a中的第二和第三贯穿孔72、74。贯穿孔72被设置成与形成于柔性管52的开口端52a中的贯穿孔53相对准,并且其被构造成合适的大小以容纳锁销54。孔74被设置用于容纳缝合线S1的两个末端。孔70也能容纳所述缝合线的末端,以增加保持力。
现在进一步参照图10至图14,砧座组件110被支撑在砧座传送系统50上。为将砧座组件110固定到砧座传送系统50上,需要使缝合线“S1”穿过形成于砧座头112上的开口119a(在图2中也有显示),这样,缝合线“S1”的第一和第二末端就被定位在中央杆152的不同侧上。接合器62的第二末端62b位于中央杆152的贯穿孔180之中,这样,纵向导向部66容纳于两个臂构件182之间。优选地,缝合线“S1”的第一和第二末端各被插入穿过形成于接合器64中的孔74以及穿过柔性构件52的开口端52a。当缝合线“S1”的第一和第二末端被拉动穿过开口74时,砧座头112旋转到第一倾斜位置,施加拉力到砧座头上迫使其逆时针(从图13所示的方向看)枢转。如前所述,这样的枢转在近端压迫柱塞154。
接合器62的第一末端62a被插进柔性构件52的开口端52a中。接合器62的第一末端62a的的环形圈64与柔性管52的内表面之间的摩擦接触把接合器62固定到柔性管52上,并且当缝合线“S1”被钉牢在接合器62的外壁和柔性管52的内壁之间时,能够阻止其松动。已预见到,可采用多于一根的缝合线将砧座头组件112固定在发射前的倾斜位置。同样也已预见到,所述缝合线S1并不需要穿过孔74,作为替代,其只需被夹紧在接合器62和柔性管52的内壁之间。
现在参照图15,阐述一种用于将砧座组件110传送到患者体内手术点的方法。在一个优选方法中,砧座组件110被设置在第一倾斜位置,其被支撑在砧座传送系统50之上,以备传送。可替代地,临床医生可把砧座组件110固定到如上所述的砧座传送系统50上。在将砧座组件110固定到柔性管52后,外科医生把柔性管52的封闭端52b插入患者的口腔“M”,并连同柔性管52把封闭端52b向下移动过食道“E”而到达手术点,也就是胃部“St”。
插入之后,外科医生就在手术点(如所示的胃“St”)作第一切口“I1”,为柔性管52的封闭端52b创造内部入口,然后拉动柔性管52的开口端52b穿过第一切口“I1”。在有些程序中,在砧座组件110的中央杆152前进并穿过切口“I1”之前拉动柔性管52穿过切口“I1”可能是有利的。当砧座组件110被合适地定位于手术点时,外科医生通过切断缝合线“S1”并把砧座组件110从接合器62的第二末端62b分离开而把砧座传送系统50从砧座组件110上松开。这时,柔性管52(连同装配62)可通过第一切口“I1”从体内拖拉出来。
切断缝合线“S1”使得柱塞154从孔164中延伸,因而使得指状物166与凸轮闩锁构件126的基体部126c相接合。凸轮闩锁构件126的旋转(如从图14的方向看为顺时针方向)促使与支撑盘120的内周缘相接合的闩锁构件126的边缘126f把砧座头组件112推回到非倾斜操作位置(例如图6中位置)。另外,缝合装置10的远端可被这样设置,使其在砧座组件110连接到手术用缝合装置10时与柱塞154的指状物166相接合。以这种方式,手术用缝合装置10的远端把柱塞向远端推动,从而确保凸轮闩锁126的旋转,并使砧座头组件112到达非倾斜位置。
进一步参照图15,在一种方式中,在手术点形成第二切口“I2”,以用于接纳手术用缝合装置10的远端头部16通过其中。作为替代方案,只要砧座传送系统50已从第一切口移出,手术用缝合装置10的远端头部16也可通过该切口而被接纳。
暂时转到图16和图17,砧座组件110被可操作地接纳在砧座固定器32上,该固定器从形成于手术用缝合装置10的远端的外壳组件31上延伸。只要砧座组件110被接纳在手术用缝合装置10上,手术用缝合装置10就以第7,364,060号美国专利所阐述的方式运作,该专利的全部内容在前已通过引用合并于此。注意,作为替代方案,缝合线S1可在缝合装置10的远端头部16接纳砧座组件110后被切断。连接上之后,转动旋转钮22,使砧座组件110靠近远端头部16以夹紧两者间的组织,然后就如第7,364,060号专利所公开的那样,驱动发射扳机,发射缝合钉。
现在将参照图18至图23阐述砧座组件110的操作。当砧座组件110位于其发射前的非倾斜位置时(例如图18),支撑盘120与托架118的后壁118a被固定器127间隔开,同时中央杆152的突出部152b接合到支撑盘120的指状物138上(如图6和图7所示)以阻止砧座头组件112围绕枢轴构件162倾斜。弹簧156推动柱塞154的指状物166,使其与凸轮闩锁构件126的基体部126c相接合,从而沿顺时针方向(如图18所示)围绕枢轴构件162推动凸轮闩锁构件126,这样,凸轮闩锁构件126的边缘126f就与支撑构件120的内周缘120b相接合。
手术用缝合装置10的发射使得其手术刀片33与切割环122相接合,从而将切割环122和支撑盘120移动到砧座头组件112的托架118的环形凹陷136中。图19中箭头“W”显示了作为手术用缝合装置10的发射结果的切割环122和支撑盘120是如何运动的。当这样的运动发生时,固定器127(被标注在图6和图7中)的可变形突出物127a向着托架118的后壁118a发生形变,同时,支撑构件120的指状物138移离中央杆152的突出部152b。另外,支撑盘120的内周缘120b移过凸轮闩锁构件126的边缘126f,这样,凸轮闩锁构件126被柱塞154(弹簧远端偏置)推动而在图21和图22中箭头“X”所示的方向围绕枢轴构件162枢转(如在图21的方向看为顺时针方向),到达凸轮闩锁126的基体部126e位于支持盘120的前面并与之接合的位置。柱塞154与凸轮闩锁构件126的接合推动凸轮构件126继续沿顺时针方向旋转,这是由于其构造使得弹簧偏置柱塞154继续向远端运动,这样柱塞154的有角表面167接触到砧座头组件112的支柱116的表面,从而将砧座头组件118运动到第二倾斜位置(图22A和图23)。应注意的是,在手术用缝合装置10发射之时,砧座头组件112不会立即倾斜到其第二倾斜位置,这是因为,在发射时,砧座头组件112位于靠近的位置,就是说,该砧座头组件112与缝合装置10的外壳组件31靠近地对齐,因而没有空间可供头组件112转动。同样地,当砧座组件110和手术用缝合装置10的外壳组件31正处于不接近,并因此在砧座组件110和缝合装置10的远端头部16之间存在足够的间隙时,所述砧座头组件112才会开始倾斜。
当砧座头组件112向前或者向着其第二倾斜位置转动时,柱塞154的指状物166使凸轮闩锁构件126的表面126e与支撑盘120保持接触,从而阻止支撑盘120在手术刀片被收回时粘住该手术刀片。应该注意的是,凸轮闩锁构件的弯曲表面126e被设置为去除一切间隙并确保凸轮闩锁构件126的表面126e与支撑盘120接触,以便在手术刀片被收回时以及收回后将支撑盘120保持在合适位置上,这样,在砧座组件112持续地倾斜的过程中,切割环和支撑盘组件保留在它们正确的位置上。砧座组件110被设置成使得砧座头组件相对于中央杆组件114向前或者向着第二倾斜位置倾斜β度角(图24)。就像能够了解的那样,砧座头组件因此从初始(第一)倾斜位置按第一方向转动至用于施加缝合钉的非倾斜的操作位置。在装置发射之后,砧座头沿同一方向转动至第二倾斜位置。在一个实施例中,砧座头组件112以小于90度,优选约为70度(70°)的角度倾斜至其第二倾斜位置,这样,砧座从收回位置或第一倾斜位置到向前位置或第二倾斜位置的整个倾斜运动的角度范围大约为140度(140°)。然而,应注意,砧座头组件112为第一和/或第二倾斜位置而倾斜其他的角度也已预见到。
应该理解的是,可对公开于此的实施例作不同的改变。例如,切割环和支撑盘可被一体地或者整合地形成。另外,砧座头组件不是必需有切割环护盖。因此,上面的说明不应被理解为是对本发明的一种限制,而只能被理解为各种优选实施例的范例。本领域的技术人员在随附的权利要求的范围或精神之内可以设想其它各种改变。
Claims (18)
1.一种手术用倾斜砧座组件,其包括:
杆;
头组件,其包括支柱和具有缝合钉变形凹处的砧座盘,且所述头组件被枢转地固定在所述杆上并且相对于所述杆在第一倾斜位置、非倾斜位置和第二倾斜位置之间枢转,其中,所述头组件从所述第一倾斜位置经过所述非倾斜位置到达所述第二倾斜位置;
柱塞和枢转的凸轮闩锁构件,其中所述柱塞具有指状物,所述凸轮闩锁构件可枢转地围绕枢轴构件安装在所述支柱的横向槽中,并且所述凸轮闩锁构件的旋转使得所述柱塞向远侧运动,以将所述头组件从所述非倾斜位置移动到所述第二倾斜位置,
其中,所述凸轮闩锁构件包括第一基体部,该第一基体部部分地自所述支柱的横向槽延伸并被定位为与柱塞的指状物相接合并构造为使得第一基体部的表面和凸轮闩锁构件的贯穿孔之间的距离围绕凸轮闩锁构件沿着顺时针方向增加,其中,所述第一基体部的这种结构使得柱塞随着凸轮闩锁构件沿逆时针方向旋转且头组件从非倾斜位置移动到第一倾斜位置而缩进,并使得柱塞随着凸轮闩锁构件沿顺时针方向转动且头组件从非倾斜位置移动到第二倾斜位置而向前运动。
2.根据权利要求1所述的倾斜砧座组件,进一步包括支撑构件,其中,所述支撑构件围绕所述支柱从第一位置运动到第二位置,在所述第一位置上,所述支撑构件被定位以阻止所述头组件从所述非倾斜位置枢转运动到所述第二倾斜位置,在所述第二位置上,所述支撑构件被定位以允许所述头组件相对于所述杆从所述非倾斜位置枢转运动到第二倾斜位置。
3.根据权利要求2所述的倾斜砧座组件,其中,所述凸轮闩锁构件被定位以与所述支撑构件接合,以防止所述支撑构件从所述第二位置运动到所述第一位置。
4.根据权利要求3所述的倾斜砧座组件,进一步包括偏置构件,所述偏置构件促使所述柱塞与所述凸轮闩锁构件接合,以将所述凸轮闩锁构件推动至枢转位置。
5.根据权利要求2或3所述的倾斜砧座组件,进一步包括固定器构件,所述固定器构件位于所述头组件中以在预定的力施加到所述支撑构件之前阻止所述支撑构件从所述第一位置运动到所述第二位置。
6.根据权利要求1至4中任一项所述的倾斜砧座组件,其中,所述头组件处在所述第一倾斜位置时的角度相对于所述非倾斜位置小于90度,并且所述头组件处在所述第二倾斜位置时的角度相对于所述非倾斜位置小于90度。
7.根据权利要求1至4中任一项所述的倾斜砧座组件,其中,所述头组件被与所述头组件相连接的拉紧构件保持在第一倾斜位置。
8.根据权利要求7所述的倾斜砧座组件,其中,所述头组件包括第一开口,并且所述拉紧构件包括延伸穿过所述开口的第一缝合线。
9.根据权利要求8所述的倾斜砧座组件,进一步包括在所述头组件中用于接纳第二缝合线的第二开口,所述第二缝合线在与所述第一缝合线相对的方向延伸以利于收回砧座组件。
10.根据权利要求2至4中任一项所述的倾斜砧座组件,其中,所述凸轮闩锁构件与所述支撑构件接合,从而把所述头组件从所述第一倾斜位置推动至所述非倾斜位置。
11.一种手术用倾斜砧座组件,其包括:
杆;
头组件,其包括托架、支柱和支撑构件,所述头组件被枢转地固定在所述杆上,并且所述头组件相对于所述杆在第一方向上从用于插入的第一倾斜位置枢转到用于操作的非倾斜位置,进而相对于所述杆从所述非倾斜位置枢转到不同于所述第一倾斜位置的第二倾斜位置;以及
柱塞和枢转的凸轮闩锁构件,其中,所述柱塞具有指状物,所述凸轮闩锁构件可枢转地围绕枢轴构件安装在所述支柱的横向槽中,所述凸轮闩锁构件在所述支撑构件前进到远侧后阻止所述支撑构件的近侧运动,并且所述凸轮闩锁构件包括第一基体部,该第一基体部部分地自所述支柱的横向槽延伸并被定位为与柱塞的指状物相接合并构造为使得第一基体部的表面和凸轮闩锁构件的贯穿孔之间的距离围绕凸轮闩锁构件沿着顺时针方向增加,并且所述第一基体部的这种结构使得柱塞随着凸轮闩锁构件沿逆时针方向旋转且头组件从非倾斜位置移动到第一倾斜位置而缩进,并使得柱塞随着凸轮闩锁构件沿顺时针方向转动且头组件从非倾斜位置移动到第二倾斜位置而向前运动。
12.根据权利要求11所述的倾斜砧座组件,其中,所述柱塞被弹簧偏置而与所述凸轮闩锁构件接合,从而使所述凸轮闩锁构件枢转。
13.一种手术用砧座传送系统,其包括:
砧座组件,其包括杆和枢转地固定在所述杆上的头组件,所述头组件相对于杆在第一倾斜位置、用于操作的非倾斜位置和第二倾斜位置之间枢转,其中,所述头组件从所述第一倾斜位置运动至非倾斜位置,且经过所述非倾斜位置到达第二倾斜位置,所述头组件包括支柱;
柱塞和枢转的凸轮闩锁构件,其中所述柱塞具有指状物,所述凸轮闩锁构件可枢转地围绕枢轴构件安装在所述支柱的横向槽中,并且所述凸轮闩锁构件包括第一基体部,该第一基体部部分地自所述支柱的横向槽延伸并被定位为与柱塞的指状物相接合并构造为使得第一基体部的表面和凸轮闩锁构件的贯穿孔之间的距离围绕凸轮闩锁构件沿着顺时针方向增加,并且所述第一基体部的这种结构使得柱塞随着凸轮闩锁构件沿逆时针方向旋转且头组件从非倾斜位置移动到第一倾斜位置而缩进,并使得柱塞随着凸轮闩锁构件沿顺时针方向转动且头组件从非倾斜位置移动到第二倾斜位置而向前运动;
柔性管,所述砧座组件连接至所述柔性管;以及
拉紧构件,其连接到所述头组件上并将所述头组件保持在所述第一倾斜位置,从而使得松开所述拉紧构件则所述头组件回到所述非倾斜位置。
14.根据权利要求13所述的砧座传送系统,其中,所述拉紧构件是第一缝合线,所述第一缝合线延伸穿过所述头组件中的孔并进入所述柔性管的开口中。
15.根据权利要求14所述的砧座传送系统,进一步包括连接到所述头组件的第二缝合线,所述第二缝合线在不同于所述第一缝合线的方向上延伸。
16.根据权利要求13或14所述的砧座传送系统,其中,所述头组件在被定位到所述非倾斜位置后进一步枢转到第二倾斜位置,所述第二倾斜位置不同于所述第一倾斜位置。
17.根据权利要求16所述的砧座传送系统,其中,所述柱塞被弹簧偏置而与所述凸轮闩锁构件相接触,并且该柱塞向远侧运动以使所述凸轮闩锁构件旋转,从而将所述头组件从所述第一倾斜位置移动到所述非倾斜位置,而且所述柱塞进一步向远侧运动,进而将所述头组件从所述非倾斜位置移动到与所述第一倾斜位置不同的第二倾斜位置。
18.根据权利要求13或14所述的砧座传送系统,进一步包括将所述砧座组件连接到所述柔性管上的接合器。
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US8109426B2 (en) | 2012-02-07 |
EP2974676A1 (en) | 2016-01-20 |
EP2153781A2 (en) | 2010-02-17 |
CN104224265A (zh) | 2014-12-24 |
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CN101647720A (zh) | 2010-02-17 |
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CA2674848A1 (en) | 2010-02-12 |
US9532781B2 (en) | 2017-01-03 |
US20140054353A1 (en) | 2014-02-27 |
CA2674848C (en) | 2016-10-11 |
EP2153781A3 (en) | 2010-03-17 |
EP2153781B1 (en) | 2011-11-02 |
EP2415407A1 (en) | 2012-02-08 |
JP5463097B2 (ja) | 2014-04-09 |
ES2552244T3 (es) | 2015-11-26 |
US20120104073A1 (en) | 2012-05-03 |
EP2208468A1 (en) | 2010-07-21 |
ES2558966T3 (es) | 2016-02-09 |
EP2974676B1 (en) | 2020-06-17 |
JP2010042259A (ja) | 2010-02-25 |
ES2754102T3 (es) | 2020-04-15 |
US8328063B2 (en) | 2012-12-11 |
EP2308392A1 (en) | 2011-04-13 |
AU2009208067B2 (en) | 2015-03-12 |
EP2208468B1 (en) | 2015-12-02 |
EP2415407B1 (en) | 2019-10-02 |
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