CN101664329B - 具有楔形板的内窥镜手术施夹器 - Google Patents

具有楔形板的内窥镜手术施夹器 Download PDF

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CN101664329B
CN101664329B CN200910171611.1A CN200910171611A CN101664329B CN 101664329 B CN101664329 B CN 101664329B CN 200910171611 A CN200910171611 A CN 200910171611A CN 101664329 B CN101664329 B CN 101664329B
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格雷戈里·索伦蒂诺
肯尼斯·H·惠特菲尔德
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Abstract

本发明公开了一种用于将手术夹子施加到体组织上的装置，所述装置包括：手柄组件；轴组件，其包括从所述手柄组件向远侧延伸的壳体，并且限定了纵轴；布置在所述轴组件中的多个手术夹子；钳口，其邻近所述轴组件的远端部安装，所述钳口可以在隔开的打开状态和接近的闭合状态之间移动；以及推杆，其可往复运动地布置在所述轴组件的壳体中，并能够可拆卸地连接到所述轴组件的壳体上，所述推杆被配置成在向远侧移动期间将最远侧手术夹子装入钳口中，而在所述钳口的接近期间保持到所述轴组件的壳体的连接，并保持在远侧的推进位置。

Description

具有楔形板的内窥镜手术施夹器
相关申请的引用
本申请要求于2008年8月29日提交的序列号为61/092,804的美国临时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
本公开涉及手术施夹器，尤其是涉及一种新型的内窥镜手术施夹器。
背景技术
内窥镜缝合器和施夹器在本领域中是公知的并且用于许多不同且有用的手术程序。在腹腔镜手术程序的情况下，通过插入皮肤中的小进入切口的窄的管子或套管来获得到腹部内部的通道。而在身体上的其它部位执行的微创程序通常一般被称作内窥镜程序。典型地，管子或者套管装置通过进入切口伸入患者的身体中，以便提供入口。此种入口允许外科医生利用套管针插入多个不同的手术器械并且用于在远离切口的地方执行手术程序。
在大多数的这些程序中，外科医生经常必须终止血液或另一种液体通过一根或多根脉管的流动。在程序中，外科医生经常会将手术夹子施加到血管或另一种导管上，以防止体液流过这些导管。内窥镜施夹器用于在进入体腔时施加单个夹子，这在本领域中是公知的。典型地，这样的单个施夹器由生物相容性材料制成并且通常被压布在脉管上。一旦施加到脉管上，该被压布的夹子就终止了液体通过导管的流动。
在共有的转让给格林(Green)等人的第5,084,057和5,100,420号美国专利中描述了在单独进入体腔中时能够在内窥镜或腹腔镜程序中施加多个夹子的内窥镜施夹器，上述两项专利的全部内容通过引用合并于此。在共有的转让给布拉德(Pratt)等人的第5,607,436号美国专利中公开了另一种复合内窥镜施夹器，该专利的全部内容同样通过引用合并于此。这些装置被典型地用在单个手术程序中，但这不是必须的。在序列号为08/515,341的美国专利申请，即现在授予给皮埃尔(Pier)等人的第5,695,502号美国专利中公开了一种可重新消毒的手术施夹器，该专利所公开的内容通过引用合并于此。该施夹器在单独插入体腔中时推进并形成多个夹子。所述可重复消毒的施夹器被配置成容纳并与可交换的弹夹合作，以便在单独进入体腔时推进和形成多个夹子。一个重要的设计目标是，在不对来自装载程序的夹子进行任何压缩的情况下将手术夹子装在钳口之间。在装载过程中的夹子的这些弯曲或扭转经常会有许多意想不到的后果。在装载时的这种压缩可能会略微地改变夹子在钳口之间的对准。这会使外科医生将夹子从钳口之间移除以便丢弃夹子。另外，这种预载压缩可能会略微地压缩夹子的某些部分而改变其几何。这会使外科医生将夹子从钳口之间移除以便丢弃夹子。
经常在远离切口的地方执行内窥镜或者腹腔镜程序。因此，对于位于装置近端的用户而言，视野或者触觉反馈的减小可能使夹子的施加复杂化。因此希望通过向用户提供单个夹子被发射的指示、包含在装载单元中的夹子的损耗或者任何其它手术事件的指示来改善器械的操作。还希望提供这样一种手术施夹器：其促进了夹子的成功负载并且分开该手术施夹器的钳口，然后将夹子装在钳口之间以防止夹子的任何损坏或者过度压缩，并在发射前防止钳口压在夹子上。
发明内容
本公开涉及新型的内窥镜手术施夹器。
根据本公开的一个方案，提供了一种用于将手术夹子施加到体组织上的装置。本装置包括：手柄组件；轴组件，其从手柄组件向远侧延伸，并且限定了纵轴；布置在轴组件中的多个手术夹子；钳口，其邻近轴组件的远端部安装，该钳口可在隔开的打开状态和接近的闭合状态之间移动；以及推杆，其可往复运动地布置在轴组件中，该推杆被配置成在钳口处于打开状态时将最远侧手术夹子装入钳口中，并在钳口的接近期间时与被装入的夹子保持接触。
推杆可包括形成在其远端处的推动器。推动器可具有狭窄轮廓以在单个位置上接触被装入的手术缝合钉。推动器可以限定与被装入的手术缝合钉的平面大体正交的平面。
所述装置可进一步包括可往复运动地布置在轴组件中的连接板。连接板可以连接到推杆上。在使用中，在连接板的最初远侧移动期间，推杆可以向着远侧推进，而在连接板的进一步远侧移动期间，连接板可以从推杆脱开。
推杆可包括支撑在其上的第一弹簧夹子，该第一弹簧夹子用于在推杆处于推进位置时选择性地与轴组件的部件接合，以选择性地将推杆保持在该推进位置。推杆可进一步包括支撑于其上的第二弹簧夹子，第二弹簧夹子用于选择性地与连接板的第一部件接合。在连接板的最初远侧移动之后，连接板的第一部件可以选择性地从第二弹簧夹子脱离。
所述装置可进一步包括可往复运动地布置在轴组件中的推进板。推进板可包括能被推杆的肩部选择性地接合的至少一个翼片。在使用中，在推杆的远侧和近侧移动期间，推杆的肩部可与推进板的至少一个翼片接合，以实现推进板的远侧和近侧移动中的一个。
所述装置可进一步包括可滑动地支撑在轴组件中的夹子输出器，夹子输出器用于向远侧方向推动多个手术夹子。夹子输出器包括从其第一表面突出的第一凸起以及从其第二表面突出的第二凸起。在使用中，随着推进板向远侧移动，夹子输出器的第一凸起可与推进板接合，从而使该夹子输出器向远侧移动以推进多个手术夹子，并且其中，随着推进板向近侧移动，夹子输出器的第二凸起可与固定部件接合，从而使夹子输出器保持固定。
所述装置可进一步包括布置在轴组件中的夹子载体，其中，该夹子载体被配置成保持多个手术夹子以及夹子输出器，并且其中，夹子输出器的第二凸起可与形成在夹子载体中的部件接合。
可逐步推进夹子输出器通过轴组件。夹子输出器可包括从其表面伸出的窗钩(catch)，其中，在最后一个手术夹子被发射之后，该窗钩可与推杆接合并可防止推杆向近侧方向移动。
所述装置可进一步包括布置在手柄组件中的棘轮组件。当推杆没有返回到近侧位置时，可以防止该棘轮组件复位。
所述装置可进一步包括支撑在壳体组件中的计数器。当手术夹子已经被发射之后，该计数器可提供指示。
所述装置可进一步包括支撑在壳体组件中的指示器。当至少一个手术夹子被装入钳口中、手术夹子被发射以及所述装置被复位时，指示器可提供听觉和触觉指示中的至少一个。
所述装置可进一步包括可往复运动地布置在轴组件中的楔形板。楔形板可以在其远端布置在钳口中的位置和其远端不在所述钳口中的位置之间移动。楔形板可进一步包括支撑在其上用于选择性地与连接板的第二部件接合的第三弹簧夹子，其中，在连接板的最初远侧移动之后，连接板的第二部件选择性地从该第三弹簧夹子脱离。
所述装置可进一步包括由手柄组件致动并连接到连接板的驱动杆，驱动杆用于实现连接板的移动。所述装置可进一步包括可往复运动地布置在轴组件中的驱动通道，其中，驱动杆选择性地与驱动通道接合以实现该驱动通道的平移。当驱动通道向远侧推进时，其远端可与钳口的表面接合，以实现钳口的接近。
驱动通道在其向远侧推进时可致动楔形锁释放装置以使楔形板向近侧移动从而使楔形板的近端从钳口退回，并允许驱动通道接近钳口。
轴组件可以相对于手柄组件围绕纵轴旋转。轴组件可包括支撑在其内的保护装置。其中，该保护装置可在第三弹簧夹子平移通过该保护装置时防止第三弹簧夹子向外张开。
楔形板和/或驱动通道可被偏置到近侧位置。
根据本公开的另一个方案，提供了一种用于将手术夹子施加到体组织上的装置。该装置包括：手柄组件；轴组件，其从手柄组件向远侧延伸，并且限定了纵轴；布置在轴组件中的多个手术夹子；钳口，其邻近轴组件的远端部安装，该钳口可以在隔开的打开状态和接近的闭合状态之间移动；以及夹子输出器，其可滑动地支撑在轴组件中，用于向远侧推动多个手术夹子。该夹子输出器包括从其第一表面突出的第一凸起以及从其第二表面突出的第二凸起。随着推进板向远侧推进，夹子输出器的第一凸起与推进板接合，从而使该夹子输出器向远侧移动以推进多个手术夹子，并且，随着推进板向近侧移动，夹子输出器的第二凸起与固定部件接合，从而使夹子输出器保持固定。
所述装置可进一步包括可往复运动地布置在轴组件中的推进板。推进板可限定沿其长度形成的多个窗口。在使用中，随着推进板往复运动，夹子输出器的第一凸起可与多个窗口中的一个窗口选择性地接合。
所述装置可进一步包括可往复运动地布置在轴组件中的推杆。该推杆被配置成可以在钳口处于打开状态时将最远侧手术夹子装入钳口中，并在钳口的接近期间与被装入的手术夹子保持接触。
推进板可包括能与推杆的肩部选择性地接合的至少一个翼片。在推杆的远侧和近侧移动期间，推杆的肩部可与推进板的至少一个翼片接合，以实现推进板的远侧和近侧移动中的一个。
推杆可包括形成在其远端处的推动器，其中，推动器具有狭窄轮廓以在单个位置上接触装入的手术缝合钉。推动器可以限定与被装入的手术缝合钉的平面大体正交的平面。
所述装置可进一步包括可往复运动地布置在轴组件中的连接板。连接板可以选择性地连接到推杆上。在使用中，在连接板的最初远侧移动期间，推杆可向远侧推进，而在连接板的进一步远侧移动期间，该连接板可以从推杆脱开。
推杆可包括支撑在其上的第一弹簧夹子，该第一弹簧夹子用于在推杆处于推进位置时可拆卸地连接到轴组件的部件上，从而将推杆保持在该推进位置。推杆可进一步包括支撑于其上的第二弹簧夹子，第二弹簧夹子用于可拆卸地连接到连接板的第一部件，其中，在连接板的最初远侧移动之后，连接板的第一部件从第二弹簧夹子脱开。
所述装置可进一步包括布置在轴组件中的夹子载体。夹子载体可被配置成保持多个手术夹子以及夹子输出器。夹子输出器的第二凸起可与形成在夹子载体中的部件接合。可逐步推进夹子输出器通过轴组件。夹子输出器可包括从其表面伸出的窗钩。在最后一个手术夹子被发射之后，窗钩可与推杆接合，并可防止推杆向近侧方向移动。
所述装置可进一步包括布置在手柄组件中棘轮组件。当推杆没有返回到近侧位置时，可防止该棘轮组件复位。
所述装置可进一步包括支撑在壳体组件中的计数器，其中，当手术夹子已经被装入或者发射之后，该计数器可提供指示。所述装置可进一步包括支撑在壳体组件中的指示器，其中，当至少一个手术夹子被装入钳口中、手术夹子被发射以及所述装置被复位时，该指示器可提供听觉和触觉指示中的至少一个。
所述装置可进一步包括可往复运动地布置在轴组件中的楔形板。楔形板可以在其远端布置在钳口中的位置和其远端不在所述钳口中的位置之间移动。该钳口可进一步包括支撑在其上用于与连接板的第二部件选择性地接合的第三弹簧夹子，其中，在连接板的最初远侧移动之后，连接板的第二部件可以选择性地从该第三弹簧夹子脱离。
所述装置可进一步包括驱动杆，驱动杆由手柄组件致动并连接到连接板上用于实现连接板的移动。所述装置可进一步包括可往复运动地布置在轴组件中的驱动通道，其中，驱动杆可以与驱动通道选择性地接合以实现该驱动通道的平移，并且其中，当驱动通道向远侧推进时，其远端可与钳口的表面接合以实现钳口的接近。驱动通道在其向远侧推进时可致动楔形锁板以使楔形板向近侧移动从而使楔形板的远端从钳口退回，并且可以允许驱动通道接近钳口。
轴组件可以相对于手柄组件围绕纵轴旋转。轴组件可包括支撑在其内的套箍(cuff)，其中，该套箍可在第三弹簧夹子平移跨过该套箍时防止第三弹簧夹子向外张开。
楔形板和/或驱动通道可被偏置到近侧位置。
根据本公开的又一个方案，提供了一种用于将手术夹子施加到体组织上的装置，其中，所述装置包括手柄组件以及从该手柄组件向远侧延伸并且限定了纵轴的轴组件。手柄组件包括扳机以及驱动杆，该驱动杆在扳机致动时可通过扳机往复平移。轴组件包括：壳体；布置在壳体中的多个手术夹子；钳口，其邻近壳体的远端部安装，该钳口可在隔开的打开状态和接近的闭合状态之间移动；可往复运动地布置在壳体中的推杆，该推杆被配置成在钳口处于打开状态时将最远侧手术夹子装入钳口中，并在钳口的接近期间与被装入的手术夹子保持接触；邻近推杆可往复运动地布置在壳体中的推进板，推进板包括选择性地与推杆的肩部接合的至少一个翼片，其中，在推杆的远侧和近侧移动期间，推杆的肩部与推进板的至少一个翼片接合，以实现推进板的远侧和近侧移动中的一个；邻近推进板布置在壳体中的夹子载体，其中，该夹子载体被配置成保持多个手术夹子；夹子输出器，其可滑动地支撑在夹子载体中最多个手术夹子的近侧位置上，该夹子输出器被配置成向远侧方向推动多个手术夹子，该夹子输出器包括从其第一表面突出的第一凸起以及从其第二表面突出的第二凸起，其中，随着推进板向远侧移动，夹子输出器的第一凸起与推进板接合，从而使该夹子输出器向远侧移动以推进多个手术夹子，并且其中，随着推进板向近侧移动，夹子输出器的第二凸起与夹子载体接合，从而使夹子输出器保持固定；邻近夹子载体可往复运动地布置在壳体中的驱动通道，其中，驱动杆与驱动通道选择性地接合以实现该驱动通道的平移，其中，当驱动通道向远侧推进时，其远端与钳口的表面接合以实现钳口的接近；以及邻近驱动通道可往复运动地布置在壳体中的楔形板，该楔形板在其远端布置在钳口中的位置和其远端不在所述钳口中的位置之间移动。
推杆可包括形成在其远端处的推动器。推动器可以具有狭窄轮廓以在单个位置上接触被装入的手术缝合钉。推动器可以限定与被装入的手术缝合钉的平面大体正交的平面。推杆可包括支撑在其上的第一弹簧夹子，该第一弹簧夹子可以在推杆处于推进位置时与轴组件的壳体的部件选择性地接合，以选择性地将推杆保持在该推进位置。推杆可进一步包括支撑于其上的第二弹簧夹子，第二弹簧夹子用于与连接板的第一部件选择性地接合，其中，在连接板的最初远侧移动之后，连接板的第一部件选择性地从第二弹簧夹子脱离。
可逐步推进夹子输出器通过轴组件。夹子输出器可包括从其表面伸出的窗钩。在使用中，在最后一个手术夹子被发射之后，窗钩可与推杆接合，并且可防止推杆向近侧方向移动。
手柄组件可进一步包括布置于其内的棘轮组件。在使用中，当推杆没有返回到近侧位置时，可以防止该棘轮组件复位。手柄组件可进一步包括支撑在壳体组件中的计数器，其中，当手术夹子已经被发射之后，该计数器可提供指示。更进一步地，手柄组件可包括支撑在其内的指示器。指示器可提供指示事件的听觉和触觉指示中的至少一个。例如，所述事件可以是至少一个手术夹子被装入钳口中、手术夹子被发射以及所述装置被复位。
楔形板可进一步包括支撑在其上用于与连接板的第二部件选择性地接合的第三弹簧夹子。在使用中，在连接板的最初远侧移动之后，连接板的第二部件可以选择性地从该第三弹簧夹子脱离。
轴组件可包括楔形板锁。在使用中，驱动通道可以在其向远侧推进后致动楔形板锁以使楔形板向近侧移动从而使楔形板的远端从钳口退回，并且允许驱动通道接近钳口。
轴组件可以相对于手柄组件围绕纵轴旋转。轴组件可包括支撑在壳体内的套箍，其中，该套箍在第三弹簧夹子平移跨过该套箍时防止第三弹簧夹子向外张开。
楔形板和/或驱动通道可被偏置到近侧位置。
附图说明
通过结合附图的下列详细描述，本施夹器将被更全面地认识并变得更好理解，在附图中：
图1是根据本公开的一个实施方式的手术施夹器的前视立体图；
图2是图1所示的施夹器的后视立体图，图示了其轴组件的旋转；
图3是图1和图2所示的施夹器的轴组件的远端的前视立体图；
图4是图1和图2所示的施夹器的俯视图；
图5是图1和图2所示的施夹器的侧面正视图；
图6是图1至图5所示的施夹器的手柄组件的立体图，图示了左半壳体被从其中移走的情况；
图7是图1至图5所示的施夹器的手柄组件的立体图，图示了右半壳体被从其中移走的情况；
图8是图1至图5所示的施夹器的手柄组件的部件分解的立体图；
图8A是图6至图8所示的手柄组件在扳机被从其中移走的情况下的立体图；
图8B是图6至图8所示的手柄组件的反馈构件的立体图；
图9是图1至图5所示的施夹器的轴组件的部件分解的立体图；
图10是图9所示的轴组件的右侧前视立体图，示出了装配的情况；
图11是图10中显示的细节表示区域的放大视图；
图12是图9至图11所示的轴组件的右侧前视图，示出了上壳体被从其中移走的情况；
图13是图12中显示的细节表示区域的放大视图；
图14是图12中显示的细节表示区域的放大视图；
图15是图12中显示的细节表示区域的放大视图；
图16是图9至15所示的轴组件的推杆的近端以及弹簧夹子(snap clip)的部件分解的立体图；
图17是图9至图15所示轴组件的仰视图，图示了推杆的近端以及布置在上壳体中的弹簧夹子；
图18是图9至图17所示的轴组件的右侧前视立体图，示出了上壳体和推杆被从其中移走的情况；
图19是图18中显示的细节表示区域的放大视图；
图20是图18中显示的细节表示区域的放大视图；
图21是图9至图20所示的轴组件的右侧前视立体图，示出了上壳体、推杆和推进板被从其中移走的情况；
图22是图21中显示的细节表示区域的放大视图；
图23是夹子输出器以及闭锁板的部件分解的立体图；
图23A是图23所示的夹子输出器以及闭锁板装配完毕后的俯视立体图；
图24是图23所示的夹子输出器的仰视立体图；
图25是图9至图23所示的轴组件的远端的右侧前视立体图，示出了上壳体、推杆、推进板以及夹子载体被从其中移走的情况；
图26是图25所示的轴组件的远端的右侧前视立体图，示出了上壳体、推杆、推进板、夹子载体以及驱动通道被从其中移走的情况；
图27是图9至图26所示的轴组件的左侧前视立体图，示出了上壳体、推杆、推进板、夹子载体、驱动通道以及楔形板被从其中移走的情况；
图28是图27中显示的细节表示区域的放大视图；
图29是图27中显示的细节表示区域的放大视图；
图30是图9至29所示的轴组件的下壳体的左侧前视立体图；
图31是图30中显示的细节表示区域的放大视图；
图31A是图30中显示的细节表示区域的放大视图；
图32是图1至31A所示的施夹器的纵向截面图，图示了处于未致动状态下的施夹器；
图33是图32中显示的细节表示区域的放大视图；
图34是图1至图31A所示的施夹器的轴组件的远端的纵向截面图；
图35是沿图34中的35-35截取的截面图；
图36是图34中显示的细节表示区域的放大视图；
图37是沿图36中的37-37截取的截面图；
图38是图34中显示的细节表示区域的放大视图；
图39是沿图38中的39-39截取的截面图；
图40是图34中显示的细节表示区域的放大视图；
图41是沿图40中的41-41截取的截面图；
图42是图34中显示的细节表示区域的放大视图；
图43是沿图42中的43-43线截取的截面图；
图44是图1至43所示的施夹器在最初致动期间的纵向截面图；
图45是图44中显示的细节表示区域的放大视图；
图46是图34中显示的细节表示区域36的在施夹器的最初致动期间的放大视图；
图47是图34中显示的细节表示区域40的在施夹器的最初致动期间的放大视图；
图47A是推杆的俯视图，图示了推杆在施夹器的最初致动期间的移动；
图47B和图47C均是轴组件的纵向截面图，图示了在施夹器的最初致动期间楔形板的移动；
图48和图49是在施夹器的最初驱动期间轴组件沿图40中41-41截取的截面的放大视图；
图50是在施夹器的最初致动期间图34中显示的细节表示区域42的放大视图；
图51是在施夹器的最初致动期间轴组件的远端的左侧仰视立体图；
图52至图54均是轴组件的纵向截面图，图示了在施夹器的最初致动期间楔形板的进一步移动，以及连接板的杆从楔形板的弹簧夹子的脱离；
图55是图1至图54所示的施夹器的纵向截面图，图示了在进一步致动期间的施夹器；
图56是图55中显示的细节表示区域的放大视图；
图56A是移去上壳体的轴组件的右视立体图，图示了在施夹器的进一步致动期间推杆的移动；
图56B和图56C均是推进板的仰视图，图示了在施夹器的进一步致动期间推进板的移动；
图57是在施夹器的进一步致动期间图34中显示的细节表示区域36的放大视图；
图58是在施夹器的进一步致动期间图34中显示的细节表示区域40施夹器的放大视图；
图59和图60是轴组件的纵向截面图，图示了在施夹器的进一步致动期间推杆的移动以及支撑在推杆上的夹子与上壳体的凸台的连接；
图61是在施夹器的进一步致动期间图34中显示的细节表示区域40的放大视图；
图62是在施夹器的进一步致动期间图34中显示的细节表示区域42的放大视图；
图63是轴组件的纵向截面图，图示了在施夹器的进一步致动期间驱动杆的移动；
图64和图65是在施夹器的进一步致动期间轴组件沿图40中41-41截取的截面的放大视图；
图66是在施夹器的进一步致动期间轴组件的远端的俯视左侧立体图；
图67至图69是轴组件的纵向截面图，图示了在施夹器的进一步致动期间连接板的移动；
图67A至图69A是根据本公开的另一可选实施方式的轴组件的纵向截面图，图示了在施夹器的进一步致动期间连接板的移动；
图70是图1至图69所示的施夹器在最后的致动期间的纵向截面图；
图71是图70中显示的细节表示区域的放大视图；
图72是在施夹器的最后致动期间图34中显示的细节表示区域42的放大视图；
图73和图74是轴组件的远端的前视立体图，图示了在施夹器的最后致动期间钳口的致动；
图75是图示了施加到脉管上的手术夹子的立体图；
图76是在施夹器的扳机被松开时图70中显示的细节表示区域71的放大视图；
图76A是在扳机在其完全致动后松开时手柄组件的侧面正视图；
图77是轴组件的纵向截面图，图示了在扳机松开期间连接板的移动；
图78是轴组件的纵向截面图，图示了在扳机的松开期间推杆的移动以及支撑在推杆上的夹子从上壳体的凸台的脱开；
图79是移去上壳体的轴组件的右视立体图，图示了在扳机的松开期间推杆的移动；
图80是在扳机松开期间图34中显示的细节表示区域40的放大视图；
图81是轴组件的纵向截面图，图示了在扳机松开期间连接板的杆再次连接到推杆的弹簧夹子上；
图82至图83均是轴组件的纵向截面图，图示了在扳机松开期间楔形板的进一步移动以及连接板的杆与楔形板的弹簧夹子上的再次接合；
图84是当施夹器处于闭锁状态时轴组件的远端的前视立体图；
图85是当施夹器处于闭锁状态时图34显示的细节表示区域42的放大视图；以及
图86是当施夹器处于闭锁状态时图70显示的细节表示区域71的放大视图。
具体实施方式
现将参照附图详细说明根据本公开的手术施夹器的实施方式，附图中相似的附图标记表示相似或相同的部件。如图所示及以下说明书通篇所描述的，按照传统，当涉及手术器械上的相对位置时，术语“近侧”指装置的靠近用户的一端，术语“远侧”指装置的远离用户的一端。
现参照图1至图5，根据本公开的一个实施例的手术施夹器总体上用100来指代。施夹器100包括手柄组件102和内窥镜部，该内窥镜部包括从手柄组件102向远侧延伸的轴组件104。
轴组件104具有约10mm的外径。取决于预计的用途诸如肥胖病手术，轴组件104可以具有各种伸长的或缩短的长度。
如图1至图5所示，手术施夹器100包括安装在轴组件104的远端并可由手柄组件102的扳机108致动的一对钳口106。一对钳口106由合适的生物相容的材料诸如不锈钢或钛制成，该一对钳口限定了在其之间用于将手术夹子“C”容纳在其中的通道106a。当一对钳口106处于相对于彼此打开或非接近的状态时，测得一对钳口106的宽度大于轴组件104的外径。
一对钳口106安装于轴组件104的远端以使它们相对该处纵向固定。旋钮110可以可旋转地安装在手柄组件102的远端，并连接于轴组件104以向轴组件104和一对钳口106传输和/或提供绕其纵轴的360°旋转(参见图2)。
现参照图1至图8，示出了手术施夹器100的手柄组件102。手柄组件102包括壳体103，该壳体具有第一或右侧半部103a和第二或左侧半部103b。手柄组件102包括可枢转地支撑在右侧半部103a和左侧半部103b之间的扳机108。如以下将更详细讨论的，手柄组件102限定了形成于壳体103中的用于支撑和显示计数机构的窗口103c。手柄组件102的壳体103可由合适的塑料制成。
壳体103将驱动组件120支撑在右侧半部103a和左侧半部103b之间。驱动组件120包括叉形连杆122，该叉形连杆具有枢转地连接于扳机108的第一端和枢转地连接于曲柄板124的第二端。如图6至图9所示，驱动组件120进一步包括可旋转地连接于曲柄板124的驱动连接器134、与驱动连接器134相互连接的柱塞135和支撑在驱动连接器134上的弹簧136。柱塞135限定了纵向狭槽135a，该纵向狭槽配置成并适于将驱动杆140的近端容纳在其中。
驱动杆140通过整体销135b连接于柱塞135(参见图9)。设置了帽144，柱塞135贯穿该帽。设置密封件(seal)(未示出)来建立柱塞135和外管150之间的气密性密封。
如图6至图8所示，手柄组件102进一步包括形成于曲柄板124中/上的齿条124a以便齿条124a可随曲柄板124移动。齿条124a包括置于曲柄板124中限定的远侧凹槽124b和近侧凹槽124c之间的多个齿。设置凹槽124b和124c以允许棘爪224翻转并当曲柄板124在近侧和远侧移动之间变化时提升至齿条124a的齿上。
手柄组件102进一步包括棘爪224，在棘爪224与曲柄板124的齿条124a大体上操作的接合的位置处，棘爪224通过棘爪销226枢转地连接于壳体103。棘爪224包括棘爪齿224a，该棘爪齿可选择地与曲柄板124的齿条124a的齿接合。棘爪齿224a可与齿条齿接合以限制齿条124a并且依次地限制曲柄板124在手柄组件102内的纵向移动。设置爪簧228以使棘爪224偏入到与曲柄板124的齿条124a操作的接合。
如图6至图8所示，曲柄板124通过销123可枢转地连接于叉形连杆122。曲柄板124限定了形成于其中的一系列棘轮齿124a以与棘爪224选择的接合。
如图8、图8A和图8B所示，手柄组件102进一步包括听觉/触觉反馈构件126，该反馈构件与扳机108操作地相关以便与其一起旋转并且当扳机108致动时绕着共同的轴旋转。反馈构件126限定了滚道126a，滚道126a限定了多个棘轮齿或梯级126b。设置有可偏转臂127，该可偏转臂包括操作的连接或布置在反馈元件126的滚道126a中并与梯级126b接触的第一端和连接于壳体103的第二端。在操作中，当致动扳机108时，臂127通过和/或沿着形成于反馈构件126中的滚道126a移动。如以下将更详细讨论的，随着臂127在反馈构件126的梯级126b上移动，臂127弹锁住梯级126b，并产生可听到的声音/喀哒声和/或可感觉到的振动。
听觉/触觉反馈构件126包括足够的梯级126b以便在夹子已经被完全装入手术施夹器100的钳口中后、在装入的夹子已经由手术施夹器100钳口形成后、并且当手术施夹器100被复位到原位并准备发射/形成另一夹子时产生听觉/触觉指示。
如图6、图7、图8和图8A所示，手术施夹器100的手柄组件102进一步包括支撑在壳体103中并通过限定在壳体103中的窗口103c可见的计数机构132。计数机构132包括显示器132a、处理器132b和使用电池等形式的能源(未示出)。
显示器132a可以是本领域已知的任何器件以提供事件的指示。事件可以涉及施夹器100的程序或操作。显示器132a是液晶显示器(LCD)。
显示器132a向外科医生显示施夹器100的一个或多个操作参数。由显示器132a显示的操作参数包括剩下的夹子的数量(amount)或数目(number)、已经使用的夹子的数目、位置参数、使用的手术时间或程序的任何其它参数。
在电池或能源和处理器132b的触头之间布置聚酯薄膜(Mylar)或另一聚合绝缘材料，该材料防止电池或能源在存储过程中被耗尽。凸起从手术施夹器100的壳体103伸出以允许凸起易于从那里移开。一旦凸起被移开，电池或能源与处理器132b的触头电接触，而使显示器132a通电。
如图6、图7、图8和图8A所示，手术施夹器100的手柄组件102进一步包括计数致动机构，该机构包括具有配置成并适于操作地、选择性地接合计数机构132的处理器132b的计数致动杠杆130。计数致动杠杆130进一步包括第二臂130b，该臂配置成并适于操作地、可滑动地接合形成在致动板128中的狭槽128a，致动板128可滑动地支撑在壳体103中。
在操作中，如以下将更详细说明的，随着扳机108被挤压，扳机108使得叉形连杆122向远侧推进，使得曲柄板124向远侧推进。当曲柄板124的臂124d推进预定距离时，臂124d接合或接触致动板128的指部128b。随着曲柄板124进一步向远侧推进，曲柄板124向远侧方向推动或拉动触发板128，从而致动计数致动杠杆130以致动计数机构132。
特别地，当致动板128向远侧移动足够的距离时，在其狭槽128b内用凸轮带动计数致动杠杆130的第二臂130b并使计数致动杠杆130旋转导致第一臂130a旋转。当致动板128向近侧移动足够的距离时，计数致动杠杆130的第二臂130b返回原位，导致计数致动杠杆130的第一臂130a脱离计数机构132。
现转至图9至图31A，手术施夹器100的轴组件104被示出并在下文中加以描述。轴组件104及其组件可由合适的生物相容的材料诸如不锈钢、钛、塑料等制成。轴组件104包括外管150，外管150具有支撑在壳体103内的近端150a、远端150b和贯穿其中的内腔150c。外管150通过从其外表面突出的凸缘被固定在壳体103内。轴组件104进一步包括均布置在外管150的内腔150c内的上壳体152a和下壳体152b。后部上壳体154布置在外管150内和上壳体152a的近侧。
如图9、图12和图13所示，轴组件104进一步包括可滑动地布置在上壳体152a和后部上壳体154内的推杆156。推杆156包括限定了窄形推动器156c的远端156a，推动器156c配置成并适于选择性地接合/移动(即向远侧推进)一堆夹子“C”的最远侧的夹钳“C1”，并在其最初形成期间与最远侧的夹钳“C1”保持接触。推杆156进一步包括近端156b。推杆156限定了具有窗钩156e的远侧窗口156d、位于远侧窗口156d的近侧并形成在其每侧边缘的一对凹槽156f、位于侧凹槽156f的近侧的细长狭槽156g和位于狭槽156g的近侧的最近侧窗口156h。
如图9和图14所示，推杆156在侧凹槽156f的远侧位置处沿着推杆156的上表面支撑第一弹簧夹子157a。第一弹簧夹子157a以这样的方式配置：其尖头突出或与推杆156的上表面间隔一定量。
如图9和图15所示，推杆156在其最近侧窗口156h的近侧位置处沿着推杆156的下表面支撑第二弹簧夹子157b。第二弹簧夹子157b以这样的方式定位：其尖头突出足以压在推杆156的最近侧窗口156h上的量。第二弹簧夹子157b的尖头彼此隔开一定量，该量小于推杆156的最近侧窗口156h的宽度。
如图9和图16至图20所示，轴组件104进一步包括可往复运动地支撑在推杆156下方的推进板162。如图16和图17所示，第四弹簧夹子157d支撑在推进板162的近端。弹簧夹子157d包括一对尖头，该尖头可拆卸地连接于形成于上壳体152a中的近侧保持槽152m和远侧保持槽152n。这样，在使用中，弹簧夹子157d可拆卸地接合保持槽152m和远侧保持槽152n以使推进板162保持在近侧或远侧位置。在推进板162向远侧推进时，用凸轮向内带动弹簧夹子157d的尖头并使得推进板162继续向远侧移动。
如图18至图20所示，推进板162包括形成于其中并沿着其长度延伸的一系列窗口162a。如图19所示，每个窗口162a限定了近侧边缘，该边缘在推进板162的表面下方延伸以便限定唇缘或凸耳162c。推进板162进一步包括一对侧翼片162b，该侧翼片从其侧边缘在朝着上壳体152a的方向上延伸。如图15所示，一对侧翼片162b可滑动地布置在推杆156的侧凹槽156f中。
如图9和图21至图22所示，轴组件104进一步包括布置在上壳体152a中并位于推进板162下方的夹子载体164。夹子载体164一般是具有上壁、一对侧壁和限定通过其的通道的下壁的盒状结构。夹子载体164包括形成于下壁中并沿着其长度纵向延伸的多个隔开的窗口164a(参见图9)。夹子载体164包括形成于上壁中并沿着其长度纵向延伸的细长窗口。
如图9和图21所示，一堆手术夹子“C”被以便于在其中和/或沿其滑动的方式装入和/或保持在夹子载体164的通道中。夹子载体164的通道配置并定尺寸成以头对尾的方式可滑动地保持一堆或多个手术夹子“C”。
如图19所示，夹子载体164的远端包括一对隔开的弹性柄脚164b。柄脚164b配置成并适于可拆卸地接合保持在夹子载体164内的该堆手术夹子“C”的最远侧手术夹子“C1”的后跨部(backspan)。
如图9和图21至图24所示，施夹器100的轴组件104进一步包括可滑动地布置在夹子载体164的通道内的夹子输出器166。如以下将更详细说明的，夹子输出器166位于该堆手术夹子“C”的后方并设置为在施夹器100的致动期间向前推动该堆夹子“C”。如将在下文中更详细说明的，夹子输出器166通过推进板162的向前和向后往复移动来致动。
如图23、图23A和图24所示，夹子输出器166包括主体部166a、大体上从主体部166a向上和向后延伸的远侧凸起166b、及大体上从主体部166a向下和向后延伸的近侧凸起166c。
夹子输出器166的远侧凸起166b配置并定尺寸成选择性地接合推进板162的窗口162a的凸耳162c。在使用中，随着推进板162向远侧方向推进或移动，夹子输出器166的远侧凸起166b面向推进板162的窗口162a的凸耳162c的接合使得夹子输出器166朝着远侧方向逐步推进或行进。
近侧凸起166c配置并定尺寸成选择性地接合形成在夹子载体164中的窗口164a。在使用中，夹子输出器166的近侧凸起166c在形成夹子载体164的窗口164a中的接合防止夹子输出器166向近侧方向行进或移动。
夹子输出器166包括支撑在其上或可选择地与其整体形成的闭锁板165。闭锁板165包括以从夹子输出器166的主体部166a向上和向后的方向从闭锁板165延伸的弹性尾部165a，该弹性尾部限定了窗口165b。
如图9、图25和图38所示，轴组件104进一步包括在夹子载体164下方的位置处可往复运动地支撑在通道组件104中的驱动通道168。驱动通道168是大体U形的通道，该通道包括从其后跨部168c在离开夹子载体164并朝着下壳体152b的方向上延伸的一对隔开的侧壁168b。驱动通道168进一步包括在狭槽168a的近侧的位置处从后跨部168c突出并在侧壁168b的方向上延伸的凸起168d。如图41所示，驱动通道168限定了形成于侧壁168b中的一个侧壁中的狭槽或窗口168e以选择性地容纳楔形板释放装置194的齿194c。
如图9和图25所示，施夹器100的轴组件104包括固定到驱动通道168上的驱动通道带箍167。带箍167固定到驱动通道168的侧壁168b上以便横跨驱动通道168的侧壁168b横向延伸。带箍167在细长槽168a的远侧位置处固定到驱动通道168上。带箍167固定到驱动通道168上以使楔形板172在驱动通道168的后跨部168c和钳口106之间延伸。
如图9、图26和图27所示，施夹器100包括安装在轴组件104上或安装在轴组件104的远端处并可由扳机108致动的一对钳口106。钳口106由合适的生物相容性材料诸如不锈钢或钛形成。
通过形成于下壳体152b中的与形成于钳口106中的容纳狭槽接合的凸台，将钳口106安装在邻近驱动通道168的远端，以使钳口106相对于驱动通道168保持固定。如图25所示，钳口106限定了在其之间用于将手术夹子“C”容纳在其中的通道106a。
如图9、图25和图26所示，施夹器100的轴组件104进一步包括楔形板172，楔形板172具有置于驱动通道168和钳口106之间的远端和贯穿轴组件104的近端。楔形板172包括大体锥形的远端172a以在钳口106之间选择性的操作的插入。如图26所示，楔形板172限定了从其下表面突出的翼片或凸起172b。如图22所示，楔形板172限定了形成在其中的最远侧狭槽172c以将连接板174的第二杆174c可滑动地容纳在其中。
如图22所示，第三弹簧夹子157c支撑在楔形板172的近端处。第三弹簧夹子157c以这样的方式定位：其尖头突出足以压在形成于楔形板172中的最近侧窗口172c上的量。第三弹簧夹子157c的尖头彼此隔开一定量，该量小于楔形板172的最近侧窗口172c的宽度。
如图9、图18、图20和图36所示，施夹器100的轴组件104进一步包括连接板174，连接板174可滑动地置于推杆156和楔形板172之间并且可拆卸地可连接于推杆156和楔形板172中的每一个。连接板174包括锥形远端174a、从其上表面延伸的第一杆174b和从其下表面延伸的第二杆174c。杆174b、174c中的每一个均具有大体泪珠形的轮廓，其中杆174b、174c中的每一个的远端均大于其近端。
在操作中，连接板174的第一杆174b配置并定尺寸成与固定到推杆156上的第二弹簧夹子157b可拆卸的连接，连接板174的第二杆174c配置并定尺寸成与固定到楔形板172上的第三弹簧夹子157c可拆卸的连接。
如图22、图36和图37所示，连接板174的第二杆174c延伸到限定在驱动杆140的窗口140b中。这样，随着驱动杆140往复运动，连接板174随其往复运动。
如图31A所示，保护装置198被支撑在下壳体152b中在其最初远侧推进期间在便于保持第三弹簧夹子157c的尖头之间的相对距离的位置处。这样，连接板174的第二杆174b不能过早地脱离第三弹簧夹子157c直到第三弹簧夹子157c已经越过保护装置198。
如图9、图27、图29和图41所示，施夹器100的轴组件104进一步包括可滑动地支撑在下壳体152b的通道中的滑动接头180。滑动接头180包括主体部182和从其延伸的杆184。当合适地定位在下壳体152b的通道中时，滑动接头180的杆184在大体远侧的方向上延伸。滑动接头180的杆184可滑动地通过形成在下壳体152b中并从下壳体152b的通道延伸的短轴152d(参见图29)。轴组件104进一步包括偏置构件186，该偏置元件以压缩弹簧的形式支撑在杆184上并置于下壳体152b的短轴152d和滑动接头180的主体部182之间。
滑动接头180的主体部182包括凸台182a，该凸台靠近主体部182的近端形成，且配置成并适于在驱动杆140的细长狭槽140a中可滑动的接合(参见图29)。滑动接头180的主体部182进一步包括窝眼182b，该窝眼靠近主体部182的远端形成，且配置成并适于将驱动通道168的凸起168d容纳在其中(参见图38和图39)。
如图9、图27和图28所示，施夹器100的轴组件104进一步包括可滑动地支撑在下壳体152b的通道中和驱动通道168中的楔形板锁190。楔形板锁190包括主体部190a、从主体部190a向远侧延伸的杆190b、从主体部190a向近侧延伸的尾部190c、形成于主体部190a的上表面中的窝眼190d和从尾部190c延伸的杆或齿190e。轴组件104进一步包括偏置构件192，该偏置构件以压缩弹簧的形式支撑在杆190b上并置于下壳体152b和楔形板锁190的主体部190a之间。
施夹器100的轴组件104进一步包括可旋转地支撑在下壳体152b的通道中的楔形板释放装置194。楔形板释放装置194包括杆194a，该杆配置为与从楔形板锁190的尾部190c延伸的齿190e接合；槌194b，该槌在朝着楔形板锁190的尾部190c的方向上从杆194a向外延伸；及齿194c，该齿在离开楔形板锁190的尾部190c的方向上从杆194a向外延伸。
现将对操作手术施夹器100以在诸如脉管的目标组织的周围形成或卷曲手术夹子进行描述。参照图32至图43，表示在任何操作或使用之前的手术施夹器100。如图32和图33所示，在使用或发射施夹器100之前，扳机108一般处于非承压或非致动状态。这样，驱动组件120的曲柄板124处于缩回或最近侧的位置，因此，柱塞135和驱动杆140也处于缩回位置。当曲柄板124处于缩回位置时，棘爪224布置在限定在曲柄板124中的远侧凹槽124b中。
如图35至图37所示，当驱动组件120和驱动杆140处于缩回位置时，连接板174位于缩回或最近侧位置。当连接板174位于缩回或最近侧位置时，推杆156也处于缩回或最近侧位置，连接板174的第一泪珠形杆174b布置在推杆156的最近侧窗口156h的近端并保持与第二弹簧夹子157b的尖头搭扣配合的接合。并且，当连接板174位于缩回或最近侧位置时，楔形板172也位于缩回或最近侧位置，且连接板174的第二泪珠形杆174c布置在楔形板172的最近侧窗口172c的近端，并保持与第三弹簧夹子157c的尖头搭扣配合的接合。
如图36和图37所示，当驱动组件120和驱动杆140处于缩回位置时，滑动接头182的凸起182a位于驱动杆140的细长狭槽140a中的最远侧位置处。
如图38和图39所示，当驱动组件120和驱动杆140处于缩回位置时，夹子输出器166位于夹子载体164的通道的最近端，其中夹子输出器166的远侧凸起166b操作地布置在推进板162的最近侧窗口162a中，近侧凸起166c操作地布置在夹子载体164的最近侧窗口164a中。
继续参照图38和图39，当驱动组件120和驱动杆140处于缩回位置时，滑动接头180位于最近侧位置，并且因为驱动通道168的凸起168d布置在滑动接头180的窝眼182b中，所以驱动通道168也位于最近侧位置。如图38和图39所示，滑动接头180紧靠从下壳体152b突出的物理止挡152e(参见图30)。
如图40和图41所示，当驱动组件120和驱动杆140处于缩回位置时，楔形板锁190位于最近侧位置以使从其尾部190c延伸的齿190e布置在形成于下壳体152b中的倾斜凸耳152f的近侧(参见图30和图31)。如图41所示，楔形板锁190紧靠从下壳体152b突出的物理止挡152g。同样如图41所示，楔形板释放装置194布置在第一位置处以便其齿194c突入到形成于驱动通道168的侧壁168b中的窗口168e中。
如图42和图43所示，当驱动组件120和驱动杆140处于缩回位置时，推杆156的推动器156c布置在保持在夹子载体164中的最远侧夹子“C”的后跨部的近侧。最远侧夹子“C”通过其柄脚164b保持在夹子载体164的通道中。并且，如上所述，在此位置处，楔形板172位于最近侧位置以便其远端172a位于钳口106的近侧。
如图43所示，当驱动通道168位于最近侧位置时，其远端从钳口106的近侧凸轮表面106b脱离。
现转到图44至图54，在初始行程的第一阶段中，随着扳机108从初始位置被挤压或致动，扳机108使得叉形连杆122向着远侧方向移动曲柄板124，而这将使得驱动连接器134和柱塞135向远侧移动并使得驱动杆140向远侧移动。当随着柱塞135向远侧移动，弹簧136被压缩初始量。
与此同时，随着曲柄板124向远侧移动，齿条124a的齿与棘爪224的齿224a接合，棘爪224移出或旋转出曲柄板124的远侧凹槽124a。这样，在没有完成完整的远侧行程的情况下，曲柄板124不能回到最近侧位置。
如图44所示，随着扳机108被挤压初始量，臂127开始平移通过反馈构件126的滚道126a。
如图46所示，随着驱动杆140向着远侧方向移动，驱动杆140向着远侧方向推动连接板174。因为推杆156通过第二弹簧夹子157b选择性地连接于连接板174，推杆156被向着远侧方向推进或拉动。并且，因为楔形板172通过第三弹簧夹子157c选择性地连接于连接板174，楔形板172也被向着远侧方向推进或拖动。
随着驱动杆140向着远侧方向移动，其细长狭槽140a也向着远侧方向移动以使滑动接头182的凸起182a在相对于其的近侧方向上平移。
如图47至图49所示，随着楔形板172向着远侧方向移动，因为楔形板172的凸起172b保持在楔形板锁190的窝眼190d中，楔形板锁190被向着远侧方向移动或拖动，这使得其尾部190c的齿190e被用凸轮带动越过形成于下壳体152b中的倾斜凸耳152f，从而从倾斜凸耳152f的近侧位置移动到倾斜凸耳152f的远侧位置。随着楔形板锁190向着远侧方向移动，偏置构件192被压缩初始量。如图49所示，楔形板锁190向着远侧方向移动直至楔形板锁190紧靠形成于下壳体152b中的物理止挡。
如图47A所示，随着推杆156向着远侧方向移动，推进板162的翼片162b在推杆156的侧凹槽156f中平移预定距离，直到翼片162b接触或接合推杆156的侧凹槽156f的近端。
如图47B和图47C所示，随着楔形板172向着远侧方向移动，由于连接板174的第二杆174c与第三弹簧夹子157c的连接，通过保护装置防止了连接板174的第二杆174c过早地从第三夹钳157c脱离。特别地，随着连接板174向着远侧方向移动，保护装置198作用于第三弹簧夹子157c的尖头的尖端以防止尖头由于第二杆174c所产生的远侧力作用于其上的力而向外张开。
如图50所示，随着推杆156向着远侧方向移动，其推动器156c接合最远侧夹子“C”的后跨部并开始向着远侧方式推动最远侧夹子“C”。随着推杆156向着远侧方向移动最远侧夹子“C”，最远侧夹子“C”从夹子载体164的柄脚164b的后方脱离并开始进入到钳口106的通道106a中。
如图51所示，随着楔形板172向着远侧方向移动，其远端172a进入钳口106之间，使得钳口106向外张开。
如图52至图54所示，一旦楔形板锁190紧靠形成于下壳体152b中的物理止挡，则防止了楔形板172向着远侧方向进一步移动。然而，驱动杆140继续向着远侧方向移动连接板174。因为连接板174被继续向远侧推动，所以一旦第三弹簧夹子157c的尖头的尖端向远侧移动到超过保护装置198，则作用于第二杆174c上的力足够使得第三弹簧夹子157c的尖头向外张开并使得第二杆174c从其间脱开，从而使得连接板174继续向着远侧方向移动。
现转到图55至图69，随着扳机108从初始行程的第一阶段被进一步挤压或致动通过初始行程的第二阶段，扳机108使得叉形连杆122进一步向着远侧方向移动曲柄板124，而这使得驱动连接器134并随后使得柱塞135进一步向远侧移动且进一步向着远侧移动驱动杆140。随着柱塞135向远侧移动，弹簧136被压缩进一步的量。
与此同时，随着曲柄板124向着远侧移动，其齿条124a的齿相对于棘爪224的齿224a进一步向着近侧移动。这样，在没有完成完整的远侧行程的情况下，曲柄板124仍不能返回到最近侧位置。
如图55所示，随着曲柄板124向着远侧移动预定距离之后，其臂124d接合或接触致动板128的指部128b。随着曲柄板124进一步向着远侧推进，曲柄板124向着远侧方向推动或拉动致动板128，从而致动计数致动杠杆130以激活计数机构132。
特别地，当致动板128向着远侧移动足够距离时，在其槽128b中用凸轮带动计数致动杠杆130的第二臂130b并促使其旋转，导致计数致动杠杆130的第一臂130a接合计数机构132，从而实现其显示器中的变化。特别地，显示手术施夹器100中剩余的夹子的数目的显示器将减少一个。可选择地，夹子计数机构将增加一个或产生某些其他变化。
随着扳机108被进一步挤压时，臂127继续平移通过反馈构件126的滚道126a。在这一点上，在扳机108的挤压中，手术夹子被装入钳口106中。相应地，臂127将与形成于反馈构件126的滚道126a中的梯级126b相互作用并产生告知用户夹子已被装入钳口中的听觉/触觉指示。
如图57所示，随着驱动杆140向着远侧方向进一步移动，驱动杆140继续向着远侧方向推动连接板174。因为推杆156仍通过第二弹簧夹子157b选择性地连接于连机板174，所以推杆156被进一步向着远侧方向推进或拖动。然而，因为楔形板172的第三弹簧夹子157c被从连接板174的第二杆174c脱离，所以楔形板172不被向着远侧方向进一步推进或拖动。
如图56A至图56C所示，随着推杆156向着远侧方向继续移动，推杆156的侧凹槽156f的近端接合推进板162的一对翼片162b，推杆156向着远侧方向推进或拖动推进板162。
如图56B和图56C所示，随着推动板162向着远侧推进，弹簧夹子157d脱离近侧保持槽152m并接合形成于上壳体152a中的远侧保持槽152n。
如图57所示，驱动杆140向着远侧方向移动，直到滑动接头182的凸起182a选择性地平移至驱动杆140的细长狭槽140a中的最近侧位置。
随着推杆156继续向着远侧方向移动，推杆156通过翼片162b继续向着远侧方向推动推进板162。如图58所示，随着推进板162向着远侧方向移动，夹子输出器166的远侧凸起166b被容纳夹子输出器166的远侧凸起166b的窗口162a的近侧边缘接合以便相对于夹子载体164向着远侧方向推动夹子输出器166，从而使该堆夹钳“C”推进增加的量。随着夹子输出器166向着远侧方向移动，使得其近侧凸起166c从夹子载体164的相对近侧窗口164a到夹子载体164的相对远侧窗口164a向远侧推进一个窗口164a。
如图58至图60所示，随着推杆156向着远侧方向移动，支撑于推杆156上的第一弹簧夹子157a弹锁在上壳体152a的凸台152h上，因而将推杆156保持在向前的位置处。
此外，如图61所示，随着推杆156继续向着远侧方向移动，使得该堆夹钳“C”向着远侧方向移动。
如图62所示，随着推杆156向着远侧方向移动，其推动器156c继续向着远侧方向移动最远侧夹子“C1”直到最远侧夹子“C1”完全进入到钳口106的通道106a中。在操作中，推杆156的推动器156c在所述夹子“C”的形成期间与装入的夹子“C”的后跨部保持接触以便为其提供稳定性并将其保持在合适的位置。
如图63所示，随着驱动杆140进一步向着远侧方向移动，其肩部140c接触驱动通道168的最近端。这样，随着驱动杆140进一步向着远侧方向移动，驱动杆140向着远侧方向移动或推动驱动通道168。
如图64所示，随着驱动通道168向着远侧方向移动，形成于驱动通道168的侧壁168b中的窗口168e的近侧边缘接触楔形板释放装置194的齿194c，使得楔形板释放装置194旋转。随着楔形板释放装置194旋转，其槌194b挤压楔形板锁190的齿190e以将齿190e从倾斜凸耳152f的后方推出或撞出。在这种情况下，如图65所示，允许偏置构件192减压，从而向着近侧方向移动楔形板锁190。如图66所示，随着楔形板锁190向着近侧方向移动，因为楔形板172连接到楔形板锁190上，所以楔形板172向着近侧方向移动以使其远端172a从与钳口106退出脱离接合。
如图58和图67至图69所示，因为推杆156通过第一弹簧夹子157a与凸台152h的连接而保持在远侧位置，所以随着驱动杆140进一步向着远侧方向移动，作用于连接板174的力使得第二弹簧夹子157b从连接板174的第一杆174b脱离，从而允许连接板174继续向着远侧方向移动。
如图67A至图69A所示，在一个实施方式中，第二弹簧夹子157b的尖头的尖端可以配置成向外突出以便接合后上部壳体154的表面(参见图9)，从而防止第二弹簧夹子157b从连接板174的第一杆174b的过早脱离。在该实施方式中，凹槽可以形成于后部上壳体154的表面中，与第二弹簧夹子157b的尖头可能向外张开的位置一致，从而允许连接板174的第一杆174b脱离并继续向着远侧方向移动。
如图70至图75所示，随着扳机108被致动进入初始行程的最后阶段，扳机108使得叉形连杆122进一步向着远侧方向移动曲柄板124，而这使得驱动连接器134和柱塞135进一步向着远侧移动并进一步向着远侧移动驱动杆140。随着驱动连接器134向着远侧移动，弹簧136被压缩进一步的量。
与此同时，随着曲柄板124向着远侧移动，其齿条124a的齿相对于棘爪224的齿224a进一步向着近侧移动至这样一个位置：在该位置处，随着棘爪224的齿224a进入曲柄板124的近侧凹槽124c，齿条124a的齿从棘爪224的齿224a脱离，从而使其本身复位。这样，当扳机108松开时，曲柄板124可以返回至最近侧位置。
如图72至图74所示，在扳机108的初始行程的最后阶段期间，驱动通道168和带箍167相对于钳口106向着远侧方向移动，以使驱动通道168的远侧边缘接合钳口106的凸轮表面106b，使得钳口106关闭并形成位于其间的夹钳“C1”。如图74所示，推杆156的推动器156c保持在远侧位置处，在所述夹子“C”的形成期间与所述夹子“C”的后跨部接触。
如图55所示，随着扳机108被挤压最后的量，臂127继续平移通过反馈构件126的滚道126a。在这一点上，在扳机108的挤压中，手术夹子“C1”已经由钳口106完全形成。相应地，臂127将与形成于反馈构件126的滚道126a中的另一梯级126b相互作用，并产生告知用户手术夹子“C1”已由钳口106形成的听觉/触觉指示。
如图75所示，手术夹子“C1”可以形成或卷曲到脉管“V”或任何其他生物组织上。
现转到图76至图84，表示随着扳机108返回至未挤压或未致动位置时的施夹器100的操作。如图76所示，随着扳机返回到未挤压位置，弹簧被允许解除压缩，从而推动曲柄板124向着近侧方向移动，而这使得柱塞向着近侧移动并向着近侧移动驱动杆。因为棘爪224已经复位，现允许曲柄板124向近侧移动直到棘爪224的齿224a再次进入曲柄板124的远侧凹槽。
如图76A所示，随着曲柄板124向着近侧移动，其臂124d脱离致动板128的指部128b，使得致动板128向着近侧方向移动。随着致动板128向着近侧移动，在其槽128b中用凸轮带动计数致动杠杆130的第二臂130b，并促使第二臂130b旋转，导致计数致动杠杆130的第一臂130a从计数机构132脱离。
如图77所示，随着驱动杆140向着近侧方向移动，驱动杆140通过第一杆174b拉动连接板174。随着连接板174向着近侧方向移动，第一杆174b与第二弹簧夹子157b的尖头接合并且通过第二弹簧夹子157b向着近侧方向推动推杆156。
如图78所示，随着力作用于推杆156上以向着近侧方向移动推杆156，所述力克服了第一弹簧夹子157a与上壳体152a的凸台152h的保持力，从而从凸台152h释放第一弹簧夹子157a并使得推杆156向着近侧方向移动。
如图79所示，随着推杆156继续向着近侧方向移动，其侧凹槽156f的远端接合推进板162的翼片162b并使得推进板162向着近侧方向移动。随着推杆156向着近侧方向移动，推杆鼻部156c咬在余留的该堆夹子“C”的最远侧夹子的后方，从而变成新的最远侧夹子“C1”。
如图80所示，随着推进板162向着近侧方向移动，夹子输出器166的近侧凸起166c接合夹子载体164的窗口164a的近侧边缘以便保持夹子输出器166在夹子载体164中的相对位置。当推进板162向着近侧方向移动，使得其远侧凸起166b从推进板162的相对近侧窗口162a到推进板162的相对远侧窗口162a向远侧推进一个窗口162a。
如图81所示，当推杆156停止其近侧移动时，当其与从上半壳体152a的内表面突出的凸台接合时，连接板174的持续的近侧移动将使得第一杆174b与第二弹簧夹子157b再次接合。随着推杆156的近侧移动停止，连接板174的持续的近侧移动将使得第一杆174b与第二弹簧夹子157b再次接合。
如图82和图83所示，随着连接板174向着近侧方向移动，由于驱动杆140的近侧移动，第二杆174c与第三弹簧夹子157c的尖头接合并通过第三弹簧夹子157c向着近侧方向推动楔形板172。随着楔形板172向着近侧方向移动，楔形板锁190向着近侧方向移动直到楔形板锁190接触下半壳体152b中的物理止挡，从而阻止楔形板172的近侧移动。一旦第三弹簧夹子157c的尖头的尖端向着远侧移动超过保护装置198，则当楔形板172停止其近侧移动时，连接板174的持续的近侧移动将使得第二杆174c与第三弹簧夹子157c再次接合。
当扳机108返回至未致动位置时，臂127将平移通过反馈构件126的滚道126a并与形成于反馈构件126的滚道126a中的另一梯级126b相互作用，且产生告知用户手术施夹器100已被复位并准备再次发射的听觉/触觉指示。
现转到图84至图85，表示手术施夹器100的构造其后是最后一个手术夹子“C”的应用。如图84和图85所示，当最后一个手术夹子已经被推进和形成时，推杆156仍处于推进或远侧位置，夹子输出器166已经通过刻度盘158被逐步推进足够的量，其闭锁板165向上偏置通过推进板162的窗口162a，并进入到推杆156的远侧窗口156d中。闭锁板165在推杆156的远侧窗口156d中的定位使得近侧窗口156d的窗钩156e进入并接合闭锁板165的窗口165b。这样，因为夹子输出器166通过在夹子载体164的远侧窗口164a中接合的其远侧凸起166c来保持在远侧位置，闭锁板165接合推杆156的窗钩156e，并防止推杆156返回到最近侧位置从而使棘爪224复位。
如图86所示，因为推杆156不能或被防止移动到其完全近侧位置，棘爪224与曲柄板124的齿条124a保持接合并且不被允许进入近侧凹槽124c从而使其本身复位。因为棘爪224不能使其本身复位，所以曲柄板124被锁住或停止向远侧或近侧移动。
应该理解，以上描述仅仅是本公开的说明。本领域技术人员可以在不背离本公开的情况下做出各种替换和改进。相应地，本公开意在包含所有这些替换、改进和变化。参照附图所描述的实施方式仅为证明本公开的某些示例而出现。与上述的和/或所附权利要求无实质上不同的其它元件、步骤、方法和技术也在本公开的范围之内。

Claims (24)

1.一种用于将手术夹子施加到体组织上的装置，所述装置包括：
手柄组件，其包括扳机以及在扳机致动时通过所述扳机往复平移的驱动杆；以及
轴组件，其从所述手柄组件向远侧延伸并且限定了纵轴，所述轴组件包括：
壳体；
多个手术夹子，其布置在所述壳体内；
钳口，其邻近所述壳体的远端部安装，所述钳口在隔开的打开状态与接近的闭合状态之间移动；
楔形板，其可往复运动地布置在所述壳体内，所述楔形板在其远端布置在所述钳口内的位置与其远端不在所述钳口内的位置之间移动；以及
楔形板偏置构件，其以所述楔形板偏置构件在将所述楔形板从近侧位置移动到远侧位置时偏置的方式布置在所述壳体内，
其中，所述轴组件进一步包括布置在所述壳体内的锁紧机构，其中，当将所述楔形板从所述近侧位置移动到所述远侧位置时，所述锁紧机构被接合并将所述楔形板保持在所述远侧位置，并且其中，所述锁紧机构包括主体部、从所述主体部向远侧延伸的第一杆、从所述主体部向近侧延伸的尾部、形成于所述主体部的上表面中的窝眼以及从所述尾部延伸的第二杆或齿。
2.根据权利要求1所述的装置，其中，所述锁紧机构的释放允许所述楔形板偏置构件不偏置并且使所述楔形板从所述远侧位置移动到所述近侧位置。
3.根据权利要求2所述的装置，进一步包括可往复运动地布置在所述壳体内的驱动通道，其中，所述驱动杆选择性地接合所述驱动通道以实现所述驱动通道的平移，其中，当所述驱动通道向远侧推进时，其远端接合所述钳口的表面以实现所述钳口的接近，并且其中，所述驱动通道在其向远侧推进时释放所述锁紧机构。
4.根据权利要求3所述的装置，其中，在所述驱动通道的所述远端接合所述钳口的所述表面之前，将所述楔形板从远侧位置移动到近侧位置。
5.根据权利要求3所述的装置，其中，在所述驱动通道的所述远端接合所述钳口的所述表面的基本同时，将所述楔形板从所述远侧位置移动到近侧位置。
6.根据权利要求1所述的装置，其中，所述手柄组件包括配置成使所述驱动杆返回到近侧位置的偏置构件，其中，所述手柄组件偏置构件具有偏置力，并且其中，所述楔形板偏置构件具有比所述手柄组件偏置构件的偏置力小的偏置力，并且其中，当所述楔形板偏置构件的力不足时，所述手柄组件偏置构件帮助所述楔形板偏置构件将所述楔形板移动到近侧位置。
7.根据权利要求1所述的装置，其中，所述轴组件进一步包括可往复运动地布置在所述壳体内的推杆，所述推杆配置成在所述钳口处于打开状态时将最远侧手术夹子装入所述钳口中，并且在所述钳口接近期间保持与装入的所述手术夹子接触。
8.根据权利要求7所述的装置，其中，所述轴组件进一步包括邻近所述推杆可往复运动地布置在所述壳体内的推进板，所述推进板包括通过所述推杆的肩部接合的至少一个翼片，其中，在所述推杆的远侧移动和近侧移动期间所述推杆的所述肩部接合所述推进板的至少一个翼片，从而实现所述推进板的远侧移动和近侧移动中的一个。
9.根据权利要求8所述的装置，其中，所述轴组件进一步包括邻近所述推进板布置在所述壳体内的夹子载体，其中，所述夹子载体配置成保持所述多个手术夹子。
10.根据权利要求9所述的装置，其中，所述轴组件进一步包括可滑动地支撑在所述夹子载体中位于所述多个手术夹子的近侧位置处的夹子输出器，所述夹子输出器配置成向远侧方向推进所述多个手术夹子，所述夹子输出器包括从其第一表面突出的第一凸起以及从其第二表面突出的第二凸起，其中，随着所述推进板向远侧移动，所述夹子输出器的所述第一凸起接合所述推进板，使得所述夹子输出器向远侧移动以推进所述多个手术夹子，并且其中，随着所述推进板向近侧移动，所述夹子输出器的所述第二凸起接合所述夹子输出器，使得所述夹子输出器保持固定。
11.一种用于将手术夹子施加到体组织上的装置，所述装置包括：
手柄组件，包括：
扳机；
驱动杆，其在扳机致动时通过所述扳机往复平移；以及
偏置构件，其配置并且布置为使所述驱动杆返回到近侧位置，其中，所述手柄组件偏置构件具有偏置力；以及
轴组件，其从所述手柄组件向远侧延伸并且限定了纵轴，所述轴组件包括：
壳体；
多个手术夹子，其布置在所述壳体内；
钳口，其邻近所述壳体的远端部安装，所述钳口在隔开的打开状态与接近的闭合状态之间移动；
楔形板，其可往复运动地布置在所述壳体内，所述楔形板在其远端布置在所述钳口内的位置与其远端不在所述钳口内的位置之间移动；以及
楔形板偏置构件，其以所述楔形板偏置构件在将所述楔形板从所述近侧位置移动到所述远侧位置时偏置的方式布置在所述壳体内，其中，所述楔形板偏置构件具有比手柄组件偏置构件的偏置力小的偏置力；
其中，当所述楔形板偏置构件的力不足时，所述手柄组件偏置构件帮助所述楔形板偏置构件将所述楔形板移动到近侧位置，
其中，所述轴组件进一步包括布置在所述壳体内的锁紧机构，其中，当将所述楔形板从所述近侧位置移动到所述远侧位置时，所述锁紧机构被接合并将所述楔形板保持在所述远侧位置，并且其中，所述锁紧机构包括主体部、从所述主体部向远侧延伸的第一杆、从所述主体部向近侧延伸的尾部、形成于所述主体部的上表面中的窝眼以及从所述尾部延伸的第二杆或齿。
12.根据权利要求11所述的装置，其中，所述锁紧机构的释放允许所述楔形板偏置构件不偏置并且使所述楔形板从所述远侧位置移动到近侧位置。
13.根据权利要求12所述的装置，进一步包括可往复运动地布置在所述壳体内的驱动通道，其中，所述驱动杆选择性地接合所述驱动通道以实现所述驱动通道的平移，其中，当所述驱动通道向远侧推进时，其远端接合所述钳口的表面以实现所述钳口的接近，并且其中，所述驱动通道在其向远侧推进时释放所述锁紧机构。
14.根据权利要求13所述的装置，其中，在所述驱动通道的所述远端接合所述钳口的所述表面之前，将所述楔形板从远侧位置移动到近侧位置。
15.根据权利要求13所述的装置，其中，在所述驱动通道的所述远端接合所述钳口的所述表面的基本同时，将所述楔形板从远侧位置移动到近侧位置。
16.根据权利要求11所述的装置，其中，所述轴组件进一步包括可往复运动地布置在所述壳体内的推杆，所述推杆配置成在所述钳口处于打开状态时将最远侧手术夹子装入所述钳口中，并且在所述钳口接近期间保持与装入的所述手术夹子的接触。
17.根据权利要求16所述的装置，其中，所述轴组件进一步包括邻近所述推杆可往复运动地布置在所述壳体内的推进板，所述推进板包括通过所述推杆的肩部接合的至少一个翼片，其中，在所述推杆的远侧移动和近侧移动期间所述推杆的所述肩部接合所述推进板的所述至少一个翼片，从而实现所述推进板的远侧移动和近侧移动中的一个。
18.根据权利要求17所述的装置，其中，所述轴组件进一步包括邻近所述推进板布置在所述壳体内的夹子载体，其中，所述夹子载体配置成保持所述多个手术夹子。
19.根据权利要求18所述的装置，其中，所述轴组件进一步包括可滑动地支撑在所述夹子载体中位于所述多个手术夹子的近侧位置处的夹子输出器，所述夹子输出器配置成向远侧方向推进所述多个手术夹子，所述夹子输出器包括从其第一表面突出的第一凸起以及从其第二表面突出的第二凸起，其中，随着所述推进板向远侧移动，所述夹子输出器的所述第一凸起接合所述推进板，使得所述夹子输出器向远侧移动以推进所述多个手术夹子，并且其中，随着所述推进板向近侧移动，所述夹子输出器的所述第二凸起接合所述夹子输出器，使得所述夹子输出器保持固定。
20.一种用于将手术夹子施加到体组织上的装置，所述装置包括：
手柄组件，其包括扳机以及在扳机致动时通过所述扳机往复平移的驱动杆；以及
轴组件，其从所述手柄组件向远侧延伸并且限定了纵轴，所述轴组件包括：
壳体；
多个手术夹子，其布置在所述壳体内；
钳口，其邻近所述壳体的远端部安装，所述钳口在隔开的打开状态与接近的闭合状态之间移动；
楔形板，其可往复运动地布置在所述壳体内，所述楔形板在其远端布置在所述钳口内的位置与其远端不在所述钳口内的位置之间移动；以及
锁紧机构，其布置在所述壳体中，其中，当将所述楔形板从近侧位置移动到远侧位置时，所述锁紧机构被接合并且将所述楔形板保持在所述远侧位置，并且其中，所述锁紧机构包括主体部、从所述主体部向远侧延伸的第一杆、从所述主体部向近侧延伸的尾部、形成于所述主体部的上表面中的窝眼以及从所述尾部延伸的第二杆或齿。
21.根据权利要求20所述的装置，其中，所述锁紧机构的释放允许所述楔形板从所述远侧位置移动到所述近侧位置。
22.根据权利要求21所述的装置，进一步包括可往复运动地布置在所述壳体内的驱动通道，其中，所述驱动杆选择性地接合所述驱动通道以实现所述驱动通道的平移，其中，当所述驱动通道向远侧推进时所述驱动通道的远端接合所述钳口的表面以实现所述钳口的接近，并且其中，所述驱动通道在其向远侧推进时释放所述锁紧机构。
23.根据权利要求22所述的装置，其中，在所述驱动通道的所述远端接合所述钳口的所述表面之前，将所述楔形板从远侧位置移动到近侧位置。
24.根据权利要求22所述的装置，其中，在所述驱动通道的所述远端接合所述钳口的所述表面的基本同时，将所述楔形板从所述远侧位置移动到所述近侧位置。
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