CN101683282A - 用于手术器械的组织止挡件 - Google Patents

用于手术器械的组织止挡件 Download PDF

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CN101683282A
CN101683282A CN200910176138A CN200910176138A CN101683282A CN 101683282 A CN101683282 A CN 101683282A CN 200910176138 A CN200910176138 A CN 200910176138A CN 200910176138 A CN200910176138 A CN 200910176138A CN 101683282 A CN101683282 A CN 101683282A
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CN101683282B (zh
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戴维·法拉肖尼
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • 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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    • 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
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • 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
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    • 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
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    • 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
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Abstract

本发明公开了一种手术器械，包括手柄组件、细长部、末端执行器及止挡构件。细长部从手柄组件向远侧延伸。末端执行器设置为邻近细长部的远侧部并且包括第一钳口构件及第二钳口构件。至少一个钳口构件相对于另一个钳口构件在分开位置与接近位置之间为可活动的。止挡构件设置为邻近第一钳口构件的远侧部并且相对于第一钳口构件在第一位置与第二位置之间为可枢转的，在第一位置处，止挡构件的显著部分位于第一钳口构件的外部，在第二位置处，止挡构件捕获在第一钳口构件与第二钳口构件之间的组织。

Description

用于手术器械的组织止挡件
技术领域
[0001]本公开通常涉及手术器械，并且尤其涉及用于外科手术上连接组织的手术器械。
背景技术
[0002]本领域公知的手术切割缝合器械用于施加并排缝合钉穿过被压紧的活组织。这些手术器械通常用于在处理或切除之前闭合组织或器官、用于在胸部及腹部手术中封闭器官，及用于在吻合术中固定组织。
[0003]一般地，这样的手术切割缝合器械包括：砧座组件；用于支撑一批手术缝合钉的钉仓组件；用于使砧座及钉仓和砧座组件相接近的接近机构；以及用于使手术缝合钉从钉仓组件中射出的发射机构。
[0004]使用中，外科医生通常先使砧座构件及钉仓构件相接近。然后，外科医生能够启动器械以将缝合钉钉入组织。另外，外科医生可以使用同一器械或独立的器械来切割邻近缝合钉排或者在缝合钉排之间的组织。可选的，在使砧座及钉仓接近的同时，手术切割缝合器械可以顺序地射出缝合钉。
发明内容
[0005]本公开涉及一种用于外科手术上连接组织的手术器械。所述手术器械包括手柄组件、细长部、末端执行器及止挡构件。所述细长部从所述手柄组件向远侧延伸。所述末端执行器设置为邻近所述细长部的远侧部并且包括第一钳口构件及第二钳口构件。至少一个钳口构件相对于另一个钳口构件在分开位置与接近位置之间为可活动的。所述止挡构件设置为邻近所述第一钳口构件的远侧部并且相对于所述第一钳口构件在第一位置与第二位置之间为可枢转的，在第一位置处，所述止挡构件的显著部分位于所述第一钳口构件的外部，在第二位置处，所述止挡构件捕获在所述第一钳口构件与所述第二钳口构件之间的组织。
[0006]在不同的实施例中，所述钉仓相对于纵轴为弯曲的。
[0007]所述手术器械可以进一步包括偏置构件，其设置为与所述止挡构件机械协作，其中所述偏置构件使止挡构件向其第一位置偏置。
[0008]在某些实施例中，所述止挡构件包括基座及止挡部，所述基座可操作地连接至所述止挡部。在一些实施例中，所述止挡部可枢转地连接至所述基座。可选的，止挡构件可以可枢转地连接至所述第一钳口构件。
[0009]所述第一钳口构件可以包括刀槽。所述止挡构件可以进一步包括第一支腿及第二支腿，所述第一支腿及所述第二支腿位于所述刀槽的相对的两侧。
[0010]所述手术器械可以附加的包括设置在所述第一钳口构件上的第一槽及第二槽，所述第一槽及第二槽中的每一个适于在其中容纳所述第一支腿及第二支腿中的一个的至少一部分。在一些实施例中，第一支腿及第二支腿中的每一个被配置为当所述止挡构件向其第二位置运动时至少部分运动通过所述第一槽或第二槽。
[0011]另外，本公开涉及一种与手术器械一起使用的工具组件。一般地，该工具组件包括末端执行器及止挡构件。末端执行器具有第一钳口构件及第二钳口构件。至少一个钳口构件相对于另一个钳口构件在分开位置与接近位置之间为可活动的。止挡构件设置为邻近所述第一钳口构件的远侧部，并且所述止挡构件相对于所述第一钳口构件在第一位置及第二位置之间为可枢转的，在第一位置处，所述止挡构件的至少一部分位于所述第一钳口构件的外部，在第二位置处，所述止挡构件捕获在所述第一钳口构件和所述第二钳口构件之间的组织，其中止挡构件的至少一部分至少部分地位于第一钳口构件的组织接触面以下，其中所述钳口构件朝向接近位置的相对运动导致所述止挡构件的至少一部分朝向所述第一钳口构件运动。
[0012]在一些实施例中，末端执行器具有纵向曲线形状。而且，在某些实施例中，止挡构件被向所述第一位置偏置。第一钳口构件可以包括至少一个形成在其中的槽。该槽被配置为容纳所述止挡构件的至少一部分。
[0013]本公开还涉及被配置为与手术器械一起使用的止挡构件。止挡构件包括基座部及止挡部，基座部配置为机械地接合手术器械的钳口构件。止挡部与基座部可枢转地接合并且在第一位置与第二位置之间为可活动的。在第一位置，止挡部被配置为利于组织相对于止挡部向近侧运动。在第二位置，止挡部被配置为阻止组织向远侧平移超过止挡部。
附图说明
[0014]在此结合附图公开目前公开的手术器械的不同实施例，其中：
[0015]图1为本公开的手术器械的实施例的立体图；
[0016]图2至图4为图1的手术器械的一部分的立体图，示出在第一位置的止挡构件；
[0017]图5至图7为图1的手术器械的末端执行器的侧视图，示出操作中的不同阶段；
[0018]图8为图1的手术器械的一部分的立体图，示出邻近其第二位置的止挡构件；
[0019]图9为根据本公开的另一个实施例的弯曲钳口构件的立体图，示出在第一位置的止挡构件；
[0020]图10为图9的弯曲钳口构件的分解立体图；
[0021]图11为图9的弯曲钳口构件的立体图，示出沿着图9的剖面线11-11所截取的远侧部的横截面；及
[0022]图12为图9的弯曲钳口构件的立体图，示出在第二位置的止挡构件。
具体实施方式
[0023]参照附图详细描述目前公开的手术器械的实施例，其中相似的附图标记标示附图中的每一幅附图中相似或者相同的元件。在附图以及下面的描述中，术语“近侧”指的是手术器械最靠近操作者的一端，而术语“远侧”指的是手术器械离操作者最远的一端。本领域技术人员可以理解的是，虽然所描述的手术器械射出缝合钉，但是其也可以适于射出其他任意的适合的紧固件，例如夹子以及两部分的紧固件。另外，所公开的止挡构件可以与电手术镊一起使用。在于2003年2月20日提交的、标题为“VESSEL SEALER AND DIVIDER AND METHOD0F MANUFACTURING”、申请号为10/369,894的共有专利申请中描述了电手术镊的细节，其全部内容通过引用合并于此。
[0024]参照图1，附图标记100标示当前公开的手术器械的一个实施例。为了简洁，本公开的重点是手术器械100的末端执行器和止挡构件。于2007年11月28日提交的公开号为2008/0105730的美国专利申请；2008年1月8日提交的公开号为2008/0110960的美国专利申请；2008年1月24日提交的公开号为2008/0142565的美国专利申请；2007年10月15日提交的公开号为2008/0041916的美国专利申请；及2008年5月5日提交的序列号为61/050273的美国临时专利申请以及2007年4月10日提交的序列号为11/786,198的美国临时专利申请详细描述了其他手术紧固组件的结构和操作。这些在先申请的全部内容通过引用合并于此。在所引用的专利申请中公开的手术紧固组件中的任何一个可以包括当前公开的止挡构件。
[0025]手术器械100被构造为夹持、固定和/或切割组织。一般地，手术器械100包括手柄组件160、从手柄组件160向远侧延伸并限定纵轴“A-A”的细长部120，及适于夹持并紧固组织的工具组件150。细长部120具有近侧部122及远侧部124并且使手柄组件160与工具组件150可操作地连接。工具组件150包括末端执行器154及止挡构件170。末端执行器154被设置为邻近细长部120的远侧部124，包括第一钳口构件130及第二钳口构件140。钳口构件130、140中的至少一个适于相对于另一钳口构件(130或者140)在分开位置与接近位置之间运动。在所描述的实施例中，第一钳口构件130包含钉仓组件132，而第二钳口构件140包括砧座组件142。如下所述，例如，砧座组件142在手柄组件160致动时相对于钉仓组件132在分开位置与接近位置之间运动。然而，可以设想的是，其他使钳口构件相互接近的方法也是可用的，包括使夹杆(clamp bar)168滑动。
[0026]手柄组件160包括固定手柄162及活动手柄164。活动手柄164适于朝向或者远离固定手柄162可枢转地运动。而且，活动手柄164通过一机构可操作地连接至砧座组件142，该机构适于将活动手柄164的至少一部分致动转化为钉仓组件132及砧座组件142中至少一个在分开位置与接近位置之间的枢转运动。如本领域技术人员所公知的，任何常规的致动机构都可以用于将活动手柄164可操作地连接至工具组件150。
[0027]参照图2至图5，钉仓组件132具有组织接触面134及多个紧固件保持槽(fastener retaining slot)136。组织接触面134大致面对砧座组件142(参照图1)，并且在操作过程中当砧座组件142接近钉仓组件132时组织接触面134接合组织。紧固件保持槽136沿着组织接触面134成排地排列。例如，每一个紧固件保持槽136适于夹持一个紧固件(未示出)，直到用户致动手柄组件160(参照图1)。当活动手柄164朝向固定手柄162枢转时，紧固件从紧固件保持槽136中被射出并向砧座组件142运动。
[0028]除紧固件保持槽136之外，钉仓组件132还具有适于可滑动地容纳刀片(未示出)或者其他任何适合的切割工具的刀槽138。刀槽138被设置在紧固件保持槽136的排之间并沿着组织接触面134延伸。在操作中，当活动手柄164朝固定手柄162枢转时，刀片(未示出)滑动通过刀槽138。可选地，能够使用其他机构来驱动刀片通过刀槽138。除刀槽138之外，钉仓组件132还具有一对在组织接触面134上形成的槽139。每个槽139提供钉仓组件132的内部的入口，并被配置为容纳止挡构件170的一部分。
[0029]在公开的实施例中，手柄组件160包含致动机构，该致动机构用于部署紧固件保持槽136中的紧固件并沿着刀槽138推进刀片。该致动机构包括可操作地连接至活动手柄164的发射杆。在操作中，活动手柄164朝向固定手柄162的枢转导致发射杆向远侧前进。发射杆依次可操作地连接至一个至少部分位于工具组件150中的轴向驱动组件。轴向驱动组件被配置为响应发射杆向远侧的平移而向远侧运动。轴向驱动组件向远侧的平移导致第二钳口构件140朝向第一钳口构件130枢转。另外，轴向驱动组件将设置在第一钳口构件130中的致动滑块(actuation sled)向远侧方向推动，而致动滑块向远侧平移通过末端执行器154。随着致动滑块向远侧前进通过第一钳口构件130，该致动滑块促使紧固件脱离紧固件保持槽136。在一个实施例中，轴向驱动组件包括安装在其远侧部的刀片。在操作中，当轴向驱动组件向远侧运动通过末端执行器154时，该刀片运动通过刀槽138。
[0030]止挡构件170被设置为邻近第一钳口构件130(显示为钉仓组件132，但是还可以是砧座组件142)的远侧部137。止挡构件170相对于第一钳口构件130在图5中所示的第一位置与图7中所示的第二位置之间可枢转。在第一位置，止挡构件170的至少一部分位于第一钳口构件130的外部，然而，在第二位置，止挡构件170的至少一部分至少部分地位于第一钳口构件130的组织接触面134以下。在不同的实施例中，当止挡构件170位于第一位置时，止挡构件170的显著部分被设置在第一钳口构件130的外部。可以设想术语“显著”是指当止挡构件170位于第一位置时，止挡构件170的每一支腿177的至少一半被设置在第一钳口构件130的外部。另外，如此处所用，“显著”可以指当止挡构件170位于第一位置时，止挡构件170的超过1/3部分被设置在第一钳口构件130的外部。
[0031]止挡构件170包括适于接合第一钳口构件130的远侧部137的外表面的基座172，及适于接合组织的止挡部174。枢轴销176或者其他任何适合的装置将止挡部174可枢转地连接至基座172。因此，止挡部174被配置为远离或朝向组织接触面134枢转。在一个实施例中，止挡构件170包括用于使止挡部174偏置离开第一钳口构件130的偏置构件(例如弹簧)。
[0032]止挡部174包含本体175及至少一个从本体175向近侧延伸的支腿177。在图2中所示的实施例中，止挡部174具有两个从本体175向近侧延伸的支腿177。但是，止挡部174可以包括更多或更少的支腿177。图2中所示的两个支腿177在其间限定了一个适于容纳刀片的空间。每个支腿177被定尺寸为被槽139容纳并且包括近侧面173。当止挡构件170位于第一位置时，每个近侧面173相对于组织接触面134限定一个倾斜角，如图5所示。相反的，当止挡构件170位于第二位置时(参照图7)，每个近侧面173限定大体上垂直于组织接触面134的角度。无论止挡构件170的位置如何，所示出的支腿177位于刀槽138的相对的两侧。因此定尺寸为容纳支腿177的槽139也位于刀槽138的相对的两侧。
[0033]参照图6至图8，止挡构件170利于在手术器械100的操作期间将组织保持在第一钳口构件130及第二钳口构件140之间。(参照图1)。也就是说，止挡构件170有助于防止组织向远侧移动或平移而超过其在钳口构件之间的期望位置。在使用中，用户先将手术器械100安置于邻近目标组织。尤其是，目标组织位于第一钳口构件130与第二钳口构件140之间。由本体175相对于组织接触面134限定的角度利于将目标组织“T”在大体箭头“A”的方向引入工具组件150，参照图6。一旦用户将目标组织的至少一部分放置在第一钳口构件130及第二钳口构件140之间，用户朝固定手柄162拉动活动手柄164以使砧座组件142接近钉仓组件132。当用户拉动活动手柄164时，砧座组件142移近钉仓组件132，并且目标组织“T”被抓取在钉仓组件132的组织接触面134之间。同时，砧座组件142将止挡部174向钉仓组件132推进。响应于由砧座组件142施加在止挡部174上的力，止挡部174例如克服偏置构件(未示出)的偏置而绕枢轴销176朝向钉仓组件132枢转。当止挡部174移近钉仓组件132时，支腿177的至少一部分通过槽139运动至钉仓组件132的内部，参照图7。当止挡构件170在第二位置时(如图7所示)，支腿177的一部分位于钉仓组件132内；相应的，近侧面173的一部分位于钉仓组件132的外面。如上所述，当止挡构件170在第二位置时，近侧面173相对于组织接触面134限定大体垂直的角度，从而防止组织在夹持过程中脱离。
[0034]本公开还考虑了止挡构件170经由常规的机械器件可拆卸地连接至末端执行器150，常规的机械器件例如为卡口式接口、掣子、掣轮器(detent)或者搭扣连接器。
[0035]参照9至图12，可以设想第一钳口构件230的另一个实施例。该实施例的第一钳口构件230具有弯曲的形状(即相对于纵轴“A-A”)。可以设想弯曲钳口构件可以利于执行特定类型的手术操作。例如，和直钳口构件(例如图1中所示的钳口构件)相比，弯曲钳口构件可以有助于进入下骨盆区，例如在低位前切除(“LAR”)或者其他结直肠手术期间。
[0036]第一钳口构件230包括适于容纳止挡部270的两个支腿277的一个开口239(图10)，代替了每个都可以容纳止挡构件170的一个支腿177的两个槽139。止挡构件270与止挡构件170相似。但是，止挡构件270具有直接连接至第一钳口构件230的远侧部237的止挡部274。远侧部237包含适于容纳枢轴销276的孔235(图10)。枢轴销276或者其它适合的装置将止挡构件270可枢转地连接至第一钳口构件230。
[0037]一般地，第一钳口构件230包括弯曲壳体231及弯曲钉仓组件232。壳体231具有适于容纳弯曲钉仓组件232的弯曲槽道233。弯曲钉仓组件232包含被配置为接合组织的组织接触面234、沿着其弯曲轮廓延伸的多排紧固件保持槽236，及适于可滑动地容纳刀片(未示出)的刀槽238。刀槽238被设置在紧固件制动槽236的排之间。
[0038]如上所述，对手柄组件160的致动不仅射出紧固件，而且沿着刀槽238驱动刀片(例如，经由活动手柄164的单个行程或者多个行程)。刀槽238通向形成在钉仓组件232的远侧部237上的开口239。凹槽280位于开口239的远侧并且包括相对于组织接触面234限定倾斜角度的斜壁282(参照图11)，并且适于在其中容纳止挡构件270的一部分。除斜壁282之外，凹槽280还具有适于容纳止挡构件270的一部分的空腔284。
[0039]止挡构件270包括本体275、一对从本体275向近侧延伸的支腿，及从本体275横向延伸的枢转凸出部286。支腿277在其间限定了容纳刀片的尺寸的空间。每个支腿277具有近侧面273，当止挡部270在第一位置时，近侧面273相对于组织接触面234限定倾斜的角度，如图9所示，并且当止挡部270在第二位置时，近侧面273相对于组织接触面234限定大体的直角，如图12所示。
[0040]本体275相对于组织接触面234限定倾斜角度。止挡构件270的枢转凸出部286适于被空腔284容纳并且具有被配置为容纳枢轴销276的孔288。枢轴销276贯穿钉仓组件232的孔235及枢转凸出部286的孔288，并且允许止挡构件270从第一位置及第二位置枢转，在第一位置处止挡构件270的至少一部分位于第一钳口构件230的外部，如图9所示；在第二位置处止挡构件270的至少一部分至少部分地位于第一钳口构件230的组织接触面234以下，如图12所示。
[0041]参照图11，本体275另外包含通向斜壁282的通孔290及朝通孔290凸出的边墙(abutment wall)292。边墙292被配置为保持偏置构件294的第一端294a，并且斜壁282适于支撑偏置构件294的第二端294b。偏置构件294将止挡构件270向其第一位置偏置。在图10与图11所示的实施例中，偏置构件294为弹簧，但是偏置构件294可以可选择地为能够将止挡构件270偏离第一钳口构件230的任何适合的装置或器件。
[0042]第一钳口构件230的操作与第一钳口构件130的操作大体上相似。第一钳口构件230与砧座组件共同工作以切割和/或固定组织。随着用户致动手柄组件160，钳口构件相互接近，这将止挡构件270从第一位置(参照图9)推进至第二位置(参照图12)。在第一位置，止挡构件270的方位利于将组织引入第一钳口构件230与砧座组件之间。而且，当止挡构件270被定位在其第二位置时，止挡构件270阻止组织向远侧脱离工具组件。当砧座组件运动离开第一钳口构件230时，止挡构件270在偏置构件294的作用下返回至其第一位置。
[0043]可以理解的是可以对本公开的手术器械进行各种修改。因此上述描述不能解释为限定，仅是作为实施例的示例。本领域技术人员可以在本公开的范围和精神内设想其他的变化。

Claims (15)

1、一种用于外科手术上连接组织的手术器械，所述手术器械包括：
手柄组件；
细长部，其从所述手柄组件向远侧延伸并且限定一纵轴；
末端执行器，其设置为邻近所述细长部的远侧部，所述末端执行器包括第一钳口构件及第二钳口构件，至少一个钳口构件相对于另一个钳口构件在分开位置与接近位置之间为可活动的；
止挡构件，其设置为邻近所述第一钳口构件的远侧部，所述止挡构件相对于所述第一钳口构件在第一位置及第二位置之间为可枢转的，在第一位置，所述止挡构件的显著部分位于所述第一钳口构件的外部，在第二位置，所述止挡构件捕获在所述第一钳口构件和所述第二钳口构件之间的组织。
2、根据权利要求1所述的手术器械，其中钉仓相对于所述纵轴为弯曲的。
3、根据权利要求1所述的手术器械，进一步包括偏置构件，其设置为与所述止挡构件机械协作，其中所述偏置构件使所述止挡构件向其第一位置偏置。
4、根据权利要求1所述的手术器械，其中所述止挡构件包括基座及止挡部，所述基座可操作地连接至所述止挡部。
5、根据权利要求4所述的手术器械，其中所述止挡部可枢转地连接至所述基座。
6、根据权利要求1所述的手术器械，其中所述止挡构件可枢转地连接至所述第一钳口构件。
7、根据权利要求1所述的手术器械，其中所述第一钳口构件包括刀槽。
8、根据权利要求7所述的手术器械，进一步包括所述止挡构件的第一支腿及第二支腿，所述第一支腿及所述第二支腿位于所述刀槽的相对的两侧。
9、根据权利要求8所述的手术器械，进一步包括设置在所述第一钳口构件上的第一槽及第二槽，所述第一槽及第二槽中的每一个适于在其中容纳所述第一支腿及第二支腿中的一个的至少一部分。
10、根据权利要求9所述的手术器械，其中所述第一支腿及第二支腿中的每一个被配置为当所述止挡构件向其第二位置运动时至少部分运动通过所述第一槽或第二槽。
11、一种与手术器械一起使用的工具组件，所述工具组件包括：
末端执行器，其包括第一钳口构件及第二钳口构件，至少一个钳口构件相对于另一个钳口构件在分开位置与接近位置之间为可活动的；
止挡构件，其设置为邻近所述第一钳口构件的远侧部，所述止挡构件相对于所述第一钳口构件在第一位置及第二位置之间为可枢转的，在第一位置处，所述止挡构件的至少一部分位于所述第一钳口构件的外部，在第二位置处，所述止挡构件捕获在所述第一钳口构件和所述第二钳口构件之间的组织，其中所述钳口构件朝向接近位置的相对运动导致所述止挡构件的至少一部分朝向所述第一钳口构件运动。
12、根据权利要求11所述的工具组件，其中所述末端执行器具有纵向曲线形状。
13、根据权利要求11所述的工具组件，其中所述止挡构件被朝向所述第一位置偏置。
14、根据权利要求11所述的工具组件，其中所述第一钳口构件包括形成在其中的至少一个槽，所述至少一个槽被配置为容纳所述止挡构件的至少一部分。
15、一种利用手术紧固件固定组织的方法，包括：
将组织布置在第一钳口构件与第二钳口构件之间；
使所述第一钳口构件相对于所述第二钳口构件枢转以接合组织；及
使设置在所述第一钳口构件与所述第二钳口构件之间的止挡构件枢转，以将组织保持在所述第一钳口构件与所述第二钳口构件之间，所述止挡构件设置在钳口的远端。
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US20110114702A1 (en) 2011-05-19
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CN103690214A (zh) 2014-04-02
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