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能够供给缝钉的内切割器

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CN101883528B
CN101883528B CN 200880106148 CN200880106148A CN101883528B CN 101883528 B CN101883528 B CN 101883528B CN 200880106148 CN200880106148 CN 200880106148 CN 200880106148 A CN200880106148 A CN 200880106148A CN 101883528 B CN101883528 B CN 101883528B
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staple
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staple feed
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布赖恩·D.·克诺德
伯纳德·A.·豪森
卢克·W.·克劳森
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卡迪卡公司
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    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
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    • AHUMAN NECESSITIES
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    • A61B17/0682Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil
    • A61B17/0686Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil having a forming anvil staying below the tissue during stapling
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Abstract

一外科手术用内切割器可以包含一端部执行器,至少部分延伸至端部执行器的至少一供给带,两个或更多个缝钉,其中每一缝钉有一易断性连接对应的供给带的第一末端和一自由的第二末端,其中缝钉形成至少一排。内切割器可以通过开口,如套针孔将端部执行器插入病人体内,用端部执行器夹住组织,通过端部执行器沿着两条缝钉线缝钉组织,在缝钉线之间切割组织,从端部执行器上放开组织,在病人体内不同位置重复抓住,缝钉和夹紧组织,而不需要从病人体内取出端部执行器,从而对病人进行治疗。

Description

能够供给缝钉的内切割器

技术领域

[0001] 本发明主要涉及一种外科手术工具及方法。更具体地说,本发明涉及一种内切割器。

[0002] 技术背景

[0003] 内切割器是一种用于缝钉和切割组织,从而横切该组织并能对切割末端止血的外科手术工具。其直径很小,足以应用于微创手术中,可以通过套针,插孔,或者身体上的小切口达到手术部位。线型的切割器属于大型的内切割器,用于横切胃肠道部分。内切割器末端通常带有一个可拆卸的单用途带装有几排缝钉的钉仓,钉仓对面有一个砧。外科医生通过套针或者其它插孔或者身体上的切口将内切割器插入体内,将内切割器末端指向需要横切的组织的方向,同时压迫砧和钉仓以夹紧组织,然后将一排或几排缝钉部署在横切线的一边,刀口沿着横切线推进将组织切开。

[0004] 在内切割器的驱动过程中,钉仓中的缝钉将被全部用完。为了装填更多的缝钉,必须从手术部位及病人体内取出内切割器,之后才能将旧钉仓更换成新钉仓,然后内切割器被再次插入病人体内。然而,再次插入后要确定手术部位是很困难的也是很费时间的。另外,每次使用后从病人体内取出内切割器,更换钉仓,之后再次确定手术部位的过程很繁琐,不便且很花时间,特别是对于那些需要多次使用内切割器的外科手术。这些不便使外科医生不愿意在这些步骤中使用内切割器,即使使用这些内切割器对病人是有益的。

[0005] 附图说明`[0006] 图1是一内切割器的示意图。

[0007] 图2是病人身体上一个套针孔的剖面图。

[0008] 图3是病人身体上多个套针孔的剖面图。

[0009] 图4是一易断性连接有三排缝钉的供给带的实施例透视图。

[0010] 图5是图4所示供给带的侧视图。

[0011] 图6是图4所示供给带的俯视图。

[0012] 图7是使用图4-6所示供给带的内切割器端部执行器的实施例的侧视图

[0013] 图8是一供给带引导器实施例的透视图。

[0014] 图9是不带有供给带的图8所示的供给带引导器侧面剖视图。

[0015] 图10是带有供给带的图8所示的供给带引导器侧面剖视图。

[0016] 图11是图7所示端部执行器实施例的缝钉盒外壳实施例透视图。

[0017] 图12是图7所示端部执行器实施例的剖面图(perspective cutaway view)。

[0018] 图13是一楔部件实施例的透视图。

[0019] 图14是图7所示端部执行器实施例的模块实施例的透视图。

[0020] 图15是一切割器实施例的透视图。

[0021] 图16是图7所示端部执行器实施例的侧面剖面图。[0022] 图17是图7所示端部执行器实施例的夹持器透视图。

[0023] 图17A是图17所示夹持器底面透视图。

[0024] 图18是易断性连接有两排缝钉的供给带的实施例透视图。

[0025] 图19是图18所示供给带的侧视图。

[0026] 图20是图18所示供给带的俯视图。

[0027] 图21是使用图18-20所示供给带的内切割器的端部执行器的实施例侧面剖视图。

[0028] 图22是图21所示端部执行器实施例的缝钉盒外壳的实施例透视图。

[0029] 图23是图21所示端部执行器实施例的模块透视图。

[0030] 图24是图21所示端部执行器实施例在邻近模块时的详细剖视图。

[0031]图25是另一种易断性连接有两排缝钉的供给带实施例的透视图。

[0032] 图26是图25所示供给带的侧视图。

[0033] 图27是图25所示供给带的俯视图。

[0034] 图28是楔部件另一实施例的远末端透视图。

[0035] 图29是一被内切割器横切的血管的透视图。

[0036] 图30是可滑行夹`具的透视图,其中每一夹具都处在相对于对应供给带的第一位置。

[0037] 图31是图30所示可滑行夹具的侧视图,其中每一夹具都处在相对于对应供给带的第一位置。

[0038] 图32是图30所示可滑行夹具的透视图,其中每一夹具都处在相对于对应供给带的第二箝位。

[0039] 图33是图30所示可滑行夹具的侧视图,其中每一夹具都处在相对于对应供给带的第二箝位。

[0040] 相同参考符号在不同的附图中代表相似或相同的部件。详细描述内切割器-三排缝钉

[0041] 如图1所示,一内切割器2包括一与杆轴6连接的端部执行器4,该杆轴6继而与手柄8连接。端部执行器4可以是一个或多个与杆轴6连接的独立的部件或者是与杆轴6远末端整体制作的部件。又如图2-3所示,端部执行器4和杆轴6的尺寸可制作成能通过位于病人14的组织12上的标准的套针孔10。有利的是,端部执行器4的尺寸应可通过开口直径为5-10毫米的套针孔10。或者,内切割器2可以用于传统的不使用套针孔的开放式外科手术中。另外,内切割器2可以用于微创手术,其可通过除套针孔以外的装置或结构到达手术位置,如Ethicon Endo-Surgery公司的LAP DISC手动进入装置,或者通过不安装套针孔或其它装置或结构的切口或开口到达病人体内的手术位置。

[0042] 套针孔10是中空的,结构总体成管状,用于插入病人组织12的切口,使切口保持打开状态,并且防止因工具活动或其它物件穿过切口而造成的对切口周围组织12的损伤。套针孔10的材料可以是塑料或者其它合适的生物适合性材料。套针孔的横截面大体上是圆形、椭圆形或其它合适的形状。套针孔10的具体尺寸根据对病人即将实施的具体程序而定,可以是任何合适的尺寸。套针孔10可以通过其中心与切割器(未显示)连接,切开组织12,然后放置于组织12。切割器可以是尖状物或者其它切割或穿孔设备。当套针孔10在胸壁放置到位后,切割器就从套针孔10移去。套针孔10和切割器的组合在本领域内是标准的。

[0043] 如图1所示,内切割器2的杆轴6自端部执行器4向近处延伸。杆轴6可以是带弹性的或是刚硬的。如果需要,杆轴6可以有至少一个铰接位置。或者,杆轴6可以带有一切口,槽或其它特征(未显示),用于容纳可能用于手术程序中的导引线(如果有的话)或者其它用于定位的辅助工具,以使其在内切割器2驱动时保持原位置。

[0044] 手柄8可以与杆轴6近末端或其它合适的部位相连接。杆轴6可以与手柄8整体制作。或者,杆轴6和手柄8是两个独立的,可以通过任何一种合适的方式连接在一起的部件。手柄8包括任何经过适当的设置能驱动端部执行器4的一个或多个装置或者一个或多个结构。手柄8也可以带有驱动端部执行器4的能源存储器。能源存储器可以是机械的(如发条),电子的(如电池),风动的(如加压气体泵)或者任何其它合适的能源存储器。能源存储器,对能源存储器的控制及其在驱动端部执行器4中的应用如2005年2月9日提交的美国专利申请11/054,265所述。该申请作为参考被整体引用于此。手柄8也可以包括一个或多个适合接收外源能源的连接装置,如与医院使用的加压气体或真空源连接的胶管,或者可与电源连接的电线。

[0045] 如图4-6所示,供给带16的一部分被置于端部执行器4内。供给带16可以是长的,狭窄的,薄的带状材料,一个或多个缝钉18可从供给带上延伸出来。供给带16可以是不锈钢,镍-钛合金或者任何其它合适的金属或者非金属材料。供给带16有足够强的柔韧性及强度,能够在线性推进后,在突起部或者其它结构部位调转为基本上相反的方向,其具体内容将在下面详述。另外,供给带16可以是刚硬的或者至少部分刚硬的,可以基本线性推进或拉回而不需沿一结构改变方向。每一个缝钉18都可以具有任何合适的形状;各缝钉18的形状可以基本一致或者各不相同。例如,每一个缝钉18大致都是V形,并且带有两个从V形基底延伸出来的脚20。如图5具体所示,缝钉18的一只脚20大致是直的,另一只脚20略微弯曲。然而,脚20的形状可以各不相同。另外,每一只脚20的形状也可以是相同的。缝钉18不必是对称的,但如果需要,可以做成对称的。缝钉18的V形基底可以是弯曲的,尖的或者其它构形`。缝钉18的一只脚20有一自由端22,因其特征可称为组织穿透尖22。如果需要,组织穿透尖22可以被削尖,从而帮助穿透组织。然而,缝钉18的脚20有一个足够小的截面,使组织穿透尖22不需要削尖就能容易的穿透组织。另外一只脚20的一端与供给带16连接。有利的是,脚20和供给带16的连接是易断的。这样,缝钉18的一端可以与供给带16连接,另一端则是开放的。另外,缝钉18可以带有3个或更多的脚20,或者做成任何其它合适的形状。

[0046] 供给带16和缝钉18可以以任何合适的形式制作在一起。例如,将一种扁平的,薄片材料用激光切割成长条,然后将每个长条用激光切割成指状,之后弯曲做成缝钉18的形状。用这种方法,缝钉18和供给带16形成一个整体结构。但是,供给带16和缝钉18可以以任何合适的形式制作在一起。比如,缝钉18和供给带可以分别制作,之后缝钉18通过焊接,粘合或者其它方法以易断性的形式与供给带16连接。

[0047] 供给带16可以以任何合适的易断性形式连接每一个对应的缝钉18。比如,如图6详细所示,每一条供给带16都带有至少一个从其侧面突出的,或位于其中心向侧面延伸的标突28(Tab 28)。或者,至少有一个位于不同方向的标突28。有利的是,在生产过程中,对缝钉18的激光切割和后续的机械变形形成了标突28,从而使标突28和缝钉18与对应的供给带整合在一起。但是,标突28和/或缝钉18可以以任何合适的方式与供给带16制造在一起或相连接。至少一个缝钉18以任何合适的方式与对应的标突28连接。缝钉18和对应的标突28间的连接方式可以是任何合适的方式。缝钉18和对应的标突28间的连接可以以任何合适的定位方向存在。例如,至少一个标突28大致是长方形的。对应的缝钉18由该长方形标突28近侧边缘延伸出来。缝钉18可以从标突28分离出来,其分离位置大致位于缝钉18和标突28的连接部位。缝钉18和对应标突28间的连接足够牢固,能够在使用前使缝钉18固定在供给带16上,同时该连接也足够脆弱,使缝钉18在使用时或使用后能够从标突28上断裂或者分离开来。或者,缝钉18和/或标突28在它们连接处或其附近带有一个被削弱的部位,使缝钉18和供给带16在使用时或使用之后容易分离。被削弱的部分带有削弱的横截面,或者带有凹口,或者其它削弱的结构。另外,被削弱的部分也可以是通过物理处理的或者设定成比周围材料薄弱,同时与周围的材料的物理大小基本相同。

[0048] 如图4-6所示为缝钉18部署前的初始结构。在初始结构中,缝钉18之间基本不接触。或者,在初始结构中,至少两个缝钉18相互接触。每一个缝钉18基本都位于同一个平面上。也就是说 ,缝钉18的形状为可使单个平面延伸贯穿整个缝钉18,并将其一分为二。或者,至少一个缝钉18不是基本位于一单个平面上。至少一个缝钉18是位于与供给带16大体垂直的平面上。或者,至少一个缝钉18是位于与供给带16成不同角度的平面上。一排或更多排26的缝钉18与供给带16连接。每排26的缝钉18位于相对于供给带16纵向中心线的基本相同的侧面位置。每排26的缝钉18基本都是纵向的。如图6很好地显示三排26缝钉18可与供给带16连接:沿着供给带16每边各一排26,沿着供给带16中心一排26。供给带16可以形成连续的环路或者具有相互分离的开端和末端。或者,可以有更多或更少排26的缝钉18与供给带16连接。每排26可沿着供给带16局部或全部或长度方向延伸。不同排26沿着供给带16延伸的长度可以不同。

[0049] 沿着单个供给带16的两排或更多不同排26的缝钉18可以以任何合适的方式排列。比如,沿着单个供给带16的两排或更多不同排26的缝钉18相互间可以错开排列。也就是说,在沿着一单个供给带16某个纵向位置上,一排26的缝钉18与供给带16连接,在相同位置上至少有另外一排26的缝钉18与供给带16不连接。这种缝钉18的错开排列有助于使用端部执行器4对组织止血。如图6很好地显示,中间排26的缝钉18与沿着供给带16侧面边缘排列的缝钉排26的缝钉18错开排列。或者,两排或更多排26的缝钉18可以以不同的方式错开。或者,沿着一单个供给带16的两排或更多排26的缝钉18可以在排26的至少部分长度上相互对齐。例如,在沿着供给带16的某个纵向位置上,一排26的缝钉18与供给带16连接,其它每排26同样有连接供给带16的缝钉。或者,沿着一单个供给带16的两排或更多排26缝钉18在该供给带16的不同纵向部分上的排列不同。缝钉18在内切割器2的不同供给带16上的相互之间的排列方式可以是相同或不同。

[0050] 每排26的缝钉18之间的间距基本相同。也就是说,任何两个纵向相邻的缝钉18的间距基本都相同。或者,在每排26中至少有两个纵向相邻的缝钉18的间距与其它两个纵向相邻的缝钉18的间距不同。这种结构在缝钉线长度不可调的情况下是有用的。由端部执行器4产生的缝钉线可以固定为某一特定数量的缝钉18,因此,每一排的缝钉18都可集合成一些组,每组具有与固定的缝钉线基本相同的长度。如果是这样,在排26中的每组缝钉18都可以与在供给带16上相邻的缝钉18组以一空白区分离。其中,空白区的长度可以是任何合适的长度。有利的是,没有缝钉18从供给带16的空白部分界定的区域延伸出来或延伸进去。

[0051] 如图7所示,端部执行器4可以包括一个缝钉盒30和一个砧32。砧32可以相对于缝钉盒30运动,从而压紧砧32和缝钉盒30之间的组织。砧32包括标准的缝钉弯曲部件使缝钉18容易闭合。或者,缝钉弯曲部件可以从砧32中去除。砧32相对于缝钉盒30可以转动。例如,至少有一个栓34从砧32的近末端或附近基本沿着砧32侧向延伸出来。每一个栓34都可以被槽36,隙缝或者其它缝钉盒30的部件容纳,栓34在该部件中可以转动,从而使砧32转动。如图16所示,用这种方法,砧32在夹紧组织之前的第一初始状态下,其远末端可以和缝钉盒30分离,并置于其上,同时,砧32的近末端和缝钉盒30连接。或者,槽36可以置于内切割器的杆轴6中,砧32与杆轴6可旋转式的连接,且相对于缝钉盒30是可运动的。或者,砧32可以以其它方式与缝钉盒连接且/或者相对于缝钉盒是可以运动的。或者,缝钉盒30相对于砧32是可以运动的。或者,缝钉盒30和砧32相对于彼此是可以运动的。缝钉盒30的远末端和砧32的远末端是钝的,这样可以防止端部执行器4在插入病人体内及到达治疗位置时,与组织无意的衔接。有利的是,缝钉盒30被固定在端部执行器4的剩余部分上和/或杆轴6,而且是不可拆卸的。如以下详细内容所述,缝钉盒30可以使用多次而不需要从病人体内取出,因此,在放出缝钉18后,我们不需要将端部执行器4从病人体内取出,来替换缝钉夹或是其它部件。但是如果需要,缝钉盒30相对于端部执行器4的剩余部分和/或杆轴6是可拆卸的;端部执行器4相对于杆轴6是可拆卸的;和/或者杆轴6相对于手柄8是可拆卸的。

[0052] 缝钉盒30可包括任何合适的部件。如图8-10所示,缝钉盒30可包括一个供给带引导器40。该供给带引导器40可以是任何形状。缝钉盒30可被构造成使得供给带引导器40的远末端就是端部执行器4的远末端。如果这样,供给带引导器40的远末端42可以基本上是钝的。供给带引导器40的远末端42的上表面44带有基本向上的角度,沿着供给带引导器40向近处运动。或者,供给带引导器40的远末端42的上表面44可以是任何其它合适的形状。供给带引导器40的远末端42的上表面44上可以设定一个或更多个隙缝46。或者,可以去除一个或更多个隙缝46,使得供给带引导器40的远末端42的上表面44是连续的。供给带引导器`40的远末端42可包括一设于其中的空间48,至少一个突出部50从远处突出进入该空间48。每一个突出部50都可以是弯曲的,且可以为凸形。例如,每一个突出部50可以为弓形,其中的弓形是圆的一部分。或者,至少有一个突出部的形状是不同的。例如,至少有一个突出部50的形状是由两个或更多个直线形成的粗糙的或平滑的弧线状。

[0053] 如图12所示,端部执行器4可包括两个供给带16,这种设计在组织切口或横切部的两边都能使用缝钉18。或者,端部执行器4包括仅仅一个或三个或更多个供给带16。供给带16之间可以相互独立,或者以任何形式连接。供给带16可以布置在每一个突出部50的周围,突出部50在侧向上相互间隔,并位于刀的相对的面,该设计如下所述。每一个供给带16可沿着一轨迹布置,该轨迹开始时基本为直线且朝向远处,然后沿着对应的突出部50的表面弯曲,之后朝向近处且逐渐变直。也就是说突出部50改变对应供给带16运行方向,使其从朝向大体远处方向转变到大体近处方向。每一个突出部50的宽度和沿着该突出部表面运动的对应供给带16的宽度基本相同。或者,至少一个突出部50比对应的供给带16更窄或者更宽。或者,可以去除突出部50,这样供给带16基本沿直线运动。

[0054] 至少一个突出部50被其中设定的狭槽52分开。狭槽52的方向基本是纵向的。但是,狭槽52也可以具有任何其它合适的方向。每一个供给带16与对应的突出部50至少部分接触,供给带16的每一最外侧的每一排26的缝钉18位于突出部50的每一边侧面。如图6所示,当供给带16的中间带有一排26缝钉18时,突出部50的狭槽52可横向放置于与中间排26缝钉18基本相同的位置。这样,狭槽52就为中间排26缝钉18滑动提供了空间。或者,至少一个突出部50被两个或更多个狭槽52分成几个部分,其可根据连接在对应供给带16上的缝钉18排26的排数决定。或者,这个狭槽或更多狭槽52不必延伸至突出部50的远末端,因为当供给带16的对应部分到达突出部50时,该部分所带缝钉18已经被部署出去了,更详细的介绍请看以下内容。或者,可以去除至少一个狭槽52。至少一个突出部50可在近处方向上延伸任何合适的长度。类似地,供给带导引器40的剩余部分可以在近处方向上延伸任何合适的长度。供给带引导器40接近远末端42的部分可以称为插入43。刀片槽54可以沿着供给带引导器40的长度方向延伸,并且可以贯穿供给带引导器40远末端42的上表面44。

[0055] 如图11所示为外壳60。外壳60可以由单片片状金属制备。或者,外壳60可以通过其它合适的方式和/或其它材料制备。外壳60包括一个基本平整的底座62,两个基本垂直底座62向上延伸的外壁64。底座62和外壁64基本为长方形。外壁64之间基本互相平行。或者,底座62和外壁64的形状,和/或设置方向各不相同。顶板66从每一个外壁64的上边缘基本侧伸出来,使得两个顶板66基本都在同一平面上。每一个顶板66基本都是长方形。每一个顶板66都带有一些隙缝67。这些隙缝67可以让缝钉18通过,进而部署出去。两个顶板66沿着他们长度方向相互分离。内壁68从每一个顶板66的内边缘大体向下延伸,并且与对应的顶板基本垂直。每一个内壁68基本都是长方形。内壁68相互分离且基本平行。但是,至少有一个内壁68的形状和/或设置方向可以是不同的。内壁68间分开的距离足够大,可以容纳刀片在其间通过,更详细描述请看以下内容。至少一个内壁68的下边缘与底座62接触`,或者也可以与底座62分离。接收空间70是由底座62,外壁64,顶板66和内壁68构成的外壳容积。外壳60可以带有两个接收空间。

[0056] 至少部分外壳60可以去除顶板66和/或内壁68,使得至少部分外壳60的形状基本为U形。供给带引导器40可以和外壳60连接,该连接可以通过任何合适的方式完成。例如,供给带引导器40的插入43可以插入一个或更多接收空间70中,然后以任何合适的方式固定。又例如,供给带引导器40可以不包括插入43,供给带引导器以任何合适的方式与外壳60远末端连接。又例如,供给带引导器40可以和外壳60整体制作在一起。或者,供给带引导器40既不连接外壳60也不固定在外壳60上。

[0057] 如图13所示,一个或更多楔形部件延伸至端部执行器4的缝钉盒30。每一个楔形部件72的臂76远末端都可以包括一个楔74。或者,楔74位于臂76的不同位置。楔74可以具有任何合适的形状。例如,楔74的上表面包括一个带有角度或向上弯曲的第一表面79,并向远处方向延伸。楔74也可以包括一个远离第一表面79的第二表面80,其中,第二表面可能带一定角度或者向下弯曲,并向远处方向延伸。第一表面79和第二表面80间的相交部分是弯曲或平滑的顶端82。或者,顶端82在第一表面79和第二表面80间形成一个不平滑的角度。楔74下表面基本上是直线形的。或者,楔74下表面是弯曲的,带有角度的,或者其它任何合适的形状。标突78可以位于臂76的任何位置。标突78基本是长方形或者其它不同的形状。标突78可以自臂76向下延伸,同时楔74可以自臂76向上延伸。或者,楔74和/或标突78相对于臂76的方向各不相同。有利的是,楔部件72是以单个整体结构制作出来的。但是,楔部件72可以通过独立的部件以任何合适的方式组装获得。如图12所示,每一个楔74最初可处于远离缝钉18排26的位置,并且在基本纵向上与对应的缝钉18排26排成直线,相对于对应的缝钉18排26能够纵向运动。每一个楔74的长度可以等于或小于缝钉18排26的纵向间距,使得楔74在移动接触后续排26的缝钉18前部署每一个缝钉18。这种楔74的构造在缝钉线长度可以调节时特别有用,因为一个缝钉18的部署与其它任何缝钉18的部署都是不相关的。或者,楔74的长度大于排26的缝钉18的纵向间距,使得当一个缝钉18的部署完成时,纵向相邻的缝钉18正在部署过程中。这种楔74结构在缝钉线的长度固定,并且供给带16上沿排26的缝钉组间存在空白区时是有用的。

[0058] 如图14所示,楔部件72的标突78可以插入模块84的接收槽86内。每一个接收槽86可以部分深入或者完全贯穿模块84。一个或多个接收槽86可以位于模块84的上表面88,或者其它表面上。一个或多个接收槽86可以位于模块84的远末端或其附近,或在模块84的其它位置。如图15所示,刀90近末端可带有一个弯钩92。栓94横向贯穿模块84近末端的刀片接收槽96,并且弯钩92可以与栓94衔接。栓94可基本上是圆柱形的或者其它能够衔接弯钩的 合适形状。或者,刀片接受槽86位于模块84的其它部分。或者,刀90的弯钩92可以是类似楔部件72的标突78的标突,这样刀片接收槽86也需要设定成与楔部件72的标突78的接受槽86 —样的构造。或者,弯钩92可以是任何其它合适的形状,例如不是弯钩的形状,刀片接收槽96也作相应的设置。或者,可以去除接受槽86,刀片接受槽86和/或标突78。楔部件72和/或刀90以不同的方式连接模块84,例如通过浇铸。或者,楔部件72,刀90和模块84可以以一个整体制作在一起。模块84基本上是长方形固体。或者,模块84是任何其它合适的形状。突出98在模块84近末端或其附近自模块84的上表面88基本向上延伸。或者,突出98可以向不同方向延伸和/或在模块84的不同位置上延伸出来。突出98大体是长方形固体,但是可以是其它合适的形状。或者,可以去除模块84,而楔部件72和刀90可以以其它合适的方式控制和/或操控。

[0059] 模块84至少部分可位于空间中,如端部执行器4和/或杆轴6的壁凹120中(图17A),模块84为了控制楔部件72和刀90的运动而能够沿着该空间纵向滑行。或者,模块84相对于端部执行器4和/或杆轴6的位置不同。或者,一个或更多滑行器100可从模块84下表面102向下延伸,以便与端部执行器和/或杆轴6对应的结构衔接,帮助模块84滑动。或者,可以去除滑行器100。如图16所示,杆104可以以任何方式与突出98连接。例如,杆104可以与突出98浇铸连接。杆104的远末端可以连接突出98,杆104可以延伸穿过杆轴6,使得杆104的近末端延伸至手柄8。杆104可以基本是钢硬的,且基本纵向延伸至杆轴6和/或通过杆轴6至手柄8。或者,杆104是可弯曲的和/或带有螺纹的,且杆104可以和突出98或模块84的其它部件中的螺纹衔接。这样,旋转杆104可以纵向推进或拉回模块84。

[0060] 如图15所示,刀90可包括自弯钩92延伸出来向远末端方向延伸的刀身106。与楔部件72的臂76相似,刀90的刀身106在横向方向是薄的,且大于其宽度和高度。或者,刀身106和/或至少一个臂76的形状不同。刀口 108位于刀身106的远末端。有利的是,刀90可以制作成单个的整体结构。但是,刀90可以由独立的弯钩92,刀身106和/或刀口108组和而成。刀口 108可以设置成任何可以切割组织的形式。例如,刀口 108包括沿着其上边缘的刀刃110,其中,刀刃110带有一个向上的角度,沿着刀口 108近处延伸。或者,刀刃110设于刀口 108上不同的方向和位置。如图11所不,刀90在顺着外壳60的内壁68间的至少部分空间内是可运动的。每一个供给带16的局部被置于每一个接收空间70中,从外壳60的内壁68横向伸出。这样,刀90在两个供给带16间可以纵向运动。[0059]或者,刀口 108和/或刀90的刀刃110可为了烧灼组织而被加热。或者,可以使电流通过刀90的刀口 108,使得使用刀口 108电烧灼组织。刀口 108可以使单极的,或者是双极系统中的一极端。或者,可以去除刀90,在其位置上使用电线。电线可以从远处穿过缝钉盒30,自缝钉盒30向上至砧32,然后从近处穿出砧32。电线的向近处的运动使电线穿过并切割组织。电线可以是电极,因此可以通过使用电流帮助切割和电烧灼组织。电线在每次使用后取出,且更换新的电线,使端部执行器4能够夹紧另一个组织结构。每次替换电线能够使切割器最大程度发挥切割和烧灼功能。

[0061] 如图16所 示为端部执行器4的一初始结构的横截面图。刀90的刀口 108在初始状态下可以完全置于缝钉盒30中,这样可以确保刀刃110在端部执行器4进入手术位置时不切割到组织。另外,刀口 108在初始状态下可以置于供给带引导器40远末端42内。或者,刀口 108可以置于不同位置。在初始状态下,缝钉18位于缝钉盒30中等待部署,每一个缝钉都位于顶板66的对应隙缝67下。模块84位于初始位置,对应刀口 108和楔部件72的初始位置。有利的是,在初始状态下,楔部件72和刀90都位于其最远的位置。但是,至少一个楔部件72和/或刀90在初始状态下的位置可以是不同的。

[0062] 如图17所示,夹持器112可位于端部执行器4和杆轴6之间。或者,夹持器112可提供端部执行器4和杆轴6之间的连接,比如可通过摩擦力或干涉配合而使端部执行器4和杆轴6连接或者以其它方式使夹持器112与端部执行器4和杆轴6连接。或者,可以将夹持器112完全置于端部执行器4中。夹持器112可以是任何合适的形状。夹持器112包括自第一部分118远末端突出的延伸部分114,其中,延伸部分114远末端包括一个斜部116。斜部116沿近处方向可以带有一个向上的角度。斜部116可以基本为直线。或者,斜部116带有不同的方向,可以是弯曲的或是某种形状。第一部分118可以制作成适合被外壳60的近末端接收的形状和大小。而且,至少第一部分118的局部可以延伸至外壳60的至少一个接收空间70的近末端。第一部分118可以通过压力或者干涉配合,粘合,焊接或其它任何合适的途径和方法固定在外壳60上。或者,夹持器112可以不固定在外壳60上或者不与外壳60连接。或者,可以去除夹持器112。或者,至少供给带引导器40局部也和夹持器112连接。例如,供给带引导器40的插入43可以完全贯穿外壳60的接收空间70,并和夹持器112接触。如果这样,供给带引导器40可以通过任何合适的形式与夹持器连接。

[0063] 如图17A所示,夹持器112底面带有一个壁凹120。该壁凹120的形状和大小可以使模块84在其间滑动。壁凹120带有一个贯穿的狭槽122,其中,狭槽122可以接收突出98,使突出98可以在狭槽122内滑动。壁凹120和/或狭槽122可以纵向引导模块84的运动,限制模块84在某位置远近移动,且能够限制模块84的横向移动。例如,壁凹120包括一远端壁124,其可在模块84向远处推进足够远时与模块84远末端接触,和一近端壁126,其可在模块84向内拉回足够近时与模块84近末端接触。或者,可以在夹持器112的不同部分设置或去除壁凹120。

[0064] 如图30所示,我们可以选择滑动夹具160,其中,每一组滑动夹具160都与对应的供给带16相联系。每一组滑动夹具160可包括一上夹具162和一下夹具164,其中,夹具162和164至少有一个相对于另一个是可以滑动的。下夹具164在大体纵向上带有一个狭槽166且处于一个基本向上的方向。上夹具162带有一个大体向下的舌状物168,其中,舌状物168的大小和构造设定成能够放置于下夹具164的狭槽166。舌状物168可以比上夹具162的剩余部分更加狭窄,或者也可以是任何合适的大小。延伸出舌状物168的上夹具162的较宽部分在其下表面形成一架突169。上夹具162的上表面可以和供给带16具有基本相同的宽度。

[0065] 如图31所示,上夹具162上的远末端最初可以向远处方向延伸而超出下夹具164的远末端。或者,下夹具164的远末端最初可以向远末端延伸而超出上夹具162的远末端。或者,每一个上夹具162,下夹具164的远末端最初向远末端延伸的长度基本相同。下夹具164的上表面可带有一个凸轮表面170。类似的,上夹具162的架突169的形状可以用于确定凸轮表面172。两个表面170和172相互衔接,使得在两个夹具162,164的初始位置时,上夹具162的高度比对应的供给带16上部高度低。这样供给带在推进的时候不会受到上夹具162的阻碍。如图32-33所示,凸轮表面170,172可制成某形状,这样当上夹具162向近处收回和/或下夹具164向远处推进时,上夹具162被往上推而与供给带16接触。这种接触可以在部署缝钉18的过程中为供给带16提供额外的支撑。内切割器-两排缝钉

[0066] 如图6所示,以上所述的内切割器2包括一个配置有两组或多组带有三排26缝钉18的端部执行器4。但是,端部执行器4可以通过例如改变一条或更多供给带16上的缝钉18排26的数量来配置两组或更多组带不同数量的排26缝钉18。该端部执行器4基本可以根据上述内容设置。例如,如图18-20所示,供给带16包括两排26缝钉18。沿着该供给带16的每边都可以设置一排26缝钉18。结果,这样的供给带16比中心部分延伸有第三排26缝钉18的供给带16狭窄。这样,端部执行器4可以通过减少缝钉18排26的数量来减小尺寸。例如,以上所述`的带有三排26缝钉18的端部执行器的大小可制作能够穿过带有直径为IOmm的通道的套针孔10。带有两排26缝钉18的端部执行器4的大小可制作成能够穿过带有直径为5mm的通道的套针孔10。如图18-20所示,缝钉18的形状和位置可以根据供给带16而定,大体如上述带有三排26缝钉18的供给带16所示。或者,缝钉18可以是相对供给带16任何合适的形状和/或位置。缝钉18和供给带16可以是如上所述的易断性连接。或者,缝钉18可以以任何合适的形式与供给带16连接。

[0067] 至少两个在不同排26的缝钉18是相互错开的。也就是说,沿着供给带16的某一个纵向位置上,一排26的缝钉18与供给带连接,另外一排26的缝钉18不和供给带16连接。这种缝钉18的错开能更好的对端部执行器4处理后的组织进行止血。或者,每一排26的缝钉18都相互对齐。也就是说沿着供给带16的某一个纵向位置上,一排26的缝钉18与供给带连接,则其它每排26的缝钉18都和供给带16连接。

[0068] 每排26的缝钉18可以基本均匀间隔。也就是说,任何两个纵向相邻的缝钉18的间距基本相同。或者,在所有排26中至少有两个纵向相邻的缝钉18的间隔与其它两个纵向相邻的缝钉18的间隔不同。这样的构造在缝钉线长度不能调节的情况下是有用的。为端部执行器4制作的缝钉18的缝钉数可以设定在某一确定的数值,且每排缝钉18都集合成一些组,每组的长度与设定的缝钉线长度基本相同。因此,排26中的每组缝钉18可以由空白区域在供给带16上与相邻的缝钉18组分离。其中,空白区的长度可以是任何合适的长度。

[0069] 如图21所示,使用带有两排26缝钉18供给带16的端部执行器4和使用如图16所示的带有三排26缝钉18供给带16的端部执行器4的构造相似。如图22所示,外壳60的构造和图11所示的外壳相似。外壳60的每个顶板66上都带有两排隙缝67,并与供给带16的两排26缝钉18对应。由于顶板66上有两排而不是三排隙缝67,顶板66及外壳60总体上比图16所示的外壳狭窄。或者,至少部分外壳60去除顶板66和/或内壁68。如图23和24所示,为了适应更加狭窄的端部执行器4的内部空间,模块84的构造可以任选的和图14所示的模块84不同。突出98可以在纵向上比图14所示的模块84的突出98更长。杆104的远末端或其它部分可以以任何形式与突出98连接。例如,杆104可以和突出98浇铸在一起。撑板130可自模块84上表面88向上延伸,其中,刀片接收槽96基本纵向设置于撑板130上。撑板130可大致为三角形,或者其它任何合适的形状。或者,撑板130可以与和杆104衔接的突出98相连接或成为其一部分。栓94可以横向延伸贯穿撑板130的刀片接收槽96,并和刀90近末端的弯钩92衔接。或者,可以去除模块84。

[0070] 模块84可以带有两个部分深入或完全贯穿的接收槽86,其基本如图14所示。如图23A所示为楔部件72的另一个实例。楔部件72如图14所示包括一个标突78和臂76。但是,图23A所示的楔部件72远末端带有两个或多个楔74,其中楔74横向相互分隔,且基本相互平行。这样,单个臂76可以控制多条楔74,减少端部执行器4的部件数量,使端部执行器4能够做得更加狭窄。楔74的形状可以如图14所示,或者可以是其它任何合适的形状。图23A所示的每个楔部件72的标突78都可以插入图23所示的模块84的对应的接收槽86内。或者,图23所示的模块84可以带有四个接收槽86,并且使用图14所示的楔部件72。或者,模块84可以设计成如上所述的如图14所示的结构。

[0071] 端部执行器4的两个实施例已经在上述内容中描述过。每个端部执行器都带有两排26缝钉18。但是,`端部执行器4也可以设计成带有一组,三组或更多组缝钉18排26。另夕卜,供给带16可以设计成在一组排26中包括任何数量的排26缝钉18。另外,刀90每边可以带有任何数量的供给带16。刀90 —边供给带16的数量可以和刀90另一边的数量相同或不同。使用的供给带16的数量与端部执行器4处理的组织类型相关。每一条供给带16上的排26缝钉18的数量可以不同或相同。每条供给带16上缝钉18排26的数量可以沿着供给带16的长度方向各不相同或者相同。在另一端部执行器4的实施例中,刀90被除去。该端部执行器4只是一个简单的缝合器而不能切割组织。如果这样,我们可以使用任何合适数量的供给带16。

[0072] 如图25-27所示为带有两排26缝钉18的供给带16的另一实施例。该供给带16带有多个在其上或穿过其中的孔132。孔132可以是圆形或其它任何合适的形状。孔的大小和/或形状可以基本相同和/或不同。孔132可以减少供给带16的阻滞性,使供给带16更加灵活,更容易顺着缝钉盒30的突出部50滑动。另外,内切割器2手柄8的栓或齿轮(未显示)可以和一个或更多孔132衔接,使供给带16运动。除孔132以外或用于替代孔132,供给带16侧面边缘可以带有一个或更多凹口 134。每一个凹口 134都与标突28相邻,或者一个或更多凹口 134的位置不同。凹口 134也有增加供给带16灵活性的作用,和/或增强手柄8的装置与供给带的衔接。

[0073] 至少一个缝钉18的形状是连续的弧形,如图26所清楚显示。缝钉18远末端可以通过如上所述的例如供给带16侧面突出的标突28和供给带16连接。缝钉18可以自标突28向下向近处延伸。之后,缝钉18继续向下弯曲,同时向远末端弯曲,形成一个隆起136。该隆起136可以向标突28的纵向位置延伸,超过标突28的远处纵向位置或者不及标突28的纵向位置。然后,缝钉18可以继续向下弯曲同时向近处弯曲。缝钉18继续向近轴方向弯曲,之后在转调点138开始向上弯曲。然后,缝钉18继续向上向近处弯曲直至到达最后的在近末端的自由端22。

[0074] 如图28所示,楔部件72的楔74的形状有助于图25_27所示缝钉的部署。楔74包括第一段140和第二段142,第一段的形状有助于缝钉18的部署,第二段的形状有助于将缝钉18从供给带16上剪下或分离。第一段140向上及远处延伸,该弯曲可以是任何有助于缝钉18形成的形状。通过楔74上两个不同的段140和142,我们可以分别控制缝钉18的形成和分离。操作

[0075] 如图2-3所 示,至少一个套针孔10被插入病人14组织12的切口。其中,套针孔10包括一切割装置(未显示),如尖状物,用于切开组织12,然后套针孔12被安装在组织上。切割装置在套针孔10放置在组织12上后可被移出套针孔10。或者,我们可以使用独立的装置先切开组织12,之后再将套针孔10置于切口处。拥有相同或不同截面形状和/或面积的多个套针孔10可以置于病人14上体内。组织12可以是病人14的胸壁,由此可以进入胸腔。但是,组织12也可以是病人14的腹壁或者其它合适的组织。或者,我们可以不使用一个或多个套针孔10,而通过其它途径到达手术位置,如以上所述方法。

[0076] 如图1,16和21所示,内切割器2的端部执行器4通过一个套针孔10进入病人14体内。内切割器2的杆轴6的至少局部随着端部执行器4进入病人14体内。或者,我们不使用一个或多个套针孔10,而在常规的开窗手术步骤中使用内部切割器2,或者直接通过组织12上的切口进入病人14体内。使用者将端部执行器4置于手术位置,例如,如图29所示,手术位置位于需要横切的血管148。需要澄清的是,本申请虽然描述了内切割器2横切血管148的手术,但是,内切割器的使用绝不仅限于横切血管。其可以用于身体任何位置上的任何其它合适的手术程序。例如,内切割器2可以用于横切胆管,切除病变的阑尾,或用于横切肠胃组织,和/或横切软组织或器官。

[0077] 如图16和21所示,在初始状态中,至少砧32的远末端是和缝钉盒30隔开的。这样可以使端部执行器4张开。端部执行器4在需要横切的血管148上推进直至血管148的整个直径长度都位于砧32和缝钉盒30之间。有利的是,血管148的角度基本垂直于砧32和缝钉盒30。但是,血管148相对于砧32和缝钉盒30的角度可以是任何合适的角度。我们通过将砧32向缝钉盒30移动来关闭端部执行器4,这样就可以将血管148夹紧在砧32和缝钉盒30间。闭合端部执行器4可以通过任何标准的或合适的方式完成。例如,可以使用软管在砧32和缝钉盒30的外表面上向远处推进,将砧32和缝钉盒30夹紧在一起。或者,砧32可以相对于端部执行器4的剩余部分和/或杆轴6是基本固定的,缝钉盒30可以向砧32移动,使端部执行器4闭合。或者,砧32和缝钉盒30为了闭合端部执行器相互都是可以移动的。端部执行器4的闭合可以通过开动内切割器2手柄8上的一个或更多个控制器和/或释放储存在手柄8内的能量完成。在端部执行器4闭合后,端部执行器4便稳定且牢固地控制了需要处理的组织。

[0078] 如图6和12所示为楔74的初始状态。其中每条楔74都远离对应排26中的缝钉18。另外,如图11所不,每排26中至少一个缝钉18最初是位于外壳60顶板66的对应隙缝67下。有利的是,一个缝钉18最初是位于外壳60顶板66的每一对应隙缝67下。如图14和17A所示,模块84最初位于或邻近壁凹120的远端壁124。或者,模块84最初位于或邻近壁凹120的近末端,或者位于相对壁凹120的不同位置。在使用如图23所示的模块84的缝钉盒30中,模块84可以是处于缝钉盒30和/或内切割器2的杆轴6内初始位置,其中,模块84位于或临近缝钉盒30和/或杆轴6内部壁凹或空间远末端。或者,模块84位于或临近缝钉盒30和/或杆轴6内部壁凹或空间近末端,或在缝钉盒30和/或杆轴6的不同位置。如图15,16和21所示,刀90位于相对于缝钉盒30的一初始位置,其中刀90的刀刃110可以完全容纳在缝钉盒30内。也可以是至少部分刀口 108容纳在缝钉盒30中,如图8所示,刀90的刀口 108和刀刃110可以位于供给带引导器40的远末端42内。

[0079] 使用者开动手柄8上的一个或更多控制器来开动端部执行器4。最终,杆104通过任何合适的机制或方法向近处移动。例如,杆104近末端延伸至手柄8,手柄8内的装置将杆104向近处移动,该装置可以通过释放手柄8内储存的能量开动。直线移动杆104的装置是标准使用的方法,但任何合适的装置都可以使用。向近处移动的杆104通过杆104和模块84上的突出98间的连接使模块84向近处移动。模块84向近处的运动继而使模块84连接的楔部件72和刀90向近处运动。或者,杆104也可以通过旋转而不是通过向近处拉回,或者通过即旋转又向近处拉回而促使模块84向近处运动。

[0080] 如果使用滑动的夹具160,且夹具还没有滑动到第二位置,其中上夹具162和供给带16接触,则滑动夹具160被移动到第二位置。这种移动包括将上夹具162向近处滑动和/或将下夹具164向远处滑动。在滑动过程中,上夹具162的舌状物168沿着下夹具164的狭槽166滑动。随着上夹具162和/或下夹具164的滑动,凸轮表面170,172相互衔接使上夹具162的上表面向上移动,并和供给带16相接处。这种接触能在楔74和缝钉18接触过程中进一步稳定供给带`16。

[0081] 楔部件72向近处的运动引发每一条楔74向近处的运动,继而使缝钉18部署出去。需要澄清的是,我们描述了单条楔74部署对应排26中一个或更多个缝钉18,楔74最初远离对应的基本成直线的排26中的缝钉18,楔74运动轨迹与对应排26基本平行或共线,随着楔74向近处运动,楔74的第一表面79与对应排中最远的缝钉18相接触。如图5所示,第一表面79和缝钉18间的接触使缝钉18受力。因为第一表面79带有一个向上指向远处的角度,使缝钉受到向近处和向上的力。另外,缝钉18受到的力产生一关于使缝钉18与供给带16相连的标突28的力矩,该力矩使缝钉18在标突28周围旋转,从而使缝钉18自由端22向上运动,穿过外壳60的顶板66上对应的隙缝67进入血管148。或者,如果没有使用标突28,缝钉18受到的力在缝钉18和供给带16连接位置产生一个力矩。在楔74运动过程中,供给带16可以是基本保持原位,或者是通过例如和对应突出部50的摩擦而被动地保持原位,或者是通过例如位于手柄8,杆轴6和/或端部执行器中的制动器或夹紧装置(未显示)而主动地保持原位。

[0082] 楔74继续向近处运动,继续对缝钉18施力,从而在标突28上产生力矩。随着缝钉18的自由端22向上旋转,其完全穿透血管148,之后与砧32的下表面接触。任选地,砧32在与缝钉18自由端22接触的位置可带有一个标准的使缝钉弯曲的结构(未显示)。随着缝钉18的自由端22与砧32接触,缝钉18在标突28周围的旋转导致自由端22向上及远处运动。但是,缝钉18自由端22和砧32的接触阻碍缝钉18自由端22继续向上运动。因此,缝钉18的自由端22沿着砧32下表面和/或使缝钉弯曲的结构向远处运动。该运动使缝钉18与自由端22连接的脚20弯曲或变形,闭合缝钉18。缝钉18可以由塑性变形材料如不锈钢制成,这样缝钉18的变形可以是塑料变形。或者,至少缝钉18的局部可弹性变形或超弹性变形。

[0083] 随着楔74继续向近处移动,楔74的顶端82靠近缝钉18,该缝钉18可能已经顶着砧32完全或基本变形了。或者,缝钉18变形的过程持续到了楔74的顶端82与缝钉18的连接点。当顶端82接触或靠近缝钉18时,施加在缝钉18上的力的方向主要是向上的。另外,这个力作用于连接缝钉18和供给带16的标突28上或其附近,这个力将缝钉18从供给带16上剪下,断开或分离开来。标突28的构造使楔74顶端82或楔74靠近顶端82的部分施加的力足以将缝钉18从供给带16上剪下,断开或分离开来。当缝钉18和/或标突28在其相交点或相交点附近带有一个削弱区域时,缝钉可以在这个削弱区域上从供给带16剪下,或与其断开或分离开来。顶端82也可以主动地将缝钉18完全推出,驱出或排出外壳60。或者,缝钉18可以是被动地从外壳60排出,这也就是说缝钉18不是被主动驱出外壳60,而是从外壳60内简单的释放出来的,且能够脱离开来。在这时,变形的、被排出的缝钉18位于血管148上。缝钉18的易断性能够使其稳固地可靠地固定在供给带16上,继而被固定在缝钉盒30内,同时也能够可靠地分离和部署。第二表面80基本上不接触缝钉18或标突28。或者,第二表面80的形状或构造能够有助于缝钉18的变形和/或排出。

[0084] 另外,楔74的构造可以如图28所示。如上所述,楔74的第一段140的形状可被制成有助于缝钉18的部署,楔74的第二段142的形状可被制成有助于剪下或分离供给带16上的缝钉18。基本如上所述,当楔74相对于缝钉18移动且接触缝钉18时,楔74的第一段140碰到缝钉18,并对其施加一向近处向上的力。第一段140可被制成一形状,其可以使缝钉18在楔74第一段140`移动离开其接触点之前基本完成成形。第二段142具有便于使缝钉18与供给带16分离的形状。随着楔74继续向近处移动,第一表面140与基本形成的缝钉180分离,第二表面142移动且接触基本形成的缝钉18。当缝钉18的形状如图25-27所示时,在缝钉18基本形成后,缝钉18的隆起136的朝向总体向下且位于第二表面142的运动轨迹上。因此,随着第二表面向近处滑动,隆起部136受到一个向上的力,这个力将形成的缝钉18从供给带16上剪下,断开或分离开来。

[0085] 当缝钉18与供给带16分离后,楔74可以继续向近处移动。随着它向近处移动,它碰到另一个缝钉18,且使该缝钉18变形,将该缝钉18和供给带16分离开来,其方式与上述方法基本相同。楔74的长度可以足够长,其可以在楔74使一个缝钉18变形到一定程度但还没有使它从供给带16上分离出来时,楔74已经和下一个最远的缝钉18衔接且开始使之变形。或者,楔74的长度可以足够短,使它在和下一个最远的缝钉18衔接且开始使之变形前,完全使一个缝钉18变形和分离。

[0086] 可以控制模块84在纵向上沿着一定距离移动每一楔部件72和对应的楔74,从而使每一楔74在驱动过程中部署一定数量的缝钉18。结果是,如图29所示,血管148或其它组织上每一条缝钉线146的长度都是固定的。“缝钉线”是指排26中缝钉18在其部署在组织上后的集合。模块84可在控制下以任何合适的方式沿着固定的长度移动。例如,杆104在内切割器2的每一次驱动过程中都可以向近处移动固定的长度。排26中固定数量的缝钉18可以集合在一起且由供给带16上的空白区域与邻近的缝钉18组隔开,其中空白区域的长度可以是任何合适的长度。空白区域使楔74的纵向长度可以足够长,从而使楔74在对上一个缝钉18仍然进行变形和/或排出时就能够衔接下一个缝钉18且开始使其变形。因此,当楔74向内侧移动至碰到空白区域时,没有缝钉18被楔74变形,从而使该组中每一个缝钉18都能完成变形且不会使接下来的缝钉被部分变形。但是,楔的长度也可以很短,使它与楔74衔接且开始变形下一个最远处的缝钉18前,完全变形且分离一个缝钉18。

[0087] 或者,模块84可以选择性的控制楔部件72和对应的楔,使其在纵向上沿着一定距离移动,从而使一定数量的缝钉18在驱动期间被楔部署。这样就可以改变和选择血管148或其它组织上缝钉线146的长度。模块84可以以任何合适的方式进行选择性地控制。例如,在内切割器2驱动期间,使用者可以将杆104向近处移动一选择的距离。杆104在手柄8驱动下沿着选择的距离移动,手柄8也可以设置成能够接收使用者对选择距离的输入。手柄8可以带有任何能够 控制杆104纵向移动距离的合适的结构。例如,手柄8可以包括一个与杆104连接的分档马达,该马达使杆104能从一组不同长度中选择某一长度。再例如,手柄8包括一个机械制动器,使用者可以移动该制动器,当杆104碰到机械制动器时停止向近处运动。也就是说,杆104可以至少在可选择的最长的缝钉线146上带有弹簧或者有偏向性,机械制动器用于使杆104的运动停止在一小于最长的可以选择的缝钉线146的距离之内。因为楔74运动的距离在每一次驱动中都可能是不同的,并且使用者是可以选择的,有利的是,供给带16都没有空白区域。另外,有利的是,楔的长度可以很短,足以使它在衔接并开始变形下一个最远处的缝钉18前,完全变形并分离一个缝钉18。

[0088] 如图11-12和14-17所示,随着模块84向近处移动,它也移动了与模块84通过弯勾92或刀90近末端其它结构连接的刀90。随着刀90向近处移动,位于砧32和缝钉盒30间的组织被切割。在刀90切割组织的同时,缝钉18也被变形并排出。随着刀90从初始位置向近处移动,刀90的刀口 108底部衔接并撑起夹持器112远末端的斜部116。随着刀口108撑起斜部116,至少刀口 108的刀刃110的局部移动至外壳顶板66之上,并开始切割砧32和缝钉盒30间的组织。当刀口 108到斜部116顶部后,其随着模块84继续向远处推动刀90而继续沿着延伸部114的上表面向远处移动。至少刀口 108的局部可以随着刀90向外拉出而在外壳内壁68间滑动。或者,刀口 108可以完全位于外壳内壁68的上面,或者以其它方式移动。或者,可以去除斜部116和延伸部114。刀口 108的刀刃110可以通过其它方式控制上升至外壳60的顶板66以上。或者,可以控制刀口 108基本只在纵向上移动,而在垂直方向上基本不运动。

[0089] 在一定数量或选择数量的缝钉18被变形和排除后,模块84停止运动。当模块84停止运动后,模块84,楔74和刀口 108均处于最后位置。刀口 108的尺寸和形状能够使刀口 108在其处于最后位置时完全切割砧32和缝钉盒30间的组织。在最后位置时,至少一条楔74和/或刀口 108接近外壳中对应的接收空间70。或者,楔74和/或刀口 108仍留在外壳60对应接受空间70中的最后位置。在一定数量或选择数量的缝钉18被变形和排除后,刀口 108的刀刃110已经横切砧32和缝钉盒30间的组织,端部执行器4回复到打开位置,释放组织。如图29所示,当所述组织为血管时,血管148被切割成两段,其中每段末端附近均带有错开的缝钉18排,形成缝钉线。每条楔74驱动对应排26中的缝钉18,如所述的缝钉18和外壳60顶板66的隙缝67错开排布。错开缝钉线146中缝钉18排26有助于血管148末端止血,因为如果缝钉18排26不错开则漏道将更长,更弯曲。

[0090] 在内切割器2驱动的另一个例子中,楔74最初靠近对应排26中的缝钉18,且楔74向远处移动而不是向近处移动以部署排26的一个或更多缝钉18。楔74向远处的运动可以通过例如将杆104向远处方向移动实现。当楔74向远处移动且部署缝钉18时,楔74的第一表面79和第二表面80为了能适当部署缝钉可以具有不同形状。另外,缝钉18相对于供给带16带有向后的方向,从而使每一个缝钉18的自由端22远离缝钉18和供给带16连接部位。为了变形缝钉18,且使其从供给带16上分离,缝钉盒30的其它操作的顺序与以上所述的顺序也大致相反。

[0091] 然后,内切割器2可以再次部署缝钉而不需将端部执行器4从病人体内取出,更换钉仓或者其它一次性缝钉盒或者从内切割器2外部填充端部执行器4。为此,手柄8在端部执行器4回到打开位置后可以驱动回复模块84至初始位置。或者,模块84在端部执行器4回到打开位置后,或在其它时间回到初始位置。杆104可以向近处方向移动使模块84回到其初始位置。或者,模块84可以以任何其它方式回到其初始位置。再例如,模块84可以偏向远处,从而可以释放杆104,使模块84自动回到初始位置。例如,模块84可以偏向近处,从而使杆104不会向近处移动,部署,排出缝钉18。如果这样,杆104可以用于将模块84向远处推回至初始位置,并保持在初始位置。或者,模块84可以通过任何合适的方式回到其初始位置。随着模块84移回至初始位置,楔74和刀口 108移回至初始位置,逆转楔74和刀口 108在端部执行器4驱动过程中的移动轨迹。或者,楔74和/或刀口 108可以通过其它途径移动和/或沿着不同的轨迹回到初始位置。因为在楔74轨迹中的缝钉18已经部署出外壳60,楔74可以回到它们初始位置而基本不接触缝钉。另外,因为端部执行器4已经放开组织,刀口 108回到初始位置而基本不接触组织。

[0092] 到这时,楔74和刀口 108在其初始位置。之后,如果供给带16在之前驱动端部执行器4过程中的运动受到滑动夹具160的阻碍,那些滑动夹具回到第一位置,从而使上夹具162不再阻碍供给带16。这种运动可包括上夹具162向远处滑动和/或下夹具164向近处滑动。在滑动中,上夹具162的舌状部168沿着下夹具164的狭槽166滑动。随着上夹具162和/或下夹具164的滑动,凸轮表面170,172相互衔接使上夹具162的上表面向下移动,而不接触供给带16,使供给带16向前运动。如果手柄8、杆轴6或端部执行器4带有不同或附加的限制装置,如刹车或离合器,则释放该装置。之后移动供给带16,将新的缝钉18推进至外壳60。供给带16的这种运动统称为推进供给带16,尽管事实上一些或全部供给带16在推进过程中可以向远处之外的方向推进。供给带16可以以任何方式推进。例如,如上所述,供给带16围着每一个突出部50,沿着带有直线起点且具有远处方向的路线,之后沿着对应突出部50的表面弯曲,之后沿着基本直线具有近处方向的路线,使对应供给带16的运动方向总体上是从远处至近处。供给带16在突起部50下面或其附近的部分可以向近处缩回,从而将位于突出部50上面或附近的供给带16部分向远处拉动,将新的缝钉18推入外壳60。供给带16位于突出部50下面和附近部分可以以任何合适的形式向近处拉回。例如,供给带16可·以部分延伸至手柄8,其中的传动装置,滚柱或其它装置对供给带16直接施力。再例如,供给带16可以连接于延伸至手柄8的中间结构或装置,并且使施力于其上。如图25所示的另一实施例,供给带16的一个或更多个开口 132与一个或更多个齿轮,栓或其它装置衔接,从而使与开口 132的衔接可以用于推进供给带16。再例如,可以使用任何合适的装置,结构或方法来移动供给带16,从而将新的、未部署的缝钉18推入外壳60。当供给带16可以基本直线运动,且未使用突出部50时,外壳60可以更长,且供给带16是简单的直线推进和缩回,从而将新的缝钉18推入外壳60内。

[0093] 供给带16可以在有或没有反馈信息的情况下推进。例如,使用分档马达或其它装置每次使供给带16推进一固定距离。当带有反馈信息时,供给带16根据反馈信息确定推进距离,该距离可以每次都不相同。例如,可以设置针轮(未显示)以使用栓衔接供给带16的开口 132,从而使供给带16的运动能够转动针轮。针轮的这种转动可以产生机械或电子反馈信息,该信息通过机械或电子方式传送到手柄8,从而能继续推进供给带16直至针轮旋转至一定量。用这种方法,针轮可以确认供给带16实际推进的位置,在这个位置上有未部署的缝钉18位于外壳60顶板66对应的隙缝67中。反馈的另一实施例是端部执行器4末端可以安置一个或多个光感器(未显示),该一个或多个光感器可以决定供给带16推进的程度。又例如,可以使用任何合适的装置产生反馈信息并通过机械,电子和/或数据的形式传送到合适的控制器,控制器可以设置在内切割器的手柄8中或其它部位。控制器可以是凸轮,集成电路,微处理器,模拟电路,数字电路,机械电脑或其它任何合适的控制器。

[0094] 楔74和刀口 108处于初始位置,未部署的缝钉18位于外壳60顶板66上对应的隙缝67位置。供给带16可以基本保持原位,或者被动地通过与对应突出部50的摩擦力保持,或者主动地通过手柄8、杆轴6和/或端部执行器4内制动器或离合器(未显示)的作用而保持。此时,端部执行器4被设置使其再次驱动,且处于基本如上所述的初始设置状态。这样,端部执行器4可以驱动多次而不需要通过能够进入病人体内的套针孔10或其它切口、结构或装置将端部执行器4取出。保留端部执行器4在病人体内而不通过能够进入病人体内的套针孔10或其它切口、结构或装置将端部执行器4取出可以理解为将端部执行器保留在病人体内。内切割器2可以在病人体内驱动多次而不需要从病人体内取出,直至用完内切割器2内的缝钉18。·内切割器2的手柄8或其它位置上可以设置指示器,用于显示内切割器2中剩下的未部署的缝钉18数量。

[0095] 为了清除起见,以上通过单排26的缝钉18的部署和排出而大致描述了内切割器2的驱动过程,其中,部署和排出可以通过基本相同的方式应用于每排26缝钉18。以上描述的内切割器2的操作过程可基本适用于任何数量排26缝钉18在供给带16上的操作。也就是说,供给带16上带有两排26或超过三排26缝钉18的内切割器2可以基本通过上述方法驱动。无人操作内切割器和其操作

[0096] 如图12,13和28所示,楔74相对于缝钉盒30可以是固定的。例如,楔74可以通过简单的浇铸、切割、形成或制作成为供给带引导器40的一部分或者是端部执行器4的其它部件。随着每一供给带16的推进,每排26最远处的未形成的缝钉18与固定的楔74接触。之后,供给带16并不停止而是继续运动。随着供给带16继续推进,供给带16和固定的楔74间的相对运动导致缝钉18变形,然后从供给带16分离,该过程与上述楔相对于基本固定的供给带16的运动为基本相同的方式。当楔74是固定时,端部执行器4并不沿着缝钉线纵向设置一排缝钉18,而是,端部执行器4随着供给带16推动缝钉18至对应的楔74时有次序的部署每一排26最远处的缝钉18。[0097] 或者,对于一次性设备,与缝钉18具有相同数量的楔74被制作成端部执行器4的一部分,且均位于对应缝钉18的最近处或最远处。随着供给带16向纵向移动,每一个缝钉18均接触对应的固定楔74,变形为闭合结构,之后从供给带16上分离下来。这样可以沿着缝钉线同时部署两个或更多个缝钉18,而不需要楔部件72。任选地,楔74在部署一缝钉18后可以自第一位置向下或其它方向运动,从而使供给带16可以被推进以将新的、未部署的缝钉18送到位,用于部署,之后楔74可以移动回其第一位置。

[0098] 虽然我们已经对本发明作了详细叙述,但是本领域内普通技术人员可以对本发明做不同的修改和修饰或使用替代品,其仍属于本发明范围内。本发明并不局限于以上有关结构、部件间关系和/或方法的详细描述或图片说明。本申请摘要中的陈述和任何简要陈述仅仅是作为举例说明,他们不能被视为是对权利要求范围的限制。另外,图片也只是作为例子并不是用于限定的。标题和小标题仅是为了阅读方便而已,其不应视为带有实际重要内容、意义或解释,也不应被视为有关任何特定标题的全部信息都包含在该标题之下。因此,本发明除了以下权利要求 及其法定等同物以外不受任何内容的限制。

Claims (19)

1.一种外科手术用内切割器,包含: 一缝钉盒; 至少一可推进和拉回的供给带,该供给带带有两个侧边缘,所述供给带至少局部延伸至所述缝钉盒;和 多个缝钉,其中每一所述缝钉包含与对应的所述供给带易断性连接的第一端,其中每一所述第一端在相对于供给带纵向中心线的基本相同的侧面位置被附着于所述供给带,和第二自由端,并且其中,所述缝钉形成至少一排,每排包含至少两个缝钉,其中至少一个所述缝钉被附着于所述供给带并位于与所述供给带垂直的平面上,或所述至少一个缝钉是位于与所述供给带成不同角度的平面上。
2.如权利要求1所述的外科手术用内切割器,其中每一所述缝钉的方向基本垂直对应于所述供给带。
3.如权利要求1所述的外科手术用内切割器,其中在至少一所述排中的多个所述缝钉集合成多个组,且其中对应的所述供给带包含相邻的所述组间的空白区。
4.如权利要求1所述的外科手术用内切割器,其中至少一排缝钉与对应的所述供给带的对应的所述侧边缘易断性连接。
5.如权利要求1所述的外科手术用内切割器,其中至少一排缝钉沿着位于所述供给带的所述侧边缘之间的线与对应的所述供给带易断性连接。
6.如权利要求1所述的外科手术用内切割器,其中至少一所述排的所述缝钉与至少另一所述排的所述缝钉错开排列。
7.一种外科手术用内切割器,包含:` 一缝钉盒; 至少一可推进和拉回的供给带,其中该至少一供给带的至少局部延伸至所述缝钉盒; 多个缝钉,该缝钉与每一所述供给带易断性连接,所述缝钉在每一所述供给带上组成至少一条大体为直线的排; 多条楔,其中每一条楔能沿着对应的所述缝钉排从初始位置基本直线移动到第二位置,从而使所述缝钉变形且与对应的所述供给带分离。
8.如权利要求7所述的外科手术用内切割器,其中所述楔沿着固定距离移动。
9.如权利要求7所述的外科手术用内切割器,其中所述楔沿着可选择距离移动。
10.如权利要求7所述的外科手术用内切割器,其中所述缝钉盒包含一弯曲的突出部,其中每一所述供给带均设置成围着对应的所述突出部推进;且其中每一楔可在所述供给带推进前回移至所述初始位置。
11.如权利要求7所述的外科手术用内切割器,进一步包含至少一个对应于至少一个所述供给带的滑动夹具,其中所述滑动夹具滑动至接触所述供给带。
12.如权利要求11所述的外科手术用内切割器,其中至少一个滑动夹具包含一个上夹具和相互接触的下夹具,每一夹具都包含一凸轮表面,其中至少一个所述上夹具和所述下夹具相对于另一个滑动,从而使所述凸轮表面间相衔接,引起所述上夹具移动至接触所述供给带。
13.—种外科手术用内切割器,包含: 一带有内部空间的缝钉盒;与所述缝钉盒连接的杆轴,所述杆轴包含一个贯通的腔; 与所述杆轴相连的手柄; 与多个缝钉易断性连接的至少一个可推进和拉回的供给带,其中至少一个所述供给带的至少局部位于所述缝钉盒空间内和所述杆轴的腔内,使得所述缝钉位于所述缝钉盒和所述杆轴内。
14.如权利要求13所述的外科手术用内切割器,其中所述缝钉盒设置为部署少于全部的所述缝钉,且其中所述缝钉的剩余部分之后被推入所述缝钉盒的所述空间内。
15.如权利要求13所述的外科手术用内切割器,其中所述供给带延伸至所述手柄。
16.如权利要求15所述的外科手术用内切割器,其中所述供给带是一个连续的环状物。
17.如权利要求13所述 的外科手术用内切割器,其中所述缝钉盒与所述杆轴是不可分离的。
18.—种外科手术用内切割器,包含: 至少一可推进和拉回的供给带; 与所述供给带易断性连接的多个缝钉;和 相对于所述缝钉移动的至少一个楔,其中所述楔在一单一连续的运动中和多个所述缝钉连接又将多个所述缝钉从所述供给带上分离出来。
19.如权利要求18所述的外科手术用内切割器,且其中至少一个所述楔连续衔接所述缝钉并将所述缝钉从所述供给带上连续分离出来。
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