CN102166129A - 关节式运动内窥镜外科施夹器 - Google Patents
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Abstract
本发明提供了一种用于将外科夹子施加到身体组织的关节式运动内窥镜外科施夹器,其包括手柄组件和轴组件。所述手柄组件包括传动组件;以及可操作地连接到所述传动组件上的扳机。所述轴组件从所述手柄组件延伸出并包括:关节式运动颈部组件;以及末端执行器组件,其支撑在所述关节式运动颈部组件的远侧端上并被配置为使外科夹子在所述身体组织的适当位置上成型。
Description
相关申请的交叉引用
本申请要求于2010年2月25日提交的、序列号为61/308,093的美国临时申请的权益和优先权,将所述申请的全部内容通过引用合并于此。
技术领域
本公开涉及外科施夹器,而且更加特别地涉及新颖的关节式运动内窥镜外科施夹器。
背景技术
内窥镜吻合器和施夹器在本领域中是公知的并且用于多个不同且有用的手术操作。在腹腔镜手术操作的情况中,通过插入皮肤中的小进入切口的小直径管或插管来实现进入腹部的内部。而在身体上的其它部位执行的微创操作通常一般被称作内窥镜操作。典型地,管子或者插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操作。
在大多数的这些操作中,外科医生必须经常终止血液或其它液体流过一个或多个脉管。在操作期间,外科医生经常会将外科夹子施加到血管或其它导管上,以防止体液流过这些血管或导管。本领域中公知的是内窥镜施夹器用于在进入体腔时施加单个夹子。典型地,这样的单个夹子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,该压布的夹子就终止液体流过脉管。
在共同转让给格林(Green)等人的第5,084,057和5,100,420号美国专利中描述了在单次进入体腔的过程中能够在内窥镜或腹腔镜操作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。在共同转让给布拉德(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操作中,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复消毒的外科施夹器,该专利所公开的内容通过引用合并于此。在单次进入体腔的过程中该施夹器推进多个夹子并使多个夹子成型。所述可重复消毒的施夹器被配置成容纳可更换的弹夹(clip magazine)并与可更换的弹夹合作,以便在单次进入体腔的过程中推进多个夹子并且使多个夹子成型。一个重要的设计目标是,将外科夹子装载在钳夹之间,而装载操作不会对夹子造成任何压缩。装载过程中夹子的这些弯曲或扭转经常会有许多没有想到的后果。装载过程中的这种压缩可能会略微地改变夹子在钳夹之间的对准。这会导致外科医生把夹子从钳夹之间移除而丢弃夹子。另外,这种预载压缩可能会轻微地压缩夹子的某些部分而改变夹子的几何形状。这将导致外科医生将被压缩的夹子从钳夹之间移除而丢弃夹子。
经常在远离切口的地方执行内窥镜或者腹腔镜操作。因此,对于位于装置的近端的用户而言,视野或者触觉反馈的减小可能使夹子的施加复杂化。因此理想的是通过提供能够关节式运动的器械来改进器械的操作。
发明内容
本公开涉及新颖的关节式运动内窥镜外科施夹器。
根据本公开的一个方案,提供了一种用于将外科夹子施加到身体组织的装置,所述装置包括手柄组件,所述手柄组件包括:传动组件;以及扳机,其可操作地连接到所述传动组件上。所述装置进一步包括轴组件,其从所述手柄组件延伸出来。所述轴组件包括:关节式运动颈部组件;以及末端执行器组件,其被支撑在所述关节式运动颈部组件的远侧端上并被配置为使外科夹子在所述身体组织的适当位置上成型。
所述末端执行器组件可以包括:设置在其中的至少一个夹子;钳夹,其配置为接收所述至少一个夹子并使所述至少一个夹子成型;推杆,其配置为将所述至少一个夹子装载到所述钳夹中;以及传动杆,其配置为选择性地接合所述推杆以实现所述钳夹的闭合。
所述装置可以进一步包括可操作地连接到所述扳机和所述末端执行器的可旋转传动构件,其中所述扳机的致动导致所述传动构件的旋转,并且所述传动构件的旋转导致所述至少一个夹子装载到所述钳夹中以及导致所述钳夹的闭合。
所述手柄组件包括外壳和轴向地可滑动地支撑在所述外壳中的传动块,其中所述传动块连接到所述扳机并且限定了穿过其中的螺旋状管腔,并且其中所述可旋转传动构件包括能够与所述传动块的螺旋状管腔螺纹接合的手柄传动螺杆。在使用中,所述传动块相对于所述手柄组件的所述手柄传动螺杆的轴向平移可以导致所述手柄传动螺杆的旋转。
所述末端执行器组件包括传动滑轨,所述传动滑轨能够在所述末端执行器组件内可滑动地轴向平移并且限定穿过其中的螺旋状管腔,并且其中所述可旋转传动构件包括能够与所述传动滑轨的螺旋状管腔螺纹接合的末端执行器传动螺杆。在使用中,所述手柄传动螺杆的旋转导致了所述末端执行器传动螺杆的旋转以及所述传动滑轨的轴向平移。
所述传动滑轨可以与所述推杆选择性地接合,以使所述传动滑轨的远侧推进导致了所述推杆的特定距离的远侧推进,然后在所述特定距离之后所述传动滑轨与所述推杆分开。
在所述钳夹的接近过程中所述推杆可以保持在远侧推进后的位置中。
所述末端执行器组件可包括可滑动地设置在其中的推动板,其中所述推动板可以可拆卸地连接到所述推杆上。在使用中,在所述推杆的远侧推进过程中,所述推杆可以与所述推动板相接合以使所述推动板向远侧移动。
所述推动板可以包括从其延伸出的翼片(tab),用于当向远侧推进所述推杆时通过所述推杆选择性地接合翼片。
所述末端执行器组件可以进一步包括夹子输出器,所述夹子输出器可滑动地支撑在所述末端执行器组件内用于在远侧方向上推进设置在所述末端执行器组件内的外科夹子。所述夹子输出器可以包括从其第一表面突出的上突起和从其第二表面突出的下突起,其中当向远侧移动所述推动板时所述夹子输出器的所述上突起与所述推动板接合以使所述夹子输出器向远侧移动以推进所述外科夹子,并且其中当所述推动板向近侧移动时所述夹子输出器的所述下突起与结构件(feature)相接合以使所述夹子输出器保持静止。
所述末端执行器组件可以进一步包括设置在其内的夹子承载器(clip carrier),其中所述夹子承载器可以配置为保持所述外科夹子和所述夹子输出器,其中所述夹子输出器的所述下突起可以与形成在所述夹子承载器中的结构件相接合。
所述夹子输出器可以被递增地推进穿过所述夹子承载器。
在通过所述推杆将夹子装载到所述钳夹中之后所述传动杆可以通过所述传动滑轨选择性地接合,并且其中所述传动滑轨的远侧推进向远侧推进所述传动杆以实现所述钳夹的闭合。
所述轴组件能够绕纵轴相对于所述手柄组件旋转。
所述颈部组件可以包括多个内连接的关节式运动接头。
所述手柄组件可以支撑关节式运动转盘(dial),其中所述关节式运动转盘可操作地连接到所述颈部组件上以使所述关节式运动转盘的致动导致所述颈部组件的关节式运动。
所述手柄组件可以包括:关节式运动螺杆,其可旋转地支撑在所述手柄组件内并连接到所述关节式运动转盘,所述关节式运动螺杆限定形成在其表面中的一对相反定向的沟槽;以及一对关节式运动致动器,它们可平移且可滑动地支撑在所述手柄组件中,其中每个关节式运动致动器与所述关节式运动螺杆的相应的螺旋状沟槽相接合,其中每个关节式运动线缆的近侧端紧固到相应的所述关节式运动致动器上。在使用中,所述关节式运动转盘的旋转导致了所述关节式运动螺杆的旋转和所述关节式运动致动器的相反平移。
所述手柄组件进一步包括与所述关节式运动转盘可操作地接合的棘齿。
根据本申请的用于施加外科夹子的装置具有提供能够使外科夹子成型并被支撑在颈部组件的远侧端上的末端执行器组件的优势。颈部组件允许末端执行器组件相对于由支撑颈部组件和末端执行器组件的轴组件限定的纵轴进行离轴的关节式运动。以这种方式,在将末端执行器组件插入目标外科手术部位之后,装置允许外科医生使得末端执行器组件进行关节式运动,同时为了在外科手术部位中如需要和/或理想地施加外科夹子,不需要从身体中的一个经过皮肤的开口取出装置的末端执行器组件并通过身体中的另一个经过皮肤的开口插入装置的末端执行器组件。以这种方式,减少了对于患者的创伤并使该创伤最小化,提高了外科手术操作的效率,并且减少了外科手术操作的持续时间。
此外,将外科夹子和用于使外科夹子装载和成型的末端执行器组件的构件设置在颈部组件的远侧上。以这种方式,将数量相对减少的末端执行器的构件设置在颈部组件内或者近侧上并且因此不需要延伸进入和/或穿过颈部组件。
附图说明
由于从下述结合下列附图考虑时的详细描述中本发明的施夹器变得更好理解,因此将能够更完全地认识本施夹器。在附图中:
图1是示出处于关节式运动状态的、根据本公开的实施例的外科施夹器的主视立体图;
图2是示出处于关节式运动状态的、图1的施夹器的后视立体图;
图3是从其上除去了半个外壳的、图1和图2的外科施夹器的手柄组件的后视左侧立体图;
图4是从其上除去了半个外壳的、图1和图2的外科施夹器的手柄组件的主视右侧立体图;
图5是部件分离的图1至图4的外科施夹器的手柄组件的立体图;
图6是图5所指示细节区域的放大立体图;
图7是图5所指示细节区域的放大立体图;
图8是图1至图4的外科施夹器的关节式运动转盘的主视立体图;
图9是部件分离的图1至图4的外科施夹器的关节式运动颈部组件的立体图;
图10是从其上去除了外壳的图1至图4的外科施夹器的手柄组件的主视立体图,示出了处于未经致动状态的关节式运动组件;
图11是示出处于未经致动状态的图9的颈部组件的纵向剖视图;
图12是从其上去除了外壳的图1至图4的外科施夹器的手柄组件的主视立体图,示出了处于致动后的状态的关节式运动组件;
图13是示出处于致动后的状态的图9的颈部组件的纵向剖视图;
图14是图1至图4的外科施夹器的主视立体图,图示出外科施夹器的轴组件的旋转;
图15是从图14的15-15截取的剖视图;
图16是部件分离的图1至图4的施夹器的施夹器用末端执行器组件的立体图;
图17是从其上除去了外管的图16的施夹器用末端执行器组件的立体图;
图18是从其上除去了外管和推杆的图16的施夹器用末端执行器组件的立体图;
图19是从其上除去了外管、推杆和上半壳体的图16的施夹器用末端执行器组件的立体图;
图20是从其上除去了外管、推杆、上半壳体和推动板的图16的施夹器用末端执行器组件的立体图;
图21是从其上除去了外管、推杆、上半壳体、推动板和夹承载凹槽的图16的施夹器用末端执行器组件的立体图;
图22是从其上除去了外管、推杆、上半壳体、推动板、夹承载凹槽和钳夹的图16的施夹器用末端执行器组件的立体图;
图23是图17的施夹器用末端执行器组件的远侧俯视立体图;
图24是图23所指示细节区域的放大图;
图25是图17的施夹器用末端执行器组件的远侧仰视立体图;
图26是图25所指示细节区域的放大图;
图27是图1至图4的施夹器的纵向侧视剖视图;
图28是图27所指示细节区域的放大图;
图29是图28所指示细节区域的放大图;
图30是从图29的30-30截取的剖视图;
图31是从图29的31-31截取的剖视图;
图32是从图29的32-32截取的剖视图;
图33是从图28的33-33截取的剖视图;
图34是从图28的34-34截取的剖视图;
图35是图27所指示细节区域的放大图;
图36是图35所指示细节区域的放大图;
图37是图35所指示细节区域的放大图;
图38是根据本公开的夹子输出器的俯视立体图;
图39是根据本公开的夹子输出器的仰视立体图;
图40是从图38的40-40截取的剖视图;
图41是示出处于组装后的状态中的夹子通道、推动板、夹子输出器和一叠夹子的俯视立体图;
图42是示出处于组装后的状态中的夹子通道、推动板、夹子输出器和一叠夹子的仰视立体图;
图43是图41所指示细节区域的放大图;
图44是图42所指示细节区域的放大图;
图45是从图41的45-45截取的剖视图;
图46是图45所指示细节区域的放大图;
图47是手柄组件的内部构件的右侧立视图,示出了外科施夹器的扳机的初始致动;
图48是从图47的48-48截取的剖视图;
图49是在外科施夹器的扳机的初始致动期间、除去了外管的外科施夹器的末端执行器组件的俯视立体图;
图50是在外科施夹器的扳机的初始致动期间、除去了外管的外科施夹器的末端执行器组件的仰视立体图;
图51是图49的从51-51截取的剖视图;
图52是图51所指示细节区域的放大图;
图53是图51所指示细节区域的放大图;
图54是图51中表示为52的区域的放大剖视图,图示出外科施夹器的扳机的进一步致动;
图55是图54所指示细节区域的放大图;
图56是在图55中图示出的夹子输出器的纵向剖视图;
图57是在外科施夹器的扳机的进一步致动期间除去了外管的外科施夹器的末端执行器组件的俯视立体图;
图58是在外科施夹器的扳机的进一步致动期间除去了外管的外科施夹器的末端执行器组件的仰视立体图;
图59是图27中指示为35的区域的放大剖视图,图示出外科施夹器的扳机的进一步致动;
图60是图59所指示细节区域的放大图;
图61是图59所指示细节区域的放大图;
图62是图61所指示细节区域的放大图;
图63是图27中指示为28的区域的放大剖视图,图示出外科施夹器的扳机的完全致动;
图64是从图63的64-64截取的剖视图;
图65是扳机完全致动时的末端执行器组件的近侧端的放大俯视立体图;
图66是末端执行器组件的远侧端的仰视主视立体图,图示出扳机完全致动时钳夹的闭合;
图67是从图66的67-67截取的剖视图;
图68是图示出在脉管适当位置上的外科夹子的立体图;
图69是图34中所示的区域的放大剖视图,图示出外科施夹器的扳机的重置;以及
图70是图27中图示出的区域的放大剖视图,图示出外科施夹器的扳机的重置。
具体实施方式
现在将参照附图详细描述根据本公开的外科施夹器的实施例,其中相同的附图标记指明的是相似或者相同的构造元件。如在附图中所示出和贯穿以下说明书所描述的,如当涉及外科器械上的相对定位时所常用的,术语“近侧”指的是器械的靠近用户的一端而术语“远侧”指的是器械的远离用户的一端。
现在参照图1至图25,根据本公开的实施例的外科施夹器通常用100表示。施夹器100包括手柄组件200和关节式运动内窥镜部分,该关节式运动内窥镜部分包括从手柄组件200向远侧延伸的轴组件300。
现在参照图1至图8,示出了外科施夹器100的手柄组件200。手柄组件200包括外壳202,外壳202具有第一或者右侧半部分202a和第二或者左侧半部分202b。手柄组件200包括可枢转地支撑在右侧半部分202a和左侧半部分202b之间的扳机208。扳机208通过弹簧或者类似物形式的偏置构件210偏置到未经致动的位置。手柄组件200的外壳202可以由适当的塑料材料构成。
如在图3至图4中所看到的,外壳202支撑右侧半部分202a和左侧半部分202b之间的传动组件220。传动组件220包括传动块222,传动块222可平移、可滑动地支撑在外壳202的右侧半部分202a和左侧半部分202b之间,用于其沿着施夹器100的纵轴“X”移动。传动块222包括从其相对的横向两侧突出的凸块(nub)222a以用于可枢转且可滑动地连接到形成在扳机208中的细长凹槽208a中。传动块222限定了穿过其中的螺纹或者螺旋状管腔222b。
如在图3至图6中看到的,手柄组件200进一步包括设置在外壳202中的棘轮机构230。棘轮机构230包括齿条232和棘爪234,齿条232被限定或支撑在外壳202中,棘爪234在棘爪234与齿条232实质上可操作地接合的位置处可枢转地支撑在传动块222上。
棘爪234包括能够选择性地与齿条232的齿相接合的棘爪齿234a。棘爪齿234a能够与齿条232的齿相接合以限制传动块222的纵向移动并且,依次地限制扳机208的纵向移动。设置爪簧236以使棘爪234偏置进入与齿条232的齿的可操作接合。
齿条232包括介于远侧反向凹部232b和近侧反向凹部232c之间的多个齿232a。在使用中,当棘爪在远侧反向凹部232b或者近侧反向凹部232c中时,当传动块222、以及因此棘爪234相对于齿条232在第一方向上平移时,齿234a被拉动经过齿条232的齿232a。在棘爪234的齿234a到达齿条232的远侧反向凹部232b或者近侧反向凹部232c中的另一个以使棘爪234的方向可以被重设或者反向之前,不能使传动块222的平移反向。一旦棘爪234的方向被重设或者反向,传动块222可以在相反的方向上平移。如这样所构造的,明显的是在完成传动块222的整个行程或者运行长度之前不能使传动块222的平移方向反向。
继续参照图3至图6,传动组件220进一步包括可旋转地支撑在外壳202内的传动螺杆224。传动螺杆224包括用于与设置在外壳202内的杯状物(cup)202c(见图28)建立点接触的近侧尖端224a。传动螺杆224进一步包括沿其长度延伸并配置为在传动块222的螺旋状管腔222b内匹配的外螺旋状螺纹224b。传动螺杆224进一步包括支撑在其远侧端上的齿冠224c。在使用中,当致动扳机208时,扳机208使得传动块222平移通过外壳202。当平移传动块222通过外壳202时,传动块222的螺旋状管腔222b与传动螺杆224的螺旋状螺纹224b相协作从而导致传动螺杆224的旋转。
传动组件220进一步包括离合器齿轮226,其可旋转地支撑在外壳202中并且被锁到传动轴250上(见图16和图31)。离合器齿轮226限定了配置并且定尺寸为与传动螺杆224的齿冠224c协作并且选择性地接合的齿轮齿冠226a。离合器齿轮226可以通过偏置构件228偏置,以使其齿冠226a与传动螺杆224的齿冠224c相接合。离合器齿轮226在其中限定了外环状座圈(outer annular race)226d。
传动组件220进一步包括可枢转地支撑在外壳202中的离合器托架238。离合器托架238包括绕着离合器齿轮226延伸的一对支腿238a,和从每个支腿238a延伸出并且进入离合器齿轮226的环状座圈226d的凸起(boss)238b。每个支腿238a的自由端238c延伸出足以接合形成在扳机208上的肋状物208b的量。在使用中,由于扳机208的按下和释放,当向远侧(由于偏置构件228)以及近侧枢转离合器托架238时,离合器托架238使离合器齿轮226与传动螺杆224的齿冠224c接近和分离。
参照图1至图7,施夹器100的手柄组件200进一步包括旋转组件240,旋转组件240具有在其远侧端上可旋转地支撑在外壳202上面或者里面的旋转球形柄(rotation knob)242。球形柄242包括设置在外壳202外部的夹持部242a和设置在外壳202内的柄部(stem portion)242b。球形柄242限定了穿过其中的管腔242c。柄部242b限定了形成在管腔242c的壁中的一对相对的、纵向延伸的凹槽或者沟槽242b1和242b2。
如图1至图15所示,手柄组件200还包括支撑在外壳202上面或者里面的关节式运动组件260。关节式运动组件260包括可旋转地支撑在外壳202中并且从外壳202上突出的关节式运动转盘262。将关节式运动转盘262紧固到或者锁到关节式运动组件260的管状螺杆主体266上。如图7所示,关节式运动转盘262包括形成在其表面上的用于可操作的接合棘轮齿轮264的齿264a的至少一个肋状物262a。一旦用户选择了末端执行器组件的期望方向或者关节式运动,齿轮264起到增加用于转盘262的旋转的摩擦力从而协助保持旋转转盘262的位置,并且依次地保持末端执行器的关节式运动的作用。此外,齿轮264为用户提供了一定程度的听觉/触觉反馈。
关节式运动组件260进一步包括可旋转地支撑在球形柄242的柄部242b的管腔242c中的管状螺杆主体266。管状螺杆主体266限定传动轴250通过其延伸的中心管腔266a和形成在其外表面上的一对相反延伸的螺旋状沟槽266b、266c。
关节式运动组件260进一步包括可平移地介于球形柄242的柄部242b和管状螺杆主体266之间的一对相对的关节式运动封套(articulation cuff)268、270。每个封套268、270包括相应的导轨268a、270a,它们形成在每个封套268、270外表面上并且配置为可滑动地容纳在形成在管腔242c的壁中的一对相对的、纵向延伸的凹槽242b1、242b2中相应的一个中。每个封套268、270进一步包括相应的螺纹部268b、270b,它们形成在每个封套268、270的内表面上并且配置为可滑动地容纳在形成在管状螺杆主体266的外表面中的一对相反延伸的螺旋状沟槽266b、266c中相应的一个中。将每个封套268、270紧固到相应的关节式运动线缆252、254的近侧端上。
在使用中,如图10至图14所示,当在第一方向上旋转关节式运动转盘262时,管状螺杆主体266也在第一方向上旋转。当在第一方向上旋转管状螺杆主体266时,使得封套268、270相对于彼此在相反的轴向上平移。当使得封套268、270相对于彼此在相反的轴向上平移时,相应的关节式运动线缆252、254也相对于彼此在相反的轴向上平移。当相应的关节式运动线缆252、254也相对于彼此在相反的轴向上平移时,使得末端执行器组件离轴地关节式运动。关节式运动转盘262的旋转角度越大,末端执行器组件的关节式运动的角度就越大。为了使得末端执行器在相反的方向上进行关节式运动,用户仅需要在相反的方向上旋转关节式运动转盘262。
现在回到图1至图5和图9至图26,示出了并将描述施夹器100的轴组件300。轴组件300及其构件可以由诸如不锈钢、钛、塑料等类似的适当的生物适应性材料构成。
轴组件300包括外管302,外管302具有支撑在外壳202内的近侧端302a、远侧端302b和延伸穿过其中的管腔302c。通过从球形柄242的管腔242c延伸出并进入形成在外管302的近侧端302a附近的相应开口302d中的球形柄242的凸块242d(见图7、15和30)将外管302紧固到旋转组件240的旋转球形柄242上。在使用中,如图14和图15所示,当球形柄242旋转时,球形柄242的旋转通过球形柄242的凸块242d传递到外管302,从而使轴组件300绕着纵轴“X”旋转。
如图1、图2和图9至图14所示,轴组件300包括支撑在外管302的远侧端302b上的关节式运动颈部组件310。关节式运动颈部组件310允许轴组件302的远侧端相对于施夹器100的纵轴“X”和轴组件300的纵轴“X”离轴地进行关节式运动。
关节式运动颈部组件310包括支撑在和/或连接到近侧外管302的远侧端302b上的近侧关节式运动接头312,支撑在和/或连接到近侧关节式运动接头312上的多个内连接关节式运动接头314和支撑在和/或连接到内连接关节式运动接头314的远侧端的远侧关节式运动接头316。关节式运动线缆(未示出)从关节式运动组件260的封套268、270延伸出,穿过近侧外管302,穿过近侧关节式运动接头312,穿过内连接关节式运动接头314,并被固定地紧固到远侧关节式运动接头316上。以这种方式,当关节式运动转盘262旋转时,如上所述,使得关节式运动线缆平移,并且因此,使得颈部组件310进行关节式运动。
如图16至图26所示,轴组件300进一步包括支撑在和/或连接到颈部组件310的远侧关节式运动接头316上的末端执行器组件320。末端执行器组件320包括外管322,外管322具有连接到远侧关节式运动接头316的近侧端322a、远侧端322b和延伸穿过外管322的管腔322c。
末端执行器组件320进一步包括均设置在外管322的管腔322c内的上半壳体324和下半壳体326。如图16所示,上半壳体324限定形成在其远侧端附近的窗口324a,形成在窗口324a近侧的纵向延伸的狭缝324b和从上半壳体324的上表面突出并位于狭缝324b近侧的凸块324c。
如图16和图18所示,末端执行器组件320进一步包括可滑动地设置在外管322和上半壳体324之间的推杆330。推杆330包括远侧端330a,远侧端330a限定了配置为并且适于在一堆夹子“C”的最远侧的夹子“C1”的初始成型期间选择性地接合/移动(即向远侧推进)一堆夹子“C”的最远侧的夹子“C1”并保持与最远侧夹子“C1”的接触的推动器330c。推杆330限定了:远侧狭缝330d,其配置为可滑动地接收推动板332的翼片332b;近侧狭缝330e,其位于远侧狭缝330d的近侧上并配置为可滑动地接收上半壳体324的凸块324c;以及弹簧或者搭扣夹(snap clip)330f,其从推杆330的近侧端330b向近侧延伸。搭扣夹330f以使得其夹齿(tine)选择性地接合从传动滑轨344突出的凸块344d的方式配置。
如图16和图19所示,末端执行器组件320进一步包括可往复运动地支撑在上半壳体324下方的推动板332。推动板332包括形成在其中并且沿着其长度延伸的一系列窗口332a。如图41和图43所示,每个窗口332a限定了在推动板332的表面下方延伸的近侧边缘从而限定唇缘或者凸缘332c。推动板332进一步包括在朝向上半壳体324的方向上从其上表面延伸或者突出的翼片或者突片332b。如图18所示,翼片332b可滑动地延伸穿过上半壳体324的狭缝324b并穿过推动器330的远侧狭缝330d。
如图16和图20所示,末端执行器组件320进一步包括设置在推动板332下方和上半壳体324下方的夹子承载器334。夹子承载器334通常是具有限定穿过其中的通道的上壁、一对侧壁和下壁的盒状的构造。夹子承载器334包括形成在下壁中并且沿着其长度纵向延伸的多个间隔开的窗口334a(见图42和图44)。夹子承载器334包括形成在上壁中并且沿着其长度纵向延伸的细长凹槽或者窗口。
如图16和图20所示,以使得一叠外科夹子“C”在夹子承载器334的通道内滑动和/或沿着其滑动的方式将一叠外科夹子“C”装载和/或保持在夹子承载器334的通道内。夹子承载器334的通道配置为并且定尺寸为以首尾相接的方式可滑动地保持其内的一叠或者多个外科夹子“C”。
夹子承载器334的远侧端部包括一对间隔开的、弹性的柄脚334b。柄脚334b配置为并且适于可拆卸地接合保持在夹子承载器334内的一叠外科夹子“C”的最远侧外科夹子“C1”的后跨部。
如图16、图20和图38至图40所示,施夹器100的末端执行器组件320进一步包括可滑动地设置在夹子承载器334的通道内的夹子输出器336。如下文将更加详细地描述的,夹子输出器336定位在一叠外科夹子“C”的后方并且设置为在施夹器100的致动期间向前推进一叠夹子“C”。如下文将更加详细地描述的,通过推动板332的往复的向前和向后运动来致动夹子输出器336。
如图38至图40所示,夹子输出器336包括从夹子输出器336大致上向上和向后地延伸的上突起336a,以及从夹子输出器336大致上向下和向后地延伸的下突起336b。
夹子输出器336的上突起336a配置为并且定尺寸为选择性地接合推动板332的窗口332a的凸缘332c。在使用中,夹子输出器336的上突起336a相对于推动板332的窗口332a的凸缘332c的接合导致当在远侧方向上推进或者移动推动板332时向远侧递增地推进或移动夹子输出器336。
下突起336b配置为并且定尺寸为选择性地接合形成在夹子承载器334中的窗口334a。在使用中,夹子输出器336的下突起336b与形成在夹子承载器334中的窗口334a的接合防止夹子输出器336在近侧方向上行进或者移动。
如图16至图21所示,外科施夹器100的末端执行器组件320包括安装在上半壳体324和外管322的远侧端上的一对钳夹326并且其能够通过手柄组件200的扳机208致动。钳夹326由诸如不锈钢、或者钛等适当的生物适应性材料构成并在其间限定了用于容纳外科夹子“C”的凹槽326a。当钳夹326相对于彼此处于开启或者非接近的状态时,钳夹326的宽度大于轴组件300的外径。钳夹326安装在上半壳体324和外管322的远侧端中以使得其相对于上半壳体324和外管322的远侧端是纵向静止的。
如图25和图26所示,每个钳夹326包括从其下表面突出的相应的隆起的凸轮表面326b。钳夹326的凸轮表面326b允许另一个传动凸轮构件与凸轮表面326b选择性、内部锁止接合以用于钳夹326的闭合和压缩。
如图16和图22所示,末端执行器组件320包括可滑动地介于钳夹326和外管322之间的传动杆340。传动杆340限定形成在其远侧端附近的并且配置为用于与钳夹326的凸轮表面326b选择性内部锁止接合的一对传动凸轮表面340a。
末端执行器组件320进一步包括连接到传动杆340的近侧端并且从其向近侧延伸的滑件接头(slider joint)342。滑件接头342包括在钳夹326的方向上从其表面突出的凸块342a。滑件接头342包括从其向近侧延伸出的柄部342b和在远离上半壳体324的方向上从柄部324b的近侧端突出的突起342c。
末端执行器组件320进一步包括可滑动地设置在外管322内的传动滑轨344。传动滑轨344包括设置在上半壳体324近侧并且限定延伸穿过传动滑轨344的螺旋状管腔344b的传动块344a。传动滑轨344进一步包括从传动块344a向远侧延伸、并且在钳夹326和外管322之间延伸的传动凹槽344c。传动凹槽344c配置为在其中可滑动地容纳滑动接头342的突起342c。传动块344a包括从其上表面突出并配置为用于通过推杆330的搭扣夹330f选择性接合的凸块344d。
末端执行器组件320进一步包括可旋转地支撑在上半壳体324上并且从上半壳体324向近侧延伸的螺旋状传动螺杆346。螺旋状传动螺杆346可操作地连接到和/或容纳在传动滑轨344的螺旋状管腔344b中。螺旋状传动螺杆346的近侧端连接到传动线缆256的远侧端上(见图9)即依次连接到传动轴250的远侧端上。
在使用中,如下文将详细描述的,当在第一方向上旋转螺旋状传动螺杆346时,由于传动轴250和传动线缆256的旋转,螺旋状传动螺杆346与传动滑轨344的螺旋状管腔344b相互作用以轴向地推动传动滑轨344,反之亦然。
此外,当在远侧方向上推动传动滑轨344时,由于推杆330的搭扣夹330f与传动滑轨344的凸块344d的连接,传动滑轨344推动推杆330并使推杆330向远侧推进。当向远侧推进推杆330时,推杆330的推动器330c接触最远侧的夹子“C1”的后跨部并在远侧方向上推进最远侧的夹子“C1”以将夹子装载在钳夹326之间。
而且,当向远侧推进推杆330时,相对于推动板332的翼片332b向远侧推进推杆330的远侧狭缝330d。当推动板332的翼片332b经过了远侧狭缝330d的一段长度时,狭缝330d的近侧端紧靠在翼片332b上并开始向远侧推进推动板332。
伴随着推杆330的推进,传动滑轨344的传动凹槽344c被向远侧推进并且相对于滑动接头342的柄部342b平移。向远侧推进传动滑轨344的传动凹槽344c直至传动滑轨344的肩部344e接合传动杆340的肩部340b。传动滑轨344配置为并且定尺寸为使得传动滑轨344不与传动杆340接合直至推杆330已经将最远侧的夹子“C1”推动进入钳夹326中。当传动滑轨344的肩部344e与传动杆340的肩部340b接合时,传动滑轨344在远侧方向上推进传动杆340。
向远侧推进推杆330直至推杆330的近侧狭缝330e接合上半壳体324的凸块324c。在这个点上,停止了推杆330的远侧前进。但是,当螺旋状传动螺杆346在远侧方向上继续旋转并推动传动滑轨344时,传动滑轨344的凸块344d从推杆330的搭扣夹330f脱离从而允许传动滑轨344的进一步远侧推进。
当进一步向远侧推进传动滑轨344时,在与传动杆340接合之后,向远侧推进传动杆340从而闭合钳夹326并且使设置在钳夹326内的夹子“C”成型。
如图16至图26所示,当末端执行器组件320处于未经致动状态时,传动滑轨344的传动块344a位于螺旋状传动螺杆346的近侧端上。
现在参考图27至图70,现在将描述使外科夹子“C”在诸如脉管“V”等目标组织附近成型或者卷曲的外科施夹器100的操作。参照图27至图46,示出了外科施夹器100在任何操作或者使用之前的状态。如图27至图34所示,在施夹器100的使用或者发射之前,扳机208通常处于未经压缩或者未经致动的状态。
当扳机208处于未经致动的状态时,传动块222在手柄组件200的传动螺杆224的最远侧位置上。同样地,将棘爪234设置在齿条232的远侧反向凹部232b内或者与其对准。
如图29所示,由于扳机208处于未经致动的位置,扳机208的肋状物208b接触离合器托架238的自由端238c并在远侧方向上推进离合器托架238从而使离合器齿轮226保持与传动螺杆224的齿冠224c的分离。
如图35至图46所示,通过未经致动位置中的扳机208,推杆330处于最近侧的位置上以使得其推动器330c设置在一叠夹子的最远侧的夹子“C1”的后跨部的近侧上。而且,将传动滑轨344设置在末端执行器组件320的传动螺杆346的最近侧位置上。
现在参照图47和图48,在扳机208的初始致动或者发射期间,扳机208作用在传动块222上以在近侧方向上推进传动块222。当在近侧方向上移动传动块222时,传动块222作用在手柄组件200的传动螺杆224上以导致传动螺杆224旋转。此外,当在近侧方向上移动传动块222时,将棘爪234从齿条232的远侧反向凹部232b移动到齿条232的齿232a上。以这样的方式,扳机208不能回到未经致动的位置直至完成其整个行程。
当初始致动扳机208时,扳机208的肋状物208b从与离合器托架238的自由端238c的接触当中移动,允许偏置构件228将离合器齿轮226推进到与传动螺杆224的齿冠224c可操作接合并且因此引起离合器托架238枢转。当离合器齿轮226与传动螺杆224的齿冠224c可操作接合时,手柄组件200的传动螺杆224的旋转导致了传动轴250的旋转,以及依次导致了末端执行器组件320的传动螺杆346的旋转。
如在图49图53所示,在扳机208的初始致动期间,当旋转末端执行器组件320的传动螺杆346时,传动螺杆346与传动滑轨344的螺旋状管腔344b相互作用以轴向地推进传动滑轨344。当在远侧方向上推进传动滑轨344时,由于推杆330的搭扣夹330f与传动滑轨344的凸块344d的连接传动滑轨344推动推杆330并向远侧推进。当向远侧推进推杆330时,推杆330的推动器330c接触最远侧的夹子“C1”的后跨部并在远侧方向上推进最远侧的夹子“C1”以使最远侧的夹子“C1”移动超出夹子承载器334的柄脚334b并将最远侧的夹子“C1”装载在钳夹326之间。
在扳机208的初始致动期间,向远侧推进推杆330直至将推杆330的远侧狭缝330d推进到与推动板332的翼片332b相接触。而且在扳机208的初始致动期间,如图50和图52所示,传动滑轨344的传动凹槽344c与传动杆340间隔开并且其肩部344e并未与传动杆340接触。
现在参照图54至图58,在扳机208的进一步致动或者发射期间,持续旋转手柄组件200的传动螺杆224,导致传动轴250的持续旋转,以及依次导致末端执行器组件320的传动螺杆346的旋转。
在末端执行器组件320的传动螺杆346的进一步旋转期间,持续地轴向推进传动滑轨344。在这个阶段,当在远侧方向上推进传动滑轨344时,传动滑轨344继续向远侧推进推杆330,依次推动推动板332的翼片332b以开始向远侧推进推动板332。当向远侧推进推动板332时,推动板332的唇缘332c接合夹子输出器336的上突起336a以在远侧方向上推进夹子输出器336,并且依次推进剩余的一叠夹子“C”。而且,当向远侧推进推动板332时,从夹子输出器334的近侧窗口334a拖动推动板332的下突起336b并使其移动到夹子输出器334的邻近窗口334a。
当进一步向远侧推进推杆330时,其推动器330c继续将最远侧夹子“C1”推进到钳夹326中。在扳机208的进一步致动期间,向远侧推进推杆330直至推杆330的近侧狭缝330e推进到与上半壳体324的凸块324b接触。
现在参照图59至图68,在扳机208的最终致动或者发射期间,继续使手柄组件200的传动螺杆224旋转,导致传动轴250的持续旋转,并且依次地导致末端执行器320的传动螺杆346的旋转。
在末端执行器组件320的传动螺杆346的最终旋转期间,继续轴向推进传动滑轨344。在这个阶段,当在远侧方向上推进传动滑轨344时,因为通过上半壳体324的凸块324b阻止了推杆330的远侧推进,使得传动滑轨344的凸块344b从推杆330的搭扣夹330f的夹齿脱离从而允许传动滑轨344的进一步远侧推进。
另外,在末端执行器组件320的传动螺杆346的最终旋转期间,使得传动滑轨344的传动凹槽344c的肩部344e与传动杆340相接触并且在远侧方向上推进传动杆340。当在远侧方向上推进传动杆340时,传动凸轮表面340a与钳夹326的凸轮表面326b相接合以推进钳夹326闭合并使布置在脉管“V”等上的钳夹326之间的夹子“C1”成型(见图68)。
与此伴随的,如图63和图64所示,当完全地致动扳机208时,使得传动块222移动到最近侧的位置以使棘爪234移动进入齿条232的近侧反向凹部232a,在该近侧反向凹部232a中棘爪234重设其本身。以这种方式,扳机208能够自由地回到未经致动的位置。
现在参照图69和图70,在扳机208的整个致动和棘爪234的重设之后,由于偏置构件210(见于图3至图5)的作用释放扳机208以允许扳机208回到未经致动的位置。当扳机208回到未经致动的位置时,扳机208作用在传动块222上以在远侧方向上推进传动块222。当在远侧方向上移动传动块222时,传动块222作用于手柄组件200的传动螺杆224以导致传动螺杆224在相反的方向上旋转。此外,当在远侧方向上移动传动块222时,使得棘爪234从齿条232的近侧反向凹部232a最终移动到齿条232的远侧反向凹部232b。
当使扳机208回到未经致动位置时,扳机208的肋状物208b接触离合器托架238的自由端238c并推进离合器托架238使得离合器齿轮226与传动螺杆224的齿冠224c脱离,并且再次偏置偏置构件228。
当扳机208回到未经致动位置并且旋转传动螺杆224时,手柄组件200的传动螺杆224使传动轴250的旋转反向,并且依次使末端执行器组件320的传动螺杆346的旋转反向。当在整个致动之后在相反方向上旋转传动螺杆346时,传动螺杆346作用于传动滑轨344以使传动滑轨344在近侧方向上移动。
当在近侧方向上移动传动滑轨344时,传动滑轨344的凸块344b作用于推杆330的搭扣夹330f的夹齿或者被其再次捕获,并且因此在近侧方向上拖动推杆330。当在近侧方向上移动推杆330时,当推杆330的远侧狭缝330d的远侧端接合推动板332的翼片332b时,推杆330在近侧方向上推进推动板332直至推动板332的翼片332b到达形成在上半壳体324中的狭缝324b的近侧端。当在近侧方向上拖动推杆330时,导致推杆330的推动器330c在新的最远侧夹子“C1”的近侧移动。
此外,当在近侧方向上移动传动滑轨344时,传动滑轨344接合滑件接头342的柄部342b的突起342c(见图16)从而在近侧方向上拖动滑件接头342,并且依次地在近侧方向上拉动传动杆340。当在近侧方向上移动传动杆340时,由于钳夹326自身类似弹簧的特征允许钳夹326再次开启。
能够理解的是,可以如期望或者必须地,或者在已经发射出所有夹子之前多次重复发射顺序。
应该理解的是,之前的描述仅仅是本公开示意性的描述。在不脱离本公开的情况下,所属领域技术人员可设计多种替换和修改。因此,本公开旨在包含所有这些替换、修改和变化。参考随附的附图描述的实施例仅仅展示了本公开的特定实例。其它非实质性不同于以上描述和/或随附的权利要求中的元件、步骤、方法和技术也希望包括在本公开的范围内。
Claims (18)
1.一种用于将外科夹子施加到身体组织的装置,所述装置包括:
手柄组件,包括:
传动组件;以及
扳机,其可操作地连接到所述传动组件上;以及
轴组件,其从所述手柄组件延伸出来,所述轴组件包括:
关节式运动颈部组件;以及
末端执行器组件,其被支撑在所述关节式运动颈部组件的远侧端上并被配置为使外科夹子在所述身体组织的适当位置上成型。
2.根据权利要求1所述的装置,其中所述末端执行器组件包括:
设置在其中的至少一个夹子;
钳夹,其配置为接收所述至少一个夹子并使所述至少一个夹子成型;
推杆,其配置为将所述至少一个夹子装载到所述钳夹中;以及
传动杆,其配置为选择性地接合所述推杆以实现所述钳夹的闭合。
3.根据权利要求2所述的装置,进一步包括可操作地连接到所述扳机和所述末端执行器的可旋转传动构件,其中所述扳机的致动导致所述传动构件的旋转,并且所述传动构件的旋转导致所述至少一个夹子装载到所述钳夹中以及导致所述钳夹的闭合。
4.根据权利要求3所述的装置,其中所述手柄组件包括外壳和轴向地可滑动地支撑在所述外壳中的传动块,其中所述传动块连接到所述扳机并且限定了穿过其中的螺旋状管腔,并且其中所述可旋转传动构件包括能够与所述传动块的螺旋状管腔螺纹接合的手柄传动螺杆,
其中所述传动块相对于所述手柄组件的所述手柄传动螺杆的轴向平移导致了所述手柄传动螺杆的旋转。
5.根据权利要求4所述的装置,其中所述末端执行器组件包括传动滑轨,所述传动滑轨能够在所述末端执行器组件内可滑动地轴向平移并且限定穿过其中的螺旋状管腔,并且其中所述可旋转传动构件包括能够与所述传动滑轨的螺旋状管腔螺纹接合的末端执行器传动螺杆,
其中所述手柄传动螺杆的旋转导致了所述末端执行器传动螺杆的旋转以及所述传动滑轨的轴向平移。
6.根据权利要求5所述的装置,其中所述传动滑轨与所述推杆选择性地接合,以使所述传动滑轨的远侧推进导致了所述推杆的特定距离的远侧推进,然后在所述特定距离之后所述传动滑轨与所述推杆分开。
7.根据权利要求2所述的装置,其中在所述钳夹的接近过程中所述推杆保持在远侧推进后的位置中。
8.根据权利要求5所述的装置,其中所述末端执行器组件包括可滑动地设置在其中的推动板,其中所述推动板可拆卸地连接到所述推杆上,
其中在所述推杆的远侧推进过程中,所述推杆与所述推动板相接合以使所述推动板向远侧移动。
9.根据权利要求8所述的装置,其中所述推动板包括从其延伸出的翼片,用于当向远侧推进所述推杆时通过所述推杆选择性地接合所述翼片。
10.根据权利要求8所述的装置,其中所述末端执行器组件进一步包括夹子输出器,所述夹子输出器可滑动地支撑在所述末端执行器组件内用于在远侧方向上推进设置在所述末端执行器组件内的外科夹子,所述夹子输出器包括从其第一表面突出的上突起和从其第二表面突出的下突起,其中当向远侧移动所述推动板时所述夹子输出器的所述上突起与所述推动板接合以使所述夹子输出器向远侧移动以推进所述外科夹子,并且其中当所述推动板向近侧移动时所述夹子输出器的所述下突起与结构件相接合以使所述夹子输出器保持静止。
11.根据权利要求10所述的装置,其中所述末端执行器组件进一步包括设置在其内的夹子承载器,其中所述夹子承载器配置为保持所述外科夹子和所述夹子输出器,其中所述夹子输出器的所述下突起与形成在所述夹子承载器中的结构件相接合。
12.根据权利要求11所述的装置,其中所述夹子输出器被递增地推进穿过所述夹子承载器。
13.根据权利要求5所述的装置,其中在通过所述推杆将夹子装载到所述钳夹中之后所述传动杆通过所述传动滑轨选择性地接合,并且其中所述传动滑轨的远侧推进向远侧推进所述传动杆以实现所述钳夹的闭合。
14.根据权利要求1所述的装置,其中所述轴组件能够绕纵轴相对于所述手柄组件旋转。
15.根据权利要求1所述的装置,其中所述颈部组件包括多个内连接的关节式运动接头。
16.根据权利要求1所述的装置,其中所述手柄组件支撑关节式运动转盘,其中所述关节式运动转盘可操作地连接到所述颈部组件上以使所述关节式运动转盘的致动导致所述颈部组件的关节式运动。
17.根据权利要求16所述的装置,其中所述手柄组件包括:
关节式运动螺杆,其可旋转地支撑在所述手柄组件内并连接到所述关节式运动转盘,所述关节式运动螺杆限定形成在其表面中的一对相反定向的沟槽;以及
一对关节式运动致动器,它们可平移且可滑动地支撑在所述手柄组件中,其中每个关节式运动致动器与所述关节式运动螺杆的相应的螺旋状沟槽相接合,其中每个关节式运动线缆的近侧端紧固到相应的所述关节式运动致动器上;
其中所述关节式运动转盘的旋转导致了所述关节式运动螺杆的旋转和所述关节式运动致动器的相反平移。
18.根据权利要求17所述的装置,其中所述手柄组件进一步包括与所述关节式运动转盘可操作地接合的棘齿。
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- 2011-02-24 JP JP2011039024A patent/JP5684604B2/ja not_active Expired - Fee Related
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- 2011-02-24 ES ES11250214.1T patent/ES2593635T3/es active Active
- 2011-02-25 CN CN201110050913.0A patent/CN102166129B/zh active Active
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2013
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2014
- 2014-09-15 US US14/486,306 patent/US9393024B2/en active Active
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2015
- 2015-01-15 JP JP2015005629A patent/JP6001699B2/ja not_active Expired - Fee Related
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2016
- 2016-01-28 JP JP2016013944A patent/JP2016116877A/ja active Pending
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2019
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JP2016116877A (ja) | 2016-06-30 |
AU2011200388B2 (en) | 2014-05-29 |
CN104739480A (zh) | 2015-07-01 |
US11918231B2 (en) | 2024-03-05 |
JP6001699B2 (ja) | 2016-10-05 |
EP2361562A1 (en) | 2011-08-31 |
CA2728538A1 (en) | 2011-08-25 |
US9393024B2 (en) | 2016-07-19 |
US20190209177A1 (en) | 2019-07-11 |
EP3097872A1 (en) | 2016-11-30 |
CN102166129B (zh) | 2015-03-25 |
US8845659B2 (en) | 2014-09-30 |
US20220096091A1 (en) | 2022-03-31 |
EP2361562B1 (en) | 2016-07-27 |
EP3097872B1 (en) | 2020-11-18 |
US10271854B2 (en) | 2019-04-30 |
US8403945B2 (en) | 2013-03-26 |
JP5684604B2 (ja) | 2015-03-18 |
CN104739480B (zh) | 2017-04-12 |
US20160249933A1 (en) | 2016-09-01 |
ES2593635T3 (es) | 2016-12-12 |
US20110208211A1 (en) | 2011-08-25 |
US11213299B2 (en) | 2022-01-04 |
JP2015119980A (ja) | 2015-07-02 |
US20130172912A1 (en) | 2013-07-04 |
AU2011200388A1 (en) | 2011-09-08 |
US20150005790A1 (en) | 2015-01-01 |
JP2011172931A (ja) | 2011-09-08 |
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