CN102342853B - 关节式运动施夹器 - Google Patents

关节式运动施夹器 Download PDF

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CN102342853B
CN102342853B CN201110201695.6A CN201110201695A CN102342853B CN 102342853 B CN102342853 B CN 102342853B CN 201110201695 A CN201110201695 A CN 201110201695A CN 102342853 B CN102342853 B CN 102342853B
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肯尼斯·惠特菲尔德
乔鲍·L·雷蒂
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/128—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
    • A61B17/1285—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips for minimally invasive surgery
    • A—HUMAN NECESSITIES
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    • A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
    • 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
    • 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
    • A61B17/07207—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 the staples being applied sequentially
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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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    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2932—Transmission of forces to jaw members
    • A61B2017/2943—Toothed members, e.g. rack and pinion

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Abstract

本发明提供了一种用于可操作地连接至手术手柄组件的末端执行器，其包括：通过转向节部相互连接的远侧壳体部和近侧壳体部，其中，所述转向节部允许所述远侧壳体部相对于其旋转以及所述远侧壳体部相对于所述近侧壳体部做关节式运动；钳夹组件，其支撑在所述远侧壳体部的远侧端中，所述钳夹组件包括能够在间隔开的位置和接近后的位置之间移动的第一钳夹和第二钳夹；以及多个紧固件，其装载在所述远侧壳体部内，所述多个紧固件中的每个均限定在大致上平行于其一对支腿的方向上延伸的紧固件轴线，多个紧固件中的每个均布置在所述底座部内以使得所述紧固件轴线相对于所述远侧壳体部的纵轴线呈一定角度布置。

Description

关节式运动施夹器
相关申请的交叉引用
本申请要求于2010年7月28日提交的、序列号为61/368,463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
本公开涉及手术施夹器，而且更确切地涉及新颖的关节式运动内窥镜手术紧固件施夹器钉仓件。
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之内。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，外科医生经常会将手术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的美国专利申请中，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手术施夹器，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，将手术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。
内窥镜或者腹腔镜操作经常在远离切口的地方执行。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
本发明涉及手术施夹器。
根据本公开的方案，提供了一种用于将手术夹子施加到身体组织的手术施夹装置，包括壳体、传动组件、轴组件和扳机。轴组件从壳体向远侧延伸。传动组件至少部分地定位在壳体内。扳机和传动组件可操作地连接。
轴组件具有第一管状构件和从所述第一管状构件向远侧定位的第二管状构件。所述第一管状构件限定纵轴线。所述第一管状构件和所述第二管状构件通过共同的枢转轴线可枢转地连接。所述枢转轴线垂直于所述纵轴线。所述传动组件可以包括柔性线缆，柔性线缆将平移力和旋转力从壳体的内部传送进所述第二管状构件中。
关节式运动机构与所述第一管状构件和所述第二管状构件可操作地连接。所述关节式运动机构包括齿轮齿条、至少一个齿轮和齿轮段。齿轮齿条具有纵向地布置于其上的多个轮齿并且位于所述第一管状构件内。至少一个齿轮与第一管状构件内的齿轮齿条可操作地连接。齿轮段从所述第二管状构件向近侧延伸并且与所述至少一个齿轮可操作地连接。所述齿轮段相对于所述第二管状构件固定。所述关节式运动机构使得所述第二管状构件以与纵轴线呈高达90°的角度绕着所述枢转轴线枢转。所述关节式运动机构包括可旋转以使得所述第二管状构件枢转的控制球形柄(control knob)。
所述第二管状构件可以包括钳夹组件和夹子钉仓件(clip cartridge)，夹子钉仓件包括布置在其中的多个紧固件。
手术施夹装置可以包括旋转机构。所述旋转机构与钳夹组件可操作地连接，并且为钳夹组件提供旋转力。旋转机构可以包括转盘(dial)和带。所述带定位在传动组件的近侧部附近。所述转盘限定内通道和内表面。所述带限定从所述转盘的内表面接收旋转力并将所述旋转力传送给所述传动组件的波状外形外表面。转盘与带可滑动地联接。
所述第二管状构件可以包括大致平行的两个齿轮段。
在另一个实施例中，提供了一种用于将手术夹子施加到身体组织的手术施夹装置，所述手术施夹装置包括壳体、传动组件、轴组件和扳机。轴组件从壳体向远侧延伸。
轴组件具有第一管状构件和从所述第一管状构件向远侧定位的第二管状构件。所述第一管状构件限定第一纵轴线，第一管状构件可绕着所述第一纵轴线旋转。所述第一管状构件和所述第二管状构件通过共同的枢转轴线可枢转地连接。
所述第二管状构件限定第二纵轴线。所述第二管状构件的远侧部能够绕着第二纵轴线旋转。所述第二管状构件包括从其近侧部向近侧延伸的齿轮段。
传动组件至少部分地定位在所述壳体内并且延伸通过所述第一管状构件并且部分地进入所述第二管状构件中。所述传动组件可以包括柔性线缆，柔性线缆将平移力和旋转力从壳体的内部传送进所述第二管状构件中。扳机和传动组件可操作地连接。
齿条沿着纵轴线的部分延伸。所述齿条位于所述第一管状构件内并且沿着第一纵轴线往复运动。所述齿条与所述齿轮段可操作地连接。
手术施夹装置可以包括关节式运动机构，关节式运动机构提供枢转力以使第二管状构件以与第一纵轴线呈高达90°的角度绕着所述枢转轴线枢转。所述关节式运动机构包括控制球形柄，所述控制球形柄可旋转以向近侧收回所述齿条并且使得所述齿条向远侧延伸。
手术施夹装置可以进一步包括旋转机构。所述旋转机构与所述传动组件可操作地连接以为第二管状构件的远侧部提供旋转力。所述旋转机构包括定位在传动组件的近侧部附近的转盘和带。所述转盘限定内通道和内表面。所述带限定能够从所述转盘的内表面接收旋转力并将所述旋转力传送给所述传动组件的近侧部的波状外形外表面。所述转盘与所述带可滑动地联接。
所述第二管状构件可以包括钳夹组件和夹子钉仓件，夹子钉仓件包括布置在其中的多个夹子。旋转机构可以与钳夹组件相连接，并且为钳夹组件提供旋转力。
根据本公开的另一个方案，提供一种用于可操作地连接至手术手柄组件的末端执行器，所述手术手柄组件包括具有可操作地连接至所述末端执行器的柔性传动线缆的可轴向往复运动的传动组件。所述末端执行器包括：远侧壳体部，其限定近侧端、远侧端和纵轴线；转向节部，其从所述远侧壳体部的近侧端向近侧延伸，所述转向节部分成第一齿轮部和第二齿轮部，所述远侧壳体部可旋转地安装至所述转向节部以使得所述远侧壳体部相对于所述转向节部绕着纵轴线旋转；钳夹组件，其从底座部向远侧延伸，所述钳夹组件包括能够在间隔开的位置和接近后的位置之间移动的第一钳夹和第二钳夹；多个手术夹子，其以部分堆叠的方式装载在所述远侧壳体部中；以及钳夹闭合机构，其设置在所述远侧壳体部中并且与所述钳夹组件和所述多个手术夹子可操作地关联。当所述远侧壳体部的纵轴线与手术手柄的纵轴线轴向地对齐或者呈一定角度时，所述柔性传动线缆的远侧端连接至所述钳夹闭合机构以传递操作力至所述钳夹闭合机构。所述钳夹闭合机构将夹子进给入所述钳夹组件中并且在所述柔性传动线缆完成单个冲程时形成进给的夹子。
末端执行器可以进一步包括近侧壳体部和齿轮联，所述近侧壳体部可枢转地连接至所述转向节部；所述齿轮联支撑在所述近侧壳体部中。所述齿轮联最远侧的齿轮与所述转向节部的第一齿轮部和第二齿轮部可操作地啮合。
末端执行器可以进一步包括齿条，所述齿条可滑动地支撑在近侧壳体部中，其中，所述齿条限定至少一轴向行的齿轮轮齿，并且其中，轴向行的齿轮轮齿与所述齿轮联的最近侧齿轮相啮合。
在使用中，所述齿条相对于盖的轴向位移引起所述远侧壳体部相对于所述近侧壳体部的关节式运动。
根据本公开的进一步方案，提供了一种用于将手术夹子施加到身体组织的末端执行器。所述末端执行器包括：限定近侧端、远侧端和纵轴线的部分；转向节部，其从底座部的近侧端向近侧延伸，所述转向节部分成第一齿轮部和第二齿轮部，所述底座部可旋转地安装至所述转向节部以使得所述底座部相对于所述转向节部绕着纵轴线旋转；钳夹组件，其从所述底座部向远侧延伸，所述钳夹组件包括能够在间隔开的位置和接近后的位置之间移动的第一钳夹和第二钳夹；以及多个紧固件，其位于所述底座部内，多个紧固件中的每个均具有从后跨部延伸出的一对支腿，多个紧固件中的每个均限定在大致上平行于一对支腿的方向上延伸的紧固件轴线，多个紧固件中的每个均布置在所述底座部内以形成所述紧固件轴线和所述纵轴线之间的角度，多个紧固件中的每个均邻近于多个紧固件的另一个而定位以形成堆叠。
所述转向节包括限定枢转轴线的枢转构造。
所述末端执行器可以进一步包括钳夹闭合机构，所述钳夹闭合机构可操作地连接至所述钳夹组件，所述钳夹闭合机构为所述第一钳夹和所述第二钳夹提供接近力。
所述转向节部包括多个轮齿。
多个紧固件可以相对于第二纵轴线在非共线的位置上堆叠。
所述第一钳夹和所述第二钳夹可以相对于纵轴线呈一定角度。
所述多个紧固件的支腿可以布置在与所述第一钳夹和所述第二钳夹大致平行的方位上。
紧固件可以具有U形或者V形。所述一叠紧固件可以平行于纵轴线延伸。
所述末端执行器可以进一步包括近侧壳体部，所述近侧壳体部连接至所述转向节部以使得底座部能够相对于所述盖离轴地枢转。所述近侧壳体部可以支撑在其远侧区域中的齿轮联，并且其中，所述齿轮联最远侧的齿轮可与所述转向节部的第一齿轮部和第二齿轮部可操作地啮合。所述末端执行器可以进一步包括齿条，齿条可滑动地支撑在近侧壳体部的近侧区域中，其中，所述齿条限定至少一轴向行的齿轮轮齿，并且其中，轴向行的齿轮轮齿与所述齿轮联的最近侧齿轮相啮合。
在使用中，所述齿条相对于所述近侧壳体部的轴向位移可引起所述底座部相对于所述近侧壳体部的关节式运动。
根据本发明的又一个方案，提供了一种用于可操作地连接至手术手柄组件的末端执行器，所述手术手柄组件包括具有可操作地连接至所述末端执行器的柔性传动线缆的可轴向往复运动的传动组件。所述末端执行器包括：远侧壳体部，其限定近侧端、远侧端和纵轴线；近侧壳体部，其限定近侧端、远侧端和纵轴线；转向节部，其使得所述远侧壳体部的近侧端与所述近侧壳体部的远侧端相互连接，其中，所述转向节部允许所述远侧壳体部相对于其旋转以及所述远侧壳体部相对于所述近侧壳体部做关节式运动；钳夹组件，其支撑在所述远侧壳体部的远侧端中，所述钳夹组件包括能够在间隔开的位置和接近后的位置之间移动的第一钳夹和第二钳夹；以及多个紧固件，其装载在所述远侧壳体部内，多个紧固件中的每个均具有从后跨部延伸出的一对支腿，多个紧固件中的每个均限定在大致上平行于一对支腿的方向上延伸的紧固件轴线，多个紧固件中的每个均布置在底座部内以使得所述紧固件轴线相对于所述远侧壳体部的纵轴线呈一定角度设置，并且其中，多个紧固件成叠地布置。
所述末端执行器可以进一步包括钳夹闭合机构，钳夹闭合机构可操作地连接至所述钳夹组件，其中，所述钳夹闭合机构在其相对于所述第一钳夹和所述第二钳夹向近侧移动时为所述第一钳夹和所述第二钳夹提供接近力。
所述钳夹闭合机构可以包括凸轮板，凸轮板轴向可滑动地支撑在所述远侧壳体部中，其中，所述凸轮板包括形成于其中的凸轮孔径，其中，所述凸轮孔径具有大致“V”形轮廓，并且其中，所述第一钳夹和所述第二钳夹中的每个均包括从其延伸出并且延伸进所述凸轮板的凸轮孔径中的柱。在使用中，所述凸轮板相对于所述第一钳夹和所述第二钳夹向近侧的移动使得对着所述第一钳夹和所述第二钳夹的凸块接合所述凸轮孔径的边缘，以使所述第一钳夹和所述第二钳夹接近。
所述凸轮板可以包括向远侧延伸进所述凸轮孔径中的突起；其中，所述凸轮板相对于所述第一钳夹和所述第二钳夹向远侧的移动使得在所述第一钳夹和所述第二钳夹的凸块之间接合所述凸轮孔径的突起，以使得所述第一钳夹和所述第二钳夹分离。
柔性传动线缆可以在所述远侧壳体部和所述近侧壳体部之间并且横过所述转向节部延伸。
传动线缆的近侧端可以与传动组件相连接，并且传动线缆的远侧端可以与可滑动地支撑在底座部中的块构件相连接，其中，传动线缆的远侧移动引起块构件的远侧移动以向远侧推进进给杆以及将紧固件装载进钳夹组件中。
末端执行器可以进一步包括轴向可滑动地支撑在底座部中的凸轮板；其中，块构件包括延伸进入设置在凸轮板中的近侧轴向延伸狭缝中的指状件；其中，凸轮板包括形成在其中的凸轮孔径；其中，凸轮孔径具有大致“V”形轮廓，并且其中，第一钳夹和第二钳夹中的每一个均包括从其延伸出并且延伸进凸轮板的凸轮孔径中的柱。在使用中，块构件的远侧移动可能引起凸轮板的远侧移动，并且块构件的近侧移动引起凸轮板的近侧移动。此外，在使用中，所述凸轮板相对于所述第一钳夹和所述第二钳夹的近侧移动对着所述第一钳夹和所述第二钳夹的凸块接合所述凸轮孔径的边缘以使所述第一钳夹和所述第二钳夹接近。
所述凸轮板可以包括向远侧延伸进所述凸轮孔径中的突起，其中，所述凸轮板相对于所述第一钳夹和所述第二钳夹的远侧移动接合所述第一钳夹和所述第二钳夹的凸块之间的所述凸轮孔径的突起，以使得所述第一钳夹和所述第二钳夹分离。
凸轮板可以偏置到远侧位置。
末端执行器可以进一步包括夹子输出器，夹子输出器布置在多个紧固件近侧，其中，夹子输出器在远侧方向上被偏置以向远侧推多个紧固件。
所述转向节部可以分成第一齿轮部和第二齿轮部。
所述近侧壳体部可在其远侧区域中支撑齿轮联，并且其中，所述齿轮联的最远侧齿轮与所述转向节部的第一齿轮部和第二齿轮部可操作地啮合。
所述末端执行器可以进一步包括齿条，齿条可滑动地支撑在近侧壳体部的近侧区域中，其中，所述齿条限定至少一轴向行的齿轮轮齿，并且其中，轴向行的齿轮轮齿与所述齿轮联的最近侧齿轮相啮合。
在使用中，所述齿条相对于所述近侧壳体部的轴向位移引起了所述底座部相对于所述近侧壳体部的关节式运动以使得所述远侧壳体部的纵轴线相对于所述近侧壳体部的纵轴线呈一定角度。
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是根据本公开的实施例的手术施夹器的立体主视图；
图2是图1的细节的指示区域的立体主视图，图示出了图1的施夹器的夹子钉仓件；
图3是图1和图2的手术施夹器的夹子钉仓件的左侧正视图；
图4是图1至图3的手术施夹器的夹子钉仓件的平面俯视图；
图5是图1至图4的手术施夹器的立体图，图示出夹子钉仓件的关节式运动；
图5A是从图5的5A-5A截取的图1至图5的手术施夹器的主体的剖视侧视图；
图5B是从图5A的5B-5B截取的图1至图5A的手术施夹器的主体的剖视图；
图6是图5的手术施夹器的轴组件的分解图；
图7是图6的轴组件的关节式运动柱塞的放大立体图；
图8是图6的轴组件的关节式运动螺杆的放大分解图；
图9是放置在图6的轴组件的关节式运动柱塞的近侧端附近的关节式运动螺杆的放大图；
图10是图6的轴组件的轴的远侧部的放大立体图，其中传动轴贯穿其中；
图11是联接至图6的轴组件的轴的齿条的放大立体图；
图12是如图6的细节所示的手术施夹器的轴组件的第一管状部的远侧端的分解图；
图12A是如图12的细节所示的手术施夹器的轴组件的第一齿轮的放大立体图；
图12B是如图12的细节所示的手术施夹器的轴组件的第二齿轮的放大立体图；
图12C是如图12的细节所示的手术施夹器的轴组件的第三齿轮的放大立体图；
图13是如图6的细节所示的手术施夹器的轴组件的第一管状部的远侧端的立体主视图；
图14是如图6的细节所示的手术施夹器的轴组件的第一管状部的远侧端的立体主视图，其中移除了右侧端盖和外管；
图15是如图6的细节所示的手术施夹器的轴组件的第一管状部的远侧端的立体主视图，其中移除了右侧端盖、外管、第一齿轮、第二齿轮和第三齿轮；
图16是如图6的细节所示的手术施夹器的轴组件的第一管状部的远侧端的纵向剖视图，示出了第二管状部的关节式运动转向节、齿条、第一齿轮、第二齿轮和第三齿轮之间的连接；
图17是如图6的细节所示的手术施夹器的轴组件的第一管状部的远侧端的进一步的纵向剖视图，示出了处于关节式运动位置上的第二管状部的关节式运动转向节、齿条、第一齿轮、第二齿轮和第三齿轮之间的连接；
图18是图17的细节的指示区域的放大纵向剖视图，图示了处于关节式运动位置上的第一管状部和第二管状部的远侧端；
图19是从图1的19-19截取的图6的轴组件的纵向剖视图；
图20是轴组件的图19的细节的指示区域的放大纵向剖视图；
图21是如图20所示的轴组件的近侧部的放大剖视图；
图22是如图20详细描述的轴组件的图20的细节的指示区域的放大剖视图；
图23是轴组件的图22的细节的指示区域的放大剖视图；
图24是轴组件的图19的细节的指示区域的放大剖视图；
图25是如图24所示的第二管状部的近侧部的图24的细节的指示区域的放大剖视图；
图26是图示出第二管状部的夹子推件的远侧端的图25的细节的指示区域的放大剖视图；
图27是零件分离的如图6所示的第二管状部的夹子钉仓件的立体图；
图27A是在图27的手术施夹器的钉仓件中使用的夹子的平面主视图；
图28是图27的夹子钉仓件的壳体的立体图；
图29是图27的夹子钉仓件的凸轮板的立体图；
图30是图27的夹子钉仓件的钳夹构造的立体图；
图31是图27的夹子钉仓件的块构件的立体图；
图32是图27的夹子钉仓件的夹子推件的立体图；
图33是图27的夹子钉仓件的夹子输出器(follower)的立体图；
图34是图27的夹子钉仓件的夹子承载器的立体图；
图35是图27的夹子钉仓件的盖的立体仰视图；
图36是联接至夹子钉仓件的转向节的壳体的立体图；
图37是从图36的壳体上移除了钳夹构造的壳体立体图；
图38是从图36的壳体上移除了钳夹构造和凸轮板的壳体立体图；
图39是包括处于适当位置上的远侧构件和夹子推件的图36的壳体的立体图；
图40是增加了夹子承载器和夹子输出器的图39的壳体的立体图；
图41是如图40所示的夹子承载器和夹子推件的放大细节图；
图42是图40的壳体增加了一叠夹子壳体的立体图；
图43是如图40所示的一叠夹子的放大细节图；
图44是夹子钉仓件的纵向剖视图，图示出在操作的第一阶段期间正在被装载的夹子；
图45是如图44所示的夹子钉仓件的放大纵向剖视图，图示出在操作的第一阶段期间正在被装载的夹子；
图46是夹子钉仓件的纵向剖视图，图示出在操作的第一阶段期间夹子推件的完全推进；
图47是如图46所示的夹子钉仓件的放大纵向剖视图，图示出在操作的第二阶段期间夹子推件的回程；
图48是夹子钉仓件的纵向剖视图，图示出在操作的第三阶段期间装载的夹子的成形；
图49是在操作的第一和第二阶段期间钳夹构造和凸轮板的立体图，图示出迫使钳夹分开的分离件；
图50是在操作的第一和第二阶段期间钳夹构造和凸轮板的平面俯视图，图示出迫使钳夹分开的分离件；
图51是在操作的第三阶段期间钳夹构造和凸轮板的平面俯视图，图示出血管附近装载的夹子的成形；以及
图52是成形在血管附近并且密封血管的夹子的立体图。
从结合附图的以下详细描述中，本公开的其他特征将变得明显，所述附图通过示例图示出了本公开的原理。
具体实施方式
现在将参照附图详细描述根据本公开的手术施夹器的实施例，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，如当涉及手术器械上的相对定位时所常用的，术语“近侧”指的是器械靠近用户的一端，而术语“远侧”指的是器械的远离用户的端。
参照图1，附图标记100表示本公开的手术施夹器的实施例。为了简要，本公开集中在手术施夹器100的关节式运动机构和施夹端机构上。2005年10月7日提交的7，637，917号美国专利详细描述了可以包含本公开的关节式运动机构和施夹端机构的手术施夹器的构造和操作，其全文通过引用合并于此。
施夹器100包括手柄组件200和从手柄组件200向远侧延伸的关节式运动内窥镜部或者轴组件300。现在参照图5、图5A、图5B至图8，示出了手术施夹器100的手柄组件200。手柄组件200包括具有第一或者右侧半部分202a和第二或者左侧半部分202b的壳体202。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。手柄组件200的壳体202可以由适当的塑料材料形成。
如在图1至图15中看到的，轴组件300包括第一管状构件302和第二管状构件或者末端执行器500。第一管状构件302限定第一纵轴线“X1”，并且末端执行器500限定第二纵轴线“X2”。末端执行器500定位在第一管状构件302的远侧。第一管状构件302和末端执行器500通过共同的枢转轴线“Z”可枢转地相互连接。共同的枢转轴线“Z”大致上与第一纵轴线“X1”和第二纵轴线“X2”均垂直。轴组件300及其部件可以由诸如不锈钢、钛、塑料等类似的适当的生物相容性材料形成。
如图5所示，第一管状构件302具有旋转机构304和关节式运动机构320。旋转机构304使得第一管状构件302绕着第一纵轴线“X1”相对于壳体202旋转。旋转机构304包括外管310和可旋转地联接至壳体202的旋转球形柄306。旋转球形柄306被支撑在壳体半部分202a、202b之间。
如图5和图6所示，外管310至少部分地由旋转球形柄306支撑，并且外管310具有近侧端310a和远侧端310b。外管310限定管腔312和一对开口314，管腔312纵向地贯穿外管310，一对开口314形成在外管310的近侧端310a附近。参照图20和图21，旋转球形柄306具有延伸进入外管310的开口314中并且与开口314接合的一对凸块307。在使用中，如图1所示，旋转球形柄306的旋转使得外管310绕着第一纵轴线“X1”旋转并且因此引起整个轴组件300的旋转。
如图5A所示，施夹器100包括可操作地连接至扳机208的传动组件220。传动组件220至少部分地定位在手柄组件200的壳体202内并且贯穿第一管状构件302且至少部分地延伸进入末端执行器500中。传动组件220能够将平移力和旋转力传递给末端执行器500。
扳机208可操作地连接至连杆210。连杆210可以连接至电动机212，而电动机212与传动构件226相连接。传动构件226经由使得传动杆222相对于传动构件226旋转的联接件230可旋转地联接至传动杆222的近侧端222a。
传动杆222可以具有圆柱形形状并且可以至少部分地沿着第一管状构件302延伸。额外地参照图44，传动组件220包括安装至传动杆222的远侧端222b的柔性传动线缆224。传动线缆224从传动杆222向远侧延伸并且进入末端执行器500中。可以构想为传动线缆224可以具有非圆形的横截面形状。
如图5至图5B所示，施夹器100进一步包括定位机构530。定位机构530与传动组件220可操作地连接以为末端执行器500的远侧部或者夹子钉仓件550提供旋转力。如图5A所示，定位机构530包括旋转球形柄306、部分传动杆222和部分传动线缆224。
传动杆222包括与旋转球形柄306中的孔径242互补的波状外形外表面或者成型带232。孔径242的尺寸稍大于传动杆222的成型带232。大尺寸的孔径242允许传动杆222纵向移动通过孔径242。传动杆222能够在第一管状构件302内自由旋转，这允许传动杆222从旋转球形柄306接收旋转力并将旋转力传送给传动组件220的近侧部。
如图5所示，施夹器100包括使第一管状构件302与末端执行器500可操作地连接的关节式运动机构320。关节式运动机构320为末端执行器500提供枢转力，以使得末端执行器500以相对于第一纵轴线“X1”呈多达大约90°的角度绕着枢转轴线枢转。
如图6和图12至图18所示，关节式运动组件320包括关节式运动球形柄322，关节式运动球形柄322由旋转球形柄306可旋转地支撑并且从旋转球形柄306向远侧突出(图5A)。参照图21，关节式运动球形柄322具有内螺纹324，内螺纹324定尺寸为容纳关节式运动螺杆330的外螺纹332(图8)并与外螺纹332互补。如图8所示，关节式运动螺杆330包括第一或者右旋半部分330a和第二或者左旋半部分330b。每个部分330a、330b均具有从内弯曲表面336向内径向突出的凸块334。每个凸块334延伸通过限定在外管310中的狭缝316(图6)并且进入关节式运动柱塞340的径向凹部342中(图7)。
关节式运动组件320包括关节式运动柱塞340，关节式运动柱塞340在近侧端340a和外管310之间延伸，近侧端340a位于关节式运动螺杆330的凸块334的近侧。关节式运动柱塞340限定管腔346，管腔346定尺寸为允许传动杆222通过其中。关节式运动柱塞340终止于具有蘑菇形头部344的远侧端340b。蘑菇形头部344具有比近侧部344a较大的远侧部344b。
参照图6至图7和图9至图11，施夹器100包括轴350，轴350限定具有近侧端350a的近侧部352、具有远侧端350b的远侧部354和中央部分350c。轴350的形状是半圆柱形以允许传动杆222沿着其通过，并且在外管310内纵向地延伸。如图4所示，除中央部分350c外，轴350的近侧端350a和远侧端350b在相反的横向方向上弯曲。轴350限定远侧孔径和近侧孔径，远侧孔径使得远侧部354与中央部分350c相分离，近侧孔径使得近侧部352与中央部分350c相分离。轴350的远侧孔径定尺寸和构造为将关节式运动柱塞340的头部344的远侧部334b容纳在其中并且远侧部形成弧，所述弧定尺寸和构造为松弛地设置在关节式运动柱塞340的头部344的远侧部344b附近。
如图11所示，轴350的近侧部352使得轴350与齿条360可拆卸地联接。齿条360的近侧端362a形成在蘑菇形尾部362中。蘑菇形尾部362的近侧端362a大于蘑菇形尾部362的远侧端362b。轴350的近侧孔径定尺寸为将蘑菇形尾部362的近侧端362b容纳在其中。轴350的近侧部352形成弧，所述弧定尺寸为松弛地设置在齿条360的蘑菇形尾部362的远侧端362b附近。
如图11所示，齿条360包括圆柱形部分363和近侧端362b，近侧端362b紧邻圆柱形部分363布置并且定尺寸为稍小于外管310的内径。如图17所示，圆柱形部分363可以具有周边附近的一个或者多个凹部364，凹部364定尺寸为将O形密封件382容纳在其中。O形密封件382能够变形以填充齿条360的圆柱形部分363和外管310的内径之间的空间以大致密封第一管状构件302的远侧部。
如图11所示，齿条360限定沿着第一纵轴线“X1”的中央通道365，中央通道365定尺寸为允许传动线缆226通过其中。齿条360的远侧部366具有矩形横截面。参照图12和图14，远侧部366定尺寸为安装通过螺旋弹簧380的纵向中心。弹簧380具有定尺寸为稍小于齿条360的圆柱形部分363的外径。其结果是，防止弹簧超出齿条360的圆柱形部分363向近侧通过。
如图11和图12所示，齿条360的远侧部366包括至少两个突起367和一组纵向排列的线性轮齿368。两个突起367从近侧部366在相反的方向上向外延伸并且排列和定尺寸为放置在限定在端盖390的内表面392中的狭缝391中。如图12所示，端盖390具有右旋侧盖390a和左旋侧盖390b。端盖390的外近侧部393限定这样的外径：所述外径定尺寸为使得端盖390能够被按压进外管310的远侧端310b中，并且在端盖390和外管310之间建立静配合。
端盖390的内表面392具有定尺寸为稍大于齿条360的矩形横截面的矩形形状，以允许齿条360在其中至少部分地纵向移动。端盖390的近侧端394a定尺寸为小于弹簧380以为弹簧380提供偏置表面。如图14和图15所示，弹簧380插置在圆柱形部363的远侧表面363a和端盖390的近侧端394a之间以向近侧偏置齿条360。
如图12和图16所示，端盖部390a、390b的内表面392限定三个圆形凹部396a、396b和396c系列。三个圆形凹部396a、396b和396c中的每一个通过端盖部分392a、392b中的每个以孔径397a、397b和397c为中心。
如上所述，齿条360位于外管310内并且延伸进端盖390中。齿条360构造为沿着第一纵轴线“X1”往复运动。齿条360的近侧位置和远侧位置由位于端盖390的相应狭缝391内的两个突起367限定。作用于狭缝391的近侧端391a的齿条360的两个突起367限定齿条360的最近侧位置。作用于狭缝391的远侧端391b的齿条360的两个突起367限定齿条360的最远侧位置。
虽然齿条360包括一对相对纵向布置的轮齿368，轮齿368与相应的齿轮组和配合构造相啮合，出于简要的目的此处将仅描述齿条360的单组轮齿368和相应的单个齿轮组和配合构造。如图12至图18所示，齿条360具有在远侧部366的相对侧上的一对纵向布置的轮齿368。纵向布置的轮齿368由远侧部366中的凹部369限定，凹部369使得远侧部366形成为“I”形梁，其中纵向布置的轮齿368沿着在相反方向上延伸的“I”形梁的凸缘的内部形成。纵向布置的轮齿368与支撑在端盖390中的第一齿轮420紧密接触。
如图12A所示，第一齿轮420限定中央孔径421、圆形底座422、第一组圆形轮齿423和第二组圆形轮齿424。第一组圆形轮齿423在直径上小于第二组圆形轮齿424并且堆叠在第二组圆形轮齿424上。圆形底座422形成与第二组圆形轮齿424大致类似的外径。如图12所示，第一销410具有：头部410a，其大于第一齿轮420的孔径421；主体部410b，其在直径上稍小于中央孔径421；以及尾部410c，其定尺寸为允许第一销410压配合进盖390中的孔径397a中。尾部410c和盖390之间的静配合将尾部410c保持在孔径397a中并且将第一齿轮420至少部分地保持在端盖390的第一凹部396a内。齿条360的纵向布置的轮齿368和第一齿轮420相连接，以使得齿条360相对于第一齿轮420的纵向移动引起第一齿轮420在第一方向上的旋转运动。
第一齿轮420与齿轮组的第二齿轮430可操作地连接。如图12B所示，第二齿轮430限定中央孔径431、凸出底座432和圆形轮齿组433。凸出底座432的横截面形状是圆形的，并且具有大致小于圆形轮齿组433的外径。第二销411具有：头部411a，其大于孔径431；主体部411b，其在直径上稍小于中央孔径431；以及尾部411c，其定尺寸为允许第二销411压配合进盖390中的孔径397b中。尾部411c和盖390之间的静配合将尾部411c保持在孔径397a中并且将第二齿轮430至少部分地保持在端盖390的第二凹部396b内。第一齿轮420的第二圆形轮齿组424与第二齿轮430的圆形轮齿组433相互连接，以使得第一齿轮420在第一方向上的旋转运动引起第二齿轮430在第二方向上的旋转运动。
第二齿轮430与齿轮组的第三齿轮440可操作地连接。如图12c所示，第三齿轮440限定中央孔径441、圆形底座442和圆形轮齿组443。圆形底座442形成与圆形轮齿组443大致类似的外径。圆形底座442的高度与第二齿轮430的凸出底座432以及第一齿轮410的圆形底座422二者的高度大致相等。第三销412具有：头部412a，其大于孔径441；主体部412b，其在直径上稍小于中央孔径441；以及尾部412c，其定尺寸为允许第三销412压配合进盖390中的孔径397c中。尾部412c和盖390之间的静配合将尾部412c保持在孔径397c中并且将第三齿轮440至少部分地保持在端盖390的第二凹部396c内。第二齿轮430的圆形轮齿组433与第三齿轮440的圆形齿轮组444相互连接，以使得第二齿轮430在第二方向上的旋转运动引起第三齿轮440在第一方向上的旋转运动。
位于第三齿轮440远侧上的每个端盖部分392a、392b限定从端盖部分392a、392b的远侧部395b向内径向地延伸的圆形凸起物398。圆形凸起物398捕获末端执行器500的圆柱形远侧部522并将其紧固至第一管状构件302。
如图12所示，末端执行器500的圆柱形远侧部522具有转向节510。转向节510包括圆柱形远侧部522和分为两部分的近侧部514。分为两部分的近侧部514限定与第一纵轴线“X1”和第二纵轴线“X2”均垂直的枢转孔径511。枢转孔径511限定枢转轴线“Z”。枢转孔径511的横截面形状是圆形的，并且定尺寸为将圆形凸起物398容纳在其中。圆形凸起物398的尺寸和排列允许端盖部分392a、392b将转向节510夹在它们之间。圆形凸起物398突出进入圆形枢转孔径511中的结果是，末端执行器510能够绕着“Z”轴线枢转或者摆动。
转向节510的分为两部分的近侧部514包括与其整体形成的两个齿轮段516a、516b，齿轮段516a、516b绕着转向节510的近侧端510a向近侧延伸。每个齿轮段516限定弧形轮齿组517，弧形轮齿组517与第三齿轮440可操作地连接。
转向节510进一步限定通过其中央的管腔518，以及圆柱形远侧部522周围的圆形凹槽520。圆形凹槽520位于转向节510的远侧端510b的近侧。中央管腔518定尺寸为允许传动线缆224至少部分地通过其中并且至少部分地进入末端执行器500的夹子钉仓件550(图24和图27)中。
现在将参照图6至图21讨论关节式运动机构的操作。具体参照图20和图21，关节式运动球形柄322(图5)相对于旋转球形柄306和外管310的旋转通过使得关节式运动球形柄322的内螺纹324反作用于关节式运动螺杆330的外螺纹332而引起关节式运动螺杆330的纵向移动。关节式运动螺杆330通过凸块334相对于外管310可旋转地固定。结果，由于关节式运动球形柄322绕着关节式运动螺杆330旋转，关节式运动螺杆330仅能够纵向地移动。因此，关节式运动球形柄322在第一方向上的旋转引起关节式运动螺杆330在远侧方向上的移动，并且关节式运动球形柄322在第二方向上的旋转引起关节式运动螺杆330在近侧方向上的移动。
关节式运动螺杆330的轴向移动使得凸块334反作用于关节式运动柱塞340，以引起关节式运动柱塞340在相同方向上的纵向移动。关节式运动柱塞340的移动引起轴350的纵向移动并且依次地引起齿条360的纵向移动。
如上文所述，第一齿轮420与齿条360的线性轮齿368可操作地连接。具体参照图17和图18，随着齿条360被迫向近侧移动，第一齿轮420在第一方向上旋转，引起第二齿轮430在第二方向上旋转。第二齿轮430使得第三齿轮440在与第一齿轮420相同的方向上旋转。第三齿轮440反作用于齿轮段516，引起第二管状构件302绕着枢转轴线“Z”枢转。
如图1至图6所示，末端执行器500呈手术施夹器的形式并且构造为支撑夹子钉仓件550。如图27所示，夹子钉仓件550具有壳体或者底座部560和盖590。参照图28，壳体560包括近侧部561a和远侧部561b。壳体560的近侧部561a的形状是圆柱形并且限定贯穿其中的纵向通道562。纵向通道562与第二纵轴线“X2”同轴地定位，并且如图22和图23所示从定尺寸为容纳转向节510的圆柱形远侧部522的通道562的较大圆柱形部562a转变为与转向节510的中央管腔518同轴地定位的较窄或者较小部分562b。
现在参照图22至图23和图27至图28，壳体560的近侧部561a还限定了位于近侧部561a的近侧端560a的远侧的一对平行销孔563。所述一对销孔563是偏心地排列的，以使得所述一对销孔563中的每一个形成通过近侧部561a延伸进纵向通道562的较大圆柱形部562a并且贯通纵向通道562的较大圆柱形部562a的单一通道。每个孔563定尺寸为将销586容纳在其中，以产生销586在销孔563内的摩擦或者静配合。所述一对销孔563中的每一个定位成通过转向节510的圆形凹槽520对销586进行定位。结果，夹子钉仓件550被销586纵向地限制至转向节510，同时允许夹子钉仓件550绕着转向节510旋转。
如图28所示，壳体560的远侧部561b是从近侧部561a的垂直表面564向远侧延伸的半圆柱形构造。参照图28，半圆柱形远侧部561b具有：一对水平壁565，其部分地沿着远侧部561b延伸；第一凹入表面567；以及第二凹入表面568，其在一对水平壁565之间限定沿着壳体560的远侧部561b纵向延伸的凹部566。一对向内的突出锁定件569沿着第一凹入表面567延伸进入纵向延伸凹部566中，其中一个突出锁定件从各个水平壁565向内延伸。弹簧狭缝570沿着第二凹入表面568纵向地限定在弹簧狭缝570远侧的位置处。水平凹部571沿着第二凹入表面568径向地限定在弹簧狭缝570远侧的位置处。两个制动件572沿着远侧端560b从第二凹入表面568突出并且限定水平壁565和制动件572之间的一对纵向开口574a、574b，以及两个制动件572之间的远侧开口573。壳体560的远侧部561b成形和定尺寸为与盖590相配合。
如图27所示，夹子钉仓件550包括壳体560和盖590之间的多个或一系列的夹子或紧固件580、凸轮弹簧600、凸轮板610、钳夹构造620、块构件640、进给杆650、夹子承载器660、夹子输出器670和输出器弹簧680。
多个手术夹子580保持在夹子钉仓件550内以施加至组织。如图27所示，每个夹子580具有从后跨部581延伸出的一对支腿582a、582b，并且限定大致上平行于一对支腿582a、582b延伸的夹子轴线“W”。夹子580相互邻近地定位以形成成角度的堆叠。参照图42和图43，一系列紧固件或者夹子580布置在夹子钉仓件550内以与第二纵轴线“X2”形成0°至90°之间但是不包括0°和90°的角度。一系列夹子580沿第二纵轴线“X2”堆叠起来或者相对于第二纵轴线“X2”呈一定角度堆叠，并且以与第二纵轴线“X2”偏置平行的方式延伸。夹子580的形状可以是U形、V形或者一些其他形状。
如图48至图51所示，夹子钉仓件550包括钳夹闭合机构532，钳夹闭合机构532包括凸轮板610，钳夹闭合机构532通过块构件640与传动组件220相连接以为钳夹构造620提供接近力。
参照图27和图29，凸轮板610限定近侧部610c和凸轮或远侧部610d。狗骨形(dog bone shaped)孔径611限定在近侧部610c中，并且凸轮孔径614限定在凸轮部610d中。凸轮板610具有：指状件612，其垂直于凸轮板610的顶/底表面延伸；以及一对制动件613，其沿着凸轮部610的侧边缘从凸轮部610c向外延伸。
凸轮孔径614大致是“V”形的。“V”形凸轮孔径614限定延伸进孔径的中央内的凸出物或者分离件615，以及沿着孔径的外边缘的一对凸轮表面616。参照图30和图49至图51，凸轮孔径614与从钳夹构造620垂直地延伸出的一对柱621相配合。每个柱621包括头部622，头部622起到将凸轮板610和钳夹构件620紧固在一起以保持两个部件之间的接触的作用。
参照图37，凸轮板610沿着壳体560的第二凹入表面568定位。凸轮板610的制动件613通过壳体560的纵向开口574a、574b径向地向外延伸，以将凸轮板610的纵向移动限定为开口574a、574b的长度。凸轮板610的近侧部610c定尺寸为装配进壳体560的纵向延伸凹部566中。当凸轮板610处于相对于壳体560最远侧的位置上时，在第二凹入表面568和凸轮板610的近侧端610a之间形成了间隙575。指状件612定尺寸为定位在壳体560的弹簧狭缝570(图28)内。在使用中，凸轮板610的纵向移动使得凸轮孔径614相对于钳夹构造620的柱621移动。
参照图38，凸轮弹簧600定位在壳体560的弹簧狭缝570内，以使得凸轮板610的指状件612布置在凸轮弹簧600的远侧。
参照图27和图30，钳夹构造620包括锁定翼片623、一对支腿625和一对钳夹626。一对锁定凹部628限定在锁定翼片623和一对支腿625之间。锁定凹部628从其侧边缘向内延伸以形成一对锁定肩部624。参照图36，锁定凹部628通过为向内突出的锁定件569提供空间而起到沿着壳体560的第一凹入表面567紧固钳夹构造620的作用。向内突出的锁定件569作用在锁定块623以及锁定肩部624上以防止钳夹构造620相对于壳体560纵向移动。
一对支腿625中的每一个从平行于第二纵轴线“X2”的相应的锁定肩部624向近侧延伸。一对钳夹626形成在支腿625的远侧端处并且包括第一钳夹626a和第二钳夹626b。各个钳夹626从相应的支腿635以一定的角度延伸出以与第二纵轴线“X2”形成一定角度。各个夹子580的夹子轴线“W”大致上平行于第一钳夹626a和第二钳夹626b中的每一个的纵轴线。每个钳夹626限定沿着内部分的凹槽627，凹槽627定尺寸为将夹子支腿582a、582b的部分容纳在其中。夹子支腿582a、582b的一个保持在第一钳夹626a的凹槽627中，并且夹子支腿582a、582b中的另一个保持在第二钳夹626b的凹槽627中。
钳夹组件或者构造620支撑在盖590上并且从盖590和壳体560之间向远侧延伸。钳夹构造620包括能够在间隔开的位置和接近后的位置之间移动的第一钳夹626a和第二钳夹626b。
参照图27和图31，凸轮板614的移动是由块构件640提供的。参照图31，块构件640包括：一对滑轨644，其从块构件640的表面延伸出；以及指状件642，其在靠近块构件640的远侧端640b的位置处从与滑轨644相对的表面延伸出。指状件642定尺寸为在钳夹支腿624和625之间延伸并且延伸进入凸轮板610的狗骨形孔径611中。
参照图31和图44至图45，块构件640的近侧端640a与传动线缆224的远侧端224b相连接。结果，传动线缆224的推进或者收缩相应地使得块构件640沿着第二纵轴线“X2”推进或者收缩。块构件640的近侧移动或收缩将使得其指状件642紧靠凸轮板610的狗骨形孔径611的近侧端611a并且将依次向近侧拉动凸轮板610。在近侧位置上，如图49和图50所示，凸轮孔径614呈现为凸轮板610的分离件615，其具有钳夹构造620的柱621之间的锥形端615a以分离柱621和打开钳夹626。
同时，块构件640的远侧移动或者推进将使得指状件642紧靠凸轮板610的狗骨形孔径611的近侧端611a并且将依次向远侧推动凸轮板610。在远侧位置上，如图51所示，凸轮板610的凸轮孔径614的凸轮表面616迫使钳夹构件620的柱621一起闭合钳夹626。指状件642的纵向长度小于狗骨形孔径611的长度，从而允许块构件640的指状件642在与凸轮板610接合和使得凸轮板610移动之前移动预定的距离。
参照图27和图32，为相对于盖590的纵向移动设置了进给杆650以将各个夹子580推进钳夹626中。如图32所示，为了利于将夹子580插入钳夹626中，进给杆650在其远侧端650b上设置有推件652，推件652构造为将单个夹子580推出一叠夹子580以及推进钳夹626中。
推件652定尺寸为和定形为选择性地将夹子580的最远侧的夹子“C1”(图42和图43)接合/移动(即向远侧推进)到钳夹626中。进给杆限定沿着其各个侧边缘的一对凹部654a、654b，一对凹部654a、654b定尺寸为和定形为容纳块构件640的滑轨644a、644b以与进给杆650和块构件640相配合。回到图44至图48，应当理解的是块构件640的移动引起进给杆650在相同方向上以及相同量值的移动。
参照图27和图39至图41，进给杆650可滑动地布置在夹子承载器660下方。夹子承载器660定形和定尺寸为将多个手术夹子580保持在其上。应当注意的是，夹子承载器660和钳夹构造620不会相对于壳体560纵向地移动。
参照图33，夹子承载器660包括定尺寸和定形为将进给杆650的推件652容纳在其中的一对远侧狭缝664。夹子承载器660形成有“帽”形横截面轮廓，包括中央平台667、从中央平台667向下突出的两个垂直壁666和从各个垂直壁666向外突出的水平壁665。水平壁665中的每一个包括沿着外边缘向上突出的两个纵向间隔的保持架661。每个保持架661限定贯穿其的开口662。远侧端660b附近的斜面部分668使得中央平台667短于水平壁665。
如图40所示，夹子承载器660的近侧端660a紧靠壳体560的垂直表面564定位，并且水平壁665位于壳体560的水平壁565上。斜面部分668使得夹子承载器660在钳夹构造620的支腿625的展开部分629上部分地延伸。斜面部分668相对于第二纵轴线“X2”形成与钳夹626大致相同的角度。
参照图27、图34和图40，夹子输出器670位于夹子承载器660的顶部上。如图34所示，夹子输出器670包括用于与一叠夹子580相接合的紧靠表面672，并且包括用于在夹子承载器660附近接合的两个臂674a、674b。夹子输出器670包括定尺寸为装配在输出器弹簧680内部的近侧延伸柱676。参照图42，夹子输出器670位于夹子承载器660上的一叠夹子580后方，以随着最远侧的夹子被发射出而推进一叠夹子580通过手术施夹器100。
夹子输出器670被输出器弹簧680向远侧偏置以沿着夹子承载器660向远侧推进一叠夹子580。盖590压在夹子承载器660上并且构造为将输出器670、输出器弹簧680和一叠夹子580保持在其中以及引导输出器670、输出器弹簧680和一叠夹子580的推进。
如图27和图35所示，夹子钉仓件550的盖590具有鼻状部592和大致为半圆柱形的主体591。两对紧固的突起593沿着盖590的半圆柱形主体591的各侧径向地向外延伸。各个紧固突起593定尺寸为和定形为装配进夹子承载器660的保持架661中的开口662以及通过所述开口662突出。盖590限定沿着其的纵向通道595。
参照图45，如上文在图40至图43中的夹子承载器660的堆叠方式所示的，夹子承载器660形成细长的夹子凹槽，其中盖590的纵向通道595的内表面用于保持多个夹子580。为了引导夹子580沿着夹子凹槽横穿并且进入钳夹626中，沿着鼻状部592在盖590的远侧端590b处设置有斜的内表面596以协助引导手术夹子580进入钳夹626中。盖590的近侧端590a定形为紧靠壳体560的垂直表面564。
参照图44至图48，现在将讨论夹子钉仓件550的操作。初始地，钳夹626定位在组织“V”附近。如图44所示，扳机208(见图5A)的致动引起传动组件220(见图5A)和传动杆222的远侧移动，由方向箭头“a”表示。传动杆222的远侧移动引起传动线缆224的远侧推进，这依次引起块构件640的推进，由方向箭头“b”表示。参照图45，块构件640的远侧移动引起进给杆650的远侧推进，由方向箭头“c”表示。随着块构件640向远侧移动，其指状件642紧靠着狗骨形凹部611的宽度减小部以向远侧推动进给杆650。随着进给杆650向远侧推进，如图46中的方向箭头“d”所示，进给杆650的推件652向远侧并且在钳夹构件626之间推动最远侧的夹子“C1”。在块构件640的进一步推进期间，如图40和图50所示，块构件640的指状件642沿着凸轮板610的狗骨形凹部611行进从而使得凸轮板610在最远侧位置上保持静止。
参照图47和图48，最远侧的夹子“C1”装载在钳夹构件626中，作为扳机208的释放结果的传动杆222的收缩，由方向箭头“g”表示，引起块构件640和进给杆650的推件652的收缩或近侧移动，如方向箭头“e”所示。随着进给杆650回到初始或者起动位置，推件652通过推件652的横跨在一叠夹子580中的下个夹子上的斜边缘653朝向于夹子钉仓件550的中央被向下推进。参照图48，斜边缘653还使得推件652定位在夹子承载器660下方，同时块构件640从初始的起动位置持续地向近侧移动，由方向箭头“h”表示。随着块构件640从初始的起动位置向近侧移动，指状件642紧靠并作用于狗骨形凹部611的宽度减小部以迫使凸轮板610向近侧移动，由方向箭头“i”表示。随着凸轮板610向近侧移动，凸轮板610的指状件612向近侧移动，由方向箭头“j”表示，以按压凸轮弹簧600，由方向箭头“k”表示。
参照图49至图52，将描述夹子“C1”在血管附近的成形。在图49中示出了如上文所述的互相连接的凸轮板610和钳夹构件626。通过将钳夹626中装载夹子“C1”且放置在血管附近，通过使块构件640向近侧移动来向近侧推进凸轮板610，以使得钳夹626的凸轮表面616(见图27)作用于钳夹构造626的柱621。随着凸轮孔径614的凸轮表面616紧靠在钳夹构造626的各个柱621上，如图52所示，将柱621一起推进以在血管附近形成夹子“C1”。
随着扳机208持续地打开以收回传动杆222，块构件640在近侧方向上被进一步地拉动直至其指状件642被拉动穿过凸轮板610的狗骨形凹部611的宽度减小部，此时允许凸轮弹簧600展开并且作用于凸轮板610的指状件612上以使凸轮板610向远侧移动并且打开钳夹构件626。
通过这种方式，扳机208的一个完整的冲程使得将夹子“C1”进给入钳夹626中以及通过钳夹626使装载的夹子成形。能够通过使末端执行器500的第二纵轴线“X2”与轴组件300的第一管状构件320的第一纵轴线“X1”轴向地对准或者呈一定角度来实现这种发射顺序。
应该理解的是，之前的描述仅仅是本公开的示例性描述。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某些实例。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、方法和技术也包括在本公开的范围内。

Claims (17)

1.一种用于可操作地连接至手术手柄组件的末端执行器，所述手术手柄组件包括可轴向往复运动的传动组件，所述传动组件具有可操作地连接至所述末端执行器的柔性传动线缆，所述末端执行器包括；
远侧壳体部，其限定近侧端、远侧端和纵轴线；
转向节部，其从所述远侧壳体部的近侧端向近侧延伸，所述转向节部分成第一齿轮部和第二齿轮部，所述远侧壳体部可旋转地安装至所述转向节部以使得所述远侧壳体部相对于所述转向节部绕着所述纵轴线旋转；
近侧壳体部，其可枢转地连接至所述转向节部；
齿轮联，其支撑在所述近侧壳体部中，其中，所述齿轮联的最远侧齿轮与所述转向节部的所述第一齿轮部和所述第二齿轮部可操作地啮合；
钳夹组件，其支撑在所述远侧壳体部上，所述钳夹组件包括从所述远侧壳体部向远侧延伸并且能够在间隔开的位置和接近后的位置之间移动的第一钳夹和第二钳夹；
多个手术夹子，其以部分堆叠的方式装载在所述远侧壳体部中；以及
钳夹闭合机构，其布置在所述远侧壳体部中并且与所述钳夹组件和所述多个手术夹子可操作地关联，
其中，当所述远侧壳体部的所述纵轴线与手术手柄的纵轴线轴向地对齐或者呈一定角度时，所述柔性传动线缆的远侧端连接至所述钳夹闭合机构以传送操作力至所述钳夹闭合机构；并且
其中，所述钳夹闭合机构将夹子进给入所述钳夹组件中，并且在所述柔性传动线缆的完成单个冲程时形成进给的夹子。
2.根据权利要求1所述的末端执行器，进一步包括齿条，所述齿条可滑动地支撑在所述近侧壳体部中，其中，所述齿条限定至少一轴向行的齿轮轮齿，并且其中，轴向行的齿轮轮齿与所述齿轮联的最近侧齿轮相啮合。
3.根据权利要求2所述的末端执行器，其中，所述齿条相对于所述近侧壳体部的轴向位移引起所述远侧壳体部相对于所述近侧壳体部的关节式运动。
4.一种用于将手术夹子施加到身体组织的末端执行器，所述末端执行器包括：
限定近侧端、远侧端和纵轴线的底座部；
转向节部，其从所述底座部的近侧端向近侧延伸，所述转向节部分成第一齿轮部和第二齿轮部，所述底座部可旋转地安装至所述转向节部以使得所述底座部相对于所述转向节部绕着所述纵轴线旋转；
近侧壳体部，所述近侧壳体部连接至转向节部以使得底座部能够相对于所述近侧壳体部离轴地枢转，其中，所述近侧壳体部支撑在其远侧区域中的齿轮联，并且其中，所述齿轮联的最远侧齿轮与所述转向节部的所述第一齿轮部和所述第二齿轮部可操作地啮合；
钳夹组件，其从所述底座部向远侧延伸，所述钳夹组件包括能够在间隔开的位置和接近后的位置之间移动的第一钳夹和第二钳夹；以及
多个紧固件，其位于所述底座部内，所述多个紧固件中的每个均具有从后跨部延伸出的一对支腿，所述多个紧固件中的每个均限定在大致上平行于所述一对支腿的方向上延伸的紧固件轴线，所述多个紧固件中的每个均布置在所述底座部内以形成所述紧固件轴线和所述纵轴线之间的角度，所述多个紧固件中的每个均邻近于所述多个紧固件中的另一个而定位以形成堆叠。
5.根据权利要求4所述的末端执行器，其中，所述转向节部包括限定枢转轴线的枢转构造。
6.根据权利要求4所述的末端执行器，进一步包括钳夹闭合机构，所述钳夹闭合机构可操作地连接至所述钳夹组件，所述钳夹闭合机构为所述第一钳夹和所述第二钳夹提供接近力。
7.根据权利要求4所述的末端执行器，其中，所述转向节部包括多个轮齿。
8.根据权利要求4所述的末端执行器，其中，所述多个紧固件相对于第二纵轴线在非共线的位置上堆叠。
9.根据权利要求4所述的末端执行器，其中，所述第一钳夹和所述第二钳夹相对于所述纵轴线呈一定角度。
10.根据权利要求9所述的末端执行器，其中，所述多个紧固件的支腿布置在与所述第一钳夹和所述第二钳夹大致平行的方位上。
11.根据权利要求4所述的末端执行器，其中，所述堆叠平行于所述纵轴线延伸。
12.根据权利要求4所述的末端执行器，进一步包括齿条，所述齿条可滑动地支撑在所述近侧壳体部的近侧区域中，其中，所述齿条限定至少一轴向行的齿轮轮齿，并且其中，轴向行的齿轮轮齿与所述齿轮联的最近侧齿轮相啮合。
13.根据权利要求12所述的末端执行器，其中，所述齿条相对于所述近侧壳体部的轴向位移引起所述底座部相对于所述近侧壳体部的关节式运动。
14.一种用于可操作地连接至手术手柄组件的末端执行器，所述手术手柄组件包括可轴向往复运动的传动组件，所述传动组件具有可操作地连接至所述末端执行器的柔性传动线缆，所述末端执行器包括：
远侧壳体部，其限定近侧端、远侧端和纵轴线；
近侧壳体部，其限定近侧端、远侧端和纵轴线；
转向节部，其使得所述远侧壳体部的所述近侧端与所述近侧壳体部的所述远侧端相互连接，其中，所述转向节部允许所述远侧壳体部相对于其旋转以及所述远侧壳体部相对于所述近侧壳体部做关节式运动，所述转向节部分成第一齿轮部和第二齿轮部；
齿轮联，其支撑在所述近侧壳体部中，其中，所述齿轮联的最远侧齿轮与所述转向节部的所述第一齿轮部和所述第二齿轮部可操作地啮合；
钳夹组件，其支撑在所述远侧壳体部的所述远侧端中，所述钳夹组件包括能够在间隔开的位置和接近后的位置之间移动的第一钳夹和第二钳夹；以及
多个紧固件，其装载在所述远侧壳体部内，所述多个紧固件中的每个均具有从后跨部延伸出的一对支腿，所述多个紧固件中的每个均限定在大致上平行于所述一对支腿的方向上延伸的紧固件轴线，所述多个紧固件中的每个均布置在所述远侧壳体部内以使得所述紧固件轴线相对于所述远侧壳体部的所述纵轴线呈一定角度布置，并且其中，所述多个紧固件成叠地布置。
15.根据权利要求14所述的末端执行器，进一步包括钳夹闭合机构，所述钳夹闭合机构可操作地连接至所述钳夹组件，所述钳夹闭合机构通过其相对于所述第一钳夹和所述第二钳夹的近侧移动为所述第一钳夹和所述第二钳夹提供接近力。
16.根据权利要求15所述的末端执行器，其中，所述钳夹闭合机构包括凸轮板，所述凸轮板轴向可滑动地支撑在所述远侧壳体部中，其中，所述凸轮板包括形成于其中的凸轮孔径，其中，所述凸轮孔径具有大致“V”形轮廓，并且其中，所述第一钳夹和所述第二钳夹中的每个均包括从其延伸出并且延伸进所述凸轮板的凸轮孔径中的柱；
其中，所述凸轮板相对于所述第一钳夹和所述第二钳夹向近侧移动使得对着所述第一钳夹和所述第二钳夹的凸块接合所述凸轮孔径的边缘，以使所述第一钳夹和所述第二钳夹接近。
17.根据权利要求16所述的末端执行器，其中，所述凸轮板包括向远侧延伸进所述凸轮孔径中的突起；其中，所述凸轮板相对于所述第一钳夹和所述第二钳夹向远侧移动使得在所述第一钳夹和所述第二钳夹的所述凸块之间接合所述凸轮孔径的所述突起，以使所述第一钳夹和所述第二钳夹分离。
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