CN103371858B - 内窥镜手术设备 - Google Patents
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Abstract
本发明公开了一种内窥镜手术设备。本发明的手术系统具有包括多个紧固件、砧座和用来推动致动滑块的传动梁的钳夹组件。传动螺杆驱动所述传动梁运动。细长主体配置为与所述钳夹组件相连接。传动连杆将挠性传动轴连接到所述传动螺杆上,所述传动连杆偏离轴线布置。所述钳夹组件和细长主体是彼此可分离的。
Description
相关申请的交叉引用
本申请是提交于2011年10月25日,序列号为13/280,859的美国专利申请的一个部分延续申请案,又是提交于2011年10月25日,序列号为13/280,898的申请的一个部分延续申请案。这些申请中的每一个申请,其全部内容通过引用合并于此。
技术领域
本公开涉及用于进行内窥镜检查手术的手术设备、装置和/或系统以及它们的使用方法。更具体地,本公开涉及机电的、手持式手术设备、装置和/或系统,其被配置为与可拆卸的可抛弃式装载单元和/或单次使用的装载单元一起使用,用来夹紧、切割和/或吻合组织。
背景技术
若干手术装置的生产商已经开发出具有适用于操作和/或操纵机电手术装置的专用驱动系统的产品线。在许多实例中,所述机电手术装置包括可重复使用的手柄组件,以及可抛弃式使用或单次使用的装载单元。在使用前,所述装载单元可以选择性地连接到所述手柄组件上,然后,在使用后,再与所述手柄组件断开连接,以便被处置或在一些实例中被消毒以重复使用。
这些机电手术装置中有许多对于制造、购买和/或操作来说都是相对昂贵的。开发对于制造、购买和/或操作来说是相对廉价的机电手术装置,是制造商和终端用户始终如一的愿望。因此,存在具有改进后的机械连杆组的机电手术设备、装置和/或系统的需求。
发明内容
参照附图,以下会更详细地描述本发明示例性实施例的更多细节和方案。
在本公开的一个方案中,手术系统包括钳夹组件和具有外壳的手柄组件,所述钳夹组件包括:可拆卸的钉仓组件,所述钉仓组件包括多个紧固件和被限定在其中的纵向狭槽;砧座,其上具有紧固件成形表面,所述钉仓组件和砧座安装成在打开位置和密切配合对齐以夹紧组织的闭合位置之间相对彼此运动;致动滑块,其被支撑在所述钉仓组件内,所述致动滑块是可移动的用来推动多个紧固件远离所述钉仓;传动梁,其包括竖直支柱和被支撑在所述竖直支柱上的凸轮构件,所述凸轮构件安置成相对于所述砧座平移,用来在发射紧固件的过程中将所述砧座保持在闭合位置处,且所述竖直支柱安置成与所述致动滑块邻接;以及传动螺杆,其被支撑在所述可拆卸钉仓组件内,所述传动螺杆具有螺纹部分,其中,所述传动梁可以螺纹联接到所述传动螺杆的所述螺纹部分上,使得所述传动螺杆的旋转会驱动所述传动梁纵向运动。所述手术系统还包括被配置为将所述手柄外壳与钳夹组件连接起来的细长主体,所述细长主体包括将所述传动螺杆机械联接到所述手柄组件的致动轴上的挠性传动轴,其中,所述传动轴会将致动轴的旋转运动传递到所述传动螺杆上,所述细长主体包括柔性部分,且其中,所述挠性传动轴容纳在所述柔性部分中。
在某些实施例中,所述手术系统的柔性部分包括多个联锁段。传动连杆可以将所述挠性传动轴与传动螺杆连接起来。所述传动螺杆限定了第一纵向轴线而所述挠性传动轴限定了第二纵向轴线,且所述传动连杆相对于所述第一和第二纵向轴线偏离布置。
在某些实施例中,所述传动连杆包括与所述挠性传动轴机械联接的近侧接合部分和与所述传动螺杆机械联接的远侧接合部分。所述近侧接合部分可以包括承窝,其结构和尺寸可与布置在所述挠性传动轴远端处的球窝接头机械接合。所述远侧接合部分可以包括销钉,其结构和尺寸可与布置在所述传动螺杆近端处的U形夹机械接合。
在某些实施例中,所述手术系统包括手术用支撑件,其可释放固定在所述砧座或吻合钉钉仓中至少其中之一的组织接触表面上,其中,所述手术用支撑件通过至少一个锚定件固定到所述砧座组件和钉仓组件中至少其中一个上,且其中,所述砧座组件和钉仓组件中至少其中一个限定了用于接收所述至少一个锚定件的端部的侧向狭槽,以及释放组件,其被布置在所述砧座组件或钉仓组件中至少其中一个内。
所述传动螺杆可以被配置为致动所述释放组件,从而释放所述锚定件且从所述砧座组件和钉仓组件中至少其中一个上除去所述手术用支撑件。所述释放组件可以进一步包括在致动所述传动组件之前延伸穿过所述纵向狭槽的第一杆,以及可操作地连接到所述第一杆上且可由所述第一杆致动的第二杆,所述第二杆的端部在致动所述传动组件之前至少部分伸进所述侧向狭槽中。
在本公开的又一个方案中,手术系统包括具有外壳的手柄组件和与细长主体远端邻接的钳夹组件,所述钳夹组件包括:钉仓组件,所述钉仓组件包括多个紧固件和被限定在其中的纵向狭槽;砧座,其上具有紧固件成形表面,所述钉仓组件和砧座安装成在打开位置和密切配合对齐以夹紧组织的闭合位置之间相对彼此运动;致动滑块,其被支撑在所述钉仓组件内,所述致动滑块是可移动的用来推动多个紧固件远离所述钉仓;传动梁,其包括竖直支柱和被支撑在竖直支柱上的凸轮构件,所述凸轮构件安置成相对于所述砧座平移,以在发射紧固件的过程中将所述砧座保持在闭合位置处,且所述竖直支柱安置成与所述致动滑块邻接;以及传动螺杆,其限定了第一纵向轴线且被支撑在所述钉仓组件内,所述传动螺杆具有螺纹部分,其中,所述传动梁可以螺纹联接到所述传动螺杆的所述螺纹部分上,使得所述传动螺杆的旋转会驱动所述传动梁纵向运动。所述器械还具有被配置为将所述手柄组件与钳夹组件连接起来的细长主体,所述细长主体包括可将所述传动螺杆机械联接到所述手柄组件的致动轴上的挠性传动轴,其中,所述传动轴会将致动轴的旋转运动传递到所述传动螺杆上。传动连杆可以将所述挠性传动轴与传动螺杆连接起来,且所述传动连杆相对于所述第一和第二纵向轴线偏离布置。
所述手术系统的细长主体可以包括容纳挠性传动轴的柔性部分。所述柔性部分可以包括多个联锁段。所述传动连杆可以包括与所述挠性传动轴机械联接的近侧接合部分和与所述传动螺杆机械联接的远侧接合部分。所述近侧接合部分包括承窝,其结构和尺寸可与布置在所述挠性传动轴远端处的球窝接头机械接合。所述远侧接合部分包括销钉,其结构和尺寸可与布置在所述传动螺杆近端处的U形夹机械接合。
在某些实施例中,在所述砧座或吻合钉钉仓至少其中之一的组织接触表面上可释放地固定手术用支撑件,其中,通过至少一个锚定件将所述手术用支撑件固定到所述砧座组件和钉仓组件中至少其中一个上,且其中,所述砧座组件和钉仓组件中至少其中一个限定了用于接收其中所述至少一个锚定件的端部的侧向狭槽。释放组件被布置在所述砧座组件或钉仓组件中至少其中一个内部。
所述传动螺杆可以被配置为致动所述释放组件,从而释放所述锚定件且从所述砧座组件和钉仓组件中至少其中一个上除去所述手术用支撑件。所述释放组件进一步包括在致动所述传动组件之前延伸穿过所述纵向狭槽的第一杆,以及可操作地连接到所述第一杆上且可由所述第一杆致动的第二杆,所述第二杆的端部在致动所述传动组件之前至少部分伸进所述侧向狭槽中。
所述手术系统的手柄组件、钳夹组件和细长轴组件可以彼此分离。
在某些实施例中,所述系统包括:电源,其被配置用来提供电能;控制组件,其被配置用来接受至少一个用户输入;第一电机,其被联接到所述电源上且被配置为响应所述至少一个用户输入而运行;第二电机,其被联接到所述电源上且被配置为响应所述至少一个用户输入而运行;以及选择变速箱组件,其包括与所述挠性传动轴机械联接的至少一个齿轮元件,其中,所述第一电机配置为选择性地移动所述至少一个齿轮元件与所述第二电机相啮合,从而致动所述挠性传动轴。
在本公开的另一个方案中,手术系统包括手柄组件,所述手柄组件包括外壳和与细长主体远端邻接的钳夹组件,所述钳夹组件包括:钉仓组件,所述钉仓组件包括多个紧固件和被限定在其中的纵向狭槽;砧座,其上具有紧固件成形表面,所述钉仓组件和砧座安装成在打开位置和密切配合对齐以夹紧组织的闭合位置之间相对彼此运动;致动滑块,被支撑在所述钉仓组件内,所述致动滑块是可移动的用来推动多个紧固件远离所述钉仓;传动梁,包括竖直支柱和被支撑在竖直支柱上的凸轮构件,安置所述凸轮构件相对于所述砧座平移,用来在发射紧固件的过程中将所述砧座保持在闭合位置处,且安置所述竖直支柱与所述致动滑块邻接;以及传动螺杆,限定了第一纵向轴线且被支撑在所述钉仓组件内,所述传动螺杆具有螺纹部分,其中,所述传动梁可以螺纹联接到所述传动螺杆的所述螺纹部分上,使得所述传动螺杆的旋转会驱动所述传动梁纵向运动。所述系统具有被配置将所述手柄组件与钳夹组件连接起来的细长主体,所述细长主体包括可将所述传动螺杆机械联接到所述手柄组件的致动轴上的挠性传动轴,其中,所述传动轴会将致动轴的旋转运动传递到所述传动螺杆上,以及可以将所述挠性传动轴与传动螺杆连接起来的传动连杆,偏离所述第一和第二纵向轴线来布置所述传动连杆。所述手柄组件,钳夹组件和细长轴组件彼此分离。所述系统包括:电源,被配置用来提供电能;控制组件,被配置用来接受至少一个用户输入;第一电机,被联接到所述电源上且被配置运行以响应所述至少一个用户输入;第二电机,被联接到所述电源上且被配置运行以响应所述至少一个用户输入;以及选择变速箱组件,包括与所述挠性传动轴机械联接的至少一个齿轮元件,其中,所述第一电机配置为选择性地移动所述至少一个齿轮元件与所述第二电机相啮合,从而致动所述挠性传动轴。
在又一个方案中,手术系统包括钳夹组件,所述钳夹组件包括:钉仓组件,其所述钉仓组件包括多个紧固件和被限定在其中的纵向狭槽;砧座,其上具有紧固件成形表面,所述钉仓组件和砧座安装成在打开位置和密切配合对齐以夹紧组织的闭合位置之间相对彼此运动;致动滑块,其被支撑在所述钉仓组件内,所述致动滑块是可移动的用来推动多个紧固件远离所述钉仓;传动梁,其包括凸轮构件,所述凸轮构件安置成相对于所述砧座平移,用来在发射紧固件的过程中将所述砧座保持在闭合位置处;以及传动螺杆,其限定了第一纵向轴线且被支撑在所述钉仓组件内,所述传动螺杆具有螺纹部分,其中,所述传动梁可以螺纹联接到所述传动螺杆的所述螺纹部分上,使得所述传动螺杆的旋转会驱动所述传动梁纵向运动。所述器械包括被配置为与所述钳夹组件相连接的细长主体,所述细长主体包括挠性传动轴,所述传动轴会将旋转运动传递到所述传动螺杆上,以及可以将所述挠性传动轴与传动螺杆连接起来的传动连杆,其中,所述传动连杆相对于所述第一和第二纵向轴线偏离布置。所述钳夹组件和细长轴组件是彼此能够分离的,所述细长主体配置为与致动器相连。
所述手术系统,在某些实施例中,包括被布置在手柄组件中的致动器。可以包括被配置用来提供电能的电源。所述系统可以包括被配置用来接受至少一个用户输入的控制组件。
在某些实施例中,所述系统具有被联接到所述电源上且被配置为响应所述至少一个用户输入而运行的第一电机。第二电机可以被联接到所述电源上且被配置为响应所述至少一个用户输入而运行。所述系统可以具有选择变速箱组件,其包括与所述挠性传动轴机械联接的至少一个齿轮元件,所述第一电机配置为选择性地移动所述至少一个齿轮元件与所述第二电机相啮合,从而致动所述挠性传动轴。
在某些实施例中,所述传动梁包括用来支撑所述凸轮构件并推动滑块的竖直支柱。所述系统可以具有内含电机的外壳。可以包括被配置用来接受用户输入的控制组件。
附图说明
参照附图,于此描述了本公开的不同实施例,其中:
图1是依照本公开的机电手术系统的立体图;
图2是依照本公开的图1中的机电手术系统的手术器械、细长构件以及末端执行器的分解立体图;
图3是依照本公开的沿图1的3-3截取的图1的手术器械的侧剖视图;
图4是依照本公开的沿图1的4-4截取的图1的手术器械的俯视剖视图;
图5是依照本公开的图1中的手术器械的正视立体图,其中图2中的细长构件为与所述手术器械分离的;
图6是依照本公开的图1中的末端执行器的正视立体图;
图7是依照本公开的图1中的末端执行器的侧剖视图;
图8是依照本公开的图1中的末端执行器的放大的侧剖视图;
图9是依照本公开的图1中的末端执行器的放大的后视立体图;
图10是依照本公开的图1中的末端执行器的分解立体图;
图11是依照本公开的图1中的末端执行器的侧剖视图;
图12是依照本公开的图1中的末端执行器的联接构件的局部分解侧视图;
图13是依照本公开的图1中的末端执行器的联接构件的局部分解立体图;
图14是依照本公开的图1中的末端执行器的联接构件的侧剖视图;
图15是依照本公开的末端执行器的正视立体图,图中部件是分离的,所述末端执行器包括固定到其组织接触表面上的手术用钉仓支撑件;
图16是末端执行器的砧座组件远端的放大立体图,呈现了依照本公开的可操作地固定到其组织接触表面上的手术用钉仓支撑件;
图17是末端执行器的钉仓组件的放大立体图,呈现了依照本公开的固定到其组织接触表面上的手术用钉仓支撑件;
图18是依照本公开的末端执行器的砧座组件远端的俯视立体图,所述末端执行器包括显示为打开形态下的缝合线释放组件;
图19是图18中的砧座组件的俯视立体图,呈现了依照本公开的被分离的缝合线释放组件的部分;
图20是依照本公开的图18中的砧座组件的仰视立体图;
图21是图18中的砧座组件的俯视平面图,呈现了依照本公开的在闭合形态下的缝合线释放组件;
图22是图18中的砧座组件的俯视平面图,其中保持器从所述砧座组件上拆除;
图23是图18中的砧座组件的俯视平面图,呈现了依照本公开的在打开形态下的缝合线释放组件;
图24是依照本公开的图18中的砧座组件的俯视平面图,其中保持器从所述砧座组件上拆除;
图25是依照本公开的末端执行器的钉仓组件远端的俯视立体图,所述末端执行器包括缝合线释放组件;
图26是图25中的钉仓组件的俯视立体图,呈现了依照本公开的被分离的缝合线释放组件的部分;
图27是依照本公开的图25中的钉仓组件远端的仰视立体图;
图28是图25中的钉仓组件的俯视平面图,呈现了依照本公开的在闭合形态下的缝合线释放组件;
图29是图25中的钉仓组件的俯视平面图,呈现了依照本公开的在打开形态下的缝合线释放组件;
图30是依照本公开的另一个实施例的末端执行器远端的立体图,所述末端执行器包括缝合线释放组件;
图31是依照本公开的图30中细部指示区域的放大图;
图32是卸除了砧座盖的砧座组件远端的俯视立体图,呈现了依照本公开的在致动形态下的缝合线释放组件;
图33是图32中的砧座组件远端的俯视立体图,呈现了依照本公开的被分离的缝合线释放组件的部分;
图34是图32中的砧座组件的俯视平面图,呈现了依照本公开的在未致动形态下的缝合线释放组件;
图35是图32中的砧座组件的俯视平面图,呈现了依照本公开的在致动形态下的缝合线释放组件;
图36是图30中的末端执行器的钉仓组件远端的仰视立体图,呈现了依照本公开的被分离的缝合线释放组件;
图37是依照本公开的图36中的缝合线释放组件的俯视立体图;
图38是依照本公开的图36中的缝合线释放组件的仰视立体图,图中部件是分离的;
图39是图36中的缝合线释放组件的俯视平面图,呈现了依照本公开的在未致动形态下的缝合线释放组件;以及
图40是图36中的缝合线释放组件的俯视平面图,呈现了依照本公开的在致动形态下的缝合线释放组件。
具体实施方式
现在将参照附图详细描述本公开的机电手术系统、设备和/或装置的实施例,其中在几幅附图的每幅附图中相同附图标记指代相同的或对应的元件。在本文中使用时,术语“远侧”是指所述机电手术系统、设备和/或装置、或其部件的距用户较远的部分,而术语“近侧”是指所述机电手术系统、设备和/或装置、或其部件的距用户较近的部分。术语“左侧”和“右侧”分别是指,当所述手术系统、设备和/或装置定向在非旋转形态下时,从近端,从面向所述机电手术系统、设备和/或装置远端的用户角度来看,所述机电手术系统、设备和/或装置、或其部件在左侧(如左舷)和在右侧(如右舷)的部分。
首先参照图1-5,依照本公开的一个实施例,显示了一种机电的、手持式、电动手术系统且一般指代为10。机电手术系统10包括一种手术设备或装置,以机电的、手持式、电动手术器械100的形式,其被配置用于经由轴组件200选择性地将多个不同的末端执行器400附接于此。末端执行器400和轴组件200配置为通过机电的、手持式、电动手术器械或手柄组件100来进行致动和操纵。特别地,手术器械100、轴组件200以及末端执行器400都是彼此可分离的,以便配置手术器械100来选择性地连接轴组件200,接下来,轴组件200配置为选择性地连接多个不同的末端执行器400中的任何一个末端执行器。
为了详细的说明示例性机电的、手持式、电动手术器械100的结构和操作,可以引用提交于2008年9月22日、申请号为PCI/US2008/077249的国际申请(国际公开号为WO2009/039506)和提交于2009年11月20日的序列号为12/622,827的美国专利申请,每个申请的全部内容通过引用合并于此。
如图1-4所示,通常,手术器械或手柄组件100包括手柄外壳102,手柄外壳102包括下壳体部分104、中壳体部分106以及上壳体部分108,其中,中壳体部分106是从下壳体部分104延伸出来和/或被支撑在下壳体部分104上,上壳体部分108是从中壳体部分106延伸出来和/或被支撑在中壳体部分106上。中壳体部分106和上壳体部分108被分离成远侧半部110a和近侧半部110b,其中,远侧半部110a是从下壳体部分104延伸出来且与之整体成形,近侧半部110b通过采用多个紧固件(图3和图4)可与远侧半部110a相连接。连接后,远侧半部110a与近侧半部110b共同限定了手柄外壳102,手柄外壳102内有空腔102a,控制组件150和传动机构160被布置在空腔102a中。器械100还包括被联接到控制组件150和传动机构160的电源(未显示)。如以下进一步详细讨论所述,控制组件150可以包括一个或多个逻辑控制器和/或用户界面(例如,开关、按钮、扳机、触摸屏等),并被配置用来控制器械100,特别是,传动机构160的各种操作。所述手柄组件可以配置为让所述器械系统用户握住,或者可以配置为能连接到轴组件上或以下讨论的细长主体上的控制台。
器械100的下壳体部分104限定了形成在其上表面的小孔(未显示),它位于中壳体部分106的下方或内部。下壳体部分104的小孔提供了通道,可供导线和其他各种电导线穿过以与位于下壳体部分104中的电气部件互相连接(例如,电源和任何对应的功率控制电路)及与位于中壳体部分106和/或上壳体部分108中的电气部件互相连接(例如,控制组件150、传动机构160等)。
参照图3和图4,上壳体部分108的远侧半部110a限定了鼻部分或连接部分108a。鼻锥114被支撑在上壳体部分108的鼻部分108a上。手柄外壳102的上壳体部分108提供了布置有传动机构160的壳体。为了实现器械100的各种操作,配置传动机构160来驱动轴和/或齿轮部件。特别地,传动机构160被配置为驱动轴和/或齿轮部件,以便相对于手柄外壳102选择性地绕纵向轴线A-A(图6A和图6B)旋转末端执行器400,以相对于彼此来移动末端执行器400的钳夹构件和/或发射紧固件,以便切断末端执行器400内握住的组织。
如图3和图4,传动机构160包括相对于轴组件200紧邻近侧的选择变速箱组件162。接近选择变速箱组件162的是具有第一电机164的功能选择模块163,第一电机164的功能为选择性地移动选择变速箱组件162内的齿轮元件来与具有第二电机166的输入传动部件165相啮合。特别参照图5,上壳体部分108的远侧半部110a限定了连接部分108a,连接部分108a被配置为用来接受轴组件200对应的传动联接组件210。
继续参照图5,器械100的连接部分108a包括用来接收轴组件200的传动联接组件210的圆柱形凹穴108b。连接部分108a可以容纳三个可旋转的传动连接器118、120、122。当轴组件200与器械100配套连接时,三个可旋转的传动连接器中的每一个传动连接器,即,器械100的第一传动连接器118、第二传动连接器120以及第三传动连接器122中的每一个传动连接器,可以机械地与其对应的可旋转的连接器套管相接合,对应的连接器套管即:轴组件200的第一连接器套管218、第二连接器套管220以及第三连接器套管222。
器械100的传动连接器118、120、222与轴组件200的连接器套管218、220、222的配套连接允许经由三个对应的连接器接口中的各自的连接器接口独立地传递旋转力。器械100的传动连接器118、120、122配置为通过传动机构160独立旋转。在这点上,传动机构160的功能选择模块163会选择器械100的传动连接器118、120、122中的一个或多个传动连接器由传动机构160的输入传动部件165来驱动。
继续参照图3和图4,传动机构160包括选择变速箱组件162和功能选择模块163,其中功能选择模块163位于靠近选择变速箱组件162的位置,其功能为选择性地移动选择变速箱组件162内的齿轮元件来与第二电机166相啮合。这样,传动机构160就可以在给定时间选择性地驱动器械100的一个或多个传动连接器118、120、122。
既然器械100的传动连接器118、120、122中的每一个连接器都是通过键和/或基本上非旋转的接口与轴组件200的相应的连接器套管218、220、222相连接,所以当轴组件200被联接到器械100上时,会选择性地将旋转力从器械100的传动机构160传递给轴组件200。
器械100的传动连接器118、120和/或122选择性的旋转允许器械100选择性地致动末端执行器400的不同功能。在一些实施例中,可以使用任意数量的传动连接器118、120和/或122来运行末端执行器400。如以下更详细地讨论所述,器械100的第一传动连接器118的选择性的且独立的旋转对应于末端执行器400的钳夹构件的选择性的且独立的打开和闭合操作,以及对应于末端执行器400的致动滑块440(图8)的传动操作。器械100的第三传动连接器120、122的选择性的且独立的旋转对应于相对于末端执行器400旋转的摄像机组件500选择性的且独立的绕枢轴旋转。传动连接器120可以用来相对于轴组件200绕枢轴旋转末端执行器400和/或旋转末端执行器400。
图6显示了细长主体或轴组件200以及末端执行器400。细长主体或轴组件200包括将刚性部分204与末端执行器400连接起来的柔性部分202。如图7和图8所示,刚性部分204容纳了第一连接器套管218,第一连接器套管218被联接到延伸穿过柔性部分202的挠性传动轴119上。轴119可以由任何适合的可与柔性部分202一起进行关节式运动的挠性和扭力刚性材料制成,以允许末端执行器400相对于刚性部分204在非关节式运动位置与关节式运动位置之间进行关节式运动,其中,在所述非关节式运动位置,由末端执行器400所限定的第一纵向轴线基本上与由刚性部分204所限定的第二纵向轴线对齐,且在所述关节式运动位置,由末端执行器400的第一纵向轴线相对于刚性部分204的第二纵向轴线基本上布置成是非零角度的。轴119可以由不锈钢或类似材料制成。
如图8所示,柔性部分202包括多个联锁段206,每个联锁段限定了贯穿其中的开口206a。如图8所示,轴119布置在开口206a内。联锁段206中的每一段在其近端都包括承窝206b,在其远端都包括球窝接头206c。一个联锁段206的球窝接头206c,其结构和尺寸可与远侧的邻近联锁段206的承窝206b接合,从而允许整个柔性部分202弯曲,从而可以绕刚性部分204的纵向轴线在整个360°空间里朝任何需要的方向进行关节式运动。
柔性部分202的关节式运动可以通过拉索205来实现。在一些实施例中,可以使用被联接到末端执行器400上且穿过柔性部分202的四根径向等距间隔开的线缆。特别地,如图9所示,可以布置每根线缆205在联锁段206各自的开口206d内。因此,施加在一根或多根线缆上的拉力将可以调整柔性部分202进行关节式运动的方向。在共同拥有的名称为“具有中间链接控制系统的进行关节式运动的链接”、申请号为61/510091美国临时专利申请中,公开了一种线缆关节式运动器械,其全部内容通过引用合并于此。
图10-14图示了末端执行器400的部件和操作。末端执行器400具有包括钉仓组件432和砧座434的钳夹组件。钉仓组件432可以容纳一个或多个被布置在其内部的紧固件433(图10),并且钉仓组件432配置为在器械100发射时,就使用紧固件433。砧座434可以移动地(例如,绕枢轴旋转)安装到末端执行器400上且可以在打开位置和闭合位置之间移动,其中,在打开位置下,砧座434与钉仓组件432彼此间隔开,在闭合位置下,砧座434与钉仓组件432密切配合对齐,从而夹紧组织。
参照图10,显示出末端执行器400的分解图。末端执行器400还包括具有细长通道411、底座412和两个平行直立壁414、416的承载器431,所述平行直立壁包括几个安装结构,如凹口439,用来支撑钉仓组件432和砧座434。纵向狭槽413延伸穿过细长通道411。
承载器431还包括被布置在其底面上的板盖415。板盖415配置为与承载器431的细长通道411相摩擦接合,其功能是保护组织免受沿承载器431外部移动的部件的损坏。承载器431还包括被布置在各自平行直立壁414、416近端且被配置用来与末端执行器400的壳体部分410联接的一对键形片407和409。
继续参照图10,细长通道411的远侧部分支撑包括多个手术紧固件433和多个对应的发射器或推进器437的钉仓组件432。如以下更详细地描述,末端执行器400包括具有直立凸轮轴楔444的致动滑块440,直立凸轮轴楔444被配置以施加紧固件传动力在推进器437上,这会驱动紧固件433远离钉仓组件432。通过会与在细长通道壁414和416的上表面成形的对应凹口439相摩擦接合的横向支柱436将钉仓组件432保持在细长通道411内。这些结构用来限制钉仓组件432在细长通道411内的横向、纵向以及立面运动。
多个间隔开的纵向狭槽(未显示)延伸穿过钉仓组件432并容纳致动滑块440的直立凸轮轴楔444。所述狭槽与多个穴442相通,在穴442内,分别支撑有多个紧固件433和推进器437。通过配置在钉仓组件432下方的推进器保持器(未显示)来固定推进器437,所述推进器保持器可以在推进器437通过致动滑块440接合之前,支撑并对齐推进器437。在操作过程中,随着致动滑块440平移通过钉仓组件432,凸轮轴楔444的角状前缘会顺序接触推进器437,导致所述推进器在狭槽446内竖直平移,从而从那推动紧固件434。如下面更详细的描述,钉仓组件432还包括纵向狭槽485以允许刀片474移动贯穿其中。
继续参照图10,末端执行器400包括被布置在砧座434上方的砧座盖435。砧座盖435会保护组织免受沿砧座434外部移动的部件的损坏。砧座盖435包括相对的安装翼450和452,其尺寸和结构可分别与砧座434的定位凹部454和456相接合。安装翼450和452的功能是在闭合过程中对齐砧座434和钉仓组件432。如下面更详细的描述,砧座434和砧座盖435配置为保持在打开形态下直到闭合。
砧座434绕枢轴旋转联接到承载器431上。承载器431包括形成在各自键形片407和409上的一对开口421和422。砧座盖435还包括成形于其中的一对相对开口457和459。枢轴销417,或一对销,穿过开口421、422、457和459,以允许砧座434绕枢轴旋转联接到承载器431上。
如图10所示,末端执行器400进一步包括轴向传动螺杆460,用来在吻合手术操作中将由挠性传动轴119施加的旋转传动力传递给致动滑块440。传动螺杆460可旋转地支撑在承载器431中并包括螺纹部分460a和近侧接合部分460b。传动螺杆460可旋转地固定在钉仓组件432的远端并包括一个或多个通过摩擦配合在接合部分460b周围的轴承466。这会允许传动螺杆460相对于承载器431旋转。末端执行器400的远侧壳体构件410经由一个或多个螺栓412联接到承载器431的近端上。壳体构件410包括贯穿其中的孔414,可以在其中容纳接合部分460b。
如图10-14所示,传动轴119包括在其远端处的联接构件500,其被联接到将轴组件200的传动轴119与末端执行器400的传动螺杆460连接起来的传动连杆组502。联接构件500包括远侧球窝接头500a和位于其颈部的一对相对的近端表面500b。布置在壳体部分410内的传动连杆组具有相对于传动螺杆460偏离轴线的传动连杆502。特别地,由传动连杆502限定的纵向轴线相对于由传动螺杆460限定的纵向轴线是成非平行角度的(例如,非零角度)。在一些实施例中,可以沿着与传动螺杆460相同的纵向轴线来布置传动连杆502。
传动连杆502包括近侧接合部分501和远侧接合部分503。近侧接合部分501配置为与联接构件500的球窝接头500a相接合,而远侧接合部分503的尺寸和结构可与传动螺杆460的近端接合部分460b相接合。特别地,接合部分501包括承窝501a,其结构和尺寸可与球窝接头500a相接合。传动连杆502还包括限定开口510c的一对相反表面501b。联接构件500的球窝接头500a插进近侧接合部分501的承窝501a中,从而允许各自的表面500b和501b彼此邻接且在机械上彼此配合。球窝接头500a和承窝501a的机械联接会防止传动连杆502从联接构件500上脱离,而表面500b和501b的邻接又允许将联接构件500的旋转运动传递到传动连杆502上。
如图11-13所示,传动连杆502的远侧接合部分503在其远端包括销503a,销503a横向延伸贯穿其中,且其结构和尺寸可与传动螺杆460的接合部分460b接合。传动螺杆460的接合部分460b的结构和尺寸可以作为U形夹与销503a接合。特别地,接合部分460b在其远端包括用来将接合部分503插入其中的孔461a。如图13所示,接合部分460b还包括被限定在孔461a两侧,从而形成U形夹461d的一对正相反的开口461b和461c。如图13所示,开口461b和461c可以形成在其远端作为具有入口的切口,从而允许将销503a插入其中。
参照图10和图11,末端执行器400进一步包括被布置在承载器431内的传动梁462。传动梁462包括竖直支柱472和与致动滑块440的中央支撑楔445相接合的邻接表面476。传动梁462还包括被布置在竖直支柱472顶部上的凸轮构件480。凸轮构件480的尺寸和结构可以相对于砧座434的外凸轮面482来接合和平移,从而在发射紧固件过程中逐步夹紧砧座434使其紧靠身体组织。
纵向狭槽484延伸穿过砧座434,可供竖直支柱472平移使用。这允许凸轮构件480在发射紧固件过程中可以在砧座盖435和砧座434之间移动。在一些实施例中,砧座盖435还可以包括在其内面上形成的对应的纵向狭槽(未显示)并且砧座盖435固定在砧座434的上表面,从而形成贯穿其间的通道。
传动梁462包括远侧保持脚488a和近侧保持脚488b,远侧保持脚488a和近侧保持脚488b各自具有贯通的孔489a和489b。孔489a和489b可以是有螺纹的或者光滑的,以供穿过其中的传动螺杆460移动。具有贯通螺纹孔490a的移动螺母490被布置在远侧保持脚488a和近侧保持脚488b之间。传动螺杆460通过孔490a螺纹联接到移动螺母490上,使得随着传动螺杆460旋转,移动螺母490会沿着由传动螺杆460限定的纵向轴线沿纵向方向移动且还与保持脚488a和488b相接合。
在使用中,随着传动螺杆460顺时针旋转,移动螺母490和传动梁462会朝着远侧方向移动,随着凸轮构件480向下推压在凸轮面482上而闭合砧座434。传动梁462还朝远侧方向推动滑块440,然后,经由凸轮楔444与推进器437相接合,从而发射紧固件433。传动梁462可以由任何适合的一次原料制成,包括但不限于,塑料、金属及其组合物。移动螺母490可以由任何适合的二次原料制成,同样包括但不限于,塑料、金属及其组合物。一次原料和二次原料可以相同或不同。在一些实施例中,传动梁462可以包括具有贯通螺纹孔的单个保持脚,其可用螺纹联接到传动螺杆460上。
参照图10,传动梁462还包括用来剖切被固定的组织的刀片474。在吻合手术中,刀片474稍落后于致动滑块440移动,从而在固定身体组织的行间形成切口。随着传动梁462向远侧方向被驱动,竖直支柱472的邻接表面476会向远侧方向推动滑块440,从而顶出紧固件433,且同时用刀片473剖切组织。刀片474和传动梁462移动穿过纵向狭槽484和485。随着传动梁463向远侧方向被驱动,传动梁463会闭合砧座,并还推动滑块440,而滑块440又在移动刀片474之前顶出紧固件433。随着紧固件433被顶出,它们会紧靠着具有多个砧座穴(未显示)的砧座434的组织接触表面(例如,下侧)发生变形。
图15显示了末端执行器400的另一个实施例。砧座434限定了一对近侧凹穴434d,它们形成在砧座434的近端附近且被布置在纵向狭槽484相对两侧上的每个侧面上。砧座434还限定了一对远侧凹穴434e,它们形成在砧座434的远端附近且被布置在纵向狭槽484相对两侧上的每个侧面上。在一个实施例中,近侧凹穴对434d和远侧凹穴对434e中每对凹穴中至少其中一个凹穴可以是非圆形的且收缩的,即具有减缩的宽度尺寸,以便通过摩擦接合和/或压紧锚定件“S”。另外,当砧座盖435与砧座434装配时,砧座盖435限定了一对形成在其中的相反凹穴435a,它们与形成在砧座434中的近侧凹穴对434d对齐。
砧座434进一步包括手术用砧座支撑件“B1”、药棉拭子或其他任何适合的手术植入物,其通过锚定件“S”可操作地被固定到砧座434的下表面或组织接触表面上,从而覆盖了至少一些砧座穴和/或至少一部分纵向狭槽484的长度。正如本公开所用,术语“锚定件”可以理解为包括但不限于缝合线、螺纹、系绳、条带、带、绳、导线、线缆、紧固件、大头钉或其他任何适合于此所公开的既定目的的材料。在某些实施例中,所述锚定件是以下所讨论的吻合钉线加固材料的延伸部分。所述锚定件可以构成所述吻合钉线加固材料的一个组成部分,或可以由相同或相似的材料制成并附着到所述吻合钉线加固材料上。特别地,锚定件“S”收紧在手术用砧座支撑件“B1”的近侧部分和近侧凹穴对434d的每个凹穴周围,并且锚定件“S”也收紧在手术用砧座支撑件“B1”的远侧部分和远侧凹穴对434e的每个凹穴周围。
当固定手术用砧座支撑件“B1”到砧座434上时,手术用砧座支撑件“B1”包括成形在其侧边缘并与砧座434的近侧凹穴对434d对齐的近侧凹口对,成形在其侧边缘并与砧座434的远侧凹穴对434e对齐的远侧凹口对,以及成形在其近侧边缘并与纵向狭槽484对齐的近侧凹口。手术用砧座支撑件“B1”进一步包括从其远侧边缘延伸出来的舌形片或键形片,以方便在装配过程中将手术用砧座支撑件“B1”附着到砧座434上。可以预期到,在将手术用砧座支撑件“B1”固定到砧座434上之后,以及在包装或装运之前,将所述舌形片从手术用砧座支撑件“B1”上拆卸下来。
如图18-24所示,砧座434进一步包括被布置在砧座434与砧座盖435之间,处于与远侧凹穴对434e可操作地相对齐的位置处的砧座释放组件574。释放组件574包括限定了贯通形成的弧形槽575a的导板575。如以下更详细的讨论所述,弧形槽575a结构和尺寸可用来接收贯通的工具(未显示)。
参照图18-20,释放组件574还包括可绕枢轴旋转地连接到砧座434和/或可选的砧座盖435上的锁或锚定杆576。锚定杆576包括在内部限定了细长通道或狭槽576b的杆体部分576a、以及从其边缘延伸出来的突指576c。突指576c可操作地与远侧凹穴对434e中的一个凹穴对齐,优选是与远侧凹穴对中具有相对较大宽度尺寸的那个凹穴对齐。
缝合线释放组件574进一步包括可绕枢轴旋转地连接到砧座434和/或可选的砧座盖435上的锚定杆致动构件577。致动构件577包括限定了旋转中心轴线的偏心凸轮577a,允许致动构件绕所述旋转中心轴线旋转。致动构件577包括突块或凸台577b,所述突块或凸台577b沿着基本上平行于偏心凸轮577a的旋转中心轴线且与之偏移径向距离的方向,从偏心凸轮577a表面延伸出来。凸台577b可滑动地且可旋转地布置在锚定杆576的细长狭槽576b中。致动构件577进一步包括释放杆577c,释放杆577c从与凸台577b大致相反侧,从偏心凸轮577a上沿大致成切线的方向延伸出来。释放杆577c限定了形成于其上的销577d,销577d与导板575的弧形槽575a对齐。在操作中,随着偏心凸轮577a旋转,释放杆577c的销577d会跟随所述旋转而沿着导板575的弧形槽575a的路径运动。
如图21和图22,缝合线释放组件574包括锁定或锚定形态,其中,锚定杆576的突指576c会伸进或覆盖上可操作地与之对齐的远侧凹穴对434e中相应的一个凹穴,致动构件577的释放杆577c会延伸穿过砧座434的纵向狭槽484,且释放杆577c的销577d被布置在导板575的弧形槽575a的第一端部或接近于导板575的弧形槽575a的第一端部。可以预期到,缝合线释放组件574包括摩擦配合或搭扣配合功能,用来在制造/装配过程之后以及器械100完成发射紧固件之前,维持和/或保持缝合线释放组件574始终处于所述锁定或锚定形态下。
如图23和24,缝合线释放组件574包括打开或释放形态,其中,锚定杆576的突指576c不会伸进或覆盖上可操作地与之对齐的远侧凹穴对434e中相应的一个凹穴,致动构件577的释放杆577c不会延伸穿过砧座434的纵向狭槽484,并且释放杆577c的销577d被布置在导板575的弧形槽575a的第二端部或接近于导板575的弧形槽575a的第二端部。
在器械100装配过程中,可以由制造商使用缝合线释放组件574,利用手术用缝合线或系绳,将手术用砧座支撑件“B”固定到砧座434的组织接触表面上,然后,由器械100的最终用户在器械100完成发射紧固件时,自动地将手术用砧座支撑件“B”从砧座434的组织接触表面上释放或解除下来。
参照图21-24,在制造过程中,利用在打开或释放形态(图23和图24)下的缝合线释放组件574,可以将手术用砧座支撑件“B”覆盖在砧座434的组织接触表面上。然后,将手术用缝合线“S1”的第一端部插进远侧凹穴对434e中的一个凹穴,并将手术用缝合线“S1”的第二端部延伸穿过手术用砧座支撑件“B1”(参照图15)并插进远侧凹穴对434e中的另一个凹穴。可以预期到,手术用缝合线“S1”的第一端部包括结点、止点或类似物(未显示),其尺寸确保不会穿过远侧凹穴对434e中的较窄的一个凹穴。
使用布置在远侧凹穴对434e中的手术用缝合线“S1”的第二端部,以及被拖拉穿过手术用砧座支撑件“B”的手术用缝合线“S1”,可以将工具(未显示)插穿导板575的弧形槽575a并与释放杆577c的销577d中的开口相接合。参照图21和图22,然后,操纵工具穿过导板575的弧形槽575a或沿着导板575的弧形槽575a移动,从而致动或移动释放杆577c并旋转偏心凸轮577a。随着偏心凸轮577a旋转,凸台577b会绕着偏心凸轮577a的枢轴线旋转并作用在锚定杆576的细长狭槽576b的两壁上,从而导致锚定杆576绕枢轴旋转。随着锚定杆576绕枢轴旋转,会导致其突指576c伸进或覆盖上远侧凹穴对434e中一个凹穴,并压紧在布置于其中的手术用缝合线的第二端部上。同时,释放杆577c已移动至可延伸穿过砧座434的纵向狭槽484的位置。如上所述,现在,缝合线释放组件574正处于锁定或锚定形态下。当锚定杆576远离凹穴434e时,理想情况是,与突指576c配合的远侧凹穴434e相对较宽,以便允许缝合线“S1”可以轻松穿进且穿出凹穴434e。安排在砧座434相对横向侧上的另一个远侧凹穴434e,可以具有相同的尺寸,或者可以是小到足以紧握住缝合线“S1”并将其固定在合适的位置以方便装配。
在操作中,使用靠在砧座434的下表面上固定的手术用砧座支撑件“B1”,在器械100发射紧固件的过程中,随着将致动滑块440从最近侧位置推进到最远侧位置,刀片474会割穿近侧缝合线“S2”的中央部分,从而将手术用砧座支撑件“B1”的近端从砧座434上解除下来。如图24所示,在使用中,随着器械100的发射行程接近结束且随着致动滑块440接近砧座434纵向狭槽484的远端,正被传动螺杆460驱动的传动梁462会接触释放杆577c,推动释放杆577c,并且接下来,使偏心凸轮577a绕其枢轴线旋转。随着偏心凸轮577a旋转,凸台577b会绕着偏心凸轮577a的枢轴线旋转并作用在锚定杆576的细长狭槽576b的两壁上,从而导致锚定杆576绕枢轴旋转。随着锚定杆576绕枢轴旋转,会导致其突指576c移动远离相对较宽的一个远侧凹穴434e,并释放布置在其中的手术用缝合线的第二端部。利用被释放或自由的手术用缝合线的第二端部,手术用砧座支撑件“B1”的远端是自由的,以便与砧座434的组织接触表面分离。
参照图15,钉仓组件432限定了形成在其近端的近侧凹穴对432a,并且所述近侧凹穴对432a布置在纵向狭槽485的相对两侧上,每侧一个凹穴。钉仓组件432进一步限定了形成在其远端的远侧凹穴对432b,并且所述远侧凹穴对432b布置在纵向狭槽485的相对两侧上,每侧一个凹穴。在一个实施例中,近侧凹穴对432a和远侧凹穴对432b中每对凹穴中至少其中一个凹穴优选是非圆形的且收缩的,或安排成通过摩擦接合和/或压紧锚定件“S”的其它形式。
钉仓组件432进一步包括手术用钉仓支撑件“B2”、药棉拭子或其他任何适合的手术植入物,其使用锚定件“S3”和“S4”可操作地固定到钉仓组件432的上表面或组织接触表面上,从而覆盖至少一些紧固件穴442和/或至少一部分纵向狭槽485的长度。特别地,锚定件“S4”收紧在手术用钉仓支撑件“B2”的近侧部分和近侧凹穴对432a的每个凹穴周围,并且锚定件“S3”也收紧在手术用钉仓支撑件“B2”的远侧部分和远侧凹穴对432b的每个凹穴周围。
在一个特定的实施例中,每个锚定件“S”的第一端部包括结点、止点或类似物(未显示),其尺寸确保不会穿过近侧凹穴对432a中的一个凹穴,而每个锚定件“S”的第二端部会越过,且横向跨过,手术用钉仓支撑件“B2”,至少一次,然后再返回穿过近侧凹穴对432a的另一个凹穴。例如,每个锚定件“S”的第二端部可以被压紧或收紧在近侧凹穴对432a的另一个凹穴中,以便锚定住锚定件“S”的第二端部并将手术用钉仓支撑件“B2”紧靠着钉仓组件432的组织接触表面固定。同样地,使用锚定件“S3”横向延伸穿过手术用钉仓支撑件“B2”并伸进远侧凹穴对432b中与之接合。
当手术用钉仓支撑件“B2”固定到钉仓组件432上时,手术用钉仓支撑件“B2”包括成形在其侧边缘并与钉仓组件432的近侧凹穴对432a对齐的近侧凹口对,成形在其侧边缘并与钉仓组件432的远侧凹穴对432b对齐的远侧凹口对,以及成形在其近侧边缘并与纵向狭槽485对齐的近侧凹口。手术用钉仓支撑件“B2”进一步包括从其远侧边缘延伸出来的舌形片或键形片,以方便在装配过程中将手术用钉仓支撑件“B2”附着到钉仓组件432上。可以预期到,手术用钉仓支撑件“B2”在其近侧部分的宽度会减小。可以进一步预期到,在将手术用钉仓支撑件“B2”固定到钉仓组件432上之后,以及在包装或装运之前,将所述舌形片从手术用钉仓支撑件“B2”上拆卸下来。
如图15和图25-29,钉仓组件432进一步包括支撑在钉仓组件432的远端及远端附近的钉仓释放组件594。释放组件594包括可以绕枢轴旋转地连接到钉仓组件432上的锁定杆或锚定杆595。锚定杆595包括具有从其边缘延伸出来的突指595b的杆体部分595a。突指595b可操作地与远侧凹穴对432b中的一个凹穴对齐,优选是与远侧凹穴对中具有较大宽度尺寸的那个凹穴对齐。
释放组件594进一步包括可以绕枢轴旋转地连接到锚定杆595(如图26和图27所示)的锚定杆致动构件597。致动构件597包括沿着致动构件597的近侧边缘定位并延伸穿过钉仓组件432的中央纵向狭槽485的第一凸轮表面597a,以及从接近于远侧凹穴对432b中的一个凹穴的致动构件597向远侧横向延伸的第二凸轮表面597b,远侧凹穴对432b中的这个凹穴与锚定杆595的突指595b可操作地相关联。致动构件597的第一凸轮表面597a基本上是弧形的或凸状的。致动构件597限定了孔或开口597c,其结构和尺寸可接收其中的锚定杆595的销595c,以便锚定杆595和致动构件597可以绕枢轴旋转或相对于彼此旋转。
在操作中,致动构件597沿第一方向绕其枢轴点旋转,其结果是导致第二凸轮表面597b与钉仓组件432的表面432g(参照图28和图29)邻接,从而移动突指595b至少部分越过和/或穿过远侧凹穴对432b中与其相关联的那个凹穴。
如图28所示,缝合线释放组件594包括锁定或锚定形态,其中,致动构件597的第一凸轮表面597a伸进并穿过钉仓组件432的中央纵向狭槽485,其中,致动构件的第二凸轮表面597b被压在钉仓组件432的表面432g上,从而锚定杆595的突指595b会伸进或覆盖上远侧凹穴对432b中可操作地与之对齐的相应的那个凹穴。使用通过将致动构件597保持处于锁定或锚定形态下的方式而与致动构件597接合的偏压构件或定位件,可以让紧固件释放组件594保持在所述锁定或锚定形态下。当处于这样的锁定或锚定形态下时,可以将缝合线“S3”推进钉仓组件432的凹穴432b中。可以预期到,缝合线释放组件594包括摩擦配合或搭扣配合功能,用来在制造/装配过程之后以及器械100完成发射紧固件之前,维持和/或保持缝合线释放组件594始终处于所述锁定或锚定形态下。
如图27和图29所示,缝合线释放组件594包括打开或释放形态,其中,锚定杆595的突指595b不会伸进或覆盖上远侧凹穴对432b中可操作地与之对齐的相应的那个凹穴,致动构件597的第一凸轮表面597a不会伸进并穿过钉仓组件432的中央纵向狭槽485,且致动构件597的第二凸轮表面597b不会被压在钉仓组件432的表面432g上。
在器械100的装配过程中,可以由制造商使用缝合线释放组件594,利用锚定件、手术用缝合线、或系绳“S”、将手术用钉仓支撑件“B2”(参照图2)固定到钉仓组件432组织接触表面上,然后,由器械100的最终用户在器械100完成发射紧固件时,自动地将手术用钉仓支撑件“B2”从钉仓组件432的组织接触表面上释放或解除下来。
参照图25-29,在制造过程中,利用在打开或释放形态下的缝合线释放组件594,可以将手术用钉仓支撑件“B2”覆盖到钉仓组件432的组织接触表面上。然后,将手术用缝合线“S”的第一端部插进远侧凹穴对432b中相对狭窄的一个凹穴中,并将手术用缝合线“S”的第二端部延伸穿过手术用钉仓支撑件“B2”并插进远侧凹穴对432b中相对较宽的一个凹穴中。可以预期到,手术用缝合线“S”的第一端部包括结点、止点或类似物(未显示),其尺寸确保不穿过远侧凹穴对432b中较窄的一个凹穴。
如图26所示,钉仓组件432包括形成于其中的接近口583,所述接近口用来插进并接收其中的缝合线释放组件594,并且可以接近致动构件597。使用布置在远侧凹穴对432b中相对较宽的一个凹穴中的手术用缝合线“S”的第二端部,以及使用被拖拉穿过手术用钉仓支撑件“B2”的手术用缝合线“S”,致动构件597可以绕枢轴线旋转,从而导致致动构件597的第一凸轮表面597a伸进并穿过钉仓组件432的中央纵向狭槽485,并导致致动构件597的第二凸轮表面597b压在钉仓组件432的表面432g(参照图13和图14)上。通过这样做,借助于足够数量的锚定杆595的突指595b,锚定杆595可以绕枢轴旋转,从而伸进或覆盖上远侧凹穴对432b中可操作地与之对齐的相应的那个凹穴,由此压紧布置在其中的手术用缝合线的第二端部。如上所述,现在,缝合线释放组件594正处于锁定或锚定形态下。
在操作中,使用靠在钉仓组件432的组织接触表面上固定的手术用钉仓支撑件“B1”,在器械100的发射过程中,随着将致动滑块440推进(即从最近侧位置到最远侧位置),刀片474会割穿近侧缝合线“S4”的中央部分,从而将手术用钉仓支撑件“B2”的近端从钉仓组件432上解除下来。如图29所示,在使用中,随着器械100的发射行程接近结束且随着致动滑块440正被传动螺杆466驱动接近钉仓组件432的中央纵向狭槽485的远端,致动滑块440会接触致动构件597的第一凸轮表面597a,推动致动构件597旋转。致动构件597的第二凸轮表面597b也会绕其枢轴销595c的枢轴线旋转。随着第二偏心凸轮表面597b绕第二凸轮表面597b的枢轴线旋转,枢轴销595c与钉仓组件432的表面432g之间的距离会减小,从而使得锚定杆595绕枢轴销595c旋转。随着锚定杆595绕枢轴旋转,会导致其突指595b移动远离相对较宽的一个远侧凹穴432b,并释放布置在其中的手术用缝合线“S”的第二端部。利用被释放或自由的手术用缝合线“S”的第二端部,手术用钉仓支撑件“B2”的远端是自由的,以便与钉仓组件432的组织接触表面分离。可操作地与锚定杆595的突指595b对齐的远侧凹穴432b的尺寸使得,尽管锚定杆595旋转,缝合线“S3”不会仍然收紧在其中。
随着将致动滑块440从近侧位置推进到远侧位置,刀片474会纵向割穿或切开手术用砧座支撑件“B1”和手术用钉仓支撑件“B2”两者,从而将支撑件“B1、B2”基本上分成两半。另外,随着将致动滑块440从最近侧位置推进到最远侧位置,致动滑块440的直立凸轮楔444致动推进器437,从而导致推进器437在保持狭槽内竖直平移,并推动紧固件433远离狭槽446。随着紧固件433被推动远离钉仓组件432的狭槽446,紧固件433的钉腿刺入并穿过手术用砧座支撑件“B1”和手术用钉仓支撑件“B2”,以及介入其间的任何组织,然后,可以紧靠着砧座434的吻合钉成形腔或者在砧座434的吻合钉成形腔内成形。支撑件“B1、B2”可以包括分割支撑件并方便于从组织中移走设备的穿孔。
根据本公开,手术用砧座支撑件“B1”和/或手术用钉仓支撑件“B2”是分别预装载到(即从制造商那里)末端执行器400的砧座434或钉仓组件432上的。装载单元发射之后,不管有没有支撑件“B”,都可以将另外的未发射的末端执行器400或钉仓432装载到器械100上。可以将支撑件和释放组件预装载到可拆卸的钉仓上,并可以为手术设备用户提供将支撑件装载到砧座组件上的装置。例如,可以使用带有胶粘剂的支撑件。根据需要或要求,适用于砧座434和/或钉仓组件432的另外的支撑件或替换支撑件可以被固定到砧座434或钉仓组件432上。
在另一个实施例中,可以安排释放组件来切断缝合线“S”。可以安排致动构件597上的凸轮表面597b用凸轮带动锚定杆595朝向缝合线“S”。面向缝合线“S”的锚定杆595的表面可以包括锋利的边缘,并且,当被所述传动组件致动时,这个表面可以切断所述缝合线。
如图30-35,显示出了末端执行器400的另一个实施例。末端执行器400的砧座434包括被布置在砧座434和砧座盖435之间且处于可操作地与远侧凹穴对670e对齐位置处的缝合线释放组件674的另一个实施例。缝合线释放组件674包括可绕枢轴旋转地连接到砧座434(图32和图33)和/或可选的砧座盖435上的连杆臂675。连杆臂675包括限定了形成在其第一侧边缘675b中的穴或凹穴675c的杆体部分675a,以及被限定基本上沿着其相邻侧边缘或近侧边缘的凸轮表面675d。穴675c具有大致弧形、圆形或滚圆的轮廓。如图18和图20所示,连杆臂675包括从杆体部分675a延伸出来的枢轴销675e,用来将连杆臂675通过绕枢轴旋转地连接到砧座434上。
释放组件674进一步包括可以绕枢轴旋转地连接到连杆臂675上且可滑动地布置在砧座434和砧座盖435之间的推杆677。推杆677包括具有基本上为矩形结构的杆体部分677a,以及从杆体部分677a的角上延伸出来且具有基本上为圆形或滚圆结构的杆头677b。推杆677的杆头677b的结构和尺寸可以绕枢轴旋转和/或旋转连接在连杆臂675的穴675c中。
如图34所示,缝合线释放组件674包括未致动形态,其中,推杆677不会伸进或覆盖上可操作地与之对齐的远侧凹穴对670e中的相应的一个凹穴中,而且,连杆臂675的纵向轴线的取向基本上平行于末端执行器400的纵向轴线。可以预期到,缝合线释放组件674包括摩擦配合或搭扣配合功能,用来在制造/装配过程之后以及手术吻合设备完成发射之前,维持和/或保持缝合线释放组件674始终处于锁定或锚定形态下。
如图35所示,缝合线释放组件674包括致动形态,其中,推杆677伸进或覆盖上可操作地与之对齐的远侧凹穴对670e中相应的一个凹穴,而且,连杆臂675的纵向轴线的取向基本上横向于末端执行器400的纵向轴线。
参照图30-35,在制造过程中,利用在未致动形态下的缝合线释放组件674,可以将手术用砧座支撑件(未显示)覆盖在砧座434的组织接触表面上。然后,将手术用缝合线“S1”的第一端部插进远侧凹穴对670e中的一个凹穴,将手术用缝合线“S1”的第二端部延伸穿过所述手术用砧座支撑件(未显示)并插进远侧凹穴对670e中的另一个凹穴。可以预期到,远侧凹穴对670e中的每个凹穴都是开端收缩的狭槽,以便通过摩擦紧抓住或紧握住布置在其中的手术用缝合线“S1”。
在操作中,使用靠在砧座434的下表面上固定的手术用砧座支撑件(未显示),在手术吻合设备的发射过程中,随着推进正被传动螺杆460驱动的传动梁462(即从最近侧位置移动到最远侧位置),刀片474会割穿所述近侧缝合线(未显示)的中央部分,从而将所述手术用砧座支撑件(未显示)的近端从砧座434上解除下来。如图35所示,在使用中,随着所述手术吻合设备的发射行程接近结束且随着所述传动梁接近砧座434的纵向狭槽484的最远端,传动梁462会接触连杆臂675的凸轮表面675d,从而推动连杆臂675旋转或绕枢轴销旋转,而且,接下来推动推杆677沿着所述狭槽的方向平移。随着推杆677平移,推杆677接触到缝合线“S1”的第二端部并将其推出可操作地与之对齐的远侧凹穴670e,以从其中释放缝合线“S1”的第二端部。利用从远侧凹穴670e上被释放或自由的手术用缝合线“S1”的第二端部,手术用砧座支撑件“B1”的远端是自由的,以便与砧座434的组织接触表面分离。
如图30、31和36-50所示,末端执行器400的钉仓组件432包括支撑在其远端中及远端附近的钉仓释放组件694。释放组件694包括保持器695,其被支撑在钉仓组件432的远端,并且位于纵向狭槽485的远端附近且至少延伸穿过纵向狭槽485的一部分。保持器695包括主体部分695a,从其表面延伸出来的凸台695b,并限定了形成在其表面中且延伸穿过其侧面的通道或凹穴695c。当被支撑在钉仓组件432中时,保持器695的凹穴695c会与钉仓组件432的远侧凹穴对682f中的一个凹穴对齐。
释放组件694进一步包括具有头部分696a的推压构件696,头部分696a可绕枢轴旋转地连接到保持器695的凸台695b上。推压构件696进一步包括从头部分696a延伸出来的第一支腿构件696b和经由活动铰接头696d连接到第一支腿构件696b的自由端的第二支腿构件696c。推压构件696进一步包括经由活动铰接头696f连接到第二支腿构件696c的自由端的活塞696e。将活塞696e可滑动地布置在保持器695的凹穴695c内,且活塞696e可以在凹穴695c中平移。在某些其他实施例中,所述推进器是具有第一连杆的连杆组件,所述第一连杆的一端可绕枢轴旋转地连接到所述钉仓上。所述第一连杆的另一端可绕枢轴旋转地连接到第二连杆的第一端。所述第二连杆的相对端,即第二端,被限制在所述保持器的凹穴中。
如图39所示,释放组件694包括未致动形态,其中,活塞696e不会伸进或覆盖上远侧凹穴对682f中的相应的那个凹穴,而且第一支腿构件696b和第二支腿构件696c相对于彼此是成角度的,并沿着钉仓组件432的纵向狭槽485向近侧伸出。可以预期到,缝合线释放组件694包括摩擦配合或搭扣配合功能,用来在制造和/或装配过程之后以及手术吻合设备完成发射之前,维持和/或保持缝合线释放组件694始终处于锁定或锚定形态下。
如图40所示,缝合线释放组件694还包括致动形态,其中,活塞696e会伸进或覆盖上可操作地与之对齐的远侧凹穴对682f中的相应的那个凹穴,而且第一支腿构件696b和第二支腿构件696c会基本上沿着共同的轴线延伸。
如图36-40,在制造过程中,利用在未致动形态下的缝合线释放组件694,将手术用钉仓支撑件(未显示)覆盖到钉仓组件432的组织接触表面上。然后,将手术用缝合线“S3”的第一端部插进远侧凹穴对682f中的一个凹穴中,并将手术用缝合线“S3”的第二端部延伸穿过所述手术用钉仓支撑件并插进远侧凹穴对682f中的另一个凹穴中。可以预期到,至少与保持器695相邻的凹穴682f是开端收缩的狭槽,以便通过摩擦紧抓住或紧握住布置在其中的手术用缝合线“S3”。
在操作中,使用靠在钉仓组件432的组织接触表面上固定的手术用钉仓支撑件(未显示),在手术吻合器械100的发射过程中,随着推进正被传动螺杆466驱动的致动滑块440(即从最近侧位置移动到最远侧位置),刀片474会割穿近侧缝合线(未显示)的中央部分,从而将手术用钉仓支撑件的近端从钉仓组件432上解除下来。如图29所示,在使用中,随着手术吻合器械100的发射行程接近结束且随着致动滑块440正被传动螺杆466驱动接近钉仓组件432的中央纵向狭槽485的远端,会驱动致动滑块440接触第一支腿构件696b和第二支腿构件696c之间的活动铰接头696d。随着进一步向远侧推进致动滑块440,会将致动滑块440向活动铰接头696d挤压,从而导致第一支腿构件696b和第二支腿构件696c延伸。随着第一支腿构件696b和第二支腿构件696c延伸,活塞696e会平移穿过保持器695的凹穴695c。随着活塞696e平移穿过保持器695的凹穴695c,活塞696e会与缝合线“S3”的第二端部接合,并将缝合线“S3”推出与之可对齐的远侧凹穴682f,以从其中释放缝合线“S3”的第二端部。利用从远侧凹穴682f上被释放或自由的手术用缝合线“S3”的第二端部,手术用钉仓支撑件“B”的远端是自由的,以便与钉仓组件432的组织接触表面分离。
根据本公开的另一些实施例,可以预期到,支撑件“B”可以设置有或形成有从其上延伸出来的一体的翼或键形片,用来插进和/或接收砧座组件和/或钉仓组件的远侧和/或近侧凹穴。可以进一步预期到,缝合线“S”可以固定到、嵌入或以其他方式连接到支撑件“B”上。
在如下的文献中显示和描述了用来与这里公开的手术吻合装置一起使用的示例性手术用支撑件“B”,其中每个专利的全部内容通过引用合并于此:共同受让的美国专利第5,542,594号、第5,908,427号、第5,964,774号以及第6,045,560号,提交于2009年10月15日的序列号为12/579,605的共同受让的美国专利申请(现在为美国专利公开第2010/0092710号),提交于2005年9月30日的序列号为11/241,267的共同受让的美国专利申请(现在为美国专利公开第2006/0085034号),以及提交于2005年10月12日的序列号为11/248,846的美国专利申请(美国专利公开第2006/0135992号,现在为美国专利第7,823,592号)。
手术用支撑件“B”可以由适当的生物可兼容的且生物可吸收的材料制成。手术用支撑件“B”可以由无法保留液体的非吸收性材料制成。手术用支撑件“B”可以靠由糖酸聚合物(GLYCOMER631)(嵌段共聚物)制成的“BIOSYN”制造成,所述糖酸聚合物是一种由乙交酯、二恶烷酮和三亚甲基碳酸酯组成的合成聚酯。
所得的共聚物的一个嵌段包括衍生自对二恶烷酮(1,4-二恶烷-2-酮)和三亚甲基碳酸酯(1,3-二恶烷-2-酮)的随机结合的单元。所述共聚物的第二个嵌段包括衍生自乙交酯和对二恶烷酮的随机结合的单元。所得的聚酯是拥有约60%乙交酯,约14%的二恶烷酮,和大约26%的三亚甲基碳酸酯的ABA三嵌段三元共聚物。
将要理解的是可以对这里公开的所述实施例进行各种修改。例如,器械100不需要使用吻合钉,而是可以使用本领域都知道的两部分紧固件。此外,可以修改吻合钉或紧固件线性的行的长度来满足特殊手术的要求。于是,所述致动轴单个行程的长度和/或在可抛弃式装载单元内吻合钉和/或紧固件的线性的行的长度可以相应地改变。因此,上述说明书不应该视为限制,仅仅是一些特定实施例的示意。本领域的技术人员在这里所附的权利要求书的范围和构思内将设想其他的修改。
Claims (16)
1.一种手术系统,其包括:
手柄外壳;
钳夹组件,其包括:
可拆卸的钉仓组件,其包括多个紧固件和纵向狭槽;
砧座,其上具有紧固件成形表面,所述钉仓组件和砧座安装成在打开位置和密切配合对齐以夹紧组织的闭合位置之间相对彼此运动;
致动滑块,其被支撑在所述钉仓组件内,所述致动滑块是能够移动的用来推动多个紧固件远离所述钉仓组件;
传动梁,其包括竖直支柱和被支撑在所述竖直支柱上的凸轮构件,所述凸轮构件安置成相对于所述砧座平移,用来在发射紧固件的过程中将所述砧座保持在闭合位置处,且所述竖直支柱安置成与所述致动滑块邻接;以及
传动螺杆,其限定了第一纵向轴线并且被支撑在所述可拆卸的钉仓组件内,所述传动螺杆具有螺纹部分,其中,所述传动梁能够螺纹联接到所述传动螺杆的所述螺纹部分上,使得所述传动螺杆的旋转会驱动所述传动梁纵向运动;以及
细长主体,其被配置为将所述手柄外壳与钳夹组件连接起来,所述细长主体包括限定了第二纵向轴线并且将所述传动螺杆机械联接到所述手柄外壳的致动轴上的挠性传动轴,其中,所述传动轴会将致动轴的旋转运动传递到所述传动螺杆上,所述细长主体包括柔性部分,且其中,所述挠性传动轴容纳在所述柔性部分中;以及
传动连杆,其将所述挠性传动轴与传动螺杆连接起来,其中所述传动连杆相对于所述第一纵向轴线和第二纵向轴线偏离布置。
2.根据权利要求1所述的手术系统,其中,所述柔性部分包括多个联锁段。
3.根据权利要求1所述的手术系统,其中,所述传动连杆包括与所述挠性传动轴机械联接的近侧接合部分和与所述传动螺杆机械联接的远侧接合部分。
4.根据权利要求3所述的手术系统,其中,所述近侧接合部分包括承窝,其结构和尺寸能够与布置在所述挠性传动轴远端处的球窝接头机械接合。
5.根据权利要求3所述的手术系统,其中,所述远侧接合部分包括销钉,其结构和尺寸能够与布置在所述传动螺杆近端处的U形夹机械接合。
6.根据权利要求1所述的手术系统,进一步包括:
手术用支撑件,其可释放地固定在所述砧座和所述钉仓组件中至少其中之一的组织接触表面上,其中,所述手术用支撑件通过至少一个锚定件固定到所述砧座和钉仓组件中至少其中一个上,且其中,所述砧座和钉仓组件中至少其中一个限定了用于接收所述至少一个锚定件的端部的侧向狭槽;以及
释放组件,其被布置在所述砧座和钉仓组件中至少其中一个内。
7.根据权利要求6所述的手术系统,其中,所述传动螺杆被配置为致动所述释放组件,从而释放所述锚定件并且从所述砧座和钉仓组件中至少其中一个上除去手术用支撑件。
8.一种手术系统,其包括:
钳夹组件,其包括:
钉仓组件,其包括多个紧固件和纵向狭槽;
砧座,其上具有紧固件成形表面,所述钉仓组件和砧座安装成在打开位置和密切配合对齐以夹紧组织的闭合位置之间相对彼此运动;
致动滑块,其被支撑在所述钉仓组件内,所述致动滑块是能够移动的用来推动多个紧固件远离所述钉仓组件;
传动梁,其包括凸轮构件,所述凸轮构件安置成相对于所述砧座平移,用来在发射紧固件的过程中将所述砧座保持在闭合位置处;以及
传动螺杆,其限定了第一纵向轴线且被支撑在所述钉仓组件内,所述传动螺杆具有螺纹部分,其中,所述传动梁能够螺纹联接到所述传动螺杆的所述螺纹部分上,使得所述传动螺杆的旋转会驱动所述传动梁纵向运动;
细长主体,其被配置为与所述钳夹组件连接,所述细长主体包括限定了第二纵向轴线的挠性传动轴,所述传动轴会将旋转运动传递到所述传动螺杆上;以及
传动连杆,其将所述挠性传动轴与传动螺杆连接起来,其中,所述传动连杆相对于所述第一纵向轴线和第二纵向轴线偏离布置,所述钳夹组件和细长主体是彼此能够分离的,所述细长主体配置为与致动器相连。
9.根据权利要求8所述的手术系统,进一步包括电源,所述电源被配置用来提供电能。
10.根据权利要求9所述的手术系统,进一步包括控制组件,所述控制组件被配置用来接受至少一个用户输入。
11.根据权利要求10所述的手术系统,进一步包括第一电机,所述第一电机被联接到所述电源上且被配置为响应所述至少一个用户输入而运行。
12.根据权利要求11所述的手术系统,进一步包括第二电机,所述第二电机被联接到所述电源上且被配置为响应所述至少一个用户输入而运行。
13.根据权利要求12所述的手术系统,进一步包括选择变速箱组件,所述选择变速箱组件包括与所述挠性传动轴机械联接的至少一个齿轮元件,其中,所述第一电机配置为选择性地移动所述至少一个齿轮元件与所述第二电机相啮合,从而致动所述挠性传动轴。
14.根据权利要求8所述的手术系统,其中,所述传动梁包括用来支撑所述凸轮构件并推动所述滑块的竖直支柱。
15.根据权利要求8所述的手术系统,进一步包括外壳,所述外壳内有电机。
16.根据权利要求8所述的手术系统,进一步包括控制组件,所述控制组件被配置用来接受用户输入。
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AU2013201994A1 (en) | 2013-10-31 |
JP2017087057A (ja) | 2017-05-25 |
EP2649948B1 (en) | 2016-03-23 |
JP6356288B2 (ja) | 2018-07-11 |
EP2649948A1 (en) | 2013-10-16 |
CA2810192A1 (en) | 2013-10-11 |
JP6128922B2 (ja) | 2017-05-17 |
CN103371858A (zh) | 2013-10-30 |
JP2013215578A (ja) | 2013-10-24 |
EP3066991A2 (en) | 2016-09-14 |
EP3066991A3 (en) | 2016-11-02 |
ES2569388T3 (es) | 2016-05-10 |
AU2013201994B2 (en) | 2017-09-07 |
EP3066991B1 (en) | 2018-09-19 |
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