CN103379871A - 通过外科器械的端部执行器进行的使用者反馈 - Google Patents

通过外科器械的端部执行器进行的使用者反馈 Download PDF

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Publication number
CN103379871A
CN103379871A CN2011800638159A CN201180063815A CN103379871A CN 103379871 A CN103379871 A CN 103379871A CN 2011800638159 A CN2011800638159 A CN 2011800638159A CN 201180063815 A CN201180063815 A CN 201180063815A CN 103379871 A CN103379871 A CN 103379871A
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Prior art keywords
end effector
surgical instruments
led
light
instruments according
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CN2011800638159A
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CN103379871B (zh
Inventor
C·G·金博尔
D·W·普莱斯
G·S·斯特罗布尔
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Ethicon Endo Surgery Inc
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Ethicon Endo Surgery Inc
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Abstract

本发明公开了一种外科器械，其包括柄部组件和传输组件，所述传输组件包括端部执行器。所述端部执行器包括视觉指示器，诸如设置在夹持臂上的点，以从设置在夹持臂和夹持垫之间的至少一个LED发射光。所述LED可连接至电源。所述端部执行器的外部护套被挤压成型以包括第一组电缆。所述端部执行器的远侧组件包括夹持臂、夹持垫、LED和第二组电缆，当所述远侧组件搭扣配合进入所述挤压成型的外部护套中时，所述第二组电缆和所述第一组电缆配合。超声外科器械包括外部护套，所述外部护套能够沿其部分从容纳在内部的LED中传输光。

Description

通过外科器械的端部执行器进行的使用者反馈
优先权
本专利申请要求于2010年11月5日提交的名称为“Energy-BasedSurgical Instruments”的美国临时申请61/410,603的优先权，该临时申请的公开内容以引用方式并入本文。
本专利申请同时要求于2011年5月19日提交的名称为“Energy-BasedSurgical Instruments”的美国临时申请61/487,846的优先权，该临时申请的公开内容以引用方式并入本文。
本专利申请同时要求于2011年10月19日提交的名称为“UserFeedback Through End Effector of Surgical Instrument”的美国非临时申请13/276,673的优先权，该非临时申请的公开内容以引用方式并入本文。
背景技术
在一些情况下，内窥镜式外科器械优于传统的开放式外科装置，因为较小的切口可减少术后恢复时间和并发症。因此，一些内窥镜式外科器械可适于将远侧端部执行器通过套管针的插管设置在所需手术部位处。这些远侧端部执行器（例如，直线切割器、抓紧器、切割器、缝合器、施夹钳、进入装置、药物/基因治疗递送装置、以及使用超声、射频、激光等的能量递送装置）可以多种方式接合组织，以达到诊断或治疗的效果。内窥镜式外科器械可包括轴，所述轴位于端部执行器和由临床医生操纵的柄部部分之间。这种轴可允许插入到期望的深度并围绕轴的纵向轴线旋转，由此有利于将端部执行器定位在患者体内。
内窥镜式外科器械的例子包括公开于下述专利中的那些美国专利公布：2006年4月13日公布的名称为“Tissue Pad Use with an UltrasonicSurgical Instrument”的美国专利公布2006/0079874，其公开内容以引用方式并入本文；2007年8月16日公布的名称为“Ultrasonic Device for Cuttingand Coagulating”的美国专利公布2007/0191713，其公开内容以引用方式并入本文；2007年12月6日公布的名称为“Ultrasonic Waveguide and Blade”的美国专利公布2007/0282333，其公开内容以引用方式并入本文；2008年8月21日公布的名称为“Ultrasonic Device for Cutting and Coagulating”的美国专利公布2008/0200940，其公开内容以引用方式并入本文；2009年8月20日公布的名称为“Motorized Surgical Cutting and Fastening InstrumentHaving Handle Based Power Source”的美国公布2009/0209990，其公开内容以引用方式并入本文；以及2010年3月18日公布的名称为“UltrasonicDevice for Fingertip Control”的美国公布2010/0069940，其公开内容以引用方式并入本文；2011年1月20日公布的名称为“Rotating Transducer Mountfor Ultrasonic Surgical Instruments”的美国专利公布2011/0015660，其公开内容以引用方式并入本文；2002年12月31日公布的名称为“Electrosurgical Systems and Techniques for Sealing Tissue”的美国专利6,500,176，其公开内容以引用方式并入本文；2008年8月26日公布的名称为“Motor-Driven Surgical Cutting and Fastening Instrument with LoadingForce Feedback”的美国专利7,416,101，其公开内容以引用方式并入本文；2010年6月15日公布的名称为“Post-Sterilization Programming of SurgicalInstruments”的美国专利7,738,971，其公开内容以引用方式并入本文；以及2011年4月14日公布的名称为“Surgical Instrument Comprising First andSecond Drive Systems Actuatable by a Common Trigger Mechanism”的美国专利公布2011/0087218，其公开内容以引用方式并入本文。另外，这些外科工具可包括无绳换能器，诸如2009年6月4日公布的名称为“CordlessHand-held Ultrasonic Cautery Cutting Device”的美国专利公布2009/0143797，其公开内容以引用方式并入本文；另外，所述外科器械可用于或者适用于机器人辅助的外科手术场景中，诸如2004年8月31日公布的名称为“Robotic Surgical Tool with Ultrasound Cauterizing and CuttingInstrument”的美国专利6,783,524中的机器人辅助的外科手术场景，其公开内容以引用方式并入本文。
尽管已研制出若干系统和方法并用于外科器械，但据信在本发明人之前还无人研制出或使用所附权利要求中描述的发明。
附图说明
虽然在说明书之后提供了特别指出和清楚地要求保护本技术的权利要求书，但是据信通过对下面结合附图的某些实施例的描述可以更好地理解本技术，附图中类似的参考标号表示相同元件，其中：
图1示出了具有内部电源的示例性医疗装置的示意图；
图2示出了具有内部电源的示例性医疗装置的透视图；
图3示出了包括视觉指示器的示例性外科器械的侧正视图；
图4示出了图3的包括照明环的端部执行器的变型的部分侧正视图；
图5示出了图4的端部执行器的局部透视图；
图6示出了示例性端部执行器的横截面端视图，所述端部执行器包括透明塑料镜片和设置在透明塑料镜片下以及端部执行器内部各部件周围的一个或多个LED；
图7示出了正在组织血管上进行操作的示例性替代端部执行器的透视图，所述端部执行器包括在上夹持臂顶表面上的一系列发光的点结构，而附接的夹持垫则夹紧所述血管；
图8示出了图7的端部执行器的横截面侧视图；
图9示出了移除了夹持臂和夹持垫的图7的示例性端部执行器的透视图；
图10示出了图8的挤压成型的外部护套的剖面图；
图11示出了具有外部护套的示例性谐波刀的侧正视图，所述外部护套能够沿其整个长度传输光；
图12示出了具有外部护套的示例性谐波刀的侧正视图，所述外部护套包括能够从内部LED源传输光的细长的局部区域；并且
图13示出了具有外部护套的示例性谐波刀的侧正视图，所述外部护套包括能够从内部LED源传输光的局部点区域。
附图并非旨在以任何方式进行限制，并且可以预期本技术的各种实施例能够以多种其它方式来执行，包括那些未必在附图中示出的方式。附图并入本说明书中并构成其一部分，示出了本技术的若干方面，并与具体实施方式一起用于说明本技术的原理；然而，应当理解，本技术不限于所示出的明确布置方式。
具体实施方式
本技术的某些例子的下述描述不应用于限制其范围。通过以下举例说明设想用于实施本技术的最佳方式之一的描述，本技术的其它例子、特征、方面、实施例和优点对于本领域技术人员将变得显而易见。应当认识到，本文所述的技术包括不脱离本技术的所有其它的不同和明显方面。因此，附图和具体实施方式应被视为实质上是示例性的，而非限制性的。
I.示例性医疗装置概述
图1以示意方块图的形式示出了示例性医疗装置10的各部件。如图所示，医疗装置10包括控制模块12、电源14和端部执行器16。仅仅示例性的电源14可以包括镍氢电池、锂离子电池（例如，棱柱状电池型锂离子电池等）、镍铬电池或者任何其它类型的电源，参考本文的教导内容，这对于本领域的普通技术人员而言可能是显而易见的。控制模块12可以包括微处理器、专用集成电路（ASIC）、存储器、印刷电路板（PCB）、存储装置（例如固态驱动器或硬盘）、固件、软件或者任何其它合适的控制模块部件，参考本文的教导内容，这对于本领域的普通技术人员而言将是显而易见的。控制模块12和电源14通过诸如缆线和/或电路板中的迹线等的电连接件22联接，以将电力从电源14传递到控制模块12。或者，电源14选择性地联接到控制模块12。这允许电源14被从医疗装置10拆下和移除，可以进一步允许电源14容易地进行再充电或者回收以例如根据本文的各种教导内容用于重新消毒和再利用。除此之外或作为另外一种选择，控制模块12可以被移除，以用于维护、测试、更换或其它目的，参考本文的教导内容，这对于本领域的普通技术人员而言将是显而易见的。
端部执行器16通过另一个电连接件22联接到控制模块12。端部执行器16能够执行医疗装置10的期望功能。仅仅以举例的方式，这样的功能可以包括烧灼组织、消融组织、切割组织、超声振动、缝合组织或者用于医疗装置10的任何其它期望的任务。从而，端部执行器16可以包括主动结构，例如超声刀、一对夹紧钳口、尖锐小刀、缝合驱动组件、单级射频电极、一对双极射频电极、加热元件和/或各种其它部件。端部执行器16也可从医疗装置10中移除以用于维护、测试、更换或任何其它目的；参考本文的教导内容，这对于本领域的普通技术人员而言将是显而易见的。在某些情形下，端部执行器16是模块化的，使得医疗装置10可以与不同类型的端部执行器一起使用（例如，如序列号为61/410,603的美国临时申请所教导的等）。根据医疗装置10的目的，可以提供端部执行器16的各种其它构型以用于各种不同的功能，参考本文的教导内容，这对于本领域的普通技术人员而言将是显而易见的。相似地，参考本文的教导内容，能够从电源14接收电力的其它类型的医疗装置10的部件对于本领域的普通技术人员而言将是显而易见的。
本例子的医疗装置10包括触发器18和传感器20，但是应当理解这样的部件仅仅是可选的。触发器18通过电连接件22联接到控制模块12和电源14。触发器18能够选择性地将电力从电源14传递到端部执行器16（和/或传递到医疗装置10的某些其它部件），以在进行手术时激活医疗装置10。传感器20也通过电连接件22联接到控制模块12并且能够在手术期间向控制模块12提供各种信息。仅以举例的方式，此类构型可包括感测端部执行器16处的温度或者确定端部执行器16的振动速率。来自传感器20的数据可以通过控制模块12处理，以实现电力到端部执行器16的递送（例如在反馈回路等中）。根据医疗装置10的目的，可以提供传感器20的各种其它构型，参考本文的教导内容，这对本领域技术人员而言将是显而易见的。当然，和本文所述的其它部件一样，医疗装置10可以具有不止一个传感器20，或者如果需要传感器20可以简单地被省略。
图2示出了医疗装置10可以采取的仅示例性的形式。具体地，图2示出了包括电源110、控制模块120、外壳130、端部执行器140、以及电连接件150的医疗装置100。在本例中，电源110内置于医疗装置100的外壳130内。或者，电源110可仅部分地伸入外壳130并可选择性的附接于外壳130的一部分。在另一个示例性构型中，外壳130的一部分可伸入电源110，并且电源110可选择性地附接于外壳130的所述部分。电源110也能够与医疗装置100分开并与控制模块120或电连接件150脱离。因此，在某些变型中，电源110可与医疗装置100完全分离。仅以举例的方式，电源110可根据2011年4月14日公布的名称为“Surgical Generator forUltrasonic and Electrosurgical Devices”的美国公布2011/0087212的教导内容进行构造，其公开内容以引用方式并入本文。在某些变型中，诸如根据本文的各种教导内容，电源110可取出以再充电或回收以供重新消毒和再利用。再充电后，或者初次充电后，电源110可插入或重新插入医疗装置100并固定到外壳130或外壳130内部。当然，医疗装置100也可允许电源110在仍然处于外壳130内部或换句话讲仍然相对于外壳130联接时进行充电和/或再充电。
也应当理解，控制模块120可被移除以用于维护、测试、更换或任何其它目的；参考本文的教导内容，这对于本领域的普通技术人员而言将是显而易见的。此外，端部执行器140也可从医疗装置100移除以用于维护、测试、更换或任何其它目的；参考本文的教导内容，这对于本领域的普通技术人员而言将是显而易见的。
尽管已描述了示例性医疗装置100的某些构型，但根据本文的教导内容，可构造医疗装置100的各种其它方式对于本领域的普通技术人员将是显而易见的。仅以举例的方式，医疗装置10,100和/或任何本文涉及的其它医疗装置可根据以下专利中的至少部分教导内容进行构造：1994年6月21日公布的名称为“Clamp Coagulator/Cutting System for Ultrasonic SurgicalInstruments”的美国专利5,322,055，其公开内容以引用方式并入本文；1999年2月23日公布的名称为“Ultrasonic Clamp Coagulator ApparatusHaving Improved Clamp Mechanism”的美国专利5,873,873，其公开内容以引用方式并入本文；1997年10月10日提交的名称为“Ultrasonic ClampCoagulator Apparatus Having Improved Clamp Arm Pivot Mount”的美国专利5,980,510，其公开内容以引用方式并入本文；2001年12月4日公布的名称为“Blades with Functional Balance Asymmetries for use with UltrasonicSurgical Instruments”的美国专利6,325,811，其公开内容以引用方式并入本文；2006年4月13日公布的名称为“Tissue Pad for Use with an UltrasonicSurgical Instrument”的美国公布2006/0079874，其公开内容以引用方式并入本文；2007年8月16日公布的名称为“Ultrasonic Device for Cutting andCoagulating”的美国公布2007/0191713，其公开内容以引用方式并入本文；2007年12月6日公布的名称为“Ultrasonic Waveguide and Blade”的美国公布2007/0282333，其公开内容以引用方式并入本文；2008年8月21日公布的名称为“Ultrasonic Device for Cutting and Coagulating”的美国公布2008/0200940，其公开内容以引用方式并入本文；2009年6月4日公布的名称为“Cordless Hand-held Ultrasonic Cautery Cutting Device”的美国公布2009/0143797，其公开内容以引用方式并入本文；2010年3月18日公布的名称为“Ultrasonic Device for Fingertip Control”的美国公布2010/0069940，其公开内容以引用方式并入本文；2011年1月20日公布的名称为“Rotating Transducer Mount for Ultrasonic Surgical Instruments”的美国公布2011/0015660，其公开内容以引用方式并入本文；和/或2010年11月5日提交的名称为“Energy-Based Surgical Instruments”的美国临时专利申请序列号61/410,603，其公开内容以引用方式并入本文。
当然，外壳130和医疗装置100可包括其它构型。例如，外壳130和/或医疗装置100可包括组织切割元件以及给组织传输双极性射频能（例如，用来止血或密封组织）的一个或多个元件。这种装置的一个例子是由Ethicon Endo-Surgery,Inc.（Cincinnati,Ohio）制造的组织密封装置。这种装置的其它例子以及相关理念公开于下列美国专利中：2002年12月31公布的名称为“Electrosurgical Systems and Techniques for SealingTissue”的美国专利6,500,176，其公开内容以引用方式并入本文；2006年9月26日公布的名称为“Electrosurgical Instrument and Method of Use”的美国专利7,112,201，其公开内容以引用方式并入本文；2006年10月24日公布的名称为“Electrosurgical Working End for Controlled Energy Delivery”的美国专利7,125,409，其公开内容以引用方式并入本文；2007年1月30日公布的名称为“Electrosurgical Probe and Method of Use”的美国专利7,169,146，其公开内容以引用方式并入本文；2007年3月6日公布的名称为“Electrosurgical Jaw Structure for Controlled Energy Delivery”的美国专利7,186,253，其公开内容以引用方式并入本文；2007年3月13日公布的名称为“Electrosurgical Instrument”的美国专利7,189,233，其公开内容以引用方式并入本文；2007年5月22日公布的名称为“Surgical Sealing Su射频acesand Methods of Use”的美国专利7,220,951，该专利的公开内容以引用方式并入本文；2007年12月18日公布的名称为“Polymer CompositionsExhibiting a PTC Property and Methods of Fabrication”的美国专利7,309,849，其公开内容以引用方式并入本文；2007年12月25日公布的名称为“Electrosurgical Instrument and Method of Use”的美国专利7,311,709，其公开内容以引用方式并入本文；2008年4月8日公布的名称为“Electrosurgical Instrument and Method of Use”的美国专利7,354,440，其公开内容以引用方式并入本文；2008年6月3日公布的名称为“Electrosurgical Instrument”的美国专利7,381,209，其公开内容以引用方式并入本文；2011年4月14日公布的名称为“Surgical Instrument ComprisingFirst and Second Drive Systems Actuatable by a Common Trigger Mechanism”的美国公布2011/0087218，其公开内容以引用方式并入本文；以及2011年6月2日提交的名称为“Motor Driven Electrosurgical Device with Mechanicaland Electrical Feedback”的美国专利申请13/151,181，其公开内容以引用方式并入本文。
另外应当理解，本文所述的教导内容、表达方式、实施例、例子等中的任何一个或多个可与本文所述的其它教导内容、表达方式、实施例、例子等中的任何一个或多个相结合。因此下述教导内容、表达方式、实施例、例子等不应视为彼此隔离。根据本文的教导内容，其中本文的教导内容可结合的各种合适方式对于本领域的普通技术人员而言将是显而易见的。这种修改形式和变化形式旨在包括在权利要求书的范围之内。
II.超声外科器械上的示例性视觉指示器
下述例子涉及各种外科器械上的示例性视觉指示器的用途，所述各种外科器械包括但不限于超声外科器械和电外科装置。应当理解，上述涉及的和/或本文引用的任何参考文献中描述的任何器械或装置10,100可很容易地结合下述任何教导内容。此类教导内容可被结合的各种合适方式对于本领域的普通技术人员将是显而易见的。正如下面将会更详细地描述，视觉指示器可用于提供外科器械的关于操作参数等方面的视觉反馈。在整个本公开中，所采用的包括文字与数字的不同扩展的参考数字在所描述的参考文献的不同型式中指示类似的组件（例如，外科器械50,50A）。
图3示出了示例性器械50A，该示例性器械是上述器械10，100的变型。多部件柄部组件60A的上表面400包括照明显示器402。外科器械50A的端部执行器80A可除此之外或者作为另外一种选择包括照明显示器404。照明显示器402，404可包括发光二极管（LED）。器械50A包括电源401、控制模块403和电连接件405，它们分别和上述器械100的电源110、控制模块120和电连接件150相似。电源401可包括例如电池。或者，器械50A可由外部电源供电，诸如美国公开2011/0087212中所述的电源。控制模块403可例如从传感器读取信息，处理传感器数据以驱动照明显示器404，以及处理传感器数据以控制端部执行器80A的致动和夹持。
图4-5示出了端部执行器80A的一种型式，该端部执行器80A包括设置在其近端处的作为照明环404A的照明显示器404。如图5所示，环404A可包括放置在端部执行器80A的夹持臂84A中的至少一个LED。重新参考图4，光纤缆线406将照明环404A连接到器械50A内的一个源（未示出），诸如容纳在多部件柄部组件60A内的电子器件和/或电池管套。至端部执行器80A的机械连接件408被设置为穿过限定在照明环404A中的一个中央孔。光纤缆线406直接连接至照明环404A。光纤缆线406可将光沿着传输组件70A的轴410向下传送并穿过端部执行器80A上的镜片以散发出光。这种光可向外科医生提供反馈，该反馈可在外科监视器上被看到，使得外科医生无需在外科手术中把视线从外科监视器上移开或是无需在外科手术中留意听能提供信息的特定可听音调。
用于照明显示器402和/或照明显示器404，404A的一个或多个LED可包括单个多色LED或多个颜色不同的LED。在使用中，光纤缆线406将光沿着轴410向下传输给端部执行器80A，如上所述。另外，整个轴410可包括能从容纳在多部件柄部组件60A内的LED发出光的透明管。参见图6，透明镜片420可被包括作为端部执行器80A的轴410的一部分。至少一个LED418可定位在镜片420下面以及内部装置部件422的外面以通过镜片420传输光，所述镜片420并不是基本上中断的，而且对于正在使用器械50A进行手术的外科医生而言是可见的。镜片420可另外包括磨砂面或任何其它合适的抛光以扩散发出的光并使镜片420看起来发光。端部执行器80A可包括结合的镜片以散发接收到的光，该光可用于向正在使用外科器械50A的外科医生指示各种状况或信息。
此类信息，除了别的以外，还可包括外科器械50A的状态指示，诸如周期完成指示，电源启动或关闭指示，器械50A的接近过载指示，电池电力指示，对此需求的指示，例如非正常工作的器械50A，端部执行器80A的温度，施加的能量，和/或正在由器械50A在上面进行操作的组织的密封状态。例如，光可变成红色以指示端部执行器80A是热的，而变成蓝色以指示端部执行器80A是冷的。或者，光脉动可表示正在通过端部执行器80A施加能量，而光常亮可指示不再通过端部执行器80A施加能量。除此之外或者作为另外一种选择，黄光可表示注意或警告器械50A，包括但不限于以下警告：器械50A非正常工作，没有准备好密封组织，或其本身没有被正在手术的外科医生正确使用。
任意一个照明显示器402，404，404A的足够的亮度可使正在手术的外科医生和器械50A的使用者检测到使用者视线范围内的相应照明显示器发出的变化的颜色。光可被散发，例如，作为光渐渐从黄色变成橙色再变成红色，以表明例如刀在使用过程中正在逐渐变热。或者，LED可发光并发出一种不同的颜色以表明由于组织被施加了太多的压力正接近于过载。除此之外或者作为另外一种选择，可在轴410上印刷或贴上有机LED（OLED）标签；其中LED的发射性电致发光层是一种响应于电流而发出光的有机化合物的膜，以使光不必要沿轴410向下传输。相反，电连接件可提供必要的电力以照明轴410上的OLED材料。
重新参考图13，在被切断的组织血管414上进行手术将其密封的过程中，或者当组织血管414的密封已经完成时，环404A在这个手术过程中向使用器械50A的外科医生提供视觉反馈。例如，当密封过程开始时环404A可闪烁，而当如上所述组织90的血管414已经处于密封完成的状态时，环404A可变成常亮。在使用中，当器械50A接通电源时，环404A可启动并闪烁光。一旦预设的量的时间过去，从环404A发出的光会停止闪烁并变成常亮以指示血管414上的密封处于完成状态，如上所述。环404A可使用时间算法以确定何时发出指示密封完成的常亮的光。或者，环404A可利用基于阻抗的发生器算法来确定何时发出常亮的光。
通过从环404A或端部执行器80A上的光管发出这种光，外科医生可在端部执行器80A的不同取向处看到血管414的密封状态。将该执行器和基于发生器算法指示的密封完成的可听变化音调结合起来，可向外科医生提供多层次的反馈以指示密封的完成。
图7示出了示例性器械50B，该示例性器械是上述器械10，100，50A的变型。器械50B包括具有夹持臂84B的端部执行器80B。夹持臂84B包括小孔416，所述小孔允许从至少一个LED诸如图6的LED418发出的光穿过。例如在腹腔镜手术过程中使用时，穿过孔416的光可很容易地被使用器械50B进行手术的外科医生看到，并能够在手术过程中将如上所述的各种类型的信息传递给外科医生。
端部执行器80B的顶表面424上的小孔416可发出各种颜色的光以从端部执行器80B中发出指示某些信息的光。端部执行器80B可包括如下所述的模塑互连装置和被照明的夹持垫86B。图8示出了三色LED426，其设置在上夹持臂84C和端部执行器80C的夹持垫86C之间的腔体内。来自LED426的光可发出或变化成各种颜色，并且来自LED426的光可经由一个或多个光管结构通过夹持垫86B以及通过夹持臂84C的孔416传递及发出。光可从两个或多个孔416同时和/或在不同时间发出。随着光在不同时间从孔416发出，发出的光的不同顺序可指示不同的信息。经由孔416以特定顺序发出的照明显示器可指示由端部执行器80B执行的组织90的密封过程的信息。例如，孔416的一对后灯可在密封过程的开始时间内照亮。随着密封的进展，更多的灯可以开始在远侧方向上照亮。所有孔416最终都照亮，包括一起包括孔416的那对后灯以及一对前灯以及设置在其间的那些灯，可指示由端部执行器80B执行的组织90的密封已经完成。
端部执行器80B的远侧组件430的近端428可如下在图8和9中所述沿箭头A的方向扣进挤压成型的外管或外部护套72B中。从远侧组件430的近端428延伸的一个或多个突起432可扣进外部护套72B的一个或多个凹口434中。在本例中，远侧组件430包括注塑的远侧外管436，突起432从该外管伸出。外部护套72B是挤压成型的并包括两根电缆438，所述电缆438贯穿并在一段长度的外部护套72B内。外管436包括电缆440，当外管436和挤压成型的外部护套72B联接时所述电缆440与电缆438配合，使得同时实现电连接和机械连接。可为包括光管的超声器械的护套搭建一个相似的连接，如下更详细地描述。例如，使光连接的方式类似于上述电连接的方式，从这种意义上来说，导线管诸如光纤缆线可将一个内部LED连接到光管护套。
导线管440与夹持臂84B内的LED426经由定位在夹持垫86C和夹持臂84B之间的线材441电连通。电缆440、线材441和导线管438一起从器械50B提供信号以点亮LED426。从LED426发出的光照亮半透明的夹持垫86B，并透过夹持臂84B的小孔416照射出来，如上所述。
参见图8，夹持臂84B可经由销442相对于外管436枢转，并经由销444连接至下夹持臂，与上述器械50的方式类似。图9示出了没有夹持臂84B和夹持垫86B附接的远侧组件430。孔446设置在外管436中并能够容纳夹持臂84B的枢轴销442。图10示出了容纳内部管状致动构件448和谐波刀82B的挤压成型的外部护套72B的剖面图。内部管状致动构件448在外部护套72B内可平移以将夹持臂84B选择性地朝着和远离刀82B枢转，如上面本文引用的各参考文献所述。将刀82B用超声能量选择性地激活，如本文引用的各参考文献所述。两根电引线或电缆438被模塑在外部护套72B内。在挤压成型的外部护套72B上的模塑的互连装置设计因此包含连接至如上所述的远侧组件430的电引线或电缆438，以给夹持臂84B内的LED426供电，使发出不同颜色的光以向使用者诸如外科医生提供视觉反馈。如上所述，光可以是渐变颜色和/或散发出的不同颜色。
图11-13示出了包括谐波刀462，464，466的超声外科器械456,458,460的相应护套450,452,454的三种不同型式。超声外科器械456,458,460可以是外科器械50或装置310或其它外科医生训练工具的替代型式。图11示出了一种型式，其中整个护套450是一种磨砂透明材料，或是将光从内部LED诸如上述LED418传递给装置456的使用者的光管。图12和13示出了护套452，454的两种其它型式，其中相应护套452，454的选择性区域不从例如LED418传输光。图12包括护套452上传导光的细长局部区域468。护套452可包括两部分：完全不透明管472和在外部完全不透明管472内的光导管474，所述光导管474只在局部区域468透过外管472露出。图13示出了护套454的区域，所述护套包括传导光的点470。例如，护套454可包括涂覆有不透明涂层的透明材料，并只在局部区域诸如点470限定的区域发射光。
在使用过程中通过观察相应装置456，458，460的护套450,452,454，可向所述装置的使用者提供可见的信息指示，诸如有多少力施加于相应的刀462,464,466。所述力可通过相应刀462,464,466上阻抗的增加来测量，或者通过使用容纳在相应的装置罩内的弯曲传感器来测定有多少力施加于相应的刀护套组件。这类组件因而能够用于帮助训练外科医生使用适量的力以及在外科手术诸如腹腔镜组织手术中优化对组织的影响以切除组织所必需的技能，如本文所述及本文引用的各参考文献所述。因此，当向紧挨组织的相应刀462,464,466上施加力且所述力开始增大时，相应的发光护套例如会由绿色变为黄色，由黄色变为橙色并且最后变为红色，以指示已经到了终点，此时提供常音调，表明使用者通过相应刀462,464,466施加的力过大，或者提交一个错误代码。当使用相应装置456,458,460时，使用者诸如外科医生可理解，绿色或黄色护套表明外科医生施加于组织上的力适量，而橙色或红色护套表明施加于组织上的力过大。
应当理解，本文所述的教导内容、表达方式、实施例、例子等中的任何一个或多个可与本文所述的其它教导内容、表达方式、实施例、例子等中的任何一个或多个相结合。因此下述教导内容、表达方式、实施例、例子等不应视为彼此隔离。根据本文的教导内容，其中本文的教导内容可结合的各种合适方式对于本领域普通技术人员将是显而易见的。这种修改形式和变化形式旨在包括在权利要求书的范围之内。
上文所述的装置的型式可适用于由医学专家执行的常规医疗处理和手术中、以及可适用于机器人辅助的医疗处理和手术中。
上文所述的型式可被设计为单次使用后丢弃，或者它们可被设计为可使用多次。在上述任一种或两种情况下，都可对这些型式进行修复，以便在使用至少一次后重复使用。修复可包括以下步骤的任意组合：拆卸装置、然后清洗或更换特定部件和随后进行重新组装。具体地讲，可拆卸所述装置的一些型式，并且可选择性地以任何组合形式来更换或拆除所述装置的任意数量的特定部件或零件。在清洗和/或更换特定零件时，所述装置的一些型式可在修复设施中重新组装或者在即将进行手术前由用户重新组装以供随后使用。本领域的技术人员将会知道，修复装置时可利用多种技术进行拆卸、清洗/更换和重新组装。这些技术的使用以及所得的修复装置均在本发明的范围内。
仅以举例的方式，本文所述的型式可在手术之前和/或之后进行消毒。在一种消毒技术中，将装置置于闭合并密封的容器中，例如，置于塑料袋或TYVEK袋中。然后可将容器和装置置于可穿透该容器的例如γ辐射、X射线或高能电子等辐射的辐射场中。辐射可杀死装置上和容器中的细菌。消毒后的装置随后可存放于消毒容器中，以备以后使用。还可使用本领域已知的任何其它技术对装置消毒，所述技术包括但不限于β辐射或γ辐射、环氧乙烷或蒸汽消毒。
尽管已在本发明中示出和描述了多个型式，但本领域的普通技术人员可在不脱离本发明范围的前提下进行适当修改以对本文所述的方法和系统进行进一步改进。已经提及了若干此类潜在的修改形式，并且其它修改形式对于本领域的技术人员而言将显而易见。例如，上文讨论的例子、型式、几何形状、材料、尺寸、比率、步骤等等均是示例性的而非必需的。因此，本发明的范围应以下面的权利要求书考虑，并且应理解为不限于说明书和附图中示出和描述的结构和操作细节。

Claims (20)

1.一种外科器械，包括：
(a)主体；
(b)从所述主体向远侧延伸的传输组件；
(c)在所述传输组件的远端处的端部执行器，其中所述端部执行器能够操作以将能量从所述传输组件递送到手术部位；和
(d)在所述传输组件或所述端部执行器上的视觉指示器，其中所述视觉指示器能够操作以在视觉上指示与所述端部执行器相关联的操作参数。
2.根据权利要求1所述的外科器械，还包括设置在所述主体上的照明装置。
3.根据权利要求1所述的外科器械，其中所述视觉指示器包括设置在所述端部执行器上的照明装置。
4.根据权利要求1所述的外科器械，其中所述端部执行器包括与所述外科器械连通的一根或多根光纤缆线以通过所述端部执行器上的视觉指示器传输光。
5.根据权利要求1所述的外科器械，其中所述端部执行器包括至少一个夹持臂，其中所述视觉指示器包括能够照明的环，其中所述环设置在所述至少一个夹持臂的近侧。
6.根据权利要求1所述的外科器械，其中所述端部执行器包括轴，其中所述轴包括透明镜片，其中所述视觉指示器包括设置在所述透明镜片下方的一个或多个LED。
7.根据权利要求1所述的外科器械，其中所述端部执行器包括上夹持臂，其中所述视觉指示器包括一个或多个LED，其中所述上夹持臂包括能够从所述一个或多个LED传输光的一系列孔。
8.根据权利要求7所述的外科器械，其中所述端部执行器还包括附接到所述上夹持臂的下夹持垫，其中所述一个或多个LED设置在所述上夹持臂和所述下夹持垫之间。
9.根据权利要求8所述的外科器械，其中所述端部执行器还包括远侧组件和挤压成型的外部护套，其中第一组电缆从所述一个或多个LED延伸穿过所述远侧组件，其中所述远侧组件能够可拆卸地附接到所述挤压成型的外部护套的近端。
10.根据权利要求9所述的外科器械，其中所述挤压成型的外部护套是注塑的并且包括第二组电缆，其中当所述远侧组件附接到所述挤压成型的外部护套时，所述第二组电缆能够电连接至所述第一组电缆。
11.根据权利要求9所述的外科器械，其中所述远侧组件包括一个或多个突起或凹口中的一者，所述一个或多个突起或凹口中的一者能够容纳在设置在所述挤压成型的外部护套中的一个或多个突起或凹口中的另一者内。
12.根据权利要求9所述的外科器械，其中所述远侧组件能够以搭扣配合连接的形式可拆卸地附接到所述挤压成型的外部护套的所述近端。
13.根据权利要求9所述的外科器械，其中所述远侧组件包括模塑的远侧外管，其中所述上夹持臂枢转地连接至所述模塑的远侧外管。
14.根据权利要求7所述的外科器械，其中所述一个或多个LED发射能够以一系列颜色中的至少一种发射的光。
15.根据权利要求14所述的外科器械，其中每种颜色与所述端部执行器的刀的温度水平相关联。
16.一种超声外科器械，包括：
(a)护套；
(b)从所述护套延伸的谐波刀；和
(c)容纳在所述超声外科器械中的LED，其中所述LED对在所述谐波刀处施加的力产生响应；
其中所述护套包括能够从所述LED传输光的光传输部分。
17.根据权利要求16所述的器械，其中整个护套包括磨砂透明材料并能够从所述LED传输光。
18.根据权利要求16所述的器械，其中所述护套包括完全不透明管和设置在所述完全不透明管内的光导管，并且所述完全不透明管包括细长的局部区域，并且其中来自所述LED和光导管的光仅通过所述细长的局部区域传输。
19.根据权利要求16所述的器械，其中所述护套包括构成局部区域的一系列点，并且其中所述点能导光以仅通过所述局部区域从所述LED传输光。
20.一种外科器械，包括：
(a)主体；
(b)从所述主体向远侧延伸的轴；
(c)容纳在所述轴的远端内的一个或多个LED，其中每个LED能够操作以在视觉上指示与所述轴的所述远端相关联的操作参数。
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