CN103415261A - 外科缝合和切割装置 - Google Patents
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Abstract
本发明公开了一种具有细长轴（12）的外科缝合和切割装置，该细长轴具有近端（12a）和远端（12b）。轴的远端具有从其延伸的柔性颈部。该装置包括设置在柔性颈部（26）的近端上的端部执行器（16）。该端部执行器包括适于将组织容纳于其间的相对的第一钳口（18）和第二钳口（20）。第一钳口具有附接到其的钉仓，其中该钉仓具有设置在其中的用于被驱动到组织中的多个缝钉。第二钳口包括用于使缝钉变形的砧座。装置还包括联接到细长管的近端的远程控制的用户界面。该界面与柔性颈部可操作地相关联，使得远程控制的用户界面的运动被柔性颈部模拟。
Description
相关申请的交叉引用
本申请为要求2006年3月23日提交的名称为“Methods and Devicesfor Controlling Articulation”的美国专利申请11/277,323的权益的部分继续申请。
技术领域
本发明广义上涉及用于控制外科装置的工作端的运动的方法和装置。
背景技术
内窥镜式外科器械常常优于传统的开放式外科装置，因为自然腔道的使用趋于减少术后恢复时间和并发症。因此，已对适于将工具的工作端穿过自然腔道精确地放置在期望的手术部位处的一系列内窥镜式外科器械进行了显著的开发。这些工具可用于通过多种方式接合和/或处理组织以达到诊断或治疗效果。
内窥镜式手术要求装置的轴为柔性的，同时仍允许工作端进行关节运动以相对于组织按一定角度来定向工作端，并且在一些情况下被致动以击发或换句话讲产生工作端的运动。由于柔性轴的使用以及内窥镜式器械的尺寸限制，因此对用于使内窥镜式装置的工作端进行关节运动和致动内窥镜式装置的工作端的控制件进行集成趋于复杂。一般来讲，控制运动作为纵向平移而全部通过轴来传送，这可影响轴的灵活性。还期望将使工作端进行关节运动和/或致动工作端所需的力降至所有或绝大多数外科医生能够操作的水平。一种已知的降低击发力的解决方法是使用电动马达。然而，外科医生通常更喜欢体验来自工作端的反馈以确保正确地操作端部执行器。使用者反馈效果未能在目前的马达驱动装置中适当地实现。
因此，仍然需要改进的方法和装置，以用于控制内窥镜式外科装置的工作端的运动。
附图说明
通过下文的具体说明并结合附图可更充分地理解本发明。其中：
图1A为外科缝合和切割装置的一个实施例的透视图，其示出了处于初始位置的装置的工作端；
图1B为图1A的外科缝合和切割装置的透视图，其示出了处于关节运动位置的装置的工作端；
图2为图1A和1B所示装置的柔性颈部的一部分的透视图；
图3A为图1A和1B所示装置的远侧部分的透视图，其示出了端部执行器以及联接到该端部执行器的图2的柔性颈部；
图3B为沿图3A所示端部执行器的线3B-3B截取的剖面图；
图4A为图1A和1B所示装置的近侧部分的透视图，其示出了活动地联接到装置的轴的近端的柄部；
图4B为图4A所示装置的近侧部分的分解图；
图5为设置在图1A和1B所示装置的柔性颈部和细长轴之间的联接元件的透视图，其示出了光学图像采集设备；
图6为图1A和1B所示装置的柄部的透视图，其示出了图像显示屏幕；
图7为与内窥镜一起使用的辅助通道的透视图；
图8A为图7所示装置的柔性颈部的透视图；
图8B为图8A所示柔性颈部的透视图，其示出了沿第一方向关节运动的颈部；
图8C为图8A所示柔性颈部的透视图，其示出了沿第二方向关节运动的颈部；
图9A为与辅助通道一起使用的柔性颈部的另一个实施例的透视图；
图9B为图9A所示柔性颈部的透视图，其示出了沿第一方向关节运动的颈部；
图9C为图9A所示柔性颈部的透视图，其示出了沿第二方向关节运动的颈部；
图10为与图7所示装置一起使用的多个缆线致动器的透视图；
图11为图7所示辅助通道的轴的剖面图；
图12为与图7的辅助通道一起使用的端盖的一个实施例的透视图；
图13A为图7所示装置的柄部和细长轴的近侧部分的分解图；
图13B为处于组装构型的图13A所示柄部和细长轴的近侧部分的剖面图；
图14A为辅助通道的另一个实施例的透视图；
图14B为图14A所示辅助通道的剖面图；
图15A为图14A和14B所示装置的柄部组件的侧视图；
图15B为图15A的柄部组件的分解图；
图17A为锁定机构的一个实施例的透视图；并且
图17B为图17A的锁定机构的透视图，该锁定机构联接到图1A和1B的外科缝合和切割装置。
具体实施方式
现在将描述某些示例性实施例，以从整体上理解本文所公开的装置和方法的结构、功能、制造和用途。这些实施例的一个或多个例子示出于附图中。本领域的普通技术人员应当理解文中具体描述并示出于附图中的装置和方法均为非限制的示例性实施例，并且本发明的范围仅由权利要求书限定。就一个示例性实施例进行图解说明或描述的结构，可与其他实施例的结构进行组合。这种修改形式和变化形式旨在涵盖于在本发明的范围之内。
本发明提供了用于控制内窥镜式外科装置的工作端的方法和装置。一般来讲，内窥镜式外科装置包括具有远侧工作端和近端的细长轴，该远侧工作端具有柔性颈部并且该近端具有柄部，该柄部用于控制远侧工作端上的柔性颈部的运动。在某些示例性实施例中，这可通过使用例如在柄部和柔性颈部之间延伸的一根或多根缆线来实现，使得柄部的运动施加力到一根或多根缆线以使柔性部分挠曲，从而移动装置的工作端。还提供了各种其他结构以有利于装置的使用。本领域的技术人员应当理解，受控的特定装置以及工作端的特定构型可变化，并且本文所述的各种控制技术可用于期望控制工作端的运动的几乎任何外科装置。
图1A和1B示出了如下技术的一个示例性实施例，该技术用于控制端部执行器进行关节运动，并且具体地用于使端部执行器模拟柄部并且与柄部同时运动。在这个实施例中，装置呈线性的缝合和切割装置10的形式，用于将多个线性的缝钉排施加到组织并用于切割缝合的组织。如图所示，装置10一般来讲包括具有近端12a和远侧工作端12a的细长轴12。该近端具有联接到其的柄部14，并且远侧工作端具有联接到其或形成于其上的端部执行器16，如将在下文更详细地讨论。在使用期间，端部执行器16能够模拟柄部14的运动。在柄部14和端部执行器16之间的模拟运动可大体通过使用致动器（未示出）来实现。该致动器在柄部14和端部执行器16之间延伸，并且能够有效地将力从柄部14传送至端部执行器16。在示例性实施例中，致动器呈多根缆线的形式。所述多根缆线围绕细长轴12的圆周间隔开，并且沿细长轴12的长度延伸。柄部14围绕轴12的近端12a的运动将施加力到一根或多根缆线，以使缆线施加力到端部执行器16，从而使端部执行器16模拟柄部14的运动。模拟运动可包括对应运动或镜像运动。通过对应运动，端部执行器16沿与柄部14相同的方向和取向运动；通过镜像运动，端部执行器16沿与柄部14相对的方向和取向运动。模拟运动还可与柄部的运动成比例。
装置10的细长轴12可具有多种构型。例如，其可为实心的或空心的，并且其可由单个部件或多个段形成。如图2所示，细长轴12为空心的并且由多个连接段形成以允许细长轴12挠曲。轴12的柔韧性以及相对小的直径使轴12可用于内窥镜式手术。在该手术中，装置穿过自然腔道经腔引入。轴的长度还可根据预期应用变化。
图2还示出了呈多根缆线34a，34b，34c，34d形式的致动器22的一个示例性实施例。所述多根缆线围绕细长轴12的圆周间隔开，并且沿细长轴12的长度延伸。缆线的数量和位置可变化。例如，三根缆线可围绕轴12的圆周彼此间隔大约120°。在图2所示的实施例中，四根缆线34a，34b，34c，34d围绕轴12的圆周彼此间隔大约90°。每根缆线34a-d可延伸穿过形成于细长轴12上、细长轴12中、或细长轴12周围的通路例如内腔。图2示出了延伸穿过切口的每根缆线34a-d，该切口形成于轴12的每一段的外表面上。因此，每一段包括围绕轴12的圆周等距间隔开的四个切口，以使缆线34a-d保持彼此等距。切口优选地具有尺寸，该尺寸能够有效地将缆线34a-d保持在切口内而同时允许缆线34a-d相对于轴12自由地滑动。
缆线34a-d的远端可与端部执行器16配合以控制端部执行器16的运动。虽然端部执行器16可具有多种构型，并且可使用本领域中已知的各种端部执行器，但图3A示出了端部执行器16的一个示例性实施例，该示例性实施例大体包括适于将组织容纳于其间的相对的第一钳口18和第二钳口20。第一钳口18适于容纳钉仓，该钉仓具有设置于其中并且能够被驱动到组织中的多个缝钉，并且第二钳口20形成用于使缝钉变形的砧座。端部执行器16的特定构型和基本操作可变化，并且本领域中已知的各种端部执行器16可被使用。通过非限制性例子，全文并入本文的名称为“SurgicalStapling Instrument Incorporating an E-Beam Firing Mechanism”的美国专利6,978,921公开了可与本发明一起使用的端部执行器的一个实施例。
为了使端部执行器16能够相对于细长轴12运动，端部执行器16可活动地联接到细长轴12的远端12b。例如，端部执行器16可通过枢转或旋转接头枢转地联接到细长轴12的远端12b。作为另外一种选择，端部执行器16可包括形成于其上的柔性颈部26，如图所示，以用于使端部执行器16相对于细长轴12运动。柔性颈部26可与轴12的远端12b和/或钳口18，20的近端整体形成，或者其可为在轴12和钳口18，20之间延伸的单独构件。如图3A所示，柔性颈部26包括第一联接器28，其用于使柔性颈部26与相对的钳口18，20的近端配合，以及第二联接器30，其用于使柔性颈部26与细长轴12的远端配合。联接器28，30能够与柔性颈部26和/或与钳口18，20和轴12可拆卸地或固定地配合。联接器28，30还用于容纳端部执行器16的某些部件。例如，第一联接器28可用于锚定其中的缆线，如将在下文讨论，并且其还可用于容纳齿轮和驱动器组件以致动（例如闭合和击发）钳口18，20。
为了有利于柔性颈部26挠曲，颈部26可包括形成于其中的一个或多个狭缝32。狭缝32的数量、位置和尺寸可变化以获得期望的柔韧性。在图3A所示的实施例中，柔性颈部26包括多排狭缝32，每一排围绕柔性颈部26径向延伸并且每一排沿柔性颈部26的长度轴向间隔开。每排狭缝包含围绕颈部26的圆周延伸的两个狭缝，并且每排狭缝32彼此轴向偏移。因此，柔性颈部26包括交替的狭缝32。本领域的技术人员应当理解，狭缝32的特定模式可变化并且图3A仅示出了用于形成狭缝32以使柔性颈部26挠曲的一种模式。其他示例性狭缝构型将在下文更详细地讨论。
如上文所述，缆线34a-d可联接到端部执行器16以使端部执行器16能够与柄部14协调地运动。缆线34a-d与端部执行器16的连接位置可根据期望的运动而变化。在所示实施例中，缆线34a-d的远端连接至柔性颈部26的远端，并且具体地缆线34a-d延伸到第一联接器28中并连接至第一联接器28。图3B示出了第一联接器28的剖面图，其示出了分别用于容纳四根缆线34a，34b，34c，34d的四个镗孔28a，28b，28c，28d。在本领域中已知的几乎任何技术可用于将缆线34a-d连接至联接器28。所述技术包括例如机械配合技术，诸如粘合剂、过盈配合、球窝连接、螺纹等。在使用期间，当轴向力由柄部14施加到缆线34a-d时，缆线34a-d在柔性颈部26的远端处的连接将允许缆线34a-d施加张力到柔性颈部26。该张力使颈部26沿由施加到每根缆线34a-d的张力的大小所指示的方向挠曲，如将在下文更详细地讨论。
装置10的柄部14可用于控制端部执行器16的运动，并且具体地用于使端部执行器16进行关节运动，并因此相对于细长轴12的纵向轴线A以一定角度对该端部执行器进行取向。尽管柄部14可具有多种构型，但是在一种示例性实施例中，柄部14活动地联接到细长轴12的近端12a，使得柄部14的运动可被端部执行器16模拟。尽管各种技术可用于将柄部14活动地联接到轴12，但是在图4A-4C所示的实施例中，球窝连接形成于柄部14和细长轴12的近端12a之间。如图4B最佳地示出，细长轴12的近端12a包括形成于其中的承窝24，并且柄部14包括形成于其远端并能够可旋转地坐置在承窝24中的半球形球13a。承窝24可与细长轴的近端12a整体形成，或者其可通过将中空外壳12c（如图所示）联接到细长轴12的近端12a来形成。半球形球13a还可与柄部14整体形成，或者其可为联接到柄部14的单独构件。为了使柄部14与轴12活动配合，可利用附接到柄部14的缆线34a-d将柄部14上的半球形球13a保持在承窝24内，如下文将讨论。然而，其他配合技术可用于使柄部14与轴12活动配合。例如，球13a可为球形的，并且其可被捕获在形成于细长轴12的近端12a内的球形承窝中，或者配合元件例如销可延伸穿过球13a以将球13a保持在承窝24内。尽管图4B示出了形成于柄部14上的球13a和形成于轴12中的承窝24，但是球窝连接可反向，使得球在轴12上并且承窝在柄部14中。此外，本领域的技术人员应当理解，多种其他技术可用于将柄部14活动地联接到细长轴12的近端12a。
在使用期间，柄部14可相对于轴12进行关节运动或枢转地运动，以使端部执行器16模拟柄部14的运动。这可通过将缆线34a-d的近端联接到柄部14来实现。缆线34a-d与柄部14的连接位置可根据期望的运动而变化。在所示实施例中，缆线（图4A仅示出三根缆线34a，34b和34c）从细长轴12延伸穿过中空外壳12c，并从形成于中空外壳12c的近端中的狭槽或开口出来。缆线34a-d随后围绕柄部14上的球13a延伸，并且连接至柄部14上围绕球13a的面向远侧的表面。在本领域中已知的几乎任何技术可被用于将缆线34a-d连接至柄部14，所述技术包括例如机械配合技术，诸如粘合剂、过盈配合、螺纹等。如图4A所示，柄部14包括形成于其中的开口，并且缆线34a-d的近端（未示出）可具有形成于其上并能够被捕获在开口内的球或其他元件。如图4A进一步所示，缆线（仅示出三根缆线34a，34b和34c）可围绕柄部14周向地保持间隔。这使柄部14的运动被端部执行器16模拟，如将在下文更详细地讨论。作为另外一种选择，缆线34a-d可在其连接至柄部14之前被交叉，以使端部执行器16沿与柄部14相同的方向运动。例如，相对的缆线34a和34c可彼此交叉并可连接至柄部14的相对侧，并且相对的缆线34b和34d可同样彼此交叉并可连接至柄部14的相对的侧。缆线34a-d可在任何位置处交叉，例如在轴12的近端12a上的中空外壳12c内。
如图4A和4B进一步所示，柄部14还可包括其他结构以有利于装置的使用。例如，柄部14可包括能够有效地闭合端部执行器16上的钳口18，20的平移构件38、以及能够有效地选择性地旋转以及致动端部执行器16的旋转构件40。在由Mark Ortiz等人提交于与本文同一天的名称为“SurgicalFastener And Cutter With Single Cable Actuator”的专利申请中更详细地描述了平移构件38和旋转构件40，该专利申请据此全文引入以供参考。在其他实施例中，柄部14可包括用于旋转和/或致动端部执行器16的触发器、旋钮等。
重新参考图1B，柄部14在使用期间可相对于细长轴12的近端12a枢转或以一定角度取向，以产生端部执行器16的模拟运动。具体地，使柄部14围绕细长轴12沿第一方向枢转将施加力到一根或多根缆线34a-d，以便轴向牵拉一根或多根缆线。因此，被致动的缆线将施加张力到柔性颈部26以使颈部26挠曲。为了防止细长轴12响应于由柄部14施加到缆线34a-d的张力而挠曲，柔性颈部26可具有比细长轴12更大的柔韧性。这可通过例如使用在前所述的交替的狭缝32来实现；或者在其他实施例中材料可不同，或者细长轴可包括稳定元件例如贯穿延伸的杆，以使轴比柔性颈部更为刚性。
柄部14的运动方向将被端部执行器16沿相同方向（例如对应运动）或相对方向（例如镜像运动）模拟，因而允许使用者精确地控制端部执行器16的位置。在示例性实施例中，端部执行器16的运动的具体的量可与柄部14的运动的量成比例。端部执行器16的运动的量可直接等于柄部14的运动的量，或者其可相对于柄部14的运动的量成比例地增加或减少。在某些实施例中，可能期望使端部执行器16的运动的量相对于柄部14的运动的量增加。因此，柄部14仅需进行小量运动来使端部执行器16进行大量运动。尽管可实现各种技术以使端部执行器16的运动倍增或增加，但是力倍增机构的一个示例性实施例为偏心凸轮，该偏心凸轮联接到缆线，并且在张力由柄部14施加至缆线34a-d时该偏心凸轮增加缆线34a-d的机械效益，该机械效益为力或位移。
本领域的技术人员应当理解，尽管装置的柄部和工作端之间的运动在理论上可成比例，但是在实践中，当力通过细长轴传送时很可能会发生力的若干损耗。因此，本文所用的成比例的运动旨在包括如下应用，在这些应用中，柄部和工作端能够以成比例的量运动，但是在装置的实际操作中可能会发生力的一些损耗。
本文所公开的各种装置还可包括多种其他结构以有利于各种装置的使用。例如，图1A的装置10可包括光学图像采集单元，该光学图像采集单元被设置在细长轴12的远端上并且能够在内窥镜式手术期间获取图像。尽管所述单元的位置可变化，但是在一个实施例中，光学图像采集单元可设置在第二联接器30上。具体地，图5示出了斜坡型外壳42，该斜坡型外壳从联接器30的外表面突出，并且其中包含光学图像采集单元。观察窗口44形成于外壳42的面向远侧的表面上，以允许所述单元获取端部执行器16和周围手术部位的图像。图像可从光学图像采集单元传送到外部图像显示屏幕，或作为另外一种选择，装置10可包括设置在该装置上或联接到该装置的近侧部分的图像显示屏幕。图6示出了从柄部14向外突起的图像显示屏幕46的一个实施例。
如在前所述，本文所公开的用于控制内窥镜式外科装置的工作端的运动的各种技术可与多种医疗设备结合使用。图7示出了医疗装置的另一个实施例，该医疗装置具有用于控制其工作端的运动的致动器。在该实施例中，医疗装置呈辅助通道100的形式，以与内窥镜一起使用。辅助通道100为外部装置，该外部装置可与内窥镜配合并且沿内窥镜滑动，以允许其他工具例如抓紧器、切割器等穿过其中被引入并且被定位成接近内窥镜的观察端。尽管辅助通道100可具有几乎任何构型、形状和尺寸，但是在图7所示的实施例中，辅助通道100包括细长管或轴102，该细长管或轴具有在其近端102a和远端102b之间延伸的内腔，其用于容纳穿过其中的工具。辅助通道100还可包括形成于其上的配合元件，其用于使辅助通道100与内窥镜、或套管、或设置于内窥镜周围的其他装置直接配合。尽管可使用几乎任何配合技术，但是在所示实施例中，辅助通道100上的配合元件呈导轨104的形式，该导轨沿一定长度的细长轴102延伸。导轨104能够容纳在互补轨道中，该互补轨道形成于内窥镜上或围绕内窥镜设置的装置例如套管上。本领域的技术人员应当理解，多种其他技术可用于使辅助通道与内窥镜直接或间接地配合。
为了控制辅助通道100的工作端的运动，装置100可包括类似于在前所述的那些的结构。具体地，装置100可具有形成于细长轴102的远端102b上或联接到细长轴102的远端102b的柔性颈部108、形成于细长轴102的近端102a上或联接到细长轴102的近端102a的柄部106、以及在柄部106和柔性颈部108之间延伸的致动器。在该实施例中，致动器能够将力从柄部106传送到柔性颈部108，使得柄部106的运动被柔性颈部108模拟，从而使延伸穿过辅助通道100的工具以期望的角取向来定位。
柔性颈部108可具有多种构型，并且其可为联接到细长轴102的单独构件，或者其可与细长轴102整体形成，如图7所示。可利用各种技术使颈部108为柔性的。例如，颈部108可由相对于彼此运动的一个或多个段形成，和/或其可由柔性材料形成。在图8A所示的示例性实施例中，颈部108包括形成于其中并能够提供颈部108的最大柔韧性的多个狭缝112。尽管狭缝112的尺寸、数量和取向可变化以获得期望的结果，但是在所示实施例中，柔性颈部108包括四列狭缝（仅示出由箭头112a，112b，112c所指示的三列狭缝）。每一列沿一定长度的柔性颈部108轴向延伸，并且每一列包括围绕颈部108的圆周径向间隔开的四排狭缝。每列狭缝112还彼此轴向偏移以使狭缝112重叠。在使用期间，当张力被施加到致动器时，狭缝112使颈部108弯曲或呈现弯曲构型，使得颈部108相对于细长轴102的剩余部分进行关节运动，如图8B和8C所示。
在其他实施例中，狭缝可被定位成使颈部在多个位置或弯曲点处挠曲，或相反使颈部挠曲到预定位置中。通过非限制性例子，图9A示出了柔性颈部108'的另一个实施例，该柔性颈部具有形成于其中的两个狭缝区域112'。具体地，柔性颈部108'包括远侧狭缝区域112a’和近侧狭缝区域112b'。每个区域112a'，112b'可包括定位在任何位置处的任意数量的狭缝，以沿一个或多个期望方向提供期望程度的柔韧性。如图9A所示，近侧狭缝区域112b'和远侧狭缝区域112a'各自包括形成于柔性颈部108'的相对侧上且沿柔性颈部108'的长度延伸的两排狭缝。在使用期间，当张力被施加到柔性颈部108'时，如将在下文更详细地描述，颈部108'将在近侧区域112b'和远侧区域112a'两者处挠曲，从而相对于细长轴102'的剩余部分进行关节运动。如图9B所示，首先在颈部108'的远侧区域112a'中发生挠曲。施加到颈部108'的另外的张力可随后使近侧区域112b'挠曲，如图9C所示。在其他实施例中，狭缝定位和/或狭缝的尺寸能够使挠曲在远侧区域112a'中发生之前先在近侧区域112b'中发生，或者作为另外一种选择，狭缝能够使近侧区域112b'和远侧区域112a'同时挠曲。本领域的技术人员应当理解，狭缝的数量、位置、尺寸和形状可被调节以获得期望的结果。用于形成每个狭缝的切口的特定构型也可变化。例如，狭缝的宽度和长度可从细长轴的外表面到细长轴的内表面保持恒定，或者作为另外一种选择，其宽度和长度可增大或减小，使得狭缝渐缩或以其他方式变化。通过非限制性例子，渐缩构型可通过形成具有三角形构型的狭缝来形成，在该三角形构型中，狭缝的长度和宽度从细长轴的外表面到细长轴的内表面减小。
如上文所述，致动器能够施加张力到柔性颈部108以使颈部108进行关节运动。致动器可具有多种构型，但是在一个示例性实施例中，致动器类似于前述致动器，并且包括在柄部106和柔性颈部108的远端之间延伸的一根或多根缆线，使得柄部106与柔性颈部108可操作地相关联。每根缆线能够施加张力到柔性颈部108，以使颈部108在运动平面中进行关节运动。因此，装置100包括仅一根缆线，柔性颈部108可在单个运动平面内进行关节运动。每根附加缆线使颈部108能够在不同的运动平面内进行关节运动。在提供多根缆线的地方，颈部108可在多个运动平面内进行关节运动。此外，缆线可被同时张紧，可能允许柔性颈部108进行360°关节运动。
尽管缆线的数量可变化，并且装置100可包括仅一根缆线，但是在图7所示的实施例中，装置100包括四根缆线（仅示出三根缆线110a，110b，110c）。在图10中更详细地示出了缆线110a，110b，110c，110d的一部分。如上所述，缆线110a-d沿位于柄部106和柔性颈部108之间的一定长度的细长轴102延伸。缆线110a-d的特定位置可变化，但是在示例性实施例中，缆线110a-d围绕细长轴102的圆周径向间隔开，并且其在柔性颈部108的最远端和柄部106之间延伸。缆线110a-d可在内部延伸穿过细长轴102或在外部沿细长轴102延伸，或者其可延伸穿过形成于细长轴102的侧壁中的内腔或通路。图11示出了细长轴102的剖面图，其示出了形成于其中的四个内腔103a，103b，103c，103d。内腔103a-d优选地具有允许缆线116a-d在其中滑动的尺寸，并且其围绕细长轴102周向地间隔开。内腔103a-d在细长轴102的近端102a和远端102b之间延伸，以使缆线110a-d在柄部106和柔性颈部108的最远端之间延伸。
缆线110a-d的远端可利用多种技术与柔性颈部108的最远端配合，但是在图12所示的一个实施例中，柔性颈部108包括联接到其最远端或形成于其最远端上的端盖114。尽管端盖114的构型可根据致动器的构型而变化，但是在示例性实施例中，端盖114包括形成于其中的四个镗孔114a，114b，114c，114d，并且围绕端盖114的圆周间隔开，使得镗孔114a-d与细长轴102中的内腔103a-d对齐。每个镗孔114a-d能够容纳缆线110a-d中的一根。各种配合技术可用于将缆线110a-d保持在镗孔114a-d内。例如，图10示出了形成于每根缆线110a-d的末端上的球状物，用于将缆线110a-d的末端保持在端盖114中的镗孔114a-d内。端盖114还可包括形成于其中的中心内腔116，用于容纳穿过其中的工具。内腔116还可用于帮助对穿过辅助通道100插入的工具进行定位。
缆线110a-d的近端可与联接到轴102的近端的柄部106配合。尽管柄部106可具有多种构型，但是在先前图7所示的示例性实施例中，柄部106可为操纵杆的形式，该操纵杆活动地联接到细长轴102的近端102a，并且具体地能够相对于细长轴102的近端102a进行关节运动。柄部106的关节运动可允许柔性颈部108模拟柄部106的运动，如下文将讨论。
尽管关节运动可利用多种类型的接头来实现，但是在所示实施例中，球窝连接形成于柄部106和细长轴102之间。具体地，如图13A和13B更详细地示出，细长轴102的近端102a包括形成于其上的外壳103，并且该外壳限定在其近端中的承窝118。柄部106包括活动地设置在承窝118内的球120，并且操纵杆从球120朝近侧延伸，从而使柄部106相对于细长轴102进行关节运动。销或其他机构可用于将球120活动地保持在承窝118内。本领域的技术人员应当理解，柄部可具有多种其他形状并且各种其他技术可用于将柄部106活动地连接至细长轴102。
如上文所述，缆线110a-d的近端能够与柄部106配合。因此，柄部106可包括用于与缆线110a-d配合的结构。尽管特定的配合结构可根据致动器的构型而变化，但是在示例性实施例中，柄部106上的操纵杆122包括形成于其上的四个腿部124a，124b，124c，124d。腿部124a-d围绕操纵杆122的圆周间隔开，使得其与缆线基本上对齐，并且每个腿部124a-d能够与缆线110a-d中的一根的终端配合。如在前相对于缆线110a-d的远端所述，球窝连接可用于使缆线110a-d与腿部配合，或者作为另外一种选择，可使用本领域中已知的任何其他配合技术。
重新参考图7，在使用期间，柄部106可相对于细长轴102的近端102a枢转或以一定角度取向，以产生柔性颈部108的模拟运动，并且因此对延伸穿过柔性颈部108的工具进行定位。如图7和13B所示，柄部106上的操纵杆可包括穿过其中而形成的内腔107，该内腔与细长轴102中的内腔102c轴向对齐，以允许工具穿过装置100引入。在其他实施例中，柄部106可从细长轴102的近端102a偏移，使得柄部106联接到缆线但是不妨碍直接进入细长轴102中的内腔102c。
为了控制柔性颈部108并因此穿过其中而定位的工具的运动，柄部106围绕细长轴102的近端102a枢转或进行关节运动。例如，柄部106沿第一方向的运动使柄部106上的腿部124a-d施加力到一根或多根缆线110a-d，以轴向牵拉缆线。因此，被致动的缆线将施加张力到柔性颈部108以使颈部108挠曲。为了防止细长轴102响应于由柄部106施加到缆线110a-d的张力而挠曲，柔性颈部108可具有比细长轴102更大的柔韧性。这可通过例如使用在前所述的狭缝来实现。或者在其他实施例中轴102可包括稳定元件例如贯穿延伸的杆，以使轴102比柔性颈部108更为刚性。柄部106的运动方向将被柔性颈部108沿相同方向（即对应运动）或相对的方向（即镜像运动）模拟，从而使使用者精确地控制柔性颈部108的位置，并因此控制延伸穿过柔性颈部108的工具的位置。在示例性实施例中，柔性颈部108的运动的具体量可与柄部106的运动的具体量成比例。即，柔性颈部108的运动的量可直接等于柄部106的运动的量，或者其可相对于柄部106的运动的量成比例地增加或减少。在某些实施例中，可能期望使柔性颈部108的运动的量相对于柄部106的运动的量增加。因此，柄部106仅需进行小量运动来使柔性颈部108进行大量运动尽管可实现各种技术以使柔性颈部108的运动成比例地倍增或增加，但是力倍增机构的一个示例性实施例为偏心凸轮，该偏心凸轮联接到缆线，并且在张力由柄部106施加至缆线110a-d时该偏心凸轮增加缆线110a-d的机械效益，该机械效益为力或位移。
如在前所述，尽管装置的柄部和工作端之间的运动在理论上可成比例，但是在实践中，当力通过细长轴传送时很可能会发生力的若干损耗。因此，本文所用的成比例的运动旨在包括如下应用，在这些应用中，柄部和工作端能够以成比例的量运动，但是在装置的实际操作中可能会发生力的若干损耗。
尽管图1A和7示出了其中工作端模拟柄部运动的装置，但是柄部可具有多种其他构型，在所述其他构型中能够在不使装置的工作端模拟柄部的运动的情况下有效地使装置的工作端进行关节运动。图14A和14B示出了具有柄部204的装置200的另一个实施例，该柄部包括可旋转构件，该可旋转构件能够相对于装置的细长轴202在一个或多个运动平面中有效地使柔性颈部206进行关节运动。一般来讲，装置200的细长轴202和在前所述的细长轴102非常类似，并且该细长轴大体包括联接到其远端或形成于其远端上的柔性颈部206。四个缆线致动器（未示出）延伸穿过位于柄部106和柔性颈部206之间的细长轴。轴102和缆线致动器类似于在前所述的关于装置100的轴102和缆线致动器110a-d，因此将不对其进行详细描述。
图15A和15B中更详细地示出了装置200的柄部204。一般来讲，柄部204包括可旋转地设置在其中的一个或多个卷轴。每个卷轴能够配合并控制缆线致动器中的一者。因此，旋转每个卷轴将卷起或释放缆线，从而使柔性颈部108沿特定方向挠曲并进行关节运动。尽管卷轴的数量可根据缆线致动器的数量变化，但是在图15A和15B所示的实施例中，柄部204包括四个卷轴208a，208b，210a，210b。前两个卷轴208a，208b彼此联接，并且后两个卷轴210a，210b彼此联接。第一缆线212a联接到第一卷轴208a并且缠绕在第一卷轴208a上，并且第二缆线212b联接到第二卷轴208b并且缠绕在第二卷轴208b上。第一缆线212a和第二缆线212b定位在细长轴202的相对侧上并且沿细长轴202的相对侧延伸。因此，施加到第一缆线212a的张力使柔性颈部206沿第一运动平面内的方向进行关节运动，并且施加到第二缆线212b的张力使柔性颈部206沿相同运动平面内的相对方向进行关节运动。为了使张力被施加到缆线212a，212b中的仅一者，第一缆线212a和第二缆线212b沿相对方向被缠绕在第一卷轴208a和第二卷轴208b上。因此，旋转第一卷轴208a和第二卷轴208b将缠绕并施加张力至缆线212a，212b中的一者，同时退绕缆线212a，212b中的另一者并且释放缆线212a，212b中的另一者上的张力。第三缆线212c和第四缆线212d同样缠绕在第三卷轴210a和第四卷轴210b上，使得旋转第三卷轴210a和第四卷轴210b将缠绕并施加张力至缆线212c，212d中的一者，同时退绕缆线212c，212d中的另一者并且释放缆线212c，212d中的另一者上的张力。第三缆线212c和第四缆线212d可在从第一缆线212a和第二缆线212b径向偏移的位置处沿轴102延伸，使得第三缆线212c和第四缆线212d引起柔性颈部206在第二不同的运动平面中的进行关节运动。例如，第三缆线212c和第四缆线212d可从第一缆线212a和第二缆线212b偏移约90°，使得缆线212a-d围绕细长轴202的圆周基本上等距地全部间隔开。本领域的技术人员应当理解，柄部204可包括任意数量的卷轴和缆线以在期望数量的平面内实现关节运动。
为了控制卷轴208a，208b，210a，210b，装置可包括一个或多个抓紧构件。如图15A和15B所示，第一旋转旋钮214联接到第一卷轴208a和第二卷轴208b，并且第二旋转旋钮216联接到第三卷轴210a和第四卷轴210b。旋钮214，216可与卷轴208a，208b，210a，210b整体形成，或者其可通过延伸穿过卷轴208a，208b，210a，210b的轴联接到卷轴208a，208b，210a，210b。在所示实施例中，第一旋钮214形成于第一卷轴208a上并且直接联接到第一卷轴208a，并且第二旋钮216通过轴218联接到第三卷轴210a和第四卷轴210b，所述轴从旋钮216延伸穿过第一卷轴208a和第二卷轴208b，并且联接到第三卷轴210a和第四卷轴210b。换句话讲，第一卷轴208a和第二卷轴208b可旋转地设置在轴218的周围。
在某些示例性实施例中，卷轴和旋转旋钮还可在尺寸上存在不同。在图15A和15B所示实施例中，第一卷轴208a和第二卷轴208b以及第一旋转旋钮214具有直径，该直径大于第三卷轴210a和第四卷轴210b以及第二旋转旋钮216的直径。尽管并非必需的，但是此种构型在其将缆线212a-d间隔开以防止缆线212a-d彼此接触时可为有利的。
在使用期间，工具可穿过细长轴202来定位，并且旋钮214，216可被旋转以使轴202上的柔性颈部206进行关节运动，从而根据需要来定位工具。如图14A和14B所示，柄部204可包括贯穿延伸且与细长轴202中的内腔对齐的内腔205，以使工具穿过柄部204和轴202。在其他实施例中，柄部204可从细长轴202偏移，以提供进入细长轴202中的内腔的直接通路。一旦工具穿过轴202被定位，则旋钮214，214可被旋转以使细长轴202的远端上的柔性颈部206进行关节运动。具体地，第一旋钮214可沿第一方向例如沿顺时针方向旋转以施加张力到缆线中的一者例如第一缆线212a，同时释放或退绕另一缆线例如第二缆线212b。因此，施加到第一缆线212a的张力将沿近侧方向牵拉柔性颈部206的最远端，使柔性颈部206挠曲从而沿第一方向进行关节运动。沿相对的方向例如沿逆时针方向旋转第一旋钮214将退绕第一缆线212a，同时缠绕第二缆线212b。柔性颈部206将回复到其初始线性构型。进一步旋转第一旋钮214将继续缠绕第二缆线212b，同时退绕第一缆线212a，从而使柔性颈部206沿相同的运动平面沿相对的方向挠曲并进行关节运动。第二旋钮216可同样被旋转以沿不同的运动平面使柔性颈部进行关节运动。旋钮214，216还可任选地同时被旋转，以在不同于第一运动平面和第二运动平面的附加运动平面中使柔性颈部206进行关节运动。
在其他实施例中，本文所公开的各种装置可包括锁定机构，该锁定机构用于锁定位于固定位置的柄部和/或致动器，以将装置的工作端保持在期望的关节运动方向或角取向。尽管锁定机构可具有多种构型，但是在一个示例性实施例中，锁定机构可为夹具的形式，该夹具能够有效地施加压力到缆线上从而防止缆线运动，以将工作端锁定在期望方向。夹具可具有多种形状和尺寸，并且其可被定位在装置上的各个位置处。图17A和17B示出了夹具300的一个示例性实施例，该夹具围绕图1A和1B上的外科紧固和切割装置10上的中空外壳12c设置。夹具300一般为环形，并且能够与邻近开口的中空外壳12c可滑动或可旋转地配合，缆线（仅三根缆线34a，34b，34c在图17B中示出）延伸穿过该开口。在初始位置，夹具300从开口被间隔开，以使穿过其中的缆线34a-d能够自由运动。一旦装置的工作端例如使端部执行器16关节运动到期望位置，则夹具300可沿中空外壳12c轴向运动，直到其延伸到开口之上并且与从其延伸的缆线34a-d接合。当夹具300位于锁定位置时，夹具300将因此防止缆线34a-d运动。为了使夹具300轴向运动并将夹具300锁定至外壳12c，夹具300可包括形成于其上的配合元件，该配合元件能够与形成于外壳12c上的对应的配合元件接合。如图17A和17B所示，夹具包括形成于其中的螺纹302，该螺纹能够与形成于外壳12c上的对应的螺纹（未示出）配合。因此，夹具300围绕外壳12c旋转使夹具300在初始位置和锁定位置之间运动。本领域的技术人员应当理解，可使用各种其他配合技术。此外，锁定机构可具有多种其他构型。例如，柄部可包括形成于其上的锁定元件，该锁定元件能够将柄部锁定在固定的关节运动位置。
在其他实施例中，缆线可用于被动地使穿过主体内腔的细长轴进行关节运动，并且夹具300或其他锁定机构可当需要时用于将装置的工作端锁定就位。在此类构型中，柄部可仅用于帮助将装置抓紧。
在其他实施例中，本文所公开的缆线致动器用于实现装置的工作端的关节运动，并且其可由电活性聚合物材料形成。电活性聚合物（EAP），也被称为人造肌肉，是响应于电场或机械场而表现出压电、热电、电致伸缩性能的材料。具体地，EAP是一组导电掺杂聚合物，当施加电压时，该导电掺杂聚合物改变形状。导电聚合物可与某一形式的离子流体或凝胶和电极配对，并且来自流体/凝胶的离子流入或流出导电聚合物可引起聚合物形状的改变。通常，可根据所使用的特定聚合物和离子流体或凝胶施加在约1V至4kV的范围内的电势。重要的是要注意，当通电时EAP不改变体积，确切地说，其仅沿一个方向伸展并沿横向收缩。因此，本文在前所公开的缆线致动器可被EAP致动器取代，并且柄部能够激活能量源以选择性地将能量传送至一根或多根缆线。在示例性实施例中，柄部的运动能够决定能量源的量以及接收能量源的缆线的量。因此，柄部的运动仍可被装置的工作端模拟，以便为使用者提供对工作端的位置的相同的精确控制。能量源可为内部源例如电池，或者其可为外部源。在其他实施例中，EAP缆线致动器可补充由柄部的运动施加到缆线的轴向力，从而成比例地增加工作端相对于柄部的运动的量。
在其他方面，缆线致动器可由形状记忆材料形成，例如镍钛诺。此种构型使将要施加到缆线的张力来使端部执行器进行关节运动，但在不需要操纵柄部的情况下使缆线回复到初始线性构型。
在另一个实施例中，本文所公开的各种装置，包括其多个部分，可被设计成单次使用后丢弃，或者其可被设计成多次使用。在任一种情况下，装置可被重新修复以供至少一次使用后再利用。重新修复可包括如下步骤的任意组合：拆卸装置、随后清洗或替换特定零件、以及后续组装。以举例的方式，图1A和1B所示的外科缝合和紧固装置可在医疗手术中被使用后进行重新修复。装置可被拆卸，并且任意数量的特定零件可以任意组合被选择性地替换或移除。例如，针对外科缝合和切割装置，设置在端部执行器内并且包含多个紧固件的仓可通过向端部执行器增加新的紧固仓而被替换。在清洗和/或替换特定部件时，该装置可在修复设施处重新组装以便后续使用，或者在即将进行外科手术前由外科手术团队重新组装。本领域的技术人员应当理解，装置的修复可利用多种用于拆卸、清洗/替换和重新组装的技术。此类技术的使用以及所得的重新修复的装置均在本发明的范围内。
上述发明还适用于机器人外科系统。此类系统在本领域中为人们所熟知，并且包括那些购自Intuitive Surgical，Inc.（Sunnyvale，CA）的系统。实例还公开于美国专利6,783,524、7,524,320和7,824,401中。所有上述专利据此以引用的方式并入本文。一般来讲，机器人外科系统具有远程控制的用户界面和远程控制的臂，该远程控制的用户界面和远程控制的臂能够与外科器械和系统交接并且对外科器械和系统进行操作。臂可利用一个或多个电子控制系统来控制，该电子控制系统通常适于本地化控制台，以供用户与该本地化控制台交接。器械可由外科系统在本地提供动力，或具有与机器人总体控制分离的动力系统。
机器人外科系统包括致动组件、监视器、机器人和附接到机器人的手臂的至少一个牢靠地附接的加载单元。该机器人的手臂具有至少一个外科器械以执行至少一项外科任务，并且该外科器械能够可释放地附接到臂的远端。
在另一个实施例中，机器人外科系统包括处理器、至少一个编码器以确定至少一个马达驱动接头的位置、用于接收从缝合单元传输的电信号并且控制缝合单元的运动的接收器。
与机器人一起使用的示例性的一次性加载单元在授予Tovey等人的美国专利6,231,565中有所公开。可由外科医生比例控制的示例性外科机器人在授予Smith等人的美国专利5,624,398中有所公开。
在本发明的另一个方面中，机器人系统具有机架、相对于机架活动的机器人的手臂，以及具有细长管的缝合组件，该细长管将缝合组件连接至机器人的手臂。具有缝合组件的细长管和缝合组件自身这两者均可释放地附接到并且可操作地联接到机器人的手臂。缝合组件的一种构型可被移除，并且不同的构型可被附接并且被操作。
关于图1。机器人系统包括可释放地附接到细长轴12的近端的联接构件，该联接构件代替柄部14。
本领域的技术人员根据上述实施例将会认识到本发明的更多特征和优点。因此，本发明并不受已具体显示和描述的内容限制，而是由所附权利要求书限定。本文引用的所有出版物和参考文献都明确地以引用方式全文并入本文中。
Claims (3)
1.一种外科缝合和切割装置，包括：
具有近端和远端的细长轴，所述远端能够有利于所述端部执行器在两个平面中进行关节运动，所述两个平面基本上垂直于所述细长轴的轴线并从所述轴线延伸；
设置在柔性颈部的近端上的端部执行器，所述端部执行器包括适于将组织容纳于其间的相对的第一钳口和第二钳口，所述第一钳口具有附接到其的钉仓，所述钉仓具有设置在其中并且能够被驱动到组织中的多个缝钉，所述第二钳口包括用于使所述缝钉变形的砧座；以及
远程控制的用户界面，所述远程控制的用户界面联接到细长管的近端并且与所述柔性颈部可操作地相关联，使得所述远程控制的用户界面的运动被所述柔性颈部模拟。
2.根据权利要求1所述的装置，其中所述柔性颈部包括形成于其中以有利于其挠曲的多个狭缝。
3.根据权利要求2所述的装置，其中所述柔性颈部包括远侧区域的狭缝和近侧区域的狭缝，并且其中所述狭缝能够使得施加到所述柔性颈部的张力使所述柔性颈部在所述近侧区域和远侧区域处弯曲。
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- 2012-02-28 EP EP12707965.5A patent/EP2680759A1/en not_active Withdrawn
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Also Published As
| Publication number | Publication date |
|---|---|
| RU2632513C2 (ru) | 2017-10-05 |
| BR112013022096A2 (pt) | 2016-12-06 |
| AU2012223473A1 (en) | 2013-08-15 |
| RU2013143954A (ru) | 2015-04-10 |
| US20110163146A1 (en) | 2011-07-07 |
| WO2012118837A8 (en) | 2013-09-06 |
| WO2012118837A1 (en) | 2012-09-07 |
| JP2014514011A (ja) | 2014-06-19 |
| CA2828712A1 (en) | 2012-09-07 |
| EP2680759A1 (en) | 2014-01-08 |
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Application publication date: 20131127 |