CN103417289A - 具有被包容的电气或机械系统的模块化手术器械 - Google Patents

具有被包容的电气或机械系统的模块化手术器械 Download PDF

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CN103417289A
CN103417289A CN2013101762309A CN201310176230A CN103417289A CN 103417289 A CN103417289 A CN 103417289A CN 2013101762309 A CN2013101762309 A CN 2013101762309A CN 201310176230 A CN201310176230 A CN 201310176230A CN 103417289 A CN103417289 A CN 103417289A
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CN103417289B (zh
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J·D·艾伦四世
R·C·阿塔莱
G·A·霍纳
D·E·克尔
P·M·米勒
A·J·雷施克
R·夏普
R·B·斯托达特
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Covidien LP
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Abstract

本发明的手术器械包括选择性地彼此分离的细长轴模块和手柄模块。细长轴模块包括细长轴构件和支撑在细长轴构件远端处的一对钳口构件，钳口构件中的至少一个可相对于另一个钳口构件在打开位置和闭合位置之间移动。手柄模块包括壳体，所述壳体包括经壳体纵向延伸的开口。开口的尺寸允许处于闭合位置的一对钳口构件通过。手柄模块还包括可移动手柄以及锁，所述可移动手柄相对于壳体可移动从而在打开位置和闭合位置之间移动一对钳口构件，以及所述锁在壳体内将细长轴模块固定就位。

Description

具有被包容的电气或机械系统的模块化手术器械
技术领域
本发明总体上涉及可重复使用的手术器械领域。具体地，本发明涉及其中具有被包容的操作系统的器械，所述被包容的操作系统有利于器械整修。
背景技术
诸如电外科手术钳的器械通常在开放式和内窥式外科手术中用于凝结、灼烧和封闭组织。这种钳子通常包括能够由医生控制以夹住目标组织（例如血管）的一对钳口。所述钳口可靠近以给组织施加机械夹持力，所述钳口关联到至少一个电极表面以允许将电外科能量传递到所述组织。已经证明机械夹持力和电外科能量的组合能将捕获在钳口之间的相邻组织层连结起来。当相邻组织层包括血管壁时，封闭所述组织可以实现止血。之后，可以通过使刀经所述钳口行进而切断被封闭的组织。可以在Dycus等人的美国专利No.7255697中找到电外科手术钳的使用的详细讨论。
在使用中，电外科手术钳的各种组织接触部件会受到污染或劣化。例如，当部分被治疗的组织粘附到电极的组织接触表面上时电极可能受污染。而且，在被重复使用后（即使在单次外科手术中），刀片也可能变钝以及在切断封闭组织方面效率变低。为了给特定的外科手术提供清洁的电极和锋利的刀，常常使用全新的器械。在手术完成后，用过的器械被抛弃。
用于多次手术的可重复使用的器械减少了每次手术的器械成本。但是提供一种可重复使用的电外科手术钳面临各种挑战。例如，电外科手术钳的复杂程度会导致在清洁程序上花费相当大的人力来预备手术钳下次使用。不正确的清洁可能导致危险的污染物被引入手术部位。还有，部分可重复使用的手术钳具有可拆除和可更换的部件从而为每次使用提供清洁的表面。很多这种器械需要费力的拆卸和再组装程序，这要求大量的练习并可能妨碍器械的使用。
发明内容
本发明描述了一种用于治疗组织的手术器械。该器械包括细长轴模块和手柄模块。细长轴模块包括：细长轴构件；和支撑在细长轴构件的远端处的一对钳口构件。钳口构件中的至少一个能够相对于另一个钳口构件在打开位置和闭合位置之间移动。手柄模块包括壳体，所述壳体包括纵向延伸通过壳体的开口。开口的尺寸设计成允许处于闭合位置的一对钳口构件通过。手柄组件还包括：相对于壳体能够移动的可移动手柄，可移动手柄操作地联接到一对钳口构件，使得响应于可移动手柄相对于壳体的运动，引起钳口构件中的至少一个相对于另一个钳口构件在打开位置和闭合位置之间移动；和锁，所述锁在第一位置和第二位置之间能够移动，在第一位置时，锁接合细长轴模块以将细长轴模块在壳体内固定就位，在第二位置时，锁与细长轴模块脱离以允许细长轴模块与手柄模块分离。
细长轴模块可以在其近端处包括连接器，所述连接器用于将器械联接到外部的电外科能量源。细长轴模块还可以在其中包括被包容的电气系统，其中电气系统包括在连接器和端部执行器之间延伸的电气路径，所述电气路径被包容在基本防潮的外壳内。
所述细长轴模块可以包括往复驱动杆，所述往复驱动杆至少部分地延伸穿过细长轴构件并可操作地联接到端部执行器和可移动手柄，从而响应于使驱动杆往复移动的可移动手柄相对于壳体的运动，引起钳口构件在打开位置和闭合位置之间运动。细长轴模块可以包括在细长轴构件的远端处联接到细长轴构件的密封构件，并且密封构件可以被设置在细长轴构件和往复驱动杆之间，从而防止污染物进入细长轴构件。密封构件可以被构造为O形环、压力密封件和波纹管中的至少一种。
细长轴模块还可以包括设置在钳口构件和外轴构件之间的柔性密封构件，并且柔性密封构件可以由热收缩管构成。钳口构件可以被联接到往复驱动杆，使得响应于驱动杆的往复运动，引起钳口构件缩回到细长轴构件内。
根据本发明的另一方面，一种手术器械包括：手柄模块，所述手柄模块包括至少一个手柄，所述手柄提供用于通过手保持器械的握持表面；以及驱动器组件，所述驱动器组件能够选择性地从手柄组件拆除。驱动器组件包括：限定了纵向轴线的细长轴构件；支撑在细长轴构件的远端处的端部执行器。端部执行器包括一对相对的钳口构件，其中钳口构件中的至少一个能够相对于另一个钳口构件在打开位置和闭合位置之间相对于细长轴构件移动。驱动器组件还包括至少部分地延伸穿过细长轴构件的往复驱动器构件。驱动器构件操作地联接到端部执行器，从而响应于驱动器构件的纵向往复运动，引起钳口构件在打开位置和闭合位置之间运动。电机可操作成使驱动器构件纵向地移动往复通过细长轴；和基本上防潮的壳体基本围绕电机和往复驱动器构件。致动器被支撑在壳体上并且可操作成激活电机。
电机可以包括伺服电机或线性电机。所述线性电机包括支撑在细长轴构件上的电线圈和支撑在往复驱动器构件上的磁体，其中磁体响应于电线圈中的电流能够纵向地移动。
驱动器组件可以包括从壳体延伸的线缆，线缆能够连接到电外科能量源。线缆可以和延伸穿过细长轴构件的电气管道电气连通，从而将电外科电流传递到端部执行器。驱动器组件还可以包括设置在驱动器组件上的柱和槽中的至少一个，所述柱和槽中的所述至少一个被配置为与设置在手柄组件上的柱和槽中的至少一个卡扣配合。
附图说明
作为说明书一部分并被纳入说明书的附图示出了本发明的实施例，并且与下面所给出的实施例的详细说明一起阐述了本发明的原理。
图1是根据本发明实施例的具有手柄组件和可拆除的轴组件的内窥镜式手术器械的立体图；
图2是图1的手柄组件的立体图，其中壳体的一部分被移除以展示该器械的内部部件；
图3是图1的器械的立体图，展示了可拆除轴组件与手柄组件的分离；
图4是根据本发明的器械的一种替换实施例的局部示意图，其包括手柄组件和具有被包容致动系统的可拆除模块；
图5A是根据本发明的器械的一种替换实施例的局部示意图，其包括具有远端密封件的被包容致动系统；
图5B是根据本发明的远端密封件的替换实施例的局部示意图；
图6是包括被包容致动系统的器械的局部示意图，所述被包容致动系统包括根据本发明的远端密封件的替换实施例；
图7是根据本发明的被包容致动系统的替换实施例的示意图；和
图8是联接到消毒区外的致动系统的消毒区内的器械的替换实施例的示意图。
具体实施方式
先参见图1，示出一种电手术器械10的实施例。该器械10包括用于经细长轴构件16远距离控制端部执行器14的手柄组件12。虽然这种方案通常是和用于腹腔镜或内窥镜外科手术的器械相关，但是本发明的各种方面可以通过传统开放式器械实施，也可以与腔内手术相结合。
器械10被联接到电外科能量源，例如电外科发电机18。所述发电机18可以包括比如Covidien所销售的血管封闭发电机和Force
Figure BDA00003183613000042
发电机等的装置。线缆20在手柄组件12和发电机18之间延伸，并包括用于将所述器械10联接到外部发电机18的连接器22。在其他实施例（未示出）中，可以提供一种电池供电的器械，其中发电机和连接器可以设置在器械内部或一体形成至器械。连接器22包括两个尖头构件22a和22b，尖头构件22a和22b的尺寸被设计成将器械10物理地连接到和电连接到相对的终端，例如与发电机18相联的正极或有源（+）终端和负极或返回（-）终端。所以，经所述器械10能提供双极能量。或者，器械10可以被配置为将单极能量传递给组织。在单极方案中，器械10将电外科能量从有源终端（例如（+））输出，同时返回垫（未示出）被大致放置在患者下方并提供到发电机18的相对终端（例如（-））的返回路径。
为了控制端部执行器14，手柄组件12包括固定手柄24和可移动手柄26。可移动手柄26可以相对于固定手柄24分离和靠近，从而分别打开和闭合端部执行器14。旋转旋钮28被设置在手柄组件12上，以允许细长轴构件16和端部执行器14围绕由细长轴构件16所定义的纵轴线X-X旋转。触发器30也被设置在手柄组件12上，并且可操作成使刀136（例如参见图5）经端部执行器14伸出和回缩。可以提供脚踏开关（未示出）以用于启动和终止给端部执行器14输送电外科能量。
现在参见图2，手柄组件12经延伸穿过细长轴构件16的往复驱动杆32和刀管34被操作地联接到端部执行器14（图1）。首先，驱动杆32通过内套管36和连杆40被可操作地联接到可移动手柄26，使得可移动手柄26的枢转运动引起了驱动杆32的纵向运动。驱动杆32和内套管36彼此接合，使得纵向运动在驱动杆32和内套管36之间传递。内套管36和连杆40通过连杆40的上凸缘42彼此接合，使得连杆40的枢转运动引起了内套管36的纵向运动，反之，使得内套管36的纵向运动引起了连杆40的枢转运动。连杆40被可枢转地联接到可移动手柄26，使得枢转运动可以在连杆40和可移动手柄26之间传递。在使用中，医生可以沿箭头44的方向朝着固定手柄24枢转可移动手柄26，这引起连杆40枢转，使得连杆40的上凸缘42向近侧移动。上凸缘42的向近侧移动继而沿着朝近侧方向牵动内套管36和驱动杆32。驱动杆32的向近侧移动引起了端部执行器14的一对钳口构件140，142（图5A）从打开构型（图5A）移动到闭合构型（图3），如下面参考图5A更详细描述那样。
接下来，刀管34通过外套管48被可操作地联接到触发器30。刀管34和外套管48彼此接合，使得纵向运动在刀管34和外套管48之间传递。外套管48和触发器30经触发器30的上凸缘50彼此接合，使得触发器30的枢转运动引起外套管48的纵向运动。在使用中，医生可以沿箭头52的方向朝着固定手柄24枢转触发器30，这引起了触发器30的上凸缘50向远侧运动。上凸缘50的向远侧运动继而沿朝远侧的方向驱动外套管48和刀管34。刀管34联接到刀136（图5A），使得刀管34的向远侧运动使刀经端部执行器14行进，如下面参考图5A更详细说明那样。
现在参见图3，器械10可选择性地分离为包括手柄组件12和细长轴组件60的两个主要模块。两个模块12，60的分离允许以模块化的方式使用该器械。例如，一个替换的细长轴组件（未示出）可以取代所述细长轴组件60，从而针对特定的外科手术提供更合适的长度。另外，两个模块12，60的分离可以通过提供进入器械10的内部部件的方便路径而有利于器械10的清洁和整修。
细长轴组件60包括被完全包容的电气系统。从尖头构件22a，22b经器械10到端部执行器14的整个导电路径是细长轴组件60的一部分。所以，在组装手柄组件12和细长轴组件60时不需要建立电气连接，并且整个电气路径可以被包封在基本防潮的外壳内。
手柄组件12包括经手柄组件的壳体64延伸的纵向开口62，用于接收细长轴组件60。开口62被配置为使得端部执行器14被布置为闭合构型时可以经该开口穿过。所以，通过将端部执行器14从器械10近侧插入开口62并且使细长轴组件60朝远侧行进，可以将细长轴组件60组装到手柄组件。当细长轴组件60经开口62朝远侧行进了足够距离后，触发器30可以被偏置为与外套管48（图2）接合，并且连杆40（图2）可以被偏置为与内套管36（图20）接合。手柄组件12还包括手柄组件上的锁66，锁66允许医生选择性地提供彻底锁定，从而保持细长轴组件60与手柄组件12的接合。锁66可以在第一位置和第二位置之间移动，在第一位置时锁66接合细长轴组件60以将细长轴组件锁定就位，在第二位置时锁66与细长轴组件脱离以允许细长轴组件60与手柄组件12分开。
因为以完全组装的状态提供端部执行器14，该模块化构型便于操作者组装。端部执行器14的许多相对小或精细的部件（比如枢转销148（图5A）、驱动销144（图5A）和刀136（图5A））被预组装以形成方便手操纵的实质模块化单元。在使用中，这种模块化构型还将电气接合部件（例如尖头构件22a，22b）定位在与潮湿的手术部位基本隔开的近侧位置中。将电气接合部件靠近侧定位可以长期保留其功能性，并且有利于清洁模块化系统。
现在参见图4，手术器械70的一个替换实施例包括两个主要部件（包括手柄组件72和驱动器组件74）。手柄组件72在其上包括槽76和柱78，槽76和柱78允许手柄组件72卡扣在布置于驱动器组件74的柱80和槽82上。手柄组件72可以提供供医生保持器械70的握持表面，但是手柄组件72可以另外不可操作成控制驱动器组件74。
驱动器组件74包括用于控制器械70的完全包容的电气系统和完全包容的机械系统。驱动器组件70的机械系统包括一对伺服电机86和88，用于在器械70内产生物理或机械运动。电机86接合细长轴构件90，并且可操作成绕纵轴线旋转细长轴构件90。电机88接合驱动杆92，并且可操作成经细长轴构件90纵向平移驱动杆92。所以，伺服电机86和88可操作成如图1所述那样旋转、打开和闭合端部执行器（未示出）。在其他实施例中（未示出），可以设置附加电机用于经细长轴平移刀。
驱动器组件74的电气系统包括延伸穿过细长轴构件90的电气管道96。电气管道96经细长轴构件90传递电外科电流，使端部执行器具备电外科切割（e-cutting）能力。在Johnson等人的美国专利No.7270664中更详细地描述了电外科切割。电气系统还包括电路板100。电路板100电联接到电机88，86以及电气管道96，用于给电机88，86以及电气管道96提供指令和电能。电路板还被电联接到一对按钮102，104，医生可以按压所述按钮来激活电机88，86以及电气管道96。按钮102，104与线缆106电联通，线缆106可以将器械70联接到电外科能量源。
壳体110包围驱动器组件74的电气和机械系统，并且不需要建立传递物理运动的电气连接或机械连接来将驱动器组件74组装到手柄组件72。因此壳体110可以被配置为具有在外科手术期间可能容纳污染物的最小间隙或缝隙。壳体110可以是基本上防潮的，以将电气系统和机械系统包封在壳体中。这有利于在下次使用前对器械70进行清洁和消毒。
现在参见图5A，手术器械114的一个替换实施例包括具有线性电机116，118以在器械114内产生物理运动的机械系统。第一线性电机116包括嵌入器械114的外轴构件122内的电线圈120，以及嵌入驱动杆126内的磁体124。第二线性电机118包括嵌入外轴构件122内的电线圈130，以及嵌入刀136内的磁体134。通过激发合适的电流经过线圈120，130，可以引起外轴构件122和驱动杆126以及刀136之间的相对纵向运动。
通过给电线圈120输送合适的电流，可以引起磁体124沿纵向移动，因此可以引起驱动杆126沿纵向移动，原因在于磁体124被嵌在驱动杆126内。驱动杆126的纵向移动引起端部执行器14在所示的打开构型和闭合构型（图3）之间移动。端部执行器14包括通过驱动销144被联接到驱动杆126的一对钳口构件140，142。驱动销144延伸穿过被限定在钳口构件140，142上的槽，例如驱动槽146。驱动槽146相对于细长轴构件122倾斜地布置，使得驱动杆126和驱动销144的纵向运动引起钳口构件140，142绕枢转销148枢转。所以，激活线性电机116引起端部执行器14在打开构型和闭合构型之间运动。
通过给电线圈130输送合适的电流，可以引起磁体134沿纵向移动，因此可以引起刀136沿纵向移动，原因在于磁体134被嵌在刀136内。因此，激活线性电机118可以引起刀136经端部执行器14移动，从而将被夹在钳口构件140，142之间的组织切断。
因为可以通过电信号激活线性电机116，118，所以器械114的机械系统不需要来自医生的物理运动输入来操作端部执行器14。因此，可以容易地密封器械114的近端（未示出）。可以通过在合适的位置处密封器械114的远端而完全包容机械系统。器械114包括设置在钳口构件140，142和外轴构件122之间的柔性密封构件150。所述柔性密封件可以由热收缩管或类似材料构成，并防止污染物进入外轴构件122。附加密封构件152被设置在外轴构件122和刀136之间。密封构件152被构造为O环，并防止污染物经外轴构件122朝近侧行进。密封件150，152基本防潮，并且包容钳口构件140，142和刀146相对于外轴构件122的运动。所述密封件有利于器械114的清洁或消毒，因为清洁或消毒介质不需要深入轴构件122或接近复杂的运动部件。
图5B示出了用于防止污染物进入外轴构件122的密封件的一个替换实施例。压力密封件158被设置在外轴构件122和刀136之间。压力密封件158可以由弹性或柔性材料的大致平坦翼构造，从而围绕并固定地联接到外轴构件122的内部。压力密封件158可以弯曲以当刀136沿纵向移动时保持和刀136的接触。额外的压力密封件（未示出）或其他密封件可以被设置在刀136和驱动杆126之间或外轴构件122和驱动杆126之间。
现在参见图6，手术器械的一个替换实施例164包括用于防止污染物进入外轴构件122的替换密封件。器械164包括设置在外轴构件122和刀136之间的波纹管密封件166。所述波纹管密封件包括允许该波纹管密封件纵向膨胀和收缩的褶皱，以包容刀136相对于外轴构件122的运动。在某些实施例中（未示出），波纹管密封件可以被设置在端部执行器14和外轴构件122之间，或者在阻止污染物进入外轴构件122的其他位置。
现在参见图7，手术器械的一个替换实施例172包括有利于器械172清洁和整修的替换的端部执行器174。端部执行器174包括驱动管178，且一对钳口构件180，182形成在驱动管178的远端处。驱动管178和钳口构件180，182可以相对于外轴184纵向地移动。钳口180，182可以和驱动管178一体形成并且可以包括柔性近端，所述柔性近端允许钳口180，182在缩入外轴184时闭合。这种类型的用于闭合钳口构件180，182的机构减少了端部执行器174中部件的数量和复杂性，并且因此可以改善器械172的清洁和利于组装。在其他实施例中（未示出），一对可收缩钳口构件可以通过枢转销彼此联接，并且可以提供压缩弹簧（未示出）以用于将所述钳口构件偏置到一种朝远侧的打开构型。
线缆190被联接到端部执行器174和驱动杆178，使得器械172的整个电气系统可以被包容在单个模块内。因此，不必建立电气连接来组装器械172。
现在参见图8，器械的一个替换实施例200包括器械本体202和服务模块204。服务模块204可以包括给器械本体202提供电力和机械动力的部件。例如，服务模块204可以包括被配置为使器械本体202的零件移动的电外科发电机和/或气动设备或液动设备。器械本体202通过包含可分离连接器208的管道206被机械地和电气地联接到服务模块204。连接器208在距离器械本体202足够远的位置被设置在管道206上，从而在器械200被使用时，被定位在手术区210以外。
为了清楚或理解的目的，已经通过示意和举例的方式详细描述了前述内容，但是在后附权利要求的范围内实施某些改变和改动是明显的。

Claims (14)

1.一种手术器械，所述手术器械包括：
细长轴模块，所述细长轴模块包括：
细长轴构件；和
端部执行器，所述端部执行器包括支撑在细长轴构件的远端处的一对钳口构件，钳口构件中的至少一个能够相对于另一个钳口构件在打开位置和闭合位置之间移动；以及
手柄模块，所述手柄模块包括：
壳体，所述壳体包括纵向延伸通过壳体的开口，开口的尺寸设计成允许处于闭合位置的一对钳口构件通过；和
相对于壳体能够移动的可移动手柄，可移动手柄操作地联接到一对钳口构件，使得响应于可移动手柄相对于壳体的运动，引起钳口构件中的至少一个相对于另一个钳口构件在打开位置和闭合位置之间移动；和
锁，所述锁在第一位置和第二位置之间能够移动，在第一位置时，锁接合细长轴模块以将细长轴模块在壳体内固定就位，在第二位置时，锁与细长轴模块脱离以允许细长轴模块与手柄模块分离。
2.根据权利要求1所述的手术器械，其中细长轴模块在其近端处包括连接器，所述连接器用于将手术器械联接到外部的电外科能量源。
3.根据权利要求2所述的手术器械，其中细长轴模块在其中包括被包容的电气系统，其中电气系统包括在连接器和端部执行器之间延伸的电气路径，所述电气路径被包容在基本防潮的外壳内。
4.根据权利要求1所述的手术器械，其中细长轴模块包括往复驱动杆，所述往复驱动杆至少部分地延伸穿过细长轴构件并可操作地联接到端部执行器和可移动手柄，从而响应于使驱动杆往复移动的可移动手柄相对于壳体的运动，引起钳口构件在打开位置和闭合位置之间运动。
5.根据权利要求4所述的手术器械，其中细长轴模块包括在细长轴构件的远端处联接到细长轴构件的密封构件，密封构件被设置在细长轴构件和往复驱动杆之间，从而防止污染物进入细长轴构件。
6.根据权利要求5所述的手术器械，其中密封构件被构造为O形环、压力密封件和波纹管中的至少一种。
7.根据权利要求5所述的手术器械，其中细长轴模块包括设置在钳口构件和外轴构件之间的柔性密封构件，柔性密封构件由热收缩管构成。
8.根据权利要求4所述的手术器械，其中钳口构件被联接到往复驱动杆，使得响应于驱动杆的往复运动，引起钳口构件缩回到细长轴构件内。
9.一种手术器械，所述手术器械包括:
手柄模块，所述手柄模块包括至少一个手柄，所述手柄提供用于通过手保持手术器械的握持表面；以及
驱动器组件，所述驱动器组件能够选择性地从手柄组件拆除，驱动器组件包括：
限定了纵向轴线的细长轴构件；
支撑在细长轴构件的远端处的端部执行器，端部执行器包括一对相对的钳口构件，其中钳口构件中的至少一个能够相对于另一个钳口构件在打开位置和闭合位置之间相对于细长轴构件移动；
至少部分地延伸穿过细长轴构件的往复驱动器构件，驱动器构件操作地联接到端部执行器，从而响应于往复驱动器构件的纵向往复运动，引起钳口构件在打开位置和闭合位置之间运动；
可操作成使往复驱动器构件纵向地移动通过细长轴构件的电机；和
基本围绕电机和往复驱动器构件的壳体，壳体基本上是防潮的；和
被支撑在壳体上的致动器，致动器可操作成激活电机。
10.根据权利要求9所述的手术器械，其中电机包括伺服电机。
11.根据权利要求9所述的手术器械，其中电机包括线性电机，所述线性电机包括支撑在细长轴构件上的电线圈和支撑在往复驱动器构件上的磁体，磁体响应于电线圈中的电流能够纵向地移动。
12.根据权利要求9所述的手术器械，其中驱动器组件还包括从壳体延伸的线缆，线缆能够连接到电外科能量源。
13.根据权利要求12所述的手术器械，其中线缆和延伸穿过细长轴构件的电气管道电气连通，从而将电外科电流传递到端部执行器。
14.根据权利要求9所述的手术器械，其中驱动器组件包括设置在驱动器组件上的柱和槽中的至少一个，所述柱和槽中的所述至少一个被配置为与设置在手柄组件上的柱和槽中的至少一个卡扣配合。
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