CN103565486B - 包括安全闭锁件和可视指示器的多次发射式手术吻合装置 - Google Patents
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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
- 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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- 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
- A61B17/0682—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/08—Accessories or related features not otherwise provided for
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
- A61B2017/00473—Distal part, e.g. tip or head
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- A—HUMAN NECESSITIES
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- 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
- A61B2017/07214—Stapler heads
- A61B2017/07235—Stapler heads containing different staples, e.g. staples of different shapes, sizes or materials
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- A61B2017/07214—Stapler heads
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- 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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- A—HUMAN NECESSITIES
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- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0803—Counting the number of times an instrument is used
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- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0814—Preventing re-use
Abstract
本发明提供了一种包括安全闭锁件和可视指示器的多次发射式手术吻合装置。所述手术吻合装置包括钉仓组件、发射组件和闭锁组件。钉仓组件构造为容纳多组手术紧固件。发射组件构造为用于重复致动,其中,在每次致动时,所述发射组件从第一位置移动至第二位置以至少部分地射出一组手术紧固件。所述发射组件进一步构造为从所述第二位置移回至所述第一位置以使所述发射组件复位以用于随后的致动。所述闭锁组件构造为允许预定次数的致动,并且所述闭锁构件构造为当所述发射组件的之前致动的次数等于预定致动次数时,从第一状态转换至第二状态,在所述第一状态中允许随后的致动,在所述第二状态中抑制随后的致动。
Description
相关申请的交叉引用
本申请要求2012年7月18日提交的、序列号为61/672,882的美国临时专利申请的优先权和权益,其全部内容通过引用合并于此。
技术领域
本公开涉及一种手术吻合装置,尤其涉及一种包括安全闭锁机构和可视指示器机构的多次发射式手术吻合装置,所述安全闭锁机构用于抑制超出预定使用次数的使用或者不完全使用,并且所述可视指示器机构用于指示装置的状况和/或状态。
背景技术
在本领域中众所周知的是其中首先将组织抓取或者夹持在相对的钳夹结构之间并且然后通过手术紧固件接合的手术设备。在一些设备中,提供了刀具来切割已经由紧固件接合的组织。典型地,紧固件的形式为手术吻合钉,但是也能够采用两件式聚合物紧固件。
用于这种目的的设备能够包括分别用来捕获或者夹持组织的两个钳夹结构。典型地,钳夹结构中的一个承载吻合钉钉仓,吻合钉钉仓容纳布置为至少两横向排的多个吻合钉,而另一个构件具有砧座,当吻合钉从吻合钉钉仓中驱动出时,砧座限定用于使吻合钉钉腿成形的表面。通常地,通过纵向地行进通过吻合钉钉仓以顺序地从吻合钉钉仓射出吻合钉的凸轮杆、驱动滑块或者其他类似的机构来实现吻合操作。刀具能够在吻合钉排之间行进以纵向地切割在吻合钉排之间吻合的组织。
在内窥镜或者腹腔镜操作中,手术是通过小的切口或者通过插入通过皮肤中的小的进入开口的狭窄的套管来实施的。为了解决内窥镜和/或腹腔镜手术操作的特定需要,已经开发出了内窥镜手术吻合设备。
尤其是对于内窥镜和/或腹腔镜手术操作,有利的是提供这样一种手术吻合装置:其能够提供预定次数的发射,而不需要从手术部位移除装置,并且还包括用于防止“空发射”(例如预定次数的发射已经终止之后的发射和/或部分发射已发生之后的发射)的安全闭锁机构。可能进一步有利的是提供可视指示器机构,其指示设备的状况和/状态,例如设备已经发射的次数、剩余发射次数,或者设备是否闭锁。
发明内容
根据本公开,提供了一种手术吻合装置。所述手术吻合装置包括钉仓组件、发射组件和闭锁组件。钉仓组件构造为在其中容纳多个手术紧固件。发射组件联接至所述钉仓组件。在致动时,所述发射组件构造为从第一位置移动至第二位置,以至少部分地从所述钉仓组件射出所述手术紧固件中的一个。所述发射组件进一步构造为从第二位置平移回至到第一位置,以使发射组件复位以用于随后的致动。闭锁组件联接至所述发射组件,并且构造为允许所述发射组件的预定次数的致动。所述闭锁构件构造为当所述发射组件的之前致动的次数等于所述闭锁组件所允许的的预定致动次数时,从所述第一状态转换至所述第二状态,在所述第一状态中允许所述发射组件的随后的致动,在所述第二状态中所述闭锁组件抑制所述发射组件从所述第一位置的实质性移动,从而抑制所述发射组件的随后的致动。
在实施例中,所述钉仓组件容纳了多组手术紧固件。容纳在所述钉仓组件内的多组手术紧固件的数量能够等于所述闭锁组件所允许的预定致动次数。
在实施例中,所述钉仓组件、所述发射组件和所述闭锁组件设置在一次性装载单元中。
在实施例中,提供了包括用于选择性地致动所述发射组件的活动手柄的手柄组件。在这种实施例中,所述一次性装载单元可以与所述手柄组件可释放地接合。
在实施例中,提供了可视指示器组件,其构造为指示剩余致动次数。所述可视指示器组件可以包括多个滑动指示器。每个滑动指示器均能够在第一位置和第二位置之间移动,在所述第一位置上所述指示器隐藏在所述手术吻合装置内,在所述第二位置上所述指示器能够从所述手术吻合装置的外部看到。
在实施例中,所述闭锁组件包括凸轮轨道和联接至所述凸轮轨道和所述发射组件的凸轮构件。所述凸轮轨道限定至少一个致动路径和完成终端。所述凸轮构件构造为当所述发射组件的之前致动的次数小于所述预定致动次数时,在所述发射组件的致动时,沿着所述至少一个致动路径中的一个致动路径平移以允许所述发射组件的致动。所述凸轮构件构造为当所述发射组件的之前致动的次数等于所述预定致动次数时,定位在所述完成终端内以抑制所述发射组件的随后的致动。
在实施例中,所述凸轮轨道限定通过多个完全致动返回路径相互连接的多个致动路径。在这种实施例中,所述凸轮构件构造为当所述发射组件的之前致动的次数小于所述预定致动次数时,在所述发射组件致动和复位时,沿着所述多个致动路径中的一个致动路径平移以及沿着所述多个完全致动返回路径中的一个完全致动返回路径返回。
在实施例中,所述凸轮轨道进一步包括将最终致动路径和所述完成终端相互连接的最终返回路径。在这种实施例中,所述凸轮构件构造为在所述发射组件的之前致动的次数等于所述预定致动次数时,沿着所述最终返回路径返回至完成终端以抑制所述发射组件的随后的致动。
在实施例中,所述凸轮轨道进一步限定至少一个部分发射返回路径和至少一个部分发射终端。在这种实施例中,在射出一组手术紧固中的一些而不是所有的手术紧固件时,所述凸轮构件构造为沿着所述至少一个部分发射返回路径中的一个部分发射返回路径返回至所述至少一个部分发射终端中的一个部分发射终端以抑制所述发射组件的随后的致动。
根据本公开提供的一种手术吻合装置包括钉仓组件、发射组件和闭锁组件。钉仓组件构造为容纳多组手术紧固件。发射组件联接至所述钉仓组件并且构造为用于重复致动。在每次致动时,所述发射组件构造为从第一位置移动至第二位置以从所述钉仓组件完全地射出所述多组手术紧固件中的一组手术紧固件。所述发射组件进一步构造为从所述第二位置移回至所述第一位置以使所述发射组件复位以用于随后的致动。闭锁组件联接至所述发射组件,并且构造为在所述发射组件从所述第一位置平移至所述第二位置并且回到所述第一位置时,允许所述发射组件的随后致动以从所述钉仓组件完全地射出所述多组手术紧固件中的另一组手术紧固件,而在所述发射组件从所述第一位置平移至设置在所述第一位置和所述第二位置之间的第三位置并且回到所述第一位置而不到达所述第二位置时抑制所述发射组件的随后的致动。
在实施例中,所述钉仓组件、所述发射组件和所述闭锁组件设置在一次性装载单元中。
在实施例中,提供了包括用于选择性地致动所述发射组件的活动手柄的手柄组件。在这种实施例中,所述一次性装载单元能够与所述手柄组件可释放地接合。
在实施例中,提供了可视指示器组件,其构造为指示剩余致动次数。更具体地,所述可视指示器组件可以包括多个滑动指示器。每个指示器均能够在第一位置和第二位置之间移动,在所述第一位置上所述指示器隐藏在所述手术吻合装置内,在所述第二位置上所述指示器能够从所述手术吻合装置的外部看到。
在实施例中,所述闭锁组件包括凸轮轨道和联接至所述凸轮轨道和所述发射组件的凸轮构件。所述凸轮轨道限定由所述多个完全致动返回路径互相连接的多个致动路径。在所述发射组件从所述第一位置移动到所述第二位置时,所述凸轮组件构造为沿着所述致动路径中的一个致动路径平移。在所述发射组件从所述第二位置移回至所述第一位置时,所述凸轮构件构造为沿着所述多个完全致动返回路径中的一个完全致动返回路径平移。此外,所述至少一个完全致动返回路径可以联接至下一个致动路径。
在实施例中,所述凸轮轨道进一步限定多个部分发射返回路径,以使得在所述发射组件从所述第三位置移回至所述第一位置而不到达所述第二位置时,所述凸轮构件沿着部分发射返回路径中的一个部分发射返回路径平移。
在实施例中,所述凸轮轨道进一步限定联接至所述部分发射返回路径中的至少一个部分发射返回路径的至少一个部分发射终端。在这种实施例中,在所述发射组件从所述第三位置移回至所述第一位置而不到达所述第二位置时,所述凸轮构件沿着部分发射返回路径中的一个部分发射返回路径平移至所述至少一个部分发射终端中的一个部分发射终端以抑制所述发射组件的随后的致动。
在实施例中,所述闭锁组件进一步构造为允许所述发射组件的预定次数的致动。在这种实施例中,所述闭锁组件构造为当所述发射组件的之前致动的次数等于预定致动次数时,从第一状态转换至第二状态,在所述第一状态中允许所述发射组件的随后的致动,在所述第二状态中所述闭锁组件抑制所述发射组件从所述第一位置的实质性移动,从而抑制所述发射组件的随后的致动。
附图说明
在下文中参照附图描述了本公开的各种实施例,其中:
图1是根据本公开的示例性手术吻合装置的立体图;
图2是图1的手术吻合装置的立体图,其中拆卸了一次性装载单元(“DLU”)并且轴旋转了90°;
图2A是图2中的“2A”所指示的区域的细节的放大立体图;
图3是图1的手术吻合装置的DLU的立体图;
图4是沿着剖面线4-4得到的图3的DLU的剖面图;
图4A是沿着剖面线4-4得到的图3的DLU的剖面图,图示出了设置在中央通道中的刀具组件和砧座组件;
图5是根据本公开的两板式推动器的立体图;
图6是图3的DLU的钉仓组件的立体图;
图7是图6的钉仓组件的分解图,图示出了一对钉仓和承载件;
图8是图7的钉仓之一的分解图,图示出了两个钉仓半部和钉仓支撑通道;
图9是图8的钉仓半部之一的分解图,图示出移除的推动器、偏置构件和紧固件;
图10是图8中的“10”所指示的区域的细节的放大、部分分解图;
图11是沿着剖面线11-11得到的图6的钉仓组件的剖面图;
图12是图11中的“12”所指示的区域的细节的放大图;
图13是图3的DLU的发射凸轮组件的俯视图;
图14是图13的发射凸轮组件的立体图;
图14A是图14中的“14A”所指示的区域的细节的放大图;
图15是图14的发射凸轮组件的分解图;
图15A是沿着剖面线15A-15A得到的图2A的DLU的剖视图;
图16是图3的DLU的部分剖开的、后视立体图,示出了图14的发射凸轮组件的可视指示器组件;
图17是图16的DLU的进一步剖开的、后视立体图,示出了图14的发射凸轮组件的可视指示器组件;
图18是图16的DLU的进一步剖开的、主视立体图,示出了图14的发射凸轮组件的可视指示器组件;
图19是图14的发射凸轮组件的安全闭锁组件的凸轮随动件的主视立体图;
图20是图14的发射凸轮组件的安全闭锁组件的凸轮壳体的一部分的内部立体图;
图21是图20中的“21”所指示的区域的细节的放大立体图;
图22是图14的发射凸轮组件的安全闭锁组件的凸轮壳体和图14的发射凸轮组件的可视指示器组件的外部立体图;
图23是图22中的“23”所指示的区域的细节的放大立体图;
图24是图14的发射凸轮组件的一部分的分解立体图;
图25是图24中的“25”所指示的区域的细节的放大图;
图26是沿着图17的剖面线26-26得到的剖面图;
图27是示出在发射期间的图6的钉仓组件的远侧端的剖面图;
图28至图30是图4中的“28,29,20”所指示的区域的细节的放大剖面图,图示出了钉仓组件的发射和再装载;
图31是示出在三次完全发射之后的限定在图14的发射凸轮组件的安全闭锁组件的凸轮壳体的内表面上的凸轮轨道的示意图;以及
图32是示出在部分发射之后的图14的发射凸轮组件的安全闭锁组件的凸轮轨道的示意图。
具体实施方式
现在将参照附图详细描述本公开的手术吻合装置的实施例,在附图中,在多幅视图中的每一幅中相似的附图标记指示相同或对应的构件。如对于手术器械所常用的,此处术语“近侧”的使用指的是器械或者其部件的较靠近使用者的部分,而此处术语“远侧”的使用指的是器械或者其部件的较远离使用者的部分。
转向图1至图3,根据本公开所提供的手术吻合装置通常由附图标记10所表示。手术吻合装置10通常包括手柄组件12、细长主体14和能够可释放地与细长主体14相接合的一次性装载单元(“DLU”)16。下文将更加详细地描述的DLU16包括工具组件18和砧座组件22,工具组件18具有容纳多个手术紧固件的钉仓组件20,砧座组件22可枢转地联接至钉仓组件20。一次性装载单元能够移除以及更换。本公开还设想了能够完全地或者部分地重复使用的装载单元。
继续参照图1至图3,手柄组件12包括固定手柄24、活动手柄26和筒部28。活动手柄26可操作地联接至DLU16以使得活动手柄26的致动(例如活动手柄26朝向于固定手柄24的按压)使得DLU16的钉仓组件20和砧座组件22接近以抓取它们之间的组织,发射手术紧固件通过抓取的组织以及使手术紧固件成形,并且分割成排的成形的手术紧固件之间的组织。
可旋转构件30被安装成朝向手柄组件12的筒部28的远侧端,以利于细长主体14相对于手柄组件12的旋转,并且因此有利于DLU16和工具组件18相对于手柄组件12的旋转。可旋转构件30可以例如在每个方向上旋转多达180°,或者可选地可以构造为在任意方向上旋转360°。此外,关节式运动杆32可操作地设置在与可旋转构件30相邻的手柄组件12的筒部28上。关节式运动杆32能够选择性地被致动以使得工具组件18相对于细长主体14做关节式运动。更具体地,关节式运动杆32相对于筒部28在第一方向上的旋转使得工具组件18在第一方向上相对于细长主体14做关节式运动,而关节式运动杆32在第二方向上的旋转使得工具组件18在第二、相对的方向上相对于细长主体14做关节式运动。可旋转构件30和关节式运动杆32分别提供了工具组件18的旋转和关节式运动,以利于根据需要定位工具组件18,这对于腹腔镜或者内窥镜手术操作特别有用。吻合装置能够包括用于致动工具组件的关节式运动的连锁件、线缆、杆或者其他结构。
继续参照图1至图3,收缩构件34可滑动地联接至手柄组件12的筒部28并且构造为沿着筒部28纵向平移。收缩构件34与工具组件18操作地关联并且能够选择性地平移以使得手术吻合装置10返回至缩回或者预发射的位置。更特别地,在操作期间,随着按压活动手柄26以致动手术吻合装置10,收缩构件34同时沿着筒部28向远侧平移。在最远侧的位置处,对应于手术吻合装置10的完全发射状态,通过闭锁机构(未示出)将收缩构件34闭锁在适当的位置上。能够手动地使收缩构件34沿着筒部28向近侧平移或者缩回至其初始位置(图1至图2),以使手术吻合装置10复位以供后续使用。能够理解的是,下文将更加详细地描述的,与工具组件18配合的收缩构件34有利于手术吻合装置10的再装载以及随后的发射,而不需要从腹腔镜或者内窥镜(或者其他)手术部位移除手术吻合装置10。
仍然参照图1至图3,提供了联接机构15以利于DLU16与细长主体14的远侧端的接合和分离。联接机构15可以包括用于使DLU16与细长主体14的远侧端可释放地接合的任何适当的联接,例如卡扣联接、搭扣配合联接、摩擦配合联接等。联接机构15进一步包括设置在手柄组件12上的释放开关15a并且释放开关15a构造为利于DLU16从细长主体14的释放或者分离。这样,可以容易并且高效地从细长主体14移除用尽的DLU16,以更换新的DLU16以供后续使用。
在授予Milliman等人的5,865,361号美国专利和授予Scirica等人的7,967,178号美国专利中公开了上文概述的手柄组件12和细长主体14的特征和功能的更加详细的描述,上述每个专利的全文通过引用合并于此。
继续参照图1至图3,如上文所述,DLU16能够可释放地与细长主体14的远侧端接合,并且DLU16通常包括:近侧壳体部100,其适于可释放地接合细长主体14的远侧端;远侧工具组件18,其构造为抓取组织,发射手术紧固件通过抓取的组织以及使手术紧固件成形,以及切割成排的成形的手术紧固件之间的组织;以及安装组件102,其可枢转地联接在近侧壳体部100和远侧工具组件18之间以允许工具组件18相对于近侧壳体部100进行关节式运动。
近侧壳体部100的近侧端构造为可释放地接合细长主体14的远侧端以使得DLU16与细长主体14可释放地相互接合。更具体地,DLU16的近侧壳体部100的近侧端包括插入尖端193、钩部258,以及一个或者多个接合小块254。为了使得DLU16与细长主体14可释放地接合,从细长主体14延伸出的控制杆52的远侧端54插入DLU16的插入尖端193中,和/或插入尖端193插入细长主体14的远侧端中以使得小块254在限定于细长主体14内的相应通道(未示出)中对准。接下来,相对于细长主体14旋转DLU16以将钩部258移动为能够与细长主体14可操性地接合。同时,小块254沿着限定在细长主体14内的环形通道(未示出)进行凸轮运动,从而经由卡扣型联接使得近侧壳体部100与细长主体14相接合,但是也可以设想其他适当的可释放联接。在授予Milliman等人的5,865,361号美国专利和授予Scirica等人的7,753,246号美国专利中能够找到用于使得DLU16的近侧壳体部100与细长主体14相接合的这个示例性接合构造和安装组件102的示例性构造的进一步细节,所述两个专利先前通过引用合并在上文中。
参照图3至图10,工具组件18包括钉仓组件20和砧座组件22,砧座组件22可枢转地联接至钉仓组件20并且能够相对于钉仓组件20在分离或者打开位置以及接近或者夹持位置之间移动以将组织抓取在它们之间。砧座组件22包括限定在其中的多个成形凹处22a(参见图4A)以利于从钉仓组件20发射出的手术紧固件围绕组织的成形。在授予Milliman等人的5,865,361号美国专利中公开了适当的砧座组件22的示例,该专利先前通过引用合并在上文中。可以经由任何适当的偏置构件(未示出)使得砧座组件22相对于钉仓组件20朝向打开位置偏置,但是也可以设想其他的构造。
继续参照图3至图10,工具组件18的钉仓组件20包括限定细长支撑通道204的承载件202(参见图7)。细长支撑通道204构造为在其两个纵向侧上容纳第一吻合钉钉仓206和第二吻合钉钉仓208。更具体地,设置了分别沿着吻合钉钉仓206、吻合钉钉仓208和细长支撑通道204形成的相对应的翼件210和狭槽212,以将吻合钉钉仓206、208接合和紧固在支撑通道204内。每个吻合钉钉仓206、208均包括支撑架214,支撑架214从各个吻合钉钉仓206、208的上表面向外延伸,并且支撑架214构造为安置在承载件202的各个侧壁顶部上,以将吻合钉钉仓206、吻合钉钉仓208支撑和稳定在支撑通道204内。
吻合钉钉仓206、吻合钉钉仓208能够在其远侧端部216处相互接合,但是在其他的情况下相互分开以限定向远侧端部216的近侧在吻合钉钉仓206、吻合钉钉仓208之间延伸的中央纵向狭槽252。如下文将更加详细地描述的,设置了中央纵向狭槽252以利于刀具组件310(参见图4A)纵向地平移通过钉仓组件20以切割成排的成形的手术紧固件110之间的组织。形成在一个吻合钉钉仓(例如吻合钉钉仓208)的远侧端部216的表面上的内孔222构造为容纳形成在另一个吻合钉钉仓(例如吻合钉钉仓206)的远侧端部216的表面上的内翼件224。内孔222和内翼件224,与翼件210、狭槽212和支撑架214相结合,起到使得吻合钉钉仓206、吻合钉钉仓208相对于彼此以及与承载件202相对准并且保持这种对准的作用,从而帮助确保和保持吻合钉钉仓206、吻合钉钉仓208在钉仓组件20内的并且相对于砧座组件22的正确的定位(参见图3和图4A)。
仍然参照图3至图10,每个吻合钉钉仓206、208分别由内半部226和外半部228形成。每个半部226、228均包括限定在其中并且构造为容纳多个推动器108和手术吻合钉或者紧固件110的多个保持狭槽230。每个紧固件110均包括限定尖端113的第一和第二支腿112,以及使得第一和第二支腿112相互连接的冠部114。虽然也可以设想其他的构造,但是保持狭槽230成纵向排对准。更具体地,每个吻合钉钉仓206、208的外半部228均包括保持狭槽230的第一排234以及保持狭槽230的第二排236的一部分236a,而每个吻合钉钉仓206、208的内半部226均包括保持狭槽230的第三排238以及保持狭槽230的第二排236的互补的部分236b。这样,当每个吻合钉钉仓206、208的内半部226和外半部228相互接合以形成吻合钉钉仓206、208时,经由互补部分236a和236b完整形成了保持狭槽230的第二排236。参见图8。因此,在组装状态下,每个吻合钉钉仓206、吻合钉钉仓208限定了保持狭槽230的三个排234、236、238,但是可以设想的是,取决于特定的目的,吻合钉钉仓206、吻合钉钉仓208可以包括更多或者更少排的保持狭槽230。
吻合钉钉仓206、208的内半部226和外半部228均包括多个凸缘240和构造为当内半部226和外半部228相互接合时容纳凸缘240的多个相应的通道242。通道242和凸缘240沿着吻合钉钉仓206、208的每个内半部226和外半部228的长度交替地设置(参见图8),但是也可以设想其他的构造。内半部226和外半部228的凸缘240可以限定保持狭槽230的第二排236的相应的保持狭槽部分236a、236b以使得如上文所述,在内半部226和外半部228接合并且凸缘240容纳在通道242内时,形成了保持狭槽230的第二排236。
继续参照图3至图10,每个钉仓206、208均包括构造为容纳内半部226和外半部228的钉仓支撑通道254。钉仓支撑通道254构造为保持内半部226和外半部228接合以及相互纵向对准。更具体地,内半部226和外半部228包括凹入部分256,凹入部分256构造为容纳钉仓支撑通道254的侧壁以将内半部226和外半部228在钉仓支撑通道254内的接合和对准。
每个钉仓206、208均包括组织接触表面104,组织接触表面104限定了包括外组织接触表面104a、中间组织接触表面104b和内组织接触表面104c的台阶式构造。从吻合钉钉仓206、208的底表面106测量时,每个组织接触表面104a至104c具有相互不同的高度,从而限定了组织接触表面104的台阶式构造。组织接触表面104a至104c的台阶式构造允许保持狭槽230的各个排234、236、238容易地保持不同尺寸的紧固件110。参见图4。例如,设置在第一排234的保持狭槽230中的手术紧固件110的支腿112可以限定第一长度,例如大约4.1mm,设置在第二排236的保持狭槽230中的手术紧固件110的支腿112可以限定第二长度,例如大约3.5mm,并且设置在第三排238的保持狭槽230中的手术紧固件110的支腿112可以限定第三长度,例如大约2.3mm,但是可以设想其他的构造。
吻合钉钉仓206、208均包括邻近每排保持狭槽230设置并且与其可操作地关联的吻合钉储藏件(staple magazine)244。参见图10。每个吻合钉储藏件244均包括设置在其中的多个紧固件110和构造为使得多个紧固件110朝向相应排的保持狭槽230偏置的多个偏置构件246。在其中每排保持狭槽230包含不同尺寸的紧固件110的构造中,与特定排的保持狭槽230相关联的储藏件244构造为包括与设置在那些保持狭槽230中的紧固件110的尺寸相同的多个紧固件110。例如,与第一排234的保持狭槽230相关联的储藏件244可以包括第一长度的紧固件110,与第二排236的保持狭槽230相关联的储藏件244可以包括第二长度的紧固件110,并且与第三排238的保持狭槽230相关联的储藏件244可以包括第三长度的紧固件110。虽然在此处的示例性实施例示出并且描述为包括具有用于DLU16的三次发射的三组紧固件110的储藏件244,但是可以设想的是,也可以设置与更多或者更少的发射次数相对应的更多或者更少组的紧固件110。
尤其是结合图3至图9地参照图10,每个吻合钉储藏件244均限定了用于将紧固件110容纳在其中的多个大致“U”或者“H”形的通道248。通道248均包括一对垂直段248a、248b和水平段248c。每个紧固件110均以竖直取向设置在一个通道248内,在垂直取向中紧固件110的尖端113朝向组织接触表面104取向,其中紧固件110的冠部114抵接水平段248c,并且紧固件110的支腿112设置在通道248的垂直段248a和248b内。
每个储藏件244均进一步包括用于容纳偏置构件246的至少一部分的至少一个通道245。每个偏置构件246从通道245延伸进与相应的紧固件110相邻的垂直段248a和248b的至少一个中以与相应的紧固件110相接合并且朝向相应的保持狭槽230促动相应的紧固件110。偏置构件246均包括构造为延伸进相应的垂直段248a、248b中的一对支腿246a、246b,但是也可以设想其他的构造。更具体地,偏置构件246的支腿246a和246b构造为使得:当偏置构件246插进储藏件244的通道245中并且接合多个紧固件110时,支腿246a和246b使得多个紧固件110朝向相应的保持狭槽230偏置并且与相应的保持狭槽230垂直配准。也即是说,偏置构件246以大致垂直的方式插入通道245中并且当碰到紧固件110时,支腿246a和246b向外偏转以向紧固件110施加偏置力“F”(参见图4A)。
参照图4至图10以及图27至图30,多个推动器108设置在钉仓206、208的内半部226和外半部228中的每一个内,并且与多个保持狭槽230可操作地相关联。每个钉仓206、208的内半部226和外半部228进一步包括至少部分地贯穿其中的纵向狭槽250,以适应驱动组件302的驱动杆303的发射凸轮340的通过。每个推动器108均包括推动器基座109a,推动器基座109a具有近侧凸轮面109b和远侧凸轮面109c。每个推动器108均进一步包括一个或者多个推动器板109d,推动器板109d从推动器基座109a延伸出并且与设置在保持狭槽230内的紧固件110可操作地相关联地设置在一个保持狭槽230内。每个推动器基座109a的近侧凸轮面109b和远侧凸轮面109c构造为在驱动杆303平移通过钉仓206、208的纵向狭槽250时与驱动杆303(参见图27)的一个或者多个发射凸轮304相接合,以向上促动推动器108从而垂直向上地促动推动器板109d通过保持狭槽230以从保持狭槽230促动紧固件110,通过组织接触表面104中的开口231,通过抓取在砧座组件22(图4A和图29)和钉仓组件20之间的组织,并且抵靠砧座组件22(图4A和图29)的吻合钉成形凹处22a(图4A和图29)以将紧固件110紧固在组织内。与保持狭槽230的每个相应的排234、236和238相对应的推动器板109d可以具有不同的尺寸以适应具有不同尺寸的紧固件110和/或允许推动器板109d适应具有不同高度的组织接触表面104a、104b、104c的排234、236和238。可选地,推动器板109d可以具有相同的尺寸。
在发射期间,随着推动器板109d垂直向上地平移通过相应的保持狭槽230,推动器板109d移动至至少部分地阻挡相应的保持狭槽230和储藏件244之间的开口232的位置,从而在完成发射之前抑制保持狭槽230再装载下一组紧固件110。随着推动器板109d返回至预发射位置,例如随着推动器板109d返回至保持狭槽230的基座,开口232被打开或者被暴露以允许来自储藏件244的接下来的紧固件110通过由偏置构件246施加的偏置力“F”(图4A和图29)被偏置到保持狭槽230内的适当位置中。
现在参照图11至图19,发射凸轮组件300至少部分地设置在DLU16的近侧壳体100内并且至少部分地延伸进工具组件18中。在DLU16与细长主体14(图1)接合时,发射凸轮组件300与手柄组件12(图1)可操作地联接,以使得在活动手柄26(图1)致动时,例如活动手柄26朝向固定手柄24(图1)的按压,发射凸轮组件300向远侧平移通过工具组件18以实现钉仓组件20和砧座组件22的接近以抓取它们之间的组织,发射紧固件110通过抓取的组织并且使紧固件110成形,并且切割各排成形的手术紧固件110之间的组织。
参照图13至图19,发射凸轮组件300包括驱动组件302、刀具组件310、安全闭锁组件320(图20至图21)和可视指示器组件340。驱动组件302包括多个驱动杆303,驱动组件302包括例如八个驱动杆303(但是也可以设想更多或者更少的驱动杆)。驱动杆303相对于彼此以并排的关系设置(在刀具组件310的每一侧上设置了四(4)个驱动杆303),每个驱动杆均限定了在其远侧端处的发射凸轮304,在其近侧端处的凸轮随动件容纳部305,以及在其远侧端和近侧端之间延伸的细长柔性中间部306。细长柔性中间部306贯穿DLU16(见图16)的安装组件102,并且其柔性的构造允许驱动杆303在工具组件18相对于近侧壳体部100做关节式运动时屈曲,从而提供了DLU16的连续运行,而与工具组件18的相对关节式运动位置无关。附加地参照图11,如上文提到的,驱动杆303构造为平移通过限定在钉仓206、208内的纵向狭槽250,以使得发射凸轮304促动推动器108从钉仓组件20发射紧固件110,通过组织,并且进入砧座组件22(图4A)以使得紧固件110围绕抓取在钉仓组件20和砧座组件22(图4A)之间的组织成形。
刀具组件310包括刀具梁312,刀具梁312具有顶部凸缘312a、底部凸缘312b和中央柱312c。中央柱312c限定了刀片312d,并且分别使得顶部凸缘312a和底部凸缘312b相互连接。刀具梁312在细长柔性中央构件314的远侧端处联接至细长柔性中央构件314。类似于驱动杆303,细长柔性中央构件314至少部分地从工具组件18向近侧延伸进DLU16的近侧壳体100中。细长柔性中央构件314的近侧端限定了凸轮随动件容纳部315。细长柔性中央构件314贯穿DLU16的安装组件102(见图16),并且其柔性的构造允许刀具组件310在工具组件18相对于近侧壳体部100做关节式运动时屈曲,从而提供了DLU16的连续运行,而与工具组件18的相对关节式运动位置无关。
能够操作手柄组件以使得发射凸轮组件300移动通过钉仓组件20。随着发射凸轮组件300向远侧移动,刀具梁312也向远侧移动,凸缘312a和凸缘312b接合砧座和通道204以使得保持其相对于彼此适当的位置。还能够使用刀具梁312来在发射之前闭合组织上的钳夹。在通过引用将其全部公开合并于此的,授予Milliman等人的5,865,361号美国专利中,描述了一种具有用于闭合吻合钉的钳夹以及发射吻合钉的驱动梁的轴向驱动组件。
如上文所述,并且附加地参照图4至图12,中央纵向狭槽252沿着钉仓组件20的在吻合钉钉仓206和吻合钉钉仓208之间的长度延伸以利于刀具梁312和刀具组件310的细长柔性中央构件314通过其中以切割各排成形的手术紧固件110之间的组织。更具体地,如图4A最佳所示,刀具梁312的顶部凸缘312a构造为平移通过被限定为贯通砧座组件22的横切的纵向狭槽22b,并且底部凸缘312b构造为沿着承载件202的底侧203纵向地平移以使得刀具组件310同时起到使得砧座组件22和钉仓组件20接近以抓取它们之间的组织,以及切割在施加至其上的各排成形的手术紧固件110之间抓取的组织。刀具组件310的刀具梁312向驱动组件302的发射凸轮304的近侧移置,以使得当推进通过钉仓组件20时,在紧固件110的发射和成形与各排成形的紧固件110之间的组织的切割之间存在略微的延迟。
再次参照图13至图19并且附加地参照图20至图26,安全闭锁组件320包括凸轮随动件322,凸轮随动件322可旋转地紧固在驱动组件302的驱动杆303的相应的凸轮随动件容纳部305、315以及刀具组件310的细长柔性中央构件314内。凸轮随动件322包括从其径向地向外延伸出的突出件324,突出件324可滑动地接合在限定于安全闭锁组件320的凸轮壳体部330的内表面331内的凸轮轨道335内。凸轮壳体部330限定了大致半柱形的构造,大致半柱形的构造在其内部、凹入表面331上限定了凸轮轨道335。凸轮壳体部330设置在DLU16的近侧壳体部100内。凸轮壳体部330部分地限定了管腔332,管腔332构造为可滑动地接纳驱动组件302的驱动杆303、刀具组件310的细长柔性中央构件314,以及凸轮随动件322,以使得当DLU16发射和复位时,例如当驱动杆303、细长柔性中央构件314以及凸轮随动件322纵向平移通过管腔332时,凸轮突出件324沿着凸轮轨道335平移,并且如将更加详细地描述地,凸轮随动件322根据凸轮轨道335(见图31至图32)的几何形状旋转。沿着凸轮轨道335的凸轮突出件324的平移以及作为其结果的凸轮随动件322的旋转提供了在预定发射次数之后抑制发射和/或在已经发生不完全的发射之后抑制发射的安全闭锁特征。如能够理解地,DLU所局限的特定发射次数可能取决于储藏件244(图10)的容量,或者其他因素。也即是说,虽然示出了三次发射的构造,可以设想将安全闭锁组件320构造为提供任何适当数量的发射。将在下文中更加详细地描述凸轮轨道335的示例性构造和安全闭锁组件320的操作。
如图2A、图3和图15A至图26最佳示出,发射凸轮组件300的可视指示器组件340朝向凸轮壳体部330的近侧端而联接至凸轮壳体部330,并且通常包括一组指示器构件,例如包括三个指示器构件341、342、343(但是也可以提供更多或者更少的指示器构件341、342、343,例如取决于所允许的发射的次数和/或其他因素)。每个指示器构件341、342、343均包括面板344,面板344包括特定的标记345。标记345可以包括指示剩余使用次数的数字(如图所示)、指示剩余使用次数的颜色编码,例如绿色表示多次剩余使用,黄色表示一次剩余使用,并且红色表示零次剩余使用,或者可以包括任何其他适当的可视指示器、印记或者符号。如将在下文更加详细描述地,DLU16的近侧壳体部100限定了一个或者多个窗口350,例如分别与每个指示器构件341、342、343相对应的窗口350a、350b、350c,取决于DLU16的状态,例如取决于DLU16已经发射的次数,可以通过窗口350a、350b、350c看到指示器构件341、342、343的一个或者多个标记345。
可视指示器组件340的每个指示器构件341、342、343进一步包括:凸缘346,其与面板344相对地延伸;柱347,其从凸缘346向远侧延伸;以及支架348,其从凸缘346向近侧延伸,支架348构造为接纳围绕其的偏置构件349以用于向远侧偏置指示器构件341、342、343。偏置构件349抵接DLU16的近侧壳体部100的近侧套环352,其抑制了偏置构件349的向近侧延伸,并且其结果是,偏置构件349朝向延伸位置的偏置向远侧促动指示器构件341、342、343。
继续参照图2A、图3和图15A至图26,发射凸轮组件300的可视指示器组件340进一步包括限定引导狭槽356的引导块354。引导块354与指示器构件341相对应,并且接合至凸轮壳体部330并且从凸轮壳体部330向近侧延伸。引导块354的引导狭槽356构造为接纳通过其中的指示器构件341的凸缘346以使得在DLU16的发射之前,指示器构件341的柱347延伸通过引导块354的引导狭槽356并且在其未发射起始位置402处进入凸轮壳体部330的凸轮轨道335中。通过在其未发射起始位置402处设置在凸轮轨道335内的指示器构件341的柱347,同样设置在凸轮轨道335的未发射起始位置402处的凸轮突出件324克服偏置构件349的偏置而向近侧促动指示器构件341,以使得指示器构件341的面板344的标记345(例如数字“3”)能够通过DLU16的近侧壳体部100的窗口350a可见。在这点上,在DLU16的初始、预发射状态下,其它的指示器构件342、343设置在相应的第二和第三发射起始位置404、406处并且经由偏置构件349向远侧偏置以使得其标记345不能分别通过窗口350b、350c可见。因此,警示用户DLU16具有三(3)次剩余发射的事实。
如将在下文更加详细地描述地,在第二发射起始位置404处将指示器构件342的柱347定位在凸轮壳体部330的凸轮轨道335内,在DLU16的首次完全发射以及随后的再装载时,凸轮随动件322平移并且旋转以使得凸轮突出件324定位在凸轮轨道335的第二发射起始位置404处。在这个位置上,凸轮突出件324克服偏置构件349的偏置而向近侧促动指示器构件342,以使得指示器构件342的标记345(例如数字“2”)能够通过DLU16的近侧壳体部100的窗口350b可见。此外,随着凸轮突出件324撤出未发射起始位置402,第一指示器构件341在偏置下向远侧返回以使得其标记345(例如数字“3”)不再能够通过窗口350a可见。在完成DLU16的第二次发射时,因为指示器构件343的柱347在第三发射起始位置406处设置在凸轮壳体部330的凸轮轨道335内并且因为实现了凸轮随动件322的平移和旋转而以使得凸轮突出件324设置在凸轮轨道335的第三发射起始位置406处,所以指示器构件343被向近侧促动以使得其标记345(例如数字“1”)能够通过DLU16的近侧壳体部100的窗口350c可见。随着凸轮突出件324撤出第二发射起始位置404,第二指示器构件342在偏置下向远侧返回以使得其标记345(例如数字“2”)不再能够通过窗口350b可见。
转到图1至图32,描述了手术吻合装置10的使用和操作。初始地,如图2至图3所示,如上文所描述地,通过将细长主体14的控制杆52的远侧端54插入DLU16的插入尖端193中并且使得DLU16相对于细长主体14旋转以使DLU16的近侧壳体部100与细长主体14可操作地接合,用户将DLU16附接至细长主体14。如图31所示,在这个点上,由于DLU16尚未发射,凸轮随动件322的凸轮突出件324在其初始的旋转位置上设置在凸轮壳体部330的凸轮轨道335的未发射起始位置402处。在这个位置上,凸轮突出件324促动指示器构件341的柱347以使得数字“3”(或者指示构件341的面板344的其他标记)能够通过DLU16(见图16至图17)的近侧壳体部100的窗口350c可见,从而指示DLU16还有三次剩余发射。
一旦组装,由DLU16引导的手术吻合装置10,例如经由远侧或者近侧平移、旋转和/或关节式运动,至少部分地插入手术部位中并且被操纵到适当位置中,以使得待抓取、紧固和切割的组织设置在工具组件18的砧座组件22和钉仓组件20之间。一旦达到期望位置,用户通过朝向于固定手柄24(见图1)按压活动手柄26来致动手柄组件12以抓取设置在砧座组件22和钉仓组件20之间的组织,并且在进一步致动时,向远侧驱动发射凸轮组件300通过钉仓组件20以发射手术紧固件110通过所抓取的组织以及切割成排的成形紧固件110(见图11至图14以及图27至图30)之间的组织。更具体地,在致动时,发射凸轮组件300向远侧平移以使得驱动组件302从近侧壳体部100向远侧平移而至少部分地进入工具组件18中,刀具组件310从近侧壳体部100向远侧平移而至少部分地进入工具组件18中,并且安全闭锁组件320的凸轮随动件322向远侧平移通过DLU16的近侧壳体部100。
总体上继续参照图1至图32,在致动的初始阶段期间,刀具组件310相对于工具组件18向远侧平移以使得刀具梁312的中央柱312c进入限定在钉仓组件20内的中央纵向狭槽252,刀具梁312的顶部凸缘312a进入砧座组件22的横切纵向狭槽22b并且刀具梁312的底部凸缘312b围绕承载件202(见图4A)的底侧203设置。作为这种构造的结果,在刀具组件310的进一步向远侧推进时,使得砧座组件22和钉仓组件20相互接近。
在发射凸轮组件300被致动以推进刀具组件310并且使得钉仓组件20和砧座组件22接近的同时,驱动组件302向远侧平移以使得驱动杆303进入并且平移通过每个吻合钉钉仓206、208(见图11至图12)的每个半部226、228的纵向狭槽250。在进一步向远侧推进时,驱动杆303的发射凸轮304被推进以顺序地接触与保持狭槽230相关联的推动器108(见图27)以使推动器板109d在保持狭槽230内垂直地平移并且从保持狭槽230促动紧固件110通过组织接触表面104中的开口231,通过设置在砧座组件22和钉仓组件20之间的组织,并且抵靠砧座组件22的紧固件成形凹处22a以使得紧固件110围绕组织成形。随着发射凸轮304继续向远侧平移,如图27所示,将推动器108保持在发射位置中,例如朝向组织接触表面104向上,以使得对应的推动器板109d阻挡或者覆盖相应的保持狭槽230和对应的储藏件244(见图27)之间的开口232,从而防止在发射期间在保持狭槽230内装载下一组紧固件110。
如上文提到的,并且如在图4A中最佳示出,随着发射凸轮组件300向远侧平移,刀具组件310也向远侧平移通过中央纵向狭槽252,从而不仅使得钉仓组件20和砧座组件22接近而且经由推进刀片312d通过其中以切割抓取在钉仓组件20和砧座组件22之间的组织。
随着发射凸轮组件300向远侧平移以实现驱动组件302和刀具组件310的向远侧平移以抓取组织,使得紧固件110成形至组织,并且切割成排的成形紧固件110之间的组织,安全闭锁组件320的凸轮随动件322也向远侧平移。随着凸轮随动件322相对于凸轮壳体部330向远侧平移,凸轮突出件324从未发射起始位置402移动以使得指示器构件341的柱347不再保持在更近侧位置中,从而允许偏置构件349向远侧促动指示器构件341以使得指示器构件341的标记345不再能够通过窗口350a可见。
如上文提到的,并且特别参照图19至图26以及图31至图32,发射凸轮组件300的致动也实现了凸轮随动件322的向远侧平移。更具体地,凸轮随动件322相对于凸轮壳体部330向远侧平移,以使得凸轮突出件324朝向第一完全发射位置422沿着第一发射路径412从未发射起始位置402沿着凸轮轨道335平移。由于凸轮突出件324在凸轮轨道335内的接合,凸轮轨道335的几何形状实现了凸轮随动件322的旋转。更具体地,在经过与工具组件18的夹持但未发射位置相对应的位置时,凸轮轨道335的第一发射路径412的第一成角度部分413a促动凸轮随动件322从初始旋转位置部分地旋转。通过进一步推进至第一完全发射位置422时,凸轮轨道335的第一发射路径412的第二成角度部分413b促动凸轮随动件322从初始旋转位置进一步地旋转。作为这种构造的结果,在到达与夹持但未发射位置相对应的位置之前,例如在紧固件110的发射的开始之前,可以停止DLU16的致动,并且可以无影响地使DLU16的致动返回至初始的状态。
一旦已经到达了第一发射路径412的第一成角度部分413a以旋转凸轮随动件322,例如一旦紧固件110的发射已经开始,则抑制返回至初始位置。相反,在这个点上,因为在通过第一成角度部分413a的促动下使得凸轮随动件322部分地旋转,中止的发射使得凸轮随动件322沿着第一部分发射返回路径432返回(如与第一发射路径412相对)。由于凸轮随动件322抵接第一终端433,抑制了随后从第一部分发射返回路径432发射的企图,这抑制了凸轮随动件322的实质性推进,并且因此,抑制了发射凸轮组件300的实质性推进。在已经发生了之前的部分发射时这种特征保护免于随后的发射,从而抑制在工具组件18中发生阻塞或者其他故障。
一旦对应于DLU16的第一完全发射的完成而达到第二成角度部分413b,则凸轮突出件424与第二成角度部分413b之间的相互作用促动凸轮随动件322旋转以使得当缩回时,凸轮突出件424沿着第一完全发射返回路径442返回,并且最终使得凸轮突出件324移动至第二发射起始位置404。由于指示器构件342的柱347在第二发射起始位置404处设置在凸轮壳体部330的凸轮轨道335内,凸轮突出件324至凸轮轨道335的第二发射起始位置404的移动克服偏置构件349的偏置饿向近侧促动指示器构件342,以使得指示器构件342的标记345(例如数字“2”)能够通过DLU16的近侧壳体部100的窗口350b可见。这向用户指示出已经实现了第一完全发射并且剩余两次发射。在下文中将描述收缩构件34的缩回以实现凸轮随动件322的返回以及DLU16的再装载以用于随后的发射。
继续参照图1至图32,在发射(例如第一完全发射)完成时,发射凸轮组件300设置在最远侧位置上。为了使手术吻合装置10缩回和复位以用于随后的发射,用户致动释放按钮35并且收缩构件34沿着手柄组件12(见图1)的筒部28向近侧缩回,以使得发射凸轮组件300,因而使得驱动组件302、刀具组件310和凸轮随动件322向近侧平移。随着驱动组件302向近侧平移通过钉仓组件20,发射凸轮304向近侧平移通过纵向狭槽250,允许推动器108远离组织接触表面104下降以使得每个推动器板109d平移,从而不再阻挡保持狭槽230和相应的储藏件244之间的开口232,从而允许在由相应的偏置构件246(见图4和图29)提供的偏置力“F”作用下促动下一个紧固件110进入保持狭槽230中。同样地,并且如图29所示,一旦发射凸轮组件300已经向近侧缩回返回至初始位置,每个保持狭槽230被重新装载以用于DLU16的随后发射。此外,在收缩构件34(图1)缩回时,刀具组件310向近侧平移以使得刀具梁312从与钉仓组件20和砧座组件22接合撤回,从而允许钉仓组件20和砧座组件22返回至相对彼此打开或者分离的位置。
除了安全闭锁组件320和可视指示器组件340的操作以外,与上文类似地实现随后的夹持、发射以及切割操作(例如用于从储藏件244发射剩余的两组紧固件110)。因此,将仅相对于安全闭锁组件320和可视指示器组件340详细地描述随后的夹持、发射以及切割操作以避免不必要的重复。
参照图31至图32,结合图1至图30,在第一完全发射和缩回之后,凸轮随动件322的凸轮突出件324设置在凸轮轨道335的第二发射起始位置404处,向近侧促动指示器342以使其标记345能够通过DLU16的近侧壳体部100的窗口350b可见。在第二发射致动时,凸轮随动件322相对于凸轮壳体部330向远侧平移,以使得凸轮突出件324沿着第二发射路径414从第二发射起始位置404沿着凸轮轨道335平移至第二完全发射位置424。凸轮轨道335的几何形状,并且更加具体地,由于在发射开始以及发射完成时,凸轮突出件324接合在凸轮轨道335内,第二发射路径414的第一成角度部分415a和第二成角度部分415b分别实现了凸轮随动件322的旋转。作为这种构造的结果,在发射开始之前,例如在到达第二发射路径414的第一成角度部分415a之前,可以停止DLU16的致动并且可以使凸轮突出件324返回至第二发射起始位置404而无影响。然而,一旦达到了第二发射路径414的第一成角度部分415a,例如一旦紧固件110的发射已经开始,中止发射使得凸轮突出件324沿着第二部分发射返回路径434返回。如上文相对于第一终端433所描述地,由于凸轮突出件324与第二终端435抵接,抑制了随后从第二部分发射返回路径434发射的企图,这抑制了进一步的发射。
一旦对应于DLU16的第二完全发射而到达了第二成角度部分415b,凸轮随动件322旋转以使得在缩回时,凸轮突出件324沿着第二完全发射返回路径444返回,最终使得凸轮突出件324移动至第三发射起始位置406。通过在第三发射起始位置406处设置在凸轮壳体部330的凸轮轨道335内的指示器构件341的柱347,凸轮突出件324至第三发射起始位置406的移动向近侧促动指示器构件343以使得指示器构件343的标记345(例如数字“1”)能够通过DLU16的近侧壳体部100的窗口350c可见。这向用户表明已经实现了第一完全发射和第二完全发射并且剩余一次发射。
第三发射的实现与如上所述的类似,通过随动件322的凸轮突出件324沿着凸轮轨道355从第三发射起始位置406沿着第三发射路径416平移至第三完全发射位置426。与上述类似地,可以没有影响地重复预发射致动和返回。然而,与上述相反地,因为第三发射是最终发射,所以不会关注这个阶段的不完全发射,而与其是否完全或者部分的发射无关。也即是说,在沿着第三发射路径416部分发射或者完全发射时,凸轮随动件322被旋转以使得在缩回时,凸轮突出件324沿着完成路径446返回至完成位置408。在完成位置408上,没有指示器构件341、342、343能够通过窗口可见,但是可以设想提供完成/用尽指示器和对应的指示器窗口。在完成位置408上,凸轮突出件424设置于在第三终端437中达到极点的终端路径436中,从而抑制超出第三发射的发射以及抑制部分第三发射的完成。
虽然在此处参照附图描述了本公开的示意性实施例,但是不应当将本公开理解为限定性的,而仅仅是特定实施例的示例。因此,应当理解的是,本公开不限于此处描述的精确的实施例,在不偏离本公开的范围或者精神的情况下,本领域技术人员可以实现各种其他的变形以及改进。
Claims (21)
1.一种手术吻合装置,包括:
钉仓组件,其构造为容纳多个手术紧固件;
发射组件,其联接至所述钉仓组件并且构造为用于致动,所述发射组件构造为从第一位置移动至第二位置,以从所述钉仓组件至少部分地射出所述手术紧固件中的一个;以及
闭锁组件,其联接至所述发射组件,所述闭锁组件构造为允许所述发射组件的预定次数的致动,所述闭锁组件构造为从第一状态转换至第二状态,在所述第一状态中允许所述发射组件的致动,在所述第二状态中所述闭锁组件抑制所述发射组件从所述第一位置的实质性移动,从而抑制所述发射组件的随后的致动,当所述发射组件的之前致动的次数等于所述闭锁组件所允许的预定致动次数时,所述闭锁组件从所述第一状态转换至所述第二状态,
其中所述闭锁组件包括凸轮轨道和联接至所述凸轮轨道和所述发射组件的凸轮构件,所述凸轮轨道限定至少一个致动路径和用于抑制致动的完成终端。
2.根据权利要求1所述的手术吻合装置,其中所述钉仓组件容纳了多组手术紧固件。
3.根据权利要求2所述的手术吻合装置,其中容纳在所述钉仓组件内的多组手术紧固件的数量等于所述闭锁组件所允许的预定致动次数。
4.根据权利要求1所述的手术吻合装置,其中所述钉仓组件、所述发射组件和所述闭锁组件设置在一次性装载单元中。
5.根据权利要求4所述的手术吻合装置,进一步包括手柄组件,所述手柄组件包括用于选择性地致动所述发射组件的活动手柄,其中所述一次性装载单元能够与所述手柄组件可释放地接合。
6.根据权利要求1所述的手术吻合装置,进一步包括构造为指示剩余致动次数的可视指示器组件。
7.根据权利要求6所述的手术吻合装置,其中所述可视指示器组件包括多个滑动指示器,每个指示器均能够在第一位置和第二位置之间移动,在所述第一位置上所述指示器隐藏在所述手术吻合装置内,在所述第二位置上所述指示器能够从所述手术吻合装置的外部看到。
8.根据权利要求1所述的手术吻合装置,其中所述凸轮构件构造为当所述发射组件的之前致动的次数小于所述预定致动次数时,在所述发射组件致动时,沿着所述至少一个致动路径中的一个致动路径平移以允许所述发射组件的致动,所述凸轮构件构造为当所述发射组件的之前致动的次数等于所述预定致动次数时,定位在所述完成终端内以抑制所述发射组件的随后的致动。
9.根据权利要求8所述的手术吻合装置,其中所述凸轮轨道限定通过多个完全致动返回路径相互连接的多个致动路径,其中所述凸轮构件构造为当所述发射组件的之前致动的次数小于所述预定致动次数时,在所述发射组件的致动和复位时,沿着所述多个致动路径中的一个致动路径平移且沿着所述多个完全致动返回路径中的一个完全致动返回路径返回。
10.根据权利要求9所述的手术吻合装置,其中所述凸轮轨道进一步包括将最终致动路径和所述完成终端相互连接的最终返回路径,并且其中所述凸轮构件构造为在所述发射组件的之前致动的次数等于所述预定致动次数时,沿着所述最终返回路径返回至完成终端以抑制所述发射组件的随后的致动。
11.根据权利要求8所述的手术吻合装置,其中所述凸轮轨道进一步限定至少一个部分发射返回路径和至少一个部分发射终端,并且其中,在射出一些而不是全部的手术紧固件时,所述凸轮构件构造为沿着所述至少一个部分发射返回路径中的一个部分发射返回路径返回至所述至少一个部分发射终端中的一个部分发射终端以抑制所述发射组件的随后的致动。
12.一种手术吻合装置,包括:
钉仓组件,其构造为容纳多组手术紧固件;
发射组件,其联接至所述钉仓组件并且构造为用于重复致动,其中,在每次致动时,所述发射组件构造为从第一位置移动至第二位置以从所述钉仓组件完全地射出所述多组手术紧固件中的一组手术紧固件,所述发射组件进一步构造为从所述第二位置移回至所述第一位置以使所述发射组件复位以用于随后的致动;以及
闭锁组件,其联接至所述发射组件,所述闭锁组件构造为在所述发射组件从所述第一位置平移至所述第二位置并且回到所述第一位置时,允许所述发射组件的随后致动以从所述钉仓组件完全地射出所述多组手术紧固件中的另一组手术紧固件,所述闭锁组件进一步构造为在所述发射组件从所述第一位置平移至设置在所述第一位置和所述第二位置之间的第三位置并且回到所述第一位置而不到达所述第二位置时抑制所述发射组件的随后的致动,
其中所述闭锁组件包括凸轮轨道和联接至所述凸轮轨道和所述发射组件的凸轮构件,所述凸轮轨道限定通过多个完全致动返回路径相互连接的多个致动路径。
13.根据权利要求12所述的手术吻合装置,其中所述钉仓组件、所述发射组件和所述闭锁组件设置在一次性装载单元中。
14.根据权利要求13所述的手术吻合装置,进一步包括手柄组件,所述手柄组件包括用于选择性地致动所述发射组件的活动手柄,其中所述一次性装载单元能够与所述手柄组件可释放地接合。
15.根据权利要求12所述的手术吻合装置,进一步包括构造为指示剩余发射次数的可视指示器组件。
16.根据权利要求15所述的手术吻合装置,其中所述可视指示器组件包括多个滑动指示器,每个指示器均能够在第一位置和第二位置之间移动,在所述第一位置上所述指示器隐藏在所述手术吻合装置内,在所述第二位置上所述指示器能够从所述手术吻合装置的外部看到。
17.根据权利要求12所述的手术吻合装置,其中在所述发射组件从所述第一位置移动到所述第二位置时,所述凸轮构件构造为沿着所述致动路径中的一个致动路径平移,并且其中,在所述发射组件从所述第二位置移回至所述第一位置时,所述凸轮构件构造为沿着所述完全致动返回路径中的一个完全致动返回路径平移。
18.根据权利要求17所述的手术吻合装置,其中至少一个所述完全致动返回路径联接至下一个致动路径。
19.根据权利要求17所述的手术吻合装置,其中所述凸轮轨道进一步限定多个部分发射返回路径,并且其中,在所述发射组件从所述第三位置移回至所述第一位置而不到达所述第二位置时,所述凸轮构件构造为沿着所述部分发射返回路径中的一个部分发射返回路径平移。
20.根据权利要求19所述的手术吻合装置,其中所述凸轮轨道进一步限定联接至所述部分发射返回路径中的至少一个部分发射返回路径的至少一个部分发射终端,并且其中,在所述发射组件从所述第三位置移回至所述第一位置而不到达所述第二位置时,所述凸轮构件构造为沿着所述部分发射返回路径中的一个部分发射返回路径平移至所述至少一个部分发射终端中的一个部分发射终端以抑制所述发射组件的随后的致动。
21.根据权利要求12所述的手术吻合装置,其中所述闭锁组件进一步构造为允许所述发射组件的预定次数的致动,并且其中所述闭锁组件构造为当所述发射组件的之前致动的次数等于预定致动次数时,从第一状态转换至第二状态,在所述第一状态中允许所述发射组件的随后的致动,在所述第二状态中所述闭锁组件抑制所述发射组件从所述第一位置的实质性移动,从而抑制所述发射组件的随后的致动。
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US13/899,882 | 2013-05-22 |
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- 2013-07-18 CN CN201310303617.6A patent/CN103565486B/zh active Active
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2016
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ES2562307T3 (es) | 2016-03-03 |
CA2818769A1 (en) | 2014-01-18 |
EP2687163A1 (en) | 2014-01-22 |
US9554796B2 (en) | 2017-01-31 |
US20170100122A1 (en) | 2017-04-13 |
EP3009083A1 (en) | 2016-04-20 |
CN103565486A (zh) | 2014-02-12 |
AU2013206352A1 (en) | 2014-02-06 |
JP2014018660A (ja) | 2014-02-03 |
EP3009083B1 (en) | 2019-01-02 |
US10537326B2 (en) | 2020-01-21 |
US20140021239A1 (en) | 2014-01-23 |
EP2687163B1 (en) | 2016-01-13 |
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