CN103876801A - 附接到钉仓表面的支撑件 - Google Patents
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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
- A61B17/072—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
- A61B17/072—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
- A61B17/07292—Reinforcements for staple line, e.g. pledgets
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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
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
- A61B17/1155—Circular staplers comprising a plurality of staples
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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
- A61B17/072—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
- A61B2017/07271—Stapler heads characterised by its cartridge
Abstract
本发明提供一种与手术装置一起使用的末端执行器,该末端执行器包括:吻合钉钉仓,其具有限定中心纵向狭槽的组织接触表面;以及砧座板,其具有限定中心纵向狭槽的组织接触表面。手术支撑件可释放地布置于吻合钉钉仓和砧座板各自的组织接触表面。粘附带布置在吻合钉钉仓和砧座板各自的中心纵向狭槽上,并且被配置为将相应的手术支撑件固持在相应的组织接触表面上。本发明还公开了附接到钉仓表面的支撑件。
Description
技术领域
本公开涉及包含手术支撑件的手术吻合装置,该手术支撑件可释放地附接于手术吻合装置,并且尤其涉及具有粘附构件的手术吻合装置,该粘附构件布置于手术吻合装置的组织接触表面上以将手术支撑件连结于手术吻合装置。
背景技术
外科医生使用手术吻合装置来顺序地或同时地施加一排或多排紧固件(例如吻合钉或两部件紧固件)到身体组织以用于将身体组织的多个段连结在一起。所述装置通常包括其间放置有待连结的身体组织的一对钳夹或指状结构。当致动或“发射”吻合装置时,纵向移动发射杆接触其中一个钳夹中的吻合钉驱动构件。吻合钉驱动构件推动手术吻合钉通过身体组织并且进入相对钳夹中的使吻合钉成形的砧座中。如果要移除或分离组织,则可以将刀片设置在所述装置的钳夹中以切割吻合钉线之间的组织。
许多的手术吻合装置依靠刀片切断手术支撑件的一部分以实现释放。这些方法典型地采用除手术支撑件之外的辅助材料或安装结构(例如缝合线)以提供手术支撑件至手术吻合装置的附接。典型地,随着必须被刀片横切的各个材料的增加而增加发射力以便释放手术支撑件。
令人期望的是提供能够可释放地固定到手术吻合装置的手术支撑件,而不需要辅助材料或安装结构并且不需要刀片来切割支撑件和/或安装结构从而将手术支撑件从手术吻合装置释放,从而可以使用更少的材料和更低的发射力。
发明内容
根据本公开的一个方案,本发明提供了一种与手术吻合器一起使用的末端执行器组件,其中末端执行器包括具有限定中心纵向狭槽的组织接触表面的吻合钉钉仓以及具有限定中心纵向狭槽的组织接触表面的砧座板。手术支撑件可释放地布置于吻合钉钉仓和砧座板各自的组织接触表面上。粘附带被布置在吻合钉钉仓和砧座板各自的中心纵向狭槽上,并被配置为将各自的手术支撑件固持于各自的组织接触表面上。优选地,手术支撑件被激光焊接于粘附带。
粘附带围绕相应的中心纵向狭槽的边缘固定到吻合钉钉仓和砧座板各自的组织接触表面。另外,粘附带在吻合钉钉仓和砧座板各自的组织接触表面的近侧端和远侧端之间纵向延伸。
根据本公开的另一个方案,本发明提供了一种与手术吻合装置一起使用的吻合钉钉仓,其中吻合钉钉仓包括:钉仓主体,其包括限定多个吻合钉固持槽且具有中心纵向狭槽的组织接触表面,以及吻合钉,其被布置于钉仓主体的每个吻合钉固持槽内。手术支撑件可释放地布置在钉仓主体的组织接触表面上。粘附带布置在钉仓主体的中心纵向狭槽上,并且被配置为将手术支撑件固持在钉仓主体的组织接触表面上。优选地,手术支撑件被激光焊接于粘附带。
粘附带围绕中心纵向狭槽的边缘固定到钉仓主体的组织接触表面。另外,粘附带在钉仓主体的组织接触表面的近侧端和远侧端之间纵向延伸。
根据本公开的另一个方案,本发明提供了一种手术吻合装置,其中手术吻合装置包括壳体和固定于壳体的末端执行器,该末端执行器包括具有组织接触表面的吻合钉钉仓组件和具有组织接触表面的砧座组件,所述吻合钉钉仓组件和所述砧座组件均具有中心纵向狭槽。手术支撑件可释放地布置于吻合钉钉仓组件和砧座组件各自的组织接触表面上。粘附带布置在吻合钉钉仓组件和砧座组件各自的中心纵向狭槽上,并被配置为将相应的手术支撑件固持在相应的组织接触表面上。优选地,手术支撑件被激光焊接于粘附带。
附图说明
参照附图,在这里公开了本公开的互锁支撑件固持系统的各种实施例,其中:
图1是根据本公开实施例的手术吻合装置的立体图;
图2是图1的手术吻合装置的吻合钉钉仓组件的零件分离的立体图,图示出与此相关联的手术支撑件;
图3是图1的手术吻合装置的砧座组件的零件分离的立体图,图示出与此相关联的手术支撑件;
图4A是吻合钉钉仓组件的立体图,图示出附着到吻合钉钉仓的手术支撑件;
图4B是图4A沿线4B-4B截取的剖视图;
图5是砧座组件的立体图,图示出附着到砧座板的手术支撑件;
图6是图1的手术吻合装置的远侧端的立体图,示出围绕组织段被放置使用;
图7是沿图6的线7-7截取的剖视图;
图8是图6的已吻合和已分割的组织部分的立体图;
图9A是依照本公开的另一个实施例的手术吻合装置的说明性实施例的立体图;
图9B是图9A的手术吻合装置的部分脱离的侧面正视图;
图10A是依照本公开实施例的包括手术支撑件的图9A的手术吻合装置的吻合钉钉仓组件的说明性实施例的立体图;
图10B是在图10A中图示出吻合钉钉仓组件和手术支撑件的俯视平面图;
图11是患者的肠区域立体图,图示出将图9A、图9B和图10的手术吻合装置的砧座杆和吻合钉钉仓组件定位于肠区域的方法;以及
图12是图11的肠区域的示意性立体图,图示出安装到手术吻合装置的砧座杆。
具体实施方式
关于与手术吻合装置一起使用的支撑件,在下面讨论本公开的各种示例性实施例。在此描述的手术支撑件可用于通过使得在包括至少一个手术支撑件的手术吻合装置的砧座板和吻合钉钉仓之间的创伤组织的边缘接近来封闭伤口。通过设在关键位置的粘附构件将该至少一个手术支撑件连结到手术吻合装置,该粘附构件可以是粘附带。粘附构件邻近中心纵向狭槽放置并定位在吻合钉钉仓和砧座板各自的组织接触表面与至少一个手术支撑件之间。手术吻合装置的发射迫使至少一个吻合钉的钉腿穿过吻合钉钉仓的开口、穿过组织然后穿过砧座板上的开口,以使手术支撑件固定于组织,以使邻近组织彼此紧固。手术支撑件可帮助封闭组织,并且支撑组织。吻合钉的发射力冲击粘附构件以断开粘附构件和手术支撑件之间的粘合,进而从组织接触表面释放手术支撑件。当刀片在中心纵向狭槽内向远侧平移时,粘附带被切断并从组织接触表面完全地释放手术支撑件。因此,本公开描述手术支撑件、支撑所述手术支撑件的手术吻合装置以及使用它们的方法和机构。
应该理解的是,多种手术吻合装置可与本公开的手术支撑件一起使用。例如,可以使用线性吻合器构造,所述线性吻合器构造例如那些包括可购自Covidien(柯惠)的Duet TRSTM再加载(reload)和使用Tri-StapleTM技术的吻合器,其中Covidien的主要营业场所在555Long Wharf Drive,North Haven,CT06511;以及横向接合吻合器,例如也可购自Covidien的EEATM、CEEATM、GIATM、EndoGIATM和TATM吻合器。还应该理解的是,本公开的原理同样适用于具有替换构造的手术吻合器,所述替换构造例如为:具有环形钉仓和砧座的端对端接合吻合器(参见,例如,名称为“Surgical Fastener Applying Apparatus(手术紧固件施加装置)”的共有美国专利No.5,915,616,该专利的全部内容通过引用并入于此);腹腔镜吻合器(参见,例如,名称均为“SurgicalStapling Apparatus(手术吻合装置)”的共有美国专利No.6,330,965和No.6,241,139,各专利的全部内容通过引用并入于此);以及横向接合吻合器(参见,例如,名称均为“Surgical fastener Applying Apparatus(手术紧固件施用装置)”的共有美国专利No.5,964,394和No.7,334,717,各专利的全部内容通过引用并入于此)。
现在将参照附图详细描述本公开的手术支撑件和手术吻合装置的实施例,在附图中相同的附图标记表示类似或相同的零件。在下面的讨论中,术语“近侧”和“尾端”可以互换地使用,并应将其理解为是指在正确使用过程中一个结构的更接近临床医生的部分。术语“远侧”和“头侧”也可以互换地使用,并应将其理解为是指在正确使用过程中一个结构的更远离临床医生的部分。如在本文使用的,应将术语“患者”理解为是指人类对象或其他动物,应将术语“临床医生”理解为是指医生、护士或是提供护理的其他人,并且“临床医生”可包括辅助人员。
现在参照图1,其公开了示例性的手术吻合装置或手术吻合器10,用于吻合组织并施加支撑件材料或手术支撑件到组织。美国专利No.7,128,253中公开了这种手术吻合装置的进一步示例,该专利的全部内容通过引用合并于此。手术吻合装置可以具有可移除的和可替换的装载单元,该装载单元包括钉仓组件和砧座组件,具有可移除和可替换的钉仓组件的手术吻合装置,或两者都有。手术吻合装置可具有用手致动的手柄组件或由电动机、压缩气体或其他流体产生动力的手柄组件。
手术吻合装置10通常包括具有细长管状构件14的手柄12,该细长管状构件14从手柄12向远侧延伸。末端执行器组件16安装在细长管状构件14的远侧端18上。末端执行器组件16包括第一钳夹或吻合钉钉仓组件200以及第二钳夹或砧座组件300,其中,吻合钉钉仓组件200被配置为在其中容纳吻合钉钉仓32。末端执行器组件16可永久性地固定于细长管状构件14,或可以是可拆卸的,并且因此可用新的末端执行器组件16替换。吻合钉钉仓组件200和砧座组件300中的一个可运动地安装于末端执行器组件16的远侧端18,并且能够在彼此远离的打开位置到基本上彼此接近的闭合位置之间运动。砧座组件300支撑砧座板302并且由适于手术使用的材料制造,例如金属材料包括但不限于不锈钢、钛、钛合金以及类似材料。吻合钉钉仓32的至少组织接触表面可由不是金属的材料制造,包括但不限于塑料、热塑性塑料、树脂、聚碳酸酯以及类似材料。
手术吻合装置10进一步包括扳机33,如图1所见,扳机33可运动地安装在手柄12上。扳机33的致动首先操作使第一钳夹和第二钳夹在打开和闭合位置之间运动,并同时致动手术吻合装置10以将吻合钉线施加到组织。为了使得末端执行器组件16相对于待被吻合的组织正确定向,手术吻合装置10加设安装在手柄12上的旋钮34。旋钮34相对于手柄12的旋转使细长管状构件14和末端执行器组件16相对于手柄12旋转,以便于末端执行器组件16相对于待吻合组织的正确定向。手术吻合装置可以具有或可以不具有能够相对细长管状构件14关节式运动或枢转的钳夹。
如图6和图7所示,驱动器36被设置为使第一钳夹或吻合钉钉仓组件200和第二钳夹或砧座组件300从打开位置运动或接近到闭合位置。驱动器36运动穿过纵向狭槽338(图3),该狭槽338成形于砧座组件300的砧座板302中。随着驱动器36穿过狭槽338,具有刀片31的刀具30关联驱动器36以切割在吻合钉钉仓组件200和砧座组件300之间被捕获的组织。驱动器期望地既接合钉仓组件又接合砧座组件来夹紧组织,并且运动经过吻合钉钉仓中的对应于狭槽338的狭槽。
可参考上面引用的共同拥有美国专利第5,915,616、6,330,965以及6,241,139号,用于示例性的手术吻合装置10的结构和操作的详述。
吻合钉钉仓组件200和/或砧座组件300可设置有手术支撑件500。手术支撑件500用于加强和封闭通过手术吻合装置10施加在组织上的吻合钉线。手术支撑件500可被配置为适于配合任何手术吻合、紧固或发射装置的任何形状、大小或尺寸。
通过在下文以更详述的方式,吻合钉钉仓组件200设有钉仓支撑件500a,并且砧座组件300设有砧座支撑件500b。该支撑件500a、500b可由任何生物相容的天然或合成材料制成。形成该支撑件500a、500b的材料可以是生物可吸收的或非生物可吸收的。应该理解为,天然的、合成的、生物可吸收的和非生物可吸收的材料的任意组合可被用来形成支撑件材料。支撑件500a、500b可以是多孔的或无孔的、多孔与无孔层的组合层。无孔的支撑件500a、500b可用于阻碍或防止周围组织的组织向内生长,从而用作粘附屏障并防止形成不想要的疤痕组织。例如,支撑件材料可包含聚乙二醇酸、乙交脂、环丙烷碳酸酯、由动物获得的材料诸如猪的或牛的胶原蛋白等等。支撑件材料可被成形加工成模制的或挤压的薄板,例如,也可考虑非织物材料、网织物材料、泡沫以及类似材料。
在此公开的与手术吻合装置一起使用的手术支撑件500a、500b的另外的示例性材料在共同转让的美国专利号为5,542,594、5,908,427、5,964,774和6,045,560的专利以及共同转让的于2006年4月20日提交的公开号为2006/0085034的美国申请、于2006年6月22日提交的公开号为2006/0135992的美国申请中给出,各个专利的全部内容均通过引用合并于此。
如当前实施例所图示的和如图2和图3所示,手术支撑件500通过设在关键位置的粘附构件或粘附带240、340可释放地附接到吻合钉钉仓组件200和/或砧座组件300,该粘附构件或粘附带240、340将手术支撑件500a、500b附接到吻合钉钉仓32和/或砧座板302的内表面或组织接触表面220、320,如下面详细所述。
参考图2,吻合钉钉仓组件200的钉仓支撑件500a通过沿着组织接触表面220邻近中心纵向狭槽238并且在中心纵向狭槽238的上方定位的粘附带240,可操作地固定到或粘附到吻合钉钉仓32的组织接触表面220。粘附带240布置于钉仓支撑件500a和组织接触表面220之间。粘附带240从吻合钉钉仓32的近侧端260纵向延伸到远侧端262。图2图示出粘附带240作为一个单体件,然而,粘附带240可包括沿组织接触表面220纵向隔开的多个小件。粘附带240的长度和宽度可依据吻合钉钉仓32而改变。优选地,粘附带240不延伸超过吻合钉钉仓32的吻合钉固持槽52。更具体地,粘附带240围绕中心纵向狭槽238(图4A)的边缘248布置在组织接触表面220上,并且不覆盖吻合钉钉仓32的吻合钉固持槽52。通过允许吻合钉固持槽52保持未被粘附带240覆盖,吻合钉50可在没有任何附加障碍物的情况下穿透组织。钉仓支撑件500a优选被激光焊接到粘附带240上。可构想将钉仓支撑件500a结合或固定于粘附带240的其他方法,诸如超声焊接、溶剂粘合或热压。
例如,在一个实施例中,可以构想的是,可使用覆料器(未示出)来将(如通过喷雾或气雾)处于液体或流体状态的粘结材料释放到吻合钉钉仓32的组织接触表面220。然后钉仓支撑件500a可被放置于液体态的粘结材料上。可选择地,液体态或流体态的粘结材料可被允许部分地固化或干燥一段时间,以便于保持一定程度的粘性或粘合性,在那以后,钉仓支撑件500a可被放置于部分固化或干燥的粘结材料的上面,并且粘附于部分固化或干燥的粘结材料。仍然可选择地,液体态或流体态的粘结材料可以是特定的组合物,并且被允许完全固化或干燥,其中该完全固化或干燥的粘结材料保持一定程度的粘性或粘合性。在那以后,钉仓支撑件500a可被放置于完全固化或干燥的粘结材料的上面,并粘附于完全固化或干燥的粘结材料。虽然上述构造应用于吻合钉钉仓,应当理解的是相似可选择的结构可被使用于砧座板。
参考图3,与钉仓支撑件500a相似,砧座支撑件500b通过粘附带340沿着组织接触表面围绕中心纵向狭槽338的边缘348,可操作地固定或粘附于砧座组件300的砧座板302的组织接触表面320。粘附带340从近侧端360和远侧端362延伸。优选地,粘附带340未延伸超过砧座板302的吻合钉成形凹部68。
图4A和图5图示出分别布置于吻合钉钉仓32和砧座板302上的支撑件500a、500b。如图所示,粘附带240、340被布置在各自的中心纵向狭槽238、338上,并且在组织接触表面220、320和支撑件500a、500b之间。图4B示出布置于吻合钉钉仓32上的钉仓支撑件500a的剖视图,该剖视图示出布置于钉仓支撑件500a和组织接触表面220之间的粘附带240。而且粘附带240被布置在中心纵向狭槽238的边缘248上并被布置为围绕中心纵向狭槽238的边缘248。虽然图4B是针对吻合钉钉仓,应当理解的是相似的结构应用于砧座板。依照本公开,粘附带240、340分别没有延伸超过砧座板302的吻合钉成形凹部68或超过吻合钉钉仓32的吻合钉固持槽52。
粘附带240、340可以是依据吻合钉钉仓32和砧座板302而定的各种宽度和厚度。优选地,粘附带240、340在宽度上是0.086英寸,以及在厚度上是在0.002-0.004英寸之间。通常地,中心纵向狭槽238、338在宽度上是0.050英寸。因此,粘附带240、340超出吻合钉钉仓32和砧座板302的各自相应的中心纵向狭槽238、338的各自边缘248、348延伸0.018英寸。然而,其他的形状和尺寸是可考虑的,粘附构件或粘附带的构造取决于吻合器的形状。
在组装期间,粘附带240、340分别被放置到吻合钉钉仓组件200和砧座组件300的各自的组织接触表面220、320。支撑件500a、500b接下来被放置在粘附带240、340上并激光焊接到粘附带240、340。
如图6图示,在使用手术吻合装置10期间,在其上装载有手术支撑件500a、500b的第一钳夹或吻合钉钉仓组件200以及第二钳夹或砧座组件300(如上所述),被放置于手术部位的两侧上。吻合钉钉仓组件200和砧座组件300的组织接触表面220、320邻近待彼此紧固的组织“T”的层定位。
如图7所示,吻合钉钉仓组件200包含手术吻合钉50,该手术吻合钉50定位在吻合钉钉仓32的单独的吻合钉固持槽52内。吻合钉50为常规类型并且包括钉冠54,钉冠54具有从钉冠54延伸出的一对钉腿56和58。钉腿56和58分别终止于组织穿透末端60和62。推动器64位于吻合钉固持槽52内并定位于吻合钉50和驱动杆66的轨道之间。
在所图示的实施例中,初始时,手术吻合装置10通过扳机33相对于手柄12(图1)的运动而被致动,引起驱动器36在箭头“A”(图6)的方向上运动并且抵靠砧座板302的斜边21,由此引起砧座组件300相对于吻合钉钉仓组件200运动至闭合位置。随着驱动杆66在吻合钉钉仓32内向远侧推进,驱动杆66推动推动器64向上抵靠吻合钉50的钉冠54,驱动吻合钉50的钉腿56和58穿过钉仓支撑件500a、组织“T”以及砧座支撑件500b,朝向砧座组件300的砧座板302中的吻合钉成形凹部68。吻合钉钉腿56和58的组织穿透末端60和62在砧座板302中的吻合钉成形凹部68内弯曲,钉冠54使手术支撑件500抵靠组织“T”而固定。手术吻合装置10的发射力开始断开支撑件500a、500b和粘附带240、340之间的接合。
在可选择的实施例中,如果粘附带240、340由生物可吸收材料制造,那么可以构想的是,手术吻合装置10的发射力开始断开支撑件500a、500b和吻合钉钉仓32及砧座板302各自的组织接触表面之间的接合。
在发射以后,为了从吻合钉钉仓32和砧座板302的各自组织接触表面220、320释放手术支撑件500a、500b,打开末端执行器组件16,释放支撑件500a、500b和粘附带240、340之间的接合。在手术吻合装置10的完全致动时,利用与手术吻合装置10相关联的并且由驱动器36承载的刀具30(图7)来切割组织“T”以及手术支撑件500a、500b和在现在成形的吻合钉50排之间的粘附带240、340。在砧座组件300运动至与吻合钉钉仓组件200隔开的打开位置时,支撑件500a、500b从粘附带240、340、相应的吻合钉钉仓组件200和砧座组件300各自的组织接触表面220、320拉开。
在图8中图示出由吻合钉50分隔并吻合闭合而形成的组织“T”。具体地,手术支撑件500a、500b通过吻合钉50的钉腿56、58和钉冠54被抵靠于组织“T”固定。因此,手术支撑件500a、500b被吻合到组织“T”,进而封闭和加固由吻合钉50产生的吻合钉线。
现在参考图9A和9B,示出了与本公开的手术支撑件124一起使用的环形手术吻合装置110。手术吻合装置110包括:具有至少一个可枢转的致动手柄构件133的手柄组件112;以及推进构件135。管状本体部114被设置为从手柄构件112延伸出,并且被构造成具有沿其长度的弯曲形状。本体部114终止于吻合钉钉仓组件122,吻合钉钉仓组件122包括一对吻合钉固持槽152的环形阵列,在各个吻合钉固持槽152中布置吻合钉150。位于吻合钉钉仓122的远侧,设置有包括砧座构件121和与其操作性地相关联的轴123的砧座组件120,用于将砧座组件120可移除地连接至吻合装置110的远侧端部。
吻合钉钉仓组件122可以固定地连接至管状本体部114的远侧端并且可以被配置为同心地装配在管状本体部114的远侧端内。吻合钉钉仓组件122包括吻合钉推动器164,吻合钉推动器164包括具有大体呈截头圆锥形形状的近侧部和限定了在圆周上间隔开的指状物(未示出)的两个同心环的远侧部,指状物中的每一个被接纳在相应的吻合钉固持槽152内。
大致呈敞口杯形式的、其边缘限定刀片131的刀具130被布置在吻合钉钉仓组件122内并且被安装在吻合钉推进器164的远侧表面上。刀具130向一对吻合钉150的环形阵列的径向内部布置。因此,在使用中,随着推进吻合钉推进器164,刀具130也在轴向上向远侧推进。
如图10A所示,手术支撑件124可释放地附接到吻合钉钉仓组件122上,粘附带140被布置在手术支撑件124与吻合钉钉仓组件122的组织接触表面134之间。如上所述,粘附带140将手术支撑件124接合到组织接触表面134上。手术支撑件124被设置成环形构造并且包括中央孔125以接纳穿过其中的砧座组件120的轴123。
设想的是,手术支撑件124能够以类似于被附接至吻合钉钉仓组件122的手术支撑件124的方式另外地或可替代地附接或粘附到砧座板121的组织接触表面上。
如图10B所示,手术支撑件124可以沿内部160被固定或粘附于吻合钉钉仓122。设想的是,可以利用其他配置来将手术支撑件124固持到吻合钉钉仓组件122,诸如沿外部162放置粘附带140,或在内部160和外部162之间交替放置多条粘附带140,或在本领域的普通技术人员的可知范围内的其他布置。
手术吻合装置110和可拆卸的砧座组件120被使用在吻合操作中以实现肠段50和肠段52的结合。典型地使用包括腹腔镜检查装置和仪器的微创手术技术来执行吻合操作。如图11所示的操作点处,患病的肠段已经先被移除了,已经将砧座组件120(在其上可选择地包括手术支撑件124)通过手术切口或穿过肛门施加到操作部位上并且放置在肠段52内,并且手术吻合装置110的管状本体部114(在其上可选择地包括手术支撑件124)已经被经肛门插入肠段50中。如图12所图示出,还示出了通过常规手段诸如荷包式缝合线“P”围绕相应的部件(例如,砧座组件120的轴123以及管状本体部114的远侧端)临时地固定肠段50和肠段52。
此后,临床医师操纵砧座组件120直到将轴123的近侧端插入手术吻合装置110的管状本体部114的远侧端,其中在管状本体部114的远侧端内的安装结构(未示出)接合轴123以实现安装。然后使砧座组件120和管状本体部114接近以便使肠段50和肠段52接近。然后发射手术吻合装置110。刀具(未示出)切割组织的一部分以及布置在刀具径向内部的手术支撑件124以完成所述吻合。砧座组件120和吻合钉钉仓组件122打开的力与吻合到肠段50和肠段52的手术支撑件124一起造成手术支撑件124在附接垫140处释放,从而将手术支撑件124从组织接触表面134释放。
本领域技术人员会理解的是,在此具体描述并图示在附图中的装置和方法为非限制性的示例性实施例,并且描述、公开和附图应仅构成特定实施例的示例。因此应该理解的是,本公开不限于所描述的精确实施例,本领域技术人员在不偏离本公开的范围或精神的前提下能够实现多种其他的改变和修改。另外,能想到的是,关于一个示例性实施例所说明或描述的元件和特征可以与另一示例性实施例的元件和特征进行组合而不偏离本公开的范围,而这种修改和变型也被有意包括在本公开的范围内。因此,除了由所附的权利要求书所指明的之外,本公开的主题不受已经具体示出和所描述的内容的限制。
Claims (12)
1.一种与手术装置一起使用的末端执行器,所述末端执行器包括:
吻合钉钉仓,具有限定中心纵向狭槽的组织接触表面;
砧座板,具有限定中心纵向狭槽的组织接触表面;
手术支撑件,可释放地布置于所述吻合钉钉仓和所述砧座板各自的组织接触表面上;以及
粘附构件,布置在所述吻合钉钉仓和所述砧座板各自的中心纵向狭槽上,并被配置为将相应的手术支撑件固持在相应的组织接触表面上。
2.根据权利要求1所述的末端执行器,其中所述手术支撑件被激光焊接于所述粘附构件。
3.根据权利要求2所述的末端执行器,其中所述粘附构件是粘附带,所述粘附带围绕相应的中心纵向狭槽的边缘固定到吻合钉钉仓和砧座板各自的组织接触表面。
4.根据权利要求3所述的末端执行器,其中所述粘附带在所述吻合钉钉仓和所述砧座板各自的组织接触表面的近侧端和远侧端之间纵向延伸。
5.一种与手术吻合装置一起使用的吻合钉钉仓,所述吻合钉钉仓包括:
钉仓主体,包含限定多个吻合钉固持槽且具有中心纵向狭槽的组织接触表面;
吻合钉,布置在所述钉仓主体的每个吻合钉固持槽内;
手术支撑件,可释放地布置在所述钉仓主体的组织接触表面上;以及
粘附带,布置在所述钉仓主体的所述中心纵向狭槽上,并被配置为将所述手术支撑件固持在所述钉仓主体的组织接触表面上。
6.根据权利要求5所述的吻合钉钉仓,其中所述手术支撑件被激光焊接于所述粘附带。
7.根据权利要求6所述的吻合钉钉仓,其中所述粘附带围绕所述中心纵向狭槽的边缘固定于所述钉仓主体的组织接触表面。
8.根据权利要求7所述的吻合钉钉仓,其中所述粘附带在所述钉仓主体的组织接触表面的近侧端和远侧端之间纵向延伸。
9.一种手术吻合装置,包括:
壳体;
末端执行器,固定于壳体,所述末端执行器包括具有组织接触表面的吻合钉钉仓组件和具有组织接触表面的砧座组件,所述吻合钉钉仓组件和所述砧座组件均具有中心纵向狭槽;
手术支撑件,可释放地布置在所述吻合钉钉仓组件和所述砧座组件各自的组织接触表面上;以及
粘附带,布置在所述吻合钉钉仓组件和所述砧座组件各自的中心纵向狭槽上,并被配置为将相应的手术支撑件固持在相应的组织接触表面上。
10.根据权利要求9所述的手术吻合装置,其中所述手术支撑件被激光焊接于相应的粘附带。
11.根据权利要求10所述的手术吻合装置,其中所述粘附带围绕相应的中心纵向狭槽的边缘固定于所述吻合钉钉仓组件和所述砧座组件各自的组织接触表面。
12.根据权利要求11所述的手术吻合装置,其中所述粘附带在所述吻合钉钉仓组件和所述砧座组件各自的组织接触表面的近侧端和远侧端之间纵向延伸。
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Also Published As
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JP2014121599A (ja) | 2014-07-03 |
CN103876801B (zh) | 2017-09-01 |
JP2018110881A (ja) | 2018-07-19 |
JP6320735B2 (ja) | 2018-05-09 |
EP2745784B1 (en) | 2020-02-12 |
CA2837451C (en) | 2020-08-11 |
ES2776006T3 (es) | 2020-07-28 |
EP2745784A1 (en) | 2014-06-25 |
AU2013266989A1 (en) | 2014-07-03 |
CA2837451A1 (en) | 2014-06-19 |
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