CN103917170A - 具有可填充流体的支撑物的外科器械 - Google Patents
具有可填充流体的支撑物的外科器械 Download PDFInfo
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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
- A61B17/00491—Surgical glue applicators
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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
- A61B17/00491—Surgical glue applicators
- A61B2017/00495—Surgical glue applicators for two-component glue
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Abstract
一种设备包括外科器械和能够保持流体粘合剂的支撑物。在一些型式中，所述支撑物包含两份式流体粘合剂，其中两种流体材料在组合时形成流体粘合剂。在一些型式中，所述支撑物能够被所述外科器械压缩，从而对所述支撑物的一部分加压。然后，所述支撑物可被切断，并且所述加压区域可能够操作以将所述流体粘合剂压迫到组织部位中。
Description
背景技术
在一些环境下，内窥镜式外科器械可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端执行器通过套管针的插管而布置在期望的手术部位处。这些远端执行器(例如，直线切割器、抓紧器、切割器、缝合器、施夹器、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位于端部执行器柄部部分之间的轴，所述柄部部分由临床医生操纵。此轴可允许插入到期望深度并关于轴的纵向轴线旋转，从而有利于将端部执行器定位在患者体内。还可通过包含一个或多个关节运动接头或特征而进一步有利于端部执行器的定位，从而使端部执行器能够选择性地进行关节运动，或者以其它方式相对于轴的纵向轴线偏转。
内窥镜式外科器械的例子包括外科缝合器。一些这样的缝合器能够操作以夹紧在组织层上、切开被夹紧的组织层、并驱动缝钉穿过组织层，以在组织层的被切断的端部附近将切断的组织层基本上密封在一起。仅作为示例性的外科缝合器在以下美国专利中有所公开：1989年2月21日公布的名称为“Pocket Configuration for Internal Organ Staplers”的美国专利号4,805,823；1995年5月16日公布的名称为“Surgical Stapler and StapleCartridge”的美国专利号5,415,334；1995年11月14日公布的名称为“Surgical Stapler Instrument”的美国专利号5,465,895；1997年1月28日公布的名称为“Surgical Stapler Instrument”的美国专利号5,597,107；1997年5月27日公布的名称为“Surgical Instrument”的美国专利号5,632,432；1997年10月7日公布的名称为“Surgical Instrument”的美国专利号5,673,840；1998年1月6日公布的名称为“Articulation Assembly forSurgical Instruments”的美国专利号5,704,534；1998年9月29日公布的名称为“Surgical Clamping Mechanism”的美国专利号5,814,055；2005年12月27日公布的名称为“Surgical Stapling Instrument Incorporating an E-BeamFiring Mechanism”的美国专利号6,978,921；2006年2月21日公布的名称为“Surgical Stapling Instrument Having Separate Distinct Closing and FiringSystems”的美国专利号7,000,818；2006年12月5日公布的名称为“Surgical Stapling Instrument having a Firing Lockout for an Unclosed Anvil”的美国专利号7,143,923；2007年12月4日公布的名称为“Surgical StaplingInstrument Incorporating a Multi-Stroke Firing Mechanism with a FlexibleRack”的美国专利号7,303,108；2008年5月6日公布的名称为“SurgicalStapling Instrument Incorporating a Multistroke Firing Mechanism Having aRotary Transmission”的美国专利号7,367,485；2008年6月3日公布的名称为“Surgical Stapling Instrument Having a Single Lockout Mechanism forPrevention of Firing”的美国专利号7,380,695；2008年6月3日公布的名称为“Articulating Surgical Stapling Instrument Incorporating a Two-Piece E-Beam Firing Mechanism”的美国专利号7,380,696；2008年7月29日公布的名称为“Surgical Stapling and Cutting Device”的美国专利号7,404,508；2008年10月14日公布的名称为“Surgical Stapling Instrument HavingMultistroke Firing with Opening Lockout”的美国专利号7,434,715；以及2010年5月25日公布的名称为“Disposable Cartridge with Adhesive for Usewith a Stapling Device”的美国专利号7,721,930。上面所引用的美国专利中的每一个的公开内容均以引用方式并入本文。虽然以上涉及的外科缝合器被描述为用于内窥镜式手术，但应当理解，此类外科缝合器也可用于开放式手术和/或其它非内窥镜式手术。
虽然已经制造和使用各种类型的外科缝合器械和相关组件，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
并入本说明书并构成其一部分的附图示出了本发明的多个实施例，并且与上文所给出的本发明的一般说明和下文所给出的实施例的详细说明一起用于解释本发明的原理。
图1A示出了关节运动式外科器械的透视图，其中端部执行器处于非关节运动位置；
图1B示出了图1A的外科器械的透视图，其中端部执行器处于关节运动位置；
图2示出了图1A至图1B的外科器械的打开的端部执行器的透视图；
图3A示出了沿着图2的线3-3截取的图2的端部执行器的侧面剖视图，其中击发杆处于近侧位置；
图3B示出了沿着图2的线3-3截取的图2的端部执行器的侧面剖视图，但是示出了在远侧位置的击发杆；
图4示出了沿着图2的线4-4截取的图2的端部执行器的端部剖视图；
图5示出了图2的端部执行器的分解透视图；
图6示出了图2的端部执行器的透视图，所述端部执行器定位在组织处并且已经在组织中被致动一次；
图7示出了与图2的端部执行器一起使用的保持器盖的透视图；
图8示出了图7的保持器盖的底侧透视图；
图9示出了与图7的端部执行器一起使用的保持器盖的侧视图；
图10示出了具有支撑物的示例性端部执行器的侧视图；
图11A示出了图10的支撑物在未压缩状态下的前视图；
图11B示出了图10的支撑物的前视图，其中砧座和下钳口是围绕支撑物夹紧的；
图11C示出了图10的支撑物在被切断之后的侧视图，其中液体已从支撑物中被压迫出来；
图12A示出了图10的支撑物在被压缩时的正面剖视图；
图12B示出了图10的支撑物在被切断之后的正面剖视图；
图13示出了具有图10的支撑物的外科器械的透视图，其中液体已从支撑物中被压迫出来；
图14示出了具有示例性替代型式的支撑物的示例性端部执行器的透视图；
图15示出了图14的示例性端部执行器的用一对支撑物夹紧组织的剖视图；
图16示出了图14的一对支撑物的在由切刃切开之后的剖视图；
图17示出了具有多个粘合区域的示例性替代支撑物的剖视图；
图18示出了具有多个粘合剂胶囊的示例性替代支撑物的剖视图；和
图19示出了用于形成图18的多个粘合剂胶囊的示例性胶囊成形腔室的剖视图。
附图并非意在以任何方式进行限制，并且可以预期本发明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，示出了本发明的若干方面，并与具体实施方式一起用于解释本发明的原理；然而，应当理解，本发明并不限于所示出的明确布置方式。
具体实施方式
本发明的某些实例的下列描述不应被用来限制本发明的范围。通过以下举例说明设想用于实施本发明的最佳方式之一的描述，本发明的其它例子、结构、方面、实施例和优点将对本领域的技术人员显而易见。正如将会意识到的，本发明能够具有其它不同且明显的方面，只要不脱离本发明即可。因此，附图和具体实施方式应被视为实质上是示例性而非限制性的。
I.示例性外科缝合器
图1至图6示出了示例性外科缝合和切断器械10，在图1A所示的非关节运动状态下，其尺寸设定成通过套管针插管通道插入到患者的手术部位中，用于执行外科手术。外科缝合和切断器械10包括连接到工具部分22的柄部部分20，所述工具部分还包括朝远侧终止于关节运动机构11中的轴23和朝远侧附接的端部执行器12。一旦关节运动机构11和远端执行器12穿过套管针的插管通道插入后，关节运动机构11便可通过关节运动控制器13远程地进行关节运动，如图1B所示。从而，端部执行器12可从期望的角度或出于其它原因而到达器官后面或接近组织。应当理解，诸如“近侧”和“远侧”的术语在本文中是结合临床医生抓握器械10的柄部部分20来使用的。因此，端部执行器12相对于更近侧的柄部部分20处于远侧。还应当理解，为简洁和清楚起见，本文可结合附图使用诸如“竖直”和“水平”的空间术语。然而，外科器械是在多个取向和位置中使用的，并且这些术语并非意图进行限制，也并非绝对的。
本例子的端部执行器12包括下钳口16和可枢转砧座18。柄部部分20包括手枪式握把24，由临床医生将闭合扳机26以枢转方式拉向所述手枪式握把，以使砧座18朝向端部执行器12的下钳口16夹紧或闭合。砧座18的这种闭合是通过最外部的闭合套管32提供的，所述闭合套管响应于闭合扳机26相对于手枪式握把24的枢转而相对于柄部部分20纵向地平移。闭合套管32的远侧闭合环33由工具部分22的框架34间接地支撑。在关节运动机构11处，闭合套管32的近侧闭合管35与远侧部分(闭合环)33连通。框架34经由关节运动机构11柔性地附接到下钳口16，使得能够在单个平面中进行关节运动。框架34还在纵向上以能够滑动的方式支撑击发驱动构件(未示出)，所述击发驱动构件延伸穿过轴23并且将击发运动从击发扳机28传递到击发杆14。击发扳机28远离闭合扳机26的外侧，并且能够被临床医生枢转地拉动，以导致被夹紧的组织在端部执行器12中被缝合和切断，如下文将更详细地描述的。然后，按下释放按钮30，以从端部执行器12释放所述组织。
图2至图5示出了采用E形梁击发杆14来执行多种功能的端部执行器12。如图3A至图3B中最佳地示出，击发杆14包括横向取向的上部销38、击发杆顶盖44、横向取向的中部销46和处于远侧的切刃48。上部销38定位在砧座18的砧座凹坑40内，并且能够在所述砧座凹坑中平移。击发杆顶盖44通过使击发杆14延伸穿过通道槽45(如图3B所示)而以能滑动的方式接合下钳口16的下表面，所述通道槽是穿过下钳口16形成的。中部销46以能够滑动的方式接合下钳口16的顶表面，从而与击发杆顶盖44协作。从而，击发杆14在击发期间肯定与端部执行器12间隔开，从而克服了最小量的夹紧组织的情况下在砧座18与下钳口16之间可能出现的挤痛情况，并且克服了在过量的夹紧组织的情况下出现的缝钉变形。
图2示出了朝近侧定位的击发杆14和枢转到打开位置的砧座18，从而允许将未耗尽的钉仓37以能够取出的方式安装到下钳口16的通道中。如图4至图5中最佳地示出，这个例子的钉仓37包括仓体70，所述仓体具有上部平台72并且与下部仓托盘74联接。如图2中最佳地示出，竖直槽49是穿过钉仓37的一部分形成的。同样如图2中最佳地示出，三行缝钉孔51在竖直槽49的一侧上形成为穿过上部平台70，而另一组三行钉孔51在竖直槽49的另一侧上形成为穿过上部平台70。重新参见图3至图5，楔形滑动件41和多个缝钉驱动器43被捕集在仓体70与托盘74之间，其中楔形滑动件41位于缝钉驱动器43近侧。楔形滑动件41可在钉仓37内纵向地运动；而缝钉驱动器43可在钉仓37内竖直地运动。缝钉47也被定位在仓体70中，处于对应的缝钉驱动器43上方。具体地，每个缝钉47在仓体70中被缝钉驱动器43竖直地驱动，以将缝钉47从相关的缝钉孔51中驱动出。如图3A至图3B和图5中最佳地示出，楔形滑动件41存在倾斜凸轮表面，当楔形滑动件41被朝远侧驱动穿过钉仓37时，所述倾斜凸轮表面向上压迫缝钉驱动器43。
在端部执行器12如图3A所示而闭合的情况下，通过使上部销38进入纵向砧座槽42，将击发杆14推进至与砧座18接合。推块80位于击发杆14的远端处，并且能够接合楔形滑动件41，使得当朝远侧推进击发杆14穿过钉仓37时，推块80朝远侧推动楔形滑动件41。在此类击发期间，击发杆14的切刃48进入钉仓37的竖直槽49，从而切断被夹紧在钉仓37与砧座18之间的组织。如图3A至图3B所示，中部销46和推块80通过进入到钉仓37内的击发槽中而一起致动钉仓37，从而驱动楔形滑动件41与缝钉驱动器43进行向上凸轮接触，所述缝钉驱动器继而将缝钉47驱动出缝钉孔51，并与砧座18的内表面上的缝钉成形凹坑53进行成形接触。图3B示出了在完成切断和缝合组织之后完全朝远侧平移的击发杆14。
图6示出了已经通过单次冲程而被致动穿过组织90的端部执行器12。如图所示，切刃48已经切割穿过组织90，同时在切刃48形成的切割线的每一侧上，缝钉驱动器43已经将交替的三行缝钉47驱动穿过组织90。在该例子中，缝钉47全部与切割线基本上平行地取向，但应当理解，缝钉47可被定位成任何适合的取向。在本例子中，在第一冲程完成之后，端部执行器12从套管针撤回，用新的钉仓替换用完的钉仓37，然后将端部执行器12再次穿过套管针插入，以到达缝合部位用于进一步的切割和缝合。这个过程可以重复到提供了期望量的切口和缝钉47为止。可能需要将砧座18闭合以有利于通过套管针插入和撤回；并且可能需要将砧座18打开以有利于替换钉仓37。
应当理解，在每个致动冲程期间，切刃48可基本上在缝钉47被驱动穿过组织的同时切断组织。在本例子中，切刃48仅稍微落后于缝钉47的驱动，使得缝钉47正好在切刃48穿过组织之前被驱动穿过该组织的相同区域，但应当理解，这个顺序可以颠倒，或者切刃48可以直接与相邻的缝钉同步。虽然图6示出了端部执行器12在组织90的两个层92、94中被致动，但应当理解，端部执行器12可被致动穿过组织90的单个层或者组织的多于两个层92、94。还应当理解，与切刃48产生的切割线相邻的缝钉47的成形和定位可基本上密封所述切割线处的组织，从而减少或防止切割线处的出血和/或其它体液的泄漏。本领域的普通技术人员参考本文的教导内容将显而易见可以使用器械10的各种适合的设置和程序。
应当理解，可以根据以下美国专利中的任何教导内容来构造和操作器械10：美国专利号4,805,823；美国专利号5,415,334；美国专利号5,465,895；美国专利号5,597,107；美国专利号5,632,432；美国专利号5,673,840；美国专利号5,704,534；美国专利号5,814,055；美国专利号6,978,921；美国专利号7,000,818；美国专利号7,143,923；美国专利号7,303,108；美国专利号7,367,485；美国专利号7,380,695；美国专利号7,380,696；美国专利号7,404,508；美国专利号7,434,715；和/或美国专利号7,721,930。如上所述，这些专利中的每一个的公开内容均以引用方式并入本文。可提供用于器械10的其它示例性修改形式将更详细地描述于下文中。本领域的普通技术人员将显而易见可将下述教导内容并入器械10内的各种适合方式。类似地，本领域的普通技术人员将显而易见可将下述教导内容与本文引用的专利的各种教导内容进行组合的各种适合方式。还应当理解，下述教导内容并不限于本文引用的专利中所教导的器械10或装置。下述教导内容可容易地应用到多种其它类型的器械，包括将不被分类为外科缝合器的器械。本领域的普通技术人员参考本文的教导内容将显而易见可应用下述教导内容的各种其它适合装置和设置。
II.示例性盖
图7至图9示出了可附接到钉仓37的示例性钉仓37保持器盖180。应当理解，保持器盖180可根据在2010年9月30日提交的名称为“Implantable Fastener Cartridge Comprising a Support Retainer”的美国专利申请序列号12/894,369中的任何教导内容来构造和操作，所述美国专利申请的整个公开以引用的方式并入本文中。保持器盖180能够操作以预防或至少抑制在将钉仓37插入到端部执行器12的下钳口16中时临床医生的拇指(例如)接触定位在钉仓37内的缝钉47的尖端。除此之外或作为替代，所述保持器盖还可防止缝钉47无意地从仓中掉落。现在参见图7和图8，本例子的保持器盖180包括底表面181和顶表面182，例如，所述底表面和顶表面可为临床医生提供用以在上面施加向下的力的推动表面。在一个仅为示例性的用途中，临床医生可抓紧保持器盖180的柄部部分184、将钉仓37的支撑部分110与端部执行器12的下钳口16对准、且将钉仓37至少部分地插入到端部执行器12的下钳口16内。然后，所述临床医生可通过将向下的力施加到保持器盖180的顶表面182而将钉仓37完全安放在端部执行器12的下钳口16中，所述顶表面可将所述向下的力直接传输到支撑部分110。在本例子中，保持器盖180包括向下延伸并接触支撑部分的平台表面111的近侧支撑187。保持器盖180还包括邻接鼻部103的远侧支撑部分183。在将向下的力施加到保持器盖180时，所述向下的力可通过近侧支撑187和/或远侧支撑部分183来传输。在一些示例性变型中，在将向下的力施加到保持器盖180之前，至少一些支撑并不与支撑部分110的顶部接触；然而，在一些型式中，保持器盖180可能够操作以向下弯曲或运动，直到保持器盖180触及支撑部分110的顶部为止。此时，可阻止或至少基本上阻止保持器盖180的向下弯曲或运动变得进一步弯曲。
如上所述，保持器盖180可附接到钉仓180，并可用于调控钉仓37的位置。在一些型式中，例如，保持器盖180可包括任何适合数目的抓握构件，所述抓握构件可能够操作以用能够释放的方式将保持器盖180固持到钉仓37的支撑部分110。例如，在本例子中，保持器盖180包括闩锁臂188、189。闩锁臂189围绕鼻部103的侧面延伸，并接合鼻部103的底表面109(图7)。相似地，闩锁臂188围绕从支撑部分110延伸的锁定突出部108的侧面延伸，并接合锁定突出部108的底表面。这些闩锁臂188能够操作以将保持器盖180定位在其中将缝钉47储存在支撑部分110内的区或区域上。在任何情况下，一旦钉仓37已被适当地定位，保持器盖180便可与钉仓37分离。当然，可使用任何其它适合的组件或结构以提供保持器盖180与钉仓37的可释放联接。在一些型式中，临床医生可将向上提举力施加到柄部184，以便使保持器盖180的远端与钉仓37的远端102分离。在至少一个此类实施例中，在向上提举柄部184时，闩锁臂188、189可向外弯曲，使得闩锁臂188、189可分别围绕锁定突出部108和鼻部103弯曲。然后，保持器盖180的近端可被远离钉仓37的近端101提举，且保持器盖180可远离钉仓37运动。在取出保持器盖180并将钉仓37正确地安放在端部执行器12的下钳口16中的情况下，可随之在外科手术中使用器械10。
III.示例性可填充支撑物
如图10至图13中所示，支撑物200可与图1至图6中所示的示例性外科切割器的端部执行器部分一起使用。应当理解，如下文将描述的支撑物200的使用可有利于手术部位的较快复原，在所述手术部位中组织已被切断并通过(例如)使已经应用缝钉47的区域稳定化而加以缝合。在一些示例性变型中，支撑物200可与上文所述的保持器盖180一起使用，或者，支撑物200可直接与上文所述的外科切断及缝合器械10一起使用而不使用保持器盖180。
图10示出，支撑物200包括第一可填充流体构件202或囊状物，以及第二可填充流体构件204或囊状物。在一些示例性变型中，第一可填充流体构件202可通过粘合剂附接到砧座18，且第二可填充流体构件204可附接到定位在下钳口16中的钉仓37的上部平台72。在其它示例性变型中，第一可填充流体构件202和第二可填充流体构件204可被粘合在一起并粘合到砧座18。在其它示例性变型中，第一可填充流体构件202和第二可填充流体构件204可被粘合在一起并粘合到钉仓37的上部平台72。在一些示例性变型中，如本领域的普通技术人员参考本文的教导内容将显而易见，可使用夹具或其它适合的机械或液体紧固系统，而非使用粘合剂以将第一可填充流体构件202或第二可填充流体构件204附接到砧座18和/或下钳口16。图10的本例子示出了正要定位在砧座18和下钳口16之间的支撑物200。
第一可填充流体构件202和第二可填充流体构件204包含两份式液体220，使得如下文将描述，在所述两部分液体220彼此接触时，其形成凝结剂以加固由图1至图6中所示的外科缝合和切断器械10影响的手术部位。在一些示例性变型中，第一可填充流体构件202填充有血纤维蛋白，而第二可填充流体构件204填充有凝血酶，但应当理解，可使用任何适合的材料。在一些型式中，第一可填充流体构件202和第二可填充流体构件204两者均可包括可能够加固手术部位而不必与另一化合物相组合的液体220。在另一示例性变型中，可使用如本领域的普通技术人员参考本文的教导内容将显而易见的任何适合数目的可填充流体构件，而非使用两个可填充流体构件。例如，可使用三个或更多个可填充流体构件，或者可使用一个可填充流体构件。此外，支撑物200可预填充有液体220，或者，用户或医生可在使用外科缝合和切断器械10之前使支撑物200填充有液体220。在一些其它示例性变型中，如本领域的普通技术人员参考本文的教导内容将显而易见，液体220可包括止血剂、生物安全性胶、或任何其它适合的粘合剂材料。
在所述示例性变型中，支撑物200具有大致平坦的矩形形状，能够装配在砧座18和下钳口16之间。支撑物200的尺寸至少稍微大于砧座18或下钳口16的宽度。在一些示例性变型中，支撑物200的尺寸可显著地大于砧座18或下钳口16的尺寸。然而，如根据本文的教导内容对本领域普通技术人员将显而易见，可使用任何适合形状或尺寸的支撑物200。此外，如下文将论述，支撑物200包括半自支撑式结构，使得在支撑物200不被压缩时，支撑物200可维持其大致平坦形状。
图11A至图11C示出了支撑物200的侧视图，其示出了含纳在第一可填充流体部分202和第二可填充流体部分204内的流体220可如何从支撑物200中被压迫出来。在所述示例性变型中，支撑物200可被放置在砧座18和下钳口16之间，其中支撑物200仍为大致平坦的，如图11A中所示。同样如图11A中示出，液体220保持为基本上不加压的状态。在一些示例性变型中，可将支撑物200预装载以放置在砧座18和下钳口16之间，使得支撑物200粘合到下钳口16中所含纳的钉仓(未示出)。在其它示例性变型中，用户或医生可在于外科定形中使用之前便将支撑物200装载在砧座18和下钳口16之间。例如，在一些示例性变型中，用户可取出上文在图7至图9中所述的保持盖180，并在将砧座18和下钳口16围绕手术部位的组织夹紧之前用支撑物200替换保持盖180。在其它仅示例性变型中，支撑物200可联接到保持盖180，其中在使用之前取出保持盖180，在砧座18和下钳口16之间仅留下支撑物200。然而，如根据本文的教导内容对本领域的普通技术人员将显而易见，可为支撑物200和保持盖180使用其它构型。
图11B示出了在由砧座18和下钳口16夹紧时将出现的导致形成压缩区域206和加压区域208的支撑物200。在加压区域208中，液体220被迫受力。如图11B中示出，在切断或缝合支撑物200之前，已紧紧地围绕支撑物200夹紧砧座18和下钳口16。
如图11C中示出，虚线210示出了在砧座18和下钳口16压缩支撑物200之前的支撑物200的轮廓。砧座18和下钳口16可被夹紧以将支撑物200夹在中间。支撑物200内所含纳的液体220在加压区208中仍然加压。尽管图11B至图11C示出了在压缩区域206一侧上的加压区域208，但应当理解，相对的加压区域208可形成在压缩区域206的相对侧上。支撑物200包括大致弹性材料，所述大致弹性材料能够伸展以使得加压区域208可填充有支撑物208中的大部分或所有液体而不在压力下裂开或爆开。加压区域208因此伸展超过由虚线210限定的区域，以适应加压区域208的压力和液体的增加。
随着如上文参见图1至图6所述的切刃48切断组织90，切刃48也切断支撑物200，导致如图11C中所示的被切断的支撑物200。几乎同时地，支撑物200也被缝合，且支撑物200因此被缝钉47弄破，从而使支撑物200开始释放液体220。在切断支撑物200时，液体220从支撑物200的加压区域208中被压迫出来并进入到手术区域的组织中，从而使得一旦已切断并缝合组织90便可辅助加固组织90。此外，如上文所提及，缝钉47的部署进一步使支撑物200破裂，从而也使液体220通过支撑物200的被缝钉47弄破的区域而被挤出来。在一些示例性变型中，支撑物200可包括可溶解的材料，使得支撑物200可被留在组织90中而不对患者造成伤害。在其它示例性变型中，一旦从支撑物200中释放液体220，便可从手术部位取出支撑物200。
图12A至图12B示出了在两层组织290之间被压缩的支撑物200的正面剖视图。在一些示例性变型中，支撑物200可夹在组织290之间，或者在一些替代型式中，可抵靠组织290的顶表面或底表面按压支撑物200。在一些示例性变型中，支撑物200的外表面可包括粘合涂层，以使支撑物200能够在释放液体220之前粘合到组织290。图12B示出了在被缝钉247切断并缝合之后的支撑物200，其中包含液体220的加压区域208压迫液体220通过压缩区域206进入到周围组织290中。在一些型式中，液体220也可通过缝钉247所致的破裂处而被压迫出来。
图13示出了正被用于切断和缝合组织90的外科切断和缝合器械10。如本例子中可见，支撑物200已在砧座18和下钳口16之间被切断。此外，已将液体220从支撑物200中压迫到周围组织90中。尽管液体220可包括任何适合的液体，但在本例子中，液体220包括凝结剂，诸如血纤维蛋白和凝血酶。液体220一旦从支撑物200中被压迫出来，压缩的操作以辅助组织90的其中已将缝钉47插入到组织90中的部分的凝固。
IV.具有可填充区域的示例性支撑物
图14至图16示出了可与图1至图6中示出的器械10的端部执行器12一起使用的支撑物300。支撑物300包括障壁部分302和粘合区域304。障壁部分302围绕粘合区域304的外周边延伸，从而限定支撑物300的第一半体306和第二半体308。第一半体306和第二半体308定位成使得竖直槽49大概定位在第一半体306和第二半体308之间。切割线314在第一半体306和第二半体308之间延伸，如图15中示出，使得切刃48可沿着切割线314切割障壁部分302。当然，可省略切割线314。例如，支撑物300可被设置成竖直槽49的每一侧上的离散部件。此外，应当理解，支撑物300可被构造成不使用单独半体306、308的单个单元。相似地，尽管在本例子中使用了单个支撑物300，但应当理解，如本领域的普通技术人员参考本文的教导内容将显而易见，可使用两个或更多个支撑物300。例如，图15示出了被夹紧在两个支撑物300之间的组织90的剖视图：一个支撑物300在仓37的平台72上，且一个支撑物300在砧座18的底侧上。
本例子的支撑物300由泡沫材料构成，但应当理解，可使用任何适合的材料。仅以举例的方式，支撑物300可包括生物可吸收织物。粘合区域304包括被保持在粘合层隔膜312内的粘合剂310。粘合剂310可包括如本领域的普通技术人员参考本文的教导内容将显而易见的任何适合的粘合剂材料。例如，粘合剂310可包括氰基丙烯酸酯、抗菌剂和/或康复剂。在其它示例性变型中，半体306、308的粘合区域304可包括两种或更多种试剂，使得仅在穿刺半体306、308之后组合所述试剂时才激活粘合性能。本领域的普通技术人员参考本文的教导内容将显而易见粘合剂310的其它适合材料。连接到障壁部分302的隔膜312形成能够保持流体粘合剂310的泡状物。例如，图15示出了封围粘合剂310的隔膜312。隔膜312可由生物可吸收塑料和/或其它生物可吸收材料构成。隔膜312还可由如本领域的普通技术人员参考本文的教导内容将显而易见的任何适合材料构成。
如上文提及，障壁部分302形成围绕粘合区域304的唇缘，使得粘合区域304中的任何流体被保持在由障壁部分302限定的周边内。例如，如图15至图16所示，夹紧在两个支撑物300之间的组织90定位成使得粘合区域304面朝组织90。砧座18被抵靠下钳口16夹紧，使得支撑物300挤压组织90，从而在障壁部分302和组织90之间形成密封。如图15中示出，缝钉47刺穿粘合区域304的隔膜312。结果，粘合区域304破裂且粘合剂310流出。障壁部分302具有杯状形状，所述杯状形状能够在粘合剂310离开粘合区域304之后仍相对于组织90保持粘合剂310；同时基本上预防粘合剂310从支撑物300中流出到周围组织中。图16示出了在粘合剂310从粘合区域304中流出并形成粘合层316之后的粘合剂310。同样在图16中，切刃48已沿着切割线314切开切割组织90。应当理解，缝钉47操作地固持被抵靠组织90按压的支撑物300。
图17示出了支撑物400的示例性替代型式，所述支撑物具有在障壁部分402内间隔开的多个粘合区域404。粘合区域404包括能够操作以在穿刺时和/或被充分压缩时爆裂的塑料模块。每个粘合区域404具有含纳在它里面的粘合剂410。应当理解，所有粘合区域404未必包含相同的粘合剂410。例如，一些粘合区域404可包括一种类型的粘合剂410和/或治疗剂材料，而其它粘合区域404可包括不同类型的粘合剂410和/或治疗剂材料。当然，除了粘合剂之外或替代粘合剂，区域404中还可包括任何其它适合的医学流体。
图18示出了具有泡沫区域504的支撑物500的另一示例性变型，其中粘合剂胶囊510嵌入和/或播散在泡沫区域504中。泡沫区域504含纳在障壁部分502内。泡沫区域504可基本上预防在将支撑物500部署在手术部位处之前粘合剂胶囊510无意地离开支撑物500。泡沫区域504还可基本上预防在将支撑物500部署在手术部位处之后从胶囊510释放的粘合剂从所述手术部位逸出。此外，泡沫区域504可基本上预防在将支撑物500部署在手术部位处之前和/或之后胶囊510的粘合剂510粘到砧座18和/或仓18上。
粘合剂胶囊510可由如本领域的普通技术人员参考本文的教导内容将显而易见的任何适合方法构成。图19示出了使用胶囊成形腔室550制作粘合剂胶囊510的一种示例性方式。腔室550包括分配器552和涂层介质556。应当理解，腔室550内可包含任何非反应性气体。分配器552分配粘合剂材料554，所述粘合剂材料作为粘合剂液滴落下，然后进入涂层介质556。涂层介质556可包括塑料，但也可使用如本领域的普通技术人员参考本文的教导内容将显而易见的任何适合材料。粘合剂材料554接触涂层介质556，且被涂层覆盖，从而在涂层介质556的底部形成粘合剂胶囊510。然后，如图18中所示，可从腔室550中取出粘合剂胶囊510并将其放置在泡沫区域504中。当然，粘合剂胶囊510还可由如本领域的普通技术人员参考本文的教导内容将显而易见的任何其它适合方法形成。
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。本领域的普通技术人员参考本文的教导内容将显而易见其中可结合本文的教导内容的各种适合方式。这些修改和变型旨在包括在权利要求书的范围内。
上文所述的装置的变型可适用于由医疗专业人员进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。
上文所述的变型可被设计为单次使用后丢弃，或者它们可被设计为可多次使用。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再使用。修复可包括以下步骤的任意组合：拆卸装置、然后清洗或替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替换或取出所述装置的任意数量的特定部件或零件。在清洗和/或替换特定零件时，所述装置的一些型式可在修复设施中被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了解，装置的修复可利用到用于拆卸、清洗/替换和重新组装的多种技术。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，将装置放置在闭合并密封的容器中，例如，塑料袋或TYVEK袋中。然后可将容器和装置放置在可穿透所述容器的辐射场中，诸如γ辐射、X射线或高能电子。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在无菌容器中，以供以后使用。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种型式，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修改形式，并且其它修改形式对本领域的技术人员将是显而易见的。例如，上文讨论的例子、型式、几何形状、材料、尺寸、比率、步骤等等均为示例性的而非必需的。因此，本发明的范围应根据下面的权利要求书来考虑，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)
1.一种设备，所述设备包括：
(a)包括远端和近端的外科切割器，其中所述近端包括柄部，其中所述远端包括砧座和下钳口，其中所述砧座和所述下钳口能够夹紧组织，其中所述外科切割器能够切断由所述砧座和所述下钳口夹紧的组织；和
(b)填充有液体的支撑物，其中所述支撑物能够被放置在所述砧座和所述下钳口之间，其中所述支撑物包括压缩部分和压力部分，其中通过所述砧座和所述下钳口夹紧所述压缩部分，所述压缩部分能够被所述外科切割器的所述远端挤压，其中所述压力部分能够响应于在所述压缩部分上的夹紧而通过液体加压，其中所述支撑物能够基本上与在所述外科切割器切断组织时同时地由所述外科切割器切断和缝合，其中一旦切断所述支撑物，所述压力部分能够迫使液体通过所述压缩部分。
2.根据权利要求1所述的设备，其中液体包括两份式粘合剂，只有一旦所述两份式粘合剂的两个部分相组合，所述两份式粘合剂便能够具有粘合性能。
3.根据权利要求1所述的设备，其中所述支撑物包括弹性材料。
4.根据权利要求1所述的设备，其中所述砧座限定砧座宽度，其中所述支撑物限定比所述砧座宽度宽的支撑物宽度。
5.根据权利要求1所述的设备，其中所述支撑物包括弹性材料。
6.根据权利要求1所述的设备，其中所述支撑物具有大致矩形形状。
7.根据权利要求1所述的设备，其中所述支撑物能够被预装载到所述外科切割器中。
8.根据权利要求1所述的设备，其中所述支撑物跨骑所述下钳口，使得所述支撑物的基本上等同部分从所述下钳口向外延伸。
9.根据权利要求1所述的设备，其中所述支撑物能够被联接到所述下钳口。
10.根据权利要求1所述的设备，其中所述支撑物包括基本上相似形状的两个流体填充构件，其中所述两个流体填充构件中的每个包括液体粘合剂。
11.根据权利要求10所述的设备，其中所述两个流体填充构件中的每个包括不同的液体组分。
12.根据权利要求1所述的设备，还包括与所述外科切割器连通的外科缝合器，其中所述外科缝合器包括一个或多个缝钉，其中所述外科缝合器能够缝合一部分组织，其中所述一个或多个缝钉能够使所述支撑物破裂。
13.根据权利要求1所述的设备，其中所述支撑物包括可溶解的材料。
14.根据权利要求1所述的设备，其中所述支撑物包括两份式流体凝结剂，其中所述两份式流体中的一个包括血纤维蛋白，其中所述两份式流体中的另一个包括凝血酶。
15.根据权利要求1所述的设备，其中所述支撑物包括在所述支撑物的外侧上的粘合剂，所述粘合剂能够操作以将所述支撑物粘合到所述外科切割器的一部分。
16.一种设备，所述设备包括：
(a)包括切割器和缝合器的外科器械，其中所述外科器械还包括在切割和缝合组织时能够操作以压缩组织的砧座和下钳口，其中所述切割器能够切割所述组织的至少一部分，其中所述缝合器能够缝合所述组织的至少一部分；和
(b)一对囊状物，其中所述一对囊状物的至少一部分定位在所述砧座和所述下钳口之间，其中所述一对囊状物包括第一囊状物和第二囊状物，其中所述第一囊状物包含第一凝结剂组分，其中所述第二囊状物包含第二凝结剂组分，其中所述切割器能够操作以使所述第一囊状物和所述第二囊状物两者同时破裂，从而混合所述第一凝结剂组分的至少一部分与所述第二凝结剂组分的至少一部分。
17.根据权利要求16所述的设备，其中所述一对囊状物中的至少一个还包含流体粘合剂。
18.根据权利要求16所述的设备，其中所述砧座和所述下钳口能够压缩所述一对囊状物的至少一部分。
19.根据权利要求16所述的设备，其中所述一对囊状物中的每个包括弹性材料。
20.一种用于使用外科器械对一个或多个囊状物加压并将其切断以使流体分布到被同时切断的组织上的方法，其中所述外科器械包括砧座和下钳口，其中所述外科器械还包括能够相对于所述砧座和所述下钳口运动的刀，其中所述一个或多个囊状物能够定位在所述砧座和所述下钳口之间，其中所述一个或多个囊状物的至少一部分包含所述流体，所述方法包括：
(a)将组织对准在所述砧座和所述下钳口之间；
(b)将所述一个或多个囊状物的一部分压缩在所述砧座和所述下钳口之间；
(c)致动所述外科器械的一部分，其中致动所述外科器械的一部分的行为能够操作以使所述刀相对于所述砧座和所述下钳口运动；
(d)用所述刀切断组织；
(e)用所述刀切断所述一个或多个囊状物；并且
(f)将所述流体分布到接近于切断的组织的区域。
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| CN109069157A (zh) * | 2016-03-21 | 2018-12-21 | 伊西康公司 | 用于与圆形吻合缝合器一起使用的临时固定工具 |
| CN109688949A (zh) * | 2016-07-13 | 2019-04-26 | 伊西康有限责任公司 | 用于液压辅助断裂肝实质的装置 |
| CN109688949B (zh) * | 2016-07-13 | 2022-01-25 | 伊西康有限责任公司 | 用于液压辅助断裂肝实质的装置 |
| WO2019091342A1 (en) * | 2017-11-10 | 2019-05-16 | Ethicon Llc | Laparoscopic stapler having bio-glue in separate pocket to aid in anastomosis |
| US11918225B2 (en) | 2017-11-10 | 2024-03-05 | Cilag Gmbh International | Laparoscopic stapler having bio-glue in separate pocket to aid in anastomosis |
Also Published As
| Publication number | Publication date |
|---|---|
| RU2014114525A (ru) | 2015-10-20 |
| MX2014002976A (es) | 2015-04-13 |
| BR112014006216A2 (pt) | 2017-04-11 |
| US9999408B2 (en) | 2018-06-19 |
| BR112014006216B1 (pt) | 2021-06-08 |
| RU2610199C2 (ru) | 2017-02-08 |
| US20130062391A1 (en) | 2013-03-14 |
| EP2755560B1 (en) | 2021-07-28 |
| EP2755560A1 (en) | 2014-07-23 |
| WO2013039820A1 (en) | 2013-03-21 |
| MX358403B (es) | 2018-08-16 |
| JP2014531240A (ja) | 2014-11-27 |
| JP6203729B2 (ja) | 2017-09-27 |
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