CN103930047A - 外科器械和支撑材料 - Google Patents

外科器械和支撑材料 Download PDF

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CN103930047A
CN103930047A CN201280055707.1A CN201280055707A CN103930047A CN 103930047 A CN103930047 A CN 103930047A CN 201280055707 A CN201280055707 A CN 201280055707A CN 103930047 A CN103930047 A CN 103930047A
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backing material
anvil block
surgical instruments
equipment according
tissue
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CN103930047B (zh
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V·M·瓦苏德万
J·V·亨特
G·C·休伊尔
I·纳
G·J·法纽尔
J·B·克莱默
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Ethicon Endo Surgery Inc
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical 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
    • A61B17/07292Reinforcements for staple line, e.g. pledgets
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00004(bio)absorbable, (bio)resorbable or resorptive
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00681Aspects not otherwise provided for
    • A61B2017/00738Aspects not otherwise provided for part of the tool being offset with respect to a main axis, e.g. for better view for the surgeon
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00831Material properties
    • A61B2017/00893Material properties pharmaceutically effective

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  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
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  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

一种包括外科器械的设备,其可用于切断并且缝合组织的一部分。在一些型式中,所述设备包括保持器盖。所述保持器盖与所述外科器械相连。所述设备还包括支撑材料,所述支撑材料能够操作以与所述外科器械的一部分联接。在一些型式中,所述支撑材料可以包括用于将所述支撑材料联接到所述外科器械的多个接头或其它类似结构。在一些型式中,切割器能够操作以使所述支撑材料脱离所述外科器械。

Description

外科器械和支撑材料
背景技术
在一些环境下,内窥镜式外科器械可以优于传统的开放式外科装置,因为较小切口能够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以适于将远侧端部执行器穿过套管针的插管放置在所需的手术部位处。这些远侧端部执行器(例如,直线切割器、抓紧器、切割器、缝合器、施夹钳、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以包括轴,所述轴在端部执行器与由临床医生操纵的柄部部分之间。此轴可以允许插入达到所需的深度并且围绕轴的纵向轴线旋转,从而有利于端部执行器在患者体内定位。还可通过添加一个或多个关节运动接头或结构而进一步利于端部执行器的定位,从而使得端部执行器能选择性地进行关节运动,或以其它方式相对轴的纵向轴线偏转。
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,切割穿过夹紧的组织层,并驱动缝钉穿过组织层,以在组织层的被切断的末端附近将切断的组织层基本上密封在一起。仅示例性的外科缝合器在以下美国专利中公开:于1989年2月21日公布的名称为“Pocket Configuration for Internal Organ Staplers”的美国专利第4,805,823号;于1995年5月16日公布的名称为“Surgical Stapler and StapleCartridge”的美国专利第5,415,334号;于1995年11月14日公布的名称为“Surgical Stapler Instrument”的美国专利第5,465,895号;于1997年1月28日公布的名称为“Surgical Stapler Instrument”的美国专利第5,597,107号;于1997年5月27日公布的名称为“Surgical Instrument”的美国专利第5,632,432号;于1997年10月7日公布的名称为“Surgical Instrument”的美国专利第5,673,840号;于1998年1月6日公布的名称为“ArticulationAssembly for Surgical Instruments”的美国专利第5,704,534号;于1998年9月29日公布的名称为“Surgical Clamping Mechanism”的美国专利第5,814,055号;于2005年12月27日公布的名称为“Surgical StaplingInstrument Incorporating an E-Beam Firing Mechanism”的美国专利第6,978,921号;于2006年2月21日公布的名称为“Surgical StaplingInstrument Having Separate Distinct Closing and Firing Systems”的美国专利第7,000,818号;于2006年12月5日公布的名称为“Surgical StaplingInstrument having a Firing Lockout for an Unclosed Anvil”的美国专利第7,143,923号;于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;于2008年5月6日公布的名称为“Surgical Stapling Instrument Incorporating a Multistroke Firing MechanismHaving a Rotary Transmission”的美国专利第7,367,485号;于2008年6月3日公布的名称为“Surgical Stapling Instrument Having a Single LockoutMechanism for Prevention of Firing”的美国专利第7,380,695号;于2008年6月3日公布的名称为“Articulating Surgical Stapling Instrument Incorporatinga Two-Piece E-Beam Firing Mechanism”的美国专利第7,380,696号;于2008年7月29日公布的名称为“Surgical Stapling and Cutting Device”的美国专利第7,404,508号;于2008年10月14日公布的名称为“Surgical StaplingInstrument Having Multistroke Firing with Opening Lockout”的美国专利第7,434,715号;以及于2010年5月25日公布的名称为“Disposable Cartridgewith Adhesive for Use with a Stapling Device”的美国专利第7,721,930号。上文所引用的美国专利中的每一者的公开内容均以引用方式并入本文。虽然上文所涉及的外科缝合器被描述为用于内窥镜式手术,但应理解,此类外科缝合器也可以用于开放式手术和/或其它非内窥镜式手术。
虽然已经制造并且使用各种类型的外科缝合器械和相关组件,但是据信,在本发明人前尚未有人研制造或使用所附权利要求书中所描述的发明。
附图说明
并入本说明书并构成其一部分的附图示出本发明的各实施例,并与上文所给出的本发明的一般说明以及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的位置;
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示出了沿图2的线3-3截取的图2的端部执行器的侧视剖视图,其中击发杆处于近侧位置;
图3B示出了沿图2的线3-3截取的图2的端部执行器的侧视剖视图,但示出了击发杆处于远侧位置;
图4示出了沿图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已在组织中被致动了一次;
图7示出了带有图2的端部执行器的保持器盖的透视图;
图8示出了图7的保持器盖的下侧透视图;
图9示出了带有图7的端部执行器的保持器盖的侧视图;
图10示出了带有支撑材料的示例性保持器盖的顶部透视图;
图11A示出了带有图10的支撑材料的保持器盖的侧视图,所述支撑材料被装载到端部执行器中;
图11B示出了带有图10的支撑材料的保持器盖的侧视图,所述保持器盖从端部执行器移除,留下装载到端部执行器中的支撑材料;
图12A示出了带有图10的支撑材料的端部执行器的砧座的剖视图,其中支撑材料通过使接头接合砧座狭槽来联接到砧座;
图12B示出了带有图10的支撑材料的端部执行器的砧座的剖视图,其中接头和组织由切割器切断;
图12C示出了带有图10的支撑材料的端部执行器的砧座的一系列剖视图,其中砧座从切断组织移除,留下支撑材料;
图13示出了砧座的示例性替代型式以及具有T形形状的接头的示例性替代型式的正面剖视图;
图14示出了具有凹口的砧座的示例性替代型式以及接头的另一示例性替代型式的正面剖视图;以及
图15示出了在使用外科器械过程中已经用于组织中的图10的支撑材料的透视图。
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说明本发明的原理;然而,应当理解,本发明不限于所示出的明确布置方式。
具体实施方式
本发明的某些实例以下描述不应用来限制本发明的范围。通过举例说明对设想用于实施本发明的其中一种最佳方式的以下描述,本发明的其它实例、结构、形态、实施例和优点对于本领域的技术人员而言将会变得显而易见。正如将会意识到的,本发明可以是其它不同且明显的方面,只要不脱离本发明。因此,附图和具体实施方式应被视为实质上是示例性的,而非限制性的。
I.示例性外科缝合器
图1至6示出了示例性外科缝合和切断器械10,在图1A中示出的非关节运动的状态下,其尺寸设定成穿过套管针的插管通道插入患者的手术部位,用于执行外科手术。外科缝合和切断器械10包括连接到执行部分22的柄部部分20,所述执行部分还包括轴23,该轴朝远侧终止于关节运动机构11和朝远侧附接的端部执行器12处。一旦关节运动机构11和端部执行器12穿过套管针的插管通道插入,关节运动机构11就可通过关节运动控制器13进行远程关节运动,如在图1B中所示出。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。还应理解,为简洁和清楚起见,本文可以结合附图使用空间术语,如“竖直”和“水平”。然而,外科器械在多个取向上和位置中使用,并且这些术语并非意图进行限制,也并非是绝对。
本实例的端部执行器12包括下钳口16和可枢转式砧座18。柄部部分20包括手枪式握把24,由临床医生将闭合触发器26枢转地拉向该手枪式握把,以使砧座18朝向端部执行器12的下钳口16夹紧或者闭合。砧座18的这种闭合通过最外侧的闭合套管32提供,所述闭合套管响应于闭合触发器26相对于手枪式握把24的枢转而相对于柄部部分20纵向平移。闭合套管32的远侧闭合环33由执行部分22的框架34间接支撑。在关节运动机构11处,闭合套管32的近侧闭合管35与远侧闭合环33相连。框架34经由关节运动机构11柔性附接到下钳口16,使得能够在单个平面中进行关节运动。框架34还在纵向上滑动地支撑击发驱动构件(未示出),所述击发驱动构件延伸穿过轴23并将击发运动从击发触发器28传递到击发杆14。击发触发器28远离闭合触发器26的外侧,并且能被临床医生枢转拉动,以使所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。然后,按下释放按钮30,以从端部执行器12释放组织。
图2至5示出了端部执行器12,其采用电子束击发杆14来执行多个功能。如图3A至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、横向取向的中间销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内并且能够在该砧座凹坑中平移。击发杆顶盖44通过使击发杆14延伸穿过通道狭槽45(如图3B所示)而滑动地接合下钳口16的下表面,该通道狭槽是穿过下钳口16形成的。中间销46滑动地接合下钳口16的顶部表面,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隔开,从而以最小量的夹紧组织来克服可能在砧座18与下钳口16之间可能出现的挤痛情况,并以过量的夹紧组织克服缝钉变形。
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,从而允许未耗尽的钉仓37可移除地安装到下钳口16的通道中。如图4至5中最佳地示出,该实例的钉仓37包括仓70,所述仓具有上部平台72并与下部的仓托盘74联接。如图2中最佳地示出,竖直狭槽49是穿过钉仓37的一部分形成的。还如图2中最佳地示出,三行缝钉孔51在竖直狭槽49的一侧上穿过上部平台72形成,其中另一组的三行缝钉孔51在竖直狭槽49的另一侧上穿过上部平台72形成。重新参见图3至5,楔形滑动件41和多个缝钉驱动器43被捕集在仓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70内,处于对应缝钉驱动器43上方。具体地讲,每个缝钉47在仓70内被缝钉驱动器43竖直地驱动,以驱动缝钉47从相关的缝钉孔51穿出。如图3A至3B和5中最佳地示出,楔形滑动件41存在倾斜凸轮表面,当朝向远侧驱动楔形滑动件41穿过钉仓37时,倾斜凸轮表面向上压迫缝钉驱动器43。
用如图3A所示地闭合的端部执行器12,通过使上部销38进入纵向砧座狭槽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,使得当击发杆14朝远侧推进穿过钉仓37时,楔形滑动件41被推块80朝远侧推动。在此类击发期间,击发杆14的切刃48进入钉仓37的竖直狭槽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3B所示,中间销46和推块80通过进入钉仓37内的狭槽49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,继而将缝钉47向外驱动穿过缝钉孔51并使缝钉47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示出了在完成组织的切断和缝合后完全朝远侧平移的击发杆14。
图6示出了端部执行器12,所述端部执行器已通过单个冲程而被致动穿过组织90。切刃48已经切割穿过组织90,同时缝钉驱动器43已经驱动三行交替的缝钉47穿过由切刃48产生的切割线的每一侧上的组织90。此实例中,缝钉47全部被取向成与切割线基本上平行,但应理解,缝钉47可定位成任何合适取向。本实例中,在第一冲程完成之后,端部执行器12从套管针撤回,所用完的钉仓37会由新的钉仓取代,然后,端部执行器12再次插入穿过套管针以到达缝合部位,用于进一步地切割并且缝合。这个过程可以重复,直到提供了期望量的切割和缝钉47。可能需要将砧座18闭合以利于通过套管针来插入和撤回;并且可能需要将砧座18打开以利于更换钉仓37。
应当理解,在每个致动冲程期间,切刃48可基本上在驱动缝钉47穿过组织的同时切断组织。本实例中,切刃48仅仅稍微落后于缝钉47的驱动,使得缝钉47正好在切刃48穿过组织前驱动穿过该组织的相同区域,但应理解,这个顺序可以颠倒,或者切刃48可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的层92、94。还应理解,与切刃48所产生的切割线相邻的缝钉47的成形和定位可基本上密封该切割线处的组织,从而,减少或者防止切割线处出血和/或体内其它体液渗漏。参考本文的教导内容,可以使用器械10的各种合适的设置和手术对于本领域的普通技术人员而言将是显而易见的。
应当理解,可以根据以下美国专利中的教导内容来配置并操作器械10:美国专利第4,805,823号;美国专利第5,415,334号;美国专利第5,465,895号;美国专利第5,597,107号;美国专利第5,632,432号;美国专利第5,673,840号;美国专利第5,704,534号;美国专利第5,814,055号;美国专利第6,978,921号;美国专利第7,000,818号;美国专利第7,143,923号;美国专利第7,303,108号;美国专利第7,367,485号;美国专利第7,380,695号;美国专利第7,380,696号;美国专利第7,404,508号;美国专利第7,434,715号;和/或美国专利第7,721,930号。
如上所述,这些专利中的每者中的公开内容均以引用方式并入本文。可提供用于器械10的另外的示例性修改形式将会在下文中更详细地描述。可将下述教导内容结合到器械10中的各种合适方式对本领域的普通技术人员而言将会显而易见。类似地是,可将下述教导内容与本文所引用的专利的各种教导内容组合的各种合适方式对本领域的普通技术人员而言将会显而易见。另外,应当理解,下述教导内容并不限于本文所引用的专利中教导的器械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。参考本文教导内容,可应用下述教导内容的各种其它合适装置和设置对本领域的普通技术人员而言将会显而易见。
II.示例性覆盖件
图7至9示出示例性的钉仓37保持器盖180,所述保持器盖可附接到钉仓37。应当理解,保持器盖180可以根据于2010年9月30日提交的名称为“Implantable Fastener Cartridge Comprising a Support Retainer”的美国专利第12/894,369号和/或于2011年4月29日提交的名称为“StapleCartridge Comprising a Tissue Thickness Compensator”的美国专利第13/097,924号来配置和操作,这些专利中的完整内容以引用的方式并入本文。保持器盖180能够操作以防止或至少阻碍临床医生的拇指(例如)在钉仓37插入端部执行器12的下钳口16时,接触定位在钉仓37内的缝钉47的尖端。另外或者在替代形式中,它可防止缝钉47无意间从仓中脱出。现在参照图7和8,本实例的保持器盖180包括底部表面181和顶部表面182,例如,这可提供推动表面以供临床医生向其施加向下的力。在一个仅示例性用途中,临床医生可以抓住保持器盖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对齐,并将钉仓37至少部分地插在端部执行器12的下钳口16内。此后,临床医生可以通过将向下的力施加到保持器盖180的顶部表面182,来使钉仓37完全坐置在端部执行器12的下钳口16中,所述顶部表面可将向下的力直接传输到支撑部分110上。本实例中,保持器盖180包括近侧支架187,所述近侧支架向下延伸并接触支撑部分的平台表面111。保持器盖180还包括远侧支撑部分183,所述远侧支撑部分邻接鼻部103。当将向下的力施加到保持器盖180时,向下的力可被传输通过近侧支架187和/或远侧支撑部分183。在一些示例性型式中,支架中的至少一些在向下的力被施加到固定器盖180前不可接触支撑部分110的顶部;然而,在一些型式中,保持器盖180能够操作以向下挠曲或移动,直到保持器盖180接触支撑部分110的顶部此时,可以阻止或者至少基本阻止保持器盖180的向下的挠曲或运动的进一步挠曲。
如上所述,保持器盖180盖可附接到钉仓37并可用于调控钉仓37位置。例如,在一些型式中,保持器盖180可以包括任何合适数量的抓持构件,例如这些抓持构件能够操作以将保持器盖180可释放地固持到钉仓37的支撑部分110。例如,在本实例中,保持器盖180包括锁臂188、189。锁臂189围绕鼻部103侧面延伸并且接合鼻部103底部表面109(图7)。相似地是,锁臂188延伸到锁突出部108侧面周围,所述锁突出部从支撑部分110延伸并接合锁突出部108的底部表面。这些锁臂188能够操作以将保持器盖180定位在其中缝钉47存放在支撑部110内的区或区域中。在任何情况下,一旦钉仓37已被适当地定位,保持器盖180可与钉仓37分离。当然,可以使用任何其它合适的组件或结构以提供保持器盖180到钉仓37的可释放的联接。在一些型式中,临床医生可以施加向上提升力到柄部184,以便使保持器盖180的远端与钉仓37的远端102分离。在至少一个此实施例中,当柄部184向上提升时,锁臂188、189可以向外挠曲,使得锁臂188、189可以分别围绕锁突出部108和鼻部103挠曲。此后,保持器盖180近端可被提升远离钉仓37的近端101,并且保持器盖180可被移动远离钉仓37。通过移除保持器盖180并通过将钉仓37适当坐置在端部执行器12的下钳口16中,器械10随后可以用于外科手术。
III.示例性支撑材料
例如,如图10至12C所示,在一些示例性型式中,保持器盖180可与支撑材料200结合使用。可期望在组织切断和/或缝合过程中利用支撑材料200以有助于支撑并且愈合切断区域。在本实例中,支撑材料200包括当手术部位被切断和缝合时能够操作以支撑手术部位的凝结剂。例如,根据本文中的教导内容,如将对于本领域的普通技术人员显而易见,支撑材料200可以包括血纤维蛋白和凝血酶,但也可以使用任何合适的凝结剂。此外,根据本文中的教导内容,如将对于本领域的普通技术人员显而易见,支撑材料200可以包括止血剂、任何合适的胶粘材料、细胞组织(例如,同种异体或者异种)、胶原、明胶、氧化再生纤维素(ORC)、可降解的织造和非织造合成材料(诸如聚乳酸酯、聚乙二醇、聚正铜酸(polycuproicacid)或者任何其它合适的材料)。在一些示例性型式中,支撑材料200可以包括血纤维蛋白垫。另外,支撑材料200可以包括多种合适材料的任何组合。
如示例性型式所示,支撑材料200可被放置在保持器盖180顶部表面以及保持器盖180底部表面上,以基本上沿保持器盖180的长度延伸。在一些示例性型式中,放置在保持器盖180的顶部表面上的支撑材料200具有与放置在保持器盖180的底部表面上的支撑材料200不同的材料组成。例如,支撑材料200的一部分可以包括血纤维蛋白,其中支撑材料200的另一部分可以包括凝血酶。然而,根据本文中的教导内容,如将对于本领域的普通技术人员显而易见,支撑材料200可以使用各种合适的材料。在所示型式中,支撑材料200大体均匀分布在保持器盖180的顶部表面和底部表面上,但应理解,支撑材料200可以分布在保持器盖180的顶部表面和底部表面的离散部分中。例如,更多数量的支撑材料200可被放置在保持器盖180的顶部表面上,或者更多数量的支撑材料200可被放置在保持器盖180的底部表面上。此外,支撑材料200可仅放置在保持器盖180的顶部表面或保持器盖180的底部表面上。根据本文中的教导内容,如将对于本领域的普通技术人员显而易见,可以使用支撑材料200沿保持器盖180的任何合适分布。支撑材料200包括半刚性的和/或刚性结构,使得如下所述当从保持器盖180中分离时,支撑材料200能够大体保持其平坦的矩形结构。
如图10所示,多个弹性接头210沿着支撑材料200顶部表面定位。接头210被间隔开来,并且沿着支撑材料200中心大体纵向对齐。接头210进一步地布置成沿支撑材料200的长度朝着交替侧向方向。应当理解,支撑材料200底部部分还可包括接头210,所述接头与定位在支撑材料200的顶部上的接头210在相反方向上相似地延伸。
接头210中的每个包括头部212和主体部分214。接头210大体对齐以便卡合到图12A至12C所示的纵向砧座狭槽42中,使得当保持器盖180按压在砧座18上时,扶壁200变成机械地联接到砧座18。接头210的头部212具有楔形形状,使得头部212可容易地推进到纵向砧座狭槽42中,而不在卡合到适当位置中时从纵向砧座狭槽42中移除。接头210被联接到支撑材料200,以使支撑材料200借助与纵向砧座狭槽42联接的接头210可联接到砧座18。尽管所示型式示出了接头210具有楔形形状,但可以采用任何合适的形状,包括T形形状或球状形状。根据本文中的教导内容,用于接头210和/或头部212的其它合适的形状对于本领域的普通技术人员来说将会显而易见。
图11A示出装载到下钳口16中的支撑材料200和保持器盖180。砧座18尚未联接支撑材料200并且砧座18保持打开。因此,用户能够查看在关闭砧座18以接合支撑材料200之前,支撑材料200和保持器盖180是否适当排列在下钳口16内。
如图11B所示,砧座18和下钳口16已接近保持器盖180,所述保持器盖覆盖有支撑材料200,从而使得接头210卡合到纵向砧座狭槽42中。扶壁200的一部分也可通过附接到定位在下钳口16内的钉仓(未示出)而联接到下钳口16。此外,下钳口16包括与用于接合扶壁200的接头210的纵向砧座狭槽42的形状相似的纵向下钳口狭槽43。此后,砧座18和下钳口16可以打开,留下联接到砧座18的支撑材料216的顶部以及联接到下钳口16的支撑材料218的底部。应当理解,保持器盖180可被固持在砧座18和下钳口16之间,直至器械10准备使用。也应理解,其它合适的配置都可使用。例如,支撑材料200可以仅联接到砧座18。在其它仅示例性型式中,支撑材料200可以仅联接到下钳口16。在其它示例性型式中,支撑材料200可以直接联接到下钳口16和/或砧座18,而不使用保持器盖180。在一些型式中,支撑材料200和保持器盖180可以预先装载到砧座18和下钳口16中,使得用户仅需在使用前移除保持器盖180即可。
图12A至C示出与支撑材料200联接的砧座18的一系列剖视图,其中接头210卡合到纵向砧座狭槽42中,同时组织90按压在扶壁200上。图12A示出扶壁200装载到砧座18中,同时接头210按压到砧座狭槽42中。头部212能够操作以防止扶壁200无意间脱离砧座18。
图12B示出切刃48,所示切刃在图1至6示出为沿纵向砧座狭槽42长度行进。切刃48割穿接头210的头部212,从而使接头210脱离纵向砧座狭槽42。如图12B所示,接头210中的每一个的主体部分214稍微偏离中心,使得当切刃48推进穿过纵向砧座狭槽42时,仅仅切断头部212。随着切刃48推进,切刃48切断组织90,使得组织90和接头210基本上同时切断。另外,随着切刃48推进,例如在图3A中示出的上部销随着切刃48行进并将头部212从砧座狭槽42压迫出来。接头210包括生物可降解的材料,使得接头210释放到组织90中的部分最终分解或以其它方式保持生物惰性,而不使得组织90暴露在任何危险下。
如图12C所示,当切刃48割穿组织90时,支撑材料200通过缝钉47缝合到到组织90,并还支撑和/或愈合周围组织90和/或增强缝钉47的线。在示例性型式中,接头210的主体部分214可以保持联接到支撑材料200和/或可以当组织愈合时简单分解。此外,随着组织90材料愈合,支撑材料200可以分解。在一些替代型式中,一旦组织90充分愈合,支撑材料200可以移除。
图13示出另一仅示例性接头310,所述接头具有分裂的T形形状并沿支撑材料300的长度连续地延伸。比起卡合到形状互补的纵向砧座狭槽342中,与支撑材料300相连的接头310可以纵向滑动到形状互补的纵向砧座狭槽342中。在其它示例性型式中,接头310可以具有分裂的蘑菇形状。应当理解,通过具有略圆形的部分,分裂的蘑菇形状能够操作以使接头310更容易地插入到砧座狭槽342中。在分裂的T形形状或分裂的蘑菇形配置中,应当理解,当切刃48推进以切断组织90时,例如在图1至6中描述,切刃48可使接头310偏转和/或变形,使得接头310因接头310变形而可容易地从砧座狭槽342中移除,。在又一示例性型式中,当切刃48推进以切断组织90时,切刃48可剪切掉接头310的一部分和/或整体,足以使得接头310脱离砧座狭槽342。
在图14所示另一示例性型式中,支撑材料400可与夹子410相连,所述夹子能够操作以接合砧座418上的一系列对应的外部凹口442以将支撑材料400联接到砧座418。一旦已经切断并且缝合组织90,用户就可脱离夹子410以使支撑材料400脱离砧座418。根据本文中的教导内容,用于将支撑材料400联接到砧座418的其它示例性的配置对于本领域的普通技术人员而言将是显而易见的。
图15示出在已经用于切断并缝合组织90后的外科切断以及缝合器械10。如在本实例中可以看出,扶壁200已经被缝合到组织90,并且此后,可以有助于通过将缝钉47稳定到组织90来恢复组织90。
应当理解,本文所述教导内容、表达方式、实施例、实例等中的任何一个或多个可与本文所述其它教导内容、表达方式、实施例、实例等中的任何一个或多个结合。因此,下述教导内容、表达方式、实施例、实例等不应视为彼此隔离。参考本文教导内容,其中本文教导内容可结合的各种合适方式对于本领域的普通技术人员而言将会显而易见。此类修改形式以及变型旨在包括在权利要求书的范围内。
上文所述装置型式可适用于医学专家所执行的常规医疗处理和手术中,并且可适用于机器人辅助的医疗处理和手术中。
上文所述型式可设计为在单次使用后丢弃,或者它们可设计为能够使用多次。在上述任一种或两种情况下,都可针对这些型式进行修复,用于在使用至少一次后再利用。修复可以包括以下步骤任何组合:拆卸装置,随后清洗或者更换特定部件,并且后续重新组装。具体地讲,可以拆卸所述装置中的一些型式,并可选择性地以任何组合的形式更换或者移除所述装置中任何数量的特定部件或零件。在清洗和/或更换特定零件时,所述装置的一些型式可在修复设施中重新组装或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会知道,装置修复可以利用多种技术进行拆卸、清洗/更换以及重新组装。此类技术的使用和所得修复装置全都在本发明的范围内。
仅以举例方式,本文所述型式可在手术之前和/或之后进行消毒。在一种消毒技术中,装置放置在闭合并密封的容器、诸如塑料袋或TYVEK袋中。随后,可将容器和装置放置在可穿透该容器的诸如γ辐射、X射线或高能电子等的辐射场中。辐射可以杀死装置上和容器中的细菌。消毒后的装置随后可以存放在消毒容器中,以备以后使用。还可使用在本领域中已知的任何其它技术进行装置消毒,所述技术包括但不限于β或γ辐射、环氧乙烷或者蒸汽消毒。
尽管已在本发明中示出并描述了多个型式,但是本领域的普通技术人员可在不脱离本发明的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地改进。已经提及若干此类潜在修改形式,并且其它修改形式对于本领域的技术人员而言将会显而易见。例如,上文所讨论的实例、型式、几何形状、材料、尺寸、比率、步骤等等均是示例性的而非所要求的。因此,本发明的范围应以以下权利要求书作考虑,并且应理解为不限于说明书和附图中示出并描述的结构以及操作细节。

Claims (20)

1.一种设备,包括:
(a)外科器械,其中所述外科器械能够切断并且缝合组织的一部分,其中所述外科器械包括近端和远端;
(b)保持器盖,其与所述外科器械的所述远端相连,其中所述保持器盖能够操作以覆盖所述外科器械的所述远端的至少一部分;
(c)支撑材料,其与所述保持器盖相连,其中所述支撑材料能够与所述外科器械的所述远端的一部分联接,其中所述保持器盖能够从所述外科器械的所述远端移除,而不使所述支撑材料脱离所述外科器械的所述远端的所述部分,其中所述支撑材料还能够脱离所述外科器械的所述远端的所述部分。
2.根据权利要求1所述的设备,其中所述外科器械包括砧座,其中所述砧座包括纵向砧座狭槽,其中所述支撑材料能够与所述纵向砧座狭槽联接。
3.根据权利要求2所述的设备,其中所述支撑材料还包括有多个接头,所述多个接头能够卡合到所述纵向砧座狭槽中。
4.根据权利要求3所述的设备,其中所述多个接头包括不可分解的接头。
5.根据权利要求3所述的设备,其中所述多个接头被布置成沿着所述支撑材料的长度朝着交替侧向方向。
6.根据权利要求3所述的设备,还包括远侧推进式切割器,其中所述外科器械限定纵向中心,其中所述切割器基本上沿着所述外科器械的所述纵向中心推进,其中所述多个接头被布置成与所述外科器械的所述纵向中心稍微错开。
7.根据权利要求6所述的设备,其中所述多个接头中的每一个包括主体部分和头部,其中当所述切割器朝远侧推进时,所述切割器能够切断所述头部。
8.根据权利要求2所述的设备,其中所述支撑材料还包括能够操作以滑动到所述纵向砧座狭槽中的T形导轨。
9.根据权利要求1所述的设备,其中所述外科器械包括砧座,其中所述砧座包括多个凹口,其中所述支撑材料还包括多个扣件,所述多个扣件能够联接到所述多个凹口。
10.根据权利要求1所述的设备,其中所述支撑材料包括止血剂。
11.根据权利要求1所述的设备,其中所述支撑材料包括血纤维蛋白垫。
12.根据权利要求1所述的设备,其中所述外科器械包括远侧推进式切刃,其中所述切刃能够使所述支撑材料脱离所述外科器械的远侧部分。
13.根据权利要求1所述的设备,其中所述外科器械的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在将要被切割并缝合的组织周围夹紧所述支撑材料,使得所述支撑材料夹着所述将要被切割并缝合的组织。
14.根据权利要求1所述的设备,其中所述支撑材料的至少一部分包括不可分解的材料。
15.根据权利要求1所述的设备,其中保持器盖包括顶部表面以及底部表面,其中所述支撑材料覆盖所述保持器盖的所述顶部表面,其中所述支撑材料还覆盖所述保持器盖的所述底部表面。
16.一种设备,所述设备包括:
(a)外科器械,所述外科器械包括砧座、下钳口和切割器,其中所述砧座和所述下钳口能够夹紧组织的一部分用于切割,其中所述切割器能够朝远侧推进以切割所述组织的部分;
(b)支撑材料,所述支撑材料能够安装在所述砧座与所述下钳口之间,其中所述支撑材料包括多个接头,其中所述多个接头能够将所述支撑材料联接到所述砧座,其中所述切割器能够切断所述多个接头中的每一个的一部分,从而使所述支撑材料脱离所述砧座。
17.根据权利要求16所述的设备,其中所述支撑材料包括第一层支撑材料和第二层支撑材料,其中所述第一层支撑材料和所述第二层支撑材料能够在其之间夹着将要被切断的组织的一部分。
18.根据权利要求16所述的设备,其中每个接头具有楔形形状,所述楔形形状能够机械地卡合到砧座的纵向砧座狭槽中。
19.根据权利要求16所述的设备,其中所述多个接头包括T形接头,并且能够滑动到砧座的互补纵向砧座狭槽中。
20.一种使用外科器械用于将支撑材料递送到组织的方法,其中所述外科器械包括切割器和缝合器,其中所述切割器能够切割组织的一部分,其中所述缝合器能够缝合组织的一部分,其中所述外科器械还包括砧座和下钳口,其中所述砧座和所述下钳口能够接收支撑材料,其中所述支撑材料与从所述支撑材料延伸的多个接头相连,所述方法包括:
(a)在所述砧座与所述下钳口之间装载所述支撑材料;
(b)在所述支撑材料与所述砧座之间形成相连,其中所述支撑材料与所述砧座之间形成相连的动作包括接合所述多个接头;
(c)将组织定位在所述砧座与所述下钳口之间用于切断和缝合;
(d)切断定位在所述砧座与所述下钳口之间的所述组织的至少一部分;
(e)切断所述多个接头的至少一部分,其中切断所述多个接头的至少一部分的动作和切断组织的至少一部分的动作两者基本上同时进行;
(f)使所述支撑材料脱离所述砧座;以及
(g)将所述支撑材料递送到所切断的组织。
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