CN103945783B - 具有收起的刀片的手术器械 - Google Patents

具有收起的刀片的手术器械 Download PDF

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CN103945783B
CN103945783B CN201280056258.2A CN201280056258A CN103945783B CN 103945783 B CN103945783 B CN 103945783B CN 201280056258 A CN201280056258 A CN 201280056258A CN 103945783 B CN103945783 B CN 103945783B
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A·韦尔曼
W·伯班克
G·杜昆
P·弗拉纳干
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Intuitive Surgical Operations Inc
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Abstract

具有收起的刀片的手术器械，该手术器械包括延长轴、连接到该轴上并且包括两个相对的夹钳的末端执行器、包含在该夹钳的一个中的壳体、安装在该壳体上且可远端移动的第一构件、与该第一构件枢轴地连接的刀、以及第二构件。该刀被配置成当被远端推进时进行切割。在该刀的切割运动过程中，该第一和第二构件以相同速率远端移动，并且在该刀的切割运动过程中，该第二构件阻止该刀相对于该第一构件的转动。移动通过该第一距离之后，该第一和第二构件之间产生相对移动，从而实现准许或引起先前被阻止的该刀的转动以使得该刀可以被收起。

Description

具有收起的刀片的手术器械
技术领域
本申请要求2011年11月15日提交的美国临时申请号61/560,225的权益，将其通过引用以其全部内容并入本文。
背景技术
微创手术技术旨在降低诊断或手术程序中破坏的无关组织的量，由此减少患者的恢复时间、不适感、以及有害副作用。其结果是，使用微创手术技术，可以显著缩短相对标准手术的平均住院天数。此外，使用微创手术还可以减少患者恢复时间、患者不适感、手术副作用、以及不工作的时间。
微创手术的一种常见形式是内窥镜检查，而内窥镜检查的一种常见形式是腹腔镜检查，这是在腹腔内进行的微创检查和手术。在标准腹腔镜手术中，将气体吹入患者的腹部，并且使插管套管穿过一个小的(大约0.5英寸或更少)切口，从而为腹腔镜器械提供入口。
腹腔镜手术仪通常包括用于观察手术范围的内窥镜(例如腹腔镜)以及用于在手术部位工作的工具。工作工具典型地类似于在传统(开放性)手术中使用的那些，除了各个工具的工作端或末端执行器与其手柄被伸缩管(还称为，例如，仪器轴或主轴)隔开之外。该末端执行器可以包括，例如，夹具、抓紧器、剪刀、吻合器、烧灼工具、线性切割器、或持针器。
为进行手术程序，外科医师将工作工具通过插管套管传递到内部手术部位并且从腹腔外操纵它们。外科医师从监视器观察程序，该监视器显示由内窥镜获取的手术部位的图像。类似内窥镜检查技术用于例如关节内窥镜术、腹膜后镜检查、盆腔镜检查、肾镜检查、膀胱镜检查、脑池镜检查(cisternoscopy)、鼻窦镜检查(sinoscopy)、宫腔镜检查、尿道镜检查术等等中。
正在开发的微创远距离手术(telesurgical)机器人系统在其工作在体内手术部位时增加外科医师的灵活性，也可以使外科医师远距离(无菌区域外)对患者进行手术。在远距离手术系统中，通常在控制台上向外科医师提供手术部位的图像。外科医师一边在合适的观察器或显示器上观察手术部位的三维图像，一边通过操纵控制台的主输入端或控制装置对患者执行手术过程。主输入端装置中的每一个控制以伺服系统方式机械致动/铰接的手术器械的动作。在手术过程中，响应于主输入端装置的操作，远距离手术系统可以提供具有外科医师可以执行多种功能(例如，持拿或驱动手术针、抓紧血管或解剖组织等)的末端执行器的各种手术器械或工具的机械致动和控制。
这些末端执行器的操纵及控制是机器人手术系统的特别有益的方面。出于此原因，理想地是提供外科工具，这些工具包括提供末端执行器的三个角度的转动运动的多个机构以模拟外科医师手腕的自然动作。应当适当调整此类机构的大小从而用于微创程序，并且此类机构在设计上应当相对简单以减少可能的故障点。此外，此类机构应当提供足够的移动范围以允许在多种多样的位置中操纵末端执行器。
手术夹紧和切割器械(例如，非机器人线性抓紧、吻合、以及切割装置，也称作外科吻合器；以及电外科学的血管密封装置)已经应用于多种不同手术程序中。例如，可以使用外科吻合器从胃肠道切除癌性或异常组织。许多已知的手术夹紧和切割装置，包括已知的外科吻合器具有用于夹紧组织的相对的夹钳，以及用于对所夹紧组织进行切割的铰链式刀。
手术夹紧和切割器械通常展开进入受限的体腔中(例如，通过插管进入骨盆内部)。因此，理想地是手术夹紧和切割器械是紧凑且有操作性的，用于最佳进入手术部位并且该手术部位可见。然而，已知手术夹紧和切割器械既不紧凑也无操作性。例如，已知的外科吻合器相对于多自由度(例如，横滚、俯仰以及偏航)以及相关的理想移动范围缺少可操作性。典型地，已知的外科吻合器比所希望的具有较小的俯仰移动范围并且不具有偏航运动范围。
此外，手术夹紧和切割器械有时不能充分致动(例如，由于硬障碍物挡住了刀径)，可能使刀片暴露。在这种情况下，理想地是刀片不处于表示关于手术部位的手术器械的移动的危险的位置。然而，已知手术夹紧和切割器械无法在紧凑且有操作性的同时避免可能的刀的危险。
因此，确信存在对改进的手术夹紧和切割器械以及相关方法的需求。此类手术夹紧和切割器械应当是紧凑且有操作性的，并且当该手术器械没有充分致动时采用相对于从手术部位移除手术器械而言不代表着危险的刀。
发明内容
在此披露了改进的手术夹紧和切割器械(例如，外科吻合器，以及电外科学的血管密封装置)以及相关方法。在此描述的手术夹紧和切割器械采用近端-远端的刀的移动，由此定位该刀，从而在该手术器械没有完全致动的情况下，当从手术部位去除手术器械时，降低无意的切割组织的可能性。在此描述的手术器械包括第一和第二移动构件，该第一和第二移动构件以相同速率朝远端移动通过第一距离以切割组织并且随后彼此相对地移动以促进该刀的收起。
因此，在一个方面中，披露了手术器械中致动刀的方法。该手术器械具有近端和远端。该方法包括由第一构件枢轴地支撑该刀。该刀被配置成当该刀朝远端移动时进行切割。在该第一构件以及第二构件以相同速率朝向远端移动时，该刀相对于第一构件的转动由第二构件阻止。在以相同速率朝向远端移动该第一和第二构件之后，该第一和第二构件之间产生相对移动以实现准许该刀的转动或引起该刀的转动中的至少一个。
在多个实施例中，使用导螺杆来致动该第一构件和第二构件。例如，以相同速率朝向远端移动该第一和第二构件可以包括转动导螺杆，该导螺杆具有可操作地连接到该第一构件或第二构件的至少一个上的螺纹部分。该第一和第二构件之间产生相对移动可以包括转动导螺杆，该导螺杆具有螺纹部分以及非螺纹部分。该螺纹部分能够可操作地连接到该第一和第二构件中的一个上并且该非螺纹部分可以与该第一和第二构件中的另一个配合以使得导螺杆的转动在该第一和第二构件之间产生相对移动。
可以使用该第一和第二构件之间的任何适合的相对移动。例如，该第一和第二构件之间产生相对移动可以包括朝向远端移动该第一构件或第二构件中的任一个，同时阻止该第一和第二构件中的另一个朝向该远端移动，使该第二构件相对于第一构件复位，从而不阻碍该刀的转动。作为另一个实例，该第一和第二构件之间产生相对移动可以包括朝向近端移动该第一构件或第二构件中的任一个，同时阻止该第一和第二构件中的另一个朝向该近端移动，使该第二构件相对于第一构件复位，从而不阻碍该刀的转动。
在多个实施例中，该第一和第二构件之间的相对移动引起该刀相对于该第一构件的转动。例如，该刀可以包括与连接到第二构件上的外部轮齿相匹配的外部轮齿，使得第一和第二构件之间的相对移动导致第二构件轮齿相对于该刀的轮齿的移动以及该刀相对于该第一构件的相应的转动。
该刀可以接合一个或更多个结构以选择性地导致该刀转动到理想的位置。例如，该方法可以包括接合该刀与强制降挡(kick-down)结构以导致该刀相对于该第一构件的转动从而将该刀的刃口收到该壳体的上表面之下。作为另一个实例，该方法可以包括接合该刀与连接到第二构件上的强制降挡结构，由此导致该刀相对于该第一构件的转动从而将该刀的刃口收到该壳体的上表面之下。作为一个另外的实例，该方法可以包括接合该刀与强制升结构挡(kick-up)结构以导致在该第一和第二构件以相同速率朝向远端的移动过程中该刀转动到切割位置。
该方法可以进一步包括使用手术器械进行的另外的动作。例如，该方法可以包括在该第一和第二构件以相同速率朝向远端的移动过程中展开吻合钉。
在另一个方面中，披露了一种手术器械。该手术器械包括延长轴，该延长轴具有轴远端以及轴近端，连接到该轴远端并且包括两个相对的夹钳的末端执行器，包含在该夹钳的一个中的壳体，安装在该壳体上且可朝向该壳体远端移动的第一构件，刀，以及第二构件。该第二构件被配置成与该第一构件一起朝向该壳体远端移动通过第一距离。在该第一和第二构件移动通过该第一距离之后，该第一和第二构件之间发生相对移动。该壳体包括壳体近端、壳体远端、在该壳体近端和远端之间延伸的上表面、在该壳体近端和远端之间延伸的中央腔、以及延伸通过该上表面的纵向槽。该刀枢轴地连接在该第一构件上。该刀具有刃口，该刃口被配置成当该第一构件朝向该壳体远端移动时进行切割。该刃口延伸超过该壳体上表面该第一构件的远端移动的至少一部分。当该第二构件与第一构件一起以相同速率朝向该壳体远端移动时，该第二构件阻碍该刀相对于该第一构件的转动，并且实现了在该第一和第二构件之间的相对移动之后准许该刀转动或在该第一和第二构件之间的相对移动过程中引起该刀的转动中的至少一个。
在多个实施例中，该手术器械包括导螺杆，该导螺杆连接在该壳体上以相对于该壳体转动。该螺纹部分可操作地连接到该第一构件或第二构件中的至少一个上以响应于该导螺杆的转动，沿着该导螺杆的至少一部分驱动所连接的构件。例如，该导螺杆可以具有螺纹部分以及配置在该螺纹部分远端的非螺纹部分。当该第二构件与该第一构件一起以相同速率朝向该壳体远端移动时，该第一和第二构件两者都可以沿着该导螺杆驱动。为了产生该第一和第二构件之间的相对移动，该第一和第二构件中的一个可以与该非螺纹部分配合并且该第一和第二构件中的另一个可以与该螺纹部分配合。
该手术器械可以使用该第一和第二构件之间的任何适合的相对移动。例如，当该第二构件相对于该第一构件移动时，该第一构件或第二构件可以朝向该壳体远端移动。作为另一个实例，当该第二构件相对于该第一构件移动时，该第一构件或第二构件可以朝向该壳体近端移动。
在该手术器械的多个实施例中，该第一和第二构件之间的相对移动引起该刀相对于该第一构件的转动。例如，该刀可以包括与连接到第二构件上的轮齿相匹配的轮齿，使得第一和第二构件之间的相对移动导致第二构件轮齿相对于该刀的轮齿的移动以及该刀相对于该第一构件的相应的转动。
在该手术器械的多个实施例中，该第二构件连同该第一构件移动直到对其进行阻止。例如，在该第一构件朝向该壳体远端移动的过程中，可以阻止该第二构件朝向该壳体远端移动以复位该第二构件，从而不阻碍该刀的转动。在多个实施例中，该第二构件可滑动地安装在该第一构件上以与该第一构件一起沿着第一距离移动并且在该第一构件朝向该远端移动的过程中，不朝向该远端移动。
该手术器械可以包括一个或更多个结构以选择性地转动该刀到理想的位置。例如，该手术器械可以包括连接到该壳体上的强制降挡结构以导致该刀相对于该第一构件的转动从而将该刀的刃口收到该壳体的上表面之下。作为另一个实例，该手术器械可以包括连接到该第二构件上的强制降挡结构从而在该第一和第二构件之间的相对运动过程中，导致该刀相对于该第一构件的转动以将该刀的刃口收到该壳体的上表面之下。作为一个另外的实例，该手术器械可以包括与该壳体连接的强制升挡结构以导致在该第一和第二构件以相同速率朝向远端的移动过程中该刀转动到切割位置。
该手术器械可以包括提供另外功能的另外的结构。例如，该壳体可以包括在该上表面与该中央腔之间延伸的多个吻合钉开口。在这些吻合钉开口中可以配置多个吻合钉，每一个吻合钉在该第一和第二构件以相同速率朝向壳体远端的移动过程中展开。
在另一个方面中，披露了一种手术器械的可拆卸附接的筒体(cartridge)。该筒体包括可拆卸附接到该手术器械的末端执行器上的壳体，安装在该壳体中并且可朝向该壳体的远端移动的第一构件，刀，以及第二构件。该第二构件是可操作的，从而与该第一构件一起朝向该远端移动通过第一距离。在该第一和第二构件移动通过该第一距离之后，该第一和第二构件之间发生相对移动。该壳体包括近端、远端、在该近端和远端之间延伸的上表面、在该近端和远端之间延伸的中央腔、以及延伸通过该上表面的纵向槽。该刀枢轴地连接在该第一构件或该第二构件上。该刀具有刃口，该刃口被配置成当朝向该远端移动时进行切割。该刃口相对于该第一构件沿着导螺杆移动的至少一部分延伸通过该纵向槽。当该第二构件与该第一构件一起移动时，该第二构件阻碍该刀相对于该第一构件的转动。在该第一和第二构件之间的相对移动之后，该第二构件实现准许该刀的转动或引起该刀的转动中的至少一个。
在多个实施例中，该筒体包括导螺杆，该导螺杆连接在该壳体上以相对于该壳体转动。该螺纹部分可操作地连接到该第一构件或第二构件中的至少一个上以响应于该导螺杆的转动，沿着该导螺杆的至少一部分驱动所连接的构件。例如，该导螺杆可以具有螺纹部分以及配置在该螺纹部分远端的非螺纹部分。当该第二构件与该第一构件一起以相同速率朝向该壳体远端移动时，该第一和第二构件两者都可以沿着该导螺杆驱动。为了产生该第一和第二构件之间的相对移动，该第一和第二构件中的一个可以与该非螺纹部分配合并且该第一和第二构件中的另一个可以与该螺纹部分配合。
在该筒体的多个实施例中，该导螺杆具有螺纹部分以及相对于该螺纹部分朝向远端配置的非螺纹部分。当该第二构件与该第一构件一起以相同速率朝向该远端移动时，沿着该螺纹部分驱动该第一和第二构件两者。该第一和第二构件中的一个可以与该螺纹部分配合并且该第一和第二构件中的另一个可以与该非螺纹部分配合以响应于该导螺杆的转动产生该第一和第二构件之间的相对移动。
该筒体可以使用该第一和第二构件之间的任何适合的相对移动。例如，当该第二构件相对于该第一构件移动时，该第一构件或第二构件可以朝向该壳体远端移动。作为另一个实例，当该第二构件相对于该第一构件移动时，该第一构件或第二构件可以朝向该壳体近端移动。
在该筒体的多个实施例中，该第一和第二构件之间的相对移动引起该刀相对于该第一构件的转动。例如，该刀可以包括与连接到第二构件上的轮齿相匹配的轮齿，使得第一和第二构件之间的相对移动导致第二构件轮齿相对于该刀的轮齿的移动以及该刀相对于该第一构件的相应的转动。
在该筒体的多个实施例中，该第二构件连同该第一构件移动直到对其进行阻止。例如，在该第一构件朝向该远端移动的过程中，可以阻止该第二构件朝向该远端移动以复位该第二构件，从而不阻碍该刀的转动。在多个实施例中，该第二构件可滑动地安装在该第一构件上以与该第一构件一起沿着第一距离移动并且在该第一构件朝向该远端移动的过程中，不朝向该远端移动。
该筒体可以包括一个或更多个结构以选择性地转动该刀到理想的位置。例如，该筒体可以包括连接到该壳体上的强制降挡结构以导致该刀相对于该第一构件的转动从而将该刀的刃口收到该壳体的上表面之下。作为另一个实例，该筒体可以包括连接到该第二构件上的强制降挡结构从而在该第一和第二构件之间的相对运动过程中，导致该刀的转动以将该刀的刃口收到该壳体的上表面之下。作为一个另外的实例，该筒体可以包括与该壳体连接的强制升挡结构以导致在该第二构件和第一构件以相同速率朝向远端的移动过程中该刀转动到切割位置。
该筒体可以包括提供另外功能的另外的结构。例如，该壳体可以包括在该上表面与该中央腔之间延伸的多个吻合钉开口。在这些吻合钉开口中可以配置多个吻合钉，每一个吻合钉在该第一和第二构件以相同速率朝向远端的移动过程中展开。
为了更详尽地理解本发明的性质和优点，应参考随后的详细说明和附图。由以下附图和详细说明，将明显的了解到本发明的其他方面、目标和优点
附图说明
图1是根据多个实施例，用于进行手术的微创机器人手术系统的平面视图。
图2是根据多个实施例，用于机器人手术系统的外科医师控制台的立体图。
图3是根据多个实施例的机器人手术系统电子手推车(cart)的立体图。
图4是根据多个实施例的机器人手术系统的图解示例。
图5A是根据多个实施例，机器人手术系统的床旁推车(外科机器人)的正视图。
图5B是根据多个实施例的机器人手术工具的正视图。
图6是根据多个实施例，包括具有相对的夹紧夹钳的末端执行器的机器人手术工具的立体图。
图7是根据多个实施例，线性吻合与切割手术器械的可拆卸附接的筒体的立体图。
图8是根据多个实施例，图7的筒体以及附接的吻合钉保持器的立体图。
图9是根据多个实施例，其示出图7的筒体与末端执行器组件之间附接细节的横剖面图。
图10示出图7的筒体的筒体的部件的分解立体图。
图11A和11B示出图7的筒体的印刷电路组件的立体图。
图12A示出图7的筒体的壳体的远端。
图12B包含图7的筒体的吻合钉推进器的立体图。
图13A示出图7的筒体部件相关的刀铰接以及吻合钉展开的立体图。
图13B进一步示出图7的筒体部件相关的刀铰接以及吻合钉展开的立体横剖面图。
图14A到14E根据多个实施例，示出手术器械中刀铰接的示意图。
图15A根据多个实施例，示出手术器械的部件相关的刀铰接以及吻合钉展开的立体图。
图15B根据多个实施例，示出与图15A相连接的导螺杆的立体横剖面图。
图15C示出图15A的部件的分解立体图。
图15D是图15A的部件的可滑动地安装的支撑元件的平面视图。
图16根据多个实施例，示出手术器械的部件相关的刀铰接以及吻合钉展开的侧视图。
图17根据多个实施例，示出手术器械的部件相关的刀铰接以及吻合钉展开的侧视图。
图18根据多个实施例，其列出手术器械中铰接切割刀片的方法的动作。
图19列出图18的方法的可任选的动作。
具体实施方式
在以下描述中，将会描述本发明的多个实施例。为了解释的目的，列举许多特定配置以及细节以便提供对实施例的透彻理解。然而，对于本领域普通技术人员来说还将明显地是，可以在不使用具体细节的情况下实践本发明。此外，为了不模糊本发明的实施例，可以省略或简化已知的结构。
微创机器人手术
现在参照附图，其中贯穿若干视图，相同的参考数字表示相同的部分，图1是微创机器人手术(MIRS)系统10的平面视图示例，该系统典型地用于对躺在手术台14上的患者12进行微创诊断或手术程序。该系统可以包括在手术过程中供外科医师18使用的外科医师操纵台16。一个或更多个助理医师20也可以参与到该手术过程中。该MIRS系统10可以进一步包括床旁手推车22(手术机器人)以及电子手推车24。该床旁手推车22可以通过患者12身体内的微创切口操作至少一个可拆卸地连接的工具组件26(下文简称为“工具”)，同时外科医师18通过操纵台16观察手术部位。可以通过内窥镜28，如立体内窥镜获得手术部位的图像，可以由床旁手推车22操纵内窥镜28以对其进行定位。电子手推车24可以用于处理对随后通过外科医师操纵台16显示给外科医师18的手术部位的图像。一次使用的手术工具26的数量通常应取决于诊断或手术程序以及在其他因素中手术室内的空间限制。如果必需变更手术过程中正使用的工具26中的一个或更多个，助理医师20可以从床旁手推车22上调动该工具26，并且用来自手术室中托盘30的另一个工具26对其进行替换。
图2是外科医师操纵台16的立体图。该外科医师操纵台16包括左眼显示器32以及右眼显示器34，用于向外科医师18呈现手术部位的协同的立体视野从而能够实现纵深感受。操纵台16进一步包括一个或更多个输入控制装置36，其进而致使床旁手推车22(图1中所示)操纵一个或更多个工具。该输入控制装置36可以提供与其所关联的工具26(图1中所示)相同的自由度，从而向外科医师提供远程呈现，或输入控制装置36与工具26整合在一起的感受，以使得外科医师具有直接控制工具26的强烈意识。出于此目的，可以采用位置、力量、以及触觉反馈传感器(未示出)将位置、力量、以及触觉通过输入控制装置36从工具26传递回该外科医师的手部。
该外科医师操纵台16通常位于和患者同一个房间，以使得外科医师可以直接监控手术过程，如果必要的话亲自上场，并且直接与助理医师对话而非经由电话或其他通讯媒体。然而，该外科医师可以位于一个不同的房间中，一个完全不同的建筑中、或允许远距离进行手术程序的远离患者的其他位置。
图3是电子手推车24的立体图。该电子手推车24可以与内窥镜28相联系并且可以包括处理器以处理所捕获的图像以用于随后显示，例如，显示给外科医师操纵台或位于本地和/或远程的另一个适合的显示器上的外科医师的图像。例如，当使用立体内窥镜时，该电子手推车24可以处理所捕获的图像以向外科医师呈现手术部位的协同的立体图像。这种协同可以包括相对的图像之间的对齐并且可以包括调节该立体内窥镜的立体工作距离。作为另一个实例，图像处理可以包括先前确定的相机校准参数的使用，以补偿图像捕获装置的成像错误，如，光学像差。
图4图解示出机器人手术系统50(如图1的MIRS系统10)。如上文所讨论的，外科医师操纵台52(如图1中的外科医师操纵台16)可由一名外科医师使用，以在微创程序过程中控制床旁手推车(手术机器人)54(如图1中的床旁手推车22)。该床旁手推车54可以使用一种成像装置，如立体内窥镜，来捕获操作部位的图像并将所捕获的图像输出到电子手推车56(如图1中的电子手推车24)。如上文所讨论的，在任何后续显示之前，该电子手推车56能以多种方式处理所捕获的图像。例如，在将合成图像经由外科医师操纵台52显示给该外科医师之前，该电子手推车56能将所捕获的图像与虚拟控制界面相叠加。该床旁手推车54可以将所捕获的图像输出以在该电子手推车56外面进行处理。例如，该床旁手推车54可以将所捕获的图像输出给可以用于处理所捕获的图像的处理器58。还可以通过组合电子手推车56和处理器58对这些图像进行处理，该电子手推车和处理器能以连接到一起以共同地、循序地、和/或其组合的方式处理所捕获的图像。还可以将一个或更多个分离的显示器60与处理器58和/或电子手推车56相连接以用于本地和/或远程的图像显示，如操作部位的图像或其他相关的图像。
图5A和5B分别显示床旁手推车22以及手术工具62。该手术工具62是这些手术工具26的实例。所示的床旁手推车22提供了三个手术工具26以及一个成像装置28，如用于捕获操作部位图像的立体内窥镜的操作。可以通过具有多个机器人关节的机器人机构提供操作。可以通过患者身体上的切口对成像装置28和手术工具26进行定位与操作以使得运动学远程中心被保持在切口处以减少切口的大小。当手术部位的图像定位在该成像装置28的视角范围内时，手术部位的图像可以包括手术工具26的远端的图像。
组织夹持末端执行器
图6显示一种手术工具70，该手术工具包括近端72、器械轴74、以及具有可以铰接以夹持患者组织的夹钳78的远端执行器76。该近侧底座包括输入连接器，该输入连接器被配置为与相应的床旁手推车22的输出连接器相配合并由其驱动。该输入连接器与配置在该器械轴74内的驱动轴驱动地连接。这些驱动轴与末端执行器76驱动地连接。
线性吻合与切割手术器械
图7显示根据多个实施例，线性吻合与切割手术器械的可拆卸附接的筒体100。该筒体100被配置为可拆卸地附接到末端执行器的夹钳上。该筒体包括附接到该末端执行器的夹钳上的近端102以及布置在该末端执行器的夹钳上的相应远端处的远端104。该筒体100包括六行吻合钉开口106、纵向槽108、近端刀库110、远端刀库112、以及转动输入端114。在多个实施例中，在每一个吻合钉开口中布置吻合钉以从此处展开。该纵向槽108容纳刀构件(未示出)的切割刀片，当该刀构件从近端刀库110向远端刀库112移动时，该切割刀片由此处延伸。操作中，吻合钉开始在筒体近端102处展开并且继续展开到筒体远端104。切割刀片移动以追踪组织的吻合，从而确保只有完全被吻合的组织被切割。图8显示具有附接的吻合钉保持器116的筒体100，在使用该筒体100之前将该吻合钉保持器去除。
图9是显示根据多个实施例，筒体100附接到末端执行器118的细节的横剖面图。该末端执行器118包括下部夹钳120、上部夹钳122、二自由度机械腕124、转动驱动的夹紧机构126、以及弹簧承载的耦合128。该下部夹钳120被配置为容纳和支撑该筒体100，以及相对于该弹簧承载的耦合128定位该筒体100。该上部夹钳122与该下部夹钳120枢轴连接以相对于该下部夹钳120进行链接从而夹紧组织。该上部夹钳122包括形成凹陷的吻合钉，该凹陷相对于该吻合钉开口106进行配置与定位，从而一旦这些吻合钉展开，其形成“B”型。
该二自由度机械腕124提供该末端执行器118到延长的器械轴130的附接，用于相对于该器械轴130铰接该末端执行器118到两个正交轴周围。可以使用的适合的二自由度机械腕的细节公开在2010年11月12日申请的，名为“具有二自由度机械腕的手术工具(SURGICAL TOOL WITH A TWO DEGREE OFFREEDOM WRIST)”的美国第12/945,748号申请案(律师案卷号ISRG02350/US)中，其全部公开内容由引用并入本文。
转动驱动的夹紧机构126相对于该下部夹钳120致动该上部夹钳122，从而紧固地夹紧上部、下部夹钳之间的组织。夹紧机构126由布置在该器械轴130内部的第一驱动轴132转动驱动。可以使用的适合的转动驱动的夹紧机构的细节公开在2010年11月12日申请的，名为“具有冗余的闭合机构的末端执行器(ENDEFFECTOR WITH REDUNDANT CLOSING MECHANISMS)”的美国第12/945,541号申请案(律师案卷号ISRG02330/US)中，其全部公开内容由引用并入本文。
该弹簧承载的耦合128转动地连接该筒体100的转动输入端114与延伸轴136，该延伸轴由布置在该器械轴130内部的第二驱动轴138转动驱动。该弹簧承载的耦合128包括螺旋弹簧140以及耦合装置142。在所示的实施例中，该耦合装置142采用与该转动输入端114以及该延伸轴136的三面外表面配合的三叶花键插座。该弹簧承载的耦合142容纳当筒体100安装到该末端执行器118中时可能发生的三叶花键的角偏差。当转动到角对准时，该弹簧承载的耦合142与该三叶花键完全接合。该转动输入端114的转动用于平移该筒体100的驱动构件。该驱动构件产生的运动用于展开这些吻合钉并且远端推进刀构件以沿着所展开的吻合钉行的中心向下切割所夹紧的组织。
该末端执行器118包括第一万向节组件148以及第二万向节组件150。该第一万向节组件148转动地连接该夹紧机构126到该第一驱动轴132上。该第二万向节组件150转动地连接该延伸轴136到该第二驱动轴138上。该第一万向节组件148和第二万向节组件150中每一个均被配置为经由适合于末端执行器118相对于器械轴130的俯仰和偏航范围的角度范围传递转矩。可以使用的适合的万向节组件的细节公开在2010年11月12日申请的，名为“双万向节(DOUBLE UNIVERSALJOINT)”的美国第12/945,740号申请案(律师案卷号ISRG02340/US)中，其全部公开内容由引用并入本文。
该第一驱动轴132和第二驱动轴138被布置为与可以独立转动地器械轴130的中心线偏置。可以用于致动该第一驱动轴132和第二驱动轴138的适合的驱动机构的细节公开在2010年11月12日申请的，名为“用于独立转动构件中的平行驱动轴的电动机接口(MOTOR INTERFACE FOR PARALLEL DRIVE SHAFTSWITHIN AN INDEPENDENTLY ROTATING MEMBER)”的美国第12/945,461号的申请案(律师案卷号ISRG02360/US)中，其全部公开内容由引用并入本文。
图10是示例筒体100的部件的分解立体图。所示例的部件包括该保持器116、66个吻合钉152、印刷电路组件(PCA)弹簧154、PCA156、筒体本体158、22个吻合钉推进器160、第一驱动构件144、第二驱动构件145、刀146、导螺杆134、止推垫圈162、导螺杆螺母164、以及罩盖166。该筒体本体158具有排成6行的66个吻合钉开口106，其中3行吻合钉开口106被布置在纵向槽108的每一侧上。该保持器116可拆卸地附接到该筒体100上并且覆盖该吻合钉开口106从而在筒体100的使用之前保持这些吻合钉152。这些吻合钉推进器160与这些吻合钉152相配合并且与该筒体本体158滑动配合。该导螺杆134具有螺纹部分135以及相对于该螺纹部分137朝向远端104布置的非螺纹部分137。该第一驱动构件144沿着该导螺杆134的螺纹部分135的运动导致这些吻合钉推进器160通过该第一驱动构件144的面向远侧的斜面176接合，以相对于该筒体本体158向上驱动这些吻合钉推进器160从而当该第一驱动构件144朝向远端104移动时，展开这些吻合钉152。该刀146由该第一驱动构件144枢轴地支撑。该刀146包括与该第二构件145上的外部轮齿相配合的外部轮齿。该罩盖166附接在该筒体本体158上。
图11A和11B进一步示出PCA156以及PCA弹簧154。该PCA弹簧154与该筒体本体158相配合并且保持PCA156。该PCA弹簧154包括PCA弹簧钩172，该弹簧钩闩扣在该筒体本体158上以保持该PCA弹簧154。当该筒体100附接到该末端执行器118上时，该末端执行器118的器械插脚174在下方滑动并且提升PCA156，由此利用这些器械插脚174电气连接PCA156并且允许增加的相关容差的使用。然而，这种安排不是决定性的，只要这些器械插脚174与PCA156合适地接触。因此，在一些实施例中，PCA156可以在边缘处打开以使得所示的切屑位于负载路径之外。PCA156可以用于电子储存与该筒体100相关联的标识、配置、和/或使用信息。
可以使用以下装配顺序对该筒体100进行装配。首先，使得该筒体本体158处于“底部向上(bottom up)”取向，将这些吻合钉推进器160安装到这些吻合钉开口106中。接着，将第一驱动构件144、由该第一驱动构件144枢轴支撑的刀145、第二驱动构件145、止推垫圈162、以及导螺杆螺母164安装到该导螺杆134上，并且该导螺杆螺母164被激光焊接为平齐于导螺杆134的端部。然后将所得的导螺杆组件安装到该筒体本体158中，其中该第一驱动构件144与第二驱动构件145定位于该导螺杆134的近端处，相对于该第一驱动构件144适当定位该第二驱动构件145从而将刀145相对于该第一驱动构件144放置于适合的取向，以使得当该第一驱动构件144远端推进并且与在该刀145的行进端部附近朝向该筒体本体158的远端收起该刀146一致时，对组织进行切割。然后可以对所得组件进行润滑，例如，通过将所得组件浸入润滑液中。接着，将该罩盖166安装在该筒体本体158上。接下来，将该组件翻转到“顶部向上(top up)”取向并且安装PCA156。接着，将该PCA弹簧154推到该筒体本体158上直到将该PCA弹簧钩172闩扣。接下来，将这些吻合钉152安装到这些吻合钉开口106中并且然后安装保持器116。最终，将数据安装到PCA156中。
图12A示出该筒体本体158的远端。图12B示出这些吻合钉推进器160中一个的顶视图以及立体图。如所示例的，这些吻合钉开口106以及吻合钉推进器160具有互补形状，这样使得这些吻合钉推进器160中的每一个被容纳到这些吻合钉开口106中的一个中，用于当该驱动构件144朝向该筒体远端104平移时，在这些吻合钉开口106之内响应于由驱动构件144驱动的平移。
图13A示出筒体100的组件200，该筒体包括第一驱动构件144、由该第一驱动构件144枢轴支撑的刀146(枢轴销未示出)、以及该第二驱动构件145。图13B示出与该导螺杆134相连接的组件。该第一驱动构件144以及该第二驱动构件145中的每一个包括与导螺杆134的螺纹部分135可操作地连接的内螺纹，用于响应于该导螺杆134的转动沿着该导螺杆134同时发生平移。当该第一和第二驱动构件144、145沿着螺纹部分135平移时，该第一和第二驱动构件144、145保持固定的相对位置，由此经由该第二驱动构件145与该刀146之间的齿轮配合阻碍该刀146相对于该第一驱动构件144的转动。在该刀146的铰接端附近，该第一驱动构件144在该导螺杆134的非螺纹部分137上驱动。此后，该导螺杆134的继续转动导致该第二驱动构件145相对于筒体本体158的继续的远端移动，而第一驱动构件144相对于筒体本体158不继续远端移动。该第二驱动构件145相对于该第一驱动构件144所产生的相对远端移动相对于该第一驱动构件144转动刀146从而收起刀146，例如，收起到纵向槽108中。可以这样配置组件200以使得该第二驱动构件145的远端表面202接触该第一驱动构件144的近端表面204以终止刀146相对于该第一驱动构件144的转动。此后，该第二驱动构件145沿着该螺纹部分135的继续远端运动可以用于远端驱动组件200，例如，进入该筒体158的远端刀库112中。
在所示的实施例中，一旦在非螺纹部分137上驱动该第一驱动构件144，该第二驱动构件145沿着该导螺杆134的继续远端运动可以用于收起该刀146。可替代地，已经在该导螺杆134的非螺纹部分137上驱动该第一驱动构件144之后，可以逆转该导螺杆134的转动方向以相对于该第一驱动构件144最近地移动该第二驱动构件145，由此相对于该第一驱动构件144转动该刀146从而将该刀收到纵向槽108中。
图14A到14E根据多个实施例，示意性地示出用于铰接手术器械210中的刀的另一种方法。该手术器械210包括壳体212、导螺杆134、第一驱动构件214、刀216、第二驱动构件218、刀强制升档结构220、以及刀强制降档结构222。该壳体212包括近端224、远端226、在该近端224和远端226之间延伸的上表面228、近端刀库230、远端刀库232、在该近端224和远端226之间延伸的中央腔、以及在该上表面228与中央腔之间延伸的纵向槽。该导螺杆134安装在该壳体212中用于相对于该壳体212转动，并且在该近端224和远端226之间延伸通过该中央腔。该导螺杆134具有螺纹部分135以及相对于该螺纹部分135朝向远端226布置的非螺纹部分137。该第一和第二驱动构件214、218具有被配置为与导螺杆134的螺纹部分135相连接的内螺纹，用于响应于该导螺杆134的转动沿着该螺纹部分135发生平移。该刀216由该第一驱动构件214枢轴地支撑。该刀强制升档结构220以及该刀强制降档结构222与该壳体212连接，并且具有相对于该壳体212固定的位置。
图14A示出处于起始配置的手术器械210，其中该刀216被布置在该近端刀库230中。该刀216以相对于该第一驱动构件214处于非切割取向形式显示(即，相对于图14B中所示的刀的切割取向转动)。通过减小第一驱动构件214与刀216的组合的初长，该刀的非切割取向可以使得能够使用较短的壳体。较短的壳体提供更加紧凑的手术器械210，由此增强手术部位之内该手术器械的可操作性和/或可视性。可替代地，该刀构件216能从切割部位开始。
由图14A中所示例的起始配置可知，该导螺杆134的转动沿着该导螺杆134同时远端驱动该第一和第二驱动构件214、218。在该第一驱动构件214的初始远端移动过程中，该刀216接触该强制降挡结构220，这导致该刀216相对于该第一驱动构件214转动到图14B中示例的切割位置。在该切割位置处，第二驱动构件218阻碍该刀216相对于该第一驱动构件214的进一步转动。
由图14B中所示例的位置可知，该导螺杆134的继续转动继续沿着该导螺杆134同时远端驱动该第一和第二驱动构件214、218，直到如图14C中所示的，在该导螺杆134的非螺纹部分137上驱动该第一驱动构件214。由图14C中所示例的位置可知，该导螺杆134的继续转动继续沿着该导螺杆134的螺纹部分134仅远端驱动该第二驱动构件218，直到如图14D中所示的，该第二驱动构件218与该第一驱动构件214相接触的地方。在图14D中所示例的位置中，该第二驱动构件218不再定位以阻碍该刀216相对于该第一驱动构件214的转动。由14D中所示例的位置可知，该导螺杆134的继续转动继续沿着该导螺杆134的螺纹部分135驱动该第二驱动构件218，由此还沿着该导螺杆134的非螺纹部分137驱动该第一驱动构件214。在该第一和第二驱动构件214、218的继续远端运动到图14E中所示例的位置的过程中，通过沿着该导螺杆134的非螺纹部分137驱动该第一驱动构件214，该刀216接触该强制降挡结构222，由此确保该刀216向下转动到该纵向槽中以将其收到远端刀库232中。
图15A到15D根据多个实施例，示出用于铰接手术器械中的刀的另一种方法。刀致动组件240包括驱动构件242、刀244、以及支撑构件246。该驱动构件242是具有内螺纹的以可操作地与导螺杆134相连接，用于响应于该导螺杆134的转动沿着该导螺杆134发生平移。该驱动构件242包括被配置为与吻合器推动器相配合的远端朝向的斜面248，从而在该驱动构件242沿着该导螺杆134平移时，展开这些吻合钉。该刀244由该驱动构件242经由枢轴销(未示出)枢轴地支撑。该支撑构件246包括中央槽250、远端部分252以及导销254。该支撑构件246可滑动地安装在该驱动构件242中。当相对于该驱动构件242定位该支撑构件246时，该支撑构件246的远端部分252阻碍该刀244相对于该驱动构件242的转动，如图15A和15B中所示。
该刀致动组件240被配置为保持如图15A和15B中所示的从该刀244的铰接开始到接近该刀244的铰接终止的配置，由此保持该刀244相对于该驱动构件242处于一个切割取向。例如，可以使用该支撑构件246与该驱动构件242之间的干涉配合和/或保持提供(例如，一种粘合剂、一种脆性结构)来防止该支撑构件246与该驱动构件242之间的无意运动。
在接近该刀244的铰接的终止端，该支撑构件246与该壳体的一部分相接触，从而防止该支撑构件246的进一步的远端移动但不防止该驱动构件242的进一步的远端移动。此后，该导螺杆134的继续转动导致该驱动构件242沿着该导螺杆134的进一步的远端移动，由此产生该支撑构件246与该驱动构件242之间的相对移动。该相对移动复位该支撑构件246以复位该支撑构件246的远端部分252以及中央槽250，从而相对于该驱动构件242准许该刀244的先前受阻的转动。一旦该支撑构件246已经相对于该驱动构件242复位从而相对于该驱动构件242准许该刀244的先前受阻的转动，该导螺杆134的继续转动可以用于沿着该导螺杆134进一步远端移动该驱动构件242，这样使得该刀244与强制降挡结构256相接触，从而确保该刀244相对于该驱动构件242的转动以收起该刀244。
图16根据多个实施例，示出用于铰接手术器械中的刀的另一种方法。刀致动组件260包括驱动构件262、刀264、远端构件266、以及导螺杆134。该驱动构件262以及该远端构件264滑动地安装在壳体内并且安装在该导螺杆134上。该驱动构件262包含内螺纹268，从而可操作地与该导螺杆134相连接，用于响应于该导螺杆134的转动沿着该导螺杆134移动该驱动构件262。该远端构件266不是可操作地与该导螺杆134相连接的。反而，该远端构件266由该驱动构件262沿着该导螺杆134远端推动。由于该远端构件266由该驱动构件262沿着该导螺杆134远端推动，该远端构件266包括被配置为与吻合钉推动器相接合的面向远端的斜面270。该刀264由该驱动构件262经由枢轴销272枢轴地支撑。
当该驱动构件262沿着该导螺杆推动该远端构件264时，该组件260被配置为使该刀264处于切割位置的取向，并且当该驱动构件262相对于该远端构件264近端移动时，收起该刀264。该远端构件264包括与该刀264相配合的配合结构274，从而使得该刀264相对于该驱动构件262进行转动取向。当该驱动构件262推动该远端构件264时，该配合结构272被定位以使得该刀264处于切割位置取向并且阻止该刀264围绕该枢轴销272的转动，由此保持该刀264处于切割位置。当该驱动构件262相对于该远端构件266近端移动时，该配合结构272还引起该刀264相对于该驱动构件262的转动，由此收起该刀264。在操作中，首先转动该导螺杆134以沿着该导螺杆134远端推进该驱动构件262，由此沿着该导螺杆134推动该远端构件266以展开吻合钉并保持该刀264在切割位置。在该组件260的远端移动的终止端处，可以逆转该导螺杆134的转动方向以相对于该远端构件266近端缩回该驱动构件262，由此经由接合结构272与该刀264之间的相互作用，引起该刀264向下转动到收回位置中。
图17根据多个实施例，示出用于铰接手术器械中的刀的另一种方法。刀致动组件280包括驱动构件282、刀284、刀橇(knife sled)286、以及导螺杆134。该驱动构件282以及该刀橇286滑动地安装在壳体内。该驱动构件282包含内螺纹，从而可操作地与该导螺杆134相连接，用于响应于该导螺杆134的转动沿着该导螺杆134移动该驱动构件282。该刀橇286可由该驱动构件282经由该驱动构件282与该刀橇286的驱动结构288之间的接触远端驱动。该刀284由该刀橇286经由枢轴销290枢轴地支撑。该刀284相对于该刀橇286的角取向是通过该驱动构件282的配合结构292与该驱动构件282相对于该刀橇286的位置相连接的，该配合结构与该刀284相配合以控制该刀284相对于该刀橇286的角取向。由于该驱动构件282沿着该导螺杆134远端移动，该驱动构件282包括被配置为与吻合钉推动器相接合的面向远端的斜面294。
当该驱动构件282沿着该导螺杆134推动该刀橇286时，该组件280被配置为使该刀284处于切割位置的取向，并且当该驱动构件282相对于该刀橇286近端移动时，收起该刀284。在操作中，首先转动该导螺杆134以沿着该导螺杆134远端推进该驱动构件282，由此在远端方向上推动该刀橇286并且角取向该刀284在切割位置。在该组件280的远端移动的终止端处，可以逆转该导螺杆134的转动方向以相对于该刀橇286近端缩回该驱动构件282，由此经由接合结构292与该刀284之间的相互作用，引起该刀284向下转动到收回位置中。
组合和/或改型
在此披露的手术器械、组件、以及筒体能以任何合适的方式被改型和/或组合。例如，在此描述的筒体100可以改型以采用在此描述的手术器械210中体现的刀铰接方法，采用如在此描述的刀致动组件240、刀致动组件260、或刀致动组件280。同样，在此描述的手术器械210可以改型以采用如在此描述的刀致动组件200、采刀致动组件240、刀致动组件260、或刀致动组件280。并且在此披露的手术器械、组件、以及筒体，或上述改型所得物能以拆卸地可安装的筒体体现，如筒体100，并且可以直接体现在手术器械中而无需拆卸地可安装到手术器械的末端执行器上。
刀铰接方法
图18根据多个实施例，示出在手术器械中铰接刀的方法300的动作。可以使用任何适合的手术器械(例如，吻合与切割手术器械、电外科学的血管密封装置)来实施该方法300。例如，可以使用在此描述的线性吻合与切割手术器械、筒体、以及相关的组件来实施该方法300。
在动作302中，刀由第一构件枢轴地支撑。该刀被配置成当该刀构件朝向壳体远端移动时进行切割。在动作304中，当该第一和第二构件以相同速率朝向远端移动时，该刀相对于该第一构件的转动由第二构件阻止。在动作306中，在该第一和第二构件以相同速率朝向远端移动之后，该第二构件相对于该第一构件移动以实现准许该刀的阻碍的转动或引起该刀的阻碍的转动中的至少一个。
图19根据多个实施例，示出可以在该方法300中实现的任选的动作。在任选的动作308中，转动导螺杆从而沿着该导螺杆远端移动该第一和第二构件。在任选的动作310中，转动具有螺纹部分和非螺纹部分的导螺杆，，从而相对于该第一构件移动该第二构件。在任选的动作312中，响应于该第一和第二构件之间的相对移动，相对于该第一构件转动刀构件。在任选的动作314中，该第一和第二构件中的一个朝向远端移动而阻止该第一和第二构件中的另一个朝向该远端移动，以使该第二构件复位，从而不阻碍该刀的转动。在任选的动作316中，接合该刀与强制降挡结构以导致该刀的转动从而将该刀的刃口收到该手术器械的壳体的上表面之下。在任选的动作318中，接合该刀与连接到第二构件上的强制降挡结构导致该刀的转动从而将该刀的刃口收到该手术器械的壳体的上表面之下。在任选的动作320中，接合该刀与强制升挡结构以在该第一和第二构件以相同速率朝向远端的移动过程中该刀转动到切割位置。在任选的动作322中，在该第一和第二构件以相同速率朝向远端的移动过程中展开吻合钉。
在此披露的方法可以用于任何合适的应用。例如，在此披露的方法可以用于手术器械、手动或电动的、手提式的或机器人式的、直接控制或远距离操作的、用于开放性或微创(单开口或多开口)的程序。
其他变体在本发明的精神之内。因此，虽然本发明易受各种改型和可替代结构的影响，但其某些示例的实施例在附图中示出并且已在上文进行了详细描述。然而，应理解，并不意图将本发明限于所披露的(一种或多种)特定形式，而相反，本发明意图涵盖落在如所附权利要求书所限定的本发明的精神和范围内的所有改型、替代结构以及等同物。
术语“力(force)”将被构造为涵盖力和扭矩两者(尤其是在以下权利要求的上下文中)，除非在文中另外地指明或明显与上下文相悖。在描述本发明的上下文中(尤其在以下权利要求的上下文中)使用术语“一个”和“一种”以及“该”和类似指示对象将被构造为同时覆盖单数和复数，除非在文中另外地指明或明显与上下文相悖。除非另外指出，术语“包括(comprising)”、“具有(having)”、“包含(including)”、以及“含有(containing)”将被构造为开放性术语(即，意指“包括但不限于，”)。术语“连接的”将被构造为部分地、或整个地包含在内、附接到、或交接在一起，即便存在某物的介入。本文中所叙述的数值范围仅仅作为一种单独地提及落入范围内的每一个不同的值的速记方法，除非在此另有指明，并且每一个不同的值都并入本说明书中，如同这些值在此被单独地叙述一样。在此所描述的所有方法都可以按任何适当次序加以执行，除非在此另有指明或上下文有明确的反面说明。在此提供的任一种或全部的实例或示例性语言(例如，“如”)仅仅意在更好地阐明本发明实施例并且除非另外声明，其不对本发明范围造成任何限制。本说明书中任何语言都不应被构造为将任一非主张的要素指示为是实践本发明所必需的。
在此描述了本发明的多个优选实施例，包括发明人已知的用于实施本发明的最佳模式。在阅读前述描述后，对本领域的普通技术人员而言，这些优选实施例的变化可以变得显而易见。本发明人预期本领域的技术人员可以在适当时采用这些变化，并且本发明人意图使本发明以与在此具体描述的方式不同的方式来进行实践。因此，在适用法律允许的情况下，本发明包括对所附权利要求书所叙述的主题的所有改型和等同物。此外，本发明包括上述元件在上述元件的所有可能的变化的情况下的任意组合，除非在此另有说明或者根据上下文另有明确的反面说明。
在本文引用的所有参考文件，包括公开文件、专利申请和专利，都通过引用并入本文，并且其相同程度就如同单独地且确切地指明每一个参考文件是通过引用而并入本文并以其全文在此提出。

Claims (18)

1.一种手术器械，其包括：
延长轴，该延长轴具有轴远端以及轴近端；
连接到该轴远端并且包括两个相对的夹钳的末端执行器；
包含在该夹钳的一个中的壳体；该壳体包括壳体近端、壳体远端、在该壳体近端和远端之间延伸的上表面、在该壳体近端和该壳体远端之间延伸的中央腔、以及延伸通过该上表面的纵向槽；
安装在该壳体中且朝向该壳体远端可移动的第一构件；
第二构件，该第二构件被配置成与该第一构件一起以相同速率朝向该壳体远端移动第一距离，在该第一构件和该第二构件移动通过该第一距离之后，该第一构件和该第二构件之间发生相对移动，当与该第一构件一起以相同速率朝向该壳体远端移动时该第二构件阻止刀相对于该第一构件的转动，并且在该第一构件和该第二构件之间的相对移动之后准许该刀转动；以及
其中，该刀与该第一构件枢轴地连接，该刀延伸通过该纵向槽，该刀具有刃口，该刃口被配置成当该第一构件朝向该壳体远端移动时进行切割，相对于该第一构件的远端移动的至少一部分，该刃口在该壳体上表面上方延伸。
2.如权利要求1所述的手术器械，进一步包括导螺杆，该导螺杆与该壳体相连接以相对于该壳体转动，该导螺杆与该第一构件或该第二构件中的至少一个可操作地连接以响应于该导螺杆的转动，沿着该导螺杆的至少一部分驱动所连接的构件。
3.如权利要求2所述的手术器械，其中，该导螺杆具有螺纹部分以及相对于该螺纹部分远端布置的非螺纹部分，当该第二构件与该第一构件一起以相同速率朝向该壳体远端移动时，该第一构件和该第二构件两者都沿着该导螺杆被驱动并且该第一构件和该第二构件中的一个与该非螺纹部分配合并且该第一构件和该第二构件中的另一个与该螺纹部分配合从而产生该第一构件和该第二构件之间的相对移动。
4.如权利要求1所述的手术器械，其中，当该第二构件相对于该第一构件移动时，该第一构件或该第二构件朝向该壳体远端移动。
5.如权利要求1所述的手术器械，其中，当该第二构件相对于该第一构件移动时，该第一构件或该第二构件朝向该壳体近端移动。
6.如权利要求1所述的手术器械，其中，该刀包括与连接到该第二构件的轮齿相匹配的轮齿，使得该第一构件和该第二构件之间的相对移动导致该刀相对于该第一构件的转动。
7.如权利要求1所述的手术器械，其中，该第二构件可滑动地安装至该第一构件以与该第一构件一起沿着该第一距离移动，并且在该第一构件和该第二构件已经移动通过该第一距离之后，该第二构件在该第一构件朝向该远端移动的过程中，不朝向该远端移动。
8.如权利要求1所述的手术器械，包括与该壳体连接的强制升挡结构以导致在该第二构件与该第一构件一起以相同速率朝向该壳体远端的移动过程中该刀转动到切割位置。
9.如权利要求1所述的手术器械，其中，该壳体包括在该上表面与该中央腔之间延伸的多个吻合钉开口，该手术器械包括布置在这些吻合钉开口中的多个吻合钉，每一个吻合钉在该第一构件和该第二构件以相同速率朝向该壳体远端的移动过程中展开。
10.一种手术器械的可拆卸附接的筒体，该筒体包括：
可拆卸附接到该手术器械的末端执行器的壳体；该壳体包括近端、远端、在该近端和远端之间延伸的上表面、在该近端和远端之间延伸的中央腔、以及延伸通过该上表面的纵向槽；
安装在该壳体中并且可朝向该远端移动的第一构件；第二构件，该第二构件是可操作的，从而与该第一构件一起朝向该远端移动通过第一距离，在该第一构件和该第二构件移动通过该第一距离之后，该第一构件和该第二构件之间发生相对移动，当与该第一构件移动时该第二构件阻止刀相对于该第一构件的转动，并且在该第一构件和该第二构件之间的相对移动之后准许该刀转动；以及
并且，该刀与该第一构件枢轴地连接，该刀具有刃口，该刃口被配置成当该刀朝向该远端移动时进行切割，相对于该第一构件的远端移动的至少一部分，该刃口延伸通过该纵向槽。
11.如权利要求10所述的筒体，进一步包括导螺杆，该导螺杆与该壳体相连接以相对于该壳体转动，该导螺杆与该第一构件或该第二构件中的至少一个可操作地连接以响应于该导螺杆的转动，沿着该导螺杆的至少一部分驱动所连接的构件。
12.如权利要求11所述的筒体，其中，该导螺杆具有螺纹部分以及相对于该螺纹部分远端布置的非螺纹部分，当该第二构件与该第一构件一起以相同速率朝向该远端移动时，该第一构件和该第二构件两者都沿着该导螺杆被驱动并且该第一构件和该第二构件中的一个与该非螺纹部分配合并且该第一构件和该第二构件中的另一个与该螺纹部分配合从而响应于该导螺杆的转动产生该第一构件和该第二构件之间的相对移动。
13.如权利要求12所述的筒体，其中，当该第二构件相对于该第一构件移动时，该第一构件或该第二构件朝向该远端移动。
14.如权利要求12所述的筒体，其中，当该第二构件相对于该第一构件移动时，该第一构件或该第二构件朝向该近端移动。
15.如权利要求10所述的筒体，其中，该刀包括与连接到该第二构件的轮齿相匹配的轮齿，使得该第一构件和该第二构件之间的相对移动导致该刀相对于该第一构件的转动。
16.如权利要求10所述的筒体，其中，该第二构件可滑动地安装至该第一构件以与该第一构件一起沿着该第一距离移动，并且在该第一构件和该第二构件已经移动通过该第一距离之后，该第二构件在该第一构件朝向该远端移动的过程中，不朝向该远端移动。
17.如权利要求10所述的筒体，包括与该壳体连接的强制升挡结构以导致在该第二构件与第一构件一起以相同速率朝向远端的移动过程中该刀转动到切割位置。
18.如权利要求10所述的筒体，其中，该壳体包括在该上表面与该中央腔之间延伸的多个吻合钉开口，该筒体包括布置在这些吻合钉开口中的多个吻合钉，每一个吻合钉在该第一构件和该第二构件以相同速率朝向该远端的移动过程中展开。
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