CN103957817A - 用于外科紧固装置的砧座仓 - Google Patents

用于外科紧固装置的砧座仓 Download PDF

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CN103957817A
CN103957817A CN201280057058.9A CN201280057058A CN103957817A CN 103957817 A CN103957817 A CN 103957817A CN 201280057058 A CN201280057058 A CN 201280057058A CN 103957817 A CN103957817 A CN 103957817A
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anvil block
storehouse
anvil
equipment according
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CN103957817B (zh
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S·J·巴利克
C·P·布德罗克斯
M·D·霍尔科布
E·A·雷哈德
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Ethicon Endo Surgery Inc
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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
    • 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
    • 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
    • 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
    • A61B2017/07257—Stapler heads characterised by its anvil
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B2017/320052—Guides for cutting instruments

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Abstract

一种外科器械包括：柄部部分；容纳击发杆的轴；包括砧座、下钳口以及响应于所述柄部部分和所述轴产生的纵向闭合运动的缝合和切断组件的端部执行器。所述下钳口能够接收可移除的仓。所述仓包括外壳、设置在所述外壳内的多个钉以及设置在所述多个钉之上的平台。所述平台限定孔，其中每个孔基本上设置在每个钉之上。所述器械包括可移除地接收在砧座框架中的砧座仓。当所述击发杆推进经过组织时，所述砧座仓由所述击发杆切断，使得来自所述砧座仓的材料释放到所述切断的组织上。

Description

用于外科紧固装置的砧座仓
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经过套管针的插管使得远侧端部执行器放置在期望手术部位。这些远侧端部执行器能通过多种方式啮合组织以便达到诊断或治疗的效果，所述远侧端部执行器如直线切割器、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。内窥镜式外科器械可包括轴，所述轴在端部执行器与临床医生所操纵的柄部部分之间。此轴可允许插入到期望深度并且围绕轴的纵向轴线旋转，由此有利于端部执行器在患者体内定位。还可通过包含一个或多个关节运动接头或结构以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。一些此类缝合器能够操作以向下夹紧组织层，切穿被夹紧的组织层并将钉驱动经过组织层，以在组织层的切断末端附近将切断的组织层大体密封在一起。仅示例性外科缝合器被公开在以下专利中：于1989年2月21日公布的名称为“PocketConfiguration for Internal Organ Staplers”的美国专利4,805,823；于1995年5月16日公布的名称为“Surgical Stapler and Staple Cartridge”的美国专利5,415,334；于1995年11月14日公布的名称为“Surgical StaplerInstrument”的美国专利5,465,895；于1997年1月28日公布的名称为“Surgical Stapler Instrument”的美国专利5,597,107；于1997年5月27日公布的名称为“Surgical Instrument”的美国专利5,632,432；于1997年10月7日公布的名称为“Surgical Instrument”的美国专利5,673,840；于1998年1月6日公布的名称为“Articulation Assembly for Surgical Instruments”的美国专利5,704,534；于1998年9月29日公布的名称为“Surgical ClampingMechanism”的美国专利5,814,055；于2005年11月15日公布的名称为“Surgical Stapling Instrument having Articulation Joint Support Plates forSupporting a Firing Bar”的美国专利6,964,363；于2005年12月27日公布的名称为“Surgical Stapling Instrument Incorporating an E-Beam FiringMechanism”的美国专利6,978,921；于2006年1月24日公布的名称为“Surgical Stapling Instrument Having a Spent Cartridge Lockout”的美国专利6,988,649；于2006年2月21日公布的名称为“Surgical Stapling InstrumentHaving Separate Distinct Closing and Firing Systems”的美国专利7,000,818；于2006年9月26日公布的名称为“Surgical Instrument Incorporating anArticulation Mechanism having Rotation about the Longitudinal Axis”的美国专利7,111,769；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7,143,923；于2007年12月4日公布的名称为“Surgical Stapling InstrumentIncorporating a Multi-Stroke Firing Mechanism with a Flexible Rack”的美国专利7,303,108；于2008年5月6日公布的名称为“Surgical StaplingInstrument Incorporating a Multistroke Firing Mechanism Having a RotaryTransmission”的美国专利7,367,485；于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7,380,695；于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7,380,696；于2008年7月29日公布的名称为“Surgical Stapling and Cutting Device”的美国专利7,404,508；于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7,434,715；于2010年5月25日公布的名称为“Disposable Cartridge with Adhesive for Use with aStapling Device”的美国专利7,721,930；以及于2008年11月25日公布的名称为“Surgical Instrument with Articulating Shaft with Rigid Firing BarSupports”的美国专利7,455,208。上文所引用的美国专利中的每个中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，但是据信，在本发明人前尚未有人研制出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描绘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描绘了图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描绘了图1A-1B的外科器械的打开的端部执行器的透视图；
图3A描绘了沿图2的线3-3截取的图2的端部执行器的侧视横截面图，其中击发杆处于近侧位置；
图3B描绘了沿图2的线3-3截取的图2的端部执行器的侧视横截面图，其中击发杆处于远侧位置；
图4描绘了沿图2的线4-4截取的图2的端部执行器的端视横截面图；
图5描绘了图2的端部执行器的分解透视图；
图6描绘了图2的端部执行器的透视图，所述端部执行器被定位在组织处并且已在组织中被致动一次；
图7描绘了图2的端部执行器的砧座的型式的局部透视图，并且砧座仓能够可移除地接收在砧座的开口中；
图8描绘了砧座仓的替代型式的从远侧至近侧正视图；
图9描绘了图2的端部执行器的砧座和下钳口的替代型式的从远侧至近侧正视图，砧座和下钳口分别包括仓；
图10描绘了图2的端部执行器的砧座的替代型式的从远侧至近侧正视图，砧座包括砧座仓的另一型式并且砧座开口能够接收该砧座仓；
图11描绘了图2的端部执行器的砧座的替代型式的从远侧至近侧正视图，砧座包括砧座仓的另一型式并且砧座开口能够接收该砧座仓；并且
图12描绘了具有包括组织修复组合物的砧座仓的端部执行器的透视图，端部执行器定位在组织内并在组织内致动以将组织修复组合物释放到组织上。
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
对本发明的某些例子的如下描述不应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、特征、形态、实施例和优点对于本领域的技术人员而言将变得显而易见。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1-6描绘了示例性外科缝合和切断器械10，在图1A中描绘的非关节运动的状态下，其尺寸设定成经过套管针的插管通道插入患者的手术部位，以便执行外科手术。外科缝合和切断器械10包括连接至执行部分22的柄部部分20，所述执行部分还包括轴23，该轴在远侧终止于关节运动机构11以及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经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件13进行远程关节运动，如在图1B中所描绘。由此，端部执行器12可从期望角度或为其它原因到达器官后面或接近组织。应当理解，诸如“近侧”和“远侧”的术语在本文中是参考器械10中临床医生抓握的柄部部分20而使用的。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，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与远侧部分(闭合环)33连通。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经过轴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地拉动，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2-5示出了端部执行器12，其采用了E形梁击发杆14来执行多个功能。如图3A-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延伸经过通道狭槽45(如图3B所示)而可滑动地接合下钳口16的下表面，该通道狭槽形成为经过下钳口16。中间销46可滑动地接合下钳口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，对于最小量的夹紧组织克服在砧座18与下钳口16之间可能出现的收缩，并且对于过多量的夹紧组织克服钉变形。
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4-5中最佳地示出，这个例子中的钉仓37包括仓体70，所述仓体具有上部平台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被形成为经过钉仓37的一部分。还如图2中最佳地示出，三行钉孔51在竖直狭槽49一侧上形成为经过上部平台72，其中另一组的三行钉孔51在竖直狭槽49另一侧上被形成为经过上部平台72。重新参见图3-5，楔形滑动件41和多个钉驱动器43被捕集在仓体70与托盘74之间，其中楔形滑动件41被定位成邻近钉驱动器43。楔形滑动件41可在钉仓37内纵向运动；而钉驱动器43可在钉仓37内竖直地运动。钉47也被定位在仓体70中，处于对应钉驱动器43上方。具体地讲，每个钉47在仓体70中被钉驱动器43竖直地驱动，以驱动钉47从相关钉孔51穿出。如图3A-3B和5中最佳地示出，楔形滑动件41提供倾斜凸轮表面，当朝向远侧驱动楔形滑动件41经过钉仓37时，倾斜凸轮表面向上推压钉驱动器43。
利用如图3A所示那样闭合的端部执行器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朝远侧推进经过钉仓37时，楔形滑动件41被推块80朝远侧推压。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-3B所示，中间销46和推块80通过进入钉仓37内的击发狭槽而一起致动钉仓37，从而驱动楔形滑动件41与钉驱动器43进行向上凸起接触，继而将钉47向外驱动经过钉孔51并使钉47与砧座18的内表面上的钉成形凹坑53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行程而被致动经过组织90。如图所示，切刃48已经切穿组织90，同时钉驱动器43已经驱动三行交替的钉47经过由切刃48产生的切割线的每一侧上的组织90。此例子中，钉47全部被取向成与切割线基本上平行，但应理解，钉47可定位成处于任何合适取向。本例子中，在第一行程完成之后，端部执行器12从套管针撤回，用完的钉仓37会由新的钉仓取代，然后，端部执行器12再次插入经过套管针以到达缝合部位，以便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，在每个致动行程期间，切刃48可基本上在驱动钉47经过组织的同时切断组织。本例子中，切刃48仅稍稍落后于钉47的驱动，使得正好在切刃48经过组织的相同区域前，钉47驱动经过该组织，但应理解，这个顺序可以颠倒，或者切刃48可直接与相邻的钉同步。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可被致动经过组织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产生的切割线相邻的钉47的成形和定位可基本上密封该切割线处的组织，由此减少或者防止切割线处出血和/或体内其它流体泄漏。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4,805,823；美国专利5,415,334；美国专利5,465,895；美国专利5,597,107；美国专利5,632,432；美国专利5,673,840；美国专利5,704,534；美国专利5,814,055；美国专利6,964,363；美国专利6,978,921；美国专利6,988,649；美国专利7,000,818；美国专利7,111,769；美国专利7,143,923；美国专利7,303,108；美国专利7,367,485；美国专利7,380,695；美国专利7,380,696；美国专利7,404,508；美国专利7,434,715；美国专利7,721,930；和/或美国专利7,455,208。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内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.示例性砧座仓
图7-8示出了被设置在砧座101的砧座框架102中的示例性砧座仓100A、100B，除非如下所述，否则砧座101类似砧座18。砧座仓100A、100B可以保持各种材料或由各种材料形成，所述材料诸如胶水、织物和/或参考本文中的教导内容将会对本领域的普通技术人员显而易见的各种材料。当致动具有砧座仓100A、100B的端部执行器12时，合适材料可以沉积在组织上。
如图7所示，砧座仓100A能够在箭头A的方向上可移除地接收在砧座框架102中。砧座框架102的远端104限定孔106，其尺寸设定成接收砧座仓100A的对应成型部分108。孔106设置在砧座狭槽103上方并与其连通，所述砧座狭槽103类似上述砧座狭槽42。砧座仓100A包括向下突出部分110，所述向下突出部分的尺寸设定成接收在砧座狭槽103中。
如图8所示，砧座仓100B或者可省略向下突出部分110，但是包括砧座仓100B的接收在砧座框架102的孔106中的部分108，使得部分108仍与砧座狭槽42连通。在任一情况中，如上所述，击发杆14可被击发经过砧座狭槽103，以便切穿砧座仓100A、100B并将材料从砧座仓100A、100B释放到组织90上，同时砧座101与端部执行器12的下钳口16协作以夹紧组织90。同时，来自仓37的钉47可朝向砧座101上的钉凹坑(未示出)被向上驱动以形成钉，该钉附接组织90并将组织90中的部分固定在一起，如上所述。
在使用中，在砧座仓100A、100B被附接到砧座框架102，端部执行器12将如上述那样进行操作以便切断并且缝合组织90。由击发杆14切断的砧座仓100A、100B的材料可以沉积在组织90上。仅以举例方式，砧座仓100A、100B可形成为支撑物，以便在结构上支撑钉线。除此之外或作为另外一种选择，砧座仓100A、100B可由例如包括止血剂的材料构成，该止血剂帮助凝聚血液并且减少沿组织90的所述切断的和/或经缝合的手术部位处的出血。除此之外或作为另外一种选择，砧座仓100A、100B可包括能够操作以有助于如上所述组织修复的可生物降解的聚合物。另外，当外科钉47由器械10以上述方式驱动到组织中时，外科钉47将压缩、连接并保持组织90的此类层92、94，如图12所示。来自砧座仓100A、100B的材料将会接触组织90并且释放到组织90上，以通过减少手术部位处的出血量来有助于组织修复。除此之外或作为另外一种选择，来自砧座仓100A、100B的材料可以增强组织90通过钉47的机械附接的完整性。外科钉47可以包含选自铁、镍钛合金、不锈钢和/或钛的材料。当然，也可使用任何其它合适材料。
用于来自砧座仓100A、100B的材料可以括例如助剂或止血剂，诸如帮助凝聚血液并且减少手术部位处的出血量的血纤维蛋白或凝血酶。此类助剂的止血能力还可有助于将此类助剂用作粘接剂和密封剂。试剂可有助于凝聚手术部位处的血液，这就允许这些血液周围的组织粘在一起，并可例如防止沿着经缝合的组织部位泄漏。助剂所形成的砧座仓100A、100B还可包括各粘合剂、治愈试剂和/或抗微生物试剂等等。此类助剂或者试剂可进一步包括但不限于：医用流体或者支撑物组分，诸如缺乏血小板的血浆(PPP)、富含血小板的血浆(PRP)、淀粉、脱乙酰壳多糖、藻酸酯盐、血纤维蛋白、多糖、纤维素、胶原、牛胶原、明胶-雷琐辛-福尔马林粘合剂、氧化纤维素、基于贻贝的粘合剂、聚(氨基酸)、琼脂糖、直链淀粉、透明质素、聚羟基丁酸酯(PHB)、透明质酸、聚(乙烯基吡咯烷酮)(PVP)、聚(乙烯醇)(PVA)、聚交酯(PLA)、聚乙交酯(PGA)、聚己内酯(PCL)以及它们的共聚物；(Ethicon,Inc.,Somerville,N.J.)；MONOCRYL材料；PANACRYL(Ethicon,Inc.,Somerville,N.J.)；和/或适于与生物材料混合并引入创伤或缺陷部位的其它材料，包括材料组合。例如，砧座仓100A、100B可以包括选自以下材料中的材料：ε-己内酯-乙交酯、牛心包膜、聚乳酸、聚乙醇酸、聚丙交酯共乙交酯(polyglactin)、聚对二氧环己酮、聚葡萄糖酸盐、乳清蛋白、纤维素胶、淀粉、明胶、丝绸、尼龙、聚丙烯、编织聚酯、聚丁酯(polybutester)、聚乙烯和/或聚醚醚酮。参照本文中的教导内容，可以用于医用流体或者支撑物的其它合适化合物、材料、物质等等将对本领域的普通技术人员显而易见。
在一些型式中，医用流体可以悬浮在生物相容性载体中，以便形成砧座仓100A、100B的材料合适载体可以包括例如生理缓冲溶液、流动性凝胶溶液、盐水溶液和水。在凝胶溶液情况下，组织修复组合物在递送到目标部位处之前可为可流动的凝胶形式或可形成凝胶，且在递送到目标部位之后保持处于适当位置。可流动的凝胶溶液可以包括具有或不具有添加的水、盐水溶液或生理缓冲溶液的一种或多种胶凝材料。合适胶凝材料包括生物材料和合成材料。示例胶凝材料包括蛋白、多糖，多核苷酸以及其它材料，诸如藻酸酯盐、交联藻酸酯盐、聚(N-异丙基丙烯酰胺)、聚(氧化烯)、聚(环氧乙烷)-聚(环氧丙烷)的共聚物、聚(乙烯醇)、聚丙烯酸酯或单硬脂酰甘油共-琥珀酸盐(co-Succinate)/聚乙二醇(MGSA/PEG)共聚物以及任何上述项的组合。
根据例如于2009年5月14日公布的名称为“Surgical Fastening Devicewith Initiator Impregnation of a Matrix or Buttress to Improve AdhesiveApplication”的美国专利申请公开2009/0120994的教导内容，砧座仓100A、100B可以包括纤维垫、泡沫、基体、网片或者另一结构，该专利申请的公开内容以引用的方式并入本文。材料可以包括例如其中具有多个开口的基体、开孔或闭孔泡沫和/或纤维垫。材料可以包括多孔部分，所述多孔部分引起芯吸结构将粘合剂拉动到材料中并且确保开口保持无粘合剂，从而允许在施加到组织90之后经过开口进行组织生长。
除此之外或作为另外一种选择，砧座仓100A、100B例如可包括但不限于诸如氰基丙烯酸酯粘合剂之类的可聚合的和/或可交联的材料的粘合剂。例如，该粘合剂可为单体(包括预聚物的)粘合剂组合物、聚合物的粘合剂组合物或者可以粘附到组织的任何其它化合物。在一些型式中，单体可为1,1-二取代的乙烯单体，例如，α-氰基丙烯酸酯。当交联或者聚合时，氰基丙烯酸酯可从液体变为固体。例如，聚合的粘合剂可配制成从柔性到刚性，并且可以是海绵状。如果需要，该粘合剂可以为一元或二元粘合剂，和/或可以包含诸如可转化化合物(alternate compound)的添加剂。粘合剂的聚合可发生自(但不限于)暴露于水分中、暴露于热量中和/或暴露于诸如美国专利申请公开2009/0120994中描述的粘合引发剂中，该专利申请的公开内容以引用的方式并入。参考本文中的教导内容，可以用来形成砧座仓100A、100B的其它合适材料和组合物将对本领域的普通技术人员显而易见。
III.另一示例性砧座仓
图9示出接收在砧座115的砧座框架118的顶部表面116上限定的凹槽114中的另一示例性砧座仓112，这与砧座18类似，不同之处如下所述。砧座仓112可由类似上述砧座仓100A、100B的材料的材料构成。下钳口16接收下钳口仓37，所述下钳口仓可以包括类似砧座仓112的材料，和/或与砧座仓112的材料协作的材料。击发杆14限定I形截面，以便击发经过砧座狭槽(未示出)和相应的相反定位的仓狭槽(未示出)，从而在组织90被夹紧在下钳口16与端部执行器12的砧座18之间时，将材料从相应的仓112、37释放到组织90上。
IV.另一示例性砧座仓
图10示出接收在砧座123的砧座框架126的顶部表面124上限定的凹槽122中的另一示例性砧座仓120，这与砧座18类似，不同之处如下所述。砧座框架126的限定凹槽122的内部侧壁127呈现大致矩形形状，以使内部侧壁127平行夹持在砧座仓120的侧部129上，以将砧座仓120保持在凹槽122中。砧座狭槽143与凹槽122连通，并且类似于上述砧座狭槽42。
砧座仓120包括顶部128和底部130。顶部128可由刚性材料构成，所述刚性材料诸如陶瓷、金属或者参考本文中的教导内容对本领域的普通技术人员显而易见的另一合适材料。底部130可由诸如附接到顶部128的材料的粘合剂的材料或者任何其它合适材料(例如，上文相对砧座仓100A、100B所描述的任何材料)构成。
击发杆14包括类似于上述横向销38的横向销134，并且包括类似上述切刃48的垂直切刃132。击发杆14击发经过砧座狭槽143，从而在组织90被夹紧在下钳口16与端部执行器12的砧座123之间时，将材料从相应的仓120释放到组织90上。具体地讲，在击发杆14的致动过程中，切刃132横贯砧座狭槽143长度。横向销134横贯凹槽122的下凹槽表面138与砧座仓120的底部130之间的间隙136。在击发杆14的致动过程中，切刃132在销134上方的上部140切穿砧座仓120的底部130。
V.另一示例性砧座仓
图11示出了在箭头B方向上可移除地接收在砧座145的通道144中的另一示例性砧座仓142，这与上述砧座18类似，不同之处如下所述。通道144被限定在砧座145的砧座框架148的顶部表面146内。与图10的凹槽122不同，通道144由砧座145的内部侧壁限定，所述内部侧壁具有大致基本上彼此平行的下部150和以相互面对关系朝彼此弯曲的顶部152。下部150将夹持抵靠在砧座仓142的侧部154上并保持这个侧部。顶部152将设置在砧座仓142的顶部表面156上以阻挡顶部表面156，这就防止砧座仓142在基本上垂直于箭头B方向的垂直方向上滑出通道144。
此例子的砧座仓142包括顶部158和底部160。顶部158可由硬化材料构成，所述硬化材料诸如陶瓷、金属或者其它合适材料，如参考本文中的教导内容将对本领域的普通技术人员显而易见的。底部160可由以下材料构成：诸如附接到顶部158的材料的粘合剂、上文相对砧座仓100A、100B所描述的任何材料和/或任何其它合适材料。
图12示出端部执行器12的例子，所述端部执行器用于将本文所述示例性砧座仓100A、100B、112、120、142中的一个的内容物施加到组织90上，从而形成组织90上的组织修复组合物162。在上述施加后，砧座仓100A、100B、112、120、142的组织修复组合物162可以大致围绕和/或至少部分涂布压缩组织90的层92、94的钉47。
应当理解，本文所述教导内容、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。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，以便在使用至少一次后重复使用。修复可以包括以下步骤任何组合：拆卸装置，然后清洗或者更换特定部件，并且随后重新组装。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件或部件。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申请的范围内。
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、诸如塑料袋或TYVEK袋中。随后，可将容器和装置放置在可穿透容器的诸如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，上文所讨论的例子、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)

1.一种外科器械设备，包括：
(a)柄部部分；
(b)容纳击发杆的轴；
(c)端部执行器，其包括砧座、下钳口以及对所述柄部部分和所述轴产生的纵向闭合运动进行响应的缝合和切断组件；
(d)可移除的仓，其中所述下钳口能够接收所述仓，所述仓包括：
(i)外壳，
(ii)设置在所述外壳中的多个钉，以及
(iii)设置在所述多个钉之上的平台，所述平台限定孔，每个孔基本上设置在每个钉之上，以及
(e)可移除的砧座仓，其能够接收在所述砧座中。
2.根据权利要求1所述的设备，其中所述砧座包括砧座狭槽和开口，并且所述砧座仓能够接收在所述砧座狭槽和所述开口中。
3.根据权利要求2所述的设备，其中所述砧座开口被限定在所述砧座的远端处。
4.根据权利要求2所述的设备，其中所述击发杆能够响应于所述柄部部分和所述轴产生的所述纵向闭合运动而推进经过所述砧座狭槽。
5.根据权利要求1所述的设备，其中所述砧座包括砧座狭槽和开口，并且所述砧座仓能够仅仅接收在所述开口中。
6.根据权利要求5所述的设备，其中所述砧座包括砧座框架，并且其中所述开口由所述砧座框架包围并且设置在所述砧座框架内。
7.根据权利要求5所述的设备，其中，当所述砧座仓接收在所述砧座的所述开口中时，所述击发杆能够响应于所述柄部部分和所述轴产生的所述纵向闭合运动而沿着足以切断所述砧座仓的长度推进经过所述砧座狭槽。
8.根据权利要求1所述的设备，其中所述砧座仓包括粘合剂。
9.根据权利要求1所述的设备，其中所述砧座仓包括设置在陶瓷或金属构件下方的粘合剂。
10.根据权利要求9所述的设备，其中所述砧座仓能够接收在所述砧座中的开口内，并且所述开口被设置在砧座狭槽上方。
11.根据权利要求10所述的设备，其中，当所述砧座仓接收在所述砧座的所述开口中时，所述击发杆能够响应于所述柄部部分和所述轴产生的所述纵向闭合运动而沿着足以切断所述砧座仓的所述粘合剂的长度推进经过所述砧座狭槽。
12.根据权利要求1所述的设备，其中所述砧座包括砧座框架、砧座狭槽以及砧座通道，其中所述砧座通道被设置在所述砧座狭槽上方，其中所述砧座仓能够接收在所述砧座通道中，并且其中所述砧座通道部分地由所述砧座框架的顶部表面形成。
13.根据权利要求12所述的设备，其中限定所述砧座通道的一对侧壁是基本上平行的。
14.根据权利要求12所述的设备，其中限定所述砧座通道的一对侧壁包括相应的相互面对的顶部，并且其中每个侧壁的每个顶部设置在所述砧座通道之上。
15.根据权利要求1所述的设备，其中所述砧座仓包括生物相容性材料。
16.一种通过外科器械释放并且活化粘合剂的方法，所述外科器械包括端部执行器、柄部部分以及轴，所述端部执行器包括下钳口和砧座，所述下钳口能够接收可移除的仓，所述器械包括对所述柄部部分和所述轴产生的纵向闭合运动进行响应的缝合和切断组件，所述方法包括以下步骤：
(a)将砧座仓接收在所述砧座中的开口内；
(b)产生所述纵向闭合运动以使所述缝合和切断组件的切断结构推进；
以及
(c)驱动所述切断结构经过所述砧座仓。
17.根据权利要求16所述的方法，其中所述切断结构包括击发杆。
18.根据权利要求16所述的方法，还包括以下步骤：
(a)将所述砧座仓的内容物沉积到组织上。
19.根据权利要求18所述的方法，其中所述砧座仓包括生物相容性材料。
20.一种外科器械，包括：
(a)柄部部分和轴，所述轴容纳击发杆；
(b)对所述柄部部分和所述轴产生的纵向闭合运动进行响应的缝合和切断组件；
(c)连接到所述柄部部分的端部执行器，所述端部执行器包括砧座和下钳口，所述砧座限定开口，所述下钳口能够接收仓；
(d)设置在所述仓的外壳内的多个钉，当具有所述仓的所述下钳口处于闭合位置时，所述砧座能够响应于所述纵向闭合运动而形成所述钉；
(e)设置在所述多个钉之上的平台，所述平台限定孔，每个孔基本上设置在每个钉之上；以及
(f)生物相容性材料，所述生物相容性材料能够接收在所述砧座的所述开口中；
其中，所述击发杆能够操作以在所述砧座与所述仓之间运动，从而切断所述材料；并且
其中，所述钉能够操作以响应于所述纵向闭合运动而被朝向所述砧座驱动并且经过所述材料。
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US9198644B2 (en) 2015-12-01
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BR112014006828A2 (pt) 2017-10-31
RU2014115985A (ru) 2015-10-27
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MX2014003514A (es) 2014-12-05
EP2757958B8 (en) 2021-04-07
WO2013043683A1 (en) 2013-03-28
BR112014006828B1 (pt) 2021-06-22
US20130075445A1 (en) 2013-03-28
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