CN103987329A - 用于组织厚度测量的可再用的线性缝合器仓装置 - Google Patents

用于组织厚度测量的可再用的线性缝合器仓装置 Download PDF

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CN103987329A
CN103987329A CN201280060254.1A CN201280060254A CN103987329A CN 103987329 A CN103987329 A CN 103987329A CN 201280060254 A CN201280060254 A CN 201280060254A CN 103987329 A CN103987329 A CN 103987329A
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tissue
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CN103987329B (zh
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V·M·瓦苏德万
S·G·哈尔
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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
    • A61B17/068—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
    • 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
    • A61B2017/07221—Stapler heads curved
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/06—Measuring instruments not otherwise provided for
    • A61B2090/061—Measuring instruments not otherwise provided for for measuring dimensions, e.g. length

Abstract

一种外科器械(20)包括：主体；可移除的插件(200)，所述可移除的插件包括测量指示器(212)；以及定位在所述主体的远端处的端部执行器(80)。所述端部执行器具有面向所述主体的近端的远侧内表面(204)。所述端部执行器能够接收所述插件。致动结构是在所述插件被接收在所述端部执行器中时与所述端部执行器和所述插件连通。所述致动结构能够朝着所述端部执行器的所述远侧内表面向远侧推进所述插件。所述可移除的插件的测量指示器能够测定被定位在所述可移除的插件与所述端部执行器的所述远侧内表面之间的组织的厚度。基于所测量的组织厚度，用户选择能够至少缝合(并还可能切断)所测量的组织的仓。所述仓接收在所述端部执行器内。

Description

用于组织厚度测量的可再用的线性缝合器仓装置
背景技术
在一些设置中，外科器械包括适合置于期望手术部位处的(例如，置于要切断和/或缝合的组织处的)远端执行器。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。此类外科器械可包括轴，轴在端部执行器与临床医生所操纵的柄部部分之间。此轴可以允许插入能够达到期望深度并且围绕轴的纵向轴线旋转，由此，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，或以其它方式相对轴的纵向轴线偏转。
此类外科器械例子包括外科缝合器。一些此类缝合器能够操作以夹在组织层上，以便切断所夹紧的组织层并驱动钉穿过组织层来在组织层被切断的末端附近将所切断的组织层基本上密封在一起。仅示例性外壳缝合器在以下专利中被公开：1993年12月21日公布的名称为“SurgicalAnastomosis Stapling Instrument with Flexible Support Shaft and AnvilAdjusting Mechanism”的美国专利第5,271,543号，该专利的公开内容以引用的方式并入本文；1995年4月11日公布的名称为“Flexible Support ShaftAssembly”的美国专利第5,405,073号，该专利的公开内容以引用的方式并入本文；1995年9月26日公布的名称为“Surgical Stapling Instrument withImproved Jaw Closure and Staple Firing Actuator Mechanism”的美国专利第5,452,836号，该专利的公开内容以引用的方式并入本文；1995年11月14日公布的名称为“Surgical Stapling Instrument with Articulated Stapling HeadAssembly on Rotatable and Flexible Support Shaft”的美国专利第5,465,894号，该专利的公开内容以引用的方式并入本文；1997年2月18日公布的名称为“Surgical Stapling Instrument with Articulated Stapling Head Assembly onRotatable and Flexible Support Shaft”的美国专利第5,603,443号，该专利的公开内容以引用的方式并入本文；1997年2月25日公布的名称为“TriggerMechanism for Surgical Instruments”的美国专利第5,605,272号，该专利的公开内容以引用的方式并入本文；1997年3月4日公布的名称为“SurgicalStapling Instrument with Articulated Stapling Head Assembly on Rotatable andFlexible Support Shaft”的美国专利第5,607,094号，该专利的公开内容以引用的方式并入本文；1997年12月16日公布的名称为“Linear Stapler withImproved Firing Stroke”的美国专利第5,697,543号，该专利的公开内容以引用的方式并入本文；1998年3月31日公布的名称为“Surgical StaplingInstrument with Articulated Stapling Head Assembly on Rotatable and FlexibleSupport Shaft”的美国专利第5,732,871号，该专利的公开内容以引用的方式并入本文；2006年1月24日公布的名称为“Retaining Pin LeverAdvancement Mechanism for a Curved Cutter Stapler”的美国专利第6,988,650号，该专利的公开内容以引用的方式并入本文；2006年11月14日公布的名称为“Knife Retraction Arm for a Curved Cutter Stapler”的美国专利第7,134,587号，该专利的公开内容以引用的方式并入本文；2007年4月17日公布的名称为“Slotted Pins Guiding Knife in a Curved Cutter Stapler”的美国专利第7,204,404号，该专利的公开内容以引用的方式并入本文；2007年4月24日公布的名称为“Cartridge with Locking Knife for a Curved CutterStapler”的美国专利第7,207,472号，该专利的公开内容以引用的方式并入本文；以及2010年8月3日公布的名称为“Articulating Curved CutterStapler”的美国专利第7,766,207号，该专利的公开内容以引用的方式并入本文。
尽管已研制出若干系统和方法并用于外科器械，但是据信，本发明人之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
本说明书所附权利要求书中特别指出并且明确主张了本技术，但是据信，通过以下结合附图对某些例子的描述将会更好地理解本技术，附图中类似的参考标号表示相同元件，其中：
图1描绘具有仓外壳和仓模块的线性外科缝合器的透视图；
图2描绘图1的线性外科缝合器的透视图，其中该仓模块移除；
图3描绘图1的线性外科缝合器的透视图，其中该仓外壳被移动到中间位置；
图4描绘图1的线性外科缝合器的透视图，其中该仓外壳被移动到闭合位置；
图5描绘线性外科缝合器的局部横截面图，其中闭合触发器略回缩；
图6描绘线性外科缝合器的局部横截面图，其中闭合触发器几乎是完全回缩；
图7描绘用于测量组织厚度的示例性可移除仓装置的侧正视图；
图8描绘用于测量组织厚度的可选择的示例性可移除仓装置的侧正视图；以及
图9描绘用于测量组织厚度的另一可选择的示例性可移除仓装置的侧正视图。
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。并入本说明书并构成其一部分的附图示出了本发明的若干方面，并与说明书一起用于说明本发明的原理；然而，应当理解本发明不受限于所示出的精确布置方式。
具体实施方式
以下对本技术的某些例子的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。正如将意识到，本文所述技术包括其它不同并明显的方面，这些都不与本技术脱离。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.对示例性线性外科缝合器的概述
图1-6示出适用于将多个外科紧固件施加到身体主体的示例性线性外科缝合器或外壳器械20。外壳器械20包括具有近端和远端的框架，其中柄部21被定位在近端处并且端部执行器80被定位在远端处。端部执行器80的形状和尺寸设定用于支持仓外壳121和砧座122。仓外壳121和砧座122可在第一间隔位置(图1)与彼此密切接近的第二间隔位置(图4)之间相对移动。器械20还包括与端部执行器80和仓外壳121关联的击发组件用于紧固件的选择性地致动。器械另外包括保持销125(参见图3)用于封闭砧座122与仓外壳121间的组织。保持销125在保持销致动组件100的控制下相对仓外壳121可移动。保持销致动组件100包括轭111(参见图5-6)，该轭可旋转地连接到柄部21以促进保持销125的手动和自动推进两者并要求保持销125的手动回缩。
右或左结构板34、35将柄部21连接到器械的端部执行器80(图1中未示出左结构板35)。柄部21具有右手罩22，所述右手罩被联接到左手罩(图1中未示出左手罩)。柄部21还具有主体部分23以夹持并且操纵外科器械20(参见图2至4)。
虽然端部执行器80在本例子中是弯曲的，但是端部执行器80可以可选择地是笔直的或者具有根据本文所引用的任何参考文献所教示的另一形状。端部执行器80是外科紧固组件，包括仓模块120(参见图2)和C形支撑结构81。参考本文中的教导内容，如对本领域的普通技术人员显而易见，支撑结构81可选择地为另一形状，使得支撑结构81能够接收对应可选择的成形的仓模块120。闭合构件28的远端30被设置成接合仓模块120。
仓模块120包括联接到砧座122的仓外壳121。仓模块120还包括保持销125(参见图3)、刀(未示出)、可移除的保持器件160(参见图2)、组织接触表面127(参见图1)，所述组织接触表面包括多个含钉狭槽128，这些含钉狭槽在刀的任一侧上的一个或多个排(即，钉线)中呈交错形成形式。钉(未示出)从仓外壳121击发到砧座122的面向仓外壳121的组织接触表面127的钉形成表面。
肩部铆钉82是从端部执行器80的支撑结构81延伸。支撑结构81通过支柱83而分别附接到左和右结构板34、35，所述支柱是从支撑结构81延伸以便接收在结构板34、35中界定的接收孔中。仅以举例方式，支撑结构81可以根据2006年1月24日公布的“Retaining Pin Lever AdvancementMechanism for a Curved Cutter Stapler”的美国专利第6,988,650号的教导内容来构造，该专利的公开内容以引用的方式并入本文。
外科器械20的柄部21包括外科医生用其手掌掌心抓持的把手24(参见图2)。把手24由右手罩柄部25(参见图1)和左手罩柄部组成(图1中未示出左手罩柄部)。闭合触发器26和击发触发器27从柄部21下侧枢转延伸。图1中示出的外科器械20被示出为带有处于它们的未致动的位置中的相应闭合触发器26和击发触发器27，并且带有插入的仓模块120和移除的保持器件160(参见图2)。因此，仓外壳121与砧座122间隔开来，以在仓外壳121与砧座122之间放置组织。
外科器械20的柄部21包括组织保持销致动组件100。保持销125与用于将保持销125推进穿过仓外壳121并进入砧座122中以从而捕获组织的保持销致动组件100关联。仅以举例方式，保持销125根据美国专利第6,988,650号的教导内容来构造，该专利的公开内容以引用的方式并入。组织保持销致动组件100包括定位在柄部21的顶表面上并与推杆102连通的鞍形滑动件101，如下所述。滑动件101的手动移动导致推杆102的远侧运动。推杆102经由耦合器(未示出)来联接到仓模块120的保持销125。推杆102的远侧运动或近侧回缩导致保持销125的相应纵向运动。具体来说，如图5和6所示，滑动件101被连接到支柱103，所述支柱从推杆驱动器104向外延伸通过柄部21中的狭槽105(参见图2)。推杆驱动器104约束用于通过狭槽105沿着外科器械20的长轴的纵向运动。推杆驱动器104通过推杆102上的周向凹槽而连接到推杆102，所述周向凹槽扣入推杆驱动器104的狭槽。推杆102的远端包括周向凹槽，所述周向凹槽与仓模块120的耦合器(未示出)的近端中的凹槽互连。耦合器的远端包括用于与保持销125上的周向狭槽互连的凹槽。
如图1和2所示，外科器械20还包括细长闭合构件28，所述细长闭合构件具有大体上U形的横截面。闭合构件28从柄部21延伸到端部执行器80的外科紧固组件之中。仅以举例方式，闭合构件28可以根据美国专利第6,988,650号的教导内容来构造，该专利的公开内容以引用的方式并入。闭合构件28包括支柱29(参见图5)，所述支柱在闭合构件28的两侧侧向延伸到柄部21内。这些支柱29可滑动地连接到轭111的L形狭槽110，轭是保持销致动组件100的部分，如下所述。轭111通过轭111上的枢转销112枢转地安装到柄部21。轭111包括定位成推动推杆驱动器104上的凸轮表面114的凸轮销或支柱113。
闭合构件28的远端部分穿过支撑结构81的壁84(参见图2)。闭合构件28的远端被设置成接收并且仓模块120的仓外壳121。闭合构件28的中心部分分别被定位在右和左结构板34、35之间。右和左闭合联接件36、37分别通过第一整体闭合联接件销38枢转地附接在闭合构件28的左和右近端。在闭合联接件36、37的相对端，闭合联接件36、37枢转附接到第二整体闭合联接件销39。第二整体闭合联接件销39将闭合联接件36、37连接到带狭槽的闭合臂联接件40。带狭槽的闭合臂联接件40在闭合触发器枢转销41处枢转地安装到外科器械20的结构板34、35。闭合触发器26从带狭槽的闭合臂联接件40下降，以便围绕闭合触发器枢转销41朝着或者远离把手24枢转。接收在柄部21的把手24中的闭合弹簧42(参见图5)被固定到带狭槽的闭合臂联接件40，以在外科医生朝着把手24挤压闭合触发器26时提供期望阻力，并且朝向打开位置偏置闭合触发器26。
保持销致动组件100还可释放地连接到柄部21内的闭合触发器26，使得闭合触发器26的致动将会导致保持销125的自动远侧运动，如果该保持销未被手动移动到其最远侧的位置的话。具体地说，器械致动期间，闭合构件28线性移动，从而转动推进保持销125的轭111。仅以举例方式，轭111根据美国专利第6,988,650号的教导内容来构造，该专利的公开内容以引用的方式并入。轭111不与滑动件101连通，并且因此，轭111或滑动件101可以分别如上所述那样操作以向远侧移动保持销125。
仅以举例方式，将仓模块120载入端部执行器80中的操作可以根据美国专利第6,988,650号的教导内容来进行，该专利的公开内容以引用的方式并入。例如，仓外壳121以按扣配合连接的方式连接到闭合构件28的远端，使得在闭合构件28远侧推进(如在下文另外描述)时，所附接的仓外壳121将向远侧推进，如果保持器件160已经移除并且并未限制仓外壳121的话。图2至图4示出在加载仓模块120并朝着把手24顺序挤压相应闭合和击发触发器26、27以致动外科器械20的端部执行器80时所发生的情况。外科器械20装载仓模块120，如图2所示，并且保持器件160移除。外科器械20现在准备接收组织，如图1所示。
当使得闭合触发器26部分挤压成靠在其第一制动器件位置(图3所示)时，仓外壳121从其完全打开位置移动到打开位置与闭合位置间的中间位置。同时，组织保持销致动组件100从仓外壳121向前移动保持销125到远侧以刺穿所夹紧的组织，并且随后进入砧座122中的开口，从而保持所刺穿并夹紧的组织。在此位置，已放置在仓外壳121与砧座122之间的组织可以适当定位，并且确保仓外壳121与砧座122之间保留所述组织。因此，当闭合触发器26已被致动到其中间位置时，仓外壳121和砧座122对应定位在它们的组织保持位置。
当完全挤压闭合触发器26以使得其邻近把手24前端时，如图4所示，仓外壳121的组织接触表面127和砧座122的钉形成表面彼此相邻，并且因此完全夹紧适当定位并保持的组织。另外，击发触发器27已经朝着把手24逆时针地旋转，以使外科医生能够抓住击发触发器27来进行钉的击发。因此，击发触发器27现在位于合适位置以供医生将其挤压到钉并且基本同时切割所夹紧的组织。当已经完全挤压击发触发器27来击发钉时，击发触发器27位于闭合触发器26附近。
在操作中，当朝着把手24挤压闭合触发器26时，带狭槽的闭合臂联接件40以及闭合联接件36在击发杆43的接收狭槽46内向远侧移动。仅以举例方式，击发杆43可以根据美国专利第6,988,650号的教导内容来构造，该专利的公开内容以引用的方式并入。带狭槽的闭合臂联接件40以及闭合联接件36的远端运动导致闭合构件28相应地向远侧移动。同样，击发杆43同时随着闭合构件28远侧移动，因为闭合联接件36、37附接到的第一整体闭合联接件销38(参见图1)延伸穿过击发杆43中接收狭槽46。
现将组合图5和6结合图1描述界定中间闭合制动器件位置的组件和闭合触发器26从致动位置到其初始未致动的位置的释放。带狭槽的闭合臂联接件40顶侧具有夹具滑动表面56，所述夹具滑动表面显示出中间制动器件57和闭合制动器件58。释放制转杆59在夹具滑动表面56滑动并可接合相应中间制动器件57和闭合制动器件58。释放制转杆59在它的远端具有侧向延伸的制转杆耳状物60(参见图1和5)。释放制转杆59位于柄部21内，且其整体地附接到设在柄部21外的释放按钮61。释放按钮61具有拇指停靠部分62(参见图5)，并且释放按钮61通过释放耳轴或枢轴63枢转地附接到柄部21。释放按钮61是从柄部21向外偏置。因此，释放制转杆59由释放弹簧64向下偏置朝着夹具滑动表面56。释放弹簧64通过弹簧保持销65来安装到柄部21，并且通过按钮弹簧支柱66来安装到释放按钮61。带狭槽的闭合臂联接件40具有位于相应中间制动器件57与闭合制动器件58之间的弧形凹部67。位于这个弧形凹部67内以实现旋转运动的是整体地连接到右侧肘节(右侧肘节未示出)的左侧肘节68。每个肘节68具有可与制转杆耳状物60接合的肘节臂69。仅以举例方式，制转杆耳状物60根据美国专利第6,988,650号的教导内容来构造，该专利的公开内容以引用的方式并入。
在图5中，闭合触发器26已经从其图1所示打开未致动的位置部分挤压。当部分挤压闭合触发器26时，它会围绕闭合触发器枢转销41朝着把手24逆时针地枢转。当该闭合触发器枢转时，带狭槽的闭合臂联接件40以及闭合板闭合联接件36、37向前远侧移动，因此，使得闭合构件28和击发杆43远侧移动。当带狭槽的闭合臂联接件40远侧运动时，释放制转杆59的制转杆耳状物60在夹具滑动表面56上近侧滑动。制转杆耳状物60接合肘节68的肘节臂69远端，并且因此，顺时针地枢转肘节68。当带狭槽的臂闭合联接件40响应于闭合触发器26朝着把手24的枢转运动而继续向远侧移动时，释放制转杆59的制转杆耳状物60将会最终进入中间制动器件57。一旦定位在中间制动器件57中，闭合弹簧42就不能够使得闭合触发器26返回到其原始未致动的位置。闭合触发器26现在处于其中间部分闭合位置，以便适当定位并保持仓外壳121与砧座122之间的组织，如图5所示。另外，当闭合构件28和击发杆43远侧移动时，弧形击发触发器联接件51的顶点52在击发杆43的滑动表面48上朝击发杆43的近端部分滑动。
保持销致动组件100在从打开位置到中间位置的闭合冲程期间激活。闭合构件28向前运动使得整体支柱29远侧移动。支柱29接触轭111的L形狭槽110。因此，支柱29凸轮L形狭槽110的远侧运动导致轭111围绕销112枢转。旋转使得支柱轭111上的支柱113接触推杆驱动器104上凸轮表面114。轭111的进一步旋转运动导致承载支柱113通过表面114上的凸轮接触来向远侧移动推杆驱动器104。推杆驱动器104接触推杆102，从而远侧移动推杆102。推杆102又使耦合器和保持销125向远侧移动。完成到中间制动器件57位置的闭合冲程导致保持销125向远侧移动通过仓外壳121的孔(未示出)，通过延伸穿过垫圈(未示出)和砧座122的孔159，并且进入支撑结构81中的孔(未示出)。设置在仓外壳121的组织接触表面127与砧座122之间的组织现被陷在保持销125与导销124之间。
仅以举例方式，根据美国专利第6,988,650号的教导内容，这种相同结果可在通过鞍形滑动件101的手动远侧运动进行闭合之前获得，构造，该专利的公开内容以引用的方式并入本文。
现在参考图6，当朝着把手24从中间制动器件57位置挤压闭合触发器26时，肘节68的肘节臂69脱离制转杆耳状物60。因此，当肘节68继续顺时针地旋转时，释放制转杆耳状物60跨在肘节臂69上，并且通过闭合触发器26的继续运动落入闭合制动器件58之中。当释放制转杆59跨在肘节臂69上时，它将释放按钮61围绕枢轴63顺时针地旋转。当释放制转杆耳状物60落入闭合制动器件58之中时，它会产生可听到的咔哒声以提醒外科医生已经到达闭合位置。
另外，当击发杆43继续向前远侧移动时，弧形击发触发器联接件51的顶点52接触击发杆43的近端部分的侧部接合表面。因此，击发触发器27被移动到其中在组织已被完全夹紧后其可继续向远侧移动击发杆43以击发钉的位置。当弧形击发触发器联接件51的顶点52移动成与击发杆43的近端部分的接合表面接合时，击发触发器27响应于击发触发器27的右侧上的扭转弹簧的动作(扭转弹簧未示出)开始朝着把手24逆时针地枢转。击发触发器27独立于闭合触发器26的枢转运动进行枢转，但其枢转旋转受到阻止，直至击发杆43已向远侧移动以实现击发触发器联接件51与击发杆43的终端接合表面的接合。仅以举例方式，根据美国专利第6,988,650号的教导内容，可以进行钉的击发，该专利的公开内容以引用的方式并入本文。参考本文中的教导内容，对于本领域的普通技术人员，器械20可能能够采用并操作的其它合适方式将会显而易见。
II.用于组织厚度测量的示例性可移除仓装置
下述例子涉及可移除仓与线性外科缝合器和/或切割器械(诸如器械20)的连接和使用，以便测量组织厚度。例如，下述组织厚度测量仓可用于仅仅通过朝着柄部25挤压闭合触发器26来测量定位在仓与肩部铆钉82的内表面204之间的组织厚度。下述教导内容并入器械20中的各种适合方式将对本领域的普通技术人员显而易见。相似地，下述教导内容可以与本文所引用的参考文献中的各种教导内容组合的各种合适方式将对本领域的普通技术人员显而易见。另外应当理解，下述教导内容并不限于本文所引用的参考文献中教导的器械20或装置。下述教导内容可容易地应用到各种其它类型的器械，包括将不被分类为线性外科缝合器器械的器械。参考本文中的教导内容，对于本领域的普通技术人员，可以应用下述教导内容的各种其它适合装置和设置将会显而易见。
A.带金属板组件的示例性可移除仓装置
图7示出能够接收在器械20的端部执行器80中的示例性可移除仓装置200。例如，根据美国专利第6,988,650号的教导内容，仓装置200可与端部执行器80以类似于仓装置120的接收的方式联接，该专利的公开内容在上文中以引用的方式并入。本例子中，仓装置200包括类似仓模块120的仓外壳121的形状，除非下文另外阐明。或者，仓装置200可以包括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任何形状。仓装置200可如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那样进行消毒，并且可以再用在多个用途中。参考本文中的教导内容，如对本领域的普通技术人员显而易见，仓装置200可由耐用塑料(诸如聚碳酸酯或液晶聚合物)、陶瓷、金属和/或任何其它合适材料进行构造。参考本文中的教导内容，用于仓装置200的其它构造也对本领域的普通技术人员显而易见。
当被装载到端部执行器80中时，仓装置200将与闭合构件28的远端形成按扣连接，这类似于仓外壳121与闭合构件28的远端形成按扣连接的方式。参考本文中的教导内容，用于仓装置200到闭合构件28的附接的另一些构造将对本领域的普通技术人员显而易见。闭合构件28可以包括能够操作以将仓装置200可移除地固定到端部执行器80的各种组件或结构。
结合图7参考图2，推杆102可联接到仓装置200的上部近侧部分202，使得通过以与上文关于器械20所描述的方式挤压闭合触发器26使得推杆102的远侧推进将会导致仓装置200朝着肩部铆钉82的内表面204远侧推进。另外，如上所述，当仓装置200装载到端部执行器80中时，闭合构件28的远端连接到仓装置200，此时，闭合构件28的远侧推进将会另外朝着端部执行器80的内表面204远侧推进仓装置200。
如图7所示，仓装置200包括上部近侧部分202以及相反远侧部分206。测量显示器210沿着上部近侧部分202与远侧部分206之间的上部边缘部分208设置。虽然本例子将测量显示器210示出为在范围从0至4.0的带刻度的标度件上包括0.5的测量增量，但也可以显示其它测量增量。增量可以是值或者以英寸、厘米、毫米或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其它单位可测量的单位。测量显示器210是下述机械测量仪器组件212的部分并连接到所述机械测量仪器组件。
机械测量仪器组件212包括板214、弹簧216、充当机械变换器水平连杆218、销220、连杆狭槽221、可枢转连杆222、狭槽223、销224以及枢转销225。参考本文中的教导内容，板214可包括金属、塑料或对本领域的普通技术人员显而易见的任何其它合适的材料。虽然本例子包括弹簧以作为偏置构件，但是参考本文中的教导内容，弹簧216可以可选择地是对本领域的普通技术人员显而易见的任何其它偏置构件。
板214包括近侧表面226和远侧表面228。向外偏置弹簧216将板214的近侧表面226弹性连接到仓装置200的远侧部分206的表面230。弹簧216将板214偏置成远离仓装置200的外壳232。水平连杆218在近侧从板214的近侧表面226延伸，并且包括在基本上垂直于水平连杆218的纵轴的方向上从水平连杆218的近端突出的销220。销220被保持在设置在仓装置200的外壳232中的水平保持狭槽(未示出)内并可沿着所述水平保持狭槽滑动。或者，销220可以设置在孔隙内，所述孔隙设置在外壳232内并且它的大小和构造被设计成接收销220。本例子中，接收销220的水平保持狭槽基本上平行于水平连杆218的纵轴并与其对齐。销220还在可枢转连杆222的下端处接收在狭槽221内。枢转销225设置在可枢转连杆222的上端与下端之间，并且可枢转连杆222能够围绕枢转销225枢转。在其中压力尚未如下所述那样施加到板214的远侧表面228的零压力位置处，可枢转连杆222将竖立在相对水平连杆218基本上成角度的位置中。可枢转连杆222的上端将定位在测量显示器210的近端，从而指示零压力单位以及零厚度测量结果(表明当前并未夹紧组织以供测量)。在其上端，可枢转连杆222包括接收销224的狭槽223。销224接收在横跨测量显示器210的纵轴的水平测量显示器狭槽(未示出)内并且可在其中滑动。
在操作中，当仓装置200如上所述那样装载到端部执行器80中时，组织(未示出)可定位在仓装置200的板214的远侧表面228与端部执行器80的内表面204之间。仓装置200能以上文关于仓外壳121所述的方式朝着端部执行器80的内表面204远侧推进，直至组织被设置在板214的远侧表面228与端部执行器80的内表面204之间并且接触两者。例如，保持销125可以刺穿组织并以上文关于仓外壳121所述的方式将其保持在板214与端部执行器80的内表面204之间。
当仓装置200紧靠组织朝远侧推进时，组织将会压缩板214的远侧表面228，从而导致板214在箭头(A)的方向上朝着仓装置200的远侧部分206的表面230压缩弹簧216。这继而将水平连杆218向内近侧移动，从而沿着仓装置200中的水平保持狭槽近侧移动销220。当销220沿着保持狭槽向内水平滑动时，销220将同时按压界定可枢转连杆222的狭槽221的表面，从而导致可枢转连杆222围绕销220和枢转销225在逆时针的方向上枢转。此类枢转运动沿着横跨至少测量显示器210的长度的水平测量显示器狭槽向远侧推进销224。狭槽221、223的长度足以允许第一位置处的销220与第二不同位置处的销224间所需要的高度可调整性。远侧推进销224的动作允许所接收的组织的厚度的适当读出，因为销224将推进到测量显示器210的与厚度测量相关的位置，以便适当测量在端部执行器80的内表面204与仓装置200的板214之间所压缩的组织的厚度。另外，从板214移除压力可以导致销224沿着水平测量显示器狭槽向近侧移动，返回初始的零压力(零组织厚度)位置。
在一些型式中，仓装置200可以包括锁定结构(未示出)，所述锁定结构能够操作以选择性地沿着测量显示器210以测量出的增量将销224锁定到位，使得销224在闭合触发器26释放后保持处于这个位置。因此，外科医生可将带有仓装置200的端部执行器80定位在患者中，朝着柄部25挤压闭合触发器26以测量定位在仓装置200与肩部铆钉82的内表面204之间的组织的厚度，随后使得端部执行器80重新定位到其中易于看到销224在测量显示器210中的锁定位置的位置(例如，患者体外)。在一些此类型式中，外科医生甚至可从端部执行器80移除仓装置200，以便观察销224在测量显示器210中的锁定位置。仅以举例方式，包括棘齿的棘轮锁定结构可以沿着可枢转连杆222的外壁、沿着水平连杆218和/或其它地方设置。当可枢转连杆222围绕枢转销225枢转时，制转杆(未示出)可在棘齿之间滑动。弹性构件可以将制转杆偏置成与该齿接合，同时按钮或者其它结构能够操作以使制转杆与该齿选择性地脱离。参考本文中的教导内容，可提供棘轮组件的其它合适方式将对本领域的普通技术人员显而易见。类似地，参考本文中的教导内容，选择性地锁定销224的位置的其它方式将对本领域的普通技术人员显而易见。
应当理解，使用仓装置200的组织测量可以允许用户选择适当大小的仓模块120以用于以上文关于器械20所描述的方式充分缝合和/或切断所测量的组织。适当大小的仓模块120可从包括例如不同高度的钉的多个仓模块120进行选择。另外或者可选择的，多个仓模块120可以包括不同大小的外壳。仓装置200允许外科医生选择具有用于使得特定组织缝合的最佳钉高度和/或外壳大小的仓模块120。在使用后，可从端部执行器80移除仓装置200，可以使用所选择的仓模块120，并可以在下次使用能够用来缝合和/或切断所测量的组织的另一部分的另一所选择的仓模块120之前，如上所述那样重置并且再用所移除的仓装置200。
B.带有弹簧模制塑料组件的示例性可移除仓装置
图8示出类似仓装置200并包括相同参考标号的示例性可选择的仓装置300。关于板和偏置构件组件，仓装置300不同于仓装置200。如图8所示，仓装置300包括板214和模制弹性构件316。弹性构件316是板214和/或仓装置300的模制结构。因此，板214、水平连杆218以及弹性构件316形成单个整体式件或组件以作为材料(例如，塑料等等)的均一化连续统一体。在一些型式中，弹性构件316、板214以及接收远侧表面230全都形成单个整体式件或组件以作为材料(例如，塑料等等)的均一化连续统一体。弹性构件316在板214的近侧表面226与仓装置300的远侧表面230之间延伸，从而将板214偏置离开远侧表面230。仓装置300能够以与上文针对仓装置200所述相同的方式来操作。
C.示例性可选择的可移除仓装置的示意图
图9示出类似仓装置200、300的另一示例性可选择的仓装置400。然而，仓装置400包括竖直测量显示器410，该显示器在本例子中示出为包括范围从0至4.0的带刻度的标度件上的0.5的测量增量。如在上文关于仓装置200所述那样，仓装置400包括机械测量仪器组件412，其与竖直测量显示器410经由示意性示出的联接件432连通，以便测量组织厚度。超过机械测量仪器组件的情况下，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其它指示器可以用来测定定位在仓装置400与端部执行器80的内表面204之间的组织的近似组织厚度。参考参考本文中的教导内容，可以用作变换器以使得施加到仓装置400的压力转换成组织厚度测量结果的各种合适组件和构造将对本领域的普通技术人员显而易见。
竖直测量显示器410沿着仓装置400的远侧边缘部分定向在这样的位置：所述位置基本上平行于其上组织被接收在与机械测量仪器组件412关联的压力测量装置434上的位置。竖直测量显示器410包括销436。销436响应于压力测量装置434上接收的压力，所述压力测量装置经由联接件432与销436连通，从而导致销436沿着竖直测量显示器410移动到适当测量显示增量。因此，销436指示压力测量装置434与端部执行器80的内表面204之间所捕获并测量的组织的厚度。
尽管已描述出仓装置200、300、400的一些构造，但是根据本文中的教导内容，仓装置200、300、400的其它合适构造将对本领域的普通技术人员显而易见。
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。上述教导内容、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将对本领域的普通技术人员显而易见。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了解，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，包括：
(a)具有近端和远端的主体，其中柄部被定位在所述近端处；
(b)可移除的插件，所述可移除的插件包括测量指示器；
(c)被定位在所述主体的所述远端处的端部执行器，所述端部执行器具有面向所述主体的所述近端的远侧内表面，所述端部执行器能够接收所述插件；和
(d)致动结构，其在所述插件被接收在所述端部执行器中时与所述端部执行器和所述插件连通，所述致动结构能够朝着所述端部执行器的所述远侧内表面向远侧推进所述插件；
其中所述可移除的插件的测量指示器能够测定被定位在所述可移除的插件与所述端部执行器的所述远侧内表面之间的组织的厚度。
2.根据权利要求1所述的外科器械，其中所述测量指示器包括机械测量仪器组件以及测量显示标度件，其中所述机械测量仪器组件与所述测量显示标度件连通。
3.根据权利要求2所述的外科器械，其中所述可移除的插件的所述机械测量仪器组件能够测定被定位在所述可移除的插件与所述端部执行器的所述远侧内表面之间的组织的组织厚度，并且其中所述测量显示标度件能够显示所测定的组织厚度。
4.根据权利要求2所述的外科器械，其中所述可移除的插件包括近端和远端以及设置在两者之间的插件轴线，其中所述机械测量仪器组件包括设置成垂直于所述插件轴线的压力接收组件，并且其中当所述插件被接收在所述端部执行器中时，所述测量显示标度件被定向成平行于在基本上竖直的位置中的所述压力接收组件。
5.根据权利要求2所述的外科器械，其中所述可移除的插件包括近端和远端以及设置在两者之间的插件轴线，其中所述机械测量仪器组件包括设置成垂直于所述插件轴线的压力接收组件，并且其中当所述插件被接收在所述端部执行器中时，所述测量显示标度件被定向成垂直于在基本上水平的位置中的所述压力接收组件。
6.根据权利要求5所述的外科器械，其中所述压力接收组件包括弹性偏置的板。
7.根据权利要求5所述的外科器械，其中所述测量显示标度件包括有刻度的标度件，它的值从所述可移除的插件的近端到远端增加。
8.根据权利要求2所述的外科器械，其中所述机械测量仪器组件包括板和设置在所述板与所述插件的接收表面之间的一个或多个弹性构件，其中在施加压力时，所述板能够压缩所述一个或多个弹性构件。
9.根据权利要求8所述的外科器械，其中所述一个或多个弹性构件包括弹簧。
10.根据权利要求8所述的外科器械，其中所述一个或多个弹性构件包括与所述板和所述插件的所述接收表面集成并成整体的塑料构件。
11.根据权利要求8所述的外科器械，其中所述板包括金属。
12.根据权利要求8所述的外科器械，其中所述板包括塑料。
13.根据权利要求8所述的外科器械，其中所述机械测量仪器组件还包括与所述板连通的水平连杆、第一销、可枢转连杆、枢转销、以及与所述医疗显示标度件和所述枢转连杆连通的第二销。
14.根据权利要求13所述的外科器械，其中所述第一销与所述水平连杆和所述枢转连杆连通，其中在经由所述水平连杆施加压力时，所述枢转连杆能够围绕所述枢转销来枢转。
15.根据权利要求14所述的外科器械，其中所述水平连杆能够响应于在所述板上所施加的压力来向近侧推进，使得所述枢转连杆围绕所述枢转销来枢转并且所述第二销沿所述医疗显示标度件向远侧推进。
16.一种外科器械，包括：
(a)具有近端和远端的主体，其中柄部被定位在所述近端处；
(b)可移除的插件，所述可移除的插件包括机械测量仪器组件和测量显示标度件；
(c)被定位在所述主体的所述远端处的端部执行器，所述端部执行器具有面向所述主体的所述近端的远侧内表面，所述端部执行器能够接收所述插件；和
(d)致动结构，其在所述插件被接收在所述端部执行器中时与所述端部执行器和所述插件连通，所述致动结构能够朝着所述端部执行器的所述远侧内表面向远侧推进所述插件；
其中所述可移除的插件的所述机械测量仪器组件能够测定被定位在所述可移除的插件与所述端部执行器的所述远侧内表面之间的组织的厚度，并且其中所述测量显示标度件能够显示所测定的组织厚度。
17.根据权利要求16所述的外科器械，其中在从所述装置移除所述可移除的插件时，所述测量显示标度件能够重置到初始的零压力值。
18.根据权利要求16所述的外科器械，其中所述测量显示标度件包括带刻度的标度件，它的值以0.5的增量从所述可移除的插件的近端到远端增加，其中所述值的范围为约0至4.0毫米。
19.一种外科器械使用方法，所述外科器械包括主体，所述主体具有包括远侧内表面并能够接收插件的端部执行器，所述插件包括面向所述端部执行器的所述远侧内表面的远侧表面、与所述插件的所述远侧表面连通的机械测量仪器组件和与所述机械测量仪器组件连通的测量显示标度件，所述方法包括以下步骤：
(a)将所述插件接收在所述端部执行器中；
(b)将组织定位在所述端部执行器的所述远侧内表面与所述插件的所述远侧表面之间；
(c)经由致动结构推进来推进所述插件以使所述组织夹紧在所述端部执行器的所述远侧内表面与所述插件的所述远侧表面之间；
(d)经由所夹紧的组织来紧靠所述插件的所述远侧表面施加压力；
(e)基于所施加的压力，经由所述机械测量仪器组件将所施加的压力转化成组织厚度的机械测量结果；以及
(f)在所述测量显示标度仪器上显示所测量的组织厚度。
20.根据权利要求19所述的方法，还包括以下步骤：
(a)从所述端部执行器移除所述插件；
(b)基于所测量的组织厚度，从多个仓选择仓，每个仓能够至少缝合具有在厚度值范围内的厚度的组织，使得所选择的仓能够至少缝合具有所测量的组织厚度的组织；以及
(c)将所选择的仓插入所述端部执行器中。
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