CN104039251A - 具有整体的手术刀刀片的外科手术器械 - Google Patents

具有整体的手术刀刀片的外科手术器械 Download PDF

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CN104039251A
CN104039251A CN201280052404.4A CN201280052404A CN104039251A CN 104039251 A CN104039251 A CN 104039251A CN 201280052404 A CN201280052404 A CN 201280052404A CN 104039251 A CN104039251 A CN 104039251A
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W·伯班克
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Intuitive Surgical Operations Inc
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    • 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
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    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
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    • 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
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
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    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
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    • A—HUMAN NECESSITIES
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    • 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
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0801—Prevention of accidental cutting or pricking

Abstract

一种外科手术器械的钉仓包含外壳、安装以便在外壳内旋转的导螺杆、可操作地与导螺杆耦接的驱动构件和手术刀构件。手术刀构件由驱动构件向远侧驱动并且被配置为在向远侧移动时进行切割。在驱动构件的最初远侧移动期间，手术刀构件与外壳耦接，以阻止手术刀构件向远侧移动。在驱动构件的最初远侧移动之后，驱动构件朝着远端驱动手术刀构件。

Description

具有整体的手术刀刀片的外科手术器械
本申请要求2011年10月26日提交的美国临时申请No.61/551,876的利益，该申请整体并入本文以供参考。
背景技术
微创外科手术技术旨在减少诊断或外科手术程序期间损伤的外部组织的量，从而减少病人恢复时间、不舒服和有害的副作用。因此，利用微创外科手术技术可以显著地缩短用于标准外科手术的平均住院时间。另外，利用微创外科手术也可以减少病人恢复时间、病人不舒服、外科手术副作用和旷工时间。
微创外科手术的常见形式是内窥镜检查，而内窥镜检查的常见形式是腹腔镜检查，其是在腹腔内的微创检查和外科手术。在标准的腹腔镜检查外科手术中，病人的腹部吹入气体，并且套管套筒穿过小的(大约二分之一英寸或更小)切口，以提供用于腹腔镜检查器械的进入端口。
腹腔镜外科手术器械通常包含用于观察外科手术区域的内窥镜(例如，腹腔镜)和用于在外科手术部位工作的工具。除了通过伸缩管(也称为，例如，器械轴或主轴)将每一个工具的工作末端或末端执行器与它的手柄分离之外，工作工具通常类似于在常规的(开放式)外科手术中使用的那些工具。例如，末端执行器可以包含夹具、抓取器、剪刀、吻合器、烧灼工具、线性切割器或持针器。
为了执行外科手术程序，外科医生将工作工具穿过套管套筒到内部的外科手术部位并且从腹部外部操纵它们。外科医生从显示由内窥镜获得的外科手术部位图像的监视器观察手术程序。例如，在关节镜检查、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)、窦镜检查、子宫镜检查、尿道镜检查、等等中采用类似的内窥镜检查技术。
正在开发微创远程手术机器人系统，以便当在内部外科手术部位工作时增加外科医生的敏捷度，以及允许外科医生从远程位置(无菌区域之外)为病人手术。在远程手术系统中，常常在控制台上为外科医生提供外科手术部位的图像。在适当的观察器或显示器上观察外科手术部位的三维图像时，外科医生通过操纵控制台的主控输入或控制设备对病人进行外科手术程序。每一个主控输入设备控制伺服-机械致动式/铰接式外科手术器械的运动。在外科手术程序期间，响应于主输入设备的操纵，远程手术系统可以提供多种外科手术器械或工具的机械致动和控制，其中所述外科手术器械或工具具有为外科医生执行多种功能(例如，握持或驱动针、抓取血管、解剖组织等)的末端执行器。
这些末端执行器的操纵和控制是机器人外科手术系统的特别有益的方面。为此，期望提供外科手术工具，其包含提供末端执行器的三个自由度的旋转运动以模仿外科医生的手腕的自然动作的机构。这样的机构应该被适当设计尺寸以用于微创程序中并且应该在设计上相对简单以减少可能的故障点。另外，这样的机构应该提供足够的运动范围，以便允许在许多位置中操纵末端执行器。
已经在很多不同的外科手术程序中采用外科手术夹持和切割器械(例如，非机器人线性夹持、吻合和切割设备，也称为外科手术吻合器；和电外科血管闭合设备)。例如，外科手术吻合器可以用于从胃肠道切除癌组织或异常的组织。包含已知的外科手术吻合器的很多已知的外科手术夹持和切割器械具有夹持组织的相对的钳和切割夹住的组织的铰接式手术刀。
外科手术夹持和切割器械常常被部署在限制性的体腔内(例如，通过套管到达骨盆内侧)。因此，为了最好地接近外科手术部位和外科手术部位的可视性，期望外科手术夹持和切割器械是紧凑的且容易操作的。然而，已知的外科手术夹持和切割器械可能无法是紧凑的和容易操作的。例如，在多个自由度(例如，滚动、俯仰和偏摆)和相关的期望的运动范围方面，已知的外科手术吻合器可能缺少可操作性。典型地，已知的外科手术吻合器具有比期望的俯仰运动更小范围的俯仰运动而且没有偏摆运动。
另外，外科手术夹持和切割器械有时可能不能完全致动(例如，由于阻碍手术刀路径的硬障碍)。在这样的事件中，期望的是，手术刀刀片不位于相对于外科手术器械从外科手术部位的移除可能表现出危险的位置处。然而，已知的外科手术夹持和切割器械可能不能避免潜在的手术刀危险并且同时可能不是紧凑和容易操作的。
因而，确信需要改进的外科手术夹持和切割器械及相关方法。这样的外科手术夹持和切割器械应该是紧凑的和容易操作的，并且当外科手术器械不能完全致动时，采用相对于外科手术器械从外科手术部位的移除不表现出危险的手术刀。
发明内容
公开了改进的外科手术夹持和切割器械(例如，外科手术吻合器、和电外科血管闭合器设备)和相关的方法。本文描述的外科手术夹持和切割器械采用近侧向远侧的手术刀移动，由此将手术刀定向，从而大大地减少无意地切割组织的可能性，同时在外科手术器械不能完全地致动的情况下从外科手术部位移除外科手术器械。本文描述的外科手术夹持和切割器械将手术刀和相关的驱动机构定位在外科手术器械的腕部的远侧，因此允许提供高可操作性的高运动腕部的使用。并且本文描述的外科手术夹持和切割器械采用在驱动机构和手术刀之间相对移动，因此减少外科手术器械的长度。
因而，在一方面中，公开了铰接外科手术器械中的切割刀片的方法。方法包含在外科手术器械的外壳内支撑具有切割刀片的手术刀构件。外壳具有近端和远端。切割刀片被配置为当手术刀构件向远侧移动时进行切割。通过从第一位置到第二位置的第一移动向远侧移动驱动构件。在驱动构件的第一移动期间，手术刀构件与外壳耦接，从而阻止手术刀构件向远侧移动。驱动构件用于在驱动构件从第二位置至第三位置的第二远侧移动期间向远侧驱动手术刀构件。
遍及驱动构件向远侧的移动，手术刀构件能够被阻止向远侧移动。例如，遍及驱动构件向远侧大约4mm的移动，手术刀构件能够被阻止向远侧移动。
在很多实施例中，将手术刀构件与外壳耦接的行为包含利用驱动构件保证手术刀构件与外壳之间的接合。例如，驱动构件能够与手术刀构件相连接，以保证手术刀构件与外壳之间的接合。在很多实施例中，手术刀构件包含与驱动构件相连接的第一突出物和阻止手术刀构件在驱动构件的第一移动期间向远侧移动的外壳接收器。手术刀构件能够被旋转，以从外壳接收器移除第一突出物。第一突出物能够被接收在驱动构件的接收器内。并且，第一突出物能够在驱动构件的第二移动期间容纳在驱动构件接收器内。
在很多实施例中，手术刀构件包含驱动特征件，该驱动特征件在驱动构件的第一移动期间不与驱动构件相连接并且在驱动构件的第二移动期间与驱动构件相连接。在很多实施例中，手术刀驱动特征件包含第二突出物。
在很多实施例中，接近致动冲程的最后，旋转手术刀构件，以将切割刀片降低到外壳内。例如，手术刀构件能够沿凸轮面驱动，从而升高手术刀构件的远端并将切割刀片降低到外壳内。
在很多实施例中，驱动构件用于提供额外的功能。例如，方法可以包含利用驱动构件在驱动构件的第二移动期间部署吻合钉。
在另一方面中，公开了外科手术器械。外科手术器械包含具有轴远端和轴近端的细长轴、耦接至轴远端和包含相对钳的末端执行器、包含在一个钳中的外壳、手术刀构件和驱动构件。外壳包含外壳近端、外壳远端、在外壳近端和远端之间延伸的上表面、在外壳近端和远端之间延伸的中央腔和延伸通过上表面的纵向狭槽。手术刀构件支撑在外壳内，以便向远侧移动。手术刀构件具有被配置为当手术刀构件向远侧移动时进行切割的切割刀片。将驱动构件滑动地安装在外壳内，以便向远侧移动。在驱动构件从第一位置至第二位置向远侧的第一移动期间，手术刀构件与外壳耦接，以便阻止手术刀向远侧移动。在驱动构件从第二位置至第三位置向远侧的第二移动期间，手术刀构件由驱动构件向远侧驱动。
遍及驱动构件向远侧的第一移动，外科手术器械的手术刀构件能够被阻止向远侧移动。例如，遍及驱动构件向远侧大约4mm的移动，手术刀构件能够被阻止向远侧移动。
在很多实施例中，驱动构件用于保证驱动构件的第一移动期间手术刀构件和外壳之间的接合，以阻止手术刀构件向远侧移动。例如，驱动构件能够与手术刀构件相连接，以保证手术刀构件与外壳之间的接合。在很多实施例中，手术刀构件包含与驱动构件相连接的第一突出物和阻止手术刀构件在驱动构件的第一移动期间向远侧移动的外壳的接收器。手术刀构件能够被旋转，以便从外壳接收器移除第一突出物。第一突出物能够被接收在驱动构件的接收器内。并且，第一突出物能够在驱动构件的第二移动期间，被容纳在驱动构件接收器内。
在很多实施例中，手术刀构件包含驱动特征件，该驱动特征件在驱动构件的第一移动期间不与驱动构件相连接并且在驱动构件的第二移动期间与驱动构件相连接。在很多实施例中，手术刀驱动特征件包含第二突出物。
在很多实施例中，在接近致动冲程的最后，旋转手术刀构件，以将切割刀片降低到外壳内。例如，外壳能够包含凸轮面，其被配置为与手术刀构件相连接，以便在驱动构件通过从第三位置至第四位置的第三移动被向远侧移动时，升高手术刀构件的远端，从而将切割刀片降低到外壳内。
在很多实施例中，外科手术器械被配置为执行额外的功能。例如，外壳能够包含在上表面和中央腔之间延伸的多个吻合钉开口。外科手术器械能够进一步包含设置在吻合钉开口内的多个吻合钉。吻合钉的每个能够响应于驱动构件向远侧的移动而部署。
另一方面，公开了外科手术器械的可拆卸附连的钉仓。钉仓包含可拆卸地附连至外科手术器械的末端执行器的外壳、与外壳耦接以便相对于外壳旋转的导螺杆、与导螺杆可旋转地耦接的旋转输入端、手术刀构件和安装在外壳内并与导螺杆耦接以便响应于导螺杆的旋转沿导螺杆移动的驱动构件。外壳包含近端、远端、在近端和远端之间延伸的上表面、外壳近端和远端之间的中央腔和延伸通过上表面的纵向狭槽。旋转输入端被配置为当将外壳附连到末端执行器时与外科手术器械的旋转输出端耦接。手术刀构件被支撑在外壳内，以便向远侧移动。在驱动构件从第一位置至第二位置向远侧的第一移动期间，手术刀构件与外壳耦接，以便阻止手术刀向远侧移动。在驱动构件从第二位置至第三位置向远侧的第二移动期间，手术刀构件由驱动构件向远侧驱动。
在很多实施例中，钉仓被配置为执行额外的功能。例如，外壳能够包含在上表面和中央腔之间延伸的多个吻合钉开口。钉仓能够进一步包含设置在吻合钉开口内的多个吻合钉。每个吻合钉能够响应于驱动构件向远侧的移动而被部署。
为了本发明的性质和优势的更完整的理解，应该参考随后的详细描述和附图。本发明的其他方面、目标和优势将通过后面的附图和详细描述显而易见。
附图说明
图1是根据很多实施例用于执行外科手术的微创机器人外科手术系统的平面图。
图2是根据很多实施例用于机器人外科手术系统的外科医生的控制台的透视图。
图3是根据很多实施例的机器人外科手术系统电子设备推车的透视图。
图4示意地图示根据很多实施例的机器人外科手术系统。
图5A是根据很多实施例的机器人外科手术系统的病人侧推车(外科手术机器人)的前视图。
图5B是根据很多实施例的机器人外科手术工具的前视图。
图6是根据很多实施例包含具有相对的钳的末端执行器的机器人外科手术工具的透视图。
图7是根据很多实施例具有六行吻合钉的线性吻合和切割外科手术器械的可拆卸附连钉仓(cartridge)的透视图。
图8是根据很多实施例图7的钉仓和附连的吻合钉固定器的透视图。
图9是显示根据很多实施例图7的钉仓和末端执行器组件之间的附连细节的横截面图。
图10是图示图7的钉仓的部件的分解透视图。
图11A和11B是图示图7的钉仓的印刷电路组件的透视图。
图12是根据很多实施例的线性吻合和切割外科手术器械的可拆卸附连钉仓的横截面图。
图13A是根据很多实施例具有四行吻合钉的线性吻合和切割外科手术器械的可拆卸附连钉仓的吻合钉部署相关的部件的局部透视图。
图13B是图13A的驱动构件的透视图。
图13C包含图13A的钉仓的吻合钉推动器的透视图。
图14A显示图7的钉仓的外壳的远端。
图14B包含图7的钉仓的吻合钉推动器的透视图。
图14C是图7的钉仓的驱动构件的透视图。
图14D是图7的钉仓的驱动构件的平面图。
图14E是图7的钉仓的驱动构件的侧面图。
图14F是图7的钉仓的驱动构件的远端视图。
图14G显示如图14D定义的图7的钉仓的驱动构件的横截面AA。
图14H显示如图14D定义的图7的钉仓的驱动构件的横截面BB。
图15A是图7的钉仓的手术刀构件的透视图。
图15B是图7的钉仓的手术刀构件的侧面图。
图15C是图7的钉仓的手术刀构件的平面图。
图15D至15G分别地显示根据很多实施例的手术刀构件的局部侧面图。
图15H显示根据很多实施例的手术刀构件的俯视图。
图16A图示图7的钉仓的手术刀构件的致动。
图16B显示根据很多实施例的接收手术刀构件的突出物以便在驱动构件向远侧移动期间阻止手术刀构件向远侧移动的外壳接收器。
图16C显示根据很多实施例的在驱动构件向远侧驱动手术刀构件时与驱动构件耦接的手术刀构件。
图16D显示根据很多实施例的在沿着外壳凸轮面驱动手术刀构件的远端以便升高手术刀的远端，从而将手术刀的切割刀片降低到外壳内之后，在致动冲程的最后的手术刀构件。
图17列出根据很多实施例的从线性吻合和切割外科手术器械中部署吻合钉和铰接刀片的方法的行为。
图18列出图17的方法的可选行为。
具体实施方式
在具体实施方式中，将描述本发明的多个实施例。为了解释的目的，阐明具体的配置和细节，以便提供对实施例的全面理解。然而，本领域的技术人员将显而易见，可以在没有具体的细节的情况下实施本发明。此外，熟知的特征可以被省略或简化以便不模糊正在描述的实施例。
微创机器人外科手术
现在参考附图，其中在几个图中相同的参考数字代表相同的部件，图1是微创机器人外科手术(MIRS)系统10的平面图图示，其典型地用于对病人12执行微创诊断或外科手术程序，其中所述病人12躺在手术台14上。系统可以包括在程序期间供外科医生18使用的外科医生控制台16。一个或更多助手20也可以参与该程序。MIRS系统10可以进一步包含病人侧推车22(外科手术机器人)和电子设备推车24。在外科医生18通过控制台16观察外科手术部位时，病人侧推车22可以通过病人12身体上的微创切口操纵至少一个可移除地耦接的工具组件26(在下文中简单地称为“工具”)。外科手术部位的图像可以通过内窥镜28(诸如立体内窥镜)获得，所述内窥镜28可以由病人侧推车22操纵以对内窥镜28定向。电子设备推车24可以用于处理外科手术部位的图像，用于随后通过外科医生控制台16向外科医生18显示。除其他因素，同时使用的外科手术工具26的数目通常将取决于诊断或外科手术程序和手术室内的空间限制。如果必须改变在程序期间正在使用的一个或更多工具26，助手20可以从病人侧推车22移除工具26，并用来自手术室内的托盘30的另一工具26代替它。
图2是外科医生控制台16的透视图。外科医生控制台16包含用于给外科医生18呈现能够深度感知的外科手术部位的协调立体视图的左眼显示器32和右眼显示器34。控制台16进一步包含一个或更多输入控制设备36，其又引起(图1示出的)病人侧推车22操纵一个或更多工具。输入控制设备36可以提供与(图1示出的)它们的相关的工具26相同的自由度从而为外科医生提供远程呈现，或提供输入控制设备36与工具26整合以便外科医生具有直接控制工具26的强烈感觉的感知。为了这个目的，位置、力和触觉反馈传感器(没有显示)可以被采用，以将来自工具26的位置、力和触觉通过输入控制设备36传递回到外科医生的手。
外科医生控制台16通常位于与病人相同的房间，以便外科医生可以直接监视程序，如果必要的话则实际出现，并且直接对助手说话，而不是通过电话或其他通信介质。然而，外科医生可以位于不同的房间，完全地不同的建筑或允许远程外科手术程序的远离病人的其他远程场所中。
图3是电子设备推车24的透视图。电子设备推车24可以与内窥镜28耦接，并且电子设备推车24可以包含处理器，用于处理捕获的图像以便诸如随后在外科医生控制台上或在位于本地和/或位于远距离的另一个适当的显示器上显示给外科医生。例如，在使用立体内窥镜的地方，电子设备推车24可已处理捕获的图像，以便给外科医生呈现外科手术部位的协调立体图像。这样的协调可以包含相对的图像之间的校准并且可以包含调整立体内窥镜的立体焦距。作为另一示例，图像处理可以包含使用之前确定的照相机校准参数以补偿图像捕获设备的成像误差，诸如光学象差。
图4示意地图示机器人外科手术系统50(诸如图1的MIRS系统10)。如上述讨论的，外科医生控制台52(如图1中的外科医生控制台16)可以由外科医生使用，以在微创程序期间控制病人侧推车(外科手术机器人)54(诸如图1中的病人侧推车22)。病人侧推车54可以使用成像设备(诸如立体内窥镜)捕获程序部位的图像并将捕获的图像输出给电子设备推车56(诸如图1中的电子设备推车24)。如上述讨论的，电子设备推车56可以在任何随后的显示之前以多种方式处理捕获的图像。例如，电子设备推车56可以在通过外科医生控制台52向外科医生显示组合的图像之前，将捕获的图像与虚拟控制界面重叠。病人侧推车54可以输出捕获的图像，用于在电子设备推车56外部处理。例如，病人侧推车54可以向处理器58输出捕获的图像，该处理器58可以用于处理捕获的图像。图像也可以通过电子设备推车56和处理器58的组合处理，电子设备推车56和处理器58可以耦合在一起，以便共同地，按顺序地和/或其组合处理捕获的图像。一个或更多单独的显示器60可以与处理器58和/或电子设备推车56耦合，用于图像(诸如程序部位的图像或其他相关的图像)的本地和/或远程显示。
图5A和5B分别显示病人侧推车22和外科手术工具62。外科手术工具62是外科手术工具26的示例。显示的病人侧推车22提供对外科手术工具26和成像设备28(诸如用于程序部位的图像的捕获的立体内窥镜)的操纵。操纵通过具有许多机器人接头的机器人机构提供。成像设备28和外科手术工具26可以通过病人的切口定位和操纵，以便在切口处维持运动学远程中心，从而最小化切口的大小。当外科手术工具26被定位在成像设备28的视野内时，外科手术部位的图像可以包含外科手术工具26的远端的图像。
组织抓持末端执行器
图6显示外科手术工具70，其包含近侧底盘72、器械轴74和具有可被铰接以便抓持病人组织的钳78的远侧末端执行器76。近侧底盘包含输入耦接器，该输入耦接器被配置为与病人侧推车22的相应的输出耦接器相连接并通过其驱动的。将输入耦接器与设置在器械轴74内的驱动轴驱动地耦接。将驱动轴与末端执行器76驱动地耦接。
线性吻合和切割外科手术器械
图7显示根据很多实施例的线性吻合和切割外科手术器械的可拆卸附连钉仓(cartridge)100。钉仓100被配置为可移除地附连到末端执行器的钳上。钉仓具有附连到末端执行器的钳上的近端102和设置在末端执行器的钳的相应远端处的远端104。钉仓100包含六行吻合钉开口106、纵向狭槽108、近侧手术刀库110、远侧手术刀库112和可旋转输入端114。在很多实施例中，吻合钉被设置在每个吻合钉开口中，用于从开口部署。随着手术刀构件从近侧手术刀库110移动至远侧手术刀库112，纵向狭槽108容纳从纵向狭槽延伸的手术刀构件(未显示)的切割刀片。在手术中，吻合钉被部署为起始于钉仓近端102并继续到钉仓远端104。切割刀片被移动以追踪组织的吻合，从而确保只切割完全吻合的组织。图8显示具有附连的吻合钉固定器116的钉仓100，该吻合钉固定器116在利用钉仓100之前被移除。
根据很多实施例，图9是显示钉仓100至末端执行器118的附连的细节的横截面视图。末端执行器118包含下部钳120、上部钳122、两个自由度的腕部124、可旋转驱动的夹持机构126和弹簧加载连接件128。下部钳120被配置为容纳和支撑钉仓100，以及相对于弹簧加载连接件128定位钉仓100。上部钳122与下部钳120可枢转地耦接，以便相对于下部钳120铰接，从而夹持组织。上部钳122包含相对于吻合钉开口106配置和定位的吻合钉形成凹槽，以便在吻合钉部署时使吻合钉形成“B”形状。
两个自由度的腕部124提供末端执行器118至细长器械轴130的附连，用于末端执行器118相对于器械轴130关于两个正交轴线的铰接。可使用的适当的两个自由度的腕部的细节在2010年11月12日提交的标题为“SURGICAL TOOL WITH A TWO DEGREE OF FREEDOMWRIST”的美国申请No.12/945,748(代理机构案号No.ISRG02350/US)中公开，其全部公开被并入本文以供参考。
可旋转驱动的夹持机构126相对于下部钳120致动上部钳122，以便在上部钳和下部钳之间牢固地夹持组织。夹持机构126通过设置在器械轴130内部的第一驱动轴132可旋转地驱动。可使用的适当的可旋转驱动的夹持机构的细节在2010年11月12日提交的标题为“ENDEFFECTOR WITH REDUNDANT CLOSING MECHANISMS”的美国申请No.12/945,541(代理机构案号No.ISRG02330/US)中公开，其全部公开被并入本文以供参考。
弹簧加载连接件128将钉仓100的导螺杆134与延伸轴136可旋转地耦接，所述延伸轴136通过设置在器械轴130内部的第二驱动轴138驱动。弹簧加载连接件128包含螺旋弹簧140和连接配件142。在显示的实施例中，连接配件142采用与可旋转输入端114和延伸轴136的三侧外表面相连接的三叶齿条(three-lobe spline)接收器。弹簧加载连接件142容许可能在钉仓100安装到末端执行器118内时出现的三叶齿条的角偏差。当旋转到角对准时，弹簧加载连接件142完全接合三叶齿条。导螺杆134的旋转用于平移钉仓100的驱动构件144。产生的驱动构件144的运动用于部署吻合钉和用于向远侧推进钉仓100的手术刀构件146，以便沿部署的吻合钉的行的中心向下切割夹持组织。
末端执行器118包含第一万向接头组件148和第二万向接头组件150。第一万向接头组件148将夹持机构126可旋转地耦接至第一驱动轴132。第二万向接头组件150将延伸轴136可旋转地耦接至第二驱动轴138。第一和第二万向接头组件148、150的每一个被配置为相对于器械轴130在适于末端执行器118的俯仰与偏摆的范围的角范围内传递扭矩。可能使用的适当的万向接头组件的细节在2010年11月12日提交的标题为“DOUBLE UNIVERSAL JOINT”的美国申请No.12/945,740(代理机构案号No.ISRG02340/US)中公开，其全部公开被并入本文以供参考。
第一和第二驱动轴132、138偏离器械轴130的中心线设置，其可独立地旋转。可用于致动第一和第二驱动轴132、138的适当的驱动机构的细节在2010年11月12日提交的标题为“MOTOR INTERFACE FORPARALLEL DRIVE SHAFTS WITHIN AN INDEPENDENTLYROTATING MEMBER”的美国申请No.12/945,461(代理机构案号No.ISRG02360/US)中公开，其全部公开被并入本文以供参考。
图10是图示钉仓100的部件的分解透视图。图示的部件包含固定器116、66吻合钉152、印刷电路组件(PCA)弹簧154、PCA156、钉仓主体158、22吻合钉推动器160、手术刀构件146、导螺杆134、驱动构件144、止推垫圈162、导螺杆螺母164和盖166。钉仓主体158具有以6行布置的66个吻合钉开口106，其中在纵向狭槽108的每侧上设置3行吻合钉开口106。固定器116可移除地附连到钉仓100，并且覆盖吻合钉开口106，以便在钉仓100的使用之前保持吻合钉152。吻合钉推动器160与吻合钉152相连接并且与钉仓主体158滑动连接。驱动构件144沿着导螺杆134的运动通过驱动构件144的面向远侧的斜坡表面176导致吻合钉推动器160的接合，从而在驱动构件144向远端104移动时，相对于钉仓主体158向上驱动吻合钉推动器160以部署吻合钉152。手术刀构件146包含近侧突出物168和远侧突出物170。盖166被附连到钉仓主体158。
图11A和11B进一步图示PCA156和PCA弹簧154。PCA弹簧154与钉仓主体158相连接并且保持PCA156。PCA弹簧154包含PCA弹簧钩172，其锁在钉仓主体158上，以便保持PCA弹簧154。当钉仓100被附连到末端执行器118时，末端执行器118的器械销174在PCA156下面滑动并举起PCA156，从而使PCA156与器械销174电连接，并允许增加的相关公差的使用。然而，只要器械销174与PCA156适当接触，这种布置不关键。因此，在某些实施例中，PCA156能够竖着转动，从而使得显示的芯片离开加载路径。PCA156能够用于电存储与钉仓100有关的标识、配置和/或应用信息。
钉仓100可以使用下列组装顺序装配。首先，通过钉仓主体158处于“倒置”取向，将吻合钉推动器160安装到吻合钉开口106内。接着，将手术刀构件146安装到近侧库110内，同时手术刀构件146的近侧突出物168放置到钉仓主体158中的近侧接收器内。接下来，将驱动构件144、止推垫圈162和导螺杆螺母164安装到导螺杆134上，并且导螺杆螺母164齐平地激光焊接到导螺杆134的末端。然后，将合成的导螺杆组件安装到钉仓主体158内，同时驱动构件144被定位在导螺杆134的近端处。接下来，将盖166安装到钉仓主体158上。例如，然后，可通过将合成的组件浸渍到润滑剂中，润滑合成的组件。接下来，将组件翻转至“顶部向上”取向并安装PCA156。接下来，将PCA弹簧154推动到钉仓主体158上，直到PCA弹簧钩172锁住。接下来，将吻合钉152安装到吻合钉开口106内并且然后安装固定器116。最后，将数据装入PCA156中。
图12图示与手术刀构件146从(图示的)起始位置到(没有图示的)结束位置的致动有关的钉仓100的部件，其中在起始位置中手术刀构件146由近侧库110遮蔽，在结束位置中手术刀构件146由远侧库112遮蔽。导螺杆134被安装以便相对于钉仓主体158旋转，并且导螺杆134沿着钉仓主体158的长度延伸。驱动构件144是内螺纹的并且与导螺杆134耦接，并且驱动构件144被可滑动地安装在钉仓主体158中以便响应于导螺杆134的旋转沿导螺杆134平移。驱动构件144包含一个或更多个面向远侧的斜坡176，其被配置为在驱动构件144朝向钉仓主体100的远端104前进时接合吻合钉推动器160。手术刀构件146包含切割刀片178、主体部分180、从主体部分180的相对两侧延伸的近侧突出物168和同样从主体部分180的相对两侧延伸的远侧突出物170。如下面更详细地描述，当驱动构件144从其图示的起始位置向远侧前进时，手术刀构件146相对于钉仓主体158保持固定，直到驱动构件144接触远侧突出物170，然后通过该远侧突出物170，手术刀构件146由驱动构件144向远侧驱动。接近驱动构件144的远侧行程的结束，沿着钉仓主体158的凸轮面182驱动手术刀构件146的远端，以升高手术刀构件146的远端，以便将切割刀片178降低到钉仓主体158的上表面184之下并进入远侧库112内。手术刀构件主体部分180通过限定纵向狭槽108的钉仓主体158的相对表面约束。手术刀近侧和远侧突出物168、170从手术刀构件主体部分180的相对侧延伸到超过纵向狭槽108的宽度，从而用于相对于钉仓主体158和驱动构件144竖直地约束手术刀构件146。
图13A至13C显示根据很多实施例的具有四行吻合钉的线性吻合和切割外科手术器械的吻合钉部署相关部件。类似于钉仓100，内螺纹的驱动构件144-4与导螺杆134耦接，并且被可滑动地安装在钉仓主体(没有显示)中，以便响应于导螺杆134的旋转沿导螺杆134平移。驱动构件144-4包含面向远侧的双线性斜坡176-4，该面向远侧的双线性斜坡176-4在驱动构件144-4沿导螺杆134向远侧前进时接合吻合钉推动器160-4。每个吻合钉推动器160-4被配置为推动单个吻合钉(没有显示)。每个吻合钉推动器160-4具有双线性斜坡表面186-6，其被配置为与驱动构件144-4的相应的倾斜的双线性斜坡176-4相连接/面接。每个吻合钉推动器160-4具有尾部188-4，其形状被设计为与钉仓主体中的吻合钉开口可滑动地相连接。
驱动构件144-4被配置为容纳手术刀构件146并与其相连接，以便首先相对于手术刀构件146向远侧移动，然后朝向钉仓主体的远端驱动手术刀构件146并将手术刀构件146的远端推到钉仓主体158的远侧斜坡182之上。驱动构件144-4特征是，与手术刀构件146的连接，包含中心狭槽190、近侧接收器192、上表面194和远侧表面196。贯穿手术刀构件146从近侧库110中的其起始位置至远侧库112中的其结束位置的冲程，中心狭槽190容纳手术刀主体部分180。近侧接收器192容纳手术刀构件近侧突出物168，同时手术刀构件146通过驱动构件144-4向远侧驱动。上表面194与近侧突出物168相连接，以便在驱动构件144-4的初始远侧移动期间保证近侧突出物168和钉仓主体158内的接收器之间的接合，其中驱动构件144-4相对于钉仓主体158和手术刀构件146两者向远侧移动，并且经由近侧突出物168和相关的钉仓主体接收器之间的接合，手术刀构件146相对于钉仓主体158保持不动。在驱动构件144-4相对于手术刀构件146的初始相对远侧移动之后，驱动构件远侧表面196与手术刀构件远侧突出物170相连接，以便向远侧驱动手术刀构件146，并且驱动构件远侧表面196连同纵向狭槽108的两侧上的钉仓主体158的表面在向远侧驱动手术刀构件146时控制远侧突出物170的竖直位置。当将手术刀构件146的远侧部分被驱动到凸轮面182之上时，远侧突出物170与远侧表面196分离，然后手术刀构件146通过驱动构件近侧接收器192的近侧壁驱动，其中所述近侧壁与手术刀构件近侧突出物168相连接，以便沿着凸轮面182驱动手术刀构件146，从而将切割刀片178装载到远侧库112内。
图14A显示钉仓主体158的远端。图14B显示吻合钉推动器160的俯视图和透视图。如图示的，吻合钉开口106和吻合钉推动器160具有互补的形状，从而使得每个吻合钉推动器160被容纳在吻合钉开口106中的一个内，以便在驱动构件144朝向钉仓远端104平移时，响应于由驱动构件144的驱动在吻合钉开口106内平移。
图14C至14H提供驱动构件144的另外的图示。图14C显示驱动构件144的透视图。图14D显示驱动构件144的俯视图。图14E显示驱动构件144的侧视图。图14F显示驱动构件144的远端图。图14G显示图14D定义的横截面图AA。并且图14H显示如图14D定义的横截面图BB。
图15A至15C提供手术刀构件146的另外的图示。在很多实施例中，切割刀片178与手术刀构件主体部分180整体形成。近侧突出物168和远侧突出物170能够与手术刀构件主体部分180是整体的，或能够通过压配销形成到手术刀构件主体部分180中的横向孔内。主体部分180和销能够由(多种)适当的材料构成，例如，17-4PH、440A或420不锈钢。切割刀片178在两侧上被斜切成磨光边，但是也能够与磨光边平直，或仅在一侧上斜切而另一侧上磨光。另外的珩磨能够被执行，以便在切割刀片178的每侧上形成倍角。
手术刀构件146的配置提供切割刀片178的稳健的支撑，这在切割刀片178用于切断除了软组织之外的某物时特别有利。例如，可能发生以下情况：钉仓100用于通过先前吻合的组织安装吻合钉，从而可能在切割刀片178的路径中放置现有的吻合钉，从而使得现有的吻合钉必须由切割刀片178切割。
图15D图示手术刀构件146的可替换的配置。在很多实施例中，手术刀构件具有带着钩状顶端179的切割刀片178。钩状顶端被钝化，并且适当地向远侧突出超过切割刀片的最顶部刀刃并且适当地在切割刀片的最顶部刀刃之上横向地突出。钩状顶端179能够有助于确保，通过防止组织翻过切割刀片178的高度，切割完整厚度的组织。如果设备故障留下暴露的切割刀片178，钩状顶端也能够减少对手术室人员的伤害的风险。
图15E图示手术刀构件146的另一可替换的配置。在很多实施例中，手术刀构件具有带钝顶端181的切割刀片178。钝顶端稍微向远侧突出超过切割刀片178的最顶部刀刃(或与其共线)，但是恰当地在切割刀片178的最顶部刀刃之上横向突出。如同图15D的切割刀片178的钩状顶端179，切割刀片178的钝顶端181能够有助于防止组织翻过并且减少意外伤害的风险。
图15F图示手术刀构件146的另一可替换的配置。在很多实施例中，手术刀构件具有带钝顶端的弧形切割刀片183。钝顶端稍微向远侧突出超过切割刀片183的最顶部刀刃(或与其共线)，但是适当地在切割刀片183的最顶部刀刃之上横向突出。弧形切割刀片183的钝顶端能够有助于防止组织翻过和减少意外伤害的风险。弧形切割刀片183也能够通过在它的最中心部分内聚集和集中组织而进一步有助于该目的。这也能够通过集中行为有助于防止组织堵塞最底下刀片/钉仓界面。切割刀片183在两侧上斜切成磨光边，但是能够与磨光边平直，或者仅在一侧斜切而另一侧磨光。另外的珩磨能够被执行，以便在切割刀片183的每侧上形成倍角。
图15G图示手术刀构件146的另一个可替换的配置。在很多实施例中，手术刀构件具有弧形切割刀片185，其很大程度上与图15F的弧形切割刀片183相同，因而共有某些特征。然而，弧形切割刀片185不包含钝顶端，因为在某些应用中，切割刀片185的弯曲单独能够防止组织翻过。
图15H图示手术刀构件146的另一可替换的配置。这里，手术刀构件146由在一侧上横向延伸的一体销187构成。类似于图15C的销168和170，销187分别提供用于将手术刀构件146附连到钉仓100的其他部分的公连接表面。例如，可通过下列方式形成销187：冲压原始材料的单个片，以与销187整体形成手术刀构件146；将销187焊接/压模/结合到单独手术刀构件146内；或与销187整体铸模手术刀构件146(根据需要，利用另外的锻造)。销187也能够在显示的相对侧上从手术刀构件146的两侧延伸，或销能够在手术刀构件146的不同的或相同的近端和远端部分处从手术刀构件146的每侧延伸。形成盲孔的锯齿状表面189也可以通过上述工艺在销的对面形成或稍后被机械加工到手术刀构件内。锯齿状表面189分别提供用于将手术刀构件146附连到钉仓100的其他部分的母螺纹连接表面。应该明白，这个销配置能够适用于此处公开的任何切割刀片设计。
图16A至16D图示在手术刀构件146从近侧库110中的其起始位置至远侧库112中的其最终位置的致动期间，钉仓100的部件的相互作用。图16A显示手术刀构件146相对于钉仓主体158的三个不同位置，具体地起始最近侧位置、中间位置和刚好在将手术刀构件146的远端被驱动抬高到钉仓主体凸轮面182上之前的远端位置。
如图16A和16B显示的，在起始最近侧位置中，驱动构件144被放置在导螺杆134的近端处，并且手术刀构件近侧突出物168被布置在钉仓主体158的接收器198内。驱动构件上表面194与手术刀构件近侧突出物168相连接，以便保持钉仓主体接收器198中的近侧突出物168，从而确保近侧突出物168和钉仓主体接收器198之间的接合。手术刀的远端被困在钉仓主体158的中央腔顶200和导螺杆134之间，并且手术刀构件主体部分180被设置在纵向狭槽108内，从而相对于钉仓主体158将手术刀构件146阻止在完全固定的位置和取向中。
从起始最近侧位置，导螺杆134的旋转沿导螺杆134向远侧驱动驱动构件144。贯穿驱动构件144沿导螺杆134的远侧移动的起始“失败移动”部分，近侧突出物168通过驱动构件上表面194保持困在钉仓主体接收器198中。当驱动构件144向远侧移动到其中驱动构件远侧表面196接触手术刀构件远侧突出物170的点时，驱动构件近侧接收器192被设置在钉仓主体接收器198下面，从而允许手术刀构件146旋转，以便将近侧突出物168从钉仓主体接收器198转移到驱动构件近侧接收器192。为了促进这种转移，如图示的，钉仓主体接收器198的远侧表面202倾斜，以便在手术刀构件远侧表面196通过接触手术刀构件远侧突出物170向远侧驱动手术刀构件146时，通过将向下的力分量施加在近侧突出物168上而增强转移。
图16C图示跟随驱动构件144沿导螺杆134的远侧移动的“失败移动”部分，驱动构件144、手术刀构件146和钉仓主体158之间的相互作用。在驱动构件远侧表面196接触到引起手术刀构件146旋转以将近侧突出物168转移到驱动构件近侧接收器192内的手术刀构件远侧突出物170之后，导螺杆134的继续旋转导致驱动构件144的继续的远侧移动和手术刀构件146的相应的远侧移动。在这个继续的远侧移动期间，手术刀构件146通过驱动构件146和钉仓主体158的顶200约束。
图16A和16D图示在驱动构件144沿导螺杆134的远侧移动的末端部分期间，驱动构件144、手术刀构件146和钉仓主体158(具体地，钉仓主体158的凸轮面182)之间的相互作用。在驱动构件144沿导螺杆134向远侧前进到接近它的行程的末端时，手术刀构件146的远端接触到凸轮面182并且随后沿凸轮面182被驱动，直到到达图16D中图示的末端最远侧位置，其中驱动构件144已经沿导螺杆134到达它的行程的末端。由于沿着向上倾斜凸轮面182驱动手术刀构件146的远端，手术刀构件146大约围绕在手术刀构件近侧突出物168旋转，从而将切割刀片178降低到远侧库112内。
线性吻合和切割方法
图17列出根据很多实施例的从线性吻合和切割外科手术器械中部署吻合钉和在线性吻合和切割外科手术器械中铰接切割刀片的方法210的行为。任何适当的线性吻合和切割外科手术器械能够用于实施方法210。例如，本文描述的线性缝合和切割外科手术器械和钉仓能够用于实施方法210。
在行为212中，具有切割刀片的手术刀构件被支撑在线性吻合和切割外科手术器械的外壳内。外壳具有近端和远端。切割刀片被配置为当手术刀构件向远侧移动时切割。在行为214中，通过从第一位置至第二位置的第一移动，向远侧移动驱动构件。
在行为216中，在驱动构件的第一移动期间，将手术刀构件与外壳耦接，以便阻止手术刀构件向远侧移动。在很多实施例中，贯穿驱动构件向远侧大约4mm移动，阻止手术刀构件向远侧移动。在很多实施例中，耦接手术刀构件与外壳包含使用驱动构件保证手术刀构件与外壳之间的接合。在很多实施例中，使用驱动构件保证手术刀构件与外壳之间的接合包含使驱动构件与手术刀构件相连接。例如，手术刀构件能够包含与驱动构件和外壳的接收器相连接的第一突出物，以便在驱动构件的第一移动期间阻止手术刀构件向远侧移动。
在行为218中，驱动构件用于在驱动构件从第二位置至第三位置的第二远侧移动期间向远侧驱动手术刀构件。在很多实施例中，手术刀构件包含在驱动构件的第一移动期间不与驱动构件相连接和在驱动构件的第二移动期间与驱动构件相连接的驱动特征件。在很多实施例中，手术刀驱动特征件包含第二突出物。
在行为220中，驱动构件用于在驱动构件的第二移动期间部署吻合钉。例如，驱动构件能够包含与吻合钉推动器相连接的斜面，其部署吻合钉。
图18显示根据很多实施例可在方法210中完成的可选的行为。在可选的行为222中，手术刀构件被旋转，以便从外壳接收器移除第一突出物。在可选的行为224中，第一突出物被接收在驱动构件的接收器内。在可选的行为226中，在驱动构件的第二移动期间，第一突出物被容纳在驱动构件接收器内。并且在可选的行为228中，沿着凸轮面驱动手术刀构件，从而升高手术刀构件的远端并且将切割刀片降低到外壳内。
本文公开的方法能够在任何适当的应用中采用。例如，能够在用于开放式或微创(单个或多个端口)程序的手动或电动手持式或自动的直接控制的或远程操纵的外科手术器械中采用此处公开的方法。
其他变体在本发明的精神内。因而，在本发明易受多种修改和可替换的构造影响时，其某些图示的实施例在图中显示并已经在上面详细描述。然而，应该理解，不意图将本发明限于具体的形式或公开的形式，而是相反，本发明包含落入如所附的权利要求限定的本发明的精神和范围内的所有修改、可替换的构造和等价物。
除非本文另外指出或通过上下文明确地否认，术语“力”应该被解释为包含力和扭矩(特别是在下列权利要求的背景中)。除非本文另外指出或通过上下文明确地否认，术语“一”、“一个”和“所述”以及相似的指示物在描述本发明的背景中(特别是在下列权利要求的背景中)的使用应该被解释为包含单数和复数。除非另外指出，术语“包括”“具有”、“包含”和“含有”应该被解释为开放式术语(即，意味着“包含，但不限于”)。即使存在某些介入，术语“连接”应该被解释为部分地或完全地包含在、附连到或结合在一起。除非本文另外指出，本文的值的范围的阐述仅意在用作单独涉及落入范围内的每个单独值的简写方法，并且每个单独的值被包括在说明书内，如同它是被单独地列举在本文。除非本文另外指出或通过上下文明确地否认，本文描述的所有的方法能够以任何适当的顺序执行。除非另外要求，本文提供的任何和所有的示例或示例性语言(例如，“诸如”)的使用仅意在更好地说明本发明的实施例而不对本发明的范围造成限制。说明书中的语言都不应被解释为将任何非请求保护的元件指示为本发明的实施必不可少的。
本文描述本发明的优选的实施例，包含发明者已知的用于实施本发明的最好的模式。在本领域的技术人员阅读前述描述时，那些优选实施例的变体对本领域的技术人员来说变得显然易见。发明人预期到技工按需要采用这样的变体，并且发明人意图以本文具体描述的之外的方式实施本发明。因此，如通过应用的法律允许的，本发明包含所附权利要求中引用的主题的所有的修改和等价物。此外，除非本文另外指出或通过上下文明确地否认，本发明包含其所有可能变体中的上述描述的元素的任何组合。
因此，通过参考相同的程度包括本文引用的所有的参考文献，包含出版物、专利申请书和专利，如同每个参考文文献单独地和特别地指出被并入本文作为参考并且以其整体阐述在本文中。

Claims (24)

1.一种铰接外科手术器械中的切割刀片的方法，所述方法包括：
在所述器械的外壳内支撑具有切割刀片的手术刀构件，所述外壳具有近端和远端，所述切割刀片被配置为当所述手术刀构件向远侧移动时进行切割；
通过从第一位置至第二位置的第一移动，向远侧移动驱动构件；
在所述驱动构件的第一移动期间耦接所述手术刀构件与所述外壳，以便阻止所述手术刀构件向远侧移动；和
在所述驱动构件从所述第二位置至第三位置的第二远侧移动期间，利用所述驱动构件向远侧驱动所述手术刀构件。
2.根据权利要求1所述的方法，贯穿所述驱动构件向远侧大约4mm的移动，阻止所述手术刀构件向远侧移动。
3.根据权利要求1所述的方法，其中耦接所述手术刀构件与所述外壳的所述行为包含使用所述驱动构件保证所述手术刀构件和所述外壳之间的接合。
4.根据权利要求3所述的方法，其中使用所述驱动构件保证所述手术刀构件和所述外壳之间的接合的所述行为包含使所述驱动构件与所述手术刀构件相连接。
5.根据权利要求4所述的方法，其中所述手术刀构件包含第一突出物，所述第一突出物与所述驱动构件和所述外壳的接收器相连接，以便在所述驱动构件的第一移动期间阻止所述手术刀构件向远侧移动。
6.根据权利要求5所述的方法，包括旋转所述手术刀构件，以从所述外壳接收器移除所述第一突出物。
7.根据权利要求6所述的方法，包括：
将所述第一突出物接收到所述驱动构件的接收器内；和
在所述驱动构件的第二移动期间，在所述驱动构件接收器中容纳所述第一突出物。
8.根据权利要求1所述的方法，其中所述手术刀构件包含在所述驱动构件的所述第一移动期间不与所述驱动构件相连接的驱动特征件，所述手术刀驱动特征件在所述驱动构件的所述第二移动期间与所述驱动构件相连接。
9.根据权利要求8所述的方法，其中所述手术刀驱动特征件包含第二突出物。
10.根据权利要求1所述的方法，包含沿凸轮面驱动所述手术刀构件，从而升高所述手术刀构件的远端并且将所述切割刀片降低到所述外壳内。
11.根据权利要求1所述的方法，进一步包括在所述驱动构件的所述第二移动期间使用所述驱动构件部署吻合钉。
12.一种外科手术器械，其包括：
具有轴远端和轴近端的细长轴；
耦接到所述轴远端且包含相对的钳的末端执行器；
包括在所述钳中的一个钳内的外壳，所述外壳包含外壳近端、外壳远端、在所述外壳近端和远端之间延伸的上表面、在所述外壳近端和远端之间延伸的中央腔和延伸通过所述上表面的纵向狭槽；
被支撑在所述外壳内以便向远侧移动的手术刀构件，所述手术刀构件具有被配置为当所述手术刀构件向远侧移动时进行切割的切割刀片；和
滑动地安装在所述外壳内以便向远侧移动的驱动构件，在所述驱动构件从第一位置至第二位置向远侧的第一移动期间所述手术刀构件与所述外壳耦接，以阻止所述手术刀构件向远侧移动，在所述驱动构件从所述第二位置至第三位置向远侧的第二移动期间，所述手术刀构件由所述驱动构件向远侧驱动。
13.根据权利要求12所述的器械，其中贯穿所述手术刀构件向远侧大约4mm的移动，阻止所述手术刀构件向远侧移动。
14.根据权利要求12所述的器械，其中所述驱动构件用于在所述驱动构件的所述第一移动期间保证所述手术刀构件和所述外壳之间的接合，以阻止所述手术刀构件向远侧移动。
15.根据权利要求14所述的器械，其中在所述驱动构件的所述第一移动期间，所述驱动构件与所述手术刀构件相连接，以保证所述手术刀构件和所述外壳之间的接合，从而阻止所述手术刀构件向远侧移动。
16.根据权利要求15所述的器械，其中所述手术刀构件包含第一突出物，所述第一突出物与所述驱动构件和所述外壳的接收器相连接，以在所述驱动构件的所述第一移动期间阻止所述手术刀构件向远侧移动。
17.根据权利要求16所述的器械，其中所述手术刀构件被旋转，以在所述驱动构件达到所述第三位置之前从所述外壳接收器移除所述第一突出物。
18.根据权利要求17所述的器械，其中所述驱动构件的接收器被配置为在所述驱动构件的所述第二移动期间接收所述第一突出物并且容纳所述第一突出物。
19.根据权利要求12所述的器械，其中所述手术刀构件包含驱动特征件，所述驱动构件在所述驱动构件的所述第一移动期间不与所述驱动特征件相连接，并且所述驱动构件在所述驱动构件的所述第二移动期间与所述驱动特征件相连接，以向远侧驱动所述手术刀构件。
20.根据权利要求19所述的器械，其中所述驱动特征件包含第二突出物。
21.根据权利要求12所述的器械，包括凸轮面，所述凸轮面被配置为在所述驱动构件通过从所述第三位置至第四位置的第三移动向远侧移动时与手术刀构件相连接，以升高所述手术刀构件的远端，从而将所述切割刀片降低到所述外壳内。
22.根据权利要求12所述的器械，其中所述外壳包含在所述上表面和所述中央腔之间延伸的多个吻合钉开口，并且所述器械进一步包括设置在所述吻合钉开口中的多个吻合钉，所述吻合钉中的每个响应于所述驱动构件向远侧的移动被部署。
23.一种外科手术器械的可拆卸附连钉仓，所述钉仓包括：
可拆卸地附连到所述外科手术器械的末端执行器的外壳，所述外壳包含近端、远端、在所述近端和所述远端之间延伸的上表面、在所述近端和远端之间延伸的中央腔和延伸通过所述上表面的纵向狭槽；
与所述外壳耦接以便相对于所述外壳旋转的导螺杆；
与所述导螺杆可旋转地耦接的旋转输入端，所述旋转输入端被配置为当所述外壳附连到所述末端执行器时，与所述外科手术器械的旋转输出端耦接；
被支撑在所述外壳内以便向远侧移动的手术刀构件，所述手术刀构件具有被配置为当向远侧移动所述手术刀构件时进行切割的切割刀片；和
驱动构件，其被安装在所述外壳内且与所述导螺杆耦接以便响应于所述导螺杆的旋转沿所述导螺杆移动，所述手术刀构件在所述驱动构件从第一位置到第二位置向远侧的第一移动期间与所述外壳耦接，以便阻止所述手术刀构件向远侧移动，所述手术刀构件在所述驱动构件从所述第二位置至第三位置向远侧的第二移动期间通过所述驱动构件向远侧驱动。
24.根据权利要求23所述的钉仓，其中所述外壳包含在所述上表面和所述中央腔之间延伸的多个吻合钉开口，并且所述钉仓进一步包括设置在所述吻合钉开口中的多个吻合钉，所述吻合钉的每个响应于所述驱动构件向远侧的移动部署。
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