CN104042327B - 具有开关激活控制的手术器械 - Google Patents
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Abstract
手术器械包括壳体和可操作地联接至致动机构的细长轴，所述致动机构能够在已致动位置和未致动位置之间移动。端部执行器包括一对相对的第一钳口构件和第二钳口构件，并且适于连接至电外科能量源。开关能够在激活位置和释放位置之间移动，所述激活位置用于启动将电外科能量输送至端部执行器，所述释放位置用于终止将电外科能量输送至端部执行器。开关激活构件构造为在激活位置和释放位置之间移动开关。开关控制构件构造为在致动机构从已致动位置至未致动位置的至少一部分运动过程中将开关维持在激活位置中。
Description
技术领域
本发明大体涉及手术器械领域。具体地，本发明涉及内窥镜电手术钳，所述内窥镜电手术钳包括用于控制治疗能量的激活和解除的系统和方法。
背景技术
诸如电手术钳的器械通常被用于开放式和内窥镜外科手术中，以凝结、烧灼和密封组织。这种钳一般包括一对钳口，所述一对钳口能够被医师控制以抓取目标组织，诸如血管。可以使钳口靠近以施加机械夹钳力至组织，并且钳口与至少一个电极相连以允许将电外科能量输送至组织。已经说明机械夹钳力和电外科能量的组合用于结合被捕获在钳口之间的相邻的组织层。当相邻的组织层包括血管壁时，密封组织可以导致止血，这可以有利于横切已密封的组织。可以在Dycus等人的美国专利No.7,255,697中找到电手术钳的使用的详细讨论。
双极电手术钳一般包括布置于钳口的夹持面上的相对的电极。电极被充电至相反的电势，以使得电外科电流能够被有选择地传送穿过抓取于电极之间的组织。为了产生适当的密封（特别是在相对大的血管中），两个主要的机械参数必须被精确地控制：施加于血管的压力、以及建立在电极之间的间隙距离。
压力和间隙距离均影响所产生的组织密封的有效性。如果未维持适当的间隙距离，则存在相反的电极将彼此接触的可能性，这可能导致短路并且防止能量被传送穿过组织。还有，如果施加过小的力，则组织在能够产生足够的密封之前可能移动。典型的有效的组织密封部的厚度最佳地在大约0.001和大约0.006英寸之间。在这个范围以下，密封部可能被撕碎或撕裂，而在这个范围以上，血管壁可能不能被有效地结合。用于密封大的组织结构的闭合压力优选地落入大约3公斤/平方厘米至大约16公斤/平方厘米的范围内。
发明内容
本发明通常涉及手术器械领域。具体地，本发明涉及内窥镜电手术钳，所述内窥镜电手术钳包括用于控制治疗能量的激活和解除的系统和方法。
正如传统的，术语“远侧的”在本文中指代远离操作者的装置端部，并且术语“近侧的”在本文中指代靠近操作者的电手术钳端部。
根据本发明的一个方面，提供手术器械。手术器械包括壳体和细长轴。所述细长轴具有从壳体延伸的远侧部分以及联接至壳体的近侧部分。纵向轴线限定为穿过细长轴。致动机构被可操作地联接至细长轴，并且能够相对于壳体在已致动位置和未致动位置之间移动，以沿纵向轴线有选择地移动细长轴。端部执行器包括能够相对于彼此从第一位置移动至第二位置的一对相对的第一钳口构件和第二钳口构件，在所述第一位置中第一钳口构件和第二钳口构件以相对于彼此间隔开的关系布置，在所述第二位置中第一钳口构件和第二钳口构件共同协作以抓取组织。端部执行器能够连接至电外科能量源，以用于将电外科能量传导穿过被抓取于第一钳口构件和第二钳口构件之间的组织，以实现组织密封部。开关被壳体支承，并且能够在激活位置和释放位置之间移动，所述激活位置用于启动将电外科能量从电外科能量源输送至端部执行器，所述释放位置用于终止将电外科能量从电外科能量源输送至端部执行器。开关激活构件布置于致动机构上，并且构造成在致动机构移动至已致动位置时将开关移动至激活位置，以及在致动机构移动至未致动位置时将开关移动至释放位置。开关控制构件构造为在致动机构从已致动位置至未致动位置的至少一部分运动过程中将开关维持在激活位置中。
额外地或替代地，手术器械还可以包括刀片，所述刀片支承于细长轴中，并且能够在纵向方向上移动穿过被沿第一钳口构件和第二钳口构件中的至少一个的长度限定的刀通路，以切割布置于第一钳口构件和第二钳口构件之间的组织。
额外地或替代地，开关可以可操作地联接至可按压按钮，所述可按压按钮从壳体延伸，并且构造为在致动机构移动至已致动位置时由开关激活构件有选择地接合。
额外地或替代地，开关控制构件可以包括布置于可按压按钮和开关之间的偏置构件。偏置构件可以构造为在致动机构从已致动位置至未致动位置的至少一部分运动过程中维持作用在开关上的力，以将开关维持在激活位置中。
额外地或替代地，开关控制构件可以包括偏置构件。所述偏置构件从致动机构延伸，并且具有构造成接合可按压按钮的按钮激活柱。偏置构件可以构造为在致动机构从已致动位置至未致动位置的至少一部分运动过程中维持作用在开关上的力，以将开关维持在激活位置中。
额外地或替代地，开关控制构件可以包括布置于可按压按钮和开关之间的偏置构件。可按压按钮可以具有从其至少部分地延伸穿过偏置构件的开关激活柱。偏置构件可以构造为在致动机构从已致动位置至未致动位置的至少一部分运动过程中维持作用在开关上的力，以将开关维持在激活位置中。
额外地或替代地，开关控制构件可以包括从致动机构延伸的偏置构件，所述偏置构件构造为在致动机构从已致动位置至未致动位置的至少一部分运动过程中维持作用在开关上的力，以将开关维持在激活位置中。
额外地或替代地，第二钳口构件可以机械地联接至细长轴的远侧端部，并且第一钳口构件可以构造为相对于第二钳口构件移动。
额外地或替代地，开关控制构件可以包括板簧。
额外地或替代地，开关控制构件可以包括盘簧。
额外地或替代地，手术器械还可以包括轴向地布置于细长轴内的静止致动构件。静止致动构件可以包括机械地联接至细长轴的远侧部分的偏心销。第一钳口构件和第二钳口构件中的一个或两个可以包括凸轮开槽，所述凸轮开槽构造成接合偏心销，以在细长轴沿纵向轴线移动时围绕枢转点在第一位置和第二位置之间移动至少一个可移动的钳口构件。
额外地或替代地，电绝缘件可以联接至钳口构件中的一个或全部。
额外地或替代地，手术器械还可以包括导电组织密封表面，所述导电组织密封表面沿第一钳口构件和第二钳口构件中的至少一个的长度延伸，并且能够连接至电外科能量源。
根据本发明的另一个方面，提供手术器械。手术器械包括壳体和细长轴。所述细长轴具有从壳体延伸的远侧部分以及联接至壳体的近侧部分。纵向轴线限定为穿过细长轴。致动机构被可操作地联接至细长轴，并且能够相对于壳体在已致动位置和未致动位置之间移动，以沿纵向轴线有选择地移动细长轴。端部执行器包括能够相对于彼此从第一位置移动至第二位置的一对相对的第一钳口构件和第二钳口构件，在所述第一位置中第一钳口构件和第二钳口构件以相对于彼此间隔开的关系布置，在所述第二位置中第一钳口构件和第二钳口构件共同协作以抓取组织。端部执行器能够连接至电外科能量源，以用于将电外科能量传导穿过被抓取于第一钳口构件和第二钳口构件之间的组织，以实现组织密封部。开关被壳体支承，并且能够在激活位置和释放位置之间移动，所述激活位置用于启动将电外科能量从电外科能量源输送至端部执行器，所述释放位置用于终止将电外科能量从电外科能量源输送至端部执行器。开关激活构件布置于致动机构上，并且构造成在致动机构移动至已致动位置时将开关移动至激活位置，以及在致动机构移动至未致动位置时将开关移动至释放位置。开关控制构件构造为在致动机构从已致动位置至未致动位置的至少一部分运动过程中将开关维持在激活位置中。刀片支承于细长轴中，并且能够在纵向方向上移动穿过被沿第一钳口构件和第二钳口构件中的至少一个的长度限定的刀通路，以切割布置于第一钳口构件和第二钳口构件之间的组织。
额外地或替代地，开关可以可操作地联接至可按压按钮，所述可按压按钮从壳体延伸，并且构造为在致动机构移动至已致动位置时由开关激活构件有选择地接合。
额外地或替代地，开关控制构件可以布置于可按压按钮和开关之间。
额外地或替代地，开关控制构件可以布置于致动机构上。
根据本发明的另一个方面，提供用于电手术器械的开关致动控制机构，所述电手术器械具有壳体和端部执行器，所述端部执行器适于连接至电外科能量源，以用于将电外科能量传导穿过被端部执行器抓取的组织，以实现组织密封部。开关致动控制机构包括被壳体支承的开关。开关能够在激活位置和释放位置之间移动，所述激活位置用于启动将电外科能量从高频电刀输送至端部执行器，所述释放位置用于终止将电外科能量从高频电刀输送至端部执行器。开关激活构件能够在已致动位置和未致动位置之间移动，以使开关在激活位置和释放位置之间有选择地移动。开关控制构件构造为在开关激活构件从已致动位置至未致动位置的至少一部分移动过程中将开关维持在激活位置中。
额外地或替代地，开关控制构件可以布置于开关和开关激活构件之间。
额外地或替代地，开关控制构件可以包括偏置构件，所述偏置构件构造为维持作用在开关上的力，以在开关激活构件从已致动位置至未致动位置的至少一部分运动过程中将开关维持在激活位置中。
附图说明
被纳入本文并且构成本说明书一部分的附图描述了本发明的实施例，并且连同以下给出的实施例的详细描述一同用于解释本发明的原理。
图1为根据本发明的实施例的电手术钳的立体图，包括壳体、细长轴、以及端部执行器；
图2A为示出带有处于开放构造中的一对钳口构件的图1的端部执行器的放大立体图；
图2B为示出带有处于闭合构造中的一对钳口构件的图1的端部执行器的放大立体图；
图3A为以部件分离的方式示出的图1的端部执行器和细长轴的立体图；
图3B为沿图3A的线3B-3B的剖视图，示出绘有导向管的图1的电手术钳的远侧部分；
图4为旋转旋钮的面向近侧的立体图，示出用于接收图1的细长轴的通道；
图5为图1的端部执行器的剖视立体图；
图6为图1的端部执行器的钳口致动机构的远侧部分的面向近侧的局部立体图；
图7为图1的端部执行器的刀致动机构的远侧部分的面向远侧的局部立体图；
图8为图1的端部执行器的下钳口构件的仰视立体图；
图9为图8的下钳口构件的仰视剖视立体图；
图10为图1的器械的近侧部分的立体图，且壳体的一部分被移除以揭示内部部件；
图11为图1的器械的近侧部分的局部侧视图；
图12A为图1的端部执行器的刀致动机构的近侧部分的放大立体图；
图12B为图1的端部执行器的刀致动机构的刀套圈的放大剖视侧视图；
图13A为图10的器械的近侧部分的内部侧视图，示出在相对于静止手柄分离位置（与图2A中示出的端部执行器的开放构造相对应）中的可移除手柄、以及在相对于静止手柄分离的构造（与刀的相对于钳口构件未致动或近侧的构造相对应）中的刀触发器；
图13B为图10的器械的近侧部分的内部侧视图，示出与端部执行器的第一闭合构造相对应的在相对于静止手柄居中位置中的可移除手柄，在所述端部执行器的第一闭合构造中钳口构件彼此相接；
图13C为图10的器械的近侧部分的内部侧视图，示出与端部执行器的第二闭合构造相对应的在相对于静止手柄接近构造中的可移除手柄，在所述端部执行器的第二闭合构造中钳口构件施加适当的压力以实现组织密封；以及
图13D为图10的器械的近侧部分的内部侧视图，示出在已致动构造（与刀的相对于钳口构件已致动或远侧的位置相对应）中的刀触发器。
具体实施方式
首先参考图1，电手术钳100的实施例通常包括壳体112，所述壳体112在其上支承多个致动器以用于通过细长轴116远程地控制端部执行器114。虽然这个构造一般与用于腹腔镜或内窥镜外科手术的器械相关联，但是可以通过传统的开放式器械并且结合某些腔内手术实践本发明的多个方面。
壳体112由左壳体半部112a和右壳体半部112b构成。壳体半部112a、112b的左右称呼指的是由使用钳100的操作者观察到的各自的方向。壳体半部112a、112b由坚固塑料构成，并且通过粘合剂、超声焊接或其他适合的组装方法结合至彼此。
为了机械控制端部执行器114，壳体112支承静止手柄120、可移动手柄122、触发器126以及旋转旋钮128。可移动手柄122可操作成在开放构造（图2A）和闭合或夹钳构造（图2B）之间移动端部执行器114，在所述开放构造中一对相对的钳口构件130、132以相对于彼此间隔开的关系布置，在所述闭合或夹钳构造中钳口构件130、132更靠近彼此。可移动手柄122与静止手柄120的接近用于将端部执行器114移动至闭合构造，并且可移动手柄122与静止手柄120的分离用于将端部执行器114移动至开放构造。触发器126可操作成当端部执行器114在闭合构造中时使得刀片156（见图2A和2B）伸出和缩回穿过端部执行器114。旋转旋钮128用于围绕延伸穿过钳的纵向轴线A-A旋转细长轴116和端部执行器114。
为了电控制端部执行器114，静止手柄120支承在其上的可按压按钮137，所述可按压按钮137能够被使用者操作以启动和终止将电外科能量输送至端部执行器114。更特别地，并且正如在图13A-13D中说明的，可按压按钮137机械地联接至被布置于静止手柄120内的开关136。在一些实施例中，一旦可移动手柄122向近侧移动，则按钮137能够被按钮激活柱138接合，按钮激活柱138从可移动手柄122的近侧侧部延伸。开关136与支承于壳体112内的电外科能量源（诸如高频电刀141或电池（未示出））电连通。高频电刀141可以包括诸如由科罗拉多Boulder的Covidien Energy-based Devices出售的VesselSealing Generator和Force的设备。线缆143在壳体112和高频电刀141之间延伸，并且包括在其上的连接器（未示出），以使得钳100可以被有选择地电联接至高频电刀141以及与高频电刀141断开。
如下文进一步详细描述的，使用者挤压可移动手柄122，以将可移动手柄122与静止手柄120接近并且激活开关136，以启动将电外科能量输送至端部执行器114并且实现组织密封。一旦完成组织密封，则使用者操作触发器126，以当端部执行器114在闭合构造中时将刀片156推进穿过端部执行器114。当使用者通过正在挤压可移动手柄122以将端部执行器114保持于闭合构造中的相同的手来触及触发器126时，可移动手柄122可能被不慎地朝远侧移动远离静止手柄120。该可移动手柄122的向远侧移动可能导致按钮激活柱138脱离按钮137，并且继而按钮137脱离和释放开关136，以终止将电外科能量输送至端部执行器114。当使用者向近侧移动触发器126以将刀片156推进穿过端部执行器114时，使用者再次挤压可移动手柄122，以使得按钮激活柱138再次接合并且按压按钮137，因此再次激活开关136。开关136的再次激活再次启动了将电外科能量输送至端部执行器114，同时刀片156被推进穿过端部执行器114。
在一些实施例中，钳100可以包括增强开关控制结构，所述增强开关控制结构被构造成在操作触发器126过程中防止开关136的释放和再次激活分别终止和再次启动将电外科能量输送至端部执行器114。参考图10，描述一个这样的实施例，其中按钮137包括从其延伸的开关激活柱137a、以及围绕开关激活柱137a布置于开关136和按钮137之间的偏置构件136a（例如盘簧）。开关激活柱137a被相对于开关136定位，以使得一旦可移动手柄122与静止手柄120接近则按钮激活柱138接合并且按压按钮137时，开关激活柱137a接合并且激活开关136。按钮137的按压还导致偏置构件136a压缩于按钮137和开关136之间，并且导致施加弹簧力于开关136上。如果在操作触发器126过程中可移动手柄122不慎地向远侧移动远离静止手柄120，那么偏置构件136a（虽当前被轻微地减压）通过维持在开关136上的弹簧力而削弱可移动手柄122向远侧移动的效果。在可移动手柄122在向远侧的方向上平移的至少一部分过程中，这个维持于开关136上的弹簧力足以保持开关136被激活，以使得在操作触发器126过程中开关136不被释放和再次激活。当可移动手柄122移动远离静止手柄120以将端部执行器114移动至开放构造（图2A）过程中，被偏置构件136a维持于开关136上的弹簧力变小，并且因此开关136被释放。
当前参考图2A-3，端部执行器114可以从开放构造（图2A）移动到闭合构造（图2B），在所述开放构造中组织（未示出）被接收于钳口构件130、132之间，在所述闭合构造中组织被夹钳并且进行治疗。上和下钳口构件130、132（例如通过各自的延伸穿过细长轴116的线）被电联接至线缆143并且因此联接至高频电刀141，以提供通向分别布置于下和上钳口构件130、132上的一对导电组织接合密封板148、150的电通路。下钳口构件132的密封板148与上钳口构件130的密封板150相对，并且在一些实施例中，密封板148和150电联接至相反的终端，例如与高频电刀141相连的正极或有源（+）端子以及负极或返回（-）端子。因此，可以通过密封板148和150提供双极能量。替代地，密封板148和150和/或端部执行器114可以构造成输送单极能量至组织。在单极构造中，密封板148和150中的一个或两个输送来自高频电刀141的活动端子（例如（+））的电外科能量，同时返回垫（未示出）大体上安置在患者上并且提供通向高频电刀141的相反端子（例如（-））的返回路径。每一个钳口构件130、132均包括钳口插入件140以及绝缘件142，所述绝缘件142用于将密封板150、148分别与钳口构件130、132的钳口插入件140电绝缘。
参考图3，细长轴116包括多个纵向部件，所述纵向部件将端部执行器114操作地联接至由壳体112（图1）支承的多个致动器。外轴构件160限定细长轴116的外表面，并且支承其他部件移动穿过其中，如下所述。外轴构件160构造成相对于被轴向地接收于外轴构件160内的内致动构件180纵向运动。内致动构件180可以为杆、轴、冲压金属、或其他适合的金属部件。外轴构件160的近侧部分166构造成接收于壳体112（图1）内，并且包括用于将外轴构件160操作地联接至致动器（其支承于壳体112上，例如可移动手柄122）的结构。内致动构件180的远侧部分186包括限定于其中的纵向凹陷部190，所述纵向凹陷部190为枢转销144提供空隙，并且因此允许枢转销144独立于内致动构件180（通过外轴构件160的往复运动）纵向往复运动。在纵向凹陷部190的远侧，偏心销192（例如通过焊接、摩擦配合、激光焊接等）机械地联接至内致动构件180的远侧部分186。内致动构件180的近侧部分188包括联接至其上的垫片187（图10）。垫片187被支承于壳体112内，并且用于阻止内致动构件180平行于纵向轴线A-A的纵向运动。
钳口构件130、132可以围绕枢转销144枢转，以将端部执行器144移动至图2B的闭合构造，在所述闭合构造中密封板148、150向抓取于其之间的组织提供压力。在一些实施例中，为了提供有效的密封，在大约3千克/平方厘米至大约16千克/平方厘米之间范围（理想地在7千克/平方厘米至13千克/平方厘米）工作范围内的压力被施加至组织。还有，在闭合构造中，可以通过布置于密封板148、150上或其附近的止动构件组154（图2A）来维持密封板148、150之间的分离或间隙距离“G”。止动构件154接触在相对的钳口构件130、132上的相对的表面，并且阻止密封板148、150的进一步接近。在一些实施例中，为了提供有效的组织密封，可以提供大约0.001英寸至大约0.010英寸（理想地在大约0.002英寸至大约0.005英寸之间）的适当的间隙距离。在一些实施例中，止动构件154由被模塑至钳口构件130、132上（例如通过诸如包覆模制或注射成型的工艺）的不导电塑料或其他材料构成。在其他实施例中，止动构件154由沉积至钳口构件130、132上的抗热陶瓷构成。
电外科能量可以通过导电密封板148、150被输送至组织以实现组织密封。一旦形成组织密封，则具有锋利远侧切割边缘157的刀片156可以推进穿过被限定于钳口构件130、132中的一个或全部中的刀通道158，以横切已密封组织。如图2A中所描述当端部执行器144在开放构造中时，刀片156从细长轴116延伸。在一些实施例中，提供刀闭锁件以防止当端部执行器114在开放构造中时刀片156延伸至刀通道158内。
外轴构件160的近侧部分166包括用于将外轴构件160联接至壳体112的多个元件的多个结构。更具体来说，按照从远到近的顺序，外轴构件160的近侧部分166包括从其近侧端部向远侧延伸以将外轴构件160联接至旋转旋钮128的纵向开槽169、限定为穿过其中的纵向刀开槽168、一对相对的远侧锁定开槽161a、161b、以及一对相对的近侧锁定开槽171a、171b。建立在外轴构件160和旋转旋钮128之间的连接以下参考图4进行描述。
枢转销144延伸穿过钳口构件130、132中的每一个的近侧部分，以将钳口构件130、132可枢转地支承于外轴构件160的远侧端部处。参考图8，钳口构件130、132中的每一个的近侧部分包括两个横向间隔开的平行凸缘或“旗状件”130a、130b和132a、132b，所述平行凸缘分别从钳口构件130和132的远侧部分向近侧延伸。横向凸轮开槽130c和横向枢转孔130d延伸穿过上钳口构件130的旗状件130a、130b中的每一个。类似地，横向凸轮开槽132c和横向枢转孔132d延伸穿过下钳口构件132的旗状件132a、132b中的每一个。枢转孔130d、132d以滑动配合的方式接收枢转销144，所述滑动配合方式允许钳口构件130、132围绕枢转销144枢转，以在开放构造和闭合构造（分别见图2A和图2B）之间移动端部执行器114。
刀杆102在最远侧端部处（例如通过焊接）联接至锋利的刀片156，并且包括成一定角度的近侧端部108，所述近侧端部108提供用于将刀杆102操作地联接至触发器126的机构。刀杆102和触发器126之间的连接在下文通过图10、11、12A和12B加以详细地描述。在形成轮廓的冲压工艺之后，刀片156的锋利边缘157可以被施加于刀片156的远侧端部。例如，可以采用诸如研磨、模压、电化学蚀刻、电抛光、或其他适合的制造工艺的多种制造技术用来形成锋利的边缘。
参考图3A和3B，引导管109布置于外轴构件160内，并且包括布置为轴向穿过其中的引导内腔107和形成于其中的引导凹陷部105。内致动构件180被接收于引导内腔107内，所述引导内腔107用于在外轴构件160内定向和对齐内致动构件180。刀杆102被接收于纵向凹陷部105内，所述纵向凹陷部105用于在外轴构件160内引导刀杆102的纵向运动。通过这种方法，内致动构件180和刀杆102通过引导管109在外轴构件160内对齐，以使得刀杆102相对于内致动构件180自由地纵向移动。
当前参考图4，旋转旋钮128包括限定为穿过其中用于接收外轴构件160的通路129。通路129具有与外轴构件160的环形轮廓相对应的大体上环形的轮廓。通路129包括构造成与外轴构件160的纵向开槽169（图3A）对齐并且就位于其中的纵向键合构件124。键合构件124沿通路129的长度横向地向内突出，从而将外轴构件160的近侧端部插入至旋转旋钮128的通路129内会将外轴构件160操作地联接至旋转旋钮128。传递至旋转旋钮128的旋转运动因此可以将旋转运动传递至细长轴116的每个部件，并且传递至联接至其上的端部执行器114。如图12中所示，旋转旋钮128位于壳体112的内隔室134内，并且如图1中所示从壳体112的相对的侧部横向地向外延伸（仅示出从壳体半部112b横向地向外延伸）。
当前参考图5，端部执行器114通过偏心销192联接至内致动构件180的远侧端部。偏心销192代表用于外轴构件160、枢转销144、和刀杆102纵向移动的纵向静止参照物。偏心销192延伸穿过下钳口构件132的旗状件132a、132b以及上钳口构件130的旗状件130a和130b。
当前参考图6，端部执行器114被示出为在开放构造中。由于内致动构件180联接至偏心销192，因此当外轴构件160处于远侧位置（未致动）、并且内致动构件180处于相对于外轴构件160的近侧位置中时，偏心销192定位于凸轮开槽130c和132c中的近侧位置中，所述凸轮开槽130c和132c被分别限定为穿过钳口构件130、132的旗状件130a、130b、132a、132b。
外轴构件160可以被相对于内致动构件180和偏心销192向近侧牵拉，以将端部执行器114移动至闭合构造（见图2B）。由于偏心销192的纵向位置被固定，并且由于凸轮开槽130c、132c被相对于纵向轴线A-A倾斜地布置，因此外轴构件160的向近侧缩回引起偏心销192向远侧平移穿过凸轮开槽130c、132c并且引起钳口构件130围绕枢转销144朝向钳口构件132枢转。相反地，当端部执行器114在闭合构造中时，外轴构件160在向远侧方向上的纵向平移引起偏心销192向近侧平移穿过凸轮开槽130c、132c并且引起钳口构件130朝向开放构造枢转远离钳口构件132。
当前参考图7，销144、192不干扰刀片156的往复运动。绝缘件142的近侧部分形成刀片引导件142a（还见图8和9），所述刀片引导件142a用于对齐刀片156，以使得刀片156容易地进入被限定于钳口构件130、132（为了清晰起见，钳口构件130在图7中被移除）中的刀通道158。
当前参考图8和9，下钳口构件132由三个主要部件构成。这些部件包括钳口插入件140、绝缘件142、以及密封板148。钳口构件132的旗状件132a、132b限定钳口插入件140的近侧部分，并且钳口插入件140的大体上U形的轮廓向远侧延伸以支承钳口构件132的组织接合部分。上钳口构件130包括与下钳口构件132相同的三个主要部件（包括密封板150），并且由与下钳口构件132相同的方式构成。
绝缘件142可以由电绝缘塑料构成，诸如聚邻苯二甲酰胺（PPA）（例如）、聚碳酸酯（PC）、丙烯腈丁二烯苯乙烯聚合物（ABS）、PC和ABS混合物、尼龙、陶瓷等。电绝缘塑料可以在单次注射成型工艺中被包覆模制至钳口插入件140上，以使得密封板148被包覆模制至钳口插入件140上。额外地或替代地，电绝缘塑料可以被机械地联接至钳口插入件140，例如按压、卡扣、胶合等。有利于将密封板148附接至插入件140的多个特征可以被模塑至绝缘件142内。例如，可以提供允许密封板148的卡扣配合附接的突片，或者可以形成允许将密封板148超声焊接至绝缘件142上的脊。密封板148可以由导电金属构成，并且可以由平板料冲压而成。
当前参考图10，描述可移动手柄122和刀触发器126至细长轴116的纵向可移动部件的连接。可以操纵可移动手柄122以将纵向运动传递至外轴构件160，并且可以操纵刀触发器126以将纵向运动传递至刀杆102。如上所述，外轴构件160的纵向运动用于将端部执行器114在图2A的开放构造和图2B的闭合构造之间移动，并且刀杆102的纵向运动用于将刀片156移动穿过刀通路158（图2A）。
可移动手柄122通过U形夹178操作地联接至外轴构件160，U形夹178限定于可移动手柄122的上端部处。U形夹178通过枢转凸台（boss）179可枢转地支承于左壳体半部112b上。互补的第二枢转凸台（未示出）设置于右壳体半部112a上以支承U形夹178。U形夹178围绕支承于外轴构件160上的驱动套圈184（图11）的相对的侧部向上延伸，并且包括在其上的圆形驱动表面197a和197b。驱动表面197a接合远侧弹簧垫片184a的面向近侧的表面，并且驱动表面197b接合驱动套圈184（图11）的近侧边沿184b的面向远侧的表面。远侧弹簧垫片184a接合远侧弹簧止动件184c的面向近侧的表面，所述远侧弹簧止动件184c继而接合延伸穿过外轴构件160的近侧部分166（图3A）的相对的远侧锁定开槽161a、161b（图3A），以将远侧弹簧止动件184c联接至外轴构件160。驱动表面197a、197b沿纵向轴线A-A布置，以使得可移动手柄122的枢转运动引起驱动套圈184（图11）沿纵向轴线A-A的相应纵向运动。
当前参考图11，可以通过用可移动手柄122（图10）如箭头D4所示（图11）向近侧推动驱动套圈184的近侧边沿184b而将向近侧纵向运动传递至外轴构件160。弹簧189被约束于驱动套圈184的面向近侧的表面和近侧弹簧止动件115之间。近侧弹簧止动件115接合相对的近侧锁定开槽171a、171b，近侧锁定开槽171a、171b延伸穿过外轴构件160的近侧部分166（图3A），以将近侧弹簧止动件115联接至外轴构件160。因此，近侧弹簧止动件115用作被弹簧189压缩的近侧止动件。
通过用可移动手柄122如箭头D3所示（图10）向远侧驱动驱动套圈184而将向远侧纵向运动传递至外轴构件160。由于驱动套圈184联接至相对的远侧锁定开槽181a、181b（其延伸穿过外轴构件160（图3A）的近侧部分166），因此驱动套圈184的向远侧纵向运动引起外轴构件160的相应向远侧运动。
外轴构件160的向近侧纵向运动向近侧牵拉钳口构件132，以使得偏心销192向远侧推进，以钳口构件130朝向钳口构件132枢转，从而将端部执行器114移动至闭合构造，正如以上参考图6所述。一旦钳口构件130和132被闭合，则外轴构件160基本上见底（即由于钳口构件130、132彼此接触，因此阻止外轴构件160的进一步向近侧移动）。然而，可移动手柄122的进一步向近侧移动（见图10）将继续向近侧移动驱动套圈184。该驱动套圈184的持续向近侧移动进一步压缩弹簧189，以将额外的力传递至外轴构件160，这产生施加于被抓取在钳口构件130、132（见图2B）之间的组织的额外的闭合力。
再次参考图10，触发器126围绕从触发器126突出的枢转凸台103可枢转地支承于壳体112内。触发器126通过刀连接机构104操作地联接至刀杆102，以使得触发器126的枢转运动引起刀杆102的纵向运动。刀连接机构104包括触发器126的上旗状件126a、126b以及刀套圈110。
当前参考图11、12A和12B，刀套圈110包括从其相对的侧部延伸的一对整体形成的销凸台139a、139b。正如图12B所示，刀套圈110包括内环形通道113，所述内环形通道113捕获刀杆102的成一定角度的近侧端部108，以将刀杆102联接至刀套圈110。一旦外轴构件160纵向运动，则刀杆102的成一定角度的近侧端部108在外轴构件160的刀开槽168（图3A）内纵向地平移，以使得外轴构件160的纵向运动不被刀杆102的成一定角度的近侧端部108阻碍。一旦通过旋转旋钮128（图1）围绕纵向轴线A-A旋转细长轴116和端部执行器114，则刀杆102的成一定角度的近侧端部108在刀套圈110的内环形通道113内自由地旋转，以使得外致动构件160和内致动构件180（为了清晰在图12B中被移除）以及刀杆102在刀套圈110内围绕纵向轴线A-A旋转。通过这种方法，刀套圈110用作外轴构件160、内致动构件180、以及刀杆102的旋转运动的静止参照物。
再次参考图10，触发器126的上旗状件126a、126b包括限定为穿过其中的各自的开槽127a、127b，所述开槽127a、127b构造成分别接收刀套圈110的销凸台139a、139b，以使得触发器126的枢转运动引起刀套圈110以及因此刀杆102（由于刀杆102联接至刀套圈110）的纵向运动。
当前参考图11和12A，当触发器126被移动以引起刀套圈110的运动从而刀片156平移穿过刀通路158时，刀套圈110沿外轴构件160在箭头A5的方向上平移以紧靠弹簧119，以使得弹簧119压缩抵靠旋转旋钮128（图10）的内部分。弹簧119将刀套圈110沿外轴构件160向近侧偏置。
如上参考图10的实施例所示，钳100可以包括增强开关控制结构，所述增强开关控制结构构造成在操作触发器126过程中防止开关136的释放和再次激活以分别终止和再次启动将电外科能量输送至端部执行器114。参考图13A、13B、13C和13D，描述另一个这样的实施例，其中弹簧杆（例如板簧）从可移动手柄122的近侧侧部延伸，并且包括激活柱135a，所述激活柱135a构造成一旦可移动手柄122与静止手柄120（图13C）接近则接合并且按压按钮137。弹簧杆135被偏置远离可移动手柄122（弹簧杆135从其延伸而出）的表面，以使得一旦可移动手柄122接近静止手柄120，则按钮激活柱135a接合并按压按钮137，并且由弹簧杆135将弹簧力施加于按钮137上。一旦可移动手柄122进一步接近静止手柄120，则按钮激活柱138接合弹簧杆135，以导致激活柱135a施加额外的力于按钮137上。如果可移动手柄122不慎地向远侧移动远离静止手柄120（例如在操作触发器126过程中），正如图13D中的箭头M7所示，则弹簧杆135通过维持在按钮137上的弹簧力而削弱可移动手柄122向远侧移动的效果。在可移动手柄122在向远侧的方向上（箭头M7）行进的至少一部分过程中，这个维持于按钮137上的弹簧力足以保持开关136激活，以使得在操作触发器126过程中开关136不被释放和再次激活。当可移动手柄122移动远离静止手柄120以将端部执行器114移动至开放构造（图13A）时，通过弹簧杆135维持于按钮137上的弹簧力减弱并且因此开关136被释放。
再次参考图13A、13B、13C和13D，可以通过移动可移动手柄122以引起外轴构件160的运动从而闭合钳口构件130、132、以及通过移动触发器126以引起刀套圈110的运动从而将刀片156平移穿过刀通道158，来启动一系列运动。首先，可移动手柄122和刀触发器126在如图13A所示的远侧或未致动位置中。可移动手柄122和触发器126的这种布置将端部执行器114保持在开放构造（图2A）中，其中钳口构件130、132被彼此完全地间隔开，并且刀片156相对于钳口构件130、132处于缩回或近侧位置中。当可移动手柄122和刀触发器126在远侧未致动位置中时，触发器126和可移动手柄122之间的干扰阻止了刀触发器126在近侧方向上（即朝向静止手柄120）的枢转运动。当端部执行器114在开放构造中时，这个干扰阻止刀片156推进穿过刀通路158。
可移动手柄122可以从图13A的远侧位置移动至图13B中的居中位置，以将钳口构件130、132移动至闭合构造（图2B）。当可移动手柄122在箭头M1的方向上（图13B）枢转时，可移动手柄122的驱动表面197b接合驱动套圈184的近侧边沿184b。驱动套圈184被向近侧驱动，以使得弹簧189向近侧偏置近侧弹簧止动件115，并且因此外轴构件160在箭头M2的方向上（图13B）被向近侧驱动。如上参考图6所述，外轴构件160的向近侧移动用于将偏心销192分别向远侧推进穿过钳口构件130、132的凸轮开槽130c、132c（图3A），并且因此使钳口构件130朝向钳口构件132（图2B）枢转。当钳口构件130、132接合至彼此，并且钳口构件130、132不可能进一步枢转移动时，防止了偏心销192的进一步向远侧移动和外轴构件160的进一步向近侧移动。
当可移动手柄122从图13A的远侧位置移动至在图13B中描述的居中位置时，从可移动手柄122的上部分向近侧延伸的齿122a接合被支承于静止手柄120内的咔哒突片120a，以产生触觉的和/或听觉的响应。由咔哒突片120a产生的这个响应对应于在钳口构件130、132之间完全抓取组织，并且用于指示医师：可移动手柄122的进一步向近侧致动将导致按钮激活柱135a接合可按压按钮137。当可移动手柄122被从图13B的居中位置移动至图13C的已致动或近侧位置时，齿122a被定位于咔哒突片120a的近侧处，并且按钮激活柱135a按压可按压按钮137，由此激活布置于静止手柄120内的开关136，以启动将电外科能量输送至端部执行器114来密封组织或以其他方式处理组织。
当可移动手柄122被从图13B的居中位置移动至图13C的已致动或近侧位置时，由钳口构件130、132施加的压力增加。当可移动手柄122在箭头M3的方向上（图13C）进一步枢转时，驱动表面197b将驱动套圈184的近侧边沿184b在箭头M4的方向上（图13C）进一步向近侧按压抵靠弹簧189。弹簧189被压缩抵靠近侧弹簧止动件115，并且张力被传送通过外轴构件160至钳口构件130、132。由弹簧189提供的张力确保了钳口构件130、132施加适当的压力以实现组织密封。
当可移动手柄122在已致动或近侧位置中时，刀触发器126可以被有选择地从图13C的远侧位置移动至图13D的近侧位置，以将刀片156向远侧推进穿过刀通路158。刀触发器126可以在箭头M5的方向上（图13D）围绕枢转凸台103枢转，以将刀触发器126的旗状件126a、126b在箭头M6的方向上向远侧推进，从而销凸台139b在开槽127b内从在图13A-13C中示出的位置平移至图13D中示出的位置。虽然未在图13A-13D中明确地示出，但是销凸台139a以如上参考销凸台139b和开槽127b所述相同的方式在开槽127a内平移。旗状件126a、126b的移动将刀套圈110向远侧牵拉，这由于刀杆102联接至刀套圈110（如上参考图12B所述）而引起刀杆102的向远侧纵向运动。
虽然本发明的若干实施例已经在附图中示出，但是并非意欲将本发明限制于此，原因在于本发明如其所容许的范围那样宽广并且说明书也应类似地解读。因此，以上描述不应当被认为是限制性的，而是仅仅作为具体实施例的示例。本领域的技术人员将设想在本发明范围以及附属权利要求精神内的其他修改。
虽然前述发明已经通过说明和示例被较具体地描述以用于清晰或理解，但是显而易见的是某些改变和修改可以在附属权利要求的范围内作出。
Claims (17)
1.一种手术器械，其特征在于，所述手术器械包括：
包括细长轴的壳体，所述细长轴具有从壳体延伸的远侧部分以及联接至壳体的近侧部分，细长轴具有限定为穿过其中的纵向轴线；
致动机构，所述致动机构被可操作地联接至细长轴，并且能够相对于壳体在已致动位置和未致动位置之间移动，以沿纵向轴线有选择地移动细长轴；
端部执行器，所述端部执行器包括能够相对于彼此从第一位置移动至第二位置的一对相对的第一钳口构件和第二钳口构件，在所述第一位置中第一钳口构件和第二钳口构件以相对于彼此间隔开的关系布置，在所述第二位置中第一钳口构件和第二钳口构件共同协作，以在细长轴沿纵向轴线移动时抓取在第一钳口构件和第二钳口构件之间的组织，端部执行器能够连接至电外科能量源，以用于将电外科能量传导穿过被抓取于第一钳口构件和第二钳口构件之间的组织，以实现组织密封部；
开关，所述开关被壳体支承，并且能够在激活位置和释放位置之间移动，所述激活位置用于启动将电外科能量从电外科能量源输送至端部执行器，所述释放位置用于终止将电外科能量从电外科能量源输送至端部执行器；
开关激活构件，所述开关激活构件布置于致动机构上，并且构造成在致动机构移动至已致动位置时将开关移动至激活位置，以及在致动机构移动至未致动位置时将开关移动至释放位置；以及
开关控制构件，所述开关控制构件构造为在致动机构从已致动位置至未致动位置的至少一部分运动过程中将开关维持在激活位置中。
2.根据权利要求1所述的手术器械，其特征在于，所述手术器械还包括刀片，所述刀片支承于细长轴中，并且能够在纵向方向上移动穿过被沿第一钳口构件和第二钳口构件中的至少一个的长度限定的刀通路，以切割被布置于第一钳口构件和第二钳口构件之间的组织。
3.根据权利要求1所述的手术器械，其特征在于，开关可操作地联接至可按压按钮，所述可按压按钮从壳体延伸，并且构造为在致动机构移动至已致动位置时由开关激活构件有选择地接合。
4.根据权利要求3所述的手术器械，其特征在于，开关控制构件包括布置于可按压按钮和开关之间的偏置构件，偏置构件构造为在致动机构从已致动位置至未致动位置的至少一部分运动过程中维持作用在开关上的力，以将开关维持在激活位置中。
5.根据权利要求3所述的手术器械，其特征在于，开关控制构件包括偏置构件，所述偏置构件从致动机构延伸，并且具有构造成接合可按压按钮的按钮激活柱，偏置构件构造为在致动机构从已致动位置至未致动位置的至少一部分运动过程中维持作用在开关上的力，以将开关维持在激活位置中。
6.根据权利要求3所述的手术器械，其特征在于，开关控制构件包括布置于可按压按钮和开关之间的偏置构件，可按压按钮具有从其至少部分地延伸穿过偏置构件的开关激活柱，偏置构件构造为在致动机构从已致动位置至未致动位置的至少一部分运动过程中维持作用在开关上的力，以将开关维持在激活位置中。
7.根据权利要求1所述的手术器械，其特征在于，开关控制构件包括从致动机构延伸的偏置构件，所述偏置构件构造为在致动机构从已致动位置至未致动位置的至少一部分运动过程中维持作用在开关上的力，以将开关维持在激活位置中。
8.根据权利要求1所述的手术器械，其特征在于，第二钳口构件机械地联接至细长轴的远侧端部，并且第一钳口构件构造为相对于第二钳口构件移动。
9.根据权利要求1所述的手术器械，其特征在于，开关控制构件包括板簧。
10.根据权利要求1所述的手术器械，其特征在于，开关控制构件包括盘簧。
11.根据权利要求1所述的手术器械，其特征在于，所述手术器械还包括轴向地布置于细长轴内的静止致动构件，静止致动构件包括机械地联接至细长轴的远侧部分的偏心销，其中，第一钳口构件和第二钳口构件中的至少一个包括凸轮开槽，所述凸轮开槽构造成接合偏心销，以在细长轴沿纵向轴线移动时围绕枢转点在第一位置和第二位置之间移动至少一个可移动的钳口构件。
12.根据权利要求1所述的手术器械，其特征在于，第一钳口构件和第二钳口构件中的至少一个包括联接至其上的电绝缘件。
13.根据权利要求1所述的手术器械，其特征在于，所述手术器械还包括导电组织密封表面，所述导电组织密封表面沿第一钳口构件和第二钳口构件中的至少一个的长度延伸，并且能够连接至电外科能量源。
14.一种手术器械，其特征在于，所述手术器械包括：
包括细长轴的壳体，所述细长轴具有从壳体延伸的远侧部分以及联接至壳体的近侧部分，细长轴具有限定为穿过其中的纵向轴线；
致动机构，所述致动机构被可操作地联接至细长轴，并且能够相对于壳体在已致动位置和未致动位置之间移动，以沿纵向轴线有选择地移动细长轴；
端部执行器，所述端部执行器包括能够相对于彼此从第一位置移动至第二位置的一对相对的第一钳口构件和第二钳口构件，在所述第一位置中第一钳口构件和第二钳口构件以相对于彼此间隔开的关系布置，在所述第二位置中第一钳口构件和第二钳口构件共同协作，以在细长轴沿纵向轴线移动时抓取在第一钳口构件和第二钳口构件之间的组织，端部执行器能够连接至电外科能量源，以用于将电外科能量传导穿过被抓取于第一钳口构件和第二钳口构件之间的组织，以实现组织密封部；
开关，所述开关被壳体支承，并且能够在激活位置和释放位置之间移动，所述激活位置用于启动将电外科能量从电外科能量源输送至端部执行器，所述释放位置用于终止将电外科能量从电外科能量源输送至端部执行器；
开关激活构件，所述开关激活构件布置于致动机构上，并且构造成在致动机构移动至已致动位置时将开关移动至激活位置，以及在致动机构移动至未致动位置时将开关移动至释放位置；
开关控制构件，所述开关控制构件构造为在致动机构从已致动位置至未致动位置的至少一部分运动过程中施加力于开关上，以将开关维持在激活位置中；以及
刀片，所述刀片支承于细长轴中，并且能够在纵向方向上移动穿过被沿第一钳口构件和第二钳口构件中的至少一个的长度限定的刀通路，以切割布置于第一钳口构件和第二钳口构件之间的组织。
15.根据权利要求14所述的手术器械，其特征在于，开关可操作地联接至可按压按钮，所述可按压按钮从壳体延伸，并且构造为在致动机构移动至已致动位置时由开关激活构件有选择地接合。
16.根据权利要求15所述的手术器械，其特征在于，开关控制构件布置于可按压按钮和开关之间。
17.根据权利要求14所述的手术器械，其特征在于，开关控制构件布置于致动机构上。
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2014
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- 2014-03-11 EP EP15184940.3A patent/EP2982326B1/en not_active Not-in-force
- 2014-03-11 EP EP14158819.4A patent/EP2777587B1/en not_active Not-in-force
- 2014-03-11 ES ES14158819.4T patent/ES2554391T3/es active Active
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2016
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2019
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2021
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Patent Citations (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| EP2316365A2 (en) * | 2004-10-21 | 2011-05-04 | Covidien AG | Bipolar forceps having monopolar extension |
| CN203736305U (zh) * | 2013-03-11 | 2014-07-30 | 柯惠有限合伙公司 | 手术器械 |
Also Published As
| Publication number | Publication date |
|---|---|
| US20210369331A1 (en) | 2021-12-02 |
| US11090111B2 (en) | 2021-08-17 |
| CN104042327A (zh) | 2014-09-17 |
| US9456863B2 (en) | 2016-10-04 |
| ES2554391T3 (es) | 2015-12-18 |
| CA2844067A1 (en) | 2014-09-11 |
| EP2777587B1 (en) | 2015-10-21 |
| AU2014200225A1 (en) | 2014-09-25 |
| EP2777587A1 (en) | 2014-09-17 |
| EP2982326B1 (en) | 2018-07-18 |
| US20190269454A1 (en) | 2019-09-05 |
| US20140257285A1 (en) | 2014-09-11 |
| US10335228B2 (en) | 2019-07-02 |
| CN203736305U (zh) | 2014-07-30 |
| US20160338767A1 (en) | 2016-11-24 |
| CA2844067C (en) | 2020-06-30 |
| EP2982326A1 (en) | 2016-02-10 |
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