CN104053408A - 用于外科缝合器的双重钉仓 - Google Patents

用于外科缝合器的双重钉仓 Download PDF

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CN104053408A
CN104053408A CN201280060301.2A CN201280060301A CN104053408A CN 104053408 A CN104053408 A CN 104053408A CN 201280060301 A CN201280060301 A CN 201280060301A CN 104053408 A CN104053408 A CN 104053408A
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CN104053408B (zh
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D·T·克鲁玛纳克尔
R·J·西姆斯
E·戈德伯格
T·A·奥斯本
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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
    • 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
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • A61B2017/0645—Surgical staples, i.e. penetrating the tissue being elastically deformed for insertion
    • 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
    • A61B2017/07228—Arrangement of the staples
    • 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
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • F—MECHANICAL ENGINEERING; LIGHTING; HEATING; WEAPONS; BLASTING
    • F04—POSITIVE - DISPLACEMENT MACHINES FOR LIQUIDS; PUMPS FOR LIQUIDS OR ELASTIC FLUIDS
    • F04C—ROTARY-PISTON, OR OSCILLATING-PISTON, POSITIVE-DISPLACEMENT MACHINES FOR LIQUIDS; ROTARY-PISTON, OR OSCILLATING-PISTON, POSITIVE-DISPLACEMENT PUMPS
    • F04C2270/00—Control; Monitoring or safety arrangements
    • F04C2270/04—Force
    • F04C2270/041—Controlled or regulated

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  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
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Abstract

一种外科缝合器(10)包括端部执行器(12)，所述端部执行器能够接收上部钉仓(160)和下部钉仓(120)。所述下部钉仓包括成非垂直或倾斜的角度来设置的钉驱动器(43)。所述钉驱动器可以相对于垂线相反地成角度。所述钉驱动器另外可以联接到致动构件，所述致动构件使得所述钉驱动器在缝合前枢转到垂直的位置。所述致动构件可由所述击发杆(14)和/或楔形滑动件(41)致动。所述上部钉仓还可包括成角度钉驱动器，其可枢转到垂直的位置。所述上部钉仓和/或所述下部钉仓还可包括钉成形凹坑(53)。或者，一个钉驱动器可以是垂直的，并且第二钉驱动器可以成非垂直的角度。所述钉驱动器可以被致动到成角度冲压成形凹槽(230)中。

Description

用于外科缝合器的双重钉仓
背景技术
在一些情况下，内窥镜式外科器械可以优于传统的开放式外科装置，因为较小切口可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适于穿过套管针的插管来将远侧端部执行器放置在期望手术部位处。这些远侧端部执行器能以多种方式来接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，该轴介于端部执行器与临床医生所操纵的柄部部分之间。这样的轴可以允许插入期望深度并绕轴的纵向轴线旋转，从而利于将端部执行器定位在患者体内。还可通过添加一个或多个关节运动接头或结构而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。一些这样的缝合器能够操作以夹紧在组织层上，切割穿过夹紧的组织层，并驱动钉穿过组织层以在组织层中的被切断的末端附近将切断的组织层基本上密封在一起。仅示例性外科缝合器在以下美国专利中公开：1989年2月21日公布的名称为“PocketConfiguration for Internal Organ Staplers”的美国专利第4,805,823号；1995年5月16日公布的名称为“Surgical Stapler and Staple Cartridge”的美国专利第5,415,334号；1995年11月14日公布的名称为“Surgical StaplerInstrument”的美国专利第5,465,895号；1997年1月28日公布的名称为“Surgical Stapler Instrument”的美国专利第5,597,107号；1997年5月27日公布的名称为“Surgical Instrument”的美国专利第5,632,432号；1997年10月7日公布的名称为“Surgical Instrument”的美国专利第5,673,840号；1998年1月6日公布的名称为“Articulation Assembly for SurgicalInstruments”的美国专利第5,704,534号；1998年9月29日公布的名称为“Surgical Clamping Mechanism”的美国专利第5,814,055号；2005年12月27日公布的名称为“Surgical Stapling Instrument Incorporating an E-BeamFiring Mechanism”的美国专利第6,978,921号；2006年2月21日公布的名称为“Surgical Stapling Instrument Having Separate Distinct Closing and FiringSystems”的美国专利第7,000,818号；2006年12月5日公布的名称为“Surgical Stapling Instrument Having a Firing Lockout for an Unclosed Anvil”的美国专利第7,143,923号；2007年12月4日公布的名称为“SurgicalStapling Instrument Incorporating a Multi-Stroke Firing Mechanism with aFlexible Rack”的美国专利第7,303,108号；2008年5月6日公布的名称为“Surgical Stapling Instrument Incorporating a Multistroke Firing MechanismHaving a Rotary Transmission”的美国专利第7,367,485号；2008年6月3日公布的名称为“Surgical Stapling Instrument Having a Single LockoutMechanism for Prevention of Firing”的美国专利第7,380,695号；2008年6月3日公布的名称为“Articulating Surgical Stapling Instrument Incorporating aTwo-Piece E-Beam Firing Mechanism”的美国专利第7,380,696号；2008年7月29日公布的名称为“Surgical Stapling and Cutting Device”的美国专利第7,404,508号；2008年10月14日公布的名称为“Surgical Stapling InstrumentHaving Multistroke Firing with Opening Lockout”的美国专利第7,434,715号；以及2010年5月25日公布的名称为“Disposable Cartridge withAdhesive for Use with a Stapling Device”的美国专利第7,721,930号。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，这样的外科缝合器也可用于开腹手术和/或其它非内窥镜式手术。
虽然已制造并使用各种类型的外科缝合器械，但是据信，在本发明人之前还无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了本发明的实施例，并且与上文所给出的本发明的一般说明和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示出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的位置；
图1B示出了图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示出了图1A-1B的外科器械中的打开的端部执行器的透视图；
图3A示出了沿图2的线3-3截取的图2的端部执行器的侧面剖视图，其中击发杆处于近侧位置；
图3B示出了沿图2的线3-3截取的图2的端部执行器的侧面剖视图，其中击发杆处于远侧位置；
图4示出了沿图2的线4-4截取的图2的端部执行器的端部剖视图；
图5示出了图2的端部执行器的分解透视图；
图6示出了图2的端部执行器的透视图，所述端部执行器定位在组织处并且已在组织中被致动一次；
图7A示出了具有示例性下部仓和上部仓的示例性端部执行器的前正视剖视图；
图7B示出了图7A的端部执行器的前正视剖视图，示出延伸穿过下部仓和上部仓中竖直狭槽的击发杆；
图7C示出了图7A的端部执行器的前正视剖视图，示出使得钉驱动器凸起的示例性的上部楔形滑动件和下部滑动件；
图8A示出了具有替代的下部仓和上部仓的示例性替代的端部执行器的前正视剖视图；并且
图8B示出了图8A的端部执行器的前正视剖视图，示出使得钉驱动器凸起的示例性的上部楔形滑动件和下部滑动件。
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
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，只要不脱离本发明即可。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示出了示例性外科缝合和切断器械10，在图1A中示出的非关节运动的状态下，其尺寸设定成穿过套管针的插管通道插入患者手术部位，以便执行外科手术。外科缝合与切断器械10包括连接到执行部分22的柄部部分20，所述执行部分还包括朝远侧终止于关节运动机构11中的轴23和朝远侧附接的端部执行器12。一旦穿过套管针的插管通道插入关节运动机构11和端部执行器12，关节运动机构11就可通过关节运动控制器13进行远程关节运动，如图1B所示。由此，端部执行器12可从期望角度或为其它原因到达器官或附近组织的后面。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和可枢转式砧座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以可枢转的方式拉向该手枪式握把，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相对于手枪式握把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是由执行部分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与远侧闭合环33相连通。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穿过轴23并将击发动作从击发触发器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，并且能被临床医生以可枢转的方式拉动，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、横向取向的中部销46和处于远侧的切割刃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延伸穿过通道狭槽45(如图3B所示)而可滑动地接合下钳口16的下表面，该通道狭槽穿过下钳口16形成。中部销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。由此，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之间可能出现的紧缩，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穿过钉仓37的一部分形成。还如图2中最佳地示出，三行钉孔51在竖直狭槽49一侧上穿过上部平台72形成，其中另一组的三行钉孔51在竖直狭槽49另一侧上穿过上部平台72形成。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内纵向地运动；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内，处于对应钉驱动器43上方。具体地讲，每个钉47在仓体70内被钉驱动器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存在倾斜凸轮表面，当朝向远侧驱动楔形滑动件41穿过钉仓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，并且能够接合楔形滑动件41，使得当击发杆14朝远侧推进穿过钉仓37时，楔形滑动件41被推块80朝远侧推动。在此类击发期间，击发杆14的切割刃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内的狭槽49而一起致动钉仓37，从而驱动楔形滑动件41与钉驱动器43形成向上凸起接触，继而将钉47向外驱动穿过钉孔51并使钉与砧座18的内表面上的钉成形凹坑53成形接触。图3B示出了在完成切断和缝合组织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穿过组织90。如图所示，切割刃48已经切割穿过组织90，同时钉驱动器43已经驱动三行交替的钉47穿过由切割刃48产生的切割线的每侧上的组织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，由新的钉仓替换所用完的钉仓37，然后，端部执行器12再次插入穿过套管针以到达缝合部位，以进一步切割并且缝合。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，切割刃48可基本上在驱动钉47穿过组织的同时切断组织。本例子中，切割刃48仅仅稍稍落后于钉47的驱动，使得钉47正好在切割刃48穿过该组织的相同区域前穿过组织驱动，但应理解，这个顺序可以颠倒，或者切割刃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可被致动穿过组织90的单个层或者组织的多于两个的层92、94。还应理解，邻近切割刃48所产生的切割线的钉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/或体内其它体液渗漏。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构造并操作器械10：美国专利第4,805,823号；美国专利第5,415,334号；美国专利第5,465,895号；美国专利第5,597,107号；美国专利第5,632,432号；美国专利第5,673,840号；美国专利第5,704,534号；美国专利第5,814,055号；美国专利第6,978,921号；美国专利第7,000,818号；美国专利第7,143,923号；美国专利第7,303,108号；美国专利第7,367,485号；美国专利第7,380,695号；美国专利第7,380,696号；美国专利第7,404,508号；美国专利第7,434,715号；和/或美国专利第7,721,930号。
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。可以提供用于器械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.示例性双重钉仓
在一些情况下，利用双重钉仓37可以是有用的。例如，使底部钉仓37和顶部钉仓37插入端部执行器12中以从相反方向缝合组织90可以是有用的。另外，使用相反的钉还可促使材料稳固联接到组织90的两个侧。在一些情况下，使钉47成角度也是有用的。此类成角度钉47可以允许钉仓37的竖直尺寸减小。尽管下文描述了双重钉仓构型的仅说明性例子，但是参照本文中的教导内容，其它合适构型将对本领域的普通技术人员显而易见。
A.示例性可旋转的钉驱动器双重钉仓。
图7A-7C示出了能够接收下部仓120和上部仓160的示例性端部执行器100。应当理解，器械10可以易于修改以结合有端部执行器100。本例子中，端部执行器100包括下钳口102和可枢转的上钳口110。端部执行器100被联接到柄部部分20，如上所述。具体地讲，临床医生以可枢转的方式朝着手枪式握把24拉动闭合触发器26，以便使得上钳口110朝着端部执行器100的下钳口102夹紧、或闭合。本例子中，下钳口102限定下部凹槽104，所述下部凹槽能够接收下部仓120。在一些型式中，下钳口102还包括了能够选择性地将下部仓120联接到下钳口102的闭锁装置106或按扣结构。另外或者作为替代，下钳口102可以包括开口远端以及纵向轨道(未示出)，下部仓120可在所述纵向轨道上或下方滑动。下钳口102和/或下部仓120可以包括位于远端的闭锁装置或者说是按扣结构，以在下部仓120沿着纵向轨道朝近侧滑动时选择性地将下部仓120联接到下钳口102。当然，参考本文中的教导内容，用于将下部仓120插入并联接到下钳口102的其它构型将对本领域的普通技术人员显而易见。
上钳口110限定上部凹槽112，所述上部凹槽能够接收上部仓160。在一些型式中，上钳口110还包括了能够选择性地将上部仓160联接到上钳口110的闭锁装置114或按扣结构。另外或者作为替代，上钳口110可以包括开口远端以及纵向轨道(未示出)，上部钉仓160可在所述纵向轨道上或上方滑动。上钳口110和/或上部仓160可以包括位于远端的闭锁装置或按扣结构，以在上部仓160沿着纵向轨道朝近侧滑动时选择性地将上部仓160联接到上钳口110。当然，参考本文中的教导内容，用于将上部仓160插入并联接到上钳口110的其它构型将对本领域的普通技术人员显而易见。
本例子的下部仓120包括仓体122、上部平台124、多个钉孔130，多个钉驱动器140以及竖直狭槽126。下部仓120还可根据本文所述仓37、160、220、260的教导内容中的至少一些进行构造。如图7A所示，上部平台124包括沿着下部仓120的纵向轴线形成的竖直狭槽126以及在所述下部仓中形成的四个钉孔130——在竖直狭槽126的每个侧上形成两个钉孔130。应当理解，四个钉孔130是沿着下部仓120纵向延伸的四行钉孔130的一部分。此外，任何数量行的钉孔130都可形成于上部平台124中，并且四行钉孔130仅是示例性的。另外，钉孔130可以围绕竖直狭槽126以各种构型来设置。例如，钉孔130可以围绕竖直狭槽126对称设置，或者钉孔130可以围绕竖直狭槽126不对称地设置。仅以举例方式，对于弯曲端部执行器100，三个钉孔130可设置在竖直狭槽126的一侧上，并且单个钉孔130可设置在相对侧上。
本例子的上部平台124还包括了钉成形凹坑128，钉190经由上部仓160的钉驱动器180凸起嵌入所述钉成形凹坑中，这将在下文红更详细地描述。本例子中，每个钉孔130还由成角度内壁132和竖直外壁134限定。或者，壁132、134可以包括弧形壁。当然，参考本文中的教导内容，用于钉孔130的其它构型和取向将对本领域的普通技术人员显而易见。竖直狭槽126纵向延伸穿过上部平台124和仓体122，使得击发杆14可以从中致动穿过。在一些型式中，竖直狭槽126是纵向笔直狭槽，然而在其它型式中，竖直狭槽126可以沿着弯曲端部执行器100的纵向轴线弯曲。
本例子的钉驱动器140设置在仓体122内，并是下部仓120内的竖直可活动的构件。在一些型式中，钉驱动器140选择性地联接在仓体122内，以防止钉驱动器140在无意中相对于仓体122致动，直到如下所述下部楔形滑动件192接合钉驱动器140为止。例如，钉驱动器140可粘附于仓体122。在其它型式中，钉驱动器140可以各自包括接头(未示出)，所述接头可插入仓体122中形成的狭槽(未示出)中，以形成干涉配合或闭锁配合。因此，钉驱动器140选择性地相对于仓体122固定，即使用户旋转或者倒置端部执行器100也是如此。当然，参考本文中的教导内容，选择性地可联接的其他构型将对本领域的普通技术人员显而易见。
本例子中，多个钉190也设置在仓体122内并设置在对应的钉驱动器140上方。具体地讲，每个钉190在仓体122内由相应的钉驱动器140竖直驱动，以驱动钉190从相关联的钉孔130穿出。在一些型式中，钉190选择性地联接到钉驱动器140，以防止钉190在无意中相对于钉驱动器140致动，直到如下所述下部楔形滑动件192接合钉驱动器140以将钉190驱逐出钉孔130为止。例如，钉驱动器190可粘附于钉驱动器140。在其它型式中，钉190可以各自包括接头(未示出)，所述接头可插入钉驱动器140中形成的狭槽(未示出)中，以形成干涉配合。此外，按扣结构可被包括在钉驱动器140上，以保持钉190与钉驱动器140直到它们展开为止。在一些型式中，钉驱动器140可以包括释放接头(未示出)，在竖直致动钉驱动器140时，所述释放接头接合仓体122上的接头(未示出)以释放钉190。仓体122上的这种接头可以在上部平台124上或在所述上部平台附近，使得钉190仅在钉驱动器140处于其竖直致动峰值时释放。因此，钉190选择性地相对于钉驱动器140固定，即使用户旋转或者倒置端部执行器100也是如此。除了或者替代固定到钉驱动器140，钉190可以选择性地固定到仓体122，诸如通过干涉配合和/或通过摩擦以其它方式来配合。
本例子中，钉驱动器140还包括了致动构件142，所述致动构件以可枢转的方式联接到一个或多个钉驱动器140，并且能够操作以将钉驱动器140相对于仓体122运动。如图7A所示，每个致动构件142包括以可枢转的方式联接到两个钉驱动器140的杆。本例子中，第一致动构件142以可枢转的方式联接到竖直狭槽126的第一侧上的第一组两个钉驱动器140。第二致动构件142以可枢转的方式联接到竖直狭槽126的相对侧上的第二组两个钉驱动器140。如将在本文中更详细地论述，致动构件142能够由击发杆14相对于仓体122向外凸起，使得钉驱动器140从钉驱动器140相对于上部平台124成角度的第一位置枢转到钉驱动器140相对于上部平台124基本上垂直的第二位置。因此，下部仓120的竖直尺寸可以减小。另外，由于钉190的初始倾斜，下部仓120中可以包括更长的钉190。换句话讲，比起仓37，仓120可以适应相对更大的钉190，而不一定增加端部执行器100的外径。此外，下钳口102和上钳口110的尺寸可以设定成因下部仓120的尺寸减小而在这两者之间允许更多组织90。当然，参考本文中的教导内容，钉驱动器140和/或致动构件142的其他构型将于本领域的普通技术人员显而易见。还应理解，钉190可以初始取向成倾斜角度，就像本例子或甚至其中砧座18替代上部仓160来使用的型式中的钉190那样。
本例子的上部仓160包括仓体162、下部平台164、多个钉孔170，多个钉驱动器180以及竖直狭槽166。上部仓160还可根据本文所述仓37、120、220、260的教导内容中的至少一些进行构造。如图7A所示，下部平台164包括沿着上部仓160的纵向轴线形成的竖直狭槽166以及在所述上部仓中形成的一对钉孔170—在竖直狭槽166的每个侧上形成的一个钉孔170。应当理解，两个钉孔170是沿着上部仓160纵向延伸的两行钉孔130的一部分。此外，任何行数的钉孔170均可形成在下部平台164中，并且两行钉孔170仅是示例性的。另外，钉孔170可以围绕竖直狭槽166以各种构型来设置。例如，钉孔170可以围绕竖直狭槽166对称设置，或者钉孔170可以围绕竖直狭槽166不对称地设置。仅以举例方式，对于弯曲端部执行器100，两个钉孔170均可设置在竖直狭槽166的同一侧上。
下部平台164还包括了钉成形凹坑168，钉190经由下部仓120的钉驱动器140凸起嵌入到钉成形凹坑之中，如下所述。本例子中，每个钉孔170还由成角度内壁172以及竖直外壁174限定。或者，壁172、174可以包括弧形壁。当然，参考本文中的教导内容，用于钉孔170的其它构型和取向将对本领域的普通技术人员显而易见。竖直狭槽166纵向延伸穿过下部平台164和仓体162，使得击发杆14可以从中致动。在一些型式中，竖直狭槽166是纵向笔直狭槽，然而在其它型式中，竖直狭槽166可以沿着弯曲端部执行器100的纵向轴线弯曲。
本例子的钉驱动器180设置在仓体162内，并是上部仓160内的竖直可活动的构件。在一些型式中，钉驱动器180选择性地联接在仓体162内，以防止钉驱动器180在无意中相对于仓体162致动，直到如下所述上部楔形滑动件196接合钉驱动器180为止。例如，钉驱动器180可粘附于仓体162。在其它型式中，钉驱动器180可以各自包括接头(未示出)，所述接头可插入仓体162中形成的狭槽(未示出)中，以形成干涉配合或闭锁配合。因此，钉驱动器180选择性地相对于仓体162固定，使得钉驱动器180不因重力进行运动。当然，参考本文中的教导内容，选择性地可联接的其他构型将对本领域的普通技术人员显而易见。
本例子中，多个钉190也设置在仓体162内并设置在对应的钉驱动器180下方，如图7A所示。具体地讲，每个钉190在仓体162内由相应钉驱动器180竖直驱动，以驱动钉190从相关联的钉孔170穿出。在一些型式中，钉190选择性地联接到钉驱动器180，以防止钉190在无意中相对于钉驱动器180致动，直到如下所述上部楔形滑动件196接合钉驱动器180以将钉190驱逐出钉孔170为止。例如，钉驱动器190可粘附于钉驱动器180。在其它型式中，钉190可以各自包括接头(未示出)，所述接头可插入钉驱动器180中形成的狭槽(未示出)中，以形成干涉配合。此外，按扣结构可被包括在钉驱动器180上，以保持钉190与钉驱动器180直到它们展开为止。在一些型式中，钉驱动器180可以包括释放接头(未示出)，在致动钉驱动器180时，所述释放接头接合仓体162上的接头(未示出)以释放钉190。仓体162上的这种接头可以在下部平台164上或在所述下部平台附近，使得钉190仅在钉驱动器180致动运动结束时释放。因此，钉190选择性地相对于钉驱动器180固定，使得钉190不因重力而脱离钉驱动器180。除了或者替代固定到钉驱动器180，钉190可以选择性地固定到仓体162，诸如通过干涉配合和/或通过摩擦以其它方式来配合。
本例子中，钉驱动器180还包括了致动构件182，所述致动构件以可枢转的方式联接到一个或多个钉驱动器180，并且能够操作以将钉驱动器180相对于仓体162运动。如图7A所示，每个致动构件182包括以可枢转的方式联接到钉驱动器180的杆。本例子中，第一致动构件182以可枢转的方式联接到竖直狭槽166的第一侧上的第一钉驱动器180。第二致动构件182以可枢转的方式联接到竖直狭槽166的相对侧上的第二钉驱动器180。如将在本文中更详细地论述，致动构件182能够由击发杆14相对于仓体162向外凸起，使得钉驱动器180从钉驱动器180相对于上部平台164成角度的第一位置枢转到钉驱动器180相对于下部平台164基本上垂直的第二位置。因此，上部仓160的竖直尺寸可以减小。另外，由于钉190的初始倾斜，上部仓160中可以包括更长的钉190。换句话讲，比起仓37，仓160可以适应相对更大的钉190，而不一定增加端部执行器100的外径。此外，下钳口102和上钳口110的尺寸可设定成因上部仓160的尺寸减小而在这两者之间允许更多组织90。当然，参考本文中的教导内容，钉驱动器180和/或致动构件182的其他构型将于本领域的普通技术人员显而易见。
图7A-7C示出了击发杆14击发穿过下部仓120和上部仓160以将钉190部署到组织90中。如图7A所示，在闭合触发器26已被致动后，组织90固定在下钳口102与上钳口110之间。在这个初始位置，致动构件142、182尚未由击发杆14接合，因此，钉驱动器140、180相对于仓体122、162分别成角度。如在上文所论述的，框架34纵向滑动地支撑击发驱动构件，所述击发驱动构件延伸穿过轴23并传递从击发触发器28到击发杆14的击发动作，如图1-5所示。当用户致动击发触发器28时，击发杆14相对于柄部部分20朝远侧推进。如图7B所示，击发杆14的切割刃48朝远侧推进以同时切断组织90并使致动构件142、182相对于击发杆14朝外凸起。因此，钉驱动器140、180通过致动构件142、182和壁134、174进行枢转，使得钉驱动器140、180相对于上部平台124和下部平台164基本上竖直。还如图7B所示，击发杆14包括位于击发杆14的顶端和底端上的一对凸缘，这对凸缘沿着下钳口102和上钳口110的外部通道滑动。如对本领域的普通技术人员显而易见，当朝远侧致动击发杆14时，凸缘可协作地将下钳口102和上钳口110压缩在一起以另外将组织90固定在两者之间。
当钉驱动器140、180在基本上竖直的方向上时，如图7C所示，下部楔形滑动件192和上部楔形滑动件196分别朝远侧推进穿过下部仓120和上部仓160。本例子的下部楔形滑动件192包括联接到基座构件195的四个倾斜构件194。倾斜构件194能够使得钉驱动器140相对于上部平台124竖直凸起。当然，如同钉孔130，下部楔形滑动件192可以具有少于四个或多于四个的倾斜构件194。本例子的上部楔形滑动件196包括联接到基座构件199的两个倾斜构件198。倾斜构件198能够使得钉驱动器180相对于下部平台164竖直凸起。当然，如同钉孔170，上部楔形滑动件196可以具有少于两个或多于两个的倾斜构件198。当下部楔形滑动件192朝远侧推进时，钉驱动器140竖直凸起，使得钉驱动器140所携载的钉190被驱动出下部仓120的钉孔130。钉190刺穿组织90并且接合上部仓160的下部平台164中形成的钉成形凹坑168。因此，钉190弯曲并且缝合组织90。类似地是，当上部楔形滑动件196朝远侧推进时，钉驱动器180竖直凸起，使得钉驱动器180所携载的钉190被驱动出上部仓160的钉孔170。钉190刺穿组织90并且接合下部仓120的上部平台124中形成的钉成形凹坑128。因此，钉190弯曲并且缝合组织90。如图7C所示，相反取向的钉190使用具有下部仓120和上部仓160的本发明的端部执行器100而来缝合穿过组织90。随后，用户可以释放击发触发器28和闭合触发器26以释放所缝合的组织90。然而，用户可用新的下部仓120和上部仓160来替换下部仓120和上部仓160以缝合组织90的新的片段。
当然，参考本文中的教导内容，端部执行器100、下部仓120和/或上部仓160的其它构型将对本领域的普通技术人员显而易见。例如，在一些型式中，支撑材料(未示出)可联接到下部钉仓120和/或上部钉仓160。具有支撑材料的下部钉仓120和/或上部钉仓160的仅示例性构型在以下专利中公开：2011年9月15日公布的名称为“Surgical Instrument and ButtressMaterial”的美国专利第13/233,664号；2011年9月13日公布的名称为“Surgical Staple Cartridge with Self-Dispensing Staple Buttress”的美国专利第13/231,064号；2011年9月14日公布的名称为“Surgical Instrument withFluid Fillable Buttress”的美国专利第13/232,401号；以及__年__月__日公布的名称为“Attachment of Surgical Staple Buttress to Cartridge”的美国专利第[代理案号END6986USNP.0585747]号，所述专利中的公开内容以引用的方式并入本文。
另外，或在替代形式中的一些型式中，助剂材料(例如，粘合剂、治疗剂等等)可以经由下部仓120和/或上部仓160施用到组织90。可以结合到下部仓120和/或上部仓160的仅示例性助剂部署机构在以下专利中进行描述：2011年10月10日公布的名称为“Device for Applying Adjunct inEndoscopic Procedure”的美国专利申请第13/206,752号；2011年10月10日公布的名称为“Surgical Staple with Localized Adjunct Coating”的美国专利申请第13/206,725号；2011年9月15日公布的名称为“Fibrin Pad Matrix withSuspended Heat Activated Beads of Adhesive”的美国专利申请第13/233,633号；2011年9月15日公布的名称为“Surgical Instrument with Filled Staple”的美国专利申请第13/233,646号；2011年9月13日公布的名称为“Resistive Heated Surgical Staple Cartridge with Phase Change Sealant”的美国专利申请第13/230,994号；2011年8月1日公布的名称为“AdjunctTherapy Device Having Driver with Cavity for Hemostatic Agent”的美国专利申请第13/195,170号；2011年9月22日公布的名称为“Adjunct TherapyDevice for Applying Hemostatic Agent”的美国专利申请第13/240,141号；2011年9月23日公布的名称为“Surgical Stapling Device with AdjunctMaterial Application Feature”的美国专利申请第13/242,164号；以及2011年9月22日公布的名称为“Surgical Staple Assembly with Hemostatic Feature”的美国专利申请第13/240,074号；这些专利中的公开内容以引用的方式并入本文。
此外，尽管本文所述的端部执行器100在下部楔形滑动件192和上部楔形滑动件196之前朝着远侧推进击发杆14，但应理解，下部楔形滑动件192和上部楔形滑动件196可先于击发杆14和/或切割刃48。例如，下部楔形滑动件192和上部楔形滑动件196可包括中心构件(未示出)，所述中心构件使致动构件142、182相对于中心构件朝外凸起。因此，下部楔形滑动件192和上部楔形滑动件196两者可竖直定向钉驱动器140、180，并可经由倾斜构件194、198使得钉驱动器140、180竖直凸起。因此，组织90可在被切割刃48切断之前被初始缝合。在另一型式中，下部楔形滑动件192和上部楔形滑动件196可基本上纵向地对齐切割刃48，使得组织90的切断和缝合基本上同时发生。参考本文中的教导内容，用于端部执行器100、下部仓120和/或上部仓160的另一些的其它构型将对本领域的普通技术人员显而易见。
B.示例性冲压成形的双重钉仓
图8A-8B示出了能够接收下部仓220和上部仓260的示例性替代的端部执行器200。应当理解，器械10可以易于修改以结合有端部执行器200。本例子中，端部执行器200包括下钳口202和可枢转的上钳口210。端部执行器200被联接到柄部部分20，如上所述。具体地讲，临床医生可朝着手枪式握把24以可枢转的方式拉动闭合触发器26，以使得上钳口210朝着端部执行器200的下钳口202夹紧、或闭合。本例子中，下钳口202限定下部凹槽204，所述下部凹槽能够接收下部仓220。下钳口202还包括了边缘206，所述边缘能够接收下部仓220的弹性下部唇缘228，使得下部仓220选择性地可联接到下钳口202。另外或者作为替代，下钳口202可以包括开口远端以及纵向轨道(未示出)，下部仓220可在所述纵向轨道上或下方滑动。下钳口202和/或下部仓220可以包括位于远端处的闭锁装置或按扣结构，以在下部仓220沿着纵向轨道朝近侧滑动时选择性地将下部仓220联接到下钳口202。另外，下钳口202可以具有闭锁装置(未示出)，其与图7A-7C所示闭锁装置106类似。当然，参考本文中的教导内容，用于将下部仓220插入并联接到下钳口202的其它构型将对本领域的普通技术人员显而易见。
上钳口210限定上部凹槽212，所述上部凹槽能够接收上部仓260。上钳口210还包括了边缘214，所述边缘能够接收上部仓220的弹性上部唇缘268，使得上部仓220选择性地可联接到上钳口210。另外或者作为替代，上钳口210可以包括开口远端以及纵向轨道(未示出)，上部仓260可在所述纵向轨道上或上方滑动。上钳口210和/或上部仓260可以包括位于远端处的闭锁装置或按扣结构，以在上部仓260沿着纵向轨道朝近侧滑动时选择性地将上部仓260联接到上钳口210。另外，上钳口210可以具有闭锁装置(未示出)，其与图7A-7C所示闭锁装置114类似。当然，参考本文中的教导内容，用于将上部仓260插入并联接到上钳口210的其它构型将对本领域的普通技术人员显而易见。
本例子的下部仓220包括仓体222、上部平台224、多个内部钉孔240、多个外部钉孔244、多个钉驱动器250、竖直狭槽226以及弹性下部唇缘228。下部仓220还可根据本文所述仓37、120、160、260的教导内容中的至少一些进行构造。本例子中，弹性下部唇缘228能够操作以通过干涉配合来选择性地将下部仓220联接到下钳口202。如图8A所示，上部平台224包括沿着下部仓220的纵向轴线形成的竖直狭槽226以及形成在所述下部仓中的四个钉孔240、244——在竖直狭槽226的每个侧上形成的外部钉孔244和内部钉孔240。应当理解，四个钉孔240、244是沿着下部仓220纵向延伸的四行钉孔240、244的一部分。此外，任何行数的钉孔240、244都可形成于上部平台224中，并且四行钉孔240、244仅是示例性的。另外，钉孔240、244可以围绕竖直狭槽226以各种构型来设置。例如，钉孔240、244可以围绕竖直狭槽226对称设置，或者钉孔240、244可以围绕竖直狭槽226不对称地设置。仅以举例方式，对于弯曲端部执行器200，单个外部钉孔244和两个内部钉孔240可以设置在竖直狭槽226的一个侧上，并且单个外部钉孔244可设置在相对侧上。
本例子中，内部钉孔240与其中具有钉驱动器250的基本上竖直凹槽242相连通。外部钉孔244与成角度凹槽246相连通，所述成角度凹槽相对于上部平台224成角度并还在其中具有钉驱动器250。成角度凹槽246的角度可以是0度至90度的整数，包括端值在内。在所示例子中，成角度凹槽246被设置成约15度的角度，但这仅是说明性的。应当理解，由于钉290的倾斜，下部仓220中可以包括更长的钉290。换句话讲，比起仓37，下部仓220可以适应相对更大的钉290，而不一定增加端部执行器200的外径。此外，下钳口202和上钳口210的尺寸可设定成因下部仓220尺寸减小而允许两者之间存在组织90和/或支撑材料(未示出)。
本例子的上部平台224还包括了其中形成有钉成形凹坑232的多个冲压成形凹槽230。钉成形凹坑232能够接收并且弯曲钉290中的部分，该钉经由上部仓260的钉驱动器286凸起，如在下文更详细地描述。本例子中，冲压成形凹槽230是与上部仓260的竖直钉孔280和凹槽282对应的基本上竖直凹槽，但这仅是可任选的。实际来说，在一些型式中，冲压成形凹槽230能以与下述外部冲压成形凹槽272类似的构型相对于上部平台224成角度。当然，参考本文中的教导内容，用于冲压成形凹槽230的其它构型和取向将对本领域的普通技术人员显而易见。竖直狭槽226纵向延伸穿过上部平台224和仓体222，使得击发杆14可以从中致动。在一些型式中，竖直狭槽226是纵向笔直狭槽，然而，在其它型式中，竖直狭槽226可以沿着弯曲端部执行器200的纵向轴线弯曲。
本例子的钉驱动器250设置在仓体222内，并是下部仓220内的竖直可活动的构件。在一些型式中，钉驱动器250选择性地联接在凹槽242、246内，以防止钉驱动器250在无意中相对于仓体222致动，直到如下所述下部楔形滑动件292接合钉驱动器250为止。例如，钉驱动器250可粘附于仓体222。在其它型式中，钉驱动器250可以各自包括接头(未示出)，所述接头可插入仓体222中形成的狭槽(未示出)中，以形成干涉配合或闭锁配合。因此，钉驱动器250选择性地相对于仓体222固定，即使用户旋转或者倒置端部执行器200。当然，参考本文中的教导内容，选择性地可联接的其他构型将对本领域的普通技术人员显而易见。
本例子中，多个钉290也设置在仓体222内并设置在对应的钉驱动器250上方。具体地讲，每个钉290在仓体222内由相应的钉驱动器250竖直驱动，以驱动钉290从相关联的钉孔240、244穿出。在一些型式中，钉290选择性地联接到钉驱动器250，以防止钉290在无意中相对于钉驱动器250致动，直到下述的下部楔形滑动件292接合钉驱动器250以将钉290驱逐出钉孔240、244为止。例如，钉驱动器290可粘附于钉驱动器250。在其它型式中，钉290可以各自包括接头(未示出)，所述接头可插入钉驱动器250中形成的狭槽(未示出)中，以形成干涉配合。此外，按扣结构可被包括在钉驱动器250上，以保持钉290与钉驱动器250直到它们展开为止。在一些型式中，钉驱动器250可以包括释放接头(未示出)，在竖直致动钉驱动器250时，所述释放接头接合仓体222上的接头(未示出)以释放钉290。仓体222上的这种接头可以在上部平台224上或在所述上部平台附近，使得钉290仅在钉驱动器250处于其竖直致动峰值时释放。因此，钉290选择性地相对于钉驱动器250固定，即使用户旋转或者倒置端部执行器200也是如此。除了或者替代固定到钉驱动器250，钉290可以选择性地固定到仓体222，诸如通过干涉配合和/或通过摩擦以其它方式来配合。
本例子的上部仓260包括仓体262、下部平台264、多个上部钉孔280，多个钉驱动器286、竖直狭槽266以及弹性上部唇缘268。上部仓260还可根据本文所述仓37、120、160、220的教导内容中的至少一些进行构造。本例子中，弹性上部唇缘268能够操作以通过干涉配合来选择性地将上部仓260联接到上钳口210。如图8A所示，下部平台264包括沿着上部仓260的纵向轴线形成的竖直狭槽266以及在竖直狭槽266的每个侧上形成的两个上部钉孔280。应当理解，两个钉孔280是沿着上部仓260纵向延伸的两行钉孔280的一部分，但是下部平台264中可以形成任何数量的钉孔280，并且所示两个钉孔280仅是示例性的。另外，钉孔280可以围绕竖直狭槽266以各种构型来设置。例如，对于弯曲的端部执行器200，两个钉孔280均可设置在竖直狭槽266的一侧上。本例子中，上部钉孔280与其中具有钉驱动器286的基本上竖直凹槽282相连通。当然，作为替代，凹槽282和钉孔280可以根据上述外部钉孔244和/或成角度凹槽246进行构造。
本例子的下部平台264还包括了在其中形成有钉成形凹坑278的多个冲压成形凹槽270、272。钉成形凹坑278能够接收并且弯曲钉290的部分，该钉经由下部仓220的钉驱动器250凸起，如上所述。在本例子中，下部平台264包括一对内部冲压成形凹槽270以及一对外部或“经铸造的”冲压成形凹槽272。内部冲压成形凹槽270包括与下部仓220的内部钉孔240和凹槽242对应的基本上竖直凹槽，但这仅是可任选的。外部冲压成形凹槽272包括与下部仓220的外部钉孔244和成角度凹槽246对应的成角度凹槽。当然，参考本文中的教导内容，用于冲压成形凹槽270、272的其它构型和取向将对本领域的普通技术人员显而易见。竖直狭槽266纵向延伸穿过下部平台264和仓体262，使得击发杆14可以从中致动。在一些型式中，竖直狭槽266是纵向笔直狭槽，然而在其它型式中，竖直狭槽266可以沿着弯曲的端部执行器200的纵向轴线弯曲。
本例子的钉驱动器286设置在仓体262内，并是上部仓260内的竖直可活动的构件。在一些型式中，钉驱动器286选择性地联接在竖直凹槽282内，以防止钉驱动器286无意中相对于仓体262致动，直到如下所述上部楔形滑动件296接合钉驱动器286为止。例如，钉驱动器286可粘附于仓体262。在其它型式中，钉驱动器286可以各自包括接头(未示出)，所述接头可插入仓体262中形成的狭槽(未示出)中，以形成干涉配合或闭锁配合。因此，钉驱动器286选择性地相对于仓体262固定，即使用户旋转或者倒置端部执行器200也是如此。当然，参考本文中的教导内容，选择性地可联接的其他构型将对本领域的普通技术人员显而易见。
在本例子中，多个钉290也设置在仓体262内并设置在对应的钉驱动器286下方，如图8A所示。具体地讲，每个钉290在仓体262内由相应的钉驱动器286竖直驱动，以驱动钉290从相关联的钉孔280穿出。在一些型式中，钉290选择性地联接到钉驱动器286，以防止钉290无意中相对于钉驱动器286致动，直到下述的上部楔形滑动件296接合钉驱动器286以将钉290驱逐出钉孔280为止。例如，钉驱动器290可粘附于钉驱动器286。在其它型式中，钉290可以各自包括接头(未示出)，所述接头可插入钉驱动器286中形成的狭槽(未示出)中，以形成干涉配合。此外，按扣结构可被包括在钉驱动器286上，以保持钉290与钉驱动器286直到它们展开为止。在一些型式中，钉驱动器286可以包括释放接头(未示出)，在致动钉驱动器286时，所述释放接头接合仓体262上的接头(未示出)以释放钉290。仓体262上的这种接头可以在下部平台264上或在所述下部平台附近，使得钉290仅在钉驱动器286致动运动结束时释放。因此，钉290选择性地相对于钉驱动器286固定，使得钉290不因重力而与钉驱动器286脱离。除了或者替代固定到钉驱动器286，钉290可以选择性地固定到仓体262，诸如通过干涉配合和/或通过摩擦以其它方式来配合。
图8A-8B示出了击发杆14击发穿过下部仓220和上部仓260以将钉290部署到组织90中。如图8A所示，在闭合触发器26已被致动后，组织90固定在下钳口202与上钳口210之间。在这个初始位置中，钉驱动器250、286尚未由下部楔形滑动件292和上部楔形滑动件296接合。如在上文所论提及的，框架34纵向滑动底支撑击发驱动构件，所述击发驱动构件延伸穿过轴23并传递从击发触发器28到击发杆14的击发动作，如图1-5所示。当用户致动击发触发器28时，击发杆14相对于柄部部分20朝远侧推进。当击发杆14朝远侧推进时，一对推块(未示出)、如上述推块80各自接合相应的楔形滑动件292、296，使得在击发杆14朝远侧推进穿过下部仓220和上部仓260时，通过推块来朝远侧推动楔形滑动件292、296。当楔形滑动件292、296朝远侧致动时，每个楔形滑动件292、296接合一组相应的钉驱动器250、286，以使钉驱动器250向上凸起并使钉驱动器286向下凸起。继而，钉驱动器250、286驱动钉290穿出相应的钉孔240、244、280，穿过组织90，然后与相应的冲压成形凹槽230、270、272中的相应的钉成形凹坑232、278成形接触。本例子中，下部楔形滑动件292包括四个倾斜构件294(两个竖直内部倾斜构件294以及两个成角度外部倾斜构件294)，所述倾斜构件能够使得钉驱动器250朝着上部平台224凸起。上部楔形滑动件296包括两个倾斜构件298，所述倾斜构件能够使得钉驱动器286朝着下部平台264凸起。当然，参考本文中的教导内容，用于下部楔形滑动件292和/或上部楔形滑动件296的其它构型将对本领域的普通技术人员显而易见。
如图8B所示，当楔形滑动件292、296朝远侧推进时，击发杆14的切割刃48同样也朝远侧推进。在一些型式中，当楔形滑动件292、296接合钉驱动器250、286并且使其凸起时，切割刃48同时切断组织90，但这仅是可任选的。实际来说，切割刃48可以能够在钉驱动器250、286凸起前或者在钉驱动器250、286凸起后切断组织90。还如图8B所示，击发杆14包括位于击发杆14的顶端和底端上的一对凸缘，这对凸缘沿着下钳口202和上钳口210的外部通道滑动。如对本领域的普通技术人员显而易见，当朝远侧致动击发杆14时，凸缘可协作地将下钳口202和上钳口210压缩在一起以进一步将组织90固定在两者之间。
类似地是，当下部楔形滑动件292朝远侧推进时，钉驱动器250凸起，使得钉驱动器250所驱动的钉290被伸出下部仓220的钉孔240、244。钉290刺穿组织90并且进入冲压成形凹槽270、272，以便接合上部仓260的下部平台264中形成的钉成形凹坑278。因此，钉290弯曲并且缝合组织90。类似地是，当上部楔形滑动件296朝远侧推进时，钉驱动器286凸起，使得钉驱动器286所驱动的钉290被伸出上部仓260的钉孔280。钉290刺穿组织90并且进入冲压成形凹槽230，以接合下部仓220的上部平台224中形成的钉成形凹坑232。因此，钉290弯曲并且缝合组织90。如图8B所示，相反取向的钉290使用具有下部仓220和上部仓260的本发明的端部执行器200而来缝合穿过组织90。随后，用户可以释放击发触发器28和闭合触发器26以释放所缝合的组织90。然而，用户可用新的下部仓220和上部仓260来替换下部仓220和上部仓260以缝合组织90的新的片段。
当然，参考本文中的教导内容，端部执行器200、下部仓220和/或上部仓260的其它构型将对本领域的普通技术人员显而易见。例如，在一些型式中，支撑材料(未示出)可联接到下部钉仓220和/或上部钉仓260。具有支撑材料的下部仓220和/或上部仓260的仅示例性构型在各种参考文献中描述，这些参考文献在本文中引用并以引用方式并入本文。另外，或在替代形式中的一些型式中，助剂材料(例如，粘合剂、治疗剂等等)可以经由下部仓220和/或上部仓260施用到组织90。可以结合到下部仓220和/或上部仓260的仅示例性助剂部署机构在各种参考文献中描述，这些参考文献在本文中引用并以引用方式并入本文。参考本文中的教导内容，端部执行器200、下部仓220和/或上部仓260的另外一些其它构型将对本领域的普通技术人员显而易见。
尽管已描述出示例性外科器械的某些构型，但是参考本文中的教导内容，外科器械可构造的各种其它方式对于本领域的普通技术人员将会显而易见。仅以举例方式，本文所提及的外科器械可以根据下述专利中的教导内容中的至少一些进行构造：美国专利第4,805,823号；美国专利第5,415,334号；美国专利第5,465,895号；美国专利第5,597,107号；美国专利第5,632,432号；美国专利第5,673,840号；美国专利第5,704,534号；美国专利第5,814,055号；美国专利第6,978,921号；美国专利第7,000,818号；美国专利第7,143,923号；美国专利第7,303,108号；美国专利第7,367,485号；美国专利第7,380,695号；美国专利第7,380,696号；美国专利第7,404,508号；美国专利第7,434,715号；以及美国专利第7,721,930号。
应当理解，所述以引用的方式并入本文中的任何专利、出版物或其它公开材料，无论是全文或部分，仅在所并入的材料与本公开中给出的定义、陈述或者其它公开材料不冲突的范围内来并入本文。由此，在必要程度下，本文所明确阐述的公开内容将会取代以引用的方式并入本文中的任何相冲突的材料。如果据述以引用的方式并入本文但与本文所述现有定义、陈述或者其它公开材料相冲突的任何材料或其部分，仅在所并入的材料与现有公开材料之间不产生冲突的程度下并入本文。
本发明的实施例可在常规内窥镜式和开放式手术器械及机器人辅助手术中得到应用。例如，本领域的普通技术人员将认识到，本文中的各种教导内容可易于与2004年8月31日公布的名称为“Robotic Surgical Tool withUltrasound Cauterizing and Cutting Instrument”的美国专利第6,783,524号中的各种教导内容结合，所述专利中的公开内容以引用的方式并入本文。
本文所公开的装置的实施例可在至少一次使用之后进行修复以供再次使用。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。
仅以举例的方式，可在外科手术之前出进行本文所述的实施例。首先，可以获取新的或用过的器械，并且根据需要进行清洗。然后，可对器械进行消毒。在一种消毒技术中，装置放置在闭合并密封的容器、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。密封容器可将器械保持处于无菌状态，直到在医疗设施中将该容器打开。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)

1.一种设备，其包括：
(a)器械，所述器械包括：
i.柄部部分，和
ii.从所述柄部部分朝近侧延伸的端部执行器，其中所述端部执行器包括下钳口和上钳口；
(b)能够插入所述端部执行器的所述下钳口中的下部钉仓，所述下部钉仓包括：
i.具有上部平台的第一仓体，所述上部平台包括在其中形成的第一多个钉孔，
ii.能够相对于所述第一仓体运动的第一多个钉驱动器，和
iii.与所述第一多个钉驱动器相连通的第一多个钉，其中所述第一多个钉能够相对于所述第一仓体运动；和
(c)能够插入所述端部执行器的所述上钳口中的上部钉仓，所述上部钉仓包括：
i.具有下部平台的第二仓体，所述下部平台包括在其中形成的第二多个钉孔，
ii.能够相对于所述第二仓体运动的第二多个钉驱动器，和
iii.与所述第二多个钉驱动器相连通的第二多个钉，其中所述第二多个钉能够相对于所述第二仓体运动。
2.根据权利要求1所述的设备，其中所述第一多个钉驱动器相对于所述上部平台成角度设置，并且其中所述第一多个钉驱动器相对于所述上部平台成非垂直的角度。
3.根据权利要求2所述的设备，其中所述第一多个钉驱动器中的至少一个钉驱动器以能够枢转的方式联接到致动构件。
4.根据权利要求3所述的设备，其中所述致动构件能够操作以将所述至少一个钉驱动器枢转到所述至少一个钉驱动器相对于所述上部平台基本上垂直的位置。
5.根据权利要求4所述的设备，其中所述器械还包括能够纵向致动的击发杆，其中所述击发杆能够操作以相对于所述第一仓体侧向致动所述致动构件。
6.根据权利要求1所述的设备，其中所述上部平台还包括竖直狭槽，其中所述竖直狭槽纵向延伸穿过所述上部平台的一部分，并且其中所述竖直狭槽限定所述上部平台的第一侧和所述上部平台的第二侧。
7.根据权利要求6所述的设备，其中第一钉驱动器设置在所述上部平台的所述第一侧下方，并且其中第二钉驱动器设置在所述上部平台的所述第二侧下方。
8.根据权利要求7所述的设备，其中所述第一钉驱动器以能够枢转的方式联接到第一致动构件，其中所述第二钉驱动器以能够枢转的方式联接到第二致动构件。
9.根据权利要求8所述的设备，其中所述第一致动构件能够操作以将所述第一钉驱动器枢转到所述第一钉驱动器相对于所述上部平台基本上垂直的位置，并且其中所述第二致动构件能够操作以将所述第二钉驱动器枢转到所述第二钉驱动器相对于所述上部平台基本上垂直的位置。
10.根据权利要求1所述的设备，其中所述上部钉仓的所述下部平台包括多个钉成形凹坑，其中所述第一多个钉驱动器能够操作以将所述第一多个钉致动成与所述多个钉成形凹坑相连通。
11.根据权利要求1所述的设备，其中所述下部钉仓的所述上部平台包括一组钉成形凹坑，其中所述第二多个钉驱动器能够操作以将所述第二多个钉致动成与所述多个钉成形凹坑相连通。
12.根据权利要求1所述的设备，其中所述下部钉仓包括下部楔形滑动件，并且其中所述下部楔形滑动件能够操作以相对于所述第一仓体驱动所述第一多个钉驱动器。
13.根据权利要求1所述的设备，其中所述第二多个钉驱动器相对于所述下部平台成角度设置，并且其中所述第二多个钉驱动器相对于所述下部平台成非垂直的角度。
14.根据权利要求1所述的设备，其中所述器械包括闭合触发器，其中所述闭合触发器能够操作以相对所述下钳口枢转所述上钳口。
15.根据权利要求1所述的设备，其中所述器械包括击发触发器，其中所述击发触发器能够操作以致动所述第一多个钉驱动器和所述第二多个钉驱动器。
16.一种钉仓，其包括：
(a)具有上部平台的仓体，所述上部平台包括：
i.穿过所述上部平台形成的多个钉孔；和
ii.纵向延伸穿过至少部分所述仓体的竖直狭槽，其中所述竖直狭槽限定所述仓体的第一侧和所述仓体的第二侧；
(b)设置在所述仓体的所述第一侧内的第一钉驱动器，其中所述第一钉驱动器能够相对于所述上部平台运动；
(c)设置在所述仓体的所述第二侧内的第二钉驱动器，其中所述第二钉驱动器能够相对于所述上部平台运动；
(d)与所述第一钉驱动器相连通的第一钉；
(e)与所述第二钉驱动器相连通的第二钉；
其中所述第一钉驱动器相对于所述上部平台成正向倾斜的角度；
其中所述第二钉驱动器相对于所述上部平台成反向倾斜的角度。
17.根据权利要求16所述的钉仓，其中所述第一钉驱动器以能够枢转的方式联接到第一致动构件，其中所述第二钉驱动器以能够枢转的方式联接到第二致动构件，其中所述第一致动构件和所述第二致动构件能够操作以将所述第一钉驱动器和所述第二钉驱动器枢转到相对于所述上部平台垂直的位置。
18.根据权利要求17所述的钉仓，还包括设置在所述仓体内的楔形滑动件，其中所述楔形滑动件能够操作以致动所述第一致动构件和所述第二致动构件。
19.一种外科缝合器，其包括：
(a)柄部部分；
(b)从所述柄部部分朝近侧延伸的端部执行器，其中所述端部执行器包括下钳口和上钳口；
(c)下部钉仓，其能够插入所述端部执行器的所述下钳口中，所述下部钉仓包括：
i.具有上部平台的第一仓体，所述上部平台包括在其中形成的第一多个钉孔，
ii.能够相对于所述第一仓体运动的第一钉驱动器，其中所述第一钉驱动器相对于所述上部平台垂直，
iii.能够相对于所述第一仓体运动的第二钉驱动器，其中所述第二钉驱动器相对于所述上部平台成非垂直的角度设置，
iv.与所述第一钉驱动器相连通的第一钉，和
v.与所述第二钉驱动器相连通的第二钉，
(d)上部钉仓，其能够插入所述端部执行器的所述上钳口中，所述上部钉仓包括：
i.具有下部平台的第二仓体，所述下部平台包括竖直冲压成形凹槽和成角度冲压成形凹槽，
ii.能够相对于所述第二仓体运动的第二多个钉驱动器，和
iii.与所述第二多个钉驱动器相连通的第二多个钉。
20.根据权利要求19所述的外科缝合器，其中所述第二钉驱动器能够操作以将所述第二钉致动到所述成角度冲压成形凹槽之中。
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US9089326B2 (en) 2015-07-28
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