CN104066388A - 手术紧固件施加设备 - Google Patents
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Abstract
一种手术紧固件施加设备,其包括钉仓支撑段和砧座支撑段,所述砧座支撑段具有纵向轴线并且包括远侧砧座部以及近侧手柄部,所述近侧手柄部包括沿其延伸的纵向延伸的第一狭槽。夹紧杆具有近侧部和远侧部,且能够从未夹紧位置移动至夹紧位置以将所述砧座支撑段可释放地固定为与所述钉仓支撑段紧密接近。发射组件包括发射旋钮,所述发射旋钮能够在纵向延伸的狭槽内从第一近侧位置移动至第二远侧位置以发射被支撑在所述钉仓支撑段内的紧固件。
Description
相关申请的交叉引用
本申请要求享有序号为61/587,871的美国临时申请的利益和优先权,其全部内容通过引用合并于此。
技术领域
本公开涉及手术紧固件施加设备,并且尤其涉及具有可重复使用的部件和一次性部件的手术紧固件施加设备。
背景技术
手术紧固件施加设备通过手术紧固件来抓紧或夹紧相对的钳夹结构之间的组织并且连结所述组织。在一些这样的设备中,刀具被提供以切割已经被紧固件连结的组织。紧固件通常是手术吻合钉的形式,但是也可以利用其他手术紧固件,诸如例如夹子或两部分式聚合体手术紧固件。
手术紧固件施加设备通常包括两个细长横梁构件,其用于捕获或夹紧其间的组织。通常,横梁构件中的一个载有容纳被排列成至少两个横排的多个吻合钉的一次性钉仓组件,而另一个横梁构件包括砧座,当吻合钉从钉仓组件中被驱出时,所述砧座限定了用于使吻合钉钉腿成形的表面。在使用两部分式紧固件的情况下,包括砧座的横梁构件载有两部分式紧固件的匹配部件,例如,接收器。大体上,吻合钉成形过程受一个或多个纵向移动的凸轮系统构件与一系列单个的吻合钉推动器之间的相互作用影响。随着凸轮系统构件纵向运动通过载有钉仓的横梁构件,各个的吻合钉推动器被向上偏置而进入被支撑在钉仓组件内的吻合钉的钉冠(backspan)以按次序地从钉仓射出吻合钉。刀具可被提供为与凸轮系统构件一起在吻合钉排之间运动以切割成形的成排的吻合钉之间的组织。这种器械的一个例子公开在序号为7,631,794的美国专利中,其全部内容通过引用合并于此。
尽管已经发展了可重复使用的紧固件施加设备,但是这种设备可能极度复杂并且证明是很难消毒的。由于与恰当消毒紧固件施加设备以重复利用相关联的困难,紧固件施加设备通常被配置为一次性设备。尽管紧固件施加设备通常在手术操作完成之后被丢弃,但是在这种一次性设备中,钉仓组件可被替换以在单一患者上执行多重紧固件施加操作。这样用后即丢弃的需要会增加与手术操作相关联的成本。
因此,本领域需要一种包括可重复使用部件的紧固件施加设备,其不极度复杂,并且被配置为利于在手术操作中使用之后恰当消毒。
发明内容
依照本公开的一个方案,提供了手术紧固件施加设备,其包括钉仓支撑段和砧座支撑段,所述砧座支撑段具有纵向轴线且包括远侧砧座部和近侧手柄部。近侧手柄部具有第一表面和相对的第二表面,所述第一表面面朝向钉仓支撑段,所述第二表面包括沿其延伸的第一纵向延伸狭槽。夹紧杆具有近侧部和远侧部,并且能够从未夹紧位置移动至夹紧位置以可释放地将砧座支撑段固定为与钉仓支撑段紧密接近。顶部发射组件包括发射旋钮,所述发射旋钮能够在纵向延伸狭槽内从第一近侧位置移动至第二远侧位置以发射被支撑在钉仓支撑段内的紧固件。
在一些实施例中,夹紧杆在近侧部包括锁定构件,其中所述锁定构件将砧座支撑段固定在夹紧位置。锁定构件可包括钩。夹紧杆可通过弹簧被偏置至未夹紧位置。
在一些实施例中,发射旋钮能够移动至在第一近侧位置的近侧的第二近侧位置以释放锁定构件从而释放夹紧杆。纵向延伸狭槽可包括至少一个制动器(detent)以将发射旋钮保持在第一近侧位置。
在一些实施例中,发射组件包括一对被可操作地连接至发射旋钮的凸轮杆,并且发射旋钮和凸轮杆是一次性的。
在一些实施例中,第一狭槽在其近侧区域具有宽度扩大部,并且发射旋钮被定位在在宽度扩大部内,处于第一近侧位置。
可提供支撑块以支撑从支撑块向远侧延伸的凸轮杆,并且支撑柱能够横向于凸轮杆从支撑块延伸出,以支撑发射旋钮。
在一些实施例中,支撑块能够移动至近侧位置以接合锁定构件从而将夹紧杆解锁。
钉仓支撑段可包括细长通道,所述细长通道用于支撑包含多个紧固件的一次性装载单元。
在一些实施例中,第二狭槽形成在砧座内,在与砧座凹穴相对的表面内并且沿其纵向地延伸。在一些实施例中,第二狭槽具有第一部分,第一部分具有比第二部分大的横向尺寸,所述第二部分更接近砧座凹穴。
在一些实施例中,设备进一步包括从夹紧杆延伸出的射出器(ejector),所述射出器能够从第一位置移动至第二位置以抵靠被定位在钉仓支撑段内的一次性装载单元施加力从而辅助一次性装载单元的射出。钉仓支撑段可包括细长通道,该细长通道用于支撑包含多个紧固件的一次性装载单元并且具有开口以接纳贯通其中的射出器。
在一些实施例中,砧座支撑段包括邻近纵向延伸狭槽的指示器以指示发射旋钮的移动程度。
依照本公开的另一个方案,提供了一种手术紧固件施加设备,其包括:钉仓支撑段;砧座支撑段,其具有纵向轴线并且包括远侧砧座部和近侧手柄部;以及夹紧杆,其具有近侧部和远侧部。夹紧杆能够从未夹紧位置移动至夹紧位置从而可释放地将砧座支撑段固定为与钉仓支撑段紧密接近并且在近侧部包括将砧座支撑段固定在夹紧位置的锁定构件。发射组件包括发射旋钮,所述发射旋钮能够从第一近侧位置移动至第二远侧位置以发射被支撑在钉仓支撑段内的紧固件并且能够收回至在第一近侧位置近侧的第二近侧位置以释放锁定构件进而释放夹紧杆。
在一些实施例中,砧座支撑段包括制动器以将发射旋钮保持在第一近侧位置。
在一些实施例中,发射组件包括一对被可操作地连接至发射旋钮的凸轮杆,并且发射旋钮和凸轮杆是一次性的。
在一些实施例中,一对凸轮杆被可操作地连接至发射旋钮,并且支撑块支撑从支撑块向远侧延伸的凸轮杆,支撑柱横向于凸轮杆从支撑块延伸出,其中,发射旋钮从支撑柱延伸出并且支撑块能够移动至近侧位置以接合锁定构件从而将夹紧杆解锁。
弹簧可被提供以将夹紧杆偏置至未夹紧位置。
砧座支撑段可包括具有多个凹穴的砧座,凹穴面对钉仓支撑段,并且细长狭槽可形成于与砧座凹穴相对的表面内并且沿其纵向地延伸。在一些实施例中,细长狭槽具有第一部分,所述第一部分具有比第二部分大的横向尺寸,所述第二部分更接近砧座凹穴。
设备可进一步包括从夹紧杆延伸出的射出器,其能够从第一位置移动至第二位置以抵靠被定位在钉仓支撑段内的一次性装载单元施加力从而辅助一次性装载单元的射出。在一些实施例中,钉仓支撑段包括用于支撑包含多个紧固件的一次性单元的细长通道,并且细长通道包括开口以接纳贯通其中的射出器。
依照本公开的另一个方案,提供一种手术紧固件施加设备,其包括:钉仓支撑段,其包括细长通道,用于支撑包含多个紧固件的一次性装载单元;砧座支撑段,其具有纵向轴线并且包括远侧砧座部和近侧手柄部;以及夹紧杆,其具有近侧部和远侧部。夹紧杆能够从未夹紧位置移动至夹紧位置以可释放地将砧座支撑段固定为与钉仓支撑段紧密接近。夹紧杆包括从其延伸出的射出器,射出器能够从第一位置移动至第二位置以抵靠被定位在钉仓支撑段内的一次性装载单元施加力从而辅助一次性装载单元的射出。发射组件包括发射旋钮,发射旋钮能够从第一近侧位置移动至第二远侧位置以发射被支撑在一次性装载单元内的紧固件。
在一些实施例中,夹紧杆朝向未夹紧位置的枢转使射出器移动。细长通道可包括狭槽以接纳贯通其中的射出器。
在一些实施例中,发射组件包括被可操作地连接至发射旋钮的一对凸轮杆,并且发射旋钮和凸轮杆是一次性的。在这种实施例中,钉仓支撑段、砧座支撑段以及夹紧杆能够被消毒并且可重复使用。
弹簧可被提供以将夹紧杆偏置至未夹紧位置。
砧座支撑段可包括:砧座,砧座具有多个面对钉仓支撑段的凹穴;以及细长狭槽,其形成在与砧座凹穴相对的表面内并且沿其纵向地延伸。在一些实施例中,砧座狭槽具有第一部分,第一部分具有比第二部分大的横向尺寸,所述第二部分更接近钉仓支撑段。
附图说明
本文参照附图描述了本公开的手术紧固件施加设备的多种实施例,其中:
图1是本公开的手术紧固件施加设备的立体图,图示手术紧固件施加设备处于夹紧位置,发射旋钮处于预发射位置;
图2是图1的手术紧固件施加设备的分解图;
图2A是沿图2的线2A-2A取得的剖视图;
图3是沿图1的线3-3取得的手术紧固件施加设备的纵向剖视图;
图4是与图1相似的立体图,其显示发射旋钮处于推进位置以发射紧固件;
图5是沿图4的线5-5取得的手术紧固件施加设备的纵向剖视图;
图6是与图1相似的立体图,其显示发射旋钮收回至最近侧位置以脱离锁止从而释放夹紧杆;
图7是沿图6的线7-7取得的纵向剖视图;
图8是图1的器械的侧视图,图示器械处于未夹紧位置,并且砧座半段与钉仓半段分离;以及
图9是显示单个的部件的立体图,其中部件被分离以用于分别的处置和清洗。
具体实施方式
现在将参照图1至图9详细描述依照本公开的目前公开的手术紧固件施加设备的实施例,其中,相同附图标记代表相似或相同的结构构件。本文所使用的,如惯例的,术语“近侧”指示设备的较接近用户的一端,而术语“远侧”指示设备的较远离用户的一端。
转向图1至图3,本公开的手术紧固件施加设备的一个实施例被总体标示为手术吻合器10。手术吻合器10包括砧座支撑段或砧座半段100、钉仓支撑段或钉仓接纳半段200、夹紧杆300、以及包括单次使用的装载单元400(下文“SULU”)和发射单元500的一次性组件600。这些部件或组件的每一个均将在下文更详细讨论。
砧座半段100、钉仓接纳半段200以及夹紧杆300可以被配置为可重复使用的部件,并且,因此,由适合于消毒和重复使用的生物相容性材料构造,例如,不锈钢。另一方面,SULU400和发射单元500是一次性的。SULU400和发射单元500可以是分离的部件,或者可选地彼此结合在一起而形成一次性组件600。图9示出了吻合器10的部件的分离。
一次性组件600,例如,SULU400和发射单元500,可由任何适当的生物相容性材料构造,例如,塑料、金属、或其组合。而且,手术吻合器10可被配置为接纳或容纳多种不同构造的一次性组件,例如,包括SULU's和用于发射不同吻合钉线长度(例如,60mm,80mm和100mm)的吻合钉的发射组件的一次性组件。
如下文将详细讨论的,砧座半段100和钉仓接纳半段200能够可释放地且可枢转地彼此接合,而夹紧杆300绕钉仓接纳半段200的中央部202被可枢转地联接至钉仓接纳半段200。夹紧杆300能够相对于钉仓接纳半段200在隔开位置(图8)与接近位置(图1和图3)之间枢转,从而使钉仓接纳半段200和砧座半段100在打开或未夹紧位置与闭合或夹紧位置(图1和图3)之间相对于彼此移动以夹紧其间的组织。在手术吻合器10处于夹紧位置的情况下,发射单元500可被操作以绕在砧座半段100和钉仓接纳半段200之间夹紧的组织按顺序地发射多个手术吻合钉402和使多个手术吻合钉402成形(图2),并且用于推进刀具440以分割被吻合的部分之间的组织。
继续参照图1至图3,砧座半段100包括近侧手柄部102和在鼻状部107处终止的远侧砧座部104。近侧手柄部具有上表面103以及相对的下表面。砧座部104包括吻合钉变形部106,其包括限定在其内的多个吻合钉变形凹槽111(图2A)。当一次性组件600接合在钉仓接纳半段200的通道构件206内时,吻合钉变形部106相对于SULU400以相对关系布置。而且,吻合钉变形部106包括中央纵向狭槽130(图2A),随着刀具440通过SULU400被推进以分割被吻合的组织,中央纵向狭槽130用于接纳SULU400的刀具440。吻合钉变形部106可与砧座半段100一体式形成,或可选地,可通过任何适合的紧固方法(例如,焊接)被固定至砧座半段100。
吻合钉变形部106被定位在砧座半段100的面朝向钉仓接纳半段200(和SULU400)的一侧上。如图2A所示,刀具狭槽130朝向砧座半段100的相对一侧延伸。如图所示,刀具狭槽130具有变窄的区域132以适应刀具440的滑行运动。刀具狭槽130的宽度(横向尺寸)远离钉仓接纳半段200(朝向砧座半段110的相对一侧)而进一步逐步地增加以形成加宽的狭槽区域134,从而利于砧座的清洁。因此,提供了沿着远侧砧座部106的长度的贯通狭槽,其向内逐渐变细以在操作过程中减小无用残渣的进入,而提供逐步增加的宽度利于进入清洁。
布置在砧座半段100的中央部105上并且定位在砧座部104的吻合钉变形部106的近侧端的邻近处的一对定位指状件108(图2),从砧座半段100朝向一次性组件600的SULU400延伸。随着砧座半段100与钉仓接纳半段200接近,定位指状件108至少部分地被接纳在限定于SULU400内的沟槽内,从而在手术吻合器10被移至夹紧位置时,恰当地使SULU400对齐吻合钉变形部106。
砧座半段100进一步包括一对横向分隔的延伸部110,其被定位在朝向一次性组件600向下延伸的指状件108的近侧。各个延伸部110还被配置为在延伸部110朝向一次性组件600平移时接触引导块的上表面(未显示),即,随着手术吻合器10朝向夹紧位置移动,使得引导块从第一、锁定位置枢转至第二、解锁位置。此引导块以及其功能和结构被详细描述在共同受让的序号为7,055,730的专利以及递交于2011年6月9日的、序号为61/494,985以及递交于2011年8月8日的、序号为61/521,070的申请中,这些专利和申请的全部内容通过引用合并于此。
砧座半段100的中央部包括一对圆柱形的横向支撑构件112。在组装砧座半段100和钉仓接纳半段200的过程中,横向支撑构件112被支撑在限定于钉仓接纳半段200的中央部202内的U型凹槽214内(图2)。中央部202的远侧壁204限定了组织止挡部。横向支撑构件112还被定位为在夹紧杆300被移动至夹紧位置时,其被接纳在形成于夹紧杆300的间隔开的凸缘部304上的切口302内(图3)。砧座半段100的近侧手柄部102人体工程学地形成并且包括拇指接合抵接部114。销115被配置为用于被接纳在钉仓接纳半段200的狭槽220内。
手柄部102的近侧端包括向下延伸的一对臂件119。横向的柱121(图2和图3)在臂件119之间延伸并且被臂件119支撑。如下所述,横向的柱121被夹紧杆300的锁定弹簧700接合。
发射狭槽109被提供在砧座段100的手柄部102的上表面103内。狭槽109具有纵向延伸部116和加宽的近侧部118。如下文所描述,狭槽109被定尺寸为接纳发射单元500的发射旋钮组件501,从而提供用于发射紧固件的顶部发射机构。此顶部发射机构使得任一只手都能容易地发射吻合器100。如下所述,细长宽度的近侧部118可包括制动器以将发射旋钮组件501保持在预发射位置。制动器可被定位在发射旋钮的近侧和发射旋钮552的远侧从而将其保持在图1的其预发射位置。
一系列指示器标记(例如记号123)可被提供在纵向延伸狭槽部116的邻近处以指示发射旋钮组件501的运动长度从而指示被施加至组织的吻合钉长度。
钉仓接纳半段200包括细长通道构件206,其具有被限定在其内的且被配置为可释放地接纳一次性组件600的基本是U型的通道208。更具体地,U型通道208包括:远侧部210,其被定尺寸为可释放地接纳SULU400;以及近侧部212,其被定尺寸为可释放地接纳发射单元500。固定壳体可被提供以支撑发射单元500和SULU400,发射单元500和SULU400随后可作为一个单元被装载入通道208。将在下文更详细解释一次性组件600及其部件,例如,SULU400和发射单元500。
如上所提到的,钉仓接纳半段200包括隔开的居中布置的U型凹槽214,其被定位为支撑砧座半段100的横向支撑构件112。钉仓接纳半段200的近侧端包括一对竖直支撑构件216。每个竖直支撑构件216均包括具有圆形底表面的细长竖直狭槽218。竖直狭槽218被定尺寸为,在组装过程中当砧座半段100被支撑在钉仓接纳半段200上时,其接纳砧座半段100的臂件119。通过将臂件119定位在竖直狭槽218内,砧座半段100能够相对于钉仓接纳半段200在打开位置和闭合位置之间以剪刀式的方式枢转。
如上所述,钉仓接纳半段200进一步包括一对相隔开的狭槽220,其被配置为接纳砧座半段100的横向延伸的销115。
通道构件206的底壁内的狭槽224位于近侧部212的近侧区域且被定尺寸为接纳夹紧杆300的贯通狭槽224的锁定弹簧700。
夹紧杆300,其最好地显示在图2中,包括手柄部306,手柄部306包括拇指接合抵接部310。一对隔开的凸缘部304被支撑在夹紧杆300的远侧端上。每个凸缘部304限定切口302,其被定尺寸为当吻合器10朝向夹紧位置移动时接纳砧座半段100的对应的横向支撑构件112。弹簧构件316包括下方折叠的、T字形的近侧端,其被接合在限定于夹紧杆300的相对的侧壁内的相对的狭槽内并且可以以任何适合的方式(例如,机械接合、焊接、胶粘、等)被固定在其内。弹簧构件200的远侧端322被配置为抵接钉仓接纳半段200的下表面219以将夹紧杆300偏置而脱离钉仓接纳半段200,即,将夹紧杆300朝向相隔的、或未夹紧位置偏置。
夹紧杆300进一步包括被定位在远侧部处的射出器凸块318。射出器318被固定地附接至夹紧杆300的底表面并且被配置为通过形成于通道构件206的底壁内的狭槽228延伸。射出器318有助于使SULU400从通道206脱离。射出器318可以是弹簧的形式。当夹紧杆300从夹紧位置(图1至图7)枢转至打开位置(图8)时,射出器318的远侧端318a被枢转以接触并施加力至SULU400的下表面403从而有助于SULU从通道208射出。
锁定弹簧700被定位在夹紧杆300的近侧端并且包括面向远侧的钩702。钩702被配置为接合砧座半段100的大致圆柱形的横向柱121。也即,当吻合器10被夹紧时,钩702被推动越过并且围绕横向柱121,然后接合横向柱121,从而将夹紧杆300保持在锁定(夹紧)位置,由于钩702与柱121的闭锁防止了夹紧杆300与砧座半段100的分离。
发射单元501脱离锁定弹簧702。更具体地,当发射旋钮552朝向其在图7和图8的最近侧位置收回时,钩构件702从横向柱121脱离以将夹紧杆300解锁,从而允许夹紧杆300在弹簧316的偏置下回到打开或未夹紧位置。该脱离是由滑块554的凸起558引起的,滑块554的凸起558从发射单元500的滑块554向近侧延伸,并如图7所示且如下文所述的接合弹簧700的下部705。
如上所述,一次性组件600可包括彼此结合在一起以形成单个部件(即,一次性组件600)的SULU400和发射单元500。在这种单个部件的实施例中,一次性组件600可包括:固定壳体(未显示),其被配置为容纳发射单元500的工作部件;以及远侧延伸部,其从固定壳体向远侧延伸且被配置为接合和保持SULU400,从而形成一体式的一次性组件600。这在递交于2011年8月8日的序号为的61/521,070的专利申请中显示并描述,其全部内容通过引用合并与此。
参照图2和图3,发射单元500包括刀具致动杆544、一对凸轮杆546、以及包括有发射旋钮552、柱556、以及滑块554的发射旋钮组件501。
凸轮杆546延伸通过SULU400内的狭槽408以发射被容纳在SULU400内的紧固件402。也即,随着凸轮杆546向远侧移动通过SULU400,它们接触被包含在SULU400内的推动器406以通过SULU400内的成排的紧固件狭槽407按顺序地发射紧固件402。
可提供诸如序号为61/494,985的专利申请中的引导块48和序号为61/521,070的申请中的引导块548的这种具有三个纵向狭槽的引导块,一个狭槽接纳一个凸轮杆546;另一个狭槽接纳刀具致动杆544。如果提供了引导块,其可被轴向地固定在固定壳体的远侧端内,并且能够从与刀具致动杆544锁定接合的第一位置枢转至响应于吻合器10向夹紧位置的移动而与刀具致动杆544脱离的第二位置。随着砧座半段100相对于钉仓接纳半段200接近以到达夹紧位置,砧座半段100的延伸部110推动引导块使其从第一接合位置枢转至第二脱离位置以脱离闭锁机构,从而使得能够发射紧固件。
器械100的发射旋钮组件501是顶部发射组件并且包括手指接合构件或旋钮552,其可被使用者的任一只手选择性地接合以使发射单元500移动通过发射冲程。如本文所使用的,发射冲程被定义为发射旋钮552从收回位置至图4和图5的完全推进位置的运动。如上所述,发射旋钮组件包括滑块554和柱556,柱556大致垂直于凸轮杆546的纵向轴线从滑块554向上延伸,从而使旋钮552与滑块554连接。柱556延伸穿过砧座段100内的纵向狭槽109。如上所述,凸块558从滑块554向近侧延伸并且被配置为接触和脱离夹紧杆300的锁定弹簧700。
刀具致动杆544包括向上翘的钩部以及上槽口和下槽口。指状件从刀具致动杆544向上突出。当滑块554向远侧推进时,其移动以推动凸轮杆546,并且滑块554的进一步的远侧移动实现了刀具致动杆544的远侧移动。这个设置允许在切割组织之前从SULU400射出吻合钉。刀具致动杆的细节公开在序号为61/494,985的未决申请中,其之前已通过引用结合于此。
参照图2,每个凸轮杆546都包括远侧部547、近侧部549以及一对侧壁。每个凸轮杆的近侧端均被固定地附接至滑块554。可选地,滑块554可绕凸轮杆546的近侧端成型出。在一个实施例中,滑块554具有一对狭槽以接纳凸轮杆546。由于这个附接,当发射旋钮552向远侧推进时,其使凸轮杆546向远侧移动通过SULU400内的狭槽408,从而凸轮杆548的远侧部547处的成角度的凸轮表面548接触推动器406以沿大致垂直于凸轮杆546的纵向轴线的方向(大致垂直于凸轮杆546的移动方向)发射紧固件402。
随着壁206接合SULU400从而封住SULU400的钉仓主体420的下侧,通道208接合SULU400并且将SULU400保留在其内。因此,SULU400经由搭扣配合接合方式被固定地紧固在通道206内。还可设想其他紧固方法。
参照图2,SULU400包括钉仓主体420、多个吻合钉推动器406、具有成角度的锋利的前沿或刀刃441的刀具440、以及多个吻合钉402。如在申请61/494,985中的安全闭锁件128和序号为61/521,070的申请中的安全闭锁件428,也可提供可枢转地安装的安全闭锁件。主体420具有多排吻合钉保留狭槽430,例如,四排、六排、等,以及居中地布置在主体420内的线性的狭槽式的刀具轨道452。刀具440包括向下弯的钩部,其被定位为接合发射单元500的刀具致动杆544的向上翘的钩部。在示出的实施例中,主体420包括两个错列排的狭槽430,其形成在线性的狭槽式的刀具轨道452的每一侧上。错列排的狭槽430延伸越过刀具轨道452的远侧端以利于越过刀具刀片440a的冲程的远侧端的吻合钉成形,但是也可设想其他构造。
吻合钉推动器406可被配置为延伸进入一个或多个狭槽430。在一个实施例中,单个推动器与每个狭槽430相关联。可选地,每个推动器406可被配置为延伸进入两个邻近的狭槽430并且被定位在被保留在狭槽430内的对应的吻合钉402下方。而且,每个推动器406包括下凸轮表面,其被定位以在凸轮杆546的远侧部547上接合凸轮表面548中的一个,从而使得凸轮杆546的通过SULU400的移动按顺序地抬起对应的一个或多个狭槽430内的每个对应的推动器406,以从狭槽430射出吻合钉。
SULU400的近侧端可包括相对的、向外延伸的锯齿状表面以利于抓紧SULU400的近侧端,从而利于SULU400(或一次性组件600)从钉仓接纳半段200的通道构件206移除和/或替换。
可提供在序号为61/521,070和61/494,985的专利申请中描述的类型(闭锁件128)的安全闭锁件428。当刀具440在发射冲程过程中朝向推进位置移动时,安全闭锁件能够朝向解锁位置枢转。当砧座半段100和钉仓接纳半段200处于夹紧位置时,安全闭锁件被防止枢转至未锁定位置,这是由于安全闭锁件的上表面接合砧座半段100的内表面从而防止了安全闭锁件的枢转。
现在将描述手术吻合器10的组装和操作。首先,一次性组件600接合在钉仓接纳半段200内。为了使一次性的组件600接合在钉仓接纳半段200内,包括SULU400和发射单元500的一次性组件600,大体对齐在钉仓接纳半段200的上方,并且分别地插入通道构件206的U型通道208或如果作为一体式单元被提供则一起插入通道构件206的U型通道208。如上所讨论的,可以通过抓紧SULU400的锯齿形表面来便于安装。
一旦一次性组件600被装载入通道构件206,砧座半段100可被组装至钉仓接纳半段200。为将砧座半段100附接至钉仓接纳半段200,横向的柱121被定位在钉仓接纳半段200的竖直支撑构件216的竖直狭槽218内。然后,砧座半段100朝向钉仓接纳半段200旋转以将横向支撑构件112定位在通道构件206的U型凹槽214内。在此位置,手术吻合器10准备好被使用。注意在此位置,发射旋钮552在砧座半段100的狭槽109的加宽的狭槽区域118内,在近侧壁118a的稍远侧。
使用时,在手术吻合器10处于打开、或未夹紧位置的情况下,手术吻合器10被操纵进入使得待吻合和待分割的组织被布置在砧座半段100和钉仓接纳半段200之间的位置。然后,手术吻合器10可以移动至夹紧位置以夹紧SULU400与砧座半段100的吻合钉变形部106之间的组织。为了将手术吻合器10定位在夹紧位置,当切口302接纳砧座半段100的销112时与钉仓接纳半段相接合的夹紧杆300,在砧座半段与钉仓接纳半段200附接之后,沿逆时针方向旋转至图1中所示的位置。随着夹紧杆300克服弹簧构件316的偏置而旋转,横向支撑构件112被接纳在夹紧杆300的凸缘部304的切口302(图2)内并且朝向钉仓接纳半段200做凸轮运动。如图1所示,在此位置,吻合钉变形部106被定位为紧密接近SULU400的上表面。
当夹紧杆300移动至夹紧位置,锁定弹簧700的钩702的成角度的面707越过横向柱121弯曲,然后,当其被柱121超过时,返回到其初始位置,以使得钩702如图3中所示的接合柱121。在此夹紧位置,钩702与横向柱121的接合将夹紧杆300锁定在夹紧或锁定位置。如下文所述,随着发射旋钮552的近侧移动,该锁止被释放。
如上所讨论的,如果提供了引导块,则随着手术吻合器10移动至夹紧位置,砧座半段100的延伸部110相对于一次性组件600接近,使得延伸部110最终接触引导块的上表面并且促动引导块沿大体地逆时针方向枢转,因此其从锁定位置移动至解锁位置,以解锁刀具致动杆544。这防止在夹紧之前刀具致动杆544相对于引导块移动,因此确保刀具致动杆544和刀具440在使用前保持恰当地被定位而用于操作性接合。
当吻合器10处于夹紧、未发射位置时,发射单元500在通道构件206的近侧端处于收回位置,在壁118a的稍远侧。发射旋钮组件501的柱556处于狭槽109的近侧区域118。锁定构件700的锁止部(钩)702接合横向的柱121以将夹紧杆300保持在夹紧位置(图3)。
当滑块554处于此收回位置时,刀具440和凸轮杆546的凸轮表面548被定位在SULU400的近侧端。如果安全闭锁件被提供,那么在此位置,安全闭锁件被保持在锁定方位。另外,刀具440的向下弯的钩部与刀具致动杆544的向上翘的钩部接合以将发射单元500连接到SULU400的刀具440。
如图4和图5所示,当发射旋钮552向远侧推进以发射紧固件时,滑块554在通道壳体200内向远侧移动,以使凸轮杆546移动通过SULU400的狭槽408并且向远侧移动至刀具致动杆544。当凸轮杆546向远侧移动时,凸轮表面548按顺序地接合推动器406以从主体420的狭槽407射出吻合钉402。同时,由于刀具致动杆544的远侧端与刀具440接合,刀具440在预先设定的延迟之后被推进通过SULU400以切割吻合钉线之间的组织。注意,随着发射旋钮552向远侧移动至图5的位置,柱556在砧座半段100的狭槽109的细长狭槽区域116内滑动。还需注意,如果制动器被提供以将发射旋钮552保持在图1的位置,则需要将足够的力施加至发射旋钮552以越过制动器从而推进发射旋钮552。
如图6和图7所示,当发射旋钮552在发射之后返回到其最近侧位置以收回凸轮杆546和刀具440时,柱556收回在狭槽109的细长狭槽区域116内,并且进入扩大的区域118。如图7所示,旋钮552的充足的近侧收回引起滑块554的近侧凸起558接合锁定弹簧700从而将其向后偏置。注意的是,如果近侧制动器被提供以将发射旋钮552保持在图1的位置,则需要足够的近侧力被施加至发射旋钮552以越过制动器从而收回发射旋钮552至其最近侧位置。
近侧凸起558弯曲锁定弹簧,使得钩702脱离与砧座半段100的横向柱121的接合。这将夹紧杆700解锁(解开)并且使弹簧316推动夹紧杆300至其未夹紧位置以允许吻合器10移动至打开位置。夹紧杆300至其打开位置的移动,使射出器318的凸起318a向上地移动通过通道构件206的狭槽228从而施加力至SULU400的下表面以帮助其从通道208射出(参见图8)。在打开位置,砧座半段100与钉仓接纳半段200隔开,并且部件可如图8被分离。注意,同样在此打开位置,如果前述的安全闭锁件被提供,安全闭锁件移动至其解锁位置,使得其从SULU400向上地突出以防止吻合器10移动回到夹紧位置。为了重新使用吻合器10,使用过的SULU400必须由新的SULU400替换。
在手术操作过程中,一次性组件600(包括SULU400和发射组件500)能够被多次替换以利于吻合器10在单个患者上的多次使用。每个一次性组件600具有新的刀具。而且,每个一次性组件600还具有新的发射单元500,例如,新的凸轮杆546和新的发射旋钮552,从而抑制其任何部件的疲劳或磨损并且简化被重新消毒的部件的数量和形式。在手术操作之后,一次性组件600可从通道构件206移除并且以合适的方式被处理。
另一方面,砧座半段100、钉仓接纳半段200以及夹紧杆300可以被消毒(例如通过高压灭菌法),并且以上面所讨论的方式与新的一次性组件600一起重新使用。因为发射单元500和SULU400都是一次性的,可重复使用的部件上保留了可用于待被捕获的组织和流体的更少的面积。同样地,设备的可重复使用的部件能够更容易消毒。
将被理解的是可对本公开的手术紧固件施加设备做多种改进。因此,上述描述不应被理解为限制性的,而仅是实施例的示范例。本领域技术人员将在本公开的范围和精神内预想其他改进。
Claims (34)
1.一种手术紧固件施加设备,包括:
钉仓支撑段;
砧座支撑段,其具有纵向轴线并且包括远侧砧座部和近侧手柄部,所述近侧手柄部具有第一表面和相对的第二表面,所述第一表面面朝向所述钉仓支撑部,所述第二表面包括沿其延伸的纵向延伸的第一狭槽;
夹紧杆,其具有近侧部和远侧部,所述夹紧杆能够从未夹紧位置移动至夹紧位置以将所述砧座支撑段可释放地固定为与所述钉仓支撑段紧密接近;以及
顶部发射组件,其包括发射旋钮,所述发射旋钮能够在纵向延伸的狭槽内从第一近侧位置移动至第二远侧位置以发射被支撑在所述钉仓支撑段内的紧固件。
2.根据权利要求1所述的手术紧固件施加设备,其中所述夹紧杆包括在所述近侧部的锁定构件,所述锁定构件将所述砧座支撑段固定在夹紧位置。
3.根据权利要求2所述的手术紧固件施加设备,所述发射旋钮能够移动至在所述第一近侧位置的近侧的第二近侧位置以释放所述锁定构件从而释放所述夹紧杆。
4.根据权利要求2和权利要求3中的任何一项权利要求所述的手术紧固件施加设备,其中所述锁定构件包括钩。
5.根据前述的任何一项权利要求所述的手术紧固件施加设备,其中纵向延伸的狭槽包括至少一个制动器以将所述发射旋钮保持在所述第一近侧位置。
6.根据前述的任何一项权利要求所述的手术紧固件施加设备,其中所述发射旋钮是一次性的。
7.根据前述的任何一项权利要求所述的手术紧固件施加设备,其中所述发射组件包括被可操作地连接至所述发射旋钮的一对凸轮杆,所述凸轮杆是一次性的。
8.根据前述的任何一项权利要求所述的手术紧固件施加设备,其中所述第一狭槽在其近侧区域具有宽度扩大部,所述发射旋钮被定位在所述宽度扩大部内,处于所述第一近侧位置。
9.根据权利要求7所述的手术紧固件施加设备,进一步包括:支撑所述凸轮杆的支撑块,所述凸轮杆从所述支撑块向远侧延伸;以及支撑柱,其横向于所述凸轮杆从所述支撑块延伸出,所述发射旋钮从所述支撑柱延伸出。
10.根据权利要求9所述的手术紧固件施加设备,其中所述夹紧杆在其近侧部包括锁定构件,所述锁定构件将所述砧座支撑段固定在夹紧位置,所述支撑块能够移动至近侧位置以接合所述锁定构件从而将所述夹紧杆解锁。
11.根据前述的任何一项权利要求所述的手术紧固件施加设备,其中所述钉仓支撑段包括用于支撑包含多个紧固件的一次性装载单元的细长通道。
12.根据前述的任何一项权利要求所述的手术紧固件施加设备,进一步包括弹簧,其将所述夹紧杆偏置至未夹紧位置。
13.根据前述的任何一项权利要求所述的手术紧固件施加设备,其中所述砧座支撑段包括:具有多个凹穴的砧座,所述凹穴面向所述钉仓支撑段;以及形成在与砧座凹穴相对的表面内并且沿其纵向延伸的第二狭槽。
14.根据权利要求13所述的手术紧固件施加设备,其中所述第二狭槽具有第一部分,所述第一部分具有比第二部分大的横向尺寸,所述第二部更接近砧座凹穴。
15.根据前述的任何一项权利要求所述的手术紧固件施加设备,进一步包括从所述夹紧杆延伸出的射出器,所述射出器能够从第一位置移动至第二位置以抵靠被定位在所述钉仓支撑段内的一次性装载单元施加力从而辅助所述一次性装载单元的射出。
16.根据前述的任何一项权利要求所述的手术紧固件施加设备,其中所述钉仓支撑段包括用于支撑包含多个紧固件的一次性装载单元的细长通道,所述细长通道包括开口以接纳射出器贯通其中。
17.根据前述的任何一项权利要求所述的手术紧固件施加设备,其中所述砧座支撑段包括邻近纵向延伸的狭槽的指示器以指示所述发射旋钮的移动程度。
18.一种手术紧固件施加设备,包括:
钉仓支撑段;
砧座支撑段,其具有纵向轴线并且包括远侧砧座部和近侧手柄部;
夹紧杆,其具有近侧部和远侧部,所述夹紧杆能够从未夹紧位置移动至夹紧位置以将砧座支撑段可释放地固定为与所述钉仓支撑段紧密接近,所述夹紧杆在近侧部包括锁定构件,所述锁定构件将砧座支撑段固定在夹紧位置;以及
发射组件,其包括发射旋钮,所述发射旋钮能够从第一近侧位置移动至第二远侧位置以发射被支撑在所述钉仓支撑段内的紧固件并且能够收回至在所述第一近侧位置的近侧的第二近侧位置以释放所述锁定构件从而释放所述夹紧杆。
19.根据权利要求18所述的手术紧固件施加设备,其中所述砧座支撑段包括制动器以将所述发射旋钮保持在所述第一近侧位置。
20.根据权利要求18和权利要求19中的任何一项权利要求所述的手术紧固件施加设备,其中所述发射组件包括被可操作地连接至所述发射旋钮的一对凸轮杆,所述发射旋钮和所述凸轮杆是一次性的。
21.根据权利要求18和权利要求19中的任何一项权利要求所述的手术紧固件施加设备,进一步包括被可操作地连接至发射旋钮的一对凸轮杆,以及支撑所述凸轮杆的支撑块,所述凸轮杆从所述支撑块向远侧延伸并且支撑柱横向于所述凸轮杆从支撑块延伸出,所述发射旋钮从所述支撑柱延伸出,其中所述支撑块能够移动至近侧位置以接合所述锁定构件从而将所述夹紧杆解锁。
22.根据权利要求18至权利要求21中的任何一项权利要求所述的手术紧固件施加设备,进一步包括弹簧,所述弹簧将所述夹紧杆偏置至未夹紧位置。
23.根据权利要求18至权利要求22中的任何一项权利要求所述的手术紧固件施加设备,其中所述砧座支撑段包括:具有多个凹穴的砧座,所述凹穴面向所述钉仓支撑段;以及形成在与砧座凹穴相对的表面内并且沿其纵向延伸的细长狭槽。
24.根据权利要求23所述的手术紧固件施加设备,其中所述细长狭槽具有第一部分,所述第一部分具有比第二部分大的横向尺寸,所述第二部分更接近砧座凹穴。
25.根据权利要求18至权利要求24中的任何一项权利要求所述的手术紧固件施加设备,进一步包括从所述夹紧杆延伸出的射出器,所述射出器能够从第一位置移动至第二位置以抵靠被定位在所述钉仓支撑段内的一次性装载单元施加力从而辅助所述一次性装载单元的射出。
26.根据权利要求25所述的手术紧固件施加设备,其中所述钉仓支撑段包括用于支撑包含多个紧固件的一次性单元的细长通道,所述细长通道包括开口以接纳射出器贯通其中。
27.一种手术紧固件施加设备,包括:
钉仓支撑段,其包括用于支撑包含多个紧固件的一次性装载单元的细长通道;
砧座支撑段,其具有纵向轴线并且包括远侧砧座部和近侧手柄部;
夹紧杆,其具有近侧部和远侧部,所述夹紧杆能够从未夹紧位置移动至夹紧位置以可释放地将砧座支撑段固定为与钉仓支撑段紧密接近,所述夹紧杆包括从其延伸出的射出器,所述射出器能够从第一位置移动至第二位置以抵靠被定位在钉仓支撑段内的一次性装载单元施加力从而辅助所述一次性装载单元的射出;以及
发射组件,其包括发射旋钮,所述发射旋钮能够从第一近侧位置移动至第二远侧位置以发射被支撑在一次性装载单元内的紧固件。
28.根据权利要求27所述的手术紧固件施加设备,其中所述夹紧杆朝向所述未夹紧位置的枢转使所述射出器移动。
29.根据权利要求27和权利要求28中的任何一项权利要求所述的手术紧固件施加设备,其中所述发射组件包括被可操作地连接至所述发射旋钮的一对凸轮杆,所述发射旋钮和所述凸轮杆是一次性的。
30.根据权利要求27至权利要求29中的任何一项权利要求所述的手术紧固件施加设备,其中所述钉仓支撑段、砧座支撑段以及夹紧杆是能够消毒的且能够重复使用的。
31.根据权利要求27至权利要求30中的任何一项权利要求所述的手术紧固件施加设备,进一步包括弹簧,所述弹簧将所述夹紧杆偏置至所述未夹紧位置。
32.根据权利要求27至权利要求31中的任何一项权利要求所述的手术紧固件施加设备,其中所述砧座支撑段包括:具有多个凹穴的砧座,所述凹穴面向钉仓支撑段;以及形成在与砧座凹穴相对的表面内并且沿其纵向延伸的细长狭槽。
33.根据权利要求32所述的手术紧固件施加设备,其中所述细长狭槽具有第一部分,所述第一部分具有比第二部分大的横向尺寸,所述第二部分更接近所述钉仓支撑段。
34.根据权利要求27至权利要求33中的任何一项权利要求所述的手术紧固件施加设备,其中所述细长通道包括狭槽以接纳射出器贯通其中。
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EP (1) | EP2804541B1 (zh) |
JP (1) | JP2015506753A (zh) |
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- 2013-01-09 CN CN201380006087.7A patent/CN104066388B/zh active Active
- 2013-01-09 EP EP13701520.2A patent/EP2804541B1/en not_active Not-in-force
- 2013-01-09 JP JP2014553323A patent/JP2015506753A/ja active Pending
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CN111885969A (zh) * | 2018-02-06 | 2020-11-03 | 爱惜康有限责任公司 | 用于线性外科缝合器的释放机构 |
CN111902091A (zh) * | 2018-02-06 | 2020-11-06 | 爱惜康有限责任公司 | 线性外科缝合器的近侧部分的可释放联接特征部 |
CN111885969B (zh) * | 2018-02-06 | 2024-05-24 | 爱惜康有限责任公司 | 用于线性外科缝合器的释放机构 |
CN111902091B (zh) * | 2018-02-06 | 2024-05-24 | 爱惜康有限责任公司 | 线性外科缝合器的近侧部分的可释放联接特征部 |
CN112584777A (zh) * | 2018-08-13 | 2021-03-30 | 爱惜康有限责任公司 | 用于线性外科缝合器的夹持组件 |
CN112584777B (zh) * | 2018-08-13 | 2024-05-28 | 爱惜康有限责任公司 | 用于线性外科缝合器的夹持组件 |
CN112822986A (zh) * | 2018-10-11 | 2021-05-18 | 爱惜康有限责任公司 | 用于线性外科缝合器的砧座组件 |
Also Published As
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CA2861710A1 (en) | 2013-07-25 |
CN104066388B (zh) | 2017-05-31 |
WO2013109445A3 (en) | 2013-09-19 |
US9693775B2 (en) | 2017-07-04 |
EP2804541B1 (en) | 2017-10-04 |
US20140353357A1 (en) | 2014-12-04 |
WO2013109445A2 (en) | 2013-07-25 |
EP2804541A2 (en) | 2014-11-26 |
AU2013210064A1 (en) | 2014-07-03 |
JP2015506753A (ja) | 2015-03-05 |
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