CN104220012A - 具有用于在不存在安装的钉仓的情况下阻止致动的闭锁系统的外科缝合装置 - Google Patents

具有用于在不存在安装的钉仓的情况下阻止致动的闭锁系统的外科缝合装置 Download PDF

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CN104220012A
CN104220012A CN201380016937.1A CN201380016937A CN104220012A CN 104220012 A CN104220012 A CN 104220012A CN 201380016937 A CN201380016937 A CN 201380016937A CN 104220012 A CN104220012 A CN 104220012A
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anvil block
elongated passageway
mounting portion
surgery
nail bin
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CN104220012B (zh
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R·L·莱姆巴赫
M·E·塞瑟
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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
    • A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
    • A61B17/105—Wound clamp magazines
    • 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
    • A61B17/07207—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 the staples being applied sequentially
    • 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
    • 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
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003—Steerable
    • A61B2017/00305—Constructional details of the flexible means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003—Steerable
    • A61B2017/00318—Steering mechanisms
    • A61B2017/00323—Cables or rods
    • A61B2017/00327—Cables or rods with actuating members moving in opposite directions
    • 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
    • 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
    • A61B2017/07257—Stapler heads characterised by its anvil
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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    • A61B2017/07214—Stapler heads
    • A61B2017/07271—Stapler heads characterised by its cartridge
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
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    • A61B17/2909—Handles
    • A61B2017/2912—Handles transmission of forces to actuating rod or piston
    • A61B2017/2923—Toothed members, e.g. rack and pinion
    • 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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    • 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
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    • A61B2017/2933—Transmission of forces to jaw members camming or guiding means
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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    • A61B2090/033—Abutting means, stops, e.g. abutting on tissue or skin
    • A61B2090/034—Abutting means, stops, e.g. abutting on tissue or skin abutting on parts of the device itself
    • A61B2090/035—Abutting means, stops, e.g. abutting on tissue or skin abutting on parts of the device itself preventing further rotation

Abstract

本发明公开了一种具有外科缝合钉仓的外科缝合器械。至少一个实施例包括端部执行器，所述端部执行器具有细长通道和砧座，所述细长通道能够在其中可操作地支撑外科钉仓，所述砧座响应于对其施加的打开动作和闭合动作而在一打开位置和多个闭合位置之间可动地支撑在所述细长通道上。砧座锁定构件(260,400)与所述砧座配合以当钉仓还未安装在所述细长通道中时将所述砧座保持在打开位置并阻止所述砧座运动到一闭合位置，直至所述钉仓已被安置在所述细长通道内。当所述仓已安装到所述端部执行器中时，外科钉仓能够使所述砧座从打开位置运动到可致动位置。

Description

具有用于在不存在安装的钉仓的情况下阻止致动的闭锁系统的外科缝合装置
背景技术
本发明涉及一种外科器械，并且在各种实施例中，本发明涉及被设计成用于切割和缝合组织的外科切割和缝合器械及其钉仓。
发明内容
根据至少一种一般形式，提供了一种外科缝合器械，所述外科缝合器械包括端部执行器，所述端部执行器具有能够在其中可操作地支撑外科钉仓的细长通道。砧座响应于对其施加的打开动作和闭合动作而在一打开位置和多个闭合位置之间可动地支撑在细长通道上。砧座锁定构件与砧座配合以当钉仓还未安装在细长通道中时将砧座保持在打开位置中并且阻止砧座运动到一闭合位置，直至钉仓已被安置在细长通道内。
根据至少一种其他一般形式，提供了一种外科缝合器械，所述外科缝合器械包括柄部和可操作地联接到柄部的细长轴组件。闭合系统由柄部可操作地支撑，以响应由柄部可操作地支撑的闭合触发器的致动而产生闭合动作和打开动作。所述器械还包括联接到细长轴组件的细长通道。所述器械还包括具有砧座安装部分的砧座，所述砧座安装部分响应于通过细长轴组件传递到其的打开动作和闭合动作而在一打开位置和多个闭合位置之间可动地支撑在细长通道上。砧座锁定构件由细长轴组件可操作地支撑，以与砧座安装部分可动地接合。外科钉仓能够被安置在细长通道内并且与砧座安装部分配合以使得当外科钉仓还未被安置在细长通道内时，砧座锁定构件与砧座安装部分配合以将砧座保持在打开位置中。此外，当外科钉仓被安置在细长通道内时，钉仓使砧座安装部分运动到其中在对砧座施加闭合动作时使砧座闭合的位置。
根据另一种一般形式，提供了与外科缝合器械结合使用的外科钉仓，所述外科缝合器械包括具有砧座的端部执行器，所述砧座支撑在打开位置中直至运动到可致动位置，其中砧座能够响应于闭合系统对其施加的闭合动作而运动到多个闭合位置。在至少一种形式中，外科钉仓包括仓体，所述仓体的尺寸设定成可移除地被安置在端部执行器的一部分内，使得当仓体被安置在端部执行器内时仓体的一部分接触砧座以使砧座从打开位置运动到可致动位置。
附图说明
通过结合附图来参考本发明实施例的以下说明，本发明的特征和优点以及其获取方法将会变得更加明显，并可更好地理解发明本身，其中：
图1为外科缝合器械实施例的透视图；
图2为图1的外科缝合器械的分解组装图；
图3为关节运动组件实施例的一部分的分解组装图；
图4为柄部的一部分的局部分解透视图；
图5为移除柄部壳体的柄部的侧视图；
图6为端部执行器和砧座锁定实施例的局部分解透视图；
图6A为另一个端部执行器和砧座锁定构件实施例的局部分解透视图；
图7为砧座锁定构件实施例的透视图；
图7A为图6A的砧座锁定构件实施例的透视图；
图8为处于打开位置的端部执行器实施例的侧正视图；
图9为图8的端部执行器的顶视图；
图10为图8和图9所示的端部执行器的底视图；
图11为砧座实施例的局部底部透视图；
图12枢转座实施例的透视图；
图13为图12的枢转座实施例的底部透视图；
图14为外科钉仓实施例的近端部分的透视图；
图15为图14中所示的外科钉仓实施例的侧正视图；
图16为将钉仓被安置在细长通道中之前的端部执行器实施例的侧视图；
图17为图16所示的端部执行器的剖视图；
图18为具有处于打开位置的砧座的图16和图17的端部执行器实施例的侧视图，其中外科钉仓正被插入到细长通道中；
图19为图18的端部执行器的剖视图；
图20为具有被安置在细长通道内的钉仓实施例的图16-19的端部执行器的侧视图；
图21为图20的端部执行器的剖视图；
图22为夹持组织的图16-22的端部执行器的侧正视图；
图23为图22的端部执行器的剖视图；
图24为处于预备击发的完全夹紧位置的图16-23的端部执行器的侧正视图；
图25为图24的端部执行器的剖视图；
图26为另一个外科缝合器械实施例的分解组装图；
图27为另一个枢转座实施例的透视图；
图28为图27的枢转座实施例的底部透视图；
图29为端部执行器和另一个砧座锁定构件实施例的局部分解透视图；
图30为另一个砧座锁定构件实施例的透视图；
图31为另一个外科钉仓实施例的近端部分的局部侧正视图；
图32为图31的外科钉仓实施例的近端部分的透视图；
图33为将钉仓安置在细长通道中之前的另一个端部执行器的侧视图；
图34为图33的端部执行器的剖视图；
图35为具有处于打开位置的砧座的图33和图34的端部执行器实施例的侧视图，其中外科钉仓正被插入到细长通道中；
图36为图35的端部执行器的剖视图；
图37为具有被安置在细长通道内的钉仓实施例的图33-36的端部执行器的侧视图；
图38为图37的端部执行器的剖视图；
图39为夹持组织的图33-38的端部执行器的侧正视图；
图40为图39的端部执行器的剖视图；
图41为处于预备击发的完全夹紧位置的图33-40的端部执行器的侧正视图；并且
图42为图41的端部执行器的剖视图。
具体实施方式
现在将描述某些示例性实施例，以从整体上理解本文所公开的装置和方法的结构、功能、制造和用途。这些实施例的一个或多个实例在附图中示出。本领域的普通技术人员将会理解，本文具体描述和在附图中示出的装置和方法为非限制性的示例性实施例，并且本发明各种实施例的范围仅由权利要求书限定。结合一个示例性实施例进行图解说明或描述的特征，可与其它实施例的特征进行组合。这种修改形式和变化形式旨在被包括在本发明的范围之内。
本说明书通篇引用的“各种实施例”、“一些实施例”、“一个实施例”或“实施例”等，是指结合所述实施例描述的具体特征、结构或特性被包括在至少一个实施例中。因此，本说明书通篇出现的短语“在各种实施例中”、“在一些实施例中”、“在一个实施例中”或“在实施例中”等并不一定都指相同的实施例。此外，在一个或多个实施例中，具体特征、结构或特性可按任何合适的方式组合。因此，在无限制的情况下，结合一个实施例示出或描述的具体特征、结构或特性可全部或部分地与一个或多个其它实施例的特征、结构或特性结合。这种修改形式和变化形式旨在被包括在本发明的范围之内。
本文所用术语“近侧”和“远侧”是参照操纵外科器械的柄部部分的临床医生而言的。术语“近侧”是指最靠近临床医生的部分，术语“远侧”是指远离临床医生的部分。还应当理解，为简洁和清楚起见，本文可相对于附图使用诸如“竖直”、“水平”、“上”和“下”之类的空间术语。然而，外科器械在许多取向和位置中使用，并且这些术语并非限制性的和/或绝对的。
提供了各种示例性装置和方法以执行腹腔镜式和微创外科手术操作。然而，本领域的普通技术人员将容易理解，本文所公开的各种方法和装置可用于许多外科手术和应用(例如，包括与开放式外科手术相结合)中。继续参阅本具体实施方式，本领域的那些普通技术人员将进一步理解，本文所公开的各种器械可以任何方式插入身体中，诸如通过自然孔、通过形成于组织中的切口或穿刺孔等。器械的工作部分或端部执行器部分可直接插入患者身体中或可通过具有工作通道的进入装置而插入，外科器械的端部执行器和细长轴能够通过所述工作通道而推进。
转到附图，其中在全部若干附图中，类似的数字代表类似的部件，图1和图2示出了能够实施本文所公开的各种实施例的独特益处的外科缝合装置10。具有使本发明的实施例可被有效采用的特征的示例性外科装置在1998年6月6日公布的名称为“Articulation Assembly For Surgical Instruments”的美国专利5,704,534中有所公开，该专利的整个公开内容以引用方式并入本文。各种其他示例性外科缝合装置实施例更详细地描述于以下美国专利中，这些专利均全文以引用方式并入本文：2005年11月15日公布的名称为“Surgical Stapling Instrument Having Articulation Joint Support Plates ForSupporting a Firing Bar”的美国专利6,964,363；2006年2月21日公布的名称为“Surgical Stapling Instrument Having Separate Distinct Closing and FiringMotions”的美国专利7,000,818；2006年5月16日公布的名称为“SurgicalStapling Instrument Having A Single Lockout Mechanism For Prevention ofFiring”的美国专利7,044,352；2006年9月26日公布的名称为“SurgicalInstrument Incorporating An Articulation Mechanism Having Rotation About theLongitudinal Axis”的美国专利7,111,769；以及2006年12月5日公布的名称为“Surgical Stapling Instrument Having A Firing Lockout For an UnclosedAnvil”的美国专利7,143,923。
再次参见图1和图2，示出的外科缝合装置10包括可操作地连接到执行部分22的柄部20，所述执行部分22还包括可操作地联接到端部执行器200的细长轴组件30。柄部20包括手枪式握把24，由临床医生将闭合触发器152朝手枪式握把枢转地拉动，以使砧座220朝端部执行器200的细长通道210夹紧或闭合。击发触发器102在闭合触发器152的更外侧，并且被临床医生枢转地拉动，以使被夹持的组织在端部执行器200中被缝合和切断。
例如，首先致动闭合触发器152。一旦临床医生对于端部执行器200的定位感到满意，该临床医生即可将闭合触发器152拉回至紧邻手枪式握把24的完全闭合的锁定位置。接着，击发触发器102被致动。当临床医生移除压力时，击发触发器102以弹簧弹动形式返回。当被按压在柄部20的近端上时，释放按钮120释放锁定的闭合触发器152。
关节运动系统
示出的实施例包括关节运动组件62，所述关节运动组件62能够有利于端部执行器200围绕装置10的细长轴线A-A进行关节运动。然而，各种实施例也可结合非关节运动式外科缝合装置而被有效地采用。如在图2中可见，例如，细长轴组件30包括由支撑在柄部20上的喷嘴60可操作地支撑的近侧闭合管段151。柄部20可由可操作地包含击发系统100和闭合系统150的两个柄部壳体21、23形成。参见图1，近侧闭合管段151的近端部分153由柄部20可旋转地支撑，以有利于其围绕细长轴线A-A的选择性旋转。如另外在图1和图2中可见，在至少一个实施例中，近侧闭合管段151的远端部分157联接到柔性颈部组件70。柔性颈部组件70具有接纳第一细长柔性传动带组件83和第二细长柔性传动带组件85的第一柔性颈部部分72和第二柔性颈部部分74。第一传动带组件83和第二传动带组件85分别具有从带的结构部分朝远侧延伸的外部加强带部分86、87。每个外部加强带部分86、87具有用于固定第一内部关节运动带89和第二内部关节运动带90的多个附接耳状物88。参见图2。传动带组件83、85可例如由塑料(尤其是以商品名Grivory GV-6H购自EMS-American Grilon公司的玻璃纤维增强型无定形聚酰胺)构成。相比之下，可能期望传动带组件83、85的内部关节运动带89、90由金属构成，所述金属优选的为全硬301不锈钢或其等同物。传动带83、85的外部加强带部分86、87上的附接耳状物88被接纳在并被固定在多个耳状物孔91内，所述耳状物孔在对应的内部关节运动带89、90上。在第一内部关节运动带组件89和第二内部关节运动带组件90的远端处，存在第一连接器92和第二连接器93。关节运动组件还包括能够分别以钩的形式与第一连接器92和第二连接器93的远侧关节运动带96和97接合。关节运动带96和97具有插孔98、99以将带96、97联接到端部执行器200，如将在下文进一步详细讨论。
在至少一种形式中，柔性颈部组件70优选地由以ISOPLAST等级2510购自Dow Chemical公司的刚性热塑性聚氨酯构成。如在图3中可见，柔性颈部组件70具有第一柔性颈部部分72和第二柔性颈部部分74。这些颈部部分72、74由中央纵向肋73隔开。参见图6。颈部部分72、74各自具有基本上被配置为半圆形盘的多个颈部肋75。柔性颈部部分72、74通常一起形成圆柱形构造。侧狭槽76延伸穿过颈部肋75，以提供穿过第一柔性颈部部分72和第二柔性颈部部分74的通道，所述通道用于接收柔性带组件83、85的内部关节运动带89、90和外部加强带部分86、87。按照类似的方式，隔开第一柔性颈部部分72和第二柔性颈部部分74的中央纵向肋73具有中央纵向狭槽，以提供接纳缝合器致动构件的通道。第一支撑引导件表面77和第二支撑引导件表面78从第一柔性颈部部分72和第二柔性颈部部分74朝近侧延伸，以支撑柔性传动带组件83、85的内部关节运动带89、90和外部加强部分86、87的往复运动。导槽79从柔性颈部部件72、74的远端延伸，以引导使缝合器致动构件进入端部执行器200的钉仓300内的运动，如将在下文进一步所讨论的。
在至少一个形式中，当使第一传动带组件83和第二传动带组件85在器械10的组装期间彼此接触时，它们形成细长的圆柱体，所述圆柱体具有穿过其的纵向腔体，所述纵向腔体同心地定位于带组件83、85之间，以使击发连杆110通过。第一带和第二带的近端具有第一齿轮齿条94和第二齿轮齿条95，所述第一齿轮齿条94和第二齿轮齿条95与关节运动组件62啮合地接合，如将在下文所讨论的。
当关节运动组件62旋转时，第一柔性传动带组件和第二柔性传动带组件中的一个向前运动，而另一个带组件向后运动。响应于带组件83、85在柔性颈部组件70的第一柔性颈部部分72和第二柔性颈部部分74内的往复运动，柔性颈部组件70弯曲以提供关节运动。如在图5中可见，关节运动组件62包括致动器63、关节运动主体64和喷嘴60。致动器63的旋转运动引起关节运动主体64在喷嘴60内的相应旋转。第一细长传动带组件83和第二细长传动带组件85因此在平行于缝合装置10的内窥镜式轴30的纵向轴线A-A的相反方向上轴向地往复运动，以使得通过柔性颈部组件70来引发端部执行器200的远程关节运动。关节运动主体64还包括其上的传动齿轮65。如在图4中可见，传动齿轮65具有穿过其的扩张开口66和下枢轴67。在传动齿轮65的扩张开口66内，存在用于接收击发连杆110的击发连杆孔68，所述击发连杆110能够响应击发触发器102的枢转旋转来将缝钉击发到夹紧的组织内。传动齿轮65被支撑用于与柔性细长传动带组件83、85上的第一驱动齿条94和第二驱动齿条95啮合地接合，以实现带组件83、85的所需往复运动。
如在图5中可见，关节运动组件62的喷嘴60具有喷嘴主体61。喷嘴主体61具有延伸穿过其的轴向镗孔69，以接收关节运动主体64的传动齿轮65。镗孔69提供了从框架到细长的内窥镜式轴30内的轴向连续开口，并且因此击发连杆110和缝合装置10的其他操作部件可与端部执行器200连通。有关关节运动组件62的其他细节可见于美国专利5,704,534中，该专利先前已以引用方式并入本文。
闭合系统
如将在下文进一步详细讨论的，端部执行器200包括能够可操作地接收外科钉仓300的细长通道210。砧座220相对于细长通道210可动地支撑着，并且可从打开位置(图16和17)运动到其中可切割和缝合组织的多个闭合位置(图24和25)。砧座220在多个打开位置和多个闭合位置之间的运动至少部分地由通常标定为150的闭合系统控制，所述闭合系统如上文所指出的那样由闭合触发器152控制。闭合系统150包括近侧闭合管段151，所述近侧闭合管段151按照上文所述的方式可操作地容纳关节运动带组件83、85并且非活动性地联接到柔性颈部组件70。
在各种形式中，近侧闭合管段151包括轴向延伸穿过喷嘴60中的膛孔69的近端部分153。近侧闭合管段151具有穿过其的细长轴向狭槽155，以允许关节运动主体64从中延伸穿过。参见图2。狭槽155允许关节运动主体64相对于近侧闭合管段151围绕关节运动轴线B-B旋转，同时有利于近侧闭合管段151相对于关节运动主体64沿轴线A-A的轴向运动。传动带83、85充当框架，近侧闭合管段151可在所述框架上轴向地运动。近侧闭合管段151的近端153可旋转地联接到闭合轭154，所述闭合轭154支撑在柄部20内，以在其中进行往复运动。参见图4和5。
闭合触发器152具有柄部部分156、齿轮段部分158和中间部分160。参见图5。镗孔延伸穿过中间部分160。从第二柄部外壳23延伸的圆柱形支撑构件162穿过镗孔以将闭合触发器152枢转地安装在柄部部分20上。闭合轭154的近端98具有由闭合触发器152的齿轮段部分158接合的齿轮齿条164。当闭合触发器152向柄部部分20的手枪式握把24运动时，闭合轭154以及近侧闭合管段151朝远侧运动，从而压缩弹簧166，所述弹簧166朝近侧偏置闭合轭152。
在至少一种形式中，闭合系统150还包括通过附接凸块72、74非活动地联接到挠曲颈部组件70的导槽部分79的远侧闭合管段170。参见图9和10。远侧闭合管段170其中具有适于与形成于砧座220上的直立的凸块224接合的开口176，如将在下文进一步详细讨论的。因此，近侧闭合管段151的轴向运动导致挠曲颈部组件70以及远侧闭合管段170的轴向运动。例如，近侧闭合管段151的远侧运动影响砧座220朝远侧以及朝端部执行器200的细长通道210的枢转平移运动，并且近侧运动影响砧座220的打开，如将在下文进一步详细讨论的。
击发系统
在至少一种形式中，外科器械10还包括通常标定为100的击发系统，所述击发系统用于响应击发触发器102的致动而对击发连杆110施加击发动作。在至少一种形式中，击发系统100还包括其上具有第一齿轮齿条105和第二齿轮齿条106的驱动构件104。第一凹口109设置在第一齿轮齿条105和第二齿轮齿条106中间的驱动构件105上。在击发触发器102的返回运动期间，在缝钉击发之后，击发触发器102上的齿112与第一凹口109接合以使驱动构件104返回到其初始位置。第二凹口114位于击发连杆110的近端，用于将击发连杆110在其未击发位置中锁定到释放按钮的120的上锁臂122上。击发系统150还包括第一一体的小齿轮111和第二一体的小齿轮113。第一一体的小齿轮111与设置在击发连杆110上的驱动齿条115接合。第二一体的小齿轮113与在驱动构件104上的第一齿轮齿条105接合。第一一体的小齿轮111具有第一直径，第二一体的小齿轮113具有小于第一直径的第二直径。
在各种实施例中，击发触发器102提供有齿轮段部分103。齿轮段部分103接合驱动构件104上的第二齿轮齿条106，以使得击发触发器102的动作引起驱动构件104在第一驱动位置和第二驱动位置之间来回运动。为了在组织夹紧发生之前阻止缝钉击发，释放按钮120上的上闩锁臂122与驱动齿条115上的第二凹口114接合，以使得击发连杆110锁定在最近侧的位置。当上闩锁臂122落入闭合轭中的凹陷部内时，上闩锁臂122与第二凹口114脱离，以允许击发连杆110的远侧运动。因为驱动构件104上的第一齿轮齿条105与击发连杆110上的驱动齿条115接合，击发触发器102的运动使击发连杆110在第一往复位置和第二往复位置之间往复运动。可参考美国专利7,000,818来获取有关击发系统150的各个方面的其他细节，该专利全文以引用方式并入本文。
如在图3中可见，在各种实施例中，击发连杆110的远端117旋转地接纳在击发连杆安装轭118内。击发连杆安装轭118具有狭槽119，用于以钩的形式接纳形成于刀杆130的近端上的钩132。此外，如图3所示，支撑杆140被支撑，以在挠曲颈部组件70的第一支撑引导件表面77和第二支撑引导件表面78之间的轴向运动。支撑杆140具有狭槽142，所述狭槽142被配置成允许刀杆130从中滑动地穿过。金属刀杆130具有形成于其远端上的组织切割刀刃134，并且能够与支撑在外科钉仓300内的楔形滑动件可操作地接合。
端部执行器
如上所述，在至少一种形式中，端部执行器200包括细长通道210，所述细长通道210能够在其中可操作地支撑外科钉仓300。如图2和6所示，细长通道210具有近端部分，所述近端部分包括两个隔开的安装凸块212，所隔开的安装凸块212能够与关节运动带96、97的远端上的钩998、99接合。因此，关节运动带96、97的往复运动使得细长通道210相对于挠曲颈部组件70进行关节运动。如上文进一步所指出，端部执行器200还包括砧座220。在至少一种形式中，砧座220由例如416不锈钢硬化和回火的RC35Min(或类似的材料)制成并在其上具有缝钉成形的下表面222，所述缝钉成形的下表面222能够与安装在细长通道210中的钉仓300正对接合。砧座220形成有朝近侧延伸的安装部分223，所述安装部分223包括两个耳轴壁226、228，所述耳轴壁226、228各自具有从其突出的耳轴30。参见图11。此外，朝下突出的枢转凸块234形成在安装部分223的下侧232，所述枢转凸块234具有贯穿延伸的狭槽236，所述狭槽236能够当在切割和缝合期间穿过端部执行器200轴向地推进刀杆130时接收并且支撑刀杆。此外，砧座开口凸块224形成于安装部分223上，使得其能够与远侧闭合管段170中的开口176可操作地接合，如将在下文进一步所讨论的。如在图16-25中可见，砧座耳轴230能够可动地接收在对应的耳轴狭槽214中，所述耳轴狭槽214形成于细长通道210的近端中。每个耳轴狭槽214具有与锁定凹口218连通的弓形段216。
为了有利于砧座安装部分223相对于细长通道210的枢转行进，各种实施例均包括枢转座240。如在图12和13中可见，枢转座240的一种形式具有能够附接到细长通道210的主体部分242。例如，主体部分242可形成有两个相对的附接凸块243，所述附接凸块243能够保持接合形成于细长通道210中的凸块开口211(图6)。此外，枢转座240具有朝近侧延伸的底脚部分244，所述底脚部分244具有从其突起的保持凸耳245，所述保持凸耳245接纳在细长通道210中的对应开口211内。参见图17。枢转座240可由例如Vectra A435液晶聚合物-天然或类似的材料制成。如在图12和13中进一步可见，主体部分242具有直立的中心部分246，所述直立的中心部分246具有在其中贯穿延伸以接纳刀杆130的狭槽247。当刀杆130被驱动穿过夹持在端部执行器200内的组织时，中心部分246为刀杆提供侧向支撑。枢转座240的各种实施例还包括形成于中心部分246的每一侧的摇臂表面248，以在其上枢转地接收砧座220的耳轴壁226、228。
砧座闭锁系统
各种实施例包括独特的和新型的砧座闭锁系统250，所述砧座闭锁系统在钉仓300仍未正确地安装在细长通道210中时阻止砧座220的闭合。参见图6和7，例如，砧座闭锁系统250的实施例包括可动的砧座锁定构件260，所述砧座锁定构件260可响应钉仓300的部分的接触而运动，如下文进一步详细讨论的。在至少一种形式中，砧座锁定构件260包括主体部分262，所述主体部分262具有形成于其上的朝远侧突起的中央支撑凸块264。狭槽266延伸穿过主体部分262和中央支撑凸块264，以允许刀杆130从中穿过。主体部分262还包括朝近侧延伸的安装杆268，所述安装杆268能够滑动地接收在挠曲颈部组件70的导槽79中的对应安装开口270内。此外，例如卷簧269形式的偏置构件支撑在开口270内，以沿远侧方向“DD”偏置砧座锁定构件260。参见图16。当将砧座220安装到细长通道210时，耳轴230被接收在细长通道210中的对应耳轴狭槽214内，砧座锁定构件260的中央支撑凸块264被接收在耳轴壁226、228之间，以进一步支撑砧座220。砧座锁定构件260的主体部分262还形成有两个凸轮表面263，所述凸轮表面263能够接合耳轴壁226、228的近端表面227、229。参见图6和7。砧座锁定构件的各种实施例可由例如Vectra A435液晶聚合物-天然或类似材料制成。
图6A和7A示出了可供选择的砧座锁定构件260’，所述砧座锁定构件260’可响应钉仓300的部分的接触而运动。在至少一种形式中，砧座锁定构件260’包括主体部分262，所述主体部分262具有形成于其上的朝远侧突起的中央支撑凸块264。狭槽266延伸穿过主体部分262和中央支撑凸块264，以允许刀杆130从中穿过。主体部分262还包括朝近侧延伸的安装杆268’，所述安装杆268’能够滑动性地并且保持性地被接收在挠曲颈部组件70’的导槽79’中的对应安装开口270’内。此外，呈例如卷簧269形式的偏置构件支撑在开口270’内以在远侧方向“DD”上偏置砧座锁定构件260’。砧座锁定构件260’另外以与砧座锁定构件260相同的方式操作。当将砧座220安装到细长通道210时，耳轴230被接收在细长通道210中的对应耳轴狭槽214内，砧座锁定构件260’的中央支撑凸块264被接收在耳轴壁226、228之间，以进一步支撑砧座220。砧座锁定构件260的主体部分262还形成有两个凸轮表面263，所述凸轮表面263能够接合耳轴壁226、228的近端表面227、229。远侧闭合管段170’以与上述远侧闭合管段170相同的方式操作。
外科钉仓
各种实施例均包括独特的和新型的外科钉仓300，所述外科钉仓300能够在安装在细长通道210中时与砧座闭锁系统250相互作用。如在图14和15中可见，在至少一种形式中，外科钉仓300包括仓体302，所述仓体302可例如由Vectra A435，20％PTFE/15％GF-天然制成。仓体302的尺寸和形状设定成可被接收在细长通道210内。在至少一种形式中，仓体302能够被安置在细长通道210中，以使得仓体可移除地保持在其中。仓体302在其中可形成有居中设置的狭槽304，以接收刀杆130。在狭槽304的每一侧，提供了缝钉开口312的行306、308、310，所述缝钉开口312列能够支撑其中的外科缝钉。在示出的实施例中，在狭槽304的每一侧上设置三行306、308、310。外科缝钉可支撑在缝钉驱动器上，所述缝钉驱动器可动地支撑在缝钉开口312内。楔形滑动件也支撑在钉仓主体302内，所述楔形滑动件能够在被切割杆接触时穿过仓体302轴向运动。楔形滑动件被配置为具有楔形驱动构件，所述楔形驱动构件在穿过仓体302朝远侧驱动楔形滑动件时，接触缝钉驱动器并且将驱动器及其对应的缝钉驱动到闭合砧座。可采用的缝钉驱动器装置和楔形滑动件装置的实例更详细地描述于美国专利7,669,746中，该专利的公开内容全文以引用方式并入本文。在各种实施例中，为了有利于在仓体302中安装楔形滑动件和驱动器，可将金属仓盘314、316附接到仓体302，如图14和15所示。仓盘314和316用于将楔形滑动件和驱动器保持在仓体302内。
在各种实施例中，仓体302另外具有形成于其上的沿近侧方向突起的至少一个释放构件。在图14所示的实施例中，两个释放构件320形成于仓300的近端319上。释放构件320各自具有限定倾斜枢转表面321的楔形形状，所述倾斜枢转表面能够在其上枢转地支撑砧座安装部分223的一部分。
钉仓的安装
参照图16-25从中获取对砧座闭锁系统的操作的理解。图16和17示出了在安装钉仓300之前砧座220相对于细长通道210的位置。当处于此“未加载”和打开位置时，砧座锁定构件260通过弹簧269朝远侧方向进行偏置，以使得砧座锁定构件260上的凸轮表面263接触耳轴壁226、228的端面227、229。砧座锁定构件260在远侧方向“DD”上推动砧座安装部分223，使得耳轴230被安置在其相应的锁定凹口218中。砧座锁定构件260上的凸轮表面263与端壁表面227、229也协同地用于将砧座枢转并且保持在打开位置，如图16和17所示。如在图16中可见，当处于此位置时，耳轴壁226、228支撑在枢转座240上的摇臂表面248上。当处于此位置时，外科医生不能通过致动闭合触发器152推进远侧闭合管170来闭合砧座220。由于闭合管段不能朝远侧推进以闭合砧座220，因此闭合触发器152不能致动到其完全闭合位置，由此可致动击发触发器102。因此，当不存在仓300时，端部执行器200不可进行致动。
图18和19示出了将钉仓300初始插入到细长通道210中。图20和21示出了钉仓300已完全被安置在细长通道210中之后的端部执行器200。如在图20中可见，例如，当仓300已完全被安置之后，仓300上的释放构件320接合耳轴壁226、228并且用于在近侧方向“PD”上来移动砧座安装部分223，使得耳轴壁226、228此时枢转地置于释放构件320上。如在图21中可见，当处于此位置时，砧座安装部分223已朝近侧运动，使得耳轴230移出其相应的锁定凹口218并且进入弓形狭槽段216的底部以形成“可致动”位置，由此可通过致动闭合触发器152来将砧座220枢转闭合。
当装置10处于起始位置并且钉仓300已如上所述加载到细长通道中时，触发器152、102中的两者均为向前的并且砧座220已运动到可致动位置，例如，典型情况是在加载的端部执行器200通过套管针或其他开口插入到体腔内之后。然后临床医生操作器械10使得待缝合和切断的组织“T”定位在钉仓300和砧座200之间，如图22和23所示。如上所述，闭合触发器152朝手枪式握把24的运动导致近侧闭合管段151、挠曲颈部组件70、和远侧闭合管段170朝远侧运动。当远侧闭合管段170朝远侧运动时，其接触砧座220上的闭合凸缘221。来自捕获在砧座220和钉仓300之间的组织的压力用于移动砧座220，使得耳轴230被定位成在弓形耳轴狭槽段216内运动。外科医生可相对于钉仓300枢转砧座220，以在端部执行器200中操纵和捕获所需组织“T”。当远侧闭合管段170接触闭合凸缘221时，砧座220朝夹紧位置枢转。收缩的刀杆130不阻碍砧座220的选择性打开和闭合。
一旦所需组织“T”已定位在砧座220和仓300之间，临床医生就朝近侧移动闭合触发器152直到直接定位成与手枪式握把24相邻，由此将柄部20锁定在闭合位置和夹紧位置中。如在图25中可见，当处于完全夹紧位置时，砧座耳轴230位于弓形狭槽部分216的上端，并且砧座凸块224被接收在远侧闭合管段170中的开口176内。在组织被夹紧后，临床医生朝近侧移动击发触发器102，从而使刀杆130朝远侧运动到端部执行器200中。具体地，刀杆130运动穿过砧座220的枢转凸块部分234中的狭槽236并且进入仓体302中的狭槽304中，以接触可操作地定位于钉仓300内的楔形滑动件。当朝远侧驱动刀杆130时，其切割组织T并且朝远侧驱动楔形滑动件，由此使缝钉被连续地击发成与砧座220的缝钉成形的下表面222成形接触。临床医生继续移动击发触发器102直至其邻近闭合触发器152和手枪式握把24。从而，缝钉的所有末端因与砧座220接合而弯曲。切刃132已完全横贯组织T。通过释放击发触发器102并且然后通过按压释放按钮120同时挤压闭合触发器152来完成此过程。此类动作导致远侧闭合管段170在近侧方向“D”上运动。当砧座凸块224接合远侧闭合管段170中的开口176时，其导致砧座枢转地打开。端面227、229再次接触砧座锁定构件260上的推杆表面263，以将砧座枢转成如图20和21所示的打开位置，以允许从细长通道210移出空仓300。
图26-42示出了另选的外科缝合器械10’，其与外科缝合器械10具有类似的构造和操作，不同之处在于下文讨论的差异。此实施例例如采用如图29和30所示的枢转座240’。如在图27和28中可见，枢转座240’的一种形式具有能够附接到细长通道210的主体部分242’。例如，主体部分242’可形成有两个相对的附接凸块243，所述附接凸块243能够保持接合形成于细长通道210中的凸块开口211(图26)。此外，枢转座240’具有朝近侧延伸的底脚部分244’，所述底脚部分244’具有贯穿延伸以轴向地接收刀杆130的狭槽247’。枢转座240’的各种实施例还包括形成于主体部分242’上的摇臂表面248’，以在其上接收砧座220的耳轴壁226、228。
此实施例还包括砧座闭锁系统250’，所述砧座闭锁系统250’在钉仓300仍未正确地安装在细长通道210中时阻止砧座220的闭合。参见图29和30，例如，砧座闭锁系统250’的实施例包括砧座锁定构件400，所述砧座锁定构件400能够接触砧座安装部分223，如将在下文进一步详细讨论的。在至少一种形式中，砧座锁定构件400包括片簧402，所述片簧402在其中具有狭槽404以容纳刀杆130。片簧402能够附接到挠曲颈部组件70”的导槽79”。
如在图31和32中可见，在至少一种形式中，外科钉仓300’包括仓体302’，所述仓体302’类似于上述外科钉仓300，不同之处在于下文讨论的差异。图29示出了按照上述方式支撑在仓体302’内的楔形滑动件360。在此实施例中，仓体302’的近端部分303能够接触砧座安装部分223的一部分，并且在仓体302’被安置在细长通道210内时朝近侧推动砧座220。
可参照图33-43从中获取对砧座闭锁系统250’的操作的理解。图33和34示出了在安装钉仓300’之前砧座220相对于细长通道210的位置。当处于该“未加载”位置时，砧座锁定构件400已接合砧座支撑部分223的上表面，使得砧座220在枢转座140’上的摇臂表面248’上枢转到打开位置。当处于该位置时，耳轴230被安置在其相应的锁定凹口218中。当处于该位置时，外科医生不能通过致动闭合触发器152从而推进远侧闭合管170’来闭合砧座220。由于闭合管段不能朝远侧推进以闭合砧座220，因此闭合触发器152不能致动到其完全闭合位置，由此可致动击发触发器102。因此，当不存在仓300’时，端部执行器200不可进行致动。
图35和36示出了将钉仓300’初始插入到细长通道210内。图37和38示出了钉仓300’已完全被安置在细长通道210中之后的端部执行器200。如在图37中可见，例如，当仓300’已完全被安置时，仓300’上的近端部分303接合耳轴壁226、228并用于使砧座安装部分223在近侧方向“PD”上运动，使得耳轴移出其相应的锁定凹口218并且进入弓形狭槽段216的底部的可致动位置内。砧座220现处于将通过致动闭合触发器152而被枢转闭合的位置。
当装置10’处于起始位置并且钉仓300’已如上所述加载到细长通道210中时，触发器152、102中的两者均为向前的并且砧座220已打开并处于可致动位置，诸如，典型情况是在加载的端部执行器200通过套管针或其他开口插入到体腔内之后。然后临床医生操作器械10’使得待缝合和切断的组织“T”定位在钉仓300’和砧座220之间，如图39和40所示。如上所述，闭合触发器152朝手枪式握把24的运动使近侧闭合管段151、挠曲颈部组件70”和远侧闭合管段170”朝远侧运动。当远侧闭合管段170’朝远侧运动时，其接触砧座220上的闭合凸缘221。来自捕获在砧座220和钉仓300’之间的组织的压力用于移动砧座220，使得耳轴230被定位成在弓形耳轴狭槽段216内运动。外科医生可相对于钉仓枢转砧座220，由此在端部执行器200中操纵和捕获所需组织“T”。当远侧闭合管段170”接触闭合凸缘221时，砧座220朝夹紧位置枢转。收缩的刀杆130不阻碍砧座220的选择性打开和闭合。
一旦所需组织“T”已定位在砧座220和仓300’之间，临床医生就朝近侧移动闭合触发器152直到直接定位成与手枪式握把24相邻，由此将柄部20锁定在闭合位置和夹紧位置中。如在图42中可见，当处于完全夹紧位置时，砧座耳轴230位于弓形狭槽部分216的上端中，并且砧座凸块224被接收在远侧闭合管段170”中的开口176内。在组织被夹紧后，临床医生朝近侧移动击发触发器102使刀杆130朝远侧运动到端部执行器200中。具体地，刀杆130运动穿过砧座220的枢转凸块部分234中的狭槽236并且进入仓体302’中的狭槽304内，以接触可操作地定位在其中的楔形滑动件360。当朝远侧驱动刀杆130时，其切割组织T并且朝远侧驱动楔形滑动件360，由此使得缝钉被连续地击发成与砧座220的缝钉成形的下表面222成形接触。临床医生继续移动击发触发器102直至使其邻近闭合触发器152和手枪式握把24。从而，缝钉的所有末端因与砧座220接合而弯曲。切刃132已完全横贯组织T。通过释放击发触发器102并且然后通过按压释放按钮120同时挤压闭合触发器152来完成此过程。此动作导致远侧闭合管段170”在近侧方向“D”上运动。当砧座凸块224接合远侧闭合管段170”中的开口176时，其使砧座220枢转地打开。砧座锁定构件400对砧座安装部分223的耳轴壁的上表面施加偏置力并用于将砧座枢转到如图33和34所示的打开位置，以允许从细长通道210移出空仓300’。
当外科钉仓不存在或者仍未正确地被安置在细长通道内时，上述实施例的各种独特和新型特征可用于阻止端部执行器闭合。当砧座处于其中砧座耳轴保持在其相应的锁定凹口内的锁定位置时，砧座保持在打开位置。当处于打开位置时，将端部执行器小心地插入通过套管针。由于完全闭合行程被阻止，因此击发系统不能被致动。因此，即使临床医生尝试致动击发触发器，该装置也不击发。各种实施例还为临床医生提供反馈，以指示仓不存在或者仍未被正确地安装在细长通道中。
可将本发明所公开的装置设计为单次使用后即进行处理，或者可将它们设计为可多次使用。然而，在任一种情况下，所述装置均可被修复，以在至少一次使用后再次使用。修复可包括如下步骤的任意组合：拆卸所述装置然后清洗或替换特定部件以及随后重新组装。具体地，所述装置可被拆卸，而且可以任意组合选择性地替换或取出所述装置的任意数目的特定部件或部分。清洗和/或替换特定部件之后，所述装置可以在修复设施处或者在即将进行外科手术前由手术团队重新组装以供随后使用。本领域的技术人员将了解到，装置的修复可利用多种用于拆卸、清洗/替换和重新组装的技术。此类技术的使用和所得修复装置全都在本申请的范围内。
优选的是，本文所述的本发明将在手术前得以处理。首先，获取新的或用过的器械，并在必要时对器械进行清洁。然后对器械进行消毒。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。然后将容器和器械置于能够穿透所述容器的辐射场内，例如γ辐射、x-射线或高能电子。辐射将器械上和容器中的细菌杀死。然后将消毒后的器械储存在无菌容器中。该密封容器将器械保持为无菌的，直到在医疗设施中打开该容器为止。
以引用方式全文或部分地并入本文的任何专利、专利公开或其它公开材料均仅在所并入的材料不与本发明所述的现有定义、陈述或其它公开材料相冲突的范围内并入本文。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。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，将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。
尽管已经将本发明作为示例性设计进行了描述，但还可以在本公开的实质和范围内对本发明进行另外的修改。因此本专利申请旨在涵盖采用本发明一般原理的任何变型、用途或改型。此外，本专利申请旨在涵盖本发明所属领域中出自已知或惯有实践范围内的背离本公开的型式。

Claims (20)

1.一种外科缝合器械，包括：
端部执行器，所述端部执行器包括：
细长通道，所述细长通道能够在其中可操作地支撑外科钉仓；和
砧座，所述砧座响应于对其所施加的打开动作和闭合动作而在一打开位置和多个闭合位置之间可动地支撑在所述细长通道上；以及
砧座锁定构件，所述砧座锁定构件与所述砧座配合以当钉仓还未被安装在所述细长通道中时将所述砧座保持在打开位置中并阻止所述砧座运动到一闭合位置，直至所述钉仓已被安置在所述细长通道内。
2.根据权利要求1所述的外科缝合器械，其中所述砧座包括被枢转地支撑在所述细长通道上的砧座安装部分，并且其中所述砧座锁定构件被偏置成与所述砧座安装部分接触。
3.根据权利要求2所述的外科缝合器械，其中所述砧座安装部分还包括一对相对的砧座耳轴，所述砧座耳轴可动地接收在所述细长通道中的对应的耳轴狭槽中。
4.根据权利要求3所述的外科缝合器械，其中每个砧座耳轴狭槽包括：
锁定凹口，所述锁定凹口用于当所述外科钉仓还未被安置在所述细长通道内时在所述锁定凹口中接收对应的砧座耳轴；和
弓形狭槽段，所述弓形狭槽段用于当所述仓已被安置在所述细长通道内时在所述弓形狭槽段中接收所述对应的砧座耳轴，使得在对所述砧座施加闭合动作时所述对应的砧座耳轴在所述弓形狭槽段内可动地移动。
5.根据权利要求4所述的外科缝合器械，其中当所述外科钉仓还未被安置在所述细长通道内时，所述砧座锁定构件偏置砧座安装构件以将所述砧座耳轴安置并保持在所述对应的锁定凹口中。
6.根据权利要求5所述的外科缝合器械，其中所述砧座安装部分能够在所述细长通道的一部分上枢转。
7.根据权利要求6所述的外科缝合器械，其中所述砧座安装部分包括能够在被支撑在所述细长通道内的枢转座上枢转的枢转凸块。
8.根据权利要求2所述的外科缝合器械，其中所述砧座锁定构件包括：
主体部分，所述主体部分能够与所述砧座安装部分接触；和
偏置构件，所述偏置构件与所述主体部分配合以将所述主体部分偏置成与所述砧座安装部分接触。
9.根据权利要求8所述的外科缝合器械，其中所述主体部分包括在其上的至少一个凸轮表面，所述至少一个凸轮表面用于当所述外科钉仓还未被安置在所述细长通道内时与所述砧座安装部分接触，以通过凸轮运动方式使所述砧座进入所述打开位置中。
10.根据权利要求2所述的外科缝合器械，其中所述砧座锁定构件包括能够与所述砧座安装部分偏置接触的片簧。
11.一种外科缝合器械，包括：
柄部；
细长轴组件，所述细长轴组件可操作地联接到所述柄部；
闭合系统，所述闭合系统由所述柄部可操作地支撑，以响应于由所述柄部可操作地支撑的闭合触发器的致动来产生闭合动作和打开动作；
细长通道，所述细长通道联接到所述细长轴组件；
包括砧座安装部分的砧座，所述砧座响应于通过所述细长轴组件传递到其的打开动作和闭合动作而在一个打开位置和多个闭合位置之间可动地支撑在所述细长通道上；
砧座锁定构件，所述砧座锁定构件由所述细长轴组件可操作地支撑以与所述砧座安装部分可动地接合；和
外科钉仓，所述外科钉仓能够被安置在所述细长通道内并与所述砧座安装部分配合，使得：
当所述外科钉仓还未被安置在所述细长通道内时，所述砧座锁定构件与所述砧座安装部分配合以将所述砧座保持在所述打开位置中；并且
当所述外科钉仓被安置在所述细长通道内时，所述钉仓使所述砧座安装部分运动到其中在对所述砧座施加闭合动作时所述砧座闭合的位置。
12.根据权利要求11所述的外科缝合器械，其中所述砧座安装部分还包括一对相对的砧座耳轴，所述砧座耳轴可动地接收在所述细长通道中的对应的耳轴狭槽中。
13.根据权利要求12所述的外科缝合器械，其中每个耳轴狭槽包括：
锁定凹口，所述锁定凹口用于当所述外科钉仓还未被安置在所述细长通道内时在所述锁定凹口中接收所述对应的砧座耳轴；和
弓形狭槽段，所述弓形狭槽段用于当所述外科钉仓已被安置在所述细长通道内时在所述弓形狭槽段中接收所述对应的砧座耳轴，使得在对所述砧座施加闭合动作时所述对应的砧座耳轴在所述弓形狭槽段内可动地移动。
14.根据权利要求13所述的外科缝合器械，其中当所述外科钉仓已被安置在所述细长通道中时，所述外科钉仓能够接触所述砧座安装部分以移动所述砧座安装部分，使得所述砧座耳轴从所述对应的锁定凹口运动到所述对应的弓形狭槽段。
15.根据权利要求14所述的外科缝合器械，其中所述外科钉仓包括：
仓体，所述仓体能够被安置在所述细长通道内；和
至少一个枢转部分，当所述外科钉仓已被安置在所述细长通道内时，所述至少一个枢转部分能够与所述砧座安装部分枢转接触。
16.根据权利要求15所述的外科缝合器械，其中所述至少一个枢转部分包括形成于所述仓体的近端上的一对楔形的枢转构件，其中所述枢转构件中的每一个限定倾斜枢转表面以与所述砧座安装部分的对应部分接触。
17.根据权利要求11所述的外科缝合器械，其中所述砧座锁定构件包括：
主体部分，所述主体部分能够与所述砧座安装部分接触；和
偏置构件，所述偏置构件与所述主体部分配合以将所述主体部分偏置成与所述砧座安装部分接触。
18.根据权利要求11所述的外科缝合器械，其中所述砧座锁定构件包括能够与所述砧座安装部分偏置接触的片簧。
19.一种与外科缝合器械一起使用的外科钉仓，所述外科缝合器械包括具有砧座的端部执行器，所述砧座被支撑在打开位置中直至运动到可致动位置，其中所述砧座能够响应于由闭合系统对其施加的闭合动作而运动到多个闭合位置，所述外科钉仓包括仓体，所述仓体的尺寸设定成可移除地安置在所述端部执行器的一部分内，使得当所述仓体被安置在所述端部执行器内时，所述仓体的一部分接触所述砧座并使所述砧座从所述打开位置运动到所述可致动位置。
20.根据权利要求19所述的外科钉仓，其中所述仓体还包括形成于所述仓体的近端上的一对楔形的枢转构件，其中所述枢转构件中的每一个限定倾斜枢转表面以与所述砧座的对应部分接触。
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