CN104224256B - 用于机电手术装置和系统的紧急情况收回的方法 - Google Patents

用于机电手术装置和系统的紧急情况收回的方法 Download PDF

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CN104224256B
CN104224256B CN201410273504.0A CN201410273504A CN104224256B CN 104224256 B CN104224256 B CN 104224256B CN 201410273504 A CN201410273504 A CN 201410273504A CN 104224256 B CN104224256 B CN 104224256B
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theater instruments
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迈克尔·英曼松
乔舒亚·斯诺
托马斯·温加德纳
戴维·麦丘恩
菲力·伊尔卡
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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
    • 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
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03—Automatic limiting or abutting means, e.g. for safety
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • A61B2017/00398—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
    • A61B2017/00473—Distal part, e.g. tip or head
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00477—Coupling
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00681—Aspects not otherwise provided for
    • A61B2017/00734—Aspects not otherwise provided for battery operated
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0807—Indication means
    • A61B2090/0811—Indication means for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument
    • A61B2090/0812—Indication means for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument indicating loosening or shifting of parts of an instrument, signaling maladjustment of parts

Abstract

本公开涉及机电手术系统及其使用方法，其包括具有控制器的手术器械，以及能够选择性地并且可拆卸地连接至所述手术器械的末端执行器，其中，当手术系统的至少一个输入元件不能提供控制信号至控制器以使电动机运转时，所述控制器进入紧急情况收回模式，其中所述紧急情况收回模式启动电动机以从驱动组件的任何推进位置缩回驱动组件。还公开用于机电手术装置和系统的紧急情况收回的方法。

Description

用于机电手术装置和系统的紧急情况收回的方法
相关申请的交叉引用
本申请要求享有提交于2013年6月18日的序号为61/836,181的美国临时专利申请的利益和优先权，其整个公开通过引用合并于此。
技术领域
本公开涉及手术装置和/或系统，并且更具体地，涉及具有紧急情况收回规则系统的机电自动控制的和/或手持式的动力手术装置和/或系统。
背景技术
许多手术装置的生产商已经开发出具有适用于操作和/或操纵机电手术装置的专用驱动系统的产品线。在许多实例中，所述机电手术装置包括可重复使用的手柄组件，以及一次性末端执行器或单次使用的末端执行器。所述末端执行器可以在使用前选择性地连接至所述手柄组件上，并且然后，在使用后再从所述手柄组件断开连接以便于被处置或在一些实例中被消毒以重复使用。
许多这种机电手术装置包括复杂的驱动部件，其利用多种可接收用户输入的用户接口(例如，控制器、按钮、触发器、屏幕、开关等)来控制装置并给用户提供反馈。为防止驱动机构的致动超过机械极限，多种开关和传感器被用来检测手术装置的运转状态。在装置和末端执行器内包括多重开关和/或传感器呈现了多种问题。另外，成本或其他考虑阻止了这种装置的使用。因此，需要具有无需依赖遍及手术装置布置的多重机械极限传感器和/或开关就能够检测机械极限的安全机构的系统和设备。
用于执行微创手术的自动控制系统也是已知的。在WO2000/51486中公开了一种系统，其中，手术器械被远程控制，此公开的全部内容通过引用结合在此。
另外，与纯粹的机械装置相比，机电手术装置提供了独特优势。然而，这种机电手术装置易受先前的未经考虑的失败模式影响。例如，一个这样的失败模式是：如上所确定的或其他设想的或已实施的任何一个或全部的用户输入发生故障。这种失败能引起机电手术装置在每当至少最小层次的功能是危急的时候被导致不运转。
因此，需要减少与机电手术装置的这种失败相关联的风险的呈规则系统的形式的方法以及与实现所述方法相联系的软件和硬件。
发明内容
本公开涉及包括紧急情况收回规则系统的机电自动控制的和/或手持式动力的手术装置和/或系统。
根据本公开的方案，提供了机电手术系统，其包括：包括有手柄壳体的手持式手术器械；布置在手柄壳体内的电动机；布置在手柄壳体内并且与电动机电连通(electricalcommunication)的控制器；电池，其能够选择性地、可拆卸地插入所述手柄壳体并且当其布置在手柄壳体内时与电动机和控制器中的至少一个电连通；以及至少一个输入元件，其支撑在手柄壳体上并且能够被用户致动以发送控制信号至控制器来使电动机运转。手术系统还包括能够选择性地并且可拆卸地连接至手术器械的末端执行器。所述末端执行器包括钳夹组件，其具有包含多个吻合钉的吻合钉钉仓和砧座以在发射时使多个吻合钉成形；以及驱动组件，其至少部分地安置在钳夹组件内并且能够在末端执行器连接至手术器械用于通过电动机致动时可操作地连接至电动机。控制器被配置为当所述至少一个输入元件不能提供控制信号至控制器以使电动机运转时进入紧急情况收回模式(emergency retractionmode)，其中所述紧急情况收回模式启动电动机以从驱动组件的任何推进位置缩回驱动组件。
当移出电池并将电池重新插入手柄壳体时，可以进入紧急情况收回模式。
可选地，可通过触发开关进入紧急情况收回模式，并且通过另外的开关顺序或联动装置或通过进入控制按钮的通常用于其它目的的特定顺序而可选地被保护。
紧急情况收回模式还能够通过遇到带有可读内存的末端执行器来致动，其中所述可读内存显示末端执行器已在先前使用或末端执行器与先前的机电手术系统相关联。
使用时，在紧急情况收回模式期间，控制器可经历重新启动，由此控制器检测到末端执行器连接至手术器械。
处于紧急情况收回模式时，驱动组件可自动地收回。
使用时，驱动组件收回至完全收回位置，可打开钳夹组件。
使用时，处于紧急情况收回模式时，控制器可使手术系统的全部剩余功能失灵。
当电池从手柄壳体移出时，可进入紧急情况收回模式，然后压下安全按钮并保持，并且然后将电池重新插入手柄壳体，其中所述安全按钮被支撑在手柄壳体上。
使用时，在紧急情况收回模式期间，控制器可经历重新启动，由此控制器检测到末端执行器连接至手术器械。
使用时，在驱动组件收回之后，当安全按钮被释放，控制器不能自动地重新推进驱动组件。
使用时，释放安全按钮之后，并且在安全按钮的重新压下并保持之后，在紧急情况收回模式下，控制器可启动所述电动机以重新闭合钳夹组件。
使用时，在紧急情况收回模式下，除关节式运动功能以外，控制器可使手术系统的全部剩余功能失灵。
使用时，在紧急情况收回模式下，可操作手术器械以使末端执行器进行关节式运动。
根据本公开的另一方案，提供了一种用于控制机电手术系统的方法，所述机电手术系统包括选择性地并且可拆卸地支撑末端执行器的手持式手术器械。所述手术器械包括电动机、与电动机进行电连通的控制器、与电动机和控制器中的至少一个进行电连通的电池、以及至少一个能够被用户致动以发送控制信号至控制器来使电动机运转的输入元件；并且其中所述末端执行器包括钳夹组件、驱动组件，所述驱动组件至少部分地布置在钳夹组件内并且在末端执行器连接至手术器械用于通过电动机致动时能够可操作地连接至所述电动机。
所述方法包括如下步骤：监视所述至少一个输入元件；当所述至少一个输入元件不能提供控制信号至控制器时，进入紧急情况收回模式；启动电动机以从驱动组件的任何推进位置缩回驱动组件。
所述方法可进一步包括如下步骤：当电池移出并重新插入手术器械时进入紧急情况收回模式。
所述方法可进一步包括如下步骤：其中在紧急情况收回模式期间，经历控制器的重新启动；以及通过控制器检测末端执行器连接至手术器械。
所述方法可进一步包括如下步骤：当处于紧急情况收回模式时自动地收回驱动组件。
所述方法可进一步包括如下步骤：伴随驱动组件收回至完全收回位置打开钳夹组件。
所述方法可进一步包括如下步骤：当处于紧急情况收回模式时，控制器使手术系统的全部剩余功能失灵。
所述方法可进一步包括如下步骤：当电池移出并重新插入手术器械时，进入紧急情况收回模式；其后，压下被支撑在手术器械上的安全按钮并保持压下；并且其后，将电池重新插入手术器械。
所述方法可进一步包括如下步骤：其中在紧急情况收回模式期间，经历控制器的重新启动；以及通过控制器检测末端执行器连接至手术器械。
所述方法可进一步包括如下步骤：当处于紧急情况收回模式时自动地收回驱动组件。
所述方法可进一步包括如下步骤：伴随驱动组件收回至完全收回位置打开钳夹组件。
所述方法可进一步包括如下步骤：驱动组件收回之后，并且在安全按钮释放之后，控制器不能自动地重新推进驱动组件。
所述方法可进一步包括如下步骤：安全按钮释放之后，并且在重新压下安全按钮并保持之后，在紧急情况收回模式下，控制器启动电动机以重新闭合钳夹组件。
所述方法可进一步包括如下步骤：当处于紧急情况收回模式时，控制器使手术系统的除关节式运动功能以外的全部剩余功能失灵。
所述方法可进一步包括如下步骤：当处于紧急情况收回模式时使末端执行器进行关节式运动。
附图说明
本文将通过参照附图描述本公开的实施例，其中：
图1是根据本公开的包括手术器械、接合器以及末端执行器的机电手术系统的分解的立体图；
图2是根据本公开的图1的手术器械的立体图；
图3是根据本公开的图1的手术器械的部件分开的立体图；
图4是根据本公开的图1的手术器械的电池的立体图；
图5是根据本公开的图1的手术器械的部分分解的俯视图；
图6是根据本公开的图1的手术器械的正视立体图，其中，所述接合器从所述手术器械分离；
图7是根据本公开的图1的手术器械沿着图2的7-7取得的侧剖视图；
图8是根据本公开的图1的手术器械沿着图2的8-8取得的俯视剖视图；
图9是根据本公开的图1的末端执行器的部件分开的立体图；
图10是根据本公开的图1的手术器械的示意图；
图11是根据本公开的实施例的用于机电手术系统的紧急情况收回规则系统的流程图；
图12是根据本公开的另一个实施例的用于机电手术系统的紧急情况收回规则系统的流程图；以及
图13是根据本公开的再一个实施例的用于机电手术系统的紧急情况收回规则系统的流程图。
具体实施方式
将参照附图详细描述本公开的用于手术装置和/或手柄组件的机电手术系统、手术装置以及接合器组件的实施例，其中在几幅附图的每幅附图中类似附图标记指代相同的或对应的元件。在本文中使用时，术语“远侧”是指所述机电手术系统、接合器组件或手术装置的较远离用户的部分或其部件，而术语“近侧”是指所述机电手术系统、接合器组件或手术装置的较接近用户的部分或其部件。
根据本公开的实施例，手术系统总体被指定为10，并且所述手术系统呈动力手持式机电器械的形式，且所述动力手持式机电器械被配置为选择性地将多个不同的末端执行器附接至其上，所述末端执行器中的每一个均被配置为用于通过所述动力手持式机电手术器械来致动和操纵。
如图1所示，手术器械100被配置为选择性连接接合器200，并且，依次地，接合器200被配置为选择性连接末端执行器或单次使用的装载单元300。
如图1至图3所示，手术器械100包括手柄壳体102，手柄壳体102具有下壳体部104、中间壳体部106以及上壳体部108，其中，中间壳体部106从下壳体部104延伸出和/或被支撑在下壳体部104上，上壳体部108从中间壳体部106延伸出和/或被支撑在中间壳体部106上。中间壳体部106和上壳体部108被分离成远侧半体110a和近侧半体110b，其中，远侧半体110a与下壳体部104一体式形成并且从下壳体部104延伸，而近侧半体110b能够通过多个紧固件与远侧半体110a连接。当结合时，远侧半体110a和近侧半体110b限定手柄壳体102，在手柄壳体102内具有安置了电路板150和驱动机构160的空腔102a。
可从图2和图3看出，远侧半体110a和近侧半体110b沿着横切上壳体部108的纵向轴线“X-X”的垂直平面被分割。手柄壳体102包括垫圈112，垫圈112完全地环绕远侧半体110a和/或近侧半体110b的边缘延伸并且被插入远侧半体110a和近侧半体110b之间。垫圈112密封远侧半体110a和近侧半体110b的周边。垫圈112的作用是在远侧半体110a和近侧半体110b之间建立气密的密封，使电路板150和驱动机构160在杀菌和/或清洁操作时被保护。
如此，手柄壳体102的空腔102a沿着远侧半体110a的周边被密封，而近侧半体110b被配置为使电路板150和驱动机构160在手柄壳体102内的组装变得更加容易且更加高效。
手柄壳体102的中间壳体部106提供了安置有电路板150的壳体。电路板150被配置为控制手术器械100的多种操作，这将在下文中更详细地介绍。
手术器械100的下壳体部104限定了孔隙(未显示)，此孔隙形成在下壳体部104的上表面并位于中间壳体部106之下或之内。下壳体部104的孔隙提供了通道，电线152穿过所述通道以将安置在下壳体部104内的电气部件(例如，如图4所示的电池156，如图3所示的电路板154，等)与安置在中间壳体部106和/或上壳体部108内的电气部件(例如，电路板150、驱动机构160等)电连通。
手柄壳体102包括布置在下壳体部104的孔隙内的垫圈103，从而塞紧或密封下壳体部104的孔隙但是允许电线152从其中穿过。垫圈103的作用是在下壳体部104和中间壳体部106之间建立气密的密封，从而使电路板150和驱动机构160在杀菌和/或清洁操作时被保护。
如图所示，手柄壳体102的下壳体部104提供了壳体，可再充电的电池156被可拆卸地布置在所述壳体内。电池156被配置为向手术器械100的任何电气部件供给电力。下壳体部104限定了空腔(未显示)，电池156被插入所述空腔。下壳体部104包括门105，门105枢轴地连接到下壳体部104用于闭合下壳体部104的空腔并且将电池156保持在所述空腔内。
参考图3和图5，上壳体部108的远侧半体110a限定了鼻形物或连接部108a。鼻椎体114被支撑在上壳体部108的鼻形部108a上。鼻椎体114由透明材料制成。照明构件116被布置在鼻椎体114内，从而穿过其中可以看见照明构件116。照明构件116可以是发光二级管印刷电路板(LED PCB)。照明构件116被配置为以具有与独特的离散事件相关联的特定颜色图案的多种颜色照明。
手柄壳体102的上壳体部108提供了安置驱动机构160的壳体。如图5所示，驱动机构160被配置为驱动轴和/或齿轮部件来执行手术器械100的多种操作。特别地，驱动机构160被配置为驱动轴和/或齿轮部件从而选择性地使末端执行器300的工具组件304相对末端执行器300的近侧主体部302移动(参见图1和图9)，使末端执行器300相对手柄壳体102绕纵向轴线“X-X”(参见图2)旋转，使砧座组件306相对末端执行器300的钉仓组件308移动，和/或从末端执行器300的钉仓组件308内发射吻合和切割钉仓。
驱动机构160包括选择器变速箱组件162，其紧靠接合器200的近侧。选择器变速箱组件162的近侧具有功能选择模块163，功能选择模块163具有第一电动机164，第一电动机164的作用是选择性地移动选择器变速箱组件162内的齿轮元件使所述齿轮元件与具有第二电动机166的输入驱动部件165接合。
如图1至图4所示，并且如上所提到的，上壳体部108的远侧半体110a限定了连接部108a，其被配置为接收接合器200的对应的驱动联接组件210。
如图6至图8所示，手术器械100的连接部108a具有圆柱形的凹槽108b，当接合器200与手术器械100匹配时，凹槽108b接纳接合器200的驱动联接组件210。连接部108a容纳三个可旋转驱动连接器118、120、122。
如图6所示，当接合器200与手术器械100匹配时，手术器械100的可旋转驱动连接器118、120、122中的每一个驱动连接器与接合器200的对应的可旋转连接器套管218、220、222相联接。在这点上，对应的第一驱动连接器118和第一连接器套管218之间的交接，对应的第二驱动连接器120和第二连接器套管220之间的交接，以及对应的第三驱动连接器122和第三连接器套管222之间的交接都是键联接，以便于手术器械100的驱动连接器118、120、122中的每一个驱动连接器的旋转都会引起接合器200的对应的连接器套管218、220、222的对应的旋转。
手术器械100的驱动连接器118、120、122与接合器200的连接器套管218、220、222的匹配允许旋转力经由三个对应的连接器交接中的每一个连接器交接独立地传递。手术器械100的驱动连接器118、120、122被配置为被驱动机构160独立地旋转。在这点上，驱动机构160的功能选择模块163会选择由驱动机构160的输入驱动部件165来驱动手术器械100的驱动连接器118、120、122中的哪一个或哪几个。
因为手术器械100的驱动连接器118、120、122中的每一个驱动连接器与接合器200的对应的连接器套管218、220、222的交接都是键式的和/或基本上不可旋转的，当接合器200联接到手术器械100时，旋转力被选择性地从手术器械100的驱动机构160传递到接合器200。
手术器械100的驱动连接器118、120和/或122的选择性旋转允许手术器械100选择性地致动末端执行器300的不同功能。如下面更详细地讨论，手术器械100的第一驱动连接器118的选择性的且独立的旋转对应末端执行器300的工具组件304的选择性的且独立的打开和闭合，以及对应末端执行器300的工具组件304的吻合/切割部件的驱动。同样，手术器械100的第二驱动连接器120的选择性的且独立的旋转对应末端执行器300的工具组件304的横切纵向轴线“X”(参见图2)的选择性且独立的关节式运动。另外，手术器械100的第三驱动连接器122的选择性的且独立的旋转对应末端执行器300相对于手术器械100的手柄壳体102绕纵向轴线“X”(参见图2)的选择性的且独立的旋转。
如上所提到的并且如图5和图8所示，驱动机构160包括选择器变速箱组件162，以及安置在选择器变速箱组件162的近侧的功能选择模块163，功能选择模块163的作用是选择性地移动选择器变速箱组件162内的齿轮元件使所述齿轮元件与第二电动机166接合。这样，在特定时间，驱动机构160选择性地驱动手术器械100的驱动连接器118、120、122中的一个。
如图1至图3所示，手柄壳体102将控制组件107支撑在中间壳体部106的远侧表面或侧面上。控制组件107是功能完善的机械子组件，其在联接至器械100之前能够与器械100的其余部分分离地组装和测试。
控制组件107，与中间壳体部106协作，将一对手指致动的控制按钮124、126和一对摇杆装置128、130支撑在壳体107a内。控制按钮124、126分别被联接至延伸轴125、127。特别地，控制组件107限定了用于可滑动地接纳延伸轴125的上孔隙124a和用于可滑动地接纳延伸轴127的的下孔隙126a。
如图1、图2以及图7所见，手术器械100包括发射按钮或安全开关132，其被支撑在中间壳体部106和上壳体部之间并且被安置在扳机壳体107之上。使用时，根据需要和/或愿望，末端执行器300的工具组件304在打开和闭合状态之间被致动。为了发射末端执行器300，当末端执行器300的工具组件304处于闭合状态下时从其中射出紧固件，安全开关132被压下从而指示手术器械100：末端执行器300已经准备好从其中射出紧固件。
对于这里没有明确描述的手术器械100的特征和部件的构造和操作的详细讨论，可以参考递交于2012年6月1日的序号为61/654,191的美国临时专利申请，其名称为“HandHeld Surgical Handle Assembly,Surgical Adapters for Use Between SurgicalHandle Assembly and Surgical End Effectors,and Methods of Use(用于手术手柄组件与手术末端执行器之间的手持式手术手柄组件、手术接合器及其使用方法)”，上述专利的全部内容通过引用结合在此。
参照图9，末端执行器300的驱动组件360包括挠性驱动轴364，挠性驱动轴364具有紧固到动力驱动横梁365的远侧端以及近侧接合体368。接合体368包括限定肩370的梯状部。接合体368的近侧端包括正相对的向内延伸的指状件372。指状件372与中空的驱动构件374接合从而将驱动构件374牢固地紧固到轴364的近侧端上。驱动构件374限定近侧孔口，近侧孔口在末端执行器300被附接到接合器200的远侧联接器230时接纳接合器200的驱动管246(图1)的连接构件。
当驱动组件360在工具组件304内被向远侧推进时，驱动横梁365的上梁在砧座板312和砧座盖310之间限定的通道内移动，而下梁在吻合钉钉仓305的通道内移动并且移动到托架316外表面的上方来闭合工具组件304并从其中发射吻合钉。
末端执行器300的近侧主体部302包括封装有上壳体部301a和下壳体部301b的鞘或外管301。上壳体部301a和下壳体部301b封装有关节式运动连杆366，关节式运动连杆366具有从末端执行器300的近侧端延伸的钩状近侧端366a。当末端执行器300被紧固到接合器200的远侧壳体232时，关节式运动连杆366的钩状近侧端366a与接合器200的联接钩(未显示)相接合。如上所述，当接合器200的驱动杆(未显示)被推进或缩回时，末端执行器300的关节式运动连杆366会在末端执行器300内被推进或缩回以使工具组件304相对于近侧主体部302的远侧端枢转。
如图9所示，工具组件304的钉仓组件308包括能够支撑在托架316内的吻合钉钉仓305。吻合钉钉仓305限定了中央纵向狭槽305a，以及定位在纵向狭槽305a的每一侧上的三个线性排吻合钉保持狭槽305b。每一个吻合钉保持狭槽305b接纳单个吻合钉307和吻合钉推动器309的一部分。在操作器械100期间，驱动组件360与致动滑板350邻接并推动致动滑板350通过钉仓305。随着致动滑板移动通过钉仓305，致动滑板350的凸轮楔顺序地与吻合钉推动器309相接合，从而在吻合钉保持狭槽305b内竖直地移动吻合钉推动器309并从其中顺序地射出单个吻合钉307以靠着砧座板312成型。
末端执行器300还可以包括一个或多个机械闭锁机构，例如在序号为5,071,052、5,397,046、5,413,267、5,415,335、5,715,988、5,718,359以及6,109,500的共有美国专利中所描述的机械闭锁机构，上述专利的全部内容通过引用结合在此。还可参考递交于2009年8月31日的公开号为2009/0314821的名称为“TOOL ASSEMBLY FOR A SURGICAL STAPLINGDEVICE(用于手术吻合装置的工具组件)”的美国专利，用于对末端执行器300的构造和操作的详细讨论。
图10显示了器械100的另一个实施例。所述器械100包括电动机164。电动机164可以是任何配置为致动一个或多个驱动器(例如，图6的可旋转驱动连接器118、120、122)的电力的电动机。电动机164被联接至电池156，所述电池156可以是直流电池(例如，可再充电的铅基的、镍基的、锂离子基的电池等)、交直流变压器、或任何其他的适合提供电能至电动机164的电源。
电池156和电动机164被联接至布置在电路板154上的电动机驱动电路404，电路板154控制电动机164的操作，包括电能从电池156流向电动机164。器械100可使用多个电动机164和电动机驱动电路404或与电动机100(全部未显示)相联系的传动装置(transmission)以驱动器械的多种功能。驱动电路404包括配置为测量电动机164和电池156的运转状态的多个传感器408a、408b、408n。传感器408a-n可包括电压传感器、电流传感器、温度传感器、遥感传感器、光学传感器、及其组合。传感器408a-408n可测量由电池156提供的电能的电压、电流以及其他电学特性。传感器408a-408n还可测量电动机164的按照每分钟的转数(RPM)的旋转速度、转矩、温度、电流消耗、以及其他运转特性。可通过测量电动机164的旋转来确定RPM。多种驱动轴(例如，图6的可旋转驱动连接器118、120、122)的位置可通过使用布置在轴内或邻近轴处的多种线性传感器来确定或从RPM测量来推定。在实施例中，在恒定的RPM下，可以基于电动机164的额定电流消耗来计算转矩。在另外的实施例中，驱动电路404和/或控制器406可测量时间并作为其函数处理上述数值(例如，包括积分和/或微分)以确定测量值的变化等。
驱动电路404还被联接至控制器406，控制器406可以是任何适合的逻辑控制电路，其适合于执行计算和/或根据一组指示运转，这将在下文中更详细地描述。控制器406可包括被可操作地连接至内存的中央处理单元，内存可包括临时类型内存(例如，RAM)和/或非临时类型内存(例如，可读取多种记忆卡、磁盘碟片、等)。控制器406包括多个用于交接驱动电路404的输入端和输出端。特别地，控制器406接收被测量的来自驱动电路404的关于电动机164和电池156的运转状态的传感器信号，并且依次地，基于传感器读数和特定的规则系统指示，输出控制信号至驱动电路404以控制电动机164的运转，这将在下文中更详细地描述。控制器406还配置为接收来自用户界面(例如，被联接至控制器406的控制组件107的开关、按钮、触摸屏等)的多个用户输入。
本公开提供了用于控制器械100或任何其他动力手术器械的设备和方法，所述动力手术器械包括但是不局限于线性动力吻合器、圆形或弓形动力吻合器、夹子施加器、抓紧器、电手术密封镊子、旋转组织混合装置等。
具体地，根据本公开，提供了在手术操作期间，即，手术器械100和/或手术系统10的初始致动之后，输入元件(即，控制按钮124、126，摇杆装置128、130，其他的按钮、开关、触摸屏、控制器、触发器等)出现故障或不能操作或不响应的时候，用于控制手术器械100和/或手术系统10的规则系统。在这种情况下，需要手术器械100和/或手术系统10具有紧急情况收回规则系统以克服手术器械100和/或手术系统10的任何输入元件的任何故障、不可操作性或不反应。
如图11所见，根据本公开的第一方案的规则系统的流程图被总体地指定为500。实现规则系统500的计算机编码或指示可被本地地保留在手术器械100的电路板150或电路板154内，在末端执行器300的内存装置(未显示)内，或在与手术器械100和/或手术系统10进行有线通信或无线通信的远程计算机系统(未显示)内。
使用时，在手术系统10操作期间，传感器等监视手术器械100和/或末端执行器300的操作。如图11的流程图所见，如果在步骤510，手术器械100如预期的正常操作(即，末端执行器300完全地发射进入组织，并且末端执行器300自动地收回未夹紧位置)，则在步骤512，紧急情况恢复模式530不被执行。
然而，如果，在步骤510，手术器械100未能正常操作或如预期的操作，则在步骤520，将执行涉及如上所讨论的输入元件的功能性的询问。如果，在步骤520已确定手术器械100没有以禁止输入元件的预期用户致动的方式发生故障(即，坏掉的按钮、被向下卡住的发射按钮、坏掉的霍尔效应传感器等)，则在步骤522，可以得出结论，末端执行器300被夹紧在下面的组织上并且不反应，需要进一步干涉。
如果，在步骤520已确定手术器械100已经以禁止输入元件的预期用户致动的方式发生故障，则在步骤524，外科医生进入紧急情况恢复模式530。
紧急情况恢复模式530包括至少下列步骤。在步骤532，外科医生将电池156从手术器械100的手柄壳体102的下壳体部移出。然后，在步骤534，将电池156重新插入手术器械100的手柄壳体102的下壳体部。将电池156重新插入手术器械100之后，在步骤536，手术器械100经历重新启动或启动顺序。
因为末端执行器300和接合器200仍然被附接至或被连接至手术器械100，在重新启动或启动顺序过程中，在步骤536，手术器械100检测末端执行器300的存在并且进入紧急情况收回模式540。
由外科医生操作的电池156的简单移出和插入，以及其自动经历的重新启动或启动顺序，可被认为是“自发激活”。即使手术器械有最大程度的损坏(即，所有输入元件被损坏而只有电池连接、主电路板150以及手术系统10的传动系统起作用)，仍可以实现通过“自发激活”进入紧急情况收回模式540。
而在紧急情况收回模式540下，在步骤542，器械100通过设置功能选择模块163以操作驱动连接器118、120、122中适当的一个(即，与末端执行器300的工具组件304的打开和闭合相关联的第一驱动连接器118)并且反过来启动第二电动机166从而自动地完全收回末端执行器300的驱动组件360。在末端执行器300的工具组件304返回到完全打开位置之前，末端执行器300的驱动组件360是收回的。当末端执行器300的工具组件304处于完全打开位置，任何在工具组件304内被捕获的组织均可被移出。
然后，在从末端执行器300的工具组件304移出被捕获的组织之前、同时、或紧接其后，在步骤544，手术器械100的全部剩余操作或功能(即，包括夹紧和/或发射)失灵。然后，在步骤546，手术器械100、接合器200和/或末端执行器300从手术部位被移出(即，从套管针或类似物缩回)。
如图12所见，根据本公开的第二方案，规则系统的流程图被总体指定为600。规则系统600可被本地地保留在手术器械100的电路板150或电路板154内，在末端执行器300的内存装置(未显示)内，或在与手术器械100和/或手术系统10进行有线通信或无线通信的远程计算机系统(未显示)内。
使用时，在手术系统10的操作期间，传感器等监视手术器械100和/或末端执行器300的操作。如图12的流程图所见，如果，在步骤610，手术器械100如预期的正常操作(即，末端执行器300完全发射入组织，并且末端执行器300自动地收回未夹紧位置)，则在步骤612，紧急情况恢复模式630将不被执行。
然而，如果，在步骤610，手术器械100未能正常操作或如预期地操作，则在步骤620，将执行涉及如上所讨论的输入元件的功能性的询问。如果，在步骤620已确定手术器械100没有以禁止输入元件的预期用户致动的方式发生故障(即，坏掉的按钮、被向下卡住的发射按钮、坏掉的霍尔效应传感器等)，则在步骤622可以得出结论，末端执行器300被夹紧在下面的组织上并且不反应。
如果在步骤620已确定手术器械100已经以禁止输入元件的预期用户致动的方式发生故障，则在步骤624，外科医生进入紧急情况恢复模式630。
紧急情况恢复模式630包括至少下列步骤。在步骤632，外科医生将电池156从手术器械100的手柄壳体102的下壳体部移出。然后，在步骤633，外科医生压下手术器械100的安全按钮132并保持压下。伴随安全按钮132被压下并被保持压下，然后，在步骤634，外科医生将电池156重新插入手术器械100的手柄壳体102的下壳体部。将电池156重新插入手术器械100之后，在步骤636，手术器械100经历重新启动或启动顺序。
因为当电池156被重新插入时安全按钮132已经被持续地压下并保持压下(即，持续大约0-30秒之间，理想的是大约20秒)，在重新启动或启动顺序的过程中，在步骤636，手术器械100检测安全按钮132已经被这样压下或保持压下并且进入紧急情况收回模式640。
在紧急情况收回模式640，在步骤642，器械100通过调整功能选择模块163以操作驱动连接器118、120、122中的适当的一个(即，与末端执行器300的工具组件304的打开和闭合相关联的第一驱动连接器118)并且反过来启动第二电动机166，以自动地完全收回末端执行器300的驱动组件360。在末端执行器300的工具组件304返回到完全打开位置之前，末端执行器300的驱动组件360是收回的。当末端执行器300的工具组件304处于完全打开位置，任何在工具组件304内被捕获的组织可被移出。
然后，在从末端执行器300的工具组件304移出被捕获的组织之前、同时、或紧接其后，在步骤644，安全按钮132被释放，而末端执行器300的钳夹306、308仍然打开。
然后，在步骤646，安全按钮132被重新压下或重新保持压下，末端执行器300的钳夹306、308被自动地重新致动至闭合或夹紧位置以重新夹紧到组织上，由此“在体内(invivo)”或重新夹紧的组织可以从手术部位被移出(即，从套管针或类似物缩回)。
在本公开的本方案中，用户或外科医生通过压下安全按钮132且保持压下特定的一段时间来控制紧急情况收回模式640的触发。依照本公开，在可选的安排或和设置中，在重新启动或启动顺序的过程中，输入元件(即，控制按钮124、126；摇杆装置128、130；等)而非安全按钮132可以被压下并保持压下特定的一段时间，以便使手术系统10和/或手术器械100进入紧急情况收回模式640。
另外，依照本公开的本方案，当手术系统10和/或手术器械100处于紧急情况收回模式640下，手术系统10和/或手术器械100的功能性仅限于末端执行器300的钳夹306、308的闭合。
如图13所见，根据本公开的另一方案的规则系统的流程图被总体地指定为700。规则系统700可被本地地保留在手术器械100的电路板150或电路板154内，在末端执行器300的内存装置(未显示)内，或在与手术器械100和/或手术系统10进行有线通信或无线通信的远程计算机系统(未显示)内。
使用时，在手术系统10的操作期间，传感器等监视手术器械100和/或末端执行器300的操作。从图13的流程图看出，如果，在步骤710，手术器械100如预期的正常操作(即，末端执行器300完全发射入组织，并且末端执行器300自动地收回未夹紧位置)，则在步骤712，紧急情况恢复模式730将不被执行。
然而，如果在步骤710手术器械100未能正常操作或如预期的操作，则在步骤720，将执行涉及如上所讨论的输入元件的功能性的询问。如果，在步骤720已确定手术器械100没有以禁止输入元件的预期用户致动的方式发生故障(即，坏掉的按钮、被向下卡住的发射按钮、坏掉的霍尔效应传感器等)，然后，在步骤722可以得出结论，末端执行器被夹紧在下面的组织上并且不反应。
如果在步骤720已确定手术器械100已经以禁止输入元件的预期用户致动的方式发生故障，则在步骤724，外科医生进入紧急情况恢复模式730。
紧急情况恢复模式730包括至少下列步骤。在步骤732，外科医生将电池156从手术器械100的手柄壳体102的下壳体部移出。然后，在步骤734，将电池156重新插入手术器械100的手柄壳体102的下壳体部。电池156重新插入手术器械100之后，在步骤736，手术器械100经历重新启动或启动顺序。
因为末端执行器300和接合器200仍然被附接或被连接至手术器械100，在重新启动或启动顺序期间，在步骤736，手术器械100检测末端执行器300的存在并且进入紧急情况收回模式740。
通过外科医生将电池156简单移出和插入，并且其自动经历重新启动或启动顺序，可被认为是“自发激活”。即使有对手术器械的最大程度的损坏(即，所有输入元件被损坏并且只有电池连接、主电路板150和手术系统10的传动系统在运行)，仍可实现通过“自发激活”进入紧急情况收回模式740。
当处于紧急情况收回模式740，在步骤742，器械100通过设置功能选择模块163以启动驱动连接器118、120、122中的适当的一个(即，与末端执行器300的工具组件304的打开和闭合相关联的第一驱动连接器118)并且反过来启动第二电动机166以自动地完全收回末端执行器300的驱动组件360。在末端执行器300的工具组件304返回到完全打开位置之前，末端执行器300的驱动组件360是收回的。当末端执行器300的工具组件304处于完全打开位置，任何在工具组件304内被捕获的组织可被移出。
然后，在从末端执行器300的工具组件304移出被捕获的组织之前、或与其同时、或紧接其后，在步骤744，除了末端执行器300的关节式运动功能，手术器械100的全部操作或功能(即，包括夹紧和/或发射)失灵。然后，在步骤746，手术器械100、接合器200和/或末端执行器300从手术部位被移出(即，从套管针或类似物缩回)。
需要理解的是可以对本公开接合器组件的实施例做出多种改进。因此，上述描述不应该被理解为是限制性的，而应理解为仅仅是实施例的示范例。本领域技术人员将可在本公开的范围和精神内预想其他的改进。
还应进一步理解的是，上述描述仅是本公开的例证性描述。可以在不脱离本公开的情况下由本领域技术人员提出多种选择和改进。因此，本公开意图包括所有这种选择、改进和变化。呈现参照附图描述的实施例仅是说明本公开的某些例子。与上述描述和/或所附权利要求在本质上没有区别的其他元件、步骤、方法和技术也意图包括在本公开的范围内。

Claims (20)

1.一种用于控制机电手术系统的方法，其包括选择性地并且可拆卸地支撑末端执行器的手持式手术器械，其中所述手术器械包括电动机、与所述电动机电连通的控制器、与所述电动机和所述控制器中的至少一个电连通的电池、以及能够被用户致动从而发送控制信号至控制器来使所述电动机运转的至少一个输入元件；并且其中所述末端执行器包括钳夹组件、驱动组件，所述驱动组件至少部分地安置在所述钳夹组件内，并且在所述末端执行器连接至所述手术器械用于通过所述电动机来致动时，所述驱动组件能够可操作地连接至所述电动机；所述方法包括如下步骤：
监视所述至少一个输入元件；
当所述至少一个输入元件不能提供控制信号至所述控制器时，进入紧急情况收回模式；
启动所述电动机以从所述驱动组件的任何推进位置缩回所述驱动组件。
2.根据权利要求1所述的方法，进一步包括如下步骤：当电池移出并重新插入手术器械时进入紧急情况收回模式。
3.根据权利要求2所述的方法，进一步包括如下步骤：
其中在紧急情况收回模式期间，经历控制器的重新启动；以及
通过控制器检测末端执行器连接至手术器械。
4.根据权利要求3所述的方法，进一步包括如下步骤：当处于紧急情况收回模式，自动地收回驱动组件。
5.根据权利要求4所述的方法，进一步包括如下步骤：伴随驱动组件收回至完全收回位置打开钳夹组件。
6.根据权利要求4所述的方法，进一步包括如下步骤：当处于紧急情况收回模式时，控制器使手术系统的全部剩余功能失灵。
7.根据权利要求1所述的方法，进一步包括如下步骤：
当电池移出并重新插入手术器械时，进入紧急情况收回模式；
其后，压下支撑在手术器械上的安全按钮并保持压下；以及
其后，将电池重新插入手术器械。
8.根据权利要求7所述的方法，进一步包括如下步骤：
在紧急情况收回模式期间，经历控制器的重新启动；以及
通过控制器检测末端执行器连接至手术器械。
9.根据权利要求8所述的方法，进一步包括如下步骤：当处于紧急情况收回模式时，自动地收回驱动组件。
10.根据权利要求9所述的方法，进一步包括如下步骤：伴随驱动组件收回至完全收回位置，打开钳夹组件。
11.根据权利要求9所述的方法，进一步包括如下步骤：在驱动组件收回之后，并且在安全按钮释放之后，控制器不会自动地重新推进驱动组件。
12.根据权利要求11所述的方法，进一步包括如下步骤：在安全按钮释放之后，并且在重新压下安全按钮并保持压下之后，在紧急情况收回模式下，控制器启动电动机以重新闭合钳夹组件。
13.根据权利要求4所述的方法，进一步包括如下步骤：当处于紧急情况收回模式时，除关节式运动功能以外，控制器使手术系统的全部剩余功能失灵。
14.根据权利要求13所述的方法，进一步包括如下步骤：当处于紧急情况收回模式时，使末端执行器进行关节式运动。
15.根据权利要求1所述的方法，进一步包括如下步骤：在紧急情况收回模式期间，经历控制器的重新启动。
16.根据权利要求15所述的方法，进一步包括如下步骤：通过控制器检测末端执行器连接至手术器械。
17.根据权利要求16所述的方法，进一步包括如下步骤：当进入紧急情况收回模式时，自动地收回驱动组件。
18.根据权利要求1所述的方法，进一步包括如下步骤：
当电池从手术器械移出时，进入紧急情况收回模式；
其后，压下支撑在手术器械上的安全按钮并保持压下；以及
其后，将电池重新插入手术器械。
19.根据权利要求18所述的方法，进一步包括如下步骤：
在紧急情况收回模式期间，经历控制器的重新启动；以及
通过控制器检测末端执行器连接至手术器械。
20.根据权利要求19所述的方法，进一步包括如下步骤：
当处于紧急情况收回模式时，自动地收回驱动组件；以及
伴随驱动组件收回至完全收回位置，打开钳夹组件。
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