CN104337558B - 用于执行手术吻合术的方法和装置 - Google Patents
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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
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
- A61B17/1155—Circular staplers comprising a plurality of staples
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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
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
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- 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
- A61B90/90—Identification means for patients or instruments, e.g. tags
- A61B90/98—Identification means for patients or instruments, e.g. tags using electromagnetic means, e.g. transponders
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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
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00221—Electrical control of surgical instruments with wireless transmission of data, e.g. by infrared radiation or radiowaves
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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
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B2017/1132—End-to-end connections
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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
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
- A61B2017/1157—Staplers for performing anastomosis in a single operation applying the staples radially
Abstract
公开了一种圆形吻合器。所述圆形吻合器包括手柄组件、细长主体以及钉仓组件。所述细长主体从所述手柄组件延伸并且限定了纵向轴线。所述钉仓组件布置为邻近所述细长主体的远侧端。所述钉仓组件包括推动器组件和刀具组件。所述推动器组件能够移动以引起吻合钉从钉仓组件射出。所述刀具组件能够相对于所述推动器组件移动以向远侧平移刀具。刀具组件的刀架在其上包括至少一个闩锁。所述至少一个闩锁被配置为响应于所述刀架和所述推动器组件之间的移动而接触推动器组件的接合表面。所述至少一个闩锁被防止向远侧平移超出所述接合表面。还公开了用于执行手术吻合术的方法和装置。
Description
技术领域
本公开总体涉及用于将手术吻合钉施加至身体组织的手术吻合装置。更特别地,本公开涉及适合于执行圆形吻合术和/或对中空组织器官的内壁的处理的手术吻合装置。
背景技术
吻合术是将分离的中空器官段进行手术连结。通常,吻合术操作是在去除病变或有缺陷的中空组织段且要连结剩余端部段的手术后进行的。根据所需的吻合术操作,端部段可以通过环形的、端对端的或侧对侧的器官重构方法来连结。
在圆形吻合术操作中,通过吻合器械连接器官段的两端,所述吻合器械驱动圆形阵列的吻合钉穿过每个器官段的端部段并且同时对被驱动的圆形吻合钉阵列之内的任何组织进行去芯,从而清空管状通道。在序号为6,053,390、5,588,579、5,119,983、5,005,749、4,646,745、4,576,167以及4,473,077的美国专利中公开了用于执行中空器官的圆形吻合术的器械的例子,上述专利的每一个的全部内容均通过引用结合在此。通常,这些器械包括细长轴,所述细长轴在近侧端具有手柄部来致动所述器械并且在其远侧端处布置有吻合钉保持部件。砧座组件包括附有砧座头的砧座杆,所述砧座组件被安装在器械的远侧端上,邻近吻合钉保持部件。待吻合的中空器官的组织的相对端部在所述砧座头和所述吻合钉保持部件之间被夹紧。通过从所述吻合钉保持部件中驱动出一个或多个吻合钉,使吻合钉的端部穿过组织并且通过所述砧座头变形,从而来吻合被夹紧的组织。环形刀具被推进用来挖出中空器官中的组织,从而清空器官内的管状通道。通常,吻合钉形成机构的致动和刀具的推动同时——即同步地——发生。
除了中空器官的吻合术,用于执行圆形吻合术的手术吻合装置已经被用来治疗直肠内的内痔。通常,在使用用于痔疮治疗的圆形吻合装置的过程中,伴随砧座头和吻合钉保持部件处于打开或未接近位置,手术吻合装置的砧座头和吻合钉保持部件通过肛门插入并进入直肠。之后,钱袋拉索式缝合线被用来朝向砧座头拉动内痔组织。接下来,砧座头接近吻合钉保持部件以夹紧砧座头和吻合钉保持部件之间的痔疮组织。吻合装置被激发以移除痔疮组织并且吻合被切割的组织。
发明内容
本公开涉及圆形吻合器,其包括手柄组件、细长主体、以及钉仓组件。所述细长主体从所述手柄组件延伸并且限定了纵向轴线。所述钉仓组件布置为邻近细长主体的远侧端。所述钉仓组件包括推动器组件和刀具组件。所述推动器组件能够移动以引起吻合钉从钉仓组件射出。所述刀具组件能够相对于所述推动器组件选择性地移动以向远侧平移刀具。所述刀具组件的刀架包括在其上的至少一个闩锁。所述至少一个闩锁被配置为响应于所述刀架与所述推动器组件之间的移动而接触所述推动器组件的接合表面。所述至少一个闩锁被防止向远侧平移超出接合表面。
在所公开的实施例中,所述刀架的至少一个闩锁被包括在挠性臂的近侧端上,并且所述挠性臂被配置为朝向所述纵向轴线弯曲。通过沿由远侧-至-近侧的方向移动所述刀架穿过贯通所述推动器组件延伸的通路,所述刀架被配置为与所述推动器组件装配在一起。
在所公开的实施例中,刀架的近侧部包括环形沟槽。所述环形沟槽被配置为接合驱动构件。所述环形沟槽被定位为比所述至少一个臂以及所述至少一个闩锁的整体更近侧。所述至少一个闩锁的近侧部包括斜面,以及,所述至少一个闩锁的远侧部包括与所述纵向轴线基本垂直的表面。
本公开还涉及圆形吻合器,其包括手柄组件、从所述手柄组件延伸并且限定了纵向轴线的细长主体、驱动构件、以及钉仓组件。所述驱动构件被配置为响应于手柄组件的致动而纵向平移,并且包括布置为邻近其远侧部的凹槽。所述钉仓组件被布置为邻近所述细长主体的远侧端,并且包括推动器组件。所述推动器组件被配置为机械接合所述驱动构件的一部分并且能够纵向平移以引起吻合钉从所述钉仓组件射出。所述推动器组件包括至少一个指状件,且所述至少一个指状件包括凸出。所述至少一个凸出被配置为响应于所述驱动构件与所述推动器组件之间的相对接近而接合所述驱动构件的凹槽。
在所公开的实施例中,至少一个凸出的远侧壁相对于所述纵向轴线形成角度α1,并且所述α1在大约70°与大约80°之间。此处,公开的是,所述凹槽的远侧壁相对于所述纵向轴线形成角度α2,并且所述α2在大约70°与大约80°之间。可以进一步预想,α1在大约75°与大约78°之间。
在所公开的实施例中,所述至少一个指状件被配置为朝向所述纵向轴线弯曲以利于驱动构件与推动器组件之间的接合。
在所公开的实施例中,所述至少一个凸出沿基本垂直于所述纵向轴线的方向的高度在大约0.010英寸与大约0.020英寸之间。可以预想所述至少一个凸出的高度接近等于0.015英寸。进一步公开的是,所述凹槽部沿基本垂直于所述纵向轴线的方向的深度在大约0.010英寸与大约0.020英寸之间。
在所公开的实施例中,所述推动器组件的至少一部分包括填充玻璃的聚碳酸酯。所述推动器组件的填充玻璃的聚碳酸酯中玻璃的百分比在大约20%与大约40%之间。
在所公开的实施例中,所述圆形吻合器进一步包括刀具组件,其能够相对于所述推动器组件选择性移动以向远侧平移刀具。
在所公开的实施例中,所述手柄组件被配置为接收来自电源的动力。所述圆形吻合器包括被布置为与所述钉仓组件机械协作的通信芯片。所述通信芯片被配置为与所述圆形吻合器的其他部分往来传递信息。
本公开还涉及用于与圆形吻合器一起使用的砧座组件。所述砧座组件包括砧座头和环刀。所述砧座头包括多个吻合钉变形凹穴和环形空腔。所述砧座头包括沿其内部环形表面布置的沟槽。环刀被配置为用于至少部分地被接纳在环形空腔内,并且包括从其外壁径向地向外延伸的至少一个凸出。所述至少一个凸出被配置为接合所述砧座头的沟槽以助于将环刀的至少一部分至少部分地保持在所述空腔内。
在所公开的实施例中,环刀包括外环、内环、布置在所述外环与所述内环之间的环形刀具通道、以及布置为近侧地邻近所述刀具通道的可割断部。在圆形吻合器的典型应用过程中,所述可割断部被配置为被刀具切割。
所述至少一个凸出包括近侧表面和远侧表面。所述至少一个凸出的近侧表面基本垂直于所述环刀的环形壁,所述至少一个凸出的远侧表面相对于环刀的环形壁并且相对于所述至少一个凸出的近侧表面成斜角地布置。此处,公开的是,环刀被配置为沿由远侧-至-近侧的方向插入所述砧座头的环形空腔,从而使所述至少一个凸出的远侧表面接触砧座头的一部分并引起环刀径向地向内地偏转以允许所述至少一个凸出向远侧延伸超出由所述沟槽的近侧表面形成的唇缘。进一步公开的是,所述至少一个凸出的近侧表面被配置为接合所述沟槽的唇缘。
环刀可包括聚乙烯。
在所公开的实施例中,所述至少一个凸出被配置为,在圆形吻合器的刀具被推进之后,并且在环刀的一部分被所述刀具切割之后,接合所述砧座头的沟槽以助于将环刀的至少一部分至少部分地保持在所述空腔内。
本公开设想用于与圆形吻合器一起使用的外壳组件。所述外壳组件包括壳体和吻合钉钉仓。所述壳体包括限定了近侧壁和远侧壁的孔隙,且限定了贯通其延伸的纵向轴线。所述吻合钉钉仓被配置为至少部分地在其中容纳多个吻合钉,并且包括至少被配置为机械接合所述孔隙的远侧壁的一个凸出。所述至少一个凸出被配置为朝向所述纵向轴线弯曲以利于组件所述壳体与所述吻合钉钉仓之间的装配。
在所公开的实施例中,所述至少一个凸出的近侧表面相对于所述纵向轴线成角度布置。
在所公开的实施例中,所述至少一个凸出的远侧表面包括基本垂直于所述纵向轴线第一表面。此处,公开的是,所述至少一个凸出的远侧表面包括相对于所述第一表面并且相对于所述纵向轴线成角度布置的第二表面。进一步公开的是,所述第一表面被径向地布置在所述第二表面的外侧。进一步公开的是,所述远侧表面的径向地最内侧的点是所述远侧表面的最近侧点。另外,公开的是,所述孔隙的远侧壁包括第一表面,其基本垂直于所述纵向轴线;以及第二表面,其相对于所述第一表面且相对于所述纵向轴线成角度布置。
在所公开的实施例中,所述外壳组件进一步包括圆柱形套管,其能够定位在所述壳体的远侧部邻近处。所述套管被配置为覆盖所述壳体的孔隙以及吻合钉钉仓的至少一个凸出。此处,公开的是,套管的至少一部分包括塑料。
本公开还涉及用于与圆形吻合器一起使用的外壳组件工具箱。所述外壳组件工具箱包括第一吻合钉钉仓、第二吻合钉钉仓、第一砧座组件和第二砧座组件。第一吻合钉钉仓被配置为容纳两排吻合钉,并且包括布置为与其机械协作的第一套管针。第二吻合钉钉仓被配置为容纳三排吻合钉,并且包括被布置与其机械协作的第二套管针。第一砧座组件包括两排吻合钉变形凹穴,以及被配置为机械接合第一套管针的第一固位杆。第二砧座组件包括三排吻合钉变形凹穴,并且包括被配置为机械接合第二套管针的第二固位杆。第一套管针被物理上地防止恰当接合第二固位杆,第二套管针被物理上地防止恰当接合第一固位杆。
在所公开的实施例中,所述第一套管针包括至少一个指示器,当所述第一套管针不恰当地接合所述第二固位杆时,所述至少一个指示器可被用户感受到。当所述第一套管针恰当地接合所述第一固位杆时,所述至少一个指示器不会被用户感受到。
在所公开的实施例中,第一固位杆包括被配置为接合第一套管针的唇缘的凹槽,第二固位杆包括被配置为接合第二套管针的唇缘的凹槽。此处,公开的是,第一固位杆包括比第二固位杆的对应的直径大的直径。进一步公开的是,第一固位杆的凹槽与近侧唇缘之间的距离小于第二固位杆的凹槽与近侧唇缘之间的距离。
在所公开的实施例中,第一固位杆的组织接触部沿其整个长度逐渐变细。此处,公开的是,第一砧座组件的砧座头能够相对于第一固位杆倾斜。
附图说明
本文参照附图公开了手术吻合器械的实施例,其中:
图1是根据本公开的实施例的手术吻合器械的立体图。
图2是图1的手术吻合器械的钉仓组件的放大立体图。
图3是图2的钉仓组件的分解立体图。
图4是处于接近位置的外壳组件的立体图,其中包括图2和图3的钉仓组件。
图5是图4所示细节指示区域的放大图。
图6是与钉仓组件的外壳体分离的吻合钉引导件的立体图。
图7是图5所示细节指示区域的剖视图。
图8是图7所示细节指示区域的放大图。
图9是被配置为与本公开的外壳组件一起使用的套管的立体图。
图10是被定位在外壳组件上的图9的套管的立体图。
图11是与本公开的钉仓组件的推动器接合器相接合的刀架的立体图。
图12是图11所示细节指示区域的放大图。
图13是图11的刀架的立体图。
图14是图11的推动器接合器的立体图。
图15是沿图14的线15-15取得的推动器接合器的剖视立体图。
图16是与图11的推动器接合器相接合的刀架的剖视图。
图17是图16所示细节指示区域的放大图。
图18是外壳组件的剖视图,其示出了图11的处于推进位置的推动器接合器。
图19是外壳组件的剖视图,其示出了图11的处于推进位置的刀架。
图20是图19所示细节指示区域的放大图。
图21是外壳组件的剖视图,其示出了图11的处于收回位置的刀架。
图22是依照本公开的实施例的包括环刀的砧座组件的一部分的立体图。
图23是图22的环刀的立体图。
图24是图22的砧座组件的砧座头的立体图。
图25是图24的砧座头的一部分的剖视立体图。
图26是图22的与本公开的外壳组件相接合的砧座组件的一部分的剖视立体图,且其并且其示出了处于近侧位置的刀具。
图27是图26的砧座组件和外壳组件的一部分的剖视立体图,并且其示出了处于推进位置的刀具。
图28是依照本公开的实施例的砧座组件的立体图。
图29是图28的砧座组件的侧视图,并且显示砧座头在组织内。
图30是图28和图29的砧座组件的侧视图,并且显示砧座头处于倾斜位置且在组织内。
图31是依照本公开的第一套管针的立体图。
图32是与第一固位杆接合的图31的第一套管针的纵向剖视图。
图32A是依照本公开的与第二固位杆接合的第二套管针的纵向剖视图。
图33是与第一固位杆部分地接合的第二套管针的纵向剖视图。
图34是与第二固位杆部分地接合的第一套管针的纵向剖视图。
图35是依照本公开的实施例的驱动构件和推动器接合器的一部分的立体装配图。
图36至图38是图35的驱动构件和推动器接合器的纵向剖视图,并且其以不同接合阶段显示。
图39是处于接合位置的图35的驱动构件和推动器接合器的一部分的立体图。
图40是依照本公开的实施例的通信芯片组件的立体图。
图41是被定位在外壳组件内的图40的通信芯片组件的立体剖视图。
具体实施方式
将参照附图详细描述本公开的手术吻合器械的实施例,其中在几幅附图中的每一幅图中,相同的附图标记代表相同的或对应的元件。如本领域中通用的,术语“近侧”表示较接近用户或操作者(即,外科医生或医师)的部分或部件,而术语“远侧”表示较远离用户的部分或部件。
图1示出了根据本公开的手术吻合器械的实施例,其被总体标示为圆形吻合器10。圆形吻合器10包括手柄组件20、从手柄组件20向远侧延伸的细长主体部30、以及安装为与细长主体部30的远侧端处邻近的外壳组件100。手柄组件20包括固定手柄22和活动手柄或扳机24。手柄组件20还包括接近旋钮26,其用于相对于外壳组件100的钉仓组件110来移动砧座组件105。本文对手柄组件20的结构和功能的描述仅达到必要地充分公开外壳组件100的操作的程度。可以预想外壳组件100可与任何致动组件一起使用,所述致动组件为电动的或手动的,并且胜任两个独立的致动冲程,例如,在递交于2010年11月15日的申请号为12/946,082的共有的美国专利中公开了具有包括第一驱动构件和第二驱动构件的动力致动组件的手术装置,上述专利的全部内容通过引用结合在此。另外,可以预想,独立致动冲程可通过完成两个冲程的相同驱动构件实现或通过两个单独的驱动构件实现。
参照图2,显示了钉仓组件110,并且其可操作地安装至圆形吻合器10的细长主体部30的远侧端(图1)。在所公开的实施例中,钉仓组件110被可拆卸地紧固至细长主体部30,以使得钉仓组件110,或其一部分,可被替换,并且圆形吻合器10可重复使用。在其他实施例中,只有部分钉仓组件110被配置为可被移除并且随后被替换或重新加载。可选地,圆形吻合器10可配置为单次使用,即,一次性的。
参照图2和图3,钉仓组件110包括壳体120、推动器组件530、吻合钉钉仓150、以及刀具组件400。钉仓组件110的壳体120包括外圆柱形部122、内圆柱形主体124、以及在内圆柱形部124和外圆柱形部122之间延伸并且使两者相互连接的多个径向延伸的支撑物或肋件(未显示)。内圆柱形部124与外圆柱形部122同轴并且在其间限定了凹槽123,凹槽123被配置为接纳推动器组件530和刀具组件400的远侧部。
刀具组件400包括刀架420和圆形刀具440。刀具440基本是圆柱形构件,其具有近侧端442、远侧端444、并贯通其中限定了纵向开口443。刀具440被定大小且被配置为通过吻合钉钉仓150的凹槽123被接纳。刀具440的远侧端444被配置为用于切割组织。刀具440的近侧端442被配置为绕刀架420的远侧部424被接纳并且包括一对相对的凸出446,凸出446被配置为被接纳在形成于刀架420的远侧部424内的对应的凹槽421内。
刀架420的近侧部422限定了环形沟槽463,环形沟槽463被配置为当卡环180处于第一或压缩情况或处于第二或膨胀情况时容纳卡环180。当圆形吻合器10处于第一或初始位置,并且在圆形吻合器10的第一冲程之后,收回推动器接合器532之前,卡环180被完全接纳在形成于刀架420内的环形沟槽463内。刀架420的近侧部422进一步限定了形成在环形沟槽463内或形成在邻近环形沟槽463处的梯状部462a。当卡环180处于第二或膨胀状态,梯状部462a被配置为接合卡环180的内环形部。而且,在第二或组织切割冲程的过程中,卡环180与梯状部462a的接合防止卡环180的径向压缩。卡环180以及其与刀架420的接合的更多细节被描述在递交于2013年1月11日的申请序号为13/739,246的美国专利中,其全部内容通过引用结合于此。
继续参照图2和图3,壳体120的外圆柱形部122的近侧端122a包括形成于其上的多个凸出125,其被配置为使钉仓组件110可操作地接合细长主体部30的远侧端(图1)。壳体120的外圆柱形部122进一步限定多个开口129。多个开口129的每一个均被配置为接合形成在推动器接合器532的远侧部534上的多个制动器538a、538b中的一对,这将在下文进一步详细讨论。
现在参照图3,推动器组件530包括推动器接合器532和推动器构件540。推动器接合器532基本是圆柱形构件,其具有近侧部532a和远侧部534。推动器接合器532的近侧部532a被配置为可操作地接合驱动构件800(例如,参见在图35至图39中公开的实施例)。推动器接合器532的远侧部534被配置为可操作地接合推动器构件540。推动器构件540不是紧固地贴上推动器接合器532,因此,在圆形吻合器10的第一或吻合冲程之后的收回推动器接合器532的过程中,推动器构件540仍然处于推进位置,这将在下文中进一步详细讨论。如此,在圆形吻合器10的第二或组织切割冲程的过程中,所需的移动推动器接合器532的力不包括所需的移动推动器构件540的力。
继续参照图3,推动器接合器532限定了贯通其中延伸的纵向通路531。纵向通路531的远侧端被定尺寸并被配置为以滑动方式接纳刀具组件400。推动器接合器532进一步限定了沿其长度延伸的多个纵向狭槽533。狭槽533在大小和地点上对应形成在壳体120内的外圆柱形部122和内圆柱形部124之间并且将此两者相互连接的支撑物(未显示)。推动器接合器532被配置为被接纳在壳体120的外圆柱形部122内并且绕壳体120的内圆柱形部124。如此,狭槽533接纳壳体120的各支撑物使得壳体120的内圆柱形部124可被接纳在推动器接合器532的纵向通路531内。多个凹槽535a形成在推动器接合器532的远侧表面534a内并且被配置为接合形成在推动器构件540的近侧的正对的表面上的凸出(未显示)(例如,以确保在发射冲程期间的径向对齐)。如上所讨论,推动器接合器532包括多个成对的制动器538a、538b,其被配置为选择性地被接纳在形成于壳体120的外圆柱形部122内的开口129内。
仍然参照图3,推动器构件540包括近侧部542和远侧部544。推动器构件540的近侧部542限定了被配置为被选择性地接纳在形成于推动器接合器532的远侧表面534a上的多个凹槽535a内的多个凸出(未显示)。推动器构件540的远侧部544包括从其向远侧延伸并且排列成三个同心排的多个推动器元件546。推动器元件546与被接纳在吻合钉钉仓150内的吻合钉“S”对齐,从而使得推动器构件540相对于吻合钉钉仓150推进以引起吻合钉“S”从吻合钉钉仓150射出。槽口535形成在推动器接合器532的远侧部534内并且被配置为接纳刀具组件400的卡环180的外环形部,并且推动器接合器532的壁架536被配置为在圆形吻合器10的第二或切割冲程的过程中接合卡环180的外环形部。另外,凸出536a被配置为将卡环180保持接合在推动器接合器532的远侧部534内。
参照图2和图3,吻合钉钉仓150基本是圆柱形构件,其被配置为可操作地接合壳体120的外圆柱形部122的远侧端122b并且限定了纵向开口151。吻合钉钉仓150包括绕开口151被布置排列成三个同心排的多个吻合钉接纳凹穴152。吻合钉接纳凹穴152与形成于推动器构件540的远侧部544上的推动器元件546对齐。
参照图4至图8,示出了壳体120与吻合钉钉仓150之间的接合。在使用圆形吻合器10之前(例如,在装配过程中),壳体120和吻合钉钉仓150被配置为彼此机械接合。在这个实施例中,壳体120能够经由机械接口与吻合钉钉仓150接合。更特别地,壳体120包括能够与吻合钉钉仓150上的至少一个凸出300相接合的至少一个孔隙200。
吻合钉钉仓150上的凸出300能够向内弯曲(相对于由细长主体部30限定的纵向轴线A-A)以利于装配。凸出300包括斜坡的近侧表面302,以及远侧表面304(图8)。可以预想,远侧表面304包括基本垂直的表面306(相对于纵向轴线A-A)、斜面308、或其组合。在图示实施例中(例如,参见图8),凸出300的远侧表面304包括垂直表面306和斜面308。斜面308是成角度的以使得更接近纵向轴线A-A的部分被布置在较远离所述纵向轴线A-A的斜面308的一部分的近侧斜面。可以预想,吻合钉钉仓150包括任何数量的凸出300。
壳体120上的孔隙200被定尺寸并被定位为与凸出300机械接合。可以预想,壳体120包括任何数量的孔隙200。进一步可以预想,孔隙200的数量等于或不等于凸出300的数量。另外,公开的是,凸出300和孔隙200的尺寸和/或定向仅允许其间的沿唯一径向定向的接合(例如,用于防错装配)。可以预想,孔隙200的远侧壁202包括基本垂直的表面204(相对于纵向轴线A-A)、斜面206、或其组合。在图示的实施例中(例如,参见图8),孔隙200的远侧壁202包括垂直表面204和斜面206。斜面206是成角度的以使得更接近所述纵向轴线A-A的部分被布置在更远离纵向轴线A-A的斜面206的部分的近侧。如图所示,孔隙200的远侧壁202的定向与凸出300的远侧表面304的定向互补。
可以预想,远侧壁202和远侧表面304的互补表面,其分别包括斜面206和308,有助于在壳体120与吻合钉钉仓150之间提供改进的固位。相对于在凸出300的远侧表面304和孔隙200的远侧壁202分别不包括斜面308和206的实施例,在这个实施例中,将需要更大的力(例如,沿图8箭头“F”的实质方向)使吻合钉钉仓150与外壳体120脱离。
在图示的实施例中,壳体120还包括多个纵向狭槽220,其中,在每一个孔隙200的每一侧上均布置有一个狭槽220。狭槽220从壳体120的远侧边缘222向近侧延伸。可以预想,狭槽220能够使壳体120的围绕孔隙200的部分径向地向外地弯曲,以利于壳体120和吻合钉钉仓150之间的机械接合。可以理解的是,为了机械接合壳体120和吻合钉钉仓150,这两个部件被接近以使得壳体120的围绕孔隙200的部分径向地向外地弯曲从而允许吻合钉钉仓150的凸出300进入孔隙200。凸出300在对应的孔隙200内之后,壳体120的围绕孔隙200的部分径向地向内地弯曲以有效地将壳体120和吻合钉钉仓150锁定在一起。
可以预想,壳体120和吻合钉钉仓150之间的机械接合是在其间唯一的接合类型。例如,机械接合消除了对两个部件之间的粘合剂的需求或将部件焊接在一起的需求。
参照图9和图10,本公开包括标签(例如,粘性标签)或套管(例如,收缩套管)350。套管350能够被定位在与壳体120的远侧部邻近处并且被配置为覆盖孔隙200、狭槽220和凸出300(参见图5)。例如,套管350的使用有助于确保组织不被捕获或挤压在孔隙200、狭槽220或凸出300内,并且还有助于在壳体120插入组织的过程中限制凸出300相对于孔隙200径向地向外移动。
另外,可以预想,套管350可包括涉及,例如,吻合器械的管腔和/或吻合钉的大小的信息(例如,标记或颜色)。可以预想,套管350的圆周等于或大于壳体120的远侧部的圆周。在套管350具有较大圆周的实施例中,套管350的重叠部将覆盖套管350与壳体120之间的纵向接合处。可以预想,套管350由塑料(例如,聚氯乙烯(PVC)、聚对苯二甲酸乙二醇酯(PET)、聚丙烯、等)或其他适合材料制成。
参照图11至图21,显示了推动器接合器532与刀架420之间的接合。特别参照图12和图13,刀架420的近侧部422包括多个闩锁426,当刀架420相对于推动器接合器532纵向平移预定量,每个闩锁426均被配置为机械接合推动器接合器532的接合表面550(例如,底切表面)。可以理解的是,闩锁426与接合表面550之间的接合防止或基本防止刀架420的部分向远侧平移超出推动器接合器532的部分。
更特别地,刀架420的闩锁426被布置在挠性臂428的近侧端。臂428被配置为朝向刀架420的径向中心偏转以利于刀架420与推动器接合器532之间的接合/装配。而且,为了装配刀架420和推动器接合器532,刀架420通过推动器接合器532的远侧开口560沿近侧方向插入,直到闩锁426的斜面430接触推动器接合器532的内壁的成角度的表面562。斜面430与成角度的表面562之间的接触,与刀架420相对于推动器接合器532的向近侧的移动一起,引起臂428径向地向内偏转,这允许闩锁426的远侧壁426a向近侧移动超出推动器接合器532的接合表面550。一旦处于这个位置,臂428径向地向外偏转(例如,朝向其偏置位置)使得推动器接合器532的接合表面550能够物理上地防止闩锁426的远侧壁426a越过其向远侧纵向平移(参见图16和图17)。进一步可以预想,闩锁426的远侧壁426a包括斜面(例如,与刀架420的径向中心最接近的斜面的近侧部分),并且推动器接合器532的接合表面550包括互补表面。
现在参照图16至图21,描述了推动器接合器532、刀架420和壳体120之间的相对移动。图16示出了处于收回位置的推动器接合器532和刀架420。如图17所示(其是图16的一部分的放大图),闩锁426和接合表面550的定向限制了刀架420相对于推动器接合器532向远侧运动的量。可以理解的是,这个定向防止用户在组织被吻合之前切割组织。图18示出了处于推进位置的推动器接合器532,并且刀架420处于收回位置(例如,响应第一致动冲程以吻合组织)。图19示出了处于推进位置的推动器接合器532,并且刀架420处于推进位置(例如,响应第二致动冲程以切割组织)。如图20所示(其是图19的一部分的放大图),闩锁426和接合表面550之间的接合防止刀架420相对于推动器接合器532的额外向远侧运动。图21示出了处于其推进位置的推动器接合器532,并且刀架420处于其收回位置(例如,组织被切割之后)。可以理解的是,在这个实施例中,推动器接合器532仍然处于其推进位置的这个事实有助于防止刀具440与圆形吻合器10的用户之间、以及刀具440与患者之间的无意接触。
此处公开的实施例中,刀架420的近侧部422被配置为接合卡环180,除此实施例外,公开了另一个实施例,其中,当刀架420机械接合推动器接合器532时,刀架420的近侧部422被配置为机械接合驱动构件或套管450刀架。更特别地,在这个实施例中,刀架420的近侧部422的环形沟槽463被包括在多个支架460上(图13),其中每个支架460包环形沟槽463的一部分,环形沟槽463被配置为接合驱动套管450的唇缘452(图16、图18、图19以及图21)。而且,支架460被配置为径向地向内偏转,这允许刀架420的近侧部422向近侧纵向平移超出驱动套管450的唇缘452,从而有效地将刀架420与驱动套管450联接(例如,参见图16、图18、图19和图21)。可以理解的是,在这个实施例中,驱动套管450的纵向平移(例如,经由手柄24的第二致动冲程)引起刀架420的对应的纵向平移。
参照图22至图27,依照本公开的实施例示出了砧座组件105的更多细节。砧座组件105能够相对于钉仓组件110纵向移动,并且包括固位杆108,其选择性地将砧座组件105与手术吻合器10的其余部分连接。砧座组件105包括砧座头600和环刀620。砧座头600包括在其内直接形成(即,无需包括惯例的砧座板)的多个吻合钉变形凹穴602。凹穴602被配置为接纳从吻合钉钉仓110射出的吻合钉的支架并且将支架变形为合适的形状。在所示实施例中,凹穴602被布置为三排并且沿砧座头600的表面604的组织接触表面环形地延伸。砧座组件105还包括从砧座头600向近侧延伸的附接构件606。附接构件606被配置为可枢转地接合固位杆108。环形空腔608由砧座头606限定并且绕(例如,围绕)附接构件606布置(图24和图25)。可以预想,砧座头606的整体是一体式的形成和/或由相同材料制成。
环刀620被配置为定位在砧座头600的环形空腔608内。更特别地,环刀620包括外环622、内环624、布置在外环622与内环624之间的环形刀具通道626、以及近侧地-邻近刀具通道626布置的可割断部628。在圆形器械10的切割冲程的过程中,可割断部628被配置为被刀具440(参见图26和图27)切割。
环刀620还包括绕其外环形边缘622布置的多个凸出630。凸出630被配置为机械地接合绕砧座头600的内环形表面612布置的沟槽610。环刀620上可以包括任何数量的凸出630(包括沿整个表面612延伸的单个凸出630))。更特别地,每一个凸出630均包括近侧表面632,其基本垂直于环形边缘629;以及远侧表面634,其相对于环形边缘629并且相对于近侧表面632成角度。
凸出630的远侧表面634被配置以利于环刀620与砧座头600之间的装配。即,在装配过程中,环刀620沿由近侧-至-远侧的方向插入环形空腔608以使得远侧表面634接触砧座头600的一部分并且引起环刀620径向地向内偏转以允许凸出630向远侧延伸超出由沟槽610的近侧表面形成的唇缘611。进一步预想,环刀620由挠性材料(例如,聚乙烯)制成以进一步利于装配。
参照图26和图27,凸出630的近侧表面632被配置为接合沟槽610的唇缘611以有助于确保其间的接合。更特别地,使用时,当刀具440被推进以切割组织,刀具440也刺入可割断部628,这分离了外环622和内环624(参见图27)。如图27所示,当与图26相比较,刀具440的远侧推进还在空腔608内向远侧推动环刀620。当砧座头600被移除时,环刀620的外环622和砧座头600之间的接合有助于确保外环622从手术部位移除。
参照图28至图30,依照本公开的实施例示出了砧座组件105与其固位杆108的更多细节。如上所讨论,砧座头600可枢转地接合固位杆108,例如,以利于砧座组件105从组织内移除。使用时,组织“T”被绑紧或被钱袋拉索式地缝合至固位杆108的远侧部108a。远侧部108a被限定为布置在唇缘109的远侧,这被配置为限制组织“T”的近侧运动,并作为固位杆108的被配置为接触组织“T”的部分。
在图示实施例中,固位杆108的远侧部108a沿其整个长度逐渐变细。而且,远侧部108a包括连续的锥形物,其包括凹部108b和凸部108c。如图所示,远侧部108a缺少梯状的形态并且缺少陡峭的角度变化。可以预想,当砧座头600倾斜并因此向近侧推动组织“T”时,固位杆108的远侧部108a的这个锥形形态有助于钱袋拉索式缝合的组织“T”容易地向近侧滑动(参见图30)。
参照图31至图34,砧座组件105的固位杆108被配置为选择性地接合向远侧延伸超出钉仓组件110的套管针700。更特别地,这个实施例示出了第一固位杆108’,其被配置为接合第一套管针700’(图32),以及第二固位杆108”,其被配置为接合第二套管针700”(图32A)。然而,此处,第一固位杆108’不能恰当地接合第二套管针700”(图33),并且第二固位杆108”不能恰当地接合第一套管针700’(图34)。即,第一固位杆108’和第一套管针700’之间的接合,以及第二固位杆108”与第二套管针700”之间的接合会导致两个部件彼此紧固地接合以使得第一部件(例如,第一固位杆108’)沿与第二部件(例如,第一套管针700’)相反的方向的纵向平移会导致第二部件的对应量的纵向平移。反之,尝试使第一固位杆108’接合第二套管针700”,或使第二固位杆108”接合第一套管针700’会导致两个部件脱离彼此的紧固接合从而使得第一部件(例如,第一固位杆108’)沿与第二部件(例如,第二套管针700”)相反的方向的纵向平移会引起第一部件移动远离第二部件。
可以预想,第一固位杆108’和第一套管针700’中的每一个均被配置为与特定形态的吻合钉一起使用。例如,可以预想,第一固位杆108’是包括两排吻合钉变形凹穴602的砧座组件105的一部分,第一套管针700’是外壳组件100和吻合钉钉仓150的一部分/与其一起使用,所述外壳组件100包括两排推动器元件546,所述吻合钉钉仓150具有两排吻合钉“S”。同样地,可以预想,第二固位杆108”是包括三排吻合钉变形凹穴602的砧座组件105的一部分,第二套管针700”是外壳组件100和吻合钉钉仓150的一部分/与其一起使用,所述外壳组件100包括三排推动器元件546,所述吻合钉钉仓150具有三排吻合钉“S”。
更特别地,第一固位杆108’包括被配置为接合从第一套管针700’延伸出的唇缘700’L的凹槽108’R(图32)。类似地,第二固位杆108”包括被配置为接合从第二套管针700”延伸出的唇缘700”L的凹槽108”R(图32A)。固位杆108’、108”和套管针700’、700”的几何形状实现其间的这个防错接合。更特别地,参照图32和图32A,可以预想并且示出了,第一固位杆108包括比第二固位杆108”的对应的直径dr”更大的直径dr’。此处,第一套管针700’包括比第二套管针700”的对应的直径dt”更大的直径dt’。另外,可以预想并且示出了,第一固位杆108’的凹槽108’R与近侧唇缘108’P之间的距离比第二固位杆108”的凹槽108”R与近侧唇缘108”P之间的距离短。同样地,示出的实施例显示了第一套管针700’的唇缘700’L与顶部700’T之间的距离比第二套管针700”的唇缘700”L与顶部700”T之间的对应的距离短。
参照图33和图34,例如,由于上面讨论的多种几何形状,第一固位杆108’的凹槽108’R不能恰当地接合第二套管针700”的唇缘700”L(图33),并且第二固位杆108”的凹槽108”R不能恰当地接合第一套管针700’的唇缘700’L(图34)。如上所讨论的,固位杆108与套管针700之间的恰当接合是其间的紧固接合。
另外,可以预想,第一套管针700’和第二套管针700”中的每一个均包括指示器702,如果固位杆108与套管针700没有恰当接合,指示器702能够被用户感受到(例如,如果用户尝试将第一固位杆108’与第二套管针700”接合,或反之亦然)。本公开包括提供视觉的(例如,色带、字母、符号、等)、声音的(例如,哔哔声、咔哒声、等)和/或触觉的(例如,振动,等)信息的指示器702。当固位杆108与套管针700恰当接合,指示器702就不能够被用户感受到(例如,视觉的)。可选地,可以预想,如果固位杆108与套管针700之间恰当接合,指示器702能够被用户感受到;而如果固位杆108与套管针700之间没有恰当接合,指示器702不能够被用户感受到。
现在参照图35至图39,依照本公开的实施例显示了关于驱动构件800和推动器接合器532之间的接合的细节。在使用圆形吻合器10的这个实施例的过程中,执行初始致动冲程以将吻合钉“S”发射至组织。此处,驱动构件800(或其部分)被向远侧推进至接合推动器接合器532,并且驱动构件800的继续推进引起推动器接合器532向远侧推动推动器构件540以射出吻合钉“S”(如上所讨论)。接下来,驱动构件800和推动器接合器532向近侧收回(而推动器构件540仍然处于其推进位置)。然后,例如,为响应第二致动冲程,驱动构件800和推动器接合器532被再次向远侧推进以使得推动器接合器532向远侧推动和/或接合刀架420以切割组织。可以理解的是,这个实施例与前面描述的实施例不同,如此处的,独立的致动冲程由完成两个冲程的相同的驱动构件800完成(与使用两个单独的驱动构件的使用相对)。
图35至图39示出了驱动构件800和推动器接合器532之间的接合的多种特征,驱动构件800和推动器接合器532被配置为有助于利于其间的接合,并且有助于在驱动构件800的推进和收回过程中确保其间的接合。更特别地,驱动构件800(例如,接合器螺母)包括被配置为接合推动器接合器532的近侧部533上的指状件820上的凸出810的凹槽802(例如,环形凹槽)。当驱动构件800向远侧平移并且接触推动器接合器532,驱动构件800的远侧表面804接触凸出810并且径向地向内推动凸出810和指状件820(图37)。驱动构件800相对于推动器接合器532的继续推进引起凸出810和指状件820径向地向外移动,从而使凸出810在凹槽802内(图38和图39)。
在所公开的实施例中并且特别参照图36和图37,凹槽802的远侧壁803相对于所述纵向轴线A-A形成在大约70°和大约90°之间的角度α1。在实施例中,角度α1在大约70°和大约80°之间,或在大约75°和大约78°之间。类似地,凸出810的远侧壁812相对于所述纵向轴线A-A形成在大约70°和大约90°之间的角度α2。在实施例中,角度α2在在大约70°和大约80°之间,或在大约75°和大约78°之间。可以预想,由凹槽802的远侧壁803形成的角度与由凸出810的远侧壁812形成的角度相等、基本相等、或彼此不同。
另外,在所公开的实施例中,凸出810的高度“h”(以及凹槽802的对应部分的对应深度)在大约0.010英寸和大约0.020英寸之间(参见图36)。在实施例中,高度“h”接近等于0.015英寸。
进一步公开的是,推动器接合器532(或至少其指状件820)由填充玻璃的聚碳酸酯制成。此处,可以预想,玻璃的百分比在大约20%和大约40%之间(例如,大约等于30%)。
可以预想,远侧壁803和812的角度的组合、凸出810的高度“h”、以及制成推动器接合器532的材料,均对紧固推动器接合器532和驱动构件800之间的接合有贡献,并且导致使推动器接合器532从驱动构件800脱离所需的最佳量的力。
参照图40和图41,本公开还包括通信芯片组件900,其被配置为至或从圆形吻合器10的其他部分传递多种信息。特别参照图40,通信芯片组件900包括容纳通信芯片902的外套910。外套910包括管部912和环部914。参照图41,外套910的管部912被配置为压配合外壳组件100的壳体120。环部914被配置为用于围绕(或至少部分地围绕)壳体120的内圆柱形主体124(例如,经由压缩配合而设置)。另外,外套910包括多个凸出916,其被配置为接合壳体120内对应的狭槽/制动器(未明确显示)以助于防止通信芯片组件900相对于壳体120旋转。
通信芯片902的近侧部包括多个触头904,用于接合圆形吻合器10的一部分(例如,接合器,未显示)的接触销。可以理解的是,触头904和接触销之间的这个接合允许信息从圆形吻合器10的一个部分(例如手柄组件20)传递至外壳组件100。进一步,通信芯片902通过偏置构件918沿近侧方向被弹簧装载(例如,允许接触销在接合器内的定位长度公差)。
可以预想,通信芯片902包括读和写能力,并且在电动手术吻合器中尤其有用。通信芯片902的读能力使得外壳组件100的多种特征连通至手柄组件20。例如,通信芯片902可以储存并且传达涉及钉仓大小、吻合钉长度、和向上夹紧距离的信息。一旦这个信息被手柄组件20接收,例如,可因此调整发射力和发射冲程。通信芯片902的写能力使得手柄组件20,例如,给使用过的(即,已经发射的)钉仓组件110编码以防止重新使用或尝试发射没有吻合钉的钉仓组件110。连通部件(例如,芯片、发射机、控制模块、等)的更多细节公开在递交于2012年7月10日的申请序号为13/545,362的美国专利中,其全部内容通过引用结合在此。
下面将描述圆形吻合器10的使用,因其涉及本公开的多种实施例。使用时,圆形吻合器10与传统的圆形吻合器的操作方式基本相似。一旦被定位使得待吻合的组织被接纳在钉仓组件110和砧座组件105之间,并且砧座组件105经由接近旋钮26的旋转朝向钉仓组件110接近,扳机24可被压下以引起手柄组件20的致动。手柄组件20的致动引起驱动组件(例如,800)的第一推进,驱动组件接合推动器组件530并且引起推动器组件530的推进。在第一或吻合钉形成冲程的过程中,推动器组件530相对于壳体120和刀具组件400移动,而刀具组件400仍然相对于壳体120固定。如此,在圆形吻合器10的第一或吻合钉形成冲程的过程中,只有吻合钉形成功能被执行。因此,所需的完成圆形吻合器10的第一冲程的力不包括与其同时还切割组织所需的力。
随着第一或吻合钉形成冲程的完成,扳机24被释放以允许推动器组件530的驱动构件和推动器接合器532的收回。在多种实施例中,推动器接合器532被收回至其初始位置的近侧的位置。例如,可以预想,推动器接合器532被收回至比其初始起步位置更近大约0.25英寸的位置。在此收回位置,形成在推动器接合器532的远侧端内的槽口535与卡环180对齐,从而允许卡环180从第一或压缩状态膨胀至第二或未被压缩状态。
扳机24的随后的压下或致动引起驱动构件和推动器接合器532的第二推进。推动器接合器532的推进引起推动器接合器532的壁架536与卡环180接合。由于卡环180仍然与刀架420接合在此位置,推动器接合器532的推进还引起刀具组件420的推进。刀具组件400的圆形刀具440的推进引起切割被定位在钉仓组件110和砧座组件105之间的组织。因为在圆形吻合器10的第一冲程的过程中吻合钉“S”被射出并形成,并且随着第一或吻合钉形成冲程之后,推动器接合器532收回,推动器构件540仍然处于推进位置,完成圆形吻合器10的第二或切割冲程所需的力小于完成吻合钉射出/形成以及组织切割操作所需的力。可以预想,在第二冲程的过程中,由驱动构件提供的力足够用于使紧固机构保持刀具组件400相对于壳体120的内圆柱形壳体124脱离。这种紧固机构可包括刀架420的内表面上和/或壳体120的内圆柱形部124的外表面上的凸出(未显示),其被配置为被接纳在形成在内圆柱形部124的外表面的另一个上的和/或形成在刀架420的内表面上的制动器(未显示)内以使得刀具组件400被允许相对于壳体120向远侧推进。
随着组织切割冲程的完成,推动器接合器532向近侧收回至初始位置或收回位置中的一个。如上所讨论,推动器组件530和刀具组件400可被配置以使得推动器组件530与刀具组件400中的一个或全部在圆形吻合器10的第二或切割冲程之后撤回。推动器接合器532收回至初始位置或收回位置中的一个引起推动器构件540从推动器接合器532脱离。如此,推动器构件540和空的吻合钉钉仓150可从壳体120分离或卸载并且可以用新的推动器构件540和/或吻合钉钉仓150来替换。
现在将描述关于圆形吻合器10的操作,包括钉仓组件110的操作的更多细节,因其涉及本公开的多种实施例。在初始情况,推动器组件530被接纳在壳体120的外圆柱形部122和内圆柱形部124之间。刀具组件400被接纳在推动器接合器532的纵向通路531内并且绕壳体120的内圆柱形部124。吻合钉钉仓150可操作地接合壳体120的远侧部以可操作地将推动器组件530和刀具组件400保留在壳体120内。卡环180处于第一或径向压缩状态并且被接纳在形成在刀架420上的环形沟槽463内。卡环180通过推动器接合器532的内壁被保持在径向压缩状态。形成在推动器接合器532的远侧端内的槽口535被布置在环形沟槽463和卡环180的远侧。如此,推动器组件530可向远侧推进而不会引起刀具组件400的推进。
在初始位置,通过推动器接合器532的远侧部534上的多个成对的制动器538a、538b(图3)与形成在壳体120的外圆柱形部122内的开口129的接合,防止推动器组件530相对于壳体120的无意地向远侧推进。
在圆形吻合器10的第一或吻合钉形成冲程的过程中,砧座组件105相对于钉仓组件110接近之后(例如,经由接近旋钮26的旋转),扳机24相对于手柄22的致动引起驱动组件(例如,800)的推进,驱动组件(例如,800)可操作地接合推动器接合器532以引起推动器组件530的远侧平移。推动器接合器532的远侧平移推动推动器构件540从而引起推动器元件546被推动进入和/或通过吻合钉钉仓150的吻合钉接纳凹穴152并且从吻合钉钉仓150射出吻合钉“S”。尽管没有很明确的显示,吻合钉“S”从吻合钉钉仓150的射出引起吻合钉“S”推进进入砧座头600的吻合钉变形凹穴602。吻合钉“S”的形成固定了保留在吻合钉钉仓150和砧座组件105之间的组织。
随着吻合冲程的完成,推动器接合器532相对于壳体120向近侧收回。推动器接合器532相对于刀架420和卡环180充分收回从而使卡环180与形成在推动器接合器532的远侧端内的槽口535对齐。槽口535与卡环180的对齐允许卡环180从第一或压缩状态移动至未压缩状态,即,卡环180能够解除压缩或径向膨胀。
在圆形吻合器10的第二或切割冲程期间,扳机24相对于手柄26的第二致动引起驱动构件(例如,800)的推进,驱动构件(例如,800)可操作地接合推动器接合器532以引起推动器接合器532向远侧平移。推动器接合器532向远侧平移引起由形成在推动器接合器532的远侧端内的槽口535限定的壁架536接合卡环180的外部,而卡环180的内部仍然与刀架420接合。特别地,在圆形吻合器10的第二或组织切割冲程期间,推动器接合器532的第二推进的过程中,形成在刀架420的沟槽463内或形成在刀架420的沟槽463的邻近处的梯状部142a接合卡环180并且防止卡环180被径向压缩回到环形沟槽463。因此,刀架420的梯状部462a将卡环180保持在第二或膨胀状态以使卡环180仍然接触推动器接合器532和刀架420两者以确保刀具组件400随着推动器接合器532的推进而同时推进。
继续推进推动器接合器532引起刀具440通过吻合钉钉仓150的纵向开口151被接纳,从而切断保留在吻合钉钉仓150和砧座组件105之间的组织,并且从而刺入环刀620的可割断部628。可以预想,推动器组件530和刀具组件400可被配置以使得驱动组件的收回引起推动器接合器532和刀架420的收回(例如,参见图11-21)。
除了由圆形吻合器10的两冲程操作提供的减小的力的需要,圆形吻合器10的独立的或解耦的吻合钉形成和组织切割功能还允许吻合钉卷曲高度相对于刀具运动距离的变化、吻合钉相对于刀具运动速度的运动速度的变化、和/或吻合钉形成和组织切割之间的停留时间的增加。这个设置允许临床医生根据给定情况(例如,组织厚度、组织柔软度和夹紧力)使吻合钉卷曲高度最佳化。这个形态还允许监测吻合钉形成和刀具切割力,如果检测到了异常力,可提醒临床医师。这个设置进一步允许监测力和其他数据并且将其用于数据收集和研究,当分析力和其他数据时,可进一步优化操作参数,例如吻合钉弯曲高度、以及停留和运动速度。通过独立控制和优化这些多种参数,改进的止血和吻合术结合强度可导致更广泛的范围的组织厚度,从而允许临床医师在结果的基础上具有改进的和自定义的控制。更进一步,当同时执行吻合和切割功能时,待吻合的组织可被刀具移动,从而引起吻合钉支架偏转并且不对齐其预期的砧座凹穴,导致不好的吻合钉形成以及可能的漏出。
需要理解的是,可对本公开的实施例做多种改进。例如,圆形吻合器10可包括用于使钉仓组件110从两冲程操作改变成单冲程操作的机构。因此,上述描述不应被理解为限制性的,而应被理解为仅是作为特定实施例的示范。本领域技术人员将在所附的权利要求的范围和精神内预想其他改进。
Claims (19)
1.一种圆形吻合器,包括:
手柄组件;
细长主体,其从所述手柄组件延伸并限定了纵向轴线;
以及
钉仓组件,其被布置为邻近所述细长主体的远侧端,所述钉仓组件包括推动器组件和刀具组件,所述推动器组件能够移动以引起吻合钉从钉仓组件射出,所述刀具组件能够相对于推动器组件选择性移动以向远侧平移刀具,其中所述刀具组件的刀架在其上包括至少一个闩锁,其中所述至少一个闩锁被配置为响应于所述刀架与所述推动器组件之间的移动而接触推动器组件的接合表面,并且其中所述至少一个闩锁被防止向远侧平移超出所述接合表面。
2.根据权利要求1所述的圆形吻合器,其中所述刀架的至少一个闩锁被包括在挠性臂的近侧端上,并且其中所述挠性臂被配置为朝向所述纵向轴线弯曲。
3.根据权利要求2所述的圆形吻合器,其中,通过沿由远侧-至-近侧的方向移动所述刀架穿过贯通所述推动器组件延伸的通路,所述刀架被配置为与所述推动器组件装配在一起。
4.根据权利要求1所述的圆形吻合器,其中,刀架的近侧部包括环形沟槽。
5.根据权利要求4所述的圆形吻合器,其中所述环形沟槽被配置为接合驱动构件。
6.根据权利要求4所述的圆形吻合器,其中所述刀架的至少一个闩锁被包括在挠性臂的近侧端上,并且其中所述环形沟槽被配置为用于接合驱动构件并且被定位为比所述挠性臂以及所述至少一个闩锁的整体更近侧。
7.根据权利要求1所述的圆形吻合器,其中所述至少一个闩锁的近侧部包括斜面,并且其中所述至少一个闩锁的远侧部包括与所述纵向轴线基本垂直的表面。
8.根据权利要求1所述的圆形吻合器,进一步包括:
驱动构件,其被配置为响应于手柄组件的致动而纵向平移,所述驱动构件包括被布置为邻近其远侧部的凹槽,
其中所述推动器组件被配置为机械接合驱动构件的一部分并且能够纵向平移以引起吻合钉从所述钉仓组件射出,所述推动器组件包括至少一个指状件,所述至少一个指状件包括至少一个凸出,所述至少一个凸出被配置为响应于驱动构件与推动器组件之间的相对接近而接合所述驱动构件的凹槽。
9.根据权利要求8所述的圆形吻合器,其中所述至少一个凸出的远侧壁相对于所述纵向轴线形成角度α1,并且其中所述α1在70°与80°之间。
10.根据权利要求9所述的圆形吻合器,其中所述至少一个凸出的远侧壁相对于所述纵向轴线形成角度α1,并且其中所述α1在75°与78°之间。
11.根据权利要求8所述的圆形吻合器,其中所述凹槽的远侧壁相对于所述纵向轴线形成角度α2,并且所述α2在70°与80°之间。
12.根据权利要求8所述的圆形吻合器,其中所述至少一个指状件被配置为朝向所述纵向轴线弯曲以利于所述驱动构件与所述推动器组件之间的接合。
13.根据权利要求8所述的圆形吻合器,其中所述至少一个凸出的沿基本垂直于所述纵向轴线的方向的高度在0.010英寸与0.020英寸之间。
14.根据权利要求13所述的圆形吻合器,其中所述至少一个凸出的高度大约是0.015英寸。
15.根据权利要求13所述的圆形吻合器,其中所述凹槽部沿基本垂直于所述纵向轴线的方向的深度在0.010英寸与0.020英寸之间。
16.根据权利要求8所述的圆形吻合器,其中所述推动器组件的至少部分包括填充玻璃的聚碳酸酯。
17.根据权利要求16所述的圆形吻合器,其中所述推动器组件的填充玻璃的聚碳酸酯中玻璃的百分比在20%与40%之间。
18.根据权利要求8所述的圆形吻合器,其中所述手柄组件被配置为接收来自电源的动力。
19.根据权利要求18所述的圆形吻合器,进一步包括通信芯片,其被布置为与钉仓组件机械协作,所述通信芯片被配置为与圆形吻合器的其他部分往来传递信息。
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AU2014203308B2 (en) | 2018-12-06 |
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JP6395289B2 (ja) | 2018-09-26 |
CA3117639A1 (en) | 2015-01-11 |
JP2018161503A (ja) | 2018-10-18 |
US10245040B2 (en) | 2019-04-02 |
CN104337558A (zh) | 2015-02-11 |
EP2823774A3 (en) | 2015-06-17 |
EP2823774A2 (en) | 2015-01-14 |
US20190216462A1 (en) | 2019-07-18 |
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