CN104582599B - 具有关节运动轴的外科器械 - Google Patents

具有关节运动轴的外科器械 Download PDF

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CN104582599B
CN104582599B CN201380044571.9A CN201380044571A CN104582599B CN 104582599 B CN104582599 B CN 104582599B CN 201380044571 A CN201380044571 A CN 201380044571A CN 104582599 B CN104582599 B CN 104582599B
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wedge
waveguide
surgical instruments
end effector
component
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CN104582599A (zh
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F·B·斯图伦
黄志凡
P·A·韦茨曼
S·P·斯莫利克
C·J·小德拉吉诺夫
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Ethicon Endo Surgery Inc
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Ethicon Endo Surgery Inc
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    • A—HUMAN NECESSITIES
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  • Ophthalmology & Optometry (AREA)
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  • Plasma & Fusion (AREA)
  • Otolaryngology (AREA)
  • Robotics (AREA)
  • Surgical Instruments (AREA)

Abstract

各种实施例涉及可进行关节运动的外科器械。一些实施例包括用于处理组织的端部执行器，其中所述端部执行器包括超声刀片。中空轴可沿着纵向轴线从所述端部执行器朝近侧延伸。波导可延伸穿过所述轴并且可在声学上联接到所述超声刀片。所述波导可包括定位在远侧的凸缘，所述凸缘从所述刀片朝近侧定位在所述中空轴内，并且所述波导可在第一枢转点处保持静止，所述第一枢转点从所述凸缘朝近侧定位在所述中空轴内。往复式楔形件可定位在所述中空轴内，使得所述楔形件的远侧运动推动所述凸缘与所述中空轴之间的所述楔形件，从而使所述超声刀片绕所述第一枢转点在第一方向上枢转。

Description

具有关节运动轴的外科器械
相关申请的交叉引用
本申请涉及下列同时提交的美国专利申请，这些美国专利申请全文以引用方式并入本文：
美国申请序列号13/539,096，名称为“Haptic Feedback Devices for SurgicalRobot”，代理人案卷号END7042USNP/110388；
美国申请序列号13/539,110，名称为“Lockout Mechanism for Use withRobotic Electrosurgical Device”，代理人案卷号END7043USNP/110389；
美国申请序列号13/539,117，名称为“Closed Feedback Control forElectrosurgical Device”，代理人案卷号END7044USNP/110390；
美国申请序列号13/538,588，名称为“Surgical Instruments withArticulating Shafts”，代理人案卷号/110392；END6423USNP
美国申请序列号13/538,601，名称为“Ultrasonic Surgical Instruments withDistally Positioned Transducers”，代理人案卷号END6819USNP/110393；
美国申请序列号13/538,711，名称为“Ultrasonic Surgical Instruments withDistally Positioned Jaw Assemblies”，代理人案卷号END7048USNP/110395；
美国申请序列号13/538,720，名称为“Surgical Instruments withArticulating Shafts”，代理人案卷号END7049USNP/110396；
美国申请序列号13/538,733，名称为“Ultrasonic Surgical Instruments withControl Mechanisms”，代理人案卷号END7050USNP/110397；以及
美国申请序列号13/539,122，名称为“Surgical Instruments With FluidManagement System”，代理人案卷号END7051USNP/110399。
背景技术
各种实施例涉及外科装置，其包括与外科装置一起使用的各种关节运动轴和超声刀片。
超声外科装置(诸如超声刀)因其独特的性能特性而用于外科手术的多种应用中。根据具体的装置构型和操作参数，超声外科装置能够基本上同时进行组织的横切和通过凝结作用的止血，从而有利地最大程度减轻患者创伤。超声外科装置包括定位在近侧的超声换能器和联接到超声换能器的器械，该器械具有安装在远侧的端部执行器，该端部执行器包括超声刀片以切割和密封组织。端部执行器通常经由轴联接到柄部和/或机器人外科工具。刀片经由延伸穿过轴的波导而在声学上联接到换能器。具有该性质的超声外科装置能够用于开放性外科用途、腹腔镜式或内窥镜式外科手术，包括机器人辅助的手术。
超声能量使用比用在电外科手术中的温度低的温度来切割和凝结组织。通过高频振动(例如每秒55,500次)，超声刀片使组织中的蛋白质变性以形成粘性凝结物。由刀表面施加在组织上的压力使血管塌缩并且允许所述凝结物形成止血密封。外科医生能够通过由端部执行器施加至组织的力、施加该力的时间、以及端部执行器的选定偏移水平来控制切割速度和凝结。
电外科装置还用于多种外科应用。电外科装置向组织施加电能以便对组织进行处理。电外科装置可包括具有安装在远侧的端部执行器的器械，该端部执行器包括一个或多个电极。端部执行器可抵靠组织定位，使得电流被引入到组织中。电外科装置能够用于双极或单极操作。在双极操作期间，电流分别通过端部执行器的有源电极和返回电极被引入组织中并从组织返回。在单极操作期间，电流通过端部执行器的有源电极被引入组织中，并通过返回电极(例如，接地垫)返回，该有源电极与返回电极分开地位于患者的身体上。流过组织的电流所生成的热可在组织内和/或在组织之间形成止血密封，并且因此可尤其适用于例如密封血管。电外科装置的端部执行器有时还包括可相对于组织和电极移动的切割构件以用于横切组织。
由电外科装置施加的电能可通过发生器传递至器械。电能可以是射频(“RF”)能量的形式。射频能量为可在300kHz至1MHz频率范围内的电能形式。在其操作期间，电外科装置可将低频射频能量传递通过组织，这会引起离子振荡或摩擦，实际上造成电阻性加热，从而升高组织的温度。由于可在受影响的组织和周围组织之间形成明显的边界，因此外科医生能够以高精确度进行操作和控制，而不损伤相邻的非目标组织。射频能量的低操作温度可适用于在密封血管的同时移除、收缩软组织，或对软组织塑形。射频能量可尤其良好地适用于结缔组织，该结缔组织主要包含胶原，并在接触热时收缩。
对于超声和电外科装置，通常需要临床医生使器械轴的远侧部分进行关节运动以便指导超声和/或射频能量的施加。然而，引起并控制此类关节运动通常是相当大的挑战。
附图说明
多个实施例的特征结构在所附权利要求书中进行了详细描述。然而，参考结合如下附图的下列描述可最好地理解多个实施例(有关手术的组织和方法两者)及其优点：
图1示出包括外科器械和超声发生器的外科系统的一个实施例。
图2示出图1所示外科器械的一个实施例。
图3示出超声端部执行器的一个实施例。
图4示出超声端部执行器的另一个实施例。
图5示出图1所示的外科器械的一个实施例的分解图。
图6示出图1所示的外科器械的一个实施例的剖视图。
图7示出图1所示的外科器械的一个实施例的各种内部部件。
图8示出包括外科器械和超声发生器的外科系统的一个实施例的顶视图。
图9示出图1的外科器械的一个示例性实施例中包括的旋转组件的一个实施例。
图10示出包括外科器械的外科系统的一个实施例，该外科器械具有单元件端部执行器。
图11是电能外科器械的一个实施例的透视图。
图12是图11的外科器械的一个实施例的柄部的侧视图，其中移除了柄部主体的一半以示出其中的一些部件。
图13示出图11的外科器械的端部执行器的一个实施例的透视图，其中钳口打开并且可轴向运动的构件的远侧端部处于回缩位置。
图14示出图11的外科器械的端部执行器的一个实施例的透视图，其中钳口闭合并且可轴向运动的构件的远侧端部处于部分推进的位置。
图15示出图11的外科器械的可轴向运动的构件的一个实施例的透视图。
图16示出图11的外科器械的端部执行器的一个实施例的截面图。
图17示出无绳的电能外科器械的一个实施例的透视图的一部分。
图18A示出图17的外科器械的一个实施例的柄部的侧视图，其中移除了柄部主体的一半以示出其中的各种部件。
图18B示出根据一个实施例的射频驱动和控制电路。
图18C示出根据一个实施例的控制器的主要部件。
图19示出机器人外科系统的一个实施例的框图。
图20示出机械臂车的一个实施例。
图21示出图20的机械臂车的机器人操纵器的一个实施例。
图22示出具有另选的装置接头结构的机械臂车的一个实施例。
图23示出可与机械臂车(诸如图19-图22的机械臂车)结合使用的控制器的一个实施例。
图24示出适于与机器人系统一起使用的超声外科器械的一个实施例。
图25示出适于与机器人系统一起使用的电外科器械的一个实施例。
图26示出器械驱动组件的一个实施例，该器械驱动组件可联接到外科操纵器以接收和控制图24所示的外科器械。
图27示出包括图24的外科器械的图26的器械驱动组件实施例的另一个视图。
图28示出包括图25的电外科器械的图26的器械驱动组件的另一个视图。
图29-图31示出了图26的器械驱动组件实施例的适配器部分的另外视图。
图32-图34示出图24-图25的器械安装部分的一个实施例，显示用于将从动元件的运动转化成外科器械的运动的部件。
图35-图37示出图24-图25的器械安装部分的另选实施例，显示用于将从动元件的旋转转化成围绕轴的轴线的旋转运动的另选示例性机构，以及用于生成一个或多个构件沿轴538的轴线的往复式平移的另选示例性机构。
图38-图42示出图24-图25的器械安装部分的另选实施例，显示用于将从动元件的旋转转化成围绕轴的轴线的旋转运动的另一个另选示例性机构。
图43-图46A示出器械安装部分的另选实施例，显示用于使构件沿轴的轴线发生微分平移(例如，用于进行关节运动)的另选示例性机构。
图46B-图46C示出包括内部功率和能量源的工具安装部分的一个实施例。
图47示出包括第一波导部分、第二波导部分和第三波导部分的超声医疗器械的一个示例性实施例的一部分的示意性剖视图，其中第二波导部分的长度基本上为谐振纵向波长的1/2。
图47A示出图47的第二波导部分的两个示例性实施例的横截面。
图48示出包括第一波导部分和第二波导部分的超声医疗器械的一个示例性实施例的一部分的示意性剖视图，其中第一波导部分跨越多个1/2谐振纵向波长。
图49示出与医疗器械一起使用并且包括第一波导部分和第二波导部分的超声波导的一个示例性实施例的示意性剖视图，其中第一波导部分通过榫钉压力配合而结合到第二波导部分。
图50示出与医疗器械一起使用并且包括第一波导部分和第二波导部分的超声波导的一个示例性实施例的示意性剖视图，其中第一波导部分通过球窝型附件结合到第二波导部分。
图51示出包括医疗超声波导的超声医疗器械的另一个实施例的一部分的示意性剖视图，该医疗超声波导具有一定的长度并且包括近侧波导部分和远侧波导部分。
图52示出了可与各种外科器械(包括本文描述的那些外科器械)一起使用的轴的一个实施例。
图53示出了图52的轴的一个实施例，其中楔形件朝远侧平移并且刀片枢转，如所描述。
图54示出了包括若干另外的特征结构的图52的轴的另选实施例。
图55示出了具有弯曲或圆形形状的示例性楔形件的一个实施例。
图56示出了与端部执行器结合的楔形件，所述端部执行器包括超声刀片以及凸缘。
图57示出了轴的一个实施例的横截面，显示了带键凸缘。
图58示出了带键楔形件的一个实施例，其包括与图57的带键凸缘的凹口匹配的台阶。
图59示出了与轴一起使用的楔形件，该楔形件具有台阶式外形。
图60示出了与具有凸轮式关节运动机构的各种外科器械(包括本文描述的那些外科器械)一起使用的轴的一个示例性实施例。
图61示出了图60的轴的剖视图，提供了轴凸轮特征结构和波导凸轮特征结构的视图。
图62-图64示出了可与各种外科器械(包括本文描述的那些外科器械)一起使用的关节运动轴的一个实施例。
图65-图67示出了联接到包括超声刀片和可枢转的夹持臂的端部执行器的轴的一个示例性实施例。
图68示出了图65-图67的端部执行器的一个实施例，显示了利用夹持臂构件打开和闭合夹持臂的第一方式。
图69-图70示出了图65-图67的端部执行器的另一个示例性实施例，显示了利用夹持臂构件打开和闭合夹持臂的另外的方式。
图71-图72示出了图65-图67的轴的一个示例性实施例，显示了用于管理平移构件的微分平移的示例性机构。
图73-图74示出了利用呈图71-图72所示构型的图65-图67的轴的手持式外科器械的一个实施例。
图75-图76示出了可与各种外科器械(包括本文描述的那些外科器械)一起使用的关节运动轴的一个实施例。
图77示出了可与各种外科器械(包括本文描述的那些外科器械)一起使用的轴的一个实施例。
图78示出了显示图77所示外轴的一个实施例的另外细节的视图。
图79示出了图77所示的轴的一个实施例的剖面图。
图80示出了图79的轴的一个实施例的剖面图，其中外轴朝远侧延伸以使刀片进行关节运动。
图81示出了具有另外的远侧凸缘的图77的轴的一个实施例。
具体实施方式
本文所描述的示例性实施例涉及进行关节运动的外科器械、其轴以及其使用方法。外科器械可包括能够以任何合适的方式处理组织的端部执行器。在一些示例性实施例中，端部执行器包括用于切割和/或凝固组织的超声刀片。本文提供了示例性超声刀片和其操作的细节。另外，在一些示例性实施例中，端部执行器可包括一个或多个电极以向组织提供电能以用来切割、凝固和/或“焊接”组织。本文描述的外科器械可在不同的外科手术环境中使用。例如，不同实施例可针对内窥镜式、腹腔镜式和/或传统开放式外科技术来优化。另外，本文描述的外科器械的不同示例性实施例可针对临床医生的手动使用和/或针对临床医生结合外科机器人的机器人使用来优化。
本文描述的外科器械的各种示例性实施例包括沿着纵向轴线从端部执行器朝近侧延伸的伸长轴。在一些示例性实施例中，端部执行器包括超声刀片，其可以从轴内部进行关节运动和/或引导(例如，在没有以其他方式使轴进行关节运动的情况下或除了以其他方式使轴进行关节运动之外)。例如，在一些示例性实施例中，超声刀片在声学上联接到波导，该波导穿过轴从超声刀片朝近侧延伸。波导可限定定位在远侧的凸缘，该凸缘从刀片朝近侧定位在中空轴内。波导还可在第一枢转点处保持静止，该第一枢转点从凸缘朝近侧定位在轴内。往复式楔形件可定位成在轴内朝远侧和朝近侧往复运动。楔形件的远侧平移可在凸缘与轴的内壁之间推动楔形件，从而致使超声刀片和波导围绕第一枢转点远离轴的纵向轴线枢转。可在围绕轴的内壁的不同角位置处放置额外的楔形件，以便使得超声刀片在不同的方向上进行关节运动。
在一些示例性实施例中，轴的内壁限定纵向指向的狭槽，并且在楔形件朝远侧和朝近侧平移时，往复式楔形件的至少一部分定位在该纵向狭槽内。另外，在一些示例性实施例中，楔形件和凸缘具有对应的带键表面。例如，凸缘可限定凹口，并且楔形件可限定对应的台阶，使得当往复式楔形件朝远侧平移时，台阶搭放在凹口内。还可存在额外的凹口和楔形件，并且在一些示例性实施例中，其形成台阶图案。在一些示例性实施例中，往复式楔形件可为台阶式的，其中台阶沿着纵向轴线布置，使得楔形件的连续台阶引起超声刀片和波导围绕枢转点枢转不同的量。
在一些示例性实施例中，轴能够沿着纵向轴线相对于波导和超声刀片平移。例如，轴可限定第一轴向指向的狭槽和第二轴向指向的狭槽，其中波导的凸缘包括定位在第一狭槽和第二狭槽内的第一栓和第二栓。轴能够相对于超声刀片平移以交替地使刀入鞘和出鞘。
在一些示例性实施例中，中空轴的内部部分限定朝纵向轴线指向的轴凸轮特征结构。轴可为可旋转的，使得轴凸轮交替地接触和不接触波导的凸缘。在一些实施例中，波导的凸缘具有对应的凸轮特征结构。当凸轮特征结构接触凸缘时，其可引起波导和超声刀片围绕枢转点枢转。在各种示例性实施例中，凸缘上的多个表面凸轮特征结构和/或多个凸轮特征结构可用于引起超声刀片和波导在不同方向上的枢转。
在各种示例性实施例中，轴的内壁限定沟槽。沟槽的不同部分定位在距端部执行器的不同轴向距离处。
该器械还可包括第一接口构件和第二接口构件，其在联结点处联接到超声刀片和/或波导。每个接口构件从联接点朝近侧延伸到栓构件。栓构件定位在沟槽内。第一接口构件具有从联接点到其栓构件的第一长度，而第二接口构件具有从联接点到其栓构件的第二长度，其中第二长度小于第一长度。当轴相对于波导和超声刀片旋转时，栓可搭放在沟槽内并且根据栓在沟槽内的位置而朝远侧和/或朝近侧受力。当从栓到联接点的距离不同于相应联接构件的长度时，联接构件可弯曲，从而使超声刀片远离纵向轴线偏转。
在各种示例性实施例中，外科器械可包括具有超声刀片的端部执行器、中空轴和波导。轴可包括刚性部分和柔性部分。端部执行器可包括超声刀片从其延伸的构件、在与纵向轴线偏置的枢转点处联接到该构件的夹持臂以及在与枢转点偏置的点处联接到该夹持臂的柔性控制缆线。控制缆线的远侧和近侧平移可引起夹持臂相对于超声刀片枢转。
现在将详细提及若干实施例，包括显示具有端部执行器的手动和机器人外科器械的示例性具体实施的实施例，所述端部执行器包括超声元件和/或电外科元件。只要可行，相似或相同的参考编号可用于多个附图并可指示相似或相同的功能。附图仅出于举例说明的目的描绘了所公开的外科器械和/或使用方法的示例性实施例。本领域的技术人员将通过以下描述容易地认识到：可在不脱离本文所述原理的情况下采用本文所示的结构和方法的另选的示例性实施例。
图1为超声外科器械10的一个实施例的右侧视图。在该例示的实施例中，超声外科器械10可用于各种外科手术，包括内窥镜式外科手术或传统的开放式外科手术。在一个示例性实施例中，超声外科器械10包括柄部组件12、细长轴组件14和超声换能器16。柄部组件12包括触发器组件24、远侧旋转组件13和开关组件28。细长轴组件14包括端部执行器组件26，该端部执行器组件包括用于解剖组织或相互抓紧、切割并凝结血管和/或组织的元件，以及用于致动端部执行器组件26的致动元件。柄部组件12适于在近侧端部接收超声换能器16。超声换能器16机械地接合到端部执行器组件26的多个部分和细长轴组件14。超声换能器16经由缆线22电联接到发生器20。虽然大部分附图描绘了结合腹腔镜式外科手术使用的多端部执行器组件26，但是超声外科器械10可用于更传统的开放式外科手术中，并且在其他实施例中，可被配置用于内窥镜式手术中，并且在其他实施例中，可被配置用于内窥镜式手术中。出于本文的目的，从内窥镜式器械的角度来描述超声外科器械10；然而，可以设想，超声外科器械10的开放式和/或腹腔镜式形式也可包括如本文所述的相同或相似的操作部件和特征结构。
在各种实施例中，发生器20包括若干功能性元件，诸如模块和/或块。不同的功能性元件或模块能够用于驱动不同种类的外科装置。例如，超声发生器模块21可以驱动超声装置，诸如超声外科器械10。在一些示例性实施例中，发生器20还包括用于驱动电外科装置(或超声外科器械10的电外科实施例)的电外科手术/射频发生器模块23。在各种实施例中，发生器20可在柄部组件12内一体地形成。在此类具体实施中，电池将协同定位在柄部组件12内以充当能量源。图18A和附随的公开内容提供了此类具体实施的一个示例。在一些实施例中，电外科手术/射频发生器模块23能够生成治疗和/或亚治疗能级。在图1所示的示例性实施例中，发生器20包括与发生器20成一体的控制系统25，以及经由缆线27连接至发生器的脚踏开关29。发生器20还可包括用于激活外科器械(诸如器械10)的触发机构。触发机构可包括电源开关(未示出)以及脚踏开关29。当由脚踏开关29激活时，发生器20可提供能量以驱动外科器械10的声学组件并以预先确定的偏移水平来驱动端部执行器18。发生器20以声学组件的任何合适的谐振频率来驱动或激发声学组件，以及/或者形成治疗/亚治疗电磁/射频能量。
在一个实施例中，电外科/射频发生器模块23可作为电外科手术单元(ESU)实施，该电外科手术单元能够利用射频(RF)能量来提供足以来执行双极电外科手术的功率。在一个实施例中，ESU可以是由ERBE USA,Inc.(Marietta,Ga.)销售的双极ERBE ICC 350。如此前所论述，在双极电外科手术应用中，可以使用具有有源电极和返回电极的外科器械，其中有源电极和返回电极可抵靠或邻近待处理的组织定位，使得电流可从有源电极通过组织流至返回电极。因此，电外科/射频发生器模块23能够通过将足以处理组织T(例如，烧灼)的电能施加到组织而用于治疗目的。
在一个实施例中，电外科/射频发生器模块23能够递送亚治疗射频信号，以实施组织阻抗测量模块。在一个实施例中，电外科/射频发生器模块23包括如下文所详述的双极射频发生器。在一个实施例中，电外科/射频发生器模块12能够监控组织T的电阻抗Z，并通过在端部执行器组件26的夹持构件上提供的返回电极来控制基于组织T的时间和功率电平属性。因此，电外科/射频发生器模块23可出于亚治疗目的能够用于测量组织T的阻抗或其他电特性。用于测量组织T的阻抗或其他电特性的技术和电路配置在共同转让的名称为“Electrosurgical Generator for Ultrasonic Surgical Instruments”的美国专利公布2011/0015631中有更详细的讨论，该美国专利公布的公开内容全文以引用方式并入本文。
合适的超声发生器模块21能够在功能上以与Ethicon Endo-Surgery,Inc(Cincinnati,Ohio)销售的GEN300相似的方式运作，如在以下美国专利中的一者或多者中所公开，所有这些专利均以引用方式并入本文：美国专利6,480,796(“Method forImproving the Start Up of an Ultrasonic System Under Zero Load Conditions”)；美国专利6,537,291(“Method for Detecting Blade Breakage Using Rate and/orImpedance Information”)；美国专利6,662,127(“Method for Detecting Presence of aBlade in an Ultrasonic System”)；美国专利6,678,899(“Method for DetectingTransverse Vibrations in an Ultrasonic Surgical System”)；美国专利6,977,495(“Detection Circuitry for Surgical Handpiece System”)；美国专利7,077,853(“Method for Calculating Transducer Capacitance to Determine TransducerTemperature”)；美国专利7,179,271(“Method for Driving an Ultrasonic System toImprove Acquisition of Blade Resonance Frequency at Startup”)；以及美国专利7,273,483(“Apparatus and Method for Alerting Generator Function in anUltrasonic Surgical System”)。
应当理解，在各种实施例中，发生器20能够以若干模式来操作。在一种模式中，发生器20能够使得超声发生器模块21和电外科/射频发生器模块23可被独立地操作。
例如，可将超声发生器模块21激活以向端部执行器组件26施加超声能量，并且随后，可通过电外科/射频发生器模块23向端部执行器组件26施加治疗或亚治疗射频能量。如此前所论述，可向夹持在端部执行器组件26的受权利要求保护元件之间的组织施加亚治疗电外科/射频能量，以测量用于控制超声发生器模块21的激活或改变其激活的组织阻抗。由施加亚治疗能量获得的组织阻抗反馈还可用于激活电外科/射频发生器模块23的治疗电平，从而将夹持在端部执行器组件26的受权利要求保护元件之间的组织(例如，血管)密封。
在另一个实施例中，超声发生器模块21和电外科/射频发生器模块23可被同时激活。在一个示例中，超声发生器模块21与用于测量组织阻抗的亚治疗射频能级被同时激活，与此同时，端部执行器组件26的超声刀片切割并凝结夹持在端部执行器组件26的夹持元件之间的组织(或血管)。此类反馈可用于例如修改超声发生器模块21的驱动输出。在另一个示例中，超声发生器模块21可与电外科/射频发生器模块23被同时驱动，使得在将端部执行器组件26的超声刀片部分用于切割受损组织的同时，电外科/射频能量被施加到端部执行器夹持组件26的电极部分以便将组织(或血管)密封。
当发生器20经由触发机构激活时，电能由发生器20连续地施加到声学组件的换能器叠堆件或组件上。在另一个实施例中，电能由发生器20以间歇方式施加(例如，为脉冲的)。发生器20的控制系统中的锁相环路可监控来自声学组件的反馈。锁相环路调节由发生器20发送的电能的频率，使其与声学组件的选定纵向振动模式的谐振频率匹配。此外，控制系统25中的第二反馈回路将提供给声学组件的电流维持在预选的恒定水平，以便在声学组件的端部执行器18处实现基本上恒定的偏移。在另一个实施例中，控制系统25中的第三反馈回路监控位于端部执行器组件26中的电极之间的阻抗。虽然图1-图9示出手动操作的超声外科器械，但是应当理解，超声外科器械还可以用于(例如)如本文所述的机器人应用中，以及手动应用和机器人应用的组合中。
在超声操作模式下，提供给声学组件的电信号可使端部执行器18的远侧端部在例如大约20kHz至250kHz的范围内纵向振动。根据各种实施例，刀片22可在约54kHz至56kHz的范围内振动，例如以约55.5kHz振动。在其他实施例中，刀片22可以其他频率振动，包括例如约31kHz或约80kHz。可通过例如控制由发生器20施加到声学组件的换能器组件的电信号的振幅来控制刀片的振动偏移。如上所述，发生器20的触发机构允许使用者激活发生器20，以使得可将电能连续地提供给声学组件。发生器20还具有电源线以便插入电外科单元或常规电源插座。据设想，还可以通过直流(DC)源诸如电池来对发生器20供电。发生器20可包括任何合适的发生器，诸如可得自Ethicon Endo-Surgery,Inc的GEN04型和/或GEN11型发生器。
图2是超声外科器械10的一个示例性实施例的左侧透视图，显示柄部组件12、远侧旋转组件13、细长轴组件14和端部执行器组件26。在该例示的实施例中，细长轴组件14包括尺寸被设计为机械地接合端部执行器组件26的远侧端部52，以及机械地接合柄部组件12和远侧旋转组件13的近侧端部50。细长轴组件14的近侧端部50接收在柄部组件12和远侧旋转组件13内。关于细长轴组件14、柄部组件12和远侧旋转组件13之间的连接的更多细节在图5和图7的描述中提供。
在该例示的实施例中，触发器组件24包括与固定柄部34结合操作的触发器32。固定柄部34和触发器32以符合人体工程学的方式形成，并且适于与使用者舒适地交接。固定柄部34与柄部组件12整体地相关联。触发器32可相对于固定柄部34可枢转地运动，如在下文相对于超声外科器械10的操作更详细地解释。触发器32可当使用者施加相对于触发器32的挤压力时沿朝着固定柄部34的方向33A可枢转地运动。弹簧元件98(图5)使触发器32在使用者释放相对于触发器32的挤压力时沿方向33B可枢转地运动。
在一个示例性实施例中，触发器32包括细长触发器钩36，其在细长触发器钩36和触发器32之间限定孔38。孔38的大小被设计成适于接收使用者的从中穿过的一根或多根手指。触发器32还可包括在触发器32基底的上方模塑的弹性部分32a。形成重叠注塑的弹性部分32a，从而得到更加舒适的接触表面，用于沿向外方向33B控制触发器32。在一个示例性实施例中，可在细长触发器钩36的一部分的上方提供重叠注塑的弹性部分32a。细长触发器钩32的近侧表面保持未涂布状态或涂布有非弹性基材，以使使用者能够轻易地将其手指滑入和滑出孔38。在另一个实施例中，触发器的几何结构形成完全闭合的套环，其限定大小被设计成适于接收使用者的从中穿过的一根或多根手指的孔。完全闭合的套环触发器还可包括在触发器基底的上方模塑的弹性部分。
在一个示例性实施例中，固定柄部34包括近侧接触表面40和握持锚定件或鞍形表面42。鞍形表面42倚靠在手上拇指和食指结合的指蹼上。近侧接触表面40具有手枪式握把轮廓，其在没有环或孔的普通手枪式握把上接收手掌。近侧接触表面40的轮廓弯曲可为波状外形的以适应或接收手掌。稳定性尾部44朝向柄部组件12的更近侧的部分定位。稳定性尾部44可以与手的位于拇指和食指之间的最上方指蹼部分接触，以稳定柄部组件12并使柄部组件12更易于控制。
在一个示例性实施例中，开关组件28可包括拨动开关30。拨动开关30可以作为位于柄部组件12内部的具有中心枢轴304的单个部件来实施，以消除同时激活的可能性。在一个示例性实施例中，拨动开关30包括第一突出旋钮30a和第二突出旋钮30b，用于将超声换能器16的功率设置设定在最小功率电平(例如，MIN)与最大功率电平(例如，MAX)之间。在另一个实施例中，摇臂开关可在标准设置和特殊设置之间枢转。特殊设置可允许由装置执行一个或多个特殊程序。当第一突出旋钮30a和第二突出旋钮30b被致动时，拨动开关30围绕中心枢轴旋转。一个或多个突出旋钮30a,30b联接到一个或多个臂，所述一个或多个臂运动通过一小段弧并且使电触点根据第一突出旋钮30a或第二突出旋钮30b的启动情况来闭合或断开电路从而以电气方式为超声换能器16供能或使超声换能器16去能。拨动开关30联接到发生器20以控制超声换能器16的启动。拨动开关30包括用于启动超声换能器16的一个或多个电功率设置开关，旨在为超声换能器16设定一项或多项功率设置。启动拨动开关30所需的力被指向为大致朝向鞍形点42，由此避免了在启动拨动开关30时器械在手中旋转的任何趋势。
在一个示例性实施例中，第一突出旋钮30a和第二突出旋钮30b位于柄部组件12的远侧端部上，使得它们能被使用者轻易地触及，从而在最低程度或基本上无需重新定位握把的情况下激活电源，因此适于在启动拨动开关30的同时维持控制并将注意力集中在手术部位(例如，腹腔镜手术中的监视器)上。突出旋钮30a,30b能够卷绕柄部组件12的侧面至一定程度，以便更易于被不同长度的手指触及，并且在不顺手位置或针对较短的手指允许较大的触及自由度来启动突出旋钮。
在该例示的实施例中，第一突出旋钮30a包括多个触觉元件30c，例如该例示的实施例中的纹理突出部或“凸耳”，以允许使用者区分第一突出旋钮30a和第二突出旋钮30b。本领域的技术人员应当理解，可将若干人体工程学特征结构结合到柄部组件12中。此类人体工程学特征结构在名称为“Ergonomic Surgical Instruments”的美国专利申请公布2009/0105750中有所描述，该专利申请公布全文以引用方式并入本文。
在一个示例性实施例中，拨动开关30可以由使用者的手操作。使用者可以在任何点轻易地触及第一突出旋钮30a和第二突出旋钮30b，同时还避免在任何时间意外或无意启动。拨动开关30可以易于用手指操作以控制传输至超声组件16和/或超声组件16的功率。例如，食指可用于启动第一接触部分30a以将超声组件16接通到最大(MAX)功率电平。食指可用于启动第二接触部分30b以将超声组件16接通到最小(MIN)功率电平。在另一个实施例中，摇臂开关可使器械10在标准设置和特殊设置之间枢转。特殊设置可允许由器械10执行一个或多个特殊程序。使用者无需观察第一突出旋钮30a或第二突出旋钮30b便可以操作拨动开关30。例如，第一突出旋钮30a或第二突出旋钮30b可以包括纹理或突出，因而无需观察便可以触觉方式区分第一突出旋钮30a和第二突出旋钮30b。
在其他实施例中，触发器32和/或拨动开关30可以单独地用于或与超声发生器模块21的激活相结合地用于致动电外科/射频发生器模块23。
在一个示例性实施例中，远侧旋转组件13可绕纵向轴线“T”在任一方向上不受限制地旋转。远侧旋转组件13机械地接合到细长轴组件14。远侧旋转组件13位于柄部组件12的远侧端部上。远侧旋转组件13包括圆柱形毂46和在毂46的上方形成的旋钮48。毂46机械地接合细长轴组件14。旋钮48可包括有凹槽的聚合物特征结构，并且可以用手指(例如，食指)接合以旋转细长轴组件14。毂46可包括在主结构的上方模塑的用于形成旋钮48的材料。旋钮48可在毂46上方重叠注塑。毂46包括在远侧端部露出的端盖部分46a。在腹腔镜式手术期间，毂46的端盖部分46a可以接触套管针的表面。毂46可以由硬质耐用塑料诸如聚碳酸酯形成，用于缓解端盖部分46a和套管针之间可能出现的任何摩擦。旋钮48可以包括由突肋48a形成的“扇形凹口”或凹槽以及位于肋48a之间的凹面部分48b，从而提供更加精确的旋转握持。在一个示例性实施例中，旋钮48可以包括多个凹槽(例如，三个或更多个凹槽)。在其他实施例中，可以采用任何合适数量的凹槽。旋钮48可以由在硬质塑性材料上重叠注塑的较软聚合材料形成。例如，旋钮48可以由柔韧的、有弹性的、柔性的聚合材料(包括例如GLS公司制造的TPE合金)形成。这种较软的重叠注塑材料可以提供更好的握持，以及对旋钮48的运动的更加精确的控制。应当理解，任何提供充分地耐受灭菌处理、具有生物相容性且提供对外科手套提供足够摩擦阻力的材料都可以用于形成旋钮48。
在一个示例性实施例中，柄部组件12由包括第一部分12a和第二部分12b的两(2)个外壳部分或护罩形成。从使用者的角度由远侧端部朝近侧端部观察柄部组件12，第一部分12a被视为右侧部分，并且第二部分12b被视为左侧部分。第一部分12a和第二部分12b中的每一个包括多个接合部69(图5)，接合部的尺寸被设计为彼此机械地对准并接合以形成柄部组件12并且封闭其内部工作部件。与柄部组件12整体地相关联的固定柄部34在组装柄部组件12的第一部分12a和第二部分12b后成形。可以在柄部组件12的第一部分12a和第二部分12b的周边周围的多个点处设置多个另外的接合部(未示出)，例如能量方向点/挠曲点，以用于超声焊接的目的。可以按本领域已知的任何方式将第一部分12a和第二部分12b(以及下文所述的其他部件)组装在一起。例如，定位销、按扣型接合部、舌状物接合部和沟槽接合部、锁定接片、粘结口可以单独或组合用于组装目的。
在一个示例性实施例中，伸长轴组件14包括适于机械地接合柄部组件12和远侧旋转组件13的近侧端部50；以及适于机械地接合端部执行器组件26的远侧端部52。细长轴组件14包括外部管状护套56和位于外部管状护套56内的往复式管状致动构件58。管状往复式管状致动构件58的近侧端部机械地接合到柄部组件12的触发器32，以响应于触发器32的致动和/或释放而沿方向60A或60B运动。可枢转地运动的触发器32可以生成沿纵向轴线“T”的往复式运动。这种运动可用于例如致动端部执行器组件26的钳口或夹紧机构。一系列连杆将触发器32的枢转旋转转化成联接到致动机构的轭的轴向运动，该轴向运动控制端部执行器组件26的夹紧机构的钳口的打开和闭合。管状往复式管状致动构件58的远侧端部机械地接合到端部执行器组件26。在该例示的实施例中，管状往复式管状致动构件58的远侧端部机械地接合到可绕枢转点70枢转的夹持臂组件64，以响应于触发器32的致动和/或释放而打开和闭合夹持臂组件64。例如，在该例示的实施例中，当沿方向33A挤压触发器32时，夹持臂组件64可绕枢转点70沿方向62A从打开位置运动到闭合位置。当沿方向33B释放触发器32或使其向外接触时，夹持臂组件64可绕枢转点70沿方向62B从闭合位置运动到打开位置。
在一个示例性实施例中，端部执行器组件26附接在细长轴组件14的远侧端部52处，并且包括夹持臂组件64和刀片66。端部执行器组件26的夹紧机构的钳口由夹持臂组件64和刀片66形成。刀片66可超声致动并在声学上联接到超声换能器16。柄部组件12上的触发器32最终连接至驱动组件，它们一起机械地配合以影响夹持臂组件64的运动。沿方向33A挤压触发器32使夹持臂组件64沿方向62A从打开位置运动到夹持或闭合位置，在打开位置，夹持臂组件64和刀片66相对于彼此以间隔关系设置，在夹持或闭合位置，夹持臂组件64和刀片66配合以夹持其间的组织。夹持臂组件64可以包括夹持垫69以接合刀片66和夹持臂64之间的组织。沿方向33B释放触发器32使夹持臂组件64沿方向62B从闭合关系运动到打开位置，在打开位置，夹持臂组件64和刀片66相对于彼此以间隔关系设置。
柄部组件12的近侧部分包括用于接收超声组件16的远侧端部的近侧开口68。超声组件16插入近侧开口68中并且机械地接合到细长轴组件14。
在一个示例性实施例中，触发器32的细长触发器钩36部分提供具有较短的跨度和旋转行程的较长的触发器杠杆。细长触发器钩36的较长杠杆允许使用者在孔38内使用多根手指来操作细长触发器钩36，并且使触发器32沿方向33B枢转以打开端部执行器组件26的钳口。例如，使用者可以将三根手指(例如，中指、无名指和小指)插入孔38中。多根手指允许外科医生可在触发器32和细长触发器钩36上施加较大的输入力来启动端部执行器组件26。当沿方向33A闭合或挤压触发器32或沿方向33B通过向外开启运动来开启触发器32时，较短的跨度和旋转行程产生更舒适的握持，从而减少进一步向外伸出手指的需求。这将显著减轻与触发器32沿方向33B的向外开启运动相关联的手部疲劳和紧张。触发器的向外开启运动可以由弹簧元件98(图5)弹簧协助以有助于缓解疲劳。开启弹簧力足以协助轻易地开启，但不足以在展开解剖期间对组织张力的触觉反馈造成不利影响。
例如，在外科手术期间，任意食指可用于控制细长轴组件14的旋转，以在合适的取向上来定位端部执行器组件26的钳口。中指和/或其他较短手指可用于挤压触发器32和抓握钳口内的组织。一旦钳口位于所期望的位置并且钳口夹持住组织，食指就可用于启动拨动开关30，从而调整超声换能器16的用于处理组织的功率电平。一旦已经处理了组织，使用者就可以使用中指和/或较短手指抵靠细长触发器钩36沿远侧方向向外推动来释放触发器32，从而打开端部执行器组件26的钳口。使用者不必调整其对柄部组件12的握持即可执行此基本过程。
图3-图4示出了细长轴组件14相对于端部执行器组件26的连接。如前所述，在该例示的实施例中，端部执行器组件26包括夹持臂组件64和刀片66以形成夹紧机构的钳口。刀片66可以是在声学上联接到超声换能器16的可超声致动的刀片。触发器32机械地连接至驱动组件。触发器32和驱动组件机械地共同配合以使夹持臂组件64沿方向62A运动到打开位置，其中夹持臂组件64和刀片66相对于彼此以间隔关系设置，并且使夹持臂组件64沿方向62B运动到夹持或闭合位置，在该位置夹持臂组件64和刀片66配合以夹持其间的组织。夹持臂组件64可以包括夹持垫69以接合刀片66和夹持臂64之间的组织。管状往复式管状致动构件58的远侧端部机械地接合到端部执行器组件26。在该例示的实施例中，管状往复式管状致动构件58的远侧端部机械地接合到可绕枢转点70枢转的夹持臂组件64，以响应于触发器32的致动和/或释放而打开和闭合夹持臂组件64。例如，在该例示的实施例中，当沿方向33A挤压触发器32时，夹持臂组件64可绕枢转点70沿方向62B从打开位置运动到闭合位置。当沿方向33B释放触发器32或使其向外接触时，夹持臂组件64可绕枢转点70沿方向62A从闭合位置移动到打开位置。
如此前所论述，夹持臂组件64可包括电联接到电外科/射频发生器模块23以接收治疗和/或亚治疗能量的电极，其中电外科/射频能量可在或不在超声能量施加至刀片66的同时被施加到电极。此类能量激活可以任何合适的组合施加，以便与算法或其他控制逻辑相配合而实现所期望的组织效应。
图5为图2所示的超声外科器械10的分解图。在该例示的实施例中，分解图显示柄部组件12的内部元件、柄部组件12、远侧旋转组件13、开关组件28和细长轴组件14。在该例示的实施例中，第一部分12a和第二部分12b配合形成柄部组件12。第一部分12a和第二部分12b各自包括多个接口69，接口的尺寸被设计为彼此机械地对准并接合以形成柄部组件12并且封闭超声外科器械10的内部工作部件。旋钮48机械地接合到外部管状护套56，使得其可以沿圆形方向54旋转最多360°。外部管状护套56位于往复式管状致动构件58之上，该往复式管状致动构件经由多个联接元件72机械地接合到柄部组件12并保持在其中。联接元件72可包括O形环72a、管套环帽72b、远侧垫圈72c、近侧垫圈72d和螺纹管套环72e。往复式管状致动构件58位于往复式轭84内，该往复式轭保持在柄部组件12的第一部分12a和第二部分12b之间。轭84是往复式轭组件88的一部分。一系列连杆将细长触发器钩32的枢转旋转转化成往复式轭84的轴向运动，该轴向运动控制超声外科器械10远侧端部处的端部执行器组件26的夹紧机构的钳口的打开和闭合。在一个示例性实施例中，四联接件设计提供例如在相对短的旋转跨度方面的机械优势。
在一个示例性实施例中，超声传输波导78设置在往复式管状致动构件58的内部。超声传输波导78的远侧端部52在声学上联接(例如，直接或间接机械联接)到刀片66，并且超声传输波导78的近侧端部50被接收在柄部组件12内。超声传输波导78的近侧端部50适于在声学上联接到超声换能器16的远侧端部，如下文更详细地讨论。超声传输波导78通过保护护套80和多个隔离元件82(诸如硅胶环)与细长轴组件14的其他元件隔离。外部管状护套56、往复式管状致动构件58和超声传输波导78通过销74机械地接合。开关组件28包括拨动开关30和电气元件86a,b，用于根据第一突出旋钮30a或第二突出旋钮30b的启动来以电气方式为超声换能器16供能。
在一个示例性实施例中，外部管状护套56将使用者或患者与超声传输波导78的超声振动隔离。外部管状护套56通常包括毂76。外部管状护套56通过螺纹连接到柄部组件12的远侧端部上。超声传输波导78延伸穿过外部管状护套56的开口，而隔离元件82将超声传输波导24与外部管状护套56隔离。外部管状护套56可使用销74附接到波导78。波导78中用于接收销74的孔穴可以标称地出现在位移波节处。波导78可通过螺栓螺纹连接或卡合到手持式柄部组件12中。毂76上的平坦部分可以允许组件扭转至所需的程度。在一个示例性实施例中，外部管状护套56的毂76部分优选地由塑料构造，并且外部管状护套56的管状细长部分由不锈钢制成。作为另外一种选择，超声传输波导78可以包括围绕在其周围的聚合材料，以隔离其与外部接触。
在一个示例性实施例中，超声传输波导78的远侧端部可以通过内部螺纹连接而联接到刀片66的近侧端部，优选地位于或靠近波腹。据设想，刀片66可通过任何合适的手段诸如焊接接头等附接到超声传输波导78。虽然刀片66可以从超声传输波导78上拆下，但另据设想，单元件端部执行器(例如，刀片66)和超声传输波导78可形成为单个一体件。
在一个示例性实施例中，触发器32联接到连杆机构以将触发器32沿方向33A和33B的旋转运动转化为往复式管状致动构件58沿相应方向60A和60B的线性运动。触发器32包括其中形成有开口以接收第一轭销92a的第一组凸缘98。第一轭销92a还定位成穿过在轭84的远侧端部处形成的一组开口。触发器32还包括用于接收联接件92的第一端部92a的第二组凸缘96。触发器销90接收在形成于联接件92和第二组凸缘96中的开口内。触发器销90接收在形成于联接件92和第二组凸缘96中的开口内，并且适于联接到柄部组件12的第一部分12a和第二部分12b以形成触发器32的触发器枢转点。联接件92的第二端部92b接收在形成于轭84的近侧端部中的狭槽384内，并通过第二轭销94b保持在其中。随着触发器32绕由触发器销90形成的枢转点190以枢转方式旋转，轭在箭头60A,B指示的方向上沿纵向轴线“T”水平平移。
图8示出超声外科器械10的一个示例性实施例。在该例示的实施例中，在柄部组件12的局部剖面图内显示超声换能器16的剖视图。超声外科器械10的一个示例性实施例包括：联接到超声换能器16的超声信号发生器20，该超声换能器16包括手持式外壳99；以及可超声致动的单元件或多元件端部执行器组件26。如此前所论述，端部执行器组件26包括可超声致动的刀片66和夹持臂64。超声换能器16(被称为“Langevin叠堆件”)通常包括换能部分100、第一谐振器部分或端罩102、第二谐振器部分或前罩104、以及辅助部件。这些部件的总体构造是谐振器。超声换能器16的长度优选地为整数个系统半波长(nλ/2；其中“n”为任何正整数；例如，n＝1、2、3…)，如下文将更详细地描述。声学组件106包括超声换能器16、鼻部锥108、速度变换器118和表面110。
在一个示例性实施例中，端罩102的远侧端部连接至换能部分100的近侧端部，而前罩104的近侧端部连接至换能部分100的远侧端部。前罩104和端罩102的长度由多个变量确定，这些变量包括换能部分100的厚度、用于制造端罩102和前罩22的材料的密度和弹性模量、以及超声换能器16的谐振频率。前罩104可以与速度变换器118一样，从其近侧端部到其远侧端部向内成锥形以放大超声振动振幅，另选地，可以不具有放大作用。合适的振动频率范围可以为约20Hz至32Hz，并且非常合适的振动频率范围可以为约30-10kHz。例如，合适的工作振动频率可以为大约55.5kHz。
在一个示例性实施例中，压电元件112可由诸如锆钛酸铅、间铌酸铅、钛酸铅、钛酸钡或其他压电陶瓷材料等任何合适的材料制成。正电极114、负电极116和压电元件112中的每个都具有延伸穿过中心的镗孔。正电极114和负电极116分别电联接到电线120和122。电线120和122封闭在缆线22内，并且可电连接到超声信号发生器20。
声学组件106的超声换能器16将来自超声信号发生器20的电信号转化为机械能，该机械能主要导致超声换能器16以及端部执行器组件26的刀片66部分出现以超声频率纵向振动运动的声学驻波。在另一个实施例中，超声换能器的振动运动可以在不同的方向起作用。例如，振动运动可包括细长轴组件14的顶端的更复杂运动的局部纵向分量。合适的发生器为得自Ethicon Endo-Surgery,Inc.(Cincinnati,Ohio)的GEN11型发生器。当声学组件106被供能时，振动运动驻波通过声学组件106生成。超声外科器械10被设计为在谐振下操作，使得产生预定振幅的声学驻波图案。沿声学组件106的任何点处的振动运动振幅取决于沿声学组件106用于测量振动运动的位置。振动运动驻波的最小或零交点通常称为波节(即，运动最小的位置)，并且驻波的局部最大绝对值或峰值通常称为波腹(例如，局部运动最大的位置)。波腹与距其最近的波节之间的距离为四分之一波长(λ/4)。
线120和122将电信号从超声信号发生器20传输到正电极114和负电极116。由超声信号发生器20响应于致动器224(诸如脚踏开关)而提供的电信号来激励压电元件112，从而在声学组件106中产生声学驻波。电信号在压电元件112中产生反复小位移形式的扰动，导致材料内出现较大的交替压缩力和张力。反复的小位移使压电元件112沿电压梯度的轴线以连续方式伸展和收缩，从而生成超声能量的纵波。通过细长轴组件14的传输部件或超声传输波导部分78将超声能量通过声学组件106传输至端部执行器组件26的刀片66部分。
在一个示例性实施例中，为了使声学组件106能够向端部执行器组件26的刀片66部分递送能量，声学组件106的所有部件必须在声学上联接到刀片66。超声换能器16的远侧端部可以在表面110处通过螺纹连接件(诸如螺柱124)在声学上联接到超声传输波导78的近侧端部。
在一个示例性实施例中，优选地对声学组件106的部件进行声学调谐，使得任何组件的长度均为整数个半波长(nλ/2)，其中波长λ是声学组件106的预选或操作的纵向振动驱动频率fd的波长。另据设想，声学组件106可以结合任何合适的声学元件布置方式。
在一个示例性实施例中，刀片66的长度可基本上等于系统半波长的整数倍(nλ/2)。刀片66的远侧端部可设置在波腹附近，以便提供远侧端部的最大纵向偏移。当换能器组件被供能时，刀片66的远侧端部能够以例如55kHz的预定振动频率在例如大约10至500微米峰到峰的范围内运动，并且优选地在约30至64微米的范围内运动。
在一个示例性实施例中，刀片66可联接到超声传输波导78。所示的刀片66和超声传输波导78由适于传输超声能量的材料形成为单个单元构造。此类材料的示例包括Ti6Al4V(含有铝和钒的钛合金)、铝、不锈钢、或其他合适的材料。另选地，刀片66可以与超声传输波导78分开(并且由不同的组合物制成)，并且通过例如螺柱、焊接件、胶水、快速连接或其他合适的已知方法联接这两个部件。超声传输波导78的长度可基本上等于例如整数个半波长(nλ/2)。超声传输波导78可以优选地由使用适合高效传播超声能量的材料(诸如上述钛合金(即，Ti6Al4V)、或任何合适的铝合金、或其他合金)构造的实芯轴制成。
在一个示例性实施例中，超声传输波导78包括在近侧端部处的纵向突出的附接柱，用于通过螺纹连接诸如螺柱124而联接到超声传输波导78的表面110。超声传输波导78可包括定位在多个波节处的多个起稳定作用的硅氧烷环或顺应性支撑件82(图5)。硅氧烷环82抑制不期望的振动并将超声能量与外部保护护套80(图5)隔离，以确保沿纵向方向的超声能量流以最大的效率到达刀片66的远侧端部。
图9示出近侧旋转组件128的一个示例性实施例。在该例示的实施例中，近侧旋转组件128包括插在圆柱形毂135上的近侧旋钮134。近侧旋钮134包括多个径向突出部138，这些突出部被接收在形成于圆柱形毂135的近侧端部上的相应狭槽130中。近侧旋钮134限定用于接收超声换能器16的远侧端部的开口142。径向突出部138由柔软的聚合材料形成，并且限定了尺寸相对比超声换能器16的外径较小的直径，以便在超声换能器16的远侧端部时形成摩擦过盈配合。聚合物径向突出部138径向地突起到开口142中，以形成牢牢地抓住超声换能器16的外壳的“抓具”肋。因此，近侧旋钮134牢固地抓住超声换能器16。
圆柱形毂135的远侧端部包括周边唇缘132和周边支承表面140。周边唇缘与形成于外壳12中的沟槽接合，周边支承表面140则与外壳12接合。这样，圆柱形毂135便机械地保持在外壳12的两个外壳部分(未示出)内。圆柱形毂135的周边唇缘132位于或“被捕获”在第一外壳部分12a和第二外壳部分12b之间，并且可在沟槽内适当地自由旋转。周边支承表面140倚靠着外壳的内部部分，以协助正确的旋转。这样，圆柱形毂135便可在外壳内适当地自由旋转。使用者利用其手指或拇指接合在近侧旋钮134上形成的凹槽136，以旋转外壳12内的圆柱形毂135。
在一个示例性实施例中，圆柱形毂135可以由耐用塑料诸如聚碳酸酯形成。在一个示例性实施例中，圆柱形毂135可以由硅化聚碳酸酯材料形成。在一个示例性实施例中，近侧旋钮134可以由柔韧的、有弹性的、柔性的聚合材料(包括例如GLS公司制造的TPE合金)形成。例如，近侧旋钮134可以由弹性体材料、被称为的热塑性橡胶、其他热塑性硫化橡胶(TPV)、或弹性体形成。然而，实施例并不限于此背景中。
图10示出包括外科器械210的外科系统200的一个示例性实施例，该外科器械210具有单元件端部执行器278。系统200可包括联接到端部执行器278的换能器组件216，以及围绕如图所示的端部执行器278的近侧部分定位的护套256。换能器组件216和端部执行器278可以与上述换能器组件16和端部执行器18相似的方式工作，从而产生可通过刀片226'传输至组织的超声能量。
图11-图18C示出了外科器械的各种实施例，这些外科器械利用治疗和/或亚治疗电能来处理和/或破坏组织，或向发生器(例如，电外科器械)提供反馈。图11-图18C的实施例适于以手动或用手操作的方式使用，但电外科器械也可用于机器人应用中。图11为包括电能外科器械310的外科器械系统300的一个示例性实施例的透视图。电外科器械310可包括近侧柄部312、远侧工作端部或端部执行器326，以及设置在它们之间的导引器或细长轴314。
电外科系统300能够独立地或者同时地向患者的组织提供能量诸如电能、超声能量、热能、或它们的任意组合，如结合例如图1所述。在一个示例性实施例中，电外科系统300包括与电外科器械310电连通的发生器320。发生器320经由合适的传输介质(诸如缆线322)连接到电外科器械310。在一个示例性实施例中，发生器320联接到控制器，诸如控制单元325。在各种实施例中，控制单元325可与发生器320一体地形成，或可作为电联接到发生器320的单独电路模块或装置提供(以虚线显示，以示出这种选择)。虽然在本发明所公开的实施例中，发生器320被显示为与电外科器械310分开，但在一个示例性实施例中，发生器320(和/或控制单元325)可与电外科器械310一体地形成以形成一体的电外科系统300，在该情况下，位于电外科器械310内的电池为能量源，而联接到电池的电路产生合适的电能、超声能量或热能。一个这样的示例在下文结合图17-图18C进行描述。
发生器320可包括位于发生器320控制台的前面板上的输入装置335。输入装置335可包括生成适于对发生器320的操作进行编程的信号的任何合适的装置，诸如键盘或输入端口。在一个示例性实施例中，第一钳口364A和第二钳口364B中的各种电极可联接到发生器320。缆线322可包括多个电导体，用于将电能施加到电外科器械310的正(+)电极和负(-)电极。控制单元325可用于激活可充当电源的发生器320。在各种实施例中，发生器320可包括例如可被独立地或同时地激活的射频源、超声源、直流电源、和/或任何其他合适类型的电能量源。
在各种实施例中，电外科系统300可包括至少一个供给导体331和至少一个返回导体333，其中电流能够经由供给导体331供给电外科器械300并且其中电流能够经由返回导体333流回发生器320。在各种实施例中，供给导体331和返回导体333可包括绝缘线和/或任何其他合适类型的导体。在某些实施例中，如下文所述，供给导体331和返回导体333可包含在缆线322内和/或可包括：在发生器320与电外科器械310的端部执行器326之间或至少部分地在它们之间延伸的缆线。在任何情况下，发生器320都能够在供给导体331与返回导体333之间施加足够的电压差，使得可将足够的电流提供至端部执行器110。
图12为外科器械310的柄部312的一个示例性实施例的侧视图。在图12中，显示柄部312，其中第一柄部主体312A(参见图11)的一半被移除以示出第二柄部主体312B内的各种部件。柄部312可以包括杠杆臂321(例如，触发器)，该杠杆臂321可以沿路径33被牵拉。杠杆臂321可以通过往复运动件384联接到设置在细长轴314内的可轴向运动的构件378(图13-图16)，该往复运动件384可操作地接合到杠杆臂321的延伸部398。往复运动件384还可以连接到偏置装置，诸如弹簧388，以沿近侧方向偏置往复运动件384并因而沿近侧方向偏置可轴向运动的构件378，由此将钳口364A和364B推压到打开位置，如图11中所见，其中该偏置装置还可以连接至第二柄部主体312B。另外，参见图11-图12，锁定构件190(参见图12)可通过锁定开关328(参见图11)在锁定位置和解锁位置之间运动，在锁定位置，基本上防止往复运动件384朝远侧运动，如图所示；在解锁位置，可允许往复运动件384自由地沿远侧方向朝细长轴314运动。柄部312可以是任何类型的手枪式握把或本领域中已知的其他类型的柄部，其能够承载用于致动第一钳口364A和第二钳口364B的致动器杠杆、触发器或滑动件。细长轴314可具有例如圆柱形或矩形横截面，并且可包括从柄部312延伸的薄壁管状套筒。细长轴314可包括贯穿其延伸的镗孔，用于承载用于致动钳口的致动器机构(例如，可轴向运动的构件378)，以及用于承载将电能递送到端部执行器326的电外科部件的电引线。
端部执行器326可以适于捕获并横切组织，并且适于同时通过能量(例如，射频能量)的受控施加而接合(welding)所捕获的组织。第一钳口364A和第二钳口364B可以闭合，由此围绕由可轴向运动的构件378限定的纵向轴线“T”来捕获或接合组织。第一钳口364A和第二钳口364B还可对组织施加压缩。在一些实施例中，细长轴314能够连同第一钳口364A和第二钳口364B一起相对于柄部312旋转完整的360°，如箭头196(参见图11)所示。例如，旋钮348可绕轴314的纵向轴线旋转，并且可联接到轴314以使得旋钮348的旋转致使轴314的相应旋转。第一钳口364A和第二钳口364B能够在旋转的同时保持为可打开和/或可闭合的。
图13显示钳口364A,364B打开的端部执行器326的一个示例性实施例的透视图，而图14显示钳口364A,364B闭合的端部执行器326的一个示例性实施例的透视图。如上所述，端部执行器326可以包括上部第一钳口364A和下部第二钳口364B，它们可以是直的或弯曲的。第一钳口364A和第二钳口364B各自可以分别包括沿它们的相应中间部分向外设置的细长狭槽或通道362A和362B。另外，第一钳口364A和第二钳口364B各自可以具有设置在第一钳口364A和第二钳口364B的内部部分上的组织夹持元件，诸如齿状物363。第一钳口364A可以包括上部第一钳口主体200A，该上部第一钳口主体具有上部第一向外表面202A和上部第一能量递送表面365A。第二钳口364B可以包括下部第二钳口主体200B，该下部第二钳口主体具有下部第二向外表面202B和下部第二能量递送表面365B。第一能量递送表面365A和第二能量递送表面365B均可围绕端部执行器326的远侧端部以“U”形延伸。
柄部312的杠杆臂321(图12)可适于致动可轴向运动的构件378，该可轴向运动的构件还可以充当钳口闭合机构。例如，当沿路径33朝近侧牵拉杠杆臂321时，可经由往复运动件384朝远侧推可轴向运动的构件378，如图12所示且如上所述。
图15是外科器械310的可轴向运动的构件378的一个示例性实施例的透视图。可轴向运动的构件378可以包括一个或若干个零件，但是在任何情况下，其均可以相对于细长轴314和/或钳口364A,364B运动或平移。另外，在至少一个示例性实施例中，可轴向运动的构件378可以由17-4沉淀硬化不锈钢制成。可轴向运动的构件378的远侧端部可以包括带凸缘的“I”形梁，该“I”形梁能够在钳口364A和364B中的通道362A和362B内滑动。可轴向运动的构件378可在通道362A,362B内滑动，以打开和闭合第一钳口364A和第二钳口364B。可轴向运动的构件378的远侧端部还可以包括上部凸缘或“c”形部分378A和下部凸缘或“c”形部分378B。凸缘378A和378B分别限定内部凸轮表面367A和367B，用于与第一钳口364A和第二钳口364B的向外表面接合。钳口364A和364B的打开和闭合可以使用凸轮机构在组织上施加非常高的压缩力，凸轮机构可以包括可运动的“I形梁”、可轴向运动的构件378以及钳口364A,364B的向外表面369A,369B。
更具体地讲，现在参见图13-图15，可轴向运动的构件378的远侧端部的内部凸轮表面367A和367B可共同地适于分别可滑动地接合第一钳口364A的第一向外表面369A和第二钳口364B的第二向外表面369B。第一钳口364A内的通道362A和第二钳口364B内的通道362B的大小可被设计成且能够适应可轴向运动的构件378的移动，该可轴向运动的构件可包括组织切割元件371，例如，包括锐利的远侧边缘。图14例如显示被至少部分地推进穿过通道362A和362B(图13)的可轴向运动的构件378的远侧端部。可轴向运动的构件378的推进可以将端部执行器326从图13所示的打开构型闭合。在图14所示的闭合位置中，上部第一钳口364A和下部第二钳口364B分别限定第一钳口364A的第一能量递送表面365A和第二钳口364B的第二能量递送表面365B之间的间隙或尺寸D。在各种实施例中，尺寸D可例如等于约0.0005英寸至约0.040英寸，并且在一些实施例中，例如介于约0.001英寸至约0.010英寸之间。另外，第一能量递送表面365A和第二能量递送表面365B的边缘可以被倒圆以防止将组织切开。
图16是外科器械310的端部执行器326的一个示例性实施例的截面图。下部钳口364B的接合表面或组织接触表面365B适于至少部分地通过导电-电阻基质(诸如可变电阻正温度系数(PTC)主体)向组织递送能量，如下文更详细地讨论。上部钳口364A和下部钳口364B中的至少一者可以承载至少一个能够将能量从发生器320递送到捕获组织的电极373。上部钳口364A的接合表面或组织接触表面365A可承载类似的导电-电阻基质(即，PTC材料)，或者在一些实施例中，该表面可为例如导电电极或绝缘层。另选地，钳口的接合表面可以承载2001年10月22日提交的名称为“ELECTROSURGICAL JAW STRUCTURE FOR CONTROLLEDENERGY DELIVERY”的美国专利6,773,409中所公开的任何能量递送部件，该专利的全部公开内容以引用方式并入本文。
第一能量递送表面365A和第二能量递送表面365B各自可以与发生器320电连通。第一能量递送表面365A和第二能量递送表面365B能够接触组织并且能够将适于密封或接合(weld)所述组织的电外科能量递送至捕获的组织。控制单元325调控由电发生器320递送的电能，继而向第一能量递送表面365A和第二能量递送表面365B递送电外科能量。可通过激活按钮328(图12)来发起能量递送，该激活按钮与杠杆臂321可操作地接合并且经由缆线322与发生器320电连通。在一个示例性实施例中，电外科器械310可通过脚踏开关329(图11)由发生器320供能。当被致动时，例如脚踏开关329触发发生器320，以将电能递送至端部执行器326。控制单元325可在激活期间对由发生器320生成的功率进行调控。尽管脚踏开关329可能适用于许多情况，但可以使用其他合适类型的开关。
如上文所提及，由电发生器320递送并由控制单元325调控或者说是控制的电外科能量可包括射频(RF)能量或其他合适形式的电能。另外，相对的第一能量递送表面365A和第二能量递送表面365B可以承载可变电阻正温度系数(PTC)主体，该主体与发生器320和控制单元325电连通。有关电外科端部执行器、钳口闭合机构、以及电外科能量递送表面的额外细节在以下美国专利和已公布的专利申请中有所描述：美国专利7,087,054、7,083,619、7,070,597、7,041,102、7,011,657、6,929,644、6,926,716、6,913,579、6,905,497、6,802,843、6,770,072、6,656,177、6,533,784和6,500,312，以及美国专利申请公布2010/0036370和2009/0076506，所有这些专利和专利申请公布均全文以引用方式并入本文并构成本说明书的一部分。
在一个示例性实施例中，发生器320可被实施为电外科单元(ESU)，该电外科单元能够利用射频(RF)能量来提供足以执行双极电外科的功率。在一个示例性实施例中，ESU可以是ERBE USA,Inc.(Marietta,Georgia)销售的双极ERBE ICC 350。在一些实施例中，诸如对于双极电外科应用，可以利用具有有源电极和返回电极的外科器械，其中有源电极和返回电极可以抵靠、邻近待处理的组织定位以及/或者定位成与待处理的组织电连通，使得电流能够从有源电极通过正温度系数(PTC)主体并通过组织而流至返回电极。因此，在各种实施例中，电外科系统300可包括供应路径和返回路径，其中正被处理的所捕获的组织使电路结束或将该电路闭合。在一个示例性实施例中，发生器320可以是单极射频ESU并且电外科器械310可以包括单极端部执行器326，在该单极端部执行器326中整合了一个或多个有源电极。对于此类系统，发生器320可能需要在远离手术部位的位置处与患者紧密接触的返回垫和/或其他合适的返回路径。返回垫可经由缆线连接到发生器320。在其他实施例中，操作员20可提供亚治疗射频能级以用于在电外科系统300中评估组织状态以及提供反馈的目的。可使用此类反馈来控制电外科器械310的治疗性射频能量输出。
在电外科器械300的操作过程中，使用者通常抓紧组织，向捕获的组织提供能量以形成接合或密封(例如，通过致动按钮328和/或踏板216)，并且然后驱动位于可轴向运动的构件378远侧端部处的组织切割元件371穿过捕获的组织。根据各种实施例，可放缓(paced)或以其他方式控制可轴向运动的构件378的轴向运动的平移，从而有助于以合适的行进速率驱动可轴向运动的构件378。通过控制行进速率，提高了在用切割元件371横切之前适当地且功能性地密封所捕获组织的可能性。
图17为包括无绳电能外科器械410的外科器械系统的一个示例性实施例的透视图。该电外科系统与电外科系统300类似。该电外科系统能够独立地或同时地向患者的组织提供能量诸如电能、超声能量、热能或它们的任意组合，如结合例如图1和图11所述。该电外科器械可利用本文结合无绳近侧柄部412所述的端部执行器326和细长轴314。在一个示例性实施例中，柄部412包括发生器电路420(参见图18)。发生器电路420执行基本上与发生器320的该电路类似的功能。在一个示例性实施例中，发生器电路420联接到控制器，诸如控制电路。在该例示的实施例中，控制电路整合到发生器电路420中。在其他实施例中，控制电路可与发生器电路420分开。
在一个示例性实施例中，端部执行器326(包括其钳口364A,364B)中的各种电极可以联接到发生器电路420。控制电路可用于激活可充当电源的发生器420。在各种实施例中，发生器420可包括例如射频源、超声波源、直流电源、和/或任何其他合适类型的电能量源。在一个示例性实施例中，可提供按钮328，用于激活发生器电路420从而向端部执行器326,326提供能量。
图18A为无绳外科器械410的柄部412的一个示例性实施例的侧视图。在图中18，显示柄部412，其中第一柄部主体的一半被移除以示出第二柄部主体434内的各种部件。柄部412可以包括杠杆臂424(例如，触发器)，该杠杆臂424可以沿路径33围绕枢转点被牵拉。杠杆臂424可以通过往复运动件联接到设置在细长轴314内的可轴向运动的构件478，该往复运动件可操作地接合到杠杆臂424的延伸部。在一个示例性实施例中，杠杆臂424限定包括远侧构件424a和近侧构件424b的牧羊杖钩形状。
在一个示例性实施例中，无绳电外科器械包括电池437。电池437向发生器电路420提供电能。电池437可以是适于以所需的能级驱动发生器电路420的任何电池。在一个示例性实施例中，电池437为100mAh三芯锂离子聚合物电池。该电池可在用于外科手术之前充满电，并且可保持约12.6V的电压。电池437可具有装配到无绳电外科器械410的两条保险丝，它们被布置成符合每个电池端子。在一个示例性实施例中，提供用于将电池437连接到直流电源(未示出)的充电端口439。
发生器电路420可以任何合适的方式配置。在一些实施例中，发生器电路包括射频驱动和控制电路440以及控制器电路482。图18B示出根据一个实施例的射频驱动和控制电路440。图18B是示出用于该实施例中以生成和控制提供给端部执行器326的射频电能的射频驱动和控制电路440的局部方框示意图。如下文将更详细地解释，在该实施例中，驱动电路440是包括关于射频放大器输出的并联谐振网络的谐振模式射频放大器，而控制电路工作以控制驱动信号的工作频率以使得其保持在驱动电路的谐振频率下，继而控制提供给端部执行器326的功率的量。根据以下说明，实现这点的方式将是显而易见的。
如图18B中所示，射频驱动和控制电路440包括上述电池437，在该示例中其被布置成提供约0V和约12V的导轨。输入电容器(Cin)442连接在0V与12V之间，用于提供低源阻抗。一对FET开关443-1和443-2(在该实施例中，此二者均为N型通道以减少功率损耗)串联连接在0V导轨与12V导轨之间。提供生成两个驱动信号的FET栅极驱动电路805，这两个驱动信号中的一个用于驱动所述两个FET 443中的每一个。该FET栅极驱动电路445生成驱动信号，其在下部FET(443-2)关闭时使得上部FET(443-1)接通，反之亦然。这使得节点447交替地连接到12V导轨(当FET 443-1接通时)和0V导轨(当FET 443-2接通时)。图18B还显示相应FET443的内部寄生二极管448-1和448-2，它们在FET 443接通的任意期间导电。
如图18B所示，节点447连接到由电感器Ls 452和电感器Lm 454形成的电感器-电感器谐振电路450。FET栅极驱动电路445被布置成以驱动频率(fd)生成驱动信号，该驱动信号以并联谐振电路450的谐振频率接通和关闭FET开关443。由于谐振电路450的谐振特性，在节点447处的方波电压将使得在驱动频率(fd)下的基本上呈正弦的电流在谐振电路450内流动。如图18B所示，电感器Lm 454是变压器455的主线圈，该变压器455的次级线圈由电感器Lsec 456形成。变压器455次级线圈的电感器Lsec 456连接到通过电感器L2 458、电容器C4460和电容器C2 462形成的电感器-电容器-电容器并联谐振电路457。变压器455将电感器Lm454两端的驱动电压(Vd)升压转换成施加到输出并联谐振电路457的电压。负载电压(VL)由并联谐振电路457输出，并施加到与由镊子的钳口和由端部执行器326所夹持的任何组织或血管的阻抗对应的负载(在图18B中由负载电阻R负载459表示)。如图18B所示，提供了一对直流阻塞电容器CbI 480-1和480-2以防止任何直流电信号施加到负载459。
在一个实施例中，变压器455可由符合以下规格的芯径(mm)、线径(mm)、以及次级线圈之间的间隙实施：
芯径，D(mm)
D＝19.9×10-3
22AWG线的线径，W(mm)
W＝7.366×10-4
次级线圈之间的间隙，间隙＝0.125
G＝间隙/25.4
在该实施例中，通过改变用于切换FET 443的转换信号的频率而对提供给端部执行器326的电量进行控制。这是可行的，因为谐振电路450充当频率相依性(较少损耗)衰减器。驱动信号越接近谐振电路450的谐振频率，驱动信号衰减得就越少。相似地，随着驱动信号的频率从电路450的谐振频率移除，该驱动信号衰减得就越多，因此提供给负载的功率减少。在该实施例中，基于将递送到负载459的所期望功率和由常规电压感测电路483和电流感测电路485获得的负载电压(VL)和负载电流(IL)的测量值，由控制器481对FET栅极驱动电路445所生成的转换信号的频率进行控制。控制器481运行的方式将在下文中更详细地描述。
在一个实施例中，电压感测电路483和电流感测电路485可以用高带宽、高速轨到轨放大器(例如，由National Semiconductor制造的LMH6643)实施。然而，此类放大器在其工作时消耗相对高的电流。因此，可提供节电电路以降低放大器在不用于电压感测电路483和电流感测电路485中时的供电电压。在一个实施例中，节电电路可使用降压稳压器(例如，由Linear Technologies制造的LT3502)来降低轨到轨放大器的供电电压并且因此延长电池437的寿命。
图18C示出根据一个实施例的控制器481的主要部件。在图18C所示的实施例中，控制器481是基于微处理器的控制器，因此图16中所示的大部分部件为基于软件的部件。然而，也可以使用基于硬件的控制器481。如图所示，控制器481包括同步I,Q取样电路491，其从感测电路483和485接收所感测到的电压和电流信号，并且获得传送到功率、Vrms和Irms计算模块493的相应样本。计算模块493使用接收到的样本来计算施加到负载459(图18B；端部执行器326及由其夹持的组织/血管)的RMS电压和RMS电流，并通过它们计算目前正施加给负载459的功率。然后将确定值传送到频率控制模块495和医疗装置控制模块497。医疗装置控制模块497使用该值来确定负载459的当前阻抗，并且基于该确定的阻抗和预定义的算法，确定应当将何种设定点功率(P设定)施加到频率控制模块495。医疗装置控制模块497继而由从使用者输入模块499接收的信号来控制，使用者输入模块从使用者接收输入(例如，按下按钮或启动柄部104上的控制杠杆114,110)，并且还经由使用者输出模块461来控制柄部104上的输出装置(灯、显示器、扬声器等)。
频率控制模块495使用从计算模块493获得的值和从医疗装置控制模块497获得的设定点功率(P设定)以及预定义的系统限制(将在下文中阐释)来确定是否要提高或降低所施加的频率。然后，将该决定的结果传送到方波发生模块463，其在该实施例中根据接收到的决定将自身生成的方波信号的频率提高或降低1kHz。如本领域的技术人员将会知道的那样，在另选的实施例中，频率控制模块495可不仅确定是否要提高或降低频率，还确定所需的频率变化的量。在这种情况下，方波发生模块463将生成与期望的频移对应的方波信号。在该实施例中，将由方波发生模块463生成的方波信号输出到FET栅极驱动电路445，该FET栅极驱动电路将该信号放大然后将其施加到FET 443-1。该FET栅极驱动电路445还转换施加到FET 443-1的信号并且将所转换的信号施加到FET 443-2。
电外科器械410可包括如相对于电外科系统300所讨论的另外的特征结构。本领域的技术人员将认识到，电外科器械410可包括旋钮348、细长轴314和端部执行器326。这些元件以与上文相对于电外科系统300所讨论的那些方式基本上类似的方式发挥作用。在一个示例性实施例中，无绳电外科器械410可包括视觉指示器435。视觉指示器435可向操作员提供视觉指示信号。在一个示例性实施例中，视觉指示信号可警示操作员装置已开启，或者装置正在向端部执行器施加能量。本领域的技术人员将认识到，视觉指示器435能够提供关于装置的多种状态的信息。
多年以来，已经开发出多种微创机器人(或“远距离外科手术”)系统以增加外科手术的灵活性，并允许外科医生以直观的方式对患者进行手术。机器人外科系统可以与许多不同类型的外科器械一起使用，这些外科器械包括例如超声或电外科器械，如本文所述。示例性机器人系统包括由Intuitive Surgical,Inc.(Sunnyvale,California,U.S.A)制造的那些。此类系统以及得自其他制造商的机器人系统在以下美国专利中进行了公开，这些美国专利各自全文以引用方式并入本文：名称为“Articulated Surgical Instrument ForPerforming Minimally Invasive Surgery With Enhanced Dexterity andSensitivity”的美国专利5,792,135、名称为“Robotic Arm DLUS For PerformingSurgical Tasks”的美国专利6,231,565、名称为“Robotic Surgical Tool WithUltrasound Cauterizing and Cutting Instrument”的美国专利6,783,524、名称为“Alignment of Master and Slave In a Minimally Invasive Surgical Apparatus”的美国专利6,364,888、名称为“Mechanical Actuator Interface System For RoboticSurgical Tools”的美国专利7,524,320、名称为“Platform Link Wrist Mechanism”的美国专利7,691,098、名称为“Repositioning and Reorientation of Master/SlaveRelationship in Minimally Invasive Telesurgery”的美国专利7,806,891，以及名称为“Surgical Tool With Writed Monopolar Electrosurgical End Effectors”的美国专利7,824,401。然而，许多此类系统在过去尚未能生成有效切割和紧固组织所需量级的力。
图19-图46A示出机器人外科系统的示例性实施例。在一些实施例中，所公开的机器人外科系统可以利用本文所述的超声或电外科器械。本领域的技术人员将会知道，所示的机器人外科系统不仅仅限于本文所述的那些器械，而是可以利用任何兼容的外科器械。本领域的技术人员还将认识到，虽然本文所述的各种实施例可以与所述的机器人外科系统一起使用，但是公开内容并不如此受到限制，而是可以与任何兼容的机器人外科系统一起使用。
图19-图25示出若干示例性机器人外科系统及其部件的结构和操作。图19示出示例性机器人外科系统1000的框图。系统1000包括至少一个控制器508和至少一个臂车510。臂车510可机械地联接到一个或多个由方框512指示的机器人操纵器或机械臂。机械臂512中的每个可以包括一个或多个外科器械514，用于对患者504执行各种手术任务。臂车510(包括臂512和器械514)的操作可由临床医生502从控制器508进行指导。在一些实施例中，由第二临床医生502'操作的第二控制器508'也可与第一临床医生502'协力指挥臂车510的操作。例如，临床医生502,502'中的每一位可以控制臂车的不同臂512，或在一些情况下，可在临床医生502,502'之间传递对臂车510的完全控制。在一些实施例中，可将另外的臂车(未示出)用于患者504。这些另外的臂车可由控制器508,508'中的一个或多个控制。臂车510和控制器508,508'可经由通信链路516彼此通信，该通信链路可以是根据任何合适的通信协议承载任何合适类型的信号(例如，电信号、光信号、红外信号等)的任何合适类型的有线或无线通信链路。机器人外科系统(诸如系统1000)的示例性具体实施在已经以引用方式并入本文的美国专利7,524,320中有所公开。因而，本文将不详细描述此类装置的各个细节，除了理解受权利要求书保护的装置的各种实施例可能必需的细节外。
图20示出机械臂车520的一个示例性实施例。机械臂车520能够致动多个外科器械或器械，它们在工作包封空间519内一般被指定为522。名称为“Multi-ComponentTelepresence System and Method”的美国专利6,132,368中公开了使用主控制器和机械臂车布置结构的各种机器人外科系统和方法，该专利的全部公开内容以引用方式并入本文。在各种形式中，机械臂车520包括基座524，在该例示的实施例中，该基座支撑有三个外科器械522。在各种形式中，外科器械522各自由一系列可在手动操作下进行关节运动的连杆(一般称为装置接头526)和机器人操纵器528支撑。本文示出的这些结构具有在机械连杆的大部分之上延伸的护盖。这些护盖可以是任选的，并且可在尺寸上有所限制或在一些实施例中完全消除，以使用于操纵此类装置的伺服机构遇到的惯性最小化、限制移动部件的体积以避免碰撞、并且限制车520的总重量。车520将通常具有适于在手术室之间搬运车520的尺寸。车520能够通常适于穿过标准的手术室门并放置到标准的医院电梯上。在各种形式中，车520将优选地具有一定的重量并且包括轮(或其他运输)系统，该轮系统使得车520可被单个维护人员定位在邻近手术台的位置。
图21示出机械臂车520的机器人操纵器528的一个示例性实施例。在图21所示的示例中，机器人操纵器528可包括约束外科器械522的运动的连杆530。在各种实施例中，连杆530包括由旋转接头以平行四边形布置方式联接在一起的刚性联接件，使得外科器械522围绕空间532中的某一点旋转，如在已公布的美国专利5,817,084中更完整地描述，该专利的全部公开内容以引用方式并入本文。平行四边形布置方式将旋转约束为围绕轴线534a(有时称为俯仰轴)枢转。支撑平行四边形连杆的联接件以枢转方式安装到装置接头526(图20)，使得外科器械522还围绕轴线534b(有时称为偏航轴线)旋转。俯仰轴线534a和偏航轴线534b在远程中心536处相交，该远程中心沿外科器械522的轴538对齐。当由操纵器540支撑时，外科器械522可具有另外的从动自由度，包括外科器械522沿着纵向器械轴线“LT-LT”的滑动运动。当外科器械522沿着器械轴线LT-LT相对于操纵器540滑动时(箭头534c)，远程中心536相对于操纵器540的基座542保持固定。因此，整个操纵器540通常运动，从而使远程中心536重新定位。操纵器540的连杆530由一系列马达544驱动。这些马达544响应于控制系统处理器的命令而主动使连杆530运动。如将在下文中进一步详细论述，马达544还用于操纵外科器械522。
图22示出具有另选的装置接头结构的机械臂车520'的一个示例性实施例。在该示例性实施例中，外科器械522由位于两个组织操纵器械之间的另选的操纵器结构528'支撑。本领域的普通技术人员将会知道，受权利要求书保护的装置的各种实施例可以包括多种另选的机器人结构，包括在美国专利5,878,193中描述的那些结构，该专利的全部公开内容以引用方式并入本文。另外，虽然本文参考外科器械522和控制器之间的通信初步描述了机器人部件和机器人外科系统的处理器之间的数据通信，但应当理解，类似的通信可发生在操纵器、装置接头、内窥镜或其他图像捕获装置等的电路和机器人外科系统的处理器之间，该机器人外科系统的处理器用于部件兼容性验证、部件类型识别、部件校准(诸如偏移等)通信、部件与机器人外科系统的联接确认等。
图23示出控制器518的一个示例性实施例，该控制器可以与机械臂车诸如在图20-图22中描绘的机械臂车520,520'结合使用。控制器518通常包括主控制器(在图23中一般表示为519)，在临床医生通过立体显示器521观察手术的同时，该主控制器由临床医生抓持并在空间操纵。外科医生反馈计515可通过显示器521来观察并为外科医生提供正施加于切割器械或动态夹紧构件的力的大小的视觉指示。主控制器519通常包括手动输入装置，该手动输入装置优选地以多个自由度运动，并且通常还具有用于致动器械(例如，用于闭合抓持锯、施加电势到电极等)的柄部或触发器。
图24示出适于与机器人外科系统一起使用的超声外科器械522的一个示例性实施例。例如，外科器械522可以联接到上文所述的外科操纵器528,528'中的一个。如在图24中可以看出，外科器械522包括外科端部执行器548，该外科端部执行器包括超声刀片550和夹持臂552，该外科端部执行器可联接到细长轴组件554，在一些实施例中，该细长轴组件可包括关节运动接头556。图25示出用电外科器械523替代超声外科器械522的另一个示例性实施例。外科器械523包括外科端部执行器548，该外科端部执行器包括可闭合的钳口551A,551B，它们具有能量递送表面553A,553B，用于接合钳口551A,551B之间的组织并向该组织提供电能。组织切割元件或刀555可定位在可轴向运动的构件557的远侧端部处，该可轴向运动的构件可延伸穿过细长轴组件554到达器械安装部分558。图26示出器械驱动组件546的一个示例性实施例，该器械驱动组件可联接到用于接收和控制外科器械522,523的外科操纵器528,528'中的一个。器械驱动组件546还可以可操作地联接到控制器518，用于接收临床医生的输入而对器械522,523进行控制。例如，夹持臂552的致动(例如，打开和闭合)、钳口551A,551B的致动(例如，打开和闭合)、超声刀片550的致动、刀555的延伸以及能量递送表面553A,553B的致动等可通过器械驱动组件546基于由临床医生通过控制器518提供的输入而加以控制。外科器械522通过器械安装部分(一般称为558)可操作地联接到操纵器。外科器械522还包括将器械安装部分558机械地联接和电联接到操纵器的接口560。
图27示出包括超声外科器械522的图26的器械驱动组件的另一个视图。图28示出包括电外科器械523的图26的器械驱动组件的另一个视图。器械安装部分558包括器械安装板562，该器械安装板可操作地支撑多个(图26中示出了四个)可旋转主体部分、从动盘或从动元件564，每个从动盘或从动元件均包括自从动元件564的表面延伸的一对销566。一个销566比同一个从动元件564上的另一个销566更靠近每个从动元件564的旋转轴线，这有助于确保从动元件564的正向角对准。从动元件564和销566可定位在器械安装板562的适配器侧567上。
接口560还包括能够与安装板562以安装方式接合的适配器部分568，如将在下文中进一步论述。适配器部分568可包括一系列电连接销570，这些电连接销可通过器械安装部分558内的电路板而联接到存储器结构。虽然参考机械联接元件、电耦接元件和磁力耦接元件在本文中描述了接口560，但是应当理解，可以使用多种遥测形式，包括红外、电感耦接等。
图29-图31示出图26的器械驱动组件546的适配器部分568的另外视图。适配器部分568通常包括器械侧572和保持器侧574(图。29)。在各种实施例中，将多个可旋转主体576安装到浮动板578，该浮动板相对于垂直于适配器568主表面的周围适配器结构具有受限的运动范围。当沿器械安装部分外壳582的侧面的杠杆580被致动时(参见图24和图25)，浮动板578的轴向运动有助于使可旋转主体576从器械安装部分558脱离。可采用其他机构/布置结构以可释放的方式将器械安装部分558联接到适配器568。在至少一种形式中，通过弹性径向构件将可旋转主体576弹性地安装到浮动板578，该弹性径向构件围绕可旋转主体576延伸到周边凹痕中。可旋转主体576可通过这些弹性结构的挠曲而相对于板578轴向运动。当可旋转主体576设置在第一轴向位置(朝器械侧572)时，可旋转主体576自由旋转而无角度限制。然而，当可旋转主体576朝器械侧572轴向运动时，突片584(从可旋转主体576径向延伸)侧向接合浮动板上的棘爪以便限制可旋转主体576围绕其轴线的角旋转。当驱动销586将可旋转主体576推动至受限的旋转位置直到销586与开口590对准(并滑动到其中)时，可使用该受限的旋转来帮助可旋转主体576与机器人系统的对应器械架部分588的驱动销586驱动接合。
可旋转主体576的器械侧572上的开口590以及保持器侧574上的开口590能够将器械安装部分558的从动元件564(图27、图28)与器械保持器588的驱动元件592准确对准。如上文关于从动元件564的内部和外部销566所述，开口590位于相距其各自的可旋转主体576的旋转轴线不同的距离处，以便确保与之要达到的位置不呈33度对准。另外，每个开口590可能略微径向伸长，以便适当地接收周边方向上的销566。这允许销566在开口590内径向滑动并适应器械522,523和器械保持器588之间的一些轴偏差，同时使驱动元件和从动元件之间的任何角偏差和角侧隙最小化。器械侧572上的开口590可与保持器侧574上的开口590(以虚线示出)偏置成约90度，如在图31中可以最清楚地看到。
各种实施例还可以包括位于适配器568的保持器侧574上的一系列电连接器销570，并且适配器568的器械侧572可包括狭槽594(图31)，用于从器械安装部分558接收销阵列(未示出)。除了在外科器械522,523和器械保持器588之间传输电信号外，可通过适配器568的电路板将这些电连接件中的至少一些联接到适配器存储器装置596(图30)。
可采用可拆卸的闩锁布置结构598以可释放的方式将适配器568附连到器械保持器588。如本文所用，术语“器械驱动组件”在用于机器人系统的上下文中时，至少涵盖适配器568和器械保持器588的各种实施例，并且其在图26中一般称为546。例如，如在图26中可以看出，器械保持器588可包括第一闩锁销布置结构600，该第一闩锁销布置结构的大小被设计成接收在适配器568中提供的相应的连接叉狭槽602中。另外，器械保持器588还可以具有第二闩锁销604，该第二闩锁销的尺寸被设计成保持在适配器568中相应的闩锁连接叉606中。参见图30。在至少一种形式中，闩锁组件608被活动地支撑在适配器568上，并且能够在第一闩锁位置和未闩锁位置之间偏置，在第一闩锁位置中，闩锁销600保持在它们各自的闩锁连接叉606中，在未闩锁位置中，第二闩锁销604可进入闩锁连接叉606或从闩锁连接叉606中移除。使用一个或多个弹簧(未示出)以将闩锁组件偏置到闩锁位置中。适配器568的器械侧572上的唇缘可以可滑动地接收器械安装外壳582的侧向延伸的突片。
如前所述，从动元件564可与器械保持器588的驱动元件592对准，使得驱动元件592的旋转运动致使从动元件564的相应旋转运动。驱动元件592和从动元件564的旋转可(例如)响应于经由控制器508从临床医生502接收的指令而经由机械臂612来电子控制。器械安装部分558可将从动元件564的旋转转化成外科器械522,523的运动。
图32-图34示出器械安装部分558的一个示例性实施例，显示用于将从动元件564的运动转化成外科器械522,523的运动的部件。图32-图34示出具有轴538的器械安装部分，该轴在其远侧端部处具有外科端部执行器610。端部执行器610可以是用于对患者执行外科任务的任何合适类型的端部执行器。例如，端部执行器能够向手术部位处的组织提供射频和/或超声能量。轴538可旋转地联接到器械安装部分558并在轴538的联轴器650处由顶部轴保持器646和底部轴保持器648固定。
在一个示例性实施例中，器械安装部分558包括用于将各种从动元件564的旋转转化成轴538的旋转、构件沿轴的轴线的微分平移(例如，用于进行关节运动)、以及一个或多个构件沿轴538的轴线的往复式平移(例如，用于延伸和缩回组织切割元件诸如555、外套管和/或其他部件)的机构。在一个示例性实施例中，可旋转主体612(例如，可旋转卷轴)联接到从动元件564。可旋转主体612可与从动元件564一体地形成。在一些实施例中，可旋转主体612可独立于从动元件564形成，前提是可旋转主体612和从动元件564固定地联接以使得驱动从动元件564致使可旋转主体612旋转。可旋转主体612中的每个联接到齿轮系或齿轮机构，用于提供轴的关节运动和旋转、夹持钳口的打开/闭合、以及刀致动。
在一个示例性实施例中，器械安装部分558包括用于引起两个或更多个构件沿轴538的轴线发生微分平移的机构。在图32-图34提供的示例中，该运动用于操纵关节运动接头556。在该例示的实施例中，例如，器械安装部分558包括齿条与小齿轮传动机构以提供微分平移并因而提供轴关节运动功能。在一个示例性实施例中，齿条与小齿轮传动机构包括联接到可旋转主体612的第一小齿轮传动装置614，使得相应从动元件564的旋转致使第一小齿轮传动装置614旋转。轴承616联接到可旋转主体612并提供于从动元件564和第一小齿轮传动装置614之间。第一小齿轮传动装置614啮合到第一齿条传动装置618以将第一小齿轮传动装置614的旋转运动转化成第一齿条传动装置618的线性运动，从而控制轴组件538的关节运动段556沿向左方向620L的关节运动。第一齿条传动装置618附接到第一关节运动带622(图32)，使得第一齿条传动装置618沿远侧方向的线性运动致使轴组件538的关节运动段556沿向左方向620L进行关节运动。第二小齿轮传动装置626联接到另一个可旋转主体612，使得相应从动元件564的旋转致使第二小齿轮传动装置626旋转。轴承616联接到可旋转主体612并提供于从动元件564与第二小齿轮传动装置626之间。第二小齿轮传动装置626啮合到第二齿条传动装置628以将第二小齿轮传动装置626的旋转运动转化成第二齿条传动装置628的线性运动，从而控制关节运动段556沿向右方向620R的关节运动。第二齿条传动装置628附接到第二关节运动带624(图33)，使得第二齿条传动装置628沿远侧方向的线性运动致使轴组件538的关节运动段556沿向右方向620R进行关节运动。可以在可旋转主体和相应齿轮之间提供另外的轴承。可以提供任何合适的轴承以支撑和稳定安装，并且减小例如轴和齿轮的旋转摩擦。
在一个示例性实施例中，器械安装部分558还包括用于将从动元件564的旋转转化成围绕轴538的轴线的旋转运动的机构。例如，旋转运动可以是轴538自身的旋转。在该例示的实施例中，第一螺旋蜗轮630联接到可旋转主体612，并且第二螺旋蜗轮632联接到轴组件538。轴承616(图17)联接到可旋转主体612并提供于从动元件564和第一螺旋蜗轮630之间。第一螺旋蜗轮630啮合到第二螺旋蜗轮632，后者可联接到轴组件538和/或器械522,523的需要其纵向旋转的另一个部件。旋转可基于第一螺旋蜗轮630和第二螺旋蜗轮632的旋转方向而沿顺时针方向(CW)和逆时针方向(CCW)进行。因此，第一螺旋蜗轮630绕第一轴线的旋转被转换为第二螺旋蜗轮632绕第二轴线的旋转，第二轴线与第一轴线正交。如图32-图33所示，例如，第二螺旋蜗轮632的顺时针旋转导致轴组件538沿634CW所指示的方向顺时针旋转。第二螺旋蜗轮632的逆时针旋转导致轴组件538沿634CCW所指示的方向逆时针旋转。可以在可旋转主体和相应齿轮之间提供另外的轴承。可以提供任何合适的轴承以支撑和稳定安装，并且减小例如轴和齿轮的旋转摩擦。
在一个示例性实施例中，器械安装部分558包括用于生成一个或多个构件沿轴538的轴线的往复式平移的机构。这种平移可用于例如驱动组织切割元件诸如555、驱动外套管以使端部执行器610闭合以及/或者进行关节运动等。在该例示的实施例中，例如，齿条与小齿轮传动机构可提供往复式平移。第一齿轮636联接到可旋转主体612，使得相应从动元件564的旋转致使第一齿轮636沿第一方向旋转。第二齿轮638围绕在器械安装板562中形成的柱640自由旋转。第一齿轮636啮合到第二齿轮638，使得第二齿轮638沿与第一齿轮636相反的方向旋转。在一个示例性实施例中，第二齿轮638是啮合到沿线性方向运动的齿条642的小齿轮。齿条642联接到平移块644，该平移块可与齿条642一起朝远侧和近侧平移。平移块644可联接到轴组件538和/或端部执行器610的任何合适的部件以便提供往复式纵向运动。例如，平移块644可机械地联接到射频外科装置523的组织切割元件555。在一些实施例中，平移块644可以联接到外套管，或端部执行器610或轴538的另一个部件。
图35-图37示出器械安装部分558的另选实施例，显示用于将从动元件564的旋转转化成围绕轴538的轴线的旋转运动的另选示例性机构，以及用于生成一个或多个构件沿轴538的轴线的往复式平移的另选示例性机构。现在参见另选旋转机构，第一螺旋蜗轮652联接到第二螺旋蜗轮654，后者联接到第三螺旋蜗轮656。可出于各种原因提供这样的布置，这些原因包括维持与现有机器人系统1000的兼容以及/或者实际情况是空间可能有限。第一螺旋蜗轮652联接到可旋转主体612。第三螺旋蜗轮656与联接到轴组件538的第四螺旋蜗轮658啮合。轴承760联接到可旋转主体612并提供于从动元件564和第一螺旋蜗轮738之间。另一个轴承760联接到可旋转主体612并提供于从动元件564和第三螺旋蜗轮652之间。第三螺旋蜗轮652啮合到第四螺旋蜗轮658，后者可联接到轴组件538和/或器械522,523的需要其纵向旋转的另一个部件。旋转可基于螺旋蜗轮656,658的旋转方向而沿顺时针方向和逆时针方向进行。因此，第三螺旋蜗轮656绕第一轴线的旋转被转换为第四螺旋蜗轮658绕第二轴线的旋转，该第二轴线与第一轴线正交。如图36和图37所示，例如，第四螺旋蜗轮658联接到轴538，并且第四螺旋蜗轮658的顺时针旋转导致轴组件538沿634CW所指示的方向顺时针旋转。第四螺旋蜗轮658的逆时针旋转导致轴组件538沿634CCW所指示的方向逆时针旋转。可以在可旋转主体和相应齿轮之间提供另外的轴承。可以提供任何合适的轴承以支撑和稳定安装，并且减小例如轴和齿轮的旋转摩擦。
现在参见用于生成一个或多个构件沿轴538的轴线的往复式平移的另选示例性机构，器械安装部分558包括齿条与小齿轮传动机构以提供沿轴538的轴线的往复式平移(例如，射频外科装置523的组织切割元件555的平移)。在一个示例性实施例中，第三小齿轮传动装置660联接到可旋转主体612，使得相应从动元件564的旋转致使第三小齿轮传动装置660沿第一方向旋转。第三小齿轮传动装置660啮合到沿线性方向运动的齿条传动装置662。齿条传动装置662联接到平移块664。平移块664可联接到装置522,523的部件，诸如，射频外科装置的组织切割元件555和/或外套管或期望其纵向平移的其他部件。
图38-图42示出器械安装部分558的另选实施例，显示用于将从动元件564的旋转转化成围绕轴538的轴线的旋转运动的另一个另选示例性机构。在图38-图42中，轴538经由联轴器676和轴衬678联接到安装部分558的其余部分。联接到可旋转主体612的第一齿轮666、包括第一开口和第二开口672的固定柱668、联接到轴组件的第一可旋转销和第二可旋转销674、以及缆线670(或绳索)。缆线缠绕在可旋转主体612周围。缆线670的一个端部定位成穿过固定柱668的顶部开口672并固定地联接到顶部可旋转销674。缆线670的另一个端部定位成穿过固定柱668的底部开口672并固定地联接到底部旋转销674。出于各种原因提供此类布置，这些原因包括维持与现有机器人系统1000的兼容以及/或者实际情况是空间可能有限。因此，可旋转主体612的旋转基于可旋转主体612的旋转方向致使围绕轴组件538沿顺时针和逆时针方向旋转(例如，轴538自身的旋转)。因此，可旋转主体612绕第一轴线的旋转被转换为轴组件538绕第二轴线的旋转，该第二轴线与第一轴线正交。如图38-图39所示，例如，可旋转主体612的顺时针旋转导致轴组件538沿634CW所指示的方向顺时针旋转。可旋转主体612的逆时针旋转导致轴组件538沿634CCW所指示的方向逆时针旋转。可以在可旋转主体和相应齿轮之间提供另外的轴承。可以提供任何合适的轴承以支撑和稳定安装，并且减小例如轴和齿轮的旋转摩擦。
图43-图46A示出器械安装部分558的另选实施例，显示用于使构件沿轴538的轴线发生微分平移(例如，用于进行关节运动)的另选示例性机构。例如，如图43-图46A所示，器械安装部分558包括双凸轮机构680以提供轴关节运动功能。在一个示例性实施例中，双凸轮机构680包括第一凸轮部分680A和第二凸轮部分680B。第一从动件悬臂682和第二从动件悬臂684可枢转地联接到相应的枢转卷轴686。当联接到双凸轮机构680的可旋转主体612旋转时，第一凸轮部分680A作用于第一从动件悬臂682，而第二凸轮部分680B作用于第二从动件悬臂684。当凸轮机构680旋转时，从动件悬臂682,684绕枢转卷轴686枢转。第一从动件悬臂682可附接到待发生微分平移的第一构件(例如，第一关节运动带622)。第二从动件悬臂684附接到待发生微分平移的第二构件(例如，第二关节运动带624)。当顶部凸轮部分680A作用于第一从动件悬臂682时，第一构件和第二构件发生微分平移。在第一构件和第二构件为相应的关节运动带622和624的示例性实施例中，轴组件538沿向左方向620L进行关节运动。当底部凸轮部分680B作用于第二从动件悬臂684时，轴组件538沿向右方向620R进行关节运动。在一些示例性实施例中，两个单独的轴衬688,690安装在相应的第一从动件悬臂682和第二从动件悬臂684之下，以允许轴在不影响第一从动件悬臂682和第二从动件悬臂684的关节运动位置的情况下旋转。对于关节运动动作，这些轴衬与第一从动件悬臂682和第二从动件悬臂684一起进行往复运动，而不影响钳口902的旋转位置。图46示出轴衬688,690和双凸轮组件680，该双凸轮组件包括第一凸轮部分680B和第二凸轮部分680B，并且第一从动件悬臂682和第二从动件悬臂684被移除以提供更详细且更清楚的视图。
在各种实施例中，器械安装部分558可另外包括内部能量源，用于驱动电子器件并向外科工具提供所需的超声和/或射频频率信号。图46B-图46C示出包括内部功率和能量源的工具安装部分558'的一个实施例。例如，利用工具安装部分558'安装的外科器械(例如，器械522,523)不需要用电线连接到外部发生器或其他功率源。相反，本文所述的各种发生器20,320的功能可在安装部分558上实施。
如图46B-图46C所示，器械安装部分558'可包括远侧部分702。远侧部分702可包括用于将驱动元件612的旋转联接到例如如上文所述的各种外科器械522,523的端部执行器的各种机构。在远侧部分702的近侧，器械安装部分558'包括内部直流(DC)能量源以及内部驱动和控制电路704。在该例示的实施例中，能量源包括第一电池706和第二电池708。在其他方面，工具安装部分558'与上文所述的工具安装部分558的各种实施例类似。
控制电路704可以与上文关于发生器20,320所述相似的方式工作。例如，当利用超声器械522时，控制电路704可以与上文关于发生器20所述相似的方式提供超声驱动信号。另外，例如，当使用能够提供治疗或非治疗射频信号的射频器械523或超声器械522时，控制电路704可提供射频驱动信号，例如，如上文关于发生器20和/或发生器300的模块23所述。在一些实施例中，控制电路704可以与上文关于图18B-图18C所述的控制电路440相似的方式进行配置。
本文所述的各种实施例包括可关节运动的轴。当使用可关节运动的轴时，从端部执行器行进穿过轴的部件必须为柔性的，以便在轴进行关节运动时弯曲。在各种实施例中，这能够通过利用具有柔性部分的波导而实现。例如，图47示出超声医疗器械1500的一个示例性实施例的一部分的示意性剖视图，该超声医疗器械包括第一波导部分、第二波导部分和第三波导部分。在图47中，为了清楚起见，省去了超声医疗器械1500的手持件和护套-关节运动控制旋钮等。在图47所示的示例性实施例中，超声医疗器械1500包括用于将超声能量从换能器(图47中未示出)传递至超声刀片1544的医疗超声波导1502。医疗超声波导1502具有一定的长度并且包括第一波导部分1504、第二波导部分1506和第三波导部分1508。第二波导部分1506纵向地位于第一波导部分1504与第三波导部分1508之间；第一波导部分1504位于第二波导部分1506的近侧；并且第三波导部分1508位于第二波导部分1506的远侧。第一波导部分1504和第三波导部分1508各自具有较大的横截面积，而第二波导部分1506具有较小的横截面积。第二波导部分1506比第一波导部分1504和第三波导部分1508的中任一者都更易弯曲。还应当注意，超声振动可以是纵向、横向和扭转振动的任一者或任意组合。在一些实施例中，区段1506可具有圆形横截面(例如，均匀的横截面半径)。
在一些实施例中，第二可弯曲波导部分1506可不具有均一的横截面半径。例如，图47A示出波导部分1506的两个示例性实施例的横截面。波导部分1506'相对于两条轴线1509,1511示出，这两条轴线也在图47中示出。在各种实施例中，波导部分1506'沿轴线1511的横截面长度可小于其沿轴线1509的横截面尺寸。在一些实施例中，沿轴线1509的横截面长度可等于其他波导部分1504,1506的横截面长度。波导部分1506'可沿轴线1509弯曲。现在参见波导部分1506”，其沿轴线1509,1511的横截面长度可以相同，从而为波导部分1506”提供更大的弯曲方向范围。
在一些示例性实施例中，医疗超声波导1502为一体式的(例如，刀片部分1544与波导1502成一整体)。另外，在一些示例性实施例中，医疗超声波导1502包括第一纵向振动波腹1510和第二纵向振动波腹1512。第一波导部分1504可在第一纵向振动波腹1510近侧过渡到第二波导部分1506；并且第二波导部分1506可在第二纵向振动波腹1512近侧过渡到第三波导部分1508。在一些示例性实施例中，如图47所示，第二波导部分1506的长度基本上为谐振纵向波长的1/2。
在图47的实施例的一个示例性应用中，超声医疗器械1500还包括围绕医疗超声波导1502的使用者致动的关节运动护套1514。在各种示例性实施例中，医疗超声波导1502包括三个(意味着至少三个)纵向振动波节1516，每一个各自位于第一波导部分1504、第二波导部分1506和第三波导部分1508上。应当注意，一个或多个另外的纵向振动波节可存在于或可不存在于三个纵向振动波节1516的任一个或两个之间。在一种修改形式中，护套1514在三个纵向振动波节1516的相应一个处接触(例如，直接接触或通过至少一个居间构件1517诸如硅胶居间构件间接接触)第一波导部分1504、第二波导部分1506和第三波导部分1508。在一个示例中，护套1514包括在第一纵向振动波节(图47的最左侧波节1516)处接触第一波导部分1504的刚性第一护套部分1518，在第二纵向振动波节(图47的中间波节1516)处接触第二波导部分1506的柔性第二护套部分1520，以及在第三纵向振动波节(图47的最右侧波节1516)处接触第三波导部分1508的刚性第三护套部分1522。在一些示例性实施例中，护套1514仅具有两个关节运动位置(例如，笔直的和完全关节运动的)。在其他示例性实施例中，根据波导1502能够形成的能量效率弯曲的数量，护套1514在笔直位置和完全关节运动位置之间具有多个中间弯曲位置。在一些示例性实施例中，此类能量效率弯曲最大程度地减少进入非纵向振动模式的振动能量。
图48示出包括第一波导部分1530和第二波导部分1532的超声医疗器械1524的一个示例性实施例的一部分的示意性剖视图，其中第一波导部分1530跨越多个1/2谐振纵向波长。在图48所示的示例性实施例中，医疗超声波导1526包括位于第一波导部分1530上的至少两个纵向振动波节1528。在一种变型中，护套1534在至少两个纵向振动波节1528处接触(例如，直接接触或通过至少一个居间构件1536诸如硅氧烷居间构件间接接触)第一波导部分1530。在一些示例性实施例中，护套1534包括两个刚性护套部分1538和1542以及一个柔性护套部分1540，其中柔性护套部分1540在两个纵向振动波节1528中的至少一个处接触第一波导部分1530，并且其中柔性护套部分1540设置在两个刚性护套部分1538和1542之间。在一个示例性实施例中，两个刚性护套部分1538和1542各自在至少两个纵向振动波节1528的相应的一个处接触第二波导部分1532。
现在参见图47，波导1502可包括适于接触并超声地处理患者组织的刀片部分1544。刀片部分1544可设置在波导1502的远侧端部(例如，刀片1502的第三刀片部分1508的远侧)。在一个示例性实施例中，外科器械1500还可以包括使用者致动的夹持臂1546，其可枢转地附接到刀片部分1544近侧的护套1514,1534，其中夹持臂1546和医疗超声波导1502至少部分地限定超声外科剪1548。已从图47中省去了组织垫和夹持臂控制机构。再次参见图48，医疗超声波导1526还可以包括类似于刀片部分1544并设置在第一波导部分1532的远侧端部处的刀片部分1545。刀片部分1545还可以适于接触并超声地处理患者组织。图48的器械1524还可以包括夹持臂1546，其与刀片部分1545一起限定超声外科剪1548。
在各种示例性实施例中，波导1502,1526的某些部分为基本上刚性的。例如，波导1502的第一部分1504和第三部分1508可以为基本上刚性的。波导1526的第一部分1532可以为基本上刚性的。再次参见图47，医疗超声波导1502可以包括第一颈部部分1550和第二颈部部分1552，它们分别结合第一波导部分1504与第二波导部分1506以及第二波导部分1506与第三波导部分1508。(类似的颈部部分1552可结合波导1526的第一波导部分1530和第二波导部分1532)。
在一种修改形式中，医疗超声波导1502从第一波导部分1504到第三波导部分1508为基本上圆柱形的，其中第一波导部分1504、第二波导部分1506和第三波导部分1508各自具有基本上恒定的直径，并且其中第二波导部分1506的直径小于第一波导部分1504和三波导部分1508中的任一者的直径。在一些示例性实施例中，第二波导部分1506的直径基本上介于1毫米和2毫米之间，而第一波导部分和第三波导部分的直径基本上介于3毫米和5毫米之间。在材料的一种选择中，医疗超声波导1502基本上由钛合金组成。在一种修改形式中，医疗超声波导1502包括第一纵向振动波腹1510和第二纵向振动波腹1512，并且第一颈部部分1550设置在第一纵向振动波腹1510的近侧而第二颈部部分1552设置在第二纵向振动波腹1512的近侧。
图49示出与医疗器械一起使用并且包括第一波导部分和第二波导部分的超声波导的1554一个示例性实施例的示意性剖视图，其中第一波导部分1556通过榫钉压力配合而结合到第二波导部分1558。在图49所示的例子中，第二波导部分1558也通过榫钉压力配合而联接到第三波导部分1560。在各种示例性实施例中，第二波导部分1558基本上由钛或镍钛诺组成。在相同或不同的图示中，第二波导部分1558的长度小于1/2波长(波长是医疗超声波导的谐振纵向波长的长度，其基本上取决于波导的材料和波导运行的频率)并且在一个示例中小于1/8波长。
图50示出与医疗器械一起使用的超声波导1564的一个示例性实施例的示意性剖视图。与波导1554类似，波导1564不是一体式波导。波导1564可包括第一波导部分1564和第二波导部分1566，其中第一波导部分1564通过球窝型附件结合到第二波导1566部分。第二波导部分1566还可以按任何合适的方式结合到第三波导部分1568。在图50的例子中，第二波导部分1566经由榫钉压力配合而结合到第三波导部分1568。波导部分之间的其他附件是本领域的技术人员可想到的。
图51示出包括医疗超声波导1572的超声医疗器械1570的另一个实施例的一部分的示意性剖视图，该医疗超声波导具有一定的长度并且包括近侧波导部分1574和远侧波导部分1576。近侧波导部分1574具有较大的横截面积，而远侧波导部分1576则具有较小的横截面积。远侧波导部分1576比近侧波导部分1574更易弯曲。远侧波导部分1576包括适于接触并超声处理患者组织的远侧端部部分1580。在各种示例性实施例中，图47的实施例的需要加大颈部并形成较大直径的端部执行器的另外1/2波长被消除，从而可以将关节运动接头放置得更靠近超声医疗器械1570的远侧端部。图47-图50所示的实施例、应用等同样适用于(在不存在第三波导部分的情况下)图51的实施例。
图52示出了可与各种外科器械(包括本文描述的那些外科器械)一起使用的轴1000的一个实施例。端部执行器1006定位在轴主体1004内并且可包括超声刀片1008。超声刀片1008可在声学上联接到从刀片1008朝近侧延伸的波导1020。波导1020可包括可弯曲部分1012，诸如上文所述的可弯曲部分1506,1530,1576等。定位在轴1000内的还有楔形件1016，其联接到平移缆线1018，该平移缆线从楔形件1016朝近侧延伸。楔形件1016可在缆线1018的控制下朝近侧和朝远侧往复运动。缆线1018可由任何合适的材料制成，包括(例如)足够刚性以在朝远侧推动缆线1018(例如，从柄部、从机器人器械安装部分等)时对楔形件1016提供远侧指向力的材料)。在一些实施例中，缆线1018可由金属材料制成。
超声波导1020可在枢转点1014处联接到轴主体1004。例如，枢转点1014可表示被接收穿过波导1020以在大约枢转点1014处保持波导相对于轴主体1004静止的销。枢转点可位于可弯曲部分1012的近侧。在波导1020的可弯曲部分1012的远侧，波导1020和/或超声刀片1008限定凸缘1010。当楔形件1016朝远侧平移时，其可接触凸缘1010。当凸缘1010升至楔形件1016之上时，波导1020可绕枢转点枢转，从而趋向于使刀片1008和波导1020远离轴1000的纵向轴线1002枢转。图53示出了轴1000的一个实施例，其中楔形件1016朝远侧平移并且刀片1008枢转，如所描述。楔形件1016从图53所示的位置朝近侧平移可释放凸缘1010上的力，该力趋向于使刀片1008偏转。在没有所述力的情况下，刀片1008和波导1020可返回到图52所示的静止位置。例如，刀片1008和/或波导1020可由弹性材料构成，所述弹性材料在弯曲之后恢复其初始形状。例如，在各种实施例中，楔形件1016可不将刀片1008和/或波导1020推动经过其相应的塑性点。凸缘1010和枢转点1014均可定位在波导1020的波节(例如，基本上没有波导1020的运动的部分)处。在一些实施例中，凸缘1010和枢转点1014可分开单个波长。
楔形件1016和缆线1018可根据任何合适的方法或机构而朝远侧和朝近侧平移。例如，当结合手动或手持式外科器械使用轴1000时，可以与上文相对于器械10的往复式管状致动构件58和/或器械300的轴向移动构件378描述的方式类似的方式朝远侧和朝近侧平移缆线1018。另外，例如，当结合外科机器人使用轴1000时，可以与上文相对于器械310的组织切割元件555描述的方式类似的方式朝远侧和朝近侧平移缆线1018。
图54示出了包括若干额外特征结构的轴1000的另选实施例。例如，如图54所示，轴1000包括任选的第二楔形件1016'和缆线1018'。第二楔形件1016'和缆线1018'可类似于上文描述的楔形件1016和缆线1018进行操作。然而，第二楔形件1016'和缆线1018'可绕纵向轴线与第一楔形件1016和缆线1018偏置，使得第一楔形件1016的远侧平移引起端部执行器1008和波导1020沿第一方向枢转并且第二楔形件1016'的远侧平移引起端部执行器1008和波导1020沿第二方向枢转。在各种示例性实施例中，第一方向和第二方向可绕纵向轴线彼此反向180°。在图54所示的示例性实施例中，轴主体1004还包括狭槽1022,1022'以用于接收相应楔形件1016,1016'的狭槽构件1024,1024'。狭槽1022,1022'和狭槽构件1024,1024'可用于维持相应楔形件1016,1016'的轴向对准。
图54还示出了用于朝远侧和朝近侧平移楔形件1016,1016'和缆线1018,1018'的一个示例性机构(例如，在机器人外科实施例中)。例如，每个缆线1018,1018'可缠绕相应的卷轴1026,1026'。卷轴1026,1026'继而可联接到机器人控制的部件，诸如如本文描述的相应可旋转主体612。卷轴1026,1026'的顺时针旋转和逆时针旋转可缠绕和解绕缆线1018,1018'，从而使楔形件1016,1016'交替地朝远侧和朝近侧平移。
以二维形式示出图52-图54的楔形件1016,1016'。然而，根据各种实施例的楔形件可具有不同的三维形状。图55示出了具有弯曲或圆形形状的示例性楔形件1028的一个实施例。楔形件1028的横截面1030示出了用于接触凸缘1010的楔形面部分1032。箭头1032指示沿着纵向轴线1002的远侧方向。图56示出了与端部执行器1006结合的楔形件1028，所述端部执行器包括超声刀片1008以及凸缘1010。
图57示出了轴1000的一个实施例的横截面，显示了带键凸缘1010'。凸缘1010'包括第一带键表面1038以用于接收带键楔形件。带键表面1038限定第一凹口1036、第二凹口1038和第三凹口1040以用于接收对应带键楔形件的台阶。图58示出了带键楔形件1044的一个实施例，该带键楔形键包括与带键凸缘1010'的凹口1036,1038,1040匹配的台阶1046,1048,1050。在各种实施例中，各种台阶1046,1048,1050的纵向坡度是相等的。带键凸缘1010'还显示具有任选的第二带键表面1042，例如用于与多楔形件实施例(诸如图54所示的实施例)中的第二带键楔形件(未示出)交接。另外，虽然示出三个凹口1036,1038,1040和三个台阶1046,1048,1050，但应当理解，带键表面1038和楔形件1044可具有更多或更少的凹口和台阶。
图59示出了与轴1000一起使用的楔形件1052，该楔形件1052具有台阶式外形。台阶式外形可允许楔形件1052将超声刀片1008和波导1020枢转离散量。例如，当楔形件1052朝远侧平移时，第一楔形部分1054推动凸缘1010，从而将刀片1008和波导1020枢转第一量。当凸缘1010到达第一平坦部分1056时，其可保持枢转第一量，直到凸缘1010遇到第二楔形部分1058。第二楔形部分1058可将刀片1008和波导1020枢转第二量，这在凸缘1010滑动穿过第二平坦部分1060时同样保持枢转第二量。第三楔形部分1062和第三平坦部分1064可在楔形件1052继续朝远侧平移时以类似的方式操作。当楔形件1052朝近侧缩回时，凸缘1010(并因此，刀片1008和波导1020)可通过与每个楔形部分和平坦部分对相关联的离散枢转量转变回来。
图60示出了与具有凸轮式关节运动机构的各种外科器械(包括本文描述的那些外科器械)一起使用的轴1066的一个示例性实施例。定位在轴1066内的是在枢转点1014处联接到轴1066的波导1020。波导1020在声学上联接到超声刀片1008，如上文描述。凸缘1068可为凸轮式凸缘，其限定波导凸轮特征结构1072，该波导凸轮特征结构能够接触轴凸轮特征结构1070以使波导1020和刀片1008绕枢转点1012偏转。图61示出了轴1066的剖视图，提供了轴凸轮特征结构1070和波导凸轮特征结构1072的视图。在各种示例性实施例中，轴主体1004可绕纵向轴线1002旋转。当轴主体1004旋转时，轴凸轮特征结构1070可接触波导凸轮特征结构1072，从而使波导1020和刀片1008绕枢转点1014远离轴凸轮特征结构1070枢转。
在一些示例性实施例中，如图61所示，凸缘1068可限定额外波导凸轮特征结构1074,1076,1078，其可以与波导凸轮特征结构1072类似的方式操作。例如，当轴主体1004旋转时，轴凸轮特征结构1070可继而接触额外波导凸轮特征结构1074,1076,1078中的每一者，从而使波导1020和刀片1008绕枢转点1014远离轴凸轮特征结构1070枢转。在各种实施例中，轴主体1004可限定额外轴凸轮特征结构(未示出)。可以任何合适的方式旋转轴主体1004。例如，在手动或用手操作的外科器械中，可以与上文相对于远侧旋转组件13和轴组件14描述的方式类似的方式旋转轴主体1004。在机器人外科器械中，例如，可以与上文相对于图32-图46C描述的方式类似的方式旋转轴主体1004。另外，图60示出了用于(例如)在机器人环境中旋转轴主体1004的另一个实施例。例如，轴主体1004的近侧端部可包括第一卷轴1085和第二卷轴1087。额外的卷轴1081,1083定位成由机器人旋转(例如，卷轴1081,1083可联接到可旋转主体612，如本文描述)。缆线1093可缠绕在卷轴1085和1081周围。相似地，缆线1091可缠绕在卷轴1083,1087周围。卷轴1081的旋转可使缆线1093从卷轴1085解绕到卷轴1081，进而使轴主体1004沿第一方向旋转。轴沿第一方向旋转还可使缆线1091从卷轴1083解绕并且缠绕至卷轴1087上。在一些实施例中，卷轴1083可被单独驱动以促进该缠绕。为了沿与第一方向相反的方向旋转轴主体1004，可沿相反方向旋转卷轴1083，从而使缆线1091从卷轴1087缠绕到卷轴1093。同时，卷轴1085可从卷轴1081拉动缆线1093。此外，卷轴1081可被单独驱动以促进该缠绕。
图62-图64示出了可与各种外科器械(包括本文描述的那些外科器械)一起使用的关节运动轴1080的一个实施例。轴主体1004包括限定沟槽1082的内壁1092。沟槽1082可具有定位在距端部执行器1006不同轴向距离处的不同部分。例如，在一些示例性实施例中，沟槽1082可为椭圆形。另外，在一些示例性实施例中，如图62-图64所示，沟槽1082可表示在与纵向轴线1002相交但不垂直于轴线1002的平面中截取的轴主体1004的部分或完整横截面。
波导1020(和/或端部执行器1006)的凸缘1010可在联接点(在图62-图64中表示为凸缘1010)处联接到一对接口构件1084,1086。第一接口构件1084可从凸缘1010朝近侧延伸并且可包括和/或限定被定位成搭放在沟槽1082内的第一栓构件1088。第二接口构件1084可从凸缘1010朝近侧延伸，并且相似地，可包括和/或限定也被定位成搭放在沟槽1082内的第二栓构件1090。如图所示，凸缘1010与第一栓1088之间的第一接口构件1084的长度比凸缘1010与第二栓1090之间的第二接口构件1086的长度长，但是这并不是必需的。
在图62-图64所示的示例性实施例中，通过使轴主体1004相对于波导1020、刀片1008和接口构件1084,1086旋转来使端部执行器1006远离纵向轴线1002枢转。这种相对旋转由轴主体1004的旋转、波导1020的旋转或两者引起。当相对旋转发生时，栓构件1088,1090可搭放在沟槽1082内。在栓构件1088,1090搭放在沟槽的较靠近和较远离端部执行器1006的部分内时，可推动栓构件1088,1090靠近和远离端部执行器1006。栓构件1088,1090的微分轴向平移可使接口构件1084,1086弯曲，导致端部执行器1006枢转。例如，如图64所示，栓构件1088,1090被放置在与端部执行器1006大致等距的位置处。由于在图64的例子中接口构件1084比接口构件1086长，所以在朝近侧牵拉构件1086时，可朝远侧推动构件1084。这可导致端部执行器1006远离纵向轴线1002枢转，如图所示。
可以任何合适的方式旋转轴主体1004和/或波导1020。例如，在手动或用手操作的外科器械中，可以与上文相对于远侧旋转组件13和轴组件14描述的方式类似的方式旋转轴主体1004和/或波导1020。在机器人外科器械中，例如，可以与上文相对于图32-图46C描述的方式类似的方式旋转轴主体1004和/或波导1020。
图65-图67示出了联接到包括超声刀片1108和可枢转的夹持臂1110的端部执行器1106的轴1100的一个示例性实施例。轴11102包括近侧管1102和柔性部分1104，其中端部执行器1106联接到柔性部分1104。夹持臂1110在枢转点1112处以能够枢转的方式联接到端部执行器1106(例如，端部执行器构件1107)。图66-图67是剖视图，示出了定位在轴1100的内部的部件。例如，波导1114可在声学上联接到超声刀片1108，并且可在大约轴1100的柔性部分1104的位置处包括可弯曲部分1116。关节运动平移构件1113,1115可分别在点1126和1124处联接到端部执行器构件1107，以引起端部执行器1106的关节运动，如下文描述。夹持臂构件1117可联接到夹持臂1110，并且可朝远侧和朝近侧平移以打开和闭合夹持臂1110，如下文描述。
图68示出了端部执行器1106的一个实施例，显示了利用夹持臂构件1117打开和闭合夹持臂1110的第一方式。如上所述，夹持臂1110可在枢转点1112处以能够枢转的方式联接到端部执行器构件1107。在图68所示的示例性实施例中，夹持臂构件1117是在1120处联接到夹持臂1110的平移构件。夹持臂构件1117的远侧平移可朝远侧推动夹持臂1110的点1120，从而使夹持臂1110绕枢转点1112枢转至打开位置(如图67中的虚线所示)。作为另外一种选择，朝近侧牵拉夹持臂构件1117可朝近侧牵拉点1120，从而使夹持臂1110枢转回到图65-图66和图68所示的闭合位置。可以任何合适的方式朝远侧和朝近侧平移该平移式夹持臂构件1117。例如，当结合手动或手持外科器械使用轴1100时，平移构件1117可以与上文相对于器械10的往复式管状致动构件58和/或器械300的轴向运动构件378所述相似的方式朝远侧和近侧平移。另外，例如，当结合外科机器人使用轴1100时，平移构件1117可以与上文相对于器械310的组织切割元件555所述相似的方式朝远侧和近侧平移。
图69-图70示出了端部执行器1106的另一个示例性实施例，显示了利用夹持臂构件1117'打开和闭合夹持臂1110的另外的方式。夹持臂构件1117'可为柔性螺纹缆线，其限定可延伸穿过端部执行器构件1107的螺纹孔1134的螺纹部分1130。夹持臂构件1117'的远侧部分可联接到定位在枢转点1112远侧的底座1132。当夹持臂构件1117'在第一方向上旋转时，其可朝远侧平移，从而朝远侧推动底座1132和夹持臂1110并且趋向于闭合夹持臂1110。当夹持臂构件1117'在沿与第一方向相反的第二方向旋转时，其可朝近侧平移，从而朝近侧牵拉底座1132并且趋向于打开夹持臂1110。可以任何合适的方式旋转夹持臂构件1117'。例如，在手动或用手操作的外科器械中，可以与上文相对于远侧旋转组件13和轴组件14描述的方式类似的方式旋转夹持臂构件1117'。在机器人外科器械中，例如，可以与上文相对于图32-图46C描述的方式类似的方式旋转夹持臂构件1117'。
现在再次参见图65-图67，应当理解，可以任何合适的方式引起端部执行器1106的关节运动。例如，当朝近侧牵拉平移构件1113时，端部执行器1106可朝平移构件1113枢转，如图65所示。相反，当朝近侧牵拉平移构件1115时，端部执行器1106可朝平移构件1115枢转。
图71-图72示出了轴1110的一个示例性实施例，显示了用于管理平移构件1113,1115的微分平移的示例性机构。如图71-图72所示，平移构件可包括和/或限定相应齿条传动装置1138,1136。小齿轮传动装置1140可定位成接合齿条传动装置1138,1136两者。当沿着纵向轴线平移该平移构件1113中的一个时，齿条传动装置1138可与小齿轮传动装置1140交接，从而引起相对平移构件1115的对应反方向平移，反之亦然。这可促进构件1113,1115的微分平移。在一些实施例中，可经由杠杆手动地和/或自动地(例如，由机器人外科装置)驱动小齿轮传动装置1140。当驱动小齿轮传动装置1140时，其可继而驱动齿条传动装置1138,1136，从而引起平移构件1113,1115的微分近侧和远侧平移以及端部执行器1106的关节运动。
可以任何合适的方式实现平移构件1113、1115的微分平移。例如，当将轴1100用于外科机器人的背景中时，构件1170,1172可利用上文相对于图32-图46C所述的任何方法和/或机构进行微分平移。作为另外一种选择，图73-图74示出了利用呈图71-图72所示构型的轴1100的手持式外科器械的一个实施例。小齿轮传动装置1140在图73中示出为联接到杠杆1142，该杠杆可由临床医生旋转以引起端部执行器1106的关节运动，如上文描述。图74示出了包括杠杆1142的器械1150，显示了用于引起关节运动的杠杆1142的放置和使用。
图75-图76示出了可与各种外科器械(包括本文描述的那些外科器械)一起使用的关节运动轴1200的一个实施例。轴1200包括远侧管1202，其经由铰链接口1208以能够枢转的方式联接到近侧管1204。铰链接口1208可为和/或包括任何合适类型的铰链，并且在一些示例性实施例中可包括销。内部可旋转构件1206可朝近侧延伸穿过近侧管1204和远侧管1202的至少一部分。内部可旋转构件1206可限定倾斜狭槽1210。远侧管1202可包括定位成搭放在倾斜狭槽1210内的栓1212。
如图所示，栓1212可定位成沿纵向轴线1002与铰链接口1208相对。由于狭槽1210倾斜，内部可旋转构件1206和狭槽1210沿第一方向的旋转可趋向于朝远侧推动栓1212，从而朝远侧推动远侧管1202。内部可旋转构件1206和狭槽1210沿与第一方向相反的第二方向的旋转可趋向于朝近侧牵拉栓1212和远侧管1202。当通过构件1206和狭槽1210的旋转朝远侧推动栓1212和远侧管1202时，远侧管1202可绕铰链接口1208远离纵向轴线1002枢转，如图76所示。当通过构件1206和狭槽1210的旋转朝近侧牵拉栓1212和远侧管1202时，远侧管1202可朝纵向轴线1002枢转回到图75所示的位置。可以任何合适的方式启动可旋转构件1206的旋转。例如，在手动或用手操作的外科器械中，可以与上文相对于远侧旋转组件13和轴组件14描述的方式类似的方式旋转构件1206。在机器人外科器械中，例如，可以与上文相对于图32-图46C描述的方式类似的方式旋转构件1206。应当理解，轴1200可与任何合适类型的外科器械一起使用，包括(例如)超声外科器械、电外科器械等。在一些实施例中，用于外科器械的电线、波导和/或其他控制装置可穿过近侧管1204和远侧管1202。例如，在一些实施例中，延伸穿过近侧管1204和远侧管1202的波导可具有例如类似于如上所述的可弯曲部分1506,1530,1576等的可弯曲部分1046。可弯曲部分可定位在大约铰链接口1208处，以便在远侧管1202枢转时弯曲。
图77示出了可与各种外科器械(包括本文描述的那些外科器械)一起使用的轴1300的一个实施例。端部执行器1309定位在内轴1322和外轴1302内。端部执行器1309包括超声刀片1303。朝近侧移动时，刀片1303在声学上联接到凸缘1305，该凸缘延伸穿过外轴1302中的狭槽1312。凸缘1305经由可弯曲波导部分1316(例如，类似于上文描述的可弯曲部分1506,1530,1576)联接到第二凸缘1306。第二凸缘1306可经由支撑件1308固定地联接到内轴1322。第二凸缘1306和支撑件1308可形成枢转点1304。外轴1302限定接收凸缘1305的狭槽1312。当相对于内轴1322朝远侧平移外轴1302时，凸缘1305可到达狭槽1312的最近侧部分，从而使刀片1303绕枢转点1304枢转。当再次朝近侧牵拉外轴1302时，刀片1303可返回到其静止位置。在各种实施例中，相应凸缘1306,1305可定位在系统的谐振波长下的波导1308的波节处。在一些实施例中，凸缘1306,1305分开单个谐振波长。
可以任何合适的方式朝远侧和朝近侧平移外轴1302。图78示出了显示外轴1302的一个实施例的额外细节的视图。在某些实施例中，外轴1302通过弹簧1310朝远侧偏置。
往复式控制构件1320可用于朝近侧牵拉外轴1302，从而克服弹簧1310的偏置。当控制构件1320上的张力被释放时，弹簧1310可朝远侧偏置外轴，从而造成如上所述的关节运动。可以任何合适的方式朝远侧和朝近侧平移控制构件1320。例如，当结合手动或手持式外科器械使用轴1200时，可以与上文相对于器械10的往复式管状致动构件58和/或器械300的轴向运动构件378描述的方式类似的方式朝远侧和朝近侧平移控制构件1320。另外，例如，当结合外科机器人使用轴1300时，可以与上文相对于器械310的组织切割元件555描述的方式类似的方式朝远侧和朝近侧平移控制构件1320。然而，在某些实施例中，可省略弹簧1310。例如，可由往复式控制构件向外轴1302提供近侧力和远侧力。
图79示出了轴1300的一个实施例的剖面图。图79示出了内轴1322的额外特征结构。例如，内轴1322可限定也可接收凸缘1305的狭槽1324。狭槽1324的面积可大于狭槽1312的面积。例如，凸缘1305可在正常操作期间不接触狭槽1324的边缘。图80示出了轴1300的一个实施例的剖面图，其中外轴1302朝远侧延伸以使刀片1303进行关节运动。如图所示，狭槽1312的远侧边缘1313接触凸缘1305，从而沿箭头1311的方向朝远侧推动该凸缘。这继而使刀片1303和凸缘1305枢转(在可弯曲波导部分1316处)至所示位置。
图81示出了具有额外远侧凸缘1307的轴1300的一个实施例。凸缘1307可基本上与凸缘1305反向延伸。为了防止干涉关节运动，外轴1302和内轴1322可限定额外狭槽1330,1332具有足以使得凸缘1307在关节运动期间不接触狭槽1330,1332的任何边缘的尺寸。另外，虽然所述实施例中的关节运动由外轴1302的远侧平移和近侧平移提供，但应当理解，类似的轴可被构造为具有往复式带槽内轴以执行由如本文描述的外轴1302提供的功能。例如，内轴能够在外轴内平移并且可限定用于接收凸缘1305的狭槽。当内轴朝远侧平移时，其狭槽可接触凸缘1305，从而使刀片1303进行关节运动，如图80所示。
非限制性实例
各种实施例涉及可进行关节运动的外科器械，其包括具有超声刀片的端部执行器、沿着纵向轴线从端部执行器朝近侧延伸的中空轴以及延伸穿过轴并且在声学上联接到超声刀片的波导。在某些实施例中，波导包括定位在远侧的凸缘，该凸缘从刀片朝近侧定位在中空轴内。波导还可在第一枢转点处保持静止，该第一枢转点从凸缘朝近侧定位在中空轴内。往复式楔形件可定位在中空轴内，使得楔形件的远侧运动推动凸缘与中空轴之间的楔形件，从而使超声刀片绕第一枢轴在第一方向上枢转。
在某些实施例中，中空轴可包括限定狭槽的第一轴，以及第二轴。第一轴和第二轴能够沿着纵向轴线相对于彼此平移。波导可包括从刀片朝近侧定位在中空轴内的定位在远侧的第一凸缘、从第一凸缘朝近侧定位的可弯曲部分以及从可弯曲部分朝近侧定位并且固定地联接到第二轴的第二凸缘。第一凸缘可延伸穿过狭槽。另外，第一轴能够从远侧位置平移至近侧位置，在所述远侧位置狭槽的近侧边缘朝远侧推动第一凸缘，从而使超声刀片弯曲远离纵向轴线。
在某些实施例中，中空轴的内部部分限定朝向纵向轴线指向的轴凸轮特征结构。另外，波导可限定远离纵向轴线指向的波导凸轮特征结构。这样，中空轴相对于波导的旋转致使轴凸轮特征结构接触波导凸轮特征结构，从而导致波导和超声刀片在第一方向上绕第一枢转点远离纵向轴线弯曲。在某些实施例中，端部执行器包括联接到定位在超声刀片周围的构件的夹持臂。夹持臂可在枢转点处以能够枢转的方式联接到该构件。柔性控制缆线可在与枢转点偏置的点处联接到夹持臂。控制缆线的远侧和近侧平移可引起夹持臂相对于超声刀片枢转。在某些实施例中，构件可限定螺纹孔，柔性螺纹缆线延伸穿过该螺纹孔。缆线还可联接到夹持臂，使得缆线的旋转致使其朝近侧和朝远侧平移，这取决于旋转方向。此类朝近侧和朝远侧平移可致使夹持臂打开和闭合。
另外，各种实施例涉及可进行关节运动的外科器械，其包括具有超声刀片的端部执行器和从端部执行器朝近侧延伸的中空轴。中空轴的内壁可限定沟槽，其中沟槽的不同位置定位在距端部执行器的不同轴向距离处。第一接口构件可在联接点处联接到波导或超声刀片并且朝近侧延伸。第一接口构件可包括定位在沟槽内的第一栓构件。第二接口构件可在联接点处联接到波导或超声刀片并且可朝近侧延伸。第二接口构件也可包括定位在沟槽内的栓构件。在中空轴相对于波导旋转时，第一栓构件和第二栓构件可在沟槽内平移，从而致使第一接口构件和第二接口构件弯曲以及第一接口构件和第二接口构件远离纵向轴线偏转。
各种实施例涉及可进行关节运动的外科器械，其包括端部执行器和沿着纵向轴线从端部执行器朝近侧延伸的轴。该轴可包括近侧管和远侧管，该远侧管在与纵向轴线偏置的铰链接口处以能够枢转的方式联接到近侧管。远侧管可包括轴向指向的栓构件。外科器械还可包括内部可旋转构件，其朝近侧延伸穿过近侧管的至少一部分和远侧管的至少一部分。内部可旋转构件可限定倾斜狭槽，使得轴向指向的栓构件至少部分地搭放在倾斜狭槽内并且使得内部可旋转构件在第一方向上的旋转朝远侧推动栓构件和远侧管，并且内部可旋转构件在与第一方向相反的第二方向上的旋转朝近侧推动栓构件和远侧管。
申请人还拥有以下专利申请，这些专利申请各自以其相应全文以引用的方式并入：
2012年6月28日提交并且名称为“Flexible Drive Member”(代理人案卷号END7131USNP/120135)的美国专利申请序列号13/536,271；
2012年6月28日提交并且名称为“Multi-Functional Powered Surgical Devicewith External Dissection Features”(代理人案卷号END7132USNP/120136)的美国专利申请序列号13/536,288；
2012年6月28日提交并且名称为“Rotary Actuatable Closure Arrangement forSurgical End Effector”(代理人案卷号END7134USNP/120138)的美国专利申请序列号13/536,295；
2012年6月28日提交并且名称为“Surgical End Effectors Having AngledTissue-Contacting Surfaces”(代理人案卷号END7135USNP/120139)的美国专利申请序列号13/536,326；
2012年6月28日提交并且名称为“Interchangeable End Effector CouplingArrangement”(代理人案卷号END7136USNP/120140)的美国专利申请序列号13/536,303；
2012年6月28日提交并且名称为“Surgical End Effector Jaw and ElectrodeConfigurations”(代理人案卷号END7137USNP/120141)的美国专利申请序列号13/536,393；
2012年6月28日提交并且名称为“Multi-Axis Articulating and RotatingSurgical Tools”(代理人案卷号END7138USNP/120142)的美国专利申请序列号13/536,362；以及
2012年6月28日提交并且名称为“Electrode Connections for Rotary DrivenSurgical Tools”(代理人案卷号END7149USNP/120153)的美国专利申请序列号13/536,417。
应当理解，根据操纵用来治疗患者的器械的一端的临床医生来在说明书中通篇使用术语“近侧”和“远侧”。术语“近侧”是指器械的最靠近临床医生的部分，术语“远侧”是指离临床医生最远的部分。还应当理解，为简明和清楚起见，本文可以参考所示实施例使用诸如“竖直”、“水平”、“上”或“下”之类的空间术语。然而，外科器械可以在许多取向和位置使用，并且这些术语并非意图是限制的或绝对的。
本文描述了外科器械和机器人外科系统的各种实施例。本领域的技术人员应当理解，本文所述的各种实施例可以与所述的外科器械和机器人外科系统一起使用。提供的说明只是为了举例，本领域的技术人员应当理解，所公开的实施例不只是限于本文所公开的装置，而是可以与任何兼容的外科器械或机器人外科系统一起使用。
本说明书通篇提及的“各种实施例”、“一些实施例”、“一个示例性实施例”或“实施例”意味着结合所述实施例描述的具体特征、结构或特性包括在至少一个示例性实施例中。因此，在整篇说明书中出现的短语“在各种实施例中”、“在一些实施例中”、“在一个示例性实施例中”或“在实施例中”并不一定都指相同的实施例。此外，在没有限制的情况下，结合一个示例性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他实施例的特征、结构或特性组合。
虽然已经通过描述若干实施例来例示了本文的各种实施例，并且虽然已经相当详细地描述了例示性实施例，但是申请人的意图不在于将所附权利要求的范围约束或以任何方式限制到这些细节中。本领域的技术人员可容易看出另外的优点和修改形式。例如，所公开的实施例中的每个可用于内窥镜式手术、腹腔镜式手术以及开放式手术，对其预期用途没有限制。
应当理解，本文的附图和描述中的至少一些已被简化以示出适于清楚地理解本公开的元件，同时为清晰起见移除了其他元件。然而，本领域的普通技术人员将认识到，这些和其他元件可为所需的。然而，由于此类元件为本领域所熟知并且由于它们不利于较好地理解本公开，因此本文未提供对这些元件的论述。
虽然已经描述了若干实施例，但应当知道，本领域技术人员在掌握了本公开的一些或全部优点之后可能对这些实施例作出各种修改、改变和改型。例如，根据各种实施例，单个部件可替换为多个部件，并且多个部件也可替换为单个部件，以执行给定的一种或多种功能。因此，在不脱离所附权利要求书限定的本公开的范围和实质的情况下，本专利申请旨在涵盖所有此类修改、变型和改型形式。
以引用方式全文或部分地并入本文的任何专利、专利公布或其他公开材料均仅在所并入的材料不与本公开所述的现有定义、陈述或其他公开材料相冲突的范围内并入本文。由此，在必要的程度下，本文所明确阐述的公开内容将取代以引用方式并入本文的任何相冲突的材料。如果据述以引用方式并入本文但与本文所述的现有定义、陈述或其他公开材料相冲突的任何材料或其部分，仅在所并入的材料和现有的公开材料之间不产生冲突的程度下并入本文。

Claims (19)

1.一种可关节运动的外科器械，包括：
用于处理组织的端部执行器，其中所述端部执行器包括超声刀片；
中空轴，所述中空轴沿着纵向轴线从所述端部执行器朝近侧延伸；
和
波导，所述波导延伸穿过所述轴并且在声学上联接到所述超声刀片，其中所述波导包括定位在远侧的凸缘，所述凸缘从所述刀片朝近侧定位在所述中空轴内，并且其中所述波导在第一枢转点处保持静止，所述第一枢转点从所述凸缘朝近侧定位在所述中空轴内；
第一往复式楔形件，所述第一往复式楔形件定位在所述中空轴内，使得所述第一往复式楔形件的远侧运动推动所述凸缘与所述中空轴之间的所述第一往复式楔形件，从而使所述超声刀片绕所述第一枢转点在第一方向上枢转。
2.根据权利要求1所述的外科器械，其中所述波导在所述第一枢转点处联接到所述中空轴。
3.根据权利要求1所述的外科器械，其中所述第一枢转点在所述波导的谐振频率下定位在所述波导的第一波节处。
4.根据权利要求3所述的外科器械，其中所述凸缘在所述波导的所述谐振频率下定位在所述波导的第二波节处。
5.根据权利要求4所述的外科器械，其中所述第一波节和所述第二波节分开单个波长。
6.根据权利要求1所述的外科器械，其中所述中空轴的内壁限定纵向指向的狭槽，并且其中当所述第一往复式楔形件朝远侧和朝近侧往复运动时，所述第一往复式楔形件的至少一部分定位在所述纵向狭槽内。
7.根据权利要求1所述的外科器械，其中所述凸缘的至少一部分是弯曲的，使得弯曲的凹侧指向所述纵向轴线，并且其中所述第一往复式楔形件是弯曲的，使得所述第一往复式楔形件接触所述凸缘的所述弯曲部分。
8.根据权利要求1所述的外科器械，其中所述凸缘限定第一凹口并且其中所述第一往复式楔形件包括对应台阶，使得当朝远侧移动所述第一往复式楔形件时，所述台阶搭放在所述第一凹口内。
9.根据权利要求8所述的外科器械，其中所述凸缘限定第二凹口并且其中所述第一往复式楔形件包括对应的第二台阶，使得当朝远侧平移所述第一往复式楔形件时，所述第二台阶搭放在所述第二凹口内。
10.根据权利要求9所述的外科器械，其中所述第一凹口和所述第二凹口形成台阶图案。
11.根据权利要求1所述的外科器械，其中所述第一往复式楔形件限定：
第一楔形部分，在该第一楔形部分，所述第一往复式楔形件具有第一坡度；
平坦部分，在该平坦部分，所述第一往复式楔形件基本上没有坡度，其中所述平坦部分从所述第一楔形部分朝近侧定位；和
第二楔形部分，其中所述第一往复式楔形件具有第二坡度。
12.根据权利要求11所述的外科器械，其中所述第一往复式楔形件定位成使得：
所述第一往复式楔形件到第一位置的远侧平移致使所述第一楔形部分将所述超声刀片绕所述第一枢转点枢转第一量；
所述第一往复式楔形件从所述第一位置到第二位置的远侧平移致使所述第一往复式楔形件的所述平坦部分接触所述凸缘；并且
所述第一往复式楔形件从所述第二位置到第三位置的远侧平移致使所述第二楔形部分将所述超声刀片绕所述第一枢转点枢转另外的量。
13.根据权利要求11所述的外科器械，其中所述第一往复式楔形件还限定：
第二平坦部分，所述第二平坦部分从所述第二楔形部分朝近侧定位，其中所述第一往复式楔形件基本上没有坡度并且位于所述第二平坦部分处；和
第三楔形部分，所述第三楔形部分具有第三坡度并且从所述第二平坦部分朝近侧定位。
14.根据权利要求11所述的外科器械，其中所述第一坡度和所述第二坡度基本上彼此相同。
15.根据权利要求1所述的外科器械，还包括：
第二往复式楔形件，所述第二往复式楔形件定位在所述中空轴内与所述第一往复式楔形件相对，使得所述第二往复式楔形件的远侧运动推动所述凸缘与所述中空轴之间的所述第二往复式楔形件，从而使所述超声刀片绕所述第一枢转点在第二方向上枢转。
16.一种可关节运动的外科器械，包括：
用于处理组织的端部执行器，其中所述端部执行器包括超声刀片；
中空轴，所述中空轴沿着纵向轴线从所述端部执行器朝近侧延伸，所述中空轴具有外壁和内壁，其中所述内壁在所述中空轴内限定沟槽，其中所述沟槽的不同部分定位在距所述端部执行器的不同轴向距离处；
波导，所述波导在声学上联接到所述超声刀片并且朝近侧延伸穿过所述中空轴；
第一接口构件，所述第一接口构件在联接点处联接到所述波导和所述超声刀片中的至少一者并且朝近侧延伸，其中所述第一接口构件包括定位在所述沟槽内的第一栓构件；
第二接口构件，所述第二接口构件在所述联接点处联接到所述波导和所述超声刀片中的至少一者并且朝近侧延伸，其中所述第二接口构件包括定位在所述沟槽内的第二栓构件，并且其中在所述中空轴相对于所述波导旋转时，所述第一栓构件和所述第二栓构件在所述沟槽内平移，从而使所述第一接口构件和所述第二接口构件弯曲并且所述第一接口构件和所述第二接口构件远离所述纵向轴线偏转。
17.根据权利要求16所述的外科器械，其中所述第一接口构件在所述第一栓构件与所述联接点之间具有第一长度，并且其中所述第二接口构件在所述第二栓构件与所述联接点之间具有小于所述第一长度的第二长度。
18.根据权利要求16所述的外科器械，其中所述第一栓构件和所述第二栓构件在所述沟槽内的移位致使所述第一接口构件朝远侧平移并且所述第二接口构件朝近侧平移，从而导致所述波导和超声刀片远离所述纵向轴线朝向所述第二接口构件枢转。
19.根据权利要求16所述的外科器械，其中所述联接点对应于在所述波导和超声刀片的谐振频率下的超声波节。
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