CN104768488B - 用于组织切割和封合的设备 - Google Patents

用于组织切割和封合的设备 Download PDF

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CN104768488B
CN104768488B CN201380055342.7A CN201380055342A CN104768488B CN 104768488 B CN104768488 B CN 104768488B CN 201380055342 A CN201380055342 A CN 201380055342A CN 104768488 B CN104768488 B CN 104768488B
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clamp
lower clamp
electro
surgical device
upper clamp
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CN104768488A (zh
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埃瑞克·瓦尔伯格
布兰登·劳德米尔克
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Aesculap AG
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/00184—Moving parts
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/00184—Moving parts
    • A61B2018/00202—Moving parts rotating
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/00297—Means for providing haptic feedback
    • A61B2018/00309—Means for providing haptic feedback passive, e.g. palpable click when activating a button
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00601—Cutting
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/0063—Sealing
    • 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
    • A61B2090/033—Abutting means, stops, e.g. abutting on tissue or skin
    • A61B2090/034—Abutting means, stops, e.g. abutting on tissue or skin abutting on parts of the device itself
    • A61B2090/035—Abutting means, stops, e.g. abutting on tissue or skin abutting on parts of the device itself preventing further rotation

Abstract

用于切割和封合组织的电外科装置包括设置在电外科装置的远侧端上、与下钳夹对置的上钳夹。下钳夹通过枢转连接件而枢转地连接至上钳夹。枢转连接件包括含有上钳夹的一部分的通道。上钳夹通过所述通道可轴向位移，以使上钳夹相对于下钳夹在相对打开的状态与相对闭合的状态之间枢转。上钳夹和下钳夹在相对闭合的状态下可被操作用于将RF能量输送至组织。

Description

用于组织切割和封合的设备
相关申请
本申请要求2012年9月26日提交的美国临时专利申请第61/705,721号的权益，其全部内容据此以引用的方式并入用于所有目的。
技术领域
本申请总体上涉及具有用于切割和封合组织的对置钳夹的电外科器械，更具体地涉及这样的电外科器械，其带有具有改进的刚度和压缩强度的钳夹以及改进的铰接机构。
背景技术
双极电外科器械将射频(RF)能量施加到手术部位以切割、切除或凝固组织。这些电外科效果的特定应用是封合血管或组织薄片。典型器械采用一对对置钳夹或镊子的形式，其中每一钳夹尖端上具有一个或多个电极。在电外科手术中，当钳夹在目标部位上闭合时电极彼此紧邻地放置，使得两个电极之间的交流电流的通路通过目标部位内的组织。由钳夹施加的机械力与电流组合从而产生所要的外科效果。通过控制机械参数及电气参数(例如，由钳夹施加的压力、电极之间的间隙距离及电压、电流、频率以及施加到组织的电外科能量的持续时间)的水平，外科医生可朝着治疗终端凝固、烧灼或封合组织。
可在开放环境中通过常规切口或者通过使用腹腔镜手术进行电外科手术。在腹腔镜手术中，电外科器械必须能够适于穿过具有通常在5mm与10mm之间的非常小的内径的套管或套管针。可以使电外科器械小到足以满足这种尺寸要求的程度。然而，使得器械更小的推动力经常与其它同等重要的设计标准相竞争。
由器械施加的压缩力是与器械尺寸竞争的最重要设计标准之一。通常，钳夹之间需要有高压缩力，以在合理的短时间内形成合适的封合。如若没有足够的压缩力，器械可能不能形成合适的封合，或者可能只有在长时间后才形成合适的封合。利用较小的电外科器械产生足够的压缩力可能非常困难，因为随着器械尺寸的减小，钳夹中非结构元件占用的空间的百分比增大。例如，控制组织切割、钳夹致动、铰接和电力输送的组件都在钳夹中占用空间。每个组件均需要从钳夹中去除材料从而为所述组件提供空间。这降低了钳夹的材料质量和刚度，从而降低了可产生的压缩力。
基于前文所述，需要可以在不牺牲像压缩强度一样的重要参数的前提下减小尺寸的改进的电外科装置。
发明内容
根据本发明的一个实例，用于切割和封合组织的电外科装置包括设置在电外科装置的远侧端上的与下钳夹对置的上钳夹。下钳夹通过枢转连接件而枢转地连接至上钳夹。枢转连接件包括含有上钳夹的一部分的通道。上钳夹通过所述通道可轴向位移以使上钳夹相对于下钳夹在相对打开的状态与相对闭合的状态之间枢转。上钳夹和下钳夹在相对闭合的状态下可被操作用于将RF能量输送至组织。
根据一个方面，一种用于切割和封合组织的电外科装置，所述电外科装置包括：设置在所述电外科装置的远侧端上、与下钳夹对置的上钳夹，所述下钳夹通过枢转连接件而枢转地连接至所述上钳夹，其中所述枢转连接件包括含有所述上钳夹的一部分的通道，所述上钳夹通过所述通道可轴向位移以使所述上钳夹相对于所述下钳夹在相对打开的状态与相对闭合的状态之间枢转，所述上钳夹和下钳夹在相对闭合的状态下可被操作用于将RF能量输送至组织。
根据所述电外科装置的另一个方面，所述上钳夹可相对于所述下钳夹围绕着设置成与所述上钳夹的外部边缘邻接的枢转点枢转，所述枢转点从所述装置的中心线偏移。
根据所述电外科装置的又一个方面，所述枢转连接件包括半圆柱形元件，所述半圆柱形元件具有与所述上钳夹的第一侧面接合的凸表面。
根据所述电外科装置的又一个方面，其中所述枢转连接件进一步包括与所述上钳夹的第二侧面接合的凹表面。
根据所述电外科装置的又一个方面，所述凸表面和所述凹表面界定了所述通道的相对壁。
根据所述电外科装置的又一个方面，所述凸表面和所述凹表面遵循围绕公共点同心的圆形轮廓。
根据所述电外科装置的又一个方面，所述装置进一步包括含有所述下钳夹的下钳夹壳体，所述下钳夹定位在所述下钳夹壳体的远侧部中。
根据所述电外科装置的又一个方面，所述下钳夹通过下钳夹枢转连接件可枢转地连接至所述下钳夹壳体。
根据所述电外科装置的又一个方面，所述下钳夹枢转连接件包括无销连接件，其包括从所述下钳夹向外凸出的一对凸台，所述凸台与下钳夹壳体中的一对孔眼接合。
根据所述电外科装置的又一个方面，所述装置包括定位在所述下钳夹壳体与所述下钳夹之间的下钳夹弹簧。
根据所述电外科装置的又一个方面，所述下钳夹弹簧设置在所述下钳夹的远侧部，所述下钳夹弹簧使所述下钳夹的远侧部朝向所述上钳夹偏置。
根据所述电外科装置的又一个方面，所述上钳夹包括在所述上钳夹上方注塑的塑料皮，从而使所述上钳夹与所述下钳夹电隔离。
根据所述电外科装置的又一个方面，所述装置进一步包括介于所述电外科装置的伸长轴与所述上钳夹和下钳夹之间的腕部区段，所述上钳夹和下钳夹在所述腕部区段处可位移以允许所述上钳夹和下钳夹相对于所述伸长轴弯曲。
根据所述电外科装置的又一个方面，所述装置进一步包括通过所述腕部区段中的通道成环的铰接线。
根据所述电外科装置的又一个方面，电力通过所述铰接线输送至所述上钳夹和下钳夹。
根据所述电外科装置的又一个方面，所述腕部区段包括椎体、套管和介于所述椎体与套管之间的自行矫直耦接头，从而促使所述上钳夹和下钳夹朝向定心的位置。
根据所述电外科装置的又一个方面，所述装置进一步包括通过所述上钳夹和下钳夹之一中的通道成环的致动线。
根据所述电外科装置的又一个方面，所述致动线包括第一致动线区段和第二致动线区段，所述第一致动线区段与所述第二致动线区段交叉，使得所述第一致动线区段和第二致动线区段在所述致动线通过其成环的所述上钳夹和下钳夹之一上施加相等的力。
根据所述电外科装置的又一个方面，电力通过所述致动线输送至所述上钳夹和下钳夹。
根据所述电外科装置的又一个方面，所述上钳夹包括第一配合表面，并且所述下钳夹包括与所述第一配合表面配合的第二表面，所述第一配合表面和第二配合表面各自包括V形轮廓。
根据所述电外科装置的又一个方面，所述装置进一步包括用于控制所述上钳夹和下钳夹的弯曲或回转运动的铰接机构。
根据所述电外科装置的又一个方面，所述铰接机构包括壳体和在所述壳体中可旋转地位移的分度盘。
根据所述电外科装置的又一个方面，所述壳体包括多个棘轮凹口，并且所述分度盘包括用于使所述棘轮凹口接合从而分度所述上钳夹和下钳夹的位置的分度臂。
根据所述电外科装置的又一个方面，所述铰接机构包括自动锁定机构，其阻止所述上钳夹和下钳夹上的外力使所述上钳夹和下钳夹从分度位置移开。
附图说明
前面的概述和下面的详细描述结合附图将更容易理解，其中：
图1是根据一个实施方案的电外科装置的截断透视图；
图2是可在图1实施方案或其它实施方案中使用的电外科装置组件的截断透视图；
图3是可在图1实施方案或其它实施方案中使用的电外科装置组件的另一个截断透视图；
图4是可在图1实施方案或其它实施方案中使用的电外科装置组件的另一个截断透视图；
图5是可在图1实施方案或其它实施方案中使用的电外科装置组件的另一个截断透视图；
图6是可在图1实施方案或其它实施方案中使用的电外科装置组件的另一个截断透视图；
图7是示出可在图1实施方案或其它实施方案中使用的与处于交叉配置中的致动线的弧长相对应的弧形物的示意图；
图8是可在图1实施方案或其它实施方案中使用的电外科装置组件的另一个截断透视图；
图9是可在图1实施方案或其它实施方案中使用的电外科装置组件的另一个截断透视图，示出铰接机构的组件，其中一些组件为清楚起见而去除；
图10是图9的组件的另一个截断透视图，其中一些组件为清楚起见而去除；
图11是图9的组件的另一个截断透视图，其中一些组件为清楚起见而去除；
图12是图9的组件的另一个截断透视图，其中一些组件为清楚起见而去除；
图13是可在图1实施方案或其它实施方案中使用的组件之间的枢转界面的平面图；
图14是电外科装置的截断透视图，其中除去一些组件以示出可在图1实施方案或其它实施方案中使用的内部组件的配置；
图15是电外科装置的放大的截断的部分横截面图，其示出可在图1实施方案或其它实施方案中使用的内部组件的配置；
图16是电外科装置的另一个放大的截断的部分横截面图，其示出可在图1实施方案或其它实施方案中使用的内部组件的配置；以及
图17是电外科装置的截断透视图，其示出可在图1实施方案或其它实施方案中使用的内部组件的配置。
具体实施方式
申请人已开发出改进的电外科装置，其解决了对减小的尺寸的需求，同时也解决了对钳夹间高压缩力的需求。所述改进的电外科装置是使用整体方法设计的，所述方法在适当的时候除去、简化或组合各个组件，同时使得钳夹的强度和刚度达到最大值。
以下实例示出设计用于解决对具有减小的尺寸的钳夹与具有较高强度刚度的钳夹的竞争性需求的特征。尽管将在电外科装置100上描述和示出不同的特征，但是其中许多特征是独立的特征。这些特征中的一些或全部都可出现在同一装置上，但是不必出现在同一装置上，并且可以不同的组合形式使用在本发明的不同实施方案上。根据本发明的装置可包括美国申请第12/027,231号和第13/070,391号中示出和描述的装置特征和特点，所述美国申请的全部内容以引用的方式并入本文。
枢转连接件
参考图1，根据一个示例性实施方案示出电外科装置100。装置100包括伸长轴102。伸长轴102具有以上钳夹120和下钳夹壳体130为特征的远侧端部110。下钳夹壳体130包含下钳夹132。图2和图3中示出的切割刀片160可在上钳夹120和下钳夹132之间位移以切割组织。
上钳夹120和下钳夹壳体130通过枢转连接件140枢转地联接，所述枢转连接件允许上钳夹相对于下钳夹壳体枢转从而使上钳夹打开和闭合。枢转连接件140包括半圆柱形元件142，所述半圆柱形元件具有与上钳夹120的第一侧面122接合的凸表面143。枢转连接件140还包括与上钳夹120的第二侧面124接合的弧形凹表面144。凸表面143和凹表面144遵循围绕枢转点148同心的圆形轮廓。半圆柱形元件142和凹表面144彼此之间被拱形通道145隔开。拱形通道145的边缘形成上钳夹120从其中滑过的轨道或滑道146。轨道146的拱形形状使得上钳夹120在滑过所述通道时相对于下钳夹壳体130枢转。上钳夹120围绕枢转点148枢转。
如可以从图1和图3中看出的，枢转连接件140显著地不同于常规销连接件。首先，枢转连接件140不需要从钳夹中去除材料。上钳夹120通过拱形通道145装入下钳夹壳体130的本体内，上钳夹和下钳夹壳体中或周围的空隙空间很小或没有空隙空间。相比之下，常规销连接件需要去除材料来容纳销并且需要去除材料来使每个钳夹能够相对于彼此枢转。从钳夹中去除材料降低了钳夹的质量，因此降低了在钳夹闭合时可施加在组织上的刚度和压缩力的量。
枢转连接件140还在枢转连接件相对于钳夹的位置上不同于常规销连接件。销连接件通常沿着器械的中线设置在上钳夹和下钳夹之间。相比之下，枢转点148从装置的中心线101偏移，与上钳夹120的外部边缘121邻接。这种偏移布置相比设置在中线上的十字头销连接件具有优势，因为它提供了穿过中线的无阻碍通畅通路。所述通畅通路允许切割刀片160沿着介于刀片之间的中线前行，而不存在由销产生的任何阻碍。
电极配置
装置100中的电极配置是平衡了对减小的尺寸与增大的钳夹刚度的需求的另一特征。许多已知电外科装置使用一个或多个放置在钳夹上的独立型(stand-alone)电极。独立型电极需要用于将所述电极捕获、隔离和容置在钳夹中的空间，牺牲了钳夹的刚度。为了解决这个问题，设计不具有独立型电极的装置100。电力直接输送至上钳夹120和下钳夹壳体130。
电力输送
已知电外科装置使用延伸穿过钳夹的专用电力传输线输送电力至电极。在许多情况下，这些专用电力传输线为固定编织线或护套线的形式。专用电力传输线占用相当大量的空间并且需要从钳夹中去除材料的直通孔(throughbore)、通道等等。因此，专用电力传输线及它们的直通孔使钳夹刚度减小，由此降低了在封合期间可施加在钳夹之间的压缩力的量。在专用线随着器械移动而不具有足够的松弛或弹性的情况下，专用电力传输线还会限制器械的移动。
为了保持钳夹的刚度并提供较高的器械可动性和挠性，根据本发明的装置优选包括控制运动输送和电力输送的多功能组件。优选避免牺牲钳夹硬度和器械可动性的专用电力传输线。能量输送可通过控制例如致动和/或铰接的同一组件来提供。能量输送还可以通过使组件平移来提供。
参考图2，示出装置100在“腕部(wrist)”或“椎体(vertebra)”区段(section)170处的横截面。在后面章节中更详细描述的腕部区段170包括椎体173，所述椎体基本上是实心的，但它的四个直通通道除外。两个直通通道容纳成环的铰接线167，一个直通通道容纳成环的致动线169。铰接线167可被操作用于允许装置的远侧端部相对于装置的纵轴弯曲。致动线169可被操作用于使上钳夹120打开和闭合。铰接线167通过所述通道形成环，从而形成两个大致平行的铰接线区段172和174。类似地，致动线169通过所述通道形成环，从而形成两个大致平行的致动线区段176和178。致动线区段176和178在图2所示的截面中彼此上下地横贯，如将更详细地解释的。图3和图14示出铰接线167和致动线169是如何通过装置的远侧端部绕送(routed)的，其中铰接线的成环端部可见。
位于椎体173的外周区段中的第一直通通道173a包含第一铰接线区段172。位于椎体173的另一外周区段中的第二直通通道173b包含第二铰接线区段174。位于椎体173的内部区段中的第三直通通道173c包含切割刀片160。位于椎体173的内部区段中的第四直通通道173d包含致动线区段176和178。
电力通过致动线169输送至上钳夹120。电力通过铰接线167输送至下钳夹壳体130，并且还可以通过可能是金属的并且彼此以串联方式接触并且与致动线169隔开的任何其它一系列金属组件输送，其包括钳夹套管、椎体或轴。下钳夹壳体130和下钳夹132两者包括彼此接触的金属表面，使得输送至下钳夹壳体的电力传导至下钳夹。
隔离
上钳夹120上的与下钳夹壳体130接合的表面和下钳夹132必须是电隔离的。为了解决这一点，装置100包括位于上钳夹120上方的塑料皮180。上钳夹120与塑料皮180重叠注塑在一起从而和与下钳夹壳体130接合的表面隔离。重叠模塑不需要各组件之间有余隙，从而保留了用以允许钳夹具有更高的材料质量的空间。重叠注塑上钳夹120还允许在上钳夹上产生偏移特征，如将在下一章节中解释的。
间隙产生的偏移特征
重叠注塑皮180具有多个功能。重叠注塑皮的第一功能是使上钳夹120与下钳夹壳体130电隔离，如上面所描述的。重叠注塑皮的第二功能是产生偏移特征，其在钳夹闭合时在电极，即上钳夹120与下钳夹132之间产生间隙空间。在图4中，所述装置的实施方案包括以横向延伸穿过上钳夹120的带150形式示出的偏移特征。带150是在重叠注塑工艺期间产生的。重叠注塑皮的第三功能是降低与组织接触的钳夹背侧的温度，以便降低组织烧伤的风险。
根据本发明的间隙产生的偏移特征不必采用横向带形式，并且可以是当钳夹闭合时将电极之间隔开的任何表面不规则物或凸出物。例如，上钳夹120可包括接纳从上钳夹的表面上凸出并且与下钳夹132接触的铆钉或铆钉样构件的多个洞。
无销下钳夹
下钳夹132通过下钳夹枢转连接件190枢转地连接至下钳夹壳体130。介于下钳夹132与下钳夹壳体130之间的枢转连接件190代表最关键的区域之一，其中的刚度和强度必须在下钳夹中达到最大值以提供足够的压缩力。销连接件和直通孔需要从下钳夹中去除材料，降低了钳夹刚度和强度，如上面所描述的。因此，枢转连接件190以一对凸台(boss)136形式的“无销”连接件为特征。凸台136从下钳夹132向外凸出并且卡入下钳夹壳体130中的小孔眼138内。在这种布置的情况下，不需要在钳夹的整个宽度上在枢转连接件190所在之处从下钳夹132中去除材料。
作为凸台和孔眼的替代，可使下钳夹壳体130轻微地卷曲从而在下钳夹壳体与下钳夹132之间产生枢转界面。
参考图5，钳夹132具有圆形凸底表面133，并且下钳夹壳体130具有圆形凹内表面131。当使下钳夹壳体130相对于上钳夹120枢转时，凹内表面130支承着凸底表面133。因此，凹内表面131和凸底表面133形成吸收介于下钳夹132与下钳夹壳体130之间的压缩力并且引导压缩力从凸台136和孔眼138上移开的支承表面。因此，下钳夹132的结构完整性并没有极大地依赖于凸台136或枢转连接件190的强度。
致动线
铰接装置的挑战之一是穿过铰接构件的传动。当装置弯曲时，通过接头的弧长随着远离中心线而改变。这一般需要使用沿着装置的中心线移动的高(针对强度)和薄(针对挠性)致动构件。向左和右铰接避免了使用布置成与铰接平面垂直的短而扁平的致动构件或成对线构件，因为所述构件或线将会翘曲和/或不等地传输运动和力。
装置100使用被制成环状从而形成一对平行线区段176和178的致动线169，如上面所指出的。致动线区段176和178被配置成当通过致动线区段施加力时使上钳夹120相对于下钳夹壳体130枢转。环状致动线169连接至上钳夹120中的销(未示出)。为了使上钳夹120枢转至打开位置，通过致动线区段176和178向上钳夹施加推力(或指向远侧端部110的力)。为了使上钳夹120枢转到闭合位置，通过致动线区段176和178向上钳夹施加拉力(或被引导从远侧端部110上移开的张紧力)。致动线区段176和178中的每一者均从铰接平面的中心线发出，但是处于允许线从左向右等同地推或拉的布置中。解决方案是使线扭曲180度，从而在铰接构件的中心于交叉点P处交叉。
图2是穿过与交叉点P相交的平面截取的装置100的横截面图，在交叉点P处，致动线区段176与致动线区段178交叉。图14是装置100的远侧端的透视图，其中除去一些组件以示出线区段176是如何与线区段178在点P交叉的。图15是示出致动线169如何与上钳夹120连接的装置100的横截面图。致动线169通过形成在上钳夹120的基部中的U形狭槽125成环状。图16和图17是装置100的横截面图，其示出致动线176和178是如何与所述装置的近侧端连接的。致动线176和178的交叉导致形成通过铰接区域的弧长，其是彼此的镜像并且仍然具有相同的长度。弧长在图7中示意地示出。交叉点P的作用类似于所述线的枢转点。通过维持相等的弧长，使力在致动线区段176与178之间平衡，甚至当致动线区段在钳夹铰接期间弯曲时亦是如此，以便所述线区段均匀地拉在上钳夹上并且对铰接线172和174造成最小的阻力。将铰接线区段172和174维持在张紧状态，以便所述系统的组件张紧地存放在一起，从而允许钳夹适当地打开和闭合以及允许装置的远侧端适当地铰接。
钳夹轮廓
参考图8，上钳夹120具有与下钳夹132配合的配合表面131。下钳夹132类似地具有与上钳夹120配合的配合表面133。配合表面131和133各自具有如所示的V形轮廓，其提供了优于平面的配合表面的数个优势。
V形轮廓提供了保持上钳夹120与下钳夹132彼此对齐的自对齐特征。自对齐特征消除了对长组件长度及在钳夹后用于控制对齐的严格公差几何形状的需求。V形配合表面131和133还比平面的表面具有更大的表面积，导致与组织接合的区域逐渐增宽。
配合表面131的轴向中心线123与沿着偏移装置100的中心线101的线137的配合表面133的轴向中心线135相交。在这种布置中，切割平面103可从装置100的中心线101处移开，从而允许切割刀片160被设置成远离中心以使得其它组件可朝向装置的中心定位。
下钳夹弹簧
再参考图1，下钳夹壳体130包含介于下钳夹壳体与下钳夹132之间的下钳夹弹簧134。下钳夹弹簧134支承着下钳夹壳体130的内部从而使下钳夹132枢转。在这种配置中，下钳夹弹簧134使得下钳夹132的远侧部137朝着上钳夹120偏置。
包括下钳夹弹簧的已知电外科装置将弹簧放置在下钳夹的近侧区段上在相对于枢转点近侧设置的点处。为了给弹簧提供空间，从下钳夹的近侧部，和/或从下钳夹壳体在类似区域中去除一定量的材料。这种材料去除可引起下钳夹和/或下钳夹壳体的近侧区段处的强度和刚度显著降低。钳夹强度和刚度在下钳夹和钳夹壳体的近侧区段处尤其重要，因为近侧区段是用于提供压缩力的关键区域。图1示出下钳夹132在其近侧区段135和其远侧区段137处的相对厚度。
为了避免下钳夹132的近侧部分135处的钳夹强度和刚度的损失，将下钳夹弹簧134设置在下钳夹的远侧部137处。这将更高的质量保留在最需要它的近侧区段135周围。下钳夹132的远侧区段137一开始比近侧区段135具有更高的质量，因此更合适于容纳下钳夹弹簧134。
下钳夹弹簧134使下钳夹132在两个地方，即132a和132b中摩擦接合。这种在两个位置处的接合有助于将能量从下钳夹壳体130传递至下钳夹132。
铰接机构
图9-12示出根据本发明的铰接机构200。铰接机构200控制在腕部区段170处的允许上钳夹120和下钳夹132向左或右弯曲的弯曲或回转运动。更具体地，铰接机构200可被操作用于将张紧力施加到铰接线区段172和174之一上从而使所述装置在腕部区段170处弯曲。
铰接机构200包括保持上、下钳夹120和132的铰接位置的一对分度盘(indexingdisk)210。铰接器机构200还包括可被操作用于使分度盘210旋转的铰接器220。铰接器220具有从分度盘向外延伸的一对把手222。把手222和分度盘210在壳体230中可旋转地位移。壳体230具有用棘轮凹口(ratchet notch)234作衬里的内壁232。每个分度盘210均具有一对分度臂212，其可被操作用于当分度盘在壳体230中旋转时与棘轮凹口234接合和分离。棘轮凹口234彼此被一系列指向内部的棘轮齿235隔开。每个分度臂212均具有远侧端213，其具有经配置成能随着分度盘210在壳体中旋转而与棘轮凹口234和棘轮齿235可滑动地相互作用和接合的尖锐尖端215。分度臂212由有弹性的挠性材料形成，所述材料允许分度臂响应于尖端215与棘轮齿235之间的接触而朝向分度盘210的中心向内在径向上挠曲或弯曲。当尖端215与棘轮齿235的最内部区段接合时，分度臂212在储能的作用下向内弯曲。当分度盘210旋转并且尖端215与棘轮凹口234对齐时，分度臂212向外弹回来并且返回至尖端定位在棘轮凹口中的松弛状态。
铰接机构200包括使铰接器220偏置到居中或“中立”状态的定心机构240。中立状态在图9中示出。定心机构240包括从每个分度盘210延伸的一对挠性叶片弹簧216。每个叶片弹簧216均具有远侧端217，其被夹持在介于铰接器220上的一对凸出物226之间的捕获位置(captive position)中。当铰接器220处于中立状态时，每个叶片弹簧216基本上是笔直的，处于松弛状态。当铰接器220开始向左或向右旋转时，凸出物226也旋转，但是分度盘210不立即旋转，而是保持静止不动，如将在下面更详细解释的。因此，每个叶片弹簧216均响应于凸出物226的初始运动而弯曲，从而在叶片弹簧中储存产生偏置力的能量。每个叶片弹簧216中的偏置力在与铰接器旋转方向相反的方向上施加力到铰接器220上，从而促使铰接器返回至中立状态。当旋转力从铰接器200中释放出来时，叶片弹簧216中的偏置力使铰接器200返回至中立状态。
铰接机构200进一步包括自动锁定机构250。锁定机构250是被动互锁机构，其阻止上、下钳夹120和132上的外力使钳夹从它们的分度位置移开。锁定机构250包括在铰接器220上的四个棘爪228，其中的两个在图中可见，而另两个在铰接器的另一侧。每个棘爪228均可相对于分度盘210在锁定位置和释放位置之间移动。在图9所示的锁定位置中，每个棘爪228均与其中一个分度臂212上的内部凸出物219对齐。在这个位置中，内部凸出物219阻挡分度臂并且阻止它们向内弯曲，从而阻止分度臂与棘轮凹口分离并且阻止钳夹从它们的分度位置铰接。在图10所示的释放位置中，每个棘爪228均从与相应内部凸出物219对齐的状态中旋转出来，从而允许分度臂向内弯曲并且允许分度臂与棘轮凹口分离从而使得钳夹容易铰接到另一个位置。
在这种布置中，铰接机构200是相对于分度盘向中立状态偏置的浮置机构。在操作时，通过经由把手222使铰接器220相对于壳体230顺时针或反时针旋转来使钳夹铰接。当初始向把手222上施加旋转力时，叶片弹簧216的定心力会对抗所施加的力。如果所施加的力大于定心力，则铰接器220将相对于分度盘210旋转，使得棘爪228从锁定位置移入释放位置。
铰接器220具有四个邻接边缘(abutment edge)225，并且分度盘210具有相应的邻接边缘211。当铰接器处于中立状态时，邻接边缘211与邻接边缘225分割开，从而产生限定行进(travel)极限的小间隙229。在把手222初始旋转后，铰接器220将会旋转，并且其中的两个邻接边缘225将逐渐接近分度盘210上的相应邻接边缘211。在把手222旋转了小旋转角阈值，诸如5度时，逐渐接近分度盘210上的邻接边缘211的邻接边缘225将达到它们的行进极限并且与分度盘210接触。此时，施加到把手上的旋转力将传递到分度盘210上，并且使分度盘与铰接器220协同地旋转。随着分度盘210旋转，当分度臂212的尖端215与棘轮齿235可滑动地接合时，所述尖端向内弯曲，而当所述尖端与棘轮凹口234在下一个分度位置对齐时，所述尖端向外弹回来。在到达期望的分度位置后，旋转力从把手222释放出来，以便叶片216使铰接器220返回至中立状态，其中棘爪228返回至锁定位置。在锁定位置中，棘爪228阻止分度臂212与棘轮凹口234分离，从而将铰接线172和174及腕部170有效地锁定在分度位置。
参考图11和图12，装置100包括安装到铰接线172和174的近侧端上的弹簧板260。弹簧板260使铰接线172和174处于张紧状态从而将腕部170中的组件紧固在一起，因此避免需要使用其它工具将腕部组件物理地联接。分度盘210将弹簧板260夹持在壳体230中的适当位置。每个铰接线172和174均延伸穿过弹簧板260的翼部262中的洞。每个铰接线172和174的近侧端均是弯曲的并且捕获在线塞(wire stopper)270中。每个线塞270均被楔合(keyed)以维持它的逆着弹簧板260的取向。每个翼部262均具有松弛状态，其中翼部相对于弹簧板260的剩余部分在近侧方向上弯曲。在装配的状态下，靠着翼部262在远侧拉线塞270从而使铰接机构200张紧。
腕部机构
实施方案可包括腕部机构，其带有具有“非圆形”枢转界面的组件。例如，介于各组件之间的枢转界面可以具有抛物线、台阶或V形凹口几何形状，从而产生移动的旋转轴，而不是与严格“圆形”几何形状，诸如球形或圆柱形对接的几何形状相关联的传统固定旋转轴。移动旋转轴提供了自行矫直或自行定心耦接头(self-centering coupling)的益处，其中毗连的椎体在铰接后被迫返回到笔直配置。当钳夹被锁定或与其它物体接触时，这种朝向矫直配置的偏置稳定了钳夹的位置并且提供了针对微动(jogging)的抵抗。
所述非圆形界面也抵御了当通过延长有效轴长来使钳夹铰接时钳夹展现的压缩力损失。在用“拉”型机构使钳夹闭合的装置中，延长轴(钳夹锁定机构中没有发生变化)将导致压缩力越高越难拉。
图13示出在腕部区段170中在介于椎体173与套管182之间的非圆形界面171的一个实例。非圆形界面171包括在椎体173上的圆形凸配合表面175，及在套管182上的圆形凹配合表面184。台阶(step)或“凸角(lobe)”177从凸配合表面175向外延伸。凸角177与凸配合表面175之间的表面过渡物是圆形的，从而沿着椎体173的边缘形成平滑的多向弯曲(compound curvature)。凹槽(recess)185延伸进凹配合表面184中并且具有符合凸角177的几何形状的形状，如所示出的。
当腕部区段170笔直时(即，当椎体未被铰接并且钳夹笔直时)，凸配合表面175和凸角177与凹配合表面184和凹槽185同相(in phase)，其中凸角嵌套在凹槽中。当腕部区段170铰接时，凸配合表面175和凸角177从与凹配合表面184和凹槽185同相的状态中移出，使得凸角从凹槽中移出并且与凹配合表面接合。在这种状况下，椎体173与套管182之间的距离逐渐增加，使得旋转轴在各零件之间移动。凸角177的尺寸相对于凸配合表面175的尺寸可能非常小。凸角177的圆形周界可从凸配合表面175上凸出少至0.002英寸。也可以使用较小或较大的凸角配置。
虽然本文已示出并描述本发明的优选实施方案，但是应理解此类实施方案仅以举例的方式给出。在不背离本发明的情况下本领域技术人员可以作出许多改变、变化和替换。因此，所附权利要求书意欲涵盖落在本发明范围内的所有此类改变。

Claims (13)

1.一种用于切割和封合组织的电外科装置，所述电外科装置包括：
设置在所述电外科装置的远侧端上、与下钳夹对置的上钳夹，所述下钳夹通过枢转连接件而枢转地连接至所述上钳夹，
其中所述枢转连接件包括含有所述上钳夹的一部分的通道，所述上钳夹通过所述通道可轴向位移以使所述上钳夹相对于所述下钳夹在相对打开的状态与相对闭合的状态之间枢转，所述上钳夹和下钳夹在相对闭合的状态下可被操作用于将RF能量输送至组织，其中所述电外科装置进一步包括通过所述上钳夹和下钳夹之一中的另一通道成环的致动线，其中所述致动线包括第一致动线区段和第二致动线区段，
其特征在于，所述第一致动线区段与所述第二致动线区段交叉，使得所述第一致动线区段和第二致动线区段在所述致动线通过其成环的所述上钳夹和下钳夹之一上施加相等的力。
2.如权利要求1所述的电外科装置，其中所述上钳夹可相对于所述下钳夹围绕着设置成与所述上钳夹的外部边缘邻接的枢转点枢转，所述枢转点从所述装置的中心线偏移。
3.如权利要求1所述的电外科装置，其中所述枢转连接件包括半圆柱形元件，所述半圆柱形元件具有与所述上钳夹的第一侧面接合的凸表面。
4.如权利要求3所述的电外科装置，其中所述枢转连接件进一步包括与所述上钳夹的第二侧面接合的凹表面。
5.如权利要求1所述的电外科装置，其进一步包括含有所述下钳夹的下钳夹壳体，所述下钳夹定位在所述下钳夹壳体的远侧部中。
6.如权利要求5所述的电外科装置，其中所述下钳夹通过下钳夹枢转连接件可枢转地连接至所述下钳夹壳体。
7.如权利要求1所述的电外科装置，其进一步包括介于所述电外科装置的伸长轴与所述上钳夹和下钳夹之间的腕部区段，所述上钳夹和下钳夹在所述腕部区段处可位移以允许所述上钳夹和下钳夹相对于所述伸长轴弯曲。
8.如权利要求7所述的电外科装置，其进一步包括通过所述腕部区段中的通道成环的铰接线。
9.如权利要求7所述的电外科装置，其中所述腕部区段包括椎体、套管和介于所述椎体与套管之间的自行矫直耦接头，从而促使所述上钳夹和下钳夹朝向定心的位置。
10.如权利要求1所述的电外科装置，其中所述上钳夹包括第一配合表面，并且所述下钳夹包括与所述第一配合表面配合的第二表面，所述第一配合表面和第二配合表面各自包括V形轮廓。
11.如权利要求1所述的电外科装置，其进一步包括用于控制所述上钳夹和下钳夹的弯曲或回转运动的铰接机构。
12.如权利要求11所述的电外科装置，其中所述铰接机构包括壳体和在所述壳体中可旋转地位移的分度盘。
13.如权利要求12所述的电外科装置，其中所述铰接机构包括自动锁定机构，其阻止所述上钳夹和下钳夹上的外力使所述上钳夹和下钳夹从分度位置移开。
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