CN104780855A - 超声和电外科装置 - Google Patents
超声和电外科装置 Download PDFInfo
- Publication number
- CN104780855A CN104780855A CN201380059631.4A CN201380059631A CN104780855A CN 104780855 A CN104780855 A CN 104780855A CN 201380059631 A CN201380059631 A CN 201380059631A CN 104780855 A CN104780855 A CN 104780855A
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- Prior art keywords
- ultrasonic
- cutter
- end effector
- waveguide
- clamping limb
- Prior art date
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- Granted
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Abstract
本发明公开了超声和电外科装置。本发明所公开的实施例包括:超声刀,所述超声刀包括各种抓持特征结构;装置,所述装置能够阻止例如流体和组织的外科物质进入超声刀与位于所述远侧密封件的远侧的内管或外管之间的空间;用于超声装置的另选的闭合机构;超声换能器旋转限制器,所述超声换能器旋转限制器用以限制所述超声换能器的旋转;超声换能器旋转系统,所述超声换能器旋转系统用以提供超声装置的无限制连续旋转;一体化超声器械,所述一体化超声器械电连接以利用超声(RF)发生器提供RF点凝;和涂覆的超声/RF刀。
Description
相关申请的交叉引用
本专利申请要求2012年11月15日提交的名称为“ULTRASONICAND ELECTROSURGICAL DEVICES”的美国临时专利申请序列号61/726,890的权益,该临时专利申请据此全文以引用方式并入。
背景技术
本公开整体涉及超声和电外科装置。更具体地,本公开涉及:用于超声刀的各种刀特征结构以改善组织抓持;各种密封件和流体出口特征结构以阻止在外科手术期间遇到的组织和其他身体物质聚集和积聚在管的远侧部分和超声外科装置的刀的附近部分上;用于超声端部执行器的夹持闭合机构以提供均匀的夹持力;用于超声换能器和装置的旋转机构;以及组合的电外科和超声装置以提供组织切割和点凝。
超声外科装置(诸如超声外科手术刀)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切断和通过凝固的止血,从而有利地使患者创伤最小化。超声外科装置包括朝近侧定位的超声换能器和联接到超声换能器的器械,该器械具有朝远侧安装的端部执行器,该端部执行器包括超声刀以切割和密封组织。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),超声刀使组织中的蛋白质变性以形成粘性凝固物。通过刀表面与夹持机构结合而施加在组织上的压力使血管塌陷并允许凝固物形成止血密封。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。电外科装置可被配置成用于双极性或单极性操作。在双极性操作期间,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,所述有源电极与所述返回电极分开地位于患者的身体上。由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能够相对于组织和电极运动的切割构件以切断组织。
由电外科装置施加的电能可通过发生器传输至器械。电能可为射频(“RF”)能的形式。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输通过组织,这引起离子振荡或摩擦,实际上造成电阻性加热,从而增大组织的温度。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,而不损伤相邻的组织或关键结构。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。
发明内容
在一个实施例中,超声外科器械包括波导,所述波导包括近侧端部和远侧端部,其中近侧端部联接到超声换能器;端部执行器,所述端部执行器联接到波导的远侧端部;管,所述管包括管腔,其中波导位于管腔内;夹持臂,所述夹持臂能够枢转地连接到管;和组织积聚阻止机构,所述组织积聚阻止机构能够阻止组织积聚在管腔中。
在超声外科器械的另一个实施例中,组织积聚阻止机构包括能够在管和端部执行器之间形成密封的防护罩阻隔件。
在超声外科器械的另一个实施例中,防护罩阻隔件利用一个或多个保持特征结构密封到管。
在超声外科器械的另一个实施例中,防护罩阻隔件包括腔。
在超声外科器械的另一个实施例中,腔为圆形的,以允许流体流出腔。
在超声外科器械的另一个实施例中,防护罩阻隔件包括与刀的多个接触点。
在超声外科器械的另一个实施例中,组织积聚阻止机构包括管中的一个或多个孔。
在超声外科器械的另一个实施例中,孔包括一个或多个窗口。
在超声外科器械的另一个实施例中,孔包括一个或多个孔穴。
在超声外科器械的另一个实施例中,远侧部分包括半球状横截面。
在超声外科器械的另一个实施例中,管包括形成于管的内侧的一个或多个肋。
在超声外科器械的另一个实施例中,组织积聚阻止机构能够在刀和管之间提供正压力流的泵,其中正压力流阻止组织进入管腔内。
在超声外科器械的另一个实施例中,泵或泵的出口定位在位于管腔内的最远侧包覆模制密封件的远侧。
在超声外科器械的另一个实施例中,组织积聚阻止机构包括设置在管腔内的可滑动管,所述可滑动管可从第一位置滑动到第二位置,其中在第一位置,所述可滑动管设置在刀上,并且在第二位置,刀为暴露的。
在一个实施例中,超声外科器械包括波导,所述波导包括近侧端部和远侧端部,其中近侧端部联接到超声换能器;联接到波导的远侧端部的端部执行器,所述端部执行器包括至少一个组织保持特征结构;夹持臂,所述夹持臂操作地联接到端部执行器。
在超声外科器械的另一个实施例中,至少一个组织保持特征结构包括形成于端部执行器中的一个或多个压痕/凹槽/凹口/纹理。
在超声外科器械的另一个实施例中,所述一个或多个压痕包括三角形齿状物。
在超声外科器械的另一个实施例中,所述一个或多个压痕包括孔穴。
在超声外科器械的另一个实施例中,所述一个或多个压痕包括水平沟槽。
在超声外科器械的另一个实施例中,所述至少一个组织保持特征结构包括自端部执行器的一个或多个突出部。
在超声外科器械的另一个实施例中,所述一个或多个突出部包括三角形齿状物。
在超声外科器械的另一个实施例中,所述一个或多个突出部包括块。
在超声外科器械的另一个实施例中,所述一个或多个突出部包括水平凸耳。
在超声外科器械的另一个实施例中,所述一个或多个突出部包括圆形凸耳。
在超声外科器械的另一个实施例中,所述至少一个组织保持特征结构设置在刀的整个长度上。
在超声外科器械的另一个实施例中,所述至少一个组织保持特征结构设置在刀的离散的节段上。
在一个实施例中,超声外科器械包括波导,所述波导包括近侧端部和远侧端部,其中近侧端部联接到超声换能器;端部执行器,所述端部执行器操作地联接到波导的远侧端部;旋转护罩,所述旋转护罩能够旋转波导;和旋转止动机构,所述旋转止动机构联接到旋转护罩以阻止旋钮旋转超过预定的旋转。
在超声外科器械的另一个实施例中,护罩包括至少一个通道;至少一个凸出部,所述至少一个凸出部位于至少一个通道内,其中所述至少一个凸出部具有预定的侧向运动极限,其中当所述至少一个凸出部达到预定的侧向运动极限时,所述至少一个凸出部阻止旋钮的进一步旋转。
在超声外科器械的另一个实施例中,旋转止动件包括门,所述门包括第一翼和第二翼,其中第一翼和第二翼成角度设置,其中门设置在护罩内并且门允许护罩的预定旋转角度。
在一个实施例中,超声外科器械包括波导,所述波导包括近侧端部和远侧端部,其中近侧端部联接到超声换能器;端部执行器,所述端部执行器联接到波导的远侧端部;夹持臂,所述夹持臂操作地联接到端部执行器;设置在波导上的管,其中管包括反向偏转元件,其中反向偏转元件能够允许刀的偏转,其中刀的偏转抵消由处于夹持位置的夹持臂施加在刀上的力。
在一个实施例中,外科器械包括波导,所述波导包括近侧端部和远侧端部,其中近侧端部联接到信号源,所述信号源能够超声信号和电外科信号;端部执行器,所述端部执行器联接到波导;夹持臂,所述夹持臂操作地联接到端部执行器;和密封按钮,其中密封按钮致使外科器械向端部执行器和/或夹持臂递送电外科信号持续第一周期,并且密封按钮致使外科器械向刀递送超声信号持续第二周期,其中第二周期在第一周期之后。
在外科器械的另一个实施例中,密封按钮致使外科器械在将电外科信号传送到端部执行器和/或夹持臂之前将超声信号递送到端部执行器。
在外科器械的另一个实施例中,密封按钮致使外科器械仅将超声信号递送到端部执行器,从而导致组织的止血切断。单独的点凝按钮设在柄部上。当压下点凝按钮时,电外科信号被提供到端部执行器或夹持臂或者这两者,以实现组织的点凝。
在外科器械的另一个实施例中,其中电外科信号为单极性RF信号。
在外科器械的另一个实施例中,其中电外科信号为双极性RF信号。
在一个实施例中,外科器械包括波导,所述波导包括近侧端部和远侧端部,其中近侧端部联接到超声换能器;端部执行器,所述端部执行器联接到波导的远侧端部;设置在波导上的管;形成于管的外表面之上或之中的凸轮表面;和夹持臂,其中夹持臂操作地联接到凸轮表面。
在外科器械的另一个实施例中,枢轴销位于由端部执行器限定的孔穴内,所述枢轴销操作地联接到夹持臂,其中夹持臂围绕枢轴销枢转。
在外科器械的另一个实施例中,枢轴销位于波导的最远侧节点处。
在外科器械的另一个实施例中,管为可致动的并且夹持臂通过管和端部执行器之间的相对运动而相对于端部执行器凸轮打开和凸轮闭合。
在一个实施例中,外科器械包括波导,所述波导包括近侧端部和远侧端部,其中近侧端部联接到超声换能器;联接到波导的远侧端部的端部执行器,所述端部执行器限定销孔穴;刚性销,所述刚性销设置在所述销孔穴内;夹持臂,所述夹持臂操作地连接到外管;和四杆连杆;其中四杆连杆操作地联接到夹持臂和刚性销,其中四杆连杆可经由端部执行器平移而致动以将夹持臂运动到夹持位置。
在外科器械的另一个实施例中,外管联接到四杆连杆并且外管将四杆连杆从第一位置致动到第二位置。
在一个实施例中,超声外科器械包括波导,所述波导包括近侧端部和远侧端部,其中近侧端部联接到超声换能器;端部执行器,所述端部执行器联接到波导的远侧端部,其中端部执行器局部涂覆有热绝缘材料和电绝缘材料,使得端部执行器的远侧端部包括一个或多个暴露节段。
在超声外科器械端部执行器的另一个实施例中,所述一个或多个暴露区域为对称的。
在超声外科器械端部执行器的另一个实施例中,所述一个或多个暴露区域为非对称的。
在超声外科器械端部执行器的另一个实施例中,所述一个或多个暴露节段由一个或多个涂覆节段分开。
在一个实施例中,超声外科器械包括波导,所述波导包括近侧端部和远侧端部,其中近侧端部联接到超声换能器;端部执行器,所述端部执行器联接到波导的远侧端部,并且夹持臂操作地连接到端部执行器,其中夹持臂局部涂覆有热绝缘材料和电绝缘材料,使得夹持臂的远侧端部包括一个或多个暴露节段。
在超声外科器械夹持臂的另一个实施例中,所述一个或多个暴露区域为对称的。
在超声外科器械夹持臂的另一个实施例中,所述一个或多个暴露区域为非对称的。
在超声外科器械夹持臂的另一个实施例中,所述一个或多个暴露节段由一个或多个涂覆节段分开。
在一个实施例中,超声外科器械包括波导,所述波导包括近侧端部和远侧端部,其中近侧端部联接到超声换能器;端部执行器,所述端部执行器联接到波导的远侧端部,并且夹持臂操作地连接到端部执行器,其中端部执行器和夹持臂局部涂覆有热绝缘材料和电绝缘材料,使得端部执行器和夹持臂的远侧端部包括一个或多个暴露节段。
在超声外科器械的另一个实施例中,所述一个或多个暴露区域为对称的。
在超声外科器械的另一个实施例中,所述一个或多个暴露区域为非对称的。
在超声外科器械的另一个实施例中,所述一个或多个暴露节段由一个或多个涂覆节段分开。
以上为发明内容,并且因此可包括细节的简化、概括、涵盖、和/或省略;因此,本领域的技术人员将会知道,发明内容仅为例示性的并且不旨在限制。本文所述的装置和/或工艺和/或其他主题的其他方面、特征、和优点在本文示出的教导内容中将变得显而易见。
上述发明内容仅为例示性的并且不旨在限制。除了上文描述的例示性方面、实施例、和特征之外,其他方面、实施例、和特征参考附图和以下详细描述将变得显而易见。
附图说明
本申请所述实施例的新颖特征在所附权利要求书中进行了详细描述。然而,通过参考以下描述并结合如下附图可更好地理解有关操作组织和方法的实施例。
图1示出了超声刀的一个实施例,所述超声刀具有形成于刀的抓持表面上的齿状抓持特征结构。
图2示出了超声刀的一个实施例,所述超声刀具有形成于刀的抓持部分上的齿状抓持特征结构,其中齿状物被机械加工到刀的抓持部分中。
图3示出了超声刀的一个实施例,所述超声刀具有形成于刀的抓持部分上的齿状抓持特征结构,其中齿状物从刀的抓持部分突出。
图4示出了超声刀的一个实施例,所述超声刀具有形成于刀的抓持部分上的突出的块状抓持特征结构。
图5为根据一个实施例的图4所示的超声刀的侧视图。
图6示出了超声刀的一个实施例,所述超声刀具有形成于刀的抓持部分上的突出的凸耳状或峰状抓持特征结构。
图7为根据一个实施例的图6所示的超声刀的侧视图。
图7A示出了根据一个实施例的凸耳状突起。
图7B示出了根据一个实施例的峰状突起。
图8示出了超声刀的一个实施例,所述超声刀具有形成于刀的抓持部分上的腔状抓持特征结构。
图9A为根据一个实施例的图8所示的超声刀的侧视图,所述超声刀具有部分地形成到刀的抓持部分中的圆柱形腔状抓持特征结构。
图9B为根据一个实施例的图8所示的超声刀的侧视图,所述超声刀具有穿过刀的抓持部分形成的圆柱形腔状抓持特征结构。
图9C为根据一个实施例的图8所示的超声刀的侧视图,所述超声刀具有部分地形成到刀的抓持部分中的锥形腔状抓持特征结构。
图10示出了超声刀的一个实施例,所述超声刀具有形成于刀的抓持部分上的横向凸耳状抓持特征结构。
图11为根据一个实施例的图10所示的超声刀的侧视图。
图12为包括医学钳的端部执行器组件的一个实施例的侧视图,所述医学钳具有活动钳口构件和超声刀,所述超声刀具有形成于刀的抓持表面上的呈齿状抓持特征结构形式的突起。
图13为图12所示的医学钳的一个实施例的顶视图,其中活动钳口构件以虚线绘制以示出定位在该活动钳口构件下方的超声刀。
图14为示出超声刀的一个实施例的侧视图,所述超声刀包括具有形成于刀的抓持表面上的三角形凹槽的齿状抓持特征结构。
图15为根据一个实施例的图14所示的超声刀的顶视图。
图16为示出超声刀的一个实施例的侧视图,所述超声刀包括齿状抓持特征结构,所述齿状抓持特征结构包括水平沟槽,所述水平沟槽具有形成于刀的抓持表面上的重复半圆形凹槽。
图17为根据一个实施例的图16所示的超声刀的顶视图。
图18为示出超声刀的一个实施例的顶视图,所述超声刀包括抓持特征结构,所述抓持特征结构包括形成于刀的抓持表面上的腔。
图19示出了包括医学钳的端部执行器组件的一个实施例,所述医学钳具有活动钳口构件和具有柔性密封件的超声刀,所述柔性密封件被定位在刀的近侧部分和管的远侧部分上以将刀密封到管的外径。
图20示出了包括医学钳的端部执行器组件的一个实施例,所述医学钳包括活动钳口构件和具有柔性密封件的超声刀,所述柔性密封件被定位在刀的近侧部分上和管的远侧部分内以将刀密封到管的内径。
图21示出了用以隐藏超声刀的纵长部分的开槽内管的一个实施例,其中狭槽提供流体出口以排出可积聚在刀和内管之间的空间中的外科物质。
图22示出了用以隐藏超声刀的纵长部分的有穿孔的残缺内管的一个实施例,所述穿孔提供流体出口以排出可积聚在刀和内管之间的空间中的外科物质。
图23示出了用以隐藏超声刀的纵长部分的有流体引导肋和穿孔的内管的一个实施例,其中流体引导肋和穿孔提供流体出口以排出可积聚在刀和内管之间的空间中的外科物质。
图24为包括会聚管的有引导流体肋和穿孔的内管的一个实施例。
图25示出了用以密封超声刀的一部分和外管之间的空间的成型密封件的一个实施例,其中柔性密封件具有两个接触点并且限定用于收集外科物质的腔。
图26示出了包括成型密封件的混合系统的一个实施例,所述成型密封件包括柔性隔膜,所述柔性隔膜用作泵以将外科物质推出远侧内管区域。
图27示出了用以密封超声刀的一部分和管之间的空间的密封件的一个实施例,所述柔性密封件具有多个接触点和低干扰接触点。
图28示出了根据一个实施例的形成于超声刀的外表面上以阻止组织进入的蚀刻区域。
图29示出了包括医学钳的端部执行器组件的一个实施例,所述医学钳具有活动钳口构件和部分地回缩在管内的可滑动超声刀。
图30示出了具有形成于其中的加工的窗口以允许在内管和外管之间引流的内管的实施例。
图31示出了包括医学钳的端部执行器组件的一个实施例,所述医学钳具有活动钳口构件和超声刀,其中活动钳口构件包括具有用以折返外科物质的组织止动部分的垫,其中组织止动部分相对于活动钳口构件成型以覆盖内管的开口。
图32示出了正压力流体流动系统的一个实施例,所述正压力流体流动系统在其远侧端部处利用位于远侧节点的远侧的泵或泵出口在外管和超声刀之间施加正压力流体流。
图33示出了根据一个实施例的包括超声刀的端部执行器组件的一部分,所述超声刀包括柔性密封件的一个实施例以在远侧节点处将超声刀密封到管。
图34示出了包括医学钳的端部执行器组件的一个实施例,所述医学钳具有活动钳口构和超声刀,所述超声刀包括定位在活动钳口构件的边缘的远侧并且锚固到管以阻止组织紧缩的柔性密封件。
图35示出了定位在内管内的密封件和定位在内管内的超声刀的一个实施例。
图36示出了用于超声刀的密封机构的一个实施例,所述密封机构具有位于最末密封件远侧的渐缩内管部分,其中内管在远侧端部处颈缩成较小直径,从而为外科物质限定减小的进入空间。
图37示出了位于内管上的包覆模制的柔性密封件的一个实施例,超声刀在组装期间刺穿所述包覆模制的柔性密封件。
图38示出了包括医学钳的端部执行器组件的一个实施例,所述医学钳具有活动钳口构件和超声刀,其中该活动钳口构件包括折返垫以折返外科物质。
图39为根据一个实施例的图38所示的折返垫的前视图。
图40示出了用于超声刀的密封系统的一个实施例。
图41示出了成型内管或附接到内管从而为流体提供迂曲路径的部件的一个实施例。
图42示出了具有柔顺臂的模制部件的一个实施例,所述模制部件用于阻挡管组件的远侧开口并且经由围绕刀中的销旋转的臂附接在节点位置处。
图43示出了附着到内管的内部的包覆模制的硅树脂缓冲垫的一个实施例。
图44-47示出了可如何将一对芯轴从两端插入内管中以形成图43中的包覆模制的缓冲垫的一个实施例。
图48示出了附连到内管的未密封到超声刀的包覆模制材料的一个实施例。
图49示出了正流体压力系统的一个实施例,其中空气沿内管的长度被泵送。
图50示出了内管一个实施例,所述内管具有附接到其的与超声刀具有最小干扰的硅树脂密封件。
图51示出了用于将超声刀密封到管的密封系统的一个实施例。
图52示出了位于内管上的柔性密封件的一个实施例,超声刀在组装期间刺穿所述柔性密封件。
图53示出了包覆模制的柔性密封件的一个实施例,所述包覆模制的柔性密封件在远侧密封件的远侧附接到超声刀。
图54示出了包覆模制的柔性密封件的一个实施例,所述包覆模制的柔性密封件在远侧密封件的远侧附接到超声刀。
图55示出了密封系统的一个实施例,所述密封系统包括多个环形密封件以在远侧密封件的远侧密封超声刀。
图56示出了包括医学钳的端部执行器组件的一个实施例,所述医学钳具有处于打开位置的活动钳口构件、超声刀、以及包括擦拭密封件的能够可滑动运动的内管。
图57示出了图56所示的包括医学钳的端部执行器组件的一个实施例,所述医学钳具有处于闭合位置的活动钳口构件。
图58示出了包括医学钳的端部执行器组件的一个实施例,所述医学钳具有以虚线示出的处于打开位置和以实线示出的处于闭合位置的活动钳口构件、超声刀、能够可滑动运动的外管、以及具有位于刀上的柔性密封件的固定内管。
图59示出了包括医学钳的端部执行器的一个实施例,所述医学钳具有处于打开位置的活动钳口构件、超声刀、能够可滑动运动的外管、以及具有包覆模制在内管上的柔性密封件的固定内管。
图60为包括医学钳的端部执行器组件的一个实施例的透视图,所述医学钳具有活动钳口构件和超声刀,其中活动钳口构件可旋转地附接到远侧节点。
图61为图60所示的端部执行器组件的一个实施例的侧视图,所述端部执行器组件具有处于打开位置并且以透明形式示出的活动钳口构件,从而示出在刀与外管之间相对运动时使活动钳口构件旋转的外管凸轮狭槽。
图62示出了图60所示的端部执行器组件的一个实施例,其中示出了活动钳口构件的枢轴。
图63为包括医学钳的端部执行器组件的一个实施例的侧视图,所述医学钳具有处于闭合位置的活动钳口构件和超声刀,所述端部执行器组件包括连杆以利用外管与刀之间的相对运动来打开和闭合活动钳口构件。
图64为根据一个实施例的具有处于打开位置的活动钳口构件的图63所示的端部执行器组件的侧视图。
图65为根据一个实施例的具有处于打开位置的活动钳口构件的图63所示的端部执行器组件的底视图。
图66为根据一个实施例的具有处于打开位置的活动钳口构件的图63所示的端部执行器组件的透视图。
图67为根据一个实施例的具有处于打开位置的活动钳口构件的图63所示的端部执行器组件的透视图。
图68为包括医学钳的端部执行器组件的一个实施例的透视图,所述医学钳具有活动钳口构和超声刀,其中活动钳口构件示为处于打开位置,其中外管相对于刀进行平移以打开和闭合活动钳口构件。
图69为根据一个实施例的外管被移除的内管的透视图,其中内管操作地联接到图68所示的端部执行器组件。
图70为根据一个实施例的图69所示的内管的凹口部分的透视图。
图71示出了包括医学钳的端部执行器组件的一个实施例,所述医学钳具有处于闭合位置的活动钳口构件、超声刀、以及能够抵消刀偏转的轴组件。
图72示出了具有改进凸缘的超声换能器的一个实施例,所述改进凸缘引入外螺纹以允许换能器旋转。
图73为超声换能器旋转系统的一个实施例的剖面图,所述超声换能器旋转系统包括护罩和适配到护罩的半部中的门。
图74A-74C示出了根据一个实施例的门与旋钮交互的动力学。
图74A示出了根据一个实施例的门,所述门处于左偏置位置,使得旋钮可顺时针旋转大约690度,直到旋钮上的成型挤出元件与门的右翼接触,使得门的左翼通过相对于护罩的静止反应而阻止运动。
图74B示出了根据一个实施例的反向旋转360°直到将门的右翼碰撞到右偏置位置的旋钮。
图74C示出了根据一个实施例的将门的右翼碰撞到右偏置位置之后的旋钮。
图75为超声换能器旋转系统的一个实施例的剖面图,所述超声换能器旋转系统包括护罩和适配到护罩的半部中的门,其中旋转系统包括触觉反馈元件。
图76A-76C示出了根据一个实施例的门与旋钮交互的动力学,其中旋钮包括触觉反馈元件。
图76A示出了根据一个实施例的门,所述门处于左偏置位置,使得包括触觉反馈元件的旋钮可顺时针旋转大约690度,直到旋钮上的成型挤出元件与门的右翼接触,使得门的左翼通过相对于护罩的静止反应而阻止运动。
图76B示出了根据一个实施例的反向旋转360°直到将门的右翼碰撞到右偏置位置的包括触觉反馈元件的旋钮。
图76C示出了根据一个实施例的将门的右翼碰撞到右偏置位置之后的包括触觉反馈元件的旋钮。
图77示出了一体化RF/超声器械的一个实施例,所述一体化RF/超声器械被电连接使得超声刀/焊头电连接至联接到器械的超声发生器的正极引线,以提供RF点凝。夹持臂和管连接到返回路径。
图78示出了包括四引线插孔连接器的一体化RF/超声器械的一个实施例,所述四引线插孔连接器与电连接至发生器的可滑动凹形配合插头相配合。
图79为与联接到超声换能器的可滑动凹形配合插头相配合的四引线插孔连接器的一个实施例的细部图,其中位置1为换能器提供超声信号,并且其中位置2为该装置提供电外科信号。
图80-83示出了超声刀的各种实施例,所述超声刀涂覆有电绝缘材料,以在组织接触区域处提供热绝缘,从而最小化组织对刀的粘附性。
图84-93示出了超声刀的各种实施例,所述超声刀局部涂覆有电绝缘材料,以在组织接触区域处提供热绝缘,从而最小化组织对刀的粘附性,其中刀的较浅着色区域表示涂覆部分,并且刀的较深着色区域表示暴露表面,所述暴露表面使得RF电流能够从刀的暴露区域穿过组织流到活动钳口构件。可以想象,该特征结构可用于刀、夹持臂、或这两者上。
图94-95示出了具有非对称暴露表面的两个超声刀的实施例,其中刀涂覆有电绝缘材料,以在组织接触区域处提供热绝缘,从而最小化组织对刀的粘附性,其中刀的较浅着色区域表示涂覆部分,并且刀的较深着色区域表示暴露表面,所述暴露表面使得RF电流能够从刀的暴露区域穿过组织流到活动钳口构件。可以想象,该特征结构可用于刀、夹持臂、或这两者上。
图96为包括金属隔热罩的超声端部执行器的一个实施例的透视图。
图97为包括可回缩的金属隔热罩的超声端部执行器的另一个实施例的透视图。
图98为包括以横截面示出的隔热罩的超声端部执行器的另一个实施例的侧视图。
图99为根据一个实施例的图98所示的超声端部执行器的前视图。
图100示出了夹持臂的一个实施例,所述夹持臂包括以闭合位置示出的活动钳口构件和位于超声刀下方的双重用途可旋转隔热罩。
图101示出了以打开位置示出的活动钳口构件和双重用途可旋转隔热罩的一个实施例,所述双重用途可旋转隔热罩被旋转以使其夹置在活动钳口构件和刀之间。
图102示出了旋转到第一位置的双重用途可旋转隔热罩的一个实施例的端视图。
图103示出了旋转到第二位置的双重用途可旋转隔热罩的一个实施例的端视图。
图104为隔热罩的一个实施例的顶部轮廓图,其中示出了护罩的渐缩部分。
图105示出了常规的骨钳外科器械。
图106示出了超声能量驱动的骨钳装置的一个实施例。
图107示出了包括外科器械和超声发生器的外科系统的一个实施例。
图108示出了图107所示的外科器械的一个实施例。
图109示出了超声端部执行器的一个实施例。
图110示出了超声端部执行器的另一个实施例。
图111示出了图107所示的外科器械的一个实施例的分解图。
图112A和112B示出了用于一体化换能器的无限制旋转连接件的一个实施例。
图113A-113C示出了用于一体化换能器的无限制旋转连接件的一个实施例。
图114A和114B示出了一体化RF/超声外科端部执行器的一个实施例。
图115A-115I示出了用于图114A和114B的一体化RF/超声外科端部执行器的各种电极布置方式。
图116A示出了空气冷却式外科器械的一个实施例。
图116B示出了涡旋管的一个实施例。
图117示出了包括双极双掷开关的一体化RF/超声外科器械的一个实施例。
图118示出了双极双掷开关的一个实施例。
图119A-119E示出了组合RF/超声端部执行器的各种实施例。
图120A-120C示出了双极组合RF/超声端部执行器的各种实施例。
图121A-121C示出了单极组合RF/超声端部执行器的各种实施例。
具体实施方式
在详细地解释超声和电外科装置的各种实施例之前,应当指出的是,本文所公开的各种实施例并不将其应用或用途限于附图和具体实施方式中所示的部件的构造和布置方式的细节。相反,本发明所公开的实施例可以其变型和修改定位或结合到其他实施例中,并且可通过各种方式来实施或执行。因此,本文所公开的超声和电外科装置的实施例实际上为例示性的,并且并非旨在限制其范围或应用。此外,除非另外指明,本文所用的术语和表达是出于方便读者而对实施例进行描述的目的选取的,并非出于限制其范围。此外,应当理解,本发明所公开的实施例、实施例表达、和/或其实例中的任何一个或多个可与其他公开的实施例、实施例表达、和/或其实例中的任何一个或多个非限制地结合。
在以下描述中,类似的参考符号指示若干附图中类似的或对应的部件。另外,在以下描述中,应当理解,诸如前、后、内部、外部、顶部、底部等等之类的术语为方便型用语,并且不应认为是限制性术语。本文所用的术语并非旨在限制本文所述的装置或其部分可以其他取向附接或使用的范围。各种实施例将参考附图进行更详细地描述。
在各种实施例中,本公开涉及包括各种抓持特征结构的超声刀的各种实施例。常规的超声刀缺少抓持特征结构。此类抓持特征结构可期望位于超声刀的抓握表面上,以在抓持和处理期间提供额外的抓握并且阻止组织挤出,这在一些情况下可改善止血。当组织节段在处理期间从外科装置的钳口滑出或挤出时,发生组织挤出。本公开提供了各种刀修改特征结构以阻止组织挤出以及提供较好的抓持力。
在各种实施例中,本公开涉及装置的各种实施例,所述装置能够阻止外科物质(例如,流体和组织)进入超声刀与位于远侧密封件的远侧的内管或外管之间的空间。描述了两种主要类型的实施例。第一,附接到刀-管子组件的压力或能量源阻止流体或组织进入刀与内管之间的空间。第二,附接到刀或内管的柔性隔膜阻止流体或组织进入。
在各种实施例中,本公开还涉及用于超声装置的另选的闭合机构的各种实施例。现有的超声装置使用管中管(TnT)闭合机构,以使得夹持臂(本文称为活动钳口构件)能够针对超声刀的有效长度闭合。用于超声装置的另选的闭合机构的现有实施例可产生若干优点。例如,相对于外管致动内管的曳力之间可存在的差异,从而导致装置夹持力的变化。另外,外管上的夹持臂的枢转位置引起明显的角度闭合,并且导致非均匀的闭合分布。此外,现有装置机构可对部件中的变化敏感,因为层叠结构在绝缘销的位置处联接内管和外管,所述绝缘销当前位于管组件的近侧端部附近。
在各种实施例中,本公开还涉及轴组件/换能器旋转限制器的各种实施例,以限制轴和超声换能器的旋转。
在各种实施例中,本公开还涉及轴/超声换能器旋转系统的各种实施例,以提供超声装置的无限制连续旋转。在各种实施例中,可在碰撞硬障碍物之前为使用者提供触觉反馈。
在各种实施例中,本公开还涉及一体化RF/超声器械的各种实施例,所述一体化RF/超声器械被电连接以利用超声/RF发生器来为组织的前超声处理或后超声处理提供RF点凝能量。一体化超声器械能够在不需要联接压力的情况下改善弥漫性出血(毛细血管出血、切口部位渗出)或组织预处理,并且改善超声器械所需的将刀联接到组织的联接压力,使得基于摩擦的组织效果有效。一体化超声器械可降低:(1)施加足够的压力以在松散支撑的(即,未夹持的)组织中产生止血效果的难度,或者(2)产生过多组织破裂而在多种情况下使弥漫性出血更严重的联接压力。在一个实施例中,四引线插孔连接器与可滑动凹形配合插头相配合,使得当在RF能量与超声能量之间切换时,使第二RF发生器与超声换能器电隔离。
在各种实施例中,本公开还涉及包括隔热罩的超声刀。隔热罩可为固定的、可平移的或可旋转的。隔热罩还可用于将RF能量传导至靶组织。
在各种实施例中,本公开还涉及涂覆的超声/RF刀。超声刀涂覆有电绝缘材料,以在组织接触区域处提供热绝缘,从而最小化组织对刀的粘附性。常规的超声装置使用一种处理模式,这限制了灵活性。例如,常规的超声装置可用于血管密封和切断组织。双极或单极RF可提供附加的有益效果,例如,用于对组织进行点凝和预处理的方法。超声与RF的结合可提供灵活性并增加有效性。然而,常规的超声装置使用涂层,以在刀的远侧端部处提供减小的摩擦和热绝缘。这些涂层为电绝缘的,并且因此限制电流,从而降低RF有效性。另外,电流密度可影响有效性。为了将两种模式结合到一个装置中,可需要掩膜或选择性涂覆去除工艺。在刀表面上形成暴露区域可提供用于电流的合适路径。可以想象,同样的原理也可应用于夹持构件。
通用外科器械概述
在开始进入各种实施例的说明之前,本公开转到图107-111的说明,其描述了外科系统的各种实施例,在其中,结合图1-106所描述的超声和电外科装置的各种实施例可被实施。因此,图107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中,包括腹腔镜式、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、和启动开关组件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能够在近侧端部处接收超声换能器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个端部执行器组件26,但是超声外科器械10可用于更多传统的开放式外科手术中,并且在其他实施例中,可被配置用于腹腔镜式或内窥镜式手术中。出于本文的目的,从腹腔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/或内窥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类型的外科装置。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内以用作能量源。
在一些实施例中,电外科手术/射频发生器模块23能够生成治疗能级和/或亚治疗能级。在图107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连接到发生器的脚踏开关29。发生器20还可包括用于启动外科器械(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。当通过脚踏开关29启动时,发生器20可提供能量以驱动外科器械10的声学组件并且以预定的偏移水平驱动端部执行器18,或者提供治疗/亚治疗电磁/RF能。发生器20以声学组件的任何合适的共振频率来驱动或激发声学组件,以及/或者驱动治疗/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)来实施,该电外科手术单元能够提供足以利用RF能量来执行双极性电外科手术的功率。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。如先前所论述,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,以实现组织阻抗测量模块。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的时间和功率水平属性。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相似的方式操作,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 for Improving the Start Up of an Ultrasonic System UnderZero Load Conditions”);美国专利6,537,291(“Method for Detecting BladeBreakage Using Rate and/or Impedance Information”);美国专利6,662,127(“Method for Detecting Presence of a Blade in an Ultrasonic System”);美国专利6,678,899(“Method for Detecting Transverse Vibrations in an UltrasonicSurgical System”);美国专利6,977,495(“Detection Circuitry for SurgicalHandpiece System”);美国专利7,077,853(“Method for CalculatingTransducer Capacitance to Determine Transducer Temperature”);美国专利7,179,271(“Method for Driving an Ultrasonic System to Improve Acquisition ofBlade Resonance Frequency at Startup”);和美国专利7,273,483(“Apparatusand Method for Alerting Generator Function in an Ultrasonic SurgicalSystem”)。
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。另选地,超声发生器模块21能够将超声能量或治疗亚治疗RF能量选择性地施加到端部执行器。
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。如先前所论述,可向夹持在端部执行器组件26的夹持元件之间的组织施加亚治疗电外科/RF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。另选地,超声和电外科/RF能量可通过单次启动而被顺序地使用,以实现期望的组织效应。
当经由触发机构启动发生器20时,在一个实施例中,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间歇地施加(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,以匹配声学组件的选定纵向振动模式的共振频率。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107-图111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22可在约40kHz至56kHz的范围内振动,例如以约50.0kHz振动。在其他实施例中,刀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,使得可将电能连续地或间歇地提供给声学组件。发生器20还具有用于插入电外科单元或常规电源插座的电源线。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108是超声外科器械10的一个示例性实施例的左侧透视图,示出了柄部组件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被接收在柄部组件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98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,并且能够与使用者舒适地交接。固定柄部34与柄部组件12整体地相联。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。当使用者施加相对于触发器32的挤压力时,触发器32沿方向33A朝着固定柄部34可枢转地运动。当使用者释放相对于触发器32的挤压力时,弹簧元件98(图111)使触发器32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的尺寸设定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。形成包覆模制的弹性部分32a以提供更加舒适的接触表面以用于沿向外方向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包覆模制的弹性部分32a。细长触发器钩32的近侧表面保持未涂覆状态或涂覆有非弹性基材,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,其限定尺寸设定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的轮廓曲线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的更近侧部分定位。稳定性尾部44可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,以消除同时启动的可能性。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以将超声换能器16的功率设置设定在最小功率水平(例如,MIN)和最大功率水平(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。特殊设置可提供由装置执行一个或多个特殊程序。当当第一突出旋钮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包括一个或多个电功率设置开关以启动超声换能器16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所需的力被导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的侧至一定程度,以便更易于被不同长度的手指触及,且允许不顺手位置启动或手指较短时具有较大的触及自由度。
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2009/055750中有所描述,所述美国专利申请公布以引用方式全文并入本文。
在一个示例性实施例中,拨动开关30可以由用户的手操作。用户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)功率水平。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)功率水平。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。特殊设置可提供由器械10执行一个或多个特殊程序。用户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可包括纹理或突出部,从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可围绕纵向轴线“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的上方形成的旋转旋钮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上方包覆模制。毂46包括暴露在远侧端部处的端盖部分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,以缓解可端盖部分46a和套管针之间出现的任何摩擦。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可以由包覆模制到硬质塑性材料上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。这种较软的包覆模制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111),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并且包封其内部工作部件。与柄部组件12整体地相联的固定柄部34在组装柄部组件12的第一部分12a和第二部分12b时成形。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/偏转点,以用于超声焊接的目的。可以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,对齐销、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,细长轴组件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。能够可枢转地运动的触发器32可以沿纵向轴线“T”生成往复式运动。此类运动可用于例如致动端部执行器组件26的钳口或夹持机构。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的夹持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围绕枢转点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可围绕枢转点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可围绕枢转点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66。端部执行器组件26的夹持机构的钳口由夹持臂组件64和刀66形成。刀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最终连接到驱动组件,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,在该打开位置,夹持臂组件64和刀66相对于彼此以间隔关系设置,在该夹持或闭合位置,夹持臂组件64和刀66配合以将组织夹持在它们之间。夹持臂组件64可以包括夹持垫69以接合位于刀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,在该打开位置,夹持臂组件64和刀66相对于彼此以间隔关系设置。
柄部组件12的近侧部分包括近侧开口68以接收超声组件16的远侧端部。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时或当沿方向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111)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的功率水平以处理组织。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109-图110示出了细长轴组件14相对于端部执行器组件26的连接。如先前所述,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66以形成夹持机构的钳口。刀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。触发器32机械地连接到驱动组件。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,在该打开位置,夹持臂组件64和刀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,在该夹持或闭合位置,夹持臂组件64和刀66配合以将组织夹持在它们之间。夹持臂组件64可以包括夹持垫69以接合位于刀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围绕枢转点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可围绕枢转点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可围绕枢转点70沿方向62A从闭合位置运动到打开位置。
如先前所论述,夹持臂组件64可包括电联接到电外科/射频发生器模块23的电极以接收治疗和/或亚治疗能量,其中电外科/射频能量可在或不在超声能量施加至刀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111为图108所示的超声外科器械10的分解图。在该例示的实施例中,分解图示出柄部组件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配合以形成柄部组件12。第一部分12a和第二部分12b各自包括多个接合部69,该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并且包封超声外科器械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上方,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的远侧端部处的端部执行器组件26的夹持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能够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、86b,以根据第一突出旋钮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,并且隔离元件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节点处。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上的平坦部分使得组件能够扭转到所需的水平。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。另选地,超声传输波导78可以包括围绕在其周围的聚合物材料,以将其与外部接触隔离。
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66的近侧端部,优选地位于波腹处或靠近波腹。据设想,刀66可通过任何合适的装置诸如焊接接头等附接到超声传输波导78。虽然刀66可以从超声传输波导78拆卸,但另据设想,单元件端部执行器(例如,刀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包括在其中形成有开口的第一组凸缘98以接收第一轭销92a。第一轭销92a还定位成穿过形成于轭84的远侧端部处的一组开口。触发器32还包括第二组凸缘96以接收联接件92的第一端部92a。触发器销90被接收在形成于联接件92和第二组凸缘96中的开口中。触发器销90被接收在形成于联接件92和第二组凸缘96中的开口中,并且能够联接到柄部组件12的第一部分12a和第二部分12b以形成用于触发器32的触发器枢转点。联接件92的第二端部92b被接收在形成于轭84的近侧端部中的狭槽384中,并通过第二轭销94b保持在其中。当触发器32围绕由触发器销90形成的枢转点190枢转地旋转时,轭在箭头60A、60B指示的方向上沿纵向轴线“T”水平平移。
具有各种抓持特征结构的超声刀
图1-11示出了包括抓持特征结构的超声刀的各种实施例。此类抓持特征结构可包括在超声刀的抓握表面上,以在抓持和处理期间提供额外的抓握并且阻止组织挤出,这在一些情况下可改善止血。当组织节段在处理期间从外科装置的钳口滑出或挤出时,发生组织挤出。下文讨论的刀修改特征结构可阻止组织挤出以及提供较好的抓持力。
对于具有活动钳口构件的医学钳中的超声夹持臂而言,当在装置未启动的情况下夹持在干鞣上时,最小抓持力为约2.25磅力。然而,在启动期间,组织可从钳口朝近侧或朝远侧挤出。用于超声剪装置的包括齿状抓持特征结构102的刀100可有助于阻止组织挤出以及提供较好的抓持力。
抓持特征结构可采取例如结合图1-11所述的若干形状的形式。抓持特征结构可仅位于刀的一部分上,例如,远侧末端、刀的中心、近侧节段、或刀的任何部分。在另一个实施例中,抓持特征结构可沿刀的整个长度或刀的一部分定位。在一些实施例中,参考图1-11所示和所述的特征结构可纵向地位于刀的一部分上,例如,被配置在沿刀的中心线上、刀的左侧、刀的右侧、或刀的右侧和左侧两者。在另一个实施例中,抓持特征结构可沿刀的整个宽度进行配置。抓持特征结构可包括例如机械加工到刀中的齿状物、从刀的表面突起的齿状物、突起的块、突起的凸耳或峰、形成于刀中的孔穴、或突起的细长凸耳。这些和其他刀抓持特征结构在下文中结合图1-11进行描述。
图1示出了超声刀100的一个实施例,其具有形成于刀100的抓持表面104上的齿状抓持特征结构102。在图1所示的实施例中,齿状抓持特征结构102沿刀100的抓持表面104的侧向部分106、108(例如,刀100的左侧和刀100的右侧)形成。在一个实施例中,齿状抓持特征结构102可沿刀100的整个有效长度或一部分形成。齿状抓持特征结构102的元件可均匀地或变间距地间隔。在其他实施例中,齿状抓持特征结构102可仅位于刀100的一部分上,例如,远侧末端110、刀100的中心112、近侧节段114、或刀100的任何部分。在另一个实施例中,齿状抓持特征结构102可沿刀100的整个长度或一部分定位。在一些实施例中,齿状抓持特征结构102可纵向地位于刀100的一部分上,例如,被配置在沿刀100的中心线116上、刀100的左侧108、刀100的右侧106、或刀100的右侧和左侧两者。在另一个实施例中,齿状抓持特征结构102可沿刀100的整个宽度进行配置。齿状抓持特征结构102可能够在启动期间捕获组织并且阻止脱离,从而阻止组织挤出以及提供较好的抓持力。因此,形成于刀100上的齿状抓持特征结构102改善组织抓持。然而,实施例并不限于此背景中。
图2示出了超声刀200的一个实施例,其具有形成于刀200的抓持部分204上的齿状抓持特征结构202,其中齿状物被机械加工到刀200的抓持部分204中。在图2所示的实施例中,刀200为具有活动钳口构件208(通常称为夹持臂)的医学钳206的一部分。活动钳口构件208包括夹持垫210,以接合位于刀200和活动钳口构件208(例如,夹持臂)之间的组织。在一个实施例中,齿状抓持特征结构202可沿刀200的整个有效长度或一部分形成。齿状抓持特征结构202的元件可均匀地或变间距地间隔。尽管未示出,但齿状抓持特征结构202可在刀200的整个抓持表面204上形成,可如图1所示沿刀200的侧向部分形成为多行,或者可沿刀200的抓持表面204的纵向部分形成为单行。齿状抓持特征结构202可能够在启动期间捕获组织并且阻止脱离,从而阻止组织挤出以及提供较好的抓持力。因此,形成于刀200上的齿状抓持特征结构202改善组织抓持。然而,实施例并不限于此背景中。
图3示出了超声刀300的一个实施例,其具有形成于刀300的抓持部分304上的齿状抓持特征结构302,其中齿状物302从刀300的抓持部分304突出。在图3所示的实施例中,刀300为具有活动钳口构件308(通常称为夹持臂)的医学钳306的一部分。活动钳口构件308包括夹持垫310,以接合位于刀300和活动钳口构件308(例如,夹持臂)之间的组织。在一个实施例中,齿状抓持特征结构302可沿刀300的整个有效长度或一部分形成。齿状抓持特征结构302的元件可均匀地或变间距地间隔。尽管未示出,但齿状抓持特征结构302可在刀300的整个抓持表面304上形成,可如图1所示沿刀300的侧向部分形成为多行,或者可沿刀300的抓持表面304的纵向部分形成为单行。齿状抓持特征结构302可能够在启动期间捕获组织并且阻止脱离,从而阻止组织挤出以及提供较好的抓持力。因此,形成于刀300上的齿状抓持特征结构302改善组织抓持。然而,实施例并不限于此背景中。
图4示出了超声刀400的一个实施例,其具有形成于刀400的抓持部分404上的突起的块状抓持特征结构402。图5为图4所示的超声刀的侧视图。在图4和图5所示的实施例中,块状抓持特征结构402沿刀400的抓持表面404的侧向部分406、408形成。在一个实施例中,块状抓持特征结构402可沿刀400的整个有效长度或一部分形成。块状抓持特征结构402的元件可均匀地或变间距地间隔。在其他实施例中,块状抓持特征结构402可仅位于刀400的一部分上,例如,远侧末端410、刀400的中心412、近侧节段414、或刀400的任何部分。在另一个实施例中,块状抓持特征结构402可沿刀400的整个长度或一部分定位。在一些实施例中,块状抓持特征结构402可纵向地位于刀400的一部分上,例如,被配置在沿刀400的中心线416上、刀400的左侧408、刀400的右侧406、或刀400的右侧和左侧两者。在另一个实施例中,块状抓持特征结构402可沿刀400的整个宽度进行配置。块状抓持特征结构402可能够在启动期间捕获组织并且阻止脱离,从而阻止组织挤出以及提供较好的抓持力。因此,形成于刀400上的块状抓持特征结构402改善组织抓持。然而,实施例并不限于此背景中。
图6示出了超声刀500的一个实施例,其具有形成于刀500的抓持部分504上的突起的抓持特征结构502。图7为图6所示的超声刀500的侧视图,并且图7A示出了呈凸耳状突起510形式的突起的抓持特征结构502,而图7B示出了呈峰状突起512形式的突起的抓持特征结构502。在图6和图7所示的实施例中,突起的抓持特征结构502沿刀500的抓持表面504的侧向部分506、508形成。在一个实施例中,抓持特征结构502可沿刀500的整个有效长度或一部分形成。抓持特征结构502的元件可均匀地或变间距地间隔。在其他实施例中,抓持特征结构502可仅位于刀500的一部分上,例如,远侧末端520、刀500的中心522、近侧节段524、或刀500的任何部分。在另一个实施例中,抓持特征结构502可沿刀500的整个长度或一部分定位。在一些实施例中,抓持特征结构502可纵向地位于刀500的一部分上,例如,被配置在沿刀500的中心线526上、刀500的左侧508、刀500的右侧506、或刀500的右侧和左侧两者。在另一个实施例中,抓持特征结构502可沿刀500的整个长度进行配置。抓持特征结构502可能够在启动期间捕获组织并且阻止脱离,从而阻止组织挤出以及提供较好的抓持力。因此,形成于刀500上的抓持特征结构502改善组织抓持。然而,实施例并不限于此背景中。
图8示出了超声刀600的一个实施例,其具有形成于刀600的抓持部分604上的腔状抓持特征结构602。图9A为超声刀600的侧视图,其具有部分地形成在刀610的抓持部分中的圆柱形腔状抓持特征结构611。图9B为超声刀600的侧视图,其具有穿过刀612的抓持部分形成的圆柱形腔状抓持特征结构613。图9C为超声刀600的侧视图,其具有部分地形成在刀614的抓持部分中的锥形腔状抓持特征结构615。在图8和9A-C所示的实施例中,腔状抓持特征结构602沿刀600的抓持表面604的部分进行分布。在一个实施例中,抓持特征结构602可沿刀600的整个有效长度或一部分形成。抓持特征结构602的元件可均匀地或变间距地间隔。在其他实施例中,抓持特征结构602可仅位于刀600的一部分上,例如,远侧末端620、刀600的中心622、近侧节段624、或刀600的任何部分。在另一个实施例中,抓持特征602结构可沿刀600的整个长度或一部分定位。在一些实施例中,抓持特征结构602可纵向地位于刀600的一部分上,例如,被配置在沿刀600的中心线626上、刀600的左侧608、刀600的右侧606、或刀600的右侧和左侧两者。在另一个实施例中,抓持特征结构602可沿刀600的整个长度进行配置。抓持特征结构602可能够在启动期间捕获组织并且阻止脱离,从而阻止组织挤出以及提供较好的抓持力。因此,形成于刀600上的抓持特征结构602改善组织抓持。然而,实施例并不限于此背景中。
图10示出了超声刀700的一个实施例,其具有形成于刀700的抓持部分704上的横向凸耳状抓持特征结构702。图11为图10所示的超声刀700的侧视图。在图10和图11所示的实施例中,横向凸耳状抓持特征结构702横向地分布在刀700的整个抓持表面704上。在一个实施例中,横向凸耳状抓持特征结构702可沿刀700的整个有效长度或一部分形成。横向凸耳状抓持特征结构702的元件可均匀地或变间距地间隔。在其他实施例中,横向凸耳状抓持特征结构702可仅位于刀700的一部分上,例如,远侧末端720、刀700的中心722、近侧节段724、或刀700的任何部分。在另一个实施例中,横向凸耳状抓持特征结构702可沿刀700的整个长度或一部分定位。在一些实施例中,横向凸耳状抓持特征结构702纵向地位于刀700的一部分上,例如,被配置在沿刀700的中心线726上、刀700的左侧708、刀700的右侧706、或刀700的右侧和左侧两者。在另一个实施例中,横向凸耳状抓持特征结构702可沿刀700的整个宽度进行配置。横向凸耳状抓持特征结构702可能够在启动期间捕获组织并且阻止脱离,从而阻止组织挤出以及提供较好的抓持力。因此,形成于刀700上的横向凸耳状抓持特征结构702改善组织抓持。然而,实施例并不限于此背景中。
图12为包括医学钳800的端部执行器组件的一个实施例的侧视图,所述医学钳具有活动钳口构件802和超声刀804,所述超声刀具有形成于刀804的抓持表面808中的呈齿状抓持特征结构形式的突起806。图13为图12所示的医学钳800的一个实施例的顶视图,其中活动钳口构件802以虚线绘制以示出定位在活动钳口构件802下方的超声刀804。
在一个实施例中,突起806(例如,齿状物)可由若干尺寸限定。第一尺寸“a”表示突起806(例如,齿状物)的高度。在一个实施例中,尺寸“a”可为约0.12mm至0.18mm。第二尺寸“b”表示突起806(例如,齿状物)的宽度。在一个实施例中,尺寸“b”可为约0.2mm。第三尺寸“c”表示各个突起806之间的间距。在一个实施例中,尺寸“c”为约0.5mm。在一个实施例中,突起806可覆盖由尺寸“d”表示的距离,所述距离可为刀804的仅2mm以提供另外的抓持强度。2mm的突起806可占刀804的任何百分比,例如,15mm刀的13%。在一个实施例中,在刀804的远侧端部810附近的突起806的高度可为大约2.3mm。在一个实施例中,突起806可占刀804的总高度的约5%。在各种实施例中,突起806可包括0.3mm-1.0mm的节距、大约0.08mm-0.8mm的深度、和大约5-90度的角度。在各种实施例中,突起806可呈块、凸耳、峰、或减速路脊的形式,如先前所述。突起806的这些另选实施例将形成为具有与结合图12和图13所述的突起806相似的尺寸,从而对组织产生相似的影响,例如,在统计学上较好的组织抓持力并且阻止组织挤出。
在一个实施例中,突起806可与形成于医学钳800的夹持臂802上或组织垫812部分上的交替特征结构配合。在另一个实施例中,此配合既不必要也不必需。在一个非配合实施例中,抓持效率可通过利用呈齿状物形式的三个特征结构而增加64%。特征结构的存在不影响刀804的组织切断能力。在一个实施例中,刀804可包括沿刀804的整个有效长度的突起806。突起806可能够在启动期间捕获组织并且阻止脱离。突起806的各种实施例可包括刀齿状物、水平沟槽、或腔,如先前所述。
图14-18示出了包括刀特征结构以解决组织挤出的超声刀的各种实施例。如先前所述,组织挤出被定义为组织在装置启动时开始从具有活动钳口构件和超声刀的超声医学钳的钳口滑出的事件。该事件增加了低可及性条件下处理组织的难度。为了解决此问题和其他问题,本公开提供了三个实施例以改善超声启动期间的抓持能力。本发明所公开的超声刀中的每一个的至少一个实施例在刀的整个有效长度上采用重复的特征结构。这些特征结构被设计成在启动期间捕获组织并且阻止脱离。基于测试,相比于常规超声刀,以下实施例在启动期间已显示出30%和40%的抓持力改善。这三个实施例提供了呈如下文结合图14-18所述的刀齿状物、水平沟槽、和孔穴(例如,腔)形式的超声刀齿状物几何形状,以在装置的超声启动时阻止组织从刀和夹持臂脱离并且在超声启动之前和期间改善组织抓持能力。在各种实施例中,超声刀包括组织捕获特征结构,以改善抓持能力并且阻止在刀的超声启动期间的组织脱离。
图14为示出超声刀900的一个实施例的侧视图,所述超声刀包括具有形成于刀900的抓持表面904上的三角形凹槽的齿状抓持特征结构902。图15为图14所示的超声刀900的顶视图。刀900包括近侧端部910和远侧端部909。刀900包括呈沿刀900的一部分或整个纵向长度重复的三角形凹槽形式的组织捕获特征结构902。每个特征结构902的朝向刀900的远侧端部909的远侧侧面906可为垂直于刀900的纵向轴线的表面,其后是沿近侧方向910逐渐渐缩的成角表面908。在一个实施例中,特征结构902可通过尺寸a、b、c、和d来表征。在一个实施例中,尺寸“a”表示特征结构902的高度,所述高度可为大约0.010",“b”表示特征结构902的宽度,所述宽度可为大约0.020",“c”表示特征结构902之间的距离,所述距离可为大约0.055",并且“d”表示从最远侧特征结构902到刀900的远侧909末端的距离,所述距离可为大约0.015"。在一个实施例中,特征结构902可沿刀900的纵向长度均匀地间隔。在另一个实施例中,三角形凹槽抓持特征结构902可沿刀900的纵向长度不均匀地间隔。在例示的实施例中,刀900包括沿刀900的纵向长度的12个均匀地间隔的三角形凹槽抓持特征结构902。
图16为示出具有齿状抓持特征结构952的超声刀950的一个实施例的侧视图,所述齿状抓持特征结构包括具有形成于刀950的抓持表面954上的重复的半圆形凹槽的水平沟槽。图17为图16所示的超声刀950的顶视图。刀950包括近侧端部960和远侧端部959。刀950包括呈水平沟槽形式的组织捕获特征结构952,所述水平沟槽具有沿刀950的纵向长度重复的半圆形凹槽。在一个实施例中,特征结构952可通过尺寸e、f、g、和h来表征。在一个实施例中,尺寸“e”表示凹槽的直径,所述直径可为大约0.020",“f”表示每个特征结构952之间的距离,所述距离可为大约0.057",“g”表示从最远侧特征结构952到刀950的远侧909末端的距离,所述距离可为大约0.015",并且“h”表示凹槽的深度,所述深度可为大约0.005"。在一个实施例中,特征结构952可沿刀950的纵向长度均匀地间隔。在另一个实施例中,半圆形凹槽抓持特征结构952可沿刀950的纵向长度不均匀地间隔。在例示的实施例中,刀950包括沿刀950的纵向长度的12个均匀地间隔的半圆形凹槽抓持特征结构952。
图18为示出包括抓持特征结构972的超声刀970的一个实施例的顶视图,所述抓持特征结构972包括形成于刀970的抓持表面974上的腔或孔穴。刀970包括近侧端部980和远侧端部979。刀970包括呈沿刀970的纵向长度重复的圆形元件形式的组织捕获特征结构972。在一个实施例中,特征结构972可通过尺寸i、j、和k来表征。在一个实施例中,尺寸“k”为圆形元件的直径,所述直径可为大约0.020",“i”表示每个圆形特征结构972之间的距离,所述距离可为大约0.057",并且“j”表示从最远侧特征结构972’到刀970的远侧979末端的距离,所述距离可为大约0.015"。在一个实施例中,圆形特征结构972可沿刀970的纵向长度均匀地间隔。在另一个实施例中,圆形特征结构972可沿刀970的纵向长度不均匀地间隔。在例示的实施例中,刀970包括沿刀970的纵向长度的12个均匀地间隔的圆形抓持特征结构972。
进入阻止
本公开描述了用以阻止外科物质(例如,流体或组织)进入超声刀与位于刀远侧密封件的远侧的内管之间的空间的装置的各种实施例。描述了两种主要类型的实施例。第一,附接到刀-管子组件的压力或能量源阻止流体或组织进入刀与内管之间的空间中。第二,附接到刀或内管的柔性隔膜阻止流体或组织进入。
在一个实施例中,可例如通过沿远侧方向施加恒定压力的流体介质(例如,空气、CO2或盐水溶液)来阻止呈流体或组织形式的外科物质进入远侧内管区域。图32示出了正压力流体流动系统2300的一个实施例,所述正压力流体流动系统2300包括位于远侧密封件的远侧的泵和/或泵出口2306。在例示的实施例中,外部泵和/或泵出口2306流体地联接到位于超声刀2304的远侧节点的远侧的装置。空气或其他流体介质2308被泵送到刀2304与内管2302之间的空间2310中,从而促使颗粒和/或体液离开空间2310。如图32所示,泵和/或泵出口2306在位于远侧刀密封件2312(例如,O形环或包覆模制密封件)的远侧的点处流体地联接到管2302与刀2304之间的空间2310。因此,正压力流体流2308被引导到装置的远侧端部,以阻止外科物质积聚在空间2310中。
图49示出了正流体压力系统3500的一个实施例,其中空气3508沿内管3502的长度被泵送穿过空间3506。空气3508阻止外科物质进入超声刀3504和内管3502之间的空间3510。图49示出了示出了类似于图32所示的概念,但远侧节点不具有针对内管3502的密封件。相反,空气3508沿内管3502的全长被泵送,以阻止流体和/或组织进入。
图26示出了包括成型密封件1700的混合系统的一个实施例,所述成型密封件包括柔性隔膜1701,所述柔性隔膜用作泵以促使外科物质1714离开远侧管1706区域。受压的柔性隔膜1701通过接触而阻止组织进入。柔性隔膜1701附接到内管1706并且密封到超声刀1704。因此,刀1704与远侧管1706之间的相对运动致使柔性隔膜1701以类似泵的方式起作用,从而促使流体、组织、或其他外科物质沿柔性隔膜1701的轮廓流动并且流出内管1706区域。成型密封件1700密封刀1704的一部分与管1706之间的空间1702。成型密封件1700与超声刀1704具有两个接触点1708、1710,以最小化摩擦和干扰并且提供双重密封。腔1712由成型密封件1700限定,以用于收集外科物质1714。在另选的实施例中,可提供独立的导管1718来对成型密封件1700的柔性隔膜施加正压力,以将外科物质1714从腔1712排出。
在各种其他实施例中,可将防护罩阻隔件(或例如密封件)添加到超声器械的端部执行器部分以阻止外科物质积聚在端部执行器上。防护罩阻隔件将超声刀密封到超声刀部分的组织作用部分的近侧端部附近的一个或多个管的远侧端部。防护罩阻隔件可由包括柔顺、热稳定性材料的任何合适材料制成,所述材料具有相对较低的摩擦系数以最小化刀上的密封负荷。适用于防护罩阻隔件的材料可包括例如硅橡胶、聚对二甲苯涂覆的硅橡胶、四氟乙烯-六氟丙烯(FEP)(其特性类似于聚四氟乙烯(PTFE)在商品方面名为特氟隆的特性)、收缩管、或任何类似的材料。在另一个实施例中,刀可被涂覆,以降低因包括防护罩阻隔件而导致的器械的功率消耗。
防护罩阻隔件密封到刀并且可对刀提供轻微的干扰。在防护罩阻隔件密封到刀的情况下,防护罩阻隔件不对刀的夹持/弯曲提供竖直作用力,以便保持刀上的负荷(来自防护罩)降至最低。防护罩阻隔件可密封到管的外径、管的内径、或两者。一个或多个保持特征结构可设在刀和/或管上,以用于将防护罩保持到刀和/或管。在一个实施例中,保持特征结构还可位于防护罩阻隔件自身上。
一般来讲,防护罩阻隔件阻止外科物质(例如,组织、血液、熔化的脂肪、以及在外科手术期间遇到的其他相关材料)聚集并且积聚在管的远侧部分与超声外科手术装置的刀的附近部分之间。这种聚集和积聚可在系统上产生大量并且变化的机械负荷,从而导致因高阻抗而产生的操作中断,由此引起共振问题或者引起系统在启动期间停顿并且有可能停止。需要管以保护组织和使用者免受超声活动刀的伤害,并且就剪切型装置而言,需要管以支撑和/或驱动夹持臂。理想的是,超声刀尽可能地在其组织作用长度的近侧部分中为(超声)活动的。最大化这种超声活动的解决方案还可延长刀在其最远侧节点与其组织有效长度的近侧端部之间的部分。就上述问题而言,结果在于产生积聚组织、血液、脂肪等的相对较大的环形体积。
图19示出了包括医学钳的端部执行器组件1000的一个实施例,所述医学钳具有活动钳口构件1002和超声刀1004。钳口构件1002可沿方向1016运动。柔性防护罩阻隔件1006被定位在刀1004的近侧部分1008和管1010的远侧部分上,以将刀1004密封到管1010的外径1012。保持特征结构1014可设在管1010的外径1012上,以将防护罩阻隔件1006保持就位。如先前所述,防护罩阻隔件1006可由硅橡胶或其他类似的材料制成。在一个实施例中,防护罩阻隔件1006可涂覆有润滑材料,例如,聚对二甲苯,以减小摩擦。在另选的实施例中,刀1104可涂覆有类似的润滑材料,以减小摩擦。减小刀1004与防护罩阻隔件1006之间的摩擦降低因包括防护罩阻隔件1006产生的功率消耗。
图20示出了包括医学钳的端部执行器组件1100的一个实施例,所述医学钳具有活动钳口构件1102和超声刀1104。柔性密封件1106被定位在刀1104的近侧部分1108上和内管1112的远侧部分1110内,以将刀1104密封到内管1112的内径1114。内管1112能够在外管1116内可滑动地运动。
图21示出了用以隐藏超声刀1202的纵长部分的开槽内管1200的一个实施例。狭槽1204提供流体/组织出口,以排出可积聚在刀1202与内管1200之间的空间1206的外科物质。位于超声装置的远侧端部处的穿过狭槽1204的流体/组织出口阻止外科物质的积聚。在超声腹腔镜式剪中,例如,包覆模制的硅树脂远侧密封件1208设在刀1202的远侧节点上或附近。例如,防护罩阻隔件可为包覆模制、定位在夹持臂边缘远侧的仅远侧(这可阻止组织紧缩),并且可锚固到内管1200或者被定位在内管1200内且对使用者不可见,如图22所示。在这些装置中,在远侧密封件1208呈现之前,刀1202的大约13mm的长度被外管(未示出)和内管1200隐藏。诸如流体、血液、脂肪、或其他组织之类的外科物质可留在刀1202的外径与内管1200的内径之间的空间中。在包括类似剪的其他器械中,暴露刀的长度可增加,从而增加组织留在其中的几率。这可因流体/组织变成散热器而导致增加的切断时间,或者如果流体/组织因施加的刀加热而硬化可导致刀上的松弛压力。另外,如果将RF模态添加到超声搭接剪切技术,则在RF能量允许从刀流过内管内的组织而非沿刀的有效(暴露)长度流过所需能量路径的情况下,组织和流体可导致短路。因此,提供了防护罩或远侧组织进入阻止方法或机构,如在下文结合图21-23所述,其中诸如流体或组织之类的外科物质通过形成于内管1200中的狭槽1204、窗口、孔、或穿孔从内管1200与刀1202之间排出。
图22示出了用以隐藏超声刀1302的纵长部分的有穿孔的内管1300的一个实施例。内管1300穿孔有孔穴1304,以允许诸如流体/组织之类的外科物质逸出。穿孔1304提供流体/组织出口,以排出可积聚在刀1302与内管1300之间的空间1306中的外科物质。在例示的实施例中,内管1300包括180°半圆并且穿孔有孔穴1304,以允许流体/组织逸出。管1300位于活动刀1302与最远侧包覆模制件1310之间,所述最远侧包覆模制件1310位于距刀1302的远侧末端的距离1308处。
图23示出了用以隐藏超声刀1402的纵长部分1401的有流体引导肋和穿孔的内管1400。流体引导肋1404、穿孔1406提供流体出口,以排出可积聚在刀1402与内管1400之间的空间1410中的外科物质。最远侧包覆模制件位于距刀1402的远侧末端的距离1408处。在例示的实施例中,肋1404向内辐射并且包括位于每个肋之间的孔穴1406。肋1404相对于刀1402具有间隙。肋1404的间距使得仅流体可穿过,而具有可测量尺寸的固体不可穿过。通道构型提高了流体速度并且增加了离开孔穴1406的可能性。
图24为包括会聚管1502的有流体引导肋和穿孔的内管1500的一个实施例。在一个实施例中,会聚管1502流体地联接到孔1504,以提供流体出口以排出外科物质。
图25示出了成型密封件1600的一个实施例,所述成型密封件密封位于远侧密封件的远侧的超声刀1604的一部分与管1606之间的空间1602。成型的柔性密封件1600与超声刀1604具有两个接触点1608、1610,以最小化摩擦和干扰并且提供双重密封。腔1612由成型的柔性密封件1600限定,以用于收集外科物质1614。
图27示出了密封件1800的一个实施例,所述密封件密封位于远侧密封件的远侧的超声刀1804的一部分与管1806之间的空间1802。柔性密封件1800具有多个接触点1808,以在密封件1800与刀1804之间提供低干扰接触点。多个接触点1808降低了刀1804的轴上的流体芯吸。密封件1800的前缘部分1810和多个接触点1808阻止外科物质进入刀1804与管1806之间的空间1802。
图28示出了形成于超声刀1900的外表面1904上的蚀刻区域1902,所述蚀刻区域阻止因刀振动产生的流体/组织沿刀的进入。
图29示出了包括医学钳的端部执行器组件2000的一个实施例,所述医学钳具有活动钳口构件2002和局部缩回在密封件2006内的可滑动超声刀2004。活动钳口构件2002包括具有活动铰链的夹持垫2014,所述活动铰链由夹持垫2014与密封垫2006的接口处的颈缩区域2012形成。刀2004可沿方向2010滑动并被接收在密封件2006内。密封件2006联接到内管2008,以将刀2004密封到管2008并且阻止流体/组织朝近侧迁移。
图30示出了其中形成有机械加工窗口2102的内管2100的一个实施例。窗口2102允许内管2100与外管之间的引流。此实施例可例如为图21所示的实施例的替代形式。
图31示出了包括医学钳的端部执行器组件2200的一个实施例,所述医学钳具有活动钳口构件2202和超声刀2204。活动钳口构件2202包括延伸的夹持臂垫2206,所述延伸的夹持臂垫沿循活动钳口构件2202(例如,夹持臂)的轮廓进入围绕刀2204的空间中,从而与组织止动元件2208一起覆盖内管的开口。组织止动元件2208折返外科物质并且阻止其进入刀2204与内管2212之间的空间。组织止动元件2208适形于活动钳口构件2202,以覆盖内管2212的开口2210。在一个实施例中,夹持臂垫2206与组织止动元件2208机械加工在一起,以在刀2204与管2212之间提供最小的干扰。垫2206和/或组织止动元件2208可由诸如特氟隆之类的润滑材料制成,以最小化刀2204上的负荷。
图38示出了包括医学钳的端部执行器组件2900的一个实施例,所述医学钳具有活动钳口构件2902和超声刀2904。活动钳口构件2902包括夹持臂垫2908,所述夹持臂垫具有折返垫2906以折返外科物质。
图39为图38所示的夹持臂垫2908和折返垫2906的前视图。孔2910设在折返垫2906中,以接收穿过其中的超声刀2904。
图33示出了包括超声刀2404的端部执行器组件2400的一部分,所述端部执行器组件2400包括防护罩阻隔件2402的一个实施例以将超声刀2404密封到位于刀的远侧节点2410的远侧的管2406。在一个实施例中,防护罩阻隔件2402将刀2404密封到设置在外管2408内的内管2406。在图33所示的实施例中,防护罩阻隔件2402可由FEP形成,以覆盖刀2404的高应力区域。在例示的实施例中,外管2408端接在刀远侧节点2410处。
图34示出了包括医学钳的端部执行器组件2500的一个实施例,所述医学钳具有活动钳口构件2502和包括柔性密封件2506的超声刀2504,所述柔性密封件定位在活动钳口构件2502的边缘2508的远侧并且锚固到外管2510以阻止组织紧缩。内管2512被定位在外管2510内。刀2504被定位内管2512内。
图35示出了端部执行器组件2600的一个实施例,所述端部执行器组件包括被定位在内管2602内的密封件2606和被定位在内管2602内的超声刀2604,使得超声刀对于使用者不可见。密封件2602可为低摩擦材料以最小化刀2604上的负荷,或者可在密封件2606与刀2604之间设置小间隙2608以阻止与刀接触。密封件2606密封限定位于远侧密封件的远侧的刀2604与内管2602的内径之间的空间2610,以阻止外科物质积聚在其中。
图36示出了用于超声刀2702的密封机构2700的一个实施例,所述密封机构2700在刀远侧密封件2716的远侧具有渐缩内管2704部分,其中内管2704在远侧端部处颈缩2706成较小直径,由此限定用于外科物质的减小的进入空间2708。常规的外管2710设在渐缩的内管2704上。在颈缩区域2706近侧的内管部分2712的直径大于在颈缩区域2706远侧的内管部分2714的直径。在一个实施例中,颈缩区域2706与恰在最远侧包覆模制件2716的远侧的位置重合。在一个实施例中,内管2704对于位于最远侧密封件的远侧的部分可为颈缩的,从而提供用于流体和固体进入的较小开口空间。
图37示出了位于内管2802上的包覆模制的柔性密封件2800的一个实施例,所述包覆模制的柔性密封件2800在组装期间被超声刀2804刺穿。如图所示,当刀2804在装置组装期间沿方向2806朝远侧运动时,刀2804穿透包覆模制的柔性密封件2800,以密封刀2804和内管2802之间的空间2808。外管远侧连接叉2816中的夹持臂枢转孔穴2814使得活动钳口构件能够打开和闭合。外管远侧连接叉2816位于外管的远侧端部上。在一个实施例中,连接叉2816可焊接在外管的远侧端部上。
图40示出了用于超声刀3002的密封系统3000的一个实施例。柔性密封件3004密封位于远侧密封件部分3008的远侧的超声刀3002。在一个实施例中,柔性密封件3004将刀3002密封到内管3006的内径。
图41示出了成型内管3100或附接到内管3100从而为流体提供迂曲路径3104的部件的一个实施例。内管3100的区域包括一对局部凹陷的凹槽3106、3108,所述凹槽可用于定位O形环,所述O形环将接触刀或提供迂曲路径,以在使用期间阻止流体进入。
图42示出了具有柔顺臂的模制部件3110的一个实施例,所述模制部件用于阻挡管组件的远侧开口并且经由围绕刀中的销旋转的臂附接在节点位置处。
图43示出了附着到内管的内部的包覆模制的硅树脂缓冲垫3112的一个实施例。缓冲垫3112阻止流体进入并且未实际上接触刀,因此刀负荷在使用期间未增加。
图44-47示出了可如何将一对芯轴3120A、3120B从两端插入内管3122中的一个实施例。芯轴3120A、3120B组合以形成包覆模制通道,硅树脂(或等同形式)缓冲垫3124材料将注入所述包覆模制通道中。然后将去除芯轴,从而仅保留缓冲垫3124。
图48示出了包括包覆模制的缓冲垫3124的密封系统3200的端视图,所述包覆模制的缓冲垫附连到内管3202并且未密封到超声刀3204。在例示的实施例中,密封件系统3200为图47所示的管组件的端视图,其中注塑的缓冲垫3124保持就位。
图50示出了内管3600的一个实施例,所述内管具有附接到其的与超声刀具有最小干扰的硅树脂密封件3602。
图51示出了用于将超声刀3704密封到管3706的密封系统3700的一个实施例。在例示的实施例中,密封系统3700包括漏斗3702,以阻止外科物质进入位于远侧节点的远侧的刀3704与内管3706之间的空间3708。漏斗3702朝远侧折返外科物质。
图52示出了位于内管3800上的柔性密封件3802的一个实施例,所述柔性密封件在组装期间被超声刀刺穿并且在位置3804处扩张。
图53示出了包覆模制的柔性密封件3900的一个实施例,所述包覆模制的柔性密封件在远侧节点的远侧附接到超声刀3902。
图54示出了包覆模制的柔性密封件4000的一个实施例,所述包覆模制的柔性密封件在远侧节点的远侧附接到超声刀。在一个实施例中,包覆模制的柔性密封件4000由FEP材料制成。
图55示出了密封系统4100的一个实施例,所述密封系统包括用以在远侧节点的远侧密封超声刀4108的多个环形密封件4102、4104、4106。环形密封件4102、4104、4106由不妨碍刀4108的小型包覆模制特征结构4110悬吊。
图56示出了包括医学钳的端部执行器组件4200的一个实施例,所述医学钳具有处于打开位置的活动钳口构件4202、超声刀4204、和包括擦拭密封件4208的能够可滑动运动的内管4206。如图56所示,当钳口构件4212沿方向4212打开时,能够可滑动运动的内管4206沿方向4210朝远侧运动。擦拭密封件4208围绕刀4204。当钳口构件4202沿方向4212打开时,擦拭密封件4208与内管4206一起沿方向4210朝远侧运动,以从刀4204擦掉外科物质。
图57示出了图56所示的包括医学钳的端部执行器组件4200的一个实施例,所述医学钳具有处于闭合位置的活动钳口构件4202。如图57所示,当钳口构件4202沿方向4216闭合时,内管4206沿方向4214朝近侧运动,以回缩擦拭密封件4208。为了利用擦拭密封件4208擦拭刀4204,则打开钳口构件4202,如结合图56所述。
图58示出了包括医学钳的端部执行器组件4300的一个实施例,所述医学钳具有以实线示出的处于闭合位置和以虚线示出的处于打开位置的活动钳口构件4302、超声刀4304、能够可滑动运动的外管4306、和具有包覆模制的柔性密封件4310的固定内管4308,所述包覆模制的柔性密封件位于刀4304上方的内管4308上。
图59示出了端部执行器组件4300的一个实施例,所述端部执行器组件包括处于打开位置的活动钳口构件4302。如图59所示,当钳口构件4202打开时,包覆模制的柔性密封件4310密封该装置的喉部4312,以阻止外科物质进入刀4304和内管4308之间的空间4314。
用于超声装置的另选的闭合机构
现有的超声装置使用管中管(TnT)闭合机构,以使得夹持臂(本文称为活动钳口构件)能够相对于超声刀的有效长度闭合。用于超声装置的另选的闭合机构的以下实施例可产生若干优点。例如,相对于外管致动内管的曳力之间可存在的差异,从而导致装置夹持力的变化。另外,外管上的夹持臂的枢转位置引起明显的角度闭合,并且放大对非均匀闭合分布的冲击。此外,谓词装置机构可对部件中的变化敏感,因为层叠结构在绝缘销的位置处联接内管和外管,所述绝缘销当前位于管组件的近侧端部附近。
包括另选的闭合机构的超声装置的一个实施例在下文中结合图60-62进行描述。在一个实施例中,超声装置包括在远侧节点处具有通孔的振荡刀、致动器机构、在远侧端部处具有凸轮表面的外管、和夹持臂。在另一个实施例中,夹持臂可旋转地固定到振荡刀。在另一个实施例中,夹持臂通过外管与振荡刀之间的相对运动而凸轮打开和凸轮闭合(相对于振荡刀)。在另一个实施例中,夹持臂的一个或多个枢轴被定位在振荡刀的远侧节点处。例示性性实例在下文中进行讨论。
图60为包括医学钳的端部执行器组件4400的一个实施例的透视图,所述医学钳具有活动钳口构件4402和超声刀4404,其中活动钳口构件可旋转地附接到远侧节点4406。外管4412以透明形式示出,以示出位于其中的超声波导4414。图61为图60所示的端部执行器组件4400的一个实施例的侧视图,所述端部执行器组件4400具有处于打开位置并且以透明形式示出的活动钳口构件4402,从而示出在刀4404与外管4412之间相对运动时使活动钳口构件4402旋转的外管凸轮狭槽4408、4410。图62示出了端部执行器组件4400的一个实施例,其中示出了活动钳口构件4402的枢轴4416。
现在参考图60-62,在一个实施例中,活动钳口构件4402(例如,夹持臂)直接可旋转地锚固到刀4404。通过除去内管并且将活动钳口构件4402附接在刀4404的最远侧节点4406处来实现锚固,以便不妨碍装置的声学链。可通过使用通孔和附接到活动钳口构件4402的绝缘销4416来形成附接,但可使用和设想其他附接装置,例如,销、螺杆、扣合接合件、包覆模制件等。另外,外管4412包括凸轮表面,所述凸轮表面定位附接到活动钳口构件4402的第二销4418,使得当在刀4404与外管4412之间存在相对运动时,活动钳口构件4402围绕位于刀4404中的销4416处的枢轴旋转。此外,可设想到用于凸轮表面的另外的几何形状,例如,弯曲、曲线等。如图62的实施例所示,销4416处的枢转位置被定位在比当前装置更近侧的位置中。将活动钳口构件4402在远侧节点4406处锚固到刀4404的有益效果允许沿刀4404的活动部分4420的更平行闭合,从而最终产生较均匀的压力分布。在一个实施例中,结合图60-62所述的构型在较低温度下操作,并且可无需活动钳口构件4402内的聚酰亚胺夹持臂垫。尽管在图62的实施例中未示出,但外管4412可沿刀的轴线纵向延伸,以阻止组织接触非活动刀4404表面。
包括另选的闭合机构的超声装置的另一个实施例在下文中结合图63-67进行描述。当前的闭合机构经受由内管相对于外管和内管相对于刀包覆模制件的相对运动产生的摩擦损耗。这些摩擦损耗可归因于由使用者经受的减小的组织反馈。此外,与管中管相关的夹持力和压力分布可对部件变化敏感。较一致的密封和切断能力可通过较苛刻的公差或减少与闭合相关的部件的数量来实现。为了解决这些问题和其他问题,在一个实施例中,超声装置包括具有穿过远侧节点的孔穴的振荡刀、外管、夹持臂、和刚性联接件。在另一个实施例中,夹持臂利用刚性联接件和转动接头系统联接到振荡刀。例示性的实例在下文中进行讨论。
图63为包括医学钳的端部执行器组件4500的一个实施例的侧视图,所述医学钳具有处于闭合位置的活动钳口构件4502和超声刀4504。端部执行器组件4500包括连杆4506以利用外管4508与刀4504之间的相对运动来打开和闭合活动钳口构件4502。图64为具有处于打开位置的活动钳口构件4502的图63所示的端部执行器组件4500的侧视图。图65为具有处于打开位置的活动钳口构件4502的图63所示的端部执行器组件4500的底视图。图66为具有处于打开位置的活动钳口构件4502的图63所示的端部执行器组件4500的透视图。图67为具有处于打开位置的活动钳口构件4502的图63所示的端部执行器组件4500的透视图。
现在参考图63-67,在一个实施例中,连杆4506可为四杆连杆,所述四杆连杆能够通过利用外管4508与刀4504之间的相对运动来致动活动钳口构件4502(例如,夹持臂)。内管可由刚性联接件4506替换。联接件4506可通过远侧节点4510销接到刀4504,但可设想到其他紧固装置,诸如,销、螺杆、扣合接合件等。将销4512定位在远侧节点4510处最小化对超声装置的声学链的干扰。联接件4506随后经由销4516销接到活动钳口构件4502的底部部分4514,并且活动钳口构件4502的第二枢轴经由销4518销接到外管4508的端部。可通过相对于刀4504沿方向4520向前移动外管4508来实现夹持。联接件4506部件确保远侧节点4510与夹持臂的下部枢轴之间的距离保持恒定。当外管4508沿方向4520移动时,联接件4506的存在促使活动钳口构件4502旋转。在一个实施例中,刚性联接件4506可包括由级进冲压形成的小型不锈钢部件,但可设想到其他材料和制造工艺,诸如,金属注塑成型(MIM)、由塑料注塑成型形成的聚合物等。刚性联接件4506的使用还允许触发器组件的简化。例如,可去除用于致动内管的触发器组件。四杆连杆4506的使用还降低了管组件中的摩擦损耗并且导致积聚的压力分布变化减小。
包括另选的闭合机构的超声装置的另一个实施例在下文中结合图68-70进行描述。图68-70所示的实施例解决了以下问题,诸如在现有超声装置的刀、活动钳口构件、内管、绝缘销、和旋钮之间的公差积聚。
图68为包括医学钳的端部执行器组件4600的一个实施例的透视图,所述医学钳具有活动钳口构件4602和超声刀4604,其中活动钳口构件4602被示为处于打开位置。内管4608相对于刀4604进行平移,以打开和闭合活动钳口构件4602。图69为外管4606被去除的内管4608的透视图。内管4608操作地联接到图68所示的端部执行器组件4600。图70为图69所示的内管4608的凹口部分4610的透视图。
现在参考图68-70,在一个实施例中,内管4608能够相对于刀4604平移以移动活动钳口构件4602(例如,夹持臂)并且抵靠刀4604产生夹持压力。在图68-70所示的实施例中,活动钳口构件4602附接在内管4608上的枢轴4612处并且在此处枢转。外管4606沿方向4614平移,以枢转活动钳口构件4602。内管4608具有如图69和图70所示的凹槽区域4610,所述凹槽区域向内挤压到形成于刀4604中并且将位于刀4604的节点位置处的凹口4616、4618中。在一个实施例中,凹槽区域4610位置中的刀4604部分可涂覆有硅树脂包覆模制的薄层,以在内管4608与刀4604之间提供紧密关系。此类密封关系相对于刀4604切割表面4620(图68)提供良好的活动钳口构件4602同步性。如图68所示,在一个实施例中,夹持臂垫4622还可设在活动钳口构件4602的内部部分上。
图71示出了包括医学钳的端部执行器组件4700的一个实施例,所述医学钳具有端部执行器,所述端部执行器具有处于闭合位置的活动钳口构件4702、超声刀4704、和能够抵消刀4704的偏转的轴组件4706。反向偏转元件4720在刀节点4718的位于远侧节点近侧的一个刀节点处设在内管4710上,以抵消活动钳口构件4702对刀4704的偏转。在一个实施例中,活动钳口构件4702对刀4704的朝下偏转4712通过反向偏转元件4720在远侧节点近侧的节点4714处的向下作用力来抵消。在一个实施例中,反向偏转元件4720可包括内管腔中的凸出部分,以提供针对夹持力的朝下反向力。在另一个实施例中,窗口4708可被切割到内管4710中,以允许朝下的力偏转刀4704而不接触内管4710的相对壁。
本文所公开的内管和/或外管中的任一者可涂覆有用作水分和介电阻挡的聚合物。在它们之中,可选择聚对二甲苯C,因为其集阻挡特性、成本、以及其他处理优点于一身。聚对二甲苯为例如多种化学气相沉积的聚(对苯二甲基)的商品名。聚合物涂层用于阻止轴中从刀到相邻的金属部件的短接。在一个实施例中,仅内管(例如,致动器)可被涂覆,以阻止其与刀短接,所述刀为组合式超声和双极(RF)装置中的一个“极”,其中其他“极”为外管和夹持臂。内管绝缘提供了比居间塑料管更稳健的和空间高效的电绝缘屏障,所述居间塑料管可被视为另选的实施例。
利用单个部件的换能器支撑和受限旋转
在一个实施例中,轴旋转限制器包括通过螺纹连接件与换能器凸缘交接的单个部件。旋转限制器通过固定在护罩通道中的部件来提供径向支撑。旋转量由部件在护罩通道中的允许的横向运动来限制,因为其沿换能器具有螺纹。轴旋转限制器的一个实例在下文中结合图72进行描述。
图72示出了具有改进凸缘4802的超声换能器4800的一个实施例,所述改进凸缘包括外螺纹4804以允许换能器旋转。在例示的实施例中,换能器凸缘4802被修改以包括外螺纹4804。外螺纹4804可与部件4810相配合,所述部件具有内螺纹和至少两个突起的凸出部4806、4808。突起的凸出部4806、4808接合到装置护罩中的通道中并且限制换能器旋转。具有螺纹内径的部件4810通过螺纹连接与换能器4800交接。由于部件4810在横向行进方面受到护罩通道的限制,因此其提供径向支撑。具有螺纹内径的部件4810将换能器4800的旋转运动转换成部件4810的侧向运动。刀或换能器4800的旋转可由固定的旋钮来提供。旋转旋钮可致使内螺纹部件4810侧向平移,并且当部件4810不能再平移时旋转将受到限制。侧向运动可由护罩中的通道的长度或换能器上的螺纹凸缘4802的长度来限定。护罩允许旋转超过360°。换能器4800的旋转量由部件4810在护罩通道(未示出)中的允许侧向运动来限制。
旋转>360°的超声装置的受限旋转
图73为超声换能器旋转系统4900的剖面图,所述超声换能器旋转系统包括护罩4902和适配到护罩4902的半部中的门4904。在例示的实施例中,门4904为L形并且具有从中心轴线4908以固定角度延伸的两个翼4906A,4906B(分别为右翼和左翼),所述中心轴线被定位在护罩4902的一部分内。一个附加部件、以及旋钮和右侧或左侧护罩4902的修改允许大约690°的旋转--几乎两整周。操作者使用旋钮来旋转装置的轴和超声换能器。附加部件在本文称为门4904。门4904可围绕轴线4908在护罩4902内旋转地运动到两个位置。旋钮将具有延伸以接触门4904的附加成型挤出元件。在门4904插入护罩4902中的情况下,护罩4902与门4904之间将存在最小量的摩擦接触,以在门4904不与旋钮接触时将门保持就位。护罩4902中的门4904受限于圆柱形孔穴4912和具有轻微底切口的两个凸出部4914、4916。位于圆柱形孔穴4912中的门4904的轴线4908将部分地受限于旋钮上的特征结构。门4904可由刚性金属或者单次冲压金属部件制成,或者可由塑料注塑而成。门4904可卡合到护罩4902中的适当位置处,或者可超声焊接或热铆接到护罩4902,由此允许门4904围绕轴线4908的自由旋转。
图74A-74C示出了门/旋钮交互的动力学。图74A示出了门4904,其处于左偏置位置使得旋钮可顺时针旋转690°,直到旋钮上的成型挤出元件4910与门4904的右翼4906A接触,使得门4904的左翼4906B通过相对于护罩4902的静止反应而阻止运动。因此,在起始点处,旋钮成型挤出元件4910接触门4904的右翼4906A的外部,并且受到限制以仅沿逆时针方向运动。
图74B示出了旋钮,所述旋钮反向旋转360°直至其将门4904的右翼4906A旋转到右偏置位置。在完全360°旋转时,旋钮挤出件4910接触门4904的右翼4906A的内部,从而使门4904在旋钮旋转时向右旋转。
图74C示出了旋钮将门4904的右翼4906A旋转到右偏置位置之后的旋钮。随后,旋钮可旋转另外的330°,直到旋钮的成型挤出元件4910接触门4904的左翼4906B并且门4904的右翼4906A通过相对于护罩4902的静止反应而阻止运动。在690°的旋转之后,旋钮接触门4904的左翼4906B的外部。门4904的右翼4906A接触护罩4902,并且因此停止旋钮沿逆时针方向的进一步旋转。此过程可反向,以使旋钮可顺时针自旋回到其起始位置。
图75为超声换能器旋转系统4920的剖面图,所述超声换能器旋转系统包括护罩4922和适配到护罩4922的半部中的门4924,其中旋转系统包括半柔顺元件。在例示的实施例中,门4924为L形并且具有从中心轴线4928以固定角度延伸的两个翼4926A、4926B(分别为右翼和左翼),所述中心轴线被定位在护罩4922的一部分内。一个附加部件、以及旋钮和右侧或左侧护罩4922的修改允许大约690°的旋转--几乎两整周。操作者使用旋钮来旋转装置轴和超声换能器。附加部件在本文称为门4924。门4924可围绕轴线4928在护罩4922内旋转地运动到两个位置。旋钮将具有延伸以接触门4924的附加成型挤出元件。在门4924插入护罩4922中的情况下,护罩4922与门4924之间将存在最小量的摩擦接触,以在门4924不与旋钮接触时将门保持就位。护罩4922中的门4924受限于圆柱形孔穴4932和具有轻微底切口的两个凸出部4934、4936。位于圆柱形孔穴4932中的门4924的轴线4928将部分地受限于旋钮上的特征结构。门4924可由刚性金属制成,或者可由塑料注塑而成。门4924可卡合到护罩4922中的适当位置处,或者可超声焊接或热铆接到护罩4922,由此允许门4924围绕轴线4928的自由旋转。
具有一体化换能器的超声剪装置的无限制(连续)旋转需要使用低性价比的附加部件。一个高性价比解决方案为限制该装置的轴的旋转,由此允许换能器与手动启动电路之间的直接有线连接。将触觉有益效果添加到该机构,所述机构在碰到硬障碍物之前将限制旋转并且提供触觉反馈。此触觉反馈元件可使得使用者能够通过以下方式来改变他们使用该装置的方式:通过旋转他们的手腕来获得另外的旋转或者通过选择将该装置旋转返回到中间位置以确保他们具有足够的旋转来完成他们需要执行的任务。
图112A和112B示出了用于一体化换能器6216的无限制旋转连接件的一个实施例。无限制旋转连接件可由超声换能器旋转系统6220提供。超声换能器旋转系统6220可包括例如凸型插头6222和凹型插座6224。凸型插头6222能够在凹型插座6224内自由地旋转,同时能够保持超声换能器6216与例如电力系统6248之间的电连接。例如,在一个实施例中,凸型插头6222和凹型插座6224可包括立体插头和插座。图112A示出了处于未联接或未配合位置的凸型插头6222和凹型插座6224。图112B示出了处于联接或配合位置的凸型插头6222和凹型插座6224。在配合位置,凸型插头6222能够在凹型插座内自由地旋转同时能够保持凸型插头6222与凹型插座6224之间的电连接。
图113A-113C示出了无限制旋转连接件6520的一个实施例。无限制旋转连接件6520包括凸型插头6522和凹型插座6524。凸型插头6522可包括联接到绝缘管6528的多个电极6526a-d。凸型插头6522可联接到轴/换能器组件,并且可与轴/换能器组件一致地旋转。在一些实施例中,第一和第二电极6526a-6526b可联接到换能器。在一些实施例中,第三和第四电极6526c-6526d可联接到位于端部执行器处的双极电极。在一些实施例中,例如单极电极布置方式,可省去第四电极6526d。多个电极6526可各自联接到线6530a-6530d。凹型插座6524可包括多个螺旋状触点6532a-6532d。多个螺旋状触点6532a-6532d可被定位成使得当凸型插头6522插入凹型插座6524中时螺旋状触点6532a-6532d中的每一个电联接到凸型插头6522上的对应电极6526a-6526d。图113B示出了沿线B-B截取的凹型插座6524的剖视图。凹型插座6524包括由绝缘体6534a-6534c隔开的单个螺旋状触点6532a-6532d。图113C示出了螺旋状触点6532a的单个螺旋状触点轮廓。螺旋状触点6532a可包括第一金属板6536a和第二金属板6536b。多根双扭线6538可进行螺旋状扭曲,以确保凸型插头6522与金属板6536a、6536b之间的接触。在一些实施例中,螺旋方向可进行交替,以在所有旋转方向提供增强的连接性。双扭线6538可包括双曲线形状。
将触觉反馈元件添加到图73-74所示的限制旋转机构,所述限制旋转机构包括位于旋钮上的附加成型挤出元件4930,所述成型挤出元件延伸以接触门4924(限制旋转的机构)。在图75-76所示的实施例中,位于旋钮上的成型挤出元件4930(图76A-76C)可由半柔顺材料制成。另选地,由元件4938指示的成型挤出元件4930的部分可由半柔顺材料构成。半柔顺材料可由橡胶、中至高密度橡胶、硅树脂、热塑性弹性体、不锈钢弹性件、弹簧钢、铜、形状记忆金属等等制成。这些材料中的任一种可嵌入注塑到或机械连接到旋钮。
旋钮上的成型挤出元件4930(图76A-76C)的目的在于接触门4924,以提供门4924起作用所需要的运动。将柔顺性添加到成型挤出元件4930旋钮特征结构使得使用者能够在硬障碍物被接触之前的几个旋转度时感觉到他们正接近硬障碍物。此反馈可使得使用者能够通过以下方式来改变他们使用该装置的方式:通过旋转他们的手腕来获得另外的旋转或者通过选择将该装置旋转返回到中间位置以确保他们具有足够的旋转来完成他们需要执行的任务。
图76A-76C示出了门与旋钮交互的动力学,其中旋钮包括触觉反馈元件。图76A示出了门4924,其处于左偏置位置使得旋钮可顺时针旋转690°,直到旋钮上的成型挤出元件4930与门4924的右翼4906A接触,使得门4924的左翼4926B通过相对于护罩4922的静止反应而阻止运动。因此,在起始点处,旋钮成型挤出元件4930接触门4924的右翼4926A的外部,并且受到限制以仅沿逆时针方向运动。(嵌入注塑的)半柔顺材料4938的层可位于成型挤出元件4930的任一侧或两侧上。半柔顺材料4938可由橡胶、中至高密度橡胶、硅树脂、热塑性弹性体、不锈钢弹性件、弹簧钢、铜、形状记忆金属等等制成。这些半柔顺材料4938中的任一种可嵌入注塑或机械连接到旋钮。
图76B示出了旋钮,所述旋钮反向旋转360°直至其将门4924的右翼4926A碰撞到右偏置位置。在完全360°旋转时,旋钮的成型挤出元件4930接触门4924的右翼4926A的内部,从而使得门4924在旋钮旋转时向右旋转。半柔顺材料4938为使用者提供触觉反馈。
图76C示出了旋钮将门4924的右翼4926A旋转到右偏置位置之后的旋钮。随后,旋钮可旋转另外的330°,直到旋钮的成型挤出元件4930接触门4924的左翼4926B并且门4924的右翼4926A通过相对于护罩4922的静止反应而阻止运动。在690°的旋转之后,旋钮接触门4924的左翼4926B的外部。门4924的右翼4926A接触护罩4922,并且因此停止旋钮沿逆时针方向的进一步旋转。此过程可反向,以使旋钮可顺时针自旋回到其起始位置。半柔顺材料4938为使用者提供触觉反馈。半柔顺材料4938触觉反馈元件垫使得使用者能够通过以下方式来改变他们使用该装置的方式:通过旋转他们的手腕来获得另外的旋转或者通过选择将该装置旋转返回到中间位置以确保他们具有足够的旋转来完成他们需要执行的任务。
利用一体化超声/RF发生器的RF点凝
图77示出了一体化RF/超声器械5000,所述一体化RF/超声器械电连接使得超声刀/焊头5002电连接到超声发生器5004的正极引线5006并且还联接到RF发生器以通过对组织5018施加RF能来提供点凝。一体化RF/超声器械5000能够在不需要超声联接压力的情况下改善弥漫性出血(毛细血管出血、切口部位渗出)。另外,超声器械将刀联接到组织使得基于摩擦的组织效果有效所需的联接压力相对较高,这导致(1)施加足够的压力以在松散支撑的(即,未夹持的)组织中产生止血效果的难度,或者(2)产生过多组织破裂从而在多种情况下使弥漫性出血更严重的联接压力。
在一个实施例中,一体化RF/超声器械5000被接线,使得焊头/刀5002直接连接到发生器5004的正极引线5006。常规超声装置被接线,使得负极/返回引线连接到焊头/刀。开关5010被提供以使两种装置功能性(1)超声和(2)双极(RF)能够被执行。开关5010的第一状态将负极/返回引线5008连接到压电换能器(PZT)堆栈5020,使得发生器5004驱动PZT堆栈5020。开关5010的第二状态隔离PZT堆栈5020并且将负极/回路5008通过电导体5014连接到装置管5016和活动钳口构件5022(例如,夹持臂),并且允许发生器5004信号被驱动穿过位于刀5002与夹持臂5022之间的组织5018。组织5018中的阻抗密封血管。反馈信号还被反向提供给发生器5004,以调节信号参数(例如,振幅、频率、脉冲、调制等)。
在一个实施例中,一体化RF/超声器械5000可包括密封按钮,其中当按压时,发生器5004可产生通过手持件进入超声刀5002中并且返回穿过夹持臂5022的双极RF能量。在一个实施例中,RF电流可围绕刀5002的外部行进并且产生稳固的双极密封。双极RF能量的持续时间可为约一秒,之后算法可导致发生器5004切换到超声功率曲线,其中刀5002将被启动并且切割将在两个RF密封的中间完成。
超声切割也可提供一些密封。RF能量的施加提供了附加的可靠性,使得刀5002的每一侧上均存在处于适当位置的RF密封。
在一个实施例中,RF/超声装置包括远侧端部涂覆有热绝缘和电绝缘材料的刀或夹持臂或者这两者,其中刀或夹持臂或者这两者的远侧端部可具有将取决于应用的不同程度的暴露(未涂覆)区域。在另一个实施例中,刀或夹持臂或者这两者上的暴露区域可根据应用而变化并且可为对称的或非对称的。在另一个实施例中,刀上的暴露区域可包括由至少一个涂覆区段隔开的至少一个暴露区域/区段。在一个实施例中,提供了对刀或夹持臂或者这两者进行掩膜以产生暴露区域的工艺。另选地,涂层可被选择性地去除,以产生同样的所需效果。此类涂覆刀的具体实施例在下文中结合图80-95进行描述。
图78示出了一体化RF/超声器械5030的一个实施例,所述一体化RF/超声器械电连接到能量源,诸如包括与可滑动凹形配合插头5048配合的四引线插孔连接器5046的发生器5032。图79为与联接到超声换能器5034的可滑动凹形配合插头5048相配合的四引线插孔连接器5046的细部图。参考图78-79,在一个实施例中,发生器5032可包括独立的或整合到同一外壳中的第一超声能量源(例如,超声发生器5040)和第二RF能量源(例如,RF发生器5044)。超声换能器5034电连接到超声发生器5040的正极引线5036(H+)和负极引线5038(H-)。单极正极引线5042(M+)联接到RF发生器5044。四引线插孔连接器5046与可滑动凹形配合插头5048相配合,以电接合从而将1)超声发生器5040引线5036、5038连接到超声换能器5034或者2)将单极RF发生器5044引线5042连接到换能器5034,由此阻止超声发生器5040和单极RF发生器5044同时连接到换能器5034。在一个实施例中,凹型连接器可整合到装置中并且四引线插孔可配合到发生器。
可滑动开关5074包括能够接收可旋转插孔连接器5046的可滑动凹型连接器5048。可旋转插孔连接器5046用于与可滑动凹型连接器5048相配合,以用于提供诸如换能器5034和发生器5032的两个电气装置之间的电连接。具体地参见图79,可旋转插孔连接器5046包括位于其前端处的末端端子部分5064、位于其后端处的接地端子部分5052、以及末端与接地端子部分5064、5052之间的两个中间端子部分5056、5060。端子部分5052、5056、5060、5064彼此由电绝缘体5054电分离。接地端子部分5052与连接部分5046连接。由于可旋转配合插头5046的结构为本领域的技术人员所熟知,因此其详细描述在此处省略。导电性端子部分1、2、3、4电连接到端子部分5052、5056、5060、5064。导电性端子部分1和2连接到端子部分5052、5056且隔离,并且不联接到换能器5034。导电性端子部分3和4电连接到端子部分5060、5064,并且电连接到换能器5034。
在一个实施例中,可滑动凹型连接器5048可在位置1与位置2之间滑动。位置1能够对应于超声操作模式,并且位置2能够对应于单极操作模式。在位置1中,来自单极RF发生器5044的单极RF引线5042(M+)与换能器5034物理断开。可滑动凹型连接器5048包括能够电接合端子部分5052、5056、5060、5064的接触部分5066、5068、5070、5072。可滑动凹型连接器5048包括使得使用者能够在多个位置之间滑动可滑动凹型连接器5048的致动器部分5074。如图79具体所示,可滑动凹型连接器5048可在位置1与位置2(超声模式与单极RF模式)之间滑动运动。
将可滑动凹型连接器5048运动到位置1中使得一体化RF/超声器械5030处于超声模式。在此位置,接触部分5066、5068与端子部分5060、5064电气接合,从而使得超声发生器5040的正极引线和负极引线5036(H+)、5038(H-)通过导电性端子部分3和4电连接到换能器5034。在位置1处,联接到RF发生器5044的单极正极引线5042(M+)与换能器5034物理断开。
将可滑动凹型连接器5048运动到位置2使得一体化RF/超声器械5030处于单极RF模式。在此位置,接触部分5066、5068与端子部分5052、5056电接合,从而使超声发生器5040的正极引线和负极引线5036(H+)、5038(H-)电气联接到隔离的导电性端子部分1和2,由此使超声发生器5040从换能器5034有效地断开。在位置2中,接触部分5070电接合端子部分5060,从而使RF发生器5044的单极正极引线5042(M+)通过导电性端子部分3电联接到换能器5034。接触部分5072电接合电隔离的或开放的末端端子部分5064。
图114A和图114B示出了一体化RF/超声外科器械的一个实施例,例如,包括一体化RF/超声端部执行器6304的一体化RF/超声外科器械5030。一体化RF/超声端部执行器6304能够将RF能量和/或超声能量递送到组织节段。图114A示出了处于打开位置的夹持臂6364。超声刀6366被定位成使得夹持臂6364和超声刀6366将组织夹持两者间的组织。超声刀6366被定位在隔热罩6322内。图114B示出了处于夹持位置的一体化RF/超声端部执行器6304。
图115A-115I示出了沿线A-A截取的一体化RF/超声端部执行器6304的横截面的各种实施例。如在图115A-115I可见,RF电极6370、6372可位于一体化RF/超声端部执行器6304的任何合适的部分上和/或可包括一体化RF/超声端部执行器6304的任何合适的部分。图115A-115F示出了包括双极电极布置方式的一体化RF/超声端部执行器6304的各种实施例。例如,图115A示出了一体化RF/超声端部执行器6304a的一个实施例。正电极6370a、6372b可位于夹持垫6368的面向组织的部分。夹持臂6364a可包括返回电极或负电极。图115B示出了一体化RF/超声端部执行器6304b的一个实施例。正电极6370b、6372b位于隔热罩6322上。绝缘体6374可位于正电极6370a、6370b与隔热罩6322之间,以与隔热罩6322绝缘。夹持臂6364可用作返回电极。图115C类似于图115A,不同的是夹持臂6364c侧向延伸超过绝缘夹持垫6368c。图115D类似于图115B,不同的是夹持臂6364d侧向延伸超过绝缘夹持垫6368d。在图115E中,夹持垫6368e包括正电极6370e和负电极6372e。在图115F中,隔热罩6322f包括正电极6370f和负电极6372f。
图115G-115I示出了包括单极电极的一体化RF/超声端部执行器6304的各种实施例。在图115G中,超声刀6366g包括用于将RF能量递送到组织节段的单极电极。在图115H中,夹持臂6364h包括单极电极。在图115I中,隔热罩6322i包括单极电极。
图117-118示出了一体化RF/超声外科器械6602的一个实施例。一体化RF/超声器械6602可包括绝缘轴6614。轴6614以及包括钳口6664和超声刀6666的端部执行器6604可利用单极RF能量来供能。单极RF能量可由位于例如一体化RF/超声器械6602的柄部6612上的双极双掷(DPDT)选择器开关6620来控制。DPDT选择器开关6628可将一体化RF/超声器械6602从超声发生器6620切换到单极RF发生器6622。图118示出了DPDT选择器开关6628的一个实施例,所述DPDT选择器开关能够在超声发生器6620与单极RF发生器6622之间切换。DPDT选择器开关6628可包括用户切换键6630。
涂覆的超声/RF刀
图80-83示出了超声刀5100的各种视图,所述超声刀涂覆有电绝缘材料5102,以在组织接触区域处提供热绝缘,从而最小化组织对刀5100的粘附性。常规的超声装置采用一种处理模式,这限制了灵活性。例如,常规的超声装置可用于血管密封和切断组织。双极RF可提供附加的有益效果,诸如用于对组织进行点凝和预处理的方法。超声与RF的结合可提供灵活性并且增加有效性。然而,常规的超声装置使用涂层,以在刀的远侧端部处提供绝缘。这些涂层为电绝缘的,并且因此限制电流,从而降低RF有效性。另外,电流密度可影响有效性。可设想到,刀的整个波导可涂覆有此类涂层,以阻止刀短接到管组件返回路径。还可设想到,类似的涂覆和掩膜工序可用于夹持臂中,以便提供用于电流的合适路径。为了将两种能量模式结合到一个装置中,可需要用于刀末端涂覆或涂覆去除过程的掩膜工艺。在刀的表面上产生暴露区域可为电流提供合适的路径。
因此,在一个实施例中,超声刀5100包括具有类似于位于如图80-83所示的刀5100的远侧端部上的特氟龙的特性的润滑涂层5102。使用RF作为处理模式需要电流从刀5100通过组织流到通常称为夹持臂的活动钳口构件。涂层5102用于在接触区域处提供热绝缘,并且最小化组织对刀5100的粘附性。然而,涂层5102还为电绝缘的,这限制了电流的量。对刀5100掩膜或选择性地去除涂层的方法可用于产生暴露表面。例如,在其他实施例中,设在刀5100上的润滑涂层5102可朝近侧延伸,以便可涂覆整个刀5100。在一个实施例中,刀5100可反向涂覆到远侧节点。
图84-93示出了各种超声刀,所述超声刀局部涂覆有电绝缘材料,以在组织接触区域处提供热绝缘和电绝缘,从而最小化组织对刀的粘附性,其中刀的较浅着色区域5202表示涂覆部分,并且刀的较深着色区域5204表示暴露表面,所述暴露表面使得RF电流能够从刀的暴露区域穿过组织流到活动钳口构件。暴露表面为对称的。刀上需要暴露表面的区域可取决于应用。因此,涂层/暴露区域的不同百分比已在图84-93中示出。然而,实施例不限于仅示出的覆盖范围。尽管结合图84-93所示的实施例示出了电绝缘刀涂层(较浅着色区域5202)的高度变化,但可以设想到,电绝缘刀涂层(较浅着色区域5202)的长度变化在本公开的范围内,使得刀的远侧末端的一部分为暴露的。在一个实例中,刀的侧面的远侧的1/3将为暴露的。
图94-95示出了具有非对称暴露表面的两个超声刀,其中刀涂覆有电绝缘材料,以在组织接触区域处提供热绝缘,从而最小化组织对刀的粘附性,其中刀的较浅着色区域5302表示涂覆部分,并且刀的较深着色区域5304表示暴露表面,所述暴露表面使得RF电流能够从刀的暴露区域穿过组织流到活动钳口构件。电流密度可影响功能性,并且可通过提供不同的表面区域来控制。表面区域在刀末端的每一侧不必为对称的,并且可根据性能而有所不同。此外,暴露区域可包括由至少一个涂覆区段(未示出)隔开的两个或多个区段。其他涂覆/暴露的几何形状也是可以的,例如,沿刀的轴线改变暴露区域的深度或宽度。
在另一个实施例中,刀和/或管组件可带电荷以排斥外科物质。
图119A-119E示出了一体化RF/超声外科端部执行器的各种实施例。夹持臂可包括例如圆形夹持臂6764a、6764b、钩形夹持臂6764c、具有腔6764d的圆形夹持臂、或弯曲的钩形夹持臂6764e。超声刀可包括例如矩形超声刀6766a、6766c和/或椭圆形超声刀6766b。图120A-120C示出了双极一体化RF/超声端部执行器的各种实施例。在一个实施例中,夹持臂6864a可包括第一电极,并且超声刀6866a可包括第二电极。夹持臂6864a或超声刀6866a可包括返回电极。在一些实施例中,夹持臂6864b可包括将夹持臂6864b与超声刀6866b隔开的绝缘垫6868。在一些实施例中,夹持臂6864c可包括第一电极6870和第二电极6872。第一和第二电极6870、6872可由夹持臂6864c的绝缘部分隔开。
图121A-121C包括单极一体化RF/超声端部执行器的各种实施例。在一些实施例中,整个夹持臂6964a可包括单极电极。在一些实施例中,夹持臂6964b可包括绝缘垫6968。夹持臂6964b的一部分可包括单极电极。在一些实施例中,夹持臂6964c和超声刀6966可包括单个单极电极。
热隔离的超声刀
图96为包括金属隔热罩5402的超声端部执行器5400的一个实施例的透视图。超声端部执行器5400包括夹持臂5410。夹持臂5410包括活动钳口构件5408(夹持臂)、组织垫5412、超声刀5404、和设在距超声刀5404一定距离处的隔热罩5402。隔热罩5402为金属的并且包括用于气流的孔5406,所述气流对隔热罩5402和超声刀5404提供冷却。隔热罩5402被设置在活动钳口构件5408的相对侧。
图97为包括可回缩的金属隔热罩5422的超声端部执行器5420的另一个实施例的透视图。超声端部执行器5420包括夹持臂5430。夹持臂5430包括活动钳口构件5428、组织垫5432、超声刀5424、和设在距超声刀5424一定距离处的隔热罩5422。在另一个实施例中,金属隔热罩5422可在最远侧节点位置处附接到超声刀5424。附接装置还用作散热器5422,以从刀5424除去热量。隔热罩5422为金属的并且包括用于气流的孔5426,所述气流对隔热罩5422和超声刀5424提供冷却。隔热罩5422被设置在活动钳口构件5428的相对侧。
图98为包括以横截面示出的隔热罩5444的超声端部执行器5440的另一个实施例的侧视图。超声端部执行器5440包括夹持臂5448。夹持臂5448包括活动钳口构件5252、超声刀5450、和还用作散热器5442的隔热罩5444。垫5452可设在活动钳口构件5252的刀5450侧,以将组织夹持在垫5452与刀5450之间。隔热罩5444/散热器5442的附接位于节点位置处。图99为根据一个实施例的图98所示的超声端部执行器5440的前视图。
图100-104示出了包括双重用途可旋转隔热罩5462的超声端部执行器5460的一个实施例的各种视图。图100示出了夹持臂5464的一个实施例,所述夹持臂包括以闭合位置示出的活动钳口构件5464和位于超声刀5468下方的双重用途可旋转隔热罩5462。超声端部执行器5460包括具有活动钳口构件5470的夹持臂5464、超声刀5468、和双重用途可旋转隔热罩5462。在一个实施例中,夹持臂5464包括图100所示的处于闭合位置的活动钳口构件5470,并且可旋转隔热罩5462位于超声刀5468下方。在该实施例中,隔热罩5462具有双重用途并且可围绕刀5468旋转。该实施例中的刀5468为直线/或非弯曲构型。当隔热罩5468设置成背向活动钳口构件5470(剪型端部执行器)时,其用作隔热罩5462。在围绕刀5468旋转之后,隔热罩5462现在设置在刀5468与活动钳口构件5470之间以提供组织夹持表面,所述组织夹持表面由刀5468支承,由此为隔热罩5468提供强度/支撑。另外,隔热罩5468可能够提供与可提供在活动钳口构件5470上的能量相反的能量,从而产生可影响组织的双极能量。
图101示出了以打开位置示出的活动钳口构件5470和双重用途可旋转隔热罩5462的一个实施例,所述双重用途可旋转隔热罩被旋转使得其夹置在活动钳口构件5470和刀5468之间。
图102示出了在第一位置旋转的双重用途可旋转隔热罩5462的一个实施例的端视图。图103示出了在第二位置旋转的双重用途可旋转隔热罩5462的一个实施例的端视图。现在参考图102-103,可旋转隔热罩5462具有目的性对齐,所述目的性对齐使得罩5642的渐缩部分能够进入刀5468表面的顶部与活动钳口构件5470之间。这种旋转能够“反向切割”(如果需要)同时仍允许正常的激活屏蔽。另外,罩5462的内部轮廓可能够在旋转时接触(如果需要)以“清洁”末端。另外,如果罩5462为绝缘的,则罩5462从阶段1位置旋转到阶段2位置使得RF能量能够被施加以仅用于密封。罩的底部表面可具有夹持件,以在旋转到位置2时还有助于抓持。
图104为隔热罩5462的一个实施例的顶部轮廓图,其中示出了罩5462的渐缩部分。如图所示,在一个实施例中,隔热罩5462包括由相对于半径R2的半径R1限定的渐缩部分,其中R2>R1。
图116A-116B示出了用于超声外科器械的冷却系统的一个实施例。空气6416可被迫使在超声外科器械6302的内管6406下和超声端部执行器6404上穿过。超声端部执行器6304上的空气运动可冷却超声端部执行器6404。在一个实施例中,冷空气可用于增加端部执行器6404的冷却。空气6416可沿所示方向运动,以通过从超声端部执行器6404到空气的对流热传递来冷却超声端部执行器6404。在一些实施例中,医院空气管道6410可被联接到超声器械6302,以通过内管6406来提供压缩空气流。在一些实施例中,手动泵6412和贮存器6414可位于外科器械6402的近侧端部中,例如,在柄部中。临床医生可操作手动泵6412,以在贮存器6414内产生空气压力。手动泵6412可包括例如压缩球。贮存器6414和/或医院空气管道6410可在钳口的每次打开和/或闭合时迫使空气在超声端部执行器6404上穿过。在一些实施例中,贮存器6414和/或医院空气管道6410可在超声端部执行器上提供连续空气流。在一些实施例中,内管6406可包括图116B所示的涡旋管。涡旋管可有利于空气6416在内管6406内的运动,以通过内管6406朝远侧6418行进、穿过超声端部执行器6404、并且返回6420到内管6406的近侧端部,所述近侧端部可开放以释放空气。涡旋管的远侧端部可包括分流器,以分离空气流6418,从而冷却超声端部执行器6404的远侧端部。
应用到超声骨钳的超声4杆闭合件
图105示出了常规的骨钳外科器械6000。诸如脊柱融合术之类的某些整形外科手术用于治疗退行性椎间盘疾病。最常使用的器械中的一个为如图105所示的骨钳6000,所述骨钳用于移除由核和坚硬环构成的椎间盘。骨钳6000使用4杆连杆结合包括活动钳口构件6004的夹持臂6002来咬除椎间盘材料。一般来讲,可需要多次咬除(10次到20次)来完全移除椎间盘。骨钳6000的多次使用可使人疲劳。
因此,图106示出了超声能量驱动的骨钳装置6100的一个实施例。超声能量驱动的骨钳装置6100包括超声换能器6102,所述超声换能器被添加到4杆机构的一个构件。骨钳装置6100还包括两个细长水平构件。如图106所示,仅联接到柄部6106的下部水平构件6104被示出。超声骨钳装置6100的两个细长水平构件各自附接到超声骨钳装置6100的一个柄部6106。水平构件与远侧端部6103处的小联接件连接,并且向前柄部6106为第二联接件。这四个构件接近平行规则。如在图106中可见,底部水平构件6104基本上为不移动的直杆。根据本公开的一个实施例,通过将下部水平构件6104的枢轴6108、6110设置在节点处,下部水平构件6104可被视为超声波导。因此,骨钳装置6100的其余部分在节点处附接到下部水平臂6104。下部水平构件6104的近侧端部可附接到超声换能器6102,以在远侧端部6103处产生超声位移。超声位移的振幅将有助于切割组织,并且因此将降低外科医生所需的力。此处未示出下述需要:将一些阻尼材料插入两个水平构件与下部水平构件6104上的护套之间,以避免接触居间组织。超声驱动骨钳装置6100的优点包括但不限于用于超声器械的基于4杆连杆的新型闭合机构、咬除椎间盘材料所需的较低力、降低外科医生疲劳、以及用于另外的应用的新型器械构造。
虽然上文说明已列举了各种细节,但应当理解超声和电外科装置的各种方面可在没有这些具有细节的情况下实施。例如,为简洁和清楚起见,以框图的形式示出了选择的方面,而不是详细地示出。本文提供的详细描述的某些部分可以呈现为对存储在计算机存储器中的数据进行操作的指令。本领域的技术人员使用此类描述和表达向本领域的其它技术人员描述和传达他们的工作要旨。通常,算法是指导致所需结果的步骤的自相容序列,其中“步骤”是指物理量的操纵,物理量可以(但不一定)采用能被存储、传送、组合、比较和以其它方式操纵的电或磁信号的形式。常用于指这些信号,如位、值、元素、符号、字符、术语、数字等。这些和类似的术语可与适当的物理量相关联并且仅仅是应用于这些量的方便的标签。
除非上述讨论中另外明确指明,否则可以理解的是,在上述描述中,使用术语如“处理”或“估算”或“计算”或“确定”或“显示”的讨论是指计算机系统或类似的电子计算设备的动作和处理,其操纵表示为计算机系统的寄存器和存储器内的物理(电子)量的数据并将其转换成相似地表示为计算机系统存储器或寄存器或其它此类信息存储、传送或显示设备内的物理量的其它数据。
值得一提的是,任何对“一个方面”、“方面”、“一个实施例”、“实施例”的提及均意指结合所述方面所述的具体特征、结构或特性包括在至少一个方面中。因此,出现在整篇说明书中的不同位置中的短语“在一个方面”、“在一方面”、“在一个实施例中”或“在实施例中”不一定都是指同一方面。此外,具体特征、结构或特性可在一个或多个方面中以任何合适的方式组合。
某些方面可以利用表达“联接”和“连接”以及它们的衍生词来描述。应当理解,这些术语并不希望是彼此同义的。例如,某些方面可以利用术语“连接”来描述,以表示两个或更多个元件彼此直接物理接触或电接触。在另一个实例中,某些方面可以利用术语“联接”来描述,以表示两个或更多个元件直接物理接触或电接触。然而,术语“联接”还可以指的是,两个或更多个元件彼此不是直接接触,而是彼此配合或相互作用。
虽然本文描述了多个实施例,但可以实现那些实施例的多种修改形式、变型形式、替代形式、变化形式和等同形式,这些形式是本领域技术人员将会想到的。另外,在公开了用于某些部件的材料的情况下,均可使用其他材料。因此,应当理解,上述具体实施方式和所附的权利要求旨在涵盖属于本发明所公开的实施例范围内的所有此类修改形式和变型形式。以下权利要求旨在涵盖所有此类修改形式和变型形式。
本文所述的实施例中的一些或全部可通常包括用于组织的超声和RF处理的技术、或者根据本文所述的技术。在一般意义上,本领域的技术人员将会认识到,可以用多种硬件、软件、固件或它们的任何组合单独和/或共同实施的本文所述的多个方面可以被看作是由多种类型的“电子电路”组成。因此,如本文所用,“电子电路”包括但不限于具有至少一个离散电路的电子电路、具有至少一个集成电路的电子电路、具有至少一个专用集成电路的电子电路、形成由计算机程序配置的通用计算设备的电子电路(例如,至少部分地实施本文所述的方法和/或设备的由计算机程序配置的通用计算机,或至少部分地实施本文所述的方法和/或设备的由计算机程序配置的微处理器)、形成存储器设备(例如,形成随机存取存储器)的电子电路,和/或形成通信设备(例如,调节解调器、通信开关或光电设备)的电子电路。本领域的技术人员将会认识到,可以模拟或数字方式或它们的一些组合实施本文所述的主题。
上述具体实施方式已通过使用框图、流程图和/或实例阐述了设备和/或方法的多个实施例。只要此类框图、流程图和/或示例包含一个或多个功能和/或操作,本领域的技术人员就要将其理解为此类框图、流程图或示例中的每个功能和/或操作都可以单独和/或共同地通过多种硬件、软件、固件或实际上它们的任何组合来实施。在一个实施例中,本文所述的主题的若干部分可以通过专用集成电路(ASIC)、现场可编程门阵列(FPGA)、数字信号处理器(DSP)或其他集成格式来实施。然而,本领域的技术人员将会认识到,本文所公开的实施例的一些方面可以作为在一台或多台计算机上运行的一个或多个计算机程序(例如,作为在一个或多个计算机系统上运行的一个或多个程序),作为在一个或多个处理器上运行的一个或多个程序(例如,作为在一个或多个微处理器上运行的一个或多个程序),作为固件,或作为实际上它们的任何组合全部或部分地在集成电路中等效地实现,并且根据本发明,设计电子电路和/或编写软件和/或硬件的代码将在本领域技术人员的技术范围内。另外,本领域的技术人员将会认识到,本文所述主题的机制能够作为多种形式的程序产品进行分布,并且本文所述主题的示例性实施例适用,而不管用于实际进行分布的信号承载介质的具体类型是什么。信号承载介质的示例包括但不限于如下:可录式媒体,诸如软盘、硬盘驱动器、光盘(CD)、数字视频光盘(DVD)、数字磁带、计算机存储器等;和传输式媒体,诸如数字和/或模拟通信媒体(例如,光纤缆线、波导、有线通信链路、无线通信链路(例如,发射器、接收器、传输逻辑、接收逻辑等)等)。
上述美国专利、美国专利申请公开、美国专利申请、国外专利、国外专利申请、本说明书中所提及和/或任何应用数据表中所列出的非专利申请或任何其它公开材料均在不与其相抵触的程度上以引用方式并入本文。由此,在必要程度下,本文所明确阐述的公开内容将会取代以引用的方式并入本文中的任何相冲突的材料。如果据述以引用的方式并入本文但与本文所述现有定义、陈述或者其它公开材料相冲突的任何材料或其部分,仅在所并入的材料与现有公开材料之间不产生冲突的程度下并入本文。
本领域技术人员将会认识到,本文所述的组成部分(例如,操作)、设备、对象和它们所附的讨论是为了概念清楚起见而用作示例,并且可以设想多种配置修改形式。因此,如本文所用,阐述的具体示例和所附的讨论旨在代表它们更一般的类别。通常,任何具体示例的使用旨在代表其类别,具体组成部分(例如操作)、设备和对象的未纳入部分不应采取限制。
对于本文中使用的基本上任何复数和/或单数术语,本领域技术人员可从复数转换成单数和/或从单数转换成复数,只要适合于上下文和/或应用就可以。为清楚起见,各种单数/复数置换在本文中没有明确表述。
本文所述的主题有时阐述了包含在其它不同部件中的不同部件或与其它不同部件连接的不同部件。应当理解,这样描述的结构仅是示例性的,并且事实上可以实现获得相同功能性的多种其它结构。在概念意义上,获得相同功能性的部件的任何布置方式都是有效“相关联的”,从而获得所需的功能性。因此,本文中为获得特定功能性而结合在一起的任何两个部件都可被视为彼此“相关联”,从而获得所需的功能性,而不论结构或中间部件如何。同样,如此相关联的任何两个部件也可被视为彼此“可操作地连接”或“可操作地联接”,以获得所需的功能性,并且能够如此相关联的任何两个部件都可被视为彼此“可操作地联接”,以获得所需的功能性。可操作地联接的具体示例包括但不限于可物理匹配的和/或物理交互部件,和/或无线交互式,和/或无线交互式部件,和/或逻辑交互式,和/或逻辑交互式部件。
在一些情况下,一个或多个部件在本文中可被称为“能够”、“可配置为”、“可操作地/操作以”、“适于”、“能”、“可适形的/适形于”等。本领域的技术人员将会认识到,除非上下文另有所指,否则“能够”通常可涵盖活动状态的部件和/或失活状态的部件和/或待机状态的部件。
虽然已经示出并描述了本文所述的本发明主题的特定方面,但是对本领域的技术人员将显而易见的是,基于本文的教导,可在不脱离本文所述的主题的情况下作出改变和修改,并且如在本文所述的主题的真实实质和范围内,其更广泛的方面并因此所附权利要求将所有此类改变和修改包括在其范围内。本领域的技术人员应当理解,一般而言,本文特别是所附权利要求(例如,所附权利要求的正文)中所使用的术语通常旨在为“开放”术语(例如,术语“包括(including)”解释为“包括但不限于”,术语“具有”应解释为“至少具有”,术语“包括(includes)”应解释为“包括但不限于”等)。本领域的技术人员还应当理解,如果所引入权利要求叙述的具体数目为预期的,则这样的意图将在权利要求中明确叙述,并且在不存在这样的叙述的情况下,不存在这样的意图。例如,为帮助理解,下述所附权利要求可含有对介绍性短语“至少一个”和“一个或多个”的使用以引入权利要求叙述。然而,对此类短语的使用不应被视为隐含通过不定冠词“一(a)”或“一(an)”引入权利要求叙述将含有此类引入权利要求叙述的任何特定权利要求限制在含有仅一个这样的叙述的权利要求中,甚至当同一权利要求包括介绍性短语“一个或多个”或“至少一个”和诸如“一(a)”或“一(an)”(例如,“一(a)”和/或“一(an)”通常应解释为意指“至少一个”或“一个或多个”)的不定冠词时;这也适用于对用于引入权利要求叙述的定冠词的使用。
另外,即使明确叙述引入权利要求叙述的特定数目,本领域的技术人员应当认识到,此种叙述通常应解释为意指至少所叙述的数目(例如,在没有其它修饰语的情况下,对“两个叙述”的裸叙述通常意指至少两个叙述、或两个或更多个叙述)。此外,在其中使用类似于“A、B和C中的至少一者等”的惯例的那些情况下,一般而言,这种结构意在具有本领域的技术人员将理解所述惯例的意义(例如,“具有A、B和C中的至少一者的系统”将包括但不限于具有仅A、仅B、仅C、A和B一起、A和C一起、B和C一起和/或A、B和C一起等的系统)。在其中使用类似于“A、B或C中的至少一者等”的惯例的那些情况下,一般而言,这种结构意在具有本领域的技术人员将理解所述惯例的意义(例如,“具有A、B或C中的至少一者的系统”将包括但不限于具有仅A、仅B、仅C、A和B一起、A和C一起、B和C一起和/或A、B和C一起等的系统)。本领域的技术人员还应当理解,通常,除非上下文另有指示,否则无论在具体实施方式、权利要求或附图中呈现两个或更多个替代术语的转折性词语和/或短语应理解为涵盖包括所述术语中的一者、所述术语中的任一个或这两个术语的可能性。例如,短语“A或B”通常将被理解为包括“A”或“B”或“A和B”的可能性。
对于所附的权利要求,本领域的技术人员将会理解,其中列出的操作通常可以任何顺序进行。另外,尽管以一定顺序列出了多个操作流程,但应当理解,可以不同于所示顺序的其它顺序进行所述多个操作,或者可以同时进行所述多个操作。除非上下文另有规定,否则此类替代排序的示例可包括重叠、交错、中断、重新排序、增量、预备、补充、同时、反向,或其它改变的排序。此外,除非上下文另有规定,否则像“响应于”、“相关”这样的术语或其它过去式的形容词通常不旨在排除此类变体。
在某些情况下,对系统或方法的使用可发生在某个范围中,即使部件位于所述范围外部。例如,在分布式计算上下文中,对分布式计算系统的使用可发生在一个范围中,即使所述系统的部件可能位于所述范围外部(例如,位于所述范围外部的继电器、服务器、处理器、信号承载介质、传输计算机、接收计算机等)。
系统或方法的销售同样可发生一个范围中,即使所述系统或方法的部件位于和/或用于所述范围外部。此外,在一个范围中实施用于执行方法的系统的至少一部分不排除在另一个范围中使用所述系统。
虽然本文描述了多个实施例,但可以实现那些实施例的多种修改形式、变型形式、替代形式、变化形式和等同形式,这些形式是本领域技术人员将会想到的。另外,在公开了用于某些部件的材料的情况下,均可使用其他材料。因此,应当理解,上述具体实施方式和所附的权利要求旨在涵盖属于本发明所公开的实施例范围内的所有此类修改形式和变型形式。以下权利要求旨在涵盖所有此类修改形式和变型形式。
总之,描述了通过采用本文所述的概念而获得的多种有益效果。上述一个或多个实施例的具体实施方式是为了说明和描述的目的而示出的。这些具体实施方式并非意图为详尽的或限定到本文所公开的精确形式。可以按照上述教导对本发明进行修改或变型。选择和描述的一个或多个实施例是为了说明原理和实际应用,从而使本领域的普通技术人员能够利用适用于预期的特定用途的所述多个实施例和多种修改形式。其旨在以与本文一起提交的权利要求限定整体范围。
本文所述主题的各个方面在以下带编号条目中陈述:
1.一种超声外科器械,包括:波导,所述波导包括近侧端部和远侧端部,其中所述近侧端部联接到超声换能器;限定管腔的管,其中所述波导位于所述管腔内;联接到所述波导的远侧端部的端部执行器,所述端部执行器包括超声刀和操作地联接到所述端部执行器的夹持臂;和组织积聚阻止机构,所述组织积聚阻止机构联接到所述端部执行器,其中所述组织积聚阻止机构能够阻止组织积聚在所述管腔内。
2.根据条目1所述的外科器械,其中所述组织积聚阻止机构包括能够在所述管和所述端部执行器之间形成密封的防护罩阻隔件。
3.根据条目2所述的外科器械,其中所述防护罩阻隔件密封到所述管。
4.根据条目2所述的外科器械,其中所述防护罩由所述管或端部执行器利用一个或多个保持特征结构来保持。
5.根据条目2所述的外科器械,其中所述防护罩阻隔件通过所述防护罩阻隔件和所述超声刀之间的过盈配合密封到所述超声刀。
6.根据条目2所述的外科器械,其中所述防护罩阻隔件包括腔。
7.根据条目6所述的外科器械,其中所述腔为圆形的,以允许流体流出所述腔。
8.根据条目2所述的外科器械,其中所述防护罩阻隔件包括与所述刀的多个接触点。
9.根据权利要求1所述的外科器械,其中所述组织积聚阻止机构包括所述管中的一个或多个孔。
10.根据权利要求9所述的外科器械,其中所述孔包括一个或多个窗口。
11.根据权利要求9所述的外科器械,其中所述孔包括一个或多个孔穴。
12.根据权利要求1所述的外科器械,其中所述管包括远侧部分,其中所述远侧部分包括半圆形横截面。
13.根据权利要求1所述的外科器械,其中所述管包括形成于所述管的内侧上的一个或多个肋。
14.根据权利要求1所述的外科器械,其中所述组织积聚阻止机构包括能够在所述刀和所述管之间提供正压力流的泵,其中所述正压力流阻止组织进入所述管腔中。
15.根据权利要求1所述的外科器械,其中所述泵定位在位于所述管腔内的最远侧包覆模制密封件的远侧。
16.根据权利要求1所述的外科器械,其中所述组织积聚阻止机构包括设置在所述管腔内的可滑动管,所述可滑动管能够从第一位置滑动到第二位置,其中在所述第一位置,所述可滑动管设置在所述刀上,并且其中在所述第二位置,所述刀为暴露的。
17.一种超声外科器械,包括:波导,所述波导包括近侧端部和远侧端部,其中所述近侧端部联接到换能器;联接到所述波导的远侧端部的端部执行器,所述端部执行器包括至少一个组织保持特征结构;夹持臂,所述夹持臂操作地联接到端部执行器。
18.根据权利要求17所述的外科器械,其中所述至少一个组织保持特征结构包括形成于所述端部执行器中的一个或多个压痕/凹槽/凹口。
19.根据权利要求18所述的外科器械,其中所述一个或多个压痕包括三角形齿状物。
20.根据权利要求18所述的外科器械,其中所述一个或多个压痕包括孔穴。
21.根据权利要求18所述的外科器械,其中所述一个或多个压痕包括水平沟槽。
22.根据权利要求17所述的外科器械,其中所述至少一个组织保持特征结构与所述端部执行器的组织分开冠(tissue dividing crown)偏置。
23.根据权利要求17所述的外科器械,其中所述至少一个组织保持特征结构包括自所述端部执行器的一个或多个突出部。
24.根据权利要求23所述的外科器械,其中所述一个或多个突出部包括三角形齿状物。
25.根据权利要求23所述的外科器械,其中所述一个或多个突出部包括块。
26.根据权利要求23所述的外科器械,其中所述一个或多个突出部包括水平凸耳。
27.根据权利要求23所述的外科器械,其中所述一个或多个突出部包括圆形凸耳。
28.根据权利要求17所述的外科器械,其中所述至少一个组织保持特征结构设置在所述刀的整个长度上。
29.根据权利要求17所述的外科器械,其中所述至少一个组织保持特征结构设置在所述刀的离散的节段上。
30.一种超声外科器械,包括:波导,所述波导包括近侧端部和远侧端部,其中所述近侧端部联接到换能器;端部执行器,所述端部执行器操作地联接到所述波导的远侧端部;旋转护罩,所述旋转护罩能够旋转所述波导;和旋转止动机构,所述旋转止动机构联接到所述旋转护罩以阻止所述旋钮旋转超过预定的旋转。
31.根据权利要求30所述的外科器械,其中所述护罩包括:至少一个通道;和至少一个凸出部,所述至少一个凸出部位于所述至少一个通道内,其中所述至少一个凸出部具有预定的侧向运动极限,其中当所述至少一个凸出部达到所述预定的侧向运动极限时,所述至少一个凸出部阻止所述旋钮的进一步旋转。
32.根据权利要求30所述的外科器械,其中所述旋转止动件包括:门,所述门包括第一翼和第二翼,其中所述第一翼和第二翼成角度设置,其中所述门设置在所述护罩内,并且所述门允许所述护罩的预定旋转角度。
33.根据权利要求30所述的外科器械,其中所述旋转止动件包括成型挤出元件。
34.根据权利要求33所述的外科器械,其中所述成型挤出元件包括触觉反馈元件。
35.根据权利要求34所述的外科器械,其中所述触觉反馈元件包括半柔顺材料,所述半柔顺材料选自橡胶、中至高密度橡胶、硅树脂、热塑性弹性体、不锈钢弹性件、弹簧钢、铜、形状记忆金属、以及它们的任何组合。
36.一种超声外科器械,包括:波导,所述波导包括近侧端部和远侧端部,其中所述近侧端部联接到换能器;端部执行器,所述端部执行器联接到所述波导的远侧端部;夹持臂,所述夹持臂操作地联接到所述端部执行器;和管,所述管设置在所述波导上,其中所述管包括反向偏转元件,其中所述反向偏转元件能够允许所述刀的偏转,其中所述刀的偏转抵消由在处于夹持位置时的所述夹持臂施加于所述刀上的力。
37.一种外科器械,包括:波导,所述波导包括近侧端部和远侧端部,其中所述近侧端部联接到信号源,所述信号源能够提供超声信号和电外科信号;端部执行器,所述端部执行器联接到所述波导;夹持臂,所述夹持臂操作地联接到所述端部执行器;和密封按钮,其中所述密封按钮致使所述外科器械向所述端部执行器和所述夹持臂递送所述电外科信号持续第一周期,并且其中所述密封按钮致使所述外科器械向所述刀递送所述超声信号持续第二周期,其中所述第二周期在所述第一周期之后。
38.一种外科器械,包括:波导,所述波导包括近侧端部和远侧端部,其中所述近侧端部联接到换能器;端部执行器,所述端部执行器联接到所述波导的远侧端部;管,所述管设置在所述波导上;凸轮表面,所述凸轮表面形成于所述管的外表面上;和夹持臂,所述夹持臂操作地联接到所述凸轮表面。
39.根据权利要求38所述的外科器械,包括:枢轴销,所述枢轴销位于由所述端部执行器限定的孔穴内,所述枢轴销操作地联接到所述夹持臂,其中所述夹持臂围绕所述枢轴销枢转。
40.根据权利要求39所述的外科器械,其中所述枢轴销位于所述波导的最远侧节点处。
41.根据权利要求38所述的外科器械,其中所述管能够致动,并且其中所述夹持臂通过所述管和所述端部执行器之间的相对运动而相对于所述端部执行器凸轮打开和凸轮闭合。
42.一种外科器械,包括:波导,所述波导包括近侧端部和远侧端部,其中所述近侧端部联接到换能器;联接到所述波导的远侧端部的端部执行器,所述端部执行器限定销孔穴;刚性销,所述刚性销设置在所述销孔穴内;夹持臂;和四杆连杆;其中所述四杆连杆操作地联接到所述夹持臂和所述刚性销,其中所述四杆连杆能够致动以将所述夹持臂运动到夹持位置。
43.根据权利要求40所述的外科器械,包括:外管,其中所述外管联接到所述四杆连杆,并且其中所述外管将所述四杆连杆从第一位置致动到第二位置。
44.一种超声外科器械,包括:波导,所述波导包括近侧端部和远侧端部,其中所述近侧端部联接到换能器;和端部执行器,所述端部执行器联接到所述波导的远侧端部,其中所述端部执行器局部涂覆有热绝缘材料和电绝缘材料,使得所述端部执行器的远侧端部包括一个或多个暴露节段。
45.根据权利要求44所述的超声外科器械,其中所述一个或多个暴露区域为对称的。
46.根据权利要求44所述的超声外科器械,其中所述一个或多个暴露区域为非对称的。
47.根据权利要求44所述的超声外科器械,其中所述一个或多个暴露节段由一个或多个涂覆节段隔开。
48.根据权利要求44所述的超声外科器械,其中所述波导完全涂覆有热绝缘材料和电绝缘材料。
49.根据权利要求44所述的超声外科器械,其中所述波导局部涂覆有热绝缘材料和电绝缘材料。
50.一种超声外科器械,包括:波导,所述波导包括近侧端部和远侧端部,其中所述近侧端部联接到换能器;和联接到所述波导的远侧端部的端部执行器、操作地连接到所述端部执行器的夹持臂,其中所述夹持臂局部涂覆有热绝缘材料和电绝缘材料,使得所述夹持臂的远侧端部包括一个或多个暴露节段。
51.根据权利要求50所述的超声外科器械,其中所述一个或多个暴露区域为对称的。
52.根据权利要求50所述的超声外科器械,其中所述一个或多个暴露区域为非对称的。
53.根据权利要求50所述的超声外科器械,其中所述一个或多个暴露节段由一个或多个涂覆节段分开。
54.根据权利要求50所述的超声外科器械,其中所述波导完全涂覆有热绝缘材料和电绝缘材料。
55.根据权利要求50所述的超声外科器械,其中所述波导完全涂覆有热绝缘材料和电绝缘材料。
56.一种超声外科器械,包括:波导,所述波导包括近侧端部和远侧端部,其中所述近侧端部联接到换能器;和联接到所述波导的远侧端部的端部执行器、操作地连接到所述端部执行器的夹持臂,其中所述夹持臂和所述端部执行器局部涂覆有热绝缘材料和电绝缘材料,使得所述端部执行器和夹持臂的远侧端部包括一个或多个暴露节段。
57.根据权利要求56所述的超声外科器械,其中所述一个或多个暴露区域为对称的。
58.根据权利要求56所述的超声外科器械,其中所述一个或多个暴露区域为非对称的。
59.根据权利要求56所述的超声外科器械,其中所述一个或多个暴露节段由一个或多个涂覆节段分开。
60.根据权利要求56所述的超声外科器械,其中所述波导完全涂覆有热绝缘材料和电绝缘材料。
61.根据权利要求56所述的超声外科器械,其中所述波导完全涂覆有热绝缘材料和电绝缘材料。
62.一种超声外科器械,包括:超声端部执行器,所述超声端部执行器包括超声外科刀和夹持臂;和隔热罩,所述隔热罩设在距所述超声刀的预定距离处。
63.根据权利要求62所述的超声器械,其中所述隔热罩能够围绕所述超声刀旋转。
64.根据权利要求62所述的超声器械,包括散热器。
65.根据权利要求62所述的超声器械,其中所述隔热罩包括多个孔。
66.根据权利要求62所述的超声器械,其中所述隔热罩包括渐缩部分。
67.一种一体化射频(RF)/超声外科器械,包括:超声换能器;插孔连接器,所述插孔连接器电联接到所述超声换能器;和可滑动凹形配合插头,所述可滑动凹形配合插头能够与所述插孔连接器相配合;其中所述可滑动凹形配合插头能够在多个位置滑动,以将所述超声换能器电联接到超声能量源或RF能量源。
68.根据权利要求67所述的一体化射频(RF)/超声外科器械,其中所述插孔连接器能够与所述超声换能器一起旋转。
69.根据权利要求67所述的一体化射频(RF)/超声外科器械,其中所述插孔连接器为四引线插孔连接器。
70.根据权利要求67所述的一体化射频(RF)/超声外科器械,其中所述可滑动凹形配合插头能够在第一位置与第二位置之间滑动;其中在所述第一位置,所述超声换能器电联接到所述超声能量源并且与所述RF能量源电隔离;并且其中在所述第二位置,所述超声换能器电联接到所述RF能量源并且与所述超声能量源电隔离。
71.一种超声能量驱动的骨钳装置,包括:至少一个细长构件;连杆,所述连杆连接到所述至少一个细长构件的远侧端部;超声换能器,所述超声换能器联接到所述至少一个细长构件;和枢轴,所述枢轴位于所述至少一个细长构件的超声节点处。
72.根据权利要求71所述的超声能量驱动的骨钳装置,包括:第二连杆,所述第二连杆连接到所述至少一个细长构件的近侧端部;和第二枢轴,所述第二枢轴位于所述至少一个细长构件的第二超声处。
73.根据权利要求71所述的超声能量驱动的骨钳装置,包括:第二细长构件,所述第二细长构件位于所述至少一个细长构件之上;和阻尼材料,所述阻尼材料设置在所述至少一个细长构件与所述第二细长构件之间。
Claims (73)
1.一种超声外科器械,包括:
波导,所述波导包括近侧端部和远侧端部,其中所述近侧端部联接到超声换能器;
限定管腔的管,其中所述波导位于所述管腔内;
联接到所述波导的远侧端部的端部执行器,所述端部执行器包括超声刀和操作地联接到所述端部执行器的夹持臂;和
组织积聚阻止机构,所述组织积聚阻止机构联接到所述端部执行器,其中所述组织积聚阻止机构能够阻止组织积聚在所述管腔内。
2.根据权利要求1所述的外科器械,其中所述组织积聚阻止机构包括能够在所述管和所述端部执行器之间产生密封的防护罩阻隔件。
3.根据权利要求2所述的外科器械,其中所述防护罩阻隔件密封到所述管。
4.根据权利要求2所述的外科器械,其中所述防护罩由所述管或端部执行器利用一个或多个保持特征结构来保持。
5.根据权利要求2所述的外科器械,其中所述防护罩阻隔件通过所述防护罩阻隔件和所述超声刀之间的过盈配合密封到所述超声刀。
6.根据权利要求2所述的外科器械,其中所述防护罩阻隔件包括腔。
7.根据权利要求6所述的外科器械,其中所述腔为圆形的,以允许流体流出所述腔。
8.根据权利要求2所述的外科器械,其中所述防护罩阻隔件包括与所述刀的多个接触点。
9.根据权利要求1所述的外科器械,其中所述组织积聚阻止机构包括所述管中的一个或多个孔。
10.根据权利要求9所述的外科器械,其中所述孔包括一个或多个窗口。
11.根据权利要求9所述的外科器械,其中所述孔包括一个或多个孔穴。
12.根据权利要求1所述的外科器械,其中所述管包括远侧部分,其中所述远侧部分包括半圆形横截面。
13.根据权利要求1所述的外科器械,其中所述管包括形成于所述管的内侧上的一个或多个肋。
14.根据权利要求1所述的外科器械,其中所述组织积聚阻止机构包括能够在所述刀和所述管之间提供正压力流的泵,其中所述正压力流阻止组织进入所述管腔中。
15.根据权利要求1所述的外科器械,其中所述泵定位在位于所述管腔内的最远侧包覆模制密封件的远侧。
16.根据权利要求1所述的外科器械,其中所述组织积聚阻止机构包括设置在所述管腔内的可滑动管,所述可滑动管能够从第一位置滑动到第二位置,其中在所述第一位置,所述可滑动管设置在所述刀上,并且其中在所述第二位置,所述刀为暴露的。
17.一种超声外科器械,包括:
波导,所述波导包括近侧端部和远侧端部,其中所述近侧端部联接到换能器;
联接到所述波导的远侧端部的端部执行器,所述端部执行器包括至少一个组织保持特征结构;
夹持臂,所述夹持臂操作地联接到所述端部执行器。
18.根据权利要求17所述的外科器械,其中所述至少一个组织保持特征结构包括形成于所述端部执行器中的一个或多个压痕/凹槽/凹口。
19.根据权利要求18所述的外科器械,其中所述一个或多个压痕包括三角形齿状物。
20.根据权利要求18所述的外科器械,其中所述一个或多个压痕包括孔穴。
21.根据权利要求18所述的外科器械,其中所述一个或多个压痕包括水平沟槽。
22.根据权利要求17所述的外科器械,其中所述至少一个组织保持特征结构与所述端部执行器的组织分开冠偏置。
23.根据权利要求17所述的外科器械,其中所述至少一个组织保持特征结构包括自所述端部执行器的一个或多个突出部。
24.根据权利要求23所述的外科器械,其中所述一个或多个突出部包括三角形齿状物。
25.根据权利要求23所述的外科器械,其中所述一个或多个突出部包括块。
26.根据权利要求23所述的外科器械,其中所述一个或多个突出部包括水平凸耳。
27.根据权利要求23所述的外科器械,其中所述一个或多个突出部包括圆形凸耳。
28.根据权利要求17所述的外科器械,其中所述至少一个组织保持特征结构设置在所述刀的整个长度上。
29.根据权利要求17所述的外科器械,其中所述至少一个组织保持特征结构设置在所述刀的离散的节段上。
30.一种超声外科器械,包括:
波导,所述波导包括近侧端部和远侧端部,其中所述近侧端部联接到换能器;
端部执行器,所述端部执行器操作地联接到所述波导的远侧端部;
旋转护罩,所述旋转护罩能够旋转所述波导;和
旋转止动机构,所述旋转止动机构联接到所述旋转护罩以阻止旋钮旋转超过预定的旋转。
31.根据权利要求30所述的外科器械,其中所述护罩包括:
至少一个通道;和
至少一个凸出部,所述至少一个凸出部位于所述至少一个通道内,其中所述至少一个凸出部具有预定的侧向运动极限,其中当所述至少一个凸出部达到所述预定的侧向运动极限时,所述至少一个凸出部阻止所述旋钮的进一步旋转。
32.根据权利要求30所述的外科器械,其中所述旋转止动件包括:
门,所述门包括第一翼和第二翼,其中所述第一翼和第二翼成角度设置,其中所述门设置在所述护罩内,并且其中所述门允许所述护罩的预定旋转角度。
33.根据权利要求30所述的外科器械,其中所述旋转止动件包括成型挤出元件。
34.根据权利要求33所述的外科器械,其中所述成型挤出元件包括触觉反馈元件。
35.根据权利要求34所述的外科器械,其中所述触觉反馈元件包括半柔顺材料,所述半柔顺材料选自橡胶、中至高密度橡胶、硅树脂、热塑性弹性体、不锈钢弹性件、弹簧钢、铜、形状记忆金属、以及它们中任何的组合。
36.一种超声外科器械,包括:
波导,所述波导包括近侧端部和远侧端部,其中所述近侧端部联接到换能器;
端部执行器,所述端部执行器联接到所述波导的远侧端部;
夹持臂,所述夹持臂操作地联接到所述端部执行器;和
管,所述管设置在所述波导上,其中所述管包括反向偏转元件,其中所述反向偏转元件能够允许所述刀的偏转,其中所述刀的偏转抵消由在处于夹持位置时的所述夹持臂施加于所述刀上的力。
37.一种外科器械,包括:
波导,所述波导包括近侧端部和远侧端部,其中所述近侧端部联接到信号源,所述信号源能够提供超声信号和电外科信号;
端部执行器,所述端部执行器联接到所述波导;
夹持臂,所述夹持臂操作地联接到所述端部执行器;和
密封按钮,其中所述密封按钮致使所述外科器械向所述端部执行器和所述夹持臂递送所述电外科信号持续第一周期,并且其中所述密封按钮致使所述外科器械向所述刀递送所述超声信号持续第二周期,其中所述第二周期在所述第一周期之后。
38.一种外科器械,包括:
波导,所述波导包括近侧端部和远侧端部,其中所述近侧端部联接到换能器;
端部执行器,所述端部执行器联接到所述波导的远侧端部;
管,所述管设置在所述波导上;
凸轮表面,所述凸轮表面形成于所述管的外表面上;和
夹持臂,所述夹持臂操作地联接到所述凸轮表面。
39.根据权利要求38所述的外科器械,包括:
枢轴销,所述枢轴销位于由所述端部执行器限定的孔穴内,所述枢轴销操作地联接到所述夹持臂,其中所述夹持臂围绕所述枢轴销枢转。
40.根据权利要求39所述的外科器械,其中所述枢轴销位于所述波导的最远侧节点处。
41.根据权利要求38所述的外科器械,其中所述管能够致动,并且其中所述夹持臂通过所述管和所述端部执行器之间的相对运动而相对于所述端部执行器凸轮打开和凸轮闭合。
42.一种外科器械,包括:
波导,所述波导包括近侧端部和远侧端部,其中所述近侧端部联接到换能器;
联接到所述波导的远侧端部的端部执行器,所述端部执行器限定销孔穴;
刚性销,所述刚性销设置在所述销孔穴内;
夹持臂;和
四杆连杆;
其中所述四杆连杆操作地联接到所述夹持臂和所述刚性销,其中所述四杆连杆能够致动以将所述夹持臂运动到夹持位置。
43.根据权利要求42所述的外科器械,包括:
外管,其中所述外管联接到所述四杆连杆,并且其中所述外管将所述四杆连杆从第一位置致动到第二位置。
44.一种超声外科器械,包括:
波导,所述波导包括近侧端部和远侧端部,其中所述近侧端部联接到换能器;和
端部执行器,所述端部执行器联接到所述波导的远侧端部,其中所述端部执行器局部涂覆有热绝缘材料和电绝缘材料,使得所述端部执行器的远侧端部包括一个或多个暴露节段。
45.根据权利要求44所述的超声外科器械,其中所述一个或多个暴露区域为对称的。
46.根据权利要求44所述的超声外科器械,其中所述一个或多个暴露区域为非对称的。
47.根据权利要求44所述的超声外科器械,其中所述一个或多个暴露节段由一个或多个涂覆节段分开。
48.根据权利要求44所述的超声外科器械,其中所述波导完全涂覆有热绝缘材料和电绝缘材料。
49.根据权利要求44所述的超声外科器械,其中所述波导局部涂覆有热绝缘材料和电绝缘材料。
50.一种超声外科器械,包括:
波导,所述波导包括近侧端部和远侧端部,其中所述近侧端部联接到换能器;和
联接到所述波导的远侧端部的端部执行器、操作地连接到所述端部执行器的夹持臂,其中所述夹持臂局部涂覆有热绝缘材料和电绝缘材料,使得所述夹持臂的远侧端部包括一个或多个暴露节段。
51.根据权利要求50所述的超声外科器械,其中所述一个或多个暴露区域为对称的。
52.根据权利要求50所述的超声外科器械,其中所述一个或多个暴露区域为非对称的。
53.根据权利要求50所述的超声外科器械,其中所述一个或多个暴露节段由一个或多个涂覆节段分开。
54.根据权利要求50所述的超声外科器械,其中所述波导完全涂覆有热绝缘材料和电绝缘材料。
55.根据权利要求50所述的超声外科器械,其中所述波导完全涂覆有热绝缘材料和电绝缘材料。
56.一种超声外科器械,包括:
波导,所述波导包括近侧端部和远侧端部,其中所述近侧端部联接到换能器;和
联接到所述波导的远侧端部的端部执行器、操作地连接到所述端部执行器的夹持臂,其中所述夹持臂和所述端部执行器局部涂覆有热绝缘材料和电绝缘材料,使得所述端部执行器的远侧端部和所述夹持臂的远侧端部包括一个或多个暴露节段。
57.根据权利要求56所述的超声外科器械,其中所述一个或多个暴露区域为对称的。
58.根据权利要求56所述的超声外科器械,其中所述一个或多个暴露区域为非对称的。
59.根据权利要求56所述的超声外科器械,其中所述一个或多个暴露节段由一个或多个涂覆节段分开。
60.根据权利要求56所述的超声外科器械,其中所述波导完全涂覆有热绝缘材料和电绝缘材料。
61.根据权利要求56所述的超声外科器械,其中所述波导完全涂覆有热绝缘材料和电绝缘材料。
62.一种超声外科器械,包括:
超声端部执行器,所述超声端部执行器包括超声外科刀和夹持臂;和
隔热罩,所述隔热罩设在距所述超声刀的预定距离处。
63.根据权利要求62所述的超声器械,其中所述隔热罩能够围绕所述超声刀旋转。
64.根据权利要求62所述的超声器械,包括散热器。
65.根据权利要求62所述的超声器械,其中所述隔热罩包括多个孔。
66.根据权利要求62所述的超声器械,其中所述隔热罩包括渐缩部分。
67.一种一体化射频(RF)/超声外科器械,包括:
超声换能器;
插孔连接器,所述插孔连接器电联接到所述超声换能器;和
可滑动凹形配合插头,所述可滑动凹形配合插头能够与所述插孔连接器相配合;
其中所述可滑动凹形配合插头能够在多个位置滑动,以将所述超声换能器电联接到超声能量源或RF能量源。
68.根据权利要求67所述的一体化射频(RF)/超声外科器械,其中所述插孔连接器能够与所述超声换能器一起旋转。
69.根据权利要求67所述的一体化射频(RF)/超声外科器械,其中所述插孔连接器为四引线插孔连接器。
70.根据权利要求67所述的一体化射频(RF)/超声外科器械,其中所述可滑动凹形配合插头能够在第一位置与第二位置之间滑动;
其中在所述第一位置,所述超声换能器电联接到所述超声能量源并且与所述RF能量源电隔离;并且
其中在所述第二位置,所述超声换能器电联接到所述RF能量源并且与所述超声能量源电隔离。
71.一种超声能量驱动的骨钳装置,包括:
至少一个细长构件;
连杆,所述连杆连接到所述至少一个细长构件的远侧端部;
超声换能器,所述超声换能器联接到所述至少一个细长构件;和
枢轴,所述枢轴位于所述至少一个细长构件的超声节点处。
72.根据权利要求71所述的超声能量驱动的骨钳装置,包括:
第二连杆,所述第二连杆连接到所述至少一个细长构件的近侧端部;和
第二枢轴,所述第二枢轴位于所述至少一个细长构件的第二超声处。
73.根据权利要求71所述的超声能量驱动的骨钳装置,包括:
第二细长构件,所述第二细长构件位于所述至少一个细长构件之上;和
阻尼材料,所述阻尼材料设置在所述至少一个细长构件与所述第二细长构件之间。
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US20140135804A1 (en) | 2014-05-15 |
EP2919676A2 (en) | 2015-09-23 |
JP6356139B2 (ja) | 2018-07-11 |
CA2891662C (en) | 2021-11-02 |
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RU2015122618A (ru) | 2017-01-10 |
WO2014078548A3 (en) | 2014-10-16 |
WO2014078548A2 (en) | 2014-05-22 |
US20150164536A1 (en) | 2015-06-18 |
US11324527B2 (en) | 2022-05-10 |
BR112015011202A2 (pt) | 2017-07-11 |
CN104780855B (zh) | 2020-06-30 |
US20150164535A1 (en) | 2015-06-18 |
AU2013344626A1 (en) | 2015-05-07 |
AU2013344626B2 (en) | 2018-12-06 |
JP2016501072A (ja) | 2016-01-18 |
US20220313297A1 (en) | 2022-10-06 |
US20150164537A1 (en) | 2015-06-18 |
KR20150085532A (ko) | 2015-07-23 |
US20150164534A1 (en) | 2015-06-18 |
MX2015006123A (es) | 2015-08-05 |
KR102195413B1 (ko) | 2020-12-29 |
CA2891662A1 (en) | 2014-05-22 |
US20150157356A1 (en) | 2015-06-11 |
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