CN105011978B - 手术吻合装置和将手术支撑件粘附于其上的方法 - Google Patents

手术吻合装置和将手术支撑件粘附于其上的方法 Download PDF

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CN105011978B
CN105011978B CN201410855756.4A CN201410855756A CN105011978B CN 105011978 B CN105011978 B CN 105011978B CN 201410855756 A CN201410855756 A CN 201410855756A CN 105011978 B CN105011978 B CN 105011978B
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托马斯·卡萨桑塔
肯尼斯·惠特菲尔德
里查德·辛普森
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Covidien LP
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
    • A61B17/105—Wound clamp magazines
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07292—Reinforcements for staple line, e.g. pledgets
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00526—Methods of manufacturing
    • A61B2017/0053—Loading magazines or sutures into applying tools
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00831—Material properties
    • A61B2017/00884—Material properties enhancing wound closure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00831—Material properties
    • A61B2017/00893—Material properties pharmaceutically effective
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B2017/0688—Packages or dispensers for surgical staplers

Abstract

本发明公开了一种手术吻合装置和将手术支撑件粘附于其上的方法。手术吻合装置包含工具组件、至少一个手术支撑件、及有弹性的多孔材料。工具组件包含钉仓组件和可枢转地联接至钉仓组件的砧座组件。钉仓组件包含限定吻合钉保持狭槽的第一组织面对表面。砧座组件包含第二组织面对表面，第二组织面对表面限定用于成形从钉仓组件的吻合保持狭槽排出的吻合钉的吻合钉凹穴。至少一个手术支撑件可释放地布置在第一组织面对表面和第二组织面对表面中的至少一个上。有弹性的多孔材料可释放地布置在第一组织面对表面和第二组织面对表面之间，且与至少一个手术支撑件接触。有弹性的多孔材料配置为：通过钉仓组件和砧座组件的接近，基于其压缩将液体从其排出。

Description

手术吻合装置和将手术支撑件粘附于其上的方法
技术领域
本公开涉及一种手术装置，该手术装置具有与其合并的支撑件材料。更具体地，本公开涉及一种手术吻合装置，该手术吻合装置包含可拆卸的手术支撑件和有弹性的多孔材料，该材料与手术支撑件一起可释放地更换的且有助于将手术支撑件粘附于手术吻合装置的组织面对表面。
背景技术
在本领域中，公知用于抓紧或夹紧在相对的钳夹结构件之间的组织且然后通过手术紧固件结合组织的手术装置。在一些器械中，刀具设置成切割已经被紧固件结合的组织。紧固件的典型形式为手术吻合钉，但是也可使用两件式聚合的紧固件。
用于这个目的的器械可包含两个细长的钳夹构件，所述两个细长的钳夹构件各自用于捕捉或夹紧组织。在某些手术吻合器中，钳夹构件之一承载容置以至少两横排的方式布置的多个吻合钉的吻合钉钉仓，而另一钳夹构件具有限定一表面的砧座，该表面用于在吻合钉从吻合钉钉仓驱动时成形吻合钉钉腿。通过纵向地移动穿过吻合钉钉仓的凸轮构件，凸轮构件作用在吻合钉推进器上来将吻合钉从吻合钉钉仓按序地弹射出，来实现吻合操作。
上述的每一器械设计为用在手术操作中，在该手术操作中，医生能够直接手动地进入到操作部位。然而，在如内窥镜或腹腔镜操作的微创操作中，通过小的切口或通过窄的套管插入皮肤中的小的进入伤口来执行手术。为了解决微创手术操作的具体需求，手术吻合装置已经开发出且被公布在如专利号为5,332,142(鲁宾逊(Robinson)等人)的美国专利中；以及专利号为6,241,139(米利曼(Milliman)等人)的美国专利中，上述专利的全部内容通过引用合并于此。这些器械包含手术吻合装置和装载单元。典型地，装载单元在快要手术之前被附接至装置。在使用之后，装载单元可从装置上移除，且新的装载单元可被紧固到装置，以执行附加的吻合和/或切割操作。这些器械已经提供了显著的临床效果。虽然如此，但仍然期望对于这些器械的改进。
当吻合相对薄的或易损坏的组织时，有效地密封吻合线而防止空气或流体泄漏是重要的。附加地，常常有必要使紧靠组织的吻合线加强来防止组织撕开或拉动吻合钉穿过组织。防止撕开或拉动穿过的一个方法涉及生物相容的织物加强材料或“支撑件”材料在吻合钉与下面组织之间的安置。在这方法中，支撑件材料层紧靠组织安置，且组织以传统方式吻合。在另一方法中，在吻合组织之前，将支撑件材料定位在其吻合器械上。对于McKean等人的专利号为5,542,594的美国专利中公布这个方法的实例，该专利的全部内容通过引用合并于此。在McKean等人的专利中，支撑件材料管在吻合器的钳夹上滑动。吻合器然后被致动来吻合目标组织，且将在组织和吻合线之间的支撑件材料固定以加强组织和吻合线。
用于微创或开放式机械手术吻合装置的预先装载的或在出售之后加上的支撑件材料，在通过手术吻合装置抓紧且操纵组织期间，可能会相对于这些材料所附接的吻合器再装载的钉仓组件和砧座组件移动位置。如果在发射手术吻合装置之前，支撑件材料的移位是明显的且通过医生不能改正，则吻合钉可能会在支撑件材料的周边或宽度的外侧成形，从而降低通过支撑件材料加强的整个吻合线的效果。
发明内容
根据本公开，提供了一种手术吻合装置。所述手术吻合装置包含工具组件、手术支撑件以及有弹性的多孔材料。所述工具组件包含钉仓组件和可枢转地联接至所述钉仓组件的砧座组件。所述钉仓组件包含限定吻合钉保持狭槽的第一组织面对表面。所述砧座组件包含第二组织面对表面，所述第二组织面对表面限定用于成形从钉仓组件的吻合保持狭槽排出的吻合钉的吻合钉凹穴。所述手术支撑件可释放地布置在所述第一组织面对表面和所述第二组织面对表面中的至少一个上。所述有弹性的多孔材料可释放地布置在所述第一组织面对表面和所述第二组织面对表面之间，且与所述手术支撑件接触。所述有弹性的多孔材料配置为：通过所述钉仓组件和所述砧座组件的接近，基于其压缩将液体从其排出。
在实施例中，所述有弹性的多孔材料可包含海绵状物。所述海绵状物可具有长椭圆形的形状且可具有第一端和第二端。所述海绵状物可从所述第一端至所述第二端成锥形。
在实施例中，所述有弹性的多孔材料可具有与所述手术支撑件的长度相等的长度以及与所述手术支撑件的宽度相等的宽度。所述有弹性的多孔材料可被定大小和形状，以占据限定在所述第一组织面对表面和所述第二组织面对表面之间的空间。所述有弹性的多孔材料可具有顶部表面和底部表面。所述顶部表面与所述第二面对表面靠紧接合，并且所述底部表面与所述手术支撑件靠紧接合。预期到的是，所述有弹性的多孔材料可包含水溶性的粘合剂。
在实施例中，所述钉仓组件和所述砧座组件可相对于彼此从第一间隔开的位置选择地移动至第二接近的位置。在第二接近的位置中，所述钉仓组件和所述砧座组件可协作以抓紧在两者之间的组织。
在实施例中，所述手术支撑件可通过至少一个锚固件被固定至所述砧座组件和所述钉仓组件中的至少一个上。
根据本公开，提供了一种手术吻合系统。所述系统包含工具组件、手术支撑件、以及有弹性的多孔材料。所述工具组件包含钉仓组件和可枢转地联接至所述钉仓组件的砧座组件。所述钉仓组件包含限定吻合钉保持狭槽的第一组织面对表面。所述砧座组件包含第二组织面对表面，所述第二组织面对表面限定用于成形从钉仓组件的吻合保持狭槽排出的吻合钉的吻合钉凹穴。所述手术支撑件可释放地布置在第一组织面对表面和第二组织面对表面的至少一个上。所述有弹性的多孔材料配置为可释放地布置在所述第一组织面对表面和所述第二面对表面之间，且与所述手术支撑件接触。所述有弹性的多孔材料配置为：通过所述钉仓组件和所述砧座组件的接近，基于其压缩将液体从其排出。
在实施例中，所述有弹性的多孔材料可具有与所述手术支撑件的长度相等的长度以及与所述手术支撑件的宽度相等的宽度。
根据本公开，提供了一种制备手术吻合装置的方法。所述方法包含提供包含钉仓组件和可枢转地联接至所述钉仓组件的砧座组件的工具组件。所述钉仓组件和所述砧座组件各自具有组织面对表面。所述方法进一步包含：提供可释放地固定至所述砧座组件和所述钉仓组件中的至少一个的组织面对表面的手术支撑件；将有弹性的多孔材料布置在钉仓组件和砧座组件的组织面对表面之间，以便所述有弹性的多孔材料与所述至少一个手术支撑件靠紧接合；将所述有弹性的多孔材料弄湿；以及使所述钉仓组件和所述砧座组件接近，以压缩在两者之间的所述有弹性的多孔材料，以便液体离开所述有弹性的多孔材料且接触手术支撑件。
在实施例中，所述有弹性的多孔材料可具有与手术支撑件的长度相等的长度以及与手术支撑件的宽度相等的宽度。所述有弹性的多孔材料可被定大小和形状，以占据限定在所述钉仓组件和所述砧座组件的组织面对表面之间的空间。所述有弹性的多孔材料可具有顶部表面和底部表面。所述顶部表面可与所述砧座组件的组织面对表面靠紧接合，并且所述底部表面可与所述手术支撑件靠紧接合。
在实施例中，将所述有弹性的多孔材料弄湿包含：在使所述钉仓组件和所述砧座组件接近之前，将所述有弹性的多孔材料插入盐溶液中。
结合附图，附加的优点将从下文的描述中变得显而易见的。
附图说明
参考附图，将进一步描述本公开，其中同样的附图标记表示几幅视图中的同样的部件，且其中：
图1是依照本公开的实施例的手术吻合装置的立体图；
图2是图1示出的手术吻合装置的装载单元的远侧端的部件分离的俯视立体图；
图3A是图2示出的装载单元的砧座组件的远侧端的放大立体图，图示出可操作地固定至其组织面对表面的手术砧座支撑件；
图3B是图2示出的装载单元的钉仓组件的放大立体图，图示出固定至其组织面对表面的手术钉仓支撑件；
图4是依照本公开的实施例的装载单元以包装的方式布置且包含钉仓组件和有弹性的多孔材料的立体图；
图5A图示出图4示出的有弹性的多孔材料，其在图2示出的装载单元的闭合之前，处于第一膨胀状态；以及
图5B图示出图4示出的有弹性的多孔材料，其在图4示出的装载单元的闭合之后，处于第二压缩状态。
具体实施方式
参考附图，现在将详细地描述本公开的手术吻合装置的实施例，其中同样的附图标记指代几幅视图中的每一视图的同一或对应的元件。
在以下的附图和说明中，如传统的，术语“近侧”将指的是手术吻合装置的靠近操作者的一端，而术语“远侧”指的是手术吻合装置的远离操作者的一端。
应该理解的是，多种手术吻合装置可与本公开的手术支撑件一起使用。例如，可使用以下线性吻合器构造，如：那些包含通过柯惠公司(Covidien)可购买到的具有Tri-StapleTM技术的Endo GIATM加强的再装载器和吻合器，以及同样通过柯惠公司可购买到的横切吻合的吻合器。还应该意识到的是，本公开的原理同等地应用到以下具有替换的构造的手术吻合器，如：具有圆形钉仓和砧座的端对端吻合的吻合器(见，如名称为“手术紧固件施加装置(Surgical Fastener Applying Apparatus)”的专利号为5,915,616的共同拥有的美国专利，该专利的全部内容通过引用合并于此)；腹腔镜吻合器(见，如各自名称为“手术吻合装置(Surgical Stapling Apparatus)”的专利号为6,330,965和6,241,139的共同拥有的美国专利，这些专利的全部内容通过引用合并于此)；以及横切吻合的吻合器(见，如名称为“手术紧固件施加装置(Surgical Fastener Applying Apparatus)”的专利号为5,964,394的共同拥有的美国专利，该专利的全部内容通过引用合并于此)。
图1示出大体以10表示的如手术吻合装置的手术装置，其包含装载单元16、附接至其上的手术支撑件“B1”、“B2”、以及与其一起可更换的大体以200表示的有弹性的多孔材料(如海绵状物)。海绵状物200用于把手术支撑件“B1”、“B2”弄湿，以有助于将手术支撑件“B1”、“B2”粘附至手术紧固装置10。为了简洁起见，本公开将重点放在手术吻合装置10的装载单元16、手术支撑件“B1”、“B2”以及海绵状物200上。手术吻合装置10的剩余部件以及使用方法的详细论述公开在专利号为6,241,139的美国专利中，该专利的公开已经通过引用合并于此。
手术吻合装置10可为内窥镜装置，且包含手柄组件12和从手柄组件12延伸的细长主体14。包含工具组件17的装载单元16可释放地固定至细长主体14的远侧端。而且，本公开预期到具有可代替的钉仓的手术吻合装置，该可代替的钉仓被接纳在装置的末端执行器(末端执行器为可移除的和可代替的或可形成手柄以及细长主体的一体部件)中。
手柄组件12包含固定手柄构件22、活动手柄构件24、以及枪管部26。旋转构件28安装在枪管部26的前端，以有助于细长主体14以及附接的装载单元16相对于手柄组件12的旋转。关节式运动杆30邻近旋转构件28也安装在枪管部26的前端，以有助于工具组件17的关节式运动。优选地，一对突出物32沿枪管部26移动地定位。突出物32向远侧地推进，以使工具组件17接近或闭合，而向近侧收缩以使工具组件17未接近或打开。
如在此示出的，装载单元16(图2)配置为施加六(6)个线性排的吻合钉，其在装载单元中测量长度为大约30mm至大约60mm。也预想到用于施加任一数量排吻合钉的、以各种图案布置的吻合钉凹穴的装载单元，和/或具有任何其它长度(如45mm)的装载单元和末端执行器。
装载单元16期望选择性地可移除地联接至细长主体14。装载单元16包含壳体部36，该壳体部36具有适于可释放地接合细长主体14的远侧端的近侧端。安装组件38在“P”处可枢转地固定至壳体部36的远端，且配置为接纳工具组件17的近侧端，以便工具组件17在“P”处的绕轴(垂直于壳体部36的纵轴)的枢转运动实现工具组件17的关节式运动。
如上所述，装载单元16包含工具组件17。工具组件17包含容置多个手术紧固件或吻合钉84(见图2)的钉仓组件18，以及相对于钉仓组件18以并置关系固定的砧座组件20。砧座组件20和钉仓组件18相对于彼此从第一间隔开的位置选择地可移动(如枢转)至第二接近的位置来闭合工具组件17。
如图2所图示的，可参考于2009年8月31日提交的名称为“用于手术吻合装置的工具组件(TOOL ASSEMBLY FOR A SURGICAL STAPLING DEVICE)”的专利号为7819896美国专利，该专利的公开通过引用合并于此，用于工具组件17的结构以及操作的典型论述。
继续参考图2，砧座组件20包含具有组织面对表面72的砧座板70。多个吻合钉成形凹穴/腔(未示出)限定在组织面对表面72中。砧座组件20进一步包括固定至砧座板70的顶部表面的盖板74，该盖板74与组织面对表面72相对。砧座板70限定一对近侧的凹槽70d，所述一对近侧的凹槽70d接近砧座板70的近侧端73形成且分别布置在纵向狭槽70b的相对侧。砧座板70限定一对远侧的凹槽70e，所述一对远侧的凹槽70e接近砧座板70的远侧端75形成且分别布置在纵向狭槽70b的相对侧。
如图2和图3A所见，砧座组件20进一步包括手术砧座支撑件“B1”(纱布等)，该手术支撑件“B1”通过锚固件“S1”、“S2”可操作地固定至砧座板70的下表面或组织面对表面72，以覆盖砧座凹穴中的至少一些和/或纵向狭槽70b的至少一部分长度。具体地，锚固件“S2”围绕手术砧座支撑件“B1”的近侧部以及一对近侧的凹槽70d中的每一个系紧，并且锚固件“S1”围绕手术砧座支撑件“B1”的远侧部以及一对远侧的凹槽70e中的每一个系紧。本申请预期到的是，可通过如使用粘合剂的其它方式来附接支撑件。
手术砧座支撑件“B1”进一步包含从其远侧边缘延伸的舌状部或凸起部，以有助于在装配过程期间将手术砧座支撑件“B1”附接至砧座组件20。预期到的是，继手术砧座支撑件“B1”附接至砧座组件20之后且在包装或装运之前，舌状部从手术砧座支撑件“B1”移除。在一些实施例中，通过如粘合剂、缝合线和/或摩擦接合的各种紧固接合，手术砧座支撑件“B1”可移除地固定至砧座板70的组织面对表面72。
在操作中，手术砧座支撑件“B1”紧靠砧座板70的组织面对表面72固定。在手术吻合装置10的发射期间，刀片66(图2)可切穿近侧缝合线“S2”的中央段，从而使手术砧座支撑件“B1”的近侧端摆脱砧座组件20。在使用期间，在手术吻合装置10的发射行程接近完成时，释放机构(未示出)释放远侧缝合线“S1”，并且手术砧座支撑件“B1”无约束地从砧座板70的组织面对表面72分离。释放机构可包含用于切下一个或多个锚固件的单独的刀具，或可包含用于把锚固件从收缩的狭槽简单地推开的杆或其它构件。在实施例中，在手术支撑件“B1”与组织吻合且固定之后，工具组件17的打开提供足够大的力来使手术支撑件“B1”从砧座板70的组织面对表面72分离。
如图1、图2和图3B所见，钉仓组件18包含组织面对表面82，该组织面对表面82限定在其中的保持狭槽82a，该保持狭槽82a用于接纳多个紧固件84和推进器86。钉仓组件18限定一对近侧的凹槽82e，所述一对近侧的凹槽82e接近钉仓组件18的近侧端83形成且分别布置在纵向狭槽82c的相对侧。吻合钉钉仓组件18进一步限定一对远侧的凹槽82f，所述一对远侧的凹槽82f接近吻合钉钉仓组件18的远侧端85形成且分别布置在纵向狭槽82c的相对侧。在一个实施例中，一对近侧的凹槽82e以及一对远侧的凹槽82f中的每一个的至少一个凹槽优选为非圆形的和收缩的或不同地布置，以便摩擦地接合和/或挤压锚固件“S3”、“S4”。
如图2和图3B所见，钉仓组件18进一步包括手术钉仓支撑件“B2”(纱布等)，该手术钉仓支撑件“B2”通过锚固件“S3”、“S4”可操作地固定至吻合钉钉仓组件18的上表面或组织面对表面82，以覆盖吻合钉凹穴82a中的至少一些和/或纵向狭槽82c的至少一部分长度。具体地，锚固件“S4”围绕手术钉仓支撑件“B2”近侧部的和一对近侧凹槽82e中的每一个系紧，并且锚固件“S3”围绕手术钉仓支撑件“B2”的远侧部和一对远侧凹槽82f中的每一个系紧。在一些实施例中，通过如粘合剂、缝合线和/或摩擦接合的各种紧固接合，手术钉仓支撑件“B2”可移除地固定至钉仓组件18的组织面对表面82。在一些实施例中，组织面对表面72、82中的仅仅一个具有附接至其上的手术支撑件。
用于与在此公开的手术吻合装置一起使用的典型的手术支撑件被示出且被描述在专利号为5,542,594、5,908,427、5,964,774、和6,045,560的共同的受让的美国专利和于2009年10月15日提交的申请号为12/579,605的共同的受让的美国申请(现在是美国专利公布第2010/0092710号，现在是专利号为8,157,151的美国专利)、于2005年9月30日提交的申请号为11/241,267的共同的受让的美国申请(美国专利公布第2006/0085034号，现在是专利号为7,938,307的美国专利)、以及于2005年10月12日提交的申请号为11/248,846的美国申请(美国专利公布第2006/0135992号，现在是专利号为7,823,592的美国专利)中，这些专利中的每一个的全部内容通过引用合并于此。依照公布在美国专利公布第2013/0123816号和/或第2013/0112731号的中的方法和材料，也可制造支撑件，这些专利的全部内容通过引用合并于此。
根据本公开，代替或除了用于将手术支撑件“B1”、“B2”附接至手术吻合装置10的砧座组件20的组织面对/接触表面72和/或手术吻合装置10的钉仓组件18的组织面对/接触表面82的上文公布的方法和系统之外，手术支撑件“B1”、“B2”能以大量的不同的方式进一步地附接至手术吻合装置10的组织面对表面72、82。
参考图4、图5A和图5B，示出可与工具组件17一起更换的海绵状物200。如图4所示，海绵状物200和工具组件17可设置成手术紧固系统100。海绵状物200和工具组件17能以泡沫包装的方式来布置，所述泡沫包装被定大小和形状以便容纳海绵状物200和工具组件17两者且使海绵状物200和工具组件17维持在无菌的和紧密的状态。如在下文详细描述的，海绵状物200由具有有弹性或可压缩的材料制成，该材料是多孔性的且配置为容易地吸收且保持在其中的液体，并且配置为基于其压缩来将液体从其排出。
在实施例中，海绵状物200可由各种材料制成，如天然的、人工制造的和/或合成材料、或可包含由天然材料制造的合成材料(如由天然的纤维素制造的合成纤维)。海绵状物200可由纤维素、如纤维素乙酸酯、三乙酸纤维素的纤维素酯、以及如棉线或人造纤维丝的纤维素天然的材料形成。海绵状物200也可由以下材料形成：如尼龙的聚酰胺、如聚乙烯和聚丙烯的聚烯烃、丙烯酸树脂、变性聚丙烯腈纤维、橡胶、塑料、热塑性塑料、聚乙烯醇、聚酯纤维、聚亚胺酯、聚醚聚氨酯(polyether urethane)、聚氯乙烯、乙烯基腈聚合物(vinylnitrile polymer)、硅酮、乳胶、其组合物和衍生物、以及在本领域的技术人员所知的其它的能吸收的材料。海绵状物200也可包含网状的、开孔的和/或闭孔的泡沫。
海绵状物200被定大小和形状来可释放地布置在砧座组件20和钉仓组件18的组织面对表面72、82。如图4和图5A所示，海绵状物200被定大小和形状以在工具组件17处于打开位置时，占据大体V形空间“SP”，该空间“SP”限定在砧座组件20和钉仓组件18的组织面对表面72、82之间。当海绵状物200布置在组织面对表面72、82之间时，海绵状物200靠紧手术支撑件“B1”、“B2”来使工具组件17朝向打开位置有弹性地偏置。预期到的是，海绵状物200包含在钉仓组件18和/或砧座组件20上能滑动的带子、腰带、钩状物、弹性带等(未示出)，以用其协助固定海绵状物200。
海绵状物200具有第一端或近侧端202和第二端或远侧端204，且限定在两者之间的成锥形的轮廓。海绵状物200具有与工具组件17的空间“SP”形状一致或对应的长椭圆形的形状。海绵状物200的第一端202具有比海绵状物200的第二端204的厚度“T2”小的厚度“T1”，以便海绵状物200在第一端和第二端之间成锥形。如图4和图5A所示，第一端202的厚度“T1”基本上等于高度“H1”(图4)，当工具组件17处于打开位置时，该高度“H1”限定在钉仓组件18和砧座组件20的近侧端83、73之间。如图4和图5A所示，海绵状物200的第二端204具有基本上等于高度“H2”(图4)的厚度“T2”，当工具组件17处于打开位置时，该高度“H2”限定在钉仓组件18和砧座组件20的远侧端85、75之间。海绵状物200具有与手术支撑件“B1”、“B2”的长度基本上相等的长度，以及与手术支撑件“B1”、“B2”的宽度基本上相等的宽度，以便使在海绵状物200和手术支撑件“B1”、“B2”之间的接触表面积最大化。如此，海绵状物200具有对应于空间“SP”形状的总体形状。
海绵状物200具有顶部表面206和底部表面208，该顶部表面206和该底部表面208在第一端202和第二端204之间各自延伸。表面206、208可为平面的，以使在海绵状物200和手术支撑件“B1”、“B2”之间的接触表面积最大化。在实施例中，纵向沟槽或通道(未示出)限定在配置为相应地容纳砧座组件20和钉仓组件18的组织面对表面72、82的顶部表面206和底部表面208中，以便海绵状物200在工具组件17的空间“SP”内的横向运动被阻止和/或防止。当海绵状物200布置在工具组件17的空间“SP”内时，顶部表面206与手术支撑件“B1”或砧座组件20的组织面对表面72靠紧接合，而底部表面208与手术支撑件“B2”或钉仓组件18的组织面对表面82靠紧接合。
在一些实施例中，海绵状物200可为各种形状和构造，如均匀的、非均匀的、平面的、波状的、弓形的、长方形的、圆形的、三角形的、V形的、U形的、多变形的和/或可变的。在一些实施例中，凸缘或唇缘(未示出)从顶部表面206和底部表面208的远侧端204延伸，其配置为与砧座组件20和钉仓组件18的远侧端75、85重叠，以阻止和/或防止海绵状物200从在钉仓组件18和砧座组件20之间向远侧移出。
海绵状物200可包含如聚糖的水溶性的粘合剂，该水溶性的粘合剂湿时，将有助于手术支撑件“B1”、“B2”与钉仓组件18和砧座组件20的组织面对表面82、72的能释放的保持。在一些实施例中，手术支撑件“B1”、“B2”包含第一成分，而海绵状物200包含第二成分。基于被弄湿和结合第一成分和第二成分，形成粘合剂。预期到的是，海绵状物200可为预先弄湿的且有囊包着的，以便基于钉仓组件18和砧座组件20的接近，囊破裂以使预先弄湿的海绵状物200暴露。
在操作中，装载单元16联接至手术紧固装置10的细长主体14。如图4和图5A所示，通过将工具组件17处于打开或未接近位置，海绵状物200布置在组织面对表面72、82之间，以便海绵状物200与手术支撑件“B1”、“B2”靠紧接合。通过如将工具组件17插入如盐溶液的液体浴中来弄湿海绵状物200。预期到的是，工具组件17可在浸入盐溶液时闭合且然后打开，以有助于盐溶液吸收进入海绵状物200内。进一步预期到的是，海绵状物200在被定位在组织面对表面72、82之间之前被弄湿。因此，弄湿海绵状物200的步骤可包含将海绵状物200预先弄湿。例如，如上文所述，海绵状物200可被预先弄湿且布置在囊内，该囊配置为基于工具组件17的闭合而破裂。在一些实施例中，液体浴可包含粘合剂。
手柄组件12被致动来使钉仓组件18和砧座组件20接近。如图5B所示，钉仓组件18和砧座组件20的接近会压缩在两者之间的海绵状物。海绵状物200的压缩引起盐溶液离开海绵状物200而接触手术支撑件“B1”、“B2”。由工具组件17的闭合所提供的夹紧压力或力引起盐溶液渗入和/或渗透手术支撑件“B1”、“B2”，其中该夹紧压力或力通过海绵状物200传递至手术支撑件“B1”、“B2”。如图5A所示，预想到的是，海绵状物200为足够有弹性地偏置到其未被压缩的或自然的状态，以便包含在其中的液体基于其压缩而从海绵状物200强制地排出。
如图5B所示，工具组件17可被保持在完全接近的位置，以便海绵状物200可继续将盐溶液从其传送至手术支撑件“B1”、“B2”。海绵状物200从在钉仓组件18和砧座组件20的组织面对表面82、72之间被移除，以便手术紧固装置10能以其用于吻合组织的普通方式来使用。
根据本公开的原理，海绵状物200有效地驱动液体进入手术支撑件“B1”、“B2”内和/或到手术支撑件“B1”、“B2”上，以使液体至少局部地浸透手术支撑件“B1”、“B2”。已经发现的是，与干的手术支撑件相比，处于弄湿状态的手术支撑件更好地粘附于钉仓组件和砧座组件的组织面对表面。因此，通过使用海绵状物200使得液体至少局部地浸透手术支撑件“B1”、“B2”，在手术紧固装置10的使用期间，阻止和/或防止手术支撑件“B1”、“B2”沿组织面对表面72、82横向地移位或滑动。
将理解的是，可对在此公开的实施例作出各种改进。因此，上文描述不应该解释为限制，而是仅仅作为优选实施例的示例。本领域的技术人员将预想到在随附其上的权利要求书的范围和构思内的其它改进。

Claims (22)

1.一种手术吻合装置，包括：
钉仓组件，其包含限定吻合钉保持狭槽的第一组织面对表面；
砧座组件，其可枢转地联接至所述钉仓组件，且包含第二组织面对表面，所述第二组织面对表面限定用于成形从钉仓组件的吻合保持狭槽排出的吻合钉的吻合钉凹穴；
至少一个手术支撑件，其可释放地布置在所述第一组织面对表面和所述第二组织面对表面之一上；以及
有弹性的多孔材料，其可释放地布置在所述第一组织面对表面和所述第二组织面对表面之间，且与所述至少一个手术支撑件接触，其中，所述有弹性的多孔材料配置为：通过所述钉仓组件和所述砧座组件的接近，基于所述有弹性的多孔材料的压缩将液体从其排出。
2.根据权利要求1所述的手术吻合装置，其中所述有弹性的多孔材料为海绵状物。
3.根据权利要求2所述的手术吻合装置，其中所述海绵状物具有长椭圆形的形状且具有第一端和第二端，其中所述海绵状物从所述第一端至所述第二端成锥形。
4.根据权利要求1所述的手术吻合装置，其中所述有弹性的多孔材料具有与所述至少一个手术支撑件的长度相等的长度以及与所述至少一个手术支撑件的宽度相等的宽度。
5.根据权利要求1所述的手术吻合装置，其中所述有弹性的多孔材料被定大小和形状，以占据限定在所述第一组织面对表面和所述第二组织面对表面之间的空间。
6.根据权利要求1所述的手术吻合装置，其中所述有弹性的多孔材料具有顶部表面和底部表面，所述顶部表面与所述第二组织面对表面靠紧接合，并且所述底部表面与所述至少一个手术支撑件靠紧接合。
7.根据权利要求1所述的手术吻合装置，其中所述钉仓组件和所述砧座组件能够相对于彼此从第一间隔开的位置选择地移动至第二接近的位置，其中所述钉仓组件和所述砧座组件协作来抓紧在两者之间的组织。
8.根据权利要求1所述的手术吻合装置，其中所述有弹性的多孔材料包含水溶性的粘合剂。
9.根据权利要求1所述的手术吻合装置，其中所述至少一个手术支撑件通过至少一个锚固件被固定至所述砧座组件和所述钉仓组件中的至少一个上。
10.一种手术吻合系统，包括：
工具组件，其包含：
钉仓组件，其包含限定吻合钉保持狭槽的第一组织面对表面；
砧座组件，其可枢转地联接至所述钉仓组件，且包含第二组织面对表面，所述第二组织面对表面限定用于成形从钉仓组件的吻合保持狭槽排出的吻合钉的吻合钉凹穴；以及
手术支撑件，其可释放地布置在所述钉仓组件和所述砧座组件的组织面对表面中的至少一个上；以及
有弹性的多孔材料，其配置为可释放地布置在所述第一组织面对表面和所述第二组织面对表面之间，且与所述手术支撑件接触，其中，所述有弹性的多孔材料配置为：通过所述钉仓组件和所述砧座组件的接近，基于所述有弹性的多孔材料的压缩将液体从其排出。
11.根据权利要求10所述的手术吻合系统，其中所述有弹性的多孔材料为海绵状物。
12.根据权利要求11所述的手术吻合系统，其中所述海绵状物具有长椭圆形的形状且具有第一端和第二端，其中所述海绵状物从所述第一端至所述第二端成锥形。
13.根据权利要求10所述的手术吻合系统，其中所述有弹性的多孔材料具有与所述手术支撑件的长度相等的长度以及与所述手术支撑件的宽度相等的宽度。
14.根据权利要求10所述的手术吻合系统，其中所述有弹性的多孔材料包含水溶性的粘合剂。
15.一种制备手术吻合装置的方法，所述方法包括：
提供工具组件，其包含：
钉仓组件，其具有第一组织面对表面；以及
砧座组件，其具有第二组织面对表面；
提供可释放地固定至所述第一组织面对表面或所述第二组织面对表面的至少一个手术支撑件；
将有弹性的多孔材料布置在所述第一组织面对表面和所述第二组织面对表面之间，以便所述有弹性的多孔材料与所述至少一个手术支撑件靠紧接合；
将所述有弹性的多孔材料弄湿；以及
使所述钉仓组件和所述砧座组件接近，以压缩在两者之间的所述有弹性的多孔材料，以便液体离开所述有弹性的多孔材料且接触所述至少一个手术支撑件。
16.根据权利要求15所述的方法，其中所述有弹性的多孔材料为海绵状物。
17.根据权利要求16所述的方法，其中所述海绵状物具有长椭圆形的形状且具有第一端和第二端，其中所述海绵状物从所述第一端至所述第二端成锥形。
18.根据权利要求15所述的方法，其中所述有弹性的多孔材料具有与所述至少一个手术支撑件的长度相等的长度以及与所述至少一个手术支撑件的宽度相等的宽度。
19.根据权利要求15所述的方法，其中所述有弹性的多孔材料被定大小和形状，以占据限定在所述第一组织面对表面和所述第二组织面对表面之间的空间。
20.根据权利要求15所述的方法，其中所述有弹性的多孔材料具有顶部表面和底部表面，所述顶部表面与所述第二组织面对表面靠紧接合，并且所述底部表面与所述至少一个手术支撑件靠紧接合。
21.根据权利要求15所述的方法，其中将所述有弹性的多孔材料弄湿包含：在使所述钉仓组件和所述砧座组件接近之前，将所述有弹性的多孔材料插入盐溶液中。
22.根据权利要求15所述的方法，其中所述有弹性的多孔材料包含水溶性的粘合剂。
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