CN105025812B - 用于外科缝合器械的钉成形特征结构 - Google Patents
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- A61B17/07207—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 the staples being applied sequentially
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Abstract
本发明提供了一种用于外科器械的端部执行器(12),所述端部执行器包括第一钳口(16)和第二钳口(18)。所述第一钳口被构造为能够接收钉仓。所述第二钳口能够相对于所述第一钳口运动且被构造为能够提供用于使钉(350)成形的砧座(18)。所述砧座具有钉成形凹坑(310)。每个钉成形凹坑包括第一钉成形表面区域(320)和第二钉成形表面区域(340),这两个钉成形表面区域被构造为能够接收相应的第一钉腿和第二钉腿。所述第一钉成形表面区域和所述第二钉成形表面区域各自具有大于所述钉成形凹坑的一半长度的相应长度。所述钉成形表面区域可包括凸形表面,所述凸形表面侧向驱动所述钉腿。所述凹坑使得钉腿尖端重新进入组织中的可能性降到最低。
Description
背景技术
在一些情况下,内窥镜式外科器械可优于传统的开放式外科装置,因为较小切口可减少术后恢复时间和并发症。因此,一些内窥镜式外科器械可适于将远侧端部执行器通过套管针的套管设置在所需手术部位处。这些远侧端部执行器(例如,内切割器、抓紧器、切割器、缝合器、施夹器、进入装置、药物/基因治疗递送装置、以及使用超声、RF、激光等的能量递送装置)可以多种方式接合组织,以达到诊断或治疗的效果。内窥镜式外科器械可包括轴,该轴位于端部执行器和由临床医生操纵的手柄部分之间。这种轴可允许插入到所需深度并向轴线旋转,由此有利于端部执行器在患者体内的定位。还可通过添加一个或多个关节运动接头或特征结构而进一步有利于端部执行器的定位,使得端部执行器能够选择性地进行关节运动,或者以其他方式相对于轴的纵向轴线偏转。
内窥镜式外科器械的示例包括外科缝合器。一些此类缝合器能够操作以夹紧组织层,切割穿过夹紧的组织层,并驱动钉穿过组织层,以在组织层的被切断的端部附近将切断的组织层基本上密封在一起。以下文献公开了一些外科缝合器:1989年2月21日公布的名称为“Pocket Configuration for Internal Organ Staplers”的美国专利4,805,823;1995年5月16日公布的名称为“Surgical Stapler and Staple Cartridge”的美国专利5,415,334;1995年11月14日公布的名称为“Surgical Stapler Instrument”的美国专利5,465,895;1997年1月28日公布的名称为“Surgical Stapler Instrument”的美国专利5,597,107;1997年5月27日公布的名称为“Surgical Instrument”的美国专利5,632,432;1997年10月7日公布的名称为“Surgical Instrument”的美国专利5,673,840;1998年1月6日公布的名称为“Articulation Assembly for Surgical Instruments”的美国专利5,704,534;1998年9月29日公布的名称为“Surgical Clamping Mechanism”的美国专利5,814,055;2005年12月27日公布的名称为“Surgical Stapling Instrument Incorporating an E-Beam Firing Mechanism”的美国专利6,978,921;2006年2月21日公布的名称为“SurgicalStapling Instrument Having Separate Distinct Closing and Firing Systems”的美国专利7,000,818;2006年12月5日公布的名称为“Surgical Stapling Instrument havinga Firing Lockout for an Unclosed Anvil”的美国专利7,143,923;2007年12月4日公布的名称为“Surgical Stapling Instrument Incorporating a Multi-Stroke FiringMechanism with a Flexible Rack”的美国专利7,303,108;2008年5月6日公布的名称为“Surgical Stapling Instrument Incorporating a Multistroke Firing MechanismHaving a Rotary Transmission”的美国专利7,367,485;2008年6月3日公布的名称为“Surgical Stapling Instrument Having a Single Lockout Mechanism forPrevention of Firing”的美国专利7,380,695;2008年6月3日公布的名称为“Articulating Surgical Stapling Instrument Incorporating a Two-Piece E-BeamFiring Mechanism”的美国专利7,380,696;2008年7月29日公布的名称为“SurgicalStapling and Cutting Device”的美国专利7,404,508;2008年10月14日公布的名称为“Surgical Stapling Instrument Having Multistroke Firing with Opening Lockout”的美国专利7,434,715;2010年5月25日公布的名称为“Disposable Cartridge withAdhesive for Use with a Stapling Device”的美国专利7,721,930;2010年10月21日公布的名称为“Surgical Stapling Instrument with An Articulatable End Effector”的美国公布2010/0264193;以及2012年9月20日公布的名称为“Motor-Driven SurgicalCutting Instrument with Electric Actuator Directional Control Assembly”的美国公布2012/0239012。上面所引用的美国专利和美国专利公布中的每一者的公开内容以引用方式并入本文。
虽然上文所涉及的外科缝合器被描述为用于内窥镜式手术,但应当理解,此类外科缝合器也可用于开腹手术和/或其他非内窥镜式手术。仅以举例方式,在不使用套管针作为缝合器的导线管的胸外科手术中,外科缝合器可通过胸廓切开术而插入,并由此插入在患者肋骨之间,以到达一个或多个器官。此类手术可包括使用缝合器切断和闭合通向肺部的血管。例如,可由缝合器切断和闭合通向器官的血管,然后把器官从胸腔中取出。当然,外科缝合器可用于各种其他场景和手术。
虽然已经制造和使用各种类型的外科缝合器械和相关部件,但据信在本发明人之前还无人制造或使用所附权利要求中描述的发明。
附图说明
并入本说明书并构成其一部分的附图示出了本发明的多个实施例,并且与上文所给出的本发明的一般说明和下文所给出的实施例的详细说明一起用于解释本发明的原理。
图1示出示例性关节运动式外科缝合器械的透视图;
图2示出图1的器械的侧正视图;
图3示出图1的器械的打开的端部执行器的透视图;
图4A示出图3的端部执行器沿图3的线4-4截取的侧剖面图,其中击发梁处于近侧位置;
图4B示出图3的端部执行器沿图3的线4-4截取的侧剖面图,其中击发梁处于远侧位置;
图5示出图3的端部执行器沿图3的线5-5截取的端部剖面图;
图6示出图3的端部执行器的分解透视图;
图7示出图3的端部执行器的透视图,该端部执行器定位在组织处并且已经在组织中被致动一次;
图8示出用于图1的器械的示例性控制电路的示意图;
图9示出图1的器械的柄部组件的透视图,其中移除了一半外壳;
图10示出图9的柄部组件的驱动组件部件的透视图;
图11示出图10的驱动组件的细长构件的透视图;
图12示出可结合到图1的器械中的示例性另选砧座的透视图;
图13示出图12的砧座的底部平面图;
图14示出图12的砧座的钉成形凹坑的放大平面图;
图15示出图14的钉成形凹坑沿图14的线15-15截取的剖面图;
图16示出图14的钉成形凹坑沿图15的线16-16截取的剖面图;
图17示出图14的钉成形凹坑形成的示例性钉的侧正视图,该钉设置于组织中;
图18A示出处于未成形状态的图17的钉的侧正视图,该钉在钉成形的第一阶段中最初接触图14的钉成形凹坑;
图18B示出图17的钉的侧正视图,该钉在钉成形的第二阶段中被驱动到图14的钉成形凹坑中;
图18C示出图17的钉的侧正视图,该钉在钉成形的第三阶段中被进一步驱动到图14的钉成形凹坑中;
图18D示出图17的钉的侧正视图,该钉在钉成形的第四阶段中被进一步驱动到图14的钉成形凹坑中;
图18E示出图17的钉的侧正视图,该钉在钉成形的最后阶段中被完全驱动到图14的钉成形凹坑中;
图19示出可结合到图1的器械中的另一个示例性另选砧座的透视图;
图20示出图19的砧座的底部平面图;
图21示出图19的砧座的钉成形凹坑的放大透视图;
图22示出图19的砧座的钉成形凹坑的放大平面图;
图23示出图22的钉成形凹坑沿图22的线23-23截取的透视剖面图;
图24示出图19的钉成形凹坑形成的示例性钉的侧正视图,该钉设置于组织中;
图25A示出处于未成形状态的图24的钉的侧正视图,该钉在钉成形的第一阶段中最初接触图19的钉成形凹坑;
图25B示出图24的钉的侧正视图,该钉在钉成形的第二阶段中被驱动到图19的钉成形凹坑中;
图25C示出图24的钉的侧正视图,该钉在钉成形的第三阶段中被进一步驱动到图19的钉成形凹坑中;
图25D示出图24的钉的侧正视图,该钉在钉成形的最后阶段中被完全驱动到图19的钉成形凹坑中;
图26示出可结合到图1的器械的砧座中的另一个示例性另选钉成形凹坑的透视图;
图27示出图26的钉成形凹坑的放大平面图;
图28示出图26的钉成形凹坑沿图27的线28-28截取的剖面图;
图29示出图26的钉成形凹坑沿图28的线29-29截取的剖面图;
图30示出可结合到图1的器械的砧座中的另一个示例性另选钉成形凹坑的透视图;
图31示出图30的钉成形凹坑的放大平面图;
图32示出图30的钉成形凹坑沿图31的线32-32截取的剖面图;
图33A示出在钉成形的第一阶段中被驱动到图30的钉成形凹坑中的钉的透视图;
图33B示出图33A的钉的透视图,该钉在钉成形的第二阶段中被进一步驱动到图30的钉成形凹坑中;
图33C示出图33A的钉的侧剖面图,该钉在钉成形的最后阶段中被完全驱动到图30的钉成形凹坑中;
图34示出图33A的钉的顶部平面图,该钉在钉成形的最后阶段中被完全驱动到图30的钉成形凹坑中;
图35示出可结合到图1的器械的砧座中的另一个示例性另选钉成形凹坑的透视图;
图36示出图35的钉成形凹坑的放大平面图;
图37示出图35的钉成形凹坑沿图36的线37-37截取的剖面图;
图38示出可结合到图1的器械的砧座中的另一个示例性另选钉成形凹坑的透视图;
图39示出图38的钉成形凹坑的放大平面图;
图40示出图38的钉成形凹坑沿图39的线40-40截取的剖面图;
图41示出可结合到图1的器械中的另一个示例性另选砧座上的钉成形凹坑的底部正视图;
图42示出由图41的钉成形凹坑形成的钉的顶部平面图;并且
图43示出由图42的钉固定的组织层。
附图并非意在以任何方式进行限制,并且可以预期本发明的各种实施例能够以多种其他方式来执行,包括那些不必在附图中示出的方式。并入本说明书并构成其一部分的附图示出了本发明的若干方面,并与具体实施方式一起用于说明本发明的原理;然而,应当理解,本发明不受限于所示出的确定布置方式。
具体实施方式
本发明的某些示例的如下描述不应被用来限制本发明的范围。通过以下举例说明设想用于实施本发明的最佳方式之一的描述,本发明的其他示例、特征结构、方面、实施例和优点将对本领域的技术人员显而易见。正如将会意识到的,本发明能够具有其他不同且明显的方面,只要不脱离本发明即可。因此,附图和具体实施方式应被视为实质上是示例性的而非限制性的。
I.示例性外科缝合器
图1-7示出示例性外科缝合和切断器械10,在图1中描绘的非关节运动的状态下,其尺寸设定成穿过套管针的插管插入患者的手术部位,以便执行外科手术。仅以举例方式,该套管针可插入到患者的腹腔中,介于患者的两根肋骨之间或其他地方。在一些环境下,器械10不与套管针一起使用。例如,器械10可通过胸廓切开术或其他类型的切口直接插入。本示例的器械10包括连接至轴22的柄部部分20。轴22远侧终止于关节运动接头11中,该关节运动接头进一步与端部执行器12联接。应当理解,本文所用的术语例如“近侧”和“远侧”是相对于抓持器械10的柄部部分20的临床医生而言的。因此,端部执行器12相对于更近侧的柄部部分20位于远侧。还应当理解,为简洁和清楚起见,本文可结合附图使用空间术语例如“竖直”和“水平”。然而,外科器械在多个取向和位置中使用,这些术语并非意图进行限制,也并非绝对。
在一些形式中,轴22是根据与本文同一日提交的名称为“Surgical Instrumentwith Multi-Diameter Shaft”的美国专利申请[代理人案卷号END7181USNP.0599180]的至少一些教导内容来构造的,其公开内容以引用方式并入本文。参考本文的教导内容,轴22的其他合适构型对于本领域的普通技术人员而言将是显而易见的。
一旦关节运动接头11和端部执行器12穿过套管针的插管通道插入,关节运动接头11就可通过关节运动控件13进行远程关节运动,如图1中以虚像所描绘的,使得端部执行器12可从轴22的纵向轴线(LA)以所需角度(α)偏转。端部执行器12可由此从所需角度或出于其他原因到达器官后面或接近组织。在一些形式中,关节运动接头11允许端部执行器12沿着单个平面偏转。在一些形式中,关节运动接头11允许端部执行器沿着一个以上的平面偏转。关节运动接头11和关节运动控件13可根据本文引用的许多参考文献中的任何参考文献的教导内容来构造。另选地,关节运动接头11和/或关节运动控件13可以具有任何其他合适的构型。仅以举例的方式,关节运动控件13可替代地被构造为旋钮,该旋钮围绕垂直于轴22的纵向轴线(LA)的轴线旋转。
在一些形式中,关节运动接头11和/或关节运动控件13根据以下专利的至少一些教导内容来构造和操作:与本文同一日提交的名称为“Surgical Instrument EndEffector Articulation Drive with Pinion and Opposing Racks”的美国专利申请[代理人案卷号END7174USNP.0599176],其公开内容以引用方式并入本文。关节运动接头11还可根据以下专利的至少一些教导内容来构造和操作:美国专利申请[代理人案卷号END7181USNP.0599180],其公开内容以引用方式并入本文。参考本文的教导内容,关节运动接头11和关节运动控件13可采用的其他合适形式对于本领域的普通技术人员而言将是显而易见的。
本示例的端部执行器12包括下钳口16和可枢转砧座18。在一些形式中,下钳口16是根据以下专利的至少一些教导内容来构造的:与本文同一日提交的名称为“Installation Features for Surgical Instrument End Effector Cartridge”的美国专利申请[代理人案卷号END7182USNP.0599227],其公开内容以引用方式并入本文。砧座18可以根据以下专利的至少一些教导内容来构造:与本文同一日提交的名称为“IntegratedTissue Positioning and Jaw Alignment Features for Surgical Stapler”的美国专利申请[代理人案卷号END7176USNP.0599177],其公开内容以引用方式并入本文;与本文同一日提交的名称为“Jaw Closure Feature for End Effector of Surgical Instrument”的美国专利申请[代理人案卷号END7177USNP.0599225],其公开内容以引用方式并入本文;以及/或者以下教导内容中的至少一些。参考本文的教导内容,下钳口16和砧座18可采用的其他合适形式对于本领域的普通技术人员而言将是显而易见的。
柄部部分20包括手枪式握把24和闭合触发器26。闭合触发器26可朝手枪式握把24枢转,以导致砧座18朝着端部执行器12的下钳口16夹紧、或闭合。砧座18的这种闭合是通过闭合管32和闭合环33提供的,闭合管32和闭合环33两者响应于闭合触发器26相对于手枪式握把24的枢转而相对于柄部部分20纵向地平移。闭合管32沿着轴22的长度延伸;并且闭合环33定位在关节运动接头11的远侧。关节运动接头11可操作地从闭合管32向闭合环33传递/传送纵向运动。
柄部部分20还包括击发触发器28。细长构件136(图11所示)纵向延伸穿过轴22,并响应于击发触发器28的致动,从柄部部分20向击发梁14传递纵向击发运动。击发梁14的这种朝远侧的平移导致被夹紧的组织在端部执行器12中被缝合和切断,如下文将更详细地描述。然后,释放触发器26,28,以从端部执行器12释放组织。
图3-6示出端部执行器12,其采用E形梁形式的击发梁14来执行多种功能。应当理解,E形梁形式仅仅是说明性的示例。击发梁14可采用任何其他合适的形式,包括但不限于非E形梁形式。如图4A-4B中最佳地示出,击发梁14包括横向取向的上部销38、击发梁顶盖44、横向取向的中间销46以及处于远侧的切割刃48。上部销38定位在砧座18的纵向砧座狭槽42内,并能够在所述纵向砧座狭槽内平移。击发梁顶盖44通过使击发梁14延伸穿过下钳口狭槽45(图4B所示)而可滑动地接合下钳口16的下表面,下钳口狭槽45是穿过下钳口16形成的。中间销46可滑动地接合下钳口16的顶表面,从而与击发梁顶盖44协作。由此,击发梁14在击发过程中,必然隔开端部执行器12。
一些非E形梁形式的击发梁14可能没有上部销38、中间销46和/或击发梁顶盖44。在击发梁14朝着远侧位置推进时,一些此类形式的器械10可仅依赖闭合环33或一些其他特征结构来将砧座18枢转到闭合位置上,并将砧座18保持在闭合位置上。仅以举例方式,击发梁14和/或相关联的闭锁特征结构可以根据以下专利的至少一些教导内容来构造和操作:与本文同一日提交的名称为“Lockout Feature for Movable Cutting Member ofSurgical Instrument”的美国专利申请[代理人案卷号END7175USNP.0599231],其公开内容以引用方式并入本文。参考本文的教导内容,击发梁14可采用的其他合适形式对于本领域的普通技术人员而言将是显而易见的。
图3示出本示例的朝近侧定位的击发梁14和枢转到打开位置的砧座18,从而允许未用完的钉仓37可拆卸地安装到下钳口16的通道中。如图5-6中最佳地示出,该示例的钉仓37包括仓体70,该仓体呈现上部平台72并且与下部仓托盘74联接。如图3中最佳地示出,竖直狭槽49被形成为穿过钉仓37的一部分。同样如图3中最佳地示出,三排钉孔51被形成为在竖直狭槽49的一侧上穿过上部平台72,另一组三排钉孔51被形成为在竖直狭槽49的另一侧上穿过上部平台72。当然,可提供任何其他合适数目的钉排(例如,两排、四排、任何其他数目的排)。重新参见图4A-6,楔形滑动件41和多个钉驱动器43被捕集在仓体70和托盘74之间,其中楔形滑动件41位于钉驱动器43近侧。楔形滑动件41可在钉仓37内纵向运动;而钉驱动器43可在钉仓37内竖直运动。钉47也定位在仓体70内,处于对应钉驱动器43上方。具体地,每个钉47在仓体70内由钉驱动器43竖直地驱动,以向外驱动钉47穿过相关联的钉孔51。如图4A-4B和图6中最佳地示出,楔形滑动件41存在倾斜凸轮表面,当楔形滑动件41朝远侧驱动穿过钉仓37时,倾斜凸轮表面向上推压钉驱动器43。
在一些形式中,钉仓37根据以下专利的至少一些教导内容来构造和操作:美国专利申请[代理人案卷号END7176USNP.0599177],其公开内容以引用方式并入本文。除此之外或作为另外一种选择,钉仓37可根据以下专利的至少一些教导内容来构造和操作:美国专利申请[代理人案卷号END7182USNP.0599227],其公开内容以引用方式并入本文。参考本文的教导内容,钉仓37可采用的其他合适形式对于本领域的普通技术人员而言将是显而易见的。
在通过朝远侧推进闭合管32和闭合环33使端部执行器12如图4A-4B所示闭合的情况下,通过使上部销38进入纵向砧座狭槽42,击发梁14随后被推进至接合砧座18。推块80(图5所示)位于击发梁14的远侧端部,并且被构造为能够接合楔形滑动件41,使得当在击发触发器28被致动时,击发梁14朝远侧推进而穿过钉仓37的情况下,推块80会朝远侧推动楔形滑动件41。此类击发期间,击发梁14的切割刃48进入钉仓37的竖直狭槽49,从而切断被夹紧在钉仓37与砧座18之间的组织。如图4A-4B所示,中间销46和推块80通过进入钉仓37内的狭槽49中而一起致动钉仓37,以将楔形滑动件41驱动成与钉驱动器43发生向上顶起接触,继而将钉47向外驱动穿过钉孔51并使钉47与砧座18的内表面上的钉成形凹坑53(图3所示)形成接触。图4B示出在完成组织切断和缝合之后完全朝远侧平移的击发梁14。应当理解,在图4A-4B的视图中,钉成形凹坑53被有意地省略;但图3中示出了钉成形凹坑53。还应理解,在图5的视图中,砧座18被有意地省略。
图7示出端部执行器12,该端部执行器已通过单行程被致动穿过组织90。如图所示,切割刃48(图7中被遮住)已切穿组织90,同时钉驱动器43已驱动三排交替的钉47穿过由切割刃48产生的切割线的每一侧上的组织90。在本示例中,钉47全部取向为基本上平行于切割线,但应当理解,钉47可被定位在任何合适的取向处。在本示例中,在第一行程完成后,端部执行器12从套管针撤回,用新钉仓替换已用完的钉仓37,然后,端部执行器12再次穿过套管针而插入到达缝合部位以进行进一步的切割和缝合。可以重复该过程,直至已提供所需量的切口和钉47。砧座18可能需要闭合以有利于通过套管针插入和撤回;并且砧座18可能需要打开以有利于更换钉仓37。
应当理解,在每个致动行程期间,切割刃48可基本上在钉47被驱动穿过组织的同时切断组织。在本示例中,切割刃48仅稍微落后于钉47的驱动,使得钉47正好在切割刃48穿过组织之前被驱动穿过该组织的相同区域,但应理解,这个顺序可以颠倒,或者切割刃48可直接与相邻的钉同步。虽然图7示出端部执行器12在组织90的两个层92,94中被致动,但应理解,端部执行器12可被致动穿过组织90的单个组织层或多于两个组织层92,94。还应当理解,与切割刃48产生的切割线相邻的钉47的成形和定位可基本上密封该切割线处的组织,从而减少或防止切割线处的出血和/或其他体液泄漏。此外,虽然图7示出端部执行器12在组织的两个基本上平坦的并置的平面层92,94中被致动,但应理解,端部执行器12也可被致动穿过管状结构,诸如血管、胃肠道的一段等等。因此,图7不应视为演示了对端部执行器12的设想用途的任何限制。参考本文的教导内容,可使用器械10的各种合适的环境和手术对于本领域的普通技术人员将是显而易见的。
应当理解,器械10可以根据以下美国专利的任何教导内容来构造和操作:美国专利4,805,823;美国专利5,415,334;美国专利5,465,895;美国专利5,597,107;美国专利5,632,432;美国专利5,673,840;美国专利5,704,534;美国专利5,814,055;美国专利6,978,921;美国专利7,000,818;美国专利7,143,923;美国专利7,303,108;美国专利7,367,485;美国专利7,380,695;美国专利7,380,696;美国专利7,404,508;美国专利7,434,715;美国专利7,721,930;美国公布2010/0264193;和/或美国公布2012/0239012。如上所述,这些专利和公布中的每一个的公开内容均以引用方式并入本文。可以为器械10提供的其他示例性修改形式将在下文中更详细地描述。可将下述教导内容并入器械10中的各种合适方式对于本领域的普通技术人员而言将是显而易见的。相似地,可将下述教导内容与本文引用的专利/公布的各种教导内容向结合的各种合适的方法对于本领域的普通技术人员而言将是显而易见的。还应理解,下述教导内容并不限于本文所引用的专利中教导的器械10或装置。以下教导内容可容易地施加于各种其他种类的器械,包括未归类为外科缝合器的器械。参考本文的教导内容,可以应用下述教导内容的各种其他合适装置和环境对于本领域的普通技术人员而言将是显而易见的。
II.示例性机动化驱动器特征结构
在本示例中,器械10提供了对击发梁14的机动化控制。图8-11示出可用于提供对击发梁14的机动化控制的示例性部件。具体地,图8示出可利用电池组104(也在图1-2中示出)产生的电力为电机102供电的示例性控制电路100。电机102能够操作以纵向平移击发梁14,如以下将更详细地描述。应当理解,整个控制电路100(包括电机102和电池组104)可容纳在柄部部分20内。图8将击发触发器28示为打开开关,但应理解,当击发触发器28被致动时,这个开关是闭合的。本示例的电路100还包括安全开关106,此安全开关必须闭合以便闭合电路100,但应理解,安全开关106仅仅是任选的。通过致动单独按钮、滑块、或柄部部分20上的其他特征结构可使安全开关106闭合。
本示例的电路100还包括闭锁开关108,闭锁开关被配置成在默认情况下为闭合的,但响应于闭锁条件自动打开。仅以举例方式,闭锁条件可包括以下中的一个或多个:下钳口16中缺少仓37、下钳口16中存在已用过的(例如,先前已击发的)仓37、未充分闭合的砧座18、确定器械10已击发许多次,和/或任何其他合适的条件。参考本文的教导内容,可以用于检测闭锁条件的各种传感器、算法以及其他特征结构对于本领域的普通技术人员而言将是显而易见的。类似地,参考本文的教导内容,其他合适种类的闭锁条件对于本领域的普通技术人员将是显而易见的。应当理解,电路100是打开的,并且因此电机102在闭锁开关108打开时不可操作。闭锁指示器110(例如,LED等等)能够操作以提供闭锁开关108的状态的视觉指示。仅以举例方式,闭锁开关108、闭锁指示器110以及相关联的部件/功能可以根据以下专利的至少一些教导内容来构造:2010年1月12日公布的名称为“Electronic Lockoutsand Surgical Instrument Including Same”的美国专利7,644,848,其公开内容以引用方式并入本文。
一旦击发梁14到达最远侧的位置(例如,在切割行程结束时),行程结束开关112就自动切换至闭合位置,从而将施加于电机102的电压的极性逆转。这使电机102的旋转方向逆转,应当理解,操作者将在这个操作阶段释放击发触发器28。在该操作状态下,电流流过反向指示器114(例如,LED等等),向操作者提供有关电机102的旋转已逆转的指示。参考本文的教导内容,行程结束开关112可在击发梁14到达最远侧的位置时自动切换至闭合位置的各种合适方式对于本领域的普通技术人员而言将是显而易见的。类似地,参考本文的教导内容,反向指示器114可以采用的各种合适形式对于本领域的普通技术人员而言将是显而易见的。
本示例的柄部部分20还包括手动返回开关116,该手动返回开关也在电路100中示出。手动返回开关116被构造为能够充当“应急”特征结构,使操作者能够在击发行程中快速将击发梁14朝近侧回缩。换句话讲,手动返回开关116可在击发梁14仅部分朝远侧推进时被手动致动。手动返回开关116可提供与行程结束开关112类似的功能性,从而使施加于电机102的电压的极性逆转,由此逆转电机102的旋转方向。同样,此逆转可通过反向指示器114以视觉方式指示。
在一些形式中,开关28,106,108,112,116中的一个或多个呈微动开关形式。参考本文的教导内容,其他合适形式对于本领域的普通技术人员而言将是显而易见的。除此之外或作为另外一种选择,电路100的至少一部分可根据以下专利的至少一些教导内容来构造:2012年7月3日公布的名称为“Motor-Driven Surgical Instrument”的美国专利8,210,411,其公开内容以引用方式并入本文。
图9-11示出可用于使击发梁14发生机动化平移的各种机械部件。具体地,图9示出容纳于柄部部分20的手枪式握把24中的电机102。应当理解,电池组104(图1-2所示)还可定位在手枪式握把24中(例如,电机102下方)和/或柄部部分20内的其他位置。电机102具有驱动轴120,该驱动轴与齿轮组件122联接。齿轮组件122具有外壳(未示出)并且能够操作以驱动上部齿轮126,上部齿轮在图10中示出。上部齿轮126与小齿轮128啮合,该小齿轮由固定在柄部部分20中的销129可旋转地支撑。因此,应当理解,启动电机102将最终使小齿轮128在柄部部分20内旋转。
同样如图9-10所示,平移齿条130包括齿132,这些齿与小齿轮128啮合,使得齿条130在小齿轮128旋转时纵向平移。如图11所示,齿条130与细长构件136联接,细长构件延伸穿过轴22,并且包括与击发梁14的近侧端部联接的远侧端部138。细长构件136在轴22内平移,使得细长构件136将齿条130的纵向运动传递给击发梁14。因此,应当理解,启动电机102将最终使击发梁14在端部执行器12内平移。具体地,电机102可将击发梁14朝远侧驱动,从而将组织90切断并将钉47驱动到组织90中。开关致动臂134从齿条130侧向延伸,并定位成在击发梁14到达最远侧的位置时(例如,在组织90已被切断并且钉47已被驱动到组织90中后)接合行程结束开关112。如上所述,对行程结束开关112的这种接合自动逆转电机102,使得击发梁14从最远侧的位置回到最近侧的位置,从而使砧座18能够枢转远离下钳口16以便释放组织90。
术语“枢转”(以及以“枢转”为词根的类似术语)的使用不应被理解为必须要求围绕固定轴线进行枢轴运动。在一些形式中,砧座18围绕由销(或类似的特征结构)所限定的轴线旋转,销(或类似的特征结构)在砧座18朝着下钳口16运动时沿着细长狭槽或通道滑动。在此类形式中,枢转轴线沿着狭槽或通道限定的路径平移,而砧座18则同时围绕这条轴线枢转。除此之外或作为另外一种选择,枢转轴线可先沿着狭槽/通道滑动,然后在枢转轴线沿着狭槽/通道滑动一定距离后,砧座18围绕枢转轴线枢转。应当理解,此类滑动/平移枢轴运动均涵盖于术语诸如“枢转(pivot/pivots/pivoting)”、“枢转的”、“能够枢转的”等内。当然,一些形式可使砧座18围绕保持固定且不在狭槽或通道内平移的轴线进行枢轴运动。
除此之外或作为另外一种选择,能够操作以驱动击发梁14的特征结构可以根据以下专利的至少一些教导内容来构造:美国公布2012/0239012,其公开内容以引用方式并入本文;和/或美国公布2012/0239012,其公开内容以引用方式并入本文。参考本文的教导内容,用于实现击发梁14的机动化的其他合适部件、特征结构以及构型对于本领域的普通技术人员而言将是显而易见的。还应理解,一些其他形式可实现对击发梁14的手动驱动,使得电机可被省略。仅以举例方式,击发梁14可根据本文所引用的任何其他专利/公布的至少一些教导内容来致动。
III.示例性砧座构型
如上所述,楔形滑动件41提供顶起动作,使得在楔形滑动件41朝远侧驱动时,在钉仓37内向上驱动钉驱动器43。钉驱动器43的这种向上运动向上推动钉47并且将其推出钉孔51。这强行将每个钉47推入砧座18的相关联的钉成形凹坑53中,最终产生弯曲/成形钉47。在钉47朝砧座18驱动时,钉腿穿透组织层90,92,使得成形钉47固定组织层90,92(如图7所示)。
应当理解,钉成形凹坑53的构型可对成形钉47的构型造成显著影响,使得当钉成形凹坑53的构型发生变化时,钉成形凹坑53所形成的钉47的构型也随之而发生显著变化。此外,应当理解,钉成形凹坑53所形成的钉47的构型变化可对成形钉47与组织层90,92相互作用的方式造成显著影响。例如,比起其他成形钉47构型,一些成形钉47构型可为组织层90,92提供更好的止血效果。仅仅作为另一个说明性示例,比起其他成形钉47构型,一些成形钉47构型可更好地固定并置的组织层90,92。仅仅作为另一个说明性示例,比起其他成形钉47构型,一些成形钉47构型可对组织层90,92造成更多创伤(例如,通过更大程度地撕裂组织),这会影响成形钉47的止血能力和/或固定并置的组织层90,92的能力等。钉成形凹坑53的若干示例性构型将在下文更详细地描述;参考本文的教导内容,其他构型对于本领域的普通技术人员而言将是显而易见的。
A.具有对齐通道的示例性钉成形凹坑
图12-13示出可用于替代上述砧座18的示例性砧座200。本示例的砧座200限定纵向延伸的狭槽204,该狭槽类似上述砧座狭槽42。在器械10的切割/缝合行程中,击发梁14的上部部分平移穿过砧座狭槽42。砧座200还包括组织接触表面202,当组织被夹紧于砧座200与钉仓37的上部平台72之间时,组织接触表面按压在组织上。一系列的钉成形凹坑210相对于组织接触表面202凹陷。在本示例中,砧座200在狭槽204的每一侧上具有两排206,208钉成形凹坑210。然而,应当理解,可在狭槽204的每一侧上提供任何其他合适排数的钉成形凹坑210。仅以举例方式,一些其他形式可在狭槽204的每一侧包括三排钉成形凹坑210。还应指出的是,在狭槽204的每一侧上,内部排206相对于外部排208纵向偏置。这种偏置将造成与图7所示类似的结果,即,成形钉47在相邻排之间纵向偏置。当然,钉成形凹坑210彼此也可具有任何其他合适的布置关系。
图14-16更详细地示出单个钉成形凹坑210。应当理解,砧座200中的所有钉成形凹坑210可具有相似的构造。本示例的钉成形凹坑210提供第一通道220和第二通道240。第二通道240与第一通道220对齐。隔离壁表面260分开通道220,240。通道220,240关于穿过壁且相对于钉成形凹坑210横向延伸的竖直平面对称。
通道220由向下倾斜凹形表面222限定,该向下倾斜凹形表面平滑地过渡到向上倾斜凹形表面224,该向上倾斜凹形表面终止在隔离壁表面260处。通道220侧向地由一对侧壁226,228限定,这对侧壁226,228竖直地成角度,使得侧壁226,228的下部区域比侧壁226,228的上部区域更靠近于彼此。侧壁226,228还侧向地成角度,使得与侧壁226,228更远离隔离壁表面260的端部相比,侧壁226,228与隔离壁表面260相邻的端部更靠近于彼此。
通道240由向下倾斜凹形表面242限定,该向下倾斜凹形表面平滑地过渡到向上倾斜凹形表面244,该向上倾斜凹形表面终止在隔离壁表面260处。通道240侧向地由一对侧壁246,248限定,这对侧壁246,248竖直地成角度,使得侧壁246,248的下部区域比侧壁246,248的上部区域更靠近于彼此。侧壁246,248还侧向地成角度,使得与侧壁246,248更远离隔离壁表面260的端部相比,侧壁246,248与隔离壁表面260相邻的端部更靠近于彼此。
钉成形凹坑210还包括引入表面280,282,引入表面280,282沿着钉成形凹坑210的长度延伸。引入表面280与侧壁226,246和隔离壁表面260相邻。引入表面282与侧壁228,248和隔离壁表面260相邻。引入表面280,282竖直地成角度,以帮助在钉朝着钉成形凹坑210驱动时将钉腿尖端引导到通道220,240中。然而,每个引入表面280,282与水平面(组织接触表面202沿其定位)之间所限定的角度小于每个侧壁226,246,228,248与相同的水平面之间限定的角度。应当理解,引入表面280,282还可在钉成形的最终阶段中,缓解钉成形凹坑210处的非常局部化的组织压缩。
图17示出由钉成形凹坑210形成的示例性钉250,该钉固定两个并置的组织层92,94。钉250包括冠部252、具有组织穿刺尖端272的第一腿270、以及具有组织穿刺尖端292的第二腿290。如图所示,腿270,290朝着彼此弯曲,尖端272,292穿过冠部252所沿着的平面。钉250的成形在图18A-18E中示出。当尖端272,292最初接触表面222,242时,腿270,290基本上笔直地垂直于冠部252。当进一步将钉250朝钉成形凹坑210驱动到某个点,使每个尖端272,292到达每个相应通道220,240的顶点(A1)时,表面222,242以顶起的方式来将尖端272,292朝着彼此驱动,从而使得腿270,290朝着彼此弯曲,如图18B所示。当进一步将钉250朝钉成形凹坑210驱动时,表面224,244以顶起的方式将尖端272,292朝着冠部252驱动,如图18C所示。当进一步将钉250朝钉成形凹坑210驱动时,表面222,224,242,244继续使腿270,290变形,从而使尖端272,292通过隔离壁表面260,如图18D所示。一旦钉250被完全驱动到钉成形凹坑210中,尖端272,292就穿过冠部252,如图18E和图17所示。因此,尖端272,292会被驱动通过两个组织层92,94两次,其中尖端272,292被定位成通过层92的与冠部252所在相同的侧。应当指出的是,在本示例中,成形钉250具有“B”形形状。还应指出的是,在本示例中,在钉250形成后,尖端272,292定位在与冠部252所在侧相同的侧面。在一些情况下,尖端272,292并不穿过冠部252,然而也不会两次穿过至少层94和可能的层92。
重新参见图18A,应当指出的是,钉成形凹坑210使每个腿270,290的纵向轴线与穿过每个对应通道220,240的顶点(A1)的平行轴线之间存在距离(d1)。另外,钉成形凹坑210使穿过冠部252中心的竖直轴线与穿过每个对应通道220,240的顶点(A1)的平行轴线之间存在距离(d2)。如下文更详细所述,在一些情况下,可期望将顶点(A1)偏移成更靠近穿过冠部252的中心的竖直轴线,从而增大距离(d1)并且减小距离(d2)。无论如何,应当理解,在一些情况下,可期望使凹坑210一侧上的距离(d1)大于凹坑210的另一侧上的对应距离(d1)。类似地,在一些情况下,可期望使凹坑一侧上的距离(d2)大于凹坑210的另一侧上的对应距离(d2)。因此,设想凹坑可以关于穿过隔离壁表面260的竖直平面不对称。
B.具有由完全倾斜壁分开的通道的示例性钉成形凹坑
图19-21示出可用于替代上述砧座18的示例性砧座300。本示例的砧座300限定纵向延伸的狭槽304,该狭槽类似上述砧座狭槽42。在器械10的切割/缝合行程中,击发梁14的上部部分平移穿过砧座狭槽42。砧座300还包括组织接触表面302,当组织被夹紧于砧座300与钉仓37的上部平台72之间时,组织接触表面按压在组织上。一系列的钉成形凹坑310相对于组织接触表面302凹陷。在本示例中,砧座300在狭槽304的每一侧上具有三排钉成形凹坑310。然而,应当理解,可在狭槽304的每一侧上提供任何其他合适排数的钉成形凹坑310。仅以举例方式,一些其他形式可在狭槽304的每一侧包括两排或多于三排的钉成形凹坑310。还应指出的是,在狭槽304的每一侧上,每排钉成形凹坑310相对于相邻排的钉成形凹坑310纵向偏置。这种偏置将造成与图7所示类似的结果,即,成形钉47在相邻排之间纵向偏置。当然,钉成形凹坑310彼此也可具有任何其他合适的布置关系。
图22-23更详细地示出钉成形凹坑310。应当理解,砧座300中的所有钉成形凹坑310可具有相似的构造。本示例的钉成形凹坑310提供第一通道320和第二通道340。虽然通道320,340大致彼此平行,但在本示例中,通道320,340并未彼此对齐。隔离壁360分开通道320,340。壁360相对于砧座300的狭槽304倾斜取向。在本示例中,虽然通道320,340不对称,但通道340的构型与通道320的构型之间仍然存在大量相似之处。
通道320由向下倾斜凹形表面322限定,该向下倾斜凹形表面平滑地过渡到向上倾斜凹形表面324,该向上倾斜凹形表面终止在通道320的终端321的组织接触表面302处。在一些情况下,表面322由单个半径限定。在一些情况下,表面322由一个以上的半径限定。除此之外或作为另外一种选择,表面322可以包括由一个或多个半径限定的一个或多个表面与竖直、水平或以其他方式成角度的一个或多个平坦表面的组合。
通道320在一侧由第一侧壁323、第二侧壁325以及第三侧壁326侧向地限定。通道320在另一侧则由第四侧壁328侧向地限定。应当理解,可使用任何其他合适数目的侧壁限定通道320。在本示例中,第一侧壁323大致平行于第四侧壁328,但应理解,这两个侧壁可具有其他合适的关系。第二侧壁325相对于第四侧壁328限定第一倾斜角度。第三侧壁326相对于第四侧壁328限定第二倾斜角度。第一倾斜角度大于第二倾斜角度。因此,当观察沿着通道320的长度的宽度时,将会发现,通道320沿着第一侧壁323与第四侧壁328之间限定的最短长度在钉腿入口端部319处最宽。然后,通道320的宽度沿着第二侧壁325与第四侧壁328之间限定的长度部分大幅变窄。接着,通道320的宽度沿着第三侧壁326与第四侧壁328之间限定的长度部分继续变窄(但幅度减小)。通道320在终端321处最窄。
在本示例中,第一侧壁323与第二侧壁325之间的过渡是平滑的,具有大体凹的曲率。第二侧壁325与第三侧壁326之间的过渡同样是平滑的,具有大体凸的曲率。另外,侧壁323,325,326,328的上部边界与组织接触表面302之间的过渡是平滑的,具有大体凸的曲率。在一些其他形式中,侧壁323,325,326,328的上部边界与组织接触表面302之间的边缘是倒角的,从而实现从组织接触表面302平坦但成角度地引入到侧壁323,325,326,328。另选地,可使用任何其他合适类型的过渡。还应理解,在本示例中,若无围绕侧壁323,325,326,328所限定的上部周边的相对短且均匀倒圆/倒角过渡,所有侧壁323,325,326,328至多延伸到达组织接触表面302。
通道340由向下倾斜凹形表面342限定,该向下倾斜凹形表面平滑地过渡到向上倾斜凹形表面344,该向上倾斜凹形表面终止在通道340的终端341的组织接触表面302处。在一些情况下,表面342由单个半径限定。在一些情况下,表面342由一个以上的半径限定。除此之外或作为另外一种选择,表面342可以包括由一个或多个半径限定的一个或多个表面与竖直、水平或以其他方式成角度的一个或多个平坦表面的组合。
通道340在一侧由第一侧壁343、第二侧壁345以及第三侧壁346侧向地限定。通道340在另一侧则由第四侧壁348侧向地限定。应当理解,可使用任何其他合适数目的侧壁限定通道340。在本示例中,第一侧壁343大致平行于第四侧壁348,但应理解,这两个侧壁可具有其他合适的关系。第二侧壁345相对于第四侧壁348限定第一倾斜角度。第三侧壁346相对于第四侧壁限定第二倾斜角度。第一倾斜角度大于第二倾斜角度。因此,当观察沿着通道340的长度的宽度时,将会发现,通道340沿着第一侧壁343与第四侧壁348之间限定的最短长度在钉腿入口端部339处最宽。然后,通道340的宽度沿着第二侧壁345与第四侧壁348之间限定的长度部分大幅变窄。接着,通道340宽度沿着第三侧壁346与第四侧壁348之间限定的长度部分继续变窄(但幅度减小)。通道340在终端341处最窄。
在本示例中,第一侧壁343与第二侧壁345之间的过渡是平滑的,具有大体凹的曲率。第二侧壁345与第三侧壁346之间的过渡同样是平滑的,具有大体凸的曲率。另外,侧壁343,345,346,348的上部边界与组织接触表面302之间的过渡是平滑的,具有大体凸的曲率。在一些其他形式中,侧壁343,345,346,348的上部边界与组织接触表面302之间的边缘是倒角的,从而实现从组织接触表面302平坦但成角度地引入到侧壁343,345,346,348。另选地,可使用任何其他合适类型的过渡。还应理解,在本示例中,若无围绕侧壁343,345,346,348所限定的上部周边的相对短且均匀倒圆/倒角过渡,所有侧壁343,345,346,348至多延伸到达组织接触表面302。
如可从图22中看到的,侧壁326,346共同限定隔离壁360。隔离壁360延伸到隔离壁360顶部与组织接触表面302基本上齐平的高度。如同样可从图22中看到的,从通道320的第二侧壁325到通道320的第三侧壁326的过渡位于钉成形凹坑310的与通道340的终端341所在相同的纵向区域内。换句话说,从通道320的第二侧壁325到通道320的第三侧壁326的过渡正好位于通道340的终端341的侧面。同样,从通道340的第二侧壁345到通道340的第三侧壁346的过渡位于钉成形凹坑310的与通道320的终端321所在相同的纵向区域内。换句话说,从通道340的第二侧壁345到通道340的第三侧壁346的过渡正好位于通道320的终端321的侧面。应当理解,钉成形凹坑310大体限定从图22的左侧延伸到图22的右侧的纵向轴线(图22是以横向取向来看)。钉成形凹坑310的整个长度沿这条纵向轴线延伸,而钉成形凹坑310的整个宽度相对于这条纵向轴线而横跨。钉成形凹坑310与沿着纵向轴线的特定点或范围相关联的部分可被视为钉成形凹坑310的“纵向区域”。因此,“纵向区域”可包括钉成形凹坑310在沿着纵向轴线的长度的特定点或范围上的整个宽度。
图24示出由钉成形凹坑310形成的示例性钉350,该钉固定两个并置的组织层92,94。钉350包括冠部352、具有组织穿刺尖端372的第一腿370、以及具有组织穿刺尖端392的第二腿390。如图所示,腿370,390朝着彼此弯曲,但腿370,390不穿过冠部352所沿着的平面。钉350的成形在图25A-25D中示出。当尖端372,392最初接触表面322,342时,腿370,390基本上笔直地垂直于冠部352。另外,腿370,390和冠部352均沿着公共的竖直平面定位。当进一步将钉350朝钉成形凹坑310驱动到某个点,使每个尖端372,392到达每个相应通道320,340的顶点(A2)时,表面322,342以顶起的方式来将尖端372,392朝着彼此驱动,从而使得腿370,390朝着彼此弯曲,如图25B所示。当进一步将钉350朝钉成形凹坑310驱动时,侧壁324,344以顶起的方式将尖端372,392朝着冠部352驱动,如图25C所示。另外,侧壁325,326侧向地驱动尖端372远离上文所提及的竖直平面,而表面345,346侧向地驱动尖端392远离上文所提及的竖直平面。因此,在这个阶段,腿370,390和冠部352不再沿着公共的竖直平面定位。具体地,相对于冠部352将腿370,390和尖端372,392在相反方向上侧向地驱动。
当进一步将钉350朝钉成形凹坑310驱动时,表面322,324,342,344和侧壁324,324,325,326继续使腿370,390变形,使得尖端372,392最终定位于钉成形凹坑320,340的相应终端321,341,如图25D所示。因此,在本示例中,尖端372,392仅仅穿过组织层92一次。然而,在一些情况下,尖端372,392被驱动到它们回穿到组织层94中的点,如图24所示。在一些其他情况下,尖端372,392并不回穿到组织层94中,这样,尖端372,392仅仅穿过组织层94一次。无论尖端372,392是否二次回穿过组织层94,都应了解,尖端372,392可相对于沿着冠部352的长度穿行的竖直平面侧向地偏置。具体地,尖端372可定位于该平面的一个侧面上,同时尖端392定位于该平面的另一个侧面上。所得的侧向偏置形式可具有与图34所示类似的外观,这将在下文更详细地描述。
重新参见图25A,应当指出的是,钉成形凹坑310使每个腿370,390的纵向轴线与穿过每个对应通道320,340的顶点(A2)的平行轴线之间存在距离(d3)。另外,钉成形凹坑310使穿过冠部352中心的竖直轴线与穿过每个对应通道320,340的顶点(A2)的平行轴线之间存在距离(d4)。如可通过将图25A与图18A进行比较看出的,距离(d3)大于距离(d1),并且距离(d4)小于距离(d2)。因此,与钉成形凹坑210中的顶点(A1)到穿过冠部252中心的竖直轴线的距离相比,钉成形凹坑310中的顶点(A2)到穿过冠部352中心的竖直轴线的距离更近。这种构型差异可促使腿370,390更好地向内弯曲,可最小化每个腿370,390在组织中最终形成的入口孔的延度,并且/或者可以提供其他结果。另外,应当指出的是,通道320,340具有比通道220,240更大的长度,这降低了腿370,390在钉成形完成之前不期望地离开通道320,340的可能性。在一些形式中,通道320,340还比通道220,240更深,这可帮助防止尖端372,392在钉成形期间二次穿过至少层92(如果没有穿过两个层92,94)。
在一些环境中,钉成形凹坑310所形成的钉350可为并置的组织层92,94提供更好止血效果,可相对于并置的组织层92,94实现更好的结构完整性,可使不期望地脱离组织层92,94的可能性降低,可使组织以后在钉线处撕裂的可能性降低,并且/或者可以其他方式将对组织层92,94所造成的创伤减至最少,尤其是在与钉成形凹坑210所形成的钉250相比的情况下。当密封某些组织结构(例如,脆弱动脉等等)时,可期望尽量减少钉刺穿的组织的量。通过不二次回穿过层92,并且在一些情况下,不二次回穿过层94,成形钉350可使此类穿刺尽量减少(例如,与成形钉250相比)。通过将钉成形凹坑310所形成的钉腿370,390的折回运动减至最小程度,与常规的钉相比,所得成形钉350可与安全组织夹具在外观和功能上具有更多类似之处。这种夹具样的构型可使比原本可能被捕获于腿270,290与冠部252之间的组织更多的组织被捕获于腿370,390与冠部352之间,这继而可实现更好的组织完整性并减小了组织在钉350附近撕裂的倾向。与使用常规钉成形凹坑来使钉成形所需的力相比,将钉腿370,390在钉成形的过程中的折回运动减至最小程度还减少了使钉350成形所需要的总力。这可减少击发行程期间将击发梁14朝远侧推进所需要的力。
C.具有由部分壁分开的通道的示例性钉成形凹坑
图26-29示出另一个仅示例性的钉成形凹坑410,该钉成形凹坑可容易地结合到本文所提及的任何砧座18,200,300以及其他砧座中。本示例的钉成形凹坑410提供第一通道420和第二通道440。虽然通道420,440大致彼此平行,但在本示例中,通道420,440并未彼此对齐。隔离壁460分开通道420,440。壁460与砧座18,200,300的狭槽42,204,304平行。在本示例中,虽然通道420,440不对称,但通道440的构型与通道420的构型之间仍然存在大量相似之处。
通道420由向下倾斜凹形表面422限定,该向下倾斜凹形表面平滑地过渡到向上倾斜凹形表面424,该向上倾斜凹形表面终止在通道420的终端421的凹陷表面403处。在一些情况下,表面422由单个半径限定。在一些情况下,表面422由一个以上的半径限定。除此之外或作为另外一种选择,表面422可以包括由一个或多个半径限定的一个或多个表面与竖直、水平或以其他方式成角度的一个或多个平坦表面的组合。在本示例中,凹陷表面403凹陷至组织接触表面402以下。在一些情况下,这可减少在缝合序列中作用于组织的局部压力。
通道420在一侧由第一侧壁423、第二侧壁425以及第三侧壁426侧向地限定。通道420在另一侧则由第四侧壁428侧向地限定。应当理解,可使用任何其他合适数目的侧壁限定通道420。在本示例中,第一侧壁423大致平行于第四侧壁428,但应理解,这两个侧壁可具有其他合适的关系。第二侧壁425相对于第四侧壁428限定倾斜角度。第三侧壁426大致平行于第四侧壁428。因此,当观察沿着通道420的长度的宽度时,将会发现,通道420沿着第一侧壁423与第四侧壁428之间限定的最短长度在钉腿入口端部419处最宽。然后,通道420的宽度沿着第二侧壁425与第四侧壁428之间限定的长度部分大幅变窄。在通道420到达终端421前,通道420的宽度沿着通道420被限定于第三侧壁426与第四侧壁428之间的剩余长度保持基本上恒定的窄度。
在本示例中,第一侧壁423与第二侧壁425之间的过渡是平滑的,具有大体凹的曲率。第二侧壁425与第三侧壁426之间的过渡同样是平滑的,第二侧壁425与凹陷表面403之间的过渡也是如此,具有大体凸的曲率。另外,侧壁423,426,428的上部边界与组织接触表面402之间的过渡是平滑的,具有大体凸的曲率。在一些其他形式中,侧壁423,426,428的上部边界与组织接触表面402之间的边缘是倒角的,从而实现从组织接触表面402平坦但成角度地引入到侧壁423,426,428。另选地,可使用任何其他合适类型的过渡。还应理解,在本示例中,若无围绕侧壁423,426,428所限定的上部周边的相对短且均匀倒圆/倒角过渡,所有侧壁423,426,428至多延伸到达组织接触表面402。
通道440由向下倾斜凹形表面442限定,该向下倾斜凹形表面平滑地过渡到向上倾斜凹形表面444,该向上倾斜凹形表面终止在通道440的终端441的组织接触表面402处。通道440在一侧由第一侧壁443、第二侧壁445以及第三侧壁446侧向地限定。在一些情况下,表面442由单个半径限定。在一些情况下,表面442由一个以上的半径限定。除此之外或作为另外一种选择,表面442可以包括由一个或多个半径限定的一个或多个表面与竖直、水平或以其他方式成角度的一个或多个平坦表面的组合。
通道440在另一侧则由第四侧壁448侧向地限定。第一侧壁443大致平行于第四侧壁448。第二侧壁445相对于第四侧壁448限定倾斜角度。应当理解,可使用任何其他合适数目的侧壁限定通道440。第三侧壁446大致平行于第四侧壁448,但应理解,这两个侧壁可具有其他合适的关系。因此,当观察沿着通道440的长度的宽度时,将会发现,通道440沿着第一侧壁443与第四侧壁448之间限定的最短长度在钉腿入口端部439处最宽。然后,通道440的宽度沿着第二侧壁445与第四侧壁448之间限定的长度部分大幅变窄。在通道440到达终端441前,通道440的宽度沿着通道440被限定于第三侧壁446与第四侧壁448之间的剩余长度保持基本上恒定的窄度。
在本示例中,第一侧壁443与第二侧壁445之间的过渡是平滑的,具有大体凹的曲率。第二侧壁445与第三侧壁446之间的过渡同样是平滑的,第二侧壁445与凹陷表面403之间的过渡也是如此,具有大体凸的曲率。另外,侧壁443,446,448的上部边界与组织接触表面402之间的过渡是平滑的,具有大体凸的曲率。在一些其他形式中,侧壁443,446,448的上部边界与组织接触表面402之间的边缘是倒角的,从而实现从组织接触表面402平坦但成角度地引入到侧壁443,446,448。另选地,可使用任何其他合适类型的过渡。还应理解,在本示例中,若无围绕侧壁443,446,448所限定的上部周边的相对短且均匀倒圆/倒角过渡,所有侧壁443,446,448至多延伸到达组织接触表面402。
如可从图27和图29中看到的,侧壁426,446共同限定隔离壁460。与上述隔离壁360不同,本示例的隔离壁460不与组织接触表面402齐平,而是相对于组织接触表面402凹陷,如图28中最佳地示出。一对边缘462,464提供从组织接触表面402到隔离壁460的过渡。边缘462,464相对于砧座18,200,300的狭槽42,204,304倾斜取向,并且还提供向下到隔离壁460的竖直成角度的过渡。
如图27中最佳地示出,边缘462位于钉成形凹坑410的与从通道420的第二侧壁425过渡到通道420的第三侧壁426所在相同的纵向区域内;并且位于与通道440的终端441所在相同的纵向区域内。换句话说,边缘462大致位于从通道420的第二侧壁425到通道420的第三侧壁426的过渡侧面;并且大致位于通道440的终端441的侧面。同样地,边缘464位于钉成形凹坑410的与从通道440的第二侧壁445过渡到通道440的第三侧壁446所在相同的纵向区域内;并且位于与通道420的终端421所在相同的纵向区域内。换句话说,边缘464大致位于从通道440的第二侧壁445到通道440的第三侧壁446的过渡侧面;并且大致位于通道420的终端421的侧面。
钉成形凹坑410形成的钉看上去类似于图24所示的钉350。具体地,当腿370,390最初被驱动到相应通道420,440时,表面422,442可将尖端372,374朝着彼此驱动。当钉350被进一步驱动到钉成形凹坑410中时,表面424,444可将尖端朝冠部352驱动。另外,侧壁425可驱动尖端372沿一个方向侧向地远离穿过隔离壁460和冠部352的竖直平面;而侧壁445驱动尖端392沿相反的方向侧向地远离穿过隔离壁460和冠部352的相同竖直平面。表面422,424,442,444和侧壁425,426,428,445,446,448最终可使腿370,390变形至构型类似于图24和图34所示的程度。例如,钉成形凹坑410可使钉350成形,其中尖端372,392仅仅回穿到层94(如果真会发生的话)中,但不二次回穿到层92中;并且其中尖端372,392相对于沿着冠部352长度的竖直平面侧向地偏置。
应当理解,每个通道420,440可具有相应的顶点,并且这些顶点的间距可类似于上述通道320,340的顶点(A2)的间距。换句话说,与钉成形凹坑210中的顶点(A1)到穿过冠部252中心的竖直轴线的距离相比,钉成形凹坑410中的顶点到穿过相关联的钉冠部中心的竖直轴线的距离可更近。这种构型差异可促使钉腿更好地向内弯曲,可最小化每个钉腿在组织中最终形成的入口孔的延度,并且/或者可以提供其他结果。另外,应当指出的是,通道420,440具有比通道220,240更大的长度,这降低了相关联的钉腿在钉成形完成之前不期望地离开通道420,440的可能性。在一些形式中,通道420,440还比通道220,240更深,这可帮助防止相关联的钉腿尖端在钉成形期间二次穿过至少层92(如果没有穿过两个层92,94)。
在一些环境中,钉成形凹坑410所形成的钉可为并置的组织层92,94提供更好止血效果,可相对于并置的组织层92,94实现更好的结构完整性,可使不期望地脱离组织层92,94的可能性降低,可使组织以后在钉线处撕裂的可能性降低,并且/或者可以其他方式将对组织层92,94所造成的创伤减至最少,尤其是在与钉成形凹坑210所形成的钉250相比的情况下。当密封某些组织结构(例如,脆弱动脉等等)时,可期望尽量减少钉刺穿的组织的量。通过不二次回穿过层92,并且在一些情况下,不二次回穿过层94,凹坑410所形成的钉可使此类穿刺尽量减少(例如,与成形钉250相比)。通过将钉成形凹坑410所形成的钉腿的折回运动减至最小程度,与常规的钉相比,所得成形钉可与安全组织夹具在外观和功能上具有更多类似之处。这种夹具样的构型可使比原本可能被捕获于腿270,290与冠部252之间的组织更多的组织被捕获于腿与冠部之间,这继而可实现更好的组织完整性并减小组织在钉附近撕裂的倾向。与使用常规钉成形凹坑来使钉成形所需的力相比,将钉腿在钉成形的过程中的折回运动减至最小程度还减少了使用钉成形凹坑410来使钉成形所需要的总力。这可减少击发行程期间将击发梁14朝远侧推进所需要的力。
D.具有单个通道和倾斜的偏转壁的示例性钉成形凹坑
图30-34示出另一个仅示例性的钉成形凹坑510,该钉成形凹坑可容易地结合到本文所提及的任何砧座18,200,300以及其他砧座中。本示例的钉成形凹坑510提供单个连续通道512,该单个连续通道具有侧向突出到通道512中的第一凸轮特征结构520和侧向突出到通道512中的第二凸轮特征结构540。通道512包括用于接收第一钉腿的第一终端514和用于接收第二钉腿的第二终端516。通道512包括端部514处的凹形入口表面515、端部516处的凹形入口表面517,以及平坦底板表面518,该平坦底板表面将表面515,517联结起来并提供通道512的纵向中间区域的最低点。应当理解,术语诸如“向下”和“最低”在此用于如图32所示那样取向的凹坑510,而图32中,组织接触表面502呈现为向上的。在实际使用中,组织接触表面502可实际呈现为向下的,这样凹坑510取向将与图32所示取向相反。因此,术语诸如“向下”、“向上”、“最低”、“顶部”、“底部”等等不应理解为限制发明人对本文中的任何装置在装置实际使用中的必要取向的设想。
第一外侧壁542从第一终端514延伸到第二凸轮特征结构540。第二外侧壁522从第二终端516延伸到第一凸轮特征结构520。外侧壁522,542相对于沿着钉成形凹坑510的中心纵向穿过的竖直平面成角度,使得侧壁522,542提供到表面515,514和底板518的引入端。换句话说,与在侧壁522,542底部处侧壁522,542间的侧向间距相比,侧壁522,542间的侧向间距在侧壁522,542顶部处(即,在组织接触表面502处)更大。
第一凸轮特征结构520包括侧向凹形侧壁524、凸形过渡区域526以及纵向侧壁528。应当理解,侧向凹形侧壁524与外侧壁542之间的距离大于纵向侧壁528与外侧壁542之间的距离。终端凸形侧壁527位于纵向侧壁528的相对端部。第一凸轮特征结构520还包括斜面529。如图32中最佳地示出,斜面529为凹面,并由小于限定表面517的曲率半径的曲率半径限定。因此,斜面529呈现的曲线比表面517呈现的曲线更陡峭。第二凸轮特征结构540包括侧向凹形侧壁544、凸形过渡区域546以及纵向侧壁548。应当理解,侧向凹形侧壁544与外侧壁522之间的距离大于纵向侧壁548与外侧壁522之间的距离。终端凸形侧壁547位于纵向侧壁548的相对端部。第一凸轮特征结构540还包括斜面549。斜面549为凹面,并由小于限定表面515的曲率半径的曲率半径限定。因此,斜面549呈现的曲线比表面515呈现的曲线更陡峭。
图33A-34示出可如何由钉成形凹坑510使钉550成形的示例。具体地,图33A示出在钉550最初被驱动到钉成形凹坑510中时,表面515,517如何将钉550的腿570,590朝彼此驱动。当钉550被进一步驱动到钉成形凹坑510中时,底板表面518引导腿570,590与侧壁524,526,528协作来沿一个方向驱动腿570侧向地远离穿过冠部552的竖直平面;同时与侧壁544,546,548协作来沿相反方向驱动腿590侧向地远离穿过冠部552的竖直平面。腿570,590的这种侧向偏转如图33B所示。腿570,590的这种侧向偏转防止腿570,590在钉550形成期间彼此碰撞。应当理解,腿570,590的这种侧向偏转还使尖端572转向斜面549,同时还使尖端592转向斜面529。因此,斜面529,549驱动对应尖端592,572朝着穿过冠部552的水平面向上,如图33C所示。腿570,590在钉550已由钉成形凹坑510形成之后的侧向偏转可在图34中最佳地示出。应当理解,成形钉550可以图24所示类似的方式来接合组织层92,94。例如,钉成形凹坑510可使钉550成形,其中尖端572,592仅仅回穿到层94(如果真会发生的话)中,但不二次回穿到层92中。
虽然本示例的钉成形凹坑510限定仅单个连续通道512,但应理解,表面517、底板518和斜面529的组合可有效地限定一个子通道,而表面515、底板518和斜面549的组合有效地限定另一个子通道。还应理解,钉成形凹坑510的每个子通道可具有相关联的有效顶点,并且这些有效顶点的间距可类似于上述通道320,340的顶点(A2)的间距。换句话说,与钉成形凹坑210中的顶点(A1)到穿过冠部252中心的竖直轴线的距离相比,钉成形凹坑510中的有效顶点到穿过钉冠部552中心的竖直轴线的距离可更近。这种构型差异可促使腿570,590更好地向内弯曲,可最小化每个钉腿570,590在组织中最终形成的入口孔的延度,并且/或者可以提供其他结果。另外,应当指出的是,钉成形凹坑510的有效子通道具有比通道220,240更大的长度,这降低了相关联的钉腿在钉成形完成之前不期望地离开通道420,440的可能性。在一些形式中,钉成形凹坑510的有效子通道还比通道220,240更深,这可帮助防止相关联的钉腿尖端在钉成形期间二次穿过至少层92(如果没有穿过两个层92,94)。
在一些环境中,钉成形凹坑510所形成的钉550可为并置的组织层92,94提供更好止血效果,可相对于并置的组织层92,94实现更好的结构完整性,可使不期望地脱离组织层92,94的可能性降低,可使组织以后在钉线处撕裂的可能性降低,并且/或者可以其他方式将对组织层92,94所造成的创伤减至最少,尤其是在与钉成形凹坑210所形成的钉250相比的情况下。当密封某些组织结构(例如,脆弱动脉等等)时,可期望尽量减少钉刺穿的组织的量。通过不二次回穿过层92,并且在一些情况下,不二次回穿过层94,成形钉550可使此类穿刺尽量减少(例如,与成形钉250相比)。通过将钉成形凹坑510所形成的钉腿570,590的折回运动减至最小程度,与常规的钉相比,所得成形钉550可与安全组织夹具在外观和功能上具有更多类似之处。这种夹具样的构型可使比原本可能被捕获于腿270,290与冠部252之间的组织更多的组织被捕获于腿570,590与冠部552之间,这继而可实现更好的组织完整性并减小了组织在钉550附近撕裂的倾向。与使用常规钉成形凹坑来使钉成形所需的力相比,将钉腿570,590在钉成形的过程中的折回运动减至最小程度还减少了使钉550成形所需要的总力。这可减少击发行程期间将击发梁14朝远侧推进所需要的力。
E.具有单个通道和完全偏转突起的示例性钉成形凹坑
图35-37示出另一个仅示例性的钉成形凹坑610,该钉成形凹坑可容易地结合到本文所提及的任何砧座18,200,300以及其他砧座中。本示例的钉成形凹坑610提供单个连续通道612,该单个连续通道具有侧向突出到通道612中的第一偏转突起620和侧向突出到通道612中的第二偏转突起640。通道612包括用于接收第一钉腿的第一终端614和用于接收第二钉腿的第二终端616。通道612包括端部614处的凹形入口表面615、端部616处的凹形入口表面617,以及平坦底板表面618,该平坦底板表面将表面615,617联结起来并提供通道612的纵向中间区域的最低点。
第一外侧壁642从第一终端614延伸到第二偏转凸起640。第二外侧壁622从第二终端616延伸到第一偏转凸起620。外侧壁622,642相对于沿着钉成形凹坑610的中心纵向穿过的竖直平面成角度,使得侧壁622,642提供到表面615,617和底板618的引入端。换句话说,与在侧壁622,642底部处侧壁622,642间的侧向间距相比,侧壁622,642间的侧向间距在侧壁622,642顶部处(即,在组织接触表面602处)更大。
第一偏转突起620包括侧向凹形侧壁624,该侧向凹形侧壁通向终止在第二外侧壁622中的凸形侧壁626。如同侧壁622那样,侧壁624,626相对于沿着钉成形凹坑610的中心纵向穿过的竖直平面倾斜,使得侧壁624,626提供到表面615,617和底板618的引入端。还应理解,侧壁624,626一直竖直延伸到通道612的顶部,使得侧壁624,626的顶部终止在组织接触表面602处。
第二偏转突起640包括侧向凹形侧壁644,该侧向凹形侧壁通向终止在第一外侧壁642中的凸形侧壁646。如同侧壁642那样,侧壁644,646相对于沿着钉成形凹坑610的中心纵向穿过的竖直平面倾斜,使得侧壁644,646提供到表面615,617和底板618的引入端。还应理解,侧壁644,646一直竖直延伸到通道612的顶部,使得侧壁644,646的顶部终止在组织接触表面602处。
当钉被驱动到钉成形凹坑610中时,结果可能类似于图24和图34所示的结果。具体地,当钉最初被驱动到钉成形凹坑610中时,表面615,617可将钉腿朝彼此驱动。突起620,640可最终使钉腿在相反方向上侧向偏转,这样腿就不会在钉成形期间碰撞彼此,并且腿最终定位于穿过钉冠部的竖直平面的相对侧上(例如,如图34所示)。钉腿尖端可最终仅穿过组织层92,94一次,而不再回穿过层94。在一些形式中,钉腿尖端可至少二次回穿过层94(例如,如图24所示)。
应当理解,钉成形凹坑610所形成的钉可为并置的组织层92,94提供更好止血效果,可相对于并置的组织层92,94实现更好的结构完整性,可使不期望地脱离组织层92,94的可能性降低,可使组织以后在钉线处撕裂的可能性降低,并且/或者可以其他方式将对组织层92,94所造成的创伤减至最少,尤其是在与钉成形凹坑210所形成的钉250相比的情况下。当密封某些组织结构(例如,脆弱动脉等等)时,可期望尽量减少钉刺穿的组织的量。通过不二次回穿过层92,并且在一些情况下,不二次回穿过层94,凹坑610所形成的钉可使此类穿刺尽量减少(例如,与成形钉250相比)。通过将钉成形凹坑610所形成的钉腿的折回运动减至最小程度,与常规的钉相比,所得成形钉可与安全组织夹具在外观和功能上具有更多类似之处。这种夹具样的构型可使比原本可能被捕获于腿270,290与冠部252之间的组织更多的组织被捕获于腿与冠部之间,这继而可实现更好的组织完整性并减小组织在钉附近撕裂的倾向。与使用常规钉成形凹坑来使钉成形所需的力相比,将钉腿在钉成形的过程中的折回运动减至最小程度还减少了使用钉成形凹坑610来使钉成形所需要的总力。这可减少击发行程期间将击发梁14朝远侧推进所需要的力。
F.具有单个通道和部分偏转突起的示例性钉成形凹坑
图38-40示出另一个仅示例性的钉成形凹坑710,该钉成形凹坑可容易地结合到本文所提及的任何砧座18,200,300以及其他砧座中。本示例的钉成形凹坑710提供单个连续通道712,该单个连续通道具有侧向突出到通道712中的第一偏转突起720和侧向突出到通道712中的第二偏转突起740。通道712包括用于接收第一钉腿的第一终端714和用于接收第二钉腿的第二终端716。通道712包括端部714处的凹形入口表面715、端部716处的凹形入口表面717,以及平坦底板表面618,该平坦底板表面将表面715,717联结起来并提供通道712的纵向中间区域的最低点。
通道712还由第一外侧壁722和第二外侧壁742限定。侧壁722,742相对于沿着钉成形凹坑710的中心纵向穿过的竖直平面成角度,使得侧壁722,742提供到表面715,717和底板718的引入端。换句话说,与在侧壁722,742底部处侧壁722,742间的侧向间距相比,侧壁722,742间的侧向间距在侧壁722,742顶部处(即,在组织接触表面702处)更大。
第一偏转突起720包括成角度上壁721以及侧向成角度侧壁724,该侧向成角度侧壁通向终止在第一外侧壁722中的凸形侧壁726。如同侧壁722那样,侧壁724,726相对于沿着钉成形凹坑710的中心纵向穿过的竖直平面倾斜,使得侧壁724,726提供到表面715,717和底板718的引入端。上壁721还相对于沿着钉成形凹坑710的中心纵向穿过的竖直平面倾斜,但其倾斜角度不如侧壁724,726所提供的角度那样陡峭。如图40中最佳地示出,在本示例中,上壁721定位于组织接触表面702的下方,使得突起720完全凹陷于通道712中。
第二偏转突起740包括成角度上壁741以及侧向成角度侧壁744,该侧向成角度侧壁通向终止在第二外侧壁742中的凸形侧壁746。如同侧壁742那样,侧壁744,746相对于沿着钉成形凹坑710的中心纵向穿过的竖直平面倾斜,使得侧壁744,746提供到表面715,717和底板718的引入端。上壁741还相对于沿着钉成形凹坑710的中心纵向穿过的竖直平面倾斜,但其倾斜角度不如侧壁744,746所提供的角度那样陡峭。如图40中最佳地示出,在本示例中,上壁741定位于组织接触表面702的下方,使得突起740完全凹陷于通道712中。
当钉被驱动到钉成形凹坑710中时,结果可能类似于图24和图34所示的结果。具体地,当钉最初被驱动到钉成形凹坑710中时,表面715,717可将钉腿朝彼此驱动。突起720,740可最终使钉腿在相反方向上侧向偏转,这样腿就不会在钉成形期间碰撞彼此,并且腿最终定位于穿过钉冠部的竖直平面的相对侧上(例如,如图34所示)。钉腿尖端可最终仅穿过组织层92,94一次,而不再回穿过层94。在一些形式中,钉腿尖端可至少二次回穿过层94(例如,如图24所示)。
应当理解,钉成形凹坑710所形成的钉可为并置的组织层92,94提供更好止血效果,可相对于并置的组织层92,94实现更好的结构完整性,可使不期望地脱离组织层92,94的可能性降低,可使组织以后在钉线处撕裂的可能性降低,并且/或者可以其他方式将对组织层92,94所造成的创伤减至最少,尤其是在与钉成形凹坑210所形成的钉250相比的情况下。当密封某些组织结构(例如,脆弱动脉等等)时,可期望尽量减少钉刺穿的组织的量。通过不二次回穿过层92,并且在一些情况下,不二次回穿过层94,凹坑710所形成的钉可使此类穿刺尽量减少(例如,与成形钉250相比)。通过将钉成形凹坑710所形成的钉腿的折回运动减至最小程度,与常规的钉相比,所得成形钉可与安全组织夹具在外观和功能上具有更多类似之处。这种夹具样的构型可使比原本可能被捕获于腿270,290与冠部252之间的组织更多的组织被捕获于腿与冠部之间,这继而可实现更好的组织完整性并减小组织在钉附近撕裂的倾向。与使用常规钉成形凹坑来使钉成形所需的力相比,将钉腿在钉成形的过程中的折回运动减至最小程度还减少了使用钉成形凹坑710来使钉成形所需要的总力。这可减少击发行程期间将击发梁14朝远侧推进所需要的力。
G.钉成形凹坑的示例性可变阵列
在一些示例性砧座中,所有钉成形凹坑均具有相同构型。在一些其他示例性砧座中,钉成形凹坑中的至少一些彼此不同。这种情况的示例在图41中示出,该图示出砧座800的一部分,其具有两排第一种钉成形凹坑210和一排第二种钉成形凹坑310。砧座800包括组织接触表面802、砧座狭槽804(其类似于上述砧座狭槽42)以及外侧806。应当理解,图41仅仅示出位于狭槽804的一侧上的凹坑210,310,并且凹坑210,310将在狭槽804的另一侧上成镜像地布置,使得砧座800关于沿着狭槽804长度垂直地延伸出附图页面的平面对称。
凹坑210与图12-16中示出且在上文中描述的凹坑210相同。凹坑310与图19-23中示出且在上文中描述的凹坑310相同。当然,可以使用任何其他合适的凹坑构型。还应理解,可以使用任何合适的布置。例如,第一排810可以包括第一类型的钉成形凹坑,而第二排820包括第二类型的钉成形凹坑,并且第三排830包括第三类型的钉成形凹坑。作为另一个仅说明性的示例,至少一排810,820,830中的钉成形凹坑可沿一个方向取向;而至少另一排810,820,830中的钉成形凹坑可沿另一个方向取向。在一些形式中,一排810,820,830中的钉成形凹坑可相对于另一排810,820,830中的钉成形凹坑倾斜取向。除此之外或作为另外一种选择,一排810,820,830中的钉成形凹坑可相对于另一排810,820,830中的钉成形凹坑垂直取向。特定排810,820,830中的钉成形凹坑甚至可与同一排810,820,830中的其他钉成形凹坑不同地取向(例如,交替的垂直或倾斜取向等等)。参考本文的教导内容,凹坑构型的各种合适的布置和组合对于本领域的普通技术人员而言将是显而易见的。
图42-43示出砧座800所形成的一系列钉250,350。钉250与图17-18E中示出且在上文中描述的钉250相同。钉350与图24-25D中示出且在上文中描述的钉350相同。如图42中最佳地示出,在每个成形钉250中,腿270,290保持沿着穿过冠部252的竖直平面定位,这使腿270,290在图42的顶部平面图中被遮住。然而,由于如上所述的凹坑310构型,钉350的腿370,390相对于穿过钉350的冠部352的竖直平面侧向且倾斜地偏转。图43示出施加至层92,94的这些成形钉250,350。由于凹坑210定位成最靠近狭槽804,因此,钉250定位成最靠近击发梁14的切割刃48形成的切割线96。
IV.其他方面
应当理解,本文所述的教导内容、表达方式、实施例、示例等中的任何一者或多者可与本文所述的其他教导内容、表达方式、实施例、示例等中的任何一者或多者相结合。上述教导内容、表达方式、实施例、示例等不应视为彼此隔离。参考本文的教导内容,其中可结合本文的教导内容的各种合适方式对于本领域普通技术人员而言将是显而易见的。这些修改和变型旨在包括在权利要求书的范围内。
应当理解,所述以引用的方式并入本文中的任何专利、出版物或其他公开材料,无论是全文或部分,仅在所并入的材料与本公开中给出的定义、陈述或者其他公开材料不冲突的范围内并入本文。因此,在必要的情况下,本文明确陈述的公开内容可取代任何与之抵触的以引用方式并入本文的材料。据述以引用方式并入本文但与本文所述的现有定义、陈述或其他公开材料相冲突的任何材料或其部分,仅在所并入的材料和现有公开材料之间不产生冲突的程度下并入本文。
上文所述的装置的变型可适用于由医疗专业人员进行的常规医疗处理和手术中、以及可适用于机器人辅助的医疗处理和手术中。仅以举例的方式,本文的各种教导内容可易于结合到机器人外科系统诸如Intuitive Surgical,Inc.(Sunnyvale,California)的DAVINCITM系统中。类似地,本领域的普通技术人员将认识到,本文中的各种教导内容可容易地结合任何以下文献中的各种教导内容:1998年8月11日公布的名称为“ArticulatedSurgical Instrument For Performing Minimally Invasive Surgery With EnhancedDexterity and Sensitivity”的美国专利5,792,135,其公开内容以引用方式并入本文;1998年10月6日公布的名称为“Remote Center Positioning Device with FlexibleDrive”的美国专利5,817,084,其公开内容以引用方式并入本文;1999年3月2日公布的名称为“Automated Endoscope System for Optimal Positioning”的美国专利5,878,193,其公开内容以引用方式并入本文;2001年5月15日公布的名称为“Robotic Arm DLUS forPerforming Surgical Tasks”的美国专利6,231,565,其公开内容以引用方式并入本文;2004年8月31日公布的名称为“Robotic Surgical Tool with Ultrasound Cauterizingand Cutting Instrument”的美国专利6,783,524,其公开内容以引用方式并入本文;2002年4月2日公布的名称为“Alignment of Master and Slave in a Minimally InvasiveSurgical Apparatus”的美国专利6,364,888,其公开内容以引用方式并入本文;2009年4月28日公布的名称为“Mechanical Actuator Interface System for Robotic SurgicalTools”的美国专利7,524,320,其公开内容以引用方式并入本文;2010年4月6日公布的名称为“Platform Link Wrist Mechanism”的美国专利7,691,098,其公开内容以引用方式并入本文;2010年10月5日公布的名称为“Repositioning and Reorientation of Master/Slave Relationship in Minimally Invasive Telesurgery”的美国专利7,806,891,其公开内容以引用方式并入本文;2013年1月10日公布的名称为“Automated End EffectorComponent Reloading System for Use with a Robotic System”的美国公布2013/0012957,其公开内容以引用方式并入本文;2012年8月9日公布的名称为“Robotically-Controlled Surgical Instrument with Force-Feedback Capabilities”的美国公布2012/0199630,其公开内容以引用方式并入本文;2012年5月31日公布的名称为“ShiftableDrive Interface for Robotically-Controlled Surgical Tool”的美国公布2012/0132450,其公开内容以引用方式并入本文;2012年8月9日公布的名称为“SurgicalStapling Instruments with Cam-Driven Staple Deployment Arrangements”的美国公布2012/0199633,其公开内容以引用方式并入本文;2012年8月9日公布的名称为“Robotically-Controlled Motorized Surgical End Effector System with RotaryActuated Closure Systems Having Variable Actuation Speeds”的美国专利公布2012/0199631,其公开内容以引用方式并入本文;2012年8月9日公布的名称为“Robotically-Controlled Surgical Instrument with Selectively Articulatable End Effector”的美国公布2012/0199632,其公开内容以引用方式并入本文;2012年8月9日公布的名称为“Robotically-Controlled Surgical End Effector System”的美国公布2012/0203247,其公开内容以引用方式并入本文;2012年8月23日公布的名称为“Drive Interface forOperably Coupling a Manipulatable Surgical Tool to a Robot”的美国公布2012/0211546;2012年6月7日公布的名称为“Robotically-Controlled Cable-Based SurgicalEnd Effectors”的美国公布2012/0138660,其公开内容以引用方式并入本文;和/或2012年8月16日公布的名称为“Robotically-Controlled Surgical End Effector System withRotary Actuated Closure Systems”的美国公布2012/0205421,其公开内容以引用方式并入本文。
上文所述的装置形式可设计为在单次使用后丢弃,或设计为能够多次使用。在上述任一种或两种情况下,可对这些形式进行修复,以便在使用至少一次后再次使用。修复可包括以下步骤的任意组合:拆卸装置、然后清洗或更换特定部件,随后重新组装。具体地,所述装置的一些形式可拆卸,并且所述装置的任意数量的特定部件或零件可选择性地以任何组合形式来替换或取出。在清洗和/或更换特定零件时,所述装置的一些版本可在修复设施中重新组装或者在即将进行手术前由用户重新组装以供随后使用。本领域的技术人员将会了解,装置修复可以利用多种技术进行拆卸、清洗/更换以及重新组装。这些技术的使用以及所得的修复装置均在本发明的范围内。
仅以举例方式,本文所描述的形式可在手术之前和/或之后进行消毒。在一种消毒技术中,将装置放置在闭合并密封的容器中,诸如塑料袋或TYVEK袋中。随后,可将容器和装置置于可穿透该容器的辐射场中,诸如γ辐射、X射线或高能电子。辐射可将装置上和容器中的细菌杀死。消毒后的装置随后可存放在无菌容器中,以供以后使用。还可使用本领域已知的任何其他技术对装置消毒,包括但不限于β辐射或γ辐射、环氧乙烷或蒸汽。
上文已经示出和描述了本发明的多个实施例,可由本领域的普通技术人员在不脱离本发明范围的情况下进行适当修改来实现本文描述的方法和系统的进一步改进。已经提及了若干此类潜在修改形式,并且其他修改形式对于本领域的技术人员而言将是显而易见的。例如,上文所讨论的示例、实施例、几何形状、材料、尺寸、比率、步骤等均是示例性的而非所要求的。因此,本发明的范围应根据下面的权利要求书来考虑,并且应理解为不限于说明书和附图中示出和描述的结构和操作细节。
Claims (4)
1.一种外科器械的端部执行器,所述端部执行器包括:
(a)第一钳口,其中所述第一钳口被构造为能够接收钉仓;和
(b)第二钳口,其中所述第二钳口能够相对于所述第一钳口运动,其中所述第二钳口被构造为能够提供用于使钉成形的砧座,所述钉从所述第一钳口中接收的钉仓驱动,其中所述砧座包括:
(i)组织接触表面,和
(ii)邻近所述组织接触表面的钉成形凹坑,其中所述钉成形凹坑限定沿纵向轴线的长度,其中所述钉成形凹坑包括:
(A)被构造为能够接收第一钉腿的第一钉成形表面区域,其中所述第一钉成形表面区域具有大于所述钉成形凹坑的所述长度的一半的长度,和
(B)被构造为能够接收第二钉腿的第二钉成形表面区域,其中所述第二钉成形表面区域具有大于所述钉成形凹坑的所述长度的一半的长度,
其中,所述钉成形凹坑限定从该钉成形凹坑的一个端部延伸至该钉成形凹坑的相对端部的单个连续通道,并且所述第一钉成形表面区域和所述第二钉成形表面区域均形成在所述单个连续通道中;
其中,所述钉成形凹坑包括侧向突出到所述单个连续通道中的第一偏转突起和侧向突出到所述单个连续通道中的第二偏转突起。
2.根据权利要求1所述的端部执行器,其中所述单个连续通道包括底板表面,其中:
(A)所述第一偏转突起具有包括第一侧向定向的凸形表面的第一凸轮型特征结构,和
(B)所述第二偏转突起具有包括第二侧向定向的凸形表面的第二凸轮型特征结构,
其中所述第一侧向定向的凸形表面和所述第二侧向定向的凸形表面面向相反的侧向方向。
3.根据权利要求2所述的端部执行器,其中所述第一凸轮型特征结构还包括第一凹形倾斜表面,所述第一凹形倾斜表面终止在所述单个连续通道的所述底板中,
其中所述第二凸型特征结构还包括第二凹形倾斜表面,所述第二凹形倾斜表面终止在所述单个连续通道的所述底板中,
其中所述第一凹形倾斜表面、所述第二侧向定向的凸形表面和所述底板共同限定所述第一钉成形表面区域,并且
其中所述第二凹形倾斜表面、所述第一侧向定向的凸形表面和所述底板共同限定所述第二钉成形表面区域。
4.根据权利要求3所述的端部执行器,其中所述底板的第一入口部分沿着由第一长度的半径限定的弧形定位,其中所述底板的第二入口部分也沿着由所述第一长度的半径限定的弧形定位,
其中所述第一凹形倾斜表面沿着由第二长度的半径限定的弧形定位,其中所述第二凹形倾斜表面沿着由所述第二长度的半径限定的弧形定位,
其中所述第一长度大于所述第二长度。
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- 2014-02-20 MX MX2015011218A patent/MX361296B/es active IP Right Grant
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WO2014133858A1 (en) | 2014-09-04 |
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US10092292B2 (en) | 2018-10-09 |
MX361296B (es) | 2018-11-30 |
JP2016508420A (ja) | 2016-03-22 |
EP3202337A1 (en) | 2017-08-09 |
MX2015011218A (es) | 2015-11-13 |
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