CN105025825A - 具有小齿轮和反向齿条的外科器械端部执行器关节运动驱动器 - Google Patents

具有小齿轮和反向齿条的外科器械端部执行器关节运动驱动器 Download PDF

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CN105025825A
CN105025825A CN201480011026.4A CN201480011026A CN105025825A CN 105025825 A CN105025825 A CN 105025825A CN 201480011026 A CN201480011026 A CN 201480011026A CN 105025825 A CN105025825 A CN 105025825A
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cam
cam wheel
end effector
securing rod
tooth
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CN105025825B (zh
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N·法内利
J·C·加格尔
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Ethicon Endo Surgery Inc
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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
    • A61B17/068—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
    • A61B17/07207—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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003—Steerable
    • A61B2017/00318—Steering mechanisms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • A61B2017/00389—Button or wheel for performing multiple functions, e.g. rotation of shaft and end effector
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2946—Locking means

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Abstract

本发明公开了一种设备，其包括主体和轴组件。所述轴组件与所述主体连通，并且包括端部执行器、第一凸轮齿轮、第二凸轮齿轮和锁定杆。所述端部执行器具有关节运动接头。所述第一凸轮齿轮可旋转地定位在所述轴组件内。所述第二凸轮齿轮在所述关节运动接头处与所述端部执行器连通。所述锁定杆朝远侧偏压以抵靠所述第二凸轮齿轮锁定。所述第一凸轮齿轮可旋转经过第一运动范围以使所述锁定杆相对于所述第二凸轮齿轮解锁。所述第一凸轮齿轮可旋转经过第二运动范围以使所述端部执行器在所述关节运动接头处旋转。

Description

具有小齿轮和反向齿条的外科器械端部执行器关节运动驱动器
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通过套管针的套管将远侧端部执行器放置在期望的手术部位处。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柄部部分之间。此轴可使能插入期望的深度并围绕轴的纵向轴线旋转，由此有利于将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，使端部执行器能够选择性地进行关节运动，或者以其它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压制组织的层，切割穿过夹紧的组织的层，并驱动钉穿过组织的层，以在组织的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。仅示例性的外科缝合器公开于：1989年2月21日公布的名称为“PocketConfiguration 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 StaplerInstrument”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 StaplingInstrument 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“Surgical Stapling InstrumentHaving 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 having a FiringLockout 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 FiringMechanism Having 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 LockoutMechanism for Prevention 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-Beam Firing Mechanism”的美国专利7,380,696；2008年7月29日公布的名称为“Surgical Stapling 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 HavingMultistroke 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 with Adhesive for Use with aStapling Device”的美国公布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；和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。
尽管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。仅以举例的方式，在胸廓外科手术中，外科缝合器可通过胸廓切开术插入，并由此位于患者肋骨之间以到达一个或多个器官，该胸廓外科手术不使用套管针作为缝合器的导管。此手术可包括使用缝合器来切断和闭合通向肺部的血管。例如，在从胸腔移除器官之前，可通过缝合器切断和闭合通向该器官的血管。当然，外科缝合器可用于各种其他情况和手术。
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1A的器械中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致动一次；
图8示出在图1的器械中使用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侧正视图，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轴组件的顶部透视图；
图13A示出图12的轴组件的顶部平面图，其中端部执行器处于第一位置；
图13B示出图12的轴组件的顶部平面图，其中端部执行器处于第二关节运动位置；
图14示出图12的轴组件的近侧端部的透视图，该图示出关节运动钮以及内部运动部件；
图15示出图12的轴组件的近侧端部沿图14的线15-15截取的顶部剖面图；
图16示出处于居中位置的图12的轴组件的顶部平面图；
图17示出图12的轴组件的端部执行器和关节运动接头的透视分解图；
图18A示出处于第一位置的图12的轴组件的关节运动接头的顶部局部内视图；
图18B示出图12的轴组件的关节运动接头的顶部局部内视图，其中第一臂和第二臂使第一凸轮齿轮旋转；
图18C示出图12的轴组件的关节运动接头的顶部局部内视图，其中第一臂和第二臂使第二凸轮齿轮和第一凸轮齿轮进一步旋转；
图18D示出图12的轴组件的关节运动接头的顶部局部内视图，其中锁定杆将锁定齿弹性地定位在第一凸轮齿轮和第二凸轮齿轮的齿间；
图18E示出图12的轴组件的关节运动接头的顶部局部内视图，其中第一臂和第二臂使第一凸轮齿轮再进一步旋转；并且
图19示出图12的轴组件的凸轮齿轮与锁定杆之间接口的平面放大视图。
附图并非意在以任何方式进行限制，并且可以设想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。结合于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。
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，本发明的其它示例、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，本发明能够具有其它不同且明显的方面，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1A中示出的非关节运动的状态下，其尺寸设定成穿过套管针的插管通道插入患者的手术部位，以便执行外科手术。仅以举例的方式，此类套管针可被插入患者的腹部，位于患者的两个肋骨之间或其他地方。在一些情况下，器械10不使用套管针。例如，器械10可通过胸廓切开术或其他类型切口直接插入。本示例的器械10包括连接到轴22的柄部部分20。轴22在远侧终止于关节运动接头11中，该关节运动接头11进一步与端部执行器12联接。应当理解，本文中使用的术语诸如“近侧”和“远侧”参照临床医生抓握器械10的柄部部分20而言。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，为便利和清楚起见，本申请结合附图使用空间术语，例如“竖直”和“水平”。然而，外科器械是在多个取向和位置中使用的，并且这些术语并非意图进行限制，也并非绝对的。
在一些形式中，轴22是根据如下专利的教导内容中的一些构造的：与本文同一天提交的名称为“Surgical Instrument with Multi-Diameter Shaft”的美国专利申请[代理人案卷号END7181USNP.0599180]，其公开内容以引用方式并入本文。根据本文的教导内容，轴22的其他合适的构型对于本领域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插入穿过套管针的管道通道，关节运动接头11就可以通过关节运动控件13向远处关节运动，如图1中的虚线示出的，使得端部执行器12可从轴22的纵向曲线LA以期望的角度(α)偏转。由此，端部执行器12可以从所需的角度或由于其他原因到达器官的后面或接近组织。在一些形式中，关节运动接头11使端部执行器12能够沿着单个平面偏转。在一些其他形式中，关节运动接头11使端部执行器能够沿着多于一个平面偏转。关节运动接头11和关节运动控件13可根据本文引用的多个参考中的任意参考中的教导内容来被构造。另选地，关节运动接头11和/或关节运动控件13可具有任何其它合适的构型。仅以举例的方式，关节运动控件13可代替地构造为钮，该钮围绕与轴22的纵向轴线LA垂直的轴线旋转。
下文更详细地描述了关节运动接头11和关节运动控件13的各种示例性替代部件、构型和可操作性。关节运动接头11也可根据根据如下专利的教导内容中的至少一些来构造和操作：美国专利申请[代理人案卷号END7181USNP.0599180]，该专利申请的全部公开内容以引用方式并入本文。考虑到本文的教导内容，关节运动接头11和关节控件13可以采用的各种其它合适的形式对于本领域普通技术人员而言将显而易见。
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是根据如下专利的教导内容中的至少一些来构造的：与本文同一天提交的名称为“Installation Features for Surgical Instrument End EffectorCartridge”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可根据如下专利的教导内容中的至少一些来构造：与本文同一天提交的名称为“Integrated Tissue Positioning andJaw 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；与本文同一天提交的名称为“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；和/或与本文同一天提交的名称为“Staple Forming Featuresfor Surgical Stapling Instrument”的美国专利申请[代理人案卷号ENDEND7180USNP.0599175]，其公开内容以引用方式并入本文。考虑到本文的教导内容，下钳口16和砧座18可以采用的各种其它合适的形式对于本领域普通技术人员而言将显而易见。
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能够朝着手枪式握把24枢转，以使得砧座18朝着端部执行器12的下钳口16夹紧、或闭合。砧座18的此类闭合是通过闭合管32和闭合环33提供的，该闭合管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在远侧定位到关节运动接头11。关节运动接头11能够操作以将纵向运动从闭合管32传送/传输到闭合环33。
柄部部分20也包括击发触发器28。细长构件136(示于图11中)纵向延伸穿过轴22，并响应于击发触发器28的致动，将纵向击发运动从柄部部分20传送至击发梁14。击发梁14的这种远侧平移，使得端部执行器12中夹紧的组织被缝合和切断，如下文将更详细地描述的。然后，将触发器26、28释放以从端部执行器12释放该组织。
图3-6示出采用电子束形式的击发梁14来执行多种功能的端部执行器12。应当理解，电子束形式仅是例证性示例。击发梁14可采取任何其他合适形式，包括但不限于非电子束形式。如最佳见于图4A-4B，击发梁14包括横向取向的上部销38、击发梁顶盖44、横向取向的中部销46和在远侧呈现的切割刃48。上部销38被定位在砧座18的纵向砧座狭槽42内，并且能够在所述纵向砧座狭槽内平移。通过使击发梁14延伸穿过下钳口狭槽45(示于图4B中)，击发梁顶盖44以能滑动的方式接合下钳口16的下表面，下钳口狭槽是穿过下钳口16形成的。中部销46以能够滑动的方式接合下钳口16的顶表面，从而与击发梁顶盖44协作。因此，击发梁14在击发期间必然隔开端部执行器12。
一些非电子束形式的击发梁14可缺少上部销38、中部销46、和/或击发梁顶盖44。器械10的一些此类形式可仅仅依靠于闭合环33或一些其他特征结构，以在击发梁14推进到远侧位置中时，将砧座18枢转到闭合位置并将砧座18保持在闭合位置中。仅通过举例的方式，击发梁14和/或相关的闭锁特征结构可根据如下专利的教导内容中的至少一些来构造：与本文同一天提交的名称为“Lockout Feature for Movable Cutting Member of SurgicalInstrument”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。根据本文的教导内容，击发梁14可以采取的其他合适的形式对于本领域的普通技术人员将是显而易见的。
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，从而允许未耗尽的钉仓37可移除地安装到下钳口16的通道中。如最佳见于图5-6，本示例的钉仓37包括仓体70，该仓体呈现出上部平台72并与下部仓托盘74联接。如最佳见于图3，竖直狭槽49是穿过钉仓37的一部分形成的。还最佳见于图3，三排钉孔51在竖直狭槽49的一侧上穿过上部平台72形成，其中另一组三排钉孔51在竖直狭槽49的另一侧上穿过上部平台72形成。当然，可提供任何其他合适数量钉排(例如，两排、四排、或其他数量)。重新参见图4A-6，楔形滑动件41和多个钉驱动器43被捕获在仓体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能够在钉仓37内纵向地活动；而钉驱动器43能够在钉仓37内竖直地活动。钉47也被定位在仓体70内，处于对应的钉驱动器43上方。具体地，每个钉47在仓体70内被钉驱动器43竖直地驱动，以将钉47驱动穿出相关的钉孔51。如最佳见于图4A-4B和6，楔形滑动件41存在倾斜凸起表面，当楔形滑动件41朝远侧驱动穿过钉仓37时，该倾斜凸起表面向上推动钉驱动器43。
在一些形式中，钉仓37根据如下专利的教导内容中的至少一些来构造和操作：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可根据如下专利的教导内容中的至少一些来构造和操作：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。根据本文的教导内容，钉仓37可采取的其他合适的形式对于本领域的普通技术人员将是显而易见的。
在通过朝远侧推进闭合管32和闭合环33以使端部执行器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，将击发梁14推进至与砧座18接合。推块80(示于图5中)位于击发梁14的远侧端部处，并且被构造成能够接合楔形滑动件41，使得当激发触发器28被致动时，楔形滑动件41随着击发梁14被朝远侧推进穿过钉仓37，而被推块80朝远侧推动。在此类击发期间，击发梁14的切割刃48进入钉仓37的竖直狭槽49，从而切断夹紧在钉仓37和砧座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中来一起致动钉仓37，从而将楔形滑动件41驱动成与钉驱动器43发生向上凸轮接触，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(示于图3中)形成接触。图4B示出在完成切断和缝合组织之后完全朝远侧平移的击发梁14。应当理解钉成形凹坑53在图4A-4B的视图中被有意省略；但钉成形凹坑53示出于图3中。还应当理解砧座18在图5中被有意省略。
图7示出端部执行器12，所述端部执行器已通过单个行程而被致动穿过组织90。如图所示，切割刃48(图7中模糊部分)已经切穿组织90，同时在切割刃48形成的切割线的每一侧上，钉驱动器43已经使交替的三排钉47驱动穿过组织90。在该示例中，钉47全部与切割线基本上平行地取向，但应当理解，钉47可被定位成任何适合的取向。在本示例中，在第一行程完成之后，端部执行器12从套管针撤回，用新的钉仓替换耗尽的钉仓37，然后将端部执行器12再次穿过套管针插入，以到达缝合部位用于进一步的切割和缝合。这个过程可以重复，直到提供了期望量的切口和钉47。可能需要将砧座18闭合以有利于通过套管针来插入和撤回；并且可能需要将砧座18打开以有利于替换钉仓37。
应当理解，在每个致动行程期间，切割刃48可在钉47被驱动穿过组织时基本上同时切断组织。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，但应当理解，这个顺序可以颠倒，或者切割刃48可以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，但应当理解，端部执行器12可被致动穿过组织90的单个层或者组织的多于两个层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所述切割线处的组织，从而减少或防止切割线处的出血和/或其它体液的渗漏。此外，尽管图7示出端部执行器12在组织的两个基本上平的相反的平面层92、94中致动，但应当理解端部执行器12也可在管状结构诸如血管、胃肠道的一部分等上致动。因此，不应将图7视为对端部执行器12的设想用途进行任何限制。根据本文的教导内容，可使用器械10的各种适合的情况和程序对于本领域的普通技术人员将是显而易见的。
应当理解，可以根据以下专利的教导内容中的任何内容来构造和操作器械10：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2012/0239012。如上所述，这些专利/公布中的每一个中的公开内容均以引用方式并入本文。可提供用于器械10的附加示例性修改将更详细地描述于下文中。下述教导内容并入器械10中的各种适合方式对本领域的普通技术人员将显而易见。类似地，将下述教导内容与本文引用的专利的各种教导内容进行组合的各种适合方式对本领域的普通技术人员将是显而易见的。还应当理解，下述教导内容并不限于本文引用的专利中所教导的器械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，包括未被归类为外科缝合器的器械。根据本文的教导内容，可以应用下述教导内容的各种其它适合装置和情况对于本领域的普通技术人员将是显而易见的。
II.示例性机动化驱动特征结构
在本示例中，器械10提供对击发梁14的机动化控制。图8-11示出可被用来提供对击发梁14的机动化控制的示例性部件。具体地，图8示出示例性控制电路100，该控制电路100可被用来从电池组104(同样示于图1-2中)使用电力对电动马达102供电。电动马达102能够操作以将击发梁14纵向平移，如将在下文所详述。应当理解，整个控制电路100，包括马达102和电池组104，可被封装在柄部部分20内。图8示出作为打开的开关的击发触发器28，但应当理解该开关在击发触发器28致动时是闭合的。本示例的电路100包括必须是闭合的以便使电路100完整的安全开关106，但是应当理解安全开关106仅仅是任选的。可通过致动柄部部分20上的分开按钮、滑块、或其他特征结构来使安全开关106闭合。
本示例的电路100还包括闭锁开关108，该闭锁开关108默认是闭合的，但是被构造成能够响应于闭锁条件而自动打开。仅以举例的方式，闭锁条件可包括以下中的一者或多者：下钳口16中缺少仓37、下钳口16中存在耗尽的(例如，先前击发的)仓37、未充分闭合的砧座18、确定器械10已被击发很长时间、和/或任何其他合式的条件。根据本文中的教导内容，可以用来检测闭锁条件的各种传感器、算法和其他特征结构对本领域的普通技术人员是显而易见的。类似地，根据本文的教导内容，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，并因此当闭合开关108打开时，马达102不能够操作。闭锁指示器110(例如LED等)能够操作以提供对闭锁开关108的状态的视觉指示。仅以举例的方式，闭锁开关108、闭锁指示器110、和相关联的部件/功能可根据下述专利的教导内容中的至少一些来构造：2010年1月12日公布的名称为“Electronic Lockouts and Surgical Instrument Including Same”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到达最远侧位置(例如，在切割行程的末端)，行程结束开关112自动转换到闭合位置，从而逆转施加到马达102的电压的极性。这逆转马达102的旋转方向，应当理解操作者在该操作阶段将使击发触发器28被释放。在该操作状态下，电流流过反向指示器114(例如LED)，以提供马达102方向已逆转的视觉指示。考虑到本文的教导内容，当击发梁14到达最远侧位置时，行程结束开关112可自动切换到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显而易见。类似地，考虑到本文的教导内容，反向指示器114可以采用的各种合适的形式对于本领域的普通技术人员而言将显而易见。
本示例的柄部部分20还包括手动返回开关116，其也示于电路100中。手动返回开关116被构造成能够充当“紧急救助”(bailout)特征结构，使操作者在击发行程期间能够快速开始朝近侧回缩击发梁14。换句话讲，当击发梁14仅已被部分地朝远侧推进时，手动返回开关116可手动致动。手动返回开关116可提供与行程结束开关112类似的功能性，即逆转施加到马达102的电压的极性，以由此逆转马达102的旋转方向。同样，该逆转在视觉上可通过反向指示器114来指示。
在一些形式中，开关28、106、108、112、116中的一者或多者是的形式为微型开关。根据本文的教导内容，其它合适形式对于本领域的普通技术人员将是显而易见的。除此之外或作为前述的代替，电路100的至少一部分可根据如下专利的教导内容中的至少一些来构造：2012年7月3日提交的名称为“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示出可被用来提供对击发梁14的机动化控制的各种机械部件。具体地，图9示出封装在柄部部分20的手枪式握把24中的马达102。应当理解，电池组104(示于图1-2中)也可位于手枪式握把24中(例如，在马达102下方)和/或柄部部分20内其他地方。马达102具有与齿轮组件122联接的驱动轴120。齿轮组件122具有外部壳体(未示出)，并能够操作以驱动上部齿轮126，示于图10中。上部齿轮126与小齿轮128啮合，小齿轮128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，马达102的激活将最终使小齿轮128在柄部部分20内旋转。
正如还在图9-10中示出，平移齿条130包括齿132，该齿132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中所示，齿条130与细长构件136联接，该细长构件136延伸穿过轴22并包括与击发梁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的纵向运动传送到击发梁14。因此应当理解，马达102的激活将最终使击发梁14在端部执行器12内平移。具体地，马达102可朝远侧驱动击发梁14以切断组织90，以及将钉47驱动到组织90中。开关致动臂134从齿条130侧向延伸，并且定位成当击发梁14到达最远侧位置(例如，在组织90已经被切断且钉47已经被驱动到组织90中后)时接合行程结束开关112。如上所述，与行程结束开关112的接合自动地逆转马达102使击发梁14从最远侧位置返回到近侧位置，使砧座18能够枢转远离下钳口16以释放组织90。
使用术语“枢转”(以及与作为基础的“枢转”类似的术语)不应被解读为必须要求围绕固定轴线进行枢转运动。在一些形式中，砧座18围绕由销(或类似的特征结构)限定的轴线枢转，该销(或类似的特征结构)在砧座18朝下钳口16运动时，沿着细长狭槽或通道滑动。在此类形式中，枢转轴线沿着由狭槽和通道限定的路径平移，而砧座18同时围绕该轴线枢转。除此之外或作为另外一种选择，枢转轴线首先可沿着狭槽/通道滑动，然后砧座18在枢转轴线已经沿着狭槽/通道滑动到某距离后围绕该枢转轴线枢转。应当理解，此类滑动/平移枢转运动包含在术语诸如“枢转(pivot/pivots/pivoting)”、“枢转的”、“能够枢转”等内。当然，一些形式可提供砧座18围绕保持固定且不在狭槽或通道内平移的轴线的枢转运动等。
除此之外或作为前述的代替，可操作以驱动击发梁14的特征结构可根据如下专利的教导内容中的至少一些来构造：美国专利公布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。考虑到本文的教导内容，用于提供击发梁14的机动的其它合适的部件、特征结构、和构型对本领域普通技术人员而言将显而易见。还应当理解，一些其他形式可提供对击发梁14的手动驱动，使得省略马达。仅以举例的方式，击发梁14可根据本文引用的任何其他专利/公布参考的教导内容中的至少一些进行致动。
III.示例性轴组件
应当理解，当使用者迫使器械10进入外科手术区域时，可能期望从特定角度接近将要夹紧、缝合或切割的组织。例如，一旦器械10的端部执行器12插入并穿过套管针、胸廓切口、或用于进入外科手术区域的其他通道，使用者想要对准的组织可能会定位在不可触及的位置，或相对于与轴22对齐的端部执行器12以歪斜角度定位。因此，可能期望器械10的一部分诸如端部执行器12进行关节运动，使得使用者能够将端部执行器12的砧座18和下钳口16成直角地或者说垂直地夹紧血管或其他组织。还将理解，使端部执行器12进行关节运动来将端部执行器12垂直地抵靠组织定位，可有利于在切割和缝合组织之前使组织完全就位并夹紧。除了关节运动之外，可能期望端部执行器12选择性地锁定在伸直或已关节运动的位置，使得使用者不用保持一致的手动偏压就可防止端部执行器12在关节运动点11发生枢转或弯曲。还可能期望在关节运动时自动锁定，而不需要致动单独的关节运动锁定结构特征。
图12示出示例性另选轴组件200，该轴组件可易于与图1的器械10结合。轴组件200提供关节运动以及对关节运动角度的选择性锁定，如下文中将更详细地描述。本示例的轴组件200包括旋转控件213、关节运动钮214，以及端部执行器212。旋转控件213可旋转地与图1的柄部部分20或任何其他合适部件(例如，机器人控制接口等)联接。旋转控件213能够操作以使轴组件200(包括关节运动钮214和端部执行器212)围绕轴组件200限定的纵向轴线(LA)相对于柄部部分20(或相对于旋转控件213可旋转地联接到的任何其他部件)旋转。这可用于将端部执行器212定位在围绕纵向轴线(LA)的期望的角度取向。
关节运动钮214部分容纳于关节运动钮外壳215内。外壳215通向细长轴232。轴组件200还包括相对于轴232在远侧定位的端部执行器212。端部执行器212包括关节运动接头211，关节运动接头211允许端部执行器212进行侧向关节运动，如下文中将更详细地描述。端部执行器212与图1的端部执行器12基本相同，除非下文另有说明。
图13A-B示出轴组件200以及端部执行器212响应于关节运动钮214的转动而进行的示例性运动。图13A示出关节运动钮214处于第一位置，在这种情况下，关节运动钮214和端部执行器212两者大体沿轴组件200的纵向轴线(LA)对齐。使用者可随后用手将关节运动钮214顺时针地旋转到第二位置，如图13B所示。响应于关节运动钮214的旋转，端部执行器212在关节运动接头211处枢转或弯曲到关节运动角度(α)，如图13B所示。在所示形式中，端部执行器212大体在关节运动钮214的旋转方向上进行关节运动，但是应当理解，端部执行器212可被构造成能够在关节运动钮214旋转的反方向上弯曲。换句话讲，当关节运动钮214顺时针旋转时，端部执行器212顺时针地侧向枢转，如图13B所示，但是在一些形式中，端部执行器212能够逆时针地枢转。图13B示出端部执行器212略微顺时针地侧向枢转。应当理解，关节运动钮214可进一步旋转以使端部执行器212在关节运动接头211处进一步侧向关节运动到任何合适角度(α)。例如，端部执行器212可以枢转直到在关节运动接头211上形成约90°角。在一些形式中，端部执行器212能够操作以更进一步枢转，使得端部执行器212相对于轴232形成锐角。参考本文的教导内容，端部执行器212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。还应理解，关节运动钮214可相对于纵向轴线(LA)限定与端部执行器212和纵向轴线(LA)之间限定的关节运动角度(α)相同的角度。这种互补地成角度可在患者体外向操作者提供视觉反馈，从而指明端部执行器212的关节运动角度(α)。
端部执行器212的关节运动的机制将在下文中更详细地描述。应当理解，关节运动钮214可沿逆时针方向旋转，使端部执行器212以逆时针方式进行关节运动。因此，根据端部执行器212的关节运动的期望方向和/或程度，使用者可仅使关节运动钮214在某个方向上进行不同程度的旋转，使用者希望端部执行器212在这个方向上进行关节运动，以使端部执行器212进行不同程度的关节运动。
图14示出关节运动钮214，其中外壳215被移除以更清楚地示出关节运动钮214的内部工作结构。关节运动钮214与关节运动小齿轮250连通。关节运动小齿轮250与第一齿条252和第二齿条256连通。第一齿条252通过第一中间块254与第一臂242连通，而第二齿条256通过第二中间块256与第二臂240连通。
关节运动钮214一体地联接至关节运动小齿轮250。因此，当使用者转动关节运动钮214时，关节运动小齿轮250随着关节运动钮214一起旋转。随着关节运动小齿轮250旋转，关节运动小齿轮250会使第一齿条252和第二齿条256相应地沿相反方向平移。例如，如图15所示，关节运动小齿轮250与第一齿条252和第二齿条256连通，使得如果关节运动小齿轮250顺时针地旋转，则第一齿条252就朝近侧远离端部执行器212回缩，而第二齿条256朝远侧向端部执行器推进。此外，当关节运动小齿轮250逆时针地旋转时，第一齿条252朝远侧向端部执行器212推进，而第二齿条256朝近侧远离端部执行器212回缩。随着第一齿条252推进和回缩，第一臂242也以类似方式推进和回缩。类似地，随着第二齿条256推进和回缩，第二臂240也随第二齿条256推进和回缩。因此，旋转连接到关节运动小齿轮250的关节运动钮214使第一臂242和第二臂240随第一齿条252和第二齿条256来回运动。第一臂242和第二臂240的运动能够操作以引起端部执行器212中的其他部件运动，这将在下文中更详细地描述。
图16示出端部执行器212的更大视图，该端部执行器包括砧座218。第一臂242和第二臂240与第一凸轮齿轮230连通。因此，第一臂242和第二臂240的推进和回缩使第一凸轮齿轮230旋转，这将在下文中更详细地描述。
图17示出端部执行器212和关节运动接头211的分解图。端部执行器212包括砧座218、下钳口216、以及钉仓275。仓275包括钉驱动器243、仓体237、托盘274、以及楔形滑动件241。应当理解，砧座218、下钳口216、托盘274、仓体237、以及楔形滑动件241基本上类似于图6中示出的砧座18、下钳口16、托盘74、仓体37、以及楔形滑动件41。一般来讲，托盘274可移除地接纳在下钳口216中；托盘274、仓体237、以及钉驱动器243卡扣在一起，形成钉仓275。砧座218的近侧部分与下钳口216配合在钳口套筒270内，该钳口套筒与关节运动接头211连通。砧座218能够操作以响应于钳口套筒270的推进而紧靠仓体237，使得砧座218和仓体237可夹紧组织，该组织随后可被缝合和切割。具体地，在夹紧组织后，楔形滑动件241朝远侧驱动，向上推动钉驱动器243，这会驱动钉(未示出，但其原本定位在钉驱动器243上方)穿过组织并抵靠于砧座218，从而将钉锚定在组织中。在所示形式中，滑动件241由刀248驱动，该刀被固定至击发梁219并由击发梁219驱动。随着击发梁219推进，刀248切割组织，同时驱动滑动件241。
本示例的端部执行器212还包括弹性闭锁特征结构249，弹性闭锁特征结构249能够操作以与凸轮保持主体276合作，在下钳口216中未装载未击发仓275的情况下，选择性地限制刀248的推进。仅通过举例的方式，闭锁特征结构249以及相关联的部件可能够根据如下专利的教导内容中的至少一些来构造和操作：与本文同一天提交的名称为“Lockout Feature for MovableCutting Member of Surgical Instrument”的美国专利申请[代理人案卷号END7175USNP]，其公开内容以引用方式并入本文。
关节运动接头211包括若干部件，这些部件将在下文中更详细地描述。一般来讲，关节运动接头211包括第一凸轮齿轮230、第二凸轮齿轮231、凸轮保持主体276、通道销217、接头基部272、锁定杆262、以及弹簧264。
第一臂242朝远侧端接于第一钩子244，而第二臂240朝远侧端接于第二钩子246。钩子244,246与第一凸轮齿轮230的凸轮开口260连通。因此，当第一臂242朝端部执行器212推进而第二臂240回缩时，第一凸轮齿轮230逆时针地旋转。相反，当第一臂242回缩而第二臂240朝端部执行器212推进时，第一凸轮齿轮230顺时针地旋转。因此，当臂242,240经由钩子244,246在凸轮开口260上推动和拉动时，第一凸轮齿轮230如刚才所述相应地旋转。
第一凸轮齿轮230堆叠在第二凸轮齿轮231上。第二凸轮齿轮231和凸轮保持销279是凸轮保持主体276的一体特征结构。在一些形式中，第二凸轮齿轮231可单独地构造并与凸轮保持主体276牢固联接，使得当第二凸轮齿轮231旋转时，凸轮保持主体276也旋转。第一凸轮齿轮230与凸轮保持销279可旋转地联接，凸轮保持销279沿枢转轴线280与接头基部272的基部开口277轴向对齐。因此，第一凸轮齿轮230可相对于第二凸轮齿轮231和凸轮保持主体276围绕枢转轴线280旋转。锁定杆262与第一凸轮齿轮230和第二凸轮齿轮231选择性地连通，这将在下文中更详细地描述。锁定杆262还与弹簧264连通，该弹簧朝远侧偏压锁定杆262。接头基部272被成形为提供便于锁定杆262推进的底座和/或通道。锁定杆262还包括一对凸台287，这对凸台能够操作以接合接头基部272，从而限制锁定杆262朝远侧的运动。
IV.轴组件的示例性运动
如上所述，致动关节运动钮214能够操作以使臂242,240执行相反的推进和回缩。应当理解，臂242,240的这种运动能够操作以使第一凸轮齿轮230围绕凸轮保持销279旋转。第一凸轮齿轮230的旋转使第二凸轮齿轮231随凸轮保持主体276旋转。因此，关节运动接头211进行关节运动，从而在关节运动接头211处枢转端部执行器212。具体地，凸轮保持销279和基部开口274限定枢转轴线280，该枢转轴线大体上垂直于纵向轴线(LA)。端部执行器212响应第一凸轮齿轮230的旋转而围绕枢转轴线280枢转，这驱动第二凸轮齿轮231，如下文将更详细地描述。图18A-E示出旋转第一凸轮齿轮230以驱动端部执行器212进行关节运动的细节。
图18A示出在第一位置的关节运动接头211。锁定杆262朝远侧偏压以接合第二凸轮齿轮231。具体地，锁定杆262的远侧端部包括锁定齿236，锁定齿236配合在第一凸轮齿233与第二凸轮齿235之间并且邻接第二凸轮齿轮231，这可在图19中更详细地看到。由于弹簧264所提供的远侧偏压，锁定齿236形成可靠锁定，并且因此维持第二凸轮齿轮231的旋转位置。通过维持第二凸轮齿轮231的旋转位置，锁定杆262维持端部执行器212围绕枢转轴线280的角度定位，从而维持任何关节运动角度(α)。第一凸轮齿轮230包括一对凸轮翼部238,239，并且凸轮保持主体276包括一对凸台271,273。凸台271,273是第二凸轮齿轮231的一体特征结构，因此当凸台271,273旋转时，第二凸轮齿轮231也会旋转。应当理解，在图18A的第一位置中，凸轮翼部238,239和凸台271,273之间限定小间隙261。因此，凸轮翼部238,239和凸台271,273没有接触。将参考图18B-E在下文更详细地描述涉及凸轮翼部238,239与凸台271,273之间的接触的相互作用。在外科手术中，使用者可利用处于伸直位置的端部执行器212(如图18A所示)引导轴组件200穿过通道(例如，套管针、胸廓切口等等)到达外科手术区域。
图19示出处于图18A所示位置的锁定齿236的放大视图。如可在所示形式中看到的，锁定齿236具有大体上笔直的平行侧部286，平行侧部286能够操作以配合在第一凸轮齿233与第二凸轮齿235之间。锁定齿236的远侧端部具有倒圆尖端285，倒圆尖端285具有通向平行侧部286的成角度的侧部281。第二凸轮齿235中的每个齿235包括大体上笔直的平行侧部283以及成角度的侧部284。平行侧部283能够操作以接合锁定齿236的平行侧部286，从而防止在没有第一凸轮齿轮230的协助的情况下，锁定齿236沿第二凸轮齿235行进。至少一个侧部283与至少一个侧部286之间的这种接合还防止凸轮保持主体276围绕枢转轴线280旋转，从而防止端部执行器212在关节运动接头211处枢转。
一旦第一凸轮齿轮230旋转(如图18B-C所示并将在下文更详细地描述)，第一凸轮齿轮230的倒圆三角形齿233将顶靠在成角度的侧部281，并将由此响应于第一凸轮230的旋转将锁定杆262朝近侧驱动。应当理解，除了三角形外，齿233还可具有多种不同形状。锁定齿236朝近侧充分地运动，使得随着第一凸轮齿轮230继续旋转并且随着第二凸轮齿轮231旋转，锁定齿236成角度的侧部281随后最终可接合第二凸轮齿235的成角度的侧部284并沿所述成角度的侧部行进。这为将锁定杆262朝近侧驱动提供了进一步的凸轮动作。锁定齿236一旦越过第二凸轮齿235的成角度的侧部284，锁定齿236就会朝远侧返回到介于下一对第一凸轮齿233与第二凸轮齿235之间的位置，该位置与图19所示定位类似。出于说明目的，将介于一组第一凸轮齿233与第二凸轮齿235之间的锁定齿236推进至相邻组的第一凸轮齿233与第二凸轮齿235之间可被视为一个关节运动增量。当将锁定齿236朝远侧推进时，锁定齿236撞击在第二凸轮齿轮231的第二凸轮齿235之间。应当理解，锁定齿236不必延伸太远就足以撞击到第二凸轮齿轮231。例如，锁定齿236可仅仅朝远侧延伸，使得平行侧部283防止在没有第一凸轮齿233的协助的情况下，锁定齿236沿第二凸轮齿轮231行进。在所示形式中，凸台287接合接头基部272，从而防止锁定杆262发生进一步的远侧运动。
如上指出，操作者可能希望端部执行器212在关节运动接头211处枢转，以更好地相对于靶点组织定位端部执行器212。图18B示出关节运动接头211的第二位置，该第二位置是其响应于转动图14所示关节运动钮214而运动所至。在所示形式中，使用者已逆时针地转动关节运动钮214，这也使得关节运动小齿轮250逆时针地旋转。当关节运动小齿轮250逆时针地旋转时，第一齿条252相对于端部执行器212朝远侧运动，并且第二齿条256相对于端部执行器212朝近侧运动。因此，第一臂242和第二臂240(如图18B所示)运动，使得第一臂242朝端部执行器212推进，而第二臂240远离端部执行器212回缩。应当理解，所示形式的第一臂242和第二臂240的远侧部分未相对于彼此平行定位。相反，第一臂242和第二臂240相对于彼此倾斜地成角度，然而应当理解，第一臂242和第二臂240可以彼此平行定位。
臂242,240的运动(如图18B所示)致使第一凸轮齿轮230围绕枢转轴线280逆时针地旋转。当第一凸轮齿轮230旋转时，两个动作大体上同时地发生。第一凸轮齿233具有倒圆三角形状，这通过第一凸轮齿233接合成角度的侧壁281所引起的凸轮动作来促使锁定杆262朝远侧远离端部执行器212推动。同样，除了三角形外，齿233还可具有多种不同形状。弹簧264压缩以适应锁定杆262的近侧运动。因此，倒圆尖端285充分地朝近侧运动，以便越过平行侧部283。另外，凸轮翼部238,239随着第一凸轮齿轮230顺时针地旋转。由于这种旋转，凸轮翼部239消除与凸台273之间的间隙261并且接合凸台273。同时，凸轮翼部238可旋转地运动远离凸台271。应当理解，当在从图18A所示的构型过渡到图18B所示的构型期间，第一凸轮齿轮230和锁定杆262响应于臂242,240的运动而运动时，第二凸轮齿轮231以及相应地端部执行器212尚未运动。因此，在这个阶段，端部执行器212维持在伸直取向上。
图18C示出关节运动接头211的第三位置。应当理解，为使端部执行器212进行关节运动，使用者继续旋转关节运动钮214。臂242,240继续运动，使得第一臂242朝远侧运动并且第二臂240朝近侧运动。臂242,240的运动继续使第一凸轮齿轮230旋转，从而使凸轮翼部239进一步可旋转地运动，由此推动凸台273同样可旋转地运动。由于凸台273与第二凸轮齿轮231成一体，因此第二凸轮齿轮231开始旋转。随着第二凸轮齿轮231的旋转，由于成角度的侧部284顶靠在锁定齿236成角度的侧部281上，锁定杆262进一步朝近侧运动。因此，锁定齿236沿第二凸轮齿235行进。第二凸轮齿轮231会一直旋转，直到第二凸轮齿轮231的尖端288接合倒圆尖端285。第二凸轮齿轮235具有平行侧部283，使得锁定齿236的成角度的边缘281能够接合成角度的侧部284，但是这种接合仅在第一凸轮齿233将锁定齿236朝近侧推动以使倒圆尖端285越过平行侧部283之后发生。在沿第一凸轮齿233行进之前，由于平行侧部283接合平行侧部286，锁定齿236一般不能够沿第二凸轮齿235行进。还应理解，随着锁定齿236沿成角度的侧部284行进，锁定齿236与第一凸轮齿233脱离。还如图18C所示，锁定杆262和锁定齿236已运动至最近侧的位置，此时，第二凸轮齿尖端288刚好接触锁定齿236。另外，由于第二凸轮齿轮231旋转，凸轮保持主体276以及相应地通向端部执行器212的套筒270在逆时针方向上进行关节运动。
图18D示出关节运动区域211的第四位置。同样，应当理解，为使端部执行器212进一步地进行关节运动，使用者继续旋转关节运动钮214。臂242,240继续运动，使得第一臂242进一步朝远侧运动并且第二臂240进一步朝近侧运动。臂242,240的运动继续使第一凸轮齿轮230旋转，从而使凸轮翼部239进一步可旋转地推动凸台273。锁定齿236继续沿第二凸轮齿235行进，直到弹簧264所造成的远侧偏压使锁定杆262被推动到图18D所示的位置。应当理解，当锁定杆262卡扣到图18D所示位置中时，可听见或感觉到可听的咔嗒声或咯哒声。因此，使用者接收可听和/或触觉确认，其指示锁定齿236已从一组凸轮齿233,235之间运动到另一组凸轮齿之间，或者已旋转单个关节运动增量。当处于图18D所示位置时，第一凸轮齿轮230停止旋转，并且锁定齿236配合在凸轮齿233,235之间。套筒270以及相应地端部执行器212停止关节运动。可靠锁定已经形成，因为受端部执行器212上的横向力推动的第二凸轮齿轮231的任何旋转运动将会导致平行侧部286接合平行侧部283并且停止第二凸轮齿轮231的任何进一步旋转，这会锁定端部执行器212的关节运动。应当理解，从图18A所示的构型过渡到图18D所示的构型表示关节运动经过一个关节运动增量(或者说关节运动的增量)，其中关节运动距离大体上由第二凸轮齿235之间的间隔限定。
应当理解，当处于图18D所示位置时，端部执行器212已经进行关节运动，由此向使用者提供具有已关节运动的端部执行器212的轴组件200。应当理解，使用者可能希望在图18D所示位置中使用轴组件200，或者可能希望使端部执行器212进一步枢转一个或多个附加关节运动增量。在使用者未进一步旋转关节运动钮214的情况下，锁定齿236会锁定于第一凸轮齿233和第二凸轮齿235之间，这种锁定防止端部执行器212枢转以返回到伸直位置。一旦端部执行器212已关节运动到期望角度(α)，应当理解，使用者可致动击发梁213以驱动刀248，使其切割组织并驱动钉穿过组织。例如，刀248和击发梁213可通过例如能够弯曲的梁连通，使得击发梁213能够通过关节运动接头211的任何程度的枢转而推进。
图18E示出关节运动接头211的第五位置，此时，使用者希望端部执行器212进一步枢转。同样，应当理解，使用者继续旋转关节运动钮214。由此，臂242,240继续运动，使得第一臂242进一步朝远侧运动并且第二臂240进一步朝近侧运动。臂242,240的运动继续使第一凸轮齿轮230旋转，这使凸轮翼部239可旋转地推动凸台273。第一凸轮齿轮230和第二凸轮齿轮231如图18B-D所示那样以类似的方式运动，这使端部执行器212进一步进行关节运动，并且锁定在关节运动程度更大的位置。应当理解，使用者可继续旋转关节运动钮214，以使端部执行器212枢转至如使用者期望的程度。此外，使用者可以使关节运动钮214在相反方向上旋转，以使臂242,240和凸轮齿230,231在相反方向上运动，从而使端部执行器212在相反方向上进行关节运动。
如在图18A-18E所示的示例性致动中所见，第一凸轮齿轮230能够操作以通过将运动从臂242,240传递到第一凸轮齿轮230而解锁关节运动接头211并使端部执行器212在关节运动接头211处围绕枢转轴线280枢转。另外，第二凸轮齿轮231和锁定杆262一起锁定关节运动接头211，从而锁定端部执行器212相对于轴组件200的纵向轴线(LA)的角度(α)。
V.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孤立。参考本文教导内容，其中本文教导内容可结合的各种合适方式将对本领域的普通技术人员显而易见。此类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。同样并且在必要的程度下，本申请明确阐述的公开内容取代了以引证方式并入本申请的任何冲突材料。以引用方式并入本文但与本文所述的现有定义、陈述或其它公开材料相冲突的任何材料或其部分，仅在所并入的材料和现有的公开材料之间不产生冲突的程度下并入本文。
上文所述的装置的形式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易于结合如下专利中的任何专利的各种教导内容：1998年8月11日公布的名称为“Articulated Surgical InstrumentFor Performing Minimally Invasive Surgery With Enhanced Dexterity andSensitivity”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”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 for Performing 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 Cauterizing and Cutting Instrument”的美国专利6,783,524中，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 Systemfor Robotic Surgical Tools”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 inMinimally 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-FeedbackCapabilities”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“Shiftable Drive 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“Surgical Stapling Instruments withCam-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 Rotary Actuated ClosureSystems Having Variable Actuation Speeds”的美国公布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 for Operably Coupling a Manipulatable Surgical Toolto a Robot”的美国公布2012/0211546，其公开内容以引用方式并入本文；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 SurgicalEnd Effector System with Rotary Actuated Closure Systems”的美国公布2012/0205421，其公开内容以引用方式并入本文。
上文所述的形式可被设计为单次使用后丢弃，或者它们可被设计为可多次使用。在上述任一种或两种情况下，都可对这些形式进行修复，以便在使用至少一次后再使用。修复可包括以下步骤的任意组合：拆卸装置、然后清洗或替换特定部件和随后进行重新组装。具体地，可拆卸所述装置的一些形式，并且可选择性地以任何组合形式来替换或取出所述装置的任意数量的特定部件或零件。在清洗和/或更换特定零件时，所述装置的一些形式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。这些技术的用途以及得到的重新修复装置均在本发明的范围内。
仅通过举例的方式，本文描述的版本在手术之前和/或之后可被消毒。在一种消毒技术中，将装置放置在闭合并密封的容器中，例如，塑料袋或TYVEK袋中。然后可将容器和装置放置在可穿透所述容器的辐射场中，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，并且其它修改形式对本领域的技术人员将是显而易见的。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 (20)

1.一种设备，所述设备包括：
(a)主体；和
(b)与所述主体连通的轴组件，其中所述轴组件包括：
(i)具有关节运动接头的端部执行器，
(ii)能够旋转地定位在所述轴组件内的第一凸轮齿轮，
(iii)在所述关节运动接头处与所述端部执行器连通的第二凸轮齿轮，和
(iv)被朝远侧偏压以抵靠所述第二凸轮齿轮锁定的锁定杆，其中所述第一凸轮齿轮能够旋转经过第一运动范围以使所述锁定杆相对于所述第二凸轮齿轮解锁，其中所述第一凸轮齿轮能够旋转经过第二运动范围以使所述端部执行器在所述关节运动接头处旋转。
2.根据权利要求1所述的设备，其中所述第一凸轮齿轮包括被构造成能够迫使所述第二凸轮齿轮旋转的多个凸轮翼部。
3.根据权利要求2所述的设备，其中所述第二凸轮齿轮包括被构造成能够接合所述多个凸轮翼部的多个凸台。
4.根据权利要求1所述的设备，所述设备还包括与第一臂和第二臂连通的关节运动钮，其中所述第一臂和所述第二臂与所述第一凸轮齿轮以相反的方式连通，其中所述关节运动钮被构造成能够旋转以执行所述第一臂和所述第二臂的相反运动。
5.根据权利要求1所述的设备，其中所述锁定杆包括锁定齿，其中所述第二凸轮齿轮包括第二凸轮齿，其中所述锁定杆被成形为与所述第二凸轮齿的形状互补。
6.根据权利要求5所述的设备，其中所述第二凸轮齿包括直壁。
7.根据权利要求5所述的设备，其中所述第一凸轮齿轮包括第一凸轮齿，其中所述第一凸轮齿具有倒圆形状。
8.根据权利要求5所述的设备，其中所述第一凸轮齿轮包括第一凸轮齿，其中所述第二凸轮齿轮包括第二凸轮齿，其中所述锁定齿能够定位在所述第一凸轮齿和所述第二凸轮齿之间。
9.根据权利要求8所述的设备，其中所述锁定齿被构造成能够卡扣到所述第一凸轮齿和所述第二凸轮齿之间的位置，其中所述锁定齿能够操作以便在所述锁定齿卡扣到所述第一凸轮齿和所述第二凸轮齿之间的所述位置时产生可听的咔嗒声。
10.根据权利要求8所述的设备，其中所述锁定齿被构造成能够卡扣到所述第一凸轮齿和所述第二凸轮齿之间的位置，其中所述锁定齿能够操作以便在所述锁定齿卡扣到所述第一凸轮齿和所述第二凸轮齿之间的所述位置时产生触觉点击反馈。
11.根据权利要求1所述的设备，其中所述第一凸轮齿轮包括凸轮翼部，其中所述第二凸轮齿轮包括凸台，其中所述凸轮翼部和所述凸台能够定位成使得所述凸轮翼部和所述凸台之间保持间隙。
12.根据权利要求1所述的设备，其中所述第一凸轮齿轮和所述第二凸轮齿轮与枢转轴线共轴对齐，其中所述枢转轴线垂直于所述端部执行器。
13.根据权利要求1所述的设备，其中所述第二凸轮齿轮包括具有平行侧部的第二凸轮齿，其中所述锁定杆包括具有平行侧部的锁定齿，其中所述锁定齿的所述平行侧部被构造成能够接合所述第二凸轮齿的所述平行侧部，从而防止所述第二凸轮齿轮旋转。
14.根据权利要求1所述的设备，其中所述锁定杆包括被构造成能够防止所述锁定杆的远侧运动超过预先确定的点的至少一个侧向延伸的凸台。
15.根据权利要求1所述的设备，所述设备还包括与所述锁定杆连通的弹簧，其中所述弹簧能够操作以使所述锁定杆朝远侧偏压。
16.一种设备，所述设备包括：
(a)主体；和
(b)与所述主体连通的轴组件，其中所述轴组件包括：
(i)定位在所述轴组件的远侧端部处的端部执行器，
(ii)定位在所述端部执行器的近侧端部处的关节运动接头，
(iii)定位在所述轴组件的所述远侧端部处的第一凸轮齿轮，其中所述第一凸轮齿轮被构造成能够旋转，
(iv)通过所述关节运动接头与所述端部执行器连通的第二凸轮齿轮，其中所述第二凸轮齿轮能够操作以在所述关节运动接头处驱动所述端部执行器的关节运动，和
(v)与所述第一凸轮齿轮和所述第二凸轮齿轮选择性地连通的锁定杆，其中所述锁定杆能够在远侧位置和近侧位置之间运动，其中所述锁定杆被构造成能够在所述锁定杆处于所述远侧位置时阻止所述第二凸轮齿轮旋转，其中所述锁定杆被构造成能够在所述锁定杆处于所述近侧位置时允许所述第二凸轮齿轮旋转，其中所述第一凸轮齿轮被构造成能够通过所述第一凸轮齿轮的旋转来将所述锁定杆从所述远侧位置驱动到所述近侧位置。
17.根据权利要求16所述的设备，其中所述锁定杆包括被构造成能够阻止所述第二凸轮齿轮的旋转运动的锁定齿。
18.根据权利要求16所述的设备，其中所述第一凸轮齿轮包括第一凸轮齿，其中所述第一凸轮齿具有被构造成能够允许所述锁定杆通过凸轮运动沿所述第一凸轮齿行进的形状。
19.根据权利要求16所述的设备，其中所述锁定杆被构造成能够在所述锁定杆与所述第二凸轮齿轮选择性地连通时产生可听的咔嗒声。
20.一种使用轴组件来使端部执行器进行关节运动的方法，所述轴组件包括第一凸轮齿轮、第二凸轮齿轮、第一臂、第二臂和锁定杆，其中所述第二凸轮齿轮与所述第一凸轮齿轮连通，其中所述第一臂和所述第二臂与所述凸轮齿轮连通，其中所述锁定杆与所述第一凸轮齿轮和所述第二凸轮齿轮选择性地连通，其中所述第二凸轮齿轮与所述端部执行器枢转连通，所述方法包括：
(a)致动所述第一臂和所述第二臂以使所述第一凸轮齿轮旋转；
(b)使所述第一凸轮齿轮旋转；
(c)使所述锁定杆在近侧方向上运动，使得所述锁定杆以顺序的方式沿所述第一凸轮齿轮和所述第二凸轮齿轮行进；
(d)使所述第二凸轮齿轮旋转，从而使所述端部执行器进行关节运动；以及
(e)使所述锁定杆在远侧方向上运动。
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