CN105078532B - 原位装载吻合器 - Google Patents
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Abstract
一种吻合设备，包括具有砧座组件和关于砧座组件可移动地支撑的钉仓组件的工具组件。钉仓组件包括限定组织接触表面和在组织接触表面上开口的多个保持狭槽的钉仓主体。钉仓主体限定多个凹陷部，每个凹陷部与多个保持狭槽中一个关联。吻合钉匣定位在每个凹陷部内并包括多个吻合钉。至少一个偏置构件邻近每个凹陷部支撑并定位成朝向保持狭槽中相应一个驱使吻合钉匣。多个推进器在钉仓主体内可移动地支撑于下方位置和提升位置间。多个推进器的每一个定位成接合并从保持狭槽射出吻合钉匣的至少一个吻合钉。至少一个偏置构件定位成在已将吻合钉匣的多个吻合钉从保持狭槽中相应一个射出后阻碍推进器从下方位置向提升位置的移动。还公开原位装载吻合器。
Description
技术领域
本申请涉及一种手术吻合设备，且更具体地，涉及一种与吻合设备联用的钉仓组件，其包括用于原位再装载该手术吻合设备的吻合钉匣和用于在吻合钉匣已经耗尽时防止该吻合设备运行的锁定件。
背景技术
将组织抓握并夹紧在相对的钳夹结构之间并后续接合、切割并紧固该组织的手术设备是为本领域所熟知的。这种设备可包括用以捕捉或夹紧组织的两个细长构件。通常而言，该构件中的其中一个携带容纳多个吻合钉的吻合钉钉仓，而另一构件具有限定用于在吻合钉被从吻合钉钉仓驱动时使吻合钉成形的表面的砧座。一般来讲，吻合操作由凸轮杆、驱动滑块或具有凸轮构件的其他类似机构实现，该凸轮构件纵向地行进穿过吻合钉钉仓并对吻合钉推进器起作用，进而从吻合钉钉仓射出吻合钉。该凸轮构件被移动至与吻合钉推进器接合，该吻合钉推进器设置在沟槽之内并以便于由纵向移动凸轮构件接触的方式定位以引起吻合钉从该手术设备的吻合钉钉仓的射出。
通常而言，手术吻合设备包括吻合钉钉仓或必须在吻合设备每次发射之后进行更换而用于该设备的后续再用的一次性装载单元(DLU)。在内窥镜检查或腹腔镜检查操作中，其中手术穿过皮肤中的小切口来执行或穿过穿透皮肤中的小切口而插入的狭窄插管来执行，更换钉仓或DLU需要从切口或插管移除该吻合设备、更换钉仓或DLU并将吻合设备重新插入到切口或插管中。例如，授予Milliman等人的专利号8,070,033的美国专利中公开了内窥镜检查手术吻合设备的实例，其全部内容通过引用结合于此。
提供一种在腹腔镜检查和/或内窥镜检查手术操作期间使用的、能够用以提供手术吻合设备的多次发射而无需从切口/插管移除该手术设备的手术吻合设备将是有益的。提供一种具有锁定件的设备来防止该设备在吻合钉供给已耗尽之后发射将同样是有益的。
发明内容
提供了一种工具组件，其包括砧座组件和相对于所述砧座组件被可移动地支撑的钉仓组件。所述钉仓组件包括钉仓主体，所述钉仓主体限定了组织接触表面和在所述组织接触表面上开口的多个保持狭槽。所述钉仓主体限定多个凹陷部，所述凹陷部的每一个均与所述多个保持狭槽的其中一个关联。吻合钉匣定位在所述凹陷部的每一个之内并包括多个吻合钉。至少一个偏置构件邻近所述凹陷部的每一个支撑并定位成朝向所述保持狭槽中的相应一个保持狭槽驱使所述吻合钉匣。多个推进器在下方位置和提升位置之间可移动地支撑在所述钉仓主体之内。所述多个推进器的每一个均定位成接合所述吻合钉匣的所述吻合钉中的至少一个并将其从所述保持狭槽射出。所述至少一个偏置构件定位成在已将所述吻合钉匣的所述多个吻合钉从所述保持狭槽的相应一个保持狭槽射出之后阻碍所述推进器从所述下方位置向所述提升位置的移动。
在实施例中，所述推进器的每一个均包括至少一个推进器板并且所述至少一个推进器板的每一个均能够在所述保持狭槽的相应一个保持狭槽之内移动以从所述钉仓主体射出所述吻合钉匣的所述多个吻合钉的其中一个。
在一些实施例中，所述至少一个推进器板的每一个均限定凹口，且所述至少一个偏置构件包括支腿。所述支腿在所述吻合钉钉仓的所述多个吻合钉已经从所述保持狭槽射出之后能够移动至与所述凹口对齐以阻碍所述推进器从所述下方位置向所述提升位置的移动。
在实施例中，所述至少一个偏置构件包括第一偏置构件和第二偏置构件。所述第一偏置构件被支撑在所述钉仓主体之内以接合所述多个吻合钉的相应一个吻合钉的支腿，并且所述第二偏置构件被支撑在所述钉仓主体之内以接合所述多个吻合钉的所述相应一个吻合钉的后跨部。
在一些实施例中，所述第一偏置构件是U形的并包括定位成接合所述多个吻合钉的相应一个吻合钉的所述支腿的一对支腿。
在实施例中，所述第二偏置构件定位成在所述吻合钉匣的所述多个吻合钉已被从所述保持狭槽的相应一个保持狭槽射出之后阻碍所述推进器的移动。
在一些实施例中，所述推进器板的每一个均包括至少一个推进器板并且能够在所述保持狭槽的相应一个保持狭槽之内移动以从所述钉仓主体射出所述吻合钉匣的所述多个吻合钉的其中一个。
在实施例中，所述至少一个推进器板的每一个均限定凹口，且所述至少一个偏置构件包括支腿。所述支腿在所述吻合钉匣的所述多个吻合钉已经从所述保持狭槽射出之后能够移动至与所述凹口对齐以阻碍所述推进器从所述下方位置移回到所述提升位置。
在一些实施例中，所述工具组件包括具有限定凸轮系统狭槽(camming slot)的第一刀片和第二刀片的发射凸轮。所述发射凸轮能够在所述钉仓主体之内于缩回位置和推进位置之间移动，使得所述凸轮系统狭槽按顺序地接收所述多个推进器且在所述发射凸轮在所述缩回位置和所述推进位置之间平移时使所述推进器在所述下方位置和所述提升位置之间移动。
在实施例中，所述多个推进器的每一个均包括至少一个推进器板和推进器底座，所述至少一个推进器板可移动地支撑在所述多个保持狭槽中相应一个保持狭槽之内，所述推进器底座定位成接收在所述发射凸轮的所述凸轮系统狭槽之内。
在一些实施例中，钉仓组件包括凸轮分离器，并且所述钉仓主体限定竖直通道。所述凸轮分离器被支撑用于在所述竖直通道之内移动并且当所述发射凸轮处于所述缩回位置时被定位在所述发射凸轮的所述凸轮系统狭槽之内以维持所述发射凸轮的所述第一刀片和所述第二刀片的分离。
在实施例中，所述钉仓主体包括第一主体半部和第二主体半部。所述第一主体半部和所述第二主体半部的每一个均限定多个保持狭槽和多个凹陷部，其中，所述多个凹陷部的每一个均容纳吻合钉匣。
在一些实施例中，所述钉仓主体的所述第一主体半部和所述第二主体半部支撑在承载件通道之内。
在实施例中，钉仓组件包括第一支撑通道和第二支撑通道。所述第一主体半部和第二主体半部被定位在所述第一支撑通道和所述第二支撑通道之内，并且所述第一支撑通道和所述第二支撑通道被支撑在所述承载件的所述承载件通道之内。
还提供了一种工具组件，其包括：砧座组件和钉仓组件，钉仓组件包括限定多个保持狭槽和多个凹陷部的钉仓主体。所述多个凹陷部的每一个均容纳包括多个吻合钉的吻合钉匣。设置了多个推进器。所述多个推进器的每一个均与所述保持狭槽的至少一个关联。发射凸轮能够在所述钉仓主体之内于缩回位置和推进位置之间移动并具有第一刀片和第二刀片。所述第一刀片和第二刀片限定凸轮系统狭槽，所述凸轮系统狭槽构造成接收所述多个推进器以实现所述推进器在下方位置和提升位置之间的移动。凸轮分离器支撑在所述钉仓主体中所限定的竖直通道之内。所述凸轮分离器在所述发射凸轮处于缩回位置时定位在所述发射凸轮的所述凸轮系统狭槽之内以维持所述第一刀片和所述第二刀片之间的间距。
在一些实施例中，至少一个偏置构件邻近所述凹陷部的每一个被支撑。所述至少一个偏置构件定位成朝向所述保持狭槽的相应一个保持狭槽驱使所述吻合钉匣。
在实施例中，所述至少一个偏置构件定位成在已将所述吻合钉匣的所述多个吻合钉从所述保持狭槽的相应一个保持狭槽射出之后阻碍所述推进器从所述下方位置向所述提升位置的移动。
在一些实施例中，所述推进器的每一个均包括至少一个推进器板，并且所述至少一个推进器板的每一个能够在所述保持狭槽的相应一个保持狭槽之内移动以从所述钉仓主体射出所述吻合钉匣的所述多个吻合钉的其中一个。
在实施例中，所述至少一个推进器板的每一个均限定凹口，且所述至少一个偏置构件包括支腿，所述支腿能够在所述吻合钉钉仓的所述多个吻合钉已经从所述保持狭槽射出之后能够移动至与所述凹口对齐以阻碍所述推进器从所述下方位置向所述提升位置的移动。
附图说明
包含在说明书中并构成说明书的一部分的附图示出了本公开的实施例，并连同上面给出的对本公开的大体描述和下面给出的对本公开的详细描述用以阐释本公开的原则，其中：
图1是根据本公开的示例性手术吻合装置的立体图；
图2是图1的手术吻合装置的立体图，其中拆除了一次性装载单元并将轴旋转了90°；
图3是图1的手术吻合装置的一次性装载单元的立体图；
图4是沿着剖面线4-4截取的图3的一次性装载单元的剖视图；
图4A是沿着剖面线4-4截取的图3的一次性装载单元的剖视图，其示出了砧座组件和布置在中央通道中的刀具组件；
图5是根据本公开的两个板状推进器的立体图；
图6是图3的一次性装载单元的钉仓组件的立体图；
图7是图6的钉仓组件的分解视图，其示出了承载件和一对钉仓；
图8是图7的其中一个钉仓的分解视图，其示出了钉仓支撑通道和两个钉仓半部；
图9是图8的其中一个钉仓半部的分解视图，其示出了被移除的推进器、偏置构件和吻合钉；
图10是由细节区域10标示的、图8的其中一个钉仓半部的远侧端的放大局部分解视图；
图11是沿着剖面线11-11截取的图6的钉仓组件的剖视图；
图12是由细节区域12标示的、图11的钉仓组件的远侧端部的放大视图；
图13是图11的钉仓组件的发射凸轮组件的俯视图；
图14是图13的发射凸轮组件的立体图；
图15是图14的发射凸轮组件的分解视图；
图16是沿着剖面线16-16截取的图6的钉仓组件的侧视剖视图；以及
图17至图19是由图4中的细节区域17、18、19标示的图4的钉仓组件的放大剖视图，其示出了保持狭槽的发射和再装载；
图20是当前公开的手术吻合装置的工具组件的可选实施例的侧视立体图；
图20A是沿着图20的线20A-20A截取的剖视图；
图21是图20中所示的工具组件的钉仓组件的钉仓主体的侧视立体图，其中钉仓被分隔成两个主体半部；
图22是图20中所示的钉仓主体的一个半部的分解侧视立体图；
图22A是图22中所示的钉仓组件的第二偏置构件的第一侧视立体图；
图23是图21中所示的钉仓主体半部的侧视立体图，其中移除了钉仓支撑通道；
图24是图23中所示的钉仓主体半部的侧视立体图，其中第一偏置构件和第二偏置构件与钉仓主体半部分隔开；
图25是同第一偏置构件和第二偏置构件关联的、图22中所示的吻合钉匣的侧视立体图；
图26是在吻合钉匣充满的情况下沿着图21的剖面线26-26截取的剖视图；
图27是图26中所示的钉仓主体半部在吻合钉匣充满的情况下的侧视立体局部剖视图；
图28是在吻合钉匣耗尽的情况下穿过图21的钉仓主体半部截取的剖视图；
图29是图1中所示的工具组件的钉仓主体半部的侧视立体图，其中钉仓主体半部以虚像示出且发射凸轮组件的远侧端在吻合钉推进器近侧定位；
图29A是沿着图29的剖面线29A-29A的剖视图；
图29B是图29A中所示的细节标记区域的放大视图；
图30是图22中所示的钉仓组件的钉仓主体半部的凸轮分离器的侧视立体图；以及
图31是钉仓主体半部的示意性俯视图，其示出了凸轮分离器和凸轮驱动杆并以虚像示出了凸轮路径。
具体实施方式
现将参照附图详细描述当前公开的手术吻合装置的实施例，其中，相同标记在若干附图的每幅中表示相同或对应的元件。正如本领域所共知的，术语“近侧”指代较靠近用户或操作者(即，外科医生或内科医生)的部分或部件，而术语“远侧”指代较远离用户的部分或部件。
图1和图2示出了当前公开的手术吻合设备10的一个实施例。简单来讲，手术吻合设备10包括手柄组件12、细长主体14和一次性装载单元(“DLU”)16。DLU 16可释放地稳固至细长主体14的远侧端并包括工具组件18。工具组件18包括容纳多个吻合钉的钉仓组件20和砧座组件22，砧座组件22相对于钉仓组件20枢转地稳固在间隔位置和接近位置之间。手柄组件12包括固定手柄24、可移动手柄26和管筒部(barrel portion)28。可旋转构件30被可旋转地支撑在管筒部28的远侧端上。可旋转构件30支撑细长主体14的近侧端并能够相对于手柄组件12的管筒部28旋转以实现主体14和工具组件18相对于手柄组件12的旋转。可旋转构件30支撑关节式运动杆32，并且管筒部28支撑缩回构件34和发射释放按钮35。例如，授予Milliman等人的专利号为8,070,033的美国专利(“‘033专利”)中详细描述了手柄组件12，上述专利的全部内容通过引用结合于此。
参照图2，主体14支撑控制杆15，其联接至将在下面进一步详细讨论的DLU 16的发射凸轮组件300的联接构件307(图14)。释放开关15a设置在手柄组件12的可旋转构件30上以促进DLU 16与细长主体14的脱离。对于主体14的更为详细的描述，参见通过引用结合于此的‘033专利。
参照图3，DLU 16包括近侧壳体部分100，其适于同主体部分14的远侧端可释放地接合(图1和图2)。安装组件102被枢转稳固至壳体部分100的远侧端，并构造成接合并支撑工具组件18的近侧端，使得安装组件102关于同壳体部分100的纵向轴线垂直的轴线的枢转运动引起工具组件18的关节式运动。关于安装组件102的详细描述，请参见例如‘033专利。
参见图3至图10，工具组件18包括钉仓组件20和枢转连接至钉仓组件20的砧座组件22。砧座组件22限定了多个吻合钉成形凹穴22a(图18)，其中每个凹穴22a均定位成接收来自钉仓组件20的吻合钉。‘033专利中详细描述了合适的砧座组件22的实例。钉仓组件20包括承载件202，其限定了细长支撑通道204(图7)并接收一对吻合钉钉仓206、208。分别沿着吻合钉钉仓206、208和细长支撑通道204形成的相对应的凸起210和狭槽212用以将吻合钉钉仓206、208固定在支撑通道204之内。沿着每个吻合钉钉仓206、208形成的支撑杆(support strut)214定位成靠在承载件202的侧壁上以将吻合钉钉仓206、208稳定在支撑通道204之内。
现在参照图6和图7，吻合钉钉仓206、208构造成在吻合钉钉仓206、208中的每一个的远侧端部216处联接在一起以限定中央纵向狭槽252。狭槽252促进刀具组件308(图14)穿过钉仓组件20。形成在吻合钉钉仓206、208的其中一个的远侧端部216的表面上的内孔222构造成接收形成在吻合钉钉仓206、208的另一个的远侧端部216的表面上的内凸起224。内孔222和内凸起224用以在吻合钉钉仓206、208被联接在一起时将它们对齐。内孔222和内凸起224与凸起210、狭槽212和支撑杆214一起还用以将吻合钉钉仓206、208维持在承载件202的细长支撑通道204之内的纵向固定位置中。
每个吻合钉钉仓206、208均包括内半部和外半部。图8示出了吻合钉钉仓208的内半部226和外半部228。注意，吻合钉钉仓206的内半部和外半部是半部226和半部228的镜像，因此本文不会具体描述。内半部226和外半部228分别构造成联接在一起。每个半部226、228均包括形成于其中的保持狭槽230，用于接收多个吻合钉110和推进器108。每个吻合钉110均包括具有尖端110d的一对支腿112和后跨部110e。保持狭槽230成排对齐，以便当内半部226和外半部228被联接在一起时，得以由吻合钉钉仓206、208中每一个都限定三排保持狭槽230。可以想到，吻合钉钉仓206、208可包括更少排或额外排的保持狭槽230。
吻合钉钉仓208的外半部228包括保持狭槽230的第一排234和保持狭槽230的第二排236的至少一部分236a。吻合钉钉仓208的内半部226包括保持狭槽230的第三排238和保持狭槽230的第二排236的至少剩余部分236b。当外半部228和内半部226被联接在一起时，保持狭槽230的第二排236得以在部分上由吻合钉钉仓208的内半部226的部分236b和外半部228的部分236a中的每一个进行限定。在一个实施例中，如图8中所示出的，吻合钉钉仓208的内半部226的部分236b和外半部228的部分236a交替地限定第二排236的保持狭槽230。
吻合钉钉仓208的内半部226和外半部228均包括多个凸缘240和多个通道242。每个凸缘240均限定第二排236的保持狭槽230。通道242构造成在内半部226被联接至吻合钉钉仓208的外半部228时接收凸缘240，使得第二排236的保持狭槽230纵向对齐。正如图8中所示出的，通道242和凸缘240可以沿着内半部226和外半部228中每一个的长度交替。可选地，内半部226和外半部228中每一个的凸缘240的保持狭槽230可略微偏离纵向轴线，使得内半部226和外半部228的各自的凸缘240的保持狭槽230并不大体纵向对齐。
现在参照图6至图8，钉仓206、208均包括钉仓支撑通道254，其设定尺寸成并构造成接收内半部226和外半部228。钉仓支撑通道254构造成使内半部226和外半部228以彼此纵向对齐的方式保持接合。内半部226和外半部228包括凹陷区256，其设定尺寸成并构造用于接收钉仓支撑通道254，使得钉仓支撑通道254同内半部226和外半部228的侧表面258基本对齐。这有助于在不向每个钉仓206、208增添额外的宽度的情况下保持内半部226和外半部228联接在一起，从而保持整个钉仓组件20的最小宽度。
再次参照图4，在实施例中，钉仓206、208均包括阶梯式组织接触表面104。例如，外组织接触表面104a、中间组织接触表面104b和内组织接触表面104c形成阶梯构造。当从支撑通道254的底表面106进行测量时，组织接触表面104a至104c相对于彼此均具有不同的高度。具体地，组织接触表面104a至104c是彼此基本平行但彼此并不共面的平坦表面。第一壁表面将组织接触表面104a和104b互连，而第二壁表面将组织接触表面104b和104c互连。第一壁表面和第二壁表面是平面结构，其中，每个壁表面均相对于由组织接触表面104a至104c所限定的平面限定了轴线。在一个实施例中，内组织接触表面104c限定在每个钉仓206、208的内半部226上，外组织接触表面104a限定在每个钉仓206、208的外半部228上，并且中间组织接触表面104b在内半部226和外半部228被联接在一起时由内半部226的凸缘240和外半部228的凸缘240限定。
内组织接触表面104c具有最大高度，外组织接触表面104a具有最小高度，而中间组织接触表面104b具有的高度介于外组织接触表面104a的高度与内组织接触表面104c的高度之间(参见图4)。尽管组织接触表面104a至104c被示出为在高度上从最外组织接触表面104a向最内组织接触表面104c增加，但每个组织接触表面的高度可根据具体手术操作改变同样落在本公开的范围之内。例如，组织接触表面104a至104c在高度上可从最内组织接触表面104c向最外组织接触表面104a增加，中间组织接触表面104b可具有最大高度，中间组织接触表面104b可具有最小高度，或者是组织接触表面104a至104c中至少两个可具有相同高度。
如图4中所示，每排保持狭槽230、234、236、238均可包括具有不同尺寸的吻合钉110。例如，布置在第一排234的保持狭槽230中的手术吻合钉110a的支腿112a可具有第一支腿长度，布置在第二排236的保持狭槽230中的手术吻合钉110b的支腿112b可具有第二支腿长度，且布置在第三排238的保持狭槽230中的手术吻合钉110c的支腿112c可具有第三支腿长度。具体地，手术吻合钉110a至110c在高度上从每个钉仓的最内排238向最外排234增加。在一个实施例中，手术吻合钉110c的支腿112c具有约2.3mm的支腿长度，手术吻合钉110b的支腿112b具有约3.5mm的支腿长度，而手术吻合钉110a的支腿112a具有约4.1mm的支腿长度。由此，内组织接触表面104c具有最大高度并保持具有最短支腿长度的手术吻合钉110c，而外组织接触表面104a具有最小高度并保持具有最长支腿长度的手术吻合钉110a。组织接触表面104在中间组织接触表面104b处朝下渐进地阶梯化并在外组织接触表面104a处再次朝下渐进地阶梯化。可以想到，任意数目的布局都是可能的，且位于本公开的范围之内。在本文所公开的任意实施例中，单个或多个钉仓可包括不同尺寸的吻合钉，或者单个或多个钉仓可具有尺寸全都相同的吻合钉。
现在参照图4及图8至图10，吻合钉钉仓208的内半部226和外半部228的每个保持狭槽230均具有与其操作性关联的吻合钉匣244。每个吻合钉匣244均包括限定在吻合钉钉仓206、208之内的凹陷部248、多个吻合钉110以及偏置构件246。偏置构件246定位成偏置多个吻合钉110并朝向相应的保持狭槽230驱使多个吻合钉110。正如上面所讨论的，保持狭槽230沿着吻合钉钉仓206、208对齐成三个不同的排234、236和238。正如上面所讨论的，每排保持狭槽230均可接收不同尺寸的吻合钉110。然而，每个吻合钉匣244中的吻合钉110均应当尺寸相同。现在参照图10，吻合钉匣244的凹陷部248大致限定了“U”或“H”形通道248用于将吻合钉110接收在其中。通道248包括一对竖直段248a、248b以及水平段248c。参照图5，布置在通道248中的每个吻合钉110保持在竖直定向，同时尖端110d朝向各个钉仓206、208的组织接触表面104定向。在该位置中，每个吻合钉匣244的每个吻合钉110的后跨部110e均靠在通道248的水平段248c上，并且吻合钉110的支腿112布置在竖直段248a和竖直段248b之内。通道248的构造确保：当吻合钉110被从吻合钉匣244装载到相应的保持狭槽230中时，吻合钉110适当地定位在组织接触表面104的下方用于发射。
每个吻合钉匣244还限定了通道244a，其接收偏置构件246的一部分以将偏置构件246相对于吻合钉匣244的多个吻合钉110稳固。每个偏置构件246均构造成从通道244a延伸到支撑每个吻合钉匣244的多个吻合钉110的通道248的竖直段248a和竖直段248b的至少一个之中。偏置构件246接合多个吻合钉110并朝向相应的保持狭槽230驱使多个吻合钉110。可以想到，单独的偏置构件246可延伸到竖直段248a和竖直段248b中的每一个。在所示的实施例中(图10)，偏置构件246包括一对支腿246b、246c以及后跨部246d。当偏置构件246插入到吻合钉匣244的通道244a中时，该对支腿246b、246c延伸到通道248的竖直段248a、248b中。
再次参照图4和图10，当偏置构件246的支腿246b和支腿246c穿过通道244a插入而与多个吻合钉110接合时，支腿246b和支腿246c朝外变形以将多个吻合钉110偏置到与相应的保持狭槽230竖直配准的位置。该偏置构件246被以大致竖直方式插入到通道244a中并且可由诸如弹簧钢的任意弹性或柔性材料制成。
可替选地，偏置构件246可包括任意合适的机构，用于如上所讨论地将布置在每个吻合钉匣244中的多个吻合钉110朝向相应的保持狭槽230偏置，该机构例如包括弹簧、弹性构件或其他类似的偏置元件。尽管所示为具有大致“U”形的板簧246a，但可以想到，偏置构件246可具有适用于将布置在吻合钉匣244中的吻合钉110朝向保持狭槽230偏置的其他形状。
现在参照图4、图5和图9，多个推进器108布置在钉仓206、208的内半部226和外半部228的每一个之内。每个推进器108均包括推进器板108c，其可滑动地定位在相应的保持狭槽230之内并与吻合钉匣的多个吻合钉110中的吻合钉接合。每个推进器板108c均构造成平移穿过相应的保持狭槽230以驱使布置在保持狭槽230中的吻合钉110穿过组合接触表面104中的对应的开口230a、穿过布置在砧座组件22和钉仓组件20之间的组织并且抵靠砧座组件22的吻合钉成形凹穴22a(图18)。
在一个实施例中，如图4中所示，布置在第一排234的保持狭槽230中的推进器板108c可具有第一尺寸，布置在第二排236的保持狭槽230中的推进器板108c可具有第二尺寸，并且布置在第三排238的保持狭槽230中的推进器板108c可具有第三尺寸。例如，第一排234的推进器板108c可小于第二排236的推进器板108c，并且第二排236的推进器板108c可小于第三排238的推进器板108c。提供不同尺寸的推进器板108c允许推进器板108c适应不同尺寸的吻合钉110a至110c和/或允许推进器板108c适应同关联于保持狭槽230的排234、236和238的组织接触表面104a至104c关联的不同高度。每个推进器108的推进器板108c可以替选地为相同尺寸。可以设置托盘或其他构件，以在吻合钉钉仓被安装到钉仓支撑通道中之前保持推进器的位置。
同样参照图5，每个推进器108可与一个或多个保持狭槽230关联，使得当其致动时，推进器108可将一个或多个吻合钉110从一排或多排保持狭槽230穿过开口230a发射。例如，推进器108a包括两个推进器板108c并构造成从保持狭槽230的两个相邻排同时发射两个吻合钉110。如图9中所示，钉仓半部226、228可包括一种类型以上的推进器，其中，例如，包括构造成用于同两个保持狭槽230操作性关联的两个推进器板108c的推进器108a可布置在相应排234、236、238的任一端，而包括构造成用于同保持狭槽230的两个相邻排中的三个保持狭槽230操作性关联的三个推进器板108c的推进器108b可布置在相应排234、236、238的端部之间。可以想到，两个和三个保持狭槽推进器108a、108b可以任意顺序被包括在内的替代布局也是可能的。替选地，可仅仅使用一种类型的推进器108，例如，仅仅是构造为与两个保持狭槽联用的推进器108a或者仅仅是构造为与三个保持狭槽联用的推进器108b。通过这种方式，每个保持狭槽230均与构造成发射布置其中的紧固件110的推进器108操作性关联。替选地，可以想到，每个推进器108可仅仅包括一个推进器板108c并可仅仅与单个保持狭槽230关联，或者每个推进器108可包括构造为与多个保持狭槽230联用的多个推进器板108c。
现参照图11至图19，发射凸轮组件300至少部分地布置在DLU 16的近侧壳体100之内并延伸到工具组件18之内。发射凸轮组件300布置成与手柄组件12操作性连通并构造成在手柄组件12致动时向远侧和向近侧平移穿过工具组件18，这将在下面更为详细地描述。
现在参照图11至图15，发射凸轮组件300包括多个驱动杆302和中央驱动构件306，驱动杆302具有布置在其远侧端的发射凸轮304a至304d，中央驱动构件306具有布置在其远侧端的刀具组件308。刀具组件308限定了大致I形横截面，其具有顶部凸缘306a、底部凸缘306b和刀片308c。如上所讨论地，限定在吻合钉钉仓206、208之间的中央纵向狭槽252沿着钉仓组件20的长度延伸以促进中央驱动构件306和刀具组件308的通过。现在参照图4A，顶部凸缘306a构造成平移穿过砧座组件22的纵向狭槽22b，并且底部凸缘306b构造成沿着承载件202的下侧202a纵向平移。
每个钉仓206、208的每个半部226、228(图11和图12)均包括至少部分地延伸穿过其中的纵向狭槽250以适应发射凸轮组件300的驱动杆302和发射凸轮304a至304d中的一个在其中通过。可以想到，例如，每个狭槽250均可适应单个驱动杆302和发射凸轮304的通过或者可适应多个驱动杆302和发射凸轮304的通过。
同样参照图4A，在手术吻合装置10运行期间，当发射凸轮组件300平移穿过DLU 16时，刀具组件308平移穿过纵向狭槽250，其中顶部凸缘306a平移穿过砧座组件22的纵向狭槽22a并且底部凸缘306b沿着承载件202的下侧202a平移而将砧座组件22和钉仓组件20靠近在一起。当刀具组件308平移穿过狭槽250时，刀片308c切断布置在砧座组件22和钉仓组件20之间的组织靠近狭槽250的部分。
同样参照图16至图19，当发射凸轮组件300平移穿过DLU 16时，发射凸轮组件300的驱动杆302平移穿过每个吻合钉钉仓206、208的每个半部226、228的纵向狭槽250。发射凸轮304被推进至相继接触与保持狭槽230关联的推进器108，以引起推进器板108c在保持狭槽230之内竖直平移并将吻合钉110从保持狭槽230驱使穿过组织接触表面104中的开口230a、穿过布置在砧座组件22和钉仓组件20之间的组织并抵靠砧座组件22的吻合钉成形凹穴22a用于吻合钉成形。
现参照图17至图19，在发射期间，当推进器板108c穿过对应的保持狭槽230平移至发射位置时，推进器板108c至少部分地阻塞或覆盖保持狭槽230和吻合钉匣244之间的开口232以抑制吻合钉匣244采用新紧固件110对保持狭槽230的再装载，直到完成发射行程。当推进器板108c返回其位于保持狭槽230的基部的预发射位置时，开口232对于吻合钉匣244而言是未覆盖的或开口的并由于偏置构件246的偏置力“F”而从吻合钉匣244接收下一个吻合钉110。可以想到，当推进器板108c朝向其预发射位置返回时，来自吻合钉匣244的下一吻合钉110可至少部分地穿过开口232并接收在保持狭槽230之内，例如，在后跨部110e穿过开口232并接收在保持狭槽230内之前，下一吻合钉110的尖端110d可穿过开口232并接收在保持狭槽230之内。
如所示，驱动杆302a至302d初始在DLU 16的近侧壳体100之内彼此相邻布置。然而，驱动杆302a至302d均由弹性柔韧材料(例如，弹簧钢)形成并且必须有助于平移穿过纵向狭槽250。
再次参照图11至图16，发射凸轮组件300可包括例如四对驱动杆302a至302d，其包括四对相对应的发射凸轮304a至304d。每对驱动杆302a至302d对应于钉仓206、208的相应的纵向狭槽250a至250d并可穿过各个纵向狭槽250a至250d平移来致动布置在相应纵向狭槽250a至250d中的推进器108，从而实现布置在对应的保持狭槽230中的吻合钉的发射。驱动杆302a至302d以及中央驱动构件306在它们的近侧端处通过焊接或类似方式联接在一起。联接构件307支撑在发射凸轮组件300的近侧端中所形成的切口中并构造成可释放地接合吻合装置10的控制杆15(图2)。
参照图5和图16，每个推进器108均包括推进器底座108d，其具有近侧凸轮表面108e和远侧凸轮表面108f。每个推进器底座108d均布置在其中一个纵向狭槽250之内，同时近侧凸轮表面108e和远侧凸轮表面108f构造为用于在推进器底座108d朝向远侧平移以引起推进器108朝向组织接触表面104平移时接合至少一个发射凸轮304。推进器108的平移进而引起对应的推进器板108c穿过对应的保持狭槽230朝向组织接触表面104平移，来从对应的保持狭槽230射出吻合钉110。
现在参照图14至图19，每个驱动杆302a至302d和发射凸轮304a至304d均包括凸轮系统狭槽310，其具有近侧部310a和远侧部310b。远侧部310b包括开口312、发射凸轮表面314和缩回凸轮表面316。开口312构造成接收推进器底座108d，使得推进器底座108d的近侧凸轮表面108e在发射凸轮304的远侧平移期间接合发射凸轮表面314。每个发射凸轮表面314均是倾斜的，使得推进器底座108d的近侧凸轮表面108e沿着发射凸轮表面314滑动，推进器108被从预发射位置朝向组织接触表面104驱使到发射位置。当推进器108被朝向组织接触表面104驱使时，对应的推进器板108c平移穿过对应的保持狭槽230以驱使布置在保持狭槽230中的吻合钉110穿过组织接触表面104的开口230a、穿过布置在砧座组件22和钉仓组件20之间的组织并抵靠砧座组件22的吻合钉成形凹穴22a。
一旦推进器底座108d到达位于发射凸轮表面314的顶部314a的发射位置，则驱动杆302a至302d以及发射凸轮304a至304d会进一步朝远侧平移，使得推进器底座108d沿着凸轮系统狭槽310朝向近侧部310a滑动。凸轮系统狭槽310的近侧部310a被设定尺寸成使得当驱动杆302a至302d以及发射凸轮304a至304d继续朝远侧平移时，推进器底座108d保持在发射位置。这允许对应的推进器板108c保持在至少部分地阻塞或覆盖保持狭槽230的开口232的位置(图18)以抑制来自与各个保持狭槽230关联的对应的吻合钉匣244的下一吻合钉110的装载。凸轮系统狭槽310沿着驱动杆302延伸足够的距离以适应发射凸轮组件300的全发射行程，例如，当驱动杆302a至302d以及发射凸轮304a至304d处于最远侧位置时，凸轮系统狭槽310的近侧端310c邻近或靠近最近侧推进器108布置。
在发射行程之后的发射凸轮组件300的缩回期间，推进器108的远侧凸轮表面108f在驱动杆302a至302d和发射凸轮304a至304d朝近侧平移时由驱动杆302a至302d的缩回凸轮表面316接合。推进器108的远侧凸轮表面108f沿着驱动杆302a至302d的缩回凸轮表面316被朝向凸轮系统狭槽310的开口312驱动以使推进器108从发射位置返回到预发射位置。当每个推进器108沿着发射凸轮304的缩回凸轮表面316朝向预发射位置滑动时，对应的推进器板108c朝向对应的保持狭槽230的基部平移并且打开或揭开对应的保持狭槽230向对应的吻合钉匣244的开口232。一旦揭开了开口232，则由于偏置构件246的偏置力，保持狭槽230接收来自吻合钉匣244的下一吻合钉110。当发射凸轮组件300完全缩回且每个保持狭槽230已由来自对应的吻合钉匣244的新吻合钉110装载时，手术吻合装置准备好执行吻合和切割操作。
现在参照图4至图10，现将对钉仓组件20的装配进行描述。吻合钉推进器108定位成与每个保持狭槽230操作性关联，同时推进器底座108d布置在每个钉仓206、208的每个半部226、228的其中一个纵向狭槽250中。吻合钉110穿过“U”形或“H”形通道248而装载到保持狭槽230中并且偏置构件246插入到吻合钉匣244的通道244a中使得支腿246b、246c延伸到通道248的竖直段248a、248b中并且将各个吻合钉匣244的吻合钉110朝向保持狭槽230偏置。
一旦装配好每个钉仓206、208的每个半部226、228的部件，通过定位每个半部226、228的凸缘240并使其进入到每个半部226、228的通道242中来将半部226、228互锁在一起，则每个钉仓206、208的内半部226和外半部228被接合或联接在一起。装配后的内半部226和外半部228随后插入到钉仓支撑通道254中，其保持内半部226和外半部228彼此接合。
现在参照图6和图7，通过将内凸起224定位在内孔222之内，装配后的钉仓206、208在远侧端部216处接合在一起以便限定中央纵向狭槽252。接合的钉仓206、208插入到承载件202的细长支撑通道204中，使得布置在钉仓206、208上的凸起210定位在承载件202的狭槽212之内并使钉仓206、208的支撑杆214靠在承载件202的侧壁上。现在钉仓组件20已装配好并准备好使用。
现在将参照图16至图19讨论手术吻合设备10在手术操作期间的操作。在手术操作期间，外科医生将装载单元16附接至细长主体14(图1)并使DLU 16穿过切口和/或插管插入到手术部位中。外科医生操纵吻合装置10来将组织定位在钉仓组件20和砧座组件22之间并致动手柄组件12来使砧座组件22和钉仓组件20靠近并抓握组织。在确认期望的组织定位在钉仓组件20和砧座组件22之间后，外科医生致动该手柄组件12来驱动发射凸轮组件300朝远侧穿过钉仓组件20并发射手术吻合钉。可以想到，外科医生对手柄组件12的单次致动可抓握组织并完全地发射该手术吻合设备10。替选地，抓握组织并发射手术吻合设备可能需要多次致动手柄组件12，其中每次致动使发射凸轮组件300穿过DLU 16前进预定距离。可以想到，手柄部可能是机动手柄组件或者是机器人控制的致动器。这种机动手柄组件或者是机器人控制的致动器可包括控制器和/或电源。
当发射凸轮组件300平移穿过钉仓组件20时，每对驱动杆302a至302d和所附接的多对发射凸轮304a至304d平移穿过钉仓206、208的内半部226和外半部228的其中一个的相应的纵向狭槽250。在发射凸轮304a至304d的远侧平移期间，每个发射凸轮304均接合一系列推进器108以相继地朝向钉仓组件20的组织接触表面104驱动推进器108并从布置在钉仓206、208中的保持狭槽230射出吻合钉110。
正如上面所讨论的，当每个发射凸轮304接合推进器108时，推进器108的近侧凸轮表面108e接合发射凸轮304的发射凸轮表面314并沿发射凸轮表面314从预发射位置向上被驱动到发射位置，例如朝向组织接触表面104。当推进器108被朝向组织接触表面104驱动时，其各个推进器板108c平移穿过对应的保持狭槽230以将对应吻合钉110从对应保持狭槽230射出穿过组织接触表面104中的相应开口230a、穿过布置在砧座组件22和钉仓组件20之间的组织以及抵靠砧座组件22的吻合钉成形凹穴22a，从而使每个吻合钉110成形。当发射凸轮304a至304d继续朝远侧平移时，推进器底座108d沿着凸轮系统狭槽310朝向近侧端部310a行进并保持在提升或发射位置，例如，被朝向组织接触表面104驱动，使得对应的推进器板108c阻塞或覆盖保持狭槽230和对应的吻合钉匣244之间的开口232。当发射凸轮组件300朝远侧平移时，刀具组件308也朝远侧平移穿过中央纵向狭槽252以切断固持在砧座组件22和钉仓组件20之间的组织。
一旦完成发射行程，在发射凸轮组件300布置在最远位置的情况下，外科医生诸如通过朝近侧撤回缩回构件34(图1)而将发射凸轮组件300缩回。当发射凸轮组件300朝近侧平移穿过钉仓组件20时，发射凸轮304a至304d朝近侧平移穿过纵向狭槽250，使得每个推进器底座108d的远侧凸轮表面108f接合缩回凸轮表面316以向下朝向开口312和预发射或较低位置驱动推进器底座108d。当每个推进器底座108d被朝向开口312驱动时，每个推进器远离组织接触表面104平移并且每个推进器板108c远离组织接触表面104朝向对应的保持狭槽230之内的预发射位置平移。当每个推进器板108c被撤回至预发射位置时，保持狭槽230和对应的吻合钉匣244之间的开口232被揭开以允许下一吻合钉110由于对应的偏置构件246的偏置力“F”(图19)而从吻合钉匣244移动到相应的保持狭槽230中。一旦发射凸轮组件300朝近侧完全平移到预发射位置，则每个保持狭槽230得以再装载且手术吻合装置10准备好执行吻合和切割操作。通过这种方式，每个保持狭槽230得以在原位再装载并准备好后续使用而无需外科医生将DLU 16从手术部位撤回或更换DLU 16。
可以想到，每个DLU 16可构造为用于多次发射行程。
在本文所公开的任意实施例中，驱动杆302可构造为彼此部分地附接的一个以上的杆。如图15中所示，每个驱动杆由两个驱动杆组成。在本文所公开的任意实施例中，每个杆可附接或部分上附接于至少一个其他相邻杆。它们可通过粘合剂或焊接而附接。例如，由两个杆组成的驱动杆在远侧端处靠近凸轮表面处焊接在一起。正如83段至86段中所描述的，通过这种凸轮杆组件中的一对来驱动每个吻合钉推进器。该组件具有更好的柔韧性并允许关节式运动。将两个或更多杆焊接在一起赋予了杆组件更多的刚度并被期望地在靠近凸轮表面304处进行焊接。在本文所公开的任意实施例中，使用一对彼此至少部分地附接的相对较细的杆，而非单个相对较粗的杆。
图20至图31示出了用于同手术吻合装置10(图1)联用的工具组件的替选实施例，其总体示出为418。工具组件418包括钉仓组件420和砧座组件422。砧座组件422基本如上面参照砧座组件22(图1)所描述的并且将不会在下面进一步详细描述。设置钉仓组件以实现多次吻合钉发射并在吻合钉耗尽时将钉仓组件420锁定。
参照图20至图22，钉仓组件420包括第一主体半部424a、第二主体半部424b、用于支撑第一主体半部424a和第二主体半部424b中的每一个的一对钉仓半部支撑通道440、以及限定用于接收支撑通道440的通道的承载件202(图20A)。第一主体半部424a限定了位于远侧的孔426且第二主体半部424b限定了位于远侧的凸起或突出部428。凸起428定位在孔426之内以将第一主体半部424a的远侧端相对于第二主体半部424b轴向固定。替选地，能够在设备上使用其他紧固技术来将第一和第二主体半部稳固在一起。当第一主体半部424a和第二主体半部424b被固定在一起时，主体半部424a和424b限定了刀具通道427(图20)。
每个主体半部424a和424b均限定了以两个线性排对齐的多个保持狭槽430。保持狭槽430在各个主体半部424a、424b的组织接触表面430a上开口。替选地，额外排的保持狭槽430可配置在每个主体半部424a、424b中。
参照图22至图27，主体半部424a是主体半部424b的镜像。由此，在此将仅仅对主体半部424a进一步详细描述。主体半部424a限定了多个凹陷部432，它们在主体半部424a的内侧壁436a和外侧壁436b上分别是开口的。多个凹陷部432中的每个凹陷部432均与保持狭槽430连通并容纳吻合钉435的吻合钉匣434，其包括与保持狭槽430对齐的吻合钉435。尽管吻合钉435的每个吻合钉匣434被示出为包括五个吻合钉435，但可以想象，吻合钉435的每个吻合钉匣434可包括不同数目的吻合钉435，例如两个或更多。凹陷部432与各自的保持狭槽430横向对齐。每个凹陷部432限定了U形轨道，其允许吻合钉435的吻合钉匣434在射出吻合钉435时朝向保持狭槽430滑动。与每个侧壁436相邻的每个凹陷部432的端部由钉仓支撑通道440进行封装，其将每个吻合钉匣434保持在其相应的凹陷部432之内。
主体半部424a支撑多个第一偏置构件442和多个第二偏置构件444。一个第一偏置构件442和一个第二偏置构件444与每个凹陷部432和每个吻合钉匣434关联。第一偏置构件442类似于上面所述的偏置构件246并包括具有后跨部442和一对支腿442b的U形弹性构件。每个第一偏置构件442的支腿442b均延伸穿过开口446(图24)并进入到凹陷部432中。当穿过开口446插入时，支腿442b被定位成接合最靠近侧壁436a、436b的最靠外吻合钉435b(图25)的支腿435c以朝向相应的保持狭槽430向内驱使吻合钉匣434。
每个第二偏置构件444(图22A)均包括单个弹性支腿444a和构造成将第二偏置构件444稳固在主体半部424a之内的连接部444b。连接部444b包括横向构件444b，其接收在主体半部424a中所形成的切口448(图26)之内以将第二偏置构件444稳固在每个凹陷部432的中央部之内。第二偏置构件444被支撑在主体半部424a之内，使得弹性支腿444a接合吻合钉匣434的吻合钉435b的后跨部435d。
参照图26至图29B，主体半部424a支撑多个推进器460。每个推进器460均基本类似于上述推进器108(图5)并包括通过推进器底座464互连的一对推进器板462。推进器底座464限定上凸轮表面466和下凸轮表面468(图29)。每个推进器板462均从下方位置至提升或发射位置可滑动地定位在相应的保持狭槽430中以从保持狭槽430射出吻合钉匣434的吻合钉435。如图26中所示，主体半部424a的内锥形壁449a限定了导入腔449以将来自保持狭槽430的吻合钉435a引导穿过组织接触表面430a。
参照图28，每个推进器板462的上表面限定了凹口470。当如下将讨论的吻合钉匣434的最后一个吻合钉435b从其对应的保持狭槽430射出并且推进器460返回到下方位置时，第二偏置构件444的弹性支腿444a弹入到保持狭槽430中以阻碍推进器板462在保持狭槽430内回到其提升位置的移动。更具体地，第二偏置构件444的支腿444a移动到与凹口470对齐的位置以防止推进器460返回提升位置的移动，这将在下面进一步详细讨论。
工具组件418包括与如上参照工具组件18所讨论的发射凸轮组件300(图14至图16)相似的发射凸轮组件。用于与工具组件418一起使用的发射凸轮组件300包括两个发射凸轮304a’(仅示出了一个发射凸轮304a’)。如图29中所示，每个发射凸轮304a’均包括通过凸轮系统狭槽310分离的第一刀片314a和第二刀片316a。当发射凸轮304a’在发射凸轮通道471(图28)之内移动以控制推进器460在下方位置与提升或发射位置之间的移动时，凸轮系统狭槽310接收相应推进器460的推进器底座464。更具体地，当发射凸轮304a’朝远侧平移穿过钉仓主体半部424a的发射凸轮通道471时，推进器底座464接收在发射凸轮304a’的凸轮系统狭槽310之内并沿着其平移。当这种情况发生时，推进器底座464的下凸轮表面468(图29)沿着发射凸轮304a’的第一刀片314a的发射凸轮表面314向上行进以将推进器460从下方位置移动至提升或发射位置。随后，当发射凸轮304a’在发射凸轮通道471之内朝近侧平移时，推进器底座464的上凸轮表面466由发射凸轮304a’的第二刀片316a的缩回凸轮表面316接合以使推进器460返回到下方位置。
再次参照图29至图31，钉仓组件420还包括与每个发射凸轮304a’相关的凸轮分离器480。每个凸轮分离器480(图30)包括通过凸轮构件484互连的一对引导构件482。该凸轮分离器480可滑动地定位在主体半部424a、424b中所形成的竖直通道490(图21)之内。由此，每个凸轮分离器480是轴向固定但能够在钉仓主体424a、424b之内竖直移动的。凸轮分离器480定位成使得当发射凸轮304a’处于缩回位置时，凸轮构件484接收在发射凸轮组件的相应发射凸轮304a’(图29)的凸轮系统狭槽310的远侧端之内。当发射凸轮304a’从缩回位置移动到推进位置时，凸轮分离器480将在主体半部424a、424b的竖直通道490之内从下方位置移动到提升位置。凸轮分离器480在发射凸轮304a’前进之前和前进期间维持发射凸轮304a’的第一刀片314a和第二刀片316a的恰当分离。
参照图29，工具组件418以与上面参照工具组件18所述基本相同的方式起作用。更具体地，当吻合设备10(图10)通过例如使可移动手柄26相对于固定手柄24(图1)朝向固定手柄24移动而被致动来推进发射凸轮304a’时，发射凸轮304a’在主体半部424a的凸轮通道471之内朝向远侧移动，使得推进器460的推进器底座464接收在发射凸轮304a’的凸轮系统狭槽310之内。注意，当前公开的工具组件还适于同机动的手术设备或机器人致动的手术设备联用。当发射凸轮304a’相对于每个推进器460朝远侧移动时，发射凸轮304a’的发射凸轮表面314定位在推进器底座464的下方并驱使推进器底座464，并因此向上驱使推进器460。当推进器460向上移动时，推进器板462在保持狭槽430之内向上移动以迫使吻合钉匣434的吻合钉435a向上并离开保持狭槽430。当推进器460处于其提升或发射位置时，推进器板462阻碍吻合钉匣434的下一吻合钉435的进入而进入到保持狭槽430。
当发射凸轮304a’缩回到发射凸轮通道471中时，每个推进器460的推进器底座464沿着凸轮系统狭槽310移动来移动推进器460，并因此使推进器板462向下朝向下方位置移动。当推进器板462经过凹陷部432时(图27)，第一偏置构件442和第二偏置构件444将吻合钉匣434朝向保持狭槽430推动以将吻合钉匣434的下一吻合钉435放置成与保持狭槽430对齐。可重复这个过程来从吻合钉匣434发射每个吻合钉435。如图29和图31中所示，当发射凸轮304a’处于缩回位置时，凸轮分离器480维持发射凸轮304a’的第一刀片314a和第二刀片314b之间的恰当间距。
参照图28，在已从主体半部424a发射每个吻合钉匣434的最后吻合钉435b后，第二偏置构件444的不再接合吻合钉后跨部435d的弹性支腿444a弹入到推进器460的每个推进器板462中所形成的凹口470的上方的位置，以防止推进器460从下方位置移回到提升位置。由于推进器460锁定在下方位置，故而防止了发射凸轮304a’穿过钉仓主体半部424a的移动并且将工具组件418锁定。
正如上面所讨论的，钉仓组件420包括第一钉仓主体半部424a和第二钉仓主体半部424b。钉仓主体半部424b还包括发射凸轮304a’。尽管未示出，但工具组件418还包括诸如图14中所示的发射凸轮组件，其包括发射凸轮304a’(图29)、中央驱动构件306和刀具308。替选地，钉仓组件420可仅具有一排或多排吻合钉，它们如上所述地支撑在钉仓主体中。该钉仓组件不必包括刀具。
可以想到，上述实施例的单独特征可进行合并而不偏离本公开的范围。尽管已经在此参照附图描述了本公开的示意性实施例，但上面的描述、公开和附图不应理解为限定，而是仅仅作为具体实施例的范例。例如，尽管工具组件18、418被描述为形成DLU的一部分，但可以想象，工具组件18、418能够完整地稳固至手术设备10(图1)的主体14。因此，应当理解，本公开并不限于在此描述的准确实施例，并且本领域技术人员可执行多种其他变化和修改而不偏离本公开的范围或精神。
Claims (14)
1.一种工具组件，包括：
砧座组件；
钉仓组件，其相对于所述砧座组件被可移动地支撑，所述钉仓组件包括钉仓主体，所述钉仓主体限定了组织接触表面和在所述组织接触表面上开口的多个保持狭槽，所述钉仓主体限定了多个凹陷部，所述凹陷部的每一个均与所述多个保持狭槽的其中一个关联；
吻合钉匣，其定位在所述凹陷部的每一个之内，所述吻合钉匣包括多个吻合钉；
至少一个偏置构件，其邻近所述凹陷部的每一个被支撑，所述至少一个偏置构件定位成朝向所述保持狭槽的相应一个保持狭槽驱使所述吻合钉匣；
多个推进器，其在下方位置和提升位置之间可移动地支撑在所述钉仓主体之内，所述多个推进器的每一个均定位成接合所述吻合钉匣的所述吻合钉的至少一个并将其从所述保持狭槽射出；
其中，所述至少一个偏置构件定位成在已将所述吻合钉匣的所述多个吻合钉从所述保持狭槽的相应一个保持狭槽射出之后防止所述推进器从所述下方位置向所述提升位置的移动。
2.根据权利要求1所述的工具组件，其中，所述推进器的每一个均包括至少一个推进器板，所述至少一个推进器板的每一个均能够在所述保持狭槽的相应一个保持狭槽之内移动以从所述钉仓主体射出所述吻合钉匣的所述多个吻合钉的其中一个。
3.根据权利要求2所述的工具组件，其中，所述至少一个推进器板的每一个均限定凹口，且所述至少一个偏置构件包括支腿，所述支腿在所述吻合钉匣的所述多个吻合钉已从所述保持狭槽射出之后能够移动至与所述凹口对齐，以防止所述推进器从所述下方位置向所述提升位置的移动。
4.根据权利要求1所述的工具组件，其中，所述至少一个偏置构件包括第一偏置构件和第二偏置构件，所述第一偏置构件被支撑在所述钉仓主体之内以接合所述多个吻合钉的相应一个吻合钉的支腿并且所述第二偏置构件被支撑在所述钉仓主体之内以接合所述多个吻合钉的相应的吻合钉的后跨部。
5.根据权利要求4所述的工具组件，其中，所述第一偏置构件是U形的并包括定位成接合所述多个吻合钉的相应一个吻合钉的支腿的一对支腿。
6.根据权利要求4所述的工具组件，其中，所述第二偏置构件定位成在所述吻合钉匣的所述多个吻合钉已从所述保持狭槽的所述相应一个保持狭槽射出之后防止所述推进器的移动。
7.根据权利要求6所述的工具组件，其中，所述推进器的每一个均包括至少一个推进器板，所述至少一个推进器板的每一个均能够在所述保持狭槽的相应一个保持狭槽之内移动以从所述钉仓主体射出所述吻合钉匣的所述多个吻合钉的其中一个。
8.根据权利要求7所述的工具组件，其中，所述至少一个推进器板的每一个均限定凹口且所述至少一个偏置构件包括支腿，所述支腿在所述吻合钉匣的所述多个吻合钉已从所述保持狭槽射出之后能够移动至与所述凹口对齐以防止所述推进器从所述下方位置移回至所述提升位置。
9.根据权利要求1所述的工具组件，进一步包括具有限定凸轮系统狭槽的第一刀片和第二刀片的发射凸轮，所述发射凸轮在所述钉仓主体之内于缩回位置和推进位置之间能够移动，所述凸轮系统狭槽构造成接收所述多个推进器，以在所述凸轮系统狭槽在所述缩回位置和所述推进位置之间平移时使所述推进器在所述下方位置和所述提升位置之间移动。
10.根据权利要求9所述的工具组件，其中，所述多个推进器的每一个均包括至少一个推进器板和推进器底座，所述至少一个推进器板可移动地支撑在所述多个保持狭槽的相应一个保持狭槽之内，所述推进器底座定位成接收在所述发射凸轮的所述凸轮系统狭槽之内。
11.根据权利要求10所述的工具组件，进一步包括凸轮分离器，其中所述钉仓主体限定了竖直通道，所述凸轮分离器被支撑用于在所述竖直通道之内移动并且当所述发射凸轮处于所述缩回位置时被定位在所述发射凸轮的所述凸轮系统狭槽之内以维持所述发射凸轮的所述第一刀片和所述第二刀片的分离。
12.根据权利要求1所述的工具组件，其中，所述钉仓主体包括第一主体半部和第二主体半部，所述第一主体半部和所述第二主体半部的每一个均限定多个保持狭槽和多个凹陷部，其中，所述多个凹陷部的每一个均容纳吻合钉匣。
13.根据权利要求12所述的工具组件，进一步包括限定了承载件通道的承载件，其中，所述钉仓主体的所述第一主体半部和所述第二主体半部支撑在所述承载件通道之内。
14.根据权利要求13所述的工具组件，进一步包括第一支撑通道和第二支撑通道，所述第一主体半部和第二主体半部被定位在所述第一支撑通道和所述第二支撑通道之内并且所述第一支撑通道和所述第二支撑通道被支撑在所述承载件的所述承载件通道之内。
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2014
- 2014-05-16 US US14/279,781 patent/US9668734B2/en active Active
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2015
- 2015-04-02 CA CA2887197A patent/CA2887197A1/en not_active Abandoned
- 2015-04-02 AU AU2015201691A patent/AU2015201691B2/en not_active Ceased
- 2015-05-14 CN CN201510246942.2A patent/CN105078532B/zh active Active
- 2015-05-14 JP JP2015099081A patent/JP2015217308A/ja active Pending
- 2015-05-15 EP EP17162033.9A patent/EP3228258B1/en active Active
- 2015-05-15 EP EP15167796.0A patent/EP2944275B1/en active Active
- 2015-05-15 ES ES15167796.0T patent/ES2635326T3/es active Active
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| CN101507623A (zh) * | 2008-02-15 | 2009-08-19 | 伊西康内外科公司 | 用于外科切割缝合器械的端部执行器耦合装置 |
| CN102283686A (zh) * | 2010-06-18 | 2011-12-21 | Tyco医疗健康集团 | 吻合位置感测器系统 |
| EP2722009A2 (en) * | 2012-10-16 | 2014-04-23 | Covidien LP | Surgical stapling apparatus comprising cartridge in two halves |
Also Published As
| Publication number | Publication date |
|---|---|
| US9668734B2 (en) | 2017-06-06 |
| JP2015217308A (ja) | 2015-12-07 |
| EP2944275A2 (en) | 2015-11-18 |
| US20150327862A1 (en) | 2015-11-19 |
| ES2635326T3 (es) | 2017-10-03 |
| EP2944275A3 (en) | 2016-01-27 |
| EP2944275B1 (en) | 2017-07-05 |
| AU2015201691B2 (en) | 2019-10-24 |
| EP3228258B1 (en) | 2020-04-22 |
| AU2015201691A1 (en) | 2015-12-03 |
| EP3228258A1 (en) | 2017-10-11 |
| CN105078532A (zh) | 2015-11-25 |
| CA2887197A1 (en) | 2015-11-16 |
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