CN105078533A - 手术仪器 - Google Patents

手术仪器 Download PDF

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Publication number
CN105078533A
CN105078533A CN201510239093.8A CN201510239093A CN105078533A CN 105078533 A CN105078533 A CN 105078533A CN 201510239093 A CN201510239093 A CN 201510239093A CN 105078533 A CN105078533 A CN 105078533A
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component
slit
main part
input cam
cam component
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斯坦尼斯洛娃·科斯切夫斯基
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Covidien LP
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Covidien LP
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/115—Staplers for performing anastomosis in a single operation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
    • A61B17/105—Wound clamp magazines
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/3209—Incision instruments
    • A61B17/3211—Surgical scalpels, knives; Accessories therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
    • A61B2017/00473—Distal part, e.g. tip or head
    • 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
    • A61B2017/07214—Stapler heads
    • A61B2017/07221—Stapler heads curved
    • 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
    • A61B2017/07214—Stapler heads
    • A61B2017/07228—Arrangement of the staples
    • 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
    • A61B2017/07214—Stapler heads
    • A61B2017/07257—Stapler heads characterised by its anvil
    • 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
    • A61B2017/07214—Stapler heads
    • A61B2017/07271—Stapler heads characterised by its cartridge
    • 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
    • A61B2017/07214—Stapler heads
    • A61B2017/07285—Stapler heads characterised by its cutter
    • 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
    • A61B17/2909—Handles
    • A61B2017/2912—Handles transmission of forces to actuating rod or piston
    • A61B2017/2913—Handles transmission of forces to actuating rod or piston cams or guiding means
    • A61B2017/2916—Handles transmission of forces to actuating rod or piston cams or guiding means pins in guiding slots
    • 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
    • A61B17/32—Surgical cutting instruments
    • A61B17/3209—Incision instruments
    • A61B17/3211—Surgical scalpels, knives; Accessories therefor
    • A61B2017/32113—Surgical scalpels, knives; Accessories therefor with extendable or retractable guard or blade

Abstract

本发明公开了一种手术仪器。提供了一种在身体组织中逐渐地吻合和形成切口的手术吻合装置。该装置包括主体部分和支撑在主体部分上的工具组件。该装置进一步包括能够在主体部分之内滑动的输入凸轮构件、可旋转地支撑在主体部分之内的鼓构件以及能够在主体部分之内滑动的输出凸轮构件。该鼓构件联接至输入凸轮构件使得输入凸轮构件的线性运动引起鼓构件的旋转运动。该输出凸轮构件被联接至鼓构件使得鼓构件的旋转运动引起输出凸轮构件的线性运动。输入凸轮构件的线性运动引起砧座相对于钉仓在松开位置和夹紧位置之间的运动。

Description

手术仪器
相关申请交叉引用
本申请要求于2014年5月16日提交的序号为61/994,155的美国临时专利申请的权益和优先权，其全部内容通过引用结合于此。
技术领域
本公开涉及用于对身体组织施加手术吻合钉并且切割身体组织的手术仪器，并且更具体地，涉及一种用于在身体组织中逐步地放置多行吻合钉并且在多行吻合钉之间形成切口的手术仪器。
背景技术
很多手术操作需要对身体器官和组织施加一个或多个手术紧固件，例如吻合钉。在很多情况下，吻合钉被以多个线性行的方式稳固至组织并且在多行吻合钉之间切割该组织。通常而言，用于吻合和切割组织的工具组件被配置用于单次使用。通过这种方式，待进行吻合和切割的组织安置在该工具组件的钉仓和砧座之间然后致动该工具组件。该组织的任何进一步吻合和切割需要更换吻合钉钉仓。提供一种能够多次致动而不必必须更换吻合钉钉仓的手术吻合器将是有益的。
发明内容
一种用于在身体组织中逐步地吻合和形成切口的手术吻合装置。该装置包括主体部分和支撑在主体部分上的工具组件。该装置进一步包括能够在主体部分之内滑动的输入凸轮构件、可旋转地支撑在主体部分之内的鼓构件(drummember)和能够在主体部分之内滑动的输出凸轮构件。该鼓构件联接至输入凸轮构件使得输入凸轮构件的线性运动引起鼓构件的旋转运动。输出凸轮构件联接至鼓构件使得鼓构件的旋转运动引起输出凸轮构件的线性运动。输入凸轮构件的线性运动导致输出凸轮构件的线性运动以引起砧座相对于钉仓在松开位置和夹紧位置之间的运动。
在一个实施例中，鼓构件包括第一柱和第二柱，并且输入凸轮构件和输出凸轮构件均限定了狭槽，第一柱被可滑动地接纳在输入凸轮构件的狭槽中，并且第二柱被可滑动地接纳在输出凸轮构件的狭槽之内。输入凸轮构件的狭槽可包括螺旋状部分和线性部分，并且输出凸轮构件中的狭槽可为螺旋状的。输入凸轮构件的推进可导致第一柱横越输入凸轮构件中的狭槽的螺旋状部分以转动鼓构件，并且鼓构件的旋转可导致第二柱横越输出凸轮构件的狭槽以引起输出凸轮构件的线性运动。第一柱接纳在输入凸轮构件中的狭槽的线性部分之内可允许输入凸轮构件的线性运动而不引起鼓构件的旋转运动。
该手术吻合装置可进一步包括联接至输入凸轮构件的推动件驱动器。该推动件驱动器可限定停驻狭槽并且输入凸轮构件可限定凸起。该凸起可滑动地接纳在停驻狭槽之内以允许输入凸轮构件相对于推动件驱动器的线性运动。在实施例中，在凸起被推进到停驻狭槽的远侧端部之后，推动件驱动器的线性运动引起输入凸轮构件的对应运动。
该手术吻合装置还可包括联接至输入凸轮构件的刀具驱动器。该刀具驱动器可限定停驻狭槽并且输入凸轮构件的凸起可滑动地接纳在停驻狭槽之内以允许输入凸轮构件相对于刀具驱动器线性运动。在凸起被推进到停驻狭槽的远侧端部之后，刀具驱动器的线性推进可对应于输入凸轮构件的运动。
在一些实施例中，刀具驱动器的停驻狭槽的远侧端部与推动件驱动器的停驻狭槽的远侧端部远侧地间隔开，使得输入凸轮构件在继推进该推动件驱动器之后引起刀具驱动器的推进。推动件驱动器的推进可吻合组织，并且刀具驱动器的推进可切割组织。
此外，手术吻合装置可包括支撑在工具组件之内的吻合钉供给组件。该吻合钉供给组件可包括一对压力板，该对压力板中的每一个均包括接合多行吻合钉中的近侧吻合钉的多个延伸部。该压力板可通过弹簧沿远侧方向偏置。该弹簧可通过弹簧夹连接至每个压力板。该对压力板中的每一个均可包括三个延伸部。
还提供了一种手术装置，包括：主体部分；能够在主体部分之内滑动的第一构件；第二构件，其可旋转地支撑在主体部分之内并且操作性地连接至第一构件；以及第三构件，其能够在主体部分之内滑动并且操作性地连接至主体部分。第一构件的线性运动引起第二构件的旋转运动，第二构件的旋转运动引起第三构件的线性运动。
该手术装置可进一步包括能够在主体部分之内滑动的第四构件，其中第一构件的线性运动引起第四构件的线性运动。该手术装置可进一步包括能够在主体部分之内滑动的第五构件，其中第一构件的线性运动引起第五构件的线性运动。
此外，提供了一种手术装置，包括：主体部分；能够在主体部分之内滑动的第一细长构件；第二细长构件，其能够在主体部分之内滑动并且操作性地连接至第一细长构件；以及第三细长构件，其能够在主体部分之内滑动并且操作性地连接至第一构件。第一细长构件推进第一距离引起第二细长构件缩回并且第一细长构件推进第二距离引起第三细长构件的推进。
该手术装置可进一步包括第四细长构件，其能够在主体部分之内滑动并且操作性地连接至第一细长构件。第一细长构件推进第三距离引起第三细长构件的继续推进和第四细长构件的推进。该手术装置可进一步包括圆柱形构件，其可旋转地支撑在主体部分之内。第一细长构件推进第一距离可引起圆柱形构件的旋转，圆柱形构件的旋转引起第二细长构件的缩回。
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，并且与上面给出的对本公开的大致描述以及下面给出的对实施例的详细描述共同用以解释本公开的原则，其中：
图1是根据本公开的实施例的包括装载单元的手术吻合器的立体图；
图2是图1中所示的装载单元的俯视图；
图3是图1中所示的装载单元的侧视图；
图4是图1中所示的装载单元的立体图；
图5是图1中所示的装载单元的主体部分的分解立体图；
图6是图1中所示的装载单元的工具组件的分解立体图；
图6A是图7中所示的工具组件的外壳构件、吻合钉钉仓和钉仓罩的放大立体图；
图6B是图6A中所示的外壳构件、吻合钉钉仓和钉仓罩的另一立体图；
图7是图1中所示的装载单元的推动组件的立体图；
图7A是图7中所示的推动组件的推动构件的放大立体图；
图8是图1中所示的装载单元的刀具驱动组件的立体图；
图9是图1中所示的装载单元的砧座组件的立体图；
图10是图1中所示装载单元沿着图2中的剖面线10-10截取的剖视图；
图11是图10中所示的标示细节区域的放大图；
图12是图1中所示的装载单元的工具组件处于第一关节式运动位置时的立体图；
图13是图1中所示的装载单元的工具组件处于第二关节式运动位置时的立体图；
图14是图10中所示的标示细节区域的放大图；
图15是图1中所示的装载单元移除主体部分的套筒后的立体图；
图16是图15中所示的标示细节区域的放大图；
图17是图1中所示的装载单元的图7中所示的推动组件、图8中所示的刀具驱动组件以及图9中所示的砧座组件的立体装配图；
图18是图17中所示的组件的另一立体图；
图19是图17中所示的组件的另一立体图；
图20是图15中所示的装载单元的安全锁定组件的立体图；
图21是图20中所示的标示细节区域的放大图；
图22是图20中所示的安全锁定组件的线性致动器的立体图；
图23是图20中所示的安全锁定组件的锁定构件的立体图；
图24是图20中所示的装载单元的近侧端部在安全机构处于第一或锁定位置时的立体图；
图25是图20中所示的装载单元的近侧端部在移除第一半壳体后的侧视图；
图26是图20中所示的装载单元的近侧端部在安全锁定组件处于第二或解锁位置时的立体图；
图27是图20中所示的装载单元的近侧端部在移除第一半壳体后的立体端视图；
图28是图1中所示的装载单元的工具组件的立体图；
图29是图1中所示的装载单元的工具组件的另一立体图；
图30是图1中所示的装载单元移除主体部分和工具组件的外套筒后的立体图；
图31是图30中所示的标记细节区域的放大图；
图32是图30中所示的工具组件的侧视立体图；
图33是图32中所示的工具组件的远侧端部的放大立体图。
图34是图32中所示的工具组件的远侧端部移除工具组件的外套筒和砧座构件后的放大立体端视图；
图35是图33中所示的工具组件的远侧端部移除钉仓罩后的放大立体端视图；
图36是图1中所示的装载单元沿着图3中所示的剖面线36-36截取的剖视图；
图37是图1中所示的装载单元沿着图3中所示的剖面线37-37截取的剖视图；
图38是图1中所示的装载单元沿着图3中所示的剖面线38-38截取的剖视图；
图39是图1中所示的装载单元沿着图10中所示的剖面线39-39截取的剖视图；
图40是图39中所示的标示细节区域的放大图；
图41是图1中所示的装载单元移除主体部分和工具组件的外套筒后的侧视立体图；
图42是图41中所示的标示细节区域的放大图；
图43是图1中所示的装载单元的吻合钉供给组件的立体图；
图44是图43中所示的吻合钉供给组件的另一立体图；
图45是图1中所示的装载单元的功能部件处于松开位置时的侧视图；
图46是图45中所示的标记细节区域的放大图；
图47是图45中所示的功能部件沿着图46中所示的剖面线47-47截取的剖视端视图；
图48是图45中所示的功能部件沿着图45中所示的剖面线48-48截取的剖视端视图；
图49是图1中所示的装载单元的功能部件处于夹紧位置时的侧视图；
图50是图49中所示的标记细节区域的放大图；
图51是图49中所示的功能部件沿着图50中所示的剖面线51-51截取的剖视端视图；
图52是图45中所示的功能部件处于夹紧位置时的立体图；
图53是图52中所示的标记细节区域的放大图；
图54是图1中所示的工具组件处于夹紧位置时的侧视图；
图55是图50中所示功能部件处于完全致动位置时的视图；
图56是图11中所示的工具组件处于致动位置时的视图；
图57是图55中所示的工具组件的远侧端部的放大侧视图，且以虚像示出了砧座组件；
图58是图1中所示的装载单元的工具组件处于吻合和切割组织的使用状态时的立体图；以及
图59是采用图1中所示的手术吻合器来吻合和切割后的组织的俯视图。
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，相同附图标记指代若干附图的每一幅图中的相同或对应元件。在整个说明书中，术语“近侧”将指代装置最为靠近用户的部分，而术语“远侧”将指代装置最为远离用户的部分。
首先参照图1，用于向身体组织施加手术吻合钉的手术仪器总体示出为手术吻合器10。手术吻合器10构造成切割并紧固身体组织。尤其且正如将在下面进一步详细描述的，在内窥镜手术操作期间，手术吻合器10构造成向组织逐步地施加多个手术紧固件，而同时在紧固的组织中逐步地形成切口。尽管示出并描述为同用于向身体组织施加手术吻合钉的手术仪器相关，但可更改本公开的方案以用于其它手术仪器，例如，手术镊、网片部署设备。
手术吻合器10包括装载单元12和致动单元14，装载单元12用于紧固和切割组织，致动单元14用于控制和致动装载单元12。如所示，致动单元14包括手柄组件16，其构造为用于由用户操作性接合并用于手动致动装载单元12。细长主体部分18从手柄组件16延伸出并构造成将装载单元12操作性地连接至手柄组件16。可以想象，装载单元12可构造为用于同具有可替换构造的致动单元一起操作。例如，致动单元可包括动力手柄组件或机器人系统。在其他实施例中，装载单元12可与致动单元14整体形成。关于对用于控制和致动装载单元12的示例性致动单元的详细描述，请参照序号为6,330,965的共有美国专利，其全部内容通过参考结合于此。
现参照图1至图6，手术吻合器10的装载单元12包括主体部分100和枢转连接至主体部分100的工具组件102。装载单元12的主体部分100构造成可释放地联接至致动单元14的细长主体部分18。尽管示出为构造为用于卡口联接，但可以想象，装载单元12可被修改为用于以任意合适的方式连接于致动单元14的细长主体部分18。
现具体参照图5，装载单元12的主体部分100包括外套筒104，外套筒104接纳第一半壳体106和第二半壳体108、输入凸轮杆112以及鼓组件114。正如将在下面进一步详细描述的，输入凸轮杆112被可滑动地接纳在第一半壳体106和第二半壳体108之内，并且鼓组件114可旋转地安装在第一半壳体106和第二半壳体108之内。输入凸轮杆112和鼓组件114构造成在手术吻合器10(图1)的操作期间引起装载单元12的工具组件102的致动，这将在下面进一步详细描述。
继续参照图5，装载单元12的主体部分100进一步包括驱动构件116、安全锁定组件118和关节式运动杆120。正如将在下面进一步详细描述的，驱动构件116构造为用于同致动单元14(图1)的驱动构件(未示出)操作性接合，使得致动单元14的操作引起工具组件102的操作，这将在下面详细讨论。安全锁定组件118构造成防止装载单元12的致动，直到装载单元12被稳固至致动单元14(图1)的细长主体部分18(图1)，并且关节式运动杆120构造成引起工具组件102相对于主体部分100的关节式运动。
在序号为8,469,254的共有美国专利中描述了安全锁定组件118的操作，上述专利的全部内容通过引用结合于此。第一连接元件121a从第一半壳体106的远侧端部延伸出，并且第二连接元件121b从第二半壳体108的远侧端部延伸出。第一连接元件121a和第二连接元件121b绕着枢转销119联接以将工具组件102枢转地稳固至主体部分100。
现参照图6，装载单元12的工具组件102包括外套筒122，外套筒122构造成接纳外壳构件124和吻合钉钉仓126。吻合钉钉仓126构造成由钉仓罩128盖住。工具组件102进一步包括一对压力板130、弹簧夹132、弹簧134以及一对推动构件136。正如将在下面进一步详细描述的，压力板130、弹簧夹132和弹簧134在外壳构件124和吻合钉钉仓126内作为吻合钉供给组件210运行，以用于向推动构件136供给吻合钉“S”。每个压力板130均包括多个延伸件130a，每个延伸件130a均构造为用于接合吻合钉行中的近侧吻合钉。每个延伸件130a均包括与吻合钉“S”的形状对应的大致C形横截面。
正如将在下面进一步详细描述的，推动件驱动器142、一对刀具驱动器(共同称作刀具驱动器144)、以及输出凸轮杆146从装载单元12的主体部分100(图4)延伸到工具组件102中。推动件驱动器142、刀具驱动器144和输出凸轮杆146各自分别包括柔韧部分142c、144c、146c以促进工具组件102相对于主体部分100的关节式运动。正如将在下面进一步详细描述的，推动件驱动器142通过第一稳固销150和一对轴承环150a、150b相对于工具组件102的外壳构件124可滑动地稳固。正如将在下面进一步详细描述的，刀具驱动器144和输出凸轮杆146通过第二稳固销154和轴承环154a相对于工具组件102的外壳构件124可滑动地稳固。
现具体参照图6A和图6B，外壳构件124的近侧端部124a限定了第一纵向通道201(图6B)，其与半环形剪切部203连通。外壳构件124的远侧端部124b进一步限定了一对纵向剪切部205，它们与半环形剪切部203连通。外壳构件124进一步限定了第二纵向通道211(图6A)，其具有沿着外壳构件124的长度延伸的内侧部分211a和外侧部分211b。外壳构件124还限定了第一内部通道215a和第二内部通道215b以及圆形孔221(图6A)。
仍旧参照图6A和图6B，吻合钉钉仓126的近侧端部126a限定了一对纵向剪切部207，当外壳构件124与吻合钉钉仓126装配后，该对纵向剪切部207与在外壳构件124的远侧端部124b中所形成的纵向剪切部205对齐。吻合钉钉仓126的远侧端部126b限定了一对剪切部209，它们与纵向剪切部207连通。吻合钉钉仓126的远侧端部126b还限定了多个凹口209a。吻合钉钉仓126进一步限定了具有内侧部分213a和外侧部分213b的纵向通道213，内侧部分213a和外侧部分213b对应于外壳构件124的第二纵向通道211的内侧部分211a和外侧部分211b。此外，吻合钉钉仓126的远侧端部126b限定了纵向延伸狭槽213c(图6A)。吻合钉钉仓126还限定了第一组狭槽217(图6B)和第二组狭槽219(图6A)，它们分别与外壳构件124的第一内部通道215a和第二内部通道215b连通。第一组狭槽217的远侧端部和第二组狭槽219的远侧端部与在吻合钉钉仓126的远侧端部126b中所形成的凹口209a(图32)对齐。吻合钉钉仓126进一步限定了圆形孔221a(图6A)，当吻合钉钉仓126被稳固至外壳构件124时，该圆形孔221a连通于外壳构件124的圆形孔221。
正如将在下面进一步详细描述的，外壳构件124和吻合钉钉仓126操作以接纳推动件驱动器142的远侧端部、刀具驱动器144的远侧端部和输出凸轮杆146的远侧端部。
现参照图7，推动构件136和推动件驱动器142为推动组件220的部件。推动件驱动器142的近侧端部142a限定了一对停驻狭槽143。正如将在下面进一步详细描述的，推动件驱动器142的停驻狭槽143可滑动地接纳在输入凸轮杆112的远侧端部112b(图5)上形成的凸起152(图5)以允许输入凸轮杆112相对于推动组件220运动。推动件驱动器142的远侧端部142b包括半环形凸缘158。一对L形接合构件159从半环形凸缘158延伸出。各个接合构件159均包括从半环形凸缘158延伸出的细长部分159a和接合推动构件136的接合部分159b。更具体地，各个推动构件136均包括沟槽137，其接纳接合构件159的接合部分159b以将推动构件136稳固至推动件驱动器142。推动件驱动器142包括柔性部分142c，其在装载单元12的主体部分100和工具组件102之间延伸。当工具组件在相对于主体部分100处于关节式运动位置中被致动时，柔性部分142c允许推动件驱动器142弯曲。
现转向图8，刀具驱动器144与刀具160共同形成刀具组件230。刀具驱动器144的近侧端部144a限定了停驻狭槽145。正如将在下面进一步详细描述的，刀具驱动器144的停驻狭槽145可滑动地接纳输入凸轮杆112的凸起152(图5)以允许输入凸轮杆112相对于刀具组件230运动。通过焊接、黏合剂和机械紧固件或者任意其他合适的方式，刀具160被稳固地安装在刀具驱动器144的远侧端部144b上。刀具驱动器144包括柔性部分144c，其接纳在装载单元12的主体部分100和工具组件102之间。当工具组件102在相对于主体部分100处于关节式运动位置中被致动时，柔性部分144c允许刀具驱动器144弯曲。
现参照图9，输出凸轮杆146与砧座构件162共同形成砧座组件240。与推动件驱动器142和刀具驱动器144类似，输出凸轮杆146限定了停驻狭槽147。正如将在下面进一步详细描述的，输出凸轮杆146的停驻狭槽147可滑动地接纳输入凸轮杆112的凸起152(图5)以允许输入凸轮杆112相对于砧座组件240运动。砧座构件162包括延伸部分164和砧座部分166，延伸部分164固定地稳固至输出凸轮杆146的远侧端部146b，砧座部分166布置在延伸部分164上。砧座构件162的砧座部分166限定了第一组吻合钉成形凹穴163和第二组吻合钉成形凹穴165以及刀具接纳凹穴167(图28)，刀具接纳凹穴167安置在第一组吻合钉成形凹穴163和第二组吻合钉成形凹穴165之间。输出凸轮杆146包括柔性部分146c，其在装载单元12的主体部分100和工具组件102之间延伸，并且当工具组件102在相对于主体部分100处于关节式运动位置中被致动时，柔性部分146c允许输出凸轮杆146弯曲。
现参照图10至图13，装载单元12的关节式运动杆120沿着主体部分100的长度延伸并且在其远侧端部120b处操作性地连接至邻近工具组件102的近侧端部的第一稳固销150(图11)。关节式运动杆的近侧端部120a安置成接合致动单元14的关节式运动机构(未示出)。例如，参见序号为8,469,254的美国专利，其全部内容在前面已通过引用结合于此。如图11中箭头“A”所标示的，关节式运动杆120相对于主体部分100的运动导致工具组件102相对于主体部分100绕着枢转销119的关节式运动。具体地，关节式运动杆120相对于主体部分100向远侧地推进导致工具组件102绕着枢转销119沿着如图12中箭头“B”所标示的第一方向的关节式运动，并且关节式运动杆120相对于主体部分100向近侧地缩回导致工具组件102绕着枢转销119沿着如图13中箭头“C”所标示的第二方向的关节式运动。在一个实施例中，并且如附图中所示出的，关节式运动杆120的推进和缩回借助操作性地支撑在致动单元14(图1)的细长主体部分18(图1)上的操作杆20(图1)来完成。
现参照图5以及图14至图19，装载单元12的鼓组件114安装在主体部分100的第一半壳体106和第二半壳体108之间用于旋转运动并且包括第一鼓轴承170a和第二鼓轴承170b以及鼓构件172。第一鼓轴承170a和第二鼓轴承170b被稳固至在第一半壳体106上形成的相应的第一支撑部件176a和第二支撑部件176b(图5)，使得鼓构件172能够相对于输入凸轮杆112和输出凸轮杆146(图4)旋转。鼓构件172包括第一鼓柱174a(图17)和第二鼓柱174b(图18)。第一鼓柱174a接纳在输入凸轮杆112的狭槽173(图19)之内，并且第二鼓柱174b接纳在输出凸轮杆146的狭槽175(图18)之内。输入凸轮杆112中的狭槽173包括纵向延伸的近侧部分173a和螺旋状远侧部分173b。输出凸轮杆146中的狭槽175是螺旋状的。
正如将在下面进一步详细描述的，输入凸轮杆112中的狭槽173的构造和输出凸轮杆146中的狭槽175的构造以及第一鼓柱174a和第二鼓柱174b在对应的狭槽173、175之内的位置使得输入凸轮杆112沿着半壳体106、108的远侧方向的推进导致鼓构件172沿着第一方向的旋转，并且鼓构件172沿第一方向的旋转导致输出凸轮杆146在半壳体106、108之内的缩回。相反，输入凸轮杆112沿近侧方向的缩回导致鼓构件172沿第二方向的旋转，并且鼓构件172沿第二方向的旋转导致输出凸轮杆146的推进。
正如上面所指出的，凸起152形成在输入凸轮杆112的远侧端部112b上。如图17至图19中所示，凸起152被接纳穿过推动件驱动器142的近侧端部142a中形成的停驻狭槽143、穿过刀具驱动器144的近侧端部144a中形成的停驻狭槽145(图7)并且穿过输出凸轮杆146中形成的停驻狭槽147。正如将在下面进一步详细描述的，推动件驱动器142中形成的停驻狭槽143和刀具驱动器144中形成的停驻狭槽145被设定尺寸为使得输入凸轮杆112在工具组件102致动期间超出第一距离“d1”的推进(图50)会推进推动件驱动器142和刀具驱动器144。同样如将在下面进一步详细描述的，输出凸轮杆146中形成的停驻狭槽147构造成使得输出凸轮杆146被允许在工具组件102致动期间相对于输入凸轮杆112缩回以导致砧座构件162相对于钉仓罩128(图15)的缩回。闩锁176形成在输入凸轮杆112的近侧端部上并且构造成由安全锁定组件118(图5)选择性接合。
具体参照图17和图18，正如上面所指出的，驱动构件116被稳固地固定至输入凸轮杆112的近侧端部112a并将输入凸轮杆112连接至延伸穿过手术吻合器10(图1)的致动单元14(图1)的细长主体部分18(图1)的驱动轴(未示出)。关于示例性驱动轴的结构和功能以及驱动构件116与致动单元的细长主体部分的连接的详细描述，请参照序号为8,469,254的共有美国专利(“‘254专利”)，其公开的全部内容通过引用结合于此。
现将参照图20至图27描述装载单元12的安全锁定组件118。安全锁定组件118包括线性致动器180、锁定构件182和弹簧184。线性致动器180可滑动地定位在装载单元12的主体部分100的第一半壳体106中所形成的纵向狭槽179之内并且构造成沿纵向移动。线性致动器180包括位于近侧端部上的邻接构件180a和位于远侧端部上的弹簧导引件180b。线性致动器180限定了中央凸轮狭槽181(图22)。弹簧184布置在第一半壳体106之内并且接合线性致动器180的弹簧导引件180b。弹簧184沿着近侧方向偏置线性致动器180。锁定构件182可滑动地安置在主体部分100的第一半壳体106的横向狭槽183b之内并且构造成在线性致动器180的纵向推进期间沿着横向移动。锁定构件182包括径向朝内延伸的凸轮构件182b(图23)和径向朝内延伸的指状件182a(图23)。凸轮构件182b被接纳在线性致动器180的中央凸轮狭槽181之内。在第一或锁定位置(图24和图25)，锁定构件182的指状件182a接合形成在输入凸轮杆112的近侧端部112a上的闩锁176，以防止输入凸轮杆112在主体部分100内纵向移动，从而防止装载单元12的致动。
具体参照图24和图25，安全锁定组件118被示出处于装载单元12附接至手术吻合器10(图1)的致动单元14(图1)的细长主体部分18(图1)之前。弹簧184将线性致动器180驱使到近侧位置。在该近侧位置，线性致动器180使指状件182a凸轮式运动，使得锁定构件182被移动到锁定位置。正如上面所讨论的，在该锁定位置，锁定构件182的指状件182a接合输入凸轮杆112的闩锁176。
转向图26和图27，装载单元12附接至手术吻合器10(图1)的致动单元14(图1)的细长主体部分18(图1)导致线性致动器180逆着弹簧184的偏置而推进，正如由图26中所示的箭头“D”所标示的。当线性致动器180被推进时，锁定构件182的凸轮构件182b骑乘在线性致动器180的中央凸轮狭槽181之内。中央凸轮狭槽181的倾斜构造导致锁定构件182相对于第一半壳体106的旋转。锁定构件182的旋转导致锁定构件182的指状件182a同输入凸轮杆112的闩锁176的脱离。一旦指状件182a同闩锁176脱离，则在致动单元14(图1)致动时，输入凸轮杆112可被纵向移动。安全锁定组件118防止输入凸轮杆112的推进，直到装载单元112已被稳固至致动单元14。关于示例性安全锁定组件的结构和功能的更详细的描述，请参照‘254专利，其内容已在前面通过引用结合于此。
现将参照图28至图43详细描述装载单元12的工具组件102。首先参照图28至图31，如上面所指出的，工具组件102通过枢转销119被枢转地稳固至装载单元12的主体部分100并且包括外套筒122、外壳构件124、吻合钉钉仓126以及钉仓罩128。通过外壳构件124的凸缘190(图6B)接纳在吻合钉钉仓126的凹口191(图6B)之内，吻合钉钉仓126稳固至外壳构件124。尽管吻合钉钉仓126被示出为通过凸缘190接纳在凹口191之内而稳固至外壳构件124，但吻合钉钉仓126可通过任意合适的方式稳固至外壳构件124。工具组件102的外套筒122安置在外壳构件124和吻合钉钉仓126周围以保持吻合钉钉仓126稳固地附接至外壳构件124。通过卡扣布局或任意其他合适的方式，钉仓罩128使外罩122稳固在外壳构件124和吻合钉钉仓126周围。
现具体参照图31至图33，外壳构件124和吻合钉钉仓126操作性地接纳推动组件220(图7)的远侧端部。具体地，推动件驱动器142的柔性部分142c可滑动地接纳在外壳构件124中的第一纵向通道201之内。推动件驱动器142通过第一稳固销150及轴承环150a、150b而维持在第一纵向通道201之内。具体地，关于稳固销150旋转的轴承环150a、150b接合推动件驱动器142以促进推动件驱动器142相对于外壳构件124的纵向移动。
推动件驱动器142的半环形凸缘158可滑动地接纳在外壳构件124中的半环形剪切部203之内并且能够在缩回位置(图54)和推进位置(图57)之间移动。推动件驱动器142的接合构件159的细长部分159a可滑动地接纳在外壳构件124的纵向剪切部205之内。接合构件159的细长部分159a从外壳构件124的纵向剪切部205延伸出并且可滑动地接纳在吻合钉钉仓126的纵向剪切部207之内。接合构件159与接纳在吻合钉钉仓126中的剪切部209之内的推动件驱动器142的推动构件136接合。具体地，推动件驱动器142的接合构件159的接合部分159b可滑动地接纳在推动构件136的沟槽137之内。推动构件136的吻合钉接合部分136a可滑动地接纳在吻合钉钉仓126中的多个凹口209a(图33)之内并且安置成选择性地接合每行吻合钉“S”中的最远的吻合钉。
同时参照图34，外壳构件124和吻合钉钉仓126进一步接纳刀具驱动组件230(图8)的远侧端部和砧座组件240(图9)的远侧端部。具体地，刀具驱动器144的远侧端部144b可滑动地接纳在外壳构件124的第二纵向通道211的内侧部分211a之内，并且输出凸轮杆146的远侧端部146b可滑动地接纳在外壳构件124的第二纵向通道211的外侧部分211b之内。刀具驱动器144和输出凸轮杆146通过第二稳固销154和轴承环154a而被保持在第二纵向通道201之内。具体地，关于第二稳固销154旋转的轴承环154a接合输出凸轮杆146以促进刀具驱动器144和输出凸轮杆146相对于外壳构件124的纵向移动。
刀具驱动器144的远侧端部144b接纳在吻合钉钉仓126的纵向通道213的内侧部分213a之内，并且输出凸轮杆146的远侧端部146b和砧座组件240的砧座162接纳在纵向通道213的外侧部分213b之内。安装在刀具驱动器144的远侧端部144b上的刀具160接纳在吻合钉钉仓126的纵向延伸狭槽213c之内。
现具体参照图36至图44，外壳构件124和吻合钉钉仓126还构造成操作性地接纳吻合钉供给组件210。具体地，吻合钉供给组件210的压力板130分别可滑动地接纳在第一内部通道215a和第二内部通道215b之内。弹簧夹132(图42)被稳固至每个压力板130的近侧端部。弹簧134的近侧端部134a被接纳穿过外壳构件124的中央孔221并稳固至弹簧夹132。弹簧134作用在弹簧夹132上以将压力板130沿远侧方向偏置穿过第一内部通道215a和第二内部通道215b。一行吻合钉“S”被接纳穿过吻合钉钉仓126的第一组狭槽217和第二组狭槽219中的每个狭槽。弹簧134的远侧端部134b延伸穿过吻合钉钉仓126的圆形孔221a并被稳固至邻近吻合钉钉仓126的远侧端部126b安置的定位销222(图33)。压力板130的延伸部130a接合每行吻合钉“S”的近侧吻合钉以朝向推动构件136的接合部分136a向远侧推动吻合钉“S”行。
吻合钉钉仓126的钉仓罩128和远侧端部126b限定了第一组开口223和第二组开口225(图38)，它们邻近吻合钉钉仓126中的相应的狭槽217、219(图37)的远侧端部安置。吻合钉“S”由推动构件136穿过开口223、225射出。第一组开口223和第二组开口225与砧座构件162的砧座166中形成的相应的吻合钉成形凹穴163、165对齐。
现将参照图45至图59描述装载单元12的操作。首先参照图45至图48，装载单元12被示出处于初始位置或松开位置。在该松开位置中，在鼓组件114的鼓构件172(图5)上形成的第一鼓柱174a布置在输入凸轮杆112中所形成的狭槽173的螺旋状部分173b的近侧端部之内，并且在鼓构件172上形成的第二鼓柱174b布置在输出凸轮杆146中所形成的狭槽175的近侧端部中。在该松开位置中，砧座杆146的砧座166与工具组件102的钉仓罩128(图49)纵向间隔开。
图49至图54示出装载单元12处于夹紧位置。通过沿着远侧方向推进装载单元12的输入凸轮杆112，会导致装载单元12从松开位置向夹紧位置的移动。更具体地，当输入凸轮杆112响应于致动单元14的操作而被朝远侧推进第一距离“d1”时，正如由图50中的箭头“E”所标示的，在鼓构件172上形成的第一鼓柱174a横越输入凸轮杆112中的狭槽173的螺旋状部分173b，如此导致鼓构件172沿着正如由图51中箭头“F”所标示的第一方向旋转。鼓构件172相对于输出凸轮杆146沿第一方向的旋转使得鼓构件172上所形成的第二鼓柱174b在输出凸轮杆146中所形成的狭槽175之内移动。第二鼓柱174b相对于输出凸轮杆146的移动导致输出凸轮杆46缩回，正如由图50中的箭头“G”所标示的。输出凸轮杆146的缩回使得砧座构件162相对于砧座罩128移动，正如由图49中箭头“H”所标示的。
正如上面所指出的，输出凸轮杆146中所形成的停驻狭槽174被设定尺寸成允许输出凸轮杆146相对于输入凸轮杆112运动。推动件驱动器142中所形成的停驻狭槽143(图53)和刀具驱动器144中所形成的停驻狭槽145(图8)还被设定尺寸成允许输入凸轮杆112相对于推动件驱动器142和刀具驱动器144推进。具体地，推动件驱动器142和刀具驱动器144的各自的停驻狭槽143、145的长度使得输入凸轮杆112的远侧端部112b上形成的凸起152在输入凸轮杆112被推进第一距离“d1”时横穿其中。
推动件驱动器142和刀具驱动器144的各自的停驻狭槽143、145的长度使得输入凸轮杆112越过第一距离“d1”的推进(如由图55中箭头“J”所标示的)导致凸起152同推动件驱动器142和刀具驱动器144均接合。一旦输入凸轮杆112的凸起152同推动件驱动器142和刀具驱动器144接合，则输入凸轮杆112的继续推进导致推动件驱动器142沿远侧方向的推进(如由图56中箭头“K”所标示的)和刀具驱动器144沿远侧方向的推进(如由图56中箭头“L”所标示的)。可以想象，推动件驱动器142和刀具驱动器144的各自的停驻狭槽143、145可构造成使得推动件驱动器142和刀具驱动器144被同时推进或者刀具驱动器144的推进相对于推动件驱动器142的推进延迟以允许在切割组织“T”之前吻合组织“T”。第一鼓柱174a接纳在于输入凸轮杆112中形成的狭槽173的纵向部分173a之内允许输入凸轮杆112相对于鼓构件172的推进而不导致鼓构件172的旋转。通过这种方式，在输入凸轮杆146相对于鼓构件172继续推进期间，输出凸轮杆146被保持在缩回位置中。
现参照图55至图57，装载单元12被示出处于完全致动位置。通过输入凸轮杆112沿远侧方向推进第二距离“d2”(图55)，装载单元12被移动至完全致动位置。当装载单元12被移动越过第一距离“d1”并到达完全致动位置时，推动件驱动器142被远侧推进来吻合组织“T”(图56)，并且刀具驱动器144被远侧推进来切割组织“T”。具体地并且参照图56和图57，当推动件驱动器142被推进时，推动件驱动器142的接合构件159的接合部分159b接合推动构件136，如此导致推动构件136相对于砧座构件164的砧座166推进，正如由图57中箭头“M”所标示的。当推动构件136被推进时，每个推动构件136的接合部分136a接触一行吻合钉“S”中的最远侧吻合钉并且迫使最远侧吻合钉穿过吻合钉钉仓126的远侧端部126b与钉仓罩128之间形成的开口223、225离开、穿过组织“T”并与砧座166的吻合钉成形凹穴163、165(图33)接合。当刀具驱动器144被推进时，刀具160被推进穿过组织“T”并进入吻合钉成形凹穴163、165之间形成的狭槽167。
在装载单元12到达完全致动位置后，输入凸轮杆112的缩回导致推动件驱动器142和刀具驱动器144的相继缩回以及砧座构件162推进至松开位置。当推动件驱动器142缩回时，推动构件136的接合部分136a被缩回到允许每行吻合钉中的后续吻合钉“S”安置到于吻合钉钉仓126的远侧端部126b中形成的凹口209a(图32)中的位置。正如上面所指出的，吻合钉供给组件210的弹簧134将压力板130向远侧偏置以远侧地促使该吻合钉“S”行同推动构件136的接合部分136a对齐。一旦输入凸轮杆112返回其初始位置，则装载单元12准备好后续致动。可以想象，在装载单元12能够后续致动之前，输入凸轮杆不必完全返回到预致动位置。
现参照图58和图59，在使用时，操纵致动单元14(图1)使得装载单元12邻近待吻合和切割的组织“T”布置。正如上面所描述的，装载单元12的工具组件102可相对于装载单元12的主体部分100关节式运动以便于将组织“T”安置在砧座166和钉仓罩128之间。一旦组织“T”被恰当地安置，则致动单元12的手柄组件16(图16)可被致动而导致组织“T”的夹紧。继续致动手柄组件16导致对组织“T”的吻合和切割。在手柄组件16完全致动之后，装载单元12可相对于组织“T”重新安置，并且可执行手柄组件16的第二次致动来夹紧、吻合和切割组织。该过程可根据需要重复以完成给定操作。
尽管在此已经参照附图描述了本公开的示意性实施例，但应当理解，本公开并不限于这些精确的实施例，而且本领域技术人员可引起对其的各种其它改变和修改而不偏离本公开的范围或精神。

Claims (20)

1.一种手术吻合装置，包括：
主体部分；
工具组件，其支撑在所述主体部分上，所述工具组件包括砧座和钉仓；
输入凸轮构件，其能够在所述主体部分之内滑动；
鼓构件，其可旋转地支撑在所述主体部分之内,所述鼓构件被联接至所述输入凸轮构件使得所述输入凸轮构件的线性运动引起所述鼓构件的旋转运动；以及
输出凸轮构件，其能够在所述主体部分之内滑动,所述输出凸轮构件被联接至所述鼓构件使得所述鼓构件的旋转运动引起所述输出凸轮构件的线性运动,其中,所述砧座联接至所述输出凸轮构件使得所述输入凸轮构件的所述线性运动引起所述砧座相对于所述钉仓在松开位置和夹紧位置之间的运动。
2.根据权利要求1所述的装置，其中，所述鼓构件包括第一柱和第二柱，并且所述输入凸轮构件和所述输出凸轮构件均限定了狭槽，所述第一柱可滑动地接纳在所述输入凸轮构件的所述狭槽中，并且所述第二柱可滑动地接纳在所述输出凸轮构件的所述狭槽之内。
3.根据权利要求2所述的装置，其中，所述输入凸轮构件的所述狭槽包括螺旋状部分和线性部分，并且所述输出凸轮构件中的所述狭槽是螺旋状的。
4.根据权利要求3所述的装置，其中，所述输入凸轮构件的推进导致所述第一柱横越所述输入凸轮构件中的所述狭槽的所述螺旋状部分以旋转所述鼓构件，并且所述鼓构件的旋转导致所述第二柱横越所述输出凸轮构件的所述狭槽以引起所述输出凸轮构件的线性运动。
5.根据权利要求4所述的装置，其中，所述第一柱接纳在所述输入凸轮构件中的所述狭槽的所述线性部分之内允许所述输入凸轮构件的线性运动而不引起所述鼓构件的旋转运动。
6.根据权利要求1所述的装置，进一步包括联接至所述输入凸轮构件的推动件驱动器，其中，所述推动件驱动器限定停驻狭槽并且所述输入凸轮构件限定凸起，所述凸起被可滑动地接纳在所述停驻狭槽之内以允许所述输入凸轮构件相对于所述推动件驱动器的线性运动，其中，在所述凸起被推进到所述停驻狭槽的远侧端部之后，所述推动件驱动器的线性推进引起所述输入凸轮构件的相应运动。
7.根据权利要求6所述的装置，进一步包括联接至所述输入凸轮构件的刀具驱动器，其中，所述刀具驱动器限定停驻狭槽，所述输入凸轮构件的所述凸起被可滑动地接纳在所述刀具驱动器的所述停驻狭槽之内以允许所述输入凸轮构件相对于所述刀具驱动器的线性运动，其中，在所述凸起被推进到所述刀具驱动器的所述停驻狭槽的远侧端部之后，所述刀具驱动器的线性推进对应于所述输入凸轮构件的运动。
8.根据权利要求7所述的装置，其中，所述刀具驱动器的所述停驻狭槽的所述远侧端部与所述推动件驱动器的所述停驻狭槽的所述远侧端部远侧地间隔开，使得所述输入凸轮构件继推进所述推动件驱动器之后引起所述刀具驱动器的推进。
9.根据权利要求8所述的装置，其中，所述推动件驱动器的推进吻合组织。
10.根据权利要求8所述的装置，其中，所述刀具驱动器的推进切割组织。
11.根据权利要求8所述的装置，进一步包括支撑在所述工具组件之内的吻合钉供给组件，所述吻合钉供给组件包括一对压力板，所述一对压力板中的每一个均包括接合多行吻合钉中的近侧吻合钉的多个延伸部。
12.根据权利要求11所述的装置，其中，所述压力板通过弹簧沿着远侧方向偏置。
13.根据权利要求12所述的装置，其中，所述弹簧通过弹簧夹连接至所述压力板中的每一个。
14.根据权利要求11所述的装置，其中，所述一对压力板中的每一个均包括三个延伸部。
15.一种手术装置，包括：
主体部分；
第一构件，其能够在所述主体部分之内滑动；
第二构件，其可旋转地支撑在所述主体部分之内并操作性地连接至所述第一构件；以及
第三构件，其能够在所述主体部分之内滑动并操作性地连接至所述第二构件，其中，所述第一构件的线性运动引起所述第二构件的旋转运动，所述第二构件的所述旋转运动引起所述第三构件的线性运动。
16.根据权利要求15所述的手术装置，进一步包括能够在所述主体部分之内滑动的第四构件，其中，所述第一构件的线性运动引起所述第四构件的线性运动。
17.根据权利要求16所述的手术装置，进一步包括能够在所述主体部分之内滑动的第五构件，其中所述第一构件的线性运动引起所述第五构件的线性运动。
18.一种手术装置，包括：
主体部分；
第一细长构件，其能够在所述主体部分之内滑动；
第二细长构件，其能够在所述主体部分之内滑动并操作性地连接至所述第一细长构件；以及
第三细长构件，其能够在所述主体部分之内滑动并操作性地连接至所述第一构件，其中所述第一细长构件推进第一距离引起所述第二细长构件的缩回，并且所述第一细长构件推进第二距离引起所述第三细长构件的推进。
19.根据权利要求18所述的手术装置，进一步包括第四细长构件，所述第四细长构件能够在所述主体部分之内滑动并操作性地连接至所述第一细长构件，其中所述第一细长构件推进第三距离引起所述第三细长构件的继续推进和所述第四细长构件的推进。
20.根据权利要求19所述的手术装置，进一步包括可旋转地支撑在所述主体部分之内的圆柱形构件，其中所述第一细长构件推进所述第一距离引起所述圆柱形构件的旋转，所述圆柱形构件的旋转引起所述第二细长构件的缩回。
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