CN105120770A - 外科器械的可运动切割构件的闭锁特征结构 - Google Patents

外科器械的可运动切割构件的闭锁特征结构 Download PDF

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CN105120770A
CN105120770A CN201480010886.6A CN201480010886A CN105120770A CN 105120770 A CN105120770 A CN 105120770A CN 201480010886 A CN201480010886 A CN 201480010886A CN 105120770 A CN105120770 A CN 105120770A
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blade assembly
jaw
projection
end effector
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CN105120770B (zh
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J·E·泽克勒
D·B·霍夫曼
W·J·怀特
R·J·西姆斯
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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
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03—Automatic limiting or abutting means, e.g. for safety
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0023—Surgical instruments, devices or methods, e.g. tourniquets disposable
    • 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
    • A61B2017/00398—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00681—Aspects not otherwise provided for
    • A61B2017/00734—Aspects not otherwise provided for battery operated
    • 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
    • A61B2017/07278—Stapler heads characterised by its sled or its staple holder
    • 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
    • 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
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03—Automatic limiting or abutting means, e.g. for safety
    • A61B2090/033—Abutting means, stops, e.g. abutting on tissue or skin
    • A61B2090/034—Abutting means, stops, e.g. abutting on tissue or skin abutting on parts of the device itself
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0801—Prevention of accidental cutting or pricking
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0807—Indication means
    • A61B2090/0811—Indication means for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0814—Preventing re-use
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30—Surgical robots

Abstract

本发明公开了一种与外科器械一起使用的端部执行器(212)，其包括第一钳口(216)、第二钳口(218)、刀片组件(250)和闭锁组件。所述第一钳口与钉仓(237)可移除地联接。所述第二钳口与所述第一钳口可运动地联接。所述刀片组件相对于所述第一钳口平移且包括第一凸块(268)。所述闭锁组件包括将所述刀片组件偏压到闭锁位置的弹性构件(280)。所述闭锁组件接合在所述闭锁位置的所述刀片组件的所述第一凸块，以当第一钳口缺少钉仓时或当用过的钉仓设置在所述第一钳口中时防止所述刀片组件相对于所述第一钳口朝远侧平移。

Description

外科器械的可运动切割构件的闭锁特征结构
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“PocketConfigurationforInternalOrganStaplers”的美国专利4,805,823；1995年5月16日公布的名称为“SurgicalStaplerandStapleCartridge”的美国专利5,415,334；1995年11月14日公布的名称为“SurgicalStaplerInstrument”的美国专利5,465,895；1997年1月28日公布的名称为“SurgicalStaplerInstrument”的美国专利5,597,107；1997年5月27日公布的名称为“SurgicalInstrument”的美国专利5,632,432；1997年10月7日公布的名称为“SurgicalInstrument”的美国专利5,673,840；1998年1月6日公布的名称为“ArticulationAssemblyforSurgicalInstruments”的美国专利5,704,534；1998年9月29日公布的名称为“SurgicalClampingMechanism”的美国专利5,814,055；2005年12月27日公布的名称为“SurgicalStaplingInstrumentIncorporatinganE-BeamFiringMechanism”的美国专利6,978,921；2006年2月21日公布的名称为“SurgicalStaplingInstrumentHavingSeparateDistinctClosingandFiringSystems”的美国专利7,000,818；2006年12月5日公布的名称为“SurgicalStaplingInstrumenthavingaFiringLockoutforanUnclosedAnvil”的美国专利7,143,923；2007年12月4日公布的名称为“SurgicalStaplingInstrumentIncorporatingaMulti-StrokeFiringMechanismwithaFlexibleRack”的美国专利7,303,108；2008年5月6日公布的名称为“SurgicalStaplingInstrumentIncorporatingaMultistrokeFiringMechanismHavingaRotaryTransmission”的美国专利7,367,485；2008年6月3日公布的名称为“SurgicalStaplingInstrumentHavingaSingleLockoutMechanismforPreventionofFiring”的美国专利7,380,695；2008年6月3日公布的名称为“ArticulatingSurgicalStaplingInstrumentIncorporatingaTwo-PieceE-BeamFiringMechanism”的美国专利7,380,696；2008年7月29日公布的名称为“SurgicalStaplingandCuttingDevice”的美国专利7,404,508；2008年10月14日公布的名称为“SurgicalStaplingInstrumentHavingMultistrokeFiringwithOpeningLockout”的美国专利7,434,715；2010年5月25日公布的名称为“DisposableCartridgewithAdhesiveforUsewithaStaplingDevice”的美国专利7,721,930；2010年10月21日公布的名称为“SurgicalStaplingInstrumentwithAnArticulatableEndEffector”的美国公布2010/0264193；和2012年9月20日公布的名称为“Motor-DrivenSurgicalCuttingInstrumentwithElectricActuatorDirectionalControlAssembly”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1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示出与图1的器械一起使用的另一个示例性端部执行器的透视图；
图13示出图12的端部执行器的分解图；
图14示出图13的端部执行器的示例性刀片的透视图；
图15示出图14的刀片的侧视图；
图16示出图13的端部执行器的示例性固定钳口的透视图；
图17示出图14的刀片的端视图，该刀片定位在图16的固定钳口的狭槽中；
图18示出图13的端部执行器的示例性闭锁特征结构的透视图；
图19示出图18的闭锁特征结构的沿图18的线19-19截取的剖面图；
图20示出图13的端部执行器的示例性弹簧的透视图；
图21示出图20的弹簧沿图20的线21-21截取的剖面图；
图22示出图13的端部执行器的示例性闭合环的透视图；
图23A示出处于初始位置的图13的端部执行器的侧剖面图；
图23B示出处于闭锁位置的图13的端部执行器的侧剖面图；
图24A示出处于初始位置的图13的端部执行器的底部透视图；
图24B示出处于闭锁位置的图13的端部执行器的底部透视图；
图25A示出处于初始位置的图13的端部执行器的侧剖面图，该端部执行器具有装载仓；
图25B示出处于第一部分击发位置的图13的端部执行器的侧剖面图，该端部执行器具有装载仓；
图25C示出处于第二部分击发位置的图13的端部执行器的侧剖面图，该端部执行器具有装载仓；
图25D示出处于第三部分击发位置的图13的端部执行器的侧剖面图，该端部执行器具有装载仓；
图25E示出处于第四部分击发位置的图13的端部执行器的侧剖面图，该端部执行器具有装载仓；并且
图25F示出处于第五部分击发位置的图13的端部执行器的侧剖面图，该端部执行器具有装载仓。
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、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“SurgicalInstrumentwithMulti-DiameterShaft”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可代替地构造为旋钮，该旋钮围绕与轴22的纵向轴线LA垂直的轴线旋转。
在一些形式中，关节运动接头11和/或关节运动控件13是根据如下专利的教导内容中的至少一些构造和操作的：与本文同一天提交的名称为“SurgicalInstrumentEndEffectorArticulationDrivewithPinionandOpposingRacks”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]，其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“InstallationFeaturesforSurgicalInstrumentEndEffectorCartridge”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“IntegratedTissuePositioningandJawAlignmentFeaturesforSurgicalStapler”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；以及与本文同一天提交的名称为“JawClosureFeatureforEndEffectorofSurgicalInstrument”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；并且/或者可根据以下专利的教导内容中的至少一些来构造：美国专利申请[代理人案卷号END7180USNP.0599175]，名称为“StapleFormingFeaturesforSurgicalStaplingInstrument”，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和处于远侧的切割刃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。击发梁14的各种示例性替代部件、构型和可操作性在下文更详细地描述。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，使得当击发触发器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(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，由此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，这些专利和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/公布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，该控制电路可被用来从电池组104使用电力对电动马达102(同样示于图1-2中)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被构造成默认是闭合的，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/或任何其他合适的条件。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“ElectronicLockoutsandSurgicalInstrumentIncludingSame”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-DrivenSurgicalInstrument”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。除此之外或另选地，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/或美国专利公布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.示例性端部执行器闭锁特征结构
在一些情况下，期望为端部执行器12提供闭锁特征结构，来防止击发梁14和切割刃48的意外击发(即远侧推进)，这样定位在钳口216，218之间的组织在未被缝合的情况下不会被切断。例如，可期望防止击发梁14和切割刃48在钉仓37没有被装载到端部执行器12内或在钉47已经从钉仓37被驱动的情况下击发。因此，可在端部执行器12中提供闭锁特征结构来防止击发梁14和切割刃48的意外击发。以下示例包括可易于引入到端部执行器12的闭锁特征结构的若干仅例示性的形式。
图12-13示出易于结合到器械10中的示例性端部执行器212。端部执行器212包括下钳口216、可枢转砧座218和闭合环233，它们类似于端部执行器12的下钳口16、砧座18和闭合环33。钉仓237可以被可移除地安装于下钳口216的通道中。本示例的钉仓237类似于端部执行器12的钉仓37。如在图13中最佳示出的，钉仓237包括与下部仓托盘247联接的仓体240。楔形滑动件290和多个钉驱动器243被捕集在仓体240和托盘247之间，其中楔形滑动件290位于钉驱动器243近侧。为了清晰起见，图13中已经省略了类似于钉47的钉，但应当理解，钉47将定位在钉驱动器243的正上方。楔形滑动件290和钉驱动器243类似于端部执行器12的楔形滑动件41和钉驱动器243，使得楔形滑动件290被构造成能够在楔形滑动件290朝远侧驱动穿过钉仓237时向上推动钉驱动器243，从而竖直地驱动钉(图13中未示出)并且驱动到位于钳口216，218之间的组织中。本示例的楔形滑动件290被刀片组件250朝远侧驱动，该刀片组件位于楔形滑动件290的近侧。梁223与刀片组件250联接(诸如，通过焊接)。梁223类似于梁14并且被构造成能够朝远侧和/或朝近侧驱动刀片组件250。弹性构件280位于刀片组件250的近侧并且被构造成能够可移除地接合刀片组件250。刀片组件250和弹性构件280位于框架构件270内。框架构件270位于闭合环233内并且与下钳口216的近侧端部联接，使得框架构件270与轴222的关节运动接头211联接。
关节运动接头211和轴222类似于关节运动接头11和轴22。仅以举例的方式，关节运动接头211和/或轴222可以根据如下专利的教导内容中的至少一些来构造：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；和/或美国专利申请[代理人案卷号END7181USNP.0599180]，其公开内容以引用方式并入本文。另选地，关节运动接头211和/或轴222可具有任何其他合适的构型。
图14-15更详细地示出了刀片组件250。刀片组件250包括切割刃252、上部伸出部260和下部伸出部255。切割刃252位于刀片组件250的上部远侧部分，使得在刀片组件250朝远侧平移穿过下钳口216时，切割刃252切断组织。上部伸出部260从切割刃252朝近侧延伸。上部伸出部260包括位于上部伸出部260的底部表面上的壁261，262，263，264，265，266。壁261朝近侧延伸到壁262。壁262向上倾斜到壁263。壁263朝近侧延伸到壁264，该壁264向下延伸到壁265。壁262，263，264一起形成凹口。壁265朝近侧延伸到壁266，该壁266向上倾斜。壁264，265，266形成凸块268，该凸块从上部伸出部260向下延伸。凸块268被构造成能够接合框架构件270，使得框架构件270可防止凸块268和刀片组件250在没有装载钉仓237的情况下朝远侧推进，如下文将更详细地描述。
下部伸出部255从下面的切割刃252朝近侧延伸。远侧末端254和远侧壁251位于下部伸出部255的远侧部分上。远侧末端254从下部伸出部255朝远侧向下延伸，使得远侧末端254被构造成能够接合楔形滑动件290的顶部表面，如下文将更详细地描述。远侧末端251竖直地定位在远侧末端254下方的下部伸出部255的远侧部分上，使得远侧壁251被构造成能够接合楔形滑动件290的近侧表面，如下文将更详细地描述。因此，当刀片组件250在下钳口216内朝远侧平移从而驱动下钳口216内的楔形滑动件290时，远侧末端254和远侧壁251可释放地接合楔形滑动件290。圆形凸块256从下部伸出部255的近侧部分向上延伸。凸块256被构造成能够接合弹性构件280，使得弹性构件280可以向下偏压凸块256和刀片组件250，继而使得刀片组件250的凸块268接合框架构件270，以防止凸块268和刀片组件250在没有装载钉仓237的情况下朝远侧推进。
突起258从下部伸出部255向下延伸并且被构造成能够在下钳口216的狭槽214内平移。突起258与下部伸出部255不一样宽，使得在突起258和下部伸出部255之间形成在下部伸出部255的底部表面上的搁架253。因此，搁架253将刀片组件250保持在下钳口216的狭槽214内的竖直位置上。搁架253提供了一种保持方法，其不需要超过刀片组件250的总体厚度的附加部分和/或延伸部分。突起258包括朝壁242倾斜的倾斜壁241。壁242朝近侧延伸到壁248，该壁248向下倾斜到壁244。壁244朝近侧延伸到壁245，该壁245向上倾斜到壁255。壁248，244，245形成凸块259，该凸块259从突起258向下延伸。
如上所述，刀片组件250被构造成能够基于击发触发器28驱动马达102和击发梁223的致动在下钳口216内朝远侧和/或朝近侧平移。如图16所示，下钳口216包括具有近侧部分215和远侧部分213的狭槽214。近侧部分215比远侧部分213宽。近侧部分215经由凸轮表面217平移至远侧部分213。图17示出在刀片组件250位于远侧未击发位置时被定位在下钳口216的狭槽214内的刀片组件250。狭槽214接收刀片组件250的突起258，使得突起258在下钳口216的狭槽214内平移。下部伸出部255位于狭槽214的上方。狭槽214的远侧部分213具有按尺寸设定成对应于突起258的侧向宽度的侧向宽度，使得在刀片组件250位于狭槽214的远侧部分213内时，搁架253侧向延伸经过狭槽214的远侧部分213以保持刀片组件250的竖直对齐或位置。狭槽214的近侧部分215具有按尺寸设定成对应于刀片组件250的下部伸出部255的侧向宽度的侧向宽度，使得如果在没有装载钉仓237的情况下推进刀片组件250，那么突起258和下部伸出部255可落入狭槽214的近侧部分215内。
狭槽214在下钳口216内继续延伸以在刀片组件250朝近侧和/或朝远侧平移时允许看到刀片组件250在下钳口216内的位置。闭合环233与下钳口216联接以进一步允许看到刀片组件250。在本示例中，闭合环233包括开口235，如图22所示。闭合环233可滑动地与下钳口216联接，使得在闭合环233被推进到远侧位置以抵靠下钳口216闭合砧座218时，开口235与狭槽214的近侧位置215相邻。开口235按尺寸设定成对应于刀片组件250的凸块259，使得如果突起258和下部伸出部255落入狭槽214的近侧部分215内，闭合环233允许看到凸块259。
下钳口216的近侧端部与框架构件270联接，如图18-19所示。框架构件270包括通道278、枢轴279和齿轮292。第一接合特征结构272和第二接合特征结构274位于通道278内，如图19所示。接合特征结构272，274被构造成能够接合刀片组件250的上部伸出部260。第一接合特征结构272包括在通道278内向上延伸的壁275。壁275过渡到壁273，该壁273朝远侧延伸到壁271。壁271在远侧方向上向下倾斜。第二接合特征结构274在第一接合特征结构272近侧。第二接合特征结构274的顶部表面包括朝远侧延伸到壁276的壁277，该壁276在远侧方向上向下倾斜。第二接合特征结构274的底部表面包括壁293，该壁293在近侧方向上向下倾斜到壁294。壁294朝近侧延伸到壁295，该壁295从壁294向上延伸。第二接合特征结构274的底部表面被构造成能够接合弹性构件280，如图23A所示。齿轮292具有齿并且在接合特征结构274近侧。枢轴279从齿轮292向上延伸。枢轴279和齿轮292被构造成能够与轴222的关节运动接头211可旋转地联接，以允许端部执行器212相对于轴222枢轴到期望的角度(α)。仅以举例的方式，齿轮292和/或关节运动接头211的其他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：美国专利申请[代理人案卷号END7174USNP.0599176]，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“SurgicalInstrumentwithArticulationLockHavingaDetentingBinarySpring”的美国专利申请序列号[代理人案卷号END7178USNP.0599232]，其公开内容以引用方式并入本文。
图20-21更详细地示出弹性构件280。弹性构件280包括远侧部分282和近侧部分285。远侧部分282包括开口283，该开口被构造成能够接收刀片组件250的下部伸出部255的凸块256。远侧部分282经由倾斜部分284平移至近侧部分285，该倾斜部分在近侧方向上向下倾斜。倾斜部分284是柔顺的并且被构造成能够弹性地向下偏压远侧部分282。壁287从近侧部分285的近侧端部向上延伸。壁287接合框架构件270的壁295，使得框架构件270被构造成能够轴向保持弹性构件280。
A.示例性闭锁序列
图23A-23B示出尝试在没有正确装载的钉仓237的情况下击发刀片组件250。例如，器械10可在非关节运动状态下被插入外科手术部位，其中钳口216，218闭合。一旦关节运动接头211和端部执行器212被插入患者体内的期望部位，可远离下钳口216将砧座218枢转到开放的端部执行器212，使得钳口216，218可定位在组织周围。关节运动控制器13可使关节运动接头211进行远程地关节运动，从而使端部执行器212可偏转到期望的角度(α)。然后，可朝手枪式握把24致动闭合触发器26，使得砧座218朝下钳口216闭合。通过闭合管32和闭合环233提供砧座的此类闭合，响应于闭合触发器26相对于手枪式握把24的枢转，闭合管32和闭合环233两者均相对于柄部部分20和下钳口216纵向平移。关节运动接头211能够操作以将纵向运动从闭合管32传送到闭合环233。
图23A示出端部执行器212在钳口216，218刚刚闭合后处于初始位置，但在下钳口216中没有钉仓237。在初始位置，刀片组件250的上部伸出部260位于框架构件270的接合特征结构272，274上方。上部伸出部260的壁261在第一接合特征结构272的壁273上静止，同时，上部伸出部260的凸块268在第二接合特征结构274的壁277上静止。弹性构件280定位在下钳口216和框架构件270之间。弹性构件280的壁287与框架构件270的壁295接合，使得壁295被构造成能够轴向地保持弹性构件280。弹性构件的开口283定位在刀片组件250的下部伸出部255上方，使得下部伸出部255的凸块256定位在弹性构件280的开口283内。下部伸出部255的突起258定位在下钳口216的狭槽214的近侧部分215内。突起258在狭槽214内竖直对齐，使得搁架253定位在狭槽214上方。由此，刀片组件250准备从初始位置被击发。
然而，在本示例中，钉仓237未被正确地装载在端部执行器212中。因此，远侧末端254和远侧壁251不与滑动件290接合。当在没有正确装载的钉仓237的情况下致动击发触发器28来朝远侧驱动击发梁223和刀片组件250时，刀片组件250向下落入端部执行器212内以接合框架构件270的接合特征结构272，274，从而防止刀片组件250在下钳口216内进一步朝远侧运动，如图23B所示。当在没有正确装载的钉仓237的情况下朝远侧推动刀片组件250时，刀片组件250的下部伸出部255的凸块256从弹性构件280的开口283朝远侧平移。然后，凸块256接合弹性构件280的远侧部分282。因为弹性构件280的远侧部分282向下偏压，所以弹性构件280向下推动刀片组件250的凸块256。这样使得刀片组件250的上部伸出部255的凸块268向下落在接合特征结构272，274之间。因此，凸块268的壁264接合第一接合特征结构272的壁275，防止刀片组件250再进一步朝远侧运动，从而将刀片组件250在端部执行器212内锁定。应当理解，当操作者打算在用过的钉仓237被装载在端部执行器中时将击发梁233从近侧位置推进到远侧位置时，也可发生上述闭锁。因此，闭锁特征结构防止当没有钉仓237被装载在端部执行器212中时，以及当端部执行器212中的仓237已经被击发并且击发梁233已经缩回到近侧位置时击发梁233的推进。
当刀片组件250向下落到图23B所示的闭锁位置时，刀片组件的下部伸出部255和突起258落入下钳口216的狭槽214的近侧部分215内。因此，突起258的凸块259延伸穿过狭槽214的近侧部分215并且穿过闭合环233的开口235。这提供刀片组件250处于闭锁位置的视觉指示，如图24A-24B所示。在图24A中，刀片组件250处于初始位置，使得凸块259定位在闭合环233的开口235上方的狭槽214内。当刀片组件250向下落到闭锁位置时，如图24B所示，凸块259延伸穿过闭合环233的开口235以提供闭锁的视觉指示。通过在闭合环233的空间内提供闭锁特征结构和视觉指示，可最小化关节运动接头211的总体长度。
在刀片组件250处于图23B的闭锁位置之后，刀片组件250可返回到图23A的初始位置。例如，可激活马达102以朝近侧拉动梁223和刀片组件250，使刀片组件250返回到图23A的初始位置。当刀片组件250朝近侧平移时，刀片组件250的上部伸出部260的倾斜壁262，266抵靠接合特征结构272，274的壁271，276朝近侧滑动。当上部伸出部260抵靠接合特征结构272，274朝近侧平移时，接合特征结构272，274的壁271，276通过顶起动作向上推动上部伸出部260和刀片组件250。刀片组件250的凸块256还向上行进以再次被定位在弹性构件280的开口283内。这样使得刀片组件250返回初始位置，如图23A所示。
B.示例性击发序列
图25A-25F示出刀片组件250在具有正确装载的钉仓237的情况下被击发。例如，器械10可在非关节运动状态下被插入外科手术部位，其中钳口216，218闭合。一旦关节运动接头211和端部执行器212被插入患者体内的期望部位，可远离下钳口216将砧座218枢转到开放的端部执行器212，使得钳口216，218可定位在组织周围。关节运动控制器13可使关节运动接头211进行远程地关节运动，从而使端部执行器212可偏转到期望的角度(α)。然后，可朝手枪式握把24致动闭合触发器26，使得砧座218朝下钳口216闭合。通过闭合管32和闭合环233提供砧座的此类闭合，响应于闭合触发器26相对于手枪式握把24的枢转，闭合管32和闭合环233两者均相对于柄部部分20和下钳口216纵向平移。关节运动接头211能够操作以将纵向运动从闭合管32传送到闭合环233。
图25A示出端部执行器212在钳口216，218刚刚闭合后处于初始位置，其具有正确装载的钉仓237。在初始位置，刀片组件250的上部伸出部260位于框架构件270的接合特征结构272，274上方。上部伸出部260的壁261在第一接合特征结构272的壁273上静止，同时，上部伸出部260的凸块268在第二接合特征结构274的壁277上静止。弹性构件280定位在下钳口216和框架构件270之间。弹性构件280的壁287与框架构件270的壁295接合，使得壁295被构造成能够轴向地保持弹性构件280。弹性构件的开口283定位在刀片组件250的下部伸出部255上方，使得下部伸出部255的凸块256定位在弹性构件280的开口283内。下部伸出部255的突起258定位在下钳口216的狭槽214的近侧部分215内。突起258在狭槽214内竖直对齐，使得搁架253定位在狭槽214上方。刀片组件250的远侧末端254被定位在滑动件290上方。由此，刀片组件250准备从图25A所示的初始位置被击发。
可致动击发触发器28来驱动击发梁223和刀片组件250。当朝远侧驱动刀片组件250时，刀片组件250的远侧末端254接合滑动件290的顶部表面292，并且刀片组件250的远侧壁251接合滑动件290的近侧端部294，如图25B所示。这样就在刀片组件被定位在下钳口216的狭槽214的近侧部分215内时保持了刀片组件250的竖直位置。当刀片组件250进一步朝远侧行进时，刀片组件250的凸块256从弹性构件280的开口283朝远侧行进，使得凸块256接合弹性构件280的远侧部分282。凸块256由此向上推动弹性构件280的远侧部分282，如图25C所示。因为滑动件290保持刀片组件250的竖直位置，所以刀片组件250的凸块268在框架构件270的接合特征结构272，274上方朝远侧平移，使得凸块268不会落在接合特征结构272，274之间，从而防止刀片组件250朝远侧运动，如图25D所示。因此，在这一阶段，刀片组件250覆盖闭锁位置。然后，当凸块256从弹性构件280朝远侧平移时，弹性构件280的远侧部分282向下偏压到在刀片组件250的凸块256近侧的标称位置，如图25E所示。然后，刀片组件250的突起258进入下钳口216的狭槽214的远侧部分213内，如图25F所示。然后，刀片组件250的搁架253定位在狭槽214上方，并且上部伸出部260的凸块268在第一接合特征结构272上方。然后，刀片组件250进一步朝远侧平移以切断和缝合位于钳口216，218之间的组织。
在刀片组件250朝远侧击发之后，刀片组件250可在下钳口216内朝近侧缩回。例如，响应于击发触发器28的第二致动和/或其他动作，在检测到击发行程完成时，刀片组件250可通过马达102的自动回转被梁223缩回。当刀片组件250缩回时，刀片组件250脱离滑动件290。在没有滑动件250的情况下，当刀片组件250在被击发后缩回时，刀片组件250可向下落到图23B的闭锁位置。在刀片组件250处于图23B的闭锁位置之后，刀片组件250可返回到图23A的初始位置。当刀片组件250被马达102朝近侧驱动时，刀片组件250的上部伸出部260的倾斜壁262，266抵靠接合特征结构272，274的壁271，276朝近侧滑动。当上部伸出部260抵靠接合特征结构272，274朝近侧平移时，接合特征结构272，274的壁271，276通过顶起动作向上推动上部伸出部260和刀片组件250。刀片组件250的凸块256还向上行进以再次被定位在弹性构件280的开口283内。这样使得刀片组件250返回初始位置，如图23A所示。
一旦位于钳口216，218之间的组织被切割和缝合，端部执行器212可通过关节运动控制器13被枢转回到非关节疼位置并且可从外科手术部位取出，同时钳口216，218闭合。另选地，钳口216，218可在枢转端部执行器212之前被打开以释放钳口216，218之间的任何组织。然后，钳口216，218可在从外科手术部位取出端部执行器212之前被重新闭合。然后，端部执行器212可被打开以使用新的钉仓取代钉仓237。为了打开端部执行器212，可远离手枪式握把24释放闭合触发器26。钉仓237可由新的钉仓取代，并且端部执行器212可被再次插入外科手术部位以进行进一步的切割和缝合。
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IntuitiveSurgical,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“ArticulatedSurgicalInstrumentForPerformingMinimallyInvasiveSurgeryWithEnhancedDexterityandSensitivity”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“RemoteCenterPositioningDevicewithFlexibleDrive”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“AutomatedEndoscopeSystemforOptimalPositioning”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“RoboticArmDLUSforPerformingSurgicalTasks”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“RoboticSurgicalToolwithUltrasoundCauterizingandCuttingInstrument”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“AlignmentofMasterandSlaveinaMinimallyInvasiveSurgicalApparatus”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“MechanicalActuatorInterfaceSystemforRoboticSurgicalTools”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“PlatformLinkWristMechanism”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“RepositioningandReorientationofMaster/SlaveRelationshipinMinimallyInvasiveTelesurgery”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“AutomatedEndEffectorComponentReloadingSystemforUsewithaRoboticSystem”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-ControlledSurgicalInstrumentwithForce-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“ShiftableDriveInterfaceforRobotically-ControlledSurgicalTool”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“SurgicalStaplingInstrumentswithCam-DrivenStapleDeploymentArrangements”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-ControlledMotorizedSurgicalEndEffectorSystemwithRotaryActuatedClosureSystemsHavingVariableActuationSpeeds”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-ControlledSurgicalInstrumentwithSelectivelyArticulatableEndEffector”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-ControlledSurgicalEndEffectorSystem”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“DriveInterfaceforOperablyCouplingaManipulatableSurgicalTooltoaRobot”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-ControlledCable-BasedSurgicalEndEffectors”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-ControlledSurgicalEndEffectorSystemwithRotaryActuatedClosureSystems”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。具体地讲，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)

1.一种与外科器械一起使用的端部执行器，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成能够与钉仓可移除地联接；
(b)第二钳口，所述第二钳口与所述第一钳口可运动地联接；
(c)刀片组件，所述刀片组件被构造成能够相对于所述第一钳口平移，其中所述刀片组件包括：
(i)切割刃，和
(ii)具有处于远侧的壁的第一凸块，其中所述处于远侧的壁在所述切割刃近侧；和
(d)闭锁组件，所述闭锁组件包括：
(i)弹性构件，和
(ii)处于近侧的壁，其中所述弹性构件被构造成能够将所述刀片组件偏压到闭锁位置，其中处于近侧的壁被构造成能够接合在所述闭锁位置的所述第一凸块的所述处于远侧的壁以防止所述刀片组件相对于所述第一钳口朝远侧平移。
2.根据权利要求1所述的端部执行器，其中所述闭锁组件包括第一接合特征结构和第二接合特征结构，其中所述第一接合特征结构包括所述处于近侧的壁。
3.根据权利要求2所述的端部执行器，其中所述刀片组件的所述第一凸块在所述第一接合特征结构和所述第二接合特征结构之间向下延伸。
4.根据权利要求1所述的端部执行器，其中所述第一钳口包括狭槽，其中所述刀片组件被构造成能够在所述第一钳口的所述狭槽内平移。
5.根据权利要求1所述的端部执行器，其中所述弹性构件包括开口，其中所述刀片组件包括第二凸块，其中所述第二凸块被构造成能够在所述刀片组件处于未击发状态时定位在所述弹性构件的所述开口内。
6.根据权利要求5所述的端部执行器，其中所述弹性构件被构造成能够在所述刀片组件朝远侧平移时接合所述刀片组件的所述第二凸块，其中所述弹性构件被构造成能够在所述弹性构件接合所述第二凸块时沿横向路径推动所述刀片组件。
7.根据权利要求6所述的端部执行器，其中所述闭锁组件被构造成能够在所述刀片组件处于横向偏转位置时接合所述刀片组件的所述第一凸块，以防止所述刀片组件在所述第一钳口内朝远侧平移。
8.根据权利要求7所述的端部执行器，其中所述刀片组件包括从所述刀片组件延伸的突起。
9.根据权利要求8所述的端部执行器，其中所述第一钳口的所述狭槽包括近侧部分，其中所述近侧部分被构造成能够在所述刀片组件处于向下位置时接收所述刀片组件的所述突起。
10.根据权利要求9所述的端部执行器，所述端部执行器还包括闭合环，其中所述闭合环包括开口，其中当所述刀片组件处于向下位置时，所述刀片组件的所述突起延伸穿过所述闭合环的所述开口。
11.根据权利要求9所述的端部执行器，所述端部执行器还包括视觉指示器，其中所述视觉指示器能够操作以指示所述刀片组件何时处于向下位置。
12.根据权利要求1所述的端部执行器，其中所述刀片组件包括远侧末端。
13.根据权利要求12所述的端部执行器，所述端部执行器还包括可平移的滑动件，其中所述刀片组件的所述远侧末端被构造成能够可释放地接合所述滑动件。
14.根据权利要求13所述的端部执行器，其中所述刀片组件被构造成能够在所述刀片组件朝远侧平移时向上驱动所述弹性构件。
15.根据权利要求1所述的端部执行器，其中所述第一钳口包括狭槽，其中所述刀片组件包括下部伸出部和从所述下部伸出部向下延伸的突起，其中所述突起被构造成能够在所述第一钳口的所述狭槽内平移。
16.根据权利要求15所述的端部执行器，其中所述第一钳口的所述狭槽包括近侧部分和远侧部分，其中所述近侧部分比所述远侧部分宽。
17.根据权利要求16所述的端部执行器，其中所述刀片组件的所述下部伸出部比所述突起宽，使得所述下部伸出部和所述突起形成搁架。
18.根据权利要求17所述的端部执行器，其中当所述突起定位在所述狭槽的所述远侧部分内时，所述下部伸出部延伸经过所述第一钳口的所述狭槽。
19.一种与外科器械一起使用的端部执行器，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成能够与钉仓可移除地联接；
(b)第二钳口，所述第二钳口与所述第一钳口可运动地联接；
(c)刀片组件，所述刀片组件被构造成能够相对于所述第一钳口平移，其中所述刀片组件被构造成能够从近侧位置平移至远侧位置；
(d)关节运动节段，所述关节运动节段包括：
(i)第一部分，和
(ii)第二部分，其中所述第二部分能够相对于所述第一部分枢转，其中所述第二部分固定在所述第二钳口内，其中所述刀片组件被构造成能够平移穿过在所述第二部分中形成的通道；和
(e)闭锁组件，所述闭锁组件包括弹性构件和在所述关节运动节段的所述第二部分的所述通道中形成的接合特征结构，其中所述弹性构件被构造成能够在所述刀片组件从所述近侧位置平移至所述远侧位置时接合所述刀片组件，其中所述弹性构件被构造成能够偏压所述刀片组件以接合所述接合特征结构，从而防止所述刀片组件进一步朝远侧行进。
20.一种与外科器械一起使用的端部执行器，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成能够与钉仓可移除地联接；
(b)第二钳口，所述第二钳口与所述第一钳口可运动地联接；
(c)刀片组件，所述刀片组件被构造成能够相对于所述第一钳口平移，其中所述刀片组件被构造成能够从近侧位置平移至远侧位置，其中所述刀片组件包括：
(i)切割刃，和
(ii)在所述切割刃近侧形成的凹口；
(d)闭锁组件，其中所述闭锁组件包括接合特征结构，所述接合特征结构被构造成能够配合在所述刀片组件的所述凹口中，其中所述闭锁组件被构造成能够在所述刀片组件从所述近侧位置平移至所述远侧位置期间偏压所述刀片组件，以将所述接合特征结构定位在所述凹口中，由此限制所述刀片组件的平移；和
(e)钉仓，所述钉仓被构造成能够与所述第一钳口和所述刀片组件联接，其中所述钉仓的结构使得能够在所述刀片组件从所述近侧位置平移至所述远侧位置期间防止所述凹口接收所述接合特征结构。
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