CN105682568B - 手术紧固件施加装置 - Google Patents
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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
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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
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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
- A61B2017/0023—Surgical instruments, devices or methods, e.g. tourniquets disposable
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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
- A61B2017/0042—Surgical instruments, devices or methods, e.g. tourniquets with special provisions for gripping
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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
- A61B2017/07214—Stapler heads
- A61B2017/07257—Stapler heads characterised by its anvil
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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
- A61B2017/07214—Stapler heads
- A61B2017/07271—Stapler heads characterised by its cartridge
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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
- A61B2017/07214—Stapler heads
- A61B2017/07285—Stapler heads characterised by its cutter
Abstract
本公开涉及一种手术紧固件施加装置，其包括：砧座半部，其包括远侧砧座部和近侧手柄部；钉仓接收半部，其限定细长通道构件并包括支撑在细长通道构件的底壁上的至少一个铰链构件(173，1194)，细长通道构件具有定尺寸为可释放地接收单次使用装载单元的远侧部和构造成支撑发射组件的近侧部，且其中至少一个铰链构件限定开口；以及夹紧操作杆(16)，其可枢转地紧固至钉仓接收半部，夹紧操作杆具有近侧端、远侧端和以悬臂方式支撑在夹紧操作杆的远侧端上的枢转构件(187，1187)；夹紧操作杆的枢转构件可滑动地接收在至少一个铰链构件的开口内以将夹紧操作杆可枢转地紧固至钉仓接收半部，夹紧操作杆能够从非夹紧位置移动到夹紧位置以使砧座半部的砧座部以与支撑在细长通道构件内的单次使用装载单元紧密靠近的方式可释放地紧固。
Description
技术领域
本公开涉及一种手术紧固件施加装置，并且，更具体地，涉及一种具有可重复使用的和一次性的部件的手术紧固件施加装置。
背景技术
如下的手术紧固件施加装置在本领域中是公知的：其中组织首先被抓握或夹紧在相对的钳夹结构之间，然后借助手术紧固件结合。在一些这样的装置中，提供刀具以切割通过紧固件(例如，手术吻合钉)已经结合的组织。
手术紧固件施加装置通常包括两个细长梁构件，所述两个细长梁构件用于捕获或夹紧其间的组织。通常情况下，梁构件中的一个承载容纳布置为至少两个横排的多个吻合钉的一次性钉仓组件，而另一梁构件包括限定如下表面的砧座：所述表面用于当吻合钉被从钉仓组件驱动时使吻合钉腿成形。在使用两部分紧固件的情况下，包括砧座的梁构件承载两部分紧固件的配合部件，例如接收器。一般地，吻合钉成形过程受到一个或多个纵向移动的凸轮构件和一系列独立的吻合钉推动器之间的相互作用的影响。由于凸轮构件纵向行进通过钉仓承载梁构件，独立的推动器构件向上偏置入支撑在钉仓组件内的吻合钉的后跨部以从钉仓顺序地射出吻合钉。刀具可以设置为与凸轮构件一起在吻合钉排之间行进，以切割形成的吻合钉排之间的组织。这种器械的例子公开在美国专利第7,631,794号中，上述专利的全部通过引用合并于此。
由于与例如手术装置的消毒不当有关的危险，使用后，紧固件施加装置通常是处理掉的。尽管可以替换钉仓组件以在单个患者上执行多个紧固件施加操作，但是在手术操作已经完成后吻合钉施加装置通常是处理掉的。处理性的这一要求可能增加与手术操作有关的成本。虽然已开发可重复使用的紧固件施加装置，这样的装置可能过于复杂且证明为很难消毒。
在本领域存在对如下紧固件施加装置的需求：其包括可重复使用的部件，不过于复杂，并且构造为利于在手术操作中使用后的恰当消毒。
发明内容
本公开涉及一种手术紧固件施加装置，其包括砧座半部，砧座半部包括远侧砧座部和近侧手柄部。钉仓接收半部限定细长通道构件并包括支撑在所述细长通道构件的底壁上的至少一个铰链构件。所述细长通道构件具有定尺寸为可释放地接收单次使用装载单元的远侧部和构造成支撑发射组件的近侧部。所述至少一个铰链构件限定开口。夹紧操作杆可枢转地紧固至钉仓接收半部并且具有近侧端、远侧端和以悬臂方式支撑在夹紧操作杆的远侧端上的枢转构件。夹紧操作杆的枢转构件可滑动地接收在所述至少一个铰链构件的开口内以将夹紧操作杆可枢转地紧固至钉仓接收半部。夹紧操作杆能够从非夹紧位置移动到夹紧位置以使砧座半部的砧座部以与支撑在细长通道构件内的单次使用装载单元紧密靠近的方式可释放地紧固。
在实施例中，发射组件构造为可释放地紧固在钉仓接收半部的近侧部中并且包括发射操作杆和固定地紧固至发射操作杆的凸轮杆。
发射组件还可以包括静止壳体，所述静止壳体构造成可释放地支撑在钉仓接收部的近侧部中并且包括具有向下延伸的突起的底壁。
在实施例中，所述细长通道构件限定开口，所述开口定尺寸为接收所述向下延伸的突起以将发射组件正确地定位在细长通道构件内。
发射组件还可以包括构造成接合支撑在所述单次使用装载单元内的刀具的刀具致动杆。
在实施例中，发射组件包括紧固至静止壳体的弹簧构件，并且细长通道构件限定定尺寸为允许弹簧构件的通过的细长狭槽。弹簧构件定位为延伸通过所述细长狭槽并接合夹紧操作杆以朝向非夹紧位置推动夹紧操作杆。
在实施例中，所述远侧砧座部具有三角形横截面且是实心的，并且限定定尺寸为接收单次使用装载单元的刀具的纵向狭槽。
在实施例中，夹紧操作杆包括具有中央枢转构件的锁定构件。锁定构件具有包括接合构件的第一端和包括手指接合表面的第二端。锁定构件能够关于中央枢转构件枢转以通过卡扣配合式接合来接合形成在钉仓接收半部上的抓捕构件，从而将夹紧操作杆保持在夹紧位置。在实施例中，所述手指接合表面定位成能够压下以使接合构件关于中央枢转构件枢转出与抓捕构件的接合。
附图说明
现在将参考附图在本文描述本处公开的手术紧固件施加装置的各种实施例，其中：
图1是本处公开的手术紧固件施加装置处于夹紧位置的实施例的侧视立体图；
图2是图1所示的手术紧固件施加装置处于打开位置的侧视立体图；
图2A是在夹紧操作杆和钉仓接收半部的组装期间，夹紧操作杆和钉仓接收半部的一部分的侧视图；
图2B是图1中所示的紧固件施加装置处于关闭、非夹紧位置的侧视立体图；
图3是图1中所示的手术紧固件施加装置的部件分离的侧视立体图；
图3A是图1中所示的手术紧固件施加装置的夹紧操作杆的仰视、侧剖视图；
图4是手术紧固件施加装置的钉仓接收半部的侧视立体图，其中，单次使用装载单元(“SULU”)与发射组件支撑在钉仓接收半部内；
图5是图4中所示的细节指示区域的放大图；
图6是从手术紧固件施加装置的钉仓接收半部上方的立体图，其中，SULU和发射组件支撑在其中；
图7是在图6中所示的细节指示区域的放大图；
图8是从图3中所示的手术紧固件施加装置的发射组件上方的前端立体图；
图9是在图8中所示的细节指示区域的放大图；
图9A是通道构件的侧视立体图，其中发射组件可释放地支撑在其中；
图9B是在图9A中所示的细节指示区域的放大图；
图9C是通道构件的中央部的侧视立体图；
图10是从图8示出的发射组件的上方的后端立体图；
图11是在图10中所示的细节指示区域的放大图；
图12是在图10中所示的发射组件的部件分离的侧视立体图；
图12A是在图12中所示的发射组件的凸轮杆的仰视、侧视立体图；
图12B是在图12中所示的发射组件的发射操作杆的仰视、侧视立体图；
图13是在图1中所示的手术紧固件施加装置的SULU的侧视立体图；
图14是在图13中所示的细节指示区域的放大图；
图15是在图13中所示的SULU的前视立体图；
图16是在图15中所示的细节指示区域的放大图；
图17是图15中所示的SULU的部件分离的侧视立体图；
图18是在图1中所示的手术紧固件施加装置处于打开位置的侧剖视图；
图19是在图18中所示的细节指示区域的放大图；
图20是在图18中所示的细节指示区域的放大图；
图21是在图18中所示的手术紧固件施加装置处于打开位置时的近侧端的立体图；
图22是在图18中所示的细节指示区域的放大图；
图23是在图1中所示的手术紧固件施加装置的夹紧操作杆的近侧端的立体图；
图24是在图1中所示的手术紧固件施加装置处于夹紧位置的侧视立体图；
图25是在图24中所示的手术紧固件施加装置处于夹紧位置的侧剖视图；
图26是在图25中所示的细节的指示区域的放大图；
图27是在图25中所示的细节的指示区域的放大图；
图28是沿着图26的剖切线28-28截取的剖视图；
图29是在图1中所示的手术紧固件施加装置在当发射组件移动通过致动行程以从装置射出紧固件时的俯视图；
图30是在图29中所示的手术紧固件施加装置的侧剖视图，其中发射组件在致动位置；
图31是在图30中所示的细节指示区域的放大图；
图32是在图30中所示的细节指示区域的放大图；
图33是在图1中所示的手术紧固件施加装置在装置已经发射并移动到打开位置后的侧剖视图；
图34是在图33中所示的细节指示区域的放大图；
图35是处于夹紧位置的本处公开的紧固件施加装置的另一实施例的侧视立体图；
图36是在图35中所示的紧固件施加装置的部件分离的侧视立体图；
图37是在图36中所示的紧固件施加装置的发射组件的仰视立体图；
图38是发射组件的远侧端的剖切的剖视图；
图39是在图36中所示的紧固件施加装置的砧座半部的侧视立体图；
图40是在图39中所示的砧座半部的远侧砧座部的远侧端的俯视图；
图41是沿图40的剖切线41-41截取的剖视图；
图42是在图36中所示的紧固件施加装置的砧座半部的侧视图；
图43是在图42中所示的砧座半部的近侧手柄部的近侧端的内表面的立体剖视图；
图44是在图36中所示的紧固件施加装置的夹紧操作杆的俯视立体图；
图44A是在图44中所示的夹紧操作杆的仰视立体图；
图45是在图44中所示的夹紧操作杆的侧视图；
图46是夹紧操作杆的近侧端的立体剖视图；
图47是在图46中所示的夹紧操作杆的近侧端的侧视剖视图；
图48是图36所示的紧固件施加装置的钉仓接收半部的侧视立体图；
图49是图48所示的钉仓接收半部的侧视图；
图50是图49所示的钉仓接收半部的近侧端的立体剖视图；和
图51是图51所示的钉仓接收半部的中央部的放大、立体剖视图。
具体实施方式
现在将参照附图详细说明依照本公开的在本处公开的手术紧固件施加装置的实施例，在附图中，相同附图标记指代相似或相同的结构元件。如本文所用，传统的，术语“近侧”指的是装置的较靠近用户的部分，而术语远侧指的是装置的较远离用户的部分。
具体参照图1至图3，手术吻合器10包括砧座半部12、钉仓接收半部14、夹紧操作杆16、单次使用装载单元18(以下称“SULU”)和发射组件20。在一个实施例中，砧座半部12、钉仓接收半部14和夹紧操作杆16构造为是可重复使用的部件，并因此，由适于消毒和重复使用的生物相容性材料(例如，不锈钢)构成。相比之下，SULU 18和发射组件20构造成是一次性的，并且因此，可以由具有所需的强度特性的任何合适的生物相容性材料构成，例如，塑料、金属、其组合。
参照图3至图7，钉仓接收半部14限定细长通道构件22，细长通道构件22限定U形通道24，U形通道24具有定尺寸为可释放地接收SULU 18的远侧部24a和定尺寸为可释放地接收发射组件20的近侧部24b。在剖视图中U形通道可以具有平坦的底部和直的腿部或者其可以具有稍微圆形的底部和/或至少一个弯曲的腿部。在剖视图中，U的底部可以由尖角或至少一个稍微圆角与腿部连接。发射组件20包括具有近侧端的静止壳体26(同样参见图12)，所述近侧端包括突起28，突起28延伸入形成在钉仓接收半部14的近侧部中的凹槽30以将发射组件20的近侧端可释放地紧固在通道构件22的近侧部24b内。发射组件20的远侧端限定三角形切口64d，三角形切口64d定位成接收形成在通道构件22(参照图9A至图9C)的内壁上的突起65以将发射组件20的远侧端可释放地紧固在通道构件22中。三角形切口可以是三角形的，或者可以是具有尖角或至少一个圆角或斜切角的三角形，并且可以不具有相等的边或者具有两个或三个相等的边。将在下面进一步详细讨论发射组件20的结构。同样，SULU18包括一对远侧突起32，远侧突起32定位在形成在通道构件22的远侧端处的切口34中以将SULU 18可释放地紧固在通道构件22的远侧部24a内。在组装期间，发射组件20必须在SULU18插入通道构件22的远侧部24a之前插入通道构件22的近侧部24b，这将在下面讨论。为将SULU 18定位在通道构件22中，SULU 18上的突起32定位在切口34中，而SULU 18定位在通道构件22上方并且与其成角度。此后，SULU 18可向下旋转到U形通道24的远侧部24a。这允许发射组件20的驱动部件与SULU 18的部件正确对准并且还利于发射组件20与支撑在SULU18中的刀具40(图17)接合。SULU 18的近侧端包括向外延伸的锯齿表面42(图7)，以利于SULU 18的近侧端的抓握，从而允许SULU 18从通道构件22的去除和/或更换。在吻合器10移动至夹紧位置之前，如下面将要讨论的，锯齿抓握表面42不会完全安置在通道构件22的远侧部24a内。
参照图8至图12，发射组件20包括静止壳体26、刀具致动杆44、凸轮杆46、导块48、发射操作杆50、滑块52和踏板(pedal)54(图12)。在实施例中，静止壳体26包括U形框架60，U形框架60包括底壁62和一对侧壁64。每个侧壁64在其近侧端被开槽以限定支撑相应的突起28的悬臂部64a(图11)。悬臂部64a允许突起28向内弯曲入通道构件22(图21)的凹槽30以如上所讨论的将发射组件20可释放地紧固在通道构件22的近侧部24b(图3)内。每个侧壁64的远侧端限定了近侧台阶64b、远侧倾斜部64c(图9)和三角形切口64d。如以上所讨论的，三角形切口64d定位成接收形成在通道构件22的内壁上的突起65(图9B)以将发射组件20的远侧端保持在通道构件22内。底壁62包括弹簧臂66(图11)，弹簧臂66接合滑块52的近侧端以防止滑块52近侧移动超过静止壳体26内的预定点。
在图35至图51所示的替代实施例中，手术吻合器1000包括发射组件1020(图36)，发射组件1020包括具有限定向下延伸的突起1027的底壁1026a(图37)的静止壳体1026。突起1027可以定尺寸为接收在形成于钉仓接收半部1014的通道构件1022内的开口(未示出)中。在形成于通道构件1022中的开口内的定位突起1027用于将发射组件1020在钉仓接收半部1014的通道构件1022内正确定位和对准。
导块48包括限定三个纵向狭槽70a-c的主体和一对向外延伸的突起72。在实施例中，每个突起72是圆柱形的并包括锥形部72a(图9)。替选地，可以设想其它突起构造。圆柱形突起72可以是具有圆形横截面的圆柱体，或可具有略呈长方形的横截面。另外，圆柱形突起72可以具有平的端部或稍微圆形或锥形的端部。突起72定尺寸为接收在形成于静止壳体26的侧壁64中的开口74(图12)中以将导块48轴向地固定在静止壳体26的远侧端内。突起72允许导块48在U形框架60内的一定程度的枢转运动。如将在下面进一步详细地讨论的，响应于吻合器10向夹紧位置的移动，导块48从与刀具致动杆44的槽口49和51锁定接合的第一位置(图19)向与刀具致动杆44的槽口49和51脱离的第二位置(图26)枢转。狭槽70a和70c中的每个都定尺寸为可滑动地接收凸轮杆46的相应的侧壁114。类似地，狭槽70b定尺寸为可滑动地接收刀具致动杆44。
滑块52包括毂80，毂80包括构造成卡扣配合到形成于发射操作杆50中的枢轴孔82的弹性指状件80a。当滑块52处于缩回位置时发射操作杆50能关于毂80枢转以利于发射组件20从吻合器10的任一侧的致动。踏板54往复地接收在形成于滑块52的孔84内。踏板54包括构造为横跨刀具致动杆44的近侧端102的分裂主体部54a。在实施例中，分裂主体部54a包括倾斜的远侧表面86。销88从踏板54通过滑块52中的孔84向上延伸。偏置构件90围绕销88定位在分裂主体部54a和滑块52之间，以促使踏板54远离滑块52向下。在滑块52的缩回位置中，踏板54接收在形成于通道构件22的底壁22a中的切口55中(图20)。
发射操作杆50包括第一手指接合构件50a和第二手指接合构件50b，其中一个可选择性地接合以从吻合器10的任一侧将发射操作杆50移动通过发射行程。弧形凹槽94(图12B)形成在发射操作杆50的底表面中，弧形凹槽94可滑动地接收踏板54的销88以限定如下旋转范围：发射操作杆50可关于滑块52的毂80枢转上述旋转范围。如本文所使用的，发射行程定义为发射操作杆50从完全缩回位置(图25)到完全推进位置(图30)的移动。止挡槽94a形成在弧形凹槽94的每一端中。止挡槽94a构造成且定尺寸为：在手术吻合器10的发射行程期间接收踏板54的销88的端部，以防止发射操作杆50关于毂80的枢转运动。更具体地，在发射操作杆50移动通过发射行程期间，当发射组件20致动以在静止壳体26内向远侧推进滑块52时，踏板54的倾斜的远侧表面86接合通道构件22并且凸轮运动地离开切口55(图27)以促使销88向上进入止挡槽94a从而防止发射操作杆50的枢转运动。如可以明显看出的，销88必须定位在止动槽94a的下方，以允许踏板54从切口55向上提起，从而允许发射操作杆50移动通过发射行程。因此，发射操作杆50必须在发射操作杆50可以移动通过发射行程之前枢转到发射组件20的一侧或另一侧。
刀具致动杆44包括具有台阶部100的近侧端，台阶部100包括具有第一高度的近侧第一台阶102和具有比第一高度大的第二高度的第二台阶104。致动杆44的远侧端包括上翘钩部106和上下槽口49和51。指状件108从刀具致动杆44在第一台阶102和第二台阶104之间向上突出。如图27所示，指状件108可滑动地接收在形成于滑块52的下侧的凹槽110中。当滑块52在静止壳体26内向远侧推进时，指状件108在凹槽110内移动，使得滑块52相对于刀具致动杆44移动直到指状件108接合限定凹槽110的近侧端的壁112(图32)。当指状件108接合壁112时，滑块52的进一步的远侧移动也会影响刀具致动杆44的远侧移动。如将从下面显而易见的，这种布置允许吻合钉在组织切割之前从SULU 18射出。
参照图12和图12A，凸轮杆46包括一对侧壁114和基壁116(图12A)。每个侧壁114的近侧端114a包括凸起的壁部118。每个凸起的壁部118构造成固定地接收在形成于滑块52的下侧的狭槽(未示出)中，以将凸轮杆46的近侧端固定地紧固至滑块52。替选地，滑块52可关于刀具致动杆44的近侧端模制。每个侧壁114的远侧端包括倾斜的凸轮表面114b。基壁116限定向远侧延伸的细长狭槽123(图12A)和向近侧延伸的纵向狭槽121，其中，细长狭槽123从凸轮杆46的远侧端沿凸轮杆46的绝大部分长度延伸。狭槽121定位成：当滑块52处于缩回位置时，利于踏板54通过通道构件22的切口55。参见图27。
凸轮杆46的侧壁114可滑动地定位在导块48的狭槽70a和70c中，并且刀具致动杆44可滑动地定位在导块48的纵向狭槽70b中。当发射组件20支撑在通道构件22中，且发射操作杆50枢转到静止壳体26的一侧并被向远侧推时，滑块52在静止壳体26内向远侧移动。当滑块52开始向远侧移动，踏板54的锥形表面86接合限定了切口55的通道构件22的远侧边缘以向上推动踏板54离开切口55，通过凸轮杆46的狭槽121并且到达发射组件20的静止壳体26的内表面上(图27)。当这发生时，踏板54的销88移入止挡槽94a，以防止发射操作杆50的进一步的枢转运动。如果发射操作杆50不枢转到销88定位在止挡槽94a的下方的位置，踏板54将被防止向上移动离开切口55，并且将防止发射操作杆50移动通过发射行程。当发射操作杆50向远侧移动时，指状件108在凹槽110内移动，使得当凸轮杆46向远侧推进时，刀具致动杆44保持静止。当指状件108接合限定凹槽110的近侧壁112时，刀具致动杆44与滑块52和凸轮杆46向远侧移动。如下面将要讨论的，当凸轮杆46和刀具致动杆44在发射组件20的静止壳体26和通道构件22内向远侧移动时，凸轮杆46的倾斜的凸轮表面114b移动通过SULU18以从SULU 18射出紧固件。同时，尽管有等于凹槽112(图32)的长度的预设延迟，刀具致动杆44驱动刀片40通过SULU 18以剖割组织。
参照图38，在一个实施例中，弹簧，如板簧1029，设置在静止壳体1026的远侧端中。弹簧1029定位成防止SULU 1018在吻合器1000已移动到夹紧位置之前就完全安置在静止壳体1026的远侧端中。在夹紧位置中，SULU 1018由砧座半部1012向下推动而与发射组件1020(图35)操作性地接合。弹簧1029防止SULU 1018在吻合器1000已经移动到夹紧位置之前就操作性地接合发射组件1020。
美国专利第7,631,794号(下称“‘794专利”)公开了一种包括与上述的类似的发射组件的手术紧固件施加装置。‘794专利整体通过引用并入本文。
图13至图17说明SULU 18。参照图17，SULU 18包括主体120、多个吻合钉推动器122(仅示出一个)、底盖124、具有倾斜的锋利前边缘或刀片40a的刀具40、多个吻合钉126(仅示出一个)以及可枢转地安装的安全锁定件128。主体120的近侧端包括突出成略微超过限定主体120的外壁的柔性指状件120a。当SULU 18可释放地定位在通道构件22内时，指状件120a摩擦接合通道构件22的内壁以将SULU 18的近侧端保持在通道构件22内。如本领域中已知的，主体120具有多排(例如，四排、六排等)吻合钉保持狭槽130以及居中布置在主体120中的线性开槽的刀轨132。手术吻合器10可以定尺寸为接收或容纳具有不同吻合钉线长度的SULU，所述吻合钉线长度包括例如60毫米、80毫米与100毫米。刀具40包括下翘钩部40b，下翘钩部40b定位成当SULU 18定位在通道构件22内时接合刀具致动杆44的上翘钩部106。
在图示的实施例中，主体120包括形成在线性开槽的刀轨132的任一侧上的两个交错排的狭槽130。交错排的狭槽130延伸超过刀轨132的远侧端，以利于在刀片40的行程的远侧端外的吻合钉成形。
吻合钉推动器122可以构造成延伸到一个或多个狭槽130。在实施例中，单个推动器与每个狭槽130相关联。替选地，如图17所示，每个推动器122可构造成延伸入两个相邻的狭槽130并且定位在保持在狭槽130中的相应的吻合钉126下方。如本领域中已知的，每个推动器122包括下凸轮表面122a，下凸轮表面122a定位成接合在凸轮杆46的远侧端的凸轮表面114b中的一个使得凸轮杆46的通过SULU 18的移动依次地提起在其相应的狭槽130中的相应的推动器122以从狭槽130射出吻合钉。
底盖124部分地包围形成在钉仓主体120内的通道125(图18)。纵向脊134形成在底盖124的上表面上并提供用于刀具支撑构件136的支撑表面，其中，刀具支撑构件136紧固至刀具40的底边缘。刀具40可以通过销、焊接或其它已知紧固技术紧固至支撑构件136。在发射行程期间，当发射操作杆50通过通道构件22推进时，刀具40被沿刀轨132引导。一对狭槽138限定在脊134的两侧和钉仓主体120的外壁之间。纵向脊134定位在主体120内并且定尺寸为可滑动地接收在凸轮杆46的细长狭槽120(图12a)中，使得凸轮杆46关于纵向脊134可滑动地移动通过钉仓主体120以从SULU 18射出吻合钉126。
安全锁定件128可枢转地布置在主体120的上近侧端并且能关于枢转构件150从锁定方位(图26)枢转到解锁方位(图34)。枢转构件150接收在主体120的开口154中。偏置构件，例如弹簧152，定位在刀具支撑构件136和安全锁定件128之间，以朝向解锁方位推动安全锁定件128。安全锁定件128包括近侧钩156，近侧钩156定位成当刀具40处于缩回位置(图19)时接收形成在刀具40上的接合构件158以将安全锁定件128保持在锁定方位。在发射行程期间当刀具40朝向推进位置移动时，响应于弹簧152的推动，接合构件158远离近侧钩156移动，以允许安全锁定件128朝向解锁位置枢转。注意的是，当砧座半部12与钉仓接收半部14处于夹紧位置时，因为安全锁定件128的顶表面128a接合砧座半部12的内表面以防止安全锁定件128的枢转，所以防止了安全锁定件128枢转到解锁位置。安全锁定件128限定定尺寸为可滑动地接收刀具40的狭槽160。在刀具40的缩回位置，刀具40的前缘40a被限制在安全锁定件128的狭槽160内，以防止与刀具40的前缘40a的意外接合和对医务人员的伤害。
再次参照图2至图3，砧座半部12包括近侧手柄部12a和远侧砧座部12b。砧座部12b包括吻合钉变形部198，正如本领域中公知的，吻合钉变形部198包括多个吻合钉变形凹槽并且当SULU 18定位在通道构件22中时面对SULU 18的顶表面。如在本领域中同样是已知的，吻合钉变形部198包括中央纵向狭槽(未示出)，所述中央纵向狭槽(未示出)用于当刀具40(图17)移动通过SULU 18时接收刀具40。吻合钉变形部198可以与砧座半部12一体形成，或在替代方案中，通过紧固工艺(如焊接)紧固至砧座半部12。一对定位指状件170定位成邻近砧座部12b的吻合钉变形部198的近侧端并且起到将SULU 18与吻合钉变形部198正确对准的作用。
在图35至图51中所示的替代实施例中，手术吻合器1000包括具有远侧砧座部1012b的砧座半部1012，远侧砧座部1012b具有实心的三角形横截面构造(图41)。砧座部1012b包括吻合钉变形部1198(图40)，吻合钉变形部1198限定定尺寸为可滑动地接收SULU1018的刀具40的纵向狭槽1198a。
砧座半部12的中央部包括一对圆柱形的横向支撑构件172。在砧座半部12和钉仓接收半部14的组装期间，横向支撑构件172支撑在形成于钉仓接收半部14的中央部173上的U形凹槽174中(图28)。横向支撑构件172还定位成当夹紧操作杆16移动到夹紧位置(图2B)时接收在形成于夹紧操作杆16的间隔开的突缘部178上的切口176中。近侧手柄部12a形成为符合人体工程学，并包括拇指接合抵接件180和抓握部182。手柄部12a的近侧端包括向下延伸的指状件184，其包括一对相对的泪滴状的突起186，这将在下面进一步详细讨论。替选地，突起186可以采取各种构造。
在图35至图51所示的替代实施例中，手术吻合器1000的砧座半部1012包括在手柄部1012a的近侧端的内侧表面1084a的相反侧上的一对间隔开的、实心的定位指状件1084(图42和图43)。定位指状件1084接收在钉仓接收半部1014的竖直支撑构件1188(图49)的竖直狭槽1188a中。指状件1084在竖直支撑构件1188的竖直狭槽1188a中的接收可枢转地支撑砧座半部1012并且将其相对于钉仓接收半部1014对准。
钉仓接收半部14包括中央部173，中央部173限定了定位成支撑砧座半部12的横向支撑构件172的间隔开的居中布置的U形凹槽174。中央部173的远侧壁173a限定了组织止挡(图3)。一对横向圆柱形枢转构件187定位在凹槽174下方。每个枢转构件可以限定平部187a(图2a)。枢转构件187可以包括圆形或锥形的端部。钉仓接收半部14的近侧端还包括一对竖直支撑构件188。每个竖直支撑构件188包括具有圆形底表面的细长竖直狭槽188a。竖直狭槽188a定尺寸为当组装期间砧座半部12支撑在钉仓接收半部14上时接收形成在砧座半部12的指状件184上的突起186(图21)。通过将突起186定位在竖直狭槽188a中，砧座半部12可以通过剪式作用而相对于钉仓接收半部14在打开位置和关闭位置之间枢转。在实施例中，突起186具有泪滴轮廓。钉仓接收半部14的至少一个侧壁包括凹陷189(见图3)，这将在下面进一步详细讨论。
夹紧操作杆16还包括手柄部190，手柄部190包括抓握件190a和拇指接合抵接件192。如上所述，一对隔开的突缘部178支撑在夹紧操作杆16的远侧端上。每个突缘部178限定切口176，切口176定尺寸为当吻合器10朝向夹紧位置(图2B)移动时接收砧座半部12的相应的横向支撑构件172。夹紧操作杆16的远侧端还限定定尺寸为接收枢转构件187的一对远侧C形凹槽194。C形凹槽194在剖视图中可以具有平的边和直的顶部和底部，或者其可以具有略圆的边和/或至少一个弯曲的顶部和/或底部。在剖视图中，C的顶部和底部可以通过尖角或至少一个稍微圆角与边连接。C的顶部以及底部可以从边以一定的角度(例如钝角)延伸。每个凹槽194限定了宽度比枢转构件187的直径小的口。因为每个C形凹槽194的口的宽度比枢转构件187的直径小，因此当夹紧操作杆16紧固至钉仓接收半部14(图24)时，枢转构件187必须沿枢转构件187的平部187a上的表面滑入凹槽194。这样，如图2A所示，夹紧操作杆16必须定位成将夹紧操作杆16关于钉仓接收半部14的枢转构件187可枢转地紧固。将枢转构件187定位在C形凹槽194中后，夹紧操作杆16可沿图2A所示的逆时针方向旋转至图2所示的位置以将夹紧操作杆16紧固至钉仓接收半部14。
在图35至图51中所示的替代实施例中，夹紧操作杆1016具有支撑在其远侧端1016a处的横向枢转构件1187。参见图36、图44和图44A，枢转构件1187以悬臂方式在一端支撑到夹紧操作杆1016的远侧端1016a。一个或多个铰链构件1194(图49)支撑在通道构件1022的底壁上。在一个实施例中，两个间隔的铰链构件1194设置在通道构件1022的底壁上。每个铰链构件1194包括定尺寸为接收枢转构件1187的开口1194a。
在使用中，通过使枢转构件1187(图44A)的自由端滑动通过铰链构件1194的开口1194a(图51)，夹紧操作杆1016安装在通道构件1022上。一旦枢转构件1187已经定位通过开口1194a，夹紧操作杆1016可相对于通道构件1022枢转以将夹紧操作杆1016的间隔开的突缘部1178的切口1176(图45)移动至接收砧座半部1012的横向支撑构件1172的位置。当横向支撑构件1172接收在切口1176中并且夹紧操作杆1016朝向钉仓接收半部1014进一步枢转时，砧座半部1012被朝着钉仓接收半部1014拉动以将砧座半部1012夹紧到钉仓接收半部1014，如上关于手术吻合器10所讨论的(图35)。当夹紧操作杆1016移动到完全夹紧位置，形成在砧座半部1012上的组织间隙销1172a(图35)移动到抵靠钉仓接收半部1014的凸起表面1175，以控制当吻合器1000在夹紧位置时砧座半部1012和钉仓接收半部1014之间的间距或间隙。
如图3A所示，夹紧操作杆16的内壁包括突起201。当夹紧操作杆16从图2A中所示的位置旋转到图2B中所示的位置时，突起201沿钉仓接收半部14的外壁移动并通过其变形，直到突起201移入形成在钉仓接收半部14的侧壁内的凹陷189(图2A)。通过将突起201定位在凹陷189中，防止了夹紧操作杆16旋转至夹紧操作杆16能与钉仓接收半部14(图2A)脱离的位置并且由此被保持在打开位置(图2B)。
参照图2，在夹紧操作杆16已经紧固至钉仓接收半部14并且SULU 18和发射组件20装载到通道构件22之后，砧座部12可组装到钉仓接收半部14。值得注意的是，SULU 18和发射组件20可在夹紧操作杆16紧固至钉仓接收半部14之前或之后装载入通道构件22。为将砧座半部12附接至钉仓接收半部14，指状件184的突起186定位在钉仓接收半部14的竖直支撑构件188的竖直狭槽188a内。此后，砧座半部12朝向钉仓接收半部14旋转以将横向支撑构件172定位在U形凹槽174中。
为了将手术吻合器10定位在夹紧位置，夹紧操作杆16从图2B中所示的位置沿逆时针方向旋转。当夹紧操作杆16旋转时，横向支撑构件172接收在突缘部178的切口176中并且朝钉仓接收半部14凸轮运动。如图3所示，弹簧构件200在一个位置(例如通过焊接)紧固至夹紧操作杆16的内表面以接合钉仓接收部14从而推动夹紧操作杆16到图2B所示的非夹紧位置。在图1中所示的夹紧位置中，吻合钉变形部198(图2)定位为与SULU 18的顶表面紧密靠近。
在图35至图51中所示的替代实施例中，弹簧构件1200(图36)可以紧固(例如通过焊接或其它已知的紧固技术)至发射组件1020的静止壳体1026的底壁1026a。弹簧构件1200定位成延伸通过形成在通道构件1022中的细长狭槽1200a(图48)，并且接合夹紧操作杆1016的内表面1017(图36)。如上关于弹簧200所描述的，弹簧1200和夹紧操作杆1016之间的接合将夹紧操作杆1016向非夹紧位置推动。通过将弹簧1200设置为一次性发射组件1020的一体部件而不是作为夹紧操作杆的一部分，吻合器1000的可重复使用的部件可以更容易地清洁和消毒以再利用。
参照图18和图22至图27，夹紧操作杆16的近侧端包括切口204、定位在切口204内的弹性悬臂锁定构件206、以及支撑在锁定构件206上的弹性接合构件208。锁定构件206限定开口210和手指接合表面212。接合构件208限定了定位在开口210内的钩部，并包括锁定表面208a。在一个实施例中，悬臂锁定构件206与夹紧操作杆16形成一体并且通过活动铰链213(图23)连接到夹紧操作杆16。参照图3、图25和图27，钉仓接收半部14的近侧端包括从钉仓接收半部14向下延伸的抓捕构件214。在一个实施例中，抓捕构件214与半部14形成一体并具有横向锁定表面214a。抓捕构件214定位成当夹紧操作杆16移动到夹紧位置时接收在开口210内并接合接合构件208且向内偏转接合构件208，使得当夹紧操作杆16移动到夹紧位置时接合构件208的锁定表面208a自动卡入与锁定表面214a的可释放的接合，以将夹紧操作杆16保持在夹紧位置。要做到这一点，锁定构件214和接合构件208限定了倾斜的凸轮表面，其在夹紧操作杆16向夹紧位置移动期间抵接以向内偏转接合构件208越过抓捕构件214。为了从抓捕构件214释放接合构件208，可通过按压手指接合表面212压下悬臂锁定构件206从而向内移动接合构件208使其与抓捕构件214脱离。当这种情况发生时，弹簧构件200自动将夹紧操作杆16向非夹紧位置推动。
在图35至图51中所示的替代实施例中，吻合器1000的夹紧操作杆1016包括弹性锁定构件1206(图45至图57)，其包括位于中央的枢转构件1206a。锁定构件1206定位在限定在夹紧操作杆1016的近侧端中的切口1204内，并且包括在一端的接合构件1208和在与接合构件1208相反的另一端的手指接合表面1212。接合构件1208包括突起1208a(图47)，其定位成接合形成在钉仓接收半部1014的近侧端上的抓捕构件1214。
参照图44至图47，接合构件1208是弹性的，并且定位成当夹紧操作杆1016朝钉仓接收半部1014枢转时向近侧弯曲并越过抓捕构件1214并且然后卡入与抓捕构件1214的接合。为了使接合构件1208脱离抓捕构件1214，手指接合表面1212可向内压入切口1204以使接合构件1208关于中央枢转构件1206a枢转出切口1204。当接合构件1208枢转出切口1204时，突起1208a从抓捕构件1214脱离从而允许弹簧构件1200将夹紧操作杆1016枢转至非夹紧位置。
参照图3、图12、图19和图26，如上所讨论的，导块48可枢转地支撑在发射组件20的静止壳体26中。导块48包括向远侧延伸的鼻部220(图12和图26)，当SULU 18支撑在通道构件22中时，鼻部220位于SULU 18的下方。导块48的内表面包括锁定表面222(图19)，当吻合器10处于非夹紧位置时，锁定表面接收在刀具致动杆44的槽口49和51中。当SULU 18定位在通道构件22中时，在夹紧操作杆16移动到夹紧位置之前，SULU 18定位在鼻部220上面并且未完全安置在通道构件22中，如以上所讨论的。当吻合器10移动到夹紧位置时，砧座半部12(图3)的定位指状件170接合SULU 18的主体120的顶表面以使SULU 18完全安置在通道构件22中。定位指状件170接合SULU 18，以相对于砧座部12b正确地定位SULU 18。当SULU 18完全安置于通道构件22中时，SULU 18向下压导块48的鼻部220以使导块48关于突起72枢转。当导块48枢转时，锁定表面222从槽口49和51移动以解锁刀具致动杆44(图26)。此构造防止在夹紧之前刀具致动杆44就相对于导块48移动，从而确保使用前的刀具致动杆44和SULU刀具40保持正确地定位用于操作性接合。
参照图24至图28，当吻合器10处于夹紧、未发射位置时，发射组件20的滑块52处于在通道构件22和静止壳体26的近侧端处的缩回位置。参见图27。在这个位置，踏板54定位在通道构件22的切口55中，并且踏板54的销88定位在发射操作杆50的在止挡槽94a的下方的弧形凹槽94中。因此，发射操作杆50可以枢转以利于从吻合器10的任一侧致动吻合器10。另外，在滑块52的这个位置，刀具致动杆44的指状件108定位为邻近滑块52的凹槽110的远侧壁。接合构件208还与锁定构件214接合以将夹紧操作杆16保持在夹紧位置。
参照图26，当滑块52处于缩回位置时，刀具40和凸轮杆46的凸轮表面114b定位在SULU 18的近侧端，并且安全锁定件128的近侧钩156定位为与刀具40的接合构件158接合以将安全锁定件128保持在锁定方位。另外，刀具40的下翘钩部40b与刀具致动杆44的上翘钩部106接合以将发射组件20连接到SULU 18的刀具40。
参照图29至图32，当发射操作杆50沿图29中箭头“A”所示的方向向远侧推进时，滑块52在发射组件20的静止壳体26内向远侧移动，以实现凸轮杆46的对应的移动和刀具致动杆44的延迟移动。如上，刀具致动杆44的延迟移动等于滑块52的凹槽110的长度，并且由于刀具致动杆44的指状件108在滑块52的凹槽110内的移动而产生。当指状件108抵接凹槽110的近侧壁112时，刀具致动杆44与滑块52的移动开始。当凸轮杆46向远侧移动通过发射组件20的静止壳体26时，凸轮杆46的侧壁114上的凸轮表面114b通过SULU 18推进以顺序地接合推动器122从而从主体120的狭槽130射出吻合钉126。同时，由于刀具致动杆44的远侧端与刀具40接合，在预设延迟之后，刀具40通过SULU 18推进以切割吻合钉线之间的组织。
如图32中虚线所示，当滑块52在静止壳体26内向远侧移动时，踏板54在通道构件22上方移上去，并沿发射组件20的静止壳体26的内表面移动。当发生这种情况，踏板54的销88移入止挡槽94a，以防止发射操作杆50的进一步枢转运动。
参照图31和图32，当刀具40在SULU 18中向远侧移动时，刀具40的接合构件158与安全锁定件128的近侧钩156脱离。
参照图33和图34，当发射操作杆50返回到其最近侧位置以缩回凸轮杆46和刀具40，并且悬臂锁定构件206压下以将接合构件208从抓捕构件214脱离时，弹簧200将夹紧操作杆16向其非夹紧位置推动以允许吻合器10移动到打开位置。在打开位置，砧座半部12与钉仓接收半部14隔开，并且弹簧152(图17)使安全锁定件128沿在由图34中箭头B指示的方向关于枢转构件150枢转到其解锁位置，从而使得安全锁定件128从SULU 18向上突出。在解锁位置，安全锁定件128防止吻合器10返回到夹紧位置的移动。为了重新使用吻合器10，用过的SULU 18必须用新的SULU 18来替换。
在手术操作期间，SULU 18可更换多次，以便于吻合器10在单个患者上的多次使用。由于每个SULU 18设置有新的刀具40，组织的撕裂最小化。在手术操作后，使用过的SULU18和发射组件20可从通道构件22移除，并以适当的方式处置。此后，通过使夹紧操作杆16旋转到图2A所示的位置并使枢转构件187从C形凹槽194脱离，夹紧操作杆16可以从钉仓接收半部14移除。砧座半部12、钉仓接收半部14和夹紧操作杆16现在可以进行消毒，如通过高压灭菌，并且以上面所讨论的方式与消毒过的SULU 18和发射组件20重新使用。
对于图35至图51中所示的手术吻合器1000的替代实施例，使用后，通过从铰链构件1194的开口1194a滑动枢转构件1187，夹紧操作杆1016可从与钉仓接收半部1014的接合移除。可从钉仓接收半部1014移除SULU 1018和发射组件，以便于砧座半部1012、钉仓接收半部1014和夹紧操作杆1016的清洁和消毒。
应当理解的是，可以对本文所公开的手术紧固件施加装置的实施例进行各种修改。因此，上面的描述不应当解释为限制性的，而仅仅是作为实施例的范例。那些本领域的技术人员将在本公开的范围和精神内设想其它修改。
Claims (9)
1.一种手术紧固件施加装置，其包括：
砧座半部，其包括远侧砧座部和近侧手柄部；
钉仓接收半部，其限定细长通道构件并包括支撑在所述细长通道构件的底壁上的至少一个铰链构件，所述细长通道构件具有定尺寸为可释放地接收单次使用装载单元的远侧部和构造成支撑发射组件的近侧部，且其中所述至少一个铰链构件限定开口；以及
夹紧操作杆，其可枢转地紧固至钉仓接收半部，所述夹紧操作杆具有近侧端、远侧端和以悬臂方式支撑在夹紧操作杆的远侧端上的枢转构件；
所述夹紧操作杆的枢转构件可滑动地接收在所述至少一个铰链构件的开口内以将夹紧操作杆可枢转地紧固至钉仓接收半部，所述夹紧操作杆能够从非夹紧位置移动到夹紧位置以使所述砧座半部的砧座部以与支撑在细长通道构件内的单次使用装载单元紧密靠近的方式可释放地紧固，
所述手术紧固件施加装置还包括发射组件，所述发射组件构造为可释放地紧固在所述钉仓接收半部的近侧部中并且包括发射操作杆和固定地紧固至发射操作杆的凸轮杆，
其中所述发射组件还包括静止壳体，所述静止壳体构造成可释放地支撑在钉仓接收半部的近侧部中，并且
弹簧设置在所述静止壳体的远侧端中。
2.根据权利要求1所述的手术紧固件施加装置，其中所述静止壳体包括具有向下延伸的突起的底壁。
3.根据权利要求2所述的手术紧固件施加装置，其中所述细长通道构件限定开口，所述开口定尺寸为接收所述向下延伸的突起以将发射组件正确地定位在细长通道构件内。
4.根据权利要求1所述的手术紧固件施加装置，其中所述发射组件还包括构造成接合支撑在所述单次使用装载单元内的刀具的刀具致动杆。
5.根据权利要求1所述的手术紧固件施加装置，其中所述发射组件包括紧固至静止壳体的弹簧构件，并且所述细长通道构件限定定尺寸为允许弹簧构件的通过的细长狭槽，所述弹簧构件定位为延伸通过所述细长狭槽并接合夹紧操作杆以朝向非夹紧位置推动夹紧操作杆。
6.根据权利要求1所述的手术紧固件施加装置，其中所述远侧砧座部具有三角形横截面。
7.根据权利要求6所述的手术紧固件施加装置，其中所述远侧砧座部是实心的，并且限定定尺寸为接收单次使用装载单元的刀具的纵向狭槽。
8.根据权利要求1所述的手术紧固件施加装置，其中所述夹紧操作杆包括具有中央枢转构件的锁定构件，所述锁定构件具有包括接合构件的第一端和包括手指接合表面的第二端，所述锁定构件能够关于中央枢转构件枢转以通过卡扣配合式接合来接合形成在钉仓接收半部上的抓捕构件，从而将夹紧操作杆保持在夹紧位置。
9.根据权利要求8所述的手术紧固件施加装置，其中所述手指接合表面定位成能够压下以使接合构件关于中央枢转构件枢转出与抓捕构件的接合。
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| PCT/US2013/068263 WO2015065487A1 (en) | 2013-11-04 | 2013-11-04 | Surgical fastener applying apparatus |
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- 2013-11-04 CA CA2926782A patent/CA2926782A1/en not_active Abandoned
- 2013-11-04 JP JP2016526354A patent/JP2016534796A/ja active Pending
- 2013-11-04 US US15/033,720 patent/US10517593B2/en active Active
- 2013-11-04 AU AU2013403917A patent/AU2013403917A1/en not_active Abandoned
- 2013-11-04 WO PCT/US2013/068263 patent/WO2015065487A1/en active Application Filing
- 2013-11-04 CN CN201380080700.XA patent/CN105682568B/zh active Active
- 2013-11-04 EP EP13795346.9A patent/EP3065649A1/en not_active Withdrawn
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Also Published As
| Publication number | Publication date |
|---|---|
| CA2926782A1 (en) | 2015-05-07 |
| JP2016534796A (ja) | 2016-11-10 |
| US20160249920A1 (en) | 2016-09-01 |
| CN105682568A (zh) | 2016-06-15 |
| US10517593B2 (en) | 2019-12-31 |
| EP3065649A1 (en) | 2016-09-14 |
| AU2013403917A1 (en) | 2016-04-28 |
| WO2015065487A1 (en) | 2015-05-07 |
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