CN105682572B - 为外科器械的使用者提供接近实时反馈 - Google Patents
为外科器械的使用者提供接近实时反馈 Download PDFInfo
- Publication number
- CN105682572B CN105682572B CN201480054434.8A CN201480054434A CN105682572B CN 105682572 B CN105682572 B CN 105682572B CN 201480054434 A CN201480054434 A CN 201480054434A CN 105682572 B CN105682572 B CN 105682572B
- Authority
- CN
- China
- Prior art keywords
- sensor
- instrument
- motor
- trigger
- gear
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Active
Links
- 238000004891 communication Methods 0.000 claims abstract description 18
- 239000012636 effector Substances 0.000 claims description 82
- 238000009527 percussion Methods 0.000 claims description 37
- 230000005540 biological transmission Effects 0.000 claims description 8
- 238000013500 data storage Methods 0.000 claims description 5
- 238000003860 storage Methods 0.000 abstract description 44
- 238000000034 method Methods 0.000 abstract description 18
- 238000001356 surgical procedure Methods 0.000 abstract description 18
- 238000010304 firing Methods 0.000 description 135
- 230000033001 locomotion Effects 0.000 description 47
- 238000005520 cutting process Methods 0.000 description 39
- 230000007246 mechanism Effects 0.000 description 19
- 230000008569 process Effects 0.000 description 9
- 230000008859 change Effects 0.000 description 8
- 235000013290 Sagittaria latifolia Nutrition 0.000 description 7
- 235000015246 common arrowhead Nutrition 0.000 description 7
- 239000000463 material Substances 0.000 description 7
- 230000004044 response Effects 0.000 description 7
- 238000010586 diagram Methods 0.000 description 6
- 230000006870 function Effects 0.000 description 6
- 238000005516 engineering process Methods 0.000 description 5
- 210000003734 kidney Anatomy 0.000 description 5
- 230000005855 radiation Effects 0.000 description 5
- 238000005452 bending Methods 0.000 description 4
- 230000008901 benefit Effects 0.000 description 4
- 230000001954 sterilising effect Effects 0.000 description 4
- 238000004458 analytical method Methods 0.000 description 3
- 238000000429 assembly Methods 0.000 description 3
- 230000008878 coupling Effects 0.000 description 3
- 238000010168 coupling process Methods 0.000 description 3
- 238000005859 coupling reaction Methods 0.000 description 3
- 230000005611 electricity Effects 0.000 description 3
- 238000003780 insertion Methods 0.000 description 3
- 230000037431 insertion Effects 0.000 description 3
- 230000008520 organization Effects 0.000 description 3
- 238000007789 sealing Methods 0.000 description 3
- 229910000831 Steel Inorganic materials 0.000 description 2
- 230000003044 adaptive effect Effects 0.000 description 2
- 239000000853 adhesive Substances 0.000 description 2
- 230000001070 adhesive effect Effects 0.000 description 2
- 230000000740 bleeding effect Effects 0.000 description 2
- 238000004140 cleaning Methods 0.000 description 2
- 238000013461 design Methods 0.000 description 2
- 239000003814 drug Substances 0.000 description 2
- 230000000694 effects Effects 0.000 description 2
- 229920001746 electroactive polymer Polymers 0.000 description 2
- 230000002439 hemostatic effect Effects 0.000 description 2
- 238000009434 installation Methods 0.000 description 2
- 238000013507 mapping Methods 0.000 description 2
- 239000002991 molded plastic Substances 0.000 description 2
- 239000004033 plastic Substances 0.000 description 2
- 229920003023 plastic Polymers 0.000 description 2
- 238000003825 pressing Methods 0.000 description 2
- 108090000623 proteins and genes Proteins 0.000 description 2
- 239000004065 semiconductor Substances 0.000 description 2
- 238000009958 sewing Methods 0.000 description 2
- 239000010959 steel Substances 0.000 description 2
- 238000004659 sterilization and disinfection Methods 0.000 description 2
- 239000013589 supplement Substances 0.000 description 2
- 230000001225 therapeutic effect Effects 0.000 description 2
- 241000894006 Bacteria Species 0.000 description 1
- IAYPIBMASNFSPL-UHFFFAOYSA-N Ethylene oxide Chemical compound C1CO1 IAYPIBMASNFSPL-UHFFFAOYSA-N 0.000 description 1
- PEDCQBHIVMGVHV-UHFFFAOYSA-N Glycerine Chemical compound OCC(O)CO PEDCQBHIVMGVHV-UHFFFAOYSA-N 0.000 description 1
- HBBGRARXTFLTSG-UHFFFAOYSA-N Lithium ion Chemical compound [Li+] HBBGRARXTFLTSG-UHFFFAOYSA-N 0.000 description 1
- 239000004775 Tyvek Substances 0.000 description 1
- 229920000690 Tyvek Polymers 0.000 description 1
- 210000001015 abdomen Anatomy 0.000 description 1
- 230000003187 abdominal effect Effects 0.000 description 1
- 230000009471 action Effects 0.000 description 1
- 230000000712 assembly Effects 0.000 description 1
- 230000004888 barrier function Effects 0.000 description 1
- 230000003796 beauty Effects 0.000 description 1
- 230000015572 biosynthetic process Effects 0.000 description 1
- 239000003990 capacitor Substances 0.000 description 1
- 230000001413 cellular effect Effects 0.000 description 1
- 238000006243 chemical reaction Methods 0.000 description 1
- 230000007547 defect Effects 0.000 description 1
- 230000001419 dependent effect Effects 0.000 description 1
- 238000000151 deposition Methods 0.000 description 1
- 230000000881 depressing effect Effects 0.000 description 1
- 230000000994 depressogenic effect Effects 0.000 description 1
- 238000001514 detection method Methods 0.000 description 1
- 238000003745 diagnosis Methods 0.000 description 1
- 239000003989 dielectric material Substances 0.000 description 1
- 201000010099 disease Diseases 0.000 description 1
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 description 1
- 238000006073 displacement reaction Methods 0.000 description 1
- 230000009429 distress Effects 0.000 description 1
- 235000013399 edible fruits Nutrition 0.000 description 1
- 238000002674 endoscopic surgery Methods 0.000 description 1
- 238000001839 endoscopy Methods 0.000 description 1
- 239000002783 friction material Substances 0.000 description 1
- 239000011521 glass Substances 0.000 description 1
- RGNPBRKPHBKNKX-UHFFFAOYSA-N hexaflumuron Chemical compound C1=C(Cl)C(OC(F)(F)C(F)F)=C(Cl)C=C1NC(=O)NC(=O)C1=C(F)C=CC=C1F RGNPBRKPHBKNKX-UHFFFAOYSA-N 0.000 description 1
- 230000006872 improvement Effects 0.000 description 1
- 230000006698 induction Effects 0.000 description 1
- 238000007689 inspection Methods 0.000 description 1
- 238000005304 joining Methods 0.000 description 1
- 229910001416 lithium ion Inorganic materials 0.000 description 1
- 229910052751 metal Inorganic materials 0.000 description 1
- 239000002184 metal Substances 0.000 description 1
- 238000002324 minimally invasive surgery Methods 0.000 description 1
- 230000004048 modification Effects 0.000 description 1
- 238000012986 modification Methods 0.000 description 1
- 238000000465 moulding Methods 0.000 description 1
- 230000003287 optical effect Effects 0.000 description 1
- 230000002980 postoperative effect Effects 0.000 description 1
- 239000000047 product Substances 0.000 description 1
- 238000011084 recovery Methods 0.000 description 1
- 230000009467 reduction Effects 0.000 description 1
- 230000003014 reinforcing effect Effects 0.000 description 1
- 230000008439 repair process Effects 0.000 description 1
- 230000000717 retained effect Effects 0.000 description 1
- 238000005096 rolling process Methods 0.000 description 1
- 241000894007 species Species 0.000 description 1
- 239000000126 substance Substances 0.000 description 1
- 238000006467 substitution reaction Methods 0.000 description 1
- 238000003786 synthesis reaction Methods 0.000 description 1
- 230000001960 triggered effect Effects 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00221—Electrical control of surgical instruments with wireless transmission of data, e.g. by infrared radiation or radiowaves
-
- 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
- A61B2017/0069—Aspects not otherwise provided for with universal joint, cardan joint
-
- 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
- A61B17/28—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
- A61B2017/2923—Toothed members, e.g. rack and pinion
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2931—Details of heads or jaws with releasable head
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B2017/320052—Guides for cutting instruments
-
- 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
-
- 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
- A61B2090/0808—Indication means for indicating correct assembly of components, e.g. of the surgical apparatus
Abstract
本发明公开了一种方法和系统,该方法和系统用于将存储在外科切割和紧固器械的存储装置中的传感器数据下载到外部或远程计算机装置。该方法可包括在涉及外科切割和紧固器械的外科手术期间,将来自外科切割和紧固器械的一个或多个传感器的数据存储到外科切割和紧固器械的控制单元的存储装置中。在该外科手术期间,该数据可被传输至局部无线通信装置,该数据然后被传输至中央数据库用于数据分析。然后将反馈通过该局部无线通信装置从该中央数据库传达至该外科装置的使用者。
Description
相关申请的交叉引用
本申请涉及下列美国专利申请,其全文以引用方式并入本文中:
(1)MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITH USERFEEDBACK SYSTEM,由Frederick E.Shelton,IV、John Ouwerkerk和Jerome R.Morgan提交,序列号为11/343,498;
(2)MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITHLOADING FORCE FEEDBACK,由Frederick E.Shelton,IV、John N.Ouwerkerk、JeromeR.Morgan和Jeffrey S.Swayze提交,序列号为11/343,573;
(3)MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITHTACTILE POSITION FEEDBACK,由Frederick E.Shelton,IV、John N.Ouwerkerk、JeromeR.Morgan和Jeffrey S.Swayze提交,序列号为11/344,035;
(4)MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITHADAPTIVE USER FEEDBACK,由Frederick E.Shelton,IV、John N.Ouwerkerk和JeromeR.Morgan提交,序列号为11/343,447;
(5)MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITHARTICULATABLE END EFFECTOR,由Frederick E.Shelton,IV和Christoph L.Gillum提交,序列号为11/343,562;
(6)MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITHMECHANICAL CLOSURE SYSTEM,由Frederick E.Shelton,IV和Christoph L.Gillum提交,序列号为11/344,024;
(7)SURGICAL CUTTING AND FASTENING INSTRUMENT WITH CLOSURE TRIGGERLOCKING MECHANISM,由Frederick E.Shelton,IV和Kevin R.Doll提交,序列号为11/343,321;
(8)GEARING SELECTOR FOR A POWERED SURGICAL CUTTING AND FASTENINGSTAPLING INSTRUMENT,由Frederick E.Shelton,IV、Jeffrey S.Swayze、EugeneL.Timperman提交,序列号为11/343,563;
(9)SURGICAL INSTRUMENT HAVING A REMOVABLE BATTERY,由FrederickE.Shelton,IV、Kevin R.Doll、Jeffrey S.Swayze和Eugene Timperman提交,序列号为11/344,020;
(10)ELECTRONIC LOCKOUTS AND SURGICAL INSTRUMENT INCLUDING SAME,由Jeffrey S.Swayze、Frederick E.Shelton,IV、Kevin R.Doll提交,序列号为11/343,439;
(11)ENDOSCOPIC SURGICAL INSTRUMENT WITH A HANDLE THAT CAN ARTICULATEWITH RESPECT TO THE SHAFT,由Frederick E.Shelton,IV、Jeffrey S.Swayze、MarkS.Ortiz和Leslie M.Fugikawa提交,序列号为11/343,547;
(12)ELECTRO-MECHANICAL SURGICAL CUTTING AND FASTENING INSTRUMENTHAVING A ROTARY FIRING AND CLOSURE SYSTEM WITH PARALLEL CLOSURE AND ANVILALIGNMENT COMPONENTS,由Frederick E.Shelton,IV、Stephen J.Balek和EugeneL.Timperman提交,序列号为11/344,021;
(13)DISPOSABLE STAPLE CARTRIDGE HAVING AN ANVIL WITH TISSUE LOCATORFOR USE WITH A SURGICAL CUTTING AND FASTENING INSTRUMENT AND MODULAR ENDEFFECTOR SYSTEM THEREFOR,由Frederick E.Shelton,IV、Michael S.Cropper、JoshuaM.Broehl、Ryan S.Crisp、Jamison J.Float、Eugene L.Timperman提交,序列号为11/343,546;和
(14)SURGICAL INSTRUMENT HAVING A FEEDBACK SYSTEM,由FrederickE.Shelton,IV、Jerome R.Morgan、Kevin R.Doll、Jeffrey S.Swayze和Eugene Timperman提交,序列号为11/343,545。
背景技术
本发明整体涉及外科器械,更具体地涉及能够记录器械的各种状态的微创外科器械。
与传统的开放式外科装置相比,内窥镜式外科器械通常是优选的,因为较小的切口往往减少术后恢复时间和并发症。因此,已对适用于将远侧端部执行器穿过套管针的套管精确地放置在期望外科手术部位处的内窥镜式外科器械进行了显著的开发。这些远侧端部执行器以多种方式接合组织以实现诊断或治疗效果(例如直线切割器、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利用超声波、RF、激光等的能量装置)。
已知的外科缝合器包括端部执行器,该端部执行器在组织中形成纵向切口,并且同时在切口的相对两侧上施加多排钉。该端部执行器包括一对协同工作的钳口构件,如果想将器械用于内窥镜式或腹腔镜式应用,则该对钳口构件能够穿过套管通道。钳口构件中的一个钳口构件接收钉仓,该钉仓具有横向隔开的至少两排钉。另一钳口构件限定砧座,该砧座具有与钉仓中的多排钉对准的钉成形凹坑。器械包括多个往复式楔形件,当朝远侧驱动时,该多个往复式楔形件穿过钉仓中的开口并且与支撑钉的驱动器接合,以使得钉朝着砧座击发。
适用于内窥镜式应用的外科缝合器的示例在Knodel等人的名称为“SURGICALSTAPLER INSTRUMENT”的美国专利5,465,895中有所描述,该专利公开了一种具有不同闭合和击发动作的直线切割器。使用该装置的临床医生能够在组织上闭合钳口构件,以在击发之前将组织定位。一旦临床医生确定钳口构件正确地夹持组织,临床医生即可用单次击发行程或多次击发行程(取决于装置)来击发外科缝合器。击发外科缝合器导致切断并缝合组织。同时进行切断和缝合避免了当利用分别仅进行切断和缝合的不同外科工具依次执行这些动作时可能产生的并发症。
在击发前能够在组织上闭合的一个具体优点是,临床医生可通过内窥镜检查是否达到理想的切割位置,包括是否已在相对的钳口之间捕获足够量的组织。否则,相对的钳口可能被拉得太近,特别是在它们的远侧端部处夹拢,并且因此不能在切断组织中有效形成闭合钉。另一个极端情况是,被夹持的过量组织可能导致束缚和不完全击发。
当内窥镜式外科器械发生故障时,通常将它们返回给制造商或其他实体,以进行故障分析。如果故障导致在器械中出现关键类别的缺陷,则制造商有必要确定故障的原因,并确定是否需要对设计作出更改。在此情况下,制造商可能花费数百工时来分析故障的器械,并且仅基于器械的损坏状态来尝试重现器械发生故障时的情况。以该方式分析器械故障可能非常昂贵且极具挑战性。另外,许多这些分析仅推断出故障是由于器械的不当使用而造成的。
附图说明
本文通过实例结合以下附图的方式描述本发明的各种实施例,其中:
图1和2是根据本发明的各种实施例的外科切割和紧固器械的透视图;
图3-5是根据本发明的各种实施例的器械的端部执行器和轴的分解图;
图6是根据本发明的各种实施例的端部执行器的侧视图;
图7是根据本发明的各种实施例的器械的柄部的分解图;
图8和9是根据本发明的各种实施例的柄部的局部透视图;
图10是根据本发明的各种实施例的柄部的侧视图;
图10A和10B示出了根据本发明的各种实施例的可被使用的比例传感器;
图11是用于根据本发明的各种实施例的器械中的电路的示意图;
图12-13是根据本发明的其他实施例的柄部的侧视图;
图14-22示出了根据本发明的各种实施例的用于锁定闭合触发器的不同机构;
图23A-B示出了可用于根据本发明的各种实施例的器械的关节运动点处的万向接头(“u型接头”);
图24A-B示出了可用于根据本发明的各种实施例的器械的关节运动点处的扭力缆线;
图25-31示出了根据本发明的另一个实施例的具有动力辅助的外科切割和紧固器械;
图32-36示出了根据本发明的另一个实施例的具有动力辅助的外科切割和紧固器械;
图37-40示出了根据本发明实施例的具有触觉反馈的外科切割和紧固器械;
图41示出了根据本发明的各种实施例的器械的端部执行器和轴的分解图;
图42示出了根据本发明的各种实施例的机械器械的柄部的侧视图;
图43是图42所示的机械致动的器械的柄部的分解图;
图44示出了用于记录根据本发明的各种实施例的器械的各种状态的记录系统的方框图;
图45-46示出了根据本发明的各种实施例的器械的柄部的剖面侧视图,该器械示出了各种传感器;
图47示出了根据本发明的各种实施例的器械的端部执行器,该器械示出了各种传感器;
图48示出了根据本发明的各种实施例的器械的击发杆,该器械包括传感器;
图49示出了根据本发明的各种实施例的器械的柄部、端部执行器和击发杆的侧视图,该器械示出了传感器;
图50是根据本发明各种实施例的器械的钉槽和钉仓各部分的分解图,该器械示出了各种传感器;
图51示出了根据本发明的各种实施例的器械的钉槽的自上而下视图,该器械示出了各种传感器;
图52A和52B示出了用于操作根据各种实施例的器械的方法的流程图;
图53示出了显示根据本发明的各种实施例的器械的示例性的记录状态的内存图表;
图54是用于记录根据本发明的实施例的器械的各种状态的记录系统的方框图;
图55是示出了与远程计算机装置通信的外科器械的图表;
图56是绘出了根据本发明的各种实施例的流程的流程图;
图57是绘出了根据本发明的各种实施例的过程的流程图;并且
图58是用于从外科器械传递至驻留在无线设备和远程计算机上的应用的系统的示意图。
具体实施方式
图1和2描述了根据本发明的各种实施例的外科切割和紧固器械10。例示的实施例是内窥镜式外科器械10,通常,本文描述的器械10的实施例是内窥镜式外科切割和紧固器械。然而,应该指出的是,根据本发明的其他实施例,器械10可以是非内窥镜式外科切割器械,诸如腹腔镜式器械。
图1和图2示出的外科器械10包括柄部6、轴8和在关节运动枢轴14处枢转地连接至轴8的关节运动端部执行器12。关节运动控制器16可邻近柄部6设置,以实现端部执行器12围绕关节运动枢轴14的旋转。应当理解,各种实施例可包括非枢转的端部执行器,因此可能不具有关节运动枢轴14或关节运动控制器16。此外,在例示的实施例中,端部执行器12被构造成能够用于夹持、切断和缝合组织的直线切割器,虽然在其他实施例中可使用不同类型的端部执行器,诸如用于其他类型的外科装置的端部执行器,诸如抓紧器、切割器、缝合器、施夹器、进入装置、药物/基因治疗装置,超声波、RF或激光装置等。
器械10的柄部6可包括用于致动端部执行器12的闭合触发器18和击发触发器20。应当理解,具有涉及不同手术任务的端部执行器的器械可具有用于操作端部执行器12的不同数量或类型的触发器或其他合适的控制器。端部执行器12被示出为优选地由细长轴8与柄部6分开。在一个实施例中,临床医生或器械10的操作者可通过利用关节运动控制器16相对于轴8来使端部执行器12进行关节运动,如在由Geoffrey C.Hueil等人于2006年1月10日提交的名称为“Surgical Instrument Having An Articulating End Effector”的未决美国专利申请序列号11/329,020中更详细描述地那样,该专利申请全文以引用的方式并入本文。
在此实例中,除了别的以外,端部执行器12包括钉槽22和可枢转地平移的夹持构件,诸如砧座24,其以确保有效地缝合和切断被夹持在端部执行器12中的组织的间隔来保持。柄部6包括手枪式握把26,由临床医生将闭合触发器18枢转拉向手枪式握把26,以致使砧座24朝着端部执行器12的钉槽22夹持或闭合,从而夹持定位在砧座24和槽22之间的组织。击发触发器20在闭合触发器18的更外侧。如以下进一步描述的,一旦闭合触发器18被锁定在闭合位置,击发触发器20即可朝向手枪式握把26略微旋转,使得其可由操作者单手触及。然后,操作者可将击发触发器20可枢转地拉向手枪式握把26,以致使缝合和切断夹持在端部执行器12中的组织。在其他实施例中,可使用除砧座24之外的不同类型的夹持构件,诸如例如相对的钳口等。
应当理解,本文所使用的术语“近侧”和“远侧”是相对于握持器械10的柄部6的临床医生而言的。因此,端部执行器12相对于更近侧的柄部6是远侧的。还应当理解,为简洁和清楚起见,本文可结合附图使用诸如“竖直”和“水平”的空间术语。然而,外科器械用于许多取向和位置中,并且这些用语并非旨在为限制性和绝对化的。
闭合触发器18可被首先致动。一旦临床医生对于端部执行器12的定位感到满意,则临床医生可将闭合触发器18拉回至其紧邻手枪式握把26的完全闭合、锁定的位置。可然后致动击发触发器20。当临床医生移除压力时,击发触发器20返回至打开位置(如图1和图2所示),如下文将更全面描述。当压下柄部6上的释放按钮时,可释放被锁定的闭合触发器18。释放按钮可实现为各种形式,诸如例如图42-43所示的释放按钮30、图14所示的滑动释放按钮160和/或图16所示的按钮172。
图3-6示出了根据各种实施例的旋转驱动端部执行器12和轴8的实施方式。图3是根据各种实施例的端部执行器12的分解图。如例示的实施例中所示,除了先前提到的槽22和砧座24之外,端部执行器12可包括切割器械32、滑动件33、可移除地安置于槽22中的钉仓34,和螺旋状螺杆轴36。切割器械32可为例如刀片。砧座24可在连接到槽22的近侧端部的枢轴销25处枢转地打开和闭合。砧座24还可包括位于其近侧端部处的凸块27,凸块27被插入机械闭合系统(下文进一步描述)的部件中以打开和闭合砧座24。当闭合触发器18被致动即被器械10的使用者拉动时,砧座24可围绕枢轴销25枢转到夹持或闭合位置。如果端部执行器12的夹持令人满意,则操作者可致动击发触发器20,如下文更详细说明的,使刀片32和滑动件33沿槽22纵向行进,从而切割被夹持在端部执行器12内的组织。滑动件33沿槽22的运动致使钉仓34的钉(未示出)被驱动穿过切断的组织并抵靠闭合的砧座24,这使得钉旋转以紧固切断的组织。在各种实施例中,滑动件33可为钉仓34的一体部件。授予Shelton,IV等人的名称为“SURGICAL STAPLING INSTRUMENT INCORPORATING AN E-BEAM FIRINGMECHANISM”的美国专利6,978,921提供了更多关于二行程切割和紧固器械的详细信息,该专利申请全文以引用的方式并入本文。滑动件33可为仓34的一部分,使得当刀片32在切割操作后回缩时,滑动件33不回缩。
应该指出的是,虽然本文描述的器械10的实施例采用缝合被切断的组织的端部执行器12,但是在其他实施例中,可使用用于紧固或密封被切断的组织的不同技术。例如,也可使用利用RF能或粘合剂来紧固被切断的组织的端部执行器。授予Yates等人的名称为“ELECTROSURGICAL HEMOSTATIC DEVICE”的美国专利5,709,680以及授予Yates等人的名称为“ELECTROSURGICAL HEMOSTATIC DEVICE WITH RECESSED AND/OR OFFSET ELECTRODES”的美国专利5,688,270公开了使用RF能来密封被切断的组织的内窥镜式切割器械,该专利申请全文以引用的方式并入本文。授予Jerome R.Morgan等人的美国专利申请序列号11/267,811以及授予Frederick E.Shelton,IV等人的美国专利申请序列号11/267,383公开了使用粘合剂来紧固被切断的组织的切割器械,该专利申请全文以引用的方式并入本文。因此,虽然本文的描述涉及切割/缝合操作等,但是应当认识到:这仅是示例性实施方式,并不意味着加以限制。也可使用其他组织紧固技术。
图4和5是根据各种实施例的端部执行器12和轴8的分解图,并且图6是它们的侧视图。如例示的实施例中所示,轴8可包括由枢轴连接件44可枢转地连接的近侧闭合管40和远侧闭合管42。远侧闭合管42包括开口45,其中砧座24上的凸块27插入到开口45中以便打开和闭合砧座24,如下面进一步所描述。在闭合管40,42内部设置的可为近侧脊管46。在近侧脊管46内部设置的可为通过锥齿轮组件52与次(或远侧)驱动轴50连接的主旋转(或近侧)驱动轴48。次驱动轴50被连接至与螺旋状螺杆轴36的近侧驱动齿轮56接合的驱动齿轮54。竖直锥齿轮52b可位于近侧脊管46的远侧端部中的开口57中并在其中枢转。远侧脊管58可用于包封次驱动轴50和驱动齿轮54,56。主驱动轴48、次驱动轴50和关节运动组件(例如锥齿轮组件52a-c)在本文中有时被全体地称作“主驱动轴组件”。
定位在钉槽22的远侧端部处的轴承38接收螺旋状驱动螺杆36,从而允许螺旋状驱动螺杆36相对于槽22自由地旋转。螺旋状螺杆轴36可交接刀片32的螺纹开口(未示出),使得轴36的旋转导致刀片32向远侧或近侧(取决于旋转方向)平移穿过钉槽22。因此,当击发触发器20的致动造成主驱动轴48旋转(在下面更详细解释)时,锥齿轮组件52a-c使次驱动轴50旋转,这继而又由于驱动齿轮54,56的接合而导致螺旋状螺杆轴36旋转,这使刀片驱动构件32沿槽22纵向行进而切割被夹持在端部执行器12内的任何组织。滑动件33可由例如塑料制成,并且可具有倾斜的远侧表面。由于滑动件33横贯槽22,其倾斜前表面可上推或驱动钉仓中的钉穿过被夹持的组织,并抵靠砧座24。砧座24使钉弯折,从而缝合被切断的组织。当刀片32回缩时,刀片32和滑动件33可变得脱离,从而使滑动件33保留在槽22的远侧端部处。
如上所述,由于缺乏切割/缝合操作的使用者反馈,所以内科医生普遍不接受其中切割/缝合操作仅通过按下按钮而致动的马达驱动的直线切割器。相比之下,本发明的实施例提供了马达驱动直线切割器,其具有针对端部执行器12中的切割器械32的部署、力和/或位置的使用者反馈。
图7-10示出了马达驱动直线切割器(特别是其柄部)的示例性实施例,该实施例提供关于端部执行器12中的切割器械32的部署和加载力的使用者反馈。此外,该实施例可利用使用者在回缩击发触发器20时提供的动力来对装置供能(所谓的“助力”模式)。该实施例可与上述的旋转驱动端部执行器12和轴8实施例一起使用。如例示的实施例中所示,柄部6包括外部下侧件59,60和外部上侧件61,62,它们配合在一起以形成一般来讲柄部6的外部。诸如锂离子电池的电池64可设置在柄部6的手枪式握把件26中。电池64为设置在柄部6的手枪式握把部26的上部中的电动马达65供电。根据各种实施例,马达65可为DC有刷驱动马达,其最大转速大约为25,000RPM。也可使用其他合适类型的电动马达。马达65可驱动包括第一锥齿轮68和第二锥齿轮70的90°锥齿轮组件66。锥齿轮组66可驱动行星式齿轮组72。行星式齿轮组件72可包括连接到驱动轴76的小齿轮74。小齿轮74可驱动配对的环形齿轮78,环形齿轮78通过驱动轴82来驱动螺旋齿轮筒80。环84可螺纹接合在螺旋齿轮筒80上。因此,当马达65旋转时,环84利用介于其间的锥齿轮组件66、行星式齿轮组件72和环形齿轮78而沿螺旋齿轮筒80行进。
柄部6还可包括与击发触发器20通信的运转马达传感器110(见图10),以便检测出操作者何时将击发触发器20拉近(或“闭合”)柄部6的手枪式握把部26,从而致动由端部执行器12执行的切割/缝合操作。传感器110可为比例传感器,诸如例如变阻器或可变电阻器。当拉回击发触发器20时,传感器110检测该运动并发出指示要供给马达65的电压(或功率)的电信号。当传感器110是可变电阻器等时,马达65的转速通常可与击发触发器20的移动量成比例。也就是说,如果操作者仅轻微拉动或者闭合击发触发器20,则马达65的转速相对较低。当完全收回击发触发器20(或处于完全闭合位置)时,马达65的转速为其最大值。换句话讲,使用者越用力拉动击发触发器20,施加到马达65上的电压就越大,从而使得转速就越大。
柄部6可包括与击发触发器20上部相邻的中间柄部件104。柄部6还可包括连接在中间柄部件104上的柱和击发触发器20上的柱之间的偏压弹簧112。偏压弹簧112可将击发触发器20朝其完全打开位置偏压。这样,当操作者释放击发触发器20时,偏压弹簧112将击发触发器20拉向其打开位置,从而移除传感器110的致动,从而停止马达65的旋转。此外,借助于偏压弹簧112,每当使用者闭合击发触发器20时,使用者将感受到对闭合操作的阻力,从而向使用者提供关于马达65所施加的旋转量的反馈。另外,操作者可停止回缩击发触发器20以因此将力从传感器100移除,从而使马达65停止。这样,使用者即可停止部署端部执行器12,从而为操作者提供了对切割/紧固操作进行控制的方式。
螺旋齿轮筒80的远侧端部包括驱动环形齿轮122的远侧驱动轴120,环形齿轮122与小齿轮124配合。小齿轮124连接到主驱动轴组件的主驱动轴48。这样,马达65的旋转致使主驱动轴组件旋转,从而启动端部执行器12,如上所述。
螺纹接合在螺旋齿轮筒80上的环84可包括设置在开槽臂90的狭槽88内的柱86。开槽臂90在其相对端94上具有开口92,开口92接收连接在柄部外侧件59,60之间的枢轴销96。枢轴销96还穿过击发触发器20中的开口100和中间柄部件104中的开口102而设置。
此外,柄部6可包括反向马达传感器(或行程结束传感器)130和止动马达(或行程开始)传感器142。在各种实施例中,反向马达传感器130可为位于螺旋齿轮筒80的远侧端部处的限位开关,使得螺纹接合在螺旋齿轮筒80上的环84在其到达螺旋齿轮筒80的远侧端部时接触并触动反向马达传感器130。反向马达传感器130在被致动时向马达65发送信号,以使其旋转反向,从而在切割操作后回缩端部执行器12的刀片32。
止动马达传感器142可为例如常闭限位开关。在各种实施例中,其可位于螺旋齿轮筒80的近侧端部处,使得环84在其到达螺旋齿轮筒80的近侧端部时触动开关142。
在操作过程中,当器械10的操作者回拉击发触发器20时,传感器110检测到击发触发器20的部署并向马达65发出信号以使马达65正向旋转,例如使马达以与操作者回拉击发触发器20的力度成比例的速率旋转。马达65的正向旋转继而使得行星式齿轮组件72的远侧端部处的环形齿轮78旋转,从而使得螺旋形齿轮筒80旋转,使螺纹接合在螺旋齿轮筒80上的环84沿螺旋齿轮筒80朝远侧行进。螺旋齿轮筒80的旋转还驱动如上所述的主驱动轴组件,这继而使端部执行器12中的刀片32被部署。也就是说,使得刀片32和滑动件33纵向穿过槽22,从而切割被夹持在端部执行器12中的组织。此外,在使用缝合型端部执行器12的实施例中使端部执行器12进行缝合操作。
当端部执行器12的切割/缝合操作完成时,螺旋齿轮筒80上的环84将已到达螺旋齿轮筒80的远侧端部,从而使反向马达传感器130被触动,传感器130将信号发送至马达65以使马达65的旋转反向。这继而使得刀片32回缩,并且还使螺旋齿轮筒80上的环84运动回到螺旋齿轮筒80的近侧端部。
中间柄部件104包括与开槽臂90接合的后侧肩部106,如图8和图9中最佳显示。中间柄部件104还具有接合击发触发器20的前移止挡件107。如以上所解释,开槽臂90的运动受马达65旋转的控制。当开槽臂90随着环84从螺旋齿轮筒80的近侧端部行进到远侧端部而逆时针旋转时,中间柄部件104将不受约束而逆时针旋转。因此,当使用者拉近击发触发器20时,击发触发器20将与中间柄部件104的前移止挡件107接合,使中间柄部件104逆时针旋转。然而,由于后侧肩部106与开槽臂90接合,中间柄部件104将只能够在开槽臂90许可的范围内逆时针旋转。这样一来,如果马达65出于某种原因停止旋转,则开槽臂90就会停止旋转,并且使用者会无法进一步拉近击发触发器20,由于中间柄部件104由于开槽臂90的约束而不能自由逆时针旋转。
图10A和10B示出了根据本发明的各种实施例的可用作运转马达传感器110的可变传感器的两种状态。传感器110可包括面部分280、第一电极(A)282、第二电极(B)284以及电极282和284之间的可压缩电介质材料286,诸如例如电活性聚合物(EAP)。传感器110可被定位成使得在回缩时面部分280接触击发触发器20。因此,当击发触发器20回缩时,电介质材料286被压缩,如图10B所示,使电极282,284一起靠得更近。由于电极282,284之间的距离“b”直接关系到电极282,284之间的阻抗,距离越大阻抗就越大,距离越近阻抗就越小。这样,由于击发触发器20的回缩而使电介质286被压缩的量(图42中以力“F”表示)与电极282,284之间的阻抗成比例,这可用于按比例控制马达65。
图7-10中还示出了用于通过回缩闭合触发器18来闭合(或夹持)端部执行器12的砧座24的示例性闭合系统的部件。在例示的实施例中,闭合系统包括通过枢轴销251连接到闭合触发器18的轭250,枢轴销251被插入穿过对准的位于闭合触发器18和轭250这二者中的开口。闭合触发器18围绕枢轴销252枢转,并且枢轴销252插入穿过闭合触发器18中的另一开口,该开口偏离销251插入穿过闭合触发器18的位置。因此,闭合触发器18的回缩使得闭合触发器18的上部逆时针旋转,轭250通过销251附接到闭合触发器18。轭250的远侧端部通过销254连接到第一闭合托架256。第一闭合托架256连接到第二闭合托架258。闭合托架256,258共同限定开口,近侧闭合管40(见图4)的近侧端部被安置和保持在该开口中,使得闭合托架256,258的纵向运动致使近侧闭合管40的纵向运动。器械10还包括设置在近侧闭合管40内的闭合杆260。闭合杆260可包括窗口261,位于柄部外部件中的一个(诸如例示的实施例中的外部下侧件59)上的柱263设置在窗口261中,以将闭合杆260固定地连接到柄部6。这样,近侧闭合管40能够相对于闭合杆260纵向运动。闭合杆260还可包括远侧轴环267,其装配在近侧脊管46中的腔269内并由帽271(见图4)保持在腔内。
在操作中,当轭250由于闭合触发器18的回缩而旋转时,闭合托架256,258使得近侧闭合管40朝远侧运动(即远离器械10的柄部端),这使得远侧闭合管42朝远侧运动,从而使得砧座24绕枢轴销25旋转到夹持或闭合位置。当闭合触发器18从锁定位置释放时,近侧闭合管40因此向近侧滑动,从而使得远侧闭合管42向近侧滑动,通过插入远侧闭合管42的窗口中45的凸块27,这使得砧座24绕枢轴销25枢转至打开或松开位置。这样,通过回缩并锁定闭合触发器18,操作者可将组织夹持在砧座24和槽22之间,并且可在切割/缝合操作后通过将闭合触发器20从锁定位置释放来松开组织。
图11是根据本发明的各种实施例的器械10的电路的示意图。当操作者在锁定闭合触发器18后开始拉近击发触发器20时,传感器110启动,从而使电流从中流过。如果常开反向马达传感器开关130打开(表明还未到达端部执行器行程的末尾),电流将流向单刀双掷继电器132。由于反向马达传感器开关130未闭合,则继电器132的电感器134不通电,因此继电器132将处于其未通电状态。电路还包括钉仓闭锁传感器136。如果端部执行器12包括钉仓34,则传感器136将处于闭合状态,从而允许电流流过。否则,如果端部执行器12不包括钉仓34,则传感器136将打开,从而防止电池64为马达65供电。
当存在钉仓34时,传感器136闭合,从而为单刀单掷继电器138通电。当为继电器138通电时,电流流经继电器136,流过可变电阻器传感器110,并通过双刀双掷继电器140到达马达65,从而为马达65供电并允许其正向旋转。
当端部执行器12到达其行程末尾时,反向马达传感器130被启动,从而闭合开关130并为继电器134通电。这使继电器134处于其通电状态(图13中未示出),使电流不通过钉仓闭锁传感器136和可变电阻器110而流向常闭双刀双掷继电器142并流回马达65,但是以导致马达65反向旋转的方式经过继电器140。
由于止动马达传感器开关142为常闭,所以电流将流回继电器134以保持其闭合,直到开关142打开。当刀片32完全回缩时,止动马达传感器开关142被启动,使得开关142断开,从而将马达65断电。
在其他实施例中,代替比例型传感器110,可使用通断型传感器。在此类实施例中,马达65的转速将不与操作者施加的力成比例。相反,马达65通常将恒速旋转。但是由于击发触发器20与齿轮驱动系接合,因此操作者仍将感受到力反馈。
图12是根据另一个实施例的动力辅助机动化直线切割器的柄部6的侧视图。图12的实施例类似于图7-10的实施例,不同的是在图12的实施例中,不存在连接至以螺纹方式接合在螺旋齿轮筒80上的环84的开槽臂。相反,在图12的实施例中,环84包括当环84在螺旋齿轮筒80上向下(和向后)行进时随环84一起运动的传感器部分114。传感器部分114包括凹口116。反向马达传感器130可位于凹口116的远侧端部,并且止动马达传感器142可位于凹口116的近侧端部。当环84在螺旋齿轮筒80上向下(和向后)运动时,传感器部分114与其一起运动。另外,如图12中所示出,中间件104可具有延伸到凹口12中的臂118。
在操作中,当器械10的操作者朝手枪式握把26回缩击发触发器20时,运转马达传感器110检测该运动并发送信号以向马达65供电,此外,这还使螺旋齿轮筒80旋转。当螺旋齿轮筒80旋转时,螺纹接合在螺旋齿轮筒80上的环84前进(或者回缩,具体取决于旋转方向)。此外,由于击发触发器20的向内牵拉,因此,中间件104由于与击发触发器20接合的前移止挡件107而随击发触发器20逆时针旋转。中间件104的逆时针旋转导致臂118随着环84的传感器部分114逆时针旋转,使得臂118保持设置在凹口116内。当环84到达螺旋齿轮筒80的远侧端部时,臂118将接触并因此触动反向马达传感器130。相似地,当环84到达螺旋齿轮筒80的近侧端部时,臂将接触并因此触动止动马达传感器142。此类动作可分别使马达65反转和停止,如上所述。
图13是根据另一个实施例的动力辅助机动化直线切割器的柄部6的侧视图。图13的实施例类似于图7-10的实施例,不同的是在图13的实施例中,臂90中没有狭槽。相反,螺纹接合在螺旋齿轮筒80上的环84包括竖直槽126。臂90包括设置在槽126中的柱128,而不是狭槽。当螺旋齿轮筒80旋转时,螺纹接合在螺旋齿轮筒80上的环84前进(或者回缩,具体取决于旋转方向)。由于柱128设置在槽126中,臂90随着环84的前进而逆时针旋转,如图13所示。
如上所述,在使用二行程机动化器械时,操作者首先向后拉动并锁定闭合触发器18。图14和图15示出了将闭合触发器18锁定在柄部6的手枪式握把部26上的方式的一个实施例。在例示的实施例中,手枪式握把部26包括钩150,其因扭转弹簧152的作用而偏向于绕枢轴点151逆时针旋转。此外,闭合触发器18包括闭合杆154。操作者将闭合触发器18向内拉动时,闭合杆154与钩150的倾斜部分156接合,从而钩150向上(或图14-15中的顺时针方向)旋转,直至闭合杆154完全通过倾斜部分156并进入钩150的凹进的凹口158,从而将闭合触发器18锁定到位。操作者可通过向下推动位于手枪式握把部26的后侧或相对侧上的滑动释放按钮160来释放闭合触发器18。推下滑动释放钮160使钩150顺时针旋转,从而使闭合杆154从凹进的凹口158释放。
图16示出了根据各种实施例的另一种闭合触发器锁定机构。在图16的实施例中,闭合触发器18包括具有箭头部分161的楔形件160。箭头部分161被片簧162向下(或顺时针方向)偏压。楔形件160和片簧162可以由例如模制塑料制成。当闭合触发器18回缩时,箭头部分161插入穿过柄部6的手枪式握把部26中的开口164。箭头部分161的下斜切面166接合开口164的下侧壁168,从而迫使箭头部分161沿逆时针方向旋转。最后,下斜切面166完全通过下侧壁168,作用于箭头部分161的逆时针转动力被消除,从而使下侧壁168滑入箭头部分161后面的凹口170中的锁定位置。
要使闭合触发器18解锁,使用者可按下闭合触发器18的相对侧上的按钮172,使箭头部分161逆时针旋转,并让箭头部分161滑出开口164。
图17-22示出了根据另一个实施例的闭合触发器锁定机构。如该实施例中所示,闭合触发器18包括纵向柔性臂176,纵向柔性臂176包括从其中伸出的侧销178。臂176和销178可以由例如模制塑料制成。柄部6的手枪式握把部26包括开口180,开口180具有设置在其中的横向延伸的楔形件182。当闭合触发器18回缩时,销178与楔形件182接合,并且销178被楔形件182的下表面184压下(即臂176顺时针旋转),如图17和18所示。当销178完全通过下表面184,臂176上顺时针方向作用力被去除,并且销178逆时针旋转,使得销178终于落入楔形件182后的凹口186中,从而锁定闭合触发器18,如图19所示。销178进一步通过从楔形件184延伸的柔性止挡件188而在锁定位置中保持就位。
为了使闭合触发器18解锁,操作者可进一步挤压闭合触发器18,使销178接合开口180的倾斜后壁190,从而促使销178向上越过柔性止挡件188,如图20和21所示。销178然后在开口180中自由地从上部槽192移出,使得闭合触发器18不再被锁定到手枪式握把部26,如图22所示。
图23A-B示出了万向接头(“u型接头”)195。u型接头195的第二构件195-2在水平面上旋转,第一构件195-1位于该水平面中。图23A示出了直线(180°)取向的u型接头195,并且图23B示出了呈大约150°取向的u型接头195。可在主驱动轴组件的关节运动点14处用u型接头195代替锥齿轮52a-c(例如见图4),以使端部执行器12进行关节运动。图24A-B示出了扭转缆线197,其可用于代替锥齿轮52a-c和u型接头195,以实现端部执行器12的关节运动。
图25-31示出了根据本发明的另一个实施例的具有动力辅助的机动化二行程外科切割和紧固器械10的另一个实施例。图25-31的实施例类似于图6-10的实施例,不同的是图23-28的实施例包括替代的齿轮驱动组件,而不是螺旋齿轮筒80。图25-31的实施例包括齿轮箱组件200,其包括设置在框架201中的数个齿轮,其中这些齿轮连接在行星式齿轮72与驱动轴48近侧端部处的小齿轮124之间。如下面进一步解释,齿轮箱组件200通过击发触发器20为使用者提供关于端部执行器12的部署和加载力的反馈。而且,用户可通过齿轮箱组件200为系统提供动力,以辅助端部执行器12的部署。从这个意义上说,类似于如上所述的实施例,图23-32的实施例是另一种动力辅助机动化器械10,其可向使用者提供关于器械所受到的加载力的反馈。
在例示的实施例中,击发触发器20包括两个部分:主体部分202和刚性部分204。主体部分202可由例如塑料制成,而刚性分204可由更刚性的材料(诸如金属)制成。在例示的实施例中,刚性部分204与主体部分202相邻,但根据其他实施例,刚性部分204可设置在主体部分202的内部。枢轴销207可插入穿过击发触发器构件202,204中的开口并可为击发触发器20围绕其旋转的点。此外,弹簧222可导致击发触发器20偏向逆时针旋转。弹簧222可具有连接至销224的远侧端部,销224连接至击发触发器20的构件202,204。弹簧222的近侧端部可连接至柄部外部下侧件59,60中的一者。
在例示的实施例中,主体部分202和刚性部分204在其上端部分(分别)包括齿轮部206,208。齿轮部206,208接合齿轮箱组件200中的齿轮(如下文所解释),以驱动主驱动轴组件并为使用者提供关于端部执行器12部署的反馈。
如例示的实施例中所示出,齿轮箱组件200可包括六(6)个齿轮。齿轮箱组件200的第一齿轮210接合击发触发器20的齿轮部206,208。此外,第一齿轮210接合更小的第二齿轮212,更小的第二齿轮212与大的第三齿轮214共轴。第三齿轮214接合更小的第四齿轮216,更小的第四齿轮与第五齿轮218共轴。第五齿轮218是90°锥齿轮,其接合连接至小齿轮124的配对的90°锥齿轮220(图31中清晰显示),小齿轮124驱动主驱动轴48。
在操作时,当使用者回缩击发触发器20时,运转马达传感器(未示出)启动,其可向马达65提供信号,使其以与操作者回缩击发触发器20的程度或者力成比例的速度旋转。这使得马达65以与来自传感器的信号成比例的速度旋转。此实施例中未示出传感器,但其可类似于上述的运转马达传感器110。传感器可位于柄部6中,使得其在击发触发器20回缩时被压缩。此外,可使用通/断型传感器,而不是比例型传感器。
马达65的旋转使锥齿轮68,70旋转,由此使得行星式齿轮72旋转,从而通过驱动轴76使环形齿轮122旋转。环形齿轮122与小齿轮124啮合,小齿轮124连接到主驱动轴48。因此,小齿轮124的旋转驱动主驱动轴48,这致动端部执行器12的切割/缝合操作。
小齿轮124的向前旋转继而使得锥齿轮220旋转,从而通过齿轮箱组件200的其他齿轮来使第一齿轮210旋转。第一齿轮210接合击发触发器20的齿轮部分206,208,从而在马达65对端部执行器12提供向前驱动时使击发触发器20逆时针旋转(并且在马达65反转而回缩端部执行器12时逆时针旋转)。这样,使用者通过其握持击发触发器20来感受关于端部执行器12的加载力和部署的反馈。因此,当使用者回缩击发触发器20时,操作者将感受到与端部执行器12受到的加载力相关的阻力。同样地,在切割/缝合操作后操作者将击发触发器20释放以使其返回到原来位置,使用者将感受到来自击发触发器20的大致与马达65的反向速度成正比的顺时针旋转力。
还应该指出的是,在此实施例中,使用者可施加力(代替或补充来自马达65的力)以通过回缩击发触发器20来致动主驱动轴组件(由此致动端部执行器12的切割/缝合操作)。也就是说,回缩击发触发器20使齿轮部分206,208逆时针旋转,使齿轮箱组件200的齿轮旋转,从而使小齿轮124旋转,这将导致主驱动轴48旋转。
尽管在图25-31中未示出,但是器械10还可包括反向马达传感器和止动马达传感器。如上所述,反向马达传感器和止动马达传感器可分别检测切割行程的结束(刀片32的全面部署)以及回缩操作的结束(刀片32的全面回缩)。与上述图11相关联的类似电路可用于为马达65适当供电。
图32-36示出了根据另一个实施例的带有动力辅助的二行程机动化外科切割和紧固器械10。图32-36的实施例类似于图25-31的实施例,不同的是在图32-36的实施例中,击发触发器20包括下部228和上部230。下、上部228,230均与穿过上、下部228,230设置的枢轴销207连接并绕其枢转。上部230包括与齿轮箱组件200的第一齿轮210接合的齿轮部232。弹簧222连接至上部230,使上部偏向顺时针旋转。上部230可还包括与击发触发器20的下部228的上表面接触的下臂234,这样,当上部230因此以顺时针旋转时下部228也顺时针旋转,并且当下部228逆时针旋转时上部230也逆时针旋转。同样,下部228包括与上部230的肩部接合的旋转止挡件238。这样,当使上部230沿逆时针方向旋转时,下部228也沿逆时针方向旋转,并且当下部228沿顺时针方向旋转时,上部230也沿顺时针方向旋转。
例示的实施例还包括为马达65传达信号的运转马达传感器110,在各种实施例中,该信号可使马达65以与操作者回缩击发触发器20时施加的力成比例的速度旋转。传感器110可为例如变阻器或某些其他可变电阻传感器,如本文所解释。此外,器械10可包括反向马达传感器130,其在与击发触发器20的上部230的正面242接触时触动或切换。当启动时,反向马达传感器130将信号发送至马达65,以使其反向。此外,器械10可包括在与击发触发器20的下部228接触时被触动或致动的止动马达传感器142。当启动时,止动马达传感器142发送信号以停止马达65的反向旋转。
在操作中,当操作者将闭合触发器18回缩到锁定位置时,击发触发器20略微回缩(通过本领域已知的机构,包括授予Frederick Shelton,IV等人的美国专利6,978,921和授予Jeffery S.Swayze等人的美国专利6,905,057,所述专利全文以引用的方式并入本文),使得使用者可抓握击发触发器20来开始切割/缝合操作,如图32和图33所示。此时,如图33所示,击发触发器20上部230的齿轮部232运动至与齿轮箱组件200的第一齿轮210接合。当操作者回缩击发触发器20时,根据各种实施例,在触动运转马达传感器110之前,击发触发器20可旋转较小的量(诸如5度),如图34中所示。传感器110的启动使马达65以与由操作者施加的回缩力成比例的速度正向旋转。如上所述,马达65正向旋转引起主驱动轴48旋转,这使得端部执行器12中的刀片32被部署(即开始穿过槽22)。连接至主驱动轴48的小齿轮124的旋转使齿轮箱组件200中齿轮210-220旋转。由于第一齿轮210与击发触发器20的上部230的齿轮部分232接合,上部232因此逆时针旋转,这导致下部228也逆时针旋转。
当刀片32的部署完成(即在切割行程结束)时,上部230的正面242触动反向马达传感器130,反向马达传感器130将信号发送至马达65,使其反方向旋转。这使得主驱动轴组件反方向旋转以回缩刀片32。主驱动轴组件的反转也导致齿轮箱组件中齿轮210-220反向旋转,使击发触发器20的上部230顺时针旋转,这将导致击发触发器20的下部228顺时针旋转,直到刀片32完全回缩时下部228触动或致动止动马达传感器142,从而使马达65停止。这样,使用者通过其握持击发触发器20来感受关于端部执行器12部署的反馈。因此,当使用者回缩击发触发器20时,操作者将感受到与端部执行器12的部署相关的阻力,特别是与由于刀片32受到的加载力相关的阻力。同样地,在切割/缝合操作后操作者将击发触发器20释放以使其返回到原来位置,使用者将感受到来自击发触发器20的大致与马达65的反向速度成正比的顺时针旋转力。
还应该指出的是,在此实施例中,使用者可施加力(代替或补充来自马达65的力)以通过回缩击发触发器20来致动主驱动轴组件(由此致动端部执行器12的切割/缝合操作)。也就是说,回缩击发触发器20导致上部230的齿轮部分232逆时针旋转,这使齿轮箱组件200的齿轮旋转,从而使小齿轮124旋转,这又使主驱动轴组件旋转。
以上所述的实施例采用动力辅助使用者反馈系统,其中带或不带用于二行程机动化切割和紧固器械的适应性控制(例如,在马达65、齿轮驱动系和端部执行器12的闭环系统之外使用传感器110,130和142)。也就是说,由于击发触发器20被(直接或间接地)啮合到马达65和主驱动轴48之间的齿轮驱动系中,由使用者施加的用以回缩击发触发器20的力可被添加到由马达65施加的力。在本发明的其他实施例中,可对使用者提供关于刀片32在端部执行器中的位置(但无需使击发触发器20啮合到齿轮驱动系中)的触觉反馈。图37-40示出了具有此类触觉位置反馈系统的机动化外科切割和紧固器械。
在图37-40的例示的实施例中,击发触发器20可具有下部228和上部230,类似于图32-36中示出的器械10。然而,不同于图32-36的实施例,上部230不具有与部分齿轮驱动系配合的齿轮部。替代地,器械包括第二马达265,第二马达265具有螺纹接合在其中的螺杆266。当马达265旋转时,螺杆266纵向往复进出(取决于旋转方向)马达265。器械10还包括编码器268,其响应主驱动轴48的旋转,将主驱动轴48(或主驱动轴组件的其他部件)的增量角运动转化成例如对应的一系列数字信号。在例示的实施例中,小齿轮124包括连接至编码器268的近侧端部驱动轴270。
器械10还包括可使用微控制器或某些其他类型的集成电路实现的控制电路(未示出),该控制电路接收来自编码器268的数字信号。根据来自编码器268的信号,控制电路可计算端部执行器12中刀片32部署的阶段。也就是说,控制电路可计算刀片32是否完全部署、完全回缩或者处于中间阶段。根据对端部执行器12部署阶段的计算,控制电路可将信号发送至第二马达265以控制其旋转,从而控制螺杆266的往复运动。
在操作中,如图37所示,当闭合触发器18未锁定到夹持位置时,击发触发器20远离柄部6的手枪式握把部26旋转,使得击发触发器20的上部230的正面242不与螺杆266的近侧端部接触。当操作者回缩闭合触发器18并将其锁定在夹持位置时,击发触发器20略微朝闭合触发器20旋转,使得操作者可握持击发触发器20,如图38所示。在此位置,上部230的正面242接触螺杆266的近侧端部。
当使用者随后回缩击发触发器20时,运转马达传感器110可以在初始旋转量(例如5度的旋转)后被致动,如上所述,使得传感器110将信号发送至马达65,以使其以与由操作者施加到击发触发器20的回缩力的量成比例的正向速度旋转。马达65的正向旋转通过齿轮驱动系使主驱动轴48旋转,由此使得刀片32和滑块33沿着槽22向下行进并切割夹持在端部执行器12中的组织。控制电路接收来自编码器268的关于主驱动轴组件的增量旋转的输出信号,将信号发送到第二马达265以使第二马达265旋转,由此使得螺杆266回缩到马达265中。这使得击发触发器20的上部230能够逆时针旋转,从而使击发触发器的下部228也逆时针旋转。这样,由于螺杆266的往复运动与主驱动轴组件的旋转相关,因此器械10的操作者通过他/她握持击发触发器20来感受关于端部执行器12位置的触觉反馈。然而,由使用者施加的回缩力不直接影响主驱动轴组件的驱动,因为击发触发器20并未啮合到此实施例中的齿轮驱动系中。
通过对来自编码器268的输出信号对主驱动轴组件的增量旋转进行跟踪,控制电路可计算刀片32何时被完全部署(即完全伸展)。此时,控制电路可将信号发送至马达65以反转方向,从而使刀片32回缩。马达65的反转方向使主驱动轴组件反向旋转,这也被编码器268检测。根据编码器268检测到的反向旋转,控制电路将信号发送至第二马达265以使其反转,使得螺杆266开始从马达265纵向延伸。此运动迫使击发触发器20的上部230顺时针旋转,从而导致下部228顺时针旋转。这样,操作者可感受到来自击发触发器20的顺时针旋转力,这为操作者提供了关于端部执行器12中刀片32的回缩位置的反馈。控制电路可确定刀片32何时完全回缩。此时,控制电路可将信号发送至马达65以使其停止旋转。
根据其他实施例,可使用反向马达传感器和止动马达传感器而不是用控制电路来确定刀片32的位置,如上所述。此外,可使用通/断开关或传感器而不是用比例传感器110来控制马达65的旋转。在此类实施例中,操作者不能控制马达65的转速。确切地说,马达会以预编程的速度旋转。
图41-43示出了机械致动的直线切割器,并且具体地为其柄部6、轴8和端部执行器12的示例性实施例。机械致动的直线切割器的更多详细信息可见于名称为“SurgicalStapling Instrument Incorporating A Multi-Stroke Firing Mechanism WithAutomatic End Of Firing Travel Retraction”的美国专利申请序列号11/052,632,该专利申请全文以引用的方式并入本文。参照图41,端部执行器12响应来自柄部6闭合运动(图41中未示出),首先通过包括砧面1002连接到砧座近侧端部1004来响应,该砧座近侧端部1004包括位于垂直突出的砧座凸块27的近侧的侧向突出的砧座枢轴销25。砧座枢轴销25在钉槽22中的肾形开口1006内移动,以相对于槽22打开和关闭砧座24。凸块27接合于弯片1007,该弯片向内伸入闭合管1005的远侧端部1008上的凸块开口45,该闭合管在远侧终止于远侧边缘1008,该远侧边缘压靠在砧面1002上。因此,当闭合管1005从其开口位置向近侧移动,闭合管1005的弯片1007将砧座凸块27拉向近侧,并且砧座枢轴销25沿着钉槽22中的肾形开口1006移动,使得砧座24同时地向近侧移动并向上旋转至打开位置。当闭合管1005向远侧移动,凸块开口45中的弯片1007从砧座凸块27释放,其远侧边缘1008压在砧面1002上,将砧座24关闭。
继续参照图41,轴8和端部执行器12还包括响应击发连杆1010的击发运动的部件。具体地讲,击发杆1010可旋转地接合于具有纵向凹缝1014的击发槽构件1012。击发槽构件1012直接响应击发杆1010的纵向移动,在框架1016内纵向运动。闭合管1005中的纵向狭槽1018可操作地连接于柄部6的右外侧和左外侧柄构件61,62(图41中未示出)。闭合管1005中的纵向狭槽1018的长度足够长,允许相对于柄构件61,62的纵向运动以分别完成击发和闭合运动,柄构件61,62的结合通过框架1016中的纵向狭槽1020传递,以与框架槽构件1012中的纵向凹缝1014滑动接合。
框架槽构件1012的远侧端部附接到在框架1016内(特别是在导轨1024内)运动的击发杆1022的近侧端部,以将刀片32向远侧伸入端部执行器12。端部执行器12包括由刀片32致动的钉仓34。钉仓34具有托盘1028,托盘1028容纳钉仓主体1030、楔形滑动件驱动器33、钉驱动器1034和钉1036。应当理解,楔形滑动件驱动器33可在位于钉仓托盘1028和钉仓主体1030之间的击发凹缝(未图示)内纵向运动。楔形滑动件驱动器33呈现凸轮表面,这些凸轮表面接触并托起钉驱动器1034,驱动钉1036。钉仓主体1030还包括在近侧开口的垂直槽1031,用作刀片32的通道。具体而言,沿着刀片32的远侧端部设有切割表面1027,在组织被缝合后切割组织。
应当理解,图4中轴8被示出为非关节运动轴。但是,本发明的应用可包括能够进行关节运动的器械,例如如上结合图1-4所示的器械以及以下的美国专利和专利申请中所述的器械,每个公开据此全文以引用方式并入:(1)由Frederick E.Shelton IV、BrianJ.Hemmelgarn、Jeffrey S.Swayze、Kenneth S.Wales提交于2003年7月9日的名称为“SURGICAL INSTRUMENT INCORPORATING AN ARTICULATION MECHANISM HAVING ROTATIONABOUT THE LONGITUDINAL AXIS”的美国专利申请公开2005/0006434;(2)授予BrianJ.Hemmelgarn的名称为“SURGICAL STAPLING INSTRUMENT INCORPORATING ANARTICULATION JOINT FOR A FIRING BAR TRACK”的美国专利6,786,382;(3)授予JeffreyS.Swayze的名称为“A SURGICAL INSTRUMENT WITH A LATERAL-MOVING ARTICULATIONCONTROL”的美国专利6,981,628;(4)授予Frederick E.Shelton IV、Michael Setser、Bruce Weisenburgh II的名称为“SURGICAL STAPLING INSTRUMENT INCORPORATING ATAPERED FIRING BAR FOR INCREASED FLEXIBILITY AROUND THE ARTICULATION JOINT”的美国专利6,964,363;以及(5)由Jeffrey S.Swayze、Joseph Charles Hueil提交于2003年7月9日的名称为“SURGICAL STAPLING INSTRUMENT HAVING ARTICULATION JOINT SUPPORTPLATES FOR SUPPORTING A FIRING BAR”的美国专利申请公开2005/0006431。
图42-43示出了柄部6的实施例,柄部6被构造成能够与以上图41所示的轴8和端部执行器12的实施例一起用于机械致动的直线切割器中。应当理解,任何合适的柄部设计均可用于机械闭合和击发端部执行器12。在图42-43中,外科缝合和切断器械10的柄部6包括提供诸如增加的力量、减小的柄部尺寸、最小化的粘结等特征的联动击发机构1060。
通过朝柄部6的手枪式握把26按压闭合触发器18使端部执行器12闭合(在图42-43中未示出)。闭合触发器18围绕闭合枢轴销252枢转,闭合枢轴销252连接到柄部6的右外部下侧件59和左外部下侧件60,使闭合触发器18的上部1094向前运动。闭合管1005通过闭合轭250接收该闭合运动,闭合轭250通过闭合轭销1044和闭合联接销1046分别与闭合联接件1042和闭合触发器18的上部1094销连接。
在图42所示的完全打开位置中,闭合触发器18的上部1094接触并保持处于所示位置的枢转闭合释放钮30的锁臂1048。在闭合触发器18达到其完全按下的位置时,闭合触发器18释放锁臂1048并且其紧靠面1050转入与枢转锁臂1048的远侧右向凹口1052接合,将闭合触发器18保持在其夹持或闭合位置。锁臂1048的近侧端部与件59,60一起围绕侧向枢转连接件1054枢转,将闭合释放钮30露出。闭合释放钮30的中间远侧1056被压簧1058向近侧推压,压簧1058在壳体结构1040和闭合释放钮30之间被压缩。其结果是,闭合释放钮30将锁臂1048逆时针(当从左侧看时)推至与闭合触发器18的紧靠面1050锁定接触,从而防止在联动击发系统1040处于未回缩状态时闭合触发器18松开。
在闭合触发器18回缩并完全按下的情况下,击发触发器20被解锁并在本实施例中可被压向手枪式握把26多次,以使端部执行器12击发。如所描述,联动击发机构1060最初被回缩,受到拉伸/压缩组合弹簧1062的作用而保持在位,组合弹簧1062约束在柄部6的手枪式握把26内,其非移动端1063连接于构件59,60,其移动端1064连接于钢带1066的向下弯折的近侧回缩端1067。
钢带1066的朝远侧设置的端部1068附接到结构负载的联接构件1070,其继而又附接到多个连接基1072a-1072d中的前面连接基1072a,这些连接基形成链接齿条1074。链接齿条1074是柔性的,但其具有形成直刚性齿条组件的远侧环节,该齿条组件可通过轴6中的击发杆1010传递有效的击发力,然而可容易地回缩到手枪式握把26内,以将柄部6的纵向长度最小化。应当理解,组合拉伸/压缩弹簧1062增大可用的击发行程量,同时将单根弹簧的最小长度基本上减小一半。
击发触发器20绕击发触发器销钉96枢转,销钉96连接于柄构件59,60。当击发触发器20向手枪式握把26按压时击发触发器20的上部228绕着击发触发器销钉96向远侧运动,从而将设置在远侧的击发触发器拉簧222拉长,拉簧222的远侧端部连接在击发触发器20的上部228和件59,60之间。在每次通过附着偏压机构1078执行的击发触发器按压期间,击发触发器20的上部228与链接齿条1074接合,在击发触发器20被释放时附着偏压机构1078也脱开接合。击发触发器拉伸弹簧222在击发触发器20被释放时将其拉至远侧,并脱开附着偏压机构1078。
当联动击发机构1040致动时,惰轮1080通过与链接齿条1074的锯齿状上表面1082接合而顺时针旋转(从左侧看)。该旋转连接到指示器齿轮1084,因此其响应于惰轮1080作逆时针旋转。惰轮1080和指示器齿轮1084均与柄部6的构件59,60可旋转地连接。链接齿条1074、惰轮齿1080与指示器齿轮1084之间的齿轮关系可有利地进行选择,使得锯齿状上表面1082具有强度适当的齿尺寸,并且在联动击发机构1060的整个击发行程中指示器齿轮1084的旋转不超过一圈。
如下面更详细地描述,指示器齿轮1084执行至少四种功能。首先,当链接齿条1074完全回缩并且两个触发器18、20均如图42所示处于张开状态时,指示器齿轮1084左侧的圆形脊1088中的开口1086呈现给锁臂1048的上表面1090。锁臂1048通过与闭合触发器18接触而偏压进开口1086,闭合触发器18继而又被闭合拉簧1092拉至其张开位置。闭合触发器拉簧1092近侧端部地连接于闭合触发器18的上部1094和柄构件59,60,因而在闭合触发器18的关闭过程中使能量被存储,该能量促使闭合触发器18向远侧回到其非关闭位置。
指示器齿轮1084的第二个功能是:其连接在设置于柄部6外侧的指示回缩旋钮1096上。因此,指示器齿轮1084将击发机构1060的相对位置传递给回缩旋钮1096,使外科医生得到关于需要多少个击发触发器20的行程来完成击发的视觉指示。
指示器齿轮1084的第三个功能是:在外科缝合和切割器械10被操作时纵向和成角度地运动止退机构(单向离合器机构)1097的止退释放杆1098。在击发行程期间,止退释放杆1098通过指示器齿轮1084的近侧运动启动止退机构1097,以允许击发杆1010向远侧运动并防止击发杆1010向近侧运动。此运动也将止退释放按钮1100从柄构件59,60的近侧端部伸出,以供操作者在击发行程期间需要让联动击发机构1060回缩时致动。击发行程完成后,指示器齿轮1084由于击发机构1060回缩而改变旋转方向。反向旋转将止退机构1097停用,将止退释放按钮1100回缩柄部6内,并将止退释放杆1098转至右侧,以使指示器齿轮1084能够继续反向旋转。
指示器齿轮1084的第四个功能是:接受来自指示回缩旋钮1096(如图42所示的顺时针方向)的手动旋转,在止退机构1097解锁的情况下将击发机构1060回缩,从而克服击发机构1060中的任何约束,该约束不容易为组合拉伸/压缩弹簧1062所克服。在击发机构1060部分击发后可使用人力辅助回缩,否则这会被将止退释放按钮1100回缩的止退机构1097阻止,因此止退释放按钮1100不会将止退释放杆1098侧向移动。
继续参照图42-43,止退机构1097由操作者可触及的止退释放杆1098构成,止退释放杆1098可操作地在其近侧端部连接于止退释放按钮1100并在其远侧端部连接于止退轭1102。具体而言,止退释放杆1098的远侧端部1099通过止退轭销钉1104接合于止退轭1102。止退轭1102纵向运动,以将旋转传递至止退凸轮槽管1106,止退凸轮槽管1106被柄构件59,90在纵向上约束,并且在击发杆1010至链接齿条1074的联接构件1070的连接部的远侧将击发杆1010围住。止退轭1102将来自止退释放杆1098的纵向运动通过凸轮槽管销1108传递给止退凸轮槽管1106。也就是说,凸轮槽管销1108在止退凸轮槽管1106的斜向槽中的纵向运动,使止退凸轮槽管1106旋转。
止退压簧1110、止退片1112和止退凸轮管1114,分别被限制在框架1016的近侧端部和止退凸轮槽管1106之间。如图所示,击发杆1010的近侧运动导致止退片1112将顶部枢转到后方,从而呈现出对于击发杆1010增大的摩擦接触,这可阻止击发杆1010的进一步近侧运动。
当止退凸轮槽管1106与止退凸轮管1114相隔很近时,这种止退片1112以类似于可保持卷帘门打开的卷帘门门锁的方式枢转。具体而言,止退压簧1110能够作用于止退片1112的顶面,将止退片1112倾翻到其锁定位置。止退凸轮槽管1106的旋转导致止退凸轮管1114的远侧凸轮运动,从而对止退片1112的顶部向远侧加力,克服来自止退压簧1110的力,从而将止退片1112定位在非倾(垂直)、未锁定位置,使击发杆1010能够向近侧回缩。
特别参照图43,附着偏压机构1078被图示为由具有向远侧突出的窄尖1118的棘爪1116和在其近侧端部向右侧突出的侧销1120组成,侧销1120可旋转地插入穿过击发触发器20的上部230中的孔1076。在击发触发器20的右侧,侧销1120接受图示出为偏压轮1122的偏压构件。由于击发触发器20从头到尾的移动,偏压轮1122在柄部6的右半构件59近侧的弧线上往返移动,在行程的远侧段越过一体地形成在右半构件59中的偏压坡道1124。有利地,偏压轮1122可用弹性、摩擦材料形成,这种材料可导致棘爪1116的侧销1120逆时针旋转(当从左侧看时),从而牵引向下偏压向远侧突出的窄尖1118,进入最近的环节1072a-d的斜坡中央轨道1075而与链接齿条1074接合。
由于击发触发器20被释放,偏压轮1122因此牵引地将棘爪1116偏压到相反方向,将窄尖1118从链接齿条1074的斜坡中央轨道1075抬起。为了确保在高负载情况下并且在棘爪1116的几乎全部远侧行程处使尖端1118脱离,棘爪1116的右侧斜升到闭合轭250右侧的面朝近侧和上侧的斜面1126上,以使狭窄末端1118与倾斜的中央轨道1075脱离。如果击发触发器20在全行程以外的任何点上被释放,偏压轮1122就用来将窄尖1118从斜坡中央轨道1075抬起。已对偏压轮1122作了描述,但应当理解,偏压构件或偏压轮1122的形状为示例性的,可有各种变化以适应各种不同的形状,使用摩擦或牵引来接合或不接合端部执行器12的击发。
外科器械10的各种实施例具有在使用过程中一次或多次记录器械状态的能力。图44是用于记录器械10的状态的系统2000的框图。应当理解,系统2000可用在具有机动化或马达辅助击发的器械10的实施例中,例如上面参照图1-40所描述,并且可用在具有机械致动击发的器械10的实施例中,例如上面参照图41-43所描述。
系统2000可包括用于感测器械状态的各种传感器2002,2004,2006,2008,2010,2012。这些传感器可定位在例如器械10之上或之内。在各种实施例中,传感器可以是仅为系统2000提供输出的专用传感器,或可以是在器械10中执行其他功能的两用传感器。例如,上述的传感器110,130,142可被构造成能够也向系统2000提供输出。
每个传感器直接地或间接地向存储装置2001提供信号,存储装置2001可记录下面更详述的信号。存储装置2001可为能够存储或记录传感器信号的任何种类的装置。例如,存储装置2001可包括微处理器、电可擦除可编程只读存储器(EEPROM)或任何其他合适的存储装置。存储装置2001可以任何合适的方式记录由传感器提供的信号。例如,在一个实施例中,当来自特定传感器的信号改变状态时,存储装置2001可以记录该信号。在另一个实施例中,存储装置2001可记录系统2000的状态,例如,在来自任一传感器的信号改变状态时记录来自包括于系统2000中的全部传感器的信号。这可以提供器械10状态的快照。在各种实施例中,存储装置2001和/或传感器可实现为包括可得自达拉斯半导体(DALLASSEMICONDUCTOR)的1-WIRE总线产品,诸如例如1-WIRE EEPROM。
在各种实施例中,存储装置2001是可从外部存取的,允许外部装置诸如计算机访问由存储装置2001记录的器械状态。例如,存储装置2001可包括数据端口2020。数据端口2020可根据任何有线或无线通信协议以(例如)串行或并行格式提供所存储的器械状态。存储装置2001还可包括除了输出端口2020以外的或取代输出端口2020的可移除介质2021。可移除介质2021可为能够可从器械10移除的任何种类的合适的数据存储装置。例如,可移除介质2021可包括任何合适种类的闪速存储器,诸如个人计算机存储卡国际协会(PCMCIA)卡、COMPACTFLASH卡、MULTIMEDIA卡、FLASHMEDIA卡等。可移除介质2021还可包括任何合适种类的盘式存储器,包括例如便携式硬盘驱动器、光盘(CD)、数字视频盘(DVD),等。
闭合触发器传感器2002可感测闭合触发器18的状态。图45和图46示出了闭合触发器传感器2002的示例性实施例。在图45和图46中,闭合触发器传感器2002定位在闭合触发器18和闭合枢轴销252之间。应当理解,将闭合触发器18拉向手枪式握把26可使闭合触发器18加力于闭合枢轴销252。例如,传感器2002可感测到此力并随之产生信号,例如以上关于传感器110并参照图10A和图10B所描述。在各种实施例中,闭合触发器传感器2002可为仅指示闭合触发器18是否被致动的数字传感器。在其他各实施例中,闭合触发器传感器2002可为指示作用于闭合触发器18的力和/或闭合触发器18的位置的模拟传感器。如果闭合触发器传感器2002为模拟传感器,则可在传感器2002和存储装置2001之间(在逻辑意义上)定位模数转换器。还应当理解,闭合触发器传感器2002可具有任何合适的形式,并可置于使闭合触发器的状态能够被感测的任何合适位置。
砧座闭合传感器2004可感测到砧座24是否被关闭。图47示出了示例性的砧座闭合传感器2004。如图所示,传感器2004定位在紧接着钉槽22的肾形开口1006的位置或肾形开口1006内。在砧座24关闭时,砧座枢轴销25滑过肾形开口1006而接触到传感器2004,导致传感器2004产生指示砧座24被关闭的信号。传感器2004可为任何合适的数字或模拟传感器,包括接近传感器等。应当理解,当砧座闭合传感器2004是模拟传感器时,可在传感器2004和存储装置2001之间(在逻辑意义上)包括模数转换器。
砧座闭合负载传感器2006如图所示置于钉槽22的内侧底部表面。使用时,传感器2006可能会接触钉仓34(图46中未示出)的底部侧。当砧座24闭合时,在钉仓34上施加作用力,该作用力被传送至传感器2006。作为响应,传感器2006产生信号。该信号可以是与钉仓34因砧座24闭合而作用于传感器2006的力成比例的模拟信号。参照图44,模拟信号可被提供给模数转换器2014,模数转换器2014将模拟信号转换至数字信号,然后将该数字信号提供给存储装置2001。应当理解,其中传感器2006是数字或二进制传感器的实施例可不包括模数转换器2014。
击发触发器传感器110可感测击发触发器20的位置和/或状态。在机动化或马达辅助的器械实施例中,击发触发器传感器可兼作以上描述的运转马达传感器110。此外,击发触发器传感器110可为上述的任何形式,并且可为模拟或数字的。图45和图46示出了击发触发器传感器110的另一个实施例。在图45和图46中,击发触发器传感器装在击发触发器20和击发触发器枢轴销96之间。击发触发器20被拉动时,会对击发触发器枢轴销96施加力,该力为传感器110所感测。参照图44,在击发触发器传感器110的输出是模拟的实施例中,在击发触发器传感器110和存储装置2001之间(在逻辑意义上)包括模数转换器2016。
刀片位置传感器2008感测刀片32或切割面1027在钉槽22中的位置。图47和图48示出了刀片位置传感器2008的实施例,这两个实施例适于同图41所示的机械致动轴8和端部执行器12一起使用。传感器2008包括连接到器械10的击发杆1022上的磁铁2009。线圈2011环绕击发杆1022定位,并可例如沿着击发槽构件1012的纵向凹缝1014安装(见图41)。当刀片32和切割面1027在钉槽22中往复通过时,击发杆1022和磁铁2009会在线圈2011中来回运动。这种相对线圈的运动感应出电压,该电压与击发杆在线圈内的位置以及切割面1027在钉槽22内的位置成比例。此电压可被提供给存储装置2001,例如通过模数转换器2018。
在各种实施例中,作为替代,刀片位置传感器2008可用置于轴8之上或之内的不同位置处的一系列数字传感器(未示出)来实现。数字传感器可以感测击发杆1022的通过轴8往复运动的结构,诸如例如磁体2009。击发杆1022在轴8内的位置,甚至于刀片32在钉槽22内的位置,可被近似为被脱开的最后一个数字传感器的位置。
应当理解,在具有旋转驱动端部执行器12和轴8的器械10的实施例中也可感测到刀片位置,例如以上参照图3-6所描述的情况。诸如编码器268的编码器可构造成能够产生与螺杆轴36(或任何其他驱动轴或齿轮)的旋转成比例的信号。因为轴36和其他驱动轴和齿轮的旋转与通过槽22的刀片32的运动成比例,由编码器268产生的信号也与刀片32的运动成比例。因此,编码器268的输出可被提供至存储装置2001。
仓存在传感器2010可感测到钉槽22内钉仓34的存在。在机动化或马达辅助的器械中,仓存在传感器2010可兼作仓闭锁传感器136,如以上参照图11所描述的情况。图50和图51示出了仓存在传感器2010的实施例。在所示的实施例中,仓存在传感器2010包括两个触点2011和2013。没有钉仓34时,触点2011,2013形成开路。当钉仓34存在时,钉仓34的仓托盘1028触碰到触点2011,2013而形成闭合电路。当电路开路时,传感器2010可输出逻辑0。当电路闭合时,传感器2010可输出逻辑1。传感器2010的输出被提供至存储装置2001,如图44中所示。
仓状态传感器2012可指示装于钉槽22内的钉仓34是否已被击发或被耗用。由于刀片32穿过端部执行器12移动,其推动滑块33,而滑块33击发钉仓。然后,刀片32移回其原始位置,将滑块33留在钉仓的远侧端部。没有滑块33来引导,刀片32可能落入闭锁袋2022中。传感器2012可感测到闭锁袋2022中是否有刀片32,这间接地表明钉仓34是否已被耗用。应当理解,在各种实施例中,传感器2012可以直接感测滑动件在钉仓34近侧端部处的存在,从而无需将刀片32落入闭锁袋2022中。
图52A和图52B描绘了根据各种实施例的用于操作外科器械10的实施例的流程2200,外科器械10被构造为直线切割器并具有记录器械状态的能力。在方框2202处,器械10的砧座24可被关闭。这导致闭合触发器传感器2002和/或砧座闭合传感器2006改变状态。作为响应,在方框2203处,存储装置2001可记录系统2000中所有传感器的状态。在方框2204处,可将器械10插入患者。当器械被插入时,砧座24可在方框2206处被打开和闭合,例如在手术部位处理组织。砧座24的每次打开和闭合导致闭合触发器传感器2002和/或砧座闭合传感器2004改变状态。作为响应,在方框2205处,存储装置2001记录系统2000的状态。
在方框2208处,组织被夹持以进行切割和缝合。如果在判定框2210处砧座24未关闭,则需要继续夹持。如果砧座24闭合,则传感器2002、2004和/或2006可改变状态,从而提示存储装置2001在方框2213处记录系统的状态。这个记录可包括从传感器2006接收的闭合压力。在方框2212处,可进行切割和缝合。在击发触发器20向手枪式握把26拉动时,击发触发器传感器110可改变状态。此外,当刀片32穿过钉槽22时,刀片位置传感器2008会改变状态。作为响应,在方框2013处,存储装置2001可记录系统2000的状态。
当切割缝合操作完成时,刀片32可返回到击发前位置。由于钉仓34现在已被击发,刀片32可能落入闭锁袋2022,改变仓状态传感器2012的状态,并在方框2015处引发存储装置2001记录系统2000的状态。然后,可打开砧座24以清除组织。这可能会导致闭合触发器传感器2002、砧座闭合传感器2004和砧座闭合负载传感器2006中的一个或多个改变状态,从而导致在方框2017处记录系统2000的状态。组织被清除后,可在方框2220处再次闭合砧座24。对于至少传感器2002和2004这将导致另一状态改变,继而又导致存储装置2001在方框2019处记录系统的状态。然后,在方框2222处,器械10可从患者移除。
如果在同一过程中再次使用器械10,砧座可在方框2224处打开,并在方框2223处引发另一次系统状态记录。用过的钉仓34可在方框2226处从端部执行器12移走。这将导致仓存在传感器2010改变状态,并导致在框2225处记录系统状态。另一钉仓34可在方框2228处插入。这会导致仓存在传感器2010的状态改变,并在方框2227处进行系统状态的记录。如果另一个钉仓34是新钉仓,则在判定框2230处指明,其插入也可导致仓状态传感器2012的状态改变。在此情况下,可在方框2231处记录系统状态。
图53示出了根据各种实施例的存储装置2001的示例性存储映射表2300。存储映射表2300包括一系列的列2302,2304,2306,2308,2310,2312,2314,2316和行(未标记)。列2302示出了每行的事件数。其他列代表系统2000的一个传感器的输出。在给定时间记录的全部传感器读数,可在相同的事件编号下记录在同一行中。因此,每一行代表一个实例,其中记录来自系统2000的传感器的一个或多个信号。
列2304给出在各个事件上记录的闭合负载。这可反映出砧座闭合负载传感器2006的输出。列2306给出击发行程位置。这可源自刀片位置传感器2008。例如,刀片32的总行程可被分为几个分区。列2306中的数字可代表刀片32当前所在的分区。列2308中给出击发负载。这可源自击发触发器传感器110。列2310给出刀片位置。与击发行程类似,刀片位置可源自刀片位置传感器2008。列2312可示出砧座24是打开还是关闭。这个值可源自砧座闭合传感器2004和/或砧座闭合负载传感器2006的输出。列2314可示出滑块33是否存在或者钉仓34是否用完。这个值可源自仓状态传感器2012。最后,列2316可示出钉仓34是否存在。这个值可源于仓存在传感器2010。应当理解,各种其他值可存储在存储装置2001中,包括例如击发行程的结束和开始,例如由传感器130、142所测。
图54和55示出了系统2000的另一个实施例。图54的例示的实施例类似于图44的例示的实施例,不同的是,在图54中传感器2002-2010与控制单元2400通信,控制单元2400优选地位于器械的柄部6中,并且更优选地位于柄部6的手枪式握把部26中。控制单元2400可包括处理器2402和存储装置2001。存储装置2001可包括只读存储器单元2404和读写存储器单元2406。控制单元2400还可包括用于与传感器2002-2010通信的模数转换器(ADC)和数模转换器(DAC)(未示出)。只读存储器单元2404可包括EPROM和/或闪速EEPROM存储器单元。读写存储器单元2406可包括易失性存储器单元,诸如随机存取存储器(RAM)单元。控制单元2400的各部件可以是分立的或它们可集成于一个或几个部件中。例如,在一个实施例中,处理器2402、ROM 2404、RAM 2406、DAC和ADC可为微控制器或单片计算机的一部分。
控制单元2400可通过动力源2408(诸如,电池)供电。对于具有用于驱动端部执行器的DC马达的器械10而言,驱动控制单元2400的动力源2408可与驱动马达的动力源相同,或者可用不同的动力源来驱动控制单元2400和马达65。
来自各种传感器的输出可以数字形式被存储至存储器单元2404,2406中的一者或两者中。已公布的美国专利申请公布2007/0175964 A1公开了一种具有用于存储和记录传感器数据的存储装置的直线切割器,该专利申请全文以引用的方式并入本文。来自上述传感器的一些的输出可为模拟形式。对于这些类型的传感器,ADC可用于将模拟传感器信号转换为数字形式,以用于存储在存储器单元2404,2406中。另外,传感器可通过有线和/或无线通信链路连接到控制单元2400。例如,传感器和控制单元2400可通过1-WIRE或I2C总线通信。对于其中传感器与控制单元2400进行无线通信的实施例,传感器可包括与控制单元2400的收发器(未示出)通信的转发器。
尽管未在图44中示出,器械10还可包括感测端部执行器的关节运动状态的一个或多个关节运动传感器。例如,关节运动传感器可位于关节运动枢轴中或靠近关节运动枢轴,并且感测端部执行器12和轴8之间的相对关节运动。关节运动传感器还可与控制单元2400通信,并且来自关节运动传感器的数据可被存储在控制单元2400的存储装置2001中。提交于2008年5月21日的名称为“Surgical Instrument With Automatically ReconfigurableArticulating End Effector”的美国专利申请序列号12/124,655提供了更多关于此类关节运动传感器的详细信息,该专利申请据此全文以引用的方式并入。此外,传感器可包括检测马达65的状态诸如RPM等的各种马达相关的传感器。
根据各种实施例,存储在存储装置2001中的数据可被加密。例如,存储器单元2404,2406中的一者诸如ROM 2404可存储加密代码或软件,该加密代码或软件在被处理器2402执行时使处理器2402对从传感器接收到的传感器数据进行加密,并且存储在存储装置2001中。
控制单元2400还可具有输出端口2020,远程计算机装置2420可通过连接至输出端口2020的通信链路2422从外部访问该输出端口。通信链路2422可为有线或无线通信链路。例如,输出端口2020可包括串行数据端口例如USB端口(包括类型A、类型B或迷你型-B USB端口)、IEEE 1394接口(包括IEEE 1394a、1394b或1394c)、RS-232端口、RS-423端口、RS-485端口、光口诸如SONET或SDH端口、或用于有线串行数据通信链路2422的任何其他合适的串行数据端口。另外,通信链路2422可为平行数据通信链路,诸如ISA、ATA、SCSI或PCI。在此类情况下,输出端口2020可为对应的平行数据输出端口。此外,通信链路2422可为无线数据链路,诸如使用IEEE 802.11标准之一的链路。
远程计算机装置2420可为具有处理器和存储器的任何装置,该装置能够与控制单元2400连接并且能够下载存储在存储装置2001中的传感器数据。例如,远程计算机装置2420可为台式计算机、膝上型计算机、服务器、工作站、掌上型计算机、小型计算机、可佩带式计算机等。此远程计算机装置2420可在器械10的外部(即,并非器械10的一部分),并且在将数据下载至计算机装置2420时可相对靠近器械10,或者计算机装置2420可远离器械10,诸如位于相邻的房间中或更远处。
图56是示出了根据本发明的各种实施例的流程的流程图。该流程于步骤2500处开始,在该步骤处,临床医生使用器械10执行外科手术。在步骤2502处,器械中的各种传感器采集数据并且将其传输到控制单元2400。在步骤2504处,数据可被控制单元2400加密,并且在步骤2506处,被加密了的数据存储在存储器单元2001中。在其他实施例中,数据不需要被加密,或者感测到的数据的仅一部分被加密。然后在步骤2508处,数据链路在远程计算机装置2420与控制单元2400之间诸如通过输出端口2020建立。然后在步骤2510处,存储在存储器单元2001中的一些或全部数据从传感器被下载至远程计算机装置2420。对于存储数据被加密的实施例而言,远程计算机装置2420可在数据被加载至远程计算机装置2420中的存储装置之前或之后对数据进行加密。在步骤2512处,现在存储在远程计算机装置2420中的数据可被调控。例如,可对数据进行计算或分析,或者其可被下载或传送至另一个存储介质。
在本文所公开的装置的一种表达中,钉仓34可包括将所安装的钉仓类型与器械10中所安装的钉仓传感器通信的装置。钉仓34可配备有传达(除了别的之外)钉仓类型的RFID标签。例如,当缝合薄组织时,使用者可选择以相比于缝合厚组织时所使用的高度较小的高度形成钉的钉仓。钉仓类型确定了可获得用于钉仓外壁和砧座之间的组织的间隙。如本领域中已知且理解的,以2.0mm至5.0mm范围内的多种接近的钉高度制造钉仓。
分立的高度通常由唯一的钉仓颜色代表,该钉仓颜色为装置的使用者提供视觉反馈。如果使用者试图击发打算用作厚组织上的薄组织的钉仓,则当闭合钳口时使用者可感受到较高的力,并且当驱动滑块33时马达可感受到较大的负载。在此示例中,由于钳口中组织的厚的特性,钉仓外壁和砧座之间的间隙可足够大以阻止钉的适当形成。这可导致出血或钉线裂开。相反地,如果使用者选择适于在厚组织中使用的钉仓,则所形成的钉仓厚度可以不提供足够的压缩力以阻止出血或渗漏。
在击发顺序期间,取决于器械10钳口中存在的组织量和组织类型,马达65可感受不同的负载。微处理器或存储装置2001可与马达65连接并且记录一些马达的参数,包括RPM、电流、电压、电容或电阻以及击发行程的持续时间。此外,时间和日期还可连同钉仓34识别信息以及器械10识别信息被记录。然后此数据可被存储在存储器2001中或通过数据端口2020或通过本领域中已知且理解的无线协议无线地发射。
为了有利于无线传输,器械10可配备有与器械10的传输范围内的任何成对蓝牙装置通信的蓝牙收发器。在一个实施例中,接收装置可为配备有以下应用的智能电话:接收所发射的信息并且使信息格式化用于显示并且由智能电话使用者操纵。该应用可将所接收的信息,连同使用者姓名、电子邮件地址、医院名称或账户姓名以及GPS位置传递至中央数据库。
在击发顺序之后,在中央数据库中接收马达65参数时,算法可根据器械和钉仓类型存储数据。算法可进一步比较所接收的信息与基于器械10和钉仓34组合的已知值或预测值。例如,当击发具有蓝或中等组织厚度的钉仓的器械10时,算法可预测马达将拉动3-4A。如果马达吸取比所预测的更大的电流,则器械10的使用者可能选择了错误厚度的钉仓。在这种情况下,算法可将警示传递至智能电话,该智能电话发起包含马达信息的消息,从而警示使用者器械10在其预测范围外工作。算法可进一步建议不同的钉仓34。这可实时完成,或该应用可形成可以电子邮件发送至使用者的报告。
该应用可通过智能电话界面(或如本领域中已知且理解的能够操作应用的任何装置上的任何其他界面)请求信息,诸如手术类型、组织类型、外科医生姓名以及医院名称。然后此信息可被添加至中央数据库以进一步细化所预测的马达参数。
现在参照图57,阐述了图示以上描述的流程的流程图。该流程于步骤5710处开始,在该步骤处,将钉仓34加载入器械10中并且通过仓传感器检测钉仓类型。在步骤5720处,击发器械10并且器械10中的各种传感器采集马达数据并且将其存储在局部存储器中或将其传输到控制单元2400。在步骤5730处,数据可被控制单元2400加密,并且在步骤5730和5740处,被加密了的数据存储在存储器单元2001中。在其他实施例中,数据不需要被加密,或者感测到的数据的仅一部分被加密。然后在步骤5750处,数据链路在远程计算机装置2420与控制单元2400之间例如通过输出端口2020建立。在器械10配备有蓝牙收发器模块的情况下,数据可被传输至成对蓝牙装置。
然后,在步骤5760处,存储在存储器单元2001中的来自传感器的一些或所有的数据被传输至成对蓝牙装置,该成对蓝牙装置具有接收、存储并且进一步通过WiFi或通过如本领域中已知且理解的蜂窝网络将信息传输至远程计算机装置上的中央数据库的应用。对于其中所存储的数据被加密的实施例,成对蓝牙装置可加密数据。在步骤5770处,将现在存储在远程计算机装置中的数据与对于所采用的钉仓类型的期望马达数据进行比较。如果如以上所述马达在期望参数外工作,则应用可将警示传达回运行马达在期望参数外工作的应用的装置。
现在参照图58,公开了一种用于在器械10的使用者和远程数据库之间传达实时和接近实时信息的系统。如上所述,在一种表达中,器械10被构造成能够具有RF(例如蓝牙)收发器。将在器械10击发期间所采集的信息通过RF链路传输至手持装置5820。在一种表达中,手持装置5820运行存储所传输的信息的应用。该应用还可从使用者中请求信息诸如外科病例的类型、医院名称、外科医生姓名、其中器械10被击发的组织类型。该应用还可自动探知其GPS位置以及日期和时间。将此信息通过互联网5830传输至远程计算机2420。计算机2420上的中央数据库程序5840可然后存储所传输的信息,分析如上所述的马达数据并且通过远程计算机2420、互联网5830以及无线装置5820将信息传输回器械10使用者。此信息可包括马达65在预测参数外工作的警示。
本文公开的装置可被设计为在一次手术(其可包含多次击发)之后丢弃,或者它们可被设计为用于多次手术中。然而,无论在哪种情况下,都可对该装置进行重新修复,以便在至少一次手术后再使用。重新修复可包括以下步骤中的任意组合:拆卸该装置、然后清洗或更换特定零件、以及随后重新组装。具体而言,该装置可以拆卸,并且可以任意组合有选择地置换或移除任意数目的特定构件或零件。清洗和/或置换特定零件后,该装置可以在重新修复设施处重新组装以便随后使用,或者在即将进行外科手术前由外科队重新组装。本领域的技术人员应该理解,装置的重新修复可利用多种用于拆卸、清洗/更换和重新组装的技术。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。
优选地,在外科手术之前将对本文所述的发明的各种实施例进行处理。首先,获取新的或用过的器械,并根据需要进行清洗。然后可对器械进行杀菌。在一种灭菌技术中,器械被布置在闭合和密封的容器内,诸如由一层TYVEK覆盖的热成形塑料外壳。然后将容器和器械置于可穿透该容器的辐射区,诸如γ辐射、x-射线或高能电子。辐射杀死器械上和容器中的细菌。然后将灭菌后的器械储存在灭菌容器中。该密封容器使器械保持无菌直到在医疗设施中打开该容器为止。
经过灭菌的器械是优选的。这可以通过任意数目的本领域技术人员已知的方式来进行,包括β辐射或γ辐射、环氧乙烷、蒸汽和其他方法。
虽然已经通过描述几个实施例显示了本发明,虽然已经相当详细地描述了示例性实施例,但是申请人的意图不在于将权利要求的范围约束或以任何方式限制到这些细节中。本领域的技术人员可容易看出另外的优点和修改形式。本发明的各种实施例表示了相对于现有缝合方法的巨大改进,所述现有缝合方法需要使用单个钉仓中的不同尺寸的钉以实现具有不同成形(最终)高度的钉。
因此,本发明对内窥镜式手术和设备进行了讨论。但是,本文使用的术语,诸如“内窥镜式”不应被理解为将本发明限于仅结合内窥镜式管(即,套管或套管针)使用的外科手术缝合和切断器械。相反,应该相信本发明可用于进入受限的任何手术中,包括但不限于腹腔镜式手术以及开腹手术。此外,在不脱离本发明的实质和范围的情况下,本发明的各种钉仓的实施例的独特和新颖的方面当与其他形式的缝合设备结合使用时具有效用。
以引用方式全文或部分地并入本文的任何专利、公布或信息均仅在所并入的材料不与本文档所述的现有定义、陈述或其他公开材料相冲突的范围内并入本文。同样地,本文明确阐述的公开内容取代了以引用方式并入本文的任何冲突材料。
Claims (2)
1.一种为外科医生提供反馈的系统,包括:
电动缝合器械;以及
远程装置;
所述器械包括:
柄部,所述柄部具有动力源和电动马达;
轴,所述轴与所述柄部连接;
端部执行器,所述端部执行器与所述轴连接并具有钉仓;
仓传感器,其用于检测所述端部执行器中仓的类型;
微处理器,所述微处理器与所述马达通信;
数据存储装置,所述数据存储装置与所述微处理器通信;
数据传输装置,所述数据传输装置与所述数据存储装置和所述微处理器通信;
其中所述微处理器被配置成能够使所述器械执行以下操作:
当所述电动缝合器械被击发时,测量马达参数;
存储所述马达参数;以及
将所述马达参数传输至所述远程装置;并且
所述微处理器还被配置成能够将仓识别信息从所述仓传感器传输至所述远程装置;并且
所述远程装置被配置成能够:
将所述马达参数与预设值进行比较,其中所述预设值是基于所述器械和仓的组合的已知值或预测值;
警示使用者所述马达在击发期间在所述预设值外工作;以及
基于所述马达参数与所述预设值的所述比较来建议仓。
2.根据权利要求1所述的系统,其中:
所述数据传输装置包括与所述数据存储装置和所述微处理器通信的RF数据传输装置;并且
所述马达参数经由所述RF数据传输装置传输至所述远程装置。
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US14/043,100 | 2013-10-01 | ||
US14/043,100 US20140175150A1 (en) | 2013-10-01 | 2013-10-01 | Providing Near Real Time Feedback To A User of A Surgical Instrument |
PCT/US2014/054682 WO2015050677A1 (en) | 2013-10-01 | 2014-09-09 | Providing near real time feedback to a user of a surgical instrument |
Publications (2)
Publication Number | Publication Date |
---|---|
CN105682572A CN105682572A (zh) | 2016-06-15 |
CN105682572B true CN105682572B (zh) | 2019-06-28 |
Family
ID=50973506
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
CN201480054434.8A Active CN105682572B (zh) | 2013-10-01 | 2014-09-09 | 为外科器械的使用者提供接近实时反馈 |
Country Status (10)
Country | Link |
---|---|
US (1) | US20140175150A1 (zh) |
EP (1) | EP2856947B1 (zh) |
JP (1) | JP6466423B2 (zh) |
CN (1) | CN105682572B (zh) |
AU (1) | AU2014329956B2 (zh) |
BR (1) | BR112016007013B1 (zh) |
MX (1) | MX2016004194A (zh) |
PL (1) | PL2856947T3 (zh) |
RU (1) | RU2690397C2 (zh) |
WO (1) | WO2015050677A1 (zh) |
Families Citing this family (555)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US9060770B2 (en) | 2003-05-20 | 2015-06-23 | Ethicon Endo-Surgery, Inc. | Robotically-driven surgical instrument with E-beam driver |
US20070084897A1 (en) | 2003-05-20 | 2007-04-19 | Shelton Frederick E Iv | Articulating surgical stapling instrument incorporating a two-piece e-beam firing mechanism |
US8215531B2 (en) | 2004-07-28 | 2012-07-10 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument having a medical substance dispenser |
US11896225B2 (en) | 2004-07-28 | 2024-02-13 | Cilag Gmbh International | Staple cartridge comprising a pan |
US11484312B2 (en) | 2005-08-31 | 2022-11-01 | Cilag Gmbh International | Staple cartridge comprising a staple driver arrangement |
US7669746B2 (en) | 2005-08-31 | 2010-03-02 | Ethicon Endo-Surgery, Inc. | Staple cartridges for forming staples having differing formed staple heights |
US10159482B2 (en) | 2005-08-31 | 2018-12-25 | Ethicon Llc | Fastener cartridge assembly comprising a fixed anvil and different staple heights |
US11246590B2 (en) | 2005-08-31 | 2022-02-15 | Cilag Gmbh International | Staple cartridge including staple drivers having different unfired heights |
US9237891B2 (en) | 2005-08-31 | 2016-01-19 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical stapling devices that produce formed staples having different lengths |
US7934630B2 (en) | 2005-08-31 | 2011-05-03 | Ethicon Endo-Surgery, Inc. | Staple cartridges for forming staples having differing formed staple heights |
US20070106317A1 (en) | 2005-11-09 | 2007-05-10 | Shelton Frederick E Iv | Hydraulically and electrically actuated articulation joints for surgical instruments |
US8186555B2 (en) | 2006-01-31 | 2012-05-29 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting and fastening instrument with mechanical closure system |
US11278279B2 (en) | 2006-01-31 | 2022-03-22 | Cilag Gmbh International | Surgical instrument assembly |
US7845537B2 (en) | 2006-01-31 | 2010-12-07 | Ethicon Endo-Surgery, Inc. | Surgical instrument having recording capabilities |
US20120292367A1 (en) | 2006-01-31 | 2012-11-22 | Ethicon Endo-Surgery, Inc. | Robotically-controlled end effector |
US7753904B2 (en) | 2006-01-31 | 2010-07-13 | Ethicon Endo-Surgery, Inc. | Endoscopic surgical instrument with a handle that can articulate with respect to the shaft |
US20110024477A1 (en) | 2009-02-06 | 2011-02-03 | Hall Steven G | Driven Surgical Stapler Improvements |
US8708213B2 (en) | 2006-01-31 | 2014-04-29 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a feedback system |
US8820603B2 (en) | 2006-01-31 | 2014-09-02 | Ethicon Endo-Surgery, Inc. | Accessing data stored in a memory of a surgical instrument |
US20110295295A1 (en) | 2006-01-31 | 2011-12-01 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical instrument having recording capabilities |
US11224427B2 (en) | 2006-01-31 | 2022-01-18 | Cilag Gmbh International | Surgical stapling system including a console and retraction assembly |
US11793518B2 (en) | 2006-01-31 | 2023-10-24 | Cilag Gmbh International | Powered surgical instruments with firing system lockout arrangements |
US8992422B2 (en) | 2006-03-23 | 2015-03-31 | Ethicon Endo-Surgery, Inc. | Robotically-controlled endoscopic accessory channel |
US8322455B2 (en) | 2006-06-27 | 2012-12-04 | Ethicon Endo-Surgery, Inc. | Manually driven surgical cutting and fastening instrument |
US7665647B2 (en) | 2006-09-29 | 2010-02-23 | Ethicon Endo-Surgery, Inc. | Surgical cutting and stapling device with closure apparatus for limiting maximum tissue compression force |
US10568652B2 (en) | 2006-09-29 | 2020-02-25 | Ethicon Llc | Surgical staples having attached drivers of different heights and stapling instruments for deploying the same |
US8652120B2 (en) | 2007-01-10 | 2014-02-18 | Ethicon Endo-Surgery, Inc. | Surgical instrument with wireless communication between control unit and sensor transponders |
US8684253B2 (en) | 2007-01-10 | 2014-04-01 | Ethicon Endo-Surgery, Inc. | Surgical instrument with wireless communication between a control unit of a robotic system and remote sensor |
US11291441B2 (en) | 2007-01-10 | 2022-04-05 | Cilag Gmbh International | Surgical instrument with wireless communication between control unit and remote sensor |
US20080169333A1 (en) | 2007-01-11 | 2008-07-17 | Shelton Frederick E | Surgical stapler end effector with tapered distal end |
US11039836B2 (en) | 2007-01-11 | 2021-06-22 | Cilag Gmbh International | Staple cartridge for use with a surgical stapling instrument |
US8727197B2 (en) | 2007-03-15 | 2014-05-20 | Ethicon Endo-Surgery, Inc. | Staple cartridge cavity configuration with cooperative surgical staple |
US8893946B2 (en) | 2007-03-28 | 2014-11-25 | Ethicon Endo-Surgery, Inc. | Laparoscopic tissue thickness and clamp load measuring devices |
US8931682B2 (en) | 2007-06-04 | 2015-01-13 | Ethicon Endo-Surgery, Inc. | Robotically-controlled shaft based rotary drive systems for surgical instruments |
US11564682B2 (en) | 2007-06-04 | 2023-01-31 | Cilag Gmbh International | Surgical stapler device |
US7753245B2 (en) | 2007-06-22 | 2010-07-13 | Ethicon Endo-Surgery, Inc. | Surgical stapling instruments |
US11849941B2 (en) | 2007-06-29 | 2023-12-26 | Cilag Gmbh International | Staple cartridge having staple cavities extending at a transverse angle relative to a longitudinal cartridge axis |
US8758391B2 (en) | 2008-02-14 | 2014-06-24 | Ethicon Endo-Surgery, Inc. | Interchangeable tools for surgical instruments |
US7819298B2 (en) | 2008-02-14 | 2010-10-26 | Ethicon Endo-Surgery, Inc. | Surgical stapling apparatus with control features operable with one hand |
US8573465B2 (en) | 2008-02-14 | 2013-11-05 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical end effector system with rotary actuated closure systems |
US8636736B2 (en) | 2008-02-14 | 2014-01-28 | Ethicon Endo-Surgery, Inc. | Motorized surgical cutting and fastening instrument |
US7866527B2 (en) | 2008-02-14 | 2011-01-11 | Ethicon Endo-Surgery, Inc. | Surgical stapling apparatus with interlockable firing system |
JP5410110B2 (ja) | 2008-02-14 | 2014-02-05 | エシコン・エンド−サージェリィ・インコーポレイテッド | Rf電極を有する外科用切断・固定器具 |
US9179912B2 (en) | 2008-02-14 | 2015-11-10 | Ethicon Endo-Surgery, Inc. | Robotically-controlled motorized surgical cutting and fastening instrument |
US11272927B2 (en) | 2008-02-15 | 2022-03-15 | Cilag Gmbh International | Layer arrangements for surgical staple cartridges |
US10390823B2 (en) | 2008-02-15 | 2019-08-27 | Ethicon Llc | End effector comprising an adjunct |
US9005230B2 (en) | 2008-09-23 | 2015-04-14 | Ethicon Endo-Surgery, Inc. | Motorized surgical instrument |
US11648005B2 (en) | 2008-09-23 | 2023-05-16 | Cilag Gmbh International | Robotically-controlled motorized surgical instrument with an end effector |
US8210411B2 (en) | 2008-09-23 | 2012-07-03 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting instrument |
US9386983B2 (en) | 2008-09-23 | 2016-07-12 | Ethicon Endo-Surgery, Llc | Robotically-controlled motorized surgical instrument |
US8608045B2 (en) | 2008-10-10 | 2013-12-17 | Ethicon Endo-Sugery, Inc. | Powered surgical cutting and stapling apparatus with manually retractable firing system |
US8517239B2 (en) | 2009-02-05 | 2013-08-27 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument comprising a magnetic element driver |
US8444036B2 (en) | 2009-02-06 | 2013-05-21 | Ethicon Endo-Surgery, Inc. | Motor driven surgical fastener device with mechanisms for adjusting a tissue gap within the end effector |
CA2751664A1 (en) | 2009-02-06 | 2010-08-12 | Ethicon Endo-Surgery, Inc. | Driven surgical stapler improvements |
US8220688B2 (en) | 2009-12-24 | 2012-07-17 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting instrument with electric actuator directional control assembly |
US8851354B2 (en) | 2009-12-24 | 2014-10-07 | Ethicon Endo-Surgery, Inc. | Surgical cutting instrument that analyzes tissue thickness |
US8783543B2 (en) | 2010-07-30 | 2014-07-22 | Ethicon Endo-Surgery, Inc. | Tissue acquisition arrangements and methods for surgical stapling devices |
US10945731B2 (en) | 2010-09-30 | 2021-03-16 | Ethicon Llc | Tissue thickness compensator comprising controlled release and expansion |
US9320523B2 (en) | 2012-03-28 | 2016-04-26 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator comprising tissue ingrowth features |
US9364233B2 (en) | 2010-09-30 | 2016-06-14 | Ethicon Endo-Surgery, Llc | Tissue thickness compensators for circular surgical staplers |
US8864009B2 (en) | 2010-09-30 | 2014-10-21 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensator for a surgical stapler comprising an adjustable anvil |
US9351730B2 (en) | 2011-04-29 | 2016-05-31 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator comprising channels |
US9517063B2 (en) | 2012-03-28 | 2016-12-13 | Ethicon Endo-Surgery, Llc | Movable member for use with a tissue thickness compensator |
US11812965B2 (en) | 2010-09-30 | 2023-11-14 | Cilag Gmbh International | Layer of material for a surgical end effector |
US11925354B2 (en) | 2010-09-30 | 2024-03-12 | Cilag Gmbh International | Staple cartridge comprising staples positioned within a compressible portion thereof |
US9629814B2 (en) | 2010-09-30 | 2017-04-25 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator configured to redistribute compressive forces |
US9592050B2 (en) | 2010-09-30 | 2017-03-14 | Ethicon Endo-Surgery, Llc | End effector comprising a distal tissue abutment member |
US11298125B2 (en) | 2010-09-30 | 2022-04-12 | Cilag Gmbh International | Tissue stapler having a thickness compensator |
US8695866B2 (en) | 2010-10-01 | 2014-04-15 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a power control circuit |
AU2012250197B2 (en) | 2011-04-29 | 2017-08-10 | Ethicon Endo-Surgery, Inc. | Staple cartridge comprising staples positioned within a compressible portion thereof |
US11207064B2 (en) | 2011-05-27 | 2021-12-28 | Cilag Gmbh International | Automated end effector component reloading system for use with a robotic system |
US9072535B2 (en) | 2011-05-27 | 2015-07-07 | Ethicon Endo-Surgery, Inc. | Surgical stapling instruments with rotatable staple deployment arrangements |
US9044230B2 (en) | 2012-02-13 | 2015-06-02 | Ethicon Endo-Surgery, Inc. | Surgical cutting and fastening instrument with apparatus for determining cartridge and firing motion status |
CN104334098B (zh) | 2012-03-28 | 2017-03-22 | 伊西康内外科公司 | 包括限定低压强环境的胶囊剂的组织厚度补偿件 |
CN104379068B (zh) | 2012-03-28 | 2017-09-22 | 伊西康内外科公司 | 包括组织厚度补偿件的保持器组件 |
CN104321024B (zh) | 2012-03-28 | 2017-05-24 | 伊西康内外科公司 | 包括多个层的组织厚度补偿件 |
US9101358B2 (en) | 2012-06-15 | 2015-08-11 | Ethicon Endo-Surgery, Inc. | Articulatable surgical instrument comprising a firing drive |
US9282974B2 (en) | 2012-06-28 | 2016-03-15 | Ethicon Endo-Surgery, Llc | Empty clip cartridge lockout |
US20140001231A1 (en) | 2012-06-28 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Firing system lockout arrangements for surgical instruments |
US11278284B2 (en) | 2012-06-28 | 2022-03-22 | Cilag Gmbh International | Rotary drive arrangements for surgical instruments |
US9289256B2 (en) | 2012-06-28 | 2016-03-22 | Ethicon Endo-Surgery, Llc | Surgical end effectors having angled tissue-contacting surfaces |
BR112014032776B1 (pt) | 2012-06-28 | 2021-09-08 | Ethicon Endo-Surgery, Inc | Sistema de instrumento cirúrgico e kit cirúrgico para uso com um sistema de instrumento cirúrgico |
US20140001234A1 (en) | 2012-06-28 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Coupling arrangements for attaching surgical end effectors to drive systems therefor |
US9204879B2 (en) | 2012-06-28 | 2015-12-08 | Ethicon Endo-Surgery, Inc. | Flexible drive member |
RU2636861C2 (ru) | 2012-06-28 | 2017-11-28 | Этикон Эндо-Серджери, Инк. | Блокировка пустой кассеты с клипсами |
RU2672520C2 (ru) | 2013-03-01 | 2018-11-15 | Этикон Эндо-Серджери, Инк. | Шарнирно поворачиваемые хирургические инструменты с проводящими путями для передачи сигналов |
JP6345707B2 (ja) | 2013-03-01 | 2018-06-20 | エシコン・エンド−サージェリィ・インコーポレイテッドEthicon Endo−Surgery,Inc. | ソフトストップを備えた外科用器具 |
US9629629B2 (en) | 2013-03-14 | 2017-04-25 | Ethicon Endo-Surgey, LLC | Control systems for surgical instruments |
US9888919B2 (en) | 2013-03-14 | 2018-02-13 | Ethicon Llc | Method and system for operating a surgical instrument |
BR112015026109B1 (pt) | 2013-04-16 | 2022-02-22 | Ethicon Endo-Surgery, Inc | Instrumento cirúrgico |
US9814460B2 (en) | 2013-04-16 | 2017-11-14 | Ethicon Llc | Modular motor driven surgical instruments with status indication arrangements |
MX369362B (es) | 2013-08-23 | 2019-11-06 | Ethicon Endo Surgery Llc | Dispositivos de retraccion de miembros de disparo para instrumentos quirurgicos electricos. |
US9283054B2 (en) | 2013-08-23 | 2016-03-15 | Ethicon Endo-Surgery, Llc | Interactive displays |
US11033264B2 (en) | 2013-11-04 | 2021-06-15 | Covidien Lp | Surgical fastener applying apparatus |
AU2013403917A1 (en) | 2013-11-04 | 2016-04-28 | Covidien Lp | Surgical fastener applying apparatus |
AU2013403916A1 (en) | 2013-11-04 | 2016-04-28 | Covidien Lp | Surgical fastener applying apparatus |
US9724092B2 (en) | 2013-12-23 | 2017-08-08 | Ethicon Llc | Modular surgical instruments |
US20150173756A1 (en) | 2013-12-23 | 2015-06-25 | Ethicon Endo-Surgery, Inc. | Surgical cutting and stapling methods |
US9839428B2 (en) | 2013-12-23 | 2017-12-12 | Ethicon Llc | Surgical cutting and stapling instruments with independent jaw control features |
US9962161B2 (en) | 2014-02-12 | 2018-05-08 | Ethicon Llc | Deliverable surgical instrument |
BR112016019387B1 (pt) | 2014-02-24 | 2022-11-29 | Ethicon Endo-Surgery, Llc | Sistema de instrumento cirúrgico e cartucho de prendedores para uso com um instrumento cirúrgico de fixação |
BR112016021943B1 (pt) | 2014-03-26 | 2022-06-14 | Ethicon Endo-Surgery, Llc | Instrumento cirúrgico para uso por um operador em um procedimento cirúrgico |
US9826977B2 (en) | 2014-03-26 | 2017-11-28 | Ethicon Llc | Sterilization verification circuit |
US10028761B2 (en) | 2014-03-26 | 2018-07-24 | Ethicon Llc | Feedback algorithms for manual bailout systems for surgical instruments |
US10004497B2 (en) | 2014-03-26 | 2018-06-26 | Ethicon Llc | Interface systems for use with surgical instruments |
CN106456158B (zh) | 2014-04-16 | 2019-02-05 | 伊西康内外科有限责任公司 | 包括非一致紧固件的紧固件仓 |
BR112016023807B1 (pt) | 2014-04-16 | 2022-07-12 | Ethicon Endo-Surgery, Llc | Conjunto de cartucho de prendedores para uso com um instrumento cirúrgico |
BR112016023698B1 (pt) | 2014-04-16 | 2022-07-26 | Ethicon Endo-Surgery, Llc | Cartucho de prendedores para uso com um instrumento cirúrgico |
US20150297225A1 (en) | 2014-04-16 | 2015-10-22 | Ethicon Endo-Surgery, Inc. | Fastener cartridges including extensions having different configurations |
US9801628B2 (en) | 2014-09-26 | 2017-10-31 | Ethicon Llc | Surgical staple and driver arrangements for staple cartridges |
US11517315B2 (en) | 2014-04-16 | 2022-12-06 | Cilag Gmbh International | Fastener cartridges including extensions having different configurations |
WO2015174985A1 (en) | 2014-05-15 | 2015-11-19 | Lp Covidien | Surgical fastener applying apparatus |
US9724094B2 (en) | 2014-09-05 | 2017-08-08 | Ethicon Llc | Adjunct with integrated sensors to quantify tissue compression |
US11311294B2 (en) | 2014-09-05 | 2022-04-26 | Cilag Gmbh International | Powered medical device including measurement of closure state of jaws |
BR112017004361B1 (pt) | 2014-09-05 | 2023-04-11 | Ethicon Llc | Sistema eletrônico para um instrumento cirúrgico |
US10105142B2 (en) | 2014-09-18 | 2018-10-23 | Ethicon Llc | Surgical stapler with plurality of cutting elements |
US11523821B2 (en) | 2014-09-26 | 2022-12-13 | Cilag Gmbh International | Method for creating a flexible staple line |
BR112017005981B1 (pt) | 2014-09-26 | 2022-09-06 | Ethicon, Llc | Material de escora para uso com um cartucho de grampos cirúrgicos e cartucho de grampos cirúrgicos para uso com um instrumento cirúrgico |
US10076325B2 (en) | 2014-10-13 | 2018-09-18 | Ethicon Llc | Surgical stapling apparatus comprising a tissue stop |
US9924944B2 (en) | 2014-10-16 | 2018-03-27 | Ethicon Llc | Staple cartridge comprising an adjunct material |
US10517594B2 (en) | 2014-10-29 | 2019-12-31 | Ethicon Llc | Cartridge assemblies for surgical staplers |
US11141153B2 (en) | 2014-10-29 | 2021-10-12 | Cilag Gmbh International | Staple cartridges comprising driver arrangements |
US9844376B2 (en) | 2014-11-06 | 2017-12-19 | Ethicon Llc | Staple cartridge comprising a releasable adjunct material |
US10736636B2 (en) | 2014-12-10 | 2020-08-11 | Ethicon Llc | Articulatable surgical instrument system |
BR112017012996B1 (pt) | 2014-12-18 | 2022-11-08 | Ethicon Llc | Instrumento cirúrgico com uma bigorna que é seletivamente móvel sobre um eixo geométrico imóvel distinto em relação a um cartucho de grampos |
US10117649B2 (en) | 2014-12-18 | 2018-11-06 | Ethicon Llc | Surgical instrument assembly comprising a lockable articulation system |
US9844374B2 (en) | 2014-12-18 | 2017-12-19 | Ethicon Llc | Surgical instrument systems comprising an articulatable end effector and means for adjusting the firing stroke of a firing member |
US9987000B2 (en) | 2014-12-18 | 2018-06-05 | Ethicon Llc | Surgical instrument assembly comprising a flexible articulation system |
US9844375B2 (en) | 2014-12-18 | 2017-12-19 | Ethicon Llc | Drive arrangements for articulatable surgical instruments |
US9943309B2 (en) | 2014-12-18 | 2018-04-17 | Ethicon Llc | Surgical instruments with articulatable end effectors and movable firing beam support arrangements |
US10085748B2 (en) | 2014-12-18 | 2018-10-02 | Ethicon Llc | Locking arrangements for detachable shaft assemblies with articulatable surgical end effectors |
US10188385B2 (en) | 2014-12-18 | 2019-01-29 | Ethicon Llc | Surgical instrument system comprising lockable systems |
US10039545B2 (en) | 2015-02-23 | 2018-08-07 | Covidien Lp | Double fire stapling |
US10285698B2 (en) | 2015-02-26 | 2019-05-14 | Covidien Lp | Surgical apparatus |
US10085749B2 (en) | 2015-02-26 | 2018-10-02 | Covidien Lp | Surgical apparatus with conductor strain relief |
US10180463B2 (en) | 2015-02-27 | 2019-01-15 | Ethicon Llc | Surgical apparatus configured to assess whether a performance parameter of the surgical apparatus is within an acceptable performance band |
US10321907B2 (en) | 2015-02-27 | 2019-06-18 | Ethicon Llc | System for monitoring whether a surgical instrument needs to be serviced |
US11154301B2 (en) | 2015-02-27 | 2021-10-26 | Cilag Gmbh International | Modular stapling assembly |
US10226250B2 (en) | 2015-02-27 | 2019-03-12 | Ethicon Llc | Modular stapling assembly |
US9924961B2 (en) | 2015-03-06 | 2018-03-27 | Ethicon Endo-Surgery, Llc | Interactive feedback system for powered surgical instruments |
US10617412B2 (en) * | 2015-03-06 | 2020-04-14 | Ethicon Llc | System for detecting the mis-insertion of a staple cartridge into a surgical stapler |
JP2020121162A (ja) | 2015-03-06 | 2020-08-13 | エシコン エルエルシーEthicon LLC | 測定の安定性要素、クリープ要素、及び粘弾性要素を決定するためのセンサデータの時間依存性評価 |
US9808246B2 (en) | 2015-03-06 | 2017-11-07 | Ethicon Endo-Surgery, Llc | Method of operating a powered surgical instrument |
US10441279B2 (en) | 2015-03-06 | 2019-10-15 | Ethicon Llc | Multiple level thresholds to modify operation of powered surgical instruments |
US10052044B2 (en) | 2015-03-06 | 2018-08-21 | Ethicon Llc | Time dependent evaluation of sensor data to determine stability, creep, and viscoelastic elements of measures |
US10245033B2 (en) | 2015-03-06 | 2019-04-02 | Ethicon Llc | Surgical instrument comprising a lockable battery housing |
US9993248B2 (en) | 2015-03-06 | 2018-06-12 | Ethicon Endo-Surgery, Llc | Smart sensors with local signal processing |
US10687806B2 (en) | 2015-03-06 | 2020-06-23 | Ethicon Llc | Adaptive tissue compression techniques to adjust closure rates for multiple tissue types |
US9901342B2 (en) | 2015-03-06 | 2018-02-27 | Ethicon Endo-Surgery, Llc | Signal and power communication system positioned on a rotatable shaft |
US10213201B2 (en) | 2015-03-31 | 2019-02-26 | Ethicon Llc | Stapling end effector configured to compensate for an uneven gap between a first jaw and a second jaw |
US10463368B2 (en) | 2015-04-10 | 2019-11-05 | Covidien Lp | Endoscopic stapler |
US10349941B2 (en) | 2015-05-27 | 2019-07-16 | Covidien Lp | Multi-fire lead screw stapling device |
US10172615B2 (en) | 2015-05-27 | 2019-01-08 | Covidien Lp | Multi-fire push rod stapling device |
US10182818B2 (en) | 2015-06-18 | 2019-01-22 | Ethicon Llc | Surgical end effectors with positive jaw opening arrangements |
US10064622B2 (en) | 2015-07-29 | 2018-09-04 | Covidien Lp | Surgical stapling loading unit with stroke counter and lockout |
US10045782B2 (en) | 2015-07-30 | 2018-08-14 | Covidien Lp | Surgical stapling loading unit with stroke counter and lockout |
US11058425B2 (en) | 2015-08-17 | 2021-07-13 | Ethicon Llc | Implantable layers for a surgical instrument |
MX2022009705A (es) | 2015-08-26 | 2022-11-07 | Ethicon Llc | Metodo para formar una grapa contra un yunque de un instrumento de engrapado quirurgico. |
US10517599B2 (en) | 2015-08-26 | 2019-12-31 | Ethicon Llc | Staple cartridge assembly comprising staple cavities for providing better staple guidance |
US10357252B2 (en) | 2015-09-02 | 2019-07-23 | Ethicon Llc | Surgical staple configurations with camming surfaces located between portions supporting surgical staples |
US10327769B2 (en) | 2015-09-23 | 2019-06-25 | Ethicon Llc | Surgical stapler having motor control based on a drive system component |
US10363036B2 (en) | 2015-09-23 | 2019-07-30 | Ethicon Llc | Surgical stapler having force-based motor control |
US10105139B2 (en) | 2015-09-23 | 2018-10-23 | Ethicon Llc | Surgical stapler having downstream current-based motor control |
US10238386B2 (en) | 2015-09-23 | 2019-03-26 | Ethicon Llc | Surgical stapler having motor control based on an electrical parameter related to a motor current |
US10076326B2 (en) | 2015-09-23 | 2018-09-18 | Ethicon Llc | Surgical stapler having current mirror-based motor control |
US10085751B2 (en) | 2015-09-23 | 2018-10-02 | Ethicon Llc | Surgical stapler having temperature-based motor control |
US10299878B2 (en) | 2015-09-25 | 2019-05-28 | Ethicon Llc | Implantable adjunct systems for determining adjunct skew |
US10736633B2 (en) | 2015-09-30 | 2020-08-11 | Ethicon Llc | Compressible adjunct with looping members |
US10524788B2 (en) | 2015-09-30 | 2020-01-07 | Ethicon Llc | Compressible adjunct with attachment regions |
US11890015B2 (en) | 2015-09-30 | 2024-02-06 | Cilag Gmbh International | Compressible adjunct with crossing spacer fibers |
US10980539B2 (en) | 2015-09-30 | 2021-04-20 | Ethicon Llc | Implantable adjunct comprising bonded layers |
US10213204B2 (en) | 2015-10-02 | 2019-02-26 | Covidien Lp | Micro surgical instrument and loading unit for use therewith |
US10772632B2 (en) | 2015-10-28 | 2020-09-15 | Covidien Lp | Surgical stapling device with triple leg staples |
US10595864B2 (en) | 2015-11-24 | 2020-03-24 | Covidien Lp | Adapter assembly for interconnecting electromechanical surgical devices and surgical loading units, and surgical systems thereof |
US10111660B2 (en) | 2015-12-03 | 2018-10-30 | Covidien Lp | Surgical stapler flexible distal tip |
US10292704B2 (en) | 2015-12-30 | 2019-05-21 | Ethicon Llc | Mechanisms for compensating for battery pack failure in powered surgical instruments |
US10265068B2 (en) | 2015-12-30 | 2019-04-23 | Ethicon Llc | Surgical instruments with separable motors and motor control circuits |
US10368865B2 (en) | 2015-12-30 | 2019-08-06 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10966717B2 (en) | 2016-01-07 | 2021-04-06 | Covidien Lp | Surgical fastener apparatus |
US10660623B2 (en) | 2016-01-15 | 2020-05-26 | Covidien Lp | Centering mechanism for articulation joint |
CN108882932B (zh) | 2016-02-09 | 2021-07-23 | 伊西康有限责任公司 | 具有非对称关节运动构造的外科器械 |
US10413291B2 (en) | 2016-02-09 | 2019-09-17 | Ethicon Llc | Surgical instrument articulation mechanism with slotted secondary constraint |
US11213293B2 (en) | 2016-02-09 | 2022-01-04 | Cilag Gmbh International | Articulatable surgical instruments with single articulation link arrangements |
US10349937B2 (en) | 2016-02-10 | 2019-07-16 | Covidien Lp | Surgical stapler with articulation locking mechanism |
US10420559B2 (en) | 2016-02-11 | 2019-09-24 | Covidien Lp | Surgical stapler with small diameter endoscopic portion |
US10448948B2 (en) | 2016-02-12 | 2019-10-22 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10258331B2 (en) | 2016-02-12 | 2019-04-16 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US11224426B2 (en) | 2016-02-12 | 2022-01-18 | Cilag Gmbh International | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10413297B2 (en) | 2016-04-01 | 2019-09-17 | Ethicon Llc | Surgical stapling system configured to apply annular rows of staples having different heights |
US10617413B2 (en) | 2016-04-01 | 2020-04-14 | Ethicon Llc | Closure system arrangements for surgical cutting and stapling devices with separate and distinct firing shafts |
US10456137B2 (en) | 2016-04-15 | 2019-10-29 | Ethicon Llc | Staple formation detection mechanisms |
US10357247B2 (en) | 2016-04-15 | 2019-07-23 | Ethicon Llc | Surgical instrument with multiple program responses during a firing motion |
US10405859B2 (en) | 2016-04-15 | 2019-09-10 | Ethicon Llc | Surgical instrument with adjustable stop/start control during a firing motion |
US10828028B2 (en) | 2016-04-15 | 2020-11-10 | Ethicon Llc | Surgical instrument with multiple program responses during a firing motion |
US10492783B2 (en) | 2016-04-15 | 2019-12-03 | Ethicon, Llc | Surgical instrument with improved stop/start control during a firing motion |
US11607239B2 (en) | 2016-04-15 | 2023-03-21 | Cilag Gmbh International | Systems and methods for controlling a surgical stapling and cutting instrument |
US10335145B2 (en) | 2016-04-15 | 2019-07-02 | Ethicon Llc | Modular surgical instrument with configurable operating mode |
US10426467B2 (en) | 2016-04-15 | 2019-10-01 | Ethicon Llc | Surgical instrument with detection sensors |
US11179150B2 (en) | 2016-04-15 | 2021-11-23 | Cilag Gmbh International | Systems and methods for controlling a surgical stapling and cutting instrument |
US11317917B2 (en) | 2016-04-18 | 2022-05-03 | Cilag Gmbh International | Surgical stapling system comprising a lockable firing assembly |
US10363037B2 (en) | 2016-04-18 | 2019-07-30 | Ethicon Llc | Surgical instrument system comprising a magnetic lockout |
US20170296173A1 (en) | 2016-04-18 | 2017-10-19 | Ethicon Endo-Surgery, Llc | Method for operating a surgical instrument |
US10561419B2 (en) | 2016-05-04 | 2020-02-18 | Covidien Lp | Powered end effector assembly with pivotable channel |
US11065022B2 (en) | 2016-05-17 | 2021-07-20 | Covidien Lp | Cutting member for a surgical instrument |
US10675024B2 (en) * | 2016-06-24 | 2020-06-09 | Ethicon Llc | Staple cartridge comprising overdriven staples |
CN109310431B (zh) | 2016-06-24 | 2022-03-04 | 伊西康有限责任公司 | 包括线材钉和冲压钉的钉仓 |
US11364029B2 (en) | 2016-09-09 | 2022-06-21 | Intuitive Surgical Operations, Inc. | Stapler reload detection and identification |
US11642126B2 (en) | 2016-11-04 | 2023-05-09 | Covidien Lp | Surgical stapling apparatus with tissue pockets |
US10631857B2 (en) | 2016-11-04 | 2020-04-28 | Covidien Lp | Loading unit for surgical instruments with low profile pushers |
US10492784B2 (en) | 2016-11-08 | 2019-12-03 | Covidien Lp | Surgical tool assembly with compact firing assembly |
US10463371B2 (en) | 2016-11-29 | 2019-11-05 | Covidien Lp | Reload assembly with spent reload indicator |
BR112019011947A2 (pt) | 2016-12-21 | 2019-10-29 | Ethicon Llc | sistemas de grampeamento cirúrgico |
US20180168598A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Staple forming pocket arrangements comprising zoned forming surface grooves |
US11090048B2 (en) | 2016-12-21 | 2021-08-17 | Cilag Gmbh International | Method for resetting a fuse of a surgical instrument shaft |
US10667810B2 (en) | 2016-12-21 | 2020-06-02 | Ethicon Llc | Closure members with cam surface arrangements for surgical instruments with separate and distinct closure and firing systems |
US10588630B2 (en) | 2016-12-21 | 2020-03-17 | Ethicon Llc | Surgical tool assemblies with closure stroke reduction features |
JP7010956B2 (ja) | 2016-12-21 | 2022-01-26 | エシコン エルエルシー | 組織をステープル留めする方法 |
US10485543B2 (en) | 2016-12-21 | 2019-11-26 | Ethicon Llc | Anvil having a knife slot width |
US20180168625A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Surgical stapling instruments with smart staple cartridges |
US20180168618A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Surgical stapling systems |
US10695055B2 (en) | 2016-12-21 | 2020-06-30 | Ethicon Llc | Firing assembly comprising a lockout |
US11134942B2 (en) | 2016-12-21 | 2021-10-05 | Cilag Gmbh International | Surgical stapling instruments and staple-forming anvils |
CN110099619B (zh) | 2016-12-21 | 2022-07-15 | 爱惜康有限责任公司 | 用于外科端部执行器和可替换工具组件的闭锁装置 |
US10639035B2 (en) | 2016-12-21 | 2020-05-05 | Ethicon Llc | Surgical stapling instruments and replaceable tool assemblies thereof |
US10542982B2 (en) | 2016-12-21 | 2020-01-28 | Ethicon Llc | Shaft assembly comprising first and second articulation lockouts |
US11419606B2 (en) | 2016-12-21 | 2022-08-23 | Cilag Gmbh International | Shaft assembly comprising a clutch configured to adapt the output of a rotary firing member to two different systems |
US11684367B2 (en) | 2016-12-21 | 2023-06-27 | Cilag Gmbh International | Stepped assembly having and end-of-life indicator |
US10893864B2 (en) | 2016-12-21 | 2021-01-19 | Ethicon | Staple cartridges and arrangements of staples and staple cavities therein |
US10426471B2 (en) | 2016-12-21 | 2019-10-01 | Ethicon Llc | Surgical instrument with multiple failure response modes |
US20180168615A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Method of deforming staples from two different types of staple cartridges with the same surgical stapling instrument |
US10758229B2 (en) | 2016-12-21 | 2020-09-01 | Ethicon Llc | Surgical instrument comprising improved jaw control |
US10709901B2 (en) | 2017-01-05 | 2020-07-14 | Covidien Lp | Implantable fasteners, applicators, and methods for brachytherapy |
US10952767B2 (en) | 2017-02-06 | 2021-03-23 | Covidien Lp | Connector clip for securing an introducer to a surgical fastener applying apparatus |
US20180235618A1 (en) | 2017-02-22 | 2018-08-23 | Covidien Lp | Loading unit for surgical instruments with low profile pushers |
US11350915B2 (en) | 2017-02-23 | 2022-06-07 | Covidien Lp | Surgical stapler with small diameter endoscopic portion |
US10849621B2 (en) | 2017-02-23 | 2020-12-01 | Covidien Lp | Surgical stapler with small diameter endoscopic portion |
US10299790B2 (en) | 2017-03-03 | 2019-05-28 | Covidien Lp | Adapter with centering mechanism for articulation joint |
US10660641B2 (en) | 2017-03-16 | 2020-05-26 | Covidien Lp | Adapter with centering mechanism for articulation joint |
US10603035B2 (en) | 2017-05-02 | 2020-03-31 | Covidien Lp | Surgical loading unit including an articulating end effector |
US11324502B2 (en) | 2017-05-02 | 2022-05-10 | Covidien Lp | Surgical loading unit including an articulating end effector |
US10524784B2 (en) | 2017-05-05 | 2020-01-07 | Covidien Lp | Surgical staples with expandable backspan |
US10390826B2 (en) | 2017-05-08 | 2019-08-27 | Covidien Lp | Surgical stapling device with elongated tool assembly and methods of use |
US10420551B2 (en) | 2017-05-30 | 2019-09-24 | Covidien Lp | Authentication and information system for reusable surgical instruments |
US10478185B2 (en) | 2017-06-02 | 2019-11-19 | Covidien Lp | Tool assembly with minimal dead space |
US10881396B2 (en) | 2017-06-20 | 2021-01-05 | Ethicon Llc | Surgical instrument with variable duration trigger arrangement |
US11653914B2 (en) | 2017-06-20 | 2023-05-23 | Cilag Gmbh International | Systems and methods for controlling motor velocity of a surgical stapling and cutting instrument according to articulation angle of end effector |
US10307170B2 (en) | 2017-06-20 | 2019-06-04 | Ethicon Llc | Method for closed loop control of motor velocity of a surgical stapling and cutting instrument |
US10368864B2 (en) | 2017-06-20 | 2019-08-06 | Ethicon Llc | Systems and methods for controlling displaying motor velocity for a surgical instrument |
US11071554B2 (en) | 2017-06-20 | 2021-07-27 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on magnitude of velocity error measurements |
US10624633B2 (en) | 2017-06-20 | 2020-04-21 | Ethicon Llc | Systems and methods for controlling motor velocity of a surgical stapling and cutting instrument |
US10881399B2 (en) | 2017-06-20 | 2021-01-05 | Ethicon Llc | Techniques for adaptive control of motor velocity of a surgical stapling and cutting instrument |
US10327767B2 (en) | 2017-06-20 | 2019-06-25 | Ethicon Llc | Control of motor velocity of a surgical stapling and cutting instrument based on angle of articulation |
US10980537B2 (en) | 2017-06-20 | 2021-04-20 | Ethicon Llc | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured time over a specified number of shaft rotations |
US10646220B2 (en) | 2017-06-20 | 2020-05-12 | Ethicon Llc | Systems and methods for controlling displacement member velocity for a surgical instrument |
US11090046B2 (en) | 2017-06-20 | 2021-08-17 | Cilag Gmbh International | Systems and methods for controlling displacement member motion of a surgical stapling and cutting instrument |
US11382638B2 (en) * | 2017-06-20 | 2022-07-12 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured time over a specified displacement distance |
US10390841B2 (en) | 2017-06-20 | 2019-08-27 | Ethicon Llc | Control of motor velocity of a surgical stapling and cutting instrument based on angle of articulation |
US10779820B2 (en) | 2017-06-20 | 2020-09-22 | Ethicon Llc | Systems and methods for controlling motor speed according to user input for a surgical instrument |
US11517325B2 (en) | 2017-06-20 | 2022-12-06 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured displacement distance traveled over a specified time interval |
US10888321B2 (en) | 2017-06-20 | 2021-01-12 | Ethicon Llc | Systems and methods for controlling velocity of a displacement member of a surgical stapling and cutting instrument |
USD890784S1 (en) | 2017-06-20 | 2020-07-21 | Ethicon Llc | Display panel with changeable graphical user interface |
USD879809S1 (en) | 2017-06-20 | 2020-03-31 | Ethicon Llc | Display panel with changeable graphical user interface |
US10813639B2 (en) | 2017-06-20 | 2020-10-27 | Ethicon Llc | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on system conditions |
USD879808S1 (en) | 2017-06-20 | 2020-03-31 | Ethicon Llc | Display panel with graphical user interface |
US11324503B2 (en) | 2017-06-27 | 2022-05-10 | Cilag Gmbh International | Surgical firing member arrangements |
US11141154B2 (en) | 2017-06-27 | 2021-10-12 | Cilag Gmbh International | Surgical end effectors and anvils |
US10772629B2 (en) | 2017-06-27 | 2020-09-15 | Ethicon Llc | Surgical anvil arrangements |
US11266405B2 (en) | 2017-06-27 | 2022-03-08 | Cilag Gmbh International | Surgical anvil manufacturing methods |
US10993716B2 (en) | 2017-06-27 | 2021-05-04 | Ethicon Llc | Surgical anvil arrangements |
US10856869B2 (en) | 2017-06-27 | 2020-12-08 | Ethicon Llc | Surgical anvil arrangements |
USD906355S1 (en) | 2017-06-28 | 2020-12-29 | Ethicon Llc | Display screen or portion thereof with a graphical user interface for a surgical instrument |
US11246592B2 (en) | 2017-06-28 | 2022-02-15 | Cilag Gmbh International | Surgical instrument comprising an articulation system lockable to a frame |
US10716614B2 (en) | 2017-06-28 | 2020-07-21 | Ethicon Llc | Surgical shaft assemblies with slip ring assemblies with increased contact pressure |
US11000279B2 (en) | 2017-06-28 | 2021-05-11 | Ethicon Llc | Surgical instrument comprising an articulation system ratio |
US10903685B2 (en) | 2017-06-28 | 2021-01-26 | Ethicon Llc | Surgical shaft assemblies with slip ring assemblies forming capacitive channels |
USD854151S1 (en) | 2017-06-28 | 2019-07-16 | Ethicon Llc | Surgical instrument shaft |
EP3420947B1 (en) | 2017-06-28 | 2022-05-25 | Cilag GmbH International | Surgical instrument comprising selectively actuatable rotatable couplers |
US10786253B2 (en) | 2017-06-28 | 2020-09-29 | Ethicon Llc | Surgical end effectors with improved jaw aperture arrangements |
USD869655S1 (en) | 2017-06-28 | 2019-12-10 | Ethicon Llc | Surgical fastener cartridge |
US11259805B2 (en) | 2017-06-28 | 2022-03-01 | Cilag Gmbh International | Surgical instrument comprising firing member supports |
US10211586B2 (en) | 2017-06-28 | 2019-02-19 | Ethicon Llc | Surgical shaft assemblies with watertight housings |
US11564686B2 (en) | 2017-06-28 | 2023-01-31 | Cilag Gmbh International | Surgical shaft assemblies with flexible interfaces |
USD851762S1 (en) | 2017-06-28 | 2019-06-18 | Ethicon Llc | Anvil |
US10765427B2 (en) | 2017-06-28 | 2020-09-08 | Ethicon Llc | Method for articulating a surgical instrument |
US10898183B2 (en) | 2017-06-29 | 2021-01-26 | Ethicon Llc | Robotic surgical instrument with closed loop feedback techniques for advancement of closure member during firing |
US10258418B2 (en) | 2017-06-29 | 2019-04-16 | Ethicon Llc | System for controlling articulation forces |
US10398434B2 (en) | 2017-06-29 | 2019-09-03 | Ethicon Llc | Closed loop velocity control of closure member for robotic surgical instrument |
US10932772B2 (en) | 2017-06-29 | 2021-03-02 | Ethicon Llc | Methods for closed loop velocity control for robotic surgical instrument |
US11007022B2 (en) | 2017-06-29 | 2021-05-18 | Ethicon Llc | Closed loop velocity control techniques based on sensed tissue parameters for robotic surgical instrument |
US11471155B2 (en) | 2017-08-03 | 2022-10-18 | Cilag Gmbh International | Surgical system bailout |
US11304695B2 (en) | 2017-08-03 | 2022-04-19 | Cilag Gmbh International | Surgical system shaft interconnection |
US11974742B2 (en) | 2017-08-03 | 2024-05-07 | Cilag Gmbh International | Surgical system comprising an articulation bailout |
US11944300B2 (en) | 2017-08-03 | 2024-04-02 | Cilag Gmbh International | Method for operating a surgical system bailout |
US10624636B2 (en) | 2017-08-23 | 2020-04-21 | Covidien Lp | Surgical stapling device with floating staple cartridge |
US10806452B2 (en) | 2017-08-24 | 2020-10-20 | Covidien Lp | Loading unit for a surgical stapling instrument |
US10966720B2 (en) | 2017-09-01 | 2021-04-06 | RevMedica, Inc. | Surgical stapler with removable power pack |
US11331099B2 (en) | 2017-09-01 | 2022-05-17 | Rev Medica, Inc. | Surgical stapler with removable power pack and interchangeable battery pack |
US10695060B2 (en) | 2017-09-01 | 2020-06-30 | RevMedica, Inc. | Loadable power pack for surgical instruments |
US11399829B2 (en) | 2017-09-29 | 2022-08-02 | Cilag Gmbh International | Systems and methods of initiating a power shutdown mode for a surgical instrument |
US10765429B2 (en) | 2017-09-29 | 2020-09-08 | Ethicon Llc | Systems and methods for providing alerts according to the operational state of a surgical instrument |
USD907647S1 (en) | 2017-09-29 | 2021-01-12 | Ethicon Llc | Display screen or portion thereof with animated graphical user interface |
USD917500S1 (en) | 2017-09-29 | 2021-04-27 | Ethicon Llc | Display screen or portion thereof with graphical user interface |
USD907648S1 (en) | 2017-09-29 | 2021-01-12 | Ethicon Llc | Display screen or portion thereof with animated graphical user interface |
US10796471B2 (en) | 2017-09-29 | 2020-10-06 | Ethicon Llc | Systems and methods of displaying a knife position for a surgical instrument |
US10743872B2 (en) | 2017-09-29 | 2020-08-18 | Ethicon Llc | System and methods for controlling a display of a surgical instrument |
US10729501B2 (en) | 2017-09-29 | 2020-08-04 | Ethicon Llc | Systems and methods for language selection of a surgical instrument |
US11134944B2 (en) | 2017-10-30 | 2021-10-05 | Cilag Gmbh International | Surgical stapler knife motion controls |
CN111526813B (zh) * | 2017-10-30 | 2023-05-12 | 爱惜康有限责任公司 | 包括反馈机构的外科器械系统 |
US11090075B2 (en) | 2017-10-30 | 2021-08-17 | Cilag Gmbh International | Articulation features for surgical end effector |
US10842490B2 (en) | 2017-10-31 | 2020-11-24 | Ethicon Llc | Cartridge body design with force reduction based on firing completion |
US10779903B2 (en) | 2017-10-31 | 2020-09-22 | Ethicon Llc | Positive shaft rotation lock activated by jaw closure |
US10925603B2 (en) | 2017-11-14 | 2021-02-23 | Covidien Lp | Reload with articulation stabilization system |
US10863987B2 (en) | 2017-11-16 | 2020-12-15 | Covidien Lp | Surgical instrument with imaging device |
US11071543B2 (en) | 2017-12-15 | 2021-07-27 | Cilag Gmbh International | Surgical end effectors with clamping assemblies configured to increase jaw aperture ranges |
US11197670B2 (en) | 2017-12-15 | 2021-12-14 | Cilag Gmbh International | Surgical end effectors with pivotal jaws configured to touch at their respective distal ends when fully closed |
US10779826B2 (en) | 2017-12-15 | 2020-09-22 | Ethicon Llc | Methods of operating surgical end effectors |
US11033267B2 (en) | 2017-12-15 | 2021-06-15 | Ethicon Llc | Systems and methods of controlling a clamping member firing rate of a surgical instrument |
US10828033B2 (en) | 2017-12-15 | 2020-11-10 | Ethicon Llc | Handheld electromechanical surgical instruments with improved motor control arrangements for positioning components of an adapter coupled thereto |
US10779825B2 (en) | 2017-12-15 | 2020-09-22 | Ethicon Llc | Adapters with end effector position sensing and control arrangements for use in connection with electromechanical surgical instruments |
US10966718B2 (en) | 2017-12-15 | 2021-04-06 | Ethicon Llc | Dynamic clamping assemblies with improved wear characteristics for use in connection with electromechanical surgical instruments |
US10743875B2 (en) | 2017-12-15 | 2020-08-18 | Ethicon Llc | Surgical end effectors with jaw stiffener arrangements configured to permit monitoring of firing member |
US10869666B2 (en) | 2017-12-15 | 2020-12-22 | Ethicon Llc | Adapters with control systems for controlling multiple motors of an electromechanical surgical instrument |
US10743874B2 (en) | 2017-12-15 | 2020-08-18 | Ethicon Llc | Sealed adapters for use with electromechanical surgical instruments |
US11006955B2 (en) | 2017-12-15 | 2021-05-18 | Ethicon Llc | End effectors with positive jaw opening features for use with adapters for electromechanical surgical instruments |
US10687813B2 (en) | 2017-12-15 | 2020-06-23 | Ethicon Llc | Adapters with firing stroke sensing arrangements for use in connection with electromechanical surgical instruments |
US11045270B2 (en) | 2017-12-19 | 2021-06-29 | Cilag Gmbh International | Robotic attachment comprising exterior drive actuator |
US10716565B2 (en) | 2017-12-19 | 2020-07-21 | Ethicon Llc | Surgical instruments with dual articulation drivers |
USD910847S1 (en) | 2017-12-19 | 2021-02-16 | Ethicon Llc | Surgical instrument assembly |
US11020112B2 (en) | 2017-12-19 | 2021-06-01 | Ethicon Llc | Surgical tools configured for interchangeable use with different controller interfaces |
US10729509B2 (en) | 2017-12-19 | 2020-08-04 | Ethicon Llc | Surgical instrument comprising closure and firing locking mechanism |
US10835330B2 (en) | 2017-12-19 | 2020-11-17 | Ethicon Llc | Method for determining the position of a rotatable jaw of a surgical instrument attachment assembly |
US11311290B2 (en) | 2017-12-21 | 2022-04-26 | Cilag Gmbh International | Surgical instrument comprising an end effector dampener |
US10682134B2 (en) | 2017-12-21 | 2020-06-16 | Ethicon Llc | Continuous use self-propelled stapling instrument |
US11076853B2 (en) | 2017-12-21 | 2021-08-03 | Cilag Gmbh International | Systems and methods of displaying a knife position during transection for a surgical instrument |
US11129680B2 (en) | 2017-12-21 | 2021-09-28 | Cilag Gmbh International | Surgical instrument comprising a projector |
CN108042165B (zh) * | 2017-12-25 | 2019-07-23 | 苏州英途康医疗科技有限公司 | 用于腔镜吻合器的适配器和腔镜吻合器 |
US10945732B2 (en) | 2018-01-17 | 2021-03-16 | Covidien Lp | Surgical stapler with self-returning assembly |
EP3758618B1 (en) | 2018-03-02 | 2024-04-24 | Covidien LP | Surgical stapling instrument |
US10849622B2 (en) | 2018-06-21 | 2020-12-01 | Covidien Lp | Articulated stapling with fire lock |
US20200015900A1 (en) | 2018-07-16 | 2020-01-16 | Ethicon Llc | Controlling an emitter assembly pulse sequence |
US10736631B2 (en) | 2018-08-07 | 2020-08-11 | Covidien Lp | End effector with staple cartridge ejector |
US11291440B2 (en) | 2018-08-20 | 2022-04-05 | Cilag Gmbh International | Method for operating a powered articulatable surgical instrument |
US11324501B2 (en) | 2018-08-20 | 2022-05-10 | Cilag Gmbh International | Surgical stapling devices with improved closure members |
US11207065B2 (en) | 2018-08-20 | 2021-12-28 | Cilag Gmbh International | Method for fabricating surgical stapler anvils |
US11039834B2 (en) | 2018-08-20 | 2021-06-22 | Cilag Gmbh International | Surgical stapler anvils with staple directing protrusions and tissue stability features |
US11045192B2 (en) | 2018-08-20 | 2021-06-29 | Cilag Gmbh International | Fabricating techniques for surgical stapler anvils |
US10842492B2 (en) | 2018-08-20 | 2020-11-24 | Ethicon Llc | Powered articulatable surgical instruments with clutching and locking arrangements for linking an articulation drive system to a firing drive system |
US10912559B2 (en) | 2018-08-20 | 2021-02-09 | Ethicon Llc | Reinforced deformable anvil tip for surgical stapler anvil |
US11253256B2 (en) | 2018-08-20 | 2022-02-22 | Cilag Gmbh International | Articulatable motor powered surgical instruments with dedicated articulation motor arrangements |
US10779821B2 (en) | 2018-08-20 | 2020-09-22 | Ethicon Llc | Surgical stapler anvils with tissue stop features configured to avoid tissue pinch |
USD914878S1 (en) | 2018-08-20 | 2021-03-30 | Ethicon Llc | Surgical instrument anvil |
US11083458B2 (en) | 2018-08-20 | 2021-08-10 | Cilag Gmbh International | Powered surgical instruments with clutching arrangements to convert linear drive motions to rotary drive motions |
US10856870B2 (en) | 2018-08-20 | 2020-12-08 | Ethicon Llc | Switching arrangements for motor powered articulatable surgical instruments |
US10849620B2 (en) | 2018-09-14 | 2020-12-01 | Covidien Lp | Connector mechanisms for surgical stapling instruments |
US11510669B2 (en) | 2020-09-29 | 2022-11-29 | Covidien Lp | Hand-held surgical instruments |
US11090051B2 (en) | 2018-10-23 | 2021-08-17 | Covidien Lp | Surgical stapling device with floating staple cartridge |
US11197673B2 (en) | 2018-10-30 | 2021-12-14 | Covidien Lp | Surgical stapling instruments and end effector assemblies thereof |
US10912563B2 (en) | 2019-01-02 | 2021-02-09 | Covidien Lp | Stapling device including tool assembly stabilizing member |
US11344297B2 (en) | 2019-02-28 | 2022-05-31 | Covidien Lp | Surgical stapling device with independently movable jaws |
US11259808B2 (en) | 2019-03-13 | 2022-03-01 | Covidien Lp | Tool assemblies with a gap locking member |
US11172929B2 (en) | 2019-03-25 | 2021-11-16 | Cilag Gmbh International | Articulation drive arrangements for surgical systems |
US11147553B2 (en) | 2019-03-25 | 2021-10-19 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
US11147551B2 (en) | 2019-03-25 | 2021-10-19 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
US11696761B2 (en) | 2019-03-25 | 2023-07-11 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
US11284892B2 (en) | 2019-04-01 | 2022-03-29 | Covidien Lp | Loading unit and adapter with modified coupling assembly |
US11284893B2 (en) | 2019-04-02 | 2022-03-29 | Covidien Lp | Stapling device with articulating tool assembly |
US11241228B2 (en) | 2019-04-05 | 2022-02-08 | Covidien Lp | Surgical instrument including an adapter assembly and an articulating surgical loading unit |
US11452528B2 (en) | 2019-04-30 | 2022-09-27 | Cilag Gmbh International | Articulation actuators for a surgical instrument |
US11903581B2 (en) | 2019-04-30 | 2024-02-20 | Cilag Gmbh International | Methods for stapling tissue using a surgical instrument |
US11253254B2 (en) | 2019-04-30 | 2022-02-22 | Cilag Gmbh International | Shaft rotation actuator on a surgical instrument |
US11648009B2 (en) | 2019-04-30 | 2023-05-16 | Cilag Gmbh International | Rotatable jaw tip for a surgical instrument |
US11432816B2 (en) | 2019-04-30 | 2022-09-06 | Cilag Gmbh International | Articulation pin for a surgical instrument |
US11426251B2 (en) | 2019-04-30 | 2022-08-30 | Cilag Gmbh International | Articulation directional lights on a surgical instrument |
US11471157B2 (en) | 2019-04-30 | 2022-10-18 | Cilag Gmbh International | Articulation control mapping for a surgical instrument |
US11399837B2 (en) | 2019-06-28 | 2022-08-02 | Cilag Gmbh International | Mechanisms for motor control adjustments of a motorized surgical instrument |
US11298132B2 (en) | 2019-06-28 | 2022-04-12 | Cilag GmbH Inlernational | Staple cartridge including a honeycomb extension |
US11464601B2 (en) | 2019-06-28 | 2022-10-11 | Cilag Gmbh International | Surgical instrument comprising an RFID system for tracking a movable component |
US11627959B2 (en) | 2019-06-28 | 2023-04-18 | Cilag Gmbh International | Surgical instruments including manual and powered system lockouts |
US11684434B2 (en) | 2019-06-28 | 2023-06-27 | Cilag Gmbh International | Surgical RFID assemblies for instrument operational setting control |
US11660163B2 (en) | 2019-06-28 | 2023-05-30 | Cilag Gmbh International | Surgical system with RFID tags for updating motor assembly parameters |
US11298127B2 (en) | 2019-06-28 | 2022-04-12 | Cilag GmbH Interational | Surgical stapling system having a lockout mechanism for an incompatible cartridge |
US11246678B2 (en) | 2019-06-28 | 2022-02-15 | Cilag Gmbh International | Surgical stapling system having a frangible RFID tag |
US11051807B2 (en) | 2019-06-28 | 2021-07-06 | Cilag Gmbh International | Packaging assembly including a particulate trap |
US11350938B2 (en) | 2019-06-28 | 2022-06-07 | Cilag Gmbh International | Surgical instrument comprising an aligned rfid sensor |
US20200405302A1 (en) * | 2019-06-28 | 2020-12-31 | Ethicon Llc | Surgical stapling system having an information decryption protocol |
US11553971B2 (en) | 2019-06-28 | 2023-01-17 | Cilag Gmbh International | Surgical RFID assemblies for display and communication |
US11478241B2 (en) | 2019-06-28 | 2022-10-25 | Cilag Gmbh International | Staple cartridge including projections |
US11638587B2 (en) | 2019-06-28 | 2023-05-02 | Cilag Gmbh International | RFID identification systems for surgical instruments |
US11291451B2 (en) | 2019-06-28 | 2022-04-05 | Cilag Gmbh International | Surgical instrument with battery compatibility verification functionality |
US11376098B2 (en) | 2019-06-28 | 2022-07-05 | Cilag Gmbh International | Surgical instrument system comprising an RFID system |
US11224497B2 (en) | 2019-06-28 | 2022-01-18 | Cilag Gmbh International | Surgical systems with multiple RFID tags |
US11523822B2 (en) | 2019-06-28 | 2022-12-13 | Cilag Gmbh International | Battery pack including a circuit interrupter |
US11771419B2 (en) | 2019-06-28 | 2023-10-03 | Cilag Gmbh International | Packaging for a replaceable component of a surgical stapling system |
US11259803B2 (en) | 2019-06-28 | 2022-03-01 | Cilag Gmbh International | Surgical stapling system having an information encryption protocol |
US11497492B2 (en) | 2019-06-28 | 2022-11-15 | Cilag Gmbh International | Surgical instrument including an articulation lock |
US11426167B2 (en) | 2019-06-28 | 2022-08-30 | Cilag Gmbh International | Mechanisms for proper anvil attachment surgical stapling head assembly |
US11219455B2 (en) | 2019-06-28 | 2022-01-11 | Cilag Gmbh International | Surgical instrument including a lockout key |
WO2021016006A1 (en) | 2019-07-19 | 2021-01-28 | RevMedica, Inc. | Surgical stapler with removable power pack |
US11224424B2 (en) | 2019-08-02 | 2022-01-18 | Covidien Lp | Linear stapling device with vertically movable knife |
US11406385B2 (en) | 2019-10-11 | 2022-08-09 | Covidien Lp | Stapling device with a gap locking member |
US11123068B2 (en) | 2019-11-08 | 2021-09-21 | Covidien Lp | Surgical staple cartridge |
US11974743B2 (en) | 2019-12-02 | 2024-05-07 | Covidien Lp | Linear stapling device with a gap locking member |
US11707274B2 (en) | 2019-12-06 | 2023-07-25 | Covidien Lp | Articulating mechanism for surgical instrument |
US11109862B2 (en) | 2019-12-12 | 2021-09-07 | Covidien Lp | Surgical stapling device with flexible shaft |
US11737747B2 (en) | 2019-12-17 | 2023-08-29 | Covidien Lp | Hand-held surgical instruments |
US11529139B2 (en) | 2019-12-19 | 2022-12-20 | Cilag Gmbh International | Motor driven surgical instrument |
US11844520B2 (en) | 2019-12-19 | 2023-12-19 | Cilag Gmbh International | Staple cartridge comprising driver retention members |
US11464512B2 (en) | 2019-12-19 | 2022-10-11 | Cilag Gmbh International | Staple cartridge comprising a curved deck surface |
US11911032B2 (en) | 2019-12-19 | 2024-02-27 | Cilag Gmbh International | Staple cartridge comprising a seating cam |
US11931033B2 (en) | 2019-12-19 | 2024-03-19 | Cilag Gmbh International | Staple cartridge comprising a latch lockout |
US11701111B2 (en) | 2019-12-19 | 2023-07-18 | Cilag Gmbh International | Method for operating a surgical stapling instrument |
US11446029B2 (en) | 2019-12-19 | 2022-09-20 | Cilag Gmbh International | Staple cartridge comprising projections extending from a curved deck surface |
US11304696B2 (en) | 2019-12-19 | 2022-04-19 | Cilag Gmbh International | Surgical instrument comprising a powered articulation system |
US11559304B2 (en) | 2019-12-19 | 2023-01-24 | Cilag Gmbh International | Surgical instrument comprising a rapid closure mechanism |
US11576672B2 (en) | 2019-12-19 | 2023-02-14 | Cilag Gmbh International | Surgical instrument comprising a closure system including a closure member and an opening member driven by a drive screw |
US11234698B2 (en) | 2019-12-19 | 2022-02-01 | Cilag Gmbh International | Stapling system comprising a clamp lockout and a firing lockout |
US11529137B2 (en) | 2019-12-19 | 2022-12-20 | Cilag Gmbh International | Staple cartridge comprising driver retention members |
US11504122B2 (en) | 2019-12-19 | 2022-11-22 | Cilag Gmbh International | Surgical instrument comprising a nested firing member |
US11291447B2 (en) | 2019-12-19 | 2022-04-05 | Cilag Gmbh International | Stapling instrument comprising independent jaw closing and staple firing systems |
US11607219B2 (en) | 2019-12-19 | 2023-03-21 | Cilag Gmbh International | Staple cartridge comprising a detachable tissue cutting knife |
US11759283B2 (en) | 2019-12-30 | 2023-09-19 | Cilag Gmbh International | Surgical systems for generating three dimensional constructs of anatomical organs and coupling identified anatomical structures thereto |
US11219501B2 (en) | 2019-12-30 | 2022-01-11 | Cilag Gmbh International | Visualization systems using structured light |
US11832996B2 (en) | 2019-12-30 | 2023-12-05 | Cilag Gmbh International | Analyzing surgical trends by a surgical system |
US11744667B2 (en) | 2019-12-30 | 2023-09-05 | Cilag Gmbh International | Adaptive visualization by a surgical system |
US11896442B2 (en) | 2019-12-30 | 2024-02-13 | Cilag Gmbh International | Surgical systems for proposing and corroborating organ portion removals |
US11648060B2 (en) | 2019-12-30 | 2023-05-16 | Cilag Gmbh International | Surgical system for overlaying surgical instrument data onto a virtual three dimensional construct of an organ |
US11284963B2 (en) | 2019-12-30 | 2022-03-29 | Cilag Gmbh International | Method of using imaging devices in surgery |
US11776144B2 (en) | 2019-12-30 | 2023-10-03 | Cilag Gmbh International | System and method for determining, adjusting, and managing resection margin about a subject tissue |
US11452524B2 (en) | 2020-01-31 | 2022-09-27 | Covidien Lp | Surgical stapling device with lockout |
US11278282B2 (en) | 2020-01-31 | 2022-03-22 | Covidien Lp | Stapling device with selective cutting |
WO2021159483A1 (en) | 2020-02-14 | 2021-08-19 | Covidien Lp | Cartridge holder for surgical staples and having ridges in peripheral walls for gripping tissue |
US11344301B2 (en) | 2020-03-02 | 2022-05-31 | Covidien Lp | Surgical stapling device with replaceable reload assembly |
US11344302B2 (en) | 2020-03-05 | 2022-05-31 | Covidien Lp | Articulation mechanism for surgical stapling device |
US11707278B2 (en) | 2020-03-06 | 2023-07-25 | Covidien Lp | Surgical stapler tool assembly to minimize bleeding |
US11246593B2 (en) | 2020-03-06 | 2022-02-15 | Covidien Lp | Staple cartridge |
US11357505B2 (en) | 2020-03-10 | 2022-06-14 | Covidien Lp | Surgical stapling apparatus with firing lockout mechanism |
US11317911B2 (en) | 2020-03-10 | 2022-05-03 | Covidien Lp | Tool assembly with replaceable cartridge assembly |
US11406383B2 (en) | 2020-03-17 | 2022-08-09 | Covidien Lp | Fire assisted powered EGIA handle |
US11331098B2 (en) | 2020-04-01 | 2022-05-17 | Covidien Lp | Sled detection device |
US11426159B2 (en) | 2020-04-01 | 2022-08-30 | Covidien Lp | Sled detection device |
US11504117B2 (en) | 2020-04-02 | 2022-11-22 | Covidien Lp | Hand-held surgical instruments |
US11937794B2 (en) | 2020-05-11 | 2024-03-26 | Covidien Lp | Powered handle assembly for surgical devices |
US11191537B1 (en) | 2020-05-12 | 2021-12-07 | Covidien Lp | Stapling device with continuously parallel jaws |
US11406387B2 (en) | 2020-05-12 | 2022-08-09 | Covidien Lp | Surgical stapling device with replaceable staple cartridge |
US11534167B2 (en) | 2020-05-28 | 2022-12-27 | Covidien Lp | Electrotaxis-conducive stapling |
USD967421S1 (en) | 2020-06-02 | 2022-10-18 | Cilag Gmbh International | Staple cartridge |
USD974560S1 (en) | 2020-06-02 | 2023-01-03 | Cilag Gmbh International | Staple cartridge |
USD975850S1 (en) | 2020-06-02 | 2023-01-17 | Cilag Gmbh International | Staple cartridge |
USD975278S1 (en) | 2020-06-02 | 2023-01-10 | Cilag Gmbh International | Staple cartridge |
USD975851S1 (en) | 2020-06-02 | 2023-01-17 | Cilag Gmbh International | Staple cartridge |
USD976401S1 (en) | 2020-06-02 | 2023-01-24 | Cilag Gmbh International | Staple cartridge |
USD966512S1 (en) | 2020-06-02 | 2022-10-11 | Cilag Gmbh International | Staple cartridge |
US11191538B1 (en) | 2020-06-08 | 2021-12-07 | Covidien Lp | Surgical stapling device with parallel jaw closure |
US11844517B2 (en) | 2020-06-25 | 2023-12-19 | Covidien Lp | Linear stapling device with continuously parallel jaws |
US11324500B2 (en) | 2020-06-30 | 2022-05-10 | Covidien Lp | Surgical stapling device |
US11446028B2 (en) | 2020-07-09 | 2022-09-20 | Covidien Lp | Tool assembly with pivotable clamping beam |
US11517305B2 (en) | 2020-07-09 | 2022-12-06 | Covidien Lp | Contoured staple pusher |
US20220031320A1 (en) | 2020-07-28 | 2022-02-03 | Cilag Gmbh International | Surgical instruments with flexible firing member actuator constraint arrangements |
US11266402B2 (en) | 2020-07-30 | 2022-03-08 | Covidien Lp | Sensing curved tip for surgical stapling instruments |
US11439392B2 (en) | 2020-08-03 | 2022-09-13 | Covidien Lp | Surgical stapling device and fastener for pathological exam |
US11395654B2 (en) | 2020-08-07 | 2022-07-26 | Covidien Lp | Surgical stapling device with articulation braking assembly |
US11602342B2 (en) | 2020-08-27 | 2023-03-14 | Covidien Lp | Surgical stapling device with laser probe |
US11678878B2 (en) | 2020-09-16 | 2023-06-20 | Covidien Lp | Articulation mechanism for surgical stapling device |
US11660092B2 (en) | 2020-09-29 | 2023-05-30 | Covidien Lp | Adapter for securing loading units to handle assemblies of surgical stapling instruments |
US11911030B2 (en) * | 2020-10-02 | 2024-02-27 | Cilag Gmbh International | Communication capability of a surgical device with component |
US11963683B2 (en) | 2020-10-02 | 2024-04-23 | Cilag Gmbh International | Method for operating tiered operation modes in a surgical system |
US11406384B2 (en) | 2020-10-05 | 2022-08-09 | Covidien Lp | Stapling device with drive assembly stop member |
US11576674B2 (en) | 2020-10-06 | 2023-02-14 | Covidien Lp | Surgical stapling device with articulation lock assembly |
US11779330B2 (en) | 2020-10-29 | 2023-10-10 | Cilag Gmbh International | Surgical instrument comprising a jaw alignment system |
US11717289B2 (en) | 2020-10-29 | 2023-08-08 | Cilag Gmbh International | Surgical instrument comprising an indicator which indicates that an articulation drive is actuatable |
US11931025B2 (en) | 2020-10-29 | 2024-03-19 | Cilag Gmbh International | Surgical instrument comprising a releasable closure drive lock |
US11452526B2 (en) | 2020-10-29 | 2022-09-27 | Cilag Gmbh International | Surgical instrument comprising a staged voltage regulation start-up system |
US11517390B2 (en) | 2020-10-29 | 2022-12-06 | Cilag Gmbh International | Surgical instrument comprising a limited travel switch |
US11617577B2 (en) | 2020-10-29 | 2023-04-04 | Cilag Gmbh International | Surgical instrument comprising a sensor configured to sense whether an articulation drive of the surgical instrument is actuatable |
US11534259B2 (en) | 2020-10-29 | 2022-12-27 | Cilag Gmbh International | Surgical instrument comprising an articulation indicator |
USD1013170S1 (en) | 2020-10-29 | 2024-01-30 | Cilag Gmbh International | Surgical instrument assembly |
US11844518B2 (en) | 2020-10-29 | 2023-12-19 | Cilag Gmbh International | Method for operating a surgical instrument |
USD980425S1 (en) | 2020-10-29 | 2023-03-07 | Cilag Gmbh International | Surgical instrument assembly |
US11896217B2 (en) | 2020-10-29 | 2024-02-13 | Cilag Gmbh International | Surgical instrument comprising an articulation lock |
US11890007B2 (en) | 2020-11-18 | 2024-02-06 | Covidien Lp | Stapling device with flex cable and tensioning mechanism |
US11653915B2 (en) | 2020-12-02 | 2023-05-23 | Cilag Gmbh International | Surgical instruments with sled location detection and adjustment features |
US11678882B2 (en) | 2020-12-02 | 2023-06-20 | Cilag Gmbh International | Surgical instruments with interactive features to remedy incidental sled movements |
US11849943B2 (en) | 2020-12-02 | 2023-12-26 | Cilag Gmbh International | Surgical instrument with cartridge release mechanisms |
US11944296B2 (en) | 2020-12-02 | 2024-04-02 | Cilag Gmbh International | Powered surgical instruments with external connectors |
US11653920B2 (en) | 2020-12-02 | 2023-05-23 | Cilag Gmbh International | Powered surgical instruments with communication interfaces through sterile barrier |
US11890010B2 (en) | 2020-12-02 | 2024-02-06 | Cllag GmbH International | Dual-sided reinforced reload for surgical instruments |
US11627960B2 (en) | 2020-12-02 | 2023-04-18 | Cilag Gmbh International | Powered surgical instruments with smart reload with separately attachable exteriorly mounted wiring connections |
US11744581B2 (en) | 2020-12-02 | 2023-09-05 | Cilag Gmbh International | Powered surgical instruments with multi-phase tissue treatment |
US11737751B2 (en) | 2020-12-02 | 2023-08-29 | Cilag Gmbh International | Devices and methods of managing energy dissipated within sterile barriers of surgical instrument housings |
US11737774B2 (en) | 2020-12-04 | 2023-08-29 | Covidien Lp | Surgical instrument with articulation assembly |
US11819200B2 (en) | 2020-12-15 | 2023-11-21 | Covidien Lp | Surgical instrument with articulation assembly |
US11553914B2 (en) | 2020-12-22 | 2023-01-17 | Covidien Lp | Surgical stapling device with parallel jaw closure |
US11759206B2 (en) | 2021-01-05 | 2023-09-19 | Covidien Lp | Surgical stapling device with firing lockout mechanism |
US11744582B2 (en) | 2021-01-05 | 2023-09-05 | Covidien Lp | Surgical stapling device with firing lockout mechanism |
US11759207B2 (en) | 2021-01-27 | 2023-09-19 | Covidien Lp | Surgical stapling apparatus with adjustable height clamping member |
US11517313B2 (en) | 2021-01-27 | 2022-12-06 | Covidien Lp | Surgical stapling device with laminated drive member |
US11701113B2 (en) | 2021-02-26 | 2023-07-18 | Cilag Gmbh International | Stapling instrument comprising a separate power antenna and a data transfer antenna |
US11749877B2 (en) | 2021-02-26 | 2023-09-05 | Cilag Gmbh International | Stapling instrument comprising a signal antenna |
US11950779B2 (en) | 2021-02-26 | 2024-04-09 | Cilag Gmbh International | Method of powering and communicating with a staple cartridge |
US11812964B2 (en) | 2021-02-26 | 2023-11-14 | Cilag Gmbh International | Staple cartridge comprising a power management circuit |
US11744583B2 (en) | 2021-02-26 | 2023-09-05 | Cilag Gmbh International | Distal communication array to tune frequency of RF systems |
US11925349B2 (en) | 2021-02-26 | 2024-03-12 | Cilag Gmbh International | Adjustment to transfer parameters to improve available power |
US11751869B2 (en) | 2021-02-26 | 2023-09-12 | Cilag Gmbh International | Monitoring of multiple sensors over time to detect moving characteristics of tissue |
US11696757B2 (en) | 2021-02-26 | 2023-07-11 | Cilag Gmbh International | Monitoring of internal systems to detect and track cartridge motion status |
US11793514B2 (en) | 2021-02-26 | 2023-10-24 | Cilag Gmbh International | Staple cartridge comprising sensor array which may be embedded in cartridge body |
US11730473B2 (en) | 2021-02-26 | 2023-08-22 | Cilag Gmbh International | Monitoring of manufacturing life-cycle |
US11723657B2 (en) | 2021-02-26 | 2023-08-15 | Cilag Gmbh International | Adjustable communication based on available bandwidth and power capacity |
US11950777B2 (en) | 2021-02-26 | 2024-04-09 | Cilag Gmbh International | Staple cartridge comprising an information access control system |
US11717300B2 (en) | 2021-03-11 | 2023-08-08 | Covidien Lp | Surgical stapling apparatus with integrated visualization |
US11723658B2 (en) | 2021-03-22 | 2023-08-15 | Cilag Gmbh International | Staple cartridge comprising a firing lockout |
US11826042B2 (en) | 2021-03-22 | 2023-11-28 | Cilag Gmbh International | Surgical instrument comprising a firing drive including a selectable leverage mechanism |
US11737749B2 (en) | 2021-03-22 | 2023-08-29 | Cilag Gmbh International | Surgical stapling instrument comprising a retraction system |
US11717291B2 (en) | 2021-03-22 | 2023-08-08 | Cilag Gmbh International | Staple cartridge comprising staples configured to apply different tissue compression |
US11826012B2 (en) | 2021-03-22 | 2023-11-28 | Cilag Gmbh International | Stapling instrument comprising a pulsed motor-driven firing rack |
US11759202B2 (en) | 2021-03-22 | 2023-09-19 | Cilag Gmbh International | Staple cartridge comprising an implantable layer |
US11806011B2 (en) | 2021-03-22 | 2023-11-07 | Cilag Gmbh International | Stapling instrument comprising tissue compression systems |
US11744603B2 (en) | 2021-03-24 | 2023-09-05 | Cilag Gmbh International | Multi-axis pivot joints for surgical instruments and methods for manufacturing same |
US11896218B2 (en) | 2021-03-24 | 2024-02-13 | Cilag Gmbh International | Method of using a powered stapling device |
US11903582B2 (en) | 2021-03-24 | 2024-02-20 | Cilag Gmbh International | Leveraging surfaces for cartridge installation |
US11849944B2 (en) | 2021-03-24 | 2023-12-26 | Cilag Gmbh International | Drivers for fastener cartridge assemblies having rotary drive screws |
US11896219B2 (en) | 2021-03-24 | 2024-02-13 | Cilag Gmbh International | Mating features between drivers and underside of a cartridge deck |
US11786239B2 (en) | 2021-03-24 | 2023-10-17 | Cilag Gmbh International | Surgical instrument articulation joint arrangements comprising multiple moving linkage features |
US11793516B2 (en) | 2021-03-24 | 2023-10-24 | Cilag Gmbh International | Surgical staple cartridge comprising longitudinal support beam |
US11857183B2 (en) | 2021-03-24 | 2024-01-02 | Cilag Gmbh International | Stapling assembly components having metal substrates and plastic bodies |
US11849945B2 (en) | 2021-03-24 | 2023-12-26 | Cilag Gmbh International | Rotary-driven surgical stapling assembly comprising eccentrically driven firing member |
US11944336B2 (en) | 2021-03-24 | 2024-04-02 | Cilag Gmbh International | Joint arrangements for multi-planar alignment and support of operational drive shafts in articulatable surgical instruments |
US11786243B2 (en) | 2021-03-24 | 2023-10-17 | Cilag Gmbh International | Firing members having flexible portions for adapting to a load during a surgical firing stroke |
US11832816B2 (en) | 2021-03-24 | 2023-12-05 | Cilag Gmbh International | Surgical stapling assembly comprising nonplanar staples and planar staples |
US11974750B2 (en) | 2021-03-26 | 2024-05-07 | Covidien Lp | Surgical staple cartridge |
US11497495B2 (en) | 2021-03-31 | 2022-11-15 | Covidien Lp | Continuous stapler strip for use with a surgical stapling device |
US11666330B2 (en) | 2021-04-05 | 2023-06-06 | Covidien Lp | Surgical stapling device with lockout mechanism |
US11576670B2 (en) | 2021-05-06 | 2023-02-14 | Covidien Lp | Surgical stapling device with optimized drive assembly |
US11812956B2 (en) | 2021-05-18 | 2023-11-14 | Covidien Lp | Dual firing radial stapling device |
US11696755B2 (en) | 2021-05-19 | 2023-07-11 | Covidien Lp | Surgical stapling device with reload assembly removal lockout |
US11771423B2 (en) | 2021-05-25 | 2023-10-03 | Covidien Lp | Powered stapling device with manual retraction |
US11510673B1 (en) | 2021-05-25 | 2022-11-29 | Covidien Lp | Powered stapling device with manual retraction |
US11701119B2 (en) | 2021-05-26 | 2023-07-18 | Covidien Lp | Powered stapling device with rack release |
US11826047B2 (en) | 2021-05-28 | 2023-11-28 | Cilag Gmbh International | Stapling instrument comprising jaw mounts |
US11576675B2 (en) | 2021-06-07 | 2023-02-14 | Covidien Lp | Staple cartridge with knife |
US11707275B2 (en) | 2021-06-29 | 2023-07-25 | Covidien Lp | Asymmetrical surgical stapling device |
US11617579B2 (en) | 2021-06-29 | 2023-04-04 | Covidien Lp | Ultra low profile surgical stapling instrument for tissue resections |
US11602344B2 (en) | 2021-06-30 | 2023-03-14 | Covidien Lp | Surgical stapling apparatus with firing lockout assembly |
US11540831B1 (en) | 2021-08-12 | 2023-01-03 | Covidien Lp | Staple cartridge with actuation sled detection |
US20230050358A1 (en) * | 2021-08-16 | 2023-02-16 | Cilag Gmbh International | Multiple-sensor firing lockout mechanism for powered surgical stapler |
US11779334B2 (en) | 2021-08-19 | 2023-10-10 | Covidien Lp | Surgical stapling device including a manual retraction assembly |
US11576671B1 (en) | 2021-08-20 | 2023-02-14 | Covidien Lp | Small diameter linear surgical stapling apparatus |
US11707277B2 (en) | 2021-08-20 | 2023-07-25 | Covidien Lp | Articulating surgical stapling apparatus with pivotable knife bar guide assembly |
US11864761B2 (en) | 2021-09-14 | 2024-01-09 | Covidien Lp | Surgical instrument with illumination mechanism |
US11653922B2 (en) | 2021-09-29 | 2023-05-23 | Covidien Lp | Surgical stapling device with firing lockout mechanism |
US11660094B2 (en) | 2021-09-29 | 2023-05-30 | Covidien Lp | Surgical fastening instrument with two-part surgical fasteners |
US11849949B2 (en) | 2021-09-30 | 2023-12-26 | Covidien Lp | Surgical stapling device with firing lockout member |
US11877745B2 (en) | 2021-10-18 | 2024-01-23 | Cilag Gmbh International | Surgical stapling assembly having longitudinally-repeating staple leg clusters |
US11957337B2 (en) | 2021-10-18 | 2024-04-16 | Cilag Gmbh International | Surgical stapling assembly with offset ramped drive surfaces |
US11937816B2 (en) | 2021-10-28 | 2024-03-26 | Cilag Gmbh International | Electrical lead arrangements for surgical instruments |
WO2023103986A1 (zh) * | 2021-12-06 | 2023-06-15 | 深圳市精锋医疗科技股份有限公司 | 套管结构、手术器械以及手术机器人 |
Citations (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US7048687B1 (en) * | 1999-04-14 | 2006-05-23 | Ob Scientific, Inc. | Limited use medical probe |
CN101011285A (zh) * | 2006-01-31 | 2007-08-08 | 伊西康内外科公司 | 带有适应用户反馈的电动外科切割和紧固器械 |
EP2044890A1 (en) * | 2007-10-05 | 2009-04-08 | Tyco Healthcare Group LP | Powered surgical stapling device |
CN101507626A (zh) * | 2008-02-14 | 2009-08-19 | 伊西康内外科公司 | 带用户反馈件的一次性装载单元及使用该单元的外科器械 |
CN101584596A (zh) * | 2008-02-14 | 2009-11-25 | 伊西康内外科公司 | 用于外科缝合设备的一次性装载单元 |
EP2462878A1 (en) * | 2010-12-07 | 2012-06-13 | Immersion Corporation | Surgical stapler having haptic feedback |
Family Cites Families (29)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5263205A (en) | 1990-10-15 | 1993-11-23 | Leunissen Henry P | Spray device for toilet |
US5688270A (en) | 1993-07-22 | 1997-11-18 | Ethicon Endo-Surgery,Inc. | Electrosurgical hemostatic device with recessed and/or offset electrodes |
US5709680A (en) | 1993-07-22 | 1998-01-20 | Ethicon Endo-Surgery, Inc. | Electrosurgical hemostatic device |
RU2110221C1 (ru) * | 1993-10-01 | 1998-05-10 | Тофик Аскерович Султанов | Хирургический сшивающий аппарат для эндоскопических операций |
US5465895A (en) | 1994-02-03 | 1995-11-14 | Ethicon Endo-Surgery, Inc. | Surgical stapler instrument |
WO2001067964A2 (en) * | 2000-03-16 | 2001-09-20 | Medigus Ltd. | Fundoplication apparatus and method |
US7464847B2 (en) * | 2005-06-03 | 2008-12-16 | Tyco Healthcare Group Lp | Surgical stapler with timer and feedback display |
US10285694B2 (en) * | 2001-10-20 | 2019-05-14 | Covidien Lp | Surgical stapler with timer and feedback display |
US7000818B2 (en) | 2003-05-20 | 2006-02-21 | Ethicon, Endo-Surger, Inc. | Surgical stapling instrument having separate distinct closing and firing systems |
US6786382B1 (en) | 2003-07-09 | 2004-09-07 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument incorporating an articulation joint for a firing bar track |
US6964363B2 (en) | 2003-07-09 | 2005-11-15 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument having articulation joint support plates for supporting a firing bar |
US6981628B2 (en) | 2003-07-09 | 2006-01-03 | Ethicon Endo-Surgery, Inc. | Surgical instrument with a lateral-moving articulation control |
US7055731B2 (en) | 2003-07-09 | 2006-06-06 | Ethicon Endo-Surgery Inc. | Surgical stapling instrument incorporating a tapered firing bar for increased flexibility around the articulation joint |
US7111769B2 (en) | 2003-07-09 | 2006-09-26 | Ethicon Endo-Surgery, Inc. | Surgical instrument incorporating an articulation mechanism having rotation about the longitudinal axis |
US6905057B2 (en) | 2003-09-29 | 2005-06-14 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument incorporating a firing mechanism having a linked rack transmission |
US8409219B2 (en) * | 2004-06-18 | 2013-04-02 | Medtronic, Inc. | Method and system for placement of electrical lead inside heart |
US7717312B2 (en) * | 2005-06-03 | 2010-05-18 | Tyco Healthcare Group Lp | Surgical instruments employing sensors |
EP3738521B1 (en) * | 2005-06-03 | 2023-10-18 | Covidien LP | Surgical stapler with timer and feedback display |
US8820603B2 (en) * | 2006-01-31 | 2014-09-02 | Ethicon Endo-Surgery, Inc. | Accessing data stored in a memory of a surgical instrument |
US7845537B2 (en) | 2006-01-31 | 2010-12-07 | Ethicon Endo-Surgery, Inc. | Surgical instrument having recording capabilities |
US7721936B2 (en) * | 2007-01-10 | 2010-05-25 | Ethicon Endo-Surgery, Inc. | Interlock and surgical instrument including same |
US8684253B2 (en) * | 2007-01-10 | 2014-04-01 | Ethicon Endo-Surgery, Inc. | Surgical instrument with wireless communication between a control unit of a robotic system and remote sensor |
US8967443B2 (en) * | 2007-10-05 | 2015-03-03 | Covidien Lp | Method and apparatus for determining parameters of linear motion in a surgical instrument |
RU2437622C2 (ru) * | 2009-12-17 | 2011-12-27 | Борис Иванович Леонов | Хирургический сшиватель для эндоскопических операций |
US8851354B2 (en) * | 2009-12-24 | 2014-10-07 | Ethicon Endo-Surgery, Inc. | Surgical cutting instrument that analyzes tissue thickness |
US8348130B2 (en) * | 2010-12-10 | 2013-01-08 | Covidien Lp | Surgical apparatus including surgical buttress |
US20120211542A1 (en) * | 2011-02-23 | 2012-08-23 | Tyco Healthcare Group I.P | Controlled tissue compression systems and methods |
US9468447B2 (en) * | 2012-08-14 | 2016-10-18 | Insurgical, LLC | Limited-use tool system and method of reprocessing |
US20140035762A1 (en) * | 2013-10-01 | 2014-02-06 | Ethicon Endo-Surgery, Inc. | Providing Near Real Time Feedback To A User Of A Surgical Instrument |
-
2013
- 2013-10-01 US US14/043,100 patent/US20140175150A1/en not_active Abandoned
-
2014
- 2014-09-09 JP JP2016519880A patent/JP6466423B2/ja active Active
- 2014-09-09 RU RU2016116947A patent/RU2690397C2/ru not_active IP Right Cessation
- 2014-09-09 CN CN201480054434.8A patent/CN105682572B/zh active Active
- 2014-09-09 MX MX2016004194A patent/MX2016004194A/es active IP Right Grant
- 2014-09-09 AU AU2014329956A patent/AU2014329956B2/en not_active Ceased
- 2014-09-09 BR BR112016007013-5A patent/BR112016007013B1/pt active IP Right Grant
- 2014-09-09 WO PCT/US2014/054682 patent/WO2015050677A1/en active Application Filing
- 2014-09-30 EP EP14187134.3A patent/EP2856947B1/en active Active
- 2014-09-30 PL PL14187134T patent/PL2856947T3/pl unknown
Patent Citations (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US7048687B1 (en) * | 1999-04-14 | 2006-05-23 | Ob Scientific, Inc. | Limited use medical probe |
CN101011285A (zh) * | 2006-01-31 | 2007-08-08 | 伊西康内外科公司 | 带有适应用户反馈的电动外科切割和紧固器械 |
EP2044890A1 (en) * | 2007-10-05 | 2009-04-08 | Tyco Healthcare Group LP | Powered surgical stapling device |
CN101507626A (zh) * | 2008-02-14 | 2009-08-19 | 伊西康内外科公司 | 带用户反馈件的一次性装载单元及使用该单元的外科器械 |
CN101584596A (zh) * | 2008-02-14 | 2009-11-25 | 伊西康内外科公司 | 用于外科缝合设备的一次性装载单元 |
EP2462878A1 (en) * | 2010-12-07 | 2012-06-13 | Immersion Corporation | Surgical stapler having haptic feedback |
Also Published As
Publication number | Publication date |
---|---|
WO2015050677A1 (en) | 2015-04-09 |
EP2856947A1 (en) | 2015-04-08 |
BR112016007013B1 (pt) | 2021-12-28 |
EP2856947B1 (en) | 2017-05-10 |
US20140175150A1 (en) | 2014-06-26 |
PL2856947T3 (pl) | 2017-10-31 |
JP2016535608A (ja) | 2016-11-17 |
RU2016116947A3 (zh) | 2018-05-29 |
MX2016004194A (es) | 2016-06-16 |
BR112016007013A2 (pt) | 2017-08-01 |
AU2014329956B2 (en) | 2019-05-02 |
RU2690397C2 (ru) | 2019-06-03 |
RU2016116947A (ru) | 2017-11-10 |
JP6466423B2 (ja) | 2019-02-06 |
CN105682572A (zh) | 2016-06-15 |
AU2014329956A1 (en) | 2016-04-07 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
CN105682572B (zh) | 为外科器械的使用者提供接近实时反馈 | |
CN103379866B (zh) | 访问存储在外科器械存储器中的数据 | |
CN102387751B (zh) | 可消毒的外科器械 | |
CN103384501A (zh) | 访问存储在外科器械存储器中的数据 | |
EP2856948B1 (en) | Providing near real time feedback to a user of a surgical instrument | |
CN103702623B (zh) | 具有记录功能的机器人控制的外科器械 | |
US8746529B2 (en) | Accessing data stored in a memory of a surgical instrument | |
CN101023879B (zh) | 具有记录能力的外科器械 | |
CN107257663A (zh) | 用于能够关节运动的外科器械的驱动布置结构 | |
CN107257664A (zh) | 用于具有能够关节运动的外科端部执行器的可拆卸的轴组件的锁定布置 | |
CN104042267A (zh) | 具有击发系统闭锁结构的动力外科器械 |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
C06 | Publication | ||
PB01 | Publication | ||
C10 | Entry into substantive examination | ||
SE01 | Entry into force of request for substantive examination | ||
GR01 | Patent grant | ||
GR01 | Patent grant |