CN105682575A - 包括具有肘节特征结构的驱动组件的外科缝合器械 - Google Patents
包括具有肘节特征结构的驱动组件的外科缝合器械 Download PDFInfo
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Abstract
本发明公开了一种设备,该设备包括端部执行器、具有平移驱动构件的轴组件、和驱动组件。该端部执行器包括远侧推进的切割构件和钉驱动器。该平移驱动构件(326)被构造成能够操作以致动所述端部执行器。该驱动组件(300)能够引起所述平移驱动构件上的线性运动,并且包括固定到框架(70)的马达(306)、旋转驱动构件(308)、第一连杆(310)、和两个肘节连杆(316,318)。该旋转驱动构件通过所述马达进行旋转。该第一连杆被旋转驱动构件驱动。该两个肘节连杆中的一个枢转地连接到平移驱动构件,并且另一个枢转地连接到框架(70)。该旋转驱动构件能够操作以将线性运动传递到第一连杆。该第一连杆通过所述两个肘节连杆来将线性运动进一步传递到所述平移驱动构件。
Description
背景技术
在一些背景下,外科医生可能希望将外科器械穿过患者的腔道口而定位,并且使用该器械来调整、定位、附接患者体内的组织和/或以其他方式与患者体内的组织相互作用。例如,在一些外科手术(如,结肠直肠手术、减肥手术、胸腔手术等)中,胃肠道和/或食道的部分等可被切割和移除以除去不期望的组织或者用于其他原因。一旦期望的组织被移除,剩余部分就可需要通过端对端吻合术重新联接在一起。一种用于完成这些吻合手术的此类工具是穿过患者的自然存在的腔道口插入的圆形缝合器。一些圆形缝合器被构造成能够基本上同时切断组织和缝合组织。例如,圆形缝合器可切断吻合部处位于圆形钉阵列内的多余组织,以在接合于吻合部处的内腔部分之间提供基本上平滑的过渡。
圆形外科缝合器的示例在以下专利中有所描述:1993年4月27日公布的名称为“SurgicalAnastomosisStaplingInstrument”的美国专利5,205,459;1993年12月21日公布的名称为“SurgicalAnastomosisStaplingInstrument”的美国专利5,271,544;1994年1月4日公布的名称为“SurgicalAnastomosisStaplingInstrument”的美国专利5,275,322;1994年2月15日公布的名称为“SurgicalAnastomosisStaplingInstrument”的美国专利5,285,945;1994年3月8日公布的名称为“SurgicalAnastomosisStaplingInstrument”的美国专利5,292,053;1994年8月2日公布的名称为“SurgicalAnastomosisStaplingInstrument”的美国专利5,333,773;1994年9月27日公布的名称为“SurgicalAnastomosisStaplingInstrument”的美国专利5,350,104;和1996年7月9日公布的名称为“SurgicalAnastomosisStaplingInstrument”的美国专利5,533,661;以及2012年11月22日公布的名称为“LowCostAnvilAssemblyforaCircularStapler”的美国专利公布2012/0292372。上面所引用的美国专利和美国专利申请公布中的每一个的公开内容以引用方式并入本文。一些此类缝合器能够操作以夹紧组织层,切割穿过被夹紧的组织层,并驱动钉穿过组织层,以在组织层的被切断的端部附近将切断的组织层基本上密封在一起,由此接合解剖学内腔的两个被切断的端部。
仅另外的其他示例性外科缝合器公开于以下专利中:1989年2月21日公布的名称为“PocketConfigurationforInternalOrganStaplers”的美国专利4,805,823;1995年5月16日公布的名称为“SurgicalStaplerandStapleCartridge”的美国专利5,415,334;1995年11月14日公布的名称为“SurgicalStaplerInstrument”的美国专利5,465,895;1997年1月28日公布的名称为“SurgicalStaplerInstrument”的美国专利5,597,107;1997年5月27日公布的名称为“SurgicalInstrument”的美国专利5,632,432;1997年10月7日公布的名称为“SurgicalInstrument”的美国专利5,673,840;1998年1月6日公布的名称为“ArticulationAssemblyforSurgicalInstruments”的美国专利5,704,534;1998年9月29日公布的名称为“SurgicalClampingMechanism”的美国专利5,814,055;2005年12月27日公布的名称为“SurgicalStaplingInstrumentIncorporatinganE-BeamFiringMechanism”的美国专利6,978,921;2006年2月21日公布的名称为“SurgicalStaplingInstrumentHavingSeparateDistinctClosingandFiringSystems”的美国专利7,000,818;2006年12月5日公布的名称为“SurgicalStaplingInstrumentHavingaFiringLockoutforanUnclosedAnvil”的美国专利7,143,923;2007年12月4日公布的名称为“SurgicalStaplingInstrumentIncorporatingaMulti-StrokeFiringMechanismwithaFlexibleRack”的美国专利7,303,108;2008年5月6日公布的名称为“SurgicalStaplingInstrumentIncorporatingaMultistrokeFiringMechanismHavingaRotaryTransmission”的美国专利7,367,485;2008年6月3日公布的名称为“SurgicalStaplingInstrumentHavingaSingleLockoutMechanismforPreventionofFiring”的美国专利7,380,695;2008年6月3日公布的名称为“ArticulatingSurgicalStaplingInstrumentIncorporatingaTwo-PieceE-BeamFiringMechanism”的美国专利7,380,696;2008年7月29日公布的名称为“SurgicalStaplingandCuttingDevice”的美国专利7,404,508;2008年10月14日公布的名称为“SurgicalStaplingInstrumentHavingMultistrokeFiringwithOpeningLockout”的美国专利7,434,715;2010年5月25日公布的名称为“DisposableCartridgewithAdhesiveforUsewithaStaplingDevice”的美国专利7,721,930。上述引用的美国专利中的每个的公开内容均以引用方式并入本文。尽管上文所涉及的外科缝合器被描述为用于内窥镜式手术,但应当理解,此类外科缝合器也可用于开腹手术和/或其它非内窥镜式手术。
虽然已经制造和使用各种类型的外科缝合器械和相关部件,但据信在本发明人之前还无人制造或使用所附权利要求中描述的发明。
附图说明
尽管本说明书得出了具体地指出和明确地声明这种技术的权利要求,但是据信从下述的结合附图描述的某些示例将更好地理解这种技术,其中相似的参考数字指示相同的元件,并且其中:
图1示出了示例性圆形缝合外科器械的侧正视图;
图2A示出了图1的器械的示例性缝合头组件的放大纵向剖面图,其示出了处于打开位置的示例性砧座;
图2B示出了图2A的缝合头组件的放大纵向剖面图,其示出了处于闭合位置的砧座;
图2C示出了图2A的缝合头组件的放大纵向剖面图,其示出了处于击发位置的示例性钉驱动器和刀片;
图3示出了抵靠砧座而形成的示例性钉的放大局部剖面图;
图4A示出了图1的外科器械的示例性致动器柄部组件的放大侧正视图,其中主体的一部分被移除,其示出了处于未击发位置的触发器和处于锁定位置的锁定特征结构;
图4B示出了图4A的致动器柄部组件的放大侧正视图,其示出了处于击发位置的触发器和处于解锁位置的锁定特征结构;
图5示出了图1的外科器械的示例性指示器组件的放大局部透视图,其示出了指示器窗口和指示器杠杆;
图6示出了图5的指示器窗口的图解视图,其示出了示例性指示器条和示例性对应钉表示;
图7A示出了处于预击发位置的与图1的圆形缝合外科器械一起使用的示例性另选驱动组件的侧透视图;
图7B示出了处于击发中位置的图7A的驱动组件的侧透视图,其中竖直连杆被向上推压;
图7C示出了处于击发后位置的图7A的驱动组件的侧透视图,其中竖直连杆下降;
图8示出了具有成角度凸轮轴特征结构的与图1的圆形缝合外科器械一起使用的另一个示例性另选驱动组件的侧透视图;
图9示出了具有齿条和小齿轮机构特征结构的与图1的圆形缝合外科器械一起使用的另一个示例性另选驱动组件的侧透视图;并且
图10示出了与圆形缝合外科器械的击发行程相关的示例性力分布。
附图并非旨在以任何方式进行限制,并且可以预期本技术的各种实施例能够以多种其他方式来执行,包括那些未必在附图中示出的方式。所结合的并且形成说明书的一部分的附图示出了本技术的若干方面,并且与说明书一起用于解释本技术的原理;然而,应当理解,这种技术不局限于所示的精确布置。
具体实施方式
下面描述的本技术的某些示例不应当用于限制本技术的范围。从下面的描述而言,本技术的其它示例、特征、方面、实施例和优点对本领域的技术人员而言将为显而易见的,下面的描述以举例的方式进行,这是为实现本技术所设想的最好的方式之一。正如将意识到的,本文所述技术能够包括其它不同的和明显的方面,这些均不脱离本发明技术。因此,附图和具体实施方式应被视为实质上是示例性的而非限制性的。
I.示例性圆形缝合外科器械的概述
图1-6示出了示例性圆形外科缝合器械10,其具有缝合头组件20、轴组件60和致动器柄部组件70,其中的每一个将在下文中更详细地描述。轴组件60从致动器柄部组件70朝远侧延伸,并且缝合头组件20联接到轴组件60的远侧端部。简而言之,致动器柄部组件70能够操作以致动缝合头组件20的钉驱动器24,以便驱动多个钉66从缝合头组件20离开。钉66由附接在器械10的远侧端部处的砧座40弯曲以形成完整的钉。因此,可使用器械10来缝合图2A-2C中示出的组织2。
在本例中,器械10包括闭合系统和击发系统。闭合系统包括套管针38、套管针致动器39和旋转旋钮98。砧座40可联接到套管针38的远侧端部。旋转旋钮98能够操作以相对于缝合头组件20纵向地平移套管针38,从而当砧座40联接到套管针38时平移砧座40以夹紧砧座40与缝合头组件20之间的组织。击发系统包括触发器74、触发器致动组件84、驱动器致动器64和钉驱动器24。钉驱动器24包括刀36,当钉驱动器24被纵向地致动时,所述刀被构造成能够切断组织。此外,钉66被定位在钉驱动器24的多个钉驱动特征结构30的远侧,使得当钉驱动器24被纵向地致动时钉驱动器24还朝远侧驱动钉66。因此,当触发器74被致动并且触发器致动组件84通过驱动器致动器64致动钉驱动器24时,刀36和构件30基本上同时切断组织2并且相对于缝合头组件20朝远侧驱动钉66进入组织。现在将更详细地描述闭合系统和击发系统的部件和功能。
A.示例性砧座
如图1-2C所示,砧座40可选择性地联接到器械10以提供这样的表面:钉66可抵靠该表面而弯曲以缝合容纳在缝合头组件20与砧座40之间的材料。本例的砧座40可选择性地联接到相对于缝合头组件20朝远侧延伸的套管针或尖杆38。参见图2A-2C,砧座40通过砧座40的近侧轴42的联接件来可选择性地联接到套管针38的远侧末端。砧座40包括大致圆形的砧座头48以及从砧座头48朝近侧延伸的近侧轴42。在示出的例子中,近侧轴42包括管状构件44,该管状构件具有弹性偏置保持夹46以将砧座40选择性地联接到套管针38,但这仅为可选的,并且应当理解还可使用其他用于将砧座40联接到套管针38的保持特征结构。例如,可使用C形夹、夹钳、手术线、销、粘合剂等将砧座40联接到套管针38。此外,虽然砧座40被描述为可选择性地联接到套管针38,但在一些型式中,近侧轴42可包括单向联接特征结构以使得砧座40一旦附接,砧座40就不能从套管针38移除。仅为示例性的单向特征结构包括倒钩、单向按扣、筒夹、箍、突片、束带等等。当然,参考本文的教导内容,用于将砧座40联接到套管针38的其他构型对于本领域的普通技术人员而言将是显而易见的。例如,套管针38可替换为中空轴,并且近侧轴42可包括被构造成能够插入到中空轴中的尖锐杆。
本例的砧座头48包括形成于砧座头48的近侧面50中的多个钉成形凹坑52。因此,如图2C所示,当砧座40处于闭合位置并且钉66被驱动离开缝合头组件20进入钉成形凹坑52中时,钉66的腿部68被弯曲以形成完整的钉。
在砧座40作为独立部件的情况下,应当理解,砧座40在联接到缝合头组件20之前可被插入并且固定到组织2的一部分。仅以举例的方式,砧座40可被插入并固定到组织2的第一管状部分,而器械10被插入并固定到组织2的第二管状部分。例如,组织2的第一管状部分可缝合到砧座40的一部分或者围绕砧座40的一部分缝合,而组织2的第二管状部分可缝合到套管针38或者围绕套管针38缝合。
如图2A所示,砧座40然后联接到套管针38。本例的套管针38以最远侧致动位置示出。套管针38的此延伸位置可在砧座40的附接之前提供组织2可联接的更大区域。此外,套管针38的延伸位置还可提供砧座40到套管针38的更容易附接。套管针38还包括渐缩的远侧末端。此末端能够刺穿组织和/或有助于砧座40插入到套管针38上,但渐缩的远侧末端仅为可选的。例如,在其他型式中,套管针38可具有钝的末端。除此之外或作为另外一种选择,套管针38可包括磁性部分(未示出),该磁性部分可吸引砧座40朝向套管针38。当然,参考本文的教导内容,砧座40和套管针38的另一些其他构型和布置方式对于本领域的普通技术人员而言将是显而易见的。
当砧座40联接到套管针38时,砧座40的近侧面和缝合头组件20的远侧面之间的距离限定间隙距离d。本例的套管针38可通过位于致动器柄部组件70的近侧端部处的调节旋钮98来相对于缝合头组件20纵向平移,如将在下文更详细地进行描述。因此,当砧座40联接到套管针38时,调节旋钮98的旋转通过相对于缝合头组件20致动砧座40来扩大或减小间隙距离d。例如,如图2A-2B依次所示,砧座40被示为相对于致动器柄部组件70从初始打开位置朝近侧致动到闭合位置,从而减小间隙距离d以及待接合的组织2的两部分之间的距离。如图2C所示,一旦间隙距离d进入预定范围之内,缝合头组件20就可被击发以缝合和切断砧座40与缝合头组件20之间的组织2。缝合头组件20能够操作以通过使用者枢转致动器柄部组件70的触发器74来缝合和切断组织2,如将在下文更详细地进行描述。
如上所述,间隙距离d对应于砧座40与缝合头组件20之间的距离。当器械10被插入到患者体内时,该间隙距离d可能不容易看到。因此,示于图5-6中的可运动指示器条110被设置为通过定位成与触发器74相对的指示器窗口120可见。指示器条110能够操作以响应调节旋钮98的旋转而运动,使得指示器条110的位置表示间隙距离d。如图6所示,指示器窗口120还包括标尺130(其指示砧座间隙位于期望的操作范围(例如,绿色区域或“绿区”)内)和位于标尺130的每一端部处的相应钉压缩表示。仅以举例的方式,如图6所示,第一钉图像132示出了较大钉高度,而第二钉图像134示出了较小钉高度。因此,使用者可通过指示器条110和标尺130观察到所联接的砧座40相对于缝合头组件20的位置。因此,使用者可随后通过调节旋钮98来调整砧座40的定位。
重新参见图2A-2C,使用者围绕管状构件44缝合组织2的一部分,使得砧座头48位于待缝合的组织2的一部分内。当组织2附接到砧座40时,保持夹46和管状构件44的一部分从组织2突起,使得使用者可将砧座40联接到套管针38。在组织2联接到套管针38和/或缝合头组件20的另一部分的情况下,使用者将砧座40附接到套管针38,并且朝向缝合头组件20朝近侧致动砧座40以减小间隙距离d。一旦器械10处于操作范围内,使用者然后就将组织2的端部缝合在一起,从而形成组织2的基本上邻接的管状部分。
砧座40还可根据以下专利的教导内容中的至少一些来构造:美国专利5,205,459、美国专利5,271,544、美国专利5,275,322、美国专利5,285,945、美国专利5,292,053、美国专利5,333,773、美国专利5,350,104、美国专利5,533,661、和/或美国公开2012/0292372,这些专利的公开内容以引用方式并入本文中;并且/或者还可参考本文的教导内容,根据对于本领域的普通技术人员而言将是显而易见的其他构型来构造。
B.示例性缝合头组件
本例的缝合头组件20联接到轴组件60的远侧端部,并且包括容纳可滑动钉驱动器24的管状壳体22和容纳在钉凹坑32内的多个钉66。钉66和钉凹坑32围绕管状壳体22而被设置成圆形阵列。在本例中,钉66和钉凹坑32被设置成一对同心环形行的钉66和钉凹坑32。钉驱动器24能够操作以响应于致动器柄部组件70的触发器74的旋转而在管状壳体22内纵向地致动。如图2A-2C所示,钉驱动器24包括具有套管针开口26、中央凹槽28、围绕中央凹槽28周向设置的多个构件30,并且相对于轴组件60朝远侧延伸的扩口圆柱形构件。每个构件30能够接触和接合钉凹坑32内的多个钉66的对应钉66。因此,当钉驱动器24相对于致动器柄部组件70朝远侧致动时,每个构件30驱动对应钉66穿过形成于管状壳体22的远侧端部中的钉孔34离开其钉凹坑32。因为每个构件30从钉驱动器24延伸,所以多个钉66基本上同时被驱动离开缝合头组件20。当砧座40处于闭合位置时,钉66被驱动进入钉成形凹坑52以弯曲钉66的腿部68,从而缝合位于砧座40与缝合头组件20之间的材料。图3示出了一个仅为示例性的钉66,所述钉由构件30驱动进入砧座40的钉成形凹坑32以弯曲腿部68。
钉驱动器24还包括圆柱形刀36,其与套管针开口26共轴并且从钉凹坑32插入。在本例中,圆柱形刀36被设置在中央凹槽28内以利用钉驱动器24朝远侧平移。如上所述,当砧座40被固定到套管针38时,砧座头48提供表面,圆柱形刀36抵靠该表面切割容纳在砧座40与缝合头组件20之间的材料。在一些型式中,砧座头48可包括用于圆柱形刀36的凹槽(未示出)以有助于切割材料(例如,通过提供协作剪切边缘)。除此之外或作为另外一种选择,砧座头48可包括从圆柱形刀36偏移的一个或多个相对的圆柱形刀(未示出),使得可提供剪刀型切割动作。参考本文的教导内容,另一些其他构型对于本领域的普通技术人员而言将是显而易见的。因此,缝合头组件20能够操作以响应于通过致动器柄部组件70的致动而基本上同时缝合并切割组织2。
当然,缝合头组件20还可根据以下专利的教导内容的至少一些来构造:美国专利5,205,459、美国专利5,271,544、美国专利5,275,322、美国专利5,285,945、美国专利5,292,053、美国专利5,333,773、美国专利5,350,104、美国专利5,533,661、和/或美国公开2012/0292372,这些专利的公开内容以引用方式并入本文中;并且/或者还可参考本文的教导内容,根据对于本领域的普通技术人员而言将是显而易见的其他构型来构造。
如前文所述,钉驱动器24包括套管针开口26。套管针开口26被构造成能够允许套管针38相对于缝合头组件20和/或轴组件60纵向滑动。如图2A-2C所示,套管针38联接到套管针致动器39,使得套管针38可通过旋转旋钮98的旋转被纵向地致动,如将在下文参考致动器柄部组件70更详细地进行描述。在本例中,套管针致动器39包括联接到套管针38的伸长的、相对刚性的轴,但这仅为可选的。在一些型式中,致动器39可包括纵向刚性材料同时允许侧向弯曲,使得器械10的部分在使用期间可选择性地弯曲或弯折;或者器械10可包括预置的弯曲轴组件60。一种仅为示例性的材料是镍钛诺。当砧座40联接到套管针38时,套管针38和砧座40能够通过致动器39平移以调整砧座40与缝合头组件20之间的间隙距离d。参考本文的教导内容,用于致动器39纵向地致动套管针38的另一些其他构型对于本领域的普通技术人员而言将是显而易见的。
C.示例性轴组件
如图2A-2C所示,缝合头组件20和套管针38被定位在轴组件60的远侧端部处。本例的轴组件60包括外部管状构件62和驱动器致动器64。外部管状构件62联接到缝合头组件20的管状壳体22和致动器柄部组件70的主体72,从而为其中的致动部件提供机械地。驱动器致动器64的近侧端部联接到致动器柄部组件70的触发器致动组件84,如下所述。驱动器致动器64的远侧端部联接到钉驱动器24,使得触发器74的旋转纵向地致动钉驱动器24。如图2A-2C所示,驱动器致动器64包括具有开放的纵向轴线的管状构件,使得联接到套管针38的致动器39可在驱动器致动器64内且相对于驱动器致动器64纵向地致动。当然,应当理解,参考本文的教导内容,可将其他部件设置在驱动器致动器64内,这对于本领域的普通技术人员而言将是显而易见的。
轴组件60还可根据以下专利的教导内容中的至少一些来构造:美国专利5,205,459、美国专利5,271,544、美国专利5,275,322、美国专利5,285,945、美国专利5,292,053、美国专利5,333,773、美国专利5,350,104、美国专利5,533,661、和/或美国公开2012/0292372,这些专利的公开内容以引用方式并入本文中;并且/或者还可参考本文的教导内容,根据对于本领域的普通技术人员而言将是显而易见的其他构型来构造。
D.示例性致动器柄部组件
现在参见图4A-5,致动器柄部组件70包括主体72、触发器74、锁定特征结构82、触发器致动组件84和套管针致动组件90。本例的触发器74以能够枢转的方式安装到主体72,并且联接到触发器致动组件84,使得触发器74从未击发位置(示于图4A)到击发位置(示于图4B)的旋转致动上文所述的驱动器致动器64。弹簧78联接到主体72和触发器74以朝向未击发位置来偏置触发器74。锁定特征结构82为联接到主体72的可枢转构件。在第一、锁定位置中,锁定特征结构82向上枢转并且远离主体72,使得锁定特征结构82接合触发器74并且通过机械抵抗使用者对触发器74的致动。在第二、解锁位置中,例如图1和4B所示,锁定特征结构82向下枢转,使得触发器74可被使用者致动。因此,在锁定特征结构82处于第二位置的情况下,触发器74可接合触发器致动组件84以击发器械10。
如图4A-4B所示,本例的触发器致动组件84包括与驱动器致动器64的近侧端部接合的可滑动触发器滑架86。滑架86包括位于滑架86近侧端部上的一组突片88以保持和接合从触发器74延伸的一对触发器臂76。因此,当触发器74被枢转时,滑架86被纵向地致动并且将纵向运动传输到驱动器致动器64。在示出的例子中,滑架86固定地联接到驱动器致动器64的近侧端部,但这仅为可选的。实际上,在一个仅为示例性的替代方案中,滑架86可仅邻接驱动器致动器64,同时远侧弹簧(未示出)相对于致动器柄部组件70朝近侧偏置驱动器致动器64。
触发器致动组件84还可根据以下专利的教导内容中的至少一些来构造:美国专利5,205,459、美国专利5,271,544、美国专利5,275,322、美国专利5,285,945、美国专利5,292,053、美国专利5,333,773、美国专利5,350,104、美国专利5,533,661、和/或美国公开2012/0292372,这些专利的公开内容以引用方式并入本文中;并且/或者还可参考本文的教导内容,根据对于本领域的普通技术人员而言将是显而易见的其他构型来构造。
主体72还容纳套管针致动组件90,其被构造成能够响应于调节旋钮98的旋转来纵向地致动套管针38。如图4A-5最佳显示,本例的套管针致动组件90包括调节旋钮98、沟槽状柄94和套管92。本例的沟槽状柄94位于套管针致动器39的近侧端部,但应当理解,沟槽状柄94和套管针致动器39可作为另外一种选择为接合以传递纵向运动的独立部件。尽管沟槽状柄94被构造成能够在主体72内平移,但沟槽状柄94不在主体72内旋转。调节旋钮98由主体72的近侧端部可旋转地支撑,并且能够操作以通过内部突片(未示出)使与沟槽状柄94接合的套管92旋转。调节旋钮98还限定内部螺纹未示出,如将在下文更详细地进行描述。本例的沟槽状柄94包括形成于沟槽状柄94的外表面中的连续沟槽96。因此,当调节旋钮98旋转时,套管92的内部突片搭乘在沟槽96内,并且沟槽状柄94相对于套管92被纵向地致动。由于沟槽状柄94位于套管针致动器39的近侧端部处,因此沿第一方向旋转调节旋钮98来相对于致动器柄部组件70朝远侧推进套管针致动器39。因此,砧座40与缝合头组件20之间的间隙距离d增加。通过在相反方向上旋转调节旋钮98,套管针致动器39相对于致动器柄部组件70被朝近侧致动,以减小砧座40与缝合头组件20之间的间隙距离d。因此,套管针致动组件90能够操作以响应于旋转调节旋钮98而致动套管针38。当然,参考本文的教导内容,套管针致动组件90的其他构型对于本领域的普通技术人员而言将是显而易见的。
本例的沟槽96包括多个不同部分96A,96B,96C,所述不同部分每轴向距离具有不同的节距或不同数目的沟槽。本发明的沟槽96被分成远侧部分96A、中间部分96B和近侧部分96C。如图5所示,远侧部分96A包括细节距或在沟槽状柄94的短的轴向长度上具有很多沟槽。中间部分96B包括每轴向长度具有相比之下较粗节距或较少沟槽的部分,以使得需要相对较少的旋转来用于套管92的内部突片横穿长的轴向距离。当砧座40相对于缝合头组件20处于初始、远侧位置时,套管92的内部突片被定位在中间部分96B中。因此,当套管92的内部突片横穿中间部分96B时,间隙距离d可通过调节旋钮98的相对较少的旋转而快速减小。本例的近侧部分96C基本上类似于远侧部分96A,并且包括细节距或在沟槽状柄94的短的轴向距离上具有很多沟槽,使得需要大量旋转来横穿短的轴向距离。当砧座40基本上靠近缝合头组件20时,本例的近侧部分96C被由旋钮98限定的内部螺纹接合,使得指示器条110在指示器窗口120内沿着标尺130运动以指示砧座间隙处于期望的操作范围内,如将在下文更详细进地行描述。因此,当沟槽状柄94到达近侧位置(其中沟槽90的近侧部分90C接合旋钮98的内部螺纹)时,调节旋钮98的每次旋转可相对少量地减小间隙距离d以提供微调。应当理解,当近侧部分96C与旋钮98的内部螺纹接合时,套管92的内部突片可与沟槽96脱离接合。
套管针致动组件90还可根据以下专利的教导内容中的至少一些来构造:美国专利5,205,459、美国专利5,271,544、美国专利5,275,322、美国专利5,285,945、美国专利5,292,053、美国专利5,333,773、美国专利5,350,104、美国专利5,533,661,这些专利的公开内容以引用方式并入本文中;并且/或者还可参考本文的教导内容,根据对于本领域的普通技术人员而言将是显而易见的其他构型来构造。
在示于图4A-4B的例子中,U形夹100附接到位于沟槽状柄94远侧的套管针致动器39的中间部分。在本例中,套管针致动器39的延伸部接合柄部组件70的壳体中的狭槽以防止当调节旋钮98旋转时套管针致动器39围绕其轴线旋转。本例的U形夹100还包括位于其相对侧的每一侧上的用于容纳附接构件(例如螺钉、螺栓、销等)的伸长狭槽102,从而出于相对于标尺130校准指示器条110的目的而选择性地调整U形夹100的伸长狭槽102相对于套管针致动器39的纵向位置。在一些型式中,附接构件(例如螺钉、螺栓、销等)与主体72的一部分接合以基本上防止当调节旋钮98旋转时套管针致动器39围绕其轴线旋转。
如图5所示,致动器柄部组件70还包括被构造成能够接合和枢转指示器104的指示器托架140。本例的指示器托架140可相对于主体72而沿着形成于主体72上的一对狭槽滑动。指示器托架140包括矩形板144、指示器臂146和成角度法兰142。成角度法兰142形成于矩形板144的近侧端部处,并且包括孔(未示出)以可滑动地安装到套管针致动器39和/或沟槽状柄94上。螺旋弹簧150插入法兰142与凸台152之间,并且抵靠U形夹100来偏置法兰142。因此,当U形夹100利用套管针致动器39和/或沟槽状柄94朝远侧致动时,螺旋弹簧150推动指示器托架140与U形夹100一起朝远侧行进。此外,当套管针致动器39和/或沟槽状柄94朝近侧平移时,U形夹100将指示器托架140相对于凸台152朝近侧推动,从而压缩螺旋弹簧150。当然,应当理解,在一些型式中,指示器托架140可固定地附接到套管针致动器39和/或沟槽状柄94。
在本例中,当指示器托架140处于不对应于当砧座间隙在期望的操作范围(例如绿色区域或“绿区”)内的纵向位置时,锁定特征结构82的一部分邻接指示器托架140的表面141。当砧座间隙位于期望的操作范围(例如,绿色区域或“绿区”)内时,指示器托架140变窄以在指示器臂146的任一侧上提供一对间隙145,该指示器臂允许锁定特征结构82枢转,从而释放触发器74。因此,锁定特征结构82和指示器托架140可基本上防止使用者释放和操作触发器74,直至砧座40处于预定操作范围内。当然,应当理解,锁定特征结构82在一些型式中可全部省去。
如上文所简要描述的,该操作范围可通过抵靠标尺130所示的指示器104的指示器条110从视觉上传达给使用者。朝远侧突出的指示器臂146在指示器托架140的远侧端部处,该指示器臂端接在侧向突出的指状件148处以用于控制指示器104的运动。如图5最佳显示,指示器臂146和指状件148能够接合指示器104的突片106,使得当指示器托架140被纵向地致动时指示器104被枢转。在本例中,指示器104在指示器104的第一端部处以能够枢转的方式联接到主体72,但这仅为可选的,并且参考本文的教导内容,指示器104的其他枢转点对于本领域的普通技术人员而言将是显而易见的。指示器条110被定位在指示器104的第二端部上,使得指示器条110响应于指示器托架140的致动而运动。因此,如上所述,指示器条110通过指示器窗口120抵靠标尺130(示于图6中)而显示,以示出砧座40与缝合头组件20之间的相对间隙距离d。
当然,指示器托架140、指示器104和/或致动器柄部组件70还可根据以下专利的教导内容中的至少一些来构造:美国专利5,205,459、美国专利5,271,544、美国专利5,275,322、美国专利5,285,945、美国专利5,292,053、美国专利5,333,773、美国专利5,350,104、美国专利5,533,661、和/或美国公开2012/0292372,这些专利的公开内容以引用方式并入本文中;并且/或者还可参考本文的教导内容,根据对于本领域的普通技术人员而言将是显而易见的其他构型来构造。
II.示例性电动致动器
在一些情况下,可期望按照避免手动地驱动圆形外科缝合器械10的方式来驱动钉66和刀36。例如,在操作者的手力不足以致动圆形外科缝合器械10的情况下,可期望提供用于钉驱动器24和刀36的电动组件。使器械10的至少一部分电动化也可降低驱动钉驱动器24和刀36中的操作者误差的风险。在一些情况下,手动驱动器械10的操作者误差可导致器械10不能完全致动。当操作者不能完全手动致动触发器74时可发生这种情况,由此可导致钉66未完全成形并且因此未完全固定吻合部。因此,使钉驱动器24和刀36的驱动电动化可确保在单个驱动行程中刀36被完全驱动以切割组织并且钉66被完全部署以紧固组织。
然而,可不必期望使圆形外科缝合器械10的所有部分电动化。例如,可期望保持旋钮98或类似特征结构的手动调节以控制砧座40和缝合头组件20之间的距离。如参考本文的教导内容对于本领域的普通技术人员将是显而易见的是,圆形外科缝合器械10的其他合适部分也可依赖于手动致动而不管其他特征结构的电动化。
A.示例性电动化肘节组件
图7A示出了示例性另选驱动组件200,其可与圆形外科缝合器械10一起使用或结合以提供钉66和刀36的电动驱动。具体地,本例的驱动组件200通过驱动器致动器226与钉驱动器224和刀236连接。钉驱动器224和刀236基本上类似于上文所述和图2B所示的钉驱动器24和刀36。驱动组件200的驱动器致动器226能够操作以纵向地驱动钉驱动器224;并且基本上类似于上文所述和图2A所示的圆形外科缝合器械10的驱动器致动器64。在本例中,驱动器致动器226包括与钉驱动器224和刀236连接的横梁状结构。具体地,驱动器致动器226能够操作以沿着纵向轴线230朝远侧推进和朝近侧回缩,使得驱动器致动器226的运动提供钉驱动器224和刀236的远侧推进和近侧回缩。
当然,这些部件中的任一个可按照多种方式进行改变,这参考本文的教导内容对于本领域的普通技术人员而言将是显而易见的。
驱动组件200还与操作者输入件202和功率源204连接。操作者输入件202可包括手动致动的触发器(例如,类似于触发器74等)和/或能够操作以启动驱动组件200的运动的一些其他输入件。例如,操作者输入件202可包括电启动驱动组件200的按钮、触发器、杆件、滑块、触控板等。除此之外或作为另外一种选择,操作者输入件202可包括由操作者操作以启动驱动组件200的电驱动致动器或软件驱动致动器。在一些型式中,操作者输入件202可包括与驱动组件200连接的脚致动踏板。参考本文的教导内容,操作者输入件202可采用的其他合适形式对于本领域的普通技术人员而言将是显而易见的。
还应当理解,操作者输入件202可布置在圆形外科缝合器械10上的任何适当位置中或相对于圆形外科缝合器械10进行布置,参考本文的教导内容,这对于本领域的普通技术人员而言将是显而易见的。例如,操作者输入件202可被定位在如图1可见的致动器柄部组件70的任何部分上。作为另外一种选择,操作者输入件202也可定位在独立于圆形外科缝合器械10的某个位置处,这可包括将操作者输入件202定位在独立的控制台或计算机上。操作者输入件202也可位于与圆形外科缝合器械10无线通信的控制台或装置上。参考本文的教导内容,用于操作者输入件202的其他合适位置对于本领域的普通技术人员而言将是显而易见的。
功率源204可采用多种形式。例如,功率源204可包括通过缆线与器械10联接的外部源(例如壁装电源插座等)。功率源204还可包括能够操作以递送能量来驱动组件200的电池或电池组(例如,位于器械10内)。在一些情况下,功率源204还可提供能够操作以功率驱动组件200的无线感应能量。参考本文的教导内容,功率源204的其他合适变型对于本领域的普通技术人员而言将是显而易见的。
本例的驱动组件200包括马达206、驱动轮208、竖直连杆210、第一和第二肘节连杆216,218、锚固件220、以及驱动器致动器226。马达206与操作者输入件202和功率源204连接。功率源204能够操作以将电功率提供到马达206,由此驱动马达206。操作者输入件202能够操作以引发从功率源204到马达206的功率流,使得操作者可发信号通知驱动组件200以启动。马达206可包括能够操作以提供旋转运动的任何合适种类的马达,这参考本文的教导内容对于本领域的普通技术人员而言将是显而易见的。
马达206与驱动轮208连接。具体地,马达206能够操作以使驱动轴240旋转,该驱动轴与驱动轮208一体地联接。本例的驱动轮208包括盘形轮。纵向轴线228延伸穿过马达206和驱动轮208,使得马达206、驱动轴240、和驱动轮208围绕轴线228同轴旋转。驱动轮208通过联接接头242和第一销212与竖直连杆210连接。竖直连杆210由驱动轮208按照反向曲轴方式来驱动。换句话讲,联接接头242安装在驱动轮208上,使得当驱动轮208旋转时,联接接头242和第一销212引导竖直连杆210相对于轴线228上升和下降。联接接头242从轴线228偏移,使得当驱动轮208旋转时,联接接头242围绕轴线228沿轨道运行。当驱动轮208旋转时,第一销212和竖直连杆210之间的接触点也围绕轴线228沿轨道运行。联接接头242可通过球窝接头、万向接头、和任何其他合适的连接(其能够操作以在驱动轮208旋转时允许竖直连杆210的下端围绕纵向轴线228沿轨道路径运行)来与第一销212连接。尽管在本例中,销212因联接接头242的整体长度而在驱动轮208和竖直连杆210之间限定相对较短的距离,但应当理解,销212可包括较长销,所述较长销仍能够操作以利用驱动轮208的运动来向上和向下驱动竖直连杆210。
竖直连杆210与第二销214连接,在此处竖直连杆210接合第一肘节连杆216和第二肘节连杆218。应当理解,竖直连杆210和第二销214可通过球窝接头、万向接头、和任何其他合适的接头(其能够操作以在驱动轮208旋转时允许竖直连杆210相对于第一和第二肘节连杆侧向地枢转)连接。在本例中,第一和第二肘节连杆216,218具有基本上类似的构造,但应当理解,可使用其他构型。例如,第一和第二肘节连杆216,218可具有不同的长度、厚度等。此外,示例性型式将第一和第二肘节连杆216,218示为具有直的构造,但应当理解,第一和第二肘节连杆216,218也可包括成角度或弯曲的横梁或其他合适的构造,这参考本文的教导内容对于本领域的普通技术人员而言将是显而易见的。同样,在示例性型式中,竖直连杆210的直的形状基本上类似于第一和第二肘节连杆216,218,但应当理解,竖直连杆210也可具有其他构型,包括弯曲或曲线的形状。参考本文的教导内容,用于连杆210,216,218的其他合适构型对于本领域的普通技术人员而言将是显而易见的。
第二肘节连杆218与锚固件220连接,使得第二肘节连杆218可相对于锚固件220枢转。具体地,第二肘节销246使锚固件220与致动器柄部组件70的一部分联接。然而,应当理解,锚固件220可附连到圆形外科缝合器械10的任何合适部分,这参考本文的教导内容对于本领域的普通技术人员而言将是显而易见的。此外,应当理解,可使用用于将第二肘节连杆218枢转地联接到锚固件220的任何合适的结构。锚固件220为第二肘节连杆218提供固定锚固点或机械地,由此阻止第二肘节连杆218相对于致动器柄部组件70平移。
第一肘节连杆216与驱动器致动器226枢转地连接。具体地,第一肘节销248将第一肘节连杆216枢转地联接到驱动器致动器226。因此,当竖直连杆210上升时,第二肘节连杆218和第一肘节连杆216分别相对于锚固件220和驱动器致动器226枢转,这使得第一和第二肘节连杆216,218彼此对准。这种对准导致驱动器致动器226朝远侧推进。第二纵向轴线230延伸穿过驱动器致动器226。当竖直连杆210上升时,第一和第二肘节连杆216,218变得与第二纵向轴线230较对准。在竖直连杆210的向上运动的峰值处,第一和第二肘节连杆216,218与第二纵向轴线230基本上对准;并且驱动器致动器226处于最远侧位置。当竖直连杆210向下行进时,肘节连杆216,218塌缩并且将驱动器致动器226牵拉到最近侧位置。
B.具有肘节组件的示例性击发序列
图7A示出了处于预击发状态的驱动组件200。当驱动组件200处于此状态时,操作者可将圆形外科缝合器械10定位在患者内的切断的、自然存在的内腔中以准备进行击发。砧座40相对于致动器柄部组件70从图2A所示的初始、打开位置朝近侧被牵拉到图2B所示的闭合位置,由此减小间隙距离d和待接合的组织的两部分之间的距离。通过调节旋钮98的手动旋转来控制距离d。在其中砧座40相对于缝合头组件20被手动调节的预击发状态下,马达206为空闲的并且驱动轮208处于旋转位置,使得销212相对于第一纵向轴线228为最低的,如图7A所示。因此,竖直连杆210相对于第一纵向轴线228也处于低点。此外,竖直连杆210被定位成基本上垂直于纵向轴线228。肘节连杆216,218被朝第一纵向轴线228牵拉并且处于塌缩装填。驱动器致动器226处于回缩状态,并且钉驱动器224和刀236也为回缩的。
一旦操作者决定击发圆形外科缝合器械10,操作者就通过操作者输入件202提供命令,由此导致功率通过功率源204递送到马达206。马达206因而被启动,由此导致驱动轮208旋转,如图7B所示。另外如图7B可见,在击发中状态下,驱动轮208已旋转半圈。竖直连杆210被向上推压并且肘节连杆216,218沿着第二纵向轴线230伸直。竖直连杆210朝驱动器致动器226倾斜。当肘节连杆216,218伸直或者彼此基本上对准时,驱动器致动器226朝远侧推进。当驱动器致动器226朝远侧推进时,钉驱动器224和刀236也推进,这类似于此前相对于圆形外科缝合器械10描述的钉驱动器24和刀36。钉驱动器224和刀236的远侧运动驱动钉66进入组织,由此在吻合部处形成环形阵列;同时刀236从部署钉66的环形阵列的内部区域切断多余组织,这类似于图2C所示。
在一些型式中,如图2A可见的砧座40包括可断开垫圈,所述可断开垫圈在刀236完成完整的远侧运动范围时被刀236断开。在一些情况下,当垫圈响应于刀236朝砧座40的完全推进的完成而断开时,垫圈因而通过致动器柄部组件70提供听觉或触觉反馈,但此类听觉/触觉反馈并非必需的。应当理解,垫圈的存在可在朝远侧推进驱动器致动器226所需的力方面提供突然增大。图10示出了在驱动器致动器226的远侧行进的范围期间由驱动器致动器226遇到的示例性力分布。在远侧运动的第一范围500内,驱动器致动器226随着刀236穿过组织2而遇到渐增的负荷或阻力。在远侧运动的第二范围510内,驱动器致动器226随着刀236穿过垫圈而遇到负荷或阻力的峰值。在远侧运动的第三范围520内,驱动器致动器226在垫圈断开之后首先遇到负荷或阻力的突然下降,然后随着钉驱动器224驱动钉进入砧座40中而由此使钉成形到其最终高度而遇到负荷或阻力的后续增大。参考上述内容,还应当理解,在从图7A所示的位置过渡到图7C所示的位置期间,当驱动器致动器226接近其远侧运动的末端时(例如,在第二远侧运动范围510期间开始),肘节连杆216,218可提供增大的机械效益,由此提供用以断开垫圈和驱动钉的较大远侧驱动力。当然,在一些型式中,可完全省去垫圈。
马达206继续沿相同旋转方向驱动轮208,如图7C可见,其中驱动轮208已完成一整圈旋转,由此返回到如图7A所示的相同旋转位置。竖直连杆210通过驱动轮208的旋转而从图7B所示的位置被向下牵拉到如图7C所示的位置。当竖直连杆210向下牵拉时,肘节连杆216,218塌缩并且朝近侧牵拉驱动器致动器226。驱动组件200的完整击发行程因而被完成。操作者随后可从手术部位移除圆形外科缝合器械10。
应当理解,功率源204或马达206被构造成能够仅允许驱动轮208的单圈旋转,所述单圈旋转表示完整致动。对于单次360度旋转而言,驱动组件200能够使得驱动器致动器226在驱动轮208旋转的第一180度期间朝远侧推进;同时驱动器致动器226在驱动轮208旋转的第二180度期间朝近侧回缩。在一些情况下,微控制器、ASIC、和/或其他类型的控制模块与功率源204和马达206连接,并且被构造成能够自动地停止马达206,由此提供用以动态地制动马达206的方式,使得马达206可被致动以准确地用于相应驱动轮208的一次旋转。仅以举例的方式,此类控制模块可与编码器连接,所述编码器与轴240连接。作为另一个仅示例性的例子,此类控制模块可与磁簧开关连接,所述磁簧开关与驱动器致动器226连接。参考本文的教导内容,可用于提供马达206的精确停止(例如,基于驱动轮208的跟踪旋转、基于轴240的平移、和/或基于一些其他参数等)的其他合适类型的传感器和控制模块对于本领域的普通技术人员而言将是显而易见的。当然,控制模块被构造成能够控制马达206以启动任何合适的旋转次数等。在一些情况下,控制马达206的启动和停止可根据与本专利同一天提交的、名称为CONTROLFEATURESFORMOTORIZEDSURGICALSTAPLINGINSTRUMENT的美国专利申请[代理人案卷号END7291USNP.0606446]的教导内容来执行,该专利申请的公开内容以引用方式并入本文。
C.具有成角度凸轮的示例性驱动组件
图8示出了示例性另选驱动组件300,其可与圆形外科缝合器械10一起使用或结合以提供钉66和刀36的电动驱动。具体地,本例的驱动组件300包括马达306、成角度凸轮308、凸轮从动件312、竖直连杆310、第一肘节连杆316、第二肘节连杆318、锚固件320、和轴326。马达306、竖直连杆310、第一肘节连杆316、第二肘节连杆318、锚固件320、和轴326基本上类似于上文所述的马达206、竖直连杆210、第一肘节连杆216、第二肘节连杆218、锚固件220、和驱动器致动器226。类似于马达206,马达306根据与本专利同一天提交的、名称为CONTROLFEATURESFORMOTORIZEDSURGICALSTAPLINGINSTRUMENT的美国专利申请[代理人案卷号END7291USNP.0606446]的教导内容中的至少一些来控制,该专利申请的公开内容以引用方式并入本文。竖直连杆310通过第一枢转销352与第一和第二肘节连杆316,318枢转地连接。第一肘节连杆316通过第二枢转销349与轴326连接。第二肘节连杆318通过第三枢转销348与锚固件320连接。
成角度凸轮308通过驱动轴340旋转地联接到马达306。成角度凸轮308具有与凸轮从动件312接触的成角度远侧表面309。具体地,凸轮从动件312具有近侧自由端342,该近侧自由端在成角度凸轮308旋转时与成角表面309保持接触。远侧表面309相对于驱动轴340的轴线为倾斜成角度的,使得当凸轮308从图8所示的位置旋转到与图8所示的凸轮308位置相差180度的位置时,远侧表面309将朝远侧驱动自由端342。凸轮从动件312枢转地固定到枢转销344。枢转销344与致动器柄部组件70的任何合适部分联接,由此提供凸轮从动件312可枢转围绕的机械地。凸轮从动件312还包括连接销346,该连接销将凸轮从动件312的远侧端部350联接到竖直连杆310。因此,凸轮从动件312和竖直连杆310能够操作以围绕连接销346枢转。枢转销344被定位在凸轮从动件312的远侧端部350和近侧自由端342之间。
成角度凸轮308和凸轮从动件312配合以通过导致凸轮从动件312围绕枢转销344枢转地摆动来升高和降低竖直连杆310。在图8所示的操作阶段中,轴326处于回缩的近侧位置,使得钉驱动器24和刀36处于回缩的近侧位置。肘节连杆316,318处于塌缩构型并且竖直连杆310处于较低位置。凸轮从动件312的近侧自由端342与成角度远侧表面309的最近侧区域接触。当马达306被启动以使成角度凸轮308旋转完成一整圈旋转的第一半时,成角度远侧表面309的最远侧区域311支承凸轮从动件312的近侧自由端342,由此朝远侧驱动近侧自由端342。这导致凸轮从动件312围绕枢转销344逆时针旋转。凸轮从动件312的远侧端部350因此被向上推压,从而向上升高竖直连杆310。当竖直连杆310向上升高时,第一和第二肘节连杆316,318伸直或者彼此基本上对准,由此朝远侧驱动轴326。这朝远侧驱动钉驱动器24和刀36,由此缝合吻合部位处的组织并且切除吻合部内的多余组织,如上所述。
在一些型式中,凸轮从动件312由能够滑动的运动部件构件,使得当凸轮从动件312逆时针旋转时,远侧端部350从枢转销344朝远侧延伸,由此允许远侧端部350完全地升高竖直连杆310。此类被构造成能够滑动的运动部件能够在凸轮从动件312围绕枢转销344旋转时允许竖直连杆310保持竖直取向,同时仍能响应于凸轮从动件312的旋转而提供竖直连杆310的竖直运动。除此之外或作为另外一种选择,凸轮从动件312可限定细长狭槽以接收连接销346。此类狭槽被构造成能够在凸轮从动件312围绕枢转销344旋转时允许竖直连杆310保持竖直取向,同时仍能响应于凸轮从动件312的旋转而提供竖直连杆310的竖直运动。还应当理解,轴326的运动也可根据与本专利同一天提交的、名称为SURGICALSTAPLERWITHROTARYCAMDRIVEANDRETURN的美国专利申请[代理人案卷号END7287USNP.0606452]的教导内容来控制,该专利申请的公开内容以引用方式并入本文。
当马达306继续驱动成角度凸轮308完成一整圈旋转的第二半时,轴326返回到图8所示的近侧位置。肘节连杆316,318返回到塌缩状态;竖直连杆310返回到向下位置;并且凸轮从动件312被顺时针旋转。在本例中,弹性构件(例如,卷簧等)弹性偏压轴326以返回到近侧位置。除此之外或作为另外一种选择,一个或多个扭转弹簧可围绕销348和/或销349进行定位以将连杆310,316弹性偏置到图8所示的位置。除此之外或作为另外一种选择,扭转弹簧可围绕销344进行定位以将凸轮从动件312弹性偏置到图8所示的位置。应当理解,在成角度凸轮308的一整圈旋转的第二半期间,凸轮从动件312的近侧自由端342从接合成角度远侧表面309的最远侧区域311过渡到接合成角度远侧表面309的最近侧区域。这种过渡允许凸轮从动件312顺时针旋转返回到图8所示的位置,因为成角度远侧表面309的成角度构型提供用于此类旋转的间隙。
在一些型式中,马达306和/或轴326可与一个或多个传感器(例如,编码器、磁簧开关等)连接,所述一个或多个传感器能够操作以监测齿轮308的旋转和/或轴326的位移。可将此类信息传送给或显示给与器械10连接的控制单元以供操作者使用。除此之外或作为另外一种选择,此类信息可通过控制模块进行处理,所述控制模块可在凸轮308的完整360度旋转完成时自动地停止马达306(例如,利用动态制动等)。参考本文的教导内容,可用于提供马达306的精确停止的各种合适类型的传感器和控制模块对于本领域的普通技术人员而言将是显而易见的。当然,控制模块被构造成能够控制马达306以启动任何合适的旋转次数等。在一些情况下,控制马达306的启动和停止可根据与本专利同一天提交的、名称为CONTROLFEATURESFORMOTORIZEDSURGICALSTAPLINGINSTRUMENT的美国专利申请[代理人案卷号END7291USNP.0606446]的教导内容来执行,该专利申请的公开内容以引用方式并入本文。
D.具有齿条和小齿轮和示例性驱动组件
图9示出了另一个示例性另选驱动组件400,其能够操作以与圆形外科缝合器械10一起使用以用于驱动钉驱动器24和刀36。本例的驱动组件400包括马达406、驱动小齿轮408、齿条410、第一肘节连杆416、第二肘节连杆418、锚固件420、和轴426。马达406、第一肘节连杆416、第二肘节连杆418、锚固件420、和轴426基本上类似于上文所述的马达206、竖直连杆210、第一肘节连杆216、第二肘节连杆218、锚固件220、和驱动器致动器226。类似于马达206,马达406可根据与本专利同一天提交的、名称为CONTROLFEATURESFORMOTORIZEDSURGICALSTAPLINGINSTRUMENT的美国专利申请[代理人案卷号END7291USNP.0606446]的教导内容中的至少一些来控制,该专利申请的公开内容以引用方式并入本文。
马达406通过驱动轴440与驱动小齿轮408连接,使得马达406驱动小齿轮408旋转。驱动小齿轮408与齿条410连接,使得驱动齿轮408的旋转升高和降低齿条410。本例的马达406能够操作以沿正向和反向旋转,由此有利于齿条410的升高和降低。具体地,如果马达406沿一个方向旋转,则齿条410向上升高,并且如果马达406沿相反方向旋转,则齿条410向下降低。齿条410的上部部分限定水平狭槽415。齿条410通过设置在狭槽415中的销414与肘节连杆416,418连接。具体地,销414能够操作以水平地滑动穿过狭槽415。肘节连杆416通过第二销442与轴426连接,而肘节连杆418通过第三销444与锚固件420连接。
驱动小齿轮408的旋转导致轴426推进或回缩以驱动钉驱动器24或刀36。具体地,当马达406使小齿轮408沿第一方向旋转以向上驱动齿条410时,肘节连杆416,418伸直或者彼此基本上对准并且由此朝远侧推进轴426。这朝远侧驱动钉驱动器24和刀36,由此缝合吻合部位处的组织并且切除吻合部内的多余组织,如上所述。当马达406使小齿轮408沿第二方向旋转以向下驱动齿条410时,肘节连杆416,418塌缩并且由此朝近侧回缩轴426。当齿条410升高和降低时,狭槽415适应销414的水平运动。
应当理解,可使用反转马达406的不同方式。例如,马达406可与被构造成能够选择性地反转马达406和停止马达406的微控制器、ASIC、和/或其他类型的控制模块连接。马达406还可根据与本专利同一天提交的、名称为CONTROLFEATURESFORMOTORIZEDSURGICALSTAPLINGINSTRUMENT的美国专利申请[代理人案卷号END7291USNP.0606446]的教导内容来控制,该专利申请的公开内容以引用方式并入本文。控制模块可与一个或多个传感器(例如,编码器、磁簧开关等)连接,所述一个或多个传感器能够操作以监测小齿轮408的旋转和/或轴426的位移。此类信息可通过控制模块进行处理,所述控制模块可在轴426的完全远侧推进完成时自动地反转马达406;并且随后在轴426的完全近侧回缩完成时停止马达406(例如,利用动态制动等)。参考本文的教导内容,可控制马达406的其他合适方式对于本领域的普通技术人员而言将是显而易见的。
作为另一个仅示例性的例子,驱动组件400能够使得马达406沿单一方向旋转驱动轴440,以便推进和回缩轴426。例如,马达406可使驱动轴440沿第一旋转方向旋转,以驱动齿条410完成第一向上运动范围,由此通过肘节连杆416,418朝远侧推进轴426。当两个肘节连杆416,418为水平取向时,轴426可到达最远侧位置。当马达406继续使驱动轴440沿第一旋转方向旋转以由此驱动齿条410完成第二向上运动范围时,齿条410可导致肘节连杆416,418再次塌缩,由此朝近侧回缩轴426。轴426可由此被推进和回缩,而不必反转驱动轴440旋转的方向。
III.杂项
在图7-9所示的例子中,马达206,306,406被取向成与驱动轴240,340,440同轴并且平行于轴226,326,426。然而,马达206,306,406可改为被定位成其他合适的取向。例如,在一些型式中,马达206,306,406可被定位成相对于驱动轴240,340,440和/或轴226,326,426垂直或成任何倾斜的角度。在一些此类型式中,马达206,306,406可被定位在由柄部组件70的另选型式提供的手枪式握把内。马达206,306,406被构造成能够通过锥齿轮等和/或利用任何其他合适的一个或多个结构来将耦合马达206,306,406沿非平行轴线的旋转运动传递到轴240,340,440。仅以举例的方式,马达206,306,406可根据与本专利同一天提交的、名称为SURGICALSTAPLERWITHROTARYCAMDRIVEANDRETURN的美国专利申请[代理人案卷号END7287USNP.0606452]的教导内容来传送运动以驱动轴240,340,440,该专利申请的公开内容以引用方式并入本文。相似地,柄部组件70可根据与本专利同一天提交的、名称为SURGICALSTAPLERWITHROTARYCAMDRIVEANDRETURN的美国专利申请[代理人案卷号END7287USNP.0606452]的教导内容来提供垂直取向的或倾斜取向的手枪式握把,该专利申请的公开内容以引用方式并入本文。参考本文的教导内容,倾斜取向的马达206,306,406可结合到本文所述的器械内的其他合适的方式对于本领域的普通技术人员而言将是显而易见的。
尽管本文的例子已提供于圆形缝合器械的上下文中,但应当理解,本文的各种教导内容可易于应用于各种其他类型的外科器械。仅以举例的方式,本文的各种教导内容可易于应用于线性缝合装置(例如直线切割器)。例如,如对于本领域的普通技术人员而言将是显而易见的,本文的各种教导内容可易于与以下专利的各种教导内容相结合:2012年9月20日公布的名称为“Motor-DrivenSurgicalCuttingInstrumentwithElectricActuatorDirectionalControlAssembly”的美国公布2012/0239012,其公开内容以引用方式并入本文;和/或2010年10月21日公布的名称为“SurgicalStaplingInstrumentwithAnArticulatableEndEffector”的美国公布2010/0264193,其公开内容以引用方式并入本文。作为另一个仅示例性例子,本文的各种教导内容可易于应用于电动电外科装置。例如,如对于本领域的普通技术人员而言将是显而易见的,本文的各种教导内容可易于与以下专利的各种教导内容相结合:2012年5月10日公布的名称为“MotorDrivenElectrosurgicalDevicewithMechanicalandElectricalFeedback”的美国公布2012/0116379,其公开内容以引用方式并入本文。可应用本文的教导内容的其他合适类型的器械以及本文的教导内容可应用于此类器械的各种方式对于本领域的普通技术人员而言将是显而易见的。
还应当理解,本文所述的教导内容、表达、实施例、示例等中的任何一者或多者可与本文所述的其他教导内容、表达、实施例、示例等中的任何一者或多者进行组合。因此上述教导内容、表达方式、实施例、例子等不应视为彼此隔离。参考本文的教导内容,本文的教导内容可进行组合的各种合适方式对于本领域的普通技术人员而言将是显而易见的。此类修改和变型旨在包括在权利要求书的范围内。
本文的教导内容中的至少一些可易于与以下专利的一个或多个教导内容相结合:2010年9月14日公布的名称为“SurgicalStaplesHavingCompressibleorCrushableMembersforSecuringTissueThereinandStaplingInstrumentsforDeployingtheSame”的美国专利7,794,475,其公开内容以引用方式并入本文;2012年12月4日提交的名称为“Trans-OralCircularAnvilIntroductionSystemwithDilationFeature”的美国专利申请13/693,430,其公开内容以引用方式并入本文;2012年11月29日提交的名称为“SurgicalStaplewithIntegralPledgetforTipDeflection”的美国专利申请13/688,951,其公开内容以引用方式并入本文;2012年12月6日提交的名称为“SurgicalStaplerwithVaryingStapleWidthsalongDifferentCircumferences”的美国专利申请13/706,827,其公开内容以引用方式并入本文;2012年11月29日提交的名称为“PivotingAnvilforSurgicalCircularStapler”的美国专利申请13/688,992,其公开内容以引用方式并入本文;2012年12月4日提交的名称为“CircularAnvilIntroductionSystemwithAlignmentFeature”的美国专利申请13/693,455,其公开内容以引用方式并入本文;2012年12月17日提交的名称为“CircularStaplerwithSelectableMotorizedandManualControl,IncludingaControlRing”的美国专利申请13/716,313,其公开内容以引用方式并入本文;2012年12月17日提交的名称为“MotorDrivenRotaryInputCircularStaplerwithModularEndEffector”的美国专利申请13/716,318,其公开内容以引用方式并入本文;和/或2012年12月17日提交的名称为“MotorDrivenRotaryInputCircularStaplerwithLockableFlexibleShaft”的美国专利申请13/176,323,其公开内容以引用方式并入本文。此类教导内容可进行组合的各种合适方式对于本领域普通技术人员而言将是显而易见的。
应当理解,据称以引用的方式并入本文中的任何专利、出版物或其它公开材料,无论是全文或部分,仅在所并入的材料与本公开中所述的定义、陈述或者其它公开材料不冲突的范围内并入本文。因此,并且在必要的程度下,本文明确阐述的公开内容取代以引用方式并入本文的任何冲突材料。据称以引用方式并入本文但与本文所述的现有定义、陈述或其它公开材料相冲突的任何材料或其部分,仅在所并入的材料和现有的公开材料之间不产生冲突的程度下并入本文。
上文所述装置的型式可应用在由医疗专业人员进行的传统医疗处理和手术中、以及可应用在机器人辅助的医疗处理和手术中。仅以举例的方式,本文的各种教导内容可易于结合到机器人外科系统诸如IntuitiveSurgical,Inc.(Sunnyvale,California)的DAVINCITM系统中。
上文所述型式可被设计成在单次使用后废弃,或者其可被设计成能够使用多次。在任一种情况下或两种情况下,可再调整型式以在至少一次使用之后重复使用。再调整可包括以下步骤的任意组合:拆卸装置、然后清洁或替换特定零件以及随后进行重新组装。具体地讲,可拆卸一些型式的所述装置,并且可选择性地以任何组合型式来替换或移除所述装置的任意数量的特定零件或部分。在清洁和/或替换特定部分时,所述装置的一些型式可在修复设施处重新组装或者在即将进行手术前由使用者重新组装以供随后使用。本领域的技术人员将会了解,装置再调整可以利用多种技术进行拆卸、清洁/替换以及重新组装。这些技术的使用和所得重新调整的装置均在本申请的范围内。
仅以举例的方式,本文描述的型式可在手术之前和/或之后消毒。在一种消毒技术中,将装置放置在闭合并密封的容器中,诸如,塑料袋或TYVEK袋中。然后可将容器和装置放置在可穿透所述容器的辐射场中,诸如γ辐射、X射线或高能电子。辐射可将装置上和容器中的细菌杀死。经杀菌的装置随后可存储在无菌容器中,以供以后使用。还可使用本领域已知的任何其它技术对装置消毒,所述技术包括但不限于β辐射或γ辐射、环氧乙烷或蒸汽。
已经示出和描述了本发明的各种实施例,可在不脱离本发明的范围的情况下由本领域的普通技术人员进行适当修改来实现本文所述的方法和系统的进一步改进。已经提及了若干此类潜在修改,并且其它修改将对本领域的技术人员显而易见。例如,上文所讨论的示例、实施例、几何形状、材料、尺寸、比率、步骤等均是例示性的而非所要求的。因此,本发明的范围应根据以下权利要求书来考虑,并且应理解为不限于说明书和图式中示出和描述的结构和操作细节。
Claims (20)
1.一种设备,包括:
(a)包括钉驱动器的端部执行器,其中所述钉驱动器能够操作以沿着所述端部执行器朝远侧推进;
(b)轴组件,所述轴组件包括与所述钉驱动器连接的能够平移的驱动构件;和
(c)与所述能够平移的驱动构件连接的驱动组件,其中所述驱动组件包括:
(i)马达,
(ii)与所述马达连接的旋转驱动构件,
(iii)与所述旋转驱动构件连接的第一连杆,和
(iv)与所述第一连杆连接的至少一个肘节连杆,其中所述至少一个肘节还与所述能够平移的驱动构件连接;
其中所述旋转驱动构件被构造成能够引起所述第一连杆的线性运动,其中所述第一连杆被构造成能够将线性运动传递到所述至少一个肘节连杆,所述至少一个肘节连杆不平行于所述第一连杆的所述线性运动。
2.根据权利要求1所述的设备,其中所述旋转驱动构件和所述第一连杆通过销连接,其中所述销从所述旋转驱动构件的中心偏移。
3.根据权利要求1所述的设备,其中所述驱动组件还包括凸轮从动件,其中所述旋转驱动构件包括成角表面,其中所述旋转驱动构件和所述第一连杆通过所述凸轮从动件连接,其中所述旋转驱动构件能够操作以使所述凸轮从动件通过凸轮运动来运动。
4.根据权利要求3所述的设备,其中所述凸轮从动件枢转地联接到机械地。
5.根据权利要求1所述的设备,其中所述旋转驱动构件被构造成能够旋转半圈以升高所述第一连杆,其中所述第一连杆能够操作以响应于所述旋转驱动构件的半圈旋转来完全地推进所述平移驱动构件。
6.根据权利要求1所述的设备,其中所述旋转驱动构件被构造成能够利用一整圈旋转来升高和降低所述第一连杆,其中所述第一连杆能够操作以利用所述旋转驱动构件的一整圈旋转来完全地推进和完全地回缩所述平移驱动构件。
7.根据权利要求1所述的设备,其中所述马达限定纵向轴线,其中所述第一连杆被定位成基本上垂直于所述纵向轴线。
8.根据权利要求1所述的设备,其中所述至少一个肘节连杆包括第一肘节连杆和第二肘节连杆。
9.根据权利要求8所述的设备,其中所述第二肘节连杆枢转地附连到锚固点。
10.根据权利要求9所述的设备,其中所述第一肘节连杆与所述平移驱动构件枢转地联接。
11.根据权利要求10所述的设备,其中所述第一肘节连杆和所述第二肘节连杆通过单个枢转点与所述第一连杆连接,其中所述第一肘节连杆和所述第二肘节连杆能够操作以形成伸直构型以朝远侧推进所述平移驱动构件,其中所述第一肘节连杆和所述第二肘节连杆能够操作以形成塌缩构型以朝近侧回缩所述平移驱动构件。
12.根据权利要求11所述的设备,其中所述轴限定纵向轴线,其中所述第一肘节连杆和所述第二肘节连杆能够操作以选择性地平行于所述纵向轴线对准。
13.根据权利要求1所述的设备,其中所述驱动组件能够操作以在所述能够平移的驱动器的远侧行进范围期间向所述能够平移的驱动器提供可变的机械效益。
14.根据权利要求1所述的设备,其中所述旋转驱动构件包括驱动小齿轮,其中所述第一连杆包括齿条。
15.根据权利要求14所述的设备,其中所述驱动组件还包括与所述至少一个肘节连杆连接的销,其中所述齿条限定狭槽,其中所述销被以能够滑动的方式设置在所述狭槽中。
16.一种设备,包括:
(a)与功率源连接的手持件;
(b)定位在所述手持件上的操作者控制件;
(c)从所述手持件朝远侧延伸的平移驱动构件,其中所述平移驱动构件能够操作以相对于所述手持件朝远侧推进和朝近侧回缩;
(d)与所述平移驱动构件连接的钉驱动器;和
(f)与所述平移驱动构件连接的驱动组件,其中所述驱动组件包括能够操作以将线性运动传递到所述平移驱动构件的马达,其中所述马达被构造成能够利用所述马达的单圈旋转来推进和回缩所述平移驱动构件。
17.根据权利要求16所述的设备,其中所述驱动组件还包括多个肘节连杆,其中所述马达和所述平移驱动构件通过所述多个肘节连杆连接。
18.根据权利要求17所述的设备,其中所述多个肘节连杆包括通过枢转销连接的竖直连杆和两个水平肘节连杆。
19.根据权利要求17所述的设备,其中所述驱动组件还包括齿条和小齿轮,所述齿条和小齿轮与所述马达连接并且还与所述多个肘节连杆连接,其中所述齿条能够平移以伸直所述多个肘节连杆以朝远侧推进所述平移驱动构件,其中所述齿条还被构造成能够平移以塌缩所述多个肘节连杆以朝近侧回缩所述平移驱动构件。
20.一种驱动钉驱动构件的方法,所述方法包括:
(a)通过所述操作者输入件接收操作者命令以驱动所述钉驱动构件;
(b)使所述马达旋转通过一整圈旋转的第一部分;
(c)将所述马达通过的所述一整圈旋转的第一部分旋转转换成所述钉驱动构件的远侧推进;
(d)使所述马达旋转通过所述一整圈旋转的第二部分以完成所述一整圈旋转;以及
(e)将所述马达通过的所述一整圈旋转的第二部分旋转转换成所述钉驱动构件的近侧回缩。
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MX2016003716A (es) | 2016-08-18 |
BR112016006275B1 (pt) | 2022-03-15 |
CN105682575B (zh) | 2019-03-19 |
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BR112016006275A2 (pt) | 2017-08-01 |
EP2851012B1 (en) | 2020-05-13 |
RU2016115749A (ru) | 2017-10-30 |
US9936949B2 (en) | 2018-04-10 |
US20150083773A1 (en) | 2015-03-26 |
JP2016530062A (ja) | 2016-09-29 |
JP6392359B2 (ja) | 2018-09-19 |
RU2016115749A3 (zh) | 2018-05-23 |
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