CN105686858B - 砧座组件输送系统 - Google Patents
砧座组件输送系统 Download PDFInfo
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- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
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- A61B17/0482—Needle or suture guides
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0467—Instruments for cutting sutures
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
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- A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
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- A61B90/08—Accessories or related features not otherwise provided for
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- A—HUMAN NECESSITIES
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- 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
- A61B90/06—Measuring instruments not otherwise provided for
Abstract
本发明公开了一种砧座组件输送系统。提供了一种适用于经口腔输送的砧座组件。该砧座组件包括构造成接纳在吻合操作期间被切断的引导缝线的壳体。还提供了一种包括砧座组件、和稳固至该砧座组件的缝线引导组件的砧座输送组件。本发明还提供一种套件。
Description
技术领域
本公开涉及一种用于与手术吻合装置联用的砧座组件。更具体地,本公开涉及一种用于砧座组件经口腔输送的砧座组件。
背景技术
用于将砧座组件输送至例如胃的手术部位的经口腔输送系统是已知的。在已知的输送系统中,引导缝线穿过在砧座组件头部中的一个或多个开口,以助于砧座组件的经口腔插入。如果在经口腔输送期间砧座组件被卡在体腔内,则该引导缝线可以被用以使砧座组件移开,和/或在紧急情况下,例如在心跳停止时,该引导缝线可以被用以将砧座组件取回。期望一种一旦砧座组件被输送至手术部位和/或已经执行了吻合操作则有助于引导缝线从砧座组件的分开的将引导缝线稳固至砧座组件的改进的方法。
发明内容
提供了一种用于手术吻合装置的砧座组件。该砧座组件包括砧座中央杆和关于枢转轴线枢转地稳固至所述砧座中央杆的头部组件。该头部组件能够在操作位置和倾斜位置之间移动。该头部组件包括壳体和支撑在该壳体内的切割构件。该壳体包括限定第一开口和第二开口的内表面,所述第一开口和所述第二开口用于接纳缝线穿过其中。该切割构件包括刀具,在第一开口和第二开口之间,该刀具能够与壳体的的内表面接合,以切断所述缝线。该内表面可以进一步包括形成在第一开口和第二开口之间的凹槽。在实施例中,该凹槽和刀具可以是环形的。该切割构件能够从与壳体的内表面间隔开的第一位置移动至与壳体的内表面接触的第二位置。
在实施例中,该头部组件可以进一步包括保持构件,该保持构件具有环形主体部和用于将切割构件维持在第一位置的脆弱环(frangible ring)。该脆弱环从环形主体部的分离可以允许切割构件从第一位置向第二位置的移动。该砧座组件可以进一步包括偏置构件,该偏置构件安置成相对于砧座中央杆推动所述头部组件,以将头部组件安置在倾斜位置。
本公开还提供了一种砧座输送系统。该砧座输送系统包括砧座组件和缝线引导组件。该缝线引导组件包括稳固至该头部组件的引导缝线、以及构造为选择性地配送该引导缝线的卷筒组件。该引导缝线可以穿过该壳体中的第一开口而被接纳并且从该壳体中的第二开口延伸出。该卷筒组件可以包括卷筒壳体和可旋转地接纳在卷筒壳体中的卷筒构件。该引导缝线可以绕着该卷筒构件被支撑。该卷筒构件可以限定用于接纳引导缝线的环形通道。在该壳体中的环形空腔内,该卷筒构件可以可旋转地支撑在卷筒壳体上。
在实施例中,该砧座输送系统进一步包括用于该砧座组件的经口腔插入的管状引导组件。该管状引导组件可以包括挠性管、以及构造为将该挠性管可操作地连接至砧座中央杆的接合器。该管状引导组件可以进一步包括用于将该砧座组件的头部组件保持在倾斜位置的保持缝线。该保持缝线可以穿过该壳体中的第三开口和第四开口而被接纳并且被稳固在接合器和挠性管之间。
另外,本公开提供了一种用于执行手术吻合操作的套件。该套件包括砧座组件、缝线引导组件以及管状引导组件。该缝线引导组件可以包括引导缝线和卷筒组件。该管状引导组件可以包括挠性管和接合器。
附图说明
当前公开的砧座组件和砧座组件输送系统的多种实施例在此参照附图进行公开,其中:
图1是包括根据本公开的砧座组件的实施例的手术吻合装置的立体图;
图2是图1的砧座组件从远侧端观看时的侧视立体图;
图3是图1和图2中所示的砧座组件从近侧端观看时的侧视立体图;
图4是图1至图3的砧座组件的分解侧视立体图;
图5是图1至图4的砧座组件的远侧端视图;
图6是沿着图5的线6-6截取的侧视剖视图;
图7是沿着图5的线7-7截取的侧视剖视图;
图8是图1至图7的砧座组件的凸轮闩锁构件的放大侧视图;
图9是与砧座输送系统接合的图1至图7的砧座组件的俯视图;
图10是图9的砧座输送系统的放大分解图;
图11是与图1至图7的砧座组件接合的图9和图10的砧座输送系统的放大俯视图;
图12是沿着图11的截面线12-12截取的侧视剖视图;
图13是与图9至图12的砧座输送系统接合的、处于发射前倾斜位置的图1至图7的砧座组件的侧视剖视图;
图14是图13中所示的指出的细节区域的放大图;
图15是图11和图12的砧座组件和砧座输送系统被经口腔地插入到患者中的图解;
图16是砧座组件被移除的图1的手术吻合装置的远侧头部的放大侧视图;
图17是图1的手术吻合装置的远侧头部的放大侧视图,其中图1至图7的砧座组件被接纳在该远侧头部上;
图18是图1的手术吻合装置的远侧头部、以及图1至图7的砧座组件处于发射前非倾斜操作位置的放大的侧视剖视图;
图19是图1的手术吻合装置的远侧头部、以及图1至图7的砧座组件处于发射后非倾斜操作位置的放大的侧视剖视图;
图20是图1至图7的砧座组件的远侧端处于发射后操作位置的放大的侧视剖视图;
图21是图1至图7的砧座组件的远侧端处于发射后倾斜位置的放大的侧视剖视图;
图22是处于发射后倾斜位置的图1至图7的砧座组件的侧视剖视图,其中该砧座组件被支撑在图1的手术器械的砧座保持件上;
图22A是处于发射后倾斜位置的图1至图7的砧座组件的另一个侧视剖视图,其中该砧座组件被支撑在图1的手术器械的砧座保持件上;
图23是图22A中所示的指出的细节区域的放大图;
图24是被支撑在图1的手术吻合装置的砧座保持件上的图22的砧座组件处于发射后倾斜位置的侧视图;
图25是根据本公开的另一个实施例的处于操作位置的砧座组件的侧视立体图;
图26是图25的砧座组件处于第一倾斜位置的侧视立体图;
图27是图25的砧座组件的分解立体图;
图28是图25的砧座组件的壳体的底部立体图;
图28A是从近侧端观看的图25的砧座组件的壳体的端视图;
图29是图25的砧座组件的头部组件的底部立体图;
图30是图28的壳体被移除的图25的砧座组件的俯视立体图;
图31是图25的砧座组件的支持构件和/或切割环组件的底部立体图;
图32是支持构件/切割环组件处于第一或近侧位置的、处于操作位置的图25的砧座组件的侧视剖视图;以及
图33是支持构件/切割环组件处于第二或远侧位置的、处于操作位置的图25的砧座组件的侧视剖视图。
具体实施方式
现将参照附图详细描述当前公开的砧座组件输送系统的实施例,其中相同参考标号表示若干附图的每幅附图中的相同或对应的元件。在整个说明书中,术语“近侧”将指代器械的最靠近操作者的部分,而术语“远侧”将指代器械的最远离操作者的部分。
图1图示出了手术吻合装置的实施例,其构造为与根据本公开的倾斜砧座组件联用。简单来讲,手术吻合装置10包括近侧手柄组件12、包括弯曲的细长外管14a的细长的中央主体部14,以及远侧头部16。可选地,在一些手术操作中,例如,在痔疮的治疗中,期望具有大体直线的、缩短的中央主体部。主体部14和远侧头部16的长度、形状和/或直径还可以改变以适应特定的手术操作。
仍旧参照图1,手柄组件12包括固定手柄18、发射扳机20、可旋转接近旋钮22和指示器24。枢转安装的扳机锁26被紧固至手柄组件12并且手动地安置以防止吻合装置10的非有意发射。指示器24安置在固定手柄18上并且包括标记,例如,颜色标记、字母数字标签等,以便外科医生判定该装置是否接近并准备要发射。头部16包括砧座组件110和壳组件31。对于手术吻合装置10的更加详细的描述,请参照米利曼(Milliman)的共有美国专利号7,364,060,该专利的全部内容通过引用合并于此。
现在参照图2至图7,根据本公开的实施例的砧座组件通常示出为砧座组件110。砧座组件110被示出为处于非倾斜位置或操作位置。砧座组件110包括头部组件112和中央杆组件114。头部组件112包括支柱116、壳体118、支持构件或支持板(backup plate)120、切割环(cutting ring)122、切割环罩123、砧座板124、间隔件或垫圈125、凸轮闩锁构件126以及保持构件127。支柱116与壳体118整体地形成并且居中地安置在壳体118中。可选地,壳体118和支柱116可以单独地形成并且通过已知的紧固技术(例如,焊接)而紧固在一起。
正如下面将进一步详细讨论的,壳体118包括开口119a、119b,其排列并且定尺寸成接纳一个或多个缝线“S”。在使用期间,第一缝线“S1”(图9)插入穿过开口119a并且被用以在砧座组件110插入到患者体内期间将头部组件112保持在缩回或第一倾斜位置(图9)。第二缝线“S2”(图9)被插入穿过开口119b并且构造成允许从患者体内取回倾斜的砧座组件110。在砧座组件110经口腔插入期间,缝线“S2”从患者的嘴部延伸出,如此允许砧座组件110经口腔地取回。
继续参照图2至图7,砧座板124被支撑在壳体118的外环形凹槽128中并且包括用于接纳吻合钉且使吻合钉变形的多个吻合钉变形凹部130。至少一个凸起124a从砧座板124朝外径向地延伸并且被接纳在形成于壳体118的外缘中的切口132中。凸起124a和切口132用以使砧座板124对准在壳体118的环形凹槽128中且将该砧座板124恰当地安置在壳体118的环形凹槽128中。
具体参照图6和图7,将详细描述头部组件112。支持板120包括中央开口134,该中央开口134绕支柱116定位在壳体118的内环形凹槽136内,内环形凹槽136位于支柱116和外环形凹槽128之间。支持板120包括凸出的平台120a。切割环122包括开口122a,该开口具有与平台120a基本相同的构造。尽管平台120a以具有圆形形状的形式被图示出,但能想到其他构造,例如,正方形、矩形、三角形等。在一个实施例中,切割环122由聚乙烯制成并且使用例如粘合剂而固定地稳固至支持板120,以形成支持板/切割环组件。支持板120由例如金属的硬质材料形成。其他替代材料构造可以被用以构造支持板120和切割环122。另外,可选地,支持板120和切割环122能够形成为单个或整体的结构。
仍旧参照图6和图7,切割环罩123使用例如粘合剂来稳固至切割环122的朝向外的表面或近侧表面。在一个实施例中,切割环罩123由具有比切割环硬度大的硬度的一种或多种材料形成,材料例如为聚酯薄膜。在一个实施例中,切割环罩123包括使用粘合剂接合在一起的两层聚酯薄膜(未示出)和聚丙烯涂层。可选地,切割环122不需要具有罩。切割环122和支持板120绕着支柱116可滑动地安装。支持板120包括一对朝内延伸的指形件138,这将会在后面进一步详细地描述。
仍旧参照图6和图7,保持构件127安置于在支持板120与壳体118的后壁118a之间的内环形凹槽136中。在一个实施例中,保持构件127是环形的并且包括与支持板120的后表面接合的多个可变形凸起127a。保持构件127防止支持板120和切割环122移入或被推入壳体118的内环形凹槽136中,直到足以使凸起127a变形的预定力被施加到支持板/切割环组件。该预定力能够靠近但是小于由手术吻合装置的环形切割刀片在其接合例如砧座组件110的切割环时所施加的力。在作为示例的实施例中,该预定力介于约10磅和约90磅之间并且能够约为三十(30)磅。当达到预定力时,例如,在组织切割期间,将支持板120推入到环形凹槽136内并且压紧保持构件127。想到的是,其他可压扁的、可变形的、可折叠的和/或移动限制构件可以被用以将支持板/切割环组件保持在固定位置,直到预定力被施加至支持板/切割环组件。
返回参照图4,砧座中央杆组件114包括中央杆152、柱塞154和柱塞弹簧156。中央杆152的第一端包括限定空腔159a的一对臂159。每个臂159具有横向通孔158,该横向通孔与中央杆152的中央纵向轴线对准。可选地,通孔158能够偏离于中央杆152的纵向轴线。头部组件112的支柱116定尺寸成安置在空腔159a内并且也包括横向通孔(未示出)。枢轴构件162经由通孔将支柱116枢转地稳固至中央杆152,使得头部组件112可以被枢转地安装至砧座中央杆组件114。
短暂地转向图8,凸轮闩锁构件126包括具有通孔126b的主体126a。通孔126b定尺寸成接纳枢轴构件162,使得凸轮闩锁构件126关于枢轴构件162枢转地安装在支柱116的横向狭槽172(图3)内。现在参照图3、图6和图7,凸轮闩锁构件126包括第一主体部126c,该第一主体部从支柱126的狭槽172部分地延伸出并且被安置成由柱塞154的指形件166接合。第一主体部126c构造成使得第一主体部126c的表面与通孔126b之间的距离关于凸轮闩锁构件沿着顺时针方向增加。通过这种方式,柱塞154能够随着凸轮闩锁构件126沿着顺时针方向旋转而朝前移动。另外地,第一主体部126c的这种构造允许柱塞154随着凸轮闩锁构件沿逆时针方向旋转而缩回。凸轮闩锁构件126还包括边缘126f,其包括凸起126g。边缘126f的前部构造成:当头部组件112处于其非倾斜或操作位置时,通过柱塞154的接合指形件166而促使边缘126f的前部与支持板120的内周120b接合。凸起126g构造成接合壳体118的后壁118a,以防止凸轮闩锁构件126相对于壳体118逆时针旋转。
参照图6,柱塞154可滑动地安置在形成于中央杆152的第一端中的孔164中。柱塞154包括接合指形件166,该接合指形件偏离于头部组件112的枢转轴线并且被偏置成与凸轮闩锁126的边缘126c接合。指形件166与凸轮闩锁126的边缘126c的接合将边缘126f的前部挤压支持板120的内周,以将头部组件112推到中央杆152上的操作或非倾斜位置。
转向图7,在头部组件112的发射前操作位置上,即,当头部组件112已经枢转到其非倾斜位置时,形成在支持板120上的指形件138接合与中央杆152的顶表面邻近的突起152b,以防止头部组件112关于枢轴构件162枢转。头部组件112可以在其发射前倾斜位置上相对于砧座中央杆组件114倾斜α度(图13)。在一个实施例中,头部组件112在其发射前倾斜位置上倾斜约70度(70°);然而,应当理解的是,还能够想到将头部组件112倾斜成其他角度。头部组件112相对于砧座中央杆组件114的倾斜引起凸轮闩锁构件126的主体部126c来接合柱塞154的指形件166。当凸轮闩锁组件126随着头部组件112的倾斜而旋转时,柱塞154借助砧座中央杆组件114的孔164来缩回,从而压缩弹簧156。通过这种方式,柱塞154的指形件166抵靠凸轮闩锁构件126的主体部126c而向远侧偏置。
参照图3和图4,中央杆152的第二端包括由多个挠性臂182限定的孔180。挠性臂182均包括开口182a,该开口定尺寸成接纳在壳组件31(图18)上形成或连接至壳组件31(图18)的突块(projection)。可选地,开口182a可以构造成接纳用于允许砧座组件110的取回的缝线。每个挠性臂182的近侧端包括内台肩184,该内台肩定尺寸成可释放地接合手术吻合装置10的壳组件31,以将砧座组件110稳固至手术吻合装置。多个键槽186绕中央杆152形成。键槽186用以将砧座组件110与手术吻合装置的吻合钉固持部对准。中央杆152还包括环形凹槽部190,以助于外科医生通过抓紧器来抓握砧座组件110。凹槽部190可包含粗糙表面或有压花的表面或二次成型(overmold),以助于砧座组件110的抓紧。
现在参照图9至图12,一种用于在患者体内输送砧座组件110的系统通常作为砧座输送系统50来示出。砧座输送系统50包括挠性管52和接合器62。挠性管52包括开口端52a。接合器62和砧座组件110被支撑在挠性管52的开口端52a上。挠性管52的开口端52a包括延伸贯通其中的通孔53,该通孔构造成接纳锁定销54。开口端52a进一步包括开口55。挠性管52的闭合端52b构造为经口腔地接纳在患者体中。挠性管52可以包括沿着其长度的标记或刻度56,以在插入期间向外科医生指示挠性管52已经有多少接纳在患者体中,和/或在移除时指示挠性管52在患者体中的剩余的长度。
具体参照图10,接合器62包括第一端62a和第二端62b,第一端62a构造成接纳在挠性管52的开口端52a中,第二端62b构造成接纳在形成于砧座组件110的中央杆152中的孔180中。第一端62a包括一系列的环形环件64,该环形环件构造成将接合器62的第一端62a摩擦地保持在挠性管52的开口端52a中。接合器62的第二端62b包括纵向引导构件66,该纵向引导构件构造成接纳在形成于砧座组件110的中央杆152中的挠性臂182之间。另外,接合器62的第二端62b设定尺寸,以允许砧座组件110的中央杆154自由地滑入和滑出接合器62的第二端62b。接合器62进一步包括形成在中央毂部62c中的第一通孔70、以及在第一端62a中形成的第二通孔72和第三通孔74。通孔72构造成与形成在挠性管52的开口端52a中的通孔53对准并且设定尺寸成接纳锁定销54。
现在具体参照图10、图13和图14,砧座组件110被支撑在砧座输送系统50上。将砧座组件110稳固至砧座输送系统50首先需要将缝线“S1”穿过形成在头部组件112上的开口119a,使得缝线“S1”的第一端和第二端安置在中央杆152的相反侧上。接下来,接合器62的第二端62b安置在中央杆152的通孔180中,使得纵向引导件66被接纳在两个臂构件182之间。缝线“S1”的第一端和第二端中的每个均插入穿过形成在挠性构件52的开口端52a中的开口55。头部组件112然后旋转到第一倾斜位置,而同时缝线“S1”的第一端和第二端被拉动穿过开口55。接合器62的第一端62a然后插入到挠性构件的开口端52a中。接合器62的第一端62a的环形环件64与挠性管52的内表面之间的摩擦接触将接合器62稳固至挠性管52,并且防止缝线“S1”松动。想到的是,可以使用一个以上的缝线来将头部组件112稳固在发射前倾斜位置。
现在参照图15,将描述一种用于将砧座组件110输送至患者体内的手术部位的方法。在一方法中,砧座组件110设置在被支撑于砧座输送系统50上的第一倾斜位置上并且准备要输送。可选地,如上所讨论的,临床医生将砧座组件110稳固至砧座输送系统50。一旦砧座组件110已经被稳固至挠性管52,则外科医生就将挠性管52的闭合端52b插入到患者的嘴部“M”中,并且将闭合端52b连同挠性管52一起向下移动穿过食管“E”至手术部位,即胃“St”。
在插入之后,外科医生然后使在手术部位(如所示的胃“St”)处的第一切口“I1”形成至挠性管52的闭合端52b的内通路,并且随后拉动挠性管52的开口端52b穿过第一切口“I1”。在一些操作中,将挠性管52拉动穿过切口“I1”直到砧座组件110的中央杆152推进穿过第一切口“I1”会是有益的。当砧座组件110恰当地安置在手术部位处时,外科医生通过切割缝线“S1”并且将砧座组件110从接合器62的第二端62b分离来将砧座输送系统50从砧座组件110释放。挠性管52(带有配件62)可然后从体内被拉动穿过第一切口“I1”。
缝线“S1”的切断允许柱塞154从孔164内延伸出,从而使得指形件166接合凸轮闩锁构件126的主体部126c。凸轮闩锁构件126的旋转使得闩锁构件126的边缘126f移动到与支持板120的内周接合,从而促使头部组件112返回到非倾斜操作位置。另外地,吻合装置10的远侧端可以构造成:当砧座组件110附接至手术吻合装置10时,来接合柱塞154的指形件166。通过这种方式,手术吻合装置10的远侧端向远侧推动柱塞154,从而确保头部组件112旋转至非倾斜位置。
具体参照图15,在方法中,第二切口“I2”然后在手术部位处形成,使得手术吻合装置10的远侧头部16可以穿过第二切口“I2”被接纳。可选地,一旦砧座输送系统50已经从第一切口“I1”移除,手术吻合装置10的远侧头部16可以穿过第一切口“I1”被接纳。
短暂地转向图16和图17,砧座组件110可操作地接纳在砧座保持件32上,该砧座保持件32从形成于手术吻合装置10的远侧端上的壳组件31上延伸出。一旦砧座组件110被接纳在手术吻合装置10上,则手术吻合装置10以在‘060专利中所论述的方式操作。
现将参照图18至图23来描述砧座组件110的操作。当砧座组件110处于其发射前非倾斜位置时,支持板120通过保持件127而与壳体118的后壁118a间隔开,并且中央杆152的突起152b接合支持板120的指形件138以防止头部组件112关于枢轴构件162倾斜。弹簧156推动柱塞154的指形件166与凸轮闩锁构件126的主体部126c接合,以关于枢轴构件162沿着顺时针方向推动凸轮闩锁构件126,使得凸轮闩锁构件126的边缘126f接合支持构件120的内周120b。
手术吻合装置10的发射引起其刀片33接合切割环122,以使切割环122和支持板120移动到头部组件112的壳体118的环形凹槽136中。图19中的箭头“W”指示:作为手术吻合装置10的结果,切割环122和支持板120如何移动。当这种移动发生时,保持件127的可变形凸起127a抵靠壳体118的后壁118a变形,并且支持构件120的指形件138移动而远离中央杆152的突起152b。此外,支持板120的内周120b移动经过凸轮闩锁构件126的边缘126f,以便通过柱塞154促使凸轮闩锁构件126关于枢轴构件162沿着由图21中的箭头“X”所标示的方向枢转至如下的位置:在所述位置中,主体部126d安置在支持板120的前方并且接合支持板120。柱塞154与凸轮闩锁构件126的接合将头部组件112推至第二倾斜位置(图22和图23)。应当注意,头部组件112在手术吻合装置10发射时将不会立即倾斜,这是因为在发射时,头部组件112处于接近位置,即,头部组件112与吻合装置10的壳组件31紧密对准,而因此,不会为头部组件112枢转提供空间。由此,当砧座组件110、和手术吻合装置10的壳组件31未接近时,头部组件112将仅仅开始倾斜。
随着头部组件112朝向其前向或第二倾斜位置枢转,柱塞154的指形件166维持凸轮闩锁构件126的表面126e与支持板120相接触,以在刀片缩回时防止支持板120卡住刀片。应当注意,凸轮闩锁构件的曲面126e构造成消除凸轮闩锁构件126的表面126e和支持板120之间的任意间隙并且确保凸轮闩锁构件126的表面126e和支持板120之间的接触,以在刀片缩回期间和缩回之后将支持板120固持在适当位置,使得在砧座组件112的持续倾斜期间,切割环和支持板组件保持在它们的正确位置上。砧座组件110构造成使得头部组件112相对于中央杆组件114倾斜β度至前向或第二倾斜位置(图24)。在一个实施例中,头部组件112倾斜约70度(70°)到其第二倾斜位置,使得砧座从缩回或第一倾斜位置至前向或第二倾斜位置的总枢转运动为约140度(140°)。然而,应当注意,还能想到头部组件112倾斜成其他角度。
如上所描述的,本公开的砧座组件构造成被经口腔地输送至手术部位,例如胃“St”(图15)。在砧座组件的经口腔输送期间,保持缝线,即第一缝线“S1”,将砧座组件的头部组件保持在第一倾斜位置,并且近侧引导缝线,即第二缝线“S2”,包括保留在患者的嘴部“M”外部的第一端“S2a”和第二端“S2b”,其允许外科医生在经口腔输送期间将砧座组件从患者体内移去或取回。
正如上面描述的并且参照图11,第二缝线“S2”穿过砧座组件110的头部组件112的壳体118中的开口119b。第二缝线“S2”从砧座组件110分开需要:拉动第二缝线“S2”的第一端“S2a”,使得第二缝线“S2”的第二端“S2b”从患者的嘴部“M”(图15)(外科医生在此处可进入)外行进穿过患者的嘴部“M”和上部胃肠(GI)道(例如,食道“E”和胃“St”(图15)),并且在不得不在返回行进穿过上部GI道并离开患者的嘴部“M”之前,所述第二缝线“S2”的第二端“S2b”穿过砧座组件110的头部组件112的壳体118中的开口119b。
现在参照图25至图33,根据本公开的可选实施例的砧座组件通常作为砧座组件210来示出。正如将在后面进一步详细描述的,砧座组件210构造成使得第二缝线“S2”(图25)在吻合操作期间被切断,以将第二缝线“S2”从砧座组件210分开并且通过拉动第二缝线“S2”的第一端“S2a”和第二端“S2b”而允许第二缝线“S2”从患者体中取出。通过这种方式,在不必拉动第二缝线“S2”的第二端“S2b”穿过患者的体腔(图15)(即,嘴部“M”、食道“E”和胃“St”)的情况下,第二缝线“S2”从砧座组件210分离并且从患者体中取出。
参照图25至图27,砧座组件210基本上类似于本文上面描述的砧座组件110,并且将针对砧座组件210与砧座组件110之间的差异来详细地描述。砧座组件210包括头部组件212和中央杆组件214。头部组件212是相对于中央杆组件214可枢转的并且包括壳体218、支持构件220、切割环222和保持构件224。砧座板226(图28)被支撑在壳体218的外缘230b(图28)上,并且包括用于接纳吻合钉(未示出)且使吻合钉变形的多个吻合钉变形凹部226a(图28)。中央杆组件214包括中央杆252、用于接合头部组件212的柱塞254、用于使柱塞254沿着远侧方向偏置的柱塞弹簧256、接纳在头部组件212内的凸轮闩锁构件258、以及将头部组件212枢转地连接至中央杆252的枢转销260。
参照图27、图28和图28A,砧座组件210的头部组件212的壳体218包括中心支柱230a并且限定中心支柱230a和外缘230b之间的空腔231。壳体218的内表面218a限定在空腔231内的凹槽217,该凹槽与中心支柱230a朝外间隔开并且围绕中心支柱230a形成。第一对开口219a和第二对开口219b(图25)延伸贯通壳体218的内表面218a。第一对开口219a接纳第一缝线“S1”,而第二对开口219b接纳第二缝线“S2”。更具体地,第二对开口219b在凹槽217的任一侧上延伸贯通壳体218的内表面218a,使得当第二缝线“S2”(图32)穿过第二对开口219b被接纳时,第二缝线“S2”遍及凹槽217而延伸。尽管凹槽217被示出为环形的并且完全地围绕壳体218的中心支柱230a延伸,但是可以想到,凹槽217仅需要延伸一段距离以助于第二缝线“S2”的通过,并且因此,可以仅部分地围绕中心支柱230a延伸。在可选的实施例中,壳体218形成为不含凹槽217并且第二缝线“S2”穿过第二对开口219b被接纳并且直接地延伸遍及壳体218的内表面218a。
参照图27至图31,支持构件220、切割环222以及保持构件224绕壳体218的中心支柱230a被接纳在壳体218的空腔231内(图28A)。支持构件220被稳固至切割环222以形成支持构件/切割环组件225。如所示,支持构件/切割环组件225通过使支持构件220与切割环222二次成型而形成。具体地,在使支持构件220与切割环222二次成型之间,形成多个支柱223,该多个支柱延伸穿过切割环222的开口221以将支持构件220稳固至切割环222。可选地,支持构件/切割环组件225形成为单个部件或使用机械紧固件或以任意其他合适的方式紧固在一起的两个部件。支持构件/切割环组件225可在空腔231内从近侧位置(图32)移动至远侧位置(图33)。支持构件/切割环组件225通过保持构件224而在壳体218的空腔231内被保持在近侧位置(图32)。
保持构件224包括环形主体部224a和被支撑在环形主体部224a上的脆弱环224b。脆弱环224b将支持构件/切割环组件225保持在近侧位置,直到足以使脆弱环224b破裂或将脆弱环224b从保持构件224的环形主体部224a分离的预定力通过手术吻合装置10(图1)的环形刀具33(图19)而被施加至支持构件/切割环组件225为止。该支持构件/切割环组件225通过多个凸起222a(图31)而被维持在壳体218的空腔231内,该多个凸起222a从切割环222向外延伸并且接合壳体218的外缘230b。
对于示例性的支持构件/切割环组件225、以及示例性的保持构件224的结构和功能的详细描述,请参照共有的美国专利申请公开号2015/0129635,该专利申请的内容通过引用其全部内容合并于此。
支持构件/切割环组件225包括刀具232,该刀具从支持构件220的远侧表面220a延伸出并且与限定在壳体218内的凹槽217对准。当支持构件220被稳固至切割环222以形成支持构件/切割环组件225时,刀具232朝向凹槽217向远侧延伸超过支持构件220的远侧表面220a(图30)。尽管所示具有环形构造且从支持构件220延伸出,但可以想到,刀具232可以包括适于接纳在形成于壳体218的内表面218a(图28)中的凹槽217中的任意构造。例如,在实施例中,刀具232的长度对应于凹槽217的长度,并因此,如上文关于凹槽217论述的,该长度仅需要是利于第二缝线“S2”切割的长度。在不含凹槽217的壳体218的实施例中,刀具232构造成接合壳体218的内表面218a。
现在参照图32,当砧座组件210的头部组件212处于发射前状态时,支持构件/切割环组件225以及因此从支持构件220延伸出的刀具232与壳体218的内表面218a纵向地间隔开。正如上面所指出的,通过与保持构件224的脆弱环224b的接合,支持构件/切割环组件225被维持在近侧位置,并且通过切割环222的多个凸起222a与壳体218的外缘230b的接合,支持构件/切割环组件225被保持在壳体218的空腔231内。
如上文论述关于图19的,在手术吻合装置10发射期间,环形刀具33从壳组件31朝远侧推进,正如由箭头“w”所表示的。现在参照图32,当砧座组件210被附接至手术吻合装置10(图19)的壳组件31(图19)时,环形刀具33(图19)的向远侧移动引起刀具33接合头部组件212的支持构件/切割环组件225的切割环222。当将保持构件224的脆弱环224b从保持构件224的环形主体部224a分离或折断时所需的预定力通过刀具33来施加至脆弱环224b时,支持构件/切割环组件225绕中央支柱230a在壳体218的空腔231向远侧地移动。来自刀具33的持续的力引起支持构件/切割环组件225向远侧地移动,直到支持构件/切割环组件225接合壳体218的内表面218a为止。随着支持构件/切割环组件225向远侧地移动,支持构件220的刀具232被接纳在形成于壳体218的内表面218a中的凹槽217内,如此引起刀具232接合并且切断第二缝线“S2”。
一旦第二缝线“S2”被切断,通过拉动第二缝线“S2”的第一端“S2a”和第二端“S2b”,每一半的切断的第二缝线“S2”从患者体内经口腔地独立移除。通过以这种方式切断第二缝线“S2”,外科医生能够使第二缝线“S2”从砧座组件210脱离并且将每一半的第二缝线“S2”直接从患者体内移除,而不必将第二缝线“S2”的第二端“S2b”拉动穿过砧座组件210中的开口219b并且穿过体腔而被向回拉到患者体外。如果在不将第二缝线“S2”切割成两半的情况下将第二缝线“S2”从患者移除,则第二缝线“S2”的一端“S2a”、“S2b”将不得不被拉到患者的体腔中,并且在被向回拉穿过体腔之前穿过砧座组件210。
正如上面所指出的,第二缝线“S2”助于砧座组件210放置在患者的胃“St”(图15)内。第二缝线“S2”如果在砧座组件210经口腔输送期间卡在体腔内,第二缝线“S2”可以被用以从砧座组件210移去,和/或在紧急情况下,第二缝线“S2”可以被用以将砧座组件210取回。由于第二缝线“S2”在砧座组件210放置并附接至手术吻合装置10(图1)的期间一直保持附接至砧座组件210,并且直到完成吻合操作,因此第二缝线“S2”可以在直至第二缝线“S2”被切断的任意点处用以将砧座组件210移去和/或取回。
在本发明的一个实施例中,砧座输送系统包括砧座组件和缝线引导组件。该缝线引导组件包括稳固至该头部组件的引导缝线、以及构造为选择性地配送该引导缝线的卷筒组件。该引导缝线可以穿过头部组件的壳体中的第一开口而被接纳并且从该壳体中的第二开口延伸出。该卷筒组件可以包括卷筒壳体和可旋转地接纳在卷筒壳体中的卷筒构件。该引导缝线可以绕着该卷筒构件被支撑。该卷筒构件可以限定用于接纳引导缝线的环形通道。在头部组件的壳体中的环形空腔内,该卷筒构件可以可旋转地支撑在卷筒壳体上。
本领域技术人员将要理解的是,在此具体描述并在附图中图示出的装置和方法是非限制性的示例性实施例。想到的是,结合一个示例性实施例图示或描述的元件和特征可以与不偏离本公开范围的另一个实施例的元件和特征合并。而且,基于上述实施例,本领技术人员将想到本公开的进一步的特征和优势。因此,本公开并不由已经具体示出和描述的所限制,除了如由所附的权利要求书所指示的。
Claims (18)
1.一种砧座组件,包括:
砧座中央杆;以及
头部组件,其关于枢转轴线枢转地稳固至所述砧座中央杆,所述头部组件能够在操作位置和倾斜位置之间移动,所述头部组件包括壳体和被支撑在所述壳体内的切割构件,所述壳体包括限定第一开口和第二开口的内表面,所述第一开口和所述第二开口用于接纳缝线穿过其中,其中,所述切割构件包括刀具,在所述第一开口和所述第二开口之间,所述刀具能够与所述壳体的内表面接合,以切断所述缝线。
2.根据权利要求1所述的砧座组件,其中,所述内表面进一步包括形成在所述第一开口和所述第二开口之间的凹槽。
3.根据权利要求2所述的砧座组件,其中,所述凹槽是环形的。
4.根据权利要求3所述的砧座组件,其中,所述刀具是环形的。
5.根据权利要求1所述的砧座组件,其中,所述切割构件能够从与所述壳体的所述内表面间隔开的第一位置移动至与所述壳体的所述内表面接触的第二位置。
6.根据权利要求5所述的砧座组件,其中,所述头部组件进一步包括保持构件,所述保持构件具有环形主体部和用于将所述切割构件维持在所述第一位置的脆弱环。
7.根据权利要求6所述的砧座组件,其中,所述脆弱环从所述环形主体部的分离允许所述切割构件从所述第一位置移动至所述第二位置。
8.根据权利要求1所述的砧座组件,进一步包括偏置构件,所述偏置构件安置成相对于所述砧座中央杆推动所述头部组件,以将所述头部组件安置在所述倾斜位置。
9.一种砧座输送系统,包括:
如权利要求1所述的砧座组件;以及
缝线引导组件,其包括稳固至所述头部组件的引导缝线、以及构造为选择性地配送所述引导缝线的卷筒组件。
10.根据权利要求9所述的砧座输送系统,其中,所述引导缝线穿过所述壳体中的所述第一开口而被接纳并且从所述壳体中的所述第二开口延伸出。
11.根据权利要求9所述的砧座输送系统,其中,所述卷筒组件包括卷筒壳体和可旋转地被接纳在所述卷筒壳体中的卷筒构件,其中所述引导缝线绕着所述卷筒构件被支撑。
12.根据权利要求11所述的砧座输送系统,其中,所述卷筒构件限定用于接纳所述引导缝线的环形通道。
13.根据权利要求11所述的砧座输送系统,其中,在所述壳体中的环形空腔内,所述卷筒构件可旋转地支撑于所述卷筒壳体上。
14.根据权利要求9所述的砧座输送系统,进一步包括用于所述砧座组件的经口腔插入的管状引导组件。
15.根据权利要求14所述的砧座输送系统,其中,所述管状引导组件包括挠性管和构造用于将所述挠性管可操作地连接至所述砧座中央杆的接合器。
16.根据权利要求15所述的砧座输送系统,其中,所述管状引导组件进一步包括用于将所述砧座组件的所述头部组件保持在所述倾斜位置的保持缝线。
17.根据权利要求16所述的砧座输送系统,其中,所述保持缝线穿过所述壳体中的第三开口和第四开口而被接纳并且被稳固在所述接合器和所述挠性管之间。
18.一种套件,包括:
根据权利要求1的砧座组件;
缝线引导组件,其包括引导缝线和卷筒组件;以及
管状引导组件,其包括挠性管和接合器。
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2014
- 2014-12-09 US US14/564,571 patent/US9855045B2/en active Active
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2015
- 2015-11-03 CA CA2911126A patent/CA2911126A1/en not_active Abandoned
- 2015-11-06 AU AU2015252140A patent/AU2015252140B2/en not_active Ceased
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ES2624636T3 (es) | 2017-07-17 |
AU2015252140B2 (en) | 2019-10-31 |
AU2015252140A1 (en) | 2016-06-23 |
US10779833B2 (en) | 2020-09-22 |
EP3031408B1 (en) | 2017-04-05 |
US9855045B2 (en) | 2018-01-02 |
CN105686858A (zh) | 2016-06-22 |
US20160157855A1 (en) | 2016-06-09 |
US20180116668A1 (en) | 2018-05-03 |
EP3031408A1 (en) | 2016-06-15 |
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