CN106037846A - 内窥镜吻合器 - Google Patents

内窥镜吻合器 Download PDF

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CN106037846A
CN106037846A CN201610221803.9A CN201610221803A CN106037846A CN 106037846 A CN106037846 A CN 106037846A CN 201610221803 A CN201610221803 A CN 201610221803A CN 106037846 A CN106037846 A CN 106037846A
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supporting leg
anastomosis staple
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CN106037846B (zh
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斯坦尼斯洛娃·科斯切夫斯基
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • A61B17/0644—Surgical staples, i.e. penetrating the tissue penetrating the tissue, deformable to closed position
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • A61B2017/0645—Surgical staples, i.e. penetrating the tissue being elastically deformed for insertion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07221—Stapler heads curved
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07271—Stapler heads characterised by its cartridge
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07278—Stapler heads characterised by its sled or its staple holder

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Abstract

本发明公开了一种内窥镜吻合器。在此描述了一种手术吻合器，其包括轴部和被支撑在轴部的远侧端上的工具组件。工具组件包括砧座和在凹口内可旋转地支撑多个吻合钉的钉仓主体。至少一个发射凸轮设置成相继接合并旋转每个吻合钉，来从钉仓主体发射吻合钉。每个吻合钉均包括第一吻合钉支腿和第二吻合钉支腿，所述第一吻合钉支腿和所述第二吻合钉支腿彼此轴向地偏移并且由中间部互连。至少一个发射凸轮设置成相继接合并旋转每个吻合钉，来从钉仓主体发射吻合钉。至少一个发射凸轮可包括轴向偏移的凸轮构件。

Description

内窥镜吻合器
相关申请的交叉引用
本申请要求于2015年4月10日提交的、美国临时专利申请第62/145,857号的权益和优先权，其全部公开内容通过引用合并于此。
技术领域
本申请涉及一种手术吻合器，并且更具体地，涉及一种用于内窥镜使用的手术吻合器。本公开还涉及与内窥镜手术吻合器联用的手术吻合钉。
背景技术
手术吻合器典型地包括容纳多个吻合钉的钉仓、用于在吻合钉从钉仓射出时使吻合钉成形的砧座、以及同时实现组织的解剖和缝合的刀。当与应用手动穿针的缝线进行比较时，使用手术吻合器来缝合和解剖组织已经增加了手术操作的速度，并因此将患者创伤最小化。
在内窥镜手术操作中，手术吻合器被插入穿过皮肤中的小切口或插入穿过插管来进入手术部位。由于已知的手术吻合器的复杂性以及已知的吻合钉成形器具的吻合钉尺寸要求，因此存在对适于内窥镜使用的小直径手术吻合器的持续需求。
发明内容
本公开旨在一种手术吻合器，其具有工具组件，该工具组件包括砧座和具有一系列吻合钉的吻合钉钉仓，所述一系列吻合钉被支撑并且构造成从吻合钉钉仓可旋转地射出到砧座中来缝合组织。支撑吻合钉并从吻合钉钉仓内射出吻合钉的方式促进了如下小直径工具组件的使用：所述小直径工具组件包含这类小直径工具组件通常所不具有的能够缝合较厚组织的吻合钉。在多个实施例中，手术吻合器包括具有错开凸轮构件的至少一个发射凸轮，并且吻合钉构造有错开的支腿。每个吻合钉支腿在变形时具有D形构造
在本公开的一个方案中，一种手术吻合器包括轴部和被支撑在所述轴部的远侧端上的工具组件。所述工具组件包括砧座和钉仓组件，所述钉仓组件具有包括限定多个凹口的至少一个支腿的钉仓主体、以及多个吻合钉。每个所述吻合钉具有将第一吻合钉支腿和第二吻合钉支腿互连的中间部。每个所述吻合钉的所述中间部具有连接至第一吻合钉支腿的第一端和连接至第二吻合钉支腿的第二端，其中所述中间部的所述第一端和所述第二端彼此轴向偏移。所述手术吻合器包括至少一个发射凸轮，所述至少一个发射凸轮具有限定包括第一凸轮表面和第二凸轮表面的凸轮构件的远侧端。所述第一凸轮表面和所述第二凸轮表面彼此轴向偏移。所述凸轮构件能够在所述工具组件内移动以使所述第一凸轮表面和所述第二凸轮表面移动到与所述多个吻合钉中的每个的所述第一吻合钉支腿和所述第二吻合钉支腿相继接合中，其中所述多个吻合钉中的每个的所述第一吻合钉支腿和所述第二吻合钉支腿、与所述凸轮构件之间的接合实现所述多个吻合钉中的每个的旋转运动，以从所述钉仓主体发射所述多个吻合钉中的每个吻合钉。
在实施例中，所述多个凹口的每个凹口构造成可旋转地支撑所述多个吻合钉中的一个吻合钉。
在一些实施例中，所述钉仓主体的所述至少一个支腿限定多个切口。所述多个切口中的每个与所述多个凹口中的相邻凹口间隔开并且构造成接纳所述多个吻合钉中的一个吻合钉的所述中间部的第一部。
在实施例中，每个所述吻合钉的所述中间部是S形的并且包括远侧U形部，所述远侧U形部构造成被接纳于在所述钉仓主体的至少一个支腿上的多个切口中的相应的一个切口中。
在某些实施例中，所述多个凹口中的每个凹口构造成可旋转地接纳所述多个吻合钉的相应的一个吻合钉的中间部的近侧部。
在实施例中，所述多个吻合钉中的每个吻合钉的第一吻合钉支腿和第二吻合钉支腿均具有弯曲构造，并且所述第一吻合钉支腿和所述第二吻合钉支腿中的每个均在抵着所述砧座成形时限定出D形。
在一些实施例中，所述多个凹口中的每个凹口均包括圆筒形的狭槽，所述圆筒形的狭槽构造成以卡扣配合的方式接纳所述多个吻合钉的相应的一个吻合钉的中间部的近侧部。
在一些实施例中，所述钉仓主体的所述至少一个支腿包括两个间隔开的支腿，并且所述多个凹口沿着两个间隔开的支腿中的每个轴向地间隔开，其中所述多个凹口中的每个均可旋转地支撑所述多个吻合钉中的一个吻合钉。
在实施例中，所述手术吻合器包括第一钉仓通道和第二钉仓通道。所述第一钉仓通道和所述第二钉仓通道中的每个均具有限定U形构件的远侧端，并且所述钉仓主体的两个间隔开的支腿中的每个均被稳固在所述U形构件的相应的一个U形构件内。
在一些实施例中，所述至少一个发射凸轮包括第一发射凸轮和第二发射凸轮。所述第一发射凸轮和所述第二发射凸轮的每个凸轮构件均具有U形形状，并关于所述钉仓主体的两个间隔开的支腿中的一个支腿定位且定位在所述第一钉仓通道和所述第二钉仓通道中的一个钉仓通道的U形构件内。
在一些实施例中，所述手术吻合器包括枢转构件，所述枢转构件可枢转地稳固至所述轴部的远侧端并且固定地稳固至所述第一钉仓通道和所述第二钉仓通道中的每个钉仓通道。
在实施例中，所述手术吻合器包括第一关节式运动连杆和第二关节式运动连杆，所述第一关节式运动连杆具有稳固至所述第一钉仓通道的近侧端的远侧端，所述第二关节式运动连杆具有稳固至所述第二钉仓通道的近侧端的远侧端。所述第一关节式运动连杆和所述第二关节式运动连杆能够轴向地移动以实现所述第一钉仓通道和所述第二钉仓通道相对于彼此的轴向移动，来使所述枢转构件相对于所述轴部枢转。
在一些实施例中，可枢转的关节式运动构件将所述第一关节式运动连杆与所述第二关节式运动连杆互连，使得所述第一关节式运动连杆沿着一个方向的运动实现所述第二关节式运动连杆沿着相反方向的运动。
在某些实施例中，所述多个吻合钉中的每个的第一吻合钉支腿和第二吻合钉支腿中的每个均具有锥形末端。
在多个实施例中，所述钉仓主体中的所述至少一个支腿包括多个凹窝，并且所述多个凹窝中的每个均被定位成接合所述多个吻合钉中的一个吻合钉的第一吻合钉支腿和第二吻合钉支腿中的一个吻合钉支腿，以将所述吻合钉稳定在所述钉仓主体上。
在本公开的另一方案中，描述了一种手术吻合钉，其包括第一弯曲支腿、第二弯曲支腿以及将所述第一弯曲支腿与所述第二弯曲支腿互连的中间部。所述吻合钉的中间部具有连接至所述第一弯曲支腿的第一端和连接至所述第二弯曲支腿的第二端，其中所述中间部的第一端和第二端彼此轴向地偏移。
在一些实施例中，所述吻合钉的中间部是S形的并且包括远侧U形部和近侧部。
在某些实施例中，第一弯曲支腿和第二弯曲支腿中的每个均包括锥形末端。
在多个实施例中，所述吻合钉的第一弯曲支腿和第二弯曲支腿构造成当抵着砧座成形时具有D形。
附图说明
在此参照附图描述当前公开的小直径手术吻合器的多种实施例，其中：
图1是当前公开的小直径手术吻合器处于非接近位置时的一个实施例侧视立体图；
图1A是从图1中所示的手术吻合器的吻合器再装载器的远侧端的侧视立体图；
图2是从图1A中所示的手术吻合器再装载器的近侧端的侧视立体图；
图3是图1A中所示的手术吻合器再装载器的侧视立体分解图；
图3A是图3中所示的手术吻合器再装载器的近侧主体部的壳体上半部的远侧端、枢转构件和连接构件的俯视立体分解图；
图3B是图3中所示的标示的细部区域的放大图；
图3C是图3中所示的标示的细部区域的放大图；
图4是图1中所示的标示的细部区域的放大图；
图5A是从图3中所示的吻合器再装载器的吻合钉的一侧的立体图；
图5B是图5A中所示的吻合钉的俯视图；
图5C是从图3中所示的吻合钉的另一侧的立体图；
图6是图3C中所示的标示的细部区域的放大图；
图7是图6中所示的标示的细部区域的放大图；
图7A是图1A中所示的手术吻合器再装载器的钉仓组件的俯视图；
图7B是图7A中所示的标示的细部区域的放大图；
图8是支撑吻合钉的钉仓主体的侧视剖切图；
图9是图3中所示的吻合器再装载器的钉仓通道的侧视立体图；
图10是图9中所示的钉仓通道的俯视图；
图11是图10中所示的标示区域的放大图；
图12是图9中所示的标示的细部区域的放大图；
图13是沿着图12的剖切线13-13截取的立体断面图；
图14是图3中所示的吻合器再装载器的错开发射凸轮的侧视立体图；
图15A是图14中所示的标示的细部区域的放大图；
图15B是图14中所示的错开发射凸轮的远侧端的俯视图；
图16是沿着图15的剖切线16-16截取的立体断面图；
图17是图3中所示的吻合器再装载器的钉仓组件被支撑在发射凸轮的远侧端上的侧视立体图；
图18是图17中所示的标示的细部区域的放大图；
图19是图3中所示的吻合器再装载器的钉仓组件被支撑在钉仓通道和发射凸轮的远侧端上的侧视立体图；
图20是图19中所示的标示的细部区域的放大图；
图21是图1A中所示的吻合器再装载器在工具组件处于非接近位置时的俯视图；
图22A是沿着图21的剖切线22A-22A截取的断面图；
图22B是沿着图21的剖切线22B-22B截取的断面图；
图23A是沿着图21的剖切线23A-23A截取的断面图；
图23B是沿着图21的剖切线23B-23B截取的断面图；
图24A是图22A中所示的标示的细部区域的放大图；
图24B是图22B中所示的标示的细部区域的放大图；
图25A是沿着图21的剖切线25A-25A截取的断面图；
图25B是沿着图21的剖切线25B-25B截取的断面图；
图26是图21中所示的吻合器再装载器的工具组件在工具组件处于接近位置且发射凸轮被推进到与多个吻合钉的最近侧吻合钉接合时的俯视立体图；
图27是图26中所示的吻合器再装载器的工具组件的侧视剖视图；
图28是图27中所示的标示的细部区域的放大图；
图29是图28中所示的细部区域的视图，其中发射凸轮被推进到与第二最近侧吻合钉接合；
图30是图29中所示的细部区域的视图，其中发射凸轮被推进到与第三最近侧吻合钉接合；
图30A是图30中所示的细部区域的视图，其中发射凸轮被推进到与第四最近侧吻合钉接合且最近侧吻合钉被从钉仓主体释放；
图31是图26中所示的吻合器再装载器的工具组件的吻合钉在吻合钉已经变形后的立体图；
图32是沿着图26的剖切线32-32截取的断面图；
图33是图1A中所示的吻合器再装载器处于非关节式运动位置和非接近位置的侧视立体图，其中移除了近侧主体部的近侧管和轴部的轴管；
图34是吻合器再装载器的近侧主体部在移除了近侧管且移除了壳体上半部时的俯视立体图；
图35是吻合器再装载器的近侧主体部的壳体上半部的俯视立体图；
图36是图35中所示的吻合器再装载器的近侧主体部在移除了近侧管和壳体上半部且转动了关节式运动构件时的俯视立体图；以及
图37是图26中所示的吻合器再装载器的工具组件处于关节式运动位置时的俯视图。
具体实施方式
现在将参照附图详细描述当前公开的内窥镜手术吻合器的实施例，该内窥镜手术吻合器包括具有错开支腿的吻合钉，其中相同参考标号在若干附图的每幅图中表示同一或对应的元件。在该描述中，术语“近侧”通常用以表示器具的较靠近临床医生的那部分，而术语“远侧”通常用以表示器具的较远离临床医生的那部分。另外，术语“内窥镜”操作通常用以表示内窥镜操作、腹腔镜操作、关节镜操作、以及穿过小切口或穿过插入到患者的身体中的插管来执行的任意其他手术操作。最后，术语临床医生通常用以表示包括医生、护士和支持人员的医疗人员。
当前公开的手术吻合器包括支撑一系列吻合钉的工具组件，该一系列吻合钉被支撑并且构造成从吻合钉钉仓旋转地射出到砧座中来缝合组织。支撑吻合钉并从吻合钉钉仓内射出吻合钉的方式促进了如下小直径工具组件的使用：所述小直径工具组件包含这类小直径工具组件通常所不具有的能够缝合较厚组织的吻合钉。在多个实施例中，手术吻合器包括具有错开凸轮构件的至少一个发射凸轮，并且吻合钉构造有错开的支腿。每个吻合钉支腿具有在变形时的D形构造。
图1至图2图示出了当前公开的手术吻合器10，其包括具有手柄组件12a的致动装置12、从手柄组件12a远侧地延伸的主体部14、以及支撑在主体部14的远侧端上的吻合器再装载器100。主体部14的远侧端适于可释放地接合再装载器100的近侧端，使得致动装置12的致动实现再装载器100的操作。在美国专利第5,865,361号(“361专利”)和第7,143,924号(“924专利”)中详细公开了一种合适的致动装置，上述专利通过引用以其全部内容合并于此。尽管当前公开的致动装置被图示为手动致动的手柄组件，但可以想到，其他已知的致动装置能够被用以致动再装载器100，这些已知的致动装置包括机器人装置、装有马达的装置和/或电气地或机械地驱动的装置。
在替代的实施例中，再装载器100能够被固定地附接至手柄组件12的远侧端并且工具组件的钉仓组件能够是可移除的且可更换的。替代地，可移除的且可更换的再装载器还能够具有可移除的且可更换的钉仓。
还参照图3至图3C，再装载器100包括近侧主体部110、细长轴部112和工具组件114。近侧主体部110包括由壳体上半部116a和壳体下半部116b限定的内壳体116(图25A)。壳体半部116a和116b限定通道，所述通道滑动地接纳近侧驱动构件118、第一关节式运动连杆120和第二关节式运动连杆122。壳体半部116a和116b被接纳在近侧主体管125内。
第一关节式运动连杆120通过将在下面详细描述的关节式运动构件123连接至第二关节式运动连杆122。近侧驱动构件118支撑驱动联结器124，该驱动联结器124适于接合致动装置12(图1)的控制杆(未示出)以操作再装载器100的工具组件114。近侧驱动构件118还支撑锁定组件126，该锁定组件126包括锁定装置128和弹簧130。驱动联结器124和锁定组件126的操作在通过引用合并于此的‘361专利中进行了描述。由此，在此将不再进一步详细描述驱动联结器124和锁定组件126。近侧驱动构件118的远侧端包括T形凹部118a。另外，第一关节式运动连杆120的远侧端和第二关节式运动连杆122的远侧端分别包括钩部120a和122a(图3B)。这些钩部120a和122a中的每一个以及T形凹部118a均会在下面进一步详细描述。
再装载器100的细长轴部112包括由接纳在轴部管112a内的壳体上半部132a和壳体下半部134b限定的内壳体134(图25A)。细长轴部112的内壳体134的近侧端接纳在近侧主体部110的内壳体116的远侧端内并且包括环形凹部135。环形凹部135接纳形成在内壳体116内的突起116c(图25A)以将近侧主体部110的内壳体116轴向地稳固至轴部112的内壳体134。细长轴部112的壳体上半部132a和壳体下半部134b限定内部通道(未示出)，所述内部通道滑动地接纳一对远侧驱动构件136a、136b，一对发射凸轮138a、138b以及一对钉仓通道构件140a、140b。钉仓通道140a、140b中的每个的近侧端分别限定切口142a、142b。钉仓通道140a、140b的切口142a、142b分别接纳第一关节式运动连杆120和第二关节式运动连杆122的钩部120a、120b(图3B)的一侧，使得第一关节式运动连杆120和第二关节式运动连杆122的线性运动实现钉仓通道140a、140b的线性运动，这会在下面进一步详细描述。
远侧驱动构件136a、136b中的每个的近侧端均包括钩部144a并且限定凹部144b。类似地，发射凸轮138a、138b的近侧端包括钩部146a并且限定凹部146b。凹部144b、146b中的每个均分别由远侧壁144c、146c限定。限定发射凸轮138a、138b的每个凹部146b的远侧壁146c定位在限定远侧驱动构件136a、136b的每个凹部144b的远侧壁144c的远侧。远侧驱动构件136a、136b的近侧端和近侧驱动构件118由驱动构件连杆119连接。驱动构件连杆119具有近侧端，该近侧端构造成被接纳在近侧驱动构件118的T形狭槽118a中。驱动构件连杆119的远侧端包括钩部119a并且限定凹部119b。钩部119a被接纳在远侧驱动构件136a、136b的相应的凹部144b和发射凸轮138a、138b的相应的凹部146b中，使得远侧驱动构件136a、136b的相应的钩部144a和发射凸轮138a、138b的相应的钩部146a滑动地接纳在驱动构件连杆119的凹部119b内。由此，近侧驱动构件118的运动实现驱动构件连杆119的相应运动。随着驱动构件连杆119向远侧地移动，驱动构件连杆119的钩部119a在远侧驱动构件136a、136b的相应的凹部144b和发射凸轮138a、138b的相应的凹部146b中移动。当钩状构件119a分别接合限定远侧驱动构件136a、136b的凹部144b的远侧壁144c和发射凸轮138a、138b的凹部146b的远侧壁146c时，驱动构件连杆119的向远侧运动将实现远侧驱动构件136a、136b和发射凸轮138a、138b的相应的向远侧运动。如上所讨论的，发射凸轮138a、138b的凹部146b的远侧壁146c相对于远侧驱动构件136a、136b的远侧壁144c定位在远侧。由此，驱动构件连杆119的向远侧运动在实现发射凸轮138a、138b的向远侧运动之前将实现远侧驱动构件136a、136b的向远侧运动，这会在下面进一步详细描述。可以想到，近侧驱动构件118和驱动构件连杆119能够形成为整体部件。正如图3中最佳地示出的，远侧驱动构件136a和136b的远侧端诸如通过焊接而被稳固至工作构件150。替代地，能够使用其他稳固技术将驱动构件136a和136b的远侧端稳固至工作构件150。在一个实施例中，工作构件150包括上梁152、下梁154以及将上梁152和下梁154互连的竖直支柱156。刀刃156a形成在或被支撑在竖直支柱156的远侧端上。竖直支柱156可移动地定位在钉仓通道140a、140b之间，发射凸轮138a、138b之间以及钉仓主体184的支腿188之间，这会在下面进一步详细描述。工作构件150定位成并构造成：当远侧驱动构件136a、136b在细长轴部112内向远侧地移动来致动工具组件114时，工作构件150移动穿过工具组件114。
再次参照图3和图3A，枢转构件157通过上连接构件160a和下连接构件160b而稳固至轴壳体半部134a、134b。每个连接构件160a、160b均包括限定开口162的远侧端和具有阶梯构造的近侧端164。每个连接构件160a、160b的近侧端164的阶梯构造被接纳在形成于轴壳体上半部134a和轴壳体下半部134b中的每个的远侧端中的切口166内，以分别将上连接构件160a和下连接构件160b固定至轴壳体上半部134a和轴壳体下半部134b。上连接构件160a和下连接构件160b中的每个的开口162接纳在形成于枢转构件157的上表面和下表面上的相应的枢转销170(仅在图3A中示出)，以将枢转构件157枢转地稳固至轴壳体半部134a、134b。枢转构件157还包括两个横向延伸的柱172。每个柱172均被接纳在形成于钉仓通道140a、140b之一中的开口210a(图3C)中，以将枢转构件156稳固在钉仓通道140a、140b之间。
参照图3至图8，工具组件114包括钉仓组件180和砧座182。钉仓组件180(图6)包括钉仓主体184和多个吻合钉185。钉仓主体184包括锥形远侧端186以及间隔开的第一支腿188和第二支腿188。钉仓主体184的锥形远侧端186用作组织引导件并且包括三个向近侧地延伸的指形件190。在间隔开的支腿188中的每个的一侧上定位指形件190中的一个，并且一个指形件190定位在间隔开的支腿188之间。每个指形件190均与相邻的支腿188限定凹部192。凹部192接纳钉仓通道140a、140b的远侧端191(图3C)以将钉仓主体184稳固至钉仓通道140a、140b的远侧端。
钉仓主体184的间隔开的第一支腿188和第二支腿188中的每个包括一系列矩形切口196和凹口198，上述矩形切口196和凹口198沿着钉仓主体184的每个支腿188间隔开。矩形切口196和间隔开的凹口198构造成并且定尺寸成可释放地接合吻合钉185，这会在下面更详细地描述。每个凹口198的基部198具有圆形构造，以在吻合钉成形时促进吻合钉185在相应的凹口198内旋转，这会在下面进一步详细地描述。一系列凹窝199沿着钉仓主体184的支腿188的内壁和外壁间隔开。凹窝199定位成接合每个吻合钉185的近侧支腿部202a以将吻合钉185稳固至钉仓主体184，这会在下面详细地描述。
参照图5A至图5C，每个吻合钉185均包括通过中间部201互连的一对吻合钉支腿200a、200b。每个吻合钉支腿200a、200b具有锥形末端200c和弯曲的大致V形的主体202。中间部201是S形的并且具有连接至吻合钉支腿200a的第一端和连接至吻合钉支腿200b的第二端。
吻合钉支腿200a、200b中的每个的V形主体202包括近侧支腿部202a和远侧支腿部202b。近侧支腿部202a的一端连接至中间部201的一端并且近侧主体部202a的另一端连接至远侧支腿部202b的一端。远侧支腿部202b的另一端限定锥形末端202c。远侧支腿部202b朝向中间部201向上并向后地弯曲。
再次参照图5A至图8，钉仓主体184的每个矩形切口196构造成接纳吻合钉185的中间部201的远侧U形部204a，以将吻合钉185稳固至钉仓主体184的各支腿188。另外，每个凹口198构造成以卡扣配合接合的方式接纳吻合钉185的中间部201的近侧部204b，以将吻合钉185旋转地稳固至钉仓主体184的各支腿188。如上所讨论的，凹窝199与每个吻合钉185的近侧支腿部202a之间的接合有助于将吻合钉可释放地稳固至钉仓主体184。在吻合钉185被稳固至钉仓主体184的支腿188的情况下，每个吻合钉185的中间部201的近侧部204b横向地延伸越过钉仓主体184的各支腿188，使得每个吻合钉185的支腿200a、200b定位在支撑吻合钉185的钉仓主体184的各支腿188的相反两侧上。
如图8中最佳地示出的，每个吻合钉185的支腿200a和支腿200b沿着钉仓主体184的纵向轴线，错开了由中间主体部201的宽度“X”(图5A)限定的距离。在一个实施例中，每个吻合钉185的外支腿200a相对于内支腿200b定位在近侧。
参照图3至图3C以及图9至图13，钉仓通道140a和140b中的每个均具有大致相似的构造。由此，在此将仅仅详细描述钉仓通道140b。钉仓通道140b(图3)包括弹性主体，该弹性主体从再装载器100(图1)的近侧主体部110(图1)延伸至工具组件114。每个钉仓通道140b的远侧端包括U形构件208，该U形构件208接纳钉仓主体184的支腿188并且限定包括近侧开口210a和远侧开口210b的两个开口(图13)。近侧开口210a接纳枢转构件157的柱172(图3A)以将钉仓组件180的钉仓通道140b稳固至枢转构件157。远侧开口210b接纳销211(图3C)，该销211延伸穿过砧座182的近侧端中的开口182a、穿过钉仓通道140b中的开口210b并且穿过钉仓主体184的每个支腿188的近侧端中的开口214(图6)，以将钉仓主体184的支腿188的近侧端稳固至各钉仓通道140a、140b。每个U形构件208的远侧端191被接纳在形成于钉仓主体184的每个支腿188的相反两侧上的相邻凹部192(图6)中。远侧端191由一对切口191a(图12)和向远侧延伸的指形件191b(图12)限定。每个钉仓通道140b的底壁193(图13)是w形并且限定通道，在吻合钉185从钉仓组件180射出时，该通道引导吻合钉185在钉仓主体140b内的旋转运动。
参照图3至图3C以及图14至图18，每个发射凸轮138a和138b的远侧端220限定凸轮构件222。每个凸轮构件222均具有弯曲形状。在某些实施例中，凸轮构件222包括第一部分和至少一个其他部分，所述第一部分用于将吻合钉185移动到与砧座182的吻合钉成形凹陷部182b接合中，所述至少一个其他部分用于使吻合钉185成形为闭合构造。在所示的实施例中，凸轮构件222具有用于使吻合钉185局部地成形的一部分，以及用于使吻合钉185变形成为其最终构造的一部分，这会在后面进一步详细描述。
第一发射凸轮138a和第二发射凸轮138b的每个凸轮构件222均具有沿着发射凸轮138的纵向轴线错开的第一凸轮表面222a和第二凸轮表面222b。每个凸轮构件222均是U形并且限定了通道224，该通道224接纳钉仓主体184的对应的一个支腿188(图3C)。凸轮构件222是能够关于钉仓主体184的对应的支腿188滑动，以将第一凸轮表面222a和第二凸轮表面222b移动到与被支撑在钉仓主体184的各支腿188上的吻合钉185的支腿200a、200b接合中。
凸轮表面222a、222b中的每个均是弯曲的，并且限定通过平稳部230互连的第一弯曲表面226和第二弯曲表面228。凸轮表面222a、222b具有从凸轮表面222a、222b中的每个的远侧端朝向凸轮表面222a、222b中的每个的近侧端增加的高度。凸轮表面222a、222b的第一弯曲表面226构造成开始吻合钉185的支腿200a、200b的变形，而第二弯曲表面228构造成完成吻合钉185的支腿200a、200b的变形并将支腿200a、200b从钉仓主体184的对应的凹口198的圆形基部198释放，这会在下面进一步详细描述。
还参照图19和图20，当钉仓通道140a和140b关于钉仓主体184的支腿188定位并且稳固至钉仓主体184时，在钉仓主体184的支腿188的侧壁与钉仓通道140a、140b的内壁之间限定了空间“s”(图32)。吻合钉支腿200a、200b定位在该空间“s”中。另外，发射凸轮138a和138b中的每个的凸轮表面222a、222b均被滑动地支撑在该空间“s”中。当发射凸轮138a和138b从缩回位置向推进位置推进时，凸轮表面222a、222b在支腿188与钉仓通道140a和140b之间移动到与吻合钉185的支腿200a、200b相继地接触中(图18)，以推动吻合钉185从钉仓主体184进入到砧座182的吻合钉成形凹陷部182b(图22A)中，这会在下面进一步详细地描述。
参照图3C以及图21至图25B，砧座182限定细长的狭槽252和细长的凹部254。工作构件150的竖直支柱156(图25B)穿过细长的狭槽252，使得上梁152滑动地定位在砧座182的细长的凹部254中。砧座182的近侧端限定锥形凸轮表面256(图22A)，该锥形凸轮表面256定位成当砧座182处于如图22A中所示的打开位置时与工作构件150的上梁152的远侧端接合。下梁154定位成沿着钉仓通道140a、140b的底表面移动。如所示，砧座182通过偏置构件而朝向打开位置偏置，例如，偏置构件为一个或多个板簧400(图3C)。在实施例中，板簧400具有U形的近侧端402，该近侧端被压缩在钉仓主体184的近侧端与枢转构件157的远侧面之间。板簧400的远侧端接合砧座182的下表面以将砧座182推到打开位置。
再次简单地参照图3，再装载器100包括锁定构件300，该锁定构件关于近侧主体部110的内壳体116的近侧端来旋转地被支撑。锁定构件300能够从第一位置移动到第二位置，在第一位置中，锁定构件300阻碍近侧驱动构件118的向远侧运动，在第二位置中，锁定构件300移动到允许近侧驱动构件118的向远侧运动的位置。美国专利第7,143,924号描述了锁定构件300及该锁定构件的详细的操作方法，并且通过引用以将其全部内容合并于此。
再次参照图3以及图21至图25B，当近侧驱动构件118(图3)处于缩回位置时，驱动构件连杆119并因此远侧驱动构件136a、136b和发射凸轮138a、138b也处于缩回位置(图25B)。在该缩回位置中，钩部119a相应的与远侧驱动构件136a、136b的钩部144a和发射凸轮138a、138b的钩部146a接合，并且定位在远侧驱动构件136a、136b的凹部144b的近侧端内和发射凸轮138a、138b的凹部146b的近侧端内。另外，工作构件150的上梁152的远侧端相对于砧座182的锥形凸轮表面256(图22A)定位在近侧，以允许偏置构件400将砧座182定位到或移动到与砧座主体184(图22A)间隔开的打开位置。在发射凸轮138a、138b的缩回位置中，发射凸轮138a、138b中的每个的凸轮表面222a、222b(图20)相对于最近侧吻合钉185(图24A)的相应的支腿200a、200b定位在近侧，使得每个发射凸轮138a、138b的凸轮表面222b的近侧端259(图18)与钉仓主体184的相应的支腿188的肩部260(图6)抵接。参照图26，当近侧驱动构件118经由致动装置12(图1)的操作而被推进时，驱动构件连杆119的钩部119a平移穿过远侧驱动构件136a、136b的凹部144b和发射凸轮138a、138b的凹部146b。发射凸轮138a、138b的凹部146b相对于远侧驱动构件136a、136b的凹部144b向远侧地延伸。当驱动构件连杆119的钩部119a接合壁144c、146c时，驱动构件连杆119的向远侧运动将实现远侧驱动构件136c、136b以及发射凸轮138a、138b的向远侧运动，其中，该壁144c、146c分别限定远侧驱动构件136a、136b的凹部144b的远侧端和限定发射凸轮138a、138b的凹部146b的远侧端。如上所讨论的，限定每个凹部146b的远侧端的壁146c相对于限定远侧驱动构件136a、136b的每个凹部144b的远侧端的壁144c定位在远侧。由此，驱动构件连杆119的向远侧运动将在引起发射凸轮138a、138b的向远侧运动之前引起远侧驱动构件136a、136b的运动。
当远侧驱动构件136a、136b经由驱动构件连杆119推进时，工作构件150与砧座182相关地被推进。当工作构件150被推进时，工作构件150的上梁152(图27)在砧座182的锥形凸轮表面256(图27)上移动以使砧座182枢转到接近位置(图26)。在该接近位置中，发射凸轮138a、138b中的每个的凸轮表面222a、222b的远侧端定位成邻近多个吻合钉185的最近侧吻合钉的近侧支腿部202a的近侧或与该支腿部202a接触。
参照图27至图33，近侧驱动构件118(图25)的继续推进将随后使发射凸轮138a、138b中的每个的凸轮表面222a、222b(图29至图33中仅示出了222b)继而移动到与吻合钉185接触。更具体地，当发射凸轮138a、138b在钉仓主体184的支腿188近处被推进时，凸轮表面222a、222b继而接合吻合钉185的近侧支腿部202a以使吻合钉185绕着凹口198内的中间部201的近侧部204b旋转或枢转。随着凸轮表面222a、222b的第一弯曲凸轮表面226在每个吻合钉185的近侧支腿部202a下方移动，每个吻合钉185被向上枢转或旋转，以将吻合钉185的锥形末端202c引导至砧座182的吻合钉成形凹陷部182b中，来开始吻合钉185(图28)的变形。
在凸轮表面222a、222b的第一弯曲凸轮表面226移动经过吻合钉185的近侧支腿部202a之后，凸轮表面222a、222b的平稳部230在吻合钉185的近侧支腿部202a下方移动。平稳部230的高度小于凹口198的基部198和矩形切口196的高度。由此，在发射凸轮138a、138b的这个推进阶段，最近侧吻合钉185保持与钉仓主体184的支腿188接合。
在继续推进发射凸轮138a、138b时，凸轮表面222a、222b中的每个的第二弯曲表面228在吻合钉185下方移动。凸轮表面222a、222b的第二弯曲表面228的接合使吻合钉185完全变形并且使得每个吻合钉185从钉仓主体184的支腿188的凹口198释放或分离。在此方面，在凸轮表面222a、222b的第二弯曲表面228的近侧端处的高度大于凹口198的基部198和切口196的高度。如上所讨论的，每个吻合钉185的吻合钉支腿200a和200b、以及发射凸轮138a、138b中的每个的凸轮表面222a和222b是错开的或轴向地偏移的。在多个实施例中，吻合钉支腿200a和200b的偏移度等于凸轮表面222a和222b的偏移度，使得在凸轮表面222b接合吻合钉185的支腿200b的同时，凸轮表面222a接合吻合钉185的支腿200a。如图30和图31中所示，完全变形的吻合钉185的支腿200a、200b具有大致D形的构造并且彼此轴向地偏移。
参照图3至图3C以及图33至图37，工具组件114能够通过钉仓通道140a、140b沿着彼此相反的方向运动来进行关节式运动。如上所讨论的，钉仓通道140a、140b从近侧主体部110延伸穿过细长轴部112至工具组件114。通过延伸穿过钉仓通道140a、140b的近侧开口210a的相应的柱172(图3A)，钉仓通道140a、140b中的每个的远侧端连接至枢转构件157。钉仓通道140a、140b的近侧端分别包括切口142a、142b(图3B)，切口142a、142b分别接纳关节式运动杆120、122的钩部120a、122a的一侧以将关节式运动杆120、122连接至钉仓通道140a、140b。第一关节式运动连杆120和第二关节式运动连杆122被滑动地支撑在近侧主体部110的壳体半部116a、116b之间。第一关节式运动连杆120具有连接至钉仓通道140a的远侧端和连接至致动装置12(图1)的关节式运动组件350(图1)的近侧端。
关节式运动构件123包括C形主体302，该C形主体302具有间隔开的指形件304、306和中央开口308(图34)。指形件304、306被接纳在切口310中，该切口310形成在第一关节式运动连杆120和第二关节式运动连杆122的远侧端中。中央开口308接纳形成在中央主体部110(图1)的壳体半部116b上的壳体柱312(图35)，使得第一关节式运动连杆120沿着由图36中的箭头“A”标示的一个方向的运动引起关节式运动构件123关于壳体柱312枢转，以引起第二关节式运动连杆122沿着由图37中的箭头“B”标示的第二方向移动。
在使用时，当第一关节式运动连杆120通过关节式运动组件350而沿方向A移动时，通过钩部120a位于切口142a(图3B)中而轴向地固定至第一关节式运动连杆120的钉仓通道140a也沿方向A移动。第一关节式运动连杆120沿方向A的运动实现关节式运动构件123的枢转运动，这引起第二关节式运动连杆122沿着箭头B的方向运动。第二关节式运动连杆122沿着箭头B的方向的运动引起钉仓通道140b沿着箭头B的方向的运动。
如上所讨论的，钉仓通道140a和140b的远侧端通过柱172连接至枢转构件157的相反两侧。当钉仓通道140a和140b沿着相反方向移动时，枢转构件157关于枢转销170枢转以使工具组件114相对于轴部112枢转，使得工具组件114的纵向轴线从与轴部112(图33)的纵向轴线对齐的位置移动到与轴部112的纵向轴线成角度的位置。应当注意，钉仓通道140a和140b、发射凸轮138a和138b以及远侧驱动构件136a和136b都由诸如弹簧钢的弹性材料形成，以促进绕关节式运动轴线(即，枢转销170的轴线)运动到关节式运动位置。
本领域技术人员应当理解，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。可以想到，关于一个示例性实施例所图示出或所描述的元件和特征可以与另一元件和特征结合而不偏离本公开的范围。同样，本领域技术人员将基于上述实施例的公开而意识到进一步的特征和优势。相应地，除由附加的权利要求书所指明的，本公开并不由已经具体示出和描述的所限制。

Claims (19)

1.一种手术吻合器，包含：
轴部；
工具组件，其被支撑在所述轴部的远侧端上，所述工具组件包括砧座和钉仓组件，所述钉仓组件包括具有限定多个凹口的至少一个支腿的钉仓主体、以及多个吻合钉，每个所述吻合钉具有将第一吻合钉支腿和第二吻合钉支腿互连的中间部，其中每个所述吻合钉的所述中间部具有连接至所述第一吻合钉支腿的第一端和连接至所述第二吻合钉支腿的第二端，其中所述中间部的所述第一端和所述第二端彼此轴向偏移；以及
至少一个发射凸轮，其包括限定具有第一凸轮表面和第二凸轮表面的凸轮构件的远侧端，所述第一凸轮表面和所述第二凸轮表面彼此轴向偏移，所述凸轮构件能够在所述工具组件内移动，以使所述第一凸轮表面和所述第二凸轮表面移动到分别与所述多个吻合钉中的每个的第一吻合钉支腿和第二吻合钉支腿相继接合中，其中所述多个吻合钉中的每个的所述第一吻合钉支腿和所述第二吻合钉支腿、与所述凸轮构件之间的接合实现所述多个吻合钉中的每个的旋转运动，以从所述钉仓主体发射所述多个吻合钉中的每个吻合钉。
2.根据权利要求1所述的手术吻合器，其中，所述多个凹口中的每个凹口构造成可旋转地支撑所述多个吻合钉中的一个吻合钉。
3.根据权利要求1所述的手术吻合器，其中，所述钉仓主体的所述至少一个支腿限定多个切口，所述多个切口中的每个与所述多个凹口中的相邻凹口间隔开并且构造成接纳所述多个吻合钉中的一个吻合钉的中间部的第一部。
4.根据权利要求1所述的手术吻合器，其中，每个所述吻合钉的所述中间部是S形的并且包括远侧U形部，所述远侧U形部构造成被接纳于在所述钉仓主体的至少一个支腿上的多个切口中的相应的一个切口中。
5.根据权利要求1所述的手术吻合器，其中，所述多个凹口中的每个凹口构造成可旋转地接纳所述多个吻合钉中的相应的一个吻合钉的中间部的近侧部。
6.根据权利要求1所述的手术吻合器，其中，所述多个吻合钉中的每个吻合钉的第一吻合钉支腿和第二吻合钉支腿均具有弯曲构造，其中所述第一吻合钉支腿和所述第二吻合钉支腿中的每个均在抵着所述砧座成形时限定出D形。
7.根据权利要求5所述的手术吻合器，其中，所述多个凹口中的每个凹口均包括圆筒形的狭槽，所述圆筒形的狭槽构造成以卡扣配合的方式接纳所述多个吻合钉中的相应的一个吻合钉的中间部的近侧部。
8.根据权利要求1所述的手术吻合器，其中，所述钉仓主体的所述至少一个支腿包括两个间隔开的支腿，所述多个凹口沿着两个间隔开的支腿中的每个轴向地间隔开，并且所述多个凹口中的每个均可旋转地支撑所述多个吻合钉中的一个吻合钉。
9.根据权利要求8所述的手术吻合器，进一步包括第一钉仓通道和第二钉仓通道，所述第一钉仓通道和所述第二钉仓通道中的每个均具有限定U形构件的远侧端，所述钉仓主体的两个间隔开的支腿中的每个均被稳固在所述U形构件中的相应的一个U形构件内。
10.根据权利要求9所述的手术吻合器，其中，所述至少一个发射凸轮包括第一发射凸轮和第二发射凸轮，所述第一发射凸轮和所述第二发射凸轮中的每个凸轮构件均具有U形形状，并关于所述钉仓主体的两个间隔开的支腿中的一个支腿定位且定位在所述第一钉仓通道和所述第二钉仓通道中的一个钉仓通道的U形构件内。
11.根据权利要求10所述的手术吻合器，进一步包括枢转构件，所述枢转构件可枢转地稳固至所述轴部的远侧端并且固定地稳固至所述第一钉仓通道和所述第二钉仓通道中的每个钉仓通道。
12.根据权利要求11所述的手术吻合器，进一步包括第一关节式运动连杆和第二关节式运动连杆，所述第一关节式运动连杆具有稳固至所述第一钉仓通道的近侧端的远侧端，所述第二关节式运动连杆具有稳固至所述第二钉仓通道的近侧端的远侧端，所述第一关节式运动连杆和所述第二关节式运动连杆能够轴向地移动以实现所述第一钉仓通道和所述第二钉仓通道相对于彼此的轴向移动，来使所述枢转构件相对于所述轴部枢转。
13.根据权利要求12所述的手术吻合器，进一步包括可枢转的关节式运动构件，其将所述第一关节式运动连杆与所述第二关节式运动连杆互连来使得所述第一关节式运动连杆沿着一个方向的运动实现所述第二关节式运动连杆沿着相反方向的运动。
14.根据权利要求1所述的手术吻合器，其中，每个所述吻合钉的第一吻合钉支腿和第二吻合钉支腿中的每个均具有锥形末端。
15.根据权利要求1所述的手术吻合器，其中，所述钉仓主体中的所述至少一个支腿中的每个均包括多个凹窝，所述多个凹窝中的每个均被定位成接合所述多个吻合钉中的一个吻合钉的第一吻合钉支腿和第二吻合钉支腿中的一个吻合钉支腿，以将所述吻合钉稳定在所述钉仓主体上。
16.一种手术吻合钉，包含：
第一弯曲支腿；
第二弯曲支腿；以及
中间部，其将所述第一弯曲支腿与所述第二弯曲支腿互连；
其中，所述手术吻合钉的所述中间部具有连接至所述第一弯曲支腿的第一端和连接至所述第二弯曲支腿的第二端，其中所述中间部的所述第一端和所述第二端彼此轴向地偏移。
17.根据权利要求16所述的手术吻合钉，其中，所述吻合钉的中间部是S形的并且包括远侧U形部和近侧部。
18.根据权利要求16所述的手术吻合钉，其中，所述第一弯曲支腿和第二弯曲支腿中的每个均包括锥形末端。
19.根据权利要求16所述的手术吻合钉，其中，所述吻合钉的第一弯曲支腿和第二弯曲支腿构造成当抵着砧座成形时具有D形。
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