CN106163445B - 带有可切换传动装置的外科手术器械 - Google Patents

带有可切换传动装置的外科手术器械 Download PDF

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CN106163445B
CN106163445B CN201580017871.7A CN201580017871A CN106163445B CN 106163445 B CN106163445 B CN 106163445B CN 201580017871 A CN201580017871 A CN 201580017871A CN 106163445 B CN106163445 B CN 106163445B
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D·W·贝利
T·W·罗杰斯
R·杰亚诺夫
R·索普
G·F·布里森
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Intuitive Surgical Operations Inc
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Abstract

一种具有延长轴的外科手术工具，该延长轴具有近端和远端。外科手术末端执行器被定位在该远端周围。外科手术末端执行器具有包括多个自由度的多个执行器机构。在近端定位有执行器主体。执行器主体包括用于驱动多个执行器机构的多个马达接口。传动装置被耦连至执行器主体。

Description

带有可切换传动装置的外科手术器械
相关申请的交叉引用
本申请要求于2014年3月31日提交的美国临时申请号61/973,257的权益，该文献通过引用的方式结合在此。
背景技术
微创医疗技术旨在减少在诊断或外科手术过程中被损伤的外部组织的量，从而减少患者的康复时间、不适感、以及有害的副作用。例如，微创外科手术的一个作用是使术后住院康复时间减少。因为标准外科手术的平均住院时间通常显著地长于类似的微创外科手术的平均住院时间，所以微创技术的使用增加每年可以节省数百万美元的住院费用。虽然每年在美国进行的许多外科手术可能能够以微创方式进行，但是由于在微创外科手术器械和掌握这些技术所涉及的额外外科手术训练方面的限制，目前的外科手术中只有一部分使用了这些有利技术。
微创远程外科手术系统已经被发展以便增加外科医生的灵巧性并且避免传统的微创技术上的一些限制。在远程外科手术中，外科医生使用一些遥控形式(例如，伺服机构等等)以便操纵外科手术器械移动，而不是通过手来直接握住以及移动器械。在远程外科手术系统中，可以为外科医生提供在外科手术工作站的外科手术部位的图像。当在显示器上观察外科手术部位的二维或三维图像时，外科医生通过操纵主控制装置为患者进行外科手术程序，这些主控制装置进而控制伺服机械操作的器械的移动。
用于远程外科手术的伺服机构通常接收来自两个主控制器(外科医生的每只手一个)的输入并且可以包括两个或更多个机器人臂，每个机器人臂上安装有外科手术器械。主控制器与相关联的机器人臂和器械组件之间的操作通信通常通过控制系统实现。该控制系统通常包括至少一个处理器，该处理器将输入命令从主控制器转发至相关联的机器人臂和器械组件，并且假如有受力反馈等等，则从该器械和臂组件转发回到相关联的主控制器。机器人外科手术系统的一个示例是系统，该系统可向IntuitiveSurgical，Inc.of Sunnyvale，California，USA(美国加州森尼维耳市直观外科有限公司)购买。
在机器人外科手术中，多种结构布置可以被用于在外科手术部位支撑外科手术器械。从动联动装置或“从动装置”常常被称作机器人外科手术操纵器，在美国专利号7,594,912；6,758,843；6,246,200；和5,800,423中描述了在微创机器人外科手术中用作机器人外科手术操纵器的示例性联动装置布置，这些专利通过引用结合在此。这些联动装置通常使用平行四边形布置来支撑具有轴的器械。这种操纵器结构可以约束器械的移动，这样使得器械围绕操纵的远程中心枢转，该远程中心被定位在沿着刚性轴的长度的空间中。通过将操纵的远程中心与通向内部外科手术部位的切口点对齐(例如，在腹腔镜外科手术中在腹壁处用套管针或插管)，通过使用操纵器联动装置移动该轴的近端，外科手术器械的末端执行器可以被安全地定位而不对腹壁潜在地施加危险的力。例如，在美国专利号7,763,015、6,702,805、6,676,669、5,855,583、5,808,665、5,445,166以及5,184,601中描述了可替代的操纵器结构，这些专利通过引用结合在此。
在机器人外科手术中，多种结构布置也可以被用于在外科手术部位支撑并定位机器人外科手术操纵器以及外科手术器械。支撑联动装置机构(有时被称作装配关节、或装配关节臂)经常被用于将每个操纵器相对于患者身体中对应的切口点定位并对齐。支撑联动装置机构促进了外科手术操纵器相对于期望的外科手术切口点以及目标解剖结构的对齐。在美国专利号6,246,200和6,788,018中描述了示例性支撑联动装置机构，这些专利通过引用结合在此。
虽然新的远程外科手术系统和装置已证明是高效且有利的，但仍然需要进一步的改善。总的来说，期望改进的微创机器人外科手术系统。通常，新型外科手术器械被研发以用于现有的远程外科手术系统平台。因此，要求器械适配于远程外科手术系统，因为为个别外科手术应用开发新型远程外科手术系统的成本高昂。然而，当现有远程外科手术平台不具有所需的马达输出量以用于特定外科手术器械的所有机构时，问题就出现了。因此，需要使新型外科手术装置适配于现有的远程外科手术系统而不限制外科手术功能并且不需要对现有的远程外科手术系统进行修改。
发明内容
许多实施例针对一种包括具有近端和远端的延长轴的外科手术工具。在该远端周围定位有外科手术末端执行器。外科手术末端执行器可以包括多个执行器机构，每个执行器机构具有一个或多个自由度(DOF)。还可以在近端定位执行器主体。执行器主体可以包括多个马达接口用于驱动多个执行器机构。例如，多个马达接口可以包括第一马达接口。传动装置可以被耦连在执行器主体与外科手术末端执行器之间。传动装置可以被配置成用于在多个执行器机构中仅部分的执行器机构和相关联的DOF之间切换第一马达接口的耦连。
许多实施例针对一种包括具有近端和远端的延长轴的外科手术工具。在该轴的远端定位有外科手术末端执行器。外科手术末端执行器具有多个末端执行器部件，每个末端执行器部件与唯一的机械自由度相关联。多个末端执行器部件具有第一末端执行器部件和第二末端执行器部件。在轴的近端定位有驱动机构。驱动机构具有第一马达接口和传动装置。传动装置包括可以在第一状态与第二状态之间移动的切换机构。在第一状态中，第一马达接口经由传动装置被耦连以驱动第一末端执行器部件而不驱动第二末端执行器部件。在第二状态中，第一马达接口经由传动装置被耦连以驱动第二末端执行器部件而不驱动第一末端执行器部件。
在许多实施例中，多个马达接口包括第二马达接口，第二马达接口被耦连用于使切换机构在第一状态与第二状态之间切换。
在许多实施例中，多个末端执行器部件包括第三末端执行器部件。该切换机构可以移动至第三状态。在第一状态以及在第二状态，第一马达接口不驱动第三末端执行器部件。在第三状态，第一马达接口经由传动装置被耦连以驱动第三末端执行器部件而不驱动第一和第二末端执行器部件。
在许多实施例中，多个马达接口包括第二马达接口，第二马达接口被耦连用于使切换机构在第一状态、第二状态以及第三状态之间切换。
在许多实施例中，第一末端执行器部件可以与第一末端执行器机械自由度相关联，并且第二末端执行器部件与第二末端执行器机械自由度相关联。驱动机构可以包括被耦连用于驱动第三末端执行器机械自由度的第二马达接口、被耦连用于驱动第四末端执行器机械自由度的第三马达接口、以及被耦连用于驱动第五末端执行器机械自由度的第四马达接口。末端执行器的第一、第二、第三、第四、以及第五机械自由度每个都是唯一的。
在许多实施例中，多个末端执行器部件包括与第六末端执行器机械自由度相关联的第三末端执行器部件。末端执行器的第一、第二、第三、第四、第五、以及第六机械自由度每个都是唯一的。
在许多实施例中，多个马达接口包括第五马达接口，第五马达接口被耦连用于使切换机构在第一状态与第二状态之间切换。
在许多实施例中，切换机构可以包括可旋转凸轮轴，其中，凸轮轴的第一位置对应于第一状态，并且凸轮轴的第二位置对应于第二状态。
在许多实施例中，该多个马达接口进一步包括被耦连用于驱动凸轮轴的第二马达接口。
在许多实施例中，传动装置可以包括可旋转凸轮轴。凸轮轴可以包括用于使第一马达接口的耦连切换至多个DOF中的第一DOF的第一凸轮轴位置；用于使第一马达接口的耦连切换至多个DOF中的第二DOF的第二凸轮轴位置；以及用于使第一马达接口的耦连切换至多个DOF中的第三DOF的第三凸轮轴位置。
在许多实施例中，多个马达接口进一步包括第二、第三、第四、以及第五马达接口，其中，凸轮轴由第二马达接口驱动。
在许多实施例中，多个DOF进一步包括专门与第三马达接口耦连的第四DOF；专门与第四马达接口耦连的第五DOF；以及专门与第五马达接口耦连的第六DOF。
在许多实施例中，外科手术末端执行器可以包括具有外科手术工具的抓取装置，其中，外科手术末端执行器包括腕部，该腕部能够使该抓取装置相对于远程控制的臂俯仰、摇摆以及滚转。
在许多实施例中，第一DOF是用于滚转腕部的机构；第二DOF是用于致动外科手术工具的机构；第三DOF是用于相对于第六DOF以大力(high force)来致动抓取装置的机构；第四DOF是用于使腕部摇摆的机构；第五DOF是用于使腕部俯仰的机构；并且第六DOF是用于相对于第三DOF以小力(low force)来致动抓取装置的机构。
在许多实施例中，该凸轮轴包括多个凸轮轴凸角。
在许多实施例中，多个凸轮轴凸角包括用于给第一、第二以及第三DOF中的每个提供动力和锁止的一对凸角。
在许多实施例中，传动装置包括用于驱动第一DOF的第一齿轮系、用于驱动第二DOF的第二齿轮系、以及用于驱动第三DOF的第三齿轮系。
在许多实施例中，第一齿轮系包括第一输入齿轮；最终与第一输入齿轮耦连的第一输出齿轮；与凸轮轴可移动地接合的第一摇臂，用于使第一输入齿轮与第一输出齿轮接合或脱离；与凸轮轴可移动地接合的第一锁止臂，用于锁止以及解锁第一输出齿轮。
在许多实施例中，第二齿轮系包括第二输入齿轮；最终与第二输入齿轮耦连的第二输出齿轮；与凸轮轴可移动地接合的第二摇臂，用于使第二输入齿轮与第二输出齿轮接合或脱离；以及与凸轮轴可移动地接合的第二锁止臂，用于锁止以及解锁第二输出齿轮。
在许多实施例中，第三齿轮系包括第三输入齿轮；最终与第三输入齿轮耦连的第三输出齿轮；与凸轮轴可移动地接合的第三摇臂，用于使第三输入齿轮与第三输出齿轮接合或脱离；与凸轮轴可移动地接合的第三锁止臂，用于锁止以及解锁第三输出齿轮。
在许多实施例中，第一输出齿轮可以被耦连至沿着轴线延伸并且可以围绕该轴线旋转的主轴，并且其中，第二和第三输出齿轮被保持在主轴之中并且随主轴围绕该轴线旋转。
在许多实施例中，第二输出齿轮可以被耦连至在主轴之中延伸的第一输出轴，并且第三输出齿轮可以被耦连至在主轴之中延伸的第二输出轴。
在许多实施例中，第一、第二以及第三齿轮系可以沿着平行于凸轮轴的共同轴线布置。
许多实施例针对一种用于切换远程控制的外科手术装置的传动装置的方法。在该方法中，外科手术装置的传动装置被切换以便使多个可切换执行器输出端中的一者接合至该外科手术装置的外科手术末端执行器。外科手术装置可以包括多个不可切换的输出端。外科手术装置可以被连接至远程控制臂。该远程控制臂可以具有多个马达，多个马达包括用于驱动传动装置的第一马达以及用于驱动该多个不可切换的输出端的多个专用马达。可以用第一马达驱动一个被接合的可切换执行器输出端以便驱动外科手术末端执行器的相应的执行器机构。
许多实施例针对一种外科手术装置中的方法，该外科手术装置包括第一马达接口、传动装置、以及包括第一和第二部件的末端执行器中的至少一者。该方法包括在第一状态操作传动装置，使该传动装置从第一状态切换至第二状态，在第二状态中操作传动装置，以及使传动装置从第二状态切换至第一状态。在第一状态中，传动装置将第一马达接口耦连至末端执行器的第一部件并且将第一马达接口与末端执行器的第二部件分离。在第二状态中，传动装置将第一马达接口耦连至末端执行器的第二部件并且将第一马达接口与末端执行器的第一部件分离。
在许多实施例中，外科手术末端执行器的多个不可切换的执行器输出端中的至少一者可以用专用马达来驱动。
在许多实施例中，通过使用第二马达驱动传动装置的凸轮轴来使传动装置进行切换。
在许多实施例中，通过旋转凸轮轴以顺序地接合多个齿轮系中的一者来驱动凸轮轴。
在许多实施例中，旋转凸轮轴以便移动接合传动装置的多个齿轮系的多个摇臂。
在许多实施例中，旋转凸轮轴使得未接合的齿轮系中的至少一者被锁止。
在许多实施例中，切换可以只沿着多个齿轮系顺序地发生。
在许多实施例中，多个执行器可切换输出端包括用于致动滚转DOF、以及大力抓取DOF、以及工具致动DOF的第一可切换输出端。
在许多实施例中，其中，多个专用DOF包括摇摆DOF、俯仰DOF、以及小力抓取DOF。
附图说明
图1是根据许多实施例的用于进行外科手术的微创远程外科手术控制的外科手术系统的平面图。
图2是根据许多实施例的用于远程外科手术控制的外科手术系统的外科医生控制台的透视图。
图3是根据许多实施例的远程外科手术控制的外科手术系统电子推车(electronics cart)的透视图。
图4示意展示了根据许多实施例的远程外科手术控制的外科手术系统。
图5A是根据许多实施例的远程外科手术控制的外科手术系统的患者侧推车的局部视图。
图5B是根据许多实施例的远程外科手术操作的外科手术工具的前视图。
图6是根据许多实施例的远程外科手术控制的外科手术系统的简化示意图。
图7A至图7H是根据许多实施例的远程外科手术操作的外科手术工具的传动装置组件的纵向及轴向横截面。
图8示出了根据许多实施例的远程外科手术操作的外科手术工具的传动装置组件的操作的凸轮状态表图。
具体实施方式
在下文的说明中，将描述本发明的多种实施例。出于解释的目的，阐述了具体的构型和细节以便提供对实施例的全面理解。然而，对于本领域的技术人员来说也将清楚的是，可以实践本发明而不用这些具体细节。此外，为了不使所描述的实施例难以理解，可以省略或简化公知的特征。
I.微创远程协助外科手术系统
现参考附图，贯穿几个视图，相同的参考数字代表相同的部分，图1是微创机器人外科手术(MIRS)系统10的平面图展示，该系统通常用于为躺在手术桌14上的患者12进行微创诊断或外科手术程序。该系统通常包括由外科医生18在程序中使用的外科医生控制台16。一个或多个助手20也可以参加到该程序中。MIRS系统10可以进一步包括患者侧推车22(外科手术机器人)和电子推车24。在外科医生18通过控制台16观察外科手术部位时，患者侧推车22可以操纵至少一个可移除耦连的工具组件26(在下文中简称“工具”)通过患者12的身体中的微创切口。外科手术部位的图像可以被内窥镜28(如立体内窥镜)获得，该内窥镜可以被患者侧推车22操纵以便定向内窥镜28。电子推车24可以用于处理外科手术部位的图像，以便通过外科医生控制台16随后显示给外科医生18。一次所使用的外科手术工具26的数量一般将取决于诊断或外科手术程序以及手术室之中的空间限制等其他因素。如果有必要改变在程序中使用的一个或多个工具26，助手20可以从患者侧推车22移除工具26，并以来自手术室中的托盘30的另一个工具26将其代替。
图2是外科医生控制台16的透视图。外科医生控制台16包括左眼显示器32和右眼显示器34，用于给外科医生18呈现能够实现深度感受的外科手术部位的协调的立体视图。控制台16进一步包括一个或多个输入控制装置36，这进而导致患者侧推车22(在图1中示出)操纵一个或多个工具。输入控制装置36可以提供与其相关联的工具26(在图1中示出)相同的自由度，以便为外科医生提供远程临场感，或者输入控制装置36与工具26是一体的感觉，这样使得外科医生具有直接控制工具26的强烈感觉。为此目的，可以使用位置、力和触觉反馈传感器(未示出)来将位置、力和触觉传感通过输入控制装置36从工具26传输回外科医生的手中。
外科医生控制台16通常与患者位于相同的房间中，这样使得外科医生可以直接地监控程序，有必要时亲自在场，并且直接同助手讲话而不是通过电话或者其他通信媒介。然而，外科医生可以位于允许进行远程外科手术程序的不同房间中、完全不同的建筑中、或者远离病人的其他远程地点。
图3是电子推车24的透视图。电子推车24可以与内窥镜28耦连并且可以包括处理器，该处理器处理捕获的图像用于随后显示，例如在外科医生控制台上或者在位于本地和/或远程的另一种合适的显示器上显示给外科医生。例如，如果使用立体内窥镜，电子推车24可以处理捕获的图像以便给外科医生呈现外科手术部位的协调立体图像。这种协调可以包括相对图像之间的对齐并且可以包括调节立体内窥镜的立体工作距离。作为另一个示例，图像处理可以包括使用之前确定的摄像机校准参数，以便补偿图像捕获装置的成像误差，例如光像差。
图4示意展示了机器人外科手术系统50(如图1的MIRS系统10)。如以上所描述的，外科医生可以在微创程序中使用外科医生控制台52(如图1中的外科医生控制台16)来控制患者侧推车(外科手术机器人)54(如图1中的患者侧推车22)。患者侧推车54可以使用成像装置，如立体内窥镜，以便捕获程序部位的图像并且输出捕获的图像至电子推车56(如图1中的电子推车24)。如以上讨论的，电子推车56可以在任何随后的显示之前用多种方式处理捕获的图像。例如，在经由外科医生控制台52为外科医生显示组合的图像之前，电子推车56可以用虚拟的控制界面覆盖捕获的图像。患者侧推车54可以输出捕获的图像，用于在电子推车56外部处理。例如，患者侧推车54可以将捕获的图像输出至处理器58，该处理器被用来处理捕获的图像。这些图像也可以由电子推车56和处理器58的组合来处理，该电子推车和处理器可以被耦连在一起以便共同地、顺序地和/或其组合处理捕获的图像。一个或多个分开的显示器60也可以与处理器58和/或电子推车56耦连用于图像(如程序部位的图像、或者其他相关的图像)的本地和/或远程显示。
图5A和图5B分别示出了患者侧推车22和外科手术工具62。外科手术工具62是外科手术工具26的示例。示出的患者侧推车22提供了三个外科手术工具26和成像装置28(如用于程序部位的图像的捕获的立体内窥镜)的操纵。操纵由具有数个机器人关节的机器人机构提供。成像装置28和外科手术工具26可以被定位并被操纵通过患者身上的切口，这样使得动力学远程中心被维持在切口处以使切口的尺寸最小。当外科手术工具26的远端被定位在成像装置28的视野范围之中时，外科手术部位的图像可以包括外科手术工具26的远端的图像。每个工具26可以从对应的外科手术操纵器31上拆卸并且被对应的外科手术操纵器31运载，该外科手术操纵器位于一个或多个机器人关节的远端。外科手术操纵器31提供了用于通过机器人关节的运动相对于患者侧推车22移动整个工具26的可移动平台。外科手术操纵器31还用机械和/或电气接口提供了操作工具26的动力。在美国专利公开号US 2013/0325034(律师卷号ISRG04330/US)中可以找到这种滑架组件的示例，该专利申请文件通过引用结合在此。
图6是远程外科手术控制的外科手术系统100的简化示意图。外科手术系统100包括外科医生控制台102，该外科医生控制台例如可以是外科医生控制台52。外科医生控制台102驱动患者侧推车104，该患者侧推车例如可以是患者侧推车22。患者侧推车104包括外科手术操纵器106，该外科手术操纵器例如可以是外科手术操纵器31。
外科手术操纵器106包括马达单元108和外科手术工具110。马达单元108是保持5个马达的滑架组件。在一些实施例中，只使用了5个马达，然而在其他实施例中可以使用多于或少于5个马达。在此，马达单元108包括多个马达，这些马达可以分配给不同的机构。在此，马达单元108包括动力马达112、凸轮轴马达114、俯仰马达116、摇摆马达118、以及小力抓取马达120，但是这些马达根据所附接的器械可以用于不同用途。一般，每个马达是与外科手术工具110的相应输入端机械地以及电气地耦连的电动马达。在一些实施例中，马达单元108可以位于外科手术工具110的近端与该外科手术工具在共用的底架中，如图5B示出的通过近端壳体所描绘的。
工具110例如可以是以上所描述的工具26。可用作工具110的工具的示例在国际公开号WO 2011/060318中(律师卷号：ISRG02360/PCT)，该专利申请文件通过引用结合在此。在此，工具110是延长的执行器单元122，该延长的执行器单元包括三个离散的输入端，这三个输入端通过外科手术操纵器106各自与俯仰马达116、摇摆马达118以及小力抓取马达120机械耦连。工具110还可以包括传动装置124，该传动装置与动力马达112和凸轮轴马达114机械地耦连。
在执行器单元122的远端定位有外科手术末端执行器126。外科手术末端执行器126和执行器单元122通过可活动腕部连接。在美国专利公开号US2011/0118709(律师卷号ISRG02350/US)中示出了这种腕部的示例，该专利申请文件通过引用结合在此。简单的来说，外科手术末端执行器特征可以在于多个离散的但是相互关联的机构，其中每个机构为外科手术末端执行器126提供自由度(DOF)。如在此使用的，DOF是用于影响相应的运动的一个或多个相互关联的机构。这些DOF赋予外科手术末端执行器126不同的操作模式，这些操作模式可以同时地或离散地操作。例如，腕部使得外科手术末端执行器126可以相对于外科手术操纵器106俯仰以及摇摆，并且相应地包括俯仰DOF 128以及摇摆DOF 130。外科手术末端执行器126还包括使外科手术末端执行器围绕延长轴线旋转的滚转DOF 132。
外科手术末端执行器126可以包括夹紧和切割机构，如外科手术吻合器。在美国专利公开号2011-0118778A1(律师卷号ISRG02330/US)中示出了这种夹紧机构的示例，该专利申请文件通过引用结合在此。该夹紧机构可以根据两种模式来进行抓取，并相应地包括两个DOF。小力DOF 132(例如线缆致动的机构)操作用于以小力拨动(toggle)夹具以便轻柔地操纵组织。小力DOF 132对于使外科手术末端执行器分阶段进行切割或吻合操作是有用的。大力DOF 134(例如，导螺杆致动的机构)操作用于以相对大的力进一步打开夹具或闭合夹具到组织上，例如到止血带(tourniquet)组织从而为切割或吻合操作做准备。一旦夹紧，外科手术末端执行器126使用工具致动DOF 138来进一步影响组织，例如吻合、切割、和/或烧灼装置。
如所示的，俯仰马达116、摇摆马达118、以及小力抓取马达120分别驱动俯仰DOF128、摇摆DOF 130、以及小力抓取DOF 139。相应地，俯仰DOF128、摇摆DOF 130、以及小力抓取DOF 139中的每个分离地与马达配对，并且可以相对于其他DOF独立地并且同时地操作。
然而，大力DOF 126、滚转DOF 132以及工具致动DOF 138经由传动装置与动力马达112共用单个输入端。相应地，大力DOF 126、滚转DOF 132以及工具致动DOF 138中只有一个可以在一个时刻进行操作，因为与动力马达112的耦连分离地发生。凸轮轴马达114被致动用于使动力马达112的输出在大力DOF 126、滚转DOF 132以及工具致动DOF 138之间切换。从而，相比于每个马达专用于单个DOF的布置，传动装置124有利地允许了更多数量的DOF。
II.示例性传动装置
发明的实施例涉及控制吻合器械的6个自由度(6个DOF)的系统和方法，该吻合器械带有从马达滑架可允许的5个输入端。这五个输入端中的一个用作切换器，然后该切换器可以允许另一个输入端被选择性地接合至三个不同的吻合器DOF。吻合器械的六个DOF可以包括腕部滚转、腕部俯仰、腕部摇摆、小力抓取(拨动)、大力抓取(夹紧)以及工具致动(吻合器发射)。腕部俯仰、摇摆、以及小力抓取可以是线缆致动的，然而滚转、夹紧和发射是由独立的同轴齿轮组驱动。在使用中，传动装置可以包括三个主要的模式：滚转、夹紧/未夹紧、以及发射。腕部转动、俯仰、摇摆、以及小力抓取均在主动伺服控制下，并且大力抓取以及发射DOF被耦连至滚转轴线。
在许多实施例中，从动输入端被选择性地耦连至腕部滚转、夹紧、和/或发射。这通过使用空转齿轮来完成，这些空转齿轮可以被旋转从而与合适的吻合器DOF接合以及脱离接合。附加地，有一种通过使用杠杆臂来锁止每个DOF使其搁置的方法。这些杠杆臂由切换输入端控制，该切换输入端可以是具有合适数量和形状的凸角的凸轮轴。在腕部的滚转运动中，夹具和发射输入环有必要随滚转齿轮一起旋转。因为此限制，器械输入与输入环以及滚转齿轮之间的齿轮比是都一样。那样，在接下来的状态中，所有的环/齿轮被接合，并且从而一起旋转，因此发射和大力抓取驱动轴不相对于腕部转动。该系统可以被配置成使得所有的转换一次只移动一种功能。这样，所有的转换可测试安全性。若转换没有接上，则滚转齿轮被锁止。为了避免腕部需要被定位使得滚转齿轮与锁止臂的齿对齐的需要，在此DOF上有次摩擦锁止件。
图7A至图7H分别示出了传动装置组件140的透视图和横截面。该传动装置包括用于大力DOF 126、滚转DOF 132、以及工具致动DOF 138中每一者的齿轮系。
A.第一齿轮系
注意图7A，第一齿轮系142定位在传动装置组件140的近端。第一齿轮系142通过轴向地旋转主轴144来驱动滚转DOF 132。主轴144包括轴向通路146，该轴向通路用于将控制线缆通至外科手术末端执行器126。通过驱动近端齿轮148的外齿轮齿147，主轴144被直接地旋转。
B.第二齿轮系
第二齿轮系150被定位在传动装置组件140的中部直接地靠近第一齿轮系142。通过中间轴152相对于主轴144的旋转，第二齿轮系150驱动大力抓取DOF 126。中间轴152被主轴144保持并且相应地随主轴144旋转。换言之，中间轴152的旋转轴线可以环绕主轴144的旋转轴线运转。
中间轴152直接地连接至中间内齿轮154，该中间内齿轮进而由中间齿轮156的内齿轮齿(此视图中未示出)驱动。中间齿轮156也包括外齿轮齿158，该外齿轮齿用于最终通过动力马达112直接地驱动中间齿轮156。中间齿轮156的外齿轮齿158与近端齿轮148的外齿轮齿147被相同地配置。从而，如果被同步驱动，采用相同的输入齿轮，则中间齿轮156和近端齿轮148之间没有相对运动，并且相应地中间轴152不相对于主轴144被驱动。
主轴144的外部通过两个轴承来保持中间齿轮156。在第二齿轮系150的第一脱离状态中，中间齿轮156(与以下描述的远端齿轮166一起)可以被配置成在中间齿轮156和近端齿轮148与动力马达112同步地接合时与主轴144同步旋转。在第一脱离状态中，中间齿轮156的旋转不会导致中间内齿轮154的旋转，因为中间齿轮156不被允许相对于主轴144滚转。换言之，在第一脱离状态中，中间齿轮156与主轴144锁定，因此不能相对于主轴144异步地移动来移动中间轴152。如以下进一步所讨论的，第二齿轮系150包括第二脱离状态，在该第二脱离状态中，中间齿轮156从动力马达112上物理地脱离并被物理地锁止，因此不能旋转并且不能驱动中间内齿轮154。
在第二齿轮系150(与动力马达112)的接合状态中，近端齿轮148和主轴144被锁止并因此不能旋转。换言之，中间内齿轮154的旋转轴线不能环绕主轴144的旋转轴线运转。然而，中间内齿轮154可以围绕其自身的旋转轴线自旋。相应地，在接合状态中，中间齿轮156相对于主轴144旋转，从而最终通过动力马达112来驱动中间内齿轮154。
C.第三齿轮系
第三齿轮系160被定位在传动装置组件140的远端部，并且大部分被以与第二齿轮系150相同的方式配置。通过远端轴162相对于主轴144的旋转，第三齿轮系160驱动工具致动DOF 138。远端轴162被主轴144保持并且相应地随主轴144旋转。以如第二齿轮系150的总体方式，远端轴162的旋转轴线可以环绕主轴144的旋转轴线运转。
远端轴162直接地连接至远端内齿轮164，该远端内齿轮进而由远端齿轮166的内齿轮齿(此视图中未示出)驱动。远端齿轮166也包括外齿轮齿168，该外齿轮齿用于最终通过动力马达112直接地驱动远端齿轮166。远端齿轮162的外齿168被以与近端齿轮148的外齿轮齿147以及中间齿轮156的外齿轮齿158相同的方式配置。从而，当被同步驱动时，在远端齿轮166、中间齿轮156以及近端齿轮148之间没有相对运动。
主轴144的外部通过两个轴承来保持远端齿轮166。在第三齿轮系160的第一脱离状态中，远端齿轮166(与中间齿轮156一起)可以被配置成在远端齿轮166和近端齿轮148与动力马达112同步地接合时与主轴144同步旋转。在第一脱离状态中，远端齿轮166的旋转不会导致远端内齿轮164的旋转，因为远端齿轮166不被允许相对于主轴144滚转。换言之，在第一脱离状态中，远端齿轮166与主轴144锁定，因此不能相对于主轴144异步地移动来移动远端轴162。如以下进一步所讨论的，第三齿轮系160包括第二脱离状态，在该第二脱离状态中，远端齿轮166从动力马达112上物理地脱离并被物理地锁止，因此不能旋转并且不能驱动远端内齿轮164。
在第三齿轮系160(与动力马达112)的接合状态中，近端齿轮148和主轴144被锁止并因此不能旋转。以此方式，远端内齿轮164的旋转轴线不能环绕主轴144的旋转轴线运转。然而，远端内齿轮164可以围绕其自身的旋转轴线自转。相应地，在接合状态中，远端齿轮166相对于主轴144旋转，从而最终通过动力马达112来驱动远端内齿轮164。
D.齿轮系构造
注意图7B-7D，示出了第二齿轮系150的代表性横截面和透视图。图7C和图7D除去了其他齿轮系部分以便允许更好地理解单个齿轮系是如何被配置的。第一齿轮系142和第三齿轮系160以同样的方式被配置，因此，下面的描述以同样方法适用于图7E和图7F，这两幅图分别示出了那些齿轮系的代表性横截面图。为了避免不必要的重复，在这些齿轮系之间相似的部分使用了共同的编号。例如，锁止臂188(II)指第二齿轮系150的锁止臂，锁止臂188(III)指第三齿轮系的锁止臂。然而，根据以下描述的共用凸轮轴的相应凸轮凸角所决定的相异正时，每个齿轮系基本上以相同的方式操作。
外科手术工具110的更大的壳体170保持传动装置组件140。动力马达112经由输入轴173驱动第一输入齿轮172(II)，如图7C和图7D所示，该输入轴被各齿轮系共用。第一输入齿轮172(II)与空转齿轮174(II)啮合，该空转齿轮进而与第二输入齿轮176(II)啮合，该第二输入齿轮可以与中间齿轮156啮合。空转齿轮174(II)和第二输入齿轮176(II)在臂177(II)上，如图7C和图7D所示，该臂177(II)围绕第一输入齿轮172(II)旋转。如所示的，第二输入齿轮176(II)被定位在该弧线的朝下部分，从而不与中间齿轮156啮合。第二输入齿轮176(II)可以被移动从而将第二输入齿轮176(II)与中间齿轮156接合。压缩弹簧(未示出)被加载在第二输入齿轮轴与壳体170之间用于使第二输入齿轮176(II)向中间齿轮156偏置，这样使得中间齿轮156被接合到动力马达112。
凸轮轴180沿齿轮系设置。凸轮轴180通常包括每个驱动链至少两个凸轮凸角。这些凸角旋转从而使DOF机构与齿轮系接合和脱离。凸轮轴180被凸轮轴马达114旋转以将凸轮凸角选择性地放置到所期望的位置。
第一凸轮凸角182(II)旋转以接合摇臂184(II)的轴承183(II)。摇臂184(II)可围绕摇臂枢轴184p(II)移动。摇臂184(II)延伸以接合第二输入齿轮176(II)的齿轮轴176S(II)，如图7C和图7D所示。当第一凸轮凸角182(II)的低部与摇臂184(II)接合时，由于压缩弹簧(未示出)的偏置作用，如所示的，第二输入齿轮176(II)被与中间齿轮156接合。
如所示的，当第一凸轮凸角182(II)的高部接合轴承183(II)时，摇臂184(II)围绕摇臂枢轴184p(II)向下移动。由于摇臂184(II)与第二输入齿轮轴176S(II)的接合，这种向下移动使第二输入齿轮176(II)与中间齿轮156(II)脱离。从而，在第一凸轮凸角182(II)的这个位置，施加于第一输入齿轮的动力不会转移至中间齿轮156。
第二凸轮凸角186(II)旋转以接合锁止臂188(II)的表面187(II)，该锁止臂围绕锁止臂枢轴190(II)枢转。锁止臂188(II)包括齿部192(II)，该齿部可以被移动从而使该齿部192(II)与中间齿轮156啮合。如图7D所示，弹簧157被加载在锁止臂188(II)与壳体170之间从而使齿部192(II)偏置远离中间齿轮156。
如所示的，当第二凸轮凸角186(II)的低部接合锁止臂188(II)的表面187(II)，齿部192(II)被移动远离中间齿轮156。从而，在此位置中，中间齿轮156被解锁并被允许旋转。
在吻合器被夹紧到组织上的系统故障的情况下，提供了手动松开特征。在一些实施例中，这可以通过使用者将凸轮轴180手动地旋转至大力抓取DOF状态来实现，如以下描述的。如图7G所示的，凸轮轴180的互锁凸轮凸角194可移动至高位状态以移动互锁标志196，该互锁标志可旋转并且被连接至单向离合器198，该单向离合器最终与中间轴152配合。穿过壳体170中的通道，用手持工具(例如扳手)可以接近单向离合器198的末端。互锁标志196阻塞该通道，除非互锁凸轮凸角194的高部正举起所示的互锁标志196。在夹紧状态下，互锁标志196提供沿仅允许钳口松开的方向经由单向离合器198驱动中间轴152的用户途径。
图7H描绘了摩擦锁止机构200，该摩擦锁止机构充当相对于锁止臂188(I-III)的次轴制动系统。摩擦锁止臂202围绕枢轴204枢转并且包括制动表面206。摩擦锁止臂202被弹簧208偏置，以使制动表面206抵靠轴144的一部分放置，如所示的。在此位置中，轴144不能滚转。凸轮轴180的摩擦锁止凸轮凸角210包括高部和低部。只要摩擦锁止凸轮凸角210的低部抵靠轴承212，轴144就会保持被制动的状态，该轴承被定位在摩擦锁止臂202上。高部可以被旋转从而举起轴承212使摩擦锁止臂远离轴144定位。在那个位置，轴144被允许滚转。
III.传动装置切换方法
当第二凸轮凸角186(I-III)的高部接合锁止臂188(I-III)的表面187(I-III)时，齿部192(I-III)被移动以接合对应的近端齿轮148、中间齿轮156、或远端齿轮166。此位置将中间齿轮156与锁止臂188锁止，并因此，中间齿轮156不能移动。锁止中间齿轮156的一个目的是将大力抓取DOF的最后位置锁止到锁止状态中。总体上，每个齿轮系以相似的方式被锁止，从而阻止不期望的移动。
凸轮轴180被配置成用于协调地操作齿轮系，这通过凸轮轴正时来达成。图8示出了传动装置140操作的凸轮状态表图。如先前所讨论的，齿轮系共用共同的凸轮轴，例如是图7B-7D中示出的凸轮轴180。凸轮轴180为每个齿轮系提供至少两个凸角，例如与第一、第二和第三齿轮系一起操作的第一凸轮凸角182(I-III)和第二凸轮凸角186(I-III)。然而，一些齿轮系可以包括更多的凸角。例如，在一些实施例中，第一齿轮系包括操作摩擦锁止的第三凸角。并且如在图7G中示出的，附加的凸角可以作为安全机构被包括在内，以便在系统故障的情况下反向驱动DOF。
通常，对每个齿轮系，一个凸轮凸角可操作用于控制动力接合并且其他凸轮凸角可操作用于锁止齿轮系。因此，每个齿轮系被动力凸轮和锁止凸轮操作。简单来说，每个凸轮具有低位状态和高位状态，其间有过渡斜坡。每个低位和高位状态的持续时间基于被举起的物体(例如，锁止臂188(I-III)和摇臂184(I-III))的操作的期望持续时间。为了此披露的目的，第一凸轮凸角182(I-III)的高位状态意味着第一凸轮凸角182(I-III)被定位成使得相关联的齿轮系与动力马达112接合，而第一凸轮凸角182(I-III)的低位状态意味着脱离。类似地，第二凸轮凸角186(I-III)的高位状态意味着第二凸轮凸角186(I-III)被定位成使得相关联的齿轮系与相关联的锁止臂188(I-III)接合，而第二凸轮凸角186(I-III)的低位状态意味着脱离。还应理解的是，中间齿轮系和远端齿轮系的输出不一定束缚于示出的DOF，所以是可互换的。
A.第一传动模式的凸轮状态
凸轮状态图表示出了每个凸轮在360度的旋转过程中的低位和高位状态。在旋转的0度位置，传动装置140被配置成为滚转DOF 132(ROLL)的操作提供动力。如所示，每个齿轮系的凸轮凸角182(I-III)在高位状态，每个齿轮系的凸轮凸角186(I-III)在低位状态。因此，第一齿轮系142被解锁并且与动力马达112接合。以此方式，第一齿轮系142的锁止臂188(I)与近端齿轮148脱离，并且第二输入齿轮与近端齿轮148接合。第二齿轮系150和第三齿轮系160也被解锁，并且中间齿轮156以及远端齿轮166与动力马达保持接触。此外，用于致动摩擦锁定臂202的摩擦凸轮凸角210被驱动至低位状态以允许轴144转动。
如以上所描述的，在滚转DOF 132的接合期间，要求中间齿轮156和远端齿轮166与近端齿轮148同步旋转，因为中间内齿轮154和远端内齿轮164被保持在轴144之中并随轴144旋转。以此方式，避免了中间齿轮156/中间内齿轮154与远端齿轮166/远端内齿轮164之间的相对运动，从而阻止了中间轴152和远端轴162的操作。因此，虽然中间齿轮156和远端齿轮166与动力马达112保持接合并从而在滚转操作中转动，但是第二齿轮系150和第三齿轮系160不操作相应的DOF。
此外，“套管中制动检查”可以在凸轮轴180旋转大约40度时执行。在此模式中，摩擦锁止臂202与轴144保持接合，但是第一齿轮系的锁止臂188(I)变成脱离状态，然而第一齿轮系142与动力马达112保持接合。因为锁止臂188(I)被脱离，这允许系统通过尝试滚转被制动的轴144来自测试摩擦锁止机构200。如果轴144能够在此情形下滚转，则可以表示摩擦锁止机构200发生故障。
B.第二传动模式的凸轮状态
在凸轮轴180旋转的大约-150度处，传动装置被切换以向工具致动DOF138(发射)提供动力。在此，第一齿轮系142的第一凸轮凸角182(I)和第三齿轮系160的第一凸轮凸角182(III)在低位状态，并且第二齿轮系150的第一凸轮凸角182(II)是高位状态。以此方式，第一齿轮系142和第三齿轮系160的第二输入齿轮与近端齿轮148和远端齿轮166分别脱离，而第二齿轮系150的第二输入齿轮与中间齿轮156接合。因此，只有中间齿轮156从动力马达112接收动力。
如所示，第一齿轮系142的第二凸轮凸角186(I)和第三齿轮系160的第二凸轮凸角186(III)在高位状态，并且第二齿轮系150的第二凸轮凸角186(II)在低位状态。通过这种方式，第一齿轮系142的锁止臂188(I)和第三齿轮系160的锁止臂188(III)与近端齿轮148和远端齿轮166分别接合，而第二齿轮系150的锁止臂188(II)与中间齿轮156脱离。因此，只有中间齿轮156自由旋转。
C.第三传动模式的凸轮状态
在凸轮轴180旋转的大约170度处，传动装置被配置成用于向大力抓取DOF 136(夹紧)提供动力。在此，第一齿轮系142的第一凸轮凸角182(I)和第二齿轮系150的第一凸轮凸角182(II)在低位状态，并且第三齿轮系160的第一凸轮凸角182(III)在高位状态。以此方式，第一齿轮系142和第二齿轮系150的第二输入齿轮与近端齿轮148和中间齿轮156分别脱离，而第二齿轮系150的第二输入齿轮与中间齿轮156接合。因此，只有远端齿轮166从动力马达112接收动力。
此外，第一齿轮系142的第二凸轮凸角186(I)和第二齿轮系150的第二凸轮凸角186(II)在高位状态，并且第三齿轮系160的第二凸轮凸角186(III)在低位状态。以此方式，第一齿轮系142的锁止臂188(I)和第二齿轮系150的锁止臂188(II)与近端齿轮148和远端齿轮156分别接合，而第三齿轮系160的锁止臂188(III)与远端齿轮166脱离。进一步地，互锁凸轮凸角194被驱动至高位状态，如以上参考图7G所描述的。这移动互锁标志196，并且允许在系统故障的情况下手动地反向驱动第二齿轮系的用户途径。
其他变体在本发明的精神范围内。因此，虽然本发明易于有各种修改和替代形式，但其特定展示的实施例在附图中示出并且已经在上文中详细描述。然而，应理解的是，并不意图将本发明限于所公开的特定的一种形式或多种形式，而相反，本发明意图涵盖落在如所附权利要求书所限定的本发明的精神和范围内的所有修改、替代构造以及等效物。
在描述本发明的上下文中(尤其在以下权利要求的上下文中)使用的术语“一个”和“一种”以及“所述”和类似指示应解释为同时覆盖单数和复数，除非在文中另外地指明或明显与上下文相悖。除非另外指出，术语“包含(comprising)”、“具有”、“包括(including)”和“含有”应解释为开放性术语(即，意为“包括，但不限于”)。术语“连接”应解释为部分地或者全部地被包含在内、附接、或结合在一起，即使有干涉。在此叙述值的范围仅旨在用作个别参考落入该范围内的每个单独数值的速记方法，除非在此另外指示，并且将每个单独数值结合在说明书中，就好像它在本文被个别引用一样。在此描述的所有方法可以任何适合的顺序进行，除非在此另外指示或明显地与上下文矛盾。在此提供的任何和所有示例或示例性语言(例如，“诸如”)的使用仅旨在更好地描述本发明的实施例并且不对本发明的范围构成限制，除非另外指示。本说明书中的任何语言均不应解释为指示任何未要求权利保护的元件对于实施本发明是必要的。
在此描述了本发明的多个优选实施例，包括发明者已知的用于实施本发明的最佳模式。在阅读前述描述后，对本领域的普通技术人员而言，这些优选实施例的变化可以变得显而易见。本发明人预期本领域的技术人员可以在适当时采用这些变化，并且本发明人意图使本发明以与在此具体描述的方式不同的方式来进行实践。因此，在适用法律允许的情况下，本发明包括对所附权利要求书所叙述的主题的所有修改和等效物。此外，本发明包括上述元件在上述元件的所有可能的变化的任意组合，除非在此另有说明或者上下文另有明确的反驳。
在本文引用的所有参考文件，包括公开文件、专利申请和专利，都通过引用结合在此，并且其程度就如同单独地且确切地指明每个参考文件是通过引用而结合在此并以其全文在此提出。

Claims (17)

1.一种外科手术工具，包括：
延长轴，其具有近端和远端；
位于所述延长轴的所述远端的外科手术末端执行器，所述外科手术末端执行器包括每个与唯一的机械自由度相关联的多个末端执行器部件，所述多个末端执行器部件包括第一末端执行器部件和第二末端执行器部件；以及
位于所述延长轴的所述近端的驱动机构，所述驱动机构包括第一马达接口和传动装置，所述传动装置包括在第一状态与第二状态之间可移动的切换机构，在所述第一状态，所述第一马达接口经由所述传动装置被耦连以驱动所述第一末端执行器部件而不驱动所述第二末端执行器部件，并且在所述第二状态中，所述第一马达接口经由所述传动装置被耦连以驱动所述第二末端执行器部件而不驱动所述第一末端执行器部件；
其中所述切换机构包括可旋转凸轮轴，所述可旋转凸轮轴包括可操作为控制动力的第一凸角和可操作为控制锁止的第二凸角。
2.如权利要求1所述的外科手术工具，其中：
所述驱动机构包括第二马达接口，所述第二马达接口被耦连用于使所述切换机构在所述第一状态与所述第二状态之间切换。
3.如权利要求1所述的外科手术工具，其中：
所述多个末端执行器部件包括第三末端执行器部件；并且
其中所述切换机构可移动至第三状态，在所述第一状态以及在所述第二状态，所述第一马达接口不驱动所述第三末端执行器部件，并且在所述第三状态，所述第一马达接口经由所述传动装置被耦连以驱动所述第三末端执行器部件而不驱动所述第一末端执行器部件和所述第二末端执行器部件。
4.如权利要求3所述的外科手术工具，其中：
所述驱动机构包括第二马达接口，所述第二马达接口被耦连用于使所述切换机构在所述第一状态、所述第二状态、以及所述第三状态之间切换。
5.如权利要求1所述的外科手术工具，其中所述可旋转凸轮轴的第一位置对应于所述第一状态，并且所述可旋转凸轮轴的第二位置对应于所述第二状态。
6.如权利要求5所述的外科手术工具，其中，所述驱动机构进一步包括被耦连用于驱动所述可旋转凸轮轴的第二马达接口。
7.如权利要求1所述的外科手术工具：
其中所述第一末端执行器部件与第一末端执行器机械自由度相关联，并且所述第二末端执行器部件与第二末端执行器机械自由度相关联；
其中所述驱动机构包括被耦连用于驱动第三末端执行器机械自由度的第二马达接口、被耦连用于驱动第四末端执行器机械自由度的第三马达接口、以及被耦连用于驱动第五末端执行器机械自由度的第四马达接口；并且
其中所述末端执行器的所述第一末端执行器机械自由度、第二末端执行器机械自由度、第三末端执行器机械自由度、第四末端执行器机械自由度、以及第五末端执行器机械自由度每个都是唯一的。
8.如权利要求7所述的外科手术工具：
其中所述多个末端执行器部件包括与第六末端执行器机械自由度相关联的第三末端执行器部件；并且
其中所述末端执行器的所述第一末端执行器机械自由度、第二末端执行器机械自由度、第三末端执行器机械自由度、第四末端执行器机械自由度、第五末端执行器机械自由度以及第六末端执行器机械自由度每个都是唯一的。
9.如权利要求8所述的外科手术工具：
其中所述驱动机构包括第五马达接口，所述第五马达接口被耦连用于使所述切换机构在所述第一状态与所述第二状态之间切换。
10.如权利要求9所述的外科手术工具，其中，所述外科手术末端执行器包括具有外科手术工具的抓取装置，其中，所述外科手术末端执行器包括腕部，所述腕部能够使所述抓取装置相对于远程控制臂俯仰、摇摆以及滚转。
11.如权利要求10所述的外科手术工具：
其中所述第一末端执行器机械自由度用于滚转所述腕部；
其中所述第二末端执行器机械自由度用于致动所述外科手术工具；
其中所述第三末端执行器机械自由度用于相对于所述第六末端执行器机械自由度以大力来致动所述抓取装置；
其中所述第四末端执行器机械自由度用于使所述腕部摇摆；
其中所述第五末端执行器机械自由度用于使所述腕部俯仰；并且
其中所述第六末端执行器机械自由度用于相对于所述第三末端执行器机械自由度以小力来致动所述抓取装置。
12.如权利要求11所述的外科手术工具，其中所述第一凸角和第二凸角包括用于为所述第一末端执行器机械自由度提供动力的一对凸角，并且其中所述可旋转凸轮轴包括用于为所述第二末端执行器机械自由度以及第三末端执行器机械自由度中的每个提供动力和锁止的一对凸角。
13.如权利要求12所述的外科手术工具，其中，所述传动装置包括用于驱动所述第一末端执行器机械自由度的第一齿轮系，用于驱动所述第二末端执行器机械自由度的第二齿轮系，以及用于驱动所述第三末端执行器机械自由度的第三齿轮系。
14.如权利要求13所述的外科手术工具，
其中，所述第一齿轮系包括：
第一输入齿轮，
第一输出齿轮，其最终与所述第一输入齿轮耦连，
第一摇臂，其与所述可旋转凸轮轴可移动地接合，以使所述第一输入齿轮与所述第一输出齿轮接合或脱离，以及
第一锁止臂，其与所述可旋转凸轮轴可移动地接合，以锁止和解锁所述第一输出齿轮；
其中，所述第二齿轮系包括：
第二输入齿轮，
第二输出齿轮，其最终与所述第二输入齿轮耦连，
第二摇臂，其与所述可旋转凸轮轴可移动地接合，以使所述第二输入齿轮与所述第二输出齿轮接合或脱离，以及
第二锁止臂，其与所述可旋转凸轮轴可移动地接合，以锁止和解锁所述第二输出齿轮；并且
其中，所述第三齿轮系包括：
第三输入齿轮，
第三输出齿轮，其最终与所述第三输入齿轮耦连，
第三摇臂，其与所述可旋转凸轮轴可移动地接合，以使所述第三输入齿轮与所述第三输出齿轮接合或脱离，以及
第三锁止臂，其与所述可旋转凸轮轴可移动地接合，以锁止和解锁所述第三输出齿轮。
15.如权利要求14所述的外科手术工具，其中，所述第一输出齿轮被耦连至沿着轴线延伸并且围绕所述轴线可旋转的主轴，并且其中，所述第二输出齿轮和第三输出齿轮被保持在所述主轴之中并且随所述主轴围绕所述轴线旋转。
16.如权利要求15所述的外科手术工具，其中，所述第二输出齿轮被耦连至在所述主轴之中延伸的第一输出轴，其中所述第三输出齿轮被耦连至在所述主轴之中延伸的第二输出轴。
17.如权利要求14所述的外科手术工具，其中，所述第一齿轮系、第二齿轮系以及第三齿轮系沿着平行于所述可旋转凸轮轴的共同轴线布置。
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