CN106175860A - 多次发射推杆吻合装置 - Google Patents
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Abstract
本公开涉及多次发射推杆吻合装置。一种手术吻合装置包括外壳和联接在一起以形成被可旋转地支撑在所述外壳内的枪管件的多个钉仓。所述钉仓中的每个均限定多个吻合钉凹穴,每个均支撑吻合钉。砧座联接至所述外壳并且能够相对于所述枪管件在打开位置和夹紧位置之间移动。导轴延伸穿过所述外壳并穿过所述枪管件。导轴支撑滑动件和夹紧构件。滑动件构造成平移穿过所述枪管件以响应于推杆的致动从多个钉仓的活动钉仓发射吻合钉。在从活动钉仓发射吻合钉后,滑动件和导轴构造成使枪管件在外壳内转位或旋转以在滑动件通过第二发射冲程而缩回和后续移动时将多个钉仓中的第二钉仓移动到活动位置。
Description
相关申请的交叉引用
本申请要求于2015年5月27日提交的美国临时专利申请第62/166,969号的权益和优先权,其全部公开通过引用合并于此。
技术领域
本公开总的来说涉及一种用于将手术紧固件施加至身体组织的手术吻合装置。更具体地,本公开涉及一种内窥镜手术吻合装置,其具有相继移动到与砧座组件对齐以允许临床医生多次发射吻合装置而不从手术部位移除吻合装置的多个吻合钉钉仓。
背景技术
用于接合组织段的手术吻合装置常常用在手术操作中。相较于传统的缝合技术,手术吻合装置的使用减少了接合和/或切割组织所需的时间,由此,减少了执行手术操作所需的时间。减少执行手术操作所需的时间将必须麻醉患者的时间最小化,并由此将对患者的损伤最小化。
在通过小切口或通过插入穿过皮肤中的小切口的狭窄插管执行手术的内窥镜或腹腔镜操作期间,吻合钉钉仓或装载单元在发射之后的更换需要从切口或插管移除手术吻合装置、更换吻合钉钉仓和/或装载单元并且将手术吻合装置再插入到切口或插管中。该处理增加了执行手术操作所需的时间并且增加了感染的可能性。
有利的是提供一种能够在需要更换吻合钉钉仓或装载单元之前多次发射的吻合钉钉仓或装载单元。
发明内容
本公开在一个方案中提供了一种手术吻合装置,其具有外壳和联接在一起以形成被可旋转地支撑在所述外壳内的枪管件的多个钉仓。所述钉仓中的每个均限定多个吻合钉凹穴并且支撑多个吻合钉。砧座枢转地联接至所述外壳并且能够相对于所述枪管件在打开位置和夹紧位置之间移动。所述钉仓中的每个均能够相继地移动到与所述砧座对齐的活动位置(active position)。导轴被可旋转地支撑在所述外壳内并且被可旋转地联接至所述枪管件使得所述导轴的旋转运动引起所述枪管件的对应旋转运动。滑动件(sled)可移动地安置在所述外壳内以平移穿过所述枪管件来从所述多个钉仓中的处于所述活动位置的第一钉仓发射吻合钉。所述滑动件和所述导轴构造成使得所述滑动件从完全缩回位置通过发射冲程和缩回冲程中的至少一个的移动引起所述枪管件旋转来将所述多个钉仓中的第二钉仓移动到所述活动位置。
在一些实施例中,所述多个钉仓包括三个钉仓。
在某些实施例中,所述导轴限定包括至少一个引导表面的至少一个凸轮通道并且所述滑动件包括凸轮构件。所述凸轮构件能够移动到与所述至少一个引导表面接合以使所述枪管件旋转来将所述多个钉仓中的所述第二钉仓移动到所述活动位置。
在一些实施例中,所述至少一个引导表面包括第一引导表面和第二引导表面,并且所述凸轮构件被安置成在所述发射冲程期间接合所述第一引导表面并且在所述缩回冲程期间接合所述第二引导表面。
在一些实施例中,所述导轴的所述第一引导表面与所述滑动件的所述凸轮构件的接合通过第一转位步骤移动所述枪管件,并且所述导轴的所述第二引导表面与所述滑动件的所述凸轮构件的接合通过第二转位步骤移动所述枪管件,其中所述第一转位步骤和所述第二转位步骤中的每个均使所述枪管件旋转β度,其中β等于360除以2x,其中x是所述多个钉仓的钉仓的数目。
在某些实施例中,所述多个钉仓包括三个钉仓并且所述转位步骤中的每个均使所述枪管件旋转60度。
在实施例中,推杆具有可操作地连接至所述滑动件的远侧端,使得所述推杆的远侧移动引起所述滑动件的远侧移动。
在一些实施例中,夹紧构件可操作地连接至所述推杆,使得所述推杆的远侧移动引起所述滑动件和所述夹紧构件的远侧移动。
在某些实施例中,所述滑动件包括多个推进器指形件并且所述钉仓中的每个均限定了与所述多个吻合钉凹穴连通的多个狭槽。所述多个推进器指形件安置成平移穿过安置在所述活动位置中的所述钉仓的所述多个狭槽以从处于所述活动位置中的所述钉仓发射多个吻合钉。
在实施例中,所述夹紧构件包括围绕所述导轴安置的毂、相对于所述毂径向向外延伸的竖直支柱以及支撑在所述竖直支柱的端部上并且相对于所述竖直支柱横向地延伸的梁。所述多个钉仓中的每个钉仓和所述砧座限定了刀具狭槽。所述竖直支柱被安置成延伸穿过处于所述活动位置中的所述钉仓的刀具狭槽和所述砧座的刀具狭槽以将所述梁安置成接合所述砧座的外表面,使得所述夹紧构件在所述钉仓组件内的远侧移动引起所述砧座从所述打开位置移动到所述夹紧位置。
在一些实施例中,所述滑动件和所述夹紧构件限定纵向通道并且所述推杆包括远侧延伸轨,其中所述远侧延伸轨接收在所述滑动件的纵向通道内和所述夹紧构件的纵向通道内以将所述推杆稳固到所述滑动件和所述夹紧构件。
在某些实施例中,所述夹紧构件的所述纵向通道具有比所述推杆的所述轨的高度大的高度,使得所述夹紧构件能够围绕所述导轴移动以使所述夹紧构件的所述梁相对于所述钉仓组件移动。
在实施例中,安装构件通过枢轴销被稳固至所述外壳的所述近侧端和所述砧座的近侧端。
在实施例中,所述安装构件限定接收所述枢轴销的细长狭槽并且所述钉仓外壳限定接收所述枢轴销的细长通孔。所述枢轴销能够在所述安装构件的所述细长狭槽和所述钉仓外壳的所述细长通孔内移动以利于所述枢轴销和所述砧座的所述近侧端相对于所述安装构件的所述近侧端和所述钉仓外壳的所述近侧端运动。
在实施中,致动装置包括手柄和支撑在所述手柄的远侧端上的接合器,并且所述手术吻合装置被支撑在所述接合器的远侧端上。
本公开在另一方案中提供了一种手术吻合器械,其包括致动装置和手术吻合装置。手术吻合装置具有外壳和联接在一起以形成被可旋转地支撑在所述外壳内的枪管件的多个钉仓。所述钉仓中的每个均限定多个吻合钉凹穴并且支撑多个吻合钉。砧座枢转地联接至所述外壳并且能够相对于所述枪管件在打开位置和夹紧位置之间移动。所述钉仓中的每个均能够相继地移动到与所述砧座对齐的活动位置。导轴被可旋转地支撑在所述外壳内并且被可旋转地联接至所述枪管件使得所述导轴的旋转运动引起所述枪管件的对应旋转运动。滑动件可移动地安置在所述外壳内以平移穿过所述枪管件来从所述多个钉仓中的处于所述活动位置的第一钉仓发射吻合钉。所述滑动件和所述导轴构造成使得所述滑动件通过发射冲程和缩回冲程中的至少一个的移动引起所述枪管件旋转来将所述多个钉仓中的第二钉仓移动到所述活动位置。
在实施例中,所述手柄是电动的。
在一些实施例中,所述多个钉仓中的每个钉仓具有包括集成电路的芯片并且所述手柄包括处理器,所述处理器能够读取所述多个钉仓的每个钉仓的所述芯片以识别所述多个钉仓中的每个钉仓是否已经发射。
在某些实施例中,所述手柄包括用于指示所述手术吻合装置的当前状况的LED屏幕。
附图说明
在此参照附图描述当前公开的手术吻合装置的各种实施例,其中:
图1是从当前公开的手术吻合装置的一个实施例的远侧端的、在砧座组件处于夹紧位置时的侧视立体图;
图2是从图1中所示的手术吻合装置的近侧端的侧视立体图;
图3是图1中所示的手术吻合装置的分解立体图;
图4是图1中所示的手术吻合装置的钉仓中的一个的侧视分解立体图;
图5是穿过图4中所示的钉仓的一部分的侧视剖视图,其中吻合钉安置在钉仓的吻合钉凹穴中;
图6是图5中所示的钉仓的吻合钉中的一个的侧视立体图;
图7是从图1中所示的手术吻合装置的滑动件的远侧端的立体图;
图8是图1中所示的手术吻合装置的内部部件的侧视立体分解图,其包括导轴、滑动件、夹紧构件和推杆的远侧端;
图9是图1中所示的手术吻合装置的侧视立体图,其中移除了外壳、枪管件和安装组件;
图9A是图9中所示的细部的标示区域的放大图;
图9B是图1中所示的手术吻合装置的近侧端在移除了外壳时的放大图;
图10是沿着图1中所示的手术吻合装置的纵轴线截取的剖视图,其中推杆处于缩回位置;
图11是沿着图1中所示的手术吻合装置的纵轴线截取的剖视图,其中推杆处于缩回位置并且手术吻合装置关节式运动;
图12是沿着图10的剖切线12-12截取的剖视图;
图13是图12中所示的细部的标示区域的放大图;
图14是手术吻合装置的导轴和枪管件的侧视立体分解图;
图15是图1中所示的手术吻合装置的侧视立体图,其中移除了外壳并且具有推杆;
图16是沿着图15的剖切线16-16截取的剖视图;
图17是图15中所示的细部的标示区域的放大图;
图18是图1中所示的手术吻合装置的近侧端的侧视图,其中手术吻合装置处于停泊位置;
图19是图1中所示的手术吻合装置的近侧端的侧视图,其中外壳和枪管件被去除并且手术吻合装置处于停泊位置;
图19A是沿着图19的剖切线19A-19A截取的剖视图;
图20是图1中所示的手术吻合装置的近侧端的侧视图,其中手术吻合装置处于打开钳夹位置;
图21是图1中所示的手术吻合装置的近侧端的侧视图,其中外壳和枪管件被去除并且手术吻合装置的钳夹处于打开位置;
图22是图1中所示的手术吻合装置的侧视立体图,其中手术吻合装置的钳夹处于打开位置;
图23是图1中所示的手术吻合装置的近侧端的侧视图,其中手术吻合装置处于夹紧位置;
图24是图1中所示的手术吻合装置的近侧端的侧视图,其中外壳和枪管件被去除并且手术吻合装置处于夹紧位置;
图25是图1中所示的手术吻合装置处于夹紧位置时的侧视立体图;
图26是图1中所示的手术吻合装置在手术吻合装置被发射时的侧视图;
图27是图1中所示的手术吻合装置的近侧端在手术吻合装置被发射时的侧视剖视图;
图28是图1中所示的手术吻合装置在发射后当推杆正在被缩回时处于第一转位阶段期间时的侧视立体图;
图29是图28中所示的细部的标示区域的放大图;
图30是图29中所示的细部的标示区域在推杆完全缩回后并且在推杆后续推进和第二转位阶段期间时的放大图;以及
图31是适于与图1中所示的手术吻合装置一起使用的致动装置的示意图。
具体实施方式
现在参考附图详细描述本公开的实施例,其中相同参考标号在若干附图的每幅图中表示相同或对应的元件。正如在此使用的,术语“临床医生”指的是医生、护士或任何其他护理提供者并且可包括支持人员。在整个描述中,术语“近侧”指的是装置或其部件的最靠近临床医生的部分且术语“远侧”指的是装置或其部件的最远离临床医生的部分。另外,正如在此使用的,术语“内窥镜操作”指的是通过皮肤中的小切口或通过一个或多个插管执行的任意操作并且包括腹腔镜操作、关节镜操作等。
正如下面详细描述的,当前公开的手术吻合装置包括由可旋转地支撑在钉仓外壳或通道内的多个彼此连接的钉仓形成的枪管件。各钉仓支撑吻合钉阵列并且能够在钉仓外壳内移动到与砧座对齐的活动位置。滑动件和夹紧构件支撑在导轴上用于移动穿过枪管件以接合支撑在处于活动位置中的钉仓,即,活动钉仓,内的吻合钉来从钉仓发射吻合钉。导轴和滑动件构造成在每次使用手术吻合装置后转位或旋转枪管件以将新的钉仓安置在活动位置中来利于吻合装置的再发射。
图1和图2图示出了总体示出为10的、当前公开的手术吻合装置的一个实施例。手术吻合装置10包括:钉仓组件12,其包括通道或外壳14;砧座16,其关于第一轴线“A”枢转地稳固至外壳14;安装组件18;推杆20;以及关节式运动杆21。外壳14限定了腔22(图27),其定尺寸成可旋转地接收下面详细描述的圆柱形枪管件24(图14)。砧座16和钉仓组件12限定了枢转地联接至安装组件18的工具组件26。
参照图3,砧座16具有近侧端,该近侧端具有限定凹面16a的外表面和一对间隔开的凸缘28。各个间隔开的凸缘28限定开口22a,该开口22a接收枢轴销30以将砧座16枢转地稳固至钉仓组件12的外壳14。凹面16a构造成接收夹紧构件40的梁126以利于工具组件26移动到打开位置,如下详细描述的。砧座14限定了多个吻合钉变形凹槽32以及安置成接收刀具37的刀具狭槽34,如下详细描述的。
钉仓组件12包括导轴36、关于导轴36可移动地支撑的滑动件38和夹紧构件40、推杆42和连接在一起以限定圆筒形枪管件24(图14)的多个钉仓44。尽管示出了三个钉仓44,但可以想到,枪管件24可以由两个以上的钉仓44形成,例如,2个、4个、5个等。钉仓外壳14具有限定支架48和横向通孔50的近侧端46,其中横向通孔50接收枢轴销30以将砧座16稳固至钉仓外壳14。锁紧垫圈30a设置在枢轴销30的每端上以将枢轴销在通孔50内稳固至外壳14。通孔50是细长的,使得枢轴销30能够在通孔50内移动以允许砧座16的近侧端朝向和远离钉仓组件12的枪管件24移动,如下描述的。支架48限定开口52,该开口52接收形成在安装组件18的上构件56上的销54以将钉仓组件12稳固至安装组件18。支架48接收在上构件56中的凹槽56a中以将钉仓外壳14固定地稳固至安装组件18。
安装组件18包括上构件56和下构件58。如上所讨论的,上构件56通过销54稳固至钉仓外壳14的支架48。安装组件18的下构件58通过一对销60稳固至上构件56。更具体地,上构件56和下构件58中的每个均限定了开口64,该开口64接收销60以将上构件56和下构件58稳固在一起。销60中的一个穿过关节式运动杆21的远侧端中的开口66安置,以将关节式运动杆21稳固至安装组件18。如下进一步详细描述的,关节式运动杆21的线性运动使安装组件18和工具组件26关于横向于轴线“A”(图1)的轴线枢转。安装组件18的下构件58限定接收枢轴销30的两个间隔开的细长狭槽68。该细长狭槽68允许枢轴销30在狭槽68内移动以如下所述地允许砧座16的近侧端朝向和远离钉仓组件12的近侧端移动。
参照图4和图5,每个钉仓44包括限定多行吻合钉凹穴72和刀具狭槽74的钉仓主体70。每个吻合钉凹穴72如下详细描述地支撑吻合钉。在实施例中,主体70在刀具狭槽74的每侧上限定三个线性行的吻合钉凹穴72。可替换地,主体70可在刀具狭槽74的每侧上限定一行或多行的吻合钉凹穴72。每个钉仓主体70具有限定两个间隔开的盲孔76的远侧端,和安置在钉仓主体70的每个侧边缘上的联接构件80。在实施例中,联接构件80包括沿着钉仓主体70的一个侧边缘安置的鸽尾形突起80a和沿着钉仓主体70的相反侧边缘安置的鸽尾形沟槽80b(图9B)。鸽尾形突起80a和鸽尾形沟槽80b利于每个钉仓44附接至相邻的钉仓44以限定圆筒形枪管件24(图9B)。位于每个钉仓44的远侧端处的盲孔76接收导轴36的端盖84的支腿84a,以使钉仓26相对于彼此稳固在径向和轴向固定的位置并且将导轴36可旋转地固定至枪管件24。端盖84固定地稳固至导轴36的远侧端,使得导轴36的旋转引起枪管件24的旋转。另外,端盖84可旋转地支撑在钉仓组件12的外壳14的远侧端中,以将导轴36可旋转地支撑在外壳14中。钉仓组件12的外壳14的内表面包括环形凸缘14a(图13),该环形凸缘14a将枪管件24保持在外壳14的远侧端中。
每个钉仓主体70限定了多个狭槽86(图9B),其中每个狭槽86与一行吻合钉90对齐。在所图示出的实施例中,每个钉仓主体70在刀具狭槽74的每侧上限定三行吻合钉90,并因此在刀具狭槽74的每侧上限定三个狭槽86。
同样参照图6,每个吻合钉凹穴72具有弯曲远侧壁92、弯曲近侧壁94以及在远侧壁92和近侧壁94之间延伸的倾斜搁板状物96。每个吻合钉90包括后跨部90a、第一支腿90b和第二支腿90c。搁板状物96支撑吻合钉90的后跨部90a。第一支腿90b从后跨部90a的一端延伸并且是细长的且弯曲的。当吻合钉90支撑在吻合钉凹穴72中时,第一支腿90b邻近各个吻合钉凹穴72的弯曲远侧壁92安置。第二支腿90c具有大致比第一支腿90b的长度短的长度并且邻近吻合钉凹穴72的近侧壁94安置。在实施例中,第一支腿90b具有比第二支腿90c的长度大2至10倍的长度。在某些实施例中,第一支腿90b具有比第二支腿90c的长度大4至8倍的长度。每个吻合钉90的后跨部90a具有三角形的或V形的构造并且包括相对于由吻合钉90的第一支腿90b和第二支腿90c限定的共有平面偏移的中央部。由此,后跨部90a相对于吻合钉凹穴72的搁板状物96朝外地延伸并且延伸到由钉仓主体70限定的各狭槽86中,使得滑动件38的推进器指形件100移动穿过钉仓主体70的狭槽86引起吻合钉90从吻合钉凹穴72发射出,如下详细描述的。
当前公开的吻合钉几何结构利于仅通过使第一细长支腿90b朝向较短的支腿90c变形而使吻合钉90从未变形构造向变形或封闭构造(图27)的变形。这样消除了如现有技术中传统的那样接合吻合钉的后跨部来使吻合钉90变形的推进器的需求。可以想到,第二支腿90c可以被从吻合钉90完全移除。
参照图7至图9B,滑动件38包括毂102、多个鳍状物104以及多个推进器指形件100。毂102限定接收导轴36(图9)的纵向孔口106。凸轮构件108在纵向孔口106内形成在毂102的内壁上。凸轮构件108构造成可操作地接合导轴36以实现枪管件24的转位,如下更为详细描述的。
滑动件38的多个推进器指形件100和鳍状物104从毂102径向向外延伸。多个指形件100中的每个均接收在限定于钉仓主体70中的各个狭槽86内并且能够平移穿过各个狭槽86,并且能够响应于滑动件38关于导轴36的移动而平移穿过狭槽86(图9B)以从钉仓主体70发射成行的吻合钉90(图4)。每个鳍状物104安置成平移穿过各个钉仓44的刀具狭槽74以在工具组件26被发射时防止枪管件24相对于滑动件38旋转。当滑动件38处于缩回位置时,鳍状物104相对于刀具狭槽74近侧地间隔开,使得枪管件24能够相对于滑动件38旋转。
每个鳍状物104均在其外周上支撑保持件110。在实施例中,每个保持件110均包括螺钉或铆钉,其接收在限定于其中一个鳍状物104的外表面中限定的孔口114(图8)内。保持件110延伸穿过钉仓外壳14中的细长狭槽116(图1)以防止滑动件38相对于钉仓外壳14旋转。每个保持件110均可以包括放大头部110a,该放大头部110a具有比狭槽116的宽度宽的宽度以防止保持件110从外壳14脱离。
在实施例中,滑动件38还限定了一对纵向通道111,该对纵向通道111至少部分穿过滑动件38地从滑动件38的近侧端延伸。通道111设置成利于滑动件38稳固至推杆42,如下详细描述的。
夹紧构件40包括限定纵向孔口122的毂120,以及从毂120径向向外延伸的竖直支柱124和突出125。梁126被支撑在竖直支柱124的外端上。竖直支柱124定尺寸成延伸穿过多个钉仓44中的活动钉仓44的刀具狭槽74(图4)。正如在此使用的,术语“活动钉仓”指的是多个钉仓44中的当前与砧座16对齐的钉仓44。当夹紧构件40远侧地移动穿过钉仓组件12以将砧座16从打开位置移动到相对于钉仓组件12的夹紧位置从而限定钉仓组件12与砧座16在发射期间的最大组织间隙时,梁126被支撑在竖直支柱124上并接合砧座16的外表面。
夹紧构件40的突出125安置成当夹紧构件40处于完全缩回位置时接合在安装组件18的下安装构件58(图3)的内壁上形成的突出狭长部(ledge)58a(图3)。突出125与突出狭长部58a的接合将夹紧构件40的梁126朝向钉仓组件12移动以使砧座16朝向钉仓组件12移动并将砧座16和钉仓组件12安置在停泊或紧密地接近位置,如下描述的。
夹紧构件40还限定了与滑动件38的纵向通道111对齐的纵向通道128。滑动件38的纵向通道111和夹紧构件40的纵向通道128分别接收轨130(图8),该轨130从推杆42的远侧端延伸以将推杆42稳固至滑动件38和夹紧构件40。在实施例中,滑动件38的通道111构造成接收推杆42的轨130以将推杆42稳固至滑动件38,使得推杆42的轴向移动转化成滑动件38的轴向移动。相反,夹紧构件40的通道128具有比轨130的高度大的高度(图19A)以在夹紧构件40的突出125接合下安装构件58的突出狭长部58a(图3)时允许夹紧构件40关于轨130向上移动,从而利于手术吻合装置10的工具组件26移动到停泊位置,如下进一步详细描述的。因为夹紧构件40安置在推杆42的远侧端和滑动件38的近侧端之间,推杆42的轴向移动也转化成夹紧构件40的轴向移动。轨130能够使用包括超声焊、摩擦力、黏合剂、销、联锁部件等的多种紧固技术来稳固至滑动件38。当推杆42由致动装置200(图31)推进时,推杆42将滑动件38和夹紧构件40沿着导轴36推进穿过枪管件24,如下详细描述的。
推杆42具有细长柔性主体134并且能够关于导轴36移动,其中细长柔性主体134具有第一和第二侧壁140。每个侧壁140均限定了细长凸轮狭槽142,该细长凸轮狭槽142具有沿着其主要长度的大致线性部143但是具有倾斜远侧部144和安置在倾斜远侧部144的远侧的短远侧线性部146。凸轮狭槽142接收枢转地支撑砧座16的近侧端的枢轴销30。由此,推杆42相对于枢轴销30的移动使枢轴销30在钉仓外壳14的横向通孔50内移动以改变砧座16的近侧端相对于钉仓组件12的枪管件24的位置。
参照图10和图11,尽管未示出,手术吻合装置10意在枢转地支撑在图31中示意性示出的致动装置200的远侧端上,使得手术吻合装置能够关于横向于轴线“A”(图1)的关节式运动轴线进行关节式运动。为了使手术吻合装置10关于关节式运动轴线进行关节式运动,关节式运动杆21的远侧端连接至其中一个销60,该销60将安装组件18的上安装构件56和下安装构件58在相对于关节式运动轴线偏移的位置处稳固在一起。当关节式运动杆21沿着由图11中的箭头“A”标示的方向移动时,工具组件26将沿着由图11中的箭头“B”标示的方向枢转,反之亦然。如所图示出的,当手术吻合装置10在工具组件26处于关节式运动位置的情况下被发射时,推杆42的柔性主体134的侧壁140关于关节式运动轴线弯曲。
参照图12和图13,下安装构件58限定开口150。每个开口150接收偏置构件(例如,板簧152)的近侧端。每个板簧152包括弯曲部152a和细长部152b。弯曲部152a稳固地安装在下安装构件58的开口150中并且细长部152b安置成在砧座16的近侧端处接合坡面156以朝向打开位置驱动砧座16。
参照图14至图17,导轴36限定多个凸轮通道160。每个凸轮通道160均能够移动到接收滑动件38的凸轮构件108的位置。每个凸轮通道160均具有沿导轴36的主要长度延伸的大致直部162,以及倾斜第一引导表面164和倾斜第二引导表面166。当滑动件38从完全缩回位置沿着导轴36初始远侧地移动时,滑动件38的凸轮构件108将接合第一引导表面164以相对于滑动件38横向地驱动导轴36。如上所讨论的,滑动件38包括鳍状物104,该鳍状物104延伸穿过外壳14的狭槽116(图1)以防止滑动件38在外壳14内旋转。因此,滑动件38的凸轮构件108与导轴36的第一引导表面164的接合引起导轴36以半转位运动旋转,如下描述的。凸轮构件108与第一引导表面164的接合将在滑动件38的鳍状物104进入枪管件24并且滑动件38的推进器指形件100进入活动钉仓44的钉仓主体70的狭槽86之前发生,这将防止枪管件在外壳14内旋转。如上所讨论的,枪管件24被支撑在固定地稳固至导轴36的端盖84的支腿84a上。由此,当滑动件38的凸轮构件108接合导轴36的第一引导表面164并且导轴36旋转时,枪管件24也将旋转。第一引导表面164构造成在与滑动件38的凸轮构件108接合时使枪管件旋转60度。可以想到,如果枪管件24包括比三个钉仓44更多或更少的钉仓,则第一凸轮表面164和/或凸轮构件108的构造能够改变以实现枪管件24旋转期望的程度。
在手术吻合装置10被发射并且滑动件38通过缩回冲程而朝向其缩回位置移动之后,凸轮构件108将接合第二引导表面166来使导轴36以半转位运动旋转60度,如下描述的。如上所讨论的,凸轮构件108与第二引导表面166的接合将在滑动件38的鳍状物104离开枪管件24的刀具狭槽74并且滑动件38的推进器指形件100离开刚刚发射的钉仓44的钉仓主体70的狭槽86之后发生。
在使用时,手术吻合装置10通过第一转位步骤而从“停泊位置”移动到“打开位置”。从“打开位置”,手术吻合装置10移动到“夹紧位置”从而通过发射冲程。在手术吻合装置10发射之后,手术吻合装置10通过缩回冲程移动,在缩回冲程中,手术吻合装置通过第二转位步骤移动。在“停泊位置”中,砧座16维持与钉仓组件12紧密对齐。在第一转位步骤期间,枪管件24转动以使钉仓与砧座16对齐,如下进一步详细描述的。在“打开位置”中,砧座16和钉仓组件12通过板簧152而被偏置到打开。在“夹紧位置”中,砧座16移动到与钉仓组件12紧密接近。在发射冲程期间,滑动件38的推动器指形件100平移穿过活动钉仓44以接合并发射来自活动钉仓44的吻合钉90。在缩回冲程期间,枪管件24通过第二转位步骤移动以使新的(未发射的)钉仓部分地朝向活动位置旋转,如下详细描述的。这些位置和冲程中的每个均将在下面进行描述。
图18至图19A图示出了当手术吻合装置10处于停泊位置时手术吻合装置10的近侧端。在停泊位置中,推杆42处于完全缩回位置,其中枢轴销30安置在推杆42的凸轮狭槽142的短远侧线性部146中。在推杆42的这种位置中,枢轴销30被保持在钉仓14的通孔50的上端中和安装组件18的细长狭槽68的上端中以维持砧座16的近侧端与钉仓组件12的紧密接近。当推杆42处于其缩回位置时,滑动件38和夹紧构件40安置在枪管件24的近侧(图21)并且夹紧构件40的突出125(图19A)与安装组件18的下安装构件58的突出狭长部58a接合。当突出125安置在下安装构件58的突出狭长部58a上时,夹紧构件40的梁126向上提升到与砧座16的近侧端的外表面190接合以使砧座16保持与钉仓组件12接合。
在停泊位置中,吻合装置10的直径被最小化以利于吻合装置10插入穿过小直径插管组件(未示出)。另外,如图19中最佳地示出的,凸轮构件108相对于导轴36的第一引导表面164略微近侧地安置。还应当注意,在停泊位置中,砧座在中途安置在两个相邻的钉仓44之间。更具体地,两个相邻钉仓44中的每个的一半相对于砧座16安置。由此,推进器指形件100未与钉仓主体70的钉仓狭槽84对齐。
当推杆42从其完全缩回位置远侧地移动以将工具组件26从“停泊位置”向“打开位置”移动时,滑动件38和夹紧构件40围绕导轴36沿着由图20和图21中的箭头“C”标示的方向远侧地移动。随着夹紧构件40关于导轴36远侧地移动,夹紧构件40的梁126从与砧座16的外表面190接合的位置移动到位于砧座16的外表面190中的凹面16a内的位置,并且枢轴销30从推杆42的凸轮狭槽142的短远侧线性部146移动穿过倾斜远侧部144并且进入到凸轮狭槽142的大致线性部143中。由此,枢轴销30被向下推动到钉仓14的通孔50的下端和安装组件18的细长狭槽68的下端来使砧座16的近侧端远离钉仓组件12移动。另外,夹紧构件40的突出125(图19A)离开安装组件18的下安装构件58的突出狭长部58a移动以允许梁126远离砧座16的外表面移动。在该位置中,板簧152关于枢轴构件30沿着由图21中的箭头“D”标示的方向驱动砧座16。
如图21中所示,在工具组件26的打开位置中,滑动件38的鳍状物104安置在枪管件24的近侧,并因此未接收在钉仓44的刀具狭槽74内。随着滑动件38关于导轴36从“停泊位置”移动到“打开位置”,凸轮构件108接合第一引导表面164并且移动越过第一引导表面164。如上所讨论的,保持构件110被稳固到鳍状物104的端部并且延伸穿过形成在钉仓外壳14中的狭槽116以防止滑动件38围绕导轴36在钉仓组件12的外壳14内旋转。由此,当滑动件38的凸轮构件108接合导轴36的第一引导表面164并且移动越过第一引导表面164时,导轴36在外壳14内旋转以使枪管件24通过第一转位步骤如由图21中的箭头“E”标示地旋转。如上所讨论的,第一引导表面164和凸轮构件108构造成在两个步骤中引起枪管件24使新的钉仓44从未活动位置旋转到活动位置。因此,在枪管件24由三个钉仓形成的情况下,每个转位步骤使枪管件旋转60度,使得在两个转位步骤之后,枪管件24旋转120度以使新的钉仓移动到活动位置。应当注意,在第一次使用之前,手术吻合装置10以枪管件处于非活动位置的情况设置,在该非活动位置中,两个钉仓44与砧座16部分地对齐。由此,在手术吻合装置10的第一次发射期间,钉仓44以单个转位步骤移动到活动位置中。在手术吻合装置10的第一次发射之后,需要两个转位步骤来将新的钉仓44安置成与砧座16对齐。
参照图23至图25,当推杆42被推进以将工具组件26从“打开位置”移动到“夹紧位置”时,滑动件38和夹紧构件40关于导轴36沿着由图23和图24中的箭头“F”标示的方向向远侧移动。随着夹紧构件40关于导轴36向远侧移动,夹紧构件40的梁126从凹面16a内的位置移动到与砧座16的在凹面16a的远侧的位置处的外表面190接合的位置,以将砧座16逆着板簧152的驱动沿着由图25中的箭头“G”标示的方向枢转至“夹紧位置”。随着推杆42远侧地移动穿过钉仓组件12的外壳14,枢轴销30移动穿过凸轮狭槽142的大致线性部143并且保持在钉仓14的通孔50的下端中和安装组件18的细长狭槽68的下端中。在“夹紧位置”中,滑动件38的鳍状物104进入钉仓44的刀具狭槽74以防止枪管件24相对于滑动件38进一步在外壳14内旋转并且滑动件38的推进器指形件100进入活动钉仓中所限定的狭槽86(图17)。
参照图26和图27,当推杆42被从“夹紧位置”推进来发射工具组件26时,滑动件38和夹紧构件40关于导轴36沿着由图26和图27中的箭头“H”标示的方向远侧地移动。随着滑动件38和夹紧构件40关于导轴36远侧地移动,滑动件38的推进器指形件100移动到与吻合钉90的后跨部90a相继接合以将第一支腿90b迫使到砧座16的吻合钉变形凹槽32中来形成穿过组织的D形吻合钉90。同时地,夹紧构件40远侧地移动穿过钉仓组件12,使得竖直支柱124上的刀具37(图24)穿过活动钉仓44的刀具狭槽74和砧座16的刀具狭槽34来切割成行的吻合钉90之间的组织。随着吻合钉90被成形并且组织被切割,夹紧构件40的梁126沿着砧座16的外表面190移动以在发射冲程期间限定砧座16与活动钉仓之间的最大组织间隙。
参照图28和图29,在手术吻合装置被发射后,推杆42通过缩回冲程移动以将滑动件38和夹紧构件40沿着由图28和图29中的箭头“I”标示的方向在钉仓组件14内朝向完全缩回位置近侧地移动。当滑动件38移动到推进器指形件100和鳍状物104安置在枪管件24和钉仓44的刀具狭槽74的近侧的部分缩回位置时,凸轮构件108(图24)接合导轴36的第二引导表面166(图14)并且沿着该第二引导表面166经过。当滑动件38的凸轮构件108接合导轴36的第二引导表面166并且移动越过该第二引导表面166时,导轴36在外壳14内旋转以使枪管件24通过第二转位步骤而如图28和图29中的箭头“J”标示地旋转。在第二转位步骤期间,枪管件24被转动到如下位置:所用过的(发射的)活动钉仓44部分地移出与砧座16的对齐并且新的(未发射的)钉仓44部分地移动到与砧座16对齐。如上关于第一转位步骤所讨论的,第二引导表面166和凸轮构件108构造成引起枪管件24使新的钉仓44在两个步骤中从非活动位置旋转到活动位置。由此,在手术吻合装置10被发射后,新的钉仓44在缩回冲程的第二转位步骤期间半途地转动到活动位置(图28和图29),并且此后,在手术吻合装置10的第二次致动期间而使工具组件26从“停泊位置”向“打开位置”的移动期间(图30),旋转到完全活动位置。
在手术吻合装置10的每次发射之后,枪管件24将如上所述地自动转位来将新的钉仓放置在活动位置中。尽管枪管件24被示出为具有三个钉仓44并且每个转位步骤被描述为使枪管件24旋转60度,可以想到,枪管件24可以包括两个以上钉仓并且每个转位步骤应当使枪管件旋转360度除以钉仓44的2倍数目。例如,如果枪管件24由四个钉仓形成,则每个转位步骤应当使枪管件24旋转360度除以(2x4)或使枪管件24旋转45度。由此,具有由四个钉仓44形成的枪管件24的手术吻合装置10的两个转位步骤将使枪管件24总共旋转90度来以未发射的钉仓替换用过的钉仓。
手术吻合装置10能够连接至致动装置,诸如图31中示意性示出并且在下面详细地描述的致动装置200。可替代的,手术吻合装置10能够连接至其他类型的致动装置,该致动装置包括手动操作的手持式装置、机器人控制的装置和/或其他类型的电动或手动致动装置。致动装置200包括具有致动按钮202a的手柄202和从手柄202远侧地延伸的接合器204。在实施例中,手术吻合装置10能够以工具组件26处于打开位置且钉仓处于活动位置的封装状态被输送。手术吻合装置10能够被装载到接合器204上并且接合器204能够被稳固至手柄202。临床医生能够通过操作致动装置来打开和关闭工具组件26和/或使工具组件相对于由接合器204限定的纵向轴线关节式运动来检查手术吻合装置10的可操作性。在手术吻合装置10穿过插管而插入之前,致动装置200被操作以将手术吻合装置10的工具组件26移动到“停泊位置”(图18和图19)来将钉仓组件12的直径最小化。当这种情况发生时,滑动件38的近侧移动将通过转位步骤移动枪管件24以从活动位置移动钉仓。在工具组件26延伸穿过插管之后,致动装置200被操作以远侧地移动滑动件38和夹紧构件40来将工具组件26移动到“打开位置”(图20至图22)。当发生这种情况时,枪管件24通过第二转位步骤移动以将钉仓移回到活动位置。工具组件26从“停泊位置”向“打开位置”的移动允许夹紧构件40的梁126和砧座16远离钉仓组件12移动以在砧座16和钉仓组件12之间设定恰当的组织间隙。工具组件10的状况可以显示在设置于致动装置200上的LED屏幕206上。在工具组件26处于打开位置的情况下,手术吻合装置10能够被操纵以将砧座16和钉仓组件12关于组织安置并且致动装置200能够被操作以夹紧组织。此后,致动装置200能够被操作以发射手术吻合装置10。枪管件24的每个钉仓44均可以设置有包括集成电路的芯片208,该芯片208能够由手柄202中的处理器210读取以识别何时用过了钉仓以及何时钉仓是新的或者装载有吻合钉。
在手术吻合装置10发射之后,能够操作致动装置200来移动滑动件38和夹紧构件40通过缩回冲程并且使工具组件26返回到“打开位置”。在此时,如果临床医生需要另外的手术吻合操作,那么临床医生能够操作致动装置200来将新的钉仓44安置在活动位置。在实施例中,致动装置可以包括重装载按钮,该重装载按钮能够被按压以使滑动件38完全缩回并后续再将滑动件38推进到“打开位置”来通过两个转位步骤移动枪管件24。如果临床医生决定不需要进一步的吻合操作,那么能够操作致动装置200来使手术吻合装置10返回到“停泊位置”以允许工具组件26从插管移除。存储在钉仓芯片208中的信息将防止用过的钉仓发射。
尽管已经描述了本公开的若干实施例,但并不意味着本公开局限于此,而是意味着本公开在范围上与本领域所允许的一样宽泛并且说明书类似地解读。上述实施例的任意组合也能被想到并且在附属权利要求的范围内。由此,上面的描述不应当理解为限制,而是仅仅作为特定实施例的范例。本领域技术人员将想到随附权利要求的范围内的其他修改。
Claims (19)
1.一种手术吻合装置,包含:
外壳;
多个钉仓,其联接在一起以形成枪管件,所述枪管件被可旋转地支撑在所述外壳内,所述钉仓中的每个均限定多个吻合钉凹穴并且支撑多个吻合钉;
砧座,其联接至所述外壳并且能够相对于所述枪管件在打开位置和夹紧位置之间移动,所述钉仓中的每个均能够相继地移动到与所述砧座对齐的活动位置;
导轴,其可旋转地支撑在所述外壳内,所述导轴被可旋转地联接至所述枪管件使得所述导轴的旋转运动引起所述枪管件的对应旋转运动;
滑动件,其可移动地安置在所述外壳内以平移穿过所述枪管件来从所述多个钉仓中的处于所述活动位置的第一钉仓发射吻合钉;
其中,所述滑动件和所述导轴构造成使得所述滑动件通过发射冲程和缩回冲程中的至少一个的移动引起所述枪管件旋转来将所述多个钉仓中的第二钉仓移动到所述活动位置。
2.根据权利要求1所述的手术吻合装置,其中,所述多个钉仓包括三个钉仓。
3.根据权利要求1所述的手术吻合装置,其中,所述导轴限定包括至少一个引导表面的至少一个凸轮通道,并且所述滑动件包括凸轮构件,所述凸轮构件能够移动到与所述至少一个引导表面接合以使所述枪管件旋转来将所述多个钉仓中的所述第二钉仓移动到所述活动位置。
4.根据权利要求2所述的手术吻合装置,其中,所述至少一个引导表面包括第一引导表面和第二引导表面,所述凸轮构件被安置成在所述发射冲程期间接合所述第一引导表面并且在所述缩回冲程期间接合所述第二引导表面。
5.根据权利要求4所述的手术吻合装置,其中,所述导轴的所述第一引导表面与所述滑动件的所述凸轮构件的接合通过第一转位步骤移动所述枪管件,并且所述导轴的所述第二引导表面与所述滑动件的所述凸轮构件的接合通过第二转位步骤移动所述枪管件,其中所述第一转位步骤和所述第二转位步骤中的每个均使所述枪管件旋转β度,其中β等于360除以2x,其中x是所述多个钉仓中的钉仓的数目。
6.根据权利要求5所述的手术吻合装置,其中,所述多个钉仓包括三个钉仓并且所述转位步骤中的每个均使所述枪管件旋转60度。
7.根据权利要求1所述的手术吻合装置,进一步包括推杆,所述推杆具有可操作地连接至所述滑动件的远侧端使得所述推杆的远侧移动引起所述滑动件的远侧移动。
8.根据权利要求7所述的手术吻合装置,进一步包括夹紧构件,其可操作地连接至所述推杆使得所述推杆的远侧移动引起所述滑动件和所述夹紧构件的远侧移动。
9.根据权利要求8所述的手术吻合装置,其中,所述滑动件包括多个推进器指形件并且所述钉仓中的每个均限定了与所述多个吻合钉凹穴连通的多个狭槽,所述多个推进器指形件被安置成平移穿过安置在所述活动位置中的所述钉仓的所述多个狭槽以从处于所述活动位置中的所述钉仓发射多个吻合钉。
10.根据权利要求9所述的手术吻合装置,其中,所述夹紧构件包括围绕所述导轴安置的毂、相对于所述毂径向向外延伸的竖直支柱以及支撑在所述竖直支柱的端部上并且相对于所述竖直支柱横向地延伸的梁,所述多个钉仓中的每个钉仓和所述砧座限定了刀具狭槽,所述竖直支柱被安置成延伸穿过处于所述活动位置中的所述钉仓的刀具狭槽和所述砧座的刀具狭槽使得所述梁安置成接合所述砧座的外表面,使得所述夹紧构件在所述钉仓组件内的远侧移动引起所述砧座从所述打开位置移动到所述夹紧位置。
11.根据权利要求10所述的手术吻合装置,其中,所述滑动件和所述夹紧构件限定纵向通道并且所述推杆包括远侧延伸轨,其中所述远侧延伸轨接收在所述滑动件的纵向通道内和所述夹紧构件的纵向通道内以将所述推杆稳固到所述滑动件和所述夹紧构件。
12.根据权利要求11所述的手术吻合装置,其中,所述夹紧构件的所述纵向通道具有比所述推杆的所述轨的高度大的高度,使得所述夹紧构件能够围绕所述导轴移动以使所述夹紧构件的所述梁相对于所述钉仓组件移动。
13.根据权利要求12所述的手术吻合装置,进一步包括支撑在所述外壳的近侧端上的安装构件,所述安装构件通过枢轴销被稳固至所述外壳的近侧端和所述砧座的近侧端。
14.根据权利要求13所述的手术吻合装置,其中,所述安装构件限定接收所述枢轴销的细长狭槽并且所述钉仓外壳限定接收所述枢轴销的细长通孔,所述枢轴销能够在所述安装构件的所述细长狭槽和所述钉仓外壳的所述细长通孔内移动,以利于所述枢轴销和所述砧座的所述近侧端相对于所述安装构件的所述近侧端和所述钉仓外壳的所述近侧端运动。
15.一种手术吻合器械,包括:
致动装置;以及
手术吻合装置,其包括:
外壳;
多个钉仓,其联接在一起以形成枪管件,所述枪管件被可旋转地支撑在所述外壳内,所述钉仓中的每个均限定多个吻合钉凹穴并且支撑多个吻合钉;
砧座,其枢转地联接至所述外壳,所述砧座能够相对于所述枪管件在打开位置和夹紧位置之间移动,所述钉仓中的每个均能够相继地移动到与所述砧座对齐的活动位置;
导轴,其可旋转地支撑在所述外壳内,所述导轴被可旋转地联接至所述枪管件使得所述导轴的旋转运动引起所述枪管件的对应旋转运动;
滑动件,其可移动地安置在所述外壳内以平移穿过所述枪管件来从所述多个钉仓中的处于所述活动位置的第一钉仓发射吻合钉;
其中,所述滑动件和所述导轴构造成使得所述滑动件通过发射冲程和缩回冲程中的至少一个的移动引起所述枪管件旋转来将所述多个钉仓中的第二钉仓移动到所述活动位置。
16.根据权利要求15所述的手术吻合器械,其中,所述致动装置包括手柄和支撑在所述手柄的远侧端上的接合器,所述手术吻合装置被支撑在所述接合器的远侧端上。
17.根据权利要求16所述的手术吻合器械,其中,所述手柄是电动的。
18.根据权利要求17所述的手术吻合器械,其中,所述多个钉仓中的每个钉仓具有包括集成电路的芯片并且所述手柄包括处理器,所述处理器能够读取所述多个钉仓中的每个钉仓的所述芯片以识别所述多个钉仓中的每个钉仓是否已经发射。
19.根据权利要求18所述的手术吻合器械,其中,所述手柄包括用于指示所述手术吻合装置的当前状况的LED屏幕。
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EP (1) | EP3097866B1 (zh) |
JP (2) | JP6758092B2 (zh) |
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2016
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- 2016-05-16 AU AU2016203149A patent/AU2016203149B2/en active Active
- 2016-05-18 CA CA2930383A patent/CA2930383A1/en active Pending
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- 2016-05-26 JP JP2016105078A patent/JP6758092B2/ja active Active
- 2016-05-26 CN CN201610363479.4A patent/CN106175860A/zh active Pending
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2019
- 2019-01-04 US US16/239,951 patent/US10912564B2/en active Active
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- 2020-04-22 JP JP2020075976A patent/JP2020124554A/ja not_active Withdrawn
Cited By (4)
Publication number | Priority date | Publication date | Assignee | Title |
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CN110831518A (zh) * | 2017-06-28 | 2020-02-21 | 爱惜康有限责任公司 | 能够与钉仓和射频仓联接并具有多个射频能量返回路径的外科系统 |
CN110831518B (zh) * | 2017-06-28 | 2023-05-26 | 爱惜康有限责任公司 | 能够与钉仓和射频仓联接并具有多个射频能量返回路径的外科系统 |
CN110786901A (zh) * | 2019-09-11 | 2020-02-14 | 康奇舒宁(苏州)医疗科技有限公司 | 一种吻合器、成型方法及其相适配的成型治具 |
CN110786901B (zh) * | 2019-09-11 | 2022-11-08 | 康奇舒宁(苏州)医疗科技有限公司 | 一种吻合器、成型方法及其相适配的成型治具 |
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JP2016221271A (ja) | 2016-12-28 |
US10172615B2 (en) | 2019-01-08 |
EP3097866B1 (en) | 2018-11-21 |
JP6758092B2 (ja) | 2020-09-23 |
US20190133580A1 (en) | 2019-05-09 |
AU2016203149A1 (en) | 2016-12-15 |
US10912564B2 (en) | 2021-02-09 |
JP2020124554A (ja) | 2020-08-20 |
US20160345973A1 (en) | 2016-12-01 |
EP3097866A1 (en) | 2016-11-30 |
CA2930383A1 (en) | 2016-11-27 |
AU2016203149B2 (en) | 2020-07-16 |
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