CN106456177B - 用于外科缝合器的可枢转关节运动接头解锁特征结构 - Google Patents

用于外科缝合器的可枢转关节运动接头解锁特征结构 Download PDF

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CN106456177B
CN106456177B CN201580034445.4A CN201580034445A CN106456177B CN 106456177 B CN106456177 B CN 106456177B CN 201580034445 A CN201580034445 A CN 201580034445A CN 106456177 B CN106456177 B CN 106456177B
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end effector
shaft assembly
cam member
cam
articulation joints
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CN106456177A (zh
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R·J·格廷尔
R·J·西姆斯
F·E·谢尔顿四世
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Ethicon Endo Surgery Inc
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    • 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
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Abstract

本发明提供了一种设备，该设备包括主体、轴组件、端部执行器、和关节运动接头。该端部执行器能够操作以操纵(例如，缝合)组织。该关节运动接头使端部执行器与轴组件联接并且允许端部执行器远离轴组件的纵向轴线偏转。该关节运动接头包括：锁定组件，该锁定组件能够操作以选择性地锁定端部执行器相对于轴组件的纵向轴线的角位置；以及解锁特征结构。该解锁特征结构能够操作以选择性地解锁该锁定组件。该轴组件还包括：第一可动构件，该第一可动构件能够操作以选择性地驱动关节运动接头处端部执行器的关节运动；以及第二可动构件，该第二可动构件能够操作以选择性地驱动解锁特征结构。该第二可动构件能够相对于第一可动构件独立地运动。

Description

用于外科缝合器的可枢转关节运动接头解锁特征结构
背景技术
在一些情况下，内窥镜式外科器械可优于传统开放式外科装置，因为较小切口可减少术后恢复时间和并发症。因此，一些内窥镜式外科器械可适于通过套管针的插管来将远侧端部执行器放置在期望手术部位处。这些远侧端部执行器(例如，直线切割器、抓紧器、切割器、缝合器、施夹器、接入装置、药物/基因治疗递送装置、以及使用超声波振动、RF、激光等的能量递送装置)可以多种方式接合组织，以实现诊断效果或治疗效果。内窥镜式外科器械可包括位于端部执行器和由临床医生操纵的柄部部分之间的轴。此类轴可使得能够插入到期望的深度并围绕轴的纵向轴线旋转，以由此有利于将端部执行器定位在患者体内。还可通过包含一个或多个关节运动接头或特征结构而进一步有利于定位该端部执行器，使得端部执行器能够选择性地进行关节运动或者以其他方式相对于轴的纵向轴线偏转。
内窥镜式外科器械的示例包括外科缝合器。一些此类缝合器能够操作以在组织层上夹紧，切割穿过被夹紧的组织层，以及将钉驱动穿过该组织层，以在该组织层的被切断的端部附近将该切断的组织层基本上密封在一起。仅示例性外科缝合器被公开于以下美国专利申请中：于1989年2月21日公布的名称为“Pocket Configuration for Internal OrganStaplers”的美国专利No.4,805,823；于1995年5月16日公布的名称为“Surgical Staplerand Staple Cartridge”的美国专利No.5,415,334；于1995年11月14日公布的名称为“Surgical Stapler Instrument”的美国专利No.5,465,895；于1997年1月28日公布的名称为“Surgical Stapler Instrument”的美国专利No.5,597,107；于1997年5月27日公布的名称为“Surgical Instrument”的美国专利No.5,632,432；于1997年10月7日公布的名称为“Surgical Instrument”的美国专利No.5,673,840；于1998年1月6日公布的名称为“Articulation Assembly for Surgical Instruments”的美国专利No.5,704,534；于1998年9月29日公布的名称为“Surgical Clamping Mechanism”的美国专利No.5,814,055；于2005年12月27日公布的名称为“Surgical Stapling Instrument Incorporating an E-Beam Firing Mechanism”的美国专利No.6,978,921；于2006年2月21日公布的名称为“Surgical Stapling Instrument Having Separate Distinct Closing and FiringSystems”的美国专利No.7,000,818；于2006年12月5日公布的名称为“Surgical StaplingInstrument Having a Firing Lockout for an Unclosed Anvil”的美国专利No.7,143,923；于2007年12月4日公布的名称为“Surgical Stapling Instrument Incorporating aMulti-Stroke Firing Mechanism with a Flexible Rack”的美国专利No.7,303,108；于2008年5月6日公布的名称为“Surgical Stapling Instrument Incorporating aMultistroke Firing Mechanism Having a Rotary Transmission”的美国专利No.7,367,485；于2008年6月3日公布的名称为“Surgical Stapling Instrument Having a SingleLockout Mechanism for Prevention of Firing”的美国专利No.7,380,695；于2008年6月3日公布的名称为“Articulating Surgical Stapling Instrument Incorporating aTwo-Piece E-Beam Firing Mechanism”的美国专利No.7,380,696；于2008年7月29日公布的名称为“Surgical Stapling and Cutting Device”的美国专利No.7,404,508；于2008年10月14日公布的名称为“Surgical Stapling Instrument Having Multistroke Firingwith Opening Lockout”的美国专利No.7,434,715；于2010年5月25日公布的名称为“Disposable Cartridge with Adhesive for Use with a Stapling Device”的美国专利No.7,721,930；于2013年4月2日公布的名称为“Surgical Stapling Instrument with AnArticulatable End Effector”的美国专利No.8,408,439；和于2013年6月4日公布的名称为“Motor-Driven Surgical Cutting Instrument with Electric ActuatorDirectional Control Assembly”的美国专利No.8,453,914。上述引用的美国专利申请中的每个专利申请的公开内容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中，但应当理解，此类外科缝合器也可用于开腹手术和/或其他非内窥镜式手术中。仅以举例的方式，在胸廓外科手术中，外科缝合器可通过胸廓切开术被插入并由此位于患者肋骨之间以到达一个或多个器官，该胸廓外科手术不使用套管针作为缝合器的导管。此手术可包括使用缝合器来切断和闭合通向肺部的血管。例如，在从胸腔移出器官之前，可通过缝合器来切断和闭合通向器官的血管。当然，外科缝合器可用于各种其他设置和手术中。
特别适用或通过胸廓切开术使用的外科缝合器的示例被公开于以下美国专利申请中：于2013年2月28日提交的名称为“Surgical Instrument End EffectorArticulation Drive with Pinion and Opposing Racks”的美国专利申请No.13/780,067；于2013年2月28日提交的名称为“Lockout Feature for Movable Cutting Member ofSurgical Instrument”的美国专利申请No.13/780,082；于2013年2月28日提交的名称为“Integrated Tissue Positioning and Jaw Alignment Features for SurgicalStapler”的美国专利申请No.13/780,106；于2013年2月28日提交的名称为“Jaw ClosureFeature for End Effector of Surgical Instrument”的美国专利申请No.13/780,120；于2013年2月28日提交的名称为“Surgical Instrument with Articulation Lock havinga Detenting Binary Spring”的美国专利申请No.13/780,162；于2013年2月28日提交的名称为“Distal Tip Features for End Effector of Surgical Instrument”的美国专利申请No.13/780,171；于2013年2月28日提交的名称为“Staple Forming Features forSurgical Stapling Instrument”的美国专利申请No.13/780,379；于2013年2月28日提交的名称为“Surgical Instrument with Multi-Diameter Shaft”的美国专利申请No.13/780,402；于2013年2月28日提交的名称为“Installation Features for SurgicalInstrument End Effector Cartridge”的美国专利申请No.13/780,417；上述引用的美国专利申请中的每个专利申请的公开内容以引用方式并入本文。
虽然已制造和使用各种外科缝合器械和相关联的部件，但据信在一个或多个发明人之前还无人制造或使用在所附权利要求中所描述的发明。
附图说明
并入本说明书中并构成本说明书的一部分的附图例示了本发明的实施方案，并且与以上所给出的本发明的一般描述和下文所给出的对实施方案的详细描述一起用于解释本发明的原理。
图1示出了示例性关节运动式外科缝合器械的透视图；
图2示出了图1的器械的侧正视图；
图3示出了图1的器械的端部执行器的透视图，其中端部执行器处于闭合构型中；
图4示出了图3的端部执行器的透视图，其中端部执行器处于打开构型中；
图5示出了图3的端部执行器的分解透视图；
图6描绘了沿图4的线6-6截取的图3的端部执行器的横截面端视图；
图7A示出了沿图4的线7-7截取的图3的端部执行器的剖面侧视图，其中击发梁处于近侧位置中；
图7B示出了沿图4的线7-7截取的图3的端部执行器的横截面侧视图，其中击发梁处于远侧位置中；
图8示出了图3的被定位在组织处并已在组织中被致动了一次的端部执行器的透视图；
图9示出了用于图1的器械的示例性控制电路的示意图；
图10示出了图1的器械的柄部组件的透视图，其中移除了一半外壳和一些内部部件；
图11示出了来自图10的柄部组件的驱动组件部件的透视图；
图12示出了来自与击发梁联接的图11的驱动组件的细长构件的透视图；
图13A示出了可结合到图1的器械中的示例性另选轴组件的顶部透视图，其中端部执行器处于第一位置中；
图13B示出了图13A的轴组件的顶部平面图，其中端部执行器处于第二关节运动位置中；
图14示出了图13A的轴组件的近侧端部的透视图，其示出了关节运动旋钮和内部运动部件；
图15示出了沿图14的线15-15截取的图13A的轴组件的近侧端部的顶部剖视图；
图16示出了图13A的处于空档位置中的轴组件顶部平面图；
图17示出了图13A的轴组件的端部执行器和关节运动接头的分解透视图；
图18A示出了图13A的处于第一位置中的轴组件的关节运动接头的顶部部分内部视图；
图18B示出了图13A的轴组件的关节运动接头的顶部部分内部视图，其中第一臂和第二臂使第一凸轮构件旋转；
图18C示出了图13A的轴组件的关节运动接头的顶部部分内部视图，其中第一臂和第二臂使第二凸轮构件和第一凸轮构件进一步旋转；
图18D示出了图13A的轴组件的关节运动接头的顶部部分内部视图，其中锁定杆将锁定齿弹性地定位在第一凸轮构件和第二凸轮构件的齿之间；
图18E示出了图13A的轴组件的关节运动接头的顶部部分内部视图，其中第一臂和第二臂使第一凸轮构件更进一步地旋转；
图19示出了图13A的轴组件的凸轮构件和锁定杆的界面的顶部平面放大视图；
图20示出了图13A的轴组件的示例性另选第一凸轮构件与第二凸轮构件和锁定杆的界面的顶部平面放大视图；
图21A示出了具有示例性另选第一凸轮构件的图13A的轴组件的关节运动接头的顶部平面放大视图；
图21B示出了图21A的关节运动接头的顶部平面放大视图，其中第一臂使第一凸轮构件旋转；
图21C示出了图21A的关节运动接头的顶部平面放大视图，其中第二臂使第二凸轮构件旋转；
图21D示出了图21A的关节运动接头的顶部平面放大视图，其中第一臂平移以重新锁定第二凸轮构件；
图22A示出了图13A的轴组件的示例性另选凸轮构件与第二凸轮构件和锁定杆的界面的顶部平面放大视图；
图22B示出了图22A的关节运动接头的顶部平面放大视图，其中第一臂使凸轮构件旋转；
图23示出了示例性另选关节运动接头的顶部平面放大视图，其中第一凸轮构件具有波形凸轮；
图24示出了图23的第一凸轮构件的底部透视图；
图25A示出了沿图23的线25-25截取的图23的第一凸轮构件的侧剖视图，该第一凸轮构件与第二凸轮构件和可纵向平移锁定杆接合，其中该锁定杆处于锁定位置中；
图25B示出了沿图23的线25-25截取的图23的第一凸轮构件的侧剖视图，该第一凸轮构件与第二凸轮构件和锁定杆接合，其中该锁定杆处于解锁位置中；
图26A示出了沿图23的线26-26截取的图23的第一凸轮构件的剖面端视图，该第一凸轮构件与第二凸轮构件和锁定杆接合，其中该锁定杆处于锁定位置中；以及
图26B示出了沿图23的线26-26截取的图23的第一凸轮构件的剖面端视图，该第一凸轮构件与第二凸轮构件和锁定杆接合，其中该锁定杆处于解锁位置。
附图并非旨在以任何方式进行限制，并且可设想本发明的各种实施方案能够以多种其他方式来执行，包括那些不必在附图中示出的方式。结合在本说明书中并形成本说明书的一部分的附图例示了本发明的若干个方面并与描述一起用于解释本发明的原理；然而，应当理解，本发明不限于所示出的精确布置。
具体实施方式
本发明的某些示例的以下描述不应被用于限制本发明的范围。根据以举例的方式示出的以下描述，本发明的其他示例、特征结构、方面、实施方案和优点对于本领域的技术人员将是显而易见的，一种最佳方式可被设想用于实施本发明。正如将会意识到的，本发明能够具有其他不同且明显的方面，这些方面均不脱离本发明。因此，图示和描述应被视为实质上是例示性的而非限制性的。
I.示例性外科缝合器
图1示出了包括柄部组件20、轴组件30和端部执行器40的示例性外科缝合和切断器械10。端部执行器40和轴组件30的远侧部分的尺寸被设定成在图1所示的非关节运动状态中穿过套管针插管插入患者的手术部位，以用于执行外科手术。仅以举例的方式，此类套管针可被插入患者的腹部中，该腹部位于患者的两个肋骨之间或其他地方。在一些情况下，在不存在套管针的情况下使用器械10。例如，端部执行器40和轴组件30的远侧部分可通过胸廓切开术或其他类型的切口直接插入。应当理解，本文中使用的术语诸如“近侧”和“远侧”是参照临床医生抓握器械10的柄部组件20而言的。因此，端部执行器40相对于更近侧的柄部组件20而位于远侧。还应当理解，为便利和清楚起见，本文结图示使用空间用语诸如“竖直”和“水平”。然而，外科器械能够在许多取向和位置中使用，并且这些术语并非限制性的和绝对的。
A.示例性柄部组件和轴组件
如图1至图2所示，本示例的柄部组件20包括手枪式握把22、闭合触发器24和击发触发器26。每个触发器24,26可朝和远离手枪式握把22选择性地枢转，如将在下文中更详细地描述的。柄部组件20还包括砧座释放按钮25、击发梁反向开关27和可移除电池组28。这些部件还将在下文中更详细地进行描述。当然，除任何上文所述那些之外或作为替代，柄部组件20可具有多种其他部件、特征结构和可操作性。参考本文的教导内容，用于柄部组件20的其他合适的构型对于本领域的普通技术人员而言将是显而易见的。
如图1至图3所示，本示例的轴组件30包括外部闭合管32、关节运动节段34和闭合环36，该闭合环与端部执行器40进一步联接。闭合管32沿轴组件30的长度延伸。闭合环36被定位在关节运动节段34的远侧。闭合管32和闭合环36被构造成能够相对于柄部组件20纵向平移。闭合管32的纵向平移经由关节运动节段34而被传送到闭合环36。可用于提供闭合管32和闭合环36的纵向平移的示例性特征结构将在下文中更详细地进行描述。
关节运动节段34能够操作以侧向偏转闭合环36和端部执行器40，从而以期望的角度(α)侧向远离轴组件30的纵向轴线(LA)。由此，端部执行器40可由此从所需的角度或由于其他原因到达器官的后面或接近组织。在一些形式中，关节运动节段34能够使得端部执行器40沿单个平面偏转。在一些其他形式中，关节运动节段34能够使得端部执行器沿多于一个平面偏转。在本示例中，关节运动通过位于轴组件30的近侧端部处的关节运动控制旋钮35而被控制。钮35能够围绕垂直于轴组件30的纵向轴线LA的轴线旋转。响应于旋钮35的旋转，闭合环36和端部执行器40围绕垂直于轴组件30的纵向轴线LA的轴线枢转。仅以举例的方式，旋钮35的顺时针旋转可引起闭合环36和端部执行器40在关节运动节段34处的对应的顺时针枢转。关节运动节段34被构造成能够将闭合管32的纵向平移传送到闭合环36，而无论关节运动节段34是处于笔直构型中还是关节运动构型中。
在一些形式中，关节运动节段34和/或关节运动控制旋钮35根据以下美国专利申请的教导内容中的至少一些教导内容进行构造和操作：于2013年2月28日提交的名称“Surgical Instrument End Effector Articulation Drive with Pinion and OpposingRacks”的美国专利申请No.13/780,067，该专利申请的公开内容以引用方式并入本文。关节运动节段34也可根据下列美国专利申请的教导内容中的至少一些教导内容进行构造和操作：与本文同一天提交的名称为“Articulation Drive Features for SurgicalStaplerr”的美国专利申请No.[代理人案卷号END7429USNP.0614273]，其公开内容以引用方式并入本文；和/或根据以下各种教导内容进行构造和操作。参考本文的教导内容，关节运动节段34和关节运动旋钮35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。
如图1至图2所示，本示例的轴组件30还包括旋钮31。旋钮31能够操作以使整个轴组件30和端部执行器40相对于柄部组件20围绕轴组件30的纵向轴线(LA)旋转。在一些形式中，旋钮31能够操作以选择性地锁定轴组件30和端部执行器40相对于围绕轴组件30的纵向轴线(LA)的柄部组件20的角位置。例如，旋钮31能够在第一纵向位置与第二纵向位置之间平移，在该第一纵向位置中，轴组件30和端部执行器40能够相对于柄部组件20围绕轴组件30的纵向轴线(LA)旋转；在该第二纵向位置中，轴组件30和端部执行器40不能够相对于柄部组件20围绕轴组件30的纵向轴线(LA)旋转。当然，除任何上文所述那些之外或作为替代，轴组件30可具有多种其他部件、特征结构和可操作性。仅以举例的方式，轴组件30的至少一部分根据以下美国专利申请的教导内容中的至少一些教导内容进行构造：于2013年2月28日提交的名称为“Surgical Instrument with Multi-Diameter Shaft”的美国专利申请No.13/780,402，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，用于轴组件30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。
B.示例性端部执行器
同样如图1至图3所示，本示例的端部执行器40包括下钳口50和可枢转砧座60。砧座60包括被设置在下钳口50的对应弯曲狭槽54中的一对集成的向外延伸的销66。销66和狭槽54被示出于图5中。砧座60能够朝和远离下钳口50在打开位置(示出出于图2和图4中)与闭合位置(示出出于图1、图3和图7A至图7B中)之间枢转。使用术语“能够枢转”(以及与作为基础的“枢转”类似的术语)不应被解读为必须要求围绕固定轴线的枢转运动。例如，在本示例中，砧座60围绕由销66限定的轴线枢转，当砧座60朝下钳口50运动时，这些销沿下钳口50的弯曲狭槽54滑动。在此类形式中，枢转轴线沿由狭槽54限定的路径平移，而砧座60同时围绕该轴线枢转。除此之外或另选地，枢转轴线首先可沿狭槽54滑动，然后在枢转轴线已沿狭槽54滑动特定距离之后，砧座60围绕该枢转轴线枢转。应当理解，此类滑动/平移枢转运动被包含在术语诸如“枢转”(“pivot”,“pivots”,“pivoting”)、“枢转的”(“pivotal”)、“能够枢转的”(“pivotable”)等内。当然，一些形式可提供砧座60围绕保持固定且不在狭槽或通道内平移的轴线的枢转运动等。
如图5充分示出的，本示例的下钳口50限定被构造成能够接收钉仓70的通道52。可将钉仓70插入到通道52中，可致动端部执行器40，并且然后可移除钉仓70并利用其他钉仓70来替换。下钳口50因此以可剥离方式保持钉仓70与砧座60对准，以用于致动端部执行器40。在一些形式中，下钳口50根据以下美国专利申请的教导内容中的至少一些教导内容进行构造：于2013年2月28日提交的名称为“Installation Features for SurgicalInstrument End Effector Cartridge”的美国专利申请No.13/780,417，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，下钳口50可采用的其他合适的形式对于本领域的普通技术人员而言将是显而易见的。
如图4至图6充分示出的，本示例的钉仓70包括仓体71和被固定到仓体71发下侧的托盘76。仓体71的上侧存在平台73，当砧座60处于闭合位置中时，组织可压靠在该平台上。仓体71还限定纵向延伸的通道72和多个钉凹坑74。钉77被定位在每个钉凹坑74中。钉驱动器75还被定位在位于对应钉77下方以及托盘76上方的每个钉凹坑74中。如将在下文中更详细地描述的，钉驱动器75能够操作以在钉凹坑74中向上平移，以由此向上驱动钉77穿过钉凹坑74并与砧座60接合。钉驱动器75由楔形滑动件78向上驱动，该楔形滑动件被捕集在仓体71与托盘76之间并纵向平移穿过仓体71。楔形滑动件78包括一对倾斜成角的凸轮表面79，这对倾斜成角的凸轮表面被构造成能够接合钉驱动器75，并由此当楔形滑动件78纵向平移穿过仓70时向上驱动钉驱动器75。例如，当楔形滑动件78处于如图7A所示的近侧位置中时，钉驱动器75处于向下位置中并且钉77位于钉凹坑74中。当通过平移刀构件80将楔形滑动件78被驱动到如图7B所示的远侧位置时，楔形滑动件78向上驱动钉驱动器75，由此驱动钉77离开钉凹坑74并进入钉成形凹坑64中。因此，当楔形滑动件78沿水平维度平移时，钉驱动器75沿垂直维度平移。
应当理解，钉仓70的构型可以多种方式改变。例如，本示例的钉仓70包括位于通道72的一侧上的两排纵向延伸的钉凹坑74；以及位于通道72的另一侧上的另一组两排纵向延伸的钉凹坑74。然而，在一些其他形式中，钉仓70在通道72的每一侧上包括三个、一个或一些其他数目的钉凹坑74。在一些形式中，钉仓70根据以下美国专利申请的教导内容中的至少一些教导内容进行构造和操作：于2013年2月28日提交的名称为“Integrated TissuePositioning and Jaw Alignment Features for Surgical Stapler”的美国专利申请No.13/780,106，该专利申请的公开内容以引用方式并入本文。除此之外或另选地，钉仓70可根据以下美国专利申请的教导内容中的至少一些教导内容进行构造和操作：于2013年2月28日提交的名称为“Installation Features for Surgical Instrument End EffectorCartridge”的美国专利申请No.13/780,417，该专利申请的公开内容以引用方式并入本文。根据本文的教导内容，钉仓70可采取的其他合适的形式对于本领域的普通技术人员将是显而易见的。
如图4充分示出的，本示例的砧座60包括纵向延伸的通道62和多个钉成形凹坑64。通道62被构造成能够当砧座60处于闭合位置中时与钉仓70的通道72对准。每个钉成形凹坑64被定位成当砧座60处于闭合位置中时位于钉仓70的对应钉凹坑74上方。钉成形凹坑64被构造成能够当驱动钉77穿过组织进入砧座60时使钉77的支脚变形。具体地，钉成形凹坑64被构造成能够使钉77的支脚弯曲，以将成形钉77固定在组织中。砧座60可根据以下美国专利申请的教导内容中的至少一些教导内容进行构造：于2013年2月28日提交的名称为“Integrated Tissue Positioning and Jaw Alignment Features for SurgicalStapler”的美国专利申请No.13/780,106；于2013年2月28日提交的名称为“Jaw ClosureFeature for End Effector of Surgical Instrument”的美国专利申请No.13/780,120；和/或于2013年2月28日提交的名称为“Staple Forming Features for SurgicalStapling Instrument”的美国专利申请No.13/780,379，这些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，砧座60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。
在本示例中，刀构件80被构造成能够通过端部执行器40而平移。如图5和图7A至图7B充分示出的，刀构件80被固定到击发梁82的远侧端部，该击发梁延伸穿过轴组件30的一部分。如图4和图6充分示出，刀构件80被定位在砧座60的通道62和钉仓70的通道72中。刀构件80包括朝远侧呈现的切割刃84，该朝远侧呈现的切割刃被构造成能够当刀构件80通过端部执行器40朝远侧平移时切断被压缩在砧座60和钉仓70的平台73之间的组织。如上文所指出并如图7A至图7B所示，当刀构件80通过端部执行器40朝远侧平移时，刀构件80也朝远侧驱动楔形滑动件78，由此驱动钉77穿过组织并抵靠砧座60成形。可用于通过端部执行器40朝远侧驱动刀构件80的各种特征结构将在下文中更详细地进行描述。
在一些形式中，端部执行器40包括闭锁特征结构，该闭锁特征结构被构造成能够当钉仓70未插入下钳口50中时阻止刀构件80通过端部执行器40朝远侧推进。除此之外或另选地，端部执行器40可包括闭锁特征结构，该闭锁特征结构被构造成能够当已被致动一次(例如，其中从中布置所有钉77)的钉仓70插入到下钳口50中时阻止刀构件80通过端部执行器40朝远侧推进。仅以举例的方式，这类闭锁特征结构可根据以下美国专利申请的教导内容中的至少一些教导内容进行构造：于2013年2月28日提交的名称为“Lockout Featurefor Movable Cutting Member of Surgical Instrument”的美国专利申请No.13/780,082，该专利申请的公开内容以引用方式并入本文；和/或与本文同一天提交的名称为“Method of Using Lockout Features for Surgical Stapler Cartridge”的美国专利申请No.[代理人案卷号END7428USNP.0614271]，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，闭锁特征结构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。另选地，端部执行器40可简单地省去此类闭锁特征结构。
C.砧座的示例性致动
在本示例中，通过相对于端部执行器40朝远侧推动闭合环36而朝下钳口50驱动砧座60。响应于闭合环36相对于端部执行器40的远侧平移，闭合环36通过凸轮作用与砧座60协作，以朝下钳口50而驱动砧座60。类似地，响应于闭合环36相对于端部执行器40的近侧平移，闭合环36可与砧座60协作，以远离下钳口50而打开砧座60。仅以举例的方式，闭合环36和砧座60可根据以下美国专利申请的教导内容中的至少一些教导内容进行相互作用：于2013年2月28日提交的名称为“Jaw Closure Feature for End Effector of SurgicalInstrument”的美国专利申请No.13/780,120，该专利申请的公开内容以引用方式并入本文；和/或与本文同一天提交的名称为“JawOpening Feature for Surgical Stapler”的美国专利申请No.[代理人案卷号END7430USNP.0614275]，该专利申请的公开内容以引用方式并入本文。可用于提供闭合环36相对于端部执行器40的纵向平移的示例性特征结构将在下文中更详细地进行描述。
如上文所指出，柄部组件20包括手枪式握把22和闭合触发器24。同样如上文所指出，响应于闭合环36的远侧推进，砧座60朝下钳口50闭合。在本示例中，闭合触发器24可朝手枪式握把22枢转，以朝远侧驱动闭合管32和闭合环36。参考本文的教导内容，可用于将闭合触发器24朝手枪式握把22的枢转运动转化成闭合管32和闭合环36相对于柄部组件20的远侧平移的各种合适的部件对于本领域的普通技术人员而言将是显而易见的。当闭合触发器24达到完全枢转状态使得砧座60相对于下钳口50处于完全闭合位置中时，柄部组件20中的锁定特征结构锁定触发器24和闭合管32的位置，由此将砧座60相对于下钳口50锁定于完全闭合位置中。这些锁定特征结构通过致动砧座释放按钮25而释放。砧座释放按钮25被构造成并定位成能够由抓握手枪式握把22的操作者的手的拇指致动。换句话讲，操作者可利用一只手来抓握手枪式握把22，利用同一只手的一个或多个手指来致动闭合触发器24，并且然后利用同一只手的拇指来致动砧座释放按钮25，而无需利用同一只来手释放手枪式握把22的抓握。参考本文的教导内容，可用于致动砧座60的其他合适特征结构对于本领域的普通技术人员将是显而易见的。
D.击发梁的示例性致动
在本示例中，器械10提供对击发梁82的机动化控制。图9-12示出了可被用于提供对击发梁82的机动化控制的示例性部件。具体地，图9示出了可被用于利用来自电池组28(同样示出于图1-图2中)的电力来对电动马达102供电的示例性控制电路100。电动马达102能够操作以将击发梁82纵向平移，如将在下文所详的。应当理解，包括马达102和电池组28的整个控制电路100可被封装在柄部组件20内。图9示出了作为打开的开关的击发触发器26，但应当理解，该开关在击发触发器26致动时是闭合的。本示例的电路100还包括必须是闭合的以便使电路100完整的安全开关106，但应当理解，安全开关106仅仅是任选的。可通过致动柄部组件20上的单独按钮、滑块或其他特征结构来使安全开关106闭合。安全开关106还可提供击发触发器26的机械闭锁，使得机械地阻止击发触发器26致动直至安全开关106被致动。
本示例的电路100还包括被构造成能够在默认情况下为闭合的但响应于闭锁条件而自动打开的闭锁开关108。仅以举例的方式，闭锁条件可包括以下各项中的一者或多者：在下钳口50中缺少仓70、在下钳口50中存在耗尽的(例如，先前击发的)仓70、未充分闭合的砧座60、确定器械10已被击发很长时间、和/或任何其他合式的条件。根据本文中的教导内容，可用于检测闭锁条件的各种传感器、算法和其他特征结构对本领域的普通技术人员将是显而易见的。类似地，根据本文的教导内容，其他合适种类的闭锁条件对于本领域的普通技术人员将是显而易见的。应当理解，电路100是打开的，并且因此马达102在闭锁开关108打开时不可操作。闭锁指示器110(例如LED等)能够操作以提供对闭锁开关108的状态的视觉指示。仅以举例的方式，闭锁开关108、闭锁指示器110、和相关联的部件/功能可根据下述专利的教导内容中的至少一些教导内容来构造：于2010年1月12日公布的名称为“Electronic Lockouts and Surgical Instrument Including Same”的美国专利No.7,644,848，其公开内容以引用方式并入本文；
一旦击发梁82到达最远侧位置(例如，切割行程的末端处)，行程结束开关112自动转换到闭合位置，从而逆转施加到马达102的电压的极性。这逆转马达102的旋转方向，应当理解，操作者在该操作阶段将使击发触发器26释放。在该操作状态中，电流流过反向指示器114(例如LED等)，以向操作者提供马达102方向已逆转的视觉指示。在本示例中并且如图12充分示出，开关致动臂134从齿条构件130侧向延伸并被定位成在击发梁82到达最远侧的位置时(例如，在组织90已被切断并且钉77已被驱动到组织90中之后)接合行程结束开关112。参考本文的教导内容，行程结束开关112可在击发梁82到达最远侧的位置时自动切换至闭合位置的各种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。类似地，考虑到本文的教导内容，反向指示器114可采用的各种合适的形式对于本领域的普通技术人员而言将是显而易见的。
本示例的柄部组件20还包括也被示出于电路100中的手动返回开关116。在本示例中，通过致动反向开关27来激活返回开关，该反向开关在图1中的柄部组件20上示出。手动返回开关116可提供与行程结束开关112类似的功能，以由此逆转施加到马达102的电压的极性，以由此逆转马达102的旋转方向。同样，该逆转可通过反向指示器114而在视觉上被指示。在一些形式中，柄部组件20还包括使得操作者能够手动逆转击发梁82并由此机械回缩击发梁82的机械返回特征结构。在本示例中，此手动返回特征结构包括被如图1所示的可移除面板21覆盖的杆件。手动返回开关116和机械返回特征结构各自被构造成能够充当“应急”特征结构，从而使得操作者能够在击发行程期间使击发梁82朝近侧快速回缩。换句话讲，手动返回开关116或机械返回特征结构可在击发梁82仅部分地朝远侧推进时被致动。
在一些形式中，开关26,106,108,112,116中的一个或多个开关为微型开关的形式。根据本文的教导内容，其他合适形式对于本领域的普通技术人员将是显而易见的。除此之外或作为前述的代替，电路100的至少一部分可根据如下专利的教导内容中的至少一些教导内容来构造：于2012年7月3日提交的名称为“Motor-Driven Surgical Instrument”的美国专利No.8,210,411，其公开内容以引用方式并入本文。
图10示出了被定位在柄部组件20的手枪式握把22内的马达102。另选地，马达102可被定位在柄部组件20内的其他位置。马达102具有与齿轮组件122联接的驱动轴120。因此，当启动马达102时，驱动轴120致动齿轮组件122。如图11所示，齿轮组件122与驱动齿轮124连通，该驱动齿轮与空载小齿轮126啮合。小齿轮126被设置在轴128上，该轴被支撑在柄部组件20内并且平行于马达102的驱动轴120进行取向。小齿轮126进一步接合齿条构件130。具体地，小齿轮126在齿条构件130的近侧端部处与齿132啮合。齿条构件130可滑动地支撑在柄部组件20中。通过上述内容应当理解，当致动马达102时，驱动轴120的对应旋转经由齿轮组件122而被传送到小齿轮126，并且小齿轮126的对应旋转通过齿132而被转化为齿条构件130的平移。如图10至图12所示，细长构件136从齿条构件130朝远侧延伸。如图12所示，耦接构件138将击发梁82与细长构件136连接。响应于马达102的致动，齿条构件130、细长构件136、联接构件138、击发梁82和刀构件80相对于柄部组件20一起平移。换句话讲，马达102的致动最终引起击发梁82纵向平移，此类平移的方向取决于驱动轴120的旋转方向。
应当理解，细长构件136、联接构件138和击发梁82的远侧部分延伸穿过轴组件30。击发梁82的一部分还延伸穿过关节运动节段34。在一些形式中，齿条构件130、细长构件136和联接构件138为基本上笔直和刚性的；而击发梁82具有足够的柔韧性以在关节运动节段34处弯曲，并且当关节运动节段34处于弯曲或关节运动状态中时纵向平移穿过关节运动节段34。
除此之外或作为前述的代替，能够操作以驱动击发梁82的特征结构可根据美国专利No.8,453,914的教导内容中的至少一些教导内容进行构造，该专利的公开内容以引用方式并入本文。考虑到本文的教导内容，用于提供击发梁82的机动的其他合适的部件、特征结构和构型对本领域普通技术人员而言将是显而易见的。还应当理解，一些其他形式可提供对击发梁82的手动驱动，使得能够省略马达。仅以举例的方式，击发梁82可根据本文引用的任何其他参考文献的教导内容中的至少一些教导内容进行致动。
图8示出了已通过单个行程被致动穿过组织90的端部执行器40。如图所示，切割刃84(在图8中被遮住)已切穿组织90，同时钉驱动器75已驱动两排交替的钉77穿过由切割刃84产生的切割线的每一侧上的组织90。在此示例中，钉77全部与切割线基本上平行地取向，但应当理解，钉77可以任何合适的取向定位。在本示例中，在第一行程完成后，端部执行器40从套管针取出，利用新钉仓70来替换已空钉仓70，并且然后端部执行器40再次插入穿过套管针而到达缝合位点以用于进行进一步的切割和缝合。这个过程可重复，直到已提供期望量的切口和钉77。可能需要将砧座60闭合以有利于插入穿过套管针和通过套管针取出；并且可能需要将砧座60打开以有利于替换钉仓70。
应当理解，在每次致动行程期间，切割刃84可基本上与钉77被驱动穿过组织同时切断组织。在本示例中，切割刃84仅稍微落后于钉77的驱动，使得钉47刚好在切割刃84穿过组织的相同区域之前被驱动穿过组织，但应当理解，这个顺序可颠倒，或者切割刃84可直接与相邻的钉77同步。虽然图8示出端部执行器40在组织90的两个层92,94中被致动，但应当理解，端部执行器40可被致动穿过组织90的单个层或组织的多于两个层92,94。还应当理解，与切割刃84产生的切割线相邻的钉77的成形和定位可基本上密封切割线处的组织，由此减少或防止切割线处的出血和/或其他体液的渗漏。此外，尽管图8示出端部执行器40在组织的两个基本上平坦的相反平面层92,94中致动，但应当理解，端部执行器40也可在管状结构诸如血管、胃肠道的一部分等上致动。因此，不应将图8视为对端部执行器40的设想用途进行任何限制。参考本文的教导内容，其中可使用器械10的各种合适情况和程序对于本领域的普通技术人员将是显而易见的。
还应当理解，器械10的任何其他部件或特征结构可根据本文所述的各种参考文献中的任何参考文献进行构造和操作。可提供用于器械10的其他示例性修改将在下文中更详细地进行描述。其中下文教导内容可并入器械10中的各种合适的方式将对本领域的普通技术人员将是显而易见的。类似地，可将下述教导内容与本文引用的参考文献的各种教导内容进行组合的各种合适方式对于本领域的普通技术人员将是显而易见的。还应当理解，下述教导内容并不限于本文引用的参考文献中教导的器械10或装置。下文教导内容可容易地应用到各种其他种类的器械，该各种其他种类的器械包括将不被归类为外科缝合器的器械。根据本文的是教导内容，其中可应用下文教导内容的各种其他合适的装置和情况将对本领域的普通技术人员将是显而易见的。
II.示例性另选轴组件
应当理解，当用户迫使器械10进入外科手术区域时，可能期望从特定角度接近将要夹紧、缝合或切割的组织。例如，一旦器械10的端部执行器40插入并穿过套管针、胸廓切口或用于进入外科手术区域的其他通道，用户想要对准的组织可能会定位在不可触及的位置，或相对于与轴组件30的纵向轴线(LA)对准的端部执行器40以歪斜角位置。因此，可能期望器械10的一部分诸如端部执行器40相对于轴组件30的纵向轴线(LA)以角度(α)进行关节运动(如图1中的虚线所示)，使得用户能够将端部执行器40的砧座60和下钳口50定位成直角地或者说垂直地夹紧血管或其他组织。还将理解，使端部执行器40进行关节运动来将端部执行器40垂直地抵靠组织定位，可有利于在切割和缝合组织之前使组织完全就位并夹紧。除进行关节运动之外，可能期望端部执行器40选择性地锁定在笔直位置或关节运动位置中，使得用户所造成的恒定手动偏置不一定阻止端部执行器40在关节运动节段34处枢转或弯曲。还可能期望在进行关节运动时自动锁定，而不需要致动单独的关节运动锁定特征结构。
图13A示出了可易于与图1的器械10结合的示例性另选轴组件200。轴组件200提供关节运动以及对关节运动角度的选择性锁定，如下文中将更详细地描述的。本示例的轴组件200包括旋转旋钮231、关节运动控制旋钮235以及端部执行器240。轴组件200还包括相对于闭合管232在远侧定位的端部执行器240。端部执行器240包括允许端部执行器240进行侧向关节运动的关节运动接头234，如下文中将更详细地描述的。除了如下文另有所述之外，端部执行器240与图1的端部执行器40基本上相同。
旋转旋钮231可与图1的柄部组件20或任何其他合适的部件(例如，机器人控制界面等)可旋转地联接。旋转旋钮231能够操作以使轴组件200(包括关节运动控制旋钮235和端部执行器240)围绕由轴组件200限定的纵向轴线(LA)相对于柄部部分20(或相对于旋转旋钮231可旋转地联接到的任何其他部件)旋转。这可用于将端部执行器240定位在围绕纵向轴线(LA)的期望的角度取向下。
A.示例性关节运动控制特征结构
关节运动控制旋钮235部分容纳在关节运动控制旋钮外壳237内。外壳237通向闭合管232。图13A至图13B示出了轴组件200以及端部执行器240响应于关节运动控制旋钮235的转动而进行的示例性运动。图13A示出处于第一位置中的关节运动控制旋钮235，在该第一位置中，关节运动控制旋钮235和端部执行器240两者沿轴组件200的纵向轴线(LA)大体上对准。用户可随后用手将关节运动控制旋钮235顺时针地旋转到第二位置，如图13B所示。响应于关节运动控制旋钮235的旋转，端部执行器240在关节运动接头234处枢转或弯曲到关节运动角度(α)，如图16B所示。在本示例中，端部执行器240大体沿关节运动控制旋钮235的旋转方向进行关节运动，但应当理解，端部执行器240可被构造成能够沿关节运动控制旋钮235的旋转方向的相反方向弯曲。换句话讲，当关节运动控制旋钮235顺时针旋转时，端部执行器240如图13B所示顺时针地侧向枢转，但可按照某些形式构造以逆时针枢转。图13B示出了端部执行器240略微顺时针地侧向枢转。应当理解，关节运动控制旋钮235可进一步旋转以使端部执行器240在关节运动接头234处进一步侧向关节运动到任何合适的角度(α)。例如，端部执行器240可枢转，直到在关节运动接头234上方形成约90°角。在一些形式中，端部执行器240能够操作以更进一步枢转，使得端部执行器240相对于管232形成锐角。参考本文的教导内容，端部执行器240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。还应理解，关节运动控制旋钮235可相对于纵向轴线(LA)来限定与在端部执行器240和纵向轴线(LA)之间限定的关节运动角度(α)相同的角度。此类互补地成角度可在患者体外向操作者提供视觉反馈，从而指示端部执行器240的关节运动角度(α)。
端部执行器240的关节运动的机制将在下文中更详细地进行描述。应当理解，关节运动控制旋钮235可沿逆时针方向旋转，使端部执行器240以逆时针方式进行关节运动。因此，根据端部执行器240的关节运动的期望方向和/或程度，用户可仅使关节运动控制旋钮235在某个方向上进行不同程度的旋转，用户希望端部执行器240在这个方向上进行关节运动，以使端部执行器240进行不同程度的关节运动。
图14示出关节运动控制旋钮235，其中外壳237被移除以更好地示出关节运动控制旋钮235的内部工作。关节运动控制旋钮235与关节运动小齿轮250连通。关节运动小齿轮250与第一齿条252和第二齿条256连通。第一齿条252通过第一中间块254与第一臂242连通，而第二齿条256通过第二中间块258与第二臂244连通。在本示例中，臂242,244基本上彼此平行。具体地，臂242,244的近侧部分(如图18所示)和臂242,244的延伸穿过轴组件200的部分彼此平行，但臂242,244的近侧端部向外略微呈喇叭形张开。由于臂242,244沿几乎其整个长度彼此平行(即，最远侧部分除外)，因此臂242,244可易于由本领域技术人员识别为“基本上彼此平行”。
关节运动控制旋钮235一体地联接至关节运动小齿轮250。因此，当用户转动关节运动控制旋钮235时，关节运动小齿轮250随着关节运动控制旋钮235一起旋转。随着关节运动小齿轮250旋转，关节运动小齿轮使第一齿条252和第二齿条256相应地沿相反方向平移。例如，如图15所示，关节运动小齿轮250与第一齿条252和第二齿条256连通，使得如果关节运动小齿轮250顺时针旋转，则第一齿条252便朝近侧远离端部执行器240回缩，而第二齿条256朝远侧向端部执行器240推进。此外，当关节运动小齿轮250逆时针地旋转时，第一齿条252朝远侧向端部执行器240推进，而第二齿条256朝近侧远离端部执行器240回缩。随着第一齿条252推进和回缩，第一臂242也以类似方式推进和回缩。类似地，随着第二齿条256推进和回缩，第二臂244也随着第二齿条256推进和回缩。因此，旋转连接到关节运动小齿轮250的关节运动控制旋钮235使第一臂242和第二臂244随着第一齿条252和第二齿条256来回运动。第一臂242和第二臂244的运动能够操作以引起端部执行器240中的其他部件的运动，这将在下文中更详细地进行描述。
图16示出包括砧座260的端部执行器240的更大视图。第一臂242和第二臂244与围绕销379枢转地设置的第一凸轮构件330连通。因此，第一臂242和第二臂244的推进和回缩使第一凸轮构件370围绕凸轮保持销379旋转，这将在下文中更详细地进行描述。
图17示出关节运动接头234的分解视图。端部执行器240被设置在关节运动接头234的远侧端部处。端部执行器240包括砧座260和下钳口268。应当理解，端部执行器240与图1的端部执行器40基本上类似。与端部执行器40的下钳口50类似，下钳口268可接收可基本上类似于钉仓70的钉仓(未示出)。另外，与上述端部执行器40类似，通过相对于端部执行器240朝远侧推动闭合环236而朝下钳口268驱动砧座260。闭合环236基于闭合管232的平移而相对于端部执行器240纵向地驱动。闭合管232的平移经由关节运动接头234而被传送到闭合环236。砧座260和下钳口268与端部执行器40的砧座60和下钳口50在功能上基本上类似，其中砧座260和下钳口268协同工作以同时切断和缝合组织，如图8所示且如上所述的。
关节运动接头234包括第一凸轮构件330、第二凸轮构件331、凸轮保持主体376、接头基部372、锁定杆262、和弹簧364。第一臂242朝远侧端接于第一钩245中，而第二臂244朝远侧端接于第二钩246中。钩245,246与第一凸轮构件330的凸轮开口360连通。因此，当第一臂242朝端部执行器240推进而第二臂244回缩时，第一凸轮构件330围绕保持销379逆时针旋转。相反，当第一臂242回缩而第二臂244朝端部执行器240推进时，第一凸轮构件330围绕保持销379顺时针旋转。因此，当臂242,244经由钩245,246在凸轮开口360上以相反方式推动和拉动时，第一凸轮构件330如刚才所述相应地旋转。
第一凸轮构件330被堆叠在第二凸轮构件331上。第二凸轮构件331和凸轮保持销379是凸轮保持主体376的一体特征结构。在一些形式中，第二凸轮构件331可单独地构造并与凸轮保持主体376牢固地联接，使得当第二凸轮构件331旋转时，凸轮保持主体376旋转。凸轮保持销379沿枢转轴线380与接头基部372的基部开口377轴向对准。因此，第一凸轮构件330可相对于第二凸轮构件231和凸轮保持主体376围绕枢转轴线380旋转。锁定杆262与第一凸轮构件330和第二凸轮构件331选择性地连通，这将在下文中更详细地进行描述。锁定杆262进一步与朝远侧偏置锁定杆262的弹簧364连通。接头基部372被成形为提供便于锁定杆262推进的底座和/或通道。锁定杆262还包括能够操作以接合接头基部372的一对凸台387，以限制锁定杆262的远侧运动。
B.轴组件的示例性关节运动
如上所述，致动关节运动控制旋钮235使得臂242,244执行相反的推进和回缩。应当理解，臂242,244的这种运动使第一凸轮构件330围绕凸轮保持销279旋转。第一凸轮构件330的旋转使第二凸轮构件331随着凸轮保持主体376旋转。因此，关节运动接头234进行关节运动，由此在关节运动接头234处使端部执行器240枢转。具体地，凸轮保持销379和基部开口374限定大体上垂直于纵向轴线(LA)的枢转轴线380，如上文所指出的。端部执行器240响应于第一凸轮构件330的旋转而围绕枢转轴线380枢转，该第一凸轮构件330驱动第二凸轮构件331，如下文将论述。换句话讲，枢转轴线380充当端部执行器240相对于轴组件200进行关节运动的轴线。图18A至图18E示出了旋转第一凸轮构件330以驱动端部执行器240进行关节运动的细节。
图18A示出了处于第一位置中的关节运动接头234。锁定杆262被朝远侧偏置以接合第二凸轮构件331。具体地，锁定杆262的远侧端部包括被配合在第一凸轮齿333和第二凸轮齿335之间并且邻接第二凸轮构件331的锁定齿336，这可在图19中进一步详细示出。由于弹簧364所提供的远侧偏置，锁定齿336起到可靠锁定的作用，并因此保持第二凸轮构件331的旋转位置。通过保持第二凸轮构件331的旋转位置，锁定杆262保持端部执行器240的围绕枢转轴线380的角位置，由此保持任何关节运动角度(α)。第一凸轮构件330包括一对凸轮翼部338,339，并且凸轮保持主体376包括一对凸台371,373。凸台371,373是第二凸轮构件331的一体特征结构，因此当凸台371,373旋转时，第二凸轮构件331也旋转。应当理解，图18A的第一位置中，凸轮翼部338,339和凸台371,373不接触。涉及凸轮翼部338,339与凸台371,373之间的接触的相互作用将在下文中结合图18B至图18E详细描述。在外科手术操作中，用户可引导轴组件200穿过通道(例如，套管针、胸廓切口等)到达手术区域，其中端部执行器240处于如图18A所示的笔直位置中。
图19示出处于图18A所示的位置的中锁定齿336的放大视图。如可以看到的，锁定齿336具有被构造成能够被配合在第一凸轮齿333和第二凸轮齿335之间的大体上笔直的平行侧部386。锁定齿336的远侧端部具有倒圆尖端385，该倒圆尖端具有通向平行侧部386的成角度的侧部381。第二凸轮齿335中的每个齿335包括大体上笔直的平行侧部383以及成角度的侧部384。平行侧部383被构造成能够接合锁定齿336的平行侧部386，以防止在没有第一凸轮构件330的协助的情况下，锁定齿336沿第二凸轮齿335行进。至少一个侧部383与至少一个侧部386之间的这种接合还防止凸轮保持主体376围绕枢转轴线380旋转，由此防止端部执行器240在关节运动接头234处枢转。
一旦第一凸轮构件330如18B至图18C所示那样旋转并如将在下文更详细地描述，第一凸轮构件330的三角形齿333便将顶靠在成角度的侧部381上，并将由此响应于第一凸轮330的旋转将锁定杆262朝近侧驱动。应当理解，除了三角形外，齿333还可具有多种不同的形状。一些示例性另选形状将在以下更加详细地进行描述，而其他的对于本领域普通技术人员根据本文的教导将是显而易见的。锁定齿336朝近侧充分地运动，使得随着第一凸轮构件330继续旋转并且随着第二凸轮构件331旋转，锁定齿336的成角度的侧部381最终可接合第二凸轮齿335的成角度的侧部384并沿成角度的侧部行进。这提供了进一步的凸轮作用以朝近侧驱动锁定杆262。类似于图19所示的定位，锁定齿336一旦越过第二凸轮齿335的成角度的侧部384，锁定齿336便会朝远侧返回到位于下一对第一凸轮齿333和第二凸轮齿335之间的位置。出于说明目的，可将位于一组第一凸轮齿333和第二凸轮齿335之间的锁定齿336的推进视为一个关节运动增量。当将锁定齿336朝远侧推进时，锁定齿336撞击第二凸轮齿335之间的第二凸轮构件331。应当理解，锁定齿336不必延伸太远便足以撞击第二凸轮构件331。例如，锁定齿336可仅朝远侧延伸，使得平行侧部383防止在没有第一凸轮齿333的协助的情况下，锁定齿336沿第二凸轮构件331行进。在所示形式中，凸台387接合接头基部382，以防止锁定杆262发生进一步的远侧运动。
如上指出，操作者可能希望端部执行器240在关节运动接头234处枢转，以更好地相对于靶点组织定位端部执行器240。图18B示出了关节运动接头234的致动的第二阶段，其响应于转动图14所示的关节运动控制旋钮235而运动。在所示形式中，用户已逆时针地转动关节运动旋钮235，这也使得关节运动小齿轮250旋转。当关节运动小齿轮250逆时针地旋转时，第一齿条252相对于端部执行器240朝远侧运动，并且第二齿条256相对于该端部执行器朝近侧运动。因此，如图18B所示的第一臂242和第二臂244运动，使得第一臂242朝端部执行器240推进，而第二臂244远离端部执行器240回缩。应当理解，所示形式的第一臂242和第二臂244的远侧部分未相对于彼此平行定位。相反，第一臂242和第二臂244相对于彼此倾斜地成角度，然而应当理解，第一臂242和第二臂244可彼此平行定位。
如图18B所示的臂242,244的运动使得第一凸轮构件330围绕枢转轴线380逆时针旋转。当第一凸轮构件330旋转时，两个动作大体上同时发生。第一凸轮齿330具有三角形形状，由于第一凸轮齿333接合成角度的侧部381而迫使锁定杆262通过凸轮作用朝近侧远离端部执行器240。同样，除了三角形外，齿333还可具有多种不同的形状。弹簧364压缩以适应锁定杆262的近侧运动。因此，倒圆尖端385充分地朝近侧运动，以便越过平行侧部383。另外，凸轮翼部338,339随着第一凸轮构件330逆时针旋转。由于这种旋转，凸轮翼部339移除凸台373之间的间隙361并且接合凸台373。同时，凸轮翼部338可旋转地运动远离凸台371。应当理解，虽然在从图18A所示构型转变到图18B所示构型的过程中，第一凸轮构件330和锁定杆262已响应于臂242,244而运动，但第二凸轮构件331和相应端部执行器240却未运动。因此，在这个阶段，端部执行器240保持在笔直取向中。
图18C示出关节运动接头234的致动的第三阶段。应当理解，为使端部执行器240进行关节运动，用户继续旋转关节运动控制旋钮235。臂242,244继续运动，使得第一臂242朝远侧运动并且第二臂244朝近侧运动。臂242,244的运动继续使第一凸轮构件330旋转，者使凸轮翼部339进一步可旋转地运动，由此推动凸台373同样可旋转地运动。由于凸台273与第二凸轮构件331成一体，因此第二凸轮构件331开始旋转。随着第二凸轮构件331的旋转，由于成角度的侧部384顶靠在锁定齿336的成角度侧部381上，锁定杆262进一步朝近侧运动。因此，锁定齿236沿第二凸轮齿335行进。第二凸轮构件331一直旋转，直到第二凸轮构件331的尖端388接合倒圆尖端385。第二凸轮齿轮335具有平行侧部383，使得锁定齿336的成角度的边缘381能够接合成角度的侧部284，但是这种接合仅在第一凸轮齿333将锁定齿336朝近侧推动以使得倒圆尖端385越过平行侧部383之后发生。在沿第一凸轮齿333行进之前，由于平行侧部383接合平行侧部386，锁定齿336一般不能够沿第二凸轮齿335行进。还应当理解，随着锁定齿336沿成角度的侧部384行进，锁定齿336与第一凸轮齿333脱离。同样如图18C充分示出，锁定杆262和锁定齿336已运动至最近侧的位置，其中第二凸轮齿尖端388刚好接触锁定齿336。另外，由于第二凸轮构件331旋转，凸轮保持主体376以及相应地通向端部执行器240的闭合环236在逆时针方向上进行关节运动。
图18D示出关节运动接头234的致动的第四阶段。同样，应当理解，为使端部执行器240进一步地进行关节运动，用户继续旋转关节运动控制旋钮235。臂242,244继续运动，使得第一臂242进一步朝远侧运动并且第二臂244进一步朝近侧运动。臂242,244的运动继续使第一凸轮构件330旋转，这使凸轮翼部339进一步可旋转地推动凸台373。锁定齿336继续沿第二凸轮齿335行进，直至由弹簧364引起的远侧偏置迫使锁定杆262进入图18D所示的位置中。应当理解，当锁定杆262按扣到图18D所示的位置中时，可听到或感觉到听得见的咔哒声或喀哒声。因此，用户接收可听和/或触觉确认，其指示锁定齿336已从一组凸轮齿333,335之间运动到另一组凸轮齿之间，或者已旋转单个关节运动增量。当处于图18D所示位置中时，第一凸轮构件330停止旋转，并且锁定齿236被配合在凸轮齿333,335之间。闭合环236以及相应地端部执行器240停止关节运动。可靠锁定已形成，因为受端部执行器240上的横向力推动的第二凸轮构件331的任何旋转运动将会导致平行侧部386接合平行侧部383并且停止第二凸轮构件331的任何进一步旋转，这将锁定端部执行器240的关节运动。应当理解，从图18A所示构型转变到图18D所示构型表示通过一个关节运动增量进行的关节运动或者关节运动的增量，其中距离由第二凸轮齿335之间的空间大致限定。
应当理解，在图18D所示位置中，端部执行器240已进行关节运动，由此向用户提供具有已进行关节运动的端部执行器240的轴组件200。应当理解，用户可能希望使用在图18D所示位置中的轴组件200，或可能希望将端部执行器240进一步枢转一个或多个另外的关节运动增量。在用户未进一步旋转关节运动钮235的情况下，锁定齿336将被锁定于第一凸轮齿333和第二凸轮齿335之间，这种锁定防止端部执行器240枢转以返回到伸直位置。一旦端部执行器240已进行关节运动到期望角度(α)，应当理解，用户可致动击发梁282以驱动刀构件280，使其切割组织并驱动钉77穿过组织。例如，刀构件280和击发梁282可通过例如能够弯曲的梁连通，使得击发梁282能够通过关节运动接头234的任何程度的枢转而推进。
图18E示出关节运动接头234的致动的第五阶段，此时，用户希望端部执行器240进一步枢转。同样，应当理解，用户继续旋转关节运动控制旋钮235。由此，臂242,244继续运动，使得第一臂242进一步朝远侧运动并且第二臂244进一步朝近侧运动。臂242,244的运动继续使第一凸轮构件330旋转，这使凸轮翼部339可旋转地推动凸台373。第一凸轮构件330和第二凸轮构件331如图18B至图18D所示那样类似地运动，这使得端部执行器240进一步进行关节运动并且被锁定在更多的进行关节运动的位置中。应当理解，用户可继续旋转关节运动控制旋钮235，以使端部执行器240枢转至如用户期望的程度。此外，用户可使关节运动控制旋钮235在相反方向上旋转，以使臂242,244和凸轮构件330,331在相反方向上运动，由此使端部执行器240在相反方向上进行关节运动。
如图18A至图18E所示的示例性致动中所见的，第一凸轮构件330能够操作以通过将运动从臂242,244传递到第一凸轮构件330而解锁关节运动接头234并使端部执行器240在关节运动接头234处围绕枢转轴线380枢转。另外，第二凸轮构件331和锁定杆262一起锁定关节运动接头234，以由此锁定端部执行器240相对于轴组件200的纵向轴线(LA)的角度(α)。
III.示例性另选关节运动接头
在某些情况下，可能期望提供用于选择性地锁定和解锁关节运动接头234的另选结构和方法。还可能期望基于用于选择性地锁定和解锁关节运动接头234的另选结构和方法来修改用于驱动关节运动接头234的结构和方法。在下文中更详细地描述可用于选择性地锁定和解锁关节运动接头的另选结构和方法的各种示例，而根据本文的教导内容，其他示例对于本领域的普通技术人员而言将是显而易见的。类似地，在下文中更详细地描述可用于驱动关节运动接头的另选结构和方法的各种示例，而根据本文的教导内容，其他示例对于本领域的普通技术人员而言将是显而易见的。应当理解，以下示例可易于结合到关节致动接头234中；或易于取代关节致动接头234而被结合到轴组件200中。以下示例可结合到器械10中的各种合适方式将对本领域的普通技术人员将是显而易见的。
A.示例性正方形锯齿状凸轮构件
图20示出了示例性另选第一凸轮构件430。第一凸轮构件430配合到关节运动接头234中并且具有与第一凸轮构件330的功能基本上相同的功能，如图18A至图18E所示且如上所述。例如，与第一凸轮构件234相同，第一凸轮构件430被构造成能够首先相对于第二凸轮构件331旋转，以通过接合锁定杆262的成角度的侧部381来将锁定杆262朝近侧平移。锁定杆262随后可平移到充分的近侧距离，以使得第二凸轮齿335的成角度的侧部384可接合锁定齿336的成角度的侧部381(参见例如，图18A至图18C和以上论述)。然而，与第一凸轮构件330不同，第一凸轮构件430包括正方形齿433而不是三角形齿333。
应当理解，锁定杆262的锁定齿336可包括重新构造的形状，以说明接合正方形齿433与三角形齿333之间的差异。例如，锁定齿336的成角度的侧部381可相对于锁定齿336的笔直平行侧部延伸较大距离。当然，锁定齿336的具体几何形状针对第一凸轮齿433的尺寸相对于第二凸轮齿335的尺寸和形状将发生变化，而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。
B.具有单个凸轮的示例性第一凸轮构件
图21A至图21D示出了可结合到关节运动接头234中的示例性另选第一凸轮构件530。第一凸轮构件530枢转地被设置在保持销379上。第一凸轮构件530围绕中心轴线是非对称的，该中心轴线平行于轴组件200的纵向轴线(LA)延伸。第一凸轮构件530和第二凸轮构件331围绕由保持销379限定的轴线380独立地旋转。在本示例中，第一凸轮构件530被构造成能够具有单个凸轮533而不是凸轮齿433,333，如相对于第一凸轮构件430,330所述。单个凸轮533被形成为朝近侧取向的凸角。第一凸轮构件530能够操作以通过由第一臂242施加的力而旋转，因而将第一凸轮构件530的单个凸轮533相对于锁定杆262推进，从而将锁定杆262朝近侧平移。第一凸轮构件530的单个凸轮533可将锁定杆262平移到其中锁定杆262不再接合第二凸轮构件331的第二凸轮齿335的程度，或平移到第二凸轮齿335的成角度的侧部384可接合锁定齿336的成角度的侧部381的程度。因此，关节运动接头234随后可通过第二凸轮构件331(其一体地附接到端部执行器240)的旋转来进行关节运动，该过程经由臂242,244以与上文关于第一凸轮构件330所述类似的方式以相反方向平移来进行。
在一些形式中，臂242,244可彼此独立地平移。例如，第一臂242能够操作以朝近侧或朝远侧平移以使第一凸轮构件530旋转，从而利用锁定杆262来选择性地锁定和解锁第二凸轮构件331。同样，第二臂244能够操作以朝近侧或朝远侧平移，以使第二凸轮构件331独立于第一凸轮构件530的旋转而旋转。从图21B中可以看出，第一臂242可朝近侧平移以使第一凸轮构件530相对于第二凸轮构件331旋转，从而经由单个凸轮533将锁定杆262朝近侧平移，以使锁定杆262从第二凸轮构件331脱离。接下来，从图21C中可以看出，第二臂244随后可朝远侧或朝近侧平移，以使关节运动接头234分别顺时针地或逆时针地进行关节运动。图21D示出一旦关节运动接头234相对于轴组件200的纵向轴线(LA)进行关节运动到期望角度(α)，关节运动接头234便可锁定在适当的位置。具体地，第一臂242可朝远侧平移以使第一凸轮构件530以逆时针旋转而旋转，从而使单个凸轮533与锁定杆262脱离接合。换句话讲，在从图21C所示状态转变到图21D所示状态的过程中，第一凸轮构件530不再朝近侧支承在锁定杆262上，以使得盘簧364将锁定杆262朝远侧驱动返回到其中锁定杆262锁定第二凸轮构件331的角位置的位置。在端部执行器240如上文所指出一体地固定到第二凸轮构件331的情况下，远侧定位的锁定杆262锁定端部执行器240的角位置。
应当理解，在其中臂242,244独立地平移的示例中，关节运动控制旋钮235可使用进行关节运动的装置而不是如上文所述且如图14至图15所示的齿条和小齿轮设备；或臂242,244可使用单独的齿条和小齿轮。例如，在一些示例中，关节运动控制旋钮235可连接到利用一个或多个马达和开关的机电控制系统。而在其他示例中，关节运动控制旋钮235可仅平移第二臂244，同时第一臂242可利用单独的锁定/解锁开关、滑块或杠杆来平移。当然，臂242,244可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任何其他合适方式独立地平移。
C.具有“π”形凸轮的示例性关节运动接头
图22A至图22B示出了示例性另选关节运动接头634，该示例性另选关节运动接头利用“π”形凸轮构件630来锁定和解锁端部执行器240在关节运动接头634处的关节运动。关节运动接头634可易于结合到轴组件200中。具体地，关节运动接头包括凸轮构件630、第二凸轮构件631、弹性偏置锁定杆662、第一臂642和第二臂644。凸轮构件630可围绕枢轴销622旋转，使得凸轮构件630可相对于第二凸轮构件631独立地旋转。凸轮构件630包括被构造成能够顶靠在锁定杆662的锁定齿636上的两个朝近侧延伸的突起623。锁定杆662朝远侧弹性地偏置，使得锁定杆662的锁定齿636接合第二凸轮构件631的凸轮齿635，由此锁定关节运动接头634。第二凸轮构件631可围绕销679旋转并且一体地连接到端部执行器240以使得当锁定杆662从第二凸轮构件631脱离时，第二凸轮构件631可使关节运动接头634进行关节运动，如以下更详细描述的。第二凸轮构件631和锁定杆662分别与第二凸轮构件331和锁定杆262类似。
图22B示出关节运动接头634的示例性操作状态。可以看出，凸轮构件630的突起623被构造成能够顶起并且由此驱动锁定杆662的锁定齿636，以使得锁定杆662被凸轮构件630部分地平移。锁定杆662此类平移是通过第一臂642沿近侧方向的独立致动来实现的。应当理解，第一臂642还可沿远侧方向致动以实现相同的结果。另外，在其他示例中，第二臂644可致动凸轮构件630而不是第一臂642。
在锁定杆662沿近侧方向部分平移以使得第二凸轮构件631被锁定杆662解锁的情况下，第二凸轮构件631可经由第二臂644围绕销679旋转。当然，如以上相对于凸轮构件630所述，第二凸轮构件631可使用第一臂642而不是第二臂644来旋转。锁定杆662可通过第二凸轮构件631的成角度的侧部684而沿近侧方向进一步平移，从而顶靠在锁定杆662的成角度的侧部681上。因此，第二凸轮构件631可类似于上述第二凸轮构件331而从一个凸轮齿635旋转到下一个凸轮齿635。应当理解，由于凸轮构件630可围绕枢轴销622独立地旋转，因此在第二凸轮构件631从一个凸轮齿635旋转到下一个凸轮齿635时，凸轮构件630可与锁定杆662保持基本上对准。因此，第一臂642可再次平移，从而将凸轮构件630枢转回到图22A所示的位置。弹簧(未示出)或其他弹性构件随后可将锁定齿636朝远侧驱动回到图22A所示的位置，由此将端部执行器240的角位置锁定在关节运动接头634处。
D.具有波形凸轮的示例性关节运动接头
图23至图26B示出了轴组件200的示例性另选关节运动接头734。在本示例中，关节运动接头734与关节运动接头234的基本相似之处在于关节运动接头734利用第一凸轮构件730和锁定杆762来锁定和解锁第二凸轮构件731，并且由此使端部执行器240相对于轴组件200的纵向轴线200进行关节运动。尽管图23至图26B中未示出，但应当理解，第二凸轮构件731可一体地附接到端部执行器240，以使得第二凸轮构件731的旋转使端部执行器240进行关节运动。第二凸轮构件731和锁定杆762可与第二凸轮构件331和锁定杆262在结构上类似，如以上相对于关节运动接头234所述的。然而，如下所述，与上述关节运动接头234相比，第二凸轮构件731和锁定杆762可以不同方式操作，以使端部执行器240进行关节运动。第一凸轮构件730和第二凸轮构件731均可围绕销735部分地旋转。端部执行器240可围绕由销735限定的纵向轴线旋转，以使端部执行器240进行关节运动。
从图24中可最佳地看出(示出了相对于图23上下颠倒的第一凸轮构件730)，与第一凸轮构件330不同，第一凸轮构件730包括相对于第一凸轮构件730的顶部表面725和底部表面726倾斜地取向的波形表面727。还与使锁定杆262纵向平移的凸轮构件330不同，本示例的第一凸轮构件730基于波形表面727的构型来提供锁定杆762的垂直运动。换句话讲，虽然锁定杆262沿平行于轴组件200的纵向轴线(LA)的纵向路径行进以提供选择性锁定和解锁，但锁定杆762沿横向于轴组件200的纵向轴线(LA)的垂直路径行进以提供选择性锁定和解锁。锁定杆762的这种垂直运动基于锁定杆762是位于下部垂直位置(锁定，图25A和图26A)中还是上部垂直位置(解锁，图25B和图26B)中而选择性地锁定第二凸轮构件731。在本示例中，锁定杆762沿穿过轴组件200的纵向轴线(LA)和销735的纵向轴线两者的垂直平面运动。在一些其他形式中，锁定杆762沿与穿过轴组件200的纵向轴线(LA)和销735的纵向轴线两者的垂直平面平行的垂直平面运动。
在一些形式中，锁定杆762的近侧端部与轴组件200的安装表面722枢转地联接，并且锁定杆762的远侧端部围绕枢转联接件垂直地枢转，以提供关节运动接头734的选择性锁定和解锁。在一些其他形式中，锁定杆762的整个长度相对于轴组件200的安装表面722沿垂直路径行进，以提供关节运动接头734的选择性锁定和解锁。在任一种形式中，锁定杆762可相对于轴组件200的安装表面722向上弹性地偏置。例如，图25A至图25B示出了圈簧721正插入锁定杆762的远侧部分与安装表面722之间，以使得圈簧721提供向上偏置力。在一些其他形式中(例如，其中锁定杆762的近侧端部与安装表面722枢转地联接的形式)，可使用扭转弹簧来提供向上偏置力。根据本文的教导内容，锁定杆762可被弹性偏置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。
根据上述内容，应当理解，随着第一凸轮构件730旋转，波形表面727能够操作以将锁定杆762向下顶起，或为弹簧721提供间隙以向上驱动锁定杆762，这取决于第一凸轮构件730的角位置。将图23与图25A至图25B进行比较，其示出了关节运动接头734的示例性操作。具体地，从图23、图25A和图26A中可看出，由波形表面727的峰部分728向下推动锁定杆762，以使得锁定杆762接合第二凸轮构件731。应当理解，在图25A所示的构型中，关节运动接头734处于锁定构型中，以使得端部执行器240的角度关节运动位置是固定的。
为了解锁端部执行器240，第一凸轮构件730可经由第一臂742和第二臂744旋转，由此使波形表面727的谷部分729朝锁定杆762旋转。随着谷部分729朝锁定杆762旋转，锁定杆762可开始朝图25B和图26B所示的位置向上行进。从图25B中可以看出，将锁定杆762被接收在波形表面727的谷部分729中并且相应地枢转到最上位置。同样地，当锁定杆762处于该上部位置中时，锁定杆762不再接合第二凸轮构件731。因此，在图25B所示的构型中，解锁第二凸轮构件731，以使得端部执行器240可被允许远离轴组件200的纵向轴线(LA)侧向地偏转。
应当理解，与关节运动接头234类似，关节运动接头734可配备有凸轮翼部738,739和凸台771,773，以使得第一凸轮构件730初始独立地旋转；并且第二凸轮构件731稍后旋转。在其他示例中，凸轮翼部738,739和凸台771,773可完全省去，并且可独立地致动臂742,744以驱动第一凸轮构件730和第二凸轮构件731独立地旋转，如以上相对于第一凸轮构件530所述的。当然，如参考本文的教导内容对于本领域的普通技术人员而言显而易见的是，也可使用导致第一凸轮构件730旋转接着第二凸轮构件731稍后旋转的任何其他合适的方法。
一旦第二凸轮构件731已通过臂742,744进行关节运动到关节运动位置，第一凸轮构件730即可进一步旋转以将第二凸轮构件731转变回到图25A和图26A所示的锁定位置。具体地，第一凸轮构件730可旋转以使得峰部分728将锁定杆762向下驱动为与第二凸轮构件731接合。应当理解，在这种构型中，第二凸轮构件731的两个锁定齿733之间的间隙将与第一凸轮构件730的峰部分728对准；并且峰部分728将锁定杆762的锁定齿736向下驱动到两个锁定齿722之间的间隙中。一旦锁定杆762与第二凸轮构件731完全接合，其中锁定齿736位于两个锁定齿722之间的间隙中，第二凸轮构件731便将锁定到合适的位置中，从而重新锁定关节运动接头734。当然，为使端部执行器240进一步进行关节运动，上述过程可再次开始以使关节运动接头734解锁、进行关节运动并再次锁定。
IV.其他方面
应当理解，本文所述的教导内容、表达、实施方案、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、实施方案、示例等中的任何一者或多者组合。因此，上述教导内容、表达、实施方案、示例等不应视为相对于彼此而独立。根据本文的教导内容，其中本文教导内容可进行组合的各种合适的方式将对本领域的普通技术人员将是显而易见的。此类修改和变型旨在被包括在权利要求书的范围内。还应当理解，本文各种教导内容可易于与本文引用的各种参考文献的教导内容结合。另外，本文各种教导内容可易于与以下美国专利申请的教导内容结合：与本申请同一日提交的名称为“Method of UnlockingArticulation Joint in Surgical Stapler”的美国专利申请No.[代理人案卷号END7431USNP.0614277]，该专利的公开内容以引用方式并入本文；和/或与以下美国专利申请的教导内容接合：与本申请同一日提交的名称为“Pivotable Aritculation JointUnlocking Feature for Surgical Stapler”的美国专利申请No.[代理人案卷号END7446USNP.0614587]，该专利的公开内容以引用方式并入本文。
应当理解，据称以引用方式并入本文中的任何专利、出版物或其他公开材料，无论是全文或部分，仅在所并入的材料与本公开中给出的定义、陈述或者其他公开材料不冲突的范围内并入本文。因此，在必要的程度下，本文明确阐述的公开内容替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、陈述或其他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。
上述装置的型式可应用于由医疗专业人员进行的传统医学治疗和手术、以及机器人辅助的医学治疗和手术中。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Intuitive Surgical,Inc.(Sunnyvale,California)的DAVINCITM系统。类似地，本领域的普通技术人员将认识到本文中的各种教导内容可易于结合以下美国专利申请中的任何申请专利的各种教导内容：于1998年8月11日公布的名称为“ArticulatedSurgical Instrument For Performing Minimally Invasive Surgery With EnhancedDexterity and Sensitivity”的美国专利No.5,792,135，其公开内容以引用方式并入本文；于1998年10月6日公布的名称为“Remote Center Positioning Device with FlexibleDrive”美国专利No.5,817,084，其公开内容以引用方式并入本文；于1999年3月2日公布的名称为“Automated Endoscope System for Optimal Positioning”的美国专利No.5,878,193，其公开内容以引用方式并入本文；于2001年5月15日公布的名称为“Robotic Arm DLUSfor Performing Surgical Tasks”的美国专利No.6,231,565，其公开内容以引用方式并入本文；于2004年8月31日公布的名称为“Robotic Surgical Tool with UltrasoundCauterizing and Cutting Instrument”的美国专利No.6,783,524中，其公开内容以引用方式并入本文；于2002年4月2日公布的名称为“Alignment of Master and Slave in aMinimally Invasive Surgical Apparatus”的美国专利No.6,364,888，其公开内容以引用方式并入本文；于2009年4月28日公布的名称为“Mechanical Actuator Interface Systemfor Robotic Surgical Tools”的美国专利No.7,524,320，其公开内容以引用方式并入本文；于2010年4月6日公布的名称为“Platform Link Wrist Mechanism”的美国专利No.7,691,098，其公开内容以引用方式并入本文；于2010年10月5日公布的名称为“Repositioning and Reorientation of Master/Slave Relationship in MinimallyInvasive Telesurgery”的美国专利No.7,806,891，其公开内容以引用方式并入本文；于2013年1月10日公布的名称为“Automated End Effector Component Reloading Systemfor Use with a Robotic System”的美国公布No.2013/0012957，其公开内容以引用方式并入本文；于2012年8月9日公布的名称为“Robotically-Controlled SurgicalInstrument with Force-Feedback Capabilities”的美国公布No.2012/0199630，其公开内容以引用方式并入本文；于2012年5月31日公布的名称为“Shiftable Drive Interfacefor Robotically-Controlled Surgical Tool”的美国公布No.2012/0132450，其公开内容以引用方式并入本文；于2012年8月9日公布的名称为“Surgical Stapling Instrumentswith Cam-Driven Staple Deployment Arrangements”的美国公布No.2012/0199633，其公开内容以引用方式并入本文；于2012年8月9日公布的名称为“Robotically-ControlledMotorized Surgical End Effector System with Rotary Actuated Closure SystemsHaving Variable Actuation Speeds”的美国公布No.2012/0199631，其公开内容以引用方式并入本文；于2012年8月9日公布的名称为“Robotically-Controlled SurgicalInstrument with Selectively Articulatable End Effector”的美国公布No.2012/0199632，其公开内容以引用方式并入本文；于2012年8月9日公布的名称为“Robotically-Controlled Surgical End Effector System”的美国公布No.2012/0203247，其公开内容以引用方式并入本文；于2012年8月23日公布的名称为“Drive Interface for OperablyCoupling a Manipulatable Surgical Tool to a Robot”的美国公布No.2012/0211546，其公开内容以引用方式并入本文；于2012年6月7日公布的名称为“Robotically-Controlled Cable-Based Surgical End Effectors”的美国公布No.2012/0138660，其公开内容以引用方式并入本文；和/或于2012年8月16日公布的名称为“Robotically-Controlled Surgical End Effector System with Rotary Actuated Closure Systems”的美国公布No.2012/0205421，其公开内容以引用方式并入本文。
上文所述的形式可被设计为单次使用后丢弃，或者它们可被设计为可多次使用。在任一种情况下或两种情况下，可对这些形式进行修复以在至少一次使用之后重复使用。修复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，可拆卸一些形式的装置，并且可选择性地以任何组合形式来替换或移除装置的任意数量的特定零件或部分。在清洁和/或更换特定部分时，该装置的一些形式可在修复设施处重新组装或者在即将进行手术前由用户重新组装以供随后使用。本领域的技术人员将会了解，装置的修复可利用多种技术进行拆卸、清洁/更换、以及重新组装。这些技术的使用和所得的修复装置均在本专利申请的范围内。
仅以举例的方式，本文描述的形式可在手术之前和/或之后进行消毒。在一种消毒技术中，将该装置被放置在闭合且密封的容器诸如塑料袋或TYVEK袋中。然后可将容器和装置放置在可穿透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。然后将经杀菌的装置存储在无菌容器中，以供以后使用。还可使用本领域已知的任何其他技术对装置进行消毒，该任何其他技术包括但不限于β辐射或γ辐射、环氧乙烷或蒸汽。
已示出和描述了本发明的各种实施方案，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。已提及了若干此类潜在修改，并且其他修改对于本领域的技术人员将是显而易见的。例如，上文所述的示例、实施方案、几何形状、材料、尺寸、比率、步骤等均为示例性的而非所要求的。因此，本发明的范围应根据以下权利要求书来考虑，并且应被理解为不限于说明书和附图中示出和描述的结构和操作的细节。

Claims (15)

1.一种外科设备，包括：
(a)主体；
(b)从所述主体朝远侧延伸的轴组件，其中所述轴组件限定纵向轴线，其中所述轴组件具有远侧端部；
(c)端部执行器，其中所述端部执行器能够操作以操纵组织；和
(d)关节运动接头，所述关节运动接头使所述端部执行器与所述轴组件的所述远侧端部联接，其中所述关节运动接头被构造成能够允许所述端部执行器远离所述轴组件的所述纵向轴线偏转，其中所述关节运动接头包括：
(i)锁定组件，所述锁定组件能够操作以选择性地锁定所述端部执行器相对于所述轴组件的所述纵向轴线的角位置，和
(ii)解锁特征结构，所述解锁特征结构能够操作以选择性地解锁所述锁定组件；
其中所述轴组件还包括：
(i)第一可动构件，所述第一可动构件能够操作以选择性地驱动所述关节运动接头处所述端部执行器的关节运动，和
(ii)第二可动构件，所述第二可动构件能够操作以选择性地驱动所述解锁特征结构，
其中所述第二可动构件能够相对于所述第一可动构件独立地运动,其中所述锁定组件包括：
(A)第一锁定构件，所述第一锁定构件一体地固定到所述端部执行器，使得所述第一锁定构件被构造成能够随着所述端部执行器相对于所述轴组件的所述纵向轴线运动，和
(B)第二锁定构件，所述第二锁定构件能够操作以选择性地接合所述第一锁定构件，以由此选择性地锁定所述端部执行器相对于所述轴组件的所述纵向轴线的所述角位置,
其中所述解锁特征结构能够操作以使所述第二锁定构件从所述第一锁定构件选择性地脱离，和
其中所述解锁特征结构能够操作以围绕第一轴线旋转，以由此使所述第二锁定构件从所述第一锁定构件选择性地脱离。
2.根据权利要求1所述的设备，其中所述第一轴线垂直于所述轴组件的所述纵向轴线。
3.根据权利要求1所述的设备，其中所述关节运动接头被构造成能够允许所述端部执行器围绕第二轴线枢转，以由此允许所述端部执行器远离所述轴组件的所述纵向轴线偏转。
4.根据权利要求3所述的设备，其中所述第一轴线和所述第二轴线彼此同延。
5.根据权利要求1所述的设备，其中所述第二锁定构件被构造成能够沿纵向路径平移，以选择性地接合所述第一锁定构件。
6.根据权利要求5所述的设备，其中所述第二锁定构件的所述纵向路径平行于所述轴组件的所述纵向轴线。
7.根据权利要求1所述的设备，其中所述第二锁定构件被构造成能够沿横向路径平移，以选择性地接合所述第一锁定构件。
8.根据权利要求7所述的设备，其中所述第二锁定构件的所述横向路径横向于所述轴组件的所述纵向轴线。
9.根据权利要求1所述的设备，其中所述第一可动构件能够沿纵向路径运动。
10.根据权利要求1所述的设备，其中所述第二可动构件能够沿纵向路径运动。
11.根据权利要求1所述的设备，其中所述解锁特征结构包括一组齿，其中所述齿具有三角形外形或正方形外形。
12.根据权利要求1所述的设备，其中所述解锁特征结构围绕中心轴线是非对称的，所述中心轴线平行于所述轴组件的所述纵向轴线延伸。
13.根据权利要求1所述的设备，其中所述解锁特征结构具有π形构型。
14.根据权利要求1所述的设备，其中所述解锁特征结构具有限定一系列峰和谷的倾斜取向的波形表面，其中所述峰能够操作以提供对所述锁定组件的锁定，其中所述谷能够操作以提供对所述锁定组件的解锁。
15.根据权利要求1所述的设备，其中所述端部执行器包括能够操作以将钉驱动到组织中的缝合组件。
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