CN106473803B - 被构造为降低热发散的电外科端部执行器组件和电外科钳 - Google Patents

被构造为降低热发散的电外科端部执行器组件和电外科钳 Download PDF

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CN106473803B
CN106473803B CN201610616298.8A CN201610616298A CN106473803B CN 106473803 B CN106473803 B CN 106473803B CN 201610616298 A CN201610616298 A CN 201610616298A CN 106473803 B CN106473803 B CN 106473803B
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丁伟江
刘凯
陈建疆
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Ke Hui Co LP
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    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
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Abstract

公开了被构造为降低热发散的电外科端部执行器组件和电外科钳。具体而言，电外科钳的端部执行器组件包括第一钳口构件和第二钳口构件。钳口构件当中至少一个相对于另一个在隔开位置和接近位置之间可移动。钳口构件当中至少一个包括定义外表面的导电内构件、部署在导电内构件的外表面的一部分上的第一电绝缘层、部署在导电内构件的外表面的另一部分上的第二电绝缘层，以及部署在第二电绝缘层上并电耦合到导电内构件的电极。电极定义对应的钳口构件的组织治疗表面。第一电绝缘层具有大于第二电绝缘层的热导率的热导率。

Description

被构造为降低热发散的电外科端部执行器组件和电外科钳
技术领域
本公开内容涉及外科器械，并且更具体而言，涉及被构造为降低到周围组织的热发散的电外科端部执行器组件和电外科钳。
背景技术
外科钳是依赖于其钳口之间的机械动作抓住、钳夹和收缩组织的像钳子一样的设备。电外科钳同时利用机械钳夹动作和能量来治疗(例如凝固、烧灼和/或密封)组织。一般地，电外科钳可被归类为单极电外科钳或双极电外科钳。
双极电外科钳一般采用被充电到不同电势的相对电极，从而使位于电极之间的组织之间和通过其的能量的传导能够治疗组织。虽然需要合适的能量来有效地治疗组织，但是能量向组织的施加应当目标在于(targeted)要被治疗的组织的特定区域。被定义为到目标区域之外相邻组织的热传递(热传导、热对流，或电流耗散)的热发散应当被最小化，因为这会导致对相邻组织的附带损害。
发明内容
如本文中所使用的，术语“远侧”指的是被描述为远离用户的部件或其部分，而术语“近侧”指的是被描述为靠近用户的部件或其部分。另外，就一致的程度而言，本文描述的任何方面可以与本文描述的任何或全部其它方面结合使用。
根据本公开内容各方面提供的电外科钳的端部执行器组件包括第一钳口构件和第二钳口构件，其中钳口构件之一或二者相对于另一个在隔开位置和接近位置之间可移动。钳口构件之一或二者包括定义外表面的导电内构件、部署在导电内构件的外表面的至少第一部分上的第一电绝缘层、部署在导电内构件的外表面的至少第二部分上的第二电绝缘层，以及部署在第二电绝缘层上并电耦合到导电内构件的电极。第一电绝缘层具有大于第二电绝缘层的热导率的热导率。电极定义对应的钳口构件的组织治疗表面。
在本公开内容的一方面，第一电绝缘层包括类金刚石碳。另外或作为替代，第二电绝缘层可以包括二氧化钛。
在本公开内容的另一方面，第二电绝缘层具有小于50W/(m K)的热导率值。
在本公开内容的又一方面，第一电绝缘层具有大于500W/(m K)的热导率值。
在本公开内容的另一方面，导电内构件包括近侧凸缘和远侧主体。在这些方面，第一电绝缘层部署在远端主体的第一部分上，并且第二电绝缘层部署在远侧主体的第二部分和近侧凸缘上。
在本公开内容的又一方面，第二电绝缘层定义窗口并且电极通过该窗口电耦合到导电内构件。
根据本公开内容各方面提供的电外科钳包括端部执行器组件，其包括各自定义组织治疗表面的第一钳口构件和第二钳口构件。钳口构件之一或二者相对于另一个在隔开位置和接近位置之间可移动。钳口构件之一或二者包括部署在钳口构件的至少第一部分上的第一电绝缘层。第一电绝缘层具有大于大约50W/(m K)的热导率值。钳口构件之一或二者还包括部署在钳口构件上并定义其组织治疗表面的电极。
在本公开内容的一方面，第一电绝缘层具有大于大约200W/(m K)的热导率值。在本公开内容的另一方面，第一电绝缘层具有大于大约500W/(m K)的热导率值。
在本公开内容的另一方面，第一电绝缘层被部署在钳口构件的相对于电极的相对侧上。
在本公开内容的又一方面，第二电绝缘层部署在钳口构件之一或二者的第二部分上。第二电绝缘层具有小于大约50W/(m K)的热导率值。
在本公开内容的又一方面，第一和/或第二钳口构件还包括定义外表面的导电内构件。第一电绝缘层部署在导电内构件的外表面的至少一部分上。
在本公开内容的又一方面，外科钳还包括外壳和从外壳向远侧延伸的轴。轴定义远端，并且包括部署在其远端处的端部执行器组件。
在本公开内容的另一方面，外科钳还包括各自定义远端的第一轴构件和第二轴构件。第一轴构件具有附连在其远端处的第一钳口构件并且第二轴构件具有附连在其远端处的第二钳口构件。
根据本公开内容各方面提供的另一电外科钳包括各自包括轴构件、在轴构件的远端处的钳口构件和在轴构件的近端处的手柄的第一导电内构件和第二导电内构件。第一内构件和第二内构件耦合到彼此，使得手柄在打开位置和闭合位置之间的运动在隔开位置和接近位置之间移动钳口构件。导电内构件之一或两者包括部署在其钳口部件的一部分上的第一电绝缘层、部署在其钳口部件的另一部分上并且还部署在其轴构件和手柄构件的一部分上的第二电绝缘层、以及部署在第二电绝缘层的在对应的钳口构件处的一部分上的电极。第一电绝缘层具有大于第二电绝缘层的热导率的热导率。
在本公开内容的一方面，第一电绝缘层具有大于200W/(m K)的热导率值。
在本公开内容的另一方面，第二电绝缘层在对应的钳口构件处定义第一窗口，并且电极通过第一窗口电耦合到该钳口构件。
在本公开内容的又一方面，第二电绝缘层在对应的手柄处定义第二窗口，并且该手柄适于通过第二窗口连接到能量源。
在本公开的又一方面，在第一和/或第二导电内构件的钳口构件处，第一电绝缘层部署在钳口构件的相对于第二电绝缘层和电极的相对侧上。
附图说明
本公开内容的各方面和特征参照附图来描述，其中：
图1是根据本公开内容提供的止血型电外科钳的透视图；
图2是根据本公开内容提供的基于轴的电外科钳的透视图；
图3是通过剖面线3-3的图1的外科钳的端部执行器组件的横剖截面图；
图4是通过剖面线4-4的图1的外科钳的端部执行器组件的横剖截面图；及
图5是被配置为结合本公开内容的各方面和特征使用的机器人外科系统的示意性说明。
具体实施方式
转到图1和图2，图1绘出了止血型电外科钳10并且图2绘出了基于轴的电外科钳10'。本公开内容的各方面和特征适用于外科钳10(图1)、外科钳10'(图2)，或任何其它合适的外科器械。显然，不同的电气和机械连接和考虑适用于每种特定类型的器械；但是，本公开内容的各方面和特征保持基本一致，不考虑所使用的特定器械。
参照图1，外科钳10被示为包括两个细长的轴构件12a、12b，每个轴构件分别具有近端16a、16b和远端14a、14b。外科钳10还包括具有附连到轴构件12a、12b的相应远端14a、14b并关于枢轴销103枢转耦合到彼此的第一钳口构件和第二钳口构件110的端部执行器组件100。每个轴构件12a、12b包括部署在其近端16a、16b处的手柄17a、17b。每个手柄17a、17b定义手指孔18a、18b，用于通过其接纳用户的手指。如可以认识到的，手指孔18a、18b促进轴构件12a、12b相对于彼此的运动，继而以便在隔开位置与接近位置之间枢转钳口构件110、120用于在其间抓握组织。
端部执行器组件100的每个钳口构件110、120包括导电内构件115、125(图3和图4)，其定义相应钳口构件110、120的近侧凸缘111、121以及相应钳口构件110、120的远侧主体112、122。近侧凸缘111、121可以关于枢轴销103枢转耦合到彼此。枢轴销103可以至少部分地由绝缘材料形成和/或包括绝缘材料，以便彼此电隔离钳口构件110、120。远侧主体112、122包括部署在其上的、定义钳口构件110、120的相应组织治疗表面114、124的电极118、128(图3)。组织治疗表面114、124(图3)被构造为在其间抓握组织并且通过组织传导能量以治疗组织，如以下详细描述的。对应的钳口构件110、120的轴构件12a、12b和内构件115、125(图3和图4)可以由钛合金或其它合适的导电材料制成。外科钳10的轴构件12a、12b中至少一个(例如轴构件12a)包括被构造为将外科钳10连接到能量源(未示出)(例如电外科发生器)的近侧轴连接器19。近侧轴连接器19将电缆2固定到外科钳10并且包括连接构件6和激活开关8。近侧轴连接器19与轴构件12a电耦合并且有选择地可与轴构件12b电耦合。更具体而言，当轴构件12a、12b相对于彼此足够接近时，连接构件6接触轴构件12b的突起13，以便在其间建立电连通，使得用户可以有选择地经由相应的轴构件12a、12b从电缆2向钳口构件110、120的内部构件115、125(图3和图4)供应能量，用于治疗被抓握在组织治疗表面114、124(图3)之间的组织。激活开关8可以有选择地被致动以发起能量到钳口构件110、120的组织治疗表面114、124(图3)的供应。作为对用来电耦合组织治疗表面114、124(图3)与电缆2的单个近侧轴连接器19的替代方案，每个轴构件12a、12b可以包括用于向其相应的组织治疗表面114、124(图3)供应能量的近侧连接器。在下文中更详细地描述端部执行器组件100的钳口构件110、120的构造和配置。
参照图2，外科钳10'一般包括外壳20、手柄组件30、旋转组件70、激活开关8'、以及端部执行器组件200。外科钳10'还包括轴12，其具有被构造为机械接合端部执行器组件200的远端14和机械接合外壳20的近端16。外科钳10'还包括电缆2'，其将外科钳10'连接到能量源(未示出)(例如电外科发生器)，但是外科钳10'可以作为替代地被构造为电池供电的设备。电缆2'包括具有足够长度延伸通过其的导线(或多根导线)(未示出)以延伸通过轴12，以便分别向端部执行器组件200的钳口构件210、220的一个或两个组织治疗表面214、224提供能量。作为替代，能量可以以任何其它合适的方式(例如经由外科钳10'的导电结构部件、电刷触点等)供应给钳口构件210、220的相应组织治疗表面214、224。激活开关8'分别耦合在钳口构件210、220的组织治疗表面214、224能量源(未示出)之间，用于使得能量能够被有选择地供应给钳口构件210、220，用于治疗被抓握在其间的组织。旋转组件70在任一方向可旋转，以便相对于外壳20旋转端部执行器组件200。
手柄组件30包括固定手柄50和可移动手柄40。固定手柄50与外壳20一体化关联，并且可移动手柄40相对于固定手柄50可移动。更具体而言，可移动手柄40可枢转耦合到外壳20中的外壳20并且操作上耦合到部署在外壳20中的驱动组件(未示出)，使得可移动手柄40和驱动组件(未示出)一起机械协作，以便在隔开位置与接近位置之间赋予钳口构件210、220之一或二者的运动，以抓握其间的组织。如图2中所示，可移动手柄40最初与固定手柄50隔开，并且对应地，钳口构件210、220部署在隔开位置。可移动手柄40可从该初始位置被按压到对应于钳口构件210、220的接近位置的按压位置。钳口构件210、220可以定义双侧构造，例如，其中两个钳口构件210、220都在隔开位置与接近位置之间可移动，或者单侧构造，例如，其中钳口构件210、220之一是固定的并且另一个钳口构件210、220在隔开位置与接近位置之间可移动。
与端部执行器组件100(图1)类似地，端部执行器组件200的钳口构件210、220各自包括近侧凸缘211、221和远侧主体212、222。虽然下面相对于外科钳10(见图1)的端部执行器100详细描述，但是本发明的各方面和特征同样适用于与外科钳10'的端部执行器200或任何其它合适的外科器械一起使用。
转到图1、图3和图4，如下面详细描述的，端部执行器组件100的钳口构件110、120被构造为抑制在组织治疗表面114、124之间定义的区域(组织治疗区域)以外的热发散，从而抑制对与组织治疗区域相邻的组织的附带损害。如上面所指示的，每个钳口构件110、120包括导电内构件115、125。内构件115、125定义钳口构件110、120的相应的近侧凸缘部分111、121(图4)和相应的远侧主体112、122(图3)。如下面详细描述的，一个或多个电绝缘外层(例如，第一电绝缘外层116、126和第二电绝缘外层117、127)，分别部署在钳口构件110、120的相应内构件115、125的远侧主体112、122(图3)上。另外，电极118、128分别部署在钳口构件110、120的远侧主体112、122(图3)的相对表面上，以便定义组织治疗表面114、124。如下面详细描述的，电极118、128部署成与相应的导电内构件115、125电连通，以便启用电极118、128的通电和能量通过分别在钳口构件110、120的组织治疗表面114、124之间被抓握的组织的传导，以便治疗组织。
参照图3，第一外层116、126分别围绕钳口构件110、120的内构件115、125的远侧主体112、122的顶部一半和底部一半的外周延伸(如图3中所看到的)。另一方面，第二外层117、127围绕钳口构件110、120的内构件115、125的远侧主体构112、122的另一半(例如，底部一半和顶部一半)的外周延伸(如图3中所看到的)。但是，第一外层116、126和第二外层117、127可以围绕内构件115、125的远侧主体构112、122的多于或少于一半延伸，例如，其中第一外层116、126和第二外层117、127围绕远侧主体112、122延伸，以便按照面积定义55/45分割、60/40分割、45/55分割、40/60分割或其它合适的覆盖率。
第一外层116、126可以经由利用任何合适的技术将电绝缘材料涂覆到内构件115、125的远侧主体112、122上而形成。在一些实施例中，第一外层116、126由具有大于大约50W/(m K)的热导率值的材料制成，在其它一些实施例中大于大约200W/(m K)，并在还有一些其它实施例中大于大约500W/(m K)。在一些实施例中，第一外层116、126可以各自具有从大约1μm至大约50μm的厚度，并且在一些其它实施例中从大约5μm至大约20μm。在一些实施例中，第一外层116、126由类金刚石碳制成。在这种实施例中，第一外层116、126可以利用例如化学气相沉积或物理气相沉积来涂覆(apply)。
继续参照图3，如上面所指出的，第二外层117、127分别围绕钳口构件110、120的内构件115、125的远侧主体112、122的底部和顶部一半的外部延伸(如在图3中所看到的)。在一些实施例中，第二外层117、127由具有小于第一外层116、126的热导率的热导率值的材料制成。在一些实施例中，第二外层117、127由具有小于约50W/(m K)的热导率值的材料制成，在一些其它实施例中小于大约25W/(m K)，并且在还有一些其它实施例中小于大约10W/(mK)。在一些实施例中，第二外层117、127可以具有从大约1μm至大约50μm的厚度，或者在一些其它实施例中从大约5μm至大约20μm。第二外层117、127可以利用任何合适的技术来涂覆和/或可以由任何合适的材料(例如二氧化钛(TiO2))形成。当第二外层117、127由二氧化钛(TiO2)制成时，第二外层117、127例如可以利用粉末涂覆来涂覆。
第二外层117、127定义延伸穿过其的窗口131、132。如下面详细描述的，提供窗口131、132被设置为启用内部构件115、125和电极118、128之间的电连接。在一些实施例中，第一外层116、126和第二外层117、127协作，以便除窗口131、132之外完全环绕并覆盖内构件115、125的外部。
在涂覆第二外层117、127之前，内构件115、125可以被预先处理，以改善第二外层117、127在其上的粘附。在一些实施例中，内构件115、125的第二外层117、127要应用到其的部分经受微弧氧化(MAO)处理，以促进第二外层117、127的后续粘附，如下面详细描述的。
仍参照图3，如上面所指出的，电极118、128部署在钳口构件110、120的远侧主体112、122上。更具体而言，电极118、128部署在第二外层117、127上，第二外层117、127又围绕内构件115、125的远端主体112、122部署。电极118、128定义钳口构件110、120的组织治疗表面114、124，并且被定位成相对于彼此处于大致相对关系，以便使得能够在钳口构件110、120的接近位置处抓握其间的组织。
电极118、128由涂覆到第二外层117、127的导电材料形成。电极118、128在相应的第二外层117、127内定义的窗口131、132之上延伸，使得电极118、128经由窗口131、132电连接到相应的内构件115、125。电极118、128可以至少部分地填充窗口131、132以建立这种连接，内构件115、125可以突入窗口131、132中以建立这种连接，和/或导电材料可以部署在窗口131、132中以建立这种连接。
在图3中电极118、128被示为嵌套在第二外层117、127中；但是，在一些实施例中，电极118、128可以从第二外层117、127突出。电极118、128可以由任何合适的导电材料制成，包括但不限于氮化物材料，诸如TiN、ZrN、TiAlN和CrN。在一些实施例中，电极118、128通过离子注入氮化物形成，但是也可以使用应用氮化物和其它导电材料的其它方法。当通过离子注入应用时，电极118、128可以是薄导电膜的形式，在一些实施例中，其具有从大约0.0001mm至大约0.05mm的厚度，或者在一些其它实施例中，从大约0.001mm至大约0.01mm。
另外参照图4，钳口构件110、120的内构件115、125的近侧凸缘111、121都涂有第二外层117、127。因此，第一外层116、126仅分别涂覆内构件115、125的远侧主体112、122的顶部一半和底部一半(如在图3中看到的)，而每个内构件115、125除了窗口131、132之外的剩余部分利用第二外层117、127涂覆，其中窗口定义非电绝缘涂覆的区域。当内构件115、125向近侧延伸并且从其远端主体112、122过渡到其近侧凸缘111、121时，被第一外层116、126覆盖的面积的百分比减小，而被第二外层117、127覆盖的百分比增加，从而定义过渡区域。作为替代，可以在远侧主体112、122和近侧凸缘111、121之间定义突然的过渡，其中第一外层116、126停止并且仅设置第二外层117、127。
另外参照图1，关于外科钳10(图1)，轴构件12a、12b可以与内构件115、125整体形成，并且可以同样分别利用第二外层117、127涂覆，以便电绝缘轴构件12a、12b。由于第二外层117、127定义相对低的热导率，因此这种配置使用户能够抓握轴构件12a、12b而没有被烧伤的危险。第二外层117、127还可以定义分别与近侧轴连接器19和突起13相邻的窗口(未示出)，以启用电缆2和轴构件12a、12b的内部导电部分之间的电连接。
一般地参照图1、图3和图4，关于端部执行器组件100的制造，端部执行器组件100的不被第二外层117、127涂覆的区域(例如，利用第一外层116、126覆盖的部分，以及窗口131、132的位置)被遮蔽。在轴构件12a、12b也利用第二外层117、127涂覆的实施例中，要分别与近侧轴连接器19和突起13相邻形成的窗口(未示出)同样被遮蔽。端部执行器组件100和/或外科钳10的未遮蔽区域然后经受微弧氧化(MAO)处理。然后第二外层117、127在相应内构件115、125和/或轴构件12a、12b的经过MAO处理的区域上形成。掩模被去除，并且电极118、128通过第二外层117、127的适当部分的离子注入处理被创建。然后，第一外层116、126在内构件115、125的之前被遮蔽的并且因此未处理的部分上形成。
仍参照图1、图3和图4，描述外科钳10的使用和操作。最初，轴构件12a、12b彼此移动分开到打开位置，这对应于钳口构件110、120的隔开位置。在这个位置，外科钳10可被操纵，使得要被抓握和治疗的组织部署在钳口构件110、120之间。
一旦组织按需被定位，轴构件12a、12b就可以朝彼此移动(例如)移动到闭合位置，以便朝着接近位置绕枢轴销103枢转钳口部件110、120，以便抓握在组织处理表面114、124之间的组织。通过轴构件12a、12b充分接近并且因此钳口构件110、120的组织处理表面114、124之间被抓握的组织处于合适的闭合压力下，轴构件12b的突起13接触连接构件6，由此建立电缆2和轴构件12b之间的电连接，其中轴构件12a已经经由近侧轴连接器19连接到电缆2。在其中单独的轴连接器(未示出)将电缆2连接到轴构件12a、12b的实施例中，这种在轴构件12a、12b充分接近时的连接是不必要的，因为在这种实施例中轴构件12a、12b已经电连接到电缆2。
通过组织在组织治疗表面114、124之间被抓握并且电连接被建立，如果需要的话，用户可以有选择地通过致动激活开关8分别经由轴构件12a、12b和内构件115、125向电极118、128施加电外科能量。当这样致动时，能量在电极118、128之间传导并且通过在由电极118、128定义的组织治疗表面114、124之间被抓握的组织，由此治疗被抓握的组织。一旦组织已被充分治疗，轴构件12a、12b就可以返回到打开位置，以便将钳口构件110、120返回到隔开位置，以释放治疗过的组织。在一些实施例中，外科钳10还可以结合机械和/或电特征，以便使得能够在组织治疗后(或者当只期望组织切割时)沿着治疗区域进行组织切割。
在组织治疗期间，由于第一外层116、126的相对高的热导率，经由电极118、128之间和通过组织的能量传导所生成的热量沿着钳口构件110、120的远侧主体112、122的长度耗散。另外，由于第一外层116、126部署在钳口构件110、120的相对于电极118、128相对侧上并且由于第一外层116、126相对于第二外层117、127的相对高的热导率，热量从电极118、128传导离开。具有相对低热导率的第二外层117、127抑制热量横向从电极118、128并接近钳口构件110、120的近侧凸缘111、121传导。因此，经由钳口构件110、120的上面详述构造，从电极118、128的热发散被减少，并且由于热发散对周围组织造成的附带损害被抑制。
参照图1-图4，外科钳10和10'(分别为图1和2)以及结合本公开内容的上面详述特征的外科器械可被构造为与机器人外科系统一起工作并且通常被称为“远程外科”。这种系统采用各种机器人元件来协助外科医生并且允许外科器械的远程操作(或部分远程操作)。各种机器人手臂、齿轮、凸轮(cam)、皮带轮(pulley)、电气和机械马达等可以被用于这个目的，并且可以利用机器人外科系统进行设计，以便在手术或治疗的过程中协助外科医生。这种机器人系统可以包括远程导向系统、自动柔性外科系统、远程柔性外科系统、远程铰接外科系统、无线外科系统、模块化或选择性可配置远程操作外科系统，等等。
机器人外科系统可供在手术室旁边或位于远程位置的一个或多个控制台采用。在这种情况下，外科医生或护士的一个团队可以准备患者进行手术，并且利用本文公开的一种或多种器械配置机器人外科系统，而另一个外科医生(或外科医生组)经由该机器人外科系统远程控制器械。如可以认识到的，高度熟练的外科医生可以在不离开他/她的远程控制台的情况下在多个地点执行多个手术，这既是经济上有利的又是对患者或一系列的患者的好处。
外科系统的机械手臂通常通过控制器耦合到一对主手柄。手柄可以由外科医生移动，以产生任何类型外科器械(例如，端部执行器、抓握器、刀、剪刀，等等)的工作端的对应运动，这可以补充本文所描述的一个或多个实施例。主手柄的运动还可被缩放，使得工作端具有与由外科医生的操作手执行的运动不同的、更小或更大的对应运动。缩放因子或传动比是可调节的，使得操作人员能够控制(一个或多个)外科器械的工作端的分辨率。
主手柄可以包括各种传感器，以便向外科医生提供关于各种组织参数或条件的反馈，诸如，由于操纵、切割或其它方式的治疗造成的组织电阻、器械在组织上的压力、组织温度、组织阻抗，等等。如可以认识到的，这种传感器为外科医生提供模拟实际手术条件的增强的触觉反馈。主手柄还可以包括各种不同的致动器，用于专门的组织操纵或治疗，从而进一步增强外科医生模拟实际手术条件的能力。
转到图5，医疗工作站总体上被示为工作站1000，并且一般可以包括多个机械手臂1002、1003；控制设备1004；以及与控制设备1004耦合的操作控制台1005。操作控制台1005可以包括显示设备1006，其尤其可被设置为显示三维图像；以及手动输入设备1007、1008，通过手动输入设备外科医生可能能够在第一操作模式下远程操纵机械手臂1002、1003。
根据本文公开的几个实施例中的任意一个，每个机械手臂1002、1003可以包括通过接头连接的多个构件，以及可以附连到其的附连设备1009、1011，例如，支撑端部执行器1100的外科工具“ST”，如将在下面更详细描述的。
机械手臂1002、1003可以被连接到控制设备1004的电驱动器(未示出)驱动。控制设备1004(例如，计算机)可被设置为以如下方式激活驱动器(具体而言通过计算机程序)：机械手臂1002、1003、其附连设备1009、1011以及继而外科工具(包括端部执行器1100)根据借助于手动输入设备1007、1008定义的运动执行期望的运动。控制设备1004还可以以如下方式设置，该方式使得控制设备1004调节机械手臂1002、1003和/或驱动器的运动。
医疗工作站1000可被构造为以最小入侵的方式借助于端部执行器1100对躺在患者检查台1012上要进行治疗的患者1013使用。医疗工作站1000还可以包括两个以上的机械手臂1002、1003，该附加的机械手臂同样连接到控制设备1004并且借助于操作控制台1005可被远程操纵。医疗器械或外科工具(包括端部执行器1100)还可以附连到附加的机械手臂。医疗工作站1000可以包括数据库1014(具体而言耦合到控制设备1004)，在该数据库1014中存储例如来自患者/活体1013的术前数据和/或解剖图谱。
根据上文并参照各个附图，本领域技术人员将认识到，在不背离其范围的情况下，也可对本公开内容进行某些修改。虽然本公开内容的若干实施例已在附图中示出，但这并不意味着本公开内容局限于此，因为本公开内容的范围预期和本领域允许的一样广泛并且本说明书同样地被阅读。因此，以上描述不应当被认为是限制，而仅仅是特定实施例的范例。本领域技术人员将预想到在所附的权利要求书的范围和精神内的其它修改。

Claims (19)

1.一种电外科钳的端部执行器组件，包括：
第一钳口构件和第二钳口构件，其中第一钳口构件或第二钳口构件当中至少一个相对于第一钳口构件或第二钳口构件当中另一个在隔开位置和接近位置之间可移动，第一钳口构件或第二钳口构件当中至少一个包括：
定义外表面的导电内构件；
部署在导电内构件的外表面的至少第一部分上的第一电绝缘层；
部署在导电内构件的外表面的至少第二部分上的第二电绝缘层，第一电绝缘层具有大于第二电绝缘层的热导率的热导率；及
部署在第二电绝缘层上并电耦合到导电内构件的电极，该电极定义第一钳口构件和第二钳口构件当中至少一个的组织治疗表面。
2.如权利要求1所述的端部执行器组件，其中第一电绝缘层包括类金刚石碳。
3.如权利要求1所述的端部执行器组件，其中第二电绝缘层包括二氧化钛。
4.如权利要求1所述的端部执行器组件，其中第二电绝缘层具有小于50W/(mK)的热导率值。
5.如权利要求1所述的端部执行器组件，其中第一电绝缘层具有大于500W/(mK)的热导率值。
6.如权利要求1所述的端部执行器组件，其中导电内构件包括近侧凸缘和远侧主体，其中第一电绝缘层部署在远侧主体的第一部分上，并且其中第二电绝缘层部署在远侧主体的第二部分和近侧凸缘上。
7.如权利要求1所述的端部执行器组件，其中第二电绝缘层定义窗口，并且其中电极通过该窗口电耦合到导电内构件。
8.一种电外科钳，包括：
端部执行器组件，包括：
第一钳口构件和第二钳口构件，每个钳口构件定义组织治疗表面，第一钳口构件或第二钳口构件当中至少一个相对于第一钳口构件或第二钳口构件当中另一个在隔开位置和接近位置之间可移动，第一钳口构件或第二钳口构件当中至少一个包括：
部署在第一钳口构件或第二钳口构件当中至少一个的至少第一部分上的第一电绝缘层，第一电绝缘层具有大于大约50W/(mK)的热导率值；
部署在第一钳口构件或第二钳口构件当中至少一个的第二部分上的第二电绝缘层，第二电绝缘层具有小于大约50W/(mK)的热导率值；和
部署在第一钳口构件或第二钳口构件当中至少一个上并定义其组织治疗表面的电极。
9.如权利要求8所述的电外科钳，其中第一电绝缘层具有大于大约200W/(mK)的热导率值。
10.如权利要求8所述的电外科钳，其中第一电绝缘层具有大于大约500W/(mK)的热导率值。
11.如权利要求8所述的电外科钳，其中第一电绝缘层被部署在第一钳口构件或第二钳口构件当中至少一个的相对于电极的相对侧上。
12.如权利要求8所述的电外科钳，其中第一钳口构件或第二钳口构件当中至少一个还包括定义外表面的导电内构件，第一电绝缘层部署在导电性内构件的外表面的至少一部分上。
13.如权利要求8所述的电外科钳，还包括：
外壳；及
从外壳向远侧延伸并定义远端的轴，其中端部执行器组件部署在轴的远端。
14.如权利要求8所述的电外科钳，还包括：
第一轴构件和第二轴构件，每个轴构件定义远端，第一轴构件具有附连在其远端处的第一钳口构件并且第二轴构件具有附连在其远端处的第二钳口构件。
15.一种电外科钳，包括：
第一导电内构件，包括第一轴构件、在第一轴构件的远端处的第一钳口构件和在第一轴构件的近端处的第一手柄；及
第二导电内构件，包括第二轴构件、在第二轴构件的远端处的第二钳口构件和在第二轴构件的近端处的第二手柄，第一导电内构件和第二导电内构件耦合到彼此，使得第一手柄和第二手柄在打开位置和闭合位置之间的运动在隔开位置和接近位置之间移动第一钳口构件和第二钳口构件，第一导电内构件或第二导电内构件当中至少一个包括：
第一电绝缘层，部署在第一导电内构件或第二导电内构件当中至少一个的钳口构件的至少第一部分上；
第二电绝缘层，部署在第一导电内构件或第二导电内构件当中至少一个的钳口构件的至少第二部分、第一导电内构件或第二导电内构件当中至少一个的轴构件的至少一部分以及第一导电内构件或第二导电内构件当中至少一个的手柄的至少一部分上，其中第一电绝缘层具有比第二电绝缘层的热导率高的热导率；及
电极，部署在第二电绝缘层的在第一导电内构件或第二导电内构件当中至少一个的钳口构件处的至少一部分上，以定义该钳口构件的组织治疗表面。
16.如权利要求15所述的电外科钳，其中第一电绝缘层具有大于200W/(mK)的热导率值。
17.如权利要求15所述的电外科钳，其中第二电绝缘层在第一导电内构件或第二导电内构件当中至少一个的钳口构件处定义第一窗口，并且其中电极通过第一窗口电耦合到第一导电内构件或第二导电内构件当中至少一个的钳口构件。
18.如权利要求15所述的电外科钳，其中第二电绝缘层在第一导电内构件或第二导电内构件当中至少一个的手柄处定义第二窗口，并且其中第一导电内构件或第二导电内构件当中至少一个的手柄适于通过第二窗口连接到能量源。
19.如权利要求15所述的电外科钳，其中，在第一导电内构件和/或第二导电内构件当中至少一个的钳口构件处，第一电绝缘层部署在钳口构件的相对于第二电绝缘层和电极的相对侧上。
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