CN106572853B - 用于外科器械的闭合锁定系统 - Google Patents
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Abstract
本发明公开了一种外科器械。该外科器械可包括第一钳口、第二钳口和钳口闭合锁定系统(1250)。第一钳口可包括枢转销狭槽(1214)和滑动销狭槽(1211、1217或1219)。第二钳口可包括砧座(1220),以及另外的包括枢转销(1230)的安装部分(1223),该枢转销可动地定位在枢转销狭槽中。可移位引导件(1240)能够可动地定位在第一钳口中,并且可包括主体(1242)和阻隔件壁(1241)。主体可包括可动地定位在滑动销狭槽中的滑动销(1243、1245或1249)。当滑动销定位在滑动销狭槽中的位置范围内时,阻隔壁可与枢转销狭槽的一部分对准,并且当滑动销定位在位置范围之外时,阻隔壁可从枢转销狭槽偏移。
Description
背景技术
本发明涉及外科器械,并且在各种实施方案中,涉及被设计成用于切割和缝合组织的外科切割和缝合器械及其钉仓。
附图说明
通过结合附图来参考本发明实施方案的以下说明,本发明的特征和优点以及其获取方法将会变得更加明显,并可更好地理解发明本身,其中:
图1为外科缝合器械实施方案的透视图;
图2为图1的外科缝合器械的分解组装视图;
图3为关节运动组件实施方案的一部分的分解组装视图;
图4为柄部的一部分的局部分解透视图;
图5为移除柄部壳体的柄部的侧视图;
图6为端部执行器和砧座锁实施方案的局部分解透视图;
图6A为另一个端部执行器和砧座锁定构件实施方案的局部分解透视图;
图7为砧座锁定构件实施方案的透视图;
图7A为图6A的砧座锁定构件实施方案的透视图;
图8为处于打开位置的端部执行器实施方案的侧正视图;
图9为图8的端部执行器的顶视图;
图10为图8和图9所示的端部执行器的底视图;
图11为砧座实施方案的局部底部透视图;
图12为枢转座实施方案的透视图;
图13为图12的枢转座实施方案的底部透视图;
图14为外科钉仓实施方案的近侧端部部分的透视图;
图15为图14所示的外科钉仓实施方案的侧正视图;
图16为将钉仓安置在细长通道中之前的端部执行器实施方案的侧视图;
图17为图16所示的端部执行器的剖视图;
图18为具有处于打开位置的砧座的图16和图17的端部执行器实施方案的侧视图,并且其中外科钉仓正被插入细长通道中;
图19为图18的端部执行器的剖视图;
图20为具有被安置在细长通道内的钉仓实施方案的图16-图19的端部执行器的侧视图;
图21为图20的端部执行器的剖视图;
图22为夹紧组织的图16-图22的端部执行器的侧正视图;
图23为图22的端部执行器的剖视图;
图24为处于预备击发的完全夹紧位置的图16-图23的端部执行器的侧正视图;
图25为图24的端部执行器的剖视图;
图26为另一个外科缝合器械实施方案的分解组装视图;
图27为另一个枢转座实施方案的透视图;
图28为图27的枢转座实施方案的底部透视图;
图29为端部执行器和另一个砧座锁定构件实施方案的局部分解透视图;
图30为另一个砧座锁定构件实施方案的透视图;
图31为另一个外科钉仓实施方案的近侧端部部分的局部侧正视图;
图32为图31的外科钉仓实施方案的近侧端部部分的透视图;
图33为将钉仓安置在细长通道中之前的另一个端部执行器的侧视图;
图34为图33所示的端部执行器的剖视图;
图35为具有处于打开位置的砧座的图33和图34的端部执行器实施方案的侧视图,并且其中外科钉仓正被插入细长通道中;
图36为图35的端部执行器的剖视图;
图37为具有被安置在细长通道内的钉仓实施方案的图33-36的端部执行器的侧视图;
图38为图37的端部执行器的剖视图;
图39为夹紧组织的图33-图38的端部执行器的侧正视图;
图40为图39的端部执行器的剖视图;
图41为处于预备击发的完全夹紧位置的图33-图40的端部执行器的侧正视图;
图42为图41的端部执行器的剖视图;
图43为根据本公开的各种实施方案的端部执行器的透视图,该端部执行器包括砧座、能够与砧座接合的闭合管、细长通道以及定位在细长通道中的钉仓。
图44为图43的端部执行器的剖面透视图,为了说明的目的,该端部执行器被示为从其中移除切割元件和楔形滑动件;
图45为图43的端部执行器的分解透视图;
图46为图43的端部执行器的局部分解透视图;
图47为图43的端部执行器的另一个局部分解透视图;
图48为图43的端部执行器的正视图,其示出处于打开取向的砧座、砧座锁定系统以及从细长通道移除的钉仓,其中已经以横截面示出端部执行器的闭合管,从而示出端部执行器的各种其他方面;
图49为在图48所示的配置中的图43的端部执行器的剖面正视图;
图50为如图48所示的砧座锁定系统的细部图;
图51为如图49所示的砧座锁定系统的细部图;
图52为图43的端部执行器的正视图,其示出处于打开取向的砧座、砧座锁定系统以及定位在细长通道中的钉仓,其中已经以横截面示出端部执行器的闭合管,从而示出端部执行器的其他各种方面;
图53为在图52所示的配置中的图43的端部执行器的剖面正视图;
图54为图53所示的砧座锁定系统的细部图,其中为了说明的目的,遮蔽砧座的安装部分;
图55为图43的端部执行器的正视图,其示出定位在细长通道中的钉仓和处于部分闭合取向的砧座,其中以横截面示出的闭合管已被朝远侧推进,以将砧座移动到其部分闭合取向中;
图56为在图55所示的配置中的图43的端部执行器的剖面正视图;
图57为如图55所示的砧座锁定系统的细部图;
图58为如图56所示的砧座锁定系统的细部图;
图59为图43的端部执行器的正视图,其示出定位在细长通道中的钉仓和处于完全夹紧取向的砧座,其中以横截面示出的闭合管已被朝远侧推进,以使砧座移动到其完全夹紧取向中;以及
图60为在图59所示的配置中的图43的端部执行器的剖面正视图。
具体实施方式
现在将描述某些示例性实施方案,以从整体上理解本文所公开的装置和方法的结构、功能、制造和用途的原理。这些实施方案的一个或多个示例在附图中示出。本领域的普通技术人员将会理解,在本文中具体描述并示出于附图中的装置和方法为非限制性的示例性实施方案,并且本发明的多个实施方案的范围仅由权利要求书限定。结合一个示例性实施方案进行图解说明或描述的特征可与其他实施方案的特征进行组合。这些修改和变型旨在被包括在本发明的范围之内。
本说明书通篇提及的“各种实施方案”、“一些实施方案”或“实施方案”等,意味着结合该实施方案描述的具体特征、结构或特性包括在至少一个实施方案中。因此,本说明书通篇出现的短语“在多种实施方案中”、“在一些实施方案中”、“在一个实施方案中”或“在实施方案中”等并不一定都指相同的实施方案。此外,在一个或多个实施方案中,具体特征、结构或特性可按任何合适的方式组合。因此,在无限制的情形下,结合一个实施方案示出或描述的具体特征、结构或特性可全部或部分地与一个或多个其他实施方案的特征、结构或特性组合。这些修改和变型旨在涵盖于本发明的范围之内。
本文所用术语“近侧”和“远侧”是相对于操纵外科器械的柄部部分的临床医生而言的。术语“近侧”是指最靠近临床医生的部分,术语“远侧”则是指位于远离临床医生的位置的部分。还应当理解,为简洁和清楚起见,本文可结合附图使用诸如“竖直”、“水平”、“上”和“下”之类的空间术语。然而,外科器械在许多取向和位置中使用,并且这些术语并非旨在为限制性的和/或绝对的。
提供各种示例性装置和方法以用于执行腹腔镜式和微创外科手术操作。然而,本领域的普通技术人员将容易理解,本文所公开的各种方法和装置可用于许多外科手术和应用中,包括例如与开放式外科手术相结合。继续参阅本具体实施方式,本领域中的普通技术人员将进一步理解,本文所公开的各种器械可以任何方式插入体内,诸如通过自然腔道、通过形成于组织中的切口或穿刺孔等。器械的工作部分或端部执行器部分可被直接插入患者体内或可通过具有工作通道的接近装置插入,外科器械的端部执行器及细长轴可通过该工作通道而推进。
转到附图,其中在全部若干附图中,类似的数字代表类似的部件,图1和图2示出了能够实施本文所公开的各种实施方案的独特益处的外科缝合装置10。具有使本发明的实施方案可被有效采用的特征的示例性外科装置在1998年6月6日公布的名称为“ARTICULATIONASSEMBLY FOR SURGICAL INSTRUMENTS”的美国专利5,704,534中有所公开,该专利的全部公开内容以引用方式并入本文。各种其他示例性外科缝合装置实施方案在以下美国专利中进行更详细地描述,这些专利全部内容均以引用方式并入本文:2005年11月15日公布的名称为“SURGICAL STAPLING INSTRUMENT HAVING ARTICULATION JOINT SUPPORT PLATESFOR SUPPORTING A FIRING BAR”的美国专利6,964,363;2006年2月21日公布的名称为“SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRINGMOTIONS”的美国专利7,000,818;2006年5月16日公布的名称为“SURGICAL STAPLINGINSTRUMENT HAVING A SINGLE LOCKOUT MECHANISM FOR PREVENTION OF FIRING”的美国专利7,044,352;2006年9月26日公布的名称为“SURGICAL INSTRUMENT INCORPORATING ANARTICULATION MECHANISM HAVING ROTATION ABOUT THE LONGITUDINAL AXIS”的美国专利7,111,769;以及2006年12月5日公布的名称为“SURGICAL STAPLING INSTRUMENT HAVING AFIRING LOCKOUT FOR AN UNCLOSED ANVIL”的美国专利7,143,923。
再次参见图1和图2,示出的外科缝合装置10包括可操作地连接到工具部分22的柄部20,该工具部分22还包括可操作地联接到端部执行器200的细长轴组件30。柄部20包括手枪式握把24,由临床医生朝向手枪式握把24枢转地拉动闭合触发器152,以使得朝向端部执行器200的细长通道210夹紧或闭合砧座220。击发触发器102在闭合触发器152的更外侧,并被临床医生枢转地拉动,以使被夹紧的组织在端部执行器200中被缝合和割断。
例如,首先致动闭合触发器152。一旦临床医生对于端部执行器200的定位感到满意,则临床医生可将闭合触发器152拉回至其紧邻手枪式握把24的完全闭合、锁定的位置。接着,致动击发触发器102。当临床医生移除压力时,击发触发器102以弹簧方式返回。当被按压在柄部20的近侧端部上时,释放按钮120释放锁定的闭合触发器152。
关节运动系统
示出的实施方案包括关节运动组件62,该关节运动组件62被构造成能够有利于端部执行器200围绕装置10的细长轴线A-A的关节运动。然而,各种实施方案也可结合非关节运动式外科缝合装置而被有效地采用。如在例如图2中可见,细长轴组件30包括由支撑在柄部20上的喷嘴60可操作地支撑的近侧闭合管段151。柄部20可由可操作地包含击发系统100和闭合系统150的两个柄部壳体21、23形成。参见图1,近侧闭合管段151的近侧端部部分153由柄部20可旋转地支撑,以有利于其围绕细长轴线A-A的选择性旋转。如另外在图1和图2中可见,在至少一个实施方案中,近侧闭合管段151的远侧端部部分157联接到挠性颈部组件70。挠性颈部组件70具有接收第一细长挠性传输带组件83和第二细长挠性传输带组件85的第一挠性颈部部分72和第二挠性颈部部分74。第一传输带组件83和第二传输带组件85具有分别从该带的结构部分朝远侧延伸的外部加强带部分86、87。每个外部加强带部分86、87具有用于固定第一内部关节运动带89和第二内部关节运动带90的多个附接耳状物88。参见图2。传输带组件83、85可例如由塑料(尤其是以商品名Grivory GV-6H购自EMS-AmericanGrilon公司的玻璃纤维增强型无定形聚酰胺)构成。相比之下,可期望传输带组件83、85的内部关节运动带89、90由金属构成,该金属优选地为全硬301不锈钢或其等同物。传输带83、85的外部加强带部分86、87上的附接耳状物88被接收在并被固定在多个耳状物孔91内,该多个耳状物孔91在对应的内部关节运动带89、90上。在第一内部关节运动带组件89和第二内部关节运动带组件90的远侧端部处,存在第一连接器92和第二连接器93。关节运动组件还包括远侧关节运动带96和97,其被构造成能够分别以钩的形式接合第一连接器92和第二连接器93。关节运动带96和97具有插孔98、99以将带96、97联接到端部执行器200,如将在下文进一步详细讨论。
在至少一种形式中,挠性颈部组件70优选地由以ISOPLAST等级2510购自陶氏化学公司的刚性热塑性聚氨酯构成。如在图3中可见,挠性颈部组件70具有第一挠性颈部部分72和第二挠性颈部部分74。这些颈部部分72、74由中央纵向肋73分开。参见图6。颈部部分72、74各自具有基本上被配置为半圆形盘的多个颈部肋75。挠性颈部部分72、74通常一起形成圆柱形构造。侧狭槽76延伸穿过颈部肋75中的每一个颈部肋,以提供穿过第一挠性颈部部分72和第二挠性颈部部分74的通道,该通道用于接收挠性带组件83、85的内部关节运动带89、90和外部加强带部分86、87。以类似的方式,分开第一挠性颈部部分72和第二挠性颈部部分74的中央纵向肋73具有中央纵向狭槽,以提供接收缝合器致动构件的通道。第一支撑引导件表面77和第二支撑引导件表面78从第一挠性颈部部分72和第二挠性颈部部分74朝近侧延伸,以支撑挠性传输带组件83、85的内部关节运动带89、90和外部加强部分86、87的往复运动。导槽79从挠性颈部部分72、74的远侧端部延伸,以引导使缝合器致动构件进入端部执行器200的钉仓300内的运动,如将在下文进一步所讨论的。
在至少一个形式中,当使第一传输带组件83和第二传输带组件85在器械10的组装期间彼此接触时,它们形成细长的圆柱体,该圆柱体具有穿过其的纵向腔,该纵向腔同心地定位在带组件83、85之间,以使击发连杆110通过。第一带和第二带的近侧端部具有第一齿轮齿条94和第二齿轮齿条95,该第一齿轮齿条94和第二齿轮齿条95啮合地接合关节运动组件62,如将在下文所讨论的。
当关节运动组件62旋转时,第一挠性传输带组件和第二挠性传输带组件中的一个带组件向前移动,而另一个带组件向后移动。响应于带组件83、85在挠性颈部组件70的第一挠性颈部部分72和第二挠性颈部部分74内的往复运动,挠性颈部组件70弯曲以提供关节运动。如在图5中可见,关节运动组件62包括致动器63、关节运动主体64和喷嘴60。致动器63的旋转运动致使关节运动主体64在喷嘴60内的对应旋转。第一细长传输带组件83和第二细长传输带组件85因此在平行于缝合装置10的内窥镜式轴30的纵向轴线A-A的相反方向上轴向地往复运动,以使得通过挠性颈部组件70来引发端部执行器200的远程关节运动。关节运动主体64还包括位于其上的驱动齿轮65。如在图4中可见,驱动齿轮65具有穿过其的扩张开口66和下枢转67。在驱动齿轮65的扩张开口66内,存在用于接收击发连杆110的击发连杆孔68,该击发连杆110能够响应击发触发器102的枢转旋转来将钉击发到夹紧的组织内。驱动齿轮65被支撑用于与挠性细长传输带组件83、85上的第一驱动齿条94和第二驱动齿条95啮合地接合,以实现带组件83、85的期望往复运动。
如在图5中可见,关节运动组件62的喷嘴60具有喷嘴主体61。喷嘴主体61具有延伸穿过其的轴向镗孔69,以接收关节运动主体64的驱动齿轮65。镗孔69提供了从框架到细长的内窥镜式轴30内的轴向连续开口,并且因此击发连杆110和缝合装置10的其他操作部件可与端部执行器200连通。有关关节运动组件62的另外的细节可见于美国专利5,704,534中,该专利先前已以引用方式并入本文。
闭合系统
如将在下文进一步详细讨论的,端部执行器200包括被构造成能够可操作地接收外科钉仓300的细长通道210。砧座220相对于细长通道210被可动地支撑,并且从打开位置(图16和图17)被移动到闭合位置,其中可切割和缝合组织(图24和图25)。砧座220在打开位置和闭合位置之间的运动至少部分地由通常标定为150的闭合系统控制,该闭合系统如上文所指出的那样由闭合触发器152控制。闭合系统150包括近侧闭合管段151,该近侧闭合管段151以上文所述的方式可操作地容纳关节运动带组件83、85并且非活动性地联接到挠性颈部组件70。
在各种形式中,近侧闭合管段151包括轴向延伸穿过喷嘴60中的膛孔69的近侧端部部分153。近侧闭合管段151具有穿过其的细长轴向狭槽155,以允许关节运动主体64从中延伸穿过。参见图2。狭槽155允许关节运动主体64相对于近侧闭合管段151围绕关节运动轴线B-B旋转,同时有利于近侧闭合管段151相对于关节运动主体64沿轴线A-A的轴向运动。传输带83、85充当框架,近侧闭合管段151可在该框架上轴向地移动。近侧闭合管段151的近侧端部153可旋转地联接到闭合轭154,该闭合轭154支撑在柄部20内,以在其中进行往复运动。参见图4和图5。
闭合触发器152具有柄部部分156、齿轮段部分158和中间部分160。参见图5。镗孔延伸穿过中间部分160。从第二柄部外壳23延伸的圆柱形支撑构件162穿过镗孔以将闭合触发器152枢转地安装在柄部部分20上。闭合轭154的近侧端部98具有由闭合触发器152的齿轮段部分158接合的齿轮齿条164。当闭合触发器152朝向柄部部分20的手枪式握把24移动时,闭合轭154以及近侧闭合管段151朝远侧移动,从而压缩弹簧166,该弹簧166朝近侧偏压闭合轭152。
在至少一种形式中,闭合系统150还包括通过附接突片72、74非可动地联接到挠曲颈部组件70的导槽部分79的远侧闭合管段170。参见图9和图10。远侧闭合管段170其中具有适于与形成于砧座220上的直立的突片224接合的开口176,如将在下文进一步详细讨论的。因此,近侧闭合管段151的轴向运动导致锁定颈部组件70以及远侧闭合管段170的轴向运动。例如,近侧闭合管段151的远侧运动影响砧座220朝远侧以及朝端部执行器200的细长通道210的枢转平移运动,并且近侧运动影响砧座220的打开,如将在下文进一步详细讨论的。
击发系统
在至少一种形式中,外科器械10还包括通常标定为100的击发系统,该击发系统用于响应击发触发器102的致动而对击发连杆110施加击发运动。在至少一种形式中,击发系统100还包括其上具有第一齿轮齿条105和第二齿轮齿条106的驱动构件104。第一凹口109设置在第一齿轮齿条105和第二齿轮齿条106中间的驱动构件105上。在击发触发器102的返回运动期间,在钉击发之后,击发触发器102上的齿112与第一凹口109接合以使驱动构件104返回到其初始位置。第二凹口114位于击发连杆110的近侧端部,用于将击发连杆110在其未击发位置中锁定到释放按钮的120的上锁臂122。击发系统150还包括第一一体的小齿轮111和第二一体的小齿轮113。第一一体的小齿轮111与设置在击发连杆110上的驱动齿条115接合。第二一体的小齿轮113与在驱动构件104上的第一齿轮齿条105接合。第一一体的小齿轮111具有第一直径,并且第二一体的小齿轮113具有小于第一直径的第二直径。
在各种实施方案中,击发触发器102设置有齿轮段部分103。齿轮段部分103接合驱动构件104上的第二齿轮齿条106,使得击发触发器102的运动引起驱动构件104在第一驱动位置和第二驱动位置之间来回移动。为了在组织夹紧已经发生之前防止钉击发,释放按钮120上的上闩锁臂122与驱动齿条115上的第二凹口114接合,使得击发连杆110锁定在其最近侧的位置。当上闩锁臂122落入闭合轭中的凹陷部中时,上闩锁臂122与第二凹口114脱离,以允许击发连杆110的远侧运动。因为驱动构件104上的第一齿轮齿条105与击发连杆110上的驱动齿条115接合,击发触发器102的运动使击发连杆110在第一往复位置和第二往复位置之间往复运动。可参考美国专利7,000,818来获取有关击发系统150的各个方面的其他细节,该专利全文以引用方式并入本文。
如在图3中可见,在各种实施方案中,击发连杆110的远侧端部117旋转地接收在击发杆安装轭118内。击发杆安装轭118具有狭槽119,用于以钩的形式接收形成于刀杆130的近侧端部上的钩132。此外,如图3所示,支撑杆140被支撑用于在挠曲颈部组件70的第一支撑引导件表面77和第二支撑引导件表面78之间的轴向移动。支撑杆140具有狭槽142,该狭槽142被构造成能够允许刀杆130从中滑动地穿过。金属刀杆130具有形成于其远侧端部上的组织切割刃134,并且被构造成能够可操作地接合支撑在外科钉仓300内的楔形滑动件。
端部执行器
如上所述,在至少一种形式中,端部执行器200包括细长通道210,该细长通道210被构造成能够在其中可操作地支撑外科钉仓300。如图2和图6所示,细长通道210具有近侧端部部分,该近侧端部部分包括两个间隔开的安装突片212,该间隔开的安装突片212被构造成能够被关节运动带96、97的远侧端部上的钩998、99接合。因此,关节运动带96、97的往复运动使得细长通道210相对于挠曲颈部组件70进行关节运动。如上文进一步所指出,端部执行器200还包括砧座220。在至少一种形式中,砧座220由例如416不锈钢硬化和回火的RC35Min(或类似的材料)制成,并且在其上具有钉成形的下表面222,该钉成形的下表面222被构造成能够与安装在细长通道210中的钉仓300正对接合。砧座220形成有朝近侧延伸的安装部分223,该安装部分223包括两个耳轴壁226、228,该耳轴壁226、228各自具有从其突出的耳轴30。参见图11。此外,朝下突出的枢转突片234形成在安装部分223的下侧232上,该枢转突片234具有延伸穿过其的狭槽236,该狭槽236被构造成能够当在切割和缝合期间通过端部执行器200轴向地推进刀杆130时接收并支撑刀杆130。此外,砧座开口突片224形成于安装部分223上,使得其能够可操作地接合远侧闭合管段170中的开口176,如将在下文进一步所讨论的。如在图16-图25中可见,砧座耳轴230被构造成能够可动地被接收在对应的耳轴狭槽214中,该耳轴狭槽214形成于细长通道210的近侧端部中。每个耳轴狭槽214具有与锁定凹口218连通的弓形段216。
为了有利于砧座安装部分223相对于细长通道210的枢转行进,各种实施方案均包括枢转座240。如在图12和13中可见,枢转座240的一种形式具有被构造成能够附接到细长通道210的主体部分242。例如,主体部分242可形成有两个相反的附接突片243,该附接突片243被构造成能够保持接合形成于细长通道210中的突片开口211(图6)。此外,枢转座240具有朝近侧延伸的底脚部分244,该底脚部分244具有从其突出的保持耳状物245,该保持耳状物245被构造成能够接收在细长通道210中的对应开口211中。参见图17。枢转座240可由例如Vectra A435液晶聚合物-天然或类似的材料制成。如在图12和图13中进一步可见,主体部分242具有直立的中心部分246,该直立的中心部分246具有延伸穿过其以轴向接收刀杆130的狭槽247。当刀杆130被驱动穿过夹紧在端部执行器200内的组织时,中心部分246为刀杆提供侧向支撑。枢转座240的各种实施方案还包括形成于中心部分246的每一侧上的摇臂表面248,以在其上枢转地接收砧座220的耳轴壁226、228。
砧座锁定系统
各种实施方案包括独特的和新型的砧座锁定系统250,该砧座锁定系统在钉仓300还未正确地安装在细长通道210中时阻止砧座220的闭合。参见例如图6和图7,砧座锁定系统250的实施方案包括可移动的砧座锁定构件260,该砧座锁定构件260可响应钉仓300的一个部分或多个部分的接触而移动,如下文进一步详细讨论的。在至少一种形式中,砧座锁定构件260包括主体部分262,该主体部分262具有形成于其上的朝远侧突出的中央支撑突片264。狭槽266延伸穿过主体部分262和中央支撑突片264,以使刀杆130能够穿过主体部分262和中央支撑突片264。主体部分262还包括朝近侧延伸的安装杆268,该安装杆268被构造成能够滑动地被接收在挠曲颈部组件70的导槽79中的对应安装开口270内。此外,例如卷簧269形式的偏压构件被支撑在开口270内,以在远侧方向“DD”上偏压砧座锁定构件260。参见图16。当将砧座220安装到细长通道210时,耳轴230被接收在细长通道210中的对应耳轴狭槽214内,砧座锁定构件260的中央支撑突片264被接收在耳轴壁226、228之间,以进一步提供对砧座220的支撑。砧座锁定构件260的主体部分262还形成有两个凸轮表面263,该凸轮表面263被构造成能够接合耳轴壁226、228的近侧端部表面227、229。参见图6和图7。砧座锁定构件的各种实施方案可由例如Vectra A435液晶聚合物-天然或类似材料制成。
图6A和图7A示出另选的砧座锁定构件260’,该砧座锁定构件260’可响应钉仓300的一个部分或多个部分的接触而移动。在至少一种形式中,砧座锁定构件260’包括主体部分262,该主体部分262具有形成于其上的朝远侧突出的中央支撑突片264。狭槽266延伸穿过主体部分262和中央支撑突片264,以使刀杆130能够穿过主体部分262和中央支撑突片264。主体部分262还包括朝近侧延伸的安装杆268’,该安装杆268’被构造成能够可滑动地且可保持地被接收在挠曲颈部组件70’的导槽79’中的对应安装开口270’内。此外,例如卷簧269形式的偏压构件被支撑在开口270’内,以在远侧方向“DD”上偏压砧座锁定构件260’。砧座锁定构件260'否则以与砧座锁定构件260相同的方式操作。当将砧座220安装到细长通道210时,耳轴230被接收在细长通道210中的它们对应的耳轴狭槽214内,砧座锁定构件260’的中央支撑突片264被接收在耳轴壁226、228之间,以进一步提供对砧座220的支撑。砧座锁定构件260的主体部分262还形成有两个凸轮表面263,该凸轮表面263被构造成能够接合耳轴壁226、228的近侧端部表面227、229。远侧闭合管段170’以与上述远侧闭合管段170相同的方式操作。
外科钉仓
各种实施方案均包括独特的和新型的外科钉仓300,该外科钉仓300被构造成能够在安装在细长通道210中时与砧座锁定系统250相互作用。如在图14和图15中可见,在至少一种形式中,外科钉仓300包括仓体302,该仓体302可例如由Vectra A435,20%PTFE/15%GF-天然制成。仓体302被设定尺寸和成形为接收在细长通道210内。在至少一种形式中,仓体302被构造成能够安置在细长通道210中,使得其可移除地保持在其中。仓体302在其中可形成有居中设置的狭槽304,以接收刀杆130。在狭槽304的每一侧上,提供了钉开口312的行306、308、310,其被构造成能够支撑其中的外科钉。在示出的实施方案中,在狭槽304的每一侧上设置三个行306、308、310。外科钉可支撑在钉驱动器上,该钉驱动器被可动地支撑在钉开口312内。楔形滑动件也支撑在钉仓主体302内,该楔形滑动件被构造成能够用于在被切割杆接触时通过仓体302轴向运动。楔形滑动件被构造成具有楔形驱动构件,该楔形驱动构件在穿过仓体302朝远侧驱动楔形滑动件时,接触钉驱动器并且将驱动器及其对应的钉朝向闭合砧座驱动。可采用的钉驱动器装置和楔形滑动件装置的实例更详细地描述于美国专利7,669,746中,该专利的公开内容全文以引用方式并入本文。在各种实施方案中,为了有利于在仓体302中安装楔形滑动件和驱动器,可将金属仓盘314、316附接到仓体302,如图14和图15中所示。仓盘314和316用于将楔形滑动件和驱动器保持在仓体302内。
在各种实施方案中,仓体302另外具有形成于其上的在近侧方向上突出的至少一个释放构件。在图14所示的实施方案中,两个释放构件320形成于仓300的近侧端部319上。释放构件320各自具有限定倾斜枢转表面321的楔形形状,该倾斜枢转表面被构造成能够在其上枢转地支撑砧座安装部分223的一部分。
钉仓的安装
参照图16-图25从中获取对砧座锁定系统的操作的理解。图16和图17示出在安装钉仓300之前砧座220相对于细长通道210的位置。当处于此“未加载”和打开位置时,砧座锁定构件260通过弹簧269朝远侧方向进行偏压,使得砧座锁定构件260上的凸轮表面263接触耳轴壁226、228的端面227、229。砧座锁定构件260在远侧方向“DD”上推动砧座安装部分223,使得耳轴230被安置在其相应的锁定凹口218中。砧座锁定构件260上的凸轮表面263与端壁表面227、229也协同地用于将砧座枢转并且保持在打开位置,如图16和图17所示。如在图16中可见,当处于此位置时,耳轴壁226、228被支撑在枢转座240上的摇臂表面248上。当处于此位置时,外科医生不能通过致动闭合触发器152从而推进远侧闭合管170来闭合砧座220。由于闭合管段不能朝远侧推进以闭合砧座220,因此闭合触发器152不能被致动到其完全闭合位置,由此可致动击发触发器102。因此,当不存在仓300时,端部执行器200不可进行致动。
图18和图19示出将钉仓300初始插入细长通道210中。图20和图21示出钉仓300已完全被安置在细长通道210中之后的端部执行器200。如在图20中可见,例如,当仓300已被完全安置之后,仓300上的释放构件320接合耳轴壁226、228,并且用于在近侧方向“PD”上移动砧座安装部分223,使得耳轴壁226、228此时枢转地置于释放构件320上。如在图21中可见,当处于此位置时,砧座安装部分223已朝近侧移动,使得耳轴230移出其相应的锁定凹口218并且进入弓形狭槽段216的底部以形成“可致动”位置,由此可通过致动闭合触发器152来将砧座220枢转闭合。
当装置10处于起始位置并且钉仓300已如上所述加载到细长通道中时,触发器152、102中的两者均为向前的并且砧座220已被移动到可致动位置,诸如,典型情况是在加载的端部执行器200通过套管针或其他开口插入到体腔内之后。然后临床医生操作器械10,使得待缝合和割断的组织“T”定位在钉仓300和砧座200之间,如图22和图23所示。如上所述,闭合触发器152朝手枪式握把24的运动导致近侧闭合管段151、挠曲颈部组件70和远侧闭合管段170朝远侧移动。当远侧闭合管段170朝远侧移动时,其接触砧座220上的闭合凸缘221。来自捕获在砧座220和钉仓300之间的组织的压力用于移动砧座220,使得耳轴230定位成在弓形耳轴狭槽段216内移动。外科医生可相对于钉仓300枢转砧座220,以在端部执行器200中操纵和捕获所需组织“T”。当远侧闭合管段170接触闭合凸缘221时,砧座220朝夹紧位置枢转。回缩的刀杆130不阻碍砧座220的选择性打开和闭合。
一旦期望组织“T”已经定位在砧座220和仓300之间,临床医生就朝近侧移动闭合触发器152直到被直接定位成与手枪式握把24相邻,从而将柄部20锁定在闭合位置和夹紧位置中。如在图25中可见,当处于完全夹紧位置时,砧座耳轴230位于弓形狭槽部分216的上端,并且砧座突片224被接收在远侧闭合管段170中的开口176内。在组织夹紧已经发生后,临床医生朝近侧移动击发触发器102,从而使刀杆130朝远侧移动到端部执行器200中。具体地,刀杆130移动穿过砧座220的枢转突片部分234中的狭槽236,并且进入仓体302中的狭槽304中,以接触可操作地定位于钉仓300内的楔形滑动件。当朝远侧驱动刀杆130时,其切割组织T并且朝远侧驱动楔形滑动件,这使钉被连续地击发成与砧座220的钉成形的下表面222成形接触。临床医生继续移动击发触发器102直至使其在闭合触发器152和手枪式握把24的近侧。从而,钉的所有端部由于与砧座220接合而弯曲。切割刃132已完全横贯组织T。通过释放击发触发器102,并且然后通过在挤压闭合触发器152的同时按压释放按钮120来完成此过程。这种动作导致远侧闭合管段170在近侧方向“D”上的运动。当砧座突片224被远侧闭合管段170中的开口176接合时,其使砧座枢转打开。端面227、229再次接触砧座锁定构件260上的推杆表面263,以将砧座枢转到如图20和图21中所示的打开位置,以允许从细长通道210移除用过的仓300。
图26-图42示出另选的外科缝合器械10’,其具有与外科缝合器械10类似的构造和操作,除了下文讨论的差异之外。此实施方案例如采用如图29和图30所示的枢转座240’。如在图27和图28中可见,枢转座240’的一种形式具有被构造成能够附接到细长通道210的主体部分242’。例如,主体部分242’可形成有两个相反的附接突片243’,该附接突片243’被构造成能够保持接合形成于细长通道210中的突片开口211(图26)。此外,枢转座240’具有朝近侧延伸的底脚部分244’,该底脚部分244’具有延伸穿过其以轴向地接收刀杆130的狭槽247’。枢转座240’的各种实施方案还包括形成于主体部分242’上的摇臂表面248’,以在其上接收砧座220的耳轴壁226、228。
此实施方案还包括砧座锁定系统250’,该砧座锁定系统250’在钉仓300’仍未正确地安装在细长通道210中时阻止砧座220的闭合。参见例如图29和图30,砧座锁定系统250’的实施方案包括砧座锁定构件400,该砧座锁定构件400被构造成能够接触砧座安装部分223,如将在下文进一步详细讨论的。在至少一种形式中,砧座锁定构件400包括片簧402,该片簧402在其中具有狭槽404以容纳刀杆130。片簧402被构造成能够用于附接到挠曲颈部组件70”的导槽79”。
如在图31和图32中可见,在至少一种形式中,外科钉仓300’包括仓体302’,该仓体302’类似于上述外科钉仓300,不同之处在于下文讨论的差异。图29示出按照上述方式支撑在仓体302’内的楔形滑动件360。在此实施方案中,仓体302’的近侧端部部分303被构造成能够接触砧座安装部分223的一部分,并且在仓体302’被安置在细长通道210内时朝近侧推动砧座220。
可参照图33-图43从中获取对砧座锁定系统250’的操作的理解。图33和34示出在安装钉仓300’之前砧座220相对于细长通道210的位置。当处于该“未加载”位置时,砧座锁定构件400已接合砧座支撑部分223的上表面,使得砧座220在枢转座140’上的摇臂表面248’上枢转到打开位置。当处于该位置时,耳轴230被安置在其相应的锁定凹口218中。当处于该位置时,外科医生不能通过致动闭合触发器152从而推进远侧闭合管170’来闭合砧座220。由于闭合管段不能朝远侧推进以闭合砧座220,因此闭合触发器152不能致动到其完全闭合位置,由此可致动击发触发器102。因此,当不存在仓300’时,端部执行器200不可进行致动。
图35和图36示出将钉仓300’初始插入细长通道210中。图37和图38示出钉仓300’已被完全安置在细长通道210中之后的端部执行器200。如在图37中可见,例如,当仓300’已被完全安置时,仓300’上的近侧端部部分303接合耳轴壁226、228并用于使砧座安装部分223在近侧方向“PD”上移动,使得耳轴移出其相应的锁定凹口218并且进入弓形狭槽段216的底部的可致动位置内。砧座220现在处于将通过致动闭合触发器152而被枢转闭合的位置。
当装置10’处于起始位置并且钉仓300’已经如上所述被加载到细长通道210中时,触发器152、102中的两者均为向前的,并且砧座220已打开并处于可致动位置,诸如,典型情况是在加载的端部执行器200通过套管针或其他开口插入体腔内之后。然后临床医生操作器械10’,使得待缝合和割断的组织“T”定位在钉仓300’和砧座220之间,如图39和图40所示。如上所述,闭合触发器152朝手枪式握把24的运动使近侧闭合管段151、挠曲颈部组件70”和远侧闭合管段170”朝远侧移动。当远侧闭合管段170’朝远侧移动时,其接触砧座220上的闭合凸缘221。来自捕获在砧座220和钉仓300’之间的组织的压力用于移动砧座220,使得耳轴230定位成在弓形耳轴狭槽段216内移动。外科医生可相对于钉仓枢转砧座220,以在端部执行器200中操纵和捕获期望组织“T”。当远侧闭合管段170”接触闭合凸缘221时,砧座220朝向夹紧位置枢转。回缩的刀杆130不阻碍砧座220的选择性打开和闭合。
一旦期望组织“T”已经定位在砧座220和仓300’之间,临床医生就朝近侧移动闭合触发器152直到被直接定位成与手枪式握把24相邻,从而将柄部20锁定在闭合位置和夹紧位置中。如在图42中可见,当处于完全夹紧位置时,砧座耳轴230位于弓形狭槽部分216的上端,并且砧座突片224被接收在远侧闭合管段170”中的开口176内。在组织夹紧已经发生后,临床医生朝近侧移动击发触发器102,从而使刀杆130朝远侧移动到端部执行器200中。具体地,刀杆130移动通过砧座220的枢转突片部分234中的狭槽236并且进入仓体302’中的狭槽304内,以接触可操作地定位在其中的楔形滑动件360。当朝远侧驱动刀杆130时,其切割组织T并且朝远侧驱动楔形滑动件360,这使得钉被连续地击发成与砧座220的钉成形的下表面222成形接触。临床医生继续移动击发触发器102直至使其在闭合触发器152和手枪式握把24的近侧。从而,钉的所有端部由于它们与砧座220接合而弯曲。切割刃132已完全横贯组织T。通过释放击发触发器102,并且然后通过在挤压闭合触发器152的同时按压释放按钮120来完成此过程。这种动作导致远侧闭合管段170”在近侧方向“D”上的运动。当砧座突片224被远侧闭合管段170”中的开口176接合时,其使砧座220枢转打开。砧座锁定构件400对砧座安装部分223的耳轴壁的上表面施加偏压力,并且用于将砧座枢转到如图33和图34所示的打开位置,以允许从细长通道210移除用过的仓300’。于2012年3月26日提交的名称为“SURGICAL STAPLING DEVICE WITH LOCKOUT SYSTEM FOR PREVENTING ACTUATION IN THEABSENCE OF AN INSTALLED STAPLE CARTRIDGE”的美国专利申请序列号13/429,647的全部公开内容以引用方式并入本文。
现在参见图43-图60,工具部分1022可联接到外科器械的柄部,诸如例如联接到外科缝合装置10的柄部20(参见例如图1和图2)。类似于工具部分22(参见例如图6),工具部分1022可包括细长轴组件1030,细长轴组件1030可以可操作地联接到端部执行器1200。在某些情况下,可类似于例如端部执行器200的端部执行器1200可包括细长通道1210和砧座1220。此外,当柄部20的闭合触发器152(参见例如图1和图2)朝向手枪式握把24(参见例如图1和图2)被枢转地拉动时,砧座1220可相对于端部执行器1200的细长通道1210夹紧和/或闭合。另外,例如,当柄部20的击发触发器102(参见例如图1和图2)朝向手枪式握把24被枢转地拉动时,端部执行器1200可缝合和/或割断夹紧在其中的组织。在各种情况下,类似于端部执行器200,端部执行器1200可被构造成能够围绕装置10的细长轴线进行关节运动,而在其他情况下,端部执行器可以是非关节运动的。
主要参见图43-图45,细长轴组件1030可类似于例如细长轴组件30,并且可包括可从柄部20(参见例如图1和图2)延伸的近侧闭合管段1151。在各种情况下,近侧闭合管段1151可包括远侧端部部分1157,远侧端部部分1157可联接到挠性颈部组件1070。挠性颈部组件1070可类似于挠性颈部组件70(参见例如图2和图3),并且在此类情况下,例如,挠性颈部组件1070可允许端部执行器1200相对于近侧闭合管段1151的关节运动。在某些情况下,挠性颈部组件1070可具有第一挠性颈部部分1072和第二挠性颈部部分1074,第一挠性颈部部分1072和第二挠性颈部部分1074可由中央纵向肋1073(图43和图45)分开。颈部部分1072、1074可以各自具有多个颈部肋1075,其可基本上被配置为例如半圆形盘。此外,侧狭槽1076(图45)可延伸穿过颈部肋1075中的每一个颈部肋,以提供穿过第一挠性颈部部分1072和第二挠性颈部部分1074的通道,该通道用于关节运动构件,诸如例如挠性带组件83、85(参见例如图2)的关节运动构件89、90(参见例如图2)和外部加强带部分86、87(参见例如图2)。
以类似的方式,挠性颈部组件1070的中央纵向肋1073可使例如第一挠性颈部部分1072和第二挠性颈部部分1074分开,并且可具有中央纵向狭槽,用于提供接收例如缝合器致动构件的通道。在各种情况下,导槽1079(图45)可从例如挠性颈部部分1072、1074的远侧端部延伸,并且可引导使缝合器致动构件进入端部执行器1200的外科钉仓1300中的运动。
如上所述,端部执行器1200可包括细长通道1210,其可被构造成能够可操作地接收外科钉仓1300。此外,砧座1220可相对于细长通道1210被可动地支撑,并且可从打开位置(参见例如图52和图53)移动到闭合位置(参见例如图59和图60),其中例如砧座1220和细长通道1210之间的组织可以被切割和/或缝合。砧座1220在打开位置和闭合位置之间的运动至少部分地由闭合系统控制,该闭合系统如上文所指出的那样由闭合触发器152(参见例如图1和图2)控制。
在至少一种形式中,闭合系统可包括远侧闭合管段1170,其可类似于例如远侧闭合管段170(参见例如图1和图2)。远侧闭合管段1170可非可动地联接到挠性颈部组件1070的导槽1079(图45)。在各种情况下,远侧闭合管段1170可包括在其中的开口1176,其可适于与形成在砧座1220上的直立突片1224接合。在各种情况下,近侧闭合管段1151的轴向运动可导致挠性颈部组件1070的轴向运动以及远侧闭合管段1170的轴向运动。在此类情况下,例如,近侧闭合管段1151的远侧运动可产生砧座1220朝远侧的平移运动,以及朝向端部执行器1200的细长通道1210的旋转运动。对应地,例如,近侧闭合管段1151的近侧运动可产生砧座1220朝近侧的平移运动,以及远离端部执行器1200的细长通道1210的旋转运动。
除了以上所述以外,如图45-图47所示,细长通道1210可具有包括间隔开的安装突片1212的近侧端部部分。例如,安装突片1212可定位在细长通道1210的每个侧面上。在各种情况下,安装突片1212可被构造成能够被关节运动带诸如例如关节运动带96和97(参见例如图2)的远侧端部上的钩接合。因此,在某些情况下,关节运动带的往复运动可影响细长通道1210相对于例如挠性颈部组件1070的关节运动。定位在细长通道1210内的钉仓1300可与细长通道1210一起移动,使得钉仓1300可定位在手术部位内。
另外除了以上所述以外,砧座1220可具有在其上的钉成形的下表面1222,当钉仓1300已经安装在细长通道1210中时,钉成形的下表面1222可被构造成能够用于与钉仓1300正对接合。在各种情况下,砧座1220还可包括闭合凸缘1221,该闭合凸缘1221可被放置成与例如远侧闭合管1170的远侧边缘抵靠接触。砧座1220可形成有例如朝近侧延伸的安装部分1223,该安装部分1223可包括耳轴壁1226、1228,该耳轴壁1226、1228各自具有从其向外突出的耳轴1230。在各种情况下,每个耳轴壁1226和1228可分别具有例如近侧端部表面1227和1229,其可与砧座锁定系统1250的砧座锁定构件1260可操作地接合,如本文进一步详细描述的。此外,在某些情况下,每个耳轴壁1226、1228还可包括例如波状外形表面1225,该波状外形表面1225可与可移位引导件1240的贴靠表面1248可操作地接合,如本文进一步详细描述的。
在各种情况下,向下突出的枢转突片1234可形成在朝近侧延伸的安装部分1223的下侧1222上。在各种情况下,通过枢转突片1234可限定纵向狭槽1236,并且在某些情况下,当刀杆130轴向地推进通过端部执行器1200以执行端部执行器1200的切割和缝合功能时,狭槽1236可被构造成能够接收和支撑刀杆,诸如例如刀杆130(参见例如图2和图3)。此外,砧座开口突片1224可形成于安装部分1223上,使得突片1224能够可操作地接合远侧闭合管段1170中的开口1176,如将在下文进一步所讨论的。
现在参见图48、图50、图52、图55、图57和图59,砧座耳轴1230可被构造成能够可动地被接收在对应的耳轴狭槽1214中,该耳轴狭槽1214形成于细长通道1210的近侧端部中。在各种情况下,每个耳轴狭槽1214可具有弓形狭槽段1216和锁定凹口1218。当砧座1220相对于例如细长通道1210枢转时,弓形狭槽段1216可形成用于例如耳轴1230的枢转路径。此外,在某些情况下,当耳轴1230被接收在锁定凹口1218中时,锁定凹口1218的几何形状可防止耳轴1230沿着例如弓形狭槽段1216行进。
在各种实施方案中,端部执行器1200可包括可移位引导件1240,该可移位引导件1240可以可滑动地保持在例如细长通道1210中。主要参见图45-图47,可移位引导件1240可包括主体部分1242,该主体部分1242可被构造成能够在细长通道1210内移动或滑动。在至少一种情况下,主体部分1242可形成有两个相反的附接突片1243,该附接突片1243被构造成能够保持接合形成于细长通道1210中的突片开口1211。除此之外地或另选地,可移位引导件1240可具有朝近侧延伸的底脚部分1244,该底脚部分1244可具有向下突出的保持耳状物1245。在各种情况下,保持耳状物1245可被设定尺寸和定位,使得其可被接收在细长通道1210的底部中对应的耳状物开口1219(参见例如图46和图47)中。除此之外或另选地,例如,可移位引导件1240可包括可从可移位引导件1240的相对侧面突出的近侧凸块1249。在各种情况下,每个凸块1249可以可滑动地定位在细长通道1210的侧面中的凸块狭槽1217(参见例如图46和图47)中。
在各种情况下,可移位引导件1240可在细长通道1210内移位和/或移动。例如,如本文进一步详细描述的,端部执行器1200的各种部件可以将可移位引导件1240偏压到细长通道1210内的不同位置中,并且/或者朝向细长通道1210内的不同位置偏压可移位引导件1240。此外,例如,当可移位引导件1240在细长通道1210内移动时,相反的附接突片1243可在突片开口1211内滑动,保持耳状物1245可在耳状物开口1219内滑动,并且/或者相反的近侧凸块1249可在凸块狭槽1217内滑动。在此类情况下,例如,突片开口1211、耳状物开口1219和/或凸块狭槽1217可约束、引导和/或限制可移位引导件1240相对于细长通道1210沿纵向路径的移位和/位移。该纵向路径可包括用于可移位引导件1240的位置范围。在各种情况下,突片开口1211、耳状物开口1219和/或凸块狭槽1217的纵向长度可限制可移位引导件1240的纵向运动范围。如本文进一步详细描述的,可移位引导件1240例如可与砧座锁定系统1250协作,并且例如可有利于砧座1220相对于细长通道1210的锁定和解锁。
仍然参见图45-图47,可移位引导件1240的主体部分1242可具有例如直立的中心部分1246,该直立的中心部分1246可具有延伸穿过其的狭槽1247,用于轴向地接收刀杆,诸如例如刀杆130(参见例如图2和图3)。例如,当中心部分1246被驱动穿过夹紧在端部执行器1200内的组织时,中心部分1246可为刀杆130提供侧向支撑。在各种情况下,可滑动引导件1240也可包括阻隔部分1241,该阻隔部分1241可从主体部分1242朝近侧延伸。阻隔部分1241可形成壁,并且在各种情况下,例如,近侧凸块1249可从阻隔部分1241的壁向外延伸。在各种情况下,可移位引导件1240可包括一对侧向阻隔壁1241,其可定位在朝近侧延伸的底脚部分1244的相对侧上。在至少一种形式中,例如,侧向阻隔壁1241可朝近侧延伸超出底脚部分1244并且在其任一侧上延伸。
在各种情况下,每个侧向阻隔壁1241可包括例如最近侧边缘,其可限定倾斜的或波状外形表面。如本文进一步详细描述的,倾斜的近侧边缘可限定对应于耳轴狭槽1214的倾斜部分的斜坡。可移位引导件1240的各种实施方案也可包括形成在每个侧向阻隔壁1241上的贴靠表面1248。例如,贴靠表面1248可沿着每个侧向阻隔壁1241的倾斜的近侧边缘延伸。如本文进一步详细描述的,例如,贴靠表面1248能够被可操作地定位成与砧座1220的朝近侧延伸的安装部分1223的一部分抵靠接触。此外,在某些情况下,例如,贴靠表面1248的轮廓可与砧座1220的朝近侧延伸的安装部分1223的部分1225匹配和/或互补。如本文进一步详细描述的,例如,可移位引导件1240的贴靠表面1248与砧座1220的安装部分1223之间的接合可以影响耳轴1230在锁定凹口1218和弓形狭槽段1216之间的运动。
在各种情况下,当可移位引导件1240在细长通道1210内移动时,侧向阻隔壁1241可相对于限定在细长通道1210中的锁定凹口1218移动。例如,当可移位引导件1240相对于细长通道1210在第一位置范围内时,侧向阻隔壁1241的一部分可与其相应的锁定凹口1218纵向对准,使得阻隔壁1241与锁定凹口1218重叠。然而,例如,当可移位引导件1240相对于细长通道1210在第二位置范围内时,侧向阻隔壁1241可从相应的锁定凹口1218纵向偏移,使得阻隔壁1241不与锁定凹口1218重叠。在各种情况下,阻隔壁1241的倾斜近侧边缘和贴靠表面1248可在远离锁定凹口1218的远侧位置和近侧位置之间移动,从而至少部分地与锁定凹口1218的至少一部分重叠并且/或者延伸经过锁定凹口1218的至少一部分。
如上进一步所示,在各种情况下,端部执行器1200可包括砧座锁定系统1250,砧座锁定系统1250可在钉仓1300尚未安装和/或尚未正确安装在细长通道1210中时防止砧座1220闭合。在各种情况下,例如,锁定系统1250可与可移位引导件1240可操作地接合,以防止或至少试图防止砧座1220的闭合。参见例如图45-图47,砧座锁定系统1250可包括例如可移动的砧座锁定构件1260,该可移动的砧座锁定构件1260可类似于例如砧座锁定构件260。在各种情况下,砧座锁定构件1260可响应于钉仓1300的一部分或多个部分的接触而移动,如下面进一步详细讨论的。此外,在至少一种形式中,砧座锁定构件1260可包括主体部分1262,该主体部分1262具有形成于其上的朝远侧突出的中央支撑突片1264。例如,狭槽1266可延伸穿过主体部分1262和中央支撑突片1264,以使得刀杆诸如例如刀杆130(参见例如图2和图3)能够从中穿过。主要参见图45,主体部分1262还可包括例如朝近侧延伸的安装杆1268,安装杆1268可被构造成能够可滑动地接收在挠性颈部组件1070的导槽1079中的对应安装开口1270内。在各种情况下,例如卷簧1269形式的偏压构件可被支撑在开口1270内,以在远侧方向“DD”(图45)上偏压砧座锁定构件1260。
当砧座1220安装到细长通道1210时,除了以上所述以外,耳轴1230可被接收在例如细长通道1210中的其对应的耳轴狭槽1214内,并且砧座锁定构件1260的中央支撑突片1264可被接收在例如耳轴壁1226、1228之间。在某些情况下,砧座锁定构件1260可被紧密地接收在耳轴壁1226、1228之间。此外,例如,中央支撑突片1264可定位在可移位引导件1240的阻隔壁1241的中间。在某些情况下,砧座锁定构件1260的主体部分1262可形成有例如两个凸轮表面1263,该两个凸轮表面1263可以被构造成能够可操作地接合砧座1220的耳轴壁1226、1228的近侧端部表面1227、1229。在此类情况下,砧座锁定构件1260的凸轮表面1263可类似于例如砧座锁定构件260的凸轮表面263朝远侧和/或向下偏压砧座1220的安装部分1223。在各种情况下,例如,砧座锁定构件1260的凸轮表面1263可将砧座1220的耳轴1230偏压到细长通道1210中的锁定凹口1218中,并且/或者将砧座1220的耳轴1230朝向细长通道1210中的锁定凹口1218偏压。简单地说,弹簧1269可朝远侧偏压砧座锁定构件1260,并且砧座锁定构件1260可接触砧座1220并朝远侧推动耳轴1230。类似地,当通过砧座锁定构件1260朝远侧推动砧座1220时,砧座1220可朝远侧推动可移位引导件1240。如下面将进一步详细描述的,例如,钉仓1300可插入细长通道1210中以朝近侧推动可移位引导件1240、砧座1220和砧座锁定构件1260,从而解锁砧座1220。可移位引导件1240、砧座1220和砧座锁定构件1260的这种近侧运动可弹性地压缩弹簧1269。在钉仓1300将从细长通道1210被移除的情况下,弹簧1269可弹性地扩张以再次朝远侧推动可移位引导件1240、砧座1220和砧座锁定构件1260,并且锁定砧座1220。
如上所述,当钉仓1300安装在细长通道1210中时,例如外科钉仓1300可被构造和配置成与例如砧座锁定系统1250和可移位引导件1240相互作用。参见图45-图47,外科钉仓1300可包括仓体1302,仓体1302可类似于例如仓体302。仓体1302可被设定尺寸和构造成接收在细长通道1210内。在至少一种形式中,仓体1302可被构造成能够安置在细长通道1210中,使得仓体1302可移除地保持在其中。仓体1302可在其中形成有居中设置的狭槽1304,用于接收刀杆,诸如例如刀杆130(参见例如图2和图3)。在各种情况下,钉开口1312的行1306、1308、1310可定位在狭槽1304的每一侧上,并且可被构造成能够支撑其中外科钉(未示出)。主要参见图43和图45,在各种情况下,钉开口1312的三行1306、1308、1310可被限定在狭槽1304的每一侧上。在其他情况下,例如,仓体1302可包括少于六行的钉开口1312或多于六行的钉开口1312。在一些情况下,开口1312可不布置成纵向的行。在各种情况下,例如,外科钉可被支撑在钉驱动器(未示出)上,该钉驱动器能够被可动地支撑在钉开口1312内。
如上面关于仓体302所述,在各种情况下,楔形滑动件诸如例如楔形滑动件360(图29)可滑动地定位在仓体1302内。楔形滑动件可被构造成能够用于在被刀杆接触时通过仓体1302的轴向运动。在各种情况下,楔形滑动件可被构造成具有例如楔形驱动构件,该楔形驱动构件可在例如穿过仓体1302朝远侧驱动楔形滑动件时,接触钉驱动器并且将驱动器及其对应的钉朝向闭合砧座驱动。可采用的钉驱动器装置和楔形滑动件装置的实例更详细地描述于2010年3月2日公布的标题为“STAPLE CARTRIDGES FOR FORMING STAPLES HAVINGDIFFERENT FORMED STAPLE HEIGHTS”的美国专利7,669,746中,该专利的公开内容全文以引用方式并入本文。在各种实施方案中,为了有利于在仓体1302中安装楔形滑动件和驱动器,可将金属仓盘1314附接到仓体1302,如图45所示。仓盘1314可用于将楔形滑动件和驱动器保持在仓体1302内。
主要参见图46和图47,仓体1302还可包括例如近侧鼻部部分1320,该近侧鼻部部分1320可在近侧方向上从仓体1302突出。例如,当仓1300被安置在细长通道1210中时,近侧鼻部部分1320可被构造成能够接合和/或接触可移位引导件1240。在各种情况下,鼻部部分1320可具有例如锥形周边,该锥形周边可有利于仓体1302和可移位引导件1240之间的接合。在至少一种情况下,可移位引导件1240的远侧端部中的锥形凹陷部1238可被构造成能够接收钉仓1300的近侧鼻部部分1320。在此类情况下,可移位引导件1240可将钉仓1300引导到完全安置的位置,并且/或者将钉仓1300引导成在细长通道1210内正确对准。此外,例如,近侧鼻部部分1320和锥形凹陷部1238之间的接合可有利于仓体1302中的狭槽1304和可移位引导件1240中的狭槽1247的正确对准,这可进一步有利于仓体1302与锁定构件1260中的狭槽1266、导槽1079中的狭槽和/或击发组件的各种元件诸如例如刀杆130(参见,例如图2和图3)的正确对准。如本文进一步详细描述的,例如,钉仓1300在细长通道1210中的放置可通过近侧鼻部部分1320与锥形凹陷部1238的接合而朝近侧偏压可移位引导件1240。例如,可移位引导件1240的近侧运动可通过可移位引导件1240的贴靠表面1248与耳轴壁1226、1228的波状外形部分1225之间的接合而使砧座1220的近侧安装部分1223朝近侧移位。例如,当使砧座1220朝近侧移位时,砧座1220的耳轴1230可移出锁定凹口1218并进入限定在细长通道1210中的耳轴狭槽1214的弓形狭槽段1216中。
砧座锁定系统1250的操作在图48-图60中示出。参见图48-图51,在钉仓插入细长通道1210之前,砧座1220可相对于细长通道1210被取向在打开位置中。在钉仓已经从细长通道1210被移除之后,砧座1220还可被取向在图48-图51所示的打开位置中。端部执行器1200的这种配置可被称为“未加载”配置。在这种未加载配置中,砧座锁定构件1260可通过弹簧1269在远侧方向“DD”上被偏压,使得砧座锁定构件1260上的凸轮表面1263(图51)与耳轴壁1226、1228端面1127、1129(图50和图51)接触。例如,砧座锁定构件1260可在远侧方向“DD”上和/或向下推动砧座安装部分1223,使得耳轴1230被安置在其相应的锁定凹口1218中。与限定在砧座1220上的端壁表面1227、1229协作的砧座锁定构件1260上的凸轮表面1263还可用于将砧座1220枢转并且保持在图48-图51所示的打开位置中。在端部执行器1200处于其未加载配置时,包括端部执行器1200的外科器械的操作者试图闭合砧座1220的情况下,砧座锁定构件1260可抵抗或防止砧座1220的闭合。换句话说,砧座锁定构件1260可防止砧座1220朝向细长通道1210旋转,这又可防止闭合管段1170的远侧位移。在此类情况下,闭合触发器152不能由外科器械的操作者致动到其完全闭合位置,并且因此,击发触发器102(参见例如图1和图2)不能被致动以击发包含在钉仓内的钉,并且/或者切割被捕获在钉仓和砧座1220之间的组织。因此,当没有钉仓存在于细长通道1020中时,并且/或者当钉仓诸如钉仓1300没有被完全安置在细长通道1020中时,端部执行器1200可不被致动。此外,在各种情况下,当错误的钉仓已经被加载到细长通道中时,诸如比预期的钉仓1300短的钉仓,砧座锁定系统1250可防止操作者闭合和致动端部执行器。这样的系统可被称为例如“无仓锁定”和/或“短仓锁定”。
再次参见图48-图51,当砧座安装部分1223在远侧方向“DD”上被偏压时,耳轴壁1226、1228的波状外形部分1225(图49和图51)可被放置和/或推动成与可移位引导件1240的朝近侧延伸的阻隔部分1241抵靠接合,使得可移位引导件1240也被移位到远侧方向“DD”,并且/或者朝向远侧方向“DD”被偏压。在此类情况下,例如,附接突片1243、保持耳状物1245和/或凸块1249可在细长通道1210中的其相应的狭槽和/或开口1211、1217、1219中朝远侧移位。此外,耳轴壁1226、1228可朝远侧推动朝近侧延伸的阻隔部分1241经过锁定凹口1218。换句话说,朝近侧延伸的阻隔部分1241可朝远侧定位,使得阻隔部分1241的近侧端部和阻隔部分1241的贴靠表面1248(图51)从锁定凹口1218纵向偏移,并且不与锁定凹口1218重叠。在这种位置中,可移位引导件1240的阻隔部分1241不阻挡耳轴1230进入锁定凹口1218。事实上,朝远侧推动可移位引导件1240的偏压力也将耳轴1230推入锁定凹口1218。耳轴1230可被构造成能够使得当耳轴1230定位在锁定凹口1218内时,该耳轴1230不旋转或至少基本上旋转,这因此防止砧座1220相对于细长通道1210旋转。在各种情况下,耳轴1230可包括例如非圆形横截面。在某些情况下,例如,每个耳轴1230可包括圆形部分和从圆形部分延伸的锁定部分。圆形部分可限定砧座1220可围绕其旋转的轴线,并且锁定部分可被构造成能够接合锁定凹口1218。在至少一种情况下,耳轴1230的锁定部分可包括被构造成能够抵靠锁定凹口1218的侧壁的楔形件,并且由于这种抵靠关系,砧座1220可相对于细长通道1210不旋转或至少基本上旋转。为了使砧座1220相对于细长通道1210旋转,可朝近侧推动砧座1220,使得耳轴1230的锁定部分与锁定凹口1218脱离接合,并且耳轴1230可进入耳轴狭槽1214的弓形部分1216,如本文所述。
图52-图60示出完全安置在细长通道1210内的钉仓1300。主要参见图52-图54,当钉仓1300已经被完全安置时,仓1300的近侧鼻部部分1320可嵌套在可移位引导件1240中的凹陷部1238(图54)内。在各种情况下,锥形鼻部部分1320可滑动到可移位引导件1240中的凹陷部1238中,直到仓体1302与可移位引导件1240抵靠接合。例如,当钉仓1300被移动成完全安置在细长通道1210内时,锥形鼻部部分1320可在近侧方向“PD”上推动可移位引导件1240。
仍然参见图52-图54,可移位引导件1240的一部分可与砧座1220的朝近侧延伸的安装部分1223的一部分抵靠接合。例如,可移位引导件1240的阻隔壁1241的近侧端部和贴靠表面1248可抵靠耳轴壁1226、1228的波状外形边缘1225定位。在此类情况下,可移位引导件1240的近侧移位也可影响安装部分1223的耳轴壁1226、1228的近侧移位。例如,阻隔壁1241可在近侧方向“PD”上推动耳轴壁1226、1228的波状外形边缘1225。在各种情况下,例如,可移位引导件1240可克服由与砧座锁定系统1250的锁定构件1260接合的弹簧1269产生的弹簧力,以使安装部分1223朝近侧移位。主要参见图52,当仓1300被完全加载到细长通道1210中时,可朝近侧移动砧座安装部分1223,使得耳轴1230被推出其相应的锁定凹口1218。例如,耳轴1230可被移动到弓形狭槽段1216的底部中,使得耳轴1230和砧座1220处于例如“解锁”或“可致动”位置,由此通过致动闭合触发器152(参见例如图1和图2),可枢转闭合砧座1220。
当钉仓1300被完全安置在细长通道1210内,并且朝近侧偏压可移位引导件1240时,如本文所述,可移位引导件1240的至少一部分可与细长通道1210中的锁定狭槽1218重叠。例如,可移位引导件1240可朝近侧移位,使得阻隔部分1241与锁定凹口1218纵向对准。在某些情况下,阻隔部分1241可例如与锁定凹口1218纵向地重叠,并且可例如从弓形狭槽段1216纵向偏移。参见图52,阻隔部分1241可移位,使得它们至少部分地覆盖和/或阻挡细长通道1210中的锁定凹口1218;然而,在这样的位置中,例如,阻隔部分1241可不覆盖和/或阻挡弓形狭槽段1216。此外,当阻隔部分1241与锁定凹口1218纵向地重叠时,阻隔部分1241可阻挡耳轴1230进入或接近锁定凹口1218。在此类情况下,例如,耳轴1230可被引导远离锁定凹口1218,并且可沿着弓形狭槽段1216引导耳轴1230。
当外科缝合器械10处于其打开、未击发配置中时,如图1中所示,两个触发器152,102可处于未致动或向前移位的位置,并且当正确的钉仓已经被正确地加载到端部执行器1200中时,砧座1220可处于可致动位置,诸如典型情况是在将加载的端部执行器1200通过套管针或其他开口插入体腔中之后。然后器械10可由临床医生操作,使得待由端部执行器1200缝合和割断的组织定位在钉仓1300和砧座1220之间。如上所述,闭合触发器152朝手枪式握把24(图1和图2)的运动可影响近侧闭合管段1151、挠性颈部组件1070和远侧闭合管段1170的远侧运动。此外,现在参见图55-图58,当远侧闭合管段1170朝远侧移动时,其可接触砧座1220上的闭合凸缘1221。砧座1220可接触组织,并且抵靠钉仓1300推动组织,以在组织内产生夹紧压力。如读者将理解的,不同类型的组织可对施加到其的夹紧压力不同地反应;尽管如此,组织可向砧座1220施加反作用力,这可使砧座1220沿着至少部分地由弓形耳轴狭槽段1216限定的路径移动。在任何情况下,外科医生可相对于钉仓1300枢转砧座1220,以操纵和捕获端部执行器1200中的期望的组织。
如上所述并且主要参见图57,当仓1300被完全地安置在细长通道1210中时,阻隔壁1241的近侧边缘和贴靠表面1248可朝近侧延伸经过锁定凹口1218。还如上所述,阻隔壁1241的一部分可与锁定凹口1218纵向地重叠,并且阻隔壁1241的近侧边缘可在锁定凹口1218和弓形狭槽段1216之间的边界处和/或其附近。在各种情况下,例如,阻隔壁1241的近侧边缘和贴靠表面1248可与弓形狭槽段1216的边缘的一部分纵向对准,使得例如当砧座1220相对于仓1300被闭合时,阻隔壁1241的近侧边缘沿着弓形狭槽段1216引导耳轴1230。
在各种情况下,一旦组织已经定位在砧座1220和仓1300之间,临床医生就可朝近侧移动闭合触发器152(参见例如图1和图2)直到直接定位成与例如手枪式握把24(参见例如图1和图2)相邻,从而将柄部20(参见例如图1和图2)锁定在闭合位置和夹紧位置中。现在参见图59和图60,当砧座1220处于其完全夹紧位置时,砧座耳轴1230可位于弓形狭槽部分1216的上端中。在组织已经被夹紧之后,临床医生可朝近侧移动击发触发器102(参见例如图1和图2),从而使刀杆130(参见例如图2和图3)朝远侧移动到端部执行器1200。具体地,刀杆130可移动穿过砧座1220的枢转突片部分1234中的狭槽1236,并且进入仓体1302中的狭槽1304中,以接触可操作地定位在钉仓1300内的楔形滑动件。当朝远侧驱动刀杆130时,其可切割被捕获在砧座1220和钉仓1300之间的组织,并且朝远侧驱动楔形滑动件,这可使得钉被连续地击发成与砧座1220的钉成形的下表面1222成形接触。
在各种情况下,临床医生可继续移动击发触发器102,直到其与闭合触发器152和手枪式握把24相邻。在某些情况下,击发触发器102的单个致动可足以使可移除地储存在钉仓1300中的所有钉变形,而在其他情况下,可需要击发触发器102的多于一次的致动,以使可移除地储存在钉仓1300中的所有钉变形。与钉变形的同时,刀杆130的切割刃132(图2和图3)可横贯组织T。一旦组织已经被充分地缝合和切割,击发触发器102就可被释放,并且砧座1220可被打开以释放被捕获在端部执行器1200内的组织。在某些情况下,通过在挤压闭合触发器152的同时按压释放按钮120(图1和图2)可打开砧座1220。这种动作可导致远侧闭合管段1170在近侧方向“PD”上的运动。在此类情况下,可由远侧闭合管段1170中的开口1176接合的砧座突片1224可使砧座1220枢转打开。另外,在各种情况下,从砧座1220延伸的向下突出的枢转突片1234(图6)可推靠用过的仓1300,以将砧座1210枢转回到图51-图54所示的打开位置。在各种情况下,然后可以从细长通道1210移除用过的钉仓1300,并且可将未用过的钉仓定位在细长通道1210中,以便再次再利用外科器械和端部执行器1200。
在各种情况下,当用过的仓1300已经从细长通道1210移除时,端部执行器1200可返回到例如图48-图51所示的“未加载”和打开位置。在此类情况下,弹簧加载的砧座锁定系统1250,例如弹簧1269和砧座锁定构件1260的凸轮表面1263可朝远侧偏压耳轴壁1226和1228的端面1227和1229,这可使耳轴1230移动到例如耳轴狭槽1214的锁定凹口1218中。此外,例如,砧座安装部分1223的波状外形表面1225可朝远侧偏压可移位引导件1240的偏压表面1248,这可使可移位引导件1240朝远侧移位,使得可移位引导件1240从锁定凹口1218纵向偏移,并且因此可解锁对锁定凹口1218的接近。
当外科钉仓不存在或者仍未正确地被安置在细长通道内时,上述实施方案的各种独特和新型特征用于阻止端部执行器闭合。当砧座处于其中砧座耳轴保持在其相应的锁定凹口内的锁定位置时,砧座保持在打开位置。当处于打开位置时,端部执行器不能被无意地插入通过套管针。由于完全闭合行程被阻止,因此击发系统不能被致动。因此,即使临床医生试图致动击发触发器,该装置也不击发。各种实施方案还为临床医生提供反馈,以指示仓不存在或者仍未被正确地安装在细长通道中。
可将本文所公开的装置设计为单次使用后即进行处理,或者可将它们设计为可多次使用。但是,无论是哪种情况,该装置都可在至少使用一次后经过修复再行使用。修复可包括拆卸装置、然后清洗或更换特定零件以及后续重新组装中的步骤的任意组合。具体地,装置可拆卸,而且可以任意组合选择性地更换或移除装置的任意数目的特定零件或部件。清洗和/或更换特定部件后,该装置可在修复设施处重新组装以便随后使用,或者在即将进行外科手术前由外科团队重新组装。本领域的技术人员应当理解,装置的修复可利用多种用于拆卸、清洗/更换和重新组装的技术。此类技术的使用以及所得的修复装置均在本发明的范围内。
优选的是,将在手术前处理本文所述的发明。首先,获取新的或用过的器械,并根据需要进行清洗。然后可对器械进行消毒。在一种消毒技术中,将该器械放置在闭合且密封的容器中,诸如塑料袋或TYVEK袋。然后将容器和器械放置在可穿透容器的辐射场,诸如γ辐射、x-射线或高能电子。辐射杀死器械上和容器中的细菌。然后可将消毒的器械储存在无菌容器中。该密封容器使器械保持无菌直到在医疗设施中打开该容器为止。
以引用方式全文或部分地并入本文的任何专利、公布或其他公开材料均仅在所并入的材料不与本公开所述的现有定义、陈述或其他公开材料相冲突的范围内并入本文。因此,并且在必要的程度下,本文明确阐述的公开内容取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。
尽管本发明已被描述为具有示例性的设计,但还能够在本公开的实质和范围内对本发明进行修改。因此本申请旨在涵盖采用本发明一般原理的任何变型、用途或修改型式。另外,本申请旨在涵盖本发明所属领域中属于已知或惯有实践范围内的与本公开不同的型式。
Claims (23)
1.一种缝合器械组件,包括:
仓支撑部分,所述仓支撑部分包括枢转狭槽,其中所述枢转狭槽包括限定闭合路径的第一部分和具有锁的第二部分;
钉仓,所述钉仓能够插入所述仓支撑部分中,其中所述钉仓包括可移除地储存在其中的多个钉;
砧座,所述砧座可动地安装到所述仓支撑部分,其中所述砧座包括被构造成能够使所述钉变形的钉成形部分,其中所述砧座能够在打开位置和闭合位置之间移动,并且其中所述砧座包括可动地定位在所述枢转狭槽中的耳轴;
可滑动构件,所述可滑动构件可滑动地定位在所述仓支撑部分中;和
偏压构件,所述偏压构件被构造成能够当所述钉仓未定位在所述仓支撑部分中时将所述耳轴偏压到所述锁中以防止所述砧座从所述打开位置移动到所述闭合位置,其中所述钉仓被构造成能够当所述钉仓定位在所述仓支撑部分中时接合所述可滑动构件并将所述耳轴推出凹口进入所述枢转狭槽的所述第一部分中,并且随着所述砧座从所述打开位置移动到所述闭合位置允许所述耳轴沿着所述闭合路径移动;
其中,所述可滑动构件被构造成能够当所述钉仓定位在所述仓支撑部分中时阻挡所述耳轴接近所述锁。
2.根据权利要求1所述的缝合器械组件,还包括锁定构件,其中所述偏压构件被构造成能够当所述钉仓未定位在所述仓支撑部分中时推动所述锁定构件与所述砧座接合并将所述砧座保持在所述打开位置。
3.根据权利要求1所述的缝合器械组件,还包括锁定构件,其中所述偏压构件被构造成能够当所述钉仓未定位在所述钉仓支撑部分中时推动所述锁定构件与所述砧座接合并使所述砧座朝向所述打开位置旋转。
4.一种外科组件,包括:
柄部,所述柄部包括击发触发器;
轴,所述轴从所述柄部延伸,其中所述轴包括击发杆;
外科端部执行器,所述外科端部执行器从所述轴延伸,其中所述外科端部执行器包括:
第一钳口,所述第一钳口包括通道,其中在所述通道中限定多个狭槽,其中所述多个狭槽包括第一狭槽和第二狭槽,并且其中所述第一狭槽包括枢转路径和锁定沟槽;
第二钳口,所述第二钳口包括具有安装部分的砧座,其中所述安装部分包括可动地定位在所述第一狭槽中的第一销;和
可移位引导件,所述可移位引导件定位在所述第一钳口中,其中所述可移位引导件包括:
主体,所述主体包括可动地定位在所述第二狭槽中的第二销,其中纵向狭缝限定在所述主体中并与所述击发杆侧向对准;和
阻隔件,所述阻隔件从所述主体延伸,其中当所述第二销定位在所述第二狭槽中的位置范围内时,所述阻隔件与所述锁定沟槽纵向对准,并且其中当所述第二销定位在所述位置范围之外时,所述阻隔件从所述第一狭槽纵向偏移;和
紧固件仓,所述紧固件仓定位在所述通道中,其中所述紧固件仓包括:
多个紧固件;和
偏压表面,所述偏压表面定位成与所述可移位引导件抵靠接合,其中所述偏压表面被构造成能够将所述第二销偏压到在所述位置范围内的一个位置中。
5.根据权利要求4所述的外科组件,还包括锁定组件,其中所述锁定组件包括:
主体,该主体包括凸轮;和
弹簧,其中所述弹簧定位成将所述凸轮偏压成与所述安装部分抵靠接合。
6.根据权利要求5所述的外科组件,其中所述凸轮被构造成能够将所述第一销偏压到所述锁定沟槽中。
7.根据权利要求6所述的外科组件,其中所述阻隔件包括被定位成与所述安装部分抵靠接合的贴靠表面,并且其中所述贴靠表面被构造成能够当所述第二销定位在位于所述位置范围内的一个位置上时将所述第一销偏压到所述枢转路径中。
8.一种外科端部执行器,包括:
第一钳口,所述第一钳口包括通道,其中在所述通道中限定多个狭槽,并且其中所述多个狭槽包括:
枢转销狭槽;和
滑动销狭槽;
第二钳口,所述第二钳口包括:
砧座;和
安装部分,所述安装部分包括枢转销,其中所述枢转销可动地定位在所述枢转销狭槽中;和
可滑动击发杆引导件,所述可滑动击发杆引导件定位在所述第一钳口中,其中所述可滑动击发杆引导件包括:
主体,所述主体包括滑动销,其中所述滑动销可动地定位在所述滑动销狭槽中;和
腿部,所述腿部从所述主体朝近侧延伸,其中当所述滑动销定位在所述滑动销狭槽中的位置范围内时,所述腿部与所述枢转销狭槽的至少一部分纵向对准,并且其中当所述滑动销定位在所述滑动销狭槽中的所述位置范围外时,所述腿部从所述枢转销狭槽纵向偏移。
9.根据权利要求8所述的外科端部执行器,其中所述枢转销狭槽包括弓形部分和锁定部分,其中所述枢转销被构造成能够当所述第二钳口相对于所述第一钳口枢转时在所述弓形部分中移动,并且其中当所述滑动销定位在所述位置范围内时,所述腿部与所述锁定部分纵向重叠。
10.根据权利要求9所述的外科端部执行器,还包括定位在所述通道中的紧固件仓,其中所述紧固件仓包括:
多个紧固件;和
偏压表面,所述偏压表面定位成与所述可滑动击发杆引导件抵靠接合,其中所述偏压表面被构造成能够使所述枢转销移动到所述弓形部分中。
11.根据权利要求8所述的外科端部执行器,还包括定位在所述通道中的紧固件仓,其中所述紧固件仓包括:
多个紧固件;和
近侧偏压表面,其中所述近侧偏压表面定位成与所述可滑动击发杆引导件抵靠接合,并且其中所述近侧偏压表面将所述滑动销滑动到所述位置范围内的一个位置中。
12.根据权利要求8所述的外科端部执行器,还包括锁定组件,所述锁定组件包括:
主体,该主体包括凸轮;和
弹簧,所述弹簧定位成将所述凸轮偏压成与所述安装部分抵靠接合。
13.根据权利要求8所述的外科端部执行器,其中在所述可滑动击发杆引导件中限定纵向狭缝,并且其中所述纵向狭缝被设定尺寸和定位成接收可平移的击发杆。
14.根据权利要求8所述的外科端部执行器,其中所述可滑动击发杆引导件包括壁,其中所述安装部分包括被构造成能够与所述壁的一部分互补的沟槽,并且其中所述壁定位成与所述沟槽相邻。
15.根据权利要求8所述的外科端部执行器,还包括围绕所述安装部分的至少一部分定位的闭合管,其中在所述闭合管中限定开口,并且其中所述安装部分包括延伸穿过所述开口的闭合突片。
16.一种外科器械,包括:
第一钳口,所述第一钳口包括通道,其中在所述通道中限定多个狭槽,并且其中所述多个狭槽包括:
枢转销狭槽;和
滑动销狭槽;
第二钳口,所述第二钳口包括:
砧座;和
安装部分,其中所述安装部分包括可动地定位在所述枢转销狭槽中的枢转销;
击发杆;和
引导件,所述引导件可动地定位在所述第一钳口中,其中所述引导件包括:
主体,所述主体包括:
纵向狭缝,所述纵向狭缝与所述击发杆侧向对准;和
滑动销,所述滑动销可动地定位在所述滑动销狭槽中;和
腿部,所述腿部从所述主体延伸,其中所述腿部被构造成能够当所述滑动销定位在所述滑动销狭槽中的第一位置范围内时阻挡所述枢转销狭槽的至少一部分。
17.根据权利要求16所述的外科器械,还包括:
端部执行器,所述端部执行器包括所述第一钳口和所述第二钳口;
柄部,所述柄部包括击发触发器;和
轴,所述轴定位在所述柄部和所述端部执行器中间。
18.根据权利要求16所述的外科器械,还包括锁定组件,所述锁定组件包括:
主体,该主体包括凸轮表面;和
弹簧,所述弹簧定位成将所述凸轮表面偏压成与所述安装部分抵靠接合。
19.根据权利要求18所述的外科器械,其中所述枢转销狭槽包括弓形狭槽和从所述弓形狭槽延伸的锁定沟槽。
20.根据权利要求19所述的外科器械,其中所述枢转销被构造成能够当所述砧座相对于所述通道枢转时在所述弓形狭槽中移动,其中当所述滑动销定位在所述滑动销狭槽中的所述第一位置范围内时,所述腿部与所述锁定沟槽纵向对准,并且其中当所述滑动销定位在所述滑动销狭槽中的第二位置范围内时,所述腿部从所述锁定沟槽纵向偏移。
21.根据权利要求19所述的外科器械,其中所述凸轮表面被构造成能够将所述枢转销偏压到所述锁定沟槽中。
22.根据权利要求19所述的外科器械,还包括定位在所述通道中的紧固件仓,其中所述紧固件仓被构造成能够将所述枢转销移位出所述锁定沟槽。
23.根据权利要求16所述的外科器械,还包括定位在所述通道中的紧固件仓,其中所述紧固件仓被构造成能够将所述滑动销偏压到所述第一位置范围内的一个位置。
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US14/304,077 US10045781B2 (en) | 2014-06-13 | 2014-06-13 | Closure lockout systems for surgical instruments |
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PCT/US2015/030935 WO2015191231A1 (en) | 2014-06-13 | 2015-05-15 | Closure lockout systems for surgical instruments |
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EP3315081B1 (en) | 2020-09-09 |
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