CN107095698B - 包括旋转末端执行器和旋转限制结构的手术器械 - Google Patents
包括旋转末端执行器和旋转限制结构的手术器械 Download PDFInfo
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Abstract
本发明涉及一种包括旋转末端执行器和旋转限制结构的手术器械。一种用于向组织施加钉的手术器械。所述手术器械包括手柄组件、细长部、外管、末端执行器、旋转组件和旋转限制结构。所述旋转组件构造成使所述外管的至少一部分关于第一纵轴线并且相对于所述手柄组件旋转。所述旋转组件包括被可旋转地固定至所述外管的近侧部的旋转旋钮。所述旋转限制结构布置成与所述旋转组件和所述手柄组件中的至少一个机械协作,并且构造成限制所述外管相对于所述手柄组件的旋转量。
Description
相关申请的交叉引用
本申请要求于2013年8月23日提交的第13/974,371号美国专利申请的部分连续申请,该申请是作为2013年6月28日提交的第13/930,770号美国专利申请的部分连续申请的于2013年8月23日提交的第13/974,338号美国专利申请的部分连续申请,并且上面提及的申请的每个申请的公开通过引用整体上合并于此。
技术领域
本申请涉及用于执行内窥镜手术操作的手术器械、装置和/或系统及其使用方法。更具体地,本公开涉及包括能够关节式运动、旋转并且具有有限的旋转量的手术器械、装置和/或系统。
背景技术
在腹腔镜或内窥镜手术操作期间,通常通过小切口或者通过插入穿过患者中的小进入伤口的窄插管来实现对于手术部位的伸入和到达。由于用于伸入和到达手术部位的有限的区域,很多内窥镜手术装置包括用于使该装置的工具组件或末端执行器关节式运动或旋转的机构。
在用以施加具有螺旋状螺纹的钉或锚定件的手术器械中,例如,当试图旋转末端执行器时,比如由于钉也构造成旋转通过末端执行器、通过手术用网状件并进入组织,存在另外的挑战。
因此,存在对如下的一种钉施加手术器械的需求:其包括用于使其末端执行器关节式运动和旋转的能力,而同时还限制整体旋转量以防止钉的过早喷射并防止当试图喷射钉时的时机问题。
发明内容
本公开涉及一种构造成向组织施加钉的手术器械。所述手术器械包括手柄组件、细长部、外管、末端执行器、旋转组件和旋转限制结构。所述细长部从所述手柄组件向远侧延伸并且限定第一纵轴线。所述外管从所述手柄组件向远侧延伸。所述末端执行器邻近所述细长部的一部分布置并且构造成在其中容纳多个钉。所述末端执行器限定第二纵轴线。所述旋转组件构造成使所述外管的至少一部分关于所述第一纵轴线并且相对于所述手柄组件旋转。所述旋转组件包括被可旋转地固定至所述外管的近侧部的旋转旋钮。所述旋转限制结构布置成与所述旋转组件和所述手柄组件中的至少一个机械协作,并且构造成限制所述外管相对于所述手柄组件的旋转量。
在实施例中,所述旋转限制结构包括从所述旋转旋钮的一部分延伸的至少一个凸起。所公开的是,所述旋转限制结构包括布置在所述手柄组件内的至少一个唇缘。进一步公开的是,所述至少一个凸起中的第一凸起构造成在所述旋转旋钮沿着第一方向旋转预定量时接触所述至少一个唇缘中的第一唇缘。另外,公开的是,所述至少一个凸起中的第二凸起构造成在所述旋转旋钮沿着第二方向旋转预定量时接触所述至少一个唇缘中的第二唇缘。还公开的是,所述旋转旋钮沿着所述第一方向的旋转预定量是约45°,并且其中所述旋转旋钮沿着所述第二方向的旋转预定量是约45°。
在所公开的实施例中,所述旋转旋钮包括非圆形的横截面,其中所述横截面垂直于所述第一纵轴线截取。
进一步公开的是,所述末端执行器的至少一部分相对于所述外管可旋转地固定。
另外,公开的是,所述旋转组件构造成使所述末端执行器的至少一部分关于所述第二纵轴线旋转。
在所公开的实施例中,所述手术器械进一步包括至少部分地布置在所述末端执行器内的多个螺纹形钉。
同样公开的是,所述手术器械进一步包括构造成使所述末端执行器从第一位置移动至第二位置的关节式运动组件,在所述第一位置,所述第二纵轴线与所述第一纵轴线共轴,在所述第二位置,所述第二纵轴线相对于所述第一纵轴线成角度地布置。进一步公开的是,所述关节式运动组件包括关节式运动旋钮,所述关节式运动旋钮能够关于所述第一纵轴线相对于所述外管的所述近侧部旋转。
本公开还涉及一种从手术器械向组织施加手术用钉的方法。所述方法包括使所述手术器械的末端执行器从第一位置关节式运动至第二位置,在所述第一位置,所述末端执行器与所述手术器械的细长部纵向地对准,在所述第二位置,所述末端执行器相对于所述细长部成角度地布置。所述方法进一步包括使所述末端执行器沿着第一方向相对于所述手术器械的手柄组件旋转第一量。所述方法进一步包括将所述末端执行器沿着所述第一方向的旋转量限制到第一预定旋转量;并且从所述手术器械喷射至少一个手术用钉。
在所公开的实施例中,所述方法进一步包括将所述第一预定旋转量限制到约45°。
所述方法的实施例进一步包括使所述末端执行器沿着第二方向相对于所述手术器械的手柄组件旋转第二量。公开的是,所述方法还包括将所述末端执行器沿着所述第二方向的旋转量限制到第二预定旋转量,并且所述第二预定旋转量为约45°。
在实施例中,使所述末端执行器关节式运动独立于使所述末端执行器旋转来执行。
附图说明
在下文中参照并入到和构成本说明书的一部分的附图来描述本公开的各方面,其中:
图1是根据本公开的用于在内窥镜手术装置中使用的手术用锚定件的立体图;
图2是图1的手术用锚定件的侧视图;
图3是图1和图2的手术用锚定件的远侧端视图;
图4是图1至图3的手术用锚定件的部分截去的侧视图;
图5是根据本公开的方案的内窥镜手术装置;
图6是图5的内窥镜手术装置在部件分离时的立体图;
图7是图6的标示的细节区域的放大图;
图8是图5的内窥镜手术装置的手柄组件在从其去除了第一壳体半部时的后视立体图;
图9是图5的内窥镜手术装置的手柄组件在从其去除了第二壳体半部时的前视立体图;
图10是图5的内窥镜手术装置的手柄组件在从其去除了第二壳体半部和扳机时的后视立体图;
图11是图5的内窥镜手术装置的手柄组件在从其去除了第二壳体半部且部件分离时的后视立体图;
图12是图8至图11的手柄组件的小齿轮的立体图;
图13是图8至图11的手柄组件的按钮和滑块的立体图;
图14是图8至图11的手柄组件的锥齿轮的立体图;
图15是图5的内窥镜手术装置的内窥镜组件在部件分离时的前视立体图;
图16是图15的标示的细节区域的放大图;
图17是图5的内窥镜手术装置的后视立体图;
图18是图17的标示的细节区域的放大图;
图19是图5的内窥镜手术装置的远侧端在末端执行器被示出从其分离时的立体图;
图20是图19的末端执行器的后视立体图;
图21是图20的末端执行器在从其去除了外管时的后视立体图;
图22是图20和图21的末端执行器在外管从其分离时的立体图;
图23是图20至图22的末端执行器在从其去除了外管并且部件部分地分离时的立体图;
图24是图20至图23的末端执行器的内管在图1至图4的多个锚定件被示出从其分离时的立体图;
图25是沿着图22的25-25截取的截面图;
图26是沿着图22的26-26截取的截面图;
图27是沿着图22的27-27截取的截面图;
图28是图20至图27的末端执行器在运送楔被示出附接至此时的立体图;
图29是通过图28的29-29截取的截面图;
图30是通过图29的30-30截取的截面图;
图31是图5的内窥镜手术装置的纵向截面视图;
图32是图31的标示的细节区域的放大图;
图33是图31的标示的细节区域的放大图;
图34是通过图31的34-34截取的截面图;
图35是图34的标示的细节区域的放大图;
图36是图34的标示的细节区域的放大图;
图37是图36的标示的细节区域的放大图;
图38是通过图33的34-34截取的截面图;
图39是通过图33的34-34截取的截面图;
图40是通过图33的34-34截取的截面图;
图41是通过图33的34-34截取的截面图;
图42是图9和图10中所示的手柄组件的放大视图,其图示出了滑块的操作;
图43是图5的内窥镜手术装置的末端执行器和内窥镜组件的纵向截面图,其图示出了末端执行器和内窥镜组件分开时的第一步骤;
图44是图5的内窥镜手术装置的末端执行器和内窥镜组件的纵向截面图,其图示出了末端执行器和内窥镜组件分开时的第二步骤;
图45是图5至图11的手柄组件的关节式运动旋钮的纵向截面图,其图示出了关节式运动旋钮的旋转;
图46是内窥镜手术装置的远侧端的纵向截面图,其图示出了末端执行器由于关节式运动旋钮的旋转而相对于内窥镜组件的关节式运动;
图47是图9和图10中所示的手柄组件的放大视图,其图示出了所示处于扳机的初始致动后的位置中的手柄组件的听觉/触觉反馈构件的操作;
图48是图9和图10中所示的手柄组件的放大视图,其图示出了所示处于扳机的完全致动后的位置中的手柄组件的听觉/触觉反馈构件的操作;
图49是内窥镜组件的末端执行器和远侧端的纵向截面图,其图示出了手术用锚定件通过手术用网状件的植入并且进入下层组织;
图50是示出手术用网状件利用多个手术紧固件锚定和/或固定到下层组织的立体图示;
图51是内窥镜手术装置的另一实施例的远侧端的立体图,其图示出了替代的末端执行器和替代的互补细长主体部,其中末端执行器被示出为与细长主体部分离;
图52是图51的内窥镜手术装置的末端执行器的立体图;
图53是图52的末端执行器在从其去除了末端执行器的外管时的立体图;
图54是图51的内窥镜手术装置的一部分在所示的末端执行器的近侧端连接至细长主体部的远侧端时的立体图,所述细长主体部示出为处于推进位置;
图55是图51的内窥镜手术装置的一部分在所示的末端执行器的近侧端连接至细长主体部的远侧端的立体图,所述细长主体部示出为处于缩回位置;
图56是根据本公开的运送楔的实施例的侧视图;
图57A是图56的运送楔在图52的末端执行器示出为布置在运送楔内并且联接至运送楔时的俯视立体图;
图57B是沿着图57A的57B-57B截取的侧视截面图;
图58A是图56的运送楔在图52的末端执行器示出为联接到运送楔并且图51的内窥镜手术装置的细长主体部相对于末端执行器被安置在运送楔内时的俯视立体图;
图58B是沿着图58A的58B-58B截取的侧视截面图;
图59至图62是图示出末端执行器被联接并稳固至细长主体部并从运送楔去除的放大渐进侧视截面图;
图63是根据本公开的另一实施例的钉施加器的侧视图;
图64A是图63的钉施加器的近侧端视图,其图示出该钉施加器的末端执行器已经关节式运动并且沿着逆时针方向旋转;
图64B是图63和图64A的钉施加器的近侧端视图,其图示出该钉施加器的末端执行器已经关节式运动而未被旋转;
图64C是图63至图64B的钉施加器的近侧端视图,其图示出该钉施加器的末端执行器已经关节式运动并且沿着顺时针方向旋转;
图65是图64B的钉施加器的手柄组件的侧视图,其图示出处于未旋转位置的旋转旋钮;
图66是图64C的钉施加器的手柄组件的侧视图,其图示出沿着顺时针或第一方向旋转的旋转旋钮;
图67是图64B和图65的钉施加器的手柄组件的剖开侧视图,其图示出旋转旋钮处于图65的未旋转位置;
图68是图64C和图66的钉施加器的手柄组件的剖开侧视图,其图示出图66的沿着顺时针或第一方向旋转的旋转旋钮;
图69和图69A是图67中所示的手柄组件的多个部分的立体图,其图示出旋转旋钮处于图65和图67的未旋转位置;
图69B是沿着图69A中的线69B-69B截取的剖开立体图,其图示出旋转旋钮处于未旋转位置;
图70是图68中所示的手柄组件的一部分的立体图,其图示出图66和图68沿着顺时针或第一方向旋转的旋转旋钮;
图71是图64B的钉施加器的远侧端的立体图,其示出锚定件处于远侧位置,并且对应于图65、图67和图69的处于未旋转位置的旋转旋钮;
图72是图71的钉施加器的远侧端的远侧端视图;
图73是图64C的钉施加器的远侧端的远侧端视图,其对应于被沿着顺时针方向旋转的旋转旋钮;
图74是图64A的钉施加器的远侧端的远侧端视图,其对应于被沿着逆时针方向旋转的旋转旋钮;并且
图75是已经被沿着顺时针方向旋转超出预定量的钉施加器的远侧端的远侧端视图。
具体实施方式
本公开的手术器械的实施例参照附图进行详细描述,其中相同的参考标号在若干视图的每个视图中表示相同或对应的元件。正如在此使用的,术语“远侧”指的是内窥镜手术装置的较远离用户的部分,而术语“近侧”指的是内窥镜手术装置的较靠近用户的部分。
可包括根据本公开的关节式运动接头的内窥镜手术装置的非限制性实施例包括手动、机械和/或机电手术用钉施加器(钉钉器)等。
首先参照图1至图4,图示出了用于与本公开的手术用钉施加器一起使用的手术用锚定件或钉,并且总体上被标出为锚定件100。如在图1至图4中所看到的,锚定件100包括头部110、网状物保持部120和带螺纹的组织捕捉(snaring)部130。头部110包括具有相应的径向外螺旋头螺纹114a、114b的一对相对的螺纹部112a、112b以及一对相对的开口或开槽部116a、116b。头部110的远侧表面形成在网状物保持部120的近侧端上或与网状物保持部120的近侧端一体地形成。
锚定件100的网状物保持部120从头部110的远侧端或表面和组织捕捉部130的近侧端延伸并且在其间延伸。网状物保持部120用以当锚定件100被旋拧入网状物中至经过组织捕捉部130的组织捕捉螺纹132的最近侧段138的深度时,锁定、锚定或以其它方式来将手术用网状件(未示出)保持到锚定件100上。因为没有定位在网状件保持部120中的螺纹来允许锚定件100被旋松或从网状件退出,这得以实现。
网状物保持部120具有圆柱形或圆锥形横截面轮廓。网状物保持部120包括相对于锚定件100的中心纵轴线的横向径向尺寸,所述横向径向尺寸小于头部110的横向径向尺寸,并且小于组织捕捉螺纹132的最近侧段138的横向径向尺寸。
锚定件100的螺纹组织捕捉部130包括形成在锥形截头主体部134上的螺旋螺纹132。远侧点或尖端136限定最远侧组织捕捉螺纹132的末端。
如在图4中所看到的,组织捕捉部130的主体部134是逐渐变细的,即朝向螺纹组织捕捉部130的远侧端变小,并且在到达锚定件100的顶点或尖端之前终止或截断到远侧截断点“TP”。主体部134包括凹锥体,使得对于给定的长度,最小直径主体部134在其截断时限定,所述最小直径近似小于0.01英寸。
锚定件100包括螺纹组织捕捉部130中的最远侧螺纹的横向尺寸“D”,所述横向尺寸“D”与设计约束将允许的一样大或大约大于0.040英寸。根据本公开,小的截头体直径和大的“D”值使组织压痕最小化。组织捕捉螺纹132终止于远侧尖端136处,所述远侧尖端136在主体部134的截断点“TP”的远侧。
通过提供向组织捕捉部130的截断点“TP”的远侧延伸的远侧尖端136,减轻了锚定件100对网状件的穿透;并且与具有带锥形螺纹的非截头体的锚定件相比,最小化了锚定件100将网状件压入到相对软的组织中的压痕。
对于由外科医生施加到手术用网状件的给定力,在钉施加器上施加远侧力,锚定件100的尺寸“D”越大,施加引起下层组织和手术用网状件的压痕的压力越小。
锚定件100是非插管的,并且由合适的生物可吸收材料(例如,聚丙交酯、聚乙交酯)构造。锚定件100由专用的生物相容性共聚物(Lactomer USS L1、BoehringerIngelheim LR 704S或Boehringer Ingelheim LG-857)形成。
现在转向图5至图49,以内窥镜手术用钉施加器或钉钉器的形式的内窥镜手术装置总体上被示出为200。钉施加器200包括手柄组件210和内窥镜组件300,所述内窥镜组件300从手柄组件210延伸并被配置成存储和从其选择性地释放或发射多个锚定件100并且进入覆盖组织“T”的网状件“M”中。(参见图50)。
如在图5至图14中所看到的,手柄组件210包括由彼此接合的第一半部212a和第二半部212b形成的手柄壳体212。手柄壳体212的第一半部212a和第二半部212b可以使用本领域技术人员已知的方法彼此连接,包括但不限于焊接、紧固件(即螺钉)等。
手柄组件210包括在远离内窥镜组件230的位置处可枢转地连接到手柄壳体212的扳机214。手柄组件210包括构造成用于将扳机214保持在延伸或未致动位置的偏置构件222。偏置构件222还被构造成具有足以使扳机214返回到未致动位置的弹簧常数。
扳机214限定在与扳机214的枢轴相对或远离的位置处形成在其上的齿条214a。扳机214的齿条214a被构造成与可旋转地支撑在手柄壳体212中的小齿轮216可操作地接合。齿条214a和小齿轮216定尺寸成使得扳机214的一次完全的挤压引起小齿轮216的一个完整的旋转。
如图7、图9、图11、图47和图48中所示,手柄组件210包括与其相关联的正时系统270。正时系统270包括形成在扳机214的表面中的滚道214c。滚道214c沿其限定多个台阶214d,以及在其中形成的初始位置214e(图9和图48)。
正时系统270包括具有第一端272a的弹性和可偏转臂272,所述第一端272a可操作地连接到滚道214c或布置在其中,并且当所述臂272的第一端272a围绕滚道214c行进时与台阶214d接触。可偏转臂272还包括连接到手柄壳体半部212b的第二端272b。扳机的滚道214c被构造成使得当扳机214处于完全未致动位置时,可偏转臂272的第一端272a定位在滚道214c的初始位置214e中。
在操作中,如在图47和图48中所看到的,当扳机214处于完全未致动位置时,正如上面所提及的,可偏转臂272的第一端272a位于滚道214c的初始位置214e中。然后,随着扳机214被致动,臂272的第一端272a经由和/或沿着形成在扳机214中的滚道214c(沿单个方向)行进。臂272的第一端272a在滚道214c的台阶214d上单向移动,使得如果扳机214在部分挤压之后被释放,则臂272的第一端272a由于台阶214d而不能向后或反向移动通过滚道214c,并且扳机214不能返回到完全未致动位置。
正如这样配置和可操作的,并且正如下面将详细描述的,仅当扳机214处于完全未致动、初始和锁定位置时,末端执行器或装载单元300可以被移除和替换。这样,当扳机214处于短行程状态(即,部分致动)时,末端执行器或装载单元300不能被移除或更换或装载在手柄组件200上/中。
另外,当臂272的第一端272a在滚道214c的台阶214d上移动时,臂272的第一端272a卡合在台阶214d上,并为外科医生产生可闻的声音/点击和/或触觉振动。可以预期到,正时系统270在滚道214c中包括足够的台阶214d,以便在如下情况下产生可闻的/触觉指示:当扳机214处于完全未致动的初始或锁定位置(用于装载/卸载末端执行器或装载单元300)时;在扳机214已被完全致动以发射单个手术用锚定件100时;以及当扳机214被复位到完全未致动的初始位置(其中扳机214可以再次被锁定)并且准备好发射另一个手术用锚定件100时,。
如在图7以及图9至图12中所看到的,手柄组件210包括小齿轮216,所述小齿轮216具有从其径向地延伸的臂216a和从臂216a延伸/突出的凸轮或斜面216b。凸轮216b包括具有限定肩部的高度的前端216c和渐缩到臂216a中的尾端216d。
如在图7至图11以及图14中所看到的,手柄组件210还包括第一锥齿轮218,所述第一锥齿轮218以冠状齿轮的形式、可操作地接合/关联于小齿轮216。第一锥齿轮218限定形成在其面218d中的弧形槽218a,用于选择性地接收和接合小齿轮216的凸轮216b。槽218a包括前端壁218b,所述前端壁218b构造成接合小齿轮216的凸轮216b的前端216c,并且槽218a沿其长度逐渐变细以与第一锥齿轮218的面218d齐平。
在使用中,当扳机214被致动时,其齿条214a沿轴向或弧形第一方向移动,由此使与其啮合的小齿轮216沿第一方向旋转。当小齿轮216沿第一方向旋转时,小齿轮216的凸轮216b的前端216c沿第一方向旋转,直到前端216c接合或接触第一锥齿轮218的槽218a的前端壁218b。在小齿轮216的前端216c接合或接触第一锥齿轮218的槽218a的前端壁218b时,小齿轮216沿第一方向的继续旋转引起第一锥齿轮218沿第一方向的伴随旋转。在这一点上,只要扳机214被致动并且齿条214a在第一方向上移动,则第一锥齿轮218继续在第一方向上旋转。
当扳机214的致动停止时,在完全致动之前或在完全致动之后,第一锥齿轮218沿第一方向的旋转也停止。
在扳机214的部分或完全致动及其释放被完成时,其齿条214a沿第二方向(与第一方向相反)移动,由此使小齿轮216沿第二方向旋转。当小齿轮216沿第二方向旋转时,其凸轮216b的后端216d沿着第一锥齿轮218的槽218b滑动,并且如果沿第二方向的旋转足够,则凸轮216b的后端216d从锥齿轮218的槽218b滑出并且沿着第一锥齿轮218的面218d滑动。
如果扳机214被完全致动,则扳机214的完全释放并且返回到完全未致动位置(其中,可偏转臂272的第一端272a返回到滚道214c的初始位置214e)将导致小齿轮216沿第二方向完全旋转,直到小齿轮216的凸轮216b的前端216c离开第一锥齿轮218的槽218a的前端壁218b,由此重新进入第一锥齿轮218的槽218a。
如在图8和图11中所看到的,钉施加器200的手柄组件210设置有棘轮机构260,所述棘轮机构260构造成在锚定件100已经被至少部分地驱动到组织中之后抑制或防止内轴组件238退出或反转。如在图8和图11所看到的,棘轮机构260包括形成在第一锥齿轮218的后表面218e上的一系列棘轮齿218f。
棘轮机构260还包括稳固在手柄组件210内的弹簧夹262。弹簧夹262包括弹性指状件262a,所述弹性指状件262a构造成用于与形成在第一锥齿轮218的后表面218e上的棘轮齿218f接合。
每个棘轮齿218f包括浅倾斜侧和陡倾斜侧。以这种方式,弹簧夹262的弹性指状件262a以如下的方式与棘轮齿218f接合:使得当第一锥齿轮218在第一方向上旋转时,弹簧夹262的弹性指状物262a在棘轮齿218f的浅倾斜侧上进行凸轮运动。同样地,如果第一锥齿轮218沿第二方向(与第一方向相反)旋转,则弹簧夹262的弹性指状件262a抵靠棘轮齿218f的陡倾斜侧而停止,由此防止或阻止第一锥齿轮218在第二方向上旋转。这样,在驱动或发射行程期间,抑制或防止了锚定件100或内轴组件238的任何反转或“退出”(倾向于引起第一锥齿轮218在第二方向上旋转)。
在替代实施例中,由于第一锥齿轮218和手柄壳体212的表面之间的静摩擦系数或者第一锥齿轮218和将第一锥齿轮218支撑其上的销之间的静摩擦系数(这趋于维持第一锥齿轮218静止),在小齿轮216沿着第二方向旋转时,第一锥齿轮218可以保持免于沿着第二方向或相反方向旋转。这种构造和组件用作用于施力器200的棘轮机构等。
参照图6、图7以及图9至图11,手柄组件210还包括具有齿轮齿220a的第二或小齿轮-锥齿轮220,所述齿轮齿220a与形成在第一锥齿轮218的外径向边缘处和前面218d上的齿轮齿218c可操作地接合或啮合。小齿轮-锥齿轮220稳固到锚定件维持/推进组件230(参见图15)的内轴组件238的近侧端。在实施例中,小齿轮-锥齿轮220键合到锚定件维持/推进组件230的内轴组件238的近侧端,使得内轴组件238能够相对于小齿轮-锥齿轮220轴向移位,并且防止其相对于小齿轮-锥齿轮220旋转。
在使用中,如上所述,在挤压扳机214时,其齿条214a引起小齿轮216沿第一方向旋转。小齿轮216在第一方向上的旋转导致第一锥齿轮218在第一方向上的旋转,并进而导致小齿轮-锥齿轮220在第一方向上的旋转。当小齿轮-锥齿轮220沿第一方向旋转时,小齿轮-锥齿轮220将旋转传递到锚定件维持/推进组件230的内轴组件238。
如在图5至图11以及图13中所看到的,手柄组件210包括按钮240,其支撑在手柄壳体212上并且被配置为允许和禁止扳机214的致动,并且用于实现末端执行器300到锚定件维持/推进组件230的装载/保持和释放/移除的。按钮240包括可滑动地支撑在手柄壳体212中的销240a。销240a定向在垂直于锚定件维持/推进组件230的纵轴线的方向上。如在图38至图41中所看到的,销240a具有如下的长度:使得当按钮240处于第一位置时,销240a的第一端从手柄壳体212的第一侧延伸,并且当按钮240处于第二位置时,销240a的第二端从手柄壳体212的第二侧延伸。
如在图13以及图38至图41中所看到的,按钮240包括支撑在销240a上并连接到销240a的板240b。板240b在其中限定了细长槽240c,小齿轮-锥齿轮220的杆220a延伸穿过槽240c。板240b的细长槽240c限定相对于销240a的纵轴线平行的主轴线。在使用中,当销240a在第一位置和第二位置之间移动时,板240b在相应的第一位置和第二位置之间移动。
按钮240包括限定在板240b中的第一止动件或凹部240d和限定在板240b中的第二止动件或凹部240e,所述第一止动件或凹部240d在按钮240处于第一位置时由偏置构件242接合,所述第二止动件或凹部240e在按钮240处于第二位置时由偏置构件242接合。偏置构件242在按钮240的第一止动件240d或第二止动件240e中的接合用于帮助将按钮240保持在第一位置或第二位置。
在实施例中,偏置构件242可以是柱塞弹簧的形式,并且,如在图33和图42所看到的,在另一个实施例中,偏置构件242可以是扭转弹簧的形式。相较柱塞弹簧更考虑使用扭转弹簧,以便降低手术用钉钉器200的总成本。
如在图8、图13、图33以及图38至图42中所看到的,按钮240包括从板240b延伸的第一壁240f和从板240b延伸的第二壁240g。在使用中,当按钮240处于第一位置时,其第一壁240f阻止或抑制装载/释放滑块244的移动,并且当按钮240处于第二位置时,其第一壁240f允许装载/释放滑块244的移动。类似地,在使用中,当按钮240处于第二位置(仅当扳机214处于完全未致动或初始位置时才可实现)时,其第二壁240g通过第二壁240g延伸到扳机214的凹口214b中来阻止或抑制扳机214致动;并且当按钮240处于第一位置时,第二壁240g离开扳机214的凹口214b,以允许扳机214的致动。
如在图5至图11、图13以及图38至图42中所看到的,手柄组件210包括装载/释放滑块244,所述装载/释放滑块244可滑动地支撑在手柄壳体212上并且构造成以单次使用装载单元(装载单元)或一次性装载单元(DLU)的形式实现末端执行器300的装载/保持和释放/移除,这将在下面更详细地讨论。滑块244包括从其向近侧并朝向按钮240延伸的第一杆244a。具体地,当按钮240处于第一位置时,滑块244的第一杆244a与从按钮240的板240b延伸的第一壁240f轴向对准(参见图39),而当按钮240处于第二位置时,滑块244的第一杆244a不与按钮240的第一壁240f轴向对准(参见图41)。
滑块244还包括从其沿着朝向锚定件保持/推进组件230的内轴组件238的方向延伸的第二杆244b。如在图15和图42中所看到的,内轴组件238支撑一对轴向间隔开的径向凸缘238d、238e,该对径向凸缘238d、238e夹挡了第二杆244b,也就是,一个凸缘位于第二杆244b的远侧,一个凸缘位于第二杆244b的近侧。
在使用中,如在图41和图42中所看到的,当按钮240处于第二位置(其中,扳机214被锁定在完全未致动位置中),使得滑块244的第一杆244a脱离与按钮240的第一壁240f的轴向对准时,滑块244自由地在第一或远侧位置与第二或近侧位置之间移动。当滑块244从其第一位置移动到其第二位置时,滑块244的第二杆244b在内轴组件238的近侧径向凸缘238d上施加力,以将内轴组件238从相应的第一位置向近侧推动到相应的第二位置。于是,当滑块244从第二位置移动到其第一位置时,滑块244的第二杆244b在内轴组件238的远侧径向凸缘238e上施加力,以将内轴组件238从相应的第二位置向远侧推动到相应的第一位置。
根据本公开,当内轴组件238在其相应的第一位置和第二位置之间移动时,被连接到联接构件238c的内轴组件238导致联接构件238c也在相应的第一位置和相应的第二位置之间移动。
滑块244可以由偏置构件245(参见图42)偏置到第一位置或远侧位置。
如在图5、图6、图8、图15、图17、图33至图35以及图45中所看到的,手柄组件210包括可旋转地支撑在手柄壳体212上的关节式运动旋钮246。关节式运动旋钮246限定内螺旋螺纹246a。内螺旋螺纹246a啮合地接收或接合连接螺母247的外螺纹247a,所述连接螺母247不可旋转地连接到锚定件保持/推进组件230的内管组件234的近侧管部234a。连接螺母247可以键合到关节式运动旋钮246以便当关节式运动旋钮246旋转时相对于关节式运动旋钮246不旋转。或者,当关节式运动旋钮246旋转时,外科医生可手动地抓持连接螺母247的远侧端(其向关节式运动旋钮246的远侧伸出/延伸)。
在使用中,如在图45和图46中所看到的,在连接螺母247抵抗关于纵轴线的旋转而被保持的情况下,当关节式运动旋钮246沿第一方向旋转时,连接螺母247沿关节式运动旋钮246的内螺旋螺纹246a行进,以引起内关节式运动管组件234在相应的第一或远侧轴向上移动;并且当关节式运动旋钮246沿第二方向旋转时,连接螺母247沿关节式运动旋钮246的内螺旋螺纹246a行进,以引起内关节式运动管组件234在相应的第二或近侧轴向上移动。根据本公开,关节式运动旋钮246在相应的第一和第二方向上的旋转导致锚定件保持/推进组件230的关节式运动和拉直,这将在下面更详细地讨论。
现在转向图15、图16、图32、图33以及图42至图46,如在这些图中所看到的,内窥镜组件230包括外管231、布置在外管231内的外支撑管组件232、内关节式运动管组件234和内轴组件238。外支撑管组件232包括近侧支撑管部232a和远侧支撑管部232b,所述近侧支撑管部232a稳固至手柄壳体212并且自其延伸,所述远侧支撑管部232b通过枢转销232c(参见图15和图16)在关节式运动接头250处枢转地连接到近侧管部232a。
如在图15、图16、图43和图44中所看到的,远侧支撑管部232b在其外表面中支撑球形止动件233。球形止动件233用于选择性地将末端执行器300稳固和保持到内窥镜组件230。在使用中,如将在下面更详细地讨论的,如在图37和图42中所看到的,由联接构件238的外凸轮表面/释放部238c1作用于球形止动件233,所述外凸轮表面/释放部238c1作用在球形止动件233上,以在内轴组件238处于远侧位置时径向向外移动球形止动件233。
内关节式运动管组件234包括同心地且可滑动地布置在外支撑管组件232的近侧管部232a内的近侧管部234a。如在图33中所看到的,近侧管部234a的近侧端234b不可旋转地连接到连接螺母247。
内关节式运动管组件234包括关节式运动连杆235,所述关节式运动连杆235具有枢转地连接到近侧管部234a的远侧端的近侧端235a和枢转地连接到外支撑管组件232的远侧管部232b的远侧端235b。关节式运动连杆235的远侧端235b在基本上远离关节式运动接头250的枢转销232c的方向上在偏离锚定件保持/推进组件230的中心纵轴线的位置处枢转地连接到外支撑管组件232的远侧管部232b。
在操作中,如在图45和图46中所看到的,由于如上所述的关节式运动旋钮246的旋转和连接螺母247的近侧轴向运动,在近侧管部234a例如沿着近侧方向轴向平移时,近侧管部234a作用于或拉动关节式运动联杆235,以引起关节式运动联杆235在近侧端方向上平移。当关节式运动联杆235沿近侧方向轴向平移时,关节式运动联杆235作用于或拉动外支撑管组件232的远侧管部232b,以引起远侧管部232b围绕枢转销232c的枢转轴线枢转。当远侧管部232b枢转时,远侧管部232b引起末端执行器300相对于锚定件保持/推进组件230的中心纵轴线移动到关节式运动定向。
于是,如上所述,由于滑块244的远侧运动,在近侧管部234a在远侧方向上轴向平移时,近侧管部234a作用于或推动关节式运动联杆235,以引起关节式运动联杆235在远侧方向上平移。当关节式运动联杆235沿远侧方向轴向平移时,关节式运动联杆235作用于或推动外支撑管组件232的远侧管部232b,以引起远侧管部232b围绕枢转销232c的枢转轴线枢转。当远侧管部232b枢转时,远侧管部232b引起末端执行器300返回到相对于锚定件保持/推进组件230的中心纵轴线的非关节式运动定向。
根据本公开,锚定件保持/推进组件230的远侧管部232b可相对于锚定件保持/推进组件230的近侧管部232a在单一方向上枢转。
参照图15、图19、图32、图33以及图35至图46,内致动轴组件238包括近侧刚性轴部238a、不可旋转地连接到近侧刚性轴部238a的远侧端并从其延伸的远侧柔性轴部238b以及不可旋转地连接到远侧柔性轴部238b的远侧端的联接构件238c。第二或小齿轮-锥齿轮220不可旋转地连接到内致动轴组件238的近侧刚性轴部238a的近侧端。内致动轴组件238构造成使得远侧柔性轴部238b延伸跨过并且越过关节式运动接头250。
理想地,联接构件238c可旋转地且可滑动地支撑在外支撑管组件232的远侧管部232b中,以便在远侧柔性轴部238b处于弯曲状态时适应和/或解决远侧柔性轴部238b的长度变化。联接构件238c是大致舌形的,并且在从外支撑管组件232的远侧管部232b向远侧的远侧方向上延伸。联接构件238c构造成用于不可旋转地连接到末端执行器300的内管338,这将在下面更详细地讨论。
远侧柔性轴部238b由例如不锈钢的扭转刚性的和柔性的材料制造。
可以想到的是,远侧柔性轴部238b可以具有约0.08'的外径。同时,锚定件保持/推进组件230具有大约0.22'的外径。远侧柔性轴部238b的外径与锚定件保持/推进组件230的外径的比率为约2.8。
内致动轴组件238构造成执行至少一对功能,第一功能和第二功能,第一功能涉及在其轴向平移时将末端执行器或装载单元300稳固到外支撑管组件232的远侧管部232b及末端执行器或装载单元300的释放,并且第二功能涉及在其旋转时当末端执行器或装载单元300联接到外支撑管组件232的远侧管部232b时紧固件100从末端执行器或装载单元300的发射。
为了让手术钉钉器200准备好用于接收末端执行器或装载单元300或者用新的末端执行器或装载单元300替换用过的末端执行器或装载单元300,如在图38至图44中所看到的,并且如上面所提及的,扳机214必须处于完全未致动位置。在扳机214处于完全未致动位置的情况下,按钮240从第一位置移动到第二位置(如上所述),使得扳机214被防止致动并且使得滑块244自由地移动。当按钮240处于第二位置时,滑块244从第一位置移动到第二位置(如上所述)。当滑块244移动到第二位置时,滑块244的第二杆244b在内轴组件238的近侧径向凸缘238d上施加力,以推动内轴组件238并进而将其联接构件238a从相应的第一位置向近侧推动到相应的第二位置。当联接构件238a从第一位置移动到第二位置时,球形止动件233随着联接构件238的外凸轮表面/释放部238c1移动成与球形止动件233轴向对准时而自由地下落或朝外管231径向向内移动。在球形止动件233自由地下落或径向向内移动的情况下,末端执行器或装载单元300可以完全联接到锚定件保持/推进组件230的远侧支撑管部232b。
再一次地,正如上面所提及的,如此配置和可操作的末端执行器或装载单元300可以仅仅在扳机214处于完全未致动的、初始和锁定位置时,才可被移除和替换。这样,在扳机214处于短行程状态(即,部分致动)的同时,末端执行器或装载单元300不能被移除或更换或装载。
在新的末端执行器或装载单元300完全联接到锚定件保持/推进组件230的远侧支撑管部232b的情况下,滑块244从第二位置移动到第一位置以将末端执行器或装载单元300稳固或锁定到锚定件保持/推进组件230的远侧支撑管部232b。特别地,当滑块244移动到第一位置时,滑块244的第二杆244b在内轴组件238的远侧径向凸缘238e上施加力,以推动内轴组件238,并进而将其联接构件238a从第二位置向远侧地推动到第一位置。当联接构件238a从第二位置移动到第一位置时,球形止动件233由联接构件238的外凸轮表面/释放部238c1推动,以使球形止动件233径向向外移动。随着球形止动件233径向向外移动,球形止动件233的一部分进入末端执行器或装载单元300的孔332c,以将末端执行器或装载单元300稳固到锚定件保持/推进组件230的远侧支撑管部232b。在末端执行器或装载单元300联接到锚定件保持/推进组件230的远侧支撑管部232b的情况下,按钮240从第二位置移动到第一位置(如上所述),使得防止滑块244致动,并且使得扳机214自由地移动。
现在转向图5、图6、图15、图17至图27、图32、图36、图37、图43、图44以及图46,示出了以装载单元或DLU形式的末端执行器300,并且将在本文中进行描述。正如上面所提及的,末端执行器300可选择性地连接到外支撑管组件232的远侧管部232b。
末端执行器或装载单元300包括外管332,所述外管332限定了穿过其中的腔332a,并且外管332被构造和定尺寸(即,基本上为矩形或犬骨形)以将锚定件保持/推进组件230的外支撑管组件232的远侧管部232b和联接构件238c接收在其中。如在图19中所看到的,外管332限定近侧键槽332b,用于与形成在外支撑管组件232的远侧管部232b中的键232c接合。在使用中,当末端执行器或装载单元300连接到外支撑管组件232的远侧管部232b时,键槽332b和键232c彼此接合以将末端执行器或装载单元300和锚定件保持/推进组件230彼此适当地对准。
末端执行器或装载单元300还包括固定地布置在外管332的远侧部内的螺旋件或螺旋管336。一对轴向间隔开的保持环337a、337b也在螺旋管336的近侧的位置处固定地布置在外管332内。
末端执行器或装载单元300还包括可旋转地布置在螺旋管336内的内管338。内管338限定穿过其中的腔,并且包括近侧端部338a和花键远侧端部338b。内管338的近侧端部338a被构造并且定尺寸定成将锚定件保持/推进组件230的联接构件238c可滑动地接收在其中。内管338包括多个保持凸起338c,所述多个保持凸起338c从内管338径向向外突出并且当内管338与外管332组装时,该保持凸起338c卡扣一对保持环337a、337b中的一个。以这种方式,外管332和内管338轴向固定并且仍可相对于彼此旋转。
内管338的远侧端部338a是开槽的,限定了一对齿338a1和一对通道338a2。内管338的远侧端部338a能够将多个锚定件100接收在内管338内。特别地,锚定件100被装载到末端执行器或装载单元300中,使得锚定件100的该对相对的螺纹部112a、112b延伸穿过内管338的远侧端部338a的相应通道338a2并且可滑动地布置在螺旋管336的沟槽内,并且内管338的远侧端部338a的一对齿338a1布置在锚定件100的该对开槽部116a、116b中。每个锚定件100装载到末端执行器或装载单元300中,使得相邻的锚定件100不彼此接触,以便不损坏远侧末端136。
在使用中,随着内管338关于其纵轴线相对于螺旋管336旋转,内管338的该对齿338a1将旋转传递到锚定件100,并且由于锚定件100的头部螺纹114a、114a与螺旋管336接合而向远侧推进锚定件100。
在手术用钉钉器200的操作中,正如在图49中所看到的,在末端执行器或装载单元300可操作地连接到锚定件保持/推进组件230的外支撑管组件232的远侧管部232b的情况下,如上所述,当内轴组件238由于扳机214的致动而旋转时,所述旋转经由锚定件维持/推进组件230的联接构件238c传递到末端执行器或装载单元300的内管338。同样,当内管338关于其纵轴线相对于螺旋管336旋转时,由于锚定件100的头部螺纹114a、114b与螺旋管336接合,内管338的该对齿338a1将旋转传递到锚定件100的整个组,并且将锚定件100的整个组向远侧推进。
根据本公开,手术用钉钉器200和锚定件100的部件被定尺寸成使得扳机214的单次完整和完全致动导致单个锚定件100(即,装载在末端执行器或装载单元300中的锚定件100组中的最远侧锚定件)从末端执行器或装载单元300的发射。
手术用钉钉器200可以被重复地发射以从末端执行器300发射锚定件,直到手术操作完成或者直到末端执行器或装载单元300用完锚定件100。如果末端执行器或装载单元300用完了锚定件100,并且如果需要另外的锚定件100来完成手术操作,则可以用新的(即,装载有锚定件100的)末端执行器或装载单元300来替换用过的末端执行器或装载单元300。
如在图40至图44中所看到的,为了用新的末端执行器或装载单元300替换用过的末端执行器或装载单元300,在扳机214处于完全未致动位置(如上所述,外科医生致动或滑动按钮244以释放用过的末端执行器或装载单元300、使末端执行器或装载单元300从锚定件保持/推进组件230分开、将新的末端执行器或装载单元300装载或连接到锚定件保持/推进组件230(通过将内管338的近侧端部338a装配到锚定件保持/推进组件230的联接构件238c上)并且释放按钮244以将新的末端执行器或装载单元300保持在锚定件保持/推进组件230上。由于扳机214在装载了新的末端执行器或装载单元300的情况下处于完全未致动位置,正时系统270被重新设定,使得扳机214的每次完全致动导致单个锚定件100的发射。
可以想到的是,末端执行器或装载单元300可以仅连接或联接到锚定件保持/推进组件230的外支撑管组件232的远侧管部232b,而同时锚定件保持/推进组件230处于非关节式运动状态。
根据本公开,在末端执行器或装载单元300连接或联接到锚定件保持/推进组件230的外支撑管组件232的远侧管部232b的情况下,关节式运动旋钮246旋转或保持就位,使得锚定件保持/推进组件230处于非关节式运动状态。
另外,根据本公开,在末端执行器或装载单元300连接或联接到锚定件保持/推进组件230的外支撑管组件232的远侧管部232b的情况下,末端执行器或装载单元300在处于非关节式运动状态的同时被引入到目标手术部位。在末端执行器或装载单元300布置在目标手术部位内的情况下,外科医生可以远程地使末端执行器或装载单元300相对于锚定件保持/推进组件230关节式运动。具体地,如在图45和图46中所看到的,外科医生旋转关节式运动旋钮246以使连接螺母247和内关节式运动管组件234的近侧管部234a轴向移位,以在近侧轴向上移动。随着近侧管部234a在近侧轴向上移动,近侧管部234a作用在关节式运动联杆235上或拉动关节式运动联杆235,以引起关节式运动联杆235在近侧方向上平移。随着关节式运动联杆235在近侧方向上轴向地平移,关节式运动联杆235作用在外支撑管组件232的远侧管部232b或拉动该远侧管部232b,以引起远侧管部232b关于枢转销232c的枢转轴线枢转。当远侧管部232b枢转时,远侧管部232b引起末端执行器300移动到相对于锚定件保持/推进组件230的中心纵轴线的关节式运动定向。
现在转向图28至图30,根据本公开,可以设置运送楔400,所述送楔400被构造和定尺寸成可释放地连接到末端执行器或装载单元300,以抑制末端执行器或装载单元300的内管338的过早旋转,并且有助于促进末端执行器或装载单元300至/从锚定件保持/推进组件230的远侧管部232b的装载/卸载。
运送楔400包括手柄部402和稳固至手柄部402或与其一体地形成的联接构件404。联接构件404基本上是具有大致C形的横截面轮廓的管状件。联接构件404限定了沿其纵向延伸的开口或缺口404a。手柄部404限定基本上垂直于联接构件404的纵轴线的纵轴线。
联接构件404具有足以在其中和沿着其容纳末端执行器或装载单元300的直径。此外,联接构件404的缺口404a具有与至少联接构件404的构造材料一起允许联接构件404被卡扣在末端执行器或装载单元300上的尺寸。可以想到的是,至少联接构件404可以由聚合物或其他基本上刚性和弹性的材料制造。
如在图29和图30中所看到的,运送楔400包括径向地延伸到联接构件404中的楔、尖状物或小块406。特别地,楔406沿基本上平行于手柄部402的纵轴线的方向延伸或突出。楔406具有足够的长度,使得当运送楔400附接到末端执行器或装载单元300时,楔406进入形成在末端执行器或装载单元300的外管332中的孔332d(参见图19、图22、图29和图30)。
另外,当运送楔400附接到末端执行器或装载单元300时,楔406延伸成与末端执行器或装载单元300的内管338的近侧端部338a紧密接近或接触。通过延伸该量,如果内管338相对于外管332经历任何旋转,楔406通过锁定或接触内管338的近侧端部338a来抑制内管338相对于外管332的旋转。
此外,当运送楔400附接到末端执行器或装载单元300时并且在楔406阻止末端执行器或装载单元300的内管338的旋转的情况下,运送楔400便于末端执行器或装载单元300至/从锚定件保持/推进组件230的远侧管部232b的装载/卸载。在将末端执行器或装载单元300装载到锚定件保持/推进组件230的远侧管部232b期间,运送楔400用于固定内管338的近侧端部338a的角定向,用于与锚定件保持/推进组件230的联接构件238c进行适当的对准和定向。
根据本公开,可以想到的是,手柄组件100可以由机电控制模块替代,该机电控制模块被构造和适于驱动柔性驱动线缆以发射或致动手术装置。机电控制模块可以包括至少一个微处理器、可由至少一个微处理器控制的至少一个驱动电机、以及用于激励至少一个微处理器和至少一个驱动电机的电源。
现在转向图51至图55,以内窥镜手术用钉施加器或钉钉器的形式的内窥镜手术装置的另一实施例总体上被示出为500。内窥镜手术装置500类似于内窥镜手术装置200,并且在此仅在描述其结构和操作中的差异所需的程度上进行描述。类似地,末端执行器的另一个实施例总体上示出为520。末端执行器520类似于末端执行器300,并且在此仅在描述其结构和操作中的差异所需的程度上进行描述。
现在参考图51,内窥镜手术装置500包括细长主体部510和可选择性地稳固到细长主体部510的远侧端的末端执行器520(例如,单次使用装载单元)。
细长主体部510包括外管512和可滑动地安置在外管512内的内致动轴514。外管512包括内表面512a和外表面512b。内表面512a限定纵向延伸穿过外管512并支撑内致动轴514的腔512c。外管512在外管512的远侧端中限定在内表面512a和外表面512b之间延伸并跨过两者延伸的凹口512d。内致动轴514纵向地延伸穿过外管512的近侧端和远侧端之间的腔512c。内致动轴514的远侧端包括接合构件516。臂或凸起518从接合构件516延伸。臂518限定至少部分地延伸穿过其中的凹部518a。
如在图51至图53中所图示出的,末端执行器520包括外管522和可旋转地安置在外管522内的带花键内管524。外管522包括内表面522a和外表面522b。内表面522a在外管522的近侧端和远侧端之间限定纵向地延伸穿过外管522的腔522c。外管522的远侧端包括远侧开口522d。外管522在外管522的近侧部中限定在内表面522a和外表面522b之间延伸的开口522e。带花键内管524支撑螺旋件336,所述螺旋件336固定地布置在外管522的远侧部内并关于带花键内管524的一对齿530布置,使得该对齿530和螺旋件336支撑适于选择性地推进穿过末端执行器520的多个手术用锚定件100。
正如能够在图53中看到的,带花键内管524包括在其近侧端处稳固地固定到外管522的内表面522a的联接构件526,并且包括从联接构件526的近侧端延伸的锁定凸起526a。如上所述,带花键内管524在其远侧端处包括一对齿530并且在其近侧端处包括接合构件532。该对齿530包括第一齿530a和第二齿530b。第一齿530a和第二齿530b间隔开并且在它们之间限定接收多个锚定件100中的每一个的一部分的第一通道530c和第二通道530d。接合构件532包括从其纵向地延伸的臂或凸起534,以及垂直于该臂534突出的销536。
在使用中,如在图54和图55中示出的,细长主体部510的内致动轴514在推进位置(图54)和缩回位置(图55)之间相对于外管512可滑动地移动。在推进位置,内致动轴514的接合构件516从外管512暴露或突出。在缩回位置,内致动轴514的接合构件516被隐藏或容纳在外管512内。更具体地,在推进位置,接合构件516的臂518延伸,使得凹部518a暴露来用于接收接合构件532的销536。
为了将末端执行器520连接到细长主体部510,接合构件532的销536插入到接合构件516的凹部518a中,使得接合构件532的臂534连接到接合构件516的臂518。在将末端执行器520连接到细长主体部510后,内致动轴514可以移动到缩回位置,该缩回位置将接合构件532、516都拉动到细长主体部510的外管512内。这样,末端执行器520的锁定凸起526a被接收在细长本主体部510的槽口512d内,以防止末端执行器520的外管522在内致动轴514旋转时相对于细长本主体部510旋转。另外,接合构件516、532容纳在末端执行器520的外管522内,从而被抑制彼此分离。
内致动轴114的旋转使接合构件516、532都相对于外管512、522和联接构件526旋转,以将旋转施加给带花键内管524,并且进而传递给该对齿530,用于将多个锚定件100沿着螺旋件336向远侧推进并且将多个锚定件100中的每一个单独地部署到末端执行器520的外管522的远侧开口522d外。
现在转向图56,运送楔的另一个实施例总体上示出为600。运送楔600包括细长的第一主体610和从第一主体610相对于第一主体610成一定角度延伸的倾斜的(angled)第二主体620。更具体地,第一主体610限定延伸穿过细长主体610的相对端610a、610b的纵轴线“A”。倾斜主体620限定延伸穿过倾斜主体620的相对端620a、620b的纵轴线“B”。纵轴线“A”和“B”之间限定了角度“α”。尽管在图56中示出为锐角,但角度“α”可以是任何合适的角度。
参照图57A和图57B,第一主体610包括在基部612b处连接的一对相对的侧壁612a。该对相对的侧壁612a在其间限定了通道614,以形成U形,其定尺寸成接收诸如内窥镜手术装置500的细长主体部510的细长主体。通道614纵向延伸穿过第一主体610。对准肋616在该对相对的侧壁612a之间延伸,并且限定延伸穿过对准肋616并将对准肋616分成一对分部616b的通路616a。
倾斜主体620包括在基部622b处连接的一对相对的侧壁622a。该对相对的侧壁622a在其间限定通道624以形成U形,该U形定尺寸成接收和保持例如末端执行器520的末端执行器(图57A和57B)。通道624纵向地延伸穿过倾斜主体620,使得通道624相对于通道614成角度(参见图57B)。倾斜主体620包括从基部622b的内表面622c延伸的隆起部626(例如,凸台或凸块)。隆起部626可以具有任何合适的形状,包括圆形的和非圆形的(例如,椭圆形、多边形等)形状。
一对对准凸缘618从第一主体610的相对侧壁612a和倾斜主体620的相对侧壁622a延伸以形成漏斗构造,其有助于内窥镜手术装置(例如内窥镜手术装置500)或其部分相对于运送楔600的正确对准。如在图57A所示出的,该对对准凸缘618中的每个对准凸缘具有从通道614和624向外延伸的曲线布置。
继续参照图57A和图57B,尽管运送楔600可与任何合适的内窥镜手术装置一起使用,但在内窥镜手术装置500的示例性使用中,内窥镜手术装置500的末端执行器520被稳固在倾斜主体620的通道624内(例如压配合)。倾斜主体620的隆起部626安置在末端执行器520的开口522e内(和/或在末端执行器520的第一和/或第二通道530c、530d内),以防止末端执行器520平移穿过倾斜主体620的通道624和/或防止末端执行器520或其部分(例如,包括该对齿530的外管522和/或内管524)在倾斜主体620的通道624内旋转。正如可以理解的,隆起部626使得末端执行器520能够在末端执行器520的运送和/或装载过程期间维持适当的定时(例如,钉/锚定件部署定时)。当末端执行器520稳固在倾斜主体620的通道624内时,末端执行器520的销536与对准肋616对准。
也参照图58A至图62,为了从运送楔600移除末端执行器520,在内窥镜手术装置500的细长主体部510的推进位置中,细长主体部510可相对于通道614定位,使得细长主体部510的远侧端与对准肋616纵向地对准。更具体地,细长主体部510的接合构件516抵接运送楔600的对准肋616,以使接合构件516的臂518与通路616a纵向对准。细长主体部510然后被插入(例如,压配合)到通道614中,使得细长主体部510的由运送楔600的对准肋616引导的臂518朝向末端执行器520的销536移动穿过通路616a(图59和图60)。当细长主体部510接合末端执行器520时,销536插入到臂518的凹部518a中,使得末端执行器520相对于细长主体部510枢转并且从倾斜主体620的通道624脱离而与细长主体部510轴向对准(图60和图61)。当末端执行器520枢转出倾斜主体620的通道624时,倾斜主体620的隆起部626与末端执行器520的开口522e分离。
如在图62中所看到的,在细长主体部510连接到末端执行器520的情况下,细长主体部510可移动到缩回位置以将末端执行器520牵拉成与细长主体部510接合,以将末端执行器520的近侧端稳固在细长主体部510的远侧端内。包括细长主体部510和末端执行器520这两者的内窥镜手术装置500然后可以被从运送楔600撤回,同时在对准肋616下方并且穿过运送楔600的通道614,以将内窥镜手术装置500与运送楔600分离(图62)。内窥镜手术装置500然后可以被用于执行手术操作。
现在参照图63至图75,内窥镜手术装置或钉施加器的不同实施例被示出并由附图标记700来标示。钉施加器700包括与钉施加器200相同或相似的关节式运动能力,如上文详细讨论的。例如,钉施加器700包括细长部或锚定件保持/推进组件710,并且包括能够相对于锚定件保持/推进组件的第一或中心纵轴线“A-A”进行关节式运动或枢转的末端执行器720。除了这些特征之外,末端执行器720可关于锚定件保持/推进组件710的中心纵轴线“A-A”旋转。此外,钉施加器700被配置并适于限制末端执行器720沿着锚定件保持/推进组件710的中心纵轴线“A-A”的旋转量。
具体参照图63至图64C,钉施加器700的各部分的各种视图被示出,其中,末端执行器720处于关节式运动位置,并且以不同的量旋转。最初,在图63中,示出了钉施加器700的侧视图。这里,末端执行器720处于关节式运动位置并且没有旋转量。参考图64A至图64C,示出了钉施加器700的近侧到远侧端视图或近侧端视图,其中,末端执行器720处于关节式运动位置并且末端执行器720以沿着锚定件保持/推进组件710的中心纵轴线“A-A”的多种旋转量示出。具体地,在图64A中,钉施加器700以末端执行器720处于第一关节式运动位置并且沿第一方向(即,逆时针)旋转示出。在图64B中,钉施加器700以末端执行器720处于第一关节式运动位置并且没有任何旋转来示出(对应于图63中所示的末端执行器720的位置)。在图64C中,钉施加器700以末端执行器720处于第一关节式运动位置并且沿第二方向(即,顺时针)旋转来示出。在图64A至图64C中的每幅图图示出末端执行器720处于特定的关节式运动位置的同时,钉施加器700还能够在末端执行器720处于任何关节式运动位置(包括不关节式运动)时旋转末端执行器720。
在使用中,钉施加器700的关节式运动和旋转能力对于外科医生而言是非常方便和重要的。例如,钉施加器700进行关节式运动的能力允许外科医生从单个位置(例如,单个进入口)进入患者体内并在患者体内达360°地施加锚定件100,而不必物理地移动到患者的相反侧。然而,外科医生可能需要相对于患者移动(例如枢转)钉施加器700以实现360°进入。有时,钉施加器700的移动引起其手柄组件接触患者(例如,患者的腿),从而导致它们之间的干扰,并且因此限制钉施加器700的运动。使钉施加器700的手柄组件相对于锚定件保持/推进组件710或中心纵轴线“A-A”旋转的能力允许手柄组件移出对患者的阻挡,以防止或最小化它们之间的任何干扰。另外,使钉施加器700的手柄组件旋转的能力使得能够或利于进入患者的各个部分(例如,朝向外科医生),而外科医生不需要相对于患者移动(例如,枢转)钉施加器700,并且外科医生不需要相对于患者物理地移动他们自身的位置。
现在参照图65和图66,以与末端执行器720的旋转相关的不同阶段示出了钉施加器700的手柄组件730的剖视图。具体地,图65是手柄组件730的侧视图,其中旋转组件740处于初始的非旋转位置。在图66中,旋转组件740处于其第二旋转位置,对应于末端执行器720被沿第二方向旋转(例如,如图64C中所示)。
参照图67和图68,在与末端执行器720的旋转相关的不同阶段中示出了钉施加器700的手柄组件730的剖视图。具体地,图67是手柄组件730的剖视图,其中旋转组件740处于初始的非旋转位置,如图64中所示。在图68中,旋转组件740处于其第二旋转位置,如图66中所示,对应于末端执行器720被在第二方向上旋转。
图69和图70示出了旋转组件740的多个部分的放大立体图。在图69中,旋转组件740被示出为处于非旋转位置,其对应于在图64B、图65和图67中示出的旋转组件740的定向。在图70中,旋转组件740被示出处于其第二旋转位置,其对应于在图64C、图66和图68中示出的旋转组件740的定向。
旋转组件740包括布置在关节式运动旋钮760近侧的旋转旋钮744。关节式运动旋钮760在功能上类似于上文讨论的关节式运动旋钮246。具体地,关节式运动旋钮760关于锚定件保持/推进组件710的中心纵轴线的旋转引起限定第二纵轴线“B-B”(图63)的末端执行器720相对于锚定件保持/推进组件710的中心纵轴线“A-A”关节式运动或枢转。特别参照图67至图70,关节式运动旋钮760包括主体部761、近侧延伸部762和近侧凸缘764。纵向间隙766被限定在主体部761的近侧面761a和近侧凸缘764之间。
旋转旋钮744包括可以可释放地接合(例如,经由螺钉连接,如所示的)的第一主体半部744a和第二主体半部744b(图66)。如在图69中所图示出的,第一主体半部744a和第二主体半部744b各自包括形成远侧凸缘746、主体部748和近侧凸缘750的部分(例如,一个横向半部)。另外地,如在图64A和图64C中所示的实施例中,例如,旋转旋钮744是非圆形的。也就是说,例如,旋转旋钮744可以是卵状的、长方形的、椭圆形等。在旋转旋钮744是非圆形的这种实施例中,外科医生可以更容易基于旋转旋钮744的横向边缘745和手柄组件730的壁731之间的位移“D”(参见图64A和64C)确定末端执行器730是否已经旋转和已经旋转了多少。
旋转旋钮744被旋转地固定到外管800的近侧部802,使得旋转旋钮744相对于手柄组件730的旋转引起外管800的相应旋转。另外地,由于外管800和末端执行器720之间的接合,外管800的旋转引起末端执行器720沿着锚定件保持/推进组件710的中心纵轴线“A-A”的相应旋转。旋转旋钮744可以被销接或以其它方式旋转地固定到外管800的近侧部802。
旋转旋钮744可相对于关节式运动旋钮760旋转。旋转组件740的远侧凸缘746被构造成配合在关节式运动旋钮760的纵向间隙766内,以利于它们之间的旋转。因此,旋转旋钮744相对于手柄组件730的旋转不会引起关节式运动旋钮760的任何旋转。同样地,关节式运动旋钮760相对于手柄组件730的旋转不会引起旋转旋钮744的任何旋转。
另外地,旋转旋钮744可相对于内轴组件770旋转。正如先前在上面的实施例中所讨论的,内轴组件770可相对于手柄组件730旋转,并响应于扳机732的致动。内轴组件770相对于手柄组件730的预定量的旋转导致至少一个锚定件100从锚定件保持/推进组件710内喷射。因此,由于旋转旋钮744可相对于内轴组件770旋转,扳机732的致动不影响旋转旋钮744的旋转(或旋转地固定到旋转旋钮744的外管800的旋转)。类似地,旋转旋钮744的旋转不影响内轴组件770的旋转。
正如上面所指出的,旋转旋钮744的旋转引起外管800的相应旋转。此外,内轴组件770(并因此锚定件100)相对于外管800的预定量的旋转引起锚定件100从末端执行器720内向远侧推进和喷射。因此,并且如下面参照图71至图75进一步详细讨论的,如果旋转旋钮744能够旋转超过特定位置,则外管800相对于锚定件100的旋转将引起至少一个锚定件100过早地喷射,或者可能破坏锚定件100在末端执行器720内的推进时机。本公开的钉施加器700包括特征件,该特征件限制旋转旋钮744的旋转量并因此限制外管800相对于内轴组件770和锚定件100的旋转量。
如在图69至图70中所示出的,钉施加器700包括旋转限制结构749。旋转限制结构749包括在第一主体半部744a上的旋转旋钮744的近侧凸缘750上的第一凸起752a。第一凸起752a构造成在旋转旋钮744相对于手柄组件730沿第一方向(即,顺时针,如图64C中所示的)旋转预定量时接触手柄组件730内的第一唇缘735a。第一凸起752a和第一唇缘735a之间的接触防止旋转旋钮744在第一方向上的进一步旋转,并且因此限制外管800可相对于锚定件100旋转的量。第一凸起752a和第一唇缘735a的位置被确定为使得旋转旋钮744能够在第一方向上旋转特定量(例如,在约35°和约55°之间;或约等于45°;其它角度也被考虑在内且在本公开的范围内)。
同样地,具体参照图69A和图69B,旋转限制结构749包括在第二主体半部744b的近侧凸缘750上的第二凸起752b,所述第二凸起752b与第一凸起752a为相同的径向取向。另外地,旋转限制结构749包括在手柄组件730上的第二唇缘735b,所述第二唇缘765b与第一唇缘735a处于相同的径向取向。近侧凸缘750的第二凸起752b构造成在旋转旋钮744相对于手柄组件730沿第二方向(即,逆时针,如在图64A中所示出的)旋转预定量时接触第二唇缘735b。在第二凸起752b和第二唇缘735b之间的接触防止旋转旋钮744在第二方向上的进一步旋转,并因此限制外管800可相对于锚定件100旋转的量。第二凸起752b和第二唇缘735b的位置被确定为使得旋转旋钮744能够在第二方向上旋转特定量(例如,在约35°和约55°之间;或约等于45°;其它角度也被考虑在内且在本公开的范围内)。
图71至图75进一步图示出了限制外管800相对于锚定件100的旋转量的重要性。外管800的远侧部包括布置在其中的螺旋件或螺旋管810。螺旋管810相对于外管810可旋转地固定。正如上面所讨论的,内轴组件770相对于外管800和螺旋管810的旋转引起锚定件100旋转并向远侧前进,这是由于锚定件100的头部螺纹114a、114b与螺旋管810之间的接合所导致。
锚定件100相对于螺旋管810的位置如在图71和图72中示出的,此时外管800未经旋转。如所示的,螺旋管810的任何部分都不与最远侧锚定件100的轴向运动相互作用。这里,第一距离或第一弧长“AL1”设置在螺旋管810的端部811和头部螺纹114a的边缘115a之间。角度“β1”与第一弧长“AL1”相关联,并且等于大约60°。也可以想到其它角度并且这也在本公开的范围内。如在该配置中所示出的,在螺旋管810的端部811和头部螺纹114a的边缘115a之间存在间隙,因此允许锚定件100向远侧平移。
图73图示出了锚定件100相对于螺旋管810的位置,此时外管800已经相对于锚定件100顺时针旋转(参见图64C、图66、图68和图70)。这里,外管800已经相对于图71和图72中所示的初始位置旋转了大约45°。这导致在螺旋管810的端部811和头部螺纹114a的边缘115a之间限定了第二距离或第二弧长“AL2”。角度“β2”与第二弧长“AL2”相关联,并且等于大约10°。也可以想到其它角度并且其也在本公开的范围内。如所示的,在该旋转量之后,螺旋管810的任何部分都不与最远侧锚定件100的轴向运动相互干扰。
图74图示出了锚定件100相对于螺旋管810的位置,此时外管800已经相对于锚定件100逆时针旋转(参见图64A)。这里,外管800已经相对于图71和图72中的初始位置旋转了大约45°,这导致在螺旋管810的端部811和头部螺纹114a的边缘115a之间限定了第三距离或第三弧长“AL3”。角度“β3”与第三弧长“AL3”相关联,并且等于大约105°。也可以想到其它角度并且其在本公开的范围内。如所示的,在该旋转量之后,螺旋管810的任何部分都不与最远侧锚定件100的轴向运动相互干扰。
图75图示出了如果外管800相对于锚定件100沿顺时针方向旋转约90°将发生的情况(正如上面所讨论的,意图让本公开的钉施加器700不能旋转该量)。在这种情况下,在该旋转量之后,螺旋管810的端部812布置在最远侧锚定件100的头部螺纹114a的近侧,并且因此与最远侧锚定件100的轴向运动相互干扰。这里,锚定件100的喷射的定时受到损害,因为扳机732的完全致动将导致锚定件100不完全从钉施加器700释放,并且相同的锚定件100部分地在组织内。结果,例如,锚定件100可以卡在组织内并且卡在钉施加器700的螺纹或螺旋管810中。另外地,如果外管800沿逆时针方向旋转约90°,则锚定件100的弹出定时也受到损害,因为在完全致动扳机732之前,锚定件100将完全从钉施加器700释放。然而,本公开的钉施加器700包括旋转限制结构749,所述旋转限制结构749限制外管800相对于内轴组件770和锚定件100的旋转,因此不会阻碍锚定件100从钉施加器700喷射的正时。
正如可以理解的,本公开的装置的任意部件的稳固可以使用已知的紧固技术(诸如焊接、压接、粘合等)来实现。例如,可以想到的是,外管800和螺旋管810可以是由螺纹辊压成形来制成的单个部件。
应当理解,可以对在此公开的实施例进行多种修改。由此,上面的描述不应当理解为限定,而是仅仅作为多种实施例的范例。本领域技术人员将想到位于所附权利要求的范围和主旨内的其他修改。
Claims (8)
1.一种构造成向组织施加钉的手术器械,所述手术器械包括:
手柄组件;
细长部,其从所述手柄组件向远侧延伸并且限定第一纵轴线;
外管,其从所述手柄组件向远侧延伸,所述外管的旋转引起末端执行器沿着所述细长部的第一纵轴线的相应旋转;
末端执行器,其邻近所述细长部的一部分布置并且构造成在其中容纳多个钉,所述末端执行器限定第二纵轴线;
内轴组件,其相对于所述外管的预定量的旋转引起所述钉从所述末端执行器内向远侧推进和喷射;
旋转组件,其构造成使所述外管的至少一部分关于所述第一纵轴线并且相对于所述手柄组件旋转,所述旋转组件包括被可旋转地固定至所述外管的近侧部的旋转旋钮,其中所述旋转旋钮的旋转不影响所述内轴组件的旋转;以及
旋转限制结构,其布置成与所述旋转组件和所述手柄组件中的至少一个机械协作,并且构造成限制所述外管相对于所述内轴组件和所述钉的旋转量以避免至少一个所述钉过早地喷射或者破坏所述钉在所述末端执行器的推进时机;
其中,所述旋转限制结构包括从所述旋转旋钮的一部分延伸的至少一个凸起和布置在所述手柄组件内的至少一个唇缘;
所述至少一个凸起中的第一凸起构造成在所述旋转旋钮沿着第一方向旋转预定量时接触所述至少一个唇缘中的第一唇缘;
所述至少一个凸起中的第二凸起构造成在所述旋转旋钮沿着第二方向旋转预定量时接触所述至少一个唇缘中的第二唇缘;
所述第一凸起和所述第一唇缘之间的接触防止所述旋转旋钮在所述第一方向上的进一步旋转,所述第二凸起和所述第二唇缘之间的接触防止所述旋转旋钮在所述第二方向上的进一步旋转。
2.根据权利要求1所述的手术器械,其中,所述旋转旋钮沿着所述第一方向的旋转预定量是约45°,并且其中所述旋转旋钮沿着所述第二方向的旋转预定量是约45°。
3.根据权利要求1所述的手术器械,其中,所述旋转旋钮包括非圆形的横截面,其中所述横截面垂直于所述第一纵轴线截取。
4.根据权利要求1所述的手术器械,其中,所述末端执行器的至少一部分相对于所述外管可旋转地固定。
5.根据权利要求1所述的手术器械,其中,所述旋转组件构造成使所述末端执行器的至少一部分关于所述第二纵轴线旋转。
6.根据权利要求1所述的手术器械,进一步包括至少部分地布置在所述末端执行器内的多个螺纹形钉。
7.根据权利要求1所述的手术器械,进一步包括构造成使所述末端执行器从第一位置移动至第二位置的关节式运动组件,在所述第一位置,所述第二纵轴线与所述第一纵轴线共轴,在所述第二位置,所述第二纵轴线相对于所述第一纵轴线成角度地布置。
8.根据权利要求7所述的手术器械,其中,所述关节式运动组件包括关节式运动旋钮,所述关节式运动旋钮能够关于所述第一纵轴线相对于所述外管的所述近侧部旋转。
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US20190021728A1 (en) | 2019-01-24 |
US10085746B2 (en) | 2018-10-02 |
US10786250B2 (en) | 2020-09-29 |
CA2957346A1 (en) | 2017-08-22 |
US20160166255A1 (en) | 2016-06-16 |
AU2017200791A1 (en) | 2017-09-07 |
CN107095698A (zh) | 2017-08-29 |
EP3207881A1 (en) | 2017-08-23 |
EP3207881B1 (en) | 2020-01-01 |
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