CN107106171A - 具有多个切割元件的外科缝合器 - Google Patents
具有多个切割元件的外科缝合器 Download PDFInfo
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- CN107106171A CN107106171A CN201580062471.8A CN201580062471A CN107106171A CN 107106171 A CN107106171 A CN 107106171A CN 201580062471 A CN201580062471 A CN 201580062471A CN 107106171 A CN107106171 A CN 107106171A
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Classifications
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- A—HUMAN NECESSITIES
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- A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
- A61B17/105—Wound clamp magazines
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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Abstract
本发明提供了一种设备，所述设备包括主体、轴组件、端部执行器、仓和钉驱动器致动器。所述端部执行器能够操作以操纵组织。所述端部执行器包括下钳口、能够枢转的砧座和平移切割器。所述平移切割器能够操作以当所述砧座朝向所述下钳口枢转时相对于所述下钳口和所述砧座平移以操纵组织。所述仓能够插入所述下钳口中并且包括多个钉。所述钉驱动器致动器设置在所述仓内。所述钉驱动器致动器包括辅助切割元件。所述端部执行器的所述平移切割器能够操作以朝远侧驱动所述钉驱动器致动器以基本上同时缝合和切割组织。
Description
背景技术
在一些背景中，内窥镜式外科器械可优于传统的开放式外科装置，因为较小的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将远侧端部执行器放置在期望的手术部位。这些远侧端部执行器可以多种方式(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)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。此类轴可使插入能够到期望的深度并围绕轴的纵向轴线旋转，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，从而使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夹紧在组织层上，切穿被夹紧的组织层，并且驱动钉穿过组织层，以在组织层的被切断的端部附近将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专利申请中：于1989年2月21日公布的名称为“Pocket Configuration for Internal Organ Staplers”的美国专利4,805,823；于1995年5月16日公布的名称为“Surgical Stapler and StapleCartridge”的美国专利5,415,334；于1995年11月14日公布的名称为“Surgical StaplerInstrument”的美国专利5,465,895；于1997年1月28日公布的名称为“Surgical StaplerInstrument”的美国专利5,597,107；于1997年5月27日公布的名称为“SurgicalInstrument”的美国专利5,632,432；于1997年10月7日公布的名称为“SurgicalInstrument”的美国专利5,673,840；于1998年1月6日公布的名称为“ArticulationAssembly for Surgical Instruments”的美国专利5,704,534；于1998年9月29日公布的名称为“Surgical Clamping Mechanism”的美国专利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6,978,921；于2006年2月21日公布的名称为“Surgical Stapling InstrumentHaving Separate Distinct Closing and Firing Systems”的美国专利7,000,818；于2006年12月5日公布的名称为“Surgical Stapling Instrument Having a FiringLockout for an Unclosed Anvil”的美国专利7,143,923；于2007年12月4日公布的名称为“Surgical Stapling Instrument Incorporating a Multi-Stroke Firing Mechanismwith a Flexible Rack”的美国专利7,303,108；于2008年5月6日公布的名称为“SurgicalStapling Instrument Incorporating a Multistroke Firing Mechanism Having aRotary Transmission”的美国专利7,367,485；于2008年6月3日公布的名称为“SurgicalStapling Instrument Having a Single Lockout Mechanism for Prevention ofFiring”的美国专利7,380,695；于2008年6月3日公布的名称为“Articulating SurgicalStapling Instrument Incorporating a Two-Piece E-Beam Firing Mechanism”的美国专利7,380,696；于2008年7月29日公布的名称为“Surgical Stapling and CuttingDevice”的美国专利7,404,508；于2008年10月14日公布的名称为“Surgical StaplingInstrument Having Multistroke Firing with Opening Lockout”的美国专利7,434,715；于2010年5月25日公布的名称为“Disposable Cartridge with Adhesive for Usewith a Stapling Device”的美国专利7,721,930；于2013年4月2日公布的名称为“Surgical Stapling Instrument with An Articulatable End Effector”的美国专利8,408,439；和于2013年6月4日公布的名称为“Motor-Driven Surgical Cutting Instrumentwith Electric Actuator Directional Control Assembly”的美国专利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规程中，但应当理解，此类外科缝合器也可用于开腹规程和/或其他非内窥镜式规程中。仅以举例的方式，在胸廓外科规程中，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，该胸廓外科规程不使用套管针作为缝合器的导管。此类规程可包括使用缝合器来切断和闭合通向肺部的血管。例如，在从胸腔移除器官之前，可通过缝合器切断并闭合通向器官的血管。当然，外科缝合器可用于各种其他设定和规程中。
可特别适合通过胸廓切开术使用的外科缝合器的示例公开于以下专利公布中：于2014年8月28日公布的名称为“Surgical Instrument End Effector Articulation Drivewith Pinion and Opposing Racks”的美国专利公布2014/0243801；于2014年8月28日公布的名称为“Lockout Feature for Movable Cutting Member of Surgical Instrument”的美国专利公布2014/0239041；于2014年8月28日公布的名称为“Integrated TissuePositioning and Jaw Alignment Features for Surgical Stapler”的美国专利公布2014/0239042；于2014年8月28日公布的名称为“Jaw Closure Feature for End Effectorof Surgical Instrument”的美国专利公布2014/0239036；于2014年8月28日公布的名称为“Surgical Instrument with Articulation Lock having a Detenting Binary Spring”的美国专利公布2014/0239040；于2014年8月28日公布的名称为“Distal Tip Featuresfor End Effector of Surgical Instrument”的美国专利公布2014/0239043；于2014年8月28日公布的名称为“Staple Forming Features for Surgical Stapling Instrument”的美国专利公布2014/0239037；于2014年8月28日公布的名称为“Surgical Instrumentwith Multi-Diameter Shaft”的美国专利公布2014/0239038；和于2014年8月28日公布的名称为“Installation Features for Surgical Instrument End Effector Cartridge”的美国专利公布2014/0239044。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已经制造或使用在所附权利要求中所描述的发明。
附图说明
并入并构成本说明书的一部分的附图示出了本发明的实施方案，并且与上面给出的本发明的一般说明以及下面给出的实施方案的详细说明一起用来解释本发明的原理。
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示出了沿着图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示出了沿着图4的线7-7截取的图3的端部执行器的横截面侧视图，其中击发梁处于近侧位置；
图7B示出了沿着图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，其中壳体半部和一些内部部件被移除；
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13示出了图3的端部执行器的示例性钉仓的局部透视图，其中示例性支撑物设置在钉仓的外顶表面之上和外顶表面上；
图14示出了图3的端部执行器和设置在砧座的下侧和钉仓的外顶表面之间和其上的图13的支撑物的正视图；
图15示出了具有图13的支撑物的端部执行器的透视图，所述端部执行器已将钉和图13的支撑物击发和释放到组织中和组织上；
图16示出了图3的端部执行器的示例性变型的局部透视图，其中端部执行器的一部分被切去以显露配备有可旋转辅助切割刀片的楔形滑动件；
图17示出了图16的楔形滑动件的侧正视图，其中辅助切割刀片处于伸出位置；
图18示出了图3的端部执行器的另一个示例性变型的局部透视图，其中端部执行器的一部分被切去以显露配备有固定辅助切割刀片的楔形滑动件；
图19示出了沿着图18的线19-19截取的图18的楔形滑动件的侧横截面视图，其中楔形滑动件处于近侧位置；
图20示出了沿着图18的线19-19截取的图18的楔形滑动件的侧横截面视图，其中楔形滑动件处于远侧位置；
图21示出了图18的楔形滑动件的示例性变型的侧横截面视图；
图22示出了与图3的端部执行器一起使用的另一个示例性楔形滑动件的透视图，所述楔形滑动件具有可向上平移的辅助切割刀片；
图23示出了沿着图22的线23-23截取的图22的楔形滑动件的侧横截面视图，其中辅助切割刀片处于回缩位置；
图24示出了沿着图22的线23-23截取的图22的楔形滑动件的侧横截面视图，其中辅助切割刀片处于伸出位置；
图25示出了与图3的端部执行器一起使用的另一个示例性楔形滑动件的透视图，所述楔形滑动件具有带有稳定前缘的固定辅助切割刀片；和
图26示出了沿着图25的线26-26截取的图25的楔形滑动件的侧横截面视图，其中辅助切割刀片被朝远侧推进。
附图不旨在以任何方式进行限制，并且能够设想，本发明的各种实施方案可以各种其他方式来实施，包括未必在附图中示出的那些方式。结合在本说明书中并形成本说明书的一部分的附图示出了本发明的若干方面，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确切布置。
具体实施方式
本发明的某些示例的以下说明不应用于限定本发明的范围。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，最佳方式之一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，以用于执行外科规程。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。在一些设定下，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”是相对于临床医生抓握器械(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，为简洁和清楚起见，本文相对于图示使用空间术语诸如“竖直”和“水平”。然而，外科器械在许多取向和位置中使用，并且这些术语并非限制性的和绝对的。
A.示例性柄部组件和轴组件
如图1-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)可选择性地朝向和远离手枪式握把(22)枢转，如将在下文中更详细地描述。柄部组件(20)进一步包括砧座释放按钮(25)、击发梁反向开关(27)和能够移除的电池组(28)。这些部件还将在下文中更详细地进行描述。当然，除上文所述那些中的任一个之外或作为替代，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-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)沿着轴组件(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)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)，以期望的角度(α)侧向远离轴组件(30)的纵向轴线(LA)。因此，端部执行器(40)可到达器官后面或从所需角度或出于其他原因接近组织。在一些型式中，关节运动节段(34)使端部执行器(40)能够沿着单个平面偏转。在一些其他型式中，关节运动节段(34)使端部执行器能够沿着多于一个平面偏转。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。旋钮(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。
在一些型式中，关节运动节段(34)和/或关节运动控制旋钮(35)根据下列美国专利申请的教导内容中的至少一些来进行构造和操作：于2013年2月28日提交的名称为“Surgical Instrument End Effector Articulation Drive with Pinion and OpposingRacks”的美国专利申请13/780,067，其公开内容以引用方式并入本文。关节运动节段(34)还可根据以下专利申请的教导内容中的至少一些和/或根据下文的各种教导内容来进行构造和操作：于2014年6月25日提交的名称为“Articulation Drive Features for SurgicalStapler”的美国专利申请14/314,125，其公开内容以引用方式并入本文。参考本文的教导内容，关节运动节段(34)和关节运动钮(35)可采取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1-图2所示，本示例的轴组件(30)进一步包括旋转旋钮(31)。旋转旋钮(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。在一些型式中，旋转旋钮(31)能够操作以选择性地锁定轴组件(30)和端部执行器(40)相对于柄部组件(20)围绕轴组件(30)的纵向轴线(LA)的角定位。例如，旋转旋钮(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，除上文所述那些中的任一个之外或作为替代，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专利申请的教导内容中的至少一些来进行构造：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-图3所示，本示例的端部执行器(40)包括下钳口(50)和能够枢转的砧座(60)。砧座(60)包括设置在下钳口(50)的相应弯曲狭槽(54)中的一对一体式向外延伸的销(66)。销(66)和狭槽(54)示出于图5中。砧座(60)能够朝向和远离下钳口(50)在打开位置(示出于图2和图4中)和闭合位置(示出于图1、图3和图7A-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)朝向下钳口(50)运动时，这些销沿着下钳口(50)的弯曲狭槽(54)滑动。在此类型式中，枢转轴线沿着由狭槽(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，枢转轴线首先可沿着狭槽(54)滑动，然后在枢转轴线已沿着狭槽(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”(“pivotable”)等内。当然，一些型式可提供砧座(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中最佳地看到，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)并利用另一个钉仓(70)来替换。因此，下钳口(50)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)。在一些型式中，下钳口(50)根据以下专利申请的教导内容中的至少一些进行构造：于2013年2月28日提交的名称为“Installation Featuresfor Surgical Instrument End Effector Cartridge”的美国专利申请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-图6中最佳地看到，本示例的钉仓(70)包括仓体(71)和被固定到仓体(71)下侧的托盘(76)。仓体(71)的上侧存在平台(73)，当砧座(60)处于闭合位置时，组织可压缩抵靠在该平台上。仓体(71)进一步限定纵向延伸通道(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)也被定位在每个钉凹坑(74)中，位于相应钉(77)下方，并且位于托盘(76)之上。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，该楔形滑动件被捕获在仓体(71)和托盘(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)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)沿着水平维度平移时，钉驱动器(75)沿着垂直维度平移。
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，在一些其他型式中，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)。在一些型式中，钉仓(70)根据以下专利申请的教导内容中的至少一些来进行构造和操作：于2013年2月28日提交的名称为“IntegratedTissue Positioning and Jaw Alignment Features for Surgical Stapler”的美国专利申请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)可根据以下专利申请的教导内容中的至少一些进行构造和操作：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，钉仓(70)可采用的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。
如图4中最佳地看到，本示例的砧座(60)包括纵向延伸通道(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)处于闭合位置时在钉仓(70)的对应钉凹坑(74)上。钉成形凹坑(64)被构造成能够当钉(77)被驱动穿过组织进入砧座(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，以将成形的钉(77)固定在组织中。砧座(60)可根据以下专利申请的教导内容中的至少一些进行构造：于2013年2月28日提交的名称为“Integrated Tissue Positioning and Jaw Alignment Featuresfor Surgical Stapler”的美国专利申请13/780,106；于2013年2月28日提交的名称为“JawClosure Feature for End Effector of Surgical Instrument”的美国专利申请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13/780,379，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，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)被构造成能够平移穿过端部执行器(40)。如图5和图7A-图7B中最佳地看到，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中最佳地看到，刀构件(80)被定位在砧座(60)和钉仓(70)的通道(62,72)中。刀构件(80)包括朝远侧呈现的切割边缘(84)，该朝远侧呈现的切割边缘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-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描述。
在一些型式中，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。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的钉仓(70)(例如，其中从中布置所有钉(77))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，此类闭锁特征结构可根据以下专利申请的教导内容中的至少一些进行构造：于2013年2月28日提交的名称为“Lockout Feature for Movable Cutting Member of Surgical Instrument”的美国专利申请13/780,082，该专利申请的公开内容以引用方式并入本文；和/或于2014年6月25日提交的名称为“Method of Using Lockout Features for Surgical Stapler Cartridge”的美国专利申请14/314,108，其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)可简单地省略此类闭锁特征结构。
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)朝远侧推进闭合环(36)而朝向下钳口(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，以朝向下钳口(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)可根据以下专利申请的教导内容中的至少一些进行相互作用：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13/780,120，该专利申请的公开内容以引用方式并入本文；和/或于2014年6月25日提交的名称为“JawOpening Feature for Surgical Stapler”的美国专利申请14/314,108，其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)。还如上文所指出，砧座(60)响应于闭合环(36)的远侧推进而朝向下钳口(50)闭合。在本示例中，闭合触发器(24)可朝向手枪式握把(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)朝向手枪式握把(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。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)被构造成能够并定位成由抓握手枪式握把(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)，而无需利用同一只手来释放手枪式握把(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-图12示出了可用于提供击对发梁(82)的机动化控制的示例性部件。具体地，图9示出了可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，如将在下文中更详细地描述。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示出了作为开放式开关的击发触发器(26)，但应当理解，该开关当击发触发器(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)中不存在仓(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)已经被击发很多次、和/或任何其他合适的条件。参考本文中的教导内容，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，参考本文的教导内容，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)当闭锁开关(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)和相关部件/功能性可根据以下专利的教导内容中的至少一些来进行构造：于2010年1月12日公布的名称为“Electronic Lockouts and Surgical Instrument IncludingSame”的美国专利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释放击发触发器(26)。在该操作状态下，电流流动穿过反向指示器(114)(例如，LED等)以向操作者提供马达(102)的旋转已被逆转的视觉指示。在本示例中，并且如图12中最佳地看到，开关致动臂(134)从齿条构件(130)侧向延伸，并定位成当击发梁(82)到达最远侧的位置时(例如，在组织(90)被切断并且钉(77)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，参考本文的教导内容，反向指示器(114)可采取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)还包括手动返回开关(116)，所述开关也在电路(100)中示出。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，从而逆转施加到马达(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。在一些型式中，柄部组件(20)进一步包括使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，该手动返回特征结构包括被如图1所示的能够移除的面板(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“救助”特征结构，从而使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当发梁(82)仅部分地朝远侧推进时被致动。
在一些型式中，开关(26,106,108,112,116)中的一者或多者为微动开关的形式。参考本文的教导内容，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。除此之外或作为前述的代替，电路(100)的至少部分可根据以下专利的教导内容中的至少一些来构造：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)连接，该驱动齿轮与惰轮小齿轮(126)啮合。小齿轮(126设置在轴(128)上，所述轴支撑在柄部组件(20)内且与马达(102)的驱动轴(120)平行取向。小齿轮(126)进一步接合齿条构件(130)。具体地，小齿轮(126)与齿条构件(130)的近侧端部处的齿(132)啮合。齿条构件(130)可滑动地支撑在柄部组件(20)中。从上述应当理解，当马达(102)被启动时，驱动轴(120)的相应旋转经由齿轮组件(122)被传送到小齿轮(126)，并且小齿轮(126)的相应旋转被齿(132)转换成齿条构件(130)的平移。如图10-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)接合。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)。在一些型式中，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8,453,914的教导内容中的至少一些进行构造，该专利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，一些其他型式可提供对击发梁(82)的手动驱动，使得省略马达。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进行致动。
图8示出了已经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，切割边缘(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)穿过由切割边缘(84)产生的切割线的每一侧上的组织(90)。在本示例中，钉(77)全部基本上平行于切割线取向，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，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以到达缝合位点用于进一步切割和缝合。该过程可重复，直至已经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，切割边缘(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，切割边缘(84)仅稍微落后于钉(77)的驱动，使得钉(47)刚好在切割边缘(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，或者切割边缘(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，与切割边缘(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，图8不应被视为对端部执行器(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)的各种合适设定和规程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引用的各种参考文献中的任一者来进行构造和操作。可提供用于器械(10)的另外示例性修改将在下文中更详细地描述。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，其中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。以下教导内容可易于应用到各种其他种类的器械，包括不会被分类为外科缝合器的器械。参考本文的教导内容，其中可应用下文教导内容的各种其他合适的装置和设定将对本领域的普通技术人员将是显而易见的。
II.示例性的另选钉仓
图13-图14示出了可被插入到端部执行器(40)的下钳口(50)中的示例性另选钉仓(270)。除了如下文列出的之外，本示例的钉仓(270)基本上类似于上述钉仓(70)。例如，与仓(70)一样，仓(270)包括仓体(271)和固定到仓体(271)的下侧的托盘(未示出)。类似地，仓体(271)的上侧呈现平台(273)，当砧座(60)处于闭合位置时，组织可被压缩抵靠该平台。
与仓(70)不同，仓(270)配备有设置在仓体(271)的平台(273)上的支撑物280。在本示例中，支撑物(280)包含被构造成能够在结构上支撑钉线的坚固但柔性材料。除此之外或另选地，支撑物(280)可由包含例如止血剂(诸如血纤蛋白)的材料构成，以有助于凝结血液并且减少沿着组织(90)的被切断的和/或被缝合的手术部位处的出血。
在其他示例中，支撑物(280)可包含除上文所述的那些之外的材料。例如，可使用其他助剂或止血剂(例如凝血酶)，使得支撑物(280)可有助于凝结血液并且减少手术部位处的出血量。此类助剂的止血能力还可有助于将此类助剂用作粘合剂和密封剂。试剂可有助于凝结手术部位处的血液，这就允许此类血液周围的组织粘在一起，并且可例如防止沿着被缝合的组织部位的渗漏。可并入支撑物(280)的其他助剂或试剂可进一步包含但不限于医用流体或基质组分。仅以举例方式，支撑物(280)可包含天然的或遗传工程的可吸收性聚合物或合成的可吸收性聚合物，或它们的混合物。天然的或遗传工程的可吸收性聚合物的仅例示性示例是蛋白质、多糖、以及它们的组合。可使用的蛋白质的仅例示性示例包括前凝血素、凝血酶、纤维蛋白原、血纤蛋白、纤粘蛋白、肝素酶、因子X/Xa、因子VII/VIla、因子IX/IXa、因子XI/XIa、因子XII/XIIa、组织因子、巴曲酶、安克洛酶、蛇静脉酶、血管性血友病因子、胶原、弹性蛋白、白蛋白、明胶、血小板表面糖蛋白、加压素、加压素类似物、肾上腺素、选择素、促凝血毒液、纤溶酶原激活剂抑制剂、血小板活化剂、具有止血活性的合成肽和/或它们的组合。多糖包括但不限于：纤维素、烷基纤维素例如甲基纤维素、烷基羟烷基纤维素、羟烷基纤维素、纤维素硫酸酯、羧甲基纤维素的盐、羧甲基纤维素、羧乙基纤维素、甲壳质、羧甲基甲壳质、透明质酸、透明质酸的盐、藻酸盐、藻酸、丙二醇藻酸盐、糖原、葡聚糖、硫酸葡聚糖、凝胶多糖、果胶、普鲁兰、黄原胶、软骨素、硫酸软骨素、羧甲基葡聚糖、羧甲基脱乙酰壳多糖、脱乙酰壳多糖、肝素、硫酸肝素、类肝素、硫酸类肝素、硫酸皮肤素、硫酸角质素、角叉菜胶、脱乙酰壳多糖、淀粉、直链淀粉、支链淀粉、聚-N-葡糖胺、聚甘露糖醛酸、聚葡糖醛酸、聚古洛糖醛酸，以及上述任一物质的衍生物。合成的可吸收性聚合物的示例是脂族聚酯聚合物、共聚物和/或它们的组合。脂族聚酯通常由单体的开环聚合反应合成，所述单体包括但不限于乳酸、丙交酯(包括L-、D-、内消旋和D、L混合物)、乙醇酸、乙交酯、ε-己内酯、对二氧杂环己酮(1,4-二氧杂环六环-2-酮)和三亚甲基碳酸酯(1,3-二氧杂环六环-2-酮)。参考本文的教导内容，可用于医用流体或基质中的其他适合的化合物、材料、物质等对于本领域的普通技术人员而言将是显而易见的。
支撑物(280)包括仓部分(282)、砧座部分(284)、以及设置在仓部分(282)的近侧端部和砧座部分(284)之间的中间部分(286)。砧座部分(284)包括翼片(288)，所述翼片裹在砧座(60)的远侧端部上，如图14所示。例如，翼片(288)限定凹坑(未示出)，所述凹坑的大小适于容纳砧座(60)的远侧端部，以由此将支撑物(280)的砧座部分(284)附接到砧座(60)上。支撑物(280)的中间部分(286)可包括预成形的弯曲部，以有利于将仓(270)装载到下钳口中并将砧座(60)插入到由翼片(288)限定的凹坑中。
仓(270)进一步包括抓握到支撑物(280)上的紧固件，诸如钩(290)。钩(290)和支撑物(280)可提供其中钩(290)连接至在支撑物(280)的材料内形成的环的紧固关系，诸如钩环紧固关系。尽管本示例被示为具有钩(290)，但应当理解，可使用任何其他合适的装置来将支撑物(280)的仓部分(282)紧固到仓(270)的平台(273)。
在使用中，带有支撑物(280)的仓(270)可移除地接收到端部执行器(40)的下钳口(50)中，如图13所示。当使用包括仓(270)和支撑物(280)的端部执行器(40)时，如图15所示，钉(277)在击发梁(82)切穿组织(90)同时还切穿支撑物(280)的同时或稍前被驱动到组织(90)中。钉(277)可捕获支撑物(280)的部分，并且将这些部分驱动到组织(90)中或至少将支撑物(280)固定到组织(90)。当击发梁(82)在使用中切断组织(90)时，该击发梁切穿支撑物(280)，从而将来自支撑物(280)的材料施加到被切断的组织上。
虽然支撑物(280)被示出为具有某种构型，但应当理解，支撑物(280)的精确构型可改变。例如，在一些型式中，医用流体可悬浮在生物相容性载体中。合适的载体可包括例如生理缓冲溶液、流动性凝胶溶液、盐水溶液和水。在凝胶溶液情况下，组织修复组合物在递送到目标部位处之前可为可流动的凝胶形式，或可形成凝胶并且在递送到目标部位之后保持处于适当位置。可流动的凝胶溶液可包括具有或不具有添加的水、盐水溶液或生理缓冲溶液的一种或多种胶凝材料。示例性胶凝材料包括蛋白质、多糖，多核苷酸以及其它材料，诸如藻酸酯盐、交联藻酸酯盐、聚(N-异丙基丙烯酰胺)、聚(氧化烯)、聚(环氧乙烷)-聚(环氧丙烷)的共聚物、聚(乙烯醇)、聚丙烯酸酯或单硬脂酰甘油共-琥珀酸盐(co-Succinate)/聚乙二醇(MGSA/PEG)共聚物以及任何上述项的任一组合。
支撑物(280)可另选地包括纤维垫、泡沫、网片或者能够包含粘合剂或其他类型的医用流体的另一个结构。仅以举例的方式，仓(270)和/或支撑物(280)可根据以下专利公布的教导内容进行构造：于2013年3月21日公布的名称为“Surgical Instrument andButtress Material”的美国专利公布20013/0068816；于2013年3月14日公布的名称为“Surgical Instrument with Fluid Fillable Buttress”的美国专利公布2013/0062391；于2013年3月21日公布的名称为“Fibrin Pad Matrix with Suspended Heat ActivatedBeads of Adheasive”的美国专利公布2013/0068820；于2013年4月4日公布的名称为“Attachment of Surgical Staple Buttress to Cartridge”的美国专利公布2013/0082086；于2013年2月14日公布的名称为“Device for Applying Adjunct in EndoscopicProcedure”的美国专利公布2013/0037596；于2013年3月14日公布的名称为“ResistiveHeated Surgical Staple Cartridge with Phase Change Sealant”的美国专利公布2013/0062393；于2013年3月28日公布的名称为“Surgical Staple Assembly withHemostatic Feature”的美国专利公布2013/0075446；于2013年3月14日公布的名称为“Surgical Staple Cartridge with Self-Dispensing Staple Buttress”的美国专利公布2013/0062394；于2013年3月28日公布的名称为“Anvil Cartridge for SurgicalFastening Device”的美国专利公布2013/0075445；和于2013年3月28日公布的名称为“Adjunct Therapy for Applying Hemostatic Agent”的美国专利公布2013/0075447，该专利的公开内容以引用方式并入本文。
III.示例性另选楔形滑动件
在一些情况下，可能需要提供另外的和/或另选的结构并用于切割组织和/或支撑物(280)。例如，在一些示例中，器械(10)本身可为可重复使用的，而仓(70,270)可为一次性的。因此，器械(10)的重复再使用可导致击发梁(82)的切割边缘(84)变钝。此类钝化可通过使用包括类似于上述那些的支撑物(280)的仓(270)而加剧。除此之外或另选地，当同一击发梁(82)被击发穿过多个支撑物(280)时，击发梁(82)的切割边缘(84)和/或其他部分可能会遇到形成支撑物(280)的材料的积聚。材料的此类积聚可不利地影响击发梁(82)切断组织和/或另外的支撑物(280)的能力。除此之外或另选地，材料的此类积聚可提供需要另外的力来将击发梁(82)朝远侧驱动的增加的摩擦或干涉作用。可用于提供至少一些一次性切割特征结构的另外的和/或另选的结构的各种示例在下文中更详细地描述，而参考本文的教导内容，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。
A.具有可旋转刀片的示例性楔形滑动件
图16示出了下钳口(50)和另选钉仓(370)的透视剖面图。钉仓(370)可用作钉仓(70)的替代物。另外，或另选地，与钉仓(270)一样，钉仓(370)可包括支撑物(280)或任何其他种类的支撑物，包括但不限于本文所引用的各种参考文献中所述的各种支撑物。钉仓(370)基本上类似于上述钉仓(70,270)，主要区别在于钉仓(370)配备有示例性另选楔形滑动件(378)。楔形滑动件(378)类似于上述楔形滑动件(78)。在本示例中，楔形滑动件(378)已相对于楔形滑动件(78)被修改成容纳可旋转到楔形滑动件(378)中的辅助切割刀片(380)。具体地，如图16-图17所示，楔形滑动件(378)包括主体(377)和多个凸轮表面(379)。主体(377)限定刀片狭槽(382)。主体和凸轮表面(379)相对于楔形滑动件(78)的凸轮表面(79)较短，但主体(377)和凸轮表面(379)以比楔形滑动件(78)的凸轮表面(79)的角度陡的角度取向。因此，楔形滑动件(378)在仓(370)内占用与仓(70,270)中的楔形滑动件(78)相同的纵向空间量，从而使楔形滑动件(378)基本上能够与楔形滑动件(78)互换。凸轮表面(379)的角度允许楔形滑动件(378)同时和/或以某一预定顺序向上驱动多个钉驱动器(75)。
刀片狭槽(382)被构造成能够容纳刀片(380)在楔形滑动件(378)内的旋转。如图17中最佳地看到，刀片狭槽(382)具有大致对应于由在回缩位置(以虚线显示)和伸出位置之间旋转的刀片(380)限定的形状的形状。另外，刀片狭槽(382)限定止挡特征结构(383)，所述止挡特征结构如将在下文中更详细地描述防止刀片朝近侧旋转超过伸出位置。刀片狭槽(382)的形状进一步限定楔形滑动件(378)中的近侧开口(384)。如将在下文中更详细地描述，近侧开口提供至刀片(380)的通路，使得刀片可由击发梁(82)从回缩位置致动到伸出位置。在其他示例中，刀片狭槽(382)可具有任何其他合适的形状，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。
如图17中最佳地看到，楔形滑动件(378)进一步包括延伸穿过刀片狭槽(382)的旋转销或轴(385)。刀片(380)中的通孔(386)允许刀片(380)以能够枢转的方式联接到楔形滑动件(378)，使得刀片(380)可以朝远侧旋转到回缩位置。尽管在图17中未示出，但应当理解，旋转轴(385)可配备有轴衬、轴承、或适于帮助刀片(380)旋转的其他部件或特征结构。另外，旋转轴(385)可配备有适于将刀片(380)朝向回缩或伸出位置弹性偏压的部件或特征结构，诸如弹簧。
刀片(380)具有类似于小刀的横截面形状。具体地，参照处于伸出位置的刀片(380)，刀片(380)具有上切割部分(388)和下附接部分(394)。上切割部分(388)包括面向远侧的角切割边缘(390)和面向近侧的平坦部分(392)。切割边缘(390)从附接部分(394)向上以角度延伸。尽管切割边缘(390)包括以角度延伸的直刃，但应当理解，切割边缘(390)可采用任何其他合适的形状。例如，切割边缘(390)可为弯曲的，有锯齿状边缘的，锯齿形的和/或以其他方式构造而成的。切割边缘(390)可进一步相对于所示角度不同地成角度。
平坦部分(392)从附接部分(394)向上延伸。与切割边缘(390)一样，平坦部分(392)不必限于本文所述的形状。如将在下文中更详细地描述，平坦部分(392)提供可与楔形滑动件(378)的止挡特征结构(383)接合的表面。
刀片(380)的上切割部分(388)向上延伸到楔形滑动件(378)之上的某一高度。在本示例中，上切割部分(388)的高度被构造成能够切穿支撑物(280)和组织(90)两者。在其他示例中，上切割部分(388)可具有小于所示高度的高度，使得上切割部分(388)仅切穿紧邻仓(370)的支撑物(280)，而不必切穿被定位在支撑物(280)之上的组织(90)。应当理解，上切割部分(388)或上述切割部分(388)的其他元件可具有任何其他合适的形状、高度或构型，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。
在示例性操作模式中，刀片(380)在仓(370)插入到下钳口(50)中之前处于回缩位置。在回缩位置中，刀片(380)整个凹入仓(370)和楔形滑动件(378)内部。因此，保护操作者免于在将仓(70,270)插入到下钳口(50)中时与刀片(380)意外接触。
一旦操作者已经将仓(370)插入到下钳口(50)中，则刀片(380)保持回缩，直至操作者开始击发序列。一旦开始击发序列，则朝远侧驱动击发梁(82)，使得刀构件(80)接触楔形滑动件(378)。刀构件(80)可包括一个或多个突伸特征结构(未示出)，所述一个或多个突起特征结构被构造成能够接合刀片(380)，使得刀片可被致动到伸出位置中，而止挡特征结构(383)阻止进一步旋转。另选地，楔形滑动件(378)可配备有适于在刀构件(80)接触楔形滑动件(378)时致动刀片(380)的特征结构。在伸出位置中，刀片(380)延伸穿过仓(370)的平台(373)。
当刀片(380)处于伸出位置时，击发梁(82)继续朝远侧推进，从而驱动刀片(380)的切割边缘(390)穿过支撑物(280)(如果配备的话)和组织(90)。刀构件(80)的切割边缘(84)可能不久就落后于刀片(380)，使得切割边缘(84)切割未由刀片(380)切割的任何组织(90)或支撑物(280)材料。应当理解，刀构件(80)的切割边缘(84)和刀片(380)的切割边缘(390)沿循基本上相同的路径。此类路径大体可由仓(370)的纵向延伸通道(372)限定。通过进行穿过支撑物(280)(且在一些型式中，也穿过组织(90))的第一遍切割，刀片(380)可减少刀构件(80)上的磨损和/或积聚，从而延长刀构件(80)的使用寿命。另外，应当理解，刀片(380)和刀构件(80)两者落后于凸轮表面(379)，使得在组织的特定区域由刀片(380)或刀构件(80)切割之前，楔形滑动件(378)将驱动钉(77)穿过组织的该给定区域。缝合和切割动作仍然可被认为在组织的该区域处是基本上同时的，因为楔形滑动件(378)被构造成使得缝合和切割之间的时间差基本上很短。
一旦器械(10)已经被击发，则仓(370)可与刀片(380)一起移除，使得新仓(370)和/或刀片(380)可插入到下钳口(50)中。应当理解，仓(370)可替换为相同的仓(370)或不同的仓(70,270,370)。例如，一些仓(370)可配备有被构造成用于不同规程的刀片(380)。仅以举例的方式，仓(370)可包括与肺组织一起使用的更锐利的刀片(380)。另选地，仓(370)可包括与胃组织一起使用的更坚固的刀片(380)。当然，仓(370)可包括适于切穿任何组织的刀片(380)，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.具有固定刀片的示例性楔形滑动件
图18示出了配备有示例性另选楔形滑动件(478)的另一个示例性另选钉仓(470)的透视剖面图。在本示例中，除仓(470)包括一体地联接到仓(470)的平台(473)的向上突出的防护件(469)以外，仓(470)与上述仓(70,270)基本上相同。与仓(70,270)一样，仓(470)包括平台(473)中的也延伸穿过防护件(469)的纵向延伸通道(472)。如将在下文中更详细地描述，防护件(469)被构造成能够覆盖固定地附接到楔形滑动件(478)的刀片(480)。
楔形滑动件(478)类似于上述楔形滑动件(78,378)。在本示例中，与楔形滑动件(378)一样，楔形滑动件(478)已经相对于楔形滑动件(78)被修改成容纳固定地固定到楔形滑动件(478)的辅助切割刀片(480)。具体地，如在图19中最佳地看到，楔形滑动件(478)包括限定刀片狭槽(482)的主体(477)。主体(477)还可包括适于经由钉驱动器将钉(77)驱动到组织中的多个凸轮表面(未示出)。主体(477)相对于楔形滑动件(78)的凸轮表面(79)较短，但主体(477)和凸轮表面以比楔形滑动件(78)的凸轮表面(79)的角度陡的角度取向。因此，楔形滑动件(478)在仓(470)内纵向地占用与楔形滑动件(78)相同的空间量，从而使楔形滑动件(478)基本上能够与楔形滑动件(78)互换。楔形滑动件(478)的角度允许楔形滑动件(478)同时和/或以某一预定顺序向上驱动多个钉驱动器(未示出)。
刀片狭槽(482)被构造成能够容纳楔形滑动件(478)内的刀片(480)。如图19中最佳地看到，刀片狭槽(482)具有大致对应于由刀片(480)的下部区域限定的形状的形状。与楔形滑动件(378)的刀片(380)不同，楔形滑动件(478)的刀片(480)相对于楔形滑动件(478)固定。因此，刀片狭槽(482)不需要被构造成能够容纳刀片(480)的旋转或枢转。在其他示例中，刀片狭槽(482)可具有任何其他合适的形状，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。
如图19中看到，楔形滑动件(478)进一步包括延伸穿过刀片狭槽(482)的销或轴(485)。刀片(480)中的通孔(486)允许刀片(480)固定地固定到楔形滑动件(478)，使得刀片(480)相对于楔形滑动件(478)基本上固定。
刀片(480)具有类似于刀片(380)的横截面形状。具体地，刀片(480)具有上切割部分(488)和下附接部分(494)。上切割部分(488)包括面向远侧的角切割边缘(490)和面向近侧的平坦部分(492)。切割边缘(490)从附接部分(494)向上以角度延伸。与上述切割边缘(390)和平坦部分(394)一样，切割边缘(490)和平坦部分(494)可包括任何合适的另选构型，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。
刀片(480)的上切割部分(488)向上延伸到楔形滑动件(478)之上的某一高度。在本示例中，上切割部分(488)的高度被构造成能够切穿支撑物(280)和组织(90)两者。但是，与上述上切割部分(388)一样，上切割部分(488)的高度可改变以切穿支撑物(280)和/或组织(90)的任何期望的组合，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。
在示例性操作模式中，并且如图19所示，刀片(480)在仓(470)插入到下钳口(50)中之前回缩到防护件(469)中。当刀片(480)回缩到防护件(469)中时，刀片(480)整个在仓(470)内。因此，保护操作者免于在操作者操纵仓(470)并且将仓(470)插入到下钳口(50)中时与刀片(480)意外接触。另外，防护件(469)可防止在砧座(60)朝向平台(473)闭合期间组织和刀片(480)之间的过早接触，直至开始击发序列(例如，直至朝远侧推进刀构件(80))。例如，在不存在防护件(469)的情况下，砧座(60)的闭合动作可趋向于当砧座(60)将组织压缩抵靠平台(473)时，将组织向近侧朝向刀片(480)驱动。如果发生组织的此类近侧“挤压”动作，则防护件(469)阻止朝近侧驱动的组织接合刀片(480)。
一旦操作者已将仓(470)插入到下钳口(50)中，则刀片(480)保持回缩，直至操作者开始击发序列。一旦开始击发序列，则朝远侧驱动击发梁(82)，以接触楔形滑动件(478)。如图20所示，击发梁(82)继续朝远侧推进，从而将楔形滑动件(478)朝远侧驱动并由此将刀片(480)驱动离开防护件(469)，使得刀片(480)的切割边缘(490)可切穿支撑物(280)(如果配备的话)和组织(90)。刀构件(80)的切割边缘(84)可能不久就落后于刀片(480)，使得切割边缘(84)切割未由刀片(480)切割的任何组织(90)或支撑物(280)材料。应当理解，刀构件(80)的切割边缘(84)和刀片(480)的切割边缘(490)沿循基本上相同的路径。此类路径大体可由仓(770)的纵向延伸通道(470)限定。通过进行穿过支撑物(280)(且在一些型式中，也穿过组织(90))的第一遍切割，刀片(480)可减少刀构件(80)上的磨损和/或积聚，从而延长刀构件(80)的使用寿命。另外，应当理解，刀片(480)和刀构件(80)两者落后于凸轮表面(479)，使得在组织的特定区域由刀片(480)或刀构件(80)切割之前，楔形滑动件(478)将驱动钉(77)穿过组织的该给定区域。缝合和切割动作仍然可被认为在组织的该区域处是基本上同时的，因为楔形滑动件(478)被构造成使得缝合和切割之间的时间差基本上很短。
一旦器械(10)已经被击发，则仓(470)可与刀片(480)一起移除，使得新仓(70,370,470)和/或刀片(480)可插入到下钳口(50)中。应当理解，仓(470)可替换为相同的仓(470)或不同的仓(70,270,370)。例如，与上述仓(370)一样，一些仓(470)可配备有被构造成用于不同的规程(诸如上文所述的那些)的刀片(480)。
图21示出了可与仓(70,270,470)一起使用的另选楔形滑动件(578)。楔形滑动件(578)在功能和结构上与上述楔形滑动件(478)相同，除非下文另有说明。与楔形滑动件(478)不同，楔形滑动件(578)包括不同的辅助切割刀片(580)。具体地，刀片(580)相对于刀片(480)较短，使得刀片(580)被构造成能够切穿仅支撑物(280)材料，而不同样到达定位在支撑物(280)之上的组织(90)。
在一些情况下，支撑物(280)材料可具有不同于所示特定厚度的厚度。因此，应当理解，切割刀片(580)不仅限于切割支撑物(280)或切穿支撑物(280)的全部。实际上，在一些情况下，刀片(580)可附带地切割组织(90)的一部分。然而在其他情况下，刀片(580)可切穿支撑(280)的仅一部分，从而留下用于由刀构件(80)的切割边缘(84)切割的剩余支撑物(280)材料。
C.具有被偏压的辅助刀片的示例性楔形滑动件
图22示出了可与仓(670)一起使用的另一个示例性另选楔形滑动件(678)的透视图，仓(670)是仓(70,270)的修改型式。在许多方面，本示例的楔形滑动件(678)类似于上述楔形滑动件(78,378,478,578)。在本示例中，与楔形滑动件(378,478,578)一样，楔形滑动件(678)已经相对于楔形滑动件(78)被修改成容纳辅助切割刀片(680)。具体地，如图23中最佳地看到，楔形滑动件(678)包括主体(677)和多个凸轮表面(679)。主体(677)限定刀片狭槽(682)，所述刀片狭槽被构造成能够容纳刀片(680)，如将在下文中更详细地描述。主体(677)和凸轮表面(679)相对于楔形滑动件(78)的凸轮表面(79)较短，但凸轮表面(679)以比楔形滑动件(78)的凸轮表面(79)的角度陡的角度取向。因此，楔形滑动件(678)在仓(70,270)内纵向地占用与楔形滑动件(78)相同的空间量，从而使楔形滑动件(678)基本上能够与楔形滑动件(78)互换。凸轮表面(679)的角度允许楔形滑动件(678)同时和/或以某一预定顺序向上驱动多个钉驱动器(未示出)。
刀片狭槽(682)被构造成能够容纳楔形滑动件(678)内的刀片(680)。如图23中最佳地看到，刀片狭槽(682)包括平移狭槽(683)和致动腔(684)。平移狭槽(683)对应于刀片(680)的平移滑动件(692)。如将在下文中更详细地描述，平移滑动件(692)被构造成能够与刀构件(80)配合以将刀片(680)经由平移狭槽(683)从回缩位置平移到伸出位置。
致动腔(684)限定用于刀片(680)的某些部件(下面描述)和楔形滑动件(678)的弹性构件(686)的空间。弹性构件(686)包括片簧，所述片簧从具有与楔形滑动件(678)一体构造的远侧固定特征结构(688)朝近侧延伸。如将在下文中更详细地描述，弹性构件(686)能够操作以在致动腔(684)内上下挠曲以将刀片(680)朝向回缩位置弹性地偏压。因此，致动腔(684)至少部分地由弹性构件(686)的挠曲运动范围限定。尽管致动腔(684)被示为具有特定形状，但应当理解，致动腔(684)的形状可根据弹性构件(686)的形状和运动范围而改变。另外或另选地，如从下文说明将理解，致动腔(684)的形状也可根据刀片(680)的形状或平移路径而变化。
刀片(680)包括上切割部分(690)、平移滑动件(692)和保持特征结构(694)。切割部分(690)包括锐利的朝远侧取向的切割边缘(691)，所述切割边缘被构造成能够切穿支撑物(280)和/或组织(90)。与上述切割边缘(390,490)一样，切割边缘(691)可具有可被构造成能够切穿多种材料的多种另选构型。
平移滑动件(692)具有与刀片(680)的一体构造并且从刀片(680)向外延伸。在其他示例中，平移滑动件(692)可与刀片(680)分开，并且固定地固定到刀片(680)。平移滑动件(692)大体与刀片(680)一体并且从刀片(680)的前侧、右侧和左侧朝远侧和向外延伸。如图22中最佳地看到，平移滑动件(692)大体为具有圆形远侧和近侧端部的矩形形状。平移滑动件(692)的矩形形状的纵向部分大体限定相对于仓(670)的纵向轴线以倾斜角度取向的平面。如将在下文中更详细地描述，平移滑动件(692)以能够滑动的方式被设置在形成于楔形滑动件(680)的主体中的平移狭槽(683)中。平移狭槽(683)为平移滑动件(692)提供凸轮表面，使得当刀片(680)相对于楔形滑动件(678)朝远侧驱动时，平移狭槽(693)和平移滑动件(692)提供刀片(680)相对于楔形滑动件(678)的向上运动。尽管平移滑动件(692)被示为相对于刀片(680)以特定角度取向，但应当理解，平移滑动件(692)可以任何合适的角度取向，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。
保持特征结构(694)从刀片(680)朝远侧延伸。具体地，保持特征结构(694)最初基本上垂直于刀片(680)的纵向轴线延伸。当保持特征结构(694)朝远侧延伸时，保持特征结构(694)以角度向下弯曲。如将理解，保持特征结构(694)的形状被构造成能够接合弹性构件(686)以将刀片(680)朝向回缩位置弹性地偏压。因此，保持特征结构(694)可根据楔形滑动件(678)和刀片(680)以及它们的其他子部件之间的特定关系采取多种另选形状。
与楔形滑动件(378,478,578)的刀片(380,480,580)不同，楔形滑动件(678)的刀片(680)被构造成能够相对于楔形滑动件(478)倾斜地平移。具体地，楔形滑动件(678)的平移狭槽(683)被构造成能够与刀片(680)的平移滑动件(692)配合。平移狭槽(683)和平移滑动件(692)均以角度取向，使得平移狭槽(683)和平移滑动件(692)能够操作以在刀片(680)朝远侧推进时协同地向上平移刀片(680)。因此，平移狭槽(683)和平移滑动件(692)能够操作以当刀片(680)朝远侧推进时将刀片(680)从回缩位置转换到伸出位置。
如图23中最佳地看到，楔形滑动件(678)的弹性构件(686)和刀片(680)的保持特征结构(694)被构造成能够彼此接合，使得弹性构件(686)对保持特征结构(694)施加具有向下分量和近侧分量的力。该力致使刀片(680)的平移滑动件(692)被朝向楔形滑动件(678)的平移狭槽(683)的近侧端部偏压，从而将刀片(680)朝向回缩位置弹性地偏压。在一些型式中，远侧突出部(83)的远侧边缘相对于水平平面以介于75度和90度之间的角度取向。此类角度可提供凸轮作用，所述凸轮作用有助于克服弹性构件(686)的偏压以朝近侧回缩刀片(680)。
在示例性操作模式中，刀片(680)最初回缩到回缩位置中以将仓(670)插入到下钳口(50)中。当刀片(680)处于回缩位置时，刀片(680)整个在仓(670)内。因此，保护操作者免于当将仓(670)插入到下钳口(50)中时与刀片(680)意外接触。
一旦操作者已将仓(670)插入到下钳口(50)中，则刀片(680)保持回缩，直至操作者开始击发序列。一旦开始击发序列，则朝远侧驱动击发梁(82)，使得刀构件(80)接触刀片(680)以首先将刀片(680)致动到伸出位置并且然后朝近侧驱动刀片(680)和楔形滑动件(678)。如图23-图24所示，刀构件(80)包括被构造成能够接触刀片(680)的远侧突出部(83)。因此，当击发梁(82)被朝远侧驱动时，刀片(680)相应地由刀构件(80)的远侧突出部(83)相对于楔形滑动件(678)朝远侧驱动。当刀片(680)被朝远侧驱动时，楔形滑动件(678)的平移狭槽(683)和刀片(680)的平移滑动件(692)同时地和协同地将刀片(680)向上驱动到伸出位置中，如在从图23所示的状态到图24所示的状态的转换中可以看到。应当理解，因为刀片(680)被朝向回缩位置弹性地偏压，所以刀片(680)只当受到刀构件(80)作用时才伸出。击发梁(82)的持续推进朝远侧推进楔形滑动件(678)并且驱动刀片(680)的切割边缘(691)穿过支撑物(280)和/或组织(90)。刀构件(80)的切割边缘(84)可能不久就落后于刀片(680)，使得切割边缘(84)切割未由刀片(680)切割的任何组织(90)或支撑物(280)材料。
应当理解，刀构件(80)的切割边缘(84)和刀片(680)的切割边缘(690)沿循基本上相同的路径。此类路径大体可由仓(670)的纵向延伸通道(未示出)限定。通过进行穿过支撑物(280)(且在一些型式中，也穿过组织(90))的第一遍切割，刀片(680)可减少刀构件(80)上的磨损和/或积聚，从而延长刀构件(80)的使用寿命。另外，应当理解，刀片(680)和刀构件(80)两者落后于凸轮表面(379)，使得在组织的特定区域由刀片(680)或刀构件(80)切割之前，楔形滑动件(678)将驱动钉(77)穿过组织的该给定区域。缝合和切割动作仍然可被认为在组织的该区域处是基本上同时的，因为楔形滑动件(678)被构造成使得缝合和切割之间的时间差基本上很短。
一旦器械(10)已经被击发，则刀构件(80)可被朝近侧回缩。刀构件(80)的近侧回缩允许弹性构件(686)将刀片(680)驱动回回缩位置。刀片(680)因此回缩到用完的仓(670)中，从而保护操作者免于当操作者移除用完的仓(670)以替换用完的仓(670)或以其他方式处置用完的仓(670)时与切割边缘(691)意外接触。仓(670)可与刀片(680)一起移除，使得配备有刀片(380,480,580,680)的新仓(70,270,370,470,570)可插入到下钳口(50)中。应当理解，仓(670)可替换为相同的仓(670)或不同的仓(70,270,370,470,570)。例如，与上述楔形滑动件(378,478,578)一样，一些仓(70,270,370,470,570)可配备有被构造成用于不同的规程(诸如上文所述的那些)的刀片(680)。
D.具有能够平移的刀片的示例性楔形滑动件
图25-图26示出了与仓(770)一起使用的另一个示例性另选楔形滑动件(778)，仓(770)是仓(70,270)的修改型式。在许多方面，本示例的楔形滑动件(778)类似于上述楔形滑动件(78,378,478,578,678)。与楔形滑动件(378,478,578,678)一样，楔形滑动件(778)已经相对于楔形滑动件(78)被修改成包括一体式辅助切割刀片(780)。具体地，如图25中最佳地看到，楔形滑动件(778)包括主体(777)和凸轮表面(779)。主体(777)和凸轮表面(779)相对于楔形滑动件(78)的凸轮表面(79)较短，但凸轮表面(779)以比楔形滑动件(78)的凸轮表面(79)的角度陡的角度取向。因此，楔形滑动件(778)在仓(70,270)内纵向地占用与楔形滑动件(78)相同的空间量，从而使楔形滑动件(778)基本上能够与楔形滑动件(78)互换。凸轮表面(779)的角度允许楔形滑动件(778)同时和/或以某一预定顺序向上驱动多个钉驱动器(75)。
刀片(780)包括上切割部分(790)、主体部分(792)和稳定构件(794)。切割部分(790)包括锐利的朝远侧取向的切割边缘(791)，所述切割边缘被构造成能够切穿支撑物(280)和/或组织(90)。与上述切割边缘(390,490,590,691)一样，切割边缘(791)可具有可被构造成能够切穿多种材料的多种另选构型。
主体部分(792)将刀片(780)与楔形滑动件(778)一体地联接。换句话讲，在本示例中，楔形滑动件(778)和刀片(780)包括单个一体式部件。在其他示例中，刀片(780)可与楔形滑动件(778)分开，并且固定地固定到楔形滑动件(680)。主体部分(792)的大小被设定成将切割部分(790)提升到适于切割支撑物(280)的高度。虽然主体部分(792)被示为具有特定高度，但应当理解，主体部分(792)的高度可根据多种因素而变化，诸如平台(773)的高度、支撑物(280)的厚度等。
稳定构件(794)被定位在切割边缘(791)之上并且从刀片(780)朝远侧延伸。如图26中最佳地看到，稳定构件(794)被定位成与支撑物(280)的顶表面对准。因此，稳定构件(794)能够操作以将支撑物(280)朝向切割边缘(791)指引，并且可进一步有助于防止支撑物(280)在与刀片(780)相邻的区域中与平台(773)分开，如将在下文中更详细地描述。另外，稳定构件(794)充当防护件以防止与切割边缘(791)的意外操作者接触。尽管稳定构件(794)被示为具有延伸特定距离的大体矩形形状，但应当理解，稳定构件(794)可具有任何合适的大小或形状。例如，在其他示例中，稳定构件(794)可比所描绘的进一步向远侧延伸。然而在其他示例中，稳定构件(794)可分别向外或向内渐缩到比刀片(780)宽或窄的宽度。当然，稳定构件(794)可包括任何其他合适的构型、大小、和/或形状，参考本文的教导内容，这对于本领域中的普通技术人员而言将是显而易见的。
在示例性操作模式中，刀片(780)最初在仓(70,270)的近侧端部处突伸离开仓(70,270)。稳定构件(794)被构造成能够防止操作者免于当仓(70,270)插入到下钳口(50)中时与切割边缘(791)的意外接触。因此，保护操作者免于与刀片(780)意外接触，即使刀片(780)从仓(70,270)向外突出。
一旦用户已将仓(70,270)插入到下钳口(50)中，则可开始击发序列。一旦开始击发序列，则朝远侧驱动击发梁(82)，使得刀构件(80)接触楔形滑动件(778)。如图26所示，刀构件(80)接触楔形滑动件(778)并且开始朝远侧驱动楔形滑动件(778)和刀片(780)。当刀片(780)被朝远侧驱动时，楔形滑动件(778)的稳定构件(794)跨置在支撑物(280)的上表面之上以稳定切割过程。应当理解，由于稳定构件(794)跨置在支撑物(280)的顶部之上，刀片(780)只切割支撑物(280)。在其他示例中，刀片(780)的切割边缘(791)可被构造成能够为竖直地更高。在一些此类示例中，稳定构件(794)可跨置在组织(90)或与砧座(60)相邻的支撑物(280)之上。因此，在其他示例中，刀片(780)可被构造成能够切割除支撑物(280)之外的其他材料，诸如组织(90)或其他另外的支撑物(280)。刀构件(80)的切割边缘(84)可能不久就落后于刀片(780)，使得切割边缘(84)切割未由刀片(780)切割的任何组织(90)或支撑物(280)材料。
应当理解，刀构件(80)的切割边缘(84)和刀片(780)的切割边缘(790)沿循基本上相同的路径。此类路径大体可由仓(770)的纵向延伸通道(未示出)限定。通过进行穿过支撑物(280)(且在一些型式中，也穿过组织(90))的第一遍切割，刀片(780)可减少刀构件(80)上的磨损和/或积聚，从而延长刀构件(80)的使用寿命。另外，应当理解，刀片(780)和刀构件(80)两者落后于凸轮表面(779)，使得在组织的特定区域由刀片(480)或刀构件(80)切割之前，楔形滑动件(778)将驱动钉(77)穿过组织的该给定区域。缝合和切割动作仍然可在组织的该区域处是基本上同时的，因为楔形滑动件(778)被构造成使得缝合和切割之间的时间差基本上很短。
一旦器械(10)已经被击发，则仓(70,270)可与刀片(780)一起被移除，使得新仓(70,270,470,570)可被插入到下钳口(50)中。应当理解，仓(70,270)可替换为相同的仓(70,270)或不同的仓(70,270,470,570)。例如，与上述楔形滑动件(378,478,578,678)一样，一些仓(570)可配备有被构造成用于不同的规程(诸如上文所述的那些)的刀片(780)。
IV.杂项
应当理解，在上述各种示例中，关节运动接头被构造成能够允许端部执行器沿着第一平面进行关节运动且由此远离轴组件的纵向轴线偏转。锁定组件能够操作以选择性地锁定关节运动接头。锁定组件包括锁定构件，所述锁定构件能够沿着第二平面运动，以选择性地接合第一锁定构件且由此锁定关节运动接头。第二平面从第一平面偏移。第二平面也不与第一平面平行。在一些情况下，第二锁定构件能够沿着垂直于轴组件的纵向轴线的第二轴线运动。解锁构件可选择性地驱动锁定构件。解锁构件可沿着第三平面运动，第三平面从第一平面和/或第二平面偏移和/或与第一平面和/或第二平面成非平行关系。解锁构件可沿着第三轴线运动，第三轴线可垂直于轴组件的纵向轴线和/或第二轴线。
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进行组合。因此，上述教导内容、表达、实施方案、示例等不应视为彼此隔离。参考本文的教导内容，可结合本文的教导内容的各种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。此类修改和变型旨在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。
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列出的现有定义、陈述或者其他公开材料不冲突的范围内并入本文。如此并且在必要的程度下，本文明确列出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列出的现有定义、陈述或其它公开材料相冲突的任何材料或其部分，将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规程、以及机器人辅助的医学治疗和规程。仅以举例的方式，本文的各种教导内容可易于并入机器人外科系统，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与以下专利中的任何专利的各种教导内容进行组合：于1998年8月11日公布的名称为“Articulated SurgicalInstrument For Performing Minimally Invasive Surgery With Enhanced Dexterityand Sensitivity”的美国专利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 Flexible Drive”美国专利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“AutomatedEndoscope System for Optimal Positioning”的美国专利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 DLUS for PerformingSurgical Tasks”的美国专利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 Ultrasound Cauterizing and CuttingInstrument”的美国专利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 a Minimally Invasive SurgicalApparatus”的美国专利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 System for Robotic Surgical Tools”的美国专利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 Minimally Invasive Telesurgery”的美国专利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 EffectorComponent Reloading System for Use with a Robotic System”的美国公布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 Surgical Instrument with Force-Feedback Capabilities”的美国公布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 Interface for Robotically-Controlled Surgical Tool”的美国公布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 Instruments with Cam-Driven Staple DeploymentArrangements”的美国公布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-Controlled Motorized Surgical End Effector Systemwith Rotary Actuated Closure Systems Having Variable Actuation Speeds”的美国公布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 Surgical Instrument with Selectively ArticulatableEnd Effector”的美国公布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“DriveInterface for Operably Coupling a Manipulatable Surgical Tool to a Robot”的美国公布2012/0211546；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 EndEffector System with Rotary Actuated Closure Systems”的美国公布2012/0205421，其公开内容以引用方式并入本文。
上文所述装置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，可拆卸装置的一些型式，并且可选择性地以任何组合型式来替换或移除所述装置的任意数量的特定零件或部分。在清洁和/或替换特定部分时，该装置的一些型式可在修复设施处重新组装或者在即将进行规程前由用户重新组装以供随后使用。本领域的技术人员将理解，装置的修复可利用多种技术进行拆卸、清洁/替换、以及重新组装。此类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，本文描述的型式可在规程之前和/或之后进行消毒。在一种消毒技术中，将该装置放置在闭合且密封的容器中，诸如塑料袋或TYVEK袋。然后可将容器和装置放置在可穿透所述容器的辐射场中，诸如γ辐射、X射线或高能量电子。辐射可杀死装置上和容器中的细菌。经消毒的装置随后可储存在无菌容器中，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，所述技术包括但不限于β辐射或γ辐射、环氧乙烷或蒸汽。
已经示出和阐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造。已经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而言将显而易见。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 (20)
1.一种设备，包括：
(a)主体；
(b)轴组件，所述轴组件从所述主体朝远侧延伸，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，所述端部执行器定位在所述轴组件的所述远侧端部处，其中所述端部执行器包括下钳口、能够枢转的砧座和平移切割器，其中所述平移切割器能够操作以相对于所述下钳口和所述砧座平移；
(d)仓，其中所述仓能够插入到所述下钳口中，其中所述仓包括多个钉；和
(e)钉驱动器致动器，所述钉驱动器致动器设置在所述仓内，其中所述钉驱动器致动器包括辅助切割元件，其中所述端部执行器的所述平移切割器能够操作以切割组织并朝远侧驱动所述钉驱动器致动器，以将钉驱动到所述组织中。
2.根据权利要求1所述的设备，其中所述辅助切割元件包括相对于所述仓以倾斜角度取向的直切割边缘。
3.根据权利要求1所述的设备，其中所述辅助切割元件包括弯曲切割边缘。
4.根据权利要求1所述的设备，其中所述辅助切割元件包括被构造成能够切割软组织的切割边缘。
5.根据权利要求1所述的设备，其中所述辅助切割元件包括被构造成能够切割致密组织的切割边缘。
6.根据权利要求1所述的设备，其中所述辅助切割元件被构造成能够选择性地在回缩位置和伸出位置之间运动，其中当所述辅助切割元件处于所述回缩位置时，所述辅助切割元件设置在所述仓内，其中当所述辅助切割元件处于所述伸出位置时，所述辅助切割元件的至少一部分延伸穿过所述仓中的纵向延伸通道。
7.根据权利要求6所述的设备，其中所述辅助切割元件被朝向所述回缩位置弹性地偏压。
8.根据权利要求7所述的设备，其中所述辅助切割元件能够操作以在所述回缩位置和所述伸出位置之间旋转。
9.根据权利要求7所述的设备，其中所述辅助切割元件能够操作以相对于所述仓以倾斜角度平移，以在所述回缩位置和所述伸出位置之间转换。
10.根据权利要求9所述的设备，其中所述辅助切割元件包括平移滑动件，其中所述钉驱动器致动器进一步包括平移狭槽，其中所述平移滑动件和所述平移狭槽被构造成能够配合，以使所述辅助切割元件在所述回缩位置和所述伸出位置之间转换。
11.根据权利要求10所述的设备，其中所述钉驱动器致动器进一步包括弹性构件，其中所述辅助切割元件进一步包括朝远侧延伸的构件，其中所述朝远侧延伸的构件被构造成能够接合所述钉驱动器致动器的所述弹性构件，以将所述辅助切割元件朝向所述回缩位置弹性地偏压。
12.根据权利要求1所述的设备，其中所述辅助切割元件相对于所述钉驱动器致动器固定。
13.根据权利要求12所述的设备，其中所述仓包括从所述仓突伸的防护件，其中所述防护件朝近侧定位在所述仓上，其中所述辅助切割元件能够操作以选择性地运动进入和运动离开所述防护件。
14.根据权利要求12所述的设备，其中所述辅助切割元件包括远侧突出部和朝远侧取向的切割边缘，其中所述远侧突出部在所述切割边缘之上取向。
15.根据权利要求1所述的设备，还包括支撑物，其中所述支撑物的至少一部分与所述仓相邻取向，其中所述辅助切割元件被构造成能够切穿所述支撑物的至少一部分。
16.一种设备，包括：
(a)主体；
(b)轴，所述轴容纳击发杆，其中所述轴从所述主体朝远侧延伸；
(c)端部执行器，包括：
(i)砧座，
(ii)下钳口，和
(iii)缝合和切断组件，所述缝合和切断组件响应于由所述主体和所述轴产生的纵向闭合运动，其中所述缝合和切断组件包括具有锐利边缘的切断特征结构；和
(d)能够移除的仓，其中所述下钳口被构造成能够接收所述仓，所述仓包括：
(i)壳体，
(ii)多个钉，所述多个钉设置在所述壳体中，
(iii)平台，所述平台设置在所述多个钉上，所述平台限定孔，其中每个孔基本上设置在相应钉上，
(iv)支撑物，所述支撑物至少部分地设置在所述平台上，和
(v)辅助切断特征结构，其中所述辅助切断特征结构具有被构造成能够切断所述支撑物的至少一部分的锐利边缘。
17.根据权利要求16所述的设备，其中所述辅助切断特征结构能够操作以在回缩位置和伸出位置之间转换。
18.根据权利要求17所述的设备，其中所述辅助切断特征结构响应于与所述缝合和切断组件的接触以在所述回缩位置和所述伸出位置之间转换。
19.根据权利要求16所述的设备，其中所述辅助切断特征结构进一步被构造成能够切割至少一些组织。
20.一种套件，包括：
(a)器械，包括：
(i)主体，
(ii)轴组件，所述轴组件从所述主体朝远侧延伸，其中所述轴组件包括远侧端部，其中所述轴组件包括具有刀片的切割构件，
(iii)端部执行器，所述端部执行器在所述轴组件的所述远侧端部的远侧，其中所述端部执行器能够操作以缝合和切割组织；和
(b)多个钉仓，其中所述多个钉仓中的每个钉仓被构造成能够可互换地插入到所述端部执行器中，其中所述多个钉仓中的每个钉仓被构造成用于不同的外科规程，其中所述多个钉仓中的至少一个钉仓包括被构造成能够辅助切割组织的辅助切割刀片。
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| CN201580062471.8A Expired - Fee Related CN107106171B (zh) | 2014-09-18 | 2015-09-08 | 具有多个切割元件的外科缝合器 |
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| Country | Link |
|---|---|
| US (6) | US10105142B2 (zh) |
| EP (1) | EP2997906B1 (zh) |
| JP (1) | JP6625619B2 (zh) |
| CN (1) | CN107106171B (zh) |
| BR (1) | BR112017005356B1 (zh) |
| PL (1) | PL2997906T3 (zh) |
| WO (1) | WO2016043999A1 (zh) |
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| CN108514439A (zh) * | 2018-03-29 | 2018-09-11 | 盈甲医疗器械制造（上海）有限公司 | 一种具有辅助组织定位装置的吻合器 |
| CN113727662A (zh) * | 2019-04-26 | 2021-11-30 | 西拉格国际有限公司 | 用于直角外科缝合器的组织切割垫圈 |
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2014
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2015
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- 2015-09-08 WO PCT/US2015/048852 patent/WO2016043999A1/en active Application Filing
- 2015-09-08 BR BR112017005356-0A patent/BR112017005356B1/pt not_active IP Right Cessation
- 2015-09-08 JP JP2017515079A patent/JP6625619B2/ja not_active Expired - Fee Related
- 2015-09-18 PL PL15185898T patent/PL2997906T3/pl unknown
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2018
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| EP2997906B1 (en) | 2017-12-20 |
| US20200015821A1 (en) | 2020-01-16 |
| US11123069B2 (en) | 2021-09-21 |
| US11284898B2 (en) | 2022-03-29 |
| US10105142B2 (en) | 2018-10-23 |
| PL2997906T3 (pl) | 2018-05-30 |
| JP6625619B2 (ja) | 2019-12-25 |
| JP2017529159A (ja) | 2017-10-05 |
| US11045198B2 (en) | 2021-06-29 |
| US20200008808A1 (en) | 2020-01-09 |
| US20190083095A1 (en) | 2019-03-21 |
| US11109864B2 (en) | 2021-09-07 |
| US20160081690A1 (en) | 2016-03-24 |
| BR112017005356A2 (pt) | 2017-12-12 |
| EP2997906A1 (en) | 2016-03-23 |
| CN107106171B (zh) | 2019-12-13 |
| WO2016043999A1 (en) | 2016-03-24 |
| BR112017005356B1 (pt) | 2022-01-18 |
| US20220233194A1 (en) | 2022-07-28 |
| US20190365384A1 (en) | 2019-12-05 |
| US12076017B2 (en) | 2024-09-03 |
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