CN107205775A - 具有旋转和关节运动机构的电外科器械 - Google Patents
具有旋转和关节运动机构的电外科器械 Download PDFInfo
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Abstract
本发明公开了一种电外科器械,该电外科器械包括端部执行器,该端部执行器包括两个可运动钳口,以将组织抓持在它们之间。钳口连接到电外科能量源,以将能量递送穿过钳口之间的组织,以执行密封。钳口包括刀通道以使刀沿着该刀通道往复运动,以切断保持在钳口之间的组织。两级关节运动接头联接到端部执行器并且联接到被构造成能够使端部执行器关节运动的关节运动带。两级关节运动接头包括外切割金属管,该外切割金属管包括多个节段和定位在外切割金属管内的实心但柔性的内芯。电外科器械还可包括可旋转闭合环和操作性地联接到可旋转闭合环的闭合连杆、联接到关节运动节段的可旋转联接接头和/或联接到刀的中空柔性管以及纵向延伸穿过其的作用杆。
Description
背景技术
本公开大体涉及具有用于夹持和治疗组织的各种机构的电外科装置。具体地,本公开涉及一种具有钳口打开和闭合机构的电外科装置。更具体地,本公开涉及一种具有钳口打开和闭合机构以及关节运动轴的电外科装置。
尽管已研制和使用了若干装置,但据信在本发明人之前还无人研制出或使用所附权利要求中描述的装置。
发明内容
在一个实施方案中,公开了一种电外科器械,所述电外科器械包括端部执行器,所述端部执行器包括第一钳口构件和第二钳口构件,所述第一钳口构件和所述第二钳口构件能够相对于彼此从第一打开位置运运动到第二闭合位置,以将组织抓紧在所述第一钳口构件和所述第二钳口构件之间,其中所述钳口机构中的至少一个钳口构件能够连接到电外科能量源,使得电外科能量可选择性地传递穿过保持在所述钳口构件之间的组织,以执行组织密封;所述第一钳口构件或所述第二钳口构件中的至少一个钳口构件包括限定于其中的刀通道,所述刀通道被构造成能够使刀沿着该刀通道往复运动,以切断保持在所述第一钳口构件和所述第二钳口构件之间的组织;和联接到所述端部执行器的两级关节运动接头,所述两级关节运动接头操作性地联接到被构造成使所述端部执行器关节运动的第一关节运动带和第二关节运动带,所述两级关节运动接头包括外切割金属管,所述外切割金属管包括多个关节运动节段,所述多个关节运动节段具有闭合和打开所述第一钳口构件和所述第二钳口构件的铰链和锁定特征结构;以及定位在所述外切割金属管内的实心但柔性的内芯。
所述电外科器械还可包括两级可旋转联接接头。
所述电外科器械的所述关节运动带可通过所述两级可旋转联接接头操作性地联接到所述第一钳口构件或所述第二钳口构件中的至少一个钳口构件。
所述电外科器械的所述两级可旋转联接接头可包括可旋转闭合环和联接到所述可旋转闭合环的闭合连杆,并且所述外管可附接到所述可旋转闭合环。
所述电外科器械的所述连杆可被构造成能够将所述第一钳口构件或所述第二钳口构件中的所述至少一个钳口构件相对于另一个钳口构件牵拉打开,并且所述可旋转闭合环被构造成能够将所述第一钳口构件或所述第二钳口构件中的所述至少一个钳口构件相对于另一个钳口构件推压闭合。
所述电外科器械的所述端部执行器可被构造成能够同时进行旋转和关节运动。
所述电外科器械的所述端部执行器可被构造成能够在所述端部执行器处于关节运动位置时旋转。
所述电外科器械还可包括刀,所述刀被构造成能够在所述刀通道内往复运动并且在所述端部执行器旋转时旋转。
所述电外科器械还可包括柔性中空缆线和刀管,其中所述柔性中空缆线联接在所述刀和所述刀管之间,使得所述刀能够被推压穿过所述关节运动节段,并且其中所述柔性中空缆线位于电导体上方。
所述电外科器械还可包括可旋转枢轴,其中所述关节运动带通过所述可旋转枢轴联接到所述第一钳口构件或所述第二钳口构件中的至少一个钳口构件。
在另一实施方案中,公开了一种电外科器械,所述电外科器械包括端部执行器,所述端部执行器包括第一钳口构件和第二钳口构件,所述第一钳口构件和所述第二钳口构件能够相对于彼此从第一打开位置运动到第二闭合位置,以将组织抓持在所述第一钳口构件和所述第二钳口构件之间,其中所述钳口构件中的至少一个能够连接到电外科能量源,使得电外科能量可选择性地传递穿过保持在所述钳口构件之间的组织,以执行组织密封;所述第一钳口构件或所述第二钳口构件中的至少一个钳口构件包括限定于其中的刀通道,所述刀通道被构造成能够使刀沿着该刀通道往复运动,以切断保持在所述第一钳口构件和所述第二钳口构件之间的组织;可旋转闭合环;以及操作性地联接到所述可旋转闭合环的闭合连杆,其中所述可旋转闭合环和所述连杆被构造成能够使所述端部执行器旋转。
所述电外科器械的所述可旋转闭合环可被构造成能够在所述第一钳口构件和所述第二钳口构件相对于所述外管以任何角度旋转时将闭合力传输至所述第一钳口构件和所述第二钳口构件。
所述电外科器械还可包括刀,所述刀被构造成能够在所述刀通道内往复运动,并且在所述端部执行器旋转时旋转。
所述电外科器械的所述刀可连接到位于所述外管内的刀管。
所述电外科器械还可包括外管,所述外管包括联接到所述端部执行器的关节运动节段,所述关节运动节段操作性地联接到被构造成能够使所述端部执行器关节运动的第一关节运动带和第二关节运动带。
在另一实施方案中,公开了一种电外科器械,所述电外科器械包括端部执行器,所述端部执行器包括第一钳口构件和第二钳口构件,所述第一钳口构件和所述第二钳口构件能够相对于彼此从第一打开位置运动到第二闭合位置,以将组织抓持在所述第一钳口构件和所述第二钳口构件之间;所述第一钳口构件或所述第二钳口构件中的至少一个钳口构件包括限定于其中的刀通道,所述刀通道被构造成能够使刀沿着该刀通道往复运动,以切断保持在所述第一钳口构件和所述第二钳口构件之间的组织;至少一个关节运动带;联接到所述端部执行器的关节运动节段,所述关节运动节段操作性地联接到被构造成能够使所述端部执行器关节运动的所述至少一个关节运动带;以及联接到所述关节运动节段的可旋转联接接头。
所述电外科器械还可包括至少第二关节运动带,其中所述第一关节运动带和所述第二关节运动带联接到所述可旋转联接接头。
所述电外科器械还可包括闭合管和可操作地联接到所述端部执行器的柄部组件,其中所述第一钳口构件能够相对于所述第二钳口构件运动,并且其中所述第一钳口构件联接到所述闭合管并且所述第二钳口构件联接到所述柄部组件。
所述电外科器械的所述至少一个关节运动带可通过所述可旋转联接接头联接到所述第二钳口构件。
在另一实施方案中,公开了一种电外科器械,所述电外科器械包括端部执行器,所述端部执行器包括第一钳口构件和第二钳口构件,所述第一钳口构件和所述第二钳口构件能够相对于彼此从第一打开位置运动到第二闭合位置,以将组织抓持在所述第一钳口构件和所述第二钳口构件之间;刀;所述第一钳口构件和所述第二钳口构件中的至少一个钳口构件包括限定于其中的刀通道,所述刀通道被构造成能够使刀沿着该刀通道往复运动,以切断保持在所述钳口构件之间的组织;联接到所述端部执行器的外管;联接到所述端部执行器的可旋转联接接头;联接到所述刀的中空柔性管,所述中空柔性管在其中限定空间;以及作用杆,所述作用杆在由所述中空柔性管限定的所述中空空间内纵向延伸。
所述电外科器械的所述中空柔性管能够经由所述刀可旋转地联接到所述端部执行器并且被构造成能够使所述端部执行器旋转。
所述电外科器械的所述作用杆可被构造成能够电联接到能量源的一个电极。
所述电外科器械还可包括电联接到所述第一钳口构件或所述第二钳口构件中的至少一个钳口构件的至少一个钳口电极,其中所述至少一个钳口电极能够连接到电外科能量源,使得电外科能量可选择性地传递穿过保持在所述第一钳口构件和所述第二钳口构件之间的组织,以执行组织密封,其中所述至少一个钳口电极限定至少一个开孔。
所述电外科器械还可包括位于所述第一钳口构件或所述第二钳口构件中的至少一个钳口构件上的至少一个阻挡构件,其中所述阻挡构件被构造成能够突出穿过所述至少一个钳口电极的所述至少一个开孔、并且控制所述第一钳口构件和所述第二钳口构件之间的间隙距离。
上述发明内容仅为说明性的,而非旨在以任何方式加以限制。除了上述说明性方面、实施方案和特征结构以外,通过参照附图和下述详细说明,其他方面、实施方案和特征结构将显而易见。
附图说明
本申请所述实施方案的新颖特征在所附权利要求书中进行了详细描述。然而,结合如下附图,参照下述说明,可更好地理解关于组织形式和操作方法两者的实施方案。
图1示出了根据一个实施方案的包括关节运动轴机构的外科器械。
图2是根据一个实施方案的图1所示外科器械的柄部组件的透视图,其中左柄部壳体护罩和轴组件中的几个护套被移除。
图3是根据一个实施方案的类似于图1和图2所示外科器械的外科器械的柄部组件的侧正视图,其中左柄部壳体护罩被移除,并且没有闭锁禁用机构。
图4是根据一个实施方案的图1到图3所示外科器械的轴组件和端部执行器部分的分解图。
图5是根据一个实施方案的图1到图3所示外科器械的外管的远侧端部和端部执行器的透视图。
图6是根据一个实施方案的图1到图3所示外科器械的轴组件和端部执行器的透视图,其示出了轴组件的平移和旋转方面。
图7是根据一个实施方案的图1到图3所示外科器械的轴组件和端部执行器的关节运动节段的剖面图。
图8是根据一个实施方案的外管的剖面图。
图9是根据一个实施方案的外管和第二钳口构件的剖面图。
图10是根据一个实施方案的图1到图3所示外科器械的端部执行器部分的透视图,其中安装有作用杆。
图11是根据一个实施方案的图10所示外科器械的端部执行器部分的透视图,其中安装有适配器和中空柔性刀缆线。
图12是根据一个实施方案的图11所示外科器械的端部执行器部分的透视图,其中锚定件安装在第二钳口构件的颈部上方。
图13是根据一个实施方案的图12所示外科器械的端部执行器部分的透视图,其中安装有柔性颈部、刀管、关节运动带和间隔管。
图14是根据一个实施方案的电极相对于连杆的细部图。
图15是根据一个实施方案的图1到图3所示外科器械的轴组件和端部执行器的剖面图。
图16是示出根据一个实施方案的图1到图3所示外科器械的端部执行器和轴组件的组装的局部分解图。
图17是根据一个实施方案的图1到图3所示外科器械的端部执行器和轴组件的最终组装。
图18是根据一个实施方案的处于关节运动位置的图1到图3所示外科器械的端部执行器和轴组件以及处于打开位置的钳口的视图。
图19是根据一个实施方案的处于关节运动位置的图1到图3所示外科器械的端部执行器和轴组件以及处于打开位置的钳口的视图。
图20是根据一个实施方案的图1到图3所示外科器械的端部执行器和轴组件的侧视图,其中钳口闭合限定示例性尺寸。
图21示出了根据一个实施方案的端部执行器,其中第一钳口元件处于打开位置。
图22示出了根据一个实施方案的端部执行器,其中第一钳口元件处于闭合位置。
图23示出了根据一个实施方案的端部执行器,其中第一钳口元件转变到打开位置。
图24是根据一个实施方案的处于关节运动位置的轴组件和端部执行器的透视图,其中钳口构件处于打开位置。
图25是根据一个实施方案的处于未关节运动(比直)位置的图24所示轴组件和端部执行器的透视图,其中钳口构件处于闭合位置。
图26是根据一个实施方案的轴组件和端部执行器的剖面图。
图27是根据一个实施方案的轴组件和端部执行器的剖面图。
图28是根据一个实施方案的轴组件的纵向剖面图。
图29是根据一个实施方案的图1到图3所示外科器械的一个实施方案的轴组件和端部执行器部分的透视图。
图30是根据一个实施方案的图1到图3所示外科器械的一个实施方案的轴组件和端部执行器部分的透视图。
图31是根据一个实施方案的图1到图3所示外科器械的一个实施方案的轴组件和端部执行器部分的透视图。
图32示出了根据一个实施方案的处于关节运动位置的图1到图3所示外科器械的一个实施方案的轴组件。
图33是根据一个实施方案的图1到图3所示外科器械的端部执行器和轴组件的侧视图,其中钳口闭合限定示例性尺寸。
具体实施方式
在下述详细说明中,参考形成其一部分的附图。在附图中,类似的符号和参考字符通常在全部几个视图中标识相似的部件,除非上下文另有说明。详细说明、附图和权利要求书中所述的说明性实施方案并非旨在加以限制。在不脱离本文呈现的主题的范围的前提下,可以利用其他实施方案,并且可以进行其他改变。
对本技术的某些示例的下述说明不应用于限制其范围。根据下述说明,本技术的其他示例、特征结构、方面、实施方案和优点对本领域的技术人员而言将显而易见,下述说明以例示的方式进行,这是为实现本技术所设想的最好的方式之一。正如将意识到的,本文所述技术能够包括其他不同的和明显的方面,这些均不脱离本发明技术。因此,附图和具体实施方式应被视为实质上是说明性的而非限制性的。
还应当理解,本文所述的教导内容、表达方式、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、表达方式、实施方案、示例等中的任何一者或多者进行组合。因此,下述教导内容、表达方式、实施方案、实施方案等不应视为彼此孤立。参考本文的教导内容,可组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被包括在权利要求书的范围内。
在详细解释具有关节运动轴机构的外科装置的各种实施方案之前,应当指出的是,本文所公开的各种实施方案在其应用或用途方面不限于附图和说明中所示的部件的构造和布置的细节。而是,所公开的实施方案可定位或结合于其他实施方案、其变型和修改中,并且可以各种方式实践或实施。因此,本文所公开的外科装置的实施方案实际上为说明性的,而非旨在限制其范围或应用。此外,除非另有说明,否则本文所采用的术语和表达方式被选取用于为方便读者描述实施方案的目的,而不应限制其范围。此外,应当理解,所公开的实施方案,实施方案的表达方式和/或其示例中的任何一个或多个可不受限制地与其他所公开的实施方案、实施方案的表达方式和/或其示例中的任何一个或多个进行组合。
此外,在下述说明中,应当理解,例如前、后、内、外、顶部、底部等术语为方便的词,而不应被解释为限制性术语。本文所用的术语并非意在限制在本文所述装置或其部分的范围内,而是可以按照其他取向附接或利用。将结合附图更详细地描述多种实施方案。
现在参见附图,其中图1示出了包括触发组件107、轴组件212和关节运动接头204以及端部执行器210的外科器械100。关节运动控制旋钮102通过可操作地联接到关节运动旋钮102的关节运动缆线或带来控制关节运动接头204的关节运动。旋钮120可操作地联接到轴组件212并且使得轴组件212能够旋转多至并包括360度。触发组件107被构造成能够夹持并且独立地击发联接到外科器械100的轴组件212的端部执行器210。在图1所示实施方案中,端部执行器210的第一钳口构件216a完全打开并且关节运动控制旋钮108处于中立、中心位置。
外科器械100包括柄部组件104。轴组件212包括近侧端部和远侧端部。轴组件212的近侧端部联接到柄部组件104的远侧端部。关节运动控制旋钮108和旋转控制旋钮120操作性地联接到柄部组件104的远侧端部并且被构造成能够接收并联接到轴组件212的近侧端部。端部执行器210联接到轴组件212的远侧端部。柄部组件104包括手枪式握把118。柄部组件104包括左柄部壳体护罩106a和右柄部壳体护罩106b。触发组件107包括能够朝向手枪式握把118致动的触发器109。可旋转轴旋钮120被构造成能够使轴组件212相对于柄部组件104旋转。柄部组件104还包括被构造成能够向端部执行器210中的一个或多个电极提供电外科能量的能量按钮122。
轴组件212包括闭合/钳口致动器、击发/切割构件致动器和外部护套。在一些实施方案中,外部护套包括闭合致动器。外部护套在远侧端部上包括被构造成能够与端部执行器210交接的一个或多个接触电极。一个或多个接触电极操作性地联接到能量按钮122和能量源(未示出)。
能量源可适用于治疗组织处理、组织烧灼/密封、以及亚治疗处理和测量能量源。能量按钮122控制能量至电极的递送。如在本公开通篇中所使用,按钮是指用于控制机器或过程的一些方面的开关机构。按钮可由诸如通常为塑料或金属等硬质材料制成。表面可被形成或成形为适应人的手指或手,以便容易被压下或按下。按钮可以是最常见的偏压开关,即使许多非偏压按钮(由于其物理性质)需要弹簧才能返回到其未按下状态。按钮的“按下”的术语可包括按压、压下、挤压和冲压。
在一些实施方案中,端部执行器210联接到轴组件212的远侧端部。端部执行器210包括第一钳口构件216a和第二钳口构件216b。第一钳口构件216a枢转地联接到第二钳口构件216b。第一钳口构件216a能够相对于第二钳口构件216b枢转地运动,以将组织抓持在它们之间。第一钳口构件216a可被称为上钳口或上钳口构件。在一些实施方案中,第二钳口构件216b是固定的。第二钳口构件216b可被称为下钳口或下钳口构件。在其他实施方案中,第一钳口构件216a和第二钳口构件216b能够枢转地运动。在一个示例中,钳口构件216a,216b中的至少一个相对于轴组件212固定。在另一示例中,这两个钳口构件216a,216b能够相对于轴组件212运动。在所示出的示例中,第一钳口构件216a能够相对于轴组件212运动并且第二钳口构件216b相对于轴组件212固定。钳口构件216a,216b能够相对于彼此从第一打开位置运动到第二闭合位置,以将组织抓持在它们之间。
钳口构件216a,216b中的至少一个能够连接到电外科能量源,使得电外科能量可选择性地传递穿过保持在钳口构件216a,216b之间的组织,以执行组织密封。端部执行器210的钳口构件216a,216b中的至少一个包括至少一个电极254,该至少一个电极能够连接到电外科能量源并且被构造成能够将能量递送至保持在钳口构件216a,216b之间的组织,以执行组织密封。电外科能量源可包括例如射频(RF)能量源、亚治疗RF能量源、超声能量源和/或其他合适的能量源。在使用多个能量源的情况下,能量可独立地或组合地递送。在一些实施方案中,切割构件(未示出)能够接收在由第一钳口构件216a和/或第二钳口构件216b限定的纵向狭槽内。切割构件被构造成能够切割抓持在第一钳口构件216a和第二钳口构件216b之间的组织。在一些实施方案中,切割构件包括用于递送能量(例如(举例来说)可独立地或组合地递送的RF、超声能量或它们的组合)的电极。
在某些实例中,如上所述,外科器械100可包括自动能量闭锁机构。能量闭锁机构可与外科器械100的闭合机构相关联。在某些实例中,能量闭锁机构可被构造成能够如果钳口构件216a,216b处于打开构型,则当能量递送按钮122被致动时,允许至端部执行器210的能量递送。在某些实例中,能量闭锁机构可被构造成能够如果钳口构件216a,216b处于闭合构型,则当能量递送按钮122被致动时,拒绝至端部执行器210的能量递送。在某些实例中,当钳口构件216a,216b例如从闭合构型转变到打开构型时,能量闭锁机构自动地从允许能量递送转变到拒绝能量递送。在某些实例中,当钳口构件216a,216b例如从打开构型转变到闭合构型时,能量闭锁机构自动地从拒绝能量递送转变到允许能量递送。
图2是根据一个实施方案的图1所示外科器械100的柄部组件104的透视图,其中右壳体护罩106a被移除以示出内部机构中的一些。触发组件107包括用于闭合钳口构件216a,216b并且击发切割构件或刀带的必要部件。触发组件107包括操作性地联接到触发器109的触发板124和击发板128。朝向手枪式握把118沿方向C挤压触发器109使触发板124旋转,触发板124操作铰接夹145以朝远侧推进轭132和闭合致动器123,以闭合端部执行器210的钳口构件216a,216b。触发板124的初始旋转也使击发板128略微旋转。击发板128包括扇形齿轮,该扇形齿轮具有接合并旋转第一小齿轮传动装置133的多个齿131,第一小齿轮传动装置133接合第二小齿轮传动装置134,以推进齿条136(在此视图中都未示出)。
单个触发器109在第一大约13度的行程中闭合钳口。触发板124被构造成能够在触发器109从初始位置旋转到第一旋转的旋转(此为例如大约13度的行程)期间与触发板124交接。触发板124可操作地联接到击发板128。在某些实例中,击发板128可包括第一狭槽128a和第二狭槽128b。第一狭槽128a接收固定地联接到触发板124的驱动销148。销148在第一狭槽128a内可滑动地运动。当销148可滑动地接收在第一狭槽128a内时,触发板124的旋转驱动击发板128的旋转。扇形齿轮的齿131接合并旋转第一小齿轮133,第一小齿轮133继而驱动第二小齿轮134,第二小齿轮134朝远侧驱动齿条136,以击发刀或刀片,但只有在刀闭锁件被解锁、释放或禁用时。
单个触发器109在最后大约29度的行程中击发刀。触发板124超过预先确定的旋转(例如(举例来说)第一旋转)的旋转致使击发板128旋转。击发板128的旋转使切割构件在端部执行器210内展开。例如,在所示出的实施方案中,击发板128包括通过第一小齿轮和第二小齿轮133,134可操作地联接到齿条136的扇形齿轮。击发板128包括被构造成能够与第一小齿轮133交接的多个齿131。击发板128的旋转使第一小齿轮和第二小齿轮133,134旋转,以朝远侧驱动齿条136。齿条136的朝远侧运动朝远侧驱动切割构件致动器,从而致使切割构件(例如,刀)在端部执行器210内展开。
轴组件212包括闭合/钳口致动器和击发/切割构件致动器。闭合/钳口致动器包括操作性地联接到闭合致动器212的轭132和铰接夹145组件,闭合致动器212作用在联接到弹簧与杆交接元件127和闭合杆116的闭合弹簧114上。在一个实例中,闭合杆经由至少一个连杆操作性地联接到钳口构件216a,216b。击发/切割构件致动器包括操作性地联接到击发杆的齿条136,击发杆可滑动地接收在闭合致动器212和闭合弹簧内。击发杆联接到刀推动器块和柔性刀带,柔性刀带包括紧固在一起的多个柔性带和位于远侧端部处的刀。沿远侧方向推进齿条136将刀带朝远侧推进穿过在钳口构件216a,216b中形成的通道或狭槽。
图3是根据一个实施方案的外科器械101的柄部组件104的侧正视图,其中左柄部壳体护罩106a被移除以暴露位于柄部组件104内的各种机构。在其他方面,外科器械101以类似于结合图1和图2所述的外科器械的方式操作。
图4到图23示出了包括关节运动轴机构的电外科器械的各种实施方案。在一个实施方案中,电外科器械包括可旋转轴,该可旋转轴具有关节运动机构和端部执行器钳口推压机构。在一个实施方案中,电外科器械包括关节运动双极射频(RF)装置,所述装置具有钳口、关节运动带以及内部柔性引导件与外部激光切割外管的组合,以形成关节运动接头。在一个实施方案中,电外科器械包括端部执行器,该端部执行器被构造成能够在刀旋转时旋转。在一个实施方案中,电外科器械包括闭合环和连杆。连杆将钳口牵拉打开并且闭合环将钳口推压关闭。在一个实施方案中,电外科器械包括柔性中空缆线以结合刀和管,使得刀可被旋转和推压穿过接头,并且使得缆线可骑在设置在端部执行器的钳口中的RF电极中的一者上。在一个实施方案中,电外科器械包括通过可旋转枢轴附接到钳口中的一者的关节运动带。在一个实施方案中,外管通过可旋转枢轴附接到闭合环。在各种实施方案中,本公开提供不受限制地包括这些特征结构中的一些或全部的组合的电外科器械。
结合图4到图23所述的电外科器械的实施方案,关节运动机构可提供多至55度的关节运动。可如下文所详述通过添加或去除接头来提供更大或更小度数的关节运动。可提供更多或更少接头以减小或增大关节运动节段的关节运动弧。旋转机构使得钳口能够在关节运动节段的远侧旋转多至并包括360度。提供闭合管以将钳口推压关闭,以最大化闭合机械优点并且使用连杆来打开钳口,以最大化打开机械优点。采用外管来闭合钳口节省内部空间并且使得闭合机构能够沿着轴的中心设置,以减少当轴处于关节运动位置时打开和闭合行程的变化。用于为端部执行器电极供能的作用杆以及刀(例如,刀片)缆线也沿着轴的长度居中设置,使得它们一起旋转,并且不需要复杂的线路径。电外科器械的组装可比常规关节运动器械容易。电外科器械的实施方案包括达到钳口长度的接头,即,其中钳口大于常规电外科器械。电外科器械的实施方案提供改进的解剖和抓持,并且使得钳口能够在切割组织之前密封组织。
图4是根据一个实施方案的图1到图3所示外科器械100,101的轴组件212和端部执行器210部分的分解图。在所示出的实施方案中,轴组件212包括可被称为闭合管或钳口管的外管202。外管202包括关节运动节段206和突片207a,207b,以在对应凹槽209a,209b处将外管202联接到柔性颈部220。外管202还包括远侧突片215,以将外管202联接到在可旋转闭合环232中形成的狭槽219。尽管外管202可使用任何合适的技术联接到柔性颈部220和可旋转闭合环232,但在所示出的实施方案中,这些元件通过下述方式来结合:将位于关节运动节段206附近的两个突片207a,207b压接到柔性颈部209a,209b上的对应凹槽209a,209b,并且将远侧突片压接到可旋转闭合环232的开孔219。
第一关节运动带208a和第二关节运动带208b位于闭合管202内部并且用来在关节运动接头204处使外管202关节运动。关节运动接头204包括多个关节运动节段206。每个关节运动带208a,208b包括远侧端部218a,218b,远侧端部218a,218b被构造成能够联接到不可旋转闭合环230的侧面。不可旋转闭合环230包括一侧上的平坦部分231a和相对侧上的类似平坦部分231b(未示出)。关节运动带208a,208b的远侧端部218a,218b联接到不可旋转闭合环230的对应平坦部分231a,231b(未示出)。尽管可采用各种技术来将关节运动带208a,208b联接到不可旋转闭合环230,但在所示出的实施方案中,关节运动带208a,208b的远侧端部218a,218b连接到不可旋转闭合环230的任一侧上的平坦部分231a,231b(未示出)。
两级关节运动接头204包括外分段或切割(例如,激光切割或简单切割)金属管和实心但柔性的内芯220,所述金属管包括被切割成外管202的多个关节运动节段206,所述多个关节运动节段外管202具有闭合和打开钳口构件216a,216b的铰链和锁定特征结构,所述内芯位于所述外切割金属管内。两级关节运动接头204将刀224和关节运动带208a,208b引导穿过关节运动接头204。使外金属关节运动节段206闭合和打开钳口构件216a,216b腾出内部空间以用于例如钳口旋转等更多特征结构。内部实心但柔性的内芯220接头允许一致的关节运动半径R。内部实心但柔性的内芯220可由塑料或其他实心但柔性材料制成。
现在简要地参见外科器械100的端部执行器210部分,端部执行器210包括第一钳口构件216a和第二钳口构件216b。第一钳口构件216a枢转地联接到第二钳口构件216b。第一钳口构件216a能够通过外管202围绕枢轴销252在打开和闭合位置之间旋转地运动。连杆236通过连杆销234a,234b操作性地联接到第一钳口构件216a并且联接到外管202。钳口电极254位于第二钳口构件216b上并且用于将RF能量引导穿过夹持在第一钳口构件和第二钳口构件216a,216b之间的组织。钳口电极254电联接到电导体238,电导体238电联接到作用杆213。作用杆213电联接到能量源。第二钳口构件216b包括颈部240,颈部240在其近侧端部处包括沟槽233。颈部240可滑动地接收可旋转闭合环232。尽管在所示出的实施方案中,沟槽233是周向的,但在其他实施方案中,沟槽233不需要围绕颈部240的直径延伸。可旋转闭合环232可滑动地定位在第二钳口构件216b的颈部240上方,使得可旋转闭合环232的近侧端部朝远侧定位超过周向沟槽233。不可旋转闭合环230的远侧端部可滑动地定位在周向环233上方,使得在不可旋转闭合环230上形成的狭槽229a,229b(未示出)与周向沟槽233对齐。一旦就位,则插件228a,228b定位穿过狭槽229a,229b(未示出),使得它们接合沟槽233。因此,不可旋转闭合环230固定地联接到第二钳口构件216b的颈部240。尽管可采用各种技术来将不可旋转闭合环230结合到第二钳口构件216a,但在所示出的实施方案中,插件228a,228b连接就位。
在一个实施方案中,端部执行器210包括两级可旋转联接接头,该两级可旋转联接接头包括可旋转闭合环232和闭合连杆236组合。不可旋转闭合环230附接到可旋转闭合环232和闭合连杆236组合。可旋转闭合环232附接到端部执行器210的颈部240。可旋转闭合环232与连杆236的组合可随端部执行器210钳口构件216a,216b一起旋转。推动可旋转闭合环232通过凸轮作用(齿轮管闭合)闭合第一钳口构件216a并且拉动连杆236打开第一钳口构件216a。当钳口构件216a,216b相对于轴202以任何角度旋转时,两级可旋转闭合环232允许钳口构件216a,216b闭合力传输到钳口构件216a,216b。分离打开和闭合机构提供钳口构件216a,216b的精确闭合和打开。用凸轮管闭合机构闭合第一钳口构件216a提供良好的机械优点,而用连杆236打开第一钳口构件216a提供对钳口构件216a,216b的精确控制(例如,用于解剖)。可旋转闭合环232能够相对于不可旋转闭合环230旋转并且形成可旋转联接接头。尽管可旋转闭合环232和不可旋转闭合环230的纵向运动同步,但闭合环232独立于不可旋转闭合环230旋转。
关节运动带208a,208b附接到包括可旋转闭合环232和闭合连杆236的可旋转联接接头。可旋转联接接头允许钳口构件216a,216b在设置关节运动角度之后旋转,并且不论钳口构件216a,216b旋转到什么角度仍使钳口构件216a闭合。可旋转联接机构通过关节运动接头204禁止所有关节运动、刀击发和钳口闭合部件的旋转,只有作用杆213和刀管214旋转。附接到关节运动带208a,208b的可旋转联接接头允许第二钳口构件216b接地至柄部组件104(图1到图3),使得外闭合管202可将第一钳口构件216a闭合到第二钳口构件206b上。换句话讲,关节运动带208a,208b通过旋转联接器附接到第二钳口构件261b。
第一钳口构件和第二钳口构件216a,216b包括狭槽以将刀224可滑动地接收穿过其。钳口构件216a,216b中的至少一个包括限定于其中的刀通道或狭槽,所述刀通道或狭槽被构造成能够使刀或切割构件沿着该刀通道往复运动,以切断保持在钳口构件216a,216b之间的组织。在所示出的示例中,第一钳口构件和第二钳口构件216a,216b包括狭槽256以使刀224在其中往复运动,以切断保持在钳口构件216a,216b之间的组织。钳口电极254还包括狭槽258以可滑动地接收刀224。提供至少一个阻挡构件259a,259b,259c以限定第一钳口构件和第二钳口构件216a,216b之间的预先确定的间隙,并且电隔离第一钳口构件和第二钳口构件216a,216b,以防止钳口构件216a,216b电短路。钳口电极258限定开孔257a,257b,257c以将阻挡构件259a,259b,259c接收穿过其。
刀224的近侧端部固定地联接到适配器222的远侧端部。适配器222的近侧端部固定地联接到中空柔性刀缆线211的远侧端部。中空柔性刀缆线211的近侧端部固定地联接到刀管214的远侧端部。中空柔性刀缆线211能够在柔性颈部220内可滑动地运动,柔性颈部220位于外管202的关节运动接头204内。作用杆213的远侧端部电联接到电导体238并且作用杆213的近侧端部电联接到能量源。作用杆213位于刀管214、中空柔性刀缆线211和适配器222内。作用杆213的远侧端部连接到电导体238。
中空柔性管222连接到刀224和穿过其中心的作用杆213。中空柔性管222可旋转以经由刀224使钳口构件216a,216b旋转。作用杆213沿着中空柔性管222的中心行进,以用于RF能量路径的电极中的一个。将作用杆213定位在轴202的中心使得作用杆213能够自由地朝任何方向旋转和弯曲。作用杆213和中空柔性管222部件被构造成能够朝任何方向旋转和关节运动,以使得钳口构件216a,261b能够旋转并且使得轴202能够关节运动。
间隔管217位于关节运动带208a,208b之间和刀管214上方。间隔管217的远侧端部226位于中空柔性刀缆线211上方。间隔管217引导中空柔性刀缆线211并且将刀管214与关节运动带208a,208b分隔开。
图5是根据一个实施方案的图1到图3所示外科器械100,101的外管202的远侧端部和端部执行器210的透视图。在所示出的实施方案中,包括第一钳口构件和第二钳口构件216a,216b的端部执行器210钳口可顺时针连续地旋转360度,如箭头所示,或者逆时针旋转越过关节运动接头204。尽管旋转示出为沿箭头A所示的顺时针方向,但端部执行器210钳口可顺时针或逆时针旋转。当关节运动接头204处于关节运动位置时,端部执行器210钳口可旋转360度。可通过添加另外的关节运动节段206来减小关节运动接头204的弧曲率半径R,并且可通过去除关节运动节段206来增大关节运动接头204的弧曲率半径R。
图6是根据一个实施方案的图1到图3所示外科器械100,101的轴组件212和端部执行器210的透视图,其示出了轴组件212的平移和旋转方面。如在所示出的实施方案中所示,通过推压外管202以将其沿方向B朝远侧推进来闭合端部执行器210的钳口构件216a,216b。通过推压第一关节运动带208a以将其沿方向C朝远侧推进来使关节运动接头204沿从右到左逆时针方向关节运动,并且牵拉第二关节运动带208b以使其沿方向D朝近侧缩回。可通过使施加到关节运动带208a,208b的力反向来使关节运动接头204沿顺时针或从左到右方向关节运动。例如,通过朝近侧牵拉第一关节运动带208a并且朝远侧推压第二关节运动带208b。刀可通过推压刀管214以使其沿方向E'朝远侧推进而在钳口构件216a,216b闭合时朝远侧推进。端部执行器210可通过使刀管214沿方向A'逆时针旋转而如结合图5所述沿方向A逆时针旋转。端部执行器210可通过使刀管214顺时针旋转而顺时针旋转。
图7是根据一个实施方案的图1到图3所示外科器械100,101的轴组件212和端部执行器210的关节运动接头204的剖面图。如图7所示,柔性颈部220位于外管202的关节运动接头204内。柔性颈部220为柔性的并且使得关节运动接头204能够关节运动。如前所述,关节运动接头204包括多个关节运动节段206以使得关节运动接头204能够关节运动。间隔管217的远侧端部刚好在柔性颈部220的近侧端部的近侧。中空柔性刀缆线211位于柔性颈部220内部。作用杆213位于中空柔性刀缆线211内。中空柔性刀缆线211的远侧端部固定地联接到适配器222的近侧端部,并且所述适配器的远侧端部固定地联接到刀224。作用杆213的远侧端部电联接到电导体238。不可旋转闭合环230位于第二钳口构件216b的颈部240上方并且通过插件228a,228b固定地附接到颈部240,插件228a,228b连接就位至颈部240中的周向沟槽233。如图所示,外管202的远侧端部邻接可旋转闭合环232的近侧端部上的唇缘。因此,当外管202被朝远侧推进时,其作用在可旋转闭合环232上,以闭合第一钳口构件216a。
连杆236经由第一连杆销234a和第二连杆销234b将第一钳口构件216a操作性地联接到可旋转闭合环232。第一连杆销234a被接收穿过连杆236中的近侧开口和可旋转闭合环232中的开口。第一连杆销234a将连杆236可旋转地联接到可旋转闭合环232。连杆236的远侧端部限定另一开口以接收第二连杆销234b。第二连杆销234b将第一钳口构件216a可旋转地联接到连杆236。第一钳口构件216a枢转地联接到枢轴销252。因此,当外管202朝远侧推动可旋转闭合环232时,第一钳口构件216a关闭。当通过连杆236朝近侧牵拉外管202时,第一钳口构件216a打开。
图8是根据一个实施方案的外管202的剖面图。所示出的视图示出了被压接到柔性颈部220上以将关节运动接头204固定地联接到柔性颈部220的外管202压接突片207b。第一关节运动带和第二关节运动带208a,208b位于柔性颈部220的任一侧上。中空柔性刀缆线217位于适配器222、刀224和电导体238上。
图9是根据一个实施方案的外管202和第二钳口构件216b的剖面图。如图所示,关节运动带208a,208b位于关节运动节段206和柔性颈部220之间。关节运动带208a,208b连接到不可旋转闭合环230的侧面。不可旋转闭合环230通过插件连接到周向沟槽233。还示出了联接到适配器222的中空柔性刀缆线211。作用杆213定位在中空柔性刀缆线211内并且电联接到电导体238。电导体238由电绝缘护套221覆盖。适配器222固定地联接到刀224,刀224可滑动地接收在不可旋转闭合环230和第二钳口构件216b的颈部240部分内。可旋转闭合环232滑套于第二钳口构件216b的颈部240上方,并且如图7所示通过连杆销234a固定到连杆236和第一钳口构件216a。
重新参照图9,第二钳口构件216b包括钳口电极254,钳口电极254经由电导体238电联接到作用杆213。钳口电极254包括狭槽258,并且钳口216a,216b包括狭槽256以使刀224沿着该刀通道往复运动,以切断保持在钳口构件216a,216b之间的组织。
至少一个阻挡构件259a,259b,259c可设置在第一钳口构件216a或第二钳口构件216b中的任一者或两者上,以控制相对钳口构件216a,216b之间的相对于彼此的间隙距离。在所示出的示例中,阻挡构件259a,259b,259c位于第二钳口构件216b上,并且突出穿过在钳口电极254中形成的对应开孔。在所示出的示例中,一个阻挡构件259a定位在狭槽258的远侧端部处,并且两个阻挡构件259b,259c侧向地设置在狭槽258的任一侧上。
阻挡构件259a,259b,259c由例如塑料、陶瓷、玻璃或任何合适的电绝缘材料等电绝缘材料形成。阻挡构件259a,259b,259c限制两个相对钳口构件216a,216b相对于彼此的运动。优选地,阻挡构件259a,259b,259c由绝缘材料制成并且尺寸使得其限制钳口构件216a,216b在间隙范围(例如,约0.001英寸至约0.006英寸)内的相对运动,并且对至少一个钳口构件216a,216b施加期望的力以密封组织。
图10到图13示出了根据一个实施方案的组装端部执行器210和内部轴组件212的顺序。图10是根据一个实施方案的图1到图3所示外科器械100,101的端部执行器210部分的透视图,其中安装有作用杆213。可旋转闭合环232插入于第二钳口构件216b的颈部240上方。第一连杆销234a通过连杆236连接到可旋转闭合环232。第二连杆销234b通过连杆236连接到第一钳口构件216a。枢轴销252通过第一钳口构件和第二钳口构件216a,216b连接。作用杆213随后连接到电导体238。
图11是根据一个实施方案的图10所示外科器械100,101的端部执行器210部分的透视图,其中安装有适配器222和中空柔性刀缆线211。刀224连接到适配器222,然后适配器222连接到中空柔性刀缆线211。
图12是根据一个实施方案的图11所示外科器械100,101的端部执行器210部分的透视图,其中不可旋转闭合环230安装在第二钳口构件216b的颈部240上。一旦不可旋转闭合环230滑套于颈部240上方,则插件228a,228b(未示出)定位穿过在不可旋转闭合环230上形成的狭槽229a,229b(未示出)并且连接就位。
图13是根据一个实施方案的图12所示外科器械100,101的端部执行器210部分的透视图,其中安装有柔性颈部220、刀管214、关节运动带208a,208b、以及间隔管217。柔性颈部220在中空柔性刀缆线211上方滑动。刀管214连接到中空柔性刀缆线211。间隔管217在刀管214和中空柔性刀缆线211上方滑动。关节运动带208a,208b位于间隔管217上方并且连接到不可旋转闭合环230的侧面。尽管未示出,但外管202(图4和图6)随后在间隔管217上方滑动,并且压接到柔性颈部220和不可旋转闭合环230。
图14是根据一个实施方案的电极254相对于连杆236的细部图。连杆236经由对应连杆销234a,234b将可旋转闭合环232(未示出)操作性地联接到第一钳口元件216a(未示出)(参见图7)。采用枢轴销252来将第一钳口元件216a枢转地联接到第二钳口元件216b(未示出)。钳口电极254电联接到电导体238,电导体238电联接到作用杆213(未示出)。电导体238位于刀224的侧面。
图15是根据一个实施方案的图1到图3所示外科器械的轴组件212和端部执行器210的剖面图。这一细部图示出了位于外管202内部的关节运动管208a中的一者。间隔管217位于关节运动带208a内部。刀管位于间隔管217内部,并且连接到中空柔性刀缆线211。中空柔性刀缆线211连接到适配器222。如前所述,中空柔性刀缆线211连接到适配器222并且连接到刀管217。间隔管217引导中空柔性刀缆线211并且将刀管217与关节运动带208a,208b(未示出)间隔开。中空柔性刀缆线211在柔性颈部220内可滑动地运动,以使得刀224(未示出)能够在关节运动接头204关节运动时推进。适配器22和刀224能够在由不可旋转闭合环230和第二钳口元件216b的颈部240限定的通道235内可滑动地运动。不可旋转闭合环230通过插件228a,228b连接到颈部240,插件228a,228b连接到颈部240上的周向沟槽233。第一钳口元件216a经由连杆236和连杆销234a,234b可操作地联接到可旋转闭合环232。第一钳口元件216a经由枢轴销252枢转地联接到第二钳口元件216b。
图16是示出根据一个实施方案的图1到图3所示外科器械100,101的端部执行器210和轴组件212的组装的局部分解图。电导体238通过颈部240的中空部分馈送并且钳口电极254就位于第二钳口元件216b上。第一钳口元件216a然后通过将枢轴销252插入穿过第二钳口元件216b中的孔270和第一钳口元件216a中的另一孔264联接到第二钳口元件216b。枢轴销252然后连接到第二钳口元件216。连杆236的远侧端部然后插入限定在第一钳口元件216a上的狭槽260中。第二连杆销234b插入穿过限定于第一钳口元件216a中的孔262并且穿过限定于连杆236的远侧端部处的孔266。第二连杆销234b然后连接到第一钳口元件216a。
中空柔性刀缆线211的远侧端部附接到适配器222,适配器222然后附接到刀224的近侧端部。作用杆213插入穿过中空柔性刀缆线211和适配器222。作用杆213然后馈送穿过不可旋转闭合环230和可旋转闭合环232,并且作用杆213的远侧端部电联接到电导体238。
可旋转闭合环232然后在连杆236的近侧端部定位在由可旋转闭合环232限定的狭槽243中时滑套于颈部240上方。第一连杆销234a然后插入穿过限定于可旋转闭合环232中的孔274和限定于连杆236的近侧端部处的孔268。第一连杆销234a然后连接到可旋转闭合环232。
不可旋转闭合环230然后滑套于颈部240上方,直到狭槽229a,229b(未示出)与限定于颈部240上的沟槽233对齐。插件228a,228b然后插入穿过狭槽229a,229b(未示出),使得它们卡住沟槽233。插件狭槽228a,228b然后连接到不可旋转闭合环230和颈部240。
图17是根据一个实施方案的图1到图3所示外科器械的端部执行器210和轴组件212的最终组装。外管202滑套于图13所示子组件上方。外管通过压接突片207a,207b附接到柔性颈部220(未示出)。外管202还通过压接突片215附接到不可旋转闭合环230(未示出)。
图18是根据一个实施方案的处于关节运动位置的图1到图3所示外科器械100,101的端部执行器210和轴组件212以及处于打开位置的钳口的视图。在所示出的实施方案中,轴组件212处于呈约55度的关节运动的关节运动位置。可通过添加关节运动节段206来提供更多关节运动。如前所述,附加关节运动节段206提供关节运动接头204的更小曲率半径。可通过去除关节运动节段206来提供更少关节运动。如前所述,更少关节运动节段206提供关节运动接头204的更大曲率半径。为在外管202关节运动时闭合钳口元件216a,216b,沿方向G向前推压外管202,使得整个关节运动接头204沿方向G向前运动。如前所述,外管202作用在可旋转闭合环232上,以推动连杆236并将第一钳口元件216a朝向第二钳口元件216b闭合。通过沿远侧方向G推进刀管214(未示出)来击发刀224(未示出)。刀224(未示出)可部分地由于柔性颈部230(未示出)和中空柔性刀缆线211(未示出)而在钳口闭合且轴组件212关节运动时击发。
图19是根据一个实施方案的处于关节运动位置的图1到图3所示外科器械100,101的端部执行器210和轴组件212以及处于打开位置的钳口的视图。在所示出的实施方案中,轴组件212处于呈约55度的关节运动的关节运动位置。超过关节运动接头204的端部执行器210节段可通过使刀管214(未示出)旋转而沿方向A或沿相反方向旋转。
图20是根据一个实施方案的图1到图3所示外科器械100,101的端部执行器210和轴组件212的侧视图,其中钳口闭合限定示例性尺寸。如图所示,不受限制地公开了各种尺寸。在一个实施方案中,在钳口元件216a,216b的远侧末端与最近侧关节运动节段206之间延伸的节段的长度L1为约2.96英寸。钳口元件的长度L2为约0.865英寸。从钳口元件216a,216b的近侧端部延伸到最远侧关节运动节段206的节段的长度L3为约1.6英寸。关节运动接头204的长度L4为约0.54英寸。其他尺寸例如可被取代。
图21到图23示出了根据一个实施方案的闭合和打开图1到图3所示外科器械100,101的钳口元件216a,216b的顺序。图21示出了根据一个实施方案的端部执行器210,其中第一钳口元件216a处于打开位置。当闭合钳口元件216a时,可旋转闭合环232推动第一钳口元件216a以将其闭合。这在闭合第一钳口元件216a时最大化机械优点。
图22示出了根据一个实施方案的端部执行器210,其中第一钳口元件216a处于闭合位置。连杆236中的狭槽272允许连杆236牵拉打开,但不推压闭合。
图23示出了根据一个实施方案的端部执行器210,其中第一钳口元件216a转变到打开位置。当打开第一钳口元件216a时,连杆236将钳口元件216a牵拉打开。这在打开时最大化机械优点。
图24到图33示出了包括具有钳口牵拉机构的关节运动轴的电外科器械的各种实施方案。在一个实施方案中,电外科器械包括关节运动双极RF装置,所述装置具有钳口、关节运动带以及内部柔性引导件与外部激光切割外管的组合,以形成关节运动接头。在一个实施方案中,电外科器械包括设置在轴的中心和刀上方的牵拉带。可压接外管以将钳口和柔性引导件保持就位。在一个实施方案中,电外科器械包括位于刀外管内部以附接到柄部机构的刀推压管。在各种实施方案中,本公开提供不受限制地包括这些特征中的一些或全部的组合的电外科器械。
结合图24到图33所述的电外科器械的实施方案,关节运动机构可提供多至55度的关节运动。牵拉带和刀可居中定位在外管内以减轻关节运动对刀和钳口牵拉位置的影响。电外科器械的组装可比常规关节运动装置容易。电外科器械的实施方案包括与当前装置相比减小的接头到钳口长度和更大的钳口。电外科器械的实施方案提供改进的解剖和抓持。电外科器械的实施方案使得组织能够在组织解剖或切割之前密封。
图24是根据一个实施方案的处于关节运动位置的轴组件312和端部执行器310的透视图,其中钳口构件316a,316b处于打开位置。图25是根据一个实施方案的处于未关节运动(笔直)位置的图24所示轴组件312和端部执行器310的透视图,其中钳口构件316a,316b处于闭合位置。轴组件312和端部执行器310可用于类似于图1到图3所示外科器械100,101的外科器械中。图24示出了根据一个实施方案的轴组件312的平移和旋转方面。
在一些实施方案中,端部执行器310联接到轴组件312的远侧端部。端部执行器310包括第一钳口构件和第二钳口构件316a,316b。第一钳口构件316a枢转地联接到第二钳口构件316b。第一钳口构件316a能够相对于第二钳口构件316b枢转地运动,以将组织抓持在它们之间。第一钳口构件316a可被称为上钳口或上钳口构件。在一些实施方案中,第二钳口构件316b是固定的。第二钳口构件316b可被称为下钳口或下钳口构件。在其他实施方案中,第一钳口构件316a和第二钳口构件316b能够枢转地运动。在一个示例中,钳口构件316a,316b中的至少一个相对于轴组件312组件固定。在另一示例中,钳口构件316a,316b两者能够相对于轴组件312运动。在所示出的示例中,第一钳口构件316a能够相对于轴组件312运动,并且第二钳口构件316b相对于轴组件312固定。钳口构件316a,316b能够相对于彼此从第一打开位置运动到第二闭合位置,以将组织抓持在它们之间。如图24和图25所示出的实施方案中所示,端部执行器310的钳口构件316a,316b可通过将钳口管314沿方向F朝近侧牵拉来闭合,并且可通过将钳口管314沿方向F'朝远侧向相反方向推压来闭合。应当指出的是,这一功能与结合图4至图23所述的其中外管被朝远侧推压以闭合钳口元件的实施方案的功能相反。至少一个钳口构件316a,316b和钳口电极354包括狭槽356,358或刀通道,以使刀沿着该刀通道往复运动并且切断抓持在第一钳口构件和第二钳口构件316a,316b之间的组织。
钳口构件316a,316b中的至少一个能够连接到电外科能量源,使得电外科能量可选择性地传递穿过保持在钳口构件316a,316b之间的组织,以执行组织密封。端部执行器310的钳口构件316a,316b中的至少一个包括至少一个电极,所述至少一个电极能够连接到电外科能量源,并且被构造成能够将能量递送至保持在钳口构件316a,316b之间的组织,以执行组织密封。由电极递送的能量可独立地或组合地包括例如射频(RF)能量、亚治疗RF能量、超声能量和/或其他合适形式的能量。在一些实施方案中,切割构件(未示出)能够接收在由第一钳口构件316a和/或第二钳口构件316b限定的纵向狭槽内。切割构件被构造成能够切割抓持在第一钳口构件316a和第二钳口构件316b之间的组织。在一些实施方案中,切割构件包括用于递送能量(例如(举例来说)可独立地或组合地递送的RF、超声能量或它们的组合)的电极。
如图25中还示出,通过致动可滑动地定位在关节运动接头306和柔性颈部320之间的关节运动带308a,308b来使轴组件312的关节运动节段304沿从右到左逆时针方向或从左到右顺时针方向关节运动(图26到图27)。可通过拉动第一关节运动带308a以使其沿方向C朝近侧缩回并且推动第二关节运动带308b以将其沿方向D'朝远侧推进来使关节运动节段沿顺时针方向关节运动。可通过使施加到第一关节运动带和第二关节运动带308a,308b的力反向来使关节运动节段304沿逆时针方向关节运动。例如,通过推压第一关节运动带308a以使其沿方向C'朝远侧推进,并且通过牵拉第二关节运动带308b以使其沿方向D朝近侧缩回。应当指出的是,不管钳口构件316a,316b是打开还是闭合,均可使轴组件312的关节运动节段304顺时针或逆时针关节运动。
刀能够通过致动刀管317朝远侧和朝近侧可滑动地运动。当钳口构件316a,316b闭合时,可通过沿方向E'朝远侧推压刀管317来推进刀以切割夹持在钳口构件316a,316b之间的组织。可通过沿方向E朝近侧牵拉刀管317来使刀缩回。
端部执行器310能够通过使刀管317沿类似方向旋转而沿顺时针或逆时针方向旋转。例如,端部执行器310可通过使刀管317顺时针旋转而顺时针旋转,并且端部执行器310可通过使刀管317逆时针旋转而逆时针旋转。应当指出的是,端部执行器310可沿任一方向旋转,而不管钳口构件316a,316b处于打开位置还是闭合位置。
能量可通过位于钳口管314内的作用杆313递送至位于端部执行器310中的钳口电极。作用杆在近侧端部上电联接到能量源,并且在远侧端部上电联接到电导体328,电导体328电联接到钳口电极。第二钳口构件316b包括钳口电极354,钳口电极354经由电导体联接到作用杆313。钳口电极354包括狭槽358以接收刀。刀通过将刀管317沿方向E'朝远侧推进来推进并通过将刀管317沿方向E牵拉来朝近侧缩回。
图26是根据一个实施方案的轴组件312和端部执行器310的剖面图。外管302可滑动地接收关节运动带308a,308b(在这一视图中未示出)、刀管317和钳口管314。作用杆313位于钳口管314内并且电联接到电极328,电极328电联接到钳口电极354。钳口管314连接到两个钳口致动带315a,315b(在这一视图中未示出)中的一个,所述钳口致动带沿着轴组件312的长度延伸到端部执行器310,在那里所述钳口致动带通过销334可枢转地联接到第一连杆338a。第一连杆338a通过销336枢转地联接到第一钳口元件316a,第一钳口元件316a通过销352可旋转地联接到外管302。销334,336,352固定地联接到外管302。因此,当钳口管314被沿方向F朝近侧牵拉时,钳口致动带315a被朝近侧牵拉,第一钳口元件316a朝向第二钳口元件316b运动到闭合位置。当钳口元件316a,316b处于闭合位置时,钳口元件316a,316b通过沿方向F'朝远侧推动钳口管314而被打开。如前所述,刀324连接到刀管317,使得刀324通过沿方向E'推动刀管317而朝远侧推进并且刀324通过沿方向E拉动刀管317而朝近侧缩回。
图27是根据一个实施方案的轴组件312和端部执行器310的剖面图。如图27所示,双钳口致动带315a,315b可滑动地接收在限定于轴组件312的关节运动节段304的柔性颈部320部分中的狭槽319内。电极328位于一个钳口致动带315a下方,并且刀324位于另一个钳口致动带315b下方。电极328从刀324侧向地设置且位于另一个钳口致动带315a下方。电导体328由电绝缘护套321覆盖。
图28是根据一个实施方案的轴组件312的纵向剖面图。如图28所示,关节运动带308a可滑动地接收在外管302内,并且刀管317可滑动地接收在关节运动带308a内。钳口管314还示出为在刀管317内纵向延伸,并且联接到右钳口致动带315a。刀324联接到刀管317并且在刀通道内往复运动。刀324通过沿方向E'推动刀管317而朝远侧推进。刀324通过沿方向E拉动刀管317而朝近侧缩回。刀324包括联接构件325a,325b,联接构件325a,325b通过将近侧联接构件325b定位穿过限定于刀管317中的狭槽323而将刀324联接到刀管317。
电联接到钳口电极354(图24到图26)的电导体328由电绝缘护套321覆盖。电导体328电联接到作用杆313,作用杆313也由电绝缘护套327覆盖。作用杆313能够连接到电外科能量源,并且被构造成能够将能量递送至保持在钳口构件316a,316b之间的组织,以执行组织密封。电外科能量源可包括例如射频(RF)能量源、亚治疗RF能量源、超声能量源和/或其他合适的能量源。在使用多个能量源的情况下,能量可独立地或组合地递送。
图29是根据一个实施方案的外科器械100,101的一个实施方案的轴组件312和端部执行器310部分的透视图。在图29所示的视图中,轴组件312的外管302、刀管314和关节运动带308a,308b被除去以更好地看到作用杆313、刀324、电导体328、钳口致动带315a,315b和端部执行器310致动机构。作用杆313连接到电导体328。钳口致动带315a,315b操作性地联接到对应第一连杆338a和第二连杆338b的近侧部分。连杆338a,338b的远侧端部联接到第一钳口构件316a。销334a位于连杆338a,338b的近侧端部和钳口致动带315a,315b之间。另一销334b位于连杆338a,338b的远侧端部和钳口构件316a的近侧端部之间。又一销352位于第一钳口构件和第二钳口构件316a,316b之间。销334a,334b和352连接就位。
第一可运动钳口构件316a能够相对于第二固定钳口构件316b围绕枢轴销352在打开位置和闭合位置之间枢转地运动。第一钳口构件316a能够通过致动钳口致动带315a,315b而相对于第二钳口构件316b运动。例如,当钳口致动带315a,315b被朝远侧推压时,连杆338a,338b的近侧端部和销334a在限定于第二钳口构件316b的颈部节段340中的狭槽342中朝远侧滑动。当连杆338a,338b的近侧端部在狭槽342中朝远侧平移时,连杆338a,338b的远侧端部沿向下方向驱动,并且致使第一钳口构件316a围绕枢轴销352枢转到打开位置,如图29所示。为抓持组织,第一钳口构件316a通过拉动钳口致动带315a,315b以将它们沿近侧方向驱动而闭合到第二钳口构件316b上。因此,连杆338a,338b的近侧端部和销334a在狭槽342中朝近侧滑动,从而致使连杆338a,338b拉直,并且致使第一钳口构件316a围绕枢轴销352旋转到闭合位置。
底部或第二钳口构件316b包括电极354以将能量递送至抓持在第一构件316a第二构件316b之间的组织。电极354电联接到电导体328,电导体328电联接到作用杆313。如前所述,作用杆313能够联接到能量源,并且充当电路的一个极。第一钳口构件316a联接到电路的第二极。因此,当组织被抓持在第一钳口构件和第二钳口构件316a,316b之间时,能量可施加至组织,以执行密封。端部执行器310包括至少一个阻挡构件359a,359b,359c,该至少一个阻挡构件可设置在第一钳口构件316a或第二钳口构件316b中的任一者或两者上,以控制相对钳口构件316a,316b之间的相对于彼此的间隙距离。在所示出的示例中,阻挡构件359a,359b,359c位于第二钳口构件316b上,并且突出穿过在钳口电极354中形成的对应开孔。在所示出的示例中,一个阻挡构件359a定位在狭槽358的远侧端部处,并且两个阻挡构件359b,359c侧向地设置在狭槽358的任一侧上。
阻挡构件359a,359b,359c由例如塑料、陶瓷、玻璃或任何合适的电绝缘材料等电绝缘材料形成。阻挡构件359a,359b,359c限制两个相对钳口构件316a,316b相对于彼此的运动。优选地,阻挡构件359a,359b,359c由绝缘材料制成且尺寸使得其限制钳口构件316a,316b在间隙范围(例如,约0.001英寸至约0.006英寸)内的相对运动,并且对至少一个钳口构件316a,316b施加期望的力以密封组织。一旦组织被密封,则刀324被构造成能够在狭槽356,358内往复运动,以切断组织。
图30是根据一个实施方案的外科器械100,101的一个实施方案的轴组件312和端部执行器310部分的透视图。在图30所示视图中,示出了轴组件312的钳口管314、刀管317、柔性颈部320和关节运动带308a,308b部分以描述其操作。现在参照图29和图30两者,轴组件312可通过使柔性颈部320在刀324、关节运动带315a,315b和电导体328上滑动来组装。刀320连接到刀管317,并且钳口管314连接到致动带315a,315b。关节运动带308a,308b通过销连接到第二钳口构件316b的颈部节段340的侧向部分。如图30所示,关节运动带308b通过销329b连接到第二钳口元件316b的颈部节段340的一侧。尽管未示出,但关节运动带308a通过另一销连接到第二钳口元件316b的颈部节段340的另一侧。如前所述,连接可通过焊接、钎焊、焊料、粘结剂、胶水、铆钉、螺钉、螺栓、压接或其他合适的装置以任何合适的附接方式来进行。
图31是根据一个实施方案的外科器械100,101的一个实施方案的轴组件312和端部执行器310节段的透视图。在图31所示的视图中,包括关节运动接头306的外管302在下伏部件上滑动。柔性颈部320例如通过压接344附接到外管304。下钳口316b例如通过焊接或压接346附接到外管302。
图32示出了根据一个实施方案的处于关节运动位置的外科器械100,101的一个实施方案的轴组件312。在所示出的示例中,轴组件312示出为在一个方向上呈55度的关节运动。轴组件312可通过拉动并推动对应关节运动带308a,308b而从笔直位置关节运动+/-55度。例如,从呈0度的笔直位置开始,轴组件312可通过拉动右关节运动带308a并推动左关节运动带308b而在0度和+55度之间及其任何中间位置关节运动。同样,从呈0度的笔直位置开始,轴组件312可通过拉动右关节运动带308a并推动左关节运动带308b而在0度和-55度之间及其任何中间位置关节运动。
图33是根据一个实施方案的图1到图3所示外科器械100,101的端部执行器310和轴组件312的侧视图,其中钳口闭合限定示例性尺寸。如图所示,不受限制地公开了各种尺寸。在一个实施方案中,在钳口元件316a,316b的远侧未端与最近侧关节运动接头306之间延伸的节段的长度L1为约2.27英寸。钳口元件的长度L2为约0.865英寸。从钳口元件316a,316b的近侧端部延伸到最远侧关节运动接头306的节段的长度L3为约0.88英寸。关节运动节段304的长度L4为约0.54英寸。其他尺寸例如可被取代。
值得注意的是,对“一个方面”、“一方面”、“一个实施方案”或“一实施方案”的任何提及意味着结合所述方面所述的特定特征结构、结构或特性包括在至少一个方面中。因此,在整个说明书中的各个地方出现的短语“在一个方面中”、“在一方面中”、“在一个实施方案中”或“在一实施方案中”并不一定都指相同的方面。此外,具体特征、结构或特性可在一个或多个方面中以任何合适的方式组合。
虽然本文描述了多个实施方案,但可以实现那些实施方案的多种修改形式、变型形式、替代形式、变化形式和等同形式,这些形式是本领域技术人员将会想到的。另外,在公开用于某些部件的材料的情况下,可采用其他材料。因此,应当理解,上述具体实施方式和所附的权利要求旨在涵盖属于本发明所公开的实施方案范围内的所有此类修改形式和变型形式。以下权利要求旨在涵盖所有此类修改形式和变型形式。
虽然本文描述了多个实施方案,但可以实现那些实施方案的多种修改形式、变型形式、替代形式、变化形式和等同形式,这些形式是本领域技术人员将会想到的。另外,在公开用于某些部件的材料的情况下,可采用其他材料。因此,应当理解,上述具体实施方式和所附的权利要求旨在涵盖属于本发明所公开的实施方案范围内的所有此类修改形式和变型形式。以下权利要求旨在涵盖所有此类修改形式和变型形式。
Claims (24)
1.一种电外科器械,包括:
端部执行器,所述端部执行器包括第一钳口构件和第二钳口构件,所述第一钳口构件和所述第二钳口构件能够相对于彼此从第一打开位置运动到第二闭合位置,以将组织抓持在所述第一钳口构件和所述第二钳口构件之间,其中所述钳口构件中的至少一个钳口构件能够连接到电外科能量源,使得电外科能量能够选择性地传递穿过保持在所述钳口构件之间的组织,以执行组织密封;
所述第一钳口构件或所述第二钳口构件中的至少一个钳口构件包括限定于其中的刀通道,所述刀通道被构造成能够使刀沿着该刀通道往复运动,以切断保持在所述第一钳口构件和所述第二钳口构件之间的组织;和
两级关节运动接头,所述两级关节运动接头联接到所述端部执行器,所述两级关节运动接头操作性地联接到被构造成能够使所述端部执行器关节运动的第一关节运动带和第二关节运动带,所述两级关节运动接头包括:
外切割金属管,所述外切割金属管包括多个关节运动节段,所述多个关节运动节段具有闭合和打开所述第一钳口构件和所述第二钳口构件的铰链和锁定特征结构;和
定位在所述外切割金属管内的实心但柔性的内芯。
2.根据权利要求1所述的电外科器械,还包括两级可旋转联接接头。
3.根据权利要求2所述的电外科器械,其中,所述关节运动带通过所述两级可旋转联接接头操作性地联接到所述第一钳口构件或所述第二钳口构件中的至少一个钳口构件。
4.根据权利要求2所述的电外科器械,其中,两级可旋转联接接头包括可旋转闭合环和联接到所述可旋转闭合环的闭合连杆,并且其中所述外管附接到所述可旋转闭合环。
5.根据权利要求4所述的电外科器械,其中,所述连杆被构造成能够将所述第一钳口构件或所述第二钳口构件中的所述至少一个钳口构件相对于另一个钳口构件牵拉打开,并且所述可旋转闭合环被构造成能够将所述第一钳口构件或所述第二钳口构件中的所述至少一个钳口构件相对于所述另一个钳口构件推压闭合。
6.根据权利要求1所述的电外科器械,其中,所述端部执行器被构造成能够同时进行旋转和关节运动。
7.根据权利要求6所述的电外科器械,其中,所述端部执行器被构造成能够在所述端部执行器处于关节运动位置时旋转。
8.根据权利要求1所述的电外科器械,还包括刀,所述刀被构造成能够在所述刀通道内往复运动并且在所述端部执行器旋转时旋转。
9.根据权利要求8所述的电外科器械,还包括柔性中空缆线和刀管,其中所述柔性中空缆线联接在所述刀和所述刀管之间,使得所述刀能够被推压穿过所述关节运动节段,并且其中所述柔性中空缆线位于电导体上方。
10.根据权利要求1所述的电外科器械,还包括可旋转枢轴,其中所述关节运动带通过所述可旋转枢轴联接到所述第一钳口构件或所述第二钳口构件中的至少一个钳口构件。
11.一种电外科器械,包括:
端部执行器,所述端部执行器包括第一钳口构件和第二钳口构件,所述第一钳口构件和所述第二钳口构件能够相对于彼此从第一打开位置运动到第二闭合位置,以将组织抓持在所述第一钳口构件和所述第二钳口构件之间,其中所述钳口构件中的至少一个钳口构件能够连接到电外科能量源,使得电外科能量能够选择性地传递穿过保持在所述钳口构件之间的组织,以执行组织密封;
所述第一钳口构件或所述第二钳口构件中的至少一个钳口构件包括限定于其中的刀通道,所述刀通道被构造成能够使刀沿着该刀通道往复运动,以切断保持在所述第一钳口构件和所述第二钳口构件之间的组织;
可旋转闭合环;和
闭合连杆,所述闭合连杆操作性地联接到所述可旋转闭合环,其中所述可旋转闭合环和所述连杆被构造成能够闭合和打开所述端部执行器。
12.根据权利要求11所述的电外科器械,其中,所述可旋转闭合环被构造成能够在所述第一钳口构件和所述第二钳口构件相对于所述外管以任何角度旋转时向所述第一钳口构件和所述第二钳口构件传输闭合力。
13.根据权利要求11所述的电外科器械,还包括刀,所述刀被构造成能够在所述刀通道内往复运动并且在所述端部执行器旋转时旋转。
14.根据权利要求11所述的电外科器械,其中,所述刀连接到位于所述外管内的刀管。
15.根据权利要求11所述的电外科器械,还包括外管,所述外管包括联接到所述端部执行器的关节运动节段,所述关节运动节段操作性地联接到被构造成能够使所述端部执行器关节运动的第一关节运动带和第二关节运动带。
16.一种电外科器械,包括:
端部执行器,所述端部执行器包括第一钳口构件和第二钳口构件,所述第一钳口构件和所述第二钳口构件能够相对于彼此从第一打开位置运动到第二闭合位置,以将组织抓持在所述第一钳口构件和所述第二钳口构件之间;
所述第一钳口构件或所述第二钳口构件中的至少一个钳口构件包括限定于其中的刀通道,所述刀通道被构造成能够使刀沿着该刀通道往复运动,以切断保持在所述第一钳口构件和所述第二钳口构件之间的组织;
至少一个关节运动带;
关节运动节段,所述关节运动节段联接到所述端部执行器,所述关节运动节段操作性地联接到被构造成能够使所述端部执行器关节运动的所述至少一个关节运动带;和
可旋转联接接头,所述可旋转联接接头联接到所述关节运动节段。
17.根据权利要求16所述的电外科器械,还包括至少第二关节运动带,其中所述第一关节运动带和所述第二关节运动带联接到所述可旋转联接接头。
18.根据权利要求16所述的电外科器械,还包括闭合管和可操作地联接到所述端部执行器的柄部组件,其中所述第一钳口构件能够相对于所述第二钳口构件运动,并且其中所述第一钳口构件联接到所述闭合管,并且所述第二钳口构件联接到所述柄部组件。
19.根据权利要求17所述的电外科器械,其中,所述至少一个关节运动带通过所述可旋转联接接头联接到所述第二钳口构件。
20.一种电外科器械,包括:
端部执行器,所述端部执行器包括第一钳口构件和第二钳口构件,所述第一钳口构件和所述第二钳口构件能够相对于彼此从第一打开位置运动到第二闭合位置,以将组织抓持在所述第一钳口构件和所述第二钳口构件之间;
刀;
所述第一钳口构件和所述第二钳口构件中的至少一个钳口构件包括限定于其中的刀通道,所述刀通道被构造成能够使所述刀沿着该刀通道往复运动,以切断保持在所述钳口构件之间的组织;
外管,所述外管联接到所述端部执行器;
可旋转联接接头,所述可旋转联接接头联接到所述端部执行器;
中空柔性管,所述中空柔性管联接到所述刀,所述中空柔性管在其中限定空间;和
作用杆,所述作用杆在由所述中空柔性管限定的中空空间内纵向延伸。
21.根据权利要求20所述的电外科器械,其中,所述中空柔性管可旋转地联接到所述端部执行器,并且被构造成能够经由所述刀使所述端部执行器旋转。
22.根据权利要求20所述的电外科器械,其中,所述作用杆被构造成能够电联接到能量源的一个电极。
23.根据权利要求20所述的电外科器械,还包括电联接到所述第一钳口构件或所述第二钳口构件中的至少一个钳口构件的至少一个钳口电极,其中所述至少一个钳口电极能够连接到电外科能量源,使得电外科能量能够选择性地传递穿过保持在所述第一钳口构件和所述第二钳口构件之间的组织,以执行组织密封,其中所述至少一个钳口电极限定至少一个开孔。
24.根据权利要求23所述的电外科器械,还包括位于所述第一钳口构件或所述第二钳口构件中的至少一个钳口构件上的至少一个阻挡构件,其中所述阻挡构件被构造成能够突出穿过所述至少一个钳口电极的所述至少一个开孔、并且控制所述第一钳口构件和所述第二钳口构件之间的间隙距离。
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PCT/US2016/014040 WO2016126420A2 (en) | 2015-02-06 | 2016-01-20 | Electrosurgical instrument with rotation and articulation mechanisms |
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CN107205775B (zh) | 2021-01-15 |
BR112017016800B1 (pt) | 2022-11-08 |
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JP2018504241A (ja) | 2018-02-15 |
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