CN107205787A - 用于微创手术的可再用手术器械 - Google Patents
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Abstract
公开了一种具有诸如解剖器、剪刀或抓钳的铰接式末端执行器(3)的可再用手术器械(1),以在各种外科手术期间提高外科医生的绩效。器械的纵向轴线通过包括由外部管(2’)覆盖的内部结构元件(2”)的轴杆(2)限定,轴杆可以可选地通过套管针插入通过手术切口进入患者的身体中。铰接式末端执行器(3)安装在轴杆的内部结构元件的远端上并且包括通过多个接头互连的多个链节,链节的移动通过外科医生的手远程地致动。此远程致动经由主要由柔性元件组成的机械传动装置(5、6、7)实现,机械传动装置能够将运动从放置于轴杆(2)的近端处的一组致动元件传递到器械的铰接式末端执行器(3)。在每次手术之后能够容易地且单独地从轴杆(2)拆卸外部管(2’),使得器械(1)能够更有效地进行清洁和消毒。
Description
技术领域
本发明涉及微创铰接器械的领域,诸如,抓钳、解剖器和剪刀,其中远侧末端执行器相对于器械轴杆的定向能够受控制。更具体来说,本发明涉及在每次手术之后必须进行清洁和消毒的可再用手术器械。最具体来说,本发明涉及此类器械,其中通过机械传动元件从器械轴杆的近端至远端远程地执行远侧末端执行器的致动和定向。本发明的器械旨在主要用于外科手术中,其中具有铰接式末端执行器的器械通过切口或套管针进入患者的体腔内,患者的体腔可以优选地用充气膨胀。
背景技术
开放性手术仍是大部分外科手术的标准技术。开放性手术已经被医学界使用了几十年,包括通过在腹部或其它体腔中的长切口进行外科手术任务,传统的手术工具通过所述长切口插入。然而,由于长切口,这种方法对病人来说及其具有创伤性,在手术过程中会造成大量失血并且在住院病人设定中具有长且痛苦的恢复周期。
为了减小开放性手术的侵入性,开发了腹腔镜手术,一种微创技术。代替单个长切口,在患者身上切开一个或更多个较小切口,长且薄的手术器械以及内窥相机通过所述较小切口插入。由于侵入性较低,腹腔镜手术减少失血和疼痛,同时还缩短住院时间。当有经验的外科医生进行手术时,这些手术能够获得类似于开放性手术的临床结果。然而,尽管具有上述优点,但是腹腔镜手术需要先进的外科手术技能来通过患者身体中的小切口操作刚性且长的器械(instrumentation)。
传统上,腹腔镜器械,诸如,抓钳、解剖器、剪刀和其它工具已安装在直的轴杆上。这些轴杆通过小切口插入患者身体内,因此这些轴杆在体内的运动范围减小。入口切口用作旋转点,从而减小外科医生在患者体内定位和定向器械的自由度。因此,由于其器械的缺点,腹腔镜手术主要局限于简单的外科手术使用,而只有少数外科医生能够在复杂手术中使用所述器械。因此,具有将远端铰接提供到腹腔镜器械的末端执行器元件的明确趋势,从而允许远侧执行器元件相对于器械轴杆的纵向轴线成角度。
腹腔镜器械能够被提供为一次性的或可再用的医疗装置。一次性装置在每次使用之后被扔掉,而不需要进行清洁。另一方面,可重复使用装置必须在每次手术之后进行清洁和消毒。在许多情况下,成本高效益和手术室效率要求器械进行清洁、消毒和重复使用。
尽管已广泛使用诸如蒸汽消毒的技术,但是这些技术通常不足以到达能够在外科手术期间进入手术器械的所有血液和组织残留物。具体来说,对于具有铰接式末端执行器的器械的情况(例如,US7819894中所公开的器械),清洁和消毒过程更具有挑战性。铰接式末端执行器的较高机械复杂性产生组织和血液能够容易渗入的额外位置。另外,为了密封并且保持体腔膨胀,这些系统用细长且闭合的管状体构造,渗透的血液和组织难以从所述管状体中清除。
一些可再用的腹腔镜器械(例如,EP1889579、US5147357、US5304203、US5308358、US5368606、US5603723和US20090299141中所公开的器械)能够拆卸用于清洁并且随后重新组装以供后续使用。这使得能够进入器械管的内部部分以及容纳在其中的内部机械元件,从而产生更可靠的清洁和消毒方法。然而,此解决方案仅在具有低复杂性末端执行器(主要具有单个远侧自由度)的器械中使用,其中组装和拆卸过程相对简单,并且因此能够由医院工作人员容易地完成。此简单组装/拆卸过程无法应用于现有的铰接器械(如US7819894中所公开的器械)。实际上,在这些器械中,器械轴杆的外部管具有向器械轴杆提供结构以及相对于套管针为器械提供密封功能以便保持在其中操作器械的腹腔膨胀的双重功能。对现有铰接器械的设计的此限制使得移除外部管是不可能的,这对此类器械的清洁和消毒带来极大挑战。在不能够移除外部管的情况下,直接进入铰接器械的内部元件是不可能的,这意味着清洁工具无法直接应用于需要清洁的元件而不管在外科手术期间血液和组织可能已污染这些元件的事实。尽管一些铰接器械允许通过水流作为清洁内部元件的方法,但是这无法提供用于完全清洁并且不是有效的解决方案。
因此,本发明的目的是在用于线驱动的手术器械的情况下通过提供具有铰接式末端执行器的新手术器械来克服已知装置的上述缺点,其中能够容易地移除构成器械的轴杆的外部管,从而进行有效清洁并且随后重新组装以供使用。
发明内容
这些目的和其它优点通过呈(例如)解剖器、剪刀或抓钳形式的新铰接和可再用的手术器械来实现。器械包括放置于器械轴杆的远端处的铰接式末端执行器,所述器械轴杆包括内部结构元件和外部管。轴杆限定器械的纵向轴线并且能够根据身体切口施加的移动约束而移动,该移动约束包含围绕其自身轴线的旋转运动。此旋转还导致安装在轴杆的远端上的末端执行器的旋转。因此,器械具有以下三重功能:(1)将末端执行器定位在患者身体的内部,(2)允许能够致动不同的远侧末端执行器铰接的不同传动元件通过,以及(3)避免空气穿过器械,以便保持在其中器械操作的体腔的膨胀。在通过内部结构元件实现前两个功能时,第三个功能主要通过外部管实现。由于其主要功能不是机械的,因此在每次手术之后外部管能够被容易地且单独地从器械拆卸。这确保正确进入穿过轴杆并且安置于轴杆上的内部元件,使得能够更有效地对器械进行清洁和消毒。最后,外部管能够被容易地重新附接到器械,以供下一次使用。
通过上述特征,此可再用器械能够将高度铰接器械的性能益处与最简单的腹腔镜器械的益处组合,所述腹腔镜器械能够由医院工作人员容易地且几乎完全地组装和拆卸,使得能够进入内部组件以进行更有效的清洁和消毒。这导致目前无法获得的安全和性能的独特组合。
附图说明
根据参考附图对若干实施例进行的以下详细描述,将更佳地理解本发明,在附图中:
图1示出根据本发明的实施例的可再用手术器械的透视图;
图2示出根据本发明的实施例的具有器械轴杆的外部管的示意性剖面的可再用手术器械的透视图,通过所述剖面可以看到穿过器械轴杆的内部结构元件;
图3示出根据本发明的实施例的具有器械轴杆的外部管的示意性剖面的可再用手术器械的透视图,通过所述剖面可以看到不同的机械传动元件;
图4示出根据本发明的实施例的可再用手术器械的铰接式末端执行器的透视图;
图5示出在第一活动位置中的根据本发明的实施例的铰接式末端执行器;
图6示出在第二活动位置中的根据本发明的实施例的铰接式末端执行器;
图7示出在第三活动位置中的根据本发明的实施例的铰接式末端执行器;
图8示出在第四活动位置中的根据本发明的实施例的铰接式末端执行器;
图9示出在第五活动位置中的根据本发明的实施例的铰接式末端执行器;
图10示出根据本发明的实施例的用于第一远侧末端执行器链节(link)的驱动拓扑;
图11示出根据本发明的实施例的用于第二远侧末端执行器链节的驱动拓扑;
图12示出根据本发明的实施例的用于近侧末端执行器链节的驱动拓扑;
图13示出根据本发明的实施例的具有不同的近侧旋转元件的近侧轮毂的透视图;
图14示出根据本发明的实施例的致动末端执行器的远侧铰接的柔性传动元件的简化路径;
图15示出根据本发明的实施例通过其能够将器械轴杆的外部管组装在可再用手术器械上和从可再用手术器械上拆卸器械轴杆的外部管的过程;
图16示出根据本发明的实施例的安装在内部结构元件上的密封元件和横向元件的详细透视图。
具体实施方式
根据本发明的实施例构造的具有可拆卸外部管2'的用于微创手术的可再用手术器械1在本文中描述并且大致在图1中看到。此器械1包含主轴杆2、铰接远侧末端执行器3和近侧轮毂4。参考图2,轴杆2由两个不同的元件:内部结构元件2”和外部管2’组成。内部结构元件2”提供末端执行器3的稳定定位并且允许不同的机械元件5、6、7的通过,不同的机械元件5、6、7能够将运动从器械(图3和图4)近端处的近侧轮毂4传递到不同的末端执行器链节8、9、10。外部管2’在轴杆2穿过切口时保护轴杆2上的内部元件并且避免空气穿过器械1,以便保持在其中操作器械1的体腔的膨胀。
仍参考图4,末端执行器3通过近侧接头被连接到内部结构元件2”,这允许近侧执行器链节8以近侧执行器链节8相对于主轴杆轴线12的定向能够改变的方式围绕近侧轴线11旋转。远侧末端执行器链节9、10通过具有重合的旋转轴线(通过远侧轴线13表示)的两个远侧接头可旋转地连接到近侧末端执行器链节8。此远侧轴线13与近侧轴线11基本上垂直且不相交,并且与主轴杆轴线12基本上相交。图5至图9示出在末端执行器接头处具有不同角位移的手术器械1。图10至图12示出传动元件5、6、7与末端执行器链节8、9、10之间的连接。
参考图13和图14,移动通过旋转元件14、15、16被传递到器械的三个远侧铰接中的每一者,所述旋转元件14、15、16能够围绕轴线17旋转并且连接到传动元件5、6、7。因此,当旋转元件14、15、16围绕轴线17旋转特定角度θ1、θ2、θ3时,将旋转α1、α2、α3传递到相应的末端执行器构件8、9、10。
外部管2’能够在每次手术之后容易地且单独地拆卸和附接到器械1。参考图15,内部结构元件2”被直接固定到近侧轮毂4,并且外部管2’能够在螺纹表面18a和18b处连接到内部结构元件2”以及从内部结构元件2”断开。因此,通过此架构,外部管2’能够从器械1移除,而不需要拆卸系统的其它部分,系统的其它部分例如铰接的末端执行器3或机械传动元件5、6、7,在不具有外部管2’的情况下,这些元件从机械视角保持完全操作。此特征促进由医院工作人员能够容易地执行的器械1的有效清洁和消毒。
朝向器械轴杆2的更远侧区域,外部管2’与密封元件19接触,这填充了外部管2’的内表面与安装在内部结构元件2”上的两个横向元件20a、20b之间的间隙。这两个横向元件20a、20b具有小通道21a、21b、21c、21d、21e、21f,传动元件5、6、7能够穿过所述小通道,从而确保器械1的气密性。
在本发明的一些实施例中,机械传动元件5、6、7可以包括绳索,所述绳索的张力能够在每次手术之后释放,使得清洁和消毒过程变得更容易。通过释放绳索上的张力,能够更容易地清除渗入在绳股之中的血液和组织。另外,能够更容易地进入绳索与其它机械元件(例如,滑轮、末端执行器链节8、9、10或旋转元件14、15、16)之间接触的区域。
尽管已参考本发明的具体实施例示出和描述本发明,但是本领域技术人员将理解,在不脱离由随附权利要求书限定的本发明的精神和范围的情况下可以对形式和细节作出各种改变。例如,外部管2’能够由不同的部分制成并且能够附接到近侧轮毂4。在另一实施例中,内部结构元件2”还能够由不同的部分组成并且能够采取具有不同截面的不同几何形状,即,管状(具有开口)或U形。
本领域技术人员还将容易地理解,本发明能够容易地部署在使用复杂器械的其它微操作任务的情况中,但是需要器械轴杆的内部元件的定期清洁和/或消毒。仅借助于实例,在污染环境中执行微操作任务,其中在每次使用之后需要器械元件的完全清洁。在此上下文中,可能需要允许进入内部元件的可拆卸外轴杆。
Claims (14)
1.一种可再用手术器械,其包括:
铰接式末端执行器,其安装在所述可再用手术器械的远端上,所述铰接式末端执行器包括一个或更多个末端执行器链节;
近侧轮毂,其安装在所述可再用器械的近端上,所述近侧轮毂包括被配置成致动所述末端执行器链节的一个或更多个旋转元件;
机械传动元件,其被配置成将运动从所述近侧轮毂传递到所述铰接式末端执行器;以及
轴杆,其限定所述器械的纵向轴线,所述轴杆包括并入所述机械传动元件的一个或更多个内部结构元件和外部管,所述外部管被配置成保护所述内部结构元件并且防止空气穿过所述可再用器械以保持体腔充气。
2.根据权利要求1所述的可再用手术器械,其中所述外部管能够从所述轴杆拆卸。
3.根据权利要求2所述的可再用手术器械,其中所述外部管能够从所述轴杆拆卸,而不需要拆卸所述可再用手术器械的任何其它组件。
4.根据权利要求2所述的可再用手术器械,其中在对所述器械执行清洁或消毒过程之后,所述外部管能够重新附接到所述轴杆。
5.根据权利要求1所述的可再用手术器械,其中所述外部管能够从所述轴杆拆卸并且重新附接到所述轴杆,以用于所述器械的多个使用周期。
6.根据权利要求2所述的可再用手术器械,其中至少一个横向元件被安装在所述一个或更多个内部结构元件上以提高所述可再用器械的气密性。
7.根据权利要求6所述的可再用手术器械,其中所述至少一个横向元件包括一个或更多个小通道,所述机械传动元件能够穿过所述一个或更多个小通道。
8.根据权利要求7所述的可再用手术器械,其中所述外部管与至少一个密封元件接触,这填充了所述外部管的内表面与所述横向元件之间的间隙。
9.根据权利要求1所述的可再用手术器械,其中所述外部管与至少一个密封元件接触,这填充了所述外部管的内表面与所述内部结构元件之间的间隙。
10.根据权利要求1所述的可再用手术器械,其中所述机械传动元件包括选自由线、链条、绳索和皮带组成的组的柔性机械元件。
11.根据权利要求10所述的可再用手术器械,其中所述机械传动元件上的张力能够在使用之后释放,以促进有效清洁和消毒过程。
12.根据权利要求1所述的可再用手术器械,其中所述旋转元件被放置于近侧铰接把手上,所述近侧铰接把手被配置成由用户的手直接控制,使得所述用户的移动传递到所述铰接式末端执行器。
13.根据权利要求1所述的可再用手术器械,其中所述可再用手术器械的近侧轮毂被配置成附接到包括主从遥控装置的机械平台,使得运动从所述主从遥控装置的近侧铰接把手传递到所述旋转元件。
14.根据权利要求13所述的可再用手术器械,其中所述可再用手术器械的近端能够容易地附接到所述机械平台以及从所述机械平台拆卸,使得所述近端被可拆卸地集成为所述主从遥控装置的部分。
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US11478315B2 (en) | 2022-10-25 |
US10646294B2 (en) | 2020-05-12 |
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WO2016097868A1 (en) | 2016-06-23 |
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EP3653145A1 (en) | 2020-05-20 |
CN107205787B (zh) | 2020-03-20 |
EP4342412A2 (en) | 2024-03-27 |
EP3232952A1 (en) | 2017-10-25 |
US20180000550A1 (en) | 2018-01-04 |
EP3232952B1 (en) | 2020-02-19 |
US20230054176A1 (en) | 2023-02-23 |
US20200268464A1 (en) | 2020-08-27 |
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