CN107249481A - 包括能够关节运动的端部执行器和用于调节击发构件击发行程的装置的外科器械系统 - Google Patents
包括能够关节运动的端部执行器和用于调节击发构件击发行程的装置的外科器械系统 Download PDFInfo
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Abstract
本发明公开了一种外科器械。所述外科器械可包括端部执行器,所述端部执行器包括砧座和钉仓。所述外科器械还可包括限定纵向轴线的轴。所述外科器械还能够包括关节运动接头,其中所述端部执行器能够在未进行关节运动的位置和至少一个关节运动位置之间围绕所述关节运动接头旋转地连接到所述轴。所述外科器械可包括如下装置,所述装置用于根据所述端部执行器相对于所述纵向轴线进行关节运动的程度来调节击发行程的长度。所述外科器械可包括传感器,所述传感器被构造成能够检测延伸穿过所述关节运动接头的所述柔性击发杆的侧向部分的移位。除此之外或另选地,所述外科器械可包括缓冲特征结构,所述缓冲特征结构被构造成能够适应柔性击发杆的侧向部分的移位。
Description
背景技术
本发明涉及外科器械,并且在各种实施方案中,涉及外科缝合和切割器械以及与其一同使用的钉仓。
缝合器械可包括一对协作细长钳口构件,其中每个钳口构件能够插入患者体内并且相对于待缝合和/或切入的组织定位。在各种实施方案中,钳口构件中的一者可支撑其中容纳有至少两个侧向地间隔开的钉排的钉仓,并且另一个钳口构件可支撑具有与钉仓中的钉排对准的钉成形凹坑的砧座。一般来讲,缝合器械还可包括推杆和刀片,所述推杆和刀片可相对于钳口构件滑动以通过推杆上的凸轮表面和/或由推杆推压的楔形滑动件上的凸轮表面将钉从钉仓中依次顶出。在至少一个实施方案中,凸轮表面可被构造成能够启动由仓承载并与钉相关联的多个钉驱动器,以推压钉贴靠在砧座上并且在夹持于钳口构件之间的组织中形成侧向地间隔的变形钉排。在至少一个实施方案中,刀片可跟随凸轮表面并且沿着钉排之间的路线切割组织。此类缝合器械的示例在名称为“SURGICAL STAPLES HAVINGCOMPRESSIBLE OR CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN AND STAPLINGINSTRUMENTS FOR DEPLOYING THE SAME”的美国专利号7,794,475中有所公开,该专利的全部公开内容以引用方式并入本文。
上述讨论仅是为了举例说明本发明的领域中相关技术目前的各个方面,而不应当视为对权利要求范围的否定。
附图说明
本文所述的实施方案的各种特征结构及其优点可结合如下附图根据以下描述来加以理解:
图1为根据本公开的各种实施方案的外科器械组件的局部平面图,所述外科器械组件包括能够关节运动的端部执行器,所述能够关节运动的端部执行器包括钉仓,其中所述能够关节运动的端部执行器被示出为处于未进行关节运动的位置,并且其中钉仓的关节运动位置也被示出以用于比较目的;
图2为图1的外科器械组件的关节运动接头的细部图,所述关节运动接头被构造成能够允许图1所示的关节运动动作;
图3为图1的外科器械组件的击发系统的击发连杆和击发杆之间的互连件的详细剖视图,其中击发系统被构造成能够从定位在图1的能够关节运动的端部执行器中的钉仓射出钉;
图4为被示出为处于与图1所示端部执行器的未进行关节运动的位置相关联的构型的图3的击发连杆和击发杆之间的互连件的细部图;
图5为沿图4的线5-5截取的图3的互连件的剖视图;
图6为根据本公开的各种实施方案的被示出为处于与图1所示端部执行器的关节运动位置相关联的构型的图3的击发连杆和击发杆之间的互连件的剖视图;
图7为被示出为处于图6所示构型的图3的击发连杆和击发杆之间的互连件的透视图,所述构型与图1所示端部执行器的关节运动位置相关联;
图8为根据本公开的各种实施方案的被示出为处于与图1所示端部执行器的关节运动位置相关联的构型的图3的击发连杆和击发系统的击发杆之间的互连件的透视图;
图9为根据本公开的各种实施方案的被示出为处于与图1所示端部执行器的未进行关节运动的位置相关联的构型的图3的击发连杆和击发杆之间的互连件的局部剖视图;
图10为被示出为处于与图1所示端部执行器的关节运动位置相关联的构型的图9的击发连杆和击发杆之间的互连件的局部剖视图;
图11为根据本公开的各种实施方案的被示出为处于与图1所示端部执行器的未进行关节运动的位置相关联的构型的图3的击发连杆和击发杆之间的互连件的局部剖视图;
图12为被示出为处于与图1所示端部执行器的关节运动位置相关联的构型的图11的击发连杆和击发杆之间的互连件的局部剖视图;
图13为根据本公开的各种实施方案的被示出为处于与图1所示端部执行器的未进行关节运动的位置相关联的构型的图3的击发连杆和击发系统的击发杆之间的互连件的局部剖视图;
图14为被示出为处于与图1所示端部执行器的关节运动位置相关联的构型的图13的击发连杆和击发杆之间的互连件的局部剖视图;
图15为根据本公开的各种实施方案的被示出为处于与图1所示端部执行器的关节运动位置相关联的构型的图3的击发连杆与击发系统的击发杆之间的局部分解图,其中击发系统包括能够相对于传感器运动的电容元件;
图16为示出当电容元件相对于传感器运动时可被图15的传感器检测到的电容的图表;
图17为根据本公开的各种实施方案的包括多个侧向部分和编码器系统的击发系统的击发杆的局部剖视透视图,所述编码器系统被构造成能够检测侧向部分相对于彼此的运动;
图18为根据本公开的各种实施方案的包括多个侧向部分和编码器系统的击发系统的击发杆的局部透视图,所述编码器系统被构造成能够检测侧向部分相对于彼此的运动;
图19为根据本公开的各种实施方案的图3的击发连杆和击发系统的击发杆之间的互连件的局部剖视图,所述击发系统被构造成能够从定位在图1的外科器械系统的端部执行器中的钉仓射出钉,所述击发系统包括位于击发连杆和击发杆之间的压缩缓冲接头;
图20为被示出为处于部分压缩状态的图19的击发连杆和击发杆之间的互连件的局部剖视图,所述部分压缩状态与处于部分关节运动位置的图1的端部执行器一致;
图21为被示出为处于压缩状态的图19的击发连杆和击发杆之间的互连件的局部剖视图,所述部分压缩状态与处于关节运动位置的图1的端部执行器一致;
图22为根据本公开的各种实施方案的钉仓以及包括钉部署滑动件和刀构件的击发系统的局部剖视图,其中击发系统包括被定位在滑动件和刀构件中间的行程补偿构件;
图23为根据本公开的各种实施方案的仓通道、被定位在仓通道中的钉仓、能够相对于钉仓和仓通道运动的击发构件、以及能够被击发构件接触的远侧刀止挡件的局部透视图;
图24为根据本公开的各种实施方案的钉仓的远侧端部的局部透视图,所述钉仓为了清楚起见以部件被移除示出并且包括限定于钉仓中的远侧开口,其中远侧开口被构造成能够允许击发系统的部分从中延伸穿过;
图25为根据本公开的各种实施方案的包括多个止挡件的能够关节运动的端部执行器的平面图,所述多个止挡件被构造成能够根据端部执行器已进行关节运动的量来限制击发构件的击发行程,其中能够关节运动的端部执行器被示出为处于未进行关节运动的位置,并且其中钉仓的关节运动位置也被示出以用于比较目的;
图26为根据本公开的各种实施方案的包括能够关节运动的端部执行器、轴和击发路径移位器的外科器械的局部平面图,其中能够关节运动的端部执行器相对于轴处于未进行关节运动的取向;
图27为图26的外科器械的局部平面图,其中能够关节运动的端部执行器相对于轴处于关节运动取向;
图28为根据本公开的各种实施方案的外科缝合器械的端部执行器的透视图;
图29为图28中的端部执行器的剖视正视图;
图30为根据本公开的各种实施方案的端部执行器的仓通道的局部透视图;
图31为根据本公开的各种实施方案的处于闭合的端部执行器的剖视正视图,其中击发构件组件处于非击发位置;
图32为图31的端部执行器的剖视正视图,其中击发构件组件处于部分击发位置;
图33为图31的端部执行器的剖视正视图,其中击发构件组件处于行程末端位置;
图34为根据本公开的各种实施方案的击发构件的侧正视图;
图35为根据本公开的各种实施方案的端部执行器的通道保持器的透视图;
图36为根据本公开的各种实施方案的端部执行器的局部透视图,所述端部执行器组件包括围绕关节运动接头可旋转地联接到轴的图35的通道保持器;
图37为处于非击发位置的图36的端部执行器组件的剖视透视图;
图38为处于行程末端位置的图36的端部执行器组件的剖视透视图;
图39为示出基于击发构件组件的状态的示例信号输出的表;
图40为图34的击发构件的另选击发构件的侧正视图;
图41为根据本公开的各种实施方案的包括另选击发构件的端部执行器组件的剖视透视图;
图42为根据本公开的各种实施方案的仓支撑通道的透视图;
图43为根据本公开的各种实施方案的包括反馈条的端部执行器组件的局部剖视透视图;
图44为根据本公开的各种实施方案的柄部组件的局部剖视透视图,所述柄部组件以部分移除被示出以用于图示目的;
图45为根据本公开的各种实施方案的柄部组件的局部透视图,所述柄部组件以部分移除被示出以用于图示目的;
图46为图45的柄部组件的剖视局部平面图;
图47为根据本公开的各种实施方案的包括行程末端离合器的剖视平面图,所述柄部组件以部分移除被示出以用于图示目的;
图48为根据本公开的各种实施方案的端部执行器的局部剖视正视图;
图49为根据本公开的各种实施方案的外科器械的端部执行器、关节运动接头、和轴的一部分的剖视正视图,其中示出处于未进行关节运动的取向的端部执行器并且还示出处于远侧位置的击发杆止挡件;
图50为图49的端部执行器、关节运动接头、和轴的局部剖视平面图,其中示出处于未进行关节运动的取向的端部执行器并且还示出处于远侧位置的击发杆止挡件;
图51为图49的端部执行器、关节运动接头、和轴的局部剖视正视图,其中示出处于未进行关节运动的取向的端部执行器并且还示出处于远侧位置的击发杆止挡件;
图52为图49的端部执行器、关节运动接头和轴的局部剖视平面图,其中示出处于关节运动取向的端部执行器并且还示出处于近侧位置的击发杆止挡件;并且
图53为图49的端部执行器、关节运动接头和轴的局部剖视正视图,其中示出处于关节运动取向的端部执行器并且还示出处于近侧位置的击发杆止挡件。
在所有这些视图中,对应的参考符号指示对应的部件。本文所述的范例以一种形式示出了本发明的各种实施方案,并且此类范例不应被解释为以任何方式限制本发明的范围。
具体实施方式
本申请的申请人拥有与本申请同日提交的下列专利申请,这些专利申请各自全文以引用方式并入本文:
-名称为“SURGICAL INSTRUMENT ASSEMBLY COMPRISING LOCKABLE SYSTEMS”的美国专利申请序列号_______(代理人案卷号END7416USNP/140291);
-名称为“DRIVE ARRANGEMENTS FOR ARTICULATABLE SURGICAL INSTRUMENTS”的美国专利申请序列号_______(代理人案卷号END7418USNP/140292);
-名称为“LOCKING ARRANGEMENTS FOR DETACHABLE SHAFT ASSEMBLIES WITHARTICULATABLE SURGICAL END EFFECTORS”的美国专利申请序列号_______(代理人案卷号END7417USNP/140293);
-名称为“SURGICAL INSTRUMENT WITH AN ANVIL THAT IS SELECTIVELY MOVABLEABOUT A DISCRETE NON-MOVABLE AXIS RELATIVE TO A STAPLE CARTRIDGE”的美国专利申请序列号_______(代理人案卷号END7485USNP/140295);
-名称为“SURGICAL INSTRUMENTS WITH IMPROVED CLOSURE ARRANGEMENTS”的美国专利申请序列号_______(代理人案卷号END7486/140296);
-名称为“SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTORS ANDMOVABLE FIRING BEAM SUPPORT ARRANGEMENTS”的美国专利申请序列号_______(代理人案卷号END7489USNP/140299);
-名称为“SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTORS ANDIMPROVED FIRING BEAM SUPPORT ARRANGEMENTS”的美国专利申请序列号_______(代理人案卷号END7491USNP/140301);
-名称为“SURGICAL INSTRUMENT ASSEMBLY COMPRISING A FLEXIBLEARTICULATION SYSTEM”的美国专利申请序列号_______(代理人案卷号END7492USNP/140302);和
-名称为“SURGICAL INSTRUMENT ASSEMBLY COMPRISING A LOCKABLEARTICULATION SYSTEM”的美国专利申请序列号_______(代理人案卷号END7494USNP/140304)。
本申请的申请人拥有2013年3月1日提交并且全文各自以引用的方式并入本文的以下专利申请:
-名称为“ARTICULATABLE SURGICAL INSTRUMENTS WITH CONDUCTIVE PATHWAYSFOR SIGNAL COMMUNICATION”的美国专利申请序列号13/782,295(现为美国专利申请公开号2014/0246471);
-名称为“ROTARY POWERED ARTICULATION JOINTS FOR SURGICAL INSTRUMENTS”的美国专利申请序列号13/782,323(现为美国专利申请公开号2014/0246472);
-名称为“THUMBWHEEL SWITCH ARRANGEMENTS FOR Surgical INSTRUMENTS”的美国专利申请序列号13/782,338(现为美国专利申请公开号2014/0249557);
-名称为“ELECTROMECHANICAL SURGICAL DEVICE WITH SIGNAL RELAYARRANGEMENT”的美国专利申请序列号13/782,499(现为美国专利申请公开号2014/0246474);
-名称为“MULTIPLE PROCESSOR MOTOR CONTROL FOR Modular SURGICALINSTRUMENTS”的美国专利申请序列号13/782,460(现为美国专利申请公开号2014/0246478);
-名称为“JOYSTICK SWITCH ASSEMBLIES FOR SURGICAL Instruments”的美国专利申请序列号13/782,358(现为美国专利申请公开号2014/0246477);
-名称为“SENSOR STRAIGHTENED END EFFECTOR DURING Removal THROUGHTROCAR”的美国专利申请序列号13/782,481(现为美国专利申请公开号2014/0246479);
-名称为“CONTROL METHODS FOR SURGICAL INSTRUMENTS WITH RemovableIMPLEMENT PORTIONS”的美国专利申请序列号13/782,518(现为美国专利申请公开号2014/0246475);
-名称为“ROTARY POWERED SURGICAL INSTRUMENTS WITH MULTIPLE DEGREES OFFREEDOM”的美国专利申请序列号13/782,375(现为美国专利申请公开号2014/0246473);和
-名称为“SURGICAL INSTRUMENT SOFT STOP”的美国专利申请序列号13/782,536(现为美国专利申请公开号2014/0246476)。
本申请的申请人还拥有提交于2013年3月14日并且各自全文以引用的方式并入本文的以下专利申请:
-名称为“ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE”的美国专利申请序列号13/803,097(现为美国专利申请公开号2014/0263542);
-名称为“CONTROL ARRANGEMENTS FOR A DRIVE MEMBER OF A SURGICALINSTRUMENT”的美国专利申请序列号13/803,193(现为美国专利申请公开号2014/0263537);
-名称为“INTERCHANGEABLE SHAFT ASSEMBLIES FOR USE WITH A SURGICALINSTRUMENT”的美国专利申请序列号13/803,053(现为美国专利申请公开号2014/0263564);
-名称为“ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATIONLOCK”的美国专利申请序列号13/803,086(现为美国专利申请公开号2014/0263541);
-名称为“SENSOR ARRANGEMENTS FOR ABSOLUTE POSITIONING SYSTEM FORSURGICAL INSTRUMENTS”的美国专利申请序列号13/803,210(现为美国专利申请公开号2014/0263538);
-名称为“MULTI-FUNCTION MOTOR FOR A SURGICALINSTRUMENT”的美国专利申请序列号13/803,148(现为美国专利申请公开号2014/0263554);
-名称为“DRIVE SYSTEM LOCKOUT ARRANGEMENTS FOR MODULAR SURGICALINSTRUMENTS”的美国专利申请序列号13/803,066(现为美国专利申请公开号2014/0263565);
-名称为“ARTICULATION CONTROL SYSTEM FOR ARTICULATABLE SURGICALINSTRUMENTS”的美国专利申请序列号13/803,117(现为美国专利申请公开号2014/0263553);
-名称为“DRIVE TRAIN CONTROL ARRANGEMENTS FOR MODULAR SURGICALINSTRUMENTS”的美国专利申请序列号13/803,130(现为美国专利申请公开号2014/0263543);和
-名称为“METHOD AND SYSTEM FOR OPERATING A SURGICAL INSTRUMENT”的美国专利申请序列号13/803,159(现为美国专利申请公开号2014/0277017)。
本申请的申请人还拥有2014年3月7日并且各自全文以引用方式并入本文的以下专利申请:
-名称为“CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS”的美国专利申请序列号14/200,111(现为美国专利申请公开号2014/0263539)。
本申请的申请人还拥有提交于2014年3月26日的以下专利申请,并且其中每一个各自全文以引用的方式并入本文:
名称为“POWER MANAGEMENT CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS”的美国专利申请序列号14/226,106;
名称为“STERILIZATION VERIFICATION CIRCUIT”的美国专利申请序列号14/226,099;
名称为“VERIFICATION OF NUMBER OF BATTERY EXCHANGES/PROCEDURE COUNT”的美国专利申请序列号14/226,094;
名称为“POWER MANAGEMENT THROUGH SLEEP OPTIONS OF SEGMENTED CIRCUITAND WAKE UP CONTROL”的美国专利申请序列号14/226,117;
名称为“MODULAR POWERED SURGICAL INSTRUMENT WITH DETACHABLE SHAFTASSEMBLIES”的美国专利申请序列号14/226,075;
名称为“FEEDBACK ALGORITHMS FOR MANUAL BAILOUT SYSTEMS FOR SURGICALINSTRUMENTS”的美国专利申请序列号14/226,093;
名称为“SURGICAL INSTRUMENT UTILIZING SENSOR ADAPTATION”的美国专利申请序列号14/226,116;
名称为“SURGICAL INSTRUMENT CONTROL CIRCUIT HAVING A SAFETY PROCESSOR”的美国专利申请序列号14/226,071;
名称为“SURGICAL INSTRUMENT COMPRISING INTERACTIVE SYSTEMS”的美国专利申请序列号14/226,097;
名称为“INTERFACE SYSTEMS FOR USE WITH SURGICAL INSTRUMENTS”的美国专利申请序列号14/226,126;
名称为“MODULAR SURGICAL INSTRUMENT SYSTEM”的美国专利申请序列号14/226,133;
名称为“SYSTEMS AND METHODS FOR CONTROLLING A SEGMENTED CIRCUIT”的美国专利申请序列号14/226,081;
名称为“POWER MANAGEMENT THROUGH SEGMENTED CIRCUIT AND VARIABLEVOLTAGE PROTECTION”的美国专利申请序列号14/226,076;
名称为“SURGICAL STAPLING INSTRUMENT SYSTEM”的美国专利申请序列号14/226,111;以及
名称为“SURGICAL INSTRUMENT COMPRISING A ROTATABLE SHAFT”的美国专利申请序列号14/226,125。
本申请的申请人还拥有2014年9月5日提交并且全文各自以引用的方式并入本文的以下专利申请:
-名称为“CIRCUITRY AND SENSORS FOR POWERED MEDICAL DEVICE)的美国专利申请序列号14/479,103;
-名称为“ADJUNCT WITH INTEGRATED SENSORS TO QUANTIFY TISSUECOMPRESSION”的美国专利申请序列号14/479,119;
-名称为“MONITORING DEVICE DEGRADATION BASED ON COMPONENT EVALUATION”的美国专利申请序列号14/478,908;
-名称为“MULTIPLE SENSORS WITH ONE SENSOR AFFECTING A SECOND SENSOR'SOUTPUT OR INTERPRETATION”的美国专利申请序列号14/478,895;
-名称为“USE OF POLARITY OF HALL MAGNET DETECTION TODETECT MISLOADEDCARTRIDGE”的美国专利申请序列号14/479,110;
-名称为“SMART CARTRIDGE WAKE UP OPERATION AND DATA RETENTION”的美国专利申请序列号14/479,098;
-名称为“MULTIPLE MOTOR CONTROL FOR POWERED MEDICAL DEVICE”的美国专利申请序列号14/479,115;和
-名称为“LOCAL DISPLAY OF TISSUE PARAMETER STABILIZATION”的美国专利申请序列号14/479,108。
本申请的申请人还拥有2014年4月9日提交并且全文各自以引用的方式并入本文的以下专利申请:
-名称为“MOTOR DRIVEN SURGICAL INSTRUMENTS WITH LOCKABLE DUAL DRIVESHAFTS”的美国专利申请序列号14/248,590(现为美国专利申请公开号2014/0305987);
-名称为“SURGICAL INSTRUMENT COMPRISING A CLOSING DRIVE AND A FIRINGDRIVE OPERATED FROM THE SAME ROTATABLE OUTPUT”的美国专利申请序列号14/248,581(现为美国专利申请公开号2014/0305989);
-名称为“SURGICAL INSTRUMENT SHAFT INCLUDING SWITCHES FOR CONTROLLINGTHE OPERATION OF THE SURGICAL INSTRUMENT”的美国专利申请序列号14/248,595(现为美国专利申请公开号2014/0305988);
-名称为“POWERED LINEAR SURGICAL STAPLER”的美国专利申请序列号14/248,588(现为美国专利申请公开号2014/0309666);
-名称为“TRANSMISSION ARRANGEMENT FOR A SURGICAL INSTRUMENT”的美国专利申请序列号14/248,591(现为美国专利申请公开号2014/0305991);
-名称为“MODULAR MOTOR DRIVEN SURGICAL INSTRUMENTS WITH ALIGNMENTFEATURES FOR ALIGNING ROTARY DRIVE SHAFTS WITH SURGICAL END EFFECTOR SHAFTS”的美国专利申请序列号14/248,584(现为美国专利申请公开号2014/0305994);
-名称为“POWERED SURGICAL STAPLER”的美国专利申请序列号14/248,587(现为美国专利申请公开号2014/0309665);
-名称为“DRIVE SYSTEM DECOUPLING ARRANGEMENT FOR A SURGICALINSTRUMENT”的美国专利申请序列号14/248,586(现为美国专利申请公开号2014/0305990);和
-名称为“MODULAR MOTOR DRIVEN SURGICAL INSTRUMENTS WITH STATUSINDICATION ARRANGEMENTS”的美国专利申请序列号14/248,607(现为美国专利申请公开号2014/0305992)。
本申请的申请人还拥有2013年4月16日提交并且全文各自以引用的方式并入本文的以下专利申请:
-名称为“SURGICAL INSTRUMENT WITH MULTIPLE FUNCTIONS PERFORMED BY ASINGLE MOTOR”的美国临时专利申请序列号61/812,365;
-名称为“LINEAR CUTTER WITH POWER”的美国临时专利申请序列号61/812,376;
-名称为“LINEAR CUTTER WITH MOTOR AND PISTOL GRIP”的美国临时专利申请序列号61/812,382;
-名称为“SURGICAL INSTRUMENT HANDLE WITH MULTIPLE ACTUATION MOTORS ANDMOTOR CONTROL”的美国临时专利申请序列号61/812,385;和
-名称为“SURGICAL INSTRUMENT WITH MULTIPLE FUNCTIONS PERFORMED BY ASINGLE MOTOR”的美国临时专利申请序列号61/812,372。
本文列出了许多具体细节,以提供对说明书中所述和附图中所示的实施方案的整体结构、功能、制造和用途的透彻理解。未详细阐述熟知的操作、部件和元件,以免使说明书中阐述的实施方案模糊不清。读者将会理解,本文所述和所示的实施方案为非限制性示例,从而可认识到,本文所公开的特定结构和功能细节可为代表性和示例性的。在不脱离权利要求的范围的情况下可对这些实施方案进行变型和改变。
术语“包括”(以及“包括”的任何形式,诸如“包括(comprises)”和“包括(comprising)”)、“具有”(和“具有”的任何形式,诸如“具有(has)”和“具有(having)”)、“包含”(和“包含”的任何形式,诸如“包含(includes)”、和“包含(including)”以及“含有”(和“含有”的任何形式,诸如“含有(contains)”和“含有(containing)”)为开放式系动词。因此,“包括”、“具有”、“包含”或“含有”一个或多个元件的外科系统、装置、或设备具有这些一个或多个元件,但不限于仅具有这些一个或多个元件。同样,“包括”、“具有”、“包含”或“含有”一个或多个特征的系统、装置、或设备的元件具有这些一个或多个特征,但不限于仅具有这些一个或多个特征。
术语“近侧”和“远侧”在本文中是相对于操纵外科器械的柄部部分的临床医生来使用的。术语“近侧”是指最靠近临床医生的部分,并且术语“远侧”是指远离临床医生定位的部分。还应当理解,为简洁和清楚起见,本文可以结合附图使用空间术语诸如“垂直”、“水平”、“上”和“下”。然而,外科器械在许多取向和位置使用,并且这些术语并非旨在限制性和/或绝对化的。
提供各种示例性装置和方法以用于执行腹腔镜式和微创外科手术操作。然而,读者将容易理解,本文所公开的各种方法和装置可用于多种外科手术和应用中,包括例如与开放式外科手术结合。继续参阅本具体实施方式,读者将进一步理解,本文所公开的各种器械可以任何方式插入身体中,诸如通过自然腔道、通过形成于组织中的切口或穿刺孔等。器械的工作部分或端部执行器部分可直接插入患者身体中或可通过具有工作通道的进入装置插入,外科器械的端部执行器和细长轴可通过所述工作通道推进。
外科缝合系统可包括轴和从轴延伸的端部执行器。端部执行器包括第一钳口和第二钳口。第一钳口包括钉仓。钉仓能够插入第一钳口并且能够从第一钳口移除;然而设想了其中钉仓不能够从第一钳口移除或至少不易于从第一钳口替换的其他实施方案。第二钳口包括被构造成能够使从钉仓射出的钉变形的砧座。第二钳口能够围绕闭合轴相对于第一钳口枢转;然而设想了其中第一钳口能够相对于第二钳口枢转的其他实施方案。外科缝合系统还包括被构造成能够允许端部执行器相对于轴旋转或进行关节运动的关节运动接头。端部执行器能够围绕延伸穿过关节运动接头的关节运动轴旋转。设想了不包括关节运动接头的其他实施方案。
钉仓包括仓体。仓体包括近侧端部、远侧端部、以及在近侧端部和远侧端部之间延伸的平台。在使用中,钉仓定位在待缝合组织的第一侧上,并且砧座定位在该组织的第二侧上。砧座朝向钉仓运动,以贴靠平台压缩并夹紧组织。然后,可移除地储存在仓体中的钉可部署到组织中。仓体包括限定于其中的钉腔,其中钉可移除地储存在钉腔中。钉腔布置成六个纵向排。三排钉腔定位在纵向狭槽的第一侧上,并且三排钉腔定位在纵向狭槽的第二侧上。钉腔和钉的其他布置也是可以的。
钉由仓体中的钉驱动器支撑。驱动器能够在第一或非击发位置与第二或击发位置之间运动,以从钉仓射出钉。驱动器通过保持器保留在仓体中,该保持器围绕仓体的底部延伸并且包括被构造成能够夹持仓体以及将保持器保持至仓体的弹性构件。驱动器能够通过滑动件在其非击发位置和击发位置之间运动。滑动件能够在邻近近侧端部的近侧位置和邻近远侧端部的远侧位置之间运动。滑动件包括多个斜坡表面,该斜坡表面被构造成能够朝向砧座在驱动器下方滑动以及提升驱动器,并且钉在驱动器上受到支撑。
除上述以外,滑动件还可通过击发构件在远侧运动。击发构件被构造成能够接触滑动件并朝向远侧端部推动滑动件。限定于仓体中的纵向狭槽被构造成能够接收击发构件。砧座还包括被构造成能够接收击发构件的狭槽。击发构件还包括接合第一钳口的第一凸轮和接合第二钳口的第二凸轮。随着击发构件在远侧推进,第一凸轮和第二凸轮可控制钉仓的平台和砧座之间的距离或组织间隙。击发构件还包括被构造成能够切入在钉仓和砧座中间捕集的组织的刀片。希望刀片定位成至少部分接近斜坡表面,使得钉先于刀片射出。
端部执行器可被构造成能够相对于外科器械的柄部和/或轴进行关节运动。例如,端部执行器能够可枢转地和/或可旋转地联接到外科器械的轴,使得端部执行器被构造成能够相对于轴和柄部枢转。在各种情况下,端部执行器可被构造成能够在定位于端部执行器和轴中间的关节运动接头处进行关节运动。在其他情况下,轴可包括例如近侧部分、远侧部分、以及可定位在轴的近侧部分和远侧部分中间的关节运动接头。
现在参见图1和图2,外科器械100的关节运动接头130被部分地示出。外科器械100包括轴110和能够关节运动的端部执行器120。图1和图2所示的能够关节运动的端部执行器120在关节运动接头130处联接到外科器械100的轴110,所述关节运动接头130允许端部执行器120相对于轴110的关节运动。钉仓122被定位在所示的端部执行器120中。主要参见图1,所示钉仓122包括具有多个钉腔126的仓体124。在各种情况下,紧固件诸如钉能够可移除地定位在钉腔126中。
在某些情况下,钉仓122能够可移除地定位在端部执行器120中,并且在其他情况下,钉仓122可永久性地固定到端部执行器120和/或与其一体形成。在某些情况下,仓体124可包括具有限定的钉腔126的刚性主体。除此之外或另选地,仓体124可包括柔性和/或可变形部分,并且钉可嵌入和/或部分地嵌入在仓体124中。
外科器械可包括可延伸穿过关节运动接头的柔性击发杆。在此类情况下,柔性击发杆可被构造成能够在端部执行器处于关节运动取向时在关节运动接头处弯曲或挠曲。在至少一种情况下,柔性击发杆可包括多个侧向层或部分。柔性击发杆可在关节运动接头的弯曲部处限定内侧曲率半径和外侧曲率半径。例如,柔性击发杆的外侧侧向部分可沿着限定关节运动接头内的外侧曲率半径的第一路径延伸,并且柔性击发杆的内侧侧向部分可沿着限定关节运动接头内的内侧曲率半径的第二路径延伸。击发杆的外侧曲率半径可大于内侧曲率半径。因此,相比于柔性击发杆的外侧侧向部分,柔性击发杆的内侧侧向部分可朝近侧延伸更大距离。每个侧向部分的曲率半径和因此每个侧向部分的相对位置可取决于端部执行器已进行关节运动的程度。
当柔性击发杆在关节运动接头处挠曲时,除上述之外,侧向部分可被构造成能够相对于彼此移位。在各种情况下,侧向部分可在远侧端部处诸如通过焊接联接在一起。在此类情况下,每个侧向部分的剩余长度(例如,非联接部分)能够相对于相邻的一个或多个侧向部分自由地移位和/或滑动。
在各种情况下,例如,当柔性击发杆挠曲并且侧向部分移位时,侧向部分中的一部分的近侧端部可相对于其他侧向部分位移。在某些情况下,例如,至少一个侧向部分的近侧端部可朝远侧位移并且至少一个侧向部分的近侧端部可朝近侧位移。在其他情况下,例如,每个侧向部分的近侧部分可朝近侧位移和/或推动。轴内的每个侧向部分相对于其他侧向部分的位置可取决于端部执行器的关节运动角度。
在各种情况下,柔性击发杆可联接到击发连杆或梁。击发连杆可被构造成能够将击发力传输到柔性击发杆。在某些情况下,击发连杆可被构造成能够运动预定义距离以使柔性击发杆位移到未进行关节运动的端部执行器中的预定义最远侧位置。然而,当端部执行器进行关节运动并且侧向部分的近侧端部已进行移位时,击发连杆运动预定义距离可不使柔性击发杆位移到关节运动的端部执行器中的预定义最远侧位置。相反,当端部执行器进行关节运动时,如果击发连杆仅位移预定义距离,则柔性击发杆可停止在预定义最远侧位置的近侧。此外,柔性击发杆在击发连杆位移预定义距离时所达到的远侧位置可取决于端部执行器进行关节运动的程度。
因此,当端部执行器进行关节运动时,被柔性击发杆驱动穿过钉仓的钉部署滑动件和/或切割边缘可不到达相对于端部执行器的远侧端部而言的同一远侧位置。相反,击发系统可在滑动件和/或切割边缘到达下述远侧位置之前停止推进滑动件和/或切割边缘,所述远侧位置将为端部执行器未进行关节运动情况下所到达的位置。因此,当端部执行器进行关节运动时,切割边缘可不完成切割动作,并且/或者滑动件可不完成击发动作并因此可不从最远侧钉腔击发钉。在各种情况下,端部执行器的关节运动程度可影响柔性击发杆、钉部署滑动件和/或切割边缘在击发行程期间所到达的远侧位置。
在某些情况下,为了确保柔性击发杆、钉部署滑动件和/或切割边缘到达其在端部执行器内的预定最远侧位置,可调节击发行程。例如,当端部执行器进行关节运动时,可调节击发行程使得击发连杆位移较大距离。在某些情况下,对击发行程的调节可取决于端部执行器的关节运动角度。例如,当端部执行器的关节运动角度增大时,击发连杆在已调节的击发行程期间的位移可增大。
参见图1-图7所示的外科器械100及其部件,外科器械100包括击发系统112,所述击发系统112被构造成能够将击发动作从外科器械100的柄部传输到端部执行器120。在所示实施方案中,击发系统112包括击发连杆114,所述击发连杆114在联接件或互连件116(图3-图7)处联接到柔性击发杆118。击发连杆114可延伸到轴110内并且可响应于在外科器械100的柄部中发起的驱动动作而平移。在各种情况下,击发连杆114可抵制传输击发动作时的变形、扭转和/或弓弯。例如,击发连杆114可由刚性和/或非柔性材料和/或结构构成。
在联接件116处,现在主要参见图3-图5,击发连杆114与柔性击发杆118的键119接合。例如,键119可延伸到击发连杆114中的孔115内。击发连杆-键接合被构造成能够将击发连杆114的平移传输到柔性击发杆118。在各种情况下,联接件116可位于关节运动接头130的近侧,使得柔性击发杆118从联接件116延伸并且穿过关节运动接头130。
柔性击发杆118包括多个侧向部分或层128a、128b、128c、128d。在各种情况下,部分128a、128b、128c、128d可保持在一起并且能够相对于彼此运动和/或移位。例如,侧向部分128a、128b、128c、128d可在柔性击发杆118的远侧端部处固定在一起。部分128a、128b、128c、128d可例如在其远侧端部处焊接、形成一体、紧固和/或以其他方式固定在一起。侧向部分128a、128b、128c、128d的剩余长度的至少一部分可被构造成能够相对于相邻的一个或多个侧向部分128a、128b、128c、128d运动和/或移位。例如,当柔性击发杆118在关节运动接头130处弯曲时,侧向部分128a、128b、128c、128d可在关节运动接头130的弯曲部和柔性击发杆118的近侧端部之间移位成交错和/或移位的构型,如图6所示。
再次参见图1-图3,柔性击发杆118的部分128a、128b、128c、128d可沿着击发路径延伸穿过关节运动接头130。当端部执行器120相对于轴110进行关节运动时,柔性击发杆118及其部分128a、128b、128c、128d可在关节运动接头130内弯曲。在此类情况下,侧向部分128a、128b、128c、128d可在端部执行器120进行关节运动时沿着改变的路径延伸。
例如,主要参见图2,外侧部分128a可沿着具有外侧曲率半径的外侧路径延伸,并且内侧部分128d可沿着具有内侧曲率半径的内侧路径延伸。由于击发杆118在关节运动接头130内的变形,内侧曲率半径可与外侧曲率半径不同。例如,参见图1和图2,外侧曲率半径大于内侧曲率半径。因此,现在参见图6,当端部执行器120相对于轴110处于关节运动取向时,部分128a、128b、128c、128d可在柔性击发杆118的近侧端部部分140处变为交错的。
在某些情况下,柔性击发杆118和击发杆部分128a、128b、128c、128d的移位的近侧端部部分140可最终影响柔性击发杆118在击发行程期间所到达的远侧位置。例如,柔性击发杆118在击发行程期间可到达的远侧位置能够在端部执行器120进行关节运动时有所改变。因此,当端部执行器120处于关节运动取向时,钉部署滑动件和/或切割元件在击发行程期间所到达的远侧位置也可移位。
在某些情况下,可期望基于计算和/或逼近来估计柔性击发杆118可通过击发行程而位移的距离。此类计算和/或逼近可基于端部执行器已进行关节运动的程度。在其他情况下,可期望监测和/或以其他方式确定柔性击发杆118在击发行程期间的位置。例如,柔性击发杆118的远侧端部、近侧端部和/或中间部分处的至少一个传感器可检测柔性击发杆118在击发行程期间的位移和/或侧向部分128a、128b、128c、128d在关节运动动作期间的移位。在各种情况下,传感器可包括例如电阻传感器、电感传感器、电容传感器、和/或磁性传感器。
在各种情况下,可期望基于柔性击发杆118的位置和/或端部执行器120的关节运动程度来调节击发行程长度。在各种情况下,检测系统和/或传感器可被构造成能够检测柔性击发杆118的侧向部分128a、128b、128c、128d的移位以确定端部执行器120的关节运动程度。在某些情况下,检测系统和/或传感器可被定位在关节运动接头130的近侧。例如,检测系统和/或传感器可被定位在柔性击发杆118和/或其侧向部分128a、128b、128c、128d的近侧端部140处和/或附近的轴110内。在其他情况下,检测系统和/或传感器可被构造成能够监测柔性击发杆118在击发行程期间的位置并且基于柔性击发杆118的所检测位置来调节击发行程长度。例如,检测系统和/或传感器可被定位在端部执行器120中和/或关节运动接头130的远侧。在其他情况下,此类传感器可被定位在关节运动接头130近侧的外科器械100的轴110中。
外科器械100可包括传感器,诸如霍尔效应传感器和/或电阻触件,该传感器可被构造成能够检测侧向部分128a、128b、128c、128d在端部执行器120进行关节运动时的移位。如本文所述,移位量可对应于端部执行器120进行关节运动的程度。检测系统250示于图6和图7中。检测系统250可被构造成能够检测侧向部分128a、128b、128c、128d在柔性击发杆118(图1-图7)的近侧端部140处的移位和/或交错。
仍参见图6和图7,检测系统250可安装在和/或以其他方式定位在外科器械100(图1)的轴110中。在各种情况下,检测系统250可包括至少一个磁体和霍尔效应传感器。例如,所示检测系统250包括例如一系列磁体252a、252b、252c、252d和252e和霍尔效应传感器254。磁体252a、252b、252c、252d和252e被定位在击发杆118上。例如,磁体252a、252b、252c、252d和252e在联接件116内沿着击发杆118的近侧端部部分140隔开。
如图6所示,磁体252a、252b、252c、252d和252e可安装到柔性击发杆118的侧向部分128a、128b、128c、128d中的至少一者。在所示布置中,磁体252a、252b、252c、252d和252e安装到第四部分128d。此外,霍尔效应传感器254还可被定位在轴110中。例如,霍尔效应传感器254可安装在击发杆118的近侧端部部分140上方的轴110上。在此类情况下,霍尔效应传感器254可相对于轴110是固定和/或静止的,并且磁体252a、252b、252c、252d和252e可被构造成能够在端部执行器120进行关节运动时相对于传感器254运动。
在某些情况下,检测系统250可包括少于或多于图6和图7所示的五个磁体252a、252b、252c、252d和252e。此外,磁体252a、252b、252c、252d和252e可安装到多个侧向部分128a、128b、128c、128d和/或其上。此外,如本文所述,至少一个霍尔效应传感器可安装到侧向部分128a、128b、128c、128d中的一者或多者。
磁体可包括例如永磁体和/或电磁体。在某些情况下,部分128a、128b、128c、128d可包括例如可形成检测系统250的磁体的铁质材料。例如,铁质材料可嵌入在侧向部分128a、128b、128c、128d中,并且/或者可包括围绕侧向部分128a、128b、128c、128d的区域的涂层。
由于检测系统250的各种部件的布置,因此检测系统250可被构造成能够检测当端部执行器120(图1)运动到关节运动取向时的击发杆交错量。在各种情况下,当击发杆118在关节运动接头130中弯曲时,侧向部分128a、128b、128c、128d可移位,使得部分128a、128b、128c、128d的近侧端部位移。当部分128a、128b、128c、128d相对于彼此移位时,安装到第四部分128d的磁体252a、252b、252c、252d和252e也可移位。在此类情况下,霍尔效应传感器254可检测磁体252a、252b、252c、252d和252e的位移。基于磁体252a、252b、252c、252d和252e的所检测位移,可确定和/或估计端部执行器进行关节运动的程度。
在各种情况下,检测系统250可与控制器通信,所述控制器可被构造成能够基于来自霍尔效应传感器254的反馈来检测关节运动角度。除此之外或另选地,控制器可被构造成能够根据基于部分128a、128b、128c、128d之间的所检测的交错和/或偏移量计算和/或估计的端部执行器关节运动程度来调节击发行程的长度。在此类情况下,控制器可调节击发行程长度,使得柔性击发杆118到达端部执行器120中的预定义最远侧位置,即,击发杆118在端部执行器120处于未进行关节运动的位置时到达的同一预定义最远侧位置。
在各种情况下,编码系统可被构造成能够检测和/或确定端部执行器的关节运动程度。例如,现在参见图8,柔性击发杆318可在联接件316处联接到击发连杆114。类似于柔性击发杆118(图1-7),柔性击发杆318被构造成能够将击发动作从击发连杆114通过关节运动接头130(图1和图2)传输到端部执行器120(图1和图2)。柔性击发杆318可包括可在端部执行器120进行关节运动时相对于彼此移位的多个侧向部分328a、328b、328c和328d。类似于上文所述,部分328a、328b、328c和328d的近侧端部可变为交错的,如图8所示。部分328a、328b、328c和328d可包括位于柔性击发杆318的近侧端部部分340处的不平坦和/或不规则区段352。
在所示实施方案中,每个不平坦区段352包括多个齿354。在其他情况下,每个不平坦区段352可包括单个齿354。除此之外或另选地,至少一个不平坦区段352可限定多个轮廓、成角部分、谷和/或峰。在某些情况下,齿354可限定例如成轮廓的和/或倒圆的谷和/或峰,使得齿354形成例如起伏和/或波动轮廓。在某些情况下,侧向部分328a、328b、328c、328d中的两者或多者可包括不平坦区段352。在一些情况下,每个侧向部分328a、328b、328c、328d可包括至少一个不平坦区段352。在各种情况下,至少两个不平坦区段352可限定不同的轮廓。
仍参见图8,示出了线性编码系统350。线性编码系统350包括信号发生器356和信号接收器358。信号发生器356可被构造成能够将信号发送到信号接收器358。当信号穿过部分328a、328b、328c和328d的不平坦区段352时,信号中的至少一些可偏转和/或转向。此外,当不平坦区段352在端部执行器120进行关节运动的情况下位移、交错和/或以其他方式受到影响时,信号接收器358可检测接收到的信号的变化并且确定侧向部分328a、328b、328c、328d的相对布置,由此确定端部执行器120的关节运动程度。
在各种情况下,检测系统350可与控制器通信,该控制器可被构造成能够基于来自接收器358的反馈来检测端部执行器120的关节运动角度。除此之外或另选地,控制器可被构造成能够基于部分328a、328b、328c、328d之间的所检测的交错和/或偏移量来调节击发行程的长度,所述交错和/或偏移量用于计算和/或估计端部执行器已进行关节运动的程度。在此类情况下,控制器可调节击发行程长度,使得柔性击发杆318到达端部执行器中的预定义最远侧位置,即,击发杆118在端部执行器120处于未进行关节运动的位置时到达的同一预定义最远侧位置。
在各种情况下,编码系统350可包括例如光学、磁性、和/或电容编码器。在某些实施方案中,例如信号发生器356可产生波诸如,光波、无线电波、微波和/或x射线。在一些情况下,信号发生器356可产生例如多个激光信号。
在某些情况下,导电材料可被构造成能够检测击发杆的侧向部分之间的交错量。现在参见图9和图10,带450被固定到柔性击发杆418的近侧端部。类似于柔性击发杆118(图1-图7),柔性击发杆418被构造成能够将击发动作从击发连杆114通过关节运动接头130(图1和图2)传输到端部执行器120(图1和图2)。柔性击发杆418包括可在端部执行器120进行关节运动时相对于彼此移位的多个侧向部分428a、428b、428c和428d。在此类情况下,部分428a、428b、428c和428d的近侧端部变为交错的。
所示带450包括固定到第四部分428d的第一端部452和固定到第一部分428a的第二端部454。当部分428a、428b、428c、428d在端部执行器120进行关节运动的情况下相对于彼此移位时,带450可拉伸以适应部分428a、428b、428c、428d的交错的近侧端部。例如,带450可在端部执行器120从未进行关节运动的取向(图9)运动到关节运动取向(图10)时拉伸。在此类情况下,当部分428a、428b、428c、428d响应于端部执行器120的关节运动继续交错时,带450可继续拉伸。例如,当端部执行器120的关节运动角度增大时,部分428a、428b、428c、428d可变得更为交错并且带450可变得更为拉伸。
仍参见图9和图10,所示带450被固定到柔性击发杆418的外侧部分428a、428d。此外,带450被构造成能够围绕柔性击发杆418的近侧端部440延伸。例如,图9和图10所示的带450围绕柔性击发杆418的近侧端部440延伸并且延伸经过中间或内侧部分428b和428c的近侧端部。
在其他情况下,带450可围绕远侧端部440近侧的柔性击发杆418的周边延伸。在其他情况下,带450可在柔性击发杆418的相邻侧向部分(例如,内侧部分428b和428c)之间延伸。除此之外或另选地,多个柔性带可安装到柔性击发杆418。
在各种情况下,柔性带450可包括例如电活性聚合物。在此类情况下,当柔性带450拉伸时,电活性聚合物可提供指示带拉伸量并因而指示击发杆交错量的信号。在其他情况下,带450可由具有反映带中的应变的不同电特性的其他导电材料构成。
在各种情况下,柔性带450可与控制器通信,该控制器可被构造成能够基于来自带450的反馈来检测关节运动角度。例如,带450中的应变可取决于端部执行器进行关节运动的程度。更具体地,应变可对应于能够被控制器检测到的电压电位。例如,当带450中的应变较大时,这对应于端部执行器120的较大关节运动角度,控制器可检测到较高电压电位。此外,如果端部执行器120相对于轴110进行较小的关节运动,即,如果端部执行器120的关节运动角度减小,则控制器可检测到降低的电压电位,这对应于带450中的减小的应变。对击发行程长度的调节可取决于端部执行器120已进行关节运动的程度并且可与关节运动的方向无关。例如,当端部执行器120已向右侧关节运动x°或向左侧关节运动x°时,击发行程长度可增大距离z。
除此之外或另选地,控制器可被构造成能够基于部分428a、428b、428c、428d之间的所检测的交错和/或偏移量来调节击发行程的长度,所述交错和/或偏移量用于计算和/或估计端部执行器120已进行关节运动的程度。在此类情况下,控制器可调节击发行程长度,使得柔性击发杆418到达端部执行器120中的预定义最远侧位置,即,击发杆418在端部执行器处于未进行关节运动的位置时到达的同一预定义最远侧位置。
在各种情况下,定位在柔性击发杆上的至少一个霍尔效应传感器可被构造成能够检测柔性击发杆的侧向部分的移位。现在参见图11和图12,示出了位于柔性击发杆518的近侧端部540处的检测系统550。类似于柔性击发杆118(图1-图7),柔性击发杆518被构造成能够将击发动作从击发连杆114通过关节运动接头130(图1和图2)传输到端部执行器120(图1和图2)。柔性击发杆518包括可在端部执行器120进行关节运动时移位的多个侧向部分528a、528b、528c和528d。在此类情况下,部分528a、528b、528c和528d的近侧端部变为交错的。
所示检测系统550包括磁体552和霍尔效应传感器554。磁体552和霍尔效应传感器554位于柔性击发杆518的相对侧面上。例如,磁体552可被定位在柔性击发杆518的外侧部分(例如,第四部分528d)上,并且霍尔效应传感器554可被定位在柔性击发杆518的另一个外侧部分诸如,第一部分528a上。
当端部执行器120从未进行关节运动的取向(图11)运动到关节运动取向(图12)时,柔性击发杆518的侧向部分528a、528b、528c、528d可相对于彼此移位。因此,外侧部分528d上的磁体552和外侧部分528a上的霍尔效应传感器554之间的距离可改变。例如,仍参见图11和图12,磁体552和传感器554可在端部执行器处于未进行关节运动的取向(图11)时隔开距离d,并且可在端部执行器处于关节运动取向(图12)时隔开大于距离d的距离d’。
在某些情况下,检测系统550还可包括导电性引导件或接触滑动件556。接触滑动件556可被构造成能够在传感器554在轴110中移位时引导和/或保护霍尔效应传感器554。在各种情况下,接触滑动件556可安装到和/或形成于击发连杆114上。例如,接触滑动件556可限定在击发连杆114的表面上和/或沿着孔115的至少一部分进行限定。
在各种情况下,接触滑动件556可向霍尔效应传感器554提供功率。例如,接触滑动件556可联接到功率源和霍尔效应传感器554。在此类情况下,霍尔效应传感器554可被构造成能够在端部执行器120从未进行关节运动的取向运动到关节运动取向时保持与接触滑动件556滑动接触。检测系统550还能够包括第二接触滑动件,该第二接触滑动件可提供从霍尔效应传感器554到电路的其余部分的返回路径。除此之外或另选地,在其中磁体552需要功率的情况下,一对接触滑动件可向磁体552提供功率。
端部执行器120已进行关节运动的程度可基于检测系统550所检测的击发杆的交错量。此外,检测系统550可与控制器通信,该控制器可基于击发杆交错量和相关的端部执行器关节运动程度来调节击发行程的长度。在此类情况下,控制器可调节击发行程长度,使得柔性击发杆518到达端部执行器120中的预定义最远侧位置,即,击发杆518在端部执行器处于未进行关节运动的位置时到达的同一预定义最远侧位置。
现在参见图13和图14,示出了柔性击发杆618。在各种情况下,柔性击发杆618可用于例如外科器械100(图1)的击发系统112中。柔性击发杆618包括多个侧向部分628a、628b、628c、628d。当端部执行器120(图1)相对于轴110未进行关节运动时,主要参见图13,侧向部分628a、628b、628c、628d在击发杆618的近侧端部640处相对于彼此交错和/或偏移。在各种情况下,侧向部分628a、628b、628c、628d可具有不同的长度。例如,内侧部分628b和628c可比外侧部分628a和628d长某一长度x。因此,外侧部分628a、628d相对于内侧部分628b、628c交错长度x。
主要参见图14,当端部执行器120(图1)相对于轴110进行关节运动时,侧向部分628a、628b、628c、628d可相对于彼此移位。例如,靠近弯曲内侧的部分(图14中的部分628c和628d)的近侧端部可相对于靠近弯曲外侧的部分(部分628a和628b)朝近侧移位。在某些情况下,第四部分628d可例如移位成与第三部分628c对准和/或朝近侧移位超过第三部分628c。另外,靠近弯曲外侧的部分(即,图14中的部分628a和628b)可相对于靠近弯曲内侧的部分(即,部分628c和628d)朝远侧移位。在某些情况下,第二部分628c可例如移位成不与第三部分628b对准。
在某些情况下,传感器可被构造成能够检测侧向部分628a、628b、628c、628d在端部执行器120(图1)进行关节运动时的移位。例如,接近传感器可被定位在轴110中以监测和/或检测侧向部分628a、628b、628c、628d的近侧端部的变化位置。传感器可包括例如电阻传感器、电感传感器、电容传感器、和/或磁性传感器。
在各种情况下,传感器可与控制器通信,该控制器可被构造成能够基于来自传感器的反馈来检测端部执行器120的关节运动角度。除此之外或另选地,控制器可被构造成能够基于部分628a、628b、628c、628d之间的所检测的交错和/或偏移量来调节击发行程的长度,所述交错和/或偏移量用于计算和/或估计端部执行器已进行关节运动的程度。在此类情况下,控制器可调节击发行程长度,使得柔性击发杆618到达端部执行器中的预定义最远侧位置,即,击发杆618在端部执行器120处于未进行关节运动的位置时到达的同一预定义最远侧位置。
如上所述,穿过关节运动接头延伸到端部执行器内的击发杆可在端部执行器进行关节运动时弯曲。在各种情况下,柔性击发杆上的电路可被构造成能够检测当击发杆在关节运动动作期间弯曲时击发杆的部分所移位的量。现在参见图15,柔性击发杆718在联接件716处联接到击发连杆114。类似于柔性击发杆118(图1-图7),柔性击发杆718被构造成能够将击发动作从击发连杆114通过关节运动接头130(图1和图2)传输到外科器械100的端部执行器120(图1)。柔性击发杆718包括在端部执行器120进行关节运动时移位的多个侧向部分728a、728b、728c和728d。在此类情况下,侧向部分728a、728b、728c和728d的近侧端部变为交错的。
仍参见图15,示出了检测系统750。检测系统750包括具有第一触件752和第二触件754的电路。电路可被构造成能够检测当端部执行器120(图1)进行关节运动时的击发杆交错量。在各种情况下,第一触件752和第二触件754可安装在击发杆718的两个或更多个侧向部分728a、728b、728c、728d之间。例如,第一触件752可安装到侧向部分中的一者诸如,第一部分728a和/或与其形成一体,并且第二触件754可安装到相邻侧向部分诸如,第二部分728b和/或与其形成一体。
仍参见图15,触件752、754可被定位在每个侧向部分728a、728b的键719上。除上述之外,每个键719可延伸到击发连杆114中的孔115内。击发连杆-键接合被构造成能够将击发连杆114的平移传输到柔性击发杆118。当第一部分728a相对于第二部分728b移位时,第一触件752可例如相对于第二触件754运动。另选地,当第二部分728b相对于第一部分728a运动时,第二触件754可相对于第一触件752运动。
在各种情况下,第二触件754可包括沿着纵向轴线具有可变尺寸的柔性电路。例如,柔性电路可限定波形曲线形态。在各种情况下,第二触件754可包括齿状和/或齿轮面766。脊和/或齿762可从第二触件754的面766突出并且/或者凹槽764可限定在第二触件754的面766内。在所示实施方案中,脊762和凹槽764的长度沿着面766的长度有所变化以形成波形曲线形态。因此,面766限定具有不同尺寸和/或长度的多个分立位置。仍参见图15,绝缘区域758可围绕第二触件754的面766延伸。在各种情况下,第一触件752可包括单个接触边缘。如图15所示,绝缘区域756可被定位在第一触件752的两个侧面上。
仍参见图15,第二触件754可联接到引线760b,该引线可将第二触件754连接到电路的其余部分。在各种情况下,引线诸如,引线760a可将第一触件752连接到电路的其余部分。
在各种情况下,检测系统750可包括例如与触件752、754类似的多对触件。例如,触件可被定位在每个键719的一个或两个侧面上。在某些情况下,例如,检测系统750还可包括电引线,诸如,可分别延伸到每个侧向部分728a、728b、728c、728d的引线760a、760b、760c、760d。引线760a、760b、760c、760d可被构造成能够将每个侧向部分728a、728b、728c、728d上的电触件联接到电路的其余部分。
仍参见图15,当第一触件752在端部执行器进行关节运动的情况下相对于第二电触件754移位时,检测系统750可检测电容变化。脊762和凹槽764沿第二触件754的面766的可变长度可影响两个触件752、754之间的电容变化。例如,当第一触件752与第二触件754的最长脊762对准时,电容可最大。在各种情况下,当端部执行器120未进行关节运动时,第一触件752可与第二触件754的最长脊762对准。当端部执行器120进行关节运动并且侧向部分移位时,第一触件752可运动远离最长脊762并且与较短脊762对准。在此类情况下,检测系统750中的电容可在端部执行器进行关节运动时降低。
在某些情况下,现在参见图16,电容可在从未进行关节运动的取向到关节运动取向的整个端部执行器关节运动范围期间减小。更具体地,当端部执行器从未进行关节运动的位置或较小关节运动位置向右侧进行关节运动时,电容可减小。类似地,当端部执行器从未进行关节运动的位置或较小关节运动位置向左侧进行关节运动时,电容可减小。此外,当端部执行器从关节运动位置运动到未进行关节运动的位置时,电容可增大。
在各种情况下,触件752、754中的一者或两者可限定另选的几何形状。在某些情况下,触件752、754可包括平坦表面,该平坦表面可在端部执行器120进行关节运动时移位成对准和/或不对准。在此类情况下,平坦表面之间的改变的对准和/或重叠可对应于电容的变化。例如,当平坦触件之间的对准程度最高时,电容可最大。在其他情况下,触件752、754中的一者可包括例如平坦表面。
在各种情况下,检测系统750可与控制器通信,该控制器可被构造成能够基于来自传感器754的反馈来检测端部执行器120的关节运动角度。除此之外或另选地,控制器可被构造成能够基于部分728a、728b、728c、728d之间的所检测的交错和/或偏移量来调节击发行程的长度,所述交错和/或偏移量用于计算和/或估计端部执行器已进行关节运动的程度。在此类情况下,控制器可调节击发行程长度,使得柔性击发杆718到达端部执行器120中的预定义最远侧位置,即,击发杆718在端部执行器120处于未进行关节运动的位置时到达的同一预定义最远侧位置。对击发行程长度的调节可取决于端部执行器120已进行关节运动的程度并且可与关节运动的方向无关。例如,当端部执行器120已向右侧关节运动x°或向左侧关节运动x°时,击发行程长度可增大距离z。
在某些情况下,检测系统可包括可被构造成能够检测柔性击发杆的线性行进的至少一个旋转编码器。检测系统850示于图17中。检测系统850包括旋转编码器852和854。旋转编码器852和854定位在柔性击发杆818附近。类似于柔性击发杆118(图1-图7),柔性击发杆818被构造成能够将击发动作从击发连杆114通过关节运动接头130(图1和图2)传输到外科器械100的端部执行器120(图1)。柔性击发杆818包括多个侧向部分828a、828b、828c和828d,该多个侧向部分828a、828b、828c和828d可在端部执行器120进行关节运动时相对于彼此移位,使得侧向部分828a、828b、828c和828d的近侧端部变为交错的。
在各种情况下,一个或多个旋转编码器852、854可被构造成能够检测柔性击发杆818和/或其部分828a、828b、828c和828d的线性位移。例如,当端部执行器120进行关节运动时,至少一个旋转编码器852、854可检测柔性击发杆818在关节运动动作期间的位移。
在各种情况下,如图17所示,旋转编码器852、854可被定位在柔性击发杆818的每一侧并且可检测外侧部分828a和828d的位移。例如,第一旋转编码器852可检测第四侧向部分828d的线性位移,并且第二旋转编码器854可检测第一侧向部分828a的线性位移。基于外侧部分828a、828d的线性位移之间的差值,可确定击发杆818的侧向部分之间的整个交错量,该交错量可对应于端部执行器120已进行关节运动的程度。
除此之外或另选地,检测系统850可被构造成能够检测柔性击发杆818在击发行程期间的线性位移。检测系统850可被定位在例如轴110的远侧部分处和/或附近、和/或关节运动接头130的远侧(图1和图2)。在其他情况下,检测系统850可被定位在轴110的近侧部分处和/或附近、和/或关节运动接头130的近侧。
在各种情况下,旋转编码器852、854可被构造成能够在端部执行器120进行关节运动和/或击发杆818在击发行程期间朝远侧推进时引导柔性击发杆818。例如,旋转编码器852、854可试图阻止和/或限制柔性击发杆818的弓弯和/或屈曲。旋转编码器852、854被定位在击发杆818的相对侧并且可对其施加紧缩力以抑制击发杆818的侧向部分之间的相对侧向运动。
在各种情况下,检测系统850可与控制器通信,该控制器可被构造成能够基于来自编码器852、854的反馈来检测端部执行器120的关节运动角度。除此之外或另选地,控制器可被构造成能够基于部分828a、828b、828c、828d之间的所检测的交错和/或偏移量来调节击发杆818的击发行程的长度,所述交错和/或偏移量用于计算和/或估计端部执行器120已进行关节运动的程度。在此类情况下,控制器可调节击发行程长度,使得柔性击发杆818到达端部执行器120中的预定义最远侧位置,即,击发杆818在端部执行器120处于未进行关节运动的位置时到达的同一预定义最远侧位置。
在某些情况下,检测系统可包括例如激光器,该激光器可被构造成能够检测柔性击发杆的侧向部分的移位和/或交错。现在参见图18,示出了检测系统950和柔性击发杆918。在各种情况下,柔性击发杆918可联接到击发连杆诸如击发连杆114,并且可用于例如外科器械100(图1)的击发系统112中。如图18所示,柔性击发杆918包括多个侧向部分,该多个侧向部分可在端部执行器120(图1)进行关节运动时相对于彼此移位。
如图18所示,多个孔956被限定在柔性击发杆918的侧向部分中。孔956包括例如穿过侧向部分限定的圆形孔。在其他情况下,孔可包括例如细长和/或多边形几何形状。当端部执行器120处于未进行关节运动的位置时,侧向部分中的孔956与相邻侧向部分中的孔956对准。当柔性击发杆918的侧向部分在端部执行器120进行关节运动的情况下相对于彼此移位时,穿过每个侧向部分限定的孔956可移位。在各种情况下,孔956可移位成与其他侧向部分中的孔956对准和/或不对准。在某些情况下,孔956可在端部执行器120未进行关节运动时对准并且可在关节运动动作期间移位成不对准,而在其他情况下,孔956可在端部执行器120完全关节运动时对准。
图18所示的检测系统950包括光学激光器952。光学激光器952可联接到例如光学导管或光管954,该光学导管或光管可延伸穿过轴110并且可延伸到外科器械100的柄部。在各种情况下,光学激光器952可被构造成能够产生激光束和/或多个激光束。检测系统950还可包括被构造成能够检测一个或多个激光束的接收器。当孔956彼此对准时,一个或多个激光束可传输穿过侧向部分而不被侧向部分阻挡。当孔956仅彼此部分地对准时,一个或多个激光束可被侧向部分部分地阻挡。当孔956彼此完全不对准时,激一个或多个光束可被侧向部分完全地阻挡。接收器所接收的激光信号可对应于孔的对准的移位,这可对应于柔性击发杆918的侧向部分的移位。
在各种情况下,检测系统950可与控制器通信。控制器可被构造成能够基于来自检测系统950的反馈来检测端部执行器120的关节运动角度。除此之外或另选地,控制器可被构造成能够根据基于侧向部分之间的所检测的交错和/或偏移量计算和/或估计的端部执行器关节运动程度来调节击发行程的长度。在此类情况下,控制器可调节击发行程长度,使得柔性击发杆918到达端部执行器120中的预定义最远侧位置,即,击发杆918在端部执行器120处于未进行关节运动的位置时到达的同一预定义最远侧位置。
相对于本文所公开的各种检测系统,诸如检测系统250、350、550、650、750、850和950、以及带450,例如,控制器可与检测系统通信并且可基于来自检测系统的反馈来调节击发行程长度。例如,当检测系统检测到端部执行器的关节运动程度时,可延伸击发行程长度以应对关节运动程度。在各种情况下,检测系统检测到的端部执行器关节运动程度越高,则击发行程长度可被延伸地越多。对击发行程长度的调节可取决于端部执行器的关节运动角度并且可与关节运动的方向无关。在各种情况下,控制器可包括具有查找表的微处理器并且/或者可与其通信。此类查找表可集成到微处理器并且/或者可被其访问。查找表可存储在例如虚拟存储器或物理存储器中。查找表可包括用于特定关节运动角度和/或特定击发杆交错量的击发行程调节量。例如,对于柔性击发杆的两个侧向部分之间的给定交错量,查找表可指示合适的击发行程调节长度。
如本文所述,在某些情况下,可期望监测柔性击发杆的线性位移和/或其侧向部分的移位以确定端部执行器已进行关节运动的程度。此外,当端部执行器已进行关节运动时,可调节击发杆的击发行程长度以应对柔性击发杆和/或其部分的变化位置。除此之外或另选地,可期望提供缓冲特征结构,该缓冲特征结构被构造成能够吸收和/或以其他方式应对击发行程长度的变化。此类缓冲特征结构可被定位在例如外科器械的轴和/或端部执行器中。
如果未调节击发行程长度以应对端部执行器的关节运动角度,则对于给定的击发行程长度,相比于端部执行器进行关节运动的情况,柔性击发杆将在端部执行器未进行关节运动时朝远侧延伸地更远。柔性击发杆在击发行程期间的最远侧位置将在关节运动角度变化时变化。例如,对于给定的击发行程长度,相比于端部执行器未进行关节运动的情况,柔性击发杆将在端部执行器进行关节运动时停止在较近侧的最远侧位置。此外,对于给定的击发行程长度,相比于端部执行器进行较大关节运动的情况,柔性击发杆将在端部执行器进行较小关节运动时停止在较远侧的最远侧位置。
为了确保柔性击发杆、钉部署滑动件和/或切割边缘至少到达其在端部执行器内的预期最远侧位置,甚至当端部执行器已进行完全关节运动时,可选择击发行程长度以使得柔性击发杆在端部执行器已进行完全关节运动时延伸到期望的最远侧位置。因此,柔性击发杆将在端部执行器进行部分关节运动或未进行关节运动时朝远侧延伸超过期望的最远侧位置。在此类情况下,钉部署滑动件和/或击发系统的其他元件可与钉仓的远侧端壁碰撞。为了降低碰撞冲击的影响和/或至少部分地吸收碰撞冲击,缓冲特征结构可接合击发系统。
在各种情况下,缓冲特征结构可被布置在外科器械的轴中。例如,缓冲特征结构可被定位在击发连杆和柔性击发杆之间的联接件处。此类缓冲特征结构可被构造成能够吸收和/或适应当外科器械的端部执行器运动到关节运动取向时的击发行程长度的变化。例如,缓冲特征结构可由柔性、可变形、和/或弹性材料构成。
现在参见图19,示出了可变形缓冲接头1050。在所示实施方案中,柔性击发杆1018在外科器械100(图1)的轴110中的联接件1016处联接到击发连杆114。类似于柔性击发杆118(参见例如图1-图7),柔性击发杆1018被构造成能够将击发动作从击发连杆114通过关节运动接头130(图1和图2)传输到端部执行器120(图1)。
在所示实施方案中,行程补偿构件或缓冲接头1050被定位在击发连杆114和柔性击发杆1018的近侧端部部分1040中间的联接件1016中。缓冲接头1050可被构造成能够在柔性击发杆1018的近侧端部1040被朝近侧推压和/或位移时变形。例如,当端部执行器120进行关节运动时,柔性击发杆1018的近侧端部1040和/或其部分可朝近侧移位。当柔性击发杆1018朝近侧运动时,近侧端部1040可压缩缓冲接头1050。
在各种情况下,缓冲接头1050可由柔性、可变形、和/或弹性材料构成。例如,缓冲接头1050可由具有比柔性击发杆1018和/或其近侧端部1040的硬度计硬度低的材料构成。除此之外或另选地,缓冲接头1050可由具有比击发连杆114的硬度计硬度低的材料构成。
主要参见图19,缓冲接头1050包括渐缩插孔1052,该渐缩插孔1052可被构造成能够接收柔性击发杆1018的近侧端部1040。渐缩插孔1052可限定例如锥形形状。在此类情况下,渐缩插孔1052可从插孔1052的远侧区域中的较宽开口渐缩到插孔1052中的中间区域处的较窄开口。插孔1052可在其近侧区域处闭合。在某些情况下,渐缩插孔1052可充当制动器,该制动器可初始减慢和/或抵制柔性击发杆1018的近侧位移(图20)。此外,当渐缩插孔1052被击发杆1018压缩时,插孔1052可停止和/或阻止柔性击发杆1018的进一步近侧位移(图21)。
在某些情况下,柔性击发杆1018可包括多个侧向部分1028a、1028b、1028c和1028d。参见图19-图21,侧向部分1028a、1028b、1028c和1028d可例如在柔性击发杆1018的近侧端部1040处固定和/或联结在一起。在此类情况下,侧向部分1028a、1028b、1028c和1028d可被构造成能够在近侧端部1040处一起运动,如图19-图21所示。在其他情况下,侧向部分1028a、1028b、1028c和1028d可在端部执行器120进行关节运动时移位,使得侧向部分1028a、1028b、1028c和1028d的近侧端部变为交错的。在此类情况下,缓冲接头1050可被构造成能够吸收和/或适应侧向部分1028a、1028b、1028c和1028d的交错位移。
如本文所述,在某些情况下,可调节和/或修改击发行程,使得柔性击发杆1018在端部执行器120进行完全关节运动时到达端部执行器120中的预定义最远侧位置。在某些情况下,可调节和/或修改击发行程,而不管端部执行器120已进行关节运动的程度。在此类情况下,当端部执行器120仅进行部分关节运动和/或未进行关节运动时,柔性击发杆1018可朝远侧推进超过端部执行器120中的预定义最远侧位置。此外,当端部执行器120仅进行部分关节运动和/或未进行关节运动时,柔性击发杆1018可在击发动作期间将滑动件朝远侧驱动成邻接端部执行器120的远侧端部。在此类情况下,缓冲接头1010可至少部分地吸收滑动件和端部执行器120的远侧端部之间的碰撞冲击。
除上述之外,缓冲接头1050可由弹性材料构成,该弹性材料可压缩和/或变形以吸收和/或适应柔性击发杆1018的近侧位移。在某些情况下,缓冲接头1050可包括例如弹簧和/或弹簧状特征结构。除此之外或另选地,缓冲接头1050可包括摩擦滑动式特征结构,诸如,离合器和/或阻尼器。
如上所述,缓冲接头1050可被定位在柔性击发杆1018的近侧端部1040处。除此之外或另选地,缓冲特征结构可被定位在柔性击发杆1018的远侧端部处。例如,此类缓冲特征结构可被定位在柔性击发杆1018的远侧端部和端部执行器120(图1)中的滑动件和/或击发构件之间。
现在参见图22,示出了行程调节构件或缓冲特征结构1150。缓冲特征结构1150被定位在柔性击发杆1118的远侧端部1140的远侧。类似于柔性击发杆118(图1-图7),柔性击发杆1118被构造成能够将击发动作从击发连杆114(参见例如图1和图3)通过关节运动接头130(图1和图2)传输到端部执行器,诸如端部执行器1120。柔性击发杆1118的远侧端部1140示于图22中,该远侧端部联接到例如击发构件1154。
仍参见图22,击发构件1154被构造成能够沿着限定于钉仓1122中的纵向狭槽1152的至少一部分滑动和/或运动。击发构件1154包括切割边缘1156,该切割边缘被构造成能够切断由端部执行器1120的砧座贴靠钉仓1122夹持的组织。在击发行程期间,柔性击发杆1118的远侧位移可朝远侧驱动切割构件1154以切割组织。
仍参见图22,滑动件或钉部署楔形件1158可运动地定位在钉仓1122中。例如,滑动件1158可包括中间部分1159,该中间部分被构造成能够沿着纵向狭槽1152的至少一部分滑动。在各种情况下,滑动件1158还能够包括多个驱动楔形件,该多个驱动楔形件可被构造成能够接合钉和/或钉驱动器以从钉腔1126射出钉并且使钉朝端部执行器1120的砧座运动。
缓冲特征结构1150被定位在击发构件1154和滑动件1158中间。在至少一种情况下,缓冲特征结构1150可通过榫槽接合联接到滑动件1158。如图22所示,缓冲特征结构1150包括榫1162,并且滑动件1158包括被构造成能够接收和保持凹槽1162的槽1164。例如,凹槽1162可摩擦配合和/或以其他方式保持在槽1164中。
在某些情况下,缓冲特征结构1150可与滑动件1158一体形成。在各种情况下,缓冲特征结构1150可初始被定位在钉仓1122的近侧端部处,并且例如当击发构件1154在击发行程期间推进滑动件1158时可朝远侧驱动该缓冲特征结构。在一些情况下,击发构件1154可在击发行程期间将缓冲特征结构1150驱动成接合滑动件1154。在某些情况下,缓冲特征结构1150可联接到例如击发构件1154。在其他情况下,缓冲特征结构1150可在纵向狭槽1152中自由地运动。例如,缓冲特征结构1150可被定位在击发构件1154和滑动件1158之间,然而,缓冲特征结构1150可例如不联接到击发构件1154或滑动件1158。
在各种情况下,缓冲特征结构1150可由柔性、可变形、和/或弹性材料构成。例如,缓冲特征结构1150可由具有比击发构件1154和/或滑动件1158的硬度计硬度低的材料构成。在此类情况下,缓冲特征结构1150可被构造成能够至少部分地吸收和/或适应击发构件1154的远侧平移和/或位移。例如,缓冲特征结构1150可充当软止挡件和/或制动器。在此类情况下,缓冲特征结构1150可初始减慢和/或抵制击发构件1154的远侧移位。此外,如果击发构件1154继续朝远侧推进,则缓冲特征结构1150可停止和/或阻止击发构件1154的进一步远侧位移。如本文所述,在各种情况下,当端部执行器120仅进行部分关节运动和/或未进行关节运动时,柔性击发杆1118可朝远侧推进超过端部执行器120中的预定义最远侧位置。此外,当端部执行器120仅进行部分关节运动和/或未进行关节运动时,柔性击发杆1118可在击发动作期间将滑动件1158朝远侧驱动成邻接端部执行器120的远侧端部。在此类情况下,缓冲特征结构1150可至少部分地吸收滑动件1158和端部执行器120的远侧端部之间的碰撞冲击。
仍参见图22所示的实施方案,缓冲特征结构1150包括渐缩插孔1166,该渐缩插孔可被构造成能够接收击发构件1154的远侧端部。在各种情况下,渐缩插孔1166可限定尖形和/或缩窄形形状。例如,渐缩插孔1166可从插孔1166的近侧区域中的较宽开口渐缩到插孔1166中的中间区域处的较窄开口。插孔1166的远侧区域可闭合。在某些情况下,渐缩插孔1166可例如充当制动器,该制动器可初始减慢和/或抵制击发构件1154的远侧位移并且可最终停止和/或阻止击发构件1154的进一步远侧位移。
在各种情况下,钉仓1122可包括组织止挡件1160,该组织止挡件可与击发构件1154的切割边缘1156对准。在各种情况下,切割边缘1156可被构造成能够接合切割止挡件1160,并且可有利于击发行程期间的缓冲和/或能量吸收。在某些情况下,组织止挡件1160可从平台1124延伸并且可覆盖和/或阻挡纵向狭槽1152的至少一部分。在某些情况下,组织止挡件1160可由柔性、可变形、和/或弹性材料构成。除此之外或另选地,组织止挡件1160可为易碎的。在其他情况下,组织止挡件1160可充当硬止挡件以阻止切割边缘1156的进一步远侧位移。2014年10月13日提交的名称为“STAPLE CARTRIDGE”的美国专利申请序列号14/512,637的整个公开内容以引用方式并入本文。
在某些情况下,击发杆止挡件可结合到外科器械的端部执行器和/或轴内。击发杆止挡件可被构造成能够限制击发杆在击发行程期间的行进。例如,击发杆止挡件可包括被定位在端部执行器和/或轴中的扣件和/或闭锁件,该扣件和/或闭锁件被构造成并且被定位成在击发行程期间接合柔性击发杆。此类闭锁件可在击发行程的一部分期间接合击发杆以限制和/或阻止击发杆的进一步远侧行进。在某些情况下,击发杆止挡件可被构造成能够在端部执行器相对于轴运动到关节运动取向时相对于轴和/或端部执行器移位。击发杆的移位位置可取决于端部执行器进行关节运动的程度。因此,击发杆止挡件可在相对于轴的不同位置处接合和限制柔性击发杆,并且所述位置可基于端部执行器进行关节运动的程度。
击发杆止挡件1658示于图49-图53所示的外科器械1600中。外科器械1600可在许多方面与外科器械100(图1)类似。外科器械1600包括能够围绕关节运动接头1630旋转地联接到轴1610的端部执行器1620。钉仓1622(图49)可被定位在端部执行器1620中。在击发行程期间,柔性击发杆1618被构造成能够在轴1610、关节运动接头1630和端部执行器1620内运动以朝远侧推进击发构件1654(图49)。击发构件1654包括切割边缘1656(图49)。在某些情况下,击发构件1654可推进钉部署滑动件,该钉部署滑动件可从钉仓1622击发钉并且可使钉运动以与端部执行器1620的砧座1624(图49、图51和图53)成形接触。
对于给定的击发行程长度,相比于端部执行器1620进行关节运动的情况,柔性击发杆1618将在端部执行器1620未进行关节运动时朝远侧延伸得更远。此外,柔性击发杆1618的最远侧位置将在关节运动角度变化时变化。换句换讲,对于给定的击发行程长度,相比于端部执行器1620未进行关节运动的情况,柔性击发杆1618将在端部执行器1620进行关节运动时停止在较近侧的最远侧位置。另外,对于给定的击发行程长度,相比于端部执行器1620进行较大关节运动的情况,柔性击发杆1618将在端部执行器1620进行较小关节运动时停止在较远侧的最远侧位置。
为了确保柔性击发杆1618、钉部署滑动件和/或切割边缘1656(图49)至少到达其在端部执行器1620内的预期最远侧位置,当端部执行器1620进行关节运动时,可选择击发行程长度以使得柔性击发杆1618在端部执行器1620进行完全关节运动时朝远侧行进到期望的最远侧位置。在此类情况下,为了阻止钉部署滑动件和/或击发系统的其他元件在端部执行器1620未进行完全关节运动时与钉仓1622的远侧端壁碰撞,可使用击发杆止挡件,诸如击发杆止挡件1658。
击发杆止挡件1658可被构造成能够在击发行程期间接合柔性击发杆1618以限制击发杆1618的进一步远侧位移。在某些情况下,击发杆止挡件1658可在击发行程的远侧部分期间接合柔性击发杆1618。击发杆止挡件1658可被构造成能够基于端部执行器1620进行关节运动的程度移位。换句换讲,击发杆止挡件1658可在击发行程的不同部分期间接合柔性击发杆1618,这取决于端部执行器1620已进行关节运动的程度。击发杆止挡件1658可形成缓冲构件,该缓冲构件适应柔性击发杆的越界行程。
击发杆止挡件1658可被构造成能够应对至端部执行器1620中期望的最远侧位置的距离变化。更具体地,击发杆止挡件1658可被构造成能够在端部执行器1620未进行关节运动时在较远侧位置处接合和限制柔性击发杆1618,并且可被构造成能够在端部执行器1620进行关节运动时在较近侧位置接合和限制柔性击发杆1618。在各种情况下,可选择击发行程长度以使得柔性击发杆1618在端部执行器1620进行完全关节运动时到达期望的最远侧位置。在此类情况下,击发杆止挡件1658可被构造成能够阻止钉部署滑动件和/或击发系统的其他元件在端部执行器1620未进行完全关节运动时与钉仓1622的远侧端壁碰撞。
图49-图53所示的击发杆止挡件1658包括柔性击发杆1618上的移位式限制件1660和扣件1662。扣件1662在柔性击发杆1618中限定凹口,并且移位式限制件1660被构造成能够在击发行程的一部分期间接合扣件1662。例如,在柔性击发杆1618在击发行程期间平移时,移位式限制件1660可运动到与柔性击发杆1618中的凹口1662邻接接触。扣件1662与移位式限制件1660的邻接被构造成能够阻止柔性击发杆1618的进一步远侧位移。
击发杆止挡件1658还包括与移位式限制件1660接合的板1670。板1670可限定几何形状,使得板1670的关节运动被构造成能够使所述移位式限制件1660移位。例如,板1670包括一对圆形突出部1672以及圆形突出部1672之间的凹陷部1674。板1670可被构造成能够与端部执行器1620一起运动。主要参见图50和图52,板1620可通过例如至少一个销1676固定到端部执行器1620。当端部执行器1620相对于轴1610运动到关节运动取向时,板1670可与端部执行器1620一起旋转。因此,板1670可相对于定位在外科器械1600的轴1610内的移位式限制件1660旋转。
当端部执行器1620处于未进行关节运动的位置时(图49-图51),板1670的凹陷部1764可接合移位式限制件1670。因此,移位式限制件1670可被定位在相对于轴1610的远侧位置中。轴1610中的弹簧1664可被构造成能够将移位式限制件偏置到远侧位置中。此外,当端部执行器1620已进行关节运动并且板1670已进行旋转(图52和图53)时,板1670的圆形突出部1672可接合移位式限制件1660。在此类情况下,移位式限制件1660可被定位在相对于轴1610的较近侧位置中。弹簧1664被构造成能够变形以适应移位式限制件1660的近侧移位。例如,当端部执行器1620继续进行关节运动时,移位式限制件1660可继续朝近侧移位并且弹簧1664可被进一步压缩。当端部执行器进行关节运动的程度增大时,板1670的圆形突出部1672可沿近侧方向更远地推压移位式限制件1660。在此类情况下,移位式限制件1660的位置可取决于端部执行器1620已进行关节运动的程度。
当移位式限制件1660处于远侧位置(图49-图51)时,柔性击发杆1618可在扣件1662运动到与移位式限制件1660邻接接触之前在端部执行器1620朝远侧更远地行进。在各种情况下,可选择移位式限制件1660的远侧位置,使得柔性击发杆1618例如到达端部执行器1620中的期望的最远侧位置并且避免与钉仓1622的远侧端部的行程末端碰撞。此外,当移位式限制件1660已运动到较近侧位置(图52和图53)时,扣件1662可运动成在较近侧位置处与移位式限制件1660邻接接触。在各种情况下,可基于端部执行器1620已进行关节运动的程度选择移位式限制件1660的一个或多个近侧位置,使得柔性击发杆1618在端部执行器1620处于关节运动取向时到达端部执行器1620中的期望的最远侧位置。在一个或多个近侧位置中,移位式限制件1660可接合扣件1663并且限制柔性击发杆1618在与钉仓1622的行程结束碰撞之前的进一步远侧位移。
现在参见图23,示出了具有缓冲特征结构1250的紧固件仓1222。紧固件仓1222可在许多方面与紧固件仓122类似(图1)。例如,紧固件仓1222的构造和尺寸可设定成替换端部执行器120(图1)中的紧固件仓122(图1)。在某些情况下,紧固件仓1222可包括仓体并且多个腔可限定在仓体中。另外,多个紧固件诸如钉能够可射出地定位在腔中。紧固件仓1222可移除地定位在仓通道1282中,该仓通道将紧固件仓1222支撑在端部执行器120的钳口中。通道1282包括限定在其中的纵向狭槽1284。
击发构件(例如,击发构件1154(图22))可被构造成能够横贯紧固件仓1222中的纵向狭槽1284的至少一部分以驱动滑动件或钉部署楔形件,例如,诸如滑动件1158(图22)。在击发行程期间,击发构件1154可例如通过滑动件1158和/或驱动器从紧固件仓1222击发紧固件,并且可切断邻近仓1222的组织。仍参见图23,击发构件可包括基座或底座1280。在各种情况下,底座1280可被定位成例如在纵向狭槽1284的较宽和/或t形部分中滑动和/或运动。
在各种情况下,软止挡件或缓冲构件1250可被至少部分地定位在纵向狭槽1284内和/或横跨纵向狭槽1284。例如,缓冲构件1250可阻挡和/或阻塞纵向狭槽1284的远侧部分。在某些情况下,击发构件的底座1280的路径可被缓冲构件1250阻挡。缓冲构件1250可例如与通道1282附接和/或一体形成。在某些情况下,缓冲构件1250可焊接和/或紧固到通道1282。
在各种情况下,缓冲构件1250可形成横跨纵向狭槽1284的桥接件。参见图23,缓冲构件1250包括一对臂1251和中心部分1253。臂1251在纵向狭槽1284的相对侧固定到通道1282。另外,中心部分1253在臂1251之间延伸,并且中心部分1253的至少一部分被定位在纵向狭槽1284中。
图23所示的缓冲构件1250可由柔性、可变形、和/或弹性材料构成。例如,缓冲特征结构1250可由具有比底座1280和/或通道1282的硬度计硬度低的材料构成。在此类情况下,缓冲特征结构1250可被构造成能够至少部分地吸收和/或适应底座1280穿过缓冲特征结构1250的近侧边缘的远侧平移和/或位移。例如,缓冲特征结构1250可充当软止挡件和/或制动器。在此类情况下,缓冲特征结构1250可初始减慢和/或抵制基座1280的远侧位移。此外,如果基座1280继续朝远侧推进,则缓冲特征结构1250可停止和/或阻止击发构件1154的进一步远侧位移。
除此之外或另选地,缓冲特征结构1250可为易碎的。例如,缓冲特征结构1250可被设计和/或构造成在基座1280朝远侧推进到和/或超过缓冲特征结构1250时破碎。在某些情况下,缓冲特征结构1250可在破碎之前减慢和/或吸收底座1280的力的至少一部分。
如本文所述,外科器械的钉仓、端部执行器和/或轴中的行程长度缓冲特征结构可被构造成能够变形、压缩和/或破碎以吸收击发力的至少一部分和/或停止击发构件在击发行程期间的进一步推进。在其他情况下,缓冲特征结构可包括钉仓中的预定义路径、通道和/或开口。此类缓冲特征结构可适应击发构件的越界行程。例如,当击发构件的击发行程未被调节以应对端部执行器120已进行关节运动的程度时,可发生击发构件的越界行程。
现在参见图24,示出了包括缓冲特征结构1350的紧固件仓1322。在许多方面,紧固件仓1322可与紧固件仓122(图1)类似。例如,紧固件仓1322的构造和尺寸可设定成替换端部执行器120(图1)中的紧固件仓122(图1)。在某些情况下,紧固件仓1322可包括仓体1324并且多个腔1326可限定在仓体1324中。另外,例如,多个紧固件诸如钉能够可射出地定位在腔1326中。
例如,击发构件诸如,击发构件1154(图22)可被构造成能够横贯仓体1324的至少一部分以例如驱动滑动件或钉部署楔形件1358。此类击发构件还可包括例如基座或底座,诸如底座1380。在击发行程期间,击发构件可例如通过滑动件1358和/或驱动器从紧固件仓1322击发紧固件,并且可切断邻近仓1322的组织。
图24所示的缓冲特征结构1350包括穿过仓1322的远侧端部限定的开口1352。例如,开口1352可形成穿过钉仓1322的远侧壁的远侧孔。在所示实施方案中,缓冲特征结构1350包括多个开口1352。开口1352延伸穿过仓1322的远侧端部并且提供路径和/或间隙以供滑动件1358的至少一部分突出穿过远侧端部。例如,当端部执行器120(图1)进行部分关节运动或未进行关节运动时,滑动件1358可朝远侧推进到与仓1322的远侧端部邻接接触。为了允许滑动件1358的继续远侧行进,开口1352的大小和尺寸可设定成接收一个或多个滑动件1358的最远侧部分。
如本文所述,端部执行器的关节运动可影响柔性击发杆在外科器械的轴和/或端部执行器中的击发路径。此外,端部执行器的关节运动可改变击发元件在击发行程期间的最远侧位置。在各种情况下,控制器可调节击发杆的击发行程长度,使得击发元件停止在同一位置,而不管端部执行器的关节运动角度如何。在其他情况下,端部执行器和/或击发系统可包括缓冲构件,该缓冲构件被构造成能够吸收和/或适应击发元件的最远侧位置的变化。
在各种情况下,可选择击发行程(例如,由击发连杆114(参见例如图1和图3)行进的距离),使得当端部执行器120(图1)进行完全关节运动时钉部署滑动件1358仍到达钉仓1322的远侧端部。在此类情况下,滑动件1358可继续朝远侧平移并且从最远侧钉腔1326击发钉。因此,当端部执行器120未进行完全关节运动(例如,进行部分关节运动和/或未进行关节运动)时,击发行程可延伸超过钉仓1322的远侧端部。在不存在缓冲特征结构诸如,孔1352的情况下,例如,滑动件1358将与钉仓1322的远侧端部碰撞。缓冲特征结构可例如在端部执行器未进行完全关节运动时阻止和/或使对击发系统的元件和/或马达造成损害最小化。
在某些情况下,当端部执行器处于关节运动取向时,击发元件的最远侧位置可朝近侧移位。例如,当端部执行器处于关节运动取向时,击发系统的部件诸如,柔性击发杆可倾向于向外弓弯。在此类情况下,当端部执行器已进行关节运动时,柔性击发杆的向外弓弯可朝近侧移位击发元件的最远侧位置,由此导致需要击发杆的较长击发行程。
紧固件仓1422示于图25中。紧固件仓1422可在许多方面与紧固件仓122(图1)类似。例如,紧固件仓1422的构造和尺寸可设定成替换端部执行器120(图1)中的紧固件仓122(图1)。在某些情况下,紧固件仓1422可包括仓体并且多个腔可限定在仓体中。另外,例如,多个紧固件诸如钉能够可射出地定位在腔中。图25所示的紧固件仓1422还包括被至少部分地定位在仓体周围的细长通道1482。所示通道1482包括至少部分地穿过其延伸的纵向狭槽1484。
仍参见图25,柔性击发杆1418可被构造成能够将击发动作传输到击发构件,诸如击发构件1154(图22)。柔性击发杆1418可被构造成能够横贯紧固件仓1422中的纵向狭槽1484的至少一部分以驱动例如击发元件诸如击发构件1154和/或钉部署滑动件诸如滑动件1158(图22)。在击发行程期间,击发构件可例如通过滑动件和/或驱动器从紧固件仓1422击发紧固件,并且可切断邻近仓1422的组织。
在图25的所示实施方案中,击发构件包括基座或底座1480。在各种情况下,底座1480可被构造成能够沿着纵向狭槽1484的至少一部分滑动和/或运动。在各种情况下,纵向狭槽1484可为t形的和/或可具有邻近通道1482的外表面的较宽部分。在某些情况下,底座1480和狭槽1484之间的接合可被构造成能够在端部执行器中引导和/或保持击发元件。
所示紧固件仓1422包括远侧止挡件1450。参见图25所示的实施方案,远侧止挡件1450被定位在纵向狭槽1484的远侧端部处。例如,纵向狭槽1484的远侧端部可形成远侧止挡件1450。在各种情况下,远侧止挡件1450可限制和/或阻止底座1480在钉仓1422中的进一步远侧位移,并且因此限制和/或阻止击发构件在钉仓1422中的进一步远侧位移。
参见图25所示的实施方案,远侧止挡件1450包括位于纵向狭槽1484的远程端部处的阶梯式外形。例如,所示远侧止挡件1450包括多个阶梯,该多个阶梯包括第一阶梯1451、第二阶梯1452和第三阶梯1453。远侧止挡件1450的阶梯1451、1452、1452被定位成并且被构造成在端部执行器被取向为不同关节运动程度时接收和/或限制击发构件的底座1480。例如,对于给定的击发行程,击发构件可停止在钉仓内的不同行程末端位置,这取决于端部执行器已进行关节运动的程度。例如,对于给定的击发行程,相比于端部执行器进行关节运动的情况,当端部执行器未进行关节运动时,击发杆将进一步地行进到钉仓内。当端部执行器未进行关节运动时,底座1480可朝远侧驱动到第一阶梯1451,该第一阶梯为最远侧阶梯。因此,当端部执行器未进行关节运动时,可允许底座1480平移到最远侧位置。仍参见图25,当端部执行器未进行关节运动时,柔性击发杆1418可与纵向狭槽1484和第一阶梯1451对准,该第一阶梯可被居中地定位在远侧止挡件1450中。在此类情况下,柔性击发杆1418可沿着纵向路径延伸,该纵向路径形成钉仓的近侧端部和底座1480的最远侧位置之间的最短距离。
现在参见图25所示的钉仓1422’,该钉仓对应于端部执行器处于关节运动取向时的钉仓1422,端部执行器120(图1)的关节运动可导致柔性击发杆1418的弓弯和/或弯曲。在此类情况下,相比于端部执行器处于未进行关节运动的取向的情况,柔性击发杆1418在更远离钉仓的远侧端部的位置开始其击发行程。除此之外或另选地,击发元件及其底座1480可朝外侧并且/或者远离钉仓1422的中心线侧向地偏置。因为当端部执行器进行关节运动并且/或者柔性击发杆1418弓弯和/或弯曲时到达最远侧阶梯1451的距离被改变,所以底座1480在击发行程期间在钉仓1422’中朝远侧延伸的距离可不如端部执行器120未进行关节运动的情况更远。
仍参见钉仓1422’,当端部执行器已进行关节运动时,底座1480可朝远侧延伸到被定位在第一阶梯1451近侧的第三阶梯1453。第三阶梯1453为最近侧阶梯。因此,相比于端部执行器120(图1和图2)处于未进行关节运动的取向的情况,当端部执行器进行关节运动时,底座1480的平移可被停止在和/或以其他方式限制在较近侧的位置。除此之外或另选地,与端部执行器的一个或多个关节运动取向相关联的一个或多个阶梯,例如,第二阶梯1452和第三阶梯1453,可朝外侧并且/或者远离钉仓1422的中心线侧向地定位。
在所示实施方案中,例如,当端部执行器关节运动75°时,底座1480受到最近侧阶梯1453的限制。在其他情况下,当端部执行器关节运动小于或大于75°时,底座1480可受到最近侧阶梯1453的限制。此外,在其他情况下,远侧止挡件1450可包括合适数量的阶梯。在一些情况下,远侧止挡件1450可包括例如两个阶梯。
在某些情况下,远侧止挡件1450可包括硬止挡件,该硬止挡件可突然地制动和/或停止底座1480的远侧行进。在其他情况下,硬止挡件可位于关节运动接头的近侧,如2010年2月9日公布的名称为“SURGICAL STAPLING INSTRUMENT WITH A GEARED RETURNMECHANISM”的美国专利号7,658,311所公开,该专利的全部公开内容以引用方式并入本文。在其他情况下,远侧止挡件1450可包括软止挡件,该软止挡件可初始减慢底座1480的远侧行进并且可最终停止底座1480的远侧行进。在至少一种情况下,远侧止挡件1450可由柔性、可变形、和/或弹性材料构成。除此之外或另选地,远侧止挡件1450可为易碎的并且可被构造成能够例如在对其施加预定义力时破碎。
如本文所述,外科端部执行器的关节运动可影响例如柔性击发杆、切割元件和/或楔形滑动件的最远侧位置。在某些情况下,在端部执行器运动到关节运动取向时,柔性击发杆、切割元件和/或楔形滑动件可停止在当端部执行器未进行关节运动时的最远侧位置近侧的位置。在此类情况下,柔性击发杆及其击发路径的弧度和/或曲率可有效地缩短击发行程。在某些情况下,如上所述,可调节击发行程长度以将端部执行器的关节运动考虑在内。在一些情况下,外科器械能够包括缓冲特征结构,该缓冲特征结构被构造成能够吸收和/或以其他方式适应击发行程的至少一部分。
在其他情况下,可调节柔性击发杆的击发路径以应对端部执行器的关节运动和击发行程长度的有效变化。例如,可沿着下述击发路径偏置和/或引导柔性击发杆,该击发路径限定到达端部执行器中的最远侧位置的较短距离。在某些情况下,调节的击发路径可抑制和/或抵制柔性击发杆的向外弓弯并且/或者可促进例如柔性击发杆的向内移位和/或弯曲。
现在参见图26和图27,示出了外科器械1500。类似于外科器械100,该外科器械包括被构造成能够夹持、紧固和/或切入组织的端部执行器1520。外科器械1500还包括轴1510和被定位在轴1510和端部执行器1520中间的关节运动接头1530。类似于柔性击发杆118,柔性击发杆1518可接收来自击发连杆诸如,击发连杆114(图1和图3-图5)的击发动作并且将击发动作传输到端部执行器1520。柔性击发杆118能够可操作地联接到例如切割元件诸如,击发构件1154和切割边缘1156(图22))和/或可驱动例如楔形滑动件诸如,滑动件1158(图22)。
在各种情况下,轴1510可包括附接部分1512,该附接部分能够旋转地和/或枢转地连接到端部执行器1520。例如,仍参见图26和图27,附接部分1512可联接到细长通道的近侧端部,该细长通道的构造和尺寸设定成接收紧固件仓。端部执行器1520可被构造成能够围绕附接部分1512相对于轴1510进行关节运动。例如,细长通道可在轴1510的附接部分1512上运动和/或枢转。
击发路径修改器或移位器1550也示于图26和图27中。击发路径修改器1550可被构造成能够调节柔性击发杆1518的击发路径。在所示实施方案中,击发路径修改器1550被定位在关节运动接头1530中。击发路径修改器1550包括弓形或弧形狭槽1552和轭或联接销组件1554。仍参见图26和图27,轭1554包括被定位在弓形狭槽1552中的第一销或端部1556和第二销或端部1558。销1556和销1558间隔开固定距离。在各种情况下,轭1554可相对于弓形狭槽1552运动。例如,销1556、1558可在狭槽1552内运动、滑动和/或浮置。
仍参见图26和图27,柔性击发杆1518的一部分可被定位在第一销1556和第二销1558之间。在此类情况下,轭1554可引导柔性击发杆1518。此外,因为轭1554的运动受到弓形狭槽1552的限制,所以移位器1550可调节击发路径和/或朝修改的击发路径偏置柔性击发杆1518。
当端部执行器1550未进行关节运动时,如图26所示,柔性击发杆1518可沿着与轴1510和端部执行器1520的纵向轴线L共线的击发路径延伸。在此类情况下,弓形狭槽1552的几何形状可被构造成能够保持击发路径和纵向轴线L的纵向对准。弧形狭槽1152的拐点可与纵向轴线L对准,其中第一销1556在纵向轴线L的第一侧被定位在狭槽1152中并且第二销1558在纵向轴线L的第二侧被定位在狭槽1152中。因此,轭1554可引导和/或保持柔性击发杆1518与纵向轴线L对准。
当端部执行器1520相对于轴1510运动到关节运动取向时,现在参见图27,移位器1550可沿着较短的击发路径移位和/或偏置柔性击发杆1518。轭1554可在弓形狭槽1552中侧向地移位。例如,当柔性击发杆1518弯曲时,柔性击发杆1518可向内牵拉轭1554。另外,轭1554可引导柔性击发杆1518,因为轭1554受到狭槽1552的限制。如图27所示,轭1554可移位成不与轴1510的纵向轴线L1对准。在此类情况下,击发路径可修改成使得击发路径在关节运动点处的内角或转角被较直接的和/或去角的路径代替。因为移位器1550能够有效地缩短击发路径,所以端部执行器1520已进行关节运动的程度对于柔性击发杆1518的行程末端位置的影响可得以降低。换句换讲,移位器1550可至少部分地抵消因关节运动动作产生的击发行程长度的变化。
主要参见图27,当端部执行器进行关节运动时,轭1554可在弓形狭槽1552中侧向地移位。尽管柔性击发杆1518可经受扭矩和/或向外弓弯力,但移位器1550可抵制扭矩和/或向外弓弯力。例如,弓形狭槽1552的侧壁上的载荷可产生摩擦力,该摩擦力可抵制柔性击发杆1518的扭矩和/或弓弯。
端部执行器组件3100示于图28-图30中。端部执行器组件3100包括第一钳口3110和第二钳口3120。第一钳口3110包括钉仓3112,该钉仓包括可移除地存储在其中的多个钉。该多个钉通过击发组件3150从钉仓3112部署。第二钳口3120包括砧座3122,该砧座被构造成能够在钉从钉仓3112射出时使钉变形。击发组件3150被构造成能够在端部执行器的近侧端部3101和远侧端部3102之间行进。击发组件3150包括被构造成能够部署钉的滑动件3151、被构造成能够在击发组件3150的纵向行进期间切入组织的切割构件3152、和被构造成能够朝远侧推动滑动件3151和/或切割构件3152穿过端部执行器组件3100的击发构件3153。击发构件3153被构造成能够在限定于钉仓3112中的纵向狭槽3111内滑动。滑动件3151、切割构件3152和/或击发构件3153可包括被构造成能够接合第一钳口3110的第一凸轮3158和被构造成能够在击发组件3150朝远侧推进时接合第二钳口3120的第二凸轮3159。第一凸轮3158和第二凸轮3159可协作以相对于钉仓3112定位砧座3122并且在这两者间限定组织间隙。击发构件3153可例如由外科器械组件致动,该外科器械组件可包括可由临床医生和/或机器人操作的致动器致动的柄部。
本文所讨论的各种实施方案利用电路内的电阻、电容和/或电感的变化来确定击发组件在端部执行器内的位置。例如,通过感测因击发组件运动穿过端部执行器产生的电路内的电阻变化,可确定击发组件的位置。参见图27,端部执行器组件3100包括多个电阻元件3105。电阻元件3105被纵向地布置在第一钳口3110内。电阻元件3105被定位在限定于钉仓3112中的纵向狭槽3111内;然而,电阻元件3105可以击发组件3150可接触电阻元件3105的任何合适方式进行布置。电阻元件3105在击发进程检测电路中被布置成并联电路段。在至少一种情况下,每个电阻元件3105与第一公共电路径通信,该第一公共电路径与击发进程检测电路的微处理器通信。在各种情况下,第一公共电路径可延伸穿过例如钉仓3112。如下文更详细所述,在击发组件3150朝远侧推进时,通过击发组件3150来完成或至少部分地完成电击发进程检测电路。
击发组件3150的一部分可为导电的,以便提供电阻元件3105和击发进程检测电路的微处理器之间的第二电路径。在至少一种此类情况下,第二电路径可延伸穿过例如击发构件3153。在其他情况下,第二电路径可延伸穿过第二钳口3120。在击发组件3150朝远侧端部3102行进穿过端部执行器3100时,包括电阻元件3105的并联电路段通过击发组件3150而被相继地闭合,因此电阻元件3105被相继地添加到由击发组件3150经受的电路径。当电阻元件3105被添加到由击发组件3150产生的电路径时,击发进程检测电路的电阻增大。可通过测量第一电路径和第二电路径中的电阻和/或电压降来检测电阻的这种变化。所测得的电阻可与击发组件3150行进的距离相关。击发进程检测电路的电阻将随着击发组件3150朝远侧推进而增大。对应地,击发进程检测电路的电阻将随着击发组件3150朝近侧回缩而减小。
当包括电阻元件3105的并联电路段被击发组件3150接触并且闭合时,电阻元件3105提供击发进程检测电路的电阻的离散增大。在各种情况下,除上述之外,并联电路段可在击发组件3150朝远侧推进时保持闭合。因此,第一并联电路段可被击发组件3150闭合并且可在击发组件3150闭合第二并联电路段和第三并联电路段时保持闭合,等等。并联电路段的闭合可区分击发构件的击发行程期间的路点。闭合并联电路段的组合可为击发进程检测电路提供独特和可识别的电阻,该电阻对应于击发组件3150的特定位置或位置范围。在其他情况下,并联电路段可被击发组件3150闭合并且可在击发组件3150由此朝远侧推进时而重新打开。此类布置可向微处理器提供瞬态脉冲,由此指示击发组件3150已到达某个路点。在至少一种此类情况下,并联电路段可各自具有不同的电阻,由此为击发进程检测电路提供独特和可识别的电阻,该电阻对应于击发组件3150的特定位置或位置范围。例如,第一并联电路段可具有第一电阻,并且第二并联电路段可具有与第一电阻不同的第二电阻,等等。
除电阻元件3105之外或者另选地,击发进程检测电路可包括例如被构造成能够跟踪击发组件3150的击发进程的电位差计。在此类情况下,击发进程检测电路的电阻可随着击发构件3150朝远侧推进而连续地增大。对应地,击发进程检测电路的电阻可随着击发组件3150朝近侧回缩而连续地减小。可通过定位在第一钳口3110和/或第二钳口3120内的纵向电阻构件来提供电阻的连续变化。击发组件3150被构造成能够沿着端部执行器3100的长度接触纵向电阻构件。击发组件所经受的电阻可随着击发组件3150行进穿过端部执行器3100而线性地变化。当击发构件3153朝远侧行进时,与击发组件3150接触的电阻构件的总长度增大。长度的增大可改变击发进程检测电路的电阻,可通过微处理器检测和评估该电阻。在各种情况下,测量击发进程检测电路的电阻变化可提供击发组件3150的位置、速度和/或加速度反馈。
参见图30,第一钳口3110的细长通道3160被构造成能够支撑根据各种实施方案的钉仓,例如,钉仓3122。细长通道3160包括被构造成能够至少部分地接收上述击发构件组件3150的狭槽3161。狭槽3160包括远侧端部3162。当击发构件组件3150到达其行程末端位置时,狭槽3160的远侧端部3162可接收击发构件组件3150。一旦击发构件组件3150到达狭槽3161的远侧端部3162,击发构件组件3150就可处于底部。
除上述之外,外科器械可包括控制系统,该控制系统包括微处理器,该微处理器被构造成能够检测击发构件组件3150何时在端部执行器3100中已处于底部。在至少一种情况下,击发构件组件3150可由电动马达驱动并且微处理器可被构造成能够监测电动马达的功率消耗。在至少一种此类情况下,微处理器可监测例如电动马达所消耗的电流。当控制系统检测到电动马达所消耗的功率的增大足以指示击发构件组件3150已处于底部时,控制系统可将电动马达的功率源中断和/或将施加到击发构件组件3150的电压的极性反转。除了或代替上文所述,端部执行器组件3100可包括可检测击发构件组件3150何时已到达其击发行程末端的传感器,诸如传感器3106。传感器3106可包括例如接近传感器和/或霍尔效应传感器。在任何情况下,控制系统可包括如下装置,该装置用于在外科器械的柄部中产生触觉反馈以向外科器械的用户指示击发构件组件3150已到达其击发行程末端。在各种情况下,触觉反馈可由包括例如不平衡转子的电动马达产生。通过将处于底部位置3162定位在关节运动接头3130的远侧,击发组件3150可行进的最远位置与端部执行器3100的远侧端部3102相关联,而不管关节运动接头3130进行关节运动的角度如何。
端部执行器组件3200示于图31-图33中。端部执行器组件3200包括第一钳口3210和第二钳口3220。第一钳口3210包括钉仓3212,该钉仓包括可移除地存储在其中的多个钉。该多个钉可通过击发组件3250从钉仓3212部署。第二钳口3220包括砧座3222,该砧座被构造成能够在钉从钉仓3212射出时使钉变形。击发组件3250被构造成能够在端部执行器的近侧端部3201和远侧端部3202之间行进。击发组件3250包括被构造成能够部署钉的滑动件3251、被构造成能够在击发组件3250的纵向行进期间切入组织的切割构件3252、和被构造成能够朝远侧推动滑动件3251和/或切割构件3252穿过端部执行器组件3200的击发构件3253。击发构件3253可由柄部致动,该柄部能够例如由临床医生和/或机器人操作的致动器致动。
端部执行器组件3200还包括远侧传感器3224b和近侧传感器3254a。远侧传感器3224b被构造成能够检测第二钳口3220的位置和/或击发组件3250的位置。近侧传感器3254a被构造成能够检测击发组件3250的位置。远侧传感器3224b和近侧传感器3254a包括例如霍尔效应传感器。远侧传感器3224b在端部执行器3200的远侧端部3202处被定位在第二钳口3220上。近侧传感器3254a被定位在击发组件3250上并且被构造成能够在端部执行器3200的近侧端部3201和结合击发组件3250的远侧端部3202之间行进。钉仓3212还包括远侧可检测元件3214b和近侧可检测元件3214a。可检测元件3214a、3214b可至少部分地例如由铁质材料构成。在各种情况下,可检测元件3214a、3214b可包括例如永磁体和/或电磁体。在任何情况下,可检测元件3214a、3214b能够通过传感器3254a、3224b检测。近侧可检测元件3214a在例如端部执行器3200的近侧端部3201处被定位在钉仓3212内。远侧可检测元件3214b在例如端部执行器3200的远侧端部3202处被定位在钉仓3212内。
当钉仓3212被定位在端部执行器3200中时,钉仓3212的可检测元件3214a、3214b可为外科器械的传感器3254a、3224b提供初始信号形态。初始信号形态可在钉仓3212安装到端部执行器3200内之后立即被传送到外科器械控制系统的微处理器。在各种情况下,外科器械能够包括仓存在传感器,该仓存在传感器被构造成能够检测钉仓是否已被定位在端部执行器3200中。仓存在传感器还与控制系统的微处理器进行信号通信。当微处理器确定钉仓未被定位在端部执行器3200中时,微处理器可不执行传感器3254a、3224b的信号评估,并且当微处理器确定钉仓被定位在端部执行器3200中时,微处理器可执行传感器3254a、3224b的初始信号评估。
作为执行传感器3254a、3224b的信号评估的一部分,微处理器可识别被定位在端部执行器3200中的钉仓3212的类型。更具体地,可与端部执行器3200一起使用的钉仓的每种类型可包括可产生独特磁场阵列的可检测元件3214a和/或3214b的独特布置,所述独特磁场阵列可被传感器3254a和/或3224b检测并且能够通过控制系统的微处理器识别。例如,可检测元件3214a可对于第一类型的钉仓产生第一磁场并且可对于第二类型的钉仓产生第二磁场,等等,这些磁场可在传感器信号的初始评估期间通过传感器3254a检测到。在各种情况下,击发系统3250可在传感器信号的初始评估期间被保持在预定或已知位置,使得定位在端部执行器3200中的钉仓可被可靠地识别。在任何情况下,微处理器可访问查找表并且利用初始信号评估期间检测到的磁场强度的值来确定用于外科器械的正确操作程度以适当地击发被定位在端部执行器3200中的钉仓。查找表可存储在虚拟存储器和/或物理存储器中。此类存储器能够通过微处理器访问和/或与微处理器集成在一起。
可监测第二钳口3220的位置以确定第二钳口3220在钉从钉仓3212射出时是否处于使钉变形的位置。远侧可检测元件3214b被定位成使得通过远侧传感器3224b检测到的信号与第二钳口3220相对于第一钳口3210的位置相关。换句话讲,远侧传感器3224b和远侧可检测元件3214b之间的距离影响由远侧传感器3224b检测到的磁场的量值。当第二钳口3220处于打开位置时,远侧传感器3224b将检测到由远侧可检测元件3214b产生的第一磁场强度。当第二钳口3220处于完全闭合位置时,远侧传感器3224b将检测到由远侧可检测元件3214b产生的第二磁场强度。读者将会知道,远侧传感器3224b检测到的第二强度大于第一场强度,因为当第二钳口3220处于其完全闭合位置时远侧传感器3224b更靠近远侧可检测元件3214b。
除上述之外,微处理器可利用远侧传感器3224b检测到的磁场强度来确定第二钳口3220相对于第一钳口3210的位置。如果微处理器确定第二钳口3220还未充分地闭合以在钉从钉仓3212射出时使钉适当地成形,则微处理器可阻止击发系统3250的远侧推进。在至少一种此类情况下,微处理器可不允许将功率供应至被构造成能够驱动击发系统3250的电动马达。如果微处理器确定第二钳口3220已充分地闭合以在钉从钉仓3212射出时使钉适当地成形,则微处理器可例如当被命令执行如下操作时:通过由外科器械的用户操作的击发致动器朝远侧推进击发系统3250。在各种情况下,微处理器可在远侧传感器3224b检测到的磁场强度处于第一范围时阻止击发系统3250被朝远侧推进,并且对应地,可在远侧传感器3224b检测到的磁场强度处于第而二范围时允许击发系统3250被朝远侧推进。
除了或代替上文所述,可在击发系统3250从端部执行器3200的近侧端部3201行进到远侧端部3202时,通过侧传感器3254a和/或远侧传感器3224b监测击发系统3250的位置。当击发系统3250处于其非击发位置时,参见图31,近侧传感器3254a被定位成邻近近侧可检测元件3214a,但相对于近侧可检测元件3214a被定位在近侧。在此类位置中,近侧传感器3254a可检测由近侧可检测元件3214a产生的第一磁场。当击发系统3250朝远侧运动时,击发系统3250运动到更靠近近侧可检测元件3214a,因此,由近侧传感器3254a检测到的第一磁场的量值增大。一旦击发系统3250穿过近侧可检测元件3214a,参见图32,由近侧传感器3254a检测到的第一磁场的量值就会下降。在各种情况下,近侧传感器3254a和近侧可检测元件3214a可沿着纵向轴线对准并且由近侧传感器3254a检测到的第一磁场的量值与近侧传感器3254a和近侧可检测元件3214a之间的距离的平方成反比例。在至少一种此类情况下,近侧可检测元件3214a可与近侧传感器3254a的路径对准。在其他情况下,近侧可检测元件3214a可相对于近侧传感器3254a的路径偏移。
如上所述,近侧传感器3254a与外科器械控制系统进行信号通信。除上述之外,微处理器可访问另一个查找表,并且利用由近侧传感器3254a检测到的第一磁场强度来估计被定位在端部执行器3200中的击发系统3250的位置。类似于上文所述,查找表可存储在虚拟存储器和/或物理存储器中。此类存储器能够通过微处理器访问和/或与微处理器集成在一起。在至少一种情况下,查找表可包括按照对应于击发系统3250的远侧行进的相继顺序进行布置的磁场值的序列。微处理器可比较由近侧传感器3254a检测到的第一磁场强度的量值并且将此值与查找表中值的序列进行比较。在一些情况下,微处理器可比较当前或最近获得的值,另外将一个或多个先前获得的值与序列进行比较。查找表还能够包括位置值序列,该位置值序列与磁场强度值序列相关联并且可向微处理器指示击发系统3250的位置。
当击发系统3250朝远侧推进时,参见图33,击发系统3250可接近远侧可检测元件3214b。类似于上文所述,近侧传感器3254a可检测由远侧可检测元件3214b产生的第二磁场。当击发系统3250朝远侧运动时,击发系统3250运动到更靠近远侧可检测元件3214b,因此,由近侧传感器3254a检测到的第二磁场的量值增大。远侧可检测元件3214b在击发系统3250的整个击发行程期间相对于近侧传感器3254a被定位在远侧。在其他实施方案中,近侧传感器3254a可在击发系统3250的击发行程期间穿过远侧可检测元件3214b。当击发系统3250穿过远侧可检测元件3214b时,在此类情况下,由近侧传感器3254a检测到的第二磁场的量值下降。在各种情况下,近侧传感器3254a和远侧可检测元件3214b可沿着纵向轴线对准并且由近侧传感器3254a检测到的第二磁场的量值与近侧传感器3254a和远侧可检测元件3214b之间的距离的平方成反比例。在至少一种此类情况下,远侧可检测元件3214b可与近侧传感器3254a的路径对准。在其他情况下,远侧可检测元件3214b可相对于近侧传感器3254a的路径偏移。
如上所述,近侧传感器3254a可被构造成能够检测由近侧可检测元件3214a产生的磁场以确定击发系统3250的位置。另选地,近侧传感器3254a可被构造成能够检测由远侧可检测元件3214b产生的磁场以确定击发系统3250的位置。当可检测元件3214a、3214b中的仅一个可检测元件在击发系统3250的击发行程期间发射磁场时,此类另选形式为可以的。在至少一个此类实施方案中,可检测元件3214a、3214b中的至少一个可检测元件可包括电磁体,该电磁体可在击发系统3250的击发行程期间停用以使得电磁体不再产生可充分检测的磁场。然而,在各种情况下,两个可检测元件3214a、3214b在击发系统3250的击发行程期间发射均产生磁场,尤其是当可检测元件3214a、3214b包括例如永磁体时。在此类情况下,近侧传感器3254a可同时检测由近侧可检测元件3214a产生的第一磁场和由远侧可检测元件3214b产生的第二磁场。因此,由近侧传感器3254a检测到的来自第一磁场和第二磁场的总磁场可被评估并且与考虑组合磁场的磁场值序列进行比较。
端部执行器组件3300示于图34-图41中。端部执行器组件3300包括第一钳口3310和第二钳口3320。第一钳口3310包括钉仓3312,该钉仓包括可移除地存储在其中的多个钉。该多个钉可通过击发组件3350从钉仓3312部署。第二钳口3320包括砧座3322,该砧座被构造成能够在钉从钉仓3312射出时使钉变形。击发组件3350被构造成能够在端部执行器的近侧端部3301和远侧端部3302之间行进。击发组件3350包括被构造成能够部署钉的滑动件3351、被构造成能够在击发组件3350的纵向行进期间切入组织的切割构件3352、和被构造成能够朝远侧推动滑动件3351和/或切割构件3352穿过端部执行器组件3300的击发构件3253。击发构件3353可由包括轴3340和关节运动接头3330的外科器械组件致动,该关节运动接头被构造成能够允许端部执行器组件3300相对于轴3340进行关节运动。击发构件3353被定位在轴3340中,使得致动当击发构件3353时,击发构件3353在轴3340内纵向地行进以击发钉仓3312中的钉。除上述之外,击发构件3353可延伸穿过关节运动接头3330并且可在端部执行器3300进行关节运动时在关节运动接头3330内弯曲。外科器械组件还可包括柄部,该柄部能够例如由临床医生和/或机器人操作的致动器致动以使击发构件3353相对于端部执行器3300运动。
端部执行器3300的近侧端部包括通道保持器3360。图35所示的通道保持器3360包括从其延伸的驱动柱3365,该驱动柱可由关节运动致动器3366朝近侧推压和/或朝远侧牵拉以使端部执行器3300围绕关节运动接头3330进行关节运动。通道保持器3360包括多个传感器,诸如第一传感器3368a和第二传感器3368b。传感器3368a、3368b相对于限定在通道保持器3360中的击发构件狭槽3331内的关节运动接头3330定位在远侧。击发构件3353可滑动地定位在击发构件狭槽3331中。主要参见图34,击发构件3353包括被布置成交错取向的多个特征结构3356a、3357a、3356b、3357b、3356c、3357c、3356d和3357d,所述交错取向包括相对于特征结构3357a-3357d的第二行3355b偏移的特征结构3356a-3356d的第一行3355a。特征结构3356a-d的第一行3355a被构造成能够被第一传感器3368a感测。特征结构3357a-d的第二行3355b被构造成能够被第二传感器3368b感测。当击发构件3353朝远侧运动穿过通道保持器3360和端部执行器3300时,第一传感器3368a和第二传感器3368b可分别感测特征结构3356a-d和3357a-d。如下文更详细所述,由传感器3368a、3368b产生的信号对应于击发构件3353的位置。
传感器3368a、3368b与外科器械控制系统的微处理器进行信号通信,该外科器械控制系统被构造成能够接收并且解译由传感器3368a、3368b产生的信号。第一传感器3368a可将第一信号传输到微处理器。第一信号可包括一系列脉冲,该一系列脉冲对应于感测特征结构3356a-d的传感器3368a。例如,第一传感器3368a可在第一传感器3368a检测到被定位成邻近第一传感器3368a的特征结构3356a-d时在与微处理器的输入通道通信的第一电路上传输高电压电位,并且可在第一传感器3368a未检测到邻近第一传感器3368a的特征结构3356a-d时在第一电路上传输低电压电位。类似地,第二传感器3368a可在第二传感器3368b检测到被定位成邻近第二传感器3368b的特征结构3357a-d时在与微处理器的输入通道通信的第二电路上传输高电压电位,并且可在第二传感器3368b未检测到邻近第二传感器3368b的特征结构3357a-d时在第二电路上传输低电压电位。微处理器可对传感器发送的脉冲计数,指示特征结构已经过传感器并且基于此计数来估计击发构件3353在其击发行程期间的位置。在某些情况下,微处理器可保持已经过第一传感器3368a的特征结构3356a-d的第一计数以及已经过第二传感器3368b的特征结构3356a-d的单独、第二计数。在其他情况下,微处理器可保持已感测到的特征结构3356a-d和3357a-d的组合计数。在任一种情况下,微处理器可对已经过传感器3368a和3368b的特征结构3356a-d和3357a-d计数以确定击发构件3353是否已到达其行程末端。
在各种情况下,可需要仅一组特征结构3356a-d和3357a-d和一个传感器3368a和3368b以确定击发构件3353的位置。单组特征结构可为微处理器提供数据序列,该数据序列可与对应于击发构件3353的位置的另一数据序列相关联。然而,采用多个特征结构组和传感器可为微处理器提供数据矩阵,该数据矩阵可与对应于击发构件3353的位置的数据序列相关联。此类数据矩阵示于图39中。
特征结构3356a-d和3357a-d可包括可分别被传感器3368a和3368b检测的任何合适的特征结构。在各种情况下,例如,特征结构3356a-d和3357a-d可包括磁性元件并且传感器3368a和3368b可包括可检测磁性元件的霍尔效应传感器。在某些情况下,例如,特征结构3356a-d和3357a-d可包括反射元件并且传感器3368a和3368b可各自包括信号发射器和接收器。在至少一种情况下,特征结构3356a-d和3357a-d可包括通孔。在至少一种此类情况下,传感器3368a和3368b可包括光学传感器,该光学传感器被构造成能够在特征结构3356a-d和3357a-d分别经过传感器3368a和3368b时检测击发构件3353的颜色和/或反射率的变化。r在某些情况下,传感器3368a和3368b可被构造成能够检测例如从击发构件3353的相对侧面发射的激光信号。在任何情况下,特征结构3356a-d可例如沿着第一行3355a以规则间隔进行定位。类似地,特征结构3357a-d可例如沿着第二行3355b以规则间隔进行定位。微处理器可被构造成能够评估特征结构3356a-d和/或特征结构3357a-d分别被第一传感器3368a和第二传感器3368b检测的速率。在此类情况下,微处理器还可评估击发构件3353的速度、速率和/或加速度。
当击发构件3353的特征结构3356a-d和3357a-d包括通孔时,该通孔可包括例如,任何合适的几何形状,诸如圆形几何形状。现在转向图40,击发构件3453包括沿着击发构件3453的纵向轴线布置的可检测特征结构3459的阵列。在至少一种情况下,可检测特征结构3459包括例如方形通孔。在某些情况下,可检测特征结构3459包括击发构件3453上的纹理化表面。在至少一种此类情况下,纹理化表面为例如方形的。
图41示出了与端部执行器组件3500一起使用的击发组件3550的另选击发构件3553,该另选击发构件包括从其延伸的齿或锯齿状突起3558。齿3558沿着击发构件3553的纵向轴线进行布置并且在齿3558中间提供间隙。安装到端部执行器3500的传感器3535被构造成能够在击发构件3353朝远侧推进时检测齿3558和/或齿3558之间的间隙。在至少一种情况下,传感器3535可包括例如光学传感器。传感器3535与外科器械系统的微处理器进行信号通信。当击发组件3550行进穿过端部执行器3500时,传感器3535发送由齿3558和/或定位在齿3558中间的间隙触发的信号和/或信号脉冲以指示击发构件3553的位置。击发构件3353可包括设定或预定数量的齿3558,该设定或预定数量的齿3558可触发传感器3535向微处理器发送设定或预定数量的信号脉冲以指示击发组件3550的行程。微处理器可对其从传感器3535接收的信号脉冲计数并且将计数的信号脉冲与预定数量的脉冲进行比较以估计击发构件3553是否已到达行程末端位置和/或估计击发构件3553在到达其行程末端位置之前必须行进的距离。控制器可对最远侧齿3558d和最近侧齿3558p之间的齿3558计数,该最远侧齿3558d为微处理器提供第一信号脉冲,该最近侧齿3558p为微处理器提供最后信号脉冲。一旦传感器3535感测到的齿3558的数量等于击发构件3553上的齿3558的数量,就可检测到行程末端位置。
细长通道3610示于图42中。细长通道3610可根据本文所公开的各种实施方案进行使用。细长通道3610被构造成能够支撑端部执行器的钉仓。通道3610包括限定在其中的第一腔3602和第二腔3604。第一腔3602位于通道3610的近侧部分3601处并且第二腔3604位于通道3610的远侧部分3603处。第一腔3602被构造成能够在其中支撑第一或近侧传感器,并且第二腔3604被构造成能够在其中支撑第二或远侧传感器。传感器可为被构造成能够检测击发组件的运动的任何合适的传感器。近侧传感器被构造成能够检测例如击发组件是否处于其未击发或未推进的位置。远侧传感器被构造成能够检测例如击发组件是否已到达其击发行程末端。
图43示出了与外科缝合器械的端部执行器组件3700一起使用的钳口3710。钳口3710包括钉仓3712和击发组件3750。钉仓3712包括限定在其中的被构造成能够接收击发组件3750的纵向狭槽3713。击发组件3750被构造成能够在钉仓3712的近侧端部3701和远侧端部3702之间行进。击发组件3750包括切割构件3752,该切割构件包括:一、被构造成能够切入组织的切割边缘;和二、用于提供横跨狭槽3713(即,从狭槽3713的一个侧面到另一个侧面)的电路径的导电部分。钉仓3712包括导电层3770,该导电层在击发组件3750行进穿过钉仓3712时接触切割构件3752的导电部分。层3770包括例如多个电阻区域,诸如区域3771、3772、3773和3774。在至少一种此类情况下,层3770沿着狭槽3713的两个侧面延伸。图41示出了层3770的两个侧面中的仅一个。如下文更详细所述,当击发组件3750行进穿过钉仓3712时在层3770与切割构件3752之间形成的电路的电阻可被监测到并且可与击发组件3750的位置相关联。
在各种情况下,除上述之外,每个电阻区域3771、3772、3773和3774由导电材料构成。在至少一种此类情况下,第一电阻区域3771由第一导电材料构成,第二电阻区域3772由第二导电材料构成,第三电阻区域3773由第三导电材料构成,并且第四电阻区域3774由第四导电材料构成。在各种情况下,第一材料、第二材料、第三材料和第四材料为例如具有不同电阻率的不同导电材料。在某些情况下,当具有相同导电材料的电阻区域彼此不相邻时,第一材料、第二材料、第三材料和/或第四材料可由相同的导电材料构成。在任何情况下,电阻区域3771、3772、3773和3774为击发进程检测电路的一部分。击发进程检测电路还包括与层3770的第一侧面通信的第一导体和与层3770的第二侧面通信的第二导体。第一导体和第二导体与微处理器通信,该微处理器可检测和评估击发进程检测电路的电阻,如下文更详细所述。
层3770的电阻区域3771、3772、3773和3774可对应于切割构件3752的不同位置以及相应地,击发组件3750的不同位置。切割构件3752能够在近侧、未推进位置和远侧、完全推进位置之间运动穿过击发行程。当切割构件3752处于其近侧、未推进位置时,切割构件3752与第一电阻区域3771接触。此类位置可被称为切割构件3752的“本位”位置。当切割构件3752与第一电阻区域3771接触时,击发进程检测电路可具有可被微处理器检测到的第一电阻。在此类情况下,击发进程检测电路可包括第一导体、第一电阻区域3771的第一侧面、切割构件3752、第一电阻区域3771的第二侧面、和第二导体。当微处理器检测到击发进程检测电路具有第一电阻时,微处理器可确定切割构件3752处于其最近侧位置并且需要完全击发行程以从钉仓完全地击发钉。尽管击发进程检测电路的第一电阻可包括特定的第一电阻,但在各种情况下,其还可包括第一电阻范围。
当切割构件3752从其本位位置朝远侧推进时,切割构件3752可运动成不与第一电阻区域3771接触并且与第二电阻区域3772接触。此类位置可被称为切割构件3752的“闭锁”位置。切割构件3752的闭锁位置为切割构件3752可在未耗尽的钉仓未被定位在第一钳口3710中的情况下可推进的最远侧位置。当切割构件3752与第二电阻区域3772接触时,击发进程检测电路可具有可被微处理器检测到的第二电阻。在此类情况下,击发进程检测电路可包括第一导体、第二电阻区域3772的第一侧面、切割构件3752、第二电阻区域3772的第二侧面、和第二导体。当微处理器检测到击发进程检测电路具有第二电阻时,微处理器可确定切割构件3752处于其闭锁位置并且切割构件3752可在未耗尽的钉仓未被定位在第一钳口3710中的情况下被阻止朝远侧推进。因此,在各种情况下,微处理器可操作电动马达,该电动马达在切割构件3752接触闭锁件的情况下并且在切割构件3752从第二电阻区域3772朝远侧向第三电阻区域3773运动时以减小的速度朝远侧驱动击发组件3750。尽管击发进程检测电路的第二电阻可包括特定的第二电阻,但在各种情况下,其还可包括第二电阻范围。
当切割构件3752从其闭锁位置朝远侧推进时,切割构件3752可运动成不与第二电阻区域3772接触并且与第三阻区域3773接触。第三电阻区域3773对应于击发组件3750从钉仓3712射出钉的位置范围。当切割构件3752与第三电阻区域3773接触时,击发进程检测电路可具有可被微处理器检测到的第三电阻。在此类情况下,击发进程检测电路可包括第一导体、第三电阻区域3773的第一侧面、切割构件3752、第三电阻区域3773的第二侧面、和第二导体。当微处理器检测到击发进程检测电路具有第三电阻时,微处理器可确定击发组件3750正将钉击发到组织内并且切割构件3752正切入组织。在各种情况下,微处理器可操作电动马达,该电动马达在切割构件3752运动穿过第三电阻区域3773时以合适的速度驱动击发组件3750。合适的速度可包括例如恒定速度。在一些情况下,切割构件3752可例如在第三电阻区域3773的近侧端部处加速并且在第三电阻区域3773的远侧端部处减速。尽管击发进程检测电路的第三电阻可包括特定的第三电阻,但在各种情况下,其还可包括第三电阻范围。
当切割构件3752从其钉击发范围朝远侧推进时,切割构件3752可运动成不与第三电阻区域3773接触并且与第四阻区域3774接触。第四电阻区域3774对应于切割构件3752的最远侧、完全击发位置。当切割构件3752与第四电阻区域3774接触时,击发进程检测电路可具有可被微处理器检测到的第四电阻。在此类情况下,击发进程检测电路可包括第一导体、第四电阻区域3774的第一侧面、切割构件3752、第四电阻区域3774的第二侧面、和第二导体。当微处理器检测到击发进程检测电路具有第四电阻时,微处理器可确定击发组件3750处于其击发行程末端。此时,微处理器可停止驱动击发组件3750的电动马达。在一些情况下,微处理器可自动地反转电动马达的方向并且回缩切割构件3752。滑动件3251可保留在钉仓3712的远侧端部3702处或与切割构件3752一起朝近侧回缩。尽管击发进程检测电路的第四电阻可包括特定的第四电阻,但在各种情况下,其还可包括第四电阻范围。
检测第一电阻、第二电阻、第三电阻和第四电阻可提供击发组件3750的实时位置检测。尽管四个电阻区域用于例示的实施方案中,但可使用任何合适数量的电阻区域。
用于检测击发组件何时已到达行程末端位置的装置也可定位在外科缝合器械的柄部组件内。柄部组件4100示于图44中。柄部组件4100包括马达4110和齿轮组件4130。击发构件4150与齿轮组件4130可操作地啮合。马达4110可由用户致动的击发致动器4111致动,以便驱动齿轮组件4130并因此驱动击发构件4150。柄部组件4100还包括被构造成能够容纳传感器的腔4121。传感器可被构造成能够检测击发构件4150的位置、速度和/或加速度。击发构件4150包括标记4151。标记4151可例如被印刷在击发杆4153上。另选的实施方案提供了例如蚀刻在击发构件4150中的标记。击发构件4150可由任何合适的材料构成,诸如塑料、玻璃纤维填充的塑料、不锈钢和/或玻璃。传感器可为被构造成能够感测击发杆4150的标记4151的任何合适的传感器。标记4151可沿着击发构件4150并且在其任何合适的侧面上以任何合适的取向纵向地延伸,所述标记可由定位在腔4121内的传感器检测。传感器可被定位在腔4121内,以在击发构件4150在外科缝合器械内纵向行进时感测击发构件4150的标记4151。
可检测击发组件位置、速度和/或加速度的另一个系统可包括听觉和/或触觉装置,该听觉和/或触觉装置被构造成能够利用声音和/或振动来向外科器械的用户通知击发构件的位置、速度和/或加速度。图45-图46示出了与外科缝合器械一起使用的击发组件4200的局部视图。击发组件4200至少部分地定位在器械的柄部组件内,该击发组件被构造成能够例如击发可移除地存储在端部执行器内的多个钉。击发组件4200包括击发构件4250、驱动齿轮4215和马达4210。马达4210安装到柄部框架或基架4220。马达4210可被外科器械的用户致动的击发致动器致动,以便驱动或旋转驱动齿轮4215。击发构件4250包括与驱动齿轮4215能够可操作地啮合的驱动齿4255的纵向阵列。当被马达4210沿第一方向驱动时,驱动齿轮4215朝远侧向端部执行器驱动击发构件4250。击发构件4250还包括触觉肋或齿4251的纵向阵列,该触觉肋或齿被构造成能够接合安装在柄部框架4220中的触觉弹簧4256。每当触觉肋4251撞击、挠曲并且经过触觉弹簧4256时,就可产生听觉咔嗒声和/或振动。
当击发构件4250朝远侧推进时,除上述之外,可在触觉肋4251接合触觉弹簧4255时向外科器械的用户以听觉方式提示例如击发组件4250的状态。如果击发构件4250正以恒定速度运动,则产生咔嗒声的速率将为恒定的。如果击发构件4250正被加速,则产生咔嗒声的速率将增大。如果击发构件4250正被减速,则产生咔嗒声的速率将降低。相比于近侧端部4257远侧的触觉肋4251,触觉肋4251在击发构件4250的近侧端部4257处包括较密的布置4252。对于击发构件4250的给定速度,被定位在击发构件4250的近侧端部4257处的触觉肋4251(即,肋4252)导致由触觉弹簧4256产生的听觉提示与当触觉弹簧4256接合近侧端部4257远侧的触觉肋4251时由触觉弹簧4256产生的提示不同。在至少一种此类情况下,肋4252加快由用户听到的咔嗒声和/或由用户感到的振动的速率。在听到由肋4252引起的增大的咔嗒声速率时,例如,外科器械的用户可理解击发构件4250可正接近或已到达行程末端位置。在此类情况下,用户可释放正驱动电动马达4210的击发致动器以停止击发构件4250。在其中击发致动器包括马达4210的可变速度控制器的情况下,用户可在释放击发致动器以停止马达4210之前减小施加到击发致动器的压力,由此减慢马达4210。此时,可通过沿第二或相反方向操作马达4210来朝近侧回缩击发构件4250。
如上所述,肋的纵向阵列可包括两部分:建立反馈基线的第一部分和提供此反馈的偏离量的第二部分。可设想到包括基线反馈和偏离基线反馈的不止一个另外反馈的其他实施方案。在各种情况下,最终反馈可包括例如在击发构件靠近其行程末端位置时的听觉咔嗒声和/或振动的加速速率。
上文结合图45和图46的实施方案描述的听觉咔嗒声和/或振动或触觉反馈产生在外科器械的柄部内并且从柄部发出。除了或代替上文所述,听觉咔嗒声和/或振动或触觉反馈产生在外科器械的轴和/或端部执行器内并且从轴和/或端部执行器发出。现在转向图48,切割元件4452被构造成能够在切割元件4456朝远侧推进时接合被定位在端部执行器4400的第一钳口4410中的肋的纵向阵列。类似于上文所述,肋可在切割元件4452从此经过时通过产生咔嗒声和/或振动来指示切割元件4452的位置。肋4455的纵向阵列包括第一部分4455、第二部分4456和第三部分4457,该第一部分4455包括间隔开第一距离的肋,该第二部分4456包括肋间隔开第二距离的肋,该第三部分4457包括间隔开第三距离的肋。例如,第二距离短于第一距离,并且第三距离短于第二距离。切割元件4452包括从其延伸的触觉节结4454,该触觉节结被构造成能够接合并且滑过肋以对于触觉节结4454接触的每个肋产生咔嗒声和/或振动。对于切割元件4452的给定速度,第一部分4455将产生以第一速率的咔嗒声和/或振动,第二部分4456将产生以第二速率的咔嗒声和/或振动,并且第三位置4457将产生以第三速率的咔嗒声和/或振动。例如,第二速率快于第一速率并且第三速率快于第二速率。用户听到的增大的咔嗒声节奏例如将向用户指示切割元件4452正到达其行程末端位置。用户可通过减慢和/或停止切割元件4452来对此反馈作出反应。
在图47中,示出了柄部组件的局部视图。柄部组件4300包括与离合器组件4330结合使用的驱动组件4320,该离合器组件被构造成能够限制传输到驱动组件4320的击发构件4350的扭矩量。驱动组件4320包括电动马达、可操作地联接到电动马达的输出轴的行星齿轮系4331、离合器轴4332、离合器驱动板4334、释放弹簧4333、输出轴4338、输出齿轮4339和击发构件4350。电动马达驱动行星齿轮系4331以便旋转离合器轴4332。还可理解,离合器轴4332可例如通过手摇柄手动地驱动。离合器轴4332与离合器驱动板4334联接,使得离合器轴4332的旋转被传输到离合器驱动板4334。更具体地,离合器驱动板4334键合到离合器轴4332,使得离合器驱动板4334能够与离合器轴4332一起旋转;然而,离合器驱动板4334能够相对于离合器轴4322滑动。如下文更详细所述,离合器驱动板4334包括齿4336,该齿被构造成能够可操作地接合和可操作地脱离输出轴4338上的齿4337。当离合器驱动板4334的齿4336与输出轴4338的齿4337可操作地接合时,离合器驱动板4334的旋转被传输到输出轴4338。输出齿轮4339联接到输出轴4338,使得输出轴4338的旋转(如果有的话)被传输到输出齿轮4339。输出齿轮4339能够与击发构件4350操作地接合,以便朝远侧推进击发构件4350和/或朝近侧回缩击发构件4350,这取决于输出齿轮4339旋转的方向。
除上述之外,释放弹簧4333将离合器驱动板4334偏置成与输出轴4338接合。更具体地,释放弹簧4333将离合器驱动板4334的齿4336偏置成与输出轴4338的齿4337操作地接合。由于齿4336、4337上的成角表面,齿4336、4337可在工作负荷被传输到这两者之间时趋于推压离合器驱动板4334远离输出轴4338。释放弹簧4333可被设计用于处理施加到离合器驱动板4334与输出轴4338之间的特定或预定工作负荷。此预定工作负荷足以在正常操作条件下操作外科器械的端部执行器。例如,预定工作负荷足以击发可移除地存储在钉仓中的钉并使其适当地变形并且足以切入正被缝合的组织。在例如击发构件4350被卡住的情况下,马达可尝试通过离合器组件传输比预定工作负荷更大的工作负荷。在此类情况下,释放弹簧4333可被克服并且离合器驱动板4334可被推压成不与输出轴4338接合。此时,离合器驱动板4334可相对于输出轴4338旋转,而不传输或至少基本上不传输两者间的相对旋转运动。
当击发构件4350已到达其击发行程末端时,除上述之外,击发构件4350可邻接例如钉仓的远侧端部。在此类情况下,钉仓的远侧端部将阻止击发构件4350的推进,并且类似于上文所述,离合器驱动板4334的齿4336将因从电动马达传输到离合器驱动板4334的扭矩被增大以试图进一步地朝远侧推进击发构件4350而相对于输出轴4338的齿4337滑脱和/或脱离啮合。施加到离合器驱动板4334的释放弹簧4333的力不足以保持离合器驱动板4334的齿4336与输出轴4338的齿4337接合以驱动输出齿轮4339。当电动马达例如沿相反方向操作时,传输到离合器接口中的导致离合器滑脱的扭矩将被释放并且齿4336将与齿4337重新啮合以便朝近侧回缩击发构件4350。
另一个实施方案可包括被定位在击发组件内的传感器,该传感器被构造成能够在击发组件到达端部执行器的远侧端部时感测由击发组件经受的力。在端部执行器的远侧端部处,止挡件可被构造成能够阻止击发构件组件的远侧运动。止挡件可被设计用于提供外科器械的控制器可检测和/或测量的已知阻力分布,以通知用户击发组件处于行程末端位置。不同的力分布将基于止挡件的设计而产生。止挡件可为能够破碎的并且可被设计为具有不连续性,由此确保击发组件在到达行程末端位置时的材料失效。阶梯状止挡件可被设计用于渐进地阻止切割构件的运动。一旦切割构件接触阶梯状止挡件的远侧壁,击发组件就将已到达最远侧位置。控制器可寻找第一期望力以向外科器械的用户通知击发构件组件正接近行程末端位置。控制器还可寻找击发构件在到达行程末端位置时经受的第二期望力。
实施例
实施例1-一种外科器械系统,包括:端部执行器,所述端部执行器包括:砧座;钉仓,所述钉仓包括:近侧端部、远侧端部、多个钉腔;和可移除地存储在所述钉腔中的多个钉;以及能够在所述钉仓内滑动以使所述钉朝所述砧座运动的滑动件。所述外科器械系统还包括能够在击发行程期间相对于所述钉仓运动以使所述滑动件从所述近侧端部朝所述远侧端部运动的击发构件;限定纵向轴线的轴;关节运动接头,其中所述端部执行器能够在未进行关节运动的位置和关节运动位置之间围绕所述关节运动接头旋转地连接到所述轴;以及调节装置,所述调节装置用于根据所述端部执行器相对于所述纵向轴线进行关节运动的程度来调节所述击发行程的长度。
实施例2-根据实施例1所述的外科器械系统,还包括用于确定所述击发行程期间的所述击发构件的位置的装置。
实施例3-根据实施例2或3所述的外科器械系统,还包括用于感测所述端部执行器相对于所述纵向轴线的所述关节运动程度的感测装置。
实施例4-根据实施例3所述的外科器械系统,还包括延伸穿过所述关节运动接头的柔性击发杆,其中所述柔性击发杆包括多个侧向部分,并且其中所述感测装置包括用于检测所述侧向部分的相对位置的装置。
实施例5-根据实施例3或4所述的外科器械系统,其中所述调节装置包括与所述感测装置通信的控制器,其中所述控制器被构造成能够基于来自所述感测装置的反馈来调节所述击发行程的长度。
实施例6-根据实施例1、2、3、4或5所述的外科器械系统,其中所述调节装置包括击发路径移位器。
实施例7-一种外科器械系统,包括:端部执行器,所述端部执行器包括砧座和钉仓,所述钉仓包括多个钉腔和可移除地存储在所述钉腔中的多个钉;限定纵向轴线的轴;和关节运动接头,其中所述端部执行器能够在未进行关节运动的位置和相对于所述纵向轴线的多个关节运动位置之间在所述关节运动接头处旋转地连接到所述轴;所述外科器械系统还包括延伸穿过所述关节运动接头的柔性击发杆,其中所述柔性击发杆包括被定位在所述关节运动接头近侧的近侧端部、被定位在所述关节运动接头远侧的远侧端部、和延伸穿过所述关节运动接头的多个侧向部分,其中所述侧向部分被构造成能够在所述端部执行器运动到关节运动位置时相对于彼此移位。所述外科器械系统还包括传感器,所述传感器被构造成能够检测所述柔性击发杆的近侧端部处第一侧向部分和第二侧向部分之间的移位。
实施例8-根据实施例7所述的外科器械系统,其中所述传感器包括霍尔效应传感器,并且其中至少一个磁体被定位在所述柔性击发杆上。
实施例9-根据实施例7或8所述的外科器械系统,其中所述传感器包括线性编码器。
实施例10-根据实施例7、8或9所述的外科器械系统,其中所述传感器包括旋转编码器。
实施例11-根据实施例7、8、9或10所述的外科器械系统,其中所述传感器包括柔性带,所述柔性带包括电活性聚合物。
实施例12-根据实施例7、8、9、10或11所述的外科器械系统,其中所述传感器包括位于所述第一侧向部分上的至少一个第一触件和位于所述第二侧向部分上的至少一个第二触件,其中所述第二侧向部分与所述第一侧向部分相邻。
实施例13-一种外科器械系统,包括:端部执行器,所述端部执行器包括砧座和钉仓,所述钉仓包括多个钉腔和可移除地存储在所述钉腔中的多个钉;限定纵向轴线的轴;关节运动接头,其中所述端部执行器能够在未进行关节运动的位置和相对于所述纵向轴线的至少一个关节运动位置之间在所述关节运动接头处旋转地连接到所述轴;延伸穿过所述关节运动接头的柔性击发构件,其中所述柔性击发构件包括多个侧向部分,并且其中所述侧向部分被构造成能够在端部执行器运动到所述至少一个关节运动位置时相对于彼此移位;以及缓冲特征结构,所述缓冲特征结构被构造成能够适应所述柔性击发构件的侧向部分的移位。
实施例14-根据实施例13所述的外科器械系统,还包括延伸穿过所述轴的刚性击发连杆,其中所述刚性击发连杆联接到所述柔性击发构件,并且其中所述缓冲特征结构被定位在所述柔性击发构件和所述刚性击发连杆中间。
实施例15-根据实施例13或14所述的外科器械系统,其中所述柔性击发构件由具有第一硬度计硬度的第一材料构成,其中所述缓冲特征结构由具有第二硬度计硬度的第二材料构成,并且其中所述第二硬度计硬度小于所述第一硬度计硬度。
实施例16-根据实施例13、14或15所述的外科器械系统,其中所述钉仓还包括能够在所述钉仓内滑动以使所述钉朝所述砧座运动的滑动件,并且其中所述缓冲特征结构被定位在所述滑动件和所述柔性击发构件中间。
实施例17-根据实施例13、14、15或16所述的外科器械系统,其中穿过所述钉仓的至少一部分限定纵向狭槽,并且其中所述缓冲特征结构包括延伸跨过所述纵向狭槽的桥接件。
实施例18-根据实施例13、14、15、16或17所述的外科器械系统,其中所述缓冲特征结构包括易碎构件。
实施例19-根据实施例13、14、15、16、17或18所述的外科器械系统,其中所述钉仓包括远侧端壁,并且其中所述缓冲特征结构包括穿过所述远侧端壁的至少一个孔。
实施例20-根据实施例13、14、15、16、17、18或19所述的外科器械系统,其中所述缓冲特征结构包括具有多个阶梯的硬止挡件。
下述文档的整个公开内容均全文以引用方式并入本文:
·1995年4月4日公布的名称为“ELECTROSURGICAL HEMOSTATIC DEVICE”的美国专利号5,403,312;
·2006年2月21日公布的名称为“SURGICAL STAPLING INSTRUMENT HAVINGSEPARATE DISTINCT CLOSING AND FIRING SYSTEMS”的美国专利号7,000,818;
·2008年9月9日公布的名称为“MOTOR-DRIVEN SURGICAL CUTTING ANDFASTENING INSTRUMENT WITH TACTILE POSITION FEEDBACK”的美国专利号7,422,139;
·2008年12月16日公布的名称为“ELECTRO-MECHANICAL SURGICAL INSTRUMENTWITH CLOSURE SYSTEM AND ANVIL ALIGNMENT COMPONENTS”的美国专利号7,464,849;
·2010年3月2日公布的名称为“SURGICAL INSTRUMENT HAVING AN ARTICULATINGEND EFFECTOR”的美国专利号7,670,334;
·2010年7月13日公布的名称为“SURGICAL STAPLING INSTRUMENTS”的美国专利号7,753,245;
·2013年3月12日公布的名称为“SELECTIVELY ORIENTABLE IMPLANTABLEFASTENER CARTRIDGE”的美国专利号8,393,514;
·名称为“SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES”的美国专利申请序列号11/343,803(现为美国专利号7,845,537);
·2008年2月14日提交的名称为“SURGICAL CUTTING AND FASTENING INSTRUMENTHAVING RF ELECTRODES”的美国专利申请序列号12/031,573;
·2008年2月15日提交的名称为“END EFFECTORS FOR A SURGICAL CUTTING ANDSTAPLING INSTRUMENT”的美国专利申请序列号12/031,873(现为美国专利号7,980,443);
·名称为“MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT”的美国专利申请序列号12/235,782(现为美国专利号8,210,411);
·名称为“POWERED SURGICAL CUTTING AND STAPLING APPARATUS WITHMANUALLY RETRACTABLE FIRING SYSTEM”美国专利申请序列号12/249,117(现为美国专利号8,608,045);
·2009年12月24日提交的名称为“MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENTWITH ELECTRIC ACTUATOR DIRECTIONAL CONTROL ASSEMBLY”的美国专利申请序列号12/647,100(现为美国专利号8,220,688);
·2012年9月29日提交的名称为“STAPLE CARTRIDGE”的美国专利申请序列号号12/893,461(现为美国专利号8,733,613);
·2011年2月28日提交的名称为“SURGICAL STAPLING INSTRUMENT”的美国专利申请序列号13/036,647(现为美国专利号8,561,870);
·名称为“SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLEDEPLOYMENT ARRANGEMENTS”的美国专利申请序列号13/118,241(现为美国专利申请公开号2012/0298719);
·2012年6月15日提交的名称为“ARTICULATABLE SURGICAL INSTRUMENTCOMPRISING A FIRING DRIVE”的美国专利申请序列号13/524,049(现为美国专利申请公开号2013/0334278);
·2013年3月13日提交的名称为“STAPLE CARTRIDGE TISSUE THICKNESS SENSORSYSTEM”的美国专利申请序列号13/800,025;
·2013年3月13日提交的名称为“STAPLE CARTRIDGE TISSUE THICKNESS SENSORSYSTEM”的美国专利申请序列号13/800,067;
·2006年1月31日提交的名称为“SURGICAL CUTTING AND FASTENING INSTRUMENTWITH CLOSURE TRIGGER LOCKING MECHANISM”的美国专利申请公开号2007/0175955;以及
·2010年4月22日提交的名称为“SURGICAL STAPLING INSTRUMENT WITH ANARTICULATABLE END EFFECTOR”的美国专利申请公开号2010/0264194(现为美国专利号8,308,040)。
虽然本文已结合某些公开的实施方案对所述装置的多种实施方案进行了描述,但也可实施这些实施方案的许多修改和变型。另外,在公开用于某些部件的材料的情况下,可使用其他材料。此外,根据多种实施方案,单个部件可被替换为多个部件,并且多个部件也可被替换为单个部件,以执行给定的一种或多种功能。上述具体实施方式和下述权利要求旨在涵盖所有此类修改和变型。
本文所公开的装置可被设计成在单次使用后被丢弃,或者其可被设计成可使用多次。然而,在任一种情况下,可修复装置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。具体地讲,可拆卸装置,并可选择性地以任何组合形式替换或移除装置的任意数量的特定零件或部件。清洗和/或更换特定部件后,所述装置可在修复设施处重新组装以用于随后使用,或者在即将进行外科手术前由外科手术队重新组装。本领域的技术人员将会知道,装置的重新修复可利用多种用于拆卸、清洗/更换和重新组装的技术。此类技术的使用以及所得的修复装置均在本申请的范围内。
优选地,本文所述的发明将在外科手术之前处理。首先,获取新的或用过的器械,并根据需要进行清洗。然后可对器械进行灭菌。在一种灭菌技术中,将该器械放置在闭合且密封的容器诸如,塑料或TYVEK袋中。然后将容器和器械放置在可穿透该容器的辐射场诸如,γ辐射、X射线或高能电子中。辐射杀死器械上和容器中的细菌。然后可将经灭菌的器械储存在无菌容器中。密封容器使器械保持无菌,直到其在医疗设施中被打开。
尽管本发明已被描述为具有示例性设计,但可在本公开的实质和范围内进一步修改本发明。因此,本申请旨在涵盖采用本发明一般原理的任何变型、用途或改型。
以引用方式全文或部分地并入本文的任何专利、公布或其他公开材料均仅在所并入的材料不与本公开所提出的现有定义、陈述或其他公开材料相冲突的范围内并入本文。同样地并且在必要的程度下,本文明确阐述的公开内容取代了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、陈述或其他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。
Claims (20)
1.一种外科器械系统,包括:
端部执行器,所述端部执行器包括:
砧座;
钉仓,所述钉仓包括:
近侧端部;
远侧端部;
多个钉腔;和
多个钉,所述多个钉可移除地存储在所述钉腔中;和
滑动件,所述滑动件能够在所述钉仓内滑动以使所述钉朝所述砧座运动;
击发构件,所述击发构件能够在击发行程期间相对于所述钉仓运动以使所述滑动件从所述钉仓的所述近侧端部朝所述钉仓的所述远侧端部运动;
轴,所述轴限定纵向轴线;
关节运动接头,其中所述端部执行器能够在未进行关节运动的位置和关节运动位置之间围绕所述关节运动接头旋转地连接到所述轴;以及
调节装置,所述调节装置用于根据所述端部执行器相对于所述纵向轴线进行关节运动的程度来调节所述击发行程的长度。
2.根据权利要求1所述的外科器械系统,还包括用于确定所述击发行程期间所述击发构件的位置的装置。
3.根据权利要求1所述的外科器械系统,还包括用于感测所述端部执行器相对于所述纵向轴线的关节运动程度的感测装置。
4.根据权利要求3所述的外科器械系统,还包括延伸穿过所述关节运动接头的柔性击发杆,其中所述柔性击发杆包括多个侧向部分,并且其中所述感测装置包括用于检测所述侧向部分的相对位置的装置。
5.根据权利要求3所述的外科器械系统,其中所述调节装置包括与所述感测装置通信的控制器,其中所述控制器被构造成能够基于来自所述感测装置的反馈来调节所述击发行程的长度。
6.根据权利要求1所述的外科器械系统,其中所述调节装置包括击发路径移位器。
7.一种外科器械系统,包括:
端部执行器,所述端部执行器包括:
砧座;和
钉仓,所述钉仓包括多个钉腔和可移除地存储在所述钉腔中的多个钉;
轴,所述轴限定纵向轴线;
关节运动接头,其中所述端部执行器能够在未进行关节运动的位置和相对于所述纵向轴线的多个关节运动位置之间在所述关节运动接头处旋转地连接到所述轴;
柔性击发杆,所述柔性击发杆延伸穿过所述关节运动接头,其中所述柔性击发杆包括:
定位在所述关节运动接头近侧的近侧端部;
定位在所述关节运动接头远侧的远侧端部;
延伸穿过所述关节运动接头的多个侧向部分,其中所述侧向部分被构造成能够在所述端部执行器运动到关节运动位置时在所述近侧端部处相对于彼此移位;和
传感器,所述传感器被构造成能够检测所述柔性击发杆的所述近侧端部处第一侧向部分和第二侧向部分之间的移位。
8.根据权利要求7所述的外科器械系统,其中所述传感器包括霍尔效应传感器,并且其中至少一个磁体被定位在所述柔性击发杆上。
9.根据权利要求7所述的外科器械系统,其中所述传感器包括线性编码器。
10.根据权利要求7所述的外科器械系统,其中所述传感器包括旋转编码器。
11.根据权利要求7所述的外科器械系统,其中所述传感器包括柔性带,所述柔性带包括电活性聚合物。
12.根据权利要求7所述的外科器械系统,其中所述传感器包括:
位于所述第一侧向部分上的至少一个第一触件;和
位于所述第二侧向部分上的至少一个第二触件,其中所述第二侧向部分与所述第一侧向部分相邻。
13.一种外科器械系统,包括:
端部执行器,所述端部执行器包括:
砧座;和
钉仓,所述钉仓包括多个钉腔和可移除地存储在所述钉腔中的多个钉;
轴,所述轴限定纵向轴线;
关节运动接头,其中所述端部执行器能够在未进行关节运动的位置和相对于所述纵向轴线的至少一个关节运动位置之间在所述关节运动接头处旋转地连接到所述轴;
柔性击发构件,所述柔性击发构件延伸穿过所述关节运动接头,其中所述柔性击发构件包括多个侧向部分,并且其中所述侧向部分被构造成能够在所述端部执行器运动到所述至少一个关节运动位置时相对于彼此移位;以及
缓冲特征结构,所述缓冲特征结构被构造成能够适应所述柔性击发构件的所述侧向部分的移位。
14.根据权利要求13所述的外科器械系统,还包括延伸穿过所述轴的刚性击发连杆,其中所述刚性击发连杆联接到所述柔性击发构件,并且其中所述缓冲特征结构被定位在所述柔性击发构件和所述刚性击发连杆中间。
15.根据权利要求13所述的外科器械系统,其中所述柔性击发构件由具有第一硬度计硬度的第一材料构成,其中所述缓冲特征结构由具有第二硬度计硬度的第二材料构成,并且其中所述第二硬度计硬度小于所述第一硬度计硬度。
16.根据权利要求13所述的外科器械系统,其中所述钉仓还包括能够在所述钉仓内滑动以使所述钉朝所述砧座运动的滑动件,并且其中所述缓冲特征结构被定位在所述滑动件和所述柔性击发构件中间。
17.根据权利要求13所述的外科器械系统,其中穿过所述钉仓的至少一部分限定纵向狭槽,并且其中所述缓冲特征结构包括延伸跨过所述纵向狭槽的桥接件。
18.根据权利要求13所述的外科器械系统,其中所述缓冲特征结构包括易碎构件。
19.根据权利要求13所述的外科器械系统,其中所述钉仓包括远侧端壁,并且其中所述缓冲特征结构包括穿过所述远侧端壁的至少一个孔。
20.根据权利要求13所述的外科器械系统,其中所述缓冲特征结构包括具有多个阶梯的硬止挡件。
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US14/574,478 US9844374B2 (en) | 2014-12-18 | 2014-12-18 | Surgical instrument systems comprising an articulatable end effector and means for adjusting the firing stroke of a firing member |
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PCT/US2015/063941 WO2016099951A2 (en) | 2014-12-18 | 2015-12-04 | Surgical instrument systems comprising an articulatable end effector and means for adjusting the firing stroke of a firing member |
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CN107249481B (zh) | 2020-05-15 |
WO2016099951A2 (en) | 2016-06-23 |
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BR112017012620A2 (pt) | 2017-12-26 |
EP3034017B1 (en) | 2018-08-29 |
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BR112017012620B1 (pt) | 2022-06-14 |
RU2017125452A (ru) | 2019-01-21 |
EP3034017A3 (en) | 2016-10-05 |
MX2017008119A (es) | 2018-03-06 |
WO2016099951A3 (en) | 2016-11-03 |
US20180110519A1 (en) | 2018-04-26 |
US11517311B2 (en) | 2022-12-06 |
JP6724011B2 (ja) | 2020-07-15 |
RU2703687C2 (ru) | 2019-10-21 |
US9844374B2 (en) | 2017-12-19 |
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