CN107257664A - 用于具有能够关节运动的外科端部执行器的可拆卸的轴组件的锁定布置 - Google Patents
用于具有能够关节运动的外科端部执行器的可拆卸的轴组件的锁定布置 Download PDFInfo
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Abstract
本发明公开了一种外科器械。在一种形式中,该外科器械包括具有可移除地附接到外壳的可互换轴组件的外壳。可互换轴组件包括细长轴,该细长轴具有可操作地联接到该细长轴以用于相对于该细长轴进行选择性关节运动的外科端部执行器。关节运动系统被构造成能够在该关节运动系统处于致动取向时选择性地对所述外科端部执行器施加关节运动动作。锁定布置防止在关节运动系统处于致动取向时可互换轴组件与外壳分离。
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它们一起使用的钉仓。
附图说明
通过结合附图来参考本发明实施方案的以下说明,本发明的特征和优点以及获得它们的方式将会变得更加明显,并且本发明本身将被更好地理解,其中:
图1是包括柄部、轴和能够关节运动的端部执行器的动力外科器械的透视图;
图2是外科器械外壳的分解组件视图;
图3是可互换轴组件的一部分的剖面图;
图4是图3的可互换轴组件的一部分的局部透视图,其中为清楚起见,已除去锁鼓和喷嘴;
图5是图4的可互换轴组件的剖面透视图;
图6是图5可互换轴组件的一部分的剖面透视图;
图7是可互换轴组件和外科端部执行器的一部分的另一剖面图,其中端部执行器处于非关节运动取向;
图8是图7的可互换轴组件的另一剖面图,其中端部执行器处于关节运动取向;
图9是另一可互换轴组件的一部分的局部透视图;
图10是图9的可互换轴组件的一部分的另一透视图,其中为清楚起见,已省去各种部件;
图11是图10的可互换轴组件的一部分的局部剖面图,其中为清楚起见,已省去一些部件;
图12是处于非关节运动构型的另一可互换轴组件的一部分的局部剖面图;
图13是处于关节运动构型的图12的可互换轴组件的另一个局部剖面图;
图14是另一可互换轴组件的一部分的另一透视图;
图15是图14的可互换轴组件的一部分的另一透视图,其中为清楚起见,已省去各种部件;
图16是图14和图15的可互换轴组件的一部分的另一透视图,其中为清楚起见,已省去各种部件;
图17是图14-图16的可互换轴组件的一部分的局部分解组件视图;
图18是图14-图17的可互换轴组件的一部分的剖面透视图,其中为清楚起见,已省去各种部件,并且其中离合器组件处于关节运动取向;
图19是图14-图18的可互换轴组件的一部分的另一剖面透视图,其中为清楚起见,已省去各种部件,并且其中离合器组件处于击发取向;
图20是图14-图19的可互换轴组件的一部分的另一剖面图,其中端部执行器处于非关节运动取向;
图21是图14-图20的可互换轴组件的一部分的另一剖面图,其中端部执行器处于关节运动取向;
图22是沿图21中的线22-22截取的图14-图21的可互换轴组件的剖面图;
图23是图14-图22的可互换轴组件的一部分的另一剖面图,其中端部执行器处于关节运动取向,并且离合器组件处于击发取向;
图24是沿图23中的线24-24截取的图14-图23的可互换轴组件的剖面图;
图25是具有可操作地联接到另一外科器械的能够关节运动的外科端部执行器的另一外科器械的透视图;
图26是图25的外科器械的柄部部分的透视图,其中为清楚起见,已省去喷嘴外壳的一部分;
图27是图25和图26的外科器械的一部分的分解透视图;
图28是图25-图27的外科器械的锁组件的部分的分解组件视图;
图29是外科器械的细长轴组件的剖面图;
图30是另一外科器械的另一细长轴组件的剖面图;
图31是另一外科器械的一部分的示意图;并且
图32是另一外科器械的一部分的示意图。
贯穿这几个视图,对应的参考符号指示对应的部件。本文示出的范例以一种形式示出本发明的某些实施方案,并且此类范例不应被理解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提交于2013年3月1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布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布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布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布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布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布2014/0246477;
-名称为Sensor Straightened End Effector During Removal Through Trocar的美国专利申请序列号13/782,481,现为美国专利申请公布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布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,现为美国专利公布2014/0246473;以及
-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布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布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布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布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布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布2014/0263538;
-名称为MULTI-FUNCTION MOTOR FOR A SURGICAL INSTRUMENT的美国专利申请序列号13/803,148,现为美国专利申请公布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布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布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布2014/0263543;以及
-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布2014/0277017;
本申请的申请人还拥有提交于2014年3月7日且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布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 CIRCUIT ANDWAKE 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 VARIABLE VOLTAGEPROTECTION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提交于2014年9月5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 TISSUE COMPRESSION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 TO DETECT 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;以及
-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提交于2014年4月9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布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布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布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布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布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布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布2014/0309665;
-名称为DRIVE SYSTEM DECOUPLING ARRANGEMENT FOR A SURGICAL INSTRUMENT的美国专利申请序列号14/248,586,现为美国专利申请公布2014/0305990;以及
-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布2014/0305992。
本申请的申请人还拥有提交于2013年4月16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;以及
-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。
本申请的申请人拥有与本申请同日提交的各自全文以引用方式并入本文的以下专利申请:
-名称为SURGICAL INSTRUMENT SYSTEMS COMPRISING AN ARTICULATABLE ENDEFFECTOR AND MEANS FOR ADJUSTING THE FIRING STROKE OF A FIRING MEMBER的美国专利申请序列号_______;代理人案卷号END7415USNP/140289;
-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;以及
-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。
本文对许多特定细节作了阐述,以使读者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、制造和用途有透彻理解。没有详细描述熟知的操作、部件和元件,以免使说明书中描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,并且因此可以理解,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“包含”、“含有”)、“具有”(以及“具有”的任何形式,诸如“带有”和“具备”)、“包含”(以及“包含”的任何形式,诸如“包括”、和“含有”)以及“含有”(和“含有”的任何形式,诸如“包含”和“容纳”)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,在许多取向和位置中使用外科器械,并且这些术语并非旨在为限制性和/或绝对的。
提供各种示例性装置和方法以执行腹腔镜式和微创外科规程操作。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规程和应用中,包括例如结合开放式外科规程使用。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该工作通道推进。
外科缝合系统可包括轴和从该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中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它实施方案。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它实施方案。外科缝合系统还包括关节运动接头,该关节运动接头被构造成能够允许端部执行器相对于轴旋转或关节运动。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它实施方案。
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,钉仓被定位在待缝合组织的第一侧上,并且砧座被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。钉腔被布置成六个纵向排。三排钉腔被定位在纵向狭槽的第一侧上,并且三排钉腔被定位在纵向狭槽的第二侧上。钉腔和钉的其它布置也是可以的。
钉是由仓体中的钉驱动器支撑的。驱动器能够在第一或非击发位置和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弹性构件,该弹性构件被构造成能够夹持仓体以及将保持器保持至仓体。驱动器能够通过滑动件在该驱动器的非击发位置和击发位置之间运动。滑动件能够在与近侧端部相邻的近侧位置和与远侧端部相邻的远侧位置之间运动。滑动件包括多个斜坡表面,该多个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,并且钉是在驱动器上受到支撑的。
除上述以外,滑动件还可由击发构件朝远侧运动。击发构件被构造成能够接触滑动件并且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与砧座之间的距离或组织间隙。击发构件还包括刀片,该刀片被构造成能够切入在钉仓和砧座中间捕集的组织。希望刀片被定位成至少部分地在斜坡表面的近侧,使得钉在刀片前面射出。
图1示出了示例性马达驱动(或“作动力”)的外科器械10,该外科器械10包括外壳100、细长可互换轴组件200和可操作地连接到可互换细长轴组件200的外科端部执行器300。虽然所示轴组件能够从外壳100拆卸,但采用专用(不可互换)轴组件的布置可同样享有各种独特和新型的特征。所示出的外科端部执行器300被构造成能够充当用于夹持、切断和缝合组织的直线切割器。然而,应当理解,各种实施方案可包括被构造成能够充当其它外科装置,包括例如,抓紧器、切割器、缝合器、施夹钳、进入装置、药物/基因疗法递送装置、超声、射频和/或激光能量装置等的端部执行器。如上所述和下文将进一步描述,外科器械10的各个部分均为马达驱动的。关于外科器械10的马达驱动部件的许多方面的更多细节例如可见于全文以引用方式并入本文的名称为ARTICULATABLE SURGICAL INSTRUMENTCOMPRISING AN ARTICULATION LOCK的美国专利申请序列号13/803,086,现为美国专利申请公布2014/0263541A1。然而,应当理解,本文所公开的各种布置和特征可有效地结合机器人控制的外科系统使用。例如,本文所公开的各种布置可与公开于以下专利申请以及以下专利的各种机器人系统、器械、部件以及方法一起使用:名称为SURGICAL STAPLINGINSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS的美国专利申请序列号13/118,241,现为美国专利申请公布No.2012/0298719以及名称为MULTI-COMPONENTTELEPRESENCE SYSTEM AND METHOD的美国专利6,132,368、名称为AUTOMATED ENDOSCOPESYSTEM FOR OPTIMAL POSITIONING的美国专利5,878,193、名称为ARTICULATED SURGICALINSTRUMENT FOR PERFORMING MINIMALLY INVASIVE SURGERY WITH ENHANCED DEXTERITYAND SENSITIVITY的美国专利5,792,135、名称为ROBOTIC ARM DLUS FOR PERFORMINGSURGICAL TASKS的美国专利6,231,565、名称为ROBOTIC SURGICAL TOOL WITH ULTRASOUNDCAUTERIZING AND CUTTING INSTRUMENT的美国专利6,783,524、名称为ALIGNMENT OFMASTER AND SLAVE IN A MINIMALLY INVASIVE SURGICAL APPARATUS的美国专利6,364,888、名称为MECHANICAL ACTUATOR INTERFACE SYSTEM FOR ROBOTIC SURGICAL TOOLS的美国专利7,524,320、名称为PLATFORM LINK WRIST MECHANISM的美国专利7,691,098、名称为REPOSITIONING AND REORIENTATION OF MASTER/SLAVE RELATIONSHIP IN MINIMALLYINVASIVE TELESURGERY的美国专利7,806,891和名称为SURGICAL TOOL WITH WRITEDMONOPOLAR ELECTROSURGICAL END EFFECTORS的美国专利7,824,401,每个上述专利的全部公开内容均据此以引用方式并入本文。
因此,如本文所用,术语“外壳”也可涵盖机器人系统的容纳或者以其它方式可操作地支撑至少一个驱动系统的外壳或类似部分,该至少一个驱动系统被构造成能够产生并施加至少一个控制动作,该至少一个控制动作可用于致动本文所公开的可互换轴组件及其相应的等同物。术语“框架”可指手持式外科器械的一部分,例如,“柄部”。术语“框架”还可表示机器人控制的外科器械的一部分和/或机器人系统的可用于可操作地控制外科器械的一部分。
应当理解,本文参照假设外科器械10的纵向或“轴轴线”与轴200的中心轴线同轴的附图给出诸如竖直、水平、右、左等空间术语。然而,在实践中,外科器械10可以各种角度取向,并且因此相对于外科器械本身使用这些空间术语。此外,对于手持式外壳而言,“近侧”用于表示临床医生的观点,该临床医生在手柄后面并且在他或她自己的远侧或远离他或她自己放置端部执行器300。如本文所用,在“纵向轴线”是轴的轴线情况下,短语“基本上横向于纵向轴线”是指几乎垂直于纵向轴线的方向。然而,应当理解,与纵向轴线的垂直方向有一些偏差的方向也基本上横向于纵向轴线。
如在图1中可以看到,端部执行器300在关节运动接头240处可枢转地连接到轴组件200。多种关节运动接头和控制系统公开于以引用方式并入本文的各种专利和专利申请并且可结合本文所公开和要求的各种特征使用。其它关节运动接头和关节运动系统公开于名称为SURGICAL STAPLING INSTRUMENTS的美国专利7,753,245和名称为SURGICALINSTRUMENT HAVING AN ARTICULATING END EFFECTOR的美国专利7,670,334,每个上述专利的全部公开内容均据此以引用方式并入本文。用于使端部执行器300进行关节运动的各种其它装置在下文中进行更详细的论述。
所示端部执行器300包括被构造成能够在其中可操作地支撑外科钉仓310的细长通道302。钉仓310包括仓体312,该仓体在其中可操作地支撑多个外科钉或紧固件(未示出)。在一个具体实施中,钉可操作地支撑在驱动器上,该驱动器可动地支撑在形成于仓体312中的对应钉凹坑314内。仓体312还包括居中设置在钉凹坑314的排之间的细长狭槽316。细长狭槽316被构造成能够容置组织切割构件(未示出),该组织切割构件被支撑用于在从击发系统对该组织切割构件施加击发动作时纵向行进穿过仓体312,如将在下文进一步详细地讨论。在某些具体实施中,组织切割构件可与致动器构件,有时被称为“楔形滑动件”或简称为“滑动件”相互配合,该致动器构件被构造成能够在楔形滑动件与组织切割构件一起朝远侧驱动时对钉驱动器施加向上动作。如在图1中还可以看到,端部执行器300包括砧座320,砧座320可动地支撑在细长通道302上,以用于朝向和远离细长通道302和支撑在其中的钉仓310选择性行进。细长通道和砧座也可被称为能够在打开位置和闭合位置之间运动的“钳口”。砧座320具有钉成形底面(未示出),该钉成形底面用于在钉的端部被驱动成与该钉成形底面形成接触时使该钉的端部成形。砧座320能够通过闭合构件组件210在打开位置与闭合位置之间运动,闭合构件组件210与由外壳100可操作地支撑的闭合系统相互配合,如将在下文进一步详细地讨论。在所示实施方案中,砧座320在闭合构件组件210在远侧方向“DD”上驱动时朝向钉仓310运动到闭合位置并且在闭合构件组件210在近侧方向“PD”上运动时返回到打开位置。多种不同的端部执行器布置和构造是已知的,并且可与本文所公开的各种独特和新型特征一起使用。因此,本文所提出的权利要求中的许多可不局限于例如图1所示的特定端部执行器布置。关于另选端部执行器的特定构造和操作的更多细节可见于以引用方式并入本文的各个美国专利申请和专利。
在所示形式中,外科器械10包括具有柄部102的外壳100。在至少一种形式中,柄部102包括通过螺钉、按扣特征结构、粘合剂等互连的一对可互连外壳段104、106。在所示布置中,柄部外壳段104、106配合形成可被临床医生抓握和操纵的手枪式握把部108。如将在下文进一步详细地讨论,柄部102在其中可操作地支撑多个驱动系统,该多个驱动系统被构造成能够产生并施加各种控制动作到可操作地附接到该多个驱动系统的可互换轴组件的对应部分。
现在参见图2,柄部102还可包括可操作地支撑多个驱动系统的框架110。例如,框架110可以可操作地支撑通常被标记为120的第一或闭合驱动系统,该驱动系统可用于对可操作地附接或联接到该驱动系统的可互换轴组件200施加闭合和打开动作。在至少一种形式中,闭合驱动系统120可包括由框架110可枢转地支撑的闭合触发器122形式的致动器。更具体地,如图2所示,闭合触发器122可由框架110可枢转地支撑,使得当临床医生抓握柄部102的手枪式握把部108时,闭合触发器122可以轻松地从起始或未致动位置枢转到致动位置,并更具体地,枢转到完全压缩或完全致动位置。闭合触发器122可被弹簧或其它偏压布置结构(未示出)偏压到未致动位置。在各种形式中,闭合驱动系统120还包括可枢转地联接到闭合触发器122的闭合连杆组件124。如在图2中可以看到,闭合连杆组件124可包括闭合连接件126,该闭合连接件126可枢转地联接到闭合触发器122。此外,闭合连杆组件124包括另一闭合连接件127,该另一闭合连接件127具有从该闭合连接件127突起的一对侧向延伸的附接凸耳或部分128。
仍参见图2,可以观察到,闭合连接件126可在其上具有锁定壁130,该锁定壁130被构造成能够与可枢转地联接到框架110的闭合释放组件140配合。在至少一种形式中,闭合释放组件140可包括释放按钮组件,该释放按钮组件具有形成于该释放按钮组件上的远侧突起凸轮从动臂144。释放按钮组件142可由释放弹簧146在逆时针方向上枢转。当临床医生将闭合触发器122从其未致动位置朝向柄部102的手枪式握把部108按压时,闭合连接件126向上枢转至某个点,在该点,凸轮从动臂144落入与闭合连接件126上的锁定壁130保持接合,从而防止闭合触发器122返回未致动位置。因此,闭合释放组件140有助于将闭合触发器122锁定在完全致动位置。当临床医生希望将闭合触发器122解锁以允许该闭合触发器122被偏压到未致动位置时,临床医生简单地枢转闭合释放按钮组件142,使得凸轮从动臂144运动成与闭合连接件126上的锁定壁130脱离接合。当凸轮从动臂144已运动成与闭合连接件126脱离接合时,闭合触发器122可以枢转回到未致动位置。也可采用其它闭合触发器锁定和释放布置结构。
在至少一种形式中,柄部102和框架110可以可操作地支撑在本文中被称为击发驱动系统150的另一驱动系统,该驱动系统被构造成能够对附接至该驱动系统的可互换轴组件200的对应部分施加击发动作。击发驱动系统也可在本文中被称为“第二驱动系统”。击发驱动系统150可以采用位于柄部102的手枪式握把部108中的电动马达(“击发马达”)152。在各种形式中,击发马达152可为例如具有约25,000RPM的最大旋转的DC有刷驱动马达。在其它布置结构中,击发马达可包括无刷马达、无绳马达、同步马达、步进马达或任何其它合适的电动马达。例如,诸如锂电池之类的电池154(或“功率源”或“功率组”)可联接到柄部102,以向控制电路板组件156并且最终向击发马达152提供电力。
击发马达152可包括与齿轮减速器组件158可操作地相互配合的可旋转轴(未示出),齿轮减速器组件158被安装成与能够纵向运动的驱动构件160上的一组或一齿条的驱动齿162啮合接合。在使用中,由电池所提供的电压极性可在顺时针方向上操作击发马达152,其中由电池施加到电动马达的电压极性可被反向,以便在逆时针方向上操作电动马达152。当电动马达152在一个方向上旋转时,驱动构件160将在远侧方向“DD”上被轴向地驱动。当马达152在相反的旋转方向上被驱动时,驱动构件160将在近侧方向“PD”上被轴向地驱动。柄部102可包括开关,所述开关被构造成能够使由电池施加到击发马达152的极性反向。如同本文所述的其它形式一样,柄部102还可包括传感器,该传感器被构造成能够检测驱动构件160的位置和/或驱动构件160运动的方向。
在所示器械中,击发马达152的致动可通过可枢转地支撑在柄部102上的击发触发器170进行控制。击发触发器170可在未致动位置和致动位置之间枢转。击发触发器170可被弹簧(未示出)或其它偏压布置结构偏压到未致动位置,使得当临床医生释放击发触发器170时,该击发触发器可被弹簧或偏压布置结构枢转到或者以其它方式返回未致动位置。在所示形式中,击发触发器170可以被定位在闭合触发器122“外侧”,如上文所讨论。在至少一种形式中,击发触发器安全按钮172可枢转地安装到闭合触发器122。安全按钮172被定位在击发触发器170和闭合触发器122之间并且具有从该安全按钮172突起的枢轴臂174。当闭合触发器122处于未致动位置时,安全按钮172被包含在柄部外壳100中,在此情况下临床医生可能无法轻易地触及该按钮并使该按钮在防止击发触发器170致动的安全位置与其中击发触发器170可被击发的击发位置之间运动。当临床医生按压闭合触发器122时,安全按钮172和击发触发器170向下枢转,其中它们随后可被临床医生操纵。
如上所述,在至少一种形式中,能够纵向运动的驱动构件160具有形成于该驱动构件160上的齿条162,该齿条用于与齿轮减速器组件158的对应驱动齿轮159啮合接合。至少一种形式还包括可手动致动的“救助”组件180,该组件被构造成能够允许临床医生在击发马达152变得被停用的情况下手动地缩回能够纵向运动的驱动构件160。救助组件180可包括杠杆或救助柄部组件182,该杠杆或救助柄部组件被构造成能够被手动地枢转到与驱动构件160中的齿162棘轮接合。因此,临床医生可通过使用救助柄部组件182而手动地缩回驱动构件160,以将驱动构件在近侧方向“PD”上缩回。美国专利申请公布US 2010/0089970公开了救助布置和也可与本文所公开的各种器械一起使用的其它部件、布置和系统。名称为POWERED SURGICAL CUTTING AND STAPLING APPARATUS WITH MANUALLY RETRACTABLEFIRING SYSTEM的美国专利申请序列号12/249,117,现为美国专利申请公布No.2010/0089970,全文据此以引用方式并入本文。
图1示出了外科器械10,其具有可操作地联接到其的可互换轴组件200。如上所述,轴组件200可被构造用于与外壳100快速附接和分离。闭合构件组件210包括远侧闭合构件段220,远侧闭合构件段220在关节运动接头240处可枢转地附接到近侧闭合构件段230。远侧闭合构件段220包括U形开口222,U形开口222被构造成能够在闭合构件组件在近侧方向“PD”上被拉动时可操作地接合砧座320上的直立砧座突片322。当U形开口222接合砧座突片322时,砧座320被枢转到打开位置。关于关节运动接头240和或其它合适的关节运动接头布置的示例的具体细节可见于已以引用方式并入本文的各种文献。
现在参见图3和图7,轴组件200包括闭合构件组件210可动地支撑在其上的脊组件250。脊组件250包括远侧端部252,该远侧端部可枢转地附接到细长通道302的近侧端部304。参见图7。这种布置有利于端部执行器300相对于脊组件250的远侧端部252围绕横向于轴轴线SA-SA的关节运动轴线A-A进行枢转关节运动。参见图1。在各种具体实施中,端部执行器300还可以能够选择性地相对于外壳100围绕轴轴线SA-SA旋转(由图1中的箭头“R”表示)。由于端部执行器300直接附接到脊组件250的远侧端部252,该脊组件250相对于外壳100的旋转也导致端部执行器300的旋转。在所示具体实施中,可互换轴组件200包括旋转喷嘴400,该旋转喷嘴由柄部102可旋转地轴颈连接或者以其它方式可旋转地支撑。在所示具体实施中,例如,旋转喷嘴400包括两个喷嘴部分402、404,该两个喷嘴部分通过按扣特征结构、螺钉、粘合剂等联接在一起,并且包括安置在脊组件250的近侧端部252中的对应凹口254中的两个相反的向内延伸的凸耳406。参见图3。这种布置有利于当喷嘴400旋转时旋转脊组件250。
通过关节运动系统500的致动来实现端部执行器300围绕关节运动轴线A-A进行关节运动。在所示具体实施中,例如,关节运动系统500包括用于致动第一关节运动驱动器520和第二关节运动驱动器530的关节运动马达510。参见图5和图6。关节运动马达510可包括类似于击发马达或本文所讨论的各种马达布置中的任何一者的马达,并且包括关节运动驱动齿轮512,该关节运动驱动齿轮与第一关节运动驱动器520的近侧端部522上的第一齿条524啮合接合。关节运动齿轮512还与第二关节运动驱动器530的近侧端部532上的第二齿条534啮合接合。如在图5中最尤为可见,关节运动齿轮512居中设置在第一齿条524和第二齿条534之间,使得关节运动齿轮在第一方向上的旋转将导致第一关节运动驱动器520在远侧方向“DD”上轴向运动以及第二关节运动驱动器530在近侧“PD”上或相反的轴向方向上同时轴向运动。同样,关节运动齿轮512在第二旋转方向上的旋转将导致第二关节运动驱动器530在远侧方向“DD”上的轴向运动以及第一关节运动驱动器520在近侧或相反方向“PD”上的同时轴向运动。参见图7,第一关节运动驱动器520的远侧端部526包括狭槽528,该狭槽被构造成能够接收形成于细长通道302上的对应销304。同样,第二关节运动驱动器530的远侧端部536包括狭槽538,该狭槽被构造成能够接收形成于细长通道302上的对应销306。因此,关节运动驱动器520、530以上述方式的轴向运动将对细长通道302施加同时的“推压和牵拉”动作,并且会导致端部执行器300围绕关节运动轴线A-A的枢转关节运动。
如上所述,外科器械10还包括组织切割构件,该组织切割构件被构造成用于轴向行进穿过外科钉仓310中的细长狭槽316。在所示具体实施中,例如,组织切割构件或组织切割表面(未示出)形成于远侧击发构件550上或者以其它方式附接到远侧击发构件550。远侧击发构件550可为层压构造,以有利于围绕关节运动轴线A-A弯曲,同时保持足够的刚性,以使得组织切割刃能够被驱动穿过夹持在外科钉仓与砧座之间的组织,并且将楔形滑动件驱动穿过该组织。各种远侧击发构件和组织切割构件构型是已知的并且公开于以引用方式并入本文的专利和/或专利申请。远侧击发构件550附接到近侧击发构件560,该近侧击发构件被支撑用于相对于脊组件250轴向行进。近侧击发构件560中具有居中设置的轴向狭槽562以容置关节运动马达510的驱动轴511。参见图5。这种布置有利于近侧击发构件560响应于由击发系统对该近侧击发构件施加的击发动作轴向行进。近侧击发构件560的近侧端部564包括凸耳566,该凸耳566被构造成能够接收在设置在可动驱动构件160的远侧端部162中的击发杆附接底座164中。参见图2。因此,击发马达152的致动将导致可动驱动构件160以及近侧击发构件560和远侧击发构件550轴向运动。
击发马达152和关节运动马达510与控制电路156(图2)连通,并且通过通常被标记为600的开关布置结构互锁。在所示构型中,开关布置结构600包括可旋转地支撑在近侧闭合构件段230上的开关鼓610。参见图3。开关鼓610包括侧向延伸的凸台611,该侧向延伸的凸台具有安装(压配合)在其中的向内延伸的凸轮销612。凸轮销612向内延伸到设置在近侧闭合构件段230中的凸轮狭槽232中。参见图4。开关鼓610还包括相反的狭槽614,该相反的狭槽被构造成能够穿过该狭槽适应喷嘴凸耳406的旋转。还提供关节运动狭槽617以有利于开关鼓610相对于关节运动马达510旋转。参见图3。开关布置结构600还包括滑环组件620,滑环组件620被构造成能够向端部执行器300并且/或者从端部执行器300向柄部102并且更具体地向柄部102内的控制电路156传导电功率和/或信号。滑环组件620在该滑环组件相反的两侧上包括多个同心或至少基本上同心的导体622,导体622可被构造成能够允许滑环组件620的半部之间的相对旋转,同时仍然保持它们之间的导电通路。此类滑环组件的示例公开于各自全文据此以引用方式并入本文的名称为STAPLE CARTRIDGE TISSUE THICKNESSSENSOR SYSTEM的美国专利申请序列号13/800,067,现为美国专利申请公布2014/0263552和名称为STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM的美国专利申请序列号13/800,025,现为美国专利申请公布2014/0263551。在所示具体实施中,滑环组件620包括隔板624,该隔板624具有开关部件626,该开关部件通过滑环组件620与控制电路156连通。开关布置结构600还包括安装到开关鼓610的开关臂部分616的可动开关部件618。
参见图4,可以看到,凸轮狭槽232具有第一部分232A和第二部分232B。当闭合构件230处于近侧(未致动)位置时,凸轮销612位于凸轮狭槽232的第一部分232A中。锁定弹簧630安装在开关鼓凸台611上以将开关鼓610偏压到第一位置中,在该第一位置中凸轮销612位于凸轮狭槽232的第一部分232A中的。参见图3。当处于所述第一位置时,可动开关部件618不与开关部件626接触或“致动接近”。当处于此“击发锁”位置时,控制电路防止击发马达152的致动。换言之,除非可动开关部件618致动开关部件626,否则不向击发马达152提供电力。因此,即使临床医生要致动击发触发器170来试图致动击发马达152,击发马达152也不会致动。
在典型外科规程期间,临床医生可通过患者体内的套管针或其它开口将端部执行器300引入手术部位中以进入目标组织。为了将端部执行器相对于目标组织定位在期望的位置,临床医生可通过致动安装在柄部102上的摇杆开关515来致动关节运动马达510。摇杆开关515与控制电路156连通并且通过在第一方向上摇动摇杆开关515将致使关节运动马达510在第一方向上旋转并且导致端部执行器300在第一关节运动方向上进行关节运动。在第二方向上摇动开关515将导致关节运动马达510在相反的旋转方向上旋转并且致使端部执行器300在相反的第二关节运动方向上进行关节运动。一旦临床医生已将端部执行器300定位在期望的位置,则临床医生可释放开关515以停止关节运动。在此刻,目标组织可被定位在外科钉仓310与砧座320之间。临床医生然后可使砧座320运动到其中目标组织被夹持在钉仓310和砧座320之间的闭合位置。
通过致动闭合触发器122来致动闭合构件组件210。近侧闭合构件段230的近侧端部支撑在闭合构件附接轭(未示出)中,该闭合构件附接轭可动地支撑在轴组件200的框架部分(未示出)中。闭合构件附接轭和轴组件的框架部分的示例更详细地描述在全文以引用方式并入本文的名称为ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRINGDRIVE的美国专利申请序列号13/803,097,现为美国专利申请公布2014/0263542。当临床医生按压闭合触发器122时,闭合构件组件210在远侧方向“DD”上运动,而这最终会致使砧座320枢转到夹持位置到达目标组织上。当闭合构件组件210朝远侧运动时,凸轮销612与凸轮狭槽232相互作用并且被用凸轮带动到凸轮狭槽232的部分232B中。凸轮销612到凸轮狭槽232的部分232B中的运动导致开关鼓组件610在致动方向上(由图3中的箭头“AD”表示)旋转运动。当开关鼓610克服弹簧630的力朝致动方向“AD”偏压时,开关部件618被启动/与开关部件626对准,而这会致使控制电路板156在击发触发器170的致动时允许电力流向击发马达152。当处于所述闭合位置时,闭合构件组件210和砧座320以上述方式被锁定在闭合位置。控制电路156还可被构造成使得当开关部件618和626处于致动对准时,在摇杆开关515意外地被致动的情况下,控制电路156防止电力至关节运动马达510的任何流动。一旦闭合构件组件210和砧座320被锁定在夹持位置,则临床医生可致动击发触发器170,以将切割构件驱动穿过端部执行器300并切割夹持在其中的目标组织,并且在组织切割线的各侧上击发外科紧固件。端部执行器300还可配备有传感器,该传感器与控制电路156连通以检测组织切割构件何时已达到其最远侧位置,从而发信号通知击发马达152停止并且使其方向反向,以使组织切割构件缩回到其起始位置。可使用其它传感器来检测组织切割构件何时已返回起始位置并且与控制电路156连通,从而为临床医生提供组织切割构件的状态的指示并且/或者使得闭合构件组件能够被解锁。一旦闭合构件组件210已被解锁,则作用于开关鼓610的锁定弹簧630将迫使凸轮销612可旋转地返回到凸轮狭槽232的部分232A。开关鼓610旋转回到该起始位置将去激活开关626,而这将会再次防止击发马达152的致动。
图9-图11示出了除了下文所讨论的差异以外基本上类似于轴组件200的另一轴组件200'。将使用相同的元件编号来标记在轴组件200中也可以找到的轴组件200'的那些部分/部件。如在图9-图11中可以看到,轴组件200'包括关节运动系统500',该关节运动系统500'包括用于致动第一关节运动驱动器520'和第二关节运动驱动器530'的关节运动马达510'。参见图10和图11。关节运动马达510'包括与关节运动齿轮组件700啮合接合的关节运动蜗轮512'。在一种形式中,关节运动齿轮组件包括关节运动正齿轮702,该关节运动正齿轮702与关节运动蜗轮512'和关节运动驱动齿轮704啮合接合,关节运动驱动齿轮704与第一关节运动驱动器520'和第二关节运动驱动器530'的部分啮合接合。关节运动齿轮组件700,并且更具体地,驱动齿轮704居中设置在第一关节运动驱动器520'上的第一齿条524'与第二关节运动驱动器530'上的第二关节运动齿条534'之间。关节运动驱动齿轮704在第一方向上的旋转将导致第一关节运动驱动器520'在远侧方向“DD”的轴向运动以及第二关节运动驱动器530'在近侧“PD”或相反轴向方向的同时轴向运动。同样,关节运动驱动齿轮704在第二旋转方向的旋转将导致第二关节运动驱动器530'在远侧方向“DD”的轴向运动以及第一关节运动驱动器520'在近侧或相反方向“PD”的同时轴向运动。
参见图11,第一关节运动驱动器520'的远侧端部526'包括狭槽528',该狭槽被构造成能够接收形成于端部执行器300的细长通道上的对应销304。同样,第二关节运动驱动器530'的远侧端部536'包括狭槽538',该狭槽被构造成能够接收形成于细长通道上的对应销306。因此,关节运动驱动器520'、530'以上述方式的轴向运动将对端部执行器300的细长通道施加同时的“推压和牵拉”动作,从而导致端部执行器300围绕关节运动轴线的枢转关节运动。如上所述,外科器械10还包括组织切割构件,该组织切割构件被构造用于轴向行进穿过被支撑在端部执行器300中的外科钉仓中的细长狭槽。组织切割构件或组织切割表面(未示出)形成于远侧击发构件550上或者以其它方式附接到远侧击发构件550。远侧击发构件550附接到击发杆560',该击发杆被支撑用于在脊组件250内轴向行进。近侧击发构件560'其中具有居中设置的轴向狭槽(未示出)以容置齿轮驱动轴701,关节运动正齿轮702和关节运动驱动齿轮704安装在该齿轮驱动轴701上。参见图9和图10。这种布置有利于近侧击发构件560'响应于由击发系统对该近侧击发构件施加的击发动作轴向行进。近侧击发构件560'的近侧端部564'包括凸耳566',该凸耳被构造成能够接收在设置在驱动构件160的远侧端部163中的击发杆附接底座164中。参见图2。因此,击发马达152的致动将导致驱动构件160以及近侧击发构件560'和远侧击发构件550的轴向运动。
击发马达152和关节运动马达510与控制电路156(图2)连通,并且通过通常被标记为600的开关布置结构互锁。在所示构型中,开关布置结构600包括开关鼓610',该开关鼓可旋转地支撑在闭合构件230'上。开关鼓610'包括侧向延伸的凸台611',该侧向延伸的凸台具有安装在其中的向内延伸的凸轮销612'。类似于上述布置,凸轮销612'向内延伸到设置在闭合构件230'中的凸轮狭槽中。开关鼓610'还包括相反的狭槽614',该相反的狭槽被构造成能够适应穿过该相反的狭槽的喷嘴凸耳406的旋转。开关鼓610'具有开放底部部分613'以有利于开关鼓610'相对于关节运动马达510'和关节运动齿轮组件700旋转。参见图9。开关布置结构600'还包括可动开关部件618',该可动开关部件安装到开关鼓610'的开关臂部分616'。
如上文所讨论,当闭合构件230'处于近侧(未致动)位置时,凸轮销612'位于凸轮狭槽的第一部分中。锁定弹簧630'安装在开关鼓凸台611'上以将开关鼓610'偏压到第一位置,在该第一位置中凸轮销612'位于凸轮狭槽的第一部分中。当处于所述第一位置时,可动开关部件618'不与开关部件626接触或“致动接近”。当处于此“击发锁”位置时,控制电路防止击发马达152的致动。换言之,除非可动开关部件致动开关部件626,否则不向击发马达152提供电力。因此,即使临床医生要致动击发触发器170来试图致动击发马达152,击发马达152也不会致动。
在所示示例中,通过致动闭合触发器122来致动闭合构件组件230'。当临床医生按压闭合触发器122时,闭合构件组件230'在远侧方向“DD”上运动,而这最终会致使砧座枢转到夹持位置到达目标组织上。当闭合构件组件230'朝远侧运动时,凸轮销612'与凸轮狭槽相互作用,而这会导致开关鼓组件610'的旋转运动。当开关鼓610'克服弹簧612'的力朝致动方向偏压时,开关部件618'被启动/与开关部件626对准,而这会致使控制电路板156在击发触发器170的致动时允许电力流向击发马达152。当处于所述闭合位置时,闭合构件组件210'和砧座以上文所述的方式锁定在闭合位置。控制电路156还可被构造成使得当开关部件618'和626处于致动对准时,在摇杆开关515意外地被致动的情况下,控制电路156防止电力至关节运动马达510'的任何流动。一旦闭合构件组件210'和砧座被锁定在夹持位置,则临床医生可致动击发触发器170,以将切割构件驱动穿过端部执行器300并切割夹持在其中的目标组织,并且在组织切割线的各侧上击发外科紧固件。端部执行器300还可配备有传感器(未示出),该传感器与控制电路156连通以检测组织切割构件何时已达到其最远侧位置,从而为控制电路提供输入以致使击发马达152停止并且使其方向反向,以使组织切割构件缩回到其起始位置。可使用其它传感器来检测组织切割构件何时已返回到起始位置并且与控制电路156连通,从而将所述信息传送给临床医生并且/或者使得闭合构件组件能够被解锁。一旦闭合构件组件210'已被解锁,则作用于开关鼓610'的锁定弹簧630'将迫使凸轮销612'将开关鼓610'可旋转地返回所述起始位置,而这将会去激活开关626,并且再次将通过控制电路来防止击发马达152的致动。
图12和图13示出了除了下文所讨论的差异以外基本上类似于轴组件200的另选的轴组件200”。将使用相同的元件编号来标记在轴组件200中也可以找到的轴组件200”的那些部分/部件。在这些附图中可以看到,轴组件200”包括脊组件250”,脊组件250”包括附接到轴框架260的近侧框架端部或近侧框架构件252”,轴框架260可枢转地联接到端部执行器框架插件330,端部执行器框架插件330附接到细长通道302。轴框架260包括枢轴销262,枢轴销262被构造成能够可旋转地接收在端部执行器框架插件330中的枢轴孔(未示出)内。这种布置结构用于限定端部执行器300可围绕其进行关节运动的关节运动接头240。
所示轴组件200”包括除了下文所述的差异以外类似于上文所讨论的关节运动驱动器520、530的第一关节运动驱动器520”和第二关节运动驱动器530”。如在图12和图13中可以看到,例如,第一关节运动驱动器520”和第二关节运动驱动器530”可滑动地支撑在脊组件250”与闭合构件组件210”之间。因此,当被致动时,关节运动驱动器520”、530”在这些部件之间轴向地滑动,以使端部执行器300围绕关节运动接头240进行关节运动。在第一关节运动驱动器520”和第二关节运动驱动器530”的致动期间为其提供支撑,在关节运动驱动器520”、530”之间居中设置空转齿轮264。第一关节运动驱动器520”包括第一远侧齿条527,并且第二关节运动驱动器530”包括第二远侧齿条537。第一远侧齿条527和第二远侧齿条537如图所示与空转齿轮264啮合接合。此外,近侧闭合构件段230”包括第一摩擦产生止动器或锁定齿234,第一摩擦产生止动器或锁定齿234被构造成能够可滑动地接合第一关节运动驱动器520”上的第一齿状或锯齿状部分529。近侧闭合构件段230”还包括第二摩擦产生止动器或锁定齿236,第二摩擦产生止动器或锁定齿236被构造成能够可滑动地接合第二关节运动驱动器530”上的第二齿状或锯齿状部分539。为有利于第一关节运动驱动器520”和第二关节运动驱动器530”的锯齿状部分529、539的分别在端部执行器300的关节运动期间的一些弯曲,在近侧框架构件252”的对应部分与关节运动驱动器520”、530”的锯齿状部分529、539之间设置间隙量。例如,近侧框架构件252”的不与锯齿状部分529、539对应的部分可具有直径“D”,并且近侧框架构件252”的与锯齿状部分529、539对应的部分可具有“M”的最小直径,其中M<D。在驱动器520”、530”'轴向推进时,这种布置为关节运动驱动器520”、530”的弯曲提供间隙。在这种轴向推进期间,止动器齿234、236接合对应锯齿状部分529、539,以防止关节运动驱动器520”、530”使端部执行器运动且实质上“锁定”就位。这不仅有利于在外科规程的执行期间将端部执行器保持在关节运动取向,而且在装置的运输期间可防止装置的部分意外地被损坏。此外,此类锁定布置结构用于在轴组件附接到柄部或外壳之前将关节运动驱动器保持在该关节运动驱动器各自的附接位置。在另选布置结构中,摩擦产生止动器或锁定齿可各自被弹簧偏压成与关节运动驱动器的对应锯齿状部分接触。例如,每个齿可以能够单独地在横向于锯齿状部分的方向上运动。偏压构件或弹簧可结合每个锁定齿设置,以将该齿偏压成与对应锯齿状部分保持接合。
图14-图24示出了可与外科器械10一起使用的另一可互换轴组件1200的部分。下文将使用相同的元件编号来描述与上述可互换轴组件200的部件相同的可互换轴组件1200的那些部件。在所示布置结构中,轴组件1200包括闭合构件组件1210可动地支撑在其上的脊组件1250。脊组件1250包括可旋转地支撑在轴组件1200的框架部分中的近侧脊段1252。近侧脊段1252具有两个沿直径相反的凹口1253,该凹口被构造成能够接收从喷嘴部分1402向内延伸的对应凸耳部分1406。关于轴框架组件和近侧脊段1252旋转附接在其中以及喷嘴部分1402旋转附接到其的更多细节可见于全文以引用方式并入本文的名称为ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE的美国专利申请序列号13/803,097(美国专利申请公布2014/0263542)。
参见图16、图17、图18、图19、图22和图24,近侧脊段1252通过闭合构件组件1210内的在近侧脊段1252和远侧框架构件1256之间延伸的框架肋1254联接到远侧框架构件1256。如在图20和图21中可以看到,远侧框架构件1256联接到框架1260。端部执行器1300类似于端部执行器300,并且被构造成能够以上述方式切割和缝合/组织。端部执行器1300包括细长通道1302,该细长通道1302具有附接到其的端部执行器框架插件1330。关于框架和端部执行器框架插件的更多细节也可见于名称为ARTICULATABLE SURGICAL INSTRUMENTCOMPRISING A FIRING DRIVE的美国专利申请序列号13/803,097(美国专利申请公布2014/0263542)。轴框架1260包括枢轴销1262,该枢轴销被构造成能够可旋转地接收在端部执行器框架插件1330中的枢轴孔(未示出)内。这种布置结构用于限定端部执行器1300可围绕其进行关节运动的关节运动接头1240。在所示具体实施中,可互换轴组件1200包括与关节运动锁1270相互配合的近侧关节运动驱动器1242。关于关节运动锁1270的更多细节也可见于名称为ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE的美国专利申请序列号13/803,097,美国专利申请公布No.2014/0263542。如在所述专利申请中更详细地讨论,近侧关节运动驱动器1240的运动,无论是近侧的还是远侧的,可将关节运动锁1270解锁。
仍然参见图19和图20,关节运动锁1270包括远侧关节运动驱动器1272,该远侧关节运动驱动器可动地联接到端部执行器框架插件1330上的驱动销1332。例如,驱动销1332紧密地接收在限定于远侧关节运动驱动器1272的远侧端部1273中的销狭槽1274内,使得驱动销1332可抵靠销狭槽1274的近侧侧壁,并且传递近侧推力P到远侧关节运动驱动器1272。这种近侧推力P将仅用于加强通过关节运动锁1270实现的锁定接合。为了释放锁定接合,并且允许端部执行器1300在由箭头1241指示的方向上旋转,现在参见图21,近侧关节运动驱动器1242朝近侧被牵拉以将锁部件充分解锁,并且允许远侧关节运动驱动器1272朝近侧运动。在各种情况下,近侧关节运动驱动器1242可继续朝近侧被牵拉,直到该近侧关节运动驱动器的一部分朝近侧牵拉远侧关节运动驱动器1272以使端部执行器1300进行关节运动。在端部执行器1300已在箭头1241的方向上适当地关节运动之后,在各种情况下,近侧关节运动驱动器10040可被释放,以允许关节运动锁1270将远侧关节运动构件1272重新锁定就位。关于关节运动锁1270的构造和操作的更多细节可见于全文以引用方式并入本文的名称为ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE的美国专利申请序列号13/803,097(美国专利申请公布2014/0263542)。
如上文所讨论,可互换轴组件1200的一种形式包括关节运动驱动器系统,该关节运动驱动器系统包括近侧关节运动驱动器1242和远侧关节运动驱动器1272。当驱动力传递到近侧关节运动驱动器1242时,无论其在近侧方向上还是在远侧方向上,驱动力均可通过关节运动锁1270传递到远侧关节运动驱动器1272。在各种情况下,除上述以外,外科器械10的驱动构件160可用于将这种驱动力赋予近侧关节运动驱动器1242。例如,可互换轴组件1200包括离合器系统1700,该离合器系统可被构造成能够选择性地将近侧关节运动驱动器1242连接到外科器械10的驱动构件160,使得驱动构件160的运动被赋予近侧关节运动驱动器1242。在使用中,离合器系统1700能够在接合状态(图22)和脱离接合状态(图24)之间运动,在接合状态下,近侧关节运动驱动器1242与近侧击发构件1560(和驱动构件160)可操作地接合,在脱离状态下,近侧关节运动驱动器1242不与近侧击发构件1560(和驱动构件160)可操作地接合。
在一种形式中,离合器系统1700包括接合构件1710,该接合构件可被构造成能够直接将近侧关节运动驱动器1242连接到近侧击发构件1560。如在图16中可以看到,例如,近侧关节运动驱动器1242包括近侧突片1243,近侧突片1243接收在环形沟槽1712内,该环形沟槽设置在接合构件1710的周边中,以将近侧关节运动驱动器1242连接到接合构件1710,同时允许它们之间的相对旋转。如在图17中可以看到,近侧击发构件1560包括细长连杆部分1562,该细长连杆部分具有形成于该细长连杆部分近侧端部上的附接凸耳1564。附接凸耳1564被构造成能够可旋转地支撑在驱动构件160上的底座162中。参见图2。如在图17中可以进一步看到,近侧击发构件1560还包括形成于连杆1562的远侧端部上的击发杆联接器1566。击发杆联接器1566包括限定圆柱形通道1568的封闭的远侧端部1567。孔1569穿过封闭的远侧端部1567而形成,该孔1569适于可滑动地接收穿过其的中间击发构件1570的近侧端部1572。在所示示例中,中间击发构件1570包括呈圆盘1574的形式的阻挡构件,该阻挡构件形成于中间击发构件1570的近侧端部1572上并且该阻挡构件的尺寸被设定成用于在击发杆联接器1566中的圆柱形通道1568内滑动行进。中间击发构件1570的远侧端部以公开于例如以引用方式并入本文的名称为ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AFIRING DRIVE的美国专利申请序列号13/803,097(美国专利申请公布2014/0263542)的各种方式联接到远侧击发构件550的近侧端部。在所示布置结构中,两个沿直径相反的V形接合沟槽1580形成于击发杆联接器1566的周边中。参见图17-19。V形沟槽1580被构造成能够可滑动地接收形成于接合构件1710的内表面1713上的对应V形关节运动止动器1714、1715。
除上述以外,再次参见图16-图24,离合器系统1700还包括致动器构件1720,该致动器构件被构造成能够在接合构件1710上轴向地运动。如在图17中最尤为可见,例如,第一接合销1716从接合构件1710向外延伸并且被构造成能够可滑动地接收在延伸穿过致动器构件1720的狭槽1722内。这种布置结构有利于致动器构件1720和接合构件1710的相对轴向运动,同时还使得致动器构件1720和接合构件1710能够作为一个单元旋转。同样在所示布置结构中,离合器系统1700包括从致动器构件1720突起的凸轮销1724。如同上述布置结构一样,凸轮销1724伸出穿过近侧闭合构件段1230中的凸轮狭槽1232。参见图15。
击发马达152与控制电路156和通过通常被标记为1600的开关布置结构连通。在所示构型中,开关布置结构1600包括可旋转地支撑在近侧闭合构件段1230上的开关鼓1610。开关鼓1610包括侧向延伸的凸台1611,该凸台能够在其中接收凸轮销1724的端部。开关鼓1610还包括相反的狭槽1614,该狭槽被构造成能够穿过该狭槽适应喷嘴凸耳1406的旋转。参见图14。开关布置结构1600还包括滑环组件1620,该滑环组件被构造成能够向端部执行器1300并且/或者从端部执行器300向柄部102并且更具体地向柄部102内的控制电路156传导电功率和/或信号。滑环组件1620在其相反的两侧上包括多个同心或至少基本上同心的导体1622,该导体可被构造成能够允许滑环组件1620的半部之间的相对旋转,同时仍然保持它们之间的导电通路。在所示具体实施中,滑环组件1620包括隔板1624,该隔板具有通过滑环1620与控制电路156连通的开关部件1626。开关布置结构1600还包括安装到开关鼓1610的开关臂部分1616的可动开关部件1618。参见图14。
如上文所讨论,在典型外科规程期间,临床医生可通过患者体内的套管针或其它开口将端部执行器1300引入外科部位中以进入目标组织。图20示出了端部执行器1300的位置,该位置用于通过套管针端口插入或者以其它方式插入患者体内以进入目标组织。如在该附图中可以看到,端部执行器1300非关节运动或换言之与轴轴线SA-SA轴向对齐。一旦端部执行器1300已穿过套管针端口,例如,临床医生可能需要使端部执行器1300进行关节运动以有利地将该端部执行器与目标组织相邻定位。图15、图18、图20、图21和图22示出了当离合器系统1700处于关节运动取向时离合器系统部件的位置。在关节运动过程期间,端部执行器1300处于打开位置。换言之,闭合构件组件1210被定位在其近侧“未致动”位置,使得端部执行器1300的砧座的远侧端部远离外科钉仓间隔开。图15示出了当处于未致动或打开位置时近侧闭合构件段1230的位置。如在该附图中可以看到,凸轮销1724位于凸轮狭槽1232的上部中。当处于该位置时,凸轮销1724将开关鼓1610定位成使得开关臂1616上的开关部件1618不与开关隔板1624上的开关部件1626致动接近或对齐。因此,当开关1626不被开关1618致动时,控制电路156可被构造成能够允许击发马达152击发有限的闭合行程但不能击发足以致动或推进中间击发构件1570和远侧击发构件550的周期,如将在下文进一步详细地讨论。如在图14中可以看到,击发系统闭锁弹簧1150设置在开关鼓1610的凸台1611上,以将开关鼓1610和最终凸轮销1724偏压到处于未致动或打开位置的凸轮狭槽1232的上部中。参见图14。因此,当闭合构件组件1210和最终端部执行器1300的砧座处于打开位置时,击发马达152的致动将不会导致中间击发构件1570和远侧击发构件550推进穿过端部执行器1300。
参见图18和图22,当离合器系统1700处于关节运动取向时,V形止动器1714、1715不与击发杆联接器1566中的对应V形狭槽1580对齐。因此,驱动构件160和近侧击发构件1560在远侧方向“DD”上的推进例如将会导致如图21所示的近侧关节运动驱动器1242的远侧推进。这种布置用于在由图21中的箭头1241表示的方向上枢转端部执行器1300。通过在第一方向上致动击发马达152来朝远侧推进驱动构件160和近侧击发构件1560。在一个具体实施中,可通过在第一方向上致动安装在柄部102上的推杆开关515来致动击发马达152。为使端部执行器1300在第二相反方向上(由图21中的箭头1243表示)枢转,在第二或相反方向上致动摇杆开关515。然而,在任一种情况下,由于闭合构件组件1210处于打开位置并且开关鼓1610上的开关1618与开关隔板1624上的开关1626脱离致动取向,该控制电路156只允许击发马达152致动以获得期望的关节运动行程所需的时间,而没有足够的持续时间,以便将中间击发构件1570朝远侧推进。图20示出了当离合器系统1700处于关节运动模式时,但在击发马达152的致动之前,位于中间击发构件1570的远侧端部上的阻挡构件1574在击发杆联接器1566中的圆柱形通道1568内的位置。图21示出了在击发马达152已被致动成在近侧方向“PD”上驱动近侧击发构件1560之后,阻挡构件1574在圆柱形通道1568内的位置。由于V形止动器1714和1715不与对应V形狭槽1580对齐,该近侧击发构件1560和击发杆联接器1566在近侧方向“PD”上的运动致使击发杆联接器1566的底部接触近侧止动器1715并且也在近侧方向“PD”上驱动接合构件1710。击发杆联接器1566的运动也在近侧方向上驱动关节运动驱动器1242,从而致使端部执行器1300在由图21中的箭头1241表示的方向上进行关节运动。击发马达152在相反旋转方向上的致动将致使近侧击发构件1560在远侧方向“DD”上运动,使得该击发马达端部1567接触远侧止动器1714以朝远侧驱动接合构件1710。接合构件1710的这种远侧运动也致使关节运动驱动器1242在远侧方向“DD”上运动,而这会导致端部执行器1300在相反关节运动方向(由图21中的箭头1243表示)上进行关节运动。因此,从上述讨论可以理解,近侧击发构件1560可轴向地运动预先确定轴向行进量,而不轴向推进中间击发构件1570和附接到该近侧击发构件1560的远侧击发构件550。此预先确定的轴向行进量可由击发杆联接器1566中的圆柱形通道1568的轴向长度“L”限定。参见图19。
一旦临床医生已将端部执行器1300定位成其中目标组织位于砧座与钉仓之间的期望取向,则临床医生然后可闭合砧座以将目标组织夹持在砧座与钉仓之间。如上文所讨论,可通过致动闭合触发器122以在远侧方向“DD”上轴向推进闭合构件组件1210来闭合砧座。当闭合构件组件1210朝远侧运动时,近侧闭合构件段1230中的凸轮狭槽1232致使凸轮销1724运动到凸轮狭槽1232的底部(此运动由图15中的箭头1725表示)。当凸轮销1724在方向1725上运动时,开关鼓1610在闭合构件组件1210上旋转,使得开关臂1616将开关部件1618运动成与开关部件1626致动对准,从而为控制电路156提供指示闭合构件组件1210且更精确地砧座处于闭合位置并准备击发的信号。然后,控制电路156将使得击发马达152能够在击发触发器170的致动时旋转足够的击发时间,以便将远侧击发构件550(和附接到该远侧击发构件或者以其它方式安装在该远侧击发构件上的切割器械)驱动到该远侧击发构件在端部执行器1300内的结束或完全击发位置。图19、图23和图24示出处于击发取向的离合器系统1700的各种部件的位置。
许多电动外科切割和紧固器械利用单独的驱动连杆来进行关节运动并用于击发装置。尽管所述方法采用一定程度的简单架构,但由于其可因在设计中复制了全驱动系统而证明是昂贵的并且具有增加的可靠性忧患。本文所公开的各种布置采用单个驱动机构来进行关节运动和击发两者,这也提供了在击发之前锁定关节运动的方式。
当在外科手术中使用能够关节运动的端部执行器时,期望防止端部执行器与外科器械的意外分离,特别是当端部执行器处于关节运动取向时。当使用采用能够与器械柄部或外壳分离的可互换轴组件的外科器械时,这个问题可能会加剧。例如,在使用期间,重要的是避免当端部执行器处于关节运动取向时,轴组件或端部执行器与器械的意外或在一些情况下粗心分离。图25示出了另一能够关节运动的外科器械2010,该外科器械包括可移除地安装到器械2010的柄部2102的可互换轴组件2200。端部执行器2300附接到可互换轴组件2200并且能够选择性地围绕关节运动轴线B-B关节运动。轴组件2200包括一种独特和新型锁定系统,该独特和新型锁定系统用于防止当端部执行器处于关节运动取向时可互换轴组件2200与柄部2102分离。外科器械2010除了至少下文所讨论的差异以外与上述外科器械10相同。如在该附图中可以看到,所示外科器械2010是马达驱动的(或“作动力的”)并且包括外壳或柄部2102,该外壳或柄部具有可操作地附接到其的可互换轴组件2200。关于可互换轴组件的各种特征和细节可见于其全部公开内容据此以引用方式并入本文的名称为INTERCHANGEABLE SHAFT ASSEMBLIES FOR USE WITH A SURGICAL INSTRUMENT的美国专利申请序列号13/803,053(美国专利申请公布2014/0263564),并且可见于其全部公开内容也据此以引用方式并入本文的提交于2014年3月26日的名称为MODULAR POWERED SURGICALINSTRUMENT WITH DETACHABLE SHAFT ASSEMBLIES的美国专利申请序列号14/226,075。
仍然参见图25,端部执行器2300可操作地附接到可互换轴组件2200。端部执行器2300可例如与端部执行器300相同,并且除了别的之外还包括被构造成能够在其中可操作地支撑钉仓2310的细长通道2302。端部执行器2300还包括其上具有钉成形底面的砧座2350。砧座2350通过闭合管组件2120在打开和闭合位置之间运动,闭合管组件2120通过致动闭合触发器2122而在远侧和近侧方向上轴向推进。闭合管组件2120包括近侧闭合管轴段2230,该近侧闭合管轴段通过关节运动接头2240可操作地联接到远侧闭合管段2220,以有利于端部执行器2300围绕横向于由可互换轴组件2200限定的轴轴线SA-SA的关节运动轴线B-B进行关节运动。
参见图26,轴组件2200包括被构造成能够可移除地联接到柄部2102的底盘2270。各种轴组件实施方案采用闩锁系统2280来将轴组件2200可移除地联接到柄部2102且更具体地联接到柄部框架。如可在图26中所见,例如,在至少一种形式中,闩锁系统2280包括可动地联接到底盘2270的锁构件或锁轭2282。在所示实施方案中,例如,锁轭2282呈U形,该U形具有两个隔开的向下延伸的腿部2284。腿部2284各自具有枢轴凸耳2285,该枢轴凸耳在该腿部上形成并且能够被接收在形成于底盘2270中的对应孔(未示出)中。参见图27。这种布置结构有利于锁轭2282至底盘2270的枢转附接。锁轭2282可包括两个朝近侧突起的锁凸耳2286,该锁凸耳被构造用于与框架的远侧附接法兰2103中的对应锁止动器或沟槽2105的可释放接合。参见图27。锁轭2282由第一弹簧或偏压构件(未示出)在近侧方向“PD”上偏压。锁轭2282的致动可通过可滑动地安装在闩锁致动器组件上的闩锁按钮2287来实现,该所述闩锁致动器组件安装到底盘2270。闩锁按钮2287可相对于锁轭2282在近侧方向上偏压。如将在下文进一步详细地讨论,锁轭2282可通过下述方式运动到解锁位置:将闩锁按钮2287在远侧方向“DD”上偏压,而这也会致使锁轭2282枢转成与框架的远侧附接法兰2103脱离保持接合。当锁轭2282与框架的远侧附接法兰2103“保持接合”时,锁凸耳2286保持安置在远侧附接法兰2103中的对应锁止动器或沟槽2105内。
可互换轴组件2200包括可滑动地支撑在底盘2270内的闭合梭动件2136。近侧闭合管段2230联接到闭合梭动件2136以相对于该闭合梭动件旋转。例如,U形连接器2137插入近侧闭合管段2230中的环形狭槽2231并且保持在闭合梭动件2136中的竖直狭槽内。这种布置结构用于将近侧闭合管段2230附接到闭合梭动件2136,以与该闭合梭动件一起轴向行进,同时使得近侧闭合管段2230能够围绕轴轴线SA-SA相对于闭合梭动件2136旋转。近侧闭合梭动件2136包括钩2138,该钩2138能够以钩的形式接合附接销(未示出),该附接销附接到第二闭合连接件(未示出),该第二闭合连接件可操作地联接到闭合触发器2122,如美国专利申请序列号14/226,075中详细描述。如所述参考文献中所述,致动闭合触发器2122将朝远侧推进闭合连接件,并且对近侧闭合梭动件2136且最终对近侧闭合管段2230施加远侧闭合动作。闭合弹簧(未示出)轴颈连接在近侧闭合管段2230上并且用于将近侧闭合管段2230在近侧方向“PD”上偏压,而这又可用于在轴组件2200可操作地联接到柄部2102时将闭合触发器2122枢转到未致动位置。
可互换轴组件2200还包括关节运动系统2500,该关节运动系统用于对延伸穿过轴组件以与端部执行器2300可操作地相互配合的第一关节运动杆2510和第二关节运动杆2520施加关节运动动作。在所示示例中,关节运动系统2500还包括关节运动致动器2550,该关节运动致动器可旋转地支撑在喷嘴外壳2530上,该喷嘴外壳支撑在底盘2270上。喷嘴外壳可包括由多个紧固件2536联接在一起的两个喷嘴段2532、2534。关节运动致动器2550包括关节运动钮2552,关节运动钮2552联接到其上具有关节运动枢轴齿轮2562的关节运动齿轮组件2560。关节运动枢轴齿轮2562被支撑成与附接到第一关节运动杆2510的第一关节运动齿条2512和附接到第二关节运动杆2520的第二关节运动齿条2522啮合接合。关节运动钮2552的旋转以驱动的方式在近侧或远侧方向上推进关节运动杆2510、2520中的一个并在相反的方向上推进关节运动杆2510、2520中的另一者,以致使端部执行器2300在期望的方向上围绕关节运动轴线进行关节运动。
外科端部执行器2300包括呈组织切割构件(未示出)的形式的击发构件。可互换轴组件2200还包括被构造成能够对击发构件施加击发动作的击发杆段2570。在所示示例中,击发杆段由马达驱动击发系统以并入本文的各种参考文献中更详细地描述的各种方式轴向地运动穿过轴组件2200。
为防止当端部执行器2300处于关节运动取向时可互换轴组件2200与柄部2102意外分离,轴组件2200还包括通常被标记为2580的独特和新型锁组件。在所示示例中,齿轮组件2560还包括其中具有锁凹口2566的锁定法兰2564。锁组件2580还包括具有尖头或锥形远侧端部2584的锁构件2582,尖头或锥形远侧端部2584被构造成用于与锁凹口2566锁定接合。锁构件2582附接到锁轭2282。在所示示例中,锁构件2582具有孔2588,该孔能够接收形成于锁轭2282上的锁凸台2283,以有利于锁构件2582与锁轭2282附接。参见图26。在所示示例中,关节运动钮2552附接到关节运动锁组件2560,使得锁凹口2566被对齐用于当关节运动钮2552的致动器鳍部分2553与轴轴线A-A轴向对齐时与锁构件2582锁定接合。参见图25。当处于这种布置时,鳍部分向临床医生指示端部执行器2300非关节运动并且实质上与轴轴线SA轴向对齐。同样当处于所述位置时,锁构件2582的远侧端部2584被接收在锁凹口2566中。当处于所述位置时,在锁构件2582的远侧端部2584与锁凹口2566之间提供足够的间隙,以使得锁轭2282能够在远侧方向上运动,从而将可互换轴组件2200与柄部分离。因此,当端部执行器处于非关节运动取向时,轴组件2200能够与柄部或外壳分离。
当临床医生期望使端部执行器2300进行关节运动时,临床医生对关节运动鳍部分2553施加足以引起齿轮组件2560的旋转的旋转力。当齿轮组件2560旋转时,锁构件2582在近侧方向上运动,以允许锁构件2582的端部2584移出锁凹口2566。在关节运动期间,端部2584围绕锁定法兰2564的边缘运行。当处于所述位置时,锁构件2582防止锁轭2282在远侧方向上运动足够远,以允许轴组件2200与柄部分离。同样地,当端部执行器处于关节运动位置时,防止锁轭运动到分离或解锁位置。这种布置不仅防止轴组件与柄部的意外分离(即,偶然地),而且防止临床医生使用闩锁按钮2287分离轴组件2200。
图28是贯通例如图25所示类型的可弯曲关节运动接头构件2600的剖面图。接头构件包括具有居中设置的通道2604的可弯曲主体2602,该居中设置的通道被构造成能够穿过该通道可滑动地支撑可弯曲击发梁2610。在这种布置中,主体2602包括两个上部通道2606,该两个上部通道的尺寸和布置被设定成穿过该两个上部通道容置对应关节运动缆线2620。关节运动缆线2620执行与本文所公开的关节运动驱动器相同的功能。例如,缆线2620中的每根附接到外科端部执行器或者以其它方式与外科端部执行器相互配合。缆线2620的近侧端部或部分与用于致动缆线以使端部执行器进行关节运动的关节运动控制系统相互配合。主体2602还包括能够容置框架组件2630的对应部分的两个下部通道2608。在所述示例中,框架组件包括第一框架带2640和第二框架带2650。带2640、2650位于可弯曲击发梁2610的每个侧面上并且延伸回到柄部或外壳。每个带2640、2650可包括悬臂弹簧臂,该悬臂弹簧臂延伸穿过对应下部通道2608,并且联接到端部执行器或者以其它方式与端部执行器相互配合。例如,每个带2640、2650的远侧端部可附接到端部执行器的细长通道的对应部分。带2640、2650将弯曲以适应端部执行器的关节运动。然而,如在图28中可以看到,每个带2640、2650被构造用于与每个下部通道2608的壁2609的对应部分摩擦接合。在所示示例中,每个带2640、2650如图所示在该带上包括摩擦凸耳或形成2642、2652。这种布置用于以摩擦方式将主体部分2602保持呈关节运动取向。
图29是贯通例如图25所示类型的可弯曲关节运动接头构件2700的剖面图。接头构件包括具有居中设置的通道2704的可弯曲主体2702,该居中设置的通道被构造成能够穿过该通道可滑动地支撑可弯曲击发梁2610。在这种布置中,主体2702包括两个侧向通道2706,该两个侧向通道的尺寸和布置被设定成穿过该侧向通道容置对应关节运动缆线2620。在所示布置中,通道2706的尺寸相对于缆线2620被设定成使得在每根缆线和对应通道2706的壁之间产生摩擦。主体2702还包括能够容置框架组件2730的对应部分的下部通道2708。在此示例中,框架组件包括第一框架带2740和第二框架带2750。带2740、2750位于可弯曲击发梁2610下方并且延伸回到柄部或外壳。每个带2740、2750可包括悬臂弹簧臂,该悬臂弹簧臂延伸穿过对应下部通道2708,并且联接到端部执行器或者以其它方式与端部执行器相互配合。例如,每个带2740、2750的远侧端部可附接到端部执行器的细长通道的对应部分。带2740、7650将弯曲以适应端部执行器的关节运动。如在图29中可以看到,带2740、2750与击发梁2610并且与下部通道2708的壁摩擦接合。这种布置结构用于以摩擦方式将主体部分2702保持呈关节运动取向。
图31以一定程度的图解形式示出了具有能够关节运动的端部执行器3300的外科器械3010,该外科器械采用独特和新型的关节运动系统3500来使端部执行器3300围绕通常被标记为3240的关节运动接头进行关节运动。具体地,外科器械3010包括框架组件3600,该框架组件附接到外科端部执行器3300的细长通道3302,使得外科端部执行器3300可选择性地围绕关节运动接头3240进行关节运动。关节运动系统3500包括第一关节运动构件或杆3510和第二关节运动构件或杆3520。第一关节运动杆3510和第二关节运动杆3520中的每一者附接到外科端部执行器3300的细长通道3302并且被布置用于相对于框架组件3600进行轴向运动。例如,第一关节运动杆3510可由第一轴承3511支撑用于相对于框架组件3600进行轴向运动,并且第二关节运动杆3520可由第二轴承3521支撑用于相对于框架组件3600进行轴向运动。
外科端部执行器3300可包括外科切割和缝合装置并且包括被构造用于在端部执行器3300内轴向行进的击发构件(未示出),如以引用方式并入本文的许多参考文献中所教导。外科器械3010配备有击发构件或连杆3560,该击发构件或连杆被构造成能够响应于来自本文所公开的以及并入本文的各种参考文献中所公开的各种类型的击发驱动系统的驱动动作而轴向运动。如图31大体示出的关节运动系统3500包括关节运动驱动组件3530,该关节运动驱动组件被构造成能够与击发驱动系统可操作地相互配合以从该击发驱动系统接收击发动作。例如,关节运动驱动组件3530的关节运动驱动器3532可通过本文和/或并入本文的参考文献中所公开的类型的开关或咬合布置3600与击发杆3560可操作地相互配合。因此,当开关布置结构3600处于“关节运动模式”时,击发驱动装置的操作被传送至关节运动驱动器3532,以对该关节运动驱动器施加轴向关节运动动作。当开关布置结构3600处于“击发模式”时,击发驱动装置的致动将导致击发构件在外科端部执行器3300内的轴向推进。
如在图31中可以进一步看到,关节运动驱动组件3532还包括附接到关节运动驱动器3532的双重作用螺线管组件3534。螺线管组件3534包括被布置用于与第一关节运动驱动器3510的一部分选择性驱动接合的关节运动接合构件3536。此外,螺线管组件3534包括被布置用于与第二关节运动杆3520选择性驱动接合的第二关节运动接合构件3538。例如,图31示出了被接收在第一关节运动驱动器3510中的第一驱动孔3512中的第一驱动器3536的一部分。类似的第二驱动孔3522被示出在第二关节运动驱动器3520中,然而,在图31中,第二驱动器3538处于回缩或脱离结合位置。也可采用其它布置来以驱动的方式接合和脱离接合关节运动驱动组件3530。因此,当第一关节运动接合构件3536与第一关节运动驱动器3510驱动接合时,击发驱动系统的致动将导致第一关节运动驱动器3510的轴向推进,并且当第二关节运动接合构件3538与第二关节运动驱动器3520驱动接合时,击发驱动系统的致动将导致第二关节运动驱动器3520的轴向推进。
如本文更详细讨论,可能期望,外科器械采用锁定装置,该锁定装置用于在装置的使用之前和/或在端部执行器已关节运动到期望的位置之后将关节运动驱动器锁定就位。为此,外科器械3010被示出具有关节运动锁系统3700。关节运动锁系统3700包括第一锁构件3702和第二锁构件3704,该第一锁构件被构造用于与第一关节运动驱动器3510的第一锯齿状或齿状锁定部分3514锁定接合,该第二锁构件被构造用于与第二关节运动驱动器3520的第二齿状或锁定部分3524锁定接合。当第一锁构件3702与第一关节运动驱动器3510的第一锯齿状部分3514接合时,第一关节运动驱动器3510将被保持在所述轴向位置。相似地,当第二锁构件3704与第二关节运动驱动器3520的第二锯齿状部分3524接合时,第二关节运动驱动器3520将被保持在该轴向位置。
图31示出了与孔3512驱动接合的第一关节运动接合构件3536。如在该附图中可以看到,第一关节运动驱动器3510的至少对应部分3516在第一侧向方向“FLD”上侧向运动,使得第一锯齿状部分3514运动成与第一锁构件3702脱离接合。如在图31中还可以看到,第二关节运动接合构件3538被缩回成与关节运动孔3522脱离接合。当处于该位置时,第一关节运动驱动器3510处于解锁取向并且能够自由在远侧方向“DD”上轴向推进以使外科端部执行器3300围绕关节运动接头3240在第一关节运动方向“FAD”上进行关节运动。当第一关节运动驱动器3510朝远侧运动时,第二关节运动驱动器3520因其与外科端部执行器3300的细长通道3302的连接而必然会在近侧方向“PD”上运动。第二关节运动驱动器3520的这种近侧运动将由在对应锯齿状物3524上“颠簸着前进”或运行或滑动的第二锁构件3704容置。同样,为了使外科端部执行器围绕关节运动接头3240在第二关节运动方向“SAD”上进行关节运动,将第一关节运动接合构件3536缩回成与第一关节运动孔3512脱离接合,并且将第二关节运动接合构件3538在第二侧向方向“SLD”上侧向运动成与第二关节运动孔3522接合,以将第二关节运动驱动器3520的第二锯齿状部分3524偏压或以其它方式运动成与第二锁构件3707脱离接合。当处于所述位置时,第二关节运动驱动器3520处于解锁取向并且能够自由在远侧方向“DD”上轴向推进以使外科端部执行器3300围绕关节运动接头3240在第二关节运动方向“SAD”上进行关节运动。当第二关节运动驱动器3520朝远侧运动时,第一关节运动驱动器3510因其与外科端部执行器3300的细长通道3302的连接而必然会在近侧方向“PD”上运动。第一关节运动驱动器3510的这种近侧运动将由在对应锯齿状物3514上“颠簸着前进”或运行或滑动的第一锁构件3702容置。
图32以一定程度的图解形式示出了具有能够关节运动的端部执行器4300的外科器械4010,该外科器械采用独特和新型的关节运动系统4500来使端部执行器4300围绕通常被标记为4240的关节运动接头进行关节运动。具体地,外科器械4010包括框架组件4600,该框架组件附接到外科端部执行器4300的细长通道4302,使得外科端部执行器4300可选择性地围绕关节运动接头4240关节运动。关节运动系统4500包括第一关节运动构件或杆4510和第二关节运动构件或杆4520。第一关节运动杆4510和第二关节运动杆4520中的每个附接到外科端部执行器4300的细长通道4302并且被布置用于相对于框架组件4600轴向运动。例如,第一关节运动杆4510可由第一轴承4511支撑用于相对于框架组件4600进行轴向运动,并且第二关节运动杆4520可由第二轴承4521支撑用于相对于框架组件4600进行轴向运动。
外科端部执行器4300可包括外科切割和缝合装置并且包括被构造用于在端部执行器4300内轴向行进的击发构件(未示出),如以引用方式并入本文的许多参考文献中所教导。外科器械4010配备有击发构件或连杆4560,该击发构件或连杆4560被构造成能够响应于来自本文所公开的以及并入本文的各种参考文献中所公开的各种类型的击发驱动系统的驱动动作而轴向运动。如图32大体示出的关节运动系统4500包括第一关节运动驱动马达4530,该第一关节运动驱动马达4530被构造成能够与第一关节运动驱动器4510可操作地相互配合,使得第一关节运动马达在一个方向上的操作导致第一关节运动杆4510在远侧方向“DD”上的轴向推进,并且第一关节运动驱动系统在相反方向上的操作导致第一关节运动杆4510在近侧方向“PD”上的轴向运动。相似地,关节运动系统4500还包括第二关节运动驱动马达4540,该第二关节运动驱动马达被构造成能够与第二关节运动驱动器4520可操作地相互配合,使得第二关节运动驱动马达4540在一个方向上的操作将导致第二关节运动驱动器在远侧方向“DD”上的轴向推进,并且第二关节运动马达在相反方向上的操作将导致第二关节运动驱动器在近侧方向“PD”上的轴向推进。第一关节运动驱动马达4530和第二关节运动驱动马达4540由控制电路和控制器布置控制,使得当驱动马达4530中的一个驱动马达被操作以将可操作地附接到该驱动马达的关节运动驱动器在一个轴向方向上驱动第一轴向距离时,另一个关节运动驱动马达在相反方向被操作以将可操作地联接到该关节运动驱动马达的另一个关节运动驱动器在相反的轴向方向上运动等于第一轴向距离的第二轴向距离,以适应外科端部执行器的关节运动。
实施例
实施例1-一种包括外壳的外科器械,该外壳具有可移除地附接到该外壳的包括细长轴的可互换轴组件。外科端部执行器可操作地联接到该细长轴,以用于相对于该细长轴进行选择性关节运动。关节运动系统被构造成能够在所述关节运动系统处于致动取向时选择性地对该外科端部执行器施加关节运动动作。该外科器械还包括用于在该关节运动系统处于该致动取向时防止该可互换轴组件与所述外壳分离的装置。
实施例2-根据实施例1所述的外科器械,其中,该可互换轴组件通过闩锁构件可移除地联接到所述外壳,该闩锁构件能够选择性地在闩锁位置和未闩锁位置之间运动,并且其中用于防止分离的所述装置与该关节运动系统和该闩锁构件可操作地相互配合。
实施例3-根据实施例1或2所述的外科器械,其中该关节运动系统包括关节运动致动器,该关节运动致动器可动地支撑在该可互换轴组件上,并且能够选择性地在未致动取向和多个致动取向之间运动,在该未致动取向中,该外科端部执行器处于非关节运动取向,在该多个致动取向中,该外科端部执行器相对于由该细长轴限定的轴轴线关节运动。第一关节运动构件与该外科端部执行器和该关节运动致动器可操作地相互配合。第二关节运动构件与该外科端部执行器和该关节运动致动器可操作地相互配合。
实施例4-根据实施例3所述的外科器械,其中,所述关节运动致动器包括与所述第一关节运动构件和所述第二关节运动构件啮合接合的关节运动驱动齿轮组件。
实施例5-根据实施例4所述的外科器械,其中,该关节运动驱动齿轮组件能够在该未致动取向和该致动取向之间运动,并且其中用于防止分离的所述装置包括锁构件,该锁构件与该关节运动驱动齿轮组件和该闩锁构件可操作地相互配合,使得当该关节运动驱动齿轮组件处于该未致动位置时,该闩锁构件能够运动到该未闩锁位置,并且当该关节运动驱动齿轮组件处于该致动位置中的任一者时,该锁构件防止该闩锁构件运动到该未闩锁位置。
实施例6-根据实施例4或5所述的外科器械,其中,该关节运动驱动齿轮组件包括与该关节运动致动器可操作地连通的锁定法兰。关节运动驱动齿轮联接到该锁定法兰且分离凹口位于该锁定法兰中。该分离凹口位于该锁定法兰上,使得当该关节运动驱动齿轮组件处于该未致动取向时,该锁构件的一部分可响应于该闩锁构件从该闩锁位置到该未闩锁位置运动而延伸到所述分离凹口中,并且当该关节运动驱动齿轮组件处于该致动位置中的任一致动位置时,该锁构件的该一部分接合锁定法兰,以将该锁构件保持在防止该闩锁构件从该闩锁位置运动到该未闩锁位置的锁定位置。
实施例7-根据实施例1、2、3、4、5或6所述的外科器械,其中,该外科端部执行器包括一对钳口,其中一个钳口能够选择性地在对该钳口施加闭合动作时相对于另一个钳口运动,并且其中该细长轴还包括闭合构件,该闭合构件与一个钳口可操作地相互配合,以在致动由该外壳可操作地支撑的闭合系统时对该钳口施加所述闭合动作。
实施例8-根据实施例1、2、3、4、5、6或7所述的外科器械,其中,该外科端部执行器还包括击发构件,该击发构件被可操作地支撑用于在对该击发构件施加击发动作时轴向行进穿过该外科端部执行器,并且其中该细长轴还包括击发杆,该击发杆与该击发构件可操作地相互配合,以在致动由该外壳可操作地支撑的击发系统时对该击发构件施加该击发动作。
实施例9-根据实施例1、2、3、4、5、6、7、8或9所述的外科器械,其中,该外壳包括柄部。
实施例10-一种包括关节运动系统的外科器械,该关节运动系统能够在未致动取向和致动取向之间致动,在该致动取向中,该关节运动系统产生对应关节运动动作。该外科器械还包括外科端部执行器和细长轴组件,该细长轴组件与该外科端部执行器可操作地相互配合,以允许该外科端部执行器相对于该细长轴组件进行选择性关节运动。该细长轴组件包括至少一个关节运动构件,该至少一个关节运动构件与该外科端部执行器和该关节运动系统可操作地相互配合。该至少一个关节运动构件被支撑用于响应于该关节运动系统对该至少一个关节运动构件施加该关节运动动作而选择性轴向运动。该外科器械还包括被支撑在该细长轴组件内并且被构造成能够保持地接合该至少一个关节运动构件并且防止该至少一个关节运动构件在该关节运动系统处于取向该未致动时进行轴向运动的装置。
实施例11-根据实施例10所述的外科器械,其中,该关节运动系统由外壳可操作地支撑,并且其中该细长轴组件能够可移除地附接到该外壳,并且其中该至少一个关节运动构件中的每个关节运动构件能够从中性位置轴向运动,在所述中性位置中,每个关节运动构件能够在该细长轴组件附接到该外壳时可操作地附接到该关节运动系统,并且其中当该细长轴组件与该外壳分离时,该保持接合装置将关节运动构件中的每个关节运动构件保持在该中性位置。
实施例12-根据实施例10或11所述的外科器械,其中,该保持接合装置包括该关节运动构件中的每个关节运动构件上的锯齿状部分。每个锯齿状部分被支撑成与该细长轴组件的另一部分上的至少一个对应锁齿啮合接合。
实施例13-根据实施例12所述的外科器械,其中,每个关节运动构件被支撑用于在中空构件内轴向运动,并且其中每个对应锁齿从该中空构件向内突起。
实施例14-根据实施例10、11、12或13所述的外科器械,其中,所述外科端部执行器包括一对钳口,其中一个钳口能够选择性地在对该钳口施加闭合动作时相对于另一个钳口运动,并且其中所述细长轴还包括中空闭合管,该中空闭合管与该钳口中的一个钳口可操作地相互配合、并且在其中容纳该关节运动构件中的每个关节运动构件,并且其中每个对应齿形成于该中空闭合管的内壁上。
实施例15-根据实施例10、11、12、13或14所述的外科器械,其中至少一个关节运动构件包括与该外科端部执行器可操作地相互配合的第一关节运动构件和与该外科端部执行器可操作地相互配合的第二关节运动构件,并且其中该关节运动系统包括双重作用螺线管,该双重作用螺线管被构造成能够选择性地接合该第一关节运动构件和该第二关节运动构件中的每个。
实施例16-根据实施例15所述的外科器械,其中,该用于保持地接合的该装置包括位于该第一关节运动构件上的第一锯齿状部分、位于该细长轴组件上的并且被构造成能够保持地接合该第一锯齿状部分的第一锁构件以及位于该第二关节运动构件上的第二锯齿状部分和位于该细长轴组件上的被构造成能够保持地接合该第二锯齿状部分的第二锁构件。
实施例17-根据实施例16所述的外科器械,其中,当该双重作用螺线管接合该第一关节运动构件时,该双重作用螺线管将该第一锯齿状部分运动成与所述第一锁构件脱离接合,并且当该双重作用螺线管接合该第二关节运动构件时,该双重作用螺线管将该第二锯齿状部分运动成与该第二锁构件脱离接合。
实施例18-根据实施例15、16或17所述的外科器械,其中,该双重作用螺线管与该外科器械的击发驱动系统可操作地相互配合。
实施例19-一种包括细长轴组件的外科器械,该细长轴组件包括关节运动接头。外科端部执行器可操作地联接到该细长轴组件,以用于围绕该关节运动接头进行选择性关节运动。第一关节运动构件与该外科端部执行器可操作地相互配合、并且被支撑用于响应于由可操作地联接到该第一关节运动构件的第一关节运动马达施加的第一关节运动动作而进行选择性轴向运动。该外科器械还包括第二关节运动构件,该第二关节运动构件与该外科端部执行器可操作地相互配合、并且被支撑用于响应于由可操作地联接到该第二关节运动构件的第二关节运动马达施加的第二关节运动动作而进行选择性轴向运动。
实施例20-根据实施例19所述的外科器械,还包括控制系统,该控制系统用于控制该第一关节运动马达和该第二关节运动马达,使得当该第一关节运动马达被操作,以将该第一关节运动构件在一个轴向方向上运动第一轴向距离时,该第二关节运动马达被操作,以将该第二关节运动构件在相反的轴向方向上运动等于该第一轴向距离的第二轴向距离。
以下专利的全部公开内容据此以引用方式并入本文:
公布于1995年4月4日的名称为ELECTROSURGICAL HEMOSTATIC DEVICE的美国专利5,403,312;
公布于2006年2月21日的名称为SURGICAL STAPLING INSTRUMENT HAVINGSEPARATE DISTINCT CLOSING AND FIRING SYSTEMS的美国专利7,000,818;
公布于2008年9月9日的名称为MOTOR-DRIVEN SURGICAL CUTTING AND FASTENINGINSTRUMENT WITH TACTILE POSITION FEEDBACK的美国专利7,422,139;
公布于2008年12月16日的名称为ELECTRO-MECHANICAL SURGICAL INSTRUMENTWITH CLOSURE SYSTEM AND ANVIL ALIGNMENT COMPONENTS的美国专利7,464,849;
公布于2010年3月2日的名称为SURGICAL INSTRUMENT HAVING AN ARTICULATINGEND EFFECTOR的美国专利7,670,334;
公布于2010年7月13日的名称为SURGICAL STAPLING INSTRUMENTS的美国专利7,753,245;
公布于2013年3月12日的名称为SELECTIVELY ORIENTABLE IMPLANTABLEFASTENER CARTRIDGE的美国专利8,393,514;
公布于2010年12月7日的名称为SURGICAL INSTRUMENT HAVING RECORDINGCAPABILITIES的美国专利7,845,537;
提交于2008年2月14日的名称为SURGICAL CUTTING AND FASTENING INSTRUMENTHAVING RF ELECTRODES的美国专利申请序列号12/031,573;
公布于2011年7月19日的名称为END EFFECTORS FOR A SURGICAL CUTTING ANDSTAPLING INSTRUMENT的美国专利7,980,443;
公布于2012年7月3日的名称为MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT的美国专利8,210,411;
公布于2013年12月17日的名称为POWERED SURGICAL CUTTING AND STAPLINGAPPARATUS WITH MANUALLY RETRACTABLE FIRING SYSTEM的美国专利8,608,045;
公布于2012年7月17日的名称为MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENTWITH ELECTRIC ACTUATOR DIRECTIONAL CONTROL ASSEMBLY的美国专利8,220,688;
公布于2014年5月27日的名称为STAPLE CARTRIDGE的美国专利8,733,613;
公布于2013年10月22日的名称为SURGICAL STAPLING INSTRUMENT的美国专利8,561,870;
提交于2011年5月27日的名称为SURGICAL STAPLING INSTRUMENTS WITHROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS的美国专利申请公布2012/0298719;
提交于2012年6月15日的名称为ARTICULATABLE SURGICAL INSTRUMENTCOMPRISING A FIRING DRIVE的美国专利申请公布2013/0334278;
提交于2013年3月13日的名称为STAPLE CARTRIDGE TISSUE THICKNESS SENSORSYSTEM的美国专利申请序列号13/800,025;
提交于2013年3月13日的名称为STAPLE CARTRIDGE TISSUE THICKNESS SENSORSYSTEM的美国专利申请序列号13/800,067;
提交于2006年1月31日的名称为SURGICAL CUTTING AND FASTENING INSTRUMENTWITH CLOSURE TRIGGER LOCKING MECHANISM的美国专利申请公布2007/0175955;以及
公布于2012年11月13日的名称为SURGICAL STAPLING INSTRUMENT WITH ANARTICULATABLE END EFFECTOR的美国专利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各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,可使用其它材料。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。上述说明和下述权利要求旨在涵盖所有这些修改和变型。
对于本文中使用的基本上任何复数和/或单数术语,本领域的技术人员可从复数转换成单数和/或从单数转换成复数,只要适合于上下文和/或应用即可。为清楚起见,各种单数/复数置换在本文中没有明确表述。
本文所述的主题有时阐述了包含在其它不同部件中的不同部件或与其它不同部件连接的不同部件。应当理解,这样描述的结构仅是示例性的,并且事实上可以实现获得相同功能性的多种其它结构。在概念意义上,获得相同功能性的组件的任何布置方式都是有效“相联的”,从而获得所需的功能性。因此,本文中为获得特定功能性而结合在一起的任何两个组件都可被视为彼此“相联”,从而获得所需的功能性,而不论结构或中间组件如何。同样,如此相联的任何两个组件也可被视为彼此“操作地连接”或“操作地联接”,以获得所需的功能性,并且能够如此相联的任何两个组件都可被视为彼此“可操作地联接”,以获得所需的功能性。可操作地联接的具体示例包括但不限于可物理匹配的和/或物理交互组件,和/或无线交互式,和/或无线交互式组件,和/或逻辑交互式,和/或逻辑交互式组件。
虽然本文描述了多个实施例,但可以实现那些实施例的多种修改形式、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,可使用其它材料。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例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。
可将本发明所公开的装置设计成单次使用后即进行处理,或者可将它们设计成是多次使用的。然而,在任一种情形下,该装置均可进行修复,以在至少一次使用后再次使用。修复可包括拆卸装置、清洗或更换具体部件以及后续重新组装的其中任意几个步骤的组合。具体地,该装置可拆卸,而且可以任意组合选择性地更换或移除该装置的任意数目的特定零件或部件。在清洁和/或替换特定部件后,可对装置重新组装以便随后在修复设施处使用或就在外科规程之前由手术团队使用。本领域的技术人员将理解,修复装置可利用多种技术来进行拆卸、清洁/替换、和重新装配。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,并且如果必要,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。然后可将容器和器械放置在可穿透容器的辐射场中,诸如γ辐射、X射线或高能电子。辐射杀死器械中和容器中的细菌。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,直到该器械在医疗设施中被打开。
以引用方式全文或部分地并入本文的任何专利、公布或其它公开材料均仅在所并入的材料不与本公开所述的现有定义、陈述或其它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上,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所述的现有定义、陈述或其它公开材料相冲突的任何材料或其部分,仅在所并入的材料和现有的公开材料之间不产生冲突的程度下并入本文。
概括地说,已经描述了由采用本文所述的概念产生的许多有益效果。为了举例说明和描述的目的,已经提供了一个或多个实施例的上述说明。所述说明并非意图为详尽的或限定到本发明所公开的精确形式。可以按照上述教导内容对本发明进行修改或变型。所选择和描述的一个或多个实施例是为了示出本发明的原理和实际用途,从而允许本领域的普通技术人员能够利用多个实施例,并且在适合设想的具体应用的情况下进行各种修改。与此一同提交的权利要求书旨在限定全部范围。
Claims (20)
1.一种外科器械,包括:
外壳;
可互换轴组件,所述可互换轴组件可移除地附接到所述外壳并且包括细长轴;
外科端部执行器,所述外科端部执行器可操作地联接到所述细长轴,以相对于所述细长轴进行选择性关节运动;
关节运动系统,所述关节运动系统被构造成能够在所述关节运动系统处于致动取向时选择性地对所述外科端部执行器施加关节运动动作;和
用于在所述关节运动系统处于所述致动取向时防止所述可互换轴组件与所述外壳分离的装置。
2.根据权利要求1所述的外科器械,其中,所述可互换轴组件通过闩锁构件可移除地联接到所述外壳,所述闩锁构件能够选择性地在闩锁位置和未闩锁位置之间运动,并且其中用于防止分离的所述装置与所述关节运动系统和所述闩锁构件可操作地相互配合。
3.根据权利要求2所述的外科器械,其中,所述关节运动系统包括:
关节运动致动器,所述关节运动致动器可动地支撑在所述可互换轴组件上,并且能够选择性地在未致动取向和多个致动取向之间运动,在所述未致动取向中,所述外科端部执行器处于非关节运动取向,在所述多个致动取向中,所述外科端部执行器相对于由所述细长轴限定的轴轴线进行关节运动;
第一关节运动构件,所述第一关节运动构件与所述外科端部执行器和所述关节运动致动器可操作地相互配合;和
第二关节运动构件,所述第二关节运动构件与所述外科端部执行器和所述关节运动致动器可操作地相互配合。
4.根据权利要求3所述的外科器械,其中,所述关节运动致动器包括与所述第一关节运动构件和所述第二关节运动构件啮合接合的关节运动驱动齿轮组件。
5.根据权利要求4所述的外科器械,其中,所述关节运动驱动齿轮组件能够在所述未致动取向和所述致动取向之间运动,并且其中用于防止分离的所述装置包括锁构件,所述锁构件与所述关节运动驱动齿轮组件和所述闩锁构件可操作地相互配合,使得当所述关节运动驱动齿轮组件处于所述未致动位置时,所述闩锁构件能够运动到所述未闩锁位置,并且当所述关节运动驱动齿轮组件处于所述致动位置中的任一致动位置时,所述锁构件防止所述闩锁构件运动到所述未闩锁位置。
6.根据权利要求5所述的外科器械,其中,所述关节运动驱动齿轮组件包括:
锁定法兰,所述锁定法兰与所述关节运动致动器可操作地连通;
关节运动驱动齿轮,所述关节运动驱动齿轮联接到所述锁定法兰;和
位于所述锁定法兰中的分离凹口,所述分离凹口位于所述锁定法兰上,使得当所述关节运动驱动齿轮组件处于所述未致动取向时,所述锁构件的一部分能够响应于所述闩锁构件从所述闩锁位置到所述未闩锁位置的运动而延伸到所述分离凹口中,并且当所述关节运动驱动齿轮组件处于所述致动位置中的所述任一致动位置时,所述锁构件的所述一部分接合所述锁定法兰,以将所述锁构件保持在防止所述闩锁构件从所述闩锁位置运动到所述未闩锁位置的锁定位置。
7.根据权利要求1所述的外科器械,其中,所述外科端部执行器包括一对钳口,其中一个所述钳口能够选择性地在对其施加闭合动作时相对于另一个所述钳口运动,并且其中所述细长轴还包括闭合构件,所述闭合构件与所述钳口中的所述一个钳口可操作地相互配合,以在致动由所述外壳可操作地支撑的闭合系统时对所述一个钳口施加所述闭合动作。
8.根据权利要求7所述的外科器械,其中,所述外科端部执行器还包括击发构件,所述击发构件被可操作地支撑用于在对其施加击发动作时轴向行进穿过所述外科端部执行器,并且其中所述细长轴还包括击发杆,所述击发杆与所述击发构件可操作地相互配合,以在致动由所述外壳可操作地支撑的击发系统时对所述击发构件施加所述击发动作。
9.根据权利要求1所述的外科器械,其中,所述外壳包括柄部。
10.一种外科器械,包括:
关节运动系统,所述关节运动系统能够在未致动取向和致动取向之间致动,在所述致动取向中,所述关节运动系统产生对应关节运动动作;
外科端部执行器;和
细长轴组件,所述细长轴组件与所述外科端部执行器可操作地相互配合,以允许所述外科端部执行器相对于所述细长轴组件进行选择性关节运动,所述细长轴组件包括:
至少一个关节运动构件,所述至少一个关节运动构件与所述外科端部执行器和所述关节运动系统可操作地相互配合,所述至少一个关节运动构件被支撑用于响应于所述关节运动系统对所述至少一个关节运动构件施加所述关节运动动作而进行选择性轴向运动;和
装置,所述装置被支撑在所述细长轴组件内并被构造成能够保持地接合所述至少一个关节运动构件、并防止所述至少一个关节运动构件在所述关节运动系统处于所述未致动取向时进行轴向运动。
11.根据权利要求10所述的外科器械,其中,所述关节运动系统由外壳可操作地支撑,并且其中所述细长轴组件能够可移除地附接到所述外壳,并且其中所述至少一个关节运动构件中的每个关节运动构件能够从中性位置轴向运动,在所述中性位置,所述至少一个关节运动构件中的每个关节运动构件能够在所述细长轴组件附接到所述外壳时可操作地附接到所述关节运动系统,并且其中当所述细长轴组件与所述外壳分离时,用于保持地接合的所述装置将所述至少一个关节运动构件中的每个关节运动构件保持在所述中性位置。
12.根据权利要求10所述的外科器械,其中,用于保持地接合的所述装置包括位于所述关节运动构件中的每个关节运动构件上的锯齿状部分,每个所述锯齿状部分与位于所述细长轴组件的另一部分上的至少一个对应锁齿啮合接合。
13.根据权利要求12所述的外科器械,其中,所述至少一个关节运动构件中的每个关节运动构件被支撑用于在中空构件内轴向运动,并且其中每个所述对应锁齿从所述中空构件向内突起。
14.根据权利要求12所述的外科器械,其中,所述外科端部执行器包括一对钳口,其中一个所述钳口能够选择性地在对其施加闭合动作时相对于另一个所述钳口运动,并且其中所述细长轴还包括中空闭合管,所述中空闭合管与所述钳口中的所述一个钳口可操作地相互配合、并将所述至少一个关节运动构件中的每个关节运动构件容纳在所述中空闭合管中,并且其中每个所述对应齿形成于所述中空闭合管的内壁上。
15.根据权利要求10所述的外科器械,其中,所述至少一个关节运动构件包括:
第一关节运动构件,所述第一关节运动构件与所述外科端部执行器可操作地相互配合;和
第二关节运动构件,所述第二关节运动构件与所述外科端部执行器可操作地相互配合,并且其中所述关节运动系统包括双重作用螺线管,所述双重作用螺线管被构造成能够选择性地接合所述第一关节运动构件和所述第二关节运动构件中的每一者。
16.根据权利要求15所述的外科器械,其中,所述用于保持地接合的所述装置包括:
第一锯齿状部分,所述第一锯齿状部分位于所述第一关节运动构件上;
第一锁构件,所述第一锁构件位于所述细长轴组件上并被构造成能够保持接合所述第一锯齿状部分;
第二锯齿状部分,所述第二锯齿状部分位于所述第二关节运动构件上;和
第二锁构件,所述第二锁构件位于所述细长轴组件上并被构造成能够保持接合所述第二锯齿状部分。
17.根据权利要求16所述的外科器械,其中,当所述双重作用螺线管接合所述第一关节运动构件时,所述双重作用螺线管使所述第一锯齿状部分运动成与所述第一锁构件脱离接合,并且当所述双重作用螺线管接合所述第二关节运动构件时,所述双重作用螺线管使所述第二锯齿状部分运动成与所述第二锁构件脱离接合。
18.根据权利要求17所述的外科器械,其中,所述双重作用螺线管与所述外科器械的击发驱动系统可操作地相互配合。
19.一种外科器械,包括:
细长轴组件,所述细长轴组件包括关节运动接头;
外科端部执行器,所述外科端部执行器可操作地联接到所述细长轴组件,以围绕所述关节运动接头进行选择性关节运动;
第一关节运动构件,所述第一关节运动构件与所述外科端部执行器可操作地相互配合、并被支撑用于响应于由可操作地联接到所述第一关节运动构件的第一关节运动马达施加的第一关节运动动作而进行选择性轴向运动;和
第二关节运动构件,所述第二关节运动构件与所述外科端部执行器可操作地相互配合、并被支撑用于响应于由可操作地联接到所述第二关节运动构件的第二关节运动马达施加的第二关节运动动作而进行选择性轴向运动。
20.根据权利要求19所述的外科器械,还包括控制系统,所述控制系统用于控制所述第一关节运动马达和所述第二关节运动马达,使得当所述第一关节运动马达被操作以使所述第一关节运动构件在一个轴向方向上运动第一轴向距离时,所述第二关节运动马达被操作,以使所述第二关节运动构件在相反的轴向方向上运动等于所述第一轴向距离的第二轴向距离。
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2014
- 2014-12-18 US US14/575,148 patent/US10085748B2/en active Active
-
2015
- 2015-12-04 MX MX2017008110A patent/MX2017008110A/es unknown
- 2015-12-04 BR BR112017013037-8A patent/BR112017013037B1/pt active IP Right Grant
- 2015-12-04 CN CN201580076418.3A patent/CN107257664B/zh active Active
- 2015-12-04 WO PCT/US2015/063960 patent/WO2016099957A2/en active Application Filing
- 2015-12-04 JP JP2017532980A patent/JP6702976B2/ja not_active Expired - Fee Related
- 2015-12-04 RU RU2017125412A patent/RU2732043C2/ru active
- 2015-12-17 EP EP19191101.5A patent/EP3590440A1/en not_active Withdrawn
- 2015-12-17 EP EP15200727.4A patent/EP3042617B1/en active Active
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2017
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- 2017-06-16 MX MX2021015345A patent/MX2021015345A/es unknown
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2018
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2021
- 2021-03-10 US US17/197,337 patent/US11812958B2/en active Active
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CN111542273B (zh) * | 2017-10-30 | 2024-02-20 | 爱惜康有限责任公司 | 包括柄部布置的外科器械系统 |
CN111601561A (zh) * | 2018-01-10 | 2020-08-28 | C.R.巴德公司 | 铰接式手术器械 |
CN111601561B (zh) * | 2018-01-10 | 2024-02-02 | C.R.巴德公司 | 铰接式手术器械 |
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MX2021015345A (es) | 2022-01-24 |
JP6702976B2 (ja) | 2020-06-03 |
US20240032915A1 (en) | 2024-02-01 |
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CN107257664B (zh) | 2020-06-30 |
BR112017013037A2 (pt) | 2018-01-02 |
US20180368837A1 (en) | 2018-12-27 |
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US20210267594A1 (en) | 2021-09-02 |
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EP3042617B1 (en) | 2020-03-04 |
JP2017538527A (ja) | 2017-12-28 |
RU2732043C2 (ru) | 2020-09-10 |
BR112017013037B1 (pt) | 2022-05-24 |
US20160174976A1 (en) | 2016-06-23 |
MX2017008110A (es) | 2018-03-06 |
EP3042617A3 (en) | 2016-11-02 |
MX2021015346A (es) | 2022-01-24 |
WO2016099957A3 (en) | 2016-10-27 |
WO2016099957A2 (en) | 2016-06-23 |
US10945728B2 (en) | 2021-03-16 |
RU2017125412A3 (zh) | 2019-06-11 |
EP3042617A2 (en) | 2016-07-13 |
RU2017125412A (ru) | 2019-01-23 |
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