CN107456270A - 用于血管闭合的两级电外科装置 - Google Patents

用于血管闭合的两级电外科装置 Download PDF

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CN107456270A
CN107456270A CN201710409426.6A CN201710409426A CN107456270A CN 107456270 A CN107456270 A CN 107456270A CN 201710409426 A CN201710409426 A CN 201710409426A CN 107456270 A CN107456270 A CN 107456270A
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clamping jaw
section
sealing surfaces
pliers
tissue
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CN107456270B (zh
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王惠荪
K.J.巴彻勒
Z.沃德
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Gyrus ACMI Inc
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    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
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    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
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    • A61B2018/1452—Probes having pivoting end effectors, e.g. forceps including means for cutting
    • A61B2018/1457—Probes having pivoting end effectors, e.g. forceps including means for cutting having opposing blades cutting tissue grasped by the jaws, i.e. combined scissors and pliers

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Abstract

本发明涉及用于血管闭合的两级电外科装置。一种钳子包括末端执行器组件，其具有：第一夹爪，其具有组织密封表面和处于所述密封表面上的电极；以及第二夹爪，其具有组织密封表面和处于所述密封表面上的电极。所述第一夹爪和所述第二夹爪在打开位置和闭合位置之间移动。所述第一夹爪和所述第二夹爪中的至少一个的密封表面具有柔性的内侧部段和刚性的外侧部段。

Description

用于血管闭合的两级电外科装置
相关申请
本申请要求于2016年6月2日提交的美国临时专利申请号62/344,749以及于2016年10月13日提交的美国临时专利申请号62/407,732的权益。
上述申请的内容通过引用整体地结合于本文中。
技术领域
本公开涉及一种电外科装置。更具体而言，本公开涉及一种用于血管闭合的电外科装置。
背景技术
本部分中的陈述仅提供与本公开相关的背景信息，并且可不构成现有技术。
一般钳子可被用于腹腔镜手术。所述钳子可被用于控制在患者体内的精细运动，并且可包括夹持组件或切割组件。此外，钳子可以在夹持组件中利用电能。通常，所述钳子具有一对相对的弹性夹爪，通过将夹爪拉到轴的远端中，该一对相对的弹性夹爪抵靠彼此闭合，所述轴的远端捕获比所述轴的远端开口要宽的所述夹爪的一部分，使得所述夹爪一起移动。类似地，所述轴可以被推过夹爪，使得夹爪一起移动，以产生夹持力。在这两种布置结构中，轴捕获夹爪并作为迫使夹爪在一起以产生夹持力的凸轮。
当前的双极电外科密封钳采用带有RF能量的一对夹爪来凝结血管，并且还采用可移动的切割刀片来在凝结之后切割密封的血管。然而，这样的装置需要高咬合力（jawforce）来压缩血管组织以获得期望的密封结果。这种高咬合力可导致不期望的组织损伤，这是因为例如大血管和小血管的咬合力需求是不同的。
因此，在本领域中需要能够密封大血管和小血管二者的电外科钳。
发明内容
本公开提供了一种末端执行器组件，其具有最佳地密封小血管和大血管二者的两级构造。
因此，根据本发明的一个方面，一种钳子包括末端执行器组件，所述末端执行器组件具有：第一夹爪，其具有组织密封表面和处于所述密封表面上的电极；以及第二夹爪，其具有组织密封表面和处于所述密封表面上的电极。所述第一夹爪和所述第二夹爪在打开位置和闭合位置之间移动。所述第一夹爪和所述第二夹爪中的至少一个的密封表面具有柔性的内侧部段和刚性的外侧部段。
本发明的上述方面可以通过本文所述的特征中的一个或任何组合来进一步表征，例如：所述第一夹爪和所述第二夹爪二者的密封表面都具有柔性的内侧部段和刚性的外侧部段；所述第一夹爪和所述第二夹爪中的每一个包括夹爪主体和密封板，所述密封板的外表面是所述第一夹爪和所述第二夹爪中的每一个的密封表面，并且其中，所述第一夹爪和所述第二夹爪中的至少一个的夹爪主体包括支撑构件，并且其中，一层柔韧材料被设置在所述支撑构件和所述密封板之间，所述一层柔韧材料由具有不同刚度的并排放置的单独的单元制成，中央单元比外侧单元要柔性；当所述第一夹爪和所述第二夹爪处于所述打开位置时，所述内侧部段凸出于所述外侧部段之上；所述内侧部段利用弹簧构件从所述外侧部段凸起；所述内侧部段被电连接到发电机，并且当所述第一夹爪和所述第二夹爪移动到所述闭合位置时，选择性的电接触件使所述外侧部段电连接到所述内侧部段；所述内侧部段被电连接到发电机，并且当所述第一夹爪和所述第二夹爪移动到所述闭合位置时，选择性的电接触件使所述外侧部段电连接到所述内侧部段；以及所述末端执行器组件包括轴向延伸通过所述第一夹爪和所述第二夹爪的相当大的部分的槽，并且还包括在所述槽内平移的刀片。
因此，根据本发明的另一方面，一种使用钳子的方法包括以下步骤中的一个或多个：打开所述钳子的第一夹爪和第二夹爪，所述第一夹爪具有组织密封表面和处于所述密封表面上的电极，并且所述第二夹爪具有组织密封表面和处于所述密封表面上的电极，所述第一夹爪和所述第二夹爪中的至少一个的密封表面具有柔性的内侧部段和刚性的外侧部段，当所述第一夹爪和所述第二夹爪处于打开位置时，所述内侧部段凸出于所述外侧部段之上，所述内侧部段被电连接到发电机，并且当所述第一夹爪和所述第二夹爪移动到闭合位置时，选择性的电接触件使所述外侧部段电连接到所述内侧部段；闭合所述第一夹爪和所述第二夹爪以在其间抓持组织；施加电外科能量以凝结在所述第一夹爪和所述第二夹爪之间抓持的组织；以及将所述第一夹爪和所述第二夹爪压在一起，以切割所述组织。
因此，根据本发明的另一方面，一种钳子的末端执行器组件包括：第一夹爪，其具有组织密封表面和处于所述密封表面上的电极；以及第二夹爪，其具有组织密封表面和处于所述密封表面上的电极，所述第一夹爪和所述第二夹爪被构造成在打开位置和闭合位置之间移动，所述第一夹爪和所述第二夹爪中的至少一个的密封表面具有可移动的远侧部段和固定的近侧部段。当所述第一夹爪和所述第二夹爪处于所述打开位置时，所述可移动的远侧部段的一部分凸出于所述固定的近侧部段之上。
本发明的上述方面可以通过本文所述的特征中的一个或任何组合来进一步表征，例如：所述远侧部段相对于所述近侧部段平移；所述第一夹爪和所述第二夹爪二者的密封表面都具有柔性的远侧部段和刚性的近侧部段；所述第一夹爪和所述第二夹爪中的至少一个的密封表面具有一对柔性的远侧部段；所述第一夹爪和所述第二夹爪二者的密封表面都具有一对柔性的远侧部段；所述末端执行器还包括轴向延伸通过所述第一夹爪和所述第二夹爪的相当大的部分的槽，并且还包括在所述槽内平移的刀片；所述远侧部段和所述近侧部段中的至少一个具有用于夹持组织的齿；所述远侧部段的所述部分利用至少一个弹簧构件从所述近侧部段凸起；所述电极被连接到电外科能量的源，所述源产生电外科能量以凝结在所述第一夹爪和所述第二夹爪之间抓持的组织；所述远侧部段和所述近侧部段被电连接，所述电极处于所述远侧部段和所述近侧部段上；以及所述可移动的远侧部段是可旋转的远侧部段。
因此，根据本发明的另一方面，一种钳子的末端执行器组件包括：第一夹爪，其具有组织密封表面和处于所述密封表面上的电极；以及第二夹爪，其具有组织密封表面和处于所述密封表面上的电极，所述第一夹爪和所述第二夹爪被构造成在打开位置和闭合位置之间移动。所述第一夹爪和所述第二夹爪中的至少一个的密封表面具有可移动的内侧部段和固定的外侧部段。所述内侧部段相对于所述外侧部段旋转。旋转轴线能够平行于所述第一夹爪和所述第二夹爪的轴向长度（axial length）。
因此，根据本发明的又一方面，一种使用钳子的方法包括以下步骤中的一个或多个：打开所述钳子的第一夹爪和第二夹爪，所述第一夹爪具有组织密封表面和处于所述密封表面上的电极，并且所述第二夹爪具有组织密封表面和处于所述密封表面上的电极，所述第一夹爪和所述第二夹爪中的至少一个的密封表面具有柔性的远侧部段和刚性的近侧部段，所述远侧部段相对于所述近侧部段平移或旋转，所述远侧部段的至少一部分从所述近侧部段凸起；闭合所述第一夹爪和所述第二夹爪以在其间抓持组织；施加电外科能量以凝结在所述第一夹爪和所述第二夹爪之间抓持的组织；以及将所述第一夹爪和所述第二夹爪压在一起，以切割所述组织。
由本文所提供的描述，另外的特征、优点和适用范围将变得显而易见。应当理解的是，描述和具体示例仅意在用于说明的目的，并不意在限制本公开的范围。
附图说明
本文所描述的附图仅用于说明的目的，并不意在以任何方式来限制本公开的范围。附图中的部件不一定按比例绘制，而是将重点放在说明本发明的原理上。在附图中：
图1图示了根据本发明的原理的电外科钳；
图2是用于图1中所示的钳子的一组夹爪的示例；
图3图示了用于钳子的管状构件和/或凸轮轴（camming shaft）的端部；
图4图示了管状构件和/或凸轮轴的端视图；
图5图示了凸轮轴的透视图；
图6图示了图1中所示的钳子的透视图；
图7图示了夹爪的侧视图；
图8图示了上部夹爪的两个部段；
图9图示了密封血管的夹爪的剖视图；
图10图示了根据本发明的原理的密封血管的另一组夹爪的剖视图；
图11图示了根据本发明的原理的又一组夹爪的剖视图；
图12图示了具有切割刀片的图6中所示的夹爪的透视图；
图13图示了具有切割刀片的图6中所示的夹爪的侧视图；
图14A图示了根据本发明的原理的又一组夹爪的侧视图；
图14B图示了图14A中所示的底部夹爪的顶视图；
图15A图示了当夹爪处于打开位置时沿图14B的线15A-15A所取的夹爪的剖视图；
图15B图示了当夹爪处于闭合位置时沿图14B的线15A-15A所取的夹爪的剖视图；
图16图示了图14A中所示的一组夹爪的透视图；
图17图示了根据本发明的原理的又一组夹爪的侧视图；
图18A图示了当夹爪处于打开位置时图17中所示的夹爪的剖视图；
图18B图示了当夹爪处于闭合位置时图17中所示的夹爪的剖视图；
图19A图示了根据本发明的原理的又一组夹爪的侧视图；
图19B图示了图19A中所示的底部夹爪的顶视图；
图20A图示了当夹爪处于打开位置时图19A中所示的夹爪的剖视图；以及
图20B图示了当夹爪处于闭合位置时图19A中所示的夹爪的剖视图。
具体实施方式
以下描述本质上仅是示例性的，并不意在限制本公开、其应用或用途。
现在参照附图，实施本发明的原理的例如腹腔镜钳之类的钳子在附图中图示并在2处标示。钳子2可以起到夹持物体的作用。在手术期间可以使用钳子2来夹持所关注的特征，包括：身体的一部分、解剖特征、组织、静脉、动脉或它们的组合。钳子2可用以在手术中使用，例如腹腔镜手术。钳子2可以在有或没有动力的情况下使用。电流可以通过钳子2，使得钳子被用于电外科手术。例如，当组织位于夹爪内时，可以使治疗电流从一个夹爪传递到第二夹爪，并且该治疗电流可以凝结血液、烧灼、切割或它们的组合。钳子2一般可以包括一个或多个工作组件以及使该一个或多个组件工作的足够的控制装置。钳子2可以包括用于执行所列举的功能的部分，并且一般可以包括探针（例如，管状构件、中空管或管的组件）、手持件（hand piece）、用于致动探针的一个或多个可操作机构或者它们的组合。该手持件可以是能够形成具有腔的手持件结构的部分或壳体结构的组件。注意，本发明并不限于腹腔镜手术。也就是说，下面描述的夹爪可以与夹持到组织上的任何类型的医疗装置一起使用。
现在转向图1，其示出了钳子2的侧视图。钳子2包括具有远端6和近端8的手持件4。手持件4还包括至少一个可操作机构50。管状构件20具有连接到手持件4的远端6的近端24。管状构件20包括远端22，该远端22包括从远端22延伸的夹爪40。夹爪40具有构件92和94，该构件92和94打开并且当管状构件20沿管状构件的纵向轴线26向前移动至与构件92和94接触或者夹爪40沿纵向轴线26向后移动至与管状构件20接触时闭合。
进一步参照图2以及图6至图9，凸轮轴70位于钳子2上，其中夹爪40从该凸轮轴70延伸。构件92和94通过凸轮轴70偏置，使得夹爪40打开和闭合。构件92和94分别包括内侧部分或部段96和98，并且一对槽100和102分别延伸穿过构件92和94。构件92在构件92的外侧部分或部段上、即在内侧部段96的两侧上包括第一压缩表面104，并且内侧部段96在槽100的两侧上包括第二压缩表面108。构件94在构件94的外侧部分或部段上、即在内侧部段98的两侧上包括第一压缩表面106，并且内侧部段98在槽102的两侧上包括第二压缩表面110。
图3图示了管状构件20或凸轮轴的端部，其示出了沿顶表面和底表面的一对内部平坦部分30。刀片凹部34在该一对内部平坦部分30之间延伸，使得刀片400（图12和图13）从管状构件20中向外延伸。
图4图示了管状构件20的剖视图。内部平坦部分30包括与夹爪44的腿具有互补形状的至少一部分。因此，当管状构件20或腿44轴向移动时，内部平坦部分30控制夹爪的取向和运动。
图5图示了插入到管状构件20中的凸轮轴70的一个示例的透视图。凸轮轴70包括模制的喇叭形张开部分（flare）74，其具有从其延伸的一对突起72。
图6图示了夹爪40，其包括位于夹爪之间的销90。销90将夹爪构件92和94保持在一起，并且为夹爪构件92和94提供枢转点，使得当管状构件20滑过相对的构件92和94时，构件92和94闭合。
转回到图9，夹爪构件92和94被示出为夹持并密封血管V。当夹爪构件92和94夹持在一起时，夹爪构件92和94利用压缩表面104和106形成第一压缩区，并且利用压缩表面108和110形成第二压缩区。在某些布置结构中，一组偏置构件112A、112B、112C和112D被设置在夹爪构件92和94的内侧部段96和98及相应的上部主体部分116和118之间，使得内侧部段96和98能够相对于主体部分116和118平移，如箭头114所示（即，沿垂直于密封表面的方向）。因此，当夹爪构件92和94打开时，内侧部段96和98，并且因此，第二压缩表面108和110，凸出于第一压缩表面104和106之上；也就是说，第二压缩表面108和110远离第一压缩表面104和106向内延伸。偏置构件112A、112B、112C和112D可由任何合适的弹簧状材料制成，例如弹性材料等。偏置构件112A、112B、112C和112D可以是螺旋弹簧或固体压缩构件。因此，夹爪40是两级末端执行器，其中，通过压缩表面104和106产生的第一压缩区比通过压缩表面108和110产生的柔性的第二压缩区要刚性。注意，这两个压缩区可以沿夹爪构件92和94的一部分或全部延伸。
因此，当夹爪构件92和94夹持到较小的血管V上时，仅通过压缩表面108和110形成的内侧的第二压缩区在血管V上夹紧并闭合。而在较大的血管V的情况下，通过压缩表面104和106形成的外侧的第一压缩区和通过压缩表面108和110形成的第二压缩区二者都在血管V上夹紧并闭合，使得外侧的第一压缩区比内侧的第二压缩区对血管V产生更低的压缩力。在各种布置结构中，内侧部段108和110和/或主体部分116和118可以被电连接到提供电外科能量源的发电机，使得具有不同电位的RF电压可以被施加于夹爪构件92和94的电连接部段。RF电压产生从一个夹爪构件通过组织传递到另一个夹爪构件的电极的电流，从而加热该组织以凝结或切割该组织。
现在转向图10，其示出了根据本发明的原理的一组替代性的夹爪240。夹爪240类似于先前描述的夹爪40。然而，除了设置在夹爪构件92和94的内侧部段96和98及相应的上部主体部分116和118之间的一组偏置构件212A、212B、212C和212D之外，夹爪240还具有一组电接触件214A、214B、214C和214D。偏置构件212A、212B、212C和212D可由任何合适的弹簧状材料制成，例如弹性材料等。偏置构件212A、212B、212C和212D可以是螺旋弹簧或固体压缩构件。因此，同样，通过压缩表面104和106产生的第一压缩区比通过压缩表面108和110产生的柔性的第二压缩区要刚性。当夹爪构件92和94以期望的力量夹持到血管V上时，电接触件214A、214B、214C和214D使内侧部段与主体部分116和118电连接。因此，如果内侧部段96和98被电连接到提供电外科能量源的发电机，则电流从一个夹爪构件的外侧和内侧部段二者通过夹爪构件92和94所夹持的组织传递到另一夹爪构件的外侧和内侧部段，从而当夹爪构件以期望的力量闭合时加热该组织以凝结或切割该组织。
图11图示了根据本发明的原理的又一组替代性的夹爪340。夹爪340包括第一夹爪构件392和第二夹爪构件394。第一夹爪构件392包括夹爪主体或支撑构件395以及设置在槽396的两侧上的密封板393。密封板393的外表面限定了密封表面300。一层柔韧材料304、308、312被设置在夹爪主体395和密封板393之间。柔韧材料层由具有不同厚度的并排放置的单独的单元（cell）制成，内侧或中央单元308比外侧单元304要柔性。在某些布置结构中，柔韧材料层包括与外侧单元304相邻定位的内侧单元308，而在其他布置结构中，中间单元312位于内侧单元308和外侧单元304之间，以提供从更柔性的内侧单元308到更刚性的外侧单元304的附加过渡。
第二夹爪构件394包括夹爪主体397以及设置在槽398的两侧上的密封板399。密封板399的外表面限定了密封表面302。一层柔韧材料306、310、314被设置在夹爪主体397和密封板399之间。柔韧材料层由具有不同厚度的并排放置的单独的单元制成，内侧或中央单元310比外侧单元304要柔性。在某些布置结构中，柔韧材料层包括与外侧单元306相邻定位的内侧单元310，而在其他布置结构中，中间单元314位于内侧单元310和外侧单元306之间，以提供从更柔性的内侧单元310到更刚性的外侧单元306的附加过渡。柔韧材料304、308、312的层和柔韧材料306、310、314的层可以沿夹爪构件392和394的一部分或全部延伸。
因此，当夹爪构件392和394一起夹持在血管上时，处于外侧单元304和306上方的密封表面300和302形成第一压缩区，并且处于内侧单元308和310上方的密封表面形成第二压缩区，该第一压缩区不如该第二压缩区柔性。同样，如果夹爪构件392和394包括中间单元312和314，则可以选择单元312和314的刚度以提供从第一压缩区到第二压缩区的期望过渡。
单元304、306、308、310、312、314可由例如弹性体之类的任何合适的柔韧材料制成。在一些布置结构中，单元304、306、308、310、312、314中没有一个是导电的。在其他布置结构中，单元304、306、308、310、312、314中的一些或全部可以是导电的。因此，当夹爪构件392和394被连接到提供电能源的发电机时，可以对导电的单元施加具有不同电位的电压，使得电流从一个夹爪构件通过夹持在夹爪构件之间的组织传递到另一个夹爪构件，以凝结或切割该组织。
先前描述的任何夹爪布置结构40、240和340都可以包括切割刀片。例如，如图12和图13中所示，夹爪40被示出为具有刀片400。刀片400包括槽402，其与销90接合以允许刀片400沿着销90往复运动。刀片400被连接到刀轴412。因此，刀轴412的轴向运动导致刀片400沿夹爪构件92和94的槽100和102的往复轴向运动，以切割夹持在夹爪构件92和94之间的组织。类似的刀片布置结构可以被添加到夹爪240和340。
现在转向图14A和图14B，其示出了根据本发明的原理的一组替代性的夹爪500。该组夹爪500包括第一夹爪构件502和第二夹爪构件504。该组夹爪500包括位于夹爪之间的销590。销590将夹爪构件502和504保持在一起，并且为夹爪构件502和504提供枢转点，使得当管状构件20滑过相对的构件502和504时，构件502和504闭合。在一些布置结构中，夹爪构件502和504包括刀片槽512（图16），以容纳上文所述以及上面图12和图13中所示的刀片布置结构。
第一夹爪构件502的外表面限定了密封表面505。第一夹爪构件502还包括具有限定第二密封表面511的外表面的一个或两个保持器508。第二夹爪构件504具有限定密封表面506的外表面。
如图15A和图15B中所示，保持器508位于第一夹爪构件502中的相应开口509中。在某些布置结构中，一个或多个偏置构件514被设置在每个保持器508和第一夹爪构件502之间。因此，当夹爪构件502和504打开时，保持器508、并且因此第二密封表面511凸出于密封表面505之上。偏置构件514可由任何合适的弹簧状材料制成，例如弹性材料等。偏置构件514可以是螺旋弹簧或固体压缩构件。因此，保持器508可相对于第一夹爪构件移动，使得该组夹爪500是两级末端执行器，其中，当夹爪构件502和504从打开位置（图15A）移动到闭合位置（图15B）时，通过密封表面505和506产生的第一压缩区比通过密封表面506和511产生的柔性的第二压缩区要刚性。
在各种布置结构中，保持器508被电连接到第一夹爪构件502，使得保持器508和第一夹爪构件502二者都是导电的。在其他布置结构中，保持器508或夹爪构件502是导电的。第二夹爪构件504的全部或一部分也可以是导电的。因此，夹爪500可以被电连接到提供电外科能量源的发电机，使得具有不同电位的RF电压可以被施加于成双极夹爪布置结构的夹爪构件502和504的电连接部段。RF电压产生从一个夹爪构件通过组织传递到另一个夹爪构件的电极的电流，从而加热该组织以凝结或切割该组织。保持器508可以包括位于密封表面511和密封表面506之间的一个或多个非导电止动件510，以防止夹爪构件502和504的电气部分短路。
现在转向图17，其示出了根据本发明的原理的又一组夹爪600。该组夹爪600包括上述第一夹爪构件502和第二夹爪构件604。该组夹爪600包括位于夹爪之间的销690。销690将夹爪构件502和604保持在一起，并且为夹爪构件502和604提供枢转点，使得当管状构件20滑过相对的构件502和604时，构件502和604闭合。在一些布置结构中，夹爪构件502和504包括类似于图16中所示的刀片槽512的刀片槽，以容纳上文所述以及上面图12和图13中所示的刀片布置结构。
第二夹爪构件604的外表面限定了密封表面606。第二夹爪构件604还包括具有限定第二密封表面611的外表面的一个或两个保持器616。同样，第一夹爪构件502的布置结构与先前关于夹爪500所述的相同。
如图18A和图18B中所示，保持器616位于第二夹爪构件604中的相应开口609中。在某些布置结构中，一个或多个偏置构件614被设置在每个保持器516和第二夹爪构件604之间。因此，当夹爪构件502和604打开时，保持器508、且因此第二密封表面511凸出于密封表面505之上，并且保持器616、且因此第二密封表面611凸出于密封表面606之上。偏置构件614可由任何合适的弹簧状材料制成，例如弹性材料等。偏置构件614可以是螺旋弹簧或固体压缩构件。因此，保持器508可相对于第一夹爪构件502移动，并且保持器616可相对于第二夹爪构件604移动，使得该组夹爪600是两级末端执行器，其中，当夹爪构件502和604从打开位置（图18A）移动到闭合位置（图18B）时，通过密封表面505和606产生的第一压缩区比通过密封表面511和611产生的柔性的第二压缩区要刚性。
在各种布置结构中，保持器508被电连接到第一夹爪构件502，使得保持器508和第一夹爪构件502二者都是导电的。在其他布置结构中，保持器508或夹爪构件502是导电的。类似地，在一些布置结构中，保持器616被电连接到第二夹爪构件604，使得保持器616和第二夹爪构件604二者都是导电的，而在布置结构中，保持器616或夹爪构件604是导电的。因此，夹爪600可以被电连接到提供电外科能量源的发电机，使得具有不同电位的RF电压可以被施加于成双极夹爪布置结构的夹爪构件502和604的电连接部段。RF电压产生从一个夹爪构件通过组织传递到另一个夹爪构件的电极的电流，从而加热该组织以凝结或切割该组织。保持器508和616可以包括位于密封表面511和密封表面611之间的一个或多个非导电止动件510和618，以防止夹爪构件502和604的电气部分短路。
现在参照图19A和图19B，其示出了根据本发明的原理的一组替代性的夹爪700。该组夹爪700包括第一夹爪构件702和第二夹爪构件704。该组夹爪700包括位于夹爪之间的销790。销790将夹爪构件702和704保持在一起，并且为夹爪构件702和704提供枢转点，使得当管状构件20滑过相对的构件702和704时，构件702和704闭合。在一些布置结构中，夹爪构件702和704包括类似于图16中所示的刀片槽512的刀片槽，以容纳上文所述以及上面图12和图13中所示的刀片布置结构。
第一夹爪构件702的外表面限定了密封表面705。第一夹爪构件702还包括具有限定第二密封表面711的外表面的一个或两个保持器708。第二夹爪构件704具有限定密封表面706的外表面。
如图20A和图20B中所示，保持器708位于第一夹爪构件702中的相应开口709中。保持器708利用销716附接到第一夹爪构件702，该销716为保持器708提供相对于第一夹爪构件702的枢转点。在某些布置结构中，一个或多个偏置构件714被设置在每个保持器708和第一夹爪构件702之间。因此，当夹爪构件702和704打开时，保持器708绕销716从密封表面705向外枢转，使得保持器708的一部分、并且因此第二密封表面711的一部分凸出于密封表面705之上。偏置构件714可由任何合适的弹簧状材料制成，例如弹性材料等。偏置构件714可以是螺旋弹簧或固体压缩构件。因此，保持器708可相对于第一夹爪构件移动，使得该组夹爪700是两级末端执行器，其中，当夹爪构件702和704从打开位置（图20A）移动到闭合位置（图20B）时，通过密封表面505和506产生的第一压缩区比通过密封表面706和711产生的柔性的第二压缩区要刚性。
在各种布置结构中，保持器708被电连接到第一夹爪构件702，使得保持器708和第一夹爪构件702二者都是导电的。在其他布置结构中，保持器708或夹爪构件702是导电的。第二夹爪构件704的全部或一部分也可以是导电的。因此，夹爪700可以被电连接到提供电外科能量源的发电机，使得具有不同电位的RF电压可以被施加于成双极夹爪布置结构的夹爪构件702和704的电连接部段。RF电压产生从一个夹爪构件通过组织传递到另一个夹爪构件的电极的电流，从而加热该组织以凝结或切割该组织。夹爪构件704可以包括位于密封表面711和密封表面706之间的一个或多个非导电止动件710，以防止夹爪构件702和704的电气部分短路。
尽管先前描述的夹爪针对枢转地附接到另一个夹爪构件的一个夹爪构件，但是本发明设想了与另一个夹爪构件夹持到组织上的任何类型的夹爪构件。例如，随着夹爪构件以包括平移和旋转运动的任何合适的方式朝向彼此移动，夹爪构件可以夹持到组织上；也就是说，远侧部段可以相对于近侧部段旋转或平移。此外，如先前所提及的，任何上述夹爪构件的各种部件可以是导电的。这些部件本身可以是导电电极，或者可以将导电材料添加到部件以在部件上形成电极。上述夹爪构件中的任一种可以具有用于夹持组织的齿。
本发明的描述本质上仅是示例性的，并且不脱离本发明的要旨的变型意在属于本发明的范围内。这样的变型不应被认为脱离本发明的精神和范围。

Claims (22)

1.一种钳子，包括：
末端执行器组件，其包括：
第一夹爪，其具有组织密封表面和处于所述密封表面上的电极；以及
第二夹爪，其具有组织密封表面和处于所述密封表面上的电极，
其中，所述第一夹爪和所述第二夹爪在打开位置和闭合位置之间移动，以及
其中，所述第一夹爪和所述第二夹爪中的至少一个的密封表面具有柔性的内侧部段和刚性的外侧部段。
2.如权利要求1所述的钳子，其特征在于，所述第一夹爪和所述第二夹爪二者的密封表面都具有柔性的内侧部段和刚性的外侧部段。
3.如权利要求1所述的钳子，其特征在于，所述第一夹爪和所述第二夹爪中的每一个包括夹爪主体和密封板，所述密封板的外表面是所述第一夹爪和所述第二夹爪中的每一个的密封表面，并且其中，所述第一夹爪和所述第二夹爪中的至少一个的夹爪主体包括支撑构件，并且其中，一层柔韧材料被设置在所述支撑构件和所述密封板之间，所述一层柔韧材料由具有不同刚度的并排放置的单独的单元制成，中央单元比外侧单元要柔性。
4.如权利要求1所述的钳子，其特征在于，当所述第一夹爪和所述第二夹爪处于所述打开位置时，所述内侧部段凸出于所述外侧部段之上。
5.如权利要求4所述的钳子，其特征在于，所述内侧部段利用弹簧构件从所述外侧部段凸起。
6.如权利要求4所述的钳子，其特征在于，所述内侧部段被电连接到发电机，并且当所述第一夹爪和所述第二夹爪移动到所述闭合位置时，选择性的电接触件使所述外侧部段电连接到所述内侧部段。
7.如权利要求1所述的钳子，其特征在于，所述内侧部段被电连接到发电机，并且当所述第一夹爪和所述第二夹爪移动到所述闭合位置时，选择性的电接触件使所述外侧部段电连接到所述内侧部段。
8.如权利要求1所述的钳子，其特征在于，所述末端执行器组件包括轴向延伸通过所述第一夹爪和所述第二夹爪的相当大的部分的槽，并且还包括在所述槽内平移的刀片。
9.一种使用钳子的方法，所述方法包括：
打开所述钳子的第一夹爪和第二夹爪，所述第一夹爪具有组织密封表面和处于所述密封表面上的电极，并且所述第二夹爪具有组织密封表面和处于所述密封表面上的电极，所述第一夹爪和所述第二夹爪中的至少一个的密封表面具有柔性的内侧部段和刚性的外侧部段，当所述第一夹爪和所述第二夹爪处于打开位置时，所述内侧部段凸出于所述外侧部段之上，所述内侧部段被电连接到发电机，并且当所述第一夹爪和所述第二夹爪移动到闭合位置时，选择性的电接触件使所述外侧部段电连接到所述内侧部段；
闭合所述第一夹爪和所述第二夹爪以在其间抓持组织；
施加电外科能量以凝结在所述第一夹爪和所述第二夹爪之间抓持的组织；以及
将所述第一夹爪和所述第二夹爪压在一起，以切割所述组织。
10. 一种钳子的末端执行器组件，包括：
第一夹爪，其具有组织密封表面和处于所述密封表面上的电极；以及
第二夹爪，其具有组织密封表面和处于所述密封表面上的电极，所述第一夹爪和所述第二夹爪被构造成在打开位置和闭合位置之间移动，所述第一夹爪和所述第二夹爪中的至少一个的密封表面具有可移动的远侧部段和固定的近侧部段，以及
其中，当所述第一夹爪和所述第二夹爪处于所述打开位置时，所述可移动的远侧部段的一部分凸出于所述固定的近侧部段之上。
11.如权利要求10所述的末端执行器组件，其特征在于，所述远侧部段相对于所述近侧部段平移。
12.如权利要求10所述的末端执行器组件，其特征在于，所述第一夹爪和所述第二夹爪二者的密封表面都具有柔性的远侧部段和刚性的近侧部段。
13.如权利要求10所述的末端执行器组件，其特征在于，所述第一夹爪和所述第二夹爪中的至少一个的密封表面具有一对柔性的远侧部段。
14.如权利要求13所述的末端执行器组件，其特征在于，所述第一夹爪和所述第二夹爪二者的密封表面都具有一对柔性的远侧部段。
15.如权利要求13所述的末端执行器组件，还包括轴向延伸通过所述第一夹爪和所述第二夹爪的相当大的部分的槽，并且还包括在所述槽内平移的刀片。
16.如权利要求10所述的末端执行器组件，其特征在于，所述远侧部段和所述近侧部段中的至少一个具有用于夹持组织的齿。
17.如权利要求10所述的末端执行器组件，其特征在于，所述远侧部段的所述部分利用至少一个弹簧构件从所述近侧部段凸起。
18.如权利要求10所述的末端执行器组件，其特征在于，所述电极被连接到电外科能量的源，所述源产生电外科能量以凝结在所述第一夹爪和所述第二夹爪之间抓持的组织，并且其中，所述远侧部段和所述近侧部段被电连接，所述电极处于所述远侧部段和所述近侧部段上。
19.如权利要求39所述的末端执行器组件，其特征在于，所述可移动的远侧部段是可旋转的远侧部段。
20. 一种钳子的末端执行器组件，包括：
第一夹爪，其具有组织密封表面和处于所述密封表面上的电极；以及
第二夹爪，其具有组织密封表面和处于所述密封表面上的电极，所述第一夹爪和所述第二夹爪被构造成在打开位置和闭合位置之间移动，以及
其中，所述第一夹爪和所述第二夹爪中的至少一个的密封表面具有可移动的内侧部段和固定的外侧部段，以及
其中，所述内侧部段相对于所述外侧部段旋转。
21.如权利要求20所述的末端执行器组件，其特征在于，旋转轴线平行于所述第一夹爪和所述第二夹爪的轴向长度。
22.一种使用钳子的方法，所述方法包括：
打开所述钳子的第一夹爪和第二夹爪，所述第一夹爪具有组织密封表面和处于所述密封表面上的电极，并且所述第二夹爪具有组织密封表面和处于所述密封表面上的电极，所述第一夹爪和所述第二夹爪中的至少一个的密封表面具有柔性的远侧部段和刚性的近侧部段，所述远侧部段相对于所述近侧部段平移或旋转，所述远侧部段的至少一部分从所述近侧部段凸起；
闭合所述第一夹爪和所述第二夹爪以在其间抓持组织；
施加电外科能量以凝结在所述第一夹爪和所述第二夹爪之间抓持的组织；以及
将所述第一夹爪和所述第二夹爪压在一起，以切割所述组织。
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US11076908B2 (en) 2021-08-03
US20210338314A1 (en) 2021-11-04
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CN113768613A (zh) 2021-12-10
EP3251624A2 (en) 2017-12-06
US20170348043A1 (en) 2017-12-07
EP3251624A3 (en) 2018-03-28

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