CN107750141B - 与超声外科器械一起使用的超声外科刀 - Google Patents

与超声外科器械一起使用的超声外科刀 Download PDF

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CN107750141B
CN107750141B CN201680035374.4A CN201680035374A CN107750141B CN 107750141 B CN107750141 B CN 107750141B CN 201680035374 A CN201680035374 A CN 201680035374A CN 107750141 B CN107750141 B CN 107750141B
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surgical instrument
tissue
distal end
treatment surface
tissue treatment
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CN107750141A (zh
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J·S·吉
A·L·马科特
J·A·威德三世
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Ethicon LLC
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
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    • A61B17/32—Surgical cutting instruments
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    • A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
    • A61B2017/320095—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw with sealing or cauterizing means

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Abstract

本发明公开了一种外科器械，该外科器械包括超声换能器、从该超声换能器延伸的超声传输波导、和声学地联接到超声传输波导的超声刀。该超声刀包括基部和从该基部朝远侧延伸的弯曲主体。该弯曲主体包括在弯曲主体的第一侧上延伸的组织处理表面和在弯曲主体的与第一侧相对的第二侧上延伸的弯曲边缘。该弯曲边缘具有近侧端部和远侧端部，其中该近侧端部在第一方向上与远侧端部偏置，其中该近侧端部在第二方向上与远侧端部偏置，并且其中该第一方向垂直于第二方向。

Description

与超声外科器械一起使用的超声外科刀
背景技术
本公开涉及外科器械，并且在各种实施方案中涉及超声外科器械。
超声外科器械因其独特性能特性而被用于外科手术中的许多应用中。在各种实例中，超声外科器械可被构造成能够用于开放式、腹腔镜式、或内窥镜式外科手术中。超声外科器械还可被构造成能够用于机器人辅助的外科手术中。
附图说明
各种实施方案的特征在所附权利要求书中进行了详细描述。然而，通过结合如下附图参考以下说明可最好地理解关于操作的组织和方法的各种实施方案及其优点：
图1为根据一个实施方案的超声外科刀的透视图；
图2为根据一个实施方案的超声外科刀的透视图；
图3为根据一个实施方案的超声外科刀的透视图；
图4为根据一个实施方案的超声外科刀的透视图；
图5为根据一个实施方案的超声外科刀的透视图；
图6为根据一个实施方案的超声外科刀的透视图；
图7为根据一个实施方案的超声外科刀的透视图；
图8为根据一个实施方案的超声外科刀的透视图；
图9为根据一个实施方案的超声外科刀的透视图；
图9A为根据一个实施方案的超声外科刀的前视图；
图10为根据一个实施方案的沿剖面线10--10截取的图12所示的超声外科刀的剖面图；
图11为根据一个实施方案的超声外科刀的顶视图；
图12为根据一个实施方案的超声外科刀的侧视图；
图13为根据一个实施方案的沿剖面线13--13截取的图11所示的超声外科刀的剖面图；
图14为根据一个实施方案的沿剖面线14--14截取的图11所示的超声外科刀的剖面图；
图15为根据一个实施方案的沿剖面线15--15截取的图11所示的超声外科刀的剖面图；
图16为根据一个实施方案的沿剖面线16--16截取的图11所示的超声外科刀的剖面图；
图17为根据一个实施方案的沿剖面线17--17截取的图11所示的超声外科刀的剖面图；
图18为根据一个实施方案的沿剖面线18--18截取的图11所示的超声外科刀的剖面图；
图19为根据一个实施方案的沿剖面线19--19截取的图11所示的超声外科刀的剖面图；
图20为根据一个实施方案的沿剖面线20--20截取的图11所示的超声外科刀的剖面图；
图21为根据一个实施方案的沿剖面线21--21截取的图11所示的超声外科刀的剖面图；
图22为根据一个实施方案的沿剖面线22--22截取的图11所示的超声外科刀的剖面图；
图23为根据一个实施方案的包括端部执行器组件的超声外科器械的局部侧视图；
图24为根据一个实施方案的图23的超声外科器械的端部执行器组件的分解图；
图25为根据一个实施方案的超声外科刀的顶视图；
图26为根据一个实施方案的沿剖面线26--26截取的图25所示的超声外科刀的剖面图；
图27为根据一个实施方案的沿剖面线27--27截取的图25所示的超声外科刀的剖面图；
图28为根据一个实施方案的沿剖面线28--28截取的图25所示的超声外科刀的剖面图；
图29为根据一个实施方案的沿剖面线29--29截取的图25所示的超声外科刀的剖面图；
图30为根据一个实施方案的沿剖面线30--30截取的图25所示的超声外科刀的剖面图；
图31为根据一个实施方案的沿剖面线31--31截取的图25所示的超声外科刀的剖面图；和
图32为根据一个实施方案的包括端部执行器组件和柄部组件的超声外科器械的侧视图。
具体实施方式
阐述了许多具体细节，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、制造和用途的彻底理解。未详细描述熟知的操作、部件和元件，以避免模糊在说明书中所述的实施方案。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修改。
术语“包括”(以及“包括”的任何形式，诸如“包括”(“comprises”和“comprising”))、具有(和“具有”的任何形式，诸如“具有”(“has”和“having”))、“包含”(和“包含”的任何形式，诸如“包含”(“includes”和“including”))、以及“含有”(和“含有”的任何形式，诸如“含有”(“contains”和“containing”))为开放式系列动词。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、或设备的元件具有那些一个或多个特征，但不限于仅具有那些一个或多个特征。
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，本文可相对于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中使用，并且这些术语并非限制性和/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穿过该工作通道推进。
大体参照图1到图9，超声刀10被示出于当刀沿逆时针方向旋转时以近似30°的间隔拍摄的各种透视图中。超声刀10包括从基部13在远侧方向上大体突出或延伸从而终止于钝的或至少基本上钝的末端14的主体12。主体12通常包括第一面16和与第一面16相对的或至少基本上相对的第二面18。读者将会理解，钝的末端14可为纤细的，但是足够无创伤的以允许改善组织平面的创口和分离。
第一面16可包括组织处理表面20、第一侧壁22和第二侧壁24，如图2最佳所示的。第二面18可包括在切割刃30处相交的第一组织处理表面26和第二组织处理表面28，如图7最佳所示的。第一中间壁32可至少部分地在第一侧壁22和第一组织切割表面26之间延伸，如图1最佳所示的。第二中间壁34可至少部分地在第二侧壁24和第二组织切割表面28之间延伸，如图4最佳所示的。
侧壁22,24在组织处理表面20的相对两侧上延伸或基本上延伸，如图2最佳所示的。在一个实施方案中，如图2所示的，组织处理表面20被侧壁22,24斜削或刮削，这使得组织处理表面20在钝的末端14近侧的位置处向远端21渐缩或变窄。换句话讲，组织处理表面20被限定在从远侧端部21朝近侧延伸的两条轮廓线23,25之间。第一轮廓线23在第一侧壁22和组织处理表面20之间延伸。并且，第二轮廓线25在第二侧壁24和组织处理表面20之间延伸。轮廓线23,25沿循在远侧端部21处相交的单独的且大体弯曲的路径。
组织处理表面20可为平坦的，或至少基本上为平坦的，使得轮廓线23,25可在单个平面中延伸或基本上延伸。组织处理表面20的平坦度可有利于使用组织处理表面20作为组织密封表面，以用于密封紧贴组织处理表面20而捕获的组织。刀10的显著优点在于其能够密封相对大的血管(诸如包括大约7mm的直径的血管)、以及相对短的横切时间(诸如例如8秒)。轮廓线23,25中的一个或两个轮廓线可呈锋利边缘的形式。另选地，轮廓线23,25中的一个或两个轮廓线呈被刮削的形式，以产生从侧壁22,24到组织处理表面20的平滑过渡。
在远侧端部21和钝的末端14之间的剩余距离中，侧壁22,24可例如彼此直接相交，或至少部分地相交。在其他实施方案中，远侧端部21可被定位在钝的末端14处，或者刚好在钝的末端14近侧。在至少一个实施方案中，远侧端部21可比基部13更靠近钝的末端15定位，如图2所示。在至少一个实施方案中，例如远侧端部21的位置在钝的末端14和基部13之间可为等距的。
角度α1可被限定在轮廓线23,25之间，如图2所示。例如，角度α1可为选自约1°至约15°的范围的任何角度。在一个示例中，角度α1可为选自约3°至约10°的范围的任何角度。在一个示例中，角度α1可为约5°。
参照图10，其示出了刀10的纵向横截面。如图10所示，刀10具有长度L1并且包括具有长度L2的直的或基本上直的部分36和具有长度L3的弯曲或弓形部分38。如图10所示，刀10的长度L1为从基部13到钝的末端14测得的。在某些实例中，长度L1可为选自约0.4英寸至约1.2英寸的范围的任何长度。在某些实例中，长度L1可为选自约0.6英寸至约0.8英寸的范围的任何长度。在某些实例中，长度L1可为选自约0.70英寸至约0.75英寸的范围的任何长度。在一个实例中，长度L1可为例如约0.728英寸。
在某些实例中，长度L2可为选自约0.02英寸至约0.10英寸的范围的任何长度。在某些实例中，长度L2可为选自约0.03英寸至约0.07英寸的范围的任何长度。在一个实例中，长度L1可为例如约0.05英寸。
在某些实例中，长度L3可为选自约0.02英寸至约0.10英寸的范围的任何长度。在某些实例中，长度L2可为选自约0.03英寸至约0.07英寸的范围的任何长度。在一个实例中，长度L3可为例如约0.767英寸。
在某些实例中，长度L3可为选自约0.50英寸至约1.00英寸的范围的任何长度。在某些实例中，长度L3可为选自约0.60英寸至约0.80英寸的范围的任何长度。在一个实例中，长度L3可为例如约0.67英寸。本公开设想到长度L1、L2和/或L3的其他值。
再次参照图10，刀10可包括基部13处的宽度W1、距基部13的近侧端部距离L4的拐折区域44处的最大宽度W2、以及钝的末端14处的最小宽度W3。如图10所示，刀10的宽度可例如沿刀10的长度从拐折区域44处的最大宽度W2逐渐渐缩为钝的末端14处的最小宽度W3。
在某些实例中，宽度W1可为选自约0.030英寸至约0.270英寸的范围的任何宽度。在某些实例中，宽度W1可为选自约0.060英寸至约0.180英寸的范围的任何宽度。在一个实例中，宽度W1可为例如约0.090英寸。
在某些实例中，宽度W2可为选自约0.030英寸至约约0.270英寸的范围的任何宽度。在某些实例中，宽度W2可为选自约0.060英寸至约0.180英寸的范围的任何宽度。在一个实例中，宽度W2可为例如约0.090英寸。
在某些实例中，宽度W3可为选自约0.120英寸至约0.010英寸的范围的任何宽度。在某些实例中，宽度W1可为选自约0.080英寸至约0.030英寸的范围的任何宽度。在一个实例中，宽度W3可为例如约0.044英寸。本公开设想到宽度W1、W2和/或W3的其他值。
在某些实例中，长度L4可为选自约0.200英寸至约0.300英寸的范围的任何长度。在某些实例中，长度L4可为选自约0.250英寸至约0.280英寸的范围的任何长度。在一个实例中，长度L3可为例如约0.270英寸。本公开设想到长度L4的其他值。
主要参照图9A、图10，限定笛卡儿坐标系，使得在图9A中笛卡尔坐标系的X轴远离页面延伸。并且在图10中，该Z轴远离页面延伸。在图9A、图10所示的实施方案中，笛卡尔坐标系的X轴和Z轴限定横切组织处理表面20的XZ平面。在某些实例中，如图10所示，XZ平面例如以约90°的角度横切组织处理表面20。此外，XZ平面可沿中心线45(图10)延伸，该中心线延伸穿过基部13。
刀10的弯曲部分38被设计成在例如腹腔镜式手术中使用刀10期间进行配合并且穿过管状通道诸如例如套管针(图中未示出)。因此，为使刀10的曲率最大化同时保持在取决于套管针的直径的尺寸限度内，例如刀10的弯曲部分38沿循相对于XZ平面的唯一轨迹。
本质上，弯曲部分38包括在XZ平面的第一侧上开始或基本上开始的基本上弓形的外形，如图10所示。弯曲部分38的外形然后穿过XZ平面到XZ平面的与第一侧相对的第二侧。然后，弯曲部分38的外形在拐折区域44处转向，并再次返回到第一侧，使得钝的末端14被完全定位在XZ平面的第一侧上，如图10所示。因此，弯曲部分38的外形在XZ平面的两侧上延伸。
如图10所示，弯曲部分38的横截面积包括近侧区域40、拐折区域44、和远侧区域42。近侧区域和远侧区域40,42可位于XZ平面的第一侧上，而拐折区域44主要位于XZ平面的第二侧上。
在一个示例中，拐折区域44处的宽度W2的超过50％位于XZ平面的第二侧上。在另一个示例中，拐折区域44处的宽度W2的超过60％位于XZ平面的第二侧上。在另一个示例中，拐折区域44处的宽度W2的超过70％位于XZ平面的第二侧上。在另一个示例中，拐折区域44处的宽度W2的超过80％位于XZ平面的第二侧上。在另一个示例中，拐折区域44处的宽度W2的超过90％位于XZ平面的第二侧上。
在某些实例中，弯曲部分38具有倾斜或不平坦的弯曲外形。如图10所示，近侧区域和远侧区域40,42可位于距XZ平面不同的垂直距离处。例如，远侧区域42可被定位成比近侧区域40更远离XZ平面。这种设计为有利的，因为其允许刀10的钝的末端14向外或向侧面延伸或突出超过基部13，这提高了钝的末端14从基部13近侧的位置的可视性，如图9A所示。
在图10所示的实施方案中，远侧区域42以选自例如约10°至约80°的范围的角度α3而与中心线45相交。在一个实施方案中，角度α3可为选自例如约30°至约60°的范围的任何角度。在一个实施方案中，角度α3可为例如约40°。本公开设想到角度α3的其他值。
在一个示例中，近侧区域40和XZ平面之间的垂直距离为约0.045英寸，而远侧区域42和XZ平面之间的垂直距离为约0.075英寸。在此示例中，如图10所示，拐折区域44和XZ平面之间的垂直距离为约0.075英寸。
在某些实例中，近侧区域40和XZ平面之间的垂直距离为选自约0.030英寸至约0.080英寸的范围的任何距离。在某些实例中，近侧区域40和XZ平面之间的垂直距离为选自约0.050英寸至约0.060英寸的范围的任何距离。在某些实例中，远侧区域42和XZ平面之间的垂直距离为选自约0.050英寸至约0.100英寸的范围的任何距离。在某些实例中，远侧区域42和XZ平面之间的垂直距离为选自约0.070英寸至约0.080英寸的范围的任何距离。在某些实例中，拐折区域44和XZ平面之间的垂直距离为选自约0.050英寸至约0.100英寸的范围的任何距离。在某些实例中，拐折区域44和XZ平面之间的垂直距离为选自约0.070英寸至约0.080英寸的范围的任何距离。本公开设想到上述距离的其他值。
在某些实例中，近侧区域40和XZ平面之间的垂直距离与远侧区域42和XZ平面之间的垂直距离的比率为选自约四分之一至约四分之三的范围的任何值。在某些实例中，近侧区域40和XZ平面之间的垂直距离与远侧区域42和XZ平面之间的垂直距离的比率为选自约三分之一至约三分之二的范围的任何值。
与弯曲部分38的宽度一样，弯曲部分38的高度也可为渐缩的。如图9所示，弯曲部分38的高度可例如沿刀10的长度从弯曲部分38的近侧端部处的最大高度H1逐渐渐缩为钝的末端14处的最小高度H2。
在某些实例中，高度H1可为选自约0.070英寸至约0.110英寸的范围的任何高度。在某些实例中，高度H1可为选自约0.070英寸至约0.100英寸的范围的任何高度。在一个实例中，高度H1可为例如约0.090英寸。
在某些实例中，高度H2可为选自约0.040英寸至约0.070英寸的范围的任何高度。在某些实例中，高度H2可为选自约0.050英寸至约0.060英寸的范围的任何高度。在一个实例中，高度H2可为例如约0.054英寸。
在某些实例中，高度H2与高度H1的比率选自介于约0.2至约0.8之间的值的范围。在某些实例中，高度H2与高度H1的比率选自介于约0.3至约0.7之间的值的范围。在一个示例中，高度H2与高度H1的比率为约0.6。
主要参照图1、图13和图14，基部13可包括具有从组织处理表面20朝近侧延伸的平坦顶部区域50的大体圆柱形状。如图10所示，中心线45可延伸穿过圆柱形基部13的中心轴。刀10的弯曲部分38穿过中心线45，从而使得钝的末端14横向延伸或突出超过基部13，以提高钝的末端14从基部13近侧的位置的可视性，如图14所示。
刀10可包括一个或多个声学平衡特征部。该声学平衡特征部为刀10的被修改以声学地平衡刀10的主要部分。在某些实例中，声学平衡特征部可为刀10的被移除或刮削以声学地平衡刀10的部分。
主要参照图1、图15和图16，第一声学平衡特征部52被设置在刀10的第一侧上。第一声学平衡特征部52涵盖从基部13的远侧端部朝远侧延伸的区域。在图1所示的实施方案中，第一声学平衡特征部52具有与组织处理表面20、第一侧壁22和第一中间壁32相交的第一轮廓线54。
如图1所示，声学平衡特征部52的第一轮廓线54中断第一侧壁22和第一中间壁32朝基部13的近侧延伸。第一声学平衡特征部52的第二轮廓线56与第一组织切割表面26相交，如图1所示。轮廓线54和56可在远侧末端57处相交，如图1所示。
如图2最佳所示的，第一声学平衡特征部52的第一轮廓线54可中断组织处理表面20的第一轮廓线23的近侧延伸，从而减小或刮削组织处理表面20的宽度，以形成变窄的近侧区域27。由第一声学平衡特征部52引起的中断修改刀10的形状，以改善其对刀10的功能至关重要的声学平衡。
主要参照图6，刀10可包括第二声学平衡特征部60。如图6所示，第二声学平衡特征部60可在轮廓线62处与第二组织切割表面28相交。在图6所示的实施方案中，第二声学平衡特征部60包括终止于峰64处的大体弯曲形状。
再次参照图6，第三声学平衡特征部66可在轮廓线68处与第一组织切割表面26相交。与第二声学平衡特征部60一样，第三声学平衡特征部66可包括终止于峰70处的大体弯曲形状。在图6所示的实施方案中，第二声学平衡特征部60包括比第三声学平衡特征部66更大的曲率半径。在其他实施方案中，第三声学平衡特征部66包括比第二声学平衡特征部60更大的曲率半径。在其他实施方案中，第二声学平衡特征部60和第三声学平衡特征部66包括相同的或至少基本上相同的曲率半径。
主要参照图7，第四声学平衡特征部72从第二声学平衡特征部60和第三声学平衡特征部66进一步朝近侧延伸。第四声学平衡特征部72包括第一轮廓线74，该第一轮廓线包括弯曲形状并且大体从峰64延伸到峰70，如图7最佳所示的。另外，第四声学平衡特征部72包括与第二声学平衡特征部60相交的第二轮廓线76和与第三声学平衡特征部66相交的第三轮廓线78。
在图7所示的实施方案中，轮廓线76,78在切割刃30的近侧端部33处彼此相交。此外，轮廓线62和68也可在切割刃30的近侧端部处彼此相交，如图7所示。
在一个实施方案中，可采用传输到压靠切割刃30的组织的超声能量来切断组织。在此类实施方案中，刀10可由操作者操纵，以紧贴组织来定位切割刃30。然后，可通过切割刃30将超声能量传输到组织，从而使得组织被切断或切割。
如图7最佳所示的，第一组织切割表面26从限定第三声学平衡特征部66的远侧周边的轮廓线68朝远侧延伸。以类似的方式，第二组织切割表面28从限定第二声学平衡特征部60的远侧周边的轮廓线62朝远侧延伸。在图7所示的实施方案中，切割表面26,28彼此并排沿大体弯曲的路径朝远侧延伸，从而在它们之间限定用于产生切割刃30的大体弯曲的轮廓线。
读者将会理解，切割表面26,28之间的角度可至少部分地确定切割刃30的锋利度。在某些实例中，切割表面26,28之间的角度可沿切割刃30的长度为相同的或基本上相同的。另选地，切割表面26,28之间的角度可沿切割刃30的长度或至少一部分长度改变。因此，切割刃30的锋利度可沿切割刃30的长度或至少一部分长度改变。在一个实施方案中，切割刃30的近侧部分可能比切割刃30的远侧部分更锋利。另选地，切割刃30的远侧部分可能比切割刃30的近侧部分更锋利。
切割表面26,28之间的一个或多个角度可选自约10°至约175°的范围。在一个实施方案中，切割表面26,28之间的一个或多个角度可选自约80°至约170°的范围。在一个实施方案中，切割表面26,28之间的一个或多个角度可选自约110°至约160°的范围。在一个实施方案中，切割表面26,28之间的一个或多个角度可选自约120°至约150°的范围。本公开设想到切割表面26,28之间的一个或多个角度的其他值。
在一个实施方案中，主要参照图18，第一声学平衡特征部52的远侧端部部分处的切割表面26,28之间的角度α2可选自约85°至约120°的范围。在一个实例中，角度α2可为例如约110°。
主要参照图9A，其示出了刀10的一个实施方案的前视图。在图9A所示的实施方案中，刀10渐缩，使得切割刃30的近侧端部33比切割刃30的远侧端部35更远离由组织处理表面20限定的平面。换句话讲，切割刃30的近侧端部33与切割刃30的远侧端部35垂直地偏置。
此外，近侧端部33和远侧端部35位于XZ平面的相对两侧上。换句话讲，切割刃30的近侧端部33可与切割刃30的远侧端部35水平地偏置。图28、图29示出了沿XZ平面截取的刀10的纵向横截面。图28示出了包括切割刃30的远侧端部35的XZ平面的第一侧。图29示出了包括切割刃30的近侧端部35的XZ平面的第二侧。
在各种实例中，超声刀10可被结合到超声外科器械中。例如，超声刀10可被结合到包括夹持构件的超声外科器械中，该夹持构件可由超声外科器械的操作者控制，以将组织捕获在夹持构件和超声刀10之间，从而处理所捕获的组织。这些超声外科器械的示例及其操作机制在以下专利中有所绘示：于2014年7月31日提交的标题为“ACTUATION MECHANISMSAND LOAD ADJUSTMENT ASSEMBLIES FOR SURGICAL INSTRUMENTS”的美国专利申请第14/448,430号和于2012年6月29日提交的标题为“ULTRASONIC SURGICAL INSTRUMENTS WITHDISTALLY POSITIONED JAW ASSEMBLIES”的美国专利公布第2014/0005704A1号。
图32示出了适合与超声刀10一起使用的超声外科器械110的一个实施方案的右侧视图。在所示实施方案中，超声外科器械110可用于各种外科手术，包括内窥镜式或常规开放式外科手术。在一个示例性实施方案中，超声外科器械110包括从细长轴组件114朝近侧延伸的柄部组件112、以及从细长轴组件114朝远侧延伸的端部执行器组件126。超声传输波导178(图24)可延伸穿过或至少部分地延伸穿过细长轴组件114。超声传输波导178的远侧端部部分可声学地联接(例如，直接或间接机械地联接)到刀10。超声传输波导178的近侧端部部分可被接收在柄部组件12内，以声学地联接到超声换能器116。
柄部组件112包括触发器132、柄部133、远侧旋转组件113、和开关组件128。细长轴组件114包括端部执行器组件126和用于致动端部执行器组件126的致动元件。柄部组件112适于在近侧端部处接收超声换能器116。超声换能器116可机械地接合到细长轴组件114以及端部执行器组件126的一些部分。超声换能器116可经由缆线122而被电联接到发生器120。在某些实例中，发生器120可例如与柄部组件112整合在一起。合适的发生器为得自Ethicon Endo-Surgery,Inc.(Cincinnati,Ohio)的型号GEN11。
超声换能器116可将来自超声信号发生器120的电信号转换成机械能，该机械能主要产生超声换能器116和端部执行器组件126的刀10部分出现以超声频率进行纵向振动运动的声学驻波。
在各种实例中，可采用在刀10中产生的能量来切割和/或凝结组织。在一个实施方案中，通过高频振动(例如，每秒55,500次)，超声刀10可使组织中的蛋白变性，以形成粘性凝结物。
虽然大部分附图示出结合腹腔镜式外科手术使用的多端部执行器组件126，但是超声外科器械110可用于更多传统的开放式外科手术中，并且在其他实施方案中可被构造用于内窥镜式手术中。
在各种实施方案中，发生器20包括若干个功能性元件，诸如模块和/或区块。不同的功能性元件或模块可被构造成能够用于驱动不同种类的外科装置。例如，超声发生器模块121可驱动超声装置，诸如超声外科器械110。在一些示例性实施方案中，该发生器120还包括用于驱动电外科装置的电外科/射频发生器模块123。在图1所示的示例性实施方案中，该发生器120包括控制系统125。当由控制系统125启动时，该发生器120可提供能量，以驱动外科器械110的刀10。
参照图32，细长轴组件114包括适于机械地接合柄部组件112和远侧旋转组件113的近侧端部部分150和适于机械地接合端部执行器组件126的远侧端部部分152。细长轴组件114包括外部管状护套156和位于该外部管状护套156内的往复式管状致动构件158，如图23所示。
该管状往复式管状致动构件158的近侧端部机械地接合到柄部组件112的触发器132，以响应于触发器132的致动和/或释放而在方向60A或60B上运动。可以枢转方式运动的触发器132可生成沿纵向轴线“T”的往复式运动。此类运动可用于例如致动端部执行器组件126的端部执行器118。
该管状往复式管状致动构件158的远侧端部机械地接合到端部执行器118(图32)。在所示实施方案中，该管状往复式管状致动构件158的远侧端部机械地接合到能够围绕枢转点170枢转的夹持构件164，以响应于触发器132的致动和/或释放而打开和关闭夹持构件164。例如，在所示实施方案中，当朝柄部133挤压触发器132时，高夹持构件164能够围绕枢转点170在方向162A上从打开位置运动到闭合位置。当释放触发器132时，该夹持构件164能够围绕枢转点170在方向162B上从闭合位置运动到打开位置。
在闭合位置中，组织(诸如例如血管)可在刀10的组织处理表面20和端部执行器18的夹持构件164的组织抓持特征部163之间被捕获。组织处理表面20对所捕获的组织施加的压力可使血管塌陷，并且允许由施加超声能量而产生的凝结物形成止血密封。外科医生可通过由端部执行器18施加到组织的力、施加该力的时间、以及端部执行器18的所选择的偏移水平来控制切割速度和凝结。
以下专利的全部公开内容以引用方式并入本文：
于2014年7月31日提交的标题为“ACTUATION MECHANISMS AND LOAD ADJUSTMENTASSEMBLIES FOR SURGICAL INSTRUMENTS”的美国专利申请序列号14/448,430；和
于2012年6月29日提交的标题为“ULTRASONIC SURGICAL INSTRUMENTS WITHDISTALLY POSITIONED JAW ASSEMBLIES”的美国专利公布第2014/0005704A1号。
实施例
实施例1-一种外科器械，该外科器械包括超声换能器、从该超声换能器延伸的超声传输波导、和声学地联接到超声传输波导的超声刀。该超声刀包括基部和从该基部朝远侧延伸的弯曲主体。该弯曲主体包括(一)在弯曲主体的第一侧上延伸的组织处理表面、和(二)在弯曲主体的与第一侧相对的第二侧上延伸的弯曲边缘。该弯曲边缘包括近侧端部和远侧端部，其中该近侧端部在第一方向上与远侧端部偏置，其中该近侧端部在第二方向上与远侧端部偏置，并且其中该第一方向垂直于第二方向。
实施例2-根据实施例1所述的外科器械，还包括钝的末端，其中该钝的末端横向延伸超过基部。
实施例3-根据实施例2所述的外科器械，其中该组织处理表面在钝的末端近侧朝远侧端部渐缩。
实施例4-根据实施例1、2或3所述的外科器械，还包括夹持构件，该夹持构件能够相对于组织处理表面运动，以将组织捕获在夹持构件和组织处理表面之间。
实施例5-根据实施例1、2、3或4所述的外科器械，还包括与组织处理表面相交的第一声学平衡特征部。
实施例6-根据实施例5所述的外科器械，还包括在切割刃的近侧端部处相交的第二声学平衡特征部和第三声学平衡特征部。
实施例7-一种外科器械，该外科器械包括超声换能器、从该超声换能器延伸的超声传输波导、和声学地联接到超声传输波导的超声刀。该超声刀包括基部和从该基部朝远侧延伸的弯曲主体。该弯曲主体包括：组织处理表面；切割刃，其中组织处理表面和切割刃位于弯曲主体的相对两侧上；钝的末端，该钝的末端横向延伸超过基部；朝钝的末端逐渐渐缩的高度；以及朝钝的末端逐渐渐缩的宽度。
实施例8-根据实施例7所述的外科器械，还包括夹持构件，该夹持构件能够相对于组织处理表面运动，以将组织捕获在夹持构件和组织处理表面之间。
实施例9-根据实施例7或8所述的外科器械，其中该组织处理表面在钝的末端近侧朝远侧端部渐缩。
实施例10-根据实施例7、8或9所述的外科器械，还包括与组织处理表面相交的第一声学平衡特征部。
实施例11-根据实施例10所述的外科器械，还包括在切割刃的近侧端部处相交的第二声学平衡特征部和第三声学平衡特征部。
实施例12-一种外科器械，该外科器械包括超声换能器、从该超声换能器延伸的超声传输波导、和声学地联接到超声传输波导的超声刀。该超声刀包括基部和从该基部朝远侧延伸的弯曲部分。该弯曲部分包括第一面，该第一面包括组织处理表面、与该组织处理表面相交的第一侧壁、和与该组织处理表面相交的第二侧壁。该弯曲部分还包括第二面，其中该第一面和第二面位于弯曲部分的相对两侧上，并且其中该第二面包括与第一侧壁相交的第一中间壁、与第二侧壁相交的第二中间壁、和沿弯曲部分的长度朝远侧延伸的切割刃。该第二面还包括第一组织切割表面和第二组织切割表面，其中该第一组织切割表面在切割刃处与第二组织切割表面相交。
实施例13-根据实施例12所述的外科器械，还包括钝的末端，其中该钝的末端横向延伸超过基部。
实施例14-根据实施例13所述的外科器械，，其中该组织处理表面在钝的末端近侧朝远侧端部渐缩。
实施例15-根据实施例12、13或14所述的外科器械，还包括夹持构件，该夹持构件能够相对于组织处理表面运动，以将组织捕获在夹持构件和组织处理表面之间。
实施例16-根据实施例12、13、14或15所述的外科器械，还包括与组织处理表面相交的第一声学平衡特征部。
实施例17-根据实施例12、13、14、15或16所述的外科器械，还包括从第二组织切割表面朝近侧延伸的第二声学平衡特征部。
实施例18-根据实施例17所述的外科器械，还包括从第一组织切割表面朝近侧延伸的第三声学平衡特征部。
实施例19-根据实施例18所述的外科器械，还包括第四声学平衡特征部，其中该第二声学平衡特征部限定第一峰，其中该第三声学平衡特征部限定第二峰，并且其中该第四声学平衡特征部从第一峰和第二峰朝近侧延伸。
实施例20-根据实施例12、13、14、15、16、17、18或19所述的外科器械，其中该第一组织切割表面和第二组织切割表面在两者之间限定角度，其中该角度选自约85°至约120°的范围。
尽管本文已结合某些所公开的实施方案描述了装置的各种实施方案，但也可对这些实施方案实施许多修改和变型。另外，在公开了用于某些部件的材料的情况下，也可使用其他材料。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。
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为多次使用的。然而在任一种情况下，该装置均可在至少使用一次之后经过修复再次使用。修复可包括以下步骤中的任何组合：拆卸该装置、然后清洁或更换特定零件、并且随后进行组装。具体地，可拆卸该装置，并且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。在清洁和/或替换特定部件之后，可对装置进行重新组装，以便随后在修复设施处使用或紧在外科规程之前由手术团队使用。本领域的技术人员应当理解，修复装置可利用各种技术来进行拆卸、清洁/替换和重新组装。对此类技术的使用和所得的修复装置均在本专利申请的范围内。
仅以举例的方式，可在外科手术之前对本文所述的各个方面进行处理。首先，可获取新的或用过的器械，并且根据需要进行清洁。然后，可对器械进行消毒。在一种消毒技术中，将器械放置在闭合且密封的容器(例如塑料或TYVEK袋)中。然后可将容器和器械置于可穿透容器的辐射场诸如γ辐射、X射线或高能电子中。辐射可杀死器械上和容器中的细菌。经消毒的器械随后可被存放在无菌容器中。密封容器可将器械保持处于无菌状态，直到在医疗设施中被打开。还可利用本领域已知的任何其他技术来对装置进行消毒，该技术包括但不限于β或γ辐射、环氧乙烷、等离子体过氧化物或蒸汽。
尽管本发明已被描述为具有示例性设计，但本发明可在本公开的实质和范围内被进一步修改。因此，本专利申请旨在涵盖使用本发明的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述的现有定义、陈述或其他公开材料相冲突的程度下并入本文。因此，并且在必要的程度下，本文明确列出的公开内容代替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与现有的公开材料之间不产生冲突的程度下并入。

Claims (18)

1.一种外科器械，包括：
超声换能器；
从所述超声换能器延伸的超声传输波导；和
声学地联接到所述超声传输波导的超声刀，其中所述超声刀包括：
基部，其中纵向轴线穿过所述基部平行地延伸；和
从所述基部朝远侧延伸的弯曲主体，其中所述弯曲主体包括：
定位在所述基部处的近侧端部；
远侧端部；
在所述弯曲主体的第一侧上延伸的组织处理表面；
在所述弯曲主体的与所述第一侧相对的第二侧上延伸的弯曲边缘，所述弯曲边缘在所述近侧端部与所述远侧端部之间的第一点处弯曲远离所述纵向轴线，然后在所述第一点与所述远侧端部之间的第二点处朝所述纵向轴线弯曲，其中所述远侧端部相对于所述纵向轴线在第一方向上偏置，其中所述远侧端部相对于所述纵向轴线在第二方向上偏置，并且其中所述第一方向垂直于所述第二方向；和
钝的末端，所述钝的末端横向延伸超过所述基部，并且其中所述钝的末端相对于所述纵向轴线在所述第一方向和所述第二方向上偏置。
2.根据权利要求1所述的外科器械，其中所述组织处理表面在所述钝的末端近侧朝远侧端部渐缩。
3.根据权利要求1所述的外科器械，还包括夹持构件，所述夹持构件能够相对于所述组织处理表面运动，以将组织捕获在所述夹持构件和所述组织处理表面之间。
4.根据权利要求1所述的外科器械，还包括与所述组织处理表面相交的第一声学平衡特征部。
5.根据权利要求4所述的外科器械，还包括在所述近侧端部处相交的第二声学平衡特征部和第三声学平衡特征部。
6.一种外科器械，包括：
超声换能器；
从所述超声换能器延伸的超声传输波导；和
声学地联接到所述超声传输波导的超声刀，其中所述超声刀包括：
基部，其中纵向轴线穿过所述基部平行地延伸；和
从所述基部朝远侧延伸的弯曲主体，其中所述弯曲主体包括：
组织处理表面；
切割刃，其中所述组织处理表面和所述切割刃位于所述弯曲主体的相对两侧上，并且其中所述切割刃包括：
近侧端部；和
远侧端部，其中所述切割刃在所述近侧端部与所述远侧端部之间沿弯曲路径延伸，所述弯曲路径在所述近侧端部与所述远侧端部之间的第一点处弯曲远离所述纵向轴线，然后在所述第一点与所述远侧端部之间的第二点处朝所述纵向轴线弯曲；其中所述弯曲路径相对于所述纵向轴线在两个不同的方向上偏置；
横向延伸超过所述基部的钝的末端，其中所述钝的末端相对于所述纵向轴线在第一方向和第二方向上偏置，其中所述第一方向垂直于所述第二方向；
朝所述钝的末端逐渐渐缩的高度；和
朝所述钝的末端逐渐渐缩的宽度。
7.根据权利要求6所述的外科器械，还包括夹持构件，所述夹持构件能够相对于所述组织处理表面运动，以将组织捕获在所述夹持构件和所述组织处理表面之间。
8.根据权利要求6所述的外科器械，其中所述组织处理表面朝所述组织处理表面的远侧端部渐缩，其中所述组织处理表面的所述远侧端部在所述钝的末端的近侧。
9.根据权利要求6所述的外科器械，还包括与所述组织处理表面相交的第一声学平衡特征部。
10.根据权利要求9所述的外科器械，还包括在所述切割刃的所述近侧端部处相交的第二声学平衡特征部和第三声学平衡特征部。
11.一种外科器械，包括：
超声换能器；
从所述超声换能器延伸的超声传输波导；和
声学地联接到所述超声传输波导的超声刀，其中所述超声刀包括：
基部，其中纵向轴线穿过所述基部平行地延伸；
从所述基部朝远侧延伸的弯曲部分，其中所述弯曲部分包括：
第一面，所述第一面包括：
近侧端部，其中所述纵向轴线延伸穿过所述近侧端部；
远侧端部，其中所述远侧端部相对于所述纵向轴线在第一方向上偏置，其中所述远侧端部相对于所述纵向轴线在第二方向上偏置，并且其中所述第一方向垂直于所述第二方向；
组织处理表面；
与所述组织处理表面相交的第一侧壁；和
与所述组织处理表面相交的第二侧壁；和
第二面，其中所述第一面和所述第二面位于所述弯曲部分的相对两侧上，并且其中所述第二面包括：
与所述第一侧壁相交的第一中间壁；
与所述第二侧壁相交的第二中间壁；
沿所述弯曲部分的长度朝远侧延伸的切割刃，所述切割刃在所述基部与所述弯曲部分的远侧端部之间的第一点处弯曲远离所述纵向轴线，然后在所述第一点与所述弯曲部分的所述远侧端部之间的第二点处朝所述纵向轴线弯曲；
第一组织切割表面；和
第二组织切割表面，其中所述第一组织切割表面在所述切割刃处与所述第二组织切割表面相交；和
钝的末端，所述钝的末端横向延伸超过所述基部，并且其中所述钝的末端相对于所述纵向轴线在所述第一方向上和所述第二方向上偏置。
12.根据权利要求11所述的外科器械，其中所述组织处理表面在所述钝的末端近侧朝远侧端部渐缩。
13.根据权利要求11所述的外科器械，还包括夹持构件，所述夹持构件能够相对于所述组织处理表面运动，以将组织捕获在所述夹持构件和所述组织处理表面之间。
14.根据权利要求11所述的外科器械，还包括与所述组织处理表面相交的第一声学平衡特征部。
15.根据权利要求11所述的外科器械，还包括从所述第二组织切割表面朝近侧延伸的第二声学平衡特征部。
16.根据权利要求15所述的外科器械，还包括从所述第一组织切割表面朝近侧延伸的第三声学平衡特征部。
17.根据权利要求16所述的外科器械，还包括第四声学平衡特征部，其中所述第二声学平衡特征部限定第一峰，其中所述第三声学平衡特征部限定第二峰，并且其中所述第四声学平衡特征部从所述第一峰和所述第二峰朝近侧延伸。
18.根据权利要求11所述的外科器械，其中所述第一组织切割表面和所述第二组织切割表面在两者之间限定角度，其中所述角度选自85°至120°的范围。
CN201680035374.4A 2015-06-17 2016-06-06 与超声外科器械一起使用的超声外科刀 Active CN107750141B (zh)

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