CN107753078B - 具有铰接式砧座保持器组件的圆形吻合装置 - Google Patents
具有铰接式砧座保持器组件的圆形吻合装置 Download PDFInfo
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Abstract
一种圆形吻合装置包含手柄组件、从所述手柄组件向远侧延伸的细长主体部分、支撑在所述细长主体部分的远端上的壳层组件、延伸穿过所述壳层组件的砧座保持器组件，以及支撑在所述砧座保持器组件上的砧座组件。所述砧座保持器组件包括包含保持器主体的保持器部件以及可枢转地支撑在所述保持器主体上的接合部件。所述接合部件可相对于所述保持器主体从回缩位置轴向移动到前移位置，以将所述接合部件相对于所述保持器主体从锁定位置移动到解锁位置。在所述解锁位置，所述接合部件可相对于所述保持器主体从非铰接位置移动到铰接位置。
Description
相关申请的交叉引用
本申请要求提交于2016年8月15日的第62/375,176号美国临时专利申请的利益和优先权，其全文公开以参见的方式合并于此。
技术领域
本公开是针对吻合装置，且更确切地说，是针对具有铰接式砧座保持器组件的圆形吻合装置。
背景技术
用于执行圆形吻合手术的圆形吻合装置是已知的。通常，圆形吻合装置包含手柄组件、从手柄组件向远侧延伸的细长轴杆、支撑在所述细长轴杆的远端上的壳层组件，以及相对于所述壳层组件可移动地支撑的砧座组件。所述砧座组件以可移除方式支撑在刚性砧座保持器上，所述刚性砧座保持器延伸穿过壳层组件且可相对于壳层组件移动，以使所述砧座组件相对于所述壳层组件在隔开位置与接近位置之间移动。
圆形吻合装置常用以在吻合手术期间将两个横切的体腔区段附接在一起或例如在痔疮切除手术或粘膜切除手术期间处理体腔内壁上的组织。在此类手术期间，砧座组件通常独立于吻合装置的主体递送到手术部位，且在体腔内附接到手术部位处的砧座保持器。归因于砧座保持器的刚性以及吻合装置所位于的受限空间，砧座组件到砧座保持器的附接可能是困难的。
因此，吻合技术中存在对于圆形吻合装置的持续的需要，所述圆形吻合装置包含的结构促进砧座组件到吻合装置的砧座保持器在受限空间中的简化附接。
发明内容
在本公开的一个方面中，一种外科吻合装置包含：手柄组件；细长主体部分，其从所述手柄组件向远侧延伸；壳层组件，其支撑在所述细长主体部分的远端上；以及砧座保持器组件，其延伸穿过所述壳层组件。所述砧座保持器组件包括包含保持器主体的保持器部件以及接合部件。所述接合部件可枢转地支撑在所述保持器主体的远侧部分上，且支撑砧座组件。
在诸实施例中，所述保持器主体包含远侧部分，所述远侧部分具有包含隔开的指形件的U形夹，且所述接合部件包含近侧延伸部，其中所述接合部件的所述近侧延伸部定位于所述保持器主体的U形夹的隔开的指形件之间。
在一些实施例中，所述近侧延伸部限定狭槽，且所述U形夹的所述隔开的指形件中的每一个限定贯穿孔。
在某些实施例中，所述外科吻合装置包含U形夹销钉，所述U形夹销钉定位成穿过所述贯穿孔和所述狭槽，以将所述接合部件可枢转地紧固到所述保持器主体。
在诸实施例中，所述狭槽是细长的，以促进所述接合部件相对于所述保持器主体在前移位置与回缩位置之间的轴向移动。
在一些实施例中，偏置部件定位成朝向所述回缩位置推动所述接合部件。
在某些实施例中，所述U形夹的所述隔开的指形件中的至少一个包含锥形末端，且所述接合部件的所述近侧延伸部限定至少一个凹部。所述至少一个指形件的所述锥形末端定位成在所述接合部件处于所述回缩位置时收纳在所述接合部件的至少一个凹部中，以防止所述接合部件相对于所述保持器主体的枢转移动。
在诸实施例中，所述至少一个隔开的指形件的所述锥形末端以及所述至少一个凹部定位成和构造成使得在所述接合部件移动到所述前移位置时，所述至少一个指形件的所述锥形末端从所述至少一个凹部移除，以允许所述接合部件相对于所述保持器主体的枢转移动。
在一些实施例中，所述隔开的指形件中的每一个包含锥形末端，且所述至少一个凹部包含两个凹部。
在某些实施例中，所述接合部件包含两个台肩，所述台肩中的每一个限定所述两个凹部中的一个。
在诸实施例中，所述外科吻合装置包含限定管腔的外壳，且所述保持器部件可移动地支撑在所述外壳的所述管腔内。
在一些实施例中，所述管腔尺寸设定成使所述接合部件从相对于所述保持器主体的枢转位置移动到相对于所述保持器主体的非枢转位置。
在某些实施例中，所述砧座保持器组件包含带螺纹驱动螺杆，且所述保持器部件限定螺纹孔。所述带螺纹的驱动螺杆可旋转地收纳在所述螺纹孔内，以使所述保持器部件在所述外壳内轴向移动。
在本公开的另一方面中，一种将外科吻合装置的砧座组件附接到所述外科吻合装置的砧座保持器组件的方法，其中所述砧座保持器组件包含具有保持器主体的保持器部件以及可枢转地支撑在所述保持器主体上的接合部件，包含：将砧座组件定位在手术部位处；将所述砧座保持器组件独立于所述砧座组件而定位在所述手术部位处；将所述接合部件枢转到相对于所述保持器部件的枢转位置；以及将所述砧座组件紧固到所述砧座保持器组件。
在诸实施例中，所述方法进一步包含将所述砧座保持器组件回缩到外壳的管腔内，以使所述接合部件从所述枢转位置移动到相对于所述保持器部件的非枢转位置。
在诸实施例中，所述方法进一步包含将所述接合部件从回缩位置移动到相对于所述保持器部件的前移位置，以解锁所述接合部件的枢转移动。
在诸实施例中，将所述砧座保持器组件回缩到外壳的管腔内包含致动驱动螺杆。
附图说明
本文中参考附图描述当前公开的包含铰接式砧座保持器组件的圆形吻合装置的各种实施例，其中：
图1为当前公开的圆形吻合装置的示范性实施例的侧视透视图；
图2为图1中所示的所指示区域的细节放大视图；
图3为图1中所示的圆形吻合装置的远端的侧视透视图，其中砧座组件与砧座保持器组件分离；
图3A为沿图3的截面线3A-3A截取的横截面图；
图4为图1中所示的圆形吻合装置的砧座保持器组件的侧视透视图；
图5为图4中所示的砧座保持器组件的侧视透视分解图；
图6为图5中所示的保持器部件的分解图；
图7为处于非铰接、锁定位置的图6中所示的保持器部件的远端的侧视透视图；
图8为沿图7的截面线8-8截取的横截面图；
图9为处于非铰接、解锁位置的图6中所示的保持器部件的远端的侧视透视图；
图10为沿图9的截面线10-10截取的横截面图；
图11为处于铰接、解锁位置的图6中所示的保持器部件的远端的从近端看的侧视透视图；
图12为处于铰接、解锁位置的图6中所示的保持器部件的远端的从远端看的侧视透视图；以及
图13为沿图11的截面线13-13截取的横截面图。
具体实施方式
现将参考附图详细描述当前公开的圆形吻合装置，在附图中，相同附图标记指代若干视图中的每个视图的相同或对应元件。在此描述中，术语“近侧”大体用来指代装置的较接近于临床医生的部分，而术语“远侧”大体用来指代装置的距临床医生较远的部分。此外，术语“内窥镜”大体用来指代内窥镜、腹腔镜、关节镜，以及通过小切口或插入到患者身体内的插管执行的任何其它外科手术。最后，术语“临床医生”大体用来指代医务人员，包含医生、护士和辅助人员。
当前公开的圆形吻合装置包含手柄组件、从所述手柄组件向远侧延伸的细长主体部分、支撑在所述细长主体部分的远端上的壳层组件、延伸穿过所述壳层组件的砧座保持器组件，以及支撑在所述砧座保持器组件上的砧座组件。所述砧座保持器组件包括包含保持器主体的保持器部件以及可枢转地支撑在所述保持器主体上的接合部件。所述保持器主体具有远端，所述远端构造成接合所述接合部件的近端以将所述接合部件相对于所述保持器主体保持在锁定、非铰接或非枢转位置。所述接合部件可相对于所述保持器主体从回缩位置轴向移动到前移位置，以将所述接合部件移动到解锁位置。在所述解锁位置中，所述接合部件可相对于所述保持器主体从非铰接位置移动到铰接位置。所述接合部件在将所述砧座组件在不容易操纵吻合装置的受限位置附接到所述吻合装置的主体期间可以枢转，以简化砧座组件到砧座保持器组件的附接。
图1到3图示外科吻合装置10，其包含手柄组件12、细长主体14、壳层组件16、砧座保持器组件18，以及支撑在砧座保持器组件18上的砧座组件20。手柄组件12图示为电动组件，且包含静止握把22以及用于控制吻合器功能操作的致动按钮24，包含使壳层组件16与砧座组件20接近以及从壳层组件16发射吻合钉(未示出)。细长主体14图示为接头组件，其联接到手柄组件12以将电力从手柄组件传递到壳层组件16和砧座组件20。尽管本公开图示电动组件，但据设想，如以下详细描述的本公开的优势还适用于具有手动操作手柄和主体组件的外科吻合装置。第7,303,106号美国专利(“'106专利”)公开了包含手动致动手柄组件的外科吻合装置的实例，且以参见全文的方式并入本文中。第9,023,014号美国专利(“'014专利”)和第9,055,943号美国专利(“'943专利”)公开了包含示范性电动手柄组件的外科吻合装置的实例。这些专利中的每一个以参见全文的方式并入本文中。
参考图2和3，砧座组件20包含砧座头部26和砧座轴杆28。在图示的实施例中，砧座轴杆28包含限定孔(未示出)的多个弹性指形件30，所述孔构造成收纳且以可移除方式接合砧座保持器组件18，如下文更详细地描述。在诸实施例中，砧座头部26可枢转地联接到砧座轴杆28，且可在用于形成吻合钉的操作位置(图1)与倾斜的轮廓减小位置(未示出)之间移动。关于包含具有弹性指形件的砧座轴杆和枢转的砧座头部的砧座组件的更详细描述，参见'106专利。
壳层组件16支撑在细长主体14的远端上，且包含限定若干行环形吻合钉收纳凹穴34的环形钉仓32。吻合钉收纳凹穴34中的每一个支撑吻合钉(未示出)，所述吻合钉可以经由手柄组件12的致动而从钉仓32发射且抵抗砧座头部26而变形。壳层组件18还包含设置成同时分别射出吻合钉与解剖组织的推动器(未示出)和环形刀具33。对于适合于与外科吻合装置10一起使用的壳层组件的更详细描述，参见'106、'014和'943专利。
参考图3A到5，外科吻合装置10的砧座保持器组件18包含限定管腔122a的外部壳体122、限定螺纹孔124a(图3A)的保持器部件124(可移动地安置于外部壳体122的管腔122a内)，以及收纳在保持器部件124的螺纹孔124a内的驱动螺杆126。驱动螺杆126包含与沿着螺纹孔124a形成的内部螺纹配合的外部螺纹126a(图3A)。在驱动螺杆126响应于外科吻合装置10的手柄组件12的致动而旋转时，驱动螺杆126与保持器部件124之间的接合实现保持器部件124相对于外部壳体122的轴向移动。保持器部件124包含纵向延伸的平板124b。平板124b接合纵向延伸的平板122b，所述平板122b限定管腔122a以防止保持器部件124在管腔122a内旋转。保持器部件124的远侧部分构造成以可移除方式接合砧座组件20(图1)，如下文进一步详细地描述。砧座保持器组件18还包含定位成相对于砧座保持器组件18的外壳122可旋转地支撑驱动螺杆126的远侧轴承组件128a和近侧轴承组件128b。尽管保持器部件124图示且描述为由可旋转驱动螺杆驱动，但据设想，保持器部件124可以紧固到手动驱动带，例如在'106专利中所描述。
参考图6，保持器部件124包含保持器主体130以及可枢转地紧固到保持器主体130的远侧部分的接合部件132。保持器主体130的远侧部分包括包含一对隔开的指形件142的U形夹140。指形件142中的每一个限定贯穿孔144且限定锥形远端146。贯穿孔144尺寸设定成收纳U形夹销钉148，如下文详细地描述。接合部件132的近侧部分包含限定细长狭槽152和一对台肩154(图7)的近侧延伸部150。近侧延伸部150构造成被收纳在U形夹140的指形件142之间，使得贯穿孔144与细长狭槽152对准。U形夹销钉148定位成穿过贯穿孔144和细长狭槽152，以将接合部件132可枢转地紧固到保持器主体130的远端。贯穿孔144的尺寸设定成以紧密的摩擦配合方式收纳U形夹销钉148。保持器部件132的细长狭槽152的长度大于U形夹销钉148的直径，使得接合部件132可相对于保持器主体130从回缩位置(图7)轴向移动到前移位置(图9)。
还参考图7到10，接合部件132的近端上的每一台肩154限定凹部156，所述凹部的尺寸设定成且构造成收纳U形夹140的指形件142中的相应指形件的锥形远端146。在接合部件132处于回缩位置(图7)时，指形件142的锥形远端146收纳在凹部156中，以防止接合部件132相对于保持器主体130的枢转移动，即铰接。在接合部件132处于前移位置(图9)时，指形件142的锥形远端146与凹部156隔开，以允许接合部件132相对于保持器主体130铰接。
接合部件132限定纵向孔160(图8)，所述纵向孔延伸穿过接合部件132的近端以与细长狭槽152连通。纵向孔160尺寸设定成且构造成容纳偏置部件162。端帽164围封纵向孔160的近端。在诸实施例中，端帽164利用螺纹(未示出)紧固在纵向孔160内。或者，端帽164使用例如熔接等任何已知固定技术紧固在纵向孔160内。偏置部件162定位于端帽164与U形夹销钉148之间，以将接合部件132推动到如图7中所示的回缩位置。在回缩位置，U形夹销钉148定位在接合部件132的细长狭槽152的远端中。在将接合部件132相对于保持器主体130向远侧拉动时，偏置部件162在端帽164与U形夹销钉148(图10)之间被压缩，且接合部件132相对于保持器主体移动到前移位置。
还参考图11到13，在接合部件132处于前移位置时，所述接合部件可以绕着U形夹销钉148从接合部件132的纵向轴线与保持器主体130的纵向轴线对准的位置(图7)做关节运动到接合部件132的纵向轴线与保持器主体130的纵向轴线不对准的位置。在诸实施例中，台肩154构造成且定位成接合保持器主体130的远端170，以限制接合部件132的枢转移动，从而将接合部件132的纵向轴线与保持器主体130的纵向轴线之间的角度限定为约90度。或者，台肩154可以定位成接合保持器主体130的远端，以将接合部件132相对于保持器主体130的枢转移动限制于其它铰接程度，例如，小于三十度。
在诸实施例中，接合部件132被构造为具有构造成刺穿组织或缝合线的锥形尖端的套管针，且砧座轴杆28(图3)构造成限定孔(未示出)，所述孔尺寸设定成收纳接合部件132，从而将砧座组件20以可移除方式联接到砧座保持器组件18。可以预见，砧座轴杆可以构造为套管针，且砧座保持器可以限定构造成收纳砧座组件且将砧座组件以可移除方式联接到砧座保持器的孔。关于接合部件132以及砧座组件与砧座保持器之间的联接接合的更详细描述，参见'106专利。
在外科吻合装置10的砧座组件20和细长主体14定位在手术部位(未示出)处，使得砧座组件20的砧座轴杆28与砧座保持器组件18的保持器部件124的对准由于限定手术部位的空间受限而难以实现时，可以由临床医生使用例如抓钳或其它手术器械抓持保持器部件124的接合部件132，以将接合部件132从回缩位置(图8)移动到前移位置(图10)。如上文所论述，在接合部件132从回缩位置移动到前移位置时，形成于接合部件132的台肩154中的凹部156相对于指形件142的锥形远端146向远侧移动，以将指形件142的锥形远端146从凹部156移除，从而解锁接合部件132相对于保持器部件130的枢转移动以促进铰接。
所属领域的技术人员将理解，在本文中具体描述且在附图中图示的装置和方法是非限制性示范性实施例。可以预见，结合一个示范性实施例所图示或描述的元件和特征可以与另一实施例的元件和特征组合，而不脱离本公开的范围。所属领域的技术人员还将基于上述实施例了解本公开的其它特征和优势。因此，本公开不受已特定示出且描述的内容限制，如由所附权利要求书指示者除外。
Claims (8)
1.一种外科吻合装置，包括：
手柄组件；
细长主体部分，其从所述手柄组件向远侧延伸；
壳层组件，其支撑在所述细长主体部分的远端上；
延伸穿过所述壳层组件的砧座保持器组件，所述砧座保持器组件包括保持器部件以及接合部件，所述保持器部件包含限定第一纵向轴线的保持器主体，所述接合部件限定第二纵向轴线，从所述壳层组件向远侧延伸，可枢转地支撑在所述保持器主体的远侧部分上，并且能够从所述第一纵向轴线与所述第二纵向轴线对准的第一位置移动至所述第一纵向轴线与所述第二纵向轴线不对准的第二位置；以及
砧座组件，其包括砧座轴杆和砧座头部，所述砧座组件以可移除方式联接到所述砧座保持器组件的所述接合部件，其中
所述保持器主体包含具有U形夹的远侧部分，且所述接合部件包含近侧延伸部，所述U形夹包含隔开的指形件，所述接合部件的近侧延伸部定位于所述保持器主体的U形夹的隔开的指形件之间；
所述近侧延伸部限定狭槽，且所述U形夹的所述隔开的指形件中的每一个限定贯穿孔，且进一步包含U形夹销钉，所述U形夹销钉定位成穿过所述贯穿孔和所述狭槽，以将所述接合部件可枢转地紧固到所述保持器主体；并且
所述狭槽是细长的，以促进所述接合部件相对于所述保持器主体在前移位置与回缩位置之间的轴向移动。
2.根据权利要求1所述的外科吻合装置，进一步包含定位成朝向所述回缩位置推动所述接合部件的偏置部件。
3.根据权利要求2所述的外科吻合装置，其中所述U形夹的所述隔开的指形件中的至少一个包含锥形末端，且所述接合部件的所述近侧延伸部限定至少一个凹部，所述至少一个指形件的所述锥形末端定位成在所述接合部件处于所述回缩位置时收纳在所述接合部件的所述至少一个凹部中，以防止所述接合部件相对于所述保持器主体的枢转移动。
4.根据权利要求3所述的外科吻合装置，其中所述至少一个隔开的指形件的锥形末端以及所述至少一个凹部定位成和构造成使得在所述接合部件移动到所述前移位置时，所述至少一个指形件的所述锥形末端从所述至少一个凹部移除，以允许所述接合部件相对于所述保持器主体的枢转移动。
5.根据权利要求4所述的外科吻合装置，其中所述隔开的指形件中的每一个包含锥形末端，且所述至少一个凹部包含两个凹部。
6.根据权利要求5所述的外科吻合装置，其中所述接合部件包含两个台肩，所述台肩中的每一个限定所述两个凹部中的一个。
7.根据权利要求1所述的外科吻合装置，进一步包含限定管腔的外壳，其中所述保持器部件可移动地支撑在所述外壳的所述管腔内，所述管腔尺寸设定成使所述接合部件从相对于所述保持器主体的枢转位置移动到相对于所述保持器主体的非枢转位置。
8.根据权利要求7所述的外科吻合装置，其中所述砧座保持器组件包含带螺纹驱动螺杆，且所述保持器部件限定螺纹孔，所述驱动螺杆可旋转地收纳在所述螺纹孔内，以使所述保持器部件在所述外壳内轴向移动。
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2022
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Also Published As
| Publication number | Publication date |
|---|---|
| EP3284415A1 (en) | 2018-02-21 |
| CN107753078A (zh) | 2018-03-06 |
| US20180042606A1 (en) | 2018-02-15 |
| EP3284415B1 (en) | 2020-04-15 |
| US11944294B2 (en) | 2024-04-02 |
| US20230012329A1 (en) | 2023-01-12 |
| US11452522B2 (en) | 2022-09-27 |
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