CN107847242B - 用于使用屏蔽型腹腔镜式胆囊切除术解剖器进行密封的可平移外管 - Google Patents

用于使用屏蔽型腹腔镜式胆囊切除术解剖器进行密封的可平移外管 Download PDF

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CN107847242B
CN107847242B CN201680038980.1A CN201680038980A CN107847242B CN 107847242 B CN107847242 B CN 107847242B CN 201680038980 A CN201680038980 A CN 201680038980A CN 107847242 B CN107847242 B CN 107847242B
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blade
end effector
friction surface
ultrasonic
high friction
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CN107847242A (zh
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S·P·康伦
J·B·舒尔特
T·C·加尔迈耶
K·G·登津格
J·T·柯克
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Ethicon LLC
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A—HUMAN NECESSITIES
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
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    • A61B2017/00845—Material properties low friction of moving parts with respect to each other
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
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    • A61B2017/00858—Material properties high friction, non-slip
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/2812—Surgical forceps with a single pivotal connection
    • A61B17/282—Jaws
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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
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    • A—HUMAN NECESSITIES
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    • 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
    • A61B2017/320072—Working tips with special features, e.g. extending parts
    • A61B2017/320078—Tissue manipulating surface
    • 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
    • A61B2017/320082—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic for incising tissue
    • 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
    • A61B2017/320089—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic node location
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    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00589—Coagulation
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    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00607—Coagulation and cutting with the same instrument

Abstract

针对用于切割和密封组织的外科器械来呈现本公开的各方面。在一些实施方案中，所述外科器械包括柄部组件、轴和端部执行器。所述端部执行器可包括：刀片，所述刀片以超声频率振动；屏蔽部分，所述屏蔽部分包封所述刀片的后边缘；高摩擦表面，所述高摩擦表面联接到所述屏蔽部分并且定位在所述屏蔽部分与所述刀片的所述后边缘之间。在所述端部执行器处于切割构型时，在所述高摩擦表面和所述刀片的所述后边缘之间限定空间。在密封构型时，所述高摩擦表面接触所述刀片的所述后边缘，这基于所述刀片与所述高摩擦表面摩擦而形成的超声振动来生成热量。所述屏蔽部分可基于所述高摩擦表面到所述屏蔽部分的热传递来凝聚出血组织。

Description

用于使用屏蔽型腹腔镜式胆囊切除术解剖器进行密封的可平 移外管
技术领域
本公开整体涉及具有用于切割和密封组织的各种机构的医疗装置。具体地讲，本公开涉及具有可平移外管的医疗装置，所述可平移外管用于使用适于执行腹腔镜式胆囊切除术的屏蔽型解剖器进行密封。
背景技术
在执行胆囊切除术时，如果可行的话，优选在腹腔镜下进行操作，而不是执行开腹手术。执行腹腔镜式胆囊切除术虽然侵入性较小，对患者的潜在伤害较小，但却为外科医生带来了另外的挑战。一般来讲，希望为外科医生提供用于最佳地执行涉及各种组织的解剖和/或去除的腹腔镜式手术，同时还要防止出现任何潜在的不希望的出血的器械。
尽管已经制造和使用了若干装置，但据信在本发明的发明人之前还无人制造出或使用所附权利要求中描述的装置。
发明内容
在一些实施方案中，提供了外科器械的端部执行器。
1.在一个示例中，端部执行器可包括：刀片，该刀片具有被构造成能够解剖和凝聚组织的切割边缘以及后边缘，该刀片被构造成能够联接到超声波导并且被构造成能够以超声频率振动从而解剖和凝聚组织；屏蔽部分，该屏蔽部分包封刀片的后边缘；高摩擦表面，该高摩擦表面联接到屏蔽部分并且定位在屏蔽部分和刀片的后边缘之间，其中在端部执行器被构造成解剖构型时，在高摩擦表面和刀片的后边缘之间限定空间；其中，在端部执行器被构造成密封构型时，高摩擦表面接触刀片的后边缘并且被构造成能够通过使刀片的超声振动摩擦地耦合到高摩擦表面来生成热量，并且其中屏蔽部分被构造成能够通过使来自高摩擦表面的热量耦合到组织来凝聚组织。
2.在另一示例中，端部执行器还包括至少一个低摩擦表面，该至少一个低摩擦表面联接到屏蔽部分并且定位在刀片的侧向边缘旁边，低摩擦表面被构造成能够允许刀片在基于刀片的侧向移动而接触低摩擦表面时发生超声振动。
3.在端部执行器的另一示例中，轴还包括支点部件，该支点部件被构造成能够联接到定位于轴内的超声波导。
4.在端部执行器的另一示例中，支点基于超声振动的频率而定位在节点处。
5.在另一示例中，端部执行器还包括防护罩，该防护罩联接到屏蔽部分并且覆盖刀片的远侧端部的至少一部分。
6.在另一示例中，端部执行器还包括凹陷部，该凹陷部凹进屏蔽部分的近侧端部中并且被构造成能够在对屏蔽部分的与刀片的位置相反的一侧施加力时，使屏蔽部分柔性地弯曲。
7.在另一示例中，端部执行器还包括滑动机构，该滑动机构被构造成能够使屏蔽部分和刀片滑入和滑出端部执行器。
8.在端部执行器的另一示例中，屏蔽部分还被构造成能够围绕刀片旋转，使得高摩擦表面被构造成能够在第一旋转构型时接触刀片的后边缘并且高摩擦表面被构造成能够在第二旋转构型时接触刀片的切割边缘。
9.在一些实施方案中，提出了一种外科器械。该外科器械包括：柄部组件；超声换能器，该超声换能器被构造成能够产生超声振动；轴，该轴联接到柄部组件；以及端部执行器。轴包括：超声波导，该超声波导联接到超声换能器并且被构造成能够以超声频率振动；以及可滑动杠杆，该可滑动杠杆被构造成能够在轴内来回滑动。端部执行器包括：刀片，该刀片具有被构造成能够切割组织的切割边缘以及后边缘，该刀片联接到超声波导并且被构造成能够以超声频率振动从而切割组织；以及加热垫，该加热垫包括高摩擦表面，该高摩擦表面包封刀片或超声波导的一部分并且联接到可滑动杠杆。在端部执行器被构造成切割构型时，在高摩擦表面和刀片或超声波导之间限定空间。在端部执行器被构造成密封构型时，可滑动杠杆被构造成能够朝向柄部组件朝近侧滑动，致使高摩擦表面接触刀片或超声波导。高摩擦表面被构造成能够通过使由于刀片或超声波导接触高摩擦表面而形成的超声振动摩擦地耦合来生成热量，并且其中刀片的后边缘被构造成能够基于从高摩擦表面到后边缘的热传递来凝聚组织。
10.在外科器械的另一示例中，柄部组件还包括电源按钮，该电源按钮被构造成能够控制密封构型的持续时间，限制高摩擦表面经由刀片或超声波导的超声振动而生成热量的时间量。
11.在外科器械的另一示例中，电源按钮以能够通信的方式联接到可滑动杠杆并且还被构造成能够在按下电源按钮时，使可滑动杠杆朝向柄部组件朝近侧滑动。
12.在外科器械的另一示例中，柄部组件还包括：启用滑动件，该启用滑动件联接到电源按钮并且被构造成能够在按下电源按钮时，垂直于电源按钮的方向朝近侧滑动；启用磁体，该启用磁体联接到启用端部；处理器；以及传感器，该传感器以能够通信的方式联接到处理器并且定位在启用磁体附近。在启用滑动件基于电源按钮被按下而朝近侧滑动时，启用磁体被构造成能够充分接近传感器移动以启用传感器并且致使传感器触发处理器中的定时程序，该定时程序限制高摩擦表面生成热量的时间量。
13.在外科器械的另一示例中，柄部组件包括第二按钮，该第二按钮以能够通信的方式联接到可滑动杠杆并且被构造成能够在按下电源按钮时，使可滑动杠杆滑动。
14.在外科器械的另一示例中，轴还包括支点部件，该支点部件联接到超声波导并且定位在轴内，其中超声波导通过支点在柄部组件的远侧端部处紧固在轴内并以其他方式悬浮在轴内。
15.在外科器械的另一示例中，支点基于超声波导的超声振动的频率而定位在与柄部组件相距与谐波节点相等的距离处。
16.在外科器械的另一示例中，柄部组件还包括滑动机构。可滑动杠杆在可滑动杠杆的近侧端部上联接到滑动机构并且在可滑动杠杆的远侧端部上联接到屏蔽部分。屏蔽部分的近侧端部经由可旋转铰链而在刀片的近侧端部处紧固到基部。屏蔽部分被构造成能够基于经由可滑动杠杆对滑动机构的操纵和由可旋转铰链的紧固引起的枢转来控制。
17.在一些实施方案中，提出了第二外科器械。该第二外科器械包括：柄部组件；超声换能器；轴，该轴联接到柄部组件，该轴包括：超声波导，该超声波导被构造成能够以超声频率振动；以及可旋转内管，该可旋转内管被构造成能够在轴内旋转；以及端部执行器。端部执行器包括：刀片，该刀片具有被构造成能够切割组织的切割边缘以及后边缘，该刀片联接到超声波导并且被构造成能够以超声频率振动从而切割组织；可旋转构件，该可旋转构件联接到可旋转内管；屏蔽部分，该屏蔽部分联接到可旋转构件并且包封刀片的后边缘；高摩擦表面，该高摩擦表面联接到屏蔽部分并且定位在屏蔽部分和刀片的后边缘之间。在端部执行器在切割构型时，在高摩擦表面和刀片的后边缘之间存在空间。在端部执行器被构造成密封构型时，屏蔽部分基于可旋转内管的旋转而旋转到刀片上，使得高摩擦表面接触刀片的后边缘并且被构造成能够基于刀片与高摩擦表面摩擦而形成的超声振动来生成热量，并且其中屏蔽部分被构造成能够基于从高摩擦表面到屏蔽部分的热传递来凝聚组织。
18.在第二外科装置的另一示例中，端部执行器被构造成能够在端部执行器被构造成密封构型时滑入和滑出套管针，并且端部执行器被构造成能够在端部执行器被构造成切割构型时，基于可旋转构件旋转到端部执行器的形状之外而不滑入或滑出套管针。
19.在第二外科装置的另一示例中，可旋转内管包括凸轮，该凸轮定位在可旋转内管的远侧端部处；并且可旋转构件包括旋钮，该旋钮定位在可旋转构件的近侧端部处，使得旋钮紧固到可旋转内管的凸轮中。
20.在第二外科装置的另一示例中，可旋转构件包括定位在可旋转构件的外边缘处的轴杆，其中轴杆联接到附连到端部执行器的外边缘的锚订件，使得可旋转构件被构造成能够使用轴杆的位置作为可旋转构件的中心旋转轴线而基于凸轮的旋转移动来旋转。
前面的概述仅仅是说明性的，并不意图以任何方式进行限制。除了上述的示例性方面、实施方案和特征部，通过参照附图和以下详细描述，本发明的其他方面、实施方案和特征部将变得显而易见。
附图说明
本申请所述实施方案的新颖特征在所附权利要求书中进行了详细描述。然而，关于组织和操作方法的实施方案均可通过参照结合附图的以下描述来更好地理解。
图1示出了根据一些实施方案的示例系统，该示例系统包括适用于腹腔镜式胆囊切除术的用来切割和密封组织的医疗器械。
图2示出了根据一些实施方案的医疗器械的端部执行器的更详细视图，该端部执行器包括示例组件，该示例组件具有刀片器械和用于包括密封机构的其他部件。
图3示出了从不同的角度看去的包括刀片和密封组件的示例端部执行器的另一角度。
图4示出了根据一些实施方案的在刀片被构造成能够加热用于密封组织的屏蔽部分时端部执行器的应用。
图5示出了根据一些实施方案的关于如何实现刀片的超声振动操作的另外的细节。
图6示出了根据一些实施方案的具有防护罩的端部执行器的变型形式。
图7示出了根据一些实施方案的具有针对屏蔽部分的凹陷部的端部执行器的另一变型形式。
图8A示出了根据一些实施方案的具有用于使刀片和密封组件滑入端部执行器中的具有套筒机构的端部执行器的另一变型形式。
图8B示出了根据一些实施方案的关于刀片和密封组件可如何滑入端部执行器中的示例。
图9示出了根据一些实施方案的密封组件的又一变型形式，密封组件这次具有多个可操作机械零件。
图10A示出了根据一些实施方案的端部执行器的远侧端部处的用于切割和密封组件的又一变型形式，切割和密封组件这次包括非对称形状的刀片和多零件密封组件。
图10B示出了根据一些实施方案的操作图10A中所描述的机电密封机构的柄部组件的附加特征部。
图10C提供了根据一些实施方案的关于可如何利用图10A所述的密封组件的一个示例。
图10D示出了根据一些实施方案的用于操纵图10A所述的密封组件的电源按钮和相关联的机械按钮的一些内部工件。
图10E示出了根据一些实施方案的按钮组件最终如何在轴的远侧端部处连接到密封组件。
图10F示出了根据一些实施方案的用于控制密封组件的按钮组件的机电部件的一部分。
图11A示出了根据一些实施方案的刀片和密封组件的又一变型形式，刀片和密封组件这次包括可旋转密封组件。
图11B示出了根据一些实施方案的在其中高摩擦表面定位于刀片上方的第二构型中旋转的可旋转密封组件。
图12A示出了根据一些实施方案的刀片和密封组件的另一变型形式，刀片和密封组件这次包括旋转凸轮机构，该旋转凸轮机构以不需要弯曲或按压刀片的旋转方式向刀片应用高摩擦表面。
图12B示出了根据一些实施方案的静止主体以及用于与旋转构件连接的机械零件中的一些的透明视图。
图12C示出了根据一些实施方案的旋转主体的透明视图。
图12D示出了旋转主体的原始打开位置。
图12E示出了在旋转的内管旋转以形成旋转主体的闭合位置时发生的情况的对比。
图12F、图12G和图12H示出了根据一些实施方案的具有旋转构件变型的刀片和密封组件的另外的视图。
具体实施方式
在以下详细描述中，参考构成其一部分的附图。附图中，类似的符号和附图标记通常在全部几个视图中标识类似的部件，除非上下文另有说明。具体实施方式、附图和权利要求中所描述的例示性实施方案并非旨在进行限制。可采用其他的实施方案，并且可以在不偏离本文所提出主题的范围的情况下作出其他变化。
下面对本技术的某些示例的描述不应用于限制本技术的范围。从下面的描述而言，本技术的其它示例、特征、方面、实施方案和优点对本领域的技术人员而言将变得显而易见，下面的描述以举例的方式进行，这是为实现本技术所设想的最好的方式中的一种方式。正如将意识到的，本文所述的技术能够具有其它不同的和明显的方面，所有这些方面均不脱离本技术。因此，图示和描述应被视为实质上是例示性的而非限制性的。
另外应当理解，本文所述的教导内容、表达方式、实施方案、实施例等中的任何一者或多者可与本文所述的其它教导内容、表达方式、实施方案、实施例等中的任何一者或多者相结合。因此，下述教导内容、表达方式、实施方案、实施例等不应视为彼此孤立。参考本文的教导内容，本文的教导内容可进行组合的各种合适方式对于本领域的普通技术人员而言将显而易见。此类修改和变型旨在包括在权利要求书的范围内。
另外，在下面的描述中，应当理解，诸如前部、后部、内侧、外侧、顶部、底部等等之类的术语为方便型用语，不应认为是限制性术语。本文所用的术语并非意在限制在本文所述装置或其部分的范围内，而是可以按照其他取向附接或利用。将结合附图更详细地描述多种实施方案。在整个公开内容中，术语“近侧”用于描述部件(例如，轴、柄部组件等)的更靠近操作外科器械的使用者(例如，外科医生)的侧，而术语“远侧”用于描述部件的离操作外科器械的使用者更远的侧。
针对被构造成用于使用超声解剖刀片来切割和密封组织的外科器械而提出了本公开的各方面。本文提出的外科器械的常见用途包括执行腹腔镜式胆囊切除术(laparoscopic cholecystectomy，通常称为lap chole)。腹腔镜式胆囊切除术是通过外科手术从肝床上去除胆囊，由此经由腹部中的一系列的几个小切口来对患者进行手术，以允许插入小的圆柱形管，将外科器械和摄像机经由这些圆柱形管放置在腹腔中。这是胆结石症状和其他胆囊疾病的常见治疗方法。对于胆囊结石和胆囊炎症的治疗来说，腹腔镜式胆囊切除术通常是比开腹胆囊切除术优选的手术，除非对腹腔镜方法存在禁忌症。这是因为开腹手术往往会使患者更容易受到感染，并且患者的恢复时间往往更长。
为了执行腹腔镜式胆囊切除术，外科医生通常利用二氧化碳使腹腔膨胀以形成操作空间。将相机经由通常在肚脐处形成的切口(“孔口”)放置在腔中。可在患者腹部周围的其他地方开出另外的孔口。一个或多个器械可经由其中一个另外的孔口抓持胆囊，而另一个器械则用于将胆囊从肝床解剖。然后能够经由其中一个孔口去除胆囊。理想的是，在这一手术过程中不会切到或损坏肝脏，但外科医生必须针对在肝脏或其他附近器官处发生一些出血的可能性做好准备。因此，希望医疗器械具有切割装置以及密封装置，由此在手术过程中外科医生可以立即使用这两种功能。例如，希望单个医疗器械同时具有切割装置和密封装置，以便消除对多个医疗器械或者为了另一个医疗器械替代而去除单个医疗器械的需要。
总的来说，腹腔镜式方法在可行的情况下侵入性较小，优于开腹手术，但对外科医生完成手术肯定会带来更多的挑战。例如，外科医生操纵任何外科装置的空间受到限制，仅限于经由患者身体上的小切口来使用该装置。此外，限制能够在任何时候应用于手术部位的医疗器械的数量。此外，希望基于腹腔镜式胆囊切除术的特定解剖结构来对医疗器械进行特别设计以执行这一手术。也就是说，腹腔镜式胆囊切除术的手术部位始终涉及将胆囊从肝床上解剖，使得手术部位的一侧(即，胆囊)受到损坏是允许的，而另一侧(即，肝床)则不应该被切到或受到损坏，事实上应特别小心，以使肝脏或周围器官可能出现的任何伤口或意想不到的出血立即密封或凝聚。
由于至少这些原因，因此针对被构造成能够切割和密封组织并且被适当地设计成在腹腔镜式胆囊切除术中解剖胆囊的医疗器械和系统提出了本公开的各方面。例如，在一些实施方案中，医疗器械可包括适于经由套针插入患者的小切口中的细长轴。端部执行器位于轴的远侧端部上，该端部执行器包括适于解剖组织的刀片以及用于凝聚或密封组织的密封装置。这个医疗器械可经由刀片器械的超声振动来执行这两个功能。在一些实施方案中，可将刀片压贴在高摩擦表面上，这由于刀片的超声振动而引起热量。刀片的屏蔽部分可能会由于来自高摩擦表面的热传递而升温，这可用于通过将屏蔽部分压贴出血组织来凝聚组织。本文提出了被构造成能够执行这些功能的医疗器械的各种示例设计，并根据以下附图更详细地描述了这些示例设计。
参考图1，图示100示出了根据一些实施方案的示例系统，该示例系统包括适用于腹腔镜式胆囊切除术的用来切割和密封组织的医疗器械。如图所示，示例医疗系统包括经由缆线联接到控制中心110的示例医疗器械105。示例控制中心110可被构造成能够向医疗器械105供电，以及提供可供外科医生和/或其团队阅读的各种诊断信息。控制中心100可包括：电力电缆，该电力电缆被插进电源插座；以及脚踏开关112，该脚踏开关被构造成能够调节将供应到医疗器械105的电力的量。例如，在一些实施方案中，医疗器械105可被构造成能够经由超声振动来操作端部执行器130处的刀片，并且脚踏开关112可被按压以修改超声振动的频率。这种构型可通过允许外科医生在手术期间使用他的手执行诸如操作医疗器械105的其他任务来给予外科医生最佳的自由度。
此外，示例控制中心110可包括超声发生器例如电源和控制逻辑件，该超声发生器经由缆线连接到柄部组件120的壳体内的超声换能器(未示出)，以使得医疗器械105能够使用超声振动来操作。在一些应用中，超声换能器称为“手持件组件”，这是因为在各种手术和操作期间，外科器械105被构造成使得外科医生可抓持并操纵超声换能器。示例发生器包括由Ethicon Endo-Surgery公司(Cincinnati,Ohio)售出的GEN04(也称为发生器300)或GEN11。示例换能器在2006年10月10日提交的标题为MEDICAL ULTRASOUND SYSTEM ANDHANDPIECE AND METHODS FOR MAKING AND TUNING的美国专利申请序号11/545,784中进行了公开，其内容以引用的方式并入本文。
在一些实施方案中，医疗器械105包括其他特征部。例如，医疗器械105可在近侧端部处包括柄部组件120。柄部组件120可被设计成符合人体工程学以适当地配合外科医生的手。如图所示，柄部组件120的形状为圆柱形，而在其他情况下，柄部组件120可以手枪式握持方式或常规地用于医学规程的其他合适形状来设计，并且实施方案不限于此。在一些实施方案中，柄部组件120可包括电源开关122，可按压该电力开关以执行密封机构。此外，柄部组件120还可包括滑动按钮124，该滑动按钮用于使外科器械105的远侧端部处的刀片来回滑动。在一些实施方案中，还可包括旋钮126，该旋钮用于允许外科器械105的一部分旋转。柄部组件120可联接到细长轴128，该细长轴被设计成装配到套管针中，该套管针能够被插入患者体内的孔口中来执行腹腔镜式胆囊切除术。在轴128的远侧端部上的是端部执行器130，该端部执行器在一体式组件132中包括刀片和密封器械。在轴内可包括超声波导(参见图5)，该超声波导在近侧端部上联接到超声换能器并且在远侧端部上联接到刀片，被构造成能够以超声频率振动。
超声换能器和超声波导一起提供图示100中的本发明的外科系统的声学组件，该声学组件在由发生器供电时为外科手术提供超声能量，该发生器可由脚踏开关112控制。医疗器械的声学组件105通常包括第一声学部分和第二声学部分。在一些实施方案中，第一声学部分包括超声换能器的超声激活部分，并且第二声学部分包括传输组件的超声激活部分。另外，在一些实施方案中，第一声学部分的远侧端部通过(例如)螺纹连接件操作地联接到第二声学部分的近侧端部。
柄部组件120还可适于使操作者与换能器内包含的声学组件的振动隔离。柄部组件120可成形为由使用者以常规方式保持。在一些实施方案中，本发明的超声医疗器械105被设计成以由器械的柄部组件120提供的剪刀状布置方式来抓持和操纵，如将要描述的那样。尽管示出了多件式柄部组件120，但柄部组件120可包括单个部件或一体式部件。超声医疗器械105的近侧端部通过将超声换能器插入柄部组件120中来接收该换能器的远侧端部并装配到其上。超声医疗器械105可作为一个单元附接到超声换能器以及从超声换能器去除。
柄部组件120可由耐用塑料诸如聚碳酸酯或液晶聚合物构造。也可设想柄部组件120或者可由包括其他塑料、陶瓷或金属的多种材料制成。然而，传统的未填充热塑性塑料的导热率仅为约0.20W/m°K(瓦特/米-°开)。为了改善该器械的散热，柄部组件可由导热的热塑性塑料构造，诸如导热率在20-100W/m°K范围内的高耐热树脂液晶聚合物(LCP)、聚苯硫醚(PPS)、聚醚醚酮(PEEK)和聚砜。PEEK是填充有不导电的氮化铝和氮化硼的热塑性塑料。导热树脂有助于管理较小器械内的热量。
柄部组件120内的传输组件(未示出)包括超声波导和刀片(参见例如图2和图5)。在某些应用中，传输组件有时称为“刀片组件”。适于将超声能量从换能器传输到刀片顶端的波导可以为柔性、半柔性或刚性的。如本领域中所熟知的，波导也可被构造成能够将通过波导传输到刀片的机械振动放大。波导还可具有控制沿波导的纵向振动增益的特征部，并且具有将波导调谐至系统谐振频率的特征部。具体地讲，波导可具有任何合适的横截面尺寸。例如，波导可具有基本上均匀的横截面或波导可在多个截面处渐缩或可沿着其整个长度渐缩。
超声波导的长度可例如基本上等于系统波长的二分之一的整数倍(nλ/2)。超声波导和刀片可优选地从由高效传播超声能量的材料制成的实芯轴制备，诸如钛合金(即Ti-6Al-4V)、铝合金、蓝宝石、不锈钢或任何其他声学相容材料。
超声波导还可包括基本上垂直于波导的纵向轴线延伸穿过其的至少一个径向孔或开孔。可被定位于节点处的开孔被构造成能够接收连接器销，该连接器销用于将波导连接到柄部组件120。
参考图2，图示200示出了根据一些实施方案的端部执行器130的更详细视图，该端部执行器包括示例组件，该示例组件具有刀片器械205和用于包括密封机构的其他部件。这里，刀片205显示为联接到端部执行器130的远侧端部。刀片205可被构造成能够将组织诸如胆囊组织从患者体内解剖，使得可从肝床去除胆囊。如图所示，刀片205被设计成仅在刀片的一侧上具有直边。另一侧显示为是平坦的并由平坦的马项圈形状的屏蔽部分210包封，该屏蔽部分被构造成能够屏蔽刀片205并使其他组织与刀片205隔离并且兼作表面，该表面用于凝聚或密封组织，这将在下面更详细地描述。在其他情况下，刀片205可以是弯曲的或成角度的，并且实施方案不限于此。刀片205可联接到端部执行器130内的超声波导并且在轴128内穿过，使得刀片205可经由超声振动来操纵，这将在下面更详细地描述。值得注意的是，由于刀片205经由超声振动来操作，因此马项圈形屏蔽部分210被构造成能够与刀片205物理地分开，以允许刀片205在不接触屏蔽部分210的情况下进行操作。这样，图示200示出了刀片205的顶部和联接到屏蔽部分210的材料215和220之间的空间。
在一些实施方案中，刀片205可与波导成为一体并形成为单个单元(参见例如图5)。在一些另选的实施方案中，刀片205可通过螺纹连接件、焊接接头或其他联接机构连接。刀片205的远侧端部设置在波腹附近，以便在声学组件未被组织承载时将声学组件调谐至优选的谐振频率f0。在超声换能器通电时，刀片205的远侧端部或刀片顶端被构造成在能够，例如在大约10微米至500微米的峰间范围内、并且优选地在约20微米至约200微米的范围内以例如55,500Hz的预定振动频率f0基本上纵向地沿x轴运动。刀片顶端也可沿y轴以x轴运动幅度的约1％至约10％振动。
在一些实施方案中，刀片末端提供功能不对称件或弯曲部分以用于改善刀片末端处的可见性，使得外科医生可验证刀片205在整个被切割或凝聚的结构上延伸(参见例如图10A)。这在大血管边缘余量的验证中尤其重要。在一些情况下，刀片205可具有弯曲的部分。刀片的某些形状可通过更加密集地复制生物学结构的曲率来提供改善的组织触及。
如图所示，在屏蔽部分210下方的是高摩擦表面215，该高摩擦表面位于外屏蔽部分210和刀片205的平坦侧之间。在一些情况下，高摩擦表面215可始终沿屏蔽部分210的内侧延伸，在刀片205上方的一侧上间隔开并且沿着刀片205的基部向下延伸。高摩擦表面的示例材料可包括聚酰亚胺。端部执行器130可被设计成使得可通过在腹腔镜式胆囊切除术期间将屏蔽部分210压贴患者的组织壁来使刀片205偏压以接触高摩擦表面215。由于刀片205的超声振动，高摩擦表面215将快速升温。由于表面215和屏蔽部分210的导热性质，到屏蔽部分210的热传递将致使屏蔽部分210也升温。屏蔽部分210的热量能够被用来凝聚任何出血组织，诸如在腹腔镜式胆囊切除术期间可能发生的肝床的任何出血。
例如，外科医生可首先使用刀片205来开始解剖胆囊。在相反侧上经历了肝床的一些不希望的出血之后，外科医生可将屏蔽部分210压贴肝床的出血壁。这将使刀片205偏压成压贴高摩擦垫215，从而致使垫215和屏蔽部分210升温。热量能够被用来凝聚肝床的出血部分。在足够的时间之后，或者在确定出血已经停止之后，外科医生可停止将屏蔽部分210压贴肝床，并且可继续解剖过程。
在一些实施方案中，低摩擦表面220也可安装在屏蔽部分210的马项圈形侧内。这些低摩擦表面220可充当缓冲器，以在刀片205从一侧移动到另一侧的情况下，使刀片205能够继续振动。低摩擦表面的示例材料可包括聚四氟乙烯(例如，
Figure BDA0001533614070000121
)。
参考图3，图示300示出了从不同的角度看去的包括刀片和密封组件132的示例端部执行器130的另一角度。如图所示，刀片205物理地远离高摩擦表面215和低摩擦表面220。刀片205和密封组件之间的物理分离可表示外科器械105的默认状态或自然状态，该密封组件由马项圈形屏蔽表面210和高摩擦表面215组成。
参考图4，图示400示出了根据一些实施方案的在刀片205被构造成能够加热用于密封组织的屏蔽部分210时端部执行器130的应用。这里，在刀片205和高摩擦表面215之间的位置410处不存在空间。这可能是由外科医生操纵外科器械105以致使屏蔽部分210压贴手术部位处的出血组织壁而引起的。如先前所讨论的，在刀片205被压贴高摩擦表面215时，刀片205的超声振动可在高摩擦表面215中生成热量，该热量可被传递到屏蔽部分210中。屏蔽部分210中生成的热量可被用来凝聚手术部位处的出血组织。
参考图5，图示500示出了根据一些实施方案的关于如何实现刀片205的超声振动操作的另外的细节。这里，端部执行器130被制作成透明的以显示管内的材料。在这个示例中，刀片205连接到超声波导505，该超声波导延伸到柄部组件120(未示出(参见图1))。将超声波导505连接到刀片205的是谐波支点510，该谐波支点在位置515处接触端部执行器130的外部。可利用超声波导505振动的特定频率来对谐波支点510进行计算，以将该谐波支点定位在远离柄部组件122的特定距离处。具体地讲，超声波导505的超声振动形成了超声波导505的正弦效应，就像握住绳子的一个端部摇动一样。换句话讲，超声振动可致使超声波导505像驻波一样振动。超声支点510定位在驻波的节点处，当然这是基于超声振动的特定频率得到的。超声支点510定位在驻波的节点处允许定位在支点510之外的刀片205继续不受阻碍地振动。相比之下，如果根据特定振动频率来将支点510放置在波腹处，则可以抵消支点510之外的任何振动，由此致使刀片205停止振动。
参考图6，图示600示出了根据一些实施方案的具有防护罩605的端部执行器130的变型。如图所示，屏蔽表面210还可包括防护罩605，该防护罩覆盖刀片205的前部。罩605可在刀片205振动时，保护其他组织使它们免于在刀片205附近被捕获。这样，刀片205就完全避开与旨在被解剖的目标组织之外的其他组织发生任何不希望的接触。
参考图7，图示700示出了根据一些实施方案的具有针对屏蔽部分210的凹陷部705的端部执行器130的另一变型。这里，凹陷部705朝向刀片205的基部放置以像铰链一样作用来使屏蔽部分210弯曲。这样，在试图通过将刀片205与高摩擦表面215连接来使用密封机构时，屏蔽部分210可以更容易地接触刀片205。
参考图8A，图示800示出了根据一些实施方案的具有用于使刀片和密封组件滑入端部执行器130中的套筒机构的端部执行器130的另一变型。在这种情况下，屏蔽部分805具有倒圆形状，其覆盖刀片205的顶部和侧面的零件。在其他情况下，屏蔽部分805可具有不同的形状，包括与屏蔽部分205类似的马项圈形状，并且实施方案不限于此。值得注意的是，凹陷部810然后可被构造成能够允许屏蔽部分805在滑入端部执行器130中时弯曲。在刀片205和屏蔽部分805沿远侧方向延伸到端部执行器130之外时，在一些实施方案中，屏蔽部分805可被构造成能够自然地弯曲，使得高摩擦表面215和屏蔽部分805向上并远离刀片205延伸。在一些实施方案中，刀片和密封组件可由滑动机构诸如滑动按钮124(参见图1)拉入端部执行器130中。滑动按钮124可机械地连接到轴128内的超声波导，该轴连接到刀片和密封组件。
参考图8B，图示850示出了根据一些实施方案的关于刀片和密封组件可如何滑入端部执行器130中的示例。如图所示，刀片和密封组件例如可由滑动机构诸如滑动按钮124(参见图1)沿方向A拉回端部执行器130中。在拉回端部执行器130中时，刀片205和高摩擦表面215可如图所示闭合在一起并进一步由屏蔽部分805封装。在经由患者体内的小切口进入手术部位时，可使用本文所示的封闭位置。这可允许将外科器械105更仔细地放置在患者体内，从而最小化由刀片205引起的任何可能损伤。
参考图9，图示900示出了根据一些实施方案的密封组件的又一变型形式，密封组件这次具有多个可操作机械零件。如图所示，第二屏蔽部分905具有与屏蔽部分205类似的马项圈形特性。屏蔽部分905仍然包括定位于刀片205的顶部附近的高摩擦表面215和低摩擦表面220。此外，屏蔽部分905经由铰链910机械地联接到静止基部915。根据一些实施方案，基部915可以是与刀片205形成为单件式结构的一部分。铰链910可允许屏蔽部分905在刀片205的顶部上枢转。如图所示，铰链910和静止基部915定位在端部执行器130的管部分内，其中为了进行示意性的说明而将本文所示的端部执行器130制作成透明的。
在这个变型中还包括用于经由连接到可滑动杆925的机械链联接件920来引导屏蔽部分905的运动的机构。在一些实施方案中，可滑动杆可延伸穿过轴128(参见图1)，该轴连接到滑动机构诸如被构造成能够由外科医生操纵的滑动按钮124。也就是说，在外科医生来回移动滑动按钮124时，可滑动杆925相应地移动。这致使可滑动杆925的远侧端部拉动链联接件920。联接由屏蔽部分905附连到铰链910而形成的杠杆作用，外科医生可以这种方式操纵屏蔽部分905来将其稍微拉离刀片205以及连接到刀片205。这样，外科医生可控制外科装置1052以解剖模式或密封模式操作。
在一些实施方案中，与图示900中所示类似的变型也能够滑入端部执行器130中，同时也被构造成能够操纵可滑动杆925。例如，柄部组件120可包括两个可滑动按钮(未示出)，一个用于操纵可滑动杆925，而另一个被构造成能够将整个刀片和密封组件滑入端部执行器130中。
参考图10A，图示1000示出了根据一些实施方案的轴128的远侧端部处的切割和密封组件的又一变型。图示1000以几种不同的变型为特征，其中的每一者都能够与本文所述的其他类似功能的零件单独地互换，并且实施方案不限于此，例如，图示1000示出了具有尖端1002、较宽后侧1004和平滑侧面1006的不同形状的刀片。尖端1002可被构造成能够解剖组织，而较宽后侧1004和平滑侧面1006可被构造成能够在刀片被加热时，凝聚组织。如图所示，刀片可连接到超声波导1008，该超声波导的绝大部分由轴128包封(这里为了进行示意性的说明而将轴显示为透明的)。
尖端1002常常称为功能不对称件。也就是说，刀片(就功能而言，刀片提供大量的组织效应)位于波导1008的纵向轴线之外(即相对于纵向轴线为非对称)，并且因此在超声波导中产生不平衡。如果该不平衡不加以纠正，那么会发生不可取的热、噪声和受损的组织效应。
通过临近刀片功能不对称件提供一个或多个平衡不对称件或平衡特征部，可以将顶端在y轴和z轴的有害偏移最小化，因此使效率最大化并且改善组织效应。
图示1000所示的另一变型包括另一种密封机构，该另一种密封机构由加热垫1010和可滑动杠杆1012组成。如图所示，加热垫1010和可滑动杠杆1012包封在轴128的圆柱形管内。如图所示，加热垫1010经由铰链1014连接到可滑动杠杆1012。加热垫1010的至少一部分可包括与用于高摩擦表面215的材料类似的高摩擦表面，该高摩擦表面被构造成能够夹持超声波导1008以在刀片和超声波导1008振动时生成热量。加热垫1010可经由电源按钮1022而通过机电装置移动到超声波导1008上，电源按钮在下图中示出且类似于图1中的按钮122。在一些实施方案中，可将轴128的远侧端部往回拉动，或者另选地，可将波导1008以及包括加热垫1010和可滑动杠杆1012的密封组件构造成能够向前滑动，由此暴露加热垫1010以获得更多的可操纵性。轴128可以这种方式起作用并被称为护套。
参考图10B，图示1020示出了根据一些实施方案的操作图示1000中所描述的机电密封机构的柄部组件124的另外的特征部。如先前所讨论的，根据一些实施方案，柄部组件120可包括电源按钮1022，该电源按钮可被构造成能够操作用于受控密封操作的定时程序。电源按钮1022可与一系列机电零件互连，该一系列机电零件经由可滑动杠杆1012而在端部执行器130的远侧端部处连接到密封组件。在一些实施方案中，另外的按钮诸如按钮1024可被构造成能够在不使用定时程序的情况下操纵密封组件。这些机构将在下图中进一步描述。
参考图10C，图示1040示出了根据一些实施方案的关于可如何利用图示1000中所描述的密封组件的一个示例。这里，图示1000中所描述的刀片在其一侧上转动以提供刀片的其他特征部上的不同透视图。这里示出了刀片的较宽后侧1004以及平滑侧面1006。在一些实施方案中，相反侧与侧面1006相同。在轴128中未示出端部执行器130的圆柱形管。在一些情况下，刀片和密封组件可被构造成能够例如通过滑动按钮124前进到护套128之外。在其他情况下，轴128可足够大以允许密封组件在轴128内移动。
如图所示，加热垫1010可包括沟槽或凹陷部1042，该沟槽或凹陷部可允许加热垫1010接触超声波导1008的更多表面区域。此外，在一些实施方案中，加热垫1010可包括高摩擦表面1046，而在其他情况下，整个加热垫1010可由用于制作高摩擦表面1046的高摩擦材料构成。凹陷部1042内和周围的区域在最低程度上可由高摩擦材料组成，使得加热垫1010在其振动时接触超声波导1008的同时生成热量。因此，在加热垫1010夹持在超声波导1008上时，来自加热垫1010的热量被传递到超声波导1008和附连在超声波导1008的远侧端部处的刀片。然后，外科医生能够经由较宽后侧1004和/或较平滑的侧表面1006来向出血区域施加热量。可滑动杠杆1012可通过沿方向C来回滑动来控制加热垫1010的运动。可基于铰链来实现对加热垫1010的控制，该铰链1044充当加热垫1010的枢转点。
参考图10D，图示1060示出了根据一些实施方案的用于操纵图示1000中所描述的密封组件的电源按钮1022和相关联的机械按钮1024的一些内部工件。这里，为了进行示意性的说明而未示出柄部组件120的外部壳体，但通常柄部组件120的外部壳体可包封按钮的这个组件的后侧和前侧，如图示1060所示(参见图示1020)。在这个示例中，单个电源按钮1022可用并且被构造成能够对密封组件的利用执行定时操作。这可部分地通过按下电源按钮1022来实现，该电源按钮连接到启用滑动件1064并且将参考后面的附图更详细地描述。而且，存在多个机械按钮1024并且它们围绕轴128均匀地间隔开，其中按压机械按钮1024中的任何一者(或多者)可被构造成能够仅激活启用超声波导以使刀片振动而无需启用加热功能。为了实现这一点，将机械按钮1024中的每一者联接到圆柱形启用滑动件1062，该启用滑动件联接到单个柱塞，该单个柱塞可推动连接到超声换能器的按钮(未示出)。这些机构的内部工件的示例将在下面的附图中更详细地描述。
参考图10E，图示1080示出了根据一些实施方案的按钮组件最终如何在轴128的远侧端部处连接到密封组件和刀片组件。如先前所讨论的，包括按钮1022和1024的按钮组件经由分别位于轴128内部的可滑动杠杆1012和波导1008而分别连接到密封组件和刀片组件。在一些实施方案中，按压围绕按钮组件间隔开的机械按钮1024中的任一者(在图10E中仅标记出一个作为示例)会经由圆形启用滑动件1062来启用波导1008以致使刀片振动，而按压电源按钮1022会经由启用滑动件1064而在定时操作中启用密封组件。在一些情况下，可通过各种方式包括具有不同的颜色、不同的形状、不同的握持部等来将电源按钮1022和其他按钮1024区分开。
参考图10F，图示1090示出了根据一些实施方案的用于控制密封组件和刀片组件的按钮组件的机电部件的一部分。这里，为了进行示意性的说明而将按钮组件切成两半以显示用于在按钮1022到可滑动杠杆1012之间以及在按钮1024到波导1008之间提供相互作用的各种机电部件的部分。图示1090的机电部件的具有阴影或设计的表面表示其中部件被切成两半的位置。
如图所示，电源按钮1022搁置在按钮组件的顶部。在外科医生按下按钮时，按钮1022向下推动启用滑动件1064的倾斜部分，该启用滑动件先前也在图10D和图10E中示出。电源按钮1022的向下移动致使启用滑动件1064的倾斜部分使启用滑动件1064朝向外科医生朝近侧滑动。在启用滑动件1064的远侧端部处的是钩，该钩附接到可滑动杠杆1012。因此，在启用滑动件1064朝向外科医生朝近侧移动时，可滑动杠杆1012相应地被朝近侧拉动。可滑动杠杆1012的牵拉运动致使加热垫1010向下夹持在超声波导1008上(参见图示1040)。因此，按下电源按钮1022会致使加热垫1010向下夹持在超声波导1008上，以使远侧端部处的刀片升温。
同时，在启用滑动件1064的近侧端部处的是启用磁体1094。在启用滑动件1064朝近侧滑动时，启用磁体1094移动得更靠近霍尔效应传感器1096。在足够靠近时，启用磁体1094可经由霍尔效应传感器1096启用内置在电路板1098的存储器中的定时程序。定时程序可被构造成能够停用对刀片的供电以阻止刀片振动。例如，在电路板1098中的定时程序被触发时，即使外科医生试图例如通过按压脚踏板112(参见图1)或按压按钮1024中的任一者(详情见下面)来继续接通电源，也能够在5秒之后自动停止用于向刀片施加超声振动的供电。这样，按压电源按钮1022会启动组织密封程序，该组织密封程序仅在固定量的时间内施加热量以安全地控制密封组件。
在一些实施方案中，机械按钮1024可提供用于控制刀片的超声振动的另外的另选机构。这里，示例按钮1024定位在按钮组件的底部，并且连接到其自己的启用滑动件1062，该启用滑动件先前也在图10D和图10E中进行了示出。启用滑动件1062连接到柱塞1095。在一些情况下，启用滑动件1062和柱塞1095可模制在一起形成为单件式结构(例如，由聚碳酸酯制成的单件式结构)。一般来讲，在按压按钮1024时，启用滑动件1062的倾斜部分接触按钮1024并致使启用滑动件1062朝向外科医生朝近侧滑动。这继而也使柱塞1095朝向外科医生朝近侧滑动。然后，柱塞1095推动启用按钮或开关1097，该启用按钮或开关被构造成能够启用超声换能器(未示出)。启用超声波换能器会致使波导1008振动，这使得轴128的远侧端部处的刀片振动。在一些实施例中，换能器可联接到波导1008的近侧端部处，从而装配到打开空间1099中。
如先前所提及的，启用滑动件1062可为圆柱形构造的，使得启用滑动件1062始终缠绕在按钮组件内，所有这些最终都连接到柱塞1095。因此，按压始终围绕按钮组件以圆柱形形状定位的机械按钮1024中的任何一者都可致使启用滑动件1062朝近侧滑动并将柱塞1095推入启用按钮1097中。这样，外科医生可使用柄部组件120内的按钮组件来控制刀片和密封组件的振动。在一些实施方案中，为了区分这些按钮，可将电源按钮1022以不同的颜色着色或以不同的方式凹入，并且实施方案不限于此。
参考图11A，图示1100示出了根据一些实施方案的刀片和密封组件的又一变型形式，刀片和密封组件这次包括可旋转密封组件。如图所示，可旋转密封组件1105以圆柱形形状定位在端部执行器130内并且包括与刀片205能够成直线地延伸的由高摩擦材料制成的长条带。密封组件1105可经由旋钮诸如旋钮126(参见图1)来旋转。因此，通过操纵旋钮126，密封组件1105可例如沿旋转方向D而围绕刀片205旋转，如图11B的图示1150所示。高摩擦材料能够以这种方式旋转以接触刀片205的更平坦且更宽的后端，或者接触刀片205自身的尖边。这两个选择可允许改变将在密封组件中实现的热度。例如，在图示1150中，将刀片205的后端压贴密封组件1105的高摩擦表面可形成更多的热量，因为刀片205的更多表面会接触高摩擦表面。相比之下，如果只是刀片205的边缘接触密封组件1105中的高摩擦表面，如图示1100所示，那么在该构型中将生成较低程度的热量，或至少热传递速率较慢。在一些实施方案中，密封组件1105还可包括其他材料诸如用于将高摩擦表面包封在类似于先前附图中所描述的马项圈形或圆柱形屏蔽部分的屏蔽部分中的材料，并且实施方案不限于此。
参考图12A，图示1200示出了根据一些实施例的刀片和密封组件的又一变型形式，刀片和密封组件这次包括旋转凸轮机构，该旋转凸轮机构以不需要弯曲或按压刀片205的旋转方式向刀片205应用高摩擦表面215。如图所示，旋转构件1202联接到屏蔽构件1204，该屏蔽构件包括高摩擦表面215，并且在一些实施方案中，包括低摩擦表面220。在图示1200中，旋转构件1202被构造成处于“打开”位置，由此滑动构件1204旋转远离刀片205。
旋转构件1202容纳在静止主体1208内。静止主体1208成形为圆柱形以便有效地连接到轴128以及滑入套管针中，尽管其他实施方案可不成形为圆柱形。旋转构件1202被构造成能够经由旋转内管1206旋转，该旋转内管经由轴128连接到旋钮诸如旋钮126(参见图1)。
参考图12B，图示1210示出了根据一些实施方案的静止主体1208以及用于与旋转构件1202连接的机械零件中的一些的透明视图。如图所示，旋转内管1206的远侧端部滑入静止主体1208的近侧端部中。旋转内管1206包括滑动凸轮1212，该滑动凸轮允许紧固到旋转构件1202的旋钮1222装配到其中(参见下面描述的图12C)。还示出了静止轴杆1214，该静止轴杆充当旋转构件1202的枢转轴线。静止轴杆1214经由锚定件1216附连到静止主体1208，同时凸轮1212安装到旋转内管1206中。还示出了刀片205的基部以供关于如何定位刀片和顶篷组件进行参考。
参考图12C，图示1220示出了根据一些实施方案的旋转主体1202的透明视图。如图所示，旋转主体1202的近侧端部成形为类似于圆柱体的一部分，使得旋转主体1202可装配到圆柱形端部执行器中。屏蔽部分1204如图所示连接到旋转主体1202。在一些实施方案中，旋转主体1202和屏蔽部分12可形成为单件式结构，例如，由模制塑料或模制金属制成的单件式结构。如先前所讨论的，旋转主体的近侧端部包括旋钮1222，该旋钮可装配到凸轮1212中。在图示1220中还示出了轴杆1214，并且轴杆1214实质上示出了旋转主体1202与旋转内管1206和旋转主体1208如何联接。因此，旋转主体1202可经由充当枢转轴线的轴杆1214旋转，并且可经由旋钮1222移动，该旋钮连接到正由旋转内管1206旋转的凸轮1212。由于凸轮1212被设计成具有直边并且轴杆1214位于旋转内管1206的中心之外，因此旋转内管1206的旋转将致使旋钮1222在不同于旋转内管1206的旋转轴线上移动。
为了说明这个运动，参考图12D，图示1230示出了旋转主体1202的原始打开位置。这与图12E形成对照，图示1240示出了在旋转内管1206沿方向E旋转时发生的情况。也就是说，屏蔽部分1204向下平移并且还逆时针旋转，直到其接触刀片205为止。旋转主体1202也平移并旋转到“闭合”位置，其中旋转主体1202得到校准以很好地装配到静止主体1208的圆柱形状中。在一些实施方案中，闭合位置是刀片和密封组件在进入患者体内之前，在进入套针时定位的方式。因此，如果刀片和密封组件定位在打开位置，那么端部执行器可能不能装配到圆柱形套管针中，这用作安全机构来确保刀片和密封组件以闭合位置开始。
参考图12F、图12G和图12H，图示1250、1260和1270示出了根据一些实施方案的具有旋转构件变型的刀片和密封组件的另外的视图。这些另外的视图在本文提供了关于与其他部件相比如何定位旋转构件1202的更多背景。例如，图示1250还示出了在节点位置515处连接到静止主体1208的谐波支点510。图示1260提供了与图示1250相同的透视图，但其中旋转构件1202处于打开位置。图示1270示出了旋转构件1202和屏蔽部分1204的反转角度的近视图。
在一些情况下，各种实施方案可实现为制造制品。所述制造制品可以包括被布置为存储用于执行一个或多个实施方案的各种操作的逻辑、指令和/或数据的计算机可读存储介质。在各种实施方案中，例如，所述制品可包括磁盘、光盘、闪存存储器或固件，这些制品均含有适于由通用处理器或专用处理器执行的计算机程序指令。然而，实施方案并不仅限于此。
结合本文所公开的实施方案描述的各种功能性元件、逻辑块、模块、和电路元件的功能可在计算机可执行指令的一般环境中实施，诸如由处理单元执行的软件、控制模块、逻辑、和/或逻辑模块。一般而言，软件、控制模块、逻辑、和/或逻辑模块包括布置成执行特定操作的任何软件元件。软件、控制模块、逻辑、和/或逻辑模块可包括执行特定任务或实施特定抽象数据类型的例程、程序、对象、部件、数据结构等。软件、控制模块、逻辑、和/或逻辑模块和技术的具体实施可存储在某种形式的计算机可读介质上并且/或者通过某种形式的计算机可读介质传输。就此而言，计算机可读介质可以是可用于存储信息且可由计算设备访问的任何可用介质。一些实施方案还可在分布式计算环境中实践，在所述分布式计算环境中，操作由通过通信网络链接的一个或多个远程处理设备执行。在分布式计算环境中，软件、控制模块、逻辑和/或逻辑模块可位于包括存储器存储设备在内的本地和远程计算机存储介质两者中。
此外，应当理解，本文所述的实施方案阐明了示例性具体实施，并且功能性元件、逻辑块、模块和电路元件可以与所述实施方案一致的各种其他方式来实施。此外，由此类功能性元件、逻辑块、模块和电路元件执行的操作可组合和/或分离以用于给定的具体实施，并且可由更多数量或更少数量的部件或模块来执行。如本领域技术人员在阅读本公开之后所显而易见的，本文所述和所示的单独实施方案中的每个具有分立部件和特征部，在不背离本公开的范围的前提下，所述部件和特征部可容易地与其他若干方面中任意方面的特征部分离或组合。可按所述事件的顺序或按任何其他在逻辑上可能的顺序来执行任何所述方法。
除非另外特别说明，否则应当理解，术语诸如“处理”、“运算”、“计算”、“确定”等是指计算机或计算系统、或类似电子计算装置的动作和/或过程，所述电子计算装置诸如通用处理器、DSP、ASIC、FPGA或其他可编程逻辑装置、分立门或晶体管逻辑件、分立硬件部件，或它们的任何组合，其被设计以执行本文所述的功能，其操纵表示为寄存器和/或存储器内的物理量(例如，电子)的数据并且/或者将其转换成类似地表示为存储器、寄存器或其他此类信息存储装置、传送装置或显示装置内的物理量的其他数据。
值得注意的是，一些实施方案可使用表达“联接”和“连接”以及它们的衍生词来描述。并不希望这些术语彼此同义。例如，一些实施方案可使用术语“连接”和/或“联接”来描述，以表示两个或更多个元件彼此直接物理接触或电接触。然而，术语“联接”还可以指两个或更多个元件彼此不是直接接触，而是彼此配合或相互作用。就软件元件而言，例如，术语“联接”可以是指接口、消息接口、应用程序接口(API)、交换消息等。
本文所公开的装置可被设计成在单次使用后废弃，或者其可被设计成能够使用多次。然而无论是哪种情况，该装置都可在至少使用一次后经过修复再行使用。修复可包括拆卸装置、清洁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，所述装置可拆卸，而且可以任意组合选择性地更换或移除所述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，可对所述装置进行重新组装，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会理解，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。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。
虽然本文描述了多个实施方案，但可以实现那些实施方案的多种修改形式、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，在公开了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方案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。

Claims (8)

1.一种端部执行器，包括：
刀片，所述刀片具有被构造成能够解剖和凝聚组织的直切割边缘以及平坦的后边缘，其中所述刀片的后边缘位于所述刀片的切割边缘的相反侧，并且所述刀片被构造成能够联接到超声波导并且被构造成能够以超声频率振动从而解剖和凝聚组织；
屏蔽部分，所述屏蔽部分能够导热，并包封所述刀片的所述后边缘，其中所述屏蔽部分被构造成能够通过覆盖所述刀片的侧面的一部分来屏蔽所述刀片并使其他组织与所述刀片隔离；以及
高摩擦表面，该高摩擦表面能够导热，并联接到屏蔽部分并且定位在屏蔽部分和刀片的后边缘之间，其中在端部执行器被构造成解剖构型时，在高摩擦表面和刀片的后边缘之间限定空间；
其中，在端部执行器被构造成密封构型时，高摩擦表面接触刀片的后边缘并且被构造成能够通过使刀片的超声振动摩擦地耦合到高摩擦表面来生成热量，并且其中屏蔽部分被构造成能够作为通过使来自高摩擦表面的热量耦合到组织来凝聚或密封组织的表面。
2.根据权利要求1所述的端部执行器，还包括至少一个低摩擦表面，所述至少一个低摩擦表面联接到所述屏蔽部分并且定位在所述刀片的侧向边缘旁边，所述低摩擦表面被构造成能够允许所述刀片在基于所述刀片的侧向移动接触所述低摩擦表面时发生超声振动。
3.根据权利要求1所述的端部执行器，还包括轴，所述轴包括支点部件，所述支点部件被构造成能够联接到定位于所述轴内的所述超声波导。
4.根据权利要求3所述的端部执行器，其中所述支点基于所述超声振动的频率而定位在节点处。
5.根据权利要求1所述的端部执行器，还包括防护罩，所述防护罩联接到所述屏蔽部分并且覆盖所述刀片的远侧端部的至少一部分。
6.根据权利要求1所述的端部执行器，还包括凹陷部，所述凹陷部凹进所述屏蔽部分的近侧端部中并且被构造成能够在对所述屏蔽部分的与所述刀片的位置相反的一侧施加力时，使所述屏蔽部分柔性地弯曲。
7.根据权利要求1所述的端部执行器，还包括滑动机构，所述滑动机构被构造成能够使所述屏蔽部分和所述刀片滑入和滑出所述端部执行器。
8.根据权利要求1所述的端部执行器，其中所述屏蔽部分还被构造成能够围绕所述刀片旋转，使得所述高摩擦表面被构造成能够在第一旋转构型时接触所述刀片的所述后边缘并且所述高摩擦表面被构造成能够在第二旋转构型时接触所述刀片的所述切割边缘。
CN201680038980.1A 2015-06-30 2016-06-24 用于使用屏蔽型腹腔镜式胆囊切除术解剖器进行密封的可平移外管 Active CN107847242B (zh)

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