CN108135608B - 在致动行程中具有相对于远侧钉的最小化距离的外科钉致动滑动件 - Google Patents
在致动行程中具有相对于远侧钉的最小化距离的外科钉致动滑动件 Download PDFInfo
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Abstract
本发明提供了一种外科器械,所述外科器械包括具有钉仓的端部执行器。所述钉仓包括平台、终端驱动器组件和楔形滑动件。所述终端驱动器组件被定位成与所述钉仓的远侧末端相邻。所述终端驱动器组件被构造成能够接收所述钉仓中的钉的第一终端部分。所述终端驱动器组件在所述端部执行器的钳口内至少部分地限定其下方的存储空间。所述楔形滑动件被构造成能够接近所述平台纵向地滑动并且接合所述终端驱动器组件,并且朝向所述砧座驱动所述多个钉的所述终端部分以在组织中成形。所述楔形滑动件的至少大部分被构造成能够在所述楔形滑动件处于远侧滑动件位置时适配在所述存储空间内并且不会朝远侧滑动超过所述终端驱动器组件。
Description
背景技术
在一些环境下,内窥镜式外科器械相对于传统的开放式外科装置来说是优选的,因为较小的切口可减少术后恢复时间和并发症。因此,一些内窥镜式外科器械可适于通过套管针的插管来将远侧端部执行器放置在期望的外科手术部位。这些远侧端部执行器(例如,直线切割器、抓紧器、切割器、缝合器、施夹器、进入装置、药物/基因治疗递送装置、以及使用超声波振动、RF、激光等的能量递送装置)可以多种方式接合组织,以实现诊断效果或治疗效果。内窥镜式外科器械可包括位于端部执行器和由临床医生操纵的柄部部分之间的轴。此种轴可使得能够插入到期望的深度并围绕轴的纵向轴线旋转,以由此有利于将端部执行器定位在患者体内。还可通过包括一个或多个关节运动接头或特征部而进一步有利于定位该端部执行器,使得端部执行器能够选择性地进行关节运动或者以其他方式相对于轴的纵向轴线偏转。
内窥镜式外科器械的示例包括外科缝合器。一些此类缝合器能够操作以夹紧组织层,切穿夹持的组织层,并且将钉驱动穿过组织层,以在组织层的切断端部附近将切断的组织层基本上密封在一起。仅示例性外科缝合器被公开于以下专利中:1989年2月21日公布的标题为“Pocket Configuration for Internal Organ Staplers”的美国专利 4,805,823;1995年5月16日公布的标题为“Surgical Stapler and Staple Cartridge”的美国专利5,415,334;1995年11月14日公布的标题为“Surgical Stapler Instrument”的美国专利5,465,895;1997年1月28 日公布的标题为“Surgical Stapler Instrument”的美国专利5,597,107; 1997年5月27日公布的标题为“Surgical Instrument”的美国专利 5,632,432;1997年10月7日公布的标题为“Surgical Instrument”的美国专利5,673,840;1998年1月6日公布的标题为“Articulation Assembly for Surgical Instruments”的美国专利5,704,534;1998年9 月29日公布的标题为“Surgical Clamping Mechanism”的美国专利 5,814,055;2005年12月27日公布的标题为“Surgical Stapling Instrument Incorporatingan E-Beam Firing Mechanism”的美国专利 6,978,921;2006年2月21日公布的标题为“Surgical Stapling Instrument Having Separate Distinct Closing and FiringSystems”的美国专利 7,000,818;2006年12月5日公布的标题为“Surgical StaplingInstrument Having a Firing Lockout for an Unclosed Anvil”的美国专利7,143,923;2007年12月4日公布的标题为“Surgical Stapling Instrument Incorporating a Multi-Stroke Firing Mechanism with a Flexible Rack”的美国专利7,303,108;2008年5月6日公布的标题为“Surgical Stapling Instrument Incorporating a Multistroke FiringMechanism Having a Rotary Transmission”的美国专利7,367,485;2008年6月3日公布的标题为“Surgical Stapling Instrument Having a Single Lockout Mechanism forPrevention of Firing”的美国专利7,380,695;2008年6 月3日公布的标题为“Articulating Surgical Stapling Instrument Incorporating a Two-Piece E-BeamFiring Mechanism”的美国专利 7,380,696;2008年7月29日公布的标题为“SurgicalStapling and Cutting Device”的美国专利7,404,508;2008年10月14日公布的标题为“Surgical Stapling Instrument Having Multistroke Firing with Opening Lockout”的美国专利7,434,715;2010年5月25日公布的标题为“Disposable Cartridge withAdhesive for Use with a Stapling Device”的美国专利7,721,930;2013年4月2日公布的标题为“Surgical Stapling Instrument with An Articulatable End Effector”的美国专利 8,408,439;和2013年6月4日公布的名称为“Motor-Driven Surgical CuttingInstrument with Electric Actuator Directional Control Assembly”的美国专利8,453,914。以上引用的美国专利中的每个的公开内容以引用方式并入本文。
尽管上文所涉及的外科缝合器被描述为用于内窥镜式手术中,但应当理解,此类外科缝合器也可用于开腹手术和/或其他非内窥镜式手术中。仅以举例的方式,在胸廓外科手术中,外科缝合器可通过胸廓切开术被插入并由此位于患者肋骨之间以到达一个或多个器官,所述胸廓外科手术不使用套管针作为缝合器的导管。此类手术可包括使用缝合器来切断和闭合通向肺部的血管。例如,在从胸腔中取出器官之前,可通过缝合器来切断并闭合通向器官的血管。当然,外科缝合器可用于各种其他情况和手术中。
特别适用于通过胸廓切开术使用的外科缝合器的示例公开于: 2015年7月29日提交的标题为“Surgical Staple Cartridge with Compression Feature at Knife Slot”的美国专利申请14/810,786;2014 年8月28日公布的标题为“Surgical Instrument EndEffector Articulation Drive with Pinion and Opposing Racks”的美国专利公布2014/0243801;2014年8月28日公布的标题为“Lockout Feature for Movable CuttingMember of Surgical Instrument”的美国专利公布 2014/0239041;2014年8月28日公布的标题为“Integrated Tissue Positioning and Jaw Alignment Features for SurgicalStapler”的美国专利公布2014/0239042;2014年8月28日公布的标题为“Jaw ClosureFeature for End Effector of Surgical Instrument”的美国专利公布 2014/0239036;2014年8月28日公布的标题为“Surgical Instrument with Articulation Lock having aDetenting Binary Spring”的美国专利公布2014/0239040;2014年8月28日公布的标题为“Distal Tip Features for End Effector of Surgical Instrument”的美国专利公布2014/0239043;2014年8月28日公布的标题为“Staple Forming Features for SurgicalStapling Instrument”的美国专利公布 2014/0239037;2014年8月28日公布的标题为“Surgical Instrument with Multi-Diameter Shaft”的美国专利公布2014/0239038;和2014 年8月28日公布的标题为“Installation Features for Surgical Instrument EndEffector Cartridge”的美国专利公布2014/0239044。上述美国专利申请中的每个的公开内容均以引用方式并入本文。
虽然已制造和使用各种外科缝合器械和相关联的部件,但据信在本发明人之前还无人制造或使用在所附权利要求中所描述的发明。
附图说明
并入本说明书中并构成本说明书的一部分的附图示出了本发明的实施方案,并且与上面给出的本发明的一般描述以及下面给出的实施方案的详细描述一起用于解释本发明的原理。
图1示出示例性进行关节运动的外科缝合器械的透视图;
图2示出了图1的器械的侧正视图;
图3示出了图1器械的端部执行器的透视图,其中端部执行器处于闭合构型;
图4示出了图3的端部执行器的透视图,其中端部执行器处于打开构型;
图5示出了图3的端部执行器的分解透视图;
图6示出了沿图4的线6-6截取的图3的端部执行器的剖面端视图;
图7A示出了图3的端部执行器沿图4的线7-7截取的剖面侧视图,其中击发梁处于近侧位置;
图7B示出了图3的端部执行器沿图4的线7-7截取的剖面侧视图,其中击发梁处于远侧位置;
图8示出了图3的被定位在组织处并已在组织中被致动了一次的端部执行器的透视图;
图9示出了另一个示例性关节运动外科缝合器械的侧正视图;
图10示出图9的器械的端部执行器的透视图,其中端部执行器处于打开构造;
图11示出了图10的端部执行器的下钳口的顶视图;
图12示出了图10的端部执行器的上钳口的底视图;
图13示出了图11的下钳口的分解透视图;
图14示出了大致沿着图11的下钳口的中心线截取的在第二纵向位置处的图13的楔形滑动件的侧剖视图,其中图13的三元组驱动器组件处于上部位置;
图15以沿图11的剖面线15-15截取的局部剖面图示出了图11 的下钳口的透视图;
图16A示出了具有延伸穿过肝脏组织的血管的肝脏的示意图;
图16B示出了图10的端部执行器切断图16A的肝脏组织的示意图;
图16C示出了从图16A的切断的肝脏组织中暴露出来的图16B 的血管的示意图;
图16D描绘了图10的端部执行器缝合图16C的暴露的血管的示意图;并且
图16E示出了具有一部分肝脏组织和从其切除的血管的图16A 的肝脏的示意图。
附图并非旨在以任何方式进行限制,并且能够设想本发明的各种实施方案可以多种其他方式来执行,包括那些未必在附图中示出的方式。结合在本说明书中并形成本说明书的一部分的附图例示了本发明的若干方面,并与描述一起用于解释本发明的原理;然而,应当理解,本发明不限于所示出的确切布置。
具体实施方式
本发明的某些示例的以下说明不应用于限定本发明的范围。根据以举例的方式示出的以下说明,本发明的其他示例、特征、方面、实施方案和优点对于本领域的技术人员将是显而易见的,一种最佳方式被设想用于实施本发明。如将认识到,本发明能够具有其他不同且明显的方面,这些方面均不脱离本发明。因此,附图和说明应被视为实质上是例示性的而非限制性的。
I.示例性外科缝合器
图1示出包括柄部组件20、轴组件30和端部执行器40的示例性外科缝合和切断器械10。端部执行器40和轴组件30的远侧部分的尺寸被设计成用于在图1所示的非关节运动状态中穿过套管针插管插入患者的手术部位,以用于执行外科手术。仅以举例的方式,此种套管针可从患者的两个肋骨之间或其他地方插入患者的腹部中。在一些情况下,在不存在套管针的情况下使用器械10。例如,端部执行器40 和轴组件30的远侧部分可通过胸廓切开术或其他类型的切口直接插入。应当理解,本文中使用的术语诸如“近侧”和“远侧”是相对于临床医生抓握器械10的柄部组件20而言的。因此,端部执行器40 相对于更近侧的柄部组件20而位于远侧。还应当理解,为便利和清楚起见,本文相对于图式使用空间用语诸如“竖直”和“水平”。然而,外科器械能够在许多取向和位置中使用,并且这些术语并非旨在为限制性的和绝对的。
A.示例性柄部组件和轴组件
如图1至图2所示,本示例的柄部组件20包括手枪式握把22、闭合触发器24和击发触发器26。每个触发器24,26可朝向和远离手枪式握把22选择性地枢转,如将在下文中更详细地描述。柄部组件 20还包括砧座释放按钮25、击发梁反向开关27和可移除电池组28。这些部件还将在下文中更详细地描述。当然,除了或代替上文所述的那些中的任何一者,柄部组件20可具有多种其他部件、特征和可操作性。参考本文的教导内容,柄部组件20的其他合适的构型对于本领域的普通技术人员将是显而易见的。
如图1至图3所示,本示例的轴组件30包括外部闭合管32、关节运动节段34和闭合环36,该闭合环与端部执行器40进一步联接。闭合管32沿轴组件30的长度延伸。闭合环36定位在关节运动节段 34的远侧。闭合管32和闭合环36被构造成能够相对于柄部组件20 纵向平移。闭合管32的纵向平移经由关节运动节段34而被传送到闭合环36。可用于提供闭合管32和闭合环36的纵向平移的示例性特征将在下文中更详细地进行描述。
关节运动节段34能够操作以侧向偏转闭合环36和端部执行器 40,从而以期望的角度(α)侧向远离轴组件30的纵向轴线LA。由此,端部执行器40可从所需的角度或由于其他原因到达器官的后面或接近组织。在一些型式中,关节运动节段34能够使得端部执行器40沿单个平面偏转。在一些其他型式中,关节运动节段34能够使得端部执行器沿多于一个平面偏转。在本示例中,关节运动通过位于轴组件 30的近侧端部的关节运动控制旋钮35而被控制。钮35能够围绕垂直于轴组件30的纵向轴线LA的轴线旋转。响应于旋钮35的旋转,闭合环36和端部执行器40围绕垂直于轴组件30的纵向轴线LA的轴线枢转。仅以举例的方式,旋钮35的顺时针旋转可引起闭合环36和端部执行器40在关节运动节段34处的对应的顺时针枢转。关节运动节段34被构造成能够将闭合管32的纵向平移传送到闭合环36,而无论关节运动节段34是处于笔直构型还是关节运动构型。
在一些型式中,关节运动节段34和/或关节运动控制旋钮35根据下列专利的教导内容中的至少一些来构造和操作:2014年8月28日公布的标题为“Surgical InstrumentEnd Effector Articulation Drive with Pinion and Opposing Racks”的美国公布2014/0243801,其公开内容以引用方式并入本文。关节运动节段34也可根据2014年6月25日提交的公开内容以引用方式并入本文的标题为“Articulation Drive Features forSurgical Stapler”的美国专利No.14/314,125,其公开内容以引用方式并入本文;并且/或者根据以下各种教导内容来构造和操作。参考本文的教导内容,关节运动节段34和关节运动旋钮35可采用的其他合适的形式对于本领域的普通技术人员将是显而易见的。
如图1至图2所示,本示例的轴组件30还包括旋钮31。旋钮31 能够操作以使整个轴组件30和端部执行器40相对于柄部组件20围绕轴组件30的纵向轴线LA旋转。在一些型式中,旋钮31能够操作以选择性地锁定轴组件30和端部执行器40相对于柄部组件20围绕轴组件30的纵向轴线(LA)的角度定位。例如,旋钮31能够在第一纵向位置与第二纵向位置之间平移,在第一纵向位置中,轴组件30和端部执行器40能够相对于柄部组件20围绕轴组件30的纵向轴线(LA) 旋转;并且在第二纵向位置中,轴组件30和端部执行器40不能够相对于柄部组件20围绕轴组件30的纵向轴线LA旋转。当然,除了或替代上文所述那些中任一者,轴组件30可具有多种其他部件、特征和可操作性。仅以举例的方式,轴组件30的至少一部分根据以下专利的教导内容中的至少一些来构造:2014年8月28日公布的标题为“SurgicalInstrument with Multi-Diameter Shaft”的美国公布 2014/0239038,其公开内容以引用方式并入本文。参考本文的教导内容,轴组件30的其他合适构型对于本领域的普通技术人员将是显而易见的。
B.示例性端部执行器
同样如图3到图5所示,本示例的端部执行器40包括下钳口50 和可枢转砧座60。砧座60包括被设置在下钳口50的对应弯曲狭槽 54中的一对一体的向外延伸的销66。砧座60能够朝向和远离下钳口 50在打开位置(示出出于图2和图4中)与闭合位置(示出出于图1、图3和图7A至图7B中)之间枢转。使用术语“能够枢转”(以及以“枢转”为基础的类似术语)不应被解读为必须要求围绕固定轴线进行枢转运动。例如,在本示例中,砧座60围绕由销66限定的轴线枢转,当砧座60朝下钳口50运动时,这些销沿下钳口50的弯曲狭槽54滑动。在此类型式中,枢轴线沿由狭槽54限定的路径平移,而砧座60同时围绕所述轴线枢转。除此之外或另选地,枢轴线首先可沿狭槽54滑动,然后在枢轴线已沿狭槽54滑动特定距离之后,砧座60围绕所述枢轴线枢转。应当理解,此种滑动/平移枢转运动被包含在诸如“枢转”(“pivot”、“pivots”、“pivoting”)、“枢转的” (“pivotal”)、“能够枢转的”(“pivotable”)等术语内。当然,一些型式可提供砧座60围绕保持固定且不在狭槽或通道内平移的轴线的枢转运动等。
如图5充分示出的,本示例的下钳口50限定被构造成能够接收钉仓70的通道52。可将钉仓70插入到通道52中,可致动端部执行器40,并且然后可移除钉仓70并利用另一个钉仓70来替换。下钳口 50因此可释放地保持钉仓70与砧座60对齐,以用于致动端部执行器40。在一些型式中,下钳口50根据以下专利的教导内容中的至少一些来构造:2014年8月28日公布的标题为“Installation Features for Surgical Instrument End EffectorCartridge”的美国公布第 2014/0239044号,该公布的公开内容以引用方式并入本文。参考本文的教导内容,下钳口50可采用的其他合适的形式对于本领域的普通技术人员将是显而易见的。
如图4至图6充分示出的,本示例的钉仓70包括仓体71和被固定到仓体71的下侧的托盘76。仓体71的上侧呈现平台73,当砧座 60处于闭合位置时,组织可压靠在所述平台上。仓体71还限定纵向延伸通道72和多个钉凹坑74。钉77被定位在每个钉凹坑74中。钉驱动器75也被定位在每个钉凹坑74中,位于对应钉77下面以及托盘76上方。如将在下文中更详细地描述的,钉驱动器75能够操作以在钉凹坑74中向上平移,以由此向上驱动钉77穿过钉凹坑74并与砧座60接合。钉驱动器75被楔形滑动件78向上驱动,所述楔形滑动件被捕获在仓体71与托盘76之间并纵向平移穿过仓体71。楔形滑动件78包括一对倾斜成角的凸轮表面79,这对倾斜成角的凸轮表面被构造成能够接合钉驱动器75,并由此当楔形滑动件78纵向平移穿过仓70时向上驱动钉驱动器75。例如,当楔形滑动件78处于如图 7A所示的近侧位置中时,钉驱动器75处于向下位置中并且钉77位于钉凹坑74中。当通过平移刀构件80将楔形滑动件78驱动到如图 7B所示的远侧位置时,楔形滑动件78向上驱动钉驱动器75,由此驱动钉77离开钉凹坑74并进入钉成形凹坑64中。因此,当楔形滑动件78沿水平维度平移时,钉驱动器75沿竖直维度平移。
应当理解,钉仓70的构型可以多种方式改变。例如,本示例的钉仓70包括位于通道72的一侧的两排纵向延伸的钉凹坑74;以及位于通道72的另一侧上的另一组两排纵向延伸的钉凹坑74。然而,在一些其他型式中,钉仓70在通道72的每一侧包括三个、一个或一些其他数目的钉凹坑74。在一些型式中,钉仓70根据以下公布的教导内容中的至少一些来构造和操作:2014年8月28日提交的标题为“Integrated Tissue Positioning and JawAlignment Features for Surgical Stapler”的美国公布第2014/0239042号,该专利的公开内容以引用方式并入本文。除此之外或另选地,钉仓70可根据以下公布的教导内容中的至少一些来构造和操作:2014年8月28日公布的标题为“Installation Features forSurgical Instrument End Effector Cartridge”的美国公布第2014/0239044号,该公布的公开内容以引用方式并入本文。参考本文的教导内容,钉仓70可采用的其他合适的形式对于本领域的普通技术人员将是显而易见的。
如在图4中最佳所见,本示例的砧座60包括纵向延伸通道62和多个钉成形凹坑64。通道62被构造成能够当砧座60处于闭合位置时与钉仓70的通道72对齐。每个钉成形凹坑64被定位成当砧座60处于闭合位置时位于钉仓70的对应钉凹坑74上方。钉成形凹坑64被构造成能够当驱动钉77穿过组织进入砧座60时使钉77的腿变形。具体地,钉成形凹坑64被构造成能够使钉77的腿弯曲,以将成形钉 77固定在组织中。砧座60可根据以下来构造:2014年8月28日公布的标题为“Integrated Tissue Positioning and Jaw Alignment Featuresfor Surgical Stapler”的美国专利公布2014/0239042;2014年8月28 日公布的标题为“Jaw Closure Feature for End Effector of Surgical Instrument”的美国专利公布2014/0239036;和/或2014年8月28日公布的标题为“Staple Forming Features forSurgical Stapling Instrument”的美国公布2014/0239037,上述公布的公开内容以引用方式并入本文。参考本文的教导内容,砧座60可采用的其他合适的形式对于本领域的普通技术人员将是显而易见的。
在本示例中,刀构件80被构造成能够通过端部执行器40而平移。如图5和图7A至图7B充分示出的,刀构件80被固定到击发梁82 的远侧端部,该击发梁延伸穿过轴组件30的一部分。如图4和图6 充分示出,刀构件80被定位在砧座60的通道62和钉仓70的通道72 中。刀构件80包括朝远侧呈现的切割刃84,所述切割刃被构造成能够当刀构件80朝远侧平移穿过端部执行器40时切断被压缩在砧座60 和钉仓70的平台73之间的组织。如上文所指出并如图7A至图7B 所示,当刀构件80通过端部执行器40朝远侧平移时,刀构件80也朝远侧驱动楔形滑动件78,由此驱动钉77穿过组织并抵靠砧座60 成形。可用于通过端部执行器40朝远侧驱动刀构件80的各种特征部将在下文中更详细地进行描述。
在一些型式中,端部执行器40包括闭锁特征部,该闭锁特征部被构造成能够当钉仓70未插入下钳口50中时阻止刀构件80通过端部执行器40朝远侧推进。除此之外或另选地,端部执行器40可包括闭锁特征部,该闭锁特征部被构造成能够当已被致动一次(例如,其中从中布置所有钉77)的钉仓70插入到下钳口50中时阻止刀构件 80通过端部执行器40朝远侧推进。仅以举例的方式,此类闭锁特征部可根据以下美国专利的教导内容中的至少一些来构造:2014年8 月28日公布的标题为“Lockout Feature for Movable CuttingMember of Surgical Instrument”的美国专利公布2014/0239041,其公开内容以引用方式并入本文;和/或2014年6月25日提交的标题为“Articulation Drive Features forSurgical Stapler”的美国专利申请No.14/314,108(其公开内容以引用方式并入本文)的教导内容中的至少一些来构造。参考本文的教导内容,闭锁特征部可采用的其他合适的形式对于本领域的普通技术人员将是显而易见的。另选地,端部执行器40可简单地省去此类闭锁特征部。
C.砧座的示例性致动
在本示例中,通过相对于端部执行器40朝远侧推动闭合环36而朝下钳口50驱动砧座60。响应于闭合环36相对于端部执行器40的远侧平移,闭合环36通过凸轮作用与砧座60协作,以朝向下钳口50 驱动砧座60。类似地,响应于闭合环36相对于端部执行器40的近侧平移,闭合环36可与砧座60协作,以远离下钳口50而打开砧座60。仅以举例的方式,闭合环36和砧座60可根据以下专利的教导内容中的至少一些来相互作用:2014年8月28日公布的标题为“Jaw Closure Feature for End Effector of Surgical Instrument”的美国专利公布 2014/0239036,其公开内容以引用方式并入本文;和/或2014年6月 25日提交的标题为“Jaw Opening Feature for Surgical Stapler”的美国专利申请14/314,108,其公开内容以引用方式并入本文。可用于提供闭合环36相对于端部执行器40的纵向平移的示例性特征部将在下文中更详细地描述。
如上所述,柄部组件20包括手枪式握把22和闭合触发器24。同样如上文所指出,响应于闭合环36的远侧推进,砧座60朝向下钳口 50闭合。在本示例中,闭合触发器24可朝向手枪式握把22枢转以朝远侧驱动闭合管32和闭合环36。参考本文的教导内容,可用于将闭合触发器24朝手枪式握把22的枢转运动转化成闭合管32和闭合环 36相对于柄部组件20的远侧平移的各种合适的部件对于本领域的普通技术人员将是显而易见的。当闭合触发器24达到完全枢转状态使得砧座60相对于下钳口50处于完全闭合位置时,柄部组件20中的锁定特征部锁定闭合触发器24和闭合管32的位置,由此将砧座60 相对于下钳口50锁定在完全闭合位置。这些锁定特征部通过致动砧座释放按钮25而释放。砧座释放按钮25被构造成并定位成能够由抓握手枪式握把22的操作者的手的拇指致动。换句话讲,操作者可利用一只手来抓握手枪式握把22,利用同一只手的一个或多个手指来致动闭合触发器24,并且然后利用同一只手的拇指来致动砧座释放按钮 25,而无需利用同一只来手释放手枪式握把22的抓握。参考本文的教导内容,可用于致动砧座60的其他合适特征部对于本领域的普通技术人员将是显而易见的。
D.击发梁的示例性致动
在本示例中,器械10提供对击发梁82的机动化控制。具体地,器械10包括机动化部件,所述机动化部件被构造成能够响应于击发触发器26朝向手枪式握把22枢转而朝远侧驱动击发梁82。在一些型式中,马达(未示出)容纳在手枪式握把22中并且从电池组28接收电力。此马达与传输组件(未示出)联接,所述传输组件将马达的驱动轴的旋转动作转换成击发梁82的线性平移。在一些此类型式中,击发梁82可仅在砧座60相对于下钳口50处于完全闭合位置时朝远侧推进。如上面参照图7A至图7B所述,在击发梁82朝远侧推进而切断组织并驱动钉77之后,用于击发梁82的驱动组件可自动反向以将击发梁82朝近侧驱动回到回缩位置(例如,从图7B所示的位置回到图7A所示的位置)。另选地,操作者可致动击发梁反向开关27,这可使得用于击发梁82的驱动组件反向以便将击发梁82回缩到近侧位置。本示例的柄部组件20还包括应急特征部21,该应急特征部能够操作以提供机械应急,由此允许操作者手动地朝近侧回缩击发梁82 (例如,万一在击发梁82处于远侧位置时出现电力丢失的情况等等)。
仅以举例的方式,能够操作以提供击发梁82的机动化致动的这些特征部可根据以下专利的教导内容中的至少一些来构造和操作: 2012年7月3日公布的标题为“Motor-Driven Surgical Instrument”的美国专利8,210,411,其公开内容以引用方式并入本文。作为另一个仅例示性示例,能够操作以提供击发梁82的机动化致动的这些特征部可根据以下专利的教导内容中的至少一些来构造和操作:2013年6 月4日公布的标题为“Motor-Driven Surgical Cutting Instrument with Electric Actuator Directional ControlAssembly”的美国专利8,453,914,其公开内容以引用方式并入本文。作为另一个仅例示性示例,能够操作以提供击发梁82的机动化致动的这些特征部可根据以下专利申请的教导内容中的至少一些来构造和操作:2014年3月26日提交的标题为“Surgical InstrumentComprising a Sensor System”的美国专利申请14/226,142,其公开内容以引用方式并入本文。
参考本文的教导内容,可用于提供击发梁82的机动化的其他合适的部件、特征部和构型对于本领域的普通技术人员将是显而易见的。还应当理解,一些其他型式可提供对击发梁82的手动驱动,使得马达可被省略。仅以举例的方式,击发梁82可根据本文引用的任何其他参考文献的教导内容中的至少一些来手动地致动。
图8示出了已通过单个行程被致动穿过组织90的端部执行器40。如图所示,切割刃84(在图8中被遮住)已切穿组织90,同时钉驱动器75已驱动两排交错的钉77穿过由切割刃84产生的切割线的每一侧的组织90。在此示例中,钉77全部与切割线基本上平行地取向,但应当理解,钉77可以任何合适的取向定位。在本示例中,在第一行程完成之后,从套管针取出端部执行器40,利用新钉仓70来替换已空钉仓70,并且随后端部执行器40再次插入穿过套管针而到达缝合位点以用于进行进一步的切割和缝合。此过程可重复进行,直到已提供期望量的切口和钉77。砧座60可需要闭合以有利于通过套管针的插入和取出;并且砧座60可需要打开以有利于钉仓70的替换。
应当理解,在每次致动行程期间,切割刃84可基本上在钉77被驱动穿过组织的同时切割组织。在本示例中,切割刃84仅稍微落后于钉77的驱动,使得钉77正好在切割刃84穿过组织之前被驱动穿过该组织的相同区域,但应理解,这个顺序可颠倒,或者切割刃84 可直接与相邻的钉同步。虽然图8示出了在组织90的两个层92,94 中被致动的端部执行器40,但应当理解,端部执行器40可被致动穿过组织90的单个层或组织的多于两个层92,94。还应当理解,与切割刃84产生的切割线相邻的钉77的成形和定位可基本上密封切割线处的组织,由此减少或防止切割线处的出血和/或其他体液的渗漏。此外,尽管图8示出端部执行器40在组织的两个基本上平坦的相反平面层 92,94中致动,但应当理解,端部执行器40也可在管状结构诸如血管、胃肠道的一部分等上致动。因此,不应将图8视为对端部执行器40 的设想用途进行任何限制。参考本文的教导内容,其中可使用器械10 的各种合适情况和程序对于本领域的普通技术人员将是显而易见的。
还应当理解,器械10的任何其他部件或特征部可根据本文所述的各种参考文献中的任一者来构造和操作。可提供用于器械10的其他示例性修改将在下文中更详细地描述。下述教导内容可并入器械10 内的各种合适方式对于本领域的普通技术人员将是显而易见的。类似地,可将下述教导内容与本文引用的参考文献的各种教导内容进行组合的各种合适方式对于本领域的普通技术人员将是显而易见的。还应当理解,下述教导内容并不限于本文引用的参考文献中教导的器械10 或装置。下述教导内容可易于应用到各种其他种类的器械,所述器械包括将不被归类为外科缝合器的器械。参考本文的教导内容,其中可应用下文教导内容的各种其他合适的装置和情况对本领域的普通技术人员将是显而易见的。
II.示例性另选缝合端部执行器
虽然上述外科器械10提供了可用于缝合和切断患者体内组织的端部执行器40的一个示例,但应理解的是,人体包括各种各样的组织,这些组织位于整个患者的不同的、有时是难以接近的部位。例如,肝脏包括具有遍及全身的血管或管腔的组织。在肝脏包含肿瘤的环境中,可能需要切除含有肿瘤的肝脏部分。切除可以是解剖的(例如,切除肝脏的右侧或左侧,包括该侧的叶)或非解剖的(例如,仅切除肝组织的单个叶或楔形部)。该切除过程可能需要至少三种步骤—第一步,将血管或管腔周围的组织(例如肝实质)解剖,从而分离或露出血管或管腔;第二步,结扎那些血管或管腔;第三步,切断结扎的血管或管腔。
一种此类肝脏切除方法包括众所周知的弯血管钳法,其中使用弯血管钳来压缩肝脏组织,从而通过压碎作用解剖组织。但是,治疗可能需要许多器械以适应人体内的各种组织和血管或管腔,从而增加与评估组织状态、选择和/或改变器械、执行切除相关联的时间和复杂性。因此可能期望提供具有端部执行器412的外科器械410,该端部执行器具有一对挤压表面414,416,这一对挤压表面被构造成能够通过挤压组织来切断组织;同时还提供相邻的钉仓418以选择性地结扎穿过组织的一个或多个血管或管腔。由此,单个外科器械410将允许操作者更快速地评估组织,并且进行进一步的组织解剖和/或血管和管腔的结扎。
以下通过利用挤压表面414,416解剖肝脏组织(例如,肝实质) 并使用钉结扎相关血管或管腔(例如,门静脉、肝静脉分支、肝动脉分支、肝外血管等)为背景,描述了外科器械410。在一些情况下(例如,在肝静脉分支和肝动脉分支等的情况下),当操作者用表面414,416压碎肝脏组织时,暴露出由钉密封的血管或管腔。在一些其他情况下(例如,在门静脉和肝外血管等的情况下),由钉密封的血管或管腔与操作者用表面414,416压碎了的肝脏组织分开。尽管以肝脏切除为背景提供了外科器械410和治疗方法的以下描述,但是应当理解,外科器械410可以可选地被构造为治疗人体内具有相似特征部的任何组织。还应当理解,下文所述的特征部可易于与上述外科器械10结合。为此,相似标号指示上文更详细描述的相似特征部。
在以下示例中,端部执行器412施加至少两个侧向间隔开的钉排,其中一排中的钉与另一排中的钉具有相同的高度。在一些变型中,端部执行器412被修改为施加至少两个侧向间隔开的钉排,其中一排中的钉的高度与另一排中的钉的高度不同。
A.具有缩短的直端部执行器的示例性缝合器械
图9至图13示出了具有端部执行器412的外科器械410,该端部执行器具有上挤压表面414、下挤压表面416、钉仓418和刀构件419。如上所述,因此可能需要提供此类具有端部执行器412的外科器械 410,所述端部执行器具有被构造成能够通过压碎组织来切断组织的挤压表面414,416;同时还提供相邻的钉仓418以选择性地结扎穿过组织的一个或多个血管。此外,刀构件419被构造成能够切割所述一个或多个血管以完全去除周围组织。由此,外科器械410将允许操作者更快速地评估组织,并且进行进一步的组织切割和/或组织结扎。本示例的外科器械410还包括上面详细讨论的柄部组件20和轴组件30。除非下文另有说明,结合柄部组件20和轴组件30的端部执行器412 被构造成与端部执行器40类似并且可类似地进行操作(参见图1)。仅以举例的方式,端部执行器412可具有约40mm的长度和约7mm的宽度。另选地,可使用任何其他合适的尺寸。
本示例的端部执行器412包括使砧座424成形的下钳口420和上钳口422。上钳口422相对于下钳口420枢转地安装,以在其中间接收组织。更具体地讲,砧座424可在打开位置和关闭位置之间(例如,响应于触发器24朝向和远离手枪式握持部22的枢转运动)朝向和远离下钳口420枢转。例如,在本示例中,砧座424围绕由销(未示出) 限定的轴线枢转,当砧座424朝下钳口420移动时,这些销沿下钳口 420的弯曲狭槽(未示出)滑动。在此类型式中,枢轴线沿由狭槽(未示出)限定的路径平移,而砧座424同时围绕所述轴线枢转。除此之外或另选地,枢轴线首先可沿狭槽(未示出)滑动,然后在枢轴线沿狭槽(未示出)滑动特定距离之后,砧座424围绕所述枢轴线枢转。另选地,一些型式可提供砧座424围绕保持固定且不在狭槽或通道内平移的轴线的枢转运动等。
如图11至图13充分示出,本示例的下钳口420限定通道426,该通道被构造成能够接收钉仓418。可将钉仓418插入到通道426中,可致动端部执行器412,并且然后可移除钉仓418并利用其它钉仓418 来替换。下钳口420因此将钉仓418可释放地保持成与砧座424对准,以用于致动端部执行器412。在一些另选型式中,钉仓418的部件完全整合到下钳口420中,使得端部执行器412仅可使用一次。参考本文的教导内容,下钳口420可采用的其他合适的形式对于本领域的普通技术人员而言将是显而易见的。在本示例中,下钳口和上钳口420, 422延伸到由钉仓418进一步限定的远侧末端432。
本示例的钉仓418包括仓体434和被固定到仓体434的下侧的托盘436。仓体434的上侧呈现平台438,当砧座424处于闭合位置时,组织可被压缩贴靠该平台。在本示例中,下挤压表面 416沿钉仓418定位。然而,应当理解,下挤压表面416以及配合的上挤压表面414可以可选地沿着端部执行器412定位,从而通过压缩来切断组织。
仓体434进一步限定了延伸穿过下钳口420并且沿端部执行器 412的中心线440线性延伸的细长通道439。出于下文更详细地讨论的原因,由砧座424限定的另一细长通道441亦延伸穿过上钳口422 并且沿着中心线440线性地延伸。多个钉凹坑442遵循沿中心线440相对侧上的平台438的预先确定的图案。更具体地讲,钉仓418包括位于中心线440的一侧上的两排纵向延伸的钉凹坑442;以及位于中心线440的另一侧上的另一组两排纵向延伸的钉凹坑442。然而,在一些其他型式中,钉仓418在中心线440的每一侧上包括三个、一个或一些其他数目的钉凹坑442。
多个钉444中的一者被定位在相应的钉凹坑442中。相邻排的钉凹坑442被构造成能够在横向于中心线440的方向上重叠,以便将多个钉444安装在组织内并且阻止其间的开口以改善结扎。换句话讲,在本示例中,在相邻钉凹坑442之间保持一致的间隙(G1)以保持一致的重叠。如本文所用,术语“重叠”旨在包括:某个特征部在至少一个方向上与另一个特征部重叠。因此,如果这些特征部在至少一个平面(诸如包括横向方向的横向平面)中重叠,某个特征部可以如本文所述从另一个特征部偏移并且仍然重叠。参考本文的教导内容,钉仓 418可采用的其他合适的形式对于本领域的普通技术人员将是显而易见的。
如图11至图13所示,本示例的砧座424具有多个钉成形凹坑 446。每个钉成形凹坑446被定位成当砧座424处于闭合位置时位于钉仓418的相应钉凹坑442上方。钉成形凹坑446被构造成能够当驱动钉444穿过组织进入砧座424时使钉444的每个腿448变形。具体地,钉成形凹坑446被构造成能够使钉444的腿448弯曲,以将成形钉444固定在组织中。参考本文的教导内容,砧座424可采用的其他合适的形式对于本领域的普通技术人员将是显而易见的。
如图13充分示出,钉仓418包括定位在钉凹坑442中、对应钉 444下方和托盘436上方的钉驱动器452。如将在下文中更详细地描述的,钉驱动器452能够操作以在钉凹坑442中向上平移,以由此向上驱动钉444穿过钉凹坑442并与砧座424接合。钉驱动器452由楔形滑动件456向上驱动,该楔形滑动件被捕集在仓体434 和托盘436之间,并且沿着一对凸轮槽457纵向平移穿过仓体434。楔形滑动件456包括具有前凸轮表面460、中间凸轮表面462和后凸轮表面464的凸轮斜面258。仅以举例的方式,前凸轮表面460可相对于水平平面成约45°的角度;并且中间凸轮表面462 可相对于水平平面成约22°的角度。另选地,可使用任何其他合适的角度。凸轮斜面458通常被构造成能够接合钉驱动器452,并且从而随着楔形滑动件456从近侧滑动件位置纵向平移通过钉仓418至远侧滑动件位置,向上驱动钉驱动器452。例如,当楔形滑动件456处于近侧滑动件位置时,钉驱动器452处于向下位置并且钉444位于钉凹坑442中。当通过平移刀构件419向远侧滑动件位置驱动楔形滑动件 456时,楔形滑动件456向上驱动钉驱动器452,由此驱动钉444离开钉凹坑442并进入钉成形凹坑446中。因此,当楔形滑动件456沿水平平面平移时,钉驱动器452沿相应的垂直平面平移。
在本示例中,刀构件419被构造成能够通过端部执行器412而平移。如在图13中最佳所见,刀构件419被固定到击发梁82的远侧端部,所述击发梁延伸穿过轴组件30的一部分。刀构件80分别定位于钉仓418和砧座424的通道439,441中。刀构件419包括被构造成能够当刀构件419朝远侧平移穿过端部执行器412时切断被压缩在砧座 424和钉仓418的平台438之间的组织的朝远侧呈现的切割刃468。如上所述,当刀构件419朝远侧平移穿过端部执行器412时,刀构件 419也朝远侧驱动楔形滑动件456,由此将钉444驱动穿过组织并抵靠砧座424成形。
1.钉仓的示例性缩短的远侧端部
如图14和图15所示,楔形滑动件456朝远侧滑动,直到其沿着中心线440的平移运动被钉仓418的远侧末端432阻挡。因此,楔形滑动件456有效地停在终端钉驱动器452下方,该终端钉驱动器连同托盘436限定用于其间的楔形滑动件456的存储空间506。换句话讲,远侧末端432阻止楔形滑动件456的远侧运动,使得大部分楔形滑动件456不能朝远侧滑动超过终端钉驱动器452。此外,楔形滑动件456 的凸轮斜面458的远侧部分被接收在远侧末端432的一对下孔508内,该远侧末端进一步限定存储空间506,使得楔形滑动件456的仅较小远侧部分朝远侧滑动超过钉驱动器452,如图14和图15所示。此外,凸轮表面460,462,464不完全穿过最远侧钉444的冠部的长度。
因此,三元组驱动器组件492、楔形滑动件456和远侧末端432 共同被构造成能够减小端部执行器412的远侧末端432的伸长率以改善对患者体内组织的接近性。首先,远侧钉驱动器452朝远侧悬伸超出驱动器凸轮494以增加钉444的最远侧位置,同时提供限定在下方的额外存储空间506。其次,楔形滑动件456包括多个前凸轮表面460 和中间凸轮表面462,以导致凸轮斜面458的缩短的长度。第三,远侧末端432内的下孔508提供沿着中心线440的最终平移而远侧末端 432不会朝远侧进一步伸长。由此,三元组驱动器组件492、楔形滑动件456和远侧末端432各自部分地被构造成能够减少楔形滑动件 456的行程并且减小端部执行器412的远侧末端432的伸长率以改善接近性。另外,最远侧钉凹坑446到远侧末端432的非常接近的纵向定位将使组织在最远侧钉444远侧的区域处被挤压表面414,416切断的发生率最小化。
2.组织切除的示例性方法
图16A至图16E示出了使用端部执行器412来切除组织诸如肝实质组织310,并且将血管或管腔316结扎在其中的一个示例。如上所述,血管或管腔316可以包括肝静脉或肝动脉。还应当理解,该方法可以进一步包括使用端部执行器412结扎其他血管,诸如门静脉和肝外血管等。
如图16B所示,操作者将端部执行器412定位成使得包括血管或管腔316的组织310位于下钳口和上钳口420,422之间。然后,操作者在上钳口和下钳口420,422分别的上挤压表面和下挤压表面414, 416之间压缩组织310,以将预定的挤压压力传递到组织310。仅以举例的方式,可以通过使触发器24朝向手枪式握持部22枢转而以这种方式致动钳口420,422。应当理解,钳口420,422不一定被致动到完全闭合的构造。在一些情况下,操作者可依靠通过触发器24和手枪式握持部22给出的触觉反馈来确定操作者是否已经在钳口420,422之间实现期望的间隙,以适当地压碎组织310而不会不利地损坏血管或管腔316。除此之外或另选地,操作者可以依赖于视觉反馈。
在任何情况下,由钳口420,422施加的挤压压力有效地切断组织 310,然后操作者从组织310移除端部执行器412以查看是否存在任何血管或管腔。如图16C中所示,血管或管腔316保持完整并且被暴露,在组织310的切断部分之间延伸。
在一些情况下,操作者可以保持血管或管腔316完好。然而,在本示例中,操作者结扎血管或管腔316以完成切除组织310的切断部分,如图16D所示。如上面更详细地讨论的,结扎包括将至少一些重叠的钉444放置在血管或管腔316内。因此,应当理解,可以使用相同的端部执行器412来压碎(并因此切断)肝脏组织310,并且将组织310中的血管或管腔316结扎。在本示例中,血管或管腔316被端部执行器412基本上同时缝合和切断,从而导致图16E中所示的构造。如图所示,血管或管腔316的切断的端部318通过钉444密封。由此,操作者完成切除组织310的右侧部分和血管或管腔316的对应部分。
如上所述,操作者移除端部执行器412以观察血管316,如图16C 所示。另选地,操作者可以施加预先确定的挤压压力(或如上所述基于触觉和/或视觉反馈确定),如图16B所示,随后立即切断并结扎残留在其中的任何组织,诸如血管或管腔316。因此,无需观察组织,但是在一个或多个肝脏切除手术中,操作者可发现这样的观察是期望的。应当理解,以上描述的切除仅仅是说明性的,并且不限于肝脏组织。另选地,可以根据用户的需要,利用端部执行器412在患者体内的其他组织上执行组织切除。
III.示例性组合
下述实施例涉及本文的教导内容可被组合或应用的各种非穷尽性方式。应当理解,下述实施例并非旨在限制可在本申请或本申请的后续提交文件中的任何时间提供的任何权利要求的覆盖范围。不旨在进行免责声明。提供以下实施例仅仅是出于例示性目的。设想到,本文的各种教导内容可按多种其他方式进行布置和应用。还设想到,一些变型可省略在以下实施例中所提及的某些特征。因此,下文提及的方面或特征中的任一者均不应被视为决定性的,除非另外例如由发明人或关注发明人的继承者在稍后日期明确指明如此。如果本申请或与本申请相关的后续提交文件中提出的任何权利要求包括下文提及的那些特征之外的附加特征,则这些附加特征不应被假定为因与专利性相关的任何原因而被添加。
实施例1
一种用于处理患者的组织的外科器械,包括:(a)轴组件;(b)从所述轴组件沿着钳口中心线延伸的端部执行器,所述端部执行器包括: (i)具有砧座的第一钳口,所述砧座被构造成能够使压靠所述砧座的多个钉成形;以及(ii)第二钳口,其中第一钳口和第二钳口被构造成能够在打开构型和闭合构型之间转变;(c)被接收在第二钳口内的钉仓,所述钉仓包括:(i)面向砧座的平台,其中该平台限定多个钉开口,其中所述多个钉分别定位在所述多个钉开口内,(ii)第一终端驱动器组件,该第一终端驱动器组件被定位成与钉仓的远侧末端相邻,其中该第一终端驱动器组件被构造成能够接收所述多个钉的第一终端部分,该第一终端驱动器组件在第二钳口内至少部分地限定其下方的存储空间,以及(iii)楔形滑动件,该楔形滑动件被构造成能够接近平台从近侧滑动件位置滑动到远侧滑动件位置并且接合第一终端驱动器组件,并且朝向所述砧座驱动所述多个钉的终端部分以在组织中成形,其中楔形滑动件的至少大部分被构造成能够在楔形滑动件处于远侧滑动件位置时适配在存储空间内并且不会朝远侧滑动超过第一终端驱动器组件。
实施例2
根据实施例1所述的外科器械,其中楔形滑动件还包括第一凸轮斜面,该第一凸轮斜面被构造成能够接合第一终端驱动器组件,并且朝向砧座驱动所述多个钉的终端部分以在组织中成形,其中所述第一凸轮斜面的大部分被构造成能够在楔形滑动件处于远侧滑动件位置时适配在存储空间内。
实施例3
根据实施例1至2中任一项或多项所述的外科器械,其中该楔形滑动件具有远侧鼻部,其中第二钳口具有沿着中心线朝远侧定位于其中的阻挡壁,其中该阻挡壁被构造成能够接收与其抵靠的楔形滑动件并阻止楔形滑动件朝远侧移动超过远侧滑动件位置。
实施例4
根据实施例3所述的外科器械,其中该阻挡壁限定间隙孔,该间隙孔被构造成能够接收处于远侧滑动件位置的楔形滑动件的远侧鼻部。
实施例5
根据实施例1至4中任一项或多项所述的外科器械,其中该楔形滑动件具有被构造成能够接合第一终端驱动器组件的第一凸轮斜面,该第一凸轮斜面还包括:(A)限定陡斜角度斜率的前凸轮表面,以及(B) 限定平缓角度斜率的中间凸轮表面,该平缓角度斜率相对于平台被成角度为小于陡斜角度斜率,其中该驱动器凸轮被构造成能够由前凸轮表面接合以将驱动器组件朝向第一钳口向上提升较短的距离,以减小楔形滑动件的伸长率,并且其中驱动器凸轮进一步被构造成能够由中间凸轮表面接合,以将驱动器组件朝向第一钳口进一步向上提升较长的距离,来提供足够的力使第一钉和第二钉压靠砧座以用于组织。
实施例6
根据实施例1至5中任一项或多项所述的外科器械,其中该第一终端驱动器组件具有第一终端远侧驱动器、第一终端中间驱动器和第一终端近侧驱动器;其中第一终端远侧驱动器、第一终端中间驱动器和第一终端近侧驱动器可操作地连接,使得第一终端远侧驱动器相对于第一终端中间驱动器和第一终端中间驱动器朝远侧悬伸,以得到其下方存储空间的最大伸长率,其中第一终端远侧驱动器与钉仓的远侧末端相邻。
实施例7
根据实施例6所述的外科器械,其中第一终端远侧驱动器、第一终端中间驱动器和第一终端近侧驱动器可操作地连接,使得第一终端远侧驱动器与第一终端近侧驱动器纵向对准,并且第一终端中间驱动器从第一终端远侧驱动器和第一终端近侧驱动器中的每一者横向偏移,其中第一终端远侧驱动器、第一终端中间驱动器和第一终端近侧驱动器分别接收所述多个钉的第一终端部分。
实施例8
根据实施例1至7中任一项或多项所述的外科器械,其中该钉仓还包括第二终端驱动器组件,该第二终端驱动器组件被定位成与远侧末端相邻并且被构造成能够接收所述多个钉的第二终端部分,该第二终端驱动器组件在第二钳口内进一步限定其下方的存储空间。
实施例9
根据实施例8所述的外科器械,其中第二终端驱动器组件包括第二终端远侧驱动器、第二终端中间驱动器和第二终端近侧驱动器;其中第二终端远侧驱动器、第二终端中间驱动器和第二终端近侧驱动器可操作地连接,使得第二终端远侧驱动器相对于第二终端中间驱动器和第二终端中间驱动器朝远侧悬伸以得到其下方存储空间的最大伸长率,其中第二终端远侧驱动器与远侧末端相邻。
实施例10
根据实施例9所述的外科器械,其中第一终端远侧驱动器组件和第二终端远侧驱动器组件定位在中心线的相对侧上。
实施例11
根据实施例10所述的外科器械,其中第一终端远侧驱动器组件和第二终端远侧驱动器组件被定位成使得第二终端远侧驱动器组件与第一终端远侧驱动器组件相对于中心线成镜像。
实施例12
根据实施例10至11中任一项或多项所述的外科器械,其中该楔形滑动件具有第一凸轮斜面和第二凸轮斜面,其中该第一凸轮斜面被构造成能够接合第一终端远侧驱动器组件,其中该第二凸轮斜面被构造成能够接合第二终端远侧驱动器组件。
实施例13
根据实施例12所述的外科器械,其中该第一凸轮斜面具有第一远侧鼻部,其中该第二凸轮斜面具有第二远侧鼻部,其中该第二钳口具有沿着中心线朝远侧定位于其中的阻挡壁,其中该阻挡壁被构造成能够接收与其抵靠的楔形滑动件并阻止楔形滑动件朝远侧移动超过远侧滑动件位置,其中该阻挡壁限定至少一个间隙孔,该至少一个间隙孔被构造成能够接收处于在远侧滑动件位置的楔形滑动件的第一远侧鼻部和第二远侧鼻部。
实施例14
根据实施例1至13中任一项或多项所述的外科器械,其中第一钳口具有延伸穿过其中的第一细长通道和第一多个标记,其中第二钳口具有延伸穿过其中的第二细长通道和第二多个标记,该器械还包括接收在第一通道和第二通道内的刀构件,其中该刀构件被构造成能够沿着第一通道和第二通道朝远侧滑动并接合楔形滑动件以使钉成形,其中该刀构件包括位于第一通道中的第一指示器和位于第二通道中的第二指示器,并且其中第一指示器和第二指示器连同第一多个标记和第二多个标记分别被构造成能够向操作者指示钉的使用。
IV.杂项
应当理解,本文所述的教导内容、表达、实施方案、示例等中的任何一者或多者可与本文所述的其他教导内容、表达、实施方案、示例等中的任何一者或多者进行组合。因此,上述教导内容、表达、实施方案、示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。
应当理解,据称以引用的方式并入本文的任何专利、专利公布或其他公开材料,无论是全文或部分,仅在所并入的材料与本公开中所述的现有定义、陈述或者其他公开材料不冲突的范围内并入本文。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、陈述或其它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。
上述装置的型式可应用于由医疗专业人员进行的传统医学治疗和手术、以及机器人辅助的医学治疗和手术中。仅以举例的方式,本文的各种教导内容可易于并入机器人外科系统,诸如Intuitive Surgical, Inc.(Sunnyvale,California)的DAVINCITM系统。类似地,本领域的普通技术人员将认识到本文中的各种教导内容可易于结合以下美国专利中的任何专利的各种教导内容:1998年8月11日公布的标题为“Articulated SurgicalInstrument For Performing Minimally Invasive Surgery With Enhanced Dexterityand Sensitivity”的美国专利 5,792,135,其公开内容以引用方式并入本文;1998年10月6日公布的标题为“Remote Center Positioning Device with Flexible Drive”美国专利5,817,084,其公开内容以引用方式并入本文;1999年3月2日公布的标题为“AutomatedEndoscope System for Optimal Positioning”的美国专利5,878,193,其公开内容以引用方式并入本文;2001年5 月15日公布的标题为“Robotic Arm DLUS for PerformingSurgical Tasks”的美国专利6,231,565,其公开内容以引用方式并入本文;2004 年8月31日公布的标题为“Robotic Surgical Tool with Ultrasound Cauterizing and CuttingInstrument”的美国专利6,783,524中,其公开内容以引用方式并入本文;2002年4月2日公布的标题为“Alignment of Master and Slave in a Minimally Invasive SurgicalApparatus”的美国专利6,364,888,其公开内容以引用方式并入本文;2009年4月28日公布的标题为“Mechanical Actuator Interface System for Robotic Surgical Tools”的美国专利7,524,320,其公开内容以引用方式并入本文;2010年4月6日公布的标题为“Platform Link Wrist Mechanism”的美国专利7,691,098,其公开内容以引用方式并入本文;2010年10 月5日公布的标题为“Repositioning and Reorientation of Master/SlaveRelationship in Minimally Invasive Telesurgery”的美国专利7,806,891,其公开内容以引用方式并入本文;2013年1月10日公布的标题为“Automated End Effector ComponentReloading System for Use with a Robotic System”的美国公布2013/0012957,其公开内容以引用方式并入本文;2012年8月9日公布的标题为“Robotically-ControlledSurgical Instrument with Force-Feedback Capabilities”的美国公布 2012/0199630,其公开内容以引用方式并入本文;2012年5月31日公布的标题为“Shiftable DriveInterface for Robotically-Controlled Surgical Tool”的美国公布2012/0132450,其公开内容以引用方式并入本文;2012年8月9日公布的标题为“Surgical StaplingInstruments with Cam-Driven Staple Deployment Arrangements”的美国公布2012/0199633,其公开内容以引用方式并入本文;2012年8月9日公布的标题为“Robotically-Controlled Motorized Surgical End Effector System with Rotary ActuatedClosure Systems Having Variable Actuation Speeds”的美国公布2012/0199631,其公开内容以引用方式并入本文;2012年8月9日公布的标题为“Robotically-ControlledSurgical Instrument with Selectively Articulatable End Effector”的美国公布2012/0199632,其公开内容以引用方式并入本文;2012年8月9 日公布的标题为“Robotically-Controlled Surgical End Effector System”的美国公布2012/0203247,其公开内容以引用方式并入本文;2012 年8月23日公布的标题为“Drive Interface forOperably Coupling a Manipulatable Surgical Tool to a Robot”的美国公布2012/0211546,其公开内容以引用方式并入本文;2012年6月7日公布的标题为“Robotically-Controlled Cable-Based Surgical End Effectors”的美国公布2012/0138660,其公开内容以引用方式并入本文;和/或2012年8 月16日公布的标题为“Robotically-ControlledSurgical End Effector System with Rotary Actuated Closure Systems”的美国专利公布 2012/0205421,其公开内容以引用方式并入本文。
上文所述的型式的装置可被设计为单次使用后丢弃,或者它们可被设计为可多次使用。在任一种情况下或两种情况下,可对这些形式进行修复以在至少一次使用之后重复使用。修复可包括以下步骤的任意组合:拆卸装置,然后清洁或替换特定零件以及随后进行重新组装。具体地,可拆卸一些形式的装置,并且可以任何组合来选择性地替换或移除装置的任意数量的特定零件或部分。在清洁和/或替换特定部分时,一些型式的装置可在修复设施处重新组装或者在即将进行规程之前由操作者重新组装用于随后使用。本领域的技术人员将会理解,装置的修复可利用多种技术进行拆卸、清洁/更换、以及重新组装。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。
仅以举例的方式,本文描述的型式可在手术之前和/或之后消毒。在一种消毒技术中,将该装置放置在闭合且密封的容器诸如塑料袋或 TYVEK袋中。然后可将容器和装置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。辐射可杀死装置上和容器中的细菌。经消毒的装置随后可储存在无菌容器中,以供以后使用。还可使用本领域已知的任何其他技术对装置进行消毒,所述技术包括但不限于β辐射或γ辐射、环氧乙烷或蒸汽。
已经示出和阐述了本发明的各种实施方案,可在不脱离本发明的范围的情况下由本领域的普通技术人员进行适当修改来实现本文所述的方法和系统的进一步改进。已经提及了若干此类可能修改,并且其他修改对于本领域的技术人员而言将显而易见。例如,上文所讨论的实施例、实施方案、几何形状、材料、尺寸、比率、步骤等均是示例性的而非必需的。因此,本发明的范围应根据以下权利要求书来考虑,并且应理解为不限于说明书和附图中示出和描述的结构和操作的细节。
Claims (13)
1.一种用于处理患者的组织的外科器械,包括:
(a)轴组件;
(b)端部执行器,所述端部执行器从所述轴组件沿着钳口中心线延伸,所述端部执行器包括:
(i)第一钳口,所述第一钳口具有砧座,所述砧座被构造成能够使压靠所述砧座的多个钉成形,以及
(ii)第二钳口,其中所述第一钳口和所述第二钳口被构造成能够在打开构型和闭合构型之间转变;以及
(c)钉仓,所述钉仓被接收在所述第二钳口内,所述钉仓包括:
(i)面向所述砧座的平台,其中所述平台限定多个钉开口,其中所述多个钉分别定位在所述多个钉开口内,
(ii)第一终端驱动器组件,所述第一终端驱动器组件被定位成与所述钉仓的远侧末端相邻,其中所述第一终端驱动器组件被构造成能够接收所述多个钉的第一终端部分,所述第一终端驱动器组件在所述第二钳口内至少部分地限定其下方的存储空间,以及
(iii)楔形滑动件,所述楔形滑动件被构造成能够接近所述平台从近侧滑动件位置滑动到远侧滑动件位置,并且接合所述第一终端驱动器组件,并且朝向所述砧座驱动所述多个钉的所述终端部分以在组织中成形,其中所述楔形滑动件的至少大部分被构造成能够在所述楔形滑动件处于所述远侧滑动件位置时适配在所述存储空间内并且不会朝远侧滑动超过所述第一终端驱动器组件;
其中所述楔形滑动件具有被构造成能够接合所述第一终端驱动器组件的第一凸轮斜面,所述第一凸轮斜面还包括:
(A)前凸轮表面,所述前凸轮表面限定陡斜角度斜率,以及
(B)中间凸轮表面,所述中间凸轮表面限定平缓角度斜率,所述平缓角度斜率相对于所述平台被成角度为小于所述陡斜角度斜率,
其中所述驱动器凸轮被构造成能够由所述前凸轮表面接合以将所述驱动器组件朝向所述第一钳口向上提升较短的距离来减小所述楔形滑动件的伸长率,并且
其中所述驱动器凸轮进一步被构造成能够由所述中间凸轮表面接合,以将所述驱动器组件朝向所述第一钳口进一步向上提升较长的距离,来提供足够的力使所述多个钉中的第一钉和第二钉压靠所述砧座以用于组织中。
2.根据权利要求1所述的外科器械,其中所述第一凸轮斜面的大部分被构造成能够在所述楔形滑动件处于所述远侧滑动件位置时适配在所述存储空间内。
3.根据权利要求1所述的外科器械,其中所述楔形滑动件具有远侧鼻部,其中所述第二钳口具有沿着所述中心线朝远侧定位于其中的阻挡壁,其中所述阻挡壁被构造成能够接收与其抵靠的所述楔形滑动件并阻止所述楔形滑动件朝远侧移动超过所述远侧滑动件位置。
4.根据权利要求3所述的外科器械,其中所述阻挡壁限定间隙孔,所述间隙孔被构造成能够接收处于所述远侧滑动件位置的所述楔形滑动件的所述远侧鼻部。
5.根据权利要求1所述的外科器械,其中所述第一终端驱动器组件具有第一终端远侧驱动器、第一终端中间驱动器和第一终端近侧驱动器;
其中所述第一终端远侧驱动器、所述第一终端中间驱动器和所述第一终端近侧驱动器可操作地连接,使得所述第一终端远侧驱动器相对于所述第一终端中间驱动器和所述第一终端近侧驱动器朝远侧悬伸以得到其下方的所述存储空间的最大伸长率,其中所述第一终端远侧驱动器与所述钉仓的所述远侧末端相邻。
6.根据权利要求5所述的外科器械,其中所述第一终端远侧驱动器、所述第一终端中间驱动器和所述第一终端近侧驱动器可操作地连接,使得所述第一终端远侧驱动器与所述第一终端近侧驱动器纵向对准,并且所述第一终端中间驱动器从所述第一终端远侧驱动器和所述第一终端近侧驱动器中的每一者横向偏移,其中所述第一终端远侧驱动器、所述第一终端中间驱动器和所述第一终端近侧驱动器分别接收所述多个钉的所述第一终端部分。
7.根据权利要求1所述的外科器械,其中所述钉仓还包括第二终端驱动器组件,所述第二终端驱动器组件被定位成与所述远侧末端相邻并且被构造成能够接收所述多个钉的第二终端部分,所述第二终端驱动器组件在所述第二钳口内进一步限定其下方的所述存储空间。
8.根据权利要求7所述的外科器械,其中所述第二终端驱动器组件包括第二终端远侧驱动器、第二终端中间驱动器和第二终端近侧驱动器;
其中所述第二终端远侧驱动器、所述第二终端中间驱动器和所述第二终端近侧驱动器可操作地连接,使得所述第二终端远侧驱动器相对于所述第二终端近侧驱动器和所述第二终端中间驱动器朝远侧悬伸以得到其下方的所述存储空间的最大伸长率,其中所述第二终端远侧驱动器与所述远侧末端相邻。
9.根据权利要求8所述的外科器械,其中所述第一终端远侧驱动器组件和所述第二终端远侧驱动器组件定位在所述中心线的相对侧上。
10.根据权利要求9所述的外科器械,其中所述第一终端远侧驱动器组件和所述第二终端远侧驱动器组件被定位成使得所述第二终端远侧驱动器组件与所述第一终端远侧驱动器组件相对于所述中心线成镜像。
11.根据权利要求9所述的外科器械,其中所述楔形滑动件具有第一凸轮斜面和第二凸轮斜面,其中所述第一凸轮斜面被构造成能够接合所述第一终端远侧驱动器组件,其中所述第二凸轮斜面被构造成能够接合所述第二终端远侧驱动器组件。
12.根据权利要求11所述的外科器械,其中所述第一凸轮斜面具有第一远侧鼻部,其中所述第二凸轮斜面具有第二远侧鼻部,其中所述第二钳口具有沿着所述中心线朝远侧定位于其中的阻挡壁,其中所述阻挡壁被构造成能够接收与其抵靠的所述楔形滑动件并阻止所述楔形滑动件朝远侧移动超过所述远侧滑动件位置,其中所述阻挡壁限定至少一个间隙孔,所述至少一个间隙孔被构造成能够接收处于所述远侧滑动件位置的所述楔形滑动件的所述第一远侧鼻部和所述第二远侧鼻部。
13.根据权利要求1所述的外科器械,其中所述第一钳口具有延伸穿过其中的第一细长通道和第一多个标记,其中所述第二钳口具有延伸穿过其中的第二细长通道和第二多个标记,所述器械还包括接收在所述第一细长通道和所述第二细长通道内的刀构件,其中所述刀构件被构造成能够沿着所述第一细长通道和所述第二细长通道朝远侧滑动并接合所述楔形滑动件以使钉成形,其中所述刀构件包括位于所述第一细长通道中的第一指示器和位于所述第二细长通道中的第二指示器,并且其中所述第一指示器和所述第二指示器连同所述第一多个标记和所述第二多个标记分别被构造成能够向操作者指示钉的使用。
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RU2728723C2 (ru) | 2020-07-30 |
RU2018117702A (ru) | 2019-11-15 |
US10226251B2 (en) | 2019-03-12 |
JP2018532491A (ja) | 2018-11-08 |
US20170105729A1 (en) | 2017-04-20 |
CN108135608A (zh) | 2018-06-08 |
JP6862436B2 (ja) | 2021-04-21 |
BR112018007456B1 (pt) | 2022-11-16 |
EP3155984A1 (en) | 2017-04-19 |
WO2017066082A1 (en) | 2017-04-20 |
RU2018117702A3 (zh) | 2020-02-26 |
BR112018007456A2 (pt) | 2018-10-23 |
EP3155984B1 (en) | 2018-11-28 |
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