CN108348261B - 可重复使用的内窥镜外科手术施夹器 - Google Patents
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B17/128—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
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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
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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
- A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
- A61B2017/00464—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable for use with different instruments
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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Abstract
可重复使用的内窥镜外科手术施夹器包括可重复使用的手柄组件和至少一个可重复使用的轴组件。
Description
技术领域
技术领域涉及外科手术施夹器。更具体地，本发明涉及具有被构造成与各种不同的内窥镜组件一起使用的手柄组件的内窥镜外科手术施夹器。
背景技术
内窥镜外科手术缝合器和外科手术施夹器在本领域中是已知的并且用于许多不同且有用的外科手术。在腹腔镜外科手术的情况下，通过穿过皮肤中的小入口切口插入的狭窄管或套管实现进入腹部内部。在身体其它地方进行的微创手术常常被称为内窥镜手术。通常通过入口切口将管或套管装置延伸到患者体内以提供进入端口。该端口允许外科医生使用套管针通过其插入许多不同的外科手术器械并用于执行远离切口的外科手术。
在大多数这些手术期间，外科医生必须经常终止血液或另一流体流动通过一个或多个血管。外科医生将经常使用特定的内窥镜外科手术施夹器将外科手术夹具施加到血管或另一个管道以防止手术期间体液从中流过。
具有各种尺寸(例如直径)的内窥镜外科手术施夹器是本领域已知的，其被构造成施夹各种不同的外科手术夹具，并且其能够在进入体腔期间施加单个或多个外科手术夹具。这种外科手术夹具通常由生物相容性材料制成并且通常在血管上压缩。一旦施加到血管上，压缩的外科手术夹具终止流体从其中流过。
在Green等人的共同转让的美国专利第5,084,057号和第5,100,420号中描述了能够在单次进入体腔期间在内窥镜或腹腔镜手术中施加多个夹具的内窥镜外科手术施夹器，两个专利整体均以引用方式并入。在Pratt等人的共同转让的美国专利第5,607,436号中公开了另一种多内窥镜外科手术施夹器，该专利内容整体也以引用方式并入本文中。这些装置通常但不一定在单次外科手术期间使用。Pier等人的美国专利第5,695,502号公开了一种可重复消毒的内窥镜外科手术施夹器，其公开内容以引用方式并入本文中。内窥镜外科手术施夹器在单次插入体腔期间推进并形成多个夹具。该可重复消毒的内窥镜外科手术施夹器被构造成接收可互换夹具库并与之协作，以便在单次进入体腔期间推进并形成多个夹具。
在内窥镜或腹腔镜手术期间，取决于待结扎的下层组织或血管，可能需要和/或必须使用不同尺寸的外科手术夹具或不同构造的外科手术夹具。为了降低内窥镜外科手术施夹器的总成本，期望单个内窥镜外科手术施夹器可装载并且能够根据需要发射不同尺寸的外科手术夹具。
因此，存在对包括手柄组件的内窥镜外科手术施夹器的需求，该手柄组件被构造成与其中装载有不同夹具的各种不同内窥镜组件一起使用，和/或被构造成用于执行各种不同的外科手术任务。
发明内容
本发明涉及可重复使用的内窥镜外科手术施夹器。
根据本发明的方面提供了一种可重复使用的外科手术施夹器的手柄组件，其被构造成可释放地接合至少两个不同的内窥镜夹具施加组件。手柄组件包括壳体、可枢转地连接到壳体并且可相对于壳体在未致动位置与致动位置之间移动的触发器，以及可滑动地支撑在壳体内并且可操作地联接到触发器的驱动杆，使得触发器从未致动位置朝向致动位置的移动使驱动杆向远侧平移穿过壳体。驱动杆包括设置在其上的棘轮齿条。手柄组件还包括支撑在壳体内并且相对于壳体的纵向轴线横向延伸的棘爪销，可枢转地且可滑动地支撑在棘爪销上的棘轮棘爪，以及旁路组件。棘轮棘爪可在使用位置与旁路位置之间围绕棘爪销横向滑动，在该使用位置中，棘轮棘爪相对于棘轮齿条对齐以在驱动杆向远侧平移之后接合棘轮齿条，在该旁路位置中，棘轮棘爪相对于棘轮齿条偏置以在驱动杆向远侧平移之后阻止与棘轮齿条的接合。旁路组件包括可滑动地设置在壳体内并且可操作地联接到棘轮棘爪的柱塞。柱塞可在第一位置与第二位置之间移动，以使棘轮棘爪在使用位置与旁路位置之间滑动。
旁路组件还可以包括与柱塞可滑动地接合的第一凸轮部件和可滑动地设置在棘轮棘爪上的第二凸轮部件。在这样的方面中，柱塞从第一位置到第二位置的移动将第一凸轮部件推动到第二凸轮部件中，从而推动第二凸轮部件以使棘轮棘爪从使用位置滑动到旁路位置。更具体地说，第一和第二凸轮部件可以被构造成使得柱塞的纵向平移实现棘轮棘爪的横向滑动。
第一偏置构件可定位成朝向使用位置偏置棘轮棘爪。附加地或替代地，第二偏置构件可以定位成朝向第一位置偏置柱塞。
柱塞可以包括从壳体延伸的手动按钮，该手动按钮相对于壳体选择性地可按压，以使柱塞从第一位置移动到第二位置。
根据本发明的其它方面提供了包括手柄组件和内窥镜夹具施加组件的可重复使用的外科手术施夹器。手柄组件包括接收器组件，该接收器组件被构造成可释放地接合内窥镜夹具施加组件并且包括外套环和内管状构件。手柄组件还包括围绕接收器组件设置的旋钮，该旋钮可相对于内管状构件滑动并接合到外套环，使得旋钮相对于内管状构件在近侧位置与远侧位置之间的滑动使外套环相对于内管状构件在近侧锁定位置与远侧解锁位置之间滑动。内窥镜夹具施加组件可插入内管状构件中。在内窥镜夹具施加组件插入到内管状构件中的情况下，旋钮可从远侧位置滑动到近侧位置，从而使外套环从远侧解锁位置滑动到近侧锁定位置以将内窥镜夹具施加组件锁定在内管状构件内。
一个或多个滚珠轴承可以被构造成部分地插入穿过限定在内管状构件内的相应孔。每个滚珠轴承被构造成容纳在限定在内窥镜夹具施加组件内的相应孔内，以将内窥镜夹具施加组件锁定在内管状构件内。在外套环的近侧锁定位置中，外套环向内推动滚珠轴承使其部分地穿过内管状构件的相应孔并且接合在限定在内窥镜夹具施加组件内的相应孔内，以将内窥镜夹具施加组件锁定在内管状构件内。
内管状构件可以限定近侧孔和远侧孔。在这样的方面中，旋钮可以包括可操作地联接到其的锁定销，该锁定销被构造成用于接合在近侧孔内以将旋钮锁定在近侧位置中并且被构造成用于接合在远侧孔内以将旋钮锁定在远侧位置中。
在没有内窥镜夹具施加组件的情况下，旋钮可锁定在远侧位置中，其中锁定销接合在远侧孔内。将内窥镜夹具施加组件插入内管状构件使锁定销与远侧孔脱离，以允许旋钮移动到近侧位置。
可以提供被构造成朝向近侧位置偏置旋钮的偏置构件，使得在锁定销与远侧孔脱离之后，旋钮在偏置构件的偏置下被推动到近侧位置。
附图说明
参考附图详细描述本发明的内窥镜外科手术施夹器的方面和特征，其中相同的附图标记标识相似或相同的结构元件，并且：
图1是根据本发明提供的内窥镜外科手术施夹器的近侧部分的透视图，其包括具有与其接合的内窥镜组件的手柄组件；
图2是图1的内窥镜外科手术施夹器的透视图，其中内窥镜组件从手柄组件移除；
图3是根据本发明提供的另一可重复使用的手柄组件的一部分的侧视图，其中一半壳体被移除以示出其中的内部部件；
图4是图3的可重复使用的手柄组件的一部分的俯视透视图，其中一半壳体被移除，并且另一半壳体示出为透明以示出其中的内部部件；
图5是图3的可重复使用的手柄组件的一部分的俯视纵向剖视图；
图6是图3的可重复使用的手柄组件的棘轮驱动组件和旁路组件的俯视图，其中棘爪设置在接合位置；
图7是图3的可重复使用的手柄组件的棘轮驱动组件和旁路组件的俯视图，其中棘爪设置在脱离位置；
图8是图3的可重复使用的手柄组件的接收器组件的侧视纵向剖视图；
图9是图3的可重复使用的手柄组件的接收器组件的侧视纵向剖视图，其中旋钮设置在远侧位置；
图10A是图3的可重复使用的手柄组件的接收器组件的侧视纵向剖视图，其中旋钮设置在远侧位置，并且插入内窥镜组件与其接合；
图10B是图10A中指示区域的放大侧视纵向剖视图；
图11是图3的可重复使用的手柄组件的接收器组件的侧视纵向剖视图，其中旋钮设置在远侧位置并且内窥镜组件设置在其中；
图12A是图3的可重复使用的手柄组件的接收器组件的侧视纵向剖视图，其中旋钮设置在近侧位置而在其中接合内窥镜组件；
图12B是图12A中指示区域的侧视透视图，其中旋钮示出为透明以示出其中的内部部件；
图13是图3的可重复使用的手柄组件的接收器组件的侧视纵向剖视图，其示出了旋钮从近侧位置到远侧位置的移动以使内窥镜组件与其脱离；
图14是图3的可重复使用的手柄组件的接收器组件的侧视纵向剖视图，其中在内窥镜组件与其脱离之后，旋钮设置在远侧位置；
图15是被构造成与图1的手柄组件一起使用的内窥镜组件的远侧部分的放大透视图；
图16是被构造成与图1的手柄组件一起使用的另一内窥镜的远侧部分的放大透视图；以及
图17是被构造成根据本发明使用的机器人外科手术系统的示意图。
具体实施方式
参考图1和图2，根据本发明提供的内窥镜外科手术施夹器由附图标记10标识。外科手术施夹器10通常包括手柄组件500和多个内窥镜组件700，该多个内窥镜组件可选择性地连接到手柄组件100并且可从手柄组件100向远侧延伸。手柄组件500有利地被构造成在连接到多个内窥镜组件700之后操作该多个内窥镜组件中的每一个，并且可以被构造成可消毒的可重复使用部件，使得手柄组件600可以在一次或多次外科手术期间与不同的和/或附加的内窥镜组件700一起重复使用。取决于具体内窥镜组件700的特定目的和/或构型，内窥镜组件700可以被构造成一次性使用的一次性部件、有限使用的一次性部件或可重复使用的部件。在任一构型中，消除了对多个手柄组件500的需求，更确切地说，外科医生只需选择合适的内窥镜组件700并将该内窥镜组件700连接到手柄组件500以准备使用。
首先详细描述手柄组件500，随后描述与通用内窥镜组件700结合的手柄组件500的使用，该通用内窥镜组件包括可与手柄组件500一起使用的任何内窥镜组件的共同特征。之后详细描述特定内窥镜组件的示例性实施例，例如，内窥镜组件300(图15)和内窥镜组件400(图16)。例如，内窥镜组件300(图15)被构造成用于抓握和操纵组织，取回外科手术夹具并且围绕组织发射并形成外科手术夹具。作为另一示例，内窥镜组件400(图16)包括至少一个装载在其中的外科手术夹具，并被构造成按顺序在组织周围发射并形成至少一个外科手术夹具。还设想可以提供用于执行各种不同外科手术任务和/或具有各种不同构型的各种其它内窥镜组件，以与手柄组件500一起使用。
参考图1到图3，手柄组件500通常包括壳体510、可枢转地联接到壳体510的触发器组件520、可操作地联接到触发器组件520的棘轮驱动组件530、可操作地联接到棘轮驱动组件530的旁路组件550、接收器组件670和旋钮680。
参考图3，棘轮驱动组件530包括驱动杆532和棘爪组件540。驱动杆532包括近侧延伸部534和棘轮齿条536。近侧延伸部534经由联动件528将驱动杆532可操作地联接到触发器组件520。如此，触发器组件520的致动使驱动杆532向远侧平移通过壳体510以发射附接到手柄组件500的内窥镜组件。
棘轮驱动组件530的棘爪组件540包括棘轮棘爪542、棘爪销544和棘爪偏置构件546。棘轮棘爪542通过棘爪销544可枢转地联接到壳体510，使得在其使用位置(图6)，棘轮棘爪542经由棘爪偏置构件546被偏置到可操作位置，以便在驱动杆532前进期间使棘轮棘爪542与棘轮齿条536能够可操作地接合，以实现棘轮驱动组件530的棘轮操作。棘轮如下所述，棘轮棘爪542可围绕棘爪销544从使用位置(图6)横向滑动到旁路位置(图7)，以相对棘轮齿条536移位棘轮棘爪542，从而使棘轮驱动组件530的棘轮操作失效。
另外参考图4和图5，旁路组件550可操作地联接到棘爪组件540并且包括柱塞552、第一偏置构件555、凸轮轴556、凸轮套筒558和第二偏置构件560。柱塞552包括近侧按钮553以及从近侧按钮553向远侧延伸的细长轴554。近侧按钮553从壳体510向近侧延伸，以使得使用者能够选择性地将近侧按钮553向内压入壳体510中。近侧按钮553向内压入壳体510中将细长轴554向远侧推动通过壳体510。第一偏置构件555围绕细长轴554设置并定位成朝向近侧位置向近侧偏置柱塞552，同时近侧按钮553向内压入壳体中将柱塞552从近侧位置推动到远侧位置。
凸轮轴556与柱塞552的细长轴554固定地接合(例如，一体成形或以其它方式固定)并从其向远侧延伸。凸轮轴556限定分叉的远端，该分叉的远端接收其间的一部分棘爪销544。凸轮轴556的远端的每个分叉部分限定第一成角度的凸轮表面557。凸轮套筒558围绕棘爪销544设置在凸轮轴556的分叉远端与棘爪542之间。凸轮套筒558限定一对第二成角度的凸轮表面559，其以与凸轮轴556的第一成角度的凸轮表面557邻接的关系进行设置。第二偏置构件560围绕棘爪销544设置并且定位在棘轮棘爪542与壳体510之间(参见图4和图5)，使得朝向其使用位置(图6)偏置棘轮棘爪542。
参考图6和图7，在柱塞552的近侧位置中，第二偏置构件560朝向其使用位置(图6)偏置棘轮棘爪542，其中棘轮棘爪542被定位成在驱动杆533前进期间使棘轮棘爪542与棘轮齿条536可操作接合以实现棘轮驱动组件530的棘轮操作。当柱塞552被按压到其远侧位置时，柱塞552向远侧平移，使得凸轮轴556同样向远侧平移以将凸轮轴556的第一成角度的凸轮表面557向远侧推动到凸轮套筒558的第二成角度的凸轮表面559中。分别由于第一成角度的凸轮表面557和第二成角度的凸轮表面559的成角度构型，凸轮轴556向远侧推动到凸轮套筒558中而沿着棘爪销544横向推动凸轮套筒558以与棘轮棘爪542接触，从而将棘轮棘爪542抵靠第二偏置构件560的偏置从使用位置(图6)推动到旁路位置(图7)。在旁路位置中，棘轮棘爪542从棘轮齿条536偏移以在致动期间抑制棘轮。
在释放柱塞552之后，柱塞552在第一偏置构件555的偏置下返回到近侧位置，并且棘轮棘爪542在第二偏置构件560的偏置下返回到使用位置(图6)。然而，还可以设想，旁路组件550包括可释放的锁定机构(未示出)，以便能够将柱塞552可释放地锁定在远侧位置，从而将棘轮棘爪542可释放地锁定在旁路位置(图7)。
参考图1、图2和图8，外科手术施夹器10还包括接收器组件670，该接收器组件从手柄组件500延伸并被构造成接收内窥镜夹具施加组件700的近侧毂710，用于使内窥镜夹具施加组件700与手柄组件500可释放地接合。接收器组件670包括外套环672和内管状构件674。旋钮680可操作地连接到接收器组件670并围绕接收器组件670设置，如下所述。内管状构件674固定到手柄组件500并从其向远侧延伸。内管状构件674限定略大于内窥镜夹具施加组件700的近侧毂710的外径的内径，以使得近侧毂710能够滑动地插入内管状构件674中而在其间没有显著间隙。内管状构件674还包括多个孔676，该多个孔被限定成穿过其中并围绕内管状构件674周向定位。孔676被构造成允许滚珠轴承678的部分但不是全部延伸穿过其中而进入其内部。
接收器组件670的内管状构件674还分别限定近侧孔679a和远侧孔679b，该孔分别彼此相邻设置并且延伸穿过内管状构件674而进入其内部。虽然相邻彼此设置，但近侧孔679a和远侧孔679b分别被内管状构件674的一部分分开，以便阻止它们之间的直接连通。下面分别详细描述近侧孔679a和远侧孔679b的功能。
接收器组件670的外套环672围绕内管状构件674的远端设置并且与旋钮680接合。外套环672可通过旋钮680并且相对于内管状构件674在解锁远侧位置与锁定近侧位置之间滑动。在锁定近侧位置中，外套环672向内推动滚珠轴承678，使得滚珠轴承678的部分延伸穿过内管状构件674的孔676而进入内管状构件674的内部。
如上所述，旋钮680可操作地联接到接收器组件670并围绕接收器组件670设置。更具体地，旋钮680可滑动地围绕接收器组件670的内管状构件674设置并且接合接收器组件670的外套环762。保持环682提供旋钮680与内管状构件674之间的摩擦，以在没有施加足够的推动力的情况下将旋钮680保持在适当的位置。偏置构件684定位成相对于内管状构件674向近侧偏置旋钮680，如下面详细描述。旋钮680可围绕内管状构件674在近侧位置与远侧位置之间滑动，在该近侧位置中，旋钮680邻接手柄组件500或设置成更靠近手柄组件500，在该远侧位置中，旋钮680与手柄组件500间隔开或间隔得更远。由于外套环672与旋钮680接合，所以旋钮680在近侧位置与远侧位置之间的滑动使外套环672在锁定近侧位置与解锁远侧位置之间滑动。
锁定组件690可操作地设置在通过旋钮680限定的横向孔686内。锁定组件690包括锁定销692、偏置构件694和固定螺钉696。锁定销692被构造成用于接合在处于旋钮680的近侧位置中的内管状构件674的近侧孔679a内以及处于旋钮680的远侧位置中的内管状构件674的远侧孔679b内，以将旋钮680相对于接收器组件670的内管状构件674锁定，如下详细描述。固定螺钉696将偏置构件694保持在横向孔686内，使得偏置构件694将锁定销692向内偏置到旋钮680的内部中。
参考图9到图14，详细描述了用于将内窥镜夹具施加组件700可释放地接合在其中的接收器组件670和旋钮680的使用和操作。最初，如图9中所示，接收器组件670是空的，旋钮680设置在远侧位置，外套环672设置在解锁远侧位置，并且锁定销692接合在内管状构件674的远侧孔679b内以相对于内管状构件674锁定旋钮680和外套环672。
参考图10A和图10B，为了将内窥镜夹具施加组件700接合在接收器组件670内，内窥镜夹具施加组件700的近侧毂710被插入内管状构件674中并相对于内管状构件674向近侧滑动。为了将内窥镜夹具施加组件700的近侧毂710插入接收器组件670的内管状构件674中，限定在近侧毂710外部内的细长通道712与锁定销692对齐，如上所述，该锁定销在此延伸穿过内管状构件674的远侧孔679b并且进入内管状构件674的内部。旋钮680可以包括设置在其外部上的对齐指示器689(图1)，以便于这种对齐。
在内窥镜夹具施加组件700的近侧毂710最初向近侧滑动到接收器组件670的内管状构件674中之后，锁定销692平移穿过细长通道712并保持接合在远侧孔679b内，从而使旋钮680保持相对于内管状构件674锁定在远侧位置。
另外参考图11，在将内窥镜夹具施加组件700的近侧毂710插入接收器组件670的内管状构件674期间，锁定销692最终到达细长通道712的端部，使得在近侧毂710进一步插入内管状构件674而到完全插入位置之后，近侧毂710的外表面向外推动锁定销692，从而使锁定销692与远侧孔679b脱离，如图11中所示。在该完全插入位置中，内管状构件674的滚珠轴承678与近侧毂710的孔714对齐，但是还没有与其接合。如下面详细描述，旋钮680从远侧位置到近侧位置的随后移动进而使外套环672从解锁远侧位置移动到锁定近侧位置，从而完成近侧毂710在接收器组件670内的接合。
还参考图12A和图12B，在锁定销692与远侧孔679b脱离的情况下，旋钮680不再相对于内管状构件674锁定。因此，一旦旋钮680从内管状构件674解锁，偏置构件684用于将旋钮680从近侧位置向近侧偏置到远侧位置，从而使外套环672从远侧解锁位置移动到近侧锁定位置。在外套环672移动到近侧锁定位置之后，外套环672向内推动滚珠轴承678，使得滚珠轴承678的部分延伸穿过内管状构件674的孔676而进入内管状构件674的内部并且接合在近侧毂710的相应孔714内，从而与接收器组件670内的近侧毂710接合。此外，在旋钮680处于近侧锁定位置的情况下，锁定销692与近侧孔679a对齐。结果，偏置构件694将锁定销692偏置成与近侧孔679a接合，从而相对于内管状构件674锁定旋钮680和外套环672，并且因此锁定近侧毂710以接合在接收器组件670内。
如上详细描述，在内窥镜夹具施加组件700的近侧毂710可操作地接合在接收器组件670内的情况下，手柄组件500(图1)可被致动以围绕组织形成内窥镜夹具施用组件700的一个或多个外科手术夹具(未示出)。
现在参考图13和图14，在外科手术完成时，或者当另外需要从接收器组件670移除内窥镜夹具施加组件700时，用户抓握旋钮680并用足够的推动力将旋钮680从近侧位置朝向远侧位置向远侧平移，以便从近侧孔679a移开锁定销692并且使旋钮680能够移动到远侧位置。在旋钮680处于远侧位置的情况下，外套环672设置在解锁远侧位置中。因此，近侧毂710与接收器组件670脱离并且可以相对容易地从内管状构件674内移除，从而使内窥镜夹具施加组件700与接收器组件670完全脱离。
参考图15，示出了根据本发明内容提供并且被构造成与手柄组件500(图1)一起使用的内窥镜组件300。如上详细描述，内窥镜组件300被构造成用于非棘轮使用，并且因此当内窥镜组件300与手柄组件500接合时，利用旁路组件550使棘轮棘爪542移动到旁路位置(参见图7)。
内窥镜组件300通常包括近侧毂(未示出)、设置在近侧毂内并延伸穿过近侧毂的内驱动组件(未示出)、从近侧毂向远侧延伸的细长轴340，以及包括设置在细长轴340的远端处的一对钳口构件360a、360b的末端执行器组件350。内窥镜组件300被构造成抓握和/或操纵组织，取回外科手术夹具并围绕组织闭合、发射或形成外科手术夹具。可以设想，内窥镜组件300被构造成闭合、发射或形成类似于美国专利第4,834,096号中所示出和描述的外科手术夹具，其全部内容以引用方式并入本文中。
如上详细描述，内窥镜组件300的近侧毂可以包括与内窥镜组件700的近侧毂710的那些特征相似的特征，以使得内窥镜组件300能够与手柄组件500(图1)可释放地接合。另外参考图3，当内窥镜组件300与手柄组件500(图1)接合时，内驱动组件可操作地定位成使得在驱动杆532响应于触发器组件520的致动而前进之后，驱动杆532接触并向远侧推动内驱动组件，从而闭合钳口构件360a、360b以发射装载在其间的外科手术夹具。
参考图16，示出了根据本发明提供并被构造成与手柄组件500(图1)一起使用的另一内窥镜组件400。内窥镜组件400被构造成用于棘轮使用，并且因此在内窥镜组件400与手柄组件500接合之后，旁路组件550不被操纵，使得棘轮棘爪542保持在使用位置，如上详细描述，因此使棘轮棘爪540能够与驱动杆532接合以在致动触发器组件520(参见图6)之后实现棘轮使用。
内窥镜组件400通常包括近侧毂(未示出)、设置在近侧毂内并延伸穿过近侧毂的内驱动组件430、从近侧毂向远侧延伸的细长轴420，以及支撑在细长轴420的远端处的一对钳口构件460a、460b。内窥镜组件400被构造成围绕组织闭合、发射或形成一个或多个外科手术夹具。更具体地，可以设想内窥镜组件400可以被构造成闭合、发射或形成类似于美国专利第7,819,886号或第7,905,890号中所示出和描述的外科手术夹具，其每一个的全部内容以引用方式并入本文中。
如上详细描述，内窥镜组件400的近侧毂可以包括与内窥镜组件700的近侧毂710的那些特征相似的特征，以使得内窥镜组件400能够与手柄组件500(图1)可释放地接合。另外参考图3，当内窥镜组件400与手柄组件500(图1)接合时，内驱动组件430可操作地定位成使得在驱动杆532响应于触发器组件520的致动而前进之后，驱动杆532接触并向远侧推动内驱动组件430，从而闭合钳口构件460a、460b以发射装载在其间的外科手术夹具。
就一致程度而言，手柄组件500和/或内窥镜组件400、700可包括在2015年6月5日提交的标题为《可重复使用的内窥镜外科手术施夹器(Endoscopic Reposable SurgicalClip Applier)》的国际专利申请第PCT/CN2015/080845号、2015年10月10日提交的标题为《内窥镜外科手术施夹器(Endoscopic Surgical Clip Applier)》的国际专利申请第PCT/CN2015/091603号，和/或2015年11月3日提交的标题为《内窥镜外科手术施夹器(Endoscopic Surgical Clip Applier)》的国际专利申请第PCT/CN2015/093626号中公开和描述的手柄组件和/或内窥镜组件的任何或全部特征，其每一个的全部内容以引用方式并入本文中。
诸如本文所述的施夹器的外科手术器械还可以被构造成与机器人外科手术系统一起工作，并且通常被称为“远程外科手术”。这类系统采用各种机器人元件来帮助外科医生并允许外科手术器械的远程操作(或部分远程操作)。各种机器人臂、齿轮、凸轮、滑轮、电动和机械马达等可以用于此目的，并且可以设计有机器人外科手术系统以在手术或治疗期间帮助外科医生。这类机器人系统可以包括远程可操纵系统、自动柔性外科手术系统、远程柔性外科手术系统、远程铰接外科手术系统、无线外科手术系统、模块化或可选择性构造的远程操作外科手术系统等。
机器人外科手术系统可以与靠近手术室或位于远程位置的一个或多个控制台一起使用。在这种情况下，一组外科医生或护士可以准备患者进行外科手术并且使用本文公开的一种或多种器械配置机器人外科手术系统，而另一位外科医生(或外科医生组)通过机器人外科手术系统远程控制器械。可以理解，高度熟练的外科医生可以在多个位置执行多个操作而不离开他/她的远程控制台，这在经济效益上有利并且对患者或一系列患者有益。
外科手术系统的机器人臂通常通过控制器联接到一对主手柄。外科医生可以移动手柄以产生任何类型的外科手术器械(例如，末端执行器、抓握器、手术刀、剪刀等)的工作端的相应移动，这可以补充本文描述的一个或多个实施例的使用。主手柄的移动可以被缩放，使得工作端具有与由外科医生的操作手所执行的移动不同、更小或更大的相应运动。比例因子或传动比可以是可调整的，使得操作者可以控制外科手术器械的工作端的分辨率。
主手柄可以包括各种传感器，以向外科医生提供关于各种组织参数或状况的反馈，例如由于操纵、切割或以其它方式治疗引起的组织阻力、由器械对组织产生的压力、组织温度、组织阻抗等。可以理解的是，这类传感器为外科医生提供了模拟实际操作条件的增强的触觉反馈。主手柄还可以包括各种不同的致动器，用于精细的组织操作或治疗，从而进一步增强外科医生模仿实际操作条件的能力。
参考图17，通常将医疗工作站示出为工作站1000并且通常可以包括多个机器人臂1002、1003；控制装置1004；以及与控制装置1004联接的操作控制台1005。操作控制台1005可以包括显示装置1006，该显示装置可以特别设置为显示三维图像；以及手动输入装置1007、1008，人员(未示出)例如外科医生能够通过该手动输入装置以第一操作模式远程操纵机器人臂1002、1003。
如将在下面更详细描述，根据本文公开的几个实施例中的任何一个，机器人臂1002、1003中的每一个可以包括通过关节连接的多个构件，以及附接装置1009、1011，例如，支撑末端执行器1100的外科手术工具“ST”可以附接到该附接装置。
机器人臂1002、1003可以通过连接到控制装置1004的电驱动器(未示出)来驱动。控制装置1004(例如，计算机)可以被设置成尤其通过计算机程序来启动驱动器，使得机器人臂1002、1003、其附接装置1009、1011以及因此外科手术工具(包括末端执行器1100)根据由手动输入装置1007、1008所限定的移动来执行期望的移动。控制装置1004还可以被设置成使得其调节机器人臂1002、1003和/或驱动装置器的移动。
医疗工作站1000可以被构造成用于躺在患者台1012上的患者1013，以通过末端执行器1100以微创方式进行治疗。医疗工作站1000还可以包括多于两个的机器人臂1002、1003，附加的机器人臂同样连接到控制装置1004并且可通过操作控制台1005进行远程操纵。医疗器械或外科手术工具(包括末端执行器1100)也可以附接到附加机器人臂。医疗工作站1000可以包括数据库1014，特别是与控制装置1004联接，其中存储例如来自患者/生物1013的术前数据和/或解剖结构图。
对于示例性机器人外科手术系统的构造和操作的详细讨论，在本文参考2011年11月3日提交的标题为《医疗工作站(Medical Workstation)》的美国专利公开第2012/0116416号，其全部内容以引用方式并入本文中。
应该理解，前面的描述仅仅是对本发明的说明。在不脱离本发明的情况下，本领域技术人员可以设计各种替代和修改。因此，本发明旨在涵盖所有这些替代、修改和变更。提出参考附图描述的实施例仅用于说明本发明的某些示例。与上述和/或所附权利要求书中描述的无实质不同的其它元件、步骤、方法和技术也旨在处于本发明的范围内。
Claims (12)
1.一种可重复使用的外科手术施夹器的手柄组件，其被构造成可释放地接合至少两个不同的内窥镜夹具施加组件，所述手柄组件包括：
壳体；
触发器，其可枢转地连接到所述壳体并且可相对于所述壳体在未致动位置与致动位置之间移动；
驱动杆，其可滑动地支撑在所述壳体内并且可操作地联接到所述触发器，使得所述触发器从所述未致动位置朝向所述致动位置的移动使所述驱动杆向远侧平移穿过所述壳体，所述驱动杆包括设置在其上的棘轮齿条；
棘爪销，其支撑在所述壳体内并且相对于所述壳体的纵向轴线横向延伸；
棘轮棘爪，其可枢转地且可滑动地支撑在所述棘爪销上，所述棘轮棘爪可围绕所述棘爪销在使用位置与旁路位置之间横向滑动，在所述使用位置中，所述棘轮棘爪相对于所述棘轮齿条对齐以在所述驱动杆向远侧平移之后接合所述棘轮齿条，在所述旁路位置中，所述棘轮棘爪相对于所述棘轮齿条偏置，以在所述驱动杆向远侧平移之后阻止与所述棘轮齿条的接合；以及
旁路组件，其包括可滑动地设置在所述壳体内并且可操作地联接到所述棘轮棘爪的柱塞，所述柱塞可在第一位置与第二位置之间移动，以使所述棘轮棘爪在所述使用位置与所述旁路位置之间滑动。
2.根据权利要求1所述的手柄组件，其中所述旁路组件还包括与所述柱塞可滑动地接合的第一凸轮部件和可滑动地设置在所述棘轮棘爪上的第二凸轮部件，其中所述柱塞从所述第一位置到所述第二位置的移动将所述第一凸轮部件推动到所述第二凸轮部件中，从而推动所述第二凸轮部件以使所述棘轮棘爪从所述使用位置滑动到所述旁路位置。
3.根据权利要求2所述的手柄组件，其中所述第一凸轮部件和第二凸轮部件被构造成使得所述柱塞的纵向平移实现所述棘轮棘爪的横向滑动。
4.根据权利要求1所述的手柄组件，还包括被定位成朝向所述使用位置偏置所述棘轮棘爪的第一偏置构件。
5.根据权利要求1所述的手柄组件，还包括被定位成朝向所述第一位置偏置所述柱塞的第二偏置构件。
6.根据权利要求1所述的手柄组件，其中所述柱塞包括从所述壳体延伸的手动按钮，所述手动按钮相对于所述壳体选择性地可按压，以使所述柱塞从所述第一位置移动到所述第二位置。
7.一种可重复使用的外科手术施夹器，包括：
手柄组件，其包括：
接收器组件，所述接收器组件包括外套环和内管状构件；以及
旋钮，其围绕所述接收器组件设置，所述旋钮可相对于所述内管状构件滑动并且接合到所述外套环，使得所述旋钮相对于所述内管状构件在近侧位置与远侧位置之间的滑动使所述外套环相对于所述内管状构件在近侧锁定位置与远侧解锁位置之间滑动；
内窥镜夹具施加组件，其可插入所述内管状构件中，其中，在所述内窥镜夹具施加组件插入所述内管状构件中的情况下，所述旋钮可从所述远侧位置滑动到所述近侧位置，从而使所述外套环从所述远侧解锁位置滑动到所述近侧锁定位置以将所述内窥镜夹具施加组件锁定在所述内管状构件内，其中所述接收器组件被构造成可释放地接合所述内窥镜夹具施加组件；以及
至少一个滚珠轴承，其被构造成用于部分地插入穿过限定在所述内管状构件内的相应孔，每个滚珠轴承被构造成用于容纳在限定在所述内窥镜夹具施加组件内的相应孔内，以将所述内窥镜夹具施加组件锁定在所述内管状构件内。
8.根据权利要求7所述的可重复使用的外科手术施夹器，其中，在所述外套环的所述近侧锁定位置中，所述外套环向内推动所述至少一个滚珠轴承使其部分地穿过所述内管状构件的所述相应孔并且接合在限定在所述内窥镜夹具施加组件内的所述相应孔内，以将所述内窥镜夹具施加组件锁定在所述内管状构件内。
9.根据权利要求7所述的可重复使用的外科手术施夹器，其中所述内管状构件限定近侧孔和远侧孔，并且其中所述旋钮包括可操作地联接到旋钮的锁定销，所述锁定销被构造成用于接合在所述近侧孔内以将所述旋钮锁定在所述近侧位置中并且被构造成用于接合在所述远侧孔内以将所述旋钮锁定在所述远侧位置中。
10.根据权利要求9所述的可重复使用的外科手术施夹器，其中，在没有所述内窥镜夹具施加组件的情况下，所述旋钮被锁定在所述远侧位置，其中所述锁定销接合在所述远侧孔内。
11.根据权利要求10所述的可重复使用的外科手术施夹器，其中将所述内窥镜夹具施加组件插入所述内管状构件使所述锁定销与所述远侧孔脱离，以允许所述旋钮移动到所述近侧位置。
12.根据权利要求11所述的可重复使用的外科手术施夹器，还包括偏置构件，其被构造成朝向所述近侧位置偏置所述旋钮，使得在所述锁定销与所述远侧孔脱离之后，所述旋钮在所述偏置构件的所述偏置下被推动到所述近侧位置。
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- 2015-11-10 ES ES15908025T patent/ES2880951T3/es active Active
- 2015-11-10 WO PCT/CN2015/094195 patent/WO2017079895A1/en active Application Filing
- 2015-11-10 EP EP15908025.8A patent/EP3373830B1/en active Active
- 2015-11-10 CN CN201580084430.9A patent/CN108348261B/zh not_active Expired - Fee Related
- 2015-11-10 CA CA2999907A patent/CA2999907A1/en not_active Abandoned
- 2015-11-10 US US15/773,181 patent/US10702280B2/en active Active
- 2015-11-10 JP JP2018521373A patent/JP6609699B2/ja not_active Expired - Fee Related
- 2015-11-10 AU AU2015414380A patent/AU2015414380B2/en not_active Ceased
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| Publication number | Priority date | Publication date | Assignee | Title |
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| US5601601A (en) * | 1991-12-13 | 1997-02-11 | Unisurge Holdings, Inc. | Hand held surgical device |
| US5562655A (en) * | 1994-08-12 | 1996-10-08 | United States Surgical Corporation | Surgical apparatus having a universal handle for actuating various attachments |
| US5833696A (en) * | 1996-10-03 | 1998-11-10 | United States Surgical Corporation | Apparatus for applying surgical clips |
| CN1939228A (zh) * | 2005-09-29 | 2007-04-04 | 伊西康内外科公司 | 具有预加载击发辅助机构的外科缝合器械 |
| CN103190939A (zh) * | 2008-08-29 | 2013-07-10 | 柯惠Lp公司 | 具有夹子保持器的内窥镜手术施夹器 |
| CN203315019U (zh) * | 2013-05-24 | 2013-12-04 | 北京中法派尔特医疗设备有限公司 | 腔镜下切割缝合器 |
| EP2815702A1 (en) * | 2013-06-12 | 2014-12-24 | Covidien LP | Stapling device with grasping jaw mechanism |
Also Published As
| Publication number | Publication date |
|---|---|
| WO2017079895A1 (en) | 2017-05-18 |
| EP3373830A1 (en) | 2018-09-19 |
| EP3373830A4 (en) | 2019-07-31 |
| EP3373830B1 (en) | 2021-06-30 |
| US20180317927A1 (en) | 2018-11-08 |
| AU2015414380B2 (en) | 2020-10-15 |
| AU2015414380A1 (en) | 2018-04-12 |
| CA2999907A1 (en) | 2017-05-18 |
| JP6609699B2 (ja) | 2019-11-20 |
| CN108348261A (zh) | 2018-07-31 |
| ES2880951T3 (es) | 2021-11-26 |
| US10702280B2 (en) | 2020-07-07 |
| JP2018535741A (ja) | 2018-12-06 |
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