CN108392239A - 变将导引器紧固到手术紧固件施加设备的连接器夹具 - Google Patents

变将导引器紧固到手术紧固件施加设备的连接器夹具 Download PDF

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CN108392239A
CN108392239A CN201810110335.7A CN201810110335A CN108392239A CN 108392239 A CN108392239 A CN 108392239A CN 201810110335 A CN201810110335 A CN 201810110335A CN 108392239 A CN108392239 A CN 108392239A
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斯坦尼斯洛娃·科斯切夫斯基
戴维·瑞森耐特
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Covidien LP
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Abstract

提供一种紧固组织的方法。所述方法包含：获得管道部分；将所述管道部分的大小调节成所要长度；将所述管道部分紧固到连接器构件；将所述连接器构件紧固到手术器械的末端执行器；使用所述管道部分将所述末端执行器导引到目标位置；以及用所述末端执行器执行外科手术。

Description

变将导引器紧固到手术紧固件施加设备的连接器夹具
相关申请的交叉引用
本申请要求2017年2月6日提交的第62/455,068号美国临时专利申请的权益和优先权，所述美国临时专利申请的全部公开内容以引用的方式并入本文中。
技术领域
本公开大体上涉及手术紧固件施加设备，且更确切地说，涉及一种用于将导引器紧固到手术紧固件施加设备以便于进入内部解剖结构的连接器构件。
背景技术
为了减少创伤和恢复时间，许多外科手术是通过皮肤中的小开口来执行，所述小开口例如切口或天然的身体孔口。一般来说，这类手术被称作“内窥镜”，但如果是对患者腹部执行，那么在此情况下所述手术被称作“腹腔镜”。贯穿本公开，术语“微创”应理解为涵盖内窥镜和腹腔镜手术两者。
在微创外科手术的过程期间，通常采用手术紧固件施加设备来连接组织的邻近部分。多种类型的此类设备在所属领域中是已知的，所述设备中的一些尤其适用于特定的外科手术，包含但不限于端端吻合术、环形端端吻合术、开放式胃肠道吻合术、内窥镜胃肠道吻合术和横向吻合术。
直线手术紧固件施加设备大体上包含两个细长的钳口构件，所述钳口构件中的一个包含容纳多个手术紧固件的手术紧固件筒，所述手术紧固件布置在两个或多于两个直线行中，且所述钳口构件中的另一个包含砧座构件，其中多个紧固件形成配置和尺寸被设置成在紧固件从手术紧固件筒弹出后收纳并形成手术紧固件的凹座。通常，手术紧固件施加设备还包含刀具，所述刀具可在手术紧固件的直线行之间移动，使得在手术紧固件施加设备的致动后同时或接近同时地切割接合和/或密封的组织。考虑到此能力，在外科手术期间常常使用直线类型的手术紧固件施加设备来同时密封并切割目标组织，例如患者的脉管系统、器官等等。
用于促进将直线手术紧固件施加设备传送到手术部位的导引组合件是已知的，参见例如共同拥有的第8,136,711号和第9,403,942号美国专利。导引组合件通常包含具有固定长度的管状构件，所述管状构件可直接紧固到直线手术紧固件施加设备的钳口构件，或可以任选地包含用于将管状构件紧固到钳口构件的适配器。由于管状构件的固定长度所呈现的限制，以及其它原因，临床医师已经转而使用手术室中找到的可切割成所要长度的导管、软管和其它管道。然而，此管道可能无法牢牢接合钳口构件。管道与钳口构件之间的不当配合可能导致钳口构件与管道分离，和/或钳口构件可能过度地插入管道中并且需要在启动之前去除管道。
因此，具有用于将例如导管的导引管连接到直线手术紧固件施加设备所连接到的适配器的连接器构件将会是有益的。
发明内容
提供一种紧固组织的方法。所述方法包含：获得管道部分；将管道部分的大小调节成所要长度；将管道部分紧固到连接器构件；将连接器构件紧固到手术器械的末端执行器；使用管道部分将末端执行器导引到目标位置；以及用末端执行器执行外科手术。
在实施例中，获得管道部分包含对导管进行定位。获得管道部分可包含对手术软管进行定位。调节管道部分的大小可包含切割管道部分。将管道部分紧固到连接器构件可包含将连接器构件的远端附接结构收纳在管道部分的通路内。将连接器构件紧固到末端执行器可包含将连接器构件附接到末端执行器的砧座构件。将连接器构件紧固到末端执行器可包含将连接器构件附接到末端执行器的筒。将连接器构件附接到砧座构件可包含将连接器构件的附接结构与砧座构件的附接结构接合。将连接器构件附接到筒可包含将连接器构件的附接结构与砧座构件的附接结构接合。
在一些实施例中，将末端执行器导引到目标位置可包含将管道部分收纳在目标组织与侧支(collateral)组织之间。执行外科手术可包含用末端执行器抓紧组织。执行外科手术可进一步包含缝合组织。执行外科手术可进一步包含切割组织。所述方法可进一步包含在用末端执行器执行外科手术之前将连接器构件与末端执行器分离。使用管道部分将末端执行器导引到目标位置可包含将目标组织收纳在末端执行器的第一钳口与第二钳口之间。
附图说明
下文参考附图描述本公开的各种实施例，在附图中：
图1是定位成用于可释放连接到手术紧固件施加设备的末端执行器的当前公开的连接器构件的示范性实施例的侧视透视图；
图2是图1中所示的手术紧固件施加设备的末端执行器的砧座构件的侧视图；
图3A是图2中所示的末端执行器的砧座构件的解剖器顶端的实施例的俯视透视图；
图3B是图2中所示的末端执行器的砧座构件的解剖器顶端的另一实施例的俯视透视图；
图4是图1中所示的连接器构件的侧视透视图；
图5是图4中所示的连接器构件的远端的俯视图，其中折板部分处于初始或松弛状况下；
图6是图4中所示的连接器构件的远端的俯视图，其中折板部分处于第二或弯曲状况下；
图7是说明图1中所示的手术紧固件施加设备的末端执行器和连接构件的部分底部透视图；
图8是图7中所指示的细节区域的放大图；
图9是被切割成所要长度的管道件的侧视透视图；
图10是图4中所示的连接器构件紧固到图9中所示的管道段的一端的侧视透视图；
图11是紧固到图4中所示的连接器构件的管道段的示意图；
图12是图11所示的连接到末端执行器的连接器构件和管道段的侧视透视图；并且
图13是图12中所示的连接到管道段以及连接器构件的末端执行器的侧视平面图，所述管道段定位在目标组织与侧支组织之间。
具体实施方式
现在将参看图式详细地描述当前公开的连接器构件的实施例及其使用方法，其中相似的参考数字表示类似或相同的元件。在附图中，且在以下描述中，术语“近端”应理解为指代下文所论述的手术紧固件施加设备或连接器构件或其组件中在恰当使用期间较靠近临床医师的一端，而术语“远端”应理解为指代更远离临床医师的一端，如在所属领域中传统且常规的那样。另外，术语“手术紧固件”应理解为包含由适合于将组织接合在一起的预期目的的生物相容性材料形成的任何基本上为刚性的结构，包含但不限于手术钉、夹具等等。
此外，术语“组织”应理解为指代任何人类或动物组织、动脉、静脉、器官或身体内存在的其它此类解剖结构。具体来说，下文对术语“目标组织”的使用表示外科手术的目标或对象的组织，而术语“侧支组织”的使用指代在并非外科手术对象的目标组织周围的任何组织。
本公开涉及用于将管道部分紧固到末端执行器的连接器构件。在管道紧固到末端执行器后，使用管道来促进相对于组织定位末端执行器。
图1说明可重复使用或一次性类型的手术紧固件施加设备10，其包含：手柄组合件12，其具有可移动手柄14和静止手柄16；从手柄组合件12远端地延伸的细长轴18；以及定位在细长轴18的远端22处的末端执行器20。连接器构件100可以可释放方式连接到末端执行器20以将管道部分“t”(图7)紧固到末端执行器20，如下文进一步详细描述。
在各种实施例中，设想手柄组合件12可包含电机驱动、液压、棘轮或其它此类机构以促进手术紧固件施加设备10的致动。一般来说，末端执行器20适于夹持邻近组织段、将邻近组织段紧固在一起并沿着切割线切断邻近组织段。在使用期间，以类似于其它已知手术紧固件施加设备的方式并且根据其它已知手术紧固件施加设备来模拟(approximate)并启动手术紧固件施加设备10。手术紧固件施加设备10的模拟和启动机构(包含手柄组合件12和驱动组合件(未图示)的组件和交互)的论述可在共同拥有的第8,136,711号美国专利(“'711专利”)中找到，所述美国专利的全部内容特此以引用的方式并入。关于示范性手术紧固件施加设备的模拟和启动的额外细节可在共同拥有的第5,865,361号美国专利中找到，所述美国专利的全部内容特此以引用的方式并入。在替代实施例中，末端执行器20可适于使用例如RF能量来密封组织。
将仅以完全公开本公开的方面所必要的程度来描述手术紧固件施加设备10的末端执行器20。对于示范性末端执行器的详细论述，请参考'711专利。
参看图1到3B，末端执行器20包含以枢转方式联接到第二钳口26以促进其模拟的第一钳口24。末端执行器20适于夹持组织、将组织紧固在一起并沿着切割线切断组织。在实施例中，末端执行器20的第一钳口24包含砧座构件28，所述砧座构件28包括砧座板30(图2)和砧座罩32(图2)。如下文将进一步详细描述，砧座板30的解剖部分83可包含接合结构82，例如凹进部分84(图8)、一个或多个通道85(图3A)、一个或多个半球面凹进部分92(图3B)，以用于将连接器构件100紧固到砧座构件28。
再次参看图1，末端执行器20的第二钳口26包含装载有多个手术紧固件(未图示)的手术紧固件筒34。如所属领域中已知的，通过致动冲程朝向静止手柄16枢转可移动手柄14模拟了第一钳口24和第二钳口26。手术紧固件筒34的远端还可包含或替代地包含用于将连接器构件100紧固到手术紧固件筒34的接合结构(未图示)。
在模拟末端执行器20的第一钳口24和第二钳口26之后，例如在使第一钳口24和第二钳口26紧密可操作对准之后，可通过一个或多个额外致动冲程来移动可移动手柄14以从手术紧固件筒34弹出多个手术紧固件(未图示)，使得多个手术紧固件被驱动到砧座板30(图2)中以形成手术紧固件。设想可从第二钳口26去除手术紧固件筒34并用装载筒(未图示)来替换。在其它实施例中，末端执行器20可构成用于手术紧固件施加设备10的可去除且可替换装载单元的组件。
现在参看图4到6，提供连接器构件100以将例如砧座构件28的手术紧固件施加设备10(图1)与管道“t”段连接。管道“t”通常包含无创伤远端，所述无创伤远端可插入主体组织与目标组织之间，并且随后被操控以促进相对于目标组织恰当定位末端执行器20。
如上文所提及，已知包含导引器的导引组合件，所述导引器例如预切割、标记或未标记的管道段。无论是因为成本、空间和/或便利性，在许多情况下，临床医师选择使用在手术室中找到的管道来充当末端执行器20的导引装置而不是使用可商购导引器，所述管道例如导管、软管等等。当在手术室中找到的管道“t”用作导引器时，管道“t”紧固到末端执行器20而无直接紧固到末端执行器20的连接器。由此，管道“t”可能过早地与末端执行器20分离和/或阻止末端执行器20恰当地起作用，例如，在恰当地定位末端执行器20后，可能阻止第一钳口24和第二钳口26的完全模拟(图1)，而不使管道“t”与第一钳口24或第二钳口26分离。如下文将进一步详细描述，连接器构件100被配置成将具有各种内部直径的管道“t”与末端执行器20的砧座构件28和/或手术紧固件筒34紧固。
连接器构件100由适合于在外科手术期间与患者的内部组织接触的生物相容性材料形成，所述生物相容性材料例如聚合材料和/或不锈钢，并且连接器构件100包含相应近端部分102和远端部分104。连接器构件100的配置和尺寸被设置成用于与砧座构件28(图1)或末端执行器20(图1)的例如手术紧固件筒34(图1)的其它此类组件可释放接合，以及用于接合到具有不同内部直径的管道“t”，以促进管道“t”可操作附接到末端执行器20。具体来说，连接器构件100的近端部分102可以可释放方式与末端执行器20接合，例如与砧座构件28(图2)的解剖器部分83(图2)接合，使得连接器构件100从砧座构件28远端地延伸，并且连接器构件100的远端部分104可与管道“t”(图8)的近端接合，使得管道“t”从连接器构件100远端地延伸。
连接器构件100的近端部分102包含凸缘102a以防止连接器构件100的远端部分104过度插入管道“t”的通路“p”中。连接器构件的近端部分102限定内部空间106，所述内部空间106的配置和尺寸被设置成至少部分地收纳砧座构件28(图1)的解剖器部分83(图1)。为了促进连接器构件100与砧座构件28之间的连接，连接器构件100的近端部分102包含配置和尺寸被设置成用于与接合结构82(图3A和3B)可释放连接的近端附接结构108，所述接合结构82包含在解剖器部分83上，所述解剖器部分83在配置和尺寸方面对应于接合结构82。尽管如上文所描述，接合结构82说明为解剖器部分83的部分，但应了解，接合结构82可与包含砧座构件28的末端执行器20的任何其它部分以及手术紧固件筒34(图1)相关联。
在实施例中，连接器构件100的近端附接结构108包含向内延伸到连接器构件100的近端部分102的内部空间106中的一个或多个凸起的突出部110。凸起的突出部110的配置和尺寸被设置成用于接合或收纳在形成于砧座构件28的解剖器部分83上的凹进部分84(图8)内。可设想，连接器构件100的近端附接结构108和解剖器部分83的接合结构82可采用适合于在连接器构件100与末端执行器20(图1)之间形成可释放连接的预期目的的任何配置或尺寸。参见例如图3A和3B。
预期附接结构108和接合结构82的特定配置和尺寸可使得在连接器构件100成功连接到末端执行器20后向临床医师提供听觉或触觉指示。
继续参看图4到6，为了促进连接器构件100与管道“t”(图8)之间的接合，连接器构件100的远端部分104包含配置和尺寸被设置成部分或完全收纳在管道“t”的通路“p”(图8)内的远端附接结构112。远端附接结构112包含一系列接合部分114，所述接合部分114各自包含底座部分116以及从底座区段116延伸的第一折板部分118和第二折板部分120。第一折板部分118和第二折板部分120中的每一个通过柔性铰链116a连接到底座区段116。柔性铰链116a将第一折板部分118和第二折板部分120径向向外偏置成初始或第一状况(图5)。尽管接合部分114展示为仅包含第一折板部分118和第二折板部分120，但设想接合部分114可包含三(3)个或多于三个折板部分116。
在实施例中，连接器构件100的远端附接结构112的接合部分114的第一折板部分118和第二折板部分120中的每一个包含分别具有倾斜外表面118a、120a的基本上三角形配置。相应第一折板部分118和第二折板部分120的倾斜外表面118a、120a被配置成在连接器构件100的远端附接结构112插入管道“t”的通路“p”(图8)内时接合管道“t”(图8)的前边缘。相应第一折板部分116和第二折板部分118的倾斜外表面118a、120a的接合致使相应第一折板部分118和第二折板部分120抵抗柔性铰链116a的偏置径向向内枢转，如图5中的箭头“A”所展示，从而准许连接器构件100的远端附接结构112插入管道“t”的通路“p”内。接合部分114中的每一个限定分别安置在底座区段116与第一折板部分118和第二折板部分120之间的凹进部分117、119。凹进部分117、119容纳相应第一折板部分118和第二折板部分120的向内弯曲。
继续参看图5和6，第一折板部分118和第二折板部分120的相应倾斜外表面118a、120a的自由端122、124被配置成在连接器构件100安置在管道“t”的通路“p”(图8)内时防止管道“t”(图8)与连接器构件100的远端附接结构112分离。第一折板部分118和第二折板部分120的相应倾斜外表面118a、120a的自由端122、124分别向外偏置，并且被配置成在试图从管道“t”的纵向通路“p”去除远端附接结构112时接合管道“t”的内表面。接合部分114的柔性铰链116a所提供的向外偏置迫使相应第一折板部分118和第二折板部分120的自由端122、124与管道“t”的内表面接合。自由端122、124被配置成咬入或钻入管道“t”的内表面中，以防止管道“t”与连接器构件的远端附接结构112分离。
如图5中所见，在第一或松弛状况下，连接器构件100的远端附接结构112的接合部分114的第一折板部分118和第二折板部分120限定第一直径d1。在第一状况下，相应第一折板部分118和第二折板部分120的倾斜外表面118a、120a相对于连接器构件100的纵向轴线“x”成角度地延伸。为了使第一折板部分118和第二折板部分120的相应倾斜表面118a、120a的自由端122、124接合管道“t”的内表面，管道“t”的纵向通路“p”的直径必须略微小于第一直径d1。如上文所论述，当远端附接结构112收纳在管道“t”的通路“p”内时，第一折板部分118和第二折板部分120向内枢转以容纳管道“t”。柔性铰链116a所提供的偏置迫使相应第一折板部分和第二折板部分的自由端122、124与管道“t”的内壁接合。
转而参看图6，在第二或弯曲状况下，连接器构件100的远端附接结构112的接合部分114的第一折板部分118和第二折板部分120限定第二直径d2。在第二状况下，相应第一折板部分118和第二折板部分120的倾斜外表面118a、120a平行于连接器构件100的纵向轴线“x”延伸。为了使第一折板部分118和第二折板部分120的相应倾斜表面118a、120a的自由端122、124接合管道“t”的内表面，管道“t”的纵向通路“p”的直径必须略微大于第二直径d2。然而，设想连接器构件100可收纳内径等于或小于第二直径的管道(未图示)。以此方式，连接器构件100将通过相应第一折板部分118和第二折板部分120的倾斜外表面118a、120a之间的摩擦配合而不是通过第一折板部分118和第二折板部分120的自由端122、124的接合来紧固到管道。
现在参看图7到12，将结合连接器构件100和管道“t”段论述用手术紧固件施加设备10(图1)紧固组织的方法。如上文所提及，管道“t”可以来自导管、手术软管或任何合适管体，例如内径介于d1与d2之间的纵向通路“p”。管道“t”可具备连接器构件100，或可在手术室中找到。另外，可在成套工具中一起提供管道“t”、连接器构件100和/或手术紧固件施加设备10。
首先参看图7和8，在将手术紧固件施加设备10(图1)插入患者体内之前，将连接器构件100的近端102附接到末端执行器20，例如砧座构件28的解剖器部分83，并且将管道“t”连接到连接器构件100的远端104。
转而参看图9，首先定位一定长度的管道“t”，并将其切割到定长。管道“t”可包含标记，和/或临床医师可向管道“t”添加标记以识别并促进将管道“t”插入患者体内的深度的可视化。如上文所提及，管道“t”可包含导管、软管或其它管状结构。
现在参看图10，首先通过将连接器构件100的远端附接结构112插入管道“t”的纵向通路“p”中而将连接器构件100连接到管道“t”。当远端附接结构112收纳在管道“t”的通路“p”内时，远端附接结构112的接合部分114的第一折板部分118和第二折板部分120向内弯曲。凸缘102a(图4)被配置成接合管道“t”的顶端以防止远端附接结构112过度插入管道“t”的通路“p”中。如上文所提及，第一折板部分118和第二折板部分120的自由端122、124与管道“t”的内表面的接合防止管道“t”与连接器构件100的远端附接结构112分离。
一旦管道“t”紧固到连接器构件100(图11)的远端部分104，连接器构件100的近端部分102就紧固到末端执行器20。更确切地说，连接器构件100的近端附接结构108与包含在砧座构件28的解剖器部分83上的对应接合结构82配合。
参看图13，在使用连接器构件100将管道“t”紧固到末端执行器20后，可操控管道“t”和末端执行器20，使得管道“t”的远端定位在目标组织“T”与侧支组织“C”之间。在操控管道“t”期间，组成管道“t”的可挠性材料允许管道“t”平缓地推动侧支组织“C”远离目标组织“T”，进而建立和/或扩展末端执行器20可沿之行进的路径。
为了促进目标组织“T”定位在砧座组件28与手术紧固件筒34(图1)之间，可抽出或近端地拉动管道“t”的远端。以此方式操控管道“t”使目标组织“T”导引到砧座组件28与手术紧固件筒34之间的位置中，同时防止侧支组织“C”与手术紧固件施加设备10(图1)的任何组件不合需要地接触。
继续参看图13，设想可在成套工具中提供连接器构件100，所述成套工具具有端盖150(以虚线展示)以用于密封管道“t”的近端。设想端盖150可包含类似于连接器构件100的远端附接结构112的远端附接结构152(以虚线展示)以准许端盖150牢牢附接到管道“t”。端盖150可包含圆形形状，如所展示，或可包含适合于管道“t”无创伤插入组织中的任何其它形状，例如锥形、圆锥形、截头圆锥形。
当到达目标组织并且目标组织“T”定位于砧座组件28与手术紧固件筒34之间时，临床医师可选择去除连接器构件100和附接的管道“t”，或将连接器构件100和管道“t”留在适当位置。临床医师可接着继续抓紧、紧固并切割目标组织“T”。
在外科手术之后，可将连接器构件100与末端执行器20分离，并且可以传统方式处理连接器构件100和管道“t”。设想连接器构件100可以是可重复使用的。连接器构件100的重复使用可能需要从远端附接结构112中切割管道“t”。
所属领域的技术人员将理解，本文中特定地描述且附图中所说明的装置和方法是非限制性示范性实施例，且应将描述、公开内容和图式仅仅认作示范特定实施例。因此，应理解，本公开不限于所描述的精确实施例，且所属领域的技术人员可在不脱离本公开的范围或精神的情况下实现各种其它改变和修改。另外，设想结合一个示范性实施例说明或描述的元件和特征可与不脱离本公开的范围的另一示范性实施例的元件和特征组合，并且此类修改和变化还意图包含在本公开的范围内。因此，本发明不受特定地展示和描述的内容限制，而是如所附权利要求书所指示。

Claims (15)

1.一种紧固组织的方法，包括：
获得管道部分；
将所述管道部分的大小调节成所要长度；
将所述管道部分紧固到连接器构件；
将所述连接器构件紧固到手术器械的末端执行器；
使用所述管道部分将所述末端执行器导引到目标位置；以及
用所述末端执行器执行外科手术。
2.根据权利要求1所述的方法，其中获得所述管道部分包含对导管进行定位。
3.根据权利要求1所述的方法，其中获得所述管道部分包含对手术软管进行定位。
4.根据权利要求1所述的方法，其中调节所述管道部分的大小包含切割所述管道部分。
5.根据权利要求1所述的方法，其中将所述管道部分紧固到所述连接器构件包含将所述连接器构件的远端附接结构收纳在所述管道部分的通路内。
6.根据权利要求1所述的方法，其中将所述连接器构件紧固到所述末端执行器包含将所述连接器构件附接到所述末端执行器的砧座构件。
7.根据权利要求1所述的方法，其中将所述连接器构件紧固到所述末端执行器包含将所述连接器构件附接到所述末端执行器的筒。
8.根据权利要求6所述的方法，其中将所述连接器构件附接到所述砧座构件包含将所述连接器构件的附接结构与所述砧座构件的附接结构接合。
9.根据权利要求7所述的方法，其中将所述连接器构件附接到所述筒包含将所述连接器构件的附接结构与所述砧座构件的附接结构接合。
10.根据权利要求1所述的方法，其中将所述末端执行器导引到所述目标位置包含将所述管道部分收纳在目标组织与侧支组织之间。
11.根据权利要求1所述的方法，其中执行外科手术包含用所述末端执行器抓紧组织。
12.根据权利要求11所述的方法，其中执行外科手术进一步包含缝合组织。
13.根据权利要求12所述的方法，其中执行外科手术进一步包含切割组织。
14.根据权利要求1所述的方法，进一步包含在用所述末端执行器执行所述外科手术之前将所述连接器构件与所述末端执行器分离。
15.根据权利要求1所述的方法，其中使用所述管道部分将所述末端执行器导引到所述目标位置包含将目标组织收纳在所述末端执行器的第一钳口与第二钳口之间。
CN201810110335.7A 2017-02-06 2018-02-05 变将导引器紧固到手术紧固件施加设备的连接器夹具 Pending CN108392239A (zh)

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