CN108472027A - 内窥镜外科手术夹具施用器 - Google Patents

内窥镜外科手术夹具施用器 Download PDF

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CN108472027A
CN108472027A CN201680079266.7A CN201680079266A CN108472027A CN 108472027 A CN108472027 A CN 108472027A CN 201680079266 A CN201680079266 A CN 201680079266A CN 108472027 A CN108472027 A CN 108472027A
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CN108472027B (zh
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胡恩成
蔡龙生
易鹏
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Nellcor Puritan Bennett LLC
Covidien LP
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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
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • 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
    • A61B17/1285—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 for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • 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
    • 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
    • A61B2017/00407—Ratchet means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30—Surgical robots

Abstract

一种可搁置外科手术夹具施用器(10)包含柄部组合件(100)和内窥镜组合件(200、300、400)。所述柄部组合件(100)包含：外壳(110)，其限定主体部分(111)和从所述主体部分(111)延伸的固定柄部部分(112)；和触发器(122)，其可枢转地连接到所述外壳(110)且可相对于所述固定柄部部分(112)在未致动位置与致动位置之间移动。所述内窥镜组合件(200、300、400)包含：近端集线器(210、310、410)，其被配置成可与所述柄部组合件(100)的所述外壳(110)选择性地接合；细长轴(340)，其从所述近端集线器向远端延伸；末端执行器(350)，其支撑在所述细长轴(340)的远侧端部处；和内部驱动组合件(320)，其包含近端部分(323)和远端部分(325)。所述近端部分(323)可在被所述末端执行器组合件(350)阻挡后在所述远端部分(325)内推进以准许所述触发器(122)返回到未致动位置。

Description

内窥镜外科手术夹具施用器
技术领域
本技术领域涉及外科手术夹具施用器。更具体地说，本公开涉及具有被配置成用于与各种不同内窥镜组合件一起使用的柄部组合件的内窥镜外科手术夹具施用器。
背景技术
内窥镜外科手术缝合器和外科手术夹具施用器在本领域中是已知的，且用于多个不同和有用的外科手术过程。在腹腔镜外科手术过程的情况下，穿过狭窄管或穿过皮肤中的小进入切口插入的插管实现到腹部内的进入。在身体中的其它地方执行微创手术通常被称为内窥镜过程。通常，管或插管装置通过用以提供进入端口的进入切口延伸到患者的身体中。端口允许外科医生使用套管针通过其插入多个不同外科手术器械，且允许远离切口执行外科手术过程。
在大部分这些过程期间，外科医生必须通常终止血液或通过一个或多个脉管的另一流体的流动。外科医生将通常使用特定内窥镜外科手术夹具施用器以将外科手术夹具施用到血管或另一管道以防止在过程期间通过其的体液的流动。
内窥镜外科手术夹具施用器具有各种尺寸(例如，直径)，其被配置成施用多种不同外科手术夹具且在本领域中是已知的，且能够在进入体腔期间施用单次或多种外科手术夹具。此类外科手术夹具典型地由生物兼容性材料制造，且通常压缩在脉管上。一旦施用到脉管，压缩的外科手术夹具终止通过其的流体的流动。
能够在内窥镜或腹腔镜过程中在单次进入体腔期间施用多种夹具的内窥镜外科手术夹具施用器描述于Green等人的共同转让的美国专利第5,084,057号和美国专利第5,100,420号中，所述美国专利以全文引用的方式并入。另一多种内窥镜外科手术夹具施用器公开于Pratt等人的共同转让的美国专利第5,607,436号中，所述专利的内容也在此以全文引用的方式并入本文中。这些装置典型地但不一定在单次外科手术过程期间使用。Pier等人的美国专利第5,695,502号公开了可再消毒的内窥镜外科手术夹具施用器，所述专利的公开内容在此以引用的方式并入本文中。内窥镜外科手术夹具施用器在单次插入到体腔中期间推进且形成多种夹具。此可再消毒的内窥镜外科手术夹具施用器被配置成接收可互换的夹具储匣且与其协作以便在单次进入体腔期间推进且形成多种夹具。
在内窥镜或腹腔镜过程期间，取决于下层组织或待结扎的脉管可能需要和/或必需使用不同尺寸的外科手术夹具或不同配置的外科手术夹具。为了减小内窥镜外科手术夹具施用器的整体成本，需要待可加载有不同尺寸外科手术夹具且能够按需要烧制不同尺寸外科手术夹具的单次内窥镜外科手术夹具施用器。
因此，需要包含柄部组合件的内窥镜外科手术夹具施用器，所述柄部组合件被配置成用于与其中加载的具有不同夹具的各种不同内窥镜组合件一起使用和/或被配置成用于执行各种不同外科手术任务。
发明内容
如本文中详述以及附图中所示出，按传统当参考在外科手术器械上相关的定位时，术语“近端”是指更接近用户的设备或其部件的端部且术语“远端”是指更远离用户的设备或其部件的端部。此外，在某种程度上一致，本文中详述的方面和特征中的任一个或全部可与本文中详述的其它方面和特征中的任一个或全部结合使用。
根据本公开的各方面提供一种包含柄部组合件和内窥镜组合件的可搁置手术夹具施用器。柄部组合件包含：外壳，其限定主体部分；和固定柄部部分，其从主体部分延伸；以及触发器，其可枢转地连接到外壳且可相对于固定柄部部分在未致动位置与致动位置之间移动。
内窥镜组合件包含：近端集线器，其被配置成可与柄部组合件的外壳选择性地接合；细长轴，其从近端集线器向远端延伸；末端执行器组合件，其支撑在细长轴的远侧端部处；和内部驱动组合件，其安置于近端集线器和细长轴内。内部驱动组合件可操作地耦接到末端执行器组合件，使得对柄部组合件的触发器的致动会操控末端执行器组合件。
内部驱动组合件包含近端部分和远端部分，其中所述远端部分被配置成可滑动地接收近端部分的至少一部分，使得近端部分可在被末端执行器组合件阻挡后在远端部分内推进，由此准许触发器返回到未致动位置。
可搁置手术夹具施用器可进一步包含偏置构件，所述偏置构件插入于内部驱动组合件的近端部分与远端部分之间，使得偏置构件使近端部分和远端部分偏置成隔开配置。
内部驱动组合件的近端部分可包含从其向远端延伸的细长构件，所述细长构件被配置成由限定在内部驱动组合件的远端部分的近侧端部内的孔可滑动地接收。
可搁置手术夹具施用器可进一步包含驱动杆，所述驱动杆可滑动地支撑在外壳的主体部分内且可操作地耦接到触发器，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端平移通过外壳的主体部分。
可搁置手术夹具施用器还可包含安置于驱动杆上的棘轮齿条。
可搁置手术夹具施用器可进一步包含棘轮棘爪，所述棘轮棘爪可枢转地支撑在外壳内且可相对于其在使用位置与绕过位置之间移动，在所述使用位置中棘轮棘爪定位成在驱动杆向远端平移后接合棘轮齿条，在所述绕过位置中棘轮棘爪从棘轮齿条移位以抑制在驱动杆向远端平移后与棘轮齿条接合。
可搁置手术夹具施用器还可包含接收器组合件，所述接收器组合件被配置成可释放地接合其中的内窥镜组合件。
可搁置手术夹具施用器可进一步包含绕过组合件，所述绕过组合件可操作地定位于接收器组合件与棘轮棘爪之间，使得所述绕过组合件可在远端位置与近端位置之间移动以用于使棘轮棘爪在使用位置与绕过位置之间移动。
近端集线器和内部驱动组合件可限定其间的环形间隙，所述环形间隙被配置成在将内窥镜组合件插入到接收器组合件中后接收绕过组合件的一部分，使得在近端集线器接合在接收器组合件内后绕过组合件维持在远端位置中，由此使棘轮棘爪维持在使用位置中以及实现棘轮棘爪在驱动杆向远端平移期间与棘轮齿条的接合。
在使用时，在触发器从未致动位置移动到未致动位置与致动位置之间的中间位置后，驱动杆可定位成使得棘轮棘爪与棘轮齿条接合以抑制触发器朝向未致动位置返回。
驱动杆可限定近端凹陷，所述近端凹陷安置在棘轮齿条的近端且被配置成使得在触发器移动到致动位置后，棘爪至少部分地安置在近端凹陷内以准许触发器返回到未致动位置。
在使用时，可准许触发器在未致动位置与致动位置之间的每个点处朝向致动位置返回。
根据本公开的另一方面，提供一种可搁置手术夹具施用器，且所述可搁置手术夹具施用器包含柄部组合件、第一内窥镜组合件和第二内窥镜组合件。
柄部组合件包含：外壳，其限定主体部分；和固定柄部部分，其从主体部分延伸；以及触发器，其可枢转地连接到外壳且可相对于固定柄部部分在未致动位置与致动位置之间移动。
第一内窥镜组合件被配置成用于棘轮效应使用且包含：近端集线器，其被配置成可与柄部组合件的外壳选择性地接合；细长轴，其从近端集线器向远端延伸；末端执行器组合件，其支撑在细长轴的远侧端部处；和内部驱动组合件，其安置于近端集线器和细长轴内。内部驱动组合件可操作地耦接到末端执行器组合件，使得对柄部组合件的触发器的致动会操控末端执行器组合件。内部驱动组合件包含近端部分和远端部分，其中所述远端部分被配置成可滑动地接收近端部分的至少一部分，使得近端部分可在被末端执行器组合件阻挡后在远端部分内推进，由此准许触发器返回到未致动位置。
第二内窥镜组合件被配置成用于非棘轮效应使用且包含：近端集线器，其被配置成可与柄部组合件的外壳选择性地接合且限定面向近端的表面；细长轴，其从近端集线器向远端延伸；末端执行器组合件，其支撑在细长轴的远侧端部处；和内部驱动组合件，其安置于近端集线器和细长轴内。内部驱动组合件可操作地耦接到末端执行器组合件，使得对柄部组合件的触发器的致动会操控末端执行器组合件。内部驱动组合件包含近端部分和远端部分，其中所述远端部分被配置成可滑动地接收近端部分的至少一部分，使得近端部分可在被末端执行器组合件阻挡后在远端部分内推进，由此准许触发器返回到未致动位置。
可搁置手术夹具施用器可进一步包含偏置构件，所述偏置构件插入于第一和第二内窥镜组合件中的每一个的内部驱动组合件的近端部分与远端部分之间，使得偏置构件使第一和第二内窥镜组合件中的每一个的近端部分和远端部分偏置成隔开配置。
第一和第二内窥镜组合件中的每一个的内部驱动组合件的近端部分可包含从其向远端延伸的细长构件，所述细长构件被配置成由限定在第一和第二内窥镜组合件中的每一个的内部驱动组合件的远端部分的近侧端部内的孔可滑动地接收。
可搁置手术夹具施用器可进一步包含驱动杆，所述驱动杆可滑动地支撑在外壳的主体部分内且可操作地耦接到触发器，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端平移通过外壳的主体部分。
可搁置手术夹具施用器还可包含安置于驱动杆上的棘轮齿条。
可搁置手术夹具施用器可进一步包含棘轮棘爪，所述棘轮棘爪可枢转地支撑在外壳内且可相对于其在使用位置与绕过位置之间移动，在所述使用位置中棘轮棘爪定位成在驱动杆向远端平移后接合棘轮齿条，在所述绕过位置中棘轮棘爪从棘轮齿条移位以抑制在驱动杆向远端平移后与棘轮齿条接合。
可搁置手术夹具施用器还可包含接收器组合件，所述接收器组合件被配置成可释放地接合其中的内窥镜组合件。
可搁置手术夹具施用器可进一步包含绕过组合件，所述绕过组合件可操作地定位于接收器组合件与棘轮棘爪之间，使得所述绕过组合件可在远端位置与近端位置之间移动以用于使棘轮棘爪在使用位置与绕过位置之间移动。
附图说明
参考附图详细地描述当前公开的内窥镜外科手术夹具施用器的方面和特征，其中相似参考标号标识类似或相同结构元件，且：
图1是根据本公开提供的包含具有与其接合的内窥镜组合件的柄部组合件的内窥镜外科手术夹具施用器的近端部分的透视图；
图2是图1的内窥镜外科手术夹具施用器的透视图，其中内窥镜组合件从柄部组合件移除；
图3是在图2中指示为“3”的细节区域的放大透视图；
图4是在图3中的截面线4-4上截取的横向剖视图；
图5是在图3中的截面线5-5上截取的横向剖视图；
图6是在图1中的截面线6-6上截取的横向剖视图；
图7是在图6中的截面线7-7上截取的纵向剖视图；
图8是图1的柄部组合件的纵向剖视图；
图9是图1的柄部组合件的分解视图；
图10是图1的柄部组合件的透视图，其中外壳的一部分被移除以说明其中的内部部件；
图11是图1的柄部组合件的内部组合件的透视图；
图12是在图8中指示为“12”的细节区域的放大纵向剖视图；
图13是在图10中指示为“13”的细节区域的放大透视图；
图14是在图11中指示为“14”的细节区域的放大透视图；
图15是被配置成用于与图1的柄部组合件一起使用的另一内窥镜组合件的透视图；
图16是图15的内窥镜组合件的远端部分的放大透视图；
图17是图15的内窥镜组合件的近端部分的放大透视图；
图18是图15的内窥镜组合件的近端部分的放大透视图，其中外部外壳的一部分以虚线示出以说明其中的内部部件；
图19是图15的内窥镜组合件的纵向剖视图；
图20是图15的内窥镜组合件的近端部分的放大纵向剖视图；
图21是说明图1的柄部组合件与图15的内窥镜组合件之间的可操作接合的放大纵向剖视图；
图22是被配置成用于与图1的柄部组合件一起使用的另一内窥镜组合件的透视图；
图23是图22的内窥镜组合件的远端部分的放大透视图；
图24是图22的内窥镜组合件的近端部分的放大透视图；
图25是图22的内窥镜组合件的近端部分的放大透视图，其中外部外壳的一部分以虚线示出以说明其中的内部部件；
图26是图22的内窥镜组合件的纵向剖视图；
图27是图22的内窥镜组合件的近端部分的纵向剖视图；
图28是说明图1的柄部组合件与图22的内窥镜组合件之间的可操作接合的放大纵向剖视图；
图29是说明根据本公开提供的内窥镜组合件的替代实施例的顶部剖视图；且
图30是被配置成用于根据本公开使用的机器人外科手术系统的示意性说明。
具体实施方式
转向图1和2，根据本公开提供的内窥镜外科手术夹具施用器由附图标记10识别。外科手术夹具施用器10大体上包含柄部组合件100以及可选择性地连接到柄部组合件100且可从柄部组合件100向远端延伸的多个内窥镜组合件200。柄部组合件100有利地被配置成在多个内窥镜组合件200中的每一个连接到其上后操作所述多个内窥镜组合件200中的每一个，且可被配置为可灭菌的可重复使用的部件，使得柄部组合件100在一个或多个外科手术过程的进程期间可反复与不同和/或额外内窥镜组合件200一起使用。取决于特定内窥镜组合件200的特定用途和/或配置，内窥镜组合件200可被配置为单次使用的一次性部件、有限使用的一次性部件或可重复使用部件。在任一配置中，避免对多个柄部组合件100的需要，且实际上，外科医生仅需要选择适当内窥镜组合件200且将内窥镜组合件200连接到柄部组合件100以准备使用。
首先详述用于与通用内窥镜组合件200连接的柄部组合件100，所述通用内窥镜组合件200包含与可与柄部组合件100一起使用的任何内窥镜组合件共同的特征。下文在其之后详述特定内窥镜组合件的示范性实施例，例如，内窥镜组合件300(图15)和内窥镜组合件400(图22)。内窥镜组合件300(图15)例如被配置成用于握紧和操控组织，取回外科手术夹具，以及围绕组织烧制和形成外科手术夹具。作为另一实例，内窥镜组合件400(图22)包含加载在其中的至少一个外科手术夹具且被配置成围绕组织连续地烧制和形成至少一个外科手术夹具。还设想用于执行各种不同外科手术任务和/或具有各种不同配置的各种其它内窥镜组合件可被提供以用于与柄部组合件100一起使用。
继续参考图1和2，如上文所指出，内窥镜组合件200被配置成选择性地连接到柄部组合件100和从柄部组合件100向远端延伸。内窥镜组合件200包含：近端集线器210，其被配置成用于插入到柄部组合件100中且在柄部组合件100内可释放接合；细长轴220，其从近端集线器210向远端延伸；和末端执行器组合件(未示出)，其安置在细长轴220的远侧端部处。内部驱动部件(未示出)延伸通过近端集线器210和细长轴220以便在内窥镜组合件200与柄部组合件100接合后将末端执行器组合件(未示出)与柄部组合件100可操作地耦接，例如，以使得能够执行内窥镜组合件200的一个或多个外科手术任务。近端集线器210限定大体上管状配置且包含限定在其中的纵向延伸狭槽212和限定在其中的环形凹槽214。纵向延伸狭槽212限定张开近侧端部213。环形凹槽214围绕近端集线器210周向延伸且与纵向延伸狭槽212相交，但也涵盖其它非相交配置。
另外参考图3到5，柄部组合件100包含接收器组合件170，所述接收器组合件170被配置成接收内窥镜组合件200的近端集线器210且实现内窥镜组合件200与柄部组合件100的可释放接合。接收器组合件170包含外部轴环172和内部管状构件174。内部管状构件174限定稍微大于内窥镜组合件200的近端集线器210的外部直径的内部直径以使得能够将近端集线器210可滑动插入到内部管状构件174中，同时其间没有显著运动。内部管状构件174进一步包含通过其限定且围绕内部管状构件174周向定位的多个孔径176。与其外部开口177b相比，孔径176限定减小的内部开口177a。滚珠轴承178安置于孔径176中的每一个内。尽管每个滚珠轴承178的一部分通过其相应孔径176的减小的内部开口177a向内突出，但减小的内部开口177a抑制滚珠轴承178完整地通过其传递。外部轴环172定位成以便阻挡孔径的外部开口177b，由此使滚珠轴承178保持在外部轴环172与减小的内部开口177a之间的孔径176内(除滚珠轴承178的延伸通过减小的内部开口177a的部分以外)。
销180延伸通过限定在内部管状构件174内的销孔径182且至少部分地通过限定在外部轴环172内的销狭槽184。销180至少部分地延伸到内部管状构件174的内部中，且如下文详述被配置成在将内窥镜组合件200插入到柄部组合件100中后促进内窥镜组合件200的对准。销180被进一步配置成使外部轴环172和内部管状构件174相对于彼此保持固定旋转定向。外部轴环172在固定旋转定向上与柄部组合件100的旋转旋钮190接合，使得在销180将外部轴环172与内部管状构件174可旋转地耦接的情况下，可实现旋转旋钮190的旋转以类似地旋转接收器组合件170。旋转旋钮190包含安置于其上的对准指示器192，所述对准指示器192与销180对准以实现内窥镜组合件200与接收器组合件170的对准而无需直接观察销180的位置。
参考图1、2、6和7，为了将内窥镜组合件200与柄部组合件100接合，内窥镜组合件200定向成使得其纵向延伸狭槽212与接收器组合件170的销180对准。如上文所指出，可经由将纵向延伸狭槽212与柄部组合件100的旋转旋钮190的对准指示器192对准而实现纵向延伸狭槽212与销180的对准，而不是必须直接观察销180。在已经实现对准后，内窥镜组合件200的近端集线器210向近端滑动到接收器组合件170的内部管状构件174中。纵向延伸狭槽212与销180的对准确保了在近端集线器210向近端滑动到内部管状构件174中后销180平移通过纵向延伸狭槽212。
在近端集线器210向近端滑动到内部管状构件174中时，滚珠轴承178在近端集线器210的外部上施加径向向内的力，从而使近端集线器210、外部轴环172、内部管状构件174和/或滚珠轴承178移动或折曲以在滚珠轴承178之间调整近端集线器210。滚珠轴承178被准许在近端集线器210向近端滑动到内部管状构件174中时在孔径176内旋转，从而减小摩擦且准许近端集线器210相对容易地滑动到内部管状构件174中。在将近端集线器210完全地插入到内部管状构件174中后，例如，在销180到达纵向延伸狭槽212的关闭远侧端部后，滚珠轴承178移动到围绕环形凹槽214的位置中。由于由滚珠轴承178施加的径向向内的力，因此在已经实现充分插入的位置后，滚珠轴承178被推动到环形凹槽214中以由此将内窥镜组合件200的近端集线器210可释放地互锁成接合在柄部组合件100的接收器组合件170内。用以使得内窥镜组合件200的操作能够执行一个或多个外科手术任务的内窥镜组合件200与柄部组合件100的可操作耦接取决于与柄部组合件100接合的内窥镜组合件200的类型且将在下文关于示范性内窥镜组合件300(图15)和400(图22)详述。
为了从柄部组合件100移除内窥镜组合件200，在足够的推动下相对于柄部组合件100向远端拉动内窥镜组合件200以便从环形凹槽214移位滚珠轴承178，因此准许内窥镜组合件200的近端集线器210向远端滑动出柄部组合件100的接收器组合件170。
参考图1、2和8到10，柄部组合件100大体上包含外壳110、可枢转地耦接到外壳110的触发器组合件120、可操作地耦接到触发器组合件120的棘轮效应驱动组合件130、可操作地耦接到棘轮效应驱动组合件130的绕过组合件150、从外壳110向远端延伸的接收器组合件170以及围绕接收器组合件170可操作地安置的旋转旋钮190。
外壳110限定主体部分111和从主体部分111向下延伸的固定柄部部分112。外壳110由经由销-支柱接合而紧固到彼此的第一外壳部件113a和第二外壳部件113b形成。但第一外壳部件113a和第二外壳部件113b可替代地可以任何其它合适的方式紧固，所述任何其它合适的方式例如，超声波焊接、胶合、其它机械接合等。外壳110被配置成容纳柄部组合件100的内部作业部件。主体部分111包含在其内部上限定环形狭槽115的远端鼻114。更具体地说，第一外壳部件113a和第二外壳部件113b各自限定半环形狭槽部分，使得当第一外壳部件113a和第二外壳部件113b配合以形成外壳110时，形成环形狭槽115。柄部组合件100的接收器组合件170包含围绕其内部管状构件174的近侧端部安置的保持夹具186。举例来说，在第一外壳部件113a和第二外壳部件113b彼此接合后，保持夹具186捕获在限定在外壳110的远端鼻114内的环形狭槽115内。保持夹具186捕获在环形狭槽115内以将接收器组合件170与外壳110可旋转地接合。柄部组合件100的旋转旋钮190例如经由外部轴环172、偏置构件194和弹性C环196相对于接收器组合件170在固定旋转定向上围绕接收器组合件170可操作地接合，使得旋转旋钮190相对于外壳110的旋转实现接收器组合件170相对于外壳110的类似旋转。因此，在内窥镜组合件200接合在接收器组合件170内时，可使旋转旋钮190相对于外壳100旋转以类似地使内窥镜组合件200相对于外壳110旋转。
外壳110的主体部分111进一步包含在外壳部件113a、113b之间横向延伸的内部枢转支柱116以及限定在外壳部件113a、113b中的一个或两个内的纵向延伸导轨117，下文详述其中每一个的重要性。外壳110的固定柄部部分112被配置成促进柄部组合件100的握紧及其操控且用主体部分111单块形成，但也涵盖其它配置。
额外参考图11，触发器组合件120大体上包含触发器122、偏置构件127和连杆128。触发器122包含握紧部分123、中间枢转部分124和近端延伸部分125。触发器122的握紧部分123从外壳110的主体部分111向下延伸，相对于外壳110的固定柄部部分112呈相反关系。握紧部分123被配置成促进触发器122的握紧和操控。触发器122的中间枢转部分124至少部分地安置于外壳110内且限定枢转孔径126a，所述枢转孔径126a被配置成接收外壳110的枢转支柱116以便实现触发器122围绕枢转支柱116且相对于外壳110例如在未致动位置与致动位置之间枢转，在所述未致动位置中触发器122的握紧部分123相对于固定柄部部分112隔开，在所述致动位置中触发器122的握紧部分123相对于固定柄部部分112合拢。
与触发器122的握紧部分123相比，触发器组合件120的触发器122的近端延伸部分125安置于中间枢转部分124且因此安置于枢转支柱116的相反侧上。由此，握紧部分123向近端推动近端延伸部分125，例如，朝向致动位置的枢转向远端推动近端延伸部分125。近端延伸部分125包含：第一孔径126b，其被配置成接收偏置构件127的第一端部；和一对第二孔径126c，其被配置成接收用于将连杆128的近侧端部与触发器122的近端延伸部分125彼此可枢转地耦接的第一销129a。偏置构件127的第二端部围绕在固定柄部部分112内横向延伸的臂118接合。偏置构件127在静止状况下安置于触发器122的握紧部分123的未致动位置中。握紧部分123朝向致动位置的枢转使其中存储能量的偏置构件127伸长，使得在释放握紧部分123后，握紧部分123在偏置构件127的偏置下朝向未致动位置返回。尽管说明为延伸螺旋弹簧，但偏置构件127可限定用于使触发器122的握紧部分123朝向未致动位置偏置的任何合适的配置。
如上文所指出，经由第一销129a将连杆128在其近侧端部处耦接到触发器122的近端延伸部分125。而且经由第二销129b将连杆128在其远侧端部处可枢转地耦接到棘轮效应驱动组合件130的驱动杆132的近端延伸部134。第二销129b从驱动杆132的近端延伸部134的任一侧或两侧向外延伸且接收在限定在外壳部件113a和/或外壳部件113b内的纵向延伸导轨117内。由于此配置，握紧部分123朝向致动位置的枢转会向远端推动近端延伸部分125，继而向远端推动连杆128，使得第二销129b向远端平移通过纵向延伸导轨117。
继续参考图1、2和8到11，柄部组合件100的棘轮效应驱动组合件130包含驱动杆132和棘爪组合件140。驱动杆132包含近端延伸部134、棘轮齿条136以及分别地远端凹陷138和近端凹陷139。近端延伸部134安置在驱动杆132的近侧端部处且限定孔径135，所述孔径135被配置成接收触发器组合件120的第二销129b以便将连杆128和驱动杆132的远侧端部彼此可枢转地耦接，如上文所指出。由此，在握紧部分123朝向致动位置枢转以通过纵向延伸导轨117向远端推动第二销129b后，驱动杆132向远端平移通过外壳110的主体部分111。驱动杆132的棘轮齿条136限定多个轮齿137且沿着其上表面上的驱动杆132纵向延伸。远端凹陷138和近端凹陷139由形成在驱动杆132中的切口限定且分别邻近于棘轮齿条136向远端定位和邻近于棘轮齿条136向近端定位。
还参考图12，棘轮效应驱动组合件130的棘爪组合件140包含棘轮棘爪142、棘爪销144和棘爪偏置构件146。棘轮棘爪142通过棘爪销144可枢转地耦接到外壳110的主体部分111以便当使用棘轮效应功能的内窥镜组合件200连接到柄部组合件100时使得棘轮棘爪142能够与棘轮齿条136可操作接合，且以便当并不使用棘轮效应功能的内窥镜组合件200连接到柄部组合件100时使得棘轮棘爪142能够枢转到绕过位置。棘轮棘爪142进一步包含从其任一侧横向延伸的一对向外延伸突出部143，下文详述其重要性。
棘爪组合件140的棘爪偏置构件146耦接于棘轮棘爪142与外壳110的主体部分111之间以便使棘轮棘爪142朝向使用位置且远离绕过位置偏置。在使用位置中，棘轮棘爪142定向成在驱动杆132向远端推进后可操作地接合棘轮齿条136。然而，在驱动杆132的对应于触发器122的未致动位置的最近端位置中，棘轮棘爪142至少部分地安置在驱动杆132的远端凹陷138内。因此，棘轮棘爪142至少初始地与棘轮齿条136脱离接合。
参考图8到14，绕过组合件150可操作地定位于棘爪组合件140与接收器组合件170之间且被配置成响应于柄部组合件100与并不使用棘轮效应功能的内窥镜组合件200的接合而使棘轮棘爪142枢转到绕过位置，由此在驱动杆132推进后抑制棘轮效应。当使用棘轮效应功能的内窥镜组合件200连接到柄部组合件100时，绕过组合件150保持闲置，使得棘轮棘爪142保持在使用位置中以在驱动杆132推进后使得棘轮棘爪142能够沿着棘轮齿条136发生棘轮效应。
绕过组合件150包含套筒152、偏置构件154和凸轮夹具156。套筒152延伸到接收器组合件170的内部管状构件174的近侧端部中且围绕驱动组合件130的驱动杆132的远侧端部安置，相对于内部管状构件174和驱动杆132两者呈可滑动关系。偏置构件154安置于接收器组合件170的内部管状构件174内且围绕套筒152安置。更具体地说，偏置构件154围绕套筒152固持在套筒152的远端轮缘153与环形肩状物179之间，所述环形肩状物179在内部管状构件174的近侧端部处限定在内部管状构件174的内部内。由于此配置，偏置构件154使套筒152向近端偏置到内部管状构件174的内部中。套筒152的远端轮缘153与限定内部管状构件174的内部壁径向隔开以便限定其间的环形间隔“A1”。套筒152进一步限定内部直径“D1”。
绕过组合件150的凸轮夹具156接合在围绕套筒152的外部朝向其近侧端部限定的环形凹槽157内。凸轮夹具156充分地设定尺寸以便抑制通过到内部管状构件174的内部中且因此抑制套筒152在偏置构件154的偏置下完全地进入内部管状构件174。凸轮夹具156在其自由端部处进一步包含一对相反的向内延伸指状物158。指状物158定位成使得在套筒152对抗偏置构件154的偏置向近端充分推动后，指状物158接触棘轮棘爪142的相应突出部143。因此，在套筒152进一步向近端移动后，指状物158向近端推动相应突出部143，最终使得棘轮棘爪142被推动成围绕棘爪销144旋转且对抗棘爪偏置构件146从使用位置到绕过位置的偏置。
转向图15到21，且示出了根据本公开提供且被配置成用于与柄部组合件100一起使用的内窥镜组合件300。内窥镜组合件300被配置成用于非棘轮效应使用且因此在内窥镜组合件300与柄部组合件100接合后，如下文详述，棘轮棘爪142枢转到绕过位置中且固持在绕过位置中，因此实现此类非棘轮效应使用。内窥镜组合件300大体上包含近端集线器310、安置于近端集线器310内且延伸通过近端集线器310的内部驱动组合件320、从近端集线器310向远端延伸的细长轴340以及包含安置在细长轴340的远侧端部处的一对夹钳构件360a、360b的末端执行器组合件350。内窥镜组合件300被配置成握紧和/或操控组织，取回外科手术夹具以及围绕组织关闭、烧制或形成外科手术夹具。预期内窥镜组合件300被配置成关闭、烧制或形成类似于在美国专利第4,834,096号中所示出和描述的那些的手术夹具，所述专利的全部内容以引用的方式并入。
额外参考图1、2、6和7，内窥镜组合件300的近端集线器310限定大体上管状配置和稍微小于柄部组合件100的接收器组合件170的内部管状构件174的外部直径的外部直径以使得能够将近端集线器310可滑动地插入到内部管状构件174中，其中其间没有显著运动。近端集线器310进一步包含类似于上文相对于内窥镜组合件200详述的那些的特征以便以类似方式实现在柄部组合件100的接收器组合件170内的近端集线器310的接合。更具体地说，近端集线器310包含被配置成接收接收器组合件170的销180的纵向延伸狭槽311以确保内窥镜组合件300相对于100的正确对准，以及被配置成接收每个滚珠轴承178的至少一部分的环形凹槽312以在内窥镜组合件300的近端集线器310接合在柄部组合件100的接收器组合件170内时可释放地互锁所述近端集线器310。
再次参考图15到21，内窥镜组合件300的近端集线器310进一步限定具有张开近侧端部314以及与孔313的直径相比直径减小的远端开口的内部孔313以便限定其间的肩状物315。套圈316安放在近端集线器310的张开近侧端部内且以任何合适的方式紧固在其中，所述任何合适的方式例如，焊接、胶合、压配、机械接合等。
近端集线器310的套圈316限定纵向延伸通过其的孔径317和面向近端的表面318，所述面向近端的表面318包围孔径317，使得面向近端的表面318限定环形配置。孔径317被安置成与近端集线器310的内部连通以便能够进入内部驱动组合件320，如下文详述，且限定充分大以便准许柄部组合件100的棘轮效应驱动组合件130的驱动杆132通过其可滑动插入的直径“D2”。然而，孔径317的直径“D2”小于套筒152的内部直径“D1”。套圈316的面向近端的表面318限定大于限定于套筒152的远端轮缘153与限定内部管状构件174的内部壁之间的环形间隔“A1”的环形宽度“A2”。由于直径“D2”小于直径“D1”且环形宽度“A2”大于环形间隔“A1”，因此抑制了近端集线器310传递到套筒152的内部中且同样地抑制了围绕套筒152的外部传递。实际上，在内窥镜组合件300的近端集线器310向近端推动到柄部组合件100的接收器组合件170的内部管状构件174中例如以将内窥镜组合件300与柄部组合件100接合后，套圈316的面向近端的表面318最终接触套筒152的远端轮缘153，使得近端集线器310进一步向近端推动到内部管状构件174中会对抗偏置构件154的偏置向近端推动套筒152。
如上文所指出，内窥镜组合件300被配置成用于非棘轮效应使用。因此，上文关于近端集线器310的部件以及绕过组合件150的相对尺寸详述的配置确保近端集线器310在内窥镜组合件300与柄部组合件100接合后将棘轮棘爪142从使用位置推动到绕过位置，因此禁用了棘轮效应驱动组合件130的棘轮效应部件。更具体地说，在销180接收在纵向延伸狭槽311内且近端集线器310向近端滑动到接收器组合件170的内部管状构件174中时但在滚珠轴承178接合在环形凹槽312内之前，套圈316的面向近端的表面318接触套筒152的远端轮缘153且向近端推动套筒152，使得凸轮夹具156的指状物158向近端推动棘轮棘爪142的突出部143以由此使棘轮棘爪142围绕棘爪销144从使用位置朝向绕过位置旋转。因此，在到达内部管状构件174内的近端集线器310的接合位置后，例如，在滚珠轴承178接合在环形凹槽312内后，如图21中所示出，套圈316已将套筒152推动到最近端位置，其中棘轮棘爪142枢转到绕过位置且固持在绕过位置中。因此，当内窥镜组合件300与柄部组合件100接合时，禁用棘轮效应驱动组合件130的棘轮效应。
仍参考图15到21，内窥镜组合件300的内部驱动组合件320包含可滑动地安置于内窥镜组合件300的近端集线器310和细长轴340两者内的内部轴322。内部轴322包含支撑安置于近端集线器310的孔313内的横向销324的近侧端部323，以及支撑朝向细长轴340的远侧端部344安置的凸轮销326的远侧端部325。如下文详述，凸轮销326安置于末端执行器组合件350的夹钳构件360a、360b的凸轮狭槽(未示出)内以使得夹钳构件360a、360b能够响应于内部轴322平移通过细长轴340而在打开与关闭位置之间枢转。
内部驱动组合件320进一步包含冲杆328以及分别地第一偏置构件330和第二偏置构件332。冲杆328可滑动地安置于近端集线器310的孔313内且在其中固持在肩状物315与套圈316之间。冲杆328限定内部空腔329，内部轴322的近侧端部323的横向销324可滑动地限制在所述内部空腔329内。
内部驱动组合件320的第一偏置构件330安置于近端集线器310的内部孔313内且插入于近端集线器310的肩状物315与内部轴322的横向销324之间。第一偏置构件330具有第一弹簧常数“K1”，所述第一弹簧常数“K1”小于第二偏置构件332的第二弹簧常数“K2”，下文详述其重要性。第二偏置构件332安置于冲杆328的空腔329内且内置于内部轴322的横向销324与冲杆328的近侧端部之间。如下文详述，分别地第一偏置构件330和第二偏置构件332促进内部轴322适当平移通过近端集线器310和细长轴340以打开和关闭夹钳构件340a、340b，以及以实现触发器122(图1)的完全致动，如下文详述。
内窥镜组合件300的细长轴340限定大体上管状配置且在近端集线器310与末端执行器组合件350之间延伸且互连近端集线器310与末端执行器组合件350。更具体地说，细长轴340的近侧端部342紧固到近端集线器310，而细长轴340的远侧端部344支撑U形夹346，所述U形夹346被配置成经由枢转销352在细长轴340的远侧端部344处可枢转地接合末端执行器组合件350的夹钳构件360a、360b。
如上文所指出，末端执行器组合件350包含第一夹钳构件360a和第二夹钳构件360b。夹钳构件360a、360b经由枢转销352可枢转地接合到彼此和U形夹346以便准许夹钳构件360a、360b相对于彼此以及介于打开位置与关闭位置之间的细长轴340的枢转。每个夹钳构件360a、360b包含相应近侧端部361a、361b和相应远侧端部362a、362b。每个夹钳部件360a、360b的近侧端部361a、361b限定被配置成接收内部轴322的凸轮销326的凸轮狭槽(未示出)，使得内部轴322的平移使夹钳构件360a、360b在打开位置与关闭位置之间枢转。夹钳构件360a、360b的远侧端部362a、362b被配置成接收和关闭、烧制或形成外科手术夹具，例如，类似于在美国专利第4,834,096号中所示出和描述的那些的外科手术夹具，所述专利先前以引用的方式并入本文中。
短暂地参考图29，说明内部驱动组合件320的替代实施例。在此实施例中，内窥镜组合件300的内部轴322分成近端部分322'和远端部分322”。远端部分322”的近侧端部322a”包含限定在其中的孔322b”，所述孔322b”被配置成可滑动地接收安置于近端部分322'的远侧端部322a'上的细长构件322b'。横向狭槽322c”通过内部轴322的远端部分322”限定且被配置成可滑动地固持横向销320a'。横向销320a'使用任何合适的装置固定地固持在限定在近端部分322'的远侧端部322a'中的孔径(未示出)内，所述任何合适的装置例如摩擦配合、焊接、胶粘剂等。偏置构件320b'安置于内部轴322的近端部分322'与远端部分322”之间且作用于远端部分322”的近侧端部322a”和安置于近端部分322'的远侧端部322a'上的环形表面322c'。以此方式偏置构件(例如，弹簧等)320b'首先被压缩，使得近端部分322'和远端部分322”维持隔开关系。横向销320a'抑制近端部分322'和远端部分322”在横向销320b'处于横向狭槽322c”的冲程中的最近端位置时被偏置构件320b'推动隔开。
在操作中，如果夹钳构件360a、360b的关闭可能被卡住或以其它方式防止其完整地关闭(例如，其中夹钳构件360a、360b将关闭到骨头上或另一外科手术夹具上)，那么可完全地完成此过载补偿系统准许柄部组合件100的棘轮效应驱动组合件130的前向冲程(其中内部轴322的近端部分322'的远端驱动力轴向地压缩具有弹簧常数“K3”的偏置构件320b'，所述弹簧常数“K3”大于“K1”或“K2”)以便准许重设或反转棘轮效应驱动组合件130且准许打开触发器122。
现在参考图8到21详述柄部组合件100结合内窥镜组合件300的使用。首先，内窥镜组合件300与柄部组合件100接合，如上文详述。内窥镜组合件300与柄部组合件100的此类接合，同样如上文详述，实现棘轮棘爪142枢转到绕过位置且使棘轮棘爪142保持在绕过位置中。一旦内窥镜组合件300和柄部组合件100与绕过位置中的棘轮棘爪142接合，柄部组合件100和内窥镜组合件300就一起准备使用。
在使用时，触发器122初始地在偏置构件127的偏置下安置于未致动位置中。在触发器122安置于未致动位置中的情况下，驱动杆132安置于最近端位置中。此外，内部轴322在第一偏置构件330和第二偏置构件332的偏置下安置于最近端位置中。因此，夹钳构件360a、360b初始地安置于打开位置中。在夹钳构件360a、360b安置于打开位置中的情况下，新的未成形打开的外科手术夹具(未示出)可位于夹钳构件360a、360b的远侧端部362a、362b内或加载在远侧端部362a、362b内。末端执行器组合件350的夹钳构件360a、360b可用于取回或拾取来自夹具固定器(未示出)的外科手术夹具，所述外科手术夹具可由用户人工地加载，末端执行器组合件350可由制造商预加载，或外科手术夹具可以任何其它合适的形式放置在夹钳构件360a、360b之间。
为了关闭、烧制或形成加载在夹钳构件360a、360b之间的外科手术夹具，触发器122从未致动位置被推动到致动位置。更具体地说，朝向外壳110的固定柄部部分112枢转触发器122的握紧部分123以向远端推动连杆128，继而向远端推动驱动杆132通过外壳110、接收器组合件170且进入内窥镜组合件300的近端集线器310的孔313。在触发器122进一步朝向致动位置枢转时，驱动杆132最终接触内窥镜组合件300的驱动组合件320的冲杆328。由于第一偏置构件330的第一弹簧常数“K1”小于第二偏置构件332的第二弹簧常数“K2”，因此在驱动杆132初始地推动到冲杆328中时，冲杆328和内部轴322一起向远端平移，使得第一偏置构件330被压缩，而第二偏置构件332保持基本上未压缩。
在内部轴322向远端平移时，凸轮销326平移通过夹钳构件360a、360b的凸轮狭槽以朝向关闭位置枢转夹钳构件360a、360b，从而关闭和/或形成加载在末端执行器组合件350内的外科手术夹具(未示出)。向远端推进凸轮销326，直到凸轮销326到达夹钳构件360a、360b的凸轮狭槽的端部为止和/或直到夹钳构件360a、360b抵靠彼此完全地合拢或在外科手术夹具上完全地关闭为止。如可了解，根据所使用的特定内窥镜组合件，形成外科手术夹具的配置和/或其它因素，用以完全地形成外科手术夹具的内部轴322的所需行进距离可变化。由于触发器122在未致动位置与致动位置之间的行进距离并不会变化，内窥镜组合件300正是此变化的原因，如下文详述。
一旦夹钳构件360a、360b已抵靠彼此完全地合拢或在外科手术夹具上完全地关闭，和/或当凸轮销326已到达夹钳构件360a、360b的凸轮狭槽的端部时，就不再准许内部轴322进一步向远端行进。因此，在进一步向远端推动驱动杆132例如以完成触发器122的致动冲程后，独立于内部轴322向远端推进冲杆328以压缩第二偏置构件332。因此，第二偏置构件332的压缩使得内部轴322能够保持在适当位置，同时完成触发器122的充分的致动冲程。
一旦已完全地形成外科手术夹具，就可释放触发器122且允许其在偏置下返回到未致动位置，由此将驱动杆132拉回到其最近端位置且允许夹钳构件360a、360b返回到打开位置。在其之后，可重复上文详述的使用以关闭、烧制或形成额外外科手术夹具。另外或可替代地，末端执行器组合件350的夹钳构件360a、360b可用于在一个或多个外科手术夹具的形成之前或之后按需要握紧和/或操控组织。
转向图22到28，示出了根据本公开提供且被配置成用于与柄部组合件100(图1)一起使用的另一内窥镜组合件400。内窥镜组合件400被配置成用于棘轮效应使用且因此在将内窥镜组合件400与柄部组合件100接合后，如下文详述，棘轮棘爪142保持在使用位置中以实现棘轮效应使用。内窥镜组合件400大体上包含近端集线器410、从近端集线器410向远端延伸的细长轴420、安置于近端集线器410和细长轴420内的驱动组合件430和支撑在细长轴420的远侧端部处的一对夹钳构件460a、460b。内窥镜组合件400被配置成围绕组织关闭、烧制或形成一个或多个外科手术夹具。更具体地说，预期内窥镜组合件400可被配置成关闭、烧制或形成类似于在美国专利第7,819,886或7,905,890号中所示出和描述的那些的外科手术夹具，所述专利中的每一个的全部内容以引用的方式并入本文中。
还参考图1、2、6和7，近端集线器410进一步包含类似于上文相对于内窥镜组合件200详述的那些的特征以便以类似方式实现在柄部组合件100的接收器组合件170内的近端集线器410的接合。更具体地说，近端集线器410包含被配置成接收接收器组合件170的销180的纵向延伸狭槽411以确保内窥镜组合件400相对于柄部组合件100的正确对准，以及被配置成接收每个滚珠轴承178的至少一部分的环形凹槽412以在内窥镜组合件400的近端集线器410接合在柄部组合件100的接收器组合件170内时可释放地互锁所述近端集线器410。
如上文所指出，内窥镜组合件400被配置成用于棘轮效应使用且因此在将内窥镜组合件400与柄部组合件100接合后，如下文详述，棘轮棘爪142保持在使用位置中以实现棘轮效应使用。为了允许此类情形，近端集线器410限定环形地安置于限定近端集线器410的外部外壳与驱动组合件430的冲杆435之间的环形孔径414，环形孔径414可滑动地安置于近端集线器410内。此环形孔径414定位和尺寸设定成在将内窥镜组合件400插入到接收器组合件170中后接收套筒152的远端轮缘153。因此，在将内窥镜组合件400的近端集线器410插入到柄部组合件100的接收器组合件170的内部管状构件174中例如以将内窥镜组合件400与柄部组合件100接合后，套筒152的远端轮缘153不受干扰地通过环形孔径414传递到近端集线器410中，使得套筒152在偏置构件154的偏置下维持在其最远端位置中。在套筒152在其最远端位置中的情况下，棘轮棘爪142保持在使用位置中，因此实现柄部组合件100的棘轮效应驱动组合件130的棘轮效应使用。
返回参考图22到28，如上文所提及，内窥镜组合件400包含从近端集线器410向远端延伸的细长轴420。细长轴420包含紧固到近端集线器410的近侧端部422和支撑第一夹钳构件460a和第二夹钳构件460b的远侧端部424。
驱动组合件430包含可滑动地支撑在细长轴420和近端集线器410的内部内的内部轴431。内部轴431包含近侧端部433和远侧端部434。内部轴431的近侧端部433延伸到近端集线器410的内部孔413中且经由在冲杆435的纵向狭槽437内接收内部轴431的横向销436而可操作地耦接到驱动组合件430的冲杆435。内部轴431的远侧端部434被配置成将第一夹钳构件460a和第二夹钳构件460b从打开位置转换到关闭位置以形成响应于内部轴431向远端平移通过细长轴420而已加载到第一夹钳构件460a和第二夹钳构件460b中的外科手术夹具(未示出)。
预期内部轴431可以与上文相对于内部轴322所公开的类似的方式分成近端部分和远端部分。内部轴431的此实施例的部件和操作类似于内部轴322的部件和操作，且因此下文中将不再描述其部件和操作的详细描述。
驱动组合件430进一步包含停止环438以及第一偏置构件439a和第二偏置构件439b，其中的每一个围绕内部轴431安置。停止环438围绕内部轴431固定地接合且安置于近端集线器410的内部孔413内。第一偏置构件439a从停止环438向远端定位且固持于停止环438与近端集线器410的远侧端部之间。第二偏置构件439b从停止环438向近端定位且固持于停止环438与冲杆435的远侧端部之间。第一偏置构件439a具有第一弹簧常数“KK1”，所述第一弹簧常数“KK1”小于第二偏置构件439b的第二弹簧常数“KK2”，下文详述其重要性。
现在参考图8到14和22到28详述柄部组合件100结合内窥镜组合件400的使用。初始地，内窥镜组合件400与柄部组合件100接合，如上文详述。由于内窥镜组合件400被配置成用于棘轮效应驱动组合件130的棘轮效应使用，因此棘轮棘爪142在内窥镜组合件400与柄部组合件100接合后保持安置于使用位置中。更具体地说，由于近端集线器410的环形孔径414和绕过组合件150的套筒152的相对位置和尺寸，因此在将近端集线器410插入到接收器组合件170中时，套筒152接收在环形孔径414内，由此使得套筒152能够在偏置构件154的偏置下保持在其最远端位置中。在套筒152保持在其最远端位置中的情况下，棘轮棘爪142在棘爪偏置构件146的偏置下固持在使用位置中。因此，如下文详述，实现柄部组合件100和内窥镜组合件400的棘轮效应使用。一旦内窥镜组合件400和柄部组合件100与保持在使用位置中的棘轮棘爪142接合，柄部组合件100和内窥镜组合件400就一起准备使用。
在使用时，触发器122初始地在偏置构件127的偏置下安置于未致动位置中。在触发器122安置于未致动位置中的情况下，驱动杆132安置于最近端位置中，使得棘轮棘爪142安置于驱动杆132的远端凹陷138内。此外，在驱动杆132安置于最近端位置中的情况下，驱动组合件430的内部轴431在分别地第一偏置构件439a和第二偏置构件439b的偏置下安置于最近端位置中。因此，夹钳构件460a、460b初始地安置在打开位置中。在夹钳构件460a、460b安置在打开位置中的情况下，新的未成形或打开的外科手术夹具(未示出)可位于夹钳构件460a、460b内或加载在夹钳构件460a、460b内，或可以其它方式可操作地定位(人工地或自动地)用于插入其间，用于在夹钳构件460a、460b的关闭后围绕组织的形成或关闭。举例来说，在一些实施例中，在烧制期间，首先从在夹钳构件460a、460b之间的细长轴420推进外科手术夹具，且在其之后，关闭夹钳构件460a、460b以形成外科手术夹具。在此类实施例中，可以类似方式在细长轴420内加载一系列外科手术夹具用于依序烧制。然而，也涵盖用于其烧制的其它合适的外科手术夹具和/或配置。
为了关闭、烧制或形成加载在夹钳构件460a、460b之间的外科手术夹具，触发器122从未致动位置被推动到致动位置。更具体地说，朝向外壳110的固定柄部部分112枢转触发器122的握紧部分123以向远端推动连杆128，继而向远端推动驱动杆132。在向远端推动驱动杆132时，棘轮棘爪142移出驱动杆132的远端凹陷138且变成与棘轮齿条136接合。一旦棘轮棘爪142与棘轮齿条136接合，触发器122就可能不会朝向未致动位置返回，且因此驱动杆132可能不会向近端返回，直到触发器122到达致动位置从而完成其充分的致动冲程为止。
在向远端平移驱动杆132时，驱动杆132推进通过外壳110、接收器组合件170且进入内窥镜组合件400的近端集线器410的孔413。最终，驱动杆132接触内窥镜组合件400的驱动组合件430的冲杆435。由于第一偏置构件439a的第一弹簧常数“KK1”小于第二偏置构件439b的第二弹簧常数“KK2”，因此在驱动杆132初始地推动到冲杆435中时，冲杆435和内部轴431一起向远端平移，使得第一偏置构件439a被压缩，而第二偏置构件439b保持基本上未压缩。当向远端平移内部轴431时，首先在第一夹钳构件460a与第二夹钳构件460b之间加载外科手术夹具，且在其之后将第一夹钳构件460a和第二夹钳构件460b从打开位置平移到关闭位置以形成围绕组织的外科手术夹具，尽管也涵盖其它配置。
如上文相对于内窥镜组合件300所指出(图15到21)，取决于所使用的特定内窥镜组合件，形成的外科手术夹具的配置和/或其它因素、内部轴431用以完全地形成外科手术夹具所需的行进距离可变化。还如上文所提及，一旦棘轮棘爪142与棘轮齿条136接合，触发器122就可能不会朝向未致动位置返回，直到触发器122到达致动位置从而完成其充分的致动冲程为止。因此，为了在驱动杆132用以完全地形成外科手术夹具所需的行进长度对于棘轮棘爪142清除棘轮齿条136且进入驱动杆132的近端凹陷139是不充分的例子中使得触发器122能够返回到未致动位置，内窥镜组合件400必须允许驱动杆132的进一步行进，如下文详述。
在进一步致动触发器122以完成其充分的致动冲程时，继续向远端驱动冲杆435。然而，由于内部轴431无法进一步向远端行进，因此第二偏置构件439b被压缩，因此允许冲杆435独立于内部轴431向远端平移。也就是说，第二偏置构件439b的压缩使得内部轴431能够保持在适当位置，同时完成触发器122的充分的致动冲程。
在触发器122的完全致动后，例如，在到达触发器122的致动位置后，将棘轮棘爪142移动到驱动杆132的近端凹陷139中。在将棘轮棘爪142安置于近端凹陷139内的情况下，可释放触发器122且在偏置构件127的偏置下使其返回到未致动位置。在其之后，可重复上文详述的使用以关闭、烧制或形成额外外科手术夹具。
预期在本公开的范围内，可提供其它内窥镜组合件，包含具有独特且多样关闭冲程长度的一对夹钳，以用于与柄部组合件100一起使用来棘轮效应使用或非棘轮效应使用，类似地如上文相对于内窥镜组合件300、400(分别地图15到21和22到28)详述。这种配置适应具有不同配置和/或不同关闭冲程长度的各种不同内窥镜组合件，同时提供触发器122的恒定致动冲程长度。因此，可提供根据本公开的原理构造的各种内窥镜组合件，其也能够在用于多个不同制造商的多个平台上烧制或形成或关闭各种尺寸、材料和配置的外科手术夹具。
例如本文中所描述的夹具施用器的外科手术器械还可被配置成对机器人外科手术系统起作用，且机器人外科手术系统通常被称为“遥控手术”。此类系统采用各种机器人元件来辅助外科医生，且允许外科手术器械的远程操作(或部分远程操作)。出于此目的可采用各种机器人臂、齿轮、凸轮、滑轮、电马达和机械马达等且可将其设计成具有机器人外科手术系统以在手术或治疗的进程期间帮助外科医生。此类机器人系统可包含远程可导向系统、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、模块化或可选择性配置远程操作外科手术系统等。
机器人外科手术系统可与靠近手术室或位于远程位置中的一个或多个控制台一起采用。在此例子中，一个团体的外科医生或护士可使患者对手术作好准备，且用一个或多个本文中所公开的器械配置机器人外科手术系统，而另一外科医生(或一组外科医生)经由机器人外科手术系统远程控制器械。如可了解，高度熟练的外科医生可在多个位置执行多个操作而不离开他/她的远程控制台，这在经济上有利且对于患者或一系列患者也是有益的。
外科手术系统的机器人臂通常通过控制器耦接到一对主控柄部。外科医生可移动柄部以产生任何类型的外科手术器械(例如，末端执行器、握紧器、小刀、剪刀等)的工作端的对应移动，所述任何类型的外科手术器械可补足本文中所描述的实施例中的一个或多个的使用。可按比例缩放主控柄部的移动，使得工作端的对应移动不同于、小于或大于通过外科医生的操作手执行的移动。可调整比例因子或齿轮比率，从而使得操作员可控制外科手术器械的工作端的分辨率。
主控柄部可包含各种传感器，所述各种传感器用以将与各种组织参数或状况，例如，归因于操控的组织抗性、切割或以其它方式治疗、通过器械压在组织上、组织温度、组织阻抗等相关的反馈提供给外科医生。如可了解，此类传感器向外科医生提供模拟实际操作状况的增强的触觉反馈。主控柄部还可包含多种不同致动器，其用于精细组织操控或治疗，从而进一步增强外科医生模仿实际操作状况的能力。
参考图30，医疗工作站通常示出为工作站1000，且其通常可包含多个机器人臂1002、1003；控制装置1004；以及与控制装置1004耦接的操作控制台1005。操作控制台1005可包含可被特定设定成显示三维图像的显示装置1006；和手动输入装置1007、1008，例如外科医生的人员(未示出)借助于所述手动输入装置可能够以第一操作模式远距离操控机器人臂1002、1003。
根据本文中所公开的若干实施例中的任一个，机器人臂1002、1003中的每一个可包含通过接合件连接的多个构件和例如支撑末端执行器1100的手术工具“ST”可附接到的附接装置1009、1011，如下文将更详细地描述。
机器人臂1002、1003可由连接到控制装置1004的电动驱动器(未示出)驱动。可具体地说借助于计算机程序激活驱动器以机器人臂1002、1003、其附接装置1009、1011且因此外科手术工具(包含末端执行器1100)根据借助于手动输入装置1007、1008限定的移动执行所需移动的方式来设定控制装置1004(例如，计算机)来激活驱动器。还可以使其调节机器人臂1002、1003的移动和/或驱动器的移动的方式来设定控制装置1004。
医疗工作站1000可被配置成用于在位于患者检查台1012上的患者1013上使用，所述患者待借助于末端执行器1100以微创方式治疗。医疗工作站1000也可包含多于两个机械臂1002、1003，额外机械臂同样地连接到控制装置1004且可借助于操作控制台1005远距离操控。医疗器械或外科手术工具(包含末端执行器1100)也可附接到额外机器人臂上。医疗工作站1000可包含数据库1014，具体地说所述数据库1014耦接为与控制装置1004结合，在所述控制装置1004中存储例如来自患者/活体1013和/或身体结构数据集的手术前数据。
在本文中参考于2011年11月3日提交的标题为“医疗工作站(MedicalWorkstation)”的美国专利公开第2012/0116416号，所述美国专利公开的全部内容以引用的方式并入，以获得对示范性机器人外科手术系统的构造和操作的更详细论述。
预期在本公开的范围内，包含具有独特且多样关闭冲程长度的一对夹钳的其它内窥镜组合件可具有与本文中所描述的驱动组合件中的任一个类似的驱动组合件，以用于将其一对夹钳的关闭冲程长度调整和调适成恒定的触发器冲程长度。
因此，可提供根据本公开的原理构造的各种内窥镜组合件且其也能够在用于多个不同制造商的多个平台上烧制或形成或关闭各种尺寸、材料和配置的外科手术夹具。
应理解，前述描述仅说明本公开。本领域的技术人员可在不脱离本公开的情况下设计各种替代和修改。因此，本公开旨在涵盖所有此类替代、修改和变化。呈现参考附图所描述的实施例仅为了展现本公开的某些实例。与上文所描述和/或所附权利要求书中的元件、步骤、方法和技术无实质不同的其它元件、步骤、方法和技术也旨在处于本公开的范围内。
应理解，前述描述仅说明本公开。本领域的技术人员可在不脱离本公开的情况下设计各种替代和修改。因此，本公开旨在涵盖所有此类替代、修改和变化。呈现参考附图所描述的实施例仅为了展现本公开的某些实例。与上文所描述和/或所附权利要求书中的元件、步骤、方法和技术无实质不同的其它元件、步骤、方法和技术也旨在处于本公开的范围内。

Claims (20)

1.一种可搁置外科手术夹具施用器，其包括：
柄部组合件，其包含：
外壳，其限定主体部分和从主体部分延伸的固定柄部部分；和
触发器，其能够枢转地连接到所述外壳且能够相对于所述固定柄部部分在未致动位置与致动位置之间移动；以及
内窥镜组合件，其包含：
近端集线器，其被配置成能够与所述柄部组合件的所述外壳选择性地接合；
细长轴，其从所述近端集线器向远端延伸；
末端执行器组合件，其支撑在所述细长轴的远侧端部处；和
内部驱动组合件，其安置于所述近端集线器和所述细长轴内且能够操作地耦接到所述末端执行器组合件，使得对所述柄部组合件的所述触发器的致动会操控所述末端执行器组合件，所述内部驱动组合件包含近端部分和远端部分，其中所述远端部分被配置成能够滑动地接收所述近端部分的至少一部分，使得所述近端部分能够在被所述末端执行器组合件阻挡后在所述远端部分内推进，由此准许所述触发器返回到未致动位置。
2.根据权利要求1所述的可搁置外科手术夹具施用器，其进一步包含插入于所述内部驱动组合件的所述近端部分与所述远端部分之间的偏置构件，其中所述偏置构件使所述近端部分和所述远端部分偏置成隔开配置。
3.根据权利要求1所述的可搁置外科手术夹具施用器，其中所述内部驱动组合件的所述近端部分包含从其向远端延伸的细长构件，所述细长构件被配置成能够由限定在所述内部驱动组合件的所述远端部分的近侧端部内的孔滑动地接收。
4.根据权利要求1所述的可搁置外科手术夹具施用器，其进一步包含驱动杆，所述驱动杆能够滑动地支撑在所述外壳的所述主体部分内且能够操作地耦接到所述触发器，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端平移通过所述外壳的所述主体部分。
5.根据权利要求4所述的可搁置外科手术夹具施用器，其进一步包含安置于所述驱动杆上的棘轮齿条。
6.根据权利要求5所述的可搁置外科手术夹具施用器，其进一步包含棘轮棘爪，所述棘轮棘爪能够枢转地支撑在所述外壳内且能够相对于其在使用位置与绕过位置之间移动，在所述使用位置中所述棘轮棘爪定位成在所述驱动杆向远端平移后接合所述棘轮齿条，在所述绕过位置中所述棘轮棘爪从所述棘轮齿条移位以抑制在所述驱动杆向远端平移后与棘轮齿条接合。
7.根据权利要求6所述的可搁置外科手术夹具施用器，其进一步包含接收器组合件，所述接收器组合件被配置成能够在其中释放地接合内窥镜组合件。
8.根据权利要求7所述的可搁置外科手术夹具施用器，其进一步包含能够操作地定位于所述接收器组合件与所述棘轮棘爪之间的绕过组合件，所述绕过组合件能够在远端位置与近端位置之间移动以用于使所述棘轮棘爪在所述使用位置与所述绕过位置之间移动。
9.根据权利要求8所述的可搁置外科手术夹具施用器，其中所述近端集线器和所述内部驱动组合件限定其间的环形间隙，所述环形间隙被配置成在将所述内窥镜组合件插入到所述接收器组合件中后接收所述绕过组合件的一部分，使得所述绕过组合件在所述近端集线器接合在所述接收器组合件内后维持在所述远端位置中，由此使所述棘轮棘爪维持在所述使用位置中且使得所述棘轮棘爪能够在所述驱动杆向远端平移期间与所述棘轮齿条接合。
10.根据权利要求9所述的可搁置外科手术夹具施用器，其中在所述触发器从所述未致动位置移动到所述未致动位置与所述致动位置之间的中间位置后，所述驱动杆定位成使得所述棘轮棘爪与所述棘轮齿条接合以抑制所述触发器朝向所述未致动位置返回。
11.根据权利要求10所述的可搁置外科手术夹具施用器，其中所述驱动杆限定从所述棘轮齿条向近端安置的近端凹陷，且被配置成使得在所述触发器移动到所述致动位置后，所述棘爪至少部分地安置在所述近端凹陷内以准许所述触发器返回到所述未致动位置。
12.根据权利要求1所述的可搁置外科手术夹具施用器，其中所述触发器被准许在所述未致动位置与所述致动位置之间的每个点处朝向所述致动位置返回。
13.一种可搁置外科手术夹具施用器，其包括：
柄部组合件，其包含：
外壳，其限定主体部分和从主体部分延伸的固定柄部部分；和
触发器，其能够枢转地连接到所述外壳且能够相对于所述固定柄部部分在未致动位置与致动位置之间移动；
被配置成用于棘轮效应使用的第一内窥镜组合件，其包含：
近端集线器，其被配置成能够与所述柄部组合件的所述外壳选择性地接合；
细长轴，其从所述近端集线器向远端延伸；
末端执行器组合件，其支撑在所述细长轴的远侧端部处；和
内部驱动组合件，其安置于所述近端集线器和所述细长轴内且能够操作地耦接到所述末端执行器组合件，使得对所述柄部组合件的所述触发器的致动会操控所述末端执行器组合件，所述内部驱动组合件包含近端部分和远端部分，其中所述远端部分被配置成能够滑动地接收所述近端部分的至少一部分，使得所述近端部分能够在被所述末端执行器组合件阻挡后在所述远端部分内推进，由此准许所述触发器返回到未致动位置；以及
被配置成用于非棘轮效应使用的第二内窥镜组合件，其包含：
被配置成能够与所述柄部组合件的所述外壳选择性地接合的近端集线器，所述近端集线器限定面向近端的表面；
细长轴，其从所述近端集线器向远端延伸；
末端执行器组合件，其支撑在所述细长轴的远侧端部处；和
内部驱动组合件，其安置于所述近端集线器和所述细长轴内且能够操作地耦接到所述末端执行器组合件，使得对所述柄部组合件的所述触发器的致动会操控所述末端执行器组合件，所述内部驱动组合件包含近端部分和远端部分，其中所述远端部分被配置成能够滑动地接收所述近端部分的至少一部分，使得所述近端部分能够在被所述末端执行器组合件阻挡后在所述远端部分内推进，由此准许所述触发器返回到未致动位置。
14.根据权利要求13所述的可搁置外科手术夹具施用器，其进一步包含偏置构件，所述偏置构件插入于所述第一和第二内窥镜组合件中的每一个的所述内部驱动组合件的所述近端部分与所述远端部分之间，其中所述偏置构件使所述第一和第二内窥镜组合件中的每一个的所述近端部分和所述远端部分偏置成隔开配置。
15.根据权利要求13所述的可搁置外科手术夹具施用器，其中所述第一和第二内窥镜组合件中的每一个的所述内部驱动组合件的所述近端部分包含从其向远端延伸的细长构件，所述细长构件被配置成能够由限定在所述第一和第二内窥镜组合件中的每一个的所述内部驱动组合件的所述远端部分的近侧端部内的孔滑动地接收。
16.根据权利要求13所述的可搁置外科手术夹具施用器，其进一步包含驱动杆，所述驱动杆能够滑动地支撑在所述外壳的所述主体部分内，且能够操作地耦接到所述触发器，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端平移通过所述外壳的所述主体部分。
17.根据权利要求16所述的可搁置外科手术夹具施用器，其进一步包含安置于所述驱动杆上的棘轮齿条。
18.根据权利要求17所述的可搁置外科手术夹具施用器，其进一步包含棘轮棘爪，所述棘轮棘爪能够枢转地支撑在所述外壳内且能够相对于其在使用位置与绕过位置之间移动，在所述使用位置中所述棘轮棘爪定位成在所述驱动杆向远端平移后接合所述棘轮齿条，在所述绕过位置中所述棘轮棘爪从所述棘轮齿条移位以抑制在所述驱动杆向远端平移后与所述棘轮齿条接合。
19.根据权利要求18所述的可搁置外科手术夹具施用器，其进一步包含接收器组合件，所述接收器组合件被配置成能够在其中释放地接合内窥镜组合件。
20.根据权利要求19所述的可搁置外科手术夹具施用器，其进一步包含能够操作地定位于所述接收器组合件与所述棘轮棘爪之间的绕过组合件，所述绕过组合件能够在远端位置与近端位置之间移动以用于使所述棘轮棘爪在所述使用位置与所述绕过位置之间移动。
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