CN108523956A - 具有钉鞘的手术钉合设备 - Google Patents

具有钉鞘的手术钉合设备 Download PDF

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CN108523956A
CN108523956A CN201810162380.7A CN201810162380A CN108523956A CN 108523956 A CN108523956 A CN 108523956A CN 201810162380 A CN201810162380 A CN 201810162380A CN 108523956 A CN108523956 A CN 108523956A
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克里斯托弗·彭纳
斯蒂芬·瑞安·凯茜
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
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    • A61B17/115—Staplers for performing anastomosis in a single operation
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    • 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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    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
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    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
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    • A61B2017/07271—Stapler heads characterised by its cartridge

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Abstract

一种用于选择性连接到手术钉合设备的仓组件包括主体部分、限定钉保持槽的组织接触表面、钉、轴环组件和钉鞘。所述钉中的每一个接收在所述组织接触表面的所述钉保持槽的相应一个中。所述轴环组件可移动地安装到所述主体部分。所述钉鞘耦合到所述轴环组件并且经置放以覆盖所述钉保持槽。所述钉鞘相对于所述组织接触表面选择性地可移动。

Description

具有钉鞘的手术钉合设备
相关申请的交叉引用
本申请要求2017年2月28日提交的美国临时申请序列第62/464,627号的权益和优先权，所述申请全部公开内容以引用的方式并入本文中。
技术领域
本公开涉及用于执行内窥镜手术程序的手术钉合设备和其使用方法。
背景技术
当接合多个人体结构(如，例如肠或支气管)时，紧固件(例如钉或两件式紧固件)已传统地用于代替缝合。用于施用这些紧固件的手术钉合设备一般被设计成夹持、切割和/或紧固在相对夹爪结构之间的组织。举例来说，圆形手术钉合设备一般包括在紧固件保持槽中支撑环形列紧固件的环形紧固件仓组件、具有在起动圆形手术钉合设备时用于形成紧固件仓的紧固件的紧固件形成凹座的环形砧座组件，和用于切割组织的环形刀片。出于将组织片段接合在一起和/或创建吻合的目的，这些圆形手术钉合设备依次或同时将这些紧固件施用到组织。
与吻合程序相关联的一个挑战包括维持吻合的完整性。在器械插入手术部位期间，存在接近手术部位的污染物可迁移到紧固件仓的紧固件保持槽中并且染污其中支撑的紧固件的风险。
因此，有利的是提供防止紧固件污染的手术钉合设备用于改进吻合的完整性。
发明内容
根据本公开的一个方面，提供手术钉合设备。手术钉合设备包括第一夹爪构件、钉、第二夹爪构件和钉鞘。第一夹爪构件具有钉保持槽。每个钉接收在钉保持槽的相应一个中。第二夹爪构件具有钉凹座。每个钉凹座被配置成在手术钉合设备起动时，形成多个钉中的钉的相应一个。钉鞘固定到第一夹爪构件并且覆盖钉保持槽。钉鞘相对于第一夹爪构件可移动，以响应于第一夹爪构件和第二夹爪构件的相对接近，露出钉保持槽。
在一些实施例中，钉鞘可为包括轴环组件和耦合到轴环组件的钉鞘的钉鞘组件的一部分。
在实施例中，第二夹爪构件可包括具有从头部组件向近侧延伸的中心棒组件的头部组件。中心棒组件可选择性地与轴环组件可接合以相对于第一夹爪构件移动钉鞘，以响应于第一夹爪构件和第二夹爪构件的相对接近，露出多个钉保持槽。
在一些实施例中，轴环组件可包括一个或多个辐条，并且第一夹爪构件可限定沿第一夹爪构件轴向延伸的一个或多个细长通道。一个或多个辐条可可滑动地可移动通过一个或多个细长通道，以使得钉鞘能够相对于第一夹爪构件移动。
在某些实施例中，第一夹爪构件可包括钉仓。钉仓可限定被配置成接收钉鞘组件的远侧末端部分的环形沟槽，以在第一和第二夹爪构件未接近时，选择性地跨钉仓固定钉鞘，从而覆盖钉保持槽。
在一些实施例中，手术钉合设备进一步包括从近侧末端部分延伸到远侧末端部分的细长轴组件。第一夹爪构件和钉鞘组件可可移除地固定到细长轴组件的远侧末端部分。
根据本公开的另一个方面，提供用于手术钉合设备的末端执行器。末端执行器包括仓组件、钉、砧座组件和钉鞘。仓组件具有钉保持槽。每个钉接收在钉保持槽的相应一个中。砧座组件具有钉凹座。每个钉凹座被配置成在手术钉合设备起动时，形成钉的相应一个。砧座组件在未接近位置和接近位置之间相对于仓组件可移动。钉鞘固定到仓组件并且经置放以覆盖钉保持槽。钉鞘随砧座组件可移动以露出多个钉保持槽并且暴露多个钉。
在某些实施例中，砧座组件可包括头部组件和从头部组件延伸的中心棒组件。中心棒组件可选择性地与轴环组件可接合，以在砧座组件相对于仓组件移动时，相对于仓组件移动钉鞘。
在实施例中，轴环组件可包括一个或多个辐条并且仓组件限定沿仓组件轴向延伸的一个或多个细长通道。一个或多个辐条可可滑动地可移动通过一个或多个细长通道，以使得钉鞘能够相对于仓组件移动。
在一些实施例中，仓组件可包括限定被配置成接收钉鞘组件的远侧末端部分的环形沟槽的钉仓，以在砧座和仓组件处于未接近位置时，选择性地将钉鞘固定在覆盖多个钉保持槽的位置。
在某些实施例中，末端执行器进一步包括从近侧末端部分延伸到远侧末端部分的细长轴组件。仓组件和钉鞘组件可可移除地固定到细长轴组件的远侧末端部分。
根据本公开的另一个方面，提供圆形钉合设备。圆形钉合设备包括细长轴组件、仓组件、钉、轴环组件和钉鞘。细长轴组件具有远侧末端部分并且限定纵向轴线。仓组件固定到细长轴组件的远侧末端部分并且具有组织接触表面。组织接触表面限定钉保持槽。每个钉接收在钉保持槽的相应一个中。轴环组件沿纵向轴线在远侧位置和近侧位置之间可移动。钉鞘耦合到轴环组件并且经置放以在轴环组件处于远侧位置时覆盖多个钉保持槽。钉鞘随轴环组件朝向近侧位置可移动以牵伸钉鞘跨多个钉保持槽。
在一些实施例中，轴环组件可包括一个或多个辐条并且仓组件可限定沿仓组件轴向延伸的一个或多个细长通道。一个或多个辐条可可滑动地可移动通过一个或多个细长通道，以使得钉鞘能够相对于仓组件移动。
在某些实施例中，仓组件可包括限定被配置成接收钉鞘的远侧末端部分的环形沟槽的钉仓，以选择性地将钉鞘固定在覆盖钉保持槽的位置。
在一些实施例中，仓组件和钉鞘组件可选择性地从细长轴组件的远侧末端部分可移除。
在实施例中，圆形钉合设备可进一步包括选择性地耦合到细长轴组件的砧座组件。砧座组件可相对于仓组件可移动以将轴环组件从远侧位置移动到近侧位置。
根据本公开的再一方面，提供用于选择性连接到手术钉合设备的仓组件。仓组件包括主体部分、组织接触表面、钉、轴环组件和钉鞘。组织接触表面限定钉保持槽。每个钉接收在钉保持槽的相应一个中。轴环组件可移动地安装到主体部分。钉鞘耦合到轴环组件并且经置放以覆盖钉保持槽。钉鞘相对于组织接触表面选择性地可移动。
在一些实施例中，主体部分限定一个或多个细长通道。轴环组件可包括可滑动地可移动通过一个或多个细长通道的一个或多个辐条，以使得钉鞘能够相对于主体部分移动。
在某些实施例中，仓组件进一步包括耦合到主体部分的钉仓。钉仓可包括组织接触表面并且可支撑钉。钉仓可限定被配置成接收钉鞘的远侧末端部分的环形沟槽，以选择性地跨钉仓的组织接触表面固定钉鞘。
在实施例中，轴环组件可在远侧和近侧位置之间相对于主体部分选择性地可移动以相对于组织接触表面移动钉鞘。
其它方面、特征和优点将从描述、附图和所附权利要求书而变得显而易见。
附图说明
并入在本说明书中且构成本说明书的一部分的附图说明本公开的实施例，并且与上文所给出的本公开的一般描述及下文给出的实施例的详细描述一起用以阐释本公开的原理，其中：
图1为根据本公开的原理的手术钉合设备的透视图；
图2为图1的手术钉合设备的末端执行器的一种透视图，其中末端执行器的砧座组件示出未接近末端执行器的仓组件；
图3为图2的仓组件的透视图，其中仓组件的钉鞘组件示出处于第一位置；
图4为在沿图3的剖面线4-4截取时图3的仓组件的横截面视图；
图5为在图3中示出的钉鞘组件的透视图；
图6为在沿图5的剖面线6-6截取时图5的钉鞘组件的横截面视图；
图7为图2的末端执行器的砧座组件的透视图；
图8为在图7中详细示出的指示区域的放大透视图；
图9为在沿图2中示出的剖面线8-8截取时图2的末端执行器的横截面视图；
图10和11分别为在图9中详细示出的指示区域的放大横截面视图；
图12为在沿图2中示出的线8-8截取时图2的末端执行器的横截面视图，其中末端执行器的砧座和仓组件示出接近并且其中仓组件的钉鞘组件示出处于第二位置；和
图13和14分别为在图12中详细示出的指示区域的放大横截面视图。
具体实施方式
参考附图详细描述本发明所公开的手术钉合设备的实施例，其中在若干视图中的每个中相似参考数字表示相同或对应元件。如本文所用，术语“远侧”是指离用户较远的设备的部分和/或其部件，而术语“近侧”是指离用户较近的设备的部分和/或其部件。如本文所用，术语“临床医生”是指医生、护士或其它医护人员且可包括辅助人员。在以下描述中，未详细地描述熟知功能或构造以免不必要的细节混淆本公开。
现在转向图1和2，机电手术钉合系统或设备(一般被称作10)限定中心线“CL”并且包括呈供电手持型机电器械形式的手术装置100。机电手术钉合系统10进一步包括选择性地可附接到手术装置100的接头组件200。接头组件200从手术装置100向远侧延伸并且具有延伸到远侧末端的细长主体202。细长主体202的远侧末端支撑末端执行器300。末端执行器300包括壳或仓组件310和砧座组件320，它们可置放在松开或未接近位置(参见图1)和夹持或接近位置(图12)之间以选择性地夹持组织(未示出)用于切割和/或钉合组织。手术装置100被配置成用于与接头组件200选择性连接，并且继而，接头组件200被配置成用于与末端执行器300选择性连接。手术装置100和接头组件200一起协作以操作末端执行器300。
在一些实施例中，机电手术钉合系统10的手术装置100包括限定用于选择性可移除接收可再充电电池103的腔“C”的把手壳体102。电池103被配置成为手术装置100的电气部件供电。腔“C”支撑被配置成控制手术装置100的各种操作的控制器或电路板105。
机电手术钉合系统10进一步包括被配置成驱动在把手壳体102内的可旋转轴和/或齿轮部件(未示出)以便执行机电手术钉合系统10的各种操作的驱动机构106。举例来说，驱动机构106可为可操作的，以绕和/或相对于机电手术钉合系统10的中心线“CL”选择性地旋转末端执行器300；以选择性地相对于仓组件310移动砧座组件320以选择性地夹持组织；和/或以起动机电手术钉合系统10用于紧固和/或切割夹持的组织。电池103、控制器105和/或驱动机构106可可操作地耦合到一个或多个触发器107a、107b(如手指致动的控制按钮、摇臂装置等)以实现机电手术钉合系统10的各种功能，如上文所述那些。
机电手术钉合系统10的驱动机构106包括向远侧延伸通过细长主体202的接近机构108并且包括支撑在接近机构108的远侧末端部分上的砧座保持器108a(图9)。砧座保持器108a被配置成沿机电手术钉合系统10的中心线“CL”在远侧和近侧位置之间移动以选择性地或可移除地耦合到砧座组件320，如在美国专利第7,303,106号中所描述，所述专利全部内容以引用的方式并入本文中。砧座保持器108a还被配置成沿机电手术钉合系统10的中心线“CL”在砧座保持器108a的远侧和近侧位置之间移动以相对于仓组件310在接近和未接近位置之间移动砧座组件320以选择性地夹持和/或松开组织。
可参考2008年9月22日提交的国际申请第PCT/US2008/077249号(国际公开第WO2009/039506号)、2014年11月21日提交的美国专利申请2015/0157320，和2009年11月20日提交的美国专利申请公开第2011/0121049号，所述申请中的每一个的全部内容以引用的方式并入本文中，用于各种示例性机电手术系统的构造和操作的详细描述，并且其部件与本文所描述的机电手术系统10的一个或多个部件可组合和/或可互换。
虽然手术钉合设备描述为机电供电的手术钉合设备，但是本发明所公开的手术钉合设备可提供为手动供电的钉合设备。为了更详细描述示例性手动供电的钉合设备的构造和操作，其一个或多个部件可与本文所描述的机电供电的钉合设备组合和/或互换，可参考2012年1月30日提交的美国专利第8,272,552号，所述专利的全部内容以引用的方式并入本文中(也参见上文以引用的方式并入本文中的美国专利第7,303,106号)。
现在转向图3和4，末端执行器300的仓组件310包括壳312、推动器313、圆柱形刀314、钉仓315和钉鞘组件316。
仓组件310的壳312固定到接头组件200的细长主体202的远侧末端并且包括被配置成选择性地接收钉仓315的外壳体部分312a、被配置成选择性地接收末端执行器300的砧座组件320的内导引部分312b，和被配置成将仓组件310耦合到接头组件200的细长主体202的耦合部分312x。耦合部分312x包括近侧部分3122、远侧部分3124和分离近侧和远侧部分3122、3124的凸缘3126。外壳体部分312a在围绕壳312的径向隔开位置处限定细长槽312c，并且所述壳312被配置成可滑动地支撑钉鞘组件316。外壳体部分312a包括被配置成便于仓组件310选择性附接到细长主体202的壳体轴环组件312d，类似于在2015年10月19日提交的美国专利申请公开第2016/0192934号中描述的，所述申请的全部内容以引用的方式并入本文中。
仓组件310的推动器313可滑动地绕壳312的内导引部分312b置放并且限定中心通孔313a。推动器313包括被配置成支撑钉317的阵列的向远侧延伸指313b的环形阵列。指313b中的一个或多个和/或钉317中的一个或多个可包括不同高度。在一些实施例中，指313b中的一个或多个和/或钉317中的一个或多个可包括相同高度。
仓组件310的圆柱形刀314摩擦地保持在推动器313的中心通孔313a内以相对于推动器313固定地固定刀314。刀314的远侧末端包括被配置成切断组织的圆形剪刃314a。
仓组件310的钉仓315包括其中形成槽315b的环形阵列的组织接触表面315a。钉仓315的槽315b的环形阵列被配置成支撑并且可滑动地接收钉317的环形阵列在其中。钉仓315包括内表面315c和外表面315d。内表面315c其中限定沟槽315e。钉仓315的内表面315c的沟槽315e可具有环形配置。
参考图5和6，仓组件310的钉鞘组件316包括耦合到钉鞘316b的轴环组件316a。
钉鞘组件316的钉鞘316b包括近侧末端部分3162、远侧末端部分3164和限定通过钉鞘316b的近侧和远侧末端部分3162、3164的开口3166。钉鞘316b进一步包括外表面3167和内表面3168。钉鞘316b的近侧末端部分3162固定到轴环组件316a，并且钉鞘316b的远侧末端部分3164可接收在钉仓315的沟槽315e内以选择性地或可移除地将钉鞘316b的远侧末端部分3164固定到钉仓315。钉鞘316b的远侧末端部分3164可在钉仓315的组织接触表面315a上方折叠和/或折叠到钉仓315的沟槽315e中。钉鞘316b被配置成覆盖组织接触表面315a、槽315b的环形阵列和钉仓315的钉317的环形阵列，同时远侧末端部分3164固定到钉仓315的沟槽315e以保护和维持钉仓315和钉317的无菌性。钉鞘316b还被配置成相对于钉仓315移动以分离钉鞘316b与沟槽315e并且沿钉仓315的组织接触表面315a滑动。
在一些实施例中，钉鞘316b或其部分可被配置成跨钉仓315牵伸以暴露组织接触表面315a和钉317。在某些实施例中，钉鞘316b可被配置成部分跨钉仓315的组织接触表面315a牵伸。在一些实施例中，钉鞘316或其部分可被配置成在起动来自钉仓315的钉317时充当保持耦合到钉仓315直到随钉317固定到组织的支持物材料。举例来说，钉鞘316b的远侧末端部分3164可与钉仓315的沟槽315e分离并且跨组织接触表面315a牵伸，使得远侧末端部分3164覆盖组织接触表面315a并且充当用于与钉317一起使用的支持物材料。
在一些实施例中，钉鞘316的远侧末端部分3164被配置成保持固定到钉仓315的沟槽315e，使得钉鞘316b相对于钉仓315的移动引起钉鞘316b撕开，将钉鞘316b分成单独的部分。在某些实施例中，钉鞘316或其部分可包括穿孔(例如穿孔的环圈，未示出)等，以使得在对其施用分离力时钉鞘316的部分能够彼此分离。在某些实施例中，钉鞘316或其部分可形成于带、层和/或其组合中。
钉鞘316b或其部分可由任何合适的聚合材料形成。聚合材料可为柔性的。在一些实施例中，钉鞘316b可包括多种材料。在实施例中，钉鞘316b或其部分可包括生物相容性和/或可生物降解材料。在一些实施例中，钉鞘316b可包括生物可接受的添加剂，如塑化剂、抗氧化剂、染料、稀释剂、治疗剂等和/或其组合，其可涂布在其上和/或浸渍在其中(例如在形成期间)。为了更详细描述用于与本公开的钉鞘一起使用的合适的材料和/或添加剂，可参考美国专利第8,453,910号，所述专利全部内容以引用的方式并入本文中。
钉鞘组件316的轴环组件316a包括耦合到第二或远侧轴环319的第一或近侧轴环318。轴环组件316a的近侧轴环318包括外部构件318a、耦合到外部构件318a的内部部件318b和从外部构件318a的远侧末端径向向外延伸以将近侧和远侧轴环318、319耦合在一起的环形凸缘318c。外部构件318a的内表面和内部部件318b的外表面限定被配置成可滑动地接收壳312的耦合部分312x的近侧部分的环形凹槽通道318d。轴环组件316a的远侧轴环319包括辐条319a。辐条319a以预先确定的弧长度环状或径向间隔开。辐条319a具有在其近侧末端部分处耦合到近侧轴环318的环形凸缘318c的轴环耦合部分319b和在其远侧末端部分处耦合到环构件319e的环耦合部分319c。辐条319a中的每一个包括耦合在一起并且相对于彼此以不同角度安置的第一臂319f、第二臂319g和第三臂319h。第一和第三臂319f、319h可相对于彼此横切或甚至垂直安置。远侧轴环319的环构件319e使用任何合适的紧固技术(如粘合剂、焊接、紧固等)固定到钉鞘316b的近侧末端部分3162。环构件319e可固定到钉鞘316b的内表面3168。
参考图7和8，末端执行器300的砧座组件320包括砧座头部组件322和砧座中心棒组件324。砧座头部组件322包括柱325、砧座头部326和砧座327。砧座头部组件322的砧座327支撑在砧座头部组件322的砧座头部326上并且包括限定被布置成对应于在末端执行器300的钉仓315中形成的槽315b的环形阵列的钉形成凹座327b的环形阵列的组织接触表面327a。砧座317的凹座327b的环形阵列被布置成当钉317从钉仓315的槽315b弹出或起动时，接收并且形成末端执行器300的钉317。砧座中心棒组件324包括限定孔324b的砧座中心棒324a并且具有柔性臂324c、324d和324e。机电手术钉合系统10的接近机构108的砧座保持器108a接收在砧座中心棒324a的中心孔324b内，使得柔性或弹性径向臂324c、324d、324e可释放地啮合接近机构108的砧座保持器108a并且选择性地将砧座保持器108a耦合到砧座组件320的中心棒324a。枢转构件或销328将砧座头部组件322固定到柱325，以使得砧座头部组件322能够绕枢转构件328相对于柱325枢转。
现在参考图9-14，在操作中，在砧座组件320未接近仓组件310并且钉鞘组件316安置在远侧位置中的情况下，钉鞘组件316的钉鞘316b固定到钉仓315，使得钉鞘316b覆盖钉仓315(图9和11)。在钉鞘组件316此远侧位置中，砧座组件320的柔性臂324c、324d、324e与近侧轴环318的内部构件318b纵向隔开，并且仓组件310的耦合部分312x的近侧部分3122完全坐落在钉鞘组件316的近侧轴环318的环形凹槽通道318d中，使得钉鞘组件316的近侧轴环318的凸缘318c和耦合部分312x的凸缘3126啮合(图10)。在钉鞘组件316在远侧位置中并且末端执行器300在未接近位置中的情况下，末端执行器300可前进到手术部位，其中钉317和/或钉仓315的组织接触表面315a保护免受可在前进到手术部位期间影响钉317和/或钉仓315的组织接触表面315a的无菌性的可能的污染物(图11)。
一旦机电手术钉合系统10的末端执行器300被置放成邻近于手术部位，末端执行器300的砧座组件320可朝向末端执行器300的仓组件310接近，如由箭头“A”(图12)指示。在砧座组件320朝向仓组件310接近时，砧座中心棒组件324的柔性臂324c、324d、324e啮合钉鞘组件316的近侧轴环318的内部构件318b的远侧末端并且向近侧前进或平移钉鞘组件316，如由箭头“B”(图12和13)指示。钉鞘组件316的继续近侧前进引起其近侧轴环318相对于机电手术钉合系统10(图1)的中心线“CL”沿仓组件310的耦合部分312x滑动并且引起钉鞘组件316的钉鞘316b与钉仓315分离。在钉鞘组件316向近侧移动时，其钉鞘316b跨钉仓315牵伸，如由箭头“D”(图14)指示，并且暴露钉仓315，使得一旦砧座组件320和仓组件310接近以将组织夹持在末端执行器300中，钉317可从仓组件310起动并且抵靠砧座组件320形成(而不必穿过钉鞘组件316的钉鞘316b)。仓组件310的圆柱形刀314(图12)还可起动以切割通过末端执行器300支撑的夹持并且紧固的组织。为了更详细描述钉的起动、切割和/或紧固，可参考美国专利第7,303,106号，所述专利上文以引用的方式并入本文中。
替代地或另外，钉鞘316b或其部分可被配置成使得钉317能够穿过其起动(例如，如在钉鞘316b或其部分充当如上所述的支持物材料的情况下)。
末端执行器300的砧座组件320然后可未接近末端执行器300的仓组件310或与其分离，以释放钉合的组织并且从手术部位移除末端执行器300。砧座和/或仓组件310、320可从机电手术钉合系统10移除和/或替换，如在美国专利第7,303,106号和/或美国专利申请公开第2016/0192934号中所描述，所述专利中的每一个上文以引用的方式并入本文中。
如可理解，可使用已知紧固技术(这类焊接、压接、胶合、紧固等)来实现紧固本发明所公开的装置的部件中的任一个。
本文所公开的各种实施例还可被配置成对机器人手术系统和通常被称为“遥控手术”的手术系统起作用。这类系统采用各种机器人元件来辅助临床医生，并且允许远程操作(或部分远程操作)手术器械。可出于此目的采用各种机器人臂、齿轮、凸轮、滑轮、电动和机械马达等，且可被设计成具有机器人手术系统以在操作或治疗过程期间辅助临床医生。这类机器人系统可包括远程可转向系统、自动柔性手术系统、远程柔性手术系统、远程铰接手术系统、无线手术系统、模块化或选择性可配置远程操作手术系统等。
机器人手术系统可用于紧接于手术室或位于远程位置中的一个或多个控制台。在此实例中，一个临床医生团队可使患者做好手术准备，并用本文所公开的器械中的一个或多个配置机器人手术系统，而另一临床医生(或一组临床医生)经由机器人手术系统远程地控制器械。如可理解，高度熟练的临床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，并且对于病人或一系列病人也是有益的。为了详细描述示例性医疗工作站和/或其部件，可参考美国专利申请公开第2012/0116416号和PCT申请公开第WO2016/025132号，所述文献中的每个的全部内容以引用的方式并入本文中。
本领域的技术人员应理解，本文特定地描述并且在附图中示出的结构和方法为非限制性示例性实施例，并且描述、公开和图应仅仅认作示例特定实施例。因此，应理解，本公开不限于所描述的精确实施例，并且本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，在不脱离本公开的范围的情况下，结合某些实施例示出或描述的元件和特征可与某些其它实施例的元件和特征组合，并且此类修改和变化也包括在本公开的范围内。因此，本公开的主题并不受已特定地示出和描述的内容限制。

Claims (20)

1.一种手术钉合设备，包含：
具有多个钉保持槽的第一夹爪构件；
多个钉，所述多个钉中的每个钉接收在所述多个钉保持槽的相应一个中；
具有多个钉凹座的第二夹爪构件，所述多个钉凹座中的每个钉凹座被配置成在所述手术钉合设备起动时，形成所述多个钉的所述钉的相应一个；和
固定到所述第一夹爪构件并且覆盖所述多个钉保持槽的钉鞘，所述钉鞘相对于所述第一夹爪构件可移动，以响应于所述第一夹爪构件和所述第二夹爪构件的相对接近，露出所述多个钉保持槽。
2.根据权利要求1所述的手术钉合设备，其中所述钉鞘为包括轴环组件的钉鞘组件的一部分，并且所述钉鞘耦合到所述轴环组件。
3.根据权利要求2所述的手术钉合设备，其中所述第二夹爪构件包括具有从头部组件向近侧延伸的中心棒组件的所述头部组件，所述中心棒组件选择性地与所述轴环组件可接合，以相对于所述第一夹爪构件移动所述钉鞘，以响应于所述第一夹爪构件和所述第二夹爪构件的相对接近，露出所述多个钉保持槽。
4.根据权利要求2所述的手术钉合设备，其中所述轴环组件包括至少一个辐条并且所述第一夹爪构件限定沿所述第一夹爪构件轴向延伸的至少一个细长通道，所述至少一个辐条可滑动地可移动通过所述至少一个细长通道，以使得所述钉鞘能够相对于所述第一夹爪构件移动。
5.根据权利要求2所述的手术钉合设备，其中所述第一夹爪构件包括钉仓，所述钉仓限定被配置成接收所述钉鞘组件的远侧末端部分的环形沟槽，以在所述第一和第二夹爪构件未接近时，选择性地跨所述钉仓固定所述钉鞘，从而覆盖所述多个钉保持槽。
6.根据权利要求1所述的手术钉合设备，进一步包含从近侧末端部分延伸到远侧末端部分的细长轴组件，所述第一夹爪构件和所述钉鞘组件可移除地固定到所述细长轴组件的所述远侧末端部分。
7.一种用于手术钉合设备的末端执行器，所述末端执行器包含：
具有多个钉保持槽的仓组件；
多个钉，所述多个钉中的每个钉接收在所述多个钉保持槽的相应一个中；
具有多个钉凹座的砧座组件，所述多个钉凹座中的每个钉凹座被配置成在所述手术钉合设备起动时，形成所述多个钉的所述钉的相应一个，所述砧座组件在未接近位置和接近位置之间相对于所述仓组件可移动；和
固定到所述仓组件并且经置放以覆盖所述多个钉保持槽的钉鞘，所述钉鞘随所述砧座组件可移动以露出所述多个钉保持槽并且暴露所述多个钉。
8.根据权利要求7所述的末端执行器，其中所述钉鞘为包括轴环组件的钉鞘组件的一部分并且所述钉鞘耦合到所述轴环组件。
9.根据权利要求8所述的末端执行器，其中所述砧座组件包括头部组件和从所述头部组件延伸的中心棒组件，所述中心棒组件选择性地与所述轴环组件可接合，以在所述砧座组件相对于所述仓组件移动时，相对于所述仓组件移动所述钉鞘。
10.根据权利要求8所述的末端执行器，其中所述轴环组件包括至少一个辐条并且所述仓组件限定沿所述仓组件轴向延伸的至少一个细长通道，所述至少一个辐条可滑动地可移动通过所述至少一个细长通道，以使得所述钉鞘能够相对于所述仓组件移动。
11.根据权利要求8所述的末端执行器，其中所述仓组件包括限定被配置成接收所述钉鞘组件的远侧末端部分的环形沟槽的钉仓，以在所述砧座和仓组件处于所述未接近位置时，选择性地将所述钉鞘固定在覆盖所述多个钉保持槽的位置。
12.根据权利要求7所述的末端执行器，进一步包含从近侧末端部分延伸到远侧末端部分的细长轴组件，所述仓组件和所述钉鞘组件可移除地固定到所述细长轴组件的所述远侧末端部分。
13.一种圆形钉合设备，包含：
具有远侧末端部分并且限定纵向轴线的细长轴组件；
固定到所述细长轴组件的所述远侧末端部分并且具有组织接触表面的仓组件，所述组织接触表面限定多个钉保持槽；
多个钉，所述多个钉中的每个钉接收在所述多个钉保持槽的相应一个中；
沿所述纵向轴线在远侧位置和近侧位置之间可移动的轴环组件；和
耦合到所述轴环组件并且经置放以在所述轴环组件处于所述远侧位置时覆盖所述多个钉保持槽的钉鞘，所述钉鞘随所述轴环组件朝向所述近侧位置可移动以牵伸所述钉鞘跨所述多个钉保持槽。
14.根据权利要求13所述的圆形钉合设备，其中所述轴环组件包括至少一个辐条并且所述仓组件限定沿所述仓组件轴向延伸的至少一个细长通道，所述至少一个辐条可滑动地可移动通过所述至少一个细长通道，以使得所述钉鞘能够相对于所述仓组件移动。
15.根据权利要求13所述的圆形钉合设备，其中所述仓组件包括限定被配置成接收所述钉鞘的远侧末端部分的环形沟槽以选择性地将所述钉鞘固定在覆盖所述多个钉保持槽的位置的钉仓。
16.根据权利要求13所述的圆形钉合设备，其中所述仓组件和所述钉鞘组件选择性从所述细长轴组件的所述远侧末端部分可移除。
17.根据权利要求13所述的圆形钉合设备，进一步包含选择性地耦合到所述细长轴组件的砧座组件，所述砧座组件相对于所述仓组件可移动以将所述轴环组件从所述远侧位置移动到所述近侧位置。
18.一种用于选择性连接到手术钉合设备的仓组件，所述仓组件包含：
主体部分；
限定多个钉保持槽的组织接触表面；
多个钉，所述多个钉中的每个钉接收在所述多个钉保持槽的相应一个中；
可移动地安装到所述主体部分的轴环组件；和
耦合到所述轴环组件并且经置放以覆盖所述多个钉保持槽的钉鞘，所述钉鞘相对于所述组织接触表面选择性地可移动。
19.根据权利要求18所述的仓组件，其中所述主体部分限定至少一个细长通道，并且其中所述轴环组件包括至少一个辐条，所述至少一个辐条可滑动地可移动通过所述至少一个细长通道，以使得所述钉鞘能够相对于所述主体部分移动。
20.根据权利要求18所述的仓组件，进一步包含耦合到所述主体部分的钉仓，所述钉仓包括所述组织接触表面并且支撑所述多个钉，并且其中所述钉仓限定被配置成接收所述钉鞘的远侧末端部分的环形沟槽以选择性地跨所述钉仓的所述组织接触表面固定所述钉鞘。
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