CN108882932A - 具有非对称关节运动构造的外科器械 - Google Patents

具有非对称关节运动构造的外科器械 Download PDF

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CN108882932A
CN108882932A CN201780018611.0A CN201780018611A CN108882932A CN 108882932 A CN108882932 A CN 108882932A CN 201780018611 A CN201780018611 A CN 201780018611A CN 108882932 A CN108882932 A CN 108882932A
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effector
axis
surgical
distal
joint
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CN108882932B (zh
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M·R·亨特
F·E·谢尔顿四世
J·L·哈里斯
S·A·沃辛顿
A·E·怀斯
L·S·维纳
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Angiotech Pharmaceuticals Inc
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Abstract

本发明公开了一种外科器械，所述外科器械包括限定轴轴线的细长轴组件。外科端部执行器枢转地联接到所述细长轴组件以用于相对于所述细长轴组件围绕关节运动轴线选择性枢转行进，所述关节运动轴线从所述轴轴线侧向地偏移且相对于所述轴轴线横向地延伸。端部执行器驱动器连接件可操作地联接到所述外科端部执行器和关节运动驱动器，所述关节运动驱动器被支撑用于在对其施加关节运动动作时沿远侧方向和近侧方向纵向行进。柔性的关节脱位构件联接到所述细长轴组件和所述外科端部执行器，以向所述外科端部执行器施加关节脱位动作。

Description

具有非对称关节运动构造的外科器械
背景技术
本发明涉及外科器械，并且在各种实施方案中，涉及外科缝合和切割器械以及与其一起使用的钉仓。
缝合器械可包括一对配合的细长钳口构件，其中每个钳口构件可适于插入患者体内并且相对于待缝合和/或切入的组织定位。在各种实施方案中，钳口构件中的一个可支撑其中容纳有至少两个侧向地隔开的钉排的钉仓，并且另一个钳口构件可支撑具有与钉仓中的钉排对准的钉成形凹坑的砧座。一般来讲，缝合器械还可包括推杆和刀片，该推杆和刀片能够相对于钳口构件滑动以经由推杆上的凸轮表面和/或由推杆推动的楔形滑动件上的凸轮表面将钉从钉仓中连续射出。在至少一个实施方案中，凸轮表面可被构造成能够致动由仓承载并与钉相关联的多个钉驱动器，以便推动钉抵靠在砧座上并且在夹持于钳口构件之间的组织中形成侧向地隔开的变形钉排。在至少一个实施方案中，刀片可跟随凸轮表面并且沿着钉排之间的线切割组织。
上述讨论仅是为了举例说明本发明的领域中相关技术目前的各个方面，而不应当视为对权利要求范围的否定。
附图说明
本文所述的实施方案的各种特征连同其优点可结合如下附图根据以下描述来加以理解：
图1为外科器械和细长轴组件实施方案的透视图；
图2为图1的外科器械的柄部或外壳部分的分解组件视图；
图3为细长轴组件的一部分的分解组件视图；
图4为图3的细长轴组件的另一部分的另一分解组件视图；
图5为外科端部执行器实施方案和闭合套筒实施方案的一部分的分解组件视图；
图6为图5的外科端部执行器和闭合套筒构造的一部分的局部剖视图；
图7为图5和图6的外科端部执行器和闭合套筒构造的透视图，其砧座处于打开位置或构型；
图8为图5至图7的外科端部执行器和闭合套筒构造的另一透视图，其砧座处于闭合位置或构型；
图9为外科端部执行器和细长轴组件实施方案的透视图，其中为清楚起见省略了其多个部分；
图10为图9的外科端部执行器和细长轴组件实施方案的部分的顶视图，其中外科端部执行器处于关节运动位置或构型；
图11为图9和图10的外科端部执行器和细长轴组件实施方案的部分的局部分解组件视图；
图12为图9至图11的外科端部执行器和细长轴组件的部分的顶视图；
图13为图9至图12的外科端部执行器和细长轴组件实施方案的部分的透视图，其中外科端部执行器处于关节运动位置或构型；
图14为图9至图13的外科端部执行器和细长轴组件实施方案的部分的顶视图，其中外科端部执行器处于关节运动构型，并且为清楚起见，其中其一些部件以剖面示出；
图15为另一细长轴组件实施方案的一部分的透视图；
图16为图15的细长轴组件实施方案的另一透视图，为了清楚起见省略了闭合套筒和闭合套筒部件；
图17为图15和图16的细长轴组件实施方案的部分的顶视图；
图18为图15至图17的细长轴组件实施方案的剖视侧正视图，其中外科钉仓安装在外科端部执行器部分中；
图19为图15至图18的细长轴组件的另一剖视侧正视图，其中外科钉仓安装在外科端部执行器部分中；
图20为图15至图19的外科端部执行器和细长轴组件的部分的顶视图，其中外科端部执行器处于关节运动位置或构型；
图20A为另一外科端部执行器和闭合套筒实施方案的一部分的侧正视图；
图21为另一外科端部执行器和细长轴组件实施方案的透视图，其中为清楚起见省略了其多个部分；
图22为图21的外科端部执行器和细长轴组件实施方案的部分的分解组件视图；
图23为图21和图22的外科端部执行器和细长轴组件实施方案的部分的顶视图；
图24为图21至图23的外科端部执行器和细长轴组件实施方案的部分的另一顶视图，其中为清楚起见省略了其多个部分；
图25为图21至图24的外科端部执行器和细长轴组件实施方案的部分的另一顶视图，其中外科端部执行器处于关节运动位置或构型；
图26为另一细长轴组件实施方案的一部分的分解透视图；
图27为另一外科端部执行器和细长轴组件实施方案的部分的分解组件视图；
图28为图27的细长轴组件实施方案的一部分的局部透视图，其中为清楚起见省略了其多个部分；
图29为图27和图28的细长轴组件实施方案的部分的另一局部透视图，其中为清楚起见省略了其多个部分；
图30为图27至图29的细长轴组件实施方案的部分的另一局部透视图，其中为清楚起见省略了其多个部分；
图31为图27至图30的外科端部执行器和细长轴组件实施方案的部分的顶视图，其中为清楚起见省略了其多个部分；
图32为图27至图31的外科端部执行器和细长轴组件实施方案的部分的另一顶视图，其中为清楚起见省略了其多个部分，并且外科端部执行器处于关节运动位置或构型；
图33为图27至图32的外科端部执行器和细长轴组件实施方案的部分的侧正视图，其中为清楚起见省略了其多个部分；
图34为图27至图33的外科端部执行器和细长轴组件实施方案的部分的透视图，其中为清楚起见省略了其多个部分；
图35为图27至图34的外科端部执行器和细长轴组件实施方案的部分的另一局部透视图，其中为清楚起见省略了其多个部分；
图36为远侧击发梁组件实施方案和侧向负荷承载构件实施方案的部分的分解组件视图；
图37为图36的远侧击发梁组件和侧向负荷承载构件的透视图；
图38为图36和图37的远侧击发梁组件和侧向负荷承载构件的部分的放大剖视图；
图39为图36至图38的远侧击发梁组件和侧向负荷承载构件的另一剖视图；
图40为附接到击发构件实施方案的远侧击发梁组件实施方案的一部分的侧正视图；
图41为图40的远侧击发梁组件实施方案和击发构件实施方案的一部分的顶视图；
图42为图40和图41的远侧击发梁组件实施方案的一部分的剖视图，其上通过轴颈连接有侧向负荷承载构件，并且远侧击发梁组件实施方案处于挠曲位置或构型；
图43为图42的远侧击发梁组件实施方案和侧向负荷承载构件实施方案的透视图；
图44为另一外科端部执行器实施方案和细长轴组件实施方案的部分的透视图，其中为清楚起见省略了其多个部分，并且外科端部执行器处于关节运动位置或构型；
图45为图44的外科端部执行器实施方案和细长轴组件实施方案的顶视图；
图46为图45的外科端部执行器实施方案和细长轴组件实施方案的另一顶视图，其枢轴连接件的部分以剖面示出；
图47为另一外科端部执行器实施方案和细长轴组件实施方案的部分的局部透视图，其中为清楚起见省略了其多个部分；
图48为图47的外科端部执行器实施方案和细长轴组件实施方案的部分的顶视图，其中为清楚起见省略了其多个部分；
图49为图48的外科端部执行器实施方案和细长轴组件实施方案的另一顶视图；
图50为图47至图49的外科端部执行器实施方案和细长轴组件实施方案的部分的顶部透视图，其中为清楚起见省略了其多个部分，并且外科端部执行器处于关节运动位置或构型；
图51为图50的外科端部执行器实施方案和细长轴组件实施方案的部分的另一顶部透视图；
图52为图51的外科端部执行器实施方案和细长轴组件实施方案的部分的放大透视图；
图53为另一外科端部执行器实施方案和细长轴组件实施方案的部分的顶视图，其中为清楚起见省略了其多个部分，并且示出了处于非关节运动位置或构型以及处于关节运动位置或构型的外科端部执行器；
图54为图53的细长轴组件实施方案的一部分的顶视图，其中关节运动系统处于中间或非关节运动位置或构型，并且为了清楚起见省略了细长轴组件的部分；
图55为图54的细长轴组件实施方案的一部分的另一顶视图，其中关节运动系统处于第一关节运动位置或构型；
图56为图54和图55的细长轴组件实施方案的一部分的另一顶视图，其中关节运动系统处于第二关节运动位置或构型；
图57为图53至图56的细长轴组件实施方案的其它部分以及处于非关节运动位置或构型的外科端部执行器实施方案的部分的局部透视图，其中为清楚起见省略了其多个部分；
图58为图57的外科端部执行器实施方案和细长轴组件实施方案的另一局部透视图，其中为清楚起见省略了其多个部分；
图59为另一细长轴组件实施方案的一部分的顶视图，其中为清楚起见省略了其多个部分；
图60为处于中间或非关节运动位置的另一关节运动系统实施方案的部分的顶视图；
图61为图60的关节运动系统的驱动器关节运动盘实施方案的顶视图；
图62为图60的关节运动系统的从动关节运动盘实施方案的顶视图；
图63为图60的关节运动系统实施方案的另一顶视图，该关节运动系统实施方案处于最初已将关节运动控制动作应用于其之后的位置或构型；
图64为图63的关节运动系统实施方案的另一顶视图，该关节运动系统实施方案处于第一关节运动位置或构型；
图65为图63和图64的关节运动系统实施方案的另一顶视图，该关节运动系统实施方案处于第二关节运动位置或构型；
图66为另一外科端部执行器和闭合套筒实施方案的透视图，其钳口处于闭合位置或构型；
图67为图66的外科端部执行器和闭合套筒实施方案的另一透视图，其钳口处于打开位置或构型；
图68为图66和图67的外科端部执行器和闭合套筒实施方案的侧正视图，其中闭合套筒以剖面示出，其钳口处于打开位置或构型；
图69为以剖面示出的图66至图68的外科端部执行器和闭合套筒实施方案的侧正视图，其钳口处于打开位置或构型；
图70为图66至图69的外科端部执行器和闭合套筒实施方案的分解组件视图；
图71为另一外科端部执行器和闭合套筒实施方案的分解组件视图；
图72为另一外科端部执行器和闭合套筒实施方案的透视图，其钳口处于打开位置或构型；
图73为图72的外科端部执行器和闭合套筒实施方案的另一透视图，其钳口处于闭合位置或构型；
图74为图72和图73的外科端部执行器和闭合套筒实施方案的分解透视组件图；
图75为图72至图74的外科端部执行器和闭合套筒实施方案的侧正视图，其钳口处于闭合位置或构型；
图76为图72至图75的外科端部执行器实施方案的后透视图，为了清楚起见，以虚线示出了其闭合套筒实施方案；
图77为图72至图76的外科端部执行器和闭合套筒实施方案的侧剖视图，其钳口处于闭合位置或构型；
图78为包括图72至图77的外科端部执行器的凸轮板中的一个和闭合套筒实施方案的另一侧剖视图，其钳口处于闭合位置或构型；
图79为包括图72至图78的外科端部执行器的凸轮板中的一个和闭合套筒实施方案的另一侧剖视图，其钳口处于打开位置或构型；
图80为另一外科端部执行器和闭合套筒实施方案的局部透视图，其钳口处于打开位置或构型；
图81为图80的外科端部执行器和闭合套筒实施方案的局部透视图，其钳口处于闭合位置或构型；
图82为图80和图81的外科端部执行器和闭合套筒实施方案的分解透视组件视图；
图83为图80至图82的外科端部执行器和闭合套筒实施方案的侧正视图，其钳口处于闭合位置或构型；
图84为图80至图83的外科端部执行器和闭合套筒实施方案的侧正视图，其中闭合套筒的一部分以剖面示出，其钳口处于打开位置或构型；
图85为另一外科端部执行器和闭合套筒实施方案的分解组件透视图；
图86为图85的外科端部执行器和闭合套筒实施方案的侧正视图，其钳口处于闭合位置或构型；
图87为图85和图86的外科端部执行器和闭合套筒实施方案的侧正视图，其钳口处于打开位置或构型，并且闭合套筒的一部分以剖面示出；
图88为另一细长轴组件实施方案的一部分的透视图；
图89为图88的细长轴组件实施方案的另一透视图，其中为清楚起见省略了其一些部件；
图90为图88和图89的细长轴组件的另一透视图，其中外科端部执行器处于关节运动位置或构型；
图91为图88至图90的细长轴组件的分解组件视图；
图92为图88至图91的细长轴组件的顶视图，为清楚起见省略了一些部件，并且其外科端部执行器在一个方向上进行关节运动；
图93为图88至图92的细长轴组件的另一顶视图，为清楚起见省略了其一些部件，并且外科端部执行器在另一方向上进行关节运动；
图94为外科钉仓实施方案的透视图；
图95为另一外科钉仓实施方案的透视图；
图96为联接到外科端部执行器的另一细长轴组件实施方案的一部分的透视图；
图97为图96的处于非关节运动取向的细长轴组件和外科端部执行器的另一透视图，其中为清楚起见省略了其多个部分；
图98为图96和图97的外科端部执行器和细长轴组件实施方案的部分的顶视图，其中外科端部执行器处于关节运动取向；
图99为图96至图98的外科端部执行器实施方案和细长轴组件实施方案的部分的另一顶视图，其中为清楚起见省略了其多个部分；
图100为图99的处于关节运动取向的外科端部执行器实施方案和细长轴组件实施方案的部分的另一顶视图；
图101为图100的处于非关节运动取向的外科端部执行器实施方案和细长轴组件实施方案的部分的另一顶视图；
图102为图101的外科端部执行器和细长轴组件实施方案的部分的另一顶视图，其中外科端部执行器沿第一关节运动方向进行关节运动；
图103为图102的外科端部执行器和细长轴组件实施方案的部分的另一顶视图，其中外科端部执行器沿第二关节运动方向进行关节运动；
图104为处于非关节运动取向的另一外科端部执行器实施方案和另一细长轴组件实施方案的部分的顶视图；
图105为图104的外科端部执行器和细长轴组件实施方案的另一顶视图，其中外科端部执行器处于关节运动取向；
图106为处于非关节运动取向的另一外科端部执行器实施方案和细长轴组件实施方案的一部分的顶视图，其中为清楚起见省略了其多个部分；
图107为图106的处于第一关节运动取向的外科端部执行器和细长轴组件的另一顶视图；
图108为图107的处于第二关节运动取向的外科端部执行器和细长轴组件的另一顶视图；
图109为处于非关节运动取向的另一外科端部执行器实施方案和细长轴组件实施方案的一部分的顶视图，其中为清楚起见省略了其多个部分；
图110为图109的处于第一关节运动取向的外科端部执行器和细长轴组件的另一顶视图；
图111为图110的处于第二关节运动取向的外科端部执行器和细长轴组件的另一顶视图；
图112为处于非关节运动取向的另一外科端部执行器实施方案和细长轴组件实施方案的一部分的顶视图，其中为清楚起见省略了其多个部分；
图113为图112的处于第一关节运动取向的外科端部执行器和细长轴组件的另一顶视图；
图114为图113的处于第二关节运动取向的外科端部执行器和细长轴组件的另一顶视图；
图115为处于非关节运动取向的另一外科端部执行器实施方案和细长轴组件实施方案的一部分的顶视图，其中为清楚起见省略了其多个部分；
图116为图115的处于第一关节运动取向的外科端部执行器和细长轴组件的另一顶视图；
图117为图116的处于第二关节运动取向的外科端部执行器和细长轴组件的另一顶视图；
图118为处于非关节运动取向的另一外科端部执行器实施方案和细长轴组件实施方案的一部分的顶视图，其中为清楚起见省略了其多个部分；
图119为图118的处于第一关节运动取向的外科端部执行器和细长轴组件的另一顶视图；
图120为处于非关节运动取向的另一外科端部执行器实施方案和细长轴组件实施方案的一部分的局部透视图，其中为清楚起见省略了其多个部分；
图121为图120的处于非关节运动取向的外科端部执行器和细长轴组件的顶视图；
图122为图121的处于第一关节运动取向的外科端部执行器和细长轴组件的另一顶视图；
图123为处于非关节运动取向的另一外科端部执行器实施方案和细长轴组件实施方案的一部分的局部透视图，其中为清楚起见省略了其多个部分；
图124为图123的处于非关节运动取向的外科端部执行器实施方案和细长轴组件实施方案的另一透视图；
图125为图123和图124的外科端部执行器和细长轴组件实施方案的分解组件透视图；
图126为图123至图125的处于非关节运动取向的外科端部执行器实施方案和细长轴组件实施方案的顶视图；
图127为图123至图126的处于第一关节运动取向的外科端部执行器和细长轴组件的另一顶视图；
图128为图123至图128的处于第二关节运动取向的外科端部执行器和细长轴组件的另一顶视图；
图129为处于非关节运动取向的另一外科端部执行器实施方案和细长轴组件实施方案的一部分的局部透视图，其中为清楚起见省略了其多个部分；
图130为图129的处于非关节运动取向的外科端部执行器和细长轴组件的顶视图；
图131为图129和图130的处于第一关节运动取向的外科端部执行器和细长轴组件的另一顶视图；
图132为细长轴组件的脊和击发梁联接器实施方案的部分的局部透视图；
图132A为细长轴组件的脊和另一击发梁联接器和锁构造的部分的局部剖视图；
图133为图132的其中安装有击发梁实施方案的脊和击发梁联接器实施方案的顶视图；
图134为击发梁实施方案的近侧端部的顶视图；
图135为另一击发梁实施方案的近侧端部的顶视图；
图136为处于非关节运动取向的另一外科端部执行器实施方案和细长轴组件实施方案的顶视图，其中为清楚起见省略了各种部件；
图137为图136的处于第一关节运动取向的外科端部执行器和细长轴组件的另一顶视图；
图138为处于非关节运动取向的另一外科端部执行器和细长轴组件实施方案的局部透视图，其中为清楚起见省略了其多个部件；
图139为图138的外科端部执行器和细长轴组件的分解透视组件视图；
图140为图139的外科端部执行器和细长轴组件的部分的另一分解透视图；
图141为图138至图140的处于第一关节运动取向的外科端部执行器和细长轴组件的另一透视图；
图142为图138至图141的处于第二关节运动取向的外科端部执行器和细长轴组件的另一透视图；
图143为另一细长轴组件的一部分的顶视图；
图144为图143的细长轴组件和外科端部执行器的一部分的局部分解组件视图；
图145为处于非关节运动取向的另一外科端部执行器实施方案和细长轴实施方案的透视图；
图146为图145的外科端部执行器和细长轴组件的缆线构件和滑轮构造的顶视图；
图147为图145的外科端部执行器和细长轴组件的部分的分解组件视图；
图148为另一细长轴组件的一部分的侧正视图；
图149为图148的细长轴组件的分解组件视图；
图150为另一细长轴组件的部分的顶视图，其中为清楚起见省略了其多个部件；
图151为细长轴组件的缆线部分和用于将张力引入缆线构件中的张紧螺杆构造的一部分的局部剖视图；
图152为闭合套筒实施方案的剖面透视图；
图153为另一闭合套筒实施方案的剖视图；
图154为另一闭合套筒实施方案的部分的剖视图；
图155为另一闭合套筒实施方案的部分的剖视图；
图156为另一闭合套筒实施方案的部分的剖视图；
图157为另一细长轴组件的部分的剖面透视图；并且
图158为图157的细长轴组件的部分的另一剖视图。
在所述若干视图中，对应的参考符号指示对应的部件。本文所述的范例以一种形式示出了本发明的各种实施方案，且这种范例不应被解释为以任何方式限制本发明的范围。
具体实施方式
本申请的申请人拥有以下专利申请，所述专利申请与本申请于同一日期提交且各自全文以引用方式并入本文：
-名称为“ARTICULATABLE SURGICAL INSTRUMENTS WITH OFF-AXIS FIRING BEAMARRANGEMENTS”的美国专利申请序列号__________，代理人案卷号END7854USNP/150533；
-名称为“ARTICULATABLE SURGICAL INSTRUMENTS WITH SINGLE ARTICULATIONLINK ARRANGEMENTS”的美国专利申请序列号__________，代理人案卷号END7852USNP/150531；
-名称为“SURGICAL INSTRUMENTS WITH AN END EFFECTOR THAT IS HIGHLYARTICULATABLE RELATIVE TO AN ELONGATE SHAFT ASSEMBLY”的美国专利申请序列号__________，代理人案卷号END7850USNP/150529；
-名称为“SURGICAL INSTRUMENT ARTICULATION MECHANISM WITH SLOTTEDSECONDARY CONSTRAINT”的美国专利申请序列号__________，代理人案卷号END7849USNP/150528；
-名称为“SURGICAL INSTRUMENTS WITH MULTIPLE LINK ARTICULATIONARRANGEMENTS”的美国专利申请序列号__________，代理人案卷号END7848USNP/150527；
-名称为“SURGICAL INSTRUMENT WITH ARTICULATING AND AXIALLYTRANSLATABLE END EFFECTOR”的美国专利申请序列号__________，代理人案卷号END7847USNP/150526；
-名称为“SURGICAL INSTRUMENTS WITH TENSIONING ARRANGEMENTS FOR CABLEDRIVEN ARTICULATION SYSTEMS”的美国专利申请序列号__________，代理人案卷号END7853USNP/150532；以及
-名称为“SURGICAL INSTRUMENTS WITH CLOSURE STROKE REDUCTIONARRANGEMENTS”的美国专利申请序列号__________，代理人案卷号END7855USNP/150534。
本申请的申请人拥有2015年6月18日提交并且各自全文以引用方式并入本文的以下专利申请：
-名称为“SURGICAL END EFFECTORS WITH POSITIVE JAW OPENINGARRANGEMENTS”的美国专利申请序列号14/742,925；
-名称为“SURGICAL END EFFECTORS WITH DUAL CAM ACTUATED JAW CLOSINGFEATURES”的美国专利申请序列号14/742,941；
-名称为“SURGICAL STAPLING INSTRUMENTS WITH LOCKOUT ARRANGEMENTS FORPREVENTING FIRING SYSTEM ACTUATION WHEN A CARTRIDGE IS SPENT OR MISSING”的美国专利申请序列号14/742,933；
-名称为“MOVABLE FIRING BEAM SUPPORT ARRANGEMENTS FOR ARTICULATABLESURGICAL INSTRUMENTS”的美国专利申请序列号14/742,914；
-名称为“ARTICULATABLE SURGICAL INSTRUMENTS WITH COMPOSITE FIRING BEAMSTRUCTURES WITH CENTER FIRING SUPPORT MEMBER FOR ARTICULATION SUPPORT”的美国专利申请序列号14/742,900；以及
-名称为“PUSH/PULL ARTICULATION DRIVE SYSTEMS FOR ARTICULATABLESURGICAL INSTRUMENTS”的美国专利申请序列号14/742,876。
本申请的申请人拥有2015年3月6日提交并且各自全文以引用方式并入本文的以下专利申请：
-名称为“POWERED SURGICAL INSTRUMENT”的美国专利申请序列号14/640,746；
-名称为“MULTIPLE LEVEL THRESHOLDS TO MODIFY OPERATION OF POWEREDSURGICAL INSTRUMENTS”的美国专利申请序列号14/640,795；
-名称为“ADAPTIVE TISSUE COMPRESSION TECHNIQUES TO ADJUST CLOSURERATES FOR MULTIPLE TISSUE TYPES”的美国专利申请序列号14/640,832；
-名称为“OVERLAID MULTI SENSOR RADIO FREQUENCY(RF)ELECTRODE SYSTEM TOMEASURE TISSUE COMPRESSION”的美国专利申请序列号14/640,935；
-名称为“MONITORING SPEED CONTROL AND PRECISION INCREMENTING OF MOTORFOR POWERED SURGICAL INSTRUMENTS”的美国专利申请序列号14/640,831；
-名称为“TIME DEPENDENT EVALUATION OF SENSOR DATA TO DETERMINESTABILITY,CREEP,AND VISCOELASTIC ELEMENTS OF MEASURES”的美国专利申请序列号14/640,859；
-名称为“INTERACTIVE FEEDBACK SYSTEM FOR POWERED SURGICAL INSTRUMENTS”的美国专利申请序列号14/640,817；
-名称为“CONTROL TECHNIQUES AND SUB-PROCESSOR CONTAINED WITHIN MODULARSHAFT WITH SELECT CONTROL PROCESSING FROM HANDLE”的美国专利申请序列号14/640,844；
-名称为“SMART SENSORS WITH LOCAL SIGNAL PROCESSING”的美国专利申请序列号14/640,837；
-名称为“SYSTEM FOR DETECTING THE MIS-INSERTION OF A STAPLE CARTRIDGEINTO A SURGICAL STAPLER”的美国专利申请序列号14/640,765；
-名称为“SIGNAL AND POWER COMMUNICATION SYSTEM POSITIONED ON AROTATABLE SHAFT”的美国专利申请序列号14/640,799；以及
-名称为“SURGICAL INSTRUMENT COMPRISING A LOCKABLE BATTERY HOUSING”的美国专利申请序列号14/640,780。
本申请的申请人拥有2015年2月27日提交并且全文各自以引用的方式并入本文的以下专利申请：
-名称为“SURGICAL INSTRUMENT SYSTEM COMPRISING AN INSPECTION STATION”的美国专利申请序列号14/633,576；
-名称为“SURGICAL APPARATUS CONFIGURED TO ASSESS WHETHER A PERFORMANCEPARAMETER OF THE SURGICAL APPARATUS IS WITHIN AN ACCEPTABLE PERFORMANCE BAND”的美国专利申请序列号14/633,546；
-名称为“SURGICAL CHARGING SYSTEM THAT CHARGES AND/OR CONDITIONS ONEOR MORE BATTERIES”的美国专利申请序列号14/633,576；
-名称为“CHARGING SYSTEM THAT ENABLES EMERGENCY RESOLUTIONS FORCHARGING A BATTERY”的美国专利申请序列号14/633,566；
-名称为“SYSTEM FOR MONITORING WHETHER A SURGICAL INSTRUMENT NEEDS TOBE SERVICED”的美国专利申请序列号14/633,555；
-名称为“REINFORCED BATTERY FOR A SURGICAL INSTRUMENT”的美国专利申请序列号14/633,542；
-名称为“POWER ADAPTER FOR A SURGICAL INSTRUMENT”的美国专利申请序列号14/633,548；
-名称为“ADAPTABLE SURGICAL INSTRUMENT HANDLE”的美国专利申请序列号14/633,526；
-名称为“MODULAR STAPLING ASSEMBLY”的美国专利申请序列号14/633,541；以及
-名称为“SURGICAL APPARATUS CONFIGURED TO TRACK AN END-OF-LIFEPARAMETER”的美国专利申请序列号14/633,562；
本申请的申请人拥有2014年12月18日提交并且各自全文以引用方式并入本文的以下专利申请：
-名称为“SURGICAL INSTRUMENT SYSTEMS COMPRISING AN ARTICULATABLE ENDEFFECTOR AND MEANS FOR ADJUSTING THE FIRING STROKE OF A FIRING”的美国专利申请序列号14/574,478；
-名称为“SURGICAL INSTRUMENT ASSEMBLY COMPRISING LOCKABLE SYSTEMS”的美国专利申请序列号14/574,483；
-名称为“DRIVE ARRANGEMENTS FOR ARTICULATABLE SURGICAL INSTRUMENTS”的美国专利申请序列号14/575,139；
-名称为“LOCKING ARRANGEMENTS FOR DETACHABLE SHAFT ASSEMBLIES WITHARTICULATABLE SURGICAL END EFFECTORS”的美国专利申请序列号14/575,148；
-名称为“SURGICAL INSTRUMENT WITH AN ANVIL THAT IS SELECTIVELY MOVABLEABOUT A DISCRETE NON-MOVABLE AXIS RELATIVE TO A STAPLE CARTRIDGE”的美国专利申请序列号14/575,130；
-名称为“SURGICAL INSTRUMENTS WITH IMPROVED CLOSURE ARRANGEMENTS”的美国专利申请序列号14/575,143；
-名称为“SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTORS ANDMOVABLE FIRING BEAM SUPPORT ARRANGEMENTS”的美国专利申请序列号14/575,117；
-名称为“SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTORS ANDIMPROVED FIRING BEAM SUPPORT ARRANGEMENTS”的美国专利申请序列号14/575,154；
-名称为“SURGICAL INSTRUMENT ASSEMBLY COMPRISING A FLEXIBLEARTICULATION SYSTEM”的美国专利申请序列号14/574,493；以及
-名称为“SURGICAL INSTRUMENT ASSEMBLY COMPRISING A LOCKABLEARTICULATION SYSTEM”的美国专利申请序列号14/574,500。
本申请的申请人拥有2013年3月1日提交并且各自全文以引用方式并入本文的以下专利申请：
-名称为“ARTICULATABLE SURGICAL INSTRUMENTS WITH CONDUCTIVE PATHWAYSFOR SIGNAL COMMUNICATION”的美国专利申请序列号13/782,295，现为美国专利申请公布2014/0246471；
-名称为“ROTARY POWERED ARTICULATION JOINTS FOR SURGICAL INSTRUMENTS”的美国专利申请序列号13/782,323，现为美国专利申请公布2014/0246472；
-名称为“THUMBWHEEL SWITCH ARRANGEMENTS FOR Surgical INSTRUMENTS”的美国专利申请序列号13/782,338，现为美国专利申请公布2014/0249557；
-名称为“ELECTROMECHANICAL SURGICAL DEVICE WITH SIGNAL RelayARRANGEMENT”的美国专利申请序列号13/782,499，现为美国专利申请公布2014/0246474；
-名称为“MULTIPLE PROCESSOR MOTOR CONTROL FOR MODULAR SURGICALINSTRUMENTS”的美国专利申请序列号13/782,460，现为美国专利申请公布2014/0246478；
-名称为“JOYSTICK SWITCH ASSEMBLIES FOR SURGICAL Instruments”的美国专利申请序列号13/782,358，现为美国专利申请公布2014/0246477；
-名称为“SENSOR STRAIGHTENED END EFFECTOR DURING Removal THROUGHTROCAR”的美国专利申请序列号13/782,481，现为美国专利申请公布2014/0246479；
-名称为“CONTROL METHODS FOR SURGICAL INSTRUMENTS WITH RemovableIMPLEMENT PORTIONS”的美国专利申请序列号13/782,518，现为美国专利申请公布2014/0246475；
-名称为“ROTARY POWERED SURGICAL INSTRUMENTS WITH MULTIPLE DEGREES OFFREEDOM”的美国专利申请序列号13/782,375，现为美国专利申请公布2014/0246473；以及
-名称为“SURGICAL INSTRUMENT SOFT STOP”的美国专利申请序列号13/782,536，现为美国专利申请公布2014/0246476。
本申请的申请人还拥有2013年3月14日提交并且全文各自以引用的方式并入本文的以下专利申请：
-名称为“ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE”的美国专利申请序列号13/803,097，现为美国专利申请公布2014/0263542；
-名称为“CONTROL ARRANGEMENTS FOR A DRIVE MEMBER OF A SURGICALINSTRUMENT”的美国专利申请序列号13/803,193，现为美国专利申请公布2014/0263537；
-名称为“INTERCHANGEABLE SHAFT ASSEMBLIES FOR USE WITH A SURGICALINSTRUMENT”的美国专利申请序列号13/803,053，现为美国专利申请公布2014/0263564；
-名称为“ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATIONLOCK”的美国专利申请序列号13/803,086，现为美国专利申请公布2014/0263541；
-名称为“SENSOR ARRANGEMENTS FOR ABSOLUTE POSITIONING SYSTEM FORSURGICAL INSTRUMENTS”的美国专利申请序列号13/803,210，现为美国专利申请公布2014/0263538；
-名称为“MULTI-FUNCTION MOTOR FOR A SURGICAL INSTRUMENT”的美国专利申请序列号13/803,148，现为美国专利申请公布2014/0263554；
-名称为“DRIVE SYSTEM LOCKOUT ARRANGEMENTS FOR MODULAR SURGICALINSTRUMENTS”的美国专利申请序列号13/803,066，现为美国专利申请公布2014/0263565；
-名称为“ARTICULATION CONTROL SYSTEM FOR ARTICULATABLE SURGICALINSTRUMENTS”的美国专利申请序列号13/803,117，现为美国专利申请公布2014/0263553；
-名称为“DRIVE TRAIN CONTROL ARRANGEMENTS FOR MODULAR SURGICALINSTRUMENTS”的美国专利申请序列号13/803,130，现为美国专利申请公布2014/0263543；以及
-名称为“METHOD AND SYSTEM FOR OPERATING A SURGICAL INSTRUMENT”的美国专利申请序列号13/803,159，现为美国专利申请公布2014/0277017。
本申请的申请人还拥有2014年3月7日提交并且全文以引用方式并入本文的以下专利申请：
-名称为“CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS”的美国专利申请序列号14/200,111，现为美国专利申请公布2014/0263539。
本申请的申请人还拥有2014年3月26日提交并且各自全文以引用方式并入本文的以下专利申请：
-名称为“POWER MANAGEMENT CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS”的美国专利申请序列号14/226,106，现为美国专利申请公布2015/0272582；
-名称为“STERILIZATION VERIFICATION CIRCUIT”的美国专利申请序列号14/226,099，现为美国专利申请公布2015/0272581；
-名称为“VERIFICATION OF NUMBER OF BATTERY EXCHANGES/PROCEDURE COUNT”的美国专利申请序列号14/226,094，现为美国专利申请公布2015/0272580；
-名称为“POWER MANAGEMENT THROUGH SLEEP OPTIONS OF SEGMENTED CIRCUITAND WAKE UP CONTROL”的美国专利申请序列号14/226,117，现为美国专利申请公布2015/0272574；
-名称为“MODULAR POWERED SURGICAL INSTRUMENT WITH DETACHABLE SHAFTASSEMBLIES”的美国专利申请序列号14/226,075，现为美国专利申请公布2015/0272579；
-名称为“FEEDBACK ALGORITHMS FOR MANUAL BAILOUT SYSTEMS FOR SURGICALINSTRUMENTS”的美国专利申请序列号14/226,093，现为美国专利申请公布2015/0272569；
-名称为“SURGICAL INSTRUMENT UTILIZING SENSOR ADAPTATION”的美国专利申请序列号14/226,116，现为美国专利申请公布2015/0272571；
-名称为“SURGICAL INSTRUMENT CONTROL CIRCUIT HAVING A SAFETYPROCESSOR”的美国专利申请序列号14/226,071，现为美国专利申请公布2015/0272578；
-名称为“SURGICAL INSTRUMENT COMPRISING INTERACTIVE SYSTEMS”的美国专利申请序列号14/226,097，现为美国专利申请公布2015/0272570；
-名称为“INTERFACE SYSTEMS FOR USE WITH SURGICAL INSTRUMENTS”的美国专利申请序列号14/226,126，现为美国专利申请公布2015/0272572；
-名称为“MODULAR SURGICAL INSTRUMENT SYSTEM”的美国专利申请序列号14/226,133，现为美国专利申请公布2015/0272557；
-名称为“SYSTEMS AND METHODS FOR CONTROLLING A SEGMENTED CIRCUIT”的美国专利申请序列号14/226,081，现为美国专利申请公布2015/0277471；
-名称为“POWER MANAGEMENT THROUGH SEGMENTED CIRCUIT AND VARIABLEVOLTAGE PROTECTION”的美国专利申请序列号14/226,076，现为美国专利申请公布2015/0280424；
-名称为“SURGICAL STAPLING INSTRUMENT SYSTEM”的美国专利申请序列号14/226,111，现为美国专利申请公布2015/0272583；以及
名称为“SURGICAL INSTRUMENT COMPRISING A ROTATABLE SHAFT”的美国专利申请序列号14/226,125，现为美国专利申请公布2015/0280384。
本申请的申请人还拥有2014年9月5日提交并且全文各自以引用的方式并入本文的以下专利申请：
-名称为“CIRCUITRY AND SENSORS FOR POWERED MEDICAL DEVICE”的美国专利申请序列号14/479,103；
-名称为“ADJUNCT WITH INTEGRATED SENSORS TO QUANTIFY TISSUECOMPRESSION”的美国专利申请序列号14/479,119；
-名称为“MONITORING DEVICE DEGRADATION BASED ON COMPONENT EVALUATION”的美国专利申请序列号14/478,908；
-名称为“MULTIPLE SENSORS WITH ONE SENSOR AFFECTING A SECOND SENSOR'SOUTPUT OR INTERPRETATION”的美国专利申请序列号14/478,895；
-名称为“USE OF POLARITY OF HALL MAGNET DETECTION TO DETECT MISLOADEDCARTRIDGE”的美国专利申请序列号14/479,110；
-名称为“SMART CARTRIDGE WAKE UP OPERATION AND DATA RETENTION”的美国专利申请序列号14/479,098；
-名称为“MULTIPLE MOTOR CONTROL FOR POWERED MEDICAL DEVICE”的美国专利申请序列号14/479,115；以及
-名称为“LOCAL DISPLAY OF TISSUE PARAMETER STABILIZATION”的美国专利申请序列号14/479,108。
本申请的申请人还拥有2014年4月9日提交并且全文各自以引用的方式并入本文的以下专利申请：
-名称为“MOTOR DRIVEN SURGICAL INSTRUMENTS WITH LOCKABLE DUAL DRIVESHAFTS”的美国专利申请序列号14/248,590，现为美国专利申请公布2014/0305987；
-名称为“SURGICAL INSTRUMENT COMPRISING A CLOSING DRIVE AND A FIRINGDRIVE OPERATED FROM THE SAME ROTATABLE OUTPUT”的美国专利申请序列号14/248,581，现为美国专利申请公布2014/0305989；
-名称为“SURGICAL INSTRUMENT SHAFT INCLUDING SWITCHES FOR CONTROLLINGTHE OPERATION OF THE SURGICAL INSTRUMENT”的美国专利申请序列号14/248,595，现为美国专利申请公布2014/0305988；
-名称为“POWERED LINEAR SURGICAL STAPLER”的美国专利申请序列号14/248,588，现为美国专利申请公布2014/0309666；
-名称为“TRANSMISSION ARRANGEMENT FOR A SURGICAL INSTRUMENT”的美国专利申请序列号14/248,591，现为美国专利申请公布2014/0305991；
-名称为“MODULAR MOTOR DRIVEN SURGICAL INSTRUMENTS WITH ALIGNMENTFEATURES FOR ALIGNING ROTARY DRIVE SHAFTS WITH SURGICAL END EFFECTOR SHAFTS”的美国专利申请序列号14/248,584，现为美国专利申请公布2014/0305994；
-名称为“POWERED SURGICAL STAPLER”的美国专利申请序列号14/248,587，现为美国专利申请公布2014/0309665；
-名称为“DRIVE SYSTEM DECOUPLING ARRANGEMENT FOR A SURGICALINSTRUMENT”的美国专利申请序列号14/248,586，现为美国专利申请公布2014/0305990；以及
-名称为“MODULAR MOTOR DRIVEN SURGICAL INSTRUMENTS WITH STATUSINDICATION ARRANGEMENTS”的美国专利申请序列号14/248,607，现为美国专利申请公布2014/0305992。
本申请的申请人还拥有2013年4月16日提交并且全文各自以引用的方式并入本文的以下专利申请：
-名称为“SURGICAL INSTRUMENT WITH MULTIPLE FUNCTIONS PERFORMED BY ASINGLE MOTOR”的美国临时专利申请序列号61/812,365；
-名称为“LINEAR CUTTER WITH POWER”的美国临时专利申请序列号61/812,376；
-名称为“LINEAR CUTTER WITH MOTOR AND PISTOL GRIP”的美国临时专利申请序列号61/812,382；
-名称为“SURGICAL INSTRUMENT HANDLE WITH MULTIPLE ACTUATION MOTORS ANDMOTOR CONTROL”的美国临时专利申请序列号61/812,385；以及
-名称为“SURGICAL INSTRUMENT WITH MULTIPLE FUNCTIONS PERFORMED BY ASINGLE MOTOR”的美国临时专利申请序列号61/812,372。
本文列出了许多具体细节，以提供对说明书中所述和附图中所示的实施方案的整体结构、功能、制造和用途的透彻理解。没有详细描述熟知的操作、部件和元件，以免使说明书中描述的实施方案模糊不清。读者将会理解，本文所述和所示的实施方案为非限制性示例，从而可认识到，本文所公开的特定结构和功能细节可为代表性和例示性的。在不脱离权利要求的范围的情况下，可对这些实施方案进行变型和改变。
术语“包括(comprise)”(以及“包括(comprise)”的任何形式，诸如“包括(comprises)”和“包括(comprising)”)、“具有(have)”(以及“具有(have)”的任何形式，诸如“具有(has)”和“具有(having)”)、“包含(include)”(以及“包含(include)”的任何形式，诸如“包含(includes)”和“包含(including)”)、以及“含有(contain)”(以及“含有(contain)”的任何形式，诸如“含有(contains)”和“含有(containing)”)为开放式系动词。因此，“包括”、“具有”、“包含”或“含有”一个或多个元件的外科系统、装置、或设备具有这些一个或多个元件，但不限于仅具有这些一个或多个元件。同样，“包括”、“具有”、“包含”或“含有”一个或多个特征的系统、装置、或设备的元件具有那些一个或多个特征，但不限于仅具有那些一个或多个特征。
术语“近侧”和“远侧”在本文中是相对于操纵外科器械的柄部部分的临床医生来使用的。术语“近侧”是指最靠近临床医生的部分，术语“远侧”是指远离临床医生定位的部分。还应当理解，为简洁和清楚起见，本文可结合附图使用诸如“竖直”、“水平”、“上”和“下”等空间术语。然而，外科器械在许多方向和位置中使用，并且这些术语并非限制性的和/或绝对的。
提供各种示例性装置和方法以用于执行腹腔镜式和微创外科手术操作。然而，读者将容易理解，本文所公开的各种方法和装置可用于多种外科手术和应用中，包括例如与开放式外科手术结合。继续参阅本具体实施方式，读者将进一步理解，本文所公开的各种器械能够以任何方式插入体内，诸如通过自然腔道、通过形成于组织中的切口或穿刺孔等。器械的工作部分或端部执行器部分可直接插入患者体内或者可通过具有工作通道的进入装置插入，外科器械的端部执行器和细长轴可通过所述工作通道推进。
外科缝合系统可包括轴和从轴延伸的端部执行器。端部执行器包括第一钳口和第二钳口。第一钳口包括钉仓。钉仓能够插入到第一钳口中并且能够从第一钳口移除；然而，设想到其中钉仓不能够从第一钳口移除或至少能够易于从第一钳口替换的其他实施方案。第二钳口包括被构造成能够使从钉仓射出的钉变形的砧座。第二钳口能够相对于第一钳口围绕闭合轴线枢转；然而，可设想到其中第一钳口能够相对于第二钳口枢转的其它实施方案。外科缝合系统还包括被构造成能够允许端部执行器相对于轴旋转或进行关节运动的关节运动接头。端部执行器能够围绕延伸穿过关节运动接头的关节运动轴线旋转。设想了不包括关节运动接头的其它实施方案。
钉仓包括仓体。仓体包括近侧端部、远侧端部和在近侧端部与远侧端部之间延伸的平台。在使用中，钉仓定位在待缝合的组织的第一侧上，并且砧座定位在组织的第二侧上。砧座朝向钉仓运动以将组织压缩并夹持抵靠平台。然后，可移除地储存在仓体中的钉可部署到组织中。仓体包括限定于其中的钉腔，其中钉可移除地储存在钉腔中。钉腔被布置成六纵向排。三排钉腔定位在纵向狭槽的第一侧上且三排钉腔定位在纵向狭槽的第二侧上。钉腔和钉的其它构造也是可以的。
钉由仓体中的钉驱动器支撑。驱动器能够在第一或非击发位置和第二或击发位置之间运动，以从钉仓射出钉。驱动器通过保持器保留在仓体中，保持器围绕仓体的底部延伸并且包括被构造成能够抓持仓体以及将保持器保持至仓体的弹性构件。驱动器能够通过滑动件在其非击发位置和击发位置之间运动。滑动件能够在与近侧端部相邻的近侧位置和与远侧端部相邻的远侧位置之间运动。滑动件包括多个斜坡表面，该斜坡表面被构造成能够朝向砧座在驱动器下方滑动以及提升驱动器，并且钉在驱动器上受到支撑。
除上述以外，滑动件还可通过击发构件朝远侧运动。击发构件被构造成能够接触滑动件并朝向远侧端部推动滑动件。限定于仓体中的纵向狭槽被构造成能够接纳击发构件。砧座还包括被构造成能够接纳击发构件的狭槽。击发构件还包括接合第一钳口的第一凸轮和接合第二钳口的第二凸轮。在击发构件朝远侧推进时，第一凸轮和第二凸轮可控制钉仓的平台和砧座之间的距离或组织间隙。击发构件还包括被构造成能够切入在钉仓和砧座中间捕集的组织的刀。希望刀定位成至少部分接近斜坡表面，使得钉先于刀被射出。
图1至图4示出了可再利用或不可再利用的马达驱动外科切割和紧固器械10。在示出的实施方案中，器械10包括外壳12，该外壳包括被构造成能够被临床医生抓持、操纵和致动的柄部14。外壳12被构造用于可操作地附接到细长轴组件200，该细长轴组件具有可操作地联接到其的外科端部执行器300，该外科端部执行器被构造成能够执行一种或多种外科任务或手术。可采用例如名称为“MODULAR POWERED SURGICAL INSTRUMENT WITHDETACHABLE SHAFT ASSEMBLIES”的美国专利申请序列号14/226,075(现为美国专利公布2015/0272579)所公开的各种方式将细长轴组件200与其它轴组件互换，该专利申请的全部公开内容据此以引用方式并入本文。在其它构造中，细长轴组件可能无法与其它轴组件互换，并且基本上包括器械的专用不可移除部分。
继续参阅本具体实施方式，将会理解，本文所公开的各种形式的可互换轴组件也可有效地与机器人控制的外科系统结合使用。因此，术语“外壳”也可以涵盖机器人系统的容纳或以其它方式可操作地支撑至少一个驱动系统的外壳或类似部分，其中所述至少一个驱动系统被构造成能够生成和施加可用于致动本文所公开的细长轴组件及其相应的等同物的至少一个控制动作。术语“框架”可指手持式外科器械的一部分。术语“框架”还可表示机器人控制的外科器械的一部分和/或机器人系统的可用于可操作地控制外科器械的一部分。例如，本文所公开的轴组件可与名称为“SURGICAL STAPLING INSTRUMENTS WITHROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS”的美国专利申请序列号13/118,241(现为美国专利9,072,535)中公开的各种机器人系统、器械、部件和方法一起使用，该专利申请据此全文以引用方式并入本文。
图1中所示的外壳12结合包括外科端部执行器300的细长轴组件200示出，所述外科端部执行器包括被构造成能够可操作地支撑其中的外科钉仓304的外科切割和紧固装置。外壳12可被构造用于与轴组件结合使用，该轴组件包括端部执行器，该端部执行器适于支撑不同尺寸和类型的钉仓，具有不同的轴长度、尺寸和类型等。除此之外，外壳12还可有效地用于多种其它轴组件，其包括被构造成能够将其它动作和形式的能量(诸如例如射频(RF)能量、超声能量和/或动作)施加到适于与各种外科应用和手术结合使用的端部执行器布置的那些组件。此外，该端部执行器、轴组件、柄部、外科器械和/或外科器械系统可利用任何一种或多种合适的紧固件来紧固组织。例如，包括可移除地被存储在其中的多个紧固件的紧固件仓能够可移除地插入轴组件的端部执行器中和/或附接到轴组件的端部执行器。
图1示出了外科器械10的外壳12和柄部14，该外科器械具有可操作地联接至其的可互换细长轴组件200。如图1中可看到的那样，柄部14可包括一对可互连的柄部外壳段16和18，该对柄部外壳段可借助螺钉、按扣特征、粘合剂等互连。在示出的构造中，柄部外壳段16和18配合以形成可被临床医生抓握和操纵的手枪式握把部19。如将在下文进一步详细地讨论，柄部14可操作地支撑其中的多个驱动系统，这些驱动系统被构造成能够生成各种控制动作并将这些控制动作施加到可操作地附接到其上的可互换轴组件的对应部分。
现在参见图2，柄部14还可包括可操作地支撑多个驱动系统的框架20。例如，框架20能够可操作地支撑通常标示为30的“第一”或闭合驱动系统，该“第一”或闭合驱动系统可用于将闭合和打开动作施加到可操作地附接或联接到其的细长轴组件200。在至少一种形式中，闭合驱动系统30可包括被框架20枢转地支撑的闭合触发器32形式的致动器。更具体地，如图2所示，闭合触发器32经由销33枢转地联接到外壳14。这种构造使闭合触发器32能够被临床医生操纵，使得当临床医生抓握柄部14的手枪式握把部19时，闭合触发器32可被其轻易地从起始或“未致动”位置枢转到“致动”位置，并且更具体地，枢转到完全压缩或完全致动位置。闭合触发器32可由弹簧或其它偏压布置(未示出)偏压到未致动位置中。在各种形式中，闭合驱动系统30还包括可枢转地联接到闭合触发器32的闭合连杆组件34。如图2中可看到的那样，闭合连杆组件34可包括由销35枢转地联接到闭合触发器32的第一闭合连接件36和第二闭合连接件38。第二闭合连接件38在本文中也可称为“附接构件”，并且包括横向附接销37。
仍参见图2，可观察到，第一闭合连接件36可在其上具有锁定壁或锁定端部39，该锁定壁或锁定端部被构造成能够与枢转地联接到框架20的闭合释放组件60配合。在至少一种形式中，闭合释放组件60可包括具有在其上形成的朝远侧突出的锁定棘爪64的释放按钮组件62。释放按钮组件62可被释放弹簧(未示出)沿逆时针方向枢转。临床医生将闭合触发器32从其未致动位置朝向柄部14的手枪式握把部19按压时，第一闭合连接件36向上枢转至某个点，其中锁定爪64落入该点中以与第一闭合连接件36上的锁定壁39保持接合，从而阻止闭合触发器32返回未致动位置。因此，闭合释放组件60用来将闭合触发器32锁定在完全致动位置。当临床医生期望将闭合触发器32解锁以允许其被偏压到未致动位置时，临床医生只需枢转闭合释放按钮组件62，使得锁定爪64运动成与第一闭合连接件36上的锁定壁39脱离接合。当锁定棘爪64已运动成与第一闭合连接件36脱离接合时，闭合触发器32可枢转回到未致动位置。也可采用其它闭合触发器锁定构造和释放构造。
当闭合触发器32被从其未致动位置运动到其致动位置时，闭合释放按钮62在第一位置和第二位置之间枢转。闭合释放按钮62的旋转可被称为向上旋转；然而，闭合释放按钮62的至少一部分朝电路板100旋转。仍然参见图2，闭合释放按钮62可包括从其延伸的臂61和安装到臂61的磁性元件63(诸如永磁体)。当闭合释放按钮62被从其第一位置旋转到其第二位置时，磁性元件63可朝电路板100运动。电路板100可包括至少一个传感器，所述至少一个传感器被构造成能够检测磁性元件63的运动。在至少一个实施方案中，“霍尔效应”传感器可安装到电路板100的底部表面。霍耳效应传感器可被构造成能够检测由磁性元件63的运动所引起的环绕霍耳效应传感器周围的磁场的变化。霍耳效应传感器可与例如微控制器进行信号通信，该微控制器可确定闭合释放按钮62是否处于其与闭合触发器32的未致动位置和端部执行器的打开构型相关联的第一位置、其与闭合触发器32的致动位置和端部执行器的闭合构型相关联的第二位置、和/或第一位置与第二位置之间的任何位置。
同样在所示出的构造中，柄部14和框架20可操作地支撑在本文中被称为击发驱动系统80的另一驱动系统，该驱动系统被构造成能够将击发动作施加到附接到其上的可互换轴组件的对应部分。击发驱动系统80也可在本文中被称为“第二驱动系统”。击发驱动系统80可以采用定位在柄部14的手枪式握把部19中的电动马达82。在各种形式中，马达82例如可以是具有约25,000RPM的最大旋转的DC有刷驱动马达。在其它构造中，马达可包括无刷马达、无绳马达、同步马达、步进马达、或任何其它合适的电动马达。马达82可由功率源90供电，在一种形式中，该功率源可包括可移除电源组92。如图2中可看到的那样，例如，电源组92可包括近侧外壳部分94，该近侧外壳部分被构造用于附接到远侧外壳部分96。近侧外壳部分94和远侧外壳部分96被构造成能够可操作地支撑其中的多个电池98。电池98可各自包括例如锂离子(“LI”)或其它合适的电池。远侧外壳部分96被构造用于以可移除方式可操作地附接到同样可操作地联接到马达82的控制电路板组件100。可使用可串联连接的多个电池98作为外科器械10的功率源。除此之外，功率源90可以是可替换的和/或可再充电的。
如上面相对于其它各种形式所概述，电动马达82包括与齿轮减速器组件84可操作地交接的可旋转轴(未示出)，该齿轮减速器组件被安装成与可纵向运动的驱动构件120上的一组或一齿条的驱动齿122啮合接合。在使用中，功率源90所提供的电压极性可沿顺时针方向操作电动马达82，其中由电池施加给电动马达的电压极性可被反转，以便沿逆时针方向操作电动马达82。当电动马达82在一个方向上旋转时，驱动构件120将在远侧方向DD上轴向地驱动。当马达82在相反的旋转方向上被驱动时，驱动构件120将在近侧方向PD上轴向地驱动。柄部14可包括开关，该开关被构造成能够使由功率源90施加到电动马达82的极性反转。与本文所述的其它形式一样，柄部14还可包括传感器，该传感器被构造成能够检测驱动构件120的位置和/或驱动构件120正在运动的方向。
马达82的致动通过被可枢转地支撑在柄部14上的击发触发器130来控制。击发触发器130可在未致动位置和致动位置之间枢转。击发触发器130可由弹簧132或其它偏压构造偏压到未致动位置中，使得当临床医生释放击发触发器130时，击发触发器可由弹簧132或偏压构造枢转或以其它方式返回到未致动位置。在至少一种形式中，击发触发器130可如上所述被定位在闭合触发器32的“外侧”。在至少一种形式中，击发触发器安全按钮134可由销35枢转地安装到闭合触发器32。安全按钮134可定位在击发触发器130和闭合触发器32之间，并具有从其突出的枢转臂136。参见图2。当闭合触发器32处于未致动位置时，安全按钮134被容纳在柄部14中，此时临床医生可能无法轻易触及该按钮，也无法将该按钮在防止对击发触发器130致动的安全位置与击发触发器130可被击发的击发位置之间运动。临床医生按压闭合触发器32时，安全按钮134和击发触发器130向下枢转，随后可被临床医生操纵。
如上文所讨论，柄部14包括闭合触发器32和击发触发器130。击发触发器130能够可枢转地安装到闭合触发器32。如上文所概述，当闭合触发器32从其未致动位置向其致动位置运动时，击发触发器130可向下下降。在安全按钮134已运动到其击发位置之后，可按压击发触发器130，以操作外科器械击发系统的马达。在各种情况下，柄部14可包括跟踪系统，该跟踪系统被构造成能够确定闭合触发器32的位置和/或击发触发器130的位置。
如上所述，在至少一种形式中，可纵向运动的驱动构件120具有在其上形成的一齿条的驱动齿122，以用于与齿轮减速器组件84的相应驱动齿轮86啮合。至少一种形式还包括可手动致动的被构造成能够使得临床医生能够在马达82变得失效情况下手动地回缩可纵向运动的驱动构件120的“救助”组件140。救助组件140可包括杠杆或救助柄部组件142，该杠杆或救助柄部组件被构造成能够被手动地枢转为与同样设置在驱动构件120中的齿124棘轮接合。因此，临床医生可通过使用救助柄部组件142来手动地回缩驱动构件120，以在近侧方向PD上啮合驱动构件120。美国专利申请公布US2010/0089970(现为美国专利8,608,045)公开了救助构造和也可与本文所公开的各种器械一起使用的其它部件、构造和系统。名称为“POWERED SURGICAL CUTTING AND STAPLING APPARATUS WITH MANUALLYRETRACTABLE FIRING SYSTEM”的美国专利申请序列号12/249,117(现为美国专利8,608,045)据此全文以引用方式并入。
现在转到图1和图3，细长轴组件200包括外科端部执行器300，所述外科端部执行器包括被构造成能够在其中可操作地支撑钉仓304的细长通道302。端部执行器300还可包括相对于细长通道302被可枢转地支撑的砧座310。如将在下文进一步详细讨论的，外科端部执行器300可以围绕关节运动接头270相对于细长轴组件进行关节运动。如图3和图4中可看到的那样，轴组件200还可包括由喷嘴部分202和203组成的近侧外壳或喷嘴201。轴组件200还包括闭合套筒260，该闭合套筒可用于闭合和/或打开端部执行器300的砧座310。如图4中可看到的那样，轴组件200包括可被构造成能够可固定地支撑关节运动锁350的轴框架部分212的脊210。有关于关节运动锁350的构建与操作的细节阐述于名称为“ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK”的美国专利申请序列号13/803,086中，现为美国专利申请公布2014/0263541，其公开内容据此以引用方式并入本文。脊210被构造成能够：第一，可滑动地支撑其中的击发构件220；第二，可滑动地支撑围绕脊210延伸的闭合套筒260。脊210还可滑动地支撑近侧关节运动驱动器230。近侧关节运动驱动器230具有远侧端部231，该远侧端部被构造成能够可操作地接合关节运动锁350。在一种构造中，关节运动锁350与关节运动框架352交接，该关节运动框架适于可操作地接合端部执行器框架(未示出)上的驱动销(未示出)。
在所示出的构造中，脊210包括可旋转地支撑在底座240中的近侧端部211。在一种构造中，例如，脊210的近侧端部211具有在其上形成的螺纹214，以便通过螺纹附接到被构造成能够被支撑在底座240内的脊轴承216。参见图3。这种构造有利于将脊210可旋转地附接到底座240，使得脊210可以相对于底座240选择性地围绕轴轴线SA-SA旋转。轴组件200还包括可滑动地支撑在底座240内使得闭合梭动件可相对于底座轴向地运动的闭合梭动件250。如图3中可看到的那样，闭合梭动件250包括被构造用于附接到附接销37的一对朝近侧突出的钩252，该附接销附接到第二闭合连接件38，如将在下文更详细所述的。参见图2。闭合套筒260的近侧端部261联接到闭合梭动件250，以相对于闭合梭动件旋转。例如，将U形连接器263插入闭合套筒260的近侧端部261中的环形狭槽262中，使其保留在闭合梭动件250中的竖直狭槽253内。参见图3。此类构造用于将闭合套筒260附接到闭合梭动件250，以与闭合梭动件一起轴向行进，同时使得闭合套筒260能够围绕轴轴线SA-SA相对于闭合梭动件250旋转。闭合弹簧268轴颈连接在闭合套筒260上，用来沿近侧方向PD偏压闭合套筒260，当轴组件200可操作地联接到柄部14时，该闭合弹簧可用来将闭合触发器枢转到未致动位置。
同样如上所述，细长轴组件200还包括击发构件220，该击发构件被支撑以便在轴脊210内轴向行进。击发构件220包括被构造用于附接到远侧切割部分或击发梁280的中间击发轴部分222。击发构件220在本文中也可被称为“第二轴”和/或“第二轴组件”。如图4中可看到的那样，中间击发轴部分222可包括可被构造成能够接纳远侧击发梁280的近侧端部282上的突片284的其远侧端部中的纵向狭槽223。纵向狭槽223和近侧端部282可被设定尺寸并被构造成能够允许它们之间的相对运动并且可包括滑动接头286。滑动接头286可允许击发驱动器220的中间击发轴部分222运动成使外科端部执行器300进行关节运动，而不运动或至少基本上不运动击发梁280。一旦外科端部执行器300已适当地取向，则中间击发轴部分222可朝远侧推进，直到纵向狭槽223的近侧侧壁与突片284发生接触，以便推进击发梁280并且击发端部执行器300中所支撑的钉仓。如图4中可进一步看到的那样，轴脊210在其中具有细长的开口或窗口213，以利于将中间击发轴部分222组装和插入到轴框架210中。一旦中间击发轴部分222已插入到其中，则顶部框架片段215可与轴框架212接合，以将中间击发轴部分222和击发梁280包封在其中。有关击发构件220的操作的进一步描述可见于美国专利申请序列号13/803,086，现为美国专利申请公布2014/0263541。
除上述之外，所示轴组件200包括离合器组件400，该离合器组件可被构造成能够选择性地且可释放地将关节运动驱动器230联接到击发构件220。在一种形式中，离合器组件400包括围绕击发构件220定位的锁定衬圈或锁定套筒402，其中锁定套筒402可在接合位置与脱离位置之间旋转，在所述接合位置，锁定套筒402将关节运动驱动器360联接到击发构件220，在所述脱离位置，关节运动驱动器360没有可操作地联接到击发构件200。当锁定套筒402处于其接合位置时，击发构件220的远侧运动可使关节运动驱动器360朝远侧运动，相应地，击发构件220的近侧运动可使近侧关节运动驱动器230朝近侧运动。当锁定套筒402处于其脱离位置时，击发构件220的运动不传递到近侧关节运动驱动器230，因此，击发构件220可独立于近侧关节运动驱动器230运动。在各种情况下，当击发构件220没有使近侧关节运动驱动器230在近侧或远侧方向上运动时，近侧关节运动驱动器230可被关节运动锁350保持就位。
如图4中可进一步看到的那样，锁定套筒402可包括柱形或至少基本上柱形的主体，该主体包括限定于其中、被构造成能够接纳击发构件220的纵向开孔403。锁定套筒402可包括沿直径相对的、面朝内的锁定突起404和面朝外的锁定构件406。锁定突起404可被构造成能够与击发构件220选择性地接合。更具体地，当锁定套筒402处于其接合位置时，锁定突起404定位在限定于击发构件220中的驱动凹口224内，使得远侧推力和/或近侧推力可从击发构件220传输至锁定套筒402。当锁定套筒402处于其接合位置时，第二锁定构件406被接纳在近侧关节运动驱动器230中限定的驱动凹口232内，使得施加到锁定套筒402的远侧推力和/或近侧拉力可传递到近侧关节运动驱动器230。实际上，当锁定套筒402处于其接合位置时，击发构件220、锁定套筒402和近侧关节运动驱动器230将一起运动。另一方面，当锁定套筒402处于其脱离位置时，锁定突起404可不定位在击发构件220的驱动凹口224内；并且因此，远侧推力和/或近侧推力可不从击发构件220传输至锁定套筒402。相应地，远侧推力和/或近侧拉力可以不传递至近侧关节运动驱动器230。在此类情况下，击发构件220可相对于锁定套筒402和近侧关节运动驱动器230朝近侧和/或朝远侧滑动。
如图4中也可看到的那样，细长轴组件200还可包括可旋转地接纳在闭合套筒260上的切换筒500。切换筒500包括中空轴段502，该中空轴段具有在其上形成的轴凸台504，以用于将向外突出的致动销410接纳在其中。在各种情况下，致动销410延伸穿过狭槽267进入设置在锁定套筒402中的纵向狭槽408，以在锁定套筒402与近侧关节运动驱动器230接合时，利于该锁定套筒做轴向运动。旋转扭簧420被构造成能够接合切换筒500上的轴凸台504和喷嘴外壳203的一部分，以将偏压力施加到切换筒500。参见图5和图6，切换筒500还可包括其中限定的至少部分周向的开口506，这些开口可被构造成能够接纳从喷嘴部分202,203延伸的周向安装架，并允许切换筒500与近侧喷嘴201之间相对旋转而不是相对平移。安装座还延伸穿过待安置在轴脊210中的凹槽中的闭合套筒260中的开口266。然而，喷嘴201至其中安装座到达其在切换筒500中的相应狭槽506的端部的点的旋转将导致切换筒500围绕轴轴线SA-SA的旋转。切换筒500的旋转最终将导致致动销410和锁定套筒402在其接合位置和脱离位置之间的旋转。因此，实质上，喷嘴201可用于以在美国专利申请序列号13/803,086(现为美国专利申请公布2014/0263541)中更详细描述的各种方式来使关节运动驱动系统与击发驱动系统操作地接合和脱离接合。
也如图3至图4所示，细长轴组件200可包括滑环组件600，例如，该滑环组件可被构造成能够将电功率传导至端部执行器300和/或从该端部执行器传导电功率，并且/或者将信号传送至外科端部执行器300和/或从该外科端部执行器接收信号。滑环组件600可包括近侧连接器法兰604和远侧连接器法兰601，该近侧连接器法兰安装到从底座240延伸的底座法兰242，该远侧连接器法兰定位在轴外壳202,203中限定的狭槽内。近侧连接器法兰604可包括第一面，并且远侧连接器法兰601可包括第二面，其中第二面与第一面相邻定位，并能够相对于第一面运动。远侧连接器法兰601可围绕轴轴线SA-SA相对于近侧连接器法兰604旋转。近侧连接器法兰604可包括限定在其第一面中的多个同心或至少基本上同心的导体602。连接器607可安装在远侧连接器法兰601的近侧面上，并可具有多个触点(未示出)，其中每个触点与导体602中的一者对应并与其电接触。这种构造在保持近侧连接器法兰604与远侧连接器法兰601之间电接触的同时，允许这两个法兰之间相对旋转。例如，近侧连接器法兰604可包括电连接器606，该电连接器可使导体602与安装到轴底座240的轴电路板610进行信号通信。在至少一种情况下，包括多个导体的线束可在电连接器606与轴电路板610之间延伸。电连接器606可朝近侧延伸穿过底座安装法兰242中限定的连接器开口243。参见图7。提交于2013年3月13日的名称为“STAPLE CARTRIDGE TISSUE THICKNESS SENSORSYSTEM”的美国专利申请序列号13/800,067，现为美国专利申请公布2014/0263552以引用的方式全文并入本文。提交于2013年3月13日的名称为“STAPLE CARTRIDGE TISSUETHICKNESS SENSOR SYSTEM”的美国专利申请序列号13/800,025，现为美国专利申请公布2014/0263551以引用的方式全文并入本文。有关滑环组件600的进一步细节可见于美国专利申请序列号13/803,086，现为美国专利申请公布2014/0263541。
如上文所讨论，细长轴组件200可包括可固定地安装到柄部14的近侧部分，以及能够围绕纵向轴轴线SA-SA旋转的远侧部分。可旋转远侧轴部分可如上所述围绕滑动环组件600相对于近侧部分旋转。滑环组件600的远侧连接器法兰601可定位在可旋转的远侧轴部分内。而且，除上述之外，切换筒500也可定位在可旋转的远侧轴部分内。当可旋转的远侧轴部分旋转时，远侧连接器法兰601和切换筒500可彼此同步地旋转。另外，切换筒500可相对于远侧连接器法兰601在第一位置与第二位置之间旋转。当切换筒500处于其第一位置时，关节运动驱动系统(即，近侧关节运动驱动器230)可与击发驱动系统可操作地脱离接合，因此，击发驱动系统的操作可不使轴组件200的端部执行器300进行关节运动。当切换筒500处于其第二位置时，关节运动驱动系统(即，近侧关节运动驱动器230)能够可操作地与击发驱动系统接合，因此，击发驱动系统的操作可以使轴组件200的端部执行器300做关节运动。当切换筒500在其第一位置和其第二位置之间运动时，切换筒5500相对于远侧连接器法兰601运动。在各种情况下，轴组件200可包括被构造成能够检测切换筒500的位置的至少一个传感器。
再次参见图4，闭合套筒组件260包括双枢轴闭合套筒组件271。根据各种形式，双枢轴闭合套筒组件271包括具有朝远侧突出的上柄脚273和下柄脚274的端部执行器闭合套筒272。上部双枢轴连接件277包括向上突出的远侧枢轴销和近侧枢轴销，这些枢轴销分别接合闭合套筒260上的朝近侧突出的上柄脚273中的上部远侧销孔以及朝远侧突出的上柄脚264中的上部近侧销孔。下部双枢轴连接件278包括向上突出的远侧枢轴销和近侧枢轴销，这些枢轴销分别接合朝近侧突出的下柄脚274中的下部远侧销孔以及朝远侧突出的下柄脚265中的下部近侧销孔。还参见图6。
图5至图8示出了外科端部执行器300的一种形式，其被构造成能够可操作地附接到上述类型的外科器械的细长轴组件或者包括闭合系统的其它外科器械构造，该闭合系统被构造成能够产生控制动作以供轴向地运动闭合构件，该闭合构件被构造成能够向外科端部执行器的一些部分施加闭合和打开运动。在所示的示例中，如将在下文进一步详细讨论的，外科端部执行器被构造成能够围绕通常标示为339的关节运动接头相对于细长轴组件的近侧部分进行关节运动。然而，其它构造可能不能够进行关节运动。如图6中可看到的那样，关节运动接头339限定了关节运动轴线B-B，外科端部执行器300可围绕该关节运动轴线选择性地进行关节运动。在所示的示例中，关节运动轴线B-B基本上横向于细长轴组件的轴轴线SA-SA。
所示的外科端部执行器300包括第一钳口308和第二钳口309，该第二钳口能够相对于第一钳口308在打开位置(图7)和各种闭合位置(图8)之间选择性地运动。在所示的实施方案中，第一钳口308包括细长通道302，该细长通道被构造成能够可操作地支撑其中的外科钉仓304，并且第二钳口309包括砧座310。然而，在不脱离本发明的实质和范围的情况下，也可以采用其它外科钳口构造。如图5中可看到的那样，支撑盘305可以附接到外科钉仓304，以向其提供额外的支撑，从而也防止形成于外科钉仓304中的钉凹坑306中所支撑的钉驱动器(未示出)在使用之前从外科钉仓中落出。如图5中可看到的那样，细长通道302具有包括两个直立侧向壁322的近侧端部部分320。砧座310包括砧座主体312，该砧座主体上形成有钉成形底面313。砧座主体的近侧端部314被击发构件狭槽315分为两部分，从而限定了一对砧座附接臂316。每个砧座附接臂316包括倾斜的上表面321，并且包括侧向突出的砧座耳轴317和限定凸轮表面或“开槽凸轮表面”319的凸轮狭槽318。参见图5。其中一个凸轮狭槽318在本文中可称为“第一凸轮狭槽”，其凸轮表面被称为“第一凸轮表面”。类似地，另一个凸轮狭槽318可称为“第二凸轮狭槽”，其凸轮表面在本文中称为“第二凸轮表面”。耳轴孔324设置在细长通道302的每个侧向壁322中，用于将砧座耳轴317中对应的一者接纳在其中。这种构造用于将砧座310可运动地附连到细长通道302，以供围绕由耳轴孔324限定的且横向于轴轴线SA-SA的砧座轴线A-A选择性枢转行进。参见图6。
在所示的构造中，砧座310通过一对开口凸轮354相对于细长通道302和支撑在其中的外科钉仓304而枢转地运动到打开位置，这一对开口凸轮可以可移除地支撑在砧座致动器构件中，或者可移除地附接到砧座致动器构件，或者永久地附接到砧座致动器构件，又或者整体地形成在砧座致动器构件中。在所示实施方案中，砧座致动器构件包括端部执行器闭合套筒272。参见图5。每个开口凸轮354包括外主体部分356，该外主体部分具有从其向内突出的凸轮突片358。在至少一种构造中，外主体部分356被构造成能够按扣在端部执行器闭合套筒272中所形成的对应凸轮孔355内可移除的接合部中。例如，外主体部分356可包括斜截角的止挡部分357，该止挡部分被构造成能够以按扣形式接合限定凸轮孔355的端部执行器闭合套筒壁的相应部分。外主体部分356的另一部分可具有形成在其上的折线形特征359，其被构造成能够被接纳在与凸轮孔355相邻的端部执行器闭合套筒272的一部分内。也可以采用其它按扣突片构造将外主体部分356可移除地附连到端部执行器闭合套筒272。在其它构造中，例如，外主体部分可以不被构造用于按扣地与端部执行器闭合套筒272接合。在此类构造中，外主体部分可以通过环形卷曲环而保持到位，该环形卷曲环在开口凸轮的整个外主体部分上围绕端部执行器闭合套筒的外周长延伸，并且被压接在适当位置。该卷曲环用于将外部主体部分夹紧在端部执行器闭合套筒的外表面上。为了给端部执行器闭合套筒提供相对平滑或不间断的外表面(这可以有利地避免相邻组织遭到损坏和/或在这些部件之间收集组织/流体等)，实际上卷曲环可以卷曲到形成于端部执行器闭合套筒中的环形凹陷部中。
当开口凸轮350安装在端部执行器闭合套筒272中时，每个凸轮突片358延伸穿过细长通道302的对应侧向壁322中的细长狭槽326，该细长通道被接纳在砧座310中的对应凸轮狭槽318中。参见图6。在此类构造中，开口凸轮350在端部执行器闭合套筒中沿直径彼此相对。在使用中，闭合套筒260朝远侧(方向DD)平移，以(例如)响应于闭合触发器32的致动而闭合砧座310。当闭合套筒260沿远侧方向DD平移时，砧座310闭合，从而使端部执行器闭合套筒272的远侧端部275与砧座主体312上的闭合唇缘311接触。具体地，随着闭合套筒260向远侧运动以开始使砧座310枢转到闭合位置，端部执行器闭合套筒272的远侧端部275跨置在砧座附接臂316的上表面321上。例如，在一种构造中，砧座310的闭合完全由端部执行器闭合套筒272与砧座310的接触而引起，而不是由开口凸轮与砧座的相互作用所引起。然而，在其它构造中，当闭合套筒260向远侧运动时，开口凸轮可被布置成也向砧座施加闭合动作。砧座310通过在近侧方向PD上将闭合套筒260向近侧平移而打开，这导致凸轮突片358沿近侧方向“PD”在凸轮表面319上的凸轮狭槽318内运动，以使砧座310枢转到如图6和图7所示的打开位置中。
即使在载荷下，外科端部执行器实施方案300也会采用两个开口凸轮来实现端部执行器钳口的正向打开。在不脱离本发明的实质和范围的情况下，可以想到其它构造仅使用一个开口凸轮或两个以上的开口凸轮。在所示的示例中，开口凸轮可移除地附连到端部执行器闭合套筒，这有利于将外科端部执行器部件轻易地组装或附接到细长轴组件，以及轻易地将它们拆卸下来。此类构型还使得人们能够使用更紧凑或更短的关节运动接头构造，这进一步促进了在患者体内的有限空间内更好地操纵外科端部执行器。为了便于将那些按扣到位的开口凸轮轻易地分离，可以在端部执行器闭合套筒中设置额外的巧妙放置的孔，以使得撬状构件能够从其中插入，从而将开口凸轮从端部执行器闭合套筒撬出。在其它构造中，开口凸轮可以一体地形成在砧座致动器构件或端部执行器闭合套筒中。例如，开口凸轮可各自包括突片，该突片被切入或以其它方式形成到砧座致动器构件或端部执行器闭合套筒的壁中，然后向内弯曲、卷曲或永久变形，以便接合第二钳口上的对应凸轮表面。例如，突片可相对于端部执行器闭合套筒的外壁以九十度(90°)向内弯曲。此类构造避免了对单独的开口凸轮部件的需要。其它变型形式可以采用附接到第二钳口的一个或多个销，这些销被构造成能够跨置在第一钳口上的对应凸轮表面。例如，一个或多个销可以被压入第一钳口中，被滚花，然后压入和/或焊接到第一钳口上。虽然已经在外科端部执行器的上下文中对上述开口凸轮构造进行了描述，其中该外科端部执行器被构造成能够支撑外科钉仓并且包括被构造成能够相对于外科钉仓运动的砧座，但读者将理解，开口凸轮构造也可以与具有可相对于彼此运动的钳口的其它端部执行器构造一起采用。
图9和图10示出了标示为200'的细长轴组件，其采用了上述细长轴组件200的许多特征。在所示的示例中，细长轴组件200'包括标示为800的双关节运动连接件构造，其采用与上述关节运动锁350类似的关节运动锁810。关节运动锁810的不同于关节运动锁350的并且为理解关节运动锁350的操作可能所需的那些部件将在下面进一步详细讨论。有关于关节运动锁350的另外细节可见于名称为“ARTICULATABLE SURGICAL INSTRUMENTCOMPRISING AN ARTICULATION LOCK”的美国专利申请序列号13/803,086，现为美国专利申请公布2014/0263541，其全部公开内容据此以引用方式并入本文。关节运动锁810可被构造成能够并操作以选择性地将外科端部执行器300锁定在各种关节运动位置。当关节运动锁810处于其解锁状态时，这种构造使外科端部执行器300能够相对于轴闭合套筒260旋转或做关节运动。
如上所述，当近侧关节运动驱动器230经由离合器系统400与击发构件220操作地接合时，击发构件220可使近侧关节运动驱动器230朝近侧和/或朝远侧运动。例如，击发构件220的近侧运动可使近侧关节运动驱动器230朝近侧运动，并且类似地，击发构件220的远侧运动可使近侧关节运动驱动器230朝远侧运动。近侧关节运动驱动器230的运动，无论其为近侧或远侧，可解锁关节运动锁810，如下文更详细的描述。如图9中可看到的那样，例如，细长轴组件200'包括轴框架812，其在一定程度上与第一远侧关节运动驱动器820共同延伸。第一远侧关节运动驱动器820被支撑在细长轴组件200'内，以供响应于施加到其的对应关节运动控制动作而在远侧方向DD和近侧方向PD上选择性纵向行进。轴框架812包括其上具有向下突出的枢轴销(未示出)的远侧端部部分814，该枢轴销适于枢转地接纳在形成于细长通道302的近侧端部部分320中的枢轴孔328内。参见例如图5中所示的类似构造。这种构造有助于外科端部执行器300的细长通道302围绕由枢轴孔328限定的关节运动轴线B-B相对于轴框架812枢转行进。如上所述，关节运动轴线B-B横向于由细长轴组件200’所限定的轴轴线SA-SA。
再次参见图9，第一远侧关节运动驱动器820可包括第一或远侧锁定腔822和第二或近侧锁定腔824，其中第一锁定腔822和第二锁定腔824可通过中间框架构件825分开。关节运动锁810还可包括被至少部分地定位在第一锁定腔822内的至少一个第一锁定元件826，该至少一个第一锁定元件可被构造成能够抑制或防止第一远侧关节运动驱动器820的近侧运动。在图9所示的实施方案中，例如，在第一锁定腔822内定位有可全部以类似、平行的方式作用并且可以可协作地充当单个锁定元件的三个第一锁定元件826。设想可利用多于三个或少于三个第一锁定元件826的其它实施方案。类似地，关节运动锁810还可包括被至少部分地定位在第二锁定腔824内的至少一个第二锁定元件828，该至少一个第二锁定元件可被构造成能够抑制或防止第一远侧关节运动驱动器820的远侧运动。就图9所示的具体实施方案而言，在第二锁定腔824内定位有可全部以类似、平行的方式作用并且可以可协作地充当单个锁定元件的三个第二锁定元件828。设想可利用多于三个或少于三个第二锁定元件828的其它实施方案。
除上述之外，主要参见图9，每个第一锁定元件826被可滑动地支撑在框架导轨830上并且包括锁定柄脚827。每个第一锁定元件826在其中具有锁定开孔(未示出)，用于接纳框架导轨830穿过其中。锁定柄脚827可设置在第一锁定腔822内，并且锁定开孔能够与安装到轴框架812的框架导轨830可滑动地接合。第一锁定元件826没有取向为与框架导轨830垂直布置；相反，第一锁定元件826以相对于框架导轨830的非垂直的角度布置和对准，使得锁定开孔的边缘或侧壁与框架导轨830接合。此外，锁定开孔的侧壁与框架导轨830之间的相互作用可在它们之间产生抵抗力或摩擦力，该抵抗力或摩擦力可抑制第一锁定元件826与框架导轨830之间的相对运动，并且因此抵抗施加到第一远侧关节运动驱动器820的近侧推力P。换句话讲，第一锁定元件826可防止或至少部分地抑制外科端部执行器300在箭头821指示的方向上旋转。如果将扭矩沿箭头821的方向施加到端部执行器300，则近侧推力P将被传递到远侧关节运动驱动器820。近侧推力P将仅用来支持第一锁定元件826与框架导轨830之间的锁定接合。更具体地，近侧推力P可传递至第一锁定元件826的柄脚827，这可导致第一锁定元件826旋转并减小限定在第一锁定元件826与框架导轨830之间的角度，并且因此增强锁定开孔的侧壁与框架导轨830之间的咬合力。最后，第一锁定元件826可将第一远侧关节运动驱动器820的运动锁定在一个方向上。
要释放第一锁定元件826并允许外科端部执行器300以箭头821指示的方向旋转，可将近侧关节运动驱动器230朝近侧拉动以使第一锁定元件826伸直或至少基本上伸直成垂直或至少基本上垂直的位置。在此位置，锁定开孔的侧壁和框架导轨830之间的咬合力或阻力可被充分地减小或消除，使得第一远侧关节运动驱动器820可朝近侧运动。要使第一锁定元件826伸直，可将近侧关节运动驱动装置230朝近侧拉动，使得近侧关节运动驱动装置230的远侧臂233接触第一锁定元件826，从而将第一锁定元件826拉动并旋转至其伸直位置。在各种情况下，可将近侧关节运动驱动器230继续朝近侧拉动，直到从其延伸的近侧臂235接触或邻接第一远侧关节运动驱动器820的近侧驱动壁832，并将该远侧关节运动驱动器820朝近侧拉动，以使外科端部执行器300进行关节运动。本质上，可将近侧拉力从近侧关节运动驱动器230通过近侧臂235和近侧驱动壁832之间的相互作用施加到远侧关节运动驱动器820，其中此类拉力可通过第一远侧驱动构件820传递至端部执行器300，如将在下文所述，以使端部执行器300沿箭头821指示的方向进行关节运动。在外科端部执行器300已沿箭头821的方向适当地进行关节运动之后，在各种情况下，可将第一远侧关节运动驱动器820释放，以允许关节运动锁810将第一远侧关节运动驱动器820和外科端部执行器300重新锁定就位。
同时，再次参见图9，当第一锁定元件826如上所述锁定和解锁时，第二锁定元件828可保留在倾斜位置。读者将理解，尽管第二锁定元件828相对于轴导轨830以成角度位置布置和对准，但第二锁定元件828不被构造成能够阻碍或至少基本上阻碍第一远侧关节运动驱动器820的近侧运动。当第一远侧关节运动驱动器820和关节运动锁810如上所述朝近侧滑动时，在各种情况下，第二锁定元件828可沿框架导轨830朝远侧滑动，而不改变或至少基本上不改变其相对于框架导轨830的成角度对准。当第二锁定元件828允许第一远侧关节运动驱动器820和关节运动锁810的近侧运动时，第二锁定元件828被构造成能够选择性地阻止或至少抑制第一远侧关节运动驱动器820的远侧运动，如下文更详细地讨论。
每个第二锁定元件828可包括锁定开孔(未示出)和锁定柄脚829。锁定柄脚829可被设置在第二锁定腔824内，并且锁定开孔可与安装到轴框架812的框架导轨830可滑动地接合。框架导轨830延伸穿过第二锁定元件828中的开孔。第二锁定元件828没有取向为与框架导轨830垂直布置；相反，第二锁定元件828以相对于框架导轨830的非垂直的角度布置和对准，使得锁定开孔的边缘或侧壁与框架导轨830接合。此外，锁定开孔的侧壁与框架导轨830之间的相互作用可在两者之间产生阻力或摩擦力，这可抑制第二锁定元件828与框架导轨830之间的相对运动，从而抵抗施加到第一远侧关节运动驱动器820的远侧力D。换句话讲，第二锁定元件828可防止或至少部分地抑制外科端部执行器300在箭头823指示的方向上旋转。如果将扭矩沿箭头823的方向施加到端部执行器300，则远侧拉力D将被传递到第一远侧关节运动驱动器820。远侧拉力D将仅用来支持第二锁定元件828与框架导轨830之间的锁定接合。更具体地，远侧拉力D可传递至第二锁定元件828的柄脚829，这可导致第二锁定元件828旋转并减小限定在第二锁定元件828和框架导轨830之间的角度，从而增强锁定开孔的侧壁与框架导轨830之间的咬合力。最后，第二锁定元件828可将第一远侧关节运动驱动器820的运动锁定在一个方向上。
要释放第二锁定元件828并允许外科端部执行器300以箭头823指示的方向进行关节运动，可将近侧关节运动驱动装置230朝远侧推动以使第二锁定元件828伸直或至少基本上伸直成垂直或至少基本上垂直的位置。在此位置，锁定开孔的侧壁和框架导轨830之间的咬合力或阻力可被充分减小或消除，使得第一远侧关节运动驱动器820可朝远侧运动。要使第二锁定元件828伸直，可将近侧关节运动驱动器230朝远侧推动，使得近侧关节运动驱动器230的近侧臂235接触第二锁定元件828，从而将第二锁定元件828推动并旋转至其伸直位置。在各种情况下，可将近侧关节运动驱动器230继续朝远侧推动，直到从其延伸的远侧臂233接触或邻接第一远侧关节运动驱动器820的远侧驱动壁833，并将该第一远侧关节运动驱动器820朝远侧推动，以使外科端部执行器300进行关节运动。本质上，可将远侧推力从近侧关节运动驱动器230通过远侧臂233和远侧驱动壁833之间的相互作用施加到第一远侧关节运动驱动器820，其中此类推力可通过第一远侧关节运动驱动器820传递，以使端部执行器300沿箭头823指示的方向进行关节运动。在外科端部执行器300已沿箭头823的方向适当地进行关节运动之后，在各种情况下，可将第一远侧关节运动驱动器820释放，以允许关节运动锁810将第一远侧关节运动驱动器820和外科端部执行器300重新锁定就位。
同时，当第二锁定元件828如上所述锁定和解锁时，第一锁定元件826可保留在倾斜位置。读者将理解，尽管第一锁定元件826相对于轴导轨830以成角度位置布置和对准，但第一锁定元件826不被构造成能够阻碍或至少基本上阻碍第一远侧关节运动驱动器820的远侧运动。当第一远侧关节运动驱动器820和关节运动锁810如上所述朝远侧滑动时，在各种情况下，第一锁定元件826可沿框架导轨830朝远侧滑动，而不改变或至少基本上不改变其相对于框架导轨830的成角度对准。当第一锁定元件826允许第一远侧关节运动驱动器820和关节运动锁810的远侧运动时，第一锁定元件826被构造成能够选择性地阻止或至少抑制第一远侧关节运动驱动器820的近侧运动，如上文所讨论。
根据上文，处于锁定状态的关节运动锁810被构造成能够抵抗第一远侧关节运动驱动器820的近侧运动和远侧运动。在阻力方面，关节运动锁810被构造成能够阻止或至少基本上阻止第一远侧关节运动驱动器820的近侧运动和远侧运动。总的来说，当第一锁定元件826处于其锁定取向时，第一远侧关节运动驱动器820的近侧运动被第一锁定元件826抵抗，并且当第二锁定元件828处于其锁定取向时，第一远侧关节运动驱动器820的远侧运动被第二锁定元件828抵抗，如上所述。换句话讲，第一锁定元件826包括第一单向锁，并且第二锁定元件828包括沿相反方向锁定的第二单向锁。
结合图9和图10所示的示例性实施方案进行讨论，近侧关节运动驱动装置230的初始近侧运动可以解锁第一远侧关节运动驱动器820和关节运动锁810的近侧运动，而近侧关节运动驱动器230的进一步近侧运动可以朝近侧驱动第一远侧关节运动驱动器820和关节运动锁810。相似地，近侧关节运动驱动器230的初始远侧运动可解锁第一远侧关节运动驱动器820和关节运动锁810的远侧运动，而近侧关节运动驱动器230的进一步远侧运动可朝远侧驱动第一远侧关节运动驱动器820和关节运动锁810。结合以下公开的多个其它示例性实施方案讨论了这种一般概念。根据上文所提供的讨论，考虑到这类讨论是重复性的或大体累积性的，为了简洁起见，不会重复这类讨论。
仍然参见图9和图10，双关节运动连接件构造800被构造成能够当通过第一远侧关节运动驱动器820对其施加关节运动力时，建立“推动/拉动”构造。从这些图中可以看出，第一远侧关节运动驱动器820具有形成于其中的第一驱动齿条842。第一关节运动杆844向远侧突出第一远侧关节运动驱动器820并附接到第一可运动联接器850，该第一可运动联接器通过第一球形接头852而附接到第一远侧关节运动驱动器820。第一联接器850也可以通过第一销854枢转地销接到细长通道302的近侧端部部分320，如图9中可看到的那样。双关节运动连接件构造800还包括第二远侧关节运动驱动器860，其具有形成于其中的第二驱动齿条862。第二远侧关节运动驱动器860可运动地支撑在细长轴组件200'内，用于沿远侧方向DD和近侧方向PD纵向行进。第二关节运动杆864向远侧突出第二远侧关节运动驱动器860并附接到第二可运动联接器870，该第二可运动联接器通过第二球形接头872而附接到第二远侧关节运动驱动器860。第二联接器870也可以通过第二销874枢转地销接到细长通道302的近侧端部部分320，如图9中可看到的那样。如图9中可看到的那样，第一联接器850在轴轴线SA的一个侧向侧上附接到细长通道302，并且第二联接器870在该轴轴线的相反侧向侧上附接到细长通道302。因此，通过同时拉动联接器850,870中的一者并推动联接器850,870中的另一者，外科端部执行器300将相对于细长轴组件200'围绕关节运动轴线B-B进行关节运动。在所示构造中，虽然联接器850,870(二者分别促进第一远侧关节运动驱动器和第二远侧关节运动驱动器820,860与细长通道302之间的相对运动)是由相对刚性的部件所制成的，然而其它构造可以使用相对“柔性”的联接器构造。例如，缆线等可延伸穿过远侧关节运动驱动器820,860、联接器850,870和球形接头852,872中的一者或两者，以联接到细长通道，从而促进关节运动动作传送于此。
从图9和图10中也可以看出，近侧小齿轮传动装置880和远侧小齿轮传动装置882居中设置在第一驱动齿条842和第二驱动齿条862之间并且与其啮合接合。在另选的实施方案中，可以仅使用一个小齿轮传动装置或两个以上的小齿轮传动装置。因此，采用至少一个小齿轮传动装置。近侧小齿轮传动装置880和远侧小齿轮传动装置882被可旋转地支撑在轴框架812中以相对于其自由旋转，使得随着第一远侧关节运动驱动器820沿远侧方向DD运动，小齿轮传动装置870,872用以在近侧方向PD上驱动第二远侧关节运动驱动器860。类似地，当第一远侧关节运动驱动器820沿着近侧方向PD被拉动时，小齿轮传动装置880,882在远侧方向DD上驱动第二远侧关节运动驱动器860。因此，为了使端部执行器300沿着箭头821的方向围绕关节运动轴线B-B进行关节运动，关节运动驱动器230经由离合器系统400可操作地与击发构件220接合，使得击发构件220在近侧方向PD上运动或拉动近侧关节运动驱动器230。近侧关节运动驱动器230沿近侧方向的运动也使第一远侧关节运动驱动器820沿近侧方向运动。当第一远侧关节运动驱动器820沿着近侧方向运动时，小齿轮传动装置880,882用于在远侧方向DD上驱动第二远侧关节运动驱动器860。第一远侧关节运动驱动器820和第二远侧关节运动驱动器860的这种运动使得外科端部执行器300，更具体地外科端部执行器300的细长通道302，围绕关节运动轴线B-B在箭头821的关节运动方向上枢转。相反地，为了使端部执行器300在箭头823的方向进行关节运动，致动击发构件220以沿远侧方向DD推动第一远侧关节运动驱动器820。当第一远侧关节运动驱动器820沿着远侧方向运动时，小齿轮传动装置880,882用于在近侧方向PD上驱动第二远侧关节运动驱动器860。第一远侧关节运动驱动器820和第二远侧关节运动驱动器860的这种运动使得外科端部执行器300，更具体地外科端部执行器300的细长通道302，围绕关节运动轴线B-B在箭头823的关节运动方向上枢转。
与其它可关节运动的外科端部执行器构型相比，双固体连接件关节运动构造800及其变型可以为外科端部执行器提供更大范围的关节运动。具体地，本文所公开的固体连接件关节运动构造可以有助于实现超过45-50°范围的关节运动范围，45-50°是通常由其它可关节运动的端部执行器构造所实现的范围。使用至少一个小齿轮传动装置来在远侧关节运动驱动器之间交接使得端部执行器能够被“推动”和“拉动”到位，还可以减少在使用期间端部执行器的“倾斜”量、或不期望或意外的运动量。本文公开的双固体连接件关节运动构造还包括与其它关节运动系统构造相比具有改善的强度特性的关节运动系统。
如上文简述的那样，中间击发轴部分222被构造成能够与远侧切割或击发梁280可操作地交接。远侧击发梁280可包括层压结构。当外科端部执行器300围绕关节运动轴线B-B进行关节运动时，此类构造能够使远侧击发梁280充分弯曲。远侧击发梁280被支撑用于在轴组件200'内进行轴向运动，并且由形成在细长通道302的近侧端部上的两个直立侧向支撑壁330可滑动地支撑。参见图11，远侧击发梁280附接到击发构件900，该击发构件包括在其上具有组织切割表面或刀片904的垂直延伸的击发构件主体902。此外，楔形滑动件910可安装在外科钉仓304内，以驱动与击发构件900的接触。在朝远侧驱动击发构件900通过仓体304时，楔形滑动件910上的楔形表面912接触钉驱动器，从而致动外科钉仓304中向上支撑的驱动器和外科钉。
采用击发梁或击发构件并且能够在例如四十五度的范围内进行关节运动的端部执行器可具有许多待克服的挑战。为了便于这种端部执行器进行可操作的关节运动，击发构件或击发梁必须足够灵活以容纳这种关节运动范围。然而，击发梁或击发构件也必须避免在遇到压缩击发载荷时发生弯曲。为了向击发梁或击发构件提供额外的支撑，已经开发了各种“支撑”或“吹出(blowout)”板布置。在名称为“SURGICAL STAPLING INSTRUMENTHAVING ARTICULATION JOINT SUPPORT PLATES FOR SUPPORTING A FIRING BAR”的美国专利6,964,363和名称为“SURGICAL STAPLING INSTRUMENT INCORPORATING ANELECTROACTIVE POLYMER ACTUATED FIRING BAR TRACK THROUGH AN ARTICULATIONJOINT”的美国专利7,213,736中公开了若干这种构造，这些专利各自的全部公开内容以引用方式并入本文。提供充分抗弯曲性的吹出板一般也难以弯曲，这增加了关节运动接头系统必须适应的力。其它击发梁支撑构造在名称为“SURGICAL INSTRUMENTS WITHARTICULATABLE END EFFECTORS AND MOVABLE FIRING BEAM SUPPORT ARRANGEMENTS”的美国专利申请序列号14/575,117中有所公开，该专利申请的全部公开内容据此以引用的方式并入本文。
参见图11至图15，细长轴组件200’还包括多支撑连接件组件920，用于在外科端部执行器300围绕关节运动轴线B-B进行关节运动时向远侧击发梁280提供侧向支撑。从图11中可以看出，多支撑连接件组件920包括中间支撑构件922，其可运动地联接到外科端部执行器300以及细长轴组件200'。例如，中间支撑构件922可枢转地销接到细长通道302的近侧端部320，使得其能够围绕枢转轴线PA相对于该近侧端部枢转。如图11中可看到的那样，中间支撑构件922包括向远侧突出的突片923，该突片中具有远侧枢轴孔924，用于接纳形成在细长通道302的近侧端部部分320上的直立支撑销332。如图11中可进一步看到的那样，中间支撑构件922还包括在其中具有细长近侧狭槽928的朝近侧突出的突片926。近侧狭槽928被构造成能够可滑动地接纳形成在框架部分812上的中间支撑销816。例如，此类构造使得中间支撑构件922能够相对于所述细长轴组件200'轴向地枢转和运动。如图11至图13所示，中间支撑构件922还包括居中设置的狭槽930，用于可运动地接纳穿过其中的远侧击发梁280。
仍然参见图11至图15，多支撑连接件组件920还包括近侧支撑连接件940和远侧支撑连接件950。近侧支撑连接件940包括细长近侧主体942，该细长近侧主体具有倒圆的近侧鼻部部分943和倒圆的远侧鼻部部分944。近侧支撑连接件940还包括一对向下突出的相反的近侧支撑壁945,946，该对近侧支撑壁在其间限定有近侧狭槽947。类似地，远侧支撑连接件950包括细长远侧主体952，该细长远侧主体具有倒圆的近侧鼻部部分953和倒圆的远侧鼻部部分954。远侧支撑连接件950还包括一对向下突出的相反的远侧支撑壁955,956，该对远侧支撑壁在其间限定有远侧狭槽957。如图14中可看到的那样，柔性远侧击发梁280被构造成能够在近侧支撑连接件940的近侧支撑壁945,946与远侧支撑连接件950的远侧支撑壁955,956之间延伸。近侧支撑壁945包括面向内的近侧弓形表面948，并且近侧支撑壁946包括面向内的近侧弓形支撑表面949，其与所述面向内的近侧弓形表面948相反。近侧弓形支撑表面948,949用于随着柔性远侧击发梁280的近侧部分的侧向侧部分在端部执行器的关节运动期间发生弯曲并且横穿关节运动接头，对该部分提供侧向支撑。根据关节运动的方向，圆角表面可匹配远侧端部击发梁280的外半径。类似地，远侧支撑壁955包括面向内的远侧弓形表面958，并且远侧支撑壁956包括面向内的远侧弓形支撑表面959，其与所述远侧弓形表面958相反。远侧弓形支撑表面958,959用于随着远侧击发梁280的远侧部分的侧向侧部分在外科端部执行器300的关节运动期间发生弯曲并且横穿关节运动接头，对该部分提供侧向支撑。根据关节运动的方向，远侧弓形表面958,959可匹配远侧击发梁280的外半径。如图12和图13中可看到的那样，轴脊210的远侧端部217包括面向远侧的弓形脊凹坑218，近侧支撑连接件940的倒圆近侧鼻部部分943延伸到该凹坑中。近侧支撑连接件940的倒圆远侧鼻部部分944枢转地接纳在中间支撑构件922中的弓形近侧凹坑932中。另外，远侧支撑连接件的倒圆近侧鼻部部分953接纳在中间支撑构件922的远侧端部中的弓形远侧支撑构件凹坑934中。远侧支撑连接件950的倒圆远侧鼻部部分954可运动地接纳在形成于细长通道302的近侧端部320上所形成的直立侧向支撑壁330中的V形通道腔334内。
当梁在较高的关节运动角度上弯曲时，多支撑连杆组件可以为柔性击发梁层压件提供较高的侧向支撑。此类构造还防止击发梁在高击发载荷下以及在相对较高的关节运动角度下屈曲。与中间支撑构件相连接的细长支撑连接件在与许多现有技术的支撑构造相比时，在整个关节运动区域上提供了对击发梁的改善的侧向支撑。在另选构造中，支撑连接件可被构造成能够以各种关节运动角度与中间支撑构件实际联锁。U形支撑连接件便于轻易安装，并且用于在每个侧向侧以及击发梁的顶部对柔性支撑梁提供支撑，以防止击发梁在击发期间进行关节运动的同时向上弯曲。
在击发构件包括组织切割表面的那些实施方案中，理想的是细长轴组件可按这样的方式进行构造：除非未用完的钉仓被正确地支撑在外科端部执行器300的细长通道302中，否则防止击发构件意外推进。例如，如果根本不存在钉仓并且击发构件向远侧被推进穿过端部执行器，则组织将被切断，但是没有被钉住。类似地，如果在端部执行器中存在用完的钉仓(即，其中至少一些钉已经从其中击发的钉仓)，并且击发构件被推进，则组织将被切断，但可能不完全被钉住。应当理解，这种情况外科手术过程中可能导致不希望的灾难性结果。名称为“SURGICAL STAPLING INSTRUMENT HAVING A SPENT CARTRIDGE LOCKOUT”的美国专利6,988,649，名称为“SURGICAL STAPLING INSTRUMENT HAVING A SINGLE LOCKOUTMECHANISM FOR PREVENTION OF FIRING”的美国专利7,044,352，以及名称为“SURGICALSTAPLING INSTRUMENT HAVING A SINGLE LOCKOUT MECHANISM FOR PREVENTION OFFIRING”的美国专利7,380,695各自公开了各种击发构件闭锁构造，其中的每一个据此以引用方式并入本文。
这种闭锁构造可以有效地与各种外科缝合器械一起使用。然而，这些构造可能并不特别适合与本文公开中采用了相对紧凑和短关节运动接头构型的各种外科缝合器械结合使用。例如，图15至图19示出了通过关节运动接头270'可操作地附接到细长轴组件200'的外科端部执行器300。细长轴组件200'限定轴轴线SA-SA，并且关节运动接头270'有利于外科端部执行器300相对于细长轴组件200'围绕与横向于轴轴线SA-SA的关节运动轴线B-B的选择性关节运动。在所示的实施方案中，可以采用双固体连接件关节运动构造800(如上所述)来选择性地将关节运动动作施加到外科端部执行器300。细长轴组件200'包括上述类型的远侧击发梁280，其在被施加击发运动时可选择性地在外科端部执行器300内从起始位置到结束位置轴向运动。远侧击发梁280延伸穿过关节运动接头270'，并且被构造成能够围绕关节运动轴线B-B弯曲，以容纳外科端部执行器300以本文所述的各种方式所进行的关节运动。在所示实施方案中，关节运动接头270'包括中间支撑构件922，该中间支撑构件可运动地附接到轴框架812的远侧端部814和细长通道302的近侧端部320。如上所述，中间支撑构件922包括向远侧突出的突片923，该突片中具有远侧枢轴孔924，用于接纳形成在细长通道302的近侧端部部分320上的直立支撑销332。中间支撑构件922还包括在其中具有细长近侧狭槽928的朝近侧突出的突片926。近侧狭槽928被构造成能够可滑动地接纳形成在框架部分812上的中间支撑销816。中间支撑构件922还包括居中设置的狭槽930，用于轴向地接纳穿过其中的远侧击发梁280。中间支撑构件922在外科端部执行器300围绕关节运动轴线B-B进行关节运动期间对远侧击发梁280提供侧向支撑，同时在击发过程中促进其轴向通过远侧击发梁280。
在所示的实施方案中，采用击发梁锁定组件980来防止远侧击发梁280从起始位置被无意地推进到结束位置，除非未击发的外科钉仓304已被可操作地安置在钉仓支撑构件或细长通道302中。从图15至图19可以看出，一种形式的击发梁锁定组件980包括形成于远侧击发梁280中的锁定凸轮或卡位装置281，使得后者从前者的上表面向上突出。偏压构件984被支撑在中间支撑构件922上并附接到该中间支撑构件。从图16中可以看出，例如，偏压构件984为基本上平面的并且包括窗口985，该窗口被构造成能够在外科端部执行器300进行关节运动期间将锁定凸轮281容纳在其中。因此，当外科端部执行器300围绕关节运动轴线B-B进行关节运动时，偏压构件984不会向远侧启动梁280施加任何偏压力或载荷。该特征可以避免使外科端部执行器300绕关节运动轴线B-B关节运动所必须产生的关节运动力的量增加。偏压构件984可以被点焊到中间支撑构件922上，或者通过其它紧固方法诸如通过螺钉、销、粘合剂等被附接到该中间支撑构件上。窗口985还可以限定锁定带或部分986，其在远侧击发梁280处于起始位置时接触锁定凸轮281。锁定凸轮281可以形成有面向远侧的倾斜表面283和面向近侧的倾斜表面285，以减小轴向运动远侧击发梁280所需的击发力和回缩力的量。参见图19。
如上所述，远侧击发梁280可操作地附接到击发构件900，该击发构件包括击发构件主体902上的组织切割表面904。在另选的构造中，组织切割表面可附接到或以其它方式形成在远侧击发梁280的一部分上或由其直接支撑。在所示的构造中，在击发构件主体902的底部上形成有侧向延伸的支脚905。击发构件主体902还包括楔形滑动件接合构件906，其被构造成能够接合外科钉仓304中的楔形滑动件，如将在下文进一步详细讨论的。
图18示出了已经正确地安装在细长通道302中的“未用完”或“未击发”外科钉仓304。如在该图中可以看到的，楔形滑动件910定位在外科钉仓304的“未击发”(最近侧)位置。楔形滑动件910包括面向近侧的倾斜表面914，该倾斜表面被构造成能够接合击发构件900上的楔形滑动件接合构件906，从而将击发构件900沿由箭头988表示的向上方向偏压，使得击发构件900的底部部分和支脚905自由地清除通过由细长通道302底部中的锁定开口303所形成的锁定壁307。当处于该位置时，远侧击发梁280和击发构件900可以在细长通道302内向远侧推进，更确切地说，安装在其中的外科钉仓304从图18所示的起始位置向远侧推进到外科钉仓304中楔形滑动件910已经将可操作地支撑在外科钉仓304中的所有外科钉射出的结束位置。在此类构造中，在击发构件900已经被完全击发(即，在外科钉仓304内从其起始位置完全推进到结束位置)之后，击发构件900回缩到图19中所示的起始位置。因为楔形滑动件910已经由击发构件900向远侧推进到钉仓304中的结束位置，并且击发构件900未附接到楔形滑动件910，所以当击发构件900回缩到起始位置时，楔形滑动件910保持在外科钉仓304内的结束位置，并且不与击发构件900一起返回到起始位置。因此，外科钉仓304被称为处于“经使用”、“用尽”或“已击发”状态。如图19中可看到的那样，当没有楔形滑动件处于未击发状态时，由于由偏压构件984的锁定带986向远侧击发梁280上的锁定凸轮281所施加的偏压运动，主体部分902的底部以及击发构件900的支脚905延伸到细长通道302底部中的锁定开口303中。当处于该位置时，如果临床医生不经意地尝试重新击发用尽的外科钉仓，则主体部分902和/或支脚905将接触细长通道302中的壁307，并且将被阻止从起始位置运动到结束位置。因此，除非未击发或未用尽的外科钉仓已经正确/可操作地安装在外科端部执行器的细长通道中，否则击发梁锁定组件980会防止远侧击发梁280以及击发构件900从起始位置推进到结束位置。还应当理解，当完全没有钉仓安装在细长通道302中时，击发梁锁定组件980还防止了远侧击发梁280的推进。除了在不向远侧击发梁施加额外载荷的情况下(施加载荷可能导致需要增加关节运动力来使外科端部执行器进行关节运动)容纳外科端部执行器300围绕关节运动轴线B-B的关节运动之外，一旦击发梁锁定组件980已经向远侧推进经过锁定壁(无论端部执行器钳口是打开还是关闭)，该击发梁锁定组件就不会在击发构件和/或远侧击发梁上施加额外载荷。
图20A示出了另一可关节运动的外科端部执行器实施方案300’，其采用包括安装在端部执行器闭合套筒272内的偏压构件984'的击发梁锁定组件980'。如在该图中可以看到的，例如，偏压构件984'将偏压力施加到远侧端部击发梁280'的倾斜或锥形部分283'。击发波束锁组件980'以与上文关于击发梁锁组件980所述的相同方式进行操作。更具体地，偏压构件984'将偏压力施加到远侧击发梁280'，迫使远侧击发梁280'和击发构件在细长通道内向下附接。除非具有处于未击发位置的楔形滑动件或其它钉射出器构件的未用尽的外科钉仓已被正确地安装在细长通道或钉仓支撑构件内，以便可操作地接合击发构件或击发梁从而运动击发构件/击发梁脱离与锁定壁的接合，否则击发构件/击发梁将被阻止从起始位置轴向推进到结束位置。
除了下文进一步详细讨论的各种差异之外，图21至图25示出了与上述细长轴组件200类似的另一细长轴组件1200的一部分。已在上文详细讨论的细长轴组件1200的那些部件用相似的元件标号来表示，并且为了简洁起见，除了对于理解轴组件1200的操作可能有必要时，例如如上所述与外科器械10的一些部分一起使用时，将不再进一步详细讨论。如图21中可看到的那样，细长轴组件1200包括关节运动锁1810，该关节运动锁基本上类似于关节运动锁810，并且以基本上相同的方式进行操作。如图22中可看到的那样，细长轴组件1200包括具有近侧腔1815的轴框架1812，该近侧腔被构造成能够将第一远侧关节运动驱动器1820的近侧部分1821可运动地支撑在其中。第一远侧关节运动驱动器1820被可运动地支撑在细长轴组件1200内，以供响应于对其施加的关节运动控制动作而在远侧方向DD和近侧方向PD上选择性纵向行进。轴框架1812还包括其上形成有枢轴销1818的远侧端部部分1814。枢轴销1818适于枢转地接纳在外科端部执行器1300的细长通道1302的近侧端部部分1320的枢轴孔(未示出)内。这种构造便于外科端部执行器1300的细长通道1302相对于轴框架1812围绕由枢轴孔和销1818限定的关节运动轴线B-B的枢转行进(即，关节运动)。轴框架1812还包括居中设置的腔1817，以及定位在远侧端部1814和该居中设置的腔1817之间的远侧凹口1819。
轴组件1200还包括第二远侧关节运动驱动器1860，其包括可旋转地轴颈连接在近侧滑轮1840和远侧滑轮1340上的环形构件1862。仍然参见图22，近侧滑轮1840可旋转地轴颈连接在滑轮心轴1842上，该滑轮心轴安装在居中设置于轴框架1812内的腔1817内。远侧滑轮1340不可旋转地支撑或形成在外科端部执行器1300的细长通道1302的近侧端部1320上。在一种形式中，环形构件1862包括例如由不锈钢、钨、铝、钛等制成的缆线。缆线可以是编织或多股结构，具有不同数量的股线以获得期望水平的拉伸强度和柔韧性。例如，在各种构造中，缆线2382可以具有在0.03英寸到0.08英寸的范围内，并且更优选地在0.05到0.08英寸的范围内的直径。优选的缆线可以例如由300系列不锈钢制成-半硬到全硬。例如，在各种构造中，缆线还可以涂覆有例如铜等以改善润滑性和/或减少拉伸。第一耳状物1863附接到缆线的一端，第二耳状物1864通过例如卷曲附接到缆线的另一端。缆线在受力情况下被张紧，而端部和/或耳状物1863,1864被焊接、粘合、机械固定等，以形成环形构件1862。心轴1842可包括与近侧滑轮1840接合以便向近侧运动滑轮1840的凸轮安装座。其它形式的张紧构造诸如皮带张紧器、螺丝扣构造等也可以用于张紧环形构件1862。
仍然参见图22，环形构件1862通过联接器组件1830联接到第一远侧关节运动驱动器1820的远侧端部1821。联接器组件1830包括形成在第一远侧关节运动驱动器1820的远侧端部1822上的上联接器部分1832，以及下联接器部分1834。下联接器部分1834形成有两个支架1835，这两个支架被构造成能够在其中接纳耳状物1862,1864。一对附接销1836被构造成能够被压入上联接器部分1832中的孔1837中，以将两个联接器部分1832和1834附连在一起。也可以使用其它紧固件构造、螺钉、铆钉、粘合剂等。当环形构件1862轴颈连接在滑轮1840和1340上时，联接器组件1830响应于第一远侧关节运动驱动器1820的轴向运动，而自由地在轴框架1812中的远侧凹口1819内轴向运动。由第一远侧关节运动驱动器1820的轴向运动产生的关节运动动作，被传送到第二远侧关节运动驱动器1860或者环形构件1862。附接球或耳状物1866附接到环形构件1862并接纳在形成在远侧滑轮1340中的沟槽或凹坑1342中。因此，环形构件1862的运动被传递到外科端部执行器1300，更具体地，传递到外科端部执行器1300的细长通道1302，以使端部执行器围绕关节运动轴线B-B进行关节运动。因此，当第一远侧关节运动驱动器1820沿远侧方向DD运动时，环形构件1862使得外科端部执行器1300围绕关节运动轴线B-B在由箭头823表示的关节运动方向上进行关节运动。参见图21。类似地，当第一远侧关节运动驱动器1820沿近侧方向PD运动时，环形构件1862使得外科端部执行器1300围绕关节运动轴线B-B在由箭头821表示的关节运动方向上进行关节运动。参见图21和图25。如图21所示，关节运动方向823与关节运动方向821相反。
除了下文进一步详细讨论的各种差异之外，图26至图31示出了与上述细长轴组件200类似的另一细长轴组件2200的一些部分。已在上文详细讨论的细长轴组件2200的那些部件用相似的元件标号来表示，并且为了简洁起见，除了对于理解细长轴组件2200的操作可能有必要时，例如如上所述与外科器械10的一些部分一起使用时，将不再进一步详细讨论。如图26中可看到的那样，细长轴组件2200包括由喷嘴部分202和203构成的近侧外壳或喷嘴201。细长轴组件2200还包括呈闭合套筒2260形式的砧座致动器构件，其可用于闭合和/或打开可操作地附接到外科端部执行器2300的该外科端部执行器的砧座2310。如图26中可看到的那样，细长轴组件2200包括近侧脊2210，该近侧脊被构造成能够与关节运动锁2350可操作地交接。近侧脊2210被构造成能够：第一，可滑动地支撑其中的击发构件2220；第二，可滑动地支撑围绕近侧脊2210延伸的闭合套筒2260。近侧脊2210还可滑动地支撑近侧关节运动驱动器2230。近侧关节运动驱动器2230具有远侧端部2231，该远侧端部被构造成能够可操作地接合关节运动锁2350。
在所示出的构造中，近侧脊2210包括可旋转地支撑在底座240中的近侧端部2211。在一种构造中，例如，近侧脊2210的近侧端部2211具有在其上形成的螺纹2214，以便通过螺纹附接到被构造成能够被支撑在底座240内的脊轴承。这种构造有利于将近侧脊2210可旋转地附接到底座240，使得近侧脊2210可以相对于底座240选择性地围绕轴轴线SA-SA旋转。如上文详细描述的，闭合套筒2260的近侧端部附接到底座中所支撑的闭合梭动件。当细长轴组件2200可操作地联接到外科器械10的柄部或外壳时，闭合触发器的操作会向远侧推进闭合套筒2260。
同样如上所述，细长轴组件2200还包括击发构件2220，该击发构件被支撑以便在近侧脊2210内轴向行进。击发构件2220包括被构造用于附接到远侧切割或击发梁组件2280的中间击发轴部分2222。参见图27。中间击发轴部分2222可包括其远侧端部中的被构造成能够接纳远侧击发梁组件2280的近侧端部上的突片的纵向狭槽2223。纵向狭槽2223和远侧击发梁组件2280的近侧端部可被设定尺寸并被构造成能够使得其允许它们之间的相对运动并且可包括滑动接头。滑动接头可允许击发驱动器2220的中间击发轴部分2222运动成使端部执行器300进行关节运动，而不运动或至少基本上不运动远侧击发梁组件2280。一旦外科端部执行器2300已适当地取向，则中间击发轴部分2222可朝远侧推进，直到纵向狭槽2223的近侧侧壁与突片发生接触，以便推进远侧击发梁组件2280并且击发端部执行器300中所支撑的钉仓。近侧脊2210也联接到远侧脊2212。
类似于细长轴组件200，所示细长轴组件2200包括离合器组件2400，该离合器组件可被构造成能够选择性地且可释放地将近侧关节运动驱动器2230联接到击发构件2220。在一种形式中，离合器组件2400包括围绕击发构件2220定位的锁定衬圈或锁定套筒2402，其中锁定套筒2402可在接合位置与脱离位置之间旋转，在所述接合位置，锁定套筒2402将近侧关节运动驱动器2230联接到击发构件2220，在所述脱离位置，近侧关节运动驱动器2230没有可操作地联接到击发构件2220。当锁定套筒2402处于其接合位置时，击发构件2220的远侧运动可使近侧关节运动驱动器2230朝远侧运动，相应地，击发构件2220的近侧运动可使近侧关节运动驱动器2230朝近侧运动。当锁定套筒2402处于其脱离位置时，击发构件2220的运动不传递到近侧关节运动驱动器2230，因此，击发构件2220可独立于近侧关节运动驱动器2230运动。在各种情况下，当击发构件2220没有使近侧关节运动驱动器2230在近侧或远侧方向上运动时，近侧关节运动驱动器2230可被关节运动锁2350保持就位。
如上所述，锁定套筒2402可包括柱形或至少基本上柱形的主体，该主体包括限定于其中、被构造成能够接纳击发构件2220的纵向开孔2403。锁定套筒2402可包括沿直径相对的、面朝内的锁定突起2404和面朝外的锁定构件2406。锁定突起2404可被构造成能够与击发构件2220选择性地接合。更具体地，当锁定套筒2402处于其接合位置时，锁定突起2404被定位在限定于击发构件2220中的驱动凹口2224内，使得远侧推力和/或近侧推力可从击发构件2220传递至锁定套筒2402。当锁定套筒2402处于其接合位置时，第二锁定构件2406被接纳在关节运动驱动器2230中限定的驱动凹口2232内，使得施加到锁定套筒2402的远侧推力和/或近侧拉力可传递到近侧关节运动驱动器2230。实际上，当锁定套筒2402处于其接合位置时，击发构件2220、锁定套筒2402和近侧关节运动驱动器2230将一起运动。另一方面，当锁定套筒2402处于其脱离位置时，锁定突起2404可不定位在击发构件2220的驱动凹口2224内；并且因此，远侧推力和/或近侧推力可不从击发构件2220传递至锁定套筒2402。相应地，远侧推力和/或近侧拉力可以不传递至近侧关节运动驱动器2230。在此类情况下，击发构件2220可相对于锁定套筒2402和近侧关节运动驱动器2230朝近侧和/或朝远侧滑动。
同样如上所述，细长轴组件2200还可包括可旋转地接纳在闭合套筒2260上的切换筒2500。切换筒2500包括中空轴段2502，该中空轴段具有在其上形成的轴凸台2504，以用于将向外突出的致动销2410接纳在其中。在各种情况下，致动销2410延伸穿过狭槽进入设置在锁定套筒2402中的纵向狭槽，以在锁定套筒2402与关节运动驱动器2230接合时，利于该锁定套筒做轴向运动。旋转扭簧2420被构造成能够接合切换筒2500上的凸台2504和喷嘴外壳203的一部分，以将偏压力施加到切换筒2500。切换筒2500还可包括限定于其中的至少部分周边开口2506，所述开口被构造成能够接纳从喷嘴半部202、203延伸的周边安装座，并且允许切换筒2500和近侧喷嘴201之间的相对旋转而不是相对平移。如上所述，切换筒2500的旋转最终将导致致动销2410和锁定套筒2402在其接合位置和脱离位置之间的旋转。因此，实质上，喷嘴201可用于以上述以及在美国专利申请序列号13/803,086(现为美国专利申请公布2014/0263541)中更详细描述的各种方式来使关节运动驱动系统与击发驱动系统操作地接合和脱离接合。
参见图27，闭合套筒组件2260包括双枢轴闭合套筒组件2271。根据各种形式，双枢轴闭合套筒组件2271包括具有朝远侧突出的上柄脚和下柄脚的端部执行器闭合套筒2272。上部双枢轴连接件2277包括向上突出的远侧枢轴销和近侧枢轴销，这些枢轴销分别接合闭合套筒2260上的朝近侧突出的上柄脚中的上部远侧销孔和朝远侧突出的上柄脚中的上部近侧销孔。下部双枢轴连接件2278包括向上突出的远侧枢轴销和近侧枢轴销，这些枢轴销分别接合朝近侧突出的下柄脚中的下部远侧销孔和朝远侧突出的下柄脚中的下部近侧销孔。
细长轴组件2200还包括类似于上文所述的外科端部执行器300的外科端部执行器2300。如图27中可看到的那样，外科端部执行器2300包括被构造成能够在其中可操作地支撑外科钉仓2304的细长通道2302。细长通道2302具有包括两个直立侧向壁2322的近侧端部部分2320。外科端部执行器2300还包括砧座2310，该砧座具有砧座主体2312，该砧座主体具有在其上形成的钉成形底面2313。砧座主体2312的近侧端部2314被击发构件狭槽2315分为两部分，以形成两个砧座附接臂2316。每个砧座附接臂2316包括侧向突出的砧座耳轴2317。耳轴狭槽2324设置在细长通道2302的每个侧向壁2322中，用于将砧座耳轴2317中对应的一个接纳在其中。这种构造用于将砧座2310可运动地附连到细长通道2302，以能够在打开位置和闭合位置或夹紧位置之间选择性枢转行进。通过将闭合套筒2260朝远侧推进，并且更具体地，将锥形附接臂2316上的端部执行器闭合套筒2272朝远侧推进，这导致砧座2310在枢转到闭合位置的同时朝远侧运动，由此砧座2310运动到闭合位置。端部执行器闭合套筒2272中设置有马蹄形开口2273，该马蹄形开口被构造成能够接合端部执行器2300的砧座2310上的直立突片2318。为了打开砧座2310，闭合套筒2260，以及更具体地，将端部执行器闭合套筒2272沿近侧方向运动。这样，由马蹄形开口2273限定的中央突片部分与砧座2310上的突片2318协作以使砧座2310枢转回到打开位置。
转到图26、28和29，如上所述，细长轴组件2200包括基本上类似于上述的关节运动锁350和810的关节运动锁2350。关节运动锁2350的不同于关节运动锁350的并且为理解关节运动锁350的操作所必需的部件将在下面进一步详细讨论。如上所述，关节运动锁2350可被构造成能够并操作以选择性地将端部执行器2300锁定就位。当关节运动锁2350处于其解锁状态时，这种构造使外科端部执行器2300能够相对于轴闭合套筒2260旋转或做关节运动。当近侧关节运动驱动器2230经由离合器系统2400与击发构件2220操作地接合时，除上述之外，击发构件2220可使近侧关节运动驱动器2230朝近侧和/或朝远侧运动。近侧关节运动驱动器2230的运动，无论其为近侧或远侧，可解锁关节运动锁2350，如上所述。该实施方案包括被可运动地支撑在近侧脊2210和远侧脊2212之间的近侧锁适配器构件2360。近侧锁适配器2360包括用于在其中接纳第一锁定元件2364和第二锁定元件2366的锁定腔2362，第一锁定元件和第二锁定元件轴颈连接在于近侧框架2210和远侧框架2212之间延伸的框架导轨2368上。关节运动锁2350以上述各种方式操作，并且为了简洁起见，在此不再进一步讨论。
如图26、28和29中可以看出，第一远侧关节运动驱动器2370附接到近侧锁适配器2360。第一远侧关节运动驱动器2370可操作地附接到第二远侧关节运动驱动器2380，该第二远侧关节运动驱动器可操作地与端部执行器2300的细长通道2302交接。第二远侧关节运动驱动器2380包括可旋转地轴颈连接在近侧滑轮2383和远侧滑轮2392上的缆线2382。远侧滑轮2392不可旋转地支撑在或整体形成在端部执行器安装组件2390上，并且包括卡位装置或凹坑2396。在所示的示例中，端部执行器安装组件2390通过弹簧销2393不可运动地附接到细长通道2302的近侧端部2320，该弹簧销延伸穿过端部执行器安装组件2390中的孔和细长通道2302的近侧端部2320中的孔2394。近侧滑轮2383可旋转地支撑在远侧脊2212上。远侧脊2212的远侧端部具有形成于其上的枢轴销2213，该枢轴销被构造成能够可旋转地接纳在形成于端部执行器安装构件2390中的枢轴孔2395内。这种构造便于细长通道2302相对于远侧脊2212围绕由枢轴孔2395和销2213限定的关节运动轴线BB的枢转行进(即，关节运动)。
在一种形式中，缆线2382可以由例如不锈钢、钨、铝、钛等制成。缆线可以是编织或多股结构，具有不同数量的股线以获得期望水平的拉伸强度和柔韧性。例如，在各种构造中，缆线2382可以具有在0.03英寸到0.08英寸的范围内，并且更优选地在0.05到0.08英寸的范围内的直径。优选的缆线可以例如由300系列不锈钢制成-半硬到全硬。例如，在各种构造中，缆线还可以涂覆有例如铜等以改善润滑性和/或减少拉伸。在所示的示例中，缆线2382具有附接到其一个端部的耳状物2384和通过例如压接附接到其另一个端部的耳状物2385。第一远侧关节运动驱动器2370包括一对间隔开的夹板2372,2374，它们彼此间隔足够大以便在其间容纳耳状物2384,2385。例如，近侧夹板2372包括用于接纳缆线2382的邻近耳状物2384的一部分的近侧狭槽2373，并且远侧夹板2374包括用于接纳缆线2382的邻近耳状物2385的相应部分的远侧狭槽2375。狭槽2373和2375分别相对于耳状物2384,2385设置尺寸，以便防止耳状物2384,2385从中穿过。与远侧狭槽2375相比，近侧狭槽2375以一定角度取向，以便紧紧抓住其中的缆线2382的对应部分。参见图30。附接球或耳状物2398附接到环形构件2382并接纳在形成在远侧滑轮2392中的卡位装置或凹坑2396中。参见图31。因此，当第一远侧关节运动驱动器2370以上述方式沿近侧方向PD轴向回缩时，环形构件2382将使端部执行器2300沿图31中箭头2376所示的方向进行关节运动。相反，当第一远侧关节运动驱动器2370沿远侧方向DD轴向推进时，外科端部执行器2300沿图31中箭头2399所示的方向进行关节运动。另外，近侧夹板2372和远侧夹板2374充分间隔开，以便在其间容纳耳状物2384,2385。张紧楔形件2378如图29至图32那样使用，以对缆线2382施加足够的张力，使得在缆线被致动时，其将向端部执行器2300施加关节运动动作。在图35所示的另选构造中，近侧夹板2374'最初未附接到第一关节运动驱动器2370。近侧夹板2374'被定位在第一远侧关节运动驱动器2370上，以便捕获远侧夹板2372和近侧夹板2374'之间的耳状物2384和2385。近侧夹板2374'朝向远侧夹板2372运动，直到在缆线2382中产生足够的张力，然后近侧夹板2374'附接到第一远侧关节运动驱动器2370。例如，近侧夹板2374'可通过激光焊接或其它合适形式的附接装置或紧固件构造附接到第一远侧关节运动驱动器2370。
参见图36至图39，该外科器械包括例如中央击发梁支撑构件2286，该中央击发梁支撑构件被构造成能够延伸穿过关节运动接头以向柔性击发梁组件2280提供支撑。在一种形式中，中央击发梁支撑构件2286包括柔性板构件或带，并且包括附接到外科端部执行器的向下突出的远侧附接突片2287和附接到细长轴组件的向上延伸的近侧端部部分2288。在至少一种构造中，远侧附接突片2287通过弹簧销2393附接到端部执行器安装组件2390，并且近侧端部部分2288通过销(未示出)销接到远侧脊2212。中央击发梁支撑构件2286沿着装置的中心线或轴轴线定位，并且用于在关节运动期间为击发梁提供支撑。这不同于采用“吹出”板或侧向支撑板的那些构造，在那些构造中，这些侧向支撑板定位在击发梁的侧向侧，并由此从轴轴线偏移，增大了它们在关节运动过程中所经受的拉伸力和压缩力。在所示的示例中，可纵向运动的柔性击发梁组件2280包括层压梁结构，该层压梁结构包括至少两个梁层，其中至少一个梁层被构造成能够邻近中央击发梁支撑构件的一个侧向侧通过，并且至少一个另一个梁构件被构造成能够邻近中央击发梁支撑构件的另一侧向侧通过。在所示的示例中，两个层压层2282和2284被构造成能够邻近柔性张力承载构件的每一侧通过。参见例如图35和图36。在各种实施方案中，层压层2282和2284可包括例如不锈钢带，这些不锈钢带通过例如在其近侧端部焊接或销接在一起而彼此互连，同时它们各自的远侧端部不连接在一起以便允许层压体或带在端部执行器做关节运动时相对于彼此张开。每一对层压层或带2282,2284被表示为击发梁组件2280的侧向击发带组件2285。因此，如图36所示，一个侧向击发带组件2285被支撑在中央关节运动棒2286的每个侧向侧上，以实现通过一系列侧向负荷承载构件2290相对于其轴向行进。每个侧向载荷承载构件2290可由例如不锈钢、铝、钛、液晶聚合物材料、塑料材料、尼龙、丙烯腈丁二烯苯乙烯(ABS)、聚乙烯等制成，并形成有相反的弓形端部2292。每个侧向载荷承载构件2290还具有从其延伸穿过的轴向通路2294，以接纳侧向击发带组件2285和中央关节运动棒2286的组件。如可以在图38中最具体地看到的那样，每个轴向通路由两个相对的弓形表面2295限定，这两个弓形表面2295便于侧向负荷承载构件290在可纵向运动的柔性击发梁组件2280上的运动。侧向载荷承载构件2290串联地布置在侧向击发带组件2285和中央关节运动棒2286上，使得相反的弓形端部2292邻接相邻侧向载荷承载构件2290的对应弓形端部2292。参见例如图36和图37。
再次参见图37，可以看出，中央关节运动棒2286的近侧端部部分2288向下延伸以附接到远侧脊2212。例如，击发梁组件2280的远侧端部2287附接到上述类型和构造的击发构件2900。如在该图中可见，击发构件2900包括在其上具有组织切割表面或刀片2904的垂直延伸的击发构件主体2902。此外，楔形滑动件2910可安装在外科钉仓2304内，以驱动与击发构件2900的接触。在朝远侧驱动击发构件2900通过仓体2304时，楔形滑动件2910的楔形表面2912接触钉驱动器，从而在钉仓2304中向上致动驱动器和支撑在其上的外科钉。击发梁组件2280以上述各种方式操作。当击发梁组件2280围绕关节运动关接头朝远侧推进时，侧向载荷承载构件2290可帮助抵抗击发梁组件2280上的弯曲载荷。侧向载荷承载构件2290还可以减少使端部执行器关节运动所需的力的量，并且与其它关节运动接头构造相比还可容纳更大的关节运动角度。固定的中央击发梁支撑构件2286用于承载在关节运动和击发期间产生的张力载荷。
如上所述，击发梁组件包括层压梁结构，该层压梁结构包括至少两个梁层。当击发梁组件(在击发期间)朝远侧推进时，击发梁组件基本上被中央击发梁支撑构件分成两部分，使得击发梁组件的一部分(即，层压层)在中央击发梁支撑构件的两侧上通过。
图40至图43示出了附接到击发构件2900的另一击发梁组件2280'的一部分。从那些图中可以看出，击发梁组件2280包括层压结构，该层压结构包括各自具有被指定为“a”的厚度的两个外层侧梁或层2282'，以及各自具有被指定为“b”的厚度的四个中心层2284'。例如，在至少一种构造中，“a”可以是大约0.005-0.008英寸，还更优选0.008英寸，并且“b”可以是大约0.008-0.012英寸，还更优选0.010英寸。然而，可采用其它厚度。在所示的示例中，“a”小于“b”。在其它构造中，“a”大于“b”。例如，在另选构造中，层压体可以由三种不同的厚度“a”、“b”、“c”组成，其中“a”＝0.006英寸，“b”＝0.008英寸，并且“c”＝0.010英寸(最厚的层压体或带在组件的中心)。在各种构造中，可能存在奇数个层压体或带，其中“c”是在中心处单层最厚的层压体。
层压体的组成有重大作用，因为施加到梁组件上的应变的量基于其厚度和距离弯曲中心线的距离。更靠近中心线的较厚层压体或带可能经历与离中心线更远的较薄层压体或带相同的应变水平，因为考虑到它们叠堆在一起的事实，它们必定更弯曲。曲线的离中心线更远的内侧上的曲率半径更大。给定相同的曲率半径，较厚的层压体或带倾向于比较薄的层压体经受更多的内部应力。因此，具有最小曲率半径的较薄侧层压体或带可能具有与靠近中心线的较厚层相同的塑性变形可能性。换句话说，当端部执行器在一个方向上做关节运动时，远离关节运动方向定位的层压体或带具有最大的弯曲半径，最靠近关节运动方向的层压体或带具有最紧的弯曲半径。不过，当端部执行器在相反方向上做关节运动时，情况正好相反。层压体叠堆内部的层压体经历相同的偏离，但是它们的弯曲半径将始终落在外层层压体的范围内。因此，为了保持灵活性，可能需要将较薄的层压体定位在叠堆的外层上。但是，为了最大限度地提高刚度和抗弯曲性，内部较厚的材料会带来额外的好处。另选地，如果端部执行器只需要在单个方向上做关节运动，则远离关节运动方向定位的层压体或带将经历最大的弯曲半径，并且定位在关节运动方向上的层压体或带具有最紧的弯曲半径。不过，由于端部执行器并不在相反方向上做关节运动，反向情况不再成立，所以层压体叠堆不需要是对称的。因此，在这种构造中，希望最薄的层压体或带将是将经历最紧的弯曲半径的层压体或带(在关节运动方向一侧上的层压体或带)。
在其它构造中，层压体或带可以由具有不同强度和模量的不同金属制成。例如，外部层压体或带可以具有与内部层压体或带的厚度相同的厚度，其中内部层压体或带由300系列不锈钢制成，并且外部层压体或带由钛或镍钛诺制成。
如图42和图43中也可以看出，远侧击发梁组件2280'可以与上述的一系列侧向载荷承载构件2290有效地一起使用。应当理解，远侧击发梁组件2280也可以上述方式与中央关节运动棒2286结合使用，使得它的一些层或侧梁(或带或层压体)沿着中央关节运动棒的侧面轴向推进。在一些实施方案中，在中央关节运动棒2286的每一侧上推进的层可具有相同的厚度、组成、形状和构型。在其它构造中，沿着中央关节运动棒的一侧通过的一个或多个层可以具有与沿着中央关节运动棒相反侧通过的一个或多个层的厚度和/或组成和/或形状不同的厚度和/或组成和/或形状，以便实现期望的行进范围和灵活性，同时保持期望的刚度量以避免在击发期间屈曲。
图44至图46示出了另一细长轴组件3200的一部分，其包括上述类型和构造的外科端部执行器300。也可以采用其它形式的外科端部执行器。细长轴组件3200还包括附接到击发构件900的可纵向运动的柔性击发梁组件3280。在另选构造中，击发梁组件3280的远侧端部可以被构造成能够在外科端部执行器内执行各种动作，而不需要附接击发构件。柔性击发梁组件3280可以包括本文所述的各种类型的层压梁构造。在一种构造中，采用至少两个压缩带，以在柔性击发梁组件3280横穿关节运动接头时为该击发梁组件提供侧向支撑。所示的实施方案采用总共四个压缩带，以在柔性击发梁横穿关节运动接头时为其提供侧向支撑。例如，细长轴组件3200还包括脊3210，该脊包括具有两个远侧腔或凹口3219的远侧端部3217，以及形成在其中的两个近侧腔或凹口3219'。一个远侧腔3219容纳定位在所述柔性击发梁组件3280的一个侧向侧3281上的第一压缩带3900的第一近侧端部3904，另一个远端腔3219容纳定位在柔性击发梁组件3280的另一侧向侧3283上的第二压缩带3901的第二近侧端部3905。第一压缩带3900包括第一远侧端部3902，该第一远侧端部安装在外科端部执行器300的细长通道302的近侧端部320上形成的对应直立侧向支撑壁330内。相似地，第二压缩带3901包括第二远侧端部3907，该第二远侧端部也安装在外科端部执行器300的细长通道302的近侧端部320上形成的对应直立侧向支撑壁330内。第一远侧压缩带3900和第二远侧压缩带3901可以由弹簧钢等制造，并且近侧端部3904,3905可以U形方式折叠以形成偏压部分，该偏压部分被构造成能够如图所示可运动地接纳在远端凹口3219内。这种构造允许第一远侧压缩带3900和第二远侧压缩带3901响应于外科端部执行器300的关节运动而弯曲，同时将近侧端部3904,3905保持在它们的相应远侧凹口3219内。
在图44至图46中也可以看出，细长轴组件3200还包括第三压缩带3910和第四压缩带3911。如同第一压缩带3900和第二压缩带3901一样，第三压缩带3910和第四压缩带3911可以由弹簧钢制成。如图44至图46中可看到的那样，第三压缩带3910可位于第一压缩带3900与柔性击发梁组件3280的侧向侧3281之间，并且第四压缩带3911可位于第二压缩带3901与柔性击发带组件3280的另一个侧向侧3283之间。第三压缩带3910的第三近侧端部3914以及第四压缩带3911的第四近侧端部3915可各自以U形方式折叠以形成可运动地接纳在脊3210中的相应近侧腔3219'内的偏压部分。第三压缩带3910的第三远侧端部3912和第四压缩带3911的第四远侧端部3917安装在外科端部执行器300中的相应侧向支撑壁330中。
细长轴组件3200还包括可运动支撑连接件组件3920，该支撑连接件组件用于当端部执行器300围绕关节运动轴线做关节运动时提供对柔性击发梁组件3280的进一步侧向支撑。如图44至图46中可看到的那样，可运动支撑连接件组件3920包括可运动地联接到外科端部执行器300以及细长轴组件3200的中间支撑构件3922。在一个实施方案中，中间支撑构件3922枢转地销接到细长通道302的远侧端部320。中间支撑构件3922还包括在其中具有细长近侧狭槽3928的朝近侧突出的突片3926。近侧狭槽3928被构造成能够可滑动地接纳形成在脊3210上的中间支撑销3211。这种构造允许中间支撑构件3922与细长轴组件3200的脊3210之间的相对枢转和轴向运动，以便容纳更大范围的关节运动，同时能够动态地运动，以便保持击发梁组件3280上足够的侧向支撑。如图44至图46中可看到的那样，中间支撑构件3922还包括居中设置的狭槽3930，其用于轴向接纳穿过其中的击发梁组件3280。
如图44至图46中可进一步看到的那样，可运动支撑连接件组件3920还包括细长的可运动枢轴连接件3940。枢轴连接件3940包括中央主体部分3942，该中央主体部分具有朝近侧突出的近侧鼻部部分3943和朝远侧突出的远侧鼻部部分3944。枢轴连接件3940还包括第一向下突出的侧向支撑壁3945和第二向下突出的侧向支撑壁3946，这两个侧向支撑壁限定其间的梁槽3947。如图46中可看到的那样，击发梁组件3280被构造成能够在击发梁组件3280的致动和外科端部执行器300的关节运动期间在第一侧向支撑壁3945和第二侧向支撑壁3946之间延伸。此外，在所示的构造中，例如，第一压缩带3900在第一侧向支撑壁3945和第三压缩带3910之间延伸，并且第二压缩带3901在第二侧向支撑壁3946和第四压缩带3911之间延伸。第一侧向支撑壁3945包括面向内的第一弓形表面3948，并且第二侧向支撑壁3946包括面向内的第二弓形表面3949。第一弓形表面3948和第二弓形表面3949用于在端部执行器300做关节运动期间击发梁组件3280弯曲时为其提供侧向支撑。根据关节运动的方向和程度，圆角表面可匹配击发梁组件3280和压缩带3900,3901,3910,3911的外半径。如图44和图45中也可看到的那样，脊3210的远侧端部3217包括一对左右相对的轴凹口3218，枢轴连接件3940的朝近侧突出的倒圆近侧鼻部部分3943根据外科端部执行器围绕关节运动轴线做关节运动的方向延伸到该轴凹口中。相似地，左右相反的支撑凹口3932设置在中间支撑件3922中，以根据端部执行器做关节运动的方向容纳枢轴连接件3940的朝远侧突出的远侧鼻部部分3944。此类凹口构造用于在向枢轴连接件3940提供侧向支撑的同时，在适合于容纳关节运动方向的取向上适当地对准枢轴连接件3940。
除了下文进一步详细讨论的各种差异之外，图47至图51示出了在一些方面与上述细长轴组件2200类似的另一细长轴组件4200。已在上文详细讨论的细长轴组件2200的那些部件将包含相似的元件标号，并且为了简洁起见，除了对于理解细长轴组件4200的操作可能有必要时，例如如上所述与外科器械10的一些部分一起使用时，将不再进一步详细讨论。如图47中可看到的那样，在至少一个示例中，细长轴组件4200包括关节运动锁2350。如上文详细讨论的，关节运动锁组件2350包括联接(例如，被销接)到第一远侧关节运动驱动器4370的近侧锁适配器2360。如图47和图50中可看到的那样，第一远侧关节运动驱动器4370包括第一近侧齿轮齿条段4371和形成在其远侧端部4372上的第一远侧齿轮齿条段4373。细长轴组件4200还包括第二远侧关节运动驱动器4380，该第二远侧关节运动驱动器包括第二近侧齿轮齿条段4381和形成在其远侧端部4382上的第二远侧齿轮齿条段4383。
第一远侧关节运动驱动器4370和第二远侧关节运动驱动器4380被构造成能够在近侧方向PD和远侧方向DD上相对于远侧脊组件4212轴向运动。如图50中可看到的那样，第一近侧齿轮齿条段4371和第二近侧齿轮齿条段4381与由远侧脊组件4212可旋转地支撑的近侧动力传递齿轮4390啮合接合。类似地，第一远侧齿轮齿条段4373和第二远侧齿轮齿条段4383与远侧动力传递齿轮组件4392啮合接合。具体地，在至少一种构造中，远侧动力传递齿轮组件4392包括与第一远侧齿轮齿条段4373和第二远侧齿轮齿条段4383啮合接合的小齿轮传动装置4393。远侧动力传递齿轮组件4392还包括被布置成与惰齿轮4395啮合接合的驱动齿轮4394。惰齿轮4395继而被支撑为与形成在外科端部执行器4300的细长通道4302的近侧端部部分4320上的从动齿轮4306啮合接合。另外，外科端部执行器4300可以类似于外科端部执行器2300，并且包括可以上述各种方式打开和闭合的砧座4310。参见图48、图49和图51，远侧脊组件4212可以包括上部脊部分4212A和下部脊部分4212B。细长通道4302的远侧动力传递齿轮组件4392、惰齿轮4395和从动齿轮部分4306各自枢转地附接到或支撑在远侧脊组件4212的底部部分4212B上。
图47中所示的细长轴组件4200包括附接到击发构件(未示出)的击发梁组件3280。击发梁组件3280可以包括本文所述的类型的层压梁构造。上面详细描述了击发构件的操作，为了简洁起见，下文将不重复。如图47中也可看到的那样，采用了名称为“SURGICALINSTRUMENTS WITH ARTICULATABLE END EFFECTORS AND MOVABLE FIRING BEAM SUPPORTARRANGEMENTS”的美国专利申请序列号14/575,117中公开的类型的击发梁支撑构件4400来在外科端部执行器4300的关节运动期间为击发梁组件3280提供支撑，该专利申请的全部公开内容据此以引用方式并入。图52示出了远侧击发梁组件2280在细长轴组件4200中的用途。在该图中可以看出，以上述方式采用多个侧向载荷承载构件2290来在外科端部执行器4300做关节运动时为远侧击发梁组件2280提供支撑。
除了下文进一步详细讨论的各种差异之外，图53至图58示出了在一些方面与上述细长轴组件2200类似的另一细长轴组件5200。已在上文相对于细长轴组件2200详细讨论的细长轴组件5200的那些部件用相似的元件标号来标识，并且为了简洁起见，除了对于理解细长轴组件5200的操作可能有必要时，例如如上所述与外科器械10的一些部分一起使用时，将不再进一步详细讨论。
类似于细长轴组件2200，所示的细长轴组件5200包括离合器组件2400，该离合器组件被构造成能够可操作地接合关节运动系统5600，该关节运动系统被构造成能够向与其可操作地联接的外科端部执行器300施加推动和拉动关节运动动作。在该实施方案中，离合器组件2400包括围绕击发构件2220定位的锁定衬圈或锁定套筒2402，其中锁定套筒2402可在接合位置与脱离位置之间旋转，在所述接合位置，锁定套筒2402将关节运动系统5600可操作地接合到击发构件2220，在所述脱离位置，关节运动系统5600没有可操作地联接到击发构件2220。具体参见图54至图56，在所示的示例中，关节运动系统5600包括被支撑用于在喷嘴201内旋转运动的关节运动盘或旋转构件5602。关节运动盘5602由驱动连接组件5610可旋转地驱动。在所示的示例中，驱动连接组件5610包括附接到关节运动盘5602的驱动销5612。关节运动驱动连接件5614通过连接器5616可操作地附接到驱动销5612，所述连接器便于关节运动驱动连接件5614相对于驱动销5612的某种运动。参见图54至图56。关节运动驱动连接件5614包括驱动联接器5618，该驱动联接器被构造成能够驱动地接合锁定套筒2402上的面向外的锁定构件2406。参见图53。
如上所述，锁定套筒2402可包括柱形或至少基本上柱形的主体，该主体包括限定于其中、被构造成能够接纳击发构件2220的纵向开孔2403。参见图53。锁定套筒2402可包括沿直径相对的、面朝内的锁定突起2404和面朝外的锁定构件2406。锁定突起2404可被构造成能够与击发构件2220选择性地接合。更具体地，当锁定套筒2402处于其接合位置时，锁定突起2404被定位在限定于击发构件2220中的驱动凹口2224内，使得远侧推力和/或近侧推力可从击发构件2220传递至锁定套筒2402。当锁定套筒2402处于其接合位置时，面向外的锁定构件2406被接纳在图53所示的驱动联接器5618中的驱动凹口5619内，使得施加到锁定套筒2402的远侧推力和/或近侧推力可传输至关节运动驱动连接件5614。实际上，当锁定套筒2402处于其接合位置时，击发构件2220、锁定套筒2402和关节运动驱动连接件5614将一起运动。另一方面，当锁定套筒2402处于其脱离位置时，锁定突起2404可不定位在击发构件2220的驱动凹口2224内；并且因此，远侧推力和/或近侧推力可不从击发构件2220传递至锁定套筒2402。相应地，驱动力DF可以不被施加到关节运动盘5602。在此类情况下，击发构件2220可相对于锁定套筒2402和近侧关节运动驱动器2230朝近侧和/或朝远侧滑动。
同样如上所述，细长轴组件5200还可包括可旋转地接纳在闭合套筒2260上的切换筒2500。参见图53。切换筒2500包括中空轴段2502，该中空轴段具有在其上形成的轴凸台2504，以用于将向外突出的致动销2410接纳在其中。在各种情况下，致动销2410延伸进入设置在锁定套筒2402中的纵向狭槽2401，以在锁定套筒2402与关节运动驱动连接件5614接合时，利于该锁定套筒做轴向运动。旋转扭簧2420被构造成能够接合切换筒2500上的凸台2504和喷嘴外壳201的一部分，以将偏压力施加到切换筒2500。如上所述，切换筒2500还可包括限定于其中的至少部分周边开口，所述开口可被构造成能够接纳从喷嘴半部延伸的周边安装座，并且允许切换筒2500和喷嘴外壳201之间的相对旋转而不是相对平移。如上所述，切换筒2500的旋转最终将导致致动销2410和锁定套筒2402在其接合位置和脱离位置之间的旋转。因此，实质上，喷嘴外壳201可用于以上述以及在美国专利申请序列号13/803,086(现为美国专利申请公布2014/0263541)中更详细描述的各种方式来使关节运动系统5600与击发驱动系统操作地接合和脱离接合。
再次参见图53至图56，所示的示例的关节运动系统5600还包括“第一”或右关节运动连杆5620和“第二”或左关节运动连杆5640。第一关节运动连杆5620包括第一关节运动连接件5622，该第一关节运动连接件包括可运动地接纳在关节运动盘5602中的第一关节运动狭槽5604内的第一关节运动销5624。第一关节运动连接件5622可运动地销接到第一关节运动连接器5626，该第一关节运动连接器被构造成能够接合关节运动锁2350。如上所述，关节运动锁2350可被构造成能够并操作以选择性地将外科端部执行器300锁定就位。当关节运动锁2350处于其解锁状态时，这种构造使外科端部执行器300能够相对于轴闭合套筒2260旋转或做关节运动。当关节运动驱动连接件5614经由离合器系统2400与击发构件2220操作地接合时，除上述之外，击发构件2220可使关节运动盘6502旋转以使第一关节运动连杆5620朝近侧和/或朝远侧运动。第一关节运动连杆5620的第一关节运动连接器5626的运动，无论其为近侧或远侧，可解锁关节运动锁2350，如上所述。近侧锁适配器2360包括用于在其中接纳第一锁定元件2364和第二锁定元件2366的锁定腔2362，第一锁定元件和第二锁定元件轴颈连接在于近侧框架2210和远侧框架之间延伸的框架导轨上。关节运动锁2350的操作在上文描述，并且为了简洁起见，在此不再进一步讨论。如图53中可看到的那样，第一远侧关节运动驱动器5370附接到近侧锁适配器2360。第一远侧关节运动驱动器5370可操作地附接到外科端部执行器300的细长通道302的近侧端部320。
如上所述，所示的示例的关节运动系统5600还包括“第二”或左关节运动连杆5640。如图54至图56中可看到的那样，第二关节运动连杆5640包括第二关节运动连接件5642，该第二关节运动连接件包括可运动地接纳在关节运动盘5602中的第二关节运动狭槽5606内的第二关节运动销5644。第二关节运动连接件5642被销接到附接到外科端部执行器300的细长通道302的近侧端部320的第二关节运动棒5646。参见图54，关节运动系统5600还包括被接纳在第一关节运动狭槽5604内的第一关节运动偏压构件5628和被接纳在第二关节运动狭槽5606内的第二关节运动偏压构件5648。图54示出了处于中间或非关节运动构型的关节运动系统5600。在该图中可以看出，第一关节运动销5624与第一关节运动偏压构件5628接触，并且第二关节运动销5644与第二关节运动偏压构件5648接触。然而，当处于该中间位置时，第一关节运动偏压构件5628和第二关节运动偏压构件5648可以不处于压缩状态。图55示出了由关节运动驱动连接件5614以上述方式在近侧方向PD上将驱动力DF施加到关节运动盘5602。在近侧方向PD上施加驱动力DF导致关节运动盘5602沿箭头5601表示的旋转方向旋转。当关节运动盘5602在旋转方向5601上旋转时，第二关节运动狭槽的端部接触第二关节运动销5644，并向第二关节运动连杆5640施加推力并且最终施加到第二关节运动棒5646。相反地，第一关节运动偏压构件5628在第一关节运动狭槽5604内在箭头5601的方向上推动第一关节运动销5624，使得在近侧方向PD上将拉力施加到第一关节运动连杆5620。该近侧拉力通过关节运动锁2350传递到第一远侧关节运动驱动器5370。施加到外科端部执行器的这种“推动和拉动动作”致使外科端部执行器300在由箭头5300表示的方向上围绕关节运动轴线做关节运动。参见图53。当关节运动盘5602处于图55所示的位置时，第二关节运动偏压构件5648可以处于压缩状态，并且第一关节运动偏压构件可以不被压缩。因此，当将驱动力DF施加到关节运动驱动连接件5614的操作中断时，第二关节运动偏压构件5648可以将关节运动盘5602偏压回到例如图54所示的中间位置。
相反地，当如图56所示，将驱动力DF在远侧方向DD上施加到关节运动驱动连接件5614时，关节运动盘5602在由箭头5603表示的旋转方向上旋转。当关节运动盘5602在旋转方向5603上旋转时，第一关节运动狭槽5604的端部接触第一关节运动销5624，并向第一关节运动连杆5620施加推力并且最终通过关节运动锁2350施加到第一远侧关节运动驱动器5370。此外，第二关节运动偏压构件5648在第二关节运动狭槽5606内在箭头5603的方向上推动第二关节运动销5644，使得在近侧方向PD上将拉力施加到第二关节运动连杆5640。该近侧拉力被传递到第二关节运动棒5646。施加到外科端部执行器300的这种“推动和拉动动作”致使外科端部执行器300在由箭头5302表示的方向上围绕关节运动轴线做关节运动。参见图53。当关节运动盘5602处于图56所示的位置时，第一关节运动偏压构件5628可以处于压缩状态，并且第二关节运动偏压构件5648可以不被压缩。因此，当将驱动力DF施加到关节运动驱动连接件5614的操作中断时，第一关节运动偏压构件5628可以将关节运动盘5602偏压回到例如图54所示的中间位置。
图57示出了轴框架812的远侧端部部分814与可操作地联接到细长轴组件5200的外科端部执行器300的附接。如上所述，远侧端部部分814具有其上的向下突出的枢轴销(未示出)，该枢轴销适于枢转地接纳在形成于细长通道302的近侧端部部分320中的枢轴孔(未示出)内。这种构造便于细长通道302围绕由该枢轴孔限定的关节运动轴线B-B相对于轴框架812枢转行进。如图57中也可看到的那样，第一远侧关节运动驱动器5370由第一球形接头852附接到第一联接器850。第一联接器850也可以通过第一销854枢转地销接到细长通道302的近侧端部部分320，如图57中可看到的那样。相似地，第二关节运动棒5646由第二球形接头872附接到第二联接器870。第二联接器870也可以通过第二销874枢转地销接到细长通道302的近侧端部部分320，如图57中可看到的那样。
参见图53和图58，细长轴组件5200还可以包括附接到上述类型的击发构件900的击发梁组件2280。击发梁组件2280附接到击发构件2220并且可以上述的各种方式轴向推进和回缩。细长轴组件5200还可以包括多支撑连接件组件920，用于在外科端部执行器300围绕关节运动轴线B-B进行关节运动时向远侧击发梁2280提供侧向支撑。如图58中可看到的那样，多支撑连接件组件920包括中间支撑构件922，该中间支撑构件以上述方式枢转地销接到细长通道302的近侧端部320。中间支撑构件922还包括居中设置的狭槽930，用于轴向地接纳穿过其中的远侧击发梁2280。多支撑连接件组件920还包括近侧支撑连接件940和远侧支撑连接件950。近侧支撑连接件940包括主体部分942，该主体部分具有倒圆的近侧端部943和倒圆的远侧端部944。近侧支撑连接件940还包括一对向下突出的侧支撑壁945，该对侧向支撑壁在其间限定有近侧狭槽。相似地，远侧支撑连接件950包括主体部分952，该主体部分具有倒圆的近侧端部953和倒圆的远侧端部954。远侧支撑连接件950还包括一对向下突出的侧支撑壁955，该对侧向支撑壁在其间限定有近侧狭槽。如图58中可看到的那样，远侧击发梁2280被构造成能够在近侧支撑连接件940的侧向支撑壁945与远侧支撑连接件950的侧向支撑壁955之间延伸。每个支撑壁945和955包括面向内的弓形表面，如上所述。支撑表面用于在外科端部执行器300做关节运动期间远侧击发梁2280弯曲时为该击发梁提供侧向支撑。另外，闭合套筒组件2260可以包括上述类型的被构造成能够与外科端部执行器300上的砧座可操作地相互作用的双枢轴闭合套筒组件。闭合套筒组件2260的操作导致以上述各种方式打开和闭合该外科执行器的砧座。
除了下面讨论的差异之外，图59示出了与细长轴组件5200基本相似的另一细长轴组件5700的一部分。具体地，关节运动系统5701的关节运动盘5702由可操作地支撑在喷嘴外壳201中的蜗轮马达5710旋转。例如，在一个实施方案中，从动齿轮5703整体形成或以其它方式不可运动地附接到关节运动盘5702，使得其与马达5710的蜗轮驱动器5712啮合接合。在所示的示例中，第一关节运动杆或构件5720可以本文所述的各种方式中的任何一种直接附接到外科端部执行器的一部分。第一关节运动销5722附接到第一关节运动杆5720并且被接纳在关节运动盘5702中形成的弓形第一关节运动狭槽5704内。第一关节运动偏压构件5705被接纳在第一关节运动狭槽5704内，用于偏压与第一关节运动销5722的接触。同样，第二关节运动杆或构件5730可以本文所述的各种方式中的任何一种直接或间接地附接到外科端部执行器的一部分。第二关节运动销5732附接到第二关节运动杆5730并且被接纳在关节运动盘5702中形成的弓形第二关节运动狭槽5706内。第二关节运动偏压构件5707被接纳在第二关节运动狭槽5706内，用于偏压与第二关节运动销5732的接触。
图59示出了处于中间或非关节运动构型的关节运动系统5701。在该图中可以看出，第一关节运动销5722与第一关节运动偏压构件5705接触，并且第二关节运动销5732与第二关节运动偏压构件5707接触。然而，当处于该中间位置时，第一关节运动偏压构件5705和第二关节运动偏压构件5707可以不处于压缩状态。马达5710的致动使关节运动盘5702在箭头5601所示的旋转方向上旋转，这将向第一关节运动杆5720施加拉动动作以使第一关节运动杆5720沿近侧方向PD运动，以及向第二关节运动杆5730施加推动动作以使第二关节运动杆5730沿远侧方向DD运动。相反，马达5710的致动使关节运动盘5702在箭头5603所示的旋转方向上旋转，这将向第一关节运动杆5720施加推动动作以使第一关节运动杆5720沿远侧方向DD运动，以及向第二关节运动杆5730施加拉动动作以使第二关节运动杆5730沿近侧方向PD运动。施加到外科端部执行器的这种“推动和拉动动作”致使外科端部执行器以上述各种方式围绕关节运动轴线做关节运动。
图60至图65示出了可以与本文所述的各种细长轴组件和执行器构造一起使用的另一关节运动系统5800。然而，在该实施方案中，关节运动系统5800包括双关节运动盘组件5810，该双关节运动盘组件包括驱动器关节运动盘5820和从动关节运动盘5830。例如，两个关节运动盘5820,5830可以被可旋转地支撑在细长轴组件的喷嘴外壳内，使得两个盘5820,5830都能够围绕公共轴线独立地旋转。在各种实施方案中，可以通过如上所述的关节运动驱动连接件5614和击发构件构造2220将驱动动作施加到驱动器关节运动盘5820。在其它实施方案中，可以上述方式通过蜗轮马达5710将旋转驱动动作施加到驱动器关节运动盘5820。
图61示出了驱动器盘5820的一种形式。如该图中可看到的那样，驱动器盘5820包括各自具有第一弓形长度FL的第一对第一弓形关节运动狭槽5822L,5822R。另外，驱动器关节运动盘5820还包括居中地设置在第一关节运动狭槽5822之间的驱动器狭槽5824，如图61中可看到的那样。根据用于驱动驱动器关节运动盘5820的方法，关节运动驱动连接件5614或蜗轮马达5710可以上述各种方式与驱动器关节运动盘5820交接，以向驱动器关节运动盘5820施加旋转运动。图62示出了从动关节运动盘5830的一种形式。如该图中可看到的那样，从动关节运动盘5830包括各自具有小于第一弓形长度FL的第二弓形长度SL的第二对第二弓形关节运动狭槽5832L,5832R。另外，从动关节运动盘5830还包括被构造成能够可运动地接纳在驱动器狭槽5824内的驱动器柱5834。
现在参见图60和图63至图65，关节运动系统5800还包括可以本文所述的各种方式中的任何一种直接或间接地附接到外科端部执行器的一部分的第一关节运动杆5840。第一关节运动销5842附接到第一关节运动杆5840并且被接纳在对应的第一弓形关节运动狭槽5822L和第二弓形关节运动狭槽5832L内。同样，第二关节运动杆或构件5850可以本文所述的各种方式中的任何一种直接附接到相同外科端部执行器的一部分。第二关节运动销5852附接到第二关节运动杆5850并且被接纳在对应的第一弓形关节运动狭槽5822R和第二弓形关节运动狭槽5832R内。图60示出了处于零点位置的关节运动系统5800，在该位置，外科端部执行器可以自由运动。图63示出了当在箭头5860表示的方向上向驱动器关节运动盘5820初始施加旋转运动时，关节运动系统5800的位置。从该图可以看出，在驱动器关节运动盘5820初始旋转时，关节运动狭槽5822L,5832L彼此偏移并且关节运动狭槽5822R,5832R彼此偏移，但是还没有运动被传送到关节运动杆5840,5850。图64示出了当在箭头5860的方向上继续向驱动器关节运动盘5820施加足以导致例如外科端部执行器相对于轴轴线进行七十五度关节运动的旋转运动时，关节运动系统5800的位置。如该图中可看到的那样，推动动作被施加到第一关节运动杆5840以使第一关节运动杆5840沿远侧方向DD轴向运动，并且拉动动作被施加到第二关节运动杆5850以使第二关节运动杆5850沿近侧方向PD轴向运动。第一关节运动杆5840和第二关节运动杆5850沿相反方向的运动导致与其可操作地交接的外科端部执行器的关节运动。图65示出了当在箭头5862表示的相反方向上向驱动器关节运动盘5820施加足以导致例如外科端部执行器在相反关节运动方向上相对于轴轴线进行七十五度关节运动的旋转运动时，关节运动系统5800的位置。如该图中可看到的那样，推动动作被施加到第二关节运动杆5850以使第二关节运动杆5850沿远侧方向DD轴向运动，并且拉动动作被施加到第一关节运动杆5840以使第一关节运动杆5840沿近侧方向PD轴向运动。第一关节运动杆5840和第二关节运动杆5850的这种相反运动导致可操作地附接到它的外科端部执行器做关节运动。在一种构型中，第一关节运动杆5840可以仅当关节运动驱动盘5820已经旋转足够的距离以达到七十五度的关节运动范围时，才向外科端部执行器施加拉力。
图66至图70示出了外科端部执行器6300，其包括可相对于轴轴线SA-SA同时在打开位置和闭合位置之间运动的第一钳口和第二钳口。在不脱离本发明的实质和范围的情况下，第一钳口和第二钳口可以包括各种外科钳口构造。利用外科端部执行器的钳口进入目标组织有时可能具有挑战性。如果钳口相对于彼此支撑的点与最近侧钉位置之间的距离最小化，则可以增强外科端部执行器，特别是被构造成能够切割并缝合组织的外科端部执行器的可操纵性。例如，那些仅采用一个可运动钳口(即，其中一个钳口相对于轴轴线固定)的外科端部执行器可能需要一个可运动钳口具有相对较大的行进范围以容纳目标组织。这种较大的行进范围可能导致使用端部执行器来有利于定位目标组织的过程复杂化。外科端部执行器6300采用相对于彼此和围绕共同的枢转轴线的轴轴线运动的第一钳口和第二钳口。例如，与仅采用一个可运动钳口的某些外科端部执行器上的相同距离相比，这种构造能够缩短枢转轴线与最近侧钉位置之间的距离。
在所示的示例中，第一钳口6310包括被构造成能够在其中支撑外科钉仓6320的细长通道6312。如图70中可看到的那样，外科钉仓6320被构造成能够在其中可操作地支撑多个钉驱动器6322，所述多个钉驱动器在其上可操作地支撑外科钉6324。钉驱动器6322可运动地支撑在形成于外科钉仓6320中的对应驱动器狭槽6321内。钉驱动器6322通过仓盘6330保持在其相应的驱动器狭槽6321内，该仓盘夹到或以其它方式附接到外科钉仓6320。钉驱动器6322在外科钉仓6320中的细长狭槽6326的每一侧上布置成行，以容纳击发构件6340从中轴向通过。楔形滑动件6350可运动地支撑在外科钉仓6320内，并且被构造成能够在击发构件6340从与外科钉仓6320的近侧端部相邻的起始位置和在外科钉仓6320的远侧部分内的结束位置被驱动时，由击发构件6340驱动接合。如上所述，当楔形滑动件6350沿远侧方向被驱动通过外科钉仓6320时，楔形滑动件6350驱动地接触钉驱动器6322以将它们朝向仓平台表面6323驱动。击发构件6340包括组织切割表面6346，当击发构件6340被朝远侧驱动时，该组织切割表面用于切割夹在钳口之间的组织。本文所述的各种类型的远侧击发梁(未示出)可操作地附接到击发构件6340以及中间击发轴部分2222或其它击发系统构造。中间击发轴部分2222驱动和回缩远侧击发梁的操作在上文已经详细讨论过，为了简明起见，将不再重复。在不脱离本发明的实质和范围的情况下，也可以使用其它的击发梁和击发系统构造(马达驱动的以及手动驱动的)来为击发构件提供动力。
所示的外科端部执行器6300还被构造用于围绕基本上横向于轴轴线SA-SA的关节运动轴线B-B进行选择性关节运动。如图66至图70中可看到的那样，外科端部执行器6300包括端部执行器安装组件6390，其适于枢转地安装到例如远侧轴框架(未示出)，该远侧轴框架包括被构造成能够可旋转地接纳在端部执行器安装组件6390中的安装孔6392内的枢轴销。外科端部执行器6300可通过上述类型的关节运动锁以及第一和第二关节运动杆构造来进行关节运动。如图70中可看到的那样，端部执行器安装组件6390还包括一对相反的侧向延伸的耳轴销6394。耳轴销6394从端部执行器安装组件6390的相反侧向侧6391侧向延伸，该相反侧向侧还限定凹坑区域6395，该凹坑区域被构造成能够在其中接纳击发构件6340。耳轴销6394用于限定枢转轴线PA-PA，第一钳口6310和第二钳口6360可围绕该枢转轴线枢转。第一钳口6310或细长通道6312的近侧端部6314包括一对相反的U形或端部开口狭槽6316，其适于在其中接纳耳轴销6394中对应的一者。这种构造用于将第一钳口6310可运动地或枢转地轴颈连接到端部执行器安装组件6390。
所示的外科端部执行器6300还包括第二钳口6360，该第二钳口可包括砧座6362。所示的砧座6362包括砧座主体6364，该砧座主体包括细长狭槽6366和在其每一侧上形成的两个钉成形表面6368。砧座6362还具有近侧端部部分6370，该近侧端部部分具有一对U形或端部开口的狭槽6372，该狭槽也适于在其中接纳耳轴销6394中对应的一者。这种构造用于将第二钳口6360可运动地或枢转地轴颈连接到端部执行器安装组件6390，使得第一钳口和第二钳口可以相对于彼此以及相对于轴轴线SA-SA运动。第一钳口6310和第二钳口6360可由本文公开的各种类型的闭合系统可运动地致动。例如，本文所述类型的第一闭合驱动系统可用于以上述方式致动闭合套筒。闭合套筒也可附接到端部执行器闭合套筒6272，该端部执行器闭合套筒可以上述方式通过双枢轴闭合套筒组件枢转地附接到闭合套筒。如上所述，例如，闭合套筒的轴向运动可通过致动闭合触发器32来控制。如图67至图69中可看到的那样，端部执行器闭合套筒6272在端部执行器安装组件6390上方延伸，并且被构造成能够接合第二钳口6360的近侧端部6370以及第一钳口6310的近侧端部6314。至少一个凸轮表面6336可形成在第一钳口6310的近侧端部6314上，使得当端部执行器闭合套筒6272的远侧端部6274接触凸轮表面6336时，第一钳口6310朝向第二钳口和轴轴线SA-SA进行凸轮运动。同样，一个或多个凸轮表面6376可形成在第二钳口6360的近侧端部部分6370上，使得当由端部执行器闭合套筒6272的远侧端部6274接触时，第二钳口6360朝向第一钳口6310和轴轴线SA-SA运动。凸轮表面6336,6376可以相对于彼此构造和定位，使得第一钳口和第二钳口以相对于彼此不同的“闭合速率”或闭合时间闭合。一个这种构造示于图68中。如图68中可看到的那样，当第一钳口和第二钳口处于其相应的完全打开位置时，沿第一钳口6310上的点P1和第二钳口6360上对应的点P2之间的弓形路径的距离由DT表示。第一点P1和第二点P2被称为彼此“对应”。例如，第一点P1和第二点P2可各自位于在两点间延伸并与轴轴线SA-SA垂直的公共线或轴线上。沿第一钳口6310上的另一点PA和轴轴线SA-SA之间的弓形路径的距离由D1表示，并且沿第二钳口上的另一对应点PB和轴轴线SA-SA之间的另一弓形路径的距离由D2表示。点PA和点PB也被称为彼此对应。例如，点PA和点PB可位于在两点间延伸并与轴轴线SA-SA垂直的公共线或轴线上。在所示的构造中，第二钳口6360或砧座6362从完全打开位置运动到其中砧座6362的钉成形表面沿着轴轴线SA-SA布置的闭合位置的距离D2大于第一钳口6310或外科钉仓6320从完全打开位置运动到其中仓平台表面沿着轴轴线SA-SA布置的闭合位置的距离D1。例如，在至少一种构造中，第二钳口或砧座将打开或运动距离DT(或沿钳口之间的另一行进路径的另一距离)的2/3，并且第一钳口或钉仓将打开或运动距离DT(或沿钳口之间的另一行进路径的其它距离)的1/3，使得实质上，一个钳口达到其完全闭合位置比另一个钳口达到其完全闭合位置更快，即使最初在相同或相似的时间向两个钳口施加一个或多个闭合运动。例如，在不脱离本发明的该实施方案的实质和范围的情况下，可以将第一钳口和第二钳口上的凸轮表面布置/构造成能够获得不同的钳口运动比率/速率。开放型弹簧6380(图70)可定位在第一钳口6310的近侧端部6314和第二钳口6360的近侧端部6370之间，以在端部执行器闭合套筒6272定位在起始位置或未致动位置时将第一钳口6310和第二钳口6360偏压到打开位置。参见图67至图69。
为了使第一钳口6310和第二钳口6360运动到闭合位置(图66)，临床医生致动闭合系统以沿远侧方向DD运动端部执行器闭合套筒6272，使其同时接触第一钳口6310的近侧端部6314上的凸轮表面6336和第二钳口6360的近侧端部6370上的凸轮表面6376，从而将第一钳口6310和第二钳口6360朝向彼此(以及轴轴线SA-SA)偏压到图66所示的位置。当端部执行器闭合套筒6272被保持在该位置时，第一钳口6310和第二钳口6360被保持在所述闭合位置。然后，击发系统可被致动以将击发构件6340朝远侧轴向推进穿过外科端部执行器6300。如图70中可看到的那样，击发构件6340可具有被构造成能够可滑动地接合砧座6362的开槽通路6374的底座部分6342和适于可滑动地接纳在细长通道6312中的开槽通路6318内的顶部突片部分6344。参见图69。因此，这种击发构件构造用于在击发构件的击发期间(即，在钉的击发和夹在第一钳口6310和第二钳口6360之间的组织的切割期间)以所需的间距布置正向保持第一钳口6310和第二钳口6360。第一钳口盖6315可移除地附接到细长通道6312，并且第二钳口盖6363可移除地附接到砧座6362，以用于组装目的，以及防止组织和/或体液渗入第一钳口和第二钳口，而这可能阻碍或妨碍击发构件6340的操作。
图71示出了与外科端部执行器6300相似的另一外科端部执行器6300'。如该图中可看到的那样，外科端部执行器6300'包括两个钳口，这两个钳口可相对于轴轴线SA-SA同时在打开位置和闭合位置之间运动。在所示的示例中，第一钳口6310’包括细长通道6312’，该细长通道被构造成能够在其中支撑外科钉仓6320’。外科钉仓6320'被构造成能够在其中可操作地支撑多个钉驱动器6322，所述钉驱动器在其上可操作地支撑外科钉6324。钉驱动器6322可运动地支撑在形成于外科钉仓6320'中的对应驱动器凹坑6321'内。钉驱动器6322通过仓盘6330'保持在其相应的驱动器凹坑6321'内，该仓盘夹到或以其它方式附接到外科钉仓6320'。钉驱动器6322在外科钉仓6320中的细长狭槽6326'的每一侧上布置成行，以容纳击发构件6340'从中轴向通过。楔形滑动件6350'可运动地支撑在外科钉仓6320'内，并且被构造成能够在击发构件6340'从与外科钉仓6320'的近侧端部相邻的起始位置处和在外科钉仓6320'的远侧部分内的结束位置处被驱动时，由击发构件6340'驱动接合。如上所述，当楔形滑动件6350'沿远侧方向被驱动通过外科钉仓6320'时，楔形滑动件6350'驱动地接触钉驱动器6322以将它们朝向仓平台表面6323'驱动。击发构件6340'包括组织切割表面6346'，当击发构件6340被朝远侧驱动时，该组织切割表面用于切割夹在钳口之间的组织。本文所述的各种类型的远侧击发梁(未示出)可操作地附接到击发构件6340'以及中间击发轴部分2222或其它击发系统构造。中间击发轴部分2222驱动和回缩远侧击发梁的操作在上文已经详细讨论过，为了简明起见，将不再重复。在不脱离本发明的实质和范围的情况下，也可以使用其它的击发梁和击发系统构造(马达驱动的以及手动驱动的)来为击发构件提供动力。
所示的外科端部执行器6300’还被构造用于围绕基本上横向于轴轴线SA-SA的关节运动轴线B-B进行选择性关节运动。端部执行器6300'包括端部执行器安装组件6390'，该端部执行器安装组件适于枢转地安装到例如远侧轴框架，该远侧轴框架包括被构造成能够可旋转地接纳在端部执行器安装组件6390’中的安装孔6392’内的枢轴销。外科端部执行器6300’可通过上述类型的关节运动锁以及第一和第二关节运动杆构造来进行关节运动。如图71中可看到的那样，端部执行器安装组件6390’还包括一对相反的侧向延伸的耳轴销6394’。耳轴销6394’从端部执行器安装组件6390’的相反侧向侧6391’侧向延伸，该相反侧向侧还限定凹坑区域6395’，该凹坑区域被构造成能够在其中接纳击发构件6340’。耳轴销6394’用于限定枢转轴线PA-PA，第一钳口6310’和第二钳口6360’可围绕该枢转轴线枢转。第一钳口6310’或细长通道6312’的近侧端部6314’包括一对相反的U形或端部开口狭槽6316’，其适于在其中接纳耳轴销6394’中对应的一者。这种构造用于将第一钳口6310’可运动地或枢转地轴颈连接到端部执行器安装组件6390’。
所示的外科端部执行器6300’还包括第二钳口6360’，该第二钳口可包括砧座6362’。所示的砧座6362’包括砧座主体6364’，该砧座主体包括细长狭槽6366’和在其每一侧上形成的两个钉成形表面。砧座6362’还具有近侧端部部分6370’，该近侧端部部分具有一对U形或端部开口的狭槽6372’，该狭槽也适于在其中接纳耳轴销6394’中对应的一者。这种构造用于将第二钳口6360’可运动地或枢转地轴颈连接到端部执行器安装组件6390’。第一钳口6310’和第二钳口6360’由本文公开的各种类型的闭合系统可运动地致动。例如，第一闭合驱动系统30可用于以本文所述的方式致动闭合套筒260。闭合套筒260也可附接到端部执行器闭合套筒6272，该端部执行器闭合套筒可以上述方式通过双枢轴闭合套筒组件271枢转地附接到闭合套筒260。如上所述，例如，闭合套筒260的轴向运动可通过致动闭合触发器32来控制。端部执行器闭合套筒6272在端部执行器安装组件6390’上方延伸，并且被构造成能够接合第二钳口6360’的近侧端部6370’以及第一钳口6310’的近侧端部6314’。至少一个凸轮表面6336’可形成在第一钳口6310’的近侧端部6314’上，使得当端部执行器闭合套筒6272的远侧端部6274接触凸轮表面6336’时，第一钳口6310’朝向第二钳口6360’和轴轴线SA-SA进行凸轮运动。同样，一个或多个凸轮表面6376’可形成在第二钳口6360’的近侧端部部分6370’上，使得当由端部执行器闭合套筒6272的远侧端部6274接触时，第二钳口6360’朝向第一钳口6310’和轴轴线SA-SA运动。弹簧(未示出)可定位在第一钳口6310’的近侧端部6314’和第二钳口6360’的近侧端部6370’之间，以在端部执行器闭合套筒6272定位在起始位置或未致动位置时将第一钳口6310’和第二钳口6360’偏压到打开位置。
为了将第一钳口6310’和第二钳口6360’运动到闭合位置，临床医生致动闭合系统以沿远侧方向DD运动端部执行器闭合套筒6272，使其同时接触第一钳口6310’的近侧端部6314’上的凸轮表面6336’和第二钳口6360’的近侧端部6370’上的凸轮表面6376’，从而将第一钳口6310’和第二钳口6360’朝向彼此(以及轴轴线SA-SA)偏压。当端部执行器闭合套筒6272被保持在该位置时，第一钳口6310’和第二钳口6360’被保持在所述闭合位置。然后，击发系统可被致动以将击发构件6340’朝远侧轴向推进穿过外科端部执行器6300’。击发构件6340’可具有被构造成能够可滑动地接合砧座6362’的开槽通路6374’的顶部突片部分6344’和适于可滑动地接纳在细长通道6312’中的开槽通路内的底座部分6342’。因此，这种击发构件构造用于在击发构件的击发期间(即，在钉的击发和夹在第一钳口6310’和第二钳口6360’之间的组织的切割期间)以所需的间距布置正向保持第一钳口6310’和第二钳口6360’。第一钳口盖6315’可移除地附接到细长通道6312’，并且第二钳口盖6363’可移除地附接到砧座6362’，以用于组装目的，以及防止组织和/或体液渗入第一钳口和第二钳口，而这可能阻碍或妨碍击发构件6340’的操作。
本文所述的外科端部执行器实施方案采用既相对于彼此又相对于轴轴线运动的钳口可提供优于其它外科端部执行器构造的各种优点，其中钳口中的一个是固定的并且不会运动，例如相对于轴轴线运动。在这种构造中，通常期望可运动钳口相对于固定钳口具有相对较大的运动范围，使得目标组织能够被操纵、定位并随后夹持在两个钳口之间。在两个钳口均可运动的实施方案中，每个钳口不需要大范围的运动来容纳目标组织在钳口之间的操纵、定位和夹持。例如，砧座的这种减少的运动可提供改进的组织定位。这种构造还可使枢转轴线和第一钉位置之间的距离能够被最小化。另外，即使在打开动作和闭合动作期间，击发构件也可以始终保持与可运动钳口(砧座和细长通道)接合。
图72至图79示出了另一种外科端部执行器6400，其被构造成能够可操作地附接到本文所述类型的细长轴组件，其限定了轴轴线SA-SA。外科端部执行器6400包括两个钳口，这两个钳口可相对于轴轴线SA-SA同时在打开位置和闭合位置之间运动。第一钳口和第二钳口可包括各种不同的外科相关的钳口构造。在所示的示例中，第一钳口6410包括被构造成能够在其中支撑外科钉仓6420的细长通道6412。如同在上文讨论的各种外科钉仓中一样，外科钉仓6420被构造成能够可操作地在其中支撑多个钉驱动器(未示出)，所述多个钉驱动器在其上可操作地支撑外科钉(未示出)。钉驱动器可运动地支撑在形成于外科钉仓6420中的对应驱动器凹坑内。钉驱动器在外科钉仓6420中的细长狭槽(未示出)的每一侧上布置成行，以容纳击发构件6440从中轴向通过。楔形滑动件(未示出)可运动地支撑在外科钉仓6420内，并且被构造成能够在击发构件6440从与外科钉仓6420的近侧端部相邻的起始位置和在外科钉仓6420的远侧部分内的结束位置被驱动时，由击发构件6440驱动接合。如上所述，当楔形滑动件沿远侧方向被驱动通过外科钉仓6420时，该楔形滑动件驱动地接触钉驱动器以将它们朝向仓平台表面(未示出)驱动。击发构件6440包括组织切割表面6446，当击发构件6440被朝远侧驱动时，该组织切割表面用于切割夹在钳口之间的组织。本文所述的各种类型的远侧击发梁(未示出)可操作地附接到击发构件6440以及中间击发轴部分2222或其它击发系统构造。中间击发轴部分2222驱动和回缩远侧击发梁的操作在上文已经详细讨论过，为了简明起见，将不再重复。在不脱离本发明的实质和范围的情况下，也可以使用其它的击发梁和击发系统构造(马达驱动的以及手动驱动的)来为击发构件提供动力。
所示的外科端部执行器6400还被构造用于围绕基本上横向于轴轴线SA-SA的关节运动轴线B-B进行选择性关节运动。如图72至图79中可看到的那样，外科端部执行器6400包括端部执行器安装组件6490，其适于枢转地安装到例如远侧轴框架，该远侧轴框架包括被构造成能够可旋转地接纳在端部执行器安装组件6490中的安装孔6492内的枢轴销。外科端部执行器6400可通过上述类型的关节运动锁以及第一和第二关节运动杆构造来进行关节运动。如图74中可看到的那样，一对凸轮板6500例如通过弹簧销6502不可运动地附接到端部执行器安装组件6490。如图74中可进一步看到的那样，每个凸轮板6500具有凸轮狭槽6504，该凸轮狭槽具有闭合楔形部分6505和打开楔形部分6507。闭合楔形部分6505由两个相反的闭合的凸轮表面6506形成，并且打开楔形部分6507由两个相反的开口凸轮表面6508形成。细长通道6412包括两个朝近侧延伸的致动器臂6416，每个致动器臂具有从其侧向突出的打开的耳轴销6418和闭合的耳轴销6419。打开的耳轴销6418和闭合的耳轴销6419被对应凸轮板6500的凸轮狭槽6504接纳。这种构造用于将第一钳口6410可运动地或枢转地轴颈连接到端部执行器安装组件6490。
所示的外科端部执行器6400还包括第二钳口6460，该第二钳口可包括砧座6462。所示的砧座6462包括砧座主体6464，该砧座主体包括细长狭槽6466和在其每一侧上形成的两个钉成形表面6468。砧座6462还具有近侧端部部分6470，该近侧端部部分包括从其突出的两个朝近侧延伸的致动器臂6472。每个致动器臂6472具有从其侧向突出的打开的耳轴销6474和闭合的耳轴销6476，所述打开的耳轴销和闭合的耳轴销也接纳在对应凸轮板6500的凸轮狭槽6504中。这种构造用于将第二钳口6460可运动地或枢转地轴颈连接到端部执行器安装组件6490。
第一钳口6410和第二钳口6460由本文公开的各种类型的闭合系统可运动地致动。例如，第一闭合驱动系统30可用于以本文所述的方式致动闭合套筒。闭合套筒260也可附接到端部执行器闭合套筒6572，该端部执行器闭合套筒可以上述方式通过双枢轴闭合套筒组件枢转地附接到闭合套筒。如上所述，例如，闭合套筒的轴向运动可通过致动闭合触发器来控制。如图77和图78中可看到的那样，端部执行器闭合套筒6572在端部执行器安装组件6490以及第一钳口6410的致动器臂6416和第二钳口6460的致动器臂6472上方延伸。当将闭合套筒6572朝远侧推进时，闭合套筒6572的远侧端部6574接触第一钳口6410的近侧端部6411和第二钳口6460的近侧端部6461，并且沿远侧方向DD运动第一钳口6410和第二钳口6460。当第一钳口6410和第二钳口6460朝远侧运动时，闭合耳轴6419,6476进入凸轮狭槽6504的闭合楔形部分6505，并且闭合凸轮表面6506使第一钳口6410和第二钳口6460朝向彼此进行凸轮运动到闭合位置(图73、图75、图77和图78)。
为了便于通过闭合套筒6572打开第一钳口6410和第二钳口6460，闭合套筒6572设置有两个向内延伸的打开突片6576，其被构造成能够在闭合套筒6572通过闭合系统沿近侧方向PD回缩时接合闭合耳轴6419,6476。如图72和图76中可看到的那样，当闭合套筒6572沿近侧方向PD运动时，打开突片6576也接触闭合耳轴6419,6476并沿近侧方向驱动闭合耳轴6419,6476。闭合耳轴6419,6476的朝近侧运动引起打开耳轴6418和6474进入凸轮板槽6504的打开楔形部分6507。开口凸轮表面6508与打开耳轴6418,6474相互作用，并引起致动器臂6416和6472在其相应的摇臂表面6417和6475上摇动打开，如图76和图79所示。与其中第一钳口和第二钳口均相对于轴轴线SA-SA运动的上述构造一样，闭合楔形部分6505和打开楔形部分6507可被构造成使得在对其施加闭合动作时，第一钳口和第二钳口以相对于彼此不同的闭合速率或闭合时间闭合。
图80至图84示出了另一外科端部执行器7400，其包括两个钳口，其中一个钳口可相对于另一个钳口在打开位置和闭合位置之间运动。在所示的示例中，第一钳口7410包括砧座7412。所示的砧座7412具有砧座主体7414，该砧座主体具有不可运动地附接到端部执行器安装组件7430的近侧端部部分7416。例如，近侧端部部分7416包括两个直立侧向壁7418，每个直立侧向壁都具有安装孔7419。参见图82。端部执行器安装组件7430被接纳在直立侧向壁7418之间，并且通过弹簧销7421不可运动地与其附接，该弹簧销延伸穿过其中进入孔7419。端部执行器安装组件7430适于枢转地安装到例如远侧轴框架，该远侧轴框架包括被构造成能够可旋转地接纳在端部执行器安装组件7430中的安装孔7432内的枢轴销。在不脱离本发明的实质和范围的情况下，外科端部执行器7400可通过上述类型的关节运动锁以及第一和第二关节运动杆构造或者通过本文所述的各种关节运动系统和关节运动杆和/或杆/缆线构造中的任一种进行关节运动。如图80和图82中也可看到的那样，砧座主体7414还包括细长狭槽7422，该细长狭槽具有在其每一侧上形成的两个钉成形表面7424。
外科端部执行器7400还包括第二钳口7440，该第二钳口包括被构造成能够在其中支撑外科钉仓7450的细长通道7442。如同在上文讨论的某些外科钉仓中一样，外科钉仓7450被构造成能够可操作地在其中支撑多个钉驱动器(未示出)，所述多个钉驱动器在其上可操作地支撑外科钉(未示出)。钉驱动器可运动地支撑在形成于外科钉仓7450中的对应驱动器凹坑7452内。钉驱动器在外科钉仓7450中的细长狭槽7454的每一侧上布置成行，以容纳击发构件7460从中轴向通过。仓盘7451附接到钉仓7450，以防止当外科端部执行器7400被操纵成各种取向时钉驱动器从其相应的驱动器凹坑7452脱落。楔形滑动件7462可运动地支撑在外科钉仓7450内，并且被构造成能够在击发构件7460从与外科钉仓7450的近侧端部相邻的起始位置和在外科钉仓7450的远侧部分内的结束位置被驱动时，由击发构件7460驱动接合。如上所述，当楔形滑动件7462沿远侧方向被驱动通过外科钉仓7450时，楔形滑动件7462驱动地接触钉驱动器以将它们朝向仓平台表面(未示出)驱动。击发构件7460包括组织切割表面7464，当击发构件7460被朝远侧驱动时，该组织切割表面用于切割夹在钳口7410,7440之间的组织。远侧击发梁280或本文所述的其它各种类型的远侧击发梁可操作地附接到击发构件7460以及中间击发轴部分2222或其它击发系统构造。中间击发轴部分2222驱动和回缩远侧击发梁280的操作在上文已经详细讨论过，为了简明起见，将不再重复。在不脱离本发明的实质和范围的情况下，也可以使用其它的击发梁和击发系统构造(马达驱动的以及手动驱动的)来为击发构件提供动力。第一钳口盖7415可移除地附接到砧座7412，第二钳口盖7441可移除地附接到第二钳口7440，以用于组装目的，以及防止组织和/或体液渗入第一钳口和第二钳口中，而这可能阻碍或妨碍击发构件6340的操作。
如图82中可看到的那样，细长通道7442包括具有两个侧向侧部分7445的近侧端部部分7444。每个侧向侧部分7445在其中具有对应的U形或端部开口的狭槽7446，其适于接纳从砧座主体7414的近侧端部部分7416侧向突出的对应枢轴销7426。这种构造用于将第二钳口7440或细长通道7442可运动地或枢转地轴颈连接到第一钳口7410或砧座7412。如可以在图80、图82和图84中最具体地看到的那样，闭合斜坡段7447形成在细长通道7442的近侧端部7444上。另外，近侧端部部分7444的每个侧向侧7445具有在其中形成的侧向凹陷区域7448。每个侧向凹陷区域7448定位在对应的闭合斜坡段7447的近侧。邻近每个侧向凹陷区域7448的近侧端部形成打开的斜坡或凸轮7449。每个打开的斜坡或凸轮7449终止于顶表面7580。参见图82和图84。
第二钳口7440或细长通道7442可通过本文公开的各种类型的闭合系统相对于第一钳口7410或砧座7412被可运动地致动。例如，本文所述类型的闭合驱动系统可用于致动本文所述类型的闭合套筒，如上文所详细讨论的。闭合套筒也可附接到端部执行器闭合套筒7572，该端部执行器闭合套筒可以上述方式通过双枢轴构造枢转地附接到闭合套筒。如上所述，例如，闭合套筒的轴向运动可通过致动闭合触发器来控制。在其它构造中，闭合套筒可以借助于机器人控制系统等等轴向地运动。如图80、图81、图83和图84中可看到的那样，端部执行器闭合套筒7572在端部执行器安装组件7430以及第二钳口7440的细长通道7442的近侧端部部分7444上方延伸。端部执行器闭合套筒7572包括两个沿直径相对的打开构件7574，其被构造成能够可操作地接合第二钳口7440或细长通道7442的近侧端部部分7444。在所示的实施方案中，打开构件7574包括向内延伸的打开突片7576，其形成在端部执行器闭合套筒7572的部分中。
通过将端部执行器闭合套筒7572沿远侧方向DD推进，第二钳口7440运动到闭合位置(图81和图83)。当端部执行器闭合套筒7572朝远侧运动时，其远侧端部7575接触形成在细长通道7442的近侧端部7444上的闭合斜坡段7447，并用于使细长通道7442朝向砧座7412进行凸轮运动。一旦端部执行器闭合套筒7552已经运动到其最远侧位置，则远侧端部7575接触细长通道7442上的邻接表面7443以维持细长通道7442上的闭合载荷或闭合力。参见图81和图83。当端部执行器闭合套筒7572处于完全闭合位置时，打开突片7576的端部被接纳在对应的侧向凹陷区域7448中。为了将第二钳口7440或细长通道7442运动到打开位置，致动闭合系统以使闭合套筒7572沿近侧方向PD运动。当端部执行器闭合套筒7572朝近侧运动时，打开突片7572将对应的打开斜坡或凸轮7449向上搭接到细长通道7442的近侧端部部分7444上，以使细长通道7442远离砧座7412进行凸轮运动或枢转。每个突片将凸轮7449向上搭接到顶表面7580上，并用于将细长通道7442正向保持在该完全打开位置。参见图84。
图85至图87示出了另一外科端部执行器8400，该外科端部执行器包括两个钳口8410,8440，这两个钳口可相对于轴轴线SA-SA同时在打开位置和闭合位置之间运动。在所示的示例中，第一钳口8410包括砧座8412。所示的砧座8412具有砧座主体8414，该砧座主体具有与端部执行器适配器8600可运动地交接的近侧端部部分8416。如图85中可看到的那样，端部执行器适配器8600包括两个朝远侧延伸的远侧壁8602，每个远侧壁具有从其侧向突出的侧向枢轴销8604。每个侧向枢轴销8604被接纳在对应的端部开口的U形狭槽8418中，该狭槽形成于砧座8412的近侧端部部分8416的侧向侧壁8417中。参见图85。这种构造允许细长通道8412相对于端部执行器适配器8600运动或枢转。如图85中可进一步看到的那样，端部执行器适配器8600不可运动地附接到端部执行器安装组件8430。例如，端部执行器适配器8600还包括两个直立侧向壁8606，每个直立侧向壁中都具有安装孔8608。端部执行器安装组件8430被接纳在直立侧向壁8606之间，并且通过弹簧销8421不可运动地与其附接，该弹簧销延伸穿过其中进入孔8608。执行器安装组件8430适于枢转地安装到例如远侧轴框架，该远侧轴框架包括被构造成能够可旋转地接纳在端部执行器安装组件8430中的安装孔8432内的枢轴销。在不脱离本发明的实质和范围的情况下，外科端部执行器8400可通过上述类型的关节运动锁以及第一和第二关节运动杆构造或者通过本文所述的各种关节运动系统和关节运动杆和/或杆/缆线构造中的任一种进行关节运动。如图85中也可看到的那样，砧座主体8414还包括细长狭槽8422，该细长狭槽具有在其每一侧上形成的两个钉成形表面8424。
外科端部执行器8400还包括第二钳口8440，该第二钳口包括被构造成能够在其中支撑外科钉仓8450的细长通道8442。如同在上文讨论的各种外科钉仓中一样，外科钉仓8450被构造成能够可操作地在其中支撑多个钉驱动器(未示出)，所述多个钉驱动器在其上可操作地支撑外科钉(未示出)。钉驱动器可运动地支撑在形成于外科钉仓8450中的对应驱动器凹坑8452内。钉驱动器在外科钉仓8450中的细长狭槽8454的每一侧上布置成行，以容纳击发构件8460从中轴向通过。仓盘8451附接到钉仓8450，以防止当外科端部执行器8400被操纵成各种取向时钉驱动器从其相应的驱动器凹坑8452脱落。楔形滑动件8462可运动地支撑在外科钉仓8450内，并且被构造成能够在击发构件8460从与外科钉仓8450的近侧端部相邻的起始位置和在外科钉仓8450的远侧部分内的结束位置被驱动时，由击发构件8460驱动接合。如上所述，当楔形滑动件8462沿远侧方向被驱动通过外科钉仓8450时，楔形滑动件8462驱动地接触钉驱动器以将它们朝向仓平台表面(未示出)驱动。击发构件8460包括组织切割表面8464，当击发构件8460被朝远侧驱动时，该组织切割表面用于切割夹在钳口8410,8440之间的组织。远侧击发梁280或本文所述的其它各种类型的远侧击发梁可操作地附接到击发构件8460以及中间击发轴部分2222或其它击发系统构造。中间击发轴部分2222驱动和回缩远侧击发梁280的操作在上文已经详细讨论过，为了简明起见，将不再重复。在不脱离本发明的实质和范围的情况下，也可以使用其它的击发梁和击发系统构造(马达驱动的以及手动驱动的)来为击发构件提供动力。第一钳口盖8415可移除地附接到砧座8412，并且第二钳口盖8441可移除地附接到第二钳口8440，以用于组装目的，以及防止组织和/或体液渗入第一钳口和第二钳口，而这可能阻碍或妨碍击发构件8460的操作。
如图85中可看到的那样，细长通道8442包括具有两个侧向侧部分8445的近侧端部部分8444。每个侧向侧部分8445在其中具有对应的U形或端部开口的狭槽8446，其适于接纳从端部执行器适配器8600侧向突出的对应侧向枢轴销8604。这种构造用于将第二钳口8440或细长通道8442可运动地或枢转地轴颈连接到第一钳口8410或砧座8412。如图85中也可看到的那样，闭合斜坡段8447形成在细长通道8442的近侧端部8444上。另外，近侧端部部分8444的每个侧向侧8445具有在其中形成的第二侧向凹陷区域8448。每个第二侧向凹陷区域8448定位在对应的第二闭合斜坡段8447的近侧。邻近每个第二侧向凹陷区域8448的近侧端部形成第二打开的斜坡或凸轮8449。每个第二打开的斜坡或凸轮8449终止于第二顶表面8450。类似地，第一凹陷区域8420形成在砧座8412的近侧端部部分8416的每个侧壁8417的底部上。邻近每个第一侧向凹陷区域8420的近侧端部形成第一打开的斜坡或凸轮8426。每个第一打开的斜坡或凸轮8426终止于第一顶表面8428。
第二钳口8440或细长通道8442和第一钳口8410或砧座8412可通过本文公开的各种类型的闭合系统同时在打开位置和闭合位置之间运动。例如，闭合驱动系统30可用于以本文所述的方式致动闭合套筒260。闭合套筒260也可附接到端部执行器闭合套筒8572，该端部执行器闭合套筒可以上述方式通过双枢轴构造枢转地附接到闭合套筒260。如上所述，例如，闭合套筒260的轴向运动可通过致动闭合触发器32来控制。在其它构造中，闭合套筒可以借助于机器人控制系统等轴向地运动。如图86和图87中可看到的那样，端部执行器闭合套筒8572在端部执行器安装组件8430、端部执行器适配器8600以及第二钳口8440的细长通道8442的近侧端部部分8444和第一钳口8410或砧座8412的近侧端部部分8416上方延伸。端部执行器闭合套筒8572包括两个沿直径相对的第一打开构件8574，其被构造成能够可操作地接合第一钳口8410的近侧端部部分8416。在所示的实施方案中，第一打开构件8574包括向内延伸的第一打开突片8576，其形成在端部执行器闭合套筒8572的部分中。同样，端部执行器闭合套筒8572还包括两个沿直径相对的第二打开构件8580，其被构造成能够可操作地接合第二钳口8440的近侧端部部分8444。在所示的实施方案中，第二打开构件8580包括向内延伸的第二打开突片8582，其形成在端部执行器闭合套筒8572的部分中。
通过将端部执行器闭合套筒8572沿远侧方向DD推进，第一钳口8410和第二钳口8440同时运动到闭合位置(图86)。当端部执行器闭合套筒8572朝远侧运动时，其远侧端部8575接触第一钳口8410或砧座8412的近侧端部部分8416的底部以及形成在细长通道8442的近侧端部8444上的闭合斜坡段8447，并且用于使第一钳口8410和第二钳口8440朝向彼此进行凸轮运动。一旦端部执行器闭合套筒8572已经运动到其最远侧位置，端部执行器闭合套筒8572的远侧端部8575就接触第一钳口8410或砧座8412上的第一邻接表面8419以及第二钳口8440或细长通道8442上的第二邻接表面8443，以维持两个钳口8410,8440上的闭合载荷或闭合力。参见图86。当端部执行器闭合套筒8572处于完全闭合位置时，第一打开突片8576的端部接纳在对应的第一侧向凹陷区域8420中，并且第二打开突片8582的端部接纳在对应的第二侧向凹陷区域8448中。为了使第一钳口8410和第二钳口8440远离彼此运动到打开位置，致动闭合系统以使闭合套筒8572沿近侧方向PD运动。当端部执行器闭合套筒8572朝近侧运动时，第一打开突片8576将对应的第一打开斜坡或凸轮8426向上搭接到第一钳口8410的近侧端部部分8416的底部上，以使第一钳口8410或砧座8412沿远离第二钳口8440或细长通道8442的方向进行凸轮运动或枢转，并且第二打开突片8582将对应的第二斜坡8449向上搭接到细长通道8442的近侧端部部分8444上，以使细长通道8442沿远离第一钳口或砧座8412的方向进行凸轮运动或枢转。第一突片8576中的每一者将对应的凸轮或斜坡8426向上搭接到对应的第一锁定表面8428上，并且第二突片8582中的每一者将对应的第二凸轮或斜坡8449向上搭接到对应的第二锁定表面8450上，从而将第一钳口8410和第二钳口8400保持在打开位置。读者将会理解，第一突片8576相对于第二突片8582的轴向位置可定位成使得第一钳口和第二钳口同时远离彼此运动，或者它们可以轴向地偏移使得一个钳口在另一个钳口运动之前运动。
图88至图93示出了另一种外科器械9010的部分，该另一种外科器械包括与细长轴组件9200可操作地交接的外科端部执行器9300。外科端部执行器9300类似于上文所详细讨论的外科端部执行器300，并且包括细长通道9302形式的第一钳口，该第一钳口被构造成能够在其中可操作地支撑外科钉仓304。所示的外科端部执行器9300还包括砧座310形式的第二钳口，该第二钳口被支撑在细长通道9302上以相对于其运动。砧座310可通过上述闭合系统可运动地被致动，并在图88和图91中示出。例如，第一闭合驱动系统可用于以本文所述的方式致动闭合套筒260。闭合套筒260附接到端部执行器闭合套筒272，该端部执行器闭合套筒以上述方式通过双枢轴闭合套筒组件271枢转地附接到闭合套筒260。如上所述，例如，闭合套筒260的轴向运动可通过致动闭合触发器来控制。也如上所述，闭合套筒272包括用于将砧座310可运动地致动到打开位置的开口凸轮。在使用中，闭合套筒260朝远侧(方向DD)平移，以(例如)响应于闭合触发器的致动而闭合砧座310。通过沿远侧方向“DD”朝远侧平移闭合套筒260以及枢转地与其联接的端部执行器闭合套筒272来闭合砧座310。当端部执行器闭合套筒272被朝远侧驱动时，开口凸轮354的凸轮突片358在砧座310中的凸轮狭槽318内朝远侧运动，以可操作地交接或跨置在凸轮表面319上，从而使砧座310的主体部分312远离外科钉仓304进行凸轮运动而进入打开位置。通过沿远侧方向DD朝远侧平移闭合套筒260来闭合砧座310，直到端部执行器闭合套筒272的远侧端部275将砧座附接臂316向上搭接以接触，这导致凸轮突片358沿近侧方向PD移入凸轮表面319上的凸轮狭槽318内，从而使砧座310枢转到打开位置。
如图91中可看到的那样，细长轴组件9200包括两件式轴框架或脊组件9812，闭合套筒组件260被接纳在该轴框架或脊组件上。脊组件9812包括近侧脊部分9814和远侧脊部分9816。近侧脊部分9816可以本文所述的各种方式可旋转地轴颈连接在柄部或外壳(未示出)中，以便于外科端部执行器9300围绕轴轴线SA旋转。尽管未示出，但外科器械9010还可包括击发梁构造和本文公开的各种击发驱动系统构造中的任一种，用于以上文讨论的各种方式驱动击发构件通过外科钉仓。如图91中可看到的那样，远侧脊部分9816包括其上具有向上突出的枢轴销9819的远侧端部部分9818，该枢轴销适于枢转地接纳在形成于细长通道9302的近侧端部部分9320中的枢轴孔9328内。这种构造有助于外科端部执行器9300的细长通道9302围绕由枢轴孔9328限定的关节运动轴线B-B相对于脊组件9812枢转行进。如上所述，关节运动轴线B-B横向于由细长轴组件9200所限定的轴轴线SA-SA。
仍然参见图91，细长轴组件9200还包括通常标示为9900的关节运动系统，其包括第一关节运动棒9910和第二关节运动棒9920。第一关节运动棒9910与第一关节运动马达9912可操作地交接，该第一关节运动马达可操作地支撑在机器人控制系统的外科器械柄部或外壳或部分中。如图92和图93中可看到的那样，第一关节运动棒9910附接至第一关节运动螺母9914，该第一关节运动螺母可通过螺纹接纳在第一关节运动马达9912的第一螺纹驱动轴9916上。第一螺纹驱动轴9916沿第一旋转方向的旋转将导致第一关节运动杆9910沿近侧方向DD朝远侧推进，并且第一螺纹驱动轴9916沿第二或相反旋转方向的旋转将导致第一关节运动驱动杆9910沿近侧方向PD朝近侧推进。
所示的关节运动系统9900还包括第二关节运动棒9920，该第二关节运动棒与第二关节运动马达9922可操作地交接，该第二关节运动马达可操作地支撑在机器人控制系统的外科器械柄部或外壳或部分中。如图92和图93中可看到的那样，第二关节运动棒9920附接至第二关节运动螺母9924，该第二关节运动螺母可通过螺纹接纳在第二关节运动马达9922的第二螺纹驱动轴9926上。第二螺纹驱动轴9926沿第一旋转方向的旋转将导致第二关节运动杆9920沿近侧方向PD朝近侧推进，并且第二螺纹驱动轴9926沿第二或相反旋转方向的旋转将导致第二关节运动驱动杆9920沿远侧方向DD朝远侧推进。
关节运动系统9900还包括可操作地附接到第一关节运动棒9910和第二关节运动棒9920的交联组件9940。如图91中可看到的那样，交联组件9940包括中间支撑构件9950，该中间支撑构件利用第一销9952枢转地销接到细长通道9302的近侧端部9320。中间支撑构件9950还包括近侧连接器突片9954，其包括用于在其中接纳第二销9958的狭槽9956，以将近侧连接器突片9954枢转地附接到远侧脊部9816的远侧端部部分9818。销和狭槽的构造有利于中间支撑构件9950相对于脊组件9812的枢转和轴向行进。中间支撑构件9950还包括用于接纳穿过其的击发梁的狭槽9960。中间支撑构件9950用于在击发梁挠曲以容纳外科端部执行器9300的关节运动时为击发梁提供侧向支撑。
如图92和图93中最具体可看到的那样，中间支撑构件9950具有有利于将第一关节运动棒9910和第二关节运动棒9920附接至其的近侧连杆突片部分9970。具体地，第一关节运动棒9910的远侧端部9911枢转地附接到第一关节运动连接件9972，该第一关节运动连接件枢转地销接到近侧连杆突片部分9970。同样，第二关节运动棒9920的远侧端部9921枢转地销接到第二关节运动连接件9974，该第二关节运动连接件枢转地销接到中间支撑构件9950的近侧连杆突片部分9970。图92示出了外科端部执行器9300沿箭头9980所示的方向的关节运动。如该图中可看到的那样，第一关节运动马达的第一螺纹驱动轴9916沿第一旋转方向旋转，以沿远侧方向驱动第一关节运动棒9910。此外，第二关节运动马达9922的第二螺纹驱动轴9926沿第二旋转方向旋转，以沿近侧方向拉动第二关节运动棒9920。第一关节运动马达9912和第二关节运动马达9922由计算机控制的系统操作，并且如图92中可看到的那样，第一关节运动杆9910沿远侧方向运动的距离不等于第二关节运动杆9920沿近侧方向运动的距离。
图93示出了外科端部执行器9300沿箭头9982所示的方向的关节运动。如该图中可看到的那样，第二关节运动马达9922的第二螺纹驱动轴9926沿第一旋转方向旋转，以沿远侧方向驱动第二关节运动棒9920。此外，第一关节运动马达9912的第一螺纹驱动轴9916沿第二旋转方向旋转，以沿近侧方向拉动第一关节运动棒9910。第一关节运动马达9912和第二关节运动马达9922由计算机控制的系统操作，并且如图92中可看到的那样，第二关节运动杆9920沿远侧方向运动的距离不等于第一关节运动杆9910沿近侧方向运动的距离。在另选的构造中，可仅使用一个关节运动马达来使端部执行器进行关节运动。在此类构造中，例如，第二连接件可通过类似于本文中详细公开的那些齿条和小齿轮构造的齿条和小齿轮构造而在近侧联接到第一连接件。
图94和图95示出了外科钉仓9304和9304'，所述外科钉仓各自包括用于照明支撑其的外科端部执行器的远侧端部的灯构件9305。钉仓9304,9304’中的每一者可具有被布置在仓底部或仓侧上的导体(未示出)，所述导体被构造成能够与细长通道中的与定位在器械柄部或外壳中的电能来源连通的对应导体电接触。因此，当仓9304,9304’正确安置在外科端部执行器的细长通道中时，其中的灯9305可通过对应导体从柄部或外壳中的电源接收电功率。
图96至图105示出了另一外科器械10010的部分，该另一外科器械包括与细长轴组件10200可操作地交接的外科端部执行器10300，该细长轴组件采用本文公开的各种轴组件的多个特征。外科端部执行器10300可基本上包括本文所述的各种端部执行器中的任何一种，或者它可包括被构造成能够执行其他外科动作/手术的其他形式的外科端部执行器。例如，在所示的构造中，外科端部执行器10300适于切割并缝合组织并且包括细长通道10302形式的第一钳口，该第一钳口被构造成能够可操作地支撑其中的外科钉仓10304。参见图96和图97。所示的外科端部执行器10300还包括砧座10310形式的第二钳口，该第二钳口被支撑在细长通道10302上以相对于其运动。参见图96。砧座10310可由本文所述的闭合驱动系统中的一个可运动地致动。例如，第一闭合驱动系统可用于以本文所述的方式致动闭合套筒260。闭合套筒260附接到端部执行器闭合套筒272，该端部执行器闭合套筒以本文所述方式中的任一种通过双枢轴闭合套筒组件271枢转地附接到闭合套筒260。如上所述，例如，闭合套筒260的轴向运动可通过致动闭合触发器来控制。当端部执行器闭合套筒272沿远侧方向D-D推进时，砧座10310被凸轮闭合。在至少一种构造中，当端部执行器闭合套筒272回缩到起始位置时，可采用弹簧(未示出)来将砧座10310枢转到打开位置。
如图96至图105中可看到的那样，外科端部执行器10300可围绕关节运动接头10270相对于细长轴组件10200进行关节运动。在所示的示例中，细长轴组件10200包括标示为10800的关节运动系统，其采用与上述关节运动锁350和810类似的关节运动锁10810。参见图97。关节运动锁10810的不同于例如关节运动锁810和/或关节运动锁350的部件并且为理解关节运动锁10810的操作可能所需的那些部件将在下面进一步详细讨论。如上所述，有关于关节运动锁350的另外细节可见于名称为“ARTICULATABLE SURGICAL INSTRUMENTCOMPRISING AN ARTICULATION LOCK”的美国专利申请序列号13/803,086，现为美国专利申请公布2014/0263541，其全部公开内容以引用方式并入本文。关节运动锁10810可被构造成能够并操作以选择性地将外科端部执行器10300锁定在各种关节运动位置。当关节运动锁10810处于其解锁状态时，这种构造使外科端部执行器10300能够相对于轴闭合套筒260旋转或做关节运动。
具体参见图96和图97，细长轴组件10200可包括脊210，所述脊被构造成能够：第一，可滑动地支撑其中的击发构件220；以及第二，可滑动地支撑围绕脊210延伸的闭合套筒260。脊210还可滑动地支撑近侧关节运动驱动器230。近侧关节运动驱动器230具有远侧端部231，该远侧端部被构造成能够可操作地接合关节运动锁10810。关节运动锁10810还包括以本文公开的各种方式附接到脊210的轴框架10812。如图97所示，轴框架10812被构造成能够可运动地支撑其中的远侧关节运动驱动器10820的近侧部分10821。远侧关节运动驱动器10820被可运动地支撑在细长轴组件10200内，以响应于对其施加的关节运动控制动作而沿远侧方向DD和近侧方向PD选择性纵向行进。
很多临床医生在外科手术过程中可能关注的一个特征是可关节运动的端部执行器与其枢轴点的净长度。这个尺寸会影响端部执行器在患者体内的受限空间中可实现的进入量。外科器械10010可被构造成能够解决该问题。例如，在所示的构造中，轴框架10812包括其上形成有枢轴销10818的远侧端部部分10814。枢轴销10818适于枢转地接纳在形成于端部执行器安装组件10390中的狭槽10395内，该端部执行器安装组件通过弹簧销10393或其他合适的构件附接到细长通道10302的近侧端部10303。枢轴销10818限定横向于轴轴线SA-SA的关节运动轴线B-B。这样的构造便于端部执行器10300围绕关节运动轴线B-B相对于轴框架10812的枢转行进(即，关节运动)以及细长通道10302相对于参考点(一个轴框架10812，例如，关节运动轴线B-B)的轴向行进或平移行进。如图99和图100中可看到的那样，关节运动系统10800还包括关节运动驱动齿轮10840，该关节运动驱动齿轮可旋转地支撑在轴10842上，该轴形成在轴框架10812上或以其他方式附接到轴框架。如图99和图100中可看到的那样，端部执行器安装组件10390具有形成在其上的关节运动齿轮轮廓10396，该关节运动齿轮轮廓被构造用于与关节运动驱动齿轮10840啮合接合。如尤其可在图97和图101至图103中可看到的那样，驱动销10844从关节运动驱动齿轮10840突出。驱动销10844被接纳在远侧关节运动驱动器10820中的狭槽10822内。因此，远侧关节运动驱动器10820沿近侧方向PD的运动(以本文所讨论的各种方式)将使关节运动驱动齿轮10840沿逆时针方向(图103中的箭头CCW)旋转，这反过来将使外科端部执行器10300沿箭头10848表示的方向进行关节运动。同样，远侧关节运动驱动器10820沿远侧方向DD的运动(以本文所讨论的各种方式)将使关节运动驱动齿轮10840沿逆时针方向(图102中的箭头CCW)旋转，这将使外科端部执行器10300沿箭头10849表示的方向进行关节运动。
仍然参见图99至图105，在至少一种构造中，关节运动齿轮轮廓10396的形状为椭圆形。关节运动齿轮轮廓10396的椭圆形构型连同狭槽10395来允许端部执行器10300在旋转或关节运动时平移(或轴向地运动)。椭圆形关节运动齿轮轮廓10396的偏心度允许关节运动驱动齿轮10840与齿轮轮廓10396之间的“中心至中心”距离减小，然后将该减小转换成端部执行器10300的平移。图101和103示出了处于非关节运动位置的外科端部执行器10300。换句话讲，由细长通道10302限定的端部执行器轴线EA与轴轴线SA-SA对准。如在本文中使用的，术语“与...对准”可表示与轴轴线SA-SA“同轴地对准”或者仅与轴轴线SA-SA平行。当处于该非关节运动位置时，细长通道10302占据一定量的空间(即，其可被称为“足迹”)。换句话讲，细长通道10302的远侧端部10309与销10818限定的关节运动轴线B-B相距第一距离D1(这里也可称为“非关节运动距离”)。参见图104。当外科端部执行器10300进行关节运动时，细长通道10302相对于轴框架10812，更具体地相对于关节运动轴线B-B朝近侧平移(图102和图103中的箭头TL)，使得细长通道10302的远侧端部10309与关节运动轴线B-B之间的距离D2(这里也可称为“关节运动距离”)小于距离D1。参见图105。当端部执行器10300处于关节运动位置时，外科端部执行器10300的这种减小的总长度允许更大的进入，并且当笔直时将保持相同的净长度。换句话讲，当端部执行器进行关节运动时，端部执行器中的第一钉与关节运动轴线之间的距离将减小，从而在处于关节运动构型时减小端部执行器的足迹。
图96至图105所示实施方案的外科端部执行器10300包括外科切割并缝合装置，该外科切割并缝合装置采用本文所述的各种类型和构型的击发梁220。然而，该实施方案的外科端部执行器10300可包括不切割和/或缝合组织的其他形式的外科端部执行器。在所示的构造中，中间支撑构件10950相对于轴框架10812被枢转地且可滑动地支撑。如图98中可看到的那样，中间支撑构件10950包括狭槽10952，该狭槽适于在其中接纳销10954，该销从脊210突出或附接到脊或形成在脊中。当外科端部执行器10300进行关节运动时，这种构造使得中间支撑构件10950能够相对于销10954枢转和平移。中间支撑构件10950还包括用于接纳穿过其的击发梁220的狭槽10960。中间支撑构件10950用于在击发梁220挠曲以适应外科端部执行器10300的关节运动时为击发梁提供侧向支撑。
图106至图108示出了另一外科器械11010的部分，该另一外科器械包括与细长轴组件11200可操作地交接的外科端部执行器11300，该细长轴组件可采用本文公开的各种轴组件的多个特征。外科端部执行器11300可基本上包括本文所述的各种端部执行器中的任何一种，或者它可包括被构造成能够执行其他外科动作/手术的其他形式的外科端部执行器。例如，在所示的构造中，外科端部执行器11300包括细长通道11302，该细长通道可适于例如支撑其中的外科钉仓。细长轴组件11200还包括脊11210，所述脊通过关节运动接头11270枢转地联接到细长通道11302。在所示的构造中，外科端部执行器11300的细长通道11302通过关节运动销11818联接到脊11210，该关节运动销被可运动地接纳在形成于细长通道11302中或端部执行器安装组件(未示出)中的细长关节运动狭槽11395内。销和狭槽构造便于细长通道11302相对于细长轴组件11200的脊11210的枢转行进和平移行进。关节运动销11818限定延伸穿过销11818的中心的关节运动轴线B-B，并且在图106至图108中突出显示，使得它横向于轴轴线SA-SA。脊11210可另外类似于上述脊210并且支撑如本文所述的击发构件和闭合套筒构造，并且为清楚起见在图106至图108中没有具体示出。
在所示的示例中，细长轴组件11200包括标示为11800的关节运动系统，其可包括与上述关节运动锁350、810和/或10810类似并且可以本文所述各种方式中的任一种致动的关节运动锁。关节运动系统11800包括远侧关节运动驱动器11820，该远侧关节运动驱动器可包括关节运动锁(未示出)的一部分或者可以以其他方式仅与关节运动控制系统交接，该关节运动控制系统被构造成使远侧关节运动驱动器11820沿远侧方向和近侧方向选择性地运动以使外科端部执行器11300进行关节运动。关节运动系统11800还包括中央关节运动连接件11900，该中央关节运动连接件可旋转地轴颈连接在关节运动销11818上，以围绕关节运动轴线B-B旋转。在所示的构造中，中央关节运动连接件11900具有三角形形状，该三角形形状限定三个端部部分11902、11904、11906。在所示实施方案中，关节运动系统11800还包括驱动器连接件11910，该驱动器连接件枢转地联接到远侧关节运动驱动器11820的端部以及中央关节运动连接件11900的端部11902。如将在下文更详细所述的，远侧关节运动驱动器11820沿近侧方向和远侧方向的运动将使中央关节运动连接件11900围绕关节运动轴线B-B旋转或枢转。
关节运动系统11800还包括端部执行器驱动器连接件11920，该端部执行器驱动器连接件具有第一端部11922，该第一端部枢转地联接到细长通道11302。端部执行器驱动器连接件11920的第二端部11924枢转地联接到中央关节运动连接件11900的端部11904。驱动器连接件11910附接到中央关节运动连接件11900的点和端部执行器驱动器连接件11920的第二端部11924附接到中央关节运动连接件11900的点可以沿着公共轴线OAS设置，但该轴线从关节运动轴线B-B偏移。参见图106。端部执行器驱动器连接件11920的第二端部11924在其上具有齿轮轮廓11926，该齿轮轮廓被构造用于与中央关节运动齿轮11930啮合接合，该中央关节运动齿轮可旋转地轴颈连接在关节运动销11818上。当远侧关节运动驱动器11820沿远侧方向DD运动时，中央关节运动连接件11900使端部执行器驱动器连接件11920的第二端部11924沿顺时针方向CW运动，同时保持与中央关节运动齿轮11930的啮合接合。关节运动驱动连接件11920沿顺时针方向的运动还使外科端部执行器11300相对于细长轴组件11200围绕关节运动轴线B-B沿顺时针方向运动。参见图107。相似地，远侧关节运动驱动器11820沿近侧方向的运动将使中央关节运动连接件11900沿逆时针CCW方向运动。中央关节运动连接件11900的这样的运动也使第二端部11924沿逆时针方向CCW运动，同时保持与中央关节运动齿轮11930的啮合接合。关节运动驱动器连接件11920沿逆时针方向的运动使外科端部执行器11300相对于细长轴组件11200沿逆时针方向围绕关节运动轴线B-B枢转。参见图108。
图106示出了相对于细长轴组件11200处于非关节运动位置的外科端部执行器11300。当处于该非关节运动位置时，细长通道11302的端部执行器轴线EA与轴轴线SA-SA基本上对准。换句话讲，由细长通道10302限定的端部执行器轴线EA与轴轴线SA-SA对准。如在本文中使用的，术语“与...对准”可表示与轴轴线SA-SA“同轴地对准”或者仅与轴轴线SA-SA平行。图107示出了外科端部执行器11300在相对于细长轴组件11200沿顺时针方向运动到完全关节运动位置之后的位置，其中端部执行器轴线EA与轴轴线SA-SA之间的角度11950为约九十度(90°)。图108示出了外科端部执行器11300在相对于细长轴组件11200沿逆时针方向运动到完全关节运动位置之后的位置，其中端部执行器轴线EA与轴轴线SA-SA之间的角度11950为约九十度(90°)。如图107和图108中也可看到的那样，细长轴组件11200的远侧端部11201在轴轴线SA的两侧上都有凹口以允许细长通道11302沿朝向轴轴线SA-SA的方向平移(由图107和108中的箭头TD表示)，以有效地缩短细长通道11302的远侧端部与关节运动轴线B-B之间的距离。这样的构造可表示对不能将端部执行器关节运动到相对于轴轴线九十度(90°)的位置(通过横向于轴线的180度路径)的现有关节运动接头构造的巨大改进。该实施方案还通过允许端部执行器在关节运动时朝向轴轴线平移而有效地减小端部执行器在进行关节运动时的足迹。
参见图106，可以观察到，当端部执行器11300处于非关节运动位置时，驱动器连接件11910在定位在轴轴线的一侧上的位置处联接到中央关节运动连接件11900的第一端部，并且端部执行器驱动器连接件11920的第二端部11924在定位在轴轴线的相对侧上的位置处附接到中央关节运动连接件11900的端部11904。中央关节运动齿轮构造用于使齿隙最小化并且用于将这样的力传递到关节运动销11818中，与相似尺寸的其他关节运动接头构造相比，这可以增大关节运动接头的整体强度。当执行需要在受限空间中进行横切并且难以进入目标软组织诸如在胸腔或盆腔中的各种外科手术时，通常需要将外科端部执行器相对于以相对高的角度附接到其上的轴进行关节运动的能力。现有端部执行器受到无法关节运动到相对于轴轴线大于四十五度(45°)的角度的影响。上述实施方案可以克服这些缺陷。
图109至图111示出了另一外科器械12010的部分，该另一外科器械包括与细长轴组件12200可操作地交接的外科端部执行器12300，该细长轴组件可采用本文公开的各种轴组件的多个特征。外科端部执行器12300可基本上包括本文所述的各种端部执行器中的任何一种，或者它可包括被构造成能够执行其他外科动作/手术的其他形式的外科端部执行器。例如，在所示的构造中，外科端部执行器12300包括细长通道12302，该细长通道可适于例如支撑其中的外科钉仓。细长轴组件12200还包括脊12210，所述脊通过关节运动接头12270枢转地联接到细长通道12302。在所示的构造中，外科端部执行器12300的细长通道12302被构造成能够延伸到脊12210的远侧端部部分12213中，并且通过关节运动系统12800可操作地联接到其上。
在所示的示例中，关节运动系统12800包括远侧关节运动驱动器12820，该远侧关节运动驱动器可枢转地联接到脊12210和细长通道12302。如图109中可看到的那样，远侧关节运动驱动器12820被构造成能够在轴轴线SA-SA的第一侧上可运动地延伸。此外，关节运动系统12800还包括在轴轴线SA的第二侧上附接到脊12210的第二关节运动连接件12900。当远侧关节运动驱动器12820沿远侧方向DD运动时，细长通道12302沿顺时针方向CW运动。在这样的关节运动期间，细长通道12302的近侧端部12303沿由箭头TD表示的方向平移以减小端部执行器足迹。参见图110。相似地，当远侧关节运动驱动器12820沿近侧方向PD运动时，细长通道12302沿逆时针CCW方向枢转。在这样的关节运动期间，细长通道12302的近侧端部沿由箭头TD表示的方向平移以减小关节运动期间的端部执行器足迹。
图109示出了相对于细长轴组件12200处于非关节运动位置的外科端部执行器12300。当处于该非关节运动位置时，细长通道12302的端部执行器轴线EA与轴轴线SA-SA基本上对准。换句话讲，由细长通道10302限定的端部执行器轴线EA与轴轴线SA-SA对准。如在本文中使用的，术语“与...对准”可以表示与轴轴线SA-SA“同轴地对准”或者仅仅与轴轴线SA-SA平行。图110示出了外科端部执行器12300在其已沿顺时针CW方向运动到相对于细长轴组件12200的完全关节运动位置之后的位置。图111示出了外科端部执行器12300在其已沿逆时针方向运动到相对于细长轴组件12200的完全关节运动位置之后的位置。
当执行需要在受限空间中进行横切并且难以进入目标软组织诸如在胸腔或盆腔中的各种外科手术时，通常需要将外科端部执行器相对于以相对高的角度附接到其上的轴进行关节运动的能力。然而，在现有端部执行器中，关节运动角度较大通常会在关节运动系统周围形成更大的力矩，可使该机构更容易弯曲或断裂。图112至图114中所描绘的实施方案包括可以解决现有的可关节运动的端部执行器的那些缺点的特征。图112至图114示出了另一外科器械13010的部分，该另一外科器械包括与细长轴组件13200可操作地交接的外科端部执行器13300，该细长轴组件可采用本文公开的各种轴组件的多个特征。细长轴组件13200限定轴轴线SA-SA。此外，外科端部执行器13300可基本上包括本文所述的各种端部执行器中的任何一种，或者它可包括被构造成能够执行其他外科动作/手术的其他形式的外科端部执行器。例如，在所示的构造中，外科端部执行器13300包括细长通道13302，该细长通道可适于例如支撑其中的外科钉仓。细长通道13302限定端部执行器轴线EA。细长轴组件13200还包括脊13210，所述脊通过关节运动接头13270枢转地联接到细长通道13302。在所示的构造中，外科端部执行器13300的细长通道13302通过关节运动销13818联接到脊13210，该关节运动销限定横向于轴轴线SA-SA的关节运动轴线B-B。在图112至图114中，关节运动轴线B-B可例如与关节运动销13818的中心轴线重合，并且在这些图中，每个图中基本上都会突出显示。脊13210可另外类似于上述脊210并且支撑如本文所述的击发构件和闭合套筒构造，并且为清楚起见在图112至图114中没有具体示出。
在所示的示例中，细长轴组件13200包括标示为13800的关节运动系统，其可包括与上述关节运动锁350、810和/或10810类似并且可以本文所述各种方式中的任一种致动的关节运动锁。关节运动系统13800包括远侧关节运动驱动器13820，该远侧关节运动驱动器可包括关节运动锁(未示出)的一部分或者可以以其他方式仅与关节运动控制系统交接，该关节运动控制系统被构造成使远侧关节运动驱动器13820沿远侧方向和近侧方向选择性地运动以使外科端部执行器13300围绕关节运动轴线B-B进行关节运动。关节运动系统13800还包括中央关节运动连接件13900，该中央关节运动连接件可旋转地轴颈连接在关节运动销13818上，以相对于细长轴组件13200的远侧端部围绕关节运动轴线B-B旋转。在所示的构造中，中央关节运动连接件13900具有三角形形状并且限定三个端部部分13902、13904、13906。在所示实施方案中，关节运动系统13800还包括中间驱动连接件13910，该中间驱动连接件枢转地联接到远侧关节运动驱动器13820的端部以及中央关节运动连接件13900的端部13902。如将在下文更详细所述的，远侧关节运动驱动器13820沿近侧方向和远侧方向的运动将使中央关节运动连接件13900围绕关节运动轴线B-B旋转。
关节运动系统13800还包括端部执行器驱动器连接件13920，该端部执行器驱动器连接件具有第一或远侧驱动器连接件端部13922，该第一或远侧驱动器连接件端部在其中具有狭槽13923。端部执行器附接构件或销13960附接到端部执行器13300且被接纳在狭槽13923中。这样的构造便于销13960在狭槽13923内的枢转的和可平移的或轴向的行进(由箭头AT表示)。端部执行器驱动器连接件13920的第二或近侧驱动器连接件端部13924枢转地联接到中央关节运动连接件13900的端部13904。中间驱动器连接件13910附接到中央关节运动连接件13900的点和端部执行器驱动器连接件13920的第二端部13924附接到中央关节运动连接件13900的点可以沿着公共轴线OAS设置，但该轴线从关节运动轴线B-B偏移。参见图112。端部执行器驱动器连接件13920的第二端部13924在其上具有齿轮轮廓13926，该齿轮轮廓被构造用于与形成在脊13210上或以其他方式附接到脊的齿轮轮廓13930啮合接合。当远侧关节运动驱动器13820沿近侧方向PD运动时，中央关节运动连接件13900使端部执行器13300相对于细长轴组件13200的远侧端部围绕关节运动轴线B-B沿逆时针方向CCW运动。在这样的运动期间，端部执行器驱动器连接件13920的第二端部11924保持与齿轮轮廓13930啮合接合。根据远侧关节运动驱动器13820的近侧行进的量，外科端部执行器13300可枢转到图113中所示的关节运动位置，其中端部执行器轴线EA垂直于轴轴线SA-SA(由图113中的角度13950表示)。相似地，远侧关节运动驱动器11820沿远侧方向DD的运动将使得端部执行器13300相对于细长轴组件13200的远侧端部围绕关节运动轴线B-B沿逆时针方向CCW运动。在这样的运动期间，端部执行器驱动器连接件13920的第二端部11924保持与齿轮轮廓13930啮合接合。根据远侧关节运动驱动器13820的远侧行进的量，外科端部执行器13300可枢转到图114中所示的关节运动位置，其中端部执行器轴线EA垂直于轴轴线SA-SA(由图114中的角度13952表示)。
如图112中可看到的那样，当处于非关节运动位置时，端部执行器轴线EA与轴轴线SA轴向地对准。此外，如图112至图114中可看到的那样，远侧关节运动驱动器13820以及中间驱动器13910各自被支撑用于沿轴线SA的一个侧向侧选择性纵向行进，并且端部执行器附接销13960定位在端部执行器轴EA的与轴轴线SA的第二侧向侧对应的次级侧向侧上。另选的实施方案可采用用于向中央关节运动连接件13900施加关节运动控制动作的其他装置。例如，缆线构造可直接附接到中央关节运动连接件，而不是远侧关节运动驱动器13820和13910。在这样的构造中，当定位在器械的柄部或外壳中的对应的关节运动系统张紧或拉动缆线时，中央关节运动连接件将枢转。在其他另选的实施方案中，远侧关节运动驱动器13820直接联接到中央关节运动连接件13900。例如，在这样的构造中，中央关节运动连接件13900在该连接处可包括狭槽而不是销，以实现关节运动轴线B-B的旋转。在另一实施方案中，端部执行器驱动连接件13920中的狭槽13923可被销连接件替代。为了实现外科端部执行器13300围绕关节运动轴线B-B的关节运动，端部执行器驱动器连接件13920上的齿轮轮廓13926是凸轮形的，以便保持与形成在脊13210上或以其他方式附接到脊13210的齿轮轮廓13390啮合接合。
图112至图114的实施方案比现有的构造更稳健，并且与不能适应端部执行器到相对于轴轴线九十度(90°)的位置(通过横向于轴轴线的180度路径)的关节运动的接头构造相比，提供更大范围的关节运动。该实施方案还可以通过允许端部执行器在关节运动时朝向轴轴线平移而有效地减小端部执行器在关节运动时的足迹。也可实现这种更大范围的关节运动，其中关节运动驱动器行程长度一般小于现有关节运动接头构造进行关节运动通常所需的行程长度。三角形中央关节运动连接件也可提供若干优点。三角形(三点)中央关节运动连接件将远侧关节运动驱动器(通过中间驱动连接件)、关节运动销和端部执行器驱动器连接件连接在一起。这种三角形的中央连接件可针对可能使得端部执行器不期望地关节脱位的力提供改善的阻力。这样的三角形连接件构造也可针对关节运动驱动器杆可能遇到的弯曲力提供更高的阻力。此外，由于中央关节运动连接件与细长轴组件的脊部分的直接连接，这样的构造也可经历减小的齿隙。在上述构造中，行星齿轮围绕定位在细长轴的远侧端部上的固定齿轮旋转。开槽的驱动器臂从行星齿轮延伸并产生力矩，该力矩使端部执行器以更高的角度进行关节运动，以减少关节驱动器的行程长度。狭槽允许端部执行器具有第二旋转中心。三角形中央关节运动连接件还减小了关节运动机构的屈曲载荷或系统的齿隙。行星齿轮越大，机械优势越多，但行星齿轮越小，关节运动越小，反之亦然。
当执行需要在受限空间中进行横切并且难以进入目标软组织诸如在胸腔或盆腔中的各种外科手术时，通常需要将外科端部执行器相对于以相对高的角度附接到其上的轴进行关节运动的能力。可商购获得的直线切割器通常不能相对于细长轴关节运动超过四十五度(45°)的角度。图115至图117示出了另一外科器械14010的多个部分，该另一外科器械能够向细长轴的两侧关节运动九十度(90°)并且提供比利用多个可商购获得的直线切割器构造可获得的相比更高的机械优势。如这些图中可看到的那样，外科器械14010包括与细长轴组件14200可操作地交接的外科端部执行器14300，该细长轴组件可采用本文公开的各种轴组件的多个特征。细长轴组件14200限定轴轴线SA-S。此外，外科端部执行器14300可基本上包括本文所述的各种端部执行器中的任何一种，或者它可包括被构造成能够执行其他外科动作/手术的其他形式的外科端部执行器。例如，在所示的构造中，外科端部执行器14300包括细长通道14302，该细长通道可适于支撑其中的外科钉仓。细长通道14302限定端部执行器轴线EA。细长轴组件14200可包括脊14210，所述脊通过关节运动接头14270枢转地联接到细长通道14302。在所示的构造中，外科端部执行器14300的细长通道14302通过关节运动销14818联接到脊14210，该关节运动销限定横向于轴轴线SA-SA的关节运动轴线B-B。在图115至图117中，关节运动轴线B-B可例如与关节运动销14818的中心轴线重合，并且在这些图中，每个图中基本上都会突出显示。脊14210可另外类似于上述脊210并且支撑如本文所述的击发构件和闭合套筒构造，并且为了清楚起见在图115至图117中没有具体示出。
在所示的示例中，细长轴组件14200包括标示为14800的关节运动系统，其可包括与上述关节运动锁350、810和/或10810类似并且可以本文所述各种方式中的任一种致动的关节运动锁。关节运动系统14800包括远侧关节运动驱动器14820，该远侧关节运动驱动器可包括关节运动锁(未示出)的一部分或者可以以其他方式仅与关节运动控制系统交接，该关节运动控制系统被构造成使远侧关节运动驱动器14820沿远侧方向和近侧方向选择性地运动以使外科端部执行器14300围绕关节运动轴线B-B进行关节运动。关节运动系统14800还包括中央连接件14900，该中央连接件通过连接销14902枢转地附接到脊14210。在所示的构造中，连接销14901限定中央连接件14900可围绕其枢转的连接件轴线LA，该连接件轴线从关节运动轴线B-B偏移。在图115至图117中，连接件轴线LA可与例如连接销14901的中心轴线重合，并且在这些图中，每个图中基本上都会突出显示，并且从关节运动轴线B-B偏移且与关节运动轴线B-B平行。如这些图中可看到的那样，在所示的构造中，中央关节运动连接件14900以非对称构型枢转地联接到脊14210。更具体地，中央关节运动连接件14900的第一端部14902与连接件轴线LA之间的第一距离小于中央关节运动连接件14900的第二端部14904与连接件轴线LA之间的第二距离。
在所示实施方案中，关节运动系统14800还包括中间驱动器连接件14910，该中间驱动其连接件枢转地联接到远侧关节运动驱动器14820的端部以及中央关节运动连接件14900的第一端部14902。关节运动系统14800还包括端部执行器驱动器连接件14920，该端部执行器驱动器连接件具有第一或远侧驱动器连接件端部14922，该第一或远侧驱动器连接件端部枢转地或可运动地联接到细长通道14302。端部执行器驱动器连接件14920的第二或近侧驱动器连接件端部14924枢转地联接到中央关节运动连接件14900的第二端部14904。在所示的构造中，中间连接件14910为三个连接件14910、14900和14920中的最短连接件，并且在至少一个构造中具有略微弓形形状。端部执行器驱动器连接件14920为三个连接件14910、14900和14920中的最长连接件，并且在至少一个构造中还具有略微弓形形状。当远侧关节运动驱动器14820沿远侧方向DD运动时，中央关节运动连接件14900使得端部执行器驱动器连接件14920相对于细长轴组件14200的远侧端部围绕关节运动轴线B-B沿逆时针方向CCW拉动端部执行器14300。参见图116。根据远侧关节运动驱动器14820的近侧行进的量，外科端部执行器14300可枢转到图116中所示的关节运动位置，其中端部执行器轴线EA垂直于轴轴线SA-SA(由图116中的角度14950表示)。相似地，远侧关节运动驱动器14820沿近侧方向PD的运动将使得端部执行器连接件14920相对于细长轴组件14200的远侧端部围绕关节运动轴线B-B沿逆时针方向CCW推动端部执行器14300。参见图117。根据远侧关节运动驱动器14820的远侧行进的量，外科端部执行器14300可枢转到图117中所示的关节运动位置，其中端部执行器轴线EA垂直于轴轴线SA-SA(由图117中的角度14952表示)。
如图115中可看到的那样，当处于非关节运动位置时，端部执行器轴线EA与轴轴线SA-SA轴向地对准。如在本文中使用的，术语“与...对准”可以表示与轴轴线SA-SA“同轴地对准”或者仅仅与轴轴线SA-SA平行。图115至图117的实施方案比现有构造更稳健，并且与不能将端部执行器关节运动到相对于轴轴线九十度(90°)的位置(通过横向于轴轴线的180度路径)的接头构造相比，提供更大范围的关节运动。该实施方案还可以通过允许端部执行器14300在关节运动时朝向轴轴线SA-SA平移而有效地减小端部执行器14300在关节运动时的足迹。在提供更大量的抗弯曲力的同时，也可获得更大范围的关节运动。到细长轴组件14200的脊14210的第二附接点(连接销14901)可以减少关节运动接头14270所经受的齿隙量。图115至图117的关节运动接头构造也可相对于使端部执行器14300进行关节运动所需的力的量提供大量的机械优势。此外，当非对称中央连接件14900旋转一百八十度(180°)时，可在关节脱位期间获得大量的机械优势。端部执行器驱动器连接件14920向前和向后平移，以使端部执行器14300围绕关节运动轴线B-B进行关节运动。当最小连接件(中间连接件14910)的远侧端部14914围绕其近侧端部(到远侧关节运动驱动器的附接点)旋转时，最小连接件(中间连接件14910)的近侧端部14912与远侧关节运动驱动器14820一起前后平移。当最小连接件14910的远侧端部14914枢转时，在中央(接地)连接件14900上形成杠杆效应，这产生关节运动力机械优势，同时减小关节运动系统所经受的齿隙。中央(接地)连接件14900围绕其销接位置(销14901)枢转以推动/拉动最长连接件(端部执行器驱动器14920)。最长连接件14920然后枢转以使端部执行器14300进行关节运动。
如上所述，当执行需要在受限空间中进行横切并且难以进入目标软组织诸如在胸腔或盆腔中的各种外科手术时，通常需要将外科端部执行器相对于以相对高的角度附接到其上的轴进行关节运动的能力。可商购获得的直线切割器通常不能相对于细长轴关节运动超过四十五度(45°)的角度。图118和图119示出了另一外科器械15010的多个部分，该另一外科器械能够向细长轴的一侧关节运动九十度(90°)，同时提供与利用多个可商购获得的直线切割器构造通常可获得的相比更高的机械优势。如这些图中可看到的那样，外科器械15010包括与细长轴组件15200可操作地交接的外科端部执行器15300，该细长轴组件可采用本文公开的各种轴组件的多个特征。细长轴组件15200限定轴轴线SA-SA。此外，外科端部执行器15300可基本上包括本文所述的各种端部执行器中的任何一种，或者它可包括被构造成能够执行其他外科动作/手术的其他形式的外科端部执行器。例如，在所示的构造中，外科端部执行器15300包括细长通道15302，该细长通道可适于支撑其中的外科钉仓。在未特别构造成切割并缝合组织的其他端部执行器实施方案中，元件15302可包括钳口或端部执行器的其他部分。细长通道15302限定端部执行器轴线EA。细长轴组件15200可包括脊15210，所述脊通过关节运动接头15270枢转地联接到细长通道15302。在所示的构造中，外科端部执行器15300的细长通道15302通过关节运动销15818联接到脊15210，该关节运动销限定横向于轴轴线SA-SA的关节运动轴线B-B。在图118和图119中，关节运动轴线B-B可例如与关节运动销15818的中心轴线重合，并且在这些图中，每个图中基本上都会突出显示。如这些图中可看到的那样，在所示的构造中，关节运动轴线B-B偏压到轴轴线SA-SA的一个侧向侧。换句话讲，关节运动轴线B-B不与轴轴线SA-SA或端部执行器轴线EA相交。脊15210可另外类似于上述脊210并且支撑如本文所述的击发构件和闭合套筒构造，并且为清楚起见在图118至图119中没有具体示出。
在所示的示例中，细长轴组件15200包括标示为15800的关节运动系统，其可包括与上述关节运动锁350、810和/或10810类似并且可以本文所述各种方式中的任一种致动的关节运动锁。关节运动系统15800包括远侧关节运动驱动器15820，该远侧关节运动驱动器可包括关节运动锁(未示出)的一部分或者可以以其他方式仅与关节运动控制系统交接，该关节运动控制系统被构造成使远侧关节运动驱动器15820沿远侧方向和近侧方向选择性地运动以使外科端部执行器15300围绕关节运动轴线B-B进行关节运动。关节运动系统15800还包括端部执行器连接件15900，该端部执行器连接件枢转地附接到远侧关节运动驱动器15820的远侧端部以及外科端部执行器15300的细长通道15302。因此，当远侧关节运动驱动器15820沿近侧方向PD运动时，外科端部执行器15300围绕关节运动轴线B-B沿逆时针CCW方向枢转。
如图118中可看到的那样，当处于非关节运动位置时，端部执行器轴线EA与轴轴线SA轴向地对准。如在本文中使用的，术语“与...对准”可表示与轴轴线SA-SA“同轴地对准”或者仅与轴轴线SA-SA平行。远侧关节运动驱动器15820沿近侧方向PD的推进将使得外科端部执行器15300沿逆时针方向围绕关节运动轴线B-B枢转。细长通道15302的近侧端部15305和脊15210的远侧端部15211成角度以使得外科端部执行器15300能够枢转到完全关节运动的位置，其中例如端部执行器轴线EA垂直于轴轴线SA(角度15952为九十度(90°))。参见图119。在一种构造中，外科端部执行器15300的近侧端部15305相对于所述端部执行器轴线EA以端部执行器角度15307取向，并且细长轴组件15200的远侧端部15211相对于轴轴线SA-SA以轴角度15213取向。在一种构造中，端部执行器角度15307等于轴角度15213。例如，端部执行器角度15307和轴角度15213均可为约四十五度(45°)。
图118和图119的实施方案还包括柔性关节脱位构件15910，该柔性关节脱位构件可附接到被构造成能够向关节脱位构件沿近侧方向PD选择性地仅施加拉动动作的外科器械的一部分。如图119中可看到的那样，关节脱位构件15910取向成在外科端部执行器15300的关节运动期间围绕关节运动销15818挠曲。在另选的构造中，关节脱位构件是弹性的并且附接到脊15210或位于靠近关节运动接头15270的位置处的外科端部执行器15300的其他部分以及附接到细长通道15302的近侧端部15305或外科器械15010的其他部分。柔性关节脱位构件可由例如弹簧回火不锈钢、塑性材料、尼龙等制成，并且可形成为扁平带或缆线，以帮助将外科端部执行器15300从关节运动位置关节脱位回到非关节运动位置。一旦临床医生期望将外科端部执行器15300返回到非关节运动取向，则远侧关节运动驱动器15820沿远侧方向DD运动，这将开始使外科端部执行器沿顺时针CW方向运动并使关节脱位构件15910沿近侧方向PD拉动。关节脱位构件15910还用于帮助将外科端部执行器沿顺时针CW方向拉动回到非关节运动位置。
图118和图119的实施方案与其他可商购获得的可关节运动的外科器械相比，可具有若干优点。例如，这样的构造在关节运动期间由于连接件的数量最小，可经历较低的齿隙。这样的构造还提供了比现有设计增大的关节运动角度。如上所述，外科端部执行器可包括本文所述的各种类型的外科缝合构造。这样的构造采用在端部执行器进行关节运动时经受一定量的挠曲的可轴向运动的击发构件或击发杆或击发梁。图118和图119的实施方案可以为击发构件提供由于非对称关节运动而改进的曲率半径。换句话讲，远侧关节运动驱动器15820以及端部执行器连接件15910定位到轴轴线SA-SA的一侧，这提供了更多的间隙，以便在关节运动期间实现击发构件的更渐进的挠曲。这种偏移的关节运动轴线构造，其沿横向于轴轴线的单个关节运动方向提供关节运动，在本文中也可称为“非对称”关节运动构造或系统，其可以促进相对高的关节运动角度。另外，在该实施方案中，关节运动轴线B-B从轴轴线侧向地偏移。在这样的实施方案中，当装置处于关节运动状态时，轴轴线和端部执行器轴线的相交点与端部执行器的远侧端部之间的距离较短，当装置处于非关节运动状态时，情况相反。
图120至图122示出了另一可关节运动的外科器械16010的部分，该另一可关节运动的外科器械包括与细长轴组件16200可操作地交接的外科端部执行器16300，该细长轴组件可采用本文公开的各种轴组件的多个特征。细长轴组件16200限定轴轴线SA-SA。此外，外科端部执行器16300可基本上包括本文所述的各种端部执行器中的任何一种，或者它可包括被构造成能够执行其他外科动作/手术的其他形式的外科端部执行器。例如，在所示的构造中，外科端部执行器16300包括细长通道16302，该细长通道可适于例如支撑其中的外科钉仓。在未特别构造成切割并缝合组织的其他端部执行器实施方案中，元件16302可包括钳口或端部执行器的其他部分。细长通道16302限定端部执行器轴线EA。细长轴组件16200可包括脊16210，所述脊通过关节运动接头16270枢转地联接到细长通道16302。在所示的构造中，外科端部执行器16300的细长通道16302包括朝近侧突出的附接臂16309，该朝近侧突出的附接臂弹簧销16818联接到脊16210，该弹簧销限定关节运动轴线B-B。关节运动轴线B-B横向于轴轴线SA-SA。在图121和图122中，关节运动轴线B-B可例如与弹簧销16818的中心轴线重合，并且在这些图中，每个图中基本上都会突出显示。如这些图中可看到的那样，在所示的构造中，关节运动轴线B-B偏压到轴轴线SA-SA的一个侧向侧。换句话讲，关节运动轴线B-B不与轴轴线SA-SA或端部执行器轴线EA相交。脊16210可另外类似于上述脊210并且支撑如本文所述的击发构件和闭合套筒构造，并且为清楚起见在图120至图122中没有具体示出。弹簧销16818被构造成能够向附接臂16309施加偏压力，以使附接臂16309以及外科端部执行器16300沿顺时针方向CW中偏压。因此，弹簧销16818用于将外科端部执行器16300偏压到图121所示的非关节运动位置，其中端部执行器轴线EA和轴轴线SA-SA轴向地对准。如在本文中使用的，术语“与...对准”可以表示与轴轴线SA-SA“同轴地对准”或者仅仅与轴轴线SA-SA平行。
在所示的示例中，细长轴组件16200还包括标示为16800的关节运动系统，其可包括与上述关节运动锁350、810和/或10810类似并且可以本文所述各种方式中的任一种致动的关节运动锁。关节运动系统16800包括远侧关节运动驱动器16820，该远侧关节运动驱动器可包括关节运动锁(未示出)的一部分或者可以以其他方式仅与关节运动控制系统交接，该关节运动控制系统被构造成使远侧关节运动驱动器16820沿远侧方向和近侧方向选择性地运动以使外科端部执行器16300围绕关节运动轴线B-B进行关节运动。远侧关节运动构件16820枢转地销接到细长通道16302的近侧端部16305。如图121中可看到的那样，远侧关节运动驱动器16820在位于轴轴线SA-SA和端部执行器轴线EA的一侧上的位置处销接到细长通道16302。关节运动轴线B-B定位在轴轴线的与远侧关节运动驱动器附接到细长通道16302的点相对的位置。如图121中可看到的那样，在所示的构造中，远侧关节运动驱动器16820附接到细长通道16302的点位于关节运动轴线B-B的远侧。当远侧关节运动驱动器15820沿近侧方向PD运动时，外科端部执行器16300围绕关节运动轴线B-B沿逆时针CCW方向枢转。
如图121中可看到的那样，当处于非关节运动位置时，端部执行器轴线EA与轴轴线SA轴向地对准。如在本文中使用的，术语“与...对准”可以表示与轴轴线SA-SA“同轴地对准”或者仅仅与轴轴线SA-SA平行。远侧关节运动驱动器16820沿近侧方向PD的推进将使得外科端部执行器16300沿逆时针方向围绕关节运动轴线B-B枢转。一旦临床医生期望将外科端部执行器16300返回到非关节运动取向，则远侧关节运动驱动器16820沿远侧方向DD运动，这将开始使外科端部执行器16300沿顺时针CW方向运动。弹簧销16818还用于帮助将外科端部执行器16300沿顺时针CW方向拉动回到非关节运动位置。
图123至图128示出了另一外科器械17010的多个部分，该另一外科器械包括与细长轴组件17200可操作地交接的外科端部执行器17300，该细长轴组件采用本文公开的各种轴组件的多个特征。外科端部执行器17300可基本上包括本文所述的各种端部执行器中的任何一种，或者它可包括被构造成能够执行其他外科动作/手术的其他形式的外科端部执行器。例如，在所示的构造中，外科端部执行器17300适于切割并缝合组织并且包括细长通道17302形式的第一钳口，该第一钳口被构造成能够可操作地支撑其中的外科钉仓17304。参见图123和图124。所示的外科端部执行器17300还包括砧座17310形式的第二钳口，该第二钳口被支撑在细长通道17302上以相对于其运动。参见图123。砧座17310可由本文所述的闭合系统中的一个可运动地致动。例如，第一闭合驱动系统可用于以本文所述的方式致动闭合套筒260。闭合套筒260附接到端部执行器闭合套筒272，该端部执行器闭合套筒以本文所述方式中的任一种通过双枢轴闭合套筒组件271枢转地附接到闭合套筒260。如上所述，例如，闭合套筒260的轴向运动可通过致动闭合触发器来控制。当端部执行器闭合套筒272沿远侧方向DD推进时，砧座17310被凸轮闭合。在至少一种构造中，当端部执行器闭合套筒272回缩到起始位置时，可采用弹簧(未示出)来将砧座17310枢转到打开位置。
如图123至图128中可看到的那样，外科端部执行器17300可以围绕关节运动接头17270相对于细长轴组件17200进行关节运动。在所示的示例中，细长轴组件17200包括标示为17800的关节运动系统，其采用与上述关节运动锁350、810、10810类似的关节运动锁17810。参见图124和图125。关节运动锁17810的不同于例如关节运动锁810和/或关节运动锁350和或关节运动锁10810的部件并且为理解关节运动锁17810的操作可能所需的那些部件将在下面进一步详细讨论。如上所述，有关于关节运动锁350的另外细节可见于名称为“ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK”的美国专利申请序列号13/803,086，现为美国专利申请公布2014/0263541，其全部公开内容以引用方式并入本文。关节运动锁17810可被构造成能够并操作以选择性地将外科端部执行器17300锁定在各种关节运动位置。当关节运动锁17810处于其解锁状态时，这样的构造使得外科端部执行器17300能够相对于轴闭合套筒260旋转或做关节运动。
具体参见图125，细长轴组件17200包括脊210，所述脊被构造成能够：第一，可滑动地支撑其中的击发构件(未示出)；以及，第二可滑动地支撑围绕脊210延伸的闭合套筒260(图123)。脊210还可滑动地支撑近侧关节运动驱动器230。近侧关节运动驱动器230具有远侧端部231，该远侧端部被构造成能够可操作地接合关节运动锁17810。关节运动锁17810还包括以本文公开的各种方式附接到脊210的轴框架17812。轴框架17812被构造成能够在其中运动地支撑远侧关节运动驱动器17820的近侧部分17821。远侧关节运动驱动器17820被可运动地支撑在细长轴组件17200内，以响应于对其施加的关节运动控制动作而沿从轴轴线SA-SA侧向地偏移且平行于轴轴线SA-SA的关节运动致动轴线AAA在远侧方向DD和近侧方向PD上选择性纵向行进。
仍然参见图124和图125，在所示的构造中，轴框架17812包括其上形成有枢轴销17818的远侧端部部分17814。枢轴销17818适于枢转地接纳在形成于端部执行器安装组件17390的枢轴基础部分17395中的枢轴孔17397内。端部执行器安装组件17390通过弹簧销17393或其他合适的构件附接到细长通道10302的近侧端部17303。枢轴销17818限定横向于轴轴线SA-SA的关节运动轴线B-B。这种构造便于端部执行器17300相对于轴框架17812围绕铰接轴线B-B枢转行进(即，关节运动)。
如图125中可看到的那样，连接销17825形成在远侧关节运动连接件17820的远侧端部17823上并且被构造成能够接纳在交叉连接件17900的近侧端部17902中的孔17904内。交叉连接件17900跨过轴轴线SA-SA横向地延伸并且包括远侧端部部分17906。远侧连接孔17908穿过交叉连接件17900的远侧端部部分17906设置，并且被构造成能够在其中可枢转地接纳从端部执行器安装组件17390的枢轴基部17395的底部延伸的基础销17398。基础销17395限定连接件轴线LA，该连接件轴线平行于关节运动轴线B-B。图124和图127示出了处于非关节运动位置的外科端部执行器17300。换句话讲，由细长通道17302限定的端部执行器轴线EA与轴轴线SA-SA对准。如在本文中使用的，术语“与...对准”可表示与轴轴线SA-SA“同轴地对准”或者仅与轴轴线SA-SA平行。远侧关节运动驱动器17820沿近侧方向PD的运动(以本文所讨论的各种方式)将使得交叉连接件17900围绕关节运动轴线B-B沿顺时针CW方向拉动外科端部执行器17300，如图126所示。远侧关节运动驱动器17820沿远侧方向DD的运动将使得交叉连接件17900使外科端部执行器17300围绕关节运动轴线B-B沿逆时针CCW方向运动，如图128所示。如该图中可看到的那样，交叉连接件17900具有弯曲形状，这允许当外科端部执行器17300沿该方向进行关节运动时，交叉连接件17900围绕关节运动销17818弯曲。当外科端部执行器17300在轴轴线SA-SA的任一侧上处于完全关节运动位置时，端部执行器轴线EA与轴轴线SA-SA之间的关节运动角度17700为约六十五度(65°)。因此，在轴轴线的任一个上的关节运动范围为一度(1°)至六十五度(65°)。
图123至图128所示实施方案的外科端部执行器17300包括外科切割并缝合装置，该外科切割并缝合装置采用本文所述的各种类型和构型的击发梁220。然而，该实施方案的外科端部执行器17300可包括不切割和/或缝合组织的其他形式的外科端部执行器。在所示的构造中，中间支撑构件17950相对于脊210被枢转地且可滑动地支撑。如图125中可看到的那样，中间支撑构件17950包括狭槽17952，该狭槽适于在其中接纳销17954，该销从脊210突出。当外科端部执行器17300进行关节运动时，这种构造使得中间支撑构件17950能够相对于销17954枢转和平移。枢轴销17958从中间支撑构件17950的下侧突出，以枢转地接纳在设置于端部执行器安装组件17390的基座部分17395中的对应的枢轴孔17399内。中间支撑构件17950还包括用于接纳穿过其的击发梁220的狭槽17960。中间支撑构件17950用于在击发梁220挠曲以适应外科端部执行器17300的关节运动时为击发梁提供侧向支撑。
图129至图131示出了另一外科器械18010的多个部分，该另一外科器械包括与细长轴组件18200可操作地交接的外科端部执行器18300，该细长轴组件采用本文公开的各种轴组件的多个特征。外科端部执行器18300适于切割并缝合组织并且包括细长通道18302形式的第一钳口，该第一钳口被构造成能够可操作地支撑其中的外科钉仓。所示的外科端部执行器18300还包括砧座18310形式的第二钳口，该第二钳口被支撑在细长通道18302上以相对于其运动。砧座18310可由本文所述的闭合系统中的一个可运动地致动。
细长轴组件18200包括轴脊18210，该轴脊限定与细长轴组件18200的中心重合的轴轴线SA-SA。换句话讲，轴轴线SA-SA沿细长轴组件18200的几何中心轴向向下延伸。脊18210可另外类似于上述脊210并且支撑如本文所述的击发构件和闭合套筒构造，并且为清楚起见在图129至图131中没有具体示出。如图131中可看到的那样，外科端部执行器18300可以围绕关节运动接头18270相对于细长轴组件18200进行关节运动。关节运动接头18270用于将细长通道18302联接到脊18210的远侧端部18215。外科端部执行器18300，更具体地，外科端部执行器18300的细长通道18302限定端部执行器轴线EA，该端部执行器轴线表示细长通道18302的轴向中心。当外科端部执行器18300处于非关节运动取向时，端部执行器轴线EA与轴轴线SA-SA轴向地对准，如图130所示。如在本文中使用的，术语“与...对准”可表示与轴轴线SA-SA“同轴地对准”或者仅与轴轴线SA-SA平行。在所示的构造中，外科端部执行器18300的细长通道18302包括朝近侧突出的附接臂18309，该朝近侧突出的附接臂通过弹簧销18818联接到脊18210，该弹簧销限定关节运动轴线B-B。关节运动轴线B-B横向于轴轴线SA-SA。在图130和图131中，关节运动轴线B-B可例如与弹簧销18818的中心轴线重合，并且在这些图中，每个图中基本上都会突出显示。如这些图中可看到的那样，在所示的构造中，关节运动轴线B-B偏移到轴轴线SA-SA的一个侧向侧18213。换句话讲，关节运动轴线B-B不与轴轴线SA或端部执行器轴线EA相交。弹簧销18818被构造成能够向附接臂18309施加偏压力，以使附接臂18309以及外科端部执行器18300沿顺时针方向CW偏压。因此，弹簧销18818用于将外科端部执行器18300偏压到图130所示的非关节运动位置，其中端部执行器轴线EA和轴轴线SA-SA轴向地对准。
所示的实施方案还包括标示为18800的关节运动系统，其采用与上述关节运动锁350、810、10810类似的关节运动锁18810。关节运动锁18810可被构造成能够并操作以选择性地将外科端部执行器18300锁定在各种关节运动位置。当关节运动锁18810处于其解锁状态时，这样的构造使得外科端部执行器18300能够相对于细长轴组件18200旋转或做关节运动。关节运动锁18810包括远侧关节运动驱动器18820，该远侧关节运动驱动器被可运动地支撑在细长轴组件18200内，以沿远侧方向DD和近侧方向PD选择性纵向行进。远侧关节运动驱动器18820能够响应于施加到其上的关节运动控制动作而沿侧向地偏移且平行于轴轴线SA-SA的关节运动致动轴线AAA运动。在另选的实施方案中，远侧关节运动驱动器18820不包括关节运动锁的一部分，而是与关节运动动作源(在柄部或机器人系统中)可操作地交接，该关节运动动作源用于使远侧关节运动驱动器18820沿远侧方向DD选择性地轴向推进并使远侧关节运动驱动器18820沿近侧方向PD回缩。远侧关节运动构件18820枢转地销接到细长通道18302的近侧端部18305。如图130中可看到的那样，远侧关节运动驱动器18820在位于轴轴线SA-SA和端部执行器轴线EA的一个侧向侧18211上的位置处销接到细长通道18302。关节运动轴线B-B定位在轴轴线SA-SA的与远侧关节运动驱动器18820附接到细长通道18302的点相对的侧向侧18213上。如图130中可看到的那样，在所示的构造中，远侧关节运动驱动器18820附接到细长通道18302的点位于关节运动轴线B-B的远侧。如图130中可看到的那样，当处于非关节运动位置时，端部执行器轴线EA与轴轴线SA-SA轴向地对准。远侧关节运动驱动器18820沿近侧方向PD的运动将使得外科端部执行器18300沿逆时针方向CCW围绕关节运动轴线B-B枢转。换句话讲，外科端部执行器18300能够关节运动到与脊18210的第一侧18211重合的轴轴线SA的一侧上的位置。一旦临床医生期望将外科端部执行器18300返回到非关节运动取向，则远侧关节运动驱动器18820沿远侧方向DD运动，这将开始使外科端部执行器18300沿顺时针方向CW运动。弹簧销16818还用于帮助将外科端部执行器18300沿顺时针CW方向拉动回到非关节运动位置。
图129至图131所示实施方案的外科端部执行器18300包括外科切割并缝合装置，该外科切割并缝合装置采用本文所述的各种类型和构型的击发梁18220。例如，在一种构造中，击发梁18220可为如本文所述的层压构造。在所示实施方案中，击发梁18220可滑动地支撑在形成于脊18210中的通路18230内，并且与本文所述的各种类型的击发系统交接，这些击发系统被构造成能够使击发梁18220沿远侧方向DD选择性地推进，并且使击发梁18220沿近侧方向PD回缩。击发梁18220的远侧端部联接到本文公开的各种类型的击发构件(未示出)或组织切割构件(未示出)或与其以其他方式可操作地交接。例如，在至少一种形式中，击发构件18220包括组织切割表面并且被构造成能够与钉支撑构件相互作用，这些钉支撑构件可操作地支撑在钉仓内，以在击发构件18220朝远侧驱动穿过钉仓时，将钉支撑构件(和支撑在其上的钉)朝向砧座驱动。
所示实施方案的关节运动接头18270便于外科端部执行器18300仅沿一个方向(CCW)关节运动。换句话讲，外科端部执行器18300能够枢转到与脊18210的第一侧向侧18211重合的关节运动位置。在一个示例中，外科端部执行器18300可关节运动到图131所示的完全关节运动位置，其中端部执行器轴线EA与轴轴线之间的角度18950为约七十五度(75°)。为了适应这个关节运动范围，脊18210的远侧端部18215具有与脊18210的第一侧18211相邻的凹口18217。
如上所述，击发梁18220可滑动地支撑在设置于脊18210中的通路18220内。在所示的构造中，通路18230包括与轴轴线SA-SA轴向地对准的“第一”或近侧部分18232，以及不轴向地对准于轴轴线SA-SA的“第二”或远侧部分18234。在所示实施方案中，通路18230的远侧部分18234在脊的远侧端部处在不与轴轴线SA-SA轴向地对准的位置处开放。例如，如图130和图131中可看到的那样，通路18230的远侧部分18234在侧向地偏移到并平行于轴轴线SA-SA的第二侧向侧18213的位置处(在图130和图131中标示为18236)开放。另外，在至少所示实施方案中，通路18230的远侧部分18234是弯曲的，以使得击发梁18220在击发梁18220离开脊18210之前开始沿关节运动方向弯曲。与沿一个方向进行关节运动的其他可关节运动的端部执行器构造的击发梁的弯曲半径相比，这样的构造为击发梁18220提供了更高的弯曲半径，并且其中击发梁离开脊18210，同时对准于轴轴线SA-SA。另外，在所示的构造中，通路18230包括与轴轴线SA-SA轴向地对准的第一或近侧部分18232、沿远离轴轴线SA-SA的第一方向弯曲的第二弓形部分18233和朝向轴轴线SA-SA弯曲的第三弓形段18235。如图130和图131中可看到的那样，击发梁18220离开脊18210的位置18236定位在与端部执行器18300关节运动到的第一侧18211相对的轴轴线SA-SA的第二侧18213上。因此，通路18230的远侧部分18234用于将击发梁18220定位或偏压到相对于轴轴线SA-SA的“偏离轴线位置”(不与轴轴线SA-SA轴向地对准的位置)。这样的构造在击发梁18220离开脊18210时为其提供渐弧形。该特征可用于降低击发梁18220在跨越关节运动接头18270进入外科端部执行器18300时屈曲的可能性。在其他构造中，通路的近侧部分可从轴轴线侧向地偏移。在其他构造中，通路的近侧部分可与轴轴线轴向地对准，并且通路的远侧部分可与轴轴线的一侧成一定角度，使得当击发梁离开通路的远侧部分时，击发梁轴轴向地偏移到端部执行器能够关节运动到的轴轴线的相对侧。在这种构造中，通路的远侧部分可以是相对直的而不是弯曲的。在其他构造中，通路的远侧部分和近侧部分可沿着公共轴线放置，该公共轴线在与端部执行器能够关节运动到的一侧相对的一侧上从轴轴线侧向地偏移。所有这样的构造使击发梁在离开脊时偏离中心并且允许更大的弯曲半径，而不增加关节运动轴线远侧的空间。
本文所公开的各种外科器械中采用的击发梁被构造成能够充分地挠曲以适应端部执行器的各种关节运动位置。在一些构造中，击发系统实际上可包括击发杆18600，该击发杆在联接件或互连件18702处联接到柔性击发梁18700。参见图132。击发杆18600可滑动地支撑在细长轴组件的脊18210中，并且可响应于例如在外科器械的柄部中发起的或由机器人系统发起的驱动动作而平移。在各种情况下，击发杆18600可抵制传输击发动作时的变形、扭转和/或弓弯。例如，击发杆18600可由刚性和/或非柔性材料和/或结构构成。
在联接件18702处，击发杆18600与柔性击发梁18700的向下突出的键18701接合(例如，参见图132A)。例如，键18701可延伸到形成于击发杆18600的远侧端部18604中的细长开孔18606内。击发杆-键接合被构造成能够将击发杆18600的平移传输到柔性击发梁18700。在各种情况下，联接件18702可位于关节运动接头18270的近侧，使得柔性击发梁18700从联接件18702延伸并且穿过关节运动接头18270。
在图133、图135所描绘的构造中，柔性击发梁18700包括多个侧向部分或多个层18702a、18702b、18702c、18702d、18702e、18702f。在各种情况下，部分18702a、18702b、18702c、18702d、18702e、18702f可保持在一起并且能够相对于彼此运动和/或移位。例如，侧向部分18702a、18702b、18702c、18702d、18702e、18702f可在柔性击发梁18700的远侧端部处固定在一起。部分18702a、18702b、18702c、18702d、18702e、18702f可例如在其远侧端部处焊接、形成一体、紧固和/或以其他方式固定在一起。侧向部分18702a、18702b、18702c、18702d、18702e、18702f的剩余长度的至少一部分可被构造成能够相对于相邻的侧向部分18702a、18702b、18702c、18702d、18702e、18702f运动和/或移位。例如，当柔性击发梁18700在关节运动接头18270处弯曲时，侧向部分18702a、18702b、18702c、18702d、18702e、18702f可在关节运动接头18270的弯曲部与柔性击发梁18700的近侧端部之间移位成交错和/或偏移的构型。图134示出了一种形式的击发梁18700'的近侧端部18704，其中当击发梁18700是直的时，侧向部分18702a、18702b、18702c、18702d、18702e甚至彼此接触。图135示出了另一种柔性梁构造，其中层部分18702a、18702b、18702c、18702d、18702e和18702f在近侧端部18704处交错。
再次参见图132和图133，柔性击发梁18700的近侧端部18704延伸到形成于击发杆18600的远侧端部18604中的腔18608内，柔性击发梁18700的部分18702a、18702d、18702e、18702d、18702e、18702e可沿着击发路径延伸穿过关节运动接头18270。当端部执行器18300相对于细长轴组件18200进行关节运动时，柔性击发梁18700及其部分18702a、18702b、18702c、18702d、18702e、18702f可在关节运动接头18270内弯曲。在此类情况下，与侧向部分18702a、18702b、18702c、18702d、18702e、18702f相邻的侧向部分可在端部执行器18300进行关节运动时沿着改变的路径延伸。在关节运动期间，缓冲器构件18610被支撑在腔中以适应部分18702a、18702b、18702c、18702d、18702e、18702f的移位。例如，缓冲器构件18610可在击发梁部分18702a、18702b、18702c、18702d、18702e、18702f相对于彼此张开时，在腔18608内旋转，使得部分18702a、18702b、18702c、18702d、18702e、18702f在击发期间(即，沿远侧方向上推进)可能变得由缓冲器构件18610均匀地载荷。
缓冲器构件18610可由柔顺材料，也可不由柔顺材料制成。关于上述击发梁/击发杆构造的进一步细节和详情以及可与本文公开的各种实施方案一起使用的其他构型可见于名称为“SURGICAL INSTRUMENT SYSTEMS COMPRISING AN ARTICULATABLE END EFFECTORAND MEANS FOR ADJUSTING THE FIRING STROKE OF A FIRING MEMBER”的美国专利申请序列号14/574,478，其全部公开内容据此以引用方式并入本文。
图132A描绘了联接构造18702'，其采用单向闩锁构造来限制击发杆18600'的远侧行进。如该图中可看到的那样，击发杆18600’包括锁定开孔18620，该锁定开孔具有成角度的远侧表面18622和垂直于或横向于击发杆18600'行进的方向的垂直表面18624。锁定构件18630被可运动地支撑在轴脊18210中的锁定腔18640内。锁定弹簧18642被支撑在锁定腔18640中，以将锁定构件18630偏压成与击发连接件18600’滑动接触。在所示实施方案中，锁定构件18630具有成角度的远侧表面18632和垂直的后表面18634，并且其尺寸被设定成当击发杆18600’已运动到预定最远侧位置时，延伸到锁定开孔18620中。当击发杆18600’朝远侧推进到图132A所示的位置时，锁定构件18630的弹簧18642将锁定构件偏压到锁定开孔18620中，从而进一步防止击发杆18600'的任何进一步的远侧运动。然而，当击发杆18600’沿近侧方向PD回缩时，击发杆18600'将接触成角度的远侧表面18632并将锁定构件18630偏压到轴脊18210中的锁定腔18640内以允许击发杆18600’沿近侧方向PD运动经过锁定构件18630。
图136至图137示出了另一外科器械19010的多个部分，该另一外科器械包括与细长轴组件19200可操作地交接的外科端部执行器19300，该细长轴组件采用本文公开的各种轴组件的多个特征。例如，细长轴组件19200与上面详细描述的细长轴组件200’类似，下面讨论的差异除外。在所示的示例中，细长轴组件19200包括标示为19800的双关节运动连接件构造，其采用与上述关节运动锁350、810和10810类似的关节运动锁19810。关节运动锁19810可被构造成能够并操作以选择性地将外科端部执行器19300锁定在各种关节运动位置。当关节运动锁19810处于其解锁状态时，这样的构造使得外科端部执行器19300能够相对于细长轴组件19200旋转或做关节运动。第一远侧关节运动驱动器19820被支撑在细长轴组件19200的脊19210内，以响应于施加到其的对应的关节运动控制动作而在远侧方向DD和近侧方向PD上选择性纵向行进。向下突出的枢轴销19818适于枢转地接纳在形成于外科端部执行器19800的细长通道19302的近侧端部部分中的枢轴孔(未示出)内。这样的构造便于外科端部执行器19300的细长通道19302围绕由枢轴孔限定的关节运动轴线B-B相对于脊19210枢转行进。如上所述，关节运动轴线B-B横向于由细长轴组件19200所限定的轴轴线SA-SA。
仍然参见图136和图137，双关节运动连接件构造19800被构造成能够当通过第一远侧关节运动驱动器19820对其施加关节运动力时，建立“推动/拉动”构造。如这些图中可看到的那样，第一远侧关节运动驱动器19820具有形成于其中的第一驱动齿条19842。第一关节运动杆19844从第一远侧关节运动驱动器19820朝远侧突出并且在其中具有第一轴向狭槽19845。此外，第一端部执行器连接件19850可运动地联接到外科端部执行器19300。例如，在一种构造中，第一端部执行器连接件19850的远侧端部19852被枢转地销接到端部执行器19300的细长通道19302。第一端部执行器连接件19850的近侧端部19854包括第一销19856，该第一销可滑动地接纳在第一远侧关节运动驱动器19820的第一关节运动杆19844中的第一轴向狭槽19845内。双关节运动连接件构造19800还包括第二远侧关节运动驱动器19860，其具有形成于其中的第二驱动齿条19862。第二远侧关节运动驱动器19860被可运动地支撑在细长轴组件19200内，以沿远侧方向DD和近侧方向PD纵向行进。第二关节运动杆19864从第二远侧关节运动驱动器19860朝远侧突出并且在其中具有第二轴向狭槽19865。此外，第二端部执行器连接件19870可运动地联接到外科端部执行器19300。例如，在一种构造中，第二端部执行器连接件19870的远侧端部19872被枢转地销接到端部执行器19300的细长通道19302。第二端部执行器连接件19870的近侧端部19874包括第二销19876，该第二销可滑动地接纳在第二远侧关节运动驱动器19860的第二关节运动杆19864中的第二轴向狭槽19865内。如图136中可看到的那样，第一端部执行器连接件19850附接到细长通道19302，以沿平行且位于轴轴线SA-SA的第一轴向侧的第一关节运动轴线FA纵向地行进。第二端部执行器连接件19870附接到细长通道19302，以沿平行且离开轴轴线SA-SA的第二侧向侧的第二关节运动轴线SDA纵向地行进。参见图136。因此，通过同时拉动端部执行器连接件19850、19870中的一者，外科端部执行器19300将相对于细长轴组件19200围绕关节运动轴线B-B进行关节运动。在所示的构造中，第一轴向狭槽19845和第二狭槽19865彼此平行并且平行于轴轴线SA-SA。如图136和137中可进一步看到的那样，第一端部执行器连接件19850和第二端部执行器连接件19870各自具有围绕关节运动轴线B-B弯曲的弯曲形状或弓形形状。此类弯曲形状还可导致更大范围的关节运动。另外，第一轴向狭槽19845和第二轴向狭槽19865中的每一个可各自具有预定长度，这便于进行期望量的关节运动。
从图136和图137中也可以看出，近侧小齿轮传动装置19880和远侧小齿轮传动装置19882居中设置在第一驱动齿条19842与第二驱动齿条19862之间并且与其啮合接合。在另选的实施方案中，可以仅使用一个小齿轮传动装置或两个以上的小齿轮传动装置。因此，采用至少一个小齿轮传动装置。近侧小齿轮传动装置19880和远侧小齿轮传动装置19882能够旋转地支撑在脊19810中以相对于其自由旋转，使得随着第一远侧关节运动驱动器19820沿远侧方向DD运动，小齿轮传动装置19880,19882用以在近侧方向PD上驱动第二远侧关节运动驱动器19860。同样，当第一远侧关节运动驱动器19820沿着近侧方向PD被拉动时，小齿轮传动装置19880,19882在远侧方向DD上驱动第二远侧关节运动驱动器19860。当第一远侧关节运动驱动器19820沿着近侧方向运动时，小齿轮传动装置19880,19882用于在远侧方向DD上驱动第二远侧关节运动驱动器19860。第一远侧关节运动驱动器19820和第二远侧关节运动驱动器19860的这样的运动使得外科端部执行器19300，更具体地外科端部执行器19300的细长通道19302，围绕关节运动轴线B-B在箭头19821的关节运动方向上枢转。相反，为了使端部执行器19300在箭头19823的方向上进行关节运动，第一远侧关节运动驱动器19820沿远侧方向运动，这使得小齿轮传动装置19880,19882沿近侧方向PD驱动第二远侧关节运动驱动器19860。第一远侧关节运动驱动器19820和第二远侧关节运动驱动器19860的这样的运动使得外科端部执行器19300，更具体地外科端部执行器19300的细长通道19302，围绕关节运动轴线B-B在箭头19823的关节运动方向上枢转。
与其它可关节运动的外科端部执行器构型相比，双固体连接件关节运动构造19800及其变型可以为外科端部执行器提供更大范围的关节运动。具体地，本文所公开的固体连接件关节运动构造可便于在一度(1°)到六十五度(65°)范围内的关节运动范围。使用至少一个小齿轮传动装置来在远侧关节运动驱动器之间交接使得端部执行器能够被“推动”和“拉动”到位，还可以减少在使用期间端部执行器的“倾斜”量、或不期望或意外的运动量。本文公开的双固体连接件关节运动构造还包括与其它关节运动系统构造相比具有改善的强度特性的关节运动系统。当端部执行器进行关节运动时，双连接件的近侧端部沿它们的相应狭槽向前和向后平移。这些狭槽可以为系统提供针对双连接件上的弯曲力的更高阻力，并通过约束双连接件的动作来减小系统的齿隙。
图138至图142示出了另一外科器械20010的多个部分，该另一外科器械包括与细长轴组件20200可操作地交接的外科端部执行器20300，该细长轴组件采用本文公开的各种轴组件的多个特征。例如，细长轴组件20200与上面详细描述的细长轴组件200’类似，下面讨论的差异除外。向下突出的枢轴销20818适于枢转地接纳在形成于外科端部执行器20300的细长通道20302的近侧端部部分中的枢轴孔20305内。参见图139。这样的构造便于外科端部执行器20300的细长通道20302围绕由枢轴孔20305限定的关节运动轴线B-B相对于脊20210的枢转行进。关节运动轴线B-B横向于由细长轴组件20200所限定的轴轴线SA-SA。在所示的示例中，细长轴组件20200包括标示为20800的双关节运动连接件构造，其采用与上述关节运动锁350、810和10810类似的关节运动锁20810(图139)。关节运动锁20810可被构造成能够并操作以选择性地将外科端部执行器20300锁定在各种关节运动位置。当关节运动锁20810处于其解锁状态时，这样的构造使得外科端部执行器20300能够相对于细长轴组件20200旋转或做关节运动。第一远侧关节运动驱动器20820被支撑在细长轴组件20200的脊20210内，以响应于施加到其的对应的关节运动控制动作而在远侧方向DD和近侧方向PD上沿第一关节运动轴线FA选择性纵向行进。第一关节运动轴线FA平行于并定位到轴轴线SA-SA的第一侧向侧。第一远侧关节运动驱动器20820包括形成于其中的第一近侧驱动齿条20842和第一远侧驱动齿条20844。双关节运动连接件构造20800还包括第二远侧关节运动驱动器20860，其具有形成于其中的第二近侧驱动齿条20862和第二远侧驱动齿条20864。第二远侧关节运动驱动器20860被可运动地支撑在细长轴组件20200内，以在远侧方向DD和近侧方向PD上沿第二关节运动轴线SDA纵向地行进。第二关节运动轴线SDA平行于并定位到轴轴线SA-SA的第二侧向侧。参见图138。第一远侧关节运动驱动器20820、20860与中央关节运动构件20850可操作地交接。如图140中可看到的那样，中央关节运动构件20850通过销20851可枢转地附接到轴脊20210，该销用于限定中央关节运动构件20850的枢转可以围绕的齿轮轴线GA。齿轮轴线GA平行于关节运动轴线BB。参见图139。中央关节运动构件20850包括主体部分20852，该主体部分具有形成于其上的齿轮部分20854。齿轮部分20854与第一远侧驱动齿条20844和第二远侧驱动齿条20864啮合接合。
图138至图142所示实施方案的外科端部执行器20300包括外科切割并缝合装置。细长通道20302被构造成能够可操作地支撑外科钉仓(未示出)和砧座组件20310。外科端部执行器20300还采用本文所述的各种类型和构型的击发梁(未示出)。在所示的构造中，中间支撑构件20950相对于轴脊框架20810被枢转地且可滑动地支撑。如图140中可看到的那样，中间支撑构件20950包括中央主体部分20952，该中央主体部分限定中央狭槽20954，该中央狭槽被构造成能够可滑动地接纳穿过其的击发构件，以在其从细长轴组件20200横穿关节运动接头20270到达细长通道20302时向击发构件提供侧向支撑。近侧舌状部20955从主体部分20952朝近侧突出，以可运动地联接到中央关节运动构件20850。在所示的构造中，附接销20960延伸穿过近侧舌状部20955中的近侧孔20956。附接销20960被接纳在附接狭槽20856内，该附接狭槽设置在中央关节运动构件20850的主体部分20852中。近侧舌状部20955还包括细长狭槽20957，该细长狭槽被构造成能够在其中接纳形成于轴脊20210中的枢轴销20211。参见图139。中间支撑构件20950还包括远侧舌状部20958，该远侧舌状部可运动地联接到细长通道20302的近侧端部。如图139中可进一步看到的那样，联接器组件20970将中间支撑构件20950枢转地联接到细长通道20302。更具体地，联接器组件20970包括主体板20972，该主体板具有从其突出的端部执行器附接销20974，该端部执行器附接销被构造成能够延伸穿过细长通道20302中的第一枢轴孔20307和中间支撑构件20950的远侧舌状部20958中的远侧枢转孔20959。这样的构造用于便于中间支撑构件20950围绕由端部执行器附接销20974限定的端部执行器枢转轴线EPA相对于细长通道20302的枢转行进。如图139中可看到的那样，端部执行器枢转轴线EPA平行于关节运动轴线B-B。在所示的构造中，多支撑连接件组件920还包括近侧支撑连接件940和远侧支撑连接件950。参见图139。关于近侧支撑连接件和远侧支撑连接件以及中间支撑构件的操作的具体细节已在上文详细讨论，并且为了简洁起见将不再重复。
双关节运动驱动器构造20800被构造成能够当通过第一远侧关节运动驱动器20820对其施加关节运动力时，建立“推动/拉动”构造。如在图138、图139、图141和图142中也可看到的那样，近侧小齿轮传动装置20880和远侧小齿轮传动装置20882居中设置在第一近侧驱动齿条20842与第二近侧驱动齿条20862之间并且与其啮合接合。在另选的实施方案中，可以仅使用一个小齿轮传动装置或两个以上的小齿轮传动装置。因此，采用至少一个小齿轮传动装置。近侧小齿轮传动装置20880和远侧小齿轮传动装置20882被可旋转地支撑在脊20810中以相对于其自由旋转，使得随着第一远侧关节运动驱动器20820沿远侧方向DD运动，小齿轮传动装置20880,20882用以在近侧方向PD上驱动第二远侧关节运动驱动器20860。同样，当第一远侧关节运动驱动器20820沿着近侧方向PD被拉动时，小齿轮传动装置20880,20882在远侧方向DD上驱动第二远侧关节运动驱动器20860。当第一远侧关节运动驱动器20820沿着近侧方向运动时，小齿轮传动装置20880,20882用于在远侧方向DD上驱动第二远侧关节运动驱动器20860。第一远侧关节运动驱动器20820和第二远侧关节运动驱动器20860的这样的运动使得穿过中间支撑构件20950的中央关节运动构件20850使外科端部执行器20300，更具体地外科端部执行器20300的细长通道20302，围绕关节运动轴线B-B在箭头20821的关节运动方向上进行关节运动。参见图141。相反，为了使端部执行器20300在箭头20823的方向上进行关节运动，第一远侧关节运动驱动器20820沿远侧方向DD运动，这使得小齿轮传动装置20880、20882沿近侧方向PD驱动第二远侧关节运动驱动器20860。第一远侧关节运动驱动器20820和第二远侧关节运动驱动器20860的这样的运动使得外科端部执行器20300，更具体地外科端部执行器20300的细长通道20302，围绕关节运动轴线B-B在箭头20823的关节运动方向上枢转。参见图142。
与其它可关节运动的外科端部执行器构型相比，双固体关节运动驱动器构造20800及其变型可以为外科端部执行器提供更大范围的关节运动。具体地，本文所公开的双固体驱动器关节运动构造可有利于在六十五度(65°)范围内的关节运动范围。使用至少一个小齿轮传动装置来在远侧关节运动驱动器之间交接使得端部执行器能够被“推动”和“拉动”到位，还可以减少在使用期间端部执行器的“倾斜”量、或不期望或意外的运动量。本文公开的双固体驱动器关节运动构造还包括与其它关节运动系统构造相比具有改善的强度特性的关节运动系统。
除了下文进一步详细讨论的各种差异之外，图143和图144示出了与上述细长轴组件1200基本上类似的细长轴组件21200的一部分。如图143中可看到的那样，细长轴组件21200包括关节运动锁21810，该关节运动锁基本上类似于关节运动锁810和1810，并且以基本上相同的方式进行操作。如图22中可看到的那样，细长轴组件21200包括轴框架21812，该轴框架包括轴框架21210的一部分。第一远侧关节运动驱动器21820被可运动地支撑在细长轴组件21200内，以响应于对其施加的关节运动控制动作而在远侧方向DD和近侧方向PD上选择性纵向行进。轴框架21812还包括其上形成有枢轴销21818的远侧端部部分21814。枢轴销21818适于枢转地接纳在提供于远侧滑轮21340中的枢轴孔(未示出)内，该远侧滑轮不可旋转地形成在外科端部执行器21300的细长通道21302的近侧端部21320上。参见图144。这种构造便于外科端部执行器21300的细长通道21302相对于轴框架21812围绕由枢轴孔和销21818限定的关节运动轴线B-B的枢转行进(即，关节运动)。轴框架21812还包括居中设置的腔21817，以及定位在远侧端部21814和该居中设置的腔21817之间的远侧凹口21819。
轴组件21200还包括第二远侧关节运动驱动器21860，其包括可旋转地轴颈连接在近侧滑轮组件21840和远侧滑轮21340上的缆线构件21862。在一种形式中，缆线构件21862包括例如由不锈钢、钨、铝、钛等制成的缆线。缆线可以是编织或多股结构，具有不同数量的股线以获得期望水平的拉伸强度和柔韧性。例如，在各种构造中，缆线构件21862可具有在0.03英寸到0.08英寸的范围内，并且更优选地在0.05到0.08英寸的范围内的直径。优选的缆线可以例如由300系列不锈钢制成-半硬到全硬。例如，在各种构造中，缆线21862还可以涂覆有例如铜等以改善润滑性和/或减少拉伸。第一耳状物21863附接到缆线21862的一端，第二耳状物21864通过例如卷曲附接到缆线21862的另一端。参见图144。
仍然参见图144，缆线构件21862通过联接器组件21830联接到第一远侧关节运动驱动器21820的远侧端部21821。联接器组件21830包括联接器主体21832，该联接器主体包括形成于其中的近侧耳状物21834和形成于其中的远侧耳状物21836。第一耳状物21863被构造成能够保持地接纳在第一耳状物腔21834内，并且第二耳状物21836被构造成能够保持地接纳在第二耳状物腔21836内。也可以使用其它紧固件构造、螺钉、铆钉、夹具、粘合剂等。当缆线构件21862轴颈连接在滑轮21840和21340上时，联接器组件21830响应于第一远侧关节运动驱动器21820的轴向运动，而自由地在轴框架21812中的远侧凹口21819内轴向运动。由第一远侧关节运动驱动器21820的轴向运动产生的关节运动动作，被传送到第二远侧关节运动驱动器21860或者缆线21862。附接球或耳状物21866附接到缆线21862并接纳在形成在远侧滑轮21340中的沟槽或凹坑(未示出)内。因此，环形构件21862的运动被传递到外科端部执行器21300，更具体地，传递到外科端部执行器21300的细长通道21302，以使端部执行器围绕关节运动轴线B-B进行关节运动。因此，当第一远侧关节运动驱动器21820沿远侧方向DD运动时，缆线构件21862使得外科端部执行器21300围绕关节运动轴线B-B在一个关节运动方向上进行关节运动，并且当第一远侧关节运动驱动器21820沿近侧方向PD运动时，缆线构件21862使得外科端部执行器21300围绕关节运动轴线B-B在相对的关节运动方向上进行关节运动。
在所示的构造中，近侧滑轮组件21840被构造成能够将张力选择性地引入缆线构件21862中。例如，如图144中可看到的那样，近侧滑轮组件21840包括可旋转地安装在滑轮安装座或轴承21844上的近侧滑轮21842。滑轮安装座21844的轴线与中心滑轮轴线CPA同心，使得近侧滑轮21842能够在滑轮安装座21844上自由旋转。滑轮安装座21844通过附接到滑轮安装座21844的偏心安装轴21846附连到轴框架21812。换句话讲，安装轴21846的中央轴线MSA从中心滑轮轴线CPA(和滑轮安装座的中心轴线)偏移。参见图143。安装轴21846的尺寸被设定成摩擦地接纳在设置于轴框架21812中的安装孔21813内。六边形承窝21848，其被构造成能够接纳标准六边形扳手，被设置在滑轮安装座21844中。参见图143。因此，通过将六边形扳手插入六边形承窝21848中并使安装轴21846沿适当的方向转动，可增大缆线构件21862中的张力。这样的动作将使得安装轴21846以及滑轮安装座21844旋转。由于滑轮安装座21844的中心轴线CPA从安装轴21846的中心轴线MSA偏移，因此中心轴线CPA可进一步运动远离远侧滑轮21340的中心轴线(其可与关节运动轴线B-B同轴)，从而增大了缆线构件21862中的张力。
除了下文进一步详细讨论的各种差异之外，图145至图147示出了与上述细长轴组件1200基本上类似的细长轴组件22200的一部分。已在上文详细讨论的细长轴组件1200的那些部件用相似的元件标号来表示，并且为了简洁起见，除了对于理解轴组件22200的操作可能有必要时，将不再进一步详细讨论。如图147中可看到的那样，细长轴组件22200包括关节运动锁22810，该关节运动锁基本上类似于关节运动锁810和1810，并且以基本上相同的方式进行操作。如图147中可看到的那样，细长轴组件22200包括轴框架22812，该轴框架包括轴脊22210的一部分。第一远侧关节运动驱动器(为清楚起见在图145至图147中已省略)被可运动地支撑在细长轴组件22200内，以响应于对其施加的关节运动控制动作而在远侧方向DD和近侧方向PD上选择性纵向行进。轴框架22812还包括其上形成有枢轴销22818的远侧端部部分22814。枢轴销22818适于枢转地接纳在形成于远侧滑轮22340中的枢轴孔22342内，该远侧滑轮不可旋转地形成在外科端部执行器22300的细长通道22302的近侧端部部分22320上。参见图147。这种构造便于细长通道22302相对于轴框架22812围绕由枢轴孔22342和销22818限定的关节运动轴线B-B的枢转行进(即，关节运动)。轴框架22812还包括居中设置的腔22817，以及定位在远侧端部22814和该居中设置的腔22817之间的远侧凹口22819。
轴组件22200还包括第二远侧关节运动驱动器22860，其包括可旋转地轴颈连接在近侧滑轮组件22840和远侧滑轮22340上的缆线构件1862。在一种形式中，缆线构件1862包括例如由不锈钢、钨、铝、钛等制成的缆线。缆线可以是编织或多股结构，具有不同数量的股线以获得期望水平的拉伸强度和柔韧性。例如，在各种构造中，缆线构件1862可具有在0.03英寸到0.08英寸的范围内，并且更优选地在0.05到0.08英寸的范围内的直径。优选的缆线可以例如由300系列不锈钢制成-半硬到全硬。例如，在各种构造中，缆线还可以涂覆有例如铜等以改善润滑性和/或减少拉伸。第一耳状物1863附接到缆线的一端，第二耳状物1864通过例如卷曲附接到缆线1862的另一端。
现在参见图145和图147，缆线构件1862通过联接器组件1830联接到第一远侧关节运动驱动器的远侧端部1821。关节运动驱动器可包括关节运动锁22810的远侧关节运动驱动器部分，并且为清楚起见未在图145和图147中示出。联接器组件1830包括形成在第一远侧关节运动驱动器(未示出)的远侧端部上的上联接器部分(未示出)以及下联接器部分1834。下联接器部分1834形成有两个支架1835，这两个支架被构造成能够在其中接纳耳状物1862,1864。一对附接销1836被构造成能够被压入上联接器部分(未示出)中的孔(未示出)内，以将两个联接器部分附连在一起。也可以使用其它紧固件构造、螺钉、铆钉、粘合剂等。当缆线构件1862轴颈连接在近侧滑轮组件22840和远侧滑轮22340上时，联接器组件1830响应于第一远侧关节运动驱动器的轴向运动，而自由地在轴框架22812中的远侧凹口22819内轴向运动。由第一远侧关节运动驱动器的轴向运动产生的关节运动动作被传送到第二远侧关节运动驱动器22860或者缆线构件1862。附接球或耳状物1866附接到缆线构件1862并接纳在形成在远侧滑轮22340中的沟槽或凹坑1342中。因此，缆线构件1862的运动被传递到外科端部执行器22300，更具体地，传递到外科端部执行器22300的细长通道22302，以使端部执行器围绕关节运动轴线B-B进行关节运动。因此，当第一远侧关节运动驱动器沿远侧方向DD运动时，缆线构件1862使得外科端部执行器22300围绕关节运动轴线B-B在一个关节运动方向上进行关节运动，并且当第一远侧关节运动驱动器沿近侧方向PD运动时，缆线构件1862使得外科端部执行器22300围绕关节运动轴线B-B在相对的关节运动方向上进行关节运动。
在所示的构造中，近侧滑轮组件22840被构造成能够将张力选择性地引入缆线构件1862中。例如，如图147中可看到的那样，近侧滑轮组件22840包括可旋转地安装在滑轮安装座或轴承22844上的近侧滑轮22842。滑轮安装座22844附接到安装块22846，该安装块被可运动地接纳在形成于轴框架22812中的轴向安装腔22821内。张紧螺杆22823定位在轴框架22812内以调节安装块22846在轴向安装腔22821内的位置。参见图145和图147。向内拧紧张紧螺钉22823将使得张紧螺钉22823的端部22825沿近侧方向偏压安装块22846，以在缆线构件1862中引入张力。这样的动作将使近侧滑轮22842的中心轴线CPA远离远侧滑轮22340的中心轴线运动张紧距离DT。因此，随着张紧距离DT的增加，缆线构件1862中的张力也增加。
图148和图149描绘了另选的近侧滑轮组件22840’，该另选的近侧滑轮组件可用于张紧缆线构件1862。例如，如图148中可看到的那样，近侧滑轮组件22840’包括可旋转地安装在滑轮安装座或轴承22844上的近侧滑轮22842。滑轮安装座22844附接到安装块22846，该安装块被可运动地接纳在形成于轴框架22812中的轴向安装腔22821内。在这种构造中，张紧凸轮22850附接到偏心安装主轴22854。偏心安装主轴22854限定从张紧凸轮22850的中心轴线偏移的中心轴线MSA’。如图149中可看到的那样，安装主轴22854具有滚花外表面并且适于接纳在轴框架22812'中的滚花孔22855内。六边形承窝22856，其被构造成能够接纳标准六边形扳手，被设置在安装主轴22854中。参见图149。因此，通过将六边形扳手插入六边形承窝22856中并使安装主轴22854沿适当的方向转动，可增大缆线构件1862中的张力。安装主轴22854的旋转将使得张紧凸轮22852旋转并使安装块22846在轴向狭槽22821内沿近侧方向PD进行凸轮运动，以在缆线构件1862中引入张力。这样的动作将使近侧滑轮22842的中心轴线CPA远离远侧滑轮22340的中心轴线运动张紧距离DT。因此，随着张紧距离DT的增加，缆线构件1862中的张力也增加。
图150示出了另一第二远侧关节运动驱动器23860，其包括能够旋转地轴颈连接在近侧滑轮23842和远侧滑轮22340上的缆线构件1862。第一耳状物1863附接到缆线1862的一端，第二耳状物1864通过例如卷曲附接到缆线1862的另一端。缆线构件1862通过联接器组件1830以本文所述的方式联接到第一远侧关节运动驱动器1820的远侧端部1821。在该实施方案中，采用缆线张紧组件23900来将期望量的张力引入到缆线构件1862中。如图150中可看到的那样，缆线张紧组件23900包括：安装支架23902，该安装支架被安装在轴框架的一个侧向侧上；以及张紧辊组件23910，该张紧辊组件被取向成接触与轴框架的第二侧向侧相邻的缆线构件1862。张紧辊组件23910包括侧向支架23912，该侧向支架可运动地联接到安装支架23902。在所示的构造中，侧向支架23912被构造用于与安装支架23902螺纹接合。张紧辊23914被安装到与缆线构件1862接触的侧向支架23912。为了增加缆线构件1862中的张力，侧向支架23912沿侧向方向LD朝安装支架运动。这样的运动使得张紧辊23914朝安装构件侧向地向内运动并接触缆线构件1862，以使缆线构件1862沿横向于旋转方向RD1和旋转方向RD2的侧向方向LD偏压，从而增加缆线构件1862中的张力。
图151示出了另一第二远侧关节运动驱动器23860’，其包括可旋转地轴颈连接在近侧滑轮(未示出)和远侧滑轮(未示出)上的缆线构件1862。第一耳状物1863附接到缆线1862的一端，第二耳状物1864通过例如卷曲附接到缆线1862的另一端。缆线构件1862通过张紧组件1830’以本文所述的方式联接到第一远侧关节运动驱动器1820的远侧端部1821。在该实施方案中，第一远侧关节运动驱动器1820'的远侧端部1821'包括近侧夹板1823'和远侧夹板1825'。远侧夹板1825’通过张紧螺钉构件23900’而可运动地附连到近侧夹板1823’。在所示的构造中，张紧螺钉构件23900'包括：第一或近侧螺纹部分23922，该第一或近侧螺纹部分沿第一螺纹方向拧入近侧夹板1823'中的螺纹孔23940内；以及第二或远侧螺纹部分23924，该第二或远侧螺纹部分沿与第一螺纹方向相反的第二螺纹方向拧入远侧夹板1825'中的螺纹孔23942内。致动螺母23926在第一螺纹部分23922与第二螺纹部分23924之间的中央位置固定到螺钉构件23900'。可通过使用扳手或其他合适的工具以旋转致动螺母23926来旋转张紧螺钉23900'。张紧螺钉23900'沿第一方向的旋转将使近侧夹板1823’和远侧夹板沿着平行于缆线构件轴线CA的张紧轴线TA而朝向彼此沿第一方向拉动。当近侧夹板1823'和远侧夹板1825'朝向彼此运动时，第一耳状物1863和第二耳状物1864也朝向彼此运动以将张力引入缆线构件1862中。张紧螺钉23920沿第二相反方向的旋转将使第一夹板和第二夹板沿着张紧轴线TA远离彼此驱动。第一夹板1823’和第二1825’远离彼此的这种运动将允许第一耳状物1863和第二耳状物1864远离彼此运动，从而减小缆线构件1862中的张力。
图152示出了闭合套筒260，其可用于闭合和/或打开端部执行器300的砧座，如上面详细描述的那样，或者换句话讲，闭合套筒可用于闭合可运动钳口或外科端部执行器的钳口。如该图中的剖视图所示，闭合套筒260包括近侧端部261，该近侧端部在其中具有环形狭槽262。此类构造用于将闭合套筒260附接到闭合梭动件，以与闭合梭动件一起轴向行进，同时使得闭合套筒260能够围绕轴轴线相对于闭合梭动件旋转。也如上所述，闭合梭动件由被构造成能够生成闭合致动动作的对应的闭合系统或闭合驱动系统轴向地致动。闭合套筒260还包括开口266，这些开口使得旋转喷嘴上的安装座能够延伸穿过其以安置在轴脊中的凹槽内。当喷嘴相对于柄部旋转时，这样的构造便于轴脊和闭合套筒260围绕轴轴线的旋转。如上所述，细长轴组件200还可包括可旋转地接纳在闭合套筒260上的切换筒500。参见图3和图4。切换筒500包括中空轴段502，该中空轴段具有在其上形成的轴凸台504，以用于将向外突出的致动销410接纳在其中。在各种情况下，致动销410延伸穿过狭槽267进入设置在锁定套筒402中的纵向狭槽408，以在锁定套筒402与近侧关节运动驱动器230接合时，利于该锁定套筒做轴向运动。有关这些结构及其操作的进一步细节见上文。如上面进一步讨论的，闭合套筒260还包括双枢轴闭合套筒组件，以便于将闭合套筒260附接到端部执行器闭合套筒272。上柄脚264和下柄脚265形成在闭合套筒260的远侧端部上，以便于上述各种方式的此类附接。
同样如上所述，为了闭合端部执行器的砧座(或者为了向钳口或端部执行器的其他部分施加闭合动作)，在致动闭合系统或闭合驱动系统时，使闭合套筒260沿远侧方向DD轴向推进。闭合套筒260必须在轴脊上运动以使砧座(或钳口)运动到闭合位置的轴向距离称为“闭合行程”。闭合套筒必须运动以完全闭合钳口或端部执行器的其他部分的最大轴向距离在本文中可称为“完全闭合行程距离”。例如，该距离可包括闭合套筒260从起始位置或非关节运动位置运动到对应于完全闭合端部执行器位置的结束位置的总轴向距离。在一个实施方案中，闭合套筒260的完全闭合行程距离为例如约0.230英寸。
图153示出了多件式闭合构件组件24260，该多件式闭合构件组件被构造成能够可运动地支撑在本文公开的各种类型的细长轴组件的脊组件(未示出)上。如下所述，“远侧闭合构件”或“远侧闭合套筒”24400被构造成能够在脊组件上运动“轴向闭合距离”，该“轴向闭合距离”小于对应的“近侧闭合构件”或“近侧闭合套筒”24261响应于来自闭合系统的闭合致动动作的施加而运动的“完全闭合行程距离”。如图153中可看到的那样，近侧闭合套筒24261可与靠近闭合套筒260的直径减小的点的闭合套筒260的部分相同。因此，近侧闭合套筒24261的与闭合套筒260的特征相同的那些特征在图153中以相同的元件编号标出。近侧闭合套筒24261与闭合套筒260的不同之处在于以下方式。第一，近侧闭合套筒24261终止于一般标示为24300的“颈缩部分”，并包括内部止动壁或接触部分24302。在所示实施方案中，远侧闭合套筒24400的远侧端部24402与闭合套筒260的远侧端部相同，并且包括上柄脚264和下柄脚265以便于以本文所公开的各种方式附接到端部执行器闭合套筒。远侧闭合套筒24400的近侧端部24404可滑动地延伸穿过近侧闭合套筒24261的颈缩部分或远侧端部24300中的开口24304。远侧闭合套筒部分24400的近侧端部24404朝外扩口，以防止远侧闭合套筒24400与近侧闭合套筒24261分离，同时有利于这些部件之间的相对滑动动作。仍然参见图153，这样的构造便于近侧闭合套筒24261在远侧闭合套筒24400轴向推进之前沿远侧方向DD行进轴向距离。该距离被称为“近侧行进区”或“死区”，其标示为24307。例如，在一种构造中，近侧闭合套筒24261被构造成能够运动经过0.230英寸的完全闭合行程距离。例如，在这样的构造中(参见图153)，近侧行进区24307的“近侧轴向长度”DZ可例如在0.050英寸至0.150英寸的范围内。因此，近侧轴向长度DZ小于近侧闭合套筒24261从起始位置运动到结束位置的完全闭合行程距离，该结束位置对应于端部执行器的完全闭合状态。换句话讲，这种构造用于在闭合系统的致动期间减小远侧闭合套筒的轴向行进量。这样的构造还使得远侧闭合套筒24400的直径能够小于近侧闭合套筒24261的直径。
图154示出了另一多件式闭合构件组件25260，其可与本文所述的各种构造的细长轴组件结合使用，其包括闭合构件组件25260可以可运动地支撑在其上的脊组件或构造。在该实施方案中，当近侧闭合套筒25261由闭合系统轴向推进通过完全闭合行程或顺序时，远侧闭合套筒25400的轴向行程小于近侧闭合套筒25261的轴向行程。近侧闭合套筒25261可与靠近闭合套筒260的直径减小的点的闭合套筒260的部分相同。因此，近侧闭合套筒25261的与闭合套筒260的特征相同的那些特征以相同的元件编号标出。近侧闭合套筒25261以上述方式与闭合系统或闭合驱动系统交接，因此当闭合系统被致动时，近侧闭合套筒25261将轴向地行进与闭合套筒260在致动时所行进相同的距离。近侧闭合套筒25261与闭合套筒260的不同之处在于以下方式。首先，近侧闭合套筒25261终止于一般标示为25300的颈缩部分。远侧闭合套筒部分24400的远侧端部24402与闭合套筒260的远侧端部相同，并且包括上柄脚和下柄脚以便于以本文所公开的各种方式附接到端部执行器闭合套筒。远侧闭合套筒25400的近侧端部25404可滑动地延伸穿过近侧闭合套筒25261的颈缩部分25300中的开口25304。远侧闭合套筒25400的近侧端部25404包括中心突片构件25306延伸穿过的开口25406。中心突片构件25306用于防止远侧闭合套筒25400与近侧闭合套筒25261分离。此外，近侧端部25404包括沿直径相对的狭槽25308，这些狭槽被构造成能够在其中接纳对应的上突片和下突片25310。这样的构造便于近侧闭合套筒25261在远侧闭合套筒24400轴向推进之前沿远侧方向DD行进轴向距离。突片25310与狭槽25308的底部之间的空间被称为“近侧行进区”或“死区”，其被标示为25307。近侧闭合套筒25261被构造成能够运动经过0.230英寸的完全闭合行程距离。例如，在这样的构造中(参见图154)，近侧行进区25307的“近侧轴向长度”DZ可例如在0.050英寸至0.150英寸的范围内。因此，近侧轴向长度DZ小于近侧闭合套筒25261从起始位置运动到结束位置的完全闭合行程距离，该结束位置对应于端部执行器的完全闭合状态。换句话讲，这种构造用于在闭合系统的致动期间减小远侧闭合套筒的轴向行进量。这样的构造还使得远侧闭合套筒25400的直径能够小于近侧闭合套筒25261的直径。
图155示出了另一两件式闭合构件组件26260，其可以与本文所述的各种构造的细长轴组件结合使用，其包括闭合构件组件26260可以可运动地支撑在其上的脊组件或构造。在该实施方案中，当近侧闭合套筒26261由闭合系统轴向推进通过完全闭合行程或顺序时，远侧闭合套筒26400的轴向行程小于近侧闭合套筒26261的轴向行程。近侧闭合套筒26261可与靠近闭合套筒的直径减小的点的闭合套筒260的部分相同。因此，近侧闭合套筒部分26261的与闭合套筒260的特征相同的那些特征以相同的元件编号标出。近侧闭合套筒部分26261以上述方式与闭合系统交接，因此当闭合系统或闭合驱动系统被致动时，近侧闭合套筒部分26261可轴向地行进与闭合套筒260在致动时所行进相同的距离。近侧闭合套筒26261与闭合套筒260的不同之处在于以下方式。首先，近侧闭合套筒26261具有法兰远侧端部26300。具体地，环形法兰26302从远侧端部26300向内延伸并限定开口26304。远侧闭合套筒26400的远侧端部与闭合套筒260的远侧端部相同，并且包括上柄脚和下柄脚以便于以本文所公开的各种方式附接到端部执行器闭合套筒。远侧闭合套筒26400的近侧端部26404可滑动地延伸穿过近侧闭合套筒26261的远侧端部26300中的开口26304。远侧闭合套筒26400的近侧端部26404延伸穿过开口26304并且包括向外延伸的环形法兰26406，该向外延伸的环形法兰与向内延伸的环形法兰26302配合，防止远侧闭合套筒26400与近侧闭合套筒26261分离。此外，近侧闭合套筒26261包括在近侧端部26300近侧的止动部分。在所示的构造中，止动部分包括向内延伸的卷曲部分26306。这样的构造便于近侧闭合套筒26261在卷曲部分26306接触环形法兰26406之前沿远侧方向DD行进轴向距离，以沿远侧方向DD轴向地驱动远侧闭合套筒26400。卷曲部分26306与向外延伸的法兰26406之间的空间被称为“近侧行进区”或“死区”，被标示为26307。例如，近侧闭合套筒26261被构造成能够运动经过0.230英寸的完全闭合行程距离。例如，在这样的构造中(参见图154)，近侧行进区26307的“近侧轴向长度”DZ可例如在0.050英寸至0.150英寸的范围内。因此，近侧轴向长度DZ小于近侧闭合套筒26261从起始位置轴向地运动到结束位置的完全闭合行程距离，该结束位置对应于端部执行器的完全闭合状态。换句话讲，这种构造用于在闭合系统的致动期间减小远侧闭合套筒的轴向行进量。这样的构造还使得远侧闭合套筒26400的直径能够小于近侧闭合套筒26261的直径。
图156示出了另一两件式闭合构件组件27260，其可以与本文所述的各种构造的细长轴组件结合使用，其包括闭合构件组件27260可以可运动地支撑在其上的脊组件或构造。在该实施方案中，当近侧闭合套筒27261由闭合系统轴向推进通过完全闭合行程或顺序时，远侧闭合套筒27400的轴向行程小于近侧闭合套筒27261的轴向行程。近侧闭合套筒部分27261可与靠近闭合套筒的直径减小的点的闭合套筒260的部分相同。因此，近侧闭合套筒部分27261的与闭合套筒260的特征相同的那些特征以相同的元件编号标出。近侧闭合套筒部分27261以上述方式与闭合系统或闭合驱动系统交接，因此当闭合系统或闭合驱动系统被致动时，近侧闭合套筒27261可轴向地行进与闭合套筒260在致动时所行进相同的距离。近侧闭合套筒27261与闭合套筒260的不同之处在于以下方式。首先，近侧闭合套筒27261具有法兰远侧端部27300。具体地，环形法兰27302从远侧端部27300向内延伸并限定开口27304。远侧闭合套筒27400的远侧端部与闭合套筒260的远侧端部相同，并且包括上柄脚和下柄脚，以便于以本文所公开的各种方式附接到端部执行器闭合套筒。远侧闭合套筒27400的近侧端部27404可滑动地延伸穿过近侧闭合套筒27261的远侧端部27300中的开口27304。远侧闭合套筒27400的近侧端部27404延伸穿过开口27304并且包括向外延伸的环形法兰27406，该向外延伸的环形法兰与向内延伸的环形法兰27302配合，防止远侧闭合套筒27400与近侧闭合套筒27261分离。此外，止动环27305附接到远侧端部27300内的近侧闭合套筒27261。例如，止动环27305可焊接到近侧闭合套筒27261。止动环27305包括向内延伸的近侧止动法兰27306。这样的构造便于近侧闭合套筒27261在止动法兰27306接触环形法兰27406之前沿远侧方向DD行进轴向距离，以沿远侧方向DD轴向地驱动远侧闭合套筒部分27400。近侧止动法兰27306与向外延伸的法兰27406之间的空间27307被称为“近侧行进区”或“死区”。例如，在具有0.230英寸的完全闭合行程距离的一个构造中，近端行进区27307的“近侧轴向长度”DZ可例如在0.050英寸至0.150英寸的范围内。因此，近侧轴向长度DZ小于近侧闭合套筒27261从起始位置轴向地运动到结束位置的完全闭合行程距离，该结束位置对应于端部执行器的完全闭合状态。换句话讲，这种构造用于在闭合系统的致动期间减小远侧闭合套筒的轴向行进量。这样的构造还使得远侧闭合套筒27400的直径能够小于近侧闭合套筒27261的直径。
图157至图158示出了另一多件式闭合套筒实施方案28260，其中远侧闭合套筒部分28400运动的距离短于近侧闭合套筒部分28261在闭合系统被致动通过完全闭合行程或顺序时运动的距离。近侧闭合套筒部分28261可与靠近闭合套筒的直径减小的点的闭合套筒260的部分基本上相同。因此，近侧闭合套筒部分28261的与闭合套筒260的特征相同的那些特征以相同的元件编号标出。近侧闭合套筒部分28261以上述方式与闭合系统交接，因此当闭合系统被致动时，近侧闭合套筒部分28261可轴向地行进与闭合套筒260在致动时所行进相同的距离。近侧闭合套筒部分28261与闭合套筒260的不同之处在于以下讨论的方式。首先，近侧闭合套筒部分28261被构造成能够与闭合行程减少组件(通常被标示为29000)交接。
如图157至图158中可看到的那样，在所示的构造中，闭合行程减少组件29000包括近侧安装环29002，该近侧安装环具有近侧毂部分29004，近侧闭合套筒28261的远侧端部28300被接纳于近侧毂部分上并附接到近侧毂部分。例如，近侧闭合套筒28261的远侧端部28300可通过焊接、粘合剂等附接到近侧毂部分29004。因此，近侧安装环29002将随近侧闭合套筒28261一起轴向地运动。如图157和图158中可进一步看到的那样，向内延伸的近侧法兰29006从近侧中心部分29004的近侧端部延伸出。提供穿过近侧法兰29006的孔29008，以穿过该孔可滑动地接纳轴脊组件2210、2212。远侧锥形构件29010附接到近侧安装环29002的远侧端部。远侧锥形构件29010可通过例如焊接、粘合剂等附接到近侧安装环29002，并且当近侧安装环29002朝远侧推进时可在远侧闭合套筒部分28400上自由滑动。
近侧安装环29002可滑动地支撑在远侧安装环29020上，该远侧安装环附接到远侧闭合套筒部分28400。远侧安装环29020包括远侧部分29022，该远侧部分具有从其突出的近侧安装毂29024。近侧安装毂29024的直径小于远侧安装环29020的远侧部分29022的直径。近侧安装毂29024可通过焊接、粘合剂等附接到远侧闭合套筒部分28400的近侧端部28404。近侧安装环29002的近侧毂部分29004可滑动地接纳在近侧安装毂29024上用于在其上轴向行进。压缩弹簧29032被接纳在弹簧腔29030内，该弹簧腔形成在远侧安装环29020的远侧部分29022与近侧安装环29002的近侧毂部分29004之间。当闭合系统处于非关节运动构型时，近侧毂部分29004的近侧法兰29006与远侧闭合套筒28400的近侧端部28404间隔开“近侧行进区”或“近侧死区”29009。近侧行进区29009的近侧轴向长度被标示为DZ。弹簧腔29030还可称为“远侧行进区”或“远侧死区”并且具有远侧轴向长度DS，该远侧轴向长度可包括死区轴向长度DZ加上在处于完全压缩状态时容纳压缩弹簧29032所需的间隙量。例如，在具有0.230英寸的完全闭合行程距离的一种构造中，近侧行进区29009的“近侧轴向长度”DZ可例如在0.050英寸至0.150英寸的范围内，并且远侧轴向长度DS可在0.100英寸至0.200英寸加上容纳完全压缩的压缩弹簧29032所需的长度的范围内。换句话讲，在所示的构造中，DS始终大于DZ。因此，近侧轴向长度DZ小于近侧闭合套筒27261从起始位置轴向地运动到结束位置的完全闭合行程距离，该结束位置对应于端部执行器的完全闭合状态。这样的构造便于近侧闭合套筒部分28261在近侧安装环29002的近侧法兰29006接触远侧闭合套筒部分28400的近侧端部28404以沿远侧方向DD轴向地驱动远侧闭合套筒部分28400之前沿远侧方向DD行进轴向距离。闭合行程减少组件29000设置成多个件以便于组装。这种构造用于在致动闭合系统期间减少远侧闭合套筒部分28400的轴向行程量。这样的构造采用远侧闭合套筒部分28400，该远侧闭合套筒部分的外径小于近侧闭合套筒部分28261的外径。在另选的实施方案中，闭合行程减少组件可定位在轴组件内的任何位置(例如，在喷嘴部分内、沿着轴的长度、在关节运动接头中或在端部执行器枢轴处)。具体地，在端部执行器枢轴/接头处可存在狭槽，以便在闭合期间允许死行程。
本文所述的外科器械系统由电动马达促动；然而，本文所述的外科器械系统可以以任何合适的方式促动。在各种情况下，例如，本文所述的外科器械系统可由手动操作的触发器促动。马达可包括机器人控制系统的一个或多个部分。
已结合钉的部署和变形描述了本文所述的外科器械系统；然而，本文所述的实施方案不限于此。例如，可以设想部署除钉之外的紧固件诸如夹具或大头钉的各种实施方案。此外，还可设想利用用于密封组织的任何合适装置的各种实施方案。例如，根据各种实施方案的端部执行器可包括被构造成能够加热和密封组织的电极。另外，例如，根据某些实施方案的端部执行器可施加振动能量来密封组织。
本文所述的外科器械系统由一个或多个电动马达促动；然而，本文所述的外科器械系统可以以任何合适的方式促动。在各种情况下，例如，本文所述的外科器械系统可由手动操作的触发器促动。
实施例
实施例1：一种外科器械，包括限定轴轴线的细长轴组件。外科端部执行器枢转地联接到细长轴组件以用于相对于细长轴组件围绕横向于轴轴线且从轴轴线侧向地偏移的关节运动轴线进行选择性关节运动。该外科端部执行器限定端部执行器轴线，并且被构造成能够在非关节运动位置至在轴轴线的一侧上的最大关节运动位置之间进行选择性地关节运动，在非关节运动位置中，执行器轴线与轴轴线轴向地对准，在最大关节运动位置中，端部执行器轴线垂直于轴轴线。关节运动系统与外科端部执行器可操作地交接，以使外科端部执行器在非关节运动位置与关节运动位置之间选择性地运动。
实施例2：根据实施例1所述的外科器械，其中关节运动系统包括关节运动驱动构件，该关节运动驱动构件可操作地联接到外科端部执行器以用于向外科端部执行器选择性地施加推动和拉动动作。
实施例3：根据实施例1或2所述的外科器械，其中关节运动系统包括关节脱位构件，该关节脱位构件被构造成能够向外科端部执行器选择性地仅施加拉动动作。
实施例4：根据实施例1、2或3所述的外科器械，其中关节运动系统包括联接到外科端部执行器的端部执行器驱动器连接件。远侧关节运动驱动器联接到端部执行器驱动器连接件并且被构造成能够向端部执行器驱动器连接件选择性地施加推动动作和拉动动作。关节脱位构件附接到外科端部执行器并且被构造成能够向外科端部执行器仅施加拉动动作。
实施例5：根据实施例1、2或3所述的外科器械，其中关节运动系统包括联接到外科端部执行器的端部执行器驱动器连接件。远侧关节运动驱动器联接到端部执行器驱动器连接件并且被构造成能够向端部执行器驱动器连接件选择性地施加推动动作和拉动动作。关节脱位构件被构造成能够向外科端部执行器施加关节脱位动作。
实施例6：根据实施例1、2、3、4或5所述的外科器械，其中外科端部执行器通过弹簧销枢转地联接到细长轴组件，该弹簧销限定关节运动轴线并且其被构造成能够向外科端部执行器施加关节脱位偏压动作。
实施例7：一种外科器械，包括限定轴轴线的细长轴组件。该外科器械还包括限定端部执行器轴线的外科端部执行器。关节运动接头被构造成能够便于外科端部执行器相对于细长轴组件在非关节运动位置与完全关节运动位置之间进行关节运动，在非关节运动位置中，端部执行器轴线与轴轴线轴向地对准，在完全关节运动位置中，端部执行器轴线垂直于轴轴线。该外科器械还包括用于向外科端部执行器施加关节运动动作的装置。该用于施加的装置仅沿轴轴线的一个侧向侧定位。
实施例8：根据实施例7所述的外科器械，其中外科端部执行器的近侧端部相对于端部执行器轴线成角度，并且其中细长轴组件的远侧端部相对于轴轴线成角度。
实施例9：根据实施例8所述的外科器械，其中外科端部执行器的近侧端部相对于端部执行器轴线以端部执行器角度取向，并且其中细长轴组件的远侧端部相对于轴轴线以轴角度取向。
实施例10：根据实施例8所述的外科器械，其中端部执行器角度和轴角度彼此相等。
实施例11：根据实施例7、8、9或10所述的外科器械，还包括用于向外科端部执行器施加关节脱位动作的装置。
实施例12：一种外科器械，包括限定轴轴线并且包括远侧端部的细长轴组件。该外科器械还包括外科端部执行器，该外科端部执行器包括近侧端部，该近侧端部枢转地联接到细长轴组件的远侧端部以用于相对于该远侧端部围绕关节运动轴线选择性枢转行进，该关节运动轴线从轴轴线侧向地偏移且相对于轴轴线横向地延伸。该外科器械还包括关节运动系统，该关节运动系统包括可操作地联接到外科端部执行器的端部执行器驱动器连接件。关节运动驱动器被支撑用于在对其施加关节运动动作时沿远侧方向和近侧方向纵向行进。关节运动驱动器联接到端部执行器驱动器连接件，以使外科端部执行器相对于细长轴组件围绕关节运动轴线选择性地进行关节运动。柔性的关节脱位构件联接到细长轴组件和外科端部执行器，以向外科端部执行器施加关节脱位动作。
实施例13：根据实施例12所述的外科器械，其中关节运动驱动器被构造成能够仅沿横向于轴轴线的一个关节运动方向向外科端部执行器施加第一关节运动动作。
实施例14：根据实施例12或13所述的外科器械，其中外科端部执行器限定端部执行器轴线，并且其中端部执行器能够在非关节运动位置至在轴轴线的一个侧向侧上的最大关节运动位置之间运动，在非关节运动位置中，执行器轴线与轴轴线轴向地对准，在最大关节运动位置中，端部执行器轴线垂直于轴轴线。
实施例15：根据实施例12、13或14所述的外科器械，其中当外科端部执行器处于非关节运动取向时，关节运动驱动器和端部执行器驱动器连接件定位在轴轴线的一个侧向侧上。
实施例16：根据实施例12、13、14或15所述的外科器械，其中外科端部执行器包括被构造用于在外科端部执行器内轴向行进的击发构件，并且其中细长轴组件还包括可轴向运动的击发梁，该可轴向运动的击发梁与击发构件可操作地交接并且能够响应于对其施加的击发动作而沿远侧方向选择性地运动。该击发梁还能够响应于对其施加的回缩动作而沿近侧方向选择性地运动。
实施例17：根据实施例12、13、14、15或16所述的外科器械，其中外科端部执行器的近侧端部通过关节运动销枢转地销接到细长轴组件的远侧端部，并且其中柔性的关节脱位构件被构造成能够在外科端部执行器围绕关节运动轴线进行关节运动时在关节运动销周围挠曲。
实施例18：根据实施例12、13、14、15、16或17所述的外科器械，其中外科端部执行器的近侧端部相对于端部执行器轴线成角度，并且其中细长轴组件的远侧端部相对于轴轴线成角度。
实施例19：根据实施例18所述的外科器械，其中外科端部执行器的近侧端部相对于端部执行器轴线以端部执行器角度取向，并且其中细长轴组件的远侧端部相对于轴轴线以轴角度取向。
实施例20：根据实施例19所述的外科器械，其中端部执行器角度和轴角度彼此相等。
实施例21：一种外科器械，包括限定轴轴线并且包括远侧端部的细长轴组件。该外科器械还包括近侧端部，该近侧端部枢转地联接到细长轴组件的远侧端部，使得外科端部执行器能够相对于轴轴线在非关节运动位置与完全关节运动位置之间选择性地运动。击发梁被可运动地支撑在细长轴组件中的通路内以用于在其中选择性纵向行进。该通路被构造成能够将离开细长轴构件的远侧端部的击发梁的一部分定位到相对于轴轴线的偏离轴线位置。
实施例22：根据实施例21所述的外科器械，其中通路包括：第一通路部分，该第一通路部分对准于轴轴线；以及第二弓形通路部分，该第二弓形通路部分与第一通路部分连通并且沿第一方向远离轴轴线弯曲。该通路还包括第三弓形通路部分，该第三弓形通路部分与第二弓形通路部分连通并且沿第二方向朝向轴轴线弯曲。
实施例23：根据实施例22或21所述的外科器械，其中外科端部执行器被构造成能够沿横向于轴轴线的仅一个关节运动方向进行关节运动。
实施例24：根据实施例21、22或23所述的外科器械，其中外科端部执行器的近侧端部在细长轴组件的远侧端部上的附接位置处枢转地联接到细长轴组件以用于围绕相对于轴轴线横向地延伸但不与轴轴线相交的关节运动轴线而在非关节运动位置与完全关节运动位置之间选择性枢转行进。
实施例25：根据实施例21、22、23或24所述的外科器械，还包括关节运动驱动器，该关节运动驱动器被支撑用于相对于细长轴组件纵向行进并且联接到外科端部执行器以用于对其施加关节运动动作。
实施例26：根据实施例25所述的外科器械，其中关节运动驱动器被构造成能够向外科端部执行器施加推动和拉动动作。
实施例27：根据实施例21、23、24、25或26所述的外科器械，其中通路包括：第一通路部分，该第一通路部分轴向地对准于轴轴线；以及第二通路部分，该第二通路部分与第一通路部分连通并且从其朝远侧延伸，使得第二通路部分的至少一部分不与轴轴线轴向地对准。
实施例28：根据实施例21、22、23、24、25、26或27所述的外科器械，其中击发梁包括层压在一起的多个梁层。
实施例29：根据实施例21、22、23、24、25、26、27或28所述的外科器械，其中外科端部执行器包括击发构件，该击发构件与击发梁可操作地交接并且被构造用于在外科端部执行器内轴向行进。
实施例30：一种外科器械，包括限定轴轴线并且包括远侧端部的细长轴组件。该外科器械还包括外科端部执行器，该外科端部执行器包括近侧端部。关节运动接头将外科端部执行器的近侧端部联接到细长轴组件的远侧端部。击发梁被可运动地支撑在细长轴组件内以用于在其中沿轴轴线纵向行进。该外科器械还包括用于将击发梁的一部分偏压成弓形构型而在关节运动接头之前与轴轴线脱离轴向对准的装置。
实施例31：根据实施例30所述的外科器械，其中关节运动接头将外科端部执行器的近侧端部枢转地联接到细长轴组件的远侧端部以用于相对于细长轴组件围绕横向于轴轴线且从轴轴线侧向地偏移的关节运动轴线进行选择性关节运动。
实施例32：根据实施例30或31所述的外科器械，其中外科端部执行器限定端部执行器轴线，并且其中外科端部执行器能够在其中端部执行器轴线与轴轴线轴向地对准的非关节运动位置与定位到轴轴线的一个侧向侧的完全关节运动位置之间选择性地进行关节运动。
实施例33：根据实施例30、31或32所述的外科器械，其中击发梁包括层压在一起的多个梁层。
实施例34：根据实施例30、31、32或33所述的外科器械，其中外科端部执行器包括击发构件，该击发构件与击发梁可操作地交接并且被构造用于在外科端部执行器内轴向行进。
实施例35：一种外科器械，包括限定轴轴线并且包括远侧端部的细长轴组件。该外科器械还包括外科端部执行器，该外科端部执行器包括近侧端部。关节运动接头将外科端部执行器的近侧端部联接到细长轴组件的远侧端部。击发梁被可运动地支撑在细长轴组件内以用于在其中沿轴轴线纵向行进。该外科器械还包括用于将击发梁的一部分偏压成在关节运动接头之前与轴轴线脱离轴向对准的装置。
实施例36：根据实施例35所述的外科器械，其中关节运动接头将外科端部执行器的近侧端部枢转地联接到细长轴组件的远侧端部以用于相对于细长轴组件围绕横向于轴轴线且从轴轴线侧向地偏移的关节运动轴线进行选择性关节运动。
实施例37：根据实施例35或36所述的外科器械，其中外科端部执行器限定端部执行器轴线，并且其中外科端部执行器能够在其中端部执行器轴线与轴轴线轴向地对准的非关节运动位置与定位到轴轴线的一个侧向侧的完全关节运动位置之间选择性地进行关节运动。
实施例38：根据实施例35、36或37所述的外科器械，其中击发梁包括层压在一起的多个梁层。
实施例39：根据实施例35、36、37或38所述的外科器械，其中外科端部执行器包括击发构件，该击发构件与击发梁可操作地交接并且被构造用于在外科端部执行器内轴向行进。
实施例40：根据实施例35、36、37、38或39所述的外科器械，其中装置包括在细长轴组件的脊部分中的弓形路径。该弓形路径被构造成能够在其中可滑动地接纳击发梁并且在从轴轴线轴向地偏移的位置处在脊部分的远侧端部处开放。
实施例41：一种外科器械，包括限定轴轴线的细长轴组件。外科端部执行器枢转地联接到细长轴组件以用于围绕相对于轴轴线横向地延伸的关节运动轴线选择性枢转行进。该外科器械还包括关节运动系统，该关节运动系统包括单个关节运动驱动器，该单个关节运动驱动器被支撑用于沿从轴轴线侧向地偏移的路径纵向行进。交叉连接件联接到关节运动驱动器并且跨过轴轴线横向地延伸以联接到外科端部执行器。
实施例42：根据实施例41所述的外科器械，其中关节运动轴线与轴轴线相交。
实施例43：根据实施例41所述的外科器械，其中外科端部执行器限定端部执行器轴线，并且其中外科端部执行器能够在其中端部执行器轴线与轴轴线轴向地对准的非关节运动位置与其中端部执行器轴线横向于轴轴线的定位到轴轴线的一个侧向侧的完全关节运动位置之间选择性地进行关节运动。
实施例44：根据实施例43所述的外科器械，其中当外科端部执行器处于完全关节运动位置时，端部执行器轴线以相对于轴轴线的关节运动角度定位。关节运动角度为至少六十五度。
实施例45：根据实施例43或44所述的外科缝合器械，其中外科端部执行器能够选择性地关节运动到定位在轴轴线的另一侧向侧上的另一完全关节运动位置。
实施例46：根据实施例41、42、43、44或45所述的外科器械，其中交叉连接件围绕平行于关节运动轴线的连接件轴线枢转地联接到外科端部执行器的近侧端部。
实施例47：根据实施例41、42、43、44、45或46所述的外科器械，其中单个远侧关节运动驱动器被构造成能够向交叉连接件施加推动和拉动动作。
实施例48：根据实施例41、42、43、44、45、46或47所述的外科器械，其中外科端部执行器包括被构造用于在外科端部执行器内轴向行进的击发构件，并且其中细长轴组件还包括可轴向运动的击发梁，该可轴向运动的击发梁与击发构件可操作地交接并且能够响应于对其施加击发动作而沿远侧方向选择性地运动且能够响应于对其施加的回缩动作而沿近侧方向选择性地运动。
实施例49：根据实施例48所述的外科器械，还包括中间支撑构件，该中间支撑构件被构造成能够在外科端部执行器围绕关节运动轴线进行关节运动时侧向地支撑击发构件。中间支撑构件枢转地联接到外科端部执行器，并且相对于细长轴组件被枢转地且可滑动地支撑。
实施例50：一种外科器械，包括限定轴轴线并且包括远侧端部的细长轴组件。该外科器械还包括外科端部执行器，该外科端部执行器包括近侧端部，该近侧端部在细长轴组件的远侧端部上的附接位置处枢转地联接到细长轴组件以用于围绕相对于轴轴线横向地延伸的关节运动轴线选择性枢转行进。关节运动驱动组件被支撑用于沿平行于轴轴线且与轴轴线的第一侧向侧间隔的关节运动致动轴线相对于细长轴组件纵向行进。关节运动驱动组件在定位在轴轴线的另一侧向侧上的单个附接位置处联接到外科端部执行器。
实施例51：根据实施例50所述的外科器械，其中关节运动驱动组件包括远侧关节运动驱动器，该远侧关节运动驱动器由细长轴组件支撑以用于响应于对其施加的关节运动控制动作而沿关节运动致动轴线纵向行进。交叉连接件联接到远侧关节运动驱动器并且跨过轴轴线横向地延伸以在单个附接位置处联接到外科端部执行器。
实施例52：根据实施例50或51所述的外科器械，其中外科端部执行器的近侧端部通过枢轴构件枢转地联接到细长轴组件的远侧端部，该枢轴构件限定关节运动轴线。
实施例53：根据实施例51或52所述的外科器械，其中交叉连接件具有弯曲形状。
实施例54：一种外科器械，包括限定轴轴线并且包括远侧端部的细长轴组件。该外科器械还包括外科端部执行器，该外科端部执行器包括近侧端部，该近侧端部在细长轴组件的远侧端部上的附接位置处枢转地联接到细长轴组件以用于围绕关节运动轴线选择性枢转行进，该关节运动轴线相对于轴轴线在轴轴线的第一侧向侧上横向地延伸经过第一关节运动角度范围并且在轴轴线的第二侧向侧上横向地延伸经过第二关节运动角度范围。关节运动驱动组件被支撑用于沿关节运动致动轴线相对于细长轴组件纵向行进，该关节运动致动轴线平行于轴轴线且在轴轴线的第一侧向侧和第二侧向侧中的一个上侧向地偏移。关节运动驱动组件在定位在轴轴线的第一侧向侧和第二侧向侧中的另一个上的单个附接位置处联接到外科端部执行器，以向外科端部执行器选择性地施加拉动和推动动作。
实施例55：根据实施例54所述的外科缝合器械，其中第一关节运动角度范围在一度与六十五度之间，并且其中第二关节运动角度范围在一度与六十五度之间。
实施例56：根据实施例54或55所述的外科缝合器械，其中关节运动驱动组件包括远侧关节运动驱动器，该远侧关节运动驱动器由细长轴组件支撑以用于响应于对其施加的关节运动控制动作而纵向行进。交叉连接件联接到远侧关节运动驱动器并且跨过轴轴线横向地延伸以在附接位置处联接到外科端部执行器。
实施例57：根据实施例56所述的外科缝合器械，其中当远侧关节运动驱动器沿远侧方向运动时，外科端部执行器沿第一关节运动方向枢转，并且当远侧关节运动驱动器沿近侧方向运动时，外科端部执行器沿第二关节运动方向枢转。
实施例58：根据实施例57所述的外科缝合器械，其中外科端部执行器包括被构造用于在外科端部执行器内轴向行进的击发构件，并且其中细长轴组件还包括可轴向运动的击发梁，该可轴向运动的击发梁与击发构件可操作地交接并且能够响应于对其施加击发动作而沿远侧方向选择性地运动且能够响应于对其施加的回缩动作而沿近侧方向选择性地运动。
实施例59：根据实施例58所述的外科缝合器械，还包括中间支撑构件，该中间支撑构件被构造成能够在外科端部执行器围绕关节运动轴线进行关节运动时侧向地支撑击发构件。中间支撑构件枢转地联接到外科端部执行器，并且相对于细长轴组件被枢转地且可滑动地支撑。
实施例60：一种外科器械，包括限定轴轴线并且包括远侧端部的细长轴组件。该外科器械还包括外科端部执行器，该外科端部执行器包括近侧端部，该近侧端部枢转地联接到细长轴组件以用于围绕相对于轴轴线横向地延伸的关节运动轴线选择性枢转行进。关节运动连接件构造被构造用于相对于轴轴线旋转，使得关节运动连接件构造的旋转引起外科端部执行器相对于细长轴组件围绕关节运动轴线进行关节运动。该外科器械还包括用于使关节运动连接件构造围绕轴轴线选择性地旋转的装置。
实施例61：根据实施例60所述的外科器械，其中关节运动连接件构造包括中央关节运动连接件，该中央关节运动连接件可运动地联接到细长轴组件的远侧端部。端部执行器驱动器连接件可运动地联接到中央关节运动连接件以用于相对于其枢转行进。端部执行器驱动器连接件可操作地联接到外科端部执行器以用于相对于其选择性枢转行进和轴向行进。用于选择性地旋转的装置包括关节运动驱动器，该关节运动驱动器被支撑用于沿远侧方向和近侧方向相对于细长轴组件选择性纵向行进。关节运动驱动器可操作地联接到中央关节运动连接件。
实施例62：根据实施例61所述的外科器械，其中端部执行器驱动器连接件包括：近侧驱动器连接件端部，该近侧驱动器连接件端部枢转地联接到中央关节运动连接件；以及远侧驱动器连接件端部，该远侧驱动器连接件端部包括轴向狭槽，该轴向狭槽被构造成能够在其中将端部执行器附接构件可滑动地接纳在其中。
实施例63：根据实施例62所述的外科器械，其中近侧驱动器连接件端部与细长轴组件的远侧端部啮合枢转接合。
实施例64：根据实施例62所述的外科器械，其中关节运动驱动器通过中间驱动器连接件而可运动地联接到中央关节运动连接件。
实施例65：根据实施例62、63或64所述的外科器械，其中中央关节运动连接件枢转地联接到细长轴组件的远侧端部以用于相对于该远侧端部围绕关节运动轴线枢转行进。
实施例66：根据实施例62、63、64或65所述的外科器械，其中中央关节运动连接件包括三角形连接件，该三角形连接件枢转地联接到细长轴组件的远侧端部以用于相对于该远侧端部围绕关节运动轴线枢转行进。
实施例67：根据实施例62、63、64、65或66所述的外科器械，其中外科端部执行器限定端部执行器轴线，该端部执行器轴线被构造用于当外科端部执行器处于非关节运动位置时与轴轴线轴向对准，并且其中关节运动驱动器被支撑用于沿轴轴线的一个侧向侧选择性纵向行进，并且其中端部执行器附接构件定位在端部执行器轴轴线的与轴轴线的第二侧向侧对应的次级侧向侧上。
实施例68：根据实施例62、63、64、65、66或67所述的外科器械，其中细长轴组件的远侧端部包括弓形太阳齿轮段，并且其中端部执行器驱动器连接件包括行星齿轮部分，该行星齿轮部分与该弓形太阳齿轮段啮合接合。
实施例69：根据实施例68所述的外科器械，其中行星齿轮部分包括多个行星齿轮齿，该多个行星齿轮齿形成在端部执行器驱动器连接件的近侧端部上。
实施例70：一种外科器械，包括限定轴轴线的细长轴组件。外科端部执行器枢转地联接到细长轴组件以用于围绕相对于轴轴线横向地延伸的关节运动轴线选择性枢转行进。该外科器械还包括关节运动系统，该关节运动系统包括关节运动驱动器，该关节运动驱动器被支撑用于沿远侧方向和近侧方向相对于细长轴组件选择性纵向行进。该关节运动系统还包括用于将关节运动驱动器可操作地联接到外科端部执行器的装置。用于可操作地联接的装置被构造成能够响应于关节运动驱动器的纵向运动而向外科端部执行器施加关节运动动作。用于可操作地联接的装置还被构造成能够相对于外科端部执行器枢转地运动和轴向地运动。
实施例71：根据实施例70所述的外科器械，其中关节运动驱动器在轴轴线的一个侧向侧上联接到用于可操作地联接的装置，并且其中用于可操作地联接的装置在轴轴线的另一侧向侧上联接到外科端部执行器。
实施例72：根据实施例70或71所述的外科器械，其中外科端部执行器包括被构造用于在外科端部执行器内轴向行进的击发构件，并且其中细长轴组件还包括可轴向运动的击发梁，该可轴向运动的击发梁与击发构件可操作地交接并且能够响应于对其施加击发动作而沿远侧方向选择性地运动且能够响应于对其施加的回缩动作而沿近侧方向选择性地运动。
实施例73：根据实施例71或72所述的外科器械，其中用于可操作地联接的装置包括三角形连接件，该三角形连接件包括第一连接件拐角部分，该第一连接件拐角部分可操作地联接到关节运动驱动器。该三角形连接件还包括：第二连接件拐角部分，该第二连接件拐角部分与外科端部执行器可操作地交接；以及第三连接件拐角部分，该第三连接件拐角部分枢转地联接到细长轴组件的远侧端部。
实施例74：根据实施例73所述的外科器械，其中第三连接件拐角部分枢转地联接到细长轴组件的远侧端部以用于相对于该远侧端部围绕关节运动轴线枢转行进。
实施例75：根据实施例73或74所述的外科器械，其中三角形连接件的第二拐角部分可操作地联接到端部执行器驱动器连接件，该端部执行器驱动器连接件联接到外科端部执行器以用于相对于其枢转行进和轴向行进。
实施例76：根据实施例73、74或75所述的外科器械，其中端部执行器驱动器连接件包括：中间近侧驱动连接件端部，该中间近侧驱动连接件端部枢转地联接到三角形连接件；以及端部执行器连接件端部，该端部执行器连接件端部包括轴向狭槽，该轴向狭槽被构造成能够在其中可滑动地接纳端部执行器附接构件。
实施例77：一种外科器械，包括细长轴组件，该细长轴组件包括远侧端部和轴轴线。外科端部执行器枢转地联接到细长轴组件的远侧端部以用于围绕横向于轴轴线的关节运动轴线选择性枢转行进。固定太阳齿轮段处于细长轴组件的远侧端部上。该外科器械还包括端部执行器驱动器连接件，该端部执行器驱动器连接件包括：远侧端部，该远侧端部联接到端部执行器以用于相对于其枢转行进和轴向行进；以及近侧端部，该近侧端部包括行星齿轮段，该行星齿轮段被支撑为与固定太阳齿轮段啮合接合。可选择性运动的关节运动驱动器组件与端部执行器驱动器连接件可操作地联接以对其施加关节运动动作。
实施例78：根据实施例77所述的外科器械，其中关节运动驱动器组件包括关节运动驱动器构件，该关节运动驱动器构件被支撑用于沿从轴轴线偏移且平行于轴轴线的轴线在远侧方向和近侧方向上相对于细长轴组件选择性纵向行进。连杆组件在轴轴线的一侧上的第一附接位置处联接到远侧关节运动驱动器构件。此外，连杆组件还联接到端部执行器驱动器连接件。
实施例79：根据实施例77或78所述的外科器械，其中外科端部执行器包括被构造用于在外科端部执行器内轴向行进的击发构件，并且其中细长轴组件还包括可轴向运动的击发梁，该可轴向运动的击发梁与击发构件可操作地交接并且能够响应于对其施加击发动作而沿远侧方向选择性地运动且能够响应于对其施加的回缩动作而沿近侧方向选择性地运动。
实施例80：一种外科器械，包括限定轴轴线的细长轴组件。外科端部执行器枢转地联接到细长轴组件以用于围绕相对于轴轴线横向地延伸的关节运动轴线选择性枢转行进。该外科器械还包括关节运动系统，该关节运动系统包括第一关节运动驱动器，该第一关节运动驱动器被支撑用于沿远侧方向和近侧方向相对于细长轴组件选择性纵向行进。该关节运动系统还包括可运动地联接到外科端部执行器的第一端部执行器连接件。第一端部执行器连接件联接到第一关节运动驱动器以用于相对于其轴向行进和枢转行进。第二关节运动驱动器被支撑用于沿远侧方向和近侧方向相对于细长轴组件选择性纵向行进。第二端部执行器连接件可运动地联接到外科端部执行器。第二端部执行器连接件联接到第二关节运动驱动器以用于相对于其轴向行进和枢转行进。
实施例81：根据实施例80所述的外科器械，其中第一端部执行器连接件通过被接纳在第一关节运动驱动器中的第一轴向狭槽内以用于在其中选择性轴向行进的第一联接器构件而联接到第一关节运动驱动器，并且其中第二端部执行器连接件通过被接纳在第二关节运动驱动器中的第二轴向狭槽内的第二联接器构件而联接到第二关节运动驱动器。
实施例82：根据实施例81所述的外科器械，其中第一轴向狭槽平行于轴轴线，并且其中第二轴向狭槽平行于轴轴线。
实施例83：根据实施例81或82所述的外科器械，其中第一联接器构件包括第一销，该第一销的尺寸被设定成在第一轴向狭槽内旋转和轴向地运动，并且其中第二联接器构件包括第二销，该第二销的尺寸被设定成在第二轴向狭槽内旋转和轴向地运动。
实施例84：根据实施例80、81、82或83所述的外科器械，其中第一关节运动驱动器被支撑用于沿着沿轴轴线的一个侧向侧延伸的第一关节运动轴线选择性纵向行进，并且其中第二关节运动驱动器被支撑用于沿着沿轴轴线的另一侧向侧延伸的第二关节运动轴线选择性纵向行进。
实施例85：根据实施例80、81、82、83或84所述的外科器械，其中外科端部执行器被构造成能够围绕关节运动轴线在轴轴线的第一侧向侧上枢转经过第一关节运动角度范围并且在轴轴线的第二侧向侧上枢转经过第二关节运动角度范围。
实施例86：根据实施例85所述的外科器械，其中第一关节运动角度范围在一度与六十五度之间，并且其中第二关节运动角度范围在一度与六十五度之间。
实施例87：根据实施例80、81、82、83、84、85或86所述的外科器械，其中外科端部执行器包括被构造用于在外科端部执行器内轴向行进的击发构件，并且其中细长轴组件还包括可轴向运动的击发梁，该可轴向运动的击发梁与击发构件可操作地交接并且能够响应于对其施加击发动作而沿远侧方向选择性地运动且能够响应于对其施加的回缩动作而沿近侧方向选择性地运动。
实施例88：根据实施例80、81、82、83、84、85、86或87所述的外科器械，其中第一端部执行器连接件是弯曲的，并且其中第二端部执行器连接件是弯曲的。
实施例89：一种外科器械，包括限定轴轴线的细长轴组件。外科端部执行器枢转地联接到细长轴组件以用于围绕相对于轴轴线横向地延伸的关节运动轴线选择性枢转行进。该外科器械还包括关节运动系统，该关节运动系统包括第一关节运动驱动器，该第一关节运动驱动器被支撑用于沿远侧方向和近侧方向相对于细长轴组件选择性纵向行进。第一端部执行器连接件可枢转地联接到外科端部执行器。第一端部执行器连接件在第一附接点处联接到第一关节运动驱动器。第二关节运动驱动器被支撑用于沿远侧方向和近侧方向相对于细长轴组件选择性纵向行进。第二端部执行器连接件可枢转地联接到外科端部执行器。第二端部执行器连接件在第二附接点处联接到第二关节运动驱动器。该关节运动系统还包括用于约束第一附接点到具有第一预定形状和第一长度的第一路径的行进的第一装置。该关节运动系统还包括用于约束第二附接点到具有第二预定形状和第二长度的第二路径的行进的第二装置。
实施例90：根据实施例89所述的外科器械，其中用于约束的第一装置包括在第一关节运动驱动器的第一远侧端部中的第一轴向狭槽，并且其中用于约束的第二装置包括在第二关节运动驱动器的第二远侧端部中的第二轴向狭槽。
实施例91：根据实施例90所述的外科器械，其中第一轴向狭槽和第二轴向狭槽彼此平行。
实施例92：根据实施例89、90或91所述的外科器械，其中第一长度和第二长度彼此相等。
实施例93：根据实施例89、90、91或92所述的外科器械，其中第一端部执行器连接件能够围绕第一附接点枢转，并且其中第二端部执行器连接件能够围绕第二附接点枢转。
实施例94：根据实施例89、90、91、92或93所述的外科器械，其中外科端部执行器被构造成能够围绕关节运动轴线在轴轴线的第一侧向侧上枢转经过第一关节运动角度范围并且在轴轴线的第二侧向侧上枢转经过第二关节运动角度范围。
实施例95：根据实施例94所述的外科器械，其中第一关节运动角度范围在一度与六十五度之间，并且其中第二关节运动角度范围在一度与六十五度之间。
实施例96：一种外科器械，包括限定轴轴线的细长轴组件。外科端部执行器枢转地联接到细长轴组件以用于围绕相对于轴轴线横向地延伸的关节运动轴线选择性枢转行进。该外科器械还包括关节运动系统，该关节运动系统包括第一关节运动驱动器，该第一关节运动驱动器被支撑用于沿远侧方向和近侧方向相对于细长轴组件选择性纵向行进。第一弯曲端部执行器连接件可枢转地联接到外科端部执行器并且可运动地联接到第一关节运动驱动器。第一销从第一弯曲端部执行器连接件突出并且被可运动地接纳在第一关节运动驱动器中的第一轴向狭槽内。第二关节运动驱动器被支撑用于沿远侧方向和近侧方向相对于细长轴组件选择性纵向行进。第二弯曲端部执行器连接件可枢转地联接到外科端部执行器并且可运动地联接到第二关节运动驱动器。第二销从第二弯曲端部执行器连接件突出并且被可运动地接纳在第二关节运动驱动器中的第二轴向狭槽内。
实施例97：根据实施例96所述的外科器械，其中第一销能够在第一轴向狭槽内旋转，并且其中第二销能够在第二轴向狭槽内旋转。
实施例98：根据实施例97所述的外科器械，其中第一轴向狭槽和第二轴向狭槽彼此平行。
实施例99：根据实施例96、97或98所述的外科器械，其中外科端部执行器包括被构造用于在外科端部执行器内轴向行进的击发构件，并且其中细长轴组件还包括可轴向运动的击发梁，该可轴向运动的击发梁与击发构件可操作地交接并且能够响应于对其施加击发动作而沿远侧方向选择性地运动且能够响应于对其施加的回缩动作而沿近侧方向选择性地运动。
实施例100：一种外科器械，包括限定轴轴线的细长轴组件。外科端部执行器枢转地联接到细长轴组件以用于围绕相对于轴轴线横向地延伸的关节运动轴线选择性枢转行进。该外科器械还包括关节运动系统，该关节运动系统包括关节运动驱动器，该关节运动驱动器被支撑用于沿远侧方向和近侧方向相对于细长轴组件选择性纵向行进。中央关节运动连接件枢转地联接到细长轴组件以用于相对于其枢转行进。中间连接件可运动地联接到关节运动驱动器和中央关节运动连接件。端部执行器驱动器可运动地联接到中央关节运动连接件和外科端部执行器。
实施例101：根据实施例100所述的外科器械，其中中央关节运动连接件枢转地联接到细长轴组件以用于相对于其围绕从关节运动轴线偏移的连接件轴线枢转行进。
实施例102：根据实施例101所述的外科器械，其中第一轴向狭槽平行于轴轴线，并且其中第二轴向狭槽平行于轴轴线。
实施例103：根据实施例101或102所述的外科器械，其中中央关节运动连接件包括：第一中央连接件端部，该第一中央连接件端部可运动地联接到中间连接件；以及第二中央连接件端部，该第二中央连接件端部可运动地附接到端部执行器驱动器，并且其中第一中央连接件端部与连接件轴线相距第一距离，并且其中第二中央连接件端部与连接件轴线相距第二距离，并且其中第一距离不同于第二距离。
实施例104：根据实施例103所述的外科器械，其中第一距离小于第二距离。
实施例105：根据实施例100、101、102、103或104所述的外科器械，其中中央关节运动连接件包括第一长度，并且中间连接件包括第二长度，并且其中端部执行器驱动器包括第三长度，并且其中第二长度短于第一长度和第三长度。
实施例106：根据实施例105所述的外科器械，其中第一长度短于第三长度。
实施例107：根据实施例100、101、102、103、104、105或106所述的外科器械，其中中间连接件沿第一方向弯曲。
实施例108：根据实施例107所述的外科器械，其中端部执行器驱动器沿与第一方向相反的第二方向弯曲。
实施例109：根据实施例100、101、102、103、104、105、106、107或108所述的外科器械，其中在向关节运动驱动器施加拉动动作时沿第一关节运动方向推动外科端部执行器，并且其中在向关节运动驱动器施加推动动作时沿第二关节运动方向拉动外科端部执行器。
实施例110：根据实施例100、101、102、103、104、105、106、107、108或109所述的外科器械，其中外科端部执行器能够在非关节运动位置与第一关节运动位置之间选择性地关节运动通过第一关节运动角度范围，并且其中外科端部执行器能够在非关节运动位置与第二关节运动位置之间关节运动通过第二关节运动角度范围。
实施例111：根据实施例110所述的外科器械，其中第一关节运动角度范围在一度与九十度之间，并且其中第二关节运动角度范围在一度与九十度之间。
实施例112：一种外科器械，包括限定轴轴线的细长轴组件。外科端部执行器枢转地联接到细长轴组件以用于围绕相对于轴轴线横向地延伸的关节运动轴线选择性枢转行进。该外科器械还包括关节运动系统，该关节运动系统包括关节运动驱动器，该关节运动驱动器被支撑用于沿远侧方向和近侧方向相对于细长轴组件选择性纵向行进。中央关节运动连接件枢转地联接到细长轴组件以用于围绕从关节运动轴线偏移的连接件轴线选择性枢转行进。弯曲的中间连接件可运动地联接到关节运动驱动器和中央关节运动连接件。弯曲的端部执行器驱动器可运动地联接到中央关节运动连接件和外科端部执行器。
实施例113：根据实施例112所述的外科器械，其中中央关节运动连接件包括：第一中央连接件端部，该第一中央连接件端部可运动地联接到中间连接件；以及第二中央连接件端部，该第二中央连接件端部可运动地附接到端部执行器驱动器，并且其中第一中央连接件端部与连接件轴线相距第一距离，并且其中第二中央连接件端部与连接件轴线相距第二距离，并且其中第一距离不同于第二距离。
实施例114：根据实施例113所述的外科器械，其中第一距离小于第二距离。
实施例115：根据实施例112、113或114所述的外科器械，其中中央关节运动连接件包括第一长度，并且中间连接件包括第二长度，并且端部执行器驱动器包括第三长度，并且其中第二长度短于第一长度和第三长度。
实施例116：根据实施例115所述的外科器械，其中第一长度短于第三长度。
实施例117：一种外科器械，包括限定轴轴线的细长轴组件。外科端部执行器枢转地联接到细长轴组件以用于围绕相对于轴轴线横向地延伸的关节运动轴线选择性枢转行进。外科端部执行器还包括击发构件，该击发构件被构造用于在外科端部执行器内轴向行进。该外科器械还包括关节运动系统，该关节运动系统包括远侧关节运动驱动器，该远侧关节运动驱动器被支撑用于沿远侧方向和近侧方向相对于细长轴组件选择性纵向行进。中央关节运动连接件可运动地销接到细长轴组件的远侧端部。中间连接件可运动地联接到远侧关节运动连接件和中央关节运动连接件。端部执行器驱动器可运动地联接到中央连接件和外科端部执行器。
实施例118：根据实施例117所述的外科器械，其中外科端部执行器限定端部执行器轴线，并且其中外科端部执行器能够在其中端部执行器轴线与轴轴线对准的第一非关节运动位置与其中端部执行器轴线垂直于轴轴线延伸的在轴轴线的第一侧向侧上的第一最大关节运动位置和其中端部执行器轴线垂直于轴轴线的在轴轴线的第二侧向侧上的第二最大关节运动位置之间选择性地进行关节运动。
实施例119：根据实施例117或118所述的外科器械，其中中央关节运动连接件包括：第一中央连接件端部，该第一中央连接件端部可运动地联接到中间连接件；以及第二中央连接件端部，该第二中央连接件端部可运动地附接到端部执行器驱动器，并且其中第一中央连接件端部与连接件轴线相距第一距离，并且其中第二中央连接件端部与连接件轴线相距第二距离，并且其中第一距离不同于第二距离。
实施例120：一种外科器械，包括限定轴轴线的细长轴组件。该外科器械还包括外科端部执行器，该外科端部执行器包括远侧端部和近侧端部。近侧端部枢转地联接到细长轴组件以用于围绕相对于轴轴线横向地延伸的关节运动轴线选择性枢转行进。外科端部执行器能够围绕关节运动轴线从其中外科端部执行器的远侧端部与关节运动轴线相距非关节运动距离的非关节运动位置选择性地枢转到其中外科端部执行器的远侧端部与关节运动轴线相距对应关节运动距离的关节运动位置，该对应关节运动距离小于非关节运动距离。
实施例121：根据实施例120所述的外科器械，其中细长轴组件包括枢轴构件，该枢轴构件限定关节运动轴线，并且其中外科端部执行器的近侧端部包括细长狭槽，该细长狭槽被构造成能够在其中可滑动地接纳枢轴构件。
实施例122：根据实施例120或121所述的外科器械，还包括用于向外科端部执行器选择性地施加关节运动动作的装置。
实施例123：根据实施例122所述的外科器械，其中用于选择性地施加的装置包括与外科端部执行器啮合接合的旋转齿轮。
实施例124：根据实施例123所述的外科器械，其中外科端部执行器的近侧端部包括与旋转齿轮啮合接合的椭圆形齿轮轮廓。
实施例125：根据实施例123或124所述的外科器械，其中用于选择性地施加的装置包括可选择性轴向运动的远侧关节运动驱动器，该可选择性轴向运动的远侧关节运动驱动器与旋转齿轮可操作地交接。
实施例126：根据实施例125所述的外科器械，还包括处于可选择性轴向运动的远侧关节运动驱动器中的驱动狭槽和附接到旋转齿轮且被可滑动地接纳在驱动狭槽中的驱动销。
实施例127：根据实施例120、121、122、123、124、125或126所述的外科器械，其中外科端部执行器限定端部执行器轴线，该端部执行器轴线被定位成使得当外科端部执行器处于非关节运动位置时，端部执行器轴线与轴轴线对准，并且其中当外科端部执行器关节运动到关节运动位置中的完全关节运动位置时，端部执行器轴线垂直于轴轴线。
实施例128：根据实施例122、123、124、125、126或127所述的外科器械，其中用于选择性地施加的装置包括被支撑用于围绕关节运动轴线旋转行进的中央关节运动连接件。可选择性轴向运动的关节运动驱动器在轴轴线的第一侧上的第一位置处与中央关节运动连接件交接。用于选择性地施加的装置还包括关节运动驱动连接件，该关节运动驱动连接件包括联接到外科端部执行器的第一端部和在轴轴线的第二侧上的第二位置处联接到中央关节运动连接件的第二端部。
实施例129：根据实施例128所述的外科器械，其中用于选择性地施加的装置包括被支撑用于围绕关节运动轴线行进的中央关节运动齿轮和定位在关节运动驱动连接件的第二端部上的齿轮轮廓。齿轮轮廓与中央关节运动齿轮啮合接合。
实施例130：一种外科器械，包括限定轴轴线并且包括远侧轴部分的细长轴组件。该外科器械还包括外科端部执行器，该外科端部执行器限定端部执行器轴线并且包括远侧端部和近侧端部。近侧端部可运动地联接到远侧轴部分以用于在其中端部执行器轴线与轴轴线对准并且外科端部执行器的远侧端部与细长轴组件的远侧端部部分相距非关节运动距离的非关节运动位置至其中端部执行器轴线横向于轴轴线并且外科端部执行器的远侧端部与远侧轴部分相距对应关节运动距离的关节运动位置之间选择性行进，该对应关节运动距离小于非关节运动距离。
实施例131：根据实施例130所述的外科器械，其中外科端部执行器的近侧端部通过可选择性轴向运动的关节运动驱动器和关节运动连接件而可运动地联接到细长轴组件的远侧轴部分。
实施例132：根据实施例130或131所述的外科器械，其中当外科端部执行器在关节运动位置之一中进行关节运动时，端部执行器轴线垂直于轴轴线。
实施例133：一种外科器械，包括限定轴轴线的细长轴组件。该外科器械还包括外科端部执行器，该外科端部执行器包括远侧端部和近侧端部。近侧端部可运动地联接到细长轴组件以用于围绕相对于轴轴线横向地延伸的关节运动轴线选择性枢转行进以及相对于关节运动轴线平移行进。关节运动系统与外科端部执行器可操作地交接，以向所述外科端部执行器选择性地施加关节运动动作。
实施例134：根据实施例133所述的外科器械，其中关节运动系统包括与外科端部执行器啮合接合的旋转齿轮和用于使旋转齿轮旋转的装置。
实施例135：根据实施例134所述的外科器械，还包括与旋转齿轮啮合接合的处于外科端部执行器的近侧端部上的椭圆形齿轮段。
实施例136：根据实施例134或135所述的外科器械，其中用于使旋转齿轮旋转的装置包括可选择性轴向运动的远侧关节运动驱动器，该可选择性轴向运动的远侧关节运动驱动器包括驱动狭槽和附接到旋转齿轮且被可滑动地接纳在驱动狭槽中的驱动销。
实施例137：根据实施例136所述的外科器械，其中驱动狭槽横向于轴轴线。
实施例138：根据实施例133、134、135、136或137所述的外科器械，其中外科端部执行器被构造成能够切割并缝合组织。
实施例139：根据实施例133、134、135、136、137或138所述的外科器械，其中关节运动系统包括被支撑用于围绕关节运动轴线旋转行进的中央关节运动连接件。可选择性轴向运动的关节运动驱动器在轴轴线的第一侧上的第一位置处与中央关节运动连接件交接。该关节运动系统还包括关节运动驱动连接件，该关节运动驱动连接件包括联接到外科端部执行器的第一端部和在轴轴线的第二侧上的第二位置处联接到中央关节运动连接件的第二端部。
实施例140：一种外科器械，包括限定轴轴线的细长轴组件。外科端部执行器枢转地联接到细长轴组件以用于相对于细长轴组件围绕横向于轴轴线的关节运动轴线进行选择性关节运动。该外科器械还包括关节运动系统，该关节运动系统包括关节运动缆线，该关节运动缆线在附接点处联接到外科端部执行器并且轴颈连接在被支撑在细长轴组件上的近侧滑轮上。近侧滑轮限定近侧滑轮轴线，该近侧滑轮轴线与附接点相距张紧距离。关节运动驱动器联接到关节运动缆线以用于选择性地致使关节运动缆线沿第一关节运动方向和第二关节运动方向围绕近侧滑轮旋转。可调节的张紧组件与近侧滑轮交接，以选择性地调节张紧距离。
实施例141：根据实施例140所述的外科器械，还包括远侧滑轮，该远侧滑轮附接到外科端部执行器并且限定附接点。
实施例142：根据实施例141所述的外科器械，其中远侧滑轮限定关节运动轴线。
实施例143：根据实施例140、141或142所述的外科器械，其中可调节的张紧组件包括滑轮安装座，该滑轮安装座在其上支撑近侧滑轮。安装轴联接到滑轮安装座并且被支撑在细长轴组件的一部分中以用于相对于其选择性地旋转。安装轴偏心地附接到滑轮安装座，使得安装轴的旋转致使近侧滑轮轴向地运动，以调节近侧滑轮轴线与附接点之间的张紧距离。
实施例144：根据实施例143所述的外科缝合器械，其中安装轴限定从近侧滑轮轴线偏移的安装轴轴线。
实施例145：根据实施例140、141或142所述的外科器械，其中可调节的张紧组件包括滑轮安装座，该滑轮安装座在其上支撑近侧滑轮。安装构件附接到滑轮安装座并且被可滑动地支撑在细长轴组件上以用于相对于其选择性轴向行进。可调节的张紧组件还包括用于使安装构件在细长轴组件上选择性轴向运动的装置。
实施例146：根据实施例145所述的外科器械，其中用于选择性轴向运动的装置包括张紧螺钉，该张紧螺钉被安装在细长轴组件中并且被构造成能够使安装构件在细长轴组件中的轴向狭槽内轴向地运动。
实施例147：根据实施例145所述的外科器械，其中用于选择性轴向运动的装置包括旋转凸轮组件，该旋转凸轮组件被安装在细长轴组件中并且被构造成能够使安装构件在细长轴组件中的轴向狭槽内轴向地运动。
实施例148：根据实施例147所述的外科器械，其中旋转凸轮组件包括张紧凸轮，该张紧凸轮被构造用于与安装构件进行凸轮接触。安装主轴联接到张紧凸轮并且被支撑在细长轴组件的一部分中以用于相对于其选择性地旋转。安装主轴附接到张紧凸轮，使得安装主轴沿第一方向的旋转致使张紧凸轮将安装构件轴向地偏压在轴向狭槽内。
实施例149：根据实施例148所述的外科器械，其中安装主轴具有滚花外表面并且被构造成能够被接纳在细长轴组件的部分中的滚花孔内。
实施例150：一种外科器械，包括限定轴轴线的细长轴组件。外科端部执行器枢转地联接到细长轴组件以用于相对于细长轴组件围绕横向于轴轴线的关节运动轴线进行选择性关节运动。该外科器械还包括关节运动系统，该关节运动系统包括关节运动缆线，该关节运动缆线轴颈连接在附接到外科端部执行器的远侧滑轮上并且轴颈连接在被支撑在细长轴组件上的近侧滑轮上。关节运动驱动器联接到关节运动缆线以用于选择性地致使关节运动缆线沿第一旋转方向和第二旋转方向围绕近侧滑轮旋转。可调节的张紧组件被支撑在细长轴组件上并且被构造成能够沿横向于第一旋转方向和第二旋转方向的方向选择性地接触关节运动缆线的一部分以增大关节运动缆线中张力的量。
实施例151：根据实施例150所述的外科器械，其中关节运动缆线包括第一缆线端部和第二缆线端部，并且其中第一缆线端部和第二缆线端部与关节运动驱动器可操作地交接。
实施例152：根据实施例151所述的外科器械，其中关节运动驱动器包括远侧端部部分，该远侧端部部分包括一对夹板。这些夹板在它们之间限定安装空间。第一缆线端部包括附接到缆线的被接纳在安装空间内的第一耳状物，并且其中第二缆线端部包括附接于其并且被接纳在该夹板对之间的安装空间内的第二耳状物。
实施例153：根据实施例150、151或152所述的外科器械，其中关节运动缆线不可旋转地联接到远侧滑轮。
实施例154：一种外科器械，包括限定轴轴线的细长轴组件。外科端部执行器枢转地联接到细长轴组件以用于相对于细长轴组件围绕横向于轴轴线的关节运动轴线进行选择性关节运动。该外科器械还包括关节运动系统，该关节运动系统包括关节运动缆线，该关节运动缆线轴颈连接在附接到外科端部执行器的远侧滑轮上并且轴颈连接在被支撑在细长轴组件上的近侧滑轮上。关节运动缆线包括第一缆线端部和第二缆线端部。该关节运动系统还包括关节运动驱动器，该关节运动驱动器用于选择性地致使关节运动缆线沿第一关节运动方向和第二关节运动方向围绕近侧滑轮旋转。关节运动驱动器包括：第一夹板，该第一夹板附接到第一缆线端部；以及第二夹板，该第二夹板附接到第二缆线端部并且与第一夹板隔开。该关节运动系统还包括联接到第一夹板和第二夹板以用于使第一缆线端部和第二缆线端部朝向彼此运动以增大关节运动缆线中张力的量的装置。
实施例155：根据实施例154所述的外科器械，其中联接到第一夹板和第二夹板以用于使第一缆线端部和第二缆线端部朝向彼此运动的装置包括旋转构件，该旋转构件联接到第一夹板和第二夹板，使得旋转构件沿第一旋转方向的旋转致使第一夹板和第二夹板朝向彼此运动并且旋转构件沿第二旋转方向的旋转致使第一夹板和第二夹板远离彼此运动。
实施例156：根据实施例155所述的外科器械，其中旋转构件包括张紧螺钉，该张紧螺钉与第一夹板和第二夹板螺纹接合。
实施例157：根据实施例154所述的外科器械，其中第一缆线端部包括附接到缆线的被接纳在第一夹板与第二夹板之间的第一耳状物，并且其中第二缆线端部包括附接到缆线并且被接纳在第一夹板与第二夹板之间的第二耳状物。
实施例158：根据实施例154、155、156或157所述的外科器械，其中关节运动缆线不可旋转地联接到远侧滑轮。
实施例159：根据实施例154、155、156、157或158所述的外科器械，其中外科端部执行器被构造成能够切割并缝合组织。
实施例160：一种外科器械，包括外科端部执行器，该外科端部执行器包括第一钳口和第二钳口，其中在向外科端部执行器施加闭合动作时，第一钳口和第二钳口中的一个能够相对于第一钳口和第二钳口中的另一个选择性地运动。该外科器械还包括细长轴组件，该细长轴组件包括闭合构件组件，该闭合构件组件被支撑用于相对于外科端部执行器轴向行进。闭合构件组件包括近侧闭合构件，该近侧闭合构件被构造成能够在对其施加闭合致动动作时被轴向地推进完全闭合行程距离。远侧闭合构件与近侧闭合构件可运动地交接，使得远侧闭合构件响应于近侧闭合构件轴向运动经过完全闭合行程距离而运动轴向闭合距离，以借此致使远侧闭合构件将闭合动作施加到外科端部执行器，并且其中轴向闭合距离小于完全闭合行程距离。
实施例161：根据实施例160所述的外科器械，其中近侧闭合构件包括远侧端部，并且其中远侧闭合构件包括近侧端部，该近侧端部可滑动地附连到该近侧闭合构件的远侧端部，使得在近侧闭合构件运动经过完全闭合行程距离时，直到近侧闭合构件已轴向地运动经过完全闭合行程距离的一部分，远侧闭合构件才开始轴向地运动经过轴向闭合距离。
实施例162：根据实施例161所述的外科器械，其中细长轴组件包括联接到外科端部执行器的脊组件，并且其中近侧闭合构件包括近侧闭合套筒，该近侧闭合套筒被支撑在脊组件的一部分上以用于在其上轴向行进经过完全闭合行程距离，并且其中远侧闭合构件包括远侧闭合套筒，该远侧闭合套筒可滑动地轴颈连接在脊组件的另一部分上并且可运动地联接到近侧闭合套筒。
实施例163：根据实施例162所述的外科器械，其中近侧闭合套筒在其远侧端部中具有开口，并且其中远侧闭合套筒的近侧端部延伸穿过开口并且被构造成能够防止远侧闭合套筒的近侧端部与近侧闭合套筒的远侧端部分离。
实施例164：根据实施例163所述的外科器械，其中近侧闭合套筒的远侧端部围绕开口朝内扩口，并且其中远侧闭合套筒的近侧端部朝外扩口，以防止远侧闭合套筒的近侧端部与近侧闭合套筒的远侧端部分离，同时便于近侧闭合套筒相对于远侧闭合套筒轴向行进经过完全闭合行程距离的一部分。
实施例165：根据实施例162所述的外科器械，其中近侧闭合套筒包括在其远侧端部中限定开口的向内延伸的法兰，并且其中远侧闭合套筒的近侧端部延伸穿过开口并且包括向外延伸的法兰，该向外延伸的法兰与该向内延伸的法兰配合以防止远侧闭合套筒的近侧端部与近侧闭合套筒的远侧端部分离。
实施例166：根据实施例162所述的外科器械，其中近侧闭合套筒包括在近侧闭合套筒的远侧端部近侧的接触部分。该接触部分被构造成能够在近侧闭合套筒已被轴向地推进经过完全闭合行程距离的预定部分之后轴向地接触远侧闭合套筒的近侧端部。
实施例167：根据实施例166所述的外科器械，其中接触部分包括近侧闭合套筒的卷曲部分。
实施例168：根据实施例166所述的外科器械，其中接触部分包括至少一个向内延伸的突片构件，该至少一个向内延伸的突片构件形成于近侧闭合套筒中并且取向成接触远侧闭合套筒的近侧端部的对应部分。
实施例169：根据实施例166所述的外科器械，其中接触部分包括形成在止动构件上的向内延伸的法兰，该止动构件附接到近侧闭合套筒的内壁。
实施例170：一种外科器械，包括外科端部执行器，该外科端部执行器包括第一钳口和第二钳口，其中在向外科端部执行器施加闭合动作时，第一钳口和第二钳口中的一个能够相对于第一钳口和第二钳口中的另一个选择性地运动。该外科器械还包括细长轴组件，该细长轴组件包括闭合构件组件，该闭合构件组件被支撑用于相对于外科端部执行器轴向行进。闭合构件组件包括近侧闭合构件，该近侧闭合构件被构造成能够在对其施加闭合致动动作时被轴向地推进完全闭合行程距离。远侧闭合构件被支撑用于轴向行进轴向闭合距离以向外科端部执行器施加闭合动作，该轴向闭合距离小于完全闭合行程距离。闭合行程减少组件与近侧闭合构件和远侧闭合构件交接，使得在近侧闭合构件运动经过完全闭合行程距离时，直到近侧闭合构件已轴向地运动经过完全闭合行程距离的一部分，远侧闭合构件才开始轴向地运动经过闭合距离。
实施例171：根据实施例170所述的外科器械，其中细长轴组件包括联接到外科端部执行器的脊组件，并且其中近侧闭合构件包括近侧闭合套筒，该近侧闭合套筒被支撑在脊组件的一部分上以用于在其上轴向行进经过完全闭合行程距离，并且其中远侧闭合构件包括远侧闭合套筒，该远侧闭合套筒被可滑动地支撑在脊组件的另一部分上以用于轴向行进经过闭合距离。
实施例172：根据实施例170或171所述的外科器械，其中闭合行程减少组件包括：近侧安装构件，该近侧安装构件联接到近侧闭合套筒以用于与其一起轴向行进经过完全闭合行程距离；以及远侧安装构件，该远侧安装构件联接到远侧闭合套筒以用于与其一起轴向行进经过闭合距离。
实施例173：根据实施例172所述的外科器械，其中近侧安装构件包括接触部分，该接触部分被构造成能够在近侧闭合套筒已运动经过完全闭合行程距离的该部分之后接触近侧安装构件和近侧闭合套筒中的至少一者。
实施例174：根据实施例173所述的外科器械，其中远侧安装构件限定远侧凸缘，并且其中近侧安装构件限定近侧凸缘，该近侧凸缘与该远侧凸缘隔开以在它们之间形成远侧行进区，并且其中接触部分与近侧安装构件和近侧闭合套筒中的至少一者隔开以在接触部分与近侧安装构件和近侧闭合套筒中的至少一者之间限定近侧行进区。
实施例175：根据实施例174所述的外科器械，其中近侧行进区具有近侧轴向宽度，并且其中远侧行进区具有与近侧轴向宽度不同的远侧轴向宽度。
实施例176：根据实施例172、173、174或175所述的外科器械，还包括定位在近侧安装构件与远侧安装构件之间的偏压构件。
实施例177：根据实施例174或175所述的外科器械，还包括被支撑在远侧行进区内的偏压构件。
实施例178：一种外科器械，包括外科端部执行器，该外科端部执行器包括第一钳口和第二钳口，其中在向外科端部执行器施加闭合动作时，第一钳口和第二钳口中的一个能够相对于第一钳口和第二钳口中的另一个选择性地运动。该外科器械还包括细长轴组件，该细长轴组件包括闭合构件组件，该闭合构件组件被支撑用于相对于外科端部执行器轴向行进。闭合构件组件包括近侧闭合构件，该近侧闭合构件被构造成能够在对其施加闭合致动动作时被轴向地推进完全闭合行程距离。近侧闭合构件被构造成能够在到达最大闭合行程距离末端时施加最大闭合力。远侧闭合构件被支撑用于轴向行进轴向闭合距离以向外科端部执行器施加闭合动作，该轴向闭合距离小于完全闭合行程距离。闭合行程减少组件与近侧闭合构件和远侧闭合构件交接，使得在近侧闭合构件运动经过完全闭合行程距离时，近侧闭合构件向远侧闭合构件施加另一闭合力，该另一闭合力小于最大闭合力。
实施例179：根据实施例178所述的外科器械，其中闭合行程减少组件包括近侧安装构件，该近侧安装构件联接到近侧闭合构件以用于与其一起轴向行进经过完全闭合行程距离。远侧安装构件联接到远侧闭合构件以用于与其一起轴向行进经过轴向闭合距离。偏压构件定位在近侧安装构件的一部分与远侧安装构件的另一部分之间。
下述专利的全部公开内容据此以引用方式并入本文：
公布于1995年4月4日的名称为“ELECTROSURGICAL HEMOSTATIC DEVICE”的美国专利5,403,312；
公布于2006年2月21日的名称为“SURGICAL STAPLING INSTRUMENT HAVINGSEPARATE DISTINCT CLOSING AND FIRING SYSTEMS”的美国专利7,000,818；
公布于2008年9月9日的名称为“MOTOR-DRIVEN SURGICAL CUTTING ANDFASTENING INSTRUMENT WITH TACTILE POSITION FEEDBACK”的美国专利7,422,139；
公布于2008年12月16日的名称为“ELECTRO-MECHANICAL SURGICAL INSTRUMENTWITH CLOSURE SYSTEM AND ANVIL ALIGNMENT COMPONENTS”的美国专利7,464,849；
公布于2010年3月2日的名称为“SURGICAL INSTRUMENT HAVING AN ARTICULATINGEND EFFECTOR”的美国专利7,670,334；
公布于2010年7月13日的名称为“SURGICAL STAPLING INSTRUMENTS”的美国专利7,753,245；
公布于2013年3月12日的名称为“SELECTIVELY ORIENTABLE IMPLANTABLEFASTENER CARTRIDGE”的美国专利8,393,514；
名称为“SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES”的美国专利申请序列号11/343,803；现为美国专利7,845,537；
提交于2008年2月14日的名称为“SURGICAL CUTTING AND FASTENING INSTRUMENTHAVING RF ELECTRODES”的美国专利申请序列号12/031,573；
提交于2008年2月15日的名称为“END EFFECTORS FOR A SURGICAL CUTTING ANDSTAPLING INSTRUMENT”的美国专利申请序列号12/031,873，现为美国专利7,980,443；
名称为“MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT”的美国专利申请序列号12/235,782，现为美国专利8,210,411；
名称为“POWERED SURGICAL CUTTING AND STAPLING APPARATUS WITH MANUALLYRETRACTABLE FIRING SYSTEM”的美国专利申请序列号12/249,117，现为美国专利8,608,045；
提交于2009年12月24日的名称为“MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENTWITH ELECTRIC ACTUATOR DIRECTIONAL CONTROL ASSEMBLY”的美国专利申请序列号12/647,100；现为美国专利8,220,688；
提交于2012年9月29日的名称为“STAPLE CARTRIDGE”的美国专利申请序列号12/893,461，现为美国专利8,733,613；
提交于2011年2月28日的名称为“SURGICAL STAPLING INSTRUMENT”的美国专利申请序列号13/036,647，现为美国专利8,561,870；
名称为“SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENTARRANGEMENTS”的美国专利申请序列号13/118,241，现为美国专利9,072,535；
提交于2012年6月15日的名称为“ARTICULATABLE SURGICAL INSTRUMENTCOMPRISING A FIRING DRIVE”的美国专利申请序列号13/524,049；现为美国专利9,101,358；
提交于2013年3月13日的名称为“STAPLE CARTRIDGE TISSUE THICKNESS SENSORSYSTEM”的美国专利申请序列号13/800,025，现为美国专利申请公布2014/0263551；
提交于2013年3月13日的名称为“STAPLE CARTRIDGE TISSUE THICKNESS SENSORSYSTEM”的美国专利申请序列号13/800,067，现为美国专利申请公布2014/0263552；
提交于2006年1月31日的名称为“SURGICAL CUTTING AND FASTENING INSTRUMENTWITH CLOSURE TRIGGER LOCKING MECHANISM”的美国专利申请公布2007/0175955；以及
提交于2010年4月22日的名称为“SURGICAL STAPLING INSTRUMENT WITH ANARTICULATABLE END EFFECTOR”的美国专利申请公布2010/0264194，现为美国专利8,308,040。
虽然本文已结合某些公开的实施方案描述了装置的各种实施方案，但也可实施对这些实施方案的许多修改和变型。另外，在公开了用于某些部件的材料的情况下，也可使用其它材料。此外，根据多种实施方案，单个部件可被替换为多个部件，并且多个部件也可被替换为单个部件，以执行给定的一种或多种功能。上述具体实施方式和下述权利要求旨在涵盖所有此类修改和变型。
本文所公开的装置可被设计成在单次使用后废弃，或者其可被设计成多次使用。然而无论是哪种情况，该装置都可在至少使用一次后经过修整再行使用。修整可包括拆卸装置、之后清洁或替换特定零件以及后续重新组装步骤的任意组合。具体地，所述装置可拆卸，而且可以任意组合选择性地替换或移除所述装置的任意数目的特定零件或部件。在清洁和/或替换特定部件后，可对所述装置进行重新组装，以便随后在修整设施处使用或就在外科手术之前由手术团队使用。本领域的技术人员将会理解，修整装置可利用各种技术来进行拆卸、清洁/替换和重新组装。此类技术的使用以及所得的修整装置均在本申请的范围内。
仅以举例的方式，可在外科手术之前对本文所述的方面进行处理。首先，可以获得新的或用过的器械，并且根据需要进行清洁。然后，可对器械进行灭菌。在一种灭菌技术中，将所述器械放置在密闭且密封的容器(诸如，塑料或TYVEK袋)中。然后可将容器和器械置于可穿透所述容器的辐射场，例如γ辐射、X射线或高能电子。辐射可以杀死器械上和容器中的细菌。经灭菌的器械随后可被存放在无菌容器中。密封容器可将器械保持处于无菌状态，直至在医疗设施中将该容器打开。还可使用本领域已知的任何其它技术对装置进行灭菌，所述技术包括但不限于β或γ辐射、环氧乙烷、等离子过氧化物或蒸汽。
尽管本发明已被描述为具有示例性设计，但可在本公开的实质和范围内进一步修改本发明。因此，本申请旨在涵盖使用本发明的一般原理的本发明的任何变型、用途或改型。
以引用方式全文或部分地并入本文的任何专利、公布或其它公开材料均仅在所并入的材料不与本公开所提出的现有定义、陈述或其它公开材料相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。

Claims (20)

1.一种外科器械，包括：
细长轴组件，所述细长轴组件限定轴轴线；
外科端部执行器，所述外科端部执行器枢转地联接到所述细长轴组件以用于相对于所述细长轴组件围绕横向于所述轴轴线且从所述轴轴线侧向地偏移的关节运动轴线进行选择性关节运动，所述外科端部执行器限定端部执行器轴线，所述外科端部执行器被构造成能够在非关节运动位置至在所述轴轴线的一侧上的最大关节运动位置之间进行选择性地关节运动，在所述非关节运动位置中，所述执行器轴线与所述轴轴线轴向地对准，在所述最大关节运动位置中，所述端部执行器轴线垂直于所述轴轴线；以及
关节运动系统，所述关节运动系统与所述外科端部执行器可操作地交接，以使所述外科端部执行器在所述非关节运动位置与所述关节运动位置之间选择性地运动。
2.根据权利要求1所述的外科器械，其中所述关节运动系统包括关节运动驱动构件，所述关节运动驱动构件可操作地联接到所述外科端部执行器以用于向所述外科端部执行器选择性地施加推动和拉动动作。
3.根据权利要求1所述的外科器械，其中所述关节运动系统包括关节脱位构件，所述关节脱位构件被构造成能够向所述外科端部执行器选择性地仅施加拉动动作。
4.根据权利要求1所述的外科器械，其中所述关节运动系统包括：
端部执行器驱动器连接件，所述端部执行器驱动器连接件联接到所述外科端部执行器；以及远侧关节运动驱动器，所述远侧关节运动驱动器联接到所述端部执行器驱动器连接件并且被构造成能够向所述端部执行器驱动器连接件选择性地施加推动动作和拉动动作；以及
关节脱位构件，所述关节脱位构件附接到所述外科端部执行器并且被构造成能够向所述外科端部执行器仅施加拉动动作。
5.根据权利要求1所述的外科器械，其中所述关节运动系统包括：
端部执行器驱动器连接件，所述端部执行器驱动器连接件联接到所述外科端部执行器；
远侧关节运动驱动器，所述远侧关节运动驱动器联接到所述端部执行器驱动器连接件并且被构造成能够向所述端部执行器驱动器连接件选择性地施加推动动作和拉动动作；以及
关节脱位构件，所述关节脱位构件被构造成能够向所述外科端部执行器施加关节脱位动作。
6.根据权利要求5所述的外科器械，其中所述外科端部执行器通过弹簧销枢转地联接到所述细长轴组件，所述弹簧销限定所述关节运动轴线并且被构造成能够向所述外科端部执行器施加关节脱位偏压动作。
7.一种外科器械，包括：
细长轴组件，所述细长轴组件限定轴轴线；
外科端部执行器，所述外科端部执行器限定端部执行器轴线；
关节运动接头，所述关节运动接头被构造成能够便于所述外科端部执行器相对于所述细长轴组件在非关节运动位置与完全关节运动位置之间进行关节运动，在所述非关节运动位置中，所述端部执行器轴线与所述轴轴线轴向地对准，在所述完全关节运动位置中，所述端部执行器轴线垂直于所述轴轴线；以及
用于向所述外科端部执行器施加关节运动动作的装置，用于施加的所述装置仅沿所述轴轴线的一个侧向侧定位。
8.根据权利要求7所述的外科器械，其中所述外科端部执行器的近侧端部相对于所述端部执行器轴线成角度，并且其中所述细长轴组件的远侧端部相对于所述轴轴线成角度。
9.根据权利要求8所述的外科器械，其中所述外科端部执行器的所述近侧端部相对于所述端部执行器轴线以端部执行器角度取向，并且其中所述细长轴组件的所述远侧端部相对于所述轴轴线以轴角度取向。
10.根据权利要求9所述的外科器械，其中所述端部执行器角度和所述轴角度彼此相等。
11.根据权利要求7所述的外科器械，还包括用于向所述外科端部执行器施加关节脱位动作的装置。
12.一种外科器械，包括：
细长轴组件，所述细长轴组件限定轴轴线并且包括远侧端部；
外科端部执行器，所述外科端部执行器包括近侧端部，所述近侧端部枢转地联接到所述细长轴组件的所述远侧端部以用于相对于该远侧端部围绕关节运动轴线选择性枢转行进，所述关节运动轴线从所述轴轴线侧向地偏移且相对于所述轴轴线横向地延伸；以及
关节运动系统，所述关节运动系统包括：
端部执行器驱动器连接件，所述端部执行器驱动器连接件可操作地联接到所述外科端部执行器；
关节运动驱动器，所述关节运动驱动器被支撑用于在对其施加关节运动动作时沿远侧方向和近侧方向纵向行进，所述关节运动驱动器联接到所述端部执行器驱动器连接件，以使所述外科端部执行器相对于所述细长轴组件围绕所述关节运动轴线选择性地进行关节运动；以及
柔性的关节脱位构件，所述柔性的关节脱位构件联接到所述细长轴组件和所述外科端部执行器，以向所述外科端部执行器施加关节脱位动作。
13.根据权利要求12所述的外科器械，其中所述关节运动驱动器被构造成能够仅沿横向于所述轴轴线的一个关节运动方向向所述外科端部执行器施加第一关节运动动作。
14.根据权利要求12所述的外科器械，其中所述外科端部执行器限定端部执行器轴线，并且其中所述端部执行器能够在非关节运动位置至在所述轴轴线的一个侧向侧上的最大关节运动位置之间运动，在所述非关节运动位置中，所述执行器轴线与所述轴轴线轴向地对准，在所述最大关节运动位置中，所述端部执行器轴线垂直于所述轴轴线。
15.根据权利要求12所述的外科器械，其中当所述外科端部执行器处于非关节运动取向时，所述关节运动驱动器和所述端部执行器驱动器连接件定位在所述轴轴线的一个侧向侧上。
16.根据权利要求12所述的外科器械，其中所述外科端部执行器包括被构造用于在所述外科端部执行器内轴向行进的击发构件，并且其中所述细长轴组件还包括可轴向运动的击发梁，所述可轴向运动的击发梁与所述击发构件可操作地交接并且能够响应于对其施加的击发动作而沿所述远侧方向选择性地运动，所述击发梁能够响应于对其施加的回缩动作而沿所述近侧方向选择性地运动。
17.根据权利要求12所述的外科器械，其中所述外科端部执行器的所述近侧端部通过关节运动销枢转地销接到所述细长轴组件的所述远侧端部，并且其中所述柔性的关节脱位构件被构造成能够在所述外科端部执行器围绕所述关节运动轴线进行关节运动时在所述关节运动销周围挠曲。
18.根据权利要求12所述的外科器械，其中所述外科端部执行器的所述近侧端部相对于所述端部执行器轴线成角度，并且其中所述细长轴组件的所述远侧端部相对于所述轴轴线成角度。
19.根据权利要求18所述的外科器械，其中所述外科端部执行器的所述近侧端部相对于所述端部执行器轴线以端部执行器角度取向，并且其中所述细长轴组件的所述远侧端部相对于所述轴轴线以轴角度取向。
20.根据权利要求19所述的外科端部执行器，其中所述端部执行器角度和所述轴角度彼此相等。
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