CN109069151B - 具有液压钉部署的外科钉仓 - Google Patents
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Abstract
本发明提供了一种外科器械，所述外科器械包括主体组件、轴组件和端部执行器。所述端部执行器具有第一钳口和第二钳口，所述第一钳口和所述第二钳口被构造成能够接收第一钳口和第二钳口之间的组织。所述端部执行器还包括钉仓，所述钉仓包括多个钉和液压可膨胀构件，所述液压可膨胀构件被构造成能够接收流体，并由此从收缩状态膨胀到膨胀状态。所述液压可膨胀构件还被构造成能够将所述多个钉中的至少一个朝向所述第一钳口的砧座引导，以迫使所述钉中的所述至少一个抵靠所述砧座并使所述钉中的所述至少一个在所述组织内成形。
Description
背景技术
在一些环境下，内窥镜式外科器械相对于传统的开放式外科装置来说是优选的，因为较小的切口可减少术后恢复时间和并发症。因此，一些内窥镜式外科器械可适于通过套管针的插管来将远侧端部执行器放置在期望的外科手术部位。这些远侧端部执行器(例如，内镜切割器、抓紧器、切割器、缝合器、施夹器、进入装置、药物/基因治疗递送装置、以及使用超声波振动、RF、激光等的能量递送装置)可以多种方式接合组织，以实现诊断效果或治疗效果。内窥镜式外科器械可包括位于端部执行器和由临床医生操纵的柄部部分之间的轴。此种轴可使得能够插入到期望的深度并围绕轴的纵向轴线旋转，以由此有利于将端部执行器定位在患者体内。还可通过包括一个或多个关节运动接头或特征部而进一步有利于定位该端部执行器，使得端部执行器能够选择性地进行关节运动或者以其它方式相对于轴的纵向轴线偏转。
内窥镜式外科器械的示例包括外科缝合器。一些此类缝合器能够操作以夹紧组织层，切穿夹持的组织层，并且将钉驱动穿过组织层，以在组织层的切断端部附近将切断的组织层基本上密封在一起。仅作为示例性目的的外科缝合器被公开在以下美国专利中：1989年2月21日公布的名称为“Pocket Configuration for Internal Organ Staplers”的美国专利4,805,823；1995年5月16日公布的名称为“Surgical Stapler and StapleCartridge”的美国专利5,415,334；1995年11月14日公布的名称为“Surgical StaplerInstrument”的美国专利5,465,895；1997年1月28日公布的名称为“Surgical StaplerInstrument”的美国专利5,597,107；1997年5月27日公布的名称为“Surgical Instrument”的美国专利5,632,432；1997年10月7日公布的名称为“Surgical Instrument”的美国专利5,673,840；1998年1月6日公布的名称为“Articulation Assembly for SurgicalInstruments”的美国专利5,704,534；1998年9月29日公布的名称为“Surgical ClampingMechanism”的美国专利5,814,055；2005年12月27日公布的名称为“Surgical StaplingInstrument Incorporating an E-Beam Firing Mechanism”的美国专利6,978,921；2006年2月21日公布的名称为“Surgical Stapling Instrument Having Separate DistinctClosing and Firing Systems”的美国专利7,000,818；2006年12月5日公布的名称为“Surgical Stapling Instrument Having a Firing Lockout for an Unclosed Anvil”的美国专利7,143,923；2007年12月4日公布的名称为“Surgical Stapling InstrumentIncorporating a Multi-Stroke Firing Mechanism with a Flexible Rack”的美国专利7,303,108；2008年5月6日公布的名称为“Surgical Stapling Instrument Incorporatinga Multistroke Firing Mechanism Having a Rotary Transmission”的美国专利7,367,485；2008年6月3日公布的名称为“Surgical Stapling Instrument Having a SingleLockout Mechanism for Prevention of Firing”的美国专利7,380,695；2008年6月3日公布的名称为“Articulating Surgical Stapling Instrument Incorporating a Two-Piece E-Beam Firing Mechanism”的美国专利7,380,696；2008年7月29日公布的名称为“Surgical Stapling and Cutting Device”的美国专利7,404,508；2008年10月14日公布的名称为“Surgical Stapling Instrument Having Multistroke Firing with OpeningLockout”的美国专利7,434,715；2010年5月25日公布的名称为“Disposable Cartridgewith Adhesive for Use with a Stapling Device”的美国专利7,721,930；2013年4月2日公布的名称为“Surgical Stapling Instrument with An Articulatable End Effector”的美国专利8,408,439；和2013年6月4日公布的名称为“Motor-Driven Surgical CuttingInstrument with Electric Actuator Directional Control Assembly”的美国专利8,453,914。以上引用的美国专利中的每一个的公开内容以引用方式并入本文。
尽管上文所涉及的外科缝合器被描述为用于内窥镜式手术中，但应当理解，此类外科缝合器也可用于开腹手术和/或其它非内窥镜式手术中。仅以举例的方式，在胸廓外科手术中，外科缝合器可通过胸廓切开术被插入并由此位于患者肋骨之间以到达一个或多个器官，所述胸廓外科手术不使用套管针作为缝合器的导管。此类手术可包括使用缝合器来切断和闭合通向肺部的血管。例如，在从胸腔中取出器官之前，可通过缝合器来切断并闭合通向器官的血管。当然，外科缝合器可用于各种其它情况和手术中。
可特别适合通过胸廓切开术使用的外科缝合器的示例被公开以下美国专利公布中：2014年8月28日公布的名称为“Surgical Instrument End Effector ArticulationDrive with Pinion and Opposing Racks”的美国专利公布2014/0243801；2014年8月28日公布的名称为“Lockout Feature for Movable Cutting Member of SurgicalInstrument”的美国专利公布2014/0239041；2014年8月28日公布的名称为“IntegratedTissue Positioning and Jaw Alignment Features for Surgical Stapler”的美国公布2014/0239042；2014年8月28日公布的名称为“Jaw Closure Feature for End Effectorof Surgical Instrument”的美国专利公布2014/0239036；2014年8月28日公布的名称为“Surgical Instrument with Articulation Lock having a Detenting Binary Spring”的美国专利公布2014/0239040；2014年8月28日公布的名称为“Distal Tip Features forEnd Effector of Surgical Instrument”的美国专利公布2014/0239043；2014年8月28日公布的名称为“Staple Forming Features for Surgical Stapling Instrument”的美国专利公布2014/0239037；2014年8月28日公布的名称为“Surgical Instrument withMulti-Diameter Shaft”的美国专利公布2014/0239038；和2014年8月28日公布的标题为“Installation Features for Surgical Instrument End Effector Cartridge”的美国专利公布2014/0239044。以上引用的美国专利公布中的每一个的公开内容均以引用方式并入本文。
另外的外科缝合器械被公开在以下美国专利中：2014年8月12日公布的名称为“Surgical Circular Stapler with Tissue Retention Arrangements”的美国专利8,801,735；2012年3月27日公布的名称为“Surgical Stapler Comprising a StaplePocket”的美国专利8,141,762；2013年2月12日公布的名称为“Surgical End EffectorHaving Buttress Retention Features”的美国专利8,371,491；2014年9月18日公布的名称为“Method and Apparatus for Sealing End-to-End Anastomosis”的美国专利公布2014/0263563；2014年9月4日公布的名称为“Rotary Powered Surgical Instrumentswith Multiple Degrees of Freedom”的美国专利公布2014/0246473；2013年8月15日公布的名称为“Linear Stapler”的美国专利公布2013/0206813；2008年7月17日公布的名称为“Buttress Material for Use with a Surgical Stapler”的美国专利公布2008/0169328；美国专利申请14/300,804；美国专利申请14/300,811；和2014年9月26日公布的名称为“Radically Expandable Staple Line”的美国专利申请14/498,070。以上引用的美国专利、美国专利公布和美国专利申请中的每一个的公开内容均以引用方式并入本文。
虽然已制造和使用各种外科缝合器械和相关联的部件，但据信在本发明人之前还无人制造或使用在所附权利要求中所描述的发明。
附图说明
并入本说明书中并构成本说明书的一部分的附图示出了本发明的实施方案，并且与上面给出的本发明的一般描述以及下面给出的实施方案的详细描述一起用于解释本发明的原理。
图1示出示例性进行关节运动的外科缝合器械的透视图；
图2示出了图1器械的端部执行器的透视图，其中该端部执行器处于打开构型，该打开构型示出了包含多个钉的第一示例性钉仓；
图3示出了图2的端部执行器和钉仓的分解透视图；
图4示出了可与图2的端部执行器一起使用的第二示例性钉仓的透视图；
图5示出了图4钉仓的分解透视图，示出了液压钉驱动系统；
图6示出了图5的液压钉驱动系统的透视图；
图7A示出了在部署钉之前处于未击发状态的图5液压钉驱动系统的顶部平面图；
图7B示出了图5液压钉驱动系统的顶部平面图，示出了处于钉部署状态的液压钉驱动系统；
图7C示出了图5液压钉驱动系统的顶部平面图，示出了限制钉部署的液压钉驱动系统；
图8A示出了具有图4钉仓的图2端部执行器的侧视图，其中端部执行器处于接收组织的打开构型；
图8B示出了具有图4钉仓的图2端部执行器的侧视图，其中端部执行器在已经接收组织之后处于闭合构型，处于未击发状态；
图8C示出了具有图4钉仓的图2端部执行器的侧视图，其中液压钉驱动系统部署钉；
图8D示出了具有图4钉仓的图2端部执行器的侧视图，其中液压钉驱动系统处于击发状态；
图9A示出了沿图8B的剖面线9A-9A截取的图8B端部执行器的放大剖视图，该端部执行器处于未击发状态；并且
图9B示出了沿图8D的剖面线9B-9B截取的图8D端部执行器的放大剖视图，该端部执行器处于击发状态。
附图并非旨在以任何方式进行限制，并且可以预期本技术的各种实施方案能够以多种其它方式来执行，包括那些未必在附图中示出的方式。并入本说明书中并构成本说明书的一部分附图示出了本发明的若干方面，并与本说明一起用于解释本发明的原理；然而，应当理解，本发明并不限于所示出的明确布置方式。
具体实施方式
本发明的某些示例的以下说明不应用于限定本发明的范围。根据以举例的方式示出的以下说明，本发明的其它示例、特征、方面、实施方案和优点对于本领域的技术人员将是显而易见的，一种最佳方式被设想用于实施本发明。如将认识到，本发明能够具有其它不同且明显的方面，所有这些方面均不脱离本发明。因此，附图和说明应被视为实质上是例示性的而非限制性的。
I.示例性外科缝合器
图1示出包括柄部组件20、轴组件30和端部执行器40的示例性外科缝合和切断器械10。端部执行器40和轴组件30的远侧部分的尺寸被设计成用于在图1所示的非关节运动状态中穿过套管针插管插入患者的手术部位，以执行外科手术。仅以举例的方式，此种套管针可从患者的两个肋骨之间或其它地方插入患者的腹部中。在一些情况下，在不存在套管针的情况下使用外科器械(10)。例如，端部执行器40和轴组件30的远侧部分可通过胸廓切开术或其它类型的切口直接插入。应当理解，本文中使用的术语诸如“近侧”和“远侧”是相对于临床医生抓握外科器械(10)的柄部组件(20)而言的。因此，端部执行器40相对于更近侧的柄部组件20而位于远侧。还应当理解，为便利和清楚起见，本文结图示使用空间用语诸如“竖直”和“水平”。然而，外科器械能够在许多取向和位置中使用，并且这些术语并非旨在为限制性的和绝对的。
A.示例性柄部组件和轴组件
如图1所示，本示例的柄部组件20包括手枪式握把22、闭合触发器24和击发触发器26。每个触发器24、26可朝向和远离手枪式握把22选择性地枢转，如将在下文中更详细地描述。柄部组件20还包括可移除的电池组28。这些部件还将在下文中更详细地描述。当然，除了或代替上文所述的那些中的任何一者，柄部组件20可具有多种其它部件、特征和可操作性。参考本文的教导内容，柄部组件20的其它合适的构型对于本领域的普通技术人员将是显而易见的。
如图1到图2所示，本示例的轴组件30包括外部闭合管32、关节运动节段34和闭合环36，所述闭合环还与端部执行器40联接。闭合管32沿轴组件30的长度延伸。闭合环36定位在关节运动节段34的远侧。闭合管32和闭合环36被构造成能够相对于柄部组件20纵向平移。闭合管32的纵向平移经由关节运动节段34而被传送到闭合环36。
关节运动节段34能够操作以侧向偏转闭合环36和端部执行器40，从而以期望的角度(α)侧向远离轴组件30的纵向轴线LA。在本示例中，关节运动通过位于轴组件30的近侧端部的关节运动控制旋钮35而被控制。响应于旋钮35的旋转，闭合环36和端部执行器40围绕垂直于轴组件30的纵向轴线LA的轴线枢转。关节运动节段34被构造成能够将闭合管32的纵向平移传送到闭合环36，而无论关节运动节段34是处于笔直构型还是关节运动构型。仅以举例的方式，关节运动节段(34)和/或关节运动控制旋钮(35)可根据以下美国公布的教导内容中的至少一些教导内容进行构造和操作：2014年8月28日公布的名称为“SurgicalInstrument End Effector Articulation Drive with Pinion and Opposing Racks”的美国公布2014/0243801，其公开内容以引用方式并入本文；2015年12月31日公布的名称为“Articulation Drive Features for Surgical Stapler”的美国公布2015/0374360，其公开内容以引用方式并入本文；和/或根据下述各种教导内容来构造和操作。参考本文的教导内容，关节运动节段34和关节运动旋钮35可采用的其它合适的形式对于本领域的普通技术人员将是显而易见的。
如图1所示，本示例的轴组件30还包括旋钮31。旋钮31能够操作以使整个轴组件30和端部执行器40相对于柄部组件20围绕轴组件30的纵向轴线LA旋转。当然，除了或替代上文所述那些中任一者，轴组件30可具有多种其它部件、特征和可操作性。仅以举例的方式，轴组件(30)的至少一部分根据以下美国公布的教导内容中的至少一些教导内容进行构造：2014年8月28日公布的名称为“Surgical Instrument with Multi-Diameter Shaft”的美国公布2014/0239038，其公开内容以引用方式并入本文。参考本文的教导内容，轴组件30的其它合适构型对于本领域的普通技术人员将是显而易见的。
B.示例性端部执行器
同样如图1到图3所示，本示例的端部执行器40包括下钳口50和可枢转砧座60。砧座60包括被设置在下钳口50的对应弯曲狭槽54中的一对一体的向外延伸的销66。砧座60能够朝向和远离下钳口50在打开位置(如图2所示)和闭合位置(如图1所示)之间枢转。使用术语“能够枢转”(以及以“枢转”为基础的类似术语)不应被解读为必须要求围绕固定轴线进行枢转运动。例如，在本示例中，砧座60围绕由销66限定的轴线枢转，当砧座60朝向下钳口50运动时，这些销沿下钳口50的弯曲狭槽54滑动。在此类型式中，枢轴线沿由狭槽54限定的路径平移，而砧座60同时围绕所述轴线枢转。除此之外或另选地，枢轴线首先可沿狭槽54滑动，然后在枢轴线已沿狭槽54滑动特定距离之后，砧座60围绕所述枢轴线枢转。应当理解，此种滑动/平移枢转运动被包含在诸如“枢转”、“枢转的”、“能够枢转的”等术语内。当然，一些型式可提供砧座60围绕保持固定且不在狭槽或通道内平移的轴线的枢转运动等。
如图3充分示出的，本示例的下钳口(50)限定被构造成能够接收第一示例性钉仓(70)的通道(52)。可将钉仓70插入到通道52中，可致动端部执行器40，并且然后可移除钉仓70并以其它钉仓70来替换。下钳口50因此将钉仓70可释放地保持成与砧座60对准，以致动端部执行器40。在一些型式中，下钳口(50)根据以下美国公布的教导内容中的至少一些教导内容进行构造：2014年8月28日公布的标题为“Installation Features for SurgicalInstrument End Effector Cartridge”的美国公布2014/0239044，其公开内容以引用方式并入本文。参考本文的教导内容，下钳口50可采用的其它合适的形式对于本领域的普通技术人员将是显而易见的。
如在图2到图3中最佳所见，本示例的钉仓70包括仓体71和被固定到仓体71的下侧的托盘76。仓体71的上侧呈现平台73，当砧座60处于闭合位置时，组织可压靠在所述平台上。仓体71还限定纵向延伸通道72和多个钉凹坑74。钉(90)被定位在每个钉凹坑(74)中。钉驱动器(75)也被定位在每个钉凹坑(74)中，位于对应钉(90)之下，托盘(76)之上。如将在下文中更详细地描述的，钉驱动器75能够操作以在钉凹坑74中向上平移，以由此向上驱动钉90穿过钉凹坑74并与砧座60接合。钉驱动器75被楔形滑动件78向上驱动，所述楔形滑动件被捕获在仓体71与托盘76之间并纵向平移穿过仓体71。
在一个示例中，一对钉驱动器(75)通过在其间延伸的驱动器凸轮(77)连接在一起，以使驱动器组件(81)成形。楔形滑动件(78)包括一对倾斜成角的凸轮表面(79)，这对倾斜成角的凸轮表面被构造成能够接合驱动器凸轮(77)，并由此在楔形滑动件(78)纵向平移穿过仓(70)时同时向上驱动连接的一对钉驱动器(75)。例如，当楔形滑动件78处于近侧位置时，钉驱动器75处于向下位置并且钉90位于钉凹坑74中。当通过平移刀构件80将楔形滑动件78驱动到远侧位置时，楔形滑动件78向上驱动钉驱动器75，由此将钉90驱动出钉凹坑74并进入形成于砧座60的下侧65中的钉成形凹坑64。因此，当楔形滑动件78沿水平维度平移时，钉驱动器75沿竖直维度平移。
在一些型式中，钉仓(70)根据以下美国公布的教导内容中的至少一些教导内容进行构造和操作：2014年8月28日公布的标题为“Integrated Tissue Positioning and JawAlignment Features for Surgical Stapler”的美国公布2014/0239042，其公开内容以引用方式并入本文。除此之外或另选地，钉仓(70)可根据以下美国公开的教导内容中的至少一些教导内容进行构造和操作：2014年8月28日公布的标题为“Installation Featuresfor Surgical Instrument End Effector Cartridge”的美国公布2014/0239044，其公开内容以引用方式并入本文。参考本文的教导内容，钉仓70可采用的其它合适的形式对于本领域的普通技术人员而言将是显而易见的。
如在图2中最佳所见，本示例的砧座60包括纵向延伸通道62和多个钉成形凹坑64。通道62被构造成能够当砧座60处于闭合位置时与钉仓70的通道72对齐。每个钉成形凹坑64被定位成当砧座60处于闭合位置时位于钉仓70的对应钉凹坑74上方。钉成形凹坑64被构造成能够当驱动钉90穿过组织进入砧座60时使钉90的腿变形。具体地，钉成形凹坑64被构造成能够使钉90的腿弯曲，以将成形钉90固定在组织中。砧座(60)可根据以下来构造：2014年8月28日公布的名称为“Integrated Tissue Positioning and Jaw Alignment Featuresfor Surgical Stapler”的美国公布2014/0239042的教导内容中的至少一些；2014年8月28日公布的名称为“Jaw Closure Feature for End Effector of Surgical Instrument”的美国公布2014/0239036的教导内容中的至少一些；和/或2014年8月28日公布的名称为“Staple Forming Features for Surgical Stapling Instrument”的美国公布2014/0239037的教导内容中的至少一些教导内容，其公开内容以引用方式并入本文。参考本文的教导内容，砧座60可采用的其它合适的形式对于本领域的普通技术人员而言将是显而易见的。
在本示例中，刀构件80被构造成能够通过端部执行器40而平移。如在图3中最佳所见，刀构件80被固定到击发梁82的远侧端部，所述击发梁延伸穿过轴组件30的一部分。如图2中最佳所见，刀构件(80)被定位在砧座(60)和钉仓(70)的相应通道(62,72)中。刀构件80包括朝远侧呈现的切割刃84，所述切割刃被构造成能够当刀构件80朝远侧平移穿过端部执行器40时切断被压缩在砧座60和钉仓70的平台73之间的组织。如上所述，当刀构件80朝远侧平移穿过端部执行器40时，刀构件80也朝远侧驱动楔形滑动件78，由此将钉90驱动穿过组织并抵靠砧座60成形。
C.端部执行器的示例性致动
在本示例中，通过相对于端部执行器40朝远侧推动闭合环36而朝下钳口50驱动砧座60。响应于闭合环36相对于端部执行器40的远侧平移，闭合环36通过凸轮作用与砧座60协作，以朝向下钳口50驱动砧座60。类似地，响应于闭合环36相对于端部执行器40的近侧平移，闭合环36可与砧座60协作，以远离下钳口50而打开砧座60。仅以举例的方式，闭合环(36)和砧座(60)可根据以下美国公布的教导内容中的至少一些教导内容相互作用：于2014年8月28日公布的名称为“Jaw Closure Feature for End Effector of SurgicalInstrument”的美国公布2014/0239036，其公开内容以引用方式并入本文；和/或2015年12月31日公布的名称为“Jaw Opening Feature for Surgical Stapler”的美国公布2015/0374373的教导内容中的至少一些教导内容，其公开内容以引用方式并入本文。
如上所述，柄部组件20包括手枪式握把22和闭合触发器24。同样如上所述，响应于闭合环(36)从打开构型到具有下钳口(50)的闭合构型的远侧推进，砧座(60)朝向下钳口(50)闭合。在本示例中，闭合触发器24可朝向手枪式握把22枢转以朝远侧驱动闭合管32和闭合环36。参考本文的教导内容，可用于将闭合触发器24朝手枪式握把22的枢转运动转化成闭合管32和闭合环36相对于柄部组件20的远侧平移的各种合适的部件对于本领域的普通技术人员将是显而易见的。
同样在本示例中，外科器械(10)提供对击发梁(82)的机动化控制。具体地，外科器械(10)包括机动化部件，该机动化部件被构造成能够响应于击发触发器(26)朝向手枪式握持部(22)枢转而朝远侧驱动击发梁(82)。在一些型式中，马达(未示出)容纳在手枪式握把22中并且从电池组28接收电力。此马达与传输组件(未示出)联接，所述传输组件将马达的驱动轴的旋转动作转换成击发梁82的线性平移。仅以举例的方式，可操作以提供击发梁(82)的电动致动的特征可根据以下美国专利的教导内容中的至少一些教导内容来构造和操作：2012年7月3日公布的名称为“Motor-Driven Surgical Instrument”的美国专利8,210,411，其公开内容以引用方式并入本文；2013年6月4日公布的名称为“Motor-DrivenSurgical Cutting Instrument with Electric Actuator Directional ControlAssembly”的美国专利8,453,914，其公开内容以引用方式并入本文；和/或2015年10月1日公布的名称为“Surgical Instrument Comprising a Sensor System”的美国公布2015/0272575，其公开内容以引用方式并入本文。
还应当理解，外科器械(10)的任何其它部件或特征部可根据本文所应用的各种参考文献中的任一者来构造和操作。可提供用于外科器械(10)的其它示例性修改将在下文中更详细地描述。下述教导内容可并入外科器械(10)内的各种合适方式对于本领域的普通技术人员而言将是显而易见的。类似地，可将下述教导内容与本文引用的参考文献的各种教导内容进行组合的各种合适方式对于本领域的普通技术人员将是显而易见的。因此应当理解，下述教导内容可易于并入本文引用的各种参考文献所教导的各种外科器械内。还应当理解，下述教导内容并不限于本文引用的参考文献中教导的外科器械(10)或装置。下述教导内容可易于应用到各种其它种类的外科器械，包括将不被归类为外科缝合器的器械。参考本文的教导内容，其中可应用下文教导内容的各种其它合适的装置和情况对本领域的普通技术人员将是显而易见的。
II.具有液压钉部署的示例性外科缝合器
在一些情况下，可能期望用液压系统装备端部执行器(40)，以驱动钉(90)的选择性运动，以使钉(90)在砧座(60)和平台(73)之间捕获的组织内成形。这种液压系统可同时向每个钉(90)提供相等的驱动力。例如，由于组织内存在各种解剖结构，一些组织可具有变化的密度。如上所述的驱动钉(90)可导致通过钉(90)在不同密度的组织上施加不相等的压力。相反，共同连接的液压系统可在每个钉(90)处的液压系统内的流体上提供反作用力。因此，流体以相等的驱动力直接或间接地同时作用在每个钉(90)上。此外，这种液压系统可包括卸压部件，以在流体压力达到阈值的情况下重新引导流体并在每个钉(90)处同时减小穿过组织的驱动力。换句话讲，卸压部件可用于限制在每个钉处施加到组织的力，以抑制破坏组织和/或防止液压流体回路的破裂。
在一些情况下，平台(73)可进一步被构造成能够适形于组织，以进一步适应具有变化密度的组织的部分；由此防止集中的力破坏组织。下面示出并更详细地描述了一个这样具有液压驱动系统(112)和可变形平台(114)的钉仓(110)的示例。应当理解，可单独使用或组合使用另选的液压系统和解码器来部署钉(90)。钉仓(110)还可替代上述钉仓(70)，以与外科器械(10)一起使用。换句话讲，本示例的钉仓(110)可易于与外科器械(10)一起使用。另选地，另一外科器械可被构造成能够适应钉仓(110)的一个或多个特征部。
A.具有液压钉驱动系统的示例性液压钉仓
图4至图5示出了具有液压钉驱动系统(112)和可变形平台(114)的钉仓(110)，以在如上所述缝合组织时沿组织均衡压缩力。钉仓(110)包括在相应的钉凹坑(74)内接收的和在托盘(76)与仓体(71)内包含的钉(90)，如上所述。为此，相似标号表示上文更详细描述的相似特征部。然而，液压钉驱动系统(112)包括与容纳流体(诸如液体)的流体供应缸(118)接合的驱动滑动件(116)，而不是楔形滑动件(78)(参考图3)。参考本文的教导内容，可用在液压钉驱动系统(112)的各种合适的流体对于本领域的普通技术人员而言将是显而易见的。液压钉驱动系统(112)还包括一对液压可膨胀构件，该对液压可膨胀构件在本示例中为被构造成能够接合驱动器组件(81)的一对可膨胀的细长球囊(120)。因此，球囊(120)被构造成能够从流体供应缸(118)接收流体以从收缩状态膨胀到膨胀状态，以向上驱动钉(90)穿过组织并朝向砧座(60)，以在组织中成形。在一些型式中，除了可膨胀之外，球囊(120)是可伸长的。在一些其它型式中，球囊(120)是可膨胀但不可伸长的。
本示例的可变形平台(114)包括上表面(121)，该上表面被构造成能够在压力下变形并适形于抵靠该上表面接收的组织。因此，液压驱动系统(112)和可变形平台(114)被构造成能够减少使用期间破坏组织的可能性。
如图5至图7A所示，驱动滑动件(116)的近端部分被配置成如上所述相对于楔形滑动件(78)(参考图3)接收刀构件(80)，以选择性地使驱动滑动件(116)从近端位置朝向远端位置纵向滑动。驱动滑动件(116)的远侧部分具有从其远侧延伸到流体供应缸(118)中的柱塞(122)。在本示例中，柱塞(122)以能够滑动的方式被设置在缸(118)中，使得缸中的柱塞(122)的远侧运动减小了容纳在其中的流体可用的存储容量。随着缸(118)容量的减小，这对流体加压以经由一对相应的供应导管(124)迫使流体进入每个球囊(120)中。因此，每个球囊(120)膨胀以用能够使钉(90)在组织内成形的膨胀力接合驱动器组件(81)，用于流体地密封组织。
虽然本示例的液压可膨胀构件为球囊(120)的形式，但是液压可膨胀构件可另选地为另一种膨胀构件或膨胀组件，诸如液压活塞，其被构造成能够在至少一个尺寸上伸长以接合驱动器组件(81)。因此，术语“液压可膨胀构件”不旨在限于示例性球囊(120)。还应当理解，柱塞(122)和缸(118)可被各种另选的结构替换。仅以举例的方式，缸(118)可被替换为可塌缩贮存器，诸如波纹管组件等，其中贮存器的近侧端部被固定到驱动滑动件(116)的远侧部分。在这种型式中，当驱动滑动件(116)被向远侧驱动时，驱动滑动件(116)可使贮存器塌缩，由此对贮存器中的流体加压，以将流体驱动到球囊(120)中。参考本文的教导内容，可使用的其它合适形式的液压可膨胀构件，以及柱塞(122)和缸(118)其它合适的替代物对于本领域的普通技术人员而言将是显而易见的。
在本示例中，每个驱动器组件(81)跨过一个球囊(120)，使得每个球囊(120)接合驱动器凸轮(77)。随着球囊(120)膨胀并接合驱动器凸轮(77)，驱动器凸轮(77)同时向上驱动相应的一对相对驱动器(75)。如上所述，被接收在其中的钉凹坑(74)和钉(90)在通道(72)的一个侧面上被布置成一对排，并且在通道(72)的另一个侧面上被布置成另一对排。因此，本示例的示例性钉驱动系统(112)在膨胀器通道(125)(参考图9A至图9B)内具有细长的球囊(120)，该膨胀器通道在通道(72)的每个侧面上的驱动器凸轮(77)的正下方。然而，球囊(120)可被另选地构造成具有更多或更少的液压可膨胀构件，诸如球囊(120)。例如，液压钉驱动系统(112)可另选地包括用于每个相应的驱动器凸轮(77)的单个球囊；或者在省略驱动器凸轮(77)的情况下，甚至包括用于每个相应的驱动器(75)的单个球囊。因此，任何类型的液压可膨胀构件可以任何所期望的布置以适应在平面(114)中任何种类的期望的钉图案。
本示例的流体供应缸(118)通常为管状和刚性结构，该结构被构造成能够接收驱动滑动件(116)的柱塞(122)。更具体地讲，柱塞(122)提供活塞结构，该活塞结构抵靠流体供应缸(118)的内表面流体密封，使得柱塞(122)的远侧运动有效地使容纳流体的流体供应缸(118)的部分塌缩，以将流体排放到球囊(120)中。为了适应驱动滑动件(116)的运动，驱动滑动件(116)的远侧端部部分被构造成能够切割并穿过流体供应缸(118)，以允许驱动滑动件(116)的完全远侧行程。另选地，流体供应缸(118)可为相对柔性的。例如，驱动滑动件(116)的远侧端部部分可使整个流体供应缸(118)有效地塌缩，使得流体供应缸(118)的远侧端部被挤压朝向流体供应缸(118)的近侧端部。因此，术语“塌缩”旨在为容纳流体的容量的任何减小，并且不旨在限于示例性流体供应缸(118)。
假定刀构件(80)向远侧迫使驱动滑动件(116)从未击发位置到击发位置的一个完整行程，柱塞(122)通常从流体供应缸(118)排出整个流体。然而，可能不需要整个流体来部署钉(90)，并且，事实上，可能会超过预定最大膨胀力而溢出球囊(120)。因此，液压钉驱动系统(112)进一步被构造成能够经由卸压贮存器(126)将膨胀力限制在预定的最大膨胀力。更具体地讲，卸压贮存器(126)经由一对分别在其间延伸的释放导管(228)流体连接到每个球囊(120)。一旦球囊(120)达到预定的最大膨胀力，释放导管(228)将过量的流体引导到卸压贮存器(126)中，直到施加到球囊(120)中流体的压力降低到低于预定的最大膨胀力。
示例性卸压贮存器(126)包括弹性主体(130)，诸如另一个球囊，其被构造成能够从收缩状态膨胀到膨胀状态。主体(130)的弹性被调谐至预定的最大膨胀力，使得球囊(120)通常在低于弹性主体(130)的压力下开始膨胀。然而，一旦球囊(120)内的流体压力増加到预定的最大膨胀力，卸压贮存器(126)的弹性主体(130)则开始从其收缩状态膨胀，以限制球囊(120)中的压力。在本示例中，主体(130)为可伸长的，因此主体(130)的可伸长弹性限定了主体(130)将开始膨胀的压力阈值。在一些其他型式中，主体(130)为不可伸长的，但是弹性构件(例如，片簧、类似支架的保持架等)与主体接合；并且弹性构件的弹性限定主体(130)将开始膨胀的压力阈值。参考本文的教导内容，弹性主体(130)可被构造成能够仅在流体压力达到预定的阈值之后膨胀的其它合适的方式对于本领域的普通技术人员而言将是显而易见的。还应当理解，可使用一个或多个压敏阀(例如，插置在释放导管(228)与卸压贮存器(126)之间的压敏阀)来建立阈值流体压力值，以选择性地向球囊(120)提供卸压。因此，卸压贮存器(126)不旨在不必要地限于本文所述的示例。
从上述内容应该理解，在将来自流体供应缸(118)的流体流动或另外的向下力施加到钉(90)的情况下，弹性主体(130)将膨胀以保持球囊(120)内预定的最大膨胀力的压力。在卸压贮存器(126)膨胀之后作用在球囊(120)上的力减小的情况下，弹性主体(130)收缩以保持预定的最大膨胀力，直到弹性主体(130)恢复到收缩状态。一旦弹性主体(130)恢复到收缩状态，球囊(120)的膨胀力可能随后降低到低于预定的最大膨胀力。因此，卸压贮存器(126)被构造成能够将球囊(120)的膨胀力限制在小于或等于预定的最大膨胀力，以抑制破坏组织。
从上述内容应该理解，本示例的钉仓(110)包含闭合液压回路。该液压回路由缸(118)、球囊(120)、导管(124,128)和弹性主体(130)形成。该液压回路的闭合性质使得钉仓(110)能够用于常规的端部执行器，诸如端部执行器(40)。换句话讲，钉仓(110)不需要与外部流体源(诸如容纳在柄部组件(20)中的流体源)联接。
B.包含液压钉仓的端部执行器的示例性致动
在使用中，本示例的钉驱动系统(112)包含流体供应缸(118)内的流体，如图7A至图7C所示。另选地，球囊(120)可流体连接到另一个流体源，诸如柄部组件中的流体源(未示出)。如图7B所示，使用者选择性地击发刀构件(80)向远侧滑动驱动滑动件(116)的柱塞(122)，并开始使容纳流体的流体供应缸(118)的部分塌缩。现在被加压的流体流过供应导管(124)并进入相应的球囊(120)以开始从收缩状态到膨胀状态的球囊(120)的膨胀，以部署钉(90)(参考图5)。球囊(120)膨胀直到达到最大预定的膨胀力，使得每个球囊(120)过量的流体流动通过释放导管(128)并进入卸压贮存器(126)，如图7C所示。这种流体流动可继续，直到柱塞(22)完成其全部行程并到达远侧位置。当流体经由球囊(120)流动到卸压贮存器(126)时，应当理解，另选的流动布置可被构造成能够流体连接卸压贮存器(126)、球囊(120)，以及各种流体源中的任一种。为此，本发明不是旨在不必要地限于上述特定的流体连接，并且可为任何可操作的流体连接。
如图8A所示，当砧座(60)处于打开位置时，砧座(60)和上表面接收患者的组织(132)。如图8B所示，在闭合构型中，朝向下钳口(50)闭合的砧座(60)抵靠平台(114)压缩组织(132)，使得上表面(114)变形以适形于组织(132)中存在的变化的密度，以沿组织(132)施加相对等量的压力。在闭合构型中，然后使用者选择性地击发刀构件(80)，以致动液压驱动系统(112)，如上所述。为此，球囊(120)用来自流体的膨胀力膨胀，以向上引导驱动器组件(81)并朝向组织(132)，如图8C所示。
在驱动器(75)和钉(90)支撑在流体连接的球囊(120)上的情况下，因为来自驱动器(75)的反作用力的压力将均匀地分布在整个流体中，所以每个驱动器(75)被以相等的膨胀力向上引导。因此，无论驱动器组件(81)的向上行进的量为多少，每个钉(90)将以相等的力刺穿组织(132)并在组织(132)内形成。驱动器(75)上的膨胀力将在柱塞(122)(参考图7C)的远侧行程期间继续増加，直到膨胀力达到最大预定的膨胀力阈值。然后，如图8D所示和如上所述，卸压贮存器(126)将接收过量的流体，以限制施加到组织(132)的压力量和限制液压回路内的压力量。
图9A至图9B分别示出了包含膨胀器通道(125)的处于收缩状态和膨胀状态的示例性球囊(120)。虽然膨胀器通道(125)先接收到楔形滑动件(78)(参考图3)以向上引导驱动器组件(81)，但是球囊(120)在膨胀器通道(125)内朝向膨胀状态膨胀以向上引导驱动器组件(81)。由此，钉(90)在驱动器(75)与砧座(60)之间成形以使钉(90)在组织(132)内成形，并在刀构件(80)切割组织(132)之前立即流体密封组织(132)。
III.示例性组合
下述实施例涉及本文的教导内容可被组合或应用的各种非穷尽性方式。应当理解，下述实施例并非旨在限制可在本专利申请或本专利申请的后续提交文件中的任何时间提供的任何权利要求的覆盖范围。不旨在进行免责声明。提供以下实施例仅仅是出于例示性目的。预期本文的各种教导内容可按多种其它方式进行布置和应用。还设想到，一些变型可省略在以下实施例中所提及的某些特征。因此，下文提及的方面或特征中的任一者均不应被视为决定性的，除非另外例如由发明人或关注发明人的继承者在稍后日期明确指明如此。如果本专利申请或与本专利申请相关的后续提交文件中提出的任何权利要求包括下文提及的那些特征之外的附加特征，则这些附加特征不应被假定为因与专利性相关的任何原因而被添加。
实施例1
一种外科器械，包括：(a)主体组件；(b)从所述主体组件朝远侧延伸的轴组件；和(c)从所述轴组件朝远侧延伸的端部执行器，其中所述端部执行器包括：(i)第一钳口，所述第一钳口具有砧座，其中所述砧座被构造成能够使多个抵靠在其上接收的钉成形；(ii)第二钳口，其中所述第一钳口能够相对于所述第二钳口从打开构型朝向闭合构型运动，以将所述组织捕获在其间并使所述钉在其中成形；和(iii)钉仓，所述钉仓由所述第二钳口接收，其中所述钉仓包括：(A)多个钉，和(B)液压可膨胀构件，所述液压可膨胀构件被构造成能够接收流体，其中所述液压可膨胀构件被构造成能够在接收所述流体时从收缩状态朝向膨胀状态膨胀，并且其中所述液压可膨胀构件被构造成能够引导多个钉中的至少一个朝向所述砧座以迫使多个钉中的至少一个抵靠所述砧座并使多个钉中的至少一个在所述组织中成形。
实施例2
根据权利要求1所述的外科器械，其中所述钉仓还包括平台，所述平台具有延伸穿过该平台的多个钉凹坑。
实施例3
根据权利要求2所述的外科器械，其中所述平台的上表面被构造成能够在闭合构型中与砧座一起接收抵靠其的组织时变形。
实施例4
根据权利要求1所述的外科器械，其中所述液压可膨胀构件包括至少一个可膨胀囊。
实施例5
根据权利要求4所述的外科器械，其中所述至少一个可膨胀囊包括第一可膨胀球囊。
实施例6
根据权利要求5所述的外科器械，其中所述钉仓还包括第二可膨胀球囊，其中所述多个钉包括第一排钉和第二排钉，并且其中所述第一可膨胀球囊和第二可膨胀球囊分别与所述第一排钉和第二排钉对齐，使得所述第一可膨胀球囊和第二可膨胀球囊能够从收缩状态朝向膨胀状态膨胀，以分别将所述第一排钉和所述第二排引导朝向所述砧座。
实施例7
根据权利要求1所述的外科器械，其中所述液压可膨胀构件被构造成能够以小于或等于预定的最大膨胀力的膨胀力从所述收缩状态朝向所述膨胀状态膨胀，以限制施加到所述多个钉中的至少一个的膨胀力。
实施例8
根据权利要求7所述的外科器械，其中所述钉仓还包括流体连接到所述液压可膨胀构件的贮存器，并且其中所述贮存器被构造成能够在所述液压可膨胀构件以所述预定的最大膨胀力膨胀时接收所述流体，并由此限制积聚在所述液压可膨胀构件内的所述流体，以限制施加到所述多个钉中的至少一个的膨胀力。
实施例9
根据权利要求8所述的外科器械，其中所述贮存器包括主体，所述主体被构造成能够弹性地膨胀以收集所述流体，并由此限制所述流体在所述液压可膨胀构件内积聚。
实施例10
根据权利要求9所述的外科器械，其中所述贮存器的所述主体被构造成能够弹性地膨胀和弹性地收缩，以将所述液压可膨胀构件的所述膨胀力限制为小于或等于所述预定的最大膨胀力。
实施例11
根据权利要求1所述的外科器械，其中所述钉仓还包括容纳流体的流体供应缸。
实施例12
根据权利要求11所述的外科器械，其中所述端部执行器包括击发构件，所述击发构件被构造成能够被选择性地从未击发位置驱动到击发位置，并且其中所述击发构件被构造成能够被选择性地从所述未击发位置朝向所述击发位置驱动，以将所述流体从所述流体供应缸朝向所述液压可膨胀构件引导，并使所述液压可膨胀构件从所述收缩状态朝向所述膨胀状态膨胀。
实施例13
根据权利要求12所述的外科器械，其中所述击发构件被构造成能够使容纳所述流体的所述流体供应缸的至少一部分塌缩，并由此在所述击发构件被从所述未击发位置朝向所述击发位置驱动时，迫使所述流体从所述流体供应缸朝向所述液压可膨胀构件。
实施例14
根据权利要求13所述的外科器械，其中所述钉仓还包括滑动件，所述滑动件与所述流体供应缸接合并被构造成能够从近侧位置朝向远侧位置滑动，其中所述滑动件被构造成能够抵靠所述滑动件直接接收所述击发构件，使得所述击发构件被构造成能够选择性地使所述滑动件从所述近侧位置滑动到所述远侧位置，以使所述流体供应缸塌缩。
实施例15
根据权利要求1所述的外科器械，其中所述液压可膨胀构件被构造成能够以膨胀力从所述收缩状态朝向所述膨胀状态膨胀，所述膨胀力将所述至少一个钉朝向所述砧座可操作地驱动，并且其中所述钉仓被构造成能够以相等的膨胀力将所述多个钉中的每一个朝向所述砧座引导。
实施例16
一种用于外科器械的钉仓，包括：(a)仓体，所述仓体被构造成能够由所述外科器械接收；(b)多个钉，所述多个钉定位在所述仓体内；和(c)所述仓体内的闭合液压回路，其中所述闭合液压回路包括液压可膨胀构件，所述液压可膨胀构件定位在所述仓体内并被构造成能够接收流体，其中所述液压可膨胀构件被构造成能够在接收所述流体时从收缩状态朝向膨胀状态膨胀，并且其中所述液压可膨胀构件被构造成能够从所述仓体引导所述多个钉中的至少一个，以迫使所述多个钉中的所述至少一个抵靠砧座并使所述钉成形。
实施例17
根据权利要求16所述的外科器械，其中所述液压可膨胀构件被构造成能够以小于或等于预定的最大膨胀力的膨胀力从所述收缩状态朝向所述膨胀状态膨胀，以限制施加到所述多个钉中的所述至少一个的膨胀力。
实施例18
根据权利要求1所述的外科器械，其中闭合液压回路还包括定位在所述仓体内的流体供应缸，并且其中所述流体供应缸容纳流体。
实施例19
一种利用具有钉仓的外科器械缝合组织的方法，其中所述钉仓包括仓体、多个钉和液压可膨胀构件，其中所述液压可膨胀构件定位在所述仓体内并被构造成能够接收流体，其中所述液压可膨胀构件被构造成能够在接收所述流体时从收缩状态朝向膨胀状态膨胀，并且其中所述液压可膨胀构件被构造成能够从所述仓体引导所述多个钉中的至少一个，以迫使所述多个钉中的所述至少一个抵靠砧座并使所述钉成形，所述方法包括：(a)将所述流体引入所述液压可膨胀构件中，以便使所述液压可膨胀构件从所述收缩状态朝向所述膨胀状态膨胀；以及(b)经由所述液压可膨胀构件将所述多个钉中的至少一个朝向所述砧座部署，以使所述多个钉中的所述至少一个成形。
实施例20
根据权利要求19所述的方法，还包括同时向被朝向所述砧座部署的所述多个钉中的每一个施加相等的力。
IV.杂项
应当理解，本文所述的教导内容、表达、实施方案、示例等中的任何一者或多者可与本文所述的其它教导内容、表达、实施方案、示例等中的任何一者或多者进行组合。因此，上述教导内容、表达、实施方案、示例等不应视为彼此孤立。参考本文的教导内容，本文的教导内容可进行组合的各种合适方式对于本领域的普通技术人员而言将显而易见。此类修改和变型旨在包括在权利要求书的范围内。
应当理解，据称以引用的方式并入本文的任何专利、专利公布或其它公开材料，无论是全文或部分，仅在所并入的材料与本公开中所述的现有定义、陈述或者其它公开材料不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。
上述装置的型式可应用于由医疗专业人员进行的传统医学治疗和手术、以及机器人辅助的医学治疗和手术中。仅以举例的方式，本文的各种教导内容可易于并入机器人外科系统，诸如Intuitive Surgical,Inc.(Sunnyvale,California)的DAVINCITM系统。相似地，本领域的普通技术人员将认识到，本文中的各种教导内容可易于结合以下美国专利中的任何一个的各种教导内容：1998年8月11日公布的名称为“Articulated SurgicalInstrument For Performing Minimally Invasive Surgery With Enhanced Dexterityand Sensitivity”的美国专利5,792,135，其公开内容以引用方式并入本文；1998年10月6日公布的名称为“Remote Center Positioning Device with Flexible Drive”的美国专利5,817,084，其公开内容以引用方式并入本文；1999年3月2日公布的名称为“AutomatedEndoscope System for Optimal Positioning”的美国专利5,878,193，其公开内容以引用方式并入本文；2001年5月15日公布的名称为“Robotic Arm DLUS for PerformingSurgical Tasks”的美国专利6,231,565，其公开内容以引用方式并入本文；2004年8月31日公布的名称为“Robotic Surgical Tool with Ultrasound Cauterizing and CuttingInstrument”的美国专利6,783,524，其公开内容以引用方式并入本文；2002年4月2日公布的名称为“Alignment of Master and Slave in a Minimally Invasive SurgicalApparatus”的美国专利6,364,888，其公开内容以引用方式并入本文；2009年4月28日公布的名称为“Mechanical Actuator Interface System for Robotic Surgical Tools”的美国专利7,524,320，其公开内容以引用方式并入本文；2010年4月6日公布的名称为“Platform Link Wrist Mechanism”的美国专利7,691,098，其公开内容以引用方式并入本文；2010年10月5日公布的名称为“Repositioning and Reorientation of Master/SlaveRelationship in Minimally Invasive Telesurgery”的美国专利7,806,891，其公开内容以引用方式并入本文；2013年1月10日公布的名称为“Automated End Effector ComponentReloading System for Use with a Robotic System”的美国专利公布2013/0012957，其公开内容以引用方式并入本文；2012年8月9日公布的名称为“Robotically-ControlledSurgical Instrument with Force-Feedback Capabilities”的美国专利公布2012/0199630，其公开内容以引用方式并入本文；2012年5月31日公布的名称为“ShiftableDrive Interface for Robotically-Controlled Surgical Tool,”的美国专利公布2012/0132450，其公开内容以引用方式并入本文；2012年8月9日公布的名称为“SurgicalStapling Instruments with Cam-Driven Staple Deployment Arrangements”的美国专利公布2012/0199633，其公开内容以引用方式并入本文；2012年8月9日公布的名称为“Robotically-Controlled Motorized Surgical End Effector System with RotaryActuated Closure Systems Having Variable Actuation Speeds”的美国专利公布2012/0199631，其公开内容以引用方式并入本文；2012年8月9日公布的名称为“Robotically-Controlled Surgical Instrument with Selectively Articulatable End Effector”的美国专利公布2012/0199632，其公开内容以引用方式并入本文；2012年8月9日公布的名称为“Robotically-Controlled Surgical End Effector System”的美国专利公布2012/0203247，其公开内容以引用方式并入本文；2012年8月23日公布的名称为“DriveInterface for Operably Coupling a Manipulatable Surgical Tool to a Robot”的美国专利公布2012/0211546，其公开内容以引用方式并入本文；2012年6月7日公布的名称为“Robotically-Controlled Cable-Based Surgical End Effectors”的美国专利公布2012/0138660，其公开内容以引用方式并入本文；和/或2012年8月16日公布的名称为“Robotically-Controlled Surgical End Effector System with Rotary ActuatedClosure Systems”的美国专利公布2012/0205421，其公开内容以引用方式并入本文。
上文所述的型式的装置可被设计为单次使用后丢弃，或者它们可被设计为可多次使用。在任一种情况下或两种情况下，可对这些型式进行修复以在至少一次使用之后重复使用。修复可包括以下步骤的任意组合：拆卸装置，然后清洁或替换特定零件以及随后进行重新组装。具体地，可拆卸一些型式的装置，并且可以任何组合来选择性地替换或移除装置的任意数量的特定零件或部分。在清洁和/或更换特定部件时，所述装置的一些型式可在修复设施处重新组装或者在即将进行手术之前由用户重新组装以供随后使用。本领域的技术人员将会了解，装置的修复可利用多种技术进行拆卸、清洁/更换、以及重新组装。此类技术的使用以及所得的修复装置均在本申请的范围内。
仅以举例的方式，本文描述的型式可在手术之前和/或之后消毒。在一种消毒技术中，将所述装置放置在闭合且密封的容器诸如塑料袋或TYVEK袋中。然后可将容器和装置放置在可穿透容器的辐射场中，诸如γ辐射、x射线、或高能电子。辐射可杀死装置上和容器中的细菌。经消毒的装置随后可存储在无菌容器中，以供以后使用。还可使用本领域已知的任何其它技术对装置进行消毒，所述技术包括但不限于β辐射或γ辐射、环氧乙烷或蒸汽。
已经示出和阐述了本发明的各种实施方案，可在不脱离本发明的范围的情况下由本领域的普通技术人员进行适当修改来实现本文所述的方法和系统的进一步改进。已经提及了若干此类可能的修改，并且其它修改对于本领域的技术人员而言将显而易见。例如，上文所讨论的实施例、实施方案、几何形状、材料、尺寸、比率、步骤等均是例示性的而非必需的。因此，本发明的范围应根据以下权利要求书来考虑，并且应理解为不限于说明书和附图中示出和描述的结构和操作的细节。
Claims (18)
1.一种外科器械，包括：
(a)主体组件；
(b)从所述主体组件朝远侧延伸的轴组件；和
(c)从所述轴组件朝远侧延伸的端部执行器，其中所述端部执行器包括：
(i)第一钳口，所述第一钳口具有砧座，其中所述砧座被构造成能够使抵靠所述砧座接收的多个钉成形，
(ii)第二钳口，其中所述第一钳口能够相对于所述第二钳口从打开构型朝向闭合构型运动，以将组织捕获在所述第一钳口和所述第二钳口之间，并使钉在所述组织中成形，和
(iii)钉仓，所述钉仓由所述第二钳口接收，其中所述钉仓包括：
(A)所述多个钉，
(B)平移构件，和
(C)液压可膨胀构件，所述液压可膨胀构件被构造成能够接收流体并从收缩状态朝向膨胀状态膨胀，以将所述多个钉中的至少一个朝向所述砧座引导以使所述至少一个钉成形，其中所述液压可膨胀构件被构造成能够响应于所述平移构件穿过所述钉仓的远侧平移而朝向所述膨胀状态膨胀。
2.根据权利要求1所述的外科器械，其中，所述钉仓还包括平台，所述平台具有延伸穿过所述平台的多个钉凹坑。
3.根据权利要求2所述的外科器械，其中，所述平台的上表面被构造成能够在闭合构型中与砧座一起接收抵靠其的组织时变形。
4.根据权利要求1所述的外科器械，其中，所述液压可膨胀构件包括至少一个可膨胀囊。
5.根据权利要求4所述的外科器械，其中，所述至少一个可膨胀囊包括第一可膨胀球囊。
6.根据权利要求5所述的外科器械，其中，所述钉仓还包括第二可膨胀球囊，其中所述多个钉包括第一排钉和第二排钉，并且其中所述第一可膨胀球囊和第二可膨胀球囊分别与所述第一排钉和第二排钉对齐，使得所述第一可膨胀球囊和第二可膨胀球囊能够从所述收缩状态朝向所述膨胀状态膨胀，以分别将所述第一排钉和第二排钉朝向所述砧座引导。
7.根据权利要求1所述的外科器械，其中，所述液压可膨胀构件被构造成能够以小于或等于预定的最大膨胀力的膨胀力从所述收缩状态朝向所述膨胀状态膨胀，以限制施加到所述多个钉中的所述至少一个的膨胀力。
8.根据权利要求7所述的外科器械，其中，所述钉仓还包括流体地连接到所述液压可膨胀构件的贮存器，并且其中所述贮存器被构造成能够在所述液压可膨胀构件以所述预定的最大膨胀力膨胀时接收所述流体，并由此限制积聚在所述液压可膨胀构件内的所述流体，以限制施加到所述多个钉中的所述至少一个的膨胀力。
9.根据权利要求8所述的外科器械，其中，所述贮存器包括主体，所述主体被构造成能够弹性地膨胀以收集所述流体，并由此限制所述流体在所述液压可膨胀构件内积聚。
10.根据权利要求9所述的外科器械，其中，所述贮存器的所述主体被构造成能够弹性地膨胀和弹性地收缩，以将所述液压可膨胀构件的所述膨胀力限制为小于或等于所述预定的最大膨胀力。
11.根据权利要求1所述的外科器械，其中，所述钉仓还包括容纳流体的流体供应缸。
12.根据权利要求11所述的外科器械，其中，所述端部执行器包括击发构件，所述击发构件被构造成能够被选择性地从未击发位置驱动到击发位置，并且其中所述击发构件被构造成能够被选择性地从所述未击发位置朝向所述击发位置驱动，以将所述流体从所述流体供应缸朝向所述液压可膨胀构件引导，并使所述液压可膨胀构件从所述收缩状态朝向所述膨胀状态膨胀。
13.根据权利要求12所述的外科器械，其中，所述击发构件被构造成能够使容纳所述流体的所述流体供应缸的至少一部分塌缩，并由此在所述击发构件被从所述未击发位置朝向所述击发位置驱动时，迫使所述流体从所述流体供应缸朝向所述液压可膨胀构件。
14.根据权利要求13所述的外科器械，其中，所述钉仓还包括滑动件，所述滑动件与所述流体供应缸接合并被构造成能够从近侧位置朝向远侧位置滑动，其中所述滑动件被构造成能够抵靠所述滑动件直接接收所述击发构件，使得所述击发构件被构造成能够选择性地使所述滑动件从所述近侧位置滑动到所述远侧位置，以使所述流体供应缸塌缩。
15.根据权利要求1所述的外科器械，其中，所述液压可膨胀构件被构造成能够以膨胀力从所述收缩状态朝向所述膨胀状态膨胀，所述膨胀力将所述至少一个钉朝向所述砧座可操作地驱动，并且其中所述钉仓被构造成能够以相等的膨胀力将所述多个钉中的每一个朝向所述砧座引导。
16.一种用于外科器械的钉仓，包括：
(a)仓体，所述仓体被构造成能够由所述外科器械接收；
(b)多个钉，所述多个钉定位在所述仓体内；和
(c)所述仓体内的闭合液压回路，其中所述闭合液压回路包括：
(i)液压可膨胀构件，所述液压可膨胀构件定位在所述仓体内并被构造成能够接收流体，其中所述液压可膨胀构件被构造成能够在接收所述流体时从收缩状态朝向膨胀状态膨胀，以从所述仓体引导所述多个钉中的至少一个钉并抵靠砧座使所述钉成形，和
(ii)卸压贮存器，所述卸压贮存器与所述液压可膨胀构件流体联接，其中所述卸压贮存器被构造成能够从所述液压可膨胀构件接收流体并由此维持所述液压可膨胀构件内的预定最大流体压力，以限制施加到所述至少一个钉的膨胀力。
17.根据权利要求16所述的钉仓，其中，所述液压可膨胀构件被构造成能够以小于或等于预定的最大膨胀力的膨胀力从所述收缩状态朝向所述膨胀状态膨胀，以限制施加到所述多个钉中的所述至少一个的膨胀力。
18.根据权利要求16所述的钉仓，其中，所述闭合液压回路还包括定位在所述仓体内的流体供应缸，并且其中所述流体供应缸容纳流体。
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- 2017-04-17 CN CN201780025000.9A patent/CN109069151B/zh not_active Expired - Fee Related
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|---|---|
| CN109069151A (zh) | 2018-12-21 |
| JP6907230B2 (ja) | 2021-07-21 |
| US20170303924A1 (en) | 2017-10-26 |
| JP2019518494A (ja) | 2019-07-04 |
| EP3235449B1 (en) | 2021-05-26 |
| WO2017184516A1 (en) | 2017-10-26 |
| EP3235449A1 (en) | 2017-10-25 |
| BR112018071491B1 (pt) | 2023-03-07 |
| BR112018071491A2 (pt) | 2019-02-19 |
| US10285700B2 (en) | 2019-05-14 |
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