CN109310416B - 被构造成能够提供组织的选择性切割的外科缝合系统 - Google Patents

被构造成能够提供组织的选择性切割的外科缝合系统 Download PDF

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CN109310416B
CN109310416B CN201780034152.5A CN201780034152A CN109310416B CN 109310416 B CN109310416 B CN 109310416B CN 201780034152 A CN201780034152 A CN 201780034152A CN 109310416 B CN109310416 B CN 109310416B
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drive
staple
shaft
firing
staples
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CN109310416A (zh
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F·E·谢尔顿四世
J·L·哈里斯
A·D·亨塞尔
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Ethicon LLC
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Ethicon LLC
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Abstract

本发明公开了一种外科器械组件，该外科器械组件包括轴、关节运动接头以及围绕关节运动接头可旋转地连接到轴的端部执行器。该端部执行器包括第一钳口、能够相对于第一钳口移动的第二钳口、包括可移除地储存在其中的多个钉的钉仓以及被构造成能够使钉变形的砧座。该端部执行器还包括驱动输入部、被构造成能够使第二钳口在打开位置和闭合位置之间移动的闭合系统、被构造成能够将钉从钉仓射出的钉闭合系统以及定位在端部执行器中的传输装置，其中传输装置能够配置在三种操作状态，以用于将闭合系统和钉击发系统与驱动轴可操作地联接。

Description

被构造成能够提供组织的选择性切割的外科缝合系统
背景技术
本发明涉及外科器械，并且在各种布置中，涉及被设计成缝合和切割组织的外科缝合和切割器械及与其一起使用的钉仓。
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理解：
图1是根据至少一个实施方案的包括可互换外科工具组件的外科器械的透视图；
图2是图1的外科器械的柄部组件的另一个透视图，其中柄部壳体的一部分被省略以暴露容纳在其中的部件；
图3是图1和图2的外科器械的柄部组件的部分的分解组装视图；
图4是图2和图3的柄部组件的剖面透视图；
图5是图2至图4的柄部组件的局部横截面侧视图，其中柄部组件的夹持部分以实线示出在相对于主壳体部分的一个位置中并且以虚线示出在相对于柄部组件的主壳体部分的另一个位置中；
图6是图2至图5的柄部组件沿图5中的线6-6截取的端部剖视图；
图7是图2至图6的柄部组件沿图5中的线7-7截取的另一端部剖视图；
图8是图2至图7的柄部组件的另一端部剖视图，示出了与旋转驱动承窝上的驱动齿轮啮合接合的移位器齿轮；
图9是图2至图8的柄部组件的另一个端部剖视图，示出了当移位器齿轮与旋转驱动承窝上的驱动齿轮啮合接合时移位器螺线管的位置；
图10是图2至图9的柄部组件的另一个透视图，其中柄部组件的某些部分以横截面示出并且柄部组件的接入面板部分以虚线示出；
图11是图2至图11的柄部组件的顶视图，其中应急系统示出为处于可致动位置；
图12是图2至图11中所示的应急系统的应急柄部的透视图；
图13是图12的应急柄部的部分的分解组装视图，其中应急柄部的部分以横截面示出；
图14是图11的柄部组件的横截面正视图；
图15是根据至少一个实施方案的可互换工具组件的分解图；
图16是图15的可互换工具组件的透视图；
图17是图15的可互换工具组件的剖视透视图；
图18是图15的可互换工具组件的剖面分解图；
图19是图15的可互换工具组件的关节运动块的透视图；
图20是包括图19的关节运动块的图15的可互换工具组件的关节运动接头的剖视透视图；
图21是图20的关节运动接头的另一个剖视透视图；
图22是图15的可互换工具组件的局部分解图；
图23是图15的可互换工具组件的另一个局部分解图；
图24是图20的关节运动接头的局部分解图；
图25是图15的可互换工具组件的近侧端部的剖视透视图；
图26是图15的可互换工具组件的端视图；
图27是图15的可互换工具组件的端部执行器沿图26中的线27-27截取的剖视图，其示出了处于夹紧但未击发状态的端部执行器；
图28是图15的可互换工具组件的端部执行器沿图26中的线28-28截取的剖视图，其示出了处于夹紧但未击发状态的端部执行器；
图29是图15的可互换工具组件的端部执行器沿图26中的线29-29截取的剖视图，其示出了处于夹紧但未击发状态的端部执行器；
图30是被示出处于拆卸状态的图15的可互换工具组件的端部执行器的剖视图；
图31示出了在第一方向上关节运动的图15的可互换工具组件的端部执行器；
图32示出了在第二方向上关节运动的图15的可互换工具组件的端部执行器；
图33是图15的可互换工具组件的仓体的透视图；
图34是根据至少一个另选的实施方案的仓体的透视图；
图35是根据至少一个另选的实施方案的可互换工具组件的端部执行器的分解图；
图36是图35的端部执行器的拆卸图；
图37是根据至少一个另选的实施方案的可互换工具组件的端部执行器的拆卸图；
图38是根据至少一个另选的实施方案的可互换工具组件的端部执行器的拆卸图；
图39是示出根据至少一个实施方案的钉仓和外科缝合器械的轴的透视图；
图40是组装到图39的缝合器械的钉仓的局部剖视图；
图41是外科缝合器械的局部剖视图，该外科缝合器械包括闭合驱动装置、砧座和闭锁件，该闭锁件被构造成能够在闭合驱动装置不处于完全延伸的位置的情况下防止砧座组装到闭合驱动装置；
图42是图41的外科缝合器械的局部剖视图，其示出了附接到闭合驱动装置的砧座；
图43是外科缝合器械的局部透视图，该外科缝合器械包括钉仓和闭合驱动装置，该闭合驱动装置被构造成能够使砧座相对于钉仓移动；
图44是图43的缝合器械的局部剖视图，其示出了闭锁件，该闭锁件被构造成能够在不将砧座附接到闭合驱动装置的情况下防止闭合驱动装置回缩；
图45是图44的缝合器械的局部剖视图，其示出了附接到闭合驱动装置的砧座以及与闭合驱动装置脱离接合的闭锁件。
图46是外科缝合器械的局部剖视图，该外科缝合器械包括钉仓，该钉仓包括可移除地储存在其中的钉，砧座，被构造成能够使砧座相对于钉仓移动的闭合驱动装置，以及被构造成能够从钉仓射出钉的击发驱动装置；
图47是闭锁件的详细视图，该闭锁件被构造成能够在砧座移动到闭合位置之前防止击发驱动装置被致动；
图48是从击发驱动装置脱离接合的图47的闭锁件的详细视图；
图49是包括钉仓的外科缝合器械的局部透视图，该钉仓包括可移除地储存在其中的钉，砧座，被构造成能够使砧座相对于钉仓移动的闭合驱动装置，以及被构造成能够从钉仓射出钉的击发驱动装置；
图50是图49的外科缝合器械的闭锁件的详细视图，该闭锁件被构造成能够在砧座对在砧座和钉仓之间捕获的组织施加足够的压力之前防止致动击发驱动装置；
图51是从击发驱动装置脱离接合的图50的闭锁件的详细视图；
图52是包括钉仓的外科缝合器械的局部透视图，该钉仓包括可移除地储存在其中的钉，砧座，被构造成能够使砧座相对于钉仓移动的闭合驱动装置，以及被构造成能够从钉仓射出钉的击发驱动装置；
图53是图52的外科缝合器械的闭锁定件的详细视图，该闭锁件被构造成能够在击发驱动装置的切割构件暴露在钉仓上方时防止砧座与闭合驱动装置分离；
图54是在击发驱动装置在击发冲程之后已经充分回缩之后与砧座脱离接合的图53的闭锁件的详细视图；
图55是外科缝合器械的局部剖视图，该外科缝合器械包括钉仓，该钉仓包括可移除地储存在其中的钉，砧座，被构造成能够使砧座相对于钉仓移动的闭合驱动装置，以及被构造成能够从钉仓射出钉的击发驱动装置；
图56是图55的外科缝合器械的局部剖视图，其示出了处于夹紧构型的闭合驱动装置和处于未击发构型的击发驱动装置，其中击发驱动装置将闭锁件保持处于未释放构型；
图57是图55的外科缝合器械的局部剖视图，其示出了处于至少部分击发构型的击发驱动装置和处于释放构型的图56的闭锁件；
图58是图55的外科缝合器械的局部剖视图，其示出了处于延伸的或打开的构型的闭合驱动装置以及与闭合驱动装置接合以防止闭合驱动装置被重新夹紧的图56的闭锁件；
图59是外科缝合器械的剖视图，该外科缝合器械包括钉仓，该钉仓包括可移除地储存在其中的钉，砧座，被构造成能够使砧座相对于钉仓移动的闭合驱动装置，以及被构造成能够从被示出处于禁用或闭锁的构型的钉仓射出钉的击发驱动装置；
图59A是图59的外科缝合器械沿图59中的线59A-59A截取的剖视端视图；
图60是被示出处于夹紧构型的图59的外科缝合器械的剖视图，其中已经启用击发驱动装置；
图60A是图59的外科缝合器械沿图60中的线60A-60A截取的剖视端视图；
图61是外科缝合器械的局部剖视图，该外科缝合器械包括钉仓，该钉仓包括可移除地储存在其中的钉，砧座，被构造成能够使砧座相对于钉仓移动的闭合驱动装置，以及被构造成能够从钉仓射出钉的击发驱动装置，其中闭合驱动装置被示出处于未夹紧构型，并且击发驱动装置被示出处于不可操作的构型；
图62是图61的外科缝合器械的局部剖视图，其中闭合驱动装置被示出处于夹紧构型，并且击发驱动装置被示出处于可操作的构型；
图63是图61的外科器械的击发驱动装置的可旋转中间驱动构件的透视图；
图64是图61的外科器械的击发驱动装置的可旋转击发轴的局部透视图；
图65是弹簧系统的正视图，该弹簧系统被构造成能够偏置图64的击发轴而不与图63的中间驱动构件接合；
图66是根据至少一个实施方案的包括钉仓的外科缝合器械的端部执行器的分解图；
图67是图66的端部执行器的局部剖视图，其示出了闭锁件，该闭锁件被构造成能够在钉仓未完全组装到缝合器械的情况下防止端部执行器操作；
图68是图66的端部执行器的局部剖视图，其示出了处于解锁构型的闭锁件；
图69是根据至少一个实施方案的包括钉仓的外科缝合器械的端部执行器的分解图；
图70是图69的端部执行器的局部剖视图，其示出了被构造成能够将钉仓可释放地保持到缝合器械的锁；
图71是图69的端部执行器的局部剖视图，其示出了处于解锁构型的锁定件；
图72示出了被构造成能够与选自多个圆形钉仓的钉仓一起使用的外科缝合器械的轴；
图73是图72的缝合器械的远侧端部的剖视图；
图74是外科缝合器械的局部剖视图，该外科缝合器械包括未击发的钉仓和闭锁系统，该闭锁系统被构造成能够在其先前已被外科器械的击发驱动装置击发之后防止钉仓被再次击发；
图75是被示出处于夹紧构型的图74的缝合器械和处于击发构型的击发驱动装置的局部剖视图；
图76是被示出处于未夹紧构型的图74的缝合器械和处于回缩构型的击发驱动装置的局部剖视图；
图77是图74的击发驱动装置和缝合器械的框架的端视图，其示出了处于未击发构型的击发驱动装置；
图78是图74的击发驱动装置和缝合器械的框架的端视图，其示出了处于回缩构型的击发驱动装置；
图79是可与图74的缝合器械一起使用的另选的钉仓设计的端视图；
图80是可与图74的缝合器械一起使用的另选的钉仓设计的端视图；
图81是根据至少一个实施方案的包括柔性轴的外科缝合器械的透视图；
图82是根据至少一个实施方案的包括多个端部执行器的外科器械套件的示意图；
图82A是根据至少一个实施方案的包括多个可附接的端部执行器的机器人外科器械系统的示意图；
图83是图82中描绘的若干端部执行器的透视图；
图84是根据至少一个实施方案的砧座的透视图；
图85是图84的砧座的剖视图；
图86是包括被示出处于击发构型的图84的砧座的端部执行器的局部剖视图；
图87是根据至少一个实施方案的砧座的透视图；
图88是图87的砧座的平面图；
图89是被示出处于夹紧的未击发构型的根据至少一个实施方案的端部执行器的剖视图；
图90是被示出处于击发构型的图89的端部执行器的剖视图；
图91是被示出处于夹紧的未击发构型的根据至少一个另选的实施方案的端部执行器的剖视图；
图92是被示出处于击发构型的图91的端部执行器的剖视图；
图93是被示出处于夹紧的未击发构型的根据至少一个另选的实施方案的端部执行器的剖视图；
图94是被示出处于击发构型的图91的端部执行器的剖视图；
图95是根据至少一个实施方案的钉成形凹坑的透视图；
图96是图95的钉成形凹坑的剖视图；
图97是被构造成能够顺序地部署第一环形钉排和第二环形钉排的根据至少一个实施方案的端部执行器的分解视图；
图98是图97的端部执行器的局部剖视图，其示出了将钉部署在第一钉排中的击发驱动装置；
图99是图97的端部执行器的局部剖视图，其示出了将钉部署在第二钉排中的图98的击发驱动装置；
图100是击发驱动装置的局部剖视图，该击发驱动装置被构造成能够顺序地驱动用于击发第一钉排的第一驱动装置，用于击发第二钉排的第二驱动装置，以及然后用于驱动切割构件的第三驱动装置；
图101是示出了处于击发位置的第一驱动装置的图100的击发驱动装置的局部透视图；
图102是示出了处于击发位置的第二驱动装置的图100的击发驱动装置的局部透视图；
图103是示出了处于击发位置的第三驱动装置的图100的击发驱动装置的局部透视图；
图104是图100的击发驱动装置的分解图；
图105是处于图103的构型中的图100的击发驱动装置的局部透视图；
图106是根据至少一个另选的实施方案的击发驱动装置的分解图；
图107是根据至少一个实施方案的与圆形外科缝合器械一起使用的外科钉仓的一部分的透视图；
图108示出了处于未成形构型和成形构型的根据至少一个实施方案的一对钉；
图109是在致动钉成形过程之前相对于图107的外科钉仓的一部分的砧座的一部分的剖视图；
图110是在钉已经成形之后图109的砧座和图107的钉仓的另一个剖视图；
图111是根据至少一个实施方案的与圆形外科缝合器械一起使用的外科钉仓的一部分的透视图；
图112是在致动钉成形过程之前相对于图111的外科钉仓的一部分的砧座的一部分的剖视图；
图113是在钉已经成形之后图112的砧座和钉仓的另一个剖视图；
图114是根据至少一个实施方案的钉仓的顶视图；
图115是根据至少一个实施方案的砧座的底视图；
图116是相对于外科钉仓的一部分的砧座的一部分的剖视图；
图117示出了三个未成形的外科钉；
图118示出了根据至少一个实施方案的圆形缝合器的钉仓的局部剖视图；并且
图119示出了根据至少一个实施方案的圆形缝合器的钉仓的局部透视图。
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“METHOD FOR OPERATING A SURGICAL STAPLING SYSTEM”的美国专利申请序列号__________；代理人案卷号END7821USNP/150535；
-名称为“MODULAR SURGICAL STAPLING SYSTEM COMPRISING A DISPLAY”的美国专利申请序列号__________；代理人案卷号END7822USNP/150536；
-名称为“SURGICAL STAPLING SYSTEM COMPRISING A DISPLAY INCLUDING A RE-ORIENTABLE DISPLAY FIELD”的美国专利申请序列号__________；代理人案卷号END7822USNP1/150536-1；
-名称为“SURGICAL INSTRUMENT HANDLE ASSEMBLY WITH RECONFIGURABLE GRIPPORTION”的美国专利申请序列号__________；代理人案卷号END7823USNP/150537；
-名称为“ROTARY POWERED SURGICAL INSTRUMENT WITH MANUALLY ACTUATABLEBAILOUT SYSTEM”的美国专利申请序列号__________；代理人案卷号END7824USNP/150538；
-名称为“SURGICAL CUTTING AND STAPLING END EFFECTOR WITH ANVILCONCENTRIC DRIVE MEMBER”的美国专利申请序列号__________；代理人案卷号END7825USNP/150539；
-名称为“CLOSURE SYSTEM ARRANGEMENTS FOR SURGICAL CUTTING AND STAPLINGDEVICES WITH SEPARATE AND DISTINCT FIRING SHAFTS”的美国专利申请序列号__________；代理人案卷号END7826USNP/150540；
-名称为“INTERCHANGEABLE SURGICAL TOOL ASSEMBLY WITH A SURGICAL ENDEFFECTOR THAT IS SELECTIVELY ROTATABLE ABOUT A SHAFT AXIS”的美国专利申请序列号__________；代理人案卷号END7827USNP/150541；
-名称为“SURGICAL STAPLING SYSTEM COMPRISING ASHIFTABLE TRANSMISSION”的美国专利申请序列号__________；代理人案卷号ENDEND7829USNP/150543；
-名称为“SURGICAL STAPLING SYSTEM COMPRISING ACONTOURABLE SHAFT”的美国专利申请序列号__________；代理人案卷号END7831USNP/150545；
-名称为“SURGICAL STAPLING SYSTEM COMPRISING A TISSUE COMPRESSIONLOCKOUT”的美国专利申请序列号__________；代理人案卷号END7832USNP/150546；
-名称为“SURGICAL STAPLING SYSTEM COMPRISING AN UNCLAMPING LOCKOUT”的美国专利申请序列号__________；代理人案卷号END7833USNP/150547；
-名称为“SURGICAL STAPLING SYSTEM COMPRISING A JAW CLOSURE LOCKOUT”的美国专利申请序列号__________；代理人案卷号END7834USNP/150548；
-名称为“SURGICAL STAPLING SYSTEM COMPRISING A JAW ATTACHMENT LOCKOUT”的美国专利申请序列号__________；代理人案卷号END7835USNP/150549；
-名称为“SURGICAL STAPLING SYSTEM COMPRISING A SPENT CARTRIDGELOCKOUT”的美国专利申请序列号__________；代理人案卷号END7836USNP/150550；
-名称为“SURGICAL INSTRUMENT COMPRISING A SHIFTING MECHANISM”的美国专利申请序列号__________；代理人案卷号END7837USNP/150551；
-名称为“SURGICAL STAPLING INSTRUMENT COMPRISING MULTIPLE LOCKOUTS”的美国专利申请序列号__________；代理人案卷号END7838USNP/150552；
-名称为“SURGICAL STAPLING INSTRUMENT”的美国专利申请序列号__________；代理人案卷号END7839USNP/150553；
-名称为“SURGICAL STAPLING SYSTEM CONFIGURED TO APPLY ANNULAR ROWS OFSTAPLES HAVING DIFFERENT HEIGHTS”的美国专利申请序列号__________；代理人案卷号END7840USNP/150554；
-名称为“SURGICAL STAPLING SYSTEM COMPRISING AGROOVED FORMING POCKET”的美国专利申请序列号__________；代理人案卷号END7841USNP/150555；
-名称为“ANVIL MODIFICATION MEMBERS FOR SURGICAL STAPLERS”的美国专利申请序列号__________；代理人案卷号END7842USNP/150556；
-名称为“STAPLE CARTRIDGES WITH ATRAUMATIC FEATURES”的美国专利申请序列号__________；代理人案卷号END7843USNP/150557；
-名称为“CIRCULAR STAPLING SYSTEM COMPRISING AN INCISABLE TISSUESUPPORT”的美国专利申请序列号__________；代理人案卷号END7844USNP/150558；
-名称为“CIRCULAR STAPLING SYSTEM COMPRISING ROTARY FIRING SYSTEM”的美国专利申请序列号__________；代理人案卷号END7845USNP/150559；以及
-名称为“CIRCULAR STAPLING SYSTEM COMPRISING LOAD CONTROL”的美国专利申请序列号__________；代理人案卷号END7845USNP1/150559-1；
本申请的申请人还拥有以下的美国专利申请，这些专利申请于2015年12月31日提交，每个都以引用方式各自完全并入本文：
-名称为“MECHANISMS FOR COMPENSATING FOR BATTERY PACK FAILURE INPOWERED SURGICAL INSTRUMENTS”的美国专利申请序列号14/984,488；
-名称为“MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWEREDSURGICAL INSTRUMENTS”的美国专利申请序列号14/984,525；以及
-名称为“SURGICAL INSTRUMENTS WITH SEPARABLE MOTORS AND MOTOR CONTROLCIRCUITS”的美国专利申请序列号14/984,552。
本申请的申请人还拥有以下的美国专利申请，这些专利申请于2016年2月9日提交，每个都以引用方式各自完全并入本文：
-名称为“SURGICAL INSTRUMENT WITH ARTICULATING AND AXIALLYTRANSLATABLE END EFFECTOR”的美国专利申请序列号15/019,220；
-名称为“SURGICAL INSTRUMENTS WITH MULTIPLE LINK ARTICULATIONARRANGEMENTS”的美国专利申请序列号15/019,228；
-名称为“SURGICAL INSTRUMENT ARTICULATION MECHANISM WITH SLOTTEDSECONDARY CONSTRAINT”的美国专利申请序列号15/019,196；
-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15/019,206；
-名称为“SURGICAL INSTRUMENTS WITH NON-SYMMETRICAL ARTICULATIONARRANGEMENTS”的美国专利申请序列号15/019,215；
-名称为“ARTICULATABLE SURGICAL INSTRUMENTS WITH SINGLE ARTICULATIONLINK ARRANGEMENTS”的美国专利申请序列号15/019,227；
-名称为“SURGICAL INSTRUMENTS WITH TENSIONING ARRANGEMENTS FOR CABLEDRIVEN ARTICULATION SYSTEMS”的美国专利申请序列号15/019,235；
-名称为“ARTICULATABLE SURGICAL INSTRUMENTS WITH OFF-AXIS FIRING BEAMARRANGEMENTS”的美国专利申请序列号15/019,230；以及
-名称为“SURGICAL INSTRUMENTS WITH CLOSURE STROKE REDUCTIONARRANGEMENTS”的美国专利申请序列号15/019,245；
本申请的申请人还拥有下面标识的美国专利申请，这些专利申请于2016年2月12日提交，并且每个都以引用的方式各自完全并入本文：
-名称为“MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWEREDSURGICAL INSTRUMENTS”的美国专利申请序列号15/043,254；
-名称为“MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWEREDSURGICAL INSTRUMENTS”的美国专利申请序列号15/043,259；
-名称为“MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWEREDSURGICAL INSTRUMENTS”的美国专利申请序列号15/043,275；以及
-名称为“MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWEREDSURGICAL INSTRUMENTS”的美国专利申请序列号15/043,289；
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“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；
-名称为“DUAL ARTICULATION DRIVE SYSTEM ARRANGEMENTS FOR ARTICULATABLESURGICAL INSTRUMENTS”的美国专利申请序列号14/742,885；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；代理人案卷号END7557USNP/140482；
-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 ASTAPLE 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 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 AFLEXIBLEARTICULATION SYSTEM”的美国专利申请序列号14/574,493；以及
-名称为“SURGICAL INSTRUMENT ASSEMBLY COMPRISING ALOCKABLEARTICULATION 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日提交并且其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 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 ASAFETY PROCESSOR”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 ASEGMENTED 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日提交并且其各自全文以引用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，现为美国专利申请公布2016/0066912；
-名称为“ADJUNCT WITH INTEGRATED SENSORS TO QUANTIFY TISSUECOMPRESSION”的美国专利申请序列号14/479,119，现为美国专利申请公布2016/0066914；
-名称为“MONITORING DEVICE DEGRADATION BASED ON COMPONENT EVALUATION”的美国专利申请序列号14/478,908，现为美国专利申请公布2016/0066910；
-名称为“MULTIPLE SENSORS WITH ONE SENSOR AFFECTING ASECOND SENSOR'SOUTPUT OR INTERPRETATION”的美国专利申请序列号14/478,895，现为美国专利申请公布2016/0066909；
-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，现为美国专利申请公布2016/0066915；
-名称为“SMART CARTRIDGE WAKE UP OPERATION AND DATA RETENTION”的美国专利申请序列号14/479,098，现为美国专利申请公布2016/0066911；
-名称为“MULTIPLE MOTOR CONTROL FOR POWERED MEDICAL DEVICE”的美国专利申请序列号14/479,115，现为美国专利申请公布2016/0066916；以及
-名称为“LOCAL DISPLAY OF TISSUE PARAMETER STABILIZATION”的美国专利申请序列号14/479,108，现为美国专利申请公布2016/0066913；
本申请的申请人还拥有2014年4月9日提交并且其各自全文以引用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 ASURGICAL INSTRUMENT”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日提交并且其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 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程序操作。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程序和应用中，包括例如与开放式外科程序结合。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，设想了其中第一钳口能够相对于第二钳口枢转的其他实施方案。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他实施方案。
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。砧座朝向钉仓移动以抵靠平台压缩并夹持组织。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。钉腔被布置成六个纵向排。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。钉腔和钉的其他布置也是可能的。
钉由仓体中的钉驱动装置支撑。驱动装置能够在第一或非击发位置与第二或击发位置之间移动，以从钉仓射出钉。驱动装置通过保持器保留在仓体中，所述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。驱动装置能够通过滑动件在其非击发位置与其击发位置之间移动。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移动。滑动件包括多个斜坡表面，所述斜坡表面被构造成能够朝向砧座在驱动装置下方滑动以及提升驱动装置，并且钉在驱动装置上受到支撑。
除了上述以外，滑动件还可通过击发构件朝远侧移动。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。砧座也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获的组织的刀。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示出了可用于执行多种不同外科程序的马达驱动外科系统10。在所示的实施方案中，马达驱动外科系统10包括选择性地可重新构造的壳体或柄部组件20，其附接到一种形式的可互换外科工具组件1000。例如，图1中描绘的系统10包括可互换外科工具组件1000，该可互换外科工具组件1000包括外科切割和紧固器械，该外科切割和紧固器械可被称为内镜切割器。如下文将进一步详细讨论的，可互换外科工具组件可包括适于支撑不同尺寸和类型的钉仓的端部执行器，并且具有不同的轴长度、尺寸和类型等。此类布置例如可利用任何合适的一个或多个紧固件来紧固组织。例如，包括可移除地储存在其中的多个紧固件的紧固件仓能够可移除地插入外科工具组件的端部执行器中和/或附接到外科工具组件的端部执行器。其他外科工具组件可与柄部组件20互换使用。例如，可互换的外科工具组件1000可与柄部组件20分离，并且以被构造成能够执行其他外科程序的不同外科工具组件替换。在其他布置中，外科工具组件可不与其他外科工具组件能互换并且基本上包括例如不可移除地附连或联接到柄部组件20的专用轴。外科工具组件也可称为细长轴组件。外科工具组件可为可重复使用的，或在其他构造中，外科工具组件可被设计成在单次使用之后被设置。
继续参阅本具体实施方式，应当理解，本文所公开的各种形式的可互换外科工具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“壳体”和“壳体组件”也可涵盖机器人系统的容纳或以其他方式可操作地支撑至少一个驱动系统的壳体或类似部分，其中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运动。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，本文所公开的外科工具组件可与诸如但不限于在名称为“SURGICALSTAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS”的美国专利申请序列号13/118,241，现为美国专利申请公布2012/0298719中公开的那些的各种机器人系统、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。
现在参见图1和图2，壳体组件或柄部组件20包括主壳体部分30，主壳体部分30可由一对壳体节段40,70形成，壳体节段40,70可由塑料、聚合物材料、金属等制成，并通过适当的紧固件布置诸如例如粘合剂、螺钉、按压配合特征、卡扣配合特征、闩锁等连结在一起。如下面将进一步详细讨论的，主壳体部分30在其中可操作地支撑多个驱动系统，这些驱动系统被构造成能够生成各种控制运动并且将各种控制运动施加到可操作地附接到驱动系统的可互换外科工具组件的对应部分。柄部组件20还包括夹持部分100，夹持部分100可动地联接到主壳体部分30并且被构造成能够在相对于主壳体部分30的各种位置中被临床医生夹持和操纵。夹持部分100可由一对夹持节段110,120制成，夹持部分110,120可由塑料、聚合物材料、金属等制成，并通过适当的紧固件布置诸如例如粘合剂、螺钉、按压配合特征、卡扣配合特征、闩锁等连结在一起，用于组装和维护目的。
如在图2中可见，夹持部分100包括夹持壳体130，夹持壳体130限定中空腔132，中空腔132被构造成能够可操作地支撑驱动马达和齿轮箱，这将在下面进一步详细讨论。夹持壳体130的上部部分134被构造成能够延伸穿过主壳体部分30中的开口80并且枢转地轴颈连接在枢转轴180上。枢转轴180限定命名为“PA”的枢转轴线。参见图3。为了参考的目的，柄部组件20限定指定为“HA”的柄部轴线，该柄部轴线可与可互换外科工具的细长轴组件的轴线“SA”平行，该可互换外科工具可操作地附接到柄部组件20。枢转轴线PA横向于柄部轴线HA。参见图1。此类布置使得夹持部分100能够相对于主壳体部分30围绕枢转轴线PA枢转到最适合于联接到柄部组件20的可互换外科工具组件的类型的位置。夹持壳体130限定通常指定为“GA”的夹持轴线。参见图2。当联接到柄部组件20的可互换外科工具组件包括例如内镜切割器时，临床医生可能想要将夹持部分100相对于主壳体部分30定位，使得夹持轴线GA垂直于或近似垂直(角度“H1”)于柄部轴线HA(本文称为“第一夹持位置”)。参见图5。然而，如果柄部组件20用于控制例如包括圆形缝合器的可互换外科工具组件，则临床医生可能希望将夹持部分100相对于主壳体部分30枢转到这样的位置，其中夹持轴线GA相对于柄部轴线HA为45度或大约45度角或其他合适的锐角(角度“H2”)。此位置在本文中被称为“第二夹持位置”。图5示出了处于第二夹持位置以虚线示出的夹持部分100。
现在参见图3至图5，柄部组件20也包括通常指定为150的柄部锁定系统，用于相对于主壳体部分30将柄部部分100选择性地锁定在期望的取向。在一种布置中，夹持锁定系统150包括尖齿154的弓形序列152。齿154彼此间隔开，并且在其间形成锁定凹槽156。每个锁定凹槽156对应于夹持部分100的特定角度锁定位置。例如，在至少一种布置中，齿154和锁定凹槽或“锁定位置”156被布置成准许夹持部分100在第一夹持位置和第二夹持位置之间以10到15度间隔锁定。该布置可采用两个止动位置，该止动位置被调制为所采用的器械类型(轴布置)。例如，对于内镜切割器轴装置，其可与轴大约成90度，并且对于圆形缝合器布置，该角度可与轴大约成45度，同时朝向外科医生向前扫掠。夹持锁定系统150还包括锁定按钮160，锁定按钮160具有被构造成能够锁定地接合锁定凹槽156的锁定部分。例如，锁定按钮160可枢转地安装在枢轴销131上的主柄部部分30中，以允许锁定按钮160枢转成与对应的锁定凹槽156接合。锁定弹簧164用于将锁定按钮160偏置到与对应的锁定凹槽156接合或锁定的位置。当临床医生按压锁定按钮160时，锁定部分和齿构型用于使齿154能够滑动穿过锁定部分。因此，为了调节夹持部分100相对于主壳体部分30的角位置，临床医生按压锁定按钮160，然后将夹持部分100枢转到期望的角位置。一旦夹持部分100已经移动到期望位置，临床医生就释放锁定按钮160。然后，锁定弹簧164将朝向一系列齿154偏置锁定按钮160，使得锁定部分进入对应的锁定凹槽156，以在使用期间将夹持部分100保持在该位置。
柄部组件20可操作地支撑第一旋转驱动系统300、第二旋转驱动系统320和第三轴向驱动系统400。旋转驱动系统300,320各自由马达200提供动力，马达200可操作地支撑在夹持部分100中。如在图2中可见，例如，马达200被支撑在夹持部分100中的腔132内并且具有齿轮箱组件202，齿轮箱组件202具有从其突出的输出驱动轴204。在各种形式中，马达200例如可为具有大约25,000RPM的最大旋转的DC有刷驱动马达。在其他布置中，马达可包括无刷马达、无绳马达、同步马达、步进马达、或任何其他合适的电动马达。马达200可由电源210供电，在一种形式中，电源210可包括可移除电源组212。电源210可包括例如在名称为SURGICAL INSTRUMENT COMPRISING A SENSOR SYSTEM的美国专利申请公布2015/0272575中进一步详细公开的各种电源布置中的任何一种，该专利申请全部公开内容据此以引用方式并入本文。在所示的布置中，例如，电源组212可包括近侧壳体部分214，该近侧壳体部分214被构造用于附接到远侧壳体部分216。近侧壳体部分214和远侧壳体部分216被构造成能够在其中可操作地支撑多个电池218。例如，电池218可各自包括例如锂离子(“LI”)或其他合适的电池。远侧壳体部分216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200的柄部电路板组件220。柄部电路板组件220在本文中通常也可称为“控制系统或CPU 224”。串联连接的多个电池218可用作柄部组件20的电源。除此之外，电源210可为可替换的和/或可再充电的。在其他实施方案中，外科器械10可由例如交流电(AC)提供动力。马达200可由安装到夹持部分100的摇臂开关206控制。
如上文所概述，马达200可操作地联接到齿轮箱组件202，齿轮箱组件202包括输出驱动轴204。驱动装置锥齿轮230附接到输出驱动轴204。马达200、齿轮箱组件202、输出驱动轴204和驱动装置锥齿轮230在本文中也可统称为“马达组件231”。驱动装置锥齿轮230与从动锥齿轮234交接，从动锥齿轮234附接到系统驱动轴232以及枢转锥齿轮238，枢轴锥齿轮238轴颈连接在枢轴180上。从动锥齿轮234能够在系统驱动轴232上在接合位置与脱离位置之间轴向移动，在接合位置中，从动锥齿轮234与驱动装置锥齿轮230啮合接合(图5)，在脱离接合位置中，从动锥齿轮234脱出与驱动锥齿轮230的啮合接合(图14)。驱动系统弹簧235轴颈连接在从动锥齿轮234和近侧端部凸缘236之间，近侧端部凸缘236形成在系统驱动轴232的近侧部分上。参见图4和图14。驱动系统弹簧235用于将从动锥齿轮234偏置脱出与驱动装置锥齿轮230的啮合接合，如下面将进一步详细讨论的。枢轴锥齿轮238便于输出驱动轴204和驱动装置锥齿轮230与柄部部分100相对于主柄部部分30的枢转行进。
在所示的示例中，系统驱动轴232与通常指定为240的旋转驱动选择器系统交接。在至少一种形式中，例如，旋转驱动选择器系统240包括能够在第一旋转驱动系统300和第二旋转驱动系统320之间选择性地移动的移位器齿轮250。如在图6至图9中可见，例如，驱动选择器系统240包括移位器安装板242，移位器安装板242不可动地安装在主柄部部分30内。例如，移位器安装板242可摩擦地保持在形成于壳体节段40,70中的安装凸耳(未示出)之间，或通过螺钉、粘合剂等以其他方式保持在其中。仍然参考图6至图9，系统驱动轴232延伸穿过移位器安装板242中的孔，并且具有不可旋转地附接到其上的中央或系统驱动齿轮237。例如，中央驱动齿轮237可通过键槽布置233附接到系统驱动轴232。参见图6至图9。在其他布置中，系统驱动轴232可通过安装到其上的对应轴承(未示出)可旋转地支撑在移位器安装板242中。在任何情况下，系统驱动轴232的旋转将导致中央驱动齿轮234的旋转。
如在图3中可见，第一驱动系统300包括第一驱动承窝302，第一驱动承窝302可旋转地支撑在形成于主柄部部分30中的远侧壁32中。第一驱动承窝302可包括具有形成于其中的长条承窝的第一主体部分304。第一从动齿轮306形成在第一主体部分304上或不可动地附接到第一主体部分304。第一主体部分304可以可旋转地支撑在设置于远侧壁32中的相应孔或通道中，或其可以可旋转地支撑在安装于远侧壁32中的对应轴承(未示出)中。相似地，第二旋转驱动系统320包括第二驱动承窝322，第二驱动承窝322也可旋转地支撑在主柄部部分30的远侧壁32中。第二驱动承窝322可包括第二主体部分324，第二主体部分324具有形成于其中的长条承窝。第二从动齿轮326形成在第二主体部分324上或不可旋转地安装到第二主体部分324。第二主体部分324可以可旋转地支撑在设置于远侧壁32中的相应孔或通道中，或其可以可旋转地支撑在安装于远侧壁32中的对应轴承(未示出)中。第一驱动承窝302和第二驱动承窝322在柄部轴线HA的每个侧向侧上彼此间隔开。例如参见图4。
如上所指出，在所示的示例中，旋转驱动选择器系统240包括移位器齿轮250。如在图6至图9中可见，移位器齿轮250可旋转地安装在惰轮轴252上，惰轮轴252可动地支撑在移位器安装板242中的弓形狭槽244中。安装移位器齿轮250以遍在惰轮轴252上自由旋转并保持与中央驱动齿轮234啮合接合。惰轮轴252联接到移位器螺线管260的轴262的端部。移位器螺线管260被钉住或以其他方式与主柄部壳体30一起安装，使得当移位器螺线管260被致动时，移位器齿轮250移动成与第一从动齿轮306或第二从动齿轮326中的一者啮合接合。例如，在一种布置中，当螺线管轴262回缩时(图6和图7)，移位器齿轮250与中央驱动齿轮234和第一从动齿轮306啮合接合，使得马达200的致动将导致第一驱动承窝302的旋转。如在图6和图7中可见，可采用移位器弹簧266来将移位器齿轮250偏置到该第一致动位置中。因此，如果外科器械10失去动力，则移位器弹簧266将自动地将移位器齿轮250偏置到第一位置中。当移位器齿轮250处于该位置时，马达200的后续致动将导致第一旋转驱动系统300的第一驱动承窝302的旋转。当移位器螺线管被致动时，移位器齿轮250移动到与第二驱动承窝322上的第二从动齿轮326啮合接合。此后，马达200的致动将导致第二旋转驱动系统320的第二驱动承窝322的致动或旋转。
如下文将进一步详细讨论的，第一旋转驱动系统300和第二旋转驱动系统320可用于为联接到它们的可互换外科工具组件的各种部件部分提供动力。如上所指出，在至少一种布置中，如果在可互换外科工具组件的致动期间马达失去动力，则移位器弹簧266将使移位器齿轮250偏置到第一位置中。根据可互换外科工具组件的哪个部件部分正在被操作，可能需要将旋转驱动运动的应用反向到第一驱动系统300，以使得可互换外科工具组件能够从患者移除。所示的示例的柄部组件20采用能够被手动致动的“应急”系统，通常指定为330，用于例如在上述场景中手动地将旋转驱动运动施加到第一旋转驱动系统300。
现在参见图3、图10和图11，所示的应急系统330包括应急驱动系332，应急驱动系332包括行星齿轮组件334。在至少一种形式中，行星齿轮组件334包括行星齿轮壳体336，行星齿轮壳体336容纳行星齿轮布置(未示出)，行星齿轮布置包括行星锥齿轮338。行星齿轮组件334包括应急驱动轴340，应急驱动轴340可操作地联接到行星齿轮壳体336内的行星齿轮布置。行星锥齿轮338的旋转使行星齿轮布置旋转，该行星齿轮布置最终使应急驱动轴340旋转。应急驱动齿轮342轴颈连接在应急驱动轴340上，使得应急驱动齿轮342可在应急驱动轴340上轴向移动，然而与其一起旋转。应急驱动齿轮342能够在形成于应急驱动轴340上的弹簧止动凸缘344和形成于应急驱动轴340的远侧端部上的轴端部止动件346之间移动。应急轴弹簧348在应急驱动轴340上轴颈连接在应急驱动齿轮342和弹簧止动凸缘344之间。应急轴弹簧348在应急驱动轴340上将应急驱动齿轮342朝远侧偏置。当应急驱动齿轮342处于应急驱动轴340上的最远侧位置时，其与应急从动齿轮350啮合接合，该应急从动齿轮350不可旋转地安装到系统驱动轴232。参见图14。
现在参见图12和图13，应急系统330包括应急致动器组件或应急柄部组件360，其有助于将应急驱动运动手动施加到应急驱动系332。如在这些图中可见，应急柄部组件360包括应急锥齿轮组件362，其包括应急锥齿轮364和棘轮齿轮366。应急柄部组件360还包括应急柄部370，其通过枢转轭372可动地联接到应急锥齿轮组件362，枢转轭372枢转地安装在棘轮齿轮366上。应急柄部370通过销374枢转地联接到枢转托架372，以用于在储存位置“SP”与致动位置“AP”之间进行选择性枢转行进。参见图12。柄部弹簧376用于将应急柄部370偏置到致动位置AP中。在至少一种布置中，例如，表示储存位置的轴线SP和表示致动位置的轴线AP之间的角度可为大约30度。参见图13。如在图13中也可见，应急柄部组件360还包括棘轮棘爪378，棘轮棘爪378可旋转地安装在枢轴轭372中的腔或孔377中。棘轮棘爪378被构造成能够当在致动方向“AD”上旋转时啮合接合棘轮齿轮366，然后当在相反方向上旋转时旋转脱出啮合接合。棘轮弹簧384和球形构件386可动地支撑在枢轴轭372中的腔379中，并用于在应急柄部370被致动(安装棘轮)时锁定地接合棘轮棘爪378中的制动装置380,382。
现在参见图3和图10，应急系统330还包括能够在打开位置和关闭位置之间操控的应急通道面板390。在所示的布置中，应急检修门390被构造成能够可移除地联接到主壳体部分30的壳体节段70。因此，在至少该实施方案中，当应急检修门390从主壳体部分30移除或拆卸时，其被称为处于“打开”位置并且当应急检修门390如图所示附接到主壳体部分30时，其被称为处于“闭合”位置。然而，可设想到其他实施方案，其中检修门可动地联接到主壳体部分，使得当检修门处于打开位置时，其保持附接至该主外壳部分。例如，在此类实施方案中，检修门可枢转地附接到主壳体部分或可滑动地附接到主壳体部分并且能够在打开位置和闭合位置之间操控。在所示的示例中，应急检修门390被构造成能够卡扣地接合壳体节段70的对应部分，以将其可移除地保持在“闭合”位置。也可以使用其他形式的机械紧固件，诸如螺钉、销等。
无论应急检修门390是否可从主壳体部分30拆卸或保持可动地附接到主壳体部分30，应急检修门390均包括驱动系统锁定构件或轭392和应急锁定构件或轭396，它们各自都从其背侧突出或以其他方式形成在其上。驱动系统锁定轭392包括驱动轴凹口394，驱动轴凹口394被构造成能够当应急检修门390安装在主壳体部分30中时在其中接纳系统驱动轴232的一部分(即，应急检修门处于“闭合”位置)。当应急检修门390定位或安装在关闭位置时，驱动系统锁定轭392用于将从动锥齿轮234偏置成与驱动装置锥齿轮230啮合接合(抵抗驱动系统弹簧235的偏置)。此外，应急锁定轭396包括应急驱动轴凹口397，其被构造成能够当应急检修门390安装或定位在闭合位置时在其中接纳应急驱动轴340的一部分。如在图5和图10中可见，应急锁定轭396也用于将应急驱动齿轮342偏置脱出与应急从动齿轮350的啮合接合(抵抗应急轴弹簧348的偏置)。因此，当应急检修门390或应急检修门390处于闭合位置时，应急锁定轭396防止应急驱动齿轮342干扰系统驱动轴232的旋转。另外，应急锁托架396包括柄部凹口398，柄部凹口398用于接合应急柄部370并且将其保持在储存位置SP中。
图4、图5和图10示出了当应急检修门390安装或处于闭合位置时驱动系统部件和应急系统部件的构型。如在这些图中可见，驱动系统锁定构件392将从动锥齿轮234偏置成与驱动装置锥齿轮230啮合接合。因此，当应急检修门390安装或处于闭合位置时，马达200的致动将导致驱动装置锥齿轮230旋转并最终导致系统驱动轴232旋转。另外，当处于该位置时，应急锁定轭396用于将应急驱动齿轮342偏置脱出与系统驱动轴232上的应急从动齿轮350的啮合接合。因此，当应急检修门390安装或处于闭合位置时，驱动系统可由马达200致动，并且应急系统330被断开或防止将任何致动运动施加到系统驱动轴232。为了激活应急系统330，临床医生首先移除应急检修门390或以其他方式将应急检修门390移动到打开位置。该动作移除驱动系统锁定构件392与从动锥齿轮234的接合，从而准许驱动系统弹簧235将从动锥齿轮234偏置脱出与驱动装置锥齿轮230的啮合接合。此外，移除应急检修门390或将应急检修门移动到打开位置也导致应急锁定轭396与应急驱动齿轮342脱离，从而准许应急轴弹簧348将应急驱动齿轮342偏置成与系统驱动轴232上的应急从动齿轮350啮合接合。因此，应急驱动齿轮342的旋转将导致应急从动齿轮350和系统驱动轴232的旋转。移除应急检修门390或以其他方式将应急检修门390移动到打开位置还准许柄部弹簧376将应急柄部370偏置到图11和图14中所示的致动位置。当处于该位置时，临床医生可以在棘轮方向RD上手动安装棘轮于应急柄部370，这导致棘轮锥齿轮364的旋转(例如，在图14中的顺时针方向)，这最终导致通过应急传动系332向系统驱动轴232施加缩回旋转运动。临床医生可多次安装棘轮于应急柄部370，直到系统驱动轴232已经充分旋转多次以回缩附接到柄部组件20的外科工具组件的外科端部执行器部分的部件。一旦应急系统330已经被充分地手动致动，则临床医生然后可更换应急检修门390(即，将应急检修门390返回到闭合位置)，从而促使驱动系统锁定构件392将从动锥齿轮234偏置成与驱动装置锥齿轮230和应急锁定轭396啮合接合，以将应急驱动齿轮342偏置脱出与应急从动齿轮350的啮合接合。如上所讨论，如果失去动力或动力中断，则移位器弹簧266将使移位器螺线管260偏置到第一致动位置中。这样，应急系统330的致动将导致向第一旋转驱动系统300施加反向或回缩运动。
如上所讨论，外科缝合器械可以包括手动致动的应急系统，该系统被构造成能够例如回缩钉击发驱动装置。在许多实例中，应急系统可需要被操作和/或弯曲不止一次以完全回缩钉击发驱动装置。在此类实例中，缝合器械的使用者可能没有把握好已经晃动了多少次应急系统和/或以换句话讲混淆了击发驱动装置还有多少需要被回缩。设想了各种实施方案，其中缝合器械包括系统，该系统被构造成能够检测击发驱动装置的击发构件的位置、确定击发构件需要回缩的距离，并显示距外科器械的使用者的距离。
在至少一个实施方案中，外科缝合器械包括一个或多个传感器，其被构造成能够检测击发构件的位置。在至少一个实例中，传感器例如包括霍尔效应传感器，并且可以定位在缝合器械的轴和/或端部执行器中。传感器与外科缝合器械的控制器进行信号通信，该控制器继而与外科缝合器械上的显示器进行信号通信。该控制器包括微处理器，该微处理器被构造成能够将击发构件的实际位置与基准或参考位置(其包括击发构件的完全回缩位置)进行比较，并计算击发构件的实际位置与参考位置之间的距离，即剩余距离。
除了上述以外，显示器包括例如电子显示器，并且控制器被构造成能够以任何合适的方式在电子显示器上显示剩余距离。在至少一个实例中，控制器在显示器上显示进度条。在此类实例中，例如，空的进度条可以表示击发构件处于其击发行程的结束，并且完整的进度条可以表示击发构件已经完全回缩。在至少一个实例中，例如，0％可以表示击发构件处于其击发行程的结束，并且100％可以表示击发构件已经完全回缩。在某些实例中，控制器被构造成能够显示需要多少次应急机构的致动以将击发构件回缩到其在显示器上的完全回缩位置。
除了上述以外，应急机构的致动可以将外科缝合器械的电池或电源与击发驱动装置的电动马达可操作地断开。在至少一个实施方案中，应急机构的致动翻转开关，该开关将电池与电动马达电分离。此系统将防止电动马达抵抗击发构件的手动回缩。
所示的柄部组件20还支撑第三轴向驱动系统，该第三轴向驱动系统通常指定为400。如在图3和图4中可见，在至少一种形式中，第三轴向驱动系统400包括螺线管402，该螺线管402具有从其突出的第三驱动致动器构件或杆410。第三驱动致动器构件410的远侧端部412具有形成于其中的第三驱动支架或承窝414，用于接纳可操作地附接到其上的可互换外科工具组件的驱动系统部件的对应部分。螺线管402有线连接到柄部电路板组件220和控制系统或CPU 224或以其他方式与柄部电路板组件220和控制系统或CPU 224通信。在至少一种布置中，螺线管402是“弹簧加载的”，使得当螺线管402未致动时，其弹簧部件将第三驱动致动器410偏置回到未致动的起始位置中。
如上所指出，可重新构造的柄部组件20可有利地用于致动各种不同的可互换外科工具组件。为此，柄部组件20包括工具安装部分，该工具安装部分通常指定为500，用于将可互换外科工具组件可操作地联接到柄部组件。在所示的示例中，工具安装部分500包括两个面向内的燕尾接纳狭槽502，其被构造成能够接合可互换外科工具组件的工具附接模块部分的对应部分。每个燕尾接纳狭槽502可为锥形的，或换句话讲，是略微V形的。燕尾接纳狭槽502被构造成能够可释放地接纳对应的锥形附接件或耳状物部分，该锥形附接件或耳状物部分形成在可互换外科工具组件的工具附接喷嘴部分的一部分上。每个可互换外科工具组件还可配备有闩锁系统，该闩锁系统被构造成能够可释放地接合形成在柄部组件20的工具安装部分500中的对应的保持凹坑504。
各种可互换外科工具组件可具有“主”旋转驱动系统，其被构造成能够可操作地联接到第一旋转驱动系统310或与第一旋转驱动系统310交接，以及“辅助”旋转驱动系统，其被构造成能够可操作地联接到第二旋转驱动系统320或与第二旋转驱动系统320交接。主旋转驱动系统和辅助旋转驱动系统可被构造成能够向特定类型的外科端部执行器的部分提供各种旋转运动，外科端部执行器的部分包括可互换外科工具组件的一部分。为了便于将主旋转驱动系统可操作地联接到第一旋转驱动系统并将辅助驱动系统可操作地联接到第二旋转驱动系统320，柄部组件20的工具安装部分500也包括一对插入斜面506，其被配置在联接过程期间朝远侧偏置可互换外科工具组件的主旋转驱动系统和辅助旋转驱动系统的部分，以便于将主旋转驱动系统与柄部组件20上的第一旋转驱动系统300对准和可操作地联接，以及将辅助旋转驱动系统与柄部组件20上的第二旋转驱动系统320对准和可操作地联接。
可互换外科工具组件也可包括“三级”轴向驱动系统，用于将(一个或多个)轴向运动施加到可互换外科工具组件的外科端部执行器的对应部分。为了便于将三级轴向驱动系统可操作地联接到柄部组件20上的第三轴向驱动系统400，第三驱动致动器构件410设置有承窝414，承窝414被构造成能够在其中可操作地接纳三级轴向驱动系统的耳状物或其他部分。
可互换工具组件2000示于图15中。可互换工具组件2000在许多方面类似于可互换工具组件1000，但是在许多方面不同于可互换工具组件1000。例如，可互换组件2000是圆形缝合组件。主要参见图15和图16，圆形缝合组件2000包括轴部分2100和端部执行器2200。例如，轴部分2100包括可释放地附接到柄部组件20的近侧部分。端部执行器2200包括围绕关节运动接头2300可旋转地附接到轴部分2100的第一部分2210。端部执行器2200还包括可释放地附接到第一部分2210的第二部分2220。第二部分2220包括仓2222，该仓2222包括限定于其中的钉腔2224的环形阵列和储存在每个钉腔2224中的钉。第二部分2220还包括砧座2230，砧座2230包括组织压缩表面2232和与钉腔2224对准的一个或多个成形凹坑2234的环形阵列(图27)，钉腔2224被构造成能够当钉从钉腔2224被射出时使钉变形。
除了上述以外，再次参见图15和图16，端部执行器2200的第二部分2220可选择性地附接到端部执行器2200的第一部分2210并且与端部执行器2200的第一部分2210选择性地分离。第二部分2220包括外部壳体2227，外部壳体2227包括近侧连接器2229，近侧连接器2229被构造成能够被接纳在限定于第一部分2210的壳体2217中的孔或室2218内。壳体2227的连接器2229和第一部分2210的壳体2217之间的配合为紧密的。连接器2229和壳体2217之间的压缩配合可防止第二部分2220相对于第一部分2210意外地纵向和/或旋转地移位。在各种实例中，止动构件可用于将第二部分2220可释放地固定到端部执行器2200的第一部分2210。
参见图15和图35-38，端部执行器2200的第二部分2220能够与其他第二部分诸如第二部分2220'、第二部分2220”、第二部分2220”'和/或另一个第二部分2220互换。第二部分2220',2220”和2220”'在许多方面类似于第二部分2220。例如，每个第二部分2220,2220',2220”和2220”'包括限定于其中的中心孔2226。也就是说，第二部分2220',2220”和2220”'在其他方面不同于第二部分2220。例如，第二部分2220'的直径大于第二部分2220。此外，限定在第二部分2220'中的钉腔2224的环形阵列具有比限定在第二部分2220中的钉腔2224的环形阵列更大的圆周。类似地，第二部分2220”具有比第二部分2220'更大的直径，并且限定在第二部分2220”中的钉腔2224的环形阵列具有比限定在第二部分2220'中的钉腔2224的环形阵列更大的圆周。另外，类似地，第二部分2220”具有比第二部分2220'更大的直径，并且限定在第二部分2220”中的钉腔2224的环形阵列具有比限定在第二部分2220'中的钉腔2224的环形阵列更大的圆周。
除了上述以外，例如，砧座2230能够与其他砧座诸如砧座2230'、砧座2230”、砧座2230”'和/或另一个砧座2230互换。砧座2230',2230”和2230”'在许多方面类似于砧座2230。例如，每个砧座2230,2230',2230”和2230”'包括纵向轴2236，纵向轴2236包括连接凸缘2238。也就是说，砧座2230',2230”和2230”'在其他方面不同于砧座2230。例如，砧座2230'的直径大于砧座2230。此外，限定在砧座2230'中的成形凹坑2234的环形阵列具有比限定在砧座2230中的成形凹坑2234的环形阵列更大的圆周，使得成形凹坑2234保持与限定在第二部分2220'中的钉腔2224对准。类似地，砧座2230”的直径大于砧座2230'，并且限定在砧座2230”中的成形凹坑2234的环形阵列具有比限定在砧座2230中的成形凹坑2234的环形阵列更大的圆周，使得成形凹坑2234保持与限定在第二部分2220'中的钉腔2224对准。另外，类似地，砧座2230”'的直径大于砧座2230”，并且限定在第二部分2220”'中的成形凹坑2234的环形阵列具有比限定在砧座2230中的成形凹坑2234的环形阵列更大的圆周，使得成形凹坑2234保持与限定在第二部分2220”'中的钉腔2224对准。
主要参见图17，轴部分2100包括近侧连接器2120和从近侧连接器2120朝远侧延伸的细长轴部分2110。近侧连接器2120包括第一输入部2318和第二输入部2418。第一输入部2318可操作地连接到端部执行器关节运动系统，并且第二输入部2418可操作地连接到端部执行器夹紧和钉击发系统。第一输入部2318和第二输入部2418可以任何合适的顺序操作。例如，第一输入部2318可在第一方向上旋转，以使端部执行器2200在第一方向上进行关节运动，并且对应地在第二方向上旋转以使端部执行器2200在第二方向上进行关节运动。一旦端部执行器2200已经适当地进行关节运动，第二输入部2428然后可旋转以闭合砧座2230并且抵靠端部执行器2200的仓部分2222夹紧组织。如下文更详细地讨论，第二输入部2428然后可操作以从钉腔2224击发钉并且切割捕获在端部执行器2200内的组织。在各种另选的实施方案中，第一输入部2318和第二输入部2328可以任何合适的顺序和/或同时操作。
第一输入部2318安装到关节运动轴2310的近侧端部，关节运动轴2310可旋转地安装在轴部分2010中。主要参见图20和图21，可旋转的关节运动轴2310包括远侧端部和安装到远侧端部的蜗轮2312。蜗轮2312与关节运动滑动件2320螺纹接合。更具体地，关节运动滑动件2320包括限定于其中的螺纹孔2322，并且蜗轮2312与螺纹孔2322螺纹配合。当关节运动轴2310在第一方向上旋转时，蜗轮2312朝远侧推动关节运动滑动件2320(图32)。当关节运动轴2310在第二方向或相反方向上旋转时，蜗轮2312朝近侧拉动关节运动滑动件2320(图31)。关节运动滑动件2320通过固定地安装在细长轴部分2110的远侧端部中的关节运动块2112被可滑动地支撑。通过限定在关节运动块2112中的引导狭槽2315，关节运动滑动件2320的移动限于通过关节运动块2112的近侧和远侧移动。关节运动滑动件2320还包括从其延伸的纵向键2326，纵向键2326被紧密地接纳在限定于引导狭槽2315的底部中的纵向键槽2116中，这将关节运动滑动件2320和关节运动块2112之间的相对移动限制到纵向路径。
再次参见图20、图21和图24，关节运动滑动件2320联接到关节运动连接件2330。关节运动滑动件2320包括从其延伸的驱动销2324，驱动销2324定位在限定于关节运动连接件2330中的近侧孔2334内。驱动销2324被紧密地接纳在孔2334内，使得驱动销2324和孔2334的侧壁协同操作以限定关节运动滑动件2320和关节运动连接件2330之间的旋转轴线。关节运动连接件2330也联接到端部执行器2200的壳体2217。更具体地，关节运动连接件2330还包括限定在其中的远侧孔2335，并且壳体2217包括定位在远侧孔2335中的销2215。销2215被紧密地接纳在孔2335内，使得销2215和孔2335的侧壁协同操作以限定关节运动连接件2330和壳体2217之间的旋转轴线。
除了上述以外，参见图18-21和图24，端部执行器2200围绕关节运动接头2300可旋转地联接到轴2100的关节运动块2112。端部执行器2200的壳体2217包括限定在其相对侧中的孔2213，并且关节运动块2112包括从其相对侧延伸的突起部2113，突起部2113定位在孔2213中。突起部2113被紧密地接纳在孔2213内，使得突起部2113和孔2213的侧壁协同操作以限定端部执行器2200可围绕其进行关节运动的关节运动轴线。当关节运动轴2310旋转以朝远侧驱动关节运动滑动件2320时，关节运动滑动件2320朝远侧驱动关节运动连接件2330的近侧端部。响应于关节运动连接件2330的近侧端部的远侧运动，关节运动连接件2330围绕驱动销2324旋转，驱动销2324使端部执行器2200围绕关节运动接头2300旋转。当关节运动输入部2310旋转以朝近侧驱动关节运动滑动件2320时，类似于上述内容，关节运动滑动件2320朝近侧拉动关节运动连接件2330的近侧端部。响应于关节运动连接件2330的近侧端部的近侧运动，关节运动连接件2330围绕驱动销2324旋转，驱动销2324使端部执行器2200围绕关节运动接头2300旋转。关节运动连接件2330在关节运动滑动件2320和壳体2217之间提供至少一个自由度。因此，关节运动连接件2330允许端部执行器2200通过宽范围的关节运动角度进行关节运动。
如上所述，参见图17和图25，可互换工具组件2000的近侧连接器2120包括第二输入部2418。第二输入部2418包括驱动齿轮2417，驱动齿轮2417与安装在驱动轴2410的近侧端部上的驱动齿轮2416啮合接合。如图19所示，驱动轴2410延伸穿过轴部分2110和限定在关节运动块2112中的孔2114。孔2114包括轴承并且可旋转地支撑驱动轴2410。另选地，孔2114可包括间隙孔。在任一种情况下，主要参见图22，驱动轴2410延伸穿过关节运动接头2300并且进入限定在端部执行器壳体2217中的室2218中。驱动轴2410通过安装到驱动轴2410的轴承2414被可旋转地支撑，轴承2414被捕获在限定于端部执行器2200的壳体2217中的凹陷部2214内。驱动轴2410还包括安装到其远侧端部的输出齿轮2412，使得驱动轴2410的旋转被传输到输出齿轮2412。
主要参见图18、图22和图23，驱动轴2410的输出齿轮2412与传输装置2420操作地接合。如下文更详细地讨论，传输装置2420被构造成能够在第一操作模式和第二操作模式之间使端部执行器2200转变，在第一操作模式中，驱动轴2410使砧座2230相对于仓体2222移动，在第二操作模式中，驱动轴2410从钉腔2224中击发钉，并且切割捕获在砧座2230和仓体2222之间的组织。传输装置2420包括轨道驱动装置，该轨道驱动装置包括行星板2421和可旋转地安装到行星板2421的四个行星齿轮2424。行星板2421包括延伸穿过其中心的间隙孔，并且驱动轴2410延伸穿过间隙孔。行星板2421和行星齿轮2424定位在限定于端部执行器壳体2217中的室2219中。每个行星齿轮2424可围绕从行星板2421延伸的齿轮销2423旋转。齿轮销2423沿围绕间隙孔的圆周定位。输出齿轮2412与行星齿轮2424啮合地接合，并且如下文更详细地描述，驱动轴2410驱动行星齿轮2424。
除了上述以外，驱动轴2410延伸穿过关节运动接头2300。为了使输出齿轮2412在端部执行器2200进行关节运动时保持与行星齿轮2424正确地接合，驱动轴2410是柔性的。在至少一个实例中，例如，驱动轴2410由塑料构成。
如上所述，传输装置2420包括第一操作模式和第二操作模式。主要参见图23和图28，可互换工具组件2000还包括能够在第一位置和第二位置之间运动的移位器2600，以在其第一操作模式与其第二操作模式之间切换传输装置2420。当移位器2600处于其第一位置时，如图28至图30所示，移位器2600不与传输装置2420的行星板2421接合，并且因此，行星板2421和行星齿轮2424通过驱动轴2410旋转。更具体地，驱动轴2410使行星齿轮2424围绕其各自的齿轮销2423旋转，并且行星齿轮2424由于行星齿轮2424和围绕行星齿轮2424延伸的环形齿环2534之间的反作用力而旋转行星板2421，如下文进一步更详细地描述。行星板2421与输出联接器2430可操作地联接，使得行星板2421的旋转被传输到输出联接器2430。主要参见图23，输出联接器2430包括围绕其外周边延伸的孔阵列2433，其中从行星板2421延伸的齿轮销2423延伸到输出联接器2430中限定的孔2433中并且被孔2433紧密地接纳，使得在行星板2421和输出联接器2430之间几乎没有相对运动(如果有的话)。
主要参见图18和图23，输出联接器2430包括驱动承窝2432。驱动承窝2432包括例如基本上六边形的孔；然而，可利用任何合适的构型。驱动承窝2432被构造成能够接纳延伸穿过端部执行器2200的第二部分2220的闭合轴2440。闭合轴2440包括近侧驱动端部2442，近侧驱动端2442具有被紧密地接纳在驱动承窝2432内的基本上六边形的形状，使得驱动轴2410的旋转能够传递至闭合轴2440。闭合轴2440通过轴承2444被可旋转地支撑在第二部分2220的壳体2227内。轴承2444包括例如推力轴承；然而，轴承2444可包括任何合适的轴承。
主要参见图23和图28-30，闭合轴2440包括螺纹部分2446，螺纹部分2446与限定在套管针2450中的螺纹孔2456螺纹接合。如下文更详细地讨论，砧座2230可附接到套管针2450，套管针2450可被转换成朝向和/或远离仓体2222移动砧座2230。再次参见图18，套管针2450包括限定于其中的至少一个纵向键槽2459，纵向键槽2459被构造成能够与从驱动套筒2540的内表面2546延伸的至少一个纵向键协同操作。驱动套筒2540是下文进一步讨论的钉击发系统的一部分，并且读者应当理解，套管针2450和驱动套筒2540一个相对于彼此滑动，并且两个协同操作地抑制两者之间的相对旋转移动。由于闭合轴2440与套管针2450之间的螺纹接合，当闭合轴2440在第一方向上旋转时，闭合轴2440可朝远侧移位或平移套管针2450，并且相应地，当闭合轴2440在第二方向或相反方向上旋转时，闭合轴2440可朝近侧移位或平移套管针2450。
如上所述，砧座2230可附接到套管针2450。砧座2230包括连接凸缘2238，连接凸缘2238被构造成能够接合和抓持套管针2450。连接凸缘2238包括连接到砧座2230的轴部分2236的悬臂梁。主要参见图23，套管针2450包括保持凹口或凹陷部2458，凹口或凹陷部2458被构造成能够当砧座2230组装到套管针2450时可释放地接纳连接凸缘2238。保持凹口2458和连接凸缘2238被构造成能够抵抗砧座2230与套管针2450无意分离。连接凸缘2238通过纵向狭槽2237隔开。纵向狭槽2237被构造成能够当砧座2230组装到套管针2450时接纳从套管针2450延伸的纵向肋2457。肋2457被紧密地接纳在狭槽2237内，并且因此，抑制砧座2230相对于套管针2450旋转。
一旦砧座2230已相对于仓体2222适当地定位，如上所讨论，工具组件2000可移位到其第二操作模式中。例如，移位器2600包括用于使端部执行器2200的传输装置2420移位的电致动马达。在各种其他实施方案中，移位器2600可包括电动和/或手动致动的任何合适的装置。移位器2600与外科缝合器械的处理器信号通信并且与外科缝合器械的电池电力通信。在各种实例中，绝缘电线例如在移位器2600和外科器械的柄部之间延伸，使得处理器可与移位器2600通信，并且电池可向移位器2600供应电力。在各种其他实例中，移位器2600可包括无线信号接收器并且处理器可与移位器2600无线通信。在某些实例中，例如，诸如通过电感电路，可向移位器2600无线地供电。在各种实例中，移位器2600可包括其自身的电源。
移位器2600包括安装在限定于端部执行器2200的近侧端部中的室2218中的壳体。移位器2600包括离合器键或切换装置2602和输出轴2604，输出轴2604能够相对于移位器壳体在第一位置和第二位置之间移动。离合器键2602包括第一锁定齿2608和第二锁定齿2609，并且当离合器键2602处于其第一位置时，第一锁定齿2608与钉击发系统的击发管2530接合，并且同时，第二锁定齿2609与传输装置2420的行星板2421脱离接合。更具体地，第一锁定齿2608定位在孔2538中，孔2538是围绕击发管2530限定的孔2538的环形阵列的一部分，并且第二锁定齿2609未定位在孔2429中，孔2429是围绕行星板2421限定的孔2429的环形阵列的一部分。由于上述内容，移位器2600防止击发管2530旋转，并且因此在离合器键2602处于其第一位置时锁定钉击发系统。虽然当离合器键2602处于其第一位置时，钉击发系统已被移位器2600锁定，但是驱动轴2410可旋转行星板2421并且操作砧座闭合系统，如上所述。
如图23中主要示出的，击发管2530包括限定在其内侧壁2532中的齿2534的内环形齿条。行星齿轮2424与齿条2534可操作地互相啮合。当移位器2600处于其第一位置时，如图28所示，击发管2530通过移位器2600保持在适当位置，并且行星齿轮2424能够通过驱动轴2410相对于击发管2530和齿条2534旋转。在此类实例中，行星齿轮2424围绕由驱动轴2410限定的纵向驱动轴线旋转，并且同时围绕由他们相应的齿轮销2423限定的轴线旋转。读者应当理解，行星齿轮2424由驱动轴2410直接驱动，并且由于行星齿轮2424与击发管2530之间产生的反作用力，行星齿轮2424驱动并且旋转行星板2421。当致动移位器2600以将离合器键2602移动到其第二位置时，第一锁定齿2608与击发管2530脱离接合，并且同时，第二锁定齿2609与行星板2421接合。当离合器键2602处于其第二位置时，行星板2421通过移位器2600保持在适当位置，并且因此闭合驱动装置已经锁定并且不能操作以移动砧座2230。当驱动轴2410在此类实例中旋转时，输出齿轮2412驱动行星齿轮2424并且使行星齿轮2424相对于行星板2421围绕其相应的齿轮销2423旋转。行星齿轮2424经由齿条2534驱动击发管2530并且围绕其纵向轴线旋转击发管2530。
除了上述以外，并且再次参见图23，击发管2530与钉击发系统的驱动套筒2540可操作地联接。更具体地，击发管2530的内侧壁2532包括限定于其中的纵向狭槽2535，纵向狭槽2535被构造成能够紧密地接纳限定在驱动套筒2540上的纵向肋2545，使得驱动套筒2540与击发管2530一起旋转。驱动套筒2540还包括螺纹远侧端部2542，螺纹远侧端部2542与驱动套环2550螺纹接合。更具体地，驱动套环2550包括螺纹孔2552，螺纹孔2552与螺纹远侧端部2542螺纹接合。例如，驱动套环2550定位在限定于端部执行器2200的壳体中的孔2228中，并且通过纵向肋和凹槽布置防止驱动套环2550在孔2228内旋转。由于上述内容，驱动套筒2540的旋转使驱动套环2550纵向平移。例如，如果驱动套筒2540在第一方向上旋转，则将驱动套环2550朝远侧推进，并且如果驱动套筒2540在第二方向或相反方向上旋转，则将驱动套环2550朝近侧回缩。
当驱动套环2550被朝远侧推动时，如上文所述，驱动套环2550例如在钉击发系统的击发行程期间朝远侧推动钉驱动装置块2560和切割构件2570诸如刀。更具体地，驱动套环2550在近侧未击发位置和远侧击发位置之间推动钉驱动装置块2560和切割构件2570，在该近侧未击发位置中，钉定位在限定于仓体部分2222中的钉腔2224中，并且切割构件2570在仓体部分2222的平台表面下方凹陷，在远侧击发位置中，钉已经相对于砧座2230变形，并且在砧座2230和仓体部分2222之间捕获的组织已经被切割构件2570横切。驱动套环2550包括驱动凹陷部2554，驱动凹陷部2554被构造成能够当驱动套环2550被朝远侧推进时邻接钉驱动装置块2560和切割构件2570。钉驱动装置块2560包括限定在其中的多个钉支架，其中每个钉支架被构造成能够支撑钉的基部。钉支架与限定在仓体部分2222中的钉腔2224对齐并且被布置成至少两个同心行。
钉驱动装置块2560和切割构件2570附接到驱动套环2550，使得当驱动套环2550从砧座2230朝近侧移动时，通过驱动套环2550朝近侧拉动钉驱动装置块2560和切割构件2570。在至少一个实例中，钉驱动装置块2560和切割构件2570包括延伸到限定在驱动套环2550中的孔2557中的一个或多个钩。在各种实例中，钉驱动装置块2560和切割构件2570可回缩，使得他们在仓体部分2222的平台表面下方完全回缩。
除了上述以外，端部执行器2200在第三操作模式下操作，其中移位器2600的离合器键2602同时与砧座闭合系统和钉击发系统可操作地接合。在该操作模式中，第一锁定齿2608与钉击发系统的击发管2530接合，并且第二锁定齿2609与传输装置2420的行星板2421接合。在此类实例中，第一锁定齿2608定位在限定于击发管2530中的孔2538中，并且第二锁定齿2609定位在限定于行星板2421中的孔2429中。由于上述内容，驱动轴2410同时使砧座2230、钉驱动装置块2560和切割构件2570相对于仓体2222移动。
再次参见图15，可互换工具组件2000的用户可从第二部分2220,2220',2220”,2220”'和/或任何其他合适的第二部分的套件中进行选择，并且将选择的第二部分组装到端部执行器2200的第一部分2210。主要参见图18，每个第二部分包括壳体连接器2229，当第二部分组装到第一部分2210时，壳体连接器2229接合第一部分2210的壳体2217。另外，每个第二部分包括闭合轴2440，当第二部分组装到第一部分2210时，闭合轴2440操作地接合第一部分2210的驱动承窝2432。此外，每个第二部分包括驱动套筒2540，当第二部分组装到第一部分2210时，驱动套筒2540操作地接合第一部分2210的击发管2530。
除了上述以外，参见图35和图36，工具组件2000'能够与工具组件2000互换。柄部组件2000'在许多方面类似于工具组件2000；然而，工具组件2000'被构造成能够施加具有比工具组件2000所施加的圆形钉线更大的直径的圆形钉线。除了其他方面，工具组件2000'包括较宽的第二部分2220'、钉驱动装置2560'、刀组件2570'、仓体2222'和砧座2230'。参见图37，工具组件2000”能够与工具组件2000互换。工具组件2000”在许多方面类似于工具组件2000和2000'；然而，工具组件2000”被构造成能够施加具有比工具组件2000'所施加的圆形钉线更大的直径的圆形钉线。除了其他方面，工具组件2000”包括较宽的第二部分2220”、钉驱动装置2560”、刀组件2570”、仓体2222”和砧座2230”。参见图38，工具组件2000”'能够与工具组件2000互换。工具组件2000”'在许多方面类似于工具组件2000,2000'和2000”；然而，工具组件2000”'被构造成能够施加具有比工具组件2000”所施加的圆形钉线更大的直径的圆形钉线。除了其他方面，工具组件2000”'包括较宽的第二部分2220”'、钉驱动装置2560”'、刀组件2570”'、仓体2222”'和砧座2230”'。
在各种实施方案中，除了上述以外，外科器械可具有任何合适数量的操作模式。在至少一个实施方案中，外科缝合器械包括传输装置，该传输装置包括第一操作模式、第二操作模式和第三操作模式，所述第一操作模式击发钉，所述第二操作模式部署切割构件，所述第三操作模式同时击发钉并且部署切割构件。在第一操作模式中，未部署切割构件。此外，此类外科器械的处理器可被编程为使得器械在没有首先完成第一操作模式的情况下不能置于第二操作模式中。由于上述内容，外科器械的用户可决定在已经击发钉之后是否切割组织。
图34中示出了与外科缝合器一起使用的钉仓体的另选的实施方案。仓体2222'包括钉腔2224的环形外排和钉腔2224'的环形内排。钉腔2224限定在仓体平台的第一阶中，并且钉腔2224'限定在仓体平台的第二阶中。第二阶在第一阶上方延伸。换句话讲，第一阶具有第一平台高度，并且第二阶具有高于第一平台高度的第二平台高度。平台壁将第一阶和第二阶隔开。在各种实施方案中，平台壁是倾斜的。在某些实施方案中，平台壁正交于第一阶和/或第二阶。
仓体2222'还包括从平台的第一阶延伸的腔延伸部2229'。腔延伸部2229'环绕钉腔2224的端部并且在第一阶上方延伸钉腔2224。当钉从钉腔2224射出时，腔延伸部2229'可至少部分地控制第一阶上方的钉。腔延伸部2229'也被构造成能够接触并压缩抵靠仓体2222'捕获的组织。腔延伸部2229'还可控制组织相对于仓体2222'的流动。例如，腔延伸部2229'可限制组织的径向流动。腔延伸部2229'可具有任何合适的构型并且可从第一阶延伸任何合适的高度。在至少一个实例中，例如，腔延伸部2229'的顶部表面与第二阶对准或具有与第二阶相同的高度。在其他实例中，腔延伸部2229'可在第二阶上方或下方延伸。
除了上述以外，钉腔2224各自包括定位在其中的第一钉，该第一钉具有第一未成形高度。钉腔2224'各自包括定位在其中的第二钉，该第二钉具有不同于第一未成形高度的第二未成形高度。例如，第一未成形高度高于第二未成形高度；然而，第二未成形高度可高于第一未成形高度。在另选的实施方案中，第一未成形钉高度和第二未成形钉高度相同。
第一钉变形至第一变形高度，并且第二钉变形至不同于第一变形高度的第二变形高度。例如，第一变形高度高于第二变形高度。此类布置可改善进入缝合组织的血流。另选地，第二变形高度可高于第一变形高度。此类布置可改善沿着内横切线的组织的柔韧性。在某些另选的实施方案中，第一变形高度和第二变形高度相同。
如上所述，除了其他方面，可互换工具组件可包括轴、端部执行器和可替换钉仓。可替换钉仓包括闭合驱动装置和击发驱动装置，该闭合驱动装置被构造成能够移动打开并闭合端部执行器以捕获端部执行器内的组织，该击发驱动装置被构造成能够缝合并切割在端部执行器内捕获的组织。当可替换钉仓组装到轴时，端部执行器的闭合驱动装置和击发驱动装置与轴的对应的闭合驱动装置和击发驱动装置可操作地联接。在可替换钉仓未正确地组装到轴的情况下，可替换钉仓可不以其预期的方式操作。如下面将更详细地描述的，可替换钉仓和/或轴可包括闭锁件，该闭锁件防止可替换钉仓操作，除非可替换钉仓正确地附接到轴。
现在转到图39，可互换工具组件3000包括轴3010和可替换钉仓3020。类似于上述内容，可替换钉仓3020包括闭合驱动装置输入部和击发驱动装置输入部，该闭合驱动装置输入部和击发驱动装置输入部在钉仓3020完全座置到轴3010上时与闭合驱动输出部和击发驱动装置输出部可操作地联接。为简洁起见，本文不再重复此类闭合和击发系统的操作。
可互换工具组件3000还包括锁定电路3090。锁定电路3090包括导体3096和接触件3092。第一接触件3092电联接到第一导体3096，并且第二接触件3092电联接到第二导体3096。在钉仓3020完全座置到轴3010上之前，第一接触件3092未电联接到第二接触件3092。钉仓3020包括接触桥3094，当钉仓3020完全座置到轴3010上时，接触桥3094接合并且电联接接触件3092。接触件3092和接触桥3094被构造并布置成使得当钉仓3020仅部分地座置到轴3010上时接触桥3094未电联接接触件3092。
可互换工具组件3000可与外科器械系统一起使用，该外科器械系统包括例如可手动操作的柄部和/或机器人系统。在各种实施方案中，外科器械系统包括被构造成能够驱动工具组件3000的钉击发系统的电动马达，以及另外的被构造成能够操作电动马达的控制器。工具组件3000的锁定电路与控制器通信。当控制器检测到接触桥3094未与接触件3092接合或者锁定电路处于打开状态时，控制器防止电动马达操作钉击发系统。在各种实例中，控制器被构造成能够使得当锁定电路处于打开状态时，其不向电动马达供应电力。在某些其他实例中，控制器被构造成能够向电动马达供应电力，使得当锁定电路处于打开状态时，其可操作闭合系统但不可操作击发系统。在至少一个此类实例中，控制器操作联接到电动马达的传输装置，使得电动马达的输出仅指向闭合系统。当控制器检测到接触桥3094与接触件3092接合或者锁定电路处于闭合状态时，控制器允许电动马达操作钉击发系统。
当外科器械系统包括柄部时，除了上述以外，当控制器检测到锁定电路处于打开构型时，控制器致动触发锁，该触发锁防止柄部的击发触发器被致动。当钉仓3020完全座置到轴3010上并且锁定电路闭合时，控制器可回缩触发锁并且允许击发触发器被致动。此类系统可与机动化和/或非机动化的击发驱动装置一起使用。例如，非机动化的击发驱动装置可由手动曲柄驱动。
如上所述，砧座2230可组装到工具组件2000的闭合驱动装置的套管针轴2450。砧座2230的连接凸缘2238被构造成能够接合限定在套管针轴2450中的凹陷部2458以将砧座2230连接到其上。一旦砧座2230已组装到套管针轴2450，套管针轴2450和砧座2230可通过闭合驱动装置朝向钉仓2222被回缩或拉动，以抵靠钉仓2222压缩组织。然而，在一些实例中，砧座2230可未正确地组装到套管针轴2450。当临床医生试图将砧座2230组装到套管针轴2450时，当套管针轴2450在钉仓2222的平台上方未充分地延伸时，可经常发生砧座2230与套管针轴2450的错误组装。通常，在此类实例中，砧座2230充分地附接到套管针轴2450，使得套管针轴2450可使砧座2230朝向钉仓2222移动，但是当砧座2230开始抵靠钉仓2222压缩组织时，砧座2230可从套管针轴2450分离。
现在转到图39和图40，示出了在许多方面类似于上文讨论的可互换工具组件2000的可互换工具组件3100。工具组件2000包括仓体3120，仓体3120包括平台3121，平台3121被构造成能够在组织通过砧座2130受压而贴靠仓体3120时支撑组织。工具组件3100还包括被构造成能够使砧座2130相对于仓体3120移动的闭合驱动装置。闭合驱动装置包括套管针轴3150，套管针轴3150与上文相似地包括限定于其中的凹陷部。凹陷部包括远侧肩部3158，远侧肩部3158被构造成能够将砧座2130保持到套管针轴3150。另外，工具组件3100还包括被构造成能够从仓体3120射出钉的击发驱动装置。击发驱动装置包括可旋转轴3162和可平移套环3160，可平移套环3160与可旋转轴3162螺纹接合，可旋转轴3162被构造成能够从仓体3120射出钉。可旋转轴3162包括限定于其中的纵向孔3164，并且套管针轴3150延伸穿过孔3164。
除了上述以外，闭合驱动装置还包括安装到套管针轴3150的夹具3190。夹具3190包括安装在限定于套管针轴3150中的狭槽内的基部3192。夹具3190还包括从基部3192延伸的柔顺臂或附属物3198。臂3198能够在延伸位置(图39)和挠曲位置(图40)之间移动(图40)。当臂3198处于其挠曲位置时，如图40所示，砧座2130可锁定到套管针轴3150。如图40所示，当套管针轴3150在仓体3120的平台3121上方已经充分地延伸时，臂3198通过击发驱动装置的可平移套环3160保持在其挠曲位置。可平移套环3160包括环形肩部3168，环形肩部3168被构造成能够当臂3198与肩部3168接触时向内弹性地偏置臂3198。
当套管针轴3150在仓平台3121上方未处于足够延伸的位置时，臂3198不被肩部3168向内偏置。在此类实例中，如图39所示，臂3198处于其延伸位置。当臂3198处于其延伸位置时，臂3198防止砧座2130附接到套管针轴3150。更具体地，臂3198防止砧座2130的连接凸缘2138座置到限定在套管针轴3150中的肩部3158后面。在此类实例中，臂3198防止砧座2130部分地附接到套管针轴3150，并且因此，试图将砧座2130组装到套管针轴3150的临床医生不能部分地将砧座2130组装到套管针轴3150，并且可避免上文讨论的问题。读者应该理解，砧座2130通常在原位或在患者体内组装到套管针轴3150，并且砧座2130适当地组装到套管针轴3150加速了所使用的外科技术的完成。上述系统提供了闭锁件，该闭锁件防止部分组装的砧座受压而贴靠组织。
现在转到图41-43，可互换工具组件3200包括被构造成能够在没有附接到其上的砧座的情况下防止闭合驱动装置回缩，如下文更详细地讨论。工具组件3200包括轴3210和端部执行器3220。端部执行器3220包括外部壳体3227、仓体3222和限定于其中的纵向孔3226。工具组件3200还包括闭合驱动装置，该闭合驱动装置包括套管针轴3250和可附接到套管针轴3250的砧座3230。类似于上述内容，闭合驱动装置被构造成能够朝向和远离仓体3222移动砧座3230。套管针轴3250能够在延伸位置和回缩位置之间移动。图42和图43都示出了处于其延伸位置的套管针轴3250。
除了上述以外，工具组件3200还包括回缩锁3290，回缩锁3290被构造成能够当砧座3230未组装到套管针轴3250时防止套管针轴3250从其伸出位置(图42和图43)朝向其回缩位置移动。回缩锁3290包括围绕突起部或销3294可旋转地安装到壳体3227的锁定臂3292。回缩锁3290还包括与锁定臂3292接合的弹簧3296，该弹簧被构造成能够将锁定臂3292朝向套管针轴3250偏置。套管针轴3250包括锁定肩部3258，并且如图42所示，当砧座3230未组装到套管针轴3250时，锁定臂3292被构造成能够扣住锁定肩部3258并且防止套管针轴3250朝近侧移动。更具体地，锁定臂3292包括被构造成能够在锁定肩部3258下滑动的扣件3298。如图43所示，当砧座3230组装到套管针轴3250时，砧座3230接触锁定臂3292，并且使锁定臂3292远离锁定肩部3258移位。在这一点上，套管针轴3250已经解锁并且可朝向仓体3222移动到其回缩位置。
现在转到图44-46，可互换工具组件3300包括闭合驱动装置、钉击发驱动装置和闭锁件，该闭锁件被构造成能够防止钉击发驱动装置操作，直到闭合驱动装置的砧座已经被设定成适当的组织间隙，如下文更详细地讨论。工具组件3300包括轴3310和端部执行器3320。端部执行器3320包括内部框架3329、外部壳体3327和仓体3322。类似于上述内容，闭合驱动装置包括套管针轴3350和可附接到套管针轴3350的砧座2230。同样类似于上述内容，套管针轴3350能够在延伸位置(图45)和回缩位置(图46)之间移动，以朝向和远离仓体3322移动砧座2230。击发驱动装置包括可旋转轴3360，可旋转轴3360被构造成能够朝远侧移位击发驱动装置，以射出储存在仓体3322中的钉。
除了上述以外，端部执行器3320包括可移动地安装到内部框架3329的击发驱动锁3390。击发驱动锁3390包括锁销3394和定位在锁销3394周围的锁定弹簧3398。锁销3394包括头部3392和止动件3396。锁定弹簧3398定位在止动件3396和限定于内部框架3329中的腔3328的侧壁中间。当套管针轴3350处于延伸位置时，如图45所示，锁定弹簧3398将锁销3394偏置到限定于钉击发驱动装置的可旋转轴3360中的锁孔3364中。在此类实例中，锁销3394与锁孔3364的侧壁之间的相互作用防止轴3360旋转以从仓体3322击发钉。当套管针轴3350充分回缩时，套管针轴3350接合锁销3394的头部3392。头部3392包括其上限定的凸轮表面，该凸轮表面被构造成能够由套管针轴3350接合，以使击发驱动锁3390在锁定构型(图45)和解锁构型(图46)之间移动。当驱动锁3390处于其解锁构型时，击发驱动装置的轴3360可旋转。
工具组件3300的击发驱动闭锁件要求砧座2230在钉可被击发之前移动到预定位置或在预定位置的范围内移动。此外，工具组件3300的击发驱动闭锁件要求砧座2230和仓体3322之间的组织间隙在钉可被击发之前小于一定距离。因此，砧座2230和/或闭合系统的位置停用钉击发闭锁件。此类布置可有助于防止钉的变形和/或组织的未压缩等等。
现在转到图47-49，可互换工具组件3400包括被构造成能够夹紧组织的闭合驱动装置、钉击发驱动装置和击发驱动闭锁件3490，击发驱动闭锁件3490被构造成能够防止钉击发驱动装置在闭合驱动装置对组织施加足够的夹紧压力之前操作。闭合驱动装置包括套管针轴3450和砧座诸如例如附接到套管针轴3450的砧座2230。类似于上述内容，套管针轴3450能够从延伸位置(图48)移动到回缩位置(图49)以抵靠工具组件3400的仓体压缩组织。击发驱动装置包括可旋转轴3460，可旋转轴3460被构造成能够使钉驱动装置朝远侧移位并且从仓体射出钉。
击发驱动闭锁件3490定位在闭合驱动装置的套管针轴3450和击发驱动装置的可旋转轴3460中间。击发驱动闭锁件3490包括远侧板3492、近侧板3494和定位在远侧板3492和近侧板3494中间的弹簧3493。击发驱动闭锁件3490还包括锁销3498，锁销3498能够在锁定构型(图48)和解锁构型(图49)之间移动，在该锁定构型中，锁销3498与轴3460接合，在该解锁构型中，锁销3498与轴3460脱离接合。锁销3498定位在限定于远侧板3492和近侧板3494之间的销室3496中。更具体地，锁销3498包括定位在限定于远侧板3492上的凸轮3495与限定于近侧板3494上的凸轮3495中间的斜面头部。当套管针轴3450朝近侧回缩时，套管针轴3450朝近侧推动远侧板3492，并且限定在远侧板3492上的凸轮3495接合锁销3498的头部。在此类实例中，如图49所示，与限定在近侧板3494上的凸轮3495协同操作的限定在远侧板3492上的凸轮3495将锁销3498转变到其解锁构型中。
如上所述，当远侧板3492通过套管针轴3450朝向近侧板3494移动时，击发驱动闭锁件3490的凸轮3495挤压锁销3498的头部。更具体地，凸轮3495向内驱动锁销3498并且驱动锁销3498而与可旋转轴3460脱离接合。当锁销3498处于其锁定构型时，锁销3498定位在限定于轴3460中的锁孔3468中，由于锁销3498与锁孔3468的侧壁之间的相互作用，锁销3498防止轴3460旋转。因此，通过击发驱动装置不能从仓体击发钉。当锁销3498移动到其解锁构型时，如上所述，锁销3498移出锁孔，并且轴3460可通过击发驱动装置旋转以从仓体击发钉。在各种实施方案中，轴3460可包括限定在轴3460中的锁孔3468的圆周阵列，锁孔3468中的每一个被构造成能够接纳锁销3498并且锁定击发驱动装置。再次参见图49-51，击发驱动闭锁件3490还包括被构造成能够将锁销3498偏置到锁孔3468中的偏置构件。
除了上述以外，击发驱动闭锁件3490的弹簧3493被构造成能够抵抗套管针轴3450的近侧移动。弹簧3493为线性线圈弹簧；然而，可使用任何合适的弹簧。此外，可使用多于一个的弹簧。在任何情况下，弹簧3493或弹簧系统具有在套管针轴3450回缩时向击发驱动闭锁件3490的远侧板3492施加弹簧力的刚度。换句话讲，由弹簧3493施加到远侧板3492的力与套管针轴3450朝近侧移位的距离成比例地增加。由弹簧3493产生的弹簧力抵抗砧座2230施加到组织的夹紧力。因此，夹紧力必须克服弹簧3493所产生的一定或预定的弹簧力，以便充分地移位远侧板3492并且解锁击发驱动装置。在此类实例中，在击发驱动锁定装置3490可停用并且钉击发动驱动装置可致动之前，组织夹紧力必须满足预定阈值。
如结合本文所公开的各种实施方案所讨论的，钉击发驱动装置抵靠砧座驱动钉以使钉变形至期望的成形高度。在各种实例中，钉击发驱动装置还被构造成能够将切割构件诸如刀例如朝远侧推动以切割捕获在仓体和砧座之间的组织。在此类实例中，刀暴露在仓体的平台上方。也就是说，当砧座处于其闭合的或夹紧的位置时，砧座定位成与仓体处于接近关系，并且即使刀暴露在仓体上方，刀大部分也被仓体覆盖。如果在刀回缩到仓体的平台下方之前砧座移动到其打开位置和/或从闭合驱动装置拆卸，则刀将未被覆盖并暴露。图52-54示出了工具组件3500，工具组件3500包括闭锁件3590，闭锁件3590被构造成能够在刀暴露在仓平台上方时防止砧座移动到其打开位置。
工具组件3500包括闭合驱动装置和击发驱动装置。闭合驱动装置包括套管针轴3550和可释放地附接到套管针轴3550的砧座3530。类似于上述内容，套管针轴3550能够通过与套管针轴3550螺纹接合的可旋转闭合轴2440朝近侧和朝远侧平移。击发驱动装置包括可旋转轴3562和与可旋转轴3562螺纹接合的可平移套环3560。类似于上述内容，当轴3562分别在第一方向和第二方向上旋转时，套环3560可朝近侧和朝远侧平移。同样类似于上述内容，击发驱动装置的套环3560被构造成能够朝向和远离砧座3530推进和回缩钉驱动装置的阵列和刀组件2570。
除了上述以外，闭锁件3590包括围绕枢轴3594可旋转地安装到击发驱动装置的轴3562的锁定臂3592。闭锁件3590还包括与锁定臂3592接合的偏置构件或弹簧3599，该偏置构件被构造成能够将锁定臂3592偏置成与砧座3530接触。在使用中，砧座3530组装到套管针轴3550，然后套管针轴3550回缩，以将砧座3530相对于仓体3530定位在其闭合或夹紧位置。当砧座3530回缩时，闭锁件3590的锁定臂3592抵靠砧座3530的外表面滑动，直到锁定臂3592与限定在砧座3530中的锁定凹陷部3532对准。在这一点上，弹簧3599将锁定臂3592偏置到锁定凹陷部3532中，如图53所示。更具体地，锁定臂3592定位在限定锁定凹陷部3532的锁定肩部后面。击发驱动装置然后可操作以击发钉并切割组织。在此类实例中，刀组件2570的切割边缘暴露在仓体上方，并且由于闭锁件3590，闭合驱动装置被锁定或防止打开，直到刀组件2570的切割边缘不再暴露。
主要参见图52，锁定臂3592还包括从其延伸的复位突片3593。击发驱动装置的套环3560还包括凸轮3563，凸轮3563被构造成能够当套环3560和刀组件2570通过击发驱动装置朝近侧回缩时接合复位突片3593。凸轮3563被构造成能够使锁定臂3592向下旋转而与限定在锁定凹陷部3532中的锁定肩部脱离接合并且解锁闭合驱动装置。凸轮3563被构造成能够当刀组件2570已经回缩到仓平台下方时解锁闭合驱动装置；然而，在其他实施方案中，当切割边缘与仓平台齐平或至少基本上齐平时，凸轮3563可解锁闭合驱动装置。在一些实施方案中，闭合驱动装置可在刀组件2570已经完全回缩之前解锁。一旦闭合驱动装置已经解锁，闭合驱动装置可操作以再次将砧座3530移动到打开或松开位置。
一旦可互换工具组件的钉已经被击发，根据各种实施方案，工具组件可不再重复使用。如下面将更详细地讨论的，工具组件还可包括闭锁件，该闭锁件被构造成能够防止工具组件在用于缝合组织之后被重新夹紧到组织上。
在至少一个实施方案中，现在参见图53-56，可互换工具组件3600包括闭合驱动装置和击发驱动装置，该闭合驱动装置被构造成能够例如相对于钉仓定位砧座诸如砧座2230，该击发驱动装置被构造成能够从钉仓驱动钉。类似于上述内容，砧座2230可附接到闭合驱动装置的可平移的套管针轴3650。同样类似于上述内容，击发驱动装置包括可旋转轴3660、与可旋转轴3660螺纹接合的可平移套环2550以及能够通过可旋转轴3660移位的钉击发驱动装置2560。在使用中，闭合驱动装置能够操作以将砧座2230相对于钉仓定位在夹紧位置，并且击发驱动装置然后能够操作以将钉击发到捕获在砧座2230和钉仓之间的组织中。然后，操作闭合驱动装置以打开砧座2230并释放组织。
除了上述以外，工具组件3600包括被构造成能够防止砧座2230被重新夹紧到组织上的闭锁件3690。闭锁件3690包括可旋转地安装到可旋转轴3660的锁定臂3692，当闭合驱动装置使砧座2230在打开的未夹紧位置(图53)和闭合的夹紧位置(图54)之间移动时，锁定臂3692通过击发驱动装置保持在解锁构型中。随着套管针轴3650和砧座2230相对于击发驱动装置移动以将砧座2230相对于钉仓定位，锁定臂3692在可旋转轴3660和可平移套环2550之间保持在其解锁构型中。臂3692保持在其解锁构型中，直到击发驱动装置被操作，如图55所示。当轴3460在第一方向上旋转时，套环2550朝远侧移位，并且闭锁件3690的弹簧3699可抵靠套管针轴3650偏置锁定臂3692。随着套环2550朝远侧移位以击发钉然后朝近侧回缩，套管针轴3650相对于锁定臂3692旋转。然后可操作闭合驱动装置以重新打开砧座2230以松开组织和/或从套管针轴3650分离砧座2230。当砧座2230重新打开时，弹簧3699将锁定臂3692偏置到限定在套管针轴3650和/或砧座2230中的锁定凹陷部3652中。一旦锁定臂3692定位在锁定凹陷部3652中，锁定臂3692就防止套管针轴3650朝近侧回缩。在闭合驱动装置操作以试图回缩套管针轴3650的情况下，锁定臂3692将邻接限定在锁定凹陷部3652中的锁定肩部并且防止套管针轴3650和砧座2230回缩。因此，闭锁件3690防止砧座2230在工具组件3600已经经历或至少部分地经历了击发循环之后被重新夹紧到组织上，并且不能再次使用工具组件3600。此外，闭锁件3690可用作用过的仓闭锁件。
现在转向图59和图60，工具组件3700包括钉仓3720和砧座3730。工具组件3700还包括闭合系统和另外的击发系统，该闭合系统被构造成能够朝向钉仓3720移动砧座3730，该击发系统被构造成能够射出或击发可移除地储存在钉仓3720中的钉。砧座3730包括纵向轴部分3736和从轴部分3736延伸的附接臂3738，附接臂3738被构造成能够弹性地抓持闭合系统的闭合致动器或套管针3734。闭合致动器3734通过闭合驱动装置朝近侧回缩，以使套管针3734在打开的未夹紧位置(图59)和闭合的夹紧位置(图60)之间移动。当闭合系统处于其打开构型时，如图59所示，钉击发系统被禁用，并且不能被致动以击发储存在钉仓3720中的钉，如下文更详细地描述。
除了上述以外，钉击发系统包括可旋转击发轴3750以及另外的可平移击发螺母2550，可旋转击发轴3750包括螺纹远侧端部，可平移击发螺母2550包括被构造成能够接纳击发轴3750的螺纹远侧端部的螺纹孔。值得注意的是，参见图59，当砧座3730处于其打开位置时，击发轴3750的螺纹远侧端部与限定在击发螺母2550中的螺纹孔之间存在间隙。因此，击发轴3750不能朝远侧移位击发螺母2550，直到击发轴3750与击发螺母2550螺纹接合。
如图60所示，当砧座3730移动到其闭合位置时，砧座3730的附接臂3738被构造成能够接合击发轴3750并且使击发轴3750向外偏转。主要参见图59A和图60A，附接臂3738被构造成能够接合限定在击发轴3750上的向内延伸的突起部3758，并且向外推动突起部3758和击发轴3750的周边。在此类实例中，击发轴3750的螺纹远侧端部被推动成在螺纹接口3790处与击发螺母2550的螺纹孔操作地接合，并且，在这一点上，当击发轴3750通过击发驱动装置旋转时，击发轴3750可朝远侧移位击发螺母2550以从钉仓3720射出钉。当砧座3730再次打开时，击发轴3750将返回到其初始构型并且与击发螺母2550可操作地脱离接合。
由于上述内容，工具组件3700包括闭锁件，如果砧座3730未附接到闭合系统，如果砧座3730未正确地附接到闭合系统，并且/或者如果砧座3730未充分闭合，则闭锁件防止钉被击发。
现在转到图61和图62，工具组件3800包括包含可移除地储存在其中的钉可替换钉仓、被构造成能够使钉变形的砧座、被构造成能够相对于钉仓移动砧座的闭合驱动系统以及被构造成能够从钉仓射出钉的击发系统。如下所述，工具组件3800还包括闭锁件，该闭锁件被构造成能够防止击发系统操作，除非钉仓完全座置到工具组件3800上。
钉仓包括被构造成能够接合工具组件3800的轴框架3810的仓框架3820。钉仓还包括驱动轴3830，当钉仓组装到工具组件3800时，驱动轴3830插入轴框架3810中。更具体地，主要参见图64，驱动轴3830包括近侧端部3832，近侧端部3832包括环形齿轮部分3833，环形齿轮部分3833被构造成能够当钉仓组装到工具组件3800中时接合并压缩击发系统的传输装置3860。主要参见图62，传输装置3860包括第一部分3862、第二部分3864和第三部分3868，第一部分3862、第二部分3864和第三部分3868在被推动成与彼此可操作接合时能够将旋转输入运动传输到驱动轴3830。
主要参见图63和图64，驱动轴3830的环形齿轮部分3833被构造成能够接合限定在第一传输部分3862的远侧侧面上的对应齿轮部分3863，并且当第一传输部分3862被驱动轴3830朝近侧推动时，第一传输部分3862操作地接合第二传输部分3864。更具体地，第一传输部分3862包括近侧齿轮部分3865，当第一传输部分3862被驱动轴3830朝近侧推动时，近侧齿轮部分3864接合第二传输部分3864的远侧齿轮部分3866，并且同时朝近侧推动第二传输部分3864。类似于上述内容，当第二传输部分3864被第一传输部分3862朝近侧推动时，第二传输部分3864操作地接合第三传输部分3868。更具体地，第二传输部分3862包括近侧齿轮部分3867，当第一传输部分3862和第二传输部分3864被驱动轴3830朝近侧推动时，近侧齿轮部分3867接合第三传输部分3864的远侧齿轮部分3869。第三传输部分3868可操作地联接到输入轴并且通过输入轴和/或轴壳体3810被支撑而朝近侧移位。
主要参见图61，传输装置3860还包括定位在第一传输部分3862和第二传输部分3864中间的至少一个弹簧构件3870。在至少一个实例中，弹簧构件3870可包括例如一个或多个波形弹簧。弹簧构件3870被构造成能够将第一传输部分3862和第二传输部分3864偏置成彼此隔开。除了上述内容之外或代替上述内容，传输装置3860还包括定位在第二传输部分3864和第三传输部分3868中间的至少一个弹簧构件3870，类似于上述内容，弹簧构件3870被构造成能够将第二传输部分3864和第三传输部分3868偏置成彼此隔开。主要参见图65，每个弹簧构件3870包括两个盘簧3872，两个盘簧3872被构造成能够在向其施加压缩力时偏转；然而，弹簧构件3870可包括任何合适的构型。
除了上述以外，并且再次参见图61，工具组件3800的输入轴可旋转第三传输部分3868；然而，除非定位在第二传输部分3864和第三传输部分3868中间的弹簧构件3870已被充分压缩以将第二传输部分3864的近侧齿轮部分3867与第三传输部分3868的远侧齿轮部分3869连接，否则第三传输部分3868的旋转不能被传输到第二传输部分3864。类似地，第二传输部分3864不能将旋转运动传输到第一传输部分3862，除非定位在第一传输部分3862与第二传输部分3864中间的弹簧构件3870已被充分地压缩以连接第一传输部分3862的近侧齿轮部分3865和第二传输部分3864的远侧齿轮部分3866。如上所述，当钉仓完全座置到轴框架3810上时，驱动轴3830将第一传输部分3862与第二传输部分3864接合并且将第二传输部分3864与第三传输部分3868接合。在此类实例中，可将输入轴的旋转传输到驱动轴3830。然而，如果钉仓未完全座置到轴框架3810上，则传输部分3862,3864和3868中的一个或多个彼此不操作地接合，并且输入轴的旋转不能被传输到驱动轴3830。因此，工具组件3800确保储存在钉仓内的钉不能从钉仓射出，除非钉仓完全座置在轴框架3810上。
现在转到图66-68，工具组件3900包括轴3910和可替换钉仓3920。可替换钉仓3920包括闭合驱动装置以及另外的击发驱动装置，该闭合驱动装置被构造成能够相对于钉仓3920移动砧座，该击发驱动装置包括可旋转击发轴3930，击发驱动轴3930被构造成能够射出可移除地储存在钉仓3920中的钉。类似于上述内容，工具组件3900包括闭锁件，该闭锁件被构造成能够防止击发驱动装置从钉仓3920射出钉，除非钉仓3920完全或充分地座置到轴3910上。更具体地，闭锁件防止击发轴3930在钉仓3920内旋转，除非钉仓3920完全或充分地座置到轴3910上。在各种实例中，参见图67，击发轴3930包括限定在其外周边中的锁孔3939的环形阵列，并且钉仓3920包括被构造成能够可释放地接合限定在轴3930中的锁孔3939的至少一个锁3929。锁3929包括朝近侧延伸的悬臂梁；然而，可利用任何合适的构型。锁3929还包括锁定突起部，该锁定突起部延伸到锁孔3939中并且防止击发轴3930相对于钉仓3920的主体旋转或至少基本上旋转。闭锁件3929被构造成能够使得其被偏压成与限定在击发轴3930中的锁孔3939接合，直到当钉仓3920完全或充分地组装到轴3910时，锁孔3929被提升出锁孔3939，如图68中所示。参见图68，轴3910的外部壳体包括楔形件3919，楔形件3919被构造成能够提升锁3929远离击发轴3930，并且使锁3929与锁孔3939脱离。楔形件3919被构造成能够使得其不使锁3929与击发轴3930脱离，除非钉仓3920已经完全或充分地座置到轴3910上，如图68中所示。图67示出了钉仓3920尚未完全或充分地座置到轴3910上的情形。
现在转到图69-71，工具组件4000包括轴4010和可替换钉仓4020。可替换钉仓4020包括闭合驱动装置以及另外的击发驱动装置，该闭合驱动装置被构造成能够相对于钉仓4020移动砧座，该击发驱动装置包括可旋转击发轴3930，击发驱动轴3930被构造成能够射出可移除地储存在钉仓4020中的钉。钉仓4020包括锁4029，锁4029被构造成能够将钉仓4020可释放地连接到轴4010。锁4029包括朝近侧延伸的悬臂和从其延伸的锁定肩部4028。锁4029被构造成能够在钉仓4020组装到轴4010时在轴4010内向内偏转，并且然后在锁4029的锁定肩部4028与限定在轴4010的外部壳体中的窗口4019对准时弹性地返回至或至少朝向其未挠曲状态。在此类实例中，当钉仓4020已完全或充分地座置在轴4010上时，锁定肩部4028进入窗口4019中，如图70中所示。为了解锁钉仓4020，临床医生可将例如工具或其手指插入窗口中，并且按压锁4029远离窗口4019。在这一点上，钉仓4020可从轴4010移除，并且如果临床医生需要，则将新的钉仓附接到轴4010。
除了上述内容之外或代替上述内容，外科缝合系统可包括电闭锁件，该电闭锁件被构造成能够当钉仓尚未完全或充分地座置到缝合系统的轴上时，防止缝合系统的闭合驱动装置将砧座夹紧到组织上并且/或者防止击发驱动装置执行其击发行程。在各种实例中，缝合系统可包括传感器以及另外的电动马达，该传感器被构造成能够检测钉仓是否已完全或充分地座置在轴上，该电动马达被构造成能够操作击发驱动装置。如果传感器检测到钉仓尚未完全或充分地附接到轴，则电动马达可被电去激活。在各种实例中，缝合系统包括与传感器和电动马达通信的控制器诸如微处理器。在至少一个实例中，控制器被构造成能够，一，如果传感器在轴上检测到正确座置的钉仓，则允许电动马达操作，以及二，如果传感器在轴上检测到未正确座置的钉仓，则防止电动马达操作。
现在转到图72，例如，工具组件套件4100包括轴4110和多个钉仓诸如4120,4120',4120”和4120”'。每个钉仓4120,4120',4120”和4120”'被构造成能够施加具有不同直径的圆形钉排。例如，钉仓4120”'被构造成能够以具有大直径的图案施加钉，而钉仓4120被构造成能够以具有小直径的图案施加钉。在各种实例中，不同的钉仓可部署具有不同的未成形高度的钉。在至少一个实例中，以较大图案施加钉的钉仓部署具有较大未成形高度的钉，而以较小图案施加钉的钉仓部署具有较小未成形高度的钉。在一些实例中，钉仓可部署具有两个或更多个未成形高度的钉。在任何情况下，从多个钉仓选择的钉仓可组装到轴4110。
参见图72和图73，工具组件4100包括检测电路4190，检测电路4190被构造成能够检测钉仓是否完全或充分地附接到轴4110。检测电路4190未完全容纳在轴4110内；相反，钉仓必须正确地组装到轴4110以完成检测电路4190。检测电路4190包括导体4193，导体4193延伸穿过限定在轴4110的框架中的通道4192并且/或者沿着轴4110的外部壳体延伸。主要参见图73，每个导体4193电联接到限定在壳体的远侧端部中的电接触件4194。例如，钉仓4120包括对应的电接触件4195，电接触件4195被定位和布置在钉仓4120的主体4122上，使得接触件4195接合轴4110上的接触件4194。钉仓4120还包括延伸穿过仓体4122并且/或者沿着仓体4122延伸的导体4196。每个导体4196与接触件4195电联接。在某些实例中，导体4196直接联接到彼此，并且在此类实例中，一旦钉仓4120正确地组装到轴4110，则闭合检测电路4190。
在某些实例中，除了上述以外，工具组件4100的检测电路4190延伸穿过钉仓4120的平台部分4124。在至少一个实例中，平台部分4124可移动地附接到仓体4122。更具体地，在至少一个此类实例中，弹簧构件4198定位在仓体4122和平台部分4124中间并且被构造成能够当组织受压而贴靠平台部分4124时允许平台部分4124相对于仓体4122移动或浮动。在至少一个实例中，例如，弹簧构件4198包含一个或多个波形弹簧。弹簧构件4198还在仓体4122和平台部分4124之间形成导电通路。更具体地，弹簧构件4198定位在分别限定在仓体4122和平台部分4124上的中间电接触件4197和4199之间。导体4196电联接到限定在仓体4122的远侧端部上的电接触件4197，并且电接触件4199通过平台部分4125中的导体电联接到彼此。如上所述，一旦钉仓4120正确组装到轴4110，闭合检测电路4190。
现在转到图74-76，工具组件4200包括被构造成能够防止可替换圆形钉仓被击发多于一次的闭锁件，如下文更详细地描述。在使用中，可替换圆形钉仓4220组装到工具组件4200的轴4210。然后工具组件4200定位在外科部位中，并且砧座2230组装到闭合驱动装置的套管针2450。然后闭合驱动装置用于使砧座2230朝钉仓4220移动，以抵靠钉仓4220夹紧患者的组织，直到砧座2230到达闭合或夹紧位置。砧座2230的该位置在图74中示出。在这一点上，击发驱动装置可操作以部署可移除地储存在钉仓4220中的钉。除了其他方面，击发驱动装置包括与驱动套环4240螺纹接合的可旋转的驱动轴4230以及另外的钉击发驱动装置2560。驱动套环4240和击发驱动装置2560包括单独的部件；然而，在另选的实施方案中，驱动套环4240和击发驱动装置2560可一体成形。击发驱动装置在击发行程期间能够在第一方向上旋转，以在未击发位置(图74)和击发位置(图75)之间朝远侧推动驱动套环4240和钉击发驱动装置2560以从钉仓4220射出钉。防止驱动套环4240和钉驱动装置2560在钉仓4220内旋转，并且因此，驱动轴4230相对于驱动套环4240和钉驱动装置2560旋转。
除了上述以外，驱动套环4240包括从其朝近侧延伸的一个或多个闭锁件4290。每个闭锁件4290包括闭锁销4292，闭锁销4292可滑动地定位在限定于驱动套环4240中的销孔4293内。每个闭锁件4290还包括被构造成能够朝近侧偏置销4292的偏置构件诸如弹簧4294。当击发驱动装置处于其未击发构型时，如图74所示，闭锁件4290未与钉仓4220的可旋转驱动轴4230和/或框架4222接合。当驱动套环4240和钉驱动装置2560被驱动轴4230朝远侧推动时，闭锁销4292移动远离驱动轴4230，如图75中所示。在击发行程已经完成并且钉已经抵靠砧座2230充分变形之后，驱动轴4230在相反方向上旋转以在回缩行程期间朝近侧拉动驱动套环4240和钉驱动装置4260。在此类实例中，闭锁件4290朝向驱动轴4230移动。值得注意的是，回缩行程比击发行程长，并且因此，驱动套环4240相对于其初始未击发位置朝近侧移动到回缩位置中，如图76中所示。在驱动套环4240的该回缩位置中，闭锁件4290已经与钉仓4220的驱动轴4230和框架4222接合。更具体地，每个闭锁件4290已进入限定在驱动轴4230和仓框架4222之间的闭锁孔中。现在参见图78，每个闭锁孔由驱动轴4230中的孔壁4295和框架4222中的孔壁4296限定。一旦闭锁销4292已经进入闭锁孔，驱动套环4240不能被驱动轴4230旋转，并且钉仓4220的击发系统已被锁定。因此，特定钉仓4220不能再次使用，并且必须用新的钉仓替换，以便再次使用工具组件4200。
除了上述以外，读者应当理解，当击发驱动装置处于其未击发构型时，闭锁销4292可或可不部分地定位在闭锁孔中，如图74中所示。然而，在某种程度上，闭锁销4292部分地定位在闭锁孔中，在此类实例中，当击发驱动轴4230旋转时，销4292可在限定于驱动套环4240中的销孔4293内朝远侧移位。如读者还应当理解的，当驱动套环4240移动到其回缩位置时，闭锁销4292足够深地座置到限定在驱动轴4230中的闭锁孔中，以便如果击发驱动轴4230再次在其第一方向上旋转，则防止销4292朝远侧移位出闭锁孔。
再次参见图78，当驱动套环4240处于其回缩位置时，闭锁孔的侧壁4295和4296彼此对准。然而，当旋转驱动轴4230时，限定在驱动轴4230中的侧壁4295将旋转而不与限定在仓框架4222中的侧壁4296对准。在一些实例中，当击发驱动装置4230旋转时，侧壁4295可暂时旋转以与侧壁4296重新对准。现在参见图77，在任何情况下，当击发系统处于其未击发构型时，侧壁4295不与侧壁4296对准。因此，当击发系统处于其未击发构型时，闭锁销4292不能进入闭锁孔，并且钉仓4220不能无意地锁定。
现在参见图80，在至少一个另选的实施方案中，一个或多个闭锁孔4295”可唯一地限定在工具组件4200”的驱动轴4230”中。在此类实施方案中，一旦闭锁销4292进入闭锁孔4295”，驱动套环4240将不能够相对于驱动轴4230”旋转。实际上，驱动套环4240和驱动轴4230”将被同步地锁定在一起，但不一定锁定到工具组件4200”的框架，这将防止驱动轴4230”相对于驱动套环2440旋转并且使驱动套环2440朝远侧移位。
现在参见图79，在至少一个另选的实施方案中，击发驱动闭锁件中的每个具有不同的构型，使得每个闭锁销与其对应的闭锁孔唯一地索引。例如，工具组件4200'包括第一闭锁销和第二闭锁销，该第一闭锁销被构造成能够进入由侧壁4295和4296限定的第一闭锁孔，该第二闭锁销被构造成能够进入由侧壁4295'和4296'限定的第二闭锁孔。然而，工具组件4200'的第一闭锁销的尺寸和构型设定成使得其不能进入第二闭锁孔，并且相应地，第二闭锁销的尺寸和构型设定成使得其不能进入第一闭锁孔。此外，第一闭锁销或第二闭锁销均不可进入由侧壁4295和4296'的组合形成的孔或由侧壁4295'和4296的组合形成的孔。
如上所述，被构造成能够部署圆形钉排的缝合器械可包括关节运动接头。关节运动接头被构造成能够允许缝合器械的端部执行器相对于缝合器械的轴进行关节运动。此类缝合器械可帮助外科医生将端部执行器定位在患者的直肠和/或结肠内。在各种实施方案中，参见图81，被构造成能够部署圆形钉排的缝合器械诸如缝合器械9000可包括可仿形或可调节的框架9010。框架9010可被构造成能够在使用期间永久地变形。在至少一个此类实施方案中，例如，框架9010由可延展的金属诸如例如银、铂、钯、镍、金和/或铜构成。在某些实施方案中，框架9010由例如可延展的塑料构成。在至少一个实施方案中，框架由包括与聚合物链键合的金属离子的聚合物诸如离子聚合物-金属复合物(IPMC)构成。可将电压电势或电势施加到IPMC材料，以便以期望的方式使轴偏转。在某些实例中，轴可沿一个曲率半径仿形，而在其他实例中，轴可沿多于一个的曲率半径仿形。例如，当轴在患者体内时，可修改电压电势或电势以使轴形成轮廓。在某些实施方案中，框架的可仿形部分包括多个可枢转的连接件。在至少一个实施方案中，框架的可仿形部分由粘弹性材料构成。
除了上述以外，缝合器械还可包括被构造成能够可释放地将缝合器械框架的可仿形部分保持在其轮廓构型中的锁。在至少一个实例中，缝合器械框架包括可关节运动的框架连接件和一个或多个纵向张力缆线，其可朝近侧拉动框架连接件并且将框架连接件锁定在一起。在某些实例中，每个框架连接件可包括延伸穿过其中的纵向孔，该纵向孔被构造成能够接纳可朝远侧移动的杆。所述杆是足够柔性的以穿过纵向孔，当可仿形部分已经轮廓化而又足够刚性以将缝合器械保持在其轮廓构型中时，该纵向孔可不与彼此完全对准。
如本文所讨论，外科器械可包括彼此组装在一起的多个模块。例如，在至少一个实施方案中，外科器械包含包括柄部的第一模块和包括轴组件的第二模块。轴组件包括被构造成能够缝合和/或切割患者组织的端部执行器；然而，轴组件可包括任何合适的端部执行器。在各种实例中，端部执行器包括可附接到轴组件的第三模块。现在参见图82和图83，柄部诸如柄部20包括控制器和与控制器通信的显示器10000。控制器被构造成能够在显示器10000上显示关于外科器械的操作的数据。显示器10000上显示的数据将关于第一模块的至少一个操作参数和/或第二模块的至少一个操作参数的信息与外科医生相关联。例如，控制器可在显示器10000上显示关于钉击发行程的进程的数据。
除了上述以外，轴组件包括第二显示器。例如，轴组件2000包括显示器10100；然而，例如，本文所公开的轴组件中的任一个可包括显示器诸如显示器10100。第二模块包括其自己的控制器，该控制器被构造成能够在显示器10100上显示关于外科器械的操作的数据。类似于上述内容，显示器10100上显示的数据涉及关于第一模块的至少一个操作参数和/或第二模块的至少一个操作参数的信息。第二模块的控制器与第一模块的控制器进行信号通信；然而，在其他实施方案中，第二模块控制器可独立于第一模块控制器操作。在某些另选的实施方案中，第二模块不包括控制器。在此类实施方案中，第一模块的控制器与第一显示器10000和第二显示器10100进行信号通信，并且控制显示在第一显示器10000和第二显示器10100上的数据。
如上所述，工具组件2000包括砧座和钉仓。柄部20包括致动系统，该致动系统被构造成能够相对于钉仓移动砧座。砧座可定位在相对于钉仓的一系列位置中，以控制砧座和钉仓之间的距离或间隙，并且因此在从钉仓射出钉时控制钉的成形高度。例如，砧座被定位成更靠近钉仓以使钉变形至较短的成形高度，并且定位成进一步远离钉仓以使钉变形至较高的成形高度。在任何情况下，工具组件2000的第二显示器10100被构造成能够显示砧座相对于钉仓的位置并且/或者显示钉将形成的或已经形成的高度。在各种实施方案中，轴组件可包括致动器和显示器，该致动器被构造成能够控制端部执行器的功能，该显示器显示关于邻近致动器的端部执行器功能的数据。
参见图1，工具组件1500包括轴和从轴延伸的端部执行器。轴包括轴框架和纵向轴轴线。端部执行器包括端部执行器框架和纵向端部执行器轴线。端部执行器还包括远侧头部和旋转接头，该旋转接头允许远侧头部相对于端部执行器框架围绕纵向端部执行器轴线旋转。远侧端部包括第一钳口和第二钳口。第一钳口包括钉仓或通道，该钉仓包括可移除地储存于其中的钉，该通道被构造成能够接纳此类钉仓，并且第二钳口包括被构造成能够使钉变形的砧座。第二钳口能够相对于第一钳口在打开位置和闭合位置之间移动；然而，设想到其他实施方案，其中第一钳口能够相对于第二钳口移动并且/或者第一钳口和第二钳口都能够相对于彼此移动。
在某些实施方案中，除了旋转接头之外，工具组件还可包括关节运动接头。在至少一个此类实施方案中，旋转接头相对于关节运动接头处于远侧。在此类实施方案中，远侧头部的旋转不影响端部执行器已进行关节运动的角度。也就是说，设想到其他实施方案，其中关节运动接头相对于旋转接头处于远侧。此类实施方案可提供远侧头部的宽扫描。在任一种情况下，纵向端部执行器轴线能够相对于纵向轴轴线移动。在至少一个实例中，纵向端部执行器轴线可在其与纵向轴轴线共线的位置与其横向于纵向轴轴线的位置之间移动。
除了上述以外，工具组件1500的远侧头部能够在初始位置和旋转位置之间旋转。在至少一个实例中，远侧头部能够在零位置或上止点位置和第二位置之间旋转。在某些实例中，远侧头部能够旋转至少360度的运动范围。在其他实例中，远侧头部能够旋转小于360度的旋转范围。在任一种情况下，工具组件1500和/或柄部20被构造成能够跟踪远侧头部的旋转位置。在各种实例中，例如，工具组件1500和/或柄部20包括电动马达以及另外的编码器，该电动马达与端部执行器的远侧头部可操作地联接，该编码器被构造成能够通过评估电动马达的轴的旋转位置而直接跟踪远侧头部的旋转并且/或者间接跟踪远侧头部的旋转。柄部20的控制器与编码器进行信号通信并且被构造成能够例如在显示器10000上显示远侧头部的旋转位置。
在至少一个实施方案中，当端部执行器的远侧头部旋转时，显示在显示器10000上的数据的取向和布置是静态的。当然，在此类实施方案中，显示在显示器10000上的数据将通过外科器械控制器更新；然而，当远侧头部旋转时，数据显示器不会重新取向和/或重新布置。此类实施方案可向外科医生提供在静态场中适当地利用外科器械所需的信息。在至少一个另选的实施方案中，显示器10000上的数据字段是动态的。在上下文中，术语动态意指多于在显示器10000上更新的数据；相反，术语动态意指当远侧头部旋转时，数据被重新取向和/或重新布置在显示器10000上。在至少一个实例中，数据的取向跟踪远侧头部的取向。例如，如果远侧头部旋转30度，则显示器10000上的数据字段旋转30度。在各种实例中，远侧头部能够旋转360度，并且数据字段能够旋转360度。
除了上述以外，数据字段可以与远侧头部的取向匹配的任何取向进行取向。此类实施方案可向外科医生提供远侧头部的取向的准确且直观的感觉。在某些实施方案中，控制器以从与远侧头部的取向最紧密地匹配的离散位置阵列中选择的取向对数据字段进行取向。例如，如果远侧头部已经旋转了27度并且可选择的离散数据字段位置相隔15度，则控制器可将数据字段从基准取向重新取向30度。类似地，例如，如果远侧头部已经旋转了17度并且可选择的离散数据字段位置相隔5度，则控制器可将数据字段从基准取向重新取向15度。在至少一个实施方案中，基准取向与外科器械自身的特征部对准。例如，柄部20的基准取向与延伸穿过柄部20的抓持件的轴线对准。在此类实施方案中，控制器可忽略柄部20相对于其环境的取向。然而，在至少一个另选的实施方案中，例如，基准取向相对于重力轴线对准。
除了上述以外，控制器被构造成能够相对于远侧头部的取向重新取向显示在显示器10000上的整个数据字段。在其他实施方案中，控制器被构造成能够相对于远侧头部的取向重新取向仅在显示器10000上移位的数据字段的一部分。在此类实施方案中，数据字段的一部分相对于基准取向保持静态，而数据字段的另一个部分相对于基准取向旋转。在某些实施方案中，数据字段的第一部分旋转第一旋转角度，并且数据字段的第二部分在相同方向上旋转第二旋转角度。例如，第二部分可旋转小于第一部分。在各种实施方案中，数据字段的第一部分在第一方向上旋转，并且数据字段的第二部分在第二或相反方向上旋转。
除了上述以外，随着远侧头部的旋转，数据字段被实时地重新取向和/或重新布置，或者至少基本上实时地重新取向和/或重新布置。此类实施方案提供非常响应的数据显示器。在其他实施方案中，数据字段的重新取向和/或重新布置可延迟远侧头部的旋转。此类实施方案可提供具有较少抖动的数据显示器。在各种实施方案中，数据字段的第一部分以第一速度重新取向和/或重新布置，并且数据字段的第二部分以第二或不同的速度重新取向和/或重新布置。例如，第二部分可以较慢的速度旋转。
如上所述，当端部执行器的远侧头部旋转时，显示器10000上的数据字段旋转。然而，在其他实施方案中，当远侧头部旋转时，数据字段或数据字段的一部分平移。又如上所述，控制器的外科器械被构造成能够在柄部显示器10000上重新取向和/或重新布置数据字段。然而，例如，外科器械的控制器可在第二显示器诸如轴显示器上重新取向和/或重新布置数据字段。
再次参见图15和图83，工具组件2000包括致动器10200，致动器10200被构造成能够致动工具组件2000的关节运动驱动系统。例如，致动器10200能够围绕纵向轴线旋转，该纵向轴线平行于或至少基本上平行于轴2100的纵向轴线。致动器10200可操作地联接到变阻器，例如，该变阻器与柄部20的控制器进行信号通信。当致动器10200围绕其纵向轴线在第一方向上旋转时，变阻器检测致动器10200的旋转，并且控制器操作电动马达以使端部执行器2200在第一方向上进行关节运动。类似地，当致动器10200围绕其纵向轴线在第二或相反方向上旋转时，变阻器检测致动器10200的旋转，并且控制器操作电动马达以使端部执行器2200在第二或相反方向上进行关节运动。在各种实例中，例如，端部执行器2200可在第一方向上从纵向轴线进行关节运动，并且/或者在第二或相反方向上从纵向轴线进行关节运动大约30度。
如读者应当理解的那样，除了上述以外，工具组件2000不具有被构造成能够操作关节运动驱动系统的板载电动马达；相反，关节运动驱动系统的电动马达在柄部诸如柄部20中，例如，工具组件2000附接到该柄部20。因此，可拆卸的轴组件上的致动器控制柄部的操作。在其他实施方案中，关节运动驱动装置系统的电动马达可在工具组件2000中。在任一种情况下，显示器10100被构造成能够以至少一些方式显示端部执行器2200的关节运动。如读者应当理解的那样，显示器10100邻近致动器10200，并且因此，外科医生能够同时容易地查看关节运动驱动系统的输入和输出。
除上述以外，例如，包括可仿形轴的手术工具组件可以有利地成形为配合在患者的直肠或结肠内。然而，这种可仿形的轴不能承受大量的拉伸和/或压缩载荷。为了对其进行补偿，在各种实施方案中，仅可旋转驱动系统可延伸穿过轴的可仿形部分。在此类实例中，轴仅需要抵抗由可旋转驱动系统生成的旋转反应力。在此类实施方案中，如果需要，驱动系统的旋转运动可相对于可仿形轴部分朝远侧转换成线性移动。此类纵向移动可生成拉伸力和/或压缩力；然而，此类力可在端部执行器内(即相对于可仿形轴部分朝远侧)解决或抵消。此类实施方案还可利用相对于可仿形轴部分朝远侧定位的关节运动接头。在此类实施方案中，工具组件不可利用横过可仿形轴部分的推拉驱动系统。
圆形缝合器械的砧座6020在图84和85中示出。砧座6020包括组织压缩表面6022和限定在组织压缩表面6022中的钉成形凹坑6024的环形阵列。砧座6028还包括框架6020、附接安装件6026和从附接安装件6026延伸的杆。杆被构造成能够可释放地附接到圆形缝合器械的闭合驱动装置，使得砧座6020可朝向和远离圆形缝合器械的钉仓移动。例如，压缩表面6022、附接安装件6026和框架6028由不锈钢构成；然而，可使用任何合适的一种或多种材料。
除了上述以外，砧座6020还包括组织支撑件6030。组织支撑件6030定位在限定于组织支撑件表面6022内的环形孔内。组织支撑件6030被紧密地固定在砧座6020内，使得在两者间有很少(如果有的话)相对移动。组织支撑件6030包括环形组织支撑件表面6032，环形组织支撑件表面6032与砧座6020的环形组织压缩表面6022相邻。组织支撑件6030还包括限定于其中的内环形壁6036，以及另外的邻近砧座6020的砧座框架6028定位的底壁6038。
现在参见图86，圆形缝合器械包括钉仓6040和击发驱动装置，钉仓6040包括第一环形钉排6070、第二环形钉排6080，该击发驱动装置被构造成能够在击发驱动装置的击发行程期间从钉仓6040射出钉6070和6080。如图86所示，当钉6070和6080从钉仓6040射出时，通过成形凹坑6024使钉6070和6080变形。在各种实例中，钉6070和钉6080变形至相同高度，而在其他实例中，钉6070和钉6080变形至不同高度。例如，钉6070可变形至比钉6080更短的变形高度。在其他实例中，钉6080变形至比钉6070更短的高度。
除了上述内容之外或代替上述内容，钉6070和钉6080可具有不同的未成形高度。例如，钉6070可具有比钉6080更短的未成形高度。在其他实例中，钉6080具有比钉6070更短的未成形高度。在某些实例中，钉6070和钉6080具有相同的未成形高度。
除了上述以外，当钉6070和6080抵靠砧座6020变形以缝合在砧座6020和钉仓6040之间捕获的组织T时，缝合器械可切割组织T。将钉从其钉腔射出的击发驱动装置将切割构件6050朝向组织T和砧座6020驱动。切割构件6050的远侧边缘横切组织T，然后沿着组织支撑件6030的内侧壁6036滑动，而不横切内侧壁6036。切割构件6050的切割边缘为环形的，并且其与组织支撑件6030的环形内壁6036对准。切割构件6050被推进到砧座6020中，直到切割构件6050横切底壁6038，如图86所示。
当抵靠砧座6020驱动钉6070和6080和/或切割组织时，击发驱动装置经受各种负载。例如，当横切先前已经缝合(诸如用钉6090)的组织时(图86)，击发驱动装置可经历增加的负载。然而，通过切割构件6050横切底壁6038产生通过击发驱动装置传递的力的突然变化或冲击。临床医生可使用外科缝合器和/或被构造成能够检测击发驱动装置中的负载变化的电子传感器系统来感测力的这种突然变化。组织支撑件6030可由在切割构件6050将负载施加到底壁6038时可按扣的材料构成。在至少一个实例中，例如，组织支撑件6030由塑料构成。在任何情况下，可检测底壁6038的横切，并且一旦检测到，临床医生和/或电子传感器系统可确定切割过程已经完成。
击发驱动装置使钉6070,6080变形并且同时用切割构件6050切割组织；然而，设想钉成形步骤和组织切割步骤可交错。在至少一个实例中，组织切割步骤在钉成形步骤完成之前不开始。
从图86应当理解，虽然表面6032可部分地支撑组织T，但是当切割构件6050朝向底壁6038移动时，切割构件6050可将组织T推动到限定在组织支撑件6030的内壁6036和附接安装件6026之间的腔中。换句话讲，切割构件6050可在最终切割组织T之前沿壁6036拖动组织T。在此类实例中，由切割构件6050制成的切口可不精确。下面讨论的是对图86中公开的实施方案的改进。
现在转到图87和图88，砧座6020的组织支撑件6030已被组织支撑件6130替换。组织支撑件6130包括第一或外环形壁6131和第二或内环形壁6133。内壁6133限定孔6136，孔6136被构造成能够紧密地接纳附接安装件6026。外壁6131和内壁6133通过侧向壁6132连接。侧向壁6132在内壁6133和外壁6131之间围绕组织支撑件6130的中心径向地延伸。侧向壁6132彼此均匀地间隔开；然而，设想另选的实施方案，其中侧向壁6132彼此不均匀地间隔开。在任一种情况下，侧向壁6132限定组织支撑件6130中的腔6134的环形阵列。在各种实例中，例如，每个腔6134可被封闭在除了面向组织的侧面之外的每个侧面上。在其他实例中，可封闭面向组织的腔的侧面。
组织支撑件6130的外壁6131和内壁6133被构造成能够在组织正被切割构件6050横切时支撑组织。当组织正被横切时，侧向壁6132还支撑组织，并且另外阻止或抵抗组织相对于外壁6131和内壁6133滑动。应当理解，当组织正被横切时，组织可进入腔6134。然而，可大大减小组织与侧壁之间的相对移动。根据需要的支撑量，可选择侧向壁6132的组合物和布置，以向组织提供更多的支撑或更少的支撑。例如，相比于较薄的侧向壁6132，较厚的侧向壁6132可提供更多的组织支撑。类似地，相比于较薄的侧向壁6132，更多的侧向壁6132可提供更多的组织支撑。
当切割构件6050移动通过其切割行程时，切割构件6050切割组织并且横切侧向壁6132。切割构件6050为环形的并且横切与外壁6131相邻的侧向壁6132。然而，切割构件可在任何合适的位置处横切壁6132。在任何情况下，侧向壁6132在切割组织之前、期间和之后支撑组织，并且防止或至少减少组织沿着外壁6131和/或内壁6133被拖动的可能性。类似于组织支撑件6030，组织支撑件6130包括在切割行程结束时被横切的底壁6138。
图89和图90中公开了包括钉仓6240和砧座6220的外科缝合器。钉仓6240在许多方面类似于钉仓6040。砧座6220在许多方面类似于砧座6020和砧座6120。砧座6220包括附接杆6226和定位在附接杆6226周围的环形组织支撑件6230。组织支撑件6230包括被构造成能够紧密地接纳杆6226的中心孔。组织支撑件6230还包括邻近砧座6220的组织压缩表面定位的环形外壁6231，以及另外的从外壁6231径向延伸的侧向壁6232。组织支撑件6230不包括内环形壁并且侧向壁6232的内端自由挠曲。类似于上述内容，组织支撑件6230还包括底壁6238，底壁6238被切割构件6050切割。
图91和图92中示出了包括钉仓6240和砧座6220的外科缝合器。然而，读者应当理解，砧座6220的组织支撑件6230已经被组织支撑件6330替换。组织支撑件6330包括环形中心孔，该环形中心孔被构造成能够紧密地接纳杆6226。组织支撑件6330还包括顶壁6332、底壁6338和在顶壁6332和底壁6338之间延伸的侧壁6336。顶壁6332和底壁6338平行或至少基本上平行；然而，设想到其中壁6332和6338不平行的实施方案。侧壁6336平行或至少基本上平行；然而，设想到其中侧壁6336不平行的实施方案。
壁6332,6336和6338限定其间的环形腔6334。腔6334在所有侧面上被封闭或至少基本上被封闭。腔6334围绕杆6226不间断地延伸；然而，设想到其中腔6334被侧壁中断和/或几何形状变化的其他实施方案。
类似于上述内容，组织支撑件6330被构造成能够在组织正被切割构件6050横切时支撑组织。组织支撑件6330被紧密地接纳在砧座6220内，使得组织支撑件6330相对于砧座6220不移动或至少基本上移动。此外，组织支撑件6330包括刚性盒形的横截面，使得当切割构件6050横切组织时，组织支撑件6330的挠曲被最小化或不显著。如图91所示，底壁6338和内侧壁6336之间存在间隙。此类间隙可在组织支撑件6330中提供一些柔性；然而，设想到不存在此类间隙的其他实施方案。例如，组织支撑件6330由塑料构成；然而，在各种实施方案中，例如，组织支撑件6330可由柔性和/或弹性材料构成。
切割构件6050在其切割行程期间横切组织支撑件6330。如图92所示，切割构件6050在横切组织之后横切顶壁6332，然后进入腔6334。顶壁6332包括限定于其中的环形凹口6333，环形凹口6333与切割构件6050的环形切割边缘对准。凹口6333减小顶壁6332的横截面并且便于顶壁6332的切口。切割构件6050还可在其切割行程期间横切底壁6338。如读者应当理解的那样，横切组织支撑件6330的顶壁6332和底壁6338可在缝合器械的击发驱动装置中产生力脉冲。顶壁6332和底壁6338可在结构上被构造成能够提供不同的脉冲，使得临床医生和/或外科器械的电子传感器系统可在击发/切割行程结束时识别脉冲之间的差值，并且不正确地解释顶部壁6332的切口。
再次参见图91和图92，组织支撑件6330的顶壁6332与砧座6220的组织压缩表面6022对准或至少基本上对准。除了上述内容之外或代替上述内容，顶壁6332可相对于组织压缩表面6022凹陷并且/或者在组织压缩表面6022上方延伸。组织支撑件的顶壁6332在砧座6220的成形表面6024上方延伸。除了上述内容之外或代替上述内容，顶壁6332可相对于成形表面6024凹陷并且/或者与成形表面6024对准。
图93和图94中示出了包括钉仓6240和砧座6220的外科缝合器。然而，读者应当理解，砧座6220的组织支撑件6230已经被组织支撑件6430替换。组织支撑件6430包括环形中心孔，该环形中心孔被构造成能够紧密地接纳杆6226。组织支撑件6430还包括顶壁6432、底壁6438和在顶壁6432和底壁6438之间延伸的侧壁6436。壁6432,6436和6438限定其间的环形腔6434。腔6434在所有侧面上被封闭或至少基本上被封闭。腔6434围绕杆6226不间断地延伸；然而，设想到其中腔6434被侧壁中断和/或几何形状变化的其他实施方案。
类似于上述内容，组织支撑件6430被构造成能够在组织正被切割构件6050横切时支撑组织。组织支撑件6430被紧密地接纳在砧座6220内，使得组织支撑件6430相对于砧座6220不移动或至少基本上移动。此外，组织支撑件6430包括刚性多边形的横截面，使得当切割构件6050横切组织时，组织支撑件6430的挠曲被最小化或不显著。如图93所示，底壁6438和内侧壁6436之间存在间隙。此类间隙可在组织支撑件6430中提供一些柔性；然而，设想到不存在此类间隙的其他实施方案。例如，组织支撑件6430由塑料构成；然而，在各种实施方案中，例如，组织支撑件6430可由柔性和/或弹性材料构成。
如在图93和图94中所示，内侧壁6436比外侧壁3436短；然而，设想到其他实施方案，其中外侧壁6436比内侧壁6436短。此外，顶壁6432不平行于底壁6438。更具体地，顶壁6432包括倾斜部分，该倾斜部分横向延伸至底壁6438和/或顶壁6432的其他部分。
切割构件6050在其切割行程期间横切组织支撑件6430。如图94所示，切割构件6050在横切组织之后横切顶壁6432，然后进入腔6434。切割构件6050还可在其切割行程期间横切底壁6438。
如上所述，本文所公开的组织支撑件被构造成能够在组织正被切割构件切割时支撑组织。通常，例如，被切割构件切割的组织先前已经被缝合，即在外科手术的较早步骤期间被缝合。在各种实例中，例如，此类钉也可由切割构件切割，即使他们由金属诸如钛和/或不锈钢构成。在其他示例中，此类钉可不被切割构件切割；相反，他们可被推动到包含组织支撑件的材料中。无论钉是否被切割构件切割，在各种实例中，本文公开的组织支撑件包括足够的强度和/或刚度，其防止由切割构件抵靠组织支撑件捕获的钉在组织支撑件中产生不仅局部的塑性变形。在至少一个此类实例中，局部塑性变形在相对于钉的任何方向上被限制于小于钉的特征长度(CL)。在至少一个实例中，例如，可选择组织支撑件的材料，使得抵靠组织支撑件捕获的钉可仅在组织支撑件中形成直径小于2*CL的塑性变形区域。在其他实例中，例如，可选择组织支撑件的材料，使得抵靠组织支撑件捕获的钉可仅在组织支撑件中形成直径小于1.5*CL的塑性变形区域。例如，钉的特征长度可以是钉冠或后跨部的宽度，和/或钉腿在其变形构型中的成形高度。此外，本文所公开的组织支撑件可由如下的材料构成，当该材料被切割构件切割时，其足够硬以支撑钉。在至少一个实例中，包括组织支撑件的材料的硬度等于或大于包括正抵靠组织支撑件被切割的钉的材料的硬度。在某些实例中，包括组织支撑件的材料的硬度小于包括被切割的钉的材料的硬度；然而，组织支撑件的结构设计足以防止组织支撑件塑性拉伸超过可接受的塑性变形区域。在某些实例中，切割组织和组织中所形成的钉所需的能量小于切割组织支撑件所需的能量。在各种实例中，包括组织支撑件的材料可抵抗被钉挖凿。在至少一个实例中，生物相容性润滑剂可放置在组织支撑件上和/或浸渍在组织支撑件内，以防止钉卡在组织支撑件上。
在各种实例中，砧座的组织压缩表面和组织支撑件的组织接触表面是平坦的或至少基本上平坦的。此类布置可将砧座施加的力分布在大面积上的组织上。设想到其中砧座的组织压缩表面和/或组织支撑件表面的组织接触表面不平坦的其他实施方案。在某些实例中，砧座的组织压缩表面和/或组织支撑件的组织接触表面包括被构造成能够接合和抓持组织的从其延伸的组织抓持构件或钉。例如，此类组织抓持构件可减少组织和砧座之间的相对移动或滑动。在至少一个实例中，砧座的组织压缩表面和组织支撑件的组织接触表面上的组织抓持构件的密度相同。在其他实例中，组织支撑件的组织接触表面上的组织抓持构件的密度高于砧座的压缩表面上的组织抓持构件的密度。在此类实例中，当组织支撑件相对于砧座的压缩表面径向向内定位时，组织抓持构件可防止组织径向向内流动或滑动。
图95中公开了砧座6520。砧座6520包括组织压缩表面6522以及另外的限定在组织压缩表面6522中的成形凹坑，该成形凹坑被构造成能够在钉从其钉仓被射出时使钉变形成期望的构型。每个成形凹坑包括一对杯，其中每对杯被构造成能够使钉的腿部变形。例如，一对成形杯可包括被构造成能够使钉的第一腿部变形的第一成形杯6530a和被构造成能够使钉的第二腿部变形的第二成形杯6530b。第一成形杯6530a和第二成形杯6530b相对于在第一成形杯6530a和第二成形杯6530b之间延伸的轴线6531是彼此的镜像。然而，也可利用其他布置。
第一成形杯6530a包括第一或外端部6532和第二或内端部6534。第一成形杯6530a还包括底部或浴缸，在外端6532和内端6534之间延伸的表面6536。第一端部6532被构造成能够接纳钉的腿部并且开始腿部的成形过程。第一端部6532包括弯曲表面，该弯曲表面被构造成能够使钉腿朝向第二端部6534偏转。底部表面6536包括弯曲表面或凹表面，该弯曲表面或凹表面被构造成能够至少部分地使钉腿向后朝向钉仓转动。第二端部6534包括弯曲表面，该弯曲表面被构造成能够将钉腿引导出成形杯6530a。
第二成形杯6530b包括与第一成形杯6530a类似的构造，并且被构造成能够使钉的第二腿部变形。由于上述内容，第一成形杯6530a将钉的第一腿部朝向第二腿部引导，并且第二成形杯6530b将钉的第二腿部朝向第一腿部引导。在各种实例中，例如，第一成形杯6530a和第二成形杯6530b协同操作以使钉变形成B型构型；然而，成形杯可被构造成能够使钉变形成任何合适的构型。
主要参见图96，每个成形杯6530(6530a和6530b)包括第一侧向侧壁6537和在第一端部6532与第二端部6534之间延伸的第二侧向侧壁6539。在各种实例中，第一侧向侧壁6537和第二侧向侧壁6539相对于延伸穿过成形杯6530的中心的纵向轴线6533是彼此的镜像。在其他实例中，第一侧向侧壁6537和第二侧向侧壁6539不是彼此的镜像。在任一种情况下，侧壁6537,6539是斜面的或倾斜的以便将钉腿朝向成形杯的中心(即朝向轴线6533)引导。
每个成形杯6530包括限定在其底部表面6536中的凹槽或通道6538。凹槽6538在成形杯6530的第一端部6532和第二端部6534之间纵向延伸。凹槽6538平行于成形杯6530的中心纵向轴线6535延伸并且相对于成形杯6530的中心纵向轴线6535侧向偏移。凹槽6538比由成形杯6530变形的钉的腿部宽。然而，设想到其中凹槽6538比钉的腿部窄的其他实施方案。在任一种情况下，凹槽6538被构造成能够沿着成形杯6530内的预定路径引导钉腿。
在各种实例中，成形杯6530的凹槽被构造成能够在腿部变形的同时扭转钉的腿部。在至少一个实例中，钉在变形前是平面的或至少基本上平面的。在至少一个此类实例中，当钉从钉仓射出时，钉的腿部和基部位于与纵向轴线6535对准的同一平面中。当钉腿进入成形杯6530中时，第一端部6532和底部表面6536是倾斜的并且/或者以其他方式被构造成能够将腿部朝向凹槽6538引导。一旦钉腿进入凹槽6538中，凹槽6538将钉腿与钉的基部扭转出平面。由于上述内容，未成形的钉构型是平面的，但是成形的钉构型是非平面的。然而，设想到其他实施方案，其中钉在其已经变形之前和之后具有非平面构型。
对于给定的一组成形杯6530，成形杯6530的凹槽6538定位在纵向轴线6535的相同侧面上，并且被构造成能够将两个钉腿扭转到钉基部的相同侧面。然而，设想到其他实施方案，其中第一钉腿扭转到钉基部的一个侧面，并且第二钉腿扭转到钉基部的另一个侧面。在至少一个此类实施方案中，第一凹槽6538定位在纵向轴线6535的第一侧面上，其被构造成能够将第一钉腿扭转到钉基部的第一侧面，而第二凹槽6538定位在纵向轴线6535的第二侧面上，其被构造成能够将第二钉腿扭转到钉基部的第二侧面。
对于给定的一组成形杯6530，成形杯6530的凹槽6538共线或至少基本上共线。然而，设想其他实施方案，其中凹槽6538定位在纵向轴线6535的相同侧面上，但是彼此不共线。在至少一个此类实例中，凹槽6538彼此平行，而在其他此类实例中，凹槽6538彼此不平行。
主要参见图96，凹槽6538比成形杯6530的底部表面6536深。然而，设想到其中成形杯的凹陷部和底部表面具有相同的深度的其他实施方案。
在各种实例中，当砧座6520是被构造成能够施加纵向钉排的纵向端部执行器的一部分时，成形杯6530以纵向排被布置。在至少一个此类实例中，成形杯的凹槽6538被布置成使得由端部执行器部署的所有钉在相同方向上弯曲出平面。在其他实例中，凹槽6538布置在成形杯6530的第一纵向排中以在第一方向上弯曲钉腿，并且布置在成形杯6530的第二纵向排中以在第二或不同方向上弯曲钉腿。在某些实例中，凹槽6538布置成使钉排中的第一钉的腿部在第一方向上弯曲，并且使钉排中的第二钉在第二或相反方向上弯曲。
在各种实例中，当砧座6520是被构造成能够施加环形钉排的环形端部执行器的一部分时，成形杯6530以环形排被布置。在至少一个此类实例中，凹槽6538相对于成形杯6530的中心纵向轴线6535径向向外定位。在其他实例中，凹槽6538相对于成形杯6530的中心纵向轴线6535径向向内定位。在某些实例中，凹槽6538在成形杯6530的第一环形排中径向向外定位，并且在成形杯6530的第二环形排中径向向内定位。
除了上述以外，砧座的成形凹坑可包括任何合适的构型。在至少一个实例中，成形凹坑可包括两个成形杯，所述成形杯相对于中心轴线是彼此的镜像。每个成形杯包括具有外端和内端的三角形构型。一对成形杯的内端彼此相邻。成形杯的外端比内端宽，并且被构造成能够接纳钉的腿部。每个成形杯还包括在外端和内端之间延伸的底部或浴缸表面，以及另外限定在被构造成能够在成形杯内引导钉腿的底部表面中的纵向凹槽。在至少一个实例中，纵向凹槽在成形杯的底部表面中居中。
图97-99中公开了圆形缝合组件的端部执行器7000。端部执行器7000包括钉仓，钉仓包括平台7030和仓体7040。平台7030包括组织压缩表面7031和限定在压缩表面7031中的钉腔7032。钉腔7032被布置在第一或内环形排和第二或外环形排中。内排中的每个钉腔7032包括可移除地储存在其中的第一钉7070a，并且外排中的每个钉腔7032包括可移除地储存在其中的第二钉7070b。
端部执行器还包括被构造成能够将钉推动出钉仓的钉驱动装置7000。例如，钉仓包括被构造成能够射出第一钉排7070a的钉驱动装置7060a的第一环形排以及被构造成能够将第二钉排7070b射出钉仓7040的钉驱动装置7060b的第二环形排。钉驱动装置7060a和7060b定位在限定于平台7030中的钉腔7032内并且/或者与限定在平台7030中的钉腔7032对准。钉驱动装置7060a和7060b可在钉腔7032内滑动，以分别从钉腔7032射出钉7070a和7070b。
端部执行器7000还包括砧座7020。砧座7020包括组织压缩表面7021和限定在压缩表面7021中的钉成形凹坑7022。钉成形凹坑7022被布置在第一或内环形排和第二或外环形排中。钉成形凹坑7022与钉腔7032对准，使得当钉7070a,7070b从钉腔7032射出时，钉7070a,7070b接触钉成形凹坑7022。
端部执行器7000还包括击发构件7056，击发构件7056被构造成能够提升钉腔7032内的钉驱动装置7060a和7060b，以分别从钉腔7032射出钉7070a和7070b。击发构件7056包括基部7054和斜坡7055。基部7054可滑动地定位在限定于击发驱动装置7050中的凹陷部7052内。斜坡7055可滑动地定位在限定于仓体7040中的狭槽7041内。如下面将更详细地描述的，斜坡7055被构造成能够在狭槽7041内滑动并且逐渐接触钉驱动装置7060a,7060b以从钉腔7032射出钉7070a,7070b。
除了上述以外，击发构件7056能够移动通过击发行程，以从钉腔7032射出钉7070a,7070b。在击发行程期间，击发构件7056沿由狭槽7041限定的弯曲的或弓形的路径移动。主要参见图97，狭槽7041包括第一端部7042和第二端部7049以及他们之间的连续路径。击发构件7056的斜坡7055在击发行程开始时定位在第一端部7042中并且在击发行程结束时定位在第二端部7049中。狭槽7041的第一端部7042与钉腔7032的内排对准，并且狭槽7041的第二端部7049与钉腔7032的外排对准。狭槽7041还包括围绕延伸穿过端部执行器7000的中心纵向轴线7090延伸的第一圆周部分7043。狭槽7041的第一圆周部分7043与钉腔7032的内排中的钉驱动装置7060a对准并且在钉驱动装置7060a下方延伸。当击发构件7056移动通过狭槽7041的第一圆周部分7043时，击发构件的斜坡7055顺序地接合钉驱动装置7060a以顺序地击发钉7070a。
第一圆周部分7043由围绕纵向轴线7090的恒定或至少基本上恒定的曲率半径限定；然而，设想到其中第一圆周部分7043的曲率半径不恒定的其他实施方案。在至少一个此类实例中，第一圆周部分7043包括螺旋。换句话讲，在此类实例中，当第一圆周部分7043围绕纵向轴线7090延伸时，第一圆周部分7043后退远离纵向轴线7090。
狭槽7041的第二圆周部分7045与钉腔7032的外排中的钉驱动装置7060b对准并且在钉驱动装置7060b下方延伸。当击发构件7056移动通过狭槽7041的第二圆周部分7045时，击发构件的斜坡7055顺序地接合钉驱动装置7060b以顺序地击发钉7070b。第二圆周部分7045由围绕纵向轴线7090的恒定或至少基本上恒定的曲率半径限定；然而，设想到第二圆周部分7045的曲率半径不恒定的其他实施方案。在至少一个此类实例中，第二圆周部分7045包括螺旋。换句话讲，在此类实例中，当第二圆周部分7045围绕纵向轴线7090延伸时，第二圆周部分7043后退远离纵向轴线7090。
除了上述以外，狭槽7041包括在第一圆周部分7043和第二圆周部分7045中间的过渡部分7044。在击发行程期间，斜坡7055顺序地滑动通过第一圆周部分7043、过渡部分7044，然后通过第二圆周部分7045。过渡部分7044允许击发构件7056在第一钉排的第一曲率半径和第二钉排的第二曲率半径之间转变。在某些实施方案中，第一圆周部分7043和第二圆周部分7045之间的过渡部分7044可以是不必要的。在至少一个此类实例中，例如，第一圆周部分7043可包括第一螺旋构型，并且第二圆周部分7045可包括第二螺旋构型，该第二螺旋构型被对准使得第一螺旋构型的端部与第二螺旋构型的起始端对准。
击发构件7056通过击发驱动装置7050沿其击发路径被驱动。例如，通过手动曲柄和/或电动马达围绕纵向轴线7090驱动击发驱动装置7050。击发驱动装置7050包括限定于其中的驱动凹陷部7052。击发构件7056的基部7054定位在驱动凹陷部7052中。驱动凹陷部7052大于击发构件7056的基部7054，使得基部7054可在驱动凹陷部7052内移动或浮动。驱动凹陷部7052由限定基部7054在凹陷部7052内的移动的侧壁限定。当击发驱动装置7050围绕纵向轴线7090旋转时，驱动凹陷部7052的侧壁接触基部7054并且推动驱动构件7056通过狭槽7051。如上所述，狭槽7051在其曲率半径上具有一个或多个变化，并且当击发构件7056移动通过此类变化时，击发构件7056的基部7054可在驱动凹陷部内滑动。
如上所述，顺序地部署第一或内钉排中的钉，并且然后顺序地部署第二或外钉排中的钉。例如，此类实施方案可在向外缝合之前控制结肠的内周边。在其他实施方案中，顺序地部署外钉排中的钉，并且然后顺序地部署内钉排中的钉。此类实施方案可在向内缝合之前在结肠组织中建立边界。
在各种实例中，除了上述以外，第一钉7070a和第二钉7070b具有相同的未成形高度。在至少一个此类实例中，第一钉7070a和第二钉7070b成形为相同的成形高度。在其他此类实例中，第一钉7070a成形为第一成形高度，并且第二钉7070b可成形为不同于第一成形高度的第二成形高度。在至少一个此类实例中，内钉排的第一成形高度比外钉排的第二成形高度短。例如，此类布置可在缝合组织和未缝合组织之间提供更平缓的过渡。在其他实例中，内钉排的第一成形高度比外钉排的第二成形高度高。例如，此类布置可允许缝合的肠的最内部组织例如更加柔性。
在某些实例中，除了上述以外，第一钉7070a具有第一未成形高度，并且第二钉7070b具有不同于第一未成形高度的第二未成形高度。在至少一个此类实例中，第一钉7070a和第二钉7070b成形为相同的成形高度。其他此类实例中，第一钉7070a成形为第一成形高度，并且第二钉7070b成形为不同于第一成形高度的第二成形高度。
端部执行器7000具有两个环形钉排；然而，端部执行器可具有任何合适数量的环形钉排。例如，端部执行器可具有三个环形钉排。在至少一个此类实例中，第一环形排中的钉可具有第一未成形钉高度，第二环形排中的钉可具有第二未成形钉高度，并且第三环形排中的第三钉可具有第三未成形钉高度。此外，在至少一个此类实例中，第一环形排中的钉可具有第一变形钉高度，第二环形排中的钉可具有第二变形钉高度，并且第三环形排中的第三钉可具有第三变形钉高度。
图100-105中示出了击发驱动装置7150。击发驱动装置7150包括能够围绕纵向轴线旋转的可旋转驱动轴7152。击发驱动装置7150还包括三级顺序驱动装置组件，该三级顺序驱动装置组件包括第一或内部驱动装置7154a、第二或中间驱动装置7154b以及第三或外部驱动装置7154c。驱动轴7152包括从其延伸的驱动销7151。驱动销7151在驱动装置7154a,7154b和7154c中的每一个中延伸穿过驱动狭槽。例如，第一驱动装置7154a包括限定在其中的第一驱动狭槽7153a，第二驱动装置7154b包括限定在其中的第二驱动狭槽7153b，并且第三驱动装置7154c包括限定在其中的第三驱动狭槽7153c。驱动狭槽7153a,7153b和7153c不具有相同的构型；然而，驱动狭槽7153a,7153b和7153c具有在驱动销7151处彼此对准或至少基本上对准的重叠构型。例如，驱动销7151处于图100中的未击发位置，并且驱动狭槽7153a,7153b和7153c与驱动销7151对准。
除了上述以外，图100示出了处于未击发位置的驱动装置7154a,7154b和7154c。现在参见图101，当驱动轴7152旋转通过其击发行程的第一部分时，驱动销7151旋转通过圆周路径，其中驱动销7151接合驱动狭槽7153a的侧壁并且朝远侧推动或凸出第一驱动装置7154a。具体地，驱动销7151在击发行程的第一部分期间还未朝远侧驱动所述驱动装置7154b和7154c。如在图100中可见，驱动狭槽7153b和7153c在击发行程的整个第一部分中与驱动销7151的圆周路径对准。当第一驱动装置7154a朝远侧移位时，第一驱动装置7154a被构造成能够击发第一环形钉排。
现在参见图102，当驱动轴7152旋转通过其击发行程的第二部分时，驱动销7151旋转通过圆周路径，其中驱动销7151接合驱动狭槽7153b的侧壁并且朝远侧推动或凸出第二驱动装置7154b。值得注意的是，驱动销7151在击发行程的第二部分期间还未朝远侧驱动所述驱动装置7154c。类似于上述内容，驱动狭槽7153a和7153c在击发行程的整个第二部分中与驱动销7151的圆周路径对准。第二驱动装置7154b被构造成能够当第二驱动装置7154b朝远侧移位时击发第二环形钉排。
现在参见图103，当驱动轴7152旋转通过其击发行程的第三部分时，驱动销7151旋转通过圆周路径，其中驱动销7151接合驱动狭槽7153c的侧壁并且朝远侧推动或凸出第三驱动装置7154c。类似于上述内容，驱动狭槽7153a和7153b在击发行程的整个第三部分中与驱动销7151的圆周路径对准。第三驱动装置7154c被构造成能够当第三驱动装置7154c朝远侧移位时部署切割构件；然而，在某些实施方案中，例如，第三驱动装置7154c可部署第三钉排。
由于上述内容，在第一钉击发阶段、第二钉击发阶段和组织切割阶段之间没有重叠。对它们按顺序定时。因此，使钉变形和切割组织所需的力在整个击发行程中扩展。此外，击发驱动装置7150在组织已经被缝合之前不能切割组织。设想到各种另选的实施方案，其中在第一钉击发阶段、第二钉击发阶段和/或组织切割阶段之间存在一些重叠。在至少一个此类实施方案中，驱动狭槽7153a,7153b和7153c的构型可适于使得在第一驱动装置7154a和第二驱动装置7154b的移动中存在部分重叠并且/或者在第二驱动装置7154b和第三驱动装置7154c的移动中存在部分重叠。
主要参见图103和图104，驱动装置7154a,7154b和7154c包括防止或至少抑制驱动装置7154a,7154b和7154c相对于彼此旋转的协同操作特征部。例如，第一驱动装置7154a包括定位在限定于第二驱动装置7154b中的纵向狭槽7156b中的纵向键7155a。键7155a和狭槽7156b被构造成能够允许第一驱动装置7154a相对于第二驱动装置7154b纵向滑动，但是阻止第一驱动装置7154a和第二驱动装置7154b之间的旋转运动。类似地，第二驱动装置7154b包括定位在限定于第三驱动装置7154c中的纵向狭槽7156c中的纵向键7155b。键7155b和狭槽7156c被构造成能够允许第二驱动装置7154b相对于第三驱动装置7154c纵向滑动，但是阻止第二驱动装置7154b和第三驱动装置7154c之间的旋转运动。
为了回缩驱动装置7154a,7154b和7154c，驱动轴7152在相反方向上旋转。在此类实例中，驱动轴7152顺序地接合驱动狭槽7153c的侧壁、驱动狭槽7153b的侧壁，然后驱动狭槽7153a的侧壁以将第三驱动装置7154c、第二驱动装置7154b和第一驱动装置7154a返回到其未击发位置(图100)。
图106中示出了击发驱动装置7250。击发驱动装置7250以与击发驱动装置7150类似的方式操作。击发驱动装置7250包括能够围绕纵向轴线旋转的驱动轴7252。驱动轴7252包括旋转通过击发行程的若干阶段的凸轮表面或斜坡7256。击发驱动装置7250还包括第一驱动装置7254a、第二驱动装置7254b和第三驱动装置7254c，当击发驱动装置7250旋转时，第一驱动装置7254a、第二驱动装置7254b和第三驱动装置7254c由驱动轴7252的凸轮7256接合。在击发行程的第一阶段中，凸轮7256接合限定在第一驱动装置7254a上的凸轮表面7255a，并且朝远侧驱动第一驱动装置7254a。在击发行程的第二阶段中，凸轮7256接合限定在第二驱动装置7254b上的凸轮表面7255b并且朝远侧驱动第二驱动装置7254b，并且在击发行程的第三阶段中，凸轮7256接合限定在第三驱动装置7254c上的凸轮表面7255c并且朝远侧驱动第三驱动装置7254c。
第一凸轮表面7255a比第二凸轮表面7255b短，并且因此，第一驱动装置7254a具有比第二驱动装置7254b短的击发行程。类似地，第二凸轮表面7255b比第三凸轮表面7255c短，并且因此，第二驱动装置7254b具有比第三驱动装置7254c短的击发行程。例如，此类布置可用于使不同的钉排成形为不同的成形高度。在其他实施方案中，驱动装置7254a,7254b和7254c可具有任何合适的击发行程。在至少一个实施方案中，例如，驱动装置7254a,7254b和7254c具有相同的击发行程。例如，此类布置可用于使不同的钉排成形为相同的成形高度。
图107是根据至少一个实施方案的与圆形外科缝合器械一起使用的钉仓4410的一部分的透视图。多种圆形外科缝合器械是已知的。例如，2015年8月26日提交的名称为“SURGICAL STAPLING CONFIGURATIONS FOR CURVED AND CIRCULAR STAPLINGINSTRUMENTS”的美国专利申请序列号14/836,110公开了各种圆形外科缝合器械布置，该文献全文以引用方式并入本文。2014年9月26日提交的名称为“CIRCULAR FASTENERCARTRIDGES FOR APPLYING RADIALLY EXPANDING FASTENER LINES”的美国专利申请序列号14/498,070还公开了各种圆形外科缝合器布置，该文献全文以引用方式并入本文。如那些参考文献中所讨论的，圆形外科缝合器通常包括框架组件，该框架组件包括附接部分，该附接部分被构造成能够将砧座可操作地联接到圆形外科缝合器。
一般来讲，砧座包括支撑钉成形凹坑的一根或多根环形线的砧座头部。砧座杆或套管针部分附接到砧座头部并且被构造成能够可移除地联接到圆形缝合器械的砧座附接部分。各种圆形外科缝合器械包括装置，该装置用于将砧座朝向和远离外科钉仓选择性地移动，使得目标组织可夹紧在砧座与外科钉仓的平台之间。外科钉仓将多个外科钉可移除地存储在其中的，所述多个外科钉被布置成与设置在砧座中的钉成形凹坑的布置对应的一个或多个环形阵列。钉可移除地储存在形成在钉仓中的对应钉腔内，并且被支撑在被可操作地接纳在圆形缝合器内的可选择性地移动的推杆组件的对应部分上。圆形缝合器还包括环形刀或切割构件，该环形刀或切割构件被构造成能够切割夹紧在砧座和钉仓之间的组织。
再次参见图107，钉仓4410包括限定环形仓平台表面4412的仓体4411。仓体4411包括间隔的内部钉腔4422的内环形排4420和间隔开的外部钉腔4442的外部环形排4440。如在图107中可见，内部钉腔4422相对于外部间隔的钉腔4442交错。被支撑在每个内部钉腔4422内的是内部外科钉4430并且被支撑在每个外部钉腔4442内的是外部外科钉4450。外部环形排4440中的外部钉4450可具有与内部环形排4420中的内部钉4430不同的特性。例如，如图108的实施方案中所示，外部钉4450具有未成形的“鸥翼”构型。具体地，每个外部钉4450包括从钉冠4452延伸的一对腿部4454,4464。每个腿部4454,4464分别包括从冠部4452延伸的竖直部分4456,4466。在一个实施方案中，竖直部分4456,4466可彼此平行。然而，在所示的布置中，竖直部分4456,4466彼此不平行。例如，所示布置中的冠部4452与竖直部分4456,4466之间的角度A1大于九十度。参见图108。关于钉构型的另外细节可在2014年6月30日提交的名称为“FASTENER CARTRIDGE COMPRISING NON-UNIFORM FASTENERS”的美国专利申请序列号14/319,008、美国专利申请公布2015/0297232中找到，其全部公开内容据此以引用方式并入本文。然而，其他竖直部分4456,4466可相对于冠部4452以其他角度进行布置。使竖直腿部4456,4466相对于冠部4452以大于90度的角度取向的一个优点是此类布置可有助于将钉临时保持在其对应的钉腔内。
至少一个腿部4454,4464包括向内延伸的端部部分。例如，在图108所示的实施方案中，每个腿部4454,4464包括向内延伸的腿部部分。在所示的布置中，腿部部分4458从竖直腿部部分4456向内延伸，并且腿部部分4468从竖直腿部部分4466向内延伸。如在图108中可见，腿部部分4458比腿部部分4468短。换句话讲，钉冠4452与腿部部分4458从竖直腿部部分4456向内成角度的点之间的距离HA大于钉冠4452与腿部4468从竖直腿部部分4466向内成角度的点之间的距离HC。因此，在至少一个实施方案中，距离HB小于长度HD。腿部部分4458相对于竖直腿部部分4556成角度的角度A2可等于腿部部分4468相对于竖直腿部部分4466成角度的角度A3，或者角度A2和A3可彼此不同。关于钉构型的另外细节可在2014年6月30日提交的名称为“FASTENER CARTRIDGE COMPRISING NON-UNIFORM FASTENERS”的美国专利申请序列号14/319,008、美国专利申请公布2015/0297232中找到，该文献以引用方式并入本文。
在至少一个实施方案中，每个内部外科钉4430可具有图108中所示的构型。如在图108中可见，内部外科钉4430具有冠部4432和从其延伸的两个竖直腿部4434,4436。竖直腿部4434,4436可从冠部4432相对垂直地延伸，或者他们可以可大于90度的角度A4延伸。此类布置可有助于将钉4430暂时保持在其对应的钉腔4422内。然而，竖直腿部4434,4436以不同的角度从冠部4432延伸。在一些实施方案中，角度A4彼此相等。在其他实施方案中，角度A4彼此不同。在所示的实施方案中，内部钉4430和外部钉4450各自具有相同的未成形高度UFH。内部钉4430和外部钉4450由常规的外科钉线材形成。在至少一个实施方案中，用于形成外部钉4450的钉线材的直径大于用于形成内部钉4430的钉线材的直径。在其他实施方案中，内部钉和外部钉可具有相同的直径，并且可由具有其他直径的线材形成。在一些布置中，内部钉和外部钉可由相同类型的钉线材形成。因此，在此类布置中，内部钉和外部钉的线材直径将是相同的。然而，在另一个实施方案中，内部钉和外部钉可具有相同的未成形形状/构型，但是由具有不同的线材直径的两个不同的钉线材形成。同样在至少一种布置中，每个外部钉4450的冠部宽度CWO大于每个内部钉4430的冠部宽度CWI。关于钉构型的另外细节可在2014年6月30日提交的名称为“FASTENER CARTRIDGE COMPRISING NON-UNIFORMFASTENERS(包括非均匀紧固件的紧固件仓)”的美国专利申请序列号14/319,008、美国专利申请公布2015/0297232中找到，该文献以引用方式并入本文。
返回到图107，钉仓4410包括在平台表面4412上方延伸的外边缘4414。在手术期间，临床医生可调整砧座相对于圆形缝合器的仓的位置。在至少一个此类实施方案中，钉仓4410还包括从平台表面4412延伸的平台特征部4416和4418。如可图107中可见，一系列内部平台特征部4416设置在钉腔4422的内排4420和中心设置的刀开口4413之间，刀或切割构件将在击发过程期间通过刀开口4413。如图107、图109和图110中所示，平台特征部4416可相对于内部钉腔和开口4413成形和定位。例如，每个内平台特征部4416均可具有与刀开口4413的壁共延的平坦壁部分4415以及与内部钉腔4422的排相邻的锥形或倾斜主体部分4417。参见图109和图110。在图107所示的实施方案中，平台特征部4416在两个相邻的内部钉腔4422之间的间隙中进行取向，并且如图所示在成对的钉腔4422之间交错。该系统中的腔延伸布置或平台特征部可用于降低平坦平台仓中通常遇到的压力。本文所公开的布置也可有助于减轻组织移动和滑移。由于组织的滑移通常是不期望的，因此外侧直径保持特征部可更大并且更多。当刀片靠近内侧内径时，内径特征部可用于增加组织张力/剪切力，这可使系统更好地切割。然而，平台特征部4416可具有不同的形状和构型，并且可位于平台表面4412上的不同位置中。
如在图107、图109和图110中也可见，每隔一个外部钉腔4442包括与其每个端部相关联的外部平台特征部4418。当钉4450从钉仓4410射出时，外部平台特征部4418在平台表面4412上方延伸并且将外部钉4450朝向砧座引导。在此类实施方案中，外部钉4450可不在外部平台特征部4418上方延伸，直到他们被击发构件朝向砧座移动。主要参见图107，在至少一个实施方案中，外部平台特征部4418不围绕整个对应的外部钉腔4442延伸。第一外部平台特征部4418定位成邻近对应的外部腔4442的第一端部，并且第二外部平台特征部4418定位成邻近外部腔4442的第二端部。如图107中可见，外部平台特征部4418与外部钉腔4442中的每隔一个相关联。此类布置可用于降低总体压力并且最小化组织拉伸和移动。然而，在其他实施方案中，第一外部平台特征部4418和第二外部平台特征部4418可与外部钉腔4442中的每一个相关联。在其他实施方案中，外部平台特征部可围绕对应的外部腔的整个周边延伸。如在图109中可见，内部平台特征部4416比外部平台特征部4418短。换句话讲，每个内部平台特征部在平台表面4412上方突出一定距离，该距离小于每个外部平台特征部4418在平台表面4412上方突出的距离。每个外部平台特征部可在平台表面4412上方突出与外边缘4414在平台表面4412上方突出相同的距离。另外，如图109中也可见，每个外部平台特征部4418具有大致圆锥形或锥形的外部轮廓，该外部轮廓可有助于在将缝合器头部插入穿过患者的结肠和直肠期间防止组织在平台特征部上钩住。
上述平台特征部可提供一个或多个优点。例如，直立的外边缘可有助于防止组织跨仓平台滑动。该直立的边缘还可包括高点和低点的重复图案，而不是一个连续的唇部成形物。内部直立特征部也可有助于将组织保持在刀片附近并且导致改善的切割。内部平台特征部可在每个腔之间，或者在另选的布置中，平台特征部可包括一个连续直立的唇部。可期望平衡台特征部的数量以使高力/压缩区域的数量最小化，同时获得期望量的组织固定。腔同心特征部可用于在钉腿从其突出的区域中最小化组织流动的附加目的。当钉腿射出并且过渡到由对应的成形凹坑组成的接纳砧座凹坑时，此类布置也便于期望的钉成形。此类局部凹坑特征部增大了低压缩区域，同时便于在钉仓离开仓时来自仓的腿部支撑。因此，此类布置使钉在其与砧座凹坑相交之前必须“跳跃”的距离最小化。组织流趋于从仓的中心径向向外增加。参见图118，改进的站立式外侧排延伸部具有当他们向上插入穿过结肠时储存组织的趋势，因为他是管。
图109和图110示出了结合砧座4480使用外科钉仓4410。砧座4480包括砧座头部部分4482，砧座头部部分4482可操作地支撑钉成形插入件或部分4484和刀垫圈4490。刀垫圈4490以与支撑在钉头部中的刀4492面对的关系被支撑。在所示的实施方案中，钉成形插入件4484由例如钢、不锈钢等制成，并且包含内部钉成形凹坑4486的内排和外部钉成形凹坑4488的外排。每个内部钉成形凹坑4486对应于内部钉腔4422中的一个，并且每个外部钉成形凹坑4488对应于外部钉腔4442中的一个。在所示的布置中，当砧座4480相对于仓平台表面4412移动到其击发位置时，内部钉成形凹坑4486比外部钉成形凹坑4488更靠近仓平台表面4412。换句话讲，第一钉成形部分4485与钉仓平台表面4412之间的第一间隙g1或第一钉成形距离小于第二钉成形部分4487与钉仓平台表面4412之间的第二间隙g2或第二钉成形距离。
如在图109和图110中进一步可见，内部钉4430各自在推动器组件4500的对应的内部驱动装置部分4502上被支撑在其对应的内部钉腔4422内，并且外部钉4450中的每一个在对应的外部驱动装置部分4504上被支撑在他们对应的外部钉腔4442内。推动器组件4500朝向砧座4480推进将使内部钉4430和外部钉4450被驱动成与他们各自对应的钉成形凹口4486,4488形成接触，如图110所示。另外，刀4492朝远侧推进穿过夹紧在砧座4480和平台表面4412之间的组织，并且穿过刀垫圈4490的易碎底部4491。此类布置用于向外部钉4450提供比内部钉4430的成形高度FHI大的成形高度FHO。换句话讲，外部钉4450的外排4440成形为更大的“B”成形物，从而产生更大的捕获体积和/或更高的钉成形高度，以减轻外钉排4440附近的高组织压缩。更大的B成形物也可改善朝向这些内排流动的血流。在各种实例中，外部钉4450的外排4440通过利用更大的钉冠、钉腿宽度和/或钉腿厚度而包括更大的展开阻力。
每个钉排中使用的钉的数量可变化。在一个实施方案中，例如，存在比内部钉4430更多的外部钉4450。另一个实施方案使用比外部钉4450更多的内部钉4430。在各种实例中，外部钉4450的线材直径大于内部钉4430的线材直径。内部钉4430和外部钉4450可具有相同的未成形高度UFH。外部钉4450的外排4440中的冠部宽度CWO大于内部钉4430的内排4420的冠部宽度CWI。外部钉4450的鸥翼构型采用位于与他们相应的冠部相距不同距离处的弯曲。借助均匀的驱动装置或推动器行程使用具有平坦的(非台阶的)仓平台表面4412的台阶式砧座构型产生具有不同成形高度的钉。
图111示出了另一个钉仓实施方案4610。如在图111中可见，钉仓4610包括仓平台4612，仓平台4612包括间隔的内部钉腔4622的内部环形排4620和外部间隔的钉腔4642的外部环形排4640。如在图111中可见，内部钉腔4622相对于外部间隔的钉腔4642交错。被支撑在每个内部钉腔4622内的是内部外科钉4630并且被支撑在每个外部钉腔4642内的是外部外科钉4650。另外，外边缘4614在平台表面4612上方延伸。在各种实施方案中，除了上述以外，钉4630,4650不会在平台表面4612上方突出，直到他们通过击发构件朝向砧座移动。此类实施方案可经常利用小钉，该小钉相对于他们储存在其中的相应钉腔的深度。在其他实施方案中，当钉处于其未击发位置时，钉的腿部在平台表面4612上方突出。在至少一个此类实施方案中，钉仓4610还包括从平台表面4612延伸的平台特征部4616和4618。
如在图111也可见，每隔一个内部钉腔4622包括与其每一端部相关联的内部平台特征部4616。当对应的内部钉4630从钉仓4610射出时，内部平台特征部4616在平台表面4612上方延伸并且将对应的内部钉4630朝向砧座引导。在此类实施方案中，内部钉4630可不在内部平台特征部4616上方延伸，直到他们被击发构件朝向砧座移动。在所示的示例中，内部平台特征部4616不围绕整个对应的内部钉腔4622延伸。第一内部平台特征部4616定位成邻近对应的内部腔4622的第一端部，并且第二内部平台特征部4616定位成邻近内部腔4622的第二端部。然而，在其他实施方案中，内部平台特征部4416可与内部钉腔4622中的每一个相关联。在其他实施方案中，内部平台特征部可围绕对应的内部钉腔的整个周边延伸。通过在其中他们与每隔一个腔相关联的同心图案中采用具有不同高度的平台特征部可提供更低压力的组织间隙区域，同时平衡他们以尽可能长地引导尽可能多的钉腿。换句话讲，此类布置可最小化组织流的量，从而减少施加到目标组织的压力的总量。
仍然参见图111，每个外部钉腔4642包括与其每个端部相关联的外部平台特征部4618。当钉4650从钉仓4610射出时，外部平台特征部4618在平台表面4612上方延伸并且将外部钉4650朝向砧座引导。在此类实施方案中，外部钉4650可不在外部平台特征部4618上方延伸，直到他们被击发构件朝向砧座移动。如在图111中可见，在所示的示例中，外部平台特征部4618不围绕整个对应的外部钉腔4642延伸。第一外部平台特征部4618定位成邻近对应的外部腔4642的第一端部，并且第二外部平台特征部4618定位成邻近外部腔4642的第二端部。如在图111中可见，外部平台特征部4618与外部钉腔4642中的每一个相关联。然而，在其他实施方案中，第一外部平台特征部4618和第二外部平台特征部4418可与外部钉腔4642中的每隔一个相关联。在其他实施方案中，外部平台特征部可围绕对应的外部腔的整个周边延伸。如在图112和图113中可见，内部平台特征部4616和外部平台特征部4618在平台表面4612上方延伸相同距离。换句话讲，他们具有相同的高度。另外，如图112和图113中也可见，每个内部平台特征部4416和每个外部平台特征部4618具有大致圆锥形或锥形的外部轮廓，该外部轮廓可有助于在将缝合器头部插入穿过患者的结肠和直肠期间防止组织在平台特征部上钩住。
图112和图113示出了结合砧座4680使用外科钉仓4610。砧座4680包括砧座头部部分4682，砧座头部部分4482可操作地支撑钉成形插入件或部分4684和刀垫圈4690。刀垫圈4690以与支撑在钉头部中的刀4692面对的关系被支撑。在所示的实施方案中，钉成形插入件4684由例如钢、不锈钢等制成，并且包含内部钉成形凹坑4686的内排和外部钉成形凹坑4688的外排。每个内部钉成形凹坑4686对应于内部钉腔4622中的一个，并且每个外部钉成形凹坑4688对应于外部钉腔4642中的一个。在所示的布置中，内部钉成形凹坑4686定位成与平台表面4612相距与外部钉成形凹坑4688相同的距离。
如在图112和图113中进一步可见，内部钉4630在推动器组件4700的对应的内部驱动装置部分4702上被支撑在对应的内部钉腔4622内。外部钉4650在对应的外部驱动装置部分4704上被支撑在对应的外部钉腔4642内。推动器组件4700朝向砧座4680推进将使内部钉4630和外部钉4650被驱动成与他们各自对应的钉成形凹口4686,4688形成接触，如图113所示。另外，刀4692朝远侧推进穿过夹紧在砧座4680和平台表面4612之间的组织，并且穿过刀垫圈4690的易碎底部4691。在图112和图113中所示的示例中，每个内部钉4630由具有第一线材直径D1并且具有第一未成形高度L1的第一钉线材形成。例如，第一线材直径D1可为大约0.0079”-0.015”(增量通常为0.0089”、0.0094”和0.00145”)并且第一未成形高度L1可为大约0.198”-0.250”。每个外部钉4650由第二钉线材形成，该第二钉线材具有第二线材直径D2并且具有第二未成形高度L2。在图112和图113中所示的实施方案中，D1<D2并且L1<L2。然而，如在图113中可见，内部钉4630和外部钉4650形成有相同的成形高度FH。相比于较小直径的内钉排相比，外侧上的较厚的线材钉趋于提供高撕裂强度和破裂强度，这趋于保持更好的止血。换句话讲，更紧密的内钉排可更好地保持止血，而较少压缩的外钉排可促进更好的愈合和血液流动。此外，具有较长腿部的钉即使在与具有较短腿部的钉的相同高度处形成时也可确保更多的B弯曲，这可使较长腿的钉更强并且更可能适当地形成以足以在高负载条件下保持。每个钉排中使用的钉的数量可变化。在一个实施方案中，例如，内排4620具有与外部钉4650的外排4640相同数量的内部钉4630。在各种布置中，钉4650的冠部宽度大于内部钉4630的冠部宽度。在其他实施方案中，钉4630,4650可具有相同的冠部宽度。在其他布置中，钉4630,4650可以是上述鸥翼式设计。例如，钉的至少一个腿部可包括向内弯曲的端部部分，或者两个腿部可包括彼此向内弯曲的端部部分。此类钉可用于内部环形排或外部环形排中或内部环形排或外部环形排两者中。
图114示出了包括仓平台4812的另一个圆形钉仓实施方案4810，仓平台4812包括三个间隔开的钉腔的环形排4820,4840,4860。内排或第一排4820包含各自以第一角度布置的第一多个内部钉腔或第一钉腔4822。每个内部钉腔4822在其中可操作地支撑对应的内部钉或第一钉4830。内部腔4822相对于切向方向以相同的均匀角度对第一钉4830进行取向。在所示的示例中，每个内部钉4830由具有第一钉直径D1的第一钉线材形成。在一个示例中，第一钉线材直径D1可为大约0.0079”-0.015”(增量通常为0.0089”、0.0094”和0.00145”)。参见图117，每个内部钉4830包括第一冠部4832和两个第一腿部4834。第一冠部具有第一冠部宽度C1，并且每个第一腿部4834具有第一未成形腿部长度L1。在一个示例中，第一冠部宽度C1可为大约0.100”-0.300”，并且第一未成形腿部长度L1可为大约0.198”-0.250”。第一腿部4834可各自相对于第一冠部4832以角度A1进行布置。角度A1可为大约90°或者其可略微大于90°，使得第一腿部4834略微向外张开，以有助于将第一钉4830保持在其对应的第一钉腔4822中。
转到图115和图116，钉仓4810旨在结合砧座4900使用，砧座4900包括第一钉成形凹坑4904的交错的或成角度的第一对4903的两个内排或第一排4902。第一钉成形凹坑4904的每个第一对4903对应于一个第一钉4830。第一钉成形凹坑4904对应于一个第一钉腿4834，并且对4903的另一个第一钉成形凹坑4904对应于另一个第一钉腿4834。此类布置用于建立成形钉构型，其中第一钉4830的第一钉腿4834与该特定第一钉4830的第一冠部4832形成在平面外，使得一个第一腿部4834形成在第一冠部4832的一个侧面上，并且另一个第一腿部4834形成在第一冠部4832的另一个侧面上。相对于图115中的第一钉成形凹坑4904中的一些示出了该“三维”成形的钉构型。
如在图116中最具体地可见，仓平台4812具有“台阶式”构型。仓平台4812包括与内部或第一钉腔4822的内部或第一环形排4820对应的内部或第一仓平台部分4814。如在图116中进一步可见，当砧座4900移动到闭合或夹紧位置时，包含第一钉成形凹坑4904的砧座4900的部分与平台部分4814间隔开第一间隙距离g1。
再次参见114、图116和图117，中间或第二排4840包含各自以第二角度布置的第二多个中间或第二钉腔4842。每个中间钉腔4842在其中可操作地支撑对应的中间或第二钉4850。中间腔4842相对于切向方向以相同的均匀的第二角度对中间或第二钉4850进行取向。然而，第二角度不同于第一角度。换句话讲，当第一钉和第二钉被支撑在其相应的第一腔和第二腔中时，每个第一钉4830的第一冠部的轴线在延伸时最终将与相邻的第二钉4850的第二冠部的延伸轴线相交。如在图116和图117中可见，每个第二或中间钉4850包括第二钉冠部或基部4852和两个第二腿部4854。钉基部4852可具有略呈矩形的横截面形状并且可由平坦的材料片形成。例如，第二钉腿4854可具有圆形横截面轮廓。第二或中间钉可包括例如2015年8月26日提交的名称为“SURGICAL STAPLING CONFIGURATIONS FOR CURVED ANDCIRCULAR STAPLING INSTRUMENTS”的美国专利申请序列号14/836,110中公开的各种钉构型，该文献全文以引用方式并入本文。具有从具有矩形横截面轮廓的钉基部部分延伸的圆形钉腿可提供没有优先弯曲平面的钉基部部分和钉腿。第二钉4850包括弯曲部分4856，在该弯曲部分处钉腿4854从钉基部部分4852延伸。弯曲部分4856可包括基本上正方形的横截面轮廓421。弯曲部分4856和钉基部部分4852各自的正方形轮廓和矩形轮廓向圆形钉腿4854提供刚性连接部和主链。圆形钉腿4854消除优先的弯曲平面，具有正方形、矩形、或任何带顶点的形状或非均匀形状横截面的钉腿可具有该优先的弯曲平面。第二钉腿4854中的每一个具有第二直径D2。在至少一个实施方案中，D2>D1。第二基部或冠部4852具有第二冠部宽度C2。在一种布置中，C2>C1。第二腿部4854可各自相对于第二基部或冠部4852以角度A2进行布置。角度A2可为大约90°或者其可略微大于90°，使得第二腿部4854略微向外张开，以有助于将第二钉4850保持在其对应的第二钉腔4842中。
转到图115和图116，砧座4900还包括第二钉成形凹坑4914的交错的或成角度的第二对4913的两个中间或第二排4912。第二钉成形凹坑4914的每个第二对4913对应于一个第二钉4850。一个第二钉成形凹坑4914对应于一个第二钉腿4854，并且对4913的另一个第二钉成形凹坑4914对应于另一个第二钉腿4854。此类布置用于建立成形钉构型，其中第二腿部4854与特定的第二钉4850的第二基部4852形成在平面外。相对于图115中的第二钉成形凹坑4914中的一些示出了该“三维”成形的钉构型。
如在图116中最具体地可见，仓平台4812还包括与中间或第二钉腔4842的中间或第二环形排4840对应的第二仓平台部分4816。如在图116中进一步可见，当砧座4900移动到闭合或夹紧位置时，包含第二钉成形凹坑4914的砧座4900的部分与平台部分4816间隔开第二间隙距离g2。在所示的示例中，g2>g1。
再次参见图114、图116和图117，外排或第三排4860包括第三多个外部钉腔或第三钉腔4862，该钉腔相对于第二钉腔4842设定尺寸，使得每个外部钉腔或第三钉腔4862跨越两个相邻的第二腔4842之间的距离。每个外部钉腔4862在其中可操作地支撑对应的外部钉或第三钉4870。外部腔4862将外部钉或第三钉4870取向成与圆周方向相切。如在图116和图117中可见，每个第三或外部钉4870包括第三钉冠部或基部4872和两个第三腿部4874。钉基部4872可具有略呈矩形的横截面形状并且可由平坦的材料片形成。例如，第三钉腿4874还可具有圆形横截面轮廓。第三或外部钉4870可包括例如2015年8月26日提交的名称为“SURGICAL STAPLING CONFIGURATIONS FOR CURVED AND CIRCULAR STAPLINGINSTRUMENTS”的美国专利申请序列号14/836,110中公开的各种钉构型，该文献全文以引用方式并入本文。具有从具有矩形横截面轮廓的钉基部部分延伸的圆形钉腿可提供没有优先弯曲平面的钉基部部分和钉腿。第三钉4870包括弯曲部分4876，在该弯曲部分处钉腿4874从钉基部部分4872延伸。弯曲部分4876可包括基本上正方形的横截面轮廓421。弯曲部分4876和钉基部部分4872各自的正方形轮廓和矩形轮廓向圆形钉腿4874提供刚性连接部和主链。圆形钉腿4874消除优先的弯曲平面，具有正方形、矩形、或任何带顶点的形状或非均匀形状横截面的钉腿可具有该优先的弯曲平面。在至少一个实施方案中，D3>D2。第三基部或冠部4872具有第三冠部宽度C3，并且每个第三腿部4874具有第三未成形的腿部长度L3。在一种布置中，C3>C2并且L3>L2。第三腿部4874可各自相对于第三基部或冠部4872以角度A3进行布置。角度A3可为大约90°或者其可略微大于90°，使得第三腿部4874略微向外张开，以有助于将第三钉4870保持在其对应的第三钉腔4862中。
转到图115和图116，砧座4900还包括外部钉成形凹坑或第三钉成形凹坑4918的外排4916。每个第三钉成形凹坑4918对应于一个第三钉4870。如在图116中最具体地可见，仓平台4812还包括第三仓平台部分4818，第三仓平台部分4818对应于外部钉腔或第三钉腔4862的外排或第三排4860。如在图116中进一步可见，当砧座4900移动到闭合或夹紧位置时，包含第三钉成形凹坑4918的砧座4900的部分与平台部分4818间隔开第二三间隙距离g3。在所示的示例中，g3>g2。如在图116中进一步可见，在至少一个实施方案中，组织厚度补偿件4920结合每个外部钉或第三钉4870使用。组织厚度补偿件可包括嵌入氧化再生纤维素(ORC)以促进止血的织造材料。组织厚度补偿件4920可包括2014年2月24日提交的名称为“IMPLANTABLE LAYER ASSEMBLIES”的美国专利申请序列号14/187,389、美国专利申请公布2015/0238187中公开的各种组织厚度补偿件布置中的任一个，这些文献的全部公开内容据此以引用方式并入本文。如在图116中可见，组织厚度补偿件4920具有指定为“a”的厚度。在一个实施方案中，组织厚度补偿件具有大约0.015”-0.045”的厚度。然而，可采用其他厚度。
因此，在如图114-117中所描绘的至少一个实施方案中，钉仓4810可使用三个钉排中的每一个中不同数量的钉。在一种布置中，内钉排包括具有最小线材直径和最短未成形腿部长度的常规钉。每个第一钉具有最短的冠部宽度，并且每个第一钉相对于切向方向以均匀的角度进行取向。中间钉具有的构型不同于第一钉构型。中间钉的每个腿部包括适度的线材直径和未成形的腿部长度。每个中间钉具有比内部钉的冠宽度略微大的冠部宽度，并且每个中间钉相对于切向方向以均匀的角度进行取向，但相对于内部内钉排以不同的角度进行取向。每个外部钉具有的构型类似于中间钉的构型。相比于内部钉和中间钉的腿部的线材直径，每个外部钉的第三腿部中的每一个包括最大的线材直径。每个外部钉的冠部宽度显著大于内部钉和中间钉的冠部宽度。每个外部钉与仓的圆周方向相切地取向。外钉排采用嵌入ORC以促进止血的织造组织厚度补偿件(间隔织物)。台阶式砧座和台阶式仓平台产生不同的成形钉高度，其中具有最短成形高度的钉在内排中，并且具有最长成形高度的钉在外排中。对应于内钉排和中间钉排的砧座凹坑“倾斜”，以在内排和中间排中产生三维钉。“浴缸类型”砧座凹坑对应于外钉排。在至少一个实施方案中，可顺序地击发钉。例如，可首先击发内排和中间排中的钉，然后击发外排中的钉。环形刀在击发过程期间切割所夹紧的组织。
如本公开的各种实施方案中所述，圆形缝合器械包括砧座和钉仓。砧座和钉仓中的一个或两个可相对于另一个在打开构型和闭合构型之间移动，以在其间捕获组织。钉仓将钉容纳或至少部分地容纳在钉腔的圆形排内。钉从他们各自的钉腔以圆形排布置到捕获的组织中并且抵靠砧座中的成形凹坑的对应的圆形排成形。击发驱动装置被构造成能够在击发驱动装置的击发行程期间从钉仓射出钉。
圆形缝合器械的砧座通常包括组织压缩表面和限定在组织压缩表面中的钉成形凹坑的环形阵列。砧座还包括附接安装件和从附接安装件延伸的杆。杆被构造成能够可释放地附接到圆形缝合器械的闭合驱动装置，使得砧座可朝向和远离圆形缝合器械的钉仓移动。
钉仓和砧座可单独地在患者体内行进，并且在外科区域处组合。在各种实例中，钉仓例如行进通过患者的狭窄的管状主体诸如例如结肠。钉仓可包括多个组织接触特征部诸如台阶式平台和凹坑扩展部。为了在钉仓朝向目标组织行进时避免对患者的无意伤害，本公开尤其呈现对若干组织接触特征部的各种修改。
参见图118，局部剖视图示出了在钉仓15500在患者身体内行进时压靠组织(T)的圆形外科器械的钉仓15500。修改钉仓15500的多个结构特征部以产生特别轮廓的外框15502以保护组织。钉仓15500包括钉腔的多个环形排。在至少一个示例中，钉腔15510的外排15504至少部分地环绕钉腔15512的内排15506，如图118所示。钉腔15510和15512被构造成能够分别容纳钉15530和15531。
术语内部和外部描绘与中心轴线15533的关系。例如，内部组织接触表面15518比外部组织接触表面15516更靠近中心轴线15533。
如图119所示，钉仓15500包括台阶式仓平台15508。外排15504限定在台阶式仓平台15508的外部组织接触表面15516中，而内排15506限定在台阶式仓平台15508的内部组织接触表面15518中。外部组织接触表面15516从内部组织接触表面15518逐步下降，这产生梯度，该梯度在钉仓15500压靠组织时减小摩擦。
在某些实例中，外部组织接触表面15516平行或至少基本上平行于内部组织接触表面15518。在其他实例中，外部组织接触表面15516倾斜成使得由外部组织接触表面15516限定的第一平面横向于由内部组织接触表面15518限定的第二平面。在第一平面和第二平面之间限定角度。该角度可为锐角。在至少一个实例中，例如，该角度可以是选自大于约0°且小于或等于约30°的范围的任何角度。在至少一个实例中，例如，该角度可以是选自大于约5°且小于或等于约25°的范围的任何角度。在至少一个实例中，例如，该角度可以是选自大于约10°且小于或等于约20°的范围的任何角度。当钉仓15500相对于组织移动时，倾斜的外部组织接触表面15516可减少对组织的摩擦或钩住组织。在至少一个实例中，倾斜的外部组织接触表面15516也从内部组织接触表面15518逐步下降。
在至少一个实例中，当钉仓15500相对于组织移动时，外部组织接触表面15516的内部部分为平面的或至少基本上平坦的，而外部组织接触表面15516的外边缘15548是倾斜的、圆角的和/或斜面的，以减少对组织的摩擦或钩住组织。例如，钉腔15510驻留在外部组织接触表面15516的平面内部部分中。当组织钉仓15500相对于组织移动时，内部组织接触表面15518的外边缘15550也可以是倾斜的、斜面的和/或圆角的，以减少对组织的摩擦或钩住组织。
为了在外排15504的钉腔15510和内排15504的钉腔15512中容纳具有相同或至少基本上相同的未成形高度的钉，外排15504的钉腔15510包括凹坑扩展部15514。凹坑扩展部15514被构造成能够在钉15530从他们相应的钉腔15510被射出时控制并引导钉15530。在某些实例中，凹坑扩展部15514可被构造成能够容纳具有比内部组织接触表面15518的钉更大的未成形高度s的钉。
如图119所示，外排15504中的钉腔15510侧向对准或至少基本上对准，其中在内排15506中的两个相邻钉腔15512之间存在间隙15520。钉腔15510包括第一端部15522和第二端部15524。第二端部15524与两个连续钉腔15512中的一个的第一端部15526重叠，使得定位在第二端部15524处的钉腿15530a与定位在第一端部15526处的钉腿15531a径向对准或至少基本上对准，如图118所示。同样，钉腔15510的第一端部15522与两个连续钉腔15512中的另一个的第二端部15528重叠。
凹坑扩展部15514包括从外部组织接触表面15516突出的第一夹套15532，以隐藏延伸超出外部组织接触表面15516的钉腿15530a的尖端15536。第一夹套15532包括从第一端部15522突出的端部15538，延伸远离端部15538的内侧壁15540和外侧壁15542，以形成第一夹套15532。在至少一个实例中，第一护套15532限定或至少基本上限定在包括第一端部15522的钉腔15510的周边15535的一部分上延伸的“C”形壁。
为了减小对组织的摩擦，内侧壁15540从外部组织接触表面15516突出到比外侧壁15542更大的高度。换句话讲，外侧壁15542的高度低于内侧壁15540。此类布置产生从内侧壁15540平滑过渡到外侧壁15542至外部组织接触表面15516的梯度。在至少一个实施方案中，内侧壁15540和内部组织接触表面15518相对于外部组织接触表面15516包括相同的或至少基本上相同的高度。另选地，内侧壁15540和内部组织接触表面相对于外部组织接触表面15516包括不同的高度15518。在某些实例中，内侧壁15540相对于外部组织接触表面15516相对于内部组织接触表面15518的高度较低。此类布置产生用于从内部组织接触表面15518平滑过渡到内侧壁15540到外侧壁15542到外部组织接触表面15516的梯度。
内部组织接触表面15518、内侧壁15540、外侧壁15542和/或外部组织接触表面15516限定具有轮廓的外框架15502的离散部分；然而，如图118所示，此类部分保持足够靠近彼此，使得当钉仓15500压靠组织时，组织不能被捕获在其间。此外，部分中的一个或多个可包括倾斜的、具有轮廓的、弯曲的、倒圆的和/或斜面的外表面以减少对组织的摩擦。如图118所示，外侧壁15542的上表面15544和内侧壁15540的上表面15546是倾斜的、具有轮廓的、弯曲的、倒圆的和/或斜面的以限定具有轮廓的外部框架15502。
在至少一个实例中，上表面15544和上表面15546限定倾斜平面，该倾斜平面横向于由外部组织接触表面15516限定的第一平面和由内部组织接触表面15518限定的第二平面。在至少一个实例中，在倾斜平面与第一平面之间限定第一角度。也可在倾斜平面和第二平面之间限定第二角度。第一角度和第二角度可为相同或至少基本上相同的值。另选地，第一角度的值可不同于第二角度。在至少一个实例中，第一角度和/或第二角度为锐角。在至少一个实例中，例如，第一角度是选自大于约0°且小于或等于约30°的范围的任何角度。在至少一个实例中，例如，第一角度是选自大于约5°且小于或等于约25°的范围的任何角度。在至少一个实例中，例如，第一角度是选自大于约10°且小于或等于约20°的范围的任何角度。在至少一个实例中，例如，第二角度是选自大于约0°且小于或等于约30°的范围的任何角度。在至少一个实例中，例如，第二角度是选自大于约5°且小于或等于约25°的范围的任何角度。在至少一个实例中，例如，第二角度是选自大于约10°且小于或等于约20°的范围的任何角度。
除了上述以外，凹坑扩展部15514包括第二夹套15534，第二夹套15534在许多方面类似于第一夹套15532。类似于第一夹套15532，第二夹套15534从外部组织接触表面15516突出，以隐藏延伸超出外部组织接触表面15516的钉腿的尖端。第二夹套15534包括从第二端部15524突出的端部15538，从端部15538延伸的内侧壁15540和外侧壁15542，以形成第二夹套15534。
虽然在图119中示出一个凹坑扩展部15514，但是应当理解，例如，一个或多个其他凹坑扩展部15514可从外部组织接触表面15516突出。在至少一个实例中，例如，第一夹套15532和第二夹套15534通过侧壁连接以限定完全环绕钉腔的凹坑扩展部。
本文所述的许多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。在各种实例中，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。在某些实例中，本文公开的马达可包括机器人控制系统的一个或多个部分。此外，本文所公开的端部执行器和/或工具组件中的任一个可与机器人外科器械系统一起使用。图82A示意性地示出机器人外科器械系统20'；然而，名称为“SURGICAL STAPLINGINSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS”的美国专利申请序列号13/118,241(现为美国专利申请公布2012/0298719)更详细地公开了机器人外科器械系统的若干示例。
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，设想了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，还设想了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。
下述专利的全部公开内容据此以引用方式并入本文：
提交于1997年3月12日的名称为“LINEAR STAPLER WITH IMPROVED FIRINGSTROKE”的欧洲专利申请号12/795298；
公布于1997年2月25日的名称为“TRIGGER MECHANISM FOR SURGICALINSTRUMENTS”的美国专利5,605,272；
公布于1997年12月16日的名称为“LINEAR STAPLER WITH IMPROVED FIRINGSTROKE”的美国专利5,697,543；
提交于2005年11月10日的名称为“ARTICULATABLE SURGICAL INSTRUMENTCOMPRISING A FIRING DRIVE”的美国专利申请公布2005/0246881；
公布于2007年9月6日的名称为“METHOD FOR STAPLING TISSUE”的美国专利申请公布2007/0208359；
公布于1985年7月9日的名称为“DISPOSABLE LINEAR SURGICAL STAPLINGINSTRUMENT”的美国专利4,527,724；
公布于1992年8月11日的名称为“FAST CLOSURE DEVICE FOR LINEAR SURGICALSTAPLING INSTRUMENT”的美国专利5,137,198；
公布于1995年4月11日的名称为“FLEXIBLE SUPPORT SHAFT ASSEMBLY”的美国专利5,405,073；
公布于2013年1月29日的名称为“SURGICAL CUTTING AND STAPLING INSTRUMENTWITH SELF ADJUSTING ANVIL”的美国专利8,360,297；
提交于2015年7月30日的名称为“SURGICAL INSTRUMENT COMPRISING SYSTEMSFOR ASSURING THE PROPER SEQUENTIAL OPERATION OF THE SURGICAL INSTRUMENT”的美国专利申请序列号14/813,242；
提交于2015年7月30日的名称为“SURGICAL INSTRUMENT COMPRISING SEPARATETISSUE SECURING AND TISSUE CUTTING SYSTEMS”的美国专利申请序列号14/813,259；
提交于2015年7月30日的名称为“SURGICAL INSTRUMENT COMPRISING SYSTEMSFOR PERMITTING THE OPTIONAL TRANSECTION OF TISSUE”的美国专利申请序列号14/813,266；
提交于2015年7月30日的名称为“SURGICAL INSTRUMENT COMPRISING A SYSTEMFOR BYPASSING AN OPERATIONAL STEP OF THE SURGICAL INSTRUMENT”的美国专利申请序列号14/813,274；
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，现为美国专利申请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，现为美国专利号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，现为美国专利号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实施方案描述了各种装置，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，也可使用其他材料。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，在任何一种情况下，可以在至少一次使用之后修复设备以便重复使用。修复可包括以下步骤的任意组合，这些步骤包括但不限于拆卸装置、之后进行装置具体部件的清洁或更换、以及随后重新组装装置。具体地，修复设施和/或外科团队可拆卸装置，并且在清洁和/或更换装置的特定部件之后，可重新组装装置以供后续使用。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复装置均在本申请的范围内。
本文所公开的装置可在手术之前进行处理。首先，可获得新的或用过的器械，并且根据需要进行清洁。然后，可对器械进行消毒。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放置在可穿透容器的辐射场，诸如γ辐射、X射线和/或高能电子。辐射可杀死器械上和容器中的细菌。经消毒的器械随后可被储存在无菌容器中。密封容器可将器械保持为无菌的，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他技术对装置进行消毒，所述技术包括但不限于β辐射、γ辐射、环氧乙烷、等离子过氧化物和/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、公布或其他公开材料均仅在所并入的材料不与本发明所述的现有定义、陈述或其他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、陈述或其他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 (12)

1.一种外科器械组件，包括：
轴；
关节运动接头；
端部执行器，所述端部执行器围绕所述关节运动接头可旋转地连接到所述轴，其中所述端部执行器包括：
第一钳口；
第二钳口，所述第二钳口能够相对于所述第一钳口移动；
钉仓，所述钉仓包括可移除地储存在其中的多个钉；
砧座，所述砧座被构造成能够使所述钉变形；
驱动输入部；
闭合系统，所述闭合系统被构造成能够使所述第二钳口在打开位置和闭合位置之间移动；
钉击发系统，所述钉击发系统被构造成能够从所述钉仓射出所述钉；以及
传输装置，所述传输装置定位在所述端部执行器中，其中所述传输装置能够配置在三种操作状态：
闭合操作状态，在所述闭合操作状态中所述驱动输入部与所述闭合系统可操作地联接并且与所述钉击发系统可操作地脱离联接；
击发操作状态，在所述击发操作状态中所述驱动输入部与所述钉击发系统可操作地联接并且与所述闭合系统可操作地脱离联接；以及
第三操作状态，在所述第三操作状态中所述驱动输入部与所述闭合系统和所述钉击发系统可操作地联接，使得所述闭合系统和所述钉击发系统同时操作。
2.根据权利要求1所述的外科器械组件，其中，所述传输装置被构造成能够在所述传输装置处于所述闭合操作状态时锁定所述钉击发系统并且防止所述钉击发系统操作。
3.根据权利要求1所述的外科器械组件，其中，所述传输装置被构造成能够当所述传输装置处于所述击发操作状态时锁定所述闭合系统。
4.根据权利要求1所述的外科器械组件，其中，所述传输装置包括电动离合器，所述电动离合器被构造成能够使所述传输装置在所述闭合操作状态、所述击发操作状态和所述第三操作状态之间转变。
5.根据权利要求1所述的外科器械组件，其中，所述驱动输入部包括柔性可旋转轴，并且其中所述柔性可旋转轴延伸穿过所述关节运动接头。
6.根据权利要求1所述的外科器械组件，其中，所述钉仓包括多个同心钉腔，并且其中所述钉仓包括可替换钉仓。
7.一种外科器械组件，包括：
轴；
关节运动接头；
端部执行器，所述端部执行器围绕所述关节运动接头可旋转地连接到所述轴，其中所述端部执行器包括：
钉仓，所述钉仓包括可移除地储存在其中的多个钉；
砧座；
驱动输入部；
闭合系统，所述闭合系统被构造成能够闭合所述砧座；
钉击发系统，所述钉击发系统被构造成能够从所述钉仓射出所述钉；以及
传输装置，所述传输装置定位在所述端部执行器中，其中所述传输装置包括能够配置在三种操作配置中的电动离合器：
闭合操作配置，在所述闭合操作配置中所述电动离合器将所述驱动输入部与所述闭合系统可操作地联接，并且将所述驱动输入部与所述钉击发系统可操作地脱离联接；
击发操作配置，在所述击发操作配置中所述电动离合器将所述驱动输入部与所述钉击发系统电联接，并且将所述驱动输入部与所述闭合系统可操作地脱离联接；以及
第三操作配置，在所述第三操作配置中所述电动离合器将所述驱动输入部与所述闭合系统和所述钉击发系统电联接，使得所述闭合系统和所述钉击发系统同时操作。
8.根据权利要求7所述的外科器械组件，其中，所述电动离合器被构造成能够在所述电动离合器处于所述闭合操作配置时锁定所述钉击发系统并且防止所述钉击发系统操作。
9.根据权利要求7所述的外科器械组件，其中，所述电动离合器被构造成能够当所述电动离合器处于所述击发操作配置时锁定所述闭合系统。
10.根据权利要求7所述的外科器械组件，其中，所述电动离合器包括拨动装置，所述拨动装置包括两个锁键。
11.根据权利要求7所述的外科器械组件，其中，所述驱动输入部包括柔性可旋转轴，并且其中所述柔性可旋转轴延伸穿过所述关节运动接头。
12.根据权利要求7所述的外科器械组件，其中，所述钉仓包括多个同心钉腔，并且其中所述钉仓包括可替换钉仓。
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