CN109310436A - 包括可切入组织支撑件的圆形缝合系统 - Google Patents

包括可切入组织支撑件的圆形缝合系统 Download PDF

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Publication number
CN109310436A
CN109310436A CN201780034454.2A CN201780034454A CN109310436A CN 109310436 A CN109310436 A CN 109310436A CN 201780034454 A CN201780034454 A CN 201780034454A CN 109310436 A CN109310436 A CN 109310436A
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China
Prior art keywords
nail
tissue
end effector
anvil block
patent application
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CN201780034454.2A
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CN109310436B (zh
Inventor
A·K·纳拉加特拉
J·L·哈里斯
F·E·谢尔顿四世
J·R·摩根
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Angiotech Pharmaceuticals Inc
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Angiotech Pharmaceuticals Inc
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Priority claimed from PCT/US2017/024459 external-priority patent/WO2017172705A1/en
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Abstract

本发明公开了一种外科器械，该外科器械包括端部执行器。该端部执行器包括钉仓，该钉仓包括：包括环形阵列钉腔的仓体，可移除地储存在钉腔中的钉，被构造成能够从钉腔射出钉的击发驱动装置，以及被钉腔围绕的切割构件。该端部执行器还包括砧座，该砧座包括组织压缩表面、被构造成能够使钉变形的成形表面以及组织块。砧座能够朝向仓体移动以压缩仓体与组织块之间的组织，并且切割构件被构造成能够在切割构件的切割行程期间切入组织和组织块。

Description

包括可切入组织支撑件的圆形缝合系统
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加以理解：
图1为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为图1的外科器械的柄部组件的另一个透视图，其中柄部外壳的一部分被省略以暴露出容纳在其中的部件；
图3为图1和图2的外科器械的柄部组件的各部分的分解装配图；
图4为图2和图3的柄部组件的剖面透视图；
图5为图2至图4的柄部组件的局部剖面侧视图，其中以实线示出的柄部组件的握持部分相对于柄部组件的主外壳部分处于一个位置，而以虚线示出的柄部组件的握持部分则相对于柄部组件的主外壳部分处于另一位置；
图6为图2至图5的柄部组件沿图5的线6-6截取的端部剖视图；
图7为图2至图6的柄部组件沿图5的线7-7截取的另一端部剖视图；
图8为图2至图7的柄部组件的另一端部剖视图，其示出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为图2至图8的柄部组件的另一端部剖视图，其示出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为图2至图9的柄部组件的另一透视图，其中其某些部分以剖面示出，并且其接入面板部分以虚线示出；
图11为图2至图11的柄部组件的顶视图，其中应急系统被示出为处于可致动位置；
图12为图2至图11所示的应急系统的应急柄部的透视图；
图13为图12的应急柄部的各部分的分解装配图，其中其各部分以剖面示出；
图14为图11的柄部组件的剖面正视图；
图15示出根据至少一个实施方案的可互换工具组件的分解图；
图16为图15的可互换工具组件的透视图；
图17为图15的可互换工具组件的剖面透视图；
图18为图15的可互换工具组件的剖面分解图；
图19为图15的可互换工具组件的关节运动块的透视图；
图20为包括图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面透视图；
图21为图20的关节运动接头的另一剖面透视图；
图22为图15的可互换工具组件的局部分解图；
图23为图15的可互换工具组件的另一局部分解图；
图24为图20的关节运动接头的局部分解图；
图25为图15的可互换工具组件的近侧端部的剖面透视图；
图26为图15的可互换工具组件的端部图；
图27为图15的可互换工具组件的端部执行器沿图26的线27-27截取的剖视图，其示出处于夹持但未击发状态的端部执行器；
图28为图15的可互换工具组件的端部执行器沿图26的线28-28截取的剖视图，其示出处于夹持但未击发状态的端部执行器；
图29为图15的可互换工具组件的端部执行器沿图26的线29-29截取的剖视图，其示出处于夹持但未击发状态的端部执行器；
图30为被示出为处于拆卸状态的图15的可互换工具组件的端部执行器的剖视图；
图31示出沿第一方向进行关节运动的图15的可互换工具组件的端部执行器；
图32示出沿第二方向进行关节运动的图15的可互换工具组件的端部执行器；
图33为图15的可互换工具组件的仓体的透视图；
图34为根据至少一个另选实施方案的仓体的透视图；
图35为根据至少一个另选实施方案的可互换工具组件的端部执行器的分解图；
图36为图35的端部执行器的拆解图；
图37为根据至少一个另选实施方案的可互换工具组件的端部执行器的拆解图；
图38为根据至少一个另选实施方案的可互换工具组件的端部执行器的拆解图；
图39为示出根据至少一个实施方案的外科缝合器械的钉仓和轴的透视图；
图40为装配到图39的缝合器械上的钉仓的局部剖视图；
图41为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未处于完全伸出位置时防止砧座装配到闭合驱动装置；
图42为图41的外科缝合器械的局部剖视图，其示出附接到闭合驱动装置的砧座；
图43为外科缝合器械的局部透视图，该外科缝合器械包括钉仓和被构造成能够相对于钉仓移动砧座的闭合驱动装置；
图44为图43的缝合器械的局部剖视图，其示出被构造成能够在砧座未附接到闭合驱动装置时防止闭合驱动装置回缩的闭锁件；
图45为图44的缝合器械的局部剖视图，其示出附接到闭合驱动装置的砧座和与闭合驱动装置脱离接合的闭锁件；
图46为外科缝合器械的局部剖视图，该外科缝合器械包括具有可移除地储存在其中的钉的钉仓、砧座、被构造成能够相对于钉仓移动砧座的闭合驱动装置，以及被构造成能够从钉仓射出钉的击发驱动装置；
图47为闭锁件的细部图，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为与击发驱动装置脱离接合的图47的闭锁件的细部图；
图49为外科缝合器械的局部透视图，该外科缝合器械包括具有可移除地储存在其中的钉的钉仓、砧座、被构造成能够相对于钉仓移动砧座的闭合驱动装置，以及被构造成能够从钉仓射出钉的击发驱动装置；
图50为图49的外科缝合器械的闭锁件的细部图，该闭锁件被构造成能够在砧座向被捕获在砧座与钉仓之间的组织施加足够压力之前防止击发驱动装置被致动；
图51为与击发驱动装置脱离接合的图50的闭锁件的细部图；
图52为外科缝合器械的局部透视图，该外科缝合器械包括具有可移除地储存在其中的钉的钉仓、砧座、被构造成能够相对于钉仓移动砧座的闭合驱动装置，以及被构造成能够从钉仓射出钉的击发驱动装置；
图53为图52的外科缝合器械的闭锁件的细部图，该闭锁件被构造成能够在击发驱动装置的切割构件暴露于钉仓上方时防止砧座与闭合驱动装置分离；
图54为图53的闭锁件的细部图，该闭锁件在击发驱动装置于击发行程之后充分回缩后与砧座脱离接合；
图55为外科缝合器械的局部剖视图，该外科缝合器械包括具有可移除地储存在其中的钉的钉仓、砧座、被构造成能够相对于钉仓移动砧座的闭合驱动装置，以及被构造成能够从钉仓射出钉的击发驱动装置；
图56为图55的外科缝合器械的局部剖视图，其示出处于夹紧构型的闭合驱动装置以及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为未释放构型；
图57为图55的外科缝合器械的局部剖视图，其示出处于至少部分击发构型的击发驱动装置以及处于释放构型的图56的闭锁件；
图58为图55的外科缝合器械的局部剖视图，其示出处于伸展或打开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持的图56的闭锁件；
图59为外科缝合器械的剖视图，该外科缝合器械包括具有可移除地储存在其中的钉的钉仓、砧座、被构造成能够相对于钉仓移动砧座的闭合驱动装置，以及被构造成能够从被示出为禁用或闭锁构型的钉仓射出钉的击发驱动装置；
图59A为图59的外科缝合器械沿图59的线59A-59A截取的剖面端视图；
图60为图59的外科缝合器械的剖视图，其被示出为处于夹紧构型，在所述夹紧构型中击发驱动装置被启用；
图60A为图59的外科缝合器械沿图60中的线60A-60A截取的剖面端视图；
图61为外科缝合器械的局部剖视图，该外科缝合器械包括具有可移除地储存在其中的钉的钉仓、砧座、被构造成能够相对于钉仓移动砧座的闭合驱动装置，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为处于未夹紧构型，并且击发驱动装置被示出为处于不可操作的构型；
图62为图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为处于夹紧构型，并且击发驱动装置被示出为处于可操作的构型；
图63为图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为图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为弹簧系统的正视图，该弹簧系统被构造成能够将图64的击发轴偏置至与图63的中间驱动构件脱离接合；
图66为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为图66的端部执行器的局部剖视图，其示出被构造成能够在钉仓未完全装配到缝合器械时防止端部执行器被操作的闭锁件；
图68为图66的端部执行器的局部剖视图，其示出处于解锁构型的闭锁件；
图69为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为图69的端部执行器的局部剖视图，其示出被构造成能够将钉仓可释放地保持到缝合器械的锁；
图71为图69的端部执行器的局部剖视图，其示出处于解锁构型的锁；
图72示出外科缝合器械的轴，该轴被构造成能够与选自多个圆形钉仓的钉仓一起使用；
图73为图72的缝合器械的远侧端部的剖视图；
图74为外科缝合器械的局部剖视图，该外科缝合器械包括未击发钉仓和闭锁系统，该闭锁系统被构造成能够在先前已通过外科器械的击发驱动装置击发后防止钉仓被再次击发；
图75为被示出为处于夹紧构型的图74的缝合器械的局部剖视图，并且击发驱动装置处于击发构型；
图76为被示出为处于未夹紧构型的图74的缝合器械的局部剖视图，并且击发驱动装置处于回缩构型；
图77为图74的缝合器械的击发驱动装置和框架的端视图，其示出处于未击发构型的击发驱动装置；
图78为图74的缝合器械的击发驱动装置和框架的端视图，其示出处于回缩构型的击发驱动装置；
图79为可与图74的缝合器械一起使用的另选钉仓设计的端视图；
图80为可与图74的缝合器械一起使用的另选钉仓设计的端视图；
图81为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为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为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为图82所示的若干端部执行器的透视图；
图84为根据至少一个实施方案的砧座的透视图；
图85为图84的砧座的剖视图；
图86为图84的包括砧座的端部执行器的局部剖视图，其被示出为处于击发构型；
图87为根据至少一个实施方案的砧座的透视图；
图88为图87的砧座的平面图；
图89为根据至少一个实施方案的端部执行器的剖视图，其被示出为处于夹紧、未击发构型；
图90为被示出为处于击发构型的图89的端部执行器的剖视图；
图91为根据至少一个另选实施方案的端部执行器的剖视图，其被示出为处于夹紧、未击发构型；
图92为被示出为处于击发构型的图91的端部执行器的剖视图；
图93为根据至少一个另选实施方案的端部执行器的剖视图，其被示出为处于夹紧、未击发构型；
图94为被示出为处于击发构型的图91的端部执行器的剖视图；
图95为根据至少一个实施方案的钉成形凹坑的透视图；
图96为图95的钉成形凹坑的剖视图；
图97为根据至少一个实施方案的端部执行器的分解图，该端部执行器被构造成能够顺序地展开第一环形排钉和第二环形排钉；
图98为图97的端部执行器的局部剖视图，其示出在第一排钉中展开钉的击发驱动装置；
图99为图97的端部执行器的局部剖视图，其示出在第二排钉中展开钉的图98的击发驱动装置；
图100为击发驱动装置的局部透视图，该击发驱动装置被构造成能够顺序地驱动用于击发第一排钉的第一驱动器，用于击发第二排钉的第二驱动器，然后是用于驱动切割构件的第三驱动器；
图101为图100的击发驱动装置的局部透视图，其示出处于击发位置的第一驱动器；
图102为图100的击发驱动装置的局部透视图，其示出处于击发位置的第二驱动器；
图103为图100的击发驱动装置的局部透视图，其示出处于击发位置的第三驱动器；
图104为图100的击发驱动装置的分解图；
图105为处于图103的构型的图100的击发驱动装置的局部透视图；
图106为根据至少一个另选实施方案的击发驱动装置的分解图；
图107为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示出根据至少一个实施方案的处于未成形和成形构型的一对钉；
图109为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为在成形钉之后图109的砧座和图107的钉仓的另一剖视图；
图111为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为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为在成形钉之后图112的砧座和钉仓的另一剖视图；
图114为根据至少一个实施方案的钉仓的顶视图；
图115为根据至少一个实施方案的砧座的底视图；
图116为相对于外科钉仓的一部分的砧座的一部分的剖视图；
图117示出三个未成形的外科钉；
图118示出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 A SHIFTABLE TRANSMISSION”的美国专利申请序列号_______；代理人案卷号END7829USNP/150543；
-名称为“SURGICAL STAPLING SYSTEM CONFIGURED TO PROVIDE SELECTIVECUTTING OF TISSUE”的美国专利申请序列号_______；代理人案卷号END7830USNP/150544；
-名称为“SURGICAL STAPLING SYSTEM COMPRISING A CONTOURABLE 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 A GROOVED 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 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美国专利申请，这些专利申请于2015年12月31日提交且各自全文以引用方式并入本文：
-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美国专利申请，这些专利申请于2016年2月9日提交且各自全文以引用方式并入本文：
-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以下美国专利申请，这些专利申请于2016年2月12日提交且各自全文以引用方式并入本文：
-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 ARTICULATABLE SURGICAL 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 A STAPLE CARTRIDGEINTO A SURGICAL STAPLER”的美国专利申请序列号14/640,765；
-名称为“SIGNAL AND POWER COMMUNICATION SYSTEM POSITIONED ON AROTATABLE SHAFT”的美国专利申请序列号14/640,799；以及
-名称为“SURGICAL INSTRUMENT COMPRISING A LOCKABLE BATTERY HOUSING”的美国专利申请序列号14/640,780。
本申请的申请人拥有2015年2月27日提交并且各自全文以引用的方式并入本文的以下专利申请：
-名称为“SURGICAL INSTRUMENT SYSTEM COMPRISING AN INSPECTION STATION”的美国专利申请序列号14/633,576；
-名称为“SURGICAL APPARATUS CONFIGURED TO ASSESS WHETHER A PERFORMANCEPARAMETER OF THE SURGICAL APPARATUS IS WITHIN AN ACCEPTABLE PERFORMANCE BAND”的美国专利申请序列号14/633,546；
-名称为“SURGICAL CHARGING SYSTEM THAT CHARGES AND/OR CONDITIONS ONEOR MORE BATTERIES”的美国专利申请序列号14/633,576；
-名称为“CHARGING SYSTEM THAT ENABLES EMERGENCY RESOLUTIONS FORCHARGING A BATTERY”的美国专利申请序列号14/633,566；
-名称为“SYSTEM FOR MONITORING WHETHER A SURGICAL INSTRUMENT NEEDS TOBE SERVICED”的美国专利申请序列号14/633,555；
-名称为“REINFORCED BATTERY FOR A SURGICAL INSTRUMENT”的美国专利申请序列号14/633,542；
-名称为“POWER ADAPTER FOR A SURGICAL INSTRUMENT”的美国专利申请序列号14/633,548；
-名称为“ADAPTABLE SURGICAL INSTRUMENT HANDLE”的美国专利申请序列号14/633,526；
-名称为“MODULAR STAPLING ASSEMBLY”的美国专利申请序列号14/633,541；以及
-名称为“SURGICAL APPARATUS CONFIGURED TO TRACK AN END-OF-LIFEPARAMETER”的美国专利申请序列号14/633,562；
本申请的申请人拥有2014年12月18日提交并且各自全文以引用方式并入本文的以下专利申请：
-名称为“SURGICAL INSTRUMENT SYSTEMS COMPRISING AN ARTICULATABLE ENDEFFECTOR AND MEANS FOR ADJUSTING THE FIRING STROKE OF A FIRING”的美国专利申请序列号14/574,478；
-名称为“SURGICAL INSTRUMENT ASSEMBLY COMPRISING LOCKABLE SYSTEMS”的美国专利申请序列号14/574,483；
-名称为“DRIVE ARRANGEMENTS FOR ARTICULATABLE SURGICAL INSTRUMENTS”的美国专利申请序列号14/575,139；
-名称为“LOCKING ARRANGEMENTS FOR DETACHABLE SHAFT ASSEMBLIES WITHARTICULATABLE SURGICAL END EFFECTORS”的美国专利申请序列号14/575,148；
-名称为“SURGICAL INSTRUMENT WITH AN ANVIL THAT IS SELECTIVELY MOVABLEABOUT A DISCRETE NON-MOVABLE AXIS RELATIVE TO A STAPLE CARTRIDGE”的美国专利申请序列号14/575,130；
-名称为“SURGICAL INSTRUMENTS WITH IMPROVED CLOSURE ARRANGEMENTS”的美国专利申请序列号14/575,143；
-名称为“SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTORS ANDMOVABLE FIRING BEAM SUPPORT ARRANGEMENTS”的美国专利申请序列号14/575,117；
-名称为“SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTORS ANDIMPROVED FIRING BEAM SUPPORT ARRANGEMENTS”的美国专利申请序列号14/575,154；
-名称为“SURGICAL INSTRUMENT ASSEMBLY COMPRISING A FLEXIBLEARTICULATION SYSTEM”的美国专利申请序列号14/574,493；以及
-名称为“SURGICAL INSTRUMENT ASSEMBLY COMPRISING A LOCKABLEARTICULATION SYSTEM”的美国专利申请序列号14/574,500。
本申请的申请人拥有2013年3月1日提交并且各自全文以引用方式并入本文的以下专利申请：
-名称为“Articulatable Surgical Instruments With Conductive PathwaysFor Signal Communication”的美国专利申请序列号13/782,295，现为美国专利申请公布2014/0246471；
-名称为“Rotary Powered Articulation Joints For Surgical Instruments”的美国专利申请序列号13/782,323，现为美国专利申请公布2014/0246472；
-名称为“Thumbwheel Switch Arrangements For Surgical Instruments”的美国专利申请序列号13/782,338，现为美国专利申请公布2014/0249557；
-名称为“Electromechanical Surgical Device with Signal RelayArrangement”的美国专利申请序列号13/782,499，现为美国专利申请公布2014/0246474；
-名称为“Multiple Processor Motor Control for Modular SurgicalInstruments”的美国专利申请序列号13/782,460，现为美国专利申请公布2014/0246478；
-名称为“Joystick Switch Assemblies For Surgical Instruments”的美国专利申请序列号13/782,358，现为美国专利申请公布2014/0246477；
-名称为“Sensor Straightened End Effector During Removal ThroughTrocar”的美国专利申请序列号13/782,481，现为美国专利申请公布2014/0246479；
-名称为“Control Methods for Surgical Instruments with RemovableImplement Portions”的美国专利申请序列号13/782,518，现为美国专利申请公布2014/0246475；
-名称为“Rotary Powered Surgical Instruments With Multiple Degrees ofFreedom”的美国专利申请序列号13/782,375，现为美国专利申请公布2014/0246473；以及
-名称为“Surgical Instrument Soft Stop”的美国专利申请序列号13/782,536，现为美国专利申请公布2014/0246476。
本申请的申请人还拥有2013年3月14日提交并且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 A SAFETYPROCESSOR”的美国专利申请序列号14/226,071，现为美国专利申请公布2015/0272578；
-名称为“SURGICAL INSTRUMENT COMPRISING INTERACTIVE SYSTEMS”的美国专利申请序列号14/226,097，现为美国专利申请公布2015/0272570；
-名称为“INTERFACE SYSTEMS FOR USE WITH SURGICAL INSTRUMENTS”的美国专利申请序列号14/226,126，现为美国专利申请公布2015/0272572；
-名称为“MODULAR SURGICAL INSTRUMENT SYSTEM”的美国专利申请序列号14/226,133，现为美国专利申请公布2015/0272557；
-名称为“SYSTEMS AND METHODS FOR CONTROLLING A SEGMENTED CIRCUIT”的美国专利申请序列号14/226,081，现为美国专利申请公布2015/0277471；
-名称为“POWER MANAGEMENT THROUGH SEGMENTED CIRCUIT AND VARIABLEVOLTAGE PROTECTION”的美国专利申请序列号14/226,076，现为美国专利申请公布2015/0280424；
-名称为“SURGICAL STAPLING INSTRUMENT SYSTEM”的美国专利申请序列号14/226,111，现为美国专利申请公布2015/0272583；以及
-名称为“SURGICAL INSTRUMENT COMPRISING A ROTATABLE SHAFT”的美国专利申请序列号14/226,125，现为美国专利申请公布2015/0280384。
本申请的申请人还拥有2014年9月5日提交并且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 A SECOND 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 A SURGICALINSTRUMENT”的美国专利申请序列号14/248,586，现为美国专利申请公布2014/0305990；以及
-名称为“MODULAR MOTOR DRIVEN SURGICAL INSTRUMENTS WITH STATUSINDICATIONARRANGEMENTS”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，外科器械在许多取向和位置中使用，并且这些术语并不旨在限制性的和/或绝对的。
提供各种示例性装置和方法以用于执行腹腔镜式和微创外科手术操作。然而，读者将容易理解，本文所公开的各种方法和装置可用于多种外科手术和应用中，包括例如与开放式外科手术结合。继续参阅本具体实施方式，读者将进一步理解，本文所公开的各种器械能够以任何方式插入体内，诸如通过自然腔道、通过形成于组织中的切口或穿刺孔等。器械的工作部分或端部执行器部分可直接插入患者体内或者可通过具有工作通道的进入装置插入，外科器械的端部执行器和细长轴可通过所述工作通道推进。
外科缝合系统可包括轴和从轴延伸的端部执行器。端部执行器包括第一钳口和第二钳口。第一钳口包括钉仓。钉仓能够插入到第一钳口中并且能够从第一钳口移除；然而，设想到其中钉仓不能够从第一钳口移除或至少能够易于从第一钳口替换的其他实施方案。第二钳口包括被构造成能够使从钉仓射出的钉变形的砧座。第二钳口能够相对于第一钳口围绕闭合轴线枢转；然而，可设想到其中第一钳口能够相对于第二钳口枢转的其它实施方案。外科缝合系统还包括被构造成能够允许端部执行器相对于轴旋转或进行关节运动的关节运动接头。端部执行器能够围绕延伸穿过关节运动接头的关节运动轴线旋转。设想了不包括关节运动接头的其它实施方案。
钉仓包括仓体。仓体包括近侧端部、远侧端部和在近侧端部与远侧端部之间延伸的平台。在使用中，钉仓定位在待缝合的组织的第一侧上，并且砧座定位在组织的第二侧上。砧座朝向钉仓运动以将组织压缩并夹持抵靠平台。然后，可移除地储存在仓体中的钉可部署到组织中。仓体包括限定于其中的钉腔，其中钉可移除地储存在钉腔中。钉腔被布置成六纵向排。三排钉腔定位在纵向狭槽的第一侧上且三排钉腔定位在纵向狭槽的第二侧上。钉腔和钉的其它构造也是可以的。
钉由仓体中的钉驱动器支撑。驱动器能够在第一或非击发位置和第二或击发位置之间运动，以从钉仓射出钉。驱动器通过保持器保留在仓体中，保持器围绕仓体的底部延伸并且包括被构造成能够抓持仓体以及将保持器保持至仓体的弹性构件。驱动器能够通过滑动件在其非击发位置和其击发位置之间运动。滑动件能够在与近侧端部相邻的近侧位置和与远侧端部相邻的远侧位置之间运动。滑动件包括多个斜坡表面，该斜坡表面被构造成能够朝向砧座在驱动器下方滑动以及提升驱动器，并且钉在驱动器上受到支撑。
除上述以外，滑动件还可通过击发构件朝远侧运动。击发构件被构造成能够接触滑动件并朝向远侧端部推动滑动件。限定于仓体中的纵向狭槽被构造成能够接纳击发构件。砧座还包括被构造成能够接纳击发构件的狭槽。击发构件还包括接合第一钳口的第一凸轮和接合第二钳口的第二凸轮。在击发构件朝远侧推进时，第一凸轮和第二凸轮可控制钉仓的平台和砧座之间的距离或组织间隙。击发构件还包括被构造成能够切入捕获在钉仓和砧座中间的组织的刀。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示出可用于执行多种不同外科手术的马达驱动外科系统10。在例示的实施方案中，马达驱动外科系统10包括可选择性地重新构造的外壳或柄部组件20，该外壳或柄部组件附接到一种形式的可互换外科工具组件1000。例如，图1所示的系统10包括可互换外科工具组件1000，该可互换外科工具组件包括可被称为直线切割器的外科切割和紧固器械。如下文将进一步详细论述，可互换外科工具组件可包括端部执行器，该端部执行器适于支撑不同尺寸和类型的钉仓并且具有不同的轴长度、尺寸和类型等。例如，这种构造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。其它外科工具组件能够与柄部组件20可互换地使用。例如，可互换外科工具组件1000可与柄部组件20分离，并且用被构造成能够执行其它外科手术的不同外科工具组件代替。在其它构造中，外科工具组件可以不与其它外科工具组件可互换并且例如基本上包括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。外科工具组件可以是可重复使用的，或者在其它构型中，外科工具组件可被设计成在单次使用之后废弃。
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“外壳”和“外壳组件”也可以涵盖机器人系统的容纳或以其它方式可操作地支撑至少一个驱动系统的外壳或类似部分，所述至少一个驱动系统被构造成能够产生和施加可用于致动本文所公开的细长轴组件及其相应的等同物的至少一个控制动作。术语“框架”可指手持式外科器械的一部分。术语“框架”还可表示机器人控制的外科器械的一部分和/或机器人系统的可用于可操作地控制外科器械的一部分。例如，本文所公开的外科工具组件可与各种机器人系统、器械、部件和方法一起使用，诸如但不限于名称为“SURGICAL STAPLING INSTRUMENTS WITH ROTATABLESTAPLE 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，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，外壳组件或柄部组件20包括可由一对外壳片段40、70形成的主外壳部分30，该一对外壳片段可以由塑料、聚合物材料、金属等制成并通过适当的紧固件构造(例如，粘合剂、螺钉、压力配合特征部、按扣配合特征部、闩锁等)接合在一起。如下文将进一步详细论述，主外壳部分30可操作地支撑其中的多个驱动系统，这些驱动系统被构造成能够产生各种控制运动并将这些控制运动施加到可操作地附接到其上的可互换外科工具组件的对应部分。柄部组件20还包括握持部分100，该握持部分活动地联接到主外壳部分30并且被构造成能够在相对于主外壳部分30的各个位置由临床医生握持并操纵。握持部分100可以由一对握持片段110、120制成，该一对握持片段可以由塑料、聚合物材料、金属等制成并通过适当的紧固件构造(例如，粘合剂、螺钉、压力配合特征部、按扣配合特征部、闩锁等)接合在一起以用于装配和维护目的。
如在图2中可见，握持部分100包括限定中空腔体132的握持外壳130，该中空腔体被构造成能够可操作地支撑将在下文中进一步详细论述的驱动马达和齿轮箱。握持外壳130的上部部分134被构造成能够延伸穿过主外壳部分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限定被标记为“PA”的枢转轴线。参见图3。出于参考目的，柄部组件20限定被标记为“HA”的柄部轴线，该柄部轴线可平行于可操作地附接到柄部组件20的可互换外科工具的细长轴组件的轴心线“SA”。枢转轴线PA横向于柄部轴线HA。参见图1。这种构造使握持部分100能够围绕枢转轴线PA相对于主外壳部分30枢转到最适合联接到柄部组件20的可互换外科工具组件类型的位置。握持外壳130限定通常被标记为“GA”的握持轴线。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直线切割器时，临床医生可能希望将握持部分100相对于主外壳部分30定位，使得握持轴线GA垂直于或大致垂直于(角度“H1”)柄部轴线HA(在本文中称为“第一握持位置位置”)。参见图5。然而，如果柄部组件20用于控制包括例如圆形缝合器的可互换外科工具组件，临床医生可能希望使握持部分100相对于主外壳部分30枢转到其中握持轴线GA相对于柄部轴线HA呈四十五度或约四十五度角或其它合适锐角(角度“H2”)的位置。此位置在本文中被称为“第二握持位置”。图5以虚线示出处于第二握持位置的握持部分100。
现在参见图3至图5，柄部组件20还包括通常被标记为150的握持锁定系统，以将握持部分100相对于主外壳部分30选择性地锁定在期望的取向上。在一种构造中，握持锁定系统150包括尖齿154的弧形序列152。齿154彼此间隔开，并且在其间形成锁定沟槽156。每个锁定沟槽156对应于握持部分100的特定角度锁定位置。例如，在至少一种构造中，齿154和锁定沟槽或“锁定位置”156被布置成允许握持部分100在第一握持位置和第二握持位置之间以10-15度间隔锁定。该构造可采用两个止动位置，其针对所采用的器械类型(轴构造)进行调制。例如，对于直线切割器轴构造，其可与轴呈大致约九十度，并且对于圆形缝合器构造，该角度可为与轴呈约四十五度，同时朝向外科医生向前扫掠。握持锁定系统150还包括锁定按钮160，该锁定按钮具有被构造成能够锁定地接合锁定沟槽156的锁定部分。例如，锁定按钮160枢转地安装在主柄部部分30中在枢轴销131上，以允许锁定按钮160枢转至与对应的锁定沟槽156接合。锁定弹簧164用于将锁定按钮160偏置至与对应的锁定沟槽156的接合或锁定位置。锁定部分和齿构型用于在临床医生按压锁定按钮160时使齿154能够滑过锁定部分。因此，为了调节握持部分100相对于主外壳部分30的角度位置，临床医生按压锁定按钮160，然后将握持部分100枢转到期望的角度位置。一旦握持部分100被移动到期望位置，临床医生释放锁定按钮160。锁定弹簧164随后将锁定按钮160朝向齿154的序列偏置，使得锁定部分进入对应的锁定沟槽156以在使用期间将握持部分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各自由可操作地支撑在握持部分100中的马达200供电。如在图2中可见，例如，马达200被支撑在握持部分100中的腔体132内并且具有齿轮箱组件202，该齿轮箱组件具有从其突出的输出驱动轴204。在各种形式中，马达200例如可以是具有约25,000RPM的最大旋转的DC有刷驱动马达。在其它构造中，马达可包括无刷马达、无绳马达、同步马达、步进马达、或任何其它合适的电动马达。马达200可由功率源210供电，在一种形式中，该功率源可包括可移除电源组212。功率源210可包括例如在名称为“SURGICALINSTRUMENT 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功率源构造中的任一种，该专利申请的全部公开内容据此以引用方式并入本文。在例示的构造中，例如，电源组212可包括近侧外壳部分214，该近侧外壳部分被构造用于附接到远侧外壳部分216。近侧外壳部分214和远侧外壳部分216被构造成能够可操作地支撑其中的多个电池218。电池218可各自包括例如锂离子(“LI”)或其它合适的电池。远侧外壳部分216被构造成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通常也可在本文中称为“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的功率源。此外，功率源210可以是可替换的和/或可再充电的。在其它实施方案中，外科器械10可通过例如交流电(AC)供电。马达200可以由安装到握持部分100的摇臂开关206控制。
如上文所述，马达200可操作地联接到包括输出驱动轴204的齿轮箱组件202。驱动锥齿轮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和驱动锥齿轮230也可在本文中统称为“马达组件231”。驱动锥齿轮230与附接到系统驱动轴232的从动锥齿轮234以及轴颈连接在枢转轴180上的枢转锥齿轮238交接。从动锥齿轮234在接合位置与脱离位置之间可在系统驱动轴232上轴向运动，在接合位置从动锥齿轮234与驱动锥齿轮230啮合接合(图5)，在脱离位置从动锥齿轮234脱离与驱动锥齿轮230的啮合接合(图14)。驱动系统弹簧235在从动锥齿轮234与形成在系统驱动轴232的近侧部分上的近侧端部凸缘236之间轴颈连接。参见图4和图14。驱动系统弹簧235用于将从动锥齿轮234偏置至脱离与驱动锥齿轮230的啮合接合，如下文将进一步详细论述。枢转锥齿轮238有利于输出驱动轴204和驱动锥齿轮230随着握持部分100相对于主柄部部分30的枢转行进。
在所示示例中，系统驱动轴232与通常被标记为240的旋转驱动选择器系统交接。例如，在至少一种形式中，旋转驱动选择器系统240包括能够在第一旋转驱动系统300与第二旋转驱动系统320之间选择性地运动的移位器齿轮250。如在图6至图9中可见，例如，驱动选择器系统240包括不可活动地安装在主柄部部分30内的移位器安装板242。例如，移位器安装板242可以摩擦地保持在形成于外壳片段40、70中的安装凸耳(未示出)之间，或者通过螺钉、粘合剂等以其它方式保持在其中。仍然参见图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心或系统驱动齿轮237。例如，中心驱动齿轮237可通过键槽构造233附接到系统驱动轴232。参见图6至图9。在其它构造中，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的旋转将导致中心驱动齿轮234的旋转。
如在图3中可见，第一驱动系统300包括可旋转地支撑在远侧壁32中的第一驱动承窝302，该远侧壁形成于主柄部部分30中。第一驱动承窝302可包括第一主体部分304，该第一主体部分具有形成于其中的花键承窝。第一从动齿轮306形成在第一主体部分304上或不可活动地附接到该第一主体部分。第一主体部分304能够可旋转地支撑在设置在远侧壁32中的对应孔或通道中，或者其能够可旋转地支撑在安装在远侧壁32中的对应轴承(未示出)中。相似地，第二旋转驱动系统320包括同样可旋转地支撑在主柄部部分30的远侧壁32中的第二驱动承窝322。第二驱动承窝322可包括第二主体部分324，该第二主体部分具有形成于其中的花键承窝。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该第二主体部分。第二主体部分324能够可旋转地支撑在设置在远侧壁32中的对应孔或通道中，或者其能够可旋转地支撑在安装在远侧壁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的每个侧面上彼此间隔开。例如，参见图4。
如上所述，在所示示例中，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，该惰轮轴被活动地支撑在移位器安装板242中的弓形狭槽244中。移位器齿轮250被安装成以便在惰轮轴252上自由旋转并保持与中心驱动齿轮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与主柄部外壳30销接或以其它方式安装在一起，使得当移位器螺线管260被致动时，移位器齿轮250移动至与第一从动齿轮306或第二从动齿轮326中的一者啮合接合。例如，在一种构造中，当螺线管轴262回缩时(图6和图7)，移位器齿轮250与中心驱动齿轮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将移位器齿轮250偏置至第一致动位置。因此，如果外科器械10的功率损失，移位器弹簧266会将移位器齿轮250自动偏置至第一位置。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移动至与第二驱动承窝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论述，第一旋转驱动系统300和第二旋转驱动系统320可用于为联接到其上的可互换外科工具组件的各种组成部分供电。如上所述，在至少一种构造中，如果在可互换外科工具组件的致动期间马达的功率损失，则移位器弹簧266会将移位器齿轮250偏置到第一位置。根据可互换外科工具组件的被操作的组成部分，可能需要将旋转驱动运动的施加逆转到第一驱动系统300，以使可互换外科工具组件能够从患者体内移除。所示示例的柄部组件20采用通常被标记为330的可手动致动的“应急”系统，例如以在上述情况中将旋转驱动运动手动地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，该应急驱动系包括行星齿轮组件334。在至少一种形式中，行星齿轮组件334包括行星齿轮外壳336，该行星齿轮外壳容纳包括行星锥齿轮338的行星齿轮构造(未示出)。行星齿轮组件334包括应急驱动轴340，该应急驱动轴可操作地联接到行星齿轮外壳336内的行星齿轮构造。行星锥齿轮338的旋转使行星齿轮构造旋转，该行星齿轮构造最终使应急驱动轴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上轴向运动，还与其一起旋转。应急驱动齿轮342可在形成于应急驱动轴340上的弹簧止动凸缘344与形成于应急驱动轴340的远侧端部上的轴端部止动件346之间运动。应急轴弹簧348轴颈连接在应急驱动轴340上介于应急驱动齿轮342与弹簧止动凸缘344之间。应急轴弹簧348将应急驱动齿轮342朝远侧偏置在应急驱动轴340上。当应急驱动齿轮342处于其在应急驱动轴340上的最远侧位置时，其与不可旋转地安装到系统驱动轴232的应急从动齿轮350啮合接合。参见图14。
现在参见图12和图13，应急系统330包括有利于将应急驱动运动手动施加到应急驱动系332的应急致动器组件或应急柄部组件360。如在这些附图中可见，应急柄部组件360包括应急锥齿轮组件362，该应急锥齿轮组件包括应急锥齿轮364和棘轮齿轮366。应急柄部组件360还包括通过枢转地安装在棘轮齿轮366上的枢转轭372活动地联接到应急锥齿轮组件362的应急柄部370。应急柄部370通过销374枢转地联接到枢转轭372，以便在储存位置“SP”与致动位置“AP”之间选择性枢转行进。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。在至少一种构造中，例如，表示储存位置的轴线SP与表示致动位置的轴线AP之间的角度可为约三十度。参见图13。如同样在图13中可见，应急柄部组件360还包括棘轮爪378，该棘轮爪可旋转地安装在枢转轭372中的腔体或孔377中。棘轮爪378被构造成能够在沿致动方向“AD”旋转时啮合地接合棘轮齿轮366，然后在沿相反方向旋转时旋转以脱离啮合接合。棘轮弹簧384和球形构件386活动地支撑在枢转轭372中的腔体379中，并且用于在应急柄部370被致动(进行棘轮运动)时锁定地接合棘轮爪378中的卡位380、382。
现在参见图3和图10，应急系统330还包括可在打开位置与闭合位置之间操纵的应急接入面板390。在所示构造中，应急接入面板390被构造成能够可移除地联接到主外壳部分30的外壳片段70。因此，在至少该实施方案中，当应急接入面板390从主外壳部分30移除或与主外壳部分分离时，则认为处于“打开”位置，并且当应急接入面板390如图所示附接到主外壳部分30时，则认为处于“闭合”位置。然而，可设想其它实施方案，其中接入面板活动地联接到主外壳部分，使得当接入面板处于打开位置时，它保持附接到其上。例如，在此类实施方案中，接入面板可枢转地附接到主外壳部分或可滑动地附接到主外壳部分，并且可在打开位置与闭合位置之间进行操纵。在所示示例中，应急接入面板390被构造成能够卡扣地接合外壳片段70的对应部分以将其可移除地保持在“闭合”位置。也可使用其它形式的机械紧固件，诸如螺钉、销等。
无论应急接入面板390是可与主外壳部分30分离还是保持活动地附接到主外壳部分30，应急接入面板390包括各自从其背面突出或以其它方式形成于其上的驱动系统锁定构件或轭392和应急锁定构件或轭396。驱动系统锁定轭392包括驱动轴凹口394，该驱动轴凹口被构造成能够在应急接入面板390安装在主外壳部分30中(即，应急接入面板处于“闭合”位置)时将系统驱动轴232的一部分接纳在其中。当应急接入面板390被定位或安装在闭合位置时，驱动系统锁定轭392用于将从动锥齿轮234偏置至与驱动锥齿轮230啮合接合(与驱动系统弹簧235的偏置相对)。此外，应急锁定轭396包括应急驱动轴凹口397，该应急驱动轴凹口被构造成能够在应急接入面板390被安装或定位在闭合位置时将应急驱动轴340的一部分接纳在其中。如在图5和图10中可见，应急锁定轭396还用于将应急驱动齿轮342偏置至脱离与应急从动齿轮350的啮合接合(与应急轴弹簧348的偏置相对)。因此，当应急接入面板390被安装或处于闭合位置时，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。此外，应急锁定轭396包括柄部凹口398，以便接合应急柄部370并将其保持在储存位置SP中。
图4、图5和图10示出当应急接入面板390被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造。如在这些附图中可见，驱动系统锁定构件392将从动锥齿轮234偏置至与驱动锥齿轮230啮合接合。因此，当应急接入面板390被安装或处于闭合位置时，马达200的致动将导致驱动锥齿轮230的旋转以及最终系统驱动轴232的旋转。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偏置至脱离与系统驱动轴232上的应急从动齿轮350的啮合接合。因此，当应急接入面板390被安装或处于闭合位置时，驱动系统可由马达200致动，并且将应急系统330断开连接或防止其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接入面板390或以其它方式将应急接入面板390移动到打开位置。该动作使驱动系统锁定构件392不与从动锥齿轮234接合，从而允许驱动系统弹簧235将从动锥齿轮234偏置至脱离与驱动锥齿轮230的啮合接合。此外，移除应急接入面板390或将应急接入面板移动到打开位置也会导致应急锁定轭396与应急驱动齿轮342脱离接合，从而允许应急轴弹簧348将应急驱动齿轮342偏置至与系统驱动轴232上的应急从动齿轮350啮合接合。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。移除应急接入面板390或以其它方式将应急接入面板390移动到打开位置还允许柄部弹簧376将应急柄部370偏置到图11和图14所示的致动位置。当处于该位置时，临床医生可在棘轮方向RD上手动地将应急柄部370进行棘轮运动，这会导致棘轮锥齿轮364的旋转(例如，沿图14的顺时针方向)，最终导致将回缩旋转运动通过应急驱动系332施加到系统驱动轴232。临床医生可将应急柄部370进行多次棘轮运动，直到系统驱动轴232充分地旋转多次以回缩外科工具组件的外科端部执行器部分的附接到柄部组件20的部件。一旦应急系统330被充分地手动致动，临床医生可随后将应急接入面板390放回原位(即，将应急接入面板390返回至闭合位置)，从而使驱动系统锁定构件392将从动锥齿轮234偏置至与驱动锥齿轮230啮合接合，并且使应急锁定轭396将应急驱动齿轮342偏置至脱离与应急从动齿轮350的啮合接合。如上所述，如果功率损失或中断，移位器弹簧266会将移位器螺线管260偏置至第一致动位置。这样，应急系统330的致动将导致向第一旋转驱动系统300施加逆转或回缩运动。
如上所述，例如，外科缝合器械可包括被构造成能够回缩钉击发驱动装置的手动致动的应急系统。在许多实例中，应急系统可能需要操作和/或转动曲柄多于一次以完全回缩钉击发驱动装置。在所述实例中，缝合器械的用户可能会忘记他们已为应急装置转动多少次曲柄和/或换句话讲不清楚击发驱动装置需要回缩的距离。可设想各种实施方案，其中缝合器械包括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，并为外科器械的用户显示该距离的系统。
在至少一个实施方案中，外科缝合器械包括被构造成能够检测击发构件的位置的一个或多个传感器。在至少一个实例中，传感器包括例如霍尔效应传感器，并且可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。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，并且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。在所述实例中，例如，空进度条可表示击发构件处于其击发行程的结束处，并且满进度条可表示击发构件已完全回缩。在至少一个实例中，例如，0％可表示击发构件处于其击发行程的结束处，并且100％可表示击发构件已完全回缩。在某些实例中，控制器被构造成能够在显示器上显示将击发构件回缩至其完全回缩位置需要致动多少次应急机构。
除上述以外，应急机构的致动可将外科缝合器械的电池或功率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，应急机构的致动将切换开关，该开关使电池与电动马达电分离。这种系统将防止电动马达抵抗击发构件的手动回缩。
所示柄部组件20还支撑通常被标记为400的第三轴向驱动系统。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，以接纳可互换外科工具组件的驱动系统部件的可操作地附接到其上的对应部分。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或以其它方式与它们通信。在至少一种构造中，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。
如上所述，可重新构造的柄部组件20可有利地用于致动多种不同的可互换外科工具组件。为此，柄部组件20包括通常被标记为500的工具安装部分，以将可互换外科工具组件可操作地联接到其上。在所示示例中，工具安装部分500包括两个面向内的燕尾形接纳狭槽502，该狭槽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。每个燕尾形接纳狭槽502可以是渐缩的，或者换句话讲，可以略成V形。燕尾形接纳狭槽502被构造成能够可释放地接纳形成于可互换外科工具组件的工具附接喷嘴部分的一部分上的对应锥形附接或凸耳部分。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于柄部组件20的工具安装部分500中的对应保持凹坑504。
各种可互换外科工具组件可具有被构造成能够可操作地联接到第一旋转驱动系统310或与其交接的“主”旋转驱动系统，以及被构造成能够可操作地联接到第二旋转驱动系统320或与其交接的“二级”旋转驱动系统。主旋转驱动系统和二级旋转驱动系统可被构造成能够为构成可互换外科工具组件的一部分的特定类型的外科端部执行器的部分提供各种旋转运动。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且将二级旋转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还包括一对插入坡道506，其被构造成能够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二级旋转驱动系统的部分，以便于将主旋转驱动系统对准并可操作地联接到柄部组件20上的第一旋转驱动系统300，并且将二级旋转驱动系统对准并可操作地联接到柄部组件20上的第二旋转驱动系统320。
可互换外科工具组件还可包括用于向可互换外科工具组件的外科端部执行器的对应部分施加轴向运动的“三级”轴向驱动系统。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，该承窝被构造成能够在其中可操作地接纳三级轴向驱动系统的凸耳或其它部分。
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，但在某些其它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。轴部分2100包括例如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包括仓部分2222，该仓部分包括限定于其中的环形阵列钉腔2224和储存在每个钉腔2224中的钉。第二部分2220还包括砧座2230，该砧座包括组织压缩表面2232和与钉腔2224对准的成形凹坑环形阵列或成形凹坑2234(图27)，这些成形凹坑环形阵列或成形凹坑被构造成能够在钉从钉腔2224射出时使钉变形。
除上述以外，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并选择性地与其分离。第二部分2220包括外部外壳2227，该外部外壳包括近侧连接器2229，该近侧连接器被构造成能够接纳在限定于第一部分2210的外壳2217中的孔或室2218内。外壳2227的连接器2229与第一部分2210的外壳2217之间的配合是紧密的。连接器2229与外壳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/或旋转移位。在各种实例中，卡位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至图38，端部执行器2200的第二部分2220可与其它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”’在其它方面不同于第二部分2220。例如，第二部分2220’具有比第二部分2220大的直径。此外，限定于第二部分2220’中的环形阵列钉腔2224具有比限定于第二部分2220中的环形阵列钉腔2224大的圆周。相似地，第二部分2220”具有比第二部分2220’大的直径，并且限定于第二部分2220”中的环形阵列钉腔2224具有比限定于第二部分2220’中的环形阵列钉腔2224大的圆周。同样，相似地，第二部分2220”’具有比第二部分2220”大的直径，并且限定于第二部分2220”’中的环形阵列钉腔2224具有比限定于第二部分2220”中的环形阵列钉腔2224大的圆周。
除上述以外，砧座2230可与其它砧座诸如砧座2230’、砧座2230”、砧座2230”’和/或另一砧座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，该纵向轴包括连接凸缘2238。也就是说，砧座2230’、2230”和2230”’在其它方面不同于砧座2230。例如，砧座2230’具有比砧座2230大的直径。此外，限定于砧座2230’中的环形阵列成形凹坑2234具有比限定于砧座2230中的环形阵列成形凹坑2234大的圆周，使得成形凹坑2234保持与限定于第二部分2220’中的钉腔2224对准。相似地，砧座2230”具有比砧座2230’大的直径，并且限定于砧座2230”中的环形阵列成形凹坑2234具有比限定于砧座2230’中的环形阵列成形凹坑2234大的圆周，使得成形凹坑2234保持与限定于第二部分2220”中的钉腔2224对准。同样，相似地，砧座2230”’具有比砧座2230”大的直径，并且限定于第二部分2220”’中的环形阵列成形凹坑2234具有比限定于砧座2230”中的环形阵列成形凹坑2234大的圆周，使得成形凹坑2234保持与限定于第二部分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2318和第二输入2418。第一输入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2418可操作地连接到端部执行器夹持和钉击发系统。第一输入2318和第二输入2418可以任何合适的顺序操作。例如，第一输入2318可沿第一方向旋转，以使端部执行器2200沿第一方向进行关节运动，并且相应地沿第二方向旋转，以使端部执行器2200沿第二方向进行关节运动。一旦端部执行器2200已适当地进行关节运动，就可旋转第二输入2428以闭合砧座2230并抵靠端部执行器2200的仓部分2222夹持组织。如下文进一步更详细地论述，第二输入2428随后可操作以从钉腔2224击发钉并切入捕获在端部执行器2200内的组织。在各种另选的实施方案中，第一输入2318和第二输入2328可以任何合适的顺序和/或同时操作。
第一输入2318被安装到关节运动轴2310的近侧端部，该关节运动轴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以螺纹方式接合。更具体地讲，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以螺纹方式配合。当关节运动轴2310沿第一方向旋转时，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沿第二方向或相反方向旋转时，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由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可滑动地支撑。关节运动滑动件2320的运动通过限定于关节运动块2112中的导槽2315而限制为关节运动块2112的近侧和远侧运动。关节运动滑动件2320还包括从其延伸的纵向键2326，该纵向键被紧密地接纳在限定于导槽2315的底部中的纵向键槽2116中，这将关节运动滑动件2320与关节运动块2112之间的相对运动限制为纵向路径。
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，该驱动销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紧密地接纳在孔2334内，使得驱动销2324和孔2334的侧壁协作以限定关节运动滑动件2320与关节运动连接件2330之间的旋转轴线。关节运动连接件2330还联接到端部执行器2200的外壳2217。更具体地讲，关节运动连接件2330还包括定位于其中的远侧孔2335，并且括外壳2217包括定位于远侧孔2335中的销2215。销2215紧密地接纳在孔2335内，使得销2215和孔2335的侧壁协作以限定关节运动连接件2330与外壳2217之间的旋转轴线。
除上述以外，参见图18至图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的外壳2217包括限定于其相对侧中的孔2213，并且关节运动块2112包括从其相对侧延伸的突出部2113，所述突出部定位于孔2213中。突出部2113紧密地接纳在孔2213内，使得突出部2113和孔2213的侧壁协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，该驱动销围绕关节运动接头2300旋转端部执行器2200。当关节运动输入装置2310旋转以朝近侧驱动关节运动滑动件2320时，类似于上述，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，该驱动销围绕关节运动接头2300旋转端部执行器2200。关节运动连接件2330在关节运动滑动件2320与外壳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2418。第二输入2418包括驱动齿轮2417，该驱动齿轮与安装在驱动轴2410的近侧端部上的驱动齿轮2416啮合地接合。驱动轴2410延伸穿过轴部分2110和限定于关节运动块2112中的孔2114，如图19所示。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并且进入限定于端部执行器外壳2217中的室2218中。驱动轴2410由安装到驱动轴2410的轴承2414可旋转地支撑，该轴承被捕获在限定于端部执行器2200的外壳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可操作地与传输装置2420接合。如下文更详细地论述，传输装置2420被构造成能够在第一操作模式与第二操作模式之间使端部执行器2200移位，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击发钉并切入被捕获在砧座2230与仓体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外壳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正确接合行星齿轮2424，驱动轴2410是柔性的。在至少一个实例中，驱动轴2410由例如塑料构成。
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还包括可在第一位置与第二位置之间运动的移位器2600，以将传输装置2420在其第一操作模式与第二操作模式之间切换。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。更具体地讲，驱动轴2410使行星齿轮2424围绕其相应齿轮销2423旋转，并且行星齿轮2424由于行星齿轮2424与围绕行星齿轮2424延伸的环形齿圈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可操作地与输出联接件2430联接，使得行星板2421的旋转被传输到输出联接件2430。主要参见图23，输出联接件2430包括围绕其外周边延伸的孔2433阵列，其中从行星板2421延伸的齿轮销2423延伸到限定于输出联接件2430中的孔2433并被其紧密接纳，使得行星板2421与输出联接件2430之间的任何相对运动很少。
主要参见图18和图23，输出联接件2430包括驱动承窝2432。驱动承窝2432包括例如大致六边形的孔；然而，可利用任何合适的构造。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，该近侧驱动端部具有被紧密接纳在驱动承窝2432内的大致六边形的形状，使得驱动轴2410的旋转可传送到闭合轴2440。闭合轴2440由轴承2444可旋转地支撑在第二部分2220的外壳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至图30，闭合轴2440包括螺纹部分2446，该螺纹部分与限定于套管针2450中的螺纹孔2456以螺纹方式接合。如下文进一步更详细地论述，砧座2230可附接到套管针2450，该套管针可平移以朝向和/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，该纵向键槽被构造成能够与从驱动套管2540的内表面2546延伸的至少一个纵向键协作。驱动套管2540是钉击发系统的一部分，如下文进一步论述，并且读者应当理解，套管针2450和驱动套管2540在一个方面相对于彼此滑动，并且在另一方面协作地抑制其间的相对旋转运动。由于闭合轴2440与套管针2450之间的螺纹接合，闭合轴2440可在闭合轴2440沿第一方向旋转时使套管针2450朝远侧移位或平移，并且相应地，在闭合轴2440沿第二或相反方向旋转时使套管针2450朝近侧移位或平移。
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，该连接凸缘被构造成能够接合和夹持套管针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，其被构造成能够在砧座2230装配到套管针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的无意脱离。连接凸缘2238被纵向狭槽2237间隔开。纵向狭槽2237被构造成能够在砧座2230装配到套管针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已适当地相对于仓部分2222定位，如上所述，工具组件2000可移位至其第二操作模式中。移位器2600包括例如用于使端部执行器2200的传输装置2420移位的电力致动马达。在各种其它实施方案中，移位器2600可包括以电的方式和/或手动致动的任何合适装置。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与外科器械的柄部之间延伸，使得处理器可以与移位器2600通信，并且电池可以向移位器2600提供电力。在各种其它实例中，移位器2600可包括无线信号接收器，并且处理器可以与移位器2600无线通信。在某些实例中，功率可例如通过感应电路以无线方式提供给移位器2600。在各种实例中，移位器2600可包括其自身的电源。
移位器2600包括外壳，该外壳安装在限定于端部执行器2200的近侧端部中的室2218中。移位器2600包括离合器键或拨动装置2602和输出轴2604，该输出轴可相对于移位器外壳在第一位置与第二位置之间运动。离合器键2602包括第一锁齿2608和第二锁齿2609，并且当离合器键2602处于其第一位置时，第一锁齿2608与钉击发系统的击发管2530接合，并且同时，第二锁齿2609与传输装置2420的行星板2421脱离接合。更具体地讲，第一锁齿2608定位在孔2538中，该孔为围绕击发管2530限定的环形阵列孔2538的一部分，并且第二锁齿2609不定位在孔2429中，该孔为围绕行星板2421限定的环形阵列孔2429的一部分。由于上述原因，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，钉击发系统被移位器2600锁定，但驱动轴2410可旋转行星板2421并操作砧座闭合系统，如上所述。
如图23所示，击发管2530包括限定于其内侧壁2532中的内环形齿条2534。行星齿轮2424可操作地与齿条2534相互啮合。当移位器2600处于其第一位置时，如图28所示，击发管2530被移位器2600保持在适当位置，并且行星齿轮2424可通过驱动轴2410相对于击发管2530和齿条2534旋转。在所述实例中，行星齿轮2424围绕由驱动轴2410限定的纵向驱动轴线旋转，并且同时围绕由其相应齿轮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，第一锁齿2608与击发管2530脱离接合，并且同时，第二锁齿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被移位器2600保持在适当位置，并且因此闭合驱动装置被锁定并且不能操作以移动砧座2230。当驱动轴2410在所述实例中旋转时，输出齿轮2412驱动行星齿轮2424并使其围绕其相应齿轮销2423相对于行星板2421旋转。行星齿轮2424经由齿条2534驱动击发管2530，并使击发管2530围绕其纵向轴线旋转。
除上述以外，并且再次参见图23，击发管2530可操作地与钉击发系统的驱动套管2540联接。更具体地讲，击发管2530的内侧壁2532包括限定于其中的纵向狭槽2535，所述纵向狭槽被构造成能够紧密地接纳限定于驱动套管2540上的纵向肋2545，使得驱动套管2540与击发管2530一起旋转。驱动套管2540还包括螺纹远侧端部2542，该螺纹远侧端部与驱动衬圈2550以螺纹方式接合。更具体地讲，驱动衬圈2550包括螺纹孔2552，该螺纹孔与螺纹远侧端部2542以螺纹方式接合。驱动衬圈2550定位在限定于端部执行器2200的外壳中的孔2228中，并且被防止例如通过纵向肋和沟槽布置在孔2228内旋转。由于上述原因，驱动套管2540的旋转使驱动衬圈2550纵向平移。例如，驱动衬圈2550在驱动套管2540沿第一方向旋转时朝远侧推进，并且在驱动套管2540沿第二或相反方向旋转时朝近侧回缩。
当驱动衬圈2550朝远侧推动时，如上所述，驱动衬圈2550例如在钉击发系统的击发行程期间朝远侧推动钉驱动块2560和切割构件2570诸如刀。更具体地讲，驱动衬圈2550将钉驱动块2560和切割构件2570推入近侧未击发位置与远侧击发位置之间，在近侧未击发位置中，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凹陷至仓体部分2222的平台表面下方，在远侧击发位置中，钉抵靠砧座2230变形，并且被捕获在砧座2230与仓体部分2222之间的组织被切割构件2570横切。驱动衬圈2550包括驱动凹陷部2554，该驱动凹陷部被构造成能够在驱动衬圈2550朝远侧推进时邻接钉驱动块2560和切割构件2570。钉驱动块2560包括限定于其中的多个钉支架，其中每个钉支架被构造成能够支撑钉的基部。钉支架与限定于仓体部分2222中的钉腔2224对准并且被布置成至少两个同心行。
钉驱动块2560和切割构件2570附接到驱动衬圈2550，使得当驱动衬圈2550远离砧座2230朝近侧移动时，钉驱动块2560和切割构件2570被驱动衬圈2550朝近侧拉动。在至少一个实例中，钉驱动块2560和切割构件2570包括延伸到限定于驱动衬圈2550中的孔2557中的一个或多个钩。在各种实例中，钉驱动块2560和切割构件2570可回缩，使得它们完全回缩到仓体部分2222的平台表面下方。
除上述以外，端部执行器2200能够在第三操作模式下操作，其中移位器2600的离合器键2602同时可操作地与砧座闭合系统和钉击发系统接合。在该操作模式中，第一锁齿2608与钉击发系统的击发管2530接合，并且第二锁齿2609与传输装置2420的行星板2421接合。在所述实例中，第一锁齿2608定位在限定于击发管2530中的孔2538中，并且第二锁齿2609定位在限定于行星板2421中的孔2429中。由于上述原因，驱动轴2410相对于仓体2222同时移动砧座2230、钉驱动块2560和切割构件2570。
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/或任何其它合适的第二部分的套件中进行选择，并将所选第二部分装配到端部执行器2200的第一部分2210上。主要参见图18，当将第二部分装配到第一部分2210时，每个第二部分包括外壳连接器2229，该外壳连接器接合第一部分2210的外壳2217。此外，当将第二部分装配到第一部分2210时，每个第二部分包括闭合轴2440，该闭合轴可操作地接合第一部分2210的驱动承窝2432。此外，当将第二部分装配到第一部分2210时，每个第二部分包括驱动套管2540，该驱动套管可操作地接合第一部分2210的击发管2530。
除上述以外，参见图35和图36，工具组件2000’可与工具组件2000互换。工具组件2000在许多方面类似于工具组件2000；然而，工具组件2000’被构造成能够施加直径比工具组件2000所施加的圆形钉线大的圆形钉线。工具组件2000’除别的之外还包括较宽的第二部分2220’、钉驱动器2560’、刀组件2570’、仓体2222’和砧座2230’。参见图37，工具组件2000”可与工具组件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”被构造成能够施加直径比工具组件2000’所施加的圆形钉线大的圆形钉线。工具组件2000”除别的之外还包括较宽的第二部分2220”、钉驱动器2560”、刀组件2570”、仓体2222”和砧座2230”。参见图38，工具组件2000”’可与工具组件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”’被构造成能够施加直径比工具组件2000”所施加的圆形钉线大的圆形钉线。工具组件2000”’除别的之外还包括较宽的第二部分2220”’、钉驱动器2560”’、刀组件2570”’、仓体2222”’和砧座2230”’。
在各种实施方案中，除上述以外，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，该传输装置包括击发钉的第一操作模式、部署切割构件的第二操作模式以及同时击发钉并部署切割构件的第三操作模式。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不能在未首先完成第一操作模式的情况下置于第二操作模式中。由于上述原因，外科器械的用户可决定是否在击发钉之后切割组织。
与外科缝合器一起使用的钉仓体的另选实施方案示于图34中。仓体2222’包括环形外排钉腔2224和环形内排钉腔2224’。钉腔2224被限定于仓体平台的第一梯级中，并且钉腔2224’被限定于仓体平台的第二梯级中。第二梯级在第一梯级上方延伸。换句话讲，第一梯级具有第一平台高度，并且第二梯级具有第二平台高度，该第二平台高度高于第一平台高度。平台壁将第一梯级和第二梯级分开。在各种实施方案中，平台壁是倾斜的。在某些实施方案中，平台壁正交于第一梯级和/或第二梯级。
仓体2222’还包括从平台的第一梯级延伸的腔体延伸部2229’。腔体延伸部2229’围绕钉腔2224的端部，并且使钉腔2224在第一梯级上方延伸。腔体延伸部2229’可在从钉腔2224射出钉时将钉至少部分地控制在第一梯级上方。腔体延伸部2229’还被构造成能够接触所捕获的组织并抵靠仓体2222’压缩该组织。腔体延伸部2229’还可控制组织相对于仓体2222’的流动。例如，腔体延伸部2229’可限制组织的径向流动。腔体延伸部2229’可具有任何合适的构型，并且可从第一梯级延伸任何合适的高度。在至少一个实例中，腔体延伸部2229’的顶表面与例如第二梯级对准或具有与第二梯级相同的高度。在其它实例中，腔体延伸部2229’可在第二梯级上方或下方延伸。
除上述以外，钉腔2224各自包括定位于其中的第一钉，该第一钉具有第一未成形高度。钉腔2224’各自包括定位于其中的第二钉，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。这种构造可改善进入所缝合组织中的血流。另选地，第二变形高度可高于第一变形高度。这种构造可提高组织沿内横断线的柔韧性。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，可互换工具组件除别的之外还可包括轴、端部执行器和可替换钉仓。可替换钉仓包括：闭合驱动装置，该闭合驱动装置被构造成能够运动以打开和闭合端部执行器以将组织捕获在端部执行器内，以及击发驱动装置，该击发驱动装置被构造成能够缝合和切割捕获在端部执行器内的组织。当可替换钉仓装配到轴时，端部执行器的闭合驱动装置和击发驱动装置可操作地与轴的对应闭合驱动装置和击发驱动装置联接。在可替换钉仓未正确装配到轴的情况下，可替换钉仓可能会不以其预期方式操作。如下文更详细地描述，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进行操作，除非可替换钉仓正确附接到轴。
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，可替换钉仓3020包括闭合驱动输入装置和击发驱动输入装置，当钉仓3020完全安置到轴3010上时，所述闭合驱动输入装置和击发驱动输入装置分别可操作地与闭合驱动输出装置和击发驱动输出装置联接。为简明起见，此类闭合和击发系统的操作在本文中不再赘述。
可互换工具组件3000还包括闭锁电路3090。闭锁电路3090包括导体3096和触点3092。第一触点3092电联接到第一导体3096，并且第二触点3092电联接到第二导体3096。在将钉仓3020完全安置到轴3010上之前，第一触点3092未电联接到第二触点3092。钉仓3020包括触点桥3094，当钉仓3020完全安置到轴3010上时，该触点桥接合并电联接触点3092。触点3092和触点桥3094被构造和布置成使得当钉仓3020仅部分地安置到轴3010上时，触点桥3094不电联接触点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，外科器械系统包括电动马达，该电动马达被构造成能够驱动工具组件3000的钉击发系统，此外还包括控制器，该控制器被构造成能够操作电动马达。工具组件3000的闭锁电路与控制器通信。当控制器检测到触点桥3094未与触点3092接合，或者闭锁电路处于断开状态时，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闭锁电路处于断开状态时，其不向电动马达提供电力。在某些其它实例中，控制器被构造成能够向电动马达提供电力，使得当闭锁电路处于断开状态时，其可操作闭合系统而不是击发系统。在至少一个所述实例中，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被引导至闭合系统。当控制器检测到触点桥3094与触点3092接合，或者闭锁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，除上述以外，在控制器检测到闭锁电路处于断开构型时，控制器可致动触发器锁，该触发器锁防止柄部的击发触发器被致动。当钉仓3020被完全安置到轴3010上并且闭锁电路闭合时，控制器可回缩触发器锁并允许击发触发器被致动。此类系统可与机动化和/或非机动化击发驱动装置一起使用。例如，非机动化击发驱动装置可由手动曲柄驱动。
如上所述，砧座2230可装配到工具组件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于套管针轴2450中的凹陷部2458以将砧座2230连接到其上。一旦砧座2230装配到套管针轴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可能不会正确地装配到套管针轴2450。当临床医生尝试将砧座2230装配到套管针轴2450时，如果套管针轴2450未充分地延伸到钉仓2222的平台上方，可常常发生砧座2230与套管针轴2450的错误装配。通常，在所述实例中，砧座2230充分地附接到套管针轴2450，使得套管针轴2450可朝向钉仓2222移动砧座2230，但当砧座2230开始抵靠钉仓2222压缩组织时，砧座2230可与套管针轴2450分离。
现在转到图39和图40，示出了可互换工具组件3100，其在许多方面类似于上文论述的可互换工具组件2000。工具组件2000包括仓体3120，该仓体包括平台3121，该平台被构造成能够在组织被砧座2130抵靠仓体3120压缩时支撑组织。工具组件3100还包括被构造成能够相对于仓体3120移动砧座2130的闭合驱动装置。闭合驱动装置包括套管针轴3150，类似于上述，该套管针轴包括限定于其中的凹陷部。凹陷部包括远侧肩部3158，该远侧肩部被构造成能够将砧座2130保持到套管针轴3150。此外，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和与可旋转轴3162以螺纹方式接合的可平移衬圈3160，该可平移衬圈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延伸的柔顺臂或附加物3198。臂3198能够在伸出位置(图39)与挠曲位置(图40)之间运动。当臂3198处于其挠曲位置时，如图40所示，砧座2130可被锁定到套管针轴3150。当套管针轴3150充分地延伸到仓体3120的平台3121上方时，如图40所示，臂3198通过击发驱动装置的可平移衬圈3160保持在其挠曲位置。可平移衬圈3160包括环形肩部3168，该环形肩部被构造成能够在臂3198与肩部3168接触时向内弹性偏置臂3198。
当套管针轴3150未处于仓平台3121上方的足够的伸出位置时，臂3198不被肩部3168向内偏置。在所述实例中，臂3198处于其伸出位置，如图39所示。当臂3198处于其伸出位置时，臂3198防止砧座2130附接到套管针轴3150。更具体地讲，臂3198防止砧座2130的连接凸缘2138被安置在限定于套管针轴3150中的肩部3158后面。在所述实例中，臂3198防止砧座2130部分地附接到套管针轴3150，并且因此，尝试将砧座2130装配到套管针轴3150的临床医生不能部分地将砧座2130装配到套管针轴3150，并且可以避免上述问题。读者应当理解，砧座2130通常在原位或患者体内装配到套管针轴3150上，并且砧座2130正确装配到套管针轴3150上会加速所采用的外科手术的完成。上述系统提供了闭锁件，该闭锁件防止部分装配的砧座抵靠组织被压缩。
现在转到图41至图43，可互换工具组件3200包括被构造成能够防止闭合驱动装置在没有砧座附接到其上时回缩的闭锁件，如下文更详细地论述。工具组件3200包括轴3210和端部执行器3220。端部执行器3220包括外部外壳3227、仓体3222和穿过其限定的纵向孔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，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能够在伸出位置与回缩位置之间运动。图42和图43均示出处于其伸出位置的套管针轴3250。
除上述以外，工具组件3200还包括回缩锁3290，该回缩锁被构造成能够防止套管针轴3250在砧座3230未装配到套管针轴3250时从其伸出位置(图42和图43)朝向其回缩位置运动。回缩锁3290包括围绕突出部或销3294可旋转地安装到外壳3227的锁臂3292。回缩锁3290还包括与锁臂3292接合的弹簧3296，该弹簧被构造成能够将锁臂3292朝向套管针轴3250偏置。套管针轴3250包括锁肩3258，并且当砧座3230未装配到套管针轴3250时，如图42所示，锁臂3292被构造成能够捕获锁肩3258并防止套管针轴3250朝近侧运动。更具体地讲，锁臂3292包括被构造成能够在锁肩3258下方滑动的捕获件3298。当砧座3230装配到套管针轴3250时，如图43所示，砧座3230接触锁臂3292并使锁臂3292远离锁肩3258移位。此时，套管针轴3250已解锁并且可朝向仓体3222移动至其回缩位置。
现在转到图44至图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被操作直到闭合驱动的砧座被设定为正确的组织间隙，如下文更详细地论述。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、外部外壳3327和仓体3322。类似于上述，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，套管针轴3350能够在伸出位置(图45)与回缩位置之间运动(图46)，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，该可旋转轴被构造成能够使击发驱动装置朝远侧移位，以射出储存在仓体3322中的钉。
除上述以外，端部执行器3320包括活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和围绕锁销3394定位的锁定弹簧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与限定于内部框架3329中的腔体3328的侧壁的中间。当套管针轴3350处于伸出位置时，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。在所述实例中，锁销3394与锁孔3364的侧壁之间的相互作用防止轴3360被旋转以从仓体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包括限定于其上的凸轮表面，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)与解锁构型(图46)之间运动。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的击发驱动闭锁件需要砧座2230在钉可被击发之前运动到预定位置或在预定位置的范围内运动。此外，工具组件3300的击发驱动闭锁件要求砧座2230与仓体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/或闭合系统的位置将停用钉击发闭锁件。这种构造可有助于防止钉的畸形和/或组织的压缩不足等等。
现在转到图47至图49，可互换工具组件3400包括被构造成能够夹持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，该击发驱动闭锁件被构造成能够防止钉击发驱动装置在闭合驱动装置向组织施加足够的夹持压力之前操作。闭合驱动装置包括套管针轴3450和附接到套管针轴3450的砧座，诸如砧座2230。类似于上述，套管针轴3450能够从伸出位置(图48)运动到回缩位置(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，该可旋转轴被构造成能够使钉驱动器朝远侧移位并从仓体射出钉。
击发驱动闭锁件3490定位在闭合驱动装置的套管针轴3450与击发驱动装置的可旋转轴3460的中间。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与近侧板3494中间的弹簧3493。击发驱动闭锁件3490还包括能够在锁定构型(图48)与解锁构型(图49)之间运动的锁销3498，在锁定构型中锁销3498与轴3460接合，在解锁构型中锁销3498与轴3460脱离接合。锁销3498定位在限定于远侧板3492与近侧板3494之间的销室3496中。更具体地讲，锁销3498包括被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的中间的倾斜头部。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，并且限定于远侧板3492上的凸轮3495接合锁销3498的头部。在所述实例中，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协作，使锁销3498移位至其解锁构型，如图49所示。
如上所述，在远侧板3492被套管针轴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。更具体地讲，凸轮3495向内驱动锁销3498并使锁销脱离与可旋转轴3460的接合。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，并且由于锁销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，钉不能被击发驱动装置从仓体击发。当锁销3498移动至解锁构型时，如上所述，锁销3498被移出锁孔，并且轴3460可被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可包括限定于轴3460中的锁孔3468的周边阵列，每个锁孔被构造成能够接纳锁销3498并锁定击发驱动装置。再次参见图49至图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，例如弹簧3499。
除上述以外，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的近侧运动。弹簧3493为线性螺旋弹簧；然而，可使用任何合适的弹簧。此外，也可使用多于一个弹簧。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，通过弹簧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增大。弹簧3493所产生的弹簧力与砧座2230施加到组织的夹持力相反。因此，夹持力必须克服弹簧3493所产生的一定或预定的弹簧力，以便使远侧板3492充分移位并解锁击发驱动装置。在所述实例中，组织夹持力必须在击发驱动闭锁件3490可能停用之前达到预定阈值，并且可致动钉击发驱动装置。
如结合本文所公开的各种实施方案所论述，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朝远侧推动以切割捕获在仓体与砧座之间的组织。在所述实例中，刀被暴露在仓体的平台上方。也就是说，当砧座处于其闭合或夹紧位置时，砧座相对于仓体紧密定位，并且即使刀暴露在仓体上方，刀在很大程度上也被砧座覆盖。在砧座将移动到其打开位置和/或在刀回缩到仓体的平台下方之前与闭合驱动装置分离时，刀将被露出并暴露。工具组件3500如图52至图54所示，其包括闭锁件3590，该闭锁件被构造成能够在刀暴露在仓平台上方时防止砧座移动至其打开位置。
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，套管针轴3550可通过与套管针轴3550以螺纹方式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以螺纹方式接合的可平移衬圈3560。类似于上述，当轴3562分别沿第一方向和第二方向旋转时，衬圈3560能够朝近侧和朝远侧平移。同样类似于上述，击发驱动装置的衬圈3560被构造成能够朝向和远离砧座3530推进和回缩钉驱动器阵列和刀组件2570。
除上述以外，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的锁臂3592。闭锁件3590还包括与锁臂3592接合的偏置构件或弹簧3599，该偏置构件或弹簧被构造成能够将锁臂3592偏置至与砧座3530接触。在使用中，将砧座3530装配到套管针轴3550，然后使套管针轴3550回缩，以相对于仓体将砧座3530定位在其闭合或夹紧位置中。当砧座3530回缩时，闭锁件3590的锁臂3592抵靠砧座3530的外表面滑动，直到锁臂3592与限定于砧座3530中的锁凹陷部3532对准。此时，弹簧3599将锁臂3592偏置到锁凹陷部3532中，如图53所示。更具体地讲，锁臂3592定位在限定锁凹陷部3532的锁肩后面。然后可操作击发驱动装置以击发钉并切割组织。在所述实例中，刀组件2570的切割刃暴露于仓体上方，并且由于闭锁件3590，闭合驱动装置被锁定或被防止打开，直到刀组件2570的切割刃不再暴露。
主要参见图52，锁臂3592还包括从其延伸的复位突片3593。击发驱动装置的衬圈3560还包括凸轮3563，该凸轮被构造成能够在衬圈3560和刀组件2570被击发驱动装置朝近侧回缩时接合复位突片3593。凸轮3563被构造成能够使锁臂3592向下旋转以脱离与限定于锁凹陷部3532中的锁肩的接合并解锁闭合驱动装置。凸轮3563被构造成能够在刀组件2570的切割刃已回缩到仓平台下方时解锁闭合驱动装置；然而，在其它实施方案中，当切割刃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，闭合驱动装置可能不会在刀组件2570完全回缩之前解锁。一旦闭合驱动装置解锁，可操作闭合驱动装置以再次将砧座3530移动到打开或未夹紧位置。
一旦可互换工具组件的钉被击发，根据各种实施方案，工具组件可能不再使用。如下文更详细地论述，工具组件可包括被构造成能够防止工具组件在其被用于缝合组织后被重新夹持到组织上的闭锁件。
现在参见图53至图56，在至少一个实施方案中，可互换工具组件3600包括：闭合驱动装置，该闭合驱动被构造成能够例如相对于钉仓定位砧座，诸如砧座2230；以及击发驱动装置，该击发驱动装置被构造成能够从钉仓驱动钉。类似于上述，砧座2230可附接到闭合驱动装置的可平移套管针轴3650。同样类似于上述，击发驱动装置包括可旋转轴3660、与可旋转轴3660以螺纹方式接合的可平移衬圈2550以及可被可旋转轴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相对于钉仓将砧座2230定位在夹紧位置，然后击发驱动装置能够操作以将钉击发到捕获在砧座2230与钉仓之间的组织中。然后，操作闭合驱动装置以打开砧座2230并释放组织。
除上述以外，工具组件3600包括被构造成能够防止砧座2230重新夹持到组织上的闭锁件3690。闭锁件3690包括可旋转地安装到可旋转轴3660的锁臂3692，当闭合驱动装置在打开的未夹紧位置(图53)与闭合的夹紧位置(图54)之间移动砧座2230时，该锁臂被击发驱动装置保持在解锁构型中。在套管针轴3650和砧座2230相对于击发驱动装置移动以相对于钉仓定位砧座2230时，锁臂3692以其解锁构型保持在可旋转轴3660与可平移衬圈2550之间。臂3692保持在其解锁构型中，直到操作击发驱动装置，如图55所示。当轴3460沿第一方向旋转时，衬圈2550朝远侧移位，并且闭锁件3690的弹簧3699可抵靠套管针轴3650偏置锁臂3692。在衬圈2550朝远侧移位以击发钉，然后朝近侧回缩时，套管针轴3650相对于锁臂3692旋转。然后可操作闭合驱动装置以重新打开砧座2230，从而松开组织和/或将砧座2230与套管针轴3650分离。在砧座2230重新打开时，弹簧3699将锁臂3692偏置到限定于套管针轴3650和/或砧座2230中的锁凹陷部3652中。一旦锁臂3692定位在锁凹陷部3652中，锁臂3692防止套管针轴3650朝近侧回缩。在尝试回缩套管针轴3650时操作闭合驱动装置的情况下，锁臂3692将邻接限定于锁凹陷部3652中的锁肩并防止套管针轴3650和砧座2230的回缩。因此，闭锁件3690防止砧座2230在工具组件3600经历或至少部分地经历击发周期之后被重新夹持到组织上，并且工具组件3600不能再次使用。此外，闭锁件3690可用作使用过的仓闭锁件。
现在转到图59和图60，工具组件3700包括钉仓3720和砧座3730。工具组件3700还包括被构造成能够朝向钉仓3720移动砧座3730的闭合系统，并且还包括被构造成能够射出或击发可移除地储存在钉仓3720中的钉的击发系统。砧座3730包括纵向轴部分3736和从轴部分3736延伸的附接臂3738，该附接臂被构造成能够弹性地夹持闭合系统的闭合致动器或套管针3734。闭合致动器3734能够通过闭合驱动装置朝近侧回缩，以将套管针3734在打开的未夹紧位置(图59)与闭合的夹紧位置(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。
除上述以外，钉击发系统包括具有螺纹远侧端部的可旋转击发轴3750，并且还包括可平移击发螺母2550，该可平移击发螺母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于击发螺母2550中的螺纹孔之间存在间隙。因此，击发轴3750不能使击发螺母2550朝远侧移位，直到击发轴3750与击发螺母2550以螺纹方式接合。
如图60所示，砧座3730的附接臂3738被构造成能够接合击发轴3750并且在砧座3730移动至其闭合位置时向外偏转击发轴3750。主要参见图59A和图60A，附接臂3738被构造成能够接合限定于击发轴3750上的向内延伸的突出部3758，并向外推动突出部3758和击发轴3750的周边。在所述实例中，击发轴3750的螺纹远侧端部被推至与螺纹界面3790处的击发螺母2550的螺纹孔操作地接合，并且此时，击发轴3750可以在击发轴3750被击发驱动装置旋转时使击发螺母2550朝远侧移位以从钉仓3720射出钉。当砧座3730再次打开时，击发轴3750将回到其初始构型并且可操作地与击发螺母2550脱离接合。
由于上述原因，工具组件3700包括闭锁件，该闭锁件在砧座3730未附接到闭合系统时、在砧座3730被不正确地附接到闭合系统时并且/或者在砧座3730未充分闭合时防止钉被击发。
现在转到图61和图62，工具组件3800包括：可替换钉仓，该可替换钉仓包括可移除地储存在其中的钉；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被操作，除非钉仓完全安置到工具组件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，当钉仓被装配到工具组件3800时，该驱动轴被插入轴框架3810中。更具体地讲，主要参见图64，驱动轴3830包括近侧端部3832，该近侧端部包括环形齿轮部分3833，该环形齿轮部分被构造成能够在钉仓被装配到工具组件3800时接合和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，这些部分在被推至彼此操作地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于第一传输部分3862的远侧上的对应齿轮部分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可以可操作地接合第二传输部分3864。更具体地讲，第一传输部分3862包括近侧齿轮部分3865，该近侧齿轮部分接合第二传输部分3864的远侧齿轮部分3866，并且在第一传输部分3862被驱动轴3830朝近侧推动时朝近侧推动第二传输部分3864。当第二传输部分3864被第一传输部分3862朝近侧推动时，类似于上述，第二传输部分3864可以可操作地接合第三传输部分3868。更具体地讲，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，该近侧齿轮部分接合第三传输部分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，并且被输入轴和/或轴外壳3810支持以朝近侧移位。
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被构造成能够偏置第一传输部分3862和第二传输部分3864，使它们彼此分开。除此之外或作为替代，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，弹簧构件被构造成能够偏置第二传输部分3864和第三传输部分3868，使它们彼此分开。主要参见图65，每个弹簧构件3870包括两个盘形弹簧3872，盘形弹簧被构造成能够在向其上施加压缩力时挠曲；然而，弹簧构件3870可包括任何合适的构型。
除上述以外，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。相似地，除非定位在第一传输部分3862和第二传输部分3864中间的弹簧构件3870已被充分压缩以将第一传输部分3862的近侧齿轮部分3865与第二传输部分3864的远侧齿轮部分3866连接，否则第二传输部分3864不能将旋转运动传输到第一传输部分3862。如上所述，当钉仓完全安置到轴框架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，如图62所示。在所述实例中，输入轴的旋转可传输到驱动轴3830。然而，如果钉仓未完全安置到轴框架3810上，则传输部分3862、3864和3868中的一个或多个不能可操作地彼此接合，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，除非钉仓完全安置到轴框架3810上。
现在转到图66至图68，工具组件3900包括轴3910和可替换钉仓3920。可替换钉仓3920包括被构造成能够相对于钉仓3920移动砧座的闭合驱动装置，并且还包括击发驱动装置，该击发驱动装置包括被构造成能够射出可移除地储存在钉仓3920中的钉的可旋转击发轴3930。类似于上述，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完全或充分地安置到轴3910上。更具体地讲，闭锁件防止击发轴3930在钉仓3920内旋转，除非钉仓3920完全或充分地安置到轴3910上。在各种实例中，参见图67，击发轴3930包括限定于其外周边中的环形阵列锁孔3939，并且钉仓3920包括被构造成能够可释放地接合限定于轴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造。锁3929还包括锁定突出部，该锁定突出部延伸到锁孔3939中并防止击发轴3930相对于钉仓3920的主体旋转或至少基本上旋转。锁3929被构造成能够使得其被偏置至与限定于击发轴3930中的锁孔3939接合，直到当钉仓3920完全或充分地装配到轴3910时，锁孔3929被提升出锁孔3939，如图68所示。参见图68，轴3910的外部外壳包括楔形件3919，该楔形件被构造成能够远离击发轴3930提升锁3929并且使锁3929与锁孔3939脱离接合。楔形件3919被构造成能够使得其不会使锁3929与击发轴3930脱离接合，除非钉仓3920已完全或充分地安置到轴3910上，如图68所示。图67示出钉仓3920未完全或充分地安置到轴3910上的场景。
现在转到图69至图71，工具组件4000包括轴4010和可替换钉仓4020。可替换钉仓4020包括被构造成能够相对于钉仓4020移动砧座的闭合驱动装置，并且还包括击发驱动装置，该击发驱动装置包括被构造成能够射出可移除地储存在钉仓4020中的钉的可旋转击发轴3930。钉仓4020包括锁4029，该锁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肩4028。锁4029被构造成能够在钉仓4020被装配到轴4010时在轴4010内向内挠曲，然后在锁4029的锁肩4028与限定于轴4010的外部外壳中的窗口4019对准时，弹性地返回其未挠曲状态或至少朝向其未挠曲状态。在所述实例中，当钉仓4020已完全或充分地安置于轴4010上时，锁肩4028进入窗口4019中，如图70所示。为了解锁钉仓4020，临床医生可例如将工具或其手指插入窗口中，并将锁4029远离窗口4019按压。此时，钉仓4020可从轴4010移除，并且如果临床医生如此期望，可将新的钉仓附接到轴4010。
除此之外或作为替代，外科缝合系统可包括电闭锁件，该电闭锁件被构造成能够防止缝合系统的闭合驱动装置将砧座夹持到组织上并且/或者防止击发驱动装置在钉仓尚未完全或充分地安置到缝合系统的轴上时执行其击发行程。在各种实例中，缝合系统可包括被构造成能够检测钉仓是否已完全或充分地安置到轴上的传感器，并且还包括被构造成能够操作击发驱动装置的电动马达。在传感器检测到钉仓尚未完全或充分地附接到轴的情况下，马达可被电停用。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，例如微处理器。在至少一个实例中，控制器被构造成能够执行以下操作：首先，允许在传感器检测到轴上正确安置的钉仓时允许电动马达被操作，其次，防止在传感器检测到轴上未正确安置的钉仓时电动马达被操作。
现在转到图72，工具组件套件4100包括轴4110和多个钉仓，例如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较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变形高度的钉，而以较小图案施加钉的钉仓部署具有较小未变形高度的钉。在一些实例中，钉仓可部署具有两种或更多种未成形高度的钉。在任何情况下，从多个钉仓中选择的钉仓可装配到轴4110。
参见图72和图73，工具组件4100包括被构造成能够检测钉仓是否完全或充分地附接到轴4110的检测电路4190。检测电路4190未完全容纳在轴4110内；相反，钉仓必须正确装配到轴4110以完成检测电路4190。检测电路4190包括导体4193，所述导体延伸穿过限定于轴4110的框架中和/或沿着轴4110的外部外壳限定的通道4192。主要参见图73，每个导体4193电联接到限定于外壳的远侧端部中的电触点4194。钉仓4120例如包括对应的电触点4195，该电触点被定位和布置在钉仓4120的主体4122上，使得触点4195接合轴4110上的触点4194。钉仓4120还包括延伸穿过仓体4122和/或沿着仓体延伸的导体4196。每个导体4196与触点4195电联接。在某些实例中，导体4196彼此直接联接，并且在所述实例中，一旦钉仓4120正确装配到轴4110，就闭合检测电路4190。
在某些实例中，除上述以外，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活动地附接到仓体4122。更具体地讲，在至少一个所述实例中，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在组织被抵靠平台部分4124压缩时允许平台部分4124相对于仓体4122移动或浮动。在至少一个实例中，弹簧构件4198包括例如一个或多个波形弹簧。弹簧构件4198还在仓体4122与平台部分4124之间形成导电通路。更具体地讲，弹簧构件4198定位在分别限定于仓体4122和平台部分4124上的电触点4197和4199中间。导体4196电联接到限定于仓体4122的远侧端部上的电触点4197，并且电触点4199通过平台部分4125中的导体彼此电联接。如上所述，一旦钉仓4120正确装配到轴4110，就闭合检测电路4190。
现在转到图74至图76，工具组件4200包括被构造成能够防止可替换的圆形钉仓被击发多于一次的闭锁件，如下文进一步更详细地描述。在使用中，将可替换的圆形钉仓4220装配到工具组件4200的轴4210。然后将工具组件4200定位在手术部位中，并且将砧座2230装配到闭合驱动装置的套管针2450。然后使用闭合驱动装置将砧座2230朝向钉仓4220移动，以抵靠钉仓4220夹持患者的组织，直到砧座2230到达闭合或夹紧位置。砧座2230的该位置如图74所示。此时，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。击发驱动装置除别的之外还包括与驱动衬圈4240以螺纹方式接合的可旋转驱动轴4230，并且还包括钉击发驱动器2560。驱动衬圈4240和击发驱动器2560包括单独的部件；然而，在另选的实施方案中，驱动衬圈4240和击发驱动器2560可一体形成。击发驱动装置能够在击发行程期间沿第一方向旋转，以在未击发位置(图74)和击发位置(图75)之间将驱动衬圈4240和钉击发驱动器2560朝远侧推动，以从钉仓4220射出钉。驱动衬圈4240和钉驱动器2560被防止在钉仓4220内旋转，并且因此，驱动轴4230相对于驱动衬圈4240和钉驱动器2560旋转。
除上述以外，驱动衬圈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包括锁定销4292，该锁定销可滑动地定位在限定于驱动衬圈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，例如弹簧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不与可旋转驱动轴4230和/或钉仓4220的框架4222接合。当驱动衬圈4240和钉驱动器2560被驱动轴4230朝远侧推动时，锁定销4292远离驱动轴4230移动，如图75所示。在击发行程已完成并且钉已抵靠砧座2230充分变形之后，驱动轴4230沿相反方向旋转以在回缩行程期间朝近侧拉动驱动衬圈4240和钉驱动器4260。在所述实例中，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，因此，驱动衬圈4240相对于其初始未击发位置朝近侧移动至回缩位置，如图76所示。在驱动衬圈4240的该回缩位置中，闭锁件4290已与驱动轴4230和钉仓4220的框架4222接合。更具体地讲，每个闭锁件4290已进入限定于驱动轴4230与仓框架4222之间的锁定孔中。现在参见图78，每个锁定孔由驱动轴4230中的孔壁4295和框架4222中的孔壁4296限定。一旦锁定销4292进入锁定孔，驱动衬圈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。
读者应当理解，除上述以外，当击发驱动装置处于其未击发构型时，锁定销4292可以或可以不部分地定位在锁定孔中，如图74所示。然而，在某种程度上，锁定销4292部分地定位在锁定孔中，在所述实例中，当击发驱动轴4230旋转时，销4292可在限定于驱动衬圈4240中的销孔4293内朝远侧移位。读者还应理解，当驱动衬圈4240移动至其回缩位置时，锁定销4292足够深地安置到限定于驱动轴4230中的锁定孔中，以便在击发驱动轴4230沿其第一方向再次旋转时，防止销4292朝远侧移出锁定孔。
再次参见图78，当驱动衬圈4240处于其回缩位置时，锁定孔的侧壁4295和4296彼此对准。然而，当驱动轴4230旋转时，限定于驱动轴4230中的侧壁4295将旋转至脱离与限定于仓体4222中的侧壁4296的对准。在一些实例中，在击发驱动装置4230旋转时，侧壁4295可暂时地旋转至与侧壁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并且钉仓4220不能无意地锁定时，锁定销4292不能进入锁定孔中。
现在参见图80，在至少一个另选实施方案中，一个或多个锁定孔4295”可仅限定于工具组件4200”的驱动轴4230”中。在此类实施方案中，一旦锁定销4292进入锁定孔4295”，驱动衬圈4240将不能相对于驱动轴4230”旋转。实际上，驱动衬圈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”的框架中，这将防止驱动轴4230”相对于驱动衬圈2440旋转并且使驱动衬圈2440朝远侧移位。
现在参见图79，在至少一个另选实施方案中，每个击发驱动闭锁件具有不同的构型，使得每个锁定销与其对应的锁定孔唯一地匹配。例如，工具组件4200’包括被构造成能够进入由侧壁4295和4296限定的第一锁定孔的第一锁定销，以及被构造成能够进入由侧壁4295’和4296’限定的第二锁定孔的第二锁定销。然而，工具组件4200’的第一锁定销的尺寸和构造使得其不能进入第二锁定孔，并且对应地，第二锁定销的尺寸和构造使得其不能进入第一锁定孔。此外，第一锁定销或第二锁定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。该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。这种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例如可包括可形成轮廓或可调节的框架9010。框架9010可被构造成能够在使用期间永久变形。例如，在至少一个此类实施方案中，框架9010由延展性金属诸如银、铂、钯、镍、金和/或铜构成。例如，在某些实施方案中，框架9010由延展性塑料构成。例如，在至少一个实施方案中，框架由包含与聚合物链结合的金属离子的聚合物构成，例如离子聚合物-金属复合材料(IPMC)。可将电压电位或电势施加到IPMC材料，以便以期望的方式使轴挠曲。在某些实例中，轴可沿一个曲率半径形成轮廓，而在其它实例中，轴可沿多于一个曲率半径形成轮廓。例如，当轴在患者体内时，可修改电压电位或电势以使轴形成轮廓。在某些实施方案中，框架的可形成轮廓的部分包括多个可枢转的连接件。在至少一个实施方案中，框架的可形成轮廓部分由粘弹性材料构成。
除上述以外，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形成轮廓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以及可朝近侧拉动框架连接件并将框架连接件锁定在一起的一个或多个纵向张力缆线。在某些实例中，每个框架连接件可包括延伸穿过其的纵向孔，该纵向孔被构造成能够接纳可朝远侧移动的杆。杆足够柔性以穿过纵向孔，当可形成轮廓的部分已形成轮廓而又足够刚性以将缝合器械保持在其轮廓构型中时，所述纵向孔可能不会完全彼此对准。
如本文所述，外科器械可以由彼此装配到一起的多个模块构成。例如，在至少一个实施方案中，外科器械包括具有柄部的第一模块和具有轴组件的第二模块。轴组件包括被构造成能够缝合和/或切入患者的组织的端部执行器；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例如包括控制器以及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。显示在显示器10000上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关联至外科医生。例如，控制器可在显示器10000上显示关于钉击发行程的进度的数据。
除上述以外，轴组件还包括第二显示器。例如，轴组件2000包括显示器10100；然而，本文所公开的任一轴组件可包括显示器，例如显示器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，显示在显示器10100上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信号通信；然而，在其它实施方案中，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。
如上文所述，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某一位置范围内，以控制砧座与钉仓之间的距离或间隙，从而控制当钉从钉仓射出时钉的成形高度。例如，砧座被定位成更靠近钉仓，以使钉变形至较小的成形高度，并且进一步远离钉仓定位，以使钉变形至较大的成形高度。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/或者显示钉将成形或已成形的高度。在各种实施方案中，轴组件可包括被构造成能够控制端部执行器的功能的致动器，以及显示关于邻近致动器的端部执行器功能的数据的显示器。
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。远侧头部包括第一钳口和第二钳口。第一钳口包括具有可移除地储存在其中的钉的钉仓或者被构造成能够接纳这种钉仓的通道，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与闭合位置之间运动；然而，也可设想其它实施方案，其中第一钳口能够相对于第二钳口运动，并且/或者第一钳口和第二钳口两者能够相对于彼此运动。
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位于远侧。在这样的实施方案中，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，可设想其中关节运动接头相对于旋转接头位于远侧的其它实施方案。此类实施方案可提供远侧头部的宽扫掠。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运动。在至少一个实例中，纵向端部执行器轴线能够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运动。
除上述以外，工具组件1500的远侧头部能够在初始位置与旋转位置之间旋转。在至少一个实例中，远侧头部能够在零或上死点位置与第二位置之间旋转。在某些实例中，远侧头部能够旋转通过至少360度的运动范围。在其它实例中，远侧头部能够旋转通过小于360度的旋转范围。在任一种情况下，工具组件1500和/或柄部20被构造成能够追踪远侧头部的旋转位置。在各种实例中，工具组件1500和/或柄部20包括可操作地与端部执行器的远侧头部联接的电动马达，并且还包括编码器，该编码器被配置成直接追踪远侧头部的旋转和/或例如通过评估电动马达的轴的旋转位置来间接追踪远侧头部的旋转。柄部20的控制器与编码器信号通信，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，在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，在这样的实施方案中，显示在显示器10000上的数据将由外科器械控制器更新；然而，数据显示不会随着远侧头部旋转而重新定向和/或重新布置。这种实施方案可以为外科医生提供在静态场中正确利用外科器械所必需的信息。在至少一个另选实施方案中，显示器10000上的数据字段是动态的。在此上下文中，术语动态不仅意味着数据在显示器10000上被更新；术语动态还意味着数据随着远侧头部旋转而在显示器10000上重新定向和/或重新布置。在至少一个实例中，数据的取向追踪远侧头部的取向。例如，如果远侧头部旋转30度，则显示器10000上的数据字段也旋转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。
除上述以外，数据字段可被定向成与远侧头部的取向匹配的任何取向。这种实施方案可以为外科医生提供对远侧头部的取向的准确且直观的感测。在某些实施方案中，控制器将数据字段定向成从与远侧头部的取向最紧密匹配的独立位置阵列中选择的取向。例如，如果远侧头部已旋转27度，并且可选择的独立数据字段位置分开15度，则控制器可重新定向数据字段以与基准取向成30度。相似地，例如，如果远侧头部已旋转17度，并且可选择的独立数据字段位置分开5度，则控制器可重新定向数据字段以与基准取向成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的握把的轴线对准。在这样的实施方案中，控制器可忽略柄部20相对于其环境的取向。然而，例如，在至少一个另选的实施方案中，基准取向相对于重力轴线对准。
除上述以外，控制器被构造成能够相对于远侧头部的取向重新定向显示在显示器10000上的整个数据字段。在其它实施方案中，控制器被构造成能够相对于远侧头部的取向重新定向在显示器10000上移位的数据字段的仅一部分。在这样的实施方案中，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沿相同方向旋转第二旋转角度。例如，第二部分可比第一部分旋转更小角度。在各种实施方案中，数据字段的第一部分沿第一方向旋转，并且数据字段的第二部分沿第二或相反方向旋转。
除上述以外，数据字段被实时或至少基本上实时地随着远侧头部的旋转而重新定向和/或重新布置。这样的实施方案提供极具响应性的数据显示。在其它实施方案中，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抖动较少的数据显示。在各种实施方案中，数据字段的第一部分以第一速度重新定向和/或重新布置，并且数据字段的第二部分以第二或不同速度重新定向和/或重新布置。例如，第二部分可以较慢的速度旋转。
如上所述，显示器10000上的数据字段随着端部执行器的远侧头部旋转而旋转。然而，在其它实施方案中，数据字段或数据字段的一部分随着远端头部旋转而平移。同样如上所述，外科器械的控制器被构造成能够将数据字段重新定向和/或重新布置在柄部显示器10000上。然而，外科器械的控制器可将数据字段重新定向和/或重新布置在第二显示器上，例如轴显示器。
再次参见图15和图83，工具组件2000包括致动器10200，该致动器被构造成能够致动工具组件2000的关节运动驱动系统。致动器10200能够围绕纵向轴线旋转，该纵向轴线例如平行于或至少基本上平行于轴2100的纵向轴线。致动器10200可操作地联接到例如与柄部20的控制器信号通信的变阻器。当致动器10200围绕其纵向轴线沿第一方向旋转时，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沿第一方向进行关节运动。相似地，当致动器10200围绕其纵向轴线沿第二或相反方向旋转时，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沿第二或相反方向进行关节运动。在各种实例中，端部执行器2200例如可沿第一方向从纵向轴线关节运动约30度，并且/或者沿第二或相反方向从纵向轴线关节运动约30度。
如读者应当理解的那样，除上述以外，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；而是，关节运动驱动系统的电动马达位于柄部中，例如柄部20，工具组件2000附接到该柄部。因此，可拆卸的轴组件上的致动器控制柄部的操作。在其它实施方案中，关节运动驱动系统的电动马达可位于工具组件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，包括可形成轮廓的轴的外科工具组件可有利地成形为适配在患者的直肠或结肠内。然而，这种可形成轮廓的轴不能承受显著量的拉伸和/或压缩负载。为了补偿这种情况，在各种实施方案中，仅可旋转驱动系统可延伸穿过轴的可形成轮廓部分。在所述实例中，轴仅需要抵抗由可旋转驱动系统产生的旋转反作用力。在此类实施方案中，如果需要，可将驱动系统的旋转运动转换为相对于可形成轮廓的轴部分朝远侧的线性运动。这种纵向运动可产生拉伸力和/或压缩力；然而，此类力可在端部执行器内即相对于可形成轮廓的轴部分朝远侧分解或平衡。此类实施方案也可以利用相对于可形成轮廓的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穿可形成轮廓的轴部分的推挽式驱动系统。
圆形缝合器械的砧座6020如图84和图85所示。砧座6020包括组织压缩表面6022和限定于组织压缩表面6022中的环形阵列钉成形凹坑6024。砧座6020还包括框架6028、附接安装件6026和从附接安装件6026延伸的杆状物。该杆状物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。压缩表面6022、附接安装件6026和框架6028由例如不锈钢构成；然而，可使用任何合适的一种或多种材料。
除上述以外，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，使得在其间存在很少的(如果有的话)相对运动。组织支撑件6030包括环形组织支撑表面6032，该环形组织支撑表面与砧座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，并且还包括邻近砧座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，该钉仓包括第一环形钉排6070、第二环形钉排6080，以及击发驱动装置，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，钉6070和6080在从钉仓6040射出时通过成形凹坑6024变形。在各种实例中，钉6070和钉6080变形至相同高度，而在其它实例中，钉6070和钉6080变形至不同高度。例如，钉6070可变形至比钉6080更小的变形高度。在其它示例中，钉6080变形至比钉6070更小的高度。
除此之外或作为替代，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更小的未成形高度。在其它示例中，钉6080具有比钉6070更小的未成形高度。在某些实例中，钉6070和钉6080具有相同的未成形高度。
除上述以外，在钉6070和6080抵靠砧座6020变形以缝合被捕获在砧座6020与钉仓6040之间的组织T时，缝合器械可切入组织T。将钉从其钉腔中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的切割刃为环形的，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，击发驱动装置经历各种负载。例如，当横切先前已例如用钉6090(图86)缝合的组织时，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会产生通过击发驱动装置传输的力的突然改变或脉冲。临床医生可使用外科缝合器和/或被配置为检测击发驱动装置的负载变化的电子传感器系统来感测力的这种突然改变。组织支撑件6030可由能够在切割构件6050将负载施加到底壁6038时抓取的材料构成。在至少一个实例中，组织支撑件6030由例如塑料构成。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完成。
击发驱动装置使钉6070、6080变形并同时使用切割构件6050切入组织；然而，可以设想，钉成形步骤和组织切割步骤可交错。在至少一个实例中，直到钉成形步骤完成才开始组织切割步骤。
从图86应当理解，当表面6032可部分地支撑组织T时，切割构件6050可在切割构件6050朝向底壁6038移动时将组织T推入限定于组织支撑件6030的内壁6036与附接安装件6026之间的腔体中。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。在所述实例中，由切割构件6050制成的切口可能不是精确的。下文讨论了图86所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包括第一环形壁或外环形壁6131和第二环形壁或内环形壁6133。内壁6133限定孔6136，该孔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围绕组织支撑件6130的中心在内壁6133与外壁6131之间径向延伸。侧向壁6132彼此均匀地间隔开；然而，可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将环形阵列腔体6134限定于组织支撑件6130中。在各种实例中，每个腔体6134例如可在除面向组织的一侧之外的每一侧上被封闭。在其它实例中，腔体的面向组织的一侧可被封闭。
组织支撑件6130的外壁6131和内壁6133被构造成能够在组织被切割构件6050横切时支撑组织。侧向壁6132还支撑组织，并且此外，在组织被横切时阻止或抵抗组织相对于外壁6131和内壁6133滑动。应当理解，当组织被横切时，组织可进入腔体6134；然而，可大大减少组织与侧壁之间的相对运动。根据期望的支撑量，可对侧向壁6132的组成和布置进行选择，以向组织提供更多的支撑或向组织提供更少的支撑。例如，较厚的侧向壁6132可提供比较薄的侧向壁6132更多的组织支撑。相似地，更多的侧向壁6132可提供比较薄的侧向壁6132更多的组织支撑。
在切割构件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横切壁6132。在任何情况下，侧向壁6132在组织被切割之前、期间和之后支撑组织，并且防止沿外壁6131和/或内壁6133拖动组织或至少降低其可能性。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。
包括钉仓6240和砧座6220的外科缝合器公开于图89和图90中。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包括附接杆状物6226和围绕附接杆状物6226定位的环形组织支撑件6230。组织支撑件6230包括被构造成能够紧密地接纳杆状物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，并且还包括从外壁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。组织支撑件6230还包括底壁6238，该底壁被切割构件6050切入，类似于上述。
包括钉仓6240和砧座6220的外科缝合器溶如图91和图92所示。然而，读者应当理解，砧座6220的组织支撑件6230已被组织支撑件6330替换。组织支撑件6330包括被构造成能够紧密地接纳杆状物6226的环形中心孔。组织支撑件6330还包括顶壁6332、底壁6338以及在顶壁6332与底壁6338之间延伸的侧壁6336。顶壁6332与底壁6338平行或至少基本上平行；然而，也可设想其中壁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，也可设想其中侧壁6336不平行的实施方案。
壁6332、6336和6338限定其间的环形腔体6334。腔体6334在所有侧上被封闭或至少基本上封闭。腔体6334围绕杆状物6226不间断地延伸；然而，例如，也可设想其中腔体6334被侧壁间断和/或几何形状变化的其它实施方案。
类似于上述，组织支撑件6330被构造成能够在组织被切割构件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不移动。此外，组织支撑件6330包括刚性盒状剖面，使得在切割构件6050横切组织时，组织支撑件6330的挠曲最小化或不显著。如图91所示，底壁6338与内侧壁6336之间存在间隙。这种间隙可在组织支撑件6330中提供一些柔韧性；然而，也可设想不存在这种间隙的其它实施方案。组织支撑件6330由例如塑料构成；然而，在各种实施方案中，组织支撑件6330可例如由柔性和/或弹性体塑料构成。
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在横切组织后横切顶壁6332，然后进入腔体6334中。顶壁6332包括限定于其中的环形凹口6333，该环形凹口与切割构件6050的环形切割刃对准。凹口6333减小了顶壁6332的剖面并且有利于切入顶壁6332。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，组织支撑件6330的顶壁6332和底壁6338的横切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辨别脉冲之间的差异，并且不会将顶壁6332的切入错误地解读为击发/切割行程的结束。
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。除此之外或作为替代，顶壁6332可相对于组织压缩表面6022凹陷和/或在组织压缩表面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。除此之外或作为替代，顶壁6332可相对于成形表面6024凹陷和/或与成形表面6024对准。
包括钉仓6240和砧座6220的外科缝合器溶如图93和图94所示。然而，读者应当理解，砧座6220的组织支撑件6230已被组织支撑件6430替换。组织支撑件6430包括被构造成能够紧密地接纳杆状物6226的环形中心孔。组织支撑件6430还包括顶壁6432、底壁6438以及在顶壁6432与底壁6438之间延伸的侧壁6436。壁6432、6436和6438限定其间的环形腔体6434。腔体6434在所有侧上被封闭或至少基本上封闭。腔体6434围绕杆状物6226不间断地延伸；然而，例如，也可设想其中腔体6434被侧壁间断和/或几何形状变化的其它实施方案。
类似于上述，组织支撑件6430被构造成能够在组织被切割构件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不移动。此外，组织支撑件6430包括刚性多边形剖面，使得在切割构件6050横切组织时，组织支撑件6430的挠曲最小化或不显著。如图93所示，底壁6438与内侧壁6436之间存在间隙。这种间隙可在组织支撑件6430中提供一些柔韧性；然而，也可设想不存在这种间隙的其它实施方案。组织支撑件6430由例如塑料构成；然而，在各种实施方案中，组织支撑件6430可例如由柔性和/或弹性体塑料构成。
如图93和图94所示，内侧壁6436矮于外侧壁3436；然而，也可设想其中外侧壁6436比内侧壁6436矮的其它实施方案。此外，顶壁6432不平行于底壁6438。更具体地讲，顶壁6432包括倾斜部分，该倾斜部分横切底壁6438和/或顶壁6432的其它部分而延伸。
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在横切组织后横切顶壁6432，然后进入腔体6434中。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切割构件切入组织时支撑组织。例如，通常，被切割构件切入的组织先前已被缝合，即，在外科手术中的先前步骤期间缝合。在各种实例中，此类钉也可以由切割构件切入，即使它们由金属诸如钛和/或不锈钢构成。在其它实例中，此类钉可能不会被切割构件切入；而是，它们可被推入构成组织支撑件的材料中。无论钉是否被切割构件切入，本文所公开的组织支撑件在各种实例中具有足够的强度和/或刚度，以防止被切割构件抵靠组织支撑件捕获的钉在组织支撑件中产生大于局部的塑性变形。在至少一个所述实例中，局部塑性变形被限制为在相对于钉的任何方向上小于钉的一个特征长度(CL)。在至少一个实例中，可对组织支撑件的材料进行选择，使得抵靠组织支撑件捕获的钉可以例如仅在组织支撑件中形成直径小于2×CL的塑性变形区。在其它实例中，可对组织支撑件的材料进行选择，使得抵靠组织支撑件捕获的钉可以例如仅在组织支撑件中形成直径小于1.5×CL的塑性变形区。钉的特征长度可例如为钉冠的宽度或后跨度，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足够硬以在钉被切割构件切入时支撑钉的材料构成。在至少一个实例中，构成组织支撑件的材料的硬度等于或大于构成被抵靠组织支撑件切入的钉的材料的硬度。在某些实例中，构成组织支撑件的材料的硬度小于构成被切入的钉的材料的硬度；然而，组织支撑件的结构设计足以防止组织支撑件被塑性拉伸超过可接受的塑性变形区。在某些实例中，切入组织和组织中的成形钉所需的能量小于切入组织支撑件所需的能量。在各种实例中，构成组织支撑件的材料可抵抗钉凿。在至少一个实例中，可将生物相容性润滑剂置于组织支撑件上和/或浸入组织支撑件内，以防止钉捕获在组织支撑件上。
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。这种构造可将由砧座施加的力分布到大面积的组织上。可设想其中砧座的组织压缩表面和/或组织支撑件的组织接触表面不平坦的其它实施方案。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从其延伸的被构造成能够接合和夹持组织的组织抓紧构件或长钉。此类组织夹持构件例如可减少组织与砧座之间的相对运动或滑动。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夹持构件密度是相同的。在其它实例中，组织支撑件的组织接触表面上的组织夹持构件密度高于砧座的压缩表面上的组织夹持构件密度。在这样的实例中，当组织支撑件相对于砧座的压缩表面径向向内定位时，组织夹持构件可防止组织径向向内流动或滑动。
砧座6520公开于图95中。砧座6520包括组织压缩表面6522，并且还包括限定于组织压缩表面6522中的成形凹坑，该成形凹坑被构造成能够在钉从其钉仓射出时使钉变形为期望的构型。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与第二成形杯6530b之间延伸的轴线6531彼此成镜像；然而，也可利用其它构造。
第一成形杯6530a包括第一端部或外端6532和第二端部或内端6534。第一成形杯6530a还包括在外端6532与内端6534之间延伸的底部或浴缸表面6536。第一端部6532被构造成能够接纳钉的腿部并开始腿部的成形过程。第一端部6532包括被构造成能够朝向第二端部6534挠曲钉腿的弯曲表面。底表面6536包括被构造成能够至少部分地将钉腿朝向钉仓转回的弯曲表面或凹表面。第二端部6534包括被构造成能够引导钉腿部脱离成形杯6530a的弯曲表面。
第二成形杯6530b包括与第一成形杯6530a的构造类似的构造，并且被构造成能够使钉的第二腿部变形。由于上述原因，第一成形杯6530a引导钉的第一腿部朝向第二腿部，并且第二成形杯6530b引导钉的第二腿部朝向第一腿部。在各种实例中，例如，第一成形杯6530a和第二成形杯6530b协作以使钉变形成B形构型；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彼此成镜像。在其它实例中，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，例如，侧壁6537、6539是倾斜的或斜面的，以便朝向成形杯的中心，即朝向轴线6533引导钉腿。
每个成形杯6530包括限定于其底表面6536中的沟槽或通道6538。沟槽6538在成形杯6530的第一端部6532与第二端部6534之间纵向延伸。沟槽6538平行于成形杯6530的中心纵向轴线6535延伸并且相对于该中心纵向轴线侧向偏移。沟槽6538比通过成形杯6530变形的钉的腿部宽；然而，也可设想其中沟槽6538比钉的腿部窄的其它实施方案。在任一种情况下，沟槽6538被构造成能够沿成形杯6530内的预定路径引导钉腿。
在各种实例中，成形杯6530的沟槽被构造成能够在使钉的腿部变形时扭转腿部。在至少一个实例中，钉在变形之前是平面的或至少基本上平面的。在至少一个所述实例中，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和底表面6536倾斜和/或以其它方式被构造成能够朝向沟槽6538引导腿部。一旦钉腿进入沟槽6538中，沟槽6538将扭转钉腿至不与钉的基部共面。由于上述原因，未成形钉构型是平面的，但成形钉构型是非平面的。然而，也可设想其中钉在其变形之前和之后具有非平面构型的其它实施方案。
成形杯6530的沟槽6538(对于一组给定的成形杯6530)定位在纵向轴线6535的同一侧上，并且被构造成能够将钉腿两者扭转到钉基部的同一侧。然而，也可设想其中第一钉腿被扭转到钉基部的一侧并且第二钉腿被扭转到钉基部的另一侧的其它实施方案。在至少一个此类实施方案中，第一沟槽6538定位在纵向轴线6535的第一侧上，该第一侧被构造成能够将第一钉腿扭转到钉基部的第一侧，而第二沟槽6538定位在纵向轴线6535的第二侧上，该第二侧被构造成能够将第二钉腿扭转到钉基部的第二侧。
对于一组给定的成形杯6530，成形杯6530的沟槽6538是共线的或至少基本上共线的。然而，也可设想其它实施方案，其中沟槽6538定位在纵向轴线6535的同一侧上，但不彼此共线。在至少一个所述实例中，沟槽6538彼此平行，而在其它此类实例中，沟槽6538彼此不平行。
主要参见图96，沟槽6538比成形杯6530的底表面6536深。然而，也可设想其中沟槽和成形杯的底表面具有相同深度的其它实施方案。
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被布置成纵向排。在至少一个所述实例中，成形杯的沟槽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。在其它实例中，沟槽6538被布置在成形杯6530的第一纵向排中以在第一方向上弯曲钉腿，并且被布置在成形杯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，沟槽6538被布置成在第一方向上弯曲钉排中第一钉的腿部并且在第二或相反方向上弯曲钉排中第二钉的腿部。
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被布置成环形排。在至少一个所述实例中，沟槽6538相对于成形杯6530的中心纵向轴线6535径向向外定位。在其它实例中，沟槽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，沟槽6538径向向外定位在成形杯6530的第一环形排中，并且径向向内定位在成形杯6530的第二环形排中。
除上述以外，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，所述成形杯为相对于中心轴线彼此成镜像的两个成形杯。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与内端之间延伸的底部或浴缸表面，并且还包括限定于底表面中的纵向沟槽，该纵向沟槽被构造成能够在成形杯内引导钉腿。在至少一个实例中，纵向沟槽在成形杯的底表面中居中。
圆形缝合组件的端部执行器7000公开于图97至图99中。端部执行器7000包括钉仓，该钉仓包括平台7030和仓体7040。平台7030包括组织压缩表面7031和限定于压缩表面7031中的钉腔7032。钉腔7032被布置成第一环形排或内环形排和第二环形排或外环形排。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7000还包括被构造成能够将钉推出钉仓的钉驱动器。例如，钉仓包括被构造成能够射出第一钉排7070a的第一环形排钉驱动器7060a，和被构造成能够从仓体7040射出第二钉排7070b的第二环形排钉驱动器7060b。钉驱动器7060a和7060b定位在限定于平台7030中的钉腔7032内和/或与所述钉腔对准。钉驱动器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和限定于压缩表面7021中的钉成形凹坑7022。钉成形凹坑7022被布置成第一环形排或内环形排和第二环形排或外环形排。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与钉成形凹坑7022接触。
端部执行器7000还包括击发构件7056，该击发构件被构造成能够将钉驱动器7060a和7060b提升到钉腔7032内以分别从钉腔7032射出钉7070a和7070b。击发构件7056包括基部7054和坡道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。坡道7055可滑动地定位在限定于仓体7040中的狭槽7041内。如下文将更详细地描述，坡道7055被构造成能够在狭槽7041内滑动并逐渐接触钉驱动器7060a、7060b以从钉腔7032射出钉7070a、7070b。
除上述以外，击发构件7056可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沿弯曲或弓形路径移动，该弯曲或弓形路径由狭槽7041限定。主要参见图97，狭槽7041包括第一端部7042和第二端部7049以及它们之间的连续路径。击发构件7056的坡道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与内排钉腔7032对准，并且狭槽7041的第二端部7049与外排钉腔7032对准。狭槽7041还包括围绕中心纵向轴线7090延伸的第一周边部分7043，该中心纵向轴线延伸穿过端部执行器7000。狭槽7041的第一周边部分7043与内排钉腔7032中的钉驱动器7060a对准并且在该钉驱动器下方延伸。击发构件的坡道7055顺序地接合钉驱动器7060a，以在击发构件7056移动穿过狭槽7041的第一周边部分7043时顺序地击发钉7070a。
第一周边部分7043由围绕纵向轴线7090的一致或至少基本上一致的曲率半径限定；然而，也可设想其中第一周边部分7043的曲率半径不一致的其它实施方案。在至少一个所述实例中，第一周边部分7043包括螺旋。换句话讲，在所述实例中，在围绕纵向轴线7090延伸时，第一周边部分7043远离纵向轴线7090后退。
狭槽7041的第二周边部分7045与外排钉腔7032中的钉驱动器7060b对准并且在该钉驱动器下方延伸。击发构件的坡道7055顺序地接合钉驱动器7060b，以在击发构件7056移动穿过狭槽7041的第二周边部分7045时顺序地击发钉7070b。第二周边部分7045由围绕纵向轴线7090的一致或至少基本上一致的曲率半径限定；然而，也可设想其中第二周边部分7045的曲率半径不一致的其它实施方案。在至少一个所述实例中，第二周边部分7045包括螺旋。换句话讲，在所述实例中，在围绕纵向轴线7090延伸时，第二周边部分7045远离纵向轴线7090后退。
除上述以外，狭槽7041包括在第一周边部分7043和第二周边部分7045中间的过渡部分7044。在击发行程期间，坡道7055顺序地滑动穿过第一周边部分7043、过渡部分7044，然后穿过第二周边部分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与第二钉排的第二曲率半径之间偏移。在某些实施方案中，第一周边部分7043与第二周边部分7045之间的过渡部分7044可能是不必要的。在至少一个所述实例中，第一周边部分7043可包括第一螺旋构型，并且第二周边部分7045可包括第二螺旋构型，该第二螺旋构型例如被对准使得第一螺旋构型的末尾与第二螺旋构型的起始对准。
击发构件7056由击发驱动装置7050沿其击发路径驱动。例如，击发驱动装置7050由手动曲柄和/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由将基部7054的运动限制在凹陷部7052内的侧壁限定。当击发驱动装置7050围绕纵向轴线7090旋转时，驱动凹陷部7052的侧壁与基部7054接触并且将驱动构件7056推动通过狭槽7051。如上文所述，狭槽7051的曲率半径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，顺序地部署第一钉排或内钉排中的钉，然后顺序地部署第二钉排或外钉排中的钉。这样的实施方案可例如在向外缝合之前控制结肠的内周边。在其它实施方案中，顺序地部署外钉排中的钉，然后顺序地部署内钉排中的钉。这样的实施方案例如可在向内缝合之前在结肠组织中形成边界。
在各种实例中，除上述以外，第一钉7070a和第二钉7070b具有相同的未成形高度。在至少一个所述实例中，第一钉7070a和第二钉7070b被成形为相同的成形高度。在其它此类实例中，第一钉7070a被成形为第一成形高度，并且第二钉7070b可被成形为不同于第一成形高度的第二成形高度。在至少一个所述实例中，内钉排的第一成形高度比外钉排的第二成形高度矮。例如，这种构造可提供缝合组织与未缝合组织之间的更渐进的过渡。在其它实例中，内钉排的第一成形高度比外钉排的第二成形高度高。例如，这种构造可使所缝合得肠的最内层组织例如更加柔韧。
在某些实例中，除上述以外，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。在至少一个所述实例中，第一钉7070a和第二钉7070b被成形为相同的成形高度。在其它此类实例中，第一钉7070a被成形为第一成形高度，并且第二钉7070b被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。在至少一个所述实例中，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，在至少一个所述实例中，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。
击发驱动装置7150示于图100至图105中。击发驱动装置7150包括可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器组件，该三级顺序驱动器组件包括第一驱动器或内驱动器7154a、第二驱动器或中间驱动器7154b以及第三驱动器或外驱动器7154c。驱动轴7152包括从其延伸的驱动销7151。驱动销7151在驱动器7154a、7154b和7154c中的每一个中延伸穿过驱动狭槽。例如，第一驱动器7154a包括限定于其中的第一驱动狭槽7153a，第二驱动器7154b包括限定于其中的第二驱动狭槽7153b，并且第三驱动器7154c包括限定于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。
除上述以外，图100示出处于未击发位置的驱动器7154a、7154b和7154c。当驱动轴7152旋转通过其击发行程的第一部分时，现在参见图101，驱动销7151旋转通过周边路径，在该周边路径中，驱动销7151接合驱动狭槽7153a的侧壁并朝远侧推动第一驱动器7154a或使第一驱动器朝远侧进行凸轮运动。值得注意的是，驱动销7151未在击发行程的第一部分期间朝远侧驱动驱动器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上与驱动销7151的周边路径对准。第一驱动器7154a被构造成能够在第一驱动器7154a朝远侧移位时击发第一环形钉排。
当驱动轴7152旋转通过其击发行程的第二部分时，现在参见图102，驱动销7151旋转通过周边路径，在该周边路径中，驱动销7151接合驱动狭槽7153b的侧壁并朝远侧推动第二驱动器7154b或使第二驱动器朝远侧进行凸轮运动。值得注意的是，驱动销7151未在击发行程的第二部分期间朝远侧驱动驱动器7154c。类似于上述，驱动狭槽7153a和7153c在击发行程的整个第二部分上与驱动销7151的周边路径对准。第二驱动器7154b被构造成能够在第二驱动器7154b朝远侧移位时击发第二环形钉排。
当驱动轴7152旋转通过其击发行程的第三部分时，现在参见图103，驱动销7151旋转通过周边路径，在该周边路径中，驱动销7151接合驱动狭槽7153c的侧壁并朝远侧推动第三驱动器7154c或使第三驱动器朝远侧进行凸轮运动。类似于上述，驱动狭槽7153a和7153b在击发行程的整个第三部分上与驱动销7151的周边路径对准。第三驱动器7154c被构造成能够在第三驱动器7154c朝远侧移位时部署切割构件；然而，在某些实施方案中，第三驱动器7154c可例如部署第三钉排。
由于上述原因，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。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展开。此外，击发驱动装置7150不能在组织缝合之前切割组织。可设想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的各种另选实施方案。在至少一个此类实施方案中，驱动狭槽7153a、7153b和7153c的构型可调适成使得第一驱动器7154a和第二驱动器7154b的运动存在部分重叠并且/或者第二驱动器7154b和第三驱动器7154c的运动存在部分重叠。
主要参见图103和图104，驱动器7154a、7154b和7154c包括防止或至少抑制驱动器7154a、7154b和7154c相对于彼此旋转的配合特征部。例如，第一驱动器7154a包括纵向键7155a，该纵向键定位在限定于第二驱动器7154b中的纵向狭槽7156b中。键7155a和狭槽7156b被构造成能够允许第一驱动器7154a相对于第二驱动器7154b纵向滑动，但阻挡第一驱动器7154a与第二驱动器7154b之间的旋转运动。相似地，第二驱动器7154b包括纵向键7155b，该纵向键定位在限定于第三驱动器7154c中的纵向狭槽7156c中。键7155b和狭槽7156c被构造成能够允许第二驱动器7154b相对于第三驱动器7154c纵向滑动，但阻挡第二驱动器7154b与第三驱动器7154c之间的旋转运动。
为了回缩驱动器7154a、7154b和7154c，驱动轴7152沿相反方向旋转。在所述实例中，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，然后接合驱动狭槽7153a的侧壁，以使第三驱动器7154c、第二驱动器7154b和第一驱动器7154a返回其未击发位置(图100)。
击发驱动装置7250如图106所示。击发驱动装置7250以与击发驱动装置7150相似的方式操作。击发驱动装置7250包括可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坡道7256。击发驱动装置7250还包括第一驱动器7254a、第二驱动器7254b和第三驱动器7254c，这些驱动器在击发驱动装置7250旋转时通过驱动轴7252的凸轮7256接合。在击发行程的第一阶段中，凸轮7256接合限定于第一驱动器7254a上的凸轮表面7255a并朝远侧驱动第一驱动器7254a。在击发行程的第二阶段中，凸轮7256接合限定于第二驱动器7254b上的凸轮表面7255b并朝远侧驱动第二驱动器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器7254c上的凸轮表面7255c并朝远侧驱动第三驱动器7254c。
第一凸轮表面7255a比第二凸轮表面7255b短，并且因此，第一驱动器7254a具有比第二驱动器7254b短的击发行程。相似地，第二凸轮表面7255b比第三凸轮表面7255c短，并且因此，第二驱动器7254b具有比第三驱动器7254c短的击发行程。例如，这种构造可用于将不同的钉排成形至不同的成形高度。在其它实施方案中，驱动器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，驱动器7254a、7254b和7254c具有例如相同的击发行程。例如，这种构造可用于将不同的钉排成形至相同的成形高度。
图107为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构造，该专利申请全文据此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公开了各种圆形外科缝合器构造，该专利申请的全部公开内容据此以引用方式并入本文。如这些参考文献中所述，圆形外科缝合器通常包括框架组件，该框架组件包括被构造成能够将砧座可操作地联接到圆形外科缝合器的附接部分。
一般来讲，砧座包括支撑钉成形凹坑的一条或多条环形线的砧座头部。砧座杆状物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用于选择性地将砧座朝向和远离外科钉仓移动的装置，使得目标组织可被夹持在砧座与外科钉仓的平台之间。外科钉仓在其中可移除地储存多个外科钉，所述多个外科钉被布置成与在砧座中提供的钉成形凹坑的构造相对应的一个或多个环形阵列。钉可移除地储存在形成于钉仓中的对应钉腔内，并且被支撑在可操作地接纳在圆形缝合器内的可选择性移动的推动器组件的对应部分上。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入被夹持在砧座与钉仓之间的组织。
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包括间隔开的内钉腔4422的内环形排4420和间隔开的外钉腔4442的外环形排4440。内钉腔4422相对于间隔开的外钉腔4442交错，如在图107中可见。内侧外科钉4430支撑在每个内钉腔4422内，并且外侧外科钉4450支撑在每个外钉腔4442内。外环形排4440中的外侧钉4450可具有与内环形排4420中的内侧钉4430不同的特征。例如，如图108的实施方案所示，外侧钉4450具有未成形的“鸥翼”构型。具体地讲，每个外侧钉4450包括从钉冠4452延伸的一对腿部4454、4464。每个腿部4454、4464分别包括从钉冠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，在所示构造中，竖直部分4456、4466彼此不平行。例如，所示构造中的钉冠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见于2014年6月30日提交的名称为“FASTENERCARTRIDGE COMPRISING NON-UNIFORM FASTENERS”的美国专利申请序列号14/319,008，现为美国专利申请公布No.2015/0297232，其全部公开内容据此以引用方式并入本文。然而，其它竖直部分4456、4466可相对于钉冠4452以其它角度布置。使竖直腿部4456、4466相对于钉冠4452以大于九十度的角度定向的一个优点是这种构造可有助于将钉暂时保持在其对应钉腔内。
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。在所示构造中，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向内倾斜的点之间的距离HA大于钉冠4452与腿部部分4468从竖直腿部部分4466向内倾斜的点之间的距离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倾斜的角度A2可以等于腿部部分4468相对于竖直腿部部分4466倾斜的角度A3，或者角度A2和A3可以彼此不同。关于钉构型的另外细节可见于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，现为美国专利申请公布No.2015/0297232，其以引用方式并入本文。
在至少一个实施方案中，每个内侧外科钉4430可具有图108所示的构型。如在图108中可见，内侧外科钉4430具有钉冠4432和从其延伸的两个竖直腿部4434、4436。竖直腿部4434、4436可从钉冠4432相对垂直地延伸，或者它们可以可大于九十度的角度A4延伸。此类构造可有助于钉4430暂时保持在其对应的钉腔4422内。然而，竖直腿部4434、4436以不同角度从钉冠4432延伸。在一些实施方案中，角度A4彼此相等。在其它实施方案中，角度A4彼此不同。在例示的实施方案中，内侧钉4430和外侧钉4450各自具有相同的未成形高度UFH。内侧钉4430和外侧钉4450由常规外科钉线形成。在至少一个实施方案中，用于形成外侧钉4450的钉线的直径大于用于形成内侧钉4430的钉线的直径。在其它实施方案中，内侧钉和外侧钉可具有相同的直径，并且可由具有其它直径的线形成。在一些构造中，内侧钉和外侧钉可由相同类型的钉线形成。因此，在此类构造中，内侧钉和外侧钉的线直径将是相同的。然而，在另一个实施方案中，内侧钉和外侧钉可具有相同的未成形形状/构型，但由具有不同线直径的两种不同钉线形成。同样，在至少一种构造中，每个外侧钉4450的钉冠宽度CWO大于每个内侧钉4430的钉冠宽度CWI。关于钉构型的另外细节可见于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，现为美国专利申请公布No.2015/0297232，其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。在外科手术期间，临床医生可以相对于圆形缝合器的仓调节砧座的位置。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。如在图107中可见，一系列内平台特征部4416设置在钉腔4422的内排4420与居中设置的刀开口4413之间，刀或切割构件将在击发过程期间穿过该刀开口。平台特征部4416可以相对于内钉腔和开口4413成形和定位，如图107、图109和图110所示。例如，每个内平台特征部4416可具有与刀开口4413的壁共延的平坦壁部分4415以及与内钉腔4422的排相邻的锥形或倾斜的主体部分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被定向在两个相邻的内钉腔4422之间的间隙中，并且如图所示在钉腔4422对之间交错。该系统中的腔体延伸构造或平台特征部可用于在平坦平台仓中常常遇到的较低压力。本发明所公开的构造也可有助于减轻组织运动和滑移。由于组织的滑移通常是不期望的，因此外径保持特征部可以更大并且更多。内部直径特征部可用于当刀片在内部内径旁边通过时增大组织张力/剪切，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。
同样如在图107、图109和图110中可见，每个其它外钉腔4442包括与其每一端相关联的外平台特征部4418。当钉4450从钉仓4410射出时，外平台特征部4418在平台表面4412上方延伸并朝向砧座引导外侧钉4450。在此类实施方案中，直到击发构件使外侧钉4450朝向砧座运动，外侧钉才可在外平台特征部4418上方延伸。主要参见图107，在至少一个实施方案中，外平台特征部4418不围绕整个对应外钉腔4442延伸。第一外平台特征部4418被定位成与对应外腔4442的第一端部相邻，并且第二外平台特征部4418被定位成与外腔4442的第二端部相邻。如在图107中可见，外平台特征部4418与每隔一个的外钉腔4442相关联。此类构造可用于降低总体压力并最小化组织拉伸和运动。然而，在其它实施方案中，第一外平台特征部和第二外平台特征部4418可与每一个外钉腔4442相关联。在其它实施方案中，外平台特征部可围绕对应外腔的整个周边延伸。如在图109中可见，内平台特征部4416比外平台特征部4418短。换句话讲，每个内平台特征部在平台表面4412上方突出一定距离，该距离小于每个外平台特征部4418在平台表面4412上方突出的距离。每个外平台特征部可在平台表面4412上方突出的距离与外边缘4414在平台表面4412上方突出的距离相同。此外，同样如在图109中可见，每个外平台特征部4418具有大致锥形或渐缩的外部轮廓，其可有助于防止在缝合器头部插入患者的结肠和直肠期间组织挂在平台特征部上。
上述平台特征构造可提供一个或多个优点。例如，直立外边缘可有助于防止组织在仓平台上滑动。该直立边缘还可包括高点和低点的重复图案，而不是形成一个连续的唇缘。内部直立特征部也可有助于保持组织邻近刀片并导致改进的切割。内部平台特征部可位于每个腔体之间或在另选的构造中，平台特征部可包括一个连续的直立唇缘。可能期望的是平衡平台特征部的数量以最小化高力/压缩区的数量，同时达到期望的组织固定量。腔体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。此类构造还有利于在钉腿射出并过渡到接纳砧座凹坑时期望的钉成形，所述接纳砧座凹坑可由对应的成形凹坑组成。此类局部凹坑特征部增大了低压缩区，同时有利于在钉离开仓时从仓支撑腿部。该构造从而使钉在与砧座凹坑相遇之前必须“跳跃”的距离最小化。组织流量趋于从仓的中心径向向外增大。参见图118，改进的直立外侧排延伸部具有在向上插入结肠中时由于其为管状而挂住组织的趋势。
图109和图110示出与砧座4480结合的外科钉仓4410的使用。砧座4480包括砧座头部部分4482，该砧座头部部分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被支撑成与支撑在缝合器头部中的刀4492呈面对关系。在例示的实施方案中，钉成形插入件4484由例如钢、不锈钢等制成，并且包含内侧钉成形凹坑4486的内排和外侧钉成形凹坑4488的外排。每个内侧钉成形凹坑4486对应于内钉腔4422中的一个，并且每个外侧钉成形凹坑4488对应于外钉腔4442中的一个。在所示构造中，当砧座4480相对于仓平台表面4412移动到其击发位置时，内侧钉成形凹坑4486比外侧钉成形凹坑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，内侧钉4430各自被支撑在其对应的内钉腔4422内在推动器组件4500的对应内驱动器部分4502上，并且每个外侧钉4450被支撑在其对应的外钉腔4442内在对应外驱动器部分4504上。朝向砧座4480推进推动器组件4500将导致内侧钉4430和外侧钉4450被驱动至与其相应的对应钉成形凹坑4486、4488成形接触，如图110所示。此外，刀4492穿过被夹持在砧座4480与平台表面4412之间的组织并穿过刀垫圈4490的易碎底部4491朝远侧推进。此类构造用于为外侧钉4450提供成形高度FHO，该成形高度大于内侧钉4430的成形高度FHI。换句话讲，外侧钉4450的外排4440被成形为更大的“B”形态，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形态也可改善朝向这些内排流动的血流。在各种实例中，外侧钉4450的外排4440通过利用更大的钉冠、钉腿宽度和/或钉腿厚度，而具有更大的展开阻力。
每排钉中使用的钉数量可以变化。在一个实施方案中，例如，存在比内侧钉4430更多的外侧钉4450。另一个实施方案采用比外侧钉4450更多的内侧钉4430。在各种实例中，外侧钉4450的线直径大于内侧钉4430的线直径。内侧钉4430和外侧钉4450可具有相同的未成形高度UFH。外侧钉4450的外排4440中的钉冠宽度CWO大于内侧钉4430的内排4420的钉冠宽度CWI。外侧钉4450的鸥翼构型采用位于与其相应钉冠相距不同距离的弯曲部。使用具有平坦(无阶梯)的仓平台表面4412的阶梯式砧座构型，通过均匀的驱动器或推动器行程，产生具有不同成形高度的钉。
图111示出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，该仓平台包括间隔开的内钉腔4622的内环形排4620和间隔开的外钉腔4642的外环形排4640。内钉腔4622相对于间隔开的外钉腔4642交错，如在图111中可见。内侧外科钉4630支撑在每个内钉腔4622内，并且外侧外科钉4650支撑在每个外钉腔4642内。此外，外边缘4614在平台表面4612上方延伸。在各种实施方案中，除上述以外，直到击发构件使钉4630、4650朝向砧座运动，钉才突出到平台表面4612上方。相对于储存钉的其相应钉腔的深度，此类实施方案可经常利用小钉。在其它实施方案中，当钉处于其未击发位置时，钉的腿部突出到平台表面4612上方。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。
同样如在图111中可见，每个其它内钉腔4622包括与其每一端相关联的内平台特征部4616。当对应内侧钉4630从钉仓4610射出时，内平台特征部4616在平台表面4612上方延伸并朝向砧座引导对应内侧钉4630。在此类实施方案中，直到击发构件使内侧钉4630朝向砧座运动，内侧钉才可在内平台特征部4616上方延伸。在所示示例中，内平台特征部4616不围绕整个对应内钉腔4622延伸。第一内平台特征部4616被定位成与对应内腔4622的第一端部相邻，并且第二内平台特征部4616被定位成与内腔4622的第二端部相邻。然而在其它实施方案中，内平台特征部4416可与每一个内钉腔4622相关联。在其它实施方案中，内平台特征部可围绕对应内钉腔的整个周边延伸。通过采用在同心图案中具有不同高度的平台特征部，其中它们与每隔一个的腔体相关联，可提供更低的压力组织间隙区域，同时平衡它们以尽可能长地引导尽可能多的钉腿。换句话讲，此类构造可最小化组织流动量，减少施加到目标组织的总压力量。
仍然参见图111，每个外钉腔4642包括与它们的每个端部相关联的外平台特征部4618。当钉4650从钉仓4610射出时，外平台特征部4618在平台表面4612上方延伸并朝向砧座引导外侧钉4650。在此类实施方案中，直到击发构件使外侧钉4650朝向砧座运动，外侧钉才可在外平台特征部4618上方延伸。如在图111中可见，在所示示例中，外平台特征部4618不围绕整个对应外钉腔4642延伸。第一外平台特征部4618被定位成与对应外腔4642的第一端部相邻，并且第二外平台特征部4618被定位成与该外腔4642的第二端部相邻。如在图111中可见，外平台特征部4618与每一个外钉腔4642相关联。然而，在其它实施方案中，第一和第二外平台特征部4618可与每隔一个的外钉腔4642相关联。在其它实施方案中，外平台特征部可围绕对应外腔的整个周边延伸。如在图112和图113中可见，内平台特征部4616和外平台特征部4618在平台表面4612上方延伸相同距离。换句话讲，它们具有相同的高度。此外，同样如在图112和图113中可见，每个内平台特征部4416和每个外平台特征部4618具有大致锥形或渐缩的外部轮廓，其可有助于防止在缝合器头部插入患者的结肠和直肠期间组织挂在平台特征部上。
图112和图113示出与砧座4680连接的外科钉仓4610的使用。砧座4680包括砧座头部部分4682，该砧座头部部分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被支撑成与支撑在缝合器头部中的刀4692呈面对关系。在例示的实施方案中，钉成形插入件4684由例如钢、不锈钢等制成，并且包含内侧钉成形凹坑4686的内排和外侧钉成形凹坑4688的外排。每个内侧钉成形凹坑4686对应于内钉腔4622中的一个，并且每个外侧钉成形凹坑4688对应于外钉腔4642中的一个。在所示构造中，内侧钉成形凹坑4686距平台表面4612的距离g1与外侧钉成形凹坑4688相同。
如在图112和图113中进一步可见，内侧钉4630被支撑在推动器组件4700的对应内驱动器部分4702上的对应内钉腔4622内。外侧钉4650被支撑在对应外驱动器部分4704上的对应外钉腔4642内。朝向砧座4680推进推动器组件4700将导致内侧钉4630和外侧钉4650被驱动至与其相应的对应钉成形凹坑4686、4688成形接触，如图113所示。此外，刀4692穿过被夹持在砧座4680与平台表面4612之间的组织并穿过刀垫圈4690的易碎底部4691朝远侧推进。在图112和图113所示的示例中，每个内侧钉4630由具有第一线直径D1并且具有第一未成形高度L1的第一钉线形成。例如，第一线直径D1可为约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可为约0.198"-0.250"。每个外侧钉4650由具有第二线直径D2并且具有第二未成形高度L2的第二钉线形成。在图112和图113所示的实施方案中，D1<D2，并且L1<L2。然而，如在图113中可见，内侧钉4630和外侧钉4650被成形为具有相同的成形高度FH。与往往更好地保持止血的较小直径钉的内排相比，外侧上较粗的线钉往往提供高撕裂和爆裂强度。换句话讲，内侧钉排越紧密，越能良好地保持止血，而外钉排的压缩越少，则可以促进更好的愈合和血液流动。此外，具有较长腿部的钉即使以与具有较短腿部的钉相同的高度成型，也可确保更多的B弯曲，这可使得较长腿部的钉更强并且更可能适当地成形为足以保持在高负载条件下。每排钉中使用的钉数量可以变化。在一个实施方案中，例如，内排4620具有的内侧钉4630的数量与外侧钉4650的外排4640相同。在各种构造中，钉4650的钉冠宽度大于内侧钉4630的钉冠宽度。在其它实施方案中，钉4630、4650可具有相同的钉冠宽度。在其它构造中，钉4630、4650可具有上述鸥翼设计。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朝向彼此向内弯曲的端部部分。此类钉可用于内环形排或外环形排或者内环形排和外环行排两者中。
图114示出另一个圆形钉仓实施方案4810，其包括仓平台4812，该仓平台包括间隔开的钉腔的三个环形排4820、4840、4860。内排或第一排4820包含第一多个内钉腔或第一钉腔4822，它们各自以第一角度布置。每个内钉腔4822在其中可操作地支撑对应的内侧钉或第一钉4830。内腔4822将第一钉4830相对于切线方向以相同的均匀角度定向。在所示示例中，每个内侧钉4830由具有第一钉直径D1的第一钉线形成。在一个示例中，第一钉线直径D1可为约0.0079"-0.015"(增量通常为0.0089"、0.0094"和0.00145")。参见图117，每个内侧钉4830包括第一钉冠4832和两个第一腿部4834。第一钉冠具有第一钉冠宽度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，第一钉冠宽度C1可为约0.100"-0.300"，并且第一未成形腿部长度L1可为约0.198"-0.250"。第一腿部4834可各自相对于第一钉冠4832以角度A1布置。角度A1可为约90°或者其可以略大于90°，使得第一腿部4834略微向外张开，以帮助将第一钉4830保持在其对应的第一钉腔4822中。
转到图115和图116，钉仓4810旨在与砧座4900结合使用，该砧座包括第一钉成形凹坑4904的交错或成角度的第一对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。一个第一钉成形凹坑4904对应于一个第一钉腿4834，并且所述一对4903的另一个第一钉成形凹坑4904对应于另一个第一钉腿4834。此类构造用于建立成形钉构型，其中第一钉4830的第一钉腿4834被成形为不与该特定第一钉4830的第一钉冠4832共面，使得一个第一腿部4834形成在第一钉冠4832的一侧上，并且另一个第一腿部4834形成在第一钉冠4832的另一侧上。这种“三维”成形钉构型相对于一些第一钉成形凹坑4904示于图115中。
如在图116中可最具体地看到，仓平台4812具有“阶梯式”构造。仓平台4812包括与内钉腔或第一钉腔4822的内环形排或第一环形排4820对应的内仓平台部分或第一仓平台部分4814。如在图116中进一步可见，当砧座4900移动至闭合或夹紧位置时，砧座4900的包含第一钉成形凹坑4904的部分与平台部分4814间隔开第一间隙距离g1。
再次参见图114、图116和图117，中间排或第二排4840包含第二多个中间钉腔或第二钉腔4842，它们各自以第二角度布置。每个中间钉腔4842在其中可操作地支撑对应的中间钉或第二钉4850。中间腔4842将中间钉或第二钉4850相对于切线方向以相同的均匀第二角度定向。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它们各自的第一腔和第二腔中时，每个第一钉4830的第一钉冠的轴线在延伸时将最终与相邻的第二钉4850的第二钉冠的延伸轴线相交。如在图116和图117中可见，每个第二钉或中间钉4850包括第二钉冠或基部4852和两个第二腿部4854。钉基部4852可具有略微矩形的剖面形状并且由平坦材料片形成。第二钉腿4854可具有例如圆形剖面轮廓。第二钉或中间钉可包括在例如2015年8月26日提交的名称为“SURGICAL STAPLING CONFIGURATIONS FOR CURVEDAND CIRCULAR STAPLING INSTRUMENTS”的美国专利申请序列号14/836,110中公开的各种钉构型，该专利申请全文以引用方式并入本文。拥有从具有矩形剖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可具有大致正方形的剖面轮廓。弯曲部分4856和钉基部部分4852的正方形轮廓和矩形轮廓分别向圆形钉腿4854提供刚性连接部和支柱。圆形钉腿4854消除了剖面为正方形、矩形或任何带顶点的形状或非均匀形状的钉腿可具有的优先弯曲平面。每个第二钉腿4854具有第二直径D2。在至少一个实施方案中，D2>D1。第二基部或钉冠4852具有第二钉冠宽度C2。在一种构造中，C2>C1。第二腿部4854可各自相对于第二基部或钉冠4852以角度A2布置。角度A2可为约90°或者其可以略大于90°，使得第二腿部4854略微向外张开，以帮助将第二钉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的交错或成角度的第二对4913的两个中间排或第二排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，并且所述一对4913的另一个第二钉成形凹坑4914对应于另一个第二钉腿4854。此类构造用于建立成形钉构型，其中第二腿部4854被成形为与特定第二钉4850的第二基部4852不共面。这种“三维”成形钉构型相对于一些第二钉成形凹坑4914示于图115中。
如在图116中可最具体地看到，仓平台4812还包括与中间钉腔或第二钉腔4842的中间环形排或第二环形排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移动至闭合或夹紧位置时，砧座4900的包含第二钉成形凹坑4914的部分与平台部分4816间隔开第二间隙距离g2。在所示示例中，g2>g1。
再次参见图114、图116和图117，外侧排或第三排4860包含相对于第二钉腔4842设定尺寸的第三多个外侧钉腔或第三钉腔4862，使得每个外钉腔或第三钉腔4862在两个相邻的第二腔4842之间跨越一定距离。每个外钉腔4862在其中可操作地支撑对应的外侧钉或第三钉4870。外腔4862将外侧钉或第三钉4870定向成与周边方向相切。如在图116和图117中可见，每个第三钉或外侧钉4870包括第三钉冠或基部4872和两个第三腿部4874。钉基部4872可具有略微矩形的剖面形状并且由平坦材料片形成。第三钉腿4874可具有例如圆形剖面轮廓。第三钉或外侧钉4870可包括在例如2015年8月26日提交的名称为“SURGICALSTAPLING CONFIGURATIONS FOR CURVED AND CIRCULAR STAPLING INSTRUMENTS”的美国专利申请序列号14/836,110中公开的各种钉构型，该专利申请全文以引用方式并入本文。拥有从具有矩形剖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可具有大致正方形的剖面轮廓。弯曲部分4876和钉基部部分4872的正方形轮廓和矩形轮廓分别向圆形钉腿4874提供刚性连接部和支柱。圆形钉腿4874消除了剖面为正方形、矩形或任何带顶点的形状或非均匀形状的钉腿可具有的优先弯曲平面。在至少一个实施方案中，D3>D2。第三基部或钉冠4872具有第三钉冠宽度C3，并且每个第三腿部4874具有第三未成形腿部长度L3。在一种构造中，C3>C2并且L3>L2。第三腿部4874可各自相对于第三基部或钉冠4872以角度A3布置。角度A3可为约90°或者其可以略大于90°，使得第三腿部4874略微向外张开，以帮助将第三钉4870保持在其对应的第三钉腔4862中。
转到图115和图116，砧座4900还包括外侧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中可最具体地看到，仓平台4812还包括与外钉腔或第三钉腔4862的外排或第三排4860对应的第三仓平台部分4818。如在图116中进一步可见，当砧座4900移动至闭合或夹紧位置时，砧座4900的包含第三钉成形凹坑4918的部分与平台部分4818间隔开第三间隙距离g3。在所示示例中，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与每个外侧钉或第三钉4870结合使用。组织厚度补偿件可包括嵌入有氧化再生纤维素(ORC)的织造材料以促进止血。组织厚度补偿件4920可包括在2014年2月24日提交的名称为“IMPLANTABLE LAYERASSEMBLIES”的美国专利申请序列号14/187,389(美国专利申请公布No.2015/0238187)中所公开的各种组织厚度补偿件构造中的任一种，该专利申请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具有被标记为“a”的厚度。在一个实施方案中，组织厚度补偿件具有约0.015"-0.045"的厚度。然而，可采用其它厚度。
因此，在图114至图117所示的至少一个实施方案中，钉仓4810可以在三排钉中的每一排中采用不同数量的钉。在一种构造中，内钉排包括具有最小线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钉冠宽度，并且每个第一钉相对于切线方向以均匀的角度定向。中间钉的构型不同于第一钉构型。中间钉的每个腿部具有适度的线直径和未成形腿部长度。每个中间钉具有比内侧钉的钉冠宽度稍大的钉冠宽度，并且每个中间钉相对于切线方向以均匀的角度定向，但相对于内侧钉的内排以不同的角度定向。每个外侧钉的构型类似于中间钉的构型。每个外侧钉的第三腿部中的每一个具有与内侧钉和中间钉的腿部的线直径相比最大的线直径。每个外侧钉的钉冠宽度显著大于内侧钉和中间钉的钉冠宽度。每个外侧钉被定向成与仓的周边方向相切。外钉排采用嵌入有ORC的织造组织厚度补偿件(间隔织物)以促进止血。阶梯式砧座和阶梯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位于内排中，而具有最长成形高度的钉位于外排中。对应于内钉排和中间钉排的砧座凹坑被“倾斜”以在内排和中间排中形成三维钉。“浴缸型”砧座凹坑对应于外钉排。在至少一个实施方案中，钉可被顺序地击发。例如，内排和中间排中的钉可首先被击发，并且随后击发外排中的钉。环形刀在击发过程期间切割夹持的组织。
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。砧座和钉仓中的一者或两者可相对于其它者在打开构型与闭合构型之间移动以捕获其间的组织。钉仓在圆形钉腔排内或至少部分地在圆形钉腔排内容纳钉。钉从其相应钉腔以圆形排部署到捕获的组织中，并且抵靠砧座中的成形凹坑的对应圆形排成形。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于组织压缩表面中的环形阵列钉成形凹坑。砧座还包括附接安装件和从附接安装件延伸的杆状物。该杆状物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。
钉仓和砧座可在患者体内单独行进，并且在手术区域处组合。在各种实例中，钉仓例如行进穿过患者的狭窄管状主体，诸如结肠。钉仓可包括若干组织接触特征部，诸如阶梯式平台和凹坑延伸部。为了避免在钉仓朝向目标组织行进时无意地伤害患者，本公开除别的之外还提出对若干组织接触特征部的各种修改。
参见图118，局部剖视图示出当钉仓15500在患者身体内行进时抵靠组织(T)按压的圆形外科器械的钉仓15500。钉仓15500的多个结构特征部被修改为形成特殊轮廓的外框架15502以保护组织。钉仓15500包括多个环形排的钉腔。在至少一个示例中，钉腔15510的外排15504至少部分地围绕钉腔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。
术语内和外描绘相对于中心轴线15533的关系。例如，内组织接触表面15518比外组织接触表面15516更靠近中心轴线15533。
如图119所示，钉仓15500包括阶梯式仓平台15508。外排15504限定于阶梯式仓平台15508的外组织接触表面15516中，而内排15506限定于阶梯式仓平台15508的内组织接触表面15518中。外组织接触表面15516从内组织接触表面15518阶梯式下降，该内组织接触表面产生在抵靠组织按压钉仓15500时减小摩擦的梯度。
在某些实例中，外组织接触表面15516平行于或至少基本上平行于内组织接触表面15518。在其它实例中，外组织接触表面15516被倾斜成使得由外组织接触表面15516限定的第一平面横向于由内组织接触表面15518限定的第二平面。在第一平面与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，该角度可为选自大于约0°且小于或等于约30°的范围内的任何角度。在至少一个实例中，例如，该角度可为选自大于约5°且小于或等于约25°的范围内的任何角度。在至少一个实例中，例如，该角度可为选自大于约10°且小于或等于约20°的范围内的任何角度。倾斜的外组织接触表面15516可在钉仓15500相对于组织移动时减少对组织的摩擦或阻碍。在至少一个实例中，倾斜外组织接触表面15516也从内组织接触表面15518阶梯式下降。
在至少一个实例中，外组织接触表面15516的内部部分是平坦的或至少基本上平坦的，而外组织接触表面15516的外边缘15548被倾斜、弯曲和/或斜切，以在钉仓15500相对于组织移动时减少对组织的摩擦或阻碍。例如，钉腔15510驻留在外组织接触表面15516的平坦内部部分中。内组织接触表面15518的外边缘15550也可被倾斜、斜切和/或弯曲，以在钉仓15500相对于组织移动时减少对组织的摩擦或阻碍。
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包括凹坑延伸部15514。凹坑延伸部15514被构造成能够在钉15530从其相应钉腔15510射出时控制并引导钉。在某些实例中，例如，凹坑延伸部15514可被构造成能够容纳具有比内组织接触表面15518的钉更大的未成形高度的钉。
如图119所示，外排15504中的钉腔15510与内排15506中的两个相邻钉腔15512之间的间隙15520侧向对准或至少基本上对准。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叠置，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叠置。
凹坑延伸部15514包括从外组织接触表面15516突出的第一夹套15532，以隐藏钉腿15530a的延伸超出外组织接触表面15516的尖端15536。第一夹套15532包括从第一端部15522突出的端部15538、远离端部15538延伸以形成第一夹套15532的内侧壁15540和外侧壁15542。在至少一个实例中，第一夹套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从外组织接触表面15516突出至比外侧壁15542更大的高度。换句话讲，外侧壁15542的高度低于内侧壁15540。这种构造产生用于从内侧壁15540到外侧壁15542再到外组织接触表面15516的平滑过渡的梯度。在至少一个示例中，内侧壁15540和内组织接触表面15518具有相对于外组织接触表面15516相同的或至少基本上相同的高度。另选地，内侧壁15540和内组织接触表面15518具有相对于外组织接触表面15516不同的高度。在某些实例中，参照外组织接触表面15516，内侧壁15540相对于内组织接触表面15518的高度较低。这种构造产生用于从内组织接触表面15518到内侧壁15540到外侧壁15542再到外组织接触表面15516的平滑过渡的梯度。
内组织接触表面15518、内侧壁15540、外侧壁15542和/或外组织接触表面15516限定形成轮廓的外框架15502的独立部分；然而，如图118所示，此类部分保持足够靠近彼此，使得在钉仓15500抵靠组织按压时组织不能捕获在其间。此外，这些部分中的一个或多个可包括倾斜的、形成轮廓的、弯曲的、弧形的和/或斜切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被倾斜、形成轮廓、弯曲、呈弧形和/或斜切以限定形成轮廓的外框架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组织接触表面15516限定的第一平面和由内组织接触表面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。也可在倾斜平面与第二平面之间限定第二角度。第一角度和第二角度可具有相同的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，第一角度为选自大于约0°且小于或等于约30°的范围内的任何角度。在至少一个实例中，例如，第一角度为选自大于约5°且小于或等于约25°的范围内的任何角度。在至少一个实例中，例如，第一角度为选自大于约10°且小于或等于约20°的范围内的任何角度。在至少一个实例中，例如，第二角度为选自大于约0°且小于或等于约30°的范围内的任何角度。在至少一个实例中，例如，第二角度为选自大于约5°且小于或等于约25°的范围内的任何角度。在至少一个实例中，例如，第二角度为选自大于约10°且小于或等于约20°的范围内的任何角度。
除上述以外，凹坑延伸部15514包括第二夹套15534，该第二夹套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从外组织接触表面15516突出，以隐藏钉腿的延伸超出外组织接触表面15516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延伸以形成第二夹套15534的内侧壁15540和外侧壁15542。
虽然一个凹坑延伸部15514如图119所示，但应当理解，例如，一个或多个其它凹坑延伸部15514可从外组织接触表面15516突出。在至少一个实例中，例如，第一夹套15532和第二夹套15534经由侧壁连接以限定完全围绕钉腔的凹坑延伸部。
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。在各种情况下，例如，本文所述的外科器械系统可由手动操作的触发器促动。在各种情况下，本文所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者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No.2012/0298719)例如更详细地公开了机器人外科器械系统的若干实例。
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，可以设想部署除钉之外的紧固件诸如夹具或大头钉的各种实施方案。此外，还可设想利用用于密封组织的任何合适装置的各种实施方案。例如，根据各种实施方案的端部执行器可包括被构造成能够加热和密封组织的电极。另外，例如，根据某些实施方案的端部执行器可施加振动能量来密封组织。
下述专利的全部公开内容据此以引用方式并入本文：
1997年3月12日提交的名称为“LINEAR STAPLER WITH IMPROVED FIRING STROKE”的欧洲专利申请No.EP 795298；
1997年2月25日公布的名称为“TRIGGER MECHANISM FOR SURGICAL INSTRUMENTS”的美国专利No.5,605,272；
1997年12月16日公布的名称为“LINEAR STAPLER WITH IMPROVED FIRINGSTROKE”的美国专利No.5,697,543；
2005年11月10日公布的名称为“METHOD FOR MAKING A SURGICAL STAPLER”的美国专利申请公布No.2005/0246881；
2007年9月6日公布的名称为“METHOD FOR STAPLING TISSUE”的美国专利申请公布No.2007/0208359；
1985年7月9日公布的名称为“DISPOSABLE LINEAR SURGICAL STAPLINGINSTRUMENT”的美国专利No.4,527,724；
1992年8月11日公布的名称为“FAST CLOSURE DEVICE FOR LINEAR SURGICALSTAPLING INSTRUMENT”的美国专利No.5,137,198；
1995年4月11日公布的名称为“FLEXIBLE SUPPORT SHAFT ASSEMBLY”的美国专利No.5,405,073；
2013年1月29日公布的名称为“SURGICAL CUTTING AND STAPLING INSTRUMENTWITH SELF ADJUSTING ANVIL”的美国专利No.8,360,297；
2015年7月30日提交的名称为“SURGICAL INSTRUMENT COMPRISING SYSTEMS FORASSURING THE PROPER SEQUENTIAL OPERATION OF THE SURGICAL INSTRUMENT”的美国专利申请序列号14/813,242；
2015年7月30日提交的名称为“SURGICAL INSTRUMENT COMPRISING SEPARATETISSUE SECURING AND TISSUE CUTTING SYSTEMS”的美国专利申请序列号14/813,259；
2015年7月30日提交的名称为“SURGICAL INSTRUMENT COMPRISING SYSTEMS FORPERMITTING THE OPTIONAL TRANSECTION OF TISSUE”的美国专利申请序列号14/813,266；
2015年7月30日提交的名称为“SURGICAL INSTRUMENT COMPRISING A SYSTEM FORBYPASSING AN OPERATIONAL STEP OF THE SURGICAL INSTRUMENT”的美国专利申请序列号14/813,274；
1995年4月4日公布的名称为“ELECTROSURGICAL HEMOSTATIC DEVICE”的美国专利No.5,403,312；
2006年2月21日公布的名称为“SURGICAL STAPLING INSTRUMENT HAVINGSEPARATE DISTINCT CLOSING AND FIRING SYSTEMS”的美国专利No.7,000,818；
2008年9月9日公布的名称为“MOTOR-DRIVEN SURGICAL CUTTING AND FASTENINGINSTRUMENT WITH TACTILE POSITION FEEDBACK”的美国专利No.7,422,139；
2008年12月16日公布的名称为“ELECTRO-MECHANICAL SURGICAL INSTRUMENTWITH CLOSURE SYSTEM AND ANVIL ALIGNMENT COMPONENTS”的美国专利No.7,464,849；
2010年3月2日公布的名称为“SURGICAL INSTRUMENT HAVING AN ARTICULATINGEND EFFECTOR”的美国专利No.7,670,334；
2010年7月13日公布的名称为“SURGICAL STAPLING INSTRUMENTS”的美国专利No.7,753,245；
2013年3月12日公布的名称为“SELECTIVELY ORIENTABLE IMPLANTABLE FASTENERCARTRIDGE”的美国专利No.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；
2008年2月14日提交的名称为“SURGICAL CUTTING AND FASTENING INSTRUMENTHAVING RF ELECTRODES”的美国专利申请序列号12/031,573；
2008年2月15日提交的名称为“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No.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No.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No.8,608,045；
2009年12月24日提交的名称为“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No.8,220,688；
2012年9月29日提交的名称为“STAPLE CARTRIDGE”的美国专利申请序列号12/893,461，现为美国专利No.8,733,613；
2011年2月28日提交的名称为“SURGICAL STAPLING INSTRUMENT”的美国专利申请序列号13/036,647，现为美国专利No.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No.9,072,535；
2012年6月15日提交的名称为“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No.9,101,358；
2013年3月13日提交的名称为“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No.2014/0263551；
2013年3月13日提交的名称为“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No.2014/0263552；
2006年1月31日提交的名称为“SURGICAL CUTTING AND FASTENING INSTRUMENTWITH CLOSURE TRIGGER LOCKING MECHANISM”的美国专利申请公布No.2007/0175955；以及
2010年4月22日提交的名称为“SURGICAL STAPLING INSTRUMENT WITH ANARTICULATABLE END EFFECTOR”的美国专利申请公布No.2010/0264194，现为美国专利No.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修改和变型。另外，在公开了用于某些部件的材料的情况下，也可使用其它材料。此外，根据多种实施方案，单个部件可被替换为多个部件，并且多个部件也可被替换为单个部件，以执行给定的一种或多种功能。上述具体实施方式和下述权利要求旨在涵盖所有此类修改和变型。
本文所公开的装置可被设计成在单次使用后废弃，或者其可被设计成多次使用。然而，在任一种情况下，装置可在至少一次使用后经过修整以便再行使用。修整可包括步骤的任意组合，所述步骤包括但不限于拆卸装置、之后清洁或替换装置的特定零件以及后续重新装配装置。具体地讲，修整设施和/或手术团队可拆卸装置，并且在清洁和/或替换装置的特定部件之后，可重新装配装置以供后续使用。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置于可穿透所述容器的辐射场，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。消毒后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处于无菌状态，直至在医疗设施中将该容器打开。还可使用本领域已知的任何其它技术对装置进行灭菌，所述技术包括但不限于β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、陈述或其它公开材料相冲突的任何材料或其部分，将仅在所并入的材料与现有的公开材料之间不产生冲突的程度下并入。

Claims (20)

1.一种与圆形外科缝合器械一起使用的端部执行器，所述端部执行器包括：
钉仓，所述钉仓包括：
仓体，所述仓体包括环形阵列钉腔；
钉，所述钉能够移除地储存在所述钉腔中；
击发驱动装置，所述击发驱动装置被构造成能够从所述钉腔射出所述钉；以及
环形切割构件，其中所述环形切割构件被所述环形阵列钉腔围绕；以及
砧座，所述砧座包括：
组织压缩表面；
成形表面，所述成形表面被构造成能够使所述钉变形；以及
组织支撑件，其中所述砧座能够朝向所述仓体移动以压缩所述仓体与所述组织支撑件之间的组织，并且其中所述切割构件被构造成能够在所述切割构件的切割行程期间切入所述组织和所述组织支撑件。
2.根据权利要求1所述的端部执行器，其中，所述组织支撑件与所述组织压缩表面对准。
3.根据权利要求1所述的端部执行器，其中，所述组织支撑件包括：
第一环形壁；
第二环形壁；以及
侧向壁，所述侧向壁连接所述第一环形壁和所述第二环形壁。
4.根据权利要求3所述的端部执行器，其中，所述切割构件被构造成能够切入所述侧向壁。
5.根据权利要求3所述的端部执行器，其中，所述组织支撑件还包括限定于所述侧向壁中间的腔体。
6.根据权利要求5所述的端部执行器，其中，所述腔体包括环形腔体。
7.根据权利要求5所述的端部执行器，其中，所述腔体是封闭的。
8.根据权利要求5所述的端部执行器，其中，所述腔体包括至少一个封闭侧和至少一个开放侧。
9.根据权利要求3所述的端部执行器，其中，所述侧向壁包括环形阵列侧向壁，并且其中所述组织支撑件还包括限定于所述环形阵列侧向壁内的环形阵列腔体。
10.根据权利要求3所述的端部执行器，其中，所述第一环形壁比所述第二环形壁短。
11.根据权利要求1所述的端部执行器，其中，所述组织支撑表面包括与所述环形切割构件对准的环形凹陷部。
12.根据权利要求1所述的端部执行器，其中，所述组织支撑件包括：
第一环形壁；
第二环形壁；以及
径向壁，所述径向壁连接所述第一环形壁和所述第二环形壁。
13.根据权利要求1所述的端部执行器，其中，所述组织支撑件包括：
环形壁；以及
侧向壁，所述侧向壁从所述环形壁延伸。
14.根据权利要求1所述的端部执行器，其中，所述组织支撑件在所述组织压缩表面上方延伸。
15.根据权利要求1所述的端部执行器，其中，所述组织支撑件在所述钉成形表面上方延伸。
16.一种圆形外科缝合器械的端部执行器，所述端部执行器包括：
钉仓，所述钉仓包括：
仓体，所述仓体包括环形阵列钉腔；
钉，所述钉能够移除地储存在所述钉腔中；
击发驱动装置，所述击发驱动装置被构造成能够从所述钉腔射出所述钉；以及
切割构件，其中所述切割构件被所述环形阵列钉腔围绕；以及
砧座，所述砧座包括：
组织压缩表面；
成形表面，所述成形表面被构造成能够使所述钉变形；以及
组织块，其中所述砧座能够朝向所述仓体移动以压缩所述仓体与所述组织块之间的组织，并且其中所述切割构件被构造成能够在所述切割构件的切割行程期间切入所述组织和所述组织块。
17.根据权利要求16所述的端部执行器，其中，所述组织块与所述组织压缩表面对准。
18.根据权利要求16所述的端部执行器，其中，所述组织块在所述组织压缩表面上方延伸。
19.根据权利要求16所述的端部执行器，其中，所述组织块在所述钉成形表面上方延伸。
20.一种在外科手术期间与包括仓体和切割构件的圆形外科缝合器械一起使用的砧座，所述砧座包括：
框架；
轴，所述轴从所述框架延伸；
组织压缩表面；
成形表面，所述成形表面被构造成能够在所述外科手术中的步骤期间使从所述外科缝合器械射出的钉变形；以及
组织块，其中所述砧座能够朝向所述外科缝合器械移动以压缩所述仓体与所述组织块之间的组织，其中所述组织已通过所述外科手术中的先前步骤在其中成形钉，其中所述切割构件和所述组织块被协作地构造成能够在所述切割构件的切割行程期间切入先前缝合的所述组织和所述组织块，并且其中所述组织块被构造成能够在所述切割行程期间防止所述成形的钉在所述组织块中产生大于局部的屈服。
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