CN109620332A - 手术装置和用于机械接合动力手术器械的接合器 - Google Patents
手术装置和用于机械接合动力手术器械的接合器 Download PDFInfo
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- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
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- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
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Abstract
本发明公开了一种手术装置。该手术装置包括接合器和末端执行器。该接合器包括:第一轴,其构造成接收来自致动机构的第一旋转输入;第一驱动件,其可旋转地与第一轴联接;第一轴向构件,其可操作地与第一驱动件联接使得第一驱动件的旋转引起第一轴向构件轴向位移;第二轴,其构造成接收来自致动机构的第二旋转输入;第二驱动件,其可旋转地与第二轴联接;以及第二和第三轴向构件,它们可操作地与所述第二驱动件联接使得第二驱动件沿第一方向的旋转引起第二轴向构件沿第三方向的轴向位移,并且第二驱动件沿与第一方向相反的第二方向的旋转引起第三轴向构件沿第三方向的轴向位移。本发明还公开了用于机械接合动力手术器械的接合器。
Description
本申请是申请号为201410123695.2、申请日为2014年3月28日、发明名称为“手术装置、手术用手柄组件和手术用装载单元之间使用的手术接合器及使用方法”的专利申请的分案申请。
技术领域
本公开涉及手术装置和/或系统、手术接合器及所述手术装置和/或系统,手术接合器的使用方法。更具体地,本公开涉及手持式动力手术装置、手术接合器和/或接合器组件,所述手术接合器和/或接合器组件在动力的、旋转和/或关节式运动的手术装置或手柄组件与用于夹紧、切割和/或吻合组织的装载单元之间使用并且用于将它们相互连接。
背景技术
吻合术是将分离的中空器官段进行手术连结。通常,吻合术操作是在去除病变或有缺陷的中空组织段且要连结剩余端部段的手术后进行的。根据所需的吻合术操作,端部段可以通过环形的、端对端的或侧对侧的器官重构方法来连结。
在环形吻合术操作中,通过吻合器械连接器官段的两端,所述吻合器械驱动吻合钉的环形阵列通过每个器官段的端部段并且同时对被驱动的环形吻合钉阵列之内的任何组织进行去芯,从而清空管状通道。通常,这些器械包括细长轴,所述细长轴在近侧端具有手柄部来致动所述器械并且在其远侧端处布置有吻合钉保持部件。砧座组件包括附有砧座头部的砧座杆,所述砧座组件安装至器械的远侧端上,邻近吻合钉保持部件。待吻合的中空器官的组织的相对端部在所述砧座头部和所述吻合钉保持部件之间被夹紧。通过从所述吻合钉保持部件中驱动出一个或多个吻合钉来吻合被夹紧的组织,从而使吻合钉的端部穿过组织并且通过所述砧座头部变形。环形刀具被推进用来挖出中空器官中的组织,从而清空器官内的管状通道。
另外一种类型的手术装置是一种直线型夹紧、切割和吻合装置。在手术操作中,可以使用这样的装置来切除胃肠道中癌变的或异常的组织。传统的直线型夹紧、切割和吻合器械包括具有细长轴和远侧部的手枪握把样式的结构。远侧部包括一对剪刀样式的夹持元件,所述夹持元件夹紧闭合结肠的开口端部。在该装置中,两个剪刀样式的夹持元件中的一个元件(如砧座部)相对于整个结构移动或枢转,而另一个夹持元件相对于整个结构保持固定。该剪切装置的致动(砧座部的枢转)是由保持在手柄中的握柄扳机来控制的。
除了剪切装置以外,远侧部还包括吻合机构。剪切机构的固定夹持元件包括吻合钉钉仓接纳区域和用来驱动吻合钉向上穿过组织的被夹紧端部抵靠砧座部从而密封先前开口的端部的机构。剪切元件可以与所述轴一体形成或者是可以拆卸的使得各种剪切元件和吻合元件可以互换。
许多手术装置的生产商已经开发出具有适用于操作和/或操纵所述手术装置的专用驱动系统的产品线。在许多实例中,所述手术装置包括:可重复使用的手柄组件;以及一次性装载单元或同类物,其可以在使用前选择性地被连接到所述手柄组件上,然后,在使用后再从所述装载单元断开连接以便于被处置或在一些实例中被消毒以重复使用。
与许多现有的手术装置和/或手柄组件一起使用的许多现有的装载单元都是由线性力来驱动。例如,适合于执行腔内胃肠直线切割吻合术操作、首尾相连的吻合术操作以及横向吻合术操作的装载单元通常均需要线性驱动力以便于被操作。因此,这些装载单元与利用旋转运动来传递动力等的手术装置和/或手柄组件无法配合使用。
为了使所述线性驱动的装载单元与利用旋转运动来传递动力的手术装置和/或手柄组件互相配合使用,需要使用接合器和/或接合器组件在所述线性驱动的装载单元和所述旋转驱动的手术装置和/或手柄组件之间进行交接并且将其相互连接。
发明内容
本公开涉及手术装置,所述手术装置包括手柄壳体、接合器、细长部、末端执行器、第一驱动元件和第二驱动元件。所述手柄壳体支承第一致动机构。所述接合器构造为用来与所述第一致动机构机械接合。所述细长部构造为从所述接合器向远侧延伸并限定了纵向轴线。所述末端执行器构造成与所述细长部的远侧部机械接合。所述第一驱动元件被布置成与所述第一驱动组件机械协作。所述第二驱动元件被布置成与所述第一驱动组件机械协作。所述第一驱动组件绕所述纵向轴线沿第一方向的旋转引起所述第一驱动元件的远侧平移。所述第一驱动组件绕所述纵向轴线沿第二方向的旋转引起所述第二驱动元件的远侧平移。所述第一方向与所述第二方向相反。
在公开的实施例中,所述第一驱动组件沿所述第一方向的旋转引起所述第二驱动元件的至少一部分的近侧平移。此处公开的是,所述第一驱动组件沿所述第二方向的旋转引起所述第一驱动元件的至少部分的近侧平移。进一步公开的是,所述末端执行器在其中包括多个紧固件,并且所述第一驱动元件的远侧平移使得所述紧固件从所述末端执行器射出。进一步公开的是,所述末端执行器在其中包括刀具,并且所述第二驱动元件的远侧平移使得所述刀具向远侧平移。
在公开的实施例中,所述手术装置进一步包括:由所述手柄壳体支承的第二致动机构,至少部分地布置在所述接合器内并且与所述第二致动机构的一部分机械协作的第二驱动组件,以及布置为与所述第二驱动组件机械协作的第三驱动元件。此处,所述第二致动机构的致动引起所述第三驱动元件的至少一部分的近侧平移。进一步公开的是,所述第三驱动元件的近侧平移引起所述末端执行器的砧座组件朝向所述末端执行器的钉仓组件移动。
在公开的实施例中,所述第一驱动组件包括一组右旋螺纹和一组左旋螺纹。此处,公开的是,所述第一驱动元件构造为与所述的一组右旋螺纹机械接合,所述第二驱动元件构造为与所述的一组左旋螺纹机械接合。进一步公开的是,所述右旋螺纹被布置为绕所述第一驱动组件的一部分的外径,而所述左旋螺纹被布置为绕所述第一驱动组件的一部分的内径。
在公开的实施例中,所述第一驱动元件包括至少部分地布置在所述接合器内的近侧部和至少部分地布置在所述细长部内的远侧部,所述第二驱动元件包括至少部分布置在所述接合器内的近侧部和至少部分布置在所述细长部内的远侧部。此处,公开的是,所述第一驱动元件的近侧部和所述第二驱动元件的近侧部中的每个均是相对于彼此以及相对于接合器壳体可旋转地固定。进一步公开的是,所述手术装置包括偏置元件,所述偏置元件构造为用来同时向近侧偏置所述第一和第二驱动元件的远侧部。
本公开还涉及一种手术装置,所述手术装置包括手柄壳体、驱动组件、细长部、第一驱动元件和第二驱动元件。所述手柄壳体支承致动机构。所述的驱动组件被布置为与所述致动机构的一部分机械协作。所述细长部从所述接合器向远侧延伸并且限定了纵向轴线。所述末端执行器被布置邻近所述细长部的远侧部。所述第一驱动元件与所述驱动组件通过螺纹接合。所述第二驱动元件与所述驱动组件通过螺纹接合。所述驱动组件绕所述纵向轴线沿第一方向的旋转引起所述第一驱动元件的远侧平移从而实现第一手术功能。所述驱动组件绕所述纵向轴线沿第二方向的旋转引起所述第二驱动元件的远侧平移从而实现第二手术功能。所述第一方向与所述第二方向相反,并且所述第一手术功能与所述第二手术功能不同。
在公开的实施例中,所述第一手术功能包括从钉仓组件向组织射出紧固件,所述第二手术功能包括向远侧推进刀具以切断组织。
在公开的实施例中,所述驱动组件包括一组右旋螺纹和一组左旋螺纹。此处,公开的是,所述第一驱动元件构造为与所述一组右旋螺纹机械接合,所述第二驱动元件构造为与所述一组左旋螺纹机械接合。进一步公开的是,所述右旋螺纹被布置为绕所述驱动组件的一部分的外径,而所述左旋螺纹被布置为绕所述驱动组件的一部分的内径。
本公开还涉及手术接合器,所述手术接合器用来机械接合具有致动机构的动力组件。所述手术接合器包括被布置为与所述致动机构的部分机械协作的驱动组件、与所述驱动组件螺纹接合的第一驱动元件,以及与所述驱动组件螺纹接合的第二驱动元件。所述驱动组件沿第一方向的旋转引起所述第一驱动元件的远侧平移从而实现第一手术功能,并且所述驱动组件沿第二方向的旋转引起所述第二驱动元件的远侧平移从而实现第二手术功能。所述第一方向与所述第二方向相反,并且所述第一手术功能与所述第二手术功能不同。
在公开的实施例中,所述驱动组件包括一组右旋螺纹和一组左旋螺纹。所述第一驱动元件构造为与所述一组右旋螺纹机械接合,并且所述第二驱动元件构造为与所述一组左旋螺纹机械接合。
附图说明
这里参照附图描述了本公开的各种实施例,其中:
图1是根据本公开实施例的包括手术接合器的手术装置的立体图;
图2是图1中所述的手术装置和手术接合器的部件分离的立体图;
图2A是图1和图2中所述的手术装置的一部分的部件分离的立体图;
图3和图4是图1和图2中的手术接合器的立体图;
图5A是图1至图4的部件去除的手术接合器的立体图;
图5B是图1至图5A的部件去除的手术接合器的立体图,包括沿着图5A中的线5B-5B截取的纵向剖面图;
图5C是图1至图5B的手术接合器的沿着图5B的线5C-5C截取的纵向剖面立体图;
图6和图7是图1至图5C的手术接合器的远侧部的立体图;
图8是根据本公开的手术接合器的第二个实施例的立体图;
图9是图8的手术接合器的部件去除的立体图;
图10是根据本公开的手术接合器的第三个实施例的立体图;
图11是图10的手术接合器的部件去除的立体图;
图12是图1至图7的手术接合器的部件分离的立体图;
图13和图14是本公开所述的手术器械的管组件的立体图;
图15描绘了图14所示的管组件的一部分;
图16是图13和图14的部件分离的管组件的立体图;
图17是图13至图16的部件分离的管组件的立体图;
图18是图13至图17的管组件的剖面图;
图19是管组件的沿着图18中的线19-19截取的剖面图;
图20是图18中所示出的细节区域的放大图;
图21是图19中所示出的细节区域的放大图;
图22是图18中所示出的细节区域的放大图;以及
图23是沿着图20中的线23-23截取的径向剖面图。
具体实施方式
现在将参照附图详细描述本公开的手术装置,以及适用于手术装置和/或手柄组件的接合器组件的实施例,其中在几幅附图的每幅附图中相同附图标记指代相同的或对应的元件。在本文中使用时,术语“远侧”是指所述接合器组件或手术装置的较远离用户的部分或其部件,而术语“近侧”是指所述接合器组件或手术装置的较接近用户的部分或其部件。
根据本公开的实施例,手术装置一般被表示为100,且显示为一种动力手持式机电器械的形式,动力手持式机电器械构造为用来选择性地将多个不同的装载单元附接于此,每一个装载单元都构造为通过动力手持式机电手术器械来实现致动和操纵。
如图1所示,手术装置100构造为用来选择性地连接接合器200,然后,依次地,接合器200构造为选择性地连接装载单元300(比如,可重复使用的装载单元或单次使用装载单元)。
如图1-2A所示,手术装置100包括手柄组件或手柄壳体102,手柄组件或手柄壳体102包括下壳体部104、中间壳体部106以及上壳体部108,其中,中间壳体部106从下壳体部104延伸出和/或被支承在下壳体部104上,上壳体部108从中间壳体部106延伸出和/或被支承在中间壳体部106上。手柄壳体102的中间壳体部106提供了一个壳体,此壳体中装备了电路板150(图2A)。电路板150构造为用来控制手术装置100的各种操作,下文将更详细介绍。
手术装置100的下壳体部104限定了一个孔隙,此孔隙形成在下壳体部104的上表面中并位于中间壳体部106的下面或里面。下壳体部104的孔隙提供了一个通道,电线通过所述通道以将设置在下壳体部104中的电气部件(例如电池),与设置在中间壳体部106和/或上壳体部108中的电气部件(例如,电路板150和驱动机构160)电互连。在中间壳体部108的远侧表面或侧面上的扳机壳体107支承一对手指致动的控制按钮124、126或致动机构,此致动机构与电路板150通信以控制手术装置100的驱动连接器。可以理解,手柄组件102可以包括任何适合的类型或数量的致动机构用来致动所述驱动连接器。
特别参照图2A,手柄壳体102的上壳体部108提供了一个壳体,驱动机构160被布置在此壳体中。驱动机构160构造为用来驱动轴和/或齿轮部件从而执行手术装置100的各种操作。特别的是,驱动机构160构造为驱动轴和/或齿轮从而有选择性地使砧座组件510相对于装载单元300的钉仓组件508移动,以从钉仓组件510发射紧固件,和/或纵向地推进刀具。电气部件(例如,电路板、电池和驱动机构)的更多细节公开于2012年6月13日递交的美国临时专利申请序列号为61/659,116中,其名称为“Apparatus for Endoscopic Procedures(用于内窥镜操作的设备)”,其全部内容通过引用的方式合并在此。
如图1-2A所示,上壳体部108的远侧段110限定了连接部108a,该连接部108a构造为用来接受接合器200的对应的驱动联接组件210。如图2所示,手术装置100的连接部108a具有圆柱形的凹部108b,当接合器200与手术装置100匹配时,凹部108b接纳接合器200的驱动联接组件210。连接部108a容纳两个可旋转驱动连接器,两个可旋转驱动连接器被布置为用来与驱动机构160机械协作。
当接合器200与手术装置100匹配时,手术装置100的每一个可旋转驱动连接器与接合器200的对应的可旋转连接器套管218,220相联接(参见图3)。在这点上,第一驱动连接器和第一连接器套管218之间的交接,以及第二驱动连接器和第二连接器套管220之间的交接都是键联接,以便于手术装置100的每一个驱动连接器的旋转都会引起接合器200的对应的连接器套管218,220的对应的旋转。
手术装置100的驱动连接器与接合器200的连接器套管218,220的匹配允许旋转力经由每个对应的连接器交接独立地传递。手术装置100的驱动连接器构造为通过驱动机构160独立地旋转。在这点上,驱动机构160的功能选择模块会选择由驱动机构160的输入驱动部件来驱动手术装置100的驱动连接器中的哪一个或哪几个。因为手术装置100的每一个驱动连接器都是与接合器200的相应的连接器套管218,220进行键联接和/或基本上非可旋转的交接,所以当接合器200被联接到手术装置100时,旋转力被选择性地从手术装置100的驱动机构160传递到接合器200。手术装置100的驱动连接器的选择性旋转允许手术装置100选择性地致动装载单元300的不同功能。
接合器200包括用于将手术装置100的可旋转驱动连接器与装载单元300的第一可轴向平移驱动构件360相互连接的第一驱动传递/转换组件或第一驱动组件。接合器200的第一驱动组件包括第一驱动或夹紧驱动件222和砧座驱动件250,第一驱动组件将手术装置100的第一可旋转驱动连接器的旋转转换并传递成砧座组件510的轴向平移。接合器200的第二驱动传递/转换组件或第二驱动组件包括第二驱动件或发射与切割驱动件223,吻合钉驱动件230,以及刀具驱动件240,第二驱动传递/转换组件或第二驱动组件将手术装置100的第二可旋转驱动连接器的旋转转换并传递成吻合钉推动器组件400的轴向平移从而发射紧固件以及刀具推动器组件380的轴向平移从而平移刀具。
更具体的讲,手术装置100的第一驱动连接器以及因此接合器200的第一连接器套管218的选择性的且独立的旋转对应于第一驱动件222的选择性且独立的移动,这引起砧座组件510相对于钉仓组件508的纵向移动。手术装置100的第二驱动连接器以及因此接合器200的第二连接器套管220的选择性的且独立的旋转对应于第二驱动件223的选择性移动。第二驱动件223的旋转引起吻合钉驱动件230的平移从而从钉仓组件508中射出紧固件,第二驱动件223的旋转还引起刀具驱动件240的平移进而切断组织。另外,第二连接器套管220沿第一方向(例如,顺时针方向)的旋转对应于第二驱动件223沿第二方向(例如,逆时针方向)的旋转,这使得同时纵向推进吻合钉驱动件230和纵向缩回刀具驱动件240;第二连接器套管220沿第二、相反方向(例如,逆时针方向)的旋转对应于第二驱动件223沿第一方向(例如,顺时针方向)的旋转,这使得同时纵向缩回吻合钉驱动件230和纵向推进刀具驱动件240。
如图3和图4所示,接合器200包括位于其近侧端处的手术装置驱动联接组件210(图3)和位于其远侧端处的装载单元联接组件215(图4)。驱动联接组件210包括驱动联接壳体210a,所述驱动联接壳体210a至少一部分在接合器壳体203内可旋转地支承。在所示的实施例中(参见图5A、图5B和图12),驱动联接组件210可旋转地支承第一可旋转近侧驱动轴或元件212和第二可旋转近侧驱动轴或元件214。第一可旋转近侧驱动轴212与第一连接器套管218匹配,第二可旋转近侧驱动轴214与第二连接器套管220匹配。
特别参考图5A、图5B和图12,近侧驱动联接组件210包括第一偏置构件219和第二偏置构件221,两个偏置构件被布置在相应的连接器套管218和220的远侧。第一偏置构件219绕第一驱动轴212布置,第二偏置构件221绕第二驱动轴214布置。当接合器200被连接到手术装置100时,偏置构件219,221作用于相应的连接器套管218和220上,从而帮助保持连接器套管218和220与手术装置100的相应的可旋转驱动连接器的远侧端接合。特别是,偏置构件219,221起到在近侧方向上偏置相应的连接器套管218、220的作用。通过这种方式,在接合器200和手术装置100组装过程中,如果连接器套管218和/或220与手术装置100的相应的驱动连接器未对准,则偏置构件219和/或221会被压缩。如此,当手术装置100的驱动机构160接合时,手术装置100的驱动连接器将旋转,而且,偏置构件219、221将使得连接器套管218、220分别向近侧向后滑动,从而有效地将手术装置100的驱动连接器与近侧驱动联接组件210的第一驱动轴212以及第二驱动轴214联接。
如附图所示,有几种方法用来将驱动联接组件210及其部件相对于第一驱动件222和第二驱动件223定位。例如,图1-7以及图12显示了线性的、平行的或正齿轮输入,图8和图9显示了90°蜗轮,图10-11和图18-21显示了成角度的输入。可以知道,在这些实施例中的每个实施例中,手术装置100、接合器200和装载单元300的功能和操作相似。所以,这里只讨论显示在图1-7和图12中实施例的细节。可以知道,平行驱动可以用圆柱齿轮来实现,垂直于输入的驱动(例如,90°蜗轮)可以使用蜗轮来实现,成角度的输入驱动可以用其他齿轮组来实现。
特别参考图5C和图12,与第一驱动轴212机械接合的第一驱动组件包括夹紧驱动件222和砧座驱动件250。夹紧驱动件222包括驱动螺母224、从驱动螺母224向远侧延伸的远侧驱动构件225,以及延伸贯通驱动螺母224和远侧驱动构件225的带螺纹镗孔226。驱动螺母224的周边具有螺纹,用来与第一驱动轴212的远侧部上的螺纹接合。砧座驱动件250包括近侧螺纹部252和包括筒夹(collet)256的远侧段254,筒夹256用来与装载单元300的套管针组件360的近侧部362机械接合。砧座驱动件250的带螺纹部分252的至少部分至少部分地延伸通过夹紧驱动件222的带螺纹镗孔226。如此,第一驱动轴212的旋转引起夹紧驱动件222的旋转,夹紧驱动件222的旋转引起砧座驱动件250的纵向平移,所述砧座驱动件250的纵向平移引起砧座组件510相对于钉仓组件508的移动,下文将更详细讨论。
继续参考图5C和图12,与第二驱动轴214机械接合的第二驱动组件包括第二驱动件223、吻合钉驱动件230和刀具驱动件240。第二驱动件223包括驱动螺母227、从驱动螺母227向远侧延伸的远侧驱动构件228,以及延伸贯通远侧驱动构件228的内镗孔229。远侧驱动构件228包括绕其外周布置的第一组螺纹228a和绕其内周布置的、邻近内镗孔229的第二组螺纹228b。第一组螺纹228a与第二组螺纹228b的螺纹定向相反。例如,第一组螺纹228a是右旋螺纹,而第二组螺纹228b是左旋螺纹,反之亦然。驱动螺母227的周边具有螺纹,此螺纹用于与第二驱动轴214的远侧部上的螺纹接合。
吻合钉驱动件230包括近侧的螺纹部232和远侧段236。螺纹部232的螺纹围绕镗孔233(图12),镗孔233构造为用来接受第二驱动件233的远侧驱动构件228的至少一部分于其中。吻合钉驱动件230的螺纹部232构造为与第二驱动件223的第一组螺纹228a机械接合。刀具驱动件240包括近侧的螺纹部242和远侧段246。螺纹部242的螺纹构造为与第二驱动件223的第二组螺纹228b机械接合。
如此,第二驱动轴214沿第一方向(例如,顺时针方向)的旋转引起第二驱动件223沿第二、相反方向(例如,逆时针方向)的旋转,所述第二驱动件223沿第二方向的旋转引起吻合钉驱动件230的远侧平移,所述吻合钉驱动件230的远侧平移使得从钉仓组件508射出紧固件,此讲在后文更详讲述,从钉仓组件508射出紧固件引起刀具驱动件240的近侧平移。而且,第二驱动轴214沿第二方向(例如,逆时针方向)的旋转引起第二驱动件223沿第一、相反方向(例如,顺时针方向)的旋转,所述第二驱动件223沿第一方向的旋转引起吻合钉驱动件230的近侧平移,吻合钉驱动件230的近侧平移引起刀具驱动件240的远侧平移,刀具驱动件240的远侧平移引起刀片的远侧推进从而切断组织,这将在后文更加详细描述。可以知道,第一组螺纹228a与第二组螺纹228b的螺纹的相反定向使得第二驱动件223的两个方向的旋转引起两个不同元件(即,吻合钉驱动件230和刀具驱动件240)沿彼此相反的方向移动。另外,可以预见,螺纹228a和228b彼此具有不同的螺距,例如,用以增加纵向位移和提供更小的力,和/或减少纵向位移和增加产生的力。
此外,砧座驱动件250、吻合钉驱动件230、刀具驱动件240和接合器壳体203中的每个都包括防旋转特征,防旋转特征由非圆形横截面形状形成。例如,特别参考图6,砧座驱动件250的远侧部包括外径,外径具有六边形横截面,该六边形横截面与刀具驱动件240的内径的对应的六边形横截面匹配。刀具驱动件240的外径包括六边形横截面,该六边形横截面与吻合钉驱动件230的内径的对应的六边形横截面匹配。吻合钉驱动件230的外径包括十二边形(12边的多边形)横截面,该十二边形横截面与接合器壳体203的内径的对应的十二边形横截面匹配。这样,所有的线性驱动(吻合钉驱动件230、刀具驱动件240以及砧座驱动件250)都可旋转地锁定到接合器壳体203。其他的非圆形形状和特征能够用来实现防旋转,比如键联接方式、花键(spline)等。
参考图13-23,关于装载单元300的更多细节将在这里讨论。装载单元300包括近侧轮毂310、从近侧轮毂310向远侧延伸的细长部350,以及布置为邻近细长部350的远侧端302的末端执行器500。近侧轮毂310构造为与接合器200的远侧部280(图6、7、20和21)匹配。更具体的讲,近侧轮毂310包括多个止动器312,止动器312构造来接纳来自接合器200的远侧部280的对应的球282(图6、12、20和23),这将固定接合器200和装载单元300之间的旋转和轴向位移。此外,球282/止动器312的交接使装载单元300相对于接合器200旋转并且在多个径向位置上锁定。
参考图16和17,装载单元300的细长部350包括外管352(图17)、套管针组件360、刀具推动器组件380、吻合钉推动器组件400以及多个偏置元件420。特别参考图16,套管针组件360的近侧部362构造为至少部分插入接合器200的筒夹256(参见图20和图21)。套管针组件360的远侧部364包括末端执行器附接件366,末端执行器附件366构造为可拆卸地附接在末端执行器500的砧座510上(参见图1和图2)。套管针组件360的中间部368将近侧部362和远侧部364相互连接,并且在所示的实施例中,包括纵向弯曲部369。中间部368将作用于近侧部362上的纵向力传递到远侧部364。
刀具推动器组件380包括近侧部382、远侧部384,以及将近侧部382和远侧部384相互连接的中间部386。近侧部382包括弹簧交接部388,以及近侧面390,近侧面390用来接合刀具驱动件240(图20-21)的远侧面247。如图所示,弹簧交接部388包括四个部分388a、388b、388c和388d(参见图17、图20和图21),四个部分围绕近侧部382的周边均匀间隔并且构造为用来接合最近侧偏置元件420a。弹簧交接部388的其他配置也可通过本公开预见。刀具推动器组件380的远侧部384包括刀具推动器392,刀具推动器392构造为用来接合末端执行器500的刀具(例如,被推进从而接触到刀具)。中间部386在所示的实施例中包括纵向弯曲部387,中间部386将作用于近侧部382上的纵向力传递给远侧部384。
吻合钉推动器组件400包括近侧部402、远侧部404,以及将近侧部402和远侧部404相互连接的中间部406。近侧部402包括轮毂408和从轮毂408向远侧延伸的远侧延伸部403。轮毂408和远侧延伸部403包括延伸贯通其中的镗孔410。镗孔410包括三个狭槽412a、412b和412c以及狭缝414,所述狭槽和狭缝延伸贯通轮毂408的彼并且部分延伸通过远侧延伸部403。狭槽412a-412c构造且定尺寸为允许弹簧交接部388的部分388a、388b和388c纵向滑动至少部分通过轮毂408和远侧延伸部403。狭缝414构造且定尺寸为允许弹簧交接部388的部分388d纵向滑动至少部分通过轮毂408和远侧延伸部403。在所示的实施例中,中间部406包括纵向弯曲部并且包括多个肋件407,多个肋件407沿着中间部的长度的至少一部分。可以预见,当组装时,肋件407抵接或基本上抵接外管352的内壁,使得当吻合钉推动器组件400相对于外管352纵向推进时,肋件407沿着外管352的内壁骑跨从而帮助抵抗施加的向内的径向力。吻合钉推动器组件400的中间部406将近侧部402和远侧部404相互连接,并且,在所示的实施例中,中间部406包括纵向弯曲部405。中间部406将作用于近侧部402上的纵向力传递给远侧部404。
外管352包括与近侧轮毂310机械接合的近侧部354以及与末端执行器500机械接合的远侧部356。外管352的中间部358将近侧部354和远侧部356相互连接,并且,在所示的实施例中,中间部358包括纵向弯曲部359。
仍参考图17-23,当组装装载单元300时,套管针组件360的近侧部362被布置在刀具推动器组件380的近侧部382内,远侧部364的至少部分被布置在刀具推动器组件380的远侧部384内,中间部368被布置为邻近刀具推动器组件380的中间部386,末端执行器附件366向远侧延伸超过刀具推动器组件380的远侧部384。
而且,当组装装载单元300时,刀具推动器组件380的近侧部382至少部分被布置在吻合钉推动器组件400的近侧部402内,刀具推动器组件380的远侧部384至少部分被布置在吻合钉推动器组件400的远侧部404内,刀具推动器组件380的中间部386被布置为邻近吻合钉推动器组件400的中间部406。此外,弹簧交接部388的部分388a-c被定位在镗孔410的相应的狭槽412a-412c内,弹簧交接部388的部分388d被定位在轮毂410的狭缝414内。
偏置元件420被布置在装载单元300的弹簧交接部388远侧、在吻合钉推动器组件400的轮毂408的远侧面409的远侧、并且在近侧轮毂310的远侧壁311的近侧。偏置元件420使刀具推动器组件380和吻合钉推动器组件400向近侧(即,朝向刀具推动器组件380和吻合钉推动器组件400的缩回位置)偏置。更特别的是,当吻合钉推动器组件400被向远侧推进时(如上讨论所述),偏置元件420在轮毂408的远侧面409和近侧轮毂310的远侧壁311之间被压缩。另外,当刀具推动器组件380被推进时(如上讨论所述),偏置元件在刀具推动器组件380的弹簧交接部388和近侧轮毂310的远侧壁311之间被压缩。此外,轮毂408和远侧延伸部403的狭槽412a-412c和狭缝414容纳弹簧交接部388并且允许弹簧交接部388纵向滑动通过其中,这样有助于使刀具推动器组件380相对于吻合钉推动器组件400纵向平移。
另外,当组装装载单元300时,套管针组件360、刀具推动器组件380、吻合钉推动器组件400以及偏置元件420全部都至少部分地布置在近侧轮毂310和/或外管352内。
根据上面所述,在这里描述手术装置100的使用。特别是,第一驱动轴212的旋转引起夹紧驱动件222的旋转,夹紧驱动件222的旋转引起砧座驱动件250的纵向平移,砧座驱动件250的纵向平移引起套管针组件360的对应的纵向平移,套管针组件360的对应的纵向平移使得末端执行器附接件366纵向平移,以使砧座组件510相对于钉仓组件508移动(例如,夹紧其间的组织)。共同地,砧座驱动件250和套管针组件360是驱动元件。
第二驱动轴214沿第一方向(例如,顺时针方向)的旋转引起第二驱动件223沿第二、相反方向(例如,逆时针方向)的旋转,第二驱动件223沿第二、相反方向的旋转引起吻合钉驱动件230的远侧平移,吻合钉驱动件230的远侧平移引起吻合钉推动器组件400的对应的远侧平移(通过吻合钉驱动件230的远侧面231与吻合钉推动器组件400的近侧面401之间的接合),吻合钉推动器组件400的对应的远侧平移使得从末端执行器500射出紧固件(例如,至少部分地穿过组织)。另外,第二驱动轴214沿第一方向的旋转引起刀具驱动件240的近侧平移。共同地,吻合钉驱动件230和吻合钉推动器组件400是驱动元件。
第二驱动轴214沿第二方向(例如,逆时针方向)的旋转引起第二驱动件223沿第一、相反方向(例如,顺时针方向)的旋转,所述第二驱动件223沿第一、相反方向的旋转引起吻合钉驱动件230的近侧平移,吻合钉驱动件230的近侧平移将引起刀具驱动件240的远侧平移。刀具驱动件240的远侧平移引起刀具推动器组件380的对应的远侧平移(通过刀具驱动件240的远侧面247与刀具推动器组件380的近侧面390之间的接合),刀具推动器组件380的对应的远侧平移引起刀具推动器392和刀具的远侧推进(例如,切断组织)。共同地,刀具驱动件240和刀具推动器组件380都是驱动元件。
虽然上面描述讨论了驱动轴212、214的动力旋转(例如,通过电池提供的动力),本公开还包括与手动操作的手柄组件(例如,包括可旋转的旋钮)一起使用的本公开的驱动组件。在这样的实施例中,可以预见,沿第一方向旋转旋钮使得紧固件从手术器械中射出,沿第二方向也就是相反的方向旋转旋钮引起刀具的远侧推进从而切断组织。在授予Milliman的专利号为8,317,075的美国专利(“Milliman”)中公开了包括可旋转旋钮的手术器械的实例,所述专利的全部内容通过引用方式合并在此。此外,Milliman公开了末端执行器500的更多细节。
上面描述讨论了包括特别类型的末端执行器500(即,砧座组件510能够相对于钉仓组件508纵向平移)的手术装置100,还可以想到其他类型的末端执行器(例如,包括至少一个可枢转钳夹构件的装载单元)。
此外,本公开包括如本文所描述的手术装置100和及其部件的使用方法。
将要理解的是,可以对这里公开的手术装置和接合器的实施例做出各种修改。因此,上面的描述不应该被理解为限制,而仅仅理解为实施例的示范例。本领域的技术人员将在所附的权利要求的范围和精神内设想其他改进。
Claims (19)
1.一种手术装置,包括:
接合器,包括:
第一轴,其构造成接收来自致动机构的第一旋转输入;
第一驱动件,其可旋转地与所述第一轴联接;
第一轴向构件,其可操作地与所述第一驱动件联接使得所述第一驱动件的旋转引起所述第一轴向构件轴向位移;
第二轴,其构造成接收来自所述致动机构的第二旋转输入;
第二驱动件,其可旋转地与所述第二轴联接;以及
第二和第三轴向构件,它们可操作地与所述第二驱动件联接使得所述第二驱动件沿第一方向的旋转引起所述第二轴向构件沿第三方向的轴向位移,并且所述第二驱动件沿与所述第一方向相反的第二方向的旋转引起所述第三轴向构件沿第三方向的轴向位移;以及
末端执行器,其包括第一、第二和第三轴向驱动件,所述第一、第二和第三轴向驱动件构造成进行轴向位移以实现所述末端执行器的第一、第二和第三功能,所述第一、第二和第三轴向驱动件可操作地联接到所述接合器的相应的第一、第二和第三轴向构件。
2.根据权利要求1所述的手术装置,其中所述第一轴与所述第一驱动件限定锐角。
3.根据权利要求2所述的手术装置,其中所述第一轴包括蜗轮。
4.根据权利要求1所述的手术装置,其中所述第一轴包括正齿轮。
5.根据权利要求1所述的手术装置,其中所述第二和第三轴向构件同轴地布置。
6.根据权利要求1所述的手术装置,其中所述末端执行器在其中包括多个紧固件,并且其中所述第二轴向构件的远侧平移使得所述多个紧固件从所述末端执行器射出。
7.根据权利要求1所述的手术装置,其中所述末端执行器在其中包括刀具,所述第三轴向构件的轴向位移使得所述刀具平移。
8.根据权利要求1所述的手术装置,其中所述末端执行器包括能够在打开位置与接近位置之间移动的砧座,所述第一轴向构件的轴向位移使所述砧座在所述打开位置与接近位置之间转换。
9.根据权利要求1所述的手术装置,其中所述第二驱动件包括构造成分别接合所述第二轴向构件和第三轴向构件的第一部分和第二部分。
10.根据权利要求9所述的手术装置,其中所述第二驱动件的所述第一和第二部分形成为单一构造。
11.根据权利要求9所述的手术装置,其中所述第二驱动件的所述第一部分和第二部分分别包括一组右旋螺纹和一组左旋螺纹。
12.根据权利要求11所述的手术装置,其中所述右旋螺纹设置在所述第二驱动件的外表面上并且所述左旋螺纹设置在所述第二驱动件的内表面上。
13.根据权利要求1所述的手术装置,其中所述第一轴或第二轴中的至少一个向近侧偏置。
14.一种用于机械接合动力手术器械的接合器,包括:
第一轴,其构造成接收来自致动机构的第一旋转输入;
第一驱动件,其可旋转地与所述第一轴联接;
第一轴向构件,其可操作地与所述第一驱动件联接使得所述第一驱动件的旋转引起所述第一轴向构件的轴向位移;
第二轴,其构造成接收来自所述致动机构的第二旋转输入;
第二驱动件,其可旋转地与所述第二轴联接;以及
第二和第三轴向构件,它们可操作地与所述第二驱动件联接使得所述第二驱动件沿第一方向的旋转引起所述第二轴向构件沿第三方向的轴向位移,并且所述第二驱动件沿与所述第一方向相反的第二方向的旋转引起所述第三轴向构件沿第三方向的轴向位移,其中所述第一、第二和第三轴向构件被构造成可操作地与所述动力手术器械的末端执行器联接使得所述第一、第二和第三轴向构件的轴向位移分别实现所述末端执行器的第一、第二和第三功能。
15.根据权利要求14所述的接合器,其中所述第一轴与所述第一驱动件限定锐角。
16.根据权利要求15所述的接合器,其中所述第一轴包括蜗轮。
17.根据权利要求14所述的接合器,其中所述第一轴包括正齿轮。
18.根据权利要求14所述的接合器,其中所述第二驱动件包括构造成分别接合所述第二轴向构件和第三轴向构件的第一部分和第二部分。
19.根据权利要求18所述的接合器,其中所述第二驱动件的所述第一部分和第二部分形成为单一构造。
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- 2014-03-28 CN CN201410123695.2A patent/CN104274222B/zh active Active
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Also Published As
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US20150014392A1 (en) | 2015-01-15 |
CN109620332B (zh) | 2022-03-04 |
CN104274222A (zh) | 2015-01-14 |
ES2589227T3 (es) | 2016-11-11 |
US10485549B2 (en) | 2019-11-26 |
CN104274222B (zh) | 2018-12-04 |
EP2823771A1 (en) | 2015-01-14 |
EP2823771B1 (en) | 2016-07-27 |
EP3120782A2 (en) | 2017-01-25 |
US9629633B2 (en) | 2017-04-25 |
US20170181749A1 (en) | 2017-06-29 |
EP3120782A3 (en) | 2017-04-05 |
CA2847192A1 (en) | 2015-01-09 |
EP3120782B1 (en) | 2019-12-18 |
JP6431269B2 (ja) | 2018-11-28 |
JP2015016295A (ja) | 2015-01-29 |
AU2014201499A1 (en) | 2015-01-29 |
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