CN109640844B - 内窥镜手术施夹器和施夹系统 - Google Patents
内窥镜手术施夹器和施夹系统 Download PDFInfo
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
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- A—HUMAN NECESSITIES
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
- A61B2017/00464—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable for use with different instruments
Abstract
一种内窥镜手术施夹器(10),其包括手柄组件(100),所述手柄组件构造成可释放地接合至少两个不同的内窥镜组件(200、300)。手柄组件(100)构造成当构造用于棘轮使用的内窥镜组件(200)与手柄组件(100)接合时从非棘轮使用状态转换到棘轮使用状态。当构造用于非棘轮使用的内窥镜组件(300)与手柄组件(100)接合时,手柄组件(100)保持在非棘轮使用状态。还提供了与手柄组件(100)一起使用的内窥镜组件(200、300)。
Description
背景技术
技术领域
本公开涉及手术施夹器和施夹系统。更具体地,本公开涉及具有构造成与各种不同的内窥镜组件一起使用的手柄组件的内窥镜手术施夹器和包含其的系统。
相关技术描述
内窥镜手术施夹器在本领域中是已知的,并且用于许多不同且有用的手术程序。在腹腔镜手术程序的情况下,通过穿过皮肤中的小入口切口插入的窄管或套管实现进入腹部内部。在身体其它地方执行的微创手术通常称为内窥镜手术。
具有各种尺寸(例如直径)的内窥镜手术施夹器在本领域中是已知的,所述施夹器被构造成应用各种不同的手术夹,并且能够在进入体腔期间应用单个或多个手术夹。此类手术夹通常由生物相容性材料制成,并且通常在血管上压缩。一旦施加到血管上,压缩的手术夹就终止通过所述血管的流体的流动。
在内窥镜手术或腹腔镜手术期间,取决于待绑扎的下层组织或血管,可能需要和/或必须使用不同尺寸的手术夹或不同构造的手术夹。为了降低内窥镜手术施夹器的总体成本,期望单个内窥镜手术施夹器能够根据需要接收并且能够击发不同尺寸的手术夹。
因此,需要这样的内窥镜手术施夹器和系统,其包括手柄组件,所述手柄组件构造成与各种不同的内窥镜组件一起使用,所述内窥镜组件具有装载在其中的不同夹子和/或被构造用于执行各种不同手术任务。
发明内容
如本文详述以及在附图中示出的那样,当涉及手术器械上的相对定位时传统所示那样,术语“近端”是指设备或其部件的更靠近使用者的端部,并且术语“远端”是指设备或其部件的更远离使用者的端部。此外,在一致的程度上,本文描述的任何或所有方面和特征均可以与本文描述的任何或所有其它方面和特征结合使用。
根据本公开的一个方面,提供了一种手术施夹器的手柄组件,其构造成可释放地接合至少两个不同的内窥镜组件。手柄组件包括限定主体部分的壳体和从主体部分延伸的固定手柄部分。触发器可枢转地连接到壳体,并且可相对于固定手柄部分在未致动位置与致动位置之间移动。驱动杆可滑动地支撑在壳体的主体部分内,并可操作地连接到触发器,使得触发器从未致动位置朝向致动位置的运动使驱动杆向远端平移穿过壳体的主体部分。驱动杆包括设置在其上的棘轮齿条,并且棘轮机构设置在壳体的主体部分内。
棘轮机构包括棘爪销、可枢转且可滑动地支撑在棘爪销上的棘轮爪、偏置构件、凸轮臂和凸轮滑块。偏置构件定位成使棘轮爪沿着棘爪销朝向相对于棘轮齿条的偏置位置偏置,使得在驱动杆的远端平移时,棘轮爪被阻止可操作地接合棘轮齿条。凸轮臂可枢转且可滑动地支撑在与棘轮爪邻近的棘爪销上。凸轮滑块可选择地平移穿过壳体的主体部分并相对于凸轮臂在第一位置和第二位置之间可选择地平移,在所述第一位置中,棘爪销在偏置构件的偏置下保持在偏置位置中,在所述第二位置中,凸轮滑块沿着棘爪销推动凸轮臂,从而沿着棘爪销将棘轮爪从偏置位置推动到对齐位置。在对齐位置,棘轮爪与棘轮齿条对齐,以允许棘轮爪在驱动杆远端平移时可操作地接合棘轮齿条。
凸轮臂和凸轮滑块可以限定凸轮表面,该凸轮表面构造成在凸轮滑块相对于凸轮臂平移时沿着彼此凸出。
凸轮滑块可以可操作地接合在限定在壳体的主体部分的内表面上的导轨内。
凸轮滑块偏置构件可以构造成使凸轮滑块朝向第一位置偏置。
棘爪偏置构件可以接合在棘轮爪与凸轮臂之间。
闩锁组件可以可操作地支撑在壳体上。闩锁组件可包括杠杆闩锁,该杠杆闩锁构造成可释放地接合插入手柄组件中的内窥镜组件。
杠杆闩锁可包括远端接合齿,该远端接合齿构造成接合插入手柄组件中的内窥镜组件。
杠杆闩锁可包括近端操纵部分,该近端操纵部分构造成用于手动操纵以使远端接合齿与内窥镜组件脱离,从而允许从手柄组件移除内窥镜组件。
根据本公开另一方面提供的手术施夹系统包括手柄组件和第一内窥镜组件。手柄组件包括壳体和触发器,该触发器可枢转地连接到壳体,并且可在未致动位置与致动位置之间相对于壳体移动。驱动杆可滑动地支撑在壳体内,并可操作地连接到触发器,使得触发器从未致动位置朝向致动位置的运动使驱动杆向远端平移穿过壳体。棘轮机构也设置在壳体内。驱动杆包括设置在其上的棘轮齿条。
棘轮机构包括棘爪销、可枢转且可滑动地支撑在棘爪销上的棘爪、定位成使棘轮爪朝向偏置位置相对于棘轮齿条偏置的偏置构件、凸轮臂和凸轮滑块。在偏置位置,在驱动杆远端平移时,棘轮爪被阻止可操作地接合棘轮齿条。凸轮臂支撑在与棘轮爪相邻的棘爪销上。凸轮滑块可选择性地通过壳体并相对于凸轮臂移动。凸轮滑块最初设置在第一位置,其中棘轮爪在偏置构件的偏置下保持在偏置位置中。第一内窥镜组件构造成用于棘轮使用,并且包括可插入壳体内并且可释放地接合在壳体内的第一近端轮毂。
在将第一近端轮毂插入壳体中时,凸轮滑块从第一位置移动到第二位置,使得凸轮滑块沿着棘爪销推动凸轮臂,从而沿着棘爪销将棘轮爪从偏置位置推动到对齐位置。在对齐位置,棘轮爪与棘轮齿条对齐,以在驱动杆远端平移时允许棘轮爪可操作地接合棘轮齿条。
可以提供构造用于非棘轮使用的第二内窥镜组件。第二内窥镜组件可包括第二近端轮毂,该第二近端轮毂可插入壳体内并可释放地接合在壳体内。在将第二近端轮毂插入壳体中时,凸轮滑块可以保持在第一位置,使得棘轮爪在偏置构件的偏置下保持在偏置位置。
第一近端轮毂可包括近端延伸部分,该近端延伸部分构造成在第一近端轮毂插入壳体中时将凸轮滑块从第一位置推动到第二位置。
第二近端轮毂可以没有近端延伸部分,使得在第二近端轮毂插入壳体中时,凸轮滑块保持在第一位置,并且棘轮爪在偏置构件的偏置下保持在偏置位置。
手柄组件还可包括旋转旋钮,该旋转旋钮从壳体向远端延伸并可旋转地连接到壳体。旋转旋钮和第一近端轮毂可以限定互补的分度特征,以在第一近端轮毂插入壳体中时相对于旋转旋钮可旋转地固定第一内窥镜组件。
手柄组件还可包括可操作地支撑在壳体上的闩锁组件。闩锁组件可包括杠杆闩锁,该杠杆闩锁构造成在第一近端轮毂插入壳体中时可释放地接合第一近端轮毂。
杠杆闩锁可包括远端接合齿,并且第一近端轮毂可限定环形通道。远端接合齿可构造成在第一近端轮毂插入壳体中时接合在环形通道内。
杠杆闩锁可包括近端操纵部分,该近端操纵部分构造成用于手动操纵,以使远端接合齿与环形通道脱离,从而允许第一近端轮毂从壳体移除。
根据本公开的另一方面提供的另一种手术施夹系统包括手柄组件、第一内窥镜组件和第二内窥镜组件。手柄组件包括壳体和驱动杆,该驱动杆构造成响应于手柄组件的致动而向远端平移穿过壳体。驱动杆包括设置在其上的棘轮齿条,并且棘轮机构设置在壳体内。
棘轮机构包括棘爪销、可枢转地且可滑动地支撑在棘爪销上的棘轮爪和定位成使棘轮爪朝向偏置位置相对于棘轮齿条偏置的偏置构件,使得棘轮爪在驱动杆的远端平移时被阻止可操作地接合棘轮齿条。凸轮滑块可相对于壳体纵向平移。凸轮滑块最初设置在第一位置,其中棘轮爪在偏置构件的偏置下保持在偏置位置中。第一内窥镜组件构造成用于棘轮使用,并且可插入壳体内并可释放地接合在壳体内。
在将第一内窥镜组件插入壳体中时,凸轮滑块从第一位置平移到第二位置,使得凸轮滑块沿着棘爪销将棘轮爪从偏置位置推动到对齐位置。在对齐位置,棘轮爪与棘轮齿条对齐,以在驱动杆的远端平移时允许棘轮爪可操作地接合棘轮齿条。第二内窥镜组件构造成用于非棘轮用途,并且可插入壳体内并可释放地接合在壳体内。在将第二内窥镜组件插入壳体中时,凸轮滑块保持在第一位置,使得棘轮爪在偏置构件的偏置下保持在偏置位置。
手柄组件还可包括可操作地支撑在壳体上的闩锁组件。闩锁组件可包括杠杆闩锁,该杠杆闩锁构造成在第一内窥镜组件或第二内窥镜组件插入壳体中时可释放地接合第一内窥镜组件或第二内窥镜组件。
第一内窥镜组件可包括限定近端延伸部分的第一近端轮毂,该近端延伸部分构造成在第一近端轮毂插入壳体中时将凸轮滑块从第一位置推动到第二位置。第二内窥镜组件可包括没有近端延伸部分的第二近端轮毂,使得在第二近端轮毂插入壳体中时,凸轮滑块保持在第一位置。
附图说明
参考附图详细描述了本发明公开的内窥镜手术施夹器的方面和特征,其中相同的附图标记表示相似或相同的结构元件,以及:
图1是根据本公开提供的内窥镜手术施夹器的前透视图,其包括手柄组件,手柄组件具有与其接合的内窥镜组件;
图2是图1的内窥镜手术施夹器的前透视图,将内窥镜组件从手柄组件移除;
图2A是图1和图2的内窥镜组件的远端的侧视透视图;
图2B是图1和图2的内窥镜组件的外轴的近端部分的侧视纵向剖视图;
图3A是另一内窥镜组件的远端的侧视透视图,该另一内窥镜组件构造成与图1的内窥镜施夹器一起使用;
图3B是图3A的内窥镜组件的外轴的近端部分的侧视纵向剖视图;
图4是图1的手柄组件的后立体分解图;
图5是图4中标记为“5”的细节区域的放大立体图;
图6是图1的手术组件的棘轮机构的立体图;
图7是图6的棘轮机构的另一个立体图,其中部分被移除;
图8是经由图2的剖面线“8-8”截取的侧纵向横截面图;
图9是经由图8的剖面线“9-9”截取的底纵向横截面图;
图10和11是图1的手柄组件的侧纵向剖视图,其示出了图1和图2的手柄组件内的图1和图2的内窥镜组件的接合;
图12是图1的手柄组件的一部分的放大的底部纵向剖视图,棘轮机构处于棘轮使用状态,并且图1和图2的内窥镜组件与之接合;以及
图13是图1的内窥镜手术施夹器的侧视立体图,壳体的一部分被移除以示出其中的内部部件。
具体实施方式
转到图1-图2,根据本公开提供的内窥镜手术施夹器由附图标记10标识。手术施夹器10通常包括手柄组件100和可选择性地连接到手柄组件100的多个内窥镜组件200、300(图3A和3B)。手柄组件100构造成在连接到其上时操作多个内窥镜组件200、300中的每一个,并且可以构造为可消毒的可重复使用的部件,使得手柄组件100可以在一个或多个外科手术过程中与不同的和/或另外的内窥镜组件200、300重复使用。内窥镜组件200、300可以取决于特定目的和/或特定内窥镜组件的构造被构造为单次使用的一次性部件、有限使用的一次性部件或可重复使用的部件。在任一种构造中,避免了对多个手柄组件100的需要,相反,外科医生仅需要选择适当的内窥镜组件200、300,并将该内窥镜组件连接到准备使用的手柄组件100。
另外参考图2A-图3B,手柄组件100,更具体地,被构造用于例如与内窥镜组件200(图1、图2和图2A-图2B)连接的棘轮使用和例如与内窥镜组件300(图3A和图3B)连接的非棘轮使用。参考图2、图2A和图2B,内窥镜组件200构造成用于棘轮使用,并且通常包括近端轮毂220、从近端轮毂220向远端延伸的细长轴240、朝向细长轴240的远端部分设置的末端执行器组件260和内部驱动组件(未示出),当内窥镜组件200与手柄组件100接合以使得能够顺序击发并在组织周围形成至少一个手术夹(未示出)时,内部驱动组件(未示出)可操作地连接在手柄组件100与末端执行器组件260之间。近端轮毂220限定多个朝向其远端部分环形设置的多个分度突起222、朝向其近端部分限定在其中的环形通道224和从近端轮毂220向近端延伸的近端管延伸部分226。近端轮毂220的这些特征在下面更详细地描述。2015年10月10日提交的国际申请号PCT/CN2015/091603中提供了端部执行器组件260和内窥镜组件200的内部驱动组件(未示出)的更详细描述,该专利的全部内容通过引用结合于本文中。进一步考虑,内窥镜组件200可类似于美国专利7,819,886或7,905,890中显示和描述的构造成闭合、击发或形成手术夹,其全部内容通过引用并入本文。
参见图3A-图3B,内窥镜组件300构造成用于非棘轮用途,并且通常包括近端轮毂320、从近端轮毂320向远端延伸的细长轴340、朝向细长轴340的远端部分设置的末端执行器组件360和内部驱动组件(未示出),当内窥镜组件300与手柄组件100接合以便能够抓握和/或操纵组织、取出手术夹并且围绕组织击发和形成手术夹子时,所述内部驱动组件(未示出)可操作地连接在手柄组件100与末端执行器组件360之间。近端轮毂320限定多个朝向其远端部分围绕其环形设置的多个分度突起322和朝向其近端部分限定在其中的环形通道324。值得注意的是,与内窥镜组件200的近端轮毂220(图2B)相反,近端轮毂320的近端限定近端轮毂320的最近端部分;近端轮毂320不包括从其延伸的近端管延伸部分。内窥镜组件300的末端执行器组件360和内部驱动组件(未示出)的更详细描述也在先前通过引用并入本文的国际申请号PCT/CN2015/091603提供。考虑内窥镜组件300可类似于美国专利第4,834,096号中显示和描述的构造成闭合、击发或形成手术夹,该专利的全部内容通过引用并入本文。
尽管上面详细描述了分别构造用于棘轮使用和非棘轮使用的示例性内窥镜组件200、300,但是可以设想用于执行各种不同的外科手术任务和/或具有适合于棘轮使用或非棘轮使用的各种不同构造的各种其他内窥镜组件同样可以与手柄组件100一起使用。更具体地,预期并且在本公开的范围内,可以提供包括具有独特且不同的闭合行程长度的一对爪的其他内窥镜组件,以与手柄组件100一起使用,用于以以上关于内窥镜组件200,300详述的类似方式棘轮使用或非棘轮使用。这种构造适应具有不同构造和/或不同闭合行程长度的各种不同内窥镜组件,同时提供手柄组件100的触发器组件120的触发器122的恒定致动行程长度。因此,可以提供根据本公开的原理构造的各种内窥镜组件,其还能够跨越多个不同制造商的多个平台来击发或形成或闭合各种尺寸、材料和构造的手术夹。
参考图1、图2和图4,手柄组件100通常包括壳体110、可枢转地连接到壳体110的触发器组件120、可操作地连接到触发器组件120的驱动组件130、可选择地可操作地与驱动组件130相关联的棘轮机构140、构造成可释放地锁定与手柄组件100接合的内窥镜组件200、300(分别为图2-图2B和图3A-图3B)的闩锁组件160、从壳体110向远端延伸并构造成接收插入手柄组件100中的内窥镜组件200、300(分别为图2-图2B和图3A-图3B)的近端轮毂220、320的接收器管170以及围绕接收器管170设置的旋转旋钮180。手柄组件100在下文结合内窥镜组件200详述。手柄组件100与非棘轮内窥镜组件(例如内窥镜组件300(图3A和图3B))以及棘轮内窥镜组件200的接合和使用的相似性在下文中为了简洁起见而不会详细描述。在适用的情况下,下文将指出它们之间的差异。
手柄组件100的壳体110限定了主体部分111和从主体部分111向下延伸的固定手柄部分112。虽然壳体110由通过多个螺钉114彼此固定的第一壳体部件或半部113a和第二壳体部件或半部113b形成,但是第一壳体部件113a和第二壳体部件113b可替代地以任何其它合适的方式固定,例如超声波焊接、胶合、其他机械接合等。壳体110构造成容纳手柄组件100的内部工作部件。主体部分111包括远端鼻部115,该远端鼻部115将环形槽116限定在其内部上。更具体地,第一壳体部件113a和第二壳体部件113b各自限定半环形槽部分,使得当第一壳体部件113a和第二壳体部件113b配合以形成壳体110时,形成环形槽116。手柄组件100的接收器管170包括朝向近端部分在其周围设置的环形边缘172。例如在第一壳体部件113a和第二壳体部件113b彼此接合时,环形边缘172被捕获在限定在壳体110的远端鼻部115内的环形槽116内。环形边缘172被捕获在环形槽116内,以使接收器管170与壳体110可旋转地接合。手柄组件100的旋转旋钮180例如通过一对相对的接合销182以相对于其固定的旋转定向围绕接收器管170接合,使得旋转旋钮180相对于壳体110的旋转实现接收器管170的相对壳体110的旋转。
壳体110的主体部分111还包括内部枢轴柱117(图4和图8),所述内部枢轴柱117(图4和图8)在壳体部件113a、113b(来自壳体部件113a、113b中的任一个或两个)与限定在每个壳体内的枢轴孔118之间横向延伸。壳体110的固定手柄部分112构造成便于手柄组件100的抓握及其操纵,并且与主体部分111整体形成,但是也可以考虑其他构造。
继续参考图1、图2和图4,触发组件120通常包括触发器122、偏置构件127和连杆128。触发器122包括抓握部分123、中间枢轴部分124和近端延伸部分125。触发器122的抓握部分123相对于壳体110的固定手柄部分112以相对的关系从壳体110的主体部分111向下延伸。抓握部分123被构造为便于触发器122的抓握和操纵。触发器122的中间枢轴部分124至少部分地设置在壳体110内,并且限定枢轴孔126a,所述枢轴孔126a构造成接收壳体110的枢轴柱117,以使得触发器122能够围绕枢轴柱117并相对于壳体110例如在未致动位置和致动位置之间枢转,在未致动位置中,触发器122的抓握部分123相对于固定手柄部分112间隔开,在致动位置中,触发器122的抓握部分123相对于固定手柄部分112近似。
与触发器122的抓握部分123相比,触发器组件120的触发器122的近端延伸部分125设置在中间枢轴部分124的相对侧上,并因此设置在枢轴柱117上。这样,抓握部分123向近端例如朝向致动位置的枢转向近端推动近端延伸部分125。近端延伸部分125经由第一销126b可枢转地联接到连杆128的近端。偏置构件127固定在任一端,并在近端延伸部分125与设置在壳体110的固定手柄部分112内的支撑件之间延伸。使抓握部分123朝向致动位置的枢转使得在其中存储能量的偏置构件127伸长,使得在释放抓握部分123时,抓握部分123在偏置构件127的偏置下朝向未致动位置返回。尽管示出为延伸螺旋弹簧,但是偏置构件127可以限定用于将触发器122的抓握部分123朝向未致动位置偏置的任何合适的构造。
如上所述,连杆128在其近端处经由第一销126b联接到触发器122的近端延伸部分125。连杆128还在其远端处经由第二销129可枢转地联接到近端延伸部分134,该近端延伸件134从驱动组件130的驱动杆132向远端延伸。由于这种构造,触发器122的抓握部分123朝向致动位置的枢转朝向远端推动触发器122的近端延伸部分125,所述近端延伸部分125又向远端推动连杆128。
手柄组件100的驱动组件130包括驱动杆132、近端延伸件134、支撑套环136和棘轮齿条138(图4、图8和图9)。驱动杆132沿大致纵向方向延伸。如上所述,近端延伸件134从驱动杆132向近端延伸并且接收第二销129,以将驱动杆132与连杆128可枢转地联接。支撑环136可滑动地设置在驱动杆132周围并固定在壳体110内。支撑环136用于将驱动杆132限制为相对于壳体110纵向平移。棘轮齿条138沿大致纵向方向延伸,类似于驱动杆132,并且在其下侧限定在驱动杆132上或与驱动杆132接合。
参见图6和图8,如上所述,手柄组件100的棘轮机构140选择性地可操作地与驱动组件130相关联,以使手柄组件100能够在棘轮状态或非棘轮状态下使用。棘轮机构140包括棘轮爪142、棘爪销144、棘爪偏置构件146、横向偏置构件148、凸轮臂152、凸轮滑块154和凸轮滑块偏置构件156。
棘轮爪142围绕棘爪销144可枢转地设置,所述棘爪销144在壳体110的壳体部件113a、113b之间横向延伸,并且容纳在壳体部件113a、113b的枢轴孔118内。棘轮爪142也可绕棘爪销144并相对于驱动组件130横向滑动。横向偏置构件148将棘轮爪142朝向偏置位置相对于驱动组件130的棘轮齿条138偏置,以阻止它们之间的可操作接合。横向偏置构件148可以构造为线圈压缩弹簧,但是也可以设想其他构造。棘轮爪142的这种偏置的偏置位置对应于棘轮机构140的非棘轮使用状态(参见图9)。如下所述的那样,响应于构造用于棘轮使用的内窥镜组件(例如,内窥镜组件200(图2、图2A和图2B)与手柄组件100的接合,对应于棘轮机构140的棘轮使用状态,棘轮爪142克服横向偏置构件148的偏置横向滑动到相对于棘轮齿条138的对齐位置。
棘轮机构140的凸轮臂152围绕邻近棘爪销144的棘爪141设置。更具体地,凸轮臂152包括围绕棘爪销144设置的基部153a和从棘爪销144延伸的延伸件153b。凸轮臂152的基部153a以固定的旋转定向可滑动地容纳在限定在凸轮滑块154内的槽155a内,并限定一对成角度的凸轮表面153c。延伸件153b从基部153a延伸到凸轮臂152的自由端。棘爪偏置构件146(图5)联接到并设置在凸轮臂152的自由端与棘轮爪142之间,以使棘轮爪142朝向操作方位相对于驱动组件130的棘轮齿条138偏置。棘爪偏置构件142可以构造为线圈拉伸弹簧,虽然也可以设想其他构造。
凸轮滑块154可滑动地容纳在限定在手柄组件100的壳体110的壳体部件113a内的纵向延伸的导轨119内(尽管导轨119可替代地限定在手柄组件100的壳体110的壳体部件113b内),以将凸轮滑块154限制为在壳体110内的和相对于壳体110的纵向平移。如上所述,凸轮滑块154限定了槽155a,所述槽155a可滑动地接收凸轮臂152的基部153a。凸轮滑块154还限定一对成角度的凸轮表面155b,所述凸轮表面155b相对于凸轮臂152的基部153a的成角度的凸轮表面153c相对地成角度并且与凸轮臂152的基部153a的成角度的凸轮表面153c邻接设置。相邻的成对的成角度的凸轮表面153c、155b相对定向,使得凸轮滑块154相对于凸轮臂152的近端平移沿着棘爪销144朝向棘爪142横向地推动凸轮臂152,以类似地沿着棘爪销144克服横向偏置构件148的偏置横向地推动棘爪142从偏置位置(图9)朝向对齐位置(图12)。凸轮滑块154的返回向远端允许棘轮爪142和因此凸轮臂152在横向偏置构件148的偏置下横向朝向偏置位置返回。
凸轮滑块偏置构件156保持在壳体部件113a的导轨119内,定位成向远端偏置凸轮滑块154,并且可以构造为线圈压缩弹簧(尽管也可以考虑其他构造)。这样,在没有其他影响的情况下,凸轮滑块154朝向最远端位置偏置,因此,棘轮爪142朝向偏置位置偏置(图9)。在棘轮爪142的偏置位置,对应于手柄组件100的非棘轮使用状态,棘轮爪142在驱动杆132的远端前进时被阻止可操作地接合棘轮齿条138(见图9)。另一方面,在棘爪142的对齐位置,对应于手柄组件100的棘轮使用状态,棘轮爪142定位成在驱动杆132的远端前进时可操作地接合棘轮齿条138(参见图12)。
参考图8、图10和图11,闩锁组件160包括闩锁杆162、枢轴销164和偏置构件166。闩锁杆162至少部分地设置在限定的切口内,而没有手柄组件100的壳体110,以便能够对其进行手动操作,并且限定远端接合部分163a、中间部分163b和近端可操纵部分163c。闩锁杆162的远端接合部分163a包括从其延伸的接合齿168。接合齿168构造成接合插入手柄组件100中的内窥镜组件,例如内窥镜组件200。关于内窥镜组件200,例如,在将内窥镜组件200的近端轮毂220插入手柄组件100中时,接合齿168构造成在近端轮毂220的近端上方凸出并且在环形通道224内接合,从而锁定与手柄组件100接合的内窥镜组件200。为此,接合齿168限定凸轮表面169,所述凸轮表面169构造成与朝向内窥镜组件200的近端轮毂220的近端部分限定的对应凸轮表面225相互作用,以便于在近端轮毂220的近端上的接合齿168的凸轮,并且在环形通道224内接合。
闩锁组件160的枢轴销164可枢转地将杠杆闩锁162的中间部分163b与手柄组件100的壳体110联接,使得杠杆闩锁162的近端操纵部分163c沿第一方向到壳体110中的推动将杠杆闩锁162的远端接合部分163a沿相反的第二方向与内窥镜组件200的近端轮毂220的环形通道224脱离接合。偏置构件166构造为具有围绕枢轴销164设置的主体167a以及设置在壳体110与杠杆闩锁162的近端操纵部分163c之间的第一腿和第二腿167b的扭转弹簧,以偏置杠杆闩锁162的近端操纵部分163c,从而朝向接合位置偏置远端接合部分163a。然而,也可以设想其他合适的偏置构件166的构造。杠杆闩锁162的近端操纵部分163c可克服偏置构件166的偏置而选择性地下压,以将远端接合部分163a推向脱离位置。
参考图8,如上所述,手柄组件100的接收器管170包括环形边缘172,所述环形边缘172被捕获在限定在壳体110的远端鼻部115内的环形槽116内,以可旋转地在壳体110内接合接收器管170。如上所述,手柄组件100的旋转旋钮180通过一对相对的接合销182围绕接收器管170接合。旋转旋钮180还限定了多个纵向延伸的凹槽184,所述凹槽184环形地布置在其内表面上。凹槽184构造成可滑动地接收内窥镜组件200的近端轮毂220的分度突起222,以在近端轮毂220插入手柄组件100中时相对于旋转旋钮180旋转地固定内窥镜组件200的近端轮毂220。这样,在使用中,旋转旋钮180的旋转实现内窥镜组件200的相应旋转。
图8-图13示出了内窥镜组件200与手柄组件100的插入和接合的各个阶段。最初,在插入内窥镜组件200之前,如图8和9所示,触发器122在偏置构件127的偏置下设置在未致动位置,驱动杆132设置在最近端位置,棘轮爪142在横向偏置构件148的偏置下设置在偏置位置,杠杆闩锁162在偏置构件166的偏置下设置在接合位置。
为了使内窥镜组件200与手柄组件100接合,将内窥镜组件200的近端轮毂220插入手柄组件100的旋转旋钮180中,使得近端轮毂220的分度突起222可滑动地容纳在旋转旋钮180的纵向延伸的凹槽184内。此后,如图10所示,近端轮毂220向近端滑动,通过旋转旋钮180和接收器管170,并进入壳体110。当近端轮毂220进入壳体110时,近端轮毂220接收驱动杆132的远端;闩锁组件160的接合齿168开始在近端轮毂220的近端上凸出;内窥镜组件200的近端管延伸件226平移成与棘轮机构140的凸轮滑块154接触。
另外参考图11和图12所示,当近端轮毂220进一步向近端滑动到壳体110中时,驱动杆132相对于内窥镜组件200的内部驱动组件(未示出)可操作地定位;闩锁组件160的接合齿168在近端轮毂220的近端上凸出并且在环形通道224内接合,以使内窥镜组件200与手柄组件100接合;内窥镜组件200的近端管延伸件226向近端推动凸轮滑块154,使得棘轮爪142从偏置位置(图9)横向滑动到对齐位置(图12)。如可以理解的那样,在与手柄组件100一起使用的内窥镜组件被构造用于非棘轮使用的实施例中,例如,与内窥镜组件300(图3A和3B)一样,因为内窥镜组件没有近端管延伸件,因此在非棘轮内窥镜组件与手柄组件100接合时,棘轮爪142在横向偏置构件148的偏置下保持设置在偏置位置中。
参考图13,内窥镜组件200与手柄组件100接合并且棘轮爪142设置在对齐位置,在使用中,触发器122的抓握部分123朝向壳体110的固定手柄部分112枢转,以向远端推动连杆128,所述连杆进而推动驱动杆132向远端穿过壳体110和近端轮毂220,以向远端驱动内部驱动组件(未示出)。当驱动杆132向远端平移时,棘轮爪142接合棘轮齿条138,阻止驱动杆132的近端返回。因此,触发器122可以不返回到未致动位置,并且驱动杆132可以不向近端返回,直到触发器122的完全致动已经完成,并且棘轮爪142已经清除了棘轮齿条138。驱动杆132的远端驱动驱动内窥镜组件200的内部驱动组件(未示出),以从端部执行器组件360(图2A)围绕组织击发手术夹并形成手术夹。如可以理解的那样,棘轮机构140在棘轮使用状态下能够增加击发内窥镜组件200。
在触发器122完全致动时,例如,在到达触发器122的致动位置时,棘轮爪142从棘轮齿条138上清除并脱离,从而允许触发器122在偏置构件127的偏置下被释放并返回到未致动位置。此后,可以重复上述详细的使用,以击发并形成另外的手术夹。
暂时参考图1、图2和图3A-图3B,内窥镜组件300与手柄组件100的使用类似于上文关于内窥镜组件200详述的内窥镜组件,除了棘轮爪142保持在偏置位置(由于非棘轮内窥镜组件不包括近端管延伸件),棘轮爪142被阻止接合棘轮齿条138。因此,在内窥镜组件300的使用期间,触发器122可以朝向未致动位置返回,并且驱动杆132可以在致动行程期间的任何点处向近端返回。
回到图13,为了使内窥镜组件200与手柄组件100脱离,例如,用于清洁和/或消毒,或者为了用另一内窥镜组件替换内窥镜组件200,闩锁组件160的杠杆闩锁162的近端操纵部分163c克服偏置构件166的偏置向内压入壳体110,以推动杠杆闩锁162的远端接合部分163a脱离内窥镜组件200的近端轮毂220的环形通道224内的接合。在杠杆闩锁162的远端接合部分163a设置在该脱离位置的情况下,内窥镜组件200的近端轮毂220可从手柄组件100向远端撤回。在从手柄组件100撤回内窥镜组件200时,棘轮机构140的棘轮爪142在横向偏置构件148的偏置下横向朝向偏置位置返回。
根据本公开,可以设想可以提供外科手术系统或套件(未示出),其包括手柄组件100、至少一个内窥镜组件200、至少一个内窥镜组件300和使用该手术系统或套件的说明书。进一步设想可在手术系统或套件中提供多个手柄组件。另外设想外科手术系统或套件可包括另外的内窥镜组件,这里未示出或描述,其与内窥镜组件200或300不同,并且被构造用于连接到手柄组件100并由手柄组件100操作。还可以设想的是,外科手术系统或套件可以包括外科夹子或紧固件(未示出)的至少一个盒,用于与本文公开的任何内窥镜组件一起使用。
应该理解,前面的描述仅是对本公开的说明。在不脱离本公开的情况下,本领域技术人员可以设计出各种替代方案和修改。因此,本公开旨在涵盖所有此类替代、修改和变化。参考附图描述的实施方案仅用于证明本公开的某些实施例。与上文所述和/或所附权利要求中基本上不同的其它元件、步骤、方法和技术也旨在落入本公开的范围内。
Claims (19)
1.一种手术施夹器的手柄组件,所述手柄组件构造成可释放地接合至少两个不同的内窥镜组件,所述手柄组件包括:
壳体,所述壳体限定主体部分和从所述主体部分延伸的固定手柄部分;
触发器,所述触发器可枢转地连接到所述壳体,并且可相对于所述固定手柄部分在未致动位置和致动位置之间移动;
驱动杆,所述驱动杆可滑动地支撑在所述壳体的主体部分内,并且可操作地连接到所述触发器,使得所述触发器从所述未致动位置朝向所述致动位置的移动使所述驱动杆向远端平移穿过所述壳体的主体部分,所述驱动杆包括设置在其上的棘轮齿条;和
棘轮机构,所述棘轮机构设置在所述壳体的主体部分内,所述棘轮机构包括:
棘爪销;
棘轮爪,所述棘轮爪可枢转地且可滑动地支撑在所述棘爪销上;
偏置构件,所述偏置构件定位成使所述棘轮爪朝向偏置位置相对于所述棘轮齿条偏置,其中所述棘轮爪在所述驱动杆的远端平移时被阻止可操作地接合所述棘轮齿条;
凸轮臂,所述凸轮臂可枢转地且可滑动地支撑在邻近于所述棘轮爪的所述棘爪销上;和
凸轮滑块,所述凸轮滑块可选择地平移通过壳体的主体部分并相对于所述凸轮臂在第一位置和第二位置之间可选择地平移,在所述第一位置中,所述棘轮爪在所述偏置构件的偏置下保持在所述偏置位置中,在所述第二位置中,所述凸轮滑块沿着所述棘爪销推动所述凸轮臂,以使所述棘轮爪沿着所述棘爪销从所述偏置位置推动到对齐位置,其中,在所述对齐位置中,所述棘轮爪与所述棘轮齿条对齐,以在所述驱动杆的远端平移时允许所述棘轮爪与所述棘轮齿条的可操作接合。
2.根据权利要求1所述的手柄组件,其中所述凸轮臂和所述凸轮滑块限定凸轮表面,所述凸轮表面构造成在所述凸轮滑块相对于所述凸轮臂平移时沿着彼此凸出。
3.根据权利要求1所述的手柄组件,其中所述凸轮滑块可操作地接合在限定在所述壳体的主体部分的内表面上的导轨内。
4.根据权利要求1所述的手柄组件,其还包括凸轮滑块偏置构件,所述凸轮滑块偏置构件构造成将所述凸轮滑块朝向所述第一位置偏置。
5.根据权利要求1所述的手柄组件,其还包括爪偏置构件,所述爪偏置构件接合在所述棘轮爪和所述凸轮臂之间。
6.根据权利要求1所述的手柄组件,其还包括可操作地支撑在所述壳体上的闩锁组件,所述闩锁组件包括杠杆闩锁,所述杠杆闩锁构造成可释放地接合插入所述手柄组件中的内窥镜组件。
7.根据权利要求6所述的手柄组件,其中所述杠杆闩锁包括远端接合齿,所述远端接合齿构造成接合插入所述手柄组件中的所述内窥镜组件。
8.根据权利要求7所述的手柄组件,其中所述杠杆闩锁包括近端操纵部分,所述近端操纵部分构造成用于手动操纵以使所述远端接合齿与所述内窥镜组件脱离,从而允许从所述手柄组件移除所述内窥镜组件。
9.一种手术施夹系统,包括:
手柄组件,包括:
壳体;
触发器,所述触发器可枢转地连接到所述壳体并且可与其相对可在未致动位置与致动位置之间移动;
驱动杆,所述驱动杆可滑动地支撑在所述壳体内,并且可操作地联接到所述触发器,使得所述触发器从所述未致动位置朝向所述致动位置的移动使所述驱动杆向远端平移穿过所述壳体,所述驱动杆包括设置在其上的棘轮齿条;和
棘轮机构,所述棘轮机构设置在所述壳体中,所述棘轮机构包括:
棘爪销;
棘轮爪,所述棘轮爪可枢转地且可滑动地支撑在所述棘爪销上;
偏置构件,所述偏置构件定位成朝向偏置位置相对于所述棘轮齿条偏置所述棘轮爪,其中所述棘轮爪在所述驱动杆的远端平移时被阻止可操作地接合所述棘轮齿条;
凸轮臂,所述凸轮臂支撑在相邻所述棘轮爪的所述棘爪销上;和
凸轮滑块,所述凸轮滑块相对于所述凸轮臂可选择性地移动穿过所述壳体,所述凸轮滑块最初设置在第一位置,其中所述棘轮爪在所述偏置构件的偏置下被保持在所述偏置位置中;和
第一内窥镜组件,所述第一内窥镜组件被构造用于棘轮使用,所述第一内窥镜组件包括可插入所述壳体内并且可释放地接合在壳体内的第一近端轮毂,其中在所述第一近端轮毂插入所述壳体中时,所述凸轮滑块从所述第一位置移动到第二位置,其中所述凸轮滑块沿着所述棘爪销推动所述凸轮臂,从而沿着所述棘爪销将所述棘轮爪从所述偏置位置推动到对齐位置,其中在所述对齐位置,所述棘轮爪与所述棘轮齿条对齐,以允许在所述驱动杆的远端平移时所述棘轮爪与所述棘轮齿条可操作地接合。
10.根据权利要求9所述的施夹系统,其还包括:
第二内窥镜组件,所述第二内窥镜组件构造成用于非棘轮使用,所述第二内窥镜组件包括第二近端轮毂,所述第二近端轮毂可插入所述壳体内并且可释放地接合在所述壳体内,其中在所述第二近端轮毂插入所述手柄组件中时,所述凸轮滑块保持在所述第一位置中,使得所述棘轮爪在所述偏置构件的偏置下保持在所述偏置位置。
11.根据权利要求10所述的施夹系统,其中所述第一近端轮毂包括近端延伸件,所述近端延伸件构造成在所述第一近端轮毂插入所述壳体中时将所述凸轮滑块从所述第一位置推动到所述第二位置。
12.根据权利要求11所述的施夹系统,其中所述第二近端轮毂没有近端延伸件,使得在将所述第二近端轮毂插入所述壳体中时,所述凸轮滑块保持在所述第一位置,并且所述棘轮爪在所述偏置构件的偏置下保持在所述偏置位置。
13.根据权利要求9所述的施夹系统,其中所述手柄组件还包括旋转旋钮,所述旋转旋钮从所述壳体向远端延伸,并且可旋转地联接到所述壳体,所述旋转旋钮和所述第一近端轮毂限定互补的分度特征,以在将第一近端轮毂插入壳体中时相对于所述旋转旋钮可旋转地固定所述第一内窥镜组件。
14.根据权利要求9所述的施夹系统,其中所述手柄组件还包括可操作地支撑在所述壳体上的闩锁组件,所述闩锁组件包括杠杆闩锁,所述杠杆闩锁构造成在所述第一近端轮毂组件插入所述壳体中时可释放地接合所述第一近端轮毂。
15.根据权利要求14所述的施夹系统,其中所述杠杆闩锁包括远端接合齿,并且其中所述第一近端轮毂限定环形通道,所述远端接合齿构造成在所述第一近端轮毂插入所述壳体中时在所述环形通道内接合。
16.根据权利要求15所述的施夹系统,其中所述杠杆闩锁包括近端操纵部分,所述近端操纵部分构造成用于手动操纵以使所述远端接合齿与所述环形通道脱离,以允许从所述壳体移除所述第一近端轮毂。
17.一种手术施夹系统,包括:
手柄组件,包括:
壳体;
驱动杆,所述驱动杆构造成响应于所述手柄组件的致动向远端平移穿过所述壳体,所述驱动杆包括设置在其上的棘轮齿条;和
棘轮机构,所述棘轮机构设置在所述壳体并包括:
棘爪销;
棘轮爪,所述棘轮爪可枢转地且可滑动地支撑在所述棘爪销上;
偏置构件,所述偏置构件定位成相对于所述棘轮齿条朝向偏置位置偏置所述棘轮爪,其中所述棘轮爪在所述驱动杆的远端平移时被阻止可操作地接合所述棘轮齿条;和
凸轮滑块,所述凸轮滑块相对于所述壳体可纵向地平移,所述凸轮滑块最初设置在第一位置,其中所述棘轮爪在所述偏置构件的偏置下被保持在所述偏置位置;和
第一内窥镜组件,所述第一内窥镜组件构造成用于棘轮使用,并且可插入壳体内并且可释放地接合在壳体内,其中在将所述第一内窥镜组件插入壳体中时,所述凸轮滑块从所述第一位置平移到第二位置,其中所述凸轮滑块沿着所述棘爪销横向推动所述棘轮爪从所述偏置位置到对齐位置,其中在所述对齐位置,所述棘轮爪与所述棘轮齿条对齐,以在所述驱动杆向远端平移时允许所述棘轮爪与所述棘轮齿条可操作地接合;和
第二内窥镜组件,所述第二内窥镜组件构造成用于非棘轮使用,并且可插入所述壳体内并且可释放地接合在所述壳体内,其中在将所述第二内窥镜组件插入所述壳体中时,所述凸轮滑块保持在所述第一位置,使得所述棘轮爪在所述偏置构件的偏置下保持在所述偏置位置。
18.根据权利要求17所述的施夹系统,其中所述手柄组件还包括可操作地支撑在所述壳体上的闩锁组件,所述闩锁组件包括杠杆闩锁,所述杠杆闩锁构造成在所述第一内窥镜组件或所述第二内窥镜组件插入所述壳体时可释放地接合所述第一内窥镜组件或所述第二内窥镜组件。
19.根据权利要求17所述的施夹系统,其中所述第一内窥镜组件包括第一近端轮毂,所述第一近端轮毂限定近端延伸件,所述近端延伸件构造成在所述第一近端轮毂插入所述壳体中时将所述凸轮滑块从所述第一位置推动到所述第二位置,并且其中所述第二内窥镜组件包括没有近端延伸件的第二近端轮毂,使得在所述第二近端轮毂插入所述壳体中时,所述凸轮滑块保持在所述第一位置。
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EP3503819A4 (en) | 2020-04-22 |
AU2016420481A1 (en) | 2019-01-17 |
WO2018035796A1 (en) | 2018-03-01 |
JP2019524326A (ja) | 2019-09-05 |
US20200305883A1 (en) | 2020-10-01 |
CN109640844A (zh) | 2019-04-16 |
US11071553B2 (en) | 2021-07-27 |
EP3503819A1 (en) | 2019-07-03 |
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