CN109640846A - 外科器械的组织加载 - Google Patents

外科器械的组织加载 Download PDF

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CN109640846A
CN109640846A CN201780052291.0A CN201780052291A CN109640846A CN 109640846 A CN109640846 A CN 109640846A CN 201780052291 A CN201780052291 A CN 201780052291A CN 109640846 A CN109640846 A CN 109640846A
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jaw
arm
end effector
surgical instrument
ultrasonic surgical
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CN109640846B (zh
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J·D·梅瑟利
W·E·克莱姆
J·A·威德三世
E·斯图特
C·T·戴维斯
J·布莱迪
J·D·丹尼斯
P·H·克劳达
M·L·泽克科尔
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Angiotech Pharmaceuticals Inc
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    • A61B17/22004—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for using mechanical vibrations, e.g. ultrasonic shock waves
    • A61B17/22012—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for using mechanical vibrations, e.g. ultrasonic shock waves in direct contact with, or very close to, the obstruction or concrement
    • A61B17/2202—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for using mechanical vibrations, e.g. ultrasonic shock waves in direct contact with, or very close to, the obstruction or concrement the ultrasound transducer being inside patient's body at the distal end of the catheter
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Abstract

本发明公开了各种超声器械。所述超声器械包括这样的结构，所述结构被构造成能够指示所述器械的所述切割长度，检测抓持的组织何时延伸越过所述器械的所述切割长度，并且防止组织延伸越过所述切割长度。本发明公开了用于每一类结构的若干技术。

Description

外科器械的组织加载
优先权
本申请要求2016年8月25日提交的美国临时专利申请序列号62/379,550的权益，该临时专利申请全文以引用方式并入本文。
背景技术
本公开整体涉及超声外科器械，并且更具体地涉及用于驱动超声波导的超声换能器。包括空芯器械和实芯器械两者在内的超声器械用于安全有效地治疗许多医学病症。超声器械，并且特别是实芯超声器械是有利的，因为它们可用于切割和/或凝结器官组织，使用的能量呈以超声频率传输到外科末端执行器的机械振动的形式。当以合适的能量级传输至有机组织并且使用合适的末端执行器时，超声振动可用于切割、解剖、拉升或烧灼组织或用于使肌肉组织与骨骼分离。由于通过波导管从超声转换器可传输至外科手术末端执行器的超声能量的量，使用实芯技术的超声器械尤其有利。此类器械可用于开放式手术或微创手术，例如内窥镜式手术或腹腔镜式手术，其中末端执行器穿过套管针到达手术部位。
以超声频率激活此类器械的末端执行器(例如，切割超声刀)可引发纵向振动，该纵向振动在相邻组织内产生局部热量。由于超声器械的性质，因此可设计特定的超声致动末端执行器来执行多个功能，包括(例如)切割和凝结。例如，通过电激活换能器在外科手术末端执行器中引发超声振动。换能器可由器械手柄中的一个或多个压电元件或磁致伸缩元件构成。换能器产生的振动经由从换能器延伸至外科手术末端执行器的超声波导管传输至外科手术末端执行器。波导管和末端执行器被设计为与换能器以相同的频率共振。因此，当末端执行器连接到换能器时，整个系统的频率与换能器自身的频率相同。
末端执行器在顶端处的纵向超声振动的振幅d表现为共振频率的简单正弦曲线，用以下公式表示：
d＝A sin(ωt)
其中：
ω＝2π乘以循环频率f的角频率；和
A＝零至峰的幅值。
将末端执行器顶端的纵向偏移定义为峰到峰(p-t-p)振幅，其恰好为正弦波振幅的两倍或2A。通常，末端执行器可包括刀片，由于所述纵向偏移，该刀片可切割和/或凝结组织。下述文献公布了各种超声外科器械：美国专利No.6，283，981，于2001年9月4日公布并且名称为“METHOD OF BALANCING ASYMMETRIC ULTRASONIC SURGICAL BLADES(平衡不对称超声外科手术刀片的方法)”；美国专利No.6，309，400，于2001年10月30日公布并且名称为“CURVED ULTRASONIC WAVEGUIDE HAVING A TRAPEZOIDAL CROSS SECTION(具有梯形截面的弯曲超声波导)”；和美国专利No.6,436,115，于2002年8月20日公布并且名称为“BALANCED ULTRASONIC WAVEGUIDE INCLUDING A PLURALITY OF BALANCE ASYMMETRIES(包括多种平衡不对称的平衡超声波波导)”，其全部公开内容据此以引用方式并入本文。
尽管已研制和使用了若干装置，但据信在本发明人之前还无人研制出或使用所附权利要求中描述的装置。
发明内容
在一个总体方面，各种方面涉及一种包括换能器的超声外科器械，所述换能器被构造为沿着外科器械的纵向轴线以预定频率生成振动。在各种方面，外科器械可包括超声波导，其沿纵向轴线延伸并联接到换能器。在各种方面，外科器械包括主体，其具有近端和远端，其中远端能够通过换能器所生成的振动相对于纵向轴线运动，并且近端机械联接到换能器。
在一个方面，提供了超声外科器械。超声外科器械包括：末端执行器；钳口，其能够相对于末端执行器运动；换能器组件，其包括至少两个压电元件，至少两个压电元件被构造成能够使末端执行器超声地振荡；和标记，其与钳口的覆盖末端执行器的部分共延。
在另一方面，提供了超声外科器械。超声外科器械包括：末端执行器；钳口，其能够在打开位置和闭合位置之间相对于末端执行器运动；换能器组件，其包括至少两个压电元件，至少两个压电元件被构造成能够使末端执行器超声地振荡；和凸轮，其经由联动装置可动地连接到钳口；其中，凸轮被构造成能够在钳口的闭合位置中朝向钳口的近端延伸；并且其中，凸轮被构造成能够在钳口的打开位置中回缩。
在另一方面，提供了超声外科器械。超声外科器械包括：末端执行器；钳口，其能够在打开位置和闭合位置之间相对于末端执行器运动；换能器组件，其包括至少两个压电元件，至少两个压电元件被构造成能够使末端执行器超声地振荡；可滑动构件，其能够在回缩位置和延伸位置之间运动，其中，可滑动构件被构造成能够在可滑动构件的延伸位置中接触钳口的近端；其中，构件被偏置到回缩位置；和突出部，其中，突出部被构造成能够在钳口的闭合位置中接触弹簧偏置构件，并且其中，突出部被构造成能够在钳口的闭合位置中使可滑动构件运动到延伸位置。
在另一方面，提供了超声外科器械。超声外科器械包括：第一臂；第二臂，其以能够枢转的方式连接至第一臂；钳口，其设置在第一臂的远端处；末端执行器，其设置在第二臂的远端处；其中，钳口能够在打开位置和闭合位置之间相对于末端执行器运动；换能器组件，其包括至少两个压电元件，至少两个压电元件被构造成能够使末端执行器超声地振荡；和杆构件，其在接近钳口的位置处从第二臂延伸穿过第一臂，杆构件包括对应于第一臂的旋转弧的曲率。
附图说明
各种方面的特征在所附权利要求书中进行了特别描述。然而，通过参考以下结合如下附图所作的说明可最好地理解所述多个方面(有关手术组织和方法)及其进一步的目的和优点。
图1示出根据本公开的一个方面的超声外科器械系统。
图2A-2C示出根据本公开的一个方面的压电换能器。
图3示出根据本公开的一个方面的D31超声换能器架构，其包括超声波导以及固定到超声波导的一个或多个压电元件。
图4示出根据本公开的一个方面的超声外科器械的透视图。
图5示出根据本公开的一个方面的图4中的超声外科器械的剖视图。
图6示出根据本公开的一个方面的图4中的超声外科器械的剖视图，其中超声外科器械为在打开位置中。
图7示出根据本公开的一个方面的图4中的超声外科器械的分解图。
图8示出根据本公开的一个方面的图4中沿线8—8的超声外科器械的剖视图。
图9示出根据本公开的一个方面的图4中的超声外科器械的钳口和末端执行器部分的细部图。
图10示出根据本公开的一个方面的包括弯曲的末端执行器的超声外科器械的远侧部分的透视图。
图11示出根据本公开的一个方面的图10中的超声外科器械的远侧部分的侧视图。
图12示出根据本公开的一个方面的包括夹具闭合件的超声外科器械的透视图。
图13示出根据本公开的一个方面的被构造成能够检测错误的组织夹持的超声外科器械的远侧部分的侧视图。
图14示出根据本公开的一个方面的图13中的超声外科器械的侧视图。
图15示出根据本公开的一个方面的组装了可枢转构件组织止动件的超声外科器械的端部的透视图，其中可枢转构件为在收起位置中。
图16示出根据本公开的一个方面的图15中的超声外科器械的端部的透视图，其中所述可枢转构件为在部署位置中。
图17示出根据本公开的一个方面的组装了机械联动装置组织止动件的超声外科器械的透视图。
图18示出根据本公开的一个方面的图17中在打开位置中的超声外科器械的侧视图。
图19示出根据本公开的一个方面的图17中在闭合位置中的超声外科器械的侧视图。
图20示出根据本公开的一个方面的组装了可变形构件组织止动件的超声外科器械的侧视图。
图21示出根据本公开的一个方面的图20中在部分夹持位置中的超声外科器械的侧视图。
图22示出根据本公开的一个方面的图20中在夹持位置中的超声外科器械的侧视图。
图23示出根据本公开的一个方面的组装了曲杆组织止动件的超声外科器械的透视图。
图24示出根据本公开的一个方面的图23中的超声外科器械的局部剖视图。
图25示出根据本公开的一个方面的图23中在打开位置中的超声外科器械的侧视图。
图26示出根据本公开的一个方面的图23中在闭合位置中的超声外科器械的侧视图。
图27示出根据本公开的一个方面的组装了末端执行器组织止动件的超声外科器械的透视图。
图28示出根据本公开的一个方面的图27中的组织止动件的一个方面的侧视图。
图29示出根据本公开的一个方面的图27中的组织止动件的前视图。
图30示出根据本公开的一个方面的图27中的组织止动件的一个方面的顶视图。
图31示出根据本公开的一个方面的组装了纵向可滑动构件组织止动件的超声外科器械的透视图，其中超声外科器械为在打开位置中。
图32示出根据本公开的一个方面的图31中在闭合位置中的超声外科器械的透视图。
图33示出根据本公开的一个方面的图31中的纵向可滑动构件组织止动件的剖视图。
图34示出根据本公开的一个方面的组装了凸轮致动构件组织止动件的超声外科器械的侧视图。
图35示出根据本公开的一个方面的图37中在闭合位置中的超声外科器械的侧视图。
图36示出根据本公开的一个方面的组装了柔性带组织止动件的超声外科器械的透视图。
图37示出根据本公开的一个方面的图36中在闭合位置中的超声外科器械的透视图。
图38示出根据本公开的一个方面的组装了柔性带组织止动件的超声外科器械的透视图。
图39示出根据本公开的一个方面的图38中在闭合位置中的超声外科器械的侧视图。
图40示出根据本公开的一个方面的图38中在打开位置中的超声外科器械的侧视图。
图41示出根据本公开的一个方面的组装了柔性带组织止动件的超声外科器械的透视图。
图42示出根据本公开的一个方面的图41中在闭合位置中的超声外科器械的侧视图。
图43示出根据本公开的一个方面的图41中在打开位置中的超声外科器械的侧视图。
具体实施方式
在详细说明各种方面之前，应当指出的是，这些方面的应用或使用并不局限于附图和具体实施方式中详细示出的部件的构造和布置。示例性方面可以单独实施，也可以与其他方面、变更形式和修改形式结合在一起实施，并可以通过多种方式实践或执行。例如，以下公开的外科器械为示例性的，而并非旨在限制它们的范围或应用。此外，除非另外指明，否则本申请所用的术语和表达是为了方便读者而针对示例性方面进行描述的目而选，并非限制其范围。
现在将描述某些方面，以提供对本发明所公开的结构、功能、制造的原理、设备的用途和方法的全面理解。这些方面的一个或多个示例在附图中示出。本领域的普通技术人员将会理解，本申请特别描述和在附图中示出的器械和方法为非限制性的示例性方面，并且多个方面的范围仅由权利要求书限定。结合一个方面示出或描述的特征部可与其它方面的特征部进行组合。此类修改和变型旨在包括在权利要求书的范围内。
本申请所述的各种方面总体涉及超声外科器械和与其一起使用的刀片。超声外科器械和刀片的示例在美国专利No.5，322，055、No.5,954,736、No.6,309,400、No.6,278,218、No.6,283,981、No.6,325,811和No.8,319,400中公开，其中其全文公开以引用方式并入本文。
根据各种方面，包括具有末端执行器(例如刀片)的外科器械的超声器械在整形手术可具有特别的有益效果，其中希望在控制出血的同时去除皮质骨和/或组织。由于其切割和凝结特性，超声外科器械的刀片可适用于一般的软组织切割和凝结。在某些情况下，根据多个方面的刀片可适用于同时切割和止血密封或烧灼组织。刀片可为直的或弯曲的，并适用于开放式或腹腔镜式用途。根据多个方面的刀片可适用于脊椎外科手术，特别是在从骨骼上去除肌肉时帮助从后部进入。
本专利申请人拥有与本文同时提交且各自全文以引用方式并入本文的以下专利申请：
代理人案卷号END7919USNP/160045M，由发明人Jeffrey Messerly等人提交于2017年8月17日，名称为“Ultrasonic Transducer Techniques for Ultrasonic SurgicalInstrument(用于超声外科器械的超声换能器技术)”；
代理人案卷号END7919USNP1/160045-1，由发明人Jeffrey Messerly等人提交于2017年8月17日，名称为“Ultrasonic Transducer For Surgical Instrument(用于外科器械的超声换能器)”；
代理人案卷号END7919USNP2/160045-2，由发明人Jeffrey Messerly等人提交于2017年8月17日，名称为“Electrical And Thermal Connections For UltrasonicTransducer(用于超声换能器的电气连接和热连接)”；
代理人案卷号END7919USNP1/160045-3，由发明人Jeffrey Messerly等人提交于2017年8月17日，名称为“Ultrasonic Transducer to Waveguide Acoustic Coupling,Connections,and Configurations(超声换能器到波导的声耦合、连接和配置)”；
代理人案卷号END7919USNP1/160045-4，由发明人Jeffrey Messerly等人提交于2017年8月17日，名称为“Ultrasonic Transducer to Waveguide Joining(超声换能器到波导的结合)”。
图1示出了超声系统10的一个方面。超声系统10的一个方面包括超声信号发生器12、手柄组件60和末端执行器50，超声信号发生器12联接到超声换能器14，手柄组件60包括手柄外壳16。超声换能器14(称为“Langevin stack”)通常包括换能部分18、第一共振器或端罩20、第二共振器或前罩22和辅助部件。在多个方面，超声换能器14的长度优选地为二分之一系统波长的整数倍(nλ/2)，如下面将详细描述。声学组件24可包括超声换能器14、安装座26、速度变换器28和表面30。
应当理解，本文使用的术语“近”和“远”是相对于握住手柄组件60的外科医生而言的。因此，末端执行器50相对于较近侧的手柄组件60而言处于远侧。还应该理解，为方便和清晰起见，本文也根据临床医生握住手柄组件60来使用诸如“顶部”和“底部”的空间术语。然而，外科器械在许多取向和位置中使用，并且这些术语并非旨在为限制性的和绝对的。
端罩20的远端连接至换能部分18的近端，并且前罩22的近端连接至换能部分18的远端。前罩22和端罩20的长度由多个变量来确定，包括换能部分18的厚度、用于制造端罩20和前罩22的材料的密度和弹性模量以及超声换能器14的共振频率。可使前罩22从其近端到其远端向内成锥形，用于随着速度变换器28放大超声振动振幅，或者前罩22可不进行放大。
再参照图1，端罩20可包括从其延伸的螺纹构件，其可被构造成能够与前罩22中的螺纹孔以螺纹方式接合。在多个方面，当端罩20和前罩22组装在一起时，压电元件(例如，压电元件32)可在端罩20和前罩22之间被压缩。压电元件32可由任何合适的材料制成，例如锆钛酸铅、偏铌酸铅、钛酸铅和/或任何合适的压电晶体材料。
在多个方面，如下面更详细讨论，换能器14还可包括电极，例如正极34和负极36，其可被构造成能够在一个或多个压电元件32两端形成电势。正极34、负极36和压电元件32中的每一个可具有中心穿孔，其可被构造成能够接纳端罩20的螺纹构件。在多个方面，正极34和负极36分别电连接至导线38和40，其中导线38和40可包裹在线缆42内，并可电连接至超声系统10的超声信号发生器12。
在多个方面，声学组件24的超声换能器14将来自超声信号发生器12的电信号转化为机械能，其导致超声换能器14和末端执行器50以超声频率主要在纵向振动。合适的发生器为得自俄亥俄州辛辛那提的爱惜康内镜外科公司(Ethicon Endo-Surgery,Inc.(Cincinnati,Ohio))的型号GEN11。当声学组件24通电时，振动驻波通过声学组件24产生。合适的振动频率范围可为约20Hz至120kHz，较为适当的振动频率范围可为约30-70kHz，一个示例性的操作振动频率可为大约55.5kHz。
沿声学组件24的任何点处的振动振幅可取决于沿声学组件24测量振动的位置。振动驻波的最小或零交点通常称为波节(即，运动通常最小的位置)，而驻波的最大绝对值或峰值通常称为波腹(即，运动通常最大的位置)。波腹与距其最近的节点之间的距离为四分之一波长(λ/4)。
如上所述，导线38，40将电信号从超声信号发生器12发送到正极34和负极36。响应于(例如)脚踏开关44，通过超声信号发生器12提供的电信号给压电元件32供电，从而在声学组件24中生成声驻波。电信号在压电元件32中引起反复小位移形式的扰动，从而导致材料内出现较大的压缩力。重复的小位移导致压电元件32以连续方式沿着电压梯度的轴线膨胀和缩回，从而产生超声能量的纵向波。
在多个方面，换能器14所生成的超声能量可经由超声传输波导46通过声学组件24传输至末端执行器50。为了使声学组件24将能量传递到末端执行器50，声学组件24的部件声学耦合到末端执行器50。例如，超声换能器14的远端可在表面30处通过螺纹连接(例如，螺柱48)声学耦合到超声传输波导管46的近端。
可对声学组件24的部件进行声学调谐，由此使得任何组件的长度均为二分之一波长的整数倍(nλ/2)，其中波长λ是声学组件24的预选或工作纵向振动驱动频率fd的波长，并且其中n为任意正整数。还可考虑声学组件24结合任何合适的声学元件布置。
超声末端执行器50的长度可基本上等于系统半波长(λ/2)的整数倍。超声末端执行器50的远端52可设置在波腹处(或至少其附近)，以便提供远端的最大(或至少接近最大)纵向偏移。在多个方面，当换能器组件通电时，超声末端执行器50的远端52可构造成以预定振动频率在例如大约10至500微米峰到峰的范围内活动，并且优选地在大约30至150微米的范围内活动。
如上所述，超声末端执行器50可连接至超声传输波导管46。在多个方面，如图所示的超声末端执行器50和超声传输波导46由适合超声能量传输的材料形成为单个单元结构。所述材料为例如Ti6Al4V(含铝和钒的钛合金)、铝、不锈钢和/或任何其他合适的材料。作为另外一种选择，超声末端执行器50可与超声传输波导46分离，并可通过例如螺柱、焊接、胶、快速连接或其他合适的已知方法联接在一起。超声传输波导46的长度可(例如)基本上等于二分之一系统波长(λ/2)的整数倍。超声传输波导46可优选地由实芯轴制成，实芯轴由高效传输超声能量的材料例如钛合金(即，Ti6Al4V)或铝合金等构造。
在图1所示的方面，超声传输波导46包括多个起稳定作用的硅树脂环或适形支撑件56，其设置在多个波节处(或至少其附近)。硅树脂环56可抑制不期望的振动并将超声能量与至少部分地围绕波导管46的护套58隔离，从而确保超声能量以最大效率沿纵向流至末端执行器50的远端52。
如图1所示，护套58可连接至手柄组件60的远端。护套58通常包括适配器或鼻锥62和细长管状构件64。管状构件64连接到适配器62和/或从其延伸，并具有纵向贯穿其中的开口。在多个方面，护套58可通过螺纹连接或按扣到外壳16的远端上。在至少一个方面，超声传输波导46穿过管状构件64的开口延伸，硅树脂环56可接触开口的侧壁并隔离其中的超声传输波导46。在多个方面，护套58的适配器62优选由例如构造而成，管状构件64由例如不锈钢制成。在至少一个方面，超声传输波导46可带有围绕其的(例如)聚合材料，以便将其与外部接触隔离。
如上所述，电压或功率源可与换能器的压电元件中的一个或多个可操作地联接，其中施加于压电元件中的每一个的电势可导致压电元件沿纵向伸展和收缩(或振动)。也如上所述，电势可为循环的，并且在多个方面，电势可以下述频率循环，该频率与部件系统谐振频率相同或几乎相同，该部件包括例如换能器14、波导46和末端执行器50。然而，在多个方面，换能器内的压电元件中的某些可比换能器内的其他压电元件对纵向振动驻波贡献更多。更具体地讲，换能器内可产生纵向应变分布，其中应变分布可控制或限制纵向位移，使得压电元件中的一些对振动驻波做出贡献，尤其是当系统以其谐振频率或接近谐振频率振动时。
参考图1的超声外科器械系统10可认识到，可需要多个部件通过波导46将来自压电元件32的机械振动联接到末端执行器50。包括声学组件24的附加元件可对系统增加额外的制造成本、加工步骤和复杂性。下文公开了超声外科器械的方面，所述超声外科器械可需要比图1所示并且如上所公开的等同装置更少的部件、制造步骤和成本。
再次参见图1，压电元件32被构造成能够“朗之万叠堆(Langevin stack)”，其中压电元件32及其激活电极34和36(与换能器14一起)交错。激活的压电元件32的机械振动沿换能器14的纵向轴线传播，并且经由声学组件24联接到波导46的末端。压电元件的此类操作模式常常被描述为元件的D33模式，尤其是包括例如锆钛酸铅，间铌酸铅或钛酸铅的陶瓷压电元件。陶瓷压电元件的D33模式在图2A-2C中示出。
图2A示出了由陶瓷压电材料制成的压电元件200。压电陶瓷材料为包括多个单独的微晶域的多晶材料。每个微晶域具有偏振轴微晶域可响应于施加的电场沿偏振轴延伸或收缩。然而，在天然陶瓷中，微晶域的偏振轴是随机排列的，因此在块体陶瓷中没有净压电效应。可通过使陶瓷经受高于材料的居里温度的温度并将材料放置在强电场中来诱导偏振轴的净重新取向。一旦将样品的温度降至居里温度以下，大部分的单独偏振轴就将被重新取向并且沿块体偏振方向固定。图2A示出了在沿诱导电场轴线P偏振之后的此类压电元件200。尽管非偏振压电元件200不含任何净压电轴线，偏振元件200可被描述为具有平行于诱导场轴线P方向的偏振轴线d3。为了完整性，与d3轴线正交的轴线可称为d1轴线。压电元件200的尺寸被标记为长度(L)、宽度(W)和厚度(T)。
图2B和图2C示出了可通过使压电元件200经受沿d3(或P)轴线取向的致动电场E而诱导的压电元件200的机械变形。图2B示出了电场E的效应，电场E具有与沿压电元件205上的d3轴线的偏振场P相同的方向。如图2B中所示，压电元件205可通过沿d3轴线展开而变形，同时沿d1轴线压缩。图2C示出了电场E的效应，电场E具有与沿压电元件210上的d3轴线的偏振场P相对的方向。如图2C中所示，压电元件210可通过沿d3轴线压紧而变形，同时沿d1轴线展开。在沿d3轴线施加电场期间沿d3轴线的振动耦合可称为使用压电元件的D33模式的D33耦合或激活。图1中所示的换能器14使用压电元件32的D33模式来将机械振动沿波导46传输到末端执行器50。因为压电元件也沿着d1轴线变形，所以在沿d3轴线施加电场期间沿d1轴线的振动耦合也可为机械振动的有效来源。此类耦合可被称为使用压电元件的D31模式的D31耦合或激活。
如图2A-2C所示，在D31模式下的操作期间，压电元件200，205，210的横向扩展可通过以下公式加以数学建模：
在公式中，L、W和T分别是指压电元件的长度、宽度和厚度尺寸。Vd31表示施加到以D31模式操作的压电元件上的电压。由上述D31耦合产生的横向扩展量由ΔL(即，压电元件沿长度尺寸的扩展)和ΔW(即，压电元件沿宽度尺寸的扩展)表示。另外，横向扩展方程对ΔL和ΔW与施加电压Vd31之间的关系进行建模。下文公开了基于压电元件的D31激活的超声外科器械的方面。
在各个方面，如下文所述，超声外科器械可包括换能器和外科器械，换能器被构造成能够产生纵向振动，外科器械具有换能器基板(例如，换能器安装部分)，换能器基板可操作地联接到换能器、末端执行器和两者间的波导。在一些方面，也如下所述，换能器可生成能够传输至末端执行器的振动，其中振动可以谐振频率或接近谐振频率驱动换能器基板、波导、末端执行器和/或超声器械的其他各种部件。在谐振中，可在例如换能器、波导和/或末端执行器中产生纵向应变图或纵向应力图。在多个方面，此类纵向应变图或纵向应力图可导致纵向应变或纵向应力沿换能器、波导和/或末端执行器的长度以正弦或大致正弦方式变化。在至少一个方面，例如，纵向应变图可具有最大峰和零点，其中在这样的峰和零点之间应变值可以非线性方式变化。
图3示出根据本公开的一个方面的超声外科器械250，其包括通过粘结材料附接到超声换能器264的超声波导252，其中超声外科器械250被构造成能够在D31模式中操作。超声换能器264包括通过粘结材料附接到超声波导252的第一压电元件254a和第二压电元件254b。压电元件254a，254b包括导电板256a，256b以电联接适于驱动压电元件254a，254b的电压源的一个极(例如，通常为高电压)。电压源的相对极通过导电接头258a,258b电联接到超声波导252。在一个方面，导电板256a，256b联接到电压源的正极，并且导电接头258a，258b通过金属超声波导252电联接至接地电位。在一个方面，超声波导252由钛或钛合金(即，Ti6Al4V)制成，并且压电元件254a，254b利用化学式Pb[ZrxTi1-x]O3(0≤x≤1)由锆钛酸铅金属间无机化合物制成。正是陶瓷钙钛矿材料(也称为PZT)示出显著的压电效应，这意味着当施加电场时，化合物改变形状。它用于许多实际应用，例如超声换能器和压电谐振器PZT。压电元件254a，254b的立杆轴线(P)由方向箭头260指示。响应于压电元件254a，245b的激励的超声波导252的运动轴线在超声波导252的远端处由运动箭头262示出，远端通常称为超声波导252的超声刀片部分。运动轴线262与立杆轴线(P)260正交。
在如图1所示的常规D33超声换能器架构中，螺栓连接的压电元件32利用电极34，36来形成与每个压电元件33的两侧的电接触。然而，根据本公开的一个方面，D31架构250采用不同的技术来产生与每个压电元件254a，254b两侧的电接触。用于提供与压电元件254a，254b的电接触的各种技术包括将导电元件(例如，导线)粘结到每个压电元件254a，254b的自由表面，以用于实现高电势连接，并且将每个压电元件254a，254b粘结到超声波导252，以用于利用焊料、导电环氧树脂或本文所述的其他技术进行接地连接。压缩可用于保持与声学系统的电接触而不产生永久性连接。这可导致装置厚度的增加，并且应当加以控制，以避免损坏压电元件254a，254b。低压缩可通过火花间隙损坏压电元件254a，254b，并且高压缩可通过局部机械磨损损坏压电元件254a，254b。在其他技术中，金属弹簧触点可用于形成与压电元件254a，254的电接触。其它技术可包括箔棉衬垫、导电泡沫、焊料。电连接到压电元件254a，254b的两侧是D31声学系统配置。如果压电元件252，254a与超声波导254b之间存在电接触，则可对导电的金属超声波导252进行电接地连接。
在各个方面，如下文所述，超声外科器械可包括换能器和外科器械，换能器被构造成能够产生纵向振动，外科器械具有换能器基板，换能器基板可操作地连接到换能器、末端执行器和两者间的波导。在一些方面，也如下所述，换能器可生成能够传输至末端执行器的振动，其中振动可以谐振频率或接近谐振频率驱动换能器基板、波导、末端执行器和/或超声器械的其他各种部件。在谐振中，可在例如换能器、波导和/或末端执行器内产生纵向应变图或纵向应力图。在多个方面，此类纵向应变图或纵向应力图可导致纵向应变或纵向应力沿换能器、波导和/或末端执行器的长度以正弦或大致正弦方式变化。在至少一个方面，例如，纵向应变图可具有最大峰和零点，其中在这样的峰和零点之间应变值可以非线性方式变化。
在图1所示的常规的D33超声换能器架构中，螺栓提供压缩，压缩在声学上将压电元件环联接到超声波导。根据本公开的一个方面，D31架构250采用多种不同的技术将压电元件254a，254b声学联接到超声波导252。这些技术在下文中公开。
图4-12示出了超声外科器械9000的各种视图。在各种方面，外科器械9000可通常被具体体现为一对超声剪切机。更具体地讲，外科器械9000可包括第一臂9002，其通过例如紧固件9006在枢转区域9016处以能够枢转的方式连接到第二臂9004。外科器械9000还包括一对柄部或眼环9010,9012，其分别设置在第一臂9002和第二臂9004的近端处。第一臂9002包括钳口9008或夹具，其定位在其远端处，其包括配合表面9026，配合表面9026被构造成能够与从第二臂9004朝远侧延伸的末端执行器9054配合。沿第一方向致动第一臂9002导致钳口9008朝向末端执行器9054枢转，并且沿第二方向致动第一臂9002导致钳口9008枢转离开末端执行器9054。在一些方面，配合表面9026还包括垫并且接合末端执行器9054，垫由聚合物或其它柔顺材料构成。外科器械9000还包括换能器组件，例如上文参考图1-3所述。换能器组件可被布置在例如D31或D33架构中。外科器械9000还包括外壳9052，外壳9052包封超声系统10(图1)的各种部件，包括：超声换能器9062的第一压电元件9064a和第二压电元件9064b，其布置在D31架构中；换能器基板9050(例如，换能器安装部分)，其包括在相对侧上的平坦面以接纳压电元件9064a,9064b；和波导9058，其从超声换能器9062向末端执行器9054纵向传输振动。外科器械9000还包括电连接器9056，其可连接到超声信号发生器，以用于驱动超声换能器9062，如上所述。波导9058可包括多个稳定有机硅环或柔顺支撑件9060，其定位在多个节点(即，位于振动驻波中的最小或零交叉处的点)处或至少多个节点附近。柔顺支撑件9060被构造成能够抑制不期望的侧向振动，以便确保超声能量被纵向传输到末端执行器9054。波导9058延伸穿过外壳9052和第二臂9004，并且在外壳9052的外部终止于末端执行器9054处。末端执行器9054和钳口9008为被构造成能够抓持组织的配合元件，通常共同地用作夹具9030。朝向末端执行器9054移动钳口9008导致位于两者间的组织接触末端执行器9054，从而允许末端执行器9054抵靠抓持的组织操作。在末端执行器9054抵靠抓持的组织超声地振动时，末端执行器9054产生摩擦力，其导致组织凝固并且最终沿末端执行器9054的切割长度切断。
在一些方面，换能器基板9050、波导9058和末端执行器9054组件被制造成平面构件。然而，在多个方面，外壳9052的内部通道(波导9058延伸穿过内部通道)为非线性的，如图8所示，因为枢转区域9016(第一臂9002在枢转区域9016处接合到第二臂9004)的组件延伸到外壳9052的内部中。当波导9058在外科器械900的组装或制造期间位于外壳9052内时，波导9058围绕枢转区域9016的内部突出部分弯曲或弹性变形。外壳9052的内部被布置成由此使得延伸越过外壳9052的波导9058的端子端(即，末端执行器9054)为与钳口9008和/或第一臂9002共面或对齐。相反，波导9058的近侧部分不与末端执行器9054共面。这种弯曲布置允许波导9058避免枢转区域9016的内部突出部分(例如，紧固件9006)，同时仍保持外壳9052的薄型轮廓。
外科器械9000的切割长度对应于末端执行器9054以及钳口9008的配合表面9026的长度。如上所述，在末端执行器9054与钳口9008的配合表面9026之间保持足够长时间的组织被末端执行器9054切割。末端执行器9054和钳口9008的对应部分可具有多种形状。在一些方面，末端执行器9054的形状为基本上线性的，如图4-8所示。在其他方面，末端执行器9054为弯曲的，如图10-11所示。在任何情况下，被构造成能够使组织与末端执行器9054接触的钳口9008的部分对应于末端执行器9054的形状，以使得钳口9008与其对齐。
在本发明的外科器械9000的一些方面，存在位于钳口9008的配合表面9026近侧的间隙9028。如果在使用外科器械9000期间组织越过钳口9008的配合表面9026延伸到间隙9028中，则这种过载组织的凝固和切割将受到负面影响，因为钳口9008的配合表面9026将不会迫使过载组织保持与末端执行器9054接触。因此，外科器械9000的各个方面包括减轻这些影响的特征。
在其中配合表面9026的长度比末端执行器9054的长度更短的一个此类方面，对应于配合表面9026的钳口9008的区域包括在其上的标记9014或记号。标记9014横跨钳口9008的外表面从配合表面9026的远端延伸到其近端。换句话说，标记9014与钳口9008的配合表面9026共延。由于外科器械9000的切割长度等于末端执行器9054和钳口9008的配合表面9026重叠的长度，因此标记9014以视觉方式向外科器械9000的操作者指示末端执行器9054的切割长度。在与末端执行器9054相对的一侧上(即，在钳口9008和/或第一臂9002上)指示外科器械9000的切割长度，在操作者不能看到末端执行器9054自身的情况下为有用的，例如当外科器械9000正用于切割遮蔽末端执行器9054的组织时。在各种方面，标记9014包括颜色、标志(例如，几何图案)、突起、表面纹理、末端执行器9054和/或钳口9008的几何结构变化(例如，曲率)，或者以其他方式在视觉上区分钳口9008的特定区域与外科器械9000的相邻结构的任何东西。在一个具体方面，标记9014为颜色。在其中末端执行器9054的长度比钳口9008的配合表面9026的长度更短的另选方面，设置在钳口9008上的标记9014反而对应于末端执行器9054的长度(即，与末端执行器共延)。仍在其它方面，标记9014设置在末端执行器9054上，而不是钳口9008上。
外壳9052以及超声系统的相关联的结构利用本领域已知的多种不同方式可附接到第一臂9002或第二臂9004中的至少一个。在图1-4所示的一个方面，外壳9052经由夹头9004牢固地附接到外科器械9000的第二臂9022。在其他方面，外壳9052可通过粘合剂、紧固件或机械连接器(例如夹具)加以附接。仍在其它方面，外壳9052可经由例如注塑成型被成形为与第一臂9002或第二臂9004中的至少一个的单一结构组件。仍在其他方面，外壳9052可另选地被牢固地附接到外科器械9000的第一臂9002。
在各种方面，与外壳9052所附连的臂相对的臂可为能够以可拆卸的方式连接到外壳9052。例如，在图12所示的外科器械9000的一个方面，第一臂9002经由设置在第一臂9002上的第一夹具9021能够以可拆卸的方式连接到外壳9052，第一夹具9021接合设置在外壳9052上的对应的第二夹具9020。在图4—7所示的另一方面，第一臂9002经由狭槽9025能够以可拆卸的方式连接到外壳9052，狭槽9025被构造成能够摩擦地接合设置在外壳9052上的对应突出部或突片9024。当不使用外科器械9000时，将第一臂9002固定到外壳9052降低了外科器械的轮廓。在其中外壳9052牢固地连接到第一臂9002的另选方面，外壳9052可以各种方式能够以可拆卸的方式连接到第二臂9004，如上文所述。
图13-14示出根据本公开的一个方面的夹持组织9900的外科器械9000的侧视图。在所示的方面，外科器械9000被构造成能够检测由外科器械9000抓持的组织9900何时过载，或者换句话讲，抓持的组织9900何时朝近侧延伸越过钳口9008的配合表面9026和/或末端执行器9054。出于多种不同的原因，期望检测这种情况。例如，当组织9900定位在间隙9028中而不是牢固地固定在配合表面9026和末端执行器9054之间时，其可能不与末端执行器9054保持一致接触，这可不利地影响外科器械9000的性能。又如，如果操作者旨在用夹具9030抓持的组织9900反而进入近侧间隙9028，则外科器械9000的操作者可凝固和/或切割组织9900的非预期部分。又如，如果组织9900向近侧移动得太远，则它可被夹在第一臂9002和第二臂9004之间，从而导致组织9900受损或以其他方式干扰外科器械9000的切割动作。
在该方面，钳口9008包括具有第一电势的第一电极9100和具有第二电势的第二电极9102。第一电极9100对应于钳口9008的配合表面9026的位置。在一个方面，第一电极9100与配合表面9026共延。第二电极9102对应于间隙9028的位置。在一个方面，第二电极9102与对应于间隙9028的钳口9008的表面共延。当组织9900接触第一电极9100和第二电极9102两者时，回路是完整的并且产生信号，从而指示已经在近侧间隙9028中检测到组织9900(即，过载)。信号可包括电信号，其经由有线连接传输至例如外科器械9000的控制器。该信号还可包括无线信号，其由与外科器械9000无线通信的对应电子设备接收。该信号可用于向外科器械9000的操作者提供警示、引发警示、停用末端执行器9054或采取其他校正行动。
除了或代替被构造成能够在视觉上指示外科器械的切割长度的部件，如结合图1-12所述，或者用于检测组织何时过载的部件，如结合图13-14所述，外科器械9000的各个方面可被构造成能够物理地防止抓持物过载。现在大致参见图15-43，示出组装了结构特征的超声外科器械9000的各个方面，结构特征被构造成能够用作止动件或障碍，止动件或障碍物理地防止组织过载，即在被抓持时防止组织朝近侧延伸经过配合表面9026和/或末端执行器9054。此类部件统称为“组织止动件”。本文所述的组织止动件中的每一个均可被构造成能够物理地阻碍或阻止组织在钳口9008相对于末端执行器9054的整个活动范围内朝近侧延伸越过配合表面9026。
图15-16示出根据本公开的一个方面的组装了可枢转构件9150组织止动件的超声外科器械9000的各种视图。在一个方面，可枢转构件9150包括一对相对的侧面9158a，9158b和开放内部9154。相对侧9158a，9158b在枢转点9156处连接到钳口9008和/或第一臂9002。由相对侧9158a,9158b构成的开放内部9154的长度大于或等于从枢转点9156至末端执行器9054和钳口9008的远端的距离，这允许可枢转构件9150从紧靠第一臂9002收起的位置围绕外科器械9000的远端枢转到部署位置，其中相对侧9158a,9158b横跨钳口9008和末端执行器9054延伸。在一个方面，当可枢转构件9150为在部署位置中时，其相对于末端执行器9054大致正交地取向。枢转点9156可定位在第一臂9002和/或钳口9008上，由此使得其与配合表面9026的近端对齐。因此，当部署可枢转构件9150时，相对侧9158a，9158b在配合表面9026的近端处从枢转点9156沿钳口9008和末端执行器9054的横向侧向下延伸，从而物理地防止组织越过它延伸。枢转点9156还可另外包括止动件，其被构造成能够防止可枢转构件9150旋转越过下述位置，在该位置中，在部署时其为大体上正交的。
在一个方面，钳口9008和/或第一臂9002还包括通道9152或狭槽，其被构造成能够接纳可枢转构件9150的至少一部分。在一个方面，通道9152的深度可大于或等于可枢转构件9150的高度。在此类方面，当在收起位置中时，可枢转构件9150与外科器械9000的表面齐平或从该表面凹陷。
图17-19示出根据本公开的一个方面的组装了机械联动装置9170组织止动件的超声外科器械9000的各种视图。机械联动装置9170为刚性构件，其包括第一末端9172和第二末端9174。第一末端9172以能够枢转的方式连接到中间联动装置9176，继而以能够枢转的方式连接到邻近钳口9008的第一臂9002。第二末端9174以能够枢转的方式连接到邻近末端执行器9054的第二臂9004。当钳口9008从图18所示的打开位置旋转至图19所示的闭合位置时，定位成邻近钳口9008的近端的搁架9178接触联动装置9170的第一末端9172，从而导致联动装置9170旋转至下述位置，在该位置中，联动装置9170基本上齐平于钳口9008的近端。因此，联动装置9170占据钳口9008的近端与第一臂9002和第二臂9004之间的空间，从而物理地防止抓持在钳口9008和末端执行器9054之间的组织朝近侧延伸越过配合表面9026。
图20-22示出根据本公开的一个方面的组装了可变形构件9190组织止动件的超声外科器械9000的各种侧视图。可变形构件9190被构造成能够在夹具9030的打开位置和闭合位置之间在夹具9030的整个运动范围内弹性变形，以便阻止组织9900延伸到间隙9028中。在一个方面，可变形构件9190包括管状构件，其由弹性体材料构成。管状构件的长度可等于夹具9030的宽度。可变形构件9190可包括第一末端9192和第二末端9194，第一末端9192附连到第二臂9004和/或末端执行器9054，第二末端9194附连到第一臂9002和/或钳口9008。在一个方面，第二末端9194在邻近配合表面9026的近端处附接到第一臂9002。当夹具9030过渡到打开位置时，第二臂9004在第一末端9192处施加力，并且第一臂9002在第二末端9194处施加力，二者的合力导致可变形构件9190在末端执行器9054与钳口9008枢转离开彼此时扩展。同样，当夹具9030过渡到闭合位置时，当末端执行器9054和钳口9008朝向彼此枢转时，可变形构件9190被压缩。因此变形构件9190占据末端执行器9054和钳口9008之间的空间，而不管它们的相对位置。可变形构件9190的末端9192,9194可经由例如粘合剂、紧固件、机械连接器附连到外科器械9000的相应部分。
图23-26示出根据本公开的一个方面的组装了曲杆9200组织止动件的超声外科器械9000的各种视图。在一个方面，外科器械9000包括曲杆9200，其从邻近末端执行器9054的第二臂9004的远端延伸。曲杆9200从朝向第一臂9002取向的第二臂9004的表面延伸穿过通道9204，通道9204延伸穿过第一臂9002。曲杆9200的曲率对应于第一臂9002或钳口9008的旋转弧9201(即，第一臂9002或钳口9008上的固定点在钳口9008在打开位置和闭合位置之间枢转时沿弧9201行进)，由此使得第一臂9002可枢转，而没有阻碍曲杆9200。在各种方面，曲杆9200还包括头部9202，其设置在其远端处，具有比通道9204的至少部分更大的宽度或直径，曲杆9200在通道9204中定位。头部9202用于限制第一臂9002相对于第二臂9004的旋转弧9201，从而防止曲杆9200由于第一臂9002的过度旋转而从通道9204中退出。
在各种方面，曲杆9200具有的宽度等于配合表面9026或末端执行器9054的宽度的至少一部分。由于曲杆9200被定位成邻近配合表面9026的近端并且第一臂9002横跨曲杆9200在第一臂9002的整个旋转弧9201上滑动，因此曲杆9200用作夹具9030的打开位置和闭合位置之间的物理障碍，从而防止抓持的组织越过其迁移。
图27-30示出根据本公开的一个方面的组装了末端执行器9250组织止动件的超声外科器械9000的透视图。环9250包括环面或环形构件，所述环面或环形构件包括延伸穿过环9250的孔9252，所述环被构造成能够通过其接纳末端执行器9054。在一个方面，环9250的孔9252被构造成能够匹配末端执行器9054的尺寸的尺寸和形状。孔9252的尺寸被设定成末端执行器9054的紧密容差，以使得环9250可沿末端执行器9054的长度滑动，但在未受到干扰时保持固定就位。当被放置在末端执行器9054上时，环9250被构造成能够延伸到钳口9008的表面，该表面限定钳口9008与末端执行器9054之间的间隙9028的上界。因此，当环9250沿末端执行器9054放置成接近配合表面9026时，环9250充当物理屏障，从而防止组织进入间隙9028。环9250可由例如弹性体材料构成。
在各种方面，环9250还包括附连到其上的夹具9256，夹具9256被构造成能够有助于将环9250固定在末端执行器9054上的适当位置。在图28-29所示的一个方面，夹具9256包括孔9258和多个臂9254，孔9258与环9250的孔9252对齐。臂9254相对于末端执行器9054从夹具9256正交地延伸。环9250的孔9258同样被构造成能够接纳穿过其中的末端执行器9054。臂9254为弹性偏置构件，其限定被构造成能够接纳钳口9008的一部分的狭槽9262。当9008钳口的一部分插入狭槽9262中时，臂9254摩擦地接合钳口9008的一部分，这将环9250保持在适当位置。在图30所示的另一个方面，夹具9256包括孔9258和多个臂9260，孔9258与环9250的孔9252对齐。臂9260相对于末端执行器9054从夹具9256纵向延伸。臂9260为弹性偏置构件，其限定被构造成能够接纳从钳口9008的内表面延伸的突出部(未示出)的狭槽9264。当从钳口9008将臂9260夹持到突出部时，臂9260摩擦地接合突出部，这将环9250保持在适当位置。
图31-33示出根据本公开的一个方面的组装了纵向可滑动构件9270组织止动件的超声外科器械9000的视图。在这一方面，外科器械9000包括设置在末端执行器9054上的纵向可滑动构件9270，纵向可滑动构件9270被构造成能够在当打开夹具9030时的第一位置或回缩位置与当关闭夹具9030时的第二位置或伸出位置之间过渡。可滑动构件9270包括通道9280、远侧表面9276和臂9278，通道9280被构造成能够接纳末端执行器9054，臂9278从近端延伸。通道9280还包括弹簧组件9272，其将可滑动构件9270朝向回缩位置偏置。换句话讲，弹簧组件9272被构造成能够使可滑动构件9270从延伸位置返回到回缩位置。外科器械9000还包括突出部9274，其从第一臂9002延伸，在钳口9008枢转至闭合位置或夹紧位置时接触可滑动构件9270的臂9278。突出部9274和臂9278之间的接触件沿末端执行器9054朝远侧驱动可滑动构件9270，从而将可滑动构件9270放置在延伸位置中。当纵向可滑动构件9270为在延伸位置中时，远侧表面9276与配合表面9026的近端接触。远侧表面9276的表面区域足以从末端执行器9054延伸到间隙9028的下界，从而允许可滑动构件9270用作物理屏障，从而在可滑动构件9270为在延伸位置中时防止组织延伸越过配合表面9026。当钳口9008枢转离开末端执行器9054至夹具9030的打开位置时，突出部9274从臂9278脱离，并且弹簧组件9272使可滑动构件9270返回到其回缩位置。
图34-35示出根据本公开的一个方面的组装了在打开位置中的凸轮9290组织止动件的超声外科器械9000的侧视图。在一个方面，外科器械9000包括第一臂9002，其通过枢轴销9296以能够枢转的方式连接到第二臂9004。外科器械9000还包括凸轮9290，其被构造成能够在远侧位置或延伸位置与近侧位置或回缩位置之间纵向平移。在一个方面，凸轮9290包括凸轮销9298或凸轮表面，其与设置在第一臂9002上的凸轮狭槽9294接合。在各种方面，凸轮狭槽9294的形状被构造成能够导致凸轮9290在钳口9008枢转离开末端执行器9054时朝远侧平移(即，延伸)，并且在钳口9008朝向末端执行器9054枢转时朝近侧平移(即，回缩)。在一个方面，凸轮狭槽9294具有弯曲或螺线型形状，包括第一坡道9302，其被构造成能够在钳口9008打开时接触凸轮销9298(如图35所示)，从而在凸轮销9298上施加第一水平力。当凸轮销9298牢固地附接到凸轮9290时，第一水平力9290导致凸轮9290朝远侧平移。凸轮狭槽9294还包括第二坡道9304，其与第一坡道9302相对，被构造成能够在钳口9008闭合时接触凸轮销9298(如图34所示)，从而在凸轮销9298上施加第二水平力。由第二坡道9304施加在凸轮销9298上的第二水平力与第一水平力相对地取向，这导致凸轮9290朝近侧平移。
凸轮9290包括引导表面或远侧表面9300，其被构造成能够充当物理障碍或屏障，从而在外科器械9000正用于抓持组织时防止组织延伸经过钳口9008的配合表面9026。当凸轮9290为在延伸位置(如
图35所示)中时，凸轮9290的远侧表面9300被定位成邻近配合表面9026的近端。当操作者打开钳口9008以抓持组织时，远侧表面9300因此阻止组织过载。一旦组织被正确地加载并且钳口9008随后闭合，凸轮9290就回缩。
凸轮9290还包括狭槽9292，其沿其长度设置，在其中接纳将第一臂9002连接到第二臂9004的枢转销9296。狭槽9292用于三个目的。首先，狭槽9292防止凸轮9290干扰在第一臂9002和第二臂9004之间的可枢转联动装置(即，枢轴销9296)。其次，在一些方面，狭槽9292的宽度等于枢轴销9296直径或宽度的紧密容差。在狭槽9292的宽度与枢轴销9296之间的紧密容差限制了凸轮9290的非纵向运动。换句话说，狭槽9292确保凸轮9290以线性或纵向方式平移。狭槽9292的长度可被构造成能够充当钳口9008可相对于末端执行器9054枢转的程度的绝对限制。当狭槽9290的近端接触枢轴销9296时，在凸轮9292移动横跨枢轴销9296时，防止凸轮9290进一步朝远侧平移。当凸轮9290被锁定而不朝远侧平移时，在凸轮销9298和凸轮狭槽9294之间的接合然后防止第一臂9002和钳口9008进一步枢转。
图36-37示出根据本公开的一个方面的组装了柔性带9350组织止动件的超声外科器械9000的透视图。在一个方面，外科器械9000包括柔性带9350，柔性带9350包括第一末端9352和第二末端9354，第一末端9352附接到邻近末端执行器9054的近端的第二臂9004，第二末端9354滑动设置在钳口9008上定位的通道9356内。柔性带9350可由下述各项构成，例如：弹性体材料；一系列刚性构件，其柔性地连接在一起；或另一种此类材料或结构，其允许柔性带9350在钳口9008相对于末端执行器9054移动时挠曲或变形。在所述的方面，柔性带9350被布置成由此使得当钳口9008朝向末端执行器9054枢转时，柔性带9350回缩到通道9356中，并且当钳口9008枢转离开末端执行器9054时，柔性带9350从通道9356延伸。然而，柔性带9350的第二末端9354保持在贯穿钳口9008的整个运动范围的通道9356内。当柔性带9350在打开位置和闭合位置之间的整个运动范围内滑进或滑出通道9356时，柔性带9350弯曲或挠曲，以使得柔性带9350的引导部分被保持为邻近配合表面9026的近端。因此，当在使用外科器械9000时，柔性带9350充当物理屏障，从而防止组织延伸越过配合表面9026。
图38-40示出根据本公开的一个方面的组装了柔性带9350组织止动件的超声外科器械9000的透视图。在一个方面，外科器械9000包括柔性带9350，其包括第一末端9352和第二末端9354，第一末端9352滑动附接到邻近末端执行器9054的近端的第二臂9004。在一个方面，第一末端9352可通过定位在第一末端9352处的一个或多个辊9358滑动附接到第二臂9004，一个或多个辊9358沿通道9360的内表面滑动定位，通道9360沿第二臂9004纵向延伸。在一个方面，第二末端9354通过例如活动铰链附连到配合表面9026。在一些方面，柔性带9350和配合表面9026被构造为连续的材料带。柔性带9350可由下述各项构成，例如：弹性体材料；一系列刚性构件，其柔性地连接在一起；或者另一种此类材料或结构，其允许柔性带9350在钳口9008相对于末端执行器9054移动时挠曲或变形。在所述的方面，柔性带9350被布置成由此使得当钳口9008朝向末端执行器9054枢转时，柔性带9350回缩到通道9360中，并且当钳口9008枢转离开末端执行器9054时，柔性带9350从通道9360延伸。然而，柔性带9350的第一末端9352保持在贯穿钳口9008的整个运动范围的通道9356内。当柔性带9350在打开位置和闭合位置之间的整个运动范围内滑进或滑出通道9356时，柔性带9350弯曲或挠曲，以使得柔性带9350的引导部分被保持为邻近配合表面9026的近端。因此，当在使用外科器械9000时，柔性带9350充当物理屏障，从而防止组织延伸越过配合表面9026。
图41-43示出根据本公开的一个方面的组装了柔性带9350组织止动件的超声外科器械9000的透视图。在一个方面，外科器械9000包括柔性带9350，其包括第一末端9352和第二末端9354，第一末端9352滑动附接到邻近末端执行器9054的近端的第二臂9004。在一个方面，第一末端9352可通过定位在第一末端9352处的一个或多个辊9358滑动附接到第二臂9004，一个或多个辊9358沿通道9360的内表面滑动定位，通道9360沿第二臂9004纵向延伸。在一个方面，第二末端9354通过粘合剂、机械紧固件或者本领域已知的其他此类附接方法附连到钳口9008。柔性带9350可由下述各项构成，例如：弹性体材料；一系列刚性构件，其柔性地连接在一起；或另一种此类材料或结构，其允许柔性带9350在钳口9008相对于末端执行器9054移动时挠曲或变形。在所述的方面，柔性带9350被布置成由此使得当钳口9008朝向末端执行器9054枢转时，柔性带9350回缩到通道9360中，并且当钳口9008枢转离开末端执行器9054时，柔性带9350从通道9360延伸。然而，柔性带9350的第一末端9352保持在贯穿钳口9008的整个运动范围的通道9356内。当柔性带9350在打开位置和闭合位置之间的整个运动范围内滑进或滑出通道9356时，柔性带9350弯曲或挠曲，以使得柔性带9350的引导部分被保持为邻近配合表面9026的近端。因此，当在使用外科器械9000时，柔性带9350充当物理屏障，从而防止组织延伸越过配合表面9026。
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。然而无论是哪种情况，该装置都可在至少使用一次后经过修整再行使用。修整可包括拆卸装置、之后清洁或替换特定零件以及后续重新组装步骤的任意组合。具体地，该装置可拆卸，而且可以任意组合选择性地替换或移除该装置的任意数目的特定零件或部件。在清洁和/或替换特定部件后，可对该装置进行重新组装，以便随后在修整设施处使用或就在外科手术之前由手术团队使用。本领域的技术人员将会理解，修整装置可利用多种技术来进行拆卸、清洁/替换和重新组装。此类技术的使用以及所得的修整装置均在本申请的范围内。
虽然本文已描述了各种方面，但是可以对那些实施方案实施多种修改和变型。例如，在各种方面，例如在图4-16所示的那些，末端执行器被描述为定位在外科器械上的钳口的下方；而在其他方面，例如在图17-43所示的那些，末端执行器被描述为定位在外科器械上的钳口的上方。值得注意的是，这些方面仅为示例性的，并且一种类型的教导内容同样适用于另一种类型，并且各种结构特征可另选方面互换使用。又如，可采用不同类型的末端执行器。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。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。
以引用方式全文或部分地并入本文的任何专利、公布或其他公开材料均仅在所并入的材料不与本发明所述的现有定义、陈述或其他公开材料相冲突的范围内并入本文。因此，并且在必要的程度下，本文明确列出的公开内容代替以引用方式并入本文的任何冲突材料。据称以引用方式并入本文但与本文列出的现有定义、陈述或其他公开材料相冲突的任何材料或其部分，将仅在所并入的材料与现有的公开材料之间不产生冲突的程度下并入。
本文所述主题的各个方面在以下编号的实施例中陈述：
实施例1.一种超声外科器械，包括：末端执行器；钳口，其能够相对于末端执行器运动；换能器组件，其包括至少两个压电元件，至少两个压电元件被构造成能够使末端执行器超声地振荡；和标记，其与钳口的覆盖末端执行器的部分共延。
实施例2.根据实施例1所述的超声外科器械，其中标记包括颜色。
实施例3.根据实施例1或实施例2所述的超声外科器械，还包括第一电极；和第二电极；其中，接触第一电极和第二电极两者的组织产生信号。
实施例4.根据实施例3所述的超声外科器械，还包括配合表面，其设置在钳口上，配合表面与末端执行器对齐，其中第一电极与配合表面以及定位在配合表面的近侧的第二电极共延。
实施例5.根据实施例1至实施例4中的一项或多项所述的超声外科器械，还包括：联动装置，其包括第一末端和第二末端，第一末端邻近末端执行器牢固地附接，第二末端邻近钳口以能够枢转的方式附接；其中，联动装置被构造成能够在钳口的闭合位置中枢转并接触钳口的近端；并且其中，联动装置被构造成能够在钳口的打开位置中枢转离开钳口的近端。
实施例6.根据实施例1至实施例5中的一项或多项所述的超声外科器械，还包括：凸轮，其经由联动装置可动地连接到钳口；其中，凸轮被构造成能够在钳口的闭合位置中延伸并接触钳口的近端；并且其中，凸轮被构造成能够在钳口的打开位置中回缩。
实施例7.根据实施例1至实施例6中的一项或多项所述的超声外科器械，还包括：可滑动构件，其能够在回缩位置和延伸位置之间运动，其中，可滑动构件被构造成能够在可滑动构件的延伸位置中接触钳口的近端；其中，构件被偏置到回缩位置；和突出部，其中，突出部被构造成能够在钳口的闭合位置中接触弹簧偏置构件，并且其中，突出部被构造成能够在钳口的闭合位置中使可滑动构件运动到延伸位置。
实施例8.根据实施例1至实施例7中的一项或多项所述的超声外科器械，还包括可枢转构件，其被构造成能够从第一位置枢转至第二位置，其中可枢转构件横跨钳口和末端执行器的横向侧延伸。
实施例9.根据实施例1至实施例8中的一项或多项所述的超声外科器械，还包括环，其被构造成能够安装在末端执行器之上。
实施例10.根据实施例1至实施例9中的一项或多项所述的超声外科器械，还包括弹性体构件，其设置在末端执行器和钳口之间，其中在钳口的打开位置中，弹性体构件在末端执行器和钳口之间被拉伸，并且其中在钳口的闭合位置中，弹性体构件在末端执行器和钳口之间被压缩。
实施例11.根据实施例1至实施例10中的一项或多项所述的超声外科器械，还包括：第一臂，其中钳口设置在第一臂的远端处；第二臂，其以能够枢转的方式连接至第一臂；其中末端执行器设置在第二臂的远端处；和杆构件，其在接近钳口的位置处从第二臂延伸穿过第一臂，杆构件包括对应于第一臂的旋转弧的曲率。
实施例12.根据实施例1至实施例11中的一项或多项所述的超声外科器械，还包括：柔性带，其包括第一末端和第二末端，第一末端牢固地附接到钳口；通道，其被构造成以能够滑动的方式接纳第二末端；其中在钳口的闭合位置中，第二末端回缩到通道中，并且其中在钳口的打开位置中，第二末端从通道延伸。
实施例13.根据实施例1至实施例12中的一项或多项所述的超声外科器械，还包括：外壳，其包封超声换能器组件；和电连接器，其设置在外壳上，电连接器电联接到超声换能器组件并且能够联接到超声信号发生器；其中，电连接器被构造成能够在被外壳内的流体接触时短路。
实施例14.一种超声外科器械，包括：末端执行器；钳口，其能够在打开位置和闭合位置之间相对于末端执行器运动；换能器组件，其包括至少两个压电元件，至少两个压电元件被构造成能够使末端执行器超声地振荡；和凸轮，其经由联动装置可动地连接到钳口；其中，凸轮被构造成能够在钳口的闭合位置中朝向钳口的近端延伸；并且其中，凸轮被构造成能够在钳口的打开位置中回缩。
实施例15.根据实施例14所述的超声外科器械，还包括：外壳，其包封换能器组件；第一臂；第二臂，其以能够枢转的方式连接至第一臂；其中，外壳牢固地连接至第一臂并且能够以可拆卸的方式连接到第二臂。
实施例16.根据实施例14或实施例15所述的超声外科器械，还包括第一电极；和第二电极；其中，接触第一电极和第二电极两者的组织产生信号。
实施例17.根据实施例14至实施例16中的一项或多项所述的超声外科器械，还包括：外壳，其包封超声换能器组件；和电连接器，其设置在外壳上，电连接器电联接到超声换能器组件并且能够联接到超声信号发生器；其中，电连接器被构造成能够在被外壳内的流体接触时短路。
实施例18.一种超声外科器械，包括：末端执行器；钳口，其能够在打开位置和闭合位置之间相对于末端执行器运动；换能器组件，其包括至少两个压电元件，至少两个压电元件被构造成能够使末端执行器超声地振荡；可滑动构件，其能够在回缩位置和延伸位置之间运动，其中，可滑动构件被构造成能够在可滑动构件的延伸位置中接触钳口的近端；其中，构件被偏置到回缩位置；和突出部，其中，突出部被构造成能够在钳口的闭合位置中接触弹簧偏置构件，并且其中，突出部被构造成能够在钳口的闭合位置中使可滑动构件运动到延伸位置。
实施例19.根据实施例18所述的超声外科器械，其中，换能器组件被包封在外壳内，并且外壳能够以可拆卸的方式连接到第一臂或第二臂中的至少一个。
实施例20.根据实施例18或实施例19所述的超声外科器械，还包括第一电极；和第二电极；其中，接触第一电极和第二电极两者的组织产生信号。
实施例21.根据实施例18至实施例20中的一项或多项所述的超声外科器械，还包括：外壳，其包封超声换能器组件；和电连接器，其设置在外壳上，电连接器电联接到超声换能器组件并且能够联接到超声信号发生器，其中，电连接器被构造成能够在被外壳内的流体接触时短路。
实施例22.一种超声外科器械，包括：第一臂；第二臂，其以能够枢转的方式连接至第一臂；钳口，其设置在第一臂的远端处；末端执行器，其设置在第二臂的远端处；其中，钳口能够在打开位置和闭合位置之间相对于末端执行器运动；换能器组件，其包括至少两个压电元件，至少两个压电元件被构造成能够使末端执行器超声地振荡；和杆构件，其在接近钳口的位置处从第二臂延伸穿过第一臂，杆构件包括对应于第一臂的旋转弧的曲率。
实施例23.根据实施例22所述的超声外科器械，其中，换能器组件被包封在外壳内，并且外壳能够以可拆卸的方式连接到第一臂或第二臂中的至少一个。
实施例24.根据实施例22或实施例23所述的超声外科器械，还包括第一电极；和第二电极；其中，接触第一电极和第二电极两者的组织产生信号。
实施例25.根据实施例22至实施例24中的一项或多项所述的超声外科器械，还包括：外壳，其包封超声换能器组件；和电连接器，其设置在外壳上，电连接器电联接到超声换能器组件并且能够联接到超声信号发生器；其中，电连接器被构造成能够在被外壳内的流体接触时短路。

Claims (25)

1.一种超声外科器械，包括：
末端执行器；
钳口，所述钳口能够相对于所述末端执行器运动；
换能器组件，所述换能器组件包括至少两个压电元件，所述至少两个压电元件被构造成能够使所述末端执行器超声地振荡；和
标记，所述标记与所述钳口的覆盖所述末端执行器的部分共延。
2.根据权利要求1所述的超声外科器械，其中，所述标记包括颜色。
3.根据权利要求1所述的超声外科器械，还包括：
第一电极；和
第二电极；
其中，接触所述第一电极和所述第二电极两者的组织产生信号。
4.根据权利要求3所述的超声外科器械，还包括配合表面，所述配合表面设置在所述钳口上，所述配合表面与所述末端执行器对齐，其中所述第一电极与所述配合表面以及定位在所述配合表面的近侧的所述第二电极共延。
5.根据权利要求1所述的超声外科器械，还包括：
联动装置，所述联动装置包括第一末端和第二末端，所述第一末端邻近所述末端执行器牢固地附接，所述第二末端邻近所述钳口以能够枢转的方式附接；
其中，所述联动装置被构造成能够在所述钳口的闭合位置中枢转并接触所述钳口的近端；并且
其中，所述联动装置被构造成能够在所述钳口的打开位置中枢转离开所述钳口的所述近端。
6.根据权利要求1所述的超声外科器械，还包括：
凸轮，所述凸轮经由联动装置可动地连接到所述钳口；
其中，所述凸轮被构造成能够在所述钳口的闭合位置中延伸并接触所述钳口的近端；并且
其中，所述凸轮被构造成能够在所述钳口的打开位置中回缩。
7.根据权利要求1所述的超声外科器械，还包括：
可滑动构件，所述可滑动构件能够在回缩位置和延伸位置之间运动，其中所述可滑动构件被构造成能够在所述可滑动构件的延伸位置接触所述钳口的近端；
其中，所述构件被偏置到所述回缩位置；和
突出部，其中，所述突出部被构造成能够在所述钳口的闭合位置中接触所述弹簧偏置构件，并且其中，所述突出部被构造成能够在所述钳口的闭合位置使所述可滑动构件运动到所述延伸位置。
8.根据权利要求1所述的超声外科器械，还包括可枢转构件，所述可枢转构件被构造成能够从第一位置枢转至第二位置，其中所述可枢转构件横跨所述钳口和所述末端执行器的所述横向侧延伸。
9.根据权利要求1所述的超声外科器械，还包括环，所述环被构造成能够安装在所述末端执行器之上。
10.根据权利要求1所述的超声外科器械，还包括弹性体构件，所述弹性体构件设置在所述末端执行器和所述钳口之间，其中在所述钳口的打开位置中，所述弹性体构件在所述末端执行器和所述钳口之间被拉伸，并且其中在所述钳口的闭合位置中，所述弹性体构件在所述末端执行器和所述钳口之间被压缩。
11.根据权利要求1所述的超声外科器械，还包括：
第一臂；
其中所述钳口设置在所述第一臂的远端处；
第二臂，所述第二臂以能够枢转的方式连接至所述第一臂；
其中所述末端执行器设置在所述第二臂的远端处；和
杆构件，所述杆构件在接近所述钳口的位置处从所述第二臂延伸穿过所述第一臂，所述杆构件包括对应于所述第一臂的旋转弧的曲率。
12.根据权利要求1所述的超声外科器械，还包括：
柔性带，所述柔性带包括：
第一末端，所述第一末端牢固地附接到所述钳口；和
第二末端；
通道，所述通道被构造成以能够滑动的方式接纳所述第二末端；
其中在所述钳口的闭合位置中，所述第二末端回缩到所述通道中，并且其中在所述钳口的打开位置中，所述第二末端从所述通道延伸。
13.根据权利要求1所述的超声外科器械，还包括：
外壳，所述外壳包封所述超声换能器组件；和
电连接器，所述电连接器设置在所述外壳上，所述电连接器电联接到所述超声换能器组件并且能够联接到超声信号发生器；
其中，所述电连接器被构造成能够在被所述外壳内的流体接触时短路。
14.一种超声外科器械，包括：
末端执行器；
钳口，所述钳口能够在打开位置和闭合位置之间相对于所述末端执行器运动；
换能器组件，所述换能器组件包括至少两个压电元件，所述至少两个压电元件被构造成能够使所述末端执行器超声地振荡；和
凸轮，所述凸轮经由联动装置可动地连接到所述钳口；
其中，所述凸轮被构造成能够在所述钳口的闭合位置朝向所述钳口的近端延伸；并且
其中，所述凸轮被构造成能够在所述钳口的打开位置中回缩。
15.根据权利要求14所述的超声外科器械，还包括：
外壳，所述外壳包封所述换能器组件；
第一臂；
第二臂，所述第二臂以能够枢转的方式连接至所述第一臂；
其中，所述外壳牢固地连接至所述第一臂并且能够以可拆卸的方式连接到所述第二臂。
16.根据权利要求14所述的超声外科器械，还包括：
第一电极；和
第二电极；
其中，接触所述第一电极和所述第二电极两者的组织产生信号。
17.根据权利要求14所述的超声外科器械，还包括：
外壳，所述外壳包封所述超声换能器组件；和
电连接器，所述电连接器设置在所述外壳上，所述电连接器电联接到所述超声换能器组件并且能够联接到超声信号发生器；
其中，所述电连接器被构造成能够在被所述外壳内的流体接触时短路。
18.一种超声外科器械，包括：
末端执行器；
钳口，所述钳口能够在打开位置和闭合位置之间相对于所述末端执行器运动；
换能器组件，所述换能器组件包括至少两个压电元件，所述至少两个压电元件被构造成能够使所述末端执行器超声地振荡；
可滑动构件，所述可滑动构件能够在回缩位置和延伸位置之间运动，其中，所述可滑动构件被构造成能够在所述可滑动构件的延伸位置接触所述钳口的近端；
其中，所述构件被偏置到所述回缩位置；和
突出部，其中，所述突出部被构造成能够在所述钳口的闭合位置接触所述弹簧偏置构件，并且其中，所述突出部被构造成能够在所述钳口的闭合位置使所述可滑动构件运动到所述延伸位置。
19.根据权利要求18所述的超声外科器械，其中，所述换能器组件被包封在外壳内，并且所述外壳能够以可拆卸的方式连接到所述第一臂或所述第二臂中的至少一个。
20.根据权利要求18所述的超声外科器械，还包括：
第一电极；和
第二电极；
其中，接触所述第一电极和所述第二电极两者的组织产生信号。
21.根据权利要求18所述的超声外科器械，还包括：
外壳，所述外壳包封所述超声换能器组件；和
电连接器，所述电连接器设置在所述外壳上，所述电连接器电联接到所述超声换能器组件并且能够联接到超声信号发生器；
其中，所述电连接器被构造成能够在被所述外壳内的流体接触时短路。
22.一种超声外科器械，包括：
第一臂；
第二臂，所述第二臂以能够枢转的方式连接至所述第一臂；
钳口，所述钳口设置在所述第一臂的远端处；
末端执行器，所述末端执行器设置在所述第二臂的远端处；
其中，所述钳口能够在打开位置和闭合位置之间相对于末端执行器运动；
换能器组件，所述换能器组件包括至少两个压电元件，所述至少两个压电元件被构造成能够使所述末端执行器超声地振荡；和
杆构件，所述杆构件在接近所述钳口的位置处从所述第二臂延伸穿过所述第一臂，所述杆构件包括对应于所述第一臂的旋转弧的曲率。
23.根据权利要求22所述的超声外科器械，其中，所述换能器组件被包封在外壳内，并且所述外壳能够以可拆卸的方式连接到所述第一臂或所述第二臂中的至少一个。
24.根据权利要求22所述的超声外科器械，还包括：
第一电极；和
第二电极；
其中，接触所述第一电极和所述第二电极两者的组织产生信号。
25.根据权利要求22所述的超声外科器械，还包括：
外壳，所述外壳包封所述超声换能器组件；和
电连接器，所述电连接器设置在所述外壳上，所述电连接器电联接到所述超声换能器组件并且能够联接到超声信号发生器；
其中，所述电连接器被构造成能够在被所述外壳内的流体接触时短路。
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