CN109907794A - 可重复使用的多发手术施夹器 - Google Patents
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Abstract
可重复使用的手术施夹器包括手柄组件、与手柄组件可释放地接合的轴组件以及可释放地接合在所述轴组件内的夹盒组件。所述手柄组件包括近侧传动构件、近侧推动器和近侧偏置构件，近侧偏置构件偏置为向近侧移动所述近侧传动构件，使得近侧推杆向远侧移动。当组装可重复使用的手术施夹器时，所述近侧传动构件近侧邻近所述轴组件的内传动组件定位，并且所述近侧推动器近侧邻近所述夹盒组件的远侧推动器定位，使得所述手柄组件的手柄朝接近位置的移动致动所述轴组件的钳口组件，而所述手柄朝间隔位置的移动将最远侧的手术夹从所述夹盒组件载至所述钳口组件中。
Description
相关申请的交叉引用
本申请要求2017年12月13日提交的美国临时专利申请62/598,445号的权益和优先权，其全部公开内容通过引用并入本文。
技术领域
本发明涉及手术施夹器，更具体地，涉及一种可重复使用的多发手术施夹器，其包括手柄组件、轴组件和夹盒组件，构造成用于选择性拆卸以利于处理任何一次性部件并再加工任何可重复使用的部件以供进一步使用。
相关技术的讨论
各种吻合器和施夹器在本领域中是已知的并且用于许多不同且有用的外科手术。例如，在Green等人的共同转让的美国专利5,084,057和5,100,420号中描述了能够在单次进入体腔期间施放多个夹子的施夹器，其全部内容通过引用并入本文。在Pratt等人的共同转让的美国专利5,607,436号中公开了另一种多夹施放器，其全部内容也通过引用并入本文。Pier等人的美国专利5,695,502号(其全部内容据此通过引用并入本文)公开了一种可重复消毒的手术施夹器，其构造成容纳并可互换的夹箱并与之配合，以便在单次进入体腔过程中推进并形成多个夹子。
发明内容
本发明涉及一种可重复使用的多发手术施夹器，其包括手柄组件、轴组件和夹盒组件，构造成用于选择性拆卸以利于处理任何一次性部件并再加工任何可重复使用的部件以供进一步使用。
根据本公开的多个方面提供的一种可重复使用的手术施夹器，包括手柄组件，与手柄组件可释放地接合的轴组件，以及可释放地接合在所述轴组件内的夹盒组件。
手柄组件包括壳体，可相对于壳体在间隔位置和接近位置之间移动的至少一个手柄，以及从壳体延伸的内致动组件。内致动组件包括可移动通过壳体的近侧传动构件(proximal drive member)，可移动通过近侧传动构件的近侧推杆，以及置于近侧传动构件周围、介于壳体的近端部与近侧传动构件的近端部之间的近侧偏置构件。所述近侧偏置构件具有构造为使所述近侧传动构件向近侧移动，使得所述近侧推杆向远侧移动的偏置。所述至少一个手柄相对于所述壳体的移动构造成在相对相反的方向上移动所述近侧传动构件和所述近侧推杆。
所述轴组件包括外管、支撑在外管远端部的钳口组件，以及内传动组件，其可滑动地置于所述外管内并且可操作地联接至所述钳口组件，使得所述内传动组件通过所述外管的远侧运动使所述钳口组件致动。
所述夹盒组件将手术夹堆叠保持在其中并且包括可操作地联接至手术夹堆叠中最远侧的手术夹的远侧推动器，使得当所述夹盒组件可释放地接合在所述轴组件内时，所述远侧推动器的远侧移动将所述最远侧的手术夹载至所述钳口组件内。
当轴组件与手柄组件可释放地接合并且夹盒组件可释放地接合在轴组件内时，近侧传动构件在近侧邻近内传动组件定位，使得所述至少一个手柄朝接近位置的移动使钳口组件致动，并且近侧推杆在近侧邻近远侧推动器定位，使得所述至少一个手柄朝间隔位置的移动将最远侧手术夹载至钳口组件中。
在本公开的一个方面中，所述壳体包括至少一个内部零件，其限定构造成可移动地容纳所述至少一个手柄的远端部的枢轴凹部。在此类方面中，所述枢轴凹部和所述至少一个手柄的尺寸和构造设计成协作以限制所述至少一个手柄的移动超过预定的接近位置和超过预定的间隔位置。
在本公开的另一个方面中，所述至少一个手柄朝所述接近位置的移动使所述近侧传动构件相对于所述近侧偏置构件的偏置，绕所述近侧推杆向远侧移动，并且使所述近侧推杆围绕并通过所述近侧传动构件向近侧移动。在此类方面中，所述至少一个手柄朝所述间隔位置的移动使所述近侧传动构件在所述近侧偏置构件的偏置下，绕所述近侧推杆向近侧移动，并且使所述近侧推杆围绕并通过所述近侧传动构件向远侧移动。
在本公开的又一方面，所述手柄组件还包括棘轮组件，其具有至少一个可枢转地支撑在所述壳体内的棘轮爪和支撑在所述近侧传动构件的远端部上的棘轮架。在此类方面中，所述至少一个棘轮爪相对于所述棘轮齿条可操作地定位，以向所述内致动组件提供棘轮功能。
在本公开的一个实施例中，所述轴组件的外管包括穿过其管状近侧段形成的至少一个窗口。在此类实施例中，当所述轴组件与所述手柄组件可释放地接合时，所述外管的近侧段邻近所述棘轮组件定位，使得所述至少一个棘轮爪置于所述至少一个窗口内以接合所述棘轮架。
在本公开的另一方面，所述轴组件还包括置于管状近侧段和内传动组件之间的内衬套。在此类方面中，内衬套包括至少一个窗口，其构造为当所述内衬套置于其中时与所述管状近侧段的至少一个窗口对齐，使得所述至少一个棘轮爪置于所述管状近侧段的至少一个窗口和所述内衬套的至少一个窗口内以接合所述棘轮架。
在本发明的又一个方面，手柄组件的壳体包括限定中央通道的远侧开口部和向内延伸到中央通道中的突起。在此类方面中，外管的管状近侧区段限定狭槽，并且内衬套限定切口，该切口构造成当内衬套置于其中时与管状近侧段的狭槽轴向对齐。在此类方面中，所述外管的狭槽和所述内衬套的切口构造成协作以在所述轴组件插入所述壳体的远侧开口部中时容纳所述壳体的突起以使所述轴组件与所述手柄组件可释放地接合。
在本公开的又一方面，内传动组件包括具有近侧颈部的近侧柱塞。在此类方面中，当所述轴组件与所述手柄组件可释放地接合时，所述近侧柱塞的近侧颈部构造成容纳在所述近侧传动构件的远端部内，以可操作地联接所述内传动组件和所述近侧传动构件。
在本公开的实施例中，近侧传动构件包括邻近其远端部的内套筒。在此类实施例中，所述内套筒构造为容纳所述内传动组件的近侧柱塞的近侧颈部，使得所述近侧推杆可移动以延伸穿过所述近侧传动构件并穿过所述内传动组件的近侧柱塞，以接合所述夹盒组件的远侧推动器。
在本公开的另一方面，近侧传动构件包括构造成可滑动地支撑近侧推杆的腔。在此类方面中，所述内传动组件的近侧柱塞包括轮毂腔，其构造成当所述近侧柱塞的近侧颈部置于所述近侧传动构件的内套筒内时，与所述近侧传动杆的腔连通，使得所述近侧推杆可移动以延伸穿过所述近侧传动构件的腔并穿过所述内传动组件的近侧柱塞的轮毂腔，以接合所述夹盒组件的远侧推动器。
在本公开的又一方面，所述手柄组件包括一对可枢转地联接至所述外壳和从其相对侧延伸的手柄。
在本公开的实施例中，所述手柄组件还包括构造成将所述一对手柄可枢转地联接到内致动组件的连杆组件。在此类方面中，所述连杆组件包括第一连杆臂，构造成将所述一对手柄中的第一手柄可操作地联接至所述近侧传动构件，和第二连杆臂，构造成将所述一对手柄中的第二手柄可操作地联接到所述近侧推杆。在此类方面中，在所述一对手柄朝向接近位置移动时，第一连杆臂构造成向远侧移动近侧传动构件，而第二连杆臂构造成向近侧移动近侧推杆。在此类方面中，在所述一对手柄朝向间隔位置移动时，第一连杆臂构造成向近侧移动近侧传动构件，而第二连杆臂构造成向远侧移动近侧推杆。
在本公开的多个方面中，所述连杆组件构造为在所述一对手柄移动时与所述近侧推杆同时移动所述近侧传动构件。
在本公开的另一方面，所述连杆组件还包括第三连杆臂，构造成将所述一对手柄中的第二手柄可操作地联接至所述近侧传动构件，和第四连杆臂，构造成将所述一对手柄中的第一手柄可操作地联接至所述近侧推杆。
在本公开的又一方面，所述第一连杆臂和所述第三连杆臂通过有孔延伸穿过其中的枢轴凸台联接至所述近端部。在此类方面中，所述近侧传动构件包括构造成与所述枢轴凸台的孔连通的腔，使得所述近侧推杆可移动以在所述一对手柄移动时延伸穿过所述枢轴凸台的孔并且穿过所述近侧传动构件的腔。
在本公开的又一方面，所述近侧推杆构造成在所述近侧推杆移动穿过所述枢轴凸台的孔并穿过所述近侧传动构件的腔时在所述第一连杆臂和所述第三连杆臂之间移动。
在本公开的实施例中，所述夹盒组件还包括构造成向近侧偏置所述远侧推动器的偏置构件。
在本公开的多个方面中，所述夹盒组件还包括盒壳，其具有构造为支撑所述远侧推动器的至少一部分的支撑基座。在此类方面中，所述支撑基座包括远侧桥部和近侧桥部，其中所述盒组件的偏置构件可操作地联接至所述远侧推动器和所述近侧桥部，以向远侧偏置所述远侧推动器。
在本公开的另一方面，夹盒组件还包括夹载体，其包括一对接合凸缘。在此类方面中，所述盒壳包括一对沿所述盒壳的至少一部分长度纵向延伸的内部凹槽。在此类方面中，所述一对内部狭槽构造成分别横向容纳所述一对接合凸缘，以防止所述夹载体相对于所述盒壳的轴向移动。
在本公开的又一方面，所述夹盒组件还包括近侧邻近所述夹载体的近端部布置的载体锁，所述载体锁包括一对相对臂，其构造成偏置接合所述盒壳的一对相对内壁。在此类方面中，载体锁构造成防止所述夹载体相对于所述盒壳向近侧移动超过载体锁。
附图说明
根据本公开内容参考附图提供了可重复使用的多发手术施夹器的多个方面和特征，其中：
图1是根据本公开提供的可重复使用的多发手术施夹器的顶部透视图，以组装状态示出，其手柄组件处于间隔位置；
图2是图1的手术施夹器的俯视图，其手柄组件处于接近位置；
图3是图1的手术施夹器的夹盒组件的正面透视图，其中部件是分开的；
图4是图3的手术施夹器的夹盒组件的俯视图；
图5是图4的夹盒组件的仰视图；
图6A是跨过图4的剖面线“6A-6A”截取的横截面视图；
图6B是图5中标记为“6B”的细节区域的底部透视图，其部件以虚线示出以说明其内部特征；
图6C是图1中标记为“6C”的细节区域的顶部透视图，其部件以虚线示出以说明其内部特征；
图7是跨过图4的剖面线“7-7”截取的纵向横截面视图；
图8是图7中标记为“8”的细节区域的放大、纵向横截面视图；
图9是图7中标记为“9”的细节区域的放大、纵向横截面视图；
图10是图1的手术施夹器的轴组件的顶部透视图，其部件以虚线示出以说明轴组件的内部特征；
图11是图10的轴组件的侧视图；
图12是图10的轴组件的俯视图；
图13是跨过图12的剖面线“13-13”截取的纵向横截面视图；
图14是图13的轴组件的顶部透视图，其中部件是分开的；
图15是图1的手柄组件的顶部透视图，移除了壳体部分以说明其中的内部部件并且部件以虚线示出以说明手柄组件的内部特征；
图16是图1的手术施夹器的正面透视图，移除了夹盒组件并且部件以虚线示出以说明手术施夹器的内部特征；
图17A是跨过剖面线“17A-17A”截取的图16中表示为“17A”的细节区域的放大横截面视图，其棘轮组件处于第一位置；
图17B是跨过剖面线“17B-17B”截取的图16中表示为“17B”的细节区域的放大横截面视图，其棘轮组件处于第二位置；
图18和19是顶部视透视图，说明了图3的夹盒组件与图10的轴组件的接合；
图20是跨过图1的剖面线“20-20”截取的纵向横截面视图；
图21是图1的手术施夹器的远侧部分的俯视图；
图22是图1的手术施夹器的远侧部分的放大、正面透视图，其部件以虚线示出以说明手术施夹器的内部特征；并且
图23是构造成根据本公开使用的机器人手术系统的示意图。
具体实施方式
下面参考附图详细描述根据本公开的可重复使用的多发手术施夹器，其中相同的参考数字标识相似或相同的结构元件。如附图所示并且如以下描述全篇所述，如在提及手术器械上的相对定位时一样传统地，术语“近侧”是指装置或其部件更靠近使用者的端部而术语“远侧”是指装置或其部件更远离使用者的端部。
现在参考图1和图2，根据本公开的实施例的手术施夹器通常表示为10。手术施夹器10包括手柄组件100，从手柄组件100向远侧延伸的轴组件200，以及安装在轴组件200内的夹盒组件300。轴组件200与手柄组件100可拆卸且可选择性地接合，并且夹盒组件300可拆卸且可选择性地安装在轴组件200内。手柄组件100和轴组件200可构造为可消毒、可重复使用的部件，而夹盒组件300可构造为单程使用部件。如下面详细描述的，将手术夹堆叠“C”(图3)装载到夹盒组件300中，以便在操作中，每次致动手柄组件100使手柄组件100、轴组件200和夹盒组件300的协作传动部件致动以在体管或其它组织周围，从手术夹堆叠“C”(图3)发射并形成单个手术夹，以连接体管或其它组织。
参考图3-9所示，夹盒组件300包括盒壳或壳体310、夹载体320、夹随动件330、远侧推动器340、滑块350、第一偏置构件360、第二偏置构件370、载体锁380和手术夹堆叠“C”。
参考图3、图6A和6B，盒壳310包括上壳体部310a、下壳部310b，以及沿盒壳310的长度在其远端部和近端部之间延伸的内腔312。盒壳310可以至少部分由透明材料例如透明塑料形成，以便能够对其内腔312可视化。盒壳310包括一对内部凹槽314a、314b，其沿盒壳310长度的至少一部分在其相对内壁311a、311b上纵向延伸。该对内部凹槽314a、314b构造成如下面将详细描述的那样，当夹载体320和载体锁380置于盒壳310的内腔312内时保持夹载体320和载体锁380。盒壳310的内腔312还构造成容纳夹随动件330、远侧推动器340、滑块350、第一偏置构件360、第二偏置构件370和其中的手术夹堆叠“C”的至少一部分。
参考图3-6A，盒壳310的上壳部分310a包括在其中形成并且构造成可滑动地容纳滑块350的盖部352的窗口316。盒壳310包括从其侧面横向延伸到近侧窗口316中的突起317。滑块350的盖部352限定了在其侧面上限定的更近侧定位的凹部353a和在其同一侧上限定的更远侧定位的凹部353b。更近侧定位的凹部353a构造成容纳盒壳310的突起317，以将滑块350可释放地保持在相对于盒壳310的远侧位置。在相对于盒壳310向近侧充分推动滑块350的盖部352时，盒壳310的突起317从滑块350的盖部352的更近侧定位的凹部353a移出，使得滑块350能够向近侧滑动通过窗口316。一旦滑块350向近侧充分滑动，突起317就接合在滑块350的盖部354的更远侧定位的凹部353b内，从而将滑块350可释放地保持在相对于盒壳310的近侧位置。下文详细描述滑块350的近侧和远侧位置。
继续参考图3-6A，盒壳310的下壳部分310b包括支撑基座313，其构造成当远侧推动器置于盒壳310的内腔312内时封闭并支撑远侧推动器340的至少一部分(图5)。支撑基座313包括在盒壳310的侧面之间延伸并且与之联接的第一或远侧桥部313a和第二或近侧桥部313b。在实施例中，第一和第二桥部313a、313b纵向间隔开，并且远侧推动器340的至少一部分置于其上。第二桥部313b包括孔径或狭槽313c，其构造成容纳第二偏置构件370的近端部372，从而如下面将进一步详述的那样，相对于盒壳310固定第二偏置构件370的近端部372。在实施例中，盒壳310的下壳部分310b可包括多于两个桥部或者可完全封闭。
参考图3、6A和6B，夹盒组件300的夹载体320包括底板324和一对侧壁326a、326b，侧壁沿底板324的相对侧纵向延伸，使得夹载体320限定大致呈U形的构造。夹载体320包括一对接合凸缘322a、322b，其构造成分别与盒壳310的相对内壁311a、311b的一对内部凹槽314a、314b接合。具体地，成对接合凸缘322a、322b分别从一对侧壁326a、326b侧向延伸，并且置于盒壳310的一对内部凹槽314a、314b内，以防止夹载体320相对于盒壳310轴向移动。
如图6B和6C所示，载体锁380包括主体382，其具有中央臂384a，置于中央臂384a的相对侧面上并从其向外偏置的一对侧臂384b、384c，以及折叠在主体382的近侧端部下面和下方的一对腿部386a、386b。每个侧臂384b、384c分别包括从其向外延伸的柄脚388a、388b。盒壳310的内腔312构造成容纳载体锁380，使得一对侧臂384b、384c分别可滑动地置于盒壳310的内部凹槽314a、314b内。盒壳310包括延伸穿过相对内壁311a、311b的一对狭槽318a、318b。一对狭槽318a、318b定位和构造成容纳分别从一对侧臂384b、384c向外延伸的一对柄脚388a、388b，以将载体锁380可释放地保持在盒壳310的内腔312内。
该对柄脚388a、388b中的每一个均包括相对于该对狭槽318a、318b的相应近侧部基本平行的近侧部389a和相对于该对狭槽318a、318b的相应远侧部成角度的远侧部389b。可以考虑到，在载体锁380相对于盒壳310向近侧移动期间，该对柄脚388a、388b的每个近侧部分389a与该对狭槽318a、318b的相应近侧部分之间的平行关系将导致对接接合，防止载体锁380的一对柄脚388a、388b从盒壳310的内腔312的一对狭槽318a、318b内意外释放。此外，可以考虑到，在载体锁380相对于盒壳310向远侧移动期间，一对柄脚388a、388b的每个远侧部分389b与一对狭槽318a、318b的相应远侧部分之间的成角度关系将导致凸轮接合，以使得载体锁380的一对柄脚388a、388b能够从盒壳310的内腔312的一对狭槽318a、318b内释放。
继续参考图6B，当夹载体320置于盒壳310内时，如上所述，载体锁380构造成向近侧邻近夹载体320的近端部定位，使得载体锁380的中央臂384a与之呈对接关系布置。在该位置，由于载体锁380通过一对柄脚388a、388b和一对狭槽318a、318b之间的接合可滑动地保持在内腔312内，因此阻止夹载体320向近侧移动超过载体锁380的中央臂384a。以这种方式，夹载体320保持在盒壳310的内腔312内。
另外参考图6C，载体锁380的一对腿部386a、386b折叠在主体382的近端部的下面和下方，以限定之间的角度“α”。在实施例中，角度“α”小于90度。这样有效地形成了四杆连杆机构，提供了更容易的清洁和消毒，所有这些都在具有更少零件的更加坚固的设计中。当盒组件300置于轴组件200内时，如下面将详细描述的那样，载体锁380的一对腿部386a、386b构造成由轴组件200的远侧传动杆242的基座243a支撑。
另外参考图7-9所示，夹载体320还包括弹性中央柄脚328，其从底板322朝夹载体320的远端部分向上延伸。弹性中央柄脚328构造成接合手术夹堆叠“C”的最远侧手术夹“C1”的后跨部，以将手术夹堆叠“C”保持在夹载体320内。夹载体320还包括腿部329，腿部329从靠近其近端部的底板322的下侧下垂。
参考图3和8，夹盒组件300的夹随动件330包括远侧滑块332，其可滑动地置于夹载体320内，位于手术夹堆叠“C”的近侧。更具体地，夹随动件330的远侧滑板332构造成用于近侧邻近手术夹堆叠“C”的最近侧夹“C2”，与之呈对接关系定位。远侧滑板332还限定了穿过其中的一对狭槽333，如下所述。夹随动件330还包括从远侧滑板332向近侧延伸的细长杆334。细长杆334限定了与远侧滑板332接合的固定远端和可滑动地置于限定在滑块350的基部354内的内腔355中的自由近端。第一偏置构件360置于远侧滑板332和滑块350的基部354之间的夹随动件330的细长杆334周围，以便使远侧滑板332向远侧偏置进入和靠在手术夹堆叠“C”中的最近侧夹“C2”上，从而使手术夹堆叠“C”向远侧偏置。在实施例中，第一偏置构件360可以采用螺旋弹簧、恒力弹簧、动力弹簧或另一合适的偏置元件的形式。
参考图3、5和8，夹盒组件300的远侧推动器340可滑动地置于夹载体320的下侧周围，与夹随动件330相对。远侧推动器340包括在其远端部的一对推动器凸缘342，其构造成在夹载体320的弹性中央柄脚328上向远侧推动手术夹堆叠“C”的最远侧手术夹“C1”并且从夹盒组件300向远侧推进钳口238(图10)。远侧推动器340还包括邻近其近端部限定的近侧狭槽344，该近侧狭槽344构造成可滑动地容纳夹载体320的腿部329，以保持远侧推动器340和夹载体320彼此对齐，同时允许远侧推动器340相对于夹载体320纵向滑动。具体地，容许远侧推动器340相对于夹载体320纵向滑动，直到夹载体320的腿部329对接远侧推动器340的近侧狭槽344的近端部或远端部。
远侧推动器340还包括在远侧推动器340的中间部分处从其下侧下垂的凸缘或突片346。突片346构造成容纳第二偏置构件370的远端部374，使得第二偏置构件370的远端部374相对于远侧推动器340固定。由于第二偏置构件370的远端部374相对于远侧推动器340固定，并且其近端部372相对于盒壳310固定(通过第二桥部313b的狭槽313c，如上所述)，第二偏置构件370用于使远侧推动器340相对于盒壳310向近侧偏置，从而相对于夹载体320和手术夹堆叠“C”偏置。
远侧推动器340另外包括置于其近端部的面向近侧的推动器表面348。面向近侧的推动器表面348可以是近侧延伸部349的一部分，近侧延伸部349与远侧推动器340整体形成并且折叠在其近端部下面和下方以限定面向近侧的推动器表面348。
参见图3、7和8，夹盒组件300的滑块350包括基部354和置于基部354上的盖部352。如以上所详述，盖部352构造成可滑动地容纳在盒壳310的窗口316内，并且可释放地接合在其中的近侧位置或远侧位置。在远侧位置，滑块350的基部354不向近侧延伸超过盒壳310的近端部。在近侧位置，基部354向近侧延伸超过盒壳310的近端部。如以下所详述，滑块350在远侧位置和近侧位置之间的移动使得夹盒组件300能够在轴组件200内选择性地锁定和解锁(图1)。
如上所述，滑块350的基部354限定了纵向延伸穿过其中的腔355。腔355构造成可滑动地容纳夹随动件330的细长杆334，如图7和8所示。滑块350的盖部352可以限定带纹理的(例如带凹槽的)上表面356，以利于抓握滑块350的盖部352以使滑块350在近侧和远侧位置之间滑动。
继续参考图3，如以上所详述的手术夹堆叠“C”支撑在夹载体320内，其夹子以从头到尾的方向布置。手术夹堆叠“C”的每个手术夹均包括通过后跨部互连的一对腿部。在一些实施例中，手术夹堆叠“C”包括位于最近侧夹“C2”近侧的锁定夹“LC”(图22)。锁定夹“LC”形成为实心盘并且可以经区别性标记和/或着色。以这种方式提供锁定夹“LC”使得使用者能够通过盒壳310观察锁定夹“LC”的位置来从视觉上确定或至少估计剩余手术夹的数量。如果载入钳口238(图23)中，则锁定夹“LC”也用作锁定装置，如以下所详述。
参见图10-14，轴组件200包括外管210、内套筒或衬套220、钳口组件230和内传动组件240。外管210包括远端开口部212、近端开口部214，分别在远端开口部和近端开口部212、214之间延伸并与之连通的腔216，以及通过外管210的侧壁限定并与内腔216连通的细长切口218。外管210还包括从远端开口部212向远侧延伸的钳口支撑构件211。在实施例中，钳口支撑构件211从外管210下部向远侧朝外管210上部延伸，以限定支撑表面211a。细长切口218与外管210的远端开口部212间隔开，使得外管210限定置于细长切口218远侧的管状远侧段219a。简要参考图22，在实施例中，外管210的管状远侧段219a可以包括标记“I”，该标记“I”构造成使得使用者能够通过盒壳310观察锁定夹“LC”的位置来从视觉上确定或至少估计剩余手术夹的数量。细长切口218也与外管210的近端开口部214间隔开，使得外管限定置于细长切口218近侧的管状远侧段219b。管状近端区段219b包括凹槽或狭槽219c，其构造成接合手柄组件100(图16)以选择性地联接轴组件200和手柄组件100，如下所述。在实施例中，管状近侧区段219b可包括多于一个狭槽219c(图11)。管状近侧段219b还包括窗口219d，窗口219d穿过其形成并构造成用于容纳手柄组件100的棘轮组件的棘轮爪146(图16)，如下所述。在实施例中，管状近侧区段219b可包括穿过其相对侧面形成的多于一个窗口219d(图12)。
参考图13和14，内衬套220置于外管210的管状近侧区段219b内。内衬套220包括开口远端222、开口近端224，分别在开口远端和近端222、224之间延伸并与之连通的腔226，以及通过内衬套220侧壁限定并从开口远端222向近侧延伸的细长狭槽或切口228。在实施例中，内衬套220可包括一个以上的狭槽228。内衬套还包括穿过其相对侧形成的一个或多个窗口229(图10)。
当内衬套220置于外管210的管状近侧区段219b内时，外管210的一个或多个狭槽219c和内衬套220的一个或多个切口228的尺寸设计为并且对齐构造成接合手柄组件100(图16)以选择性地将外管210和轴组件200的内衬套220与手柄组件100联接，如下所述。进一步地，当内衬套220置于外管210的管状近侧区段219b内时，外管210的一个或多个窗口219d和内衬套220的一个或多个窗口229的尺寸设计为并且对齐构造成容纳手柄组件100的棘轮组件的棘轮爪146(图16)，如下所述。
参见图12和14，钳口组件230包括固定基座232和钳口部件236。固定基座232通过焊接或其它合适的方法固定在外管210内至其内表面。固定基座232包括近侧基部233、中央挡块234和远侧基部235。钳口部件236包括近侧轮毂237a、分叉颈部237b和一对钳口238，其中一个钳口附接到分叉颈部237b的每个分叉部分的自由远端。钳口部件236的近侧轮毂237a限定狭槽237c，狭槽237c构造成容纳固定基座232的中央挡块234，以将钳口部件236接合并固定维持在外管210内。在钳口部件236以这种方式围绕固定基座232接合的情况下，钳口238从外管210的开口远端212向远侧延伸。
钳口组件230的钳口238通过分叉颈部237b彼此偏置隔开。钳口238限定面向外侧的凸轮表面239a和面向内侧的通道239b。内传动组件240的远侧传动杆242构造成接合钳口238的凸轮表面239a并且朝向彼此推动钳口238，如下所述。钳口238的面向内侧的通道239b构造成从其中的手术夹堆叠“C”容纳手术夹的腿部，以在手术夹形成期间将手术夹保持在钳口238内，如下面还详述的。
继续参考图10-14所示，轴组件200的内传动组件240包括远侧传动杆242和近侧传动柱塞244。远侧传动杆242包括基座243a和一对侧壁243b，侧壁沿基座243a的相对侧纵向延伸，以便限定沿远侧传动杆242纵向延伸的内部通道243c。
内传动组件240的远侧传动杆242还包括盒状远端部243d和通过基部243a朝其盒状远端部243d限定的狭槽243e。远侧传动杆242可滑动地置于外管210的腔216内。远侧传动杆242的狭槽243e构造成可滑动地容纳钳口组件230的固定基座232，以使远侧传动杆242能够在外管210内和围绕固定基座232滑动。远侧传动杆242的盒状远端部243d构造成用于围绕钳口组件230的分叉颈部237b定位。在远侧传动杆242向远侧推进时，如下所述，远侧传动杆242的盒状远端部243d围绕钳口部件236向远侧推进，以围绕钳口238的凸轮表面239a进行凸轮带动，从而将钳口238朝向彼此推动。
当内衬套220置于外管210的管状近侧区段219b内时，内传动组件240的近侧传动柱塞244可滑动地置于内衬套220的腔226内。近侧传动柱塞244包括轮毂245，轮毂245具有有外径“D1”的远侧主体部分245a，具有小于远侧主体部分245a的直径“D1”的外径“D2”的近侧颈部245b，以及位于其中间部分的肩部245c，由从远侧主体部分245a的外径“D1”到近侧颈部245b的外径“D2”的过渡限定。
轮毂245包括邻近远侧主体部分245a的远端开口部246a，邻近近侧颈部245b的近端开口部246b，以及在远侧和近侧主体部分245a、245b之间延伸并分别与远端和近端开口部246a、246b连通的轮毂腔247。轮毂245的远端开口部246a与远侧传动杆242的内部通道243c的近端部接合，使得轮毂腔247与远侧传动杆242的内部通道243c连通。轮毂245还包括螺纹开口或孔249，其构造成容纳锁定螺钉250(图16)以可释放地固定远侧传动杆242和手柄组件100的外传动管142，如下所述。
钳口部件236和内传动组件240可从外管210移除，以便于再加工其各个部件以便重复使用。为了插入钳口部件236和内传动组件240以与外管210可操作地接合并且彼此可操作地接合，由其近侧轮毂237a引导的钳口部件236通过外管210的开口远端212向近侧插入，直到钳口部件236的狭槽237c在固定基座232的中央挡块234上方对齐。由开口远端222引导的内衬套220通过外管210的开口近端214从远侧插入并围绕外管210的管状近侧段219b向远侧滑动，直到内衬套220置于腔216内，使得外管210的一个或多个狭槽219c和内衬套220的一个或多个切口228各自轴向对齐，并且外管210的一个或多个窗口219d和内衬套220的一个或多个窗口229分别各自轴向对齐。接下来，由远侧传动杆242的盒状远端部分243d引导的内传动组件240通过外管210的开口近端214和内衬套220的开口近端224从远侧插入并且围绕钳口部件236向远侧滑动，直到远侧传动杆242的盒状远端部分243d被围绕钳口部件236的分叉颈部237b布置，使得钳口部件236的近端毂237a设置在远侧传动杆242的底座243a的槽243e上方，并且使得近侧传动柱塞244的轮毂245置于内衬套220的腔226内。
一旦内传动组件240和钳口部件236如上所述定位，钳口部件236的近侧轮毂237a可通过远侧传动杆242的基座243a的狭槽243e与固定基座232接合。更具体地，钳口部件236的近侧轮毂237a被推向固定基座232的中心块234，使得中心块234被容纳在钳口部件236的狭槽237c内。由于钳口部件236以这种方式与固定基座232接合，固定基座232至少部分地延伸通过远侧传动杆242的底座243a的槽243e，并且远侧传动杆242的盒装远端部分243d设置在钳口部件236的分叉颈部237b周围。因此，外管210、内衬套220、钳口部件236和内传动组件240可操作地彼此接合。当轴组件200如图10和13所示组装时，外管210的腔216、内衬套220的腔226和远侧传动杆242的轮毂腔247彼此连通以可滑动地容纳手柄组件100，如下所述。钳口部件236、内衬套220和内传动组件240从外管210脱离和移除以与以上述详述的插入和接合相反的方式实现。
参考图1和15，手柄组件100包括壳体110、一对手柄130、内致动组件140和连杆组件160。壳体110包括通过多个螺钉116彼此固定的上壳部112和下壳部114，但是也可以考虑其它合适的接合。每个壳部112、114还包括由内部零件限定的一对枢轴凹槽117，例如内部弧形壁119。每个枢轴凹槽117具有基本上呈“V”形的构造，其具有锥形远端部117a和开口近端部117b。每个枢轴凹槽117包括与开口近端部117b相邻的宽度“W1”，该宽度“W1”朝其锥形远端部117a逐渐减小。枢轴凹槽117构造成使得一对手柄130能够分别围绕壳体110在间隔位置(图1)和接近位置(图2)之间移动。每个枢轴凹槽117的相应宽度“W1”和每个手柄130的宽度“W2”被构造成至少部分地协作限制一对手柄130的移动超过预定的最大间隔位置和超过预定的最大接近位置。
继续参考图1和15，壳体110包括远侧开口部126a，其构造成容纳穿过其中的轴组件200的近端部，以将轴组件200与手柄组件100可释放地接合，如下所述。远侧开口部126由上壳部112和下壳部114的配合口部形成，并限定中央通道118。壳体110还包括由上壳部112和下壳部114的配合部分形成的近端开口部126b。中央通道118在远端开口部126a和近端开口部126b之间延伸并与之连通。
上壳部和下壳部112、114中的至少一个包括邻近远侧开口部126a并且向内径向延伸到中央通道118中的突片或突起128(图15)。突起128构造成分别可释放地接合管状近侧段219b的狭槽219c(图14)和内衬套220的切口228(图14)，使得外管210和内衬套220是可释放地固定到壳体110，以将轴组件200与手柄组件100可释放地接合，如下所述。
此外，参考图15、17A和17B，上壳部和下壳部112、114中的至少一个包括在其中形成的一个或多个棘轮爪狭槽或凹槽127。棘轮爪凹槽127具有基本上呈三角形的轮廓并且由壳体110的内部零件，例如一对凹槽壁129a限定。每个棘轮爪凹槽127还包括限定在一对凹槽壁129a之间的内角中的枢轴孔129b。每个棘轮爪凹槽127构造成可枢转地支撑棘轮组件的棘轮爪146，如下面将详细描述的。
参考图15，手柄组件100的手柄130可枢转地联接到壳体110并从其相对侧向外延伸。更具体地，每个手柄130包括位于其远端部的枢轴孔132和位于其近端部的指环134。手柄130的每个远端部置于壳体110的相应枢轴凹槽117内，使得多个螺钉116延伸穿过上壳部和下壳部112、114中的至少一个并且穿过枢轴孔132以使得手柄130能够相对于壳体110在间隔位置和接近位置之间枢转。指环134便于操纵手柄130以在间隔和接近位置之间枢转手柄130。
继续参考图15，内致动组件140包括近侧传动构件，例如外传动动管142，具有棘轮架144和一对棘轮爪146的棘轮组件，近侧推杆148以及近侧偏置构件150。
外传动管142的至少一部分可滑动地置于壳体110内。外传动管142包括主体部分143，主体部分143具有邻近其远端部的内套筒143a，置于其近端部的近侧套环143b，从近侧套环143b向近侧延伸的基本平坦的安装部143c，以及在主体部分143的远端部和近端部之间纵向延伸，与内套筒143a和安装部143c连通的腔143d。
参考图15、17A和17B，内套筒143a从其远端部向近侧延伸穿过主体部分143，并包括置于主体部分143内的近侧套筒壁141。近侧套筒壁141包括与主体部分143的腔143d连通的开口或孔径141a，使得内套筒143a与主体部分143的腔143d连通。在操作中，内套筒143a构造成可滑动地容纳轴组件200的内传动组件240的近侧传动柱塞244的轮毂245。在实施例中，内套筒143a包括螺纹开口或孔141b，其构造成当轮毂245置于内套筒143a内时与轮毂245的孔249轴向对齐。内套筒143a的孔141b和轮毂245的孔249构造成配合以容纳锁定螺钉250(图16)以可移动地联接远侧传动杆242和外传动管142。当轮毂245置于主体部分143的内套筒143a内时，轮毂腔247构造成与主体部分143的腔143d连通，使得近侧推杆148可移动以相对于其呈可滑动关系延伸穿过主体部分143的腔143d，以相对于其呈可滑动关系并且从轮毂245向远侧穿过轮毂245的轮毂腔247，如下面将详细描述的那样。
继续参考图15、17A和17B，棘轮组件的棘轮架144朝主体部分143的远端部固定支撑在外传动管142上，并限定沿其相对侧延伸的第一和第二组齿145。第一和第二组齿145中的每一组分别在置于主体部分143的相对侧上的第一和第二组远侧和近侧架间隙147a、147b之间纵向延伸。
第一和第二组齿145构造成分别接合第一和第二棘轮爪146。每个棘轮爪146都具有基本上呈三角形的轮廓，具有远侧齿146a、近侧齿146b，以及限定在离棘轮架144最远的棘轮爪146的远程角落处的枢轴构件或柱146c。每个棘轮爪146的枢轴柱146c构造成容纳在棘轮爪凹槽127的相应枢轴孔129内，使得每个棘轮爪146可枢转地支撑在壳体110的相应棘轮爪凹槽127内。在操作中，棘轮爪146构造成在第一位置(图17A)和第二位置(图17B)之间切换。如图17A所示，在棘轮爪146的第一位置，邻近远侧齿146a的第一棘轮爪壁与邻近远侧齿146a的第一凹槽壁129a对接或接合，并且近侧齿146b与棘轮架144的齿145接合或对齐，直到近侧齿146b容纳在远侧架间隙147a内，其中棘轮爪146的方向翻转以能够朝向第二位置切换。如图17B所示，在棘轮爪146的第二位置，邻近近侧齿146b的第二棘轮爪壁与邻近近侧齿146b的第二凹槽壁129a对接或接合，并且远侧齿146a与棘轮架144的齿145接合或对齐，直到远侧齿146a容纳在近侧架间隙147b内，其中棘轮爪146的方向翻转以使得能够切换回第一位置。可以考虑到，棘轮爪146相对于棘轮架144的第一和第二组齿145可操作地定位，以向内致动组件140提供棘轮功能，如下面将详细描述的。可以考虑到，棘轮爪146和棘轮架144的棘轮功能构造成提供可听见的咔哒声和/或触觉振动，指示手柄130通过致动或返回行程移动。在实施例中，棘轮爪146和棘轮架144的棘轮功能进一步提供了安全机构，以避免部分夹无意形成和部分形成的夹的无意发射。
在操作中，当释放手柄130时，四杆连杆机构将自动倾向于翻转棘轮爪146的方向。
继续参考图15，近侧偏置构件150置于外传动管142的主体部分143周围。近侧偏置构件150的远端部152a对接壳体110的近侧壁，邻近其近端开口部126b，而近侧偏置构件160的近端部对接外传动管142的主体部分143的近侧套环143b。以这种方式，提供近侧偏置构件150以朝向其最近侧位置向近侧偏置外传动管142，如下面将详细描述的。这样，近侧偏置构件150用于将一对手柄130相对于壳体110(图1)朝间隔位置偏置，如下面将详细描述的。
手柄组件100还包括连杆组件160，其构造成将手柄130可枢转地联接到内致动组件140。连杆组件160包括第一连杆臂162、第二连杆臂164、第三连杆臂166和第四连杆臂168。第一和第二连杆臂162、164中的每一个在其第一端部处通过第一枢轴凸台161a可枢转地联接到一个手柄130的中间部，并且第三和第四连杆臂166、168中的每一个在其第一端部处通过第二枢轴凸台161b可枢转地联接到另一个手柄130的中间部。第一和第四连杆臂162、168中的每一个通过第三枢轴凸台161c在内部可枢转地联接在邻近主体143的近端部的外传动管142的安装部143c处。第二和第三连杆臂164、166中的每一个在内部通过第四枢轴凸台161d在其第二端部处可枢转地联接到邻近推杆148近端部的推动器支架148a。如图15所示，第三枢轴凸台161c包括延伸穿过其中并构造成与外传动管142的腔143d连通的孔163。在操作中，近侧推杆148在第一和第四连杆臂162、168之间延伸，穿过第三枢轴凸台161c的孔163，与之呈可滑动关系，并且穿过外传动管142的腔143d向远侧延伸。
在实施例中，第一、第二、第三和第四连杆臂162、164、166和168设置成使得手柄130的中间部、外传动管142的安装部143c和近侧推杆148的推动器支架148a中的每一个如上所述夹在第一、第二、第三和第四连杆臂162、164、166和168的相应部分之间。在实施例中，第一、第二、第三和第四枢轴凸台161a、161b、161c和161d中的每一个包括锁定元件165，其构造成阻止第一、第二、第三和第四枢轴凸台161a、161b、161c和161d在如上所述组装连杆组件160时的轴向移动和无意释放。
参见图1、图2和图15，在操作中，手柄130相对于壳体110置于间隔位置，外传动管142置于最近侧位置，而近侧推杆148置于最远侧位置。随着手柄130朝向壳体110枢转，朝向接近位置，第一和第四连杆臂162、168向远侧推动外传动管142，并且第二和第三连杆臂164、166向近侧拉动近侧推杆148。可以考虑，当手柄130朝向接近位置枢转时，连杆组件160构造成与近侧推杆148同时移动外传动管142。在手柄130设置在相对于壳体110的接近位置(图2)的情况下，外传动管142设置在最远侧位置，而近侧推杆148设置在最近侧位置。
在上述手柄130向接近位置枢转期间，当外传动管142由连杆组件160的第一和第四连杆臂162、168向远侧推动时，近侧偏置构件150压缩在邻近其近端开口部126b的壳体110近侧壁与外传动管142的主体部分143的近侧套环143b之间。以这种方式，手柄130克服近侧偏置构件150的偏置而移动通过致动行程。如前所述，预定的最大接近位置至少部分地由壳体110的每个枢轴凹槽117的宽度“W1”分别与每个手柄130的宽度“W2”之间的配合来确定。
另外参考图17B，在上述手柄130朝接近位置枢转期间，棘轮爪146置于第二位置。具体地，当外传动管142和固定在其上的棘轮架144向远侧推动时，邻近近侧齿146b的第二棘轮爪壁与邻近近侧齿146b的第二凹槽壁129a对接或接合，并且远侧齿146a与棘轮架144的齿145接合或对齐以提供可听见的咔哒声和/或触觉振动，指示手柄130正移动通过致动行程。在手柄130到达接近位置时，远侧齿146a被容纳在近侧架间隙147b内，使得棘轮爪146的定向被翻转以使得能够朝第一位置切换(图17A)，并提供可听见的行程终止咔哒声和/或触觉振动。
在手柄130相对于壳体110朝向间隔位置(图1)释放或返回时，手柄130移动第一和第四连杆臂162、168以向近侧拉动外传动管142，并移动第二和第三连杆臂164、166以向远侧推动近侧推杆148。可以考虑，当手柄130朝向间隔位置枢转时，连杆组件160构造成与近侧推杆148同时移动外传动管142。在手柄130相对于壳体110设置在间隔位置的情况，外传动管142设置在最近侧位置，而近侧推杆148设置在最远侧位置。
在上述手柄130向间隔位置返回期间，手柄弹簧组件144的弹簧臂147与手柄接合，使得手柄130通过弹簧臂147的向外偏置移动通过返回行程。因此，手柄弹簧组件144的偏置构造成向近侧拉动外传动管142并向远侧推动近侧推杆148。如前所述，预定的最大间隔位置至少部分地由壳体110的每个枢轴凹槽117的宽度“W1”分别与每个手柄130的宽度“W2”之间的配合来确定。
另外参考图17A，在上述手柄130朝向间隔位置返回期间，棘轮爪146置于第一位置。具体地，当外传动管142和固定在其上的棘轮架144向近侧拉动时，邻近远侧齿146a的第一棘轮爪壁与邻近远侧齿146a的第一凹槽壁129a对接或接合，并且近侧齿146b与棘轮架144的齿145接合或对齐以提供可听见的咔哒声和/或触觉振动，指示手柄130正移动通过返回行程。在手柄130到达接近位置时，近侧齿146b被容纳在远侧架间隙147a内，使得棘轮爪146的定向被翻转以使得能够切换回第二位置(图17B)，并提供可听见的返回终止咔哒声和/或触觉振动。
现在转向图1、16、18和19，为了组装手术施夹器10以供使用，手柄组件100、轴组件200和夹盒组件300，如果没有预先组装，则单独组装，如上所述。此后，轴组件200与手柄组件100接合，如下所述。
参考图15-17B，为了使轴组件200与手柄组件100接合，轴组件200的近端部分向近侧插入壳体110的远侧开口部126a中。更具体地，轴组件200相对于手柄组件100向近侧移动，使得轴组件200的外管210的管状近侧段219b从近侧插入中央通道118中，直到轴组件200的近端部邻近壳体110的近侧内壁设置并且突起128分别容纳在内衬套220的管状近侧段219b的狭槽219c(图10)和切口228(图10)内，从而可释放地将轴组件200与手柄组件100接合。在该位置，外管210的窗口219d和内衬套220的窗口229轴向对齐并构造成配合以容纳穿过其中的手柄组件100的棘轮爪146。
在实施例中，如果壳体110是预组装的，则可以移除或松开多个螺钉116以使上壳部112和下壳部114间隔开，使得管状近侧段219b的狭槽219c(图10)和内衬套220的切口228(图10)可以与突起128对齐。一旦突起128容纳在管状近侧段219b的狭槽219c和内衬套220的切口228内，上壳部112和下壳部114就可通过多个螺钉116彼此固定。
在上述轴组件200的近端部插入壳体110的远端开口部126a期间，外传动管142的主体部分143的内套筒143a可滑动地容纳内传动组件240的轮毂245的近侧颈部245b，直到轮毂245的肩部245c定位在主体部分143的远端部附近，并且轮毂245的近端开口部246b定位在置于主体部分143内的近侧套筒壁141附近。由于远侧传动杆242的轮毂245的近侧颈部245b置于外传动管142的主体部分143的内套筒143a内，锁定螺钉250(图16)置于外部传动管142的内套筒143a的孔141b(图15)和轮毂245的孔249(图14)内以便可移动地联接远侧传动杆242和外部传动管142。
在这种构造中，置于外传动管142的腔143d内的近侧推杆148容纳在轴组件200的内传动组件240的近侧传动柱塞244的轮毂245的轮毂腔247内并且延伸穿过其中。
此外，如上所述，轴组件200与手柄组件100接合时，近侧推杆148相对于其呈可滑动关系延伸穿过外传动管142的主体143的腔143d，相对于其呈可滑动关系穿过轮毂245的轮毂腔247，并且从轮毂245的远端开口部246a向远侧延伸。一旦轴组件200与手柄组件100接合，夹盒组件300就可以接合在轴组件200内，如下所述。
参考图18和19所示，为了将夹盒组件300接合在轴组件200内，夹盒组件300的滑块350(如果尚未处于远侧位置)移动到远侧位置，其中滑块350的基部354不向近侧延伸超出盒壳310的近端部，并且其中滑块350的盖部352的更近侧定位的凹槽353a接合在盒壳310的突起317内，以将滑块350保持在远侧位置。
参考图18，滑块350处于远侧位置时，夹盒组件300通过轴组件200的外管210的细长切口218并且相对于外管210从远侧插入，使得盒壳310的远端部钻到外管210的管状远侧段219a下方并延伸穿过腔216由外管210的管状远侧段219a限定的部分。在以这种方式定位盒壳310的远端部之后，夹盒组件300的其余部分通过细长切口218插入以安置在外管210的腔216内。
参见图7、8和19，一旦夹盒组件300完全安置在外管210的腔216内，盒壳310的远端部延伸穿过外管210的管状远侧段219a，滑块350就被推向近侧，使得盒壳310的突起317从滑块350的盖部352的更近侧定位的凹槽353a移出，滑块350通过窗口316向近侧滑动，并且突起317接合在滑块350的盖部352的更远侧定位的凹槽353b内以将滑块350保持在近侧位置。
在滑块350的近侧位置，滑块350的基部354向近侧延伸超过盒壳310的近端部并进入外管210的管状近侧段219b。因此，滑块350的基部354延伸到外管210的管状近侧段219b中并且盒壳310的远端部延伸穿过外管210的管状远侧段219a，夹盒组件300锁定接合在轴组件200内。夹盒组件300的脱离和移除以与上面详述的插入和接合相反的方式实现。
另外参考图2，在上述夹盒组件300插入轴组件200期间，手柄组件100的手柄130移动并保持在接近位置，尽管在滑块350移动期间不需要将手柄130保持在接近位置就能将夹盒组件300锁定在轴组件200内。
通过在将夹盒组件300插入轴组件200期间将手柄组件100的手柄130保持在接近位置，将近侧推杆148置于最近侧位置，使得近侧推杆148不会干扰夹盒组件300插入轴组件200中。相反，在其最近侧位置的近侧推杆148保持在夹盒组件300的远侧推动器340的面向近侧的推动器表面348的近侧。
参考图1、3、7-9、13和20所示，一旦夹盒组件300置于轴组件200内，手柄130就可以朝间隔位置(图1)释放或返回，使得近侧推杆148通过外传动管142的腔143d向远侧朝向近侧推杆148的最远侧位置移动。当近侧推杆148向远侧移动时，近侧推杆148的远端部被推到远侧推动器340的面向近侧的推动器表面348，从而向远侧推动远侧推动器340。当远侧推动器340向远侧移动时，其推动器凸缘342接合手术夹堆叠“C”的最远侧手术夹“C1”的后跨部，并且在夹载体320的弹性中央柄脚328上向远侧推动最远侧手术夹“C1”并且从夹盒组件300向远侧推进钳口238的面向内侧的通道239b中。因此，手术施夹器10在钳口238内装有手术夹并准备好使用(图9)。当手术夹堆叠“C”的最远侧夹装至钳口238中时，夹随动件330的滑板332在第一偏置构件360的偏置下向远侧推动手术夹堆叠中“C”的剩余夹子，使得每个夹子取得先前被其远侧相邻夹子占据的位置。
在使用中，一般参考图1、2、13和20-22，操纵手术施夹器10，使得待结扎的体管(或其它组织)置于钳口238之间。一旦达到该位置，手柄130就从间隔位置(图1)向接近位置(图2)移动。如上所述，当手柄130克服近侧偏置构件150的偏置朝接近位置移动时，向远侧推动外传动管142。向远侧推动外传动管142时，通过锁定螺钉250联接到外传动管142的近侧传动柱塞244又向远侧移动，从而向远侧推动远侧传动杆242。当远侧传动杆242向远侧推进时，远侧传动杆242的盒状远端部243d向远侧推进以围绕钳口238的凸轮表面239a进行凸轮带动，从而将钳口238朝彼此推动以在体管(或其它组织)周围形成其中装载的手术夹。
一旦在体管(或其它组织)周围形成手术夹，如由棘轮架144和棘轮爪146提供的行程结束指示所示，手柄130可朝间隔位置释放或返回，使得手术夹堆叠“C”的下一个最远侧手术夹“C1”载入钳口238中以便随后发射。可以重复上述手术施夹器10的使用，以从手术夹堆叠“C”中发射多个手术夹，直到只剩下锁定夹“LC”。
参考图1、21和22，一旦最近侧夹“C2”，即邻近锁定夹“LC”的远侧设置的手术夹，已经被发射并且手柄130朝间隔位置释放或返回，远侧推动器340就向远侧移动，使其推动器凸缘342与锁定夹“LC”的面向近侧的边缘接合，并将锁定夹“LC”从夹盒组件300向远侧推入钳口238的面向内侧的通道239b中。因为锁定夹“LC”形成为实心盘，所以当锁定夹“LC”置于它们之间时，阻止钳口238朝彼此移动。因此，阻止致动手柄130。此外，在夹盒组件300中没有夹子剩余的情况下，夹随动件330的滑板332在第一偏置构件360的偏置下移动到夹载体320的远端部。由于这种构造，当推动器凸缘342响应于手柄130朝间隔位置释放或返回而向近侧移动时，推动器凸缘342接合在夹随动件330的滑板332的狭槽333内以进一步阻止手柄130后续致动。因此，阻止了手术施夹器10无夹发射。
本公开考虑到手术施夹器10能够在轴组件200内装载不同的手术夹盒组件300。具体地，手术施夹器10可装载有夹盒组件300，其具有特定尺寸和/或构造的手术夹堆叠“C”。例如，根据特定目的，具有第一尺寸的手术夹堆叠“C”的第一夹盒组件300或具有不同于第一尺寸的第二尺寸的手术夹堆叠“C”的第二夹盒组件300可以装入轴组件200中。另外，在外科手术过程中，如果需要使用不同尺寸和/或构造的手术夹，则使用者可以移除正在使用的夹盒组件300以利于不同的夹盒组件300。
本公开还考虑了一种手术套件，其包括手柄组件100、轴组件200，以及一个或多个夹盒组件300(彼此相似或不同)。该套件还可以包括组装手术施夹器10，使用手术施夹器10，和/或在使用后再加工手术施夹器10的可重复使用部件的说明书。还可以提供包装、容器或盒子。
本文描述的诸如施夹器或其部件的手术器械还可以构造成与机器人手术系统一起工作，并且通常称为“远程手术”。此类系统采用各种机器人元件来辅助外科医生并允许对手术器械的远程操作(或部分远程操作)。各种机器人臂、齿轮、凸轮、滑轮、电动和机械马达等可以用于此目的，并且可以设计有机器人手术系统以在操作或治疗过程中辅助外科医生。此类机器人系统可以包括远程可操纵系统、自动柔性手术系统、远程柔性手术系统、远程关节连接手术系统、无线手术系统、模块化或可选择性构造的远程操作手术系统等。
机器人手术系统可以与一个或多个控制台一起使用，所述控制台紧邻手术室或位于远程位置。在这种情况下，一组外科医生或护士可以为患者准备进行手术并且为机器人手术系统配置本文公开的一种或多种器械，而另一名外科医生(或另一组外科医生)通过机器人手术系统远程控制该器械。正如可以认识到的那样，高度熟练的外科医生可以进行多个场所的多个操作而无需离开他/她的远程控制台，这既在经济上有利，又对患者或一系列患者有益。
手术系统的机器人臂通常通过控制器联接到一对主手柄。手柄可由外科医生移动以产生任何类型的手术器械(例如，末端效应器、抓握器、刀、剪刀等)的工作端的相应移动，这可以补充本文所述一个或多个实施例的使用。可以缩放主手柄的移动，使得工作端具有与由外科医生的操作手所进行的移动不同、更小或更大的相应移动。比例因子或传动比可以是可调节的，以便操作者可以控制手术器械工作端的分辨率。
主手柄可以包括各种传感器，以向外科医生提供与各种组织参数或条件有关的反馈，例如，由于操纵、切割或以其它方式处理产生的组织阻力，由仪器施加到组织上的压力，组织温度、组织阻抗等。正如可以认识到的那样，此类传感器为外科医生提供了模拟实际操作条件的增强的触觉反馈。主手柄还可以包括各种不同的致动器，用于精细的组织操纵或治疗，进一步增强外科医生模拟实际操作条件的能力。
参考图23，医疗工作站总体上示为工作站1000，且大体上可包括：多个机械臂1002、1003；控制装置1004；以及与控制装置1004联接的操作控制台1005。操作控制台1005可包括：显示装置1006，其特别设置为显示三维图像；以及手动输入装置1007、1008，个人(未示出)例如外科医生，能够借助于手动输入装置远程操纵机器人臂1002、1003。
正如下面将更详细地描述的那样，根据本文公开的若干实施例中的任何一个，每个机器人臂1002、1003可包括多个通过关节连接的构件，以及附接装置1009、1011，例如支撑末端效应器1100的手术工具“ST”可与之附接。
机械臂1002、1003可由连接到控制装置1004的电力传动装置(未示)传动。控制装置1004(例如，计算机)可以设置为激活传动装置，尤其是借助于计算机程序，其方式是使得机器人臂1002、1003，其附接装置1009、1011以及因此手术工具(包括末端效应器1100)根据通过手动输入装置1007、1008限定的移动来执行所需移动。还可设置控制装置1004，其方式使得所述控制装置调节机械臂1002、1003和/或传动装置的移动。
医疗工作站1000可以被构造用于在躺在患者台1012上的患者1013上使用，以通过末端效应器1100以微创方式进行治疗。医疗工作站1000还可包含多于两个机械臂1002、1003，额外的机械臂同样连接到控制装置1004且通过操作控制台1005远距离操控。医疗器械或手术工具(包括末端效应器1100)也可以附接到附加机器人臂。医疗工作站1000可包含确切地说联接到控制装置1004的数据库1014，所述数据库中存储例如来自患者/生物体1013和/或解剖图谱的术前数据。
本文参考美国专利8,828,023号，其全部内容通过引用并入本文，以更详细地讨论示例性机器人手术系统的构造和操作。
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方案、修改和变化。参考附图描述的实施例仅用于证明本公开的某些实例。与上文所描述的和/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 (20)
1.一种可重复使用的手术施夹器，其包括：
手柄组件，包括：
壳体；
从所述壳体延伸并可相对于所述壳体在间隔位置和接近位置之间移动的至少一个手柄；和
从所述壳体延伸并且可操作地联接到所述至少一个手柄的内致动组件，所述内致动组件包括：
可移动通过所述壳体的近侧传动构件；
可移动通过所述近侧传动构件的近侧推杆，其中所述至少一个手柄相对于所述壳体的移动构造成在相对相反的方向上移动所述近侧传动构件和所述近侧推杆；和
置于所述近侧传动构件周围、介于所述壳体的近端部与所述近侧传动构件的近端部之间的近侧偏置构件，所述近侧偏置构件具有构造为使所述近侧传动构件向近侧移动以使得所述近侧推杆向远侧移动的偏置；
与所述手柄组件可释放地接合的轴组件，所述轴组件包括：
外管；
支撑在所述外管远端部的钳口组件；和
内传动组件，其可滑动地置于所述外管内并且可操作地联接至所述钳口组件，使得所述内传动组件通过所述外管的远侧移动使所述钳口组件致动；和
可释放地接合在所述轴组件内的夹盒组件，所述夹盒组件将手术夹堆叠保持在其中并且包括可操作地联接至手术夹堆叠中最远侧的手术夹的远侧推动器，使得当所述夹盒组件可释放地接合在所述轴组件内时，所述远侧推动器的远侧移动将所述最远侧的手术夹载至所述钳口组件内，
其中，当所述轴组件可释放地与所述手柄组件接合，并且所述夹盒组件可释放地接合在所述轴组件内时：
所述近侧传动构件近侧邻近所述内传动组件定位，使得所述至少一个手柄朝所述接近位置的移动使所述钳口组件致动，并且
所述近侧推杆近侧邻近所述远侧推动器定位，使得所述至少一个手柄朝间隔位置的移动将所述最远侧的手术夹载至所述钳口组件中。
2.根据权利要求1所述的可重复使用的手术施夹器，其中所述壳体包括至少一个内部零件，其限定构造成可移动地容纳所述至少一个手柄的远端部的枢轴凹部，所述枢轴凹部和所述至少一个手柄的尺寸和构造设计成协作以限制所述至少一个手柄的移动超过预定的接近位置和超过预定的间隔位置。
3.根据权利要求1所述的可重复使用的手术施夹器，其中所述至少一个手柄朝所述接近位置的移动使所述近侧传动构件相对于所述近侧偏置构件的偏置，绕所述近侧推杆向远侧移动，并且使所述近侧推杆围绕并通过所述近侧传动构件向近侧移动，并且其中所述至少一个手柄朝所述间隔位置的移动使所述近侧传动构件在所述近侧偏置构件的偏置下绕所述近侧推杆向近侧移动，并且使所述近侧推杆围绕并通过所述近侧传动构件向远侧移动。
4.根据权利要求1所述的可重复使用的手术施夹器，其中所述手柄组件还包括棘轮组件，其具有至少一个可枢转地支撑在所述壳体内的棘轮爪和支撑在所述近侧传动构件的远端部上的棘轮架，其中所述至少一个棘轮爪相对于所述棘轮架可操作地定位，以向所述内致动组件提供棘轮功能。
5.根据权利要求4所述的可重复使用的手术施夹器，其中所述轴组件的外管包括穿过其管状近侧段形成的至少一个窗口，其中当所述轴组件与所述手柄组件可释放地接合时，所述外管的近侧段邻近所述棘轮组件定位，使得所述至少一个棘轮爪置于所述至少一个窗口内以接合所述棘轮架。
6.根据权利要求5所述的可重复使用的手术施夹器，其中所述轴组件还包括置于所述管状近侧段和所述内传动组件之间的内衬套，所述内衬套包括至少一个窗口，其构造为当所述内衬套置于其中时与所述管状近侧段的至少一个窗口对齐，使得所述至少一个棘轮爪置于所述管状近侧段的至少一个窗口和所述内衬套的至少一个窗口内以接合所述棘轮架。
7.根据权利要求6所述的可重复使用的手术施夹器，其中所述手柄组件的壳体包括限定中央通道的远侧开口部和向内延伸到所述中央通道中的突起，并且其中所述外管的管状近侧段限定狭槽并且所述内衬套限定切口，该切口构造成当所述内衬套置于其中时与所述管状近侧段的狭槽轴向对齐，所述外管的狭槽和所述内衬套的切口构造成协作以在所述轴组件插入所述壳体的远侧开口部中时容纳所述壳体的突起以使所述轴组件与所述手柄组件可释放地接合。
8.根据权利要求1所述的可重复使用的手术施夹器，其中所述内传动组件包括具有近侧颈部的近侧柱塞，其中当所述轴组件与所述手柄组件可释放地接合时，所述近侧柱塞的近侧颈部构造成容纳在所述近侧传动构件的远端部内，以可操作地联接所述内传动组件和所述近侧传动构件。
9.根据权利要求8所述的可重复使用的手术施夹器，其中所述近侧传动构件包括邻近其远端部的内套筒，所述内套筒构造为容纳所述内传动组件的近侧柱塞的近侧颈部，使得所述近侧推杆可移动以延伸穿过所述近侧传动构件并穿过所述内传动组件的近侧柱塞，以接合所述夹盒组件的远侧推动器。
10.根据权利要求9所述的可重复使用的手术施夹器，其中所述近侧传动构件包括构造成可滑动地支撑所述近侧推杆的腔，并且其中所述内传动组件的近侧柱塞包括轮毂腔，其构造成当所述近侧柱塞的近侧颈部置于所述近侧传动构件的内套筒内时，与所述近侧传动杆的腔连通，使得所述近侧推杆可移动以延伸穿过所述近侧传动构件的腔并穿过所述内传动组件的近侧柱塞的轮毂腔，以接合所述夹盒组件的远侧推动器。
11.根据权利要求1所述的可重复使用的手术施夹器，其中所述手柄组件包括一对可枢转地联接至所述外壳和从其相对侧延伸的手柄。
12.根据权利要求11所述的可重复使用的手术施夹器，其中所述手柄组件还包括构造为将所述一对手柄可枢转地联接至所述内致动组件的连杆组件，所述连杆组件具有第一连杆臂，构造成将所述一对手柄中的第一手柄可操作地联接至所述近侧传动构件，和第二连杆臂，构造成将所述一对手柄中的第二手柄可操作地联接到所述近侧推杆，其中所述一对手柄朝所述接近位置移动时，所述第一连杆臂构造成向远侧移动所述近侧传动构件而所述第二连杆臂构造成向近侧移动所述近侧推杆，并且其中所述一对手柄朝所述间隔位置移动时，所述第一连杆臂构造成向近侧移动所述近侧传动构件而所述第二连杆臂构造成向远侧移动所述近侧推杆。
13.根据权利要求12所述的可重复使用的手术施夹器，其中所述连杆组件构造为在所述一对手柄移动时与所述近侧推杆同时移动所述近侧传动构件。
14.根据权利要求12所述的可重复使用的手术施夹器，其中所述连杆组件还包括第三连杆臂，构造成将所述一对手柄中的第二手柄可操作地联接至所述近侧传动构件，和第四连杆臂，构造成将所述一对手柄中的第一手柄可操作地联接至所述近侧推杆。
15.根据权利要求14所述的可重复使用的手术施夹器，其中所述第一连杆臂和所述第三连杆臂通过有孔延伸穿过其中的枢轴凸台联接至近端部，并且其中所述近侧传动构件包括构造成与所述枢轴凸台的孔连通的腔，使得所述近侧推杆可移动以在所述一对手柄移动时延伸穿过所述枢轴凸台的孔并且穿过所述近侧传动构件的腔。
16.根据权利要求15所述的可重复使用的手术施夹器，其中所述近侧推杆构造成在所述近侧推杆移动穿过所述枢轴凸台的孔并穿过所述近侧传动构件的腔时在所述第一连杆臂和所述第三连杆臂之间移动。
17.根据权利要求1所述的可重复使用的手术施夹器，其中所述夹盒组件还包括构造成向近侧偏置所述远侧推动器的偏置构件。
18.根据权利要求17所述的可重复使用的手术施夹器，其中所述夹盒组件还包括盒壳，其具有构造为支撑所述远侧推动器的至少一部分的支撑基座，所述支撑基座包括远侧桥部和近侧桥部，其中所述盒组件的偏置构件可操作地联接至所述远侧推动器和所述近侧桥部，以向远侧偏置所述远侧推动器。
19.根据权利要求18所述的可重复使用的手术施夹器，其中所述夹盒组件还包括夹载体，其包括一对接合凸缘，并且其中所述盒壳包括一对沿所述盒壳的至少一部分长度纵向延伸的内部凹槽，所述一对内部狭槽构造成分别横向容纳所述一对接合凸缘，以防止所述夹载体相对于所述盒壳的轴向移动。
20.根据权利要求19所述的可重复使用的手术施夹器，其中所述夹盒组件还包括近侧邻近所述夹载体的近端部布置的载体锁，所述载体锁包括一对相对臂，其构造成偏置接合所述盒壳的一对相对内壁，其中所述载体锁构造成阻止所述夹载体相对于所述盒壳向近侧移动超过所述载体锁。
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| US10660723B2 (en) | 2017-06-30 | 2020-05-26 | Covidien Lp | Endoscopic reposable surgical clip applier |
| US10639032B2 (en) | 2017-06-30 | 2020-05-05 | Covidien Lp | Endoscopic surgical clip applier including counter assembly |
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| US11051827B2 (en) | 2018-01-16 | 2021-07-06 | Covidien Lp | Endoscopic surgical instrument and handle assemblies for use therewith |
-
2018
- 2018-09-26 US US16/142,197 patent/US10743887B2/en active Active
- 2018-11-08 AU AU2018260894A patent/AU2018260894A1/en not_active Abandoned
- 2018-12-04 JP JP2018227222A patent/JP2019103799A/ja not_active Ceased
- 2018-12-10 CN CN201811502465.1A patent/CN109907794A/zh active Pending
- 2018-12-12 EP EP18212043.6A patent/EP3498195B1/en active Active
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Also Published As
| Publication number | Publication date |
|---|---|
| AU2018260894A1 (en) | 2019-06-27 |
| EP3498195A1 (en) | 2019-06-19 |
| EP3498195B1 (en) | 2020-07-22 |
| US10743887B2 (en) | 2020-08-18 |
| JP2019103799A (ja) | 2019-06-27 |
| US20190175189A1 (en) | 2019-06-13 |
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