CN111031939A - 内窥镜外科手术施夹器和与其一起使用的手柄组件 - Google Patents
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Abstract
一种与外科手术器械一起使用的手柄组件包含限定接触壁的壳体、可移动手柄、柱塞、连杆和反馈机构。所述柱塞至少部分地安置在所述壳体内并限定纵向轴线。所述连杆将所述可移动手柄与所述柱塞互连,使得所述可移动手柄的致动导致所述柱塞相对于所述壳体纵向平移。所述反馈机构被配置成向用户提供听觉反馈,并且包含指示器卡扣线和由所述壳体的壁限定的轨道。所述卡扣线被配置成响应于所述柱塞的纵向平移而沿着所述轨道移动。所述卡扣线被配置成与所述壳体的所述接触壁接合,以在所述可移动手柄已经被致动预定量时产生用户可听到的声音。
Description
背景技术
技术领域
本公开涉及外科手术施夹器。更具体地说,本公开涉及具有手柄组件的内窥镜外科手术施夹器,所述手柄组件被配置成在致动其手柄时增强机械效益。
相关技术描述
内窥镜外科手术缝合器和外科手术施夹器是本领域已知的并且用于许多不同且有用的外科手术程序。在腹腔镜外科手术程序的情况下,通过穿过皮肤中的小入口切口插入的窄管或插管来实现进入腹部内部。在身体中的其它地方执行的微创程序通常被统称为内窥镜程序。典型地,管或插管装置通过入口切口延伸到患者的身体中以提供进入端口。所述端口允许外科医生使用套管针通过其插入许多不同的外科手术器械并且远离切口执行外科手术程序。
在这些程序中的大多数程序期间,外科医生通常必须终止血液或另一种流体通过一根或多根血管流动。外科医生会经常使用特定的内窥镜外科手术施夹器将外科手术夹具施加到血管或另一种导管,以防止体液在程序期间通过其流动。
具有各种大小(例如,直径)的被配置成施加各种不同的外科手术夹具的内窥镜外科手术施夹器是本领域已知的,并且在进入体腔期间能够施加单个或多个外科手术夹具。此类外科手术夹具通常由生物相容性材料制成并且通常压紧在血管上。一旦施加到血管,所压紧的外科手术夹具就终止流体通过血管流动。
能够在内窥镜程序或腹腔镜程序中在单次进入体腔期间施加多个夹具的内窥镜外科手术施夹器在共同转让给Green等人的美国专利第5,084,057号和第5,100,420号中进行了描述,所述两个美国专利均通过引用整体并入本文。另一种多内窥镜外科手术施夹器公开于Pratt等人共同转让的美国专利第5,607,436号中,所述美国专利的内容也在此通过引用整体并入本文。这些装置通常(虽然并非必需地)用于单次外科手术程序期间。授予Pier等人的美国专利第5,695,502号公开了一种可重复消毒内窥镜外科手术施夹器,所述美国专利的公开内容在此通过引用并入本文中。在单次插入体腔期间,内窥镜外科手术施夹器推进并形成多个夹具。这种可重复消毒内窥镜外科手术施夹器被配置成收纳可互换夹盒并与可互换夹盒合作,以便在单次进入体腔期间推进和形成多个夹具。
在内窥镜程序或腹腔镜程序期间,可能期望和/或需要根据待连接的下层组织或血管来使用不同大小的外科手术夹具或不同配置的外科手术夹具。为了降低内窥镜外科手术施夹器的整体成本,期望单个内窥镜外科手术施夹器可装载有不同大小的外科手术夹具并且能够根据需要触发不同大小的外科手术夹具。因此,需要以下内窥镜外科手术施夹器:其包括手柄组件,所述手柄组件被配置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和/或被配置用于执行各种不同外科手术任务的不同夹具。
另外,例如,由于放置外科手术夹具所需的力和/或目标组织的密度,可能在物理上难以完全致动可移动手柄以帮助确保外科手术夹具的正确放置。因此,例如,还可期望增加致动施夹器的可移动手柄的机械效益。
发明内容
如本文详述以及在附图中示出的那样,如在涉及外科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用户的端部,并且术语“远端”是指设备或其部件的更远离用户的端部。此外,在一致的程度上,本文详述的任何或所有方面和特征均可以与本文详述的任何或所有其它方面和特征结合使用。
根据本公开的方面提供一种与外科手术器械一起使用的手柄组件。手柄组件包含限定接触壁的壳体、可枢转地安装到壳体上的可移动手柄、柱塞、连杆和反馈机构。柱塞至少部分地安置在壳体内并限定纵向轴线。柱塞相对于壳体的远端平移被配置成影响外科手术器械的功能。连杆将可移动手柄与柱塞互连,使得可移动手柄的致动导致柱塞相对于壳体的纵向平移。反馈机构被配置成向用户提供听觉反馈,并且包含指示器卡扣线和由壳体的壁限定的轨道。卡扣线被配置成响应于柱塞的纵向平移而沿着轨道移动。卡扣线被配置成与壳体的接触壁接合,以在可移动手柄已经被致动预定量时产生用户可听到的声音。
在公开的实施例中,卡扣线固定到柱塞以与柱塞一起移动。
还公开了卡扣线的远端延伸穿过安置在柱塞的近端部分处的孔。
还公开了卡扣线的一部分沿着轨道中平行于纵向轴线的第一路径向远端运动。在实施例中,卡扣线的一部分沿着轨道中平行于纵向轴线的第二路径向近端运动。公开了轨道的第一路径偏离轨道的第二路径。还公开了在可移动手柄已经被致动预定量之后,卡扣线沿着轨道的第二路径移动。还公开了轨道的第一路径比轨道的第二路径更接近于纵向轴线。
在公开的实施例中,卡扣线的一部分沿着轨道的第三路径相对于纵向轴线横向移动。在实施例中,当沿着轨道的第三路径移动时,卡扣线的一部分保持平行于纵向轴线。公开了卡扣线的一部分沿着轨道的第四路径相对于纵向轴线横向移动并且与壳体的接触壁接触。还公开了紧接在卡扣线的一部分沿着轨道的第四路径移动之前,卡扣线的一部分沿着轨道的第三路径移动。
还公开了卡扣线的一部分与壳体的接触壁之间的接合使得手柄组件的至少一部分振动。
另外,公开了当可移动手柄已完成致动行程时,卡扣线的一部分被配置成与壳体的接触壁接合。
在公开的实施例中,卡扣线大体上为“U”形。公开了卡扣线包含第一翼形部、第二翼形部和连接部分,并且所述连接部分使第一翼形部与第二翼形部互连。还公开了壳体的轨道是第一轨道,卡扣线的第一翼形部沿着第一轨道移动,并且卡扣线的第二翼形部沿着由壳体的第二壁限定的第二轨道移动。还公开了卡扣线的连接部分的远端延伸穿过柱塞的孔。
附图说明
参考附图详细描述了本发明公开的内窥镜外科手术施夹器的方面和特征,其中相同的附图标记表示类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外科手术施夹器的透视图,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的内窥镜外科手术施夹器的透视图,其中将内窥镜组件从手柄组件移除;
图3是图2中指示为“3”的细节区域的放大透视图;
图4是跨越图3中的剖面线4-4截取的横向横截面图;
图5是跨越图3中的剖面线5-5截取的横向横截面图;
图6是跨越图1中的剖面线6-6截取的横向横截面图;
图7是跨越图6中的剖面线7-7截取的纵向横截面图;
图8是图1的手柄组件的纵向横截面图;
图9是图1的手柄组件的分解视图;
图10是图1的手柄组件的透视图,其中壳体的一部分被移除以示出其中的内部部件;
图11是图1的手柄组件的内部组件的透视图;
图12是图8中指示为“12”的细节区域的放大纵向横截面图;
图13是图10中指示为“13”的细节区域的放大透视图;
图14是图11中指示为“14”的细节区域的放大透视图;
图15是被配置成与图1的手柄组件一起使用的另一内窥镜组件的透视图;
图16是图15的内窥镜组件的远端部分的放大透视图;
图17是图15的内窥镜组件的近端部分的放大透视图;
图18是图15的内窥镜组件的近端部分的放大透视图,其中用虚线示出的外壳的一部分,以示出其中的内部部件;
图19是图15的内窥镜组件的纵向横截面图;
图20是图15的内窥镜组件的近端部分的放大纵向横截面图;
图21是示出图1的手柄组件与图15的内窥镜组件之间的可操作接合的放大纵向横截面图;
图22是被配置成与图1的手柄组件一起使用的另一内窥镜组件的透视图;
图23是图22的内窥镜组件的远端部分的放大透视图;
图24是图22的内窥镜组件的近端部分的放大透视图;
图25是图22的内窥镜组件的近端部分的放大透视图,其中用虚线示出外壳的一部分,以示出其中的内部部件;
图26是图22的内窥镜组件的纵向横截面图;
图27是图22的内窥镜组件的近端部分的纵向横截面图;
图28是示出图1的手柄组件与图22的内窥镜组件之间的可操作接合的放大纵向横截面图;
图29是示出根据本公开提供的内窥镜组件的替代实施例的顶部横截面图;
图30是根据本公开的另一实施例提供的内窥镜组件的手柄组件的透视图;
图31是图30的手柄组件的透视剖视图;
图32是示出处于第一位置的图30和31的手柄组件的侧视剖视图;
图33是示出处于第二位置的图30到32的手柄组件的侧视剖视图;
图34是示出处于第三位置的图30到33的手柄组件的侧视剖视图;且
图35是示出致动图30到34的手柄组件的可移动手柄所需的力的量相对于时间的曲线图;
图36是根据本公开的另一实施例提供的内窥镜组件的手柄组件的透视剖视图,其包含听觉反馈机构;
图37是图36的手柄组件的指示器线的透视图;
图38是跨越图36中的剖面线38-38截取的透视剖视图;
图39是示出处于第一位置的图36到38的手柄组件的侧视剖视图;
图40是跨越图36中的剖面线40-40截取的透视剖视图;
图41是图40中所指示的细节区域的放大视图;
图42是示出处于第二位置的图36到41的手柄组件的侧视剖视图;
图43是处于第二位置的图36到42的手柄组件的一部分的透视剖视图;
图44是示出处于第三位置的图36到43的手柄组件的侧视剖视图;
图45是处于第三位置的图36到44的手柄组件的一部分的透视剖视图;
图46是处于第四位置的图36到45的手柄组件的一部分的透视剖视图;
图47是处于第五位置的图36到46的手柄组件的一部分的透视剖视图;且
图48是被配置成根据本公开使用的机器人外科手术系统的示意性图示。
具体实施方式
转到图1和2,根据本公开提供的内窥镜外科手术施夹器由附图标记10标识。外科手术施夹器10通常包含手柄组件100和可选择性地连接到手柄组件100且可从手柄组件向远端延伸的多个内窥镜组件200。手柄组件100有利地被配置成在连接到其上时操作多个内窥镜组件200中的每一个,并且可以被配置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程序过程中与不同的和/或另外的内窥镜组件200一起重复使用。内窥镜组件200可以取决于特定目的和/或特定内窥镜组件200的配置被配置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。在任一种配置中,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并将所述内窥镜组件200连接到准备使用的手柄组件100。
首先详述了手柄组件100,以结合通用内窥镜组件200使用,所述通用内窥镜组件包含可与手柄组件100一起使用的任何内窥镜组件所共有的特征。此后,以下详细描述特定内窥镜组件的示例性实施例,例如,内窥镜组件300(图15)和内窥镜组件400(图22)。例如,内窥镜组件300(图15)被配置成用于抓握和操控组织、取回外科手术夹具,以及围绕组织触发和形成外科手术夹具。作为另一实例,内窥镜组件400(图22)包含装载在其中的至少一个外科手术夹具,并且被配置成围绕组织顺序触发并形成至少一个外科手术夹具。还可以预见,可以提供用于执行各种不同的外科手术任务和/或具有各种不同的配置的各种其它内窥镜组件,以与手柄组件100一起使用。
继续参考图1和2,如上所述,内窥镜组件200被配置成选择性地连接到手柄组件100并从手柄组件向远端延伸。内窥镜组件200包含被配置用于插入手柄组件100中并与其可释放地接合的近端轮毂210、从近端轮毂210向远端延伸的细长轴220,以及安置在细长轴220的远端处的末端执行器组件(未示出)。内部驱动部件(未示出)延伸穿过近端轮毂210和细长轴220,以便在内窥镜组件200与手柄组件100接合时将末端执行器组件(未示出)与手柄组件100可操作地联接,例如以能够执行内窥镜组件200的一项或多项外科手术任务。近端轮毂210限定大体上管状的配置,并且包含限定在其中的纵向延伸的狭槽212和限定在其中的环形凹槽214。纵向延伸的狭槽212限定了开放的近端213。环形凹槽214围绕近端轮毂210周向延伸并且与纵向延伸的狭槽212相交,但是也可以考虑其它非相交的配置。
另外参考图3到5,手柄组件100包含接收器组件170,所述接收器组件被配置成接纳内窥镜组件200的近端轮毂210,并使内窥镜组件200与手柄组件100能够可释放地接合。接收器组件170包含外部轴环172和内部管状构件174。内部管状构件174限定的内径略大于内窥镜组件200的近端轮毂210的外径,以使得近端轮毂210可滑动地插入内部管状构件174中而在它们之间没有明显的间隙。内部管状构件174还包含多个孔176,所述多个孔穿过内部管状构件限定并且围绕内部管状构件174周向定位。与其外部开口177b相比,孔176限定了减小的内部开口177a。滚珠轴承178安置在每个孔176内。尽管每个滚珠轴承178的一部分穿过其相应的孔176的减小的内部开口177a向内突出,但是减小的内部开口177a阻止了滚珠轴承178完全穿过。定位外部轴环172以阻塞孔的外部开口177b,从而将滚珠轴承178保持在外部轴环172与减小的内部开口177a之间的孔176内(除了滚珠轴承178延伸穿过减小的内部开口177a的部分之外)。
销180延伸穿过限定在内部管状构件174内的销孔182,并且至少部分地延伸穿过限定在外部轴环172内的销槽184。销180至少部分地延伸到内部管状构件174的内部,并且如下文详述,被配置成在将内窥镜组件200插入手柄组件100中时便于内窥镜组件200的对准。销180还被配置成将外部轴环172和内部管状构件174相对于彼此保持在固定的旋转取向上。外部轴环172以固定的旋转取向与手柄组件100的旋钮190接合,使得在销180可旋转地联接外部轴环172和内部管状构件174的情况下,可实现旋钮190的旋转以类似地旋转接收器组件170。旋钮190包含安置在其上的对准指示器192,所述对准指示器与销180对准,以使得内窥镜组件200与接收器组件170对准而无需直接查看销180的位置。
参考图1、2、6和7,为了使内窥镜组件200与手柄组件100接合,将内窥镜组件200定向成使得其纵向延伸的狭槽212与接收器组件170的销180对准。如上所述,可以通过将纵向延伸的狭槽212与手柄组件100的旋钮190的对准指示器192对准来实现纵向延伸的狭槽212和销180的对准,而不必直接查看销180。一旦实现对准,内窥镜组件200的近端轮毂210就向近端滑动到接收器组件170的内部管状构件174中。纵向延伸的狭槽212和销180的对准确保在近端轮毂210向近端滑动到内部管状构件174中时,销180平移通过纵向延伸的狭槽212。
当近端轮毂210向近端滑入内部管状构件174中时,滚珠轴承178在近端轮毂210的外部上施加径向向内的力,从而使得近端轮毂210、外部轴环172、内部管状构件174和/或滚珠轴承178移动或弯曲以将近端轮毂210容纳在滚珠轴承178之间。当近端轮毂210向近端滑入内部管状构件174中时,滚珠轴承178被允许在孔176内旋转,从而减小摩擦并允许近端轮毂210相对容易地滑入内部管状构件174中。当近端轮毂210完全插入内部管状构件174中时,例如当销180到达纵向延伸的狭槽212的封闭的远端时,滚珠轴承178被移动到围绕环形凹槽214的位置。由于滚珠轴承178施加的径向向内的力,一旦达到完全插入位置,就将滚珠轴承178推入环形凹槽214中,从而以接合方式将内窥镜组件200的近端轮毂210可释放地锁定在手柄组件100的接收器组件170内。可操作地联接内窥镜组件200与手柄组件100以使其能够执行一个或多个外科手术任务取决于与手柄组件100接合的内窥镜组件200的类型,并且下面将针对示例性内窥镜组件300(图15)和400(图22)进行详细描述。
为了从手柄组件100移除内窥镜组件200,在足够的推动下相对于手柄组件100向远端拉动内窥镜组件200,以将滚珠轴承178从环形凹槽214移开,从而允许内窥镜组件200的近端轮毂210远离手柄组件100的接收器组件170向远端滑动。
参考图1、2和8到10,手柄组件100通常包含壳体110、可枢转地联接到壳体110的触发器组件120、可操作地联接到触发器组件120的棘轮驱动组件130、可操作地联接到棘轮驱动组件130的旁路组件150、从壳体110向远端延伸的接收器组件170,以及可操作地围绕接收器组件170安置的旋钮190。
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由通过销柱接合彼此固定的第一壳体部件113a和第二壳体部件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、其它机械接合等。壳体110被配置成容纳手柄组件100的内部工作部件。主体部分111包含远端鼻部114,所述远端鼻部将环形狭槽115限定在其内部上。更具体地说,第一壳体部件113a和第二壳体部件113b各自限定半环形狭槽部分,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,形成环形狭槽115。手柄组件100的接收器组件170包含围绕其内部管状构件174的近端安置的保持夹具186。例如在第一壳体部件113a与第二壳体部件113b彼此接合时,保持夹具186被捕获在限定在壳体110的远端鼻部114内的环形狭槽115内。保持夹具186被捕获在环形狭槽115内,以使接收器组件170与壳体110可旋转地接合。手柄组件100的旋钮190例如通过外部轴环172、偏置构件194和弹性C形环196以相对于其固定的旋转取向围绕接收器组件170可操作地接合,使得旋钮190相对于壳体110的旋转实现接收器组件170相对于壳体110的类似旋转。因此,在将内窥镜组件200接合在接收器组件170内的情况下,旋钮190可以相对于壳体100旋转,以类似地相对于壳体110旋转内窥镜组件200。
壳体110的主体部分111还包含内部枢轴柱116,所述内部枢轴柱在壳体部件113a、113b与限定在壳体部件113a、113b中的一个或两个内的纵向延伸的导轨117之间横向延伸,每一个壳体部件的重要性在下面详述。壳体110的固定手柄部分112被配置成便于手柄组件100的抓握及其操控,并且与主体部分111整体形成,但是也可以考虑其它配置。
另外参考图11,触发器组件120通常包含触发器122、偏置构件127和连杆128。触发器122包含抓握部分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被配置成有利于触发器122的抓握和操控。触发器122的中间枢轴部分124至少部分地安置在壳体110内,并且限定枢轴孔126a,所述枢轴孔被配置成接纳壳体110的枢轴柱116,以使得触发器122能够围绕枢轴柱116并相对于壳体110例如在未致动位置与致动位置之间枢转,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接近。
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安置在中间枢轴部分124的相对侧上,并因此安置在枢轴柱116上。这样,抓握部分123向近端,例如朝向致动位置的枢转向远端推动近端延伸部分125。近端延伸部分125包含被配置成接纳偏置构件127的第一端的第一孔126b和被配置成接纳第一销129a的一对第二孔126c,所述第一销用于将连杆128的近端与触发器122的近端延伸部分125彼此可枢转地联接。偏置构件127的第二端围绕在固定手柄部分112内横向延伸的臂118接合。偏置构件127以静止状态安置在触发器122的抓握部分123的未致动位置。使抓握部分123朝向致动位置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配置。
如上所述,连杆128在其近端处通过第一销129a联接到触发器122的近端延伸部分125。连杆128还在其远端处通过第二销129b可枢转地联接到棘轮驱动组件130的驱动杆132的近端延伸部134。第二销129b从驱动杆132的近端延伸部134的一侧或两侧向外延伸,并且被接纳在限定在壳体部件113a和/或壳体部件113b内的一个或多个纵向延伸的导轨117中。由于这种配置,抓握部分123朝向致动位置的枢转向远端推动近端延伸部分125,这又向远端推动连杆128使得第二销129b向远端平移通过一个或多个纵向延伸的导轨117。
继续参考图1、2和8到11,手柄组件100的棘轮驱动组件130包含驱动杆132和棘爪组件140。驱动杆132分别包含近端延伸部134,棘轮架136,以及远端凹口138和近端凹口139。近端延伸部134安置在驱动杆132的近端处,并且限定孔135,所述孔被配置成接纳触发器组件120的第二销129b,以便将连杆128和驱动杆132的远端彼此可枢转地联接,如上所述。这样,当抓握部分123朝向致动位置枢转以通过一个或多个纵向延伸的导轨117向远端推动第二销129b时,驱动杆132向远端平移通过壳体110的主体部分111。驱动杆132的棘轮架136限定了多个齿137,并且在驱动杆132的上表面上沿着驱动杆纵向延伸。远端凹口138和近端凹口139由形成在驱动杆132中的切口限定,并且分别定位成远端邻近棘轮架136和近端邻近棘轮架136。
还参考图12,棘轮驱动组件130的棘爪组件140包含棘轮棘爪142、棘爪销144和棘爪偏置构件146。棘轮棘爪142通过棘爪销144可枢转地联接到壳体110的主体部分111,以便在使用棘轮功能的内窥镜组件200连接到手柄组件100时使棘轮棘爪142与棘轮架136可操作地接合,并在不使用棘轮功能的内窥镜组件200连接到手柄组件100时使棘轮棘爪142枢转到旁路位置。棘轮棘爪142还包含从其任一侧横向延伸的一对向外延伸的突片143,其重要性在下面详述。
棘爪组件140的棘爪偏置构件146联接在棘轮棘爪142与壳体110的主体部分111之间,以将棘轮棘爪142朝向使用位置并远离旁路位置偏置。在使用位置,棘轮棘爪142定向成在驱动杆132向远端前进时可操作地接合棘轮架136。然而,在驱动杆132的最近端位置,对应于触发器122的未致动位置,棘轮棘爪142至少部分地安置在驱动杆132的远端凹口138内。因此,至少在一开始,棘轮棘爪142与棘轮架136脱离。
参考图8到14,旁路组件150可操作地定位在棘爪组件140与接收器组件170之间,并且被配置成响应于手柄组件100与不使用棘轮功能的内窥镜组件200的接合而将棘轮棘爪142枢转到旁路位置,从而抑制了驱动杆132前进时的棘轮效应。当使用棘轮功能的内窥镜组件200连接到手柄组件100时,旁路组件150保持闲置状态,使得棘轮棘爪142保持在使用位置,以便在驱动杆132前进时使棘轮棘爪142沿着棘轮架136发生棘轮效应。
旁路组件150包含套筒152、偏置构件154和凸轮夹具156。套筒152延伸到接收器组件170的内部管状构件174的近端中,并且围绕驱动组件130的驱动杆132的远端相对于内部管状构件174和驱动杆132两者以可滑动的关系安置。偏置构件154安置在接收器组件170的内部管状构件174内并且围绕套筒152安置。更具体地说,偏置构件154围绕套筒152保持在套筒152的远端边缘153与在其近端处限定在内部管状构件174的内部之内的环形肩部179之间。由于所述配置,偏置构件154将套筒152向近端偏置到内部管状构件174的内部中。套筒152的远端边缘153与限定内部管状构件174的内壁径向间隔开,从而在其间限定环形间隔“A1”。套筒152进一步限定内径“D1”。
旁路组件150的凸轮夹具156接合在围绕套筒152的外部朝向其近端限定的环形凹槽157内。凸轮夹具156具有足够的尺寸,以禁止进入内部管状构件174的内部,并因此在偏置构件154的偏置下,防止套筒152完全进入内部管状构件174。凸轮夹具156在其自由端处还包含一对相对的向内延伸的指状物158。指状物158被定位成使得在套筒152抵抗偏置构件154的偏置充分向近端推动时,指状物158接触棘轮棘爪142的相应突片143。因此,在套筒152进一步向近端移动时,指状物158向近端推动相应的突片143,最终使得棘轮棘爪142被推动以围绕棘爪销144旋转并且抵抗棘爪偏置构件146的偏置从使用位置旋转到旁路位置。
转向图15到21,示出了根据本公开提供的并且被配置为与手柄组件100一起使用的内窥镜组件300。内窥镜组件300被配置用于非棘轮用途,并且因此,如下文详述,在内窥镜组件300与手柄组件100接合时,棘轮棘爪142枢转到并保持在旁路位置,从而实现这种非棘轮用途。内窥镜组件300通常包含近端轮毂310、安置在近端轮毂310内并延伸穿过近端轮毂310的内部驱动组件320、从近端轮毂310向远端延伸的细长轴340,以及包含安置在细长轴340的远端的一对夹钳构件360a、360b的末端执行器组件350。内窥镜组件300被配置成抓握和/或操控组织,取回外科手术夹具,并且围绕组织闭合、触发或形成外科手术夹具。预期内窥镜组件300类似于美国专利第4,834,096号中示出和描述的内窥镜组件被配置成闭合、触发或形成外科手术夹具,所述美国专利的全部内容通过引用并入本文。
另外参考图1、2、6和7,内窥镜组件300的近端轮毂310限定大体上管状配置,并且其外径略小于手柄组件100的接收器组件170的内部管状构件174的外径,以使近端轮毂310能够可滑动地插入内部管状构件174而在其间没有明显的间隙。近端轮毂310还包含与以上关于内窥镜组件200所详述的那些特征类似的特征,以使得近端轮毂310能够以类似的方式接合在手柄组件100的接收器组件170内。更具体地说,近端轮毂310、被配置成接纳接收器组件170的销180以确保内窥镜组件300相对于手柄组件100正确对准的纵向延伸的狭槽311,以及被配置成接纳每个滚珠轴承178的至少一部分从而以接合方式将内窥镜组件300的近端轮毂310可释放地锁定在手柄组件100的接收器组件170内的环形凹槽312。
再次参考图15到21,内窥镜组件300的近端轮毂310还限定了内部孔径313,所述内部孔径具有开放的近端314和与孔径313的直径相比减小的直径的远端开口,以便在其间限定肩部315。套圈316位于近端轮毂310的开放的近端内,并以任何合适的方式固定在其中,例如焊接、胶合、压入配合、机械接合等。
近端轮毂310的套圈316限定纵向延伸穿过其的孔317和环绕孔317的面向近端的表面318,使得面向近端的表面318限定环形配置。孔317安置成与近端轮毂310的内部连通,以便进入内部驱动组件320,如下所述,并且限定直径“D2”,所述直径足够大以允许手柄组件100的棘轮驱动组件130的驱动杆132穿过所述孔可滑动地插入。然而,孔317的直径“D2”小于套筒152的内径“D1”。套圈316的面向近端的表面318限定环形宽度“A2”,所述环形宽度大于在套筒152的远端边缘153与限定内部管状构件174的内壁之间限定的环形间隔“A1”。由于直径“D2”小于直径“D1”并且环形宽度“A2”大于环形间隔“A1”,因此近端轮毂310被禁止进入套筒152的内部,并且同样被禁止通过套筒152的外部。相反,在将内窥镜组件300的近端轮毂310向近端推动到手柄组件100的接收器组件170的内部管状构件174中例如使内窥镜组件300与手柄组件100接合时,套圈316的面向近端的表面318最终接触套筒152的远端边缘153,使得将近端轮毂310进一步向近端推动到内部管状构件174中会抵抗偏置构件154的偏置向近端推动套筒152。
如上所述,内窥镜组件300被配置用于非棘轮用途。因此,关于近端轮毂310的部件和旁路组件150的部件的相对尺寸的上述详细配置确保了在内窥镜组件300与手柄组件100接合时,近端轮毂310将棘轮棘爪142从使用位置推向旁路位置,从而使棘轮驱动组件130的棘轮部件失效。更具体地说,在销180被接纳在纵向延伸的狭槽311内并且近端轮毂310向近端滑动到接收器组件170的内部管状构件174中时,但是在滚珠轴承178接合在环形凹槽312内之前,套圈316的面向近端的表面318接触套筒152的远端边缘153并向近端推动套筒152,使得凸轮夹具156的指状物158向近端推动棘轮棘爪142的突片143,从而使棘轮棘爪142围绕棘爪销144从使用位置朝向旁路位置旋转。因此,如图21所示,在近端轮毂310在内部管状构件174内到达接合位置时,例如,在滚珠轴承178接合在环形凹槽312内时,套圈316已将套筒152推动到最近端位置,其中棘轮棘爪142枢转到并保持在旁路位置。因此,当内窥镜组件300与手柄组件100接合时,使棘轮驱动组件130的棘轮效应失效。
仍然参考图15到21,内窥镜组件300的内部驱动组件320包含可滑动地安置在内窥镜组件300的近端轮毂310和细长轴340内的内轴322。内轴322包含支撑安置在近端轮毂310的孔径313内的横向销324的近端323和支撑朝向细长轴340的远端344安置的凸轮销326的远端325。如下详述,凸轮销326安置在末端执行器组件350的夹钳构件360a、360b的凸轮狭槽(未示出)内,以使得夹钳构件360a、360b能够响应于内轴322平移通过细长轴340在打开位置与闭合位置之间枢转。
内部驱动组件320还分别包含柱塞328以及第一偏置构件330和第二偏置构件332。柱塞328可滑动地安置在近端轮毂310的孔径313内,并在肩部315与套圈316之间保持在所述孔径中。柱塞328限定内部空腔329,内轴322的近端323的横向销324可滑动地限制在所述内部空腔中。
内部驱动组件320的第一偏置构件330安置在近端轮毂310的内部孔径313内,并介于近端轮毂310的肩部315与内轴322的横向销324之间。第一偏置构件330具有第一弹簧常数“K1”,所述第一弹簧常数小于第二偏置构件332的第二弹簧常数“K2”,其重要性在下面详述。第二偏置构件332安置在柱塞328的空腔329内,并且介于内轴322的横向销324与柱塞328的近端之间。如下详述,第一偏置构件330和第二偏置构件332分别促进内轴322适当平移通过近端轮毂310和细长轴340,以打开和闭合夹钳构件340a、340b,并使得能够完全致动触发器122(图1),如下所示。
内窥镜组件300的细长轴340限定大体上管状的配置,并且在近端轮毂310与末端执行器组件350之间延伸并使这两者互连。更具体地说,细长轴340的近端342被固定到近端轮毂310,而细长轴340的远端344支撑U形夹346,所述U形夹被配置成在细长轴340的远端344处通过枢轴销352与末端执行器组件350的夹钳构件360a、360b可枢转地接合。
如上所述,末端执行器组件350包含第一夹钳构件360a和第二夹钳构件360b。夹钳构件360a、360b经由枢轴销352可枢转地彼此接合并接合到U形夹346,以允许夹钳构件360a、360b相对于彼此和细长轴340在打开位置与闭合位置之间枢转。每个夹钳构件360a、360b包含相应的近端361a、361b和相应的远端362a、362b。每个夹钳构件360a、360b的近端361a、361b限定了凸轮狭槽(未示出),所述凸轮狭槽被配置成接纳内轴322的凸轮销326,使得内轴322的平移使夹钳构件360a、360b在打开位置与闭合位置之间枢转。夹钳构件360a、360b的远端362a、362b被配置成接纳并闭合、触发或形成外科手术夹具,例如,类似于美国专利第4,834,096中示出和描述的外科手术夹具,所述美国专利先前通过引用并入本文。
暂时参考图29,示出了内部驱动组件320的替代实施例。在所述实施例中,内窥镜组件300的内轴322被分成近端部分322'和远端部分322"。远端部分322"的近端322a"包含限定在其中的孔径322b",所述孔径被配置成可滑动地接纳安置在近端部分322'的远端322a'上的细长构件322b'。穿过内轴322的远端部分322"限定了横向狭槽322c",所述横向狭槽被配置成可滑动地保持横向销320a'。横向销320a'使用任何合适的方式(例如摩擦配合、焊接、粘合剂等)固定地保持在限定在近端部分322'的远端322a'中的孔(未示出)内。偏置构件320b'安置在内轴322的近端部分322'与远端部分322"之间,并且作用在远端部分322"的近端322a"和安置在近端部分322'的远端322a'上的环形表面322c'上。以这种方式,偏置构件(例如,弹簧等)320b'最初被压缩成使得近端部分322'和远端部分322"维持间隔开的关系。当横向销320b'处于横向狭槽322c"的行程中的最近端位置时,横向销320a'阻止近端部分322'和远端部分322"被偏置构件320b'推动分开。
在操作中,如果夹钳构件360a、360b的闭合处卡住或以其它方式无法完全闭合(例如,当夹钳构件360a,360b在骨骼或另一外科手术夹具上正闭合时),那么所述过载补偿系统允许手柄组件100的棘轮驱动组件130的前向行程可以完全完成(其中,内轴322的近端部分322'的远端驱动力轴向压缩具有弹簧常数“K3”的偏置构件320b',所述偏置常数大于“K1”或“K2”),以便允许棘轮驱动组件130的复位或反转并允许触发器122打开。
现在参考图8到21详细描述手柄组件100与内窥镜组件300的结合使用。最初,内窥镜组件300与手柄组件100接合,如上所述。也如上所述,内窥镜组件300与手柄组件100的这种接合实现使棘轮棘爪142枢转到旁路位置且使棘轮棘爪142保持在旁路位置。一旦内窥镜组件300和手柄组件100与棘轮棘爪142接合在旁路位置,手柄组件100和内窥镜组件300就一起准备好使用。
在使用中,触发器122最初在偏置构件127的偏置下安置在未致动位置。在将触发器122安置在未致动位置的情况下,将驱动杆132安置在最近端位置。此外,内轴322在第一偏置构件330和第二偏置构件332的偏置下安置在最近端位置。因此,最初将夹钳构件360a、360b安置在打开位置。在将夹钳构件360a、360b安置在打开位置的情况下,可以将新的、未形成或打开的外科手术夹具(未示出)定位或装载在夹钳构件360a、360b的远端362a、362b内。末端执行器组件350的夹钳构件360a、360b可用于从夹具保持器(未示出)取回或拾取外科手术夹具,所述外科手术夹具可由用户手动装载,末端执行器组件350可由制造商预先装载,或外科手术夹具可以以任何其它合适的方式放置在夹钳构件360a、360b之间。
为了闭合、触发或形成装载在夹钳构件360a、360b之间的外科手术夹具,将触发器122从未致动位置推向致动位置。更具体地说,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,这又向远端推动驱动杆132以穿过壳体110、接收器组件170并推动到内窥镜组件300的近端轮毂310的孔径313中。当触发器122进一步朝向致动位置枢转时,驱动杆132最终接触内窥镜组件300的驱动组件320的柱塞328。由于第一偏置构件330的第一弹簧常数“K1”小于第二偏置构件332的第二弹簧常数“K2”,当驱动杆132最初被推入柱塞328中时,柱塞328和内轴322一起向远端平移,使得第一偏置构件330被压缩,而第二偏置构件332基本保持未压缩。
当内轴322向远端平移时,凸轮销326平移通过夹钳构件360a、360b的凸轮狭槽,以使夹钳构件360a、360b朝向闭合位置枢转,从而闭合和/或形成装载在末端执行器组件350内的外科手术夹具(未示出)。凸轮销326向远端前进,直到凸轮销326到达夹钳构件360a、360b的凸轮狭槽的末端和/或直到夹钳构件360a、360b彼此完全接近或在外科手术夹具上完全闭合。如可了解,取决于所使用的特定内窥镜组件、所形成的外科手术夹具的配置和/或其它因素,内轴322完全形成外科手术夹具所需的行进距离可以发生变化。由于触发器122在未致动位置与致动位置之间的行进距离没有变化,因此内窥镜组件300解释了这种变化,如下所述。
一旦夹钳构件360a、360b彼此完全接近或在外科手术夹具上完全闭合,和/或当凸轮销326到达夹钳构件360a、360b的凸轮狭槽的末端时,不再允许内轴322进一步向远端行进。因此,在驱动杆132进一步向远端推动时,例如,为了完成触发器122的致动行程,柱塞328独立于内轴322向远端前进,以压缩第二偏置构件332。因此,第二偏置构件332的压缩使得内轴322能够保持在适当位置,同时完成触发器122的整个致动行程。
一旦外科手术夹具已经完全形成,就可以释放触发器122并使其在偏置下返回到未致动位置,从而将驱动杆132拉回到其最近端位置并允许夹钳构件360a、360b返回到打开位置。此后,可以重复上述详细的使用,以闭合、触发并形成另外的外科手术夹具。另外地或替代地,末端执行器组件350的夹钳构件360a、360b可用于在形成一个或多个外科手术夹具之前或之后根据需要抓握和/或操控组织。
转向图22到28,示出了根据本公开提供且被配置成与手柄组件100(图1)一起使用的另一种内窥镜组件400。内窥镜组件400被配置成用于棘轮用途,并且因此,如下文详述,在内窥镜组件400与手柄组件100接合时,棘轮棘爪142保持在使用位置以实现棘轮用途。内窥镜组件400通常包含近端轮毂410、从近端轮毂410向远端延伸的细长轴420、安置在近端轮毂410和细长轴420内的驱动组件430,以及支撑在细长轴420的远端的一对夹钳构件460a、460b。内窥镜组件400被配置成闭合、触发或形成围绕组织的一个或多个外科手术夹具。更具体地说,预期内窥镜组件400可以被配置成闭合、触发或形成与美国专利第7,819,886号或第7,905,890号中所示出和所描述的那些外科手术夹具类似的外科手术夹具,所述美国专利的全部内容通过引用并入本文。
还参考图1、2、6和7,近端轮毂410还包含与以上关于内窥镜组件200所详述的那些特征类似的特征,以使得近端轮毂410能够以类似的方式接合在手柄组件100的接收器组件170内。更具体地说,近端轮毂410、被配置成接纳接收器组件170的销180以确保内窥镜组件400相对于手柄组件100正确对准的纵向延伸的狭槽411,以及被配置成接纳每个滚珠轴承178的至少一部分从而以接合方式将内窥镜组件400的近端轮毂410可释放地锁定在手柄组件100的接收器组件170内的环形凹槽412。
如上所述,内窥镜组件400被配置成用于棘轮用途,并且因此,在内窥镜组件400与手柄组件100接合时,棘轮棘爪142保持在使用位置以实现棘轮用途。为了允许这样,近端轮毂410限定环形地安置在限定近端轮毂410的外壳与驱动组件430的柱塞435之间的环形孔414,所述柱塞可滑动地安置在近端轮毂410内。在将内窥镜组件400插入接收器组件170中时,所述环形孔414的位置和尺寸被设置为接纳套筒152的远端边缘153。因此,在将内窥镜组件400的近端轮毂410插入到手柄组件100的接收器组件170的内部管状构件174中,例如以使内窥镜组件400与手柄组件100接合时,套筒152的远端边缘153通过不受干扰的环形孔414进入近端轮毂410,使得套筒152在偏置构件154的偏置下维持在其最远端位置。在套筒152处于其最远端位置的情况下,棘轮棘爪142保持在使用位置,从而实现手柄组件100的棘轮驱动组件130的棘轮用途。
返回参考图22到28,如上所述,内窥镜组件400包含从近端轮毂410向远端延伸的细长轴420。细长轴420包含固定到近端轮毂410的近端422和支撑第一夹钳构件460a和第二夹钳构件460b的远端424。
驱动组件430包含可滑动地支撑在细长轴420和近端轮毂410的内部的内轴431。内轴431包含近端433和远端434。内轴431的近端433延伸到近端轮毂410的内部孔径413中,并且通过将内轴431的横向销436接纳在柱塞435的纵向狭槽437中而可操作地联接到驱动组件430的柱塞435。内轴431的远端434被配置成将第一夹钳构件460a和第二夹钳构件460b从打开位置转变到闭合位置,以形成已经响应于内轴431向远端平移通过细长轴420而被装载到第一夹钳构件460a和第二夹钳构件460b中的外科手术夹具(未示出)。
预期内轴431可以以与上文关于内轴322公开的类似的方式分成近端部分和远端部分。内轴431的所述实施例的部件和操作与内轴322的部件和操作类似,且因此,以下将不对其部件及操作进行详细描述。
驱动组件430进一步包含止动环438以及第一偏置构件439a和第二偏置构件439b,每个偏置构件均围绕内轴431安置。止动环438围绕内轴431固定地接合并且安置在近端轮毂410的内部孔径413内。第一偏置构件439a位于止动环438的远端,并且保持在止动环438与近端轮毂410的远端之间。第二偏置构件439b定位在止动环438的近端,并保持在止动环438与柱塞435的远端之间。第一偏置构件439a具有第一弹簧常数“KK1”,所述第一弹簧常数小于第二偏置构件439b的第二弹簧常数“KK2”,其重要性在下面详述。
现在参考图8到14和22到28详细描述手柄组件100与内窥镜组件400的结合使用。最初,内窥镜组件400与手柄组件100接合,如上所述。由于内窥镜组件400被配置用于棘轮驱动组件130的棘轮用途,因此当内窥镜组件400与手柄组件100接合时,棘轮棘爪142保持安置在使用位置。更具体地说,由于近端轮毂410的环形孔414和旁路组件150的套筒152的相对位置和尺寸,当近端轮毂410被插入接收器组件170时,套筒152被接纳在环形孔414内,从而使套筒152在偏置构件154的偏置下保持在其最远端位置。在套筒152保持在其最远端位置的情况下,棘轮棘爪142在棘爪偏置构件146的偏置下保持在使用位置。因此,如下详述,实现手柄组件100和内窥镜组件400的棘轮用途。一旦内窥镜组件400和手柄组件100与保持在使用位置的棘轮棘爪142接合,手柄组件100和内窥镜组件400就一起准备好使用。
在使用中,触发器122最初在偏置构件127的偏置下安置在未致动位置。在将触发器122安置于未致动位置的情况下,将驱动杆132安置于最近端位置,使得棘轮棘爪142安置于驱动杆132的远端凹口138内。此外,在将驱动杆132安置在最近端位置的情况下,驱动组件430的内轴431分别在第一偏置构件439a和第二偏置构件439b的偏置下安置在最近端位置。因此,最初将夹钳构件460a、460b安置在打开位置。在将夹钳构件460a、460b安置在打开位置的情况下,新的、未形成或打开的外科手术夹具(未示出)可以定位或装载在夹钳构件460a、460b内,或者可以以其它方式可操作地定位(手动或自动)以插入于其间,以用于在闭合夹钳构件460a、460b时围绕组织形成或闭合。例如,在一些实施例中,在触发期间,外科手术夹具首先从细长轴420在夹钳构件460a、460b之间前进,然后闭合夹钳构件460a、460b以形成外科手术夹具。在这样的实施例中,一系列外科手术夹具可被装载在细长轴420内,以供以类似方式进行顺序触发。然而,也可以考虑其它合适的外科手术夹具和/或用于其触发的配置。
为了闭合、触发或形成装载在夹钳构件460a、460b之间的外科手术夹具,将触发器122从未致动位置推向致动位置。更具体地说,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,这又会向远端推动驱动杆132。当驱动杆132向远端推动时,棘轮棘爪142移出驱动杆132的远端凹口138,并与棘轮架136接合。一旦棘轮棘爪142与棘轮架136接合,触发器122就不会返回未致动位置,且因此,驱动杆132可能不会向近端返回,直到触发器122到达致动位置,从而完成其整个致动行程。
当驱动杆132向远端平移时,驱动杆132前进穿过壳体110、接收器组件170,并进入内窥镜组件400的近端轮毂410的孔径413中。最终,驱动杆132接触内窥镜组件400的驱动组件430的柱塞435。由于第一偏置构件439a的第一弹簧常数“KK1”小于第二偏置构件439b的第二弹簧常数“KK2”,当驱动杆132最初被推入柱塞435时,柱塞435和内轴431一起向远端平移,使得第一偏置构件439a被压缩,而第二偏置构件439b基本保持未压缩。当内轴431向远端平移时,首先在第一夹钳构件460a与第二夹钳构件460b之间装载外科手术夹具,然后,第一夹钳构件460a和第二夹钳构件460b从打开位置转变到闭合位置以围绕组织形成外科手术夹具,但也考虑其它配置。
如上文关于内窥镜组件300(图15到21)所述,取决于所使用的特定内窥镜组件、所形成的外科手术夹具的配置和/或其它因素,内轴431完全形成外科手术夹具所需的行进距离可能会有所不同。同样如上所述,一旦棘轮棘爪142与棘轮架136接合,触发器122可能就不会返回未致动位置,直到触发器122到达致动位置,从而完成其整个致动行程。因此,为了在驱动杆132完全形成外科手术夹具所需的行进长度不足以使棘轮棘爪142离开棘轮架136并进入驱动杆132的近端凹口139的情况下使触发器122返回到未致动位置,内窥镜组件400必须允许驱动杆132的进一步行进,如下所述。
随着触发器122被进一步致动以完成其整个致动行程,柱塞435继续被向远端驱动。然而,由于内轴431不能进一步向远端行进,所以第二偏置构件439b被压缩,从而允许柱塞435独立于内轴431向远端平移。也就是说,第二偏置构件439b的压缩使得内轴431能够保持在适当位置,同时完成触发器122的整个致动行程。
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,棘轮棘爪142移动到驱动杆132的近端凹口139中。在棘轮棘爪142安置在近端凹口139内的情况下,触发器122可以在偏置构件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,以闭合、触发并形成另外的外科手术夹具。
参考图30到35,提供了内窥镜组件的手柄组件的另一实施例。手柄组件通常由附图标记500标识,并且被配置成在可移动手柄520的致动期间提高对用户的机械效益。手柄组件500包含壳体510、可移动手柄520、第一连杆530和第二连杆560。可移动手柄520、第一连杆530和第二连杆560协作以使柱塞435相对于壳体510平移。
第一连杆530的第一部分532可枢转地连接到壳体510的壳体销512。第一连杆530的第二部分540可滑动地连接到可移动手柄520的销522。第一连杆530的第三部分550可枢转地连接到第二连杆560。更具体地说,壳体销512延伸穿过(或至少部分穿过)限定在第一连杆530的第一部分532内的孔534。另外,可移动手柄520的销522延伸穿过(或至少部分穿过)限定在第一连杆530的第二部分540内的狭槽542。此外,连杆销570延伸穿过(或至少部分地穿过)限定在第一连杆530的第三部分550内的孔(在图31到34中被隐藏了)。
另外,如图31所示,手柄组件500包含两个第二连杆560和560',其中一个第二连杆560安置在柱塞435的第一横向侧上,另一个第二连杆560'安置在柱塞435的第二横向侧上。为了简洁起见,本文仅描述一个第二连杆560。
第二连杆560的第一部分562可枢转地连接到柱塞435。第二连杆560的第二部分564可枢转地连接到第一连杆530。更具体地说,安置在柱塞435上的柱塞销442延伸穿过(或至少部分地穿过)限定在第二连杆560的第一部分562内的孔563。另外,连杆销570延伸穿过(或至少部分穿过)由第二连杆560的第二部分564限定的孔565。
如图31到34所示,第一连杆530限定大体上线性的形状(在其第一部分532与第二部分540之间),并且包含与第二部分540相邻的大体上三角形的延伸部(例如,第三部分550)。另外,如图32到34所示,第二连杆560限定大体上线性的形状(在其第一部分562与第二部分564之间),并且包含与第二部分564相邻的V形部分566。V形部分566(例如,包含凹陷和隆起)被配置成防止第二连杆560与可移动手柄520的销522之间的干涉(参见图32)。
可移动手柄520的最初的部分致动使手柄组件500从第一位置(图32)移动到第二位置(图33),这将柱塞435向远端前进第一距离。具体地说,可移动手柄520的最初的部分致动使第一连杆530的第一部分532围绕壳体510的壳体销512枢转,使限定在第一连杆530的第二部分540内的狭槽542相对于可移动手柄520的销522滑动,并且使可移动手柄520的销522沿图32中箭头“A”的大致方向朝向柱塞435(例如,柱塞销442)推动第一连杆530的第二部分540。更具体地说,可移动手柄520的最初的部分致动将可移动手柄520的销522推入狭槽542的侧壁543中,从而使第一连杆530的第二部分540朝向柱塞435移动。另外,第一连杆530的第二部分540相对于壳体510的移动也引起第一连杆530的第三部分550相对于壳体510的相应移动。
此外,可移动手柄520的最初的部分致动(且特别是第一连杆530的第三部分550的移动)使得第二连杆560的第二部分564相对于第一连杆530的第三部分550围绕连杆销570枢转。第一连杆530的第三部分550的移动还使得第二连杆560的第二部分564向柱塞435移动。第二连杆560的第二部分564向柱塞435的移动使得第二连杆560的第一部分562围绕柱塞435的柱塞销442枢转,并因此使得柱塞435向远端移动。
可移动手柄520的第二或继续致动使手柄组件500从第二位置(图33)移动到第三(例如,完全致动)位置(图34),这使柱塞435向远端前进第二距离。具体地说,可移动手柄520的继续致动使得第一连杆530的第一部分532继续围绕壳体510的壳体销512枢转,使得第一连杆530的第二部分540的狭槽542相对于可移动手柄520的销522滑动(例如,朝向其初始位置),并使可移动手柄520的销522沿图33中箭头“B”的大致方向朝向柱塞435(例如,柱塞销442)移动第一连杆530的第二部分540。狭槽542相对于可移动手柄520的销522朝向其初始位置滑动,直到销522接触(或几乎接触)狭槽542的端部544(图34)。另外,第一连杆530的第二部分540相对于壳体510的继续移动也引起第一连杆530的第三部分550相对于壳体510的相应继续移动。
此外,可移动手柄520的继续致动(且特别是第一连杆530的第三部分550的移动)使得第二连杆560的第二部分564继续相对于第一连杆530的第三部分550围绕连杆销570枢转,这使得第二连杆560的第二部分564朝向柱塞435继续移动,从而使得第二连杆560的第一部分562继续围绕柱塞435的柱塞销442枢转,以及柱塞435继续向远端移动。
图35是示出致动可移动手柄520所需的各种力(动力)的量的实例相对于时间的曲线图。最初的部分致动用附图标记IA指示,并且继续致动用附图标记CA指示。如图所示,在整个致动行程中,致动可移动手柄520所需的力的量逐渐增大。与例如缺少第一连杆530和第二连杆540的手柄组件相比,包含手柄组件500有助于减少致动其可移动手柄520所需的力的总量。所述曲线图还示出了对于连杆530、540的特定尺寸,手柄组件500的峰值或最大机械效益约为5.617:1,手柄组件500的最小机械效益约为0.814:1,手柄组件500的平均机械效益约为2.54:1,且总行程长度约为1.238英寸。
可以想到的是,可移动手柄520的最初的部分致动引起第一功能(例如,第一夹具的插入或加载),并且可移动手柄520的继续致动引起第二功能(例如,第一夹具的触发)。
参考图36到47,提供了内窥镜组件的手柄组件的另一实施例。手柄组件通常由附图标记600标识,并且被配置成在可移动手柄620的致动期间提高对用户的机械效益,并且向用户提供听觉反馈以指示手柄组件600的特定功能的完成。手柄组件600包含壳体610、可移动手柄620、第一连杆630、第二连杆660和反馈机构700。可移动手柄620、第一连杆630和第二连杆660协作以使柱塞435相对于壳体610平移,并且反馈机构700向用户提供听觉反馈。可移动手柄620、第一连杆630和第二连杆660的功能已在上文中关于手柄组件500进行了论述,为简洁起见,本文中不再进一步详细论述。另外,虽然示出了反馈机构700与特定的手柄组件(包含第一连杆630和第二连杆660)结合,但是反馈机构700可与各种其它类型的手柄组件一起使用而不脱离本公开的范围。
参考图36到38,示出了手柄组件600的一部分。具体地说,示出了与壳体610结合的反馈机构700。壳体610包含第一半壳体610a和第二半壳体610b(图38)。反馈机构700包含延伸穿过柱塞435的孔450的指示器卡扣线710以及安置在壳体610内并由壳体610的壁限定的轨道750。尽管示出了由半壳体610a的壁限定的单个轨道750,但是本公开的手柄组件600还包含由半壳体610b的壁限定的第二轨道。特别参考图37,指示器卡扣线710通常为“U”形或礼帽形,包含第一翼形部720、第二翼形部730和将第一翼形部720与第二翼形部730互连的连接部分740。如图36和38所示,连接部分740的远端742延伸穿过柱塞435的孔450。指示器卡扣线710可以由任何合适的材料制成,包含例如金属或塑料。另外,指示器卡扣线710的第一翼形部720可以在图37中箭头“C”的大致方向上偏离第二翼形部730,且指示器卡扣线710的第二翼形部730可以在图37中箭头“D”的大体方向上偏离第一翼形部720。
如图38到47所示,由于柱塞435与指示器卡扣线710的连接部分740的远端742之间的接合,所以柱塞435的纵向移动引起指示器卡扣线710(或指示器卡扣线710的至少一部分)的相应的纵向移动。具体地说,当柱塞435纵向移动时,指示器卡扣线710的至少一个翼形部(例如,第一翼形部720)沿着由壳体610内的壁限定的轨道750行进。在可移动手柄620的致动行程的末端处或附近,指示器卡扣线710的一部分(例如,第一翼形部720和/或第二翼形部730)与轨道750的横向坡道756接合,其使第一翼形部720重新定向并产生可听见的声音。例如,所述声音警告用户可移动手柄620的致动行程已完成。尽管以下描述指示了指示器卡扣线710的第一翼形部720沿轨道750行进,但是本公开还考虑了仅指示器卡扣线710的第二翼形部730沿相应的轨道行进,以及第一翼形部720和第二翼形部730两者都沿相应的轨道行进。
特别参考图41,轨道750包含前进段752、下降坡道754、横向坡道756、接触部分758、倾斜段760、缩回段762和复位段764。在可移动手柄620的致动行程期间,指示器卡扣线710的第一翼形部720从起始位置(图40和41)沿着前进段752行进(所述前进段沿其长度是线性的),沿下降坡道754向下行进并与横向坡道756(图38、42和43)接合。第一翼形部720与横向坡道756之间的接合迫使第一翼形部720在图38中箭头“E”的大致方向上向远端并横向向内移动。可移动手柄620和因此柱塞435和指示器卡扣线710继续致动使第一翼形部720移动越过壳体610的壁757(图38),并响应于指示器卡扣线710的偏置和/或回弹沿箭头“F”的大致方向横向向外卡扣,并与壳体610的接触壁611接合(图38),使得第一翼形部720在轨道750的接触部分758中(图44和45)。第一翼形部720与壳体610的接触壁611之间的接合产生了用户可听到的声音,从而警告用户可移动手柄620已完成其致动行程。例如,可移动手柄620的致动行程的完成可以导致紧固件的触发和/或组织的切割。另外,第一翼形部720与壳体610的接触壁611之间的接合可产生触觉振动,从而进一步警告用户可移动手柄620已完成其致动行程。
当可移动手柄620和因此柱塞435缩回时,轨道750的形状迫使第一翼形部720沿着缩回段762(图46)沿倾斜段760向上,并且沿复位段764(图47)向下。缩回段762沿着其长度是线性的。在可移动手柄620已经完全缩回并且指示器卡扣线710的第一翼形部720已经沿复位段764向下移动之后,第一翼形部720被定位在其原始位置(图41),使得可移动手柄620准备好进行另一致动(例如,触发附加紧固件)。
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夹钳的其它内窥镜组件,以与手柄组件100一起使用,以供棘轮使用或非棘轮使用。这种配置适应具有不同配置和/或不同闭合行程长度的各种不同内窥镜组件,同时提供触发器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触发或形成或闭合各种大小、材料和配置的外科手术夹具。
本文中描述的外科手术器械,例如施夹器也可被配置成对机器人外科手术系统起作用,且其通常被称作“遥控外科手术”。此类系统采用各种机器人元件来辅助外科医生并允许外科手术器械的远程操作(或部分远程操作)。出于此目的,可以采用各种机器人臂、齿轮、凸轮、滑轮、电动马达和机械马达等并且其可以设计有机器人外科手术系统以便在操作或处理的过程期间辅助外科医生。此类机器人系统可以包含远程可操纵系统、自动柔性外科手术系统、远程柔性外科手术系统、远程关节运动式外科手术系统、无线外科手术系统、模块化或可选择性配置的远程操作外科手术系统等。
机器人外科手术系统可与紧接于手术室或位于远程位置的一个或多个控制台一起采用。在此例子中,一个外科医生或护士团队可使患者做好外科手术准备,并用本文中所公开的器械中的一个或多个配置机器人外科手术系统,而另一外科医生(或一组外科医生)经由机器人外科手术系统远程地控制所述器械。如可了解,高度熟练的外科医生可在多个位置执行多个操作而不离开他/她的远程控制台,这在经济上有利,且对于患者或一系列患者也是有益的。
外科手术系统的机器人臂通常通过控制器联接到一对主手柄。外科医生可以移动手柄以使任何类型的外科手术器械(例如,末端执行器、抓握器、刀、剪刀等)的工作端产生对应的移动,这可以补充本文所描述的实施例中的一个或多个实施例的使用。可以按比例调整主手柄的移动使得工作端具有与由外科医生的操作手执行的移动不同、更小或更大的对应移动。比例因子或齿轮传动比可以是可调整的,使得操作者可以控制一个或多个外科手术器械的工作端的分辨率。
主手柄可以包含各种传感器,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、切割或其它治疗导致的组织阻力;器械对组织的压力;组织温度;组织阻抗等。如可了解,这种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。主手柄还可以包含各种不同的致动器,以用于精细的组织操纵或治疗,从而进一步提高外科医生模拟实际操作条件的能力。
参考图48,医疗工作站通常被示为工作站1000,并且通常可以包含多个机器人臂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可包含:显示装置1006,其可特定设定成显示三维图像;和手动输入装置1007、1008,例如外科医生的人员(未示出)借助所述手动输入装置能够以第一操作模式远程操控机器人臂1002、1003。
根据本文公开的几个实施例中的任何一个,每个机器人臂1002、1003可以包含通过关节连接的多个构件,以及附接装置1009、1011,例如支撑末端执行器1100的外科手术工具“ST”可以与所述附接装置附接,如下文将更详细地描述。
机器人臂1002、1003可由连接到控制装置1004的电动驱动器(未示出)驱动。可以设置控制装置1004(例如,计算机)来激活驱动器,具体是通过计算机程序来激活驱动器,使得机器人臂1002、1003,其附接装置1009、1011以及因此外科手术工具(包含末端执行器1100)根据由手动输入装置1007、1008定义的移动执行所需移动。也可以以这样的方式设置控制装置1004:其调节机器人臂1002、1003和/或驱动器的移动。
医疗工作站1000可以被配置成用于躺在患者台1012上的待通过末端执行器1100以微创方式治疗的患者1013。医疗工作站1000也可以包含多于两个机器人臂1002、1003,另外的机器人臂同样地连接到控制装置1004并且可通过操作控制台1005远程操控。医疗器械或外科手术工具(包含末端执行器1100)也可以附接到另外的机器人臂。医疗工作台1000可包含数据库1014,具体地是与控制装置1004联接的数据库,在所述数据库中存储例如来自患者/活体1013和/或解剖图表集的术前数据。
参考了Neff等人的标题为“医疗工作站”的美国专利第8,828,023号,以用于对示范性机器人外科手术系统的构造和操作的更详细的讨论,所述美国专利的全部内容通过引用并入本文。
设想了并且在本公开的范围内,包含具有其唯一且不同的闭合行程长度的一对夹钳的其它内窥镜组件可以设置有驱动组件,所述驱动组件与本文所描述的驱动组件中的任何驱动组件类似、用于适应其所述一对夹钳的闭合行程长度以及将所述一对夹钳的闭合行程长度调整成恒定的触发行程长度。
因此,可以提供根据本公开的原理构造的各种内窥镜组件,所述内窥镜组件也能够跨越多种不同制造商的多个平台触发或形成或闭合各种大小、材料和配置的外科手术夹具。
应当理解,前述描述仅是对本公开的说明性描述。在不脱离本公开的情况下,本领域的技术人员可以设计出各种替代性方案和修改。因此,本公开旨在涵盖所有这类替代、修改和变化。呈现参考附图所描述的实施例仅为了表明本公开的某些实例。与上文所述和/或所附权利要求中大致上不同的其它元件、步骤、方法和技术也旨在属于本公开的范围内。
Claims (18)
1.一种与外科手术器械一起使用的手柄组件,所述手柄组件包括:
壳体,其限定接触壁;
可移动手柄,其可枢转地安装到所述壳体上;
柱塞,其至少部分地安置在所述壳体内并限定纵向轴线,其中所述柱塞相对于所述壳体的远端平移被配置成影响所述外科手术器械的功能;
连杆,其将所述可移动手柄与所述柱塞互连,使得所述可移动手柄的致动导致所述柱塞相对于所述壳体纵向平移;和
反馈机构,被配置成向用户提供听觉反馈,所述反馈机构包含指示器卡扣线和由所述壳体的壁限定的轨道,所述卡扣线被配置成响应于所述柱塞的纵向平移而沿着所述轨道移动,以及所述卡扣线被配置成与所述壳体的所述接触壁接合,从而在所述可移动手柄已被致动预定量时产生用户能够听到的声音。
2.根据权利要求1所述的手柄组件,其中所述卡扣线被固定到所述柱塞以与所述柱塞一起移动。
3.根据权利要求1所述的手柄组件,其中所述卡扣线的远端延伸穿过安置在所述柱塞的近端部分处的孔。
4.根据权利要求1所述的手柄组件,其中所述卡扣线的一部分沿着所述轨道中平行于所述纵向轴线的第一路径向远端移动。
5.根据权利要求4所述的手柄组件,其中所述卡扣线的所述部分沿着所述轨道中平行于所述纵向轴线的第二路径向近端移动。
6.根据权利要求5所述的手柄组件,其中所述轨道的所述第一路径偏离所述轨道的所述第二路径。
7.根据权利要求6所述的手柄组件,其中在所述可移动手柄已被致动所述预定量之后,所述卡扣线沿着所述轨道的所述第二路径移动。
8.根据权利要求5所述的手柄组件,其中所述轨道的所述第一路径相较于所述轨道的所述第二路径更接近于所述纵向轴线。
9.根据权利要求1所述的手柄组件,其中所述卡扣线的所述部分沿着所述轨道的第三路径相对于所述纵向轴线横向移动。
10.根据权利要求9所述的手柄组件,其中所述卡扣线的所述部分在沿着所述轨道的所述第三路径移动时保持平行于所述纵向轴线。
11.根据权利要求9所述的手柄组件,其中所述卡扣线的所述部分沿着所述轨道的第四路径相对于所述纵向轴线横向移动,并与所述壳体的所述接触壁接触。
12.根据权利要求11所述的手柄组件,其中紧接在所述卡扣线的所述部分沿着所述轨道的所述第四路径移动之前,所述卡扣线的所述部分沿着所述轨道的所述第三路径移动。
13.根据权利要求1所述的手柄组件,其中所述卡扣线的所述部分与所述壳体的所述接触壁之间的接合使得所述手柄组件的至少一部分振动。
14.根据权利要求1所述的手柄组件,其中所述卡扣线的所述部分被配置成在所述可移动手柄已完成致动行程时与所述壳体的所述接触壁接合。
15.根据权利要求1所述的手柄组件,其中所述卡扣线大体上为“U”形。
16.根据权利要求15所述的手柄组件,其中所述卡扣线包含第一翼形部、第二翼形部和连接部分,所述连接部分使所述第一翼形部与所述第二翼形部互连。
17.根据权利要求16所述的手柄组件,其中所述壳体的所述轨道是第一轨道,其中所述卡扣线的所述第一翼形部沿着所述第一轨道移动,并且其中所述卡扣线的所述第二翼形部沿着由所述壳体的第二壁限定的第二轨道移动。
18.根据权利要求16所述的手柄组件,其中所述卡扣线的所述连接部分的远端延伸穿过所述柱塞的孔。
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Also Published As
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US20190076210A1 (en) | 2019-03-14 |
US10835341B2 (en) | 2020-11-17 |
EP3681414A1 (en) | 2020-07-22 |
WO2019055359A1 (en) | 2019-03-21 |
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Application publication date: 20200417 |