CN111491572B - 控制外科器械的夹持构件击发速率的系统 - Google Patents

控制外科器械的夹持构件击发速率的系统 Download PDF

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CN111491572B
CN111491572B CN201880080827.4A CN201880080827A CN111491572B CN 111491572 B CN111491572 B CN 111491572B CN 201880080827 A CN201880080827 A CN 201880080827A CN 111491572 B CN111491572 B CN 111491572B
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motor
end effector
surgical instrument
tissue
clamping member
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CN111491572A (zh
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F·E·谢尔顿四世
S·A·沃辛顿
J·L·哈里斯
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Ethicon LLC
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Abstract

本发明公开了控制外科器械的各种系统和方法。外科器械可包括马达和联接到马达的控制电路。马达可联接到夹持构件，该夹持构件被构造成能够使端部执行器在打开位置和闭合位置之间转变、切割组织以及/或者从端部执行器中的钉仓射出钉。控制电路可被编程为使马达在第一位置与第二位置之间的第一区域中以第一速率驱动夹持构件，并且使马达在第一位置与第二位置之间的第二区域中以第二速率驱动夹持构件；其中所述第一速率小于所述第二速率。

Description

控制外科器械的夹持构件击发速率的系统
背景技术
本发明涉及外科器械，并且在各种布置中，涉及被设计成缝合和切割组织的外科缝合和切割器械以及与其一起使用的钉仓。
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
在一个方面，一种外科器械包括：马达；以及联接到马达的控制电路，该控制电路被配置成能够：检测能够连接到外科器械的端部执行器是否处于闭合位置，该端部执行器被构造成能够接收支撑多个钉的仓；并且检测能够由马达在第一位置和第二位置之间驱动的夹持构件的位置，其中夹持构件被构造成能够：在夹持构件从第一位置运动到第二位置时，使端部执行器转变到闭合位置；并且在端部执行器处于闭合位置之后，随着夹持构件运动到第二位置而从仓部署多个钉；其中控制电路还被配置成能够：使马达在第一位置与第二位置之间的第一区域中以第一速率驱动夹持构件；并且使马达在第一位置与第二位置之间的第二区域中以第二速率驱动夹持构件；其中第一速率小于第二速率。
在另一方面，一种外科器械包括：马达；以及联接到马达的控制电路，该控制电路被配置成能够：检测能够连接到外科器械的端部执行器是否处于闭合位置，该端部执行器被构造成能够接收支撑多个钉的仓；并且检测能够由马达在第一位置、第二位置和第三位置之间驱动的夹持构件的位置，其中夹持构件被构造成能够：在夹持构件从第一位置运动到第二位置时，使端部执行器转变到闭合位置；并且在夹持构件从第二位置运动到第三位置时，从仓部署多个钉；其中控制电路还被配置成能够：使马达在第一位置与第二位置之间的第一区域中以第一速率驱动夹持构件；并且使马达在第二位置与第三位置之间的第二区域中以第二速率驱动夹持构件；其中第一速率小于第二速率。
在另一方面，一种外科器械包括：马达；以及联接到马达的控制电路，该控制电路被配置成能够：检测能够连接到外科器械的端部执行器是否处于闭合位置，该端部执行器被构造成能够接收支撑多个钉的仓；并且检测能够由马达在第一位置、第二位置和第三位置之间驱动的夹持构件的位置，其中夹持构件被构造成能够：在夹持构件从第一位置运动到第二位置时，使端部执行器转变到闭合位置；并且在夹持构件从第二位置运动到第三位置时，从仓部署多个钉；其中控制电路还被配置成能够使马达以对应于夹持构件在第二位置与第三位置之间的位置的可变速率驱动夹持构件，该夹持构件越靠近第二位置，可变速率越慢。
附图说明
本文所述的实施方案的各种特征连同其优点可结合如下附图根据以下描述来加以理解：
图1为机电外科系统的透视图；
图2为图1的外科系统的机电外科器械部分的远侧端部的透视图；
图3为外壳特征部和图2的机电外科器械的分解组件视图；
图4为图2的机电外科器械的一部分的后透视图；
图5为图1的外科系统的适配器和机电外科器械的一部分的局部分解组件视图；
图6为图5的适配器的一部分的分解组件视图；
图7为适配器的关节运动组件的一部分的剖面透视图；
图8为图7的关节运动组件的透视图；
图9为图8的关节运动组件的另一个透视图；
图10为图1的机电外科系统中采用的加载单元的分解组件视图；
图11为另选的适配器实施方案的透视图；
图12为图11的适配器的加载单元的一部分的侧正视图，其钳口处于打开位置；
图13为图11的加载单元的一部分的另一个侧正视图，其各部分以剖面示出并且其钳口处于闭合位置；
图14为图13的加载单元的一部分的底视图，其各部分以剖面示出；
图15为图11的加载单元的一部分的透视图，外管的一部分以虚线示出；
图16为用于控制外科器械的马达的电路的示意图；
图17为用于控制外科器械的马达的电路的示意图；
图18为外科器械的位置传感器的示意图；
图19为用于监测外科器械的马达电流的过程的逻辑流程图；
图20为根据图19所示的逻辑执行的各种夹持构件行程的一对曲线图；
图21为根据图19所示的逻辑执行的各种夹持构件行程的一对曲线图；
图22为包括间隙传感器和仓类别传感器的端部执行器的图；
图23为霍尔效应传感器的示意图；
图24为部分地接合到适配器的远侧端部的端部执行器的剖面图；
图25为沿其纵向轴线接合到适配器的远侧端部的端部执行器的剖面；
图26为用于选择击发夹持构件的初始速度的过程的逻辑流程图；并且
图27为根据图26所示的逻辑执行的各种夹持构件行程的曲线图。
具体实施方式
本申请的申请人拥有2017年12月15日提交且各自全文以引用方式并入本文的以下美国专利申请：
-名称为“SEALED ADAPTERS FOR USE WITH ELECTROMECHANICAL SURGICALINSTRUMENTS”的美国专利申请序列号15/843,485；
-名称为“END EFFECTORS WITH POSITIVE JAW OPENING FEATURES FOR USE WITHADAPTERS FOR ELECTROMECHANICAL SURGICAL INSTRUMENTS”的美国专利申请序列号15/843,518；
-名称为“SURGICAL END EFFECTORS WITH CLAMPING ASSEMBLIES CONFIGURED TOINCREASE JAW APERTURE RANGES”的美国专利申请序列号15/843,535；
-名称为“SURGICAL END EFFECTORS WITH PIVOTAL JAWS CONFIGURED TO TOUCHAT THEIR RESPECTIVE DISTAL ENDS WHEN FULLY CLOSED”的美国专利申请序列号15/843,558；
-名称为“SURGICAL END EFFECTORS WITH JAW STIFFENER ARRANGEMENTSCONFIGURED TO PERMIT MONITORING OF FIRING MEMBER”的美国专利申请序列号15/843,528；
-名称为“ADAPTERS WITH END EFFECTOR POSITION SENSING AND CONTROLARRANGEMENTS FOR USE IN CONNECTION WITH ELECTROMECHANICAL SURGICALINSTRUMENTS”的美国专利申请序列号15/843,567；
-名称为“DYNAMIC CLAMPING ASSEMBLIES WITH IMPROVED WEARCHARACTERISTICS FOR USE IN CONNECTION WITH ELECTROMECHANICAL SURGICALINSTRUMENTS”的美国专利申请序列号15/843,556；
-名称为“ADAPTERS WITH FIRING STROKE SENSING ARRANGEMENTS FOR USE INCONNECTION WITH ELECTROMECHANICAL SURGICAL INSTRUMENTS”的美国专利申请序列号15/843,514；
-名称为“ADAPTERS WITH CONTROL SYSTEMS FOR CONTROLLING MULTIPLE MOTORSOF AN ELECTRICAL MECHANICAL SURGICAL INSTRUMENT”的美国专利申请序列号15/843,501；
-名称为“HANDHELD ELECTROMECHANICAL SURGICAL INSTRUMENTS WITH IMPROVEDMOTOR CONTROL ARRANGEMENTS FOR POSITIONING COMPONENTS OF AN ADAPTER COUPLEDTHERETO”的美国专利申请序列号15/843,508；
-名称为“SYSTEMS AND METHODS OF CONTROLLING A CLAMPING MEMBER”的美国专利申请序列号15/843,689；以及
-名称为“METHODS OF OPERATING SURGICAL END EFFECTORS”的美国专利申请序列号15/843,704。
本文列出了许多具体细节，以提供对说明书中所述和附图中所示的实施方案的整体结构、功能、制造和用途的透彻理解。没有详细描述熟知的操作、部件和元件，以免使说明书中描述的实施方案模糊不清。读者将会理解，本文所述和所示的实施方案为非限制性示例，从而可认识到，本文所公开的特定结构和功能细节可为代表性和例示性的。在不脱离权利要求的范围的情况下，可对这些实施方案进行变型和改变。
术语“包括(comprise)”(以及“包括(comprise)”的任何形式，诸如“包括(comprises)”和“包括(comprising)”)、“具有(have)”(以及“具有(have)”的任何形式，诸如“具有(has)”和“具有(having)”)、“包含(include)”(以及“包含(include)”的任何形式，诸如“包含(includes)”和“包含(including)”)、以及“含有(contain)”(以及“含有(contain)”的任何形式，诸如“含有(contains)”和“含有(containing)”)为开放式系动词。因此，“包括”、“具有”、“包含”或“含有”一个或多个元件的外科系统、装置、或设备具有这些一个或多个元件，但不限于仅具有这些一个或多个元件。同样，“包括”、“具有”、“包含”或“含有”一个或多个特征部的系统、装置、或设备的元件具有那些一个或多个特征部，但不限于仅具有那些一个或多个特征部。
术语“近侧”和“远侧”在本文中是相对于操纵外科器械的柄部部分的临床医生来使用的。术语“近侧”是指最靠近临床医生的部分，术语“远侧”是指远离临床医生定位的部分。还应当理解，为简洁和清楚起见，本文可结合附图使用诸如“竖直”、“水平”、“上”和“下”等空间术语。然而，外科器械在许多方向和位置中使用，并且这些术语并非限制性的和/或绝对的。
提供各种示例性装置和方法以用于执行腹腔镜式和微创外科手术。然而，读者将容易理解，本文所公开的各种方法和装置可用于多种外科手术和应用中，包括例如与开放式外科手术结合。继续参阅本具体实施方式，读者将进一步理解，本文所公开的各种器械能够以任何方式插入体内，诸如通过自然腔道、通过成形于组织中的切口或穿刺孔等。器械的工作部分或端部执行器部分可直接插入患者体内或者可通过具有工作通道的进入装置插入，外科器械的端部执行器和细长轴可通过所述工作通道推进。
外科缝合系统可包括轴和从轴延伸的端部执行器。端部执行器包括第一钳口和第二钳口。第一钳口包括钉仓。钉仓能够插入到第一钳口中并且能够从第一钳口移除；然而，设想到其中钉仓不能够从第一钳口移除或至少能够易于从第一钳口替换的其它实施方案。第二钳口包括被构造成能够使从钉仓射出的钉变形的砧座。第二钳口能够相对于第一钳口围绕闭合轴线枢转；然而，可设想到其中第一钳口能够相对于第二钳口枢转的其它实施方案。外科缝合系统还包括被构造成能够允许端部执行器相对于轴旋转或进行关节运动的关节运动接头。端部执行器能够围绕延伸穿过关节运动接头的关节运动轴线旋转。设想了不包括关节运动接头的其它实施方案。
钉仓包括仓体。仓体包括近侧端部、远侧端部和在近侧端部与远侧端部之间延伸的平台。在使用中，钉仓被定位在待缝合的组织的第一侧上，并且砧座被定位在组织的第二侧上。砧座朝向钉仓运动以将组织压缩并夹持抵靠平台。然后，可移除地储存在仓体中的钉可被部署到组织中。仓体包括限定于其中的钉腔，其中钉可移除地储存在钉腔中。钉腔被布置成六纵向排。三排钉腔被定位在纵向狭槽的第一侧上且三排钉腔被定位在纵向狭槽的第二侧上。钉腔和钉的其它布置也是可能的。
钉由仓体中的钉驱动装置支撑。驱动装置能够在第一或非击发位置和第二或击发位置之间运动，以从钉仓射出钉。驱动装置通过保持器保留在仓体中，保持器围绕仓体的底部延伸并且包括被构造成能够抓持仓体以及将保持器保持至仓体的弹性构件。驱动装置能够通过滑动件在其非击发位置与其击发位置之间运动。滑动件能够在与近侧端部相邻的近侧位置和与远侧端部相邻的远侧位置之间运动。滑动件包括多个斜坡表面，该斜坡表面被构造成能够朝向砧座在驱动装置下方滑动以及提升驱动装置，并且钉在驱动装置上受到支撑。
除上述以外，滑动件还可通过击发构件朝远侧运动。击发构件被构造成能够接触滑动件并朝向远侧端部推动滑动件。限定于仓体中的纵向狭槽被构造成能够接收击发构件。砧座还包括被构造成能够接收击发构件的狭槽。击发构件还包括接合第一钳口的第一凸轮和接合第二钳口的第二凸轮。在击发构件朝远侧推进时，第一凸轮和第二凸轮可控制钉仓的平台和砧座之间的距离或组织间隙。击发构件还包括被构造成能够切入在钉仓和砧座中间捕集的组织的刀。希望刀定位成至少部分接近斜坡表面，使得钉先于刀被射出。
图1描绘了可用于执行各种不同外科手术的马达驱动(机电)外科系统1。从该图可以看出，外科系统1的一个示例包括电动手持式机电外科器械100，该电动手持式机电外科器械被构造用于选择性地附接到多个不同的外科工具器具(在本文中称为“适配器”)上，所述多个不同的外科工具器具各自被构造用于由电动手持式机电外科器械致动和操纵。如图1所示，手持式外科器械100被构造用于与适配器200选择性地连接，并且适配器200继而被构造用于与包括单次使用的加载单元(“SULU”)或一次性加载单元(“DLU”)或多次使用的加载单元(“MULU”)的端部执行器选择性地连接。在另一个外科系统实施方案中，各种形式的适配器200可以有效地与机器人控制的外科系统或自动外科系统的工具驱动组件一起使用。例如，本文所公开的外科工具组件可与各种机器人系统、器械、部件和方法诸如但不限于名称为“SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENTARRANGEMENTS”的美国专利9,072,535中公开的那些一起使用，该专利申请据此全文以引用方式并入本文。
如图1和图2所示，外科器械100包括电源组101和外壳壳体10，该外壳壳体被构造成能够选择性地接收和基本上包封电源组101。电源组101在本文中也可称为柄部组件101。一种形式的外科器械100例如在名称为“HANDHELD ELECTROMECHANICAL SURGICAL SYSTEM”的国际公布WO 2016/057225A1、国际申请PCT/US2015/051837中有所公开，该申请的全部公开内容据此以引用方式并入本文。除了理解本文所公开的本发明的各种特征部所必需之外，本文将不公开外科器械100的各个特征部，并且应当理解，可通过参考WO 2016/057225和以引用方式并入本文的其它参考文献获得更多细节。
如图3所示，外壳壳体10包括远侧半节段10a和近侧半节段10b，该近侧半节段通过沿远侧半节段10a和近侧半节段10b的上边缘定位的铰链16可枢转地连接到远侧半节段10a。当接合时，远侧半节段10a和近侧半节段10b在其中限定外壳腔体10c，电源组101选择性地位于该外壳腔体中。远侧半节段10a和近侧半节段10b中的每个包括相应的上部外壳部分12a、12b和相应的下部外壳部分14a、14b。下部外壳部分14a、14b限定按扣闭合特征部18，该按扣闭合特征部用于将下部外壳部分14a、14b选择性地彼此固定并且用于将外壳壳体10保持在闭合状态。外壳壳体10的远侧半节段10a限定连接部分20，该连接部分被构造为能够接纳适配器200的对应驱动联接组件210(参见图5)。具体地讲，外壳壳体10的远侧半节段10a具有凹陷部，当适配器200配合到外科器械100时，该凹陷部接收适配器200的驱动联接组件210的一部分。
远侧半节段10a的连接部分20限定从其内侧表面径向向内突出的一对轴向延伸的导轨21a、21b，如图5所示。当适配器200配合到外科器械100时，导轨21a、21b有助于使适配器200相对于外科器械100旋转取向。远侧半节段10a的连接部分20限定三个孔22a、22b、22c，所述孔形成在其面向远侧的表面中并且被布置在彼此共用的平面或线中。远侧半节段10a的连接部分20还限定同样形成在其面向远侧的表面中的细长狭槽24。远侧半节段10a的连接部分20还限定形成在其表面中的凹形连接特征部26(参见图2)。凹形连接特征部26选择性地接合适配器200的凸形连接特征部。
外壳壳体10的远侧半节段10a支撑面向远侧的切换控制按钮30。切换控制按钮30能够在向其施加对应的力或向其施加按压力时沿向左、向右、向上和向下方向被致动。外壳壳体10的远侧半节段10a支撑一对右侧控制按钮32a、32b(参见图3)；以及一对左侧控制按钮34a、34b(参见图2)。右侧控制按钮32a、32b和左侧控制按钮34a、34b能够在向其施加对应的力或向其施加按压力时被致动。外壳壳体10的近侧半节段10b支撑右侧控制按钮36a(参见图3)和左侧控制按钮36b(参见图2)。右侧控制按钮36a和左侧控制按钮36b能够在向其施加对应的力或向其施加按压力时被致动。
外壳壳体10包括选择性地支撑在远侧半节段10a中的无菌阻隔板组件60。具体地讲，无菌阻隔板组件60设置在远侧半节段10a的连接部分20后面和外壳壳体10的外壳腔体10c内。板组件60包括板62，该板可旋转地支撑三个联接轴64a、64b、64c(参见图3和图5)。每个联接轴64a、64b、64c从板62的相对侧延伸并且具有三叶形横截面轮廓。当无菌阻隔板组件60设置在外壳壳体10的外壳腔体10c内时，每个联接轴64a、64b、64c延伸穿过远侧半节段10a的连接部分20的相应孔22a、22b、22c。板组件60还包括支撑在板62上的电直通连接器66。直通连接器66从板62的相对侧延伸。直通连接器66限定多个接触路径，所述多个接触路径各自包括用于使电连接在板62上延伸的电缆。当板组件60设置在外壳壳体10的外壳腔体10c内时，联接轴64a、64b、64c的远侧端部和直通连接器66的远侧端部设置或位于外壳壳体10的远侧半节段10a的连接部分20内，并且被构造成能够与适配器200的各个对应特征部电接合和/或机械接合。
参见图3和图4，电源组或柄部组件101包括内部柄部壳体110，该内部柄部壳体具有下部壳体部分104和从下部壳体部分104延伸并且/或者支撑在下部壳体部分上的上部壳体部分108。下部壳体部分104和上部壳体部分108被分成远侧半节段110a和近侧半节段110b，该近侧半节段可通过多个紧固件连接到远侧半节段110a。当接合时，远侧半节段110a和近侧半节段110b限定其中具有内部壳体腔体110c的内部柄部壳体110，电源组芯组件106位于该内部壳体腔体中。电源组芯组件106被构造成能够控制外科器械100的各种操作。
内部柄部壳体110的远侧半节段110a支撑远侧切换控制接口130，该远侧切换控制接口与外壳壳体10的远侧切换控制按钮30可操作地对准。在使用中，当电源组101设置在外壳壳体10内时，切换控制按钮30的致动在切换控制接口130上施加力。内部柄部壳体110的远侧半节段110a还支撑一对右侧控制接口(未示出)和一对左侧控制接口132a、132b。在使用中，当电源组101设置在外壳壳体10内时，对外壳壳体10的远侧半节段10a的右侧控制按钮对或左侧控制按钮对中的一者的致动在内部柄部壳体110的远侧半节段110a的右侧控制接口对132a、132b或左侧控制接口对132a、132b中的相应一者上施加力。
参考图1至图5，内部柄部壳体110提供了电源组芯组件106位于其中的壳体。电源组芯组件106包括电池电路140、控制器电路板142和被构造成能够向外科器械100的电子部件中的任一个供电的可再充电电池144。控制器电路板142包括马达控制器电路板142a、主控制器电路板142b以及将马达控制器电路板142a和主控制器电路板142b互连的第一带缆142c。电源组芯组件106还包括支撑在主控制器电路板142b上的显示屏146。显示屏146通过设置在内部柄部壳体110的近侧半节段110b中的透光或透明窗口110d(参见图3)可见。可以设想，内部柄部壳体110的至少一部分可由透明刚性塑料等制成。还可以设想，外壳壳体10可包括形成在其中的窗口(与显示屏146和内部柄部壳体110的近侧半节段110b的窗口110d视觉对准)，并且/或者外壳壳体10可由透明刚性塑料等制成。
电源组芯组件106还包括由马达托架148支撑并且各自电连接到控制器电路板142和电池144的第一马达152、第二马达154和第三马达156。马达152、154、156设置在马达控制器电路板142a与主控制器电路板142b之间。每个马达152、154、156包括从其延伸的相应马达轴152a、154a、156a。每个马达轴152a、154a、156a具有用于传递旋转力或扭矩的三叶形横截面轮廓。每个马达152、154、156由相应的马达控制器控制。马达轴152a、154a、156a通过相应马达152、154、156的旋转用于驱动适配器200的轴和/或齿轮部件，以便执行外科器械100的各种操作。具体地，电源组芯组件106的马达152、154、156被配置成能够驱动适配器200的轴和/或齿轮部件。
如图1和图5所示，外科器械100被构造用于与适配器200选择性地连接，并且继而适配器200被配置用于与端部执行器500选择性地连接。适配器200包括外部旋钮壳体202和从旋钮壳体202的远侧端部延伸的外管206。旋钮壳体202和外管206的构造和尺寸被设计为容纳适配器组件200的部件。外管206的尺寸被设计用于内窥镜插入，具体地，外管可穿过典型的套管针端口、插管等。旋钮壳体202的尺寸被设计为不进入套管针端口、插管等。旋钮壳体202被构造成能够并且适于连接到外科器械100的外壳壳体10的连接部分20。
适配器200被配置成能够将外科器械100的第一联接轴64a或第二联接轴64b中的任一个的旋转转换成可用于操作端部执行器500的驱动组件540和关节运动连接件560的轴向平移，如图10所示并且如将在下文更详细地描述。如图6所示，适配器200包括可旋转地支撑其中的第一可旋转近侧驱动轴212、第二可旋转近侧驱动轴214和第三可旋转近侧驱动轴216的近侧内部壳体组件204。每个近侧驱动轴212、214、216作为旋转接收构件用于接收来自外科器械100的相应联接轴64a、64b和64c的旋转力。此外，适配器200的驱动联接组件210也被构造成能够可旋转地支撑分别布置在彼此共用的平面或线中的第一连接器套管218、第二连接器套管220和第三连接器套管222。每个连接器套筒218、220、222被构造成能够与外科器械100的相应的第一联接轴64a、第二联接轴64b和第三联接轴64c配合，如上所述。每个连接器套管218、222、220被进一步构造成能够与适配器200的相应的第一近侧驱动轴212、第二近侧驱动轴214和第三近侧驱动轴216的近侧端部配合。
适配器200的驱动联接组件210还包括设置在相应的第一连接器套管218、第二连接器套管220和第三连接器套管222远侧的第一偏置构件224、第二偏置构件226和第三偏置构件228。每个偏置构件224、226和228设置在相应的第一可旋转近侧驱动轴212、第二可旋转近侧驱动轴214和第三可旋转近侧驱动轴216周围。偏置构件224、226和228作用在相应的连接器套管218、222和220上，以在适配器200连接到外科器械100时帮助保持连接器套管218、222和220与外科器械100的相应联接轴64a、64b和64c的远侧端部接合。
同样在所示布置中，适配器200分别包括各自设置在内部壳体组件204和外管206内的第一驱动转换组件240、第二驱动转换组件250和第三驱动转换组件260。每个驱动转换组件240、250、260被构造成能够并且适于将外科器械100的第一联接轴64a、第二联接轴64b和第三联接轴64c的旋转传递到或转换成：适配器200的关节运动驱动器或杆258的轴向平移，以实现端部执行器500的关节运动；适配器200的环形齿轮266的旋转，以实现适配器200的旋转；或者适配器200的远侧驱动构件248的轴向平移，以实现端部执行器500的闭合、打开和击发。
仍然参见图6，第一力/旋转传递/转换组件240包括第一可旋转近侧驱动轴212，如上所述，该第一可旋转近侧驱动轴可旋转地支撑在内部壳体组件204内。第一可旋转近侧驱动轴212包括被构造用于与第一连接器套管218连接的非圆形或成型的近侧端部部分，所述第一连接器套管连接到外科器械100的相应第一联接轴64a。第一可旋转近侧驱动轴212包括螺纹远侧端部部分212b。第一力/旋转传递/转换组件240还包括驱动联接螺母244，该驱动联接螺母与第一可旋转近侧驱动轴212的螺纹远侧端部部分212b螺纹接合，并且可滑动地设置在外管206内。驱动联接螺母244可滑动地键合在外管206的近侧芯管部分内，以防止在第一可旋转近侧驱动轴212旋转时旋转。这样，在第一可旋转近侧驱动轴212旋转时，驱动联接螺母244沿着第一可旋转近侧驱动轴212的螺纹远侧端部部分212b平移，并且继而穿过和/或沿着外管206平移。
第一力/旋转传递/转换组件240还包括远侧驱动构件248，该远侧驱动构件与驱动联接螺母244机械接合，使得驱动联接螺母244的轴向运动导致远侧驱动构件248的对应量的轴向运动。远侧驱动构件248的远侧端部部分支撑连接构件247，该连接构件的构造和尺寸被设计用于与端部执行器500(图10)的驱动组件540的接合构件546选择性地接合。驱动联接螺母244和/或远侧驱动构件248用作端部执行器500的部件的力传递构件。在操作中，在由于外科器械100的第一联接轴64a的旋转而使第一可旋转近侧驱动轴212旋转时，驱动联接螺母244沿着第一可旋转近侧驱动轴212轴向平移。在驱动联接螺母244沿着第一可旋转近侧驱动轴212轴向平移时，远侧驱动构件248相对于外管206轴向平移。在远侧驱动构件248轴向平移时，其中连接构件247连接到远侧驱动构件上并且与附接到端部执行器500(图10)的驱动组件540的中空驱动构件548接合，远侧驱动构件248引起端部执行器500的驱动组件540的同时轴向平移，以实现端部执行器500的工具组件部分600的闭合和工具组件内的各种部件的击发。
仍然参见图6，适配器200的第二驱动转换组件250包括可旋转地支撑在内部壳体组件204内的第二近侧驱动轴214。第二可旋转近侧驱动轴214包括被构造用于与外科器械100的第二联接轴64c连接的非圆形或成型的近侧端部部分。第二可旋转近侧驱动轴214还包括螺纹远侧端部部分214a，该螺纹远侧端部部分被构造成能够与关节运动轴承组件252的关节运动轴承壳体253螺纹接合。参见图6至图9，关节运动轴承壳体253支撑具有内座圈257的关节运动轴承255，该内座圈可相对于外座圈259独立地旋转。关节运动轴承壳体253具有非圆形外部轮廓，例如泪滴形状，它可滑动地且不可旋转地设置在内部壳体毂部204a的互补孔(未示出)内。适配器200的第二驱动转换组件250还包括关节运动杆258，该关节运动杆具有固定到关节运动轴承255的内座圈257的近侧部分。关节运动杆258的远侧部分在其中包括狭槽258a，该狭槽被构造成能够接纳端部执行器500的关节运动连接件560(图10)的钩562。关节运动杆258用作端部执行器500的部件的力传递构件。在所示布置中并且如WO2016/057225A1中进一步讨论，关节运动轴承组件252是可旋转的且可纵向平移的，并且被构造成能够当端部执行器500的第一钳口构件610和第二钳口构件700处于接近位置时和/或当钳口构件610、700进行关节运动时允许端部执行器的自由、无阻碍的旋转运动。
在操作中，在第二近侧驱动轴214旋转时，关节运动轴承组件252沿第二近侧驱动轴214的螺纹远侧端部部分214a轴向平移，继而引起关节运动杆258相对于外管206轴向平移。当关节运动杆258轴向平移时，联接到端部执行器500的关节运动连接件560的关节运动杆258引起端部执行器500的关节运动连接件560的同时轴向平移，以实现工具组件600的关节运动。关节运动杆258固定到关节运动轴承253的内座圈257，并且因此相对于关节运动轴承253的外座圈259围绕纵向轴线自由旋转。
如图6所示，适配器200包括支撑在内部壳体组件204中的第三驱动转换组件260。第三驱动转换组件260包括固定地支撑在外部旋钮壳体202中并连接到外部旋钮壳体的旋转环形齿轮266。环形齿轮266限定齿轮齿266a的内部阵列，并且包括一对沿直径相对的径向延伸的突起266b。突起266b被构造成能够设置在限定于外部旋钮壳体202中的凹陷部内，使得环形齿轮266的旋转导致外部旋钮壳体202的旋转，反之亦然。第三驱动转换组件260还包括第三可旋转近侧驱动轴216，如上所述，该第三可旋转近侧驱动轴可旋转地支撑在内部壳体组件204内。第三可旋转近侧驱动轴216包括被构造用于与第三连接器220连接的非圆形或成型的近侧端部部分。第三可旋转近侧驱动轴216包括键合到其远侧端部的正齿轮216。反向正齿轮264将第三可旋转近侧驱动轴216的正齿轮216a相互接合到环形齿轮266的齿轮齿266a。在操作中，在第三可旋转近侧驱动轴216由于外科器械100的第三联接轴64b的旋转而旋转时，第三可旋转近侧驱动轴216的正齿轮216a与反向齿轮264接合，从而引起反向齿轮264旋转。在反向齿轮264旋转时，环形齿轮266也旋转，从而引起外部旋钮壳体202旋转。外部旋钮壳体202的旋转使外管206围绕适配器200的纵向轴线旋转。在外管206旋转时，连接到适配器200的远侧端部部分的端部执行器500也围绕适配器200的纵向轴线旋转。
适配器200还包括支撑在从适配器200的驱动联接组件210突出的杆273(图6)上的附接/脱离按钮272(图5)。附接/脱离按钮272由设置在杆273内或周围的偏置构件(未示出)偏置到未致动状态。按钮272包括唇缘或凸缘，该唇缘或凸缘被构造成能够卡扣在外科器械100的连接部分20的对应唇缘或凸缘后面。同样如WO 2016/057225 A1中所讨论，适配器200还可包括用于固定远侧驱动构件248的轴向位置的锁定机构280。从图21可以看出，例如，锁定机构280包括可滑动地支撑在外部旋钮壳体202上的按钮282。锁定按钮282连接到纵向延伸穿过外管206的致动杆(未示出)。致动杆在锁定按钮282运动时运动。在操作中，为了锁定远侧驱动构件248的位置和/或取向，使用者将锁定按钮282从远侧位置运动到近侧位置，从而引起锁定件(未示出)朝近侧运动，使得锁定件的远侧面运动脱离与凸轮构件288的接触，这致使凸轮构件288凸轮进入远侧驱动构件248的凹陷部249中。这样，防止远侧驱动构件248的远侧和/或近侧运动。当锁定按钮282从近侧位置运动到远侧位置时，致动杆的远侧端部抵抗偏置构件(未示出)的偏置而朝远侧运动到锁定件(未示出)中，以迫使凸轮构件288离开凹陷部249，从而允许远侧驱动构件248的无阻碍的轴向平移和径向运动。
再次返回图6，适配器200包括支撑在外部旋钮壳体202和内部壳体组件204之上和之中的电组件290。电组件290包括支撑在电路板294上的多个电接触刀片292，用于电连接到外科器械100的外壳壳体10的板组件的直通连接器。电组件290用于允许校准和通信信息(即，寿命周期信息、系统信息、力信息)经由外科器械100的电源组芯组件106的电插座部分传递到外科器械100的电路板。电组件290还包括电连接到电路板294的应变仪296。应变仪296安装在内部壳体组件204内，以限制应变仪296相对于其旋转。第一可旋转近侧驱动轴212延伸穿过应变仪296，以使应变仪296能够为第一可旋转近侧驱动轴212所表现出的击发/夹持负载提供闭环反馈。电组件290还包括滑环298，该滑环沿着外管206的驱动联接螺母244不可旋转地且可滑动地设置。滑环298与电路板294电连接，并且用于允许第一可旋转近侧驱动轴212的旋转和驱动联接螺母244的轴向平移，同时仍然保持滑环298与适配器200内的至少另一个电子部件的电接触，并且同时允许其它电子部件围绕第一可旋转近侧驱动轴212和驱动联接螺母244旋转。
仍然参见图6，内部壳体组件204包括毂部205，该毂部具有朝远侧取向的环形壁207，该环形壁限定基本上圆形的外部轮廓。毂部205包括基本上泪滴形的内部凹陷部或孔，该内部凹陷部或孔的形状和尺寸被设计为将关节运动轴承组件252可滑动地接收在其内。内部壳体组件204还包括固定到毂部204a的朝远侧取向的环形壁207的远侧面的环板254。环板254限定穿过其的孔254a，该孔的尺寸被设计为并形成于其中以便与第二近侧驱动轴214对齐并且可旋转地接收其远侧末端。这样，在第二近侧驱动轴214旋转以使关节运动轴承组件252轴向平移时，第二近侧驱动轴214的远侧末端被支撑并被防止远离第二近侧驱动轴214的纵向旋转轴线径向运动。
接下来转到图10，在一个示例中，端部执行器500可被构造用于单次使用(“一次性加载单元-DLU”)并且类似于名称为“LOADING UNIT HAVING DRIVE ASSEMBLY LOCKINGMECHANISM”的美国专利申请公布US 2010/0301097、名称为“LOCKING MECHANISM FOR USEWITH LOADING UNITS”的美国专利申请公布US 2012/0217284以及名称为“ADAPTERASSEMBLIES FOR INTERCONNECTING SURGICAL LOADING UNITS AND HANDLE ASSEMBLIES”的美国专利申请公布US 2015/0374371中所公开的那些DLU，每个此类参考文献的全部公开内容据此以引用方式并入本文。还可以设想，端部执行器500可被构造用于多次使用(MULU)，诸如在名称为“MULTI-USE LOADING UNIT”的美国专利申请公布US 2017/0095250中公开的那些端部执行器，该专利申请公布的全部公开内容据此以引用方式并入本文。
所描绘的外科器械100击发钉，但也可适于击发任何其它合适的紧固件，诸如夹具和两件式紧固件。在所示布置中，端部执行器500包括加载单元510。加载单元510包括近侧主体部分520和工具组件600。工具组件600包括一对钳口构件，所述一对钳口构件包括具有砧座组件612的第一钳口构件610和具有仓组件701的第二钳口构件700。一个钳口构件相对于另一个枢转，以使组织能够夹持在钳口构件之间。仓组件701可相对于砧座组件612运动，并且可在打开或未夹紧位置与闭合或接近位置之间运动。然而，砧座组件612或仓组件701和砧座组件612两者可以是可运动的。
仓组件701具有仓体702，并且在一些情况下具有通过卡扣配合连接、卡位装载、闩锁或通过另一种类型的连接附接到通道720的支撑板710。仓组件701包括紧固件或钉704，所述紧固件或钉被可运动地支撑在多个侧向间隔开的钉保持狭槽706中，所述钉保持狭槽被构造为组织接触表面708中的开口。每个狭槽706被构造成能够在其中接收紧固件或钉。仓体702还限定多个凸轮楔形狭槽，所述多个凸轮楔形狭槽容纳钉推动器709并且在底部(即，远离组织接触表面)是开放的以允许致动滑动件712纵向地穿过其中。在钉从仓体702击发之后，仓组件701可从通道720移除。另一个可移除的仓组件能够被加载到通道720上，使得外科器械100可被再次致动以击发另外的紧固件或钉。关于仓组件的另外细节可见于例如美国专利申请公布US2017/0095250以及以引用方式并入本文的各种其它参考文献中。
仓组件701相对于砧座组件612枢转，并且可在打开或未夹紧位置与闭合或夹紧位置之间运动，以穿过套管针的插管插入。近侧主体部分520至少包括驱动组件540和关节运动连接件560。在一种布置中，驱动组件540包括具有远侧端部544和近侧接合节段546的柔性驱动梁542。接合节段546的近侧端部包括沿直径相对的向内延伸的指状物547，该指状物接合中空驱动构件548以将驱动构件548牢固地固定到梁542的近侧端部。驱动构件548限定近侧孔口，当端部执行器500附接到适配器200的远侧端部时，该近侧孔口接收适配器200的第一驱动转换组件240的驱动管246的连接构件247。
端部执行器500还包括壳体组件530，该壳体组件包括外部壳体532和设置在外部壳体532内的内部壳体534。第一和第二耳状物536各自设置在外部壳体532的近侧端部533的外表面上，并且被构造成能够可操作地接合适配器200的远侧端部，如WO 2016/057225A1中进一步详细讨论。
参考图10，例如，砧座组件612包括砧座盖630和砧座板620，该砧座板包括多个钉成形凹入部。砧座板620固定到砧座盖630的下侧。当工具组件600处于接近位置时，钉成形凹入部被定位成与仓组件701的钉接收狭槽并置对齐。
工具组件600包括安装组件800，该安装组件包括上部安装部分810和下部安装部分812。安装尾部632从砧座盖630的近侧端部631朝近侧突出。居中定位的枢转构件814从每个上部安装部分810和下部安装部分812延伸穿过形成在联接构件820中的开口822。在至少一种布置中，上部安装部分810的枢转构件814也延伸穿过安装尾部632中的开口634。联接构件820各自包括联锁近侧部分824，该联锁近侧部分被构造成能够接收到形成在外部壳体532和内部壳体534的远侧端部中的对应沟槽中。端部执行器500的近侧主体部分520包括具有钩状近侧端部562的关节运动连接件560。关节运动连接件560的尺寸被设计为可滑动地定位在内部壳体中的狭槽内。一对H块组件830被定位成与外部壳体532的远侧端部相邻并且与轴向驱动组件540的远侧端部544相邻，以防止柔性驱动梁542在外科缝合装置10的关节运动和击发期间向外屈曲和鼓起。每个H块组件830包括柔性主体832，该柔性主体包括牢固地固定到外部壳体532的远侧端部的近侧端部和牢固地固定到安装组件800的远侧端部。在一种布置中，关节运动连接件的远侧端部564枢转地销接到右侧H块组件830。关节运动连接件560的轴向运动将致使工具组件相对于主体部分520进行关节运动。
图11至图15示出了适配器200’，除下述不同之外，该适配器基本上与适配器200相同。从图11可以看出，适配器200’包括外管206，该外管具有近侧端部部分910，该近侧端部部分具有第一直径“FD”并且安装在外部旋钮壳体202内。近侧端部部分910可例如以WO2016/057225A1中进一步详细讨论的方式联接到内部壳体组件204或以其它方式支撑在其中。近侧端部部分910从具有第二直径“SD”的中心管部分912朝近侧延伸。在所示实施方案中，端部执行器500联接到轴组件203或外管206的远侧端部914。外管206限定在近侧端部部分910与远侧端部914之间延伸的纵向轴线LA，如在图11中可见。从图10和图11可以看出，端部执行器500的近侧主体部分520的外部套管570具有远侧端部部分572和近侧端部部分574。近侧端部部分574的直径SD’大致等于中心管部分912的第二直径SD。远侧端部部分572具有第三直径“TD”。在一种布置中，FD和TD大致等于且大于SD。还可设想其它布置，其中FD和TD不相等，但各自均大于SD。然而，优选的是，对于大多数情况，FD和TD的尺寸被设计用于通过典型的套管针端口、插管等插入内窥镜。在至少一种布置(图11)中，外部套管570形成有平坦的或圆齿状的侧面576以有利于改善在患者体内的通路，同时有效地容纳适配器200’的各种驱动和关节运动部件。此外，通过提供具有减小的直径的中心管部分912，可为适配器200’提供改善的胸廓肋骨间通路。
在至少一种布置中，可由金属片加工或制成的通道720包括一对近侧孔722(图10)，该对近侧孔被构造成能够与砧座盖630中的一对对应孔636对齐以接收对应的销或凸台638(图12)，从而有利于砧座组件612与仓组件701之间的枢转关系。在所示的示例中，动态夹持组件550附接到柔性驱动梁542的远侧端部544或形成于该远侧端部处。动态夹持组件550包括竖直主体部分552，该竖直主体部分具有形成在其上或附接到其上的组织切割表面554。例如参见图10。砧座接合特征部556形成在主体部分552的一个端部上，并且包括从主体部分552的每个侧面突出的砧座接合突片557。类似地，通道接合特征部558形成在主体部分552的另一个端部上，并且包括从主体部分552的每个侧面突出的通道接合突片559。参见图15。
如上所述，砧座组件612包括砧座板620。砧座板620包括细长狭槽622，该细长狭槽被构造成能够在击发过程中动态夹持组件550轴向推进时容纳动态夹持组件550的主体部分552。细长狭槽622被限定在沿着细长狭槽622的每个侧面延伸的两个砧座板凸缘624之间。参见图10。在动态夹持组件550朝远侧推进时，砧座接合突片557可滑动地接合砧座板凸缘624，以保持砧座组件612被夹持在靶组织上。相似地，在击发操作期间，动态夹持组件550的主体部分552延伸穿过通道720中的中心狭槽，并且通道接合突片559可滑动地接合沿着中心通道狭槽的每一侧延伸的通道凸缘725，以保持仓组件701被夹持在靶组织上。
转到图13和图15，通道720限定一般标示为730的对接区域，该对接区域被构造成能够在动态夹持组件550处于其最近侧位置(在本文中称为未击发或起始位置)时容纳动态夹持组件。具体地，对接区域730由平坦对接表面732部分地限定，所述平坦对接表面在动态夹持组件550上的通道接合突片559之间提供间隙以使仓组件701能够枢转到完全打开位置。倾斜或凸轮表面726从对接表面732中的每个的远侧端部延伸。倾斜表面726由动态夹持组件550接合，以使砧座组件612和仓组件701相对于彼此运动。在其它实施方案中，类似的凸轮表面可设置在砧座组件612上。可以设想，倾斜表面726还可有利于通道720与支撑板620和/或仓体702之间的对齐和/或接合。在驱动组件540朝远侧推进(击发)时，动态夹持组件550上的通道接合突片559接合对应的倾斜表面726以向仓组件701施加闭合运动，从而闭合仓组件701和砧座组件612。动态夹持组件550的进一步远侧平移使致动滑动件712朝远侧运动穿过仓体702，这使得致动滑动件712的凸轮楔形件713依次接合钉推动器709，以使钉推动器709在钉保持狭槽706内竖直运动，并将钉704射入砧座板620的钉成形凹入部中。在钉704从保持狭槽706射出(并进入组织中)之后，当动态夹持组件550的竖直主体部分552上的组织切割刃554朝远侧行进穿过仓体702的中心狭槽703时，动态夹持组件550的切割刃554切断被缝合的组织。在钉704从仓体702射出并且使用者希望使用同一器械10来击发另外的钉704(或另一种类型的紧固件或刀)之后，使用者可从适配器200’移除加载单元510并将其替换为另一个新的或未用过的加载单元。在另选的布置中，使用者可简单地移除用过的仓体702，并将其替换为新的未用过的或未击发的仓体702。
外科器械100可包括用于检测与外科器械100的操作相关联的各种状态和/或参数的传感器组件。控制电路或处理器可监测这些感测到的状态和/或参数，然后相应地控制外科器械100的操作。例如，外科器械100可监测由驱动第一力/旋转传递/转换组件240(图6)的马达所消耗的电流，以便控制夹持构件550(图10)平移的速度。又如，当端部执行器500被夹紧时，外科器械100可监测钳口构件或砧座板620(图10)与仓体702(图10)之间的间隙或距离，以便控制其后夹持构件550被驱动的速度。具有由控制电路或处理器结合传感器组件执行的对应逻辑的这些和其它传感器组件在下文中进行了描述。
图16和图17示出了根据本公开的各个方面的用于控制外科器械的马达2010的电路2000的示意图。在所描绘的方面，电路2000包括开关2002、第一限位开关2004(例如，常开开关)、第二限位开关2006(例如，常闭开关)、功率源2008和马达2010(例如，被配置成能够驱动第一力/旋转传递/转换组件240的马达)。电路2002还可包括第一继电器2012(例如，单刀双掷继电器)、第二继电器2014(例如，单刀单掷继电器)、第三继电器2016(例如，双刀双掷继电器)、电流传感器2018和电流检测模块2030。在一个方面，电路2000可包括马达控制电路2028，该马达控制电路被配置成能够感测通过马达2010的电流，然后相应地控制电流。在图16所示的方面，第二继电器2014、电流传感器2018、位置传感器2020和电流检测模块2030共同构成马达控制电路2028。在图17所示的方面，第二继电器2014、电流传感器2018、位置传感器2020和控制器2034共同构成马达控制电路2028。如下所述，马达控制电路2028通过基于所感测到的电流中断电流来控制流入马达2010的电流，从而在某些状况发生时停用马达2010。
当外科器械100的操作者开始夹持构件550的击发以夹紧端部执行器500并切割和/或缝合组织时，开关2002被激活。第一限位开关2004被构造成能够在端部执行器500的切割/缝合操作尚未完成时保持断开。当第一限位开关2004断开时，第一继电器2012的线圈2022断电，从而经由继电器2012的常闭触点在功率源2008与第二继电器2014之间形成导电路径。第二继电器2014的线圈2026由电流检测模块2030和位置传感器2020控制，如下所述。当第二继电器2014的线圈2026和第一继电器2022的线圈2022断电时，在功率源2008与第三继电器2016的常闭触点之间形成导电路径。第三继电器2016基于开关2004、2006的状态控制马达2010的旋转方向。当第一限位开关2004断开并且第二限位开关2006闭合时(指示夹持构件550尚未朝远侧完全部署)，第三继电器2016的线圈2024断电。因此，当线圈2022、2024、2026共同断电时，来自功率源2008的电流经由第三继电器2016的常闭触点流过马达2010，并且引起马达2010的正向旋转，这继而引起夹持构件550被马达2010朝远侧驱动以夹持端部执行器500并切割和/或缝合组织。
当夹持构件550已朝远侧完全推进时，第一限位开关2004被构造成能够闭合。当第一限位开关2004闭合时，第一继电器2012的线圈2022通电，并且第三继电器2016的线圈2024经由继电器2012的常开触点通电。因此，电流现在经由继电器2012、2016的常开触点流向马达2010，从而引起马达2010的反向旋转，这继而引起夹持构件550从其远侧位置回缩并且第一限位开关2004断开。第二限位开关2004被构造成能够在夹持构件550完全回缩时断开。继电器2012的线圈2022保持通电，直到第二限位开关2006断开，指示夹持构件550的完全回缩。
在马达2010正向旋转期间通过马达的电流的大小指示当夹持构件550被马达2010朝远侧驱动时施加在夹持构件上的力。如果钉仓702未被加载到端部执行器500中，则不正确的钉仓702被加载到端部执行器500中，或者如果夹持构件550在切割和/或缝合组织时经历来自组织的出乎意料地高的阻力，针对夹持构件550施加的抗力使马达扭矩增大，从而使马达电流增大。如果马达电流超过阈值，则马达控制电路2028可切断流向马达2010的电流，停用马达并因此暂停夹持构件550的推进。因此，通过感测通过马达2010的电流，马达控制电路2028可以区分夹持构件550的部署的正常操作阈值与潜在错误状态。
电流传感器2018可联接到电路2000的路径，该电路在马达2010正向旋转期间将电流传导到马达。电流传感器2018可以是适用于生成表示所感测到的马达电流的信号(例如，电压信号)的任何电流感测装置(例如，分流电阻器、霍尔效应电流换能器等)。所生成的信号可被输入到电流检测模块2030以在其中进行处理。根据图16所示的方面，电流检测模块2030可被构造用于经由比较器电路2032将由电流传感器2018生成的信号与阈值信号(例如，阈值电压信号)进行比较，以接收阈值和电流传感器2018信号并基于所接收信号的比较来生成离散输出。在一些方面，阈值信号的值可以先验地通过在切割和缝合操作期间当夹持构件550(例如，在其远侧运动的初始周期或长度上)被初始部署时测量电流传感器2018所生成的峰值信号来根据经验确定。在其它方面，阈值信号的值可以是预先确定的值，在一个示例中，该预先确定的值可以从存储器中检索。
在一些方面，期望将所感测到的马达电流与阈值的比较限制在沿夹持构件550的击发行程的特定位置或位置范围。在这些方面，马达控制电路2028还包括位置传感器2020，该位置传感器被配置成能够生成指示夹持构件550(或者另选地，对于其中图16和图17中表示的马达2010驱动第二或第三力/旋转传递/转换组件250、260的各方面，则为第二或第三力/旋转传递/转换组件250、260的部件)的位置的信号。位置传感器2020可包括例如图18所示且下文更详细地描述的位置感测组件。位置传感器2020与比较器电路2032(或图17所示方面的微控制器2034)串联连接，以基于夹持构件550的位置来限制比较。因此，如果由电流传感器2018生成的信号超过阈值信号(指示夹持构件550遇到出乎意料地高的阻力)并且夹持构件550位于由位置传感器2020确定的特定区域内，则第二继电器2014的线圈2026将通电。这致使第二继电器2014的常闭开关断开，从而中断流向马达2010的电流并暂停夹持构件550的推进。这样，如果当夹持构件550的位置不在激活位置传感器2020的位置时超过阈值信号，则马达控制电路2038将不停用马达2010，而不管比较结果如何。在其它方面，马达控制电路2038被配置成能够沿着夹持构件550的整个击发行程监测马达电流。在这些方面，马达控制电路2038缺少位置传感器2020(或者位置传感器2020被停用)，并且比较器电路2032(或微控制器2034)的输出被直接馈送到第二继电器2014。因此，如果由电流传感器2018生成的信号在沿着夹持构件550的击发行程的任何点处超过阈值信号，则以上述方式中断流向马达2010的电流。
根据图17所示的方面，马达控制电路2028可包括基于处理器的微控制器2034以代替上述电流检测模块2030。尽管为清楚起见未示出，但微控制器2034可包括微控制器领域中熟知的部件，诸如处理器、随机存取存储器(RAM)单元、可擦除可编程只读存储器(EPROM)单元、中断控制器单元、定时器单元、模数转换(ADC)和数模转换(DAC)单元，以及用于接收和传输数字和模拟信号的多个通用输入/输出(I/O)端口。在一个示例中，微控制器2034包括马达控制器，该马达控制器包括得自Allegro Microsystems,Inc的A3930/31K马达驱动器。A3930/31K马达驱动器被设计成控制具有N沟道外部功率MOSFET的3相无刷直流(BLDC)马达，诸如马达152、154、156(图4)。马达控制器中的每个联接到设置在主控制器电路板142b(图4)上的主控制器。主控制器还联接到存储器，该存储器也设置在主控制器电路板142b(图4)上。在一个示例中，主控制器包括得自Freescale Semiconductor,Inc的ARMCortex M4处理器，其包括1024千字节的内部闪存存储器。主控制器通过FPGA与马达控制器通信，该FPGA提供控制逻辑信号。然后马达控制器的控制逻辑使用固定频率脉宽调制(PWM)将对应的激励信号输出到其相应的马达152、154、156。
电流传感器2018和位置传感器2020可分别连接到微控制器2034的模拟输入和数字输入，并且第二继电器2014的线圈2026可连接到微控制器2034的数字输出。应当理解，在其中位置传感器2020的输出是模拟信号的方面，位置传感器2020可改为连接到模拟输入。另外，尽管电路2000包括继电器2012、2014、2016，但应当理解，在其它方面，继电器切换功能可使用固态开关器件、软件以及它们的组合来复制。在某些方面，例如，在微控制器2034中存储和执行的指令可用于控制微控制器2034的固态切换输出。在此类方面，开关2004、2006可连接到微控制器2034的数字输入。
图18示出了根据本公开的一个方面的外科器械100的位置传感器2102的示意图。位置传感器2102可被实现为AS5055EQFT单片磁性旋转位置传感器，其购自AustriaMicrosystems,AG。位置传感器2102与控制器2104交接，以提供绝对定位系统2100。位置传感器2102为低电压和低功率部件，并且包括在位置传感器2102的位于磁体上方的区域2120中的四个霍尔效应元件2106A、2106B、2106C、2106D，所述磁体联接到外科器械100的部件。磁体可联接到例如驱动第一力/旋转传递/转换组件240的马达的驱动轴、第一力/旋转传递/转换组件240的近侧驱动轴212、或者在夹持构件550平移时由夹持构件550可旋转地驱动的齿轮组件。换句话讲，磁体可联接到外科器械100的部件，使得磁体相对于霍尔效应元件2106A、2106B、2106C、2106D的角位置对应于例如夹持构件550的纵向位置。在芯片上也提供了高分辨率ADC 2108和智能型电源管理控制器2112。提供了CORDIC处理器2110(针对坐标旋转数字计算机(Coordinate Rotation Digital Computer))，也称为逐位法和Volder算法，以实现简单有效的算法来计算双曲线函数和三角函数，这些函数仅需要加法操作、减法操作、位位移操作和表查找操作。角位置、报警位和磁场信息通过标准串行通信接口诸如SPI接口2114传输到控制器2104。位置传感器2102提供12或14位分辨率。位置传感器2102可以是以小QFN 16引脚4mm×4mm×0.85mm封装提供的AS5055芯片。
霍尔效应元件2106A、2106B、2106C、2106D位于旋转磁体(未示出)正上方。霍尔效应是众所周知的效应，并且为了方便起见，本文中将不对其进行详细描述；但是，霍尔效应通常会在整个导体上产生横向于导体中的电流的电压差(霍尔电压)和垂直于该电流的磁场。霍尔系数被限定为感应电场与电流密度和所施加磁场的乘积的比率。其为从中制备导体的材料的特性，因为其值取决于构成电流的电荷载体的类型、数目和性能。在AS5055位置传感器2102中，霍尔效应元件2106A、2106B、2106C、2106D能够产生电压信号，其指示根据磁体1202经过单次转动的角度的磁体1202的绝对位置。由CORDIC处理器2110计算角度的这个值(其为独特位置信号)，并且将其以机载方式存储在寄存器或存储器中的AS5055位置传感器2102上。在多种技术中，例如在加电时或在控制器2104发出请求时，向控制器2104提供角度的值，其指示经过一次转动的磁体1202的位置。
AS5055位置传感器2102在连接至控制器2104时需要仅几个外部部件就可操作。使用单一功率源的简单应用需要六根电线：两根电线用于电力，四根电线2116用于与控制器2104的SPI接口2114。可加入第七连接，以便向控制器2104发送中断以通知可读取新的有效角度。在通电时，AS5055位置传感器2102执行完全通电序列，包括一个角度测量。该循环的完成表示为INT输出2118，并且角度值存储在内部寄存器中。一旦设定了这一输出，AS5055位置传感器2102就暂停为休眠模式。控制器2104可通过SPI接口2114从AS5055位置传感器2102读取角度值来响应INT输出2118处的INT请求。一旦控制器2104读取了角度值，就再次清除INT输出2118。由控制器2104通过SPI接口2114向位置传感器2102发送“读取角度”命令也自动使芯片加电并且启动另一个角度测量。控制器2104一完成角度值的读取，就清除INT输出2118并且将新的结果存储在角度寄存器中。通过设定INT输出2118和状态寄存器中的对应标记再次指示角度测量的完成。
由于AS5055位置传感器2102的测量原理，每个加电序列之后，在非常短的时间(约600μs)内执行仅单次角度测量。一个角度的测量一完成，AS5055位置传感器2102就暂停为掉电状态。未执行根据数字平均化的角度值的片上过滤，因为这将需要不止一个角度测量并且因此需要更长加电时间，这在低功率应用中是不期望的。可通过在控制器2104中对数个角度样本进行平均来减少角度抖动。例如，平均四个采样可使抖动减少6dB(50％)。
图19示出了根据本公开的一个方面的用于监测外科器械100的马达电流的过程2200的逻辑流程图。在对过程2200的以下描述中，还应参考图16至图18，其中描绘了过程2200所利用的各种传感器组件；以及图20至图21，其中描绘了根据过程2200执行的夹持构件550的各种击发行程。本发明所述的过程2200可由控制器执行，该控制器包括图16至图17所示的控制电路、图18的微控制器2104或者执行存储在外科器械100的存储器中的逻辑和/或指令的其它控制电路和/或处理器。当端部执行器500的夹持和切割/缝合操作开始2202时，开始执行过程2200。
因此，由控制器执行的过程2200通过使夹持构件550可操作地连接的马达2010通电而将夹持构件550从第一或近侧位置推进2204。夹持构件550在第一或近侧位置与第二或远侧位置之间的推进可称为行程或击发行程。在夹持构件550的整个行程的过程中，夹持构件550将夹紧端部执行器500，然后切割和/或缝合由此保持的组织。夹持构件550的行程可以表示为例如曲线图，在该曲线图中x轴对应于夹持构件550已推进的距离或时间，如图20至图21所示。由夹持构件550实现的动作可对应于限定在夹持构件550的行程内的位置或区域。例如，在行程中可存在夹持构件550已闭合端部执行器500并且然后切割和/或缝合组织的位置。又如，在夹持构件550的行程中可存在夹持构件550不再射出钉或切割组织的位置。控制器也可根据夹持构件550的位置采取各种动作。例如，可存在其中夹持构件550被驱动的速度由控制器控制或改变的位置。这些位置或区域可以指夹持构件所处的实际物理位置或夹持构件的行程内的相对位置。所述位置或区域可以另选地表示为夹持构件550的行程中的时间，如图20所示。
在夹持构件550被推进2204时，控制器经由例如电流传感器2018检测马达电流2206。然后，控制器确定夹持构件550是否处于闭合结束位置2208。在一个示例中，控制器可经由位置传感器2102确定夹持构件是否处于闭合结束位置2208。闭合结束位置对应于夹持构件550的击发行程中夹持构件550闭合端部执行器500之后的位置，并且然后在夹持构件550继续朝远侧推进时切割组织和/或击发钉。在一些方面，控制器可从存储器中检索闭合结束位置，然后将所存储的闭合结束位置与夹持构件550的检测位置进行比较，以确定检测位置是否匹配或超过所存储的闭合结束位置。在其它方面，控制器可通过例如监测马达电流的峰值来确定闭合结束位置。如果夹持构件550不处于闭合结束位置，则过程2200沿着“否”分支继续进行，并且控制器继续使马达2010推进2204夹持构件550。过程2200继续该循环，直到夹持构件550位于闭合结束位置。
如果控制器确定2208夹持构件550位于或超出闭合结束位置，则过程2200沿着“是”分支继续进行，并且控制器根据闭合结束位置处的马达电流的值选择2210夹持构件550将由马达2010驱动的目标击发速度。闭合端部执行器500所需的马达电流水平可指示所夹持的组织的各种特性。例如，由于夹持构件550施加以夹持组织的力与组织的厚度成比例，因此闭合结束位置处的马达电流的值可对应于所夹持组织的厚度。当由夹持构件550施加的力或由马达2010施加的扭矩与马达2010所消耗的电流成比例时，闭合结束位置处的马达电流水平因此对应于所夹持组织的厚度。期望根据所夹持组织的厚度设定夹持构件550被驱动的目标击发速度，因为过快地推进夹持构件550穿过厚组织可导致不当的钉成形并增加马达2010上的应变。又如，马达电流水平还可对应于所夹持组织(例如，肺组织、胃肠组织或心脏组织)的解剖类型，因为由夹持构件550驱动的施加在切割表面554上的物理阻力可针对不同组织类型而变化。在一些方面，控制器可将闭合结束位置处的马达电流的感测值与马达电流值的范围进行比较，然后确定所感测到的马达电流是否超过一个或多个阈值或落入该范围的一个或多个区域内。然后，控制器可以选择夹持构件550的目标击发速度2210作为特定值，或者设定包括一系列值的目标击发速度的公差阈值，这些值对应于所感测到的马达电流处于该范围内的位置。
在选择目标击发速度2210之后，控制器随后使夹持构件550以初始速度推进2212。初始速度以及夹持构件550以初始速度推进的时间或距离长度可被设定为由控制器从存储器检索的值或由控制器根据组织厚度确定的计算值。在一些方面，控制器缺少过程2200的该步骤，而是简单地继续以所确定的目标速度推进夹持构件550。初始速度可以是小于目标击发速度的值。换句话讲，控制器可以使马达2010初始以相对于击发行程的后续部分或区域的较低速度在击发行程的第一区域或部分中推进夹持构件550。在一些方面，初始速度的值可以为零或几乎为零。期望初始以较低速度推进2212夹持构件550，以便允许流体从夹持在端部执行器500处的组织中排出。由于由端部执行器500施加在组织上的机械力，流体从所夹持的组织排出。在一个方面，夹持构件550以初始速度推进的时间或距离长度可根据所夹持的组织的厚度而变化。
在夹持构件550的击发行程中紧接在闭合结束位置之后的部分期间，控制器还确定马达电流是否超过最大阈值或锁定阈值2214。控制器可从存储器检索锁定阈值。超过锁定阈值的所感测到的马达电流指示夹持构件550未从闭合结束位置朝远侧推进。出于多种原因，诸如如果端部执行器500缺少钉仓组件700，则可防止夹持构件550在其击发行程中紧接在闭合结束位置之后的部分中朝远侧推进。如果马达电流超过锁定阈值，则过程2200沿着“是”分支继续进行并停止2216，以便减小马达2010上的应变。然后，控制器可以使外科器械100向操作者显示警示或采取其它此类动作。
如果马达电流未超过锁定阈值，则过程2200沿着“否”分支继续进行，然后控制器使夹持构件550以速率增加的速度推进2218，直到速度达到目标速度值或在目标速度范围(其为组织厚度的函数)内。在一些方面，控制器使马达2010驱动夹持构件550以增加夹持构件550的速度的速率为设定速率或预先确定的速率。在其它方面，夹持构件550的速度增加的速率取决于一个或多个参数诸如组织厚度的函数。换句话讲，控制器可被配置成能够使夹持构件550的速度对于较厚的组织而言增加较慢或者对于较薄的组织而言增加较快。
当夹持构件550朝远侧推进(即，击发)时，控制器检测马达电流2220。因此，控制器确定所感测到的马达电流是否超过阈值2222。在一个示例中，控制器可以从存储器检索阈值以与所检测到的2220马达电流进行比较。该阈值可以与上述锁定阈值相同或不同。此外，阈值可以对应于例如组织厚度。在一些方面，如果控制器确定马达电流已超过所确定的阈值2222，则过程2200沿着“是”分支继续进行，并且控制器降低夹持构件550的击发速度2224。在其它方面，如果控制器确定马达电流已超过所确定的阈值2222，则过程2200沿着“是”分支继续进行，并且控制器使夹持构件550在其击发行程中的当前位置处暂停2224。降低夹持构件550的击发速度或使夹持构件暂停2224减小了马达2010所经受的扭矩(至零，在暂停夹持构件550的情况下)。在特定时间长度之后或在夹持构件550推进特定距离之后(在夹持构件550减慢、未暂停的情况下)，过程2200重新循环并且控制器再次使夹持构件550推进2218。控制器开始使夹持构件550的速度增加之前经过的时间或距离可以是设定值或者可以是组织参数(例如，组织厚度)的函数。
如果控制器确定2222夹持构件550未超过阈值，则过程2200沿着“否”分支继续进行，然后控制器确定2226夹持构件550是否位于击发结束位置。击发结束位置对应于夹持构件550在其击发行程中达到的远侧点，以从端部执行器500切割组织和/或击发钉。如果夹持构件550未达到击发结束位置，则过程2200沿着“否”分支继续进行并重新循环。然后，控制器继续推进2218夹持构件550(并且视情况增加其速度)，并且在击发行程的过程中检测马达电流2220以确定2222马达电流是否超过阈值。控制器继续该循环，直到确定2226夹持构件550位于击发结束位置。如果控制器确定2226夹持构件550位于击发结束位置，则过程2200沿着“是”分支继续进行，然后停止2228。
为了提供关于控制器被配置成能够执行的上述功能的进一步解释，将根据图20至图21所示的若干示例性击发行程来讨论过程2200。图20示出了第一曲线图2300和第二曲线图2302，各自描绘了夹持构件550的第一击发行程2304和第二击发行程2306。第一曲线图2300描绘了夹持构件550的示例性击发行程2304、2306的马达电流2303与时间2301的关系，并且第二曲线图2302描绘了夹持构件速度2305与时间2301的关系。时间2301轴被描绘成“闭合”区域、“切割/缝合”区域和“停止”区域，其指示夹持构件550在其击发行程的每个相应部分中实现的动作。总的来讲，第一曲线图2300和第二曲线图2302示出了不同击发行程2304、2306的马达电流2303与夹持构件速度2305之间的关系以及由执行图19所示的过程2200的控制器采取的结果动作。
如上文结合图19所述，执行过程2200的控制器可被配置成能够根据闭合结束位置2308处的马达电流选择2210夹持构件550将被驱动的击发速度。换句话讲，控制器被配置成能够选择2210夹持构件550的击发速度，该击发速度适于或以其它方式对应于所夹持组织的厚度，如闭合结束位置2308处的马达电流所指示。在一个方面，控制器根据闭合结束位置2308处所感测的马达电流落入值的范围内的位置来选择夹持构件550的击发速度。在一些方面，这可表示为闭合结束位置2308处的马达电流是否已超过马达电流值范围中的一个或多个阈值。在其它方面，这可表示为闭合结束位置2308处的马达电流是否落入马达电流值范围的一个或多个特定区域内。
在所描绘的方面，存在第一阈值T1、第二阈值T2和第三阈值T3，这些阈值可界定分别对应于薄组织、中等组织和厚组织的区域。换句话讲，如果闭合结束位置2308处的马达电流低于T1，则可认为组织是薄的，因为马达2010施加相对小的扭矩以将端部执行器500夹持在组织上。相应地，如果闭合结束位置2308处的马达电流已超过T1，但低于T2，则可认为组织具有中等、正常或预期的厚度。相应地，如果闭合结束位置2308处的马达电流已超T2，但低于T3，则可认为组织是厚的，因为需要马达2010施加高度的扭矩以夹持组织。如果闭合结束位置2308处的马达电流超过T3，则可认为组织过厚而不能切割和缝合或者可能已被不当地夹持。在这种情况下，过程2200可向操作者显示警告并且/或者锁定外科器械100以免进一步推进夹持构件550。然而，三个阈值T1、T2、T3的描绘仅仅是示例性的，并且过程2200可包含任何数量的阈值。夹持构件550将被驱动的速度可通过由控制器执行的过程2200来选择，以对应于由闭合结束位置2308处的马达电流指示的相对组织厚度。在所述方面，存在当马达电流不超过T1时选择的第一速度区域S1、当马达电流落入T1和T2之间时选择的第二速度区域S2以及当马达电流落入T2和T3之间时选择的第三速度区域S3。第一速度区域S1至第三速度区域S3对应于越来越慢的速度。期望以较快的速率驱动夹持构件550穿过较薄的组织，因为薄组织对适当的钉成形的阻力极小，因此可在不牺牲钉质量的情况下更快地完成操作。反之，期望以较慢的速率驱动夹持构件550穿过较厚的组织，因为如果滑动件712(图10)被夹持构件550过快地驱动，则钉可能不会在较厚的组织中正确地成形。因此，以较慢的速率驱动滑动件712确保钉完全刺穿组织并抵靠砧座板620完全成形(图10)。
第一击发行程2304和第二击发行程2306是其中控制器确定2222在夹持构件击发行程的过程中马达电流超过阈值，然后暂停2224夹持构件550的示例。例如，在第一击发行程2304中，闭合结束位置2308处的闭合马达电流2312已超过第二阈值T2；因此，控制器选择最慢速度区域S3作为夹持构件550在击发行程的切割/缝合阶段期间被驱动的目标速度。在第二击发行程2306中，闭合结束位置2308处的闭合马达电流2319已超过第一阈值T1；因此，控制器选择中等速度区域S2作为夹持构件550在击发行程的切割/缝合阶段期间被驱动的目标速度。速度区域S1、S2、S3设定夹持构件550被马达2010驱动的速度的上限和下限公差阈值。如果夹持构件550的速度超过由控制器选择的速度区域S1、S2、S3的上限和下限，则控制器可被配置成能够采取各种动作，诸如控制马达2010以增加或降低驱动夹持构件550的速度或者调节提供给马达2010的电能。换句话讲，速度区域S1、S2、S3表示其中夹持构件550实际平移的速度可变化而不引起控制器采取纠正动作的可接受速度范围。应当理解，尽管目标速度区域S1、S2、S3被描绘为第二曲线图2302中的范围，但它们可另选地作为离散值。一般来讲，期望设定夹持构件550推进的速度的公差范围，因为该速度将在击发行程期间自然地变化，因为组织的厚度不均匀，在滑动件712射出(彼此间隔开的)钉时，夹持构件550趋于减慢，并且组织切割表面554(图10)可推进穿过具有不同物理特性的不同类型的组织。
继续描述第一击发行程2304，在闭合结束位置2308之后，控制器使夹持构件550被推进的速度从闭合速度2332下降到初始速度2333，该初始速度可低于所选目标速度(并且在一些情况下为零)。初始速度2333对应于低初始马达电流2313。然后，控制器将夹持构件550被驱动的速度逐渐增加到目标速度2334，该目标速度在控制器先前选择的目标速度范围S3内。在夹持构件速度增加时，马达电流同样增大2314。如果在组织切割表面554被驱动穿过夹持构件550时夹持构件不会遇到来自组织的任何异常阻力，则夹持构件速度将因此通过击发行程保持在目标速度范围S3内，直到停止位置2310。然而，在该示例中，速度相反地在之后开始降低。随着速度降低，马达电流增大，直到其达到峰值2315并达到最大阈值T3。当马达电流同时增大时夹持构件速度下降表明由夹持构件550驱动的组织切割表面554遇到比预期厚的组织，或者否则存在导致马达2010上的扭矩意外增加的误差。当遇到出乎意料地厚的组织时，马达2010上的扭矩可增大，同时夹持构件速度最多被保持或在这种情况下下降。当马达电流达到或超过最大阈值T3(在峰值2315处)时，控制器减小或切断2316流向马达2010的电流，这导致夹持构件速度下降2335至较低速度，或者在一些方面，下降至零(即，夹持构件550被暂停)。在一段时间之后，控制器为马达2010再次通电并逐渐增大2317马达电流，以使夹持构件550被驱动的速度逐渐增大至目标速度范围S3内的目标速度2336。只要马达电流未再次超过最大阈值T3，夹持构件550就继续推进，直到其达到停止位置2310。此时，在夹持构件由于马达2010断电而减慢至停止时，控制器使马达电流下降2318至零，并且夹持构件速度同样下降2337至零。
上文相对于第一击发行程2304所述的类似系列事件相对于第二击发行程2306发生，不同的是控制器选择目标速度范围作为S2，因为闭合马达电流2319仅在闭合结束位置2308处超过第一阈值T1。与第一击发行程2304一样，在闭合结束位置2308之后，控制器使夹持构件550推进的速度从闭合速度2326下降到初始速度2327。然后，控制器将夹持构件550被驱动的速度逐渐增加到目标速度2328，该目标速度在控制器先前选择的目标速度范围S2内。在夹持构件速度增加时，马达电流同样增大2321。与第一击发行程3406一样，速度开始降低并且马达电流增大，直到其达到峰值2322并且达到最大阈值T3。当马达电流达到或超过最大阈值T3(在峰值2322处)时，控制器减小或切断2323流向马达2010的电流，这导致夹持构件速度下降2329至较低速度，或者在一些方面，下降至零(即，夹持构件550被暂停)。在一段时间之后，控制器为马达2010再次通电并逐渐增大2324马达电流，以使夹持构件速度增大到目标速度范围S2内的目标速度2330。在控制器为马达再次通电之前的时间延迟可针对在击发行程期间遇到的不同条件而变化。从第一曲线图2300或第二曲线图2302可以看出，电流在第一击发行程2304中被切断2316的时间长度大于电流在第二击发行程2306中被切断2323的时间长度。在一些方面，暂停的长度(或夹持构件550以较低速度或初始速度被驱动的时间长度)可以是组织厚度的函数。例如，对于较厚的组织，控制器可较长地暂停夹持构件550的推进。控制器继续推进夹持构件550，直到其达到停止位置2338。此时，在夹持构件由于马达2010断电而减慢至停止时，控制器使马达电流下降2325至零，并且夹持构件速度同样下降2331至零。如可进一步指出的那样，停止位置2338、2310可以是变化的。在一些方面，停止位置2338、2310的位置可根据存在于端部执行器500中的仓体702的长度而变化。在其它方面，外科器械100的操作者可将停止位置2338、2310的位置设定为比最大停止位置更短(即，更近侧)的位置。
图21示出了第三曲线图2400和第四曲线图2402，各自描绘了夹持构件550的第三击发行程2404、第四击发行程2406和第五击发行程2408。第三曲线图2400描绘了夹持构件550的示例性击发行程2404、2406、2408的马达电流2403与夹持构件位移距离2401的关系，并且第四曲线图2402描绘了夹持构件速度2405与位移距离2401的关系。位移距离2401轴被描绘成“闭合”区域、“切割/缝合”区域和“停止”区域，其指示夹持构件550在其击发行程的每个相应部分中驱动的动作。总的来讲，第三曲线图2400和第四曲线图2402示出了不同击发行程2404、2406、2408的马达电流2403与夹持构件速度2405之间的关系以及由执行图19所示的过程2200的控制器采取的结果动作。
如上文结合图19所述，执行过程2200的控制器可被配置成能够根据闭合结束位置2410处的马达电流选择夹持构件550将被驱动的击发速度2210。换句话讲，控制器被配置成能够选择夹持构件550的击发速度2210，该击发速度适于或以其它方式对应于所夹持组织的厚度，如闭合结束位置2410处的马达电流所指示。在一个方面，控制器根据闭合结束位置2410处所感测的马达电流落入值的范围内的位置来选择夹持构件550的击发速度。在一些方面，这可表示为闭合结束位置2410处的马达电流是否已超过马达电流值范围中的一个或多个阈值。在其它方面，这可表示为闭合结束位置2410处的马达电流是否落入马达电流值范围的一个或多个特定区域内。在所描绘的方面，马达电流2403包括第一区域i1、第二区域i2和第三区域i3。这些区域可彼此接续或可不彼此接续。然而，沿着马达电流2403的轴线的三个区域i1、i2、i3的描绘仅仅是示例性的，并且过程2200可包含任何数量的阈值。
同样如上文结合图19所述，由控制器执行的过程2200可被配置成能够确定2214马达电流是否超过锁定阈值2415。第三击发行程2404表示示例性击发行程，其中控制器确定2214超过锁定阈值2415。在第三击发行程2404中，当夹持构件速度急剧下降2416至零时，击发行程中紧接在闭合结束位置2410之后的部分中的马达电流达到峰值2414，从而达到或超过锁定阈值2415。换句话讲，马达电流急剧增大，且夹持构件550的对应运动最小或没有对应运动。当马达电流达到锁定阈值2415时，由控制器执行的过程2200停止2216，并且控制器可向操作者显示警告和/或锁定外科器械100以免击发夹持构件550。在一个示例中，紧接在闭合结束位置2410之后第三击发行程2404表现出的马达电流的峰值2414可指示仓702不存在或不当地加载在端部执行器500中。
第四击发行程2406是其中控制器确定在夹持构件行程的过程中马达电流超过阈值2222，然后降低夹持构件550的速度2224的示例。在第四击发行程2406中，闭合马达电流2418落入i2区域内；因此，控制器选择S2作为目标速度范围2436。在闭合结束位置2410之后，控制器使夹持构件速度从闭合速度2432降低至初始速度2434。然后，控制器使位移构件速度从初始速度2434增加到所选速度范围S2内的目标速度2436。应当指出的是，初始速度2434可以是设定值或值范围。马达电流随着位移构件速度的增加而相应地增大2420。当夹持构件550在第四击发行程2406中继续推进时，夹持构件550达到其中马达电流急剧增大2422使得其超过由i2区域的上边界界定的阈值的点。马达电流的急剧增大2422指示切割表面554被驱动穿过所夹持组织的出乎意料地厚的部分。在该示例中，存在多个阈值(由电流区域i1、i2、i3的边界界定)，控制器将所感测到的马达电流与所述多个阈值进行比较以确定2222是降低2224位移构件速度还是暂停夹持构件550。这与第一击发行程2304和第二击发行程2306形成对比，其中控制器仅在马达电流达到或超过单一最大阈值(T3)时才采取动作(即，在特定示例中暂停夹持构件550)。当马达电流超过阈值时，控制器将夹持构件速度从初始速度范围S2降低2438至较低速度范围S3。然后，控制器使马达2010以较低速度2440推进夹持构件550。当夹持构件550以较低速度范围S3推进时，马达电流在较高电流范围i3内继续2424，直到其急剧减小2426超过i3电流区域的下边界。马达电流的急剧减小2426指示切割表面554被驱动穿过所夹持组织的较薄部分，因为以目标速度推进夹持构件550所需的电流较少。当马达电流达到或超过由该下边界表示的阈值时，控制器随后使马达2010将夹持构件速度从较低速度范围S3增加2442回到初始速度范围S2。通过第四击发行程2406的剩余部分，位移构件速度在目标速度范围S2内继续2444(其中马达电流同样在其相应范围i2内继续2428)，直到夹持构件550达到击发结束位置2412。当夹持构件550达到击发结束位置2412时，控制器切断2430马达电流，并且在马达2010断电时夹持构件速度相应地下降2446至零。
第五击发行程2408表示其中夹持构件550被驱动穿过所夹持组织，而厚度没有任何显著变化的击发行程。在第五击发行程2408中，闭合马达电流2448落入i1区域内；因此，控制器选择S1作为目标速度范围2458。在闭合结束位置2410之后，控制器使夹持构件速度从闭合速度2454降低至初始速度2456。然后，控制器使位移构件速度从初始速度2456增加到所选速度范围S3内的目标速度2458。在本示例中，夹持构件550在击发行程的整个长度内将其速度保持在目标速度2458内。马达电流同样保持2450在电流区域i1的边界内。换句话讲，在夹持构件550从闭合结束位置2410推进到击发结束位置2412时，夹持构件550不会遇到相对于预期组织厚度(即，由闭合马达电流2418指示的组织厚度)明显更厚或更薄的组织的任何部分。当夹持构件550达到击发结束位置2412时，控制器切断2452马达电流，这致使在马达2010断电时夹持构件速度下降2460至零。
图22示出了根据本公开的一个方面的包括间隙传感器10006和仓类别传感器10010的端部执行器10000的图。间隙传感器10006被配置成能够通过感测磁体10008的相对位置来感测第一钳口构件10004(即，砧座组件610)与第二钳口构件10006(即，仓组件700)之间的间隙或距离。位置传感器10006可包括霍尔效应传感器以及被配置成能够检测部件之间的相对距离的其它传感器。在图23所示的一个方面，位置传感器10006包括霍尔元件10100、放大器10102和功率源10104。霍尔元件包括第一输入末端10108A和第二输入末端10108B。第一输入末端10108A和第二输入末端10108B被配置成能够从功率源10104接收恒定的输入电流。当磁场不存在时，输入电流进入第一输入末端10108A且退出第二输入末端10108B，而不对霍尔元件10100的任一侧造成电势损耗。当诸如通过磁体10008将磁场施加到霍尔元件10100时，由于流经霍尔元件10100的电子的偏转，因此在霍尔元件10100的所述侧处形成电势。第一输出末端10108C和第二输出末端10108D位于霍尔元件10100的相对侧。第一输出末端10108C和第二输出末端10108D将由磁场形成的电势提供到放大器10102。放大器10102放大霍尔元件10100经受的电势，并将放大的电压输出到输出末端10106。因此，位置传感器10006的输出对应于磁体10008与霍尔元件10100的相对距离。检测钳口构件10006、10008之间的距离可以是有益的，因为当端部执行器10000被夹紧时，该距离对应于被抓持的组织的厚度。因此，感测钳口构件10006、10008之间的距离可用于代替或补充由马达电流确定组织厚度以夹紧端部执行器10000，如上所述。
重新参见图22，仓类别传感器10010被配置成能够感测存在于端部执行器10000中的仓702的类型或类别。在其中端部执行器10000是具有可替换仓702的MULU的一个方面，仓类别传感器10010包括被配置成能够接收从仓702传输的信号(例如，RF信号)的接收器。在其中端部执行器10000是MULU的另一方面，仓类别传感器10010包括电接触件，该电接触件被构造成能够在仓702被插入端部执行器10000中时与仓702的对应电接触件接触。在插入仓702时，仓702通过电连接的电接触件传输信号，该信号由外科器械100的控制器接收以识别仓702。
在其中端部执行器10000是SULU的另一方面，仓类别传感器10010被配置成能够检测端部执行器10000何时配合到适配器200。在图24至图25所示的该方面，适配器200的末端10206包括一个或多个电接触件10200，所述一个或多个电接触件各自包括弯曲部分10202。端部执行器500还包括设置在端部执行器壳体10201之内或之上的存储器。存储器包括存储器芯片和电连接到该存储器芯片的一个或多个电接触件10204。存储器芯片被构造成能够存储与端部执行器500相关的一个或多个参数。所述参数可包括端部执行器500的序列号、端部执行器500和/或其中的仓702的类型、端部执行器500和/或其中的仓702的尺寸、钉尺寸、识别端部执行器500是否已被击发的信息、端部执行器500和/或其中的仓702的长度、端部执行器500的最大使用次数以及它们的组合。当端部执行器500配合到适配器200时，端部执行器电接触件10204接合适配器电接触件10200。存储器芯片被构造成能够在端部执行器500与适配器200接合时，经由电接触件10200、100204传送端部执行器500的存在和本文所述的端部执行器500的一个或多个参数。
图26示出了根据本公开的一个方面的用于选择击发夹持构件550的初始速度的过程10300的逻辑流程图。在对过程10300的以下描述中，还应参考图22至图25，其中描绘了过程10300所利用的各种传感器组件；以及图27，其中描绘了根据过程10300执行的夹持构件550的各种击发行程。本发明所述的过程10300可由控制器执行，该控制器包括图16至图17所示的控制电路、图18的微控制器2104或者执行存储在外科器械100的存储器中的逻辑和/或指令的其它控制电路和/或处理器。当端部执行器500的夹持和切割/缝合操作开始10302时，开始执行过程10300。
因此，由控制器执行的过程10300首先通过使夹持构件550可操作地连接的马达2010通电而推进10304夹持构件550。然后，控制器确定夹持构件550是否处于闭合结束位置10306。在一个示例中，控制器可经由位置传感器2102(图18)确定夹持构件550是否处于闭合结束位置10306。闭合结束位置对应于夹持构件550的击发行程中夹持构件550闭合端部执行器500之后的位置，并且然后切割组织和/或击发钉。在一些方面，控制器可从存储器中检索闭合结束位置，然后将已知闭合结束位置与夹持构件550的感测位置进行比较。在其它方面，控制器可通过监测马达电流的峰值来确定闭合结束位置。如果夹持构件550不处于闭合结束位置，则过程10300沿着“否”分支继续进行，并且控制器继续使马达2010推进10304夹持构件550。过程2200继续该循环，直到夹持构件550位于或超出闭合结束位置。
如果控制器确定夹持构件550在其击发行程中位于或超出闭合结束位置10306，则过程10300沿着“是”分支继续进行，然后确定砧座组件610与仓组件700之间的间隙距离10308。在一个示例中，控制器经由间隙传感器10006确定间隙距离10308。然后，控制器确定仓702和/或端部执行器500的类型或类别10310。在一个示例中，控制器经由仓类别传感器10100确定仓702的类型或类别10310。然后，仓确定间隙距离对于所感测到的仓类型是否可接受10312。不同类型的仓702具有不同的可接受公差范围；因此，适用于一种类型的仓702(即，在操作公差内)的砧座组件610与仓组件700之间的间隙距离可能不适用于另一种类型的仓702。如果控制器确定间隙距离不适用于给定仓类型，则过程10300沿着“否”分支继续进行并停止10314。在这种情况下，过程10300可向操作者显示警告并且/或者锁定外科器械100以免击发夹持构件550。
如果控制器确定间隙距离适用于给定仓类型，则过程10300沿着“是”分支继续进行，并且接下来根据所感测到的间隙距离和所感测到的仓类型来确定夹持构件550的目标击发速度10316。在一个方面，控制器可根据所感测到的间隙距离是超过一个或多个阈值还是落入给定仓类型特定的间隙距离范围内的一个或多个区域内来选择目标击发速度。换句话讲，不同的仓类型可对于夹持构件550可针对所夹持组织的不同厚度推进的速度具有不同的公差范围。在整个仓类型中，控制器可被配置成能够通常为较厚的组织选择较慢的击发速度并且为较薄的组织选择较快的击发速度；然而，给定厚度的组织被认为是相对厚的还是相对薄的将根据仓类型而变化。在确定适当的目标击发速度10316之后，过程10300停止10318。
为了提供关于控制器被配置成能够执行的上述功能的进一步解释，将根据图27所示的若干示例性击发行程来讨论过程10300。图27示出了曲线图10400，其中描绘了夹持构件550的对应于不同仓类型的若干击发行程10406、10408、10410、10412、10414、10416、10418。在曲线图10400中，第一击发行程10406、第二击发行程10408、第五击发行程10414和第七击发行程10418对应于第一仓类型；第三击发行程10410和第六击发行程10416对应于第二仓类型；并且第四击发行程10412对应于第三仓类型。曲线图10400描绘了端部执行器500的间隙距离10404与夹持构件550的位移距离10402的关系。执行过程10300的控制器采取的结果动作(即，确定击发速度10316)取决于每个击发行程的仓类型在闭合结束位置10420处的间隙距离10404。曲线图10400还描绘了沿着间隙距离10404轴线的界定其间的区域的各种阈值x1...x6。按顺序增大的阈值x1...x6可对应于间隙距离10404的越来越大的值。每个仓类型不一定利用所有所描绘的阈值x1...x6，并且不同的仓类型可使用相同或不同的阈值x1...x6和/或区域，如下文将讨论的那样。此外，尽管描绘了六个阈值x1...x6，但由控制器执行的过程10300可在实践中利用任何数量的阈值和/或区域。
对于第一仓类型，阈值x6、x5和x3限定确定由控制器选择的击发速度的区域。例如，在闭合结束位置10420处，第一击发行程10406位于超过x6的位置10407处。超过x6阈值对应于所夹持的组织过厚以至于不能针对给定仓类型进行切割和缝合或者被不当地夹持。在这种情况下，控制器可向操作者显示警告并且/或者锁定外科器械100以免击发夹持构件550。第二击发行程10408位于闭合结束位置10420处的介于x6和x5之间的区域中的位置10409处，该位置对应于给定仓类型的大间隙或厚组织。因此，控制器可为夹持构件550选择较慢的击发速度。第五击发行程10414位于闭合结束位置10420处的介于x5和x3之间的区域中的位置10415处，该位置对应于给定仓类型的中等间隙或者中等、正常或预期的组织厚度。因此，控制器可为夹持构件550选择中等或正常击发速度。第七击发行程10418位于闭合结束位置10420处的低于x3的区域中的位置10419处，该位置对应于给定仓类型的小间隙或薄组织。因此，控制器可为夹持构件550选择快击发速度。
相关的阈值可针对不同的仓类型而变化。对于第二仓类型，x4阈值界定限定快击发速度和正常击发速度的区域。例如，第三击发行程10410位于闭合结束位置10420处的高于x4的区域中的位置10411处，该位置对应于给定仓类型的中等间隙或者中等、正常或预期的组织厚度。因此，控制器可为夹持构件550选择中等或正常击发速度。第六击发行程10416位于闭合结束位置10420处的低于x4的区域中的位置10417处，该位置对应于给定仓类型的小间隙或薄组织。因此，控制器可为夹持构件550选择快击发速度。
相关的阈值也可在不同的仓类型之间共享。对于第三仓类型，x4阈值界定限定快击发速度和正常击发速度的区域(与第三击发行程10410和第六击发行程10416的第二仓类型一样)。例如，第四击发行程10412位于闭合结束位置10420处的低于x4的区域中的位置10413处，该位置对应于给定仓类型的小间隙或薄组织。因此，控制器将为夹持构件550选择快击发速度。
总之，由控制器执行的过程10300可根据所感测到的砧座组件610与仓组件700之间的间隙距离相对于各种公差范围下降的位置来选择夹持构件550在其击发行程的切割/缝合部分期间的适当击发速度，所述公差范围对于每种仓类型而言可以是唯一的。因此，过程10300允许控制器定制夹持构件550被击发以根据所夹持组织的厚度和仓类型切割和/或缝合组织的速度。
虽然本文已描述了各种方面，但是可以对那些方面实施多种修改和变型。例如，可以采用不同类型的端部执行器。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、公布或其它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、陈述或其它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、陈述或其它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1-一种外科器械，该外科器械包括马达，该马达包括联接到该马达并且被配置成能够检测能够连接到外科器械的端部执行器是否处于闭合位置的控制电路。在至少一个实施例中，端部执行器被构造成能够接收支撑多个钉的仓。控制电路还被配置成能够检测夹持构件的位置，该夹持构件能够由马达在第一位置和第二位置之间驱动。夹持构件被构造成能够在夹持构件从第一位置运动到第二位置时使端部执行器转变到闭合位置，并且在端部执行器处于闭合位置之后，随着夹持构件运动到第二位置而从仓部署多个钉。控制电路还被配置成能够使马达在第一位置与第二位置之间的第一区域中以第一速率驱动夹持构件，并且使马达在第一位置与第二位置之间的第二区域中以第二速率驱动夹持构件。在至少一个实施例中，第一速率小于第二速率。
实施例2-根据实施例1所述的外科器械，其中，第一区域相对于第二区域在近侧定位。
实施例3-根据实施例1所述的外科器械，其中，第一区域位于第二区域之前。
实施例4-根据实施例1、2或3所述的外科器械，其中，第一区域的长度对应于被抓持在端部执行器处的组织的厚度。
实施例5-根据实施例3所述的外科器械，其中，外科器械包括传感器，该传感器被配置成能够检测端部执行器的钳口构件之间的间隙。该间隙对应于组织的厚度。
实施例6-根据实施例4或5所述的外科器械，其中，控制电路被配置成能够在端部执行器转变到闭合位置时检测马达的电流，马达的电流对应于组织的厚度。
实施例7-一种外科器械，该外科器械包括马达，该马达包括联接到马达的控制电路，其中控制电路被配置成能够检测能够连接到外科器械的端部执行器是否处于闭合位置。在至少一个实施例中，端部执行器被构造成能够接收支撑多个钉的仓。控制电路该被配置成能够检测夹持构件的位置，该夹持构件能够由马达在第一位置、第二位置和第三位置之间驱动。夹持构件被构造成能够在夹持构件从第一位置运动到第二位置时，使端部执行器转变到闭合位置。夹持构件还被构造成能够在夹持构件从第二位置运动到第三位置时，从仓部署多个钉。控制电路还被配置成能够使马达在第一位置与第二位置之间的第一区域中以第一速率驱动夹持构件，并且使马达在第二位置与第三位置之间的第二区域中以第二速率驱动夹持构件。在至少一个实施例中，第一速率小于第二速率。
实施例8-根据实施例7所述的外科器械，其中，第一区域相对于第二区域在近侧定位。
实施例9-根据实施例7所述的外科器械，其中，第一区域位于第二区域之前。
实施例10-根据实施例7、8或9所述的外科器械，其中，第一区域的长度对应于被抓持在端部执行器处的组织的厚度。
实施例11-根据实施例10所述的外科器械，其中，外科器械包括传感器，该传感器被配置成能够检测端部执行器的钳口构件之间的间隙，该间隙对应于组织的厚度。
实施例12-根据实施例10或11所述的外科器械，其中，控制电路被配置成能够在端部执行器转变到闭合位置时检测马达的电流，马达的电流对应于组织的厚度。
实施例13-一种外科器械，该外科器械包括马达，该马达包括联接到马达的控制电路，该控制电路被配置成能够检测能够连接到外科器械的端部执行器是否处于闭合位置。在至少一个实施例中，端部执行器被构造成能够接收支撑多个钉的仓。控制电路该被配置成能够检测夹持构件的位置，该夹持构件能够由马达在第一位置、第二位置和第三位置之间驱动。夹持构件被构造成能够在夹持构件从第一位置运动到第二位置时使端部执行器转变到闭合位置，并且在夹持构件从第二位置运动到第三位置时从仓部署多个钉。控制电路还被配置成能够使马达以对应于夹持构件在第二位置与第三位置之间的位置的可变速率驱动夹持构件。在至少一个实施例中，越靠近第二位置，可变速率越慢。
实施例14-根据实施例13所述的外科器械，其中，控制电路被配置成能够使马达在对应于被抓持在端部执行器处的组织的厚度的时间段内以较慢的速率驱动夹持构件。
实施例15-根据实施例13或14所述的外科器械，其中，外科器械包括传感器，该传感器被配置成能够检测端部执行器的钳口构件之间的间隙，该间隙对应于组织的厚度。
实施例16-根据实施例13、14或15所述的外科器械，其中控制电路被配置成能够在端部执行器转变到闭合位置时检测马达的电流，马达的电流对应于组织的厚度。
本文所述的许多外科器械系统由电动马达促动；但是本文所述的外科器械系统可以任何合适的方式促动。在各种实例中，例如，本文所述的外科器械系统可由手动操作的触发器促动。在某些情况下，本文公开的马达可包括机器人控制系统的一部分或多个部分。此外，本文公开的任何端部执行器和/或工具组件可与机器人外科器械系统一起使用。例如，名称为“SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENTARRANGEMENTS”的美国专利申请序列号13/118,241(现为美国专利9,072,535)更详细地公开了机器人外科器械系统的若干示例。
已结合钉的部署和变形描述了本文所述的外科器械系统；然而，本文所述的实施方案不限于此。例如，设想了部署除钉之外的紧固件诸如夹具或大头钉的各种实施方案。此外，还设想了利用用于密封组织的任何合适装置的各种实施方案。例如，根据各种实施方案的端部执行器可包括被配置成能够加热和密封组织的电极。另外，例如，根据某些实施方案的端部执行器可施加振动能量来密封组织。
虽然本文已结合某些实施方案描述了各种装置，但也可实施对这些实施方案的许多修改和变型。在一个或多个实施方案中，具体特征、结构或特性可以任何合适的方式进行组合。因此，在无限制的情况下，结合一个实施方案示出或描述的具体特征、结构或特性可全部或部分地与一个或多个其它实施方案的特征、结构或特性组合。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。此外，根据多种实施方案，单个部件可被替换为多个部件，并且多个部件也可被替换为单个部件，以执行给定的一种或多种功能。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。
本文所公开的装置可被设计成在单次使用之后废弃，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。修整可包括以下步骤的任意组合，这些步骤包括但不限于拆卸装置、之后进行装置具体部件的清洁或更换、以及随后重新组装装置。具体地，修整设施和/或外科团队可拆卸装置，并且在清洁和/或更换装置的特定部件之后，可重新组装装置以供后续使用。本领域的技术人员将会理解，修整装置可利用各种技术来进行拆卸、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。
本文所公开的装置可在手术之前进行处理。首先，可获得新的或用过的器械，并且根据需要进行清洁。然后，可对器械进行消毒。在一种消毒技术中，将所述器械放置在密闭且密封的容器(诸如，塑料或TYVEK袋)中。然后可将容器和器械置于可穿透容器的辐射场，诸如γ辐射、X射线和/或高能电子。辐射可杀死器械上和容器中的细菌。经消毒的器械随后可被储存在无菌容器中。密封容器可将器械保持为无菌的，直至在医疗设施中将该容器打开。还可使用本领域已知的任何其它技术对装置进行消毒，所述技术包括但不限于β辐射、γ辐射、环氧乙烷、等离子过氧化物和/或蒸汽。
尽管本发明已被描述为具有示例性设计，但可在本公开的实质和范围内进一步修改本发明。因此，本申请旨在涵盖使用本发明的一般原理的本发明的任何变型、用途或改型。

Claims (15)

1.一种外科器械，包括：
马达；和
控制电路，所述控制电路联接到所述马达，所述控制电路被配置成能够：
检测能够连接到所述外科器械的端部执行器是否处于闭合位置，所述端部执行器被构造成能够接收支撑多个钉的仓；以及
检测能够由所述马达在第一位置和第二位置之间驱动的夹持构件的位置，其中所述夹持构件联接至所述端部执行器的驱动组件，且被构造成能够：
在所述夹持构件从所述第一位置运动到所述第二位置时，使所述端部执行器转变到所述闭合位置；以及
在所述端部执行器处于闭合位置之后，随着所述夹持构件运动到所述第二位置而从所述仓部署所述多个钉；
其中所述控制电路还被配置成能够：
使所述马达在所述第一位置与所述第二位置之间的第一区域中以第一速率驱动所述夹持构件；以及
使所述马达在所述第一位置与所述第二位置之间的第二区域中以第二速率驱动所述夹持构件；
其中，所述第一速率小于所述第二速率，且所述第一区域位于所述第二区域之前。
2.根据权利要求1所述的外科器械，其中，所述第一区域相对于所述第二区域在近侧定位。
3.根据权利要求1所述的外科器械，其中，所述第一区域的长度对应于被抓持在所述端部执行器处的组织的厚度。
4.根据权利要求3所述的外科器械，其中，所述外科器械包括传感器，所述传感器被配置成能够检测所述端部执行器的钳口构件之间的间隙，所述间隙对应于所述组织的厚度。
5.根据权利要求3所述的外科器械，其中，所述控制电路被配置成能够在所述端部执行器转变到所述闭合位置时检测所述马达的电流，所述马达的电流对应于所述组织的厚度。
6. 一种外科器械，包括：
马达；和
控制电路，所述控制电路联接到所述马达，所述控制电路被配置成能够：
检测能够连接到所述外科器械的端部执行器是否处于闭合位置，所述端部执行器被构造成能够接收支撑多个钉的仓；以及
检测能够由所述马达在第一位置、第二位置和第三位置之间驱动的夹持构件的位置，其中所述夹持构件联接至所述端部执行器的驱动组件，且被构造成能够：
在所述夹持构件从所述第一位置运动到所述第二位置时，使所述端部执行器转变到所述闭合位置；以及
在所述夹持构件从所述第二位置运动到所述第三位置时，从所述仓部署所述多个钉；
其中所述控制电路还被配置成能够：
使所述马达在所述第一位置与所述第二位置之间的第一区域中以第一速率驱动所述夹持构件；以及
使所述马达在所述第二位置与所述第三位置之间的第二区域中以第二速率驱动所述夹持构件；
其中，所述第一速率小于所述第二速率。
7.根据权利要求6所述的外科器械，其中，所述第一区域相对于所述第二区域在近侧定位。
8.根据权利要求6所述的外科器械，其中，所述第一区域位于所述第二区域之前。
9.根据权利要求6所述的外科器械，其中，所述第一区域的长度对应于被抓持在所述端部执行器处的组织的厚度。
10.根据权利要求9所述的外科器械，其中，所述外科器械包括传感器，所述传感器被配置成能够检测所述端部执行器的钳口构件之间的间隙，所述间隙对应于所述组织的厚度。
11.根据权利要求9所述的外科器械，其中，所述控制电路被配置成能够在所述端部执行器转变到所述闭合位置时检测所述马达的电流，所述马达的电流对应于所述组织的厚度。
12. 一种外科器械，包括：
马达；和
控制电路，所述控制电路联接到所述马达，所述控制电路被配置成能够：
检测能够连接到所述外科器械的端部执行器是否处于闭合位置，所述端部执行器被构造成能够接收支撑多个钉的仓；以及
检测能够由所述马达在第一位置、第二位置和第三位置之间驱动的夹持构件的位置，其中所述夹持构件联接至所述端部执行器的驱动组件，且被构造成能够：
在所述夹持构件从所述第一位置运动到所述第二位置时，使所述端部执行器转变到所述闭合位置；以及
在所述夹持构件从所述第二位置运动到所述第三位置时，从所述仓部署所述多个钉；
其中，所述控制电路被配置成能够使夹持构件在所述第一位置和所述第二位置之间的第一区域中以第一速率被推进，其中，所述控制电路还被配置成能够使所述马达以对应于所述夹持构件在所述第二位置与所述第三位置之间的位置的可变速率驱动所述夹持构件，所述夹持构件越靠近所述第二位置，所述可变速率越慢，其中所述第一速率小于所述可变速率。
13.根据权利要求12所述的外科器械，其中，所述控制电路被配置成能够使夹持构件在所述第一区域中以所述第一速率被推进的时长或距离对应于被抓持在所述端部执行器处的组织的厚度。
14.根据权利要求13所述的外科器械，其中，所述外科器械包括传感器，所述传感器被配置成能够检测所述端部执行器的钳口构件之间的间隙，所述间隙对应于所述组织的厚度。
15.根据权利要求13所述的外科器械，其中，所述控制电路被配置成能够在所述端部执行器转变到所述闭合位置时检测所述马达的电流，所述马达的电流对应于所述组织的厚度。
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