CN111513786A - 用于动力式手术装置的末端执行器的可编程远侧倾斜位置 - Google Patents
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Abstract
一种手术装置包含具有控制器和马达的手柄组合件。所述手术装置还包含适配器组合件,所述适配器组合件具有:管状壳体,所述管状壳体具有被配置成联接到所述手柄组合件的近侧端部分和远侧端部分;和致动组合件,所述致动组合件被配置成联接到所述马达。所述手术进一步包含再装载件,所述再装载件被配置成联接到所述适配器组合件的所述远侧端部分;以及砧座组合件,所述砧座组合件包含枢转地联接到砧座轴的砧座头,所述砧座组合件被配置成联接到所述致动组合件和所述再装载件。所述手术装置的所述控制器被配置成控制所述马达以致动所述致动组合件以基于所述再装载件或所述砧座头中的一个的尺寸,使所述砧座组合件在远侧方向上移动一段距离,从而使所述砧座头相对于所述砧座轴枢转,同时保持所述砧座组合件接合到所述再装载件。
Description
相关申请的交叉引用
本申请要求2019年2月4日提交的美国临时专利申请第62/800,836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
本公开涉及手术装置。更具体地说,本公开涉及用于用不同大小的末端执行器执行手术程序的手持式机电手术系统。
背景技术
一种类型的手术装置是圆形夹持、切割和钉合装置。这类装置可以在手术程序中用于重新附接先前横断的直肠部分或相似程序。常规的圆形夹持、切割和钉合装置包含手枪或线性握把式结构,其具有从其延伸的细长轴和支撑在细长轴的远侧端上的钉仓。在此情况下,医生可以将圆形钉合装置的装载单元部分插入到患者的直肠中,且沿着患者的结肠道向上朝向横断的直肠部分操纵装置。装载单元包含具有多个钉的仓组合件。沿着横断的结肠的近侧部分,可以将砧座组合件缩拢系于其中。替代地,如果需要,砧座部分可以通过邻近横断的结肠的切口插入结肠中。砧座和仓组合件朝向彼此接近,并且钉从仓组合件朝向砧座组合件弹射从而在组织中形成钉以实现端对端吻合,且起动环形刀以对所夹持组织部分的一部分进行取芯。在已经实现端对端吻合之后,将圆形钉合装置从手术部位移除。
许多手术装置制造商还已开发了用于操作和/或操纵末端执行器的专有动力式驱动系统。动力式驱动系统可以包含可重新使用的动力式手柄组合件和可移除地连接到动力式手柄组合件的一次性末端执行器。
供与现有动力式手术装置和/或手柄组合件一起使用的许多现有末端执行器是由线性驱动力驱动的。举例来说,用于执行内胃肠道吻合程序、端对端吻合程序和横向吻合程序的末端执行器是由线性驱动力致动的。由此,这些末端执行器与使用旋转运动的手术装置和/或手柄组合件不兼容。
供与动力式手术装置一起使用的一些末端执行器具有不同的大小。这样,动力式手术装置基于末端执行器的大小进行对接并致动末端执行器。因此,需要考虑到末端执行器的大小和其它物理属性而被编程成与各种末端执行器一起操作的动力式手术装置。
发明内容
本公开提供了一种供与环形钉合器再装载件和对应的砧座组合件一起使用的动力式手术装置。在使用期间,砧座朝向再装载件接近,以压迫并穿过组织形成钉。在该程序完成之后,从患者体内取出手术装置,并将砧座组合件从再装载件移开。本公开通过如下方式提供受控的抽出过程,即,使砧座组合件向远侧移动预定距离,使得砧座组合件的砧座头倾斜,而砧座组合件仍接合到再装载件,例如,经由砧座轴和再装载件上的对接花键。这确保了可以在不使砧座组合件从再装载件取出的情况下操纵手术装置。
根据本公开的一个实施例,手术装置包含具有控制器和马达的手柄组合件。手术装置还包含适配器组合件,所述适配器组合件具有:管状壳体,所述管状壳体具有被配置成联接到手柄组合件的近侧端部分和远侧端部分;和致动组合件,所述致动组合件被配置成联接到马达。手术装置进一步包含再装载件,所述再装载件被配置成联接到适配器组合件的远侧端部分;以及砧座组合件,所述砧座组合件包含枢转地联接到砧座轴的砧座头,所述砧座组合件被配置成联接到致动组合件和再装载件。手术装置的控制器被配置成控制马达以致动致动组合件以基于再装载件或砧座头中的一个的尺寸,使砧座组合件在远侧方向上移动一段距离,从而使砧座头相对于砧座轴枢转,同时保持砧座组合件接合到再装载件。
根据以上实施例的一个方面,砧座组合件包含安置在砧座轴上的多个第一花键,并且再装载件包含多个第二花键,使得在将砧座组合件联接到再装载件时,多个第一花键与多个第二花键对接。
根据以上实施例的另一方面,控制器包含存储多个距离值的存储器。再装载件包含存储再装载件或砧座头中的一个的尺寸值的存储装置。控制器进一步被配置成访问存储装置以读取尺寸值。控制器还被配置成基于尺寸值从多个距离值中选择一个距离值,并基于所选择的距离值来控制马达。距离值等于砧座头的半径。
附图说明
在本文中参考附图描述本公开的实施例,在附图中:
图1是根据本公开的实施例的手持式手术装置、适配器组合件、具有再装载件的末端执行器和砧座组合件的透视图;
图2是示出根据本公开的实施例的图1的适配器组合件和手柄组合件的连接的透视图;
图3是根据本公开的实施例的手柄组合件的内部部件的透视图;
图4是根据本公开的实施例的无再装载件的图1的适配器组合件的透视图;
图5是根据本公开的实施例的图1的再装载件的侧截面视图;
图6A是根据本公开的实施例的适配器组合件的远侧端部分的透视图;
图6B是根据本公开的实施例的适配器组合件的远侧端部分的截面视图;
图7是根据本公开的砧座组合件的前透视图;
图8是图5的砧座组合件的后透视图;
图9是图5的砧座组合件的透视图,其中零件分开;
图10是示出了与图1的适配器组合件的远侧端部分对齐并分离的图5的再加载件的纵向截面视图;
图11是根据本公开的实施例的适配器组合件的远侧端部分的侧视图,所述适配器组合件的远侧端部分具有再装载件和处于倾斜构型的第一砧座组合件;和
图12是根据本公开的实施例的适配器组合件的远侧端部分的侧视图,所述适配器组合件的远侧端部分具有再装载件和处于倾斜构型的第二砧座组合件。
具体实施方式
现在参考图式详细描述本公开的实施例,其中在若干视图中的每一个中,相同参考标号指定相同或对应元件。如本文中所使用,术语“临床医生”是指医生、护士或任何其它医护人员且可以包含辅助人员。贯穿本说明书,术语“近侧”将是指更接近临床医生的装置的部分或其部件,并且术语“远侧”将是指更远离临床医生的装置的部分或其部件。此外,在图式中和在以下描述中,为描述方便起见简单地使用术语,如前部、后部、上部、下部、顶部、底部和类似的方向术语,并且不旨在限制本公开。在以下描述中,未详细描述众所周知的功能或构造,以免以不必要的细节使本公开模糊不清。
本公开涉及可与环形再装载件和对应的环形砧座组合件一起操作的动力式手术装置。砧座组合件包含相对于砧座轴可枢转的砧座头。这允许砧座组合件在砧座组合件在患者体内的导航期间从倾斜构型和展开构型移动,在所述展开构型中,砧座组合件用于将组织夹持在再装载件之间并在组织中形成钉。再装载件包含存储装置,所述存储装置存储描述再装载件的一个或多个的数据值,如尺寸(例如直径)。手术装置可访问存储装置,所述手术装置利用数据值来确定在抽出期间用于移动砧座组合件的距离。具体地说,手术装置在其存储器中存储多个距离值,并基于来自存储装置的数据值选择适当的距离值。这确保了手术装置将砧座组合件移动选定的距离,所述距离是预定的,以确保砧座组合件在与再装载件接合时过渡到倾斜构型。
参考图1,动力式手术装置10包含手柄组合件20,所述手柄组合件20被配置成用于与适配器组合件30选择性连接,所述适配器组合件30又被配置成用于与如环形再装载件40的末端执行器选择性连接。手柄组合件20包含手柄壳体22,其具有下部壳体部分24、从下部壳体部分24的一部分延伸和/或支撑在下部壳体部分24的一部分上的中间壳体部分26,和从中间壳体部分26的一部分延伸和/或支撑在中间壳体部分26的一部分上的上部壳体部分28。如图2所示,上部壳体部分28的远侧部分限定鼻部或连接部分28a,其被配置成接纳适配器组合件30的近侧端部分30b。
参考图3,手柄组合件20包含联接到电池37的一个或多个马达36。手柄组合件20还包含用于操作手柄组合件20的马达36和其它电子部件的主控制器38、适配器组合件30和再装载件40。主控制器38主要包含任何合适的逻辑控制器(例如,FPGA)和存储软件指令的存储器,所述软件指令可由逻辑控制器执行以操作马达36以及手术装置10的其它部件。除了软件指令之外,主控制器38的存储器还可以存储各种数据。马达36联接到对应驱动轴39(图2),所述对应驱动轴39被配置成将插口33接合在近侧端部分30b上,使得在插口33上施加驱动轴39的旋转。致动组合件52(图6B)联接到相应的插口33。致动组合件52被配置成将插口33的旋转运动转换成线性运动并连同砧座组合件58一起致动再装载件40(图1)。
参考图4,适配器组合件30包含管状壳体30a,其在近侧端部分30b与相反的远侧端部分30c之间延伸,所述近侧端部分30b被配置成用于可操作地连接到手柄组合件20的连接部分28a,所述相反的远侧端部分30c被配置成用于可操作地连接到再装载件40。以此方式,适配器组合件30被配置成将由手柄组合件20提供的旋转运动转换成轴向平移,其可用于推进/缩回可滑动地安置于适配器组合件30的远侧端部分30c内的套管针构件50(图5),以起动再装载件40的钉。
参考图2,连接部分28a包含具有多个电接触件31的电插座29,所述多个电接触件与手柄组合件20的电子部件(例如,主控制器38)和电部件(例如,电池37)电连通。适配器组合件30包含被配置成接合电插座29的支撑在近侧端部分30b内的对应电连接器32。电连接器32还包含多个电接触件34,其接合且电连接到其对应电接触件31。电连接器32是适配器组合件30的。
参考图4,套管针构件50可滑动地安置于适配器组合件30的管状壳体30a内且延伸通过其远侧端部分30c。以此方式,套管针构件50被配置成用于轴向平移,这又致使再装载件40的砧座组合件58(图1)的对应轴向平移,以起动安置于其中的钉(未示出)。套管针构件50包含近侧端,其联接到适配器组合件30的管状壳体30a。套管针构件50的远侧端部分被配置成选择性地接合再装载件40的砧座组合件58(图4)。以此方式,当砧座组合件58连接到套管针构件50时,如下文中将详细描述,套管针构件50在第一方向上的轴向平移导致砧座组合件58相对于再装载件40的打开,且套管针构件50在第二相反方向上的轴向平移导致砧座组合件58相对于再装载件40的关闭。
如图1和5所示,再装载件40被配置成用于可操作地连接到适配器组合件30且被配置成起动和形成手术钉的环形阵列,并切断组织环。再装载件40包含具有近侧端部分42a和远侧端部分42b的壳体42以及固定地紧固到壳体42的远侧端部分42b的钉仓44。壳体42的近侧端部分42a被配置成用于选择性连接到适配器组合件30的远侧端部分30c且包含用于确保再装载件40相对于适配器组合件30径向对齐或对准的装置。
参考图5,再装载件40的壳体42包含外圆柱形部分42c和内圆柱形部分42d。再装载件40的外圆柱形部分42c和内圆柱形部分42d是同轴的且限定凹槽46。再装载件40的凹槽46包含从其内表面凸出的多个纵向延伸的脊状部或花键48,所述内表面被配置成在钉合程序期间将砧座组合件58相对于再装载件40径向对齐。
再装载件40还包含存储装置41,可以是被配置成存储与再装载件40有关的任何数据的任何非易失性存储介质(例如,EEPROM),所述数据包含但不限于使用次数、识别信息、型号、序列号、钉大小、行程长度、最大致动力、最小致动力、工厂校准数据等。在实施例中,数据可以被加密并且只能由具有适当密钥的主控制器38解密。数据也可以用于验证再装载件40。存储装置41可以被配置为只读或读/写模式,从而允许主控制器38读取数据和将数据写在存储装置41上。
负载感测组合件66经由线束电连接到电连接器32。如图6A和6B所示,联接到套管针构件50的致动组合件52延伸通过负载感测组合件66。负载感测组合件66提供在夹持、钉合、切割和其它机械致动期间当联接到砧座组合件58时套管针构件50的移动期间对适配器组合件30施加的应变测量。负载感测组合件66安置在支撑块54与连接器套筒56之间。在手术装置10的操作期间(即夹持、钉合和切割),负载感测组合件66与施加到支撑块54和连接器套筒56的力成比例地弹性变形(类似于支撑梁)。测量信号的基线的变化指示施加在支撑块54和连接器套筒56上的力,这些力通常描述了在夹持、钉合和切割期间遇到的力。
现在参考图7-10,提供了砧座组合件58,并且砧座组合件58被配置成用于选择性连接到适配器组合件30的套管针构件50,并且与再装载件40配合用于夹持、钉合和切割组织。砧座组合件58包含头组合件112和中心杆组合件114。如图9所示,头组合件112包含柱116、壳体118、切割环122、切割环盖123、砧板124、垫片121、凸轮闩锁126和保持器构件127。柱116居中地定位在壳体118内。
砧板124支撑在壳体118的外部环形凹槽中,并且包含形成在其中并被配置成接收和形成钉的多个钉袋130。切割环122包含中央开口,所述中央开口围绕柱116定位在壳体118的内部环形凹槽中,在柱116与外部环形凹槽之间。切割环122可以由任何热塑性材料如聚乙烯形成。切割环盖123被固定到切割环122的面向外的表面或近侧表面。
保持器构件127定位在切割环122与壳体118的后壁之间的内部环形凹槽中。保持器构件127是环形的,并且包含接合切割环122的后表面的多个可变形突片。保持器构件127防止切割环122移动或被推入壳体118的内部环形凹槽中,直到足以使突片变形的预定力已经施加到切割环122为止。当达到预定力时,例如在组织切割期间,切割环122被推入内部环形凹槽136中并压缩保持器构件。
参考图9,砧座中心杆组合件114包含中心杆152、柱塞154和柱塞弹簧156。中心杆152的第一端包含限定腔119a的一对臂119。提供枢轴销162以将柱116枢转地固定到中心杆152,使得砧座头组合件112枢转地安装到砧座中心杆组合件114。
凸轮闩锁126枢转地安装在壳体118的柱116的横向槽内并且围绕枢轴销162枢转地安装。凸轮闩锁126具有外部凸轮轮廓,所述外部凸轮轮廓允许当凸轮闩锁126在远侧方向上旋转时柱塞154向前移动,并且允许当凸轮闩锁在近侧方向上旋转时柱塞154缩回。
柱塞154可滑动地定位在形成于中心杆152的第一端中的孔中。柱塞154包含接合指状件,所述接合指状件从砧座头组合件112的枢转轴线偏移并且被偏压成与凸轮闩锁126的边缘接合。柱塞154的指状件与凸轮闩锁126的边缘的接合将凸轮闩锁126的边缘的前部压向切割环122的内周,以将砧座头组合件112推向中心杆152上的可操作或非倾斜构型。
砧座头组合件112可以以预起动的倾斜构型相对于砧座中心杆组合件114倾斜。砧座头组合件112相对于砧座中心杆组合件114的倾斜导致凸轮闩锁126的主体部分接合柱塞154的指状件166。随着凸轮闩锁126随着砧座头组合件112的倾斜而旋转,柱塞154与砧座中心杆组合件114的孔一起缩回,从而压缩弹簧156。以此方式,柱塞154的指状件166向远侧偏压抵靠凸轮闩锁126的主体部分。
参考图8和9,中心杆152的第二端包含由多个挠性臂182限定的孔180。每个挠性臂182的近侧端包含内部肩部,所述内部肩部的尺寸被设计成可释放地接合适配器组合件30的套管针构件50的肩部,以将砧座组合件58固定到适配器组合件30,如图10所示。多个花键186围绕中心杆152形成。花键186通过接合钉仓44的花键48使砧座组合件58与再装载件40对齐。
对于包含适配器组合件和再装载件的示例性动力式手术钉合器的详细描述,可以参考Contini等人的2016年4月12日提交的标题为“手持式机电手术系统(HandheldElectromechanical Surgical System)”的美国专利申请公开第2016/0310134号,其以引用方式并入上文中。
砧座组合件58与再装载件40一起用于钉合和随后切割组织,如在吻合程序期间。在完成钉合和切割顺序之后,使用者开始松开顺序以例如通过按压手柄组合件20上的控制按钮而从套管针构件50释放砧座组合件58。套管针构件50自动地向远侧延伸,从而使砧座组合件58远离再装载件40移动并且将组织松开到预设的砧座倾斜距离。松开顺序可以在显示屏47(图3)上示出。具体地说,松开动画示出了砧座组合件58向远侧移动并且头组合件112倾斜。另外,显示屏47还可以显示锁定图标,以显示砧座组合件58被固定到套管针构件50。一旦砧座组合件58从再装载件40移开至其倾斜距离,显示屏47就显示砧座组合件58处于扩展状态,而头组合件112处于倾斜状态。这指示使用者可以从患者身上移除适配器组合件30。
适配器组合件30可以与各种不同大小的再装载件40一起使用。在实施例中,再装载件40可具有约20毫米(mm)到约40mm的直径。可以基于要切除的器官的厚度来选择再装载件40。此外,砧座组合件58的大小与程序中使用的再加载件40对应,使得再加载件40的钉接触砧座组合件58的钉袋130。由于不同的砧座组合件58的大小差异,手术装置10基于砧座组合件58的尺寸使砧座组合件58前进至预设的砧座倾斜距离。由于砧座组合件58的尺寸,如其直径和/或半径,对应于再装载件40的尺寸,因此手术装置10从存储装置41获得尺寸数据。因此,手术装置10不是将所有的砧座组合件58移动到相同的砧座倾斜距离,而是基于再装载件40的尺寸将砧座组合件58移动到预定的倾斜距离。这确保了砧座组合件58的花键186继续接合钉仓44的花键48。
参考图11和12,示出了处于倾斜构型的砧座组合件158。图11示出了较小的再装载件40(例如,约21mm),而图12示出了较大的再装载件40(例如,约33mm)。每个砧座组合件158延伸到预定距离,所述预定距离对应于砧座组合件158的大小,即其直径和/或半径。如图11和12所示,基于砧座组合件158的相应半径r1和r2,图11的砧座组合件158延伸距离a,并且图12的砧座组合件158延伸距离b。
手术装置10的主控制器38被配置成访问存储在再加载件40的存储装置41上的尺寸数据。主控制器38还在其存储器中存储多个倾斜距离。主控制器38被配置成基于如从存储装置41读取的再装载件40以及对应地砧座组合件58的尺寸,从多个倾斜距离中选择一个倾斜距离。然后,主控制器38操作致动组合件52以将砧座组合件58移动到选定的倾斜距离,直到砧座头组合件112倾斜,从而允许抽出手术装置10。
通过保持接合到钉仓44的花键48,防止砧座组合件58响应于手术装置10的旋转而旋转,如在临床医生扭转手术装置10以拉动通过吻合口的期间。能够扭转手术装置10允许砧座组合件58在潜在的钩住情况下被拉动通过吻合口。相反,当砧座组合件58未固定时,它自由旋转并且可以保持卡在相同位置,而与手术装置10的扭转或操纵无关。确保砧座组合件58保持固定在减肥手术中可能是有益的,因为操纵砧座组合件58的组织和位置往往随再装载件40一起移动,而不是允许砧座组合件58滑动通过吻合口。在这些情况下,由于针对每个不同的再装载件大小编程的定制的砧座倾斜距离,由于砧座组合件58与再装载件40接合,手术装置10的扭转允许更容易地移除。另一个益处是定制的距离缩短了操作手术装置10所需的时间。
应理解,可以对目前公开的适配器组合件的实施例进行各种修改。因此,以上描述不应解释为限制性的,而仅仅是作为实施例的例证。本领域的技术人员将设想在本公开的范围和精神内的其它修改。
Claims (9)
1.一种手术装置,其包含:
手柄组合件,所述手柄组合件包含控制器和马达;
适配器组合件,所述适配器组合件包含:
管状壳体,所述管状壳体具有被配置成联接到所述手柄组合件的近侧端部分和远侧端部分;以及
致动组合件,所述致动组合件被配置成联接到所述马达;
再装载件,所述再装载件被配置成联接到所述适配器组合件的所述远侧端部分;以及
砧座组合件,所述砧座组合件包含枢转地联接到砧座轴的砧座头,所述砧座组合件被配置成联接到所述致动组合件和所述再装载件,其中所述控制器被配置成控制所述马达以致动所述致动组合件以基于所述再装载件或所述砧座头中的一个的尺寸,使所述砧座组合件在远侧方向上移动一段距离,从而使所述砧座头相对于所述砧座轴枢转。
2.根据权利要求1所述的手术装置,其中所述砧座组合件包含安置在所述砧座轴上的多个第一花键,并且所述再装载件包含多个第二花键。
3.根据权利要求2所述的手术装置,其中在将所述砧座组合件联接到所述再装载件时,所述多个第一花键与所述多个第二花键对接。
4.根据权利要求1所述的手术装置,其中所述控制器包含存储多个距离值的存储器。
5.根据权利要求4所述的手术装置,其中所述再装载件包含存储所述再装载件或所述砧座头中的一个的尺寸值的存储装置。
6.根据权利要求5所述的手术装置,其中所述控制器被配置成访问所述存储装置以读取所述尺寸值。
7.根据权利要求6所述的手术装置,其中所述控制器被配置成基于所述尺寸值,从所述多个距离值中选择一个距离值。
8.根据权利要求7所述的手术装置,其中所述控制器被配置成基于选定的距离值,控制所述马达。
9.根据权利要求7所述的手术装置,其中所述距离值等于所述砧座头的半径。
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US11723664B2 (en) | 2023-08-15 |
US11202635B2 (en) | 2021-12-21 |
EP4066751A3 (en) | 2022-10-12 |
CN111513786B (zh) | 2024-01-26 |
EP3689269A1 (en) | 2020-08-05 |
EP3689269B1 (en) | 2022-04-20 |
AU2020200182A1 (en) | 2020-08-20 |
US20200246010A1 (en) | 2020-08-06 |
EP4066751A2 (en) | 2022-10-05 |
JP2020124492A (ja) | 2020-08-20 |
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US20220104824A1 (en) | 2022-04-07 |
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