CN111671479A - Rigid segment of endoscopic stapling device for performing fundoplication - Google Patents
Rigid segment of endoscopic stapling device for performing fundoplication Download PDFInfo
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- CN111671479A CN111671479A CN202010533202.8A CN202010533202A CN111671479A CN 111671479 A CN111671479 A CN 111671479A CN 202010533202 A CN202010533202 A CN 202010533202A CN 111671479 A CN111671479 A CN 111671479A
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B90/37—Surgical systems with images on a monitor during operation
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
- A61B2090/309—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure using white LEDs
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B90/37—Surgical systems with images on a monitor during operation
- A61B2090/378—Surgical systems with images on a monitor during operation using ultrasound
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2217/00—General characteristics of surgical instruments
- A61B2217/002—Auxiliary appliance
- A61B2217/007—Auxiliary appliance with irrigation system
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2560/00—Constructional details of operational features of apparatus; Accessories for medical measuring apparatus
- A61B2560/04—Constructional details of apparatus
- A61B2560/0462—Apparatus with built-in sensors
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Abstract
The invention discloses a rigid section of an endoscope stapling device for carrying out fundoplication, which comprises a rigid section shell, wherein the side part of the rigid section shell is provided with a nail bin seat groove extending along the axial direction, and a titanium nail firing part is movably arranged in the nail bin seat groove; one end of the titanium nail firing piece is fixedly connected with a launching steel wire; the nail bin seat groove is internally provided with a nail bin seat assembly, the nail bin seat assembly is provided with a titanium nail accommodating groove, a titanium nail and a propeller are movably arranged in the titanium nail accommodating groove, and the propeller is positioned below the titanium nail; the nail bin seat assembly is positioned on the outer side of the titanium nail firing component; the handle pulls the launching steel wire to drive the titanium nail triggering part to move forwards along the nail bin seat groove, and the titanium nail triggering part pushes the titanium nails to move outwards through the propeller, so that the titanium nails are triggered. The invention can form a nailing mechanism with the end surface of the top end part, thereby being used for minimally invasive treatment of gastroesophageal reflux disease under an endoscope.
Description
Technical Field
The invention relates to a minimally invasive surgical treatment instrument, in particular to a rigid section of an endoscope stapling device for implementing fundoplication.
Background
Gastroesophageal reflux disease (GERD) refers to the reflux of excess contents of the stomach or duodenum into the esophagus, causing symptoms such as acid regurgitation, heartburn, and the like, and may cause esophagitis and tissue damage other than the esophagus, such as the pharynx, larynx, trachea, and the like. Gastroesophageal reflux disease (GERD) is a common disease in Western countries, and studies have shown that the incidence rate of gastroesophageal reflux disease in Western countries is about 10% -20%, Australia is about 11.6%, and Asian is about 5% in recent years. The incidence rate increases with the age, and the age of 40-60 years is the peak incidence age, and men and women have no difference, but patients with reflux esophagitis are more male than female. With the improvement of the living standard of residents, the requirements of people on the quality of life are continuously improved, and the gastroesophageal reflux prevalence rate is 5.77 percent in China according to the statistics of the digestive disease society of the Chinese medical society. Patients with gastroesophageal reflux disease in general can be cured by changing lifestyle or medication. However, some patients with cardia laxity or hiatal hernia have poor effects after drug treatment, some patients can only solve part of symptoms after drug treatment, and some patients need to insist on taking the medicine for a long time, and the patients need to be treated by surgical operation. Studies have shown that about 25% to 30% of patients with GERD have poor drug therapy or are intolerant of long-term medication and require surgical treatment.
The existing surgical treatment of gastroesophageal reflux disease generally adopts laparoscopic fundoplication or endoscopic suturing technology and radio frequency ablation technology, although the problem of repeated attack of symptoms can be solved, postoperative complications are often accompanied, and the postoperative quality of life is greatly influenced, so the mode of surgical treatment of gastroesophageal reflux disease is not popularized, and once the gastroesophageal reflux disease is suffered, the quality of life of a patient is obviously reduced.
Disclosure of Invention
The invention aims to solve the technical problem of providing a rigid section of an endoscope stapling device for implementing fundoplication, which can form a stapling mechanism with the end surface of the top end part, thereby realizing minimally invasive treatment of gastroesophageal reflux disease under an endoscope.
In order to solve the technical problems, the technical solution of the rigid section of the endoscopic stapling device for performing fundoplication according to the present invention is:
the nail magazine comprises a rigid section shell 4-1, wherein a nail magazine seat groove 4-1-1 extending along the axial direction is formed in the side part of the rigid section shell 4-1, a titanium nail firing part 4-7 is movably arranged in the nail magazine seat groove 4-1-1, and the length of the titanium nail firing part 4-7 is smaller than that of the nail magazine seat groove 4-1-1; one end of the titanium nail firing part 4-7 is fixedly connected with one end of the launching steel wire 4-8, and the other end of the launching steel wire 4-8 is connected with the handle 1; a nail bin seat assembly is arranged in the nail bin seat groove 4-1-1, a titanium nail accommodating groove 4-3-1 is formed in the nail bin seat assembly, a titanium nail 4-4 and a propeller 4-6 are movably arranged in the titanium nail accommodating groove 4-3-1, and the propeller 4-6 is positioned on the inner side of the titanium nail 4-4; the nail bin seat assembly is positioned on the outer side of the titanium nail firing component 4-7; the handle 1 pulls the launching steel wire 4-8 to drive the titanium nail firing part 4-7 to move forwards along the nail bin seat groove 4-1-1, and the titanium nail firing part 4-7 pushes the titanium nail 4-4 to move outwards through the thruster 4-6, so that the titanium nail 4-4 is fired; one end of the rigid section shell 4-1 is fixedly connected with a sensor positioning disc 4-2, the side part of the sensor positioning disc 4-2 is provided with a sensor positioning groove 4-2-1, and an angle tracking sensor 7 is fixedly arranged in the sensor positioning groove 4-2-1; the angle tracking sensor 7 is connected with an angle tracking sensor signal line 7-1; the sensor positioning groove 4-2-1 and the nail bin seat groove 4-1-1 are positioned in the same circumferential direction of the rigid section 4.
In another embodiment, the nail bin seat assembly comprises a nail bin seat 4-3, the titanium nail accommodating groove 4-3-1 is formed in the nail bin seat 4-3, and the titanium nail accommodating groove 4-3-1 is communicated along the radial direction, so that a titanium nail firing part 4-7 positioned on the inner side of the nail bin seat 4-3 can contact a propeller 4-6 in the titanium nail accommodating groove 4-3-1; the nail bin seat 4-3 is also provided with a reflector accommodating groove 4-3-2, and an ultrasonic reflector 4-5 is arranged in the reflector accommodating groove 4-3-2; the nail bin seat 4-3 is also provided with a positioning pin hole 4-3-3 corresponding to the end positioning pin 11 and two chopping board screw matching holes 4-3-4 corresponding to the chopping board screws 6-3.
In another embodiment, the dowel hole 4-3-3 has a hole depth less than the length of the end dowel 11 extending out of the top seat 6-1.
In another embodiment, the anvil screw engaging hole 4-3-4 has a hole depth less than the length of the anvil screw 6-3 extending out of the anvil 6-2.
In another embodiment, the surface of the cartridge seat 4-3 is arcuate.
In another embodiment, the arcuate surface of the cartridge seat 4-3 is a partial circumference of the rigid segment housing 4-1.
In another embodiment, the back of the staple cartridge seat 4-3 is formed with titanium staple firing guide slots 4-3-5, and the titanium staple firing guide slots 4-3-5 are in one-to-one correspondence with the firing plates 4-7-1 of the titanium staple firing 4-7; the outer edge of the trigger plate 4-7-1 extends into the titanium nail trigger guide groove 4-3-5, and when the titanium nail trigger 4-7 moves along the nail bin seat groove 4-1-1, the titanium nail trigger guide groove 4-3-5 can guide the titanium nail trigger 4-7.
In another embodiment, the titanium staple firing guide slots 4-3-5 extend along the length of the staple cartridge pocket 4-1-1.
In another embodiment, the titanium staple firing member 4-7 comprises N firing plates 4-7-1 arranged side by side; the firing plate 4-7-1 is provided with a first plane 4-7-11, a pushing inclined plane 4-7-12 and a second plane 4-7-13, wherein the second plane 4-7-13 is higher than the first plane 4-7-11, and a height difference is formed between the second plane 4-7-13 and the first plane 4-7-11; one end of the titanium nail firing part 4-7 forms a steel wire connecting part 4-7-2; the height difference formed between the second plane 4-7-13 and the first plane 4-7-11 is the firing stroke of the titanium nails 4-4.
In another embodiment, the propeller 4-6 comprises a propeller main body 4-6-1, and the bottom of the propeller main body 4-6-1 is provided with a sliding groove 4-6-2; a guide part 4-6-3 is formed at the rear part of the propeller main body 4-6-1, and a guide inclined plane 4-6-12 matched with a pushing inclined plane 4-7-12 of the titanium nail firing part 4-7 is formed at the bottom of the guide part 4-6-3; the front part of the propeller main body 4-6-1 forms a limiting part 4-6-4, and the bottom surface of the limiting part 4-6-4 is matched with the second plane 4-7-13 of the titanium nail firing part 4-7.
The invention can achieve the technical effects that:
the titanium nail firing mechanism is arranged in the folding stapling device, when the top end portion is in a stapling state, the titanium nail firing mechanism is started to fire the titanium nails embedded in the titanium nail accommodating grooves to the top end portion, the titanium nails are subjected to the reaction force of the chopping board, nail legs of the titanium nails can be bent inwards, and the lower esophagus section and part of two layers of tissues at the bottom of the stomach are stapled together to form a folding stapling portion, so that a circle of His angle alpha around the esophagus is restored to be an acute angle, a gastroesophageal flap valve is restored, and an effective barrier for preventing gastroesophageal reflux is established.
The titanium nail percussion mechanism can realize percussion of the titanium nail only by pulling the launching steel wire, is simple and easy to operate, and is beneficial to minimally invasive operation of doctors.
The titanium nail firing stroke of the invention is determined by the height of the pushing inclined plane of the titanium nail firing part, and the firing stroke of the titanium nail can not be influenced even if the force for pulling the firing steel wire is too large, so that the invention can accurately control the firing stroke of the titanium nail, can not influence the nailing effect due to different operator forces, and can ensure the operation effect.
The nail bin seat assembly is detachable, when titanium nails in the nail bin seat assembly are triggered, the next nailing operation can be carried out by replacing a new nail bin seat assembly, and therefore the nailing operation can be triggered for many times.
Drawings
It is to be understood by those skilled in the art that the following description is only exemplary of the principles of the present invention, which may be applied in numerous ways to achieve many different alternative embodiments. These descriptions are made for the purpose of illustrating the general principles of the present teachings and are not meant to limit the inventive concepts disclosed herein.
The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the invention and, together with the general description given above and the detailed description of the drawings given below, serve to explain the principles of the invention.
The invention is described in further detail below with reference to the following figures and detailed description:
FIG. 1 is a schematic view of an endoscopic stapling device for performing fundoplication in accordance with the present invention;
FIGS. 2-7 are schematic views of the operation of the present invention;
FIG. 8 is a schematic view of a titanium nail of the present invention, shown in its initial state;
FIG. 9 is a schematic view of a titanium staple of the present invention shown in a stapled condition;
FIG. 10 is a schematic view of a rigid segment of the present invention;
FIG. 11 is an exploded schematic view of the rigid segment assembly of the present invention;
FIG. 12 is a cross-sectional schematic view of the rigid segment assembly of the present invention with the titanium staple firing mechanism in an unfired state;
FIG. 13 is a schematic view of a titanium staple firing member of the present invention;
FIG. 14 is an exploded view of the cartridge holder assembly of the present invention;
FIG. 15a is a schematic front view of a cartridge seat of the present invention;
FIG. 15b is a schematic back view of the cartridge seat of the present invention;
FIG. 16 is a schematic view of the propeller of the present invention;
FIG. 17 is a schematic view of the titanium staple firing mechanism of the present invention in an unfired condition in relative position to the titanium staples;
FIG. 18 is a schematic view of the titanium staple firing mechanism of the present invention with the titanium staples and pusher in the cartridge bay in the unfired condition;
FIG. 19 is a diagrammatic view of the titanium staple firing mechanism of the present invention during firing thereof;
FIG. 20 is a schematic view of the titanium staple firing mechanism of the present invention with one of the titanium staples in the process of firing;
FIG. 21 is a schematic cross-sectional view of the rigid section of the present invention with the titanium staple firing mechanism in a fired state with the titanium staples exiting the staple cartridge receptacle;
FIG. 22 is a schematic view of the titanium staple firing mechanism of the present invention in a fired state relative to titanium staples
FIG. 23 is a schematic illustration of the relative positions of the titanium staples and the pusher with the staple cartridge receptacle of the titanium staple firing mechanism of the present invention in the fired state;
FIG. 24 is a schematic view of the tip portion of the present invention;
FIG. 25 is a schematic end view of the tip portion of the present invention;
FIG. 26 is a schematic sectional view A-A of FIG. 25;
FIG. 27 is a schematic view of an anvil of the present invention;
FIG. 28 is an exploded view of the tip portion of the present invention;
fig. 29 is a schematic sectional view of the tip portion of the present invention.
The reference numbers in the figures illustrate:
100 is an endoscope nailing device which comprises a nail head,
1 is a handle, 2 is a conical protective sleeve,
3 is an insertion tube, 4 is a rigid section,
5 is a bending part, 6 is a top end part,
an angle tracking sensor 7, a miniature camera 8,
9 is an LED lamp, 10 is an ultrasonic detector,
the positioning pin 11 is an end positioning pin,
4-1 is a rigid section shell, 4-2 is a sensor positioning disk,
4-3 is a nail bin seat, 4-4 is a titanium nail,
4-5 are ultrasonic wave reflecting mirrors,
4-2-1 is a sensor positioning groove,
4-3-1 is a titanium nail accommodating groove, 4-3-2 is a reflector accommodating groove,
4-3-3 is a positioning pin hole, 4-3-4 is a chopping board screw matching hole,
4-6-1 is a propeller main body, 4-6-2 is a chute,
4-6-3 is a guide part, 4-6-4 is a limit part,
4-6-11 is a titanium nail limiting surface, 4-6-12 is a guide inclined surface,
4-7-1 is a percussion plate, 4-7-2 is a steel wire connecting part,
4-7-11 is a first plane, 4-7-12 is an inclined plane,
4-7-13 is a second plane,
6-1 is a top seat, 6-2 is a chopping block,
6-3 is a chopping board screw, 6-4 is a chopping board driving shaft,
6-5 is a driven gear, 6-6 is a screw guide seat of the chopping board,
6-7 are driven gear positioning pins, 6-8 are chopping block positioning pins,
6-1-1 is a top seat body, 6-1-2 is a chopping block positioning groove,
6-1-3 is a cutting board driving shaft through hole, 6-1-4 is a driven gear shaft through hole,
6-1-5 is an LED lamp positioning hole, 6-1-6 is a micro camera positioning hole,
6-1-7 is an ultrasonic detector mounting hole, 6-1-8 is an end positioning pin accommodating hole,
6-1-9 is a driven gear positioning pin through hole, 6-1-10 is a limit boss,
6-2-0 is the chopping block body, 6-2-1 is the chopping block screw through hole,
6-2-2, 6-2-3, 6-2-4, 6-2-5 and 6-2-6 are titanium nail bending guide grooves,
6-2-7 is a first baffle lug, 6-2-8 is a second baffle lug,
7-1 is an angle tracking sensor signal line,
9-1 is an LED lamp shade,
the esophagus 201 and the stomach 202 are shown.
Detailed Description
In order to make the objects, technical solutions and advantages of the embodiments of the present invention clearer, the technical solutions of the embodiments of the present invention will be clearly and completely described below with reference to the drawings of the embodiments of the present invention. It is to be understood that the embodiments described are only a few embodiments of the present invention, and not all embodiments. All other embodiments, which can be derived by a person skilled in the art from the described embodiments of the invention without any inventive step, are within the scope of protection of the invention. Unless defined otherwise, technical or scientific terms used herein shall have the ordinary meaning as understood by one of ordinary skill in the art to which this invention belongs.
As shown in figure 1, the endoscope stapling device 100 for implementing the fundoplication comprises a handle 1, a conical protective sleeve 2, an insertion tube 3, a rigid section 4, a bending part 5 and a top end part 6, wherein the front end of the handle 1 is fixedly connected with the insertion tube 3 through the conical protective sleeve 2, and the front end of the insertion tube 3 is fixedly connected with the rigid section 4, the bending part 5 and the top end part 6 in sequence; the side surface of the rigid section 4 and the end surface of the top end part 6 form a nailing mechanism;
the outer diameters of the insertion tube 3, the rigid section 4, the bending section 5 and the tip section 6 are smaller than the inner diameter of the esophagus 201, so that the front end of the endoscopic stapling apparatus can be inserted into the stomach 202 through the esophagus 201 through the oral cavity;
the handle 1 is provided with a bending angle control mechanism which can control the bending angle of the bending part 5, so that the included angle between the top end part 6 at the two ends of the bending part 5 and the rigid section 4 is changed within the range of 0-270 degrees, and the end surface of the top end part 6 is driven to move relative to the side surface of the rigid section 4;
in the initial state, the bending angle of the bending part 5 is 0 degrees, and then the top end part 6, the bending part 5 and the rigid section 4 are on the same straight line; the front end of the endoscopic stapling device 100 (i.e., the tip portion 6, the bending portion 5 and the rigid section 4) is inserted into the stomach 202 through the mouth via the esophagus 201, and the inside of the stomach 202 (e.g., mucosal structure) can be observed by the micro-camera 8 of the tip portion 6, as shown in FIG. 2;
when the rigid segment 4 is positioned at the bottom of the esophagus 201, as shown in fig. 3, the bending angle control mechanism of the handle 1 is manipulated to gradually bend the bending portion 5 to move the tip portion 6 relative to the rigid segment 4, thereby changing the relative position between the end surface of the tip portion 6 and the side surface of the rigid segment 4;
when the bending angle of the bending part 5 reaches 180 degrees, the end face of the top end part 6 is pressed against the inner wall of a part of the fundus stomach; in the course of increasing the bending angle of the bending portion 5 from 180 ° to 270 °, the portion of the fundus is pushed by the end face of the tip portion 6 to move toward the esophageal direction, as shown in fig. 4;
when the bending angle of the bending portion 5 is 270 °, the portion of the fundus is pushed by the end surface of the tip portion 6 to overlap with the lower section of the esophagus, thereby achieving folding of the portion of the fundus with the esophagus, as shown in fig. 5; when the side surface of the rigid section 4 is opposite to the end surface of the top end part 6, the ultrasonic reflector 4-5 of the rigid section 4 can reflect all ultrasonic signals emitted by the ultrasonic detector 10 of the top end part 6 and send the reflected ultrasonic signals to the ultrasonic detector 10, the bending part 5 is bent to the position, and the top end part 6 is in a nailing state;
the end positioning pin 11 is driven by the positioning pin driving motor to extend outwards, so that the tip of the end positioning pin 11 of the top end part 6 passes through two layers of tissues of the fundus and esophagus and extends into the positioning pin hole 4-3-3 of the rigid section 4, the top end part 6 is kept in a nailing state, and the position positioning between the top end part 6 and the rigid section 4 is realized; because the hole depth of the positioning pin hole 4-3-3 is smaller than the extension length of the end positioning pin 11, when the end positioning pin 11 extends to the right position, a distance H1 is formed between the end surface of the top end part 6 and the side surface of the rigid section 4, and the distance H1 is the thickness of two layers of tissues;
then, the two chopping board screws 6-3 are driven by the chopping board screw driving mechanism to extend outwards, so that the tip ends of the chopping board screws 6-3 at the top end part 6 penetrate through the two layers of tissues and are screwed into the chopping board screw matching holes 4-3-4 of the nail bin seat 4-3 of the rigid section 4; in the process that the chopping board screws 6-3 are screwed inwards, the two chopping board screws 6-3 respectively penetrate through the two layers of tissues along the thickness direction and extrude the two layers of tissues together; because the hole depth of the anvil screw fitting hole 4-3-4 is smaller than the extension length of the anvil screw 6-3, when the anvil screw 6-3 extends in place, a distance H2 is formed between the end surface of the top end portion 6 and the side surface of the rigid section 4, and the distance H2 is the nailing thickness of the titanium nail 4-4; h1 > H2; after the chopping board screw 6-3 extends to the right position, the end positioning pin 11 can be retracted;
starting a titanium nail firing mechanism, simultaneously ejecting five titanium nails 4-4 (at the moment, the titanium nails 4-4 are in the shape shown in fig. 8, and the legs of the titanium nails 4-4 are outward) of the nail bin assembly, wherein the titanium nails 4-4 sequentially penetrate through the lower esophageal section and part of the fundus tissue after being ejected, and are subjected to the reaction force of the cutting board 6-2 on the end surface of the top end part 6, so that the two legs of the titanium nails 4-4 are bent inwards to form a B shape shown in fig. 9, and at the moment, the titanium nails 4-4 can nail the lower esophageal section and part of the two layers of fundus tissue together to form a folded nailing part 200 as shown in fig. 6, so that the part is nailed and fixed;
replacing a new nail bin seat assembly, rotating the handle 1 by an angle around the axial direction to enable the end surface of the top end part 6 to contact the inner wall of the other stomach fundus, and realizing the folding and nailing of the other stomach fundus and the lower esophagus segment as shown in fig. 7; according to the practical situation, a plurality of (such as three) folds and staples are implemented around the circumference of the esophagus, so that the circle of His angle alpha around the esophagus is restored to an acute angle, the gastroesophageal flap valve is restored, and an effective barrier for preventing the gastroesophageal reflux is established.
The invention realizes the relative position positioning between the top end part 6 and the rigid section 4 before the stapling through the end positioning pin 11, thereby realizing the preliminary positioning of the tissue to be stapled, avoiding or reducing the deviation of the positioning position of the tissue in the stapling process and improving the operation precision.
According to the invention, the anvil plate screw 6-3 is used for extruding and positioning the tissue to be stapled, so that the two layers of tissues can be tightly fixed together by the titanium nail 4-4 without separation after the nail legs of the titanium nail 4-4 are bent in the stapling process, and the newly formed His angle (gastroesophageal angle) can not be changed for a long time. In addition, the nailing thickness of the titanium nail 4-4 is determined by the chopping board screw 6-3, so that the titanium nail 4-4 can be accurately launched to the titanium nail bending guide groove of the chopping board 6-2, the device can be suitable for different people, and even if the thicknesses of two layers of tissues of the stomach fundus and the esophagus of an individual are different due to different constitutions, the phenomena of infirm nailing and reduced operation effect can not be generated.
The invention precisely controls the extension stroke of the chopping board screw 6-3 through the chopping board screw driving mechanism, so that the thickness of two layers of tissues between the end surface of the top end part 6 and the side surface of the rigid section 4 is gradually reduced and reaches the nailing thickness of the titanium nail 4-4 capable of implementing nailing; the thickness variation of the two layers of tissue can be monitored by the ultrasonic detector 10, so that the thickness of the stapled tissue can be accurately controlled.
The bend angle control mechanism for controlling the bending portion 5 in the present invention is a conventional one, and will not be described herein.
As shown in fig. 10 to 12, the rigid section 4 includes a rigid section housing 4-1, one end of the rigid section housing 4-1 is fixedly connected to a sensor positioning plate 4-2, a sensor positioning groove 4-2-1 is formed in a side portion of the sensor positioning plate 4-2, and an angle tracking sensor 7 is fixedly arranged in the sensor positioning groove 4-2-1; the angle tracking sensor 7 is connected with one end of an angle tracking sensor signal line 7-1, and the other end of the angle tracking sensor signal line 7-1 is connected with the main board to realize synchronous transmission and feedback of signals;
a nail bin seat groove 4-1-1 extending along the axial direction is formed in the side part of the rigid section shell 4-1, a titanium nail firing part 4-7 is movably arranged in the nail bin seat groove 4-1-1, and the length of the titanium nail firing part 4-7 is smaller than that of the nail bin seat groove 4-1-1; one end of the titanium nail firing part 4-7 is fixedly connected with one end of the launching steel wire 4-8, and the other end of the launching steel wire 4-8 is connected with the handle 1; the launching steel wire 4-8 can be pulled through the control handle 1, so that the titanium nail firing part 4-7 is driven to move back and forth along the nail bin seat groove 4-1-1;
a nail bin seat assembly is arranged in the nail bin seat groove 4-1-1, five titanium nail accommodating grooves 4-3-1 are formed in the nail bin seat assembly, and the titanium nail accommodating grooves 4-3-1 are used for accommodating titanium nails 4-4 and a propeller 4-6; the propeller 4-6 is abutted against the bottom of the titanium nail 4-4;
as shown in FIG. 13, the titanium staple firing member 4-7 comprises three firing plates 4-7-1 arranged side by side, with the three firing plates 4-7-1 corresponding to five titanium staples 4-4, such that the five titanium staples 4-4 can simultaneously contact the titanium staple firing member 4-7;
the firing plate 4-7-1 is provided with a first plane 4-7-11, a pushing inclined plane 4-7-12 and a second plane 4-7-13, the second plane 4-7-13 is higher than the first plane 4-7-11, and the height difference between the second plane 4-7-13 and the first plane 4-7-11 is the firing stroke of the titanium nail 4-4;
one end of the titanium nail firing part 4-7 forms a steel wire connecting part 4-7-2, and the titanium nail firing part 4-7 is fixedly connected with one end of the launching steel wire 4-8 through the steel wire connecting part 4-7-2.
As shown in FIG. 14, the cartridge holder assembly comprises a cartridge holder 4-3, the surface of the cartridge holder 4-3 is a partial circumference of the rigid section housing 4-1 (i.e., the arc-shaped surface of the cartridge holder 4-3 is a partial circumference of the rigid section housing 4-1);
as shown in fig. 15a and 15b, five titanium nail accommodating grooves 4-3-1 are formed in the nail bin seat 4-3, and the titanium nail accommodating grooves 4-3-1 are communicated in the radial direction (i.e., the thickness direction of the nail bin seat 4-3), so that the titanium nail firing member 4-7 positioned at the inner side of the nail bin seat 4-3 can contact the pusher 4-6 in the titanium nail accommodating groove 4-3-1; the titanium nail accommodating groove 4-3-1 is internally provided with a titanium nail 4-4 and a propeller 4-6; the propeller 4-6 is positioned at the bottom of the titanium nail 4-4;
the back of the nail bin seat 4-3 is provided with a titanium nail firing part guide groove 4-3-5, and the titanium nail firing part guide groove 4-3-5 is in one-to-one correspondence with a firing plate 4-7-1 of the titanium nail firing part 4-7; the outer edge of the trigger plate 4-7-1 extends into the titanium nail trigger guide groove 4-3-5, and when the titanium nail trigger 4-7 moves along the nail bin seat groove 4-1-1, the titanium nail trigger guide groove 4-3-5 can guide the titanium nail trigger 4-7;
the nail bin seat 4-3 is also provided with a reflector containing groove 4-3-2, an ultrasonic reflector 4-5 is arranged in the reflector containing groove 4-3-2, and the ultrasonic reflector 4-5 is used for receiving an ultrasonic signal sent by the ultrasonic detector 10 and reflecting the received ultrasonic signal to the ultrasonic detector 10;
the nail bin seat 4-3 is also provided with a positioning pin hole 4-3-3 corresponding to the end positioning pin 11 and two chopping board screw matching holes 4-3-4 corresponding to the chopping board screws 6-3; the hole depth of the positioning pin hole 4-3-3 is smaller than the extension length of the end positioning pin 11, and the hole depth of the chopping board screw matching hole 4-3-4 is smaller than the extension length of the chopping board screw 6-3.
As shown in fig. 16, the pusher 4-6 comprises a pusher body 4-6-1, a sliding groove 4-6-2 is formed at the bottom of the pusher body 4-6-1, and the width of the sliding groove 4-6-2 is matched with the thickness of the firing plate 4-7-1, so that the pusher 4-6 can straddle the firing plate 4-7-1, and the relative sliding between the pusher 4-6 and the firing plate 4-7-1 can be realized; the bottom of the propeller main body 4-6-1 forms a conical surface with a big top and a small bottom;
the rear part of the propeller main body 4-6-1 is provided with a guide part 4-6-3, the bottom of the guide part 4-6-3 is provided with a guide inclined plane 4-6-12, the inclination of the guide inclined plane 4-6-12 is matched with the push inclined plane 4-7-12 of the trigger plate 4-7-1, and the titanium nail trigger 4-7 can push the propeller 4-6 to move outwards through the push inclined plane 4-7-12 in the moving process;
the front part of the propeller main body 4-6-1 forms a limiting part 4-6-4; when the titanium nail firing part 4-7 moves to the state that the second plane 4-7-13 contacts with the thruster 4-6, the second plane 4-7-13 of the titanium nail firing part 4-7 contacts with the bottom surface of the limiting part 4-6-4;
the upper surface of the propeller main body 4-6-1 is used as a titanium nail limiting surface 4-6-11; the thruster main body 4-6-1 provides percussion force for the titanium nails 4-4 through the titanium nail limiting surfaces 4-6-11, and when the titanium nail percussion piece 4-7 pushes the thruster 4-6 to move outwards along the titanium nail accommodating groove 4-3-1, the thruster 4-6 can push the titanium nails 4-4 to move outwards, so that the titanium nails 4-4 can be struck.
4-7 parts of titanium nail firing part, 4-8 parts of launching steel wire and 4-6 parts of propeller form a titanium nail firing mechanism; in an initial state, the titanium nail firing part 4-7 is positioned at the rear end of the nail bin seat groove 4-1-1; at the moment, the titanium nails 4-4 and the pusher 4-6 in the nail bin seat 4-3 are positioned above the first plane 4-7-11 of the trigger plate 4-7-1; to avoid false firing, a gap is formed between the pusher 4-6 and the first plane 4-7-11, as shown in fig. 12 and 17; at this time, the titanium nail 4-4 is positioned in the titanium nail accommodating groove 4-3-1, and the propeller 4-6 is positioned at the bottom of the titanium nail accommodating groove 4-3-1, as shown in fig. 18;
when in percussion, the launching steel wire 4-8 is pulled to drive the titanium nail percussion piece 4-7 to move forward for a section of stroke along the nail bin seat groove 4-1-1; during the forward movement of the titanium staple firing member 4-7, the pusher ramp 4-7-12 of the titanium staple firing member 4-7 contacts the pusher 4-6, thereby pushing the titanium staple 4-4 outward by the pusher 4-6, as shown in FIGS. 19 and 20; when the titanium staple firing member 4-7 moves to the front end of the staple cartridge pocket 4-1-1, the second flat surface 4-7-13 of the titanium staple firing member 4-7 contacts the pusher 4-6 and the titanium staple 4-4 completes the firing stroke, as shown in FIG. 21 and as shown in FIG. 22; at the moment, the titanium nail firing part 4-7 pushes the pusher 4-6 to the top of the titanium nail accommodating groove 4-3-1, the pusher 4-6 pushes the titanium nail 4-4 out of the titanium nail accommodating groove 4-3-1, and as shown in fig. 23, five titanium nails 4-4 are simultaneously ejected;
in the process that the titanium nails 4-4 leave the titanium nail accommodating grooves 4-3-1, the nail legs of the titanium nails 4-4 contact the surface of the chopping board 6-2, the chopping board 6-2 provides bending reaction force for the titanium nails 4-4, the nail legs are guided by the bottoms of the bending guide grooves, so that the two nail legs of the same titanium nail 4-4 are bent inwards twice, the titanium nails 4-4 are deformed into a nailing shape as shown in fig. 10, and the titanium nails 4-4 can tightly fix two layers of tissues together, so that a new acute angle His angle alpha is formed.
According to the invention, the titanium nail firing part 4-7 is driven by the launching steel wire 4-8 to move forwards along the nail bin seat groove 4-1-1, and in the process that the titanium nail firing part 4-7 moves forwards, the titanium nail 4-4 is pushed to move outwards by the propeller 4-6 by means of the inclined plane formed by the titanium nail firing part 4-7 and the guide part 4-6-3 of the propeller 4-6 to match, so that the titanium nail 4-4 is fired. Because the triggering stroke of the titanium nails 4-4 is determined by the height of the inclined plane of the titanium nail triggering part 4-7, the triggering stroke of the titanium nails 4-4 can not be influenced even if the force for pulling the launching steel wire 4-8 is overlarge, therefore, the invention can accurately control the triggering stroke of the titanium nails 4-4 and can not influence the nailing effect due to different force of different operators.
According to the invention, the ultrasonic reflector 4-5 is arranged near the titanium nail accommodating groove 4-3-1, the ultrasonic detector 10 is arranged on the end face of the top end part 6, and the nailing point can be accurately determined with the help of the ultrasonic detector 10, so that the operation precision of the fundoplication can be greatly improved.
According to the invention, the rigid section 4 is provided with the angle tracking sensor 7, when the handle 1 rotates around the axial direction, the rigid section 4 deflects along with the axial direction, the angle tracking sensor 7 also deflects along with the axial direction, the angle tracking sensor 7 transmits a deflection angle signal to the main board in real time, and the main board receives the deflection angle signal and then displays the deflection angle signal in a display picture visually. The invention can accurately determine the relative position of the top part 6 and the esophagus through the angle tracking sensor 7 so as to determine the specific position of the other part of the fundus ventriculi, thereby providing accurate and visual guidance for the fundoplication operation.
As shown in fig. 24 to 26, the top end portion 6 comprises a top end seat 6-1, an end face of the top end seat 6-1 is provided with a cutting board 6-2, a micro camera 8, an LED lamp 9, an ultrasonic detector 10 and an end portion positioning pin 11, the cutting board 6-2 is fixedly arranged in the middle of the end face, the length of the cutting board 6-2 extends in the longitudinal direction, and the surface of the cutting board 6-2 protrudes out of the end face of the top end seat 6-1, so that a bending force can be provided for the titanium nails 4-4; the miniature camera 8 and the LED lamp 9 are positioned on one side of the chopping board 6-2, and the ultrasonic detector 10 and the end positioning pin 11 are positioned on the other side of the chopping board 6-2; the LED lamp 9 is used for providing an illumination light source, and the micro camera 8 is used for collecting images; the ultrasonic detector 10 is used for transmitting and receiving ultrasonic signals; the ultrasonic detector 10 is matched with the ultrasonic reflector 4-5 of the rigid section 4, the ultrasonic detector 10 emits an ultrasonic signal, the ultrasonic signal is reflected back to the ultrasonic detector 10 through the ultrasonic reflector 4-5, and the ultrasonic detector 10 judges whether the top end part 6 is perfectly matched with the position of the nail bin seat 4-3 of the rigid section 4 according to the strength change condition of the received signal; when the ultrasonic signal is stable, the end positioning pin 11 extends outwards and is matched with the positioning pin hole 4-3-3 of the rigid section 4, so that the tissue is positioned;
the middle part of the end part positioning pin 11 is provided with an external thread 11-1, and the end part positioning pin 11 is connected with the top end seat 6-1 through a thread; the free end of the end positioning pin 11 is a tip end, and the fixed end of the end positioning pin 11 is connected with a positioning pin driving motor; the end positioning pin 11 is driven to rotate by the positioning pin driving motor, so that the end positioning pin 11 can move in a telescopic manner relative to the top seat 6-1; the free end of the end positioning pin 11 is matched with the positioning pin hole 4-3-3 of the rigid section 4, so that tissue positioning can be carried out, and the deviation of the positioning position of the tissue in the operation process is avoided or reduced.
Since the side surface of the rigid segment 4 is opposed to the end surface of the distal end portion 6 in the stapled state, the view angle of the micro-camera 8 positioned at the distal end portion 6 is blocked by the fundus tissue, and therefore image information cannot be acquired, resulting in a blind area in the entire stapled state. The invention is provided with the ultrasonic reflectors 4-5 and the ultrasonic detector 10 on the side surface of the rigid section 4 and the end surface of the top end part 6 respectively, and can monitor the relative position between the rigid section 4 and the top end part 6 in the nailing process, thereby enabling an operator to still visually observe the position information between the rigid section 4 and the top end part 6 in the nailing state.
As shown in figure 27, the anvil 6-2 comprises an anvil body 6-2-0 having an arc-shaped surface, the arc-shaped surface of the anvil body 6-2-0 being fitted with the side of the rigid section 4; the length direction of the anvil body 6-2-0 corresponds to the circumferential direction (namely the arc length direction) of the nail bin seat 4-3; when the top end part 6 is in a nailed state, the surface of the chopping block body 6-2-0 is matched with the side part of the rigid section 4;
two ends of the anvil plate body 6-2-0 are respectively provided with anvil plate screw penetrating holes 6-2-1, anvil plate screws 6-3 are movably arranged in the anvil plate screw penetrating holes 6-2-1, and the anvil plate screws 6-3 are connected with an anvil plate screw driving mechanism arranged in the top seat 6-1; the chopping board screw 6-3 can perform telescopic motion relative to the chopping board body 6-2-0 under the action of the chopping board screw driving mechanism;
five groups of titanium nail bending guide grooves 6-2-2, 6-2-3, 6-2-4, 6-2-5 and 6-2-6 are distributed on the surface of the anvil plate body 6-2-0 (five different patterns are used for respectively representing the groove bottoms of the five groups of titanium nail bending guide grooves in the figure); each group of titanium nail bending guide grooves comprises two parallel bending guide grooves, and each bending guide groove corresponds to one nail leg of the titanium nail 4-4; the bottom of each bending guide groove is arc-shaped with two high ends and a low middle part, and the bottom of each group of titanium nail bending guide grooves is symmetrically arranged; the bending guide groove can guide the bending direction of the nail legs of the titanium nails 4-4.
Two stop lugs are arranged on the side part of the anvil plate body 6-2-0, and the first stop lug 6-2-7 is positioned on the outer side above the LED lamp 9 and right above the water outlet hole; the second stop lug 6-2-8 is positioned at the outer side above the miniature camera 8 and right above the air outlet, as shown in fig. 25; the bottom surfaces of the two baffle lugs are respectively vertical to the water outlet hole and the air outlet hole; when the water outlet hole sprays water, the first baffle lug 6-2-7 reflects water flow, so that the water flow is sprayed to the miniature camera 8 and the LED lamp 9, and the lens of the miniature camera 8 and the LED lamp 9 are washed; when the air outlet is exhausted, the second baffle lug 6-2-8 reflects the air flow, so that the air flow is sprayed to the micro-camera 8 and the LED lamp 9, and the lens of the micro-camera 8 and the LED lamp 9 are blown and swept.
As shown in fig. 28 and 29, the anvil screw driving mechanism comprises an anvil driving shaft 6-4, and the anvil driving shaft 6-4 can rotate under the driving of power; a driving gear is arranged on the chopping board driving shaft 6-4, and two sides of the driving gear are respectively meshed with a driven gear 6-5; two driven gears 6-5 are respectively fixedly connected with chopping board screws 6-3;
the bottom of the chopping board 6-2 is fixedly provided with two chopping board screw guide seats 6-6, and the chopping board screw guide seats 6-6 are connected with chopping board screws 6-3 through threads; the chopping board screw guide seats 6-6 and the driven gears 6-5 are in one-to-one correspondence and are coaxially arranged;
the bottom of the driven gear 6-5 is provided with a driven gear positioning pin 6-7; the driven gear positioning pin 6-7 is longitudinally arranged in a driven gear positioning pin hole 6-1-9 of the top seat 6-1 in a penetrating manner; the driven gear positioning pin 6-7 can limit the driven gear 6-5, so that the driven gear 6-5 is prevented from axial displacement, and the transmission precision of the chopping board screw driving mechanism is ensured;
the chopping board driving shaft 6-4 drives the two driven gears 6-5 to synchronously rotate, so as to drive the chopping board screw 6-3 to do telescopic motion relative to the chopping board 6-2; the anvil screw guide seat 6-6 can guide the anvil screw 6-3, thereby precisely controlling the stroke of the anvil screw 6-3.
It will be apparent to those skilled in the art that various modifications and variations can be made in the present invention without departing from the spirit or scope of the invention. Thus, it is intended that the present invention cover the modifications and variations of this invention provided they come within the scope of the appended claims and their equivalents.
Claims (10)
1. A rigid section of an endoscope stapling device for performing gastric fundoplication is characterized by comprising a rigid section shell (4-1), wherein a nail bin seat groove (4-1-1) extending along the axial direction is formed in the side part of the rigid section shell (4-1), a titanium nail firing part (4-7) is movably arranged in the nail bin seat groove (4-1-1), and the length of the titanium nail firing part (4-7) is smaller than that of the nail bin seat groove (4-1-1); one end of the titanium nail firing part (4-7) is fixedly connected with one end of the launching steel wire (4-8), and the other end of the launching steel wire (4-8) is connected with the handle (1);
a nail bin seat assembly is arranged in the nail bin seat groove (4-1-1), the nail bin seat assembly is provided with M titanium nail accommodating grooves (4-3-1), titanium nails (4-4) and propellers (4-6) are movably arranged in the titanium nail accommodating grooves (4-3-1), and the propellers (4-6) are positioned on the inner sides of the titanium nails (4-4); the nail bin seat assembly is positioned on the outer side of the titanium nail firing component (4-7); the titanium nail firing part (4-7) is driven to move forwards along the nail bin seat groove (4-1-1) by pulling the launching steel wire (4-8) through the handle (1), and the titanium nail firing part (4-7) pushes the titanium nail (4-4) to move outwards through the propeller (4-6), so that the titanium nail (4-4) is fired;
one end of the rigid section shell (4-1) is fixedly connected with a sensor positioning disc (4-2), a sensor positioning groove (4-2-1) is formed in the side portion of the sensor positioning disc (4-2), and an angle tracking sensor (7) is fixedly arranged in the sensor positioning groove (4-2-1); the angle tracking sensor (7) is connected with an angle tracking sensor signal line (7-1); the sensor positioning groove (4-2-1) and the nail bin seat groove (4-1-1) are positioned in the same circumferential direction of the rigid section (4).
2. The rigid section of an endoscopic stapling device for performing fundoplication according to claim 1, wherein said cartridge holder assembly comprises a cartridge holder (4-3), said titanium staple receiving slot (4-3-1) being provided in the cartridge holder (4-3), said titanium staple receiving slot (4-3-1) being radially connected such that a titanium staple firing member (4-7) located inside the cartridge holder (4-3) can contact the pusher (4-6) in the titanium staple receiving slot (4-3-1);
the nail bin seat (4-3) is also provided with a reflector accommodating groove (4-3-2), and an ultrasonic reflector (4-5) is arranged in the reflector accommodating groove (4-3-2); the nail bin seat (4-3) is also provided with a positioning pin hole (4-3-3) corresponding to the end positioning pin (11) and two cutting board screw matching holes (4-3-4) corresponding to the cutting board screws (6-3).
3. Rigid segment of an endoscopic stapling device to perform fundoplications according to claim 2, characterized in that the hole depth of the positioning pin hole (4-3-3) is smaller than the length of the end positioning pin (11) protruding out of the top seat (6-1).
4. Rigid segment of an endoscopic stapling device to perform fundoplications according to claim 3, characterized in that the hole depth of the anvil screw fitting hole (4-3-4) is smaller than the length of the anvil screw (6-3) protruding from the anvil (6-2).
5. Rigid segment of an endoscopic stapling device to perform fundoplications according to claim 2, characterized in that the surface of the cartridge seat (4-3) is curved.
6. Rigid segment of an endoscopic stapling device to perform fundoplications according to claim 2, characterized in that the curved surface of the cartridge seat (4-3) is part of the circumference of the rigid segment housing (4-1).
7. The rigid section of an endoscopic stapling device for performing fundoplication according to claim 2, wherein the staple cartridge seat (4-3) is formed with titanium staple firing guide slots (4-3-5) on its back side, the titanium staple firing guide slots (4-3-5) corresponding one-to-one to the firing plates (4-7-1) of the titanium staple firing (4-7); the outer edge of the trigger plate (4-7-1) extends into the titanium nail trigger guide groove (4-3-5), and when the titanium nail trigger (4-7) moves along the nail bin seat groove (4-1-1), the titanium nail trigger guide groove (4-3-5) can guide the titanium nail trigger (4-7).
8. Rigid segment of an endoscopic stapling device to perform fundoplications according to claim 7, characterized in that said titanium staple firing guide slot (4-3-5) extends along the length of the cartridge pocket (4-1-1).
9. Rigid segment of an endoscopic stapling device to perform fundoplications according to claim 1, characterized in that said titanium staple firing member (4-7) comprises N number of firing plates (4-7-1) arranged side by side; the firing plate (4-7-1) is provided with a first plane (4-7-11), a pushing inclined plane (4-7-12) and a second plane (4-7-13), the second plane (4-7-13) is higher than the first plane (4-7-11), and a height difference is formed between the second plane (4-7-13) and the first plane (4-7-11); one end of the titanium nail firing part (4-7) forms a steel wire connecting part (4-7-2); the height difference formed between the second plane (4-7-13) and the first plane (4-7-11) is the firing stroke of the titanium nail (4-4).
10. Rigid segment of an endoscopic stapling device to perform fundoplications according to claim 9, characterized in that said pusher (4-6) comprises a pusher body (4-6-1), the bottom of the pusher body (4-6-1) being provided with a chute (4-6-2); a guide part (4-6-3) is formed at the rear part of the propeller main body (4-6-1), and a guide inclined plane (4-6-12) matched with the pushing inclined plane (4-7-12) of the titanium nail firing part (4-7) is formed at the bottom of the guide part (4-6-3); the front part of the propeller main body (4-6-1) forms a limiting part (4-6-4), and the bottom surface of the limiting part (4-6-4) is matched with the second plane (4-7-13) of the titanium nail firing part (4-7).
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| CN202010533202.8A CN111671479B (en) | 2020-06-12 | 2020-06-12 | Rigid segment of endoscopic stapling device for performing fundoplication |
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| CN202010533202.8A CN111671479B (en) | 2020-06-12 | 2020-06-12 | Rigid segment of endoscopic stapling device for performing fundoplication |
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