CN111743581A - 试样采集缝合器 - Google Patents
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Abstract
本公开涉及一种试样采集缝合器。一种外科缝合装置包含末端执行器和可操作地联接到所述末端执行器的手柄组合件。所述末端执行器包含砧座组合件和钉仓组合件。所述外科缝合装置还包含粘附到所述砧座组合件和所述钉仓组合件的细长支撑通道两者的试样袋。所述试样袋包含在拉绳外壳内的拉绳。一旦将所述外科缝合装置插入到患者体内并且所述砧座组合件和所述钉仓组合件打开,就将组织试样放入所述试样袋中。然后,使所述砧座组合件和所述钉仓组合件在所述组织试样上闭合,并且击发所述外科缝合装置。然后使所述试样袋与所述外科缝合装置分离,并且从所述患者移除所述外科缝合装置和所述试样袋两者。
Description
相关申请的交叉引用
本申请要求2019年3月26日提交的第62/824,106号美国临时专利申请的权益和优先权,所述申请的全部公开内容以引用的方式并入本文中。
技术领域
本公开一般涉及用于微创外科手术(例如内窥镜和/或腹腔镜手术)的手术设备,更具体地,本公开涉及一种手术设备,其包含用于在这些手术过程中收集身体组织和/或体液的试样获取装置。
背景技术
微创手术,例如内窥镜手术,降低了外科手术的侵入性。内窥镜手术涉及通过体壁进行手术,例如对卵巢、子宫、胆囊、肠、肾、阑尾等进行观察和/或手术。存在许多常见的内窥镜外科手术,仅举几例而言,包含关节镜检查、腹腔镜检查、胃肠镜检查和喉镜检查。在这些手术中,利用套管针穿过切口并穿透腹壁,进而允许执行内窥镜手术。将套管针管或插管装置延伸到腹壁中并原位静置以提供用于内窥镜手术工具的进入。通过套管针管插入摄像头或内窥镜以允许对体腔的视觉检查和放大。然后,外科医生可以借助于专用仪器在手术部位进行诊断和/或治疗程序,所述专用仪器例如是设计成适合穿过另外的套管的镊子、抓握器、切割器、涂药器等。
当从体腔切除某些组织,例如肿瘤组织时,重要的是肿瘤组织不与健康或未涉及到的组织接触。如果必须切除肿瘤组织或组织部分,可将其引入“提取袋”(在本文中也称为“试样袋”)中,在这里已将肿瘤或病变组织与周围组织分离,之后将试样袋从体内抽出,从而将病变组织与健康组织的接触最小化。
包含用于微创外科手术的试样袋的改进装置仍然是合乎需要的。
发明内容
本公开提供了外科缝合装置和用于使用所述装置的方法。在实施例中,本公开的外科缝合装置包含末端执行器,所述末端执行器包含可枢转地彼此联接的砧座组合件和钉仓组合件,所述砧座组合件与所述钉仓组合件可相对移动,使得所述末端执行器可在打开位置与夹紧位置之间移动。本公开的外科缝合装置还包含试样袋,所述试样袋包含主体和限定开口端的袋口,所述袋口附接到所述砧座组合件和所述钉仓组合件,使得所述末端执行器向所述打开位置的移动使所述试样袋的所述袋口移动到打开位置。
在一些实施例中,所述试样袋的所述袋口包含其中具有拉绳的拉绳外壳。
在实施例中,本公开的方法包含:将包含砧座组合件和钉仓组合件的外科缝合装置推进到与要从患者体内移除的组织相邻的体腔中;以及将要从患者体内移除的所述组织放置到试样袋中,所述试样袋的袋口附接到所述砧座组合件和所述钉仓组合件。使所述砧座组合件和所述钉仓组合件在所述组织上闭合,并且击发所述外科缝合装置以使组织样本从所述组织分离。
在一些实施例中,本公开的方法进一步包含抓紧所述组织试样以将所述组织试样更深地拉入所述试样袋中。
在其它实施例中,抓紧所述组织试样以将所述组织试样更深地拉入所述试样袋中是在击发所述外科缝合装置之后发生。
在实施例中,本公开的方法进一步包含在击发所述外科缝合装置之后闭合所述试样袋的所述口。
在实施例中,闭合所述试样袋的所述袋口是通过向近侧拉动环绕所述试样袋的所述袋口的拉绳而发生。
在一些实施例中,向近侧拉动环绕所述试样袋的所述袋口的所述拉绳进一步包含使所述试样袋的所述袋口从所述砧座组合件和所述钉仓组合件脱离。
在其它实施例中,向近侧拉动环绕所述试样袋的所述袋口的所述拉绳进一步包含使所述试样袋从所述外科缝合装置的适配器组合件脱离。
在其它实施例中,向近侧拉动环绕所述试样袋的所述袋口的所述拉绳包含从患者体内移除所述试样袋。
附图说明
在本文中参考附图描述本公开的实施例,其中:
图1为根据本公开的实施例的包含手柄外壳、适配器组合件、末端执行器和附接到其的试样袋的外科缝合装置的透视图;
图2为图1所示的外科缝合装置的末端执行器和试样袋的透视图,所述试样袋包含拉绳和拉绳外壳;
图3是沿图1的截面线3-3截取的横截面视图;
图4为图3所示的细节指示区域的放大视图;
图5为图1中所示的外科缝合装置的远侧部分在手术期间的顶视图,此时试样袋展开;
图6为示出在图5中所示的外科缝合装置的击发之后,本公开的试样袋的顶视图;
图7为示出试样袋从图6中所示的外科缝合装置脱离的顶视图;和
图8为示出在试样袋从图7中所示的外科缝合装置脱离之后,从患者体内移除拉绳和拉绳外壳的侧视图。
具体实施方式
本公开提供了一种用于微创外科手术的试样获取装置。如本文中参考本公开所使用的,微创外科手术涵盖腹腔镜手术、关节镜手术和内窥镜手术,并且涉及利用具有能够通过皮肤中的小切口插入的相对狭窄的操作部分的观测设备或类似装置的手术。
可以修改本公开的方面以连同用于在微创外科手术(有时在本文中称为微创手术)过程中用于获取组织试样的各种方法一起使用。微创手术的实例包含例如胆囊切除术、阑尾切除术、肾切除术、结肠切除术、脾切除术等。
现在参考附图详细描述本发明公开的试样获取装置,图中相同附图标号在若干视图中的每个视图中标示相同或对应元件。在本说明书中,术语“近侧”通常用于表示装置的更靠近临床医生的部分,而术语“远端”通常用于表示装置的更远离临床医生的部分。术语“临床医生”通常用于指医务人员,包含医生、外科医生、护士和支持人员。
现在转向图1,根据本公开的实施例的外科缝合装置10呈手持式手术器械的形式。外科缝合装置10包含手柄组合件100、适配器组合件200和末端执行器300。手柄组合件100被配置成用于与适配器组合件200选择性地连接,并且继而,适配器组合件200被配置成用于与末端执行器300选择性地连接。
外科缝合装置10可以是手动外科缝合装置或电动外科缝合装置。电动装置包含一个或多个电动机以及内部或外部电源,而手动装置具有可移动的手柄和用于驱动设备功能的机构。此类缝合装置的实例包含第5,865,361号、第5,782,396号、第8,672,206号美国专利和国际WO 04/032,760中公开的装置,其中的每一个的全部公开内容以引用的方式并入本文中。
将仅在完全公开本公开的方面所必要的程度来进一步描述手柄组合件100、适配器组合件200和末端执行器300。为了详细描述示例性手柄、适配器组合件和末端执行器的结构和功能,可参考共同拥有的美国专利申请公开第2016/0310134号,其全部公开内容以引用的方式并入本文中。
现在参考图1,手柄组合件100包含外壳壳体112,所述外壳包含近侧半部112a和远侧半部112b。外壳壳体112包含多个致动器116(例如,手指致动的控制按钮、旋钮、肘节、滑动件、接口等),以用于激活手术装置10(图1)的各种功能。如上所述,手柄112可以包含电源(未示出),所述电源被配置为对手术装置10或手柄112的各种操作进行供电和控制。或者,还可以设想手柄112可以手动提供动力。
现参考图1-2,末端执行器300呈单次使用负载单元形式。然而,应理解,还可使用其它类型的末端执行器,其中本公开的手术装置10包含例如端对端缝合负载单元、多用途负载单元、横向负载单元和弧形负载单元。
末端执行器300包含近侧主体部分310和工具组合件320。末端执行器300的近侧主体部分310可释放地可附接到适配器组合件200的远侧盖206(图1),并且工具组合件320可枢转地附接到末端执行器300的近侧主体部分310。末端执行器300的工具组合件320包含砧座组合件330和钉仓组合件340,所述砧座组合件与钉仓组合件可枢转地彼此联接,使得工具组合件320可在打开或未夹紧位置与闭合或夹紧位置之间移动。
如图3所示,砧座组合件330包含砧座板332和在砧座板332上固定的盖板334,使得盖板334限定砧座组合件330的外表面334b。
钉仓组合件340包含缝合钉钉仓342和钉仓托架344。
如图1和2所描绘,本公开的外科缝合装置10还包含粘附到末端执行器300的砧座组合件330和钉仓组合件340两者的试样袋400。试样袋400包含具有大致呈管状或细长构造的主体460,所述主体由可打开且可闭合的部分(或袋口)440以及闭合部分470(图1)限定。袋口440限定了当砧座组合件330和钉仓组合件340处于打开位置时打开的开口450。试样袋400包含在拉绳外壳420内的拉绳410。在实施例中,拉绳410的近侧部分可具有环430,以利于抓紧拉绳410(图1和2)。拉绳外壳420沿着适配器组合件200的长度粘附。试样袋400可以被压缩,使得其适配在砧座组合件330与钉仓组合件340之间,并且可以穿过插管、套管针或类似装置(未示出)。拉绳外壳420将足够长,以使其粘在套管针(未示出)的外部。
在其它实施例(未示出)中,本公开的试样袋400可以使用在末端执行器300的砧座组合件330、钉仓组合件340或两者上滑动的环附接到末端执行器300的砧座组合件330、药筒组合件340或两者,以将试样袋固定在其上。这将允许试样袋作为单独的产品出售,以与现有的外科缝合装置一起使用。
试样袋400的主体460可以由能够形成柔性可收缩构件或膜的任何合适的生物相容性材料(例如,尼龙、聚氨酯、防撕裂尼龙或乳胶)制成。在实施例中,制备试样袋的材料是弹性的、抗静电的、无热原的、无毒的和可消毒的。试样袋400可以是不透明的或透明的。在一些实施例中,试样袋400的主体460由尼龙材料或尼龙材料的组合形成。
如在图3和4中更详细地示出,在实施例中,试样袋400粘附到砧座组合件330和钉仓组合件340两者。如图4所示,在其中具有拉绳410的拉绳外壳420使用包含生物相容性粘合剂在内的任何合适的方式附接到砧座330和钉仓组合件340。尽管未描绘,但拉绳420类似地附接到钉仓组合件。
在使用中,如图5所示,在实施例中,可以通过切口“I”引入套管针500以进入患者的体腔“BC”。末端执行器300插入穿过套管针500,使得砧座组合件330和钉仓组合件340定位在体腔“BC”内。组织试样“TS”放入试样袋400中,所述试样袋将开始展开。然后,使砧座组合件330和钉仓组合件340在组织试样“TS”上闭合,并且击发外科缝合装置10(未示出)。
在击发缝合器之后,如图6所示,组织试样“TS”保留在试样袋400中,而保留在患者体内的组织“TR”在缝合点处具有缝合线“S”。
然后可以使用镊子抓紧组织试样“TS”以将组织试样“TS”更深地拉入试样袋400中(未示出)。
如图7所示,一旦组织试样“TS”完全位于试样袋400中,就向近侧(未示出)拉动拉绳410以闭合试样袋400。在闭合试样袋400的同时,拉绳外壳420从砧座组合件330和钉仓组合件340脱离。
然后拉动拉绳外壳420,以使其从适配器组合件200(未示出)脱离。此时,整个试样袋400和拉绳外壳420从外科缝合装置10完全脱离,并且可以从患者(未示出)移除外科缝合装置10。如图8所示,其中具有拉绳410的拉绳外壳420然后准备好通过向近侧拉动拉绳外壳420和其中的拉绳410(由图8中的箭头“A”指示)而经由套管针500移除。接下来,可以从患者移除套管针500,同时医生通过维持拉绳410(未示出)上的张力来确保试样袋400保持闭合,此后,可以从患者(未示出)移除试样袋400。
一旦组织试样从患者移除,就很可能将其用于组织病理学测试,以确保没有癌细胞保留在切割线附近。
本公开的装置和方法相对于先前的试样获取装置提供若干优点。
例如,使用本公开的装置允许将病变组织试样直接放置到试样袋中,以最小化在从体腔内移除病变组织试样期间使癌细胞扩散的风险。这也减少了常规装置将组织试样放入试样袋所需的操纵,所述操纵可能导致组织试样错误地与健康组织接触。
另外,本公开的方法和装置允许在更接近缝合线的位置进行组织病理学检查,而不必担心流体从不健康的组织中释放出来。按照目前的做法,来自被切除的组织的最好样本是最接近于切割线的那部分,以确定在剩余的健康组织上是否残留了任何癌症子细胞。当病变组织被切开时,也将其缝合在一起。在一些情况下,缝合会使组织变形,使其无法再用于组织病理学检查,因此,病理学家必须使用下一个最接近的未受损组织样本,所述未受损组织处于距切割线三条缝合线的宽度处。然而,如果未缝合被切除的组织,则组织内部的任何内容物都可能排入其容纳腔中。这可能导致腹腔感染。使用本公开的装置和方法,通过立即隔离试样袋中的被切除组织,在没有将被切除组织缝合或仅用距切割线足够远的一排缝合线缝合以允许进行组织病理学检查的情况下,无需担心腹部感染的风险。
最后,由于将试样袋与缝合钉装填组合在一起,因此所需设备较少。
尽管已经在附图中示出了本公开的若干实施例,但是不旨在将本公开限制于此,因为旨在使本公开的范围与本领域所允许的一样宽,并且同样地阅读说明书。因此,上文的描述不应被解释为限制性的,而仅仅是具体实施例的示范。本领域技术人员将设想在本文所附的权利要求书的范围和精神内的其它修改。另外,可以设想,在不脱离本公开的范围的情况下,结合一个示例性实施例说明或描述的元件和特征可以与另一个示例性实施例的元件和特征组合,并且还旨在将此类修改和变型包含在本公开的范围内。因此,除了由所附权利要求书指示的内容之外,本发明不受已经具体示出和描述的内容的限制。
Claims (10)
1.一种外科缝合装置,其包括:
末端执行器,其包含能枢转地彼此联接的砧座组合件和钉仓组合件,所述砧座组合件与所述钉仓组合件能相对移动,使得所述末端执行器能在打开位置与夹紧位置之间移动;以及
试样袋,其包含主体和限定开口端的袋口,所述袋口附接到所述砧座组合件和所述钉仓组合件,使得所述末端执行器向所述打开位置的移动使所述试样袋的所述袋口移动到打开位置。
2.根据权利要求1所述的外科缝合装置,其中所述试样袋的所述袋口包含在其中具有拉绳的拉绳外壳。
3.一种方法,其包括:
将包含砧座组合件和钉仓组合件的外科缝合装置推进到与要从患者体内移除的组织相邻的体腔中;以及
将要从所述患者体内移除的所述组织放置到试样袋中,所述试样袋的袋口附接到所述砧座组合件和所述钉仓组合件;
使所述砧座组合件和所述钉仓组合件在所述组织上闭合;以及
击发所述外科缝合装置以使组织样本从所述组织分离。
4.根据权利要求3所述的方法,其进一步包括抓紧所述组织试样以将所述组织试样更深地拉入所述试样袋中。
5.根据权利要求4所述的方法,其中抓紧所述组织试样以将所述组织试样更深地拉入所述试样袋中是在击发所述外科缝合装置之后发生。
6.根据权利要求3所述的方法,其进一步包括在击发所述外科缝合装置之后闭合所述试样袋的所述袋口。
7.根据权利要求6所述的方法,其中闭合所述试样袋的所述袋口是通过向近侧拉动环绕所述试样袋的所述袋口的拉绳而发生。
8.根据权利要求7所述的方法,其中向近侧拉动环绕所述试样袋的所述袋口的所述拉绳进一步包含使所述试样袋的所述袋口从所述砧座组合件和所述钉仓组合件脱离。
9.根据权利要求8所述的方法,其中向近侧拉动环绕所述试样袋的所述袋口的所述拉绳进一步包含使所述试样袋从所述外科缝合装置的适配器组合件脱离。
10.根据权利要求8所述的方法,其中向近侧拉动环绕所述试样袋的所述袋口的所述拉绳包含从所述患者体内移除所述试样袋。
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