CN112236089A - 具有由击发构件驱动的具有机载组织切割特征部的凸轮作用组件的外科钉仓 - Google Patents
具有由击发构件驱动的具有机载组织切割特征部的凸轮作用组件的外科钉仓 Download PDFInfo
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Abstract
本发明公开了一种被构造用于与外科缝合器一起使用的外科钉仓,该外科缝合器包括被构造成能够逐渐轴向地接合缝合器的砧座和通道的击发构件。该仓包括凸轮组件,该凸轮组件被构造成能够与击发构件可操作地交接,使得击发构件在远侧方向上的轴向运动将凸轮组件从起始位置驱动到结束位置。切割构件由凸轮组件可动地支撑在部署位置和凹陷位置之间,在该部署位置,切割构件的至少一部分在平台表面上方延伸,在该凹陷位置,切割构件位于平台表面下方。
Description
相关申请的交叉引用
本申请要求2019年2月19日提交的名称为“METHODS FOR CONTROLLING A POWEREDSURGICAL STAPLER THAT HAS SEPARATE ROTARY CLOSURE AND FIRING SYSTEMS”的美国临时专利申请序列号62/807,310、2019年2月19日提交的名称为“SURGICAL STAPLINGDEVICES WITH IMPROVED LOCKOUT SYSTEMS”的美国临时专利申请序列号62/807,319、以及2019年2月19日提交的名称为“SURGICAL STAPLING DEVICES WITH IMPROVED ROTARYDRIVEN CLOSURE SYSTEMS”的美国临时专利申请序列号62/807,309的权益,这些申请的公开内容全文以引用方式并入本文。本申请要求2018年3月30日提交的名称为“SURGICALSYSTEMS WITH OPTIMIZED SENSING CAPABILITIES”的美国临时专利申请序列号62/650,887的权益,该申请的公开内容全文以引用方式并入本文。本申请要求2018年3月28日提交的名称为“INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATIONCAPABILITIES”的美国临时专利申请序列号62/649,302、2018年3月28日提交的名称为“DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZEDRECORD”的美国临时专利申请序列号62/649,294、2018年3月28日提交的名称为“SURGICALHUB SITUATIONAL AWARENESS”的美国临时专利申请序列号62/649,300、2018年3月28日提交的名称为“SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATINGTHEATER”的美国临时专利申请序列号62/649,309、2018年3月28日提交的名称为“COMPUTERIMPLEMENTED INTERACTIVE SURGICAL SYSTEMS”的美国临时专利申请序列号62/649,310、2018年3月28日提交的名称为“USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TODETERMINE PROPERTIES OF BACK SCATTERED LIGHT”的美国临时专利申请序列号62/649,291、2018年3月28日提交的名称为“ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICALDEVICES”的美国临时专利申请序列号62/649,296、2018年3月28日提交的名称为“CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER”的美国临时专利申请序列号62/649,333、2018年3月28日提交的名称为“CLOUD-BASED MEDICALANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES”的美国临时专利申请序列号62/649,327、2018年3月28日提交的名称为“DATA HANDLING ANDPRIORITIZATION IN A CLOUD ANALYTICS NETWORK”的美国临时专利申请序列号62/649,315、2018年3月28日提交的名称为“CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES”的美国临时专利申请序列号62/649,313、2018年3月28日提交的名称为“DRIVE ARRANGEMENTSFOR ROBOT-ASSISTED SURGICAL PLATFORMS”的美国临时专利申请序列号62/649,320、2018年3月28日提交的名称为“AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICALPLATFORMS”的美国临时专利申请序列号62/649,307、以及2018年3月28日提交的名称为“SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS”的美国临时专利申请序列号62/649,323的权益,这些申请的公开内容全文以引用方式并入本文。
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。
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为动力外科缝合系统的透视图;
图2为图1的动力外科缝合系统的可互换外科轴组件的透视图;
图3为图1的动力外科缝合系统的柄部组件的各部分的分解组装视图;
图4为图2的可互换外科轴组件的分解组装视图;
图5为图4的可互换外科轴组件的一部分的另一个局部分解组装视图;
图6为另一个动力外科缝合系统的透视图;
图7为图6的动力外科缝合系统的轴组件的部分的分解组装视图;
图8为图6的动力外科缝合系统的柄部组件的各部分的分解组装视图;
图9为另一个动力外科缝合系统的透视图;
图10为图9的动力外科缝合系统的一部分的顶视图;
图11为图9的外科缝合系统的轴组件的关节运动接头的局部透视图;
图12为图11的关节运动接头的顶视图;
图13为击发构件和击发驱动轴的透视组件视图;
图14为图9的动力外科缝合系统的端部执行器和关节运动接头的各部分的透视图;
图15为图14的端部执行器和关节运动接头的另一个透视图;
图16为图14的端部执行器的砧座的顶视图;
图17为附接到图14的端部执行器的细长通道的图16的砧座的另一个顶视图;
图18为沿图17中的线18-18截取的图17的砧座和端部执行器的剖视图;
图19为沿图17中的线19-19截取的图17的砧座和端部执行器的另一个剖视图;
图20为图14的端部执行器的闭合连杆组件和闭合驱动轴的分解组装视图;
图21为图20的闭合连杆组件和闭合驱动轴的透视图;
图22为另一个旋转动力外科端部执行器的砧座、闭合连杆组件和闭合驱动轴的局部透视图;
图23为图22的砧座、闭合连杆组件和闭合驱动轴的局部端部正视图,其中驱动轴以横截面示出;
图24为另一个旋转动力外科端部执行器的砧座、闭合连杆组件、旋转击发驱动轴和闭合驱动轴的侧正视图,其中其砧座处于闭合位置;
图25为图24的砧座、闭合连杆组件、旋转击发驱动轴和闭合驱动轴的另一个侧正视图,其中砧座处于打开位置;
图26为图24的旋转动力外科端部执行器的剖面端视图;
图27为图24的旋转动力外科端部执行器的另一个剖面端视图;
图28为另一个旋转动力外科端部执行器的一部分的侧正视图,其中其砧座处于打开位置;
图29为图28的旋转动力外科端部执行器的一部分的放大局部透视图;
图30为图28和图29的旋转动力外科端部执行器的各部分的局部侧正视图,其中其砧座处于打开位置;
图31为图30的旋转动力外科端部执行器的各部分的另一个局部侧正视图,其中其砧座处于闭合位置;
图32为图31的旋转动力外科端部执行器的砧座和细长通道的部分的剖面侧视图;
图33为另一个旋转动力外科端部执行器的局部透视图,其中其砧座处于闭合位置;
图34为图33的旋转动力外科端部执行器的部分的侧正视图,其中其砧座处于打开位置;
图35为图34的旋转动力外科端部执行器的部分的另一个侧正视图,其中其砧座处于闭合位置;
图36为图33的旋转动力外科端部执行器的一部分的剖面端视图;
图37为图33的旋转动力外科端部执行器的旋转击发驱动轴和旋转闭合驱动轴的局部剖面侧视图;
图38为端部执行器的示意图,该端部执行器采用闭合连接件布置以打开和闭合端部执行器的钳口,其中钳口被示出处于打开位置;
图39为图38的端部执行器的另一个示意图,其中钳口处于闭合位置;
图40为另一个端部执行器的示意图,该端部执行器采用闭合连接件布置以打开和闭合端部执行器的钳口,其中钳口被示出处于打开位置;
图41为图40的端部执行器的另一个示意图,其中钳口处于闭合位置;
图42为另一个端部执行器的示意图,该端部执行器采用闭合连接件布置以打开和闭合端部执行器的钳口,其中钳口被示出处于打开位置;
图43为图42的端部执行器的另一个示意图,其中钳口处于闭合位置;
图44为另一个外科端部执行器的各部分的侧正视图,其中其以虚线示出的砧座处于打开位置;
图45为图44的外科端部执行器的端视图;
图46为图45的端部执行器的砧座的局部剖面透视图;
图47为图44的外科端部执行器的砧座闭合构件的侧正视图;
图48为图44的外科端部执行器的击发构件的侧正视图;
图49为图44的外科端部执行器的局部侧正视图,其中其以虚线示出的砧座处于打开位置;
图50为图49的外科端部执行器的另一个局部侧正视图,其中其砧座处于闭合位置;
图51为图50的外科端部执行器的另一个侧正视图,其中其击发构件开始击发过程;
图52为图50的外科端部执行器的另一个侧正视图,其中砧座闭合构件和击发构件部分地朝远侧部署在端部执行器中;
图53为另一个动力外科器械的透视图;
图54为图53的动力外科器械的一部分的顶视图;
图55为图53的外科器械的外科端部执行器的各部分的局部剖视图;
图56为图53的外科器械的外科端部执行器的砧座和端部顶盖部分的局部分解组装视图;
图57为图53的外科器械的外科端部执行器的局部剖面端视图;
图58为图57的外科端部执行器的细长通道的一部分的透视近侧端部端视图;
图59为图57的外科端部执行器的一部分的局部侧正视图,其中一些部件以横截面示出并且其砧座处于闭合位置;
图60为沿图59的线60-60截取的图59的外科端部执行器的剖面端视图;
图61为沿图59的线61-61截取的图59的外科端部执行器的剖面端视图;
图62为图59的外科端部执行器的细长通道和击发构件的局部底部透视图;
图63为另一个动力外科器械的透视图;
图64为图63的动力外科器械的顶视图;
图65为图63的动力外科器械的外科端部执行器的局部剖面侧视图,其中外科钉仓可操作地安装在其中;
图66为图65的外科钉仓的透视图;
图67为图65的外科端部执行器的细长通道部分的局部透视组件视图和图66的外科钉仓的底部透视图;
图68为当钉仓已可操作地安装在细长通道中时与图67的细长通道的一部分接合的图67的外科钉仓的夹具的侧正视图;
图69为图65的外科端部执行器的击发闭锁组件的局部分解组装视图;
图70为与图66的外科钉仓的一部分接合的图69的击发闭锁组件的顶视剖视图;
图71为图65的外科端部执行器的侧剖视图,其中可操作地安装有外科钉仓并且击发闭锁组件处于解锁位置;
图72为图65的外科端部执行器的另一个侧剖视图,其中可操作地安装有外科钉仓并且其砧座处于打开位置;
图73为另一个外科端部执行器的局部剖视图,其中其砧座在将外科钉仓安装在其中之前处于打开位置;
图74为图73的外科端部执行器在砧座已开始闭合之后的另一个局部剖面侧视图;
图75为图73的外科端部执行器的击发构件和击发构件闭锁特征部的分解组装视图;
图76为与安装在图73的外科端部执行器的细长通道中的外科钉仓的一部分接合的图75的击发构件闭锁特征部的一部分的放大视图;
图77为在将外科钉仓安装到图73的外科端部执行器的细长通道中之前处于锁定位置的图76的击发构件闭锁特征部的一部分的另一个放大视图;
图78为图73的外科端部执行器的一部分和安装在该端部执行器中的外科钉仓的凸轮作用组件的剖视图;
图79为图73的外科端部执行器的剖面侧视图,其中安装有外科钉仓并且其砧座处于打开位置;
图80为图73的外科端部执行器的另一个剖面侧视图,其中其砧座处于闭合位置;
图81为其中安装有外科钉仓的另一个外科端部执行器的一部分的透视图;
图82为图81的外科端部执行器的击发构件和闭合系统的一部分的透视图;
图83为图81的外科端部执行器的细长通道和闭合梭动件的一部分的剖面端视图;
图84为图81的外科端部执行器在将钉仓安装在其中之前的局部透视图;
图85为图84的外科端部执行器的另一个局部透视图,其中其击发闭锁构件处于锁定位置,因为端部执行器中未安装仓;
图86为图84的外科端部执行器的另一个局部透视图,其中安装有仓;
图87为图86的外科端部执行器的另一个局部透视图,其中仓的一部分被移除以使得能够看到击发闭锁构件与仓的凸轮作用组件接合;
图88为图86的外科端部执行器的另一个局部透视图,其中安装有仓并且外科端部执行器的击发构件朝远侧向前运动;
图89为图86的外科端部执行器的另一个局部透视图,其中仓的一部分被省略以使得能够看到击发闭锁构件与仓的凸轮作用组件接合;
图90为与外科端部执行器的旋转击发驱动轴通过螺纹接合的另一个击发构件的透视图;
图91为相对于外科端部执行器的砧座的图90的击发构件的侧正视图,其中砧座处于打开位置并且以横截面示出;
图92为相对于外科端部执行器的细长通道的一部分的图90的击发构件的一部分的侧视图;
图93为与外科端部执行器的旋转击发驱动轴以螺纹方式接合的另一个击发构件的透视图;
图94为图93的击发构件的法兰组件的近侧段的一部分的局部侧正视图;
图95为图94的法兰组件的远侧段的一部分的局部侧正视图;
图96为相对于外科端部执行器的砧座的图93的击发构件的侧正视图,其中砧座处于打开位置并且以横截面示出;
图97为动力外科器械的反馈系统示例的逻辑图;
图98为用于动力外科器械的控制电路示例的示意图;
图99为用于动力外科器械的组合逻辑电路示例的示意图;
图100为用于动力外科器械的时序逻辑电路示例的示意图;
图101为用于动力外科器械的击发过程控制系统示例的图形示意图;
图102为用于操作动力外科器械的击发控制系统的时序逻辑电路示例;
图103为用于动力外科器械的另一个击发过程控制系统示例的图形示意图;
图104为用于操作另一个动力外科器械的击发控制系统的时序逻辑电路示例;
图105为用于操作另一个动力外科器械的击发控制系统的时序逻辑电路示例;
图106为安装在其旋转击发驱动轴上的外科端部执行器的另一个击发构件的透视图;
图107为图106的击发构件的各部分分解组装视图;
图108为安装在图106的旋转击发驱动轴上的击发构件和驱动螺母布置的局部剖视图;
图109为外科端部执行器的另一个击发构件的局部透视图,该击发构件安装在其旋转击发驱动轴上并且与外科钉仓的凸轮作用组件解锁接合,其中其组织切割构件处于部署位置;
图110为图109的击发构件和凸轮作用组件的另一个局部透视图,其中组织切割构件处于储存位置;
图111为外科端部执行器的另一个击发构件的局部透视图,该击发构件安装在其旋转击发驱动轴上并且与外科钉仓的凸轮作用组件解锁接合,其中其组织切割构件处于部署位置;
图112为另一个外科钉仓的透视图;
图113为图112的外科钉仓的近侧端部的放大透视图,其中其凸轮作用组件以虚线示出;
图114为图112的外科钉仓的凸轮作用组件的透视图,其中省略了其组织切割构件;
图115为图112的外科钉仓的远侧端部的剖视图,其中其凸轮作用组件接近其中的最远侧结束位置;
图116为图112的外科钉仓的远侧端部在凸轮作用组件已到达结束位置并且其组织切割构件已运动到储存位置之后的另一个剖视图;
图117为图112的外科钉仓的近侧端部的局部剖面侧视图,其中其组织切割构件处于部署位置;
图118为图112的外科钉仓的远侧端部的另一个局部剖面侧视图,其中其组织切割构件处于储存位置;
图119为图112的外科钉仓的远侧端部的透视图,其中省略了一部分以将其凸轮作用组件暴露在结束位置并且将其组织切割构件暴露在储存位置;
图120为图119的外科钉仓的另一个透视图;
图121为外科端部执行器在其中安装外科钉仓期间的局部侧正视图,其中为清楚起见省略了端部执行器和仓的部分;
图122为图121的外科端部执行器和钉仓的另一个局部侧正视图,其中端部执行器的击发构件在击发过程开始之前与仓的凸轮作用组件可操作地接合;
图123为图121的外科端部执行器和钉仓在击发过程完成之后并且在击发构件在近侧方向上回缩期间的另一个局部侧正视图;
图124为动力外科端部执行器的另一个外科钉仓和击发构件的一部分的透视图;
图125为图124的击发构件的一部分和图124的外科钉仓的可移除刀片结构的另一个透视图;
图126为图125的可移除刀片结构的透视图;
图127为示出在外科钉仓的初始安装期间图124的钉仓的刀片结构和击发构件的位置的局部剖面顶视图;
图128为图124的外科钉仓和击发构件的一部分在击发构件朝远侧推进穿过钉仓期间的另一个顶视剖视图;
图129为在击发构件回缩回到起始位置期间图124的外科钉仓和击发构件的一部分的另一个顶视剖视图;
图130为另一个可移除刀片结构的透视图;
图131为另一个可移除刀片结构的透视图;并且
图132为另一个动力外科器械的另一个外科钉仓和击发构件的透视图。
在所述若干视图中,对应的参考符号指示对应的部件。本文所述的范例以一种形式示出了本发明的各种实施方案,且这种范例不应被解释为以任何方式限制本发明的范围。
具体实施方式
本申请的申请人拥有与本申请于同一日期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“METHODS FOR CONTROLLING A POWERED SURGICAL STAPLER THAT HASSEPARATE ROTARY CLOSURE AND FIRING SYSTEMS”的美国专利申请,代理人案卷号END9020USNP1/180504-1M;
-名称为“STAPLE CARTRIDGE COMPRISING A LOCKOUT KEY CONFIGURED TO LIFTA FIRING MEMBER”的美国专利申请,代理人案卷号END9021USNP1/180505-1;
-名称为“SURGICAL STAPLERS WITH ARRANGEMENTS FOR MAINTAINING A FIRINGMEMBER THEREOF IN A LOCKED CONFIGURATION UNLESS A COMPATIBLE CARTRIDGE HASBEEN INSTALLED THEREIN”的美国专利申请,代理人案卷号END9021USNP2/180505-2;
-名称为“SURGICAL INSTRUMENT COMPRISING CO-OPERATING LOCKOUT FEATURES”的美国专利申请,代理人案卷号END9021USNP3/180505-3;
-名称为“SURGICAL STAPLING ASSEMBLY COMPRISING A LOCKOUT AND ANEXTERIOR ACCESS ORIFICE TO PERMIT ARTIFICIAL UNLOCKING OF THE LOCKOUT”的美国专利申请,代理人案卷号END9021USNP4/180505-4;
-名称为“SURGICAL STAPLING DEVICES WITH FEATURES FOR BLOCKINGADVANCEMENT OF A CAMMING ASSEMBLY OF AN INCOMPATIBLE CARTRIDGE INSTALLEDTHEREIN”的美国专利申请,代理人案卷号END9021USNP5/180505-5;
-名称为“STAPLING INSTRUMENT COMPRISING A DEACTIVATABLE LOCKOUT”的美国专利申请,代理人案卷号END9021USNP6/18505-6;
-名称为“SURGICAL INSTRUMENT COMPRISING A JAW CLOSURE LOCKOUT”的美国专利申请,代理人案卷号END9021USNP7/180505-7;
-名称为“SURGICAL STAPLING DEVICES WITH CARTRIDGE COMPATIBLE CLOSUREAND FIRING LOCKOUT ARRANGEMENTS”的美国专利申请,代理人案卷号END9021USNP8/180505-8;
-名称为“SURGICAL STAPLING DEVICES WITH IMPROVED ROTARY DRIVEN CLOSURESYSTEMS”的美国专利申请,代理人案卷号END9022USNP2/180508-2;
-名称为“SURGICAL STAPLING DEVICES WITH ASYMMETRIC CLOSURE FEATURES”的美国专利申请,代理人案卷号END9022USNP3/180508-3;
-名称为“ROTARY DRIVEN FIRING MEMBERS WITH DIFFERENT ANVIL AND CHANNELENGAGEMENT FEATURES”的美国专利申请,代理人案卷号END9022USNP4/180508-4;以及
-名称为“SURGICAL STAPLING DEVICE WITH SEPARATE ROTARY DRIVEN CLOSUREAND FIRING SYSTEMS AND FIRING MEMBER THAT ENGAGES BOTH JAWS WHILE FIRING”的美国专利申请,代理人案卷号END9022USNP5/180508-5。
本申请的申请人拥有于2019年2月19日提交且各自全文以引用方式并入本文的以下美国临时专利申请:
-名称为“METHODS FOR CONTROLLING A POWERED SURGICAL STAPLER THAT HASSEPARATE ROTARY CLOSURE AND FIRING SYSTEMS”的美国临时专利申请序列号62/807,310;
-名称为“SURGICAL STAPLING DEVICES WITH IMPROVED LOCKOUT SYSTEMS”的美国临时专利申请序列号62/807,319;以及
-名称为“SURGICAL STAPLING DEVICES WITH IMPROVED ROTARY DRIVEN CLOSURESYSTEMS”的美国临时专利申请序列号62/807,309。
本申请的申请人拥有于2018年3月28日提交的以下美国临时专利申请,这些临时专利申请中的每个临时专利申请以引用方式全文并入本文:
-名称为“INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATIONCAPABILITIES”的美国临时专利申请序列号62/649,302;
-名称为“DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS ANDCREATE ANONYMIZED RECORD”的美国临时专利申请序列号62/649,294;
-名称为“SURGICAL HUB SITUATIONAL AWARENESS”的美国临时专利申请序列号62/649,300;
-名称为“SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES INOPERATING THEATER”的美国临时专利申请序列号62/649,309;
-名称为“COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS”的美国临时专利申请序列号62/649,310;
-名称为“USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINEPROPERTIES OF BACK SCATTERED LIGHT”的美国临时专利申请序列号62/649,291;
-名称为“ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES”的美国临时专利申请序列号62/649,296;
-名称为“CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION ANDRECOMMENDATIONS TO A USER”的美国临时专利申请序列号62/649,333;
-名称为“CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATIONTRENDS AND REACTIVE MEASURES”的美国临时专利申请序列号62/649,327;
-名称为“DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICSNETWORK”的美国临时专利申请序列号62/649,315;
-名称为“CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES”的美国临时专利申请序列号62/649,313;
-名称为“DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS”的美国临时专利申请序列号62/649,320;
-名称为“AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICALPLATFORMS”的美国临时专利申请序列号62/649,307;以及
-名称为“SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS”的美国临时专利申请序列号62/649,323。
本申请的申请人拥有于2018年3月30日提交的以下美国临时专利申请,该临时专利申请以引用方式全文并入本文:
-名称为“SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES”的美国临时专利申请序列号62/650,887。
本申请的申请人拥有于2018年12月4日提交的以下美国专利申请,该专利申请以引用方式全文并入本文:
-名称为“METHOD OF COMPRESSING TISSUE WITHIN A STAPLING DEVICE ANDSIMULTANEOUSLY DISPLAYING THE LOCATION OF THE TISSUE WITHIN THE JAWS”的美国专利申请序列号16/209,423。
本申请的申请人拥有于2018年8月20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“METHOD FOR FABRICATING SURGICAL STAPLER ANVILS”的美国专利申请序列号16/105,101;
-名称为“REINFORCED DEFORMABLE ANVIL TIP FOR SURGICAL STAPLER ANVIL”的美国专利申请序列号16/105,183;
-名称为“SURGICAL STAPLER ANVILS WITH STAPLE DIRECTING PROTRUSIONS ANDTISSUE STABILITY FEATURES”的美国专利申请序列号16/105,150;
-名称为“FABRICATING TECHNIQUES FOR SURGICAL STAPLER ANVILS”的美国专利申请序列号16/105,098;
-名称为“SURGICAL STAPLER ANVILS WITH TISSUE STOP FEATURES CONFIGUREDTO AVOID TISSUE PINCH”的美国专利申请序列号16/105,140;
-名称为“METHOD FOR OPERATING A POWERED ARTICULATABLE SURGICALINSTRUMENT”的美国专利申请序列号16/105,081;
-名称为“SURGICAL INSTRUMENTS WITH PROGRESSIVE JAW CLOSUREARRANGEMENTS”的美国专利申请序列号16/105,094;
-名称为“POWERED SURGICAL INSTRUMENTS WITH CLUTCHING ARRANGEMENTS TOCONVERT LINEAR DRIVE MOTIONS TO ROTARY DRIVE MOTIONS”的美国专利申请序列号16/105,097;
-名称为“POWERED ARTICULATABLE SURGICAL INSTRUMENTS WITH CLUTCHING ANDLOCKING ARRANGEMENTS FOR LINKING AN ARTICULATION DRIVE SYSTEM TO A FIRINGDRIVE SYSTEM”的美国专利申请序列号16/105,104;
-名称为“ARTICULATABLE MOTOR POWERED SURGICAL INSTRUMENTS WITHDEDICATED ARTICULATION MOTOR ARRANGEMENTS”的美国专利申请序列号16/105,119;
-名称为“SWITCHING ARRANGEMENTS FOR MOTOR POWERED ARTICULATABLESURGICAL INSTRUMENTS”的美国专利申请序列号16/105,160;以及
-名称为“SURGICAL STAPLER ANVILS”的美国设计专利申请序列号29/660,252。
本申请的申请人拥有各自全文以引用方式并入本文的以下美国专利申请和美国专利:
-名称为“SURGICAL STAPLING INSTRUMENTS AND REPLACEABLE TOOL ASSEMBLIESTHEREOF”的美国专利申请序列号15/386,185,现为美国专利申请公布2018/0168642;
-名称为“ARTICULATABLE SURGICAL STAPLING INSTRUMENTS”的美国专利申请序列号15/386,230,现为美国专利申请公布2018/0168649;
-名称为“LOCKOUT ARRANGEMENTS FOR SURGICAL END EFFECTORS”的美国专利申请序列号15/386,221,现为美国专利申请公布2018/0168646;
-名称为“SURGICAL END EFFECTORS AND FIRING MEMBERS THEREOF”的美国专利申请序列号15/386,209,现为美国专利申请公布2018/0168645;
-名称为“LOCKOUT ARRANGEMENTS FOR SURGICAL END EFFECTORS ANDREPLACEABLE TOOL ASSEMBLIES”的美国专利申请序列号15/386,198,现为美国专利申请公布2018/0168644;
-名称为“SURGICAL END EFFECTORS AND ADAPTABLE FIRING MEMBERS THEREFOR”的美国专利申请序列号15/386,240,现为美国专利申请公布2018/0168651;
-名称为“STAPLE CARTRIDGES AND ARRANGEMENTS OF STAPLES AND STAPLECAVITIES THEREIN”的美国专利申请序列号15/385,939,现为美国专利申请公布2018/0168629;
-名称为“SURGICAL TOOL ASSEMBLIES WITH CLUTCHING ARRANGEMENTS FORSHIFTING BETWEEN CLOSURE SYSTEMS WITH CLOSURE STROKE REDUCTION FEATURES ANDARTICULATION AND FIRING SYSTEMS”的美国专利申请序列号15/385,941,现为美国专利申请公布2018/0168630;
-名称为“SURGICAL STAPLING INSTRUMENTS AND STAPLE-FORMING ANVILS”的美国专利申请序列号15/385,943,现为美国专利申请公布2018/0168631;
-名称为“SURGICAL TOOL ASSEMBLIES WITH CLOSURE STROKE REDUCTIONFEATURES”的美国专利申请序列号15/385,950,现为美国专利申请公布2018/0168635;
-名称为“STAPLE CARTRIDGES AND ARRANGEMENTS OF STAPLES AND STAPLECAVITIES THEREIN”的美国专利申请序列号15/385,945,现为美国专利申请公布2018/0168632;
-名称为“SURGICAL STAPLING INSTRUMENTS AND STAPLE-FORMING ANVILS”的美国专利申请序列号15/385,946,现为美国专利申请公布2018/0168633;
-名称为“SURGICAL INSTRUMENTS WITH JAW OPENING FEATURES FOR INCREASINGA JAW OPENING DISTANCE”的美国专利申请序列号15/385,951,现为美国专利申请公布2018/0168636;
-名称为“METHODS OF STAPLING TISSUE”的美国专利申请序列号15/385,953,现为美国专利申请公布2018/0168637;
-名称为“FIRING MEMBERS WITH NON-PARALLEL JAW ENGAGEMENT FEATURES FORSURGICAL END EFFECTORS”的美国专利申请序列号15/385,954,现为美国专利申请公布2018/0168638;
-名称为“SURGICAL END EFFECTORS WITH EXPANDABLE TISSUE STOPARRANGEMENTS”的美国专利申请序列号15/385,955,现为美国专利申请公布2018/0168639;
-名称为“SURGICAL STAPLING INSTRUMENTS AND STAPLE-FORMING ANVILS”的美国专利申请序列号15/385,948,现为美国专利申请公布2018/0168584;
-名称为“SURGICAL INSTRUMENTS WITH POSITIVE JAW OPENING FEATURES”的美国专利申请序列号15/385,956,现为美国专利申请公布2018/0168640;
-名称为“SURGICAL INSTRUMENTS WITH LOCKOUT ARRANGEMENTS FOR PREVENTINGFIRING SYSTEM ACTUATION UNLESS AN UNSPENT STAPLE CARTRIDGE IS PRESENT”的美国专利申请序列号15/385,958,现为美国专利申请公布2018/0168641;
-名称为“STAPLE CARTRIDGES AND ARRANGEMENTS OF STAPLES AND STAPLECAVITIES THEREIN”的美国专利申请序列号15/385,947,现为美国专利申请公布2018/0168634;
-名称为“METHOD FOR RESETTING A FUSE OF A SURGICAL INSTRUMENT SHAFT”的美国专利申请序列号15/385,896,现为美国专利申请公布2018/0168597;
-名称为“STAPLE-FORMING POCKET ARRANGEMENT TO ACCOMMODATE DIFFERENTTYPES OF STAPLES”的美国专利申请序列号15/385,898,现为美国专利申请公布2018/0168599;
-名称为“SURGICAL INSTRUMENT COMPRISING IMPROVED JAW CONTROL”的美国专利申请序列号15/385,899,现为美国专利申请公布2018/0168600;
-名称为“STAPLE CARTRIDGE AND STAPLE CARTRIDGE CHANNEL COMPRISINGWINDOWS DEFINED THEREIN”的美国专利申请序列号15/385,901,现为美国专利申请公布2018/0168602;
-名称为“SURGICAL INSTRUMENT COMPRISING A CUTTING MEMBER”的美国专利申请序列号15/385,902,现为美国专利申请公布2018/0168603;
-名称为“STAPLE FIRING MEMBER COMPRISING A MISSING CARTRIDGE AND/ORSPENT CARTRIDGE LOCKOUT”的美国专利申请序列号15/385,904,现为美国专利申请公布2018/0168605;
-名称为“FIRING ASSEMBLY COMPRISING A LOCKOUT”的美国专利申请序列号15/385,905,现为美国专利申请公布2018/0168606;
-名称为“SURGICAL INSTRUMENT SYSTEM COMPRISING AN END EFFECTOR LOCKOUTAND A FIRING ASSEMBLY LOCKOUT”的美国专利申请序列号15/385,907,现为美国专利申请公布2018/0168608;
-名称为“FIRING ASSEMBLY COMPRISING A FUSE”的美国专利申请序列号15/385,908,现为美国专利申请公布2018/0168609;
-名称为“FIRING ASSEMBLY COMPRISING A MULTIPLE FAILED-STATE FUSE”的美国专利申请序列号15/385,909,现为美国专利申请公布2018/0168610;
-名称为“STAPLE-FORMING POCKET ARRANGEMENTS”的美国专利申请序列号15/385,920,现为美国专利申请公布2018/0168620;
-名称为“ANVIL ARRANGEMENTS FOR SURGICAL STAPLERS”的美国专利申请序列号15/385,913,现为美国专利申请公布2018/0168614;
-名称为“METHOD OF DEFORMING STAPLES FROM TWO DIFFERENT TYPES OFSTAPLE CARTRIDGES WITH THE SAME SURGICAL STAPLING INSTRUMENT”的美国专利申请序列号15/385,914,现为美国专利申请公布2018/0168615;
-名称为“BILATERALLY ASYMMETRIC STAPLE-FORMING POCKET PAIRS”的美国专利申请序列号15/385,893,现为美国专利申请公布2018/0168594;
-名称为“CLOSURE MEMBERS WITH CAM SURFACE ARRANGEMENTS FOR SURGICALINSTRUMENTS WITH SEPARATE AND DISTINCT CLOSURE AND FIRING SYSTEMS”的美国专利申请序列号15/385,929,现为美国专利申请公布2018/0168626;
-名称为“SURGICAL STAPLERS WITH INDEPENDENTLY ACTUATABLE CLOSING ANDFIRING SYSTEMS”的美国专利申请序列号15/385,911,现为美国专利申请公布2018/0168612;
-名称为“SURGICAL STAPLING INSTRUMENTS WITH SMART STAPLE CARTRIDGES”的美国专利申请序列号15/385,927,现为美国专利申请公布2018/0168625;
-名称为“STAPLE CARTRIDGE COMPRISING STAPLES WITH DIFFERENT CLAMPINGBREADTHS”的美国专利申请序列号15/385,917,现为美国专利申请公布2018/0168617;
-名称为“STAPLE-FORMING POCKET ARRANGEMENTS COMPRISING PRIMARYSIDEWALLS AND POCKET SIDEWALLS”的美国专利申请序列号15/385,900,现为美国专利申请公布2018/0168601;
-名称为“NO-CARTRIDGE AND SPENT CARTRIDGE LOCKOUT ARRANGEMENTS FORSURGICAL STAPLERS”的美国专利申请序列号15/385,931,现为美国专利申请公布2018/0168627;
-名称为“FIRING MEMBER PIN ANGLE”的美国专利申请序列号15/385,915,现为美国专利申请公布2018/0168616;
-名称为“STAPLE-FORMING POCKET ARRANGEMENTS COMPRISING ZONED FORMINGSURFACE GROOVES”的美国专利申请序列号15/385,897,现为美国专利申请公布2018/0168598;
-名称为“SURGICAL INSTRUMENT WITH MULTIPLE FAILURE RESPONSE MODES”的美国专利申请序列号15/385,922,现为美国专利申请公布2018/0168622;
-名称为“SURGICAL INSTRUMENT WITH PRIMARY AND SAFETY PROCESSORS”的美国专利申请序列号15/385,924,现为美国专利申请公布2018/0168624;
-名称为“ANVIL HAVING A KNIFE SLOT WIDTH”的美国专利申请序列号15/385,910,现为美国专利申请公布2018/0168611;
-名称为“CLOSURE MEMBER ARRANGEMENTS FOR SURGICAL INSTRUMENTS”的美国专利申请序列号15/385,903,现为美国专利申请公布2018/0168604;
-名称为“FIRING MEMBER PIN CONFIGURATIONS”的美国专利申请序列号15/385,906,现为美国专利申请公布2018/0168607;
-名称为“STEPPED STAPLE CARTRIDGE WITH ASYMMETRICAL STAPLES”的美国专利申请序列号15/386,188,现为美国专利申请公布2018/0168585;
-名称为“STEPPED STAPLE CARTRIDGE WITH TISSUE RETENTION AND GAPSETTING FEATURES”的美国专利申请序列号15/386,192,现为美国专利申请公布2018/0168643;
-名称为“STAPLE CARTRIDGE WITH DEFORMABLE DRIVER RETENTION FEATURES”的美国专利申请序列号15/386,206,现为美国专利申请公布2018/0168586;
-名称为“DURABILITY FEATURES FOR END EFFECTORS AND FIRING ASSEMBLIESOF SURGICAL STAPLING INSTRUMENTS”的美国专利申请序列号15/386,226,现为美国专利申请公布2018/0168648;
-名称为“SURGICAL STAPLING INSTRUMENTS HAVING END EFFECTORS WITHPOSITIVE OPENING FEATURES”的美国专利申请序列号15/386,222,现为美国专利申请公布2018/0168647;
-名称为“CONNECTION PORTIONS FOR DEPOSABLE LOADING UNITS FOR SURGICALSTAPLING INSTRUMENTS”的美国专利申请序列号15/386,236,现为美国专利申请公布2018/0168650;
-名称为“METHOD FOR ATTACHING A SHAFT ASSEMBLY TO A SURGICALINSTRUMENT AND,ALTERNATIVELY,TO A SURGICAL ROBOT”的美国专利申请序列号15/385,887,现为美国专利申请公布2018/0168589;
-名称为“SHAFT ASSEMBLY COMPRISING A MANUALLY-OPERABLE RETRACTIONSYSTEM FOR USE WITH A MOTORIZED SURGICAL INSTRUMENT SYSTEM”的美国专利申请序列号15/385,889,现为美国专利申请公布2018/0168590;
-名称为“SHAFT ASSEMBLY COMPRISING SEPARATELY ACTUATABLE ANDRETRACTABLE SYSTEMS”的美国专利申请序列号15/385,890,现为美国专利申请公布2018/0168591;
-名称为“SHAFT ASSEMBLY COMPRISING A CLUTCH CONFIGURED TO ADAPT THEOUTPUT OF A ROTARY FIRING MEMBER TO TWO DIFFERENT SYSTEMS”的美国专利申请序列号15/385,891,现为美国专利申请公布2018/0168592;
-名称为“SURGICAL SYSTEM COMPRISING A FIRING MEMBER ROTATABLE INTO ANARTICULATION STATE TO ARTICULATE AN END EFFECTOR OF THE SURGICAL SYSTEM”的美国专利申请序列号15/385,892,现为美国专利申请公布2018/0168593;
-名称为“SHAFT ASSEMBLY COMPRISING A LOCKOUT”的美国专利申请序列号15/385,894,现为美国专利申请公布2018/0168595;
-名称为“SHAFT ASSEMBLY COMPRISING FIRST AND SECOND ARTICULATIONLOCKOUTS”的美国专利申请序列号15/385,895,现为美国专利申请公布2018/0168596;
-名称为“SURGICAL STAPLING SYSTEMS”的美国专利申请序列号15/385,916,现为美国专利申请公布2018/0168575;
-名称为“SURGICAL STAPLING SYSTEMS”的美国专利申请序列号15/385,918,现为美国专利申请公布2018/0168618;
-名称为“SURGICAL STAPLING SYSTEMS”的美国专利申请序列号15/385,919,现为美国专利申请公布2018/0168619;
-名称为“SURGICAL STAPLE CARTRIDGE WITH MOVABLE CAMMING MEMBERCONFIGURED TO DISENGAGE FIRING MEMBER LOCKOUT FEATURES”的美国专利申请序列号15/385,921,现为美国专利申请公布2018/0168621;
-名称为“SURGICAL STAPLING SYSTEMS”的美国专利申请序列号15/385,923,现为美国专利申请公布2018/0168623;
-名称为“JAW ACTUATED LOCK ARRANGEMENTS FOR PREVENTING ADVANCEMENT OFA FIRING MEMBER IN A SURGICAL END EFFECTOR UNLESS AN UNFIRED CARTRIDGE ISINSTALLED IN THE END EFFECTOR”的美国专利申请序列号15/385,925,现为美国专利申请公布2018/0168576;
-名称为“AXIALLY MOVABLE CLOSURE SYSTEM ARRANGEMENTS FOR APPLYINGCLOSURE MOTIONS TO JAWS OF SURGICAL INSTRUMENTS”的美国专利申请序列号15/385,926,现为美国专利申请公布2018/0168577;
-名称为“PROTECTIVE COVER ARRANGEMENTS FOR A JOINT INTERFACE BETWEEN AMOVABLE JAW AND ACTUATOR SHAFT OF A SURGICAL INSTRUMENT”的美国专利申请序列号15/385,928,现为美国专利申请公布2018/0168578;
-名称为“SURGICAL END EFFECTOR WITH TWO SEPARATE COOPERATING OPENINGFEATURES FOR OPENING AND CLOSING END EFFECTOR JAWS”的美国专利申请序列号15/385,930,现为美国专利申请公布2018/0168579;
-名称为“ARTICULATABLE SURGICAL END EFFECTOR WITH ASYMMETRIC SHAFTARRANGEMENT”的美国专利申请序列号15/385,932,现为美国专利申请公布2018/0168628;
-名称为“ARTICULATABLE SURGICAL INSTRUMENT WITH INDEPENDENT PIVOTABLELINKAGE DISTAL OF AN ARTICULATION LOCK”的美国专利申请序列号15/385,933,现为美国专利申请公布2018/0168580;
-名称为“ARTICULATION LOCK ARRANGEMENTS FOR LOCKING AN END EFFECTOR INAN ARTICULATED POSITION IN RESPONSE TO ACTUATION OF A JAW CLOSURE SYSTEM”的美国专利申请序列号15/385,934,现为美国专利申请公布2018/0168581;
-名称为“LATERALLY ACTUATABLE ARTICULATION LOCK ARRANGEMENTS FORLOCKING AN END EFFECTOR OF A SURGICAL INSTRUMENT IN AN ARTICULATEDCONFIGURATION”的美国专利申请序列号15/385,935,现为美国专利申请公布2018/0168582;
-名称为“ARTICULATABLE SURGICAL INSTRUMENTS WITH ARTICULATION STROKEAMPLIFICATION FEATURES”的美国专利申请序列号15/385,936,现为美国专利申请公布2018/0168583;
-名称为“FASTENER CARTRIDGES INCLUDING EXTENSIONS HAVING DIFFERENTCONFIGURATIONS”的美国专利申请序列号14/318,996,现为美国专利申请公布2015/0297228;
-名称为“FASTENER CARTRIDGE COMPRISING FASTENER CAVITIES INCLUDINGFASTENER CONTROL FEATURES”的美国专利申请序列号14/319,006,现为美国专利10,010,324;
-名称为“SURGICAL FASTENER CARTRIDGES WITH DRIVER STABILIZINGARRANGEMENTS”的美国专利申请序列号14/318,991,现为美国专利9,833,241;
-名称为“SURGICAL END EFFECTORS WITH FIRING ELEMENT MONITORINGARRANGEMENTS”的美国专利申请序列号14/319,004,现为美国专利9,844,369;
-名称为“FASTENER CARTRIDGE COMPRISING NON-UNIFORM FASTENERS”的美国专利申请序列号14/319,008,现为美国专利申请公布2015/0297232;
-名称为“FASTENER CARTRIDGE COMPRISING DEPLOYABLE TISSUE ENGAGINGMEMBERS”的美国专利申请序列号14/318,997,现为美国专利申请公布2015/0297229;
-名称为“FASTENER CARTRIDGE COMPRISING TISSUE CONTROL FEATURES”的美国专利申请序列号14/319,002,现为美国专利9,877,721;
-名称为“FASTENER CARTRIDGE ASSEMBLIES AND STAPLE RETAINER COVERARRANGEMENTS”的美国专利申请序列号14/319,013,现为美国专利申请公布2015/0297233;以及
-名称为“FASTENER CARTRIDGE INCLUDING A LAYER ATTACHED THERETO”的美国专利申请序列号14/319,016,现为美国专利申请公布2015/0297235。
本申请的申请人拥有于2016年6月24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“STAPLE CARTRIDGE COMPRISING WIRE STAPLES AND STAMPED STAPLES”的美国专利申请序列号15/191,775,现为美国专利申请公布2017/0367695;
-名称为“STAPLING SYSTEM FOR USE WITH WIRE STAPLES AND STAMPEDSTAPLES”的美国专利申请序列号15/191,807,现为美国专利申请公布2017/0367696;
-名称为“STAMPED STAPLES AND STAPLE CARTRIDGES USING THE SAME”的美国专利申请序列号15/191,834,现为美国专利申请公布2017/0367699;
-名称为“STAPLE CARTRIDGE COMPRISING OVERDRIVEN STAPLES”的美国专利申请序列号15/191,788,现为美国专利申请公布2017/0367698;以及
-名称为“STAPLE CARTRIDGE COMPRISING OFFSET LONGITUDINAL STAPLE ROWS”的美国专利申请序列号15/191,818,现为美国专利申请公布2017/0367697。
本申请的申请人拥有于2016年6月24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“SURGICAL FASTENER”的美国设计专利申请序列号29/569,218,现为美国设计专利D826,405;
-名称为“SURGICAL FASTENER”的美国设计专利申请序列号29/569,227,现为美国设计专利D822,206;
-名称为“SURGICAL FASTENER CARTRIDGE”的美国设计专利申请序列号29/569,259;以及
-名称为“SURGICAL FASTENER CARTRIDGE”的美国设计专利申请序列号29/569,264。
本申请的申请人拥有于2016年4月1日提交且各自全文以引用方式并入本文的以下专利申请:
-名称为“METHOD FOR OPERATING A SURGICAL STAPLING SYSTEM”的美国专利申请序列号15/089,325,现为美国专利申请公布2017/0281171;
-名称为“MODULAR SURGICAL STAPLING SYSTEM COMPRISING A DISPLAY”的美国专利申请序列号15/089,321,现为美国专利申请公布2017/0281163;
-名称为“SURGICAL STAPLING SYSTEM COMPRISING A DISPLAY INCLUDING A RE-ORIENTABLE DISPLAY FIELD”的美国专利申请序列号15/089,326,现为美国专利申请公布2017/0281172;
-名称为“SURGICAL INSTRUMENT HANDLE ASSEMBLY WITH RECONFIGURABLE GRIPPORTION”的美国专利申请序列号15/089,263,现为美国专利申请公布2017/0281165;
-名称为“ROTARY POWERED SURGICAL INSTRUMENT WITH MANUALLY ACTUATABLEBAILOUT SYSTEM”的美国专利申请序列号15/089,262,现为美国专利申请公布2017/0281161;
-名称为“SURGICAL CUTTING AND STAPLING END EFFECTOR WITH ANVILCONCENTRIC DRIVE MEMBER”的美国专利申请序列号15/089,277,现为美国专利申请公布2017/0281166;
-名称为“INTERCHANGEABLE SURGICAL TOOL ASSEMBLY WITH A SURGICAL ENDEFFECTOR THAT IS SELECTIVELY ROTATABLE ABOUT A SHAFT AXIS”的美国专利申请序列号15/089,296,现为美国专利申请公布2017/0281168;
-名称为“SURGICAL STAPLING SYSTEM COMPRISING A SHIFTABLE TRANSMISSION”的美国专利申请序列号15/089,258,现为美国专利申请公布2017/0281178;
-名称为“SURGICAL STAPLING SYSTEM CONFIGURED TO PROVIDE SELECTIVECUTTING OF TISSUE”的美国专利申请序列号15/089,278,现为美国专利申请公布2017/0281162;
-名称为“SURGICAL STAPLING SYSTEM COMPRISING A CONTOURABLE SHAFT”的美国专利申请序列号15/089,284,现为美国专利申请公布2017/0281186;
-名称为“SURGICAL STAPLING SYSTEM COMPRISING A TISSUE COMPRESSIONLOCKOUT”的美国专利申请序列号15/089,295,现为美国专利申请公布2017/0281187;
-名称为“SURGICAL STAPLING SYSTEM COMPRISING AN UNCLAMPING LOCKOUT”的美国专利申请序列号15/089,300,现为美国专利申请公布2017/0281179;
-名称为“SURGICAL STAPLING SYSTEM COMPRISING A JAW CLOSURE LOCKOUT”的美国专利申请序列号15/089,196,现为美国专利申请公布2017/0281183;
-名称为“SURGICAL STAPLING SYSTEM COMPRISING A JAW ATTACHMENT LOCKOUT”的美国专利申请序列号15/089,203,现为美国专利申请公布2017/0281184;
-名称为“SURGICAL STAPLING SYSTEM COMPRISING A SPENT CARTRIDGELOCKOUT”的美国专利申请序列号15/089,210,现为美国专利申请公布2017/0281185;
-名称为“SURGICAL INSTRUMENT COMPRISING A SHIFTING MECHANISM”的美国专利申请序列号15/089,324,现为美国专利申请公布2017/0281170;
-名称为“SURGICAL STAPLING INSTRUMENT COMPRISING MULTIPLE LOCKOUTS”的美国专利申请序列号15/089,335,现为美国专利申请公布2017/0281155;
-名称为“SURGICAL STAPLING INSTRUMENT”的美国专利申请序列号15/089,339,现为美国专利申请公布2017/0281173;
-名称为“SURGICAL STAPLING SYSTEM CONFIGURED TO APPLY ANNULAR ROWS OFSTAPLES HAVING DIFFERENT HEIGHTS”的美国专利申请序列号15/089,253,现为美国专利申请公布2017/0281177;
-名称为“SURGICAL STAPLING SYSTEM COMPRISING A GROOVED FORMING POCKET”的美国专利申请序列号15/089,304,现为美国专利申请公布2017/0281188;
-名称为“ANVIL MODIFICATION MEMBERS FOR SURGICAL STAPLERS”的美国专利申请序列号15/089,331,现为美国专利申请公布2017/0281180;
-名称为“STAPLE CARTRIDGES WITH ATRAUMATIC FEATURES”的美国专利申请序列号15/089,336,现为美国专利申请公布2017/0281164;
-名称为“CIRCULAR STAPLING SYSTEM COMPRISING AN INCISABLE TISSUESUPPORT”的美国专利申请序列号15/089,312,现为美国专利申请公布2017/0281189;
-名称为“CIRCULAR STAPLING SYSTEM COMPRISING ROTARY FIRING SYSTEM”的美国专利申请序列号15/089,309,现为美国专利申请公布2017/0281169;以及
-名称为“CIRCULAR STAPLING SYSTEM COMPRISING LOAD CONTROL”的美国专利申请序列号15/089,349,现为美国专利申请公布2017/0281174。
本申请的申请人还拥有于2015年12月31日提交且各自全文以引用方式并入本文的如下标识的美国专利申请:
-名称为“MECHANISMS FOR COMPENSATING FOR BATTERY PACK FAILURE INPOWERED SURGICAL INSTRUMENTS”的美国专利申请序列号14/984,488,现为美国专利申请公布2017/0189018;
-名称为“MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWEREDSURGICAL INSTRUMENTS”的美国专利申请序列号14/984,525,现为美国专利申请公布2017/0189019;以及
-名称为“SURGICAL INSTRUMENTS WITH SEPARABLE MOTORS AND MOTOR CONTROLCIRCUITS”的美国专利申请序列号14/984,552,现为美国专利申请公布2017/0189020。
本申请的申请人还拥有于2016年2月9日提交且各自全文以引用方式并入本文的如下标识的美国专利申请:
-名称为“SURGICAL INSTRUMENT WITH ARTICULATING AND AXIALLYTRANSLATABLE END EFFECTOR”的美国专利申请序列号15/019,220,现为美国专利申请公布2017/0224333;
-名称为“SURGICAL INSTRUMENTS WITH MULTIPLE LINK ARTICULATIONARRANGEMENTS”的美国专利申请序列号15/019,228,现为美国专利申请公布2017/0224342;
-名称为“SURGICAL INSTRUMENT ARTICULATION MECHANISM WITH SLOTTEDSECONDARY CONSTRAINT”的美国专利申请序列号15/019,196,现为美国专利申请公布2017/0224330;
-名称为“SURGICAL INSTRUMENTS WITH AN END EFFECTOR THAT IS HIGHLYARTICULATABLE RELATIVE TO AN ELONGATE SHAFT ASSEMBLY”的美国专利申请序列号15/019,206,现为美国专利申请公布2017/0224331;
-名称为“SURGICAL INSTRUMENTS WITH NON-SYMMETRICAL ARTICULATIONARRANGEMENTS”的美国专利申请序列号15/019,215,现为美国专利申请公布2017/0224332;
-名称为“ARTICULATABLE SURGICAL INSTRUMENTS WITH SINGLE ARTICULATIONLINK ARRANGEMENTS”的美国专利申请序列号15/019,227,现为美国专利申请公布2017/0224334;
-名称为“SURGICAL INSTRUMENTS WITH TENSIONING ARRANGEMENTS FOR CABLEDRIVEN ARTICULATION SYSTEMS”的美国专利申请序列号15/019,235,现为美国专利申请公布2017/0224336;
-名称为“ARTICULATABLE SURGICAL INSTRUMENTS WITH OFF-AXIS FIRING BEAMARRANGEMENTS”的美国专利申请序列号15/019,230,现为美国专利申请公布2017/0224335;以及
-名称为“SURGICAL INSTRUMENTS WITH CLOSURE STROKE REDUCTIONARRANGEMENTS”的美国专利申请序列号15/019,245,现为美国专利申请公布2017/0224343。
本申请的申请人还拥有于2016年2月12日提交且各自全文以引用方式并入本文的如下标识的美国专利申请:
-名称为“MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWEREDSURGICAL INSTRUMENTS”的美国专利申请序列号15/043,254,现为美国专利申请公布2017/0231623;
-名称为“MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWEREDSURGICAL INSTRUMENTS”的美国专利申请序列号15/043,259,现为美国专利申请公布2017/0231626;
-名称为“MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWEREDSURGICAL INSTRUMENTS”的美国专利申请序列号15/043,275,现为美国专利申请公布2017/0231627;以及
-名称为“MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWEREDSURGICAL INSTRUMENTS”的美国专利申请序列号15/043,289,现为美国专利申请公布2017/0231628。
本申请的申请人拥有于2015年6月18日提交且各自全文以引用方式并入本文的以下专利申请:
-名称为“SURGICAL END EFFECTORS WITH POSITIVE JAW OPENINGARRANGEMENTS”的美国专利申请序列号14/742,925,现为美国专利申请公布2016/0367256;
-名称为“SURGICAL END EFFECTORS WITH DUAL CAM ACTUATED JAW CLOSINGFEATURES”的美国专利申请序列号14/742,941,现为美国专利10,052,102;
-名称为“MOVABLE FIRING BEAM SUPPORT ARRANGEMENTS FOR ARTICULATABLESURGICAL INSTRUMENTS”的美国专利申请序列号14/742,914,现为美国专利申请公布2016/0367255;
-名称为“ARTICULATABLE SURGICAL INSTRUMENTS WITH COMPOSITE FIRING BEAMSTRUCTURES WITH CENTER FIRING SUPPORT MEMBER FOR ARTICULATION SUPPORT”的美国专利申请序列号14/742,900,现为美国专利申请公布2016/0367254;
-名称为“DUAL ARTICULATION DRIVE SYSTEM ARRANGEMENTS FOR ARTICULATABLESURGICAL INSTRUMENTS”的美国专利申请序列号14/742,885,现为美国专利申请公布2016/0367246;以及
-名称为“PUSH/PULL ARTICULATION DRIVE SYSTEMS FOR ARTICULATABLESURGICAL INSTRUMENTS”的美国专利申请序列号14/742,876,现为美国专利10,178,992。
本申请的申请人拥有于2015年3月6日提交且各自全文以引用方式并入本文的以下专利申请:
-名称为“POWERED SURGICAL INSTRUMENT”的美国专利申请序列号14/640,746,现为美国专利9,808,246;
-名称为“MULTIPLE LEVEL THRESHOLDS TO MODIFY OPERATION OF POWEREDSURGICAL INSTRUMENTS”的美国专利申请序列号14/640,795,现为美国专利申请公布2016/02561185;-名称为“ADAPTIVE TISSUE COMPRESSION TECHNIQUES TO ADJUST CLOSURERATES FOR MULTIPLE TISSUE TYPES”的美国专利申请序列号14/640,832,现为美国专利申请公布2016/0256154;
-名称为“OVERLAID MULTI SENSOR RADIO FREQUENCY(RF)ELECTRODE SYSTEM TOMEASURE TISSUE COMPRESSION”的美国专利申请序列号14/640,935,现为美国专利申请公布2016/0256071;
-名称为“MONITORING SPEED CONTROL AND PRECISION INCREMENTING OF MOTORFOR POWERED SURGICAL INSTRUMENTS”的美国专利申请序列号14/640,831,现为美国专利9,895,148;
-名称为“TIME DEPENDENT EVALUATION OF SENSOR DATA TO DETERMINESTABILITY,CREEP,AND VISCOELASTIC ELEMENTS OF MEASURES”的美国专利申请序列号14/640,859,现为美国专利10,052,044;
-名称为“INTERACTIVE FEEDBACK SYSTEM FOR POWERED SURGICAL INSTRUMENTS”的美国专利申请序列号14/640,817,现为美国专利申请公布9,924,961;
-名称为“CONTROL TECHNIQUES AND SUB-PROCESSOR CONTAINED WITHIN MODULARSHAFT WITH SELECT CONTROL PROCESSING FROM HANDLE”的美国专利申请序列号14/640,844,现为美国专利10,045,776;
-名称为“SMART SENSORS WITH LOCAL SIGNAL PROCESSING”的美国专利申请序列号14/640,837,现为美国专利9,993,248;
-名称为“SYSTEM FOR DETECTING THE MIS-INSERTION OF A STAPLE CARTRIDGEINTO A SURGICAL STAPLER”的美国专利申请序列号14/640,765,现为美国专利申请公布2016/0256160;
-名称为“SIGNAL AND POWER COMMUNICATION SYSTEM POSITIONED ON AROTATABLE SHAFT”的美国专利申请序列号14/640,799,现为美国专利9,901,342;以及
-名称为“SURGICAL INSTRUMENT COMPRISING A LOCKABLE BATTERY HOUSING”的美国专利申请序列号14/640,780,现为美国专利申请公布2016/0256161。
本申请的申请人拥有于2015年2月27日提交且各自全文以引用方式并入本文的以下专利申请:
-名称为“SURGICAL INSTRUMENT SYSTEM COMPRISING AN INSPECTION STATION”的美国专利申请序列号14/633,576,现为美国专利10,045,779;
-名称为“SURGICAL APPARATUS CONFIGURED TO ASSESS WHETHER A PERFORMANCEPARAMETER OF THE SURGICAL APPARATUS IS WITHIN AN ACCEPTABLE PERFORMANCE BAND”的美国专利申请序列号14/633,546,现为美国专利10,180,463;
-名称为“SURGICAL CHARGING SYSTEM THAT CHARGES AND/OR CONDITIONS ONEOR MORE BATTERIES”的美国专利申请序列号14/633,560,现为美国专利申请公布2016/0249910;
-名称为“CHARGING SYSTEM THAT ENABLES EMERGENCY RESOLUTIONS FORCHARGING A BATTERY”的美国专利申请序列号14/633,566,现为美国专利申请公布2016/0249918;
-名称为“SYSTEM FOR MONITORING WHETHER A SURGICAL INSTRUMENT NEEDS TOBE SERVICED”的美国专利申请序列号14/633,555,现为美国专利申请公布2016/0249916;
-名称为“REINFORCED BATTERY FOR A SURGICAL INSTRUMENT”的美国专利申请序列号14/633,542,现为美国专利9,931,118;
-名称为“POWER ADAPTER FOR A SURGICAL INSTRUMENT”的美国专利申请序列号14/633,548,现为美国专利申请公布2016/0249909;
-名称为“ADAPTABLE SURGICAL INSTRUMENT HANDLE”的美国专利申请序列号14/633,526,现为美国专利申请公布2016/0249945;
-名称为“MODULAR STAPLING ASSEMBLY”的美国专利申请序列号14/633,541,现为美国专利申请9,993,258;以及
-名称为“SURGICAL APPARATUS CONFIGURED TO TRACK AN END-OF-LIFEPARAMETER”的美国专利申请序列号14/633,562,现为美国专利10,159,483。
本申请的申请人拥有于2014年12月18日提交且各自全文以引用方式并入本文的以下专利申请:
-名称为“SURGICAL INSTRUMENT SYSTEMS COMPRISING AN ARTICULATABLE ENDEFFECTOR AND MEANS FOR ADJUSTING THE FIRING STROKE OF A FIRING MEMBER”的美国专利申请序列号14/574,478,现为美国专利9,844,374;
-名称为“SURGICAL INSTRUMENT ASSEMBLY COMPRISING LOCKABLE SYSTEMS”的美国专利申请序列号14/574,483,现为美国专利申请公布2016/0174969;
-名称为“DRIVE ARRANGEMENTS FOR ARTICULATABLE SURGICAL INSTRUMENTS”的美国专利申请序列号14/575,139,现为美国专利9,844,375;
-名称为“LOCKING ARRANGEMENTS FOR DETACHABLE SHAFT ASSEMBLIES WITHARTICULATABLE SURGICAL END EFFECTORS”的美国专利申请序列号14/575,148,现为美国专利10,085,748;
-名称为“SURGICAL INSTRUMENT WITH AN ANVIL THAT IS SELECTIVELY MOVABLEABOUT A DISCRETE NON-MOVABLE AXIS RELATIVE TO A STAPLE CARTRIDGE”的美国专利申请序列号14/575,130,现为美国专利申请公布2016/0174972;
-名称为“SURGICAL INSTRUMENTS WITH IMPROVED CLOSURE ARRANGEMENTS”的美国专利申请序列号14/575,143,现为美国专利10,004,501;
-名称为“SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTORS ANDMOVABLE FIRING BEAM SUPPORT ARRANGEMENTS”的美国专利申请序列号14/575,117,现为美国专利9,943,309;
-名称为“SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTORS ANDIMPROVED FIRING BEAM SUPPORT ARRANGEMENTS”的美国专利申请序列号14/575,154,现为美国专利9,968,355;
-名称为“SURGICAL INSTRUMENT ASSEMBLY COMPRISING A FLEXIBLEARTICULATION SYSTEM”的美国专利申请序列号14/574,493,现为美国专利9,987,000;以及
-名称为“SURGICAL INSTRUMENT ASSEMBLY COMPRISING A LOCKABLEARTICULATION SYSTEM”的美国专利申请序列号14/574,500,现为美国专利10,117,649;
本申请的申请人拥有于2013年3月1日提交且各自全文以引用方式并入本文的以下专利申请:
-名称为“ARTICULATABLE SURGICAL INSTRUMENTS WITH CONDUCTIVE PATHWAYSFOR SIGNAL COMMUNICATION”的美国专利申请序列号13/782,295,现为美国专利申请公布2014/0246471;
-名称为“ROTARY POWERED ARTICULATION JOINTS FOR SURGICAL INSTRUMENTS”的美国专利申请序列号13/782,323,现为美国专利申请公布2014/0246472;
-名称为“THUMBWHEEL SWITCH ARRANGEMENTS FOR SURGICAL INSTRUMENTS”的美国专利申请序列号13/782,338,现为美国专利申请公布2014/0249557;
-名称为“ELECTROMECHANICAL SURGICAL DEVICE WITH SIGNAL RELAYARRANGEMENT”的美国专利申请序列号13/782,499,现为美国专利申请公布9,358,003;
-名称为“MULTIPLE PROCESSOR MOTOR CONTROL FOR MODULAR SURGICALINSTRUMENTS”的美国专利申请序列号13/782,460,现为美国专利申请公布2014/0246478;
-名称为“JOYSTICK SWITCH ASSEMBLIES FOR SURGICAL INSTRUMENTS”的美国专利申请序列号13/782,358,现为美国专利申请公布9,326,767;
-名称为“SENSOR STRAIGHTENED END EFFECTOR DURING REMOVAL THROUGHTROCAR”的美国专利申请序列号13/782,481,现为美国专利申请公布9,468,438;
-名称为“CONTROL METHODS FOR SURGICAL INSTRUMENTS WITH REMOVABLEIMPLEMENT PORTIONS”的美国专利申请序列号13/782,518,现为美国专利申请公布2014/0246475;
-名称为“ROTARY POWERED SURGICAL INSTRUMENTS WITH MULTIPLE DEGREES OFFREEDOM”的美国专利申请序列号13/782,375,现为美国专利申请公布9,398,911;以及
-名称为“SURGICAL INSTRUMENT SOFT STOP”的美国专利申请序列号13/782,536,现为美国专利申请公布9,307,986。
本申请的申请人还拥有于2013年3月14日提交且各自全文以引用方式并入本文的以下专利申请:
-名称为“ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE”的美国专利申请序列号13/803,097,现为美国专利9,687,230;
-名称为“CONTROL ARRANGEMENTS FOR A DRIVE MEMBER OF A SURGICALINSTRUMENT”的美国专利申请序列号13/803,193,现为美国专利申请公布9,332,987;
-名称为“INTERCHANGEABLE SHAFT ASSEMBLIES FOR USE WITH A SURGICALINSTRUMENT”的美国专利申请序列号13/803,053,现为美国专利9,883,860;
-名称为“ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATIONLOCK”的美国专利申请序列号13/803,086,现为美国专利申请公布2014/0263541;
-名称为“SENSOR ARRANGEMENTS FOR ABSOLUTE POSITIONING SYSTEM FORSURGICAL INSTRUMENTS”的美国专利申请序列号13/803,210,现为美国专利9,808,244;
-名称为“MULTI-FUNCTION MOTOR FOR A SURGICAL INSTRUMENT”的美国专利申请序列号13/803,148,现为美国专利申请公布2014/0263554;
-名称为“DRIVE SYSTEM LOCKOUT ARRANGEMENTS FOR MODULAR SURGICALINSTRUMENTS”的美国专利申请序列号13/803,066,现为美国专利9,629,623;
-名称为“ARTICULATION CONTROL SYSTEM FOR ARTICULATABLE SURGICALINSTRUMENTS”的美国专利申请序列号13/803,117,现为美国专利申请公布9,351,726;
-名称为“DRIVE TRAIN CONTROL ARRANGEMENTS FOR MODULAR SURGICALINSTRUMENTS”的美国专利申请序列号13/803,130,现为美国专利申请公布9,351,727;以及
-名称为“METHOD AND SYSTEM FOR OPERATING A SURGICAL INSTRUMENT”的美国专利申请序列号13/803,159,现为美国专利9,888,919;
本申请的申请人还拥有于2014年3月7日提交且全文以引用方式并入本文的以下专利申请:
-名称为“CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS”的美国专利申请序列号14/200,111,现为美国专利9,629,629。
本申请的申请人还拥有于2014年3月26日提交且各自全文以引用方式并入本文的以下专利申请:
-名称为“POWER MANAGEMENT CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS”的美国专利申请序列号14/226,106,现为美国专利申请公布2015/0272582;
-名称为“STERILIZATION VERIFICATION CIRCUIT”的美国专利申请序列号14/226,099,现为美国专利9,826,977;
-名称为“VERIFICATION OF NUMBER OF BATTERY EXCHANGES/PROCEDURE COUNT”的美国专利申请序列号14/226,094,现为美国专利申请公布2015/0272580;
-名称为“POWER MANAGEMENT THROUGH SLEEP OPTIONS OF SEGMENTED CIRCUITAND WAKE UP CONTROL”的美国专利申请序列号14/226,117,现为美国专利10,013,049;
-名称为“MODULAR POWERED SURGICAL INSTRUMENT WITH DETACHABLE SHAFTASSEMBLIES”的美国专利申请序列号14/226,075,现为美国专利9,743,929;
-名称为“FEEDBACK ALGORITHMS FOR MANUAL BAILOUT SYSTEMS FOR SURGICALINSTRUMENTS”的美国专利申请序列号14/226,093,现为美国专利10,028,761;
-名称为“SURGICAL INSTRUMENT UTILIZING SENSOR ADAPTATION”的美国专利申请序列号14/226,116,现为美国专利申请公布2015/0272571;
-名称为“SURGICAL INSTRUMENT CONTROL CIRCUIT HAVING A SAFETYPROCESSOR”的美国专利申请序列号14/226,071,现为美国专利9,690,362;
-名称为“SURGICAL INSTRUMENT COMPRISING INTERACTIVE SYSTEMS”的美国专利申请序列号14/226,097,现为美国专利9,820,738;
-名称为“INTERFACE SYSTEMS FOR USE WITH SURGICAL INSTRUMENTS”的美国专利申请序列号14/226,126,现为美国专利申请公布10,004,497;
-名称为“MODULAR SURGICAL INSTRUMENT SYSTEM”的美国专利申请序列号14/226,133,现为美国专利申请公布2015/0272557;
-名称为“SYSTEMS AND METHODS FOR CONTROLLING A SEGMENTED CIRCUIT”的美国专利申请序列号14/226,081,现为美国专利9,804,618;
-名称为“POWER MANAGEMENT THROUGH SEGMENTED CIRCUIT AND VARIABLEVOLTAGE PROTECTION”的美国专利申请序列号14/226,076,现为美国专利9,733,663;
-名称为“SURGICAL STAPLING INSTRUMENT SYSTEM”的美国专利申请序列号14/226,111,现为美国专利9,750,499;以及
-名称为“SURGICAL INSTRUMENT COMPRISING A ROTATABLE SHAFT”的美国专利申请序列号14/226,125,现为美国专利申请公布2015/0280384。
本申请的申请人还拥有于2014年9月5日提交且各自全文以引用方式并入本文的以下专利申请:
-名称为“CIRCUITRY AND SENSORS FOR POWERED MEDICAL DEVICE”的美国专利申请序列号14/479,103,现为美国专利10,111,679;
-名称为“ADJUNCT WITH INTEGRATED SENSORS TO QUANTIFY TISSUECOMPRESSION”的美国专利申请序列号14/479,119,现为美国专利9,724,094;
-名称为“MONITORING DEVICE DEGRADATION BASED ON COMPONENT EVALUATION”的美国专利申请序列号14/478,908,现为美国专利9,737,301;
-名称为“MULTIPLE SENSORS WITH ONE SENSOR AFFECTING A SECOND SENSOR'SOUTPUT OR INTERPRETATION”的美国专利申请序列号14/478,895,现为美国专利9,757,128;
-名称为“POLARITY OF HALL MAGNET TO IDENTIFY CARTRIDGE TYPE”的美国专利申请序列号14/479,110,现为美国专利10,016,199;
-名称为“SMART CARTRIDGE WAKE UP OPERATION AND DATA RETENTION”的美国专利申请序列号14/479,098,现为美国专利10,135,242;
-名称为“MULTIPLE MOTOR CONTROL FOR POWERED MEDICAL DEVICE”的美国专利申请序列号14/479,115,现为美国专利9,788,836;以及
-名称为“LOCAL DISPLAY OF TISSUE PARAMETER STABILIZATION”的美国专利申请序列号14/479,108,现为美国专利申请公布2016/0066913。
本申请的申请人还拥有于2014年4月9日提交且各自全文以引用方式并入本文的以下专利申请:
-名称为“MOTOR DRIVEN SURGICAL INSTRUMENTS WITH LOCKABLE DUAL DRIVESHAFTS”的美国专利申请序列号14/248,590,现为美国专利9,826,976;
-名称为“SURGICAL INSTRUMENT COMPRISING A CLOSING DRIVE AND A FIRINGDRIVE OPERATED FROM THE SAME ROTATABLE OUTPUT”的美国专利申请序列号14/248,581,现为美国专利9,649,110;
-名称为“SURGICAL SYSTEM COMPRISING FIRST AND SECOND DRIVE SYSTEMS”的美国专利申请序列号14/248,595,现为美国专利9,844,368;
-名称为“POWERED LINEAR SURGICAL STAPLER”的美国专利申请序列号14/248,588,现为美国专利申请公布2014/0309666;
-名称为“SURGICAL INSTRUMENT COMPRISING A GAP SETTING SYSTEM”的美国专利申请序列号14/248,591,现为美国专利10,149,680;
-名称为“MODULAR MOTOR DRIVEN SURGICAL INSTRUMENTS WITH ALIGNMENTFEATURES FOR ALIGNING ROTARY DRIVE SHAFTS WITH SURGICAL END EFFECTOR SHAFTS”的美国专利申请序列号14/248,584,现为美国专利9,801,626;
-名称为“POWERED SURGICAL STAPLER”的美国专利申请序列号14/248,587,现为美国专利9,867,612;
-名称为“DRIVE SYSTEM DECOUPLING ARRANGEMENT FOR A SURGICALINSTRUMENT”的美国专利申请序列号14/248,586,现为美国专利10,136,887;以及
-名称为“MODULAR MOTOR DRIVEN SURGICAL INSTRUMENTS WITH STATUSINDICATION ARRANGEMENTS”的美国专利申请序列号14/248,607,现为美国专利9,814,460。
本申请的申请人还拥有于2013年4月16日提交且各自全文以引用方式并入本文的以下专利申请:
-名称为“SURGICAL INSTRUMENT WITH MULTIPLE FUNCTIONS PERFORMED BY ASINGLE MOTOR”的美国临时专利申请序列号61/812,365;
-名称为“LINEAR CUTTER WITH POWER”的美国临时专利申请序列号61/812,376;
-名称为“LINEAR CUTTER WITH MOTOR AND PISTOL GRIP”的美国临时专利申请序列号61/812,382;
-名称为“SURGICAL INSTRUMENT HANDLE WITH MULTIPLE ACTUATION MOTORS ANDMOTOR CONTROL”的美国临时专利申请序列号61/812,385;以及
-名称为“SURGICAL INSTRUMENT WITH MULTIPLE FUNCTIONS PERFORMED BY ASINGLE MOTOR”的美国临时专利申请序列号61/812,372。
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,并且术语“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,诸如通过自然孔口、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他实施方案。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他实施方案。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他实施方案。
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抵靠平台压缩并夹持。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。钉腔和钉的其他布置也是可能的。
钉由仓体中的钉驱动器支撑。驱动器能够在第一或未击发位置和第二或击发位置之间运动,以从钉腔射出钉。驱动器通过保持器保留在仓体中,该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。驱动器能够通过滑动件在其未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器下方滑动以及提升驱动器,并且钉在驱动器上受到支撑。
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地接近斜坡表面,使得钉先于刀被射出。
图1示出了包括可操作地联接到外壳1012的可互换轴组件1200的外科器械1010。图2示出了与外壳1012或柄部1014分离的可互换轴组件1200。如在图3中可见,柄部1014可包括一对可互连柄部外壳段1016和1018,这对柄部外壳段可借助螺钉、按扣特征部、粘合剂等互连。在例示的布置中,柄部外壳段1016和1018配合形成手枪式握把部1019。图1和图3示出了可再利用或不可再利用的马达驱动外科切割和紧固器械1010。在例示的实施方案中,器械1010包括先前的外壳1012,该外壳包括被构造成能够被临床医生抓持、操纵和致动的柄部1014。外壳1012被构造用于可操作地附接到可互换轴组件1200,该可互换轴组件具有可操作地联接到其的外科端部执行器1300,该外科端部执行器被构造成能够执行一种或多种外科任务或外科手术。继续参阅本具体实施方式,将会理解,本文所公开的各种形式的可互换轴组件也可有效地与机器人控制的外科系统结合使用。因此,术语“外壳”也可涵盖机器人系统的容纳或以其他方式可操作地支撑至少一个驱动系统的外壳或类似部分,所述至少一个驱动系统被构造成能够生成并施加可用于致动本文所公开的可互换轴组件及其相应的等同物的至少一种控制动作。此外,各种部件可被“容纳”或包含在外壳中,或者各种部件可与外壳“相关联”。在此类情况下,部件可不容纳在外壳内或由外壳直接支撑。术语“框架”可指手持式外科器械的一部分。术语“框架”还可表示机器人控制的外科器械的一部分和/或机器人系统的可用于可操作地控制外科器械的一部分。例如,本文所公开的可互换轴组件可与名称为“SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENTARRANGEMENTS”的美国专利9,072,535中公开的各种机器人系统、器械、部件和方法一起使用,该专利全文以引用方式并入本文。
图1所示的先前外壳1012结合可互换轴组件1200示出(图2、图4和图5),该可互换轴组件包括端部执行器1300,该端部执行器包括被构造成能够在其中可操作地支撑外科钉仓4000的外科切割和紧固装置。外壳1012可被构造用于与可互换轴组件结合使用,该可互换轴组件包括端部执行器,该端部执行器适于支撑不同尺寸和类型的钉仓,具有不同的轴长度、尺寸和类型等。此外,外壳1012还可有效地用于多种其他可互换轴组件,其包括被构造成能够将其他动作和形式的能量(诸如例如射频(RF)能量、超声能量和/或运动)施加到适合与各种外科应用和手术结合使用的端部执行器布置的那些组件。此外,端部执行器、轴组件、柄部、外科器械和/或外科器械系统可利用任意合适的可被临床医生抓握和操纵的紧固件。如将在下文进一步详细地讨论,柄部1014可操作地支撑其中的多个驱动系统,这些驱动系统被构造成能够生成各种控制动作并将这些控制动作施加到可操作地附接到其上的可互换轴组件的对应部分。
现在参见图3,柄部1014还可包括可操作地支撑多个驱动系统的框架1020。例如,框架1020可操作地支撑通常被标记为1030的“第一”或闭合驱动系统,该“第一”或闭合驱动系统可用于将闭合和打开动作施加到操作地附接或联接到其的可互换轴组件1200。在至少一种形式中,闭合驱动系统1030可包括被框架1020枢转地支撑的闭合触发器1032形式的致动器。更具体地,如图3所示,闭合触发器1032经由销1033枢转地联接到柄部1014。这种构造使闭合触发器1032能够被临床医生操纵,使得当临床医生抓握柄部1014的手枪式握把部1019时,闭合触发器1032可被其轻易地从起始或“未致动”位置枢转到“致动”位置,并且更具体地,枢转到完全压缩或完全致动位置。闭合触发器1032可由弹簧或其他偏压布置(未示出)偏压到未致动位置。在各种形式中,闭合驱动系统1030还包括枢转地联接到闭合触发器1032的闭合连杆组件1034。如在图3中可见,闭合连杆组件1034可包括通过销1035枢转地联接到闭合触发器1032的第一闭合连接件1036和第二闭合连接件1038。第二闭合连接件1038在本文中也可称为“附接构件”,并且包括横向附接销1037。
仍参见图3,可观察到,第一闭合连接件1036可在其上具有锁定壁或锁定端部1039,该锁定壁或锁定端部被构造成能够与枢转地联接到框架1020的闭合释放组件1060配合。在至少一种形式中,闭合释放组件1060可包括具有在其上形成的朝远侧突起的锁定棘爪1064的释放按钮组件1062。释放按钮组件1062可被释放弹簧(未示出)沿逆时针方向枢转。临床医生将闭合触发器1032从其未致动位置朝向柄部1014的手枪式握把部1019按压时,第一闭合连接件1036向上枢转至某个点,其中锁定棘爪1064落入该点中以与第一闭合连接件1036上的锁定壁1039保持接合,从而阻止闭合触发器1032返回未致动位置。因此,闭合释放组件1060用来将闭合触发器1032锁定在完全致动位置。当临床医生期望将闭合触发器1032解锁以允许其被偏压到未致动位置时,临床医生只需枢转闭合释放按钮组件1062,使得锁定棘爪1064运动成与第一闭合连接件1036上的锁定壁1039脱离接合。当锁定棘爪1064已运动成与第一闭合连接件1036脱离接合时,闭合触发器1032可枢转回到未致动位置。也可采用其他闭合触发器锁定布置和释放布置。
臂1061可从闭合释放按钮1062延伸。磁性元件1063(诸如永磁体)例如可安装到臂1061。当闭合释放按钮1062从其第一位置旋转到其第二位置时,磁性元件1063可朝向电路板1100运动。电路板1100可包括至少一个传感器,该至少一个传感器被构造成能够检测磁性元件1063的运动。在至少一个实施方案中,例如,“霍尔效应”传感器(未示出)可安装到电路板1100的底部表面。霍尔效应传感器可被构造成能够检测由磁性元件1063的运动引起、在霍尔效应传感器周围出现的磁场变化。霍尔效应传感器可与例如微控制器进行信号通信,该微控制器可确定闭合释放按钮1062是否处于其与闭合触发器1032的未致动位置和端部执行器的打开构型相关联的第一位置、其与闭合触发器1032的致动位置和端部执行器的闭合构型相关联的第二位置和/或第一位置与第二位置之间的任何位置。
在至少一种形式中,柄部1014和框架1020可以可操作地支撑在本文中被称为击发驱动系统1080的另一个驱动系统,该驱动系统被构造成能够向附接到其的可互换轴组件的对应部分施加击发运动。击发驱动系统1080也可在本文中被称为“第二驱动系统”。击发驱动系统1080可采用电动马达1082,该电动马达位于柄部1014的手枪式握把部1019中。在各种形式中,马达1082例如可为具有约25,000RPM的最大旋转的DC有刷驱动马达。在其他布置中,马达可包括无刷马达、无绳马达、同步马达、步进马达、或任何其他合适的电动马达。马达1082可由功率源1090供电,在一种形式中,该功率源可包括可移除电源组1092。如在图3中可见,例如,电源组1092可包括近侧外壳部分1094,该近侧外壳部分被构造用于附接到远侧外壳部分1096。近侧外壳部分1094和远侧外壳部分1096被构造成能够在其中可操作地支撑多个电池1098。电池1098可各自包括例如锂离子(“LI”)或其他合适的电池。远侧外壳部分1096被构造用于以可移除方式可操作地附接到同样可操作地联接到马达1082的电路板1100。可使用可串联连接的多个电池1098作为外科器械1010的功率源。此外,功率源1090可为可更换的和/或可充电的。
如上文相对于其他各种形式所概述,电动马达1082可包括与齿轮减速器组件1084可操作地交接的可旋转轴(未示出),该齿轮减速器组件与一组或一齿条的驱动齿1122啮合接合地安装在可纵向运动的驱动构件1120上。在使用中,功率源1090所提供的电压极性可沿顺时针方向操作电动马达1082,其中由电池施加给电动马达的电压极性可被反转,以便沿逆时针方向操作电动马达1082。当电动马达1082在一个方向上旋转时,驱动构件1120将在远侧方向“DD”上轴向地驱动。当马达82在相反的旋转方向上被驱动时,驱动构件1120将在近侧方向“PD”上轴向地驱动。柄部1014可包括开关,该开关被构造成能够使由功率源1090施加到电动马达1082的极性反转。与本文所述的其他形式一样,柄部1014还可包括传感器,该传感器被构造成能够检测驱动构件1120的位置和/或驱动构件1120正在运动的方向。
马达1082的致动可通过被枢转地支撑在柄部1014上的击发触发器1130来控制。击发触发器1130可在未致动位置和致动位置之间枢转。击发触发器1130可由弹簧1132或其他偏压构造偏压到未致动位置,使得当临床医生释放击发触发器1130时,击发触发器可由弹簧1132或偏压构造枢转或以其他方式返回到未致动位置。在至少一种形式中,击发触发器1130可定位在闭合触发器1032的“外侧”,如上文所讨论。在至少一种形式中,击发触发器安全按钮1134可由销1035枢转地安装到闭合触发器1032。安全按钮1134可定位在击发触发器1130和闭合触发器1032之间,并具有从其突起的枢转臂1136。当闭合触发器1032处于未致动位置时,安全按钮1134被容纳在柄部1014中,此时临床医生可能无法轻易触及该按钮,也无法将该按钮在防止对击发触发器1130致动的安全位置与击发触发器1130可被击发的击发位置之间运动。临床医生按压闭合触发器1032时,安全按钮1134和击发触发器1130向下枢转,随后可被临床医生操纵。
如上所述,在至少一种形式中,能够纵向运动的驱动构件1120具有在其上形成的一齿条的齿1122,以用于与齿轮减速器组件1084的相应驱动齿轮1086啮合接合。至少一种形式还包括可手动致动的被构造成能够使得临床医生能够在马达1082变得失效情况下手动地回缩能够纵向运动的驱动构件1120的“应急”组件1140。应急组件1140可包括杠杆或应急柄部组件1142,该杠杆或应急柄部组件被构造成能够被手动地枢转为与同样设置在驱动构件1120中的齿1124棘轮接合。因此,临床医生可使用应急柄部组件1142手动地缩回驱动构件1120,以使驱动构件1120沿近侧方向“PD”进行棘轮运动。名称为“POWERED SURGICALCUTTING AND STAPLING APPARATUS WITH MANUALLY RETRACTABLE FIRING SYSTEM”的美国专利8,608,045公开了也可与本文所公开的各种器械一起使用的应急布置和其他部件、布置和系统。美国专利8,608,045据此全文以引用方式并入本文。
现在转到图2和图5,可互换轴组件1200包括外科端部执行器1300,该外科端部执行器包括被构造成能够在其中可操作地支撑钉仓4000的细长通道1310。端部执行器1300还可包括相对于细长通道1310被枢转地支撑的砧座2000。可互换轴组件1200还可包括关节运动接头3020和关节运动锁2140,该关节运动锁可被构造成能够可释放地将端部执行器1300相对于轴轴线SA保持在期望的位置。端部执行器1300、关节运动接头3020和关节运动锁的至少一种形式的各种特征的示例可在2013年3月14日提交的名称为“ARTICULATABLESURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK”的美国专利申请序列号13/803,086(现为美国专利申请公布2014/0263541)中找到。2013年3月14日提交的名称为“ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK”的美国专利申请序列号13/803,086(现为美国专利申请公布2014/0263541)的完整公开内容据此以引用方式并入本文。如在图4中可见,可互换轴组件1200还可包括由喷嘴部分1202和1203组成的近侧外壳或喷嘴1201。
可互换轴组件1200还可包括闭合系统或闭合构件组件3000,该闭合系统或闭合构件组件可用于闭合和/或打开端部执行器1300的砧座2000。轴组件1200可包括脊1210,该脊被构造成能够:第一,在其中可滑动地支撑击发构件;第二,可滑动地支撑围绕脊1210延伸的闭合构件组件3000。如在图5中可见,脊1210的远侧端部1212终止于上凸耳安装特征部1270和下凸耳安装特征部1280。上凸耳安装特征部1270在其中形成有凸耳狭槽1272,该凸耳狭槽适于将上安装连接件1274安装支撑在其中。类似地,下凸耳安装特征部1280在其中形成有凸耳狭槽1282,该凸耳狭槽适于在其中安装地支撑下安装连接件1284。上安装连接件1274在其中包括枢轴承窝1276,该枢轴承窝适于将枢轴销1292可旋转地接收在其中,该枢轴销形成在附接到细长通道1310的近侧端部部分1312的通道顶盖或砧座保持器1290上。下安装连接件1284包括下枢轴销1286,该下枢轴销适于被接收在形成于细长通道1310的近侧端部部分1312中的枢轴孔1314内。参见图5。下枢轴销1286与枢轴承窝1276竖直对准以限定关节运动轴线AA,外科端部执行器1300可围绕该关节运动轴线AA相对于轴轴线SA进行关节运动。参见图2。
在例示的示例中,外科端部执行器1300能够由关节运动系统2100围绕关节运动轴线AA选择性地进行关节运动。在一种形式中,关节运动系统2100包括近侧关节运动驱动器2102,该近侧关节运动驱动器枢转地联接到关节运动连接件2120。如图5中可以最具体地看出,在近侧关节运动驱动器2102的远侧端部2110上形成偏移附接凸耳2114。枢轴孔2116形成在偏移附接凸耳2114中,并且被构造成能够将形成在关节运动连接件2120的近侧端部2122上的近侧连接件销2124枢转地接收在其中。关节运动连接件2120的远侧端部2126包括枢轴孔2128,该枢轴孔被构造成能够将形成在细长通道1310的近侧端部部分1312上的通道销1317枢转地接收在其中。因此,近侧关节运动驱动器2102的轴向运动将由此向细长通道1310施加关节运动动作,从而使外科端部执行器1300围绕关节运动轴线AA相对于脊1210进行关节运动。有关于关节运动系统2100的构造和操作的更多细节可见于以引用方式并入本文的各种参考文献中,包括2017年6月28日提交的名称为“SURGICAL INSTRUMENT WITHAXIALLY MOVABLE CLOSURE MEMBER”的美国专利申请序列号15/635,631中,现为美国专利申请公布2019/0000464,其全部公开内容据此以引用方式并入本文。在各种情况下,当近侧关节运动驱动器2102没有在近侧或远侧方向上运动时,近侧关节运动驱动器2102可被关节运动锁2140保持就位。关于关节运动锁2140的示例的附加细节可见于美国专利申请序列号15/635,631,现为美国专利申请公布2019/0000464,以及以引用方式并入本文的其他参考文献中。
在各种情况下,脊1210可包括可旋转地支撑在底座1240中的近侧端部1211。在一种布置中,例如,脊1210的近侧端部1211具有在其上形成的螺纹1214,以便通过螺纹附接到被构造成能够被支撑在底座1240内的脊轴承1216。参见图4。这种布置有利于脊1210到底座1240的可旋转附接,使得脊1210可以选择性地相对于底座1240围绕轴轴线SA旋转。
主要参见图4,可互换轴组件1200包括闭合梭动件1250,该闭合梭动件被可滑动地支撑在底座1240内,使得闭合梭动件相对于底座轴向运动。闭合梭动件1250包括被构造用于附接到附接销1037的一对朝近侧突起的钩1252(图3),该附接销附接到第二闭合连接件1038,如将在下文进一步详细地讨论。在至少一个示例中,闭合构件组件3000包括具有近侧端部3012的近侧闭合构件段3010,该近侧端部联接到闭合梭动件1250以相对于其旋转。例如,将U形连接器1263插入近侧闭合构件段3010的近侧端部3012中的环形狭槽3014中,并使其保留在闭合梭动件1250中的竖直狭槽1253内。此类布置用于将近侧闭合构件段3010附接到闭合梭动件1250,以与闭合梭动件一起轴向地行进,同时使得近侧闭合构件段3010能够相对于闭合梭动件1250围绕轴轴线SA旋转。闭合弹簧1268轴颈连接在近侧闭合构件段3010上,用来沿近侧方向“PD”偏压近侧闭合构件段3010,当轴组件可操作地联接到柄部1014时,该闭合弹簧可用来将闭合触发器1032枢转到未致动位置。
在至少一种形式中,可互换轴组件1200还可包括关节运动接头3020。然而,其他可互换轴组件可能无法进行关节运动。如在图5中可见,例如,远侧闭合构件或远侧闭合管段3030联接到近侧闭合构件段3010的远侧端部。关节运动接头3020包括双枢轴闭合套管组件3022。根据各种形式,双枢轴闭合套管组件3022包括具有朝远侧突出的上柄脚3052和下柄脚3054的端部执行器闭合管3050。上部双枢轴连接件3056包括向上突出的远侧枢轴销和近侧枢轴销,这些枢轴销分别接合远侧闭合管段3030上的朝近侧突出的上柄脚3052中的上部远侧销孔以及朝远侧突出的上柄脚3032中的上部近侧销孔。下部双枢轴连接件3058包括向上突出的远侧枢轴销和近侧枢轴销,这些枢轴销分别接合朝近侧突出的下柄脚3054中的下部远侧销孔以及朝远侧突出的下柄脚3034中的下部近侧销孔。参见图4和图5。如将在下文进一步详细讨论的,闭合构件组件3000朝远侧(方向“DD”)平移,以例如响应于闭合触发器1032的致动而使砧座2000闭合。通过朝近侧平移闭合构件组件3000来打开砧座2000,这使端部执行器闭合套管与砧座2000相互作用并使其枢转至打开位置。
同样如上所述,可互换轴组件1200还包括击发构件1900,该击发构件被支撑以便在脊1210内轴向行进。击发构件1900包括被构造用于附接到远侧切割部分或刀杆1910的中间击发轴部分1222。中间击发轴部分1222可在其远侧端部中包括纵向狭槽1223,该纵向狭槽可被构造成能够接收远侧刀杆1910的近侧端部上的接片1912。纵向狭槽1223和近侧端部接片1912的尺寸和构造可被设置成允许该纵向狭槽和该近侧端部接片之间的相对运动并且可包括滑动接头1914。滑动接头1914可以允许击发构件1900的中间击发轴部分1222运动,以在不使刀杆1910运动或至少基本上不使刀杆1910运动的情况下,使端部执行器1300进行关节运动。一旦端部执行器1300已合适地取向,中间击发轴部分1222便可朝远侧推进,直到纵向狭槽1223的近侧侧壁与接片1912发生接触,以便推进刀杆1910并击发定位在通道1310内的钉仓4000。刀杆1910包括刀部分1920,该刀部分包括刀片或组织切割刃1922并且包括上部砧座接合接片1924和下部通道接合接片1926。各种击发构件构型和操作公开于以引用方式并入本文的各种其他参考文献中。
如在图4中可见,轴组件1200还包括可旋转地接收在近侧闭合构件段3010上的切换筒1500。切换筒1500包括中空轴段1502,该中空轴段具有在其上形成的轴凸台,用于将向外突起的致动销接收在其中。在各种情况下,致动销延伸穿过设置在锁套管中的纵向狭槽,以便在锁套管与关节运动驱动器接合的情况下,利于锁套管进行轴向运动。旋转扭转弹簧1420被构造成能够接合切换筒1500上的凸台以及喷嘴外壳1203的一部分,以将偏压力施加到切换筒1500。切换筒1500还可包括限定于其中的至少部分周边开口1506,该开口可被构造成能够接收从喷嘴部分1202、1203延伸的周边安装架,并且允许切换筒1500和喷嘴1201之间的相对旋转而不是相对平移。安装架还延伸穿过待安置在脊1210中的凹槽1219中的近侧闭合构件段3010中的开口3011。切换筒1500围绕轴轴线SA的旋转最终将引起致动销的旋转,并引起锁套管在其接合位置与脱离位置之间旋转。在一种布置中,切换筒1500的旋转可与闭合管或闭合构件的轴向推进相关联。因此,实质上,闭合系统的致动可以各种方式可操作地使关节运动驱动系统与击发驱动系统接合和脱离接合,这些方式在名称为“ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK”的美国专利申请序列号13/803,086(现为美国专利申请公布No.2014/0263541)和名称为“SURGICALINSTRUMENT COMPRISING A SENSOR SYSTEM”的美国专利No.9,913,642中更详细地描述,这些专利各自的全部公开内容据此以引用方式并入本文。例如,当闭合管处于其对应于“钳口打开”位置的最近侧位置时,闭合构件段3010将已定位切换筒1500,以便将关节运动系统与击发驱动系统连接。当闭合管已运动到其对应于“钳口闭合”位置的远侧位置时,闭合管已将切换筒1500旋转到其中关节运动系统与击发驱动系统脱离连接的位置。
也如图4所示,轴组件1200可包括滑环组件1600,例如,该滑环组件可被构造成能够将电力传导至端部执行器1300和/或从该端部执行器传导电力,并且/或者将信号传送至端部执行器1300和/或从该端部执行器接收信号。滑环组件1600可包括近侧连接器法兰1604和远侧连接器法兰,该近侧连接器法兰安装到从底座1240延伸的底座法兰1242上,该远侧连接器法兰定位在限定于轴外壳中的狭槽内。近侧连接器法兰1604可包括第一面,并且远侧连接器法兰可包括第二面,其中第二面与第一面相邻定位,并能够相对于第一面运动。远侧连接器法兰可围绕轴轴线SA相对于近侧连接器法兰1604旋转。近侧连接器法兰1604可包括限定于其第一面中的多个同心或至少基本上同心的导体。连接器可安装在连接器法兰的近侧侧面上,并且可具有多个触点,其中每个触点对应于导体中的一个并且与其电接触。这种布置在保持近侧连接器法兰1604与远侧连接器法兰之间电接触的同时,允许这两个法兰之间进行相对旋转。例如,近侧连接器法兰1604可包括电连接器1606,该电连接器可使导体与安装到轴底座1240的轴电路板1610进行信号通信。在至少一种情况下,包括多个导体的线束可在电连接器1606与轴电路板1610之间延伸。电连接器1606可朝近侧延伸穿过限定于底座法兰1242中的连接器开口1243。参见图4。例如,关于滑环组件1600的进一步细节可见于名称为“ARTICULATABLE SURGICAL INSTRUMENT COMPRISING ANARTICULATION LOCK”的美国专利申请序列号13/803,086(现为美国专利申请公布2014/0263541)、提交于2013年3月13日的名称为“STAPLE CARTRIDGE TISSUE THICKNESS SENSORSYSTEM”的美国专利申请序列号13/800,067(现为美国专利申请公布2014/0263552,以及名称为“STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM”的美国专利9,345,481。美国专利申请序列号13/803,086(现为美国专利申请公布2014/0263541)、美国专利申请序列号13/800,067(现为美国专利申请公布2014/0263552)和美国专利9,345,481据此各自全文以引用方式并入本文。
如上文所讨论,轴组件1200可包括可固定地安装到柄部1014的近侧部分,以及能够围绕纵向轴线旋转的远侧部分。可旋转远侧轴部分可如上所述围绕滑环组件1600相对于近侧部分旋转。滑环组件1600的远侧连接器法兰可定位在可旋转远侧轴部分内。而且,除上述之外,切换筒1500也可定位在可旋转远侧轴部分内。当可旋转远侧轴部分旋转时,远侧连接器法兰和切换筒1500可彼此同步地旋转。另外,切换筒1500可相对于远侧连接器法兰在第一位置和第二位置之间旋转。当切换筒1500处于其第一位置时,关节运动驱动系统可与击发驱动系统可操作地脱离接合,因此,击发驱动系统的操作可不使轴组件1200的端部执行器1300进行关节运动。当切换筒1500处于其第二位置时,关节运动驱动系统可以与击发驱动系统可操作地接合,因此,击发驱动系统的操作可以使轴组件1200的端部执行器1300进行关节运动。当切换筒1500在其第一位置和其第二位置之间运动时,切换筒1500相对于远侧连接器法兰运动。在各种情况下,轴组件1200可包括被构造成能够检测切换筒1500的位置的至少一个传感器。
再次参见图4,底座1240包括在其上形成的至少一个、优选两个渐缩的附接部分1244,这种附接部分适于被接收在对应的燕尾形狭槽1702内,该燕尾形狭槽在框架1020的远侧附接法兰部分1700内形成。参见图3。每个燕尾形狭槽1702可以是锥形,或换句话讲,可以略成V形,从而以坐置方式将附接部分1244接收在其中。如可在图4中进一步所见,轴附接凸耳1226形成在中间击发轴部分1222的近侧端部上。如将在下文进一步详细地讨论,当可互换轴组件1200联接到柄部1014时,轴附接凸耳1226被接收在形成于纵向驱动构件1120的远侧端部1125中的击发轴附接支架1126中。参见图3。
各种轴组件实施方案采用闩锁系统1710用于将轴组件1200可移除地联接到外壳1012并且更具体地联接到框架1020。如图4中可见,例如,在至少一种形式中,闩锁系统1710包括可运动地联接到底座1240的锁构件或锁定轭1712。在例示的实施方案中,例如,锁定轭1712为U形,有两个隔开并向下延伸的腿部1714。腿部1714各自具有在其上形成的枢轴凸耳1715,这些枢轴凸耳适于被接收在底座1240中形成的对应孔1245中。这种布置有利于将锁定轭1712枢转附接到底座1240。锁定轭1712可包括两个朝近侧突起的锁定凸耳1716,这两个锁定凸耳被构造成能够与框架1020的远侧附接法兰部分1700中对应的锁定棘爪或凹槽1704可释放地接合。参见图3。在各种形式中,锁定轭1712被弹簧或偏压构件(未示出)沿近侧方向偏压。锁定轭1712的致动可通过闩锁按钮1722实现,该闩锁按钮可滑动地安装在安装于底座1240的闩锁致动器组件1720上。闩锁按钮1722可相对于锁定轭1712沿近侧方向偏压。如将在下文进一步详细地讨论,锁定轭1712可通过沿远侧方向偏压闩锁按钮而运动到解锁位置,这也使锁定轭1712枢转成不再与框架1020的远侧附接法兰部分1700保持接合。当锁定轭1712与框架1020的远侧附接法兰部分1700“保持接合”时,锁定凸耳1716保持安置在远侧附接法兰部分1700中对应的锁定棘爪或凹槽1704内。
当采用包括适于切割和紧固组织的本文所述类型的端部执行器以及其他类型的端部执行器的可互换轴组件时,可能有利的是防止可互换轴组件在端部执行器致动期间不经意地从外壳脱离。例如,在使用中,临床医生可致动闭合触发器1032以抓持目标组织并将其操纵成期望的位置。一旦目标组织以期望取向定位在端部执行器1300内,临床医生就可完全致动闭合触发器1032,以闭合砧座2000并将目标组织夹持在合适位置供切割与缝合。在这种情况下,第一驱动系统1030已被完全致动。在目标组织已被夹持在端部执行器1300中之后,可能有利的是防止轴组件1200不经意地从外壳1012脱离。闩锁系统1710的一种形式被构造成能够防止这种不经意的脱离。
如图4中可最清楚地看到的那样,锁定轭1712包括至少一个、优选两个锁钩1718,这些锁钩适于接触闭合梭动件1250上形成的对应锁定凸耳部分1256。在闭合梭动件1250处于未致动位置(也就是第一驱动系统1030未致动并且砧座2000打开)的情况下,锁定轭1712可沿远侧方向枢转,以将可互换轴组件1200从外壳1012解锁。处于该位置时,锁钩1718不接触闭合梭动件1250上的锁耳部分1256。但是,在闭合梭动件1250运动到致动位置(即第一驱动系统1030被致动并且砧座2000处于闭合位置)的情况下,锁定轭1712受到阻碍,不能枢转到解锁位置。换句话讲,如果临床医生试图将锁定轭1712枢转到解锁位置,或者例如,锁定轭1712不经意地以原本可能致使其向远侧枢转的方式受到碰撞或发生接触,则锁定轭1712上的锁钩1718将接触闭合梭动件1250上的锁定凸耳部分1256,并且防止锁定轭1712运动到解锁位置。
现在将描述可互换轴组件1200与柄部1014的附接。要开始联接过程,临床医生可将可互换轴组件1200的底座1240定位在框架1020的远侧附接法兰1700上方或附近,使得底座1240上形成的渐缩附接部分1244与框架1020中的燕尾形狭槽1702对准。然后临床医生可使轴组件1200沿垂直于轴轴线SA的安装轴线运动,以安置附接部分1244,使其与对应的燕尾形接收狭槽1702“可操作地接合”。这样做时,中间击发轴部分1222上的轴附接凸耳1226也将安置在能够纵向运动的驱动构件1120中的支架1126中,并且第二闭合连接件1038上的销1037的部分将安置在闭合梭动件1250中的对应钩1252中。如本文所用,术语“可操作地接合”在两个部件的背景下是指这两个部件彼此充分地接合,使得一旦向其施加致动动作,这些部件便可执行其预期行动、功能和/或程序。
可互换轴组件1200的至少五个系统可以与柄部1014的至少五个对应系统可操作地联接。第一系统可包括框架系统,该框架系统将轴组件1200的框架或脊与柄部1014的框架1020联接并/或对准。另一个系统可包括闭合驱动系统1030,该闭合驱动系统可将柄部1014的闭合触发器1032与轴组件1200的闭合管1260和砧座2000可操作地连接。如上文所概述,轴组件1200的闭合梭动件1250可与第二闭合连接件1038上的销1037接合。另一个系统可包括击发驱动系统1080,该击发驱动系统可将柄部1014的击发触发器1130与轴组件1200的中间击发轴部分1222可操作地连接。如上文所概述,轴附接凸耳1226可与纵向驱动构件1120的支架1126可操作地连接。另一个系统可包括电气系统,该电气系统能够:发送轴组件(诸如轴组件1200)已与柄部1014可操作地接合的信号到柄部1014中的控制器(诸如微控制器),并且/或者在轴组件1200与柄部1014之间传导功率和/或通信信号。例如,轴组件1200可包括可操作地安装到轴电路板1610的电连接器1810。电连接器1810被构造用于与柄部控制板1100上的对应电连接器1800配合接合。关于电路系统和控制系统的更多细节可见于美国专利申请序列号13/803,086(现为美国专利申请公布2014/0263541)和美国专利申请序列号14/226,142(现为美国专利9,913,642),这两者各自的完整公开内容此前以引用方式并入本文。第五系统可由用于可释放地将轴组件1200锁定到柄部1014的闩锁系统组成。
在例示的示例中,砧座2000包括终止于砧座安装部分2010中的砧座主体2002。砧座安装部分2010可动地或可枢转地支撑在细长通道1310上,以便于围绕横向于轴轴线SA的固定砧座枢转轴线PA相对于该细长通道选择性枢转行进。在例示的布置中,枢转构件或砧座耳轴2012侧向延伸出砧座安装部分2010的每个侧向侧,以接收在形成于细长通道1310的近侧端部部分1312的直立壁1315中的对应耳轴支架1316中。砧座耳轴2012由通道顶盖或砧座保持器1290枢转地保持在其对应的耳轴支架1316中。通道顶盖或砧座保持器1290包括一对附接凸耳,该对附接凸耳被构造成能够保持地接收在形成于细长通道1310的近侧端部部分1312的直立壁1315中的对应凸耳凹槽或凹口内。参见图5。
仍然参见图5,在至少一种布置中,远侧闭合构件或端部执行器闭合管3050采用两个轴向偏移的近侧正钳口打开特征部3060和远侧正钳口打开特征部3062。正钳口打开特征部3060、3062被构造成能够与在砧座安装部分2010上形成的对应的释放区域和阶梯部分交接,如在名称为“SURGICAL INSTRUMENT WITH AXIALLY MOVABLE CLOSURE MEMBER”的美国专利申请序列号15/635,631,现为美国专利申请公布2019/0000464中进一步详细描述的,其全部公开内容以引用方式并入本文。可采用其他钳口打开布置。
图6至图8示出了先前的外科切割和紧固器械5010,其被构造成能够产生旋转驱动动作以用于操作外科端部执行器5012。内窥镜式外科器械5010包括柄部5006、轴5008和在关节运动枢轴5014处枢转地连接至轴5008的进行关节运动的外科端部执行器5012。关节运动控件5016可邻近柄部5006提供,以实现端部执行器5012围绕关节运动枢轴5014的旋转。应当理解,各种实施方案可包括非枢转的端部执行器,并且因此可不具有关节运动枢轴5014或关节运动控件5016。
器械5010的柄部5006可包括用于致动端部执行器5012的闭合触发器5018和击发触发器5020。应当理解,具有涉及不同外科手术任务的端部执行器的器械可具有用于操作端部执行器5012的不同数量或类型的触发器或其他合适的控件。在一个实施方案中,器械5010的临床医生或操作者可通过利用关节运动控件5016使端部执行器5012相对于轴5008进行关节运动,如在名称为“SURGICAL INSTRUMENT HAVING AN ARTICULATING ENDEFFECTOR”的未决美国专利7,670,334中更详细地描述,该专利的全部公开内容以引用方式并入本文。在该示例中,端部执行器5012包括(除了别的以外)钉通道5022和能够枢转地平移的夹持构件诸如砧座5024,该钉通道和能够枢转地平移的夹持构件保持在确保有效缝合和切断夹持在端部执行器5012中的组织的间距处。柄部5006包括手枪式握把5026,临床医生将闭合触发器5018枢转地拉向该手枪式握把,以使砧座5024朝端部执行器5012的钉通道5022夹持或闭合,从而夹持定位在砧座5024和通道5022之间的组织。
在图7所示的布置中,除了前述通道5022和砧座5024之外,端部执行器5012还包括切割器械5032、滑动件5033、可移除地安置在通道5022中的钉仓5034、以及螺旋状螺杆轴5036。切割器械5032可为例如刀。砧座5024包括枢轴销5025,该枢轴销被可动地支撑在通道5022中的对应狭槽中。在一种布置中,砧座5024包括位于其近侧端部处的接片5027,该接片插入机械闭合系统(下文进一步描述)的部件中以打开和闭合砧座5024。
仍然参见图7,轴5008包括由枢转连接件5044可枢转地连接的近侧闭合管5040和远侧闭合管5042。远侧闭合管5042包括开口5045,砧座5024上的接片5027插入该开口中,以便打开和闭合砧座5024,如下文进一步所述。近侧脊管5046可设置在闭合管5040、5042内。主旋转(或近侧)驱动轴5048可设置在近侧脊管5046内,该主旋转(或近侧)驱动轴经由锥齿轮组件5052a-c与次(或远侧)驱动轴5050连通。次驱动轴5050连接至驱动齿轮5054,该驱动齿轮接合螺旋状螺杆轴5036的近侧驱动齿轮5056。竖直锥齿轮5052b可位于近侧脊管5046的远侧端部中的开口5057中并在其中枢转。远侧脊管5058可用于包封次驱动轴5050和驱动齿轮5054、5056。主驱动轴5048、次驱动轴5050和关节运动组件(例如,锥齿轮组件5052a-c)在本文中有时统称为“主驱动轴组件”。
定位在钉通道5022的远侧端部处的轴承5038接收螺旋状螺杆轴5036,从而允许螺旋状螺杆轴5036相对于通道5022自由地旋转。螺旋状螺杆轴5036可与刀5032的螺纹开口(未示出)交接,使得螺旋状螺杆轴5036的旋转致使刀5032朝远侧或朝近侧(取决于旋转方向)平移穿过钉通道5022。
接下来转到图8,柄部5006包括外部下侧件5059、5060和喷嘴件5061、5062,它们装配在一起以总体上形成柄部5006的外部。电池5064诸如锂离子电池可设置在柄部5006的手枪式握把部分5026中。电池5064为设置在柄部5006的手枪式握把部5026的上部部分中的马达5065供电。马达5065可驱动包括第一锥齿轮5068和第二锥齿轮5070的90°锥齿轮组件5066。锥齿轮组件5066可驱动行星齿轮组件5072。行星齿轮组件5072可包括连接到驱动轴5076的小齿轮5074。小齿轮5074可驱动配对的环形齿轮5078,该配对的环形齿轮经由驱动轴驱动螺旋齿轮鼓5080。环5084可螺纹接合在螺旋齿轮鼓5080上。因此,当马达5065旋转时,通过插置的锥齿轮组件5066、行星齿轮组件5072和环形齿轮5078使环5084沿着螺旋齿轮鼓5080行进。
柄部5006可包括与击发触发器5020的上部部分相邻的中间柄部件5104。柄部5006还可包括连接在中间柄部件5104上的柱与击发触发器5020上的柱之间的偏压弹簧5112。偏压弹簧5112可将击发触发器5020偏压到其完全打开位置。这样,当操作者释放击发触发器5020时,偏压弹簧5112将击发触发器5020牵拉至其打开位置。螺旋齿轮鼓5080的远侧端部包括驱动环形齿轮5122的远侧驱动轴5120,该环形齿轮与小齿轮5124配合。小齿轮5124连接到主驱动轴组件的主驱动轴5048。这样,马达5065的旋转导致主驱动轴组件旋转,这导致端部执行器5012的致动。螺纹接合在螺旋齿轮鼓5080上的环5084可包括设置在开槽臂5090的狭槽5088内的柱5086。开槽臂5090在其相对端部5094中具有开口5092,该开口接收连接在柄部外侧件5059、5060之间的枢轴销5096。枢轴销5096还设置成穿过击发触发器5020中的开口5100和中间柄部件5104中的开口5102。
中间柄部件5104包括接合开槽臂5090的后侧肩部5106。中间柄部件5104还具有与击发触发器5020接合的向前动作止挡件5107。开槽臂5090的运动由马达5065的旋转控制。当开槽臂5090随着环5084从螺旋齿轮鼓5080的近侧端部行进至远侧端部而逆时针旋转时,中间柄部件5104将自由地逆时针旋转。因此,当使用者拉近击发触发器5020时,击发触发器5020将接合中间柄部件5104的前移止挡件5107,从而使中间柄部件5104逆时针旋转。然而,由于后侧肩部5106接合开槽臂5090,因此中间柄部件5104将仅能够在开槽臂5090允许的范围内逆时针旋转。这样,如果马达5065出于某种原因应该停止旋转,则开槽臂5090将停止旋转,并且使用者将不能进一步拉近击发触发器5020,因为中间柄部件5104将由于开槽臂5090而不能自由地逆时针旋转。
图8中还示出了用于通过回缩闭合触发器5018来闭合(或夹持)端部执行器5012的砧座5024的示例性闭合系统的部件。在例示的实施方案中,闭合系统包括连接到闭合触发器5018的轭5250。枢轴销5252穿过闭合触发器5018和轭5250两者中的对准开口插入,使得它们两者围绕相同点旋转。轭5250的远侧端部经由销5254连接到第一闭合托架5256。第一闭合托架5256连接到第二闭合托架5258。闭合托架5256、5258共同限定开口,近侧闭合管5040(参见图7)的近侧端部安置并保持在该开口中,使得闭合托架5256、5258的纵向运动引起近侧闭合管5040的纵向动作。器械5010还包括设置在近侧闭合管5040内的闭合驱动轴5260。闭合驱动轴5260可包括窗口5261,位于柄部外部件之一(诸如例示的实施方案中的外部下侧件5059)上的柱5263设置在该窗口中,以将闭合驱动轴5260固定地连接至柄部5006。这样,近侧闭合管5040能够相对于闭合驱动轴5260纵向运动。闭合驱动轴5260还可包括远侧套环5267,该远侧套环装配到近侧脊管5046中的腔中并且通过顶盖保持在其中。
在操作中,当轭5250由于闭合触发器5018的回缩而旋转时,闭合托架5256、5258使得近侧闭合管5040朝远侧运动(即,远离器械5010的柄部端部),这使得远侧闭合管5042朝远侧运动,从而使得砧座5024围绕枢轴销5025旋转到夹持或闭合位置。当闭合触发器5018从锁定位置解锁时,致使近侧闭合管5040朝近侧滑动,这致使远侧闭合管5042朝近侧滑动,这借助于将接片5027插入远侧闭合管5042的开口5045中,致使砧座5024围绕枢轴销5025枢转到打开或松开位置中。这样,通过回缩并锁定闭合触发器5018,操作者可将组织夹持在砧座5024和通道5022之间,并且可在切割/缝合操作之后通过将闭合触发器5018从锁定位置解锁来松开组织。关于现有外科器械5010的构造和操作的更多细节可见于名称为“SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES”的美国专利7,845,537,该专利的全部公开内容据此以引用方式并入本文。被构造用于与各种形式的机器人系统一起使用的其他旋转驱动布置公开于名称为“STAPLING END EFFECTOR CONFIGURED TO COMPENSATEFOR AN UNEVEN GAP BETWEEN A FIRST JAW AND A SECOND JAW”的美国专利申请公布2016/0287251中,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。
下面转到图9和图10,图中示出了可再利用或不可再利用的另一个马达驱动的外科切割和紧固器械10010。在例示的实施方案中,器械10010包括外壳10012,该外壳包括被构造成能够被临床医生抓持、操纵和致动的柄部10014。如在图9中可见,例如器械10010包括轴组件10200,该轴组件具有可操作地联接到其的外科端部执行器10300,该外科端部执行器被构造成能够执行一种或多种外科任务或外科手术。在一种布置中,轴组件10200包括可互换轴组件,该可互换轴组件旨在能够以本文所公开的各种方式可移除地联接到柄部组件10014。然而,轴组件10200还可包括不旨在从柄部10014移除的专用轴组件。下文将仅更详细地讨论理解轴组件10200的功能和操作所必需的那些特定部件。
如在图9中可见,例如外科端部执行器10300包括被构造成能够在其中可操作地支撑钉仓10400的细长通道10310。端部执行器10300还包括砧座10500,该砧座能够相对于细长通道10310枢转地被支撑。在一种布置中,例如,砧座10500可使用名称为“METHOD FORFABRICATING SURGICAL STAPLER ANVILS”的美国专利申请序列号16/105,101中描述的各种制造技术来制造,该专利申请的全部公开内容据此以引用方式并入本文。轴组件10200还可包括关节运动接头10250,该关节运动接头有助于外科端部执行器10300围绕关节运动轴线AA进行关节运动,该关节运动轴线AA横向于纵向轴轴线LA。然而,其他轴组件可能无法进行关节运动。在例示的示例中,轴组件10200包括从喷嘴组件10202朝远侧延伸的近侧外轴管或构件10210。细长通道的近侧端部10312包括管状部分10314,该管状部分在尺寸上类似于近侧外轴管10120并且联接到近侧外轴管10210的远侧端部以形成关节运动接头10250。关节运动接头10250包括双枢轴轴组件10252。参见图11和图12。根据各种形式,细长通道10310的管状部分10314包括朝近侧突出的上部柄脚10316和下部柄脚10318。参见图11。上部双枢轴连接件10320包括向上突出的远侧枢轴销和近侧枢轴销,这些枢轴销分别接合近侧外轴管10210上的朝近侧突出的上部柄脚10316中的上部销孔以及朝远侧突出的上部柄脚10212中的上部远侧销孔。下部双枢轴连接件10322包括向下突出的远侧枢轴销和近侧枢轴销,这些枢轴销分别接合近侧外轴管10210中的朝近侧突出的下部柄脚10318中的下部远侧销孔以及朝远侧突出的下部柄脚10214中的下部近侧销孔。参见图11。轴组件10200还包括内部脊构件10230,该内部脊构件枢转地联接到插入件组件10330,该插入件组件被接收在细长通道10310的管状部分10314内并且通过例如焊接、粘合剂、紧固件等附接到其上。内部脊构件10230的近侧端部可以例如本文所公开的各种方式可旋转地联接到喷嘴组件10202内的底座(未示出)。内部脊构件10230的远侧端部可销接到插入件组件10330,以有利于细长通道10310相对于内部脊构件10230的枢转行进。
在例示的示例中,外科端部执行器10300能够由关节运动系统10260围绕关节运动轴线AA选择性地进行关节运动。在一种形式中,关节运动系统10260包括例如被可操作地支撑在喷嘴组件10202中的关节运动马达10262。参见图10。在其他示例中,关节运动马达10262可以被可操作地支撑在外壳10012或柄部10014或机器人系统的其他部分中。参见图10,关节运动马达10262联接到与驱动齿轮齿条10266啮合接合的关节运动驱动齿轮10264,该驱动齿轮齿条附接到近侧关节运动驱动器10268或以其他方式形成于该近侧关节运动驱动器中。近侧关节运动驱动器10268的远侧端部枢转地联接到远侧关节运动连接件10270。如在图12中可见,偏移附接凸耳10272形成于近侧关节运动驱动器10268的远侧端部10271上。枢轴孔形成于偏移附接凸耳10272中,并且被构造成能够将形成于远侧关节运动连接件10270的近侧端部10274上的近侧连接件销10276枢转地接收在其中。远侧关节运动连接件10270的远侧端部10278包括枢轴孔,该枢轴孔被构造成能够将形成于插入件组件10330上的通道销10332枢转地接收在其中。关节运动马达10262的操作将使近侧关节运动驱动器10268轴向运动。近侧关节运动驱动器10268的轴向运动将向细长通道10310施加关节运动动作,从而使外科端部执行器10300相对于内部脊构件10230围绕关节运动轴线AA进行关节运动。可以本文所公开的各种方式使用其他关节运动系统和布置。在其他实施方案中,外科端部执行器可能不能够进行关节运动。
在至少一种布置中,外科端部执行器10300包括击发构件,该击发构件能够在外科端部执行器10300内在起始位置和结束位置之间轴向运动。如将在下文进一步详细地讨论,击发构件可被构造成能够切断夹持在砧座10500与被可操作地支撑在细长通道10310中的外科钉仓10400之间的组织。在一种布置中,钉仓10400包括被可操作地支撑在对应驱动器上的多排外科钉或紧固件,这些对应驱动器被可动地支撑在仓中。随着朝远侧驱动击发构件,击发构件与支撑在钉仓中的滑动件或凸轮作用组件协作,该滑动件或凸轮作用组件用于在朝向闭合砧座的方向上推进驱动器,这使得支撑在其上的钉或紧固件刺穿所夹持的组织而与闭合砧座的下侧形成接触。一旦击发构件已在端部执行器内从其近侧起始位置朝远侧推进到其结束位置,则其可回缩回到其起始位置以允许砧座打开,从而有利于从端部执行器移除所切割/缝合的组织。在其他布置中,击发构件可留在结束位置处,其中允许其与砧座脱离结合以有利于打开砧座。
在至少一种布置中,外科器械10010还采用击发系统10600,该击发系统被构造成能够向击发构件施加旋转驱动动作以在起始位置和结束位置之间驱动击发构件。在图10所示的示例中,击发系统10600包括例如被可操作地支撑在喷嘴组件10202中的击发马达10602。在其他示例中,击发马达10602可以被可操作地支撑在外壳或柄部或机器人系统的其他部分中。击发马达10602联接到击发驱动齿轮10604,该击发驱动齿轮与从动齿轮10606啮合接合,该从动齿轮附接到旋转击发驱动轴10610或以其他方式形成于该旋转击发驱动轴中。如在图11和图12中可见,击发驱动轴10610可以是柔性的,以允许外科端部执行器10300以上述方式进行关节运动。
图13示出了可用于外科端部执行器10300中的旋转驱动击发构件10620的一个示例。如在图13中可见,击发构件10620包括主体部分10622,该主体部分包括两个向下延伸的中空安装部分10624,这两个中空安装部分为无螺纹的并且彼此间隔开以在它们之间接收螺纹驱动螺母10630。螺纹驱动螺母10630螺纹接合到旋转击发驱动轴10610的螺纹部分10612上。旋转击发驱动轴10610的远侧端部10614可被构造成能够可旋转地支撑在容纳在细长通道内的轴承(未示出)中,并且被构造成能够在其中可旋转地支撑旋转击发驱动轴10610。驱动螺母10630包括竖直接片部分10632,该竖直接片部分定尺寸成延伸穿过细长通道的底部中的轴向狭槽。两个侧向延伸的通道接合法兰10634形成于螺纹驱动螺母10630上并且被构造成能够接合细长通道的底部。此外,两个侧向延伸的砧座接合接片10626形成于击发构件主体10622的顶部上,并且被构造成能够在击发构件10620在端部执行器10300内轴向运动时接合形成于砧座10500中的对应凸缘。、在该布置中,击发构件10620包括凸轮作用滑动件接合特征部10628,该凸轮滑动件接合特征部被构造成能够可操作地接合可动地储存在钉仓中的凸轮作用组件。凸轮作用滑动件或凸轮作用组件(未示出)可包括附接到击发构件10620的组织切割构件或组织切割特征部。击发构件10620可储存在未击发钉仓内并且被构造成能够在仓可操作地安装在细长通道内时安置在螺纹驱动螺母10630上。然而,也可采用多种其他旋转驱动击发构件布置。例如,也可采用永久性地被螺纹接合到旋转击发驱动轴上的击发构件和组织切割构件。在各个方面,当击发构件10620朝远侧被驱动穿过外科钉仓10400时,通过砧座接合接片10626与砧座10500的接合以及通道接合法兰10634与通道10310的接合,击发构件10620可用于在钉仓10400上的平台表面10402与砧座10500上的钉成形下表面10502之间保持所需量的组织间隙。参见图9。
在图10至图21所示的示例中,除了旋转驱动击发系统之外,外科器械10010还包括旋转驱动闭合系统10700,该旋转驱动闭合系统被构造成能够向砧座10500施加旋转闭合动作。如在图10中可见,例如,在一种布置中,旋转驱动闭合系统10700包括例如被可操作地支撑在喷嘴组件10202中的闭合马达10702。在其他示例中,闭合马达10702可以被可操作地支撑在外壳或柄部或机器人系统的其他部分中。闭合马达10702联接到闭合驱动齿轮10704,该击发驱动齿轮与从动齿轮10706啮合接合,该从动齿轮附接到旋转闭合驱动轴10710或以其他方式形成于该旋转击发驱动轴中。如在图11和图12中可见,闭合驱动轴10710可以是柔性的,以允许外科端部执行器10300以上述方式进行关节运动。
在例示的示例中,外科端部执行器10300包括砧座10500,该砧座包括被构造成能够枢转地附接到插入件组件10330的远侧插入件部分10334的朝近侧延伸的安装接片10510。在另选的布置中,远侧插入件部分10334可与插入件组件10330分离,并且以其他方式通过焊接、粘合剂、紧固件等附接到细长通道10310的近侧端部部分10312。在其他布置中,远侧插入件部分10334可实际上包括细长通道10310的一部分并且与其一体形成。在例示的布置中,砧座安装接片10510包括远侧部分10512,横向狭槽10514延伸穿过该远侧部分,并且与远侧插入件部分10334中的横向狭槽10336以及细长通道10310的管状部分10314中的狭槽10315对准。参见图18。砧座安装接片10510通过铆钉10340枢转地附接到细长通道10310。砧座安装接片10510以及远侧插入件部分10334足够稳固以在铆钉10340操作时提供足够的强度,这提供了将枢转附接点定位在端部执行器的中心线或中点上方的能力,从而在其中为击发构件部件和旋转驱动部件提供足够的空间。铆钉10340的轨道形成将砧座安装接片10510枢转地系紧到细长通道10310,并且可移除用于将铆钉10340置于完全或显著完全剪切以抵抗闭合负载的过度间隙或运动(公差斜率)。此外,此类部件之间的相对较宽的接触还可用于防止或最小化砧座安装接片10510和细长通道10310之间的扭转。
如在图14、图15和图17中可见,砧座10500非对称地联接到细长通道10310。换句话讲,砧座10500附接到细长通道10310的位置从端部执行器中心线EC侧向偏移。在至少一种布置中,铆钉10340包括直径为0.05"至0.1"的实芯铆钉和在铆钉柄部10344的一个端部上形成的轨道形成的头部10342,以及在铆钉柄部10344的另一个端部上形成的机加工头部10346。在一种布置中,铆接以一定方式进行,使得铆钉10340将保持最终成形高度,该最终成形高度将确保砧座安装接片10510与细长通道10310的对应附接部分之间的紧密接触。“轨道形成的”头部10342将使砧座安装接片10510和细长通道部分的该侧上的铆钉柄部10344溶胀,这可防止铆钉相对于该部分旋转,而另一个“预机加工”侧10346将不具有可允许相邻部件旋转的溶胀柄部部分。在一个示例中,铆钉10340相对于通道部分固定以避免其中砧座相对于插入件和细长通道自由枢转的状况。
图10至图19所示的示例采用被构造成能够向砧座10500施加打开动作和闭合动作的旋转致动闭合系统10700。在一种布置中,闭合系统10700包括闭合连杆组件10716,该闭合连杆组件枢转地联接到砧座安装接片10510以用于相对于该砧座安装接片围绕共同闭合轴线CA枢转行进。如在图19和图20中可见,闭合驱动轴10710包括螺纹驱动段10714,该螺纹驱动段被构造成能够通过螺纹接合由驱动轭10720支撑的驱动螺母10730。驱动轭10720包括两个轭臂10722,这两个轭臂具有穿过其中的无螺纹孔10724以允许闭合驱动轴10710穿过其中。驱动螺母10730具有穿过其中的螺纹孔10732,该螺纹孔螺纹接合到闭合驱动轴10710的螺纹驱动段10714上并且被接收在轭臂10722之间。闭合连接件10740通过销10742枢转地联接到驱动轭10720。闭合连接件10740还通过销10744枢转地附接(销接)到砧座安装接片10510。参见图19。如在图19中可见,提供间隔件构件10746以填充闭合连接件10740与砧座安装接片10510的间隔臂10516之间的间隔。另选地,闭合连接件的尺寸和形状可被设计成填充该间隔。如在图19中进一步可见,保持器接片10311形成于细长通道10310中以限定用于在其中可滑动地接收驱动轭10720的轴向槽10313。旋转闭合驱动轴10710在第一旋转方向上旋转将使驱动轭10720朝远侧运动并且使闭合连接件10740在打开方向上牵拉砧座安装接片10510,这使砧座10500围绕枢转轴线PA枢转到打开位置。同样,旋转闭合驱动轴10710在第二旋转方向上旋转将使驱动轭10720朝近侧运动并且使闭合连接件10740在闭合方向上推动砧座安装接片10510,这使砧座10500围绕枢转轴线PA枢转到闭合位置。在各个方面,旋转驱动闭合系统10700可在旋转驱动击发系统10600的致动期间被致动,使得当击发构件被轴向驱动穿过钉仓时,闭合系统10700继续向砧座施加附加的闭合动作。
图22和图23示出了另选的闭合驱动布置,其中砧座10500'的砧座安装接片10510'大致居中支撑在端部执行器内。砧座安装部分10510'可以上述方式枢转地联接到细长通道10310'。在该布置中,旋转闭合驱动轴10710'为中空的并且在其中同心地支撑旋转击发轴10610'。旋转闭合驱动轴10710'和旋转击发驱动轴10610'居中设置在细长通道10310'内,如在图23中可见。旋转击发驱动轴10610'可旋转地延伸穿过旋转闭合驱动轴10710'并且包括远侧螺纹部分10612',该远侧螺纹部分被构造成能够例如以上述方式通过螺纹驱动击发构件10620。
图22和图23所示的示例采用被构造成能够向砧座10500'施加打开动作和闭合动作的旋转致动闭合连杆组件10716'。在一种布置中,闭合连杆组件10716'包括近侧驱动轭组件10720'和远侧驱动轭组件10750。近侧驱动轭组件10720'包括两个间隔轭臂10722',这两个间隔轭臂具有穿过其中的无螺纹孔10724'以允许闭合驱动轴10710'穿过其中。近侧驱动螺母10730'被接收在间隔轭臂10722'之间并且包括螺纹孔以用于通过螺纹接合旋转闭合驱动轴10710'上的近侧螺纹段10712'。近侧驱动轭组件10720'枢转地联接到近侧闭合连接件10740',该近侧闭合连接件枢转地销接到砧座安装部分10510'。远侧驱动轭组件10750包括两个间隔轭臂10752,这两个间隔轭臂具有穿过其中的无螺纹孔10754以允许闭合驱动轴10710'穿过其中。远侧驱动螺母10760被接收在间隔轭臂10752之间并且包括螺纹孔以用于通过螺纹接合旋转闭合驱动轴10710'上的远侧螺纹段10714'。近侧螺纹段10712'和远侧螺纹段10714'在相反方向上被螺纹接合。远侧驱动轭组件10750枢转地联接到U形远侧闭合连接件10770,该U形远侧闭合连接件枢转地销接到砧座安装部分10510'。U形远侧闭合连接件10770为闭合连杆组件10716'提供对称的承重布置。旋转闭合驱动轴10710'在第一旋转方向上旋转将使近侧驱动轭10720'和远侧驱动轭组件10750远离彼此轴向运动以在打开方向上牵拉砧座安装接片10510',从而使砧座10500'围绕枢转轴线PA枢转到打开位置。同样,旋转闭合驱动轴10710'在第二旋转方向上旋转将使近侧驱动轭10720'和远侧驱动轭组件10750朝彼此运动并且在闭合方向上推动砧座安装接片10510',从而使砧座10500'围绕枢转轴线PA枢转到闭合位置。此类布置可用于向砧座10500'施加大体更大的闭合力。应当理解,旋转击发驱动轴10610'能够相对于旋转闭合驱动轴10710'独立地旋转。在各个方面,旋转驱动闭合系统10700可在旋转驱动击发系统10600的致动期间被致动,使得当击发构件被轴向驱动穿过钉仓时,闭合系统10700继续向砧座施加附加的闭合动作。
图24至图27示出了采用闭合驱动布置的另一个外科端部执行器10800,其中砧座10802的砧座安装接片10804居中地支撑在端部执行器10800内,并且两个旋转闭合轴10830和10840用于向砧座10802施加闭合动作。在该布置中,砧座安装接片10804的远侧部分10806包括一对侧向延伸的枢转构件10808,该对枢转构件适于枢转地支撑在细长通道10310"的远侧安装部分的直立壁10354中的枢转支架10356中。参见图27。因此,枢转构件10808能够在其对应的枢转支架10356内竖直运动或“浮动”。在该布置中,旋转击发驱动轴10610(图26)被竖直地支撑在旋转闭合驱动轴10710(图24和图25)上方。在例示的示例中,旋转击发驱动轴10610包括击发驱动齿轮10611,该击发驱动齿轮被构造成能够驱动地接合远侧击发驱动轴10613上的从动齿轮(未示出),该远侧击发驱动轴以本文所述的各种方式可旋转地支撑在细长通道10310"中。参见图27。击发构件驱动螺母10630螺纹接合在远侧击发驱动轴10613上并且用于在旋转击发驱动轴10610以本文所述的方式旋转时驱动端部执行器10800内的击发构件10620。
如在图24和图25中可见,旋转闭合驱动轴10710包括居中设置在右远侧闭合轴10830和左远侧闭合轴10840之间的闭合驱动齿轮10715。右远侧闭合轴10830包括与闭合驱动齿轮10715啮合接合的右从动齿轮10832,并且左远侧闭合轴10840包括也与闭合驱动齿轮10715啮合接合的左从动齿轮10842。旋转闭合驱动轴10710的旋转将导致右远侧闭合轴10830在第一旋转方向上旋转以及左远侧闭合轴10840在第二旋转方向上旋转。
图24至图26所示的示例采用被构造成能够向砧座10802施加打开动作和闭合动作的旋转致动的右闭合连杆组件10850和旋转致动的左闭合连杆组件10860。在一种布置中,右闭合连杆组件10850包括近侧驱动螺母组件10852,该近侧驱动螺母组件螺纹接合到右远侧闭合轴10830上并且联接到附接到砧座安装接片10804的右闭合连接件10854。同样,左闭合连杆组件10860包括左驱动螺母组件10862,该左驱动螺母组件螺纹接合到左远侧闭合轴10840上并且联接到附接到砧座安装接片10804的左闭合连接件10864。在一种布置中,右远侧闭合轴10830和左远侧闭合轴10840的直径D可为约0.078"。参见图26。右驱动螺母组件10852与左驱动螺母组件10862之间的间隔“E”可为约0.093",并且通道10310"的宽度“W”可为约0.256"。然而,可采用端部执行器部件的其他尺寸和形状。旋转闭合驱动轴10710在第一旋转方向上旋转将使右驱动螺母组件10852和左驱动螺母组件10862以同步方式运动,从而以平衡均匀的方式打开砧座10802。旋转闭合驱动轴10710在第二旋转方向上旋转将使右驱动螺母组件10852和左驱动螺母组件10862以同步方式运动,从而在砧座10802枢转闭合时以平衡均匀的方式闭合砧座10802并减少砧座10802上的任何扭转力矩。
如在图24和图25中还可见,砧座安装接片10804包括穹顶形或球形远侧表面部分10809。闭合环10811(图27)可动地轴颈连接在球形远侧表面部分10809上。当砧座10802通过右闭合连杆组件10850和左闭合连杆组件10860枢转到闭合位置时,闭合环10811用于将砧座10802约束到细长通道10310"。图24示出了处于闭合位置的砧座10802。如在图24中可见,连接件10854和10864几乎垂直于(竖直于)端部执行器轴线EC。此类布置建立了用于将砧座10802保持在闭合位置的最大力矩臂MA。图25示出了处于打开位置的砧座10802。例如,砧座10802以与水平面成约20°的角度向上枢转,如图所示。当处于该位置时,连接件10854和10864几乎是水平的(相对于彼此),这导致施加比当砧座运动到闭合位置时建立的闭合力更小量的闭合力。在一种布置中,连接件10854和10864可具有例如约0.150"的长度L。在各个方面,旋转驱动闭合系统10700可在旋转驱动击发系统10600的致动期间被致动,使得当击发构件被轴向驱动穿过钉仓时,闭合系统10700继续向砧座施加附加的闭合动作。
图28至图31示出了采用闭合驱动布置的另一个外科端部执行器10800',其中砧座10802'的砧座安装接片10804'也居中地支撑在端部执行器10800'内,并且两个旋转闭合轴10830和10840用于向砧座10802'施加闭合动作。参见图29。在一种布置中,例如,砧座10802'可使用名称为“METHOD FOR FABRICATING SURGICAL STAPLER ANVILS”的美国专利申请序列号16/105,101中描述的各种制造技术来制造,该专利申请的全部公开内容据此以引用方式并入本文。在该布置中,砧座安装接片10804'的远侧部分10806'包括一对侧向延伸的枢转构件10808',该对枢转构件适于枢转地支撑在细长通道10310"的远侧安装部分10352"的直立壁10354"中的枢转支架10356"中。参见图30和图31。因此,枢转构件10808'能够在其对应的枢转支架10356"内竖直运动或“浮动”。在该布置中,旋转击发驱动轴10610(类似于图26所示)被竖直地支撑在细长轴中的旋转闭合驱动轴10710(图24和图25)上方。如上文所讨论,在例示的示例中,旋转击发驱动轴(未示出)包括击发驱动齿轮(未示出),该击发驱动齿轮被构造成能够驱动地接合远侧击发驱动轴10613'上的从动齿轮(未示出),该远侧击发驱动轴以本文所述的各种方式可旋转地支撑在细长通道10310"中。参见图28和图29。远侧击发驱动轴10613'被构造成能够在旋转击发驱动轴和远侧击发驱动轴10613'以本文所述的方式旋转时通过螺纹驱动端部执行器10800'内的击发构件10620'。
如上所述,旋转闭合驱动轴10710包括居中设置在右远侧闭合轴10830和左远侧闭合轴10840之间的闭合驱动齿轮10715。参见图29至图31。右远侧闭合轴10830包括与闭合驱动齿轮10715啮合接合的右从动齿轮,并且左远侧闭合轴10840包括也与闭合驱动齿轮10715啮合接合的左从动齿轮10842。旋转闭合驱动轴10710的旋转将导致右远侧闭合轴10830在第一旋转方向上旋转以及左远侧闭合轴10840在第二旋转方向上旋转。图30和图31的示例采用被构造成能够向砧座10802'施加打开动作和闭合动作的旋转致动的右闭合连杆组件10850和旋转致动的左闭合连杆组件10860。在一种布置中,右闭合连杆组件10850包括近侧驱动螺母组件10852,该近侧驱动螺母组件螺纹接合到右远侧闭合轴10830上并且联接到附接到砧座安装接片10804'右闭合连接件10854。同样,左闭合连杆组件10860包括左驱动螺母组件10862,该左驱动螺母组件螺纹接合到左远侧闭合轴10840上并且联接到附接到砧座安装接片10804'左闭合连接件10864。旋转闭合驱动轴10710在第一旋转方向上旋转将使右驱动螺母组件10852和左驱动螺母组件10862以同步方式运动,从而以平衡均匀的方式打开砧座10802'。旋转闭合驱动轴10710在第二旋转方向上旋转将使右驱动螺母组件10852和左驱动螺母组件10862以同步方式运动,从而在砧座10802'枢转闭合时以平衡均匀的方式闭合砧座10802'并减少砧座10802'上的任何扭转力矩。
如在图30至图32中可见,砧座安装接片10804'包括穹顶形或球形远侧表面部分10809'。闭合环10811'可动地轴颈连接在球形远侧表面部分10809'上。当砧座10802'通过右闭合连杆组件10850和左闭合连杆组件10860枢转到闭合位置时,闭合环10811'用于将砧座10802约束到细长通道10310"。在例示的示例中,枢转弹簧10813'安置在支架10356"中的每个支架中,该支架用于将枢转构件10808'在其相应支架10356"中向上偏压。在至少一种布置中,球形表面部分10809'的远侧部分包括浅凹口区域10815',该浅凹口区域为闭合环10811'提供附加间隙以使砧座10802'能够进一步枢转打开,例如,其中砧座10802'的下表面10803'与安置在通道10310"内的外科钉仓的平台表面成至少20°(角度A)。参见图30。例如,枢转构件10808'的中心到球形表面10809'之间的径向距离在图30和图31中被指定为“r”。从枢转构件10808'的中心线到凹口区域10815'的径向距离被指定为“r'”,其中r'>r。
图30示出了处于完全打开位置的砧座10802'。如在图30中可见,闭合环10811'与枢转构件10808'约轴向对准,该枢转构件用于将枢转构件10808'驱动到其相应支架10356"的底部中并压缩其中的枢转弹簧10813'。图31示出了处于闭合位置的砧座10802',其中闭合环10811'略微朝近侧从枢转构件10808'轴向偏移,这允许枢转弹簧10813'在其相应支架10356"内向上偏压枢转构件10808'。
这些实施方案中的闭合环基本上环绕对应的砧座部分和细长通道部分。为了有利于将砧座打开至所需的开口孔或开角度,允许闭合环朝近侧运动到远侧少量(例如,0.0"至0.1"),同时被弹簧偏压到远侧位置。该环不引起闭合,而是仅约束砧座和通道竖直运动分开,从而允许在两个部件之间发生枢转动作。此类布置有利于更厚砧座的使用,尤其是在砧座安装区域中的使用,这可改善砧座强度和可靠性。该布置还可使得钳口(砧座和通道)能够以改善砧座位于枢转位置近侧的力矩臂状态的方式枢转,并且有利于将端部执行器打开到更大的打开角度。在各个方面,旋转驱动闭合系统10700可在旋转驱动击发系统10600的致动期间被致动,使得当击发构件被轴向驱动穿过钉仓时,闭合系统10700继续向砧座施加附加的闭合动作。
图33至图35示出了另一个端部执行器10900,其采用另选的闭合驱动布置以用于相对于其细长通道10910打开和闭合砧座10920。砧座10920包括砧座安装接片10922,该砧座安装接片沿砧座10920的中心线朝近侧突起并且以本文所公开的各种方式枢转地联接到细长通道10910的近侧端部10912。在一种布置中,例如,砧座10920可使用名称为“METHODFOR FABRICATING SURGICAL STAPLER ANVILS”的美国专利申请序列号16/105,101中描述的各种制造技术来制造,该专利申请的全部公开内容据此以引用方式并入本文。在该布置中,旋转闭合驱动轴10710'为中空的并且在其中同心地支撑旋转击发驱动轴10610'。旋转闭合驱动轴10710'和旋转击发驱动轴10610'居中设置在细长通道10910内,如在图33中可见。旋转击发驱动轴10610'可旋转地延伸穿过旋转闭合驱动轴10710'并且包括远侧螺纹部分10612',该远侧螺纹部分被构造成能够例如以上述方式通过螺纹驱动击发构件10620。
参见图33,闭合梭动件10940被支撑用于在细长通道10910内轴向行进。闭合梭动件10940通过螺纹轴颈连接在螺纹闭合驱动轴10710'上,使得螺纹闭合驱动轴10710'在第一方向上旋转导致闭合梭动件10940朝远侧运动,并且螺纹闭合驱动轴10710'在第二旋转方向上旋转导致闭合梭动件10940在细长通道10910内朝近侧运动。如在图33中可见,右闭合连接件10950和左闭合连接件10960枢转地联接到砧座安装接片10922。右闭合连接件10950还包括接收在闭合梭动件10940中的对应的右致动凹口10942内的致动端部10952,并且左闭合连接件10960包括接收在闭合梭动件10940中的对应的左致动凹口10944内的致动端部10962。同样在例示的布置中,右驱动凹口10954设置在右闭合连接件10950的致动端部10952中,并且左驱动凹口10964设置在左闭合连接件10960的致动端部10962中。驱动凹口10954、10964被构造成能够分别驱动地接合致动凹口10942、10944。
图33和图35示出了处于最近侧回缩位置的闭合梭动件10940。当处于该位置时,右闭合连接件10950和左闭合连接件10960向上推动砧座安装接片10922并使砧座10920围绕枢转轴线PA枢转到闭合位置。当闭合梭动件10940已运动到其最远侧延伸位置时,右闭合连接件10950和左闭合连接件10960向下牵拉砧座接片10922并将砧座10920枢转到打开位置,如图34所示。图36示出了外科端部执行器10900的各种部件的一些示例性尺寸。在一种布置中,例如,总高度“H”可为约0.500"。砧座高度“AH”可为约0.120"。铆钉通路可具有例如约0.070"的直径“PD”,并且基部高度“BH”可为约0.310"。参见图37,中空闭合驱动轴10710'可具有约0.100"的内径“ID”和约0.129"的无螺纹外径“UTD”和约0.164"的螺纹外径“TD”:击发驱动轴10610'可具有例如约0.0668"的无螺纹直径“UTD'”和约0.0854"的螺纹外径“TD'”。也可采用其他直径、部件大小和尺寸。
图38和图39为采用另选的闭合连接件布置的端部执行器10900'的示意图。如在这些图中可见,远侧闭合连接件(或多个连接件)10970枢转地销接或以其他方式枢转地联接到砧座10920'和细长通道10910'。此外,近侧闭合连接件10972附接到砧座安装接片部分10922'并且经由对应的销10974可滑动地联接,该对应的销被接收在细长通道10910'中的对应轴向狭槽10911'中或在闭合梭动件或其他构件(未示出)中,该闭合梭动件或其他构件被构造成能够使近侧闭合连接件10972在对应于砧座10920'的打开位置的第一位置(图38)和对应于砧座10920'的闭合位置的第二位置(图39)之间运动。
图40和图41为采用另选的闭合连接件布置的端部执行器10900"的示意图。如在这些图中可见,砧座10920"的近侧端部部分10923"通过近侧安装连接件10980枢转地联接到细长通道10910"。近侧安装连接件10980(图中仅示出一个)枢转地附接到细长通道10910"以用于相对于其围绕下部枢转轴线LPA枢转行进。近侧安装连接件10980还枢转地联接到近侧端部部分10923"以相对于其围绕砧座枢转轴线APA枢转行进。端部执行器10900"还包括闭合连杆组件10982,该闭合连杆组件包括至少一个远侧连接件10984和一个近侧连接件10986。在其他布置中,闭合连杆组件10982包括一对远侧连接件10984(细长通道的每一侧上各有一个)和一对近侧连接件10986(细长通道的每一侧上各有一个)。远侧连接件10984附接到砧座10920"以用于围绕砧座枢转轴线APA枢转行进以及附接到对应的近侧连接件10986。近侧连接件的另一个端部枢转地附接到细长通道10910"。闭合连杆组件10982由一个或多个滑块销10988致动,该一个或多个滑块销被约束为在细长通道中或在闭合梭动件或其他构件(未示出)中轴向运动,该闭合梭动件或其他构件被构造成能够使销10988在对应于砧座10920"的打开位置的第一位置(图40)和对应于砧座10920"的闭合位置的第二位置(图41)之间运动。如图所示,闭合连杆组件10982可包括复合连接件组。此类布置可具有限制一个连杆相对于第二连杆的旋转的交互表面。这样,砧座10920"对于给定速率的角旋转的闭合可引起第一闭合速率和第二闭合速率,并且还建立用于闭合砧座的不同机械优点。例如,闭合致动器的闭合行程的初始部分可初始采用快速闭合速率,然后在闭合行程的其余部分期间可采用较慢的闭合速率,这可导致向砧座施加增大的闭合力。
图42和图43为采用另选的闭合连接件布置的端部执行器10900'"的示意图。如在这些图中可见,砧座10920'"的近侧端部部分10923'"通过近侧安装连接件10980枢转地联接到细长通道10910'"。近侧安装连接件10980(图中仅示出一个)枢转地附接到细长通道10910'"以用于相对于其围绕下部枢转轴线LPA枢转行进。近侧安装连接件10980还枢转地联接到近侧端部部分10923'"以相对于其围绕砧座枢转轴线APA枢转行进。端部执行器10900'"还包括闭合连杆组件10990,该闭合连杆组件包括至少一个远侧连接件10992和一个近侧连接件10994。在其他布置中,闭合连杆组件10990包括一对远侧连接件10992(细长通道的每一侧上各有一个)和一对近侧连接件10994(细长通道的每一侧上各有一个)。远侧连接件10992附接到砧座10920'"以用于围绕砧座枢转轴线APA枢转行进以及附接到对应的近侧连接件10994。近侧连接件的另一个端部枢转地附接到细长通道10910'"。闭合连杆组件10990由一个或多个滑块销10988致动,该一个或多个滑块销被约束为在细长通道中的对应狭槽中或在闭合梭动件或其他构件(未示出)中轴向运动,该闭合梭动件或其他构件被构造成能够使销10988在对应于砧座的打开位置的第一位置(图42)和对应于砧座的闭合位置的第二位置(图43)之间运动。滑块销10988联接到近侧连接件10994。在打开状态下,滑块销10988处于最远侧位置(图42)。为了闭合砧座10920'",滑块销10988在近侧方向上运动,这将近侧闭合连接件10994牵拉至图43所示的位置,其中远侧闭合连接件10992从中心弹出以将砧座10920'"保持在闭合状态。闭合期间的力矢量由处于压缩状态的近侧闭合连接件和远侧闭合连接件提供,从而抵抗在闭合期间由夹持在端部执行器中的组织产生的负载。
接下来转到图44至图52,示出了另一个外科端部执行器11000,该外科端部执行器包括枢转地支撑在细长通道11010上的砧座11100,该细长通道被构造成能够在其中可操作地支撑外科钉仓(未示出)。该布置还采用两个旋转致动轴-一个用于闭合(即,使砧座和细长通道在打开位置和闭合位置之间运动),一个用于在砧座和细长通道内击发(即,使击发构件轴向运动)。在例示的示例中,砧座11100包括细长砧座主体11110和砧座安装部分11140。在一种布置中,例如,砧座11100可使用名称为“METHOD FOR FABRICATING SURGICALSTAPLER ANVILS”的美国专利申请序列号16/105,101中描述的各种制造技术来制造,该专利申请的全部公开内容据此以引用方式并入本文。一对砧座耳轴11142从砧座安装部分11140侧向突起。每个砧座耳轴枢转地支撑在对应耳轴支架11016中,该对应耳轴支架形成于细长通道11010的近侧端部部分11012的对应直立壁11014中。参见图44。细长通道11010的近侧端部部分11012枢转地联接到本文所述类型的外科器械10010的细长轴组件10200,例如以便于端部执行器11000进行关节运动。在其他布置中,细长通道11010可能不能够进行关节运动。砧座耳轴11142可通过砧座保持器(未示出)保持在其相应耳轴支架11016内,该砧座保持器在构造和操作上可类似于上述通道顶盖或砧座保持器1290。
在例示的示例中,外科端部执行器11000包括各自独立控制并且能够轴向运动的砧座闭合构件11200和击发构件11300。图47示出了可采用的闭合构件11200的一种形式。如在图47中可见,闭合构件11200包括竖直延伸的闭合主体11202,该闭合主体具有从其侧向突起的两个底部通道接片10204。闭合主体11202的一部分被构造成能够延伸穿过细长通道11010的底部表面11018中的狭槽11019,并且通道接片11204侧向向外延伸以可滑动地接合通道11010的底部。类似地,一对砧座接合接片11206从闭合主体11202的顶部侧向突起以可滑动地接合砧座11100。闭合主体11202包括螺纹通孔11208,用于通过螺纹接合可旋转闭合驱动轴10710的螺纹部分10712,从而以本文所述的各种方式轴向驱动闭合构件11200。
如上所述,外科端部执行器11000还包括能够轴向运动的击发构件11300。图48示出了可采用的击发构件11300的一种形式。如在图48中可见,击发构件11300包括竖直延伸的击发构件主体11302,该击发构件主体具有组织切割表面11303以及从其侧向突起的两个底部通道接片11304。击发构件主体11302的一部分被构造成能够延伸穿过细长通道11010的底部表面11018中的狭槽11019,并且通道接片11304侧向向外延伸以可滑动地接合通道11010的底部。参见图45。类似地,一对砧座接合接片11306从击发构件主体11302的顶部侧向突起以可滑动地接合砧座11100。击发构件主体11302包括螺纹通孔11308,以用于通过螺纹接合可旋转击发驱动轴(诸如上述击发驱动轴10610)的螺纹部分。远侧击发轴10610穿过闭合主体11202中的无螺纹间隙孔11210。参见图47。击发驱动轴10610沿细长通道11010轴向向下延伸,并且通过轴承(未示出)或其他布置可旋转地支撑在其远侧端部部分中。类似地,闭合驱动轴10710可沿细长通道11010轴向向下延伸,并且通过轴承(未示出)或其他布置可旋转地支撑在其远侧端部部分中。因此,击发构件主体11302类似地具有穿过其中的无螺纹间隙孔11310以容纳闭合驱动轴10710。应当理解,在此类布置中,闭合驱动轴10710和击发驱动轴10610可以竖直堆叠布置支撑,使得它们可独立地旋转。
图46示出了砧座11100的一种形式,其中其部分以横截面示出。砧座安装部分11140包括中心交叉支架11144,该中心交叉支架用于限定开口11146,该开口用于在闭合构件11200处于其最近侧位置时在其中容纳闭合构件11200,该最近侧位置对应于砧座11100的打开位置。如在图46中可见,砧座主体11110限定细长狭槽11112,用于容纳穿过其中的击发构件主体11302和闭合主体11202。击发构件11300位于闭合构件11200的远侧。击发构件11302上的砧座接合接片11306被构造成能够可滑动地接合形成于狭槽11112的每一侧上的对应第一凸缘或下凸缘11114。如在图49和图50中可见,下凸缘11114在其近侧端部处略微向下渐缩,以在砧座枢转到其打开位置时容纳击发构件11300上的砧座接合接片11306。闭合构件11200上的砧座接合接片11206被构造成能够可滑动地接合形成于狭槽11112的每一侧上的对应第二凸缘或上凸缘11116。参见图46。为了打开砧座11100,旋转闭合驱动轴以通过螺纹将闭合构件11200朝近侧驱动到其最近侧位置(图49)。当闭合构件11200处于其最近侧位置时,其上的砧座接合接片11206向砧座11100施加枢转打开动作以将砧座枢转打开。击发构件11300处于其起始位置,使得击发构件11300的砧座接合接片11306不向砧座11100施加闭合动作。
为了闭合砧座11100,闭合驱动轴10710在相反方向上旋转,以将闭合构件11200朝远侧推进到闭合位置。击发驱动轴10610也可同时旋转以将击发构件11300朝远侧推进到起始位置。当闭合构件11200和击发构件11300处于那些位置时,砧座11100闭合并且击发构件11300准备好被击发。因此,假设未用尽的外科钉仓已首先被可操作地支撑在细长通道11010中并且端部执行器11000被操纵以将目标组织捕获在钉仓和砧座之间,则使用者可以上述方式将砧座11100闭合到组织上,以使端部执行器准备好被击发。在该闭合过程期间,击发驱动轴10610旋转以将击发构件11300朝远侧驱动到所夹持的组织中以切割组织并使储存在钉仓中的钉在切口的两侧上形成到所切割的组织中。在该过程期间,闭合构件11200也可朝远侧驱动以向砧座11100和细长通道11010施加附加的闭合动作。根据例如击发构件11300所经历的阻力的量,闭合构件11200可与击发构件11300一起推进、停止并随后再次行进。闭合构件11200可以与击发构件的远侧推进速率不同的速率朝远侧推进。可控制闭合构件11200和击发构件11300之间的距离DC以平衡在击发过程期间经历的负载。参见图52。例如,如果使用者想要减小击发构件11300所经历的竖直负载的量,则闭合构件11200可在推进期间运动得更靠近击发构件11300。可通过增加击发构件11300与闭合构件11200之间的距离来增加击发构件11300所经历的竖直负载。
返回图47和图48,闭合构件11200上的砧座接合接片11206的厚度t1大于击发构件11300上的砧座接合接片11306的厚度t2。在一种布置中,闭合构件11200上的砧座接合接片11206的长度L1略小于击发构件11300上的砧座接合接片11306的长度L2。同样,闭合构件11200上的通道接片11204的厚度t3大于击发构件11300上的通道接片11304的厚度t4。在一种布置中,闭合构件11200上的通道接片11204的长度L1短于击发构件11300上的通道接片11304的长度L3。在这两种情况下,螺纹孔11208、11308的直径d1可大于无螺纹通孔11210、11310的直径d2。此外,砧座接合接片11206、11306与其对应的砧座凸缘之间的相对冲角以及通道接片11204、11304与其对应的通道凸缘之间的相对冲角可改变,可相同或不同。在一种布置中,击发构件11300上的砧座接合接片11306相对于其对应的砧座凸缘以略高于闭合构件11200上的砧座接合接片11206的攻角的攻角布置。在一种布置中,通道接片11204和11304骑在形成于细长通道11010的底部中的相同凸缘上。参见图45。闭合构件11200和击发构件11300具有单独的作用路径,这可允许闭合构件被设计成容纳来自砧座枢轴的更大力矩臂以实现更好的击发效率。
当使用前述构型时可经历的一个优点是闭合构件11200可运动远离击发构件11300以在闭合期间获得显著量的机械优点。闭合构件11200不需要行进击发行程的完整长度。例如,如果闭合构件11200将沿端部执行器向下推进约一半,则砧座11100的相对刚度将减少击发构件11300所遇到的负载的量。采用用于检测击发系统部件和闭合系统部件所经历的负载的量的传感器(例如,应变仪等)的控制系统以及算法可用于平衡两个系统所遇到的负载。例如,可基于击发构件部件11300的几何形状和组成在控制器中设定该击发构件所经历的竖直负载的最大阈值。当负载接近该阈值时,算法可自动推进闭合构件11200,使得其吸收更多的负载并减少击发构件11300所经历的负载量。在各个方面,当击发构件11300朝远侧被驱动穿过外科钉仓时,通过砧座接合接片11306与砧座11100的接合以及通道接合接片11304与通道11010的接合,击发构件11300可用于在钉仓上的平台表面与砧座11100上的钉成形下表面之间保持所需量的组织间隙。其他闭合控制方法也可与打开和闭合外科端部执行器11000结合使用,诸如名称为“METHOD FOR OPERATING A POWERED ARTICULATABLESURGICAL INSTRUMENT”的美国专利申请序列号16/105,081中所公开的那些,该专利申请的全部公开内容据此以引用方式并入本文。
图53示出了可用于切割和缝合组织的外科器械12000。该器械包括外壳12010,该外壳包括被构造成能够被临床医生抓持、操纵和致动的柄部12012。如在图53中可见,例如器械12000包括轴组件12100,该轴组件具有可操作地联接到其的外科端部执行器12200,该外科端部执行器被构造成能够执行一种或多种外科任务或外科手术。轴组件12100包括可互换轴组件,该可互换轴组件旨在能够以本文所公开的各种方式可移除地联接到柄部组件12012。然而,在其他布置中,轴组件12100还可包括不旨在从柄部12012移除的专用轴组件。在其他布置中,轴组件12100可以可操作地联接到机器人系统或与机器人系统可操作地交接,该机器人系统能够产生以本文所公开的各种方式操作外科端部执行器所需的旋转操作动作。下文将仅更详细地讨论理解轴组件12100的功能和操作所必需的那些特定部件。
在例示的示例中,细长轴组件12100包括关节运动接头12120,该关节运动接头有助于外科端部执行器12200围绕关节运动轴线AA进行关节运动,该关节运动轴线AA横向于纵向轴轴线LA。然而,其他轴组件可能无法进行关节运动。在例示的示例中,轴组件12100包括从喷嘴组件12014朝远侧延伸的近侧外轴管或构件12110,如将在下文进一步详细地讨论,外科端部执行器12200可操作地附接到端部顶盖附接特征部12400。在一种布置中,端部顶盖附接特征部12400包括管状形状主体12402,该管状形状主体在尺寸上类似于近侧外轴管12110并且联接到近侧外轴管12110的远侧端部12112以形成关节运动接头12120。轴组件12100还可包括枢转地联接到端部顶盖12400的内部脊构件(未示出)。内部脊构件的近侧端部可以例如本文所公开的各种方式可旋转地联接到喷嘴组件12014内的底座(未示出)。
在例示的示例中,外科端部执行器12200能够通过关节运动系统12030围绕关节运动轴线AA选择性地进行关节运动。在一种形式中,关节运动系统12030包括例如被可操作地支撑在喷嘴组件12014中的关节运动马达12032。参见图54。在其他示例中,关节运动马达可以被可操作地支撑在外壳或柄部或机器人系统的其他部分中。参见图54,关节运动马达12032联接到与驱动齿轮齿条12036啮合接合的关节运动驱动齿轮12034,该驱动齿轮齿条附接到近侧关节运动驱动器12038或以其他方式形成于该近侧关节运动驱动器中。近侧关节运动驱动器12038的远侧端部枢转地联接到远侧关节运动连接件(未示出),该远侧关节运动连接件跨越关节运动接头并且联接到端部顶盖12400。关节运动马达12032的操作将使近侧关节运动驱动器12038轴向运动。近侧关节运动驱动器12038的轴向运动将向附接到其上的端部顶盖12400和细长通道12210施加关节运动动作,从而使外科端部执行器12200相对于轴组件12100围绕关节运动轴线AA进行关节运动。可以本文所公开的各种方式使用其他关节运动系统和布置,或者在其他实施方案中,外科端部执行器可能不能够进行关节运动。
外科端部执行器12200还包括砧座12300,该砧座能够通过闭合系统12500相对于细长通道12210在打开构型和闭合构型之间选择性地枢转。在一种布置中,例如,砧座12300可使用名称为“METHOD FOR FABRICATING SURGICAL STAPLER ANVILS”的美国专利申请序列号16/105,101中描述的各种制造技术来制造,该专利申请的全部公开内容据此以引用方式并入本文。在至少一种布置中,外科端部执行器12200还包括击发构件12620,该击发构件能够在外科端部执行器12200内在起始位置和结束位置之间轴向运动。参见图55。如将在下文进一步详细地讨论,击发构件12620可被构造成能够切断夹持在砧座12300与被可操作地支撑在细长通道12210中的外科钉仓12700之间的组织。在一种布置中,钉仓12700包括被可操作地支撑在对应驱动器上的多排外科钉或紧固件(未示出),这些对应驱动器(未示出)被可动地支撑在仓中。当朝远侧驱动击发构件12620时,击发构件12620与支撑在钉仓12700中的滑动件或凸轮作用组件(未示出)协作,该滑动件或凸轮作用组件用于使驱动器在朝向闭合砧座12300的方向上进行凸轮运动,这使得支撑在其上的钉或紧固件刺穿所夹持的组织而与闭合砧座的下侧形成接触。一旦击发构件12620已在端部执行器12200内从其近侧起始位置朝远侧推进到其结束位置,则其可回缩回到其起始位置以允许砧座12300打开,从而有利于从端部执行器12200移除所切割/缝合的组织。在其他布置中,击发构件12620可留在结束位置处,其中允许其与砧座脱离结合以有利于打开砧座。
在至少一种布置中,外科器械12000还采用击发系统12600,该击发系统被构造成能够向击发构件12620施加旋转驱动动作以在起始位置和结束位置之间驱动击发构件。在图54所示的示例中,击发系统12600包括例如被可操作地支撑在喷嘴组件12014中的击发马达12602。在其他示例中,击发马达12602可以被可操作地支撑在外壳或柄部或机器人系统的其他部分中。击发马达12602联接到击发驱动齿轮12604,该击发驱动齿轮与从动齿轮12606啮合接合,该从动齿轮附接到旋转击发驱动轴12610或以其他方式形成于该旋转击发驱动轴中。击发驱动轴12610可以是柔性的,以允许外科端部执行器12200以上述方式进行关节运动。如在图55中可见,击发构件12620包括主体部分12622,该主体部分包括两个向下延伸的中空安装部分12624,这两个中空安装部分为无螺纹的并且彼此间隔开以在它们之间接收螺纹驱动螺母12630。螺纹驱动螺母12630螺纹接合到旋转击发驱动轴12610的螺纹部分12612上。旋转击发驱动轴12610的远侧端部12614可被构造成能够可旋转地支撑在容纳在细长通道内的轴承(未示出)中,以在其中可旋转地支撑旋转击发驱动轴12610。驱动螺母12630包括竖直接片部分12632,该竖直接片部分定尺寸成延伸穿过细长通道12210的底部表面12211中的轴向狭槽12216。参见图62。两个侧向延伸的保持法兰12634形成于竖直接片部分12632上以可滑动地接合细长通道12210的底部表面12211。此外,两个侧向延伸的砧座接合接片12628形成于击发构件12620的主体部分12622的顶部上,并且被构造成能够在击发构件12620在端部执行器内轴向运动时接合砧座12300。螺纹驱动螺母12630螺纹接合到旋转击发驱动轴12610的螺纹部分12612上。旋转击发驱动轴12610的远侧端部可被构造成能够可旋转地支撑在容纳在细长通道12210内的轴承(未示出)中,以在其中可旋转地支撑旋转击发驱动轴12610。在各个方面,当击发构件12620朝远侧被驱动穿过外科钉仓12700时,通过砧座接合接片12628与砧座12300的接合以及侧向延伸的保持法兰12634与通道12210的接合,击发构件12620可用于在钉仓12700上的平台表面12702与砧座12300上的钉成形下表面12307之间保持所需量的组织间隙。参见图53。
在例示的示例中,除了旋转驱动击发系统12600之外,外科器械12000还包括旋转驱动闭合系统12500,该旋转驱动闭合系统被构造成能够向砧座12300施加旋转闭合动作。如在图54中可见,例如,在一种布置中,旋转驱动闭合系统12500包括例如被可操作地支撑在喷嘴组件12014中的闭合马达12502。在其他示例中,闭合马达12502可以被可操作地支撑在外壳或柄部或机器人系统的其他部分中。闭合马达12502联接到闭合驱动齿轮12504,该击发驱动齿轮与从动齿轮12506啮合接合,该从动齿轮附接到旋转闭合驱动轴12510或以其他方式形成于该旋转击发驱动轴中。闭合驱动轴12510可以是柔性的,以允许外科端部执行器12200以上述方式进行关节运动。
如在图56中可见,砧座12300包括朝近侧突起的砧座安装接片12310,该砧座安装接片被构造成能够枢转地联接到端部顶盖12400的对应枢轴凸耳部分12404。例如,枢轴凸耳部分12404形成于端部顶盖中心线ECL的第一侧或右侧上,并且砧座安装接片12310的对应砧座安装部分12312形成于砧座中心线ACL的第二侧或左侧上,当两个部件联接在一起时,该第二侧或左侧对应于端部顶盖中心线ECL(与之对准)。当砧座12300可动地联接到端部顶盖12400时,砧座中心线ACL和端部顶盖中心线ECL沿着轴向延伸穿过端部执行器12200的中心的端部执行器轴线或端部执行器中心平面ECP对准。换句话讲,端部执行器中心平面ECP对分端部执行器12200。参见图60和图61。在一个方面,枢轴凸耳部分12404包括竖直延伸的枢轴凸耳附接面12405,该竖直延伸的枢轴凸耳附接面适于可滑动地面对形成于砧座安装接片12310的中心部分12316上的竖直延伸的砧座附接面12317。仍然参见图56,砧座安装接片12310的近侧端部12314在侧向上宽于中心部分12316。当砧座12300附接到端部顶盖12400时,砧座安装接片12310的近侧端部部分12314位于枢轴凸耳部分12404和枢轴凸耳附接面12405的近侧,并且竖直延伸的砧座附接面12317沿居中设置的端部执行器中心平面ECP可动地面对彼此。参见图60。在例示的布置中,砧座12300的砧座主体部分12302的上表面12303和砧座安装接片12310的砧座安装部分12312被圆化以匹配或至少大致匹配端部顶盖12400的半径,从而有利于例如容易地将外科端部执行器和细长轴插入穿过套管针。
在一个方面,砧座12300通过铆钉12370枢转地联接到端部顶盖12400,该铆钉延伸穿过砧座安装接片12310的砧座安装部分12312中的通路12360以及端部顶盖12400的枢轴凸耳部分12404中的对应通路12406。在至少一种布置中,铆钉12370包括具有柄部12372的实芯铆钉,该柄部具有例如0.05"至0.1"的直径,其中轨道形成头部12374在一个端部上并且机加工端部12376形成于另一个端部上。参见图57。铆钉12370可被安装成使得其可保持最终成形高度,该最终成形高度将确保砧座安装部分12312与枢轴凸耳部分12404之间的紧密接触。轨道形成的铆钉头部12374将使铆钉柄部12372在砧座12300或端部顶盖12400的该侧溶胀,从而防止铆钉12370相对于该部件旋转,而机加工端部12376将不具有允许相邻部分相对于铆钉12370和另一个部分(砧座安装部分12312或枢轴凸耳部分12404)旋转的溶胀柄部。在图57所示的示例中,铆钉12370与砧座安装部分12312相邻的端部是轨道形成的,使得铆钉12370的一部分不相对于砧座安装部分12312旋转,并且铆钉12370延伸穿过端部顶盖12400的部分自由旋转,从而允许砧座12300相对于枢轴凸耳部分12404自由枢转。如在图57中可见,铆钉柄部12372具有预定的最终形状长度RL,该预定的最终形状长度定尺寸成有利于此类旋转行进。另外,如在图56中可见,例如,在一种布置中,端部顶盖12400可具有约0.675"的长度EL。砧座主体12302还可形成有向下延伸的组织止动构件12305,该向下延伸的组织止动构件被构造成能够防止所夹持的组织朝近侧延伸超过安置在细长通道12210中的钉仓12700中的最近侧钉或紧固件。在例示的示例中,组织止动件12305可具有约0.400"的止动件长度SL,并且从每个组织止动件12305的远侧端部到通路12360的中心线的距离PSD为约0.500"。该距离可对应于从最近侧钉或紧固件到枢转轴线PA的距离,砧座12300相对于端部顶盖12400围绕该枢转轴线枢转。
如在图58中可见,一对通道附接接片12214从细长通道12210的近侧端部12212突起。通道附接接片12214被构造成能够安置在端部顶盖12400中的对应凹槽12408中。参见图60。接片12214可与端部顶盖12400焊接、胶合、销接等。
现在转到图55和图59至图61,旋转驱动闭合系统12500还包括能够轴向运动的闭合梭动件12520,该闭合梭动件与闭合驱动轴12510的螺纹部分12512螺纹接合。在例示的布置中,闭合梭动件12520包括梭动件基部部分12522,该梭动件基部部分延伸穿过形成于端部顶盖12400的底部中的近侧顶盖狭槽12410。侧法兰12524从梭动件基部部分12522的每一侧侧向延伸,以可滑动地接合端部顶盖12400的底部。参见图55。如在图55中进一步可见,闭合驱动轴12510为中空的以允许击发驱动轴12610同心地延伸穿过其中。因此,闭合驱动轴12510在第一旋转方向上旋转将使闭合梭动件12520朝远侧运动,并且闭合驱动轴12510在相反旋转方向上旋转将使闭合梭动件12520沿近侧方向运动。
在例示的示例中,闭合梭动件12520的轴向运动通过枢转闭合连杆组件12530传递到砧座12300。在一种布置中,闭合连杆组件12530包括各自枢转地附接到砧座安装接片12310的近侧端部部分12314并从其悬吊下来的第一枢转臂12540和第二枢转臂12550。如在图61中可见,例如,第一枢转臂12540和第二枢转臂12550可通过枢轴销12560枢转地联接到砧座安装接片12310的近侧端部部分12314,该枢轴销限定枢转臂12540和12550可围绕其枢转的共同近侧枢转轴线PPA。第一枢转臂12540包括第一自由端部12542,该第一自由端部宽于第一枢转臂12540的其余部分并且被构造成能够可动地并且可驱动地接合在闭合梭动件基部部分12522中的第一驱动凹槽12526中。参见图61。第一枢转臂12540在第一点FP处联接到砧座安装接片12310,该第一点FP位于距端部执行器中心平面ECP第一枢转臂距离FPD处。同样,第二枢转臂12550包括第二自由端部12552,该第二自由端部宽于第二枢转臂12550的其余部分并且被构造成能够可动地并且可驱动地接合在闭合梭动件基部部分12522中的第二驱动凹槽12528中。第二枢转臂12550在第二点SP处联接到砧座安装接片12310,该第二点SP位于距端部执行器中心平面ECP第二枢转臂距离SPD处。在例示的布置中,闭合系统非对称地联接到砧座12300。例如,如在图61中可见,SPD>FPD。当闭合梭动件12520在远侧方向DD上被驱动时,使得枢转臂12540和12550由于其与闭合梭动件12520的接合而在第一方向(图59中的顺时针CW方向)上枢转,这使得枢转打开动作被施加到砧座安装接片12310,以使砧座12300相对于端部顶盖12400围绕枢转轴线PA枢转到打开位置。当闭合梭动件12520在近侧方向PD上轴向运动时,枢转臂12540、12550在第二方向(图59中的逆时针CCW方向)上枢转,这使得闭合动作被施加到砧座安装接片12310,以使砧座12300相对于端部顶盖12400围绕枢转轴线PA枢转到闭合位置(图59)。枢转臂12540、12550的较大自由端部12542、12552分别比枢转臂的其余部分更稳固,以通过枢转臂更好地分布闭合力。
图63示出了可用于切割和缝合组织的外科器械13000。该器械包括外壳13010,该外壳包括被构造成能够被临床医生抓持、操纵和致动的柄部13012。如在图63中可见,例如器械13000包括轴组件13100,该轴组件具有可操作地联接到其的外科端部执行器13200,该外科端部执行器被构造成能够切割和缝合组织。如将在下文进一步详细地讨论,例如,外科端部执行器13200包括细长通道13210和砧座13300,该细长通道被构造成能够在其中可操作地支撑可替换外科钉仓13700,该砧座相对于该细长通道被可动地支撑以用于在打开位置和闭合位置之间运动。轴组件13100包括可互换轴组件,该可互换轴组件旨在能够以本文所公开的各种方式可移除地联接到柄部组件13012。然而,在其他布置中,轴组件13100还可包括不旨在从柄部13012移除的专用轴组件。在其他布置中,轴组件13100可以可操作地联接到机器人系统或与机器人系统可操作地交接,该机器人系统能够产生以本文所公开的各种方式操作外科端部执行器所需的旋转操作动作。下文将仅更详细地讨论理解轴组件13100的功能和操作所必需的那些特定部件。
在例示的示例中,轴组件13100包括关节运动接头13120,该关节运动接头有助于外科端部执行器13200围绕关节运动轴线AA进行关节运动,该关节运动轴线AA横向于纵向轴轴线LA。然而,其他轴组件可能无法进行关节运动。根据一个方面,轴组件13100包括从喷嘴组件13014朝远侧延伸的近侧外轴管或构件13110,如将在下文进一步详细地讨论,外科端部执行器13200可操作地附接到端部顶盖附接特征部13400。在一种布置中,端部顶盖附接特征部13400包括管状形状主体13402,该管状形状主体在尺寸上类似于近侧外轴管13110并且联接到近侧外轴管13110的远侧端部13112以形成关节运动接头13120。端部顶盖13400还可包括细长通道13210的近侧部分。轴组件13100还可包括枢转地联接到端部顶盖13400的内部脊构件(未示出)。内部脊构件的近侧端部可以例如本文所公开的各种方式可旋转地联接到喷嘴组件13014内的底座(未示出)。
在例示的示例中,外科端部执行器13200能够通过关节运动系统13030围绕关节运动轴线AA选择性地进行关节运动。在一种形式中,关节运动系统13030包括例如被可操作地支撑在喷嘴组件13014中的关节运动马达13032。参见图64。在其他示例中,关节运动马达可以被可操作地支撑在外壳或柄部或机器人系统的其他部分中。参见图64,关节运动马达13032联接到与驱动齿轮齿条13036啮合接合的关节运动驱动齿轮13034,该驱动齿轮齿条附接到近侧关节运动驱动器13038或以其他方式形成于该近侧关节运动驱动器中。近侧关节运动驱动器13038的远侧端部枢转地联接到远侧关节运动连接件(未示出),该远侧关节运动连接件跨越关节运动接头并且联接到端部顶盖13400。关节运动马达13032的操作将使近侧关节运动驱动器13038轴向运动。近侧关节运动驱动器13038的轴向运动将向附接到其上的端部顶盖13400和细长通道13210施加关节运动动作,从而使外科端部执行器13200相对于轴组件13100围绕关节运动轴线AA进行关节运动。可以本文所公开的各种方式使用其他关节运动系统和布置。在其他实施方案中,外科端部执行器可能不能够进行关节运动。
如上所述,外科端部执行器13200包括砧座13300,该砧座能够通过旋转驱动闭合系统13500相对于细长通道13210在打开构型和闭合构型之间选择性地运动。如在图64中可见,例如,在一种布置中,旋转驱动闭合系统13500包括例如被可操作地支撑在喷嘴组件13014中的闭合马达13502。在其他示例中,闭合马达13502可以被可操作地支撑在外壳或柄部或机器人系统的其他部分中。闭合马达13502联接到闭合驱动齿轮13504,该击发驱动齿轮与从动齿轮13506啮合接合,该从动齿轮附接到旋转闭合驱动轴13510或以其他方式形成于该旋转击发驱动轴中。闭合驱动轴13510可以是柔性的,以允许外科端部执行器13200以上述方式进行关节运动。
如在图65中可见,砧座13300包括朝近侧突起的砧座安装接片13310,该砧座安装接片被构造成能够通过例如铆钉13401或本文所公开的其他枢转布置枢转地联接到端部顶盖13400的对应部分。在例示的布置中,旋转驱动闭合系统13500还包括能够轴向运动的闭合梭动件13520,该闭合梭动件与螺纹远侧闭合轴段13512螺纹接合,该螺纹远侧闭合轴段被构造成能够驱动地联接闭合驱动轴13510。在例示的布置中,闭合梭动件13520包括梭动件基部部分13522,该梭动件基部部分延伸穿过形成于端部顶盖13400的底部中的近侧顶盖狭槽(未示出)。侧法兰(未示出)从梭动件基部部分13522的每一侧侧向延伸,从而以本文所公开的各种方式可滑动地接合端部顶盖13400的底部。在一种布置中,例如,砧座13300可使用名称为“METHOD FOR FABRICATING SURGICAL STAPLER ANVILS”的美国专利申请序列号16/105,101中描述的各种制造技术来制造,该专利申请的全部公开内容据此以引用方式并入本文。
在例示的示例中,闭合梭动件13520的轴向运动通过枢转闭合连接件组件13530传递到砧座13300。在一种布置中,闭合连接件组件13530包括各自枢转地附接到砧座安装接片13310的近侧端部部分13314并从其悬吊下来的一对枢转臂13540(图65中仅可见一个)。每个枢转臂13540包括自由端部13542,该自由端部包括凹口13544,该凹口被构造成能够驱动地接合闭合梭动件基部部分13522中的相应驱动凹槽13526。当闭合梭动件13520在远侧方向DD上被驱动时,枢转臂13540由于其与闭合梭动件13520的接合而在第一方向上枢转以向砧座安装接片13310施加枢转打开动作。这种打开动作导致砧座13300枢转到打开位置。当闭合梭动件13520在近侧方向PD上轴向运动时,枢转臂13540在第二方向上枢转,这使得枢转闭合动作被施加到砧座安装接片13310并且砧座13300被枢转到闭合位置。
同样如上所述,外科端部执行器13200被构造成能够在其中可操作地支撑可替换外科钉仓13700。钉仓13700包括机载击发构件13820,该机载击发构件被构造成能够在钉仓13700内的起始位置与结束位置之间被可旋转地驱动。击发构件13820包括竖直延伸的击发构件主体13822,该击发构件主体具有形成于其上或附接到其上的组织切割表面13824。一对通道接合接片13826从击发构件主体13822的底部侧向延伸,并且一对砧座接合接片13828从击发构件主体13822的顶部部分延伸,使得当从其端部观察时,击发构件13820类似于I形梁构型。如在图66中可见,在例示的示例中,外科钉仓13700包括细长仓体13702,该细长仓体包括平台表面13707。仓体13702还包括居中设置的细长仓狭槽13704,该细长仓狭槽被构造成能够容纳击发构件13820在其中的轴向行进。同样在例示的示例中,三排外科钉凹坑13706形成于细长狭槽13704的每一侧上并且穿过平台表面13707打开。每个钉凹坑13706可具有与其相关联的钉驱动器(未示出),该钉驱动器在其上支撑外科钉或紧固件(未示出)。
如在图65中可见,仓体13702可操作地支撑机载旋转击发驱动轴13710。击发驱动轴13710包括近侧螺纹段13712、无螺纹段13714以及从无螺纹段13714延伸到无螺纹远侧端部13718的远侧螺纹段13716。击发驱动轴13710的无螺纹远侧端部13718可旋转地支撑在远侧轴承13720中,该远侧轴承支撑在仓体13702的远侧端部13703中。在例示的示例中,当处于最近侧“加载位置”时,击发构件主体13822被螺纹接合到近侧螺纹段13712上。如在图66中可见,安全停放部13732形成于仓体13702的近侧端部13730上,使得当击发构件13820处于加载位置时,组织切割表面13824由此受到保护(未暴露)。当击发构件13820处于加载位置时,击发构件主体13822的底部被构造成能够在仓13700安装到细长通道13210中期间延伸穿过细长通道13210的底部13212中的加载开口13214。如在图67中可见,通道狭槽13216设置在细长通道13210的底部13212中并且从加载开口13214朝远侧延伸。当钉仓13700可操作地安置在细长通道13210中时,击发构件13820的底部部分突起穿过加载开口13214,使得当击发构件13820朝远侧推进时,击发构件主体13822与通道狭槽13216对准,并且通道接合接片13826被定位成能够在通道狭槽13216的每一侧上滑动地接合细长通道13210的底部13212。
在一个示例中,至少一个C形夹具13890可轴颈连接在仓体13702内,使得夹具13890的中心部分13892延伸穿过仓体13702中的细长仓狭槽13704,使得夹具13890的上腿部13894骑在与仓狭槽13704相邻的仓体13702中的内表面或凸缘13708上。夹具13890的下腿部13896骑在通道底部13212的底部表面13213上,如图68所示。当初始安装仓13700时,C形夹具13890可定位在细长通道狭槽13216的近侧,使得仓13700可正确地安置在其中。当击发构件13820朝远侧推进时,C形夹具13890沿对准的仓狭槽13704和通道狭槽13216朝远侧向下推进,以在击发操作期间提供仓13700的附加稳定性。
如在图67中还可见,在至少一种布置中,至少一个仓定位器构件13722形成于仓体13702上或以其他方式附接到该仓体,并且其位置和尺寸被设计成安置在形成于细长通道13210中的对应凹口13218或其他配合特征部中,以确保仓13700在安装期间正确地安置在细长通道13210中。在一个示例中,定位器构件13722形成于仓体13702的每个侧向侧上。同样在例示的示例中,驱动轴支撑支架13222形成于通道13210的远侧端部13220上,并且被构造成能够可旋转地支撑击发驱动轴13710的无螺纹远侧端部13718(位于支撑轴承13720近侧)。参见图65。
返回图64,外科器械13000还采用旋转驱动击发系统13800,该旋转驱动击发系统被构造成能够向击发构件13820施加旋转驱动动作以在钉仓13700内的起始位置和结束位置之间驱动击发构件13820。在图64所示的示例中,旋转驱动击发系统13800包括被可操作地支撑在喷嘴组件13014中的击发马达13802。在其他示例中,击发马达13802可以被可操作地支撑在外壳或柄部或机器人系统的其他部分中。击发马达13802联接到击发驱动齿轮13804,该击发驱动齿轮与从动齿轮13806啮合接合,该从动齿轮附接到旋转击发驱动轴13810或以其他方式形成于该旋转击发驱动轴中。击发驱动轴13810可以是柔性的,以允许外科端部执行器13200以上述方式进行关节运动。如在图65和图67中可见,击发驱动轴13810延伸穿过中空远侧闭合轴段13512,该中空远侧闭合轴段被构造成能够驱动地联接到闭合驱动轴13510并且具有附接到其上的驱动联接器13812。在一种布置中,驱动联接器13812包括凹形驱动承窝13814,该凹形驱动承窝被构造成能够可驱动地接收击发驱动轴13710上的对应凸形联接器13724。当凸形联接器13724与凹形驱动承窝13814驱动接合时,击发驱动轴13810的旋转将导致击发驱动轴13710在外科钉仓13700中旋转。
图65示出了处于加载位置的击发构件13820。当处于该位置时,击发构件13820可邻接凸形联接器13724的衬圈部分13726。如在图65中还可见,钉仓13700还包括被可动地支撑在钉仓13700中的滑动件或凸轮作用组件13740。凸轮作用组件13740通过一系列内螺纹13742通过螺纹轴颈连接在击发驱动轴13710上。如在图65中可见,当击发构件13820处于加载位置时,凸轮作用组件13740中的内螺纹13742位于击发驱动轴13710的无螺纹段13714上。
例示的示例还采用砧座闭锁组件13900,该砧座闭锁组件被构造成能够防止砧座13300的闭合,直到仓13700已正确地安置在细长通道13210中。在一种布置中,砧座闭锁组件13900包括被可动地支撑在细长通道13210中的砧座闭锁构件13910。转到图69和图70,在一种布置中,砧座闭锁构件13910包括夹具主体13912,该夹具主体具有从其远侧端部侧向突起的远侧弹簧接片13914和从夹具主体13912的相对侧向侧侧向突起的近侧键接片13916。夹具主体13912还包括从夹具主体13912向上突起的竖直延伸的锁定接片13918。如在图69和图70中可见,闭锁构件13910能够在远侧锁定位置LP和近侧解锁位置ULP之间轴向运动。锁定弹簧13920设置在通道凸耳13230和远侧弹簧接片13914之间,以将闭锁构件13910朝远侧偏压到锁定位置LP中。图65和图69示出了处于锁定位置LP的砧座闭锁组件13900。如在图65和图69中可见,竖直延伸的锁定接片13918与形成于砧座13300上的砧座闭锁突起部13930竖直对准。因此,当砧座闭锁组件13900处于锁定位置时,使用者不能使砧座13300运动到闭合位置。
在例示的布置中,仓体13702包括键构件13760,该键构件被构造成能够在仓13700已正确地安置在细长通道13210内时使闭锁构件13910从锁定位置LP运动到解锁位置ULP。在一个示例中,键构件13760包括朝近侧延伸的翼片13762,该翼片被构造成能够接触夹具主体13912上的近侧键接片13916。当仓13700已可操作地安置在细长通道13210中时,翼片13762使闭锁构件13910从锁定位置LP朝近侧运动到解锁位置ULP。
如在图71中可见,击发构件13820还可配备有机载击发构件闭锁组件13840,该机载击发构件闭锁组件包括通过枢轴销13846枢转地联接到击发构件主体13822的闭锁构件13842。闭锁构件13842包括滑动件闩锁13848,该滑动件闩锁被构造成能够在凸轮作用组件13740处于未击发位置时由凸轮作用组件13740接合。如在图71中可见,凸轮作用组件13740包括被构造成能够接合闭锁构件13482上的滑动件闩锁13848的击发构件凸缘13741。闭锁弹簧13850安装在细长通道13210中并且被构造成能够向下偏压闭锁构件13842,使得如果凸轮作用组件13740不处于其未击发位置,则闭锁构件13842的远侧边缘13849接合加载开口13214的远侧边缘。当处于该位置时,如果使用者无意中试图朝远侧推进击发构件13820,则闭锁构件13842接触加载开口13214的远侧边缘以防止击发构件13820朝远侧推进。
图65和图67示出了将新鲜的未击发钉仓13700插入到端部执行器13200中。当使用者将仓13700插入到通道13210中时,凸形联接器13724被插入到凹形联接器13812中,并且仓体13702安置在通道13210中,如图72所示。当处于该位置时,翼片13762将闭锁构件13910偏压到解锁位置。然后,使用者可通过启动闭合驱动系统13500(图64)以在第一旋转方向上旋转闭合驱动轴13510以在近侧方向PD上驱动闭合梭动件13520,从而使砧座13300运动到闭合位置。一旦闭合梭动件13520已使砧座13300运动到闭合位置,使用者就可以启动击发系统13800。如在图72中还可见,凸轮作用组件13740已将击发构件闭锁构件13842枢转到解锁位置。当击发驱动轴13810在第一旋转方向上旋转时,仓击发驱动轴13710的近侧螺纹段13712朝远侧(远侧方向DD)驱动击发构件13820。当击发构件13820朝远侧运动时,凸轮作用组件13740被推动成与仓击发驱动轴13710的远侧螺纹段13716螺纹接合。仓击发驱动轴13710的继续旋转导致击发构件13820和凸轮作用组件13740朝远侧运动到其相应结束位置。当朝远侧驱动凸轮作用组件13740时,其上的凸轮作用部分朝向闭合砧座13300驱动支撑在钉仓13700中的驱动器,使得支撑在其上的钉或紧固件被迫穿过夹持在砧座13300与仓13700之间的组织并与砧座13300的下侧形成接触。击发构件13820位于凸轮作用组件13740的近侧,使得其上的组织切割表面13824在所夹持的组织已被缝合之后切割该组织。在各个方面,当击发构件13820朝远侧被驱动穿过外科钉仓13700时,通过砧座接合接片13828与砧座13300的接合以及通道接合接片13826与通道13210的接合,击发构件13820可用于在钉仓13700上的平台表面13707与砧座13300上的钉成形下表面13302之间保持所需量的组织间隙。一旦凸轮作用组件13740和击发构件13820已到达其结束位置,击发驱动轴13810就可以在反转旋转方向上旋转以将击发构件13820和凸轮作用组件13740驱动回到其相应起始位置。一旦击发构件13820已返回到起始位置,闭合驱动轴13510就可以在第二旋转方向上旋转以在远侧方向DD上驱动闭合梭动件13520,从而将砧座13300枢转到打开位置(图72),以能够从端部执行器13200松开所缝合的组织。在包括C形夹具13890的示例中,这些夹具也被凸轮作用组件13740和/或击发构件13820朝远侧驱动,直到夹具13890到达结束位置,其中其下腿部13896位于通道底部13212中的开口(未示出)中,以能够从细长通道13210移除用尽的仓13700。
图73至图80示出了与非常类似于上述器械13000的外科器械14000一起使用的另一个外科端部执行器14200。除了下文讨论的差异之外,外科端部执行器14200在一定程度上类似于上述外科端部执行器13200。在本文中以类似的元件编号示出外科器械14000与外科器械13000相同的部件中的至少一些部件。外科端部执行器14200包括细长通道14210,该细长通道被构造成能够在其中可操作地支撑可替换外科钉仓14700。外科端部执行器14200还包括砧座14300,该砧座能够通过旋转驱动闭合系统13500(图64)相对于细长通道14210在打开构型和闭合构型之间选择性地枢转。如在图73和图74中可见,砧座14300包括朝近侧突起的砧座安装接片14310,该砧座安装接片被构造成能够枢转地联接到端部顶盖14400的对应部分,该端部顶盖附接到细长通道14210的一部分或包括该细长通道的一部分。砧座安装接片14310通过例如铆钉14401或本文所公开的其他枢转布置附接到端部顶盖14400。端部执行器14200还采用上述旋转驱动闭合系统13500。在一种布置中,例如,砧座14300可使用名称为“METHOD FOR FABRICATING SURGICAL STAPLER ANVILS”的美国专利申请序列号16/105,101中描述的各种制造技术来制造,该专利申请的全部公开内容据此以引用方式并入本文。
如上文所讨论,旋转驱动闭合系统13500包括能够轴向运动的闭合梭动件13520,该闭合梭动件与螺纹远侧闭合轴段13512螺纹接合,该螺纹远侧闭合轴段被构造成能够驱动地联接闭合驱动轴13510(图64)。在例示的布置中,闭合梭动件13520包括梭动件基部部分13522,该梭动件基部部分延伸穿过形成于端部顶盖14400的底部中的近侧顶盖狭槽(未示出)。侧法兰(未示出)从梭动件基部部分13522的每一侧侧向延伸,从而以本文所公开的各种方式可滑动地接合端部顶盖14400的底部。
在例示的示例中,闭合梭动件13520的轴向运动通过枢转闭合连接件组件13530传递到砧座14300。在一种布置中,闭合连接件组件13530包括各自枢转地附接到砧座安装接片14310的近侧端部部分14314并从其悬吊下来的一对枢转臂13540(图73和图74中仅可见一个)。每个枢转臂13540包括自由端部13542,该自由端部包括凹口13544,该凹口被构造成能够驱动地接合闭合梭动件基部部分13522中的相应驱动凹槽13526。当闭合梭动件13520在远侧方向DD上被驱动时,枢转臂13540由于其与闭合梭动件13520的接合而向砧座安装接片14310施加枢转打开动作,以使砧座14300枢转到打开位置(图73)。当闭合梭动件13520在近侧方向PD上轴向运动时,枢转臂13540在第二方向上枢转,这使得枢转闭合动作被施加到砧座安装接片13310以使砧座13300枢转到闭合位置(图80)。
与其中击发构件13820包含在可替换外科钉仓13700内的外科端部执行器13200不同,外科端部执行器14200采用永久性地轴颈连接在旋转击发驱动轴13810上的专用击发构件14820。在例示的示例中,旋转击发驱动轴13810和螺纹远侧闭合轴段13512可旋转地支撑在细长通道14210中。如将在下文进一步详细地讨论,旋转击发驱动轴13810在螺纹远侧闭合轴段13512远侧的一部分包括近侧螺纹段13811、无螺纹段13815和远侧螺纹段13817。
图75示出了可与端部执行器14200一起使用的击发构件14820的一种形式。如在图75中可见,击发构件14820包括主体部分14822,该主体部分包括两个向下延伸的中空安装部分14824,这两个中空安装部分为无螺纹的并且彼此间隔开以在它们之间接收螺纹驱动螺母14830。螺纹驱动螺母14830被构造成能够通过螺纹接合旋转击发驱动轴13810的螺纹段13811、13817。驱动螺母14830包括竖直接片部分14832,该竖直接片部分定尺寸成延伸穿过细长通道14210的底部中的轴向狭槽14216。两个侧向延伸的保持法兰14834形成于螺纹驱动螺母14830上并且被构造成能够接合细长通道14210的底部。此外,两个侧向延伸的砧座接合接片14826形成于击发构件主体14822的顶部上,并且被构造成能够在击发构件14820在端部执行器14200内轴向运动时接合砧座14300。组织切割表面14828形成或附接到击发构件主体14822。
在该布置中,击发构件14820包括击发构件闭锁特征部14840,该击发构件闭锁特征部被构造成能够防止击发构件14820从其起始位置朝远侧推进,除非新鲜的未击发钉仓已正确地安置在细长通道14210中。如在图75中可见,在一个示例中,击发构件闭锁特征部14840包括闭锁件主体14842,该闭锁件主体具有从其突起的两个间隔附接腿部14844,这两个间隔附接腿部围绕击发构件主体14822的安装部分14824延伸。每个附接腿部14844包括向内延伸的枢轴销14846,该枢轴销适于枢转地被接收在设置在安装部分14824中的对应开槽开口14825中。闭锁特征部14840还包括滑动件闩锁14848,该滑动件闩锁被构造用于与被可操作地支撑在钉仓14700中的凸轮作用滑动件或凸轮作用组件14740(图77)接触。
图76和图77示出了处于最近侧起始位置的击发构件14820。如在图76和图77中可见,通过细长通道14210的底部提供击发闭锁孔14215。闭锁弹簧14850安装在细长通道14210中并且被构造成能够向下偏压闭锁特征部14840,使得如果新鲜的未击发钉仓尚未正确地加载到细长通道14210中,则闭锁件主体14842的远侧边缘14849接合击发闭锁孔14215的成角度远侧边缘14217。当处于该位置时,如果使用者无意中试图朝远侧推进击发构件14820,则闭锁特征部14840防止击发构件14820朝远侧推进。如图76所示,在强力“F2”下,销14846沿其相应狭槽14825向上滑动。当销14846沿其相应狭槽14825向上滑动时,附接腿部14844的近侧端部14847接合形成于击发构件主体14822的安装部分14824上的对应止回件壁14827,以减小施加在枢轴销14846上的应力。参见图76。
新鲜的未击发外科钉仓14700包含位于起始位置的凸轮作用组件14740,该起始位置位于支撑在仓体中的多排钉驱动器的近侧。如本文所用,术语“新鲜的、未击发的”意指钉仓的所有预期钉或紧固件处于其相应的未击发位置,并且凸轮作用组件处于近侧未击发起始位置。当新鲜的未击发外科钉仓14700已正确地安置在细长通道14210内时,凸轮作用组件14740上朝近侧延伸的解锁部分14742接合闭锁特征部14840上的滑动件闩锁14848,以使闭锁特征部14840枢转到解锁位置,其中闭锁特征部14840不延伸到细长通道中的击发闭锁孔14215中。图78示出了处于起始位置的凸轮作用组件14740。为清楚起见,已省略外科钉仓14700的其余部分。如在图78中可见,凸轮作用组件14740包括内螺纹段14744,该内螺纹段的长度“a”小于旋转击发驱动轴13810上的无螺纹部分13815的轴向长度“b”。凸轮作用组件14740的底部14746是打开的,以使得当仓14700安置在细长通道14210中时凸轮作用组件14740能够扣合在旋转击发驱动轴13810上。
在一个示例中,凸轮作用组件14740中的内螺纹14744被构造成能够仅在远侧方向上驱动凸轮作用组件14740。例如,内螺纹14744可具有引导部分14747,该引导部分被构造成能够有利于与击发驱动轴13810上的螺纹段13817螺纹接合。然而,内螺纹14744可具有后部部分14748,当凸轮作用组件14740已被驱动到其结束位置并且击发驱动轴13810在相反方向上旋转以将击发构件14820驱动回到起始位置时,该后部部分被构造成能够防止与螺纹13817螺纹接合。在图79和图80中,凸轮作用组件14740的结束位置以虚线示出。如在图79和图80中可见,击发驱动轴13810的远侧部分13819没有螺纹。当凸轮作用组件14740已朝远侧驱动到其结束位置时,内螺纹14744与击发驱动轴13810的螺纹段13817脱离接合。当击发驱动轴13810在相反的方向上旋转时,内螺纹14744被设计成滑动并且不重新接合螺纹段13817,使得当击发构件14820回缩回到起始位置时,凸轮作用组件14740保持在钉仓14700内的结束位置。因此,一旦钉仓14700已被用尽(例如,完全击发),凸轮作用组件14740就不返回到其起始位置。因此,如果要将用尽的仓无意中重新安装在端部执行器14200中,则凸轮作用组件14740不处于解锁闭锁特征部14840的位置。在仓被击发之后,可通过干扰位于仓体内的下落的钉驱动器来辅助这种状况。此外,内螺纹14744可具有大于击发驱动轴13810上的螺纹13817的节圆直径的节圆直径,以有利于其间的一些“间隙”,这可允许击发构件14820在朝远侧被驱动时与凸轮作用组件14740进行接触。当仓体14702安装在细长通道14210中时,此类布置可有利于凸轮作用组件14740的一些运动,同时仍与击发驱动轴13810的螺纹段13817建立螺纹驱动接触。
如图所示的端部执行器14200还包括砧座闭锁组件13900,该砧座闭锁组件被构造成能够防止砧座14300的闭合,除非钉仓14700已正确地安置在其中。上文描述了砧座闭锁构件13910的操作,为了简洁起见,下文将不再重复。
图73示出了其中未安装外科钉仓并且砧座14300处于完全打开位置的外科端部执行器14200。如在图73中可见,闭合梭动件13520处于其最远侧位置。如在图73中进一步可见,砧座闭锁构件13910的竖直延伸的锁定接片13918与形成于砧座14300上的砧座闭锁突起部14930对准。图74示出了砧座14300在闭合驱动系统的意外致动期间不能闭合。在图73中,闭合梭动件13520已从其起始位置朝近侧运动,但由于锁定接片13918与闭锁突起部14930之间的接触而防止闭合砧座14300。如在图73和图74中还可见,击发构件闭锁特征部14840偏置到锁定位置,其中闭锁特征部14840对准以接触细长通道底部14212。在使用者意外致动击发驱动系统的情况下,闭锁特征部14840将接触细长通道14210的底部14212以防止击发构件14820朝远侧推进。
图79示出了其中已安装新鲜的未击发外科钉仓14700之后的端部执行器14200。如在该图中可见,仓体14702内的凸轮作用组件14740处于最近侧起始位置,其中凸轮作用组件14740上的解锁部分14742与闭锁特征部14840上的滑动件闩锁14848接合。解锁部分14742和滑动件闩锁14848之间的这种接触使闭锁特征部14840运动到解锁位置。如在图79中还可见,仓体14702上的朝近侧延伸的翼片14762已将闭锁构件13910从锁定位置朝近侧偏压到解锁位置,从而允许闭合砧座14300。如上文所讨论,凸轮作用组件14740中的内螺纹段14744的长度a小于击发驱动轴13810上的无螺纹段13815的长度b。此外,螺纹击发螺母14830内的螺纹的长度“c”大于击发驱动轴13810上的无螺纹段13815的长度b。因此:a<b<c。
图80示出了图79的外科端部执行器14200,其中砧座14300处于完全闭合位置。如在图80中可见,远侧闭合轴段13512已在第一旋转方向上旋转,以使闭合梭动件13520轴向运动到其最近侧位置,从而使闭合连接件组件13530使砧座14300枢转到其完全闭合位置。如在图80中可见,当砧座14300处于完全闭合位置时,枢转臂13540相对于驱动轴轴线DSA几乎竖直。此类构型导致向砧座施加最大闭合力矩(例如,力矩臂角度MA为约90°)。如在图80中进一步可见,砧座接合特征部14826与形成于砧座狭槽的每个侧向侧上的对应细长通道14301对准,以在击发构件14820从其起始位置朝远侧推进到结束位置时允许在其中轴向行进。为了朝远侧推进击发构件14820,使用者启动击发驱动系统13800(图64)以使击发驱动轴13810在第一旋转方向上旋转。当击发构件14820朝远侧被驱动时,击发构件14820推进无螺纹段13815上的凸轮作用组件14740,直到内螺纹段14744通过螺纹接合螺纹段13817。一旦螺纹14744与螺纹段13817螺纹接合,驱动轴13810的旋转就导致凸轮作用组件14740继续朝远侧运动。当凸轮作用组件14740朝远侧运动时,其上的凸轮表面向上驱动储存在仓14700中的钉驱动器。钉驱动器的向上运动导致支撑在其上的钉或紧固件刺穿被夹持在砧座14300与仓14700之间的组织并与砧座14300的钉成形下侧14303形成接触。当击发构件14820朝远侧被驱动时,在紧固件已形成于组织中之后,组织切割表面14828切穿所夹持的组织。击发驱动轴13810继续旋转,直到击发构件14820已到达其结束位置,此时一个或多个传感器可使击发马达13802停止在第一方向上旋转。然后,器械控制器可使击发马达13802在相反的方向上旋转以使击发构件14820回缩回到其起始位置,或者控制器可要求使用者引发回缩旋转。在任一种情况下,凸轮作用组件14740保持在仓14700的远侧端部中。然后,使用者可从端部执行器移除用尽的仓并将其丢弃。因为凸轮作用组件14740保持在用尽的仓的远侧端部中,所以如果用尽的仓无意中错误处理新鲜的未击发仓并重新加载到端部执行器中,则闭锁特征部14840将保持在锁定位置以防止击发构件的意外击发。如在图80中可见,击发构件14820的侧向延伸的保持法兰14834的轴向长度“e”长于通道14210的底部14212中的击发闭锁孔14215的轴向长度“d”。此外,通过仓底部4212的远侧部分提供安装孔14213,以便于穿过其中安装击发构件14820。因此,安装孔14213的轴向长度“f”大于击发构件14820的侧向延伸的保持法兰14834的轴向长度“e”。因此:d<e<f。
图81示出了另一个外科端部执行器15200的一部分,其中为清楚起见省略了其砧座。外科端部执行器15200包括在端部执行器15200内的起始位置和结束位置之间轴向驱动的两件式击发构件15820。端部执行器15200可采用由闭合驱动轴13510轴向驱动的旋转闭合梭动件13520,以向砧座施加打开动作和闭合动作。如上所述,闭合梭动件13520被支撑用于在端部顶盖14400内轴向行进,如图82至图83所示。参见例如图64和图65,这两个附图中示出了关于砧座的打开和闭合的更多细节。此外,两件式击发构件15820由旋转击发驱动轴13810轴向驱动,该旋转击发驱动轴以本文所公开的各种方式延伸穿过远侧闭合驱动轴段。
如在图82中可见,击发构件15820包括主体部分15822,该主体部分包括两个向下延伸的中空安装部分15824,这两个中空安装部分为无螺纹的并且彼此间隔开以在它们之间接收螺纹驱动螺母15830。螺纹驱动螺母15830被构造成能够通过螺纹接合螺纹旋转击发驱动轴13810。驱动螺母15830包括竖直接片部分(未示出),该竖直接片部分定尺寸成延伸穿过外科端部执行器15200的细长通道15210的底部中的轴向狭槽(未示出)。两个侧向延伸的保持法兰15834形成于螺纹驱动螺母15830上并且被构造成能够接合细长通道15210的底部。此外,两个侧向延伸的砧座接合接片15826形成于击发构件主体15822的顶部上,并且被构造成能够在击发构件15820在端部执行器15200内轴向运动时接合砧座。在例示的示例中,击发构件15820被构造成能够与凸轮作用组件15740可操作地交接,该凸轮作用组件在其上具有机载组织切割刀15743。参见图87和图89。在另选的布置中,组织切割表面形成或附接到主体构件15822。
如在图82中还可见,击发构件15820还可配备有机载击发构件闭锁组件15840,该机载击发构件闭锁组件包括枢转地联接到击发构件主体15822的闭锁构件15842。闭锁构件15842包括滑动件闩锁15848,该滑动件闩锁被构造成能够在凸轮作用组件15740处于未击发位置时由凸轮作用组件15740接合。如在图87和图89中可见,凸轮作用组件15740包括被构造成能够接合闭锁构件15482上的滑动件闩锁15848的击发构件凸缘15741。闭锁弹簧15850安装在细长通道15210中并且被构造成能够向下偏压闭锁构件15842,使得如果凸轮作用组件15740不处于其未击发位置,则远侧边缘15849接合通道15210的底部15212中的闭锁腔15214的远侧边缘。当处于该位置时,如果使用者无意中试图朝远侧推进击发构件15820,则闭锁构件15842接触闭锁腔15214的远侧边缘以防止击发构件15820朝远侧推进。
图84示出了其中安装有外科钉仓15700(图81)之前的端部执行器15200。如在图84中可见,击发构件15820处于其最近侧起始位置。图85示出了如果击发构件15820在不存在仓时无意中朝远侧推进会发生什么。如在图85中可见,闭锁构件15842已被弹簧15850向下偏压,使得闭锁构件15842的远侧端部表面15849已接触通道15210中的闭锁腔15214的远侧边缘,以防止击发构件15820进一步朝远侧推进。
图86和图87示出了端部执行器15200,其中未击发外科钉仓15700可操作地加载在细长通道15210中。如在图89中可见,凸轮作用组件15740上的击发构件凸缘15741与闭锁构件15482上的滑动件闩锁15848解锁接合,这将击发构件15820提升脱离与闭锁腔15214的锁定接合。图88和图89示出击发构件15820在击发过程已开始并且击发构件15820已开始在远侧方向上运动之后的位置。
图90示出了可结合上述端部执行器15200以及本文所公开的各种其他端部执行器布置使用的另选的击发构件16820。如在图90中可见,击发构件16820包括主体部分16822,该主体部分包括轴向延伸的螺纹通路16824,该螺纹通路适于例如以本文所公开的各种方式由击发驱动轴13810通过螺纹接合。在击发过程期间,击发构件主体16822被构造成能够延伸穿过已安装在端部执行器的细长通道中的外科钉仓中的轴向狭槽。钉仓中的轴向狭槽与细长通道15210的底部中的轴向狭槽竖直对准,以使击发构件主体16822的底部部分能够在击发过程期间延伸穿过其中。底部通道接合构件或基部16830附接到击发构件主体18622或形成于该击发构件主体上,如图90所示。基部16830被构造成能够在击发期间可滑动地接合通道的底部。此外,顶部砧座接合构件16826形成于击发构件主体16822的顶部部分上或附接到该击发构件主体的顶部部分。
仍然参见图90,在一个方面,基部16830包括从击发构件主体16822的左侧侧向突起的左法兰组件16832L和从击发构件主体16822的右侧侧向突起的右法兰组件16832R。基部16830的基部宽度BW大于击发构件主体16822的下部部分的宽度LBW。在一个方面,下部主体宽度LBW小于外科钉仓和细长通道中的轴向狭槽的宽度,并且基部宽度BW大于外科钉仓和细长通道中的轴向狭槽的宽度。顶部砧座接合构件16826包括从击发构件主体16822的左侧侧向突起的左顶部法兰组件16827L和从击发构件主体16822的右侧侧向突起的右顶部法兰组件16827R。顶部砧座接合构件16826的宽度TW大于击发构件主体16822的上部部分的宽度TBW。在一个方面,顶部主体宽度TBW小于砧座中的轴向狭槽的宽度,以使击发构件主体16822的顶部部分能够可滑动地穿过其中,而顶部砧座接合构件16826的宽度TW大于砧座狭槽的宽度。
图91示出除了下文指出的差异之外可与本文所公开的许多砧座构型相同的击发构件16820和砧座16300。如在图91中可见,砧座16300包括细长砧座主体16302和砧座安装部分16310。细长砧座主体部分16302包括细长砧座狭槽(未示出),该细长砧座狭槽被构造成能够容纳穿过其中的击发构件主体16822的顶部砧座接合构件16826的轴向通道。砧座主体16302还包括轴向延伸的凸缘16304,该凸缘限定位于砧座狭槽的每一侧上的轴向法兰通路16308以用于在其中容纳对应的右顶部法兰16827R和左顶部法兰16827L。在图91所示的示例中,凸缘16304的近侧部分16306形成有径向或平缓斜面,如图所示。图91还示出了处于其中顶部砧座接合构件16826准备好骑在凸缘16304的近侧部分16306上并开始向砧座16300施加闭合动作的位置的击发构件16820。在该示例中,凸缘16304的近侧部分16306是弓形的或逐渐倾斜的,以便于顶部砧座接合构件16826容易地过渡到凸缘16304上。在一个示例中,倾斜度可为约0°至8°。这可减少在砧座16300的初始闭合期间可在击发构件16820和砧座16300之间发生的摩擦力和粘合力的量。当击发构件16820进入砧座主体16302中的法兰通路16308时,击发构件主体16820可相对于垂直于通道底部15212的参考轴线RA略微倾斜(倾斜角度TA-参见图92)。底部法兰16832R、16832L的远侧端部为圆角的以有助于此类过渡。此外,通过使顶部砧座接合构件16826朝近侧轴向偏移偏移距离OD并且/或者通过使顶部砧座接合构件16826的轴向长度TL小于轴向基部长度BL,可减少顶部砧座接合构件16826与凸缘16304的近侧部分16306之间的粘合量。当然,在该过程期间产生的所有摩擦力和粘合力通常增加了必须施加到击发构件16820以闭合砧座16300的闭合力的量。
图93示出了可结合上述端部执行器15200以及本文所公开的各种其他端部执行器布置使用的另选的击发构件17820。如在图93中可见,击发构件17820包括主体部分17822,该主体部分包括轴向延伸的螺纹通路17824,该螺纹通路适于例如以本文所公开的各种方式由击发驱动轴13810通过螺纹接合。如上文所讨论,在击发过程期间,击发构件主体17822被构造成能够延伸穿过已安装在端部执行器的细长通道中的外科钉仓中的轴向狭槽。钉仓中的轴向狭槽与细长通道的底部中的轴向狭槽竖直对准,以使击发构件主体17822的底部部分能够在击发过程期间延伸穿过其中。底部通道接合构件或基部17830附接到击发构件主体17822或形成于该击发构件主体上,如图93所示。基部17830被构造成能够在击发期间可滑动地接合通道的底部。此外,顶部砧座接合构件17826形成于击发构件主体17822的顶部部分上或附接到该击发构件主体的顶部部分。
仍然参见图93,在一个方面,基部17830包括从击发构件主体17822的左侧侧向突起的左法兰组件17832L和从击发构件主体17822的右侧侧向突起的右法兰组件17832R。基部17830的基部宽度BW'大于击发构件主体17822的下部部分的宽度LBW'。在一个方面,下部主体宽度LBW'小于外科钉仓和细长通道中的轴向狭槽的宽度。基部宽度BW'大于外科钉仓和细长通道中的轴向狭槽的宽度。顶部砧座接合构件17826包括从击发构件主体17822的左侧侧向突起的左顶部法兰组件17827L和从击发构件主体17822的右侧侧向突起的右顶部法兰组件17827R。顶部砧座接合构件17826的宽度TW'大于击发构件主体17822的上部部分的宽度TBW'。在一个方面,顶部主体宽度TBW'小于砧座中的轴向狭槽的宽度,以使主体17822的顶部部分能够可滑动地穿过其中,而顶部砧座接合构件17826的宽度TW'大于砧座狭槽的宽度。
在一个方面,左法兰组件17832L和右法兰组件17832R中的每一者包括具有轴向长度CL的中心段17834、具有轴向近侧长度PL的近侧段17836和具有轴向远侧长度DL的远侧段17838。参见图93。基部16830具有总轴向长度BL'。因此:BL'=PL+CL+DL。在一个示例中,PL和DL各自>CL。在一种布置中,PL=DL>CL。对于每个法兰组件17832L和17832R,近侧段17836的近侧端部17840是圆角的,以在击发构件17820回缩回到起始位置期间减少与细长通道的摩擦接合。此外,近侧段17836可具有近侧渐缩上表面17842,该近侧渐缩上表面从中心段17834到圆角近侧端部17840朝近侧渐缩。例如,中心段17834的厚度HC大于近侧端部17840的厚度HD,如图所示。在一种布置中,例如,近侧渐缩上表面17842可从中心段17834的水平上表面17837以约小于8度并且优选地低于4度并且大于0度的近侧法兰角度PFA向下成角度。因此,在至少一个示例中,8°>PFA<4°。同样,远侧段17838的远侧端部17844是圆角的,以在击发过程期间减少与细长通道的摩擦接合。此外,远侧段17838可具有远侧渐缩上表面17846,该远侧渐缩上表面从中心段17834到圆角远侧端部17844朝近侧渐缩。参见图95。例如,中心段17834的厚度HC大于远侧端部17844的厚度HD,如图所示。在一种布置中,例如,远侧渐缩上表面17846可从中心段17834的水平上表面17837以约小于8度并且优选地低于4度并且大于0度的远侧法兰角度DFA向下成角度。因此,在至少一个示例中,8°>DFA<4°。
图96示出除了下文指出的差异之外可与本文所公开的许多砧座构型相同的击发构件17820和砧座17300。如在图96中可见,砧座17300包括细长砧座主体17302和砧座安装部分17310。细长砧座主体部分17302包括细长砧座狭槽(未示出),该细长砧座狭槽被构造成能够容纳穿过其中的击发构件主体17822的上部部分的轴向通道。砧座主体17302还包括轴向延伸的凸缘17304,该凸缘限定位于砧座狭槽的每一侧上的轴向法兰通路17308以用于在其中容纳对应的右顶部法兰17827R和左顶部法兰17827L。在图96所示的示例中,凸缘17304包括远侧部分17305、过渡部分17306和近侧部分17307。远侧部分17305形成为不具有轴向斜率,即水平。过渡部分17306相对于远侧部分17305以过渡角度TLA形成。近侧部分17307相对于远侧部分17305以大于过渡角度TLA的近侧角度PLA形成。该布置用于减少在闭合期间在击发构件17820和砧座17300之间建立的摩擦力和粘合力的量。此外,通过使顶部砧座接合构件17826朝近侧轴向偏移偏移距离OD'并且/或者通过使顶部砧座接合构件17826的轴向长度TL'小于轴向基部长度BL',可减少顶部砧座接合构件17826与凸缘17304的近侧部分17307之间的粘合量。当然,在该过程期间产生的所有摩擦力和粘合力通常增加了必须施加到击发构件17820以闭合砧座17300的闭合力的量。此类构型还可用于改善击发构件17820的引导以及减少在击发过程期间施加到旋转击发驱动轴13810的扭转或弯曲负载。
图97示出了反馈系统17900的逻辑图的示例,可由本文所公开的多个马达驱动外科器械结合其击发系统来使用该反馈系统。例如,可由外科器械13000的击发系统13800使用反馈系统17900。反馈系统17900包括电路。该电路包括控制器17902,该控制器包括处理器17904和存储器17906。击发马达13802由马达驱动器17908驱动以使击发驱动轴13810旋转,从而轴向驱动击发构件13820。跟踪系统17910被构造成能够确定击发构件13820的位置。将位置信息提供给处理器17904,该处理器可被编程或被构造成能够确定击发构件13820的位置以及凸轮作用组件13740的位置和击发驱动轴13810等。
在图97所示的方面,传感器17912(诸如,应变仪或微应变仪)被构造成能够测量端部执行器13200的一个或多个参数,诸如,在夹持操作期间施加在砧座13300上的应变的幅值,该幅值可以指示施加到砧座13300的闭合力。将所测量的应变转换成数字信号并提供给处理器17904。另选地或除了传感器17912之外,传感器17914(诸如负荷传感器)可以测量由闭合驱动系统13500施加到砧座13300的闭合力。传感器17916诸如负荷传感器可以测量在外科器械13000的击发行程中施加到I形梁的击发力。另选地,可以采用电流传感器17918来测量由击发马达13802消耗的电流。推进击发构件13820所需的力可对应于例如由击发马达13802消耗的电流。将所测量的力转换成数字信号并提供给处理器17904。
图98示出了被构造成能够控制本文所公开的外科器械13000或其他外科器械/系统的各方面的控制电路。图98示出了根据本公开的一个方面的被构造成能够控制外科器械13000的各方面的控制电路17920。控制电路17920可被构造成能够实现本文所述的各种过程。控制电路17920可以包括控制器,该控制器包括联接接到至少一个存储器电路17924的一个或多个处理器17922(例如,微处理器、微控制器)。存储器电路17924存储在由处理器17922执行时使处理器17922执行机器指令以实现本文所述的各种过程的机器可执行指令。处理器17922可以是本领域中已知的多种单核处理器或多核处理器中的任一种。存储器电路17924可包括易失性存储介质和非易失性存储介质。处理器17922可包括指令处理单元17926和运算单元17928。指令处理单元可被构造成能够从本公开的存储器电路17924接收指令。
图99示出了被构造成能够控制本文所公开的外科器械13000或其他外科器械/系统的各方面的组合逻辑电路17930。组合逻辑电路17930可被构造成能够实现本文所述的各种过程。电路17930可包括有限状态机,该有限状态机包括组合逻辑电路17932,该组合逻辑电路被构造成能够在输入17934处接收与外科器械13000相关联的数据,通过组合逻辑17932处理数据,并且提供输出17936。
图100示出了被构造成能够控制本文所公开的外科器械13000或其他外科器械/系统的各方面的时序逻辑电路17940。时序逻辑电路17940可被构造成能够实现本文所述的各种过程。电路17940可以包括有限状态机,该有限状态机包括组合逻辑电路17942。时序逻辑电路17940可包括例如组合逻辑电路17942、至少一个存储器电路17944和时钟17949。至少一个存储器电路17944可以存储有限状态机的当前状态。在某些情况下,时序逻辑电路17940可为同步的或异步的。组合逻辑电路17942被构造成能够在输入17946处接收与外科器械13000或本文所公开的其他外科器械/系统相关联的数据,通过组合逻辑电路17942处理数据,并且提供输出17948。在其他方面,电路可包括处理器17922和有限状态机的组合以实现本文的各种过程。在其他方面,有限状态机可以包括组合逻辑电路17930和时序逻辑电路17940的组合。
各方面可实现为制造制品。制造制品可包括被布置成存储用于执行一个或多个方面的各种操作的逻辑、指令和/或数据的计算机可读存储介质。例如,制造制品可包括磁盘、光盘、闪速存储器或固件,这些制造制品包括适用于由通用处理器或专用处理器执行的计算机程序指令。本文所公开的马达中的每个马达可包括扭矩传感器以测量马达的轴上的输出扭矩。可以任何常规方式感测端部执行器上的力,诸如通过钳口的外侧上的力传感器或通过用于致动钳口的马达的扭矩传感器来感测端部执行器上的力。
当夹持在厚组织上时,如在使用较长端部执行器(例如,60mm端部执行器)时可发生的,砧座可受到相当大的应力。例如,砧座可实际上弯曲,这可使砧座的钉成形下表面远离外科钉仓的平台向上弯曲。不仅从部件可靠性观点来看这种状况通常是不期望的,而且该状况还可导致变形的钉。在极端条件下,在砧座初始闭合位置,其位置可相对于外科钉仓成一角度。
图101和图102示出了可用于操作本文所公开的各种击发控制系统的过程17950。图101以图形形式示出了过程17950的一种形式,该过程涉及击发构件14820(或例如击发构件13820)的x位置随在击发过程期间经过的时间量的变化。通过操作击发马达13802以按恒定速率驱动击发构件14820来开始击发过程17952。当操作击发马达13802以按恒定速率正向驱动击发构件14820(17952)时,控制电路在17954处监测击发马达13802电流,直到马达电流超过与砧座的最终闭合位置相关联的预定义马达电流阈值MCP。可基于击发构件14820必须行进直到砧座13300到达最终闭合位置的轴向距离来选择预先确定的马达电流阈值MCP。在一种布置中,例如,击发构件14820可初始从其起始位置朝远侧行进约(0.250")。在该阶段,击发马达13802停止17956达预先确定的第一停留时间量TD1,这允许所夹持的组织中的流体开始流动或迁移出所夹持的组织(组织蠕变)。另外,在等待时段之后,击发构件14820可遇到较低量的竖直负载或阻力,从而改善穿过该位置的可能性。在一种布置中,例如,TD1可为1至5秒。在第一停留时间量TD1到期之后,击发马达13802可在反转旋转方向17958上被驱动以使击发构件14820回缩(在近侧方向上轴向运动)预先确定的轴向距离ADP1。在一个示例中,ADP1可为例如约0.1"至0.15"。此类动作允许组织继续蠕变(流体离开所夹持的组织)。一旦击发构件14820已回缩预先确定的轴向距离ADP1,击发马达13802就停止17960达第二预先确定的停留时间量TD2。在一个示例中,TD2可为例如约0.5至1.0秒。在TD2到期之后,击发马达13802被操作17962以将击发构件14820朝远侧驱动第二轴向距离ADD2。在一个示例中,第二轴向距离ADD2可为例如约0.0125"至0.250"。在这个阶段17964,击发马达13802停止第三预先确定的停留时间量TD3,以促进额外的组织蠕变。在一种布置中,例如,TD3可为1至5秒。在第三停留时间量TD3到期之后,击发马达13802在反转旋转方向17966上被驱动以使击发构件14820回缩(在近侧方向上轴向运动)第二预先确定的轴向距离ADP2。在一个示例中,ADP2可为例如约0.1"至0.15"。此时,击发马达13802可操作17968以朝远侧驱动击发构件14820,直到其到达其结束位置。在另选的替代方案中,在击发构件14820已朝近侧被驱动轴向距离ADP2之后,击发马达13802可在被操作以朝远侧驱动击发构件之前停止达另一个停留时间TD4。在一个示例中,TD4可为例如约0.5至1.0秒。在优选的布置中,在17968处,击发构件14820已进入砧座轨道平行于细长通道的部分。一旦击发构件14820已到达其结束位置(如可由传感器检测到的),则击发马达13802可反转17969以使击发构件14820回缩回到起始位置。此类过程可用于减少砧座在稳固组织的夹持和缝合期间遇到的弯曲和其他应力的量。
图103和图104示出了操作本文所公开的各种击发控制系统的另一个过程17970。图103以图形形式示出了过程17970,该过程涉及击发构件14820(或例如13820)的x位置随在击发过程期间经过的时间量的变化。通过操作击发马达13802以将击发构件14820驱动第一轴向远侧距离ADD1来开始17972击发过程。击发构件14820的位置可由定位在砧座14300中的传感器(霍尔效应等)检测并传送到控制电路17920。在另选的过程17970'中,击发马达13802可操作达第一预先确定的时间段TP1(17972')以将击发构件14820驱动第一轴向远侧距离ADD1。参见图105。然后,击发马达13802在反转旋转方向17974上被驱动以使击发构件14820回缩(在近侧方向上轴向运动)预先确定的轴向近侧距离ADP1。在一个示例中,ADP1可为例如约0.1"至0.15"。此类动作允许组织继续蠕变(流体迁移出或离开所夹持的组织)。在过程17970'中,击发马达13802可操作达第二预先确定的时间段TP2(17974')以将击发构件13820驱动第一轴向近侧距离ADP1。一旦击发构件14820已回缩预先确定的轴向近侧距离ADP1,则在17976处驱动击发马达13802以将击发构件14820朝远侧驱动第二轴向远侧距离ADD2。在另选的过程17970'中,击发马达13802可操作达第三预先确定的时间段TP3(17976')以将击发构件14820驱动第二轴向远侧距离ADD2。然后,击发马达13802在反转旋转方向17978上被驱动以使击发构件14820回缩第二预先确定的轴向近侧距离ADP2。在一个示例中,ADP2可为例如约0.1"至0.15"。在另选的过程17970'中,击发马达13802可操作达第四预先确定的时间段TP4(17978')以将击发构件14820驱动第二轴向近侧距离ADP2。然后,在17980处驱动击发马达13802以将击发构件14820朝远侧驱动第三轴向远侧距离ADD3。在另选的过程17970'中,击发马达13802可操作达第五预先确定的时间段TP5(17980')以将击发构件14820驱动第三轴向远侧距离ADD3。然后,击发马达13802在反转旋转方向17982上被驱动以使击发构件14820回缩第三预先确定的轴向近侧距离ADP3。在一个示例中,ADP3可为例如约0.1"至0.15"。在另选的过程17970'中,击发马达13802可操作达第六预先确定的时间段TP6(17982')以将击发构件14820驱动第三轴向近侧距离ADP3。然后,在17984处驱动击发马达13802以将击发构件14820朝远侧驱动到其结束位置。在另选的过程17970'中,击发马达13802可操作达第七预先确定的时间段TP7(17984')以将击发构件14820驱动到结束位置。一旦击发构件14820已到达其结束位置(例如,由传感器检测到的),则击发马达13802可反转17986、17986'以使击发构件14820回缩回到起始位置。
在优选的布置中,在17984处,击发构件14820已进入砧座轨道平行于细长通道的部分。此类过程可用于减少砧座在稳固组织的夹持和缝合期间的弯曲和应力。在其他布置中,可改变各种轴向远侧距离和时间段。在一种布置中,轴向远侧距离ADD1、ADD2、ADD3可相同或可不同。同样,时间段TP1、TP3、TP5可相同或可不同。
过程17950、17970、17970'在夹持和击发穿过相对厚的组织时可为尤其有用的。一些旋转驱动端部执行器布置可被构造成具有相对较短的砧座安装接头,该砧座安装接头可必然包括与砧座的砧座安装部分相邻的相对较陡峭的砧座起始斜坡。当使用常规的闭合和击发系统过程时,此类陡峭的起始斜坡可能特别难以横贯。本文所公开的各种过程和手术允许/有利于砧座的完全闭合,同时减少/最小化击发构件在以其他方式使用常规击发和闭合过程时通常遇到的粘合应力的量。
图106和图107示出了在许多方面可类似于击发构件14820的击发构件18820的另一种形式。如在图106和图107中可见,击发构件18820包括主体部分18822,该主体部分包括两个向下延伸的中空安装部分18824,这些中空安装部分为无螺纹的并且彼此间隔开以在它们之间接收螺纹驱动螺母18830。如在图107和图108中可见,驱动螺母18830包括螺纹通路18831,该螺纹通路被构造成能够通过螺纹接合击发驱动轴13810。驱动螺母18830包括竖直接片部分18832,该竖直接片部分定尺寸成延伸穿过细长通道的底部中的轴向狭槽,如上所述。两个侧向延伸的通道接合法兰18834形成于螺纹驱动螺母18830上并且被构造成能够接合细长通道的底部。击发驱动轴13810的旋转导致驱动螺母18830轴向运动。当驱动螺母18830轴向运动时,驱动螺母18830向击发构件主体18822施加轴向驱动力DF,如图108所示,以轴向驱动击发构件18820。此类构型使剪切力SF被施加到击发驱动轴13810,如图所示。该加载布置将击发驱动轴13810置于剪切失效模式,这对于弯曲可为优选的。参见图108。通过使击发驱动轴13810穿过中空安装部分18824中的一者并且将其螺纹连接到驱动螺母18830中的螺纹通路18831中来组装该系统,直到击发驱动轴13810穿过第二中空安装部分18824并且所组装的击发构件18820处于击发驱动轴13810上的期望位置。此外,两个侧向延伸的砧座接合接片18826形成于击发构件主体18822的顶部上,并且被构造成能够在击发构件18820在端部执行器内轴向运动时接合砧座。击发构件主体18822的顶部部分还包括朝远侧延伸的砧座鼻部部分18836。
在该布置中,击发构件18820包括击发构件闭锁特征部18840,该击发构件闭锁特征部被构造成能够防止击发构件18820从其起始位置朝远侧推进,除非新鲜的未击发钉仓已正确地安置在细长通道中。在一个示例中,击发构件闭锁特征部18840包括闭锁件主体18842,该闭锁件主体具有从其突起的两个间隔附接腿部18844,这两个间隔附接腿部围绕击发构件主体18822延伸。每个附接腿部18844包括向内延伸的枢轴销18846,该枢轴销适于枢转地被接收在安装部分18824中的开口18825中。闭锁特征部18840还包括滑动件闩锁18848,该滑动件闩锁被构造用于与钉仓中的凸轮作用组件18740接触。
转到图109和图110,击发构件18820被构造成能够与凸轮作用组件18740可操作地交接,该凸轮作用组件在许多方面类似于上述凸轮作用组件14740。例如,在一个方面,凸轮作用组件18740被可操作地支撑在钉仓中并且被构造成能够以本文所述的各种方式中的任一种扣合在击发驱动轴13810上或以其他方式与该击发驱动轴可操作地交接。例如,凸轮作用组件18740包括凸轮作用组件主体18741,该凸轮作用组件主体可具有一系列内螺纹段(未示出),这些内螺纹段被构造成能够以上述方式通过螺纹接合击发驱动轴13810上的螺纹或螺纹段。在其他布置中,凸轮作用组件18740可不具有螺纹。在此类构型中,击发构件主体18822被构造成能够例如围绕击发驱动轴13810延伸(无螺纹接合)。在此类构型中,凸轮作用组件18740由击发构件18820朝远侧驱动穿过钉仓。一旦击发构件18820和凸轮作用组件18740已被驱动到其最远侧结束位置,击发构件18820便可通过在反转旋转方向上旋转击发驱动轴13810而回缩回到其起始位置,同时凸轮作用组件18740保持在其结束位置。
如在图109和图110中进一步可见,凸轮作用组件主体18741包括被构造成能够接合闭锁特征部18840上的滑动件闩锁18848的近侧延伸的解锁部分18742。因此,如上所述,当包含凸轮作用组件18740的新鲜的未击发外科钉仓已正确地安置在端部执行器的细长通道内时,凸轮作用组件18740上的解锁部分18742接合闭锁特征部18840上的滑动件闩锁18848,以使闭锁特征部18840枢转到解锁位置,其中闭锁特征部18840不延伸到细长通道中的闭锁孔中。如在图109和图110中还可见,凸轮作用组件主体18741包括一系列凸轮构件18743,这些凸轮构件与在钉仓内成排支撑的对应钉驱动器对准。
一旦处于其未击发起始位置的其中包含凸轮作用组件18740的新鲜钉仓已被正确地加载到端部执行器的细长通道中并且其砧座已通过闭合系统的启动而运动到闭合位置,则击发系统可被启动以朝远侧驱动击发构件18820。击发构件18820的继续远侧运动使得凸轮作用组件18740中的内螺纹(如果存在)接合击发驱动轴13810上的对应螺纹。击发驱动轴13810的继续旋转导致凸轮作用组件18740和击发构件18820以本文所述的方式朝远侧运动穿过钉仓。当凸轮构件18743接触仓体中的对应钉驱动器时,凸轮构件18743在这些驱动器的相应凹坑中向上驱动驱动器。当驱动器被向上驱动时,支撑在其上的钉或紧固件被迫穿过被夹持在仓与砧座之间的组织并与砧座上的钉成形下表面形成接触。
与凸轮作用组件14740不同,凸轮作用组件18740包含组织切割构件或刀片18747。在一个方面,组织切割构件18747被可动地支撑在凸轮作用组件主体18741上,使得其能够从部署位置(图109)运动到凹陷或储存位置(图110)。在一个方面,凸轮构件18743朝远侧延伸超过组织切割构件18747,使得钉或紧固件在组织切割构件18747切穿组织之前被部署穿过组织。因此,当击发构件18820和凸轮作用组件18740朝远侧被驱动时,所夹持的组织被缝合并且随后被切割。在一个方面,组织切割构件18747枢转地支撑在枢轴销18749上,使得其能够在部署位置和储存位置之间枢转。组织切割构件18747安装在限定于凸轮作用组件主体18741中的刀片安装部分18746中。在一个示例中,组织切割构件18747可以通过组织切割构件18747中的卡位件(未示出)可释放地保持在部署位置,该卡位件被构造成能够可释放地接合凸轮作用组件主体18741中的对应凹陷部。设想了其他可释放的组织切割保持器布置。在至少一种布置中,一旦凸轮作用组件18740已被驱动到钉仓内的最远侧结束位置,组织切割构件18747就被构造成能够通过与设置在仓体的远侧端部中的对应致动特征部接触而枢转到储存位置。在击发行程完成时,击发驱动轴13810在相反方向上旋转,以使击发构件18820朝近侧被驱动回到端部执行器内的起始位置。凸轮作用组件18740与击发驱动轴13810脱离接合并保持在结束位置。在击发构件18820已返回到起始位置之后,闭合系统可被启动以使砧座运动到打开位置,从而从端部执行器释放所缝合的组织。然后,可从端部执行器的细长通道移除“用尽的”钉仓。如果使用者试图再利用用尽的仓,因为凸轮作用组件18740不处于起始位置,所以闭锁特征部18840将防止击发构件18820的意外致动。
图111示出了另选的击发构件布置18820',其与上述击发构件18820相同,不同的是组织分离特征部18821形成于击发构件主体18822'的远侧边缘18823上。换句话讲,击发构件主体18822'的远侧边缘18823渐缩到更薄的横截面,而不在其上形成组织切割刃。该组织分离特征部可使用例如各种金属注塑成型技术形成。此类特征部有助于在组织已被凸轮作用组件18740上的组织切割构件17847'切割之后散开组织(而无需附加切割)。
此类凸轮作用组件布置为每个新仓提供新鲜的切割表面。此外,跨不同仓的组织切割构件根据特定应用可具有不同的轮廓、厚度和侵蚀性。例如,被构造用于与支撑材料一起使用的仓可具有更稳固的组织切割构件(例如,组织切割构件可为更尖锐的、更厚的、具有更小的磨削角度、为锯齿状的等)。图111示出了例如锯齿状组织切割构件18747'。因此,可针对待切割和缝合的组织的特定类型和厚度来定制组织切割构件的特定构型。
图112和图113示出了包括凸轮作用组件18740'的外科钉仓18700,除了例如下文指出的差异之外,该凸轮作用组件可与凸轮作用组件18740相同。仓18700包括细长仓体18702,该细长仓体具有居中设置的细长仓狭槽18704,该细长仓狭槽被构造成能够容纳击发构件18820在其中的轴向行进。同样在例示的示例中,三排外科钉凹坑18706形成于细长狭槽18704的每一侧上。每个钉凹坑18706限定仓体18702的仓平台表面18703中的开口。每个钉凹坑18706可具有与其相关联的钉驱动器(未示出),该钉驱动器在其上支撑一个或多个外科钉或紧固件(未示出)。如在图113中可见,安全停放部18732形成于仓体13702的近侧端部18730上,使得当凸轮作用组件18740处于其起始位置时,组织切割构件18747(处于其部署位置)由此受到保护(未暴露)。
图114示出了凸轮作用组件18740'的一种形式,其中为清楚起见省略了组织切割构件。凸轮作用组件18740'与凸轮作用组件18740基本上相同,不同的是凸轮作用组件主体18741'另外包括延伸到刀片安装部分18746中的回缩通路18745。转到图115和图116,在一个方面,组织切割构件18747包括致动尾部18748,该致动尾部在被形成于仓体18702的远侧端部18734上的回缩构件18738接触时可使组织切割构件18747从其部署位置(图115)枢转到其凹陷或储存位置(图116)。如在图115中可见,当凸轮作用组件18740'接近结束位置时,回缩构件18738延伸穿过凸轮作用组件主体18741'中的回缩通路18745以接触组织切割构件18747上的致动尾部18748。当凸轮作用组件18740'到达仓体18702的远侧端部18734中的最终最远侧位置时,回缩构件18738将组织切割构件18747枢转到凹陷或储存位置(图116)。如在图116中可见,在一个示例中,凸轮构件18743接触仓体18702的远侧端部18734中的端壁18736。间隙开口18739设置在仓体18702的远侧端部中,以为组织切割构件18747提供足够的间隙来枢转到凹陷或储存位置。如在图116中进一步可见,当组织切割构件18747处于凹陷或储存位置时,其上的切割表面18751储存在仓体18702的仓平台表面18703下方以防止对该仓平台表面的接近。
图117示出了处于起始位置的凸轮作用组件18740',其中组织切割构件18747处于部署状态。如在图117中可见,组织切割构件18747定位在仓体18702的近侧端部18730上的停放部部分18732内,使得其上的组织切割表面18751被完全接收在其中并且不暴露以防止使用者在抓握仓18700时受伤。图118示出了在运动到仓的远侧端部处的凹陷或储存位置之后的组织切割构件18747。如在图118中可见,组织切割表面18751安全地位于仓平台表面18703下方,以防止在击发之后在移除和处置用尽的仓期间无意中受伤。参见例如图119和图120。
图121至图123示出了另选的组织切割构件18747",其被构造成能够与设置在击发构件上的切割构件保持器相互作用。图121示出了在其他方面与上击发构件18820相同的击发构件18820'。然而,击发构件18820'还包括切割构件保持器18827。如在图121中可见,凸轮作用组件18740"处于其在钉仓18700'内的起始位置。组织切割构件18747"处于其部署位置并且被接收在仓体18702的停放部部分18732内。扭转弹簧18753安装在凸轮作用组件主体18741上并且被构造成能够向组织切割构件18747"施加偏压动作,该偏压动作将使组织切割构件18747"枢转到储存位置。为了在击发之前抵抗由弹簧18753施加的偏压动作而将组织切割构件18747"保持在部署位置,易碎刀片保持器18755被支撑在车库18732中以将组织切割构件18747"保持在部署位置。刀片保持器18755可由柔软材料(诸如橡胶等)制成,当凸轮作用组件18740"在击发过程中朝远侧推进穿过仓18700"时,该柔软材料可被组织切割构件18747"上的组织切割表面18751切断。
图121示出了在仓18700'已正确地加载到端部执行器中之后并且在击发之前钉仓18700'和击发构件18820'的位置。如在图121中可见,击发构件18820'处于起始位置并且尚未朝远侧推进到与凸轮作用组件18740"接合。在图122中,击发构件18820'已初始朝远侧推进以接触凸轮作用组件18740"到一点,其中击发构件18820'上的切割构件保持器18827已接合组织切割构件18747"上的致动尾部18748",以在击发过程期间将组织切割构件18747"保持在部署位置。击发构件18820'和凸轮作用组件18740"的远侧推进将使组织切割构件18747"随着击发过程的进行而切穿仓体停放部18732中的易碎刀片保持器18755。图123示出了处于其结束位置并且在击发构件18820'已初始开始在近侧方向PD上回缩运动之后的凸轮作用组件18740"。如在图122中可见,切割构件保持器18827已与组织切割构件18747"上的致动尾部18748"脱离接合,以允许扭转弹簧18753将组织切割构件18747"偏压到储存位置。击发构件18820'回缩回到起始位置,以能够从端部执行器移除用尽的仓。在击发过程期间的任何时间(即,在击发构件18820'和凸轮作用组件18740"朝远侧推进期间),如果击发过程停止并且有必要回缩击发构件18820',则击发构件18820"的近侧运动将导致致动尾部18748"与切割构件保持器18827脱离接合,此时扭转弹簧18753将组织切割构件18747"偏压到储存位置。因此,凸轮作用组件18470"不必处于结束位置以将组织切割构件18747"偏压到储存位置。
图124示出了可替换钉仓14700'的一种形式,除了下文讨论的差异之外,该可替换钉仓与上文详细描述的钉仓14700基本上相同。钉仓14700'可例如与上述外科器械14000结合使用。在一个方面,除了下文讨论的差异之外,外科器械14000包括非常类似于上述击发构件14820的击发构件14820'。击发构件14820'包括主体部分14822',该主体部分包括两个向下延伸的中空安装部分,这两个中空安装部分为无螺纹的并且彼此间隔开以在它们之间接收螺纹驱动螺母。螺纹驱动螺母被构造成能够以上述方式通过螺纹接合旋转击发驱动轴的螺纹段。击发构件14820'具有从击发构件主体14822'的底部侧向延伸的一对通道接合接片,以及从击发构件主体14822'的顶部部分延伸的一对砧座接合接片14828,使得当从其端部观察时,击发构件14820'类似于I形梁构型。
仍然参见图124,外科钉仓14700'包括细长仓体14702',该细长仓体具有居中设置的细长仓狭槽14704,该细长仓狭槽被构造成能够容纳击发构件14820'在其中的轴向行进。同样在例示的示例中,三排外科钉凹坑14706形成于细长狭槽14704的每一侧上。每个钉凹坑14706可具有与其相关联的钉驱动器(未示出),该钉驱动器在其上支撑外科紧固件(未示出)。在一个方面,可替换钉仓14700'包括可替换刀片结构14860,可针对仓14700'旨在切割和缝合的组织的类型和组成特别定制该可替换刀片结构。更具体地讲,仓体14702'包括形成于仓体14702'的近侧端部14703上的刀片储存停放部14780。
在例示的示例中,击发构件14820'被构造成能够可移除地支撑可移除刀片结构14860,该可移除刀片结构储存在仓14700'中的刀片储存停放部14780中。在一个方面,可移除刀片结构14860包括终止于组织切割刃14862中的刀片主体14861。参见图125和图126。刀片主体14861还包括两个柔性附接腿部14864,每个柔性附接腿部在其上具有定位卡位件14866和保持器接片14868。如在图125中可见,击发构件主体14822'的上部部分形成有刀片安装特征部14870,该刀片安装特征部被构造成能够以扣合方式在其上接收刀片结构14860。刀片安装特征部14870包括对应于刀片主体14861上的定位卡位件14866的定位凹槽14872以及对应于刀片主体14861上的保持器接片14868的两个闩锁腔14874。
转到图127,刀片结构14860储存在刀片储存停放部14780中的腔14782中。击发构件主体14822'定尺寸成穿过限定在形成于刀片储存停放部14780的近侧端部14781中的两个向内延伸的顶出接片14786之间的开口14784。当外科钉仓14700'初始安装在外科端部执行器的细长通道中时,击发构件14820'处于起始位置,该起始位置位于刀片储存停放部14780的近侧端部14781的近侧。击发构件14820'在远侧方向DD上的初始致动将使刀片安装特征部14870通过刀片储存停放部14780中的开口14784进入以与其中的刀片结构14860接合。参见图127。击发构件14820'继续朝远侧推进将使刀片结构14860扣合成与刀片安装特征部14870接合,使得刀片结构14860与击发构件14820'一起沿狭槽14704向下轴向行进以切割夹持在砧座和外科钉仓14700'之间的组织。参见图128。如在图128中可见,保持器接片14868安置在刀片安装特征部14870中的对应闩锁腔14874中。刀片结构14860相对于仓体14702'中的轴向狭槽14704定尺寸成使得保持器接片14868在击发和回缩回到刀片储存停放部14780期间紧密地保持在其相应闩锁腔14874中。图129示出了击发构件14820'在近侧方向PD上的回缩。如在图128中可见,当保持器接片14868接触顶出接片14786时,防止保持器插片14868朝近侧运动以使刀片安装特征部14870能够与刀片结构14860脱离接合。在一个方面,刀片储存停放部14780中的腔14782宽于仓体14702'中的狭槽14704,从而使刀片结构14860的柔性附接腿部14864能够侧向向外展开并与刀片安装特征部14870脱离接合。因此,刀片结构14860保持在刀片储存停放部14780中以与用尽的钉仓14700'一起被丢弃。
可替换钉仓14700'可包含针对待切割组织的类型和组成而特别定制的特定刀片结构。例如,由硬化金属制成的刀片结构14860'可用于其中刀片结构可能必须横切钉线的应用中。参见图130。在刀片可能不得不切穿支撑材料的应用中,可有利地采用具有锯齿状切割刃14862"的刀片结构14860"。参见图131。此类布置为使用者提供具有每个新钉仓的新鲜刀片。
图132示出了可替换钉仓13700'的另一种形式,除了下文讨论的差异之外,该可替换钉仓与上述钉仓13700基本上相同。钉仓13700'可例如与上述外科器械13000结合使用。在一个方面,除了下文讨论的差异之外,钉仓13700'包括与上述击发构件13820相同的机载击发构件13820'。以上述方式,例如,击发构件13820'包括竖直延伸的击发构件主体13822',该竖直延伸的击发构件主体被构造成能够在外科钉仓13700'内由机载旋转击发驱动轴13710轴向驱动,如本文所述。击发构件13820'具有从击发构件主体13822'的底部侧向延伸的一对通道接合接片,以及从击发构件主体13822'的顶部部分延伸的一对砧座接合接片13828,使得当从其端部观察时,击发构件13820'类似于I形梁构型。
仍然参见图132,外科钉仓13700'包括细长仓体13702',该细长仓体具有居中设置的细长仓狭槽13704,该细长仓狭槽被构造成能够容纳击发构件13820'在其中的轴向行进。同样在例示的示例中,三排外科钉凹坑13706形成于细长狭槽13704的每一侧上。每个钉凹坑13706可具有与其相关联的钉驱动器(未示出),该钉驱动器在其上支撑外科紧固件(未示出)。在一个方面,击发构件13820'被构造成能够以上述方式可移除地支撑可移除刀片结构14860。刀片结构14860储存在刀片储存停放部13780中,该刀片储存停放部形成于仓体13702'的近侧端部13701中,如上文详细讨论的。然而,在这种情况下,刀片结构14860保持在机载击发构件13820'上,并且可与仓和机载击发构件13820'一起被丢弃。
本文所述主题的各个方面在以下实施例中阐述:
实施例1-一种外科钉仓,所述外科钉仓被构造用于与外科缝合器一起使用,所述外科缝合器包括通道和相对于所述通道被可动地支撑的砧座以及被构造成能够逐渐轴向地接合所述砧座和所述通道的击发构件。所述外科钉仓包括仓体、可移除地储存在所述仓体中的多个外科钉、凸轮组件以及被支撑在所述凸轮组件上以用于与所述凸轮组件一起行进的切割构件。所述仓体包括仓平台表面。所述凸轮组件被可动地支撑在所述仓体中并且被构造成能够与所述击发构件可操作地交接,使得所述击发构件在远侧方向上的轴向运动将所述凸轮组件从所述仓体中的起始位置驱动到结束位置。
实施例2-根据实施例1所述的外科钉仓,其中,所述切割构件由所述凸轮组件可动地支撑并且能够在部署位置和凹陷位置之间运动,在所述部署位置,所述切割构件的至少一部分在所述仓体的所述仓平台表面上方延伸,在所述凹陷位置,所述切割构件的所述部分位于所述仓平台表面下方。
实施例3-根据实施例2所述的外科钉仓,其中,当所述凸轮组件处于所述起始位置时,所述切割构件保持在所述部署位置。
实施例4-根据实施例2或3所述的外科钉仓,其中,所述仓体包括停放部部分,所述停放部部分被构造成能够在所述凸轮组件处于所述起始位置并且所述切割构件处于所述部署位置时包封所述切割构件的所述部分。
实施例5-根据实施例4所述的外科钉仓,其中,所述切割构件通过所述停放部部分中的可切断保持器保持在所述部署位置。
实施例6-根据实施例2所述的外科钉仓,其中,当所述仓体可操作地安置在所述通道中时,所述切割构件通过所述击发构件上的闩锁特征部保持在所述部署位置。
实施例7-根据实施例6所述的外科钉仓,其中,当所述击发构件在所述远侧方向上将所述凸轮组件从所述起始位置驱动到所述结束位置时,所述切割构件通过所述击发构件上的所述闩锁特征部保持在所述部署位置。
实施例8-根据实施例2所述的外科钉仓,其中,所述仓体还包括释放特征部,所述释放特征部被构造成能够在所述凸轮组件运动到所述结束位置时使所述切割构件运动到所述凹陷位置。
实施例9-根据实施例6或7所述的外科钉仓,其中,所述击发构件上的所述闩锁特征部被构造成能够在所述击发构件在近侧方向上回缩时与所述切割构件脱离接合。
实施例10-根据实施例6或7所述的外科钉仓,还包括偏压件,所述偏压件用于在所述闩锁特征部与所述凸轮组件脱离接合时将所述切割构件偏压到所述凹陷位置。
实施例11-根据实施例1、2、3、4、5、6、7、8、9或10所述的外科钉仓,其中,所述击发构件是马达驱动的。
实施例12-一种外科钉仓,所述外科钉仓被构造用于与外科缝合器一起使用,所述外科缝合器包括通道和相对于所述通道被可动地支撑的砧座以及被构造成能够逐渐轴向地接合所述砧座和所述通道的击发构件。所述外科钉仓包括仓体、可移除地储存在所述仓体中的多个外科钉、凸轮组件以及切割构件。所述仓体包括仓平台表面。所述凸轮组件被可动地支撑在所述仓体中并且被构造成能够与所述击发构件可操作地交接,使得所述击发构件在远侧方向上的轴向运动将所述凸轮组件从所述仓体中的起始位置驱动到结束位置。所述切割构件被构造用于当所述击发构件朝远侧被驱动成与所述切割构件接触时可移除地附接到所述击发构件。所述切割构件储存在所述仓体的近侧部分中的就绪位置。
实施例13-根据实施例12所述的外科钉仓,其中,所述切割构件被构造成能够在所述击发构件朝远侧被驱动成与所述切割构件接触时夹持到所述击发构件上。
实施例14-根据实施例12或13所述的外科钉仓,其中,所述切割构件包括主体构件,所述主体构件限定刀片和一对间隔弹簧臂,所述一对间隔弹簧臂之间限定保持间隔,所述保持间隔被构造成能够将所述击发构件的一部分保持地接收在所述一对间隔弹簧臂之间。
实施例15-根据实施例12、13或14所述的外科钉仓,其中,随着所述击发构件从初始位置朝远侧被驱动,所述切割构件可移除地附接到所述击发构件,并且其中当所述击发构件回缩回到所述初始位置时,所述切割构件从所述击发构件移除以保持在所述仓体的所述近侧部分上的刀片储存停放部内。
实施例16-根据实施例12、13或14所述的外科钉仓,其中,所述切割构件在附接到所述击发构件之前保持在所述仓体的近侧端部上的刀片储存停放部内。
实施例17-根据实施例12、13、14、15或16所述的外科钉仓,其中,所述击发构件被螺纹接合到旋转驱动轴上,并且其中所述凸轮组件可滑动地轴颈连接在所述旋转驱动轴上。
实施例18-一种外科器械,包括仓支撑件、砧座、I形梁击发构件和外科钉仓。所述砧座和所述仓支撑件中的一者能够相对于所述砧座和所述仓支撑件中的另一者在打开位置和闭合位置之间运动。所述I形梁击发构件被构造成能够逐渐轴向地接合所述砧座和所述仓支撑件。所述外科钉仓包括仓体、可移除地储存在所述仓体中的多个外科钉、凸轮组件以及切割构件。所述仓体被构造成能够被可移除地支撑在所述仓支撑件中并且包括仓平台表面。所述凸轮组件被可动地支撑在所述仓体中并且被构造成能够与所述I形梁击发构件可操作地交接,使得所述I形梁击发构件在远侧方向上的轴向运动将所述凸轮组件从所述仓体中的起始位置驱动到结束位置。所述切割构件由所述凸轮组件可动地支撑在部署位置和凹陷位置之间,其中在所述部署位置处,所述切割构件的至少一部分在所述仓体的所述仓平台表面上方延伸,在所述凹陷位置处,所述切割构件的所述部分位于所述仓平台表面下方。
实施例19-根据实施例18所述的外科器械,还包括可操作地联接到所述仓支撑件的细长轴组件、可操作地附接到所述细长轴组件的外壳以及由所述外壳可操作地支撑并且与所述I形梁击发构件交接以轴向地驱动所述I形梁击发构件的马达。
实施例20-根据实施例18或19所述的外科器械,其中,当所述仓体可操作地安置在所述仓支撑件中时,所述切割构件通过所述I形梁击发构件上的闩锁特征部保持在所述部署位置。
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。在各种情况下,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。
下述专利的全部公开内容据此以引用方式并入本文:
-公布于1995年4月4日的名称为“ELECTROSURGICAL HEMOSTATIC DEVICE”的美国专利5,403,312;
-公布于2006年2月21日的名称为“SURGICAL STAPLING INSTRUMENT HAVINGSEPARATE DISTINCT CLOSING AND FIRING SYSTEMS”的美国专利7,000,818;
-公布于2008年9月9日的名称为“MOTOR-DRIVEN SURGICAL CUTTING ANDFASTENING INSTRUMENT WITH TACTILE POSITION FEEDBACK”的美国专利7,422,139;
-公布于2008年12月16日的名称为“ELECTRO-MECHANICAL SURGICAL INSTRUMENTWITH CLOSURE SYSTEM AND ANVIL ALIGNMENT COMPONENTS”的美国专利7,464,849;
-公布于2010年3月2日的名称为“SURGICAL INSTRUMENT HAVING ANARTICULATING END EFFECTOR”的美国专利7,670,334;
-公布于2010年7月13日的名称为“SURGICAL STAPLING INSTRUMENTS”的美国专利7,753,245;
-公布于2013年3月12日的名称为“SELECTIVELY ORIENTABLE IMPLANTABLEFASTENER CARTRIDGE”的美国专利8,393,514;
-名称为“SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES”的美国专利申请序列号11/343,803,现为美国专利7,845,537;
-提交于2008年2月14日的名称为“SURGICAL CUTTING AND FASTENINGINSTRUMENT HAVING RF ELECTRODES”的美国专利申请序列号12/031,573;
-提交于2008年2月15日的名称为“END EFFECTORS FOR A SURGICAL CUTTING ANDSTAPLING INSTRUMENT”的美国专利申请序列号12/031,873(现为美国专利7,980,443);
-名称为“MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT”的美国专利申请序列号12/235,782,现为美国专利8,210,411;
-名称为“MOTORIZED SURGICAL INSTRUMENT”的美国专利申请序列号12/235,972,现为美国专利9,050,083。
-名称为“POWERED SURGICAL CUTTING AND STAPLING APPARATUS WITH MANUALLYRETRACTABLE FIRING SYSTEM”的美国专利申请序列号12/249,117,现为美国专利8,608,045;
-提交于2009年12月24日的名称为“MOTOR-DRIVEN SURGICAL CUTTINGINSTRUMENT WITH ELECTRIC ACTUATOR DIRECTIONAL CONTROL ASSEMBLY”的美国专利申请序列号12/647,100,现为美国专利8,220,688;
-提交于2012年9月29日的名称为“STAPLE CARTRIDGE”的美国专利申请序列号12/893,461,现为美国专利8,733,613;
-提交于2011年2月28日的名称为“SURGICAL STAPLING INSTRUMENT”的美国专利申请序列号13/036,647,现为美国专利8,561,870;
-名称为“SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLEDEPLOYMENT ARRANGEMENTS”的美国专利申请序列号13/118,241,现为美国专利9,072,535;
-提交于2012年6月15日的名称为“ARTICULATABLE SURGICAL INSTRUMENTCOMPRISING A FIRING DRIVE”的美国专利申请序列号13/524,049,现为美国专利9,101,358;
-提交于2013年3月13日的名称为“STAPLE CARTRIDGE TISSUE THICKNESS SENSORSYSTEM”的美国专利申请序列号13/800,025,现为美国专利9,345,481;
-提交于2013年3月13日的名称为“STAPLE CARTRIDGE TISSUE THICKNESS SENSORSYSTEM”的美国专利申请序列号13/800,067,现为美国专利申请公布2014/0263552;
-提交于2006年1月31日的名称为“SURGICAL CUTTING AND FASTENINGINSTRUMENT WITH CLOSURE TRIGGER LOCKING MECHANISM”的美国专利申请公布2007/0175955;以及
-提交于2010年4月22日的名称为“SURGICAL STAPLING INSTRUMENT WITH ANARTICULATABLE END EFFECTOR”的美国专利申请公布2010/0264194,现为美国专利8,308,040。
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他实施方案的特征、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,也可使用其他材料。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外科手术之前进行处理。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他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 (20)
1.一种外科钉仓,所述外科钉仓被构造用于与外科缝合器一起使用,所述外科缝合器包括通道和相对于所述通道被可动地支撑的砧座以及被构造成能够逐渐轴向地接合所述砧座和所述通道的击发构件,所述外科钉仓包括:
仓体,所述仓体包括仓平台表面;
多个外科钉,所述多个外科钉可移除地储存在所述仓体中;
凸轮组件,所述凸轮组件被可动地支撑在所述仓体中并且被构造成能够与所述击发构件可操作地交接,使得所述击发构件在远侧方向上的轴向运动将所述凸轮组件从所述仓体中的起始位置驱动到结束位置;以及
切割构件,所述切割构件被支撑在所述凸轮组件上以与所述凸轮组件一起行进。
2.根据权利要求1所述的外科钉仓,其中,所述切割构件由所述凸轮组件可动地支撑并且能够在部署位置和凹陷位置之间运动,在所述部署位置,所述切割构件的至少一部分在所述仓体的所述仓平台表面上方延伸,在所述凹陷位置,所述切割构件的所述至少一部分位于所述仓平台表面下方。
3.根据权利要求2所述的外科钉仓,其中,当所述凸轮组件处于所述起始位置时,所述切割构件保持在所述部署位置。
4.根据权利要求3所述的外科钉仓,其中,所述仓体包括停放部部分,所述停放部部分被构造成能够在所述凸轮组件处于所述起始位置并且所述切割构件处于所述部署位置时包封所述切割构件的所述至少一部分。
5.根据权利要求4所述的外科钉仓,其中,所述切割构件通过所述停放部部分中的可切断保持器保持在所述部署位置。
6.根据权利要求2所述的外科钉仓,其中,当所述仓体可操作地安置在所述通道中时,所述切割构件通过所述击发构件上的闩锁特征部保持在所述部署位置。
7.根据权利要求6所述的外科钉仓,其中,当所述击发构件在所述远侧方向上将所述凸轮组件从所述起始位置驱动到所述结束位置时,所述切割构件通过所述击发构件上的所述闩锁特征部保持在所述部署位置。
8.根据权利要求2所述的外科钉仓,其中,所述仓体还包括释放特征部,所述释放特征部被构造成能够在所述凸轮组件运动到所述结束位置时使所述切割构件运动到所述凹陷位置。
9.根据权利要求7所述的外科钉仓,其中,所述击发构件上的所述闩锁特征部被构造成能够在所述击发构件在近侧方向上回缩时与所述切割构件脱离接合。
10.根据权利要求6所述的外科钉仓,还包括偏压件,所述偏压件用于在所述闩锁特征部与所述凸轮组件脱离接合时将所述切割构件偏压到所述凹陷位置。
11.根据权利要求1所述的外科钉仓,其中,所述击发构件是马达驱动的。
12.一种外科钉仓,所述外科钉仓被构造用于与外科缝合器一起使用,所述外科缝合器包括通道和相对于所述通道被可动地支撑的砧座以及被构造成能够逐渐轴向地接合所述砧座和所述通道的击发构件,所述外科钉仓包括:
仓体,所述仓体包括仓平台表面;
多个外科钉,所述多个外科钉可移除地储存在所述仓体中;
凸轮组件,所述凸轮组件被可动地支撑在所述仓体中并且被构造成能够与所述击发构件可操作地交接,使得所述击发构件在远侧方向上的轴向运动将所述凸轮组件从所述仓体中的起始位置驱动到结束位置;以及
切割构件,所述切割构件被构造用于当所述击发构件朝远侧被驱动成与所述切割构件接触时可移除地附接到所述击发构件,所述切割构件储存在所述仓体的近侧部分中的就绪位置。
13.根据权利要求12所述的外科钉仓,其中,所述切割构件被构造成能够在所述击发构件朝远侧被驱动成与所述切割构件接触时夹持到所述击发构件上。
14.根据权利要求13所述的外科钉仓,其中,所述切割构件包括主体构件,所述主体构件限定刀片和一对间隔弹簧臂,所述一对间隔弹簧臂之间限定保持间隔,所述保持间隔被构造成能够将所述击发构件的一部分保持地接收在所述一对间隔弹簧臂之间。
15.根据权利要求12所述的外科钉仓,其中,随着所述击发构件从初始位置朝远侧被驱动,所述切割构件可移除地附接到所述击发构件,并且其中当所述击发构件回缩回到所述初始位置时,所述切割构件从所述击发构件移除以保持在所述仓体的所述近侧部分上的刀片储存停放部内。
16.根据权利要求12所述的外科钉仓,其中,所述切割构件在附接到所述击发构件之前保持在所述仓体的近侧端部上的刀片储存停放部内。
17.根据权利要求12所述的外科钉仓,其中,所述击发构件被螺纹接合到旋转驱动轴上,并且其中所述凸轮组件可滑动地轴颈连接在所述旋转驱动轴上。
18.一种外科器械,包括:
仓支撑件;
砧座,其中所述砧座和所述仓支撑件中的一者能够相对于所述砧座和所述仓支撑件中的另一者在打开位置和闭合位置之间运动;
I形梁击发构件,所述I形梁击发构件被构造成能够逐渐轴向地接合所述砧座和所述仓支撑件;以及
外科钉仓,所述外科钉仓包括:
仓体,所述仓体被构造成能够被可移除地支撑在所述仓支撑件中并且包括仓平台表面;
多个外科钉,所述多个外科钉可移除地储存在所述仓体中;
凸轮组件,所述凸轮组件被可动地支撑在所述仓体中并且被构造成能够与所述I形梁击发构件可操作地交接,使得所述I形梁击发构件在远侧方向上的轴向运动将所述凸轮组件从所述仓体中的起始位置驱动到结束位置;以及
切割构件,所述切割构件由所述凸轮组件可动地支撑在部署位置和凹陷位置之间,在所述部署位置,所述切割构件的至少一部分在所述仓体的所述仓平台表面上方延伸,在所述凹陷位置,所述切割构件的所述至少一部分位于所述仓平台表面下方。
19.根据权利要求18所述的外科器械,还包括:
细长轴组件,所述细长轴组件可操作地联接到所述仓支撑件;
外壳,所述外壳可操作地附接到所述细长轴组件;以及
马达,所述马达由所述外壳可操作地支撑并且与所述I形梁击发构件交接以轴向地驱动所述I形梁击发构件。
20.根据权利要求18所述的外科器械,其中,当所述仓体可操作地安置在所述仓支撑件中时,所述切割构件通过所述I形梁击发构件上的闩锁特征部保持在所述部署位置。
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WO2019186466A1 (en) | 2019-10-03 |
JP2023175948A (ja) | 2023-12-12 |
US10973520B2 (en) | 2021-04-13 |
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CN112236089B (zh) | 2024-03-15 |
EP3545861A2 (en) | 2019-10-02 |
EP3545861A3 (en) | 2019-12-04 |
US20190298351A1 (en) | 2019-10-03 |
JP2021519148A (ja) | 2021-08-10 |
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