CN112839596B - 用于外科缝合器砧座的制造技术 - Google Patents
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Abstract
本发明公开了制造用于外科缝合器的砧座的方法。在各种布置结构中，这些方法包括通过轧制、挤出、金属注射成型或电化学加工来形成砧座主体。通过机加工或在金属注射成型工艺或电化学加工工艺期间在砧座主体中形成初步钉成形凹坑构型。使用另一个制造步骤(诸如压印或锻造)为钉成形凹坑提供最终构型。
Description
背景技术
本发明涉及外科器械，并且在各种布置结构中，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它们一起使用的钉仓。
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为电动外科缝合系统的透视图；
图2为图1的电动外科缝合系统的可互换外科轴组件的透视图；
图3为图1的电动外科缝合系统的柄部组件的多个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为图2的可互换外科轴组件的端部执行器部分的另一个局部透视图，其中该端部执行器的钳口处于打开位置；
图7为图6的端部执行器和可互换外科轴组件的一部分的另一个透视图；
图8为远侧闭合构件实施方案的透视图；
图9为图8的远侧闭合构件实施方案的端视图；
图10为图7的端部执行器和可互换外科轴组件的一部分的侧正视图，其中该可互换外科轴组件的砧座和闭合构件处于完全打开位置；
图11为沿图10中的线11-11截取的图10的端部执行器和闭合构件的剖视图；
图12为图11的端部执行器和可互换外科轴组件的一部分的侧正视图，其中砧座和闭合构件处于闭合位置；
图13为沿图12中的线13-13截取的图12的砧座和闭合构件的剖视图；
图14为图13的端部执行器和可互换外科轴组件的一部分的侧正视图，其中该可互换外科轴组件的砧座和闭合构件处于“过度闭合”位置；
图15为沿图14的线15-15截取的图14的端部执行器和闭合构件的剖视图；
图16为另一个端部执行器和可互换外科轴组件的一部分的透视图，其中该可互换外科轴组件的砧座处于打开位置；
图17为图16的端部执行器和可互换外科轴组件的一部分的侧正视图，其中该可互换外科轴组件的砧座和闭合构件处于完全打开位置；
图18为沿图17中的线18-18截取的图17的端部执行器和闭合构件的剖视图；
图19为图17的端部执行器和可互换外科轴组件的一部分的侧正视图，其中该可互换外科轴组件的砧座和闭合构件处于闭合位置；
图20为沿图19中的线20-20截取的图19的端部执行器和闭合构件的剖视图；
图21为图19的端部执行器和可互换外科轴组件的一部分的侧正视图，其中该可互换外科轴组件的砧座和闭合构件处于过度闭合位置；
图22为沿图21中的线22-22截取的图21的端部执行器和闭合构件的剖视图；
图23为另一个远侧闭合构件实施方案的端视图；
图24为另一个端部执行器和另一个可互换外科轴组件的一部分的侧正视图，其中该可互换外科轴组件的砧座和闭合构件处于打开位置；
图25为沿图24中的线25-25截取的图24的端部执行器和闭合构件的剖视图；
图26为图24的端部执行器和可互换外科轴组件的侧正视图，其中该可互换外科轴组件的砧座和闭合构件处于闭合位置；
图27为沿图26中的线27-27截取的图26的端部执行器和闭合构件的剖视图；
图28为图24的端部执行器和可互换外科轴组件的侧正视图，其中该可互换外科轴组件的砧座和闭合构件处于过度闭合位置；
图29为沿图28中的线29-29截取的图28的端部执行器和闭合构件的剖视图；
图30为另一个闭合构件实施方案的端视图；
图31为另一个端部执行器和另一个可互换外科轴组件的一部分的侧正视图，其中该可互换外科轴组件的砧座和闭合构件处于闭合位置；
图32为图31的可互换外科轴组件的端部执行器的另一个侧正视图，其中该可互换外科轴组件的砧座和闭合构件处于“过度闭合”位置；
图33为图31的端部执行器和闭合构件的一部分的放大侧正视图，其中砧座处于闭合位置；
图34为图32的端部执行器和闭合构件的一部分的另一个放大侧正视图，其中砧座处于过度闭合位置；
图35为另一个端部执行器和另一个可互换外科轴组件的一部分的侧正视图，其中该可互换外科轴组件的砧座和闭合构件处于闭合位置；
图36为图35的端部执行器和闭合构件的一部分的放大侧正视图，其中砧座处于闭合位置；
图37为图35的可互换外科轴组件的端部执行器的另一个侧正视图，其中该可互换外科轴组件的砧座和闭合构件处于过度闭合位置；
图38为图37的端部执行器和闭合构件的一部分的另一个放大侧正视图，其中砧座处于过度闭合位置；
图39为被构造成能够形成柔性外科钉线的先前外科钉仓的透视图；
图40为通过图39的外科钉仓在组织中形成的外科钉线的顶视图；
图41为先前外科钉实施方案的侧正视图；
图42为另一个先前外科钉实施方案的侧正视图；
图43为先前砧座的剖视图；
图44为用扫描电镜拍摄的图43的先前砧座的焊接接头的横截面的照片；
图45为在其中形成钉成形凹坑之前的图61和图62的先前砧座的一部分的剖视图；
图46为在其中压印了钉成形凹坑之后的图45的先前砧座的另一个剖视图；
图47为用扫描电镜拍摄的图43的先前砧座的横截面的照片；
图48为用扫描电镜拍摄的图43的先前砧座的一部分的横截面的另一张照片；
图49为用扫描电镜拍摄的图43的先前砧座的一部分的横截面的另一张照片；
图50为用扫描电镜拍摄的图43的先前砧座的一部分的横截面的另一张照片；
图51为用扫描电镜拍摄的图43的先前砧座的一部分的横截面的另一张照片；
图52为用扫描电镜拍摄的图43的先前砧座的钉成形下表面的一部分的另一张照片；
图53为用扫描电镜拍摄的图52的先前砧座的钉成形凹坑的一部分的另一张照片；
图54为用扫描电镜拍摄的图53的钉成形凹坑的底部表面的一部分的另一张照片；
图55为用于形成外科缝合器砧座的方法的示意图；
图56为使用图55的方法形成的另一个砧座的一部分的剖视图；
图57为使用图55的方法形成的完成的砧座的一部分的另一个剖视图；
图58为在施加压印动作之前的图56的砧座的钉成形凹坑剖视图；
图59为在施加压印动作之后的图58的钉成形凹坑的另一个剖视图；
图60为用于形成外科缝合器砧座的另一种方法的示意图；
图61为在施加压印动作之前使用图60的方法形成的另一个砧座的钉成形凹坑的剖视图；
图62为图61的钉成形凹坑布置的顶视图；
图63为在施加压印动作之后的图61的钉成形凹坑的另一个剖视图；
图64为图63的钉成形凹坑布置的顶视图；
图65为用于形成外科缝合器砧座的另一种方法的示意图；
图66为用于形成外科缝合器砧座的另一种方法的示意图；
图67为用于形成外科缝合器砧座的另一种方法的示意图；
图68为用于形成外科缝合器砧座的另一种方法的示意图；
图69为用于形成外科缝合器砧座的另一种方法的示意图；
图70为用于形成外科缝合器砧座的另一种方法的示意图；
图71为用于形成外科缝合器砧座的另一种方法的示意图；并且
图72为用于形成外科缝合器砧座的另一种方法的示意图。
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“METHOD FOR FAbricating SURGICAL STAPLER ANVILS”(代理人案卷号END8577USNP/180088m)的美国专利申请序列号________；
-名称为“REINFORCED DEFORMABLE ANVIL TIP FOR SURGICAL STAPLER ANVIL”(代理人案卷号END8578USNP/180393)的美国专利申请序列号________；
-名称为“SURGICAL STAPLER ANVILS WITH STAPLE DIRECTING PROTRUSIONS ANDTISSUE STABILITY FEATURES”(代理人案卷号END8579USNP/180089)的美国专利申请序列号________；
-名称为“SURGICAL STAPLING DEVICES WITH IMPROVED CLOSURE MEMBERS”(代理人案卷号END8581USNP/180091)的美国专利申请序列号________；
-名称为“SURGICAL STAPLER ANVILS WITH TISSUE STOP FEATURES CONFIGUREDTO AVOID TISSUE PINCH”(代理人案卷号END8582USNP/180092)的美国专利申请序列号________；
-名称为“METHOD FOR OPERATING A POWERED ARTICULATABLE SURGICALINSTRUMENT”(代理人案卷号END8583USNP/180093M)的美国专利申请序列号________；
-名称为“SURGICAL INSTRUMENTS WITH PROGRESSIVE JAW CLOSUREARRANGEMENTS”(代理人案卷号END8584USNP/180094)的美国专利申请序列号________；
-名称为“POWERED SURGICAL INSTRUMENTS WITH CLUTCHING ARRANGEMENTS TOCONVERT LINEAR DRIVE MOTIONS TO ROTARY DRIVE MOTIONS”(代理人案卷号END8585USNP/180095)的美国专利申请序列号________；
-名称为“POWERED ARTICULATABLE SURGICAL INSTRUMENTS WITH CLUTCHING ANDLOCKING ARRANGEMENTS FOR LINKING AN ARTICULATION DRIVE SYSTEM TO A FIRINGDRIVE SYSTEM”(代理人案卷号END8586USNP/180096)的美国专利申请序列号________；
-名称为“ARTICULATABLE MOTOR POWERED SURGICAL INSTRUMENTS WITHDEDICATED ARTICULATION MOTOR ARRANGEMENTS”(代理人案卷号END8587USNP/180097)的美国专利申请序列号________；
-名称为“SWITCHING ARRANGEMENTS FOR MOTOR POWERED ARTICULATABLESURGICAL INSTRUMENTS”(代理人案卷号END8588USNP/180098)的美国专利申请序列号________；以及
-名称为“SURGICAL STAPLER ANVILS”(代理人案卷号END8581USDP/180099D)的美国专利申请序列号________。
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，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，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，美国专利申请公布2018/-01686；
-名称为“SURGICAL END EFFECTORS AND FIRING MEMBERS THEREOF”的美国专利申请序列号15/386,209，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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，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；
-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；
-名称为“STAMPED STAPLES AND STAPLE CARTRIDGES USING THE SAME”的美国专利申请序列号15/191,834；
-名称为“STAPLE CARTRIDGE COMPRISING OVERDRIVEN STAPLES”的美国专利申请序列号15/191,788；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。
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；
-名称为“SURGICAL FASTENER”的美国设计专利申请序列号29/569,227；
-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；
-名称为“MODULAR SURGICAL STAPLING SYSTEM COMPRISING A DISPLAY”的美国专利申请序列号15/089,321；
-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；
-名称为“SURGICAL INSTRUMENT HANDLE ASSEMBLY WITH RECONFIGURABLE GRIPPORTION”的美国专利申请序列号15/089,263；
-名称为“ROTARY POWERED SURGICAL INSTRUMENT WITH MANUALLY ACTUATABLEBAILOUT SYSTEM”的美国专利申请序列号15/089,262；
-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；
-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；
-名称为“SURGICAL STAPLING SYSTEM COMPRISING A SHIFTABLE TRANSMISSION”的美国专利申请序列号15/089,258；
-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；
-名称为“SURGICAL STAPLING SYSTEM COMPRISING A CONTOURABLE SHAFT”的美国专利申请序列号15/089,284；
-名称为“SURGICAL STAPLING SYSTEM COMPRISING A TISSUE COMPRESSIONLOCKOUT”的美国专利申请序列号15/089,295；
-名称为“SURGICAL STAPLING SYSTEM COMPRISING AN UNCLAMPING LOCKOUT”的美国专利申请序列号15/089,300；
-名称为“SURGICAL STAPLING SYSTEM COMPRISING A JAW CLOSURE LOCKOUT”的美国专利申请序列号15/089,196；
-名称为“SURGICAL STAPLING SYSTEM COMPRISING A JAW ATTACHMENT LOCKOUT”的美国专利申请序列号15/089,203；
-名称为“SURGICAL STAPLING SYSTEM COMPRISING A SPENT CARTRIDGELOCKOUT”的美国专利申请序列号15/089,210；
-名称为“SURGICAL INSTRUMENT COMPRISING A SHIFTING MECHANISM”的美国专利申请序列号15/089,324；
-名称为“SURGICAL STAPLING INSTRUMENT COMPRISING MULTIPLE LOCKOUTS”的美国专利申请序列号15/089,335；
-名称为“SURGICAL STAPLING INSTRUMENT”的美国专利申请序列号15/089,339；
-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；
-名称为“SURGICAL STAPLING SYSTEM COMPRISING A GROOVED FORMING POCKET”的美国专利申请序列号15/089,304；
-名称为“ANVIL MODIFICATION MEMBERS FOR SURGICAL STAPLERS”的美国专利申请序列号15/089,331；
-名称为“STAPLE CARTRIDGES WITH ATRAUMATIC FEATURES”的美国专利申请序列号15/089,336；
-名称为“CIRCULAR STAPLING SYSTEM COMPRISING AN INCISABLE TISSUESUPPORT”的美国专利申请序列号15/089,312；
-名称为“CIRCULAR STAPLING SYSTEM COMPRISING ROTARY FIRING SYSTEM”的美国专利申请序列号15/089,309；以及
-名称为“CIRCULAR STAPLING SYSTEM COMPRISING LOAD CONTROL”的美国专利申请序列号15/089,349。
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；
-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；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。
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；
-名称为“SURGICAL INSTRUMENTS WITH MULTIPLE LINK ARTICULATIONARRANGEMENTS”的美国专利申请序列号15/019,228；
-名称为“SURGICAL INSTRUMENT ARTICULATION MECHANISM WITH SLOTTEDSECONDARY CONSTRAINT”的美国专利申请序列号15/019,196；
-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；
-名称为“SURGICAL INSTRUMENTS WITH NON-SYMMETRICAL ARTICULATIONARRANGEMENTS”的美国专利申请序列号15/019,215；
-名称为“ARTICULATABLE SURGICAL INSTRUMENTS WITH SINGLE ARTICULATIONLINK ARRANGEMENTS”的美国专利申请序列号15/019,227；
-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；
-名称为“ARTICULATABLE SURGICAL INSTRUMENTS WITH OFF-AXIS FIRING BEAMARRANGEMENTS”的美国专利申请序列号15/019,230；以及
-名称为“SURGICAL INSTRUMENTS WITH CLOSURE STROKE REDUCTIONARRANGEMENTS”的美国专利申请序列号15/019,245。
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；
-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；
-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；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。
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；
-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；
-名称为“MOVABLE FIRING BEAM SUPPORT ARRANGEMENTS FOR ARTICULATABLESURGICAL INSTRUMENTS”的美国专利申请序列号14/742,914；
-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；
-名称为“DUAL ARTICULATION DRIVE SYSTEM ARRANGEMENTS FOR ARTICULATABLESURGICAL INSTRUMENTS”的美国专利申请序列号14/742,885；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。
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，现为美国专利申请公布2016/0256184；
-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，现为美国专利申请公布2016/0256153；
-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，现为美国专利申请公布2016/0256187；
-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2016/0256186；
-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，现为美国专利申请公布2016/0256155；
-名称为“SMART SENSORS WITH LOCAL SIGNAL PROCESSING”的美国专利申请序列号14/640,837，现为美国专利申请公布2016/0256163；
-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，现为美国专利申请公布2016/0256162；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，现为美国专利申请公布2016/0249919；
-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，现为美国专利申请公布2016/0249915；
-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，现为美国专利申请公布2016/0249908；
-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，现为美国专利申请公布2016/0249927；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，现为美国专利申请公布2016/0249917。
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，现为美国专利申请公布2016/0174977；
-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，现为美国专利申请公布2016/0174978；
-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，现为美国专利申请公布2016/0174976；
-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，现为美国专利申请公布2016/0174983；
-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，现为美国专利申请公布2016/0174975；
-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，现为美国专利申请公布2016/0174973；
-名称为“SURGICAL INSTRUMENT ASSEMBLY COMPRISING A FLEXIBLEARTICULATION SYSTEM”的美国专利申请序列号14/574,493；现为美国专利申请公布2016/0174970；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，现为美国专利申请公布2016/0174971。
本申请的申请人拥有2013年3月1日提交的下列专利申请，这些专利申请各自全文以引用方式并入本文：
-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2013年3月14日提交的下列专利申请，这些专利申请各自全文以引用方式并入本文：
-名称为“ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE”的美国专利申请序列号13/803,097，现为美国专利申请公布2014/0263542；
-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，现为美国专利申请公布2014/0263564；
-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，现为美国专利申请公布2014/0263538；
-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，现为美国专利申请公布2014/0263565；
-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，现为美国专利申请公布2014/0277017。
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，现为美国专利申请公布2014/0263539。
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，现为美国专利申请公布2015/0272581；
-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，现为美国专利申请公布2015/0272574；
-名称为“MODULAR POWERED SURGICAL INSTRUMENT WITH DETACHABLE SHAFTASSEMBLIES”的美国专利申请序列号14/226,075，现为美国专利申请公布2015/0272579；
-名称为“FEEDBACK ALGORITHMS FOR MANUAL BAILOUT SYSTEMS FOR SURGICALINSTRUMENTS”的美国专利申请序列号14/226,093，现为美国专利申请公布2015/0272569；
-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，现为美国专利申请公布2015/0272578；
-名称为“SURGICAL INSTRUMENT COMPRISING INTERACTIVE SYSTEMS”的美国专利申请序列号14/226,097，现为美国专利申请公布2015/0272570；
-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2015/0272572；
-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，现为美国专利申请公布2015/0277471；
-名称为“POWER MANAGEMENT THROUGH SEGMENTED CIRCUIT AND VARIABLEVOLTAGE PROTECTION”的美国专利申请序列号14/226,076，现为美国专利申请公布2015/0280424；
-名称为“SURGICAL STAPLING INSTRUMENT SYSTEM”的美国专利申请序列号14/226,111，现为美国专利申请公布2015/0272583；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2014年9月5日提交并且其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，现为美国专利申请公布2016/0066912；
-名称为“ADJUNCT WITH INTEGRATED SENSORS TO QUANTIFY TISSUECOMPRESSION”的美国专利申请序列号14/479,119，现为美国专利申请公布2016/0066914；
-名称为“MONITORING DEVICE DEGRADATION BASED ON COMPONENT EVALUATION”的美国专利申请序列号14/478,908，现为美国专利申请公布2016/0066910；
-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，现为美国专利申请公布2016/0066909；
-名称为“POLARITY OF HALL MAGNET TO DETECT MISLOADED CARTRIDGE”的美国专利申请序列号14/479,110，现为美国专利申请公布2016/0066915；
-名称为“SMART CARTRIDGE WAKE UP OPERATION AND DATA RETENTION”的美国专利申请序列号14/479,098，现为美国专利申请公布2016/0066911；
-名称为“MULTIPLE MOTOR CONTROL FOR POWERED MEDICAL DEVICE”的美国专利申请序列号14/479,115，现为美国专利申请公布2016/0066916；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2014年4月9日提交并且其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，现为美国专利申请公布2014/0305987；
-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，现为美国专利申请公布2014/0305989；
-名称为“SURGICAL INSTRUMENT SHAFT INCLUDING SWITCHES FOR CONTROLLINGTHE OPERATION OF THE SURGICAL INSTRUMENT”的美国专利申请序列号14/248,595，现为美国专利申请公布2014/0305988；
-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“TRANSMISSION ARRANGEMENT FOR A SURGICAL INSTRUMENT”的美国专利申请序列号14/248,591，现为美国专利申请公布2014/0305991；
-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，现为美国专利申请公布2014/0305994；
-名称为“POWERED SURGICAL STAPLER”的美国专利申请序列号14/248,587，现为美国专利申请公布2014/0309665；
-名称为“DRIVE SYSTEM DECOUPLING ARRANGEMENT FOR A SURGICALINSTRUMENT”的美国专利申请序列号14/248,586，现为美国专利申请公布2014/0305990；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，现为美国专利申请公布2014/0305992。
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，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，外科器械在许多取向和方位中使用，并且这些术语并非是限制性的和/或绝对的。
提供各种示例性装置和方法以用于执行腹腔镜式和微创外科手术。然而，读者将容易理解，本文所公开的各种方法和装置可用于多种外科手术和应用中，包括例如与开放式外科手术结合。继续参阅本具体实施方式，读者将进一步理解，本文所公开的各种器械能够以任何方式插入体内，诸如通过自然腔道、通过成形于组织中的切口或穿刺孔等。器械的工作部分或端部执行器部分可直接插入患者体内或者可通过具有工作通道的进入装置插入，外科器械的端部执行器和细长轴可通过所述工作通道推进。
外科缝合系统可包括轴和从轴延伸的端部执行器。端部执行器包括第一钳口和第二钳口。第一钳口包括钉仓。钉仓能够插入到第一钳口中并且能够从第一钳口移除；然而，设想到其中钉仓不能够从第一钳口移除或至少能够易于从第一钳口替换的其他实施方案。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压缩并抵靠平台夹持。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。钉腔被布置成六个纵向排。在纵向狭槽的第一侧上定位三排钉腔，并且在纵向狭槽的第二侧上定位三排钉腔。钉腔和钉的其他布置结构也是可能的。
钉由仓体中的钉驱动器支撑。驱动器能够在第一或非击发位置和第二或击发位置之间运动，以从钉仓射出钉。驱动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弹性构件，这些弹性构件被构造成能够抓持仓体并将保持器保持至仓体。驱动器能够通过滑动件在其非击发位置与其击发位置之间运动。滑动件能够在与近侧端部相邻的近侧位置和与远侧端部相邻的远侧位置之间运动。滑动件包括多个斜坡表面，该斜坡表面被构造成能够朝向砧座在驱动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。随着击发构件朝远侧推进，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获的组织的刀。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与其可操作地联接的外科端部执行器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“容纳”或包含在外壳中，或者各种部件可与外壳“相关联”。在此类实例中，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 ROTATABLESTAPLE DEPLOYMENT ARRANGEMENTS”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，并且可互换轴组件具有不同的轴长度、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/或动作)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结构的那些组件。此外，该端部执行器、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紧固件来紧固组织。例如，包括可移除地被存储在其中的多个紧固件的紧固件仓能够可移除地插入轴组件的端部执行器中和/或附接到轴组件的端部执行器。
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示出了从外壳1012或柄部1014脱离的可互换轴组件1200。如图3中可见，柄部1014可包括一对可互连的柄部外壳段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。在例示的布置结构中，柄部外壳段1016和1018配合形成可被临床医生抓握和操纵的手枪式握把部1019。如将在下文进一步详细地讨论，柄部1014在其中可操作地支撑多个驱动系统，这些驱动系统被配置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可操作地附接或联接到其上的可互换轴组件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枢转地联接到外壳1014。此类布置结构使闭合触发器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结构(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的闭合连接组件1034。如图3中可见，闭合连接组件1034可包括经由销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可包括释放按钮组件1062，该释放按钮组件具有在其上形成的朝远侧突出的锁定棘爪1064。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和释放布置结构。
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，所述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、环绕霍尔效应传感器的磁场变化。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，该驱动系统被配置成能够向附接到其上的可互换轴组件的对应部分施加击发动作。击发驱动系统1080在本文中也可被称为“第二驱动系统”。击发驱动系统1080可以采用定位在柄部1014的手枪式握把部1019中的电动马达1082。在各种形式中，马达1082例如可为具有约25,000RPM的最大转速的DC有刷驱动马达。在其他布置结构中，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的电路板组件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/或可再充电的。
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啮合接合地安装在能够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，该开关可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，该传感器被配置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，并具有从其突出的枢转臂1136。参见图21。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。在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的对应驱动齿轮1086啮合接合。至少一种形式还包括能够手动致动的“应急”组件1140，该“应急”组件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。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手动地回缩驱动构件1120，以使驱动构件1120沿近侧方向“PD”做棘轮运动。名称为“POWEREDSURGICAL CUTTING AND STAPLING APPARATUS WITH MANUALLY RETRACTABLE FIRINGSYSTEM”的美国专利号8608045公开了也可与本文所公开的各种器械一起使用的应急结构和其他部件、布置结构和系统。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将端部执行器1300相对于轴轴线SA可释放地保持在期望的位置。有关端部执行器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部的示例可见于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。2013年3月14日提交的名称为“ARTICULATABLE SURGICALINSTRUMENT COMPRISING AN ARTICULATION LOCK”的美国专利申请序列号13/803,086的全部公开内容据此以引用方式并入本文。如图4中可见，可互换轴组件1200还可包括由喷嘴部分1202和1203构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1211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，该凸耳狭槽适于在其中安装地支撑上安装连接件1274。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中包括枢轴承窝1276，该枢轴承窝适于在其中可旋转地接收枢轴销1292，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在细长通道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垂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可由关节运动系统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2112上形成偏置附接凸耳2114。枢轴孔2116形成在偏置附接凸耳2114中，并且被构造成能够在其中枢转地接收形成在关节运动连接件3020的近侧端部2122上的近侧连接件销2124。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在其中枢转地接收形成在细长通道1310的近侧端部部分1312上的通道销1317。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相对于脊组件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，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15/635631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可包括近侧端部1211，该近侧端部可旋转地支撑在底座1240中。在一种布置结构中，例如，脊1210的近侧端部1211具有形成在其上的螺纹1214，以便通过螺纹附接到被构造成能够支撑在底座1240内的脊轴承1216。参见图4。此类布置结构有利于将脊柱1210可旋转地附接到底座1240，使得脊柱1210可以相对于底座1240选择性地围绕轴轴线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的一对朝近侧突出的钩1252(图2和图3)，所述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以相对于闭合梭动件旋转。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。此类布置结构用于将近侧闭合管段3010附接到闭合梭动件1250，以与闭合梭动件一起轴向行进，同时使得近侧闭合管段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管段3010上并且用于沿近侧方向“PD”偏压近侧闭合管段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或近侧闭合管段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，闭合管组件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管组件3000来打开砧座2000，这使得端部执行器闭合套管与砧座2000交接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轴脊1210内轴向行进。击发构件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的近侧端部上的插片1912。纵向狭槽1223和近侧端部插片1912可被设定尺寸并被构造成能够允许该纵向狭槽和该近侧端部插片之间的相对运动并且可包括滑动接头。滑动接头1914可允许击发驱动装置的中间击发轴部分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做关节运动。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的近侧侧壁与插片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并且包括上部砧座接合插片1924和下部通道接合插片1926，该刀部分包括刀片或组织切割刃1922。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。
如图4中可见，轴组件1200还包括可旋转地接收在闭合管1260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，以用于在其中接收向外突出的致动销。在各种情况下，该致动销延伸穿过狭槽进入设置在锁定套筒中的纵向狭槽，以在锁定套筒与关节运动驱动器接合时有利于该锁定套筒轴向运动。旋转扭簧1420被构造成能够接合切换筒1500上的凸台和喷嘴外壳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圆周开口1506，所述开口可被构造成能够接收从喷嘴半部1202、1203延伸的圆周安装座，并且允许切换筒1500和近侧喷嘴1201之间的相对旋转但不允许平移。安装座还延伸穿过待坐置在脊轴1210中的凹陷部1219中的近侧闭合管段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和锁定套筒在其接合位置和脱离位置之间的旋转。在一种结构中，切换筒1500的旋转可与闭合管或闭合构件的轴向推进关联。因此，闭合系统的致动本质上可按下列文献中进一步详细描述的各种方式，将关节运动驱动系统与击发驱动系统可操作地接合，以及使这两个系统脱离接合：美国专利申请序列号13/803,086，和名称为“SURGICAL INSTRUMENT COMPRISING ASENSOR SYSTEM”的美国专利9,913,642，这些文献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，闭合管段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。
同样如图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可包括近侧连接器凸缘1604和远侧连接器凸缘，该近侧连接器凸缘安装到从底座1240延伸的底座凸缘1242，该远侧连接器凸缘定位在限定在轴外壳中的狭槽内。近侧连接器凸缘1604可包括第一面，并且远侧连接器凸缘可包括第二面，该第二面与第一面相邻定位并能够相对于第一面运动。远侧连接器凸缘可围绕轴轴线SA相对于近侧连接器凸缘1604旋转。近侧连接器凸缘1604可包括限定在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凸缘的近侧侧面上，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。此类结构在保持近侧连接器凸缘1604与远侧连接器凸缘之间电接触的同时，允许这两个凸缘之间进行相对旋转。例如，近侧连接器凸缘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。在至少一个实例中，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可朝近侧延伸穿过底座安装凸缘1242中限定的连接器开口1243。参见图4。关于滑环组件1600的更多细节可见于例如美国专利申请序列号13/803,086、2013年3月13日提交的名称为“STAPLE CARTRIDGETISSUE THICKNESS SENSOR SYSTEM”的美国专利申请序列号13/800,067、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、美国专利申请序列号13/800,067和美国专利9,345,481各自据此全文以引用方式并入本文。
如上文所讨论，轴组件1200可包括近侧部分和远侧部分，该近侧部分可固定地安装到柄部1014，该远侧部分能够围绕纵向轴线旋转。可旋转远侧轴部分可如上文所讨论围绕滑环组件1600相对于近侧部分旋转。滑环组件1600的远侧连接器凸缘可定位在可旋转远侧轴部分内。而且，除上述以外，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，远侧连接器凸缘和切换筒1500可彼此同步地旋转。另外，切换筒1500可相对于远侧连接器凸缘在第一位置与第二位置之间旋转。切换筒1500处于其第一位置时，关节运动驱动系统可以可操作地与击发驱动系统脱离接合，因此，击发驱动系统的操作可以不使轴组件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，关节运动驱动系统能够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相对于远侧连接器凸缘运动。在各种实例中，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、优选地两个锥形附接部分1244，该锥形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的远侧附接凸缘部分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，从而在其中以坐置方式接收附接部分1244。如可在图22中进一步所见，轴附接凸耳1226形成在中间击发轴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，具有两个隔开并向下延伸的支脚1714。支脚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。此类布置结构有利于将锁定轭1712枢转附接到底座1240。锁定轭1712可包括两个朝近侧突出的锁凸耳1716，这两个锁凸耳被构造用于与框架1020的远侧附接凸缘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上的闩锁致动器组件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可通过将闩锁按钮沿远侧方向偏压而运动到解锁位置，这也使得锁定轭1712枢转成不再与框架1020的远侧附接凸缘1700保持接合。当锁定轭1712与框架1020的远侧附接凸缘1700“保持接合”时，锁凸耳1716保持坐置在远侧附接凸缘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1306并将目标组织夹紧就位以供切割与缝合。在这种实例中，已完全致动第一驱动系统1030。在目标组织已被夹紧在端部执行器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。当闭合梭动件1250处于未致动位置(即，第一驱动系统1030未致动并且砧座1306打开)时，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上的锁定凸耳部分1256。但是，当闭合梭动件1250运动到致动位置(即，第一驱动系统1030被致动并且砧座1306处于闭合位置)时，锁定轭1712受到阻碍而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引起其朝远侧枢转的方式受到碰撞或发生接触，则锁定轭1712上的锁定钩1718将接触闭合梭动件1250上的锁定凸耳1256，并防止锁定轭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的远侧附接凸缘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。然后临床医生可沿垂直于轴轴线SA的安装轴线运动轴组件1200，以使附接部分1244坐置成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1222上的轴附接凸耳1226也将坐置在能够纵向运动的驱动构件1120的支架1126中，并且第二闭合连接件1038上销1037的部分将坐置在闭合轭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的至少五个系统能够可操作地与柄部1014的至少五个对应系统联接。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的闭合管附接轭1250可与第二闭合连接件1038上的销1037接合。另一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被构造成用于与柄部控制板1100上的对应电连接器1800配合接合。有关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和美国专利申请序列号14/226,142，这两者各自的全部公开内容此前以引用方式并入本文。第五系统可由用于将轴组件1200可释放地锁定到柄部1014的闩锁系统组成。
现参见图5至图7，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被可运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地枢转行进。在例示的布置结构中，枢轴构件或砧座耳轴2012横向延伸出砧座安装部分2010的每个侧向侧，以接收在形成在细长通道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在细长通道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7、图8和图9，在至少一种布置结构中，远侧闭合构件或端部执行器闭合管3050采用两个轴向偏置的近侧正钳口开口特征部3060和远侧正钳口开口特征部3062。在图7中，近侧正钳口开口特征部2060位于轴轴线SA的右侧(如工具组件的使用者所观察的角度)。正钳口开口特征部3060、3062被构造成能够与形成于砧座安装部分2010上的对应的释放区域3064、3066和阶梯部分交接，如在2017年6月28日提交的名称为“SURGICALINSTRUMENT WITH AXIALLY MOVABLE CLOSURE MEMBER”的美国专利申请序列号15/635,631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。可采用其他钳口开口布置结构。
图6和图7示出了包括细长砧座主体部分2002的砧座2000的一种形式，该细长砧座主体部分终止于被构造成能够与端部执行器闭合套管3050交接的安装部分2010以最小化端部执行器闭合管3050随着砧座2000从完全打开位置运动到闭合位置并最终运动到过度闭合位置所经受的合力的量。砧座主体部分2002包括钉成形下表面2004，该钉成形下表面具有形成在其中的一系列砧座成形凹坑(未示出)。细长狭槽2006延伸穿过主体部分2002和安装部分2010，以有利于刀部分或“击发构件”1920穿过其中。此外，砧座盖2030附接到砧座主体2002以覆盖狭槽2006。在各种情况下，砧座安装部分2010包括形成在其上的砧座凸轮表面2020。砧座凸轮表面2020被细长狭槽2006对分或以其他方式分开。如图6和图7中可见，砧座盖2030的近侧端部部分2032以对应于砧座凸轮表面2020的角度/取向的角度取向。图10和图11示出了处于完全打开位置的砧座2000。如图10中可见，当“第二钳口”或砧座2000处于其完全打开位置时，远侧或端部执行器闭合管3050处于其最近侧位置。当处于该位置时，形成在端部执行器闭合管3050的远侧端部3070上的凸轮表面3072不向凸轮闭合表面2020施加任何闭合力。随着端部执行器闭合管3050朝远侧运动，端部执行器闭合管3050上的凸轮表面3072接触砧座安装部分2010上的凸轮闭合表面2020和砧座盖2030的近侧端部部分2032上的对应闭合表面2034，以将砧座2000枢转到“闭合”位置。图12和图13示出了在砧座2000处于闭合位置时端部执行器闭合管3050和砧座2000的位置。
随着端部执行器闭合管3050继续朝远侧推进以向砧座施加附加的闭合动作，从而最终将砧座运动到“过度闭合”位置，端部执行器闭合管可经历显著的应力，这可随时间推移而发生，使端部执行器闭合管变得竖直地伸长(当从端部观察时)，或换句话讲，变成略微椭圆形的形状，这可最终导致失效或以其他方式不利地影响获得完全闭合位置的能力。其为轴向的，当薄壁管或圆柱体经受内部压力时，在管的壁中产生“环箍”和纵向应力。该环向应力作用于圆周并且垂直于圆柱体壁的轴线和半径。此类环向应力可计算为：
σh＝pd/(2t)，其中：
σh＝环向应力(MPa,psi)
p＝管或圆柱体中的内部压力(MPa,psi)
d＝管或圆柱体的内径(mm,in)
t＝管壁或圆柱体壁的厚度(mm,in)
已开发出具有各种管壁构型的端部执行器闭合管。此类管构型的示例在2016年12月21日提交的名称为“CLOSURE MEMBER ARRANGEMENTS FOR SURGICAL INSTRUMENTS”的美国专利申请序列号15/385,903中公开，该美国专利的全部公开内容据此以引用方式并入本文。
图8和图9示出了端部执行器闭合管3050的一种形式。闭合管3050包括外表面3074和内壁表面3076。在至少一种形式中，闭合管3050包括恒定内径ID和恒定外径OD以限定在闭合管3050或闭合管的被构造成能够与端部执行器钳口诸如砧座2000和细长通道1310交接的至少一部分的整个长度上均匀或恒定的壁厚度CT。
现在返回图12，在至少一种布置结构中，当砧座2000处于“闭合位置”时，当没有组织被夹紧在砧座2000与仓之间时，可在砧座主体2002的钉成形下侧2004与支撑在细长通道1310内的仓的仓平台表面之间观察到间隙距离“CD”。图13为沿图12中的线13-13截取的横跨闭合凸轮表面2020以及穿过端部执行器闭合管3050的远侧端部部分以及砧座安装部分2020和细长通道1310的近侧端部部分的剖视图。如该图中可见，通过端部执行器闭合管3050将各种闭合力CF施加到砧座2000和细长通道1310。例如，将闭合力CF施加到闭合凸轮表面2020和砧座盖2030的近侧端部部分2032上以及施加到细长通道1310上。
在图6至图15所示的示例中，砧座安装部分2020形成为建立多个离散的负载传递位置，所述多个离散的负载传递位置被构造成能够当端部执行器闭合管3050处于对应于砧座2000的闭合位置的位置时，由端部执行器闭合管3050的内表面3076接触。在至少一种布置结构中，至少两个离散的负载传递位置位于竖直平面VP的每一侧上，当砧座2000处于闭合位置时，该竖直平面对分砧座2000。例如，在图13中，第一右负载传递位置或边缘2070R、第二右负载传递位置或边缘2072R、第三右负载传递位置或边缘2074R以及第四右负载传递位置或边缘2076R形成在竖直平面VP的右侧上。类似地，第一左负载传递位置或边缘2070L、第二左负载传递位置或边缘2072L、第三左负载传递位置或边缘2074L和第四左负载传递位置或边缘2076L形成在竖直平面VP的左侧上。如在该上下文中所用，术语“至少两个离散的负载传递位置”意指负载传递位置相对于彼此形成，使得在砧座安装部分2010的在负载传递位置之间延伸的部分与端部执行器闭合管3050的内表面3076之间形成空间或间隙。
例如，第一间隙量CR1在端部执行器闭合管3050的内表面3076之间形成，在第一右负载传递位置2070R与第二右负载传递位置2072R之间延伸。第二间隙量CR2在端部执行器闭合管3050的内表面之间形成，在第二右负载传递位置2072R与第三右负载传递位置2074R之间延伸。第三间隙量CR3在第三右负载传递位置2074R与第四右负载传递位置2076R之间形成。第一间隙量CL1在端部执行器闭合管的内表面之间形成，在第一左负载传递位置2070L与第二左负载传递位置2072L之间延伸。第二间隙量CL2在端部执行器闭合管的内表面3076之间形成，在第二左负载传递位置2072L与第三左负载传递位置2074L之间延伸。第三间隙量CL3在第三左负载传递位置2074L与第四左负载传递位置2076L之间形成。在至少一种布置结构中，施加到闭合凸轮表面2020以及砧座盖2030的近侧部分2032的闭合力CF可均匀地分布在第一右负载传递位置2070R和第一左负载传递位置2070L之间。同样，施加到细长通道1310的闭合力CF可以均匀地分布在例如第四右负载传递位置2076R和第四左负载传递位置2076L之间。
在至少一种布置结构中，至少两个右负载传递位置2070R、2072R和至少两个左负载传递位置2070L、2072L位于对分端部执行器1300的水平平面HP的一侧上。如图13所示，这两个右负载传递位置2070R、2072R位于竖直平面VP的与这两个左负载传递位置2070L、2072L相对的一侧上。同样在至少一种布置结构中，第三右负载传递位置2074R和第四右负载传递位置2076R位于水平平面HP的与第一右负载传递位置2070R和第二右负载传递位置2072R相对的一侧上。类似地，第三左负载传递位置2074L和第四左负载传递位置2076L位于水平平面HP的与第一左负载传递位置2070L和第二左负载传递位置2072L相对的一侧上。右负载传递位置2074R、2076R位于竖直平面VP的与两个左负载传递位置2074L、2076L相对的一侧上。如图6和图10中可见，负载传递位置可由扇形或释放区域2080、2082、2084形成，使得负载传递位置包括由邻接表面形成的拐角。设想了其他负载传递位置形状。
图14和图15示出了处于“过度闭合”状态的砧座2000和端部执行器闭合管3050，该“过度闭合”状态是在砧座2000已到达闭合位置之后端部执行器闭合管3050朝远侧进一步推进时产生的。在至少一个示例中，当砧座2000的主体部分2002的远侧端部部分2003与用细长通道1310可操作地支撑的钉仓的仓平台接触时，砧座2000处于“过度闭合状态”。参见图14。在砧座2000已到达闭合位置之后，端部执行器闭合管3050继续朝远侧推进可显著增加形成在端部执行器闭合管3050中的环向应力，这可导致端部执行器闭合管全然失效或竖直伸长，这可在用于将来的应用中时不利地影响砧座的适当闭合。如图15所示，第一右间隙量CR1和第一左间隙量CL1可各自具有位于水平平面HP的公共侧上的间隙宽度CW1。第二右间隙量CR2和第二左间隙量CL2各自跨越水平平面HP。换句话讲，第二右间隙量CR2的部分位于水平平面HP的每一侧上，并且第二左间隙量CL2的部分位于水平平面HP的每一侧上。
当端部执行器闭合管3050朝远侧运动到过度闭合位置时，形成位于竖直平面的每一侧上的至少两个离散的负载传递位置可减少在该端部执行器闭合管中形成的有害环向应力的量。当端部执行器闭合管3050朝远侧运动到过度闭合位置时，形成位于竖直平面的每一侧上的至少三个离散的负载传递位置还可减少在该端部执行器闭合管中形成的有害环向应力的量。当端部执行器闭合管3050朝远侧运动到过度闭合位置时，形成位于竖直平面的每一侧上的至少四个离散的负载传递位置还可减少在该端部执行器闭合管中形成的有害环向应力的量。此类布置结构使得端部执行器闭合管3050能够以如上所述的恒定壁厚度制成，这可降低与制造端部执行器闭合管相关联的制造成本。
图16至图22示出了另选的砧座2000'，除下述不同之外，该另选的砧座基本上与上述砧座2000相同。如图16中可见，砧座安装部分2010'形成有不被任何负载传递位置中断的连续弓形砧座凸轮作用表面2020'。图17和图18示出了处于完全打开位置的砧座2000'。如图17中可见，当“第二钳口”或砧座2000'处于其完全打开位置时，端部执行器闭合管3050'处于其最近侧位置。当处于该位置时，端部执行器闭合管3050'不向凸轮闭合表面2020'施加任何闭合力。
图23示出了端部执行器闭合管3050'的一种形式，除下文指出的差异外，该端部执行器闭合管可与上述端部执行器闭合管3050相同。端部执行器闭合管3050'包括外表面3074'和内壁表面3076'。在至少一种形式中，除了位于端部执行器闭合管3050'的顶部处的壁的区段As之外，闭合管3050'具有恒定的壁厚度WT1，该区段具有大于WT1的较厚的壁厚度WT2。此类布置结构形成单个负载传递位置2070'。
图19和图20示出了在砧座2000'处于闭合位置时端部执行器闭合管3050'和砧座2000'的位置。如图20中可见，当端部执行器闭合管3050'朝远侧运动时，端部执行器闭合管3050'上的负载传递位置2070'接触砧座盖2030的近侧部分2032上的凸轮表面2034。端部执行器闭合管3050'还接触对分端部执行器的竖直平面VP的每一侧上的细长通道1310的部分。负载传递位置2070'可横跨整个凸轮表面2034以接触竖直平面VP的每一侧上的凸轮表面2020'的上部部分，如图20所示。当处于图19和图20所示的闭合位置时，此类布置结构用于在端部执行器闭合管3050'的内表面3076'的对应部分与砧座安装部分2010'的凸轮表面2020'之间形成空间3077，如图20所示。空间3077各自从负载传递位置2070'和其中内表面3076'接触细长通道1310的区域(空间距离SD)延伸。因此，当砧座2000'运动到闭合位置时，存在位于水平平面HP的一侧上的离散的第一负载传递位置2070'和位于水平平面HP的相对侧上的两个离散的负载传递位置2072R'、2072L'位置。当砧座2000'处于闭合位置时，离散的第一负载传递位置2070'通过空间3077与离散的负载传递位置2072R'，2072L'中的每一者分开。参见图20。如在图20中也可见，负载传递位置2072R'、2072L'位于竖直平面VP的相对侧上。
图21和图22示出了当端部执行器闭合管3050'已使砧座2000'以过度闭合取向运动时端部执行器闭合管3050'与砧座2000'之间的相互关系。如图22中可见，当处于过度闭合位置时，端部执行器闭合管3050'接触砧座2000'和细长通道1310以形成离散的负载传递位置2070'，该离散的负载传递位置通过空间3079R、3079L与离散的负载传递位置2074R'、2074L'分开。离散的负载传递位置2074R'通过空间3081R与离散的负载传递位置2076R'分开，并且离散的负载传递位置2074L'通过空间3081L与离散的负载传递位置2076L'分开。因此，在该布置结构中，至少一个离散的负载传递位置(2070')跨越对分端部执行器的竖直平面VP，并且至少两个离散的负载传递位置跨越对分端部执行器的水平平面HP。此外，至少一个离散的负载传递位置位于水平平面HP的每一侧上，并且至少一个离散的负载传递位置位于竖直平面VP的每一侧上。负载传递位置以上述方式的此类布置结构可有助于防止端部执行器闭合管3050'的竖直伸长。
图24至图30示出了另选的砧座2000”，除下述不同之外，该另选的砧座基本上与上述砧座2000相同。如图24中可见，砧座安装部分2010”形成有弓形砧座凸轮作用表面2020”以及右凹口或凹陷部分和左凹口部分或凹陷部分2022”。图24和图25示出了处于完全打开位置的砧座2000”。如图24中可见，当“第二钳口”或砧座2000”处于其完全打开位置时，端部执行器闭合管3050”处于其最近侧位置。当处于该位置时，端部执行器闭合管3050”不向凸轮闭合表面2020”施加任何闭合力。图30示出了端部执行器闭合管3050”的一种形式，除下文指出的差异外，该端部执行器闭合管可与上述端部执行器闭合管3050相同。端部执行器闭合管3050”包括外表面3074”和内壁表面3076”。在至少一种形式中，闭合管3050”具有如图30所示布置的第一壁厚度WT1、第二壁厚度WT2、第三壁厚度WT3和第四壁厚度WT4。在至少一种布置结构中，例如，WT1<WT2<WT3≤WT4。在一些情况下，WT3>WT4。端部执行器闭合管3050”的具有对应于WT4的壁厚度的部分形成负载传递位置2070”。在例示的布置结构中，例如，负载传递位置2070”横跨对分端部执行器闭合管3050”的竖直平面VP。端部执行器闭合管3050”的具有壁厚度WT3的部分形成负载传递位置2072R”、2072L”。在如图30所示的至少一种布置结构中，负载传递位置2072R”、2072L”横跨对分端部执行器闭合管3050”的水平平面HP。
现在参见图26和图27，随着端部执行器闭合管3050”朝远侧运动，负载传递位置2070”接触砧座盖2030的近侧部分2032上的凸轮表面2034。负载传递位置2072R”、2072L”还接触砧座安装部分2010”的对应部分。另外，端部执行器闭合管3050”的部分形成负载传递位置2074R”、2074L”，这些负载传递位置接触细长通道1310的对应部分以使砧座2000”运动到图26和图27所示的闭合位置。当处于图26和图27所示的闭合位置时，此类布置结构用于在端部执行器闭合管3050”的内表面3076”的对应部分与砧座安装部分2010”的凸轮表面2020”之间形成空间3077”、3079”，如图27所示。空间3077”位于负载传递位置2070”和负载传递位置2072R”、2072L”之间。空间3079”位于负载传递位置2072R”、2072L”和负载传递位置2074R、2074L”之间，如图27所示。
图28和图29示出了当端部执行器闭合管3050”已使砧座2000”运动成过度闭合取向时端部执行器闭合管3050”与砧座2000”之间的相互关系。如图29中可见，除了负载传递位置2070”、2072R”、2072L”、2074R”、2074L”之外，离散的负载传递位置2076R”、2076L”由形成在砧座安装部分2010”上的凹陷部分2022”的边缘形成。此类离散的负载传递位置2076R”、2076L”通过对应的空间3081”与对应离散的负载传递位置2072R”、2072L”分开。提供负载传递位置以上述方式的此类结构可有助于防止端部执行器闭合管3050”的竖直伸长。
当使用本文所述类型和构造的端部执行器1300时，临床医生操纵第一钳口和第二钳口(具有可操作地安装在其中的外科钉仓的砧座2000和细长通道1310)，以将待切割和缝合的组织(“目标组织”)捕获在其间。如图5和图7中可见，例如，外科钉仓4000包括仓体4010，该仓体被构造成能够被可移除地支撑在细长通道1310中。仓体4010包括细长仓狭槽4016，该细长仓狭槽从近侧端部4012延伸穿过仓体4010到达远侧端部部分4014以使刀构件或击发构件1920能够穿过其中。仓体4010还在细长狭槽4016的每一侧上限定仓平台表面4020。多个钉腔4022在细长狭槽4016的每一侧上设置在仓体4010中。每个腔4022打开穿过平台表面4020以在其中可移除地支撑一个或多个外科钉。在至少一个仓布置结构中，在细长狭槽4016的每一侧上设置三排钉腔4022。这些排被成形为使得中心排中的钉相对于两个相邻外排中的钉交错。这些钉被支撑在钉驱动器上，这些钉驱动器可运动地支撑在每个钉腔内。在至少一些布置结构中，例如，钉驱动器被布置成当被与刀构件1920相关联的凸轮构件或凸轮作用部分接触时向上接触或“击发”。在一些布置结构中，楔形滑动件或凸轮作用滑动件可运动地支撑在仓体中，并且适于在刀构件1920穿过仓从仓体4010的近侧端部部分4012轴向部署到远侧端部部分4014时，轴向移位穿过仓体。楔形滑动件包括与每排钉腔相关联的凸轮作用构件或楔形件，以便连续地部署支撑在其中的钉驱动器。当凸轮接触钉驱动器时，驱动器在钉腔内被向上驱动，从而驱动支撑在其上的一个或多个钉离开钉腔并穿过夹紧的组织，驱动成与砧座的钉成形下表面成形接触。楔形滑动件或凸轮作用构件位于刀或者刀或击发构件1920的组织切割刃的远侧，使得组织在被组织切割刃切断之前被缝合。
当临床医生初始地将靶组织定位在砧座和钉仓之间时，重要的是靶组织被定位成使得刀不会切入目标组织中，除非目标组织首先被缝合。在先前的砧座布置结构中，组织止动件设置在砧座主体的近侧端部上，以防止目标组织朝近侧运动经过钉仓中的最近侧钉凹坑。此类组织止动件形成面对或面向端部执行器闭合管的远侧端部的陡近侧端部。随着闭合管朝远侧运动以使砧座闭合，从砧座和仓之间向外延伸的组织偶尔会变得不期望地别在或夹紧在组织止动件的近侧端部和端部执行器闭合管的远侧端部之间。下文所公开的示例被构造成能够当砧座以本文所述的各种方式运动到闭合位置和过度闭合位置时，使组织被夹紧在组织止动件和端部执行器闭合管之间的可能性最小化。
转到图7，例如，钉仓4000包括钉(未示出)，这些钉可移除地支撑或储存在最近侧钉腔4022P中的每个最近侧钉腔中，这些最近侧钉腔定位在细长狭槽4016的每一侧上的位于仓体4010中的多排钉腔4022中。在各种情况下，为了防止目标组织在最近侧钉腔4022P中的钉的近侧被夹紧，砧座2000包括两个组织止动构件2040，这两个组织止动构件向下突出经过砧座主体的每一侧上的钉成形下表面。当砧座处于闭合位置或处于过度闭合位置时，组织止动构件2040中的每个组织止动构件在仓体4010的每一侧上向下突出。图7示出了处于打开构型的砧座2000。如该图中可见，组织止动件2040中的每个组织止动件延伸到仓平台表面下方，以防止目标组织朝近侧延伸经过最近侧钉腔4022P中的钉。如图7、图31和图32中可见，在至少一种布置结构中，组织止动件2040与砧座主体部分2002形成一体。砧座主体部分2002和组织止动件2040的近侧端部略微延伸到形成于砧座安装部分2010上的对应凸轮作用表面2020上方。在例示的示例中，组织止动件2040的近侧端部被分段成上部近侧端部部分2042、下部近侧端部部分2043和底部近侧端部部分2044。参见图31和图32。如在图31和图32中也可见，成角度表面或倒角表面2045形成在砧座安装部分上的上部近侧端部部分2042与凸轮作用表面2020之间。成角度表面或倒角表面2046形成在下部近侧端部部分2043和凸轮作用表面2020之间，并且成角度表面或倒角表面2047形成在下部近侧端部部分2044和凸轮作用表面2020之间。在扇形或释放区域2080、2082、2084形成在砧座安装部分2010中的例示的布置结构中，倒角2045对应于释放区域2080。参见图33。下部近侧端部部分2043和伴随的倒角2046对应于释放区域2082，并且底部近侧端部部分2044和伴随的倒角2047对应于释放区域2084。
如上文所讨论，砧座2000通过能够轴向运动的端部执行器闭合管3050从完全打开位置运动到闭合位置和过度闭合位置。图31和图33示出了当砧座2000处于闭合位置时端部执行器闭合管3050相对于组织止动件2040的位置。如图33中可见，上近侧端部部分2042和伴随的倒角2045大致平行于端部执行器闭合管3050的远侧端部3051的对应部分。为了降低组织被无意地夹紧在组织止动件2040与端部执行器闭合管3050的远侧端部3051之间的可能性，组织止动件2040的下部近侧端部部分2043和底部近侧端部部分2044以及对应倒角2046和2047与端部执行器闭合管3050的远侧端部3051成一角度。这种布置结构具有增加组织止动件的部分与最可能遇到相邻组织的端部执行器闭合管之间的距离的实际效果。
图33为图31所示端部执行器的一部分的放大视图，其中砧座2000处于闭合位置。当处于该位置时，每个组织止动件2040的上部近侧端部部分2042被定位成距端部执行器闭合管3050的远侧端部3051第一组织距离TD1。每个组织止动件2040的底部近侧端部部分2044被定位成距端部执行器闭合管3050的远侧端部3051第二组织距离TD2。如该图中可见，TD2>TD1。图32和图34示出了处于过度闭合位置的砧座2000。每个组织止动件2040的上部近侧端部部分2042与端部执行器闭合管3050的远侧端部3051之间的第一组织距离TD1'仍略小于每个组织止动件2040的底部近侧端部部分2044与端部执行器闭合管3050的远侧端部3051之间的第二组织距离TD2'，这仍将降低其间夹紧组织的可能性。在至少一个示例中，TD2和/或TD2'可为大致万英寸至大致二十五万英寸。然而，可获得其他厚度。另外，包括倒角表面2045、2046和2047可有助于降低当砧座200运动到闭合位置和过度闭合位置时组织夹紧在组织止动件2040与端部执行器闭合管3050的远侧端部3051之间的可能性。本领域的普通技术人员将会知道，上述组织止动件构型也将与其他形式的端部执行器闭合管和闭合构件布置结构一起使用。
图35至图38示出了除与组织止动件5040相关的差异之外与上述砧座2000相同的另一个砧座实施方案5000。组织止动件5040可与组织止动件2040相同，不同的是每个组织止动件的近侧端部部分5042、5043、5044以及伴随的倒角5045、5046、5047大致平行于端部执行器闭合管5030的远侧端部5031。除下文讨论的差异外，端部执行器闭合管5050可与上述端部执行器闭合管3050相同。图35和图36示出了处于闭合位置的砧座5000。在该布置结构中，原本可易于夹紧组织的区域为端部执行器闭合管5050的底部近侧端部部分5044的边缘和远侧端部5031的面对部分。为了缓解和最小化这种可能性，释放区域5060形成在端部执行器闭合管5030的远侧端部5031中，该端部执行器闭合管面对组织止动件5040中的每一个组织止动件的底部近侧端部5044或换句话讲与其相对。在例示的示例中，每个释放区域5060包括弓形凹口5062，该弓形凹口形成在端部执行器闭合管5030的远侧端部5031的对应于每个组织止动件5040的底部近侧端部部分5044的部分中。在例示的布置结构中，例如，当端部执行器闭合管5050处于对应于砧座5000的闭合位置的位置时，组织止动件5040中的每个组织止动件的底部近侧端部部分5044终止于底部拐角5070，并且顶点或底部5064直接从底部拐角5070跨越。然而，可采用其他凹口形状。
图36为图35所示端部执行器的一部分的放大视图，其中砧座5000处于闭合位置。当处于该位置时，每个组织止动件5040的上部近侧端部部分5042、下部近侧端部部分5043和底部近侧端部部分5044被定位成距端部执行器闭合管5050的远侧端部3051第一组织距离TD1。每个组织止动件5040的底部近侧端部部分5044被定位成距端部执行器闭合管5050的远侧端部5051中的凹口5062的顶点或底部5064第二组织距离TD2。如该图中可见，TD2>TD1。图37和图38示出了处于过度闭合位置的砧座5000。每个组织止动件5040的底部近侧端部部分5044与端部执行器闭合管5050的远侧端部5051之间的第一组织距离TD1'仍小于每个组织止动件2040的底部近侧端部部分5044与端部执行器闭合管5050的远侧端部5051中的对应凹口5062的顶点5064之间的第二组织距离TD2'，这仍将降低其间夹紧组织的可能性。另外，包括倒角表面5045、5046和5047可有助于降低当砧座5000运动到闭合位置和过度闭合位置时在组织止动件5040与端部执行器闭合管5050的远侧端部5051之间夹紧组织的可能性。本领域的普通技术人员将会知道，上述组织止动件构型也将与其他形式的端部执行器闭合管和闭合构件布置结构一起使用。
图39示出了先前外科钉仓4000，该先前外科钉仓包括仓体4010，该仓体被构造成能够被可移除地支撑在细长通道1310中。仓体4010包括细长仓狭槽4016，该细长仓狭槽从近侧端部4012穿过仓体4010延伸到远侧端部部分4014以使得刀构件或击发构件1920(图5)能够穿过其中。仓体4010还在细长狭槽4016的每一侧上限定仓平台表面4020。参见图39。多个钉腔4022在细长狭槽4016的每一侧上设置在仓体4010中。每个腔4022打开穿过平台表面4020以在其中可移除地支撑一个或多个外科钉。在至少一个仓布置结构中，三排钉腔4022设置在细长狭槽4016的每一侧上。在例示的示例中，这些排被成形为使得中心排中的钉相对于两个相邻外排中的钉交错。这些钉被支撑在钉驱动器上，这些钉驱动器可运动地支撑在每个钉腔内。在至少一些布置结构中，例如，钉驱动器被布置成当被与刀构件1920相关联的凸轮构件或凸轮作用部分接触时向上接触或“击发”。在一些布置结构中，“楔形”滑动件或凸轮作用滑动件可运动地支撑在仓体4010中，并且适于随着刀构件1920穿过仓从仓体4010的近侧端部部分4012轴向部署到远侧端部部分4014而轴向移位穿过仓体4010。楔形滑动件包括与每排钉腔相关联的凸轮作用构件或“楔形件”，以便连续地部署支撑在其中的钉驱动器。随着对应的楔形件或凸轮接触钉驱动器时，驱动器在钉腔内被向上驱动，从而驱动支撑在其上的一个或多个钉离开钉腔并穿过夹紧的组织，并与端部执行器的面对砧座的钉成形下表面成形接触。楔形滑动件或凸轮作用构件位于刀或者刀或击发构件1920的组织切割刃的远侧，使得组织在被刀或击发构件上的组织切割刃切断之前被缝合。
钉线中的钉的布置结构和/或几何结构的变化可影响钉线的柔性和密封特性。例如，由线性对准钉构成的钉线可提供有限量的柔性或拉伸，因为钉线可在线性钉之间挠曲或拉伸。因此，钉线的有限部分(例如，钉之间的部分)是柔性的。由成角度取向的钉构成的钉线也可在钉之间挠曲或拉伸。然而，成角度取向的钉也能够旋转，这在钉线内提供附加的拉伸程度。例如，由成角度取向的钉构成的钉线可拉伸超过60％。在某些实例中，例如，由成角度取向的钉构成的钉线可拉伸至少25％或至少50％。例如，钉的布置结构包括钉的相对取向和钉之间的间距。例如，钉的几何结构包括钉的尺寸和形状。基于钉的布置结构和/或几何结构，钉线的柔性和密封特性可在纵向和/或侧向位置处改变。在某些实例中，希望在沿钉线的一个或多个位置处改变钉线的柔性和/或密封特性。例如，可希望使钉线或其一部分的柔性最大化。除此之外或另选地，可希望使钉线或其一部分的柔性最小化。也可希望使钉线或其一部分的密封特性最大化。除此之外或另选地，可希望使钉线或其一部分的密封特性最小化。
钉仓中钉腔的布置结构对应于钉仓所产生的钉线中的钉的布置结构。例如，钉仓中的钉腔的间距和相对取向对应于由钉仓产生的钉线中的钉的间距和相对取向。在各种实例中，钉仓可包括钉腔的布置结构，其被选择和/或设计成优化所得钉线的柔性和/或密封特性。例如，外科医生可基于待执行的外科手术和/或外科手术期间待治疗的组织的特性来选择具有特定布置结构的钉腔的钉仓。
在某些实例中，可希望产生具有不同钉图案的钉线。钉线可包括用于其第一部分的第一钉图案和用于其第二部分的第二钉图案。第一图案和第二图案可纵向偏置。例如，第一图案可被定位在钉线的近侧端部或远侧端部处。在其他实例中，第一图案和第二图案可侧向偏置，并且在其他实例中，第一图案和第二图案可侧向偏置和纵向偏置。钉线可包括至少两种不同的钉图案。
在某些实例中，钉线中的大部分钉可形成主图案，并且钉线中的其他钉可形成一个或多个次图案。主图案可跨越钉线的重要部分并且可包括纵向重复的子图案。在某些实例中，次图案或不规则形状可偏离主图案。次图案可以是例如沿钉线的长度的一个或多个位置处的异常。钉线中的不同图案可被构造成能够在预定位置处产生不同的特性。例如，主图案可为高度柔性或弹性的图案，其可允许缝合的组织的广泛拉伸，并且次图案可较不柔性或较不弹性。例如，可希望大部分钉线高度柔性，并且一个或多个有限部分柔性较低。在其他实例中，次图案可比主图案更具柔性。在某些实例中，由于次图案沿钉线的较短部分延伸，因此次图案的柔性可不影响或不会显著影响整个钉线的总体柔性。名称为“STAPLECARTRIDGE AND ARRANGEMENTS OF STAPLES AND STAPLE CAVITIES THEREIN”的美国专利申请序列号15/385,389(现为美国专利申请公布2018/0168629(其全部公开内容据此以引用方式并入本文)公开了各种钉仓和钉驱动器布置结构。
名称为“FASTENER CARTRIDGE FOR CREATING FLEXIBLE STAPLE LINES”的美国专利9,801,627(其全部公开内容据此以引用方式并入本文)公开了用于产生柔性外科钉线的各种仓和砧座布置结构。
再次参见图39，仓4000中的大部分钉腔4022被布置成第一图案或主图案4030。第一图案4030为成角度取向的钉腔4022的纵向重复的图案。纵向重复的图案是其中子图案或布置纵向重复的图案。例如，狭槽4016的每一侧上的三个钉腔(内部钉腔、中间钉腔和外部钉腔)的布置结构可沿钉仓体4010的长度的至少一部分重复。成角度取向的钉腔的各种纵向重复的图案描述于2014年9月26日提交的名称为“METHOD FOR CREATING A FLEXIBLESTAPLE LINE”的美国专利申请14/498,145，现为美国专利申请公布2016/0089142，该专利申请全文据此以引用方式并入本文。第一图案4030中的钉腔4022的开口4024形成人字形图案，其在仓平台表面4020中具有六排成角度取向的钉腔开口4024。钉腔4022的内排4026a、中间排4026b和外排4026c被定位在狭槽4016的每一侧上。
每个钉腔开口4024具有近侧端部4027和远侧端部4028。第一图案4030中的钉腔4022的近侧端部4027和远侧端部4028侧向偏置。换句话说，第一图案4030中的每个钉腔4022相对于纵向钉仓轴线SCA成角度地取向。腔轴线CA在每个开口4024的近侧端部4027和远侧端部4028之间延伸。腔轴线CA相对于狭槽4016倾斜地取向。更具体地，钉腔4022的内排4026a和钉腔4022的外排4026c中的开口4024以相对于纵向钉仓轴线SCA的45度或约45度取向，并且钉腔4022的中间排4026b中的开口4024以相对于内排4026a和外排4026c的开口4024的90度或约90度取向。
在图39的示例中，仓体4010中的某些钉腔以相对于第一图案4030中的钉腔4022异常或不规则的角度取向。更具体地，近侧钉腔4022a、4022b、4022c和4022d以及远侧钉腔4022e、4022f、4022g和4022h的角度取向不符合第一图案4030中的钉腔4022的人字形布置结构。相反，近侧钉腔4022a-4022d和远侧钉腔4022e-4022h与第一图案4030中的钉腔4022成角度地偏置。近侧钉腔4022a、4022b、4022c和4022d相对于第一图案4030中的钉腔4022倾斜地取向，并且远侧钉腔4022e、4022f、4022g和4022h也相对于第一图案4030中的钉腔4022倾斜地取向。近侧钉腔和远侧钉腔4022a-4022h被取向成平行于狭槽4016并且平行于纵向钉仓轴线SCA。
近侧钉腔4022a-4022d形成与第一图案4030不同的近侧图案4040，并且远侧钉腔4022e-4022h形成也与第一图案4030不同的远侧图案4042。在所示出的布置结构中，近侧图案4040包括在狭槽4016的第一侧上的第一对平行的纵向对准的钉腔4022a、4022b以及在纵向狭槽4016的第二侧上的第二对平行的纵向对准的钉腔4022c、4022d。远侧图案4042还包括在纵向狭槽4016的第一侧上的第一对平行的纵向对准的钉腔4022e、4022f以及在纵向狭槽4016的第二侧上的第二对平行的纵向对准的钉腔4022g、4022h。在其他实例中，远侧图案4042可与近侧图案4040不同。
近侧图案4040和远侧图案4042相对于纵向钉仓轴线SCA对称。在其他实例中，近侧图案4040和/或远侧图案4042可相对于纵向钉仓轴线SCA不对称。例如，钉腔4022e和4022f可与钉腔4022g和4022h纵向偏置，并且/或者钉腔4022a和4022b可与钉腔4022c和4022d纵向偏置。除此之外或另选地，在某些实例中，钉仓体4010可包括近侧图案4040或远侧图案4042。在其他实例中，限定在钉仓体4010中的钉腔4022可包括钉腔4022的附加和/或不同的图案。
如在图39中进一步可见，无创伤扩张器4050围绕第一图案4030中的钉腔4022的一部分从平台表面4020延伸或突出。无创伤扩张器4050分别围绕第一图案4030中的钉腔4022的开口4024的近侧端部4027和远侧端部4028。无创伤扩张器4050可被构造成能够抓持由端部执行器夹紧的组织。除此之外或另选地，在某些实例中，钉腿的末端可从仓体4010突出。在此类实例中，无创伤扩张器4050可被构造成能够与钉腿的末端齐平地延伸和/或延伸超出钉腿的末端，以防止末端过早地穿透组织。因此，较大的钉(例如具有较长腿的钉)可被定位在钉腔4022中，这些钉腔具有被定位在其周围的无创伤扩张器4050。例如，再次参见图39，与近侧图案4040和远侧图案4042中的钉腔中的钉相比，在第一图案4030中的钉腔4022中可定位较大的钉，，同时不存在由较长的钉腿过早刺穿组织的风险。在某些实例中，无创伤扩张器4050可被定位在近侧图案4040和/或远侧图案4042中的钉腔4022周围，并且较大的钉也可被定位在那些钉腔4022a-4022h中的一个或多个钉腔中。
钉仓体4010可被构造成能够产生沿其长度具有不同特性的钉线。由钉仓体4010产生并嵌入组织T中的钉线4060在图40中示出。钉线4060由钉4062构成，并且用于与本文所述的各种钉仓一起使用的示例性钉4062在图41中示出。例如，钉4062可由弯曲的线材构成。线材的直径可具有0.0079英寸或约0.0079英寸的直径。在其他实例中，线材可具有0.0089英寸或约0.0089英寸的直径。在其他实例中，线材可具有0.0094英寸或约0.0094英寸的直径。在某些实例中，线材可具有小于0.0079英寸或大于0.0094英寸的直径。读者将理解，线材的直径可决定钉的直径。钉4062是基本上U形的钉，其具有基部4064、从基部4064的第一端部延伸的第一腿部4066、以及从基部4064的第二端部延伸的第二腿部4068。第一腿部4066基本上平行于第二腿部4068并且基本上垂直于基部4064。当被植入组织T中时，基部4064的角度取向对应于钉4062从其被击发的钉腔开口4024的角度取向。
可与本文所述的各种钉仓一起使用的另一个示例性钉4070在图42中示出。钉4070是基本上“V形”的钉，其具有基部4072、从基部4072的第一端部延伸的第一腿部4074、以及从基部4072的第二端部延伸的第二腿部4076。第一腿部4074相对于第二腿部4076和基部4072倾斜地取向。当被植入组织T中时，基部4072的取向对应于钉4070从其被击发的钉腔开口4024的取向。读者将理解，具有不同几何结构的钉也可从本文所述的钉仓被击发。
再次参见图40，钉线4060包括第一部分4061、近侧部分4063和远侧部分4065。第一部分4061由第一图案或主图案4030生成并且沿钉线4030的大部分延伸。由于钉4062在第一部分4030中的角度取向，第一部分4061是基本上柔性的或柔顺的。例如，因为在使对组织T的创伤最小化的同时成角度取向的钉4062可在缝合组织T内旋转，所以第一部分4061被构造成能够在缝合过的组织拉伸时纵向和/或侧向拉伸或延伸。
近侧部分4063由近侧图案4040生成并且形成钉线4060的近侧端部。远侧部分4065由远侧图案4042生成并且形成钉线4060的远侧端部。由于钉4062在钉线4060的近侧部分4063和远侧部分4065中的平行取向，钉线4060的近侧部分4063和远侧部分4065可具有比第一部分4061小的柔性。然而，近侧部分4063和远侧部分4065的柔性降低可不会影响或基本上不影响钉线4060的整体柔性。此外，如本文所述，近侧部分4063和远侧部分4065可不邻近切割线延伸，并且在某些实例中，近侧部分4063可不存在或从钉线4060中缺失。
如本文所述，钉可移除地被定位在钉仓中并且在使用期间从钉仓被击发。在各种实例中，钉可从钉仓中的钉腔中被驱出并与砧座成形接触。例如，击发元件可在击发行程期间平移穿过钉仓，以将钉从钉仓朝向砧座驱动。在某些实例中，钉可被钉驱动器支撑，并且击发元件可提升钉驱动器以从钉仓射出或移除钉。
砧座可包括钉成形表面，该钉成形下表面具有限定在其中的钉成形凹坑。在某些实例中，钉成形凹坑可冲压在砧座中。例如，钉成形凹坑可压印在砧座的平坦表面中。读者将理解，钉成形凹坑的某些特征部可以是压印过程的有意后果。例如，在钉成形产品的拐角和/或边缘处的一定程度的倒圆可以是压印过程的有意结果。这些特征部还可设计成更好地将钉形成为其成形构造，包括在部署期间变得偏斜和/或以其他方式不对准的钉。
钉仓中的每个钉可与砧座的钉成形凹坑对准。换句话说，用于端部执行器的钉仓中的钉腔和钉的布置可对应于或匹配端部执行器的砧座中的钉成形凹坑的布置。更具体地，每个钉腔的角度取向可匹配相应的钉成形凹坑的角度取向。例如，当钉腔以人字形图案布置时，钉成形凹坑也可以人字形图案布置。
当钉从钉仓被驱动并与砧座成形接触时，钉可形成为“击发”构造。在各种实例中，击发构造可以是“B形”构造，其中钉腿的末端朝向钉基部或冠部弯曲，以形成具有对称的上部环和下部环的大写字母B。在其他实例中，击发构造可以是改进的B形，诸如偏斜的B形构造，其中钉腿的至少一部分与钉基部扭转出平面，或者是不对称的B形构造，其中大写字母B的上部环和下部环是不对称的。可在成形的钉内捕获或夹紧组织。
钉仓中的钉和/或钉腔的布置可被构造成能够优化钉互补砧座的成形表面中的钉成形凹坑的对应布置。例如，钉仓中的钉的角度取向和间距可设计成优化砧座的成形表面。在某些实例中，砧座中的钉成形凹坑的占有面积可受到砧座的几何结构的限制。在钉成形凹坑相对于纵向轴线倾斜地取向的实例中，砧座的宽度可限制倾斜地取向的钉成形凹坑的尺寸和间距。例如，钉成形凹坑的中间排的宽度可限定中间排的一侧上的第一排(例如外排)与中间排的另一侧上的第二排(例如内排)之间的最小距离。此外，成排的钉成形凹坑被限制在砧座的内侧边缘(诸如刀狭槽)和砧座的外侧边缘之间。
在各种实例中，凹坑可沿砧座的钉成形下表面相邻地嵌套。例如，中间凹坑可嵌套在内部凹坑和外部凹坑之间。凹坑的角度取向可逐排变化以便于其嵌套。例如，内排中的钉成形凹坑可以第一角度取向，中间排中的钉成形凹坑可以第二角度取向，并且外排中的钉成形凹坑可以第三角度取向。第一角度、第二角度和第三角度可以是不同的，这可促进钉成形凹坑的紧密布置。
再次参见图39所示的先前钉仓和例如以下专利中所公开的其他先前钉仓：名称为“FASTENER CARTRIDGE FOR CREATING FLEXIBLE STAPLE LINES”的美国专利9,801,627，以及/或者2014年9月26日提交的美国专利申请14/498,145，现为名称为“METHOD FORCREATING A FLEXIBLE STAPLE LINE”的美国专利申请公布2016/0089142，可选择每排中的钉和钉腔的变化角度以优化钉成形凹坑在互补砧座中的嵌套。对于每个此类钉仓，互补的砧座可被构造成能够具有钉成形凹坑的对应布置结构。此外，互补砧座中的钉成形凹坑可比钉腔大以有利于钉腿着陆或落入钉成形凹坑内。例如，钉腿可向外偏压，诸如在V形钉的情况下(参见图42)，并且钉成形凹坑的较大占有面积可在击发期间捕获向外偏压的钉腿。在各种实例中，钉成形凹坑可比对应的钉腔和/或钉长0.005英寸至0.015英寸。除此之外或另选地，每个钉成形凹坑的钉接收杯可比对应的钉腔宽0.005英寸至0.015英寸。在其他实例中，长度和/或宽度的差异可小于0.005英寸或大于0.015英寸。
在钉的尺寸在钉仓内变化的实例中，钉成形凹坑的尺寸可在互补的砧座内相应地变化。改变钉成形凹坑的尺寸可进一步促进其嵌套。例如，在中间排中的钉成形凹坑比内排或外排中的钉成形凹坑短的实例中，可减小钉凹坑的中间排的宽度，这可最小化内排和外排之间的必要间距。
钉成形凹坑的间距也可被构造成能够优化其嵌套。例如，布置在内排中的凹坑可相对于布置在外排中的凹坑纵向交错。此外，内排中的凹坑可部分地与外排中的凹坑纵向地重叠。中间排中的凹坑可相对于内排中的凹坑和外排中的凹坑纵向交错。例如，中间排中的凹坑可与外排中的凹坑和内排中的凹坑等距地纵向偏置。
被构造用于在外科缝合应用中使用的砧座可使用各种制造技术和方法形成。一种用于制造外科缝合器砧座的先前制造方法包括“压印”的过程。“压印”是精确冲压的形式，其中砧座材料经受足够高的应力以在材料的表面上引起塑性流动。压印通常使用齿轮驱动的压机、液压机或机械压机来完成。与常规压印工艺中通常使用的相比，压印通常需要更高的吨位压机，因为工件是塑性变形的并且实际上未被切割。虽然压印是在砧座的钉成形下表面中形成钉成形凹坑的有效方法，但其可导致在成品砧座中产生一些不期望的特性。
在采用压印的各种先前砧座制造方法中，通常首先将可包含金属材料诸如不锈钢等的砧座原材料挤出或轧制成初始坯件或主体。然后可使用各种常规机加工技术来机加工砧座主体，以便在形成于主体中的细长狭槽的每个尺寸上初始地形成平坦的成形表面。一旦主体已被机加工成使得成形表面为平坦的，则成形凹坑随后以期望的图案被压印在成形表面中。
图43以横截面示出了先前砧座8300的一部分。该先前砧座包括砧座主体8310，该砧座主体由通过细长狭槽8326分开的左钉成形下表面8330L和右钉成形下表面8330R组成。砧座主体部分8310可由304不锈钢或类似材料挤出或轧制而成。细长狭槽8326和砧座成形表面8330L、8330R通常在其中形成钉成形凹坑8360之前被机加工成平坦的。可由17-4PH不锈钢制成的砧座盖8390在接头8392处用焊接件8394焊接到主体部分8310。图44包括使用先前砧座8300的焊接接头8392的扫描电镜拍摄的照片，示出了砧座主体8310和砧座盖8390以及焊接8394的不同晶粒结构。
图45以横截面示出了在使用先前的压印方法在其中形成钉成形凹坑8360之前砧座8300的一部分。如在该图中可见，成形表面8330R已在细长狭槽8326的一侧上被机加工成平的，该细长狭槽也使用常规机加工方法和技术机加工到砧座主体8310中。附图示出了在压印操作之前砧座主体材料的结晶结构8312。期望的最终钉成形凹坑8360构型以虚线示出。图46示出了在其中已压印钉成形凹坑8360之后的砧座主体8310。压印操作由以下组成：用模具(未示出)击打成形表面8330，这导致高材料位移，从而造成围绕成形凹坑8360的高材料密度(线8314)。图47是使用扫描电镜的先前砧座8300的一部分的横截面的照片。该照片示出了由于压印工艺而在凹坑8360下方形成的大量晶粒变形和闭塞。
图48是在压印工艺之后在凹坑8360下方拍摄的先前砧座主体8310的一部分的照片。图49和图50包括压印凹坑下方的区域的照片，示出了在材料中形成的内含物8397。这些细长非金属内含物8397通常存在于锻造产品中。内含物的方向性指示材料被轧制或挤出。图51包括先前砧座8300在未压印区域中的一部分的更高放大率照片，其示出了其中的非金属内含物8398和8399。
除了用于形成先前砧座8300的先前压印工艺之外，一旦成形凹坑8360已被压印到成形表面8330L、8330R中，成形表面8330L、8330R和凹坑8360就可被刷洗和超声清洁，以去除由压印工艺产生的任何润滑和碎屑。图52包括在清洁过程之后的先前砧座8300的一部分的照片。图53和图54是成形凹坑8360中的一个成形凹坑的底部部分的照片，示出了由压印工艺产生的一些金属涂污8361。如图47至图51以及图53和图54所示，上述先前的砧座制造方法可导致在砧座主体中形成具有不期望的内含物的砧座，这可弱化砧座。此类工艺还可导致形成具有不期望的粗糙成形表面的钉成形凹坑。
图55至图59示出了可避免在使用先前的砧座制造方法时通常遇到的一些前述问题的方法8400。在至少一种构型中，方法8400涉及采用金属注射成型(“MIM”)工艺来形成砧座8500的砧座主体部分8510。MIM是一种金属加工工艺，其中将细粉金属与粘结剂材料混合以形成“原料”(动作8402)，该“原料”使用注射成型(8404)成形并固化成砧座主体8510。在注射成型(8404)之后，砧座主体8510经历调整操作以去除粘结剂并使粉末致密(脱粘-8406)。在至少一种构型中，MIM工艺用于形成具有多个“初步”钉成形凹坑构型的砧座主体8510，该多个“初步”钉成形凹坑构型具有与“最终”期望的凹坑构型或几何形状不同的“近净构型”或近净“几何形状”。例如，初步凹坑构型可具有与最终凹坑构型类似的形状，但最终凹坑构型可在砧座主体中包括更大且更深的空隙或凹坑。
更具体地并且参考图56，示出了在已使用MIM工艺(例如，动作8402、8404、8406)形成砧座主体8510之后的砧座主体8510的一部分。在至少一种布置结构中，砧座主体8510最初形成有平的或平坦的钉成形下表面8430，该钉成形下表面具有形成于其中的多个钉成形凹坑8560P，每个钉成形凹坑具有“近净”形状或几何形状或“预形状”。在以图56的横截面所示的示例中，“预成形”凹坑8560P包括底部表面8532P和两个倾斜侧壁8534P。倾斜侧壁8534P形成具有初步宽度“PW”(在横截面中)的凹坑开口。底部表面8532P被定位成距钉成形下表面8530初步深度“PD”。期望的最终凹坑形状8360F在图56中以分段线示出。一旦砧座主体8510形成有“预成形”或“初步”凹坑8360P，就采用压印工艺8408在该凹坑中形成最终成形凹坑8560F。
图57示出了已形成到砧座主体8510中的最终成形凹坑8560F。如在该图中可见，最终成形凹坑8560F包括最终底部表面8532F和两个倾斜侧壁8534F，它们限定具有最终宽度“FW”的凹坑开口。最终底部表面8532F被定位成距成形表面8530最终深度“FD”。在例示的示例中，FW>P并且FD>P。图56和图57中所示的成形凹坑8560P、8560F的横截面形状仅用于进行示意性的说明，而不应具有限制性。凹坑的形状可以变化，其中最终成形凹坑大于初步或预成形的成形凹坑。虽然最终凹坑8560F的几何形状可类似于预成形凹坑8560P的几何形状，但由于压印工艺8408，最终凹坑8560F将大于预成形凹坑8560P。此外，因MIM工艺8402、8404、8406形成的预成形凹坑8560P的预表面光洁度8536P可不同于因压印工艺8408形成的最终凹坑8560F的最终表面光洁度8536F。例如，预表面光洁度8536P可比最终表面光洁度8536F粗糙。图58示出了已使用MIM工艺初步形成的初步或预成形的成形凹坑8560P。如在该图中可见，成形凹坑8560P的表面光洁度8536P可比通过最终压印工艺8408形成的最终成形凹坑8560F(图59中所示)的最终表面光洁度8536F略粗糙。因为初步或预成形的成形凹坑具有预形状，所以压印工艺以比先前压印操作中通常使用的力小的力执行。与使用先前的压印操作时通常经历的相比，此类较低的压印力导致较少的材料位移和较小的压缩。在另选的方法中，压印工艺可替换为锻造工艺。在该另选的方法中，例如，在砧座主体已使用上述MIM工艺形成有先前的或预成形的成形凹坑之后，砧座主体可在其用锻模撞击的同时被加热，该锻模被构造成能够以上述方式在其中形成最终成形凹坑。
图60至图64示出了方法8400'在砧座主体材料8510中形成钉成形凹坑8560F'的另选用途。在该方法8400'中，除了在其中提供也称为“钉成形路径”8570的钉腿引导沟槽之外，预成形凹坑构型8560P'以相对最终的形状和尺寸形成。钉成形路径8570被压印到凹坑的底部表面8532P中(动作8408')。钉成形路径8570仅压印在凹坑8560P'的底部8532P中以形成凹坑8560F'。参见图63和图64。如在图64中可见，钉成形路径8570比由MIM工艺形成的周围表面平滑。即，钉成形路径8570的表面光洁度8572F'比凹坑8560F'的剩余壁的表面光洁度8536P'平滑。由于由压印获得的压缩，钉成形路径8570也比MIM成形部分硬且致密。然而，由于使用方法8400'获得的较小的力和压缩，与先前压印操作相关联的问题不太可能发生。
图65中示出了另一种砧座制造方法8600。方法8600涉及使用液体金属或Vitreloy形成砧座主体8510。采用液态金属工艺来形成砧座主体8510，其中砧座凹坑8560P呈其近净形状(动作8602)。与方法8600一样，使用压印工艺8604为成形凹坑8560F提供其最终构型。图66示出了方法8600'，该方法包括使用液体金属工艺形成具有包括最终形状的凹坑的砧座主体8510(动作8602')，然后将钉成形路径8570压印到每个凹坑中(动作8604')。与上述工艺8400一样，最终成形凹坑8560F可具有与预成形或近净成形凹坑8560P类似的几何形状，其中最终成形凹坑8560F更大且更深。
图67中示出了另一种砧座制造方法8700。方法8700包括挤出或轧制尺寸和形状被设定成被机加工成期望的最终构型的初始坯件或主体(动作8702)。使用各种常规机加工技术来机加工砧座主体，以便在细长狭槽的每个尺寸上初始地形成平坦的成形表面。此外，在该布置结构中，该方法涉及将预成形或初始凹坑8560P机加工到平坦的成形表面中(操作8704)。例如，预成形凹坑8560P可类似于诸如图56所示的那些预成形凹坑构型。此后，最终凹坑构型8560F通过压印形成以获得诸如图57所示的构型(动作8706)。然而，在使用方法8700时，不使用MIM或液体金属来形成砧座主体。相反，砧座主体材料可被挤出或轧制，然后进行机加工。然而，因为所需的压印力低于先前使用的压印方法所提供的力，所以压缩和材料位移将更低。图68示出了方法8700’，该方法包括挤出或轧制尺寸和形状被设定成被机加工成期望的最终构型的初始坯件或主体(动作8702)。使用各种常规机加工技术来机加工砧座主体，以便在细长狭槽的每个尺寸上将凹坑初始地形成为平坦的成形表面。然后采用压印(动作8706')来将钉成形路径8570压印到每个凹坑中。
图69示出了采用动作8402来形成原料的另一种方法8800。在该方法中，砧座主体是以最终形式注射成型的(动作8404')，但其中不形成任何砧座凹坑。然后调整砧座主体(动作8406)。然后将预成形凹坑8560P机加工到砧座主体中(动作8808)。然后将最终凹坑8560F通过压印而形成到砧座主体中(动作8810)。图70示出了与方法8800类似的另一种方法8800'，不同的是凹坑被机加工成具有其最终构型(动作8808')。然后将钉成形路径压印到每个凹坑的底部中(动作8810')。
图71示出了另一种方法8900，其中使用液体金属来形成砧座主体(动作8902)。然后将近净凹坑机加工到砧座主体中(动作8904)。然后将最终凹坑构型压印到砧座主体中(动作8906)。图72示出了与方法8900类似的另一种方法8900'，不同的是凹坑被机加工成具有其最终构型(动作8904')。然后将钉成形路径压印到每个凹坑的底部中(动作8906')。在另选的布置结构中，预成形凹坑8560P可使用电化学加工(ECM)而形成于砧座主体8510中。ECM是一种通过电化学工艺去除金属的方法。ECM与电火花加工(EDM)的类似之处在于，通过具有带负电的电极(阴极)、导电流体(电解质)和导电工件(阳极)的电解材料去除工艺在电极与部件之间传递高电流。ECM切割工具沿着靠近工件但不接触工件的期望路径被引导。一旦使用ECM工艺在砧座主体中形成预成形凹坑，最终凹坑形式或钉成形路径就被压印到每个凹坑中。
通过使用MIM工艺或液体金属工艺形成砧座主体，可避免在其中砧座主体被挤出或轧制的工艺中经常遇到的不规则性和包含物。通过在压印之前使用本文所述的各种方法使凹坑在砧座主体中预成形，使得在形成最终凹坑构型或钉成形路径时能够采用较小的压印力。此类较低的压印力导致较小的压缩和较少的材料位移，并因此导致当采用先前的砧座制造方法时通常遇到的不规则性和闭塞的减少。
实施例
实施例1-一种制造用于外科缝合器的砧座的方法，其中，所述方法包括提供砧座材料并在所述砧座材料中建立组织接触表面。所述方法还包括通过所述组织接触表面将钉成形凹坑成形到所述砧座材料中。所述成形动作包括采用第一制造工艺在所述砧座材料中建立具有初步几何形状和初步表面光洁度的所述钉成形凹坑；以及采用与所述第一制造工艺不同的第二制造工艺来将所述钉成形凹坑的所述初步几何形状改变为期望的最终几何形状，所述期望的最终几何形状与所述初步几何形状不同并且具有与所述初步表面光洁度不同的最终期望的表面光洁度。
实施例2-根据实施例1所述的方法，其中，所述初步几何形状包括初步底部表面，所述初步底部表面被定位成距所述组织接触表面初步深度。所述初步几何形状还包括至少两个初步倾斜壁，所述至少两个初步倾斜壁从所述初步底部表面的相对两侧延伸到所述组织接触表面，以在其中形成初步凹坑开口，所述初步凹坑开口具有初步开口宽度。所述期望的最终几何形状包括最终底部表面，所述最终底部表面被定位成距所述组织接触表面最终深度，其中所述最终深度大于所述初步深度。所述期望的最终几何形状还包括至少两个最终倾斜壁，所述至少两个最终倾斜壁从所述最终底部表面的相对两侧延伸到所述组织接触表面，以在其中形成最终凹坑开口，所述最终凹坑开口具有最终开口宽度，其中所述最终开口宽度大于所述初步开口宽度。
实施例3-根据实施例1或2所述的方法，其中，所述第一制造工艺选自由以下组成的第一制造工艺：电化学加工工艺、金属注射成型工艺和液体金属成形工艺。
实施例4-根据实施例1、2或3所述的方法，其中，所述第二制造工艺选自由以下组成的第二制造工艺：压印和锻造。
实施例5-根据实施例1、2、3或4所述的方法，其中，所述期望的最终几何形状的仅一部分具有所述最终期望的表面光洁度。
实施例6-根据实施例1、3、4或5所述的方法，其中，所述初步几何形状包括初步底部表面，所述初步底部表面被定位成距所述组织接触表面初步深度。所述初步几何形状还包括至少两个倾斜壁，所述至少两个倾斜壁从所述初步底部表面的相对两侧延伸到所述组织接触表面以在其中形成凹坑开口，并且其中所述期望的最终几何形状包括最终底部表面，其中所述最终底部表面的至少一部分被定位成距所述组织接触表面最终深度，其中所述最终深度大于所述初步深度，并且其中所述最终底部表面的至少一部分具有所述最终期望的表面光洁度。
实施例7-根据实施例6所述的方法，其中，所述最终底部表面的至少一部分包括在所述最终底部表面中的钉腿引导凹槽。
实施例8-根据实施例6或7所述的方法，其中，所述第一制造工艺选自由以下组成的第一制造工艺：电化学加工工艺、金属注射成型工艺和液体金属成形工艺。
实施例9-根据实施例6、7或8所述的方法，其中，所述第二制造工艺选自由以下组成的第二制造工艺：压印和锻造。
实施例10-根据实施例6、7、8或9所述的方法，其中，所述第二制造工艺仅应用于所述初步底部表面的至少一部分，而不应用于所述至少两个倾斜壁。
实施例11-根据实施例1、2、3、4、5、6、7、8、9或10所述的方法，其中，采用所述第二制造工艺来将所述钉成形凹坑的所述初步几何形状改变为与所述初步几何形状不同的中间几何形状，并且其中所述方法还包括采用第三制造工艺来将所述钉成形凹坑的所述中间几何形状改变为期望的最终几何形状，所述期望的最终几何形状与所述中间几何形状不同并且具有与所述初步表面光洁度不同的最终期望的表面光洁度。
实施例12-实施例1、2、3、4、5、6、6、8、9或10所述的方法，其中，采用所述第二制造工艺来将所述钉成形凹坑的所述初步几何形状改变为中间几何形状，所述中间几何形状与所述初步几何形状不同并且具有与所述初步表面光洁度不同的中间表面光洁度，并且其中所述方法还包括采用第三制造工艺来将所述钉成形凹坑的所述中间几何形状改变为期望的最终几何形状，所述期望的最终几何形状与所述中间几何形状不同并且所述期望的最终几何形状的至少一部分具有与所述中间表面光洁度不同的最终期望的表面光洁度。
实施例13-一种制造用于外科缝合器的砧座的方法，其中，所述方法包括提供砧座材料并在所述砧座材料中建立组织接触表面。所述方法还包括通过所述组织接触表面将钉成形凹坑成形到所述砧座材料中。所述成形动作包括采用第一制造工艺来在砧座材料中建立具有初步几何形状的钉成形凹坑，并且采用第二制造工艺来将钉成形凹坑的初步几何形状改变为与所述初步几何形状不同的期望的最终几何形状。
实施例14-根据实施例13所述的方法，其中，所述初步几何形状包括底部表面，所述底部表面被定位成距所述组织接触表面一深度。所述初步几何形状还包括至少两个倾斜壁，所述至少两个倾斜壁从所述底部表面的相对两侧延伸到所述组织接触表面以在其中形成凹坑开口，并且其中所述第二制造工艺包括在所述底部表面中形成钉腿引导凹槽。
实施例15-根据实施例14所述的方法，其中，所述第二制造工艺包括将所述钉腿引导凹槽压印到所述底部表面中。
实施例16-根据实施例14或15所述的方法，其中，所述底部表面具有第一表面光洁度，并且其中所述钉腿引导凹槽具有与所述第一表面光洁度不同的第二表面光洁度。
实施例17-根据实施例13所述的方法，其中，所述初步几何形状包括初步底部表面，所述初步底部表面被定位成距所述组织接触表面初步深度。所述初步几何形状还包括至少两个倾斜壁，所述至少两个倾斜壁从所述初步底部表面的相对两侧延伸到所述组织接触表面以在其中形成凹坑开口，并且其中所述期望的最终几何形状包括最终底部表面，所述最终底部表面的至少一部分被定位成距所述组织接触表面最终深度，其中所述最终深度大于所述初步深度，并且其中所述最终底部表面的所述至少一部分比所述初步底部表面光滑且硬。
实施例18-根据实施例13、14、15、16或17所述的方法，其中，所述第一制造工艺选自由以下组成的第一制造工艺：电化学加工工艺、金属注射成型工艺和液体金属成形工艺。
实施例19-根据实施例13、14、15、16、17或18所述的方法，其中，所述第二制造工艺选自由以下组成的第二制造工艺：压印和锻造。
实施例20-根据实施例13、14、15、16、17、18或19所述的方法，其中，进采用所述第二制造工艺来改变所述初步几何形状的一部分。
本文所述的许多外科器械系统由电动马达促动；但是本文所述的外科器械系统可以任何合适的方式促动。在各种实例中，例如，本文所述的外科器械系统可由手动操作的触发器促动。在某些实例中，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构造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12/235972，现为美国专利9050083。
-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，具体特征部、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部、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部、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复装置均在本申请的范围内。
本文所公开的装置可在手术之前进行处理。首先，可获得新的或用过的器械，并且根据需要进行清洁。然后，可对器械进行消毒。在一种消毒技术中，将所述器械放置在密闭且密封的容器(诸如，塑料或TYVEK袋)中。然后可将容器和器械置于可穿透容器的辐射场，诸如γ辐射、X射线和/或高能电子。辐射可杀死器械上和容器中的细菌。经消毒的器械随后可被储存在无菌容器中。密封容器可将器械保持为无菌的，直至在医疗设施中将该容器打开。还可使用本领域已知的任何其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 (15)
1.一种制造用于外科缝合器的砧座的方法，所述方法包括：
提供砧座材料；
在所述砧座材料中建立组织接触表面；以及
通过所述组织接触表面将钉成形凹坑成形到所述砧座材料中，其中所述成形包括：
采用第一制造工艺在所述砧座材料中建立具有初步几何形状的所述钉成形凹坑；以及
采用第二制造工艺来将所述钉成形凹坑的所述初步几何形状改变为与所述初步几何形状不同的期望的最终几何形状；
其中，所述第二制造工艺选自由以下组成的第二制造工艺：压印和锻造；并且
其中，所述最终几何形状比所述初步几何形状大。
2.根据权利要求1所述的方法，其中，所述初步几何形状包括：
底部表面，所述底部表面被定位成距所述组织接触表面一深度；以及
至少两个倾斜壁，所述至少两个倾斜壁从所述底部表面的相对两侧延伸到所述组织接触表面以在其中形成凹坑开口，并且其中所述第二制造工艺包括在所述底部表面中形成钉腿引导凹槽。
3.根据权利要求2所述的方法，其中，所述第二制造工艺包括将所述钉腿引导凹槽压印到所述底部表面中。
4.根据权利要求2或3所述的方法，其中，所述底部表面具有第一表面光洁度，并且其中所述钉腿引导凹槽具有与所述第一表面光洁度不同的第二表面光洁度。
5.根据权利要求1所述的方法，其中，所述初步几何形状包括：
初步底部表面，所述初步底部表面被定位成距所述组织接触表面初步深度；和
至少两个倾斜壁，所述至少两个倾斜壁从所述初步底部表面的相对两侧延伸到所述组织接触表面以在其中形成凹坑开口，并且其中所述期望的最终几何形状包括最终底部表面，所述最终底部表面的至少一部分被定位成距所述组织接触表面最终深度，其中所述最终深度大于所述初步深度，并且其中所述最终底部表面的所述至少一部分比所述初步底部表面光滑且硬。
6.根据权利要求1所述的方法，其中，所述采用第一制造工艺在所述砧座材料中建立具有初步几何形状的所述钉成形凹坑建立初步表面光洁度，并且其中，所述第二制造工艺与所述第一制造工艺不同，以将所述钉成形凹坑的所述初步几何形状改变为期望的最终几何形状，所述期望的最终几何形状与所述初步几何形状不同并且具有与所述初步表面光洁度不同的最终期望的表面光洁度。
7.根据权利要求6所述的方法，其中，所述初步几何形状包括：
初步底部表面，所述初步底部表面被定位成距所述组织接触表面初步深度；和
至少两个倾斜壁，所述至少两个倾斜壁从所述初步底部表面的相对两侧延伸到所述组织接触表面以在其中形成初步凹坑开口，所述初步凹坑开口包括初步开口宽度，并且其中所述期望的最终几何形状包括：
最终底部表面，所述最终底部表面被定位成距所述组织接触表面最终深度，其中所述最终深度大于所述初步深度；并且
至少两个最终倾斜壁，所述至少两个最终倾斜壁从所述最终底部表面的相对两侧延伸到所述组织接触表面，以在其中形成最终凹坑开口，所述最终凹坑开口具有最终开口宽度，其中所述最终开口宽度大于所述初步开口宽度。
8.根据权利要求7所述的方法，其中，所述期望的最终几何形状的仅一部分具有所述最终期望的表面光洁度。
9.根据权利要求6所述的方法，其中，所述初步几何形状包括：
初步底部表面，所述初步底部表面被定位成距所述组织接触表面初步深度；和
至少两个倾斜壁，所述至少两个倾斜壁从所述初步底部表面的相对两侧延伸到所述组织接触表面以在其中形成凹坑开口，并且其中所述期望的最终几何形状包括最终底部表面，其中所述最终底部表面的至少一部分被定位成距所述组织接触表面最终深度，其中所述最终深度大于所述初步深度，并且其中所述最终底部表面的至少一部分具有所述最终期望的表面光洁度。
10.根据权利要求9所述的方法，其中，所述最终底部表面的所述至少一部分包括在所述最终底部表面中的钉腿引导凹槽。
11.根据权利要求6所述的方法，其中，采用所述第二制造工艺来将所述钉成形凹坑的所述初步几何形状改变为与所述初步几何形状不同的中间几何形状，并且其中所述方法还包括采用第三制造工艺来将所述钉成形凹坑的所述中间几何形状改变为所述期望的最终几何形状，所述期望的最终几何形状与所述中间几何形状不同并且具有与所述初步表面光洁度不同的所述最终期望的表面光洁度。
12.根据权利要求6所述的方法，其中，采用所述第二制造工艺来将所述钉成形凹坑的所述初步几何形状改变为中间几何形状，所述中间几何形状与所述初步几何形状不同并且具有与所述初步表面光洁度不同的中间表面光洁度，并且其中所述方法还包括采用第三制造工艺来将所述钉成形凹坑的所述中间几何形状改变为所述期望的最终几何形状，所述期望的最终几何形状与所述中间几何形状不同并且所述期望的最终几何形状的至少一部分具有与所述中间表面光洁度不同的所述最终期望的表面光洁度。
13.根据权利要求1所述的方法，其中，所述第一制造工艺选自由以下组成的第一制造工艺：电化学加工工艺、金属注射成型工艺和液体金属成形工艺。
14.根据权利要求1所述的方法，其中，仅采用所述第二制造工艺来改变所述初步几何形状的一部分。
15.根据权利要求2所述的方法，其中，所述第二制造工艺仅应用于所述底部表面的至少一部分，而不应用于所述至少两个倾斜壁。
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