CN113710170B - 用于手术器械的钉仓 - Google Patents
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Abstract
本披露内容提供一种用于手术器械诸如组织密封器械的钉仓。该钉仓包括外壳和在外壳内的一个或多个钉组件。每个钉组件包括一个或多个钉推动器和相关联的钉。钉推动器和外壳包括耦接元件,该耦接元件被构造成彼此协作,以在手术中使用之前将钉组件固持到外壳。耦接元件连同仓和器械的其他部件导致相对于常规设备更小的钉仓,从而允许更紧凑和可操纵的手术器械。
Description
技术领域
本申请要求于2019年4月15日提交的美国临时申请序列号No.62/833,820的权益,其全部披露内容通过引用并入本文以用于所有目的。
背景技术
本披露内容的领域涉及医疗器械,并且更具体地涉及用于手术中的组织密封器械。甚至更具体地,本披露内容涉及一种手术缝合器械,该手术缝合器械具有用于保持钉的更紧凑的钉仓。
微创医疗技术旨在减少在诊断或手术过程期间受损的外部组织的数量,从而缩短患者恢复时间、减轻患者的不适以及减少有害副作用。微创手术的一种效果是例如缩短了术后住院恢复时间。标准开放手术的平均住院时间通常明显长于类似微创手术(MIS)的平均住院时间。因此,增加MIS的使用每年可以节省数百万美元的医院费用。虽然美国每年进行的许多手术都有可能以微创方式进行,但由于微创手术器械的局限性以及掌握这些器械所需的额外手术培训,目前仅一部分手术使用这些有利技术。
改进的手术器械诸如组织进入、导航、解剖和密封器械,使MIS能够重新定义手术领域。这些器械允许在减少对患者的创伤的情况下执行手术和诊断过程。微创手术的常见形式是内窥镜检查,内窥镜检查的常见形式是腹腔镜检查,腹腔镜检查是在腹腔内部的微创检查和手术。在标准的腹腔镜手术中,患者的腹部充满气体,插管套筒穿过小(大约二分之一英寸或更小)切口,以为腹腔镜器械提供进入端口。
腹腔镜手术器械通常包括用于观察手术区域的内窥镜(例如,腹腔镜)和用于在手术部位工作的工具。工作工具通常类似于常规(开放)手术中使用的工具,不同之处在于每个工具的工作端或端部执行器通过伸长管(也称为例如器械轴或主轴)与其柄部分开。端部执行器可以包括例如夹具、抓紧器、剪刀、缝合器/吻合器(stapler)、烧灼工具、线性切割器或持针器。
为了执行手术过程,外科医生将工作工具通过插管套管传递到内部手术部位并且从腹部的外部操纵它们。外科医生通过监视器查看该过程,该监视器显示从内窥镜获取的手术部位的图像。类似的内窥镜技术用于例如关节镜检查、腹膜后镜检查、盆腔镜检查、肾镜检查、膀胱镜检查、脑池镜检查、窦镜检查、宫腔镜检查、尿道镜检查等。
正在开发微创远程手术机器人系统,以提高外科医生在内部手术部位工作时的灵巧性,以及允许外科医生从远程位置(无菌区外部)对患者进行手术。在远程手术系统中,外科医生通常在控制台处获得手术部位的图像。在合适的查看器或显示器上查看手术部位的三维图像时,外科医生通过操纵控制台的主输入或控制设备对患者执行手术过程,该控制台继而控制伺服机械操作的从动器械的运动。
用于远程手术的伺服机构通常会接受来自两个主控制器(外科医生的每只手一个)的输入,并且可以包括两个或更多个机器人臂,每个机器人臂上安装有手术器械。主控制器与相关联的机器人臂和器械组件之间的操作通信通常通过控制系统实现。控制系统通常包括至少一个处理器,该处理器在例如力反馈等的情况下将来自主控制器的输入命令中继到相关联的机器人臂和器械组件并且从器械和臂组件返回到相关联的主控制器。机器人手术系统的一个示例是由加利福尼亚州桑尼维尔市的直观外科手术公司(IntuitiveSurgical,Inc.of Sunnyvale,California)商品化的DAVINCITM系统。
在机器人手术期间,多种结构布置已被用于在手术部位处支撑手术器械。被动连杆或“从动装置”通常被称为机器人手术操纵器,并且在美国专利No.7,594,912(2004年9月30日提交)、No.6,758,843(2002年4月26日提交)、No.6,246,200(1999年8月3日提交)以及No.5,800,423(1995年7月20日提交)中描述了在微创机器人手术期间用作机器人手术操纵器的示例性连杆布置,以上专利的全部披露内容通过引用并入本文以用于所有目的。这些连杆通常操纵安装有具有轴的器械的器械保持器。这种操纵器结构可以包括平行四边形连杆部分,该平行四边形连杆部分产生器械保持器的运动,该运动被限制为围绕俯仰轴线旋转,该俯仰轴线与沿器械轴的长度定位的远程操纵中心相交。这种操纵器结构还可以包括偏航接头,该偏航接头产生器械保持器的运动,该运动被限制为围绕垂直于俯仰轴线并且还与远程操纵中心相交的偏航轴线旋转。通过将远程操纵中心与切口点对准内部手术部位(例如,在腹腔镜手术期间,在腹壁处使用套管针或插管),可以通过使用操纵器连杆移动轴的近侧端部来安全地定位手术器械的端部执行器,而不会对腹壁施加潜在的危险力。替代的操纵器结构在例如美国专利No.6,702,805(2000年11月9日提交)、No.6,676,669(2002年1月16日提交)、No.5,855,583(1996年11月22日提交)、No.5,808,665(1996年9月9日提交)、No.5,445,166(1994年4月6日提交)以及No.5,184,601(1991年8月5日提交),以上专利的全部披露内容通过引用并入本文以用于所有目的。
在手术过程期间,远程手术系统可以提供对具有端部执行器的各种手术器械或工具的机械致动和控制,这些端部执行器响应于主输入设备的操纵而为外科医生执行各种功能,例如保持或驱动针、抓握血管、解剖组织等。操纵和控制这些端部执行器是机器人手术系统的特别有益的方面。为此理由,期望提供包括提供端部执行器的三个旋转运动度以模仿外科医生手腕的自然动作的机构的手术工具。此类机构应具有适当的尺寸以用于微创过程,并且设计相对简单以减少可能的故障点。此外,此类机构应提供足够的运动范围,以允许在各种位置操纵端部执行器。
手术夹持和切割器械(例如,非机器人线性夹持、缝合和切割设备,也称为手术缝合器;以及电外科血管密封设备)已被用于许多不同的手术过程。例如,手术缝合器可以用于从胃肠道切除癌变或异常组织。许多已知的手术夹持和切割装置(包括已知的手术缝合器)具有夹持组织的相对的钳口和切割被夹持组织的铰接刀。
手术夹持和切割器械经常被部署到限制性体腔中(例如,通过插管进入骨盆内部)。因此,期望手术夹持和切割器械既紧凑又可操纵,以最好地接近手术部位并且能见到手术部位。然而,已知的手术夹持和切割器械可能既不紧凑又不易于操纵。例如,已知的手术缝合器在多个自由度(例如,滚动、俯仰和偏航)和相关联的期望运动范围方面可缺乏可操纵性。
常规的手术夹持和切割器械通常包括被设计成装配在端部执行器的可移动钳口内的钉仓。钉仓通常包含多排钉组件,每排钉组件包括钉和钉推动器。钉推动器在使用前将钉保持在适当位置,然后在器械被致动时将钉驱动到组织中。然而,钉仓所需的尺寸和形状限制了设计者减小整个手术器械的尺寸和形状的能力。
限制其最小尺寸的常规钉仓的设计特征之一是钉推动器必须在使用之前(即,在装运、处理等期间)附接到钉仓的外壳。同时,钉推动器必须能够在使用期间相对于钉仓强制运动,以将钉驱动到组织中。为了满足这些要求,常规钉仓通常包括围绕仓外壳的至少一部分延伸以将钉推动器固持在外壳内的外盖。该盖将钉推动器固持在仓内,同时在手术器械的使用期间允许必要的运动自由度。然而,这种外盖的缺点之一是它向整个钉仓增加了材料,从而增加了仓的高度和直径,并且对仓和手术器械的总体尺寸提供了向下的限制。
因此,虽然新的远程手术系统和设备已被证明非常有效和有利,但仍期望进一步的改进。一般而言,期望提供更紧凑和可操纵的改进的手术器械,以提高微创系统的效率和易用性。更具体地,创建更小的缝合器仓将是有益的,这继而将允许设计更紧凑和更易操作的手术器械。
发明内容
下文给出了要求保护的主题的简化综述,以便提供对要求保护的主题的一些方面的基本理解。该综述不是对要求保护的主题的广泛概述。它既不旨在确定要求保护的主题的关键或重要要素,也不描绘要求保护的主题的范围。其唯一目的是以简化形式呈现要求保护的主题的一些概念,作为稍后呈现的更详细描述的序言。
本披露内容提供了一种用于手术器械的钉仓,其包括外壳,该外壳具有沿外壳的纵向轴线彼此间隔开的多个开口。钉仓还包括一个或多个钉组件,每个钉组件具有至少一个钉推动器和钉用于将钉驱动到患者组织中。每个钉推动器包括突起,该突起被构造成与外壳中的开口中的一个配合以将钉组件固持到外壳。钉推动器突起与外壳中的开口的协作消除了对设计用于防止钉组件在使用前(例如,在运输和处理期间)与外壳脱离接合的钉仓盖的需要。省去这个盖可以从设备上去除材料厚度,从而允许在给定尺寸的钉仓内设计更高的钉。可替代地,这种设计可以允许在更紧凑的钉仓中使用具有常规高度的钉,并且因此允许手术器械更紧凑且可操作性更高。
在优选的实施例中,钉推动器突起包括具有倾斜外表面或斜面的固持凸台,该倾斜外表面或斜面被构造成延伸穿过外壳的开口中的一个。凸台被构造成将钉推动器固持在外壳内。斜面还优选地允许钉推动器相对于外壳仅在一个方向上强制运动,使得在使用期间,手术器械的驱动构件可以基本上垂直于钉仓的纵向轴线驱动钉推动器和钉进入患者的组织。
在某些实施例中,钉仓的外壳包括内壁区段和外壁区段,每个区段具有沿外壳的纵向轴线延伸的一排开口。钉仓还包括沿外壳的内壁区段和外壁区段延伸的两排钉组件。每个钉组件包括可移除地耦接到钉的至少一个钉推动器。在某些实施例中,每个钉组件将包括两个或三个钉推动器及其相关联的钉。钉推动器具有从其横向延伸的突起,这些突起与壁区段中的开口对齐,从而接合开口并且将钉推动器固持到仓。
在另一个实施例中,外壳由两个彼此耦接的分离的纵向区段形成。单独的纵向区段中的每个包括用于固持钉推动器的一排开口。纵向区段优选地彼此分开地制造,以便于在例如注射模制工艺期间形成开口。每个纵向区段包括耦接元件,该耦接元件优选地形成在这些区段的远侧部分上。相应的耦接元件彼此协作以将两个纵向区段附接在一起并且形成仓。在示例性实施例中,耦接区段包括将这些区段彼此对齐的配合元件和经设定尺寸和构造以形成将两个纵向区段的远侧部分锁定在一起的过盈配合的耦接元件。
在本发明的另一方面,根据本披露内容的手术器械包括端部执行器,该端部执行器包括第一固定钳口和第二钳口。第二钳口被构造成相对于第一钳口从打开位置移动到闭合位置。手术器械还包括耦接到第一钳口或第二钳口中的一个的钉仓。钉仓包括外壳,该外壳具有沿外壳的纵向轴线彼此间隔开的多个开口。钉仓还包括一个或多个钉组件,每个钉组件具有至少一个钉推动器和钉以用于将钉驱动到患者组织中。一个或多个钉推动器包括突起,该突起被构造成与外壳中的开口中的一个协作,以将钉组件固持到外壳。
在优选的实施例中,手术器械还包括驱动构件,该驱动构件被构造成通过端部执行器朝远侧平移和朝近侧回缩。驱动构件具有通过固定钳口中的通道平移的中央部分。该中央部分可以是例如切割器械诸如刀具,该切割器械被构造成当钳口处于闭合位置时切割在第一钳口与第二钳口之间抓握的组织。驱动构件还包括至少一个外部部分,该外部部分与中央部分横向间隔开并且具有被构造成接合钉组件的倾斜表面或斜面。当驱动构件朝远侧平移时,驱动构件斜面在与外壳的纵向轴线垂直的方向上推动钉推动器和钉,以将钉驱动到组织中。在特别优选的实施例中,中央部分和斜面被集成到一个单个驱动构件中,该驱动构件平移穿过形成在钉仓中的通道。
在本发明的另一方面,手术器械还包括与驱动构件的中央部分接触的致动机构。该致动机构被构造成通过端部执行器朝远侧推进驱动构件并且通过端部执行器朝近侧回缩驱动构件。在示例性实施例中,致动器包括机器人远程手术系统的控制设备,该控制设备可以例如响应于远离手术器械定位的主输入设备的操纵而允许手术器械的机械致动和控制以执行多种功能,诸如抓握血管、解剖组织等。
在本发明的又一方面,根据本披露内容的手术器械包括端部执行器,该端部执行器包括第一固定钳口和第二钳口。第二钳口被构造成相对于第一钳口从打开位置移动到闭合位置。手术器械还包括耦接到第一钳口或第二钳口中的一个的钉仓以及被构造成通过端部执行器朝远侧平移和朝近侧回缩的驱动构件。钉仓包括一个或多个钉组件,每个钉组件具有可移除地耦接到钉的至少一个钉推动器。钉推动器包括被构造成将钉推动器固持到外壳的耦接元件,同时允许驱动构件迫使钉推动器在基本垂直于纵向轴线的方向上相对于外壳移动。
在另一个实施例中,用于手术器械的钉仓包括第一细长区段和第二细长区段,每个区段具有尺寸设定成用于接收钉组件的一个或多个隔室和基本上沿纵向轴线延伸的壁。每个细长区段还包括沿每个区段的壁彼此间隔开并且与隔室基本上对齐的多个开口。一个或多个耦接元件将细长区段附接在一起以形成钉仓。优选地,这些区段耦接在一起,使得第一排开口位于仓的外部区段上,而第二排开口位于仓内。该设备尤其有助于在标准模制工艺(例如,注射模制)中形成第二排内部开口。在形成之后,细长区段优选地在它们的远侧端部处与形成过盈配合的一个或多个耦接元件耦接,诸如锥形燕尾、卡扣配合、压配合销等。
应当理解,前述一般描述和以下详细描述均仅是示例性和解释性的,而不是对本披露内容的限制。本披露内容的附加特征将部分地在随后的描述中阐述或者可以通过本披露内容的实践被获悉。
附图说明
包含在本说明书中并且构成本说明书一部分的附图示出了本披露内容的若干实施例并且与描述一起用于解释本披露内容的原理。
图1示出具有安装到细长轴的端部执行器的说明性手术器械的透视图;
图1A是说明性手术器械的远侧端部部分的透视俯视图,其中钳口处于打开位置;
图1B是用于说明性手术器械的代表性钉仓的部分分离的仰视透视图;
图1C示出驱动构件的一部分与形成图1B的钉仓的一部分的多个钉推动器和钉之间的协作关系的放大视图;
图1D是图1A的手术器械的远侧端部部分的透视俯视图;
图2是根据本披露内容的某些实施例的钉仓的透视俯视图;
图3是根据本披露内容的某些实施例的钉推动器的透视侧视图;
图4是根据本披露内容的某些实施例的钉仓的一部分的半透明视图;
图5A是根据本披露内容的实施例的钉仓的两个区段的透视俯视图;
图5B是根据本披露内容的实施例的钉仓的远侧端部部分的透视图;
图5C是根据本披露内容的另一实施例的钉仓的远侧端部部分的透视图;
图6是说明性手术器械的远侧端部部分的透视图,其中部件被移除;
图7A是用于图1的说明性手术器械的驱动构件的前视图;
图7B是图7A的驱动构件的侧视图;
图8A是根据图1的手术器械的用于驱动构件的致动机构的局部截面透视图;
图8B是根据图1的手术器械的用于驱动构件的致动机构的局部截面侧视图;
图9是图1的说明性手术器械的一部分的截面侧视图;
图10是根据本披露内容的实施例的钉仓和驱动构件的横向截面视图;
图11示出采用利用本发明的方面的机器人手术系统的手术室的俯视图;以及
图12示出可用于本发明的各方面的机器人臂组件的简化侧视图。
具体实施方式
本说明书和附图示出了示例性实施例并且不应被视为限制性的,其中权利要求限定了本披露内容的范围,包括等效物。在不脱离本说明书和权利要求的范围的情况下,可以进行各种机械、组成、结构和操作的改变,包括等效物。在一些情况下,没有详细示出或描述众所周知的结构和技术,以免混淆本披露内容。两个或更多个图中相同的数字代表相同或相似的元件。此外,参考一个实施例详细描述的元件及其相关联的方面,只要可行时,都可以包括在未具体示出或描述它们的其他实施例中。例如,如果参考一个实施例详细描述了元件并且没有参考第二实施例描述该元件,则该元件仍然可以被要求为包括在第二实施例中。此外,本文的描述仅用于说明性目的,并不一定反映系统或所示部件的实际形状、大小或尺寸。
注意,如在本说明书和所附权利要求中使用的,单数形式“一”、“一个”和“所述”以及任何词的任何单数使用,均包括复数所指对象,除非清楚且明确地限制到一个所指对象。如本文所用,术语“包括”及其语法变体旨在是非限制性的,使得列表中的项目的引用不排除可以替换或添加到所列项目的其他类似项目。
虽然以下披露内容是关于其中钉被顺序地击发的线性手术缝合器呈现的,但应当理解,当前描述的手术器械的特征可以容易地适用于任何类型的手术夹持、切割、或密封器械,无论该手术夹紧和切割器械是否使用紧固件。例如,当前描述的驱动构件和致动机构可以用于电外科器械中,其中钳口包括用于向组织施加能量以治疗(例如,烧灼、消融、熔合或切割)该组织的电极。手术夹持和切割器械可以是微创(例如,腹腔镜)器械或用于开放手术的器械。
此外,当前描述的手术缝合器械的特征可以容易地适用于使用本领域技术人员的能力范围内的任何技术启动的手术器械中,例如手动启动的手术器械、动力手术器械(例如,机电动力器械)、机器人手术器械等。
图1是根据本披露内容的某些实施例的说明性手术器械100的透视图,该手术器械具有手柄组件102和安装在手术缝合器械100的细长轴106上的端部执行器110。端部执行器110包括第一钳口111和第二钳口112。手柄组件102包括固定手柄102a和可移动手柄102b,该可移动手柄用作手术器械100的致动器。
在某些实施例中,手柄组件102可以包括输入耦接器(未示出)来代替或补充固定手柄和可移动手柄。输入耦接器在器械的驱动腱或缆线与驱动系统的机械接口的机动轴线之间提供机械耦接。输入耦接器可以与远程手术系统的对应输出耦接器(未示出)接合并且由其驱动,诸如在美国专利公开No.2014/0183244A1中公开的系统,该专利的全部披露内容通过引用并入本文。输入耦接器与设置在器械轴106和端部执行器110内的一个或多个输入构件(未示出)驱动地耦接。合适的输入耦接器可以适于与各种类型的马达组(未示出)配合,诸如在美国专利No.8,912,746中公开的缝合器专用马达组,或美国专利No.8,529,582中公开的通用马达组,以上两个专利的披露内容通过引用整体并入本文。已知的输入耦接器和手术系统的进一步细节在例如美国专利No.8,597,280、美国专利No.7,048,745以及美国专利No.10,016,244中有所描述,这些专利中的每个通过引用整体并入本文。
手术器械100的致动机构可以采用与马达和滑轮的系统结合使用的驱动缆线。众所周知的是动力手术系统,其包括机器人手术系统,该机器人手术系统利用连接到马达和滑轮系统的驱动缆线以实现各种功能,包括钳口的打开和闭合,以及端部执行器的运动和致动。已知的驱动缆线手术系统的进一步细节在例如美国专利No.7,666,191和美国专利No.9,050,119中有所描述,这些专利均通过引用整体并入本文。虽然本文关于被构造成与机器人手术系统一起使用的器械进行了描述,但是应当理解,本文描述的腕部组件可以结合到手动致动器械、机电动力器械或以任何其他方式致动的器械中。
图1A示出手术器械100的远侧端部部分,该远侧端部部分包括具有第一钳口111和第二钳口112的端部执行器110、用于将钳口111、112安装到器械的U形夹140,以及铰接机构,诸如腕部160。第一钳口111包括砧座115,该砧座115具有钉成形凹穴116(参见图1D)。在某些实施例中,第二钳口112是被构造成相对于第一钳口111从打开位置移动到闭合位置的可移动钳口。在另一些实施例中,第一钳口111是被构造成相对于第二钳口112在打开位置与闭合位置之间移动的可移动钳口。在另一些实施例中,钳口111、112都可以相对于彼此移动。在打开位置,可以将新的钉仓122(有时称为重新装载并且在图1B中更清楚地示出)装载到可移动钳口112中,并且组织可以定位在钳口111、112之间。在闭合位置,钳口111、112协作以夹紧组织,使得仓122和砧座115紧密协作对准。
现在参考图1B和图1C,代表性钉仓122可以包括多个钉组件,每个钉组件包括一个或多个钉124,这些钉支撑在对应的钉驱动器或推动器126上,该钉驱动器或推动器126设置在形成于仓122中的相应钉孔127内。在某些实施例中,(一个或多个)钉推动器126包括在其顶表面上方延伸的一个或多个支撑元件,用于在钉124搁置在其上时为钉124提供支撑。当然,根据本发明,可以使用钉推动器126的其他合适的几何设计来接收和保持钉124。例如,如在2019年5月31日提交的共同转让的、共同未决的临时专利申请序列号No.62/855,371中所描述的,推动器126可以具有用于接收钉124的凹槽(未示出)。替代地,推动器126可以具有允许钉124的后跨部搁置在其上的更平坦的上表面(即,没有凹槽或凹穴),如共同转让的、共同未决的临时专利申请序列号No.62,783,460中所描述的,两个申请的完整披露内容通过引用整体并入本文以用于所有目的。
在某些实施例中,仓122还可以包括具有倾斜远侧表面125的梭件123,当向远侧运动时,该倾斜远侧表面顺序地作用在钉推动器126上,使它们向上凸轮传动,从而移动钉124与砧座115变形接触(参见图1D)。梭件123可以是下文更详细地描述的驱动构件150(图7A和图7B)的一部分。仓122可以可移除地被接收在可移动钳口112内,或者在单次使用的实施例中,可以制造为可移动钳口112的一部分。
图3示出了根据本发明的钉推动器126的优选实施例。如图所示,推动器126具有从推动器126横向向外延伸的突起或保持凸台230。凸台230优选地具有倾斜外表面232,其目的将在下文更充分地描述。推动器126还包括在推动器126的顶表面中的凹槽或凹穴240,以用于至少接收和保持钉124的后跨部(如图1B和图1C所示),使得钉的两个支腿从推动器126基本上竖直地向上延伸。本领域技术人员将认识到,钉推动器126的其他合适的几何设计可以用于接收和保持钉124。例如,推动器126可以具有更平坦的上表面(即,没有凹槽或凹穴),该上表面允许钉124的后跨部搁置在其上,如共同转让的、共同未决的临时专利申请No.62,783,460中所描述的,该申请的完整披露内容通过引用整体并入本文以用于所有目的。
现在参考图2,现在将描述钉仓122的优选实施例。如图所示,钉仓122包括外壳202,该外壳基本上沿纵向轴线204延伸并且包括多个隔室206,这些隔室在外壳内形成凹穴以接收钉组件。每个钉组件包括至少一个(优选地2个-4个)钉推动器126,该钉推动器可移除地耦接到至少一个(优选地2个-4个)钉124。钉组件优选地布置在隔室206内,使得钉推动器126靠近外壳202的底表面定位,并且钉124的支腿面向外壳202的顶表面。为了便于参考,外壳的顶表面面向固定钳口111(参见图1)。如上所述,整个钉仓122可以装载到或永久地固定到可移动钳口112以用于手术中,如下文更详细描述的。
在大多数常规钉仓设计中,仓122还将包括围绕仓122的至少一部分的金属板盖(未示出)。该盖用于防止钉组件在用于手术之前,例如在装运、处理等期间,从仓122中掉出。然而,盖增加了仓的竖直高度和水平宽度的材料厚度。在本发明中,仓122不包括该盖,并且因此与常规钉仓相比,钉仓122可以被设计为具有更高的钉和/或更小的整体轮廓(例如,直径)。在示例性实施例中,本发明的钉仓122优选地具有小于12mm、更优选地约8mm的直径。这种较小直径的仓允许设计更小、更紧凑的手术器械,这为外科医生在手术过程期间提供了更多的可操纵性。此外,更小和更紧凑的手术器械不太可能接触并且可能损坏手术场地中的附属组织。
在本发明的一个实施例中,钉仓122的外壳202包括多个开口214,这些开口彼此间隔开并且基本上在纵向轴线204的方向上延伸。如图2中更清楚地所示,每个开口214与钉推动器126中的一个对齐,使得保持凸台230与开口214协作并且突出穿过开口214(参见图4)。保持凸台230和开口214经设定尺寸和构造使得当凸台230延伸穿过开口214时推动器126被固持到外壳206。在使用期间(下文更全面地描述),凸台230的倾斜外表面232在推动器126向上移动时允许凸轮传动表面232沿开口214的边缘向上竖直驱动推动器126(相对于图4)。因此,保持凸台230基本上抑制推动器126相对于外壳206的运动,同时允许推动器126仅在一个方向上的强制或被动运动(参见下文)。
本发明允许钉组件被固持到钉仓122的外壳202而不存在常规的金属片盖。然而,应当注意的是,本发明不限于本文描述的实施例,并且可以使用其他耦接机构在使用之前将钉组件固持到钉仓。例如,钉推动器126和外壳206可以包括将推动器126固持到外壳206同时仍允许该推动器被驱动构件150在一个方向上驱动的其他协作或耦接元件,诸如过盈配合、卡扣配合特征、压配合连接器、具有各种几何形状的凸轮传动表面等。
如图2所示,仓122优选地包括沿纵向轴线204延伸的两排钉组件。由此,仓122包括在内壁220中的内排开口216和在外壁222中的外排开口218,这些开口与用于钉组件208的相应隔室206对齐。为了便于制造这种设计(特别是内排开口216),仓122由两个纵向成形的区段224、226(如图5A所示)形成。区段224、226优选地代表整个钉仓122的两个半部。然而,应当认识到,这些区段中的一个可以比另一个大,只要每个区段在其中包含一排开口。
现在参考图5B和图5C,仓122的区段224、226的远侧部分通过将仓的两个半部保持在一起的耦接元件而彼此耦接。图5B和图5C示出了耦接元件的优选实施例。如图5B所示,区段224包括具有锥形燕尾形状的凸形构件240。区段226包括锥形燕尾形状的对应凹形构件242。如图5C所示,区段224、226可以包括一个或多个按扣特征244,以补充或替代凸形构件和凹形构件240、242。在优选实施例中,仓122将包括图5B和图5C的两个特征。在该实施例中,凸形和凹形燕尾构件240、242装配在一起以对齐区段224、226并且按扣特征244形成将区段224、226的远侧部分锁定在一起的压配合。应当注意的是,本发明不限于图5B和图5C中所示的耦接元件。例如,其他耦接元件可以与本发明一起使用,诸如压配合连接器,诸如实心或顺应性压配合销和插座以及卡扣特征的其他几何形状,诸如环形悬臂、扭转、L-形、U形等。
在某些实施例中,钳口111、112经由合适的耦接设备诸如U形夹140附接到手术器械100。U形夹140包括上部部分和下部部分,它们在组装时协作以形成突起145,该突起被构造成接合钳口111的突片113(参考图1A),以将钳口111牢固地安装在器械100上的固定位置中。U形夹140还包括用于接收枢轴销130的开口,该枢轴销130限定钳口112围绕其枢转的枢轴线,如下文更详细描述的。与本发明一起使用的合适的U形夹140的更全面的描述可以见于共同转让的、共同未决的临时专利申请:2018年12月21日提交的No.62,783,444;2018年12月21日提交的No.62,783,481;2018年12月21日提交的No.62,783,460;2018年10月19日提交的No.62,747,912;以及2018年12月21日提交的No.62,783,429,其全部披露内容通过引用整体并入本文以用于所有目的。当然,本领域技术人员将认识到,本领域技术人员已知的其他耦接机构可以与本发明一起使用,以将钳口11、112附接到手术器械100的近侧部分。
现在参考图6,端部执行器110可以通过铰接机构在多个方向上铰接。在某些实施例中,铰接机构可以是如图所示的腕部160,但可以设想其他铰接机构。如图6所示,腕部160的优选实施例包括多个铰接接头162、164、166等,这些接头限定了孔167,致动机构(在某些实施例中,线圈120和驱动缆线171,参见图8A)可以穿过该孔。在离开铰接腕部160时,线圈120进入并且穿过U形夹140的内部通道(未示出),最终接合驱动构件150的上承座152的近侧表面(参见图8A)。本领域技术人员已知的其他铰接机构可以替代腕部160。其他示例性铰接机构在例如共同转让的、共同未决的美国出版物No.2015/0250530和2019年11月20日提交的美国专利申请No.PCT/US19/62344中示出,上述文献的全部披露内容通过引用整体并入本文以用于所有目的。
如图7A和图7B所示,驱动构件150的优选实施例可以包括主体、上承座152、下承座154、中央部分156以及横向部分159。横向部分159是形成前面所示的梭件123的翼片。驱动构件150的横向部分159均包括与推动器126接合的远侧倾斜表面或斜面161,以在驱动构件150朝远侧平移时竖直地或垂直于纵向轴线204驱动推动器126(以及相关联的钉124)。在优选的实施例中,梭件翼片159与驱动构件150的下承座154成一体。在常规设计中,这通常是不可能的,这是因为用于将钉组件208固持在钉仓122的外壳202内的外金属片盖。将梭件翼片159与驱动构件150成一体为钉仓122的设计提供了更大的灵活性。例如,这可以允许减小钉仓122和手术器械100的尺寸,并且/或者对于手术器械100的给定尺寸增加钉124的长度。
如图8A和图8B所示,致动组件190包括驱动缆线171、线圈120、围绕线圈120的护套121和驱动杆175。驱动缆线171包括扩大的远侧端部173。驱动构件150的上承座152包括驱动缆线171被布线到其中的孔158。当组装说明性手术器械100时,线圈120和保护护套121滑过驱动缆线171的自由端部。驱动缆线171的自由端部附接到驱动杆175,从而将线圈120和保护护套121固定在驱动构件150与驱动杆175之间,如在图7B中最佳可见。护套121可以起到促进稳定性、平滑移动并且防止在手术器械100致动时弯曲的作用。护套121可以由聚酰亚胺或具有必要的强度要求的任何其他合适材料制成,诸如各种增强塑料、诸如NITINOLTM的镍钛合金、诸如可从杜邦公司商购获得的KEVRALTM的聚对苯二甲酰对苯二胺(polyparaphenyleneterphtalamide)材料。本领域技术人员可以设想其他合适的材料。
驱动缆线171的扩大的远侧端部173位于驱动构件150的上承座152中的孔158的扩大的远侧部分159内,使得当驱动缆线171被朝近侧(即在图8B中箭头“B”的方向上)拉动时扩大的远侧端部173的近侧面157可以在上承座152上施加回缩力。驱动杆175可操作地连接到致动器(例如,可移动手柄102b),该致动器允许致动组件190的远侧平移和近侧回缩。本领域技术人员将认识到,在手动致动的器械中,致动器可以是可移动手柄,诸如图1所示的可移动手柄102b;在动力器械中,致动器可以是使马达作用在驱动杆上的按钮(未示出);并且在机器人系统中,致动器可以是控制设备,诸如下文结合图12描述的控制设备。可以使用用于驱动手术缝合器械的部件的任何合适的后端致动机构。对于与使用推/拉驱动缆线的示例性致动机构有关的附加细节,参见例如共同转让的、共同未决的国际申请WO2018/049217,其披露内容通过引用整体并入本文。
现在参考图10,驱动构件150的上承座152与固定钳口111中的通道118基本上对齐并且平移通过该通道,而驱动构件150的下承座154与通道119和下钳口112基本上对齐并且平移通过该通道和下钳口。如图8A和图8B所示,孔158穿过152形成以接收驱动缆线171,如将在下文更详细地描述的。上承座152的近侧表面153被构造成与致动组件190的线圈120接合,使得线圈120可以向上承座152施加力,以朝远侧推进驱动构件150,即在图8B中的箭头“A”的方向上。刀具128可以沿上承座152和中央部分156之间的远侧边缘形成在驱动构件150上。
在说明性手术器械100的致动期间,驱动杆175向线圈120施加力,从而使线圈120向驱动构件150的上承座152施加力,使该上承座朝远侧平移(即,在图7B中的箭头“A”的方向上),首先闭合钳口111、112,然后将钉124从仓122弹出到钉组织。在缝合完成后,驱动杆175在近侧方向上施加力,以实现驱动构件的回缩。在回缩期间,驱动缆线171的扩大远侧端部173被孔158的扩大部分159的壁157阻挡,导致驱动缆线171向驱动构件150的上承座152施加力,从而使驱动构件150在近侧方向上平移。在某些实施例中,手术器械可以被设计成使得驱动构件150在钉被击发之后不在近侧方向上回缩。本领域的普通技术人员将理解,驱动构件150、驱动缆线171以及驱动杆175都一致地移动并且彼此保持在相同的相对位置。
在使用中,在打开配置中,驱动构件150定位在形成于可移动钳口112上的凸轮表面114的近侧。当驱动构件150在远侧方向上平移时,可移动钳口112将围绕枢轴117朝向闭合位置旋转。一旦驱动构件150与可移动钳口112的凸轮表面114接触,驱动构件150的下部部分154就骑置在凸轮表面114下方,驱动构件150推动可移动钳口112,使其朝向闭合位置枢转。在闭合位置中,驱动构件150已经朝远侧平移越过凸轮表面114。在该位置中,组织被夹紧,并且驱动构件的进一步推进将切断和缝合组织。当然,本领域技术人员将认识到,驱动构件150可以是能够以必要的力推动手术缝合器械的梭件或刀具中的至少一个以有效地切断或缝合人体组织的任何结构。驱动构件150可以是工字梁、E字梁或能够执行类似功能的任何其他类型的驱动构件。驱动构件150可移动地支撑在手术缝合器械100上,使得当该手术缝合器械被击发(例如,致动)时,驱动构件150可以朝远侧穿过钉仓和固定的上钳口111与下钳口112。
作为示例,图11示出了采用机器人手术系统的手术室的俯视图。在这种情况下,机器人手术系统是包括由外科医生(“S”)在躺在手术台(“O”)上的患者(“P”)身上执行(通需要来自一个或多个助手(“A”)的辅助)微创诊断或手术过程时使用的控制台(“C”)的机器人手术系统300。
控制台包括用于向外科医生显示手术部位的图像的监视器304、左右可操纵控制设备308和309、脚踏板305以及处理器302。控制设备308和309可以包括各种输入设备中的任何一个或多个,诸如操纵杆、手套、扳机枪、手动控制器等。处理器302可以是可以与控制台成一体或放置在控制台旁边的专用计算机。
外科医生通过操纵控制设备308和309(在本文也称为“主操纵器”)以使得处理器302使它们分别关联的机器人臂组件328和329(在本文也称为“从动操纵器”)相应地操纵它们各自的可移除地耦接的手术器械338和339(在本文也称为“工具”)来执行微创手术过程,同时,外科医生在该手术部位由立体内窥镜340捕获时在控制台监视器304上以3-D方式查看手术部位。
工具338和339中的每个以及内窥镜340可以通过插管或其他工具引导件(未示出)插入到患者体内,以便通过相应的微创切口诸如切口366向下延伸到手术部位。机器人臂中的每个通常由连杆诸如连杆362形成,这些连杆耦接在一起并且通过马达控制的或活动的接头诸如接头363进行操纵。
一次使用的手术工具的数量以及因此在系统300中使用的机器人臂的数量通常将取决于诊断或手术过程以及手术室内的空间限制等因素。如果在手术过程期间需要更换正在使用的工具中的一个或多个,则助手可以从其机器人臂上移除不再使用的工具,并且从手术室中的托盘(“T”)将其替换为另一个工具331。
监视器304可以定位在外科医生的手附近,使得其将显示被定向的投影图像,使得外科医生感觉他或她实际上是直接向下查看手术部位。为此,工具338和339的图像可能看起来基本上位于外科医生的手所在的位置。
处理器302在系统300中执行各种功能。它执行的一个重要功能是通过总线310上的控制信号将控制设备308和309的机械运动转换和传递到它们各自的机器人臂328和329,使得外科医生可以有效地操纵他们各自的工具338和339。另一个重要功能是实施如本文所述的各种控制系统过程。
尽管被描述为处理器,但是应当理解,处理器302可以在实践中通过硬件、软件和固件的任何组合实施。此外,如在本文描述的其功能可以由一个单元来执行,或者在不同的部件之间划分,每个部件继而由硬件、软件和固件的任意组合实施。有关机器人手术系统的其他详细信息,参见例如共同拥有的美国专利No.6,493,608“Aspects of a ControlSystem of a Minimally Invasive Surgical Apparatus(微创手术仪器的控制系统方面)”,以及共同拥有的美国专利No.6,671,581“Camera Referenced Control in aMinimally Invasive Surgical Apparatus(微创手术仪器中的相机参考控制)”,这些专利通过引用整体并入本文以用于所有目的。
图12示出了作为示例的保持用于执行手术过程的手术器械450(其代表工具338和339)的简化(不一定成比例或完整的)说明性机器人臂组件400(其代表机器人臂组件328和329)的侧视图。手术器械450可移除地保持在工具保持器440中。臂组件400被基座401机械地支撑,该基座可以是患者侧可移动推车的一部分或固定到手术台或天花板。它包括连杆402和403,连杆402和403通过装配接头404和405耦接在一起并且连接到基座401。
在该示例中,装配接头404和405是在它们的制动器被释放时允许手动定位臂400的被动接头。例如,装配接头404允许连杆402围绕轴线406手动地旋转,装配接头405允许连杆403围绕轴线407手动地旋转。尽管在该示例中仅示出两个连杆和两个装配接头,但在该机器人臂组件和其他机器人臂组件中,可以结合本发明适当地使用更多或更少的连杆和装配接头。例如,虽然装配接头404和405可以用于臂400的水平定位,但可以包括附加的安装接头并且附加的安装接头用于臂400的受限的竖直和角度定位。然而,对于臂400的主要竖直定位,臂400也可以沿基座401的竖直轴线滑动并且被锁定在合适的位置。
机器人臂组件400还包括由马达驱动的三个主动接头。偏航接头410允许臂区段430围绕轴线461旋转,并且俯仰接头420允许臂区段430围绕与轴线461垂直并且与附图的平面正交的轴线旋转。臂区段430被构造成使得当俯仰接头420通过其马达旋转时,区段431和432总是彼此平行。因此,器械450可以通过驱动偏航和俯仰马达可控制地移动,以围绕枢轴点462枢转,该枢轴点通常通过装配接头404和405的手动定位而定位,以便在切入点处进入患者体内。此外,插入齿轮445可以耦接到线性驱动机构(未示出),以沿其轴线463延伸或回缩器械450。
尽管偏航、俯仰和插入接头或齿轮410、420和445中的每个由单独的接头或齿轮控制器控制,但是这三个控制器由共同的主/从控制系统控制,使得机器人臂组件400(在本文也称为“从属操纵器”)可以通过其相关联的主操纵器的用户(例如,外科医生)操纵来控制。可以在共同转让的美国专利No.9,295,524、No.9,339,344、No.9,358,074以及No.9,452,019中找到对与本发明一起使用的说明性机器人手术系统的更完整描述,这些专利的完整披露内容通过引用整体并入本文以用于所有目的。
据此,本说明书中提及的所有已颁发的专利、已公布的专利申请和非专利出版物通过引用整体并入本文以用于所有目的,其程度如同每个单独的已颁发专利、已公布的专利申请或非专利出版物被特别地和单独地指示为以引用的方式并入。
虽然在附图中示出了本披露内容的若干实施例,但本披露内容并不旨在限于此,因为本披露内容的范围与本领域所允许的范围一样宽,并且本说明书应被同样地阅读。因此,以上描述不应被解释为限制性的,而仅被解释为当前所公开的实施例的示例。因此,实施例的范围应由所附权利要求及其合法等效物确定,而不是由给出的示例确定。
本领域技术人员将理解,在本文具体描述和在附图中示出的设备和方法是非限制性示例性实施例。结合一个示例性实施例示出或描述的特征可以与其他实施例的特征组合。在不脱离本披露内容的情况下,本领域技术人员可以设想各种替代和修改。因此,本披露内容旨在包括所有此类替代、修改和变化。同样,本领域技术人员将基于上述实施例理解本披露内容的进一步特征和优点。因此,除了所附权利要求所指示的之外,本披露内容不受已经具体示出和描述的内容的限制。
考虑到本文公开的实施例的说明书和实践,其他实施例对于本领域技术人员来说将是显而易见的。说明书和示例旨在仅被视为示例性的,实施例的真实范围和精神由随附权利要求指示。
Claims (25)
1.一种手术器械,包括:
端部执行器,所述端部执行器包括第一钳口和第二钳口,所述第一钳口和所述第二钳口被构造成相对于彼此从打开位置移动到闭合位置;以及
钉仓,所述钉仓耦接到所述第一钳口或所述第二钳口中的一个,并且包括:
外壳,其包括纵向轴线和具有开口的侧壁;以及
一个或多个钉组件,每个钉组件包括钉推动器和钉,其中,所述钉推动器具有耦接元件,所述耦接元件经设定尺寸以接合所述外壳的一部分,使得所述钉组件固持到所述外壳,其中所述突起包括外部倾斜表面,并且所述外部倾斜表面的至少一部分穿过所述外壳中的所述开口从所述外壳的所述侧壁横向向外延伸。
2.根据权利要求1所述的手术器械,其中,所述钉仓可移除地耦接到所述第一钳口或所述第二钳口中的一个。
3.根据权利要求1所述的手术器械,其中,所述外部倾斜表面经设定尺寸以允许所述钉推动器在基本上垂直于所述纵向轴线的单个方向上的强制运动。
4.根据权利要求3所述的手术器械,其中,在进行所述强制运动时,所述钉推动器能够从所述钉仓分离。
5.根据权利要求1所述的手术器械,其中,所述外壳包括内壁区段和外壁区段,所述内壁区段和所述外壁区段均具有彼此间隔开并且沿所述外壳的所述纵向轴线延伸的多个开口。
6.根据权利要求5所述的手术器械,还包括在所述外壳内彼此相邻的第一排钉推动器和第二排钉推动器,其中,每个钉推动器具有经设定尺寸以与所述外壳的所述内壁区段和所述外壁区段中的所述开口中的一个接合的突起,以将每排钉推动器固持到所述外壳。
7.根据权利要求1所述的手术器械,其中,所述外壳包括彼此耦接的第一纵向区段和第二纵向区段,所述第一纵向区段和所述第二纵向区段中的每个包括壁和在所述壁中沿每个区段纵向地延伸的一排开口。
8.根据权利要求7所述的手术器械,其中,所述第一纵向区段和所述第二纵向区段均包括耦接构件,并且其中,每个区段的所述耦接构件被构造成彼此协作,以形成将所述区段彼此耦接的过盈配合。
9.根据权利要求8所述的手术器械,还包括驱动构件,所述驱动构件被构造成朝远侧平移穿过所述端部执行器,所述驱动构件包括中央部分以及各自具有倾斜表面的第一外部部分和第二外部部分。
10.根据权利要求9所述的手术器械,其中,在组装所述第一部分和所述第二部分时,所述第一纵向区段和所述第二纵向区段协作以形成通道,所述通道经设定尺寸以接收所述驱动构件的所述中央部分。
11.根据权利要求9所述的手术器械,其中,所述驱动构件的所述外部部分的所述倾斜表面被构造成在所述驱动构件通过所述钉仓的所述通道朝远侧平移时接合所述钉推动器,并且使所述钉从所述外壳内部内的第一位置移动到所述外壳外部的第二位置。
12.根据权利要求11所述的手术器械,还包括致动机构,所述致动机构与所述驱动构件接触并且被构造成使所述驱动构件朝远侧平移通过所述端部执行器。
13.根据权利要求12所述的手术器械,还包括能够操作地连接到所述致动机构的致动器,其中,所述致动器包括设置在所述手术器械的所述近侧端部部分处的手柄组件的可移动手柄。
14.根据权利要求13所述的手术器械,其中,所述致动器包括机器人手术系统的控制设备。
15.根据权利要求14所述的手术器械,其中,所述固定钳口包括砧座并且所述可移动钳口包括所述钉仓。
16.一种用于手术器械的钉仓,包括:
外壳,所述外壳具有纵向轴线和侧壁,所述侧壁具有基本上沿所述纵向轴线彼此间隔开的一个或多个开口;以及
一个或多个钉组件,每个钉组件包括钉推动器和钉,
其中,所述钉推动器中的每个包括突起,所述突起被构造成与所述外壳中的所述开口中的一个协作,使得所述钉组件固持到所述外壳,其中所述突起包括外部倾斜表面,并且所述外部倾斜表面的至少一部分穿过所述外壳中的所述开口从所述外壳的所述侧壁横向向外延伸。
17.根据权利要求16所述的钉仓,其中,所述突起的所述倾斜表面经设定尺寸以基本上抑制所述钉推动器相对于所述外壳的所述外壁的运动,并且允许所述钉推动器在基本上平行于所述壁并且基本上垂直于所述纵向轴线的方向上的强制运动。
18.根据权利要求17所述的钉仓,其中,所述外壳包括内壁区段和外壁区段,所述内壁区段和所述外壁区段均具有基本上沿所述纵向轴线彼此间隔开的多个开口。
19.根据权利要求18所述的钉仓,还包括邻近所述外壳的相应所述内壁区段和外壁区段的第一排钉组件和第二排钉组件。
20.根据权利要求19所述的钉仓,其中,所述第一排钉组件和所述第二排钉组件中的每个包括可移除地耦接到钉的多个钉推动器,每个钉推动器具有横向突起,所述横向突起经设定尺寸以与所述外壳的所述内壁区段和所述外壁区段中的所述开口中的一个接合,以将每排钉组件固持到所述外壳。
21.根据权利要求16所述的钉仓,其中,所述外壳包括彼此耦接的第一纵向区段和第二纵向区段,所述第一纵向区段和所述第二纵向区段中的每个包括一排间隔开的开口。
22.根据权利要求21所述的钉仓,其中,所述第一纵向区段和所述第二纵向区段各自包括耦接构件,并且其中,每个区段的所述耦接构件被构造成彼此协作,以将所述纵向区段彼此耦接。
23.根据权利要求22所述的钉仓,其中,所述耦接构件彼此形成过盈配合。
24.根据权利要求23所述的钉仓,其中,在组装所述第一区段和所述第二区段时,所述第一纵向区段和所述第二纵向区段协作以形成通道,所述通道经设定尺寸以接收驱动构件,以实现所述驱动构件穿过所述通道的纵向平移。
25.根据权利要求16所述的钉仓,其中,所述外壳具有约8mm或更小的外径。
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EP2374419A2 (en) * | 2010-04-07 | 2011-10-12 | Tyco Healthcare Group LP | Surgical fastener applying apparatus |
EP2540231A2 (en) * | 2011-06-30 | 2013-01-02 | Covidien LP | Surgical instrument and cartridge for use therewith |
EP2944275A2 (en) * | 2014-05-16 | 2015-11-18 | Covidien LP | In-situ loaded stapler |
EP3120780A2 (en) * | 2015-07-20 | 2017-01-25 | Covidien LP | Endoscopic stapler and staple |
Also Published As
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US20220183686A1 (en) | 2022-06-16 |
US20240260959A1 (en) | 2024-08-08 |
US11944302B2 (en) | 2024-04-02 |
EP3955831A1 (en) | 2022-02-23 |
WO2020214258A1 (en) | 2020-10-22 |
CN113710170A (zh) | 2021-11-26 |
EP3955831A4 (en) | 2022-12-28 |
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