CN113747843B - 用于外科器械的可旋转钳口末端 - Google Patents
用于外科器械的可旋转钳口末端 Download PDFInfo
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Abstract
本发明公开了一种外科器械，所述外科器械包括第一钳口和第二钳口。所述第一钳口和所述第二钳口中的至少一者包括近侧部分和能够相对于所述近侧部分旋转的远侧末端。
Description
相关申请的交叉引用
本申请要求2019年4月30日提交的名称为“SURGICAL INSTRUMENT COMPRISING ANADAPTIVE CONTROL SYSTEM”的美国临时专利申请序列号62/840,715的权益，该美国临时专利申请的全部公开内容以引用方式并入本文。
技术领域
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是根据至少一个实施方案的外科器械的透视图；
图1B是图1的外科器械的左侧正视图；
图1C是图1的外科器械的右侧正视图；
图1D是图1的外科器械的前正视图；
图1E是图1的外科器械的后正视图；
图1F是图1的外科器械的平面图；
图1G是图1的外科器械的底视图；
图2是图1的外科器械的局部透视图；
图3是图1的外科器械的轴的局部透视图；
图4是图3的轴的管嘴的透视图；
图5是图1的外科器械的取向开关的正视图；
图6是根据至少一个实施方案的外科器械的局部透视图，该外科器械包括具有取向传感器的柄部和具有能够由取向传感器检测到的磁性元件的轴；
图7是根据至少一个实施方案的外科器械的局部正视图，该外科器械包括柄部和在柄部的相对侧上的关节运动致动器；
图8是图7的外科器械的局部平面图；
图9是根据至少一个实施方案的外科器械的透视图，该外科器械包括柄部和可旋转轴，该可旋转轴包括在轴的相对侧上的关节运动致动器；
图10是图9的轴的端视图；
图11是根据至少一个实施方案的外科器械的透视图，该外科器械包括柄部和可旋转轴，该可旋转轴包括在轴的相对侧上的两个关节运动致动器；
图12是图11的轴的端视图；
图13是根据至少一个实施方案的外科器械的透视图，该外科器械包括可滑动关节运动致动器，该可滑动关节运动致动器包括两个位置和位于两个位置之间的止动器；
图14示出了电容式开关，该电容式开关包括第一侧和第二侧、第一侧中的当接触第一侧时点亮的第一灯、以及第二侧中的当接触第二侧时点亮的第二灯；
图15示出了根据至少一个实施方案的用于使外科器械的端部执行器进行关节运动的两级摇臂开关；
图16是根据至少一个实施方案的外科器械的局部顶视图，该外科器械包括端部执行器和定位在端部执行器的相对侧上的灯，这些灯被点亮以指示端部执行器正在进行关节运动的方向；
图17是图16的外科器械的局部正视图；
图18是根据至少一个实施方案的外科器械的局部正视图，该外科器械包括方向指示器，该方向指示器被点亮以指示端部执行器正在进行关节运动的方向；
图19是根据至少一个实施方案的外科器械的透视图，该外科器械包括可滑动关节运动开关，该可滑动关节运动开关包括三个位置——关节运动左侧位置、关节运动右侧位置和中心位置或原始位置；
图20是根据至少一个实施方案的外科器械的正视图，该外科器械包括能够沿纵向轴线致动的关节运动操纵杆；
图21是根据至少一个实施方案的外科器械的正视图，该外科器械包括端部执行器和能够被致动以使端部执行器围绕多于一条轴线进行关节运动的关节运动操纵杆；
图22A是根据至少一个实施方案的包括多个关节运动控制件的外科器械的前正视图；
图22B是图22A的外科器械的局部侧正视图；
图23是根据至少一个实施方案的包括4向触觉关节运动控制件的外科器械的正视图；
图24是根据至少一个实施方案的包括4向触觉关节运动控制件的外科器械的局部正视图，该4向触觉关节运动控制件包括中心致动器或归位致动器；
图25是根据至少一个实施方案的包括4向电容式表面的外科器械的正视图；
图26A示出了根据至少一个实施方案的外科器械，该外科器械包括端部执行器和定位在端部执行器的相对侧上的灯，这些灯被点亮以指示端部执行器正在进行关节运动的方向；
图26B是图26A的外科器械的透视图；
图27示出了根据至少一个实施方案的外科器械，该外科器械包括关节运动接头、能够围绕关节运动接头进行关节运动的端部执行器、以及被构造成能够使端部执行器围绕关节运动接头旋转的可平移关节运动致动器；
图28是可关节运动的端部执行器、被构造成能够使端部执行器围绕关节运动接头旋转的关节运动致动器以及关节运动致动器上的分界线的局部透视图，该分界线指示端部执行器进行关节运动和/或正在进行关节运动的方向；
图29是根据至少一个实施方案的外科器械的透视图，该外科器械包括柄部、从柄部延伸的可旋转轴、以及位于柄部上的可旋转致动器，该可旋转致动器被构造成能够使轴围绕纵向轴线旋转；
图30是图29的外科器械的透视图，示出了处于旋转位置的轴；
图31是图29的外科器械的透视图，示出了柄部外壳的一部分被移除；
图32是图1的外科器械的关节运动接头的局部细部图，示出了一些部件被移除；
图33是根据至少一个另选实施方案的可与图1的外科器械一起使用的关节运动接头的局部细部图；
图34是从图33的实施方案的端部执行器的框架延伸的关节运动驱动销的局部透视图；
图35是图33的实施方案的局部细部图，示出了处于关节运动位置的端部执行器；
图36是图33的实施方案的局部细部图，示出了处于另一关节运动位置的端部执行器；
图37是图33的实施方案的局部细部图，示出了处于另一关节运动位置的端部执行器；
图38是图1的外科器械的端部执行器的剖视图，示出为处于打开构型；
图39是图1的外科器械的端部执行器的局部剖视图，示出了端部执行器的组织止挡件；
图40是图1的外科器械的端部执行器的局部剖视图，示出了端部执行器的钉仓钳口和砧座钳口之间的枢转接头；
图41是图40的钉仓钳口的局部平面图，其中钉仓没有定位在钉仓钳口中；
图42是图40的砧座钳口的局部透视图；
图43是图40的枢转接头的局部顶视图；
图44是根据至少一个实施方案的端部执行器的钉仓钳口的局部剖视图，示出在钉仓钳口中没有钉仓；
图45A是处于打开构型的图44的端部执行器的局部剖视图；
图45B是处于闭合构型的图44的端部执行器的局部剖视图；
图46是图1的外科器械的端部执行器的局部剖视图，示出了处于非击发位置的击发构件；
图47是图1的外科器械的端部执行器的局部剖视图，示出了砧座钳口上的仓止挡件，该仓止挡件被构造成能够阻止钉仓朝近侧插入钉仓钳口中；
图48是图1的外科器械的砧座钳口的局部透视图，示出了被构造成能够在端部执行器处于打开构型时将图46的击发构件的位置控制在其非击发位置的表面；
图49是图1的外科器械的局部正视图；
图50是图1的外科器械的局部透视图；
图51是根据至少一个实施方案的外科器械的局部正视图；
图52是图51的外科器械的局部透视图；
图53是根据至少一个实施方案的外科器械的局部正视图；
图54是图53的外科器械的局部透视图；
图55是图1的外科器械的透视图；
图56是根据至少一个实施方案的外科器械的局部透视图；
图57是图56的外科器械的轴的局部透视图；
图58是由图56的外科器械实现的控制算法；
图59是根据至少一个实施方案的外科器械的轴的局部透视图；
图60是根据至少一个实施方案的外科器械的轴的局部透视图；
图61是根据至少一个实施方案的外科器械的轴的局部透视图；
图62是根据至少一个实施方案的外科器械的轴的局部透视图；
图63是根据至少一个实施方案的外科器械的滑环组件的透视图；
图64是图63的滑环组件的另一个透视图；
图65是图63的外科器械的轴部件的透视图；
图66是图63的外科器械的局部透视图；
图67是描绘根据至少一个实施方案的轴取向传感器阵列的图示；
图68是包括砧座钳口和仓钳口的端部执行器的局部正视图，其中砧座钳口包括远侧部分，该远侧部分能够在第一操作取向与不同于第一操作取向的第二操作取向之间旋转，并且其中砧座钳口的远侧部分被示出为处于第一操作取向；
图69是图68的砧座钳口的局部透视图，其中砧座钳口的远侧部分被示出为处于部分旋转取向；
图69A描绘了将远侧部分保持在图68的砧座钳口的连接器；
图70是图68的端部执行器的局部正视图，其中砧座钳口的远侧部分被示为处于第二操作取向；
图71是图68的端部执行器的局部透视图，其中砧座钳口的远侧部分被示为处于第二操作取向；
图72是根据至少一个实施方案的近侧关节运动杆的远侧端部的透视图；
图73是根据至少一个实施方案的关节运动驱动装置的近侧关节运动杆和远侧关节运动杆之间的接合部的透视图；
图73A是图73的近侧关节运动杆和关节运动锁之间的接合部的细部图；
图74是图72的近侧关节运动杆与图73的远侧关节运动杆之间的接合部的透视图；
图74A是图72的近侧关节运动杆与图73A的关节运动锁之间的接合部的细部图；
图75是图73A的关节运动锁的透视图；
图76是图73A的关节运动锁的另一个透视图；
图77示出了图73的远侧关节运动杆的运动范围；
图78是用于控制系统评估和获取关节运动系统的位置的算法；
图79描绘了图1的外科器械的端部执行器以及钉击发行程期间的钉击发系统的速度图表算法；
图80描绘了根据至少一个实施方案的图1的外科器械的端部执行器以及钉击发系统的速度图表算法；
图81描绘了图1的外科器械的端部执行器以及钉击发行程期间的钉击发系统的速度图表算法；
图82A描绘了图1的外科器械的钉击发系统在三个钉击发行程期间的占空比和所经历的击发力的曲线图；
图82B描绘了在比图82A的击发速度更高的击发速度下的三个钉击发行程期间，图1的外科器械的钉击发系统的占空比和所经历的击发力的曲线图；
图83A描绘了图1的外科器械的钉击发系统在穿过1.35mm厚的空肠组织的钉击发行程期间所经历的占空比、击发力和击发速度的曲线图；
图83B描绘了图1的外科器械的钉击发系统在穿过4mm厚的胃组织的钉击发行程期间所经历的占空比、击发力和击发速度的曲线图；
图84A和图84B描绘了比较穿过组织的击发力与组织类似物的击发力的曲线图；
图85A和图85B描绘了展示图1的外科器械的钉击发系统在若干钉击发行程期间所经历的占空比和击发速度的曲线图；
图86A描绘了图1的外科器械的钉击发系统在穿过薄空肠组织的钉击发行程期间的占空比的曲线图；
图86B描绘了图1的外科器械的钉击发系统在穿过厚空肠组织的钉击发行程期间的占空比的曲线图；
图86C描绘了图1的外科器械的钉击发系统在穿过胃组织的钉击发行程期间的占空比的曲线图；
图87描绘了图1的外科器械的钉击发系统在钉击发行程期间的占空比的曲线图，其中控制系统增加了钉击发行程的速度；
图88描绘了图1的外科器械的钉击发系统在钉击发行程期间的占空比的曲线图，其中控制系统在整个钉击发行程中基本上保持相同的速度；并且
图89描绘了图1的外科器械的钉击发系统在钉击发行程期间的占空比的曲线图，其中控制系统降低了钉击发行程的速度。
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
本申请的申请人还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 OPERATING A SURGICAL INSTRUMENT”的美国专利申请；代理人案卷号END9169USNP1/190177-1M；
-名称为“ARTICULATION ACTUATORS FOR A SURGICAL INSTRUMENT”的美国专利申请；代理人案卷号END9169USNP2/190177-2；
-名称为“ARTICULATION DIRECTIONAL LIGHTS ON A SURGICAL INSTRUMENT”的美国专利申请；代理人案卷号END9169USNP3/190177-3；
-名称为“SHAFT ROTATION ACTUATOR ON A SURGICAL INSTRUMENT”的美国专利申请；代理人案卷号END9169USNP4/190177-4；
-名称为“ARTICULATION CONTROL MAPPING FOR A SURGICAL INSTRUMENT”的美国专利申请；代理人案卷号END9169USNP5/190177-5；
-名称为“INTELLIGENT FIRING ASSOCIATED WITH A SURGICAL INSTRUMENT”的美国专利申请；代理人案卷号END9169USNP6/190177-6；
-名称为“INTELLIGENT FIRING ASSOCIATED WITH A SURGICAL INSTRUMENT”的美国专利申请；代理人案卷号END9169USNP7/190177-7；
-名称为“TISSUE STOP FOR A SURGICAL INSTRUMENT”的美国专利申请；代理人案卷号END9169USNP9/190177-9；以及
-名称为“ARTICULATION PIN FOR A SURGICAL INSTRUMENT”的美国专利申请；代理人案卷号END9169USNP10/190177-10。
本申请的申请人拥有于2019年2月21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“METHODS FOR CONTROLLING A POWERED SURGICAL STAPLER THAT HASSEPARATE ROTARY CLOSURE AND FIRING SYSTEMS”的美国专利申请序列号16/281658；
-名称为“STAPLE CARTRIDGE COMPRISING A LOCKOUT KEY CONFIGURED TO LIFTA FIRING MEMBER”的美国专利申请序列号16/281,670；
-名称为“SURGICAL STAPLERS WITH ARRANGEMENTS FOR MAINTAINING A FIRINGMEMBER THEREOF IN A LOCKED CONFIGURATION UNLESS A COMPATIBLE CARTRIDGE HASBEEN INSTALLED THEREIN”的美国专利申请序列号16/281675；
-名称为“SURGICAL INSTRUMENT COMPRISING CO-OPERATING LOCKOUT FEATURES”的美国专利申请序列号16/281685；
-名称为“SURGICAL STAPLING ASSEMBLY COMPRISING A LOCKOUT AND ANEXTERIOR ACCESS ORIFICE TO PERMIT ARTIFICIAL UNLOCKING OF THE LOCKOUT”的美国专利申请序列号16/281693；
-名称为“SURGICAL STAPLING DEVICES WITH FEATURES FOR BLOCKINGADVANCEMENT OF A CAMMING ASSEMBLY OF AN INCOMPATIBLE CARTRIDGE INSTALLEDTHEREIN”的美国专利申请序列号16/281,704；
-名称为“STAPLING INSTRUMENT COMPRISING A DEACTIVATABLE LOCKOUT”的美国专利申请序列号16/281707；
-名称为“SURGICAL INSTRUMENT COMPRISING A JAW CLOSURE LOCKOUT”的美国专利申请序列号16/281741；
-名称为“SURGICAL STAPLING DEVICES WITH CARTRIDGE COMPATIBLE CLOSUREAND FIRING LOCKOUT ARRANGEMENTS”的美国专利申请序列号16/281762；
-名称为“SURGICAL STAPLING DEVICES WITH IMPROVED ROTARY DRIVEN CLOSURESYSTEMS”的美国专利申请序列号16/281666；
-名称为“SURGICAL STAPLING DEVICES WITH ASYMMETRIC CLOSURE FEATURES”的美国专利申请序列号16/281672；
-名称为“ROTARY DRIVEN FIRING MEMBERS WITH DIFFERENT ANVIL AND CHANNELENGAGEMENT FEATURES”的美国专利申请序列号16/281678；以及
-名称为“SURGICAL STAPLING DEVICE WITH SEPARATE ROTARY DRIVEN CLOSUREAND FIRING SYSTEMS AND FIRING MEMBER THAT ENGAGES BOTH JAWS WHILE FIRING”的美国专利申请序列号16/281682。
本申请的申请人拥有于2019年2月19日提交且各自全文以引用方式并入本文的以下美国临时专利申请：
-名称为“METHODS FOR CONTROLLING A POWERED SURGICAL STAPLER THAT HASSEPARATE ROTARY CLOSURE AND FIRING SYSTEMS”的美国临时专利申请序列号62/807,310；
-名称为“SURGICAL STAPLING DEVICES WITH IMPROVED LOCKOUT SYSTEMS”的美国临时专利申请序列号62/807,319；以及
-名称为“SURGICAL STAPLING DEVICES WITH IMPROVED ROTARY DRIVEN CLOSURESYSTEMS”的美国临时专利申请序列号62/807,309。
本专利申请的申请人拥有于2018年3月28日提交的以下美国临时专利申请，这些临时专利申请中的每个临时专利申请全文以引用方式并入本文：
-名称为“INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATIONCAPABILITIES”的美国临时专利申请序列号62/649,302；
-名称为“DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS ANDCREATE ANONYMIZED RECORD”的美国临时专利申请序列号62/649,294；
-名称为“SURGICAL HUB SITUATIONAL AWARENESS”的美国临时专利申请序列号62/649,300；
-名称为“SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES INOPERATING THEATER”的美国临时专利申请序列号62/649,309；
-名称为“COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS”的美国临时专利申请序列号62/649,310；
-名称为“USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINEPROPERTIES OF BACK SCATTERED LIGHT”的美国临时专利申请序列号62/649,291；
-名称为“ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES”的美国临时专利申请序列号62/649,296；
-名称为“CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION ANDRECOMMENDATIONS TO A USER”的美国临时专利申请序列号62/649,333；
-名称为“CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATIONTRENDS AND REACTIVE MEASURES”的美国临时专利申请序列号62/649,327；
-名称为“DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICSNETWORK”的美国临时专利申请序列号62/649,315；
-名称为“CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES”的美国临时专利申请序列号62/649,313；
-名称为“DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS”的美国临时专利申请序列号62/649,320；
-名称为“AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICALPLATFORMS”的美国临时专利申请序列号62/649,307；以及
-名称为“SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS”的美国临时专利申请序列号62/649,323。
本申请的申请人拥有于2018年3月30日提交的以下美国临时专利申请，该临时专利申请全文以引用方式并入本文：
-名称为“SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES”的美国临时专利申请序列号62/650,887。
本申请的申请人拥有于2018年12月4日提交的以下美国专利申请，该专利申请以引用方式全文并入本文：
-名称为“METHOD OF COMPRESSING TISSUE WITHIN A STAPLING DEVICE ANDSIMULTANEOUSLY DISPLAYING THE LOCATION OF THE TISSUE WITHIN THE JAWS”的美国专利申请序列号16/209,423。
本申请的申请人拥有于2018年8月20日提交且各自全文以引用方式并入本文的以下美国专利申请：
-名称为“METHOD FOR FABRICATING SURGICAL STAPLER ANVILS”的美国专利申请序列号16/105,101；
-名称为“REINFORCED DEFORMABLE ANVIL TIP FOR SURGICAL STAPLER ANVIL”的美国专利申请序列号16/105,183；
-名称为“SURGICAL STAPLER ANVILS WITH STAPLE DIRECTING PROTRUSIONS ANDTISSUE STABILITY FEATURES”的美国专利申请序列号16/105,150；
-名称为“FABRICATING TECHNIQUES FOR SURGICAL STAPLER ANVILS”的美国专利申请序列号16/105,098；
-名称为“SURGICAL STAPLER ANVILS WITH TISSUE STOP FEATURES CONFIGUREDTO AVOID TISSUE PINCH”的美国专利申请序列号16/105,140；
-名称为“METHOD FOR OPERATING A POWERED ARTICULATABLE SURGICALINSTRUMENT”的美国专利申请序列号16/105,081；
-名称为“SURGICAL INSTRUMENTS WITH PROGRESSIVE JAW CLOSUREARRANGEMENTS”的美国专利申请序列号16/105,094；
-名称为“POWERED SURGICAL INSTRUMENTS WITH CLUTCHING ARRANGEMENTS TOCONVERT LINEAR DRIVE MOTIONS TO ROTARY DRIVE MOTIONS”的美国专利申请序列号16/105,097；
-名称为“POWERED ARTICULATABLE SURGICAL INSTRUMENTS WITH CLUTCHING ANDLOCKING ARRANGEMENTS FOR LINKING AN ARTICULATION DRIVE SYSTEM TO A FIRINGDRIVE SYSTEM”的美国专利申请序列号16/105,104；
-名称为“ARTICULATABLE MOTOR POWERED SURGICAL INSTRUMENTS WITHDEDICATED ARTICULATION MOTOR ARRANGEMENTS”的美国专利申请序列号16/105,119；
-名称为“SWITCHING ARRANGEMENTS FOR MOTOR POWERED ARTICULATABLESURGICAL INSTRUMENTS”的美国专利申请序列号16/105,160；以及
-名称为“SURGICAL STAPLER ANVILS”的美国设计专利申请序列号29/660,252。
本申请的申请人拥有各自全文以引用方式并入本文的以下美国专利申请和美国专利：
-名称为“SURGICAL STAPLING INSTRUMENTS AND REPLACEABLE TOOL ASSEMBLIESTHEREOF”的美国专利申请序列号15/386,185，现为美国专利申请公布2018/0168642；
-名称为“ARTICULATABLE SURGICAL STAPLING INSTRUMENTS”的美国专利申请序列号15/386,230，现为美国专利申请公布2018/0168649；
-名称为“LOCKOUT ARRANGEMENTS FOR SURGICAL END EFFECTORS”的美国专利申请序列号15/386,221，现为美国专利申请公布2018/0168646；
-名称为“SURGICAL END EFFECTORS AND FIRING MEMBERS THEREOF”的美国专利申请序列号15/386,209，现为美国专利申请公布2018/0168645；
-名称为“LOCKOUT ARRANGEMENTS FOR SURGICAL END EFFECTORS ANDREPLACEABLE TOOL ASSEMBLIES”的美国专利申请序列号15/386,198，现为美国专利申请公布2018/0168644；
-名称为“SURGICAL END EFFECTORS AND ADAPTABLE FIRING MEMBERS THEREFOR”的美国专利申请序列号15/386,240，现为美国专利申请公布2018/0168651；
-名称为“STAPLE CARTRIDGES AND ARRANGEMENTS OF STAPLES AND STAPLECAVITIES THEREIN”的美国专利申请序列号15/385,939，现为美国专利申请公布2018/0168629；
-名称为“SURGICAL TOOL ASSEMBLIES WITH CLUTCHING ARRANGEMENTS FORSHIFTING BETWEEN CLOSURE SYSTEMS WITH CLOSURE STROKE REDUCTION FEATURES ANDARTICULATION AND FIRING SYSTEMS”的美国专利申请序列号15/385,941，现为美国专利申请公布2018/0168630；
-名称为“SURGICAL STAPLING INSTRUMENTS AND STAPLE-FORMING ANVILS”的美国专利申请序列号15/385,943，现为美国专利申请公布2018/0168631；
-名称为“SURGICAL TOOL ASSEMBLIES WITH CLOSURE STROKE REDUCTIONFEATURES”的美国专利申请序列号15/385,950，现为美国专利申请公布2018/0168635；
-名称为“STAPLE CARTRIDGES AND ARRANGEMENTS OF STAPLES AND STAPLECAVITIES THEREIN”的美国专利申请序列号15/385,945，现为美国专利申请公布2018/0168632；
-名称为“SURGICAL STAPLING INSTRUMENTS AND STAPLE-FORMING ANVILS”的美国专利申请序列号15/385,946，现为美国专利申请公布2018/0168633；
-名称为“SURGICAL INSTRUMENTS WITH JAW OPENING FEATURES FOR INCREASINGA JAW OPENING DISTANCE”的美国专利申请序列号15/385,951，现为美国专利申请公布2018/0168636；
-名称为“METHODS OF STAPLING TISSUE”的美国专利申请序列号15/385,953，现为美国专利申请公布2018/0168637；
-名称为“FIRING MEMBERS WITH NON-PARALLEL JAW ENGAGEMENT FEATURES FORSURGICAL END EFFECTORS”的美国专利申请序列号15/385,954，现为美国专利申请公布2018/0168638；
-名称为“SURGICAL END EFFECTORS WITH EXPANDABLE TISSUE STOPARRANGEMENTS”的美国专利申请序列号15/385,955，现为美国专利申请公布2018/0168639；
-名称为“SURGICAL STAPLING INSTRUMENTS AND STAPLE-FORMING ANVILS”的美国专利申请序列号15/385,948，现为美国专利申请公布2018/0168584；
-名称为“SURGICAL INSTRUMENTS WITH POSITIVE JAW OPENING FEATURES”的美国专利申请序列号15/385,956，现为美国专利申请公布2018/0168640；
-名称为“SURGICAL INSTRUMENTS WITH LOCKOUT ARRANGEMENTS FOR PREVENTINGFIRING SYSTEM ACTUATION UNLESS AN UNSPENT STAPLE CARTRIDGE IS PRESENT”的美国专利申请序列号15/385,958，现为美国专利申请公布2018/0168641；
-名称为“STAPLE CARTRIDGES AND ARRANGEMENTS OF STAPLES AND STAPLECAVITIES THEREIN”的美国专利申请序列号15/385,947，现为美国专利申请公布2018/0168634；
-名称为“METHOD FOR RESETTING A FUSE OF A SURGICAL INSTRUMENT SHAFT”的美国专利申请序列号15/385,896，现为美国专利申请公布2018/0168597；
-名称为“STAPLE-FORMING POCKET ARRANGEMENT TO ACCOMMODATE DIFFERENTTYPES OF STAPLES”的美国专利申请序列号15/385,898，现为美国专利申请公布2018/0168599；
-名称为“SURGICAL INSTRUMENT COMPRISING IMPROVED JAW CONTROL”的美国专利申请序列号15/385,899，现为美国专利申请公布2018/0168600；
-名称为“STAPLE CARTRIDGE AND STAPLE CARTRIDGE CHANNEL COMPRISINGWINDOWS DEFINED THEREIN”的美国专利申请序列号15/385,901，现为美国专利申请公布2018/0168602；
-名称为“SURGICAL INSTRUMENT COMPRISING A CUTTING MEMBER”的美国专利申请序列号15/385,902，现为美国专利申请公布2018/0168603；
-名称为“STAPLE FIRING MEMBER COMPRISING A MISSING CARTRIDGE AND/ORSPENT CARTRIDGE LOCKOUT”的美国专利申请序列号15/385,904，现为美国专利申请公布2018/0168605；
-名称为“FIRING ASSEMBLY COMPRISING A LOCKOUT”的美国专利申请序列号15/385,905，现为美国专利申请公布2018/0168606；
-名称为“SURGICAL INSTRUMENT SYSTEM COMPRISING AN END EFFECTOR LOCKOUTAND A FIRING ASSEMBLY LOCKOUT”的美国专利申请序列号15/385,907，现为美国专利申请公布2018/0168608；
-名称为“FIRING ASSEMBLY COMPRISING A FUSE”的美国专利申请序列号15/385,908，现为美国专利申请公布2018/0168609；
-名称为“FIRING ASSEMBLY COMPRISING A MULTIPLE FAILED-STATE FUSE”的美国专利申请序列号15/385,909，现为美国专利申请公布2018/0168610；
-名称为“STAPLE-FORMING POCKET ARRANGEMENTS”的美国专利申请序列号15/385,920，现为美国专利申请公布2018/0168620；
-名称为“ANVIL ARRANGEMENTS FOR SURGICAL STAPLERS”的美国专利申请序列号15/385,913，现为美国专利申请公布2018/0168614；
-名称为“METHOD OF DEFORMING STAPLES FROM TWO DIFFERENT TYPES OFSTAPLE CARTRIDGES WITH THE SAME SURGICAL STAPLING INSTRUMENT”的美国专利申请序列号15/385,914，现为美国专利申请公布2018/0168615；
-名称为“BILATERALLY ASYMMETRIC STAPLE-FORMING POCKET PAIRS”的美国专利申请序列号15/385,893，现为美国专利申请公布2018/0168594；
-名称为“CLOSURE MEMBERS WITH CAM SURFACE ARRANGEMENTS FOR SURGICALINSTRUMENTS WITH SEPARATE AND DISTINCT CLOSURE AND FIRING SYSTEMS”的美国专利申请序列号15/385,929，现为美国专利申请公布2018/0168626；
-名称为“SURGICAL STAPLERS WITH INDEPENDENTLY ACTUATABLE CLOSING ANDFIRING SYSTEMS”的美国专利申请序列号15/385,911，现为美国专利申请公布2018/0168612；
-名称为“SURGICAL STAPLING INSTRUMENTS WITH SMART STAPLE CARTRIDGES”的美国专利申请序列号15/385,927，现为美国专利申请公布2018/0168625；
-名称为“STAPLE CARTRIDGE COMPRISING STAPLES WITH DIFFERENT CLAMPINGBREADTHS”的美国专利申请序列号15/385,917，现为美国专利申请公布2018/0168617；
-名称为“STAPLE-FORMING POCKET ARRANGEMENTS COMPRISING PRIMARYSIDEWALLS AND POCKET SIDEWALLS”的美国专利申请序列号15/385,900，现为美国专利申请公布2018/0168601；
-名称为“NO-CARTRIDGE AND SPENT CARTRIDGE LOCKOUT ARRANGEMENTS FORSURGICAL STAPLERS”的美国专利申请序列号15/385,931，现为美国专利申请公布2018/0168627；
-名称为“FIRING MEMBER PIN ANGLE”的美国专利申请序列号15/385,915，现为美国专利申请公布2018/0168616；
-名称为“STAPLE-FORMING POCKET ARRANGEMENTS COMPRISING ZONED FORMINGSURFACE GROOVES”的美国专利申请序列号15/385,897，现为美国专利申请公布2018/0168598；
-名称为“SURGICAL INSTRUMENT WITH MULTIPLE FAILURE RESPONSE MODES”的美国专利申请序列号15/385,922，现为美国专利申请公布2018/0168622；
-名称为“SURGICAL INSTRUMENT WITH PRIMARY AND SAFETY PROCESSORS”的美国专利申请序列号15/385,924，现为美国专利申请公布2018/0168624；
-名称为“ANVIL HAVING A KNIFE SLOT WIDTH”的美国专利申请序列号15/385,910，现为美国专利申请公布2018/0168611；
-名称为“CLOSURE MEMBER ARRANGEMENTS FOR SURGICAL INSTRUMENTS”的美国专利申请序列号15/385,903，现为美国专利申请公布2018/0168604；
-名称为“FIRING MEMBER PIN CONFIGURATIONS”的美国专利申请序列号15/385,906，现为美国专利申请公布2018/0168607；
-名称为“STEPPED STAPLE CARTRIDGE WITH ASYMMETRICAL STAPLES”的美国专利申请序列号15/386,188，现为美国专利申请公布2018/0168585；
-名称为“STEPPED STAPLE CARTRIDGE WITH TISSUE RETENTION AND GAPSETTING FEATURES”的美国专利申请序列号15/386,192，现为美国专利申请公布2018/0168643；
-名称为“STAPLE CARTRIDGE WITH DEFORMABLE DRIVER RETENTION FEATURES”的美国专利申请序列号15/386,206，现为美国专利申请公布2018/0168586；
-名称为“DURABILITY FEATURES FOR END EFFECTORS AND FIRING ASSEMBLIESOF SURGICAL STAPLING INSTRUMENTS”的美国专利申请序列号15/386,226，现为美国专利申请公布2018/0168648；
-名称为“SURGICAL STAPLING INSTRUMENTS HAVING END EFFECTORS WITHPOSITIVE OPENING FEATURES”的美国专利申请序列号15/386,222，现为美国专利申请公布2018/0168647；
-名称为“CONNECTION PORTIONS FOR DEPOSABLE LOADING UNITS FOR SURGICALSTAPLING INSTRUMENTS”的美国专利申请序列号15/386,236，现为美国专利申请公布2018/0168650；
-名称为“METHOD FOR ATTACHING A SHAFT ASSEMBLY TO A SURGICALINSTRUMENT AND,ALTERNATIVELY,TO A SURGICAL ROBOT”的美国专利申请序列号15/385,887，现为美国专利申请公布2018/0168589；
-名称为“SHAFT ASSEMBLY COMPRISING A MANUALLY-OPERABLE RETRACTIONSYSTEM FOR USE WITH A MOTORIZED SURGICAL INSTRUMENT SYSTEM”的美国专利申请序列号15/385,889，现为美国专利申请公布2018/0168590；
-名称为“SHAFT ASSEMBLY COMPRISING SEPARATELY ACTUATABLE ANDRETRACTABLE SYSTEMS”的美国专利申请序列号15/385,890，现为美国专利申请公布2018/0168591；
-名称为“SHAFT ASSEMBLY COMPRISING A CLUTCH CONFIGURED TO ADAPT THEOUTPUT OF A ROTARY FIRING MEMBER TO TWO DIFFERENT SYSTEMS”的美国专利申请序列号15/385,891，现为美国专利申请公布2018/0168592；
-名称为“SURGICAL SYSTEM COMPRISING A FIRING MEMBER ROTATABLE INTO ANARTICULATION STATE TO ARTICULATE AN END EFFECTOR OF THE SURGICAL SYSTEM”的美国专利申请序列号15/385,892，现为美国专利申请公布2018/0168593；
-名称为“SHAFT ASSEMBLY COMPRISING A LOCKOUT”的美国专利申请序列号15/385,894，现为美国专利申请公布2018/0168595；
-名称为“SHAFT ASSEMBLY COMPRISING FIRST AND SECOND ARTICULATIONLOCKOUTS”的美国专利申请序列号15/385,895，现为美国专利申请公布2018/0168596；
-名称为“SURGICAL STAPLING SYSTEMS”的美国专利申请序列号15/385,916，现为美国专利申请公布2018/0168575；
-名称为“SURGICAL STAPLING SYSTEMS”的美国专利申请序列号15/385,918，现为美国专利申请公布2018/0168618；
-名称为“SURGICAL STAPLING SYSTEMS”的美国专利申请序列号15/385,919，现为美国专利申请公布2018/0168619；
-名称为“SURGICAL STAPLE CARTRIDGE WITH MOVABLE CAMMING MEMBERCONFIGURED TO DISENGAGE FIRING MEMBER LOCKOUT FEATURES”的美国专利申请序列号15/385,921，现为美国专利申请公布2018/0168621；
-名称为“SURGICAL STAPLING SYSTEMS”的美国专利申请序列号15/385,923，现为美国专利申请公布2018/0168623；
-名称为“JAW ACTUATED LOCK ARRANGEMENTS FOR PREVENTING ADVANCEMENT OFA FIRING MEMBER IN A SURGICAL END EFFECTOR UNLESS AN UNFIRED CARTRIDGE ISINSTALLED IN THE END EFFECTOR”的美国专利申请序列号15/385,925，现为美国专利申请公布2018/0168576；
-名称为“AXIALLY MOVABLE CLOSURE SYSTEM ARRANGEMENTS FOR APPLYINGCLOSURE MOTIONS TO JAWS OF SURGICAL INSTRUMENTS”的美国专利申请序列号15/385,926，现为美国专利申请公布2018/0168577；
-名称为“PROTECTIVE COVER ARRANGEMENTS FOR A JOINT INTERFACE BETWEEN AMOVABLE JAW AND ACTUATOR SHAFT OF A SURGICAL INSTRUMENT”的美国专利申请序列号15/385,928，现为美国专利申请公布2018/0168578；
-名称为“SURGICAL END EFFECTOR WITH TWO SEPARATE COOPERATING OPENINGFEATURES FOR OPENING AND CLOSING END EFFECTOR JAWS”的美国专利申请序列号15/385,930，现为美国专利申请公布2018/0168579；
-名称为“ARTICULATABLE SURGICAL END EFFECTOR WITH ASYMMETRIC SHAFTARRANGEMENT”的美国专利申请序列号15/385,932，现为美国专利申请公布2018/0168628；
-名称为“ARTICULATABLE SURGICAL INSTRUMENT WITH INDEPENDENT PIVOTABLELINKAGE DISTAL OF AN ARTICULATION LOCK”的美国专利申请序列号15/385,933，现为美国专利申请公布2018/0168580；
-名称为“ARTICULATION LOCK ARRANGEMENTS FOR LOCKING AN END EFFECTOR INAN ARTICULATED POSITION IN RESPONSE TO ACTUATION OF A JAW CLOSURE SYSTEM”的美国专利申请序列号15/385,934，现为美国专利申请公布2018/0168581；
-名称为“LATERALLY ACTUATABLE ARTICULATION LOCK ARRANGEMENTS FORLOCKING AN END EFFECTOR OF A SURGICAL INSTRUMENT IN AN ARTICULATEDCONFIGURATION”的美国专利申请序列号15/385,935，现为美国专利申请公布2018/0168582；
-名称为“ARTICULATABLE SURGICAL INSTRUMENTS WITH ARTICULATION STROKEAMPLIFICATION FEATURES”的美国专利申请序列号15/385,936，现为美国专利申请公布2018/0168583；
-名称为“FASTENER CARTRIDGES INCLUDING EXTENSIONS HAVING DIFFERENTCONFIGURATIONS”的美国专利申请序列号14/318,996，现为美国专利申请公布2015/0297228；
-名称为“FASTENER CARTRIDGE COMPRISING FASTENER CAVITIES INCLUDINGFASTENER CONTROL FEATURES”的美国专利申请序列号14/319,006，现为美国专利10,010,324；
-名称为“SURGICAL FASTENER CARTRIDGES WITH DRIVER STABILIZINGARRANGEMENTS”的美国专利申请序列号14/318,991，现为美国专利9,833,241；
-名称为“SURGICAL END EFFECTORS WITH FIRING ELEMENT MONITORINGARRANGEMENTS”的美国专利申请序列号14/319,004，现为美国专利9,844,369；
-名称为“FASTENER CARTRIDGE COMPRISING NON-UNIFORM FASTENERS”的美国专利申请序列号14/319,008，现为美国专利申请公布2015/0297232；
-名称为“FASTENER CARTRIDGE COMPRISING DEPLOYABLE TISSUE ENGAGINGMEMBERS”的美国专利申请序列号14/318,997，现为美国专利申请公布2015/0297229；
-名称为“FASTENER CARTRIDGE COMPRISING TISSUE CONTROL FEATURES”的美国专利申请序列号14/319,002，现为美国专利9,877,721；
-名称为“FASTENER CARTRIDGE ASSEMBLIES AND STAPLE RETAINER COVERARRANGEMENTS”的美国专利申请序列号14/319,013，现为美国专利申请公布2015/0297233；以及
-名称为“FASTENER CARTRIDGE INCLUDING A LAYER ATTACHED THERETO”的美国专利申请序列号14/319,016，现为美国专利申请公布2015/0297235。
本申请的申请人拥有于2016年6月24日提交且各自全文以引用方式并入本文的以下美国专利申请：
-名称为“STAPLE CARTRIDGE COMPRISING WIRE STAPLES AND STAMPED STAPLES”的美国专利申请序列号15/191,775，现为美国专利申请公布2017/0367695；
-名称为“STAPLING SYSTEM FOR USE WITH WIRE STAPLES AND STAMPEDSTAPLES”的美国专利申请序列号15/191,807，现为美国专利申请公布2017/0367696；
-名称为“STAMPED STAPLES AND STAPLE CARTRIDGES USING THE SAME”的美国专利申请序列号15/191,834，现为美国专利申请公布2017/0367699；
-名称为“STAPLE CARTRIDGE COMPRISING OVERDRIVEN STAPLES”的美国专利申请序列号15/191,788，现为美国专利申请公布2017/0367698；以及
-名称为“STAPLE CARTRIDGE COMPRISING OFFSET LONGITUDINAL STAPLE ROWS”的美国专利申请序列号15/191,818，现为美国专利申请公布2017/0367697。
本申请的申请人拥有于2016年6月24日提交且各自全文以引用方式并入本文的以下美国专利申请：
-名称为“SURGICAL FASTENER”的美国设计专利申请序列号29/569,218，现为美国设计专利D826,405；
-名称为“SURGICAL FASTENER”的美国设计专利申请序列号29/569,227，现为美国设计专利D822,206；
-名称为“SURGICAL FASTENER CARTRIDGE”的美国设计专利申请序列号29/569,259；以及
-名称为“SURGICAL FASTENER CARTRIDGE”的美国设计专利申请序列号29/569,264。
本申请的申请人拥有2016年4月1日提交且各自全文以引用方式并入本文的以下专利申请：
-名称为“METHOD FOR OPERATING A SURGICAL STAPLING SYSTEM”的美国专利申请序列号15/089,325，现为美国专利申请公布2017/0281171；
-名称为“MODULAR SURGICAL STAPLING SYSTEM COMPRISING A DISPLAY”的美国专利申请序列号15/089,321，现为美国专利10,271,851；
-名称为“SURGICAL STAPLING SYSTEM COMPRISING A DISPLAY INCLUDING A RE-ORIENTABLE DISPLAY FIELD”的美国专利申请序列号15/089,326，现为美国专利申请公布2017/0281172；
-名称为“SURGICAL INSTRUMENT HANDLE ASSEMBLY WITH RECONFIGURABLE GRIPPORTION”的美国专利申请序列号15/089,263，现为美国专利申请公布2017/0281165；
-名称为“ROTARY POWERED SURGICAL INSTRUMENT WITH MANUALLY ACTUATABLEBAILOUT SYSTEM”的美国专利申请序列号15/089,262，现为美国专利申请公布2017/0281161；
-名称为“SURGICAL CUTTING AND STAPLING END EFFECTOR WITH ANVILCONCENTRIC DRIVE MEMBER”的美国专利申请序列号15/089,277，现为美国专利申请公布2017/0281166；
-名称为“INTERCHANGEABLE SURGICAL TOOL ASSEMBLY WITH A SURGICAL ENDEFFECTOR THAT IS SELECTIVELY ROTATABLE ABOUT A SHAFT AXIS”的美国专利申请序列号15/089,296，现为美国专利申请公布2017/0281168；
-名称为“SURGICAL STAPLING SYSTEM COMPRISING A SHIFTABLE TRANSMISSION”的美国专利申请序列号15/089,258，现为美国专利申请公布2017/0281178；
-名称为“SURGICAL STAPLING SYSTEM CONFIGURED TO PROVIDE SELECTIVECUTTING OF TISSUE”的美国专利申请序列号15/089,278，现为美国专利申请公布2017/0281162；
-名称为“SURGICAL STAPLING SYSTEM COMPRISING A CONTOURABLE SHAFT”的美国专利申请序列号15/089,284，现为美国专利申请公布2017/0281186；
-名称为“SURGICAL STAPLING SYSTEM COMPRISING A TISSUE COMPRESSIONLOCKOUT”的美国专利申请序列号15/089,295，现为美国专利申请公布2017/0281187；
-名称为“SURGICAL STAPLING SYSTEM COMPRISING AN UNCLAMPING LOCKOUT”的美国专利申请序列号15/089,300，现为美国专利申请公布2017/0281179；
-名称为“SURGICAL STAPLING SYSTEM COMPRISING A JAW CLOSURE LOCKOUT”的美国专利申请序列号15/089,196，现为美国专利申请公布2017/0281183；
-名称为“SURGICAL STAPLING SYSTEM COMPRISING A JAW ATTACHMENT LOCKOUT”的美国专利申请序列号15/089,203，现为美国专利申请公布2017/0281184；
-名称为“SURGICAL STAPLING SYSTEM COMPRISING A SPENT CARTRIDGELOCKOUT”的美国专利申请序列号15/089,210，现为美国专利申请公布2017/0281185；
-名称为“SURGICAL INSTRUMENT COMPRISING A SHIFTING MECHANISM”的美国专利申请序列号15/089,324，现为美国专利申请公布2017/0281170；
-名称为“SURGICAL STAPLING INSTRUMENT COMPRISING MULTIPLE LOCKOUTS”的美国专利申请序列号15/089,335，现为美国专利申请公布2017/0281155；
-名称为“SURGICAL STAPLING INSTRUMENT”的美国专利申请序列号15/089,339，现为美国专利申请公布2017/0281173；
-名称为“SURGICAL STAPLING SYSTEM CONFIGURED TO APPLY ANNULAR ROWS OFSTAPLES HAVING DIFFERENT HEIGHTS”的美国专利申请序列号15/089,253，现为美国专利申请公布2017/0281177；
-名称为“SURGICAL STAPLING SYSTEM COMPRISING A GROOVED FORMING POCKET”的美国专利申请序列号15/089,304，现为美国专利申请公布2017/0281188；
-名称为“ANVIL MODIFICATION MEMBERS FOR SURGICAL STAPLERS”的美国专利申请序列号15/089,331，现为美国专利申请公布2017/0281180；
-名称为“STAPLE CARTRIDGES WITH ATRAUMATIC FEATURES”的美国专利申请序列号15/089,336，现为美国专利申请公布2017/0281164；
-名称为“CIRCULAR STAPLING SYSTEM COMPRISING AN INCISABLE TISSUESUPPORT”的美国专利申请序列号15/089,312，现为美国专利申请公布2017/0281189；
-名称为“CIRCULAR STAPLING SYSTEM COMPRISING ROTARY FIRING SYSTEM”的美国专利申请序列号15/089,309，现为美国专利申请公布2017/0281169；以及
-名称为“CIRCULAR STAPLING SYSTEM COMPRISING LOAD CONTROL”的美国专利申请序列号15/089,349，现为美国专利申请公布2017/0281174。
本申请的申请人还拥有于2015年12月30日提交且各自全文以引用方式并入本文的如下标识的美国专利申请：
-名称为“MECHANISMS FOR COMPENSATING FOR BATTERY PACK FAILURE INPOWERED SURGICAL INSTRUMENTS”的美国专利申请序列号14/984,488，现为美国专利申请公布2017/0189018；
-名称为“MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWEREDSURGICAL INSTRUMENTS”的美国专利申请序列号14/984,525，现为美国专利申请公布2017/0189019；以及
-名称为“SURGICAL INSTRUMENTS WITH SEPARABLE MOTORS AND MOTOR CONTROLCIRCUITS”的美国专利申请序列号14/984,552，现为美国专利10,265,068。
本申请的申请人还拥有于2016年2月9日提交且各自全文以引用方式并入本文的如下标识的美国专利申请：
-名称为“SURGICAL INSTRUMENT WITH ARTICULATING AND AXIALLYTRANSLATABLE END EFFECTOR”的美国专利申请序列号15/019,220，现为美国专利10,245,029；
-名称为“SURGICAL INSTRUMENTS WITH MULTIPLE LINK ARTICULATIONARRANGEMENTS”的美国专利申请序列号15/019,228，现为美国专利申请公布2017/0224342；
-名称为“SURGICAL INSTRUMENT ARTICULATION MECHANISM WITH SLOTTEDSECONDARY CONSTRAINT”的美国专利申请序列号15/019,196，现为美国专利申请公布2017/0224330；
-名称为“SURGICAL INSTRUMENTS WITH AN END EFFECTOR THAT IS HIGHLYARTICULATABLE RELATIVE TO AN ELONGATE SHAFT ASSEMBLY”的美国专利申请序列号15/019,206，现为美国专利申请公布2017/0224331；
-名称为“SURGICAL INSTRUMENTS WITH NON-SYMMETRICAL ARTICULATIONARRANGEMENTS”的美国专利申请序列号15/019,215，现为美国专利申请公布2017/0224332；
-名称为“ARTICULATABLE SURGICAL INSTRUMENTS WITH SINGLE ARTICULATIONLINK ARRANGEMENTS”的美国专利申请序列号15/019,227，现为美国专利申请公布2017/0224334；
-名称为“SURGICAL INSTRUMENTS WITH TENSIONING ARRANGEMENTS FOR CABLEDRIVEN ARTICULATION SYSTEMS”的美国专利申请序列号15/019,235，现为美国专利10,245,030；
-名称为“ARTICULATABLE SURGICAL INSTRUMENTS WITH OFF-AXIS FIRING BEAMARRANGEMENTS”的美国专利申请序列号15/019,230，现为美国专利申请公布2017/0224335；以及
-名称为“SURGICAL INSTRUMENTS WITH CLOSURE STROKE REDUCTIONARRANGEMENTS”的美国专利申请序列号15/019,245，现为美国专利申请公布2017/0224343。
本申请的申请人还拥有于2016年2月12日提交且各自全文以引用方式并入本文的如下标识的美国专利申请：
-名称为“MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWEREDSURGICAL INSTRUMENTS”的美国专利申请序列号15/043,254，现为美国专利10,258,331；
-名称为“MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWEREDSURGICAL INSTRUMENTS”的美国专利申请序列号15/043,259，现为美国专利申请公布2017/0231626；
-名称为“MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWEREDSURGICAL INSTRUMENTS”的美国专利申请序列号15/043,275，现为美国专利申请公布2017/0231627；以及
-名称为“MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWEREDSURGICAL INSTRUMENTS”的美国专利申请序列号15/043,289，现为美国专利申请公布2017/0231628。
本申请的申请人拥有2015年6月18日提交且各自全文以引用方式并入本文的以下专利申请：
-名称为“SURGICAL END EFFECTORS WITH POSITIVE JAW OPENINGARRANGEMENTS”的美国专利申请序列号14/742,925，现为美国专利10,182,818；
-名称为“SURGICAL END EFFECTORS WITH DUAL CAM ACTUATED JAW CLOSINGFEATURES”的美国专利申请序列号14/742,941，现为美国专利10,052,102；
-名称为“SURGICAL STAPLING INSTRUMENTS WITH LOCKOUT ARRANGEMENTS FORPREVENTING FIRING SYSTEM ACTUATION WHEN A CARTRIDGE IS SPENT OR MISSING”的美国专利申请序列号14/742,933，现为美国专利10,154,841；
-名称为“MOVABLE FIRING BEAM SUPPORT ARRANGEMENTS FOR ARTICULATABLESURGICAL INSTRUMENTS”的美国专利申请序列号14/742,914，现为美国专利申请公布2016/0367255；
-名称为“ARTICULATABLE SURGICAL INSTRUMENTS WITH COMPOSITE FIRING BEAMSTRUCTURES WITH CENTER FIRING SUPPORT MEMBER FOR ARTICULATION SUPPORT”的美国专利申请序列号14/742,900，现为美国专利申请公布2016/0367254；
-名称为“DUAL ARTICULATION DRIVE SYSTEM ARRANGEMENTS FOR ARTICULATABLESURGICAL INSTRUMENTS”的美国专利申请序列号14/742,885，现为美国专利申请公布2016/0367246；以及
-名称为“PUSH/PULL ARTICULATION DRIVE SYSTEMS FOR ARTICULATABLESURGICAL INSTRUMENTS”的美国专利申请序列号14/742,876，现为美国专利10,178,992。
本申请的申请人拥有2015年3月6日提交且各自全文以引用方式并入本文的以下专利申请：
-名称为“POWERED SURGICAL INSTRUMENT”的美国专利申请序列号14/640,746，现为美国专利9,808,246；
-名称为“MULTIPLE LEVEL THRESHOLDS TO MODIFY OPERATION OF POWEREDSURGICAL INSTRUMENTS”的美国专利申请序列号14/640,795，现为美国专利申请公布2016/02561185；
-名称为“ADAPTIVE TISSUE COMPRESSION TECHNIQUES TO ADJUST CLOSURERATES FOR MULTIPLE TISSUE TYPES”的美国专利申请序列号14/640,832，现为美国专利申请公布2016/0256154；
-名称为“OVERLAID MULTI SENSOR RADIO FREQUENCY(RF)ELECTRODE SYSTEM TOMEASURE TISSUE COMPRESSION”的美国专利申请序列号14/640,935，现为美国专利申请公布2016/0256071；
-名称为“MONITORING SPEED CONTROL AND PRECISION INCREMENTING OF MOTORFOR POWERED SURGICAL INSTRUMENTS”的美国专利申请序列号14/640,831，现为美国专利9,895,148；
-名称为“TIME DEPENDENT EVALUATION OF SENSOR DATA TO DETERMINESTABILITY,CREEP,AND VISCOELASTIC ELEMENTS OF MEASURES”的美国专利申请序列号14/640,859，现为美国专利10,052,044；
-名称为“INTERACTIVE FEEDBACK SYSTEM FOR POWERED SURGICAL INSTRUMENTS”的美国专利申请序列号14/640,817，现为美国专利申请公布9,924,961；
-名称为“CONTROL TECHNIQUES AND SUB-PROCESSOR CONTAINED WITHIN MODULARSHAFT WITH SELECT CONTROL PROCESSING FROM HANDLE”的美国专利申请序列号14/640,844，现为美国专利10,045,776；
-名称为“SMART SENSORS WITH LOCAL SIGNAL PROCESSING”的美国专利申请序列号14/640,837，现为美国专利9,993,248；
-名称为“SYSTEM FOR DETECTING THE MIS-INSERTION OF A STAPLE CARTRIDGEINTO A SURGICAL STAPLER”的美国专利申请序列号14/640,765，现为美国专利申请公布2016/0256160；
-名称为“SIGNAL AND POWER COMMUNICATION SYSTEM POSITIONED ON AROTATABLE SHAFT”的美国专利申请序列号14/640,799，现为美国专利9,901,342；以及
-名称为“SURGICAL INSTRUMENT COMPRISING A LOCKABLE BATTERY HOUSING”的美国专利申请序列号14/640,780，现为美国专利10,245,033。
本申请的申请人拥有于2015年2月27日提交且各自全文以引用方式并入本文的以下专利申请：
-名称为“SURGICAL INSTRUMENT SYSTEM COMPRISING AN INSPECTION STATION”的美国专利申请序列号14/633,576，现为美国专利10,045,779；
-名称为“SURGICAL APPARATUS CONFIGURED TO ASSESS WHETHER A PERFORMANCEPARAMETER OF THE SURGICAL APPARATUS IS WITHIN AN ACCEPTABLE PERFORMANCE BAND”的美国专利申请序列号14/633,546，现为美国专利10,180,463；
-名称为“SURGICAL CHARGING SYSTEM THAT CHARGES AND/OR CONDITIONS ONEOR MORE BATTERIES”的美国专利申请序列号14/633,560，现为美国专利申请公布2016/0249910；
-名称为“CHARGING SYSTEM THAT ENABLES EMERGENCY RESOLUTIONS FORCHARGING A BATTERY”的美国专利申请序列号14/633,566，现为美国专利10,182,816；
-名称为“SYSTEM FOR MONITORING WHETHER A SURGICAL INSTRUMENT NEEDS TOBE SERVICED”的美国专利申请序列号14/633,555，现为美国专利申请公布2016/0249916；
-名称为“REINFORCED BATTERY FOR A SURGICAL INSTRUMENT”的美国专利申请序列号14/633,542，现为美国专利9,931,118；
-名称为“POWER ADAPTER FOR A SURGICAL INSTRUMENT”的美国专利申请序列号14/633,548，现为美国专利10,245,028；
-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9,993,258；
-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10,226,250；以及
-名称为“SURGICAL APPARATUS CONFIGURED TO TRACK AN END-OF-LIFEPARAMETER”的美国专利申请序列号14/633,562，现为美国专利10,159,483。
本申请的申请人拥有2014年12月18日提交且各自全文以引用方式并入本文的以下专利申请：
-名称为“SURGICAL INSTRUMENT SYSTEMS COMPRISING AN ARTICULATABLE ENDEFFECTOR AND MEANS FOR ADJUSTING THE FIRING STROKE OF A FIRING MEMBER”的美国专利申请序列号14/574,478，现为美国专利9,844,374；
-名称为“SURGICAL INSTRUMENT ASSEMBLY COMPRISING LOCKABLE SYSTEMS”的美国专利申请序列号14/574,483，现为美国专利10,188,385；
-名称为“DRIVE ARRANGEMENTS FOR ARTICULATABLE SURGICAL INSTRUMENTS”的美国专利申请序列号14/575,139，现为美国专利9,844,375；
-名称为“LOCKING ARRANGEMENTS FOR DETACHABLE SHAFT ASSEMBLIES WITHARTICULATABLE SURGICAL END EFFECTORS”的美国专利申请序列号14/575,148，现为美国专利10,085,748；
-名称为“SURGICAL INSTRUMENT WITH AN ANVIL THAT IS SELECTIVELY MOVABLEABOUT A DISCRETE NON-MOVABLE AXIS RELATIVE TO A STAPLE CARTRIDGE”的美国专利申请序列号14/575,130，现为美国专利10,245,027；
-名称为“SURGICAL INSTRUMENTS WITH IMPROVED CLOSURE ARRANGEMENTS”的美国专利申请序列号14/575,143，现为美国专利10,004,501；
-名称为“SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTORS ANDMOVABLE FIRING BEAM SUPPORT ARRANGEMENTS”的美国专利申请序列号14/575,117，现为美国专利9,943,309；
-名称为“SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTORS ANDIMPROVED FIRING BEAM SUPPORT ARRANGEMENTS”的美国专利申请序列号14/575,154，现为美国专利9,968,355；
-名称为“SURGICAL INSTRUMENT ASSEMBLY COMPRISING A FLEXIBLEARTICULATION SYSTEM”的美国专利申请序列号14/574,493，现为美国专利9,987,000；以及
-名称为“SURGICAL INSTRUMENT ASSEMBLY COMPRISING A LOCKABLEARTICULATION SYSTEM”的美国专利申请序列号14/574,500，现为美国专利10,117,649。
本申请的申请人拥有2013年3月1日提交且各自全文以引用方式并入本文的以下专利申请：
-名称为“ARTICULATABLE SURGICAL INSTRUMENTS WITH CONDUCTIVE PATHWAYSFOR SIGNAL COMMUNICATION”的美国专利申请序列号13/782,295，现为美国专利9,700,309；
-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9,782,169；
-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9,554,794；
-名称为“Joystick Switch Assemblies For Surgical Instruments”的美国专利申请序列号13/782,358，现为美国专利申请公布9,326,767；
-名称为“Sensor Straightened End Effector During Removal ThroughTrocar”的美国专利申请序列号13/782,481，现为美国专利申请公布9,468,438；
-名称为“Control Methods for Surgical Instruments with RemovableImplement Portions”的美国专利申请序列号13/782,518，现为美国专利申请公布2014/0246475；
-名称为“Rotary Powered Surgical Instruments With Multiple Degrees ofFreedom”的美国专利申请序列号13/782,375，现为美国专利申请公布9,398,911；以及
-名称为“Surgical Instrument Soft Stop”的美国专利申请序列号13/782,536，现为美国专利申请公布9,307,986。
本申请的申请人还拥有于2013年3月14日提交且各自全文以引用方式并入本文的以下专利申请：
-名称为“ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE”的美国专利申请序列号13/803,097，现为美国专利9,687,230；
-名称为“CONTROL ARRANGEMENTS FOR A DRIVE MEMBER OF A SURGICALINSTRUMENT”的美国专利申请序列号13/803,193，现为美国专利申请公布9,332,987；
-名称为“INTERCHANGEABLE SHAFT ASSEMBLIES FOR USE WITH A SURGICALINSTRUMENT”的美国专利申请序列号13/803,053，现为美国专利9,883,860；
-名称为“ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATIONLOCK”的美国专利申请序列号13/803,086，现为美国专利申请公布2014/0263541；
-名称为“SENSOR ARRANGEMENTS FOR ABSOLUTE POSITIONING SYSTEM FORSURGICAL INSTRUMENTS”的美国专利申请序列号13/803,210，现为美国专利9,808,244；
-名称为“MULTI-FUNCTION MOTOR FOR A SURGICAL INSTRUMENT”的美国专利申请序列号13/803,148，现为美国专利申请公布2014/0263554；
-名称为“DRIVE SYSTEM LOCKOUT ARRANGEMENTS FOR MODULAR SURGICALINSTRUMENTS”的美国专利申请序列号13/803,066，现为美国专利9,629,623；
-名称为“ARTICULATION CONTROL SYSTEM FOR ARTICULATABLE SURGICALINSTRUMENTS”的美国专利申请序列号13/803,117，现为美国专利申请公布9,351,726；
-名称为“DRIVE TRAIN CONTROL ARRANGEMENTS FOR MODULAR SURGICALINSTRUMENTS”的美国专利申请序列号13/803,130，现为美国专利申请公布9,351,727；以及
-名称为“METHOD AND SYSTEM FOR OPERATING A SURGICAL INSTRUMENT”的美国专利申请序列号13/803,159，现为美国专利9,888,919；
本申请的申请人还拥有于2014年3月7日提交且全文以引用方式并入本文的以下专利申请：
-名称为“CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS”的美国专利申请序列号14/200,111，现为美国专利9,629,629。
本申请的申请人还拥有于2014年3月26日提交且各自全文以引用方式并入本文的以下专利申请：
-名称为“POWER MANAGEMENT CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS”的美国专利申请序列号14/226,106，现为美国专利申请公布2015/0272582；
-名称为“STERILIZATION VERIFICATION CIRCUIT”的美国专利申请序列号14/226,099，现为美国专利9,826,977；
-名称为“VERIFICATION OF NUMBER OF BATTERY EXCHANGES/PROCEDURE COUNT”的美国专利申请序列号14/226,094，现为美国专利申请公布2015/0272580；
-名称为“POWER MANAGEMENT THROUGH SLEEP OPTIONS OF SEGMENTED CIRCUITAND WAKE UP CONTROL”的美国专利申请序列号14/226,117，现为美国专利10,013,049；
-名称为“MODULAR POWERED SURGICAL INSTRUMENT WITH DETACHABLE SHAFTASSEMBLIES”的美国专利申请序列号14/226,075，现为美国专利9,743,929；
-名称为“FEEDBACK ALGORITHMS FOR MANUAL BAILOUT SYSTEMS FOR SURGICALINSTRUMENTS”的美国专利申请序列号14/226,093，现为美国专利10,028,761；
-名称为“SURGICAL INSTRUMENT UTILIZING SENSOR ADAPTATION”的美国专利申请序列号14/226,116，现为美国专利申请公布2015/0272571；
-名称为“SURGICAL INSTRUMENT CONTROL CIRCUIT HAVING A SAFETYPROCESSOR”的美国专利申请序列号14/226,071，现为美国专利9,690,362；
-名称为“SURGICAL INSTRUMENT COMPRISING INTERACTIVE SYSTEMS”的美国专利申请序列号14/226,097，现为美国专利9,820,738；
-名称为“INTERFACE SYSTEMS FOR USE WITH SURGICAL INSTRUMENTS”的美国专利申请序列号14/226,126，现为美国专利申请公布10,004,497；
-名称为“MODULAR SURGICAL INSTRUMENT SYSTEM”的美国专利申请序列号14/226,133，现为美国专利申请公布2015/0272557；
-名称为“SYSTEMS AND METHODS FOR CONTROLLING A SEGMENTED CIRCUIT”的美国专利申请序列号14/226,081，现为美国专利9,804,618；
-名称为“POWER MANAGEMENT THROUGH SEGMENTED CIRCUIT AND VARIABLEVOLTAGE PROTECTION”的美国专利申请序列号14/226,076，现为美国专利9,733,663；
-名称为“SURGICAL STAPLING INSTRUMENT SYSTEM”的美国专利申请序列号14/226,111，现为美国专利9,750,499；以及
-名称为“SURGICAL INSTRUMENT COMPRISING A ROTATABLE SHAFT”的美国专利申请序列号14/226,125，现为美国专利10,201,364。
本申请的申请人还拥有于2014年9月5日提交且各自全文以引用方式并入本文的以下专利申请：
-名称为“CIRCUITRY AND SENSORS FOR POWERED MEDICAL DEVICE”的美国专利申请序列号14/479,103，现为美国专利10,111,679；
-名称为“ADJUNCT WITH INTEGRATED SENSORS TO QUANTIFY TISSUECOMPRESSION”的美国专利申请序列号14/479,119，现为美国专利9,724,094；
-名称为“MONITORING DEVICE DEGRADATION BASED ON COMPONENT EVALUATION”的美国专利申请序列号14/478,908，现为美国专利9,737,301；
-名称为“MULTIPLE SENSORS WITH ONE SENSOR AFFECTING A SECOND SENSOR'SOUTPUT OR INTERPRETATION”的美国专利申请序列号14/478,895，现为美国专利9,757,128；
-名称为“POLARITY OF HALL MAGNET TO IDENTIFY CARTRIDGE TYPE”的美国专利申请序列号14/479,110，现为美国专利10,016,199；
-名称为“SMART CARTRIDGE WAKE UP OPERATION AND DATA RETENTION”的美国专利申请序列号14/479,098，现为美国专利10,135,242；
-名称为“MULTIPLE MOTOR CONTROL FOR POWERED MEDICAL DEVICE”的美国专利申请序列号14/479,115，现为美国专利9,788,836；以及
-名称为“LOCAL DISPLAY OF TISSUE PARAMETER STABILIZATION”的美国专利申请序列号14/479,108，现为美国专利申请公布2016/0066913。
本申请的申请人还拥有于2014年4月9日提交且各自全文以引用方式并入本文的以下专利申请：
-名称为“MOTOR DRIVEN SURGICAL INSTRUMENTS WITH LOCKABLE DUAL DRIVESHAFTS”的美国专利申请序列号14/248,590，现为美国专利9,826,976；
-名称为“SURGICAL INSTRUMENT COMPRISING A CLOSING DRIVE AND A FIRINGDRIVE OPERATED FROM THE SAME ROTATABLE OUTPUT”的美国专利申请序列号14/248,581，现为美国专利9,649,110；
-名称为“SURGICAL SYSTEM COMPRISING FIRST AND SECOND DRIVE SYSTEMS”的美国专利申请序列号14/248,595，现为美国专利9,844,368；
-名称为“POWERED LINEAR SURGICAL STAPLER”的美国专利申请序列号14/248,588，现为美国专利申请公布2014/0309666；
-名称为“SURGICAL INSTRUMENT COMPRISING A GAP SETTING SYSTEM”的美国专利申请序列号14/248,591，现为美国专利10,149,680；
-名称为“MODULAR MOTOR DRIVEN SURGICAL INSTRUMENTS WITH ALIGNMENTFEATURES FOR ALIGNING ROTARY DRIVE SHAFTS WITH SURGICAL END EFFECTOR SHAFTS”的美国专利申请序列号14/248,584，现为美国专利9,801,626；
-名称为“POWERED SURGICAL STAPLER”的美国专利申请序列号14/248,587，现为美国专利9,867,612；
-名称为“DRIVE SYSTEM DECOUPLING ARRANGEMENT FOR A SURGICALINSTRUMENT”的美国专利申请序列号14/248,586，现为美国专利10,136,887；以及
-名称为“MODULAR MOTOR DRIVEN SURGICAL INSTRUMENTS WITH STATUSINDICATION ARRANGEMENTS”的美国专利申请序列号14/248,607，现为美国专利9,814,460。
本申请的申请人还拥有于2013年4月16日提交且各自全文以引用方式并入本文的以下专利申请：
-名称为“SURGICAL INSTRUMENT WITH MULTIPLE FUNCTIONS PERFORMED BY ASINGLE MOTOR”的美国临时专利申请序列号61/812,365；
-名称为“LINEAR CUTTER WITH POWER”的美国临时专利申请序列号61/812,376；
-名称为“LINEAR CUTTER WITH MOTOR AND PISTOL GRIP”的美国临时专利申请序列号61/812,382；
-名称为“SURGICAL INSTRUMENT HANDLE WITH MULTIPLE ACTUATION MOTORS ANDMOTOR CONTROL”的美国临时专利申请序列号61/812,385；以及
-名称为“SURGICAL INSTRUMENT WITH MULTIPLE FUNCTIONS PERFORMED BY ASINGLE MOTOR”的美国临时专利申请序列号61/812,372。
本专利申请的申请人拥有于2017年12月28日提交的以下美国临时专利申请，这些临时专利申请中的每一者的公开内容全文以引用方式并入本文：
-名称为“INTERACTIVE SURGICAL PLATFORM”的美国临时专利申请序列号62/611,341；
-名称为“CLOUD-BASED MEDICAL ANALYTICS”的美国临时专利申请序列号62/611,340；以及
-名称为“ROBOT ASSISTED SURGICAL PLATFORM”的美国临时专利申请序列号62/611,339。
本专利申请的申请人拥有于2018年3月28日提交的以下美国临时专利申请，这些临时专利申请中的每个临时专利申请全文以引用方式并入本文：
-名称为“INTERACTIVE SURGICAL SYSTEMS WITH encrypted COMMUNICATIONCAPABILITIES”的美国临时专利申请序列号62/649,302；
-名称为“DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS ANDCREATE ANONYMIZED RECORD”的美国临时专利申请序列号62/649,294；
-名称为“SURGICAL HUB SITUATIONAL AWARENESS”的美国临时专利申请序列号62/649,300；
-名称为“SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES INOPERATING THEATER”的美国临时专利申请序列号62/649,309；
-名称为“COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS”的美国临时专利申请序列号62/649,310；
-名称为“USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINEPROPERTIES OF BACK SCATTERED LIGHT”的美国临时专利申请序列号62/649,291；
-名称为“ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES”的美国临时专利申请序列号62/649,296；
-名称为“CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION ANDRECOMMENDATIONS TO A USER”的美国临时专利申请序列号62/649,333；
-名称为“CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATIONTRENDS AND REACTIVE MEASURES”的美国临时专利申请序列号62/649,327；
-名称为“DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICSNETWORK”的美国临时专利申请序列号62/649,315；
-名称为“CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES”的美国临时专利申请序列号62/649,313；
-名称为“DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS”的美国临时专利申请序列号62/649,320；
-名称为“AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICALPLATFORMS”的美国临时专利申请序列号62/649,307；以及
-名称为“SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS”的美国临时专利申请序列号62/649,323。
本申请的申请人拥有于2018年3月29日提交的以下美国专利申请，这些专利申请中的每个专利申请全文以引用方式并入本文：
-名称为“INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATIONCAPABILITIES”的美国专利申请序列号15/940,641；
-名称为“INTERACTIVE SURGICAL SYSTEMS WITH CONDITION HANDLING OFDEVICES AND DATA CAPABILITIES”的美国专利申请序列号15/940,648；
-名称为“SURGICAL HUB COORDINATION OF CONTROL AND COMMUNICATION OFOPERATING ROOM DEVICES”的美国专利申请序列号15/940,656；
-名称为“Spatial awareness of surgical hubs in operating rooms”的美国专利申请序列号15/940,666；
-名称为“COOPERATIVE UTILIZATION OF DATA DERIVED FROM SECONDARYSOURCES BY INTELLIGENT SURGICAL HUBS”的美国专利申请序列号15/940,670；
-名称为“SURGICAL HUB CONTROL ARRANGEMENTS”的美国专利申请序列号15/940,677；
-名称为“DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS ANDCREATE ANONYMIZED RECORD”的美国专利申请序列号15/940,632；
-名称为“COMMUNICATION HUB AND STORAGE DEVICE FOR STORING PARAMETERSAND STATUS OF A SURGICAL DEVICE TO BE SHARED WITH CLOUD BASED ANALYTICSSYSTEMS”的美国专利申请序列号15/940640；
-名称为“SELF DESCRIBING DATA PACKETS GENERATED AT AN ISSUINGINSTRUMENT”的美国专利申请序列号15/940,645；
-名称为“DATA PAIRING TO INTERCONNECT A DEVICE MEASURED PARAMETER WITHAN OUTCOME”的美国专利申请序列号15/940,649；
-名称为“SURGICAL HUB SITUATIONAL AWARENESS”的美国专利申请序列号15/940654；
-名称为“SURGICAL SYSTEM DISTRIBUTED PROCESSING”的美国专利申请序列号15/940,663；
-名称为“AGGREGATION AND REPORTING OF SURGICAL HUB DATA”的美国专利申请序列号15/940,668；
-名称为“SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES INOPERATING THEATER”的美国专利申请序列号15/940,671；
-名称为“DISPLAY OF ALIGNMENT OF STAPLE CARTRIDGE TO PRIOR LINEARSTAPLE LINE”的美国专利申请序列号15/940,686；
-名称为“STERILE FIELD INTERACTIVE CONTROL DISPLAYS”的美国专利申请序列号15/940,700；
-名称为“COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS”的美国专利申请序列号15/940,629；
-名称为“USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINEPROPERTIES OF BACK SCATTERED LIGHT”的美国专利申请序列号15/940,704；
-名称为“CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OFMONO-CHROMATIC LIGHT REFRACTIVITY”的美国专利申请序列号15/940,722；以及
-名称为“DUAL CMOS ARRAY IMAGING”的美国专利申请序列号15/940,742。
本申请的申请人拥有于2018年3月29日提交的以下美国专利申请，这些专利申请中的每个专利申请全文以引用方式并入本文：
-名称为“ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES”的美国专利申请序列号15/940,636；
-名称为“ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL HUBS”的美国专利申请序列号15/940,653；
-名称为“CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION ANDRECOMMENDATIONS TO A USER”的美国专利申请序列号15/940,660；
-名称为“CLOUD-BASED MEDICAL ANALYTICS FOR LINKING OF LOCAL USAGETRENDS WITH THE RESOURCE ACQUISITION BEHAVIORS OF LARGER DATA SET”的美国专利申请序列号15/940,679；
-名称为“CLOUD-BASED MEDICAL ANALYTICS FOR MEDICAL FACILITY SEGMENTEDINDIVIDUALIZATION OF INSTRUMENT FUNCTION”的美国专利申请序列号15/940,694；
-名称为“CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATIONTRENDS AND REACTIVE MEASURES”的美国专利申请序列号15/940,634；
-名称为“DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICSNETWORK”的美国专利申请序列号15/940,706；以及
-名称为“CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES”的美国专利申请序列号15/940,675。
本申请的申请人拥有于2018年3月29日提交的以下美国专利申请，这些专利申请中的每个专利申请全文以引用方式并入本文：
-名称为“DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMs”的美国专利申请序列号15/940,627；
-名称为“COMMUNICATION ARRANGEMENTS FOR ROBOT-ASSISTED SURGICALPLATFORMS”的美国专利申请序列号15/940,637；
-名称为“CONTROLS FOR ROBOT-ASSISTED SURGICAL PLATFORMS”的美国专利申请序列号15/940,642；
-名称为“AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICALPLATFORMS”的美国专利申请序列号15/940,676；
-名称为“CONTROLLERS FOR ROBOT-ASSISTED SURGICAL PLATFORMS”的美国专利申请序列号15/940,680；
-名称为“COOPERATIVE SURGICAL ACTIONS FOR ROBOT-ASSISTED SURGICALPLATFORMS”的美国专利申请序列号15/940,683；
-名称为“DISPLAY ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS”的美国专利申请序列号15/940,690；以及
-名称为“SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS”的美国专利申请序列号15/940,711。
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。所述端部执行器包括第一钳口和第二钳口。第一钳口具有钉仓。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。第二钳口能够围绕闭合轴线相对于第一钳口枢转；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。仓体包括限定于仓体中的钉腔，其中钉可移除地储存在钉腔中。钉腔被布置成六个纵向排。三排钉腔被定位在纵向狭槽的第一侧上且三排钉腔被定位在纵向狭槽的第二侧上。钉腔和钉的其他布置结构也是可能的。
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，所述保持器围绕仓体的底部延伸并且包括被构造成能够抓持仓体以及将保持器保持至仓体的弹性构件。驱动器能够通过滑动件在其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，滑动件还可通过击发构件朝远侧运动。击发构件被构造成能够接触滑动件并朝向远侧端部推动滑动件。限定于仓体中的纵向狭槽被构造成能够接纳击发构件。砧座还包括被构造成能够接纳击发构件的狭槽。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接近斜坡表面，使得钉先于刀被射出。
外科器械10000示于图1中。外科器械10000包括柄部10100、从柄部10100延伸的轴10200以及端部执行器10400。端部执行器10400包括被构造成能够接纳钉仓的第一钳口10410和能够相对于第一钳口10410运动的第二钳口10420。第二钳口10420包括砧座，该砧座包括限定于其中的钉成形凹坑。外科器械10000还包括闭合致动器10140，该闭合致动器被构造成能够驱动外科器械10000的闭合系统并使第二钳口10420在未夹紧位置和夹紧位置之间运动。参考图3，闭合致动器10140与闭合管10240可操作地联接，当闭合致动器10140闭合时，该闭合管朝远侧推进。在此类情况下，闭合管10240接触第二钳口并且用凸轮带动和/或向下推动第二钳口10420进入其夹紧位置。第二钳口10420围绕枢转轴线可枢转地联接到第一钳口。也就是说，在另选实施方案中，第二钳口可随着其运动到其夹紧位置而平移和旋转。此外，在各种另选实施方案中，外科器械包括钉仓钳口，该钉仓钳口能够相对于砧座钳口在未夹紧位置和夹紧位置之间运动。在任何情况下，柄部10100包括被构造成能够将闭合致动器10140可释放地保持在其夹紧位置的锁。柄部10100还包括释放致动器10180a、10180b，当任一个释放致动器被致动时，解锁闭合致动器10140，使得端部执行器可被重新打开。在各种另选实施方案中，柄部10100包括电动马达，该电动马达被构造成当由临床医生致动时能够使闭合管10240朝近侧和/或朝远侧运动。
端部执行器10400围绕关节运动接头10500附接到轴10200并且能够在平面内围绕关节运动轴线旋转。轴10200限定纵向轴线，并且端部执行器10400能够在端部执行器10400与纵向轴线对准的位置和端部执行器10400相对于纵向轴线以横向角度延伸的位置之间进行关节运动。柄部10100包括电动马达和被构造成能够控制电动马达的操作的控制系统。电动马达包括无刷直流马达；然而，电动马达可包括任何合适的马达，诸如有刷直流马达。2018年12月11日公布的名称为“POWERED SURGICAL CUTTING AND STAPLING APPARATUSWITH MANUALLY RETRACTABLE FIRING SYSTEM”的美国专利10,149,683的完整公开内容以引用方式并入本文。2018年5月10日公布的名称为“MOTOR-DRIVEN SURGICAL CUTTINGINSTRUMENT”的美国专利申请公布2018/0125481的全部公开内容以引用方式并入本文。柄部10100还包括能够附接到柄部外壳的可替换和/或可再充电电池10300，该可替换和/或可再充电电池为外科器械10000供电。2014年1月21日公布的名称为“POWER CONTROLARRANGEMENTS FOR SURGICAL INSTRUMENTS AND BATTERIES”的美国专利8,632,525的全部公开内容以引用方式并入本文。电动马达与外科器械10000的击发驱动装置10250可操作地联接，并且被构造成能够驱动击发驱动装置10250的击发构件通过钉击发行程。电动马达包括可旋转输出件，该可旋转输出件包括与击发驱动装置10250的可平移齿条接合的齿轮。电动马达沿第一方向操作以驱动击发构件通过钉击发行程，并且沿第二方向或相反方向操作以回缩击发构件和/或重置击发驱动装置10250。外科器械10000还包括与马达控制系统连通的致动器10150，该致动器在被致动或旋转时向马达控制系统发信号以沿第一方向操作电动马达并开始钉击发行程。如果释放致动器10150，则马达控制系统停止电动马达。当致动器10150被重新致动时，马达控制系统再次沿第一方向操作电动马达以继续钉击发行程。当击发构件到达钉击发行程的末端时，控制系统停止电动马达，等待临床医生的输入。当临床医生在此时释放致动器10150时，控制系统使电动马达的操作反向以使击发构件回缩回到其非击发位置。柄部10100还包括与马达控制系统连通的回缩致动器，该回缩致动器在由临床医生致动时使电动马达的方向反向以回缩击发驱动装置。当回缩致动器被压下时，无论击发构件是否已到达钉击发行程的末端，钉击发行程都终止。
外科器械10000的电动马达还用于选择性地驱动关节运动驱动系统以使端部执行器10400进行关节运动。更具体地，关节运动驱动系统包括能够与击发驱动装置选择性地接合的关节运动驱动器，并且当关节运动驱动器与击发驱动装置接合时，关节运动驱动器能够通过电动马达的操作朝近侧和朝远侧运动以使端部执行器10400进行关节运动。当电动马达沿其第一方向操作时，在此类情况下，端部执行器10400沿第一方向进行关节运动以朝远侧推动关节运动驱动器。相似地，当电动马达沿其第二方向操作时，端部执行器10400沿第二方向进行关节运动以朝近侧牵拉关节运动驱动器。当关节运动驱动器未与击发驱动装置接合时，电动马达的操作不使端部执行器10400进行关节运动。相反，在此类情况下，电动马达仅运动击发驱动装置。也就是说，应当理解，击发驱动装置使端部执行器10400进行关节运动的运动不会导致执行钉击发行程。与钉击发行程的运动范围相比，使端部执行器10400进行关节运动所需的运动范围较小，并且在钉击发行程开始处附近发生，使得在端部执行器10400进行关节运动时钉不被射出并且组织不被切割。外科器械10000还包括关节运动锁，该关节运动锁在关节运动驱动器被击发驱动装置纵向运动时解锁，然后在关节运动驱动器未被击发驱动装置驱动时将端部执行器10400锁定就位。2017年4月25日公布的名称为“CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS”的美国专利9,629,629的全部公开内容以引用方式并入本文。如上所述，除了用于驱动关节运动驱动系统的击发马达之外，外科器械还可包括单独的关节运动马达。
除上述之外，参考图2，柄部10100包括框架10110、外壳10120和关节运动致动器10160。关节运动致动器10160包括例如摇臂开关，该摇臂开关在外壳10120上竖直地取向并且与马达控制系统连通。摇臂开关能够围绕轴线向上和向下旋转，以使端部执行器10400进行关节运动。临床医生推动关节运动致动器10160的上部部分以使端部执行器10400向左进行关节运动，并且推动关节运动致动器10160的下部部分以使端部执行器10400向右进行关节运动。这种布置为临床医生提供直观的接合部；然而，可使用任何其他合适的布置。柄部10100还包括与马达控制系统连通的归位致动器10170。当归位致动器10170被临床医生致动时，马达控制系统操作电动马达以使端部执行器10400沿外科器械10000的轴10200的纵向轴线重定心。为此，控制系统被配置成能够跟踪端部执行器的位置，使得当归位致动器10170被致动时，控制系统沿正确的方向操作电动马达以使端部执行器10400沿正确的方向并以正确的量进行关节运动。在各种情况下，外科器械10000包括线性编码器，该线性编码器例如被构造成能够跟踪关节运动驱动器的位置，使得当归位致动器10170被致动时，控制系统可适当地使端部执行器10400定心。
除上述之外，轴10200能够相对于柄部10100旋转。轴10200包括附接到柄部10100的框架10110的框架10210。在其中轴10200能够易于从柄部10100移除的实施方案中，轴框架10210可与柄部框架10110分离。在其中轴10200不能从柄部10100移除的实施方案中，轴框架10210和柄部框架10110可一体形成。在任何情况下，轴10200包括固定地安装到轴10200的闭合管10240的管嘴或握持件10220。握持件10220包括限定于其中的手指沟槽10222和在手指沟槽10222之间延伸的脊10224，该脊提供壁，临床医生可抵靠该壁推动他们的手指并辅助临床医生使轴10200围绕其纵向轴线旋转。
值得注意的是，除上述之外，当轴10200围绕其纵向轴线旋转时，端部执行器10400与轴10200一起旋转。因此，端部执行器10400在轴10200被临床医生顺时针旋转时顺时针旋转，并且在轴10200被临床医生逆时针旋转时逆时针旋转。在各种另选实施方案中，外科器械10000包括被构造成能够使轴10200围绕其纵向轴线旋转的电动马达。在任一种情况下，轴10200能够从上止点(TDC)位置旋转到完整360度位置范围内的任何其他合适的位置，在该上止点位置中，砧座10420定位在钉仓钳口10410的正上方。例如，轴10200能够旋转到右90度位置或左90度位置，在右90度位置中，砧座10420面向柄部10100的右侧，在左90度位置中，砧座10420面向柄部10100的左侧。轴10200还能够旋转到下止点(BDC)位置，在该下止点位置中钉仓钳口10410定位在砧座10420的正上方。
如上所述，端部执行器10400既能够围绕关节运动接头10500进行关节运动并且也能够与轴10200一起旋转。如上所述，当端部执行器10400处于其TDC位置时，当端部执行器10400在平面内旋转时，关节运动控制件10160对用户来说是直观的——向上推以向左进行关节运动，并且向下推以向右进行关节运动。即使在轴10200和端部执行器10400已经向右或向左旋转90度之后，这种布置也是直观的。然而，当轴10200和端部执行器10400已沿任一方向旋转经过90度时，关节运动控制件10160可变得对临床医生是反直觉的(counter-intuitive)。事实上，关节运动控制件10160可看起来是向后的。据此，外科器械10000的控制系统被配置成在轴10200和端部执行器10400已沿任一方向旋转经过90度时，能够翻转外科器械响应关节运动控制件10160的方式。在此类情况下，控制件变为：向上推以向右进行关节运动，并且向下推以向左进行关节运动。为此，如下文更详细所述，外科器械10000被构造成能够检测轴10200相对于柄部10100的取向，即，外科器械被构造成能够检测端部执行器10400是否相对于柄部10100至少部分地倒置，然后进入另选的操作控制模式，其中外科器械10000对关节运动控制件10160的响应性已反向。这种布置可使外科器械10000更易于在各种情况下使用。
参考图2至图5，外科器械10000包括安装到柄部10100的与控制系统连通的开关10130，该控制系统被配置成能够检测轴10200相对于柄部10100的旋转。开关10130包括固定地安装到柄部框架10110的开关主体10132和三个电接触件10133，这三个电接触件是与控制系统连通的开关电路的一部分。开关10000还包括可旋转地连接到开关主体10132的开关臂10134和定位在开关主体10132上的电接触件10136。开关臂10134由导电材料(诸如黄铜)构成，并且当开关臂10134与电接触件10136接触时，开关臂闭合开关电路。当轴10200旋转经过左侧或右侧90度位置时，开关臂10134在断开位置(图5)和闭合位置之间旋转。更具体地，握持件或管嘴10220包括限定于其上的凸轮10230，当轴10200和端部执行器10400至少部分地倒置时，该凸轮将开关臂10134推动到其闭合位置中。当轴10200向上旋转经过90度位置时，凸轮10230允许开关臂10134弹性地运动回到其断开位置并且断开开关电路。开关臂10134包括安装到其上的辊10135，以有利于开关臂10134和握持件10220之间的相对旋转。
外科器械11000示于图6中。外科器械11000在许多方面类似于外科器械10000。外科器械11000包括柄部11100和从柄部11100延伸的轴11200。柄部11100包括框架11110，并且轴11200包括附接到柄部框架11110的框架11210。轴11200包括握持件或管嘴11220、定位在握持件11220的一侧上的第一磁性元件11230s和定位在握持件11220的相对侧上的第二磁性元件11230n。换句话讲，第一磁性元件11230s和第二磁性元件11230n安装成间隔开180度。柄部11100还包括控制系统，该控制系统包括安装到柄部框架11110的至少一个传感器11130，诸如霍尔效应传感器，该至少一个传感器被配置成能够感测磁性元件11230s和11230n的位置，并且利用该信息确定轴11200相对于柄部11100的取向。值得注意的是，第一磁性元件11230s包括具有面向柄部11100的南极和背向柄部11100的北极的永磁体，并且第二磁性元件11230n包括具有面向柄部11100的北极和背向柄部11100的南极的永磁体。磁性元件11230s和11230n干扰由霍尔效应传感器发射的磁场，并且当轴11200至少部分地倒置时，与轴11200的这种取向相关联的干扰由外科器械11000的控制系统经由包括传感器11130的感测电路来检测。在此类情况下，与上文相似，控制系统进入其第二操作模式，该第二操作模式将外科器械11000对关节运动控制件10160的响应性翻转，如上所述。
外科器械12000示于图7和图8中。外科器械12000在许多方面类似于外科器械10000。外科器械12000包括柄部12100和从柄部12100延伸的轴12200。柄部12100包括外壳、定位在柄部外壳的第一侧上的第一关节运动控制件12160a、以及定位在柄部外壳的第二侧或相对侧上的第二关节运动控制件12160b。第一关节运动控制件12160a经由第一控制电路与外科器械12000的控制系统连通，并且第二关节运动控制件12160b经由第二控制电路与控制系统连通。控制系统被配置成能够在第一关节运动控制件12160a被致动时沿第一方向操作钉击发驱动装置的电动马达以使轴12200的端部执行器沿第一方向进行关节运动，并且在第二关节运动控制件12160b被致动时沿第二方向或相反方向操作钉击发驱动装置的电动马达以使端部执行器沿第二方向或相反方向进行关节运动。柄部12100还包括定位在柄部12100的第一侧上的定心致动器或归位致动器10170a和定位在柄部12100的第二侧上的第二定心致动器或第二归位致动器10170b。与上文相似，致动器10170a和10170b与控制系统连通，该控制系统被配置成使得对定心致动器10170a或10170b中的任一者的致动致使控制系统操作电动马达以使端部执行器重定心。
外科器械13000示于图9和图10中。外科器械13000在许多方面类似于外科器械10000。外科器械13000包括柄部13100和从柄部13100延伸的轴13200。轴13200包括外壳、定位在轴外壳的第一侧上的第一关节运动控制件13260a、以及定位在轴外壳的第二侧或相对侧上的第二关节运动控制件13260b。第一关节运动控制件13260a经由第一控制电路与外科器械13000的控制系统连通，并且第二关节运动控制件13260b经由第二控制电路与控制系统连通。控制系统被配置成能够在第一关节运动控制件13260a被致动时沿第一方向操作钉击发驱动装置的电动马达以使轴13200的端部执行器10400沿第一方向进行关节运动，并且在第二关节运动控制件13260b被致动时沿第二方向或相反方向操作钉击发驱动装置的电动马达以使端部执行器10400沿第二方向或相反方向进行关节运动。换句话讲，端部执行器10400沿被致动的关节运动控制件的方向进行关节运动。第一关节运动控制件13260a定位在限定于轴13200的握持件或管嘴13220上的第一手指脊上，并且第二关节运动控制件13260b定位在限定于握持件13220上的第二手指脊上。值得注意的是，关节运动控制件13260a和13260b定位成间隔开180度。另选地，关节运动控制件13260a和13260b可定位在限定于握持件13220中的手指沟槽中，但可使用任何合适的布置。该布置提供了使关节运动控制件处于在使用期间临床医生的手可容易触及的位置的优点，并且因此，它们可以直观的方式使用，因为关节运动控制件13260a和13260b的相对布置和关节运动方向是固定的。
外科器械14000示于图11和图12中。外科器械14000在许多方面类似于外科器械13000。外科器械14000包括柄部13100和从柄部13100延伸的轴14200。轴14200包括外壳、定位在轴外壳的第一侧上的第一关节运动控制件14260a、以及定位在轴外壳的第二侧上的第二关节运动控制件14260b。第一关节运动控制件14260a经由第一控制电路与外科器械14000的控制系统连通，并且第二关节运动控制件14260b经由第二控制电路与控制系统连通。控制系统被配置成能够在第一关节运动控制件14260a被致动时沿第一方向操作钉击发驱动装置的电动马达以使轴14200的端部执行器10400沿第一方向进行关节运动，并且在第二关节运动控制件14260b被致动时沿第二方向或相反方向操作钉击发驱动装置的电动马达以使端部执行器10400沿第二方向或相反方向进行关节运动。第一关节运动控制件14260a定位在限定于轴14200的握持件或管嘴14220中的第一手指沟槽中，并且第二关节运动控制件14260b定位在限定于握持件14220中的第二手指沟槽中，但可使用任何合适的布置。
除上述之外，轴14200还包括定位在轴外壳的第二侧上的第三关节运动控制件14260c和定位在轴外壳的第一侧上的第四关节运动控制件14260d。第三关节运动控制件14260c经由第三控制电路与外科器械14000的控制系统连通，并且第四关节运动控制件14260b经由第四控制电路与控制系统连通。控制系统被配置成能够在第三关节运动控制件14260c被致动时沿第二方向操作钉击发驱动装置的电动马达以使轴14200的端部执行器沿第二方向进行关节运动，并且在第四关节运动控制件14260d被致动时沿第一方向操作钉击发驱动装置的电动马达以使端部执行器沿第一方向进行关节运动。第三关节运动控制件14260c定位在限定于轴14200的握持件14220中的第三手指沟槽中，并且第四关节运动控制件14260d定位在限定于握持件14220中的第四手指沟槽中，但可使用任何合适的布置。
外科器械15000示于图13中。外科器械15000在许多方面类似于外科器械10000。外科器械15000包括柄部15100和从柄部15100延伸的轴10200。柄部15100包括与外科器械15000的控制系统连通的关节运动致动器15160。与竖直布置的关节运动致动器10160相反，关节运动致动器15160水平布置。关节运动致动器15160包括可旋转元件，该可旋转元件能够在平行于或至少基本上平行于轴10200的纵向轴线的平面内旋转。可旋转元件能够朝远侧旋转以使端部执行器10400关节运动到柄部15100的右侧，并且能够朝近侧旋转以使端部执行器10400关节运动到柄部15100的左侧。无论端部执行器10400向上旋转还是向下旋转，这都是真实的，因为当端部执行器10400从其TDC位置沿任一方向旋转经过90度时，控制响应性翻转。也就是说，关节运动致动器15160的控制件可如上所述反向。关节运动致动器15160包括作为第一关节运动控制电路的一部分的远侧接触件和作为第二关节运动控制电路的一部分的近侧接触件。当可旋转元件处于其远侧位置时，可旋转元件接合远侧接触件并且闭合第一关节运动控制电路。当可旋转元件处于其远侧位置时，可旋转元件不与近侧接触件接触，并且因此第二关节运动控制电路断开。相似地，当可旋转元件处于其近侧位置时，可旋转元件接合近侧接触件并且闭合第二关节运动控制电路。对应地，当可旋转元件处于其近侧位置时，可旋转元件不与远侧接触件接触，并且因此第一关节运动控制电路断开。
除上述之外，关节运动致动器15160包括位于可旋转元件的运动范围中间的止动器。止动器被构造成能够在可旋转元件从关节运动致动器15160的一侧运动到另一侧时抵抗可旋转元件的运动。对可旋转元件的运动的这种抵抗可向临床医生发出信号，即一旦临床医生使可旋转元件运动经过该点，他们将使端部执行器10400沿相反方向进行关节运动。此外，此类止动器提供了停止可旋转元件的位置，使得端部执行器10400不沿任一方向进行关节运动。可旋转元件包括能够与其中心位置或停止位置对准的脊，临床医生能够推动和牵拉该脊以运动可旋转元件。此类脊为临床医生提供可旋转元件旋转的方向的触感，并且因此提供端部执行器10400进行关节运动的方向的触感。
如上所述，设想了各种实施方案，其中外科器械的控制响应性的翻转可被阻止。在至少一种情况下，外科器械的柄部包括与控制系统连通的致动器，该致动器在被致动时致使控制系统不进入其第二操作模式或翻转操作模式。在至少一个此类情况中，柄部还包括指示器，诸如发光二极管(LED)，该指示器被点亮以指示外科器械的状态，即，当端部执行器从其TDC位置旋转经过90度时关节运动控制件是否将翻转。在某些情况下，外科器械包括与控制系统的微处理器连通的输入屏幕，该输入屏幕可接收输入以防止控制系统进入其第二操作模式或翻转操作模式。除了或代替上文所述，可调节外科器械进入其第二操作模式的翻转点。在至少一个此类实施方案中，临床医生可例如从端部执行器的TDC位置沿任一方向将翻转点修改至85度。可使用任何合适的数量(诸如80度、95度或100度)来适应临床医生的偏好。在至少一个实施方案中，外科器械包括与控制系统的微处理器连通的输入屏幕，该输入屏幕被配置成能够接收来自临床医生的输入以调节关节运动控制翻转点。
在使用期间，在临床医生正在使用关节运动控制件时，期望关节运动控制件不会意外地翻转。当临床医生开始使端部执行器进行关节运动时，控制系统保持关节运动控制模式，直到临床医生释放关节运动控制件，即使端部执行器和轴在关节运动期间旋转经过翻转点。一旦关节运动已停止，控制系统就可重定向关节运动控制件，或者如果端部执行器和轴仍然处于倒置位置，则切换到翻转的关节运动控制模式。在某些实施方案中，控制系统不立即翻转关节运动控制件。相反，控制系统包括定时器电路和/或控制系统的微处理器被编程为在翻转控制件之前等待一定量的时间。在至少一种情况下，控制系统在翻转关节运动控制件之前等待例如从关节运动控制件被使用的上次时间起的5秒。另选地，控制系统可等待例如2秒或10秒。此类布置可有助于防止与外科器械的用户混淆。在各种实施方案中，外科器械包括与控制系统连通的触觉反馈发生器，当关节运动控制件被翻转时，该触觉反馈发生器由控制系统激活。可使用例如马达噪声、光、声音和/或振动反馈。在一些实施方案中，轴和/或柄部包括机械开关，当轴沿任一方向旋转经过其翻转点时，该机械开关可听见地发出咔嗒声。
图56和图57示出了外科器械32000，外科器械32000包括柄部32100和轴32200。柄部32100包括与外科器械32000的控制系统连通的关节运动控制件32160和关节运动翻转开关32130。关节运动翻转开关32130安装到控制板，诸如印刷控制板(PCB)，该控制板包括用于外科器械32000的控制系统的硬件和软件。当轴32200旋转经过其90度左侧位置或右位置时，轴32200接触关节运动翻转开关32130，这由控制系统检测到。此时，控制系统遵循用于决定何时或是否翻转关节运动控制件的算法。算法32900在图58中示出，其可控制这一点，但可使用任何合适的算法。与上文相似，轴32200包括凸轮32230，该凸轮被构造成能够接触关节运动翻转开关32130。由于上述原因，关节运动翻转开关32130在轴32200旋转180度时断开或“关断”，并且在轴32200旋转另一个180度时闭合或“接通”。凸轮32230被模制到轴32200的护罩中，但可包括任何合适的布置。如上所述，凸轮32230的行程被设计成使得轴32200或凸轮32230的旋转中的任何侧向浮动或偏心度不会意外地闭合或断开关节运动翻转开关32130。为此，轴32200包括用于控制轴32200和凸轮32230的旋转的固定轴承。值得注意的是，关节运动翻转开关32130被密封以防止流体进入。
在各种情况下，外科器械包括输入件，该输入件被构造成能够允许临床医生选择关节运动控制件是以其普通关节运动控制模式操作还是以其翻转的关节运动控制模式操作。在至少一种情况下，外科器械的柄部包括与外科器械的控制系统连通的输入开关。例如，当输入开关断开时，算法根据一组预先确定的标准来控制关节运动控制件的取向。当输入开关由临床医生闭合时，算法不使用该组预先确定的标准来控制关节运动控制件的取向。相反，该算法使用由临床医生选择的关节运动控制件的取向。在至少一种情况下，柄部包括与控制系统连通的三个输入开关：第一开关，该第一开关指示控制系统使用“砧座向上”关节运动控制件；第二开关，该第二开关指示控制系统使用“砧座向下”关节运动控制件；以及第三开关，该第三开关指示控制系统使用自动控制件。在一些实施方案中，外科器械不具有本文所述的自动翻转控制件，并且可仅包括第一开关输入件和第二开关输入件。此类布置可大大降低外科器械的成本和/或复杂性。
在各种情况下，除上述之外，翻转点可以是轴10200的旋转中的特定点。在某些情况下，参考图55，灰区可存在于翻转点周围。例如，灰区可以包括例如与翻转点的任一侧成20度。在轴10200处于灰区中时，控制系统的算法被配置成能够不翻转关节运动控制件，即使轴10200可能已经旋转经过翻转点。此类布置允许轴10200在灰区内来回旋转而不重复地翻转关节运动控制件。然而，一旦轴10200旋转出灰区，控制系统算法就翻转关节运动控制件，这取决于翻转关节运动控制件所需的任何其他标准。在各种情况下，在“砧座向上”取向的范围和“砧座向下”取向的范围之间存在接合部。对于能够旋转360度的轴，存在彼此间隔180度的两个此类接合部。这些接合部中的每个接合部定位在取向的过渡范围内，该过渡范围延伸到“砧座向上”取向范围和“砧座向下”取向范围内。当轴10200从“砧座向上”取向旋转到过渡范围内时，控制系统不翻转关节运动控制件，但是进一步将轴10200旋转出过渡范围至“砧座向下”取向中将导致关节运动控制件翻转。相似地，当轴10200从“砧座向下”取向旋转到过渡范围内时，控制系统不使关节运动控制件翻转，但使轴10200进一步旋转出过渡范围至“砧座向上”取向中将导致关节运动控制件翻转。在至少一种情况下，每个过渡区包括例如从“砧座向上”范围起的5度取向和从“砧座向下”范围起的5度取向。在其他实施方案中，例如，每个过渡区包括从“砧座向上”范围起的10度取向和从“砧座向下”范围起的10度取向。
在各种实施方案中，除上文所述，相对于可旋转地支撑轴的柄部和/或外壳来测量轴10200的向上取向和向下取向。在此类情况下，柄部包括顶部和底部(无论其重力取向如何)，并且轴10200的向上取向与柄部的顶部相关联，而轴10200的向下取向与柄部的底部相关联。在至少一个此类实施方案中，轴10200包括重力传感器，诸如加速度计和/或陀螺仪，并且柄部包括重力传感器。在此类实施方案中，轴重力传感器和柄部重力传感器与控制系统连通，该控制系统被配置成能够使用来自重力传感器的数据来评估轴和柄部之间的相对取向。在其他实施方案中，轴10200的向上取向和向下取向相对于重力进行测量，而不管柄部的重力取向如何。在至少一个此类实施方案中，轴10200包括与控制系统连通的重力传感器，并且轴10200的向上取向与竖直向上位置相关联，而轴10200的向下取向与竖直向下位置相关联。
图14中示出了关节运动控制件16160。关节运动控制件16160包括第一电容式开关16162和第二电容式开关16164。第一电容式开关16162和第二电容式开关16164定位在轴线16167的相对侧上。第一电容式开关16162是与外科器械的控制系统连通的第一关节运动控制电路的一部分，并且第二电容式开关16164是与控制系统连通的第二关节运动控制电路的一部分。当临床医生将他们的手指放在第一电容式开关16162上时，第一电容式开关16162的电容改变，该改变由控制系统检测到，并且响应于该改变，控制系统使外科器械的端部执行器向右进行关节运动。当临床医生将他们的手指放在第二电容式开关16164上时，第二电容式开关16164的电容改变，该改变由控制系统检测到，并且响应于该改变，控制系统使外科器械的端部执行器向左进行关节运动。在各种情况下，轴线16167包括死区，如果临床医生触摸该死区，该触摸不能可检测地或充分地改变第一电容式开关16162或第二电容式开关16164的电容。
图15中示出了双级开关17160。当开关17160被按压到其第一级中时，第一关节运动控制电路闭合。第一关节运动控制电路与外科器械的控制系统连通。当控制系统检测到第一关节运动控制电路已闭合时，控制系统沿第一方向操作关节运动驱动马达，以使外科器械的端部执行器沿第一方向进行关节运动。当开关17160被按压到其第二级中时，第二关节运动控制电路闭合。在各种情况下，第一级包括第一止动器，并且第二级包括第二止动器。在至少一个此类情况中，开关17160包括例如可按压到两种不同深度的双止动器开关。在任何情况下，第二关节运动控制电路与外科器械的控制系统连通。当控制系统检测到第二关节运动控制电路已闭合时，控制系统沿第二方向操作关节运动驱动马达，以使外科器械的端部执行器沿第二方向进行关节运动。除上述之外，第二关节运动控制电路在第一关节运动控制电路闭合时断开，并且同样，第一关节运动控制电路在第二关节运动控制电路闭合时断开。如上所述，在另选实施方案中，当关节运动控制电路处于其操作关节运动马达的相应级时，关节运动控制电路可被断开。
除上述之外，许多临床医生更喜欢在执行开放式手术时看着患者和/或在执行腹腔镜式手术时看着内窥镜监视器。因此，临床医生通常不看他们握住的外科器械，而是依靠外科器械的触感和/或直观设计来操作外科器械。换句话讲，临床医生可能不喜欢向下看他们握住的器械的柄部以验证他们正使器械进行关节运动的方向。也就是说，参考图16和图17，外科器械可包括轴18200，该轴包括被构造成能够指示端部执行器(诸如端部执行器18400)进行关节运动的方向的指示灯。在临床医生直接地或通过内窥镜系统监视器看着外科器械的端部执行器18400时，关节运动指示灯对于临床医生是可见的。在各种情况下，内窥镜系统包括细长柔性轴，该细长柔性轴包括相机、灯和/或与控制中枢(control hub)连通的任何其他合适的光学装置，该控制中枢包括控制系统和/或被配置成能够显示相机的输出的视频监视器。在此类情况下，端部执行器18400和指示灯在视频监视器上是可见的。
除上述之外，再次参考图16和图17，轴18200包括定位在端部执行器18400的右侧上的第一指示灯18260a，该第一指示灯经由第一电路与外科器械的控制系统连通。当控制系统接收到使端部执行器18400向右进行关节运动的输入时，控制系统沿使端部执行器18400向右进行关节运动的方向操作关节运动驱动马达，并且还点亮第一指示灯18260a。当控制系统不再接收到该输入时，控制系统去激活关节运动驱动马达和第一指示灯18260a。相似地，轴18200包括定位在端部执行器18400的左侧上的第二指示灯18260b，该第二指示灯经由第二电路与外科器械的控制系统连通。当控制系统接收到使端部执行器18400向左进行关节运动的输入时，控制系统沿使端部执行器18400向左进行关节运动的方向操作关节运动驱动马达，并且还点亮第二指示灯18260b。当控制系统不再接收到该输入时，控制系统去激活关节运动驱动马达和第二指示灯18260b。
如上所述，第一指示灯18260a和第二指示灯18260b定位在端部执行器18400上的某个位置，当临床医生看着端部执行器18400时，临床医生可以容易地观察到该位置。指示灯18260a和18260b相对于关节运动接头10500在远侧定位；然而，在另选实施方案中，指示灯18260a和18260b定位在关节运动接头10500的近侧。在各种实施方案中，外科器械包括多于一组指示灯。在至少一个此类实施方案中，第一组指示灯18260a、18260b相对于关节运动接头10500在远侧定位，并且第二组指示灯18260a、18260b相对于关节运动接头10500在近侧定位。在轴18200'上包括指示灯18260a'和18260b'的另选实施方案在图18中示出。指示灯18260a'包括呈向右箭头形状的LED，而指示灯18260b'包括呈向左箭头形状的LED。向右箭头18260a'指向端部执行器的右侧，但由于轴18200'的可能旋转，不一定指向外科器械柄部和/或临床医生的右侧。相似地，向左箭头18260b'指向端部执行器的左侧，但由于轴18200'的可能旋转，不一定指向外科器械柄部和/或临床医生的左侧。换句话讲，箭头在点亮时指向端部执行器正在进行关节运动的方向。例如，假定在内窥镜监视器上用端部执行器可观察到箭头，则当致动关节运动致动器时箭头被点亮时，临床医生将对端部执行器运动的方向产生感觉。如果临床医生观察到被点亮的箭头与他们在致动关节运动致动器时所预期的相反，则临床医生可以快速反应并沿正确的方向重新致动关节运动致动器。在各种另选实施方案中，箭头18260a'和18260b'可在关节运动致动器被致动时改变颜色。例如，当端部执行器未向右进行关节运动时箭头18260a’被点亮为红色，而当端部执行器向右进行关节运动时则被点亮为绿色。同样，当端部执行器未向左进行关节运动时箭头18260b'被点亮为红色，而当端部执行器向左进行关节运动时则被点亮为绿色。
在各种实施方案中，除上述之外，关节运动指示灯可嵌入轴的外壳中和/或定位在轴的外壳上。在某些实施方案中，指示灯定位在轴的内部，但例如能够通过限定在轴中的窗口和/或开口从轴的外部观察到。
图26A和图26B中示出了外科器械26000。外科器械26000包括柄部26100和从柄部26100延伸的轴12200。轴12200包括端部执行器26400，该端部执行器包括钉仓钳口26410和砧座钳口10420。端部执行器26400还包括定位在端部执行器26400的第一侧上的第一关节运动指示灯26460a和定位在端部执行器26400的第二侧上的第二关节运动指示灯26460b。与上文相似，当端部执行器26400沿第一方向进行关节运动时，外科器械26000的控制系统点亮第一关节运动指示灯26460a。在此类情况下，控制系统不点亮第二关节运动指示灯26460b。对应地，当端部执行器26400沿第二方向进行关节运动时，外科器械26000的控制系统点亮第二关节运动指示灯26460b。在此类情况下，控制系统不点亮第一关节运动指示灯26460a。指示灯26460a和26460b安装到和/或嵌入钉仓钳口26410的框架中。也就是说，指示灯26460a和26460b可安装到和/或嵌入定位在钉仓钳口26410中的钉仓内。在此类情况下，钉仓钳口26410包括与外科器械的控制系统连通的电路，该电路被放置成当钉仓安置在钉仓钳口26410中时与钉仓中的电路连通。
如上所述，外科器械的关节运动系统可包括关节运动驱动器，该关节运动驱动器能够朝近侧运动以使端部执行器沿第一方向进行关节运动，并且能够朝远侧运动以使端部执行器沿第二方向进行关节运动。参考图27，外科器械可以包括柄部26100、从柄部26100延伸的轴12200、以及围绕关节运动接头10500可旋转地连接到轴12200的端部执行器10400。轴12200包括关节运动驱动器10260，该关节运动驱动器包括可操作地联接到关节运动驱动系统的近侧端部和联接到端部执行器10400的远侧端部。为此，关节运动驱动器10260朝远侧延伸经过关节运动接头10500，并且在该实施方案中，对于握住外科器械的临床医生而言是部分可见的。关节运动驱动器10260的临床医生可见的部分也可以通过内窥镜监视器被临床医生看到。事实上，临床医生能够通过内窥镜监视器观察关节运动驱动器10260的运动。关节运动驱动器10260的可见部分包括其上的标记，诸如标记24640a'和标记24640b'，这些标记将关节运动驱动器10260的运动与端部执行器10400的运动相关联。在至少一种情况下，标记可包括第一组标记，该第一组标记包括指向远侧的箭头24640a'和圆形箭头，该圆形箭头指示如果关节运动驱动器10260朝远侧运动则端部执行器10400将旋转的方向。标记还可包括第二组标记，该第二组标记包括指向近侧的箭头24640b'和沿相反方向的圆形箭头，该圆形箭头指示如果关节运动驱动器10260朝近侧运动则端部执行器10400将旋转的方向。另选的关节运动驱动器10260'在图28中示出，该关节运动驱动器包括临床医生可容易看到的侧向延伸部分。在此类情况下，上述标记定位在侧向延伸部分上。
外科器械19000示于图19中。外科器械19000在许多方面类似于外科器械15000。外科器械19000包括柄部19100和从柄部19100延伸的轴10200。柄部19100包括与外科器械19000的控制系统连通的关节运动致动器19160。与竖直布置的关节运动致动器10160相反，关节运动致动器19160水平布置。关节运动致动器19160包括可滑动元件19162，该可滑动元件能够沿着平行于或至少基本上平行于轴10200的纵向轴线的轴线滑动。在至少一种情况下，关节运动致动器19160的轴线与轴10200的纵向轴线对准。可滑动元件19162定位在外科器械19000的柄部19100上的狭槽19164内。可滑动元件19162能够朝远侧滑动以使端部执行器10400关节运动到柄部19100的右侧，并且能够朝近侧滑动以使端部执行器10400关节运动到柄部19100的左侧。无论端部执行器10400向上旋转还是向下旋转，这都是真实的，因为当端部执行器10400从其TDC位置沿任一方向旋转经过90度时，控制响应性翻转。也就是说，关节运动致动器19160的控制件可如上所述反向。
关节运动致动器19160包括作为第一关节运动控制电路的一部分的远侧接触件和作为第二关节运动控制电路的一部分的近侧接触件。当可滑动元件19162处于其远侧位置时，可滑动元件19162接合远侧接触件并且闭合第一关节运动控制电路。当可滑动元件19162处于其远侧位置时，可滑动元件19162不与近侧接触件接触，并且因此第二关节运动控制电路断开。相似地，当可滑动元件19162处于其近侧位置时，可滑动元件19162接合近侧接触件并且闭合第二关节运动控制电路。对应地，当可滑动元件19162处于其近侧位置时，可滑动元件19162不与远侧接触件接触，并且因此第一关节运动控制电路断开。在任何情况下，关节运动致动器19160包括位于可滑动元件19162的运动范围中间的止动器19163。止动器19163被构造成能够在可滑动元件19162从关节运动致动器19160的一侧运动到另一侧时抵抗可滑动元件19162的运动。对可滑动元件19162的运动的这种抵抗可向临床医生发信号，即一旦临床医生使可滑动元件19162运动经过该点，他们将使端部执行器10400沿相反方向进行关节运动。此外，此类止动器19163提供了停止可滑动元件19162的位置，使得端部执行器10400不沿任一方向进行关节运动。
外科器械20000示于图20中。外科器械20000在许多方面类似于外科器械10000。外科器械20000包括柄部20100和从柄部20100延伸的轴12200。柄部20100包括与外科器械20000的控制系统连通的关节运动致动器20160。关节运动致动器20160包括二维操纵杆，该二维操纵杆能够在与轴12200的纵向轴线对准、平行或至少基本上平行的平面内运动。操纵杆能够朝远侧运动以使端部执行器10400关节运动到柄部20100的右侧，并且能够朝近侧运动以使端部执行器10400关节运动到柄部20100的左侧。在至少一种情况下，操纵杆包括具有内端的柄部，该内端定位在与外科器械20000的控制系统连通的传感器座中。当临床医生操纵操纵杆柄部的外端时，临床医生能够使操纵杆在传感器座内枢转。操纵杆的此类运动能够由控制系统检测到，控制系统响应于来自传感器座的输入操作关节运动系统。关节运动致动器20160包括一个或多个偏置机构，诸如弹簧，所述一个或多个偏置机构被构造成能够将操纵杆柄部偏置到传感器座中的定心位置或至少基本上定心的位置，其中控制系统不使端部执行器10400进行关节运动。
如上所述，端部执行器10400能够在平面内进行关节运动。在另选实施方案中，外科器械包括第二关节运动接头。在此类实施方案中，端部执行器10400能够在多于一个平面内旋转。在各种实施方案中，外科器械包括允许端部执行器10400在三维球形位置范围内旋转的关节运动接头。参考图21，外科器械21000包括轴21200，该轴包括允许端部执行器10400进行此类关节运动的关节运动接头21500。外科器械21000还包括柄部21100，该柄部包括与外科器械21000的控制系统连通的关节运动致动器21160。关节运动致动器21160包括三维操纵杆，该三维操纵杆能够朝近侧、朝远侧、向上、向下以及沿复合方向运动。操纵杆能够朝远侧运动以使端部执行器关节运动到柄部20100的右侧，并且能够朝近侧运动以使端部执行器关节运动到柄部21100的左侧。操纵杆能够例如向上运动以使端部执行器向上进行关节运动，以及向下运动以使端部执行器向下进行关节运动。操纵杆还能够沿向上和朝远侧两者的方向运动，以使端部执行器沿例如向上和向右两者的方向运动。操纵杆还能够沿向下和朝近侧两者的方向运动，以使端部执行器沿例如向下和向左两者的方向运动。在至少一种情况下，操纵杆包括具有内端的柄部，该内端定位在与外科器械21000的控制系统连通的传感器座中。当临床医生操纵柄部的外端时，临床医生可使操纵杆在传感器座内沿轨道运动。操纵杆的此类运动能够由控制系统检测到，控制系统响应于来自传感器座的输入操作关节运动系统。关节运动致动器21160包括一个或多个偏置机构，诸如弹簧，所述一个或多个偏置机构被构造成能够将操纵杆柄部偏置到传感器座中的定心位置或至少基本上定心的位置，其中控制系统不使端部执行器10400进行关节运动。
图22A和图22B中示出了外科器械22000。外科器械22000在许多方面类似于外科器械21000。外科器械22000包括柄部22100和从柄部22100延伸的轴21200。柄部22100包括定位在柄部22100的侧面上的关节运动致动器21160，并且另外还包括定位在柄部22100的前部上的关节运动致动器22160。类似于关节运动致动器21160，关节运动致动器22160包括三维操纵杆，该三维操纵杆与外科器械21000的控制系统连通并且能够使外科器械21000的端部执行器在三维场中进行关节运动。前关节运动致动器22160可由握住柄部22100的手枪式握持件的临床医生的食指容易地触及。设想了包括关节运动致动器22160但不包括关节运动致动器22160的另选实施方案。
参考图23，外科器械23000包括轴21200，该轴包括允许端部执行器10400进行三维关节运动的关节运动接头21500。外科器械23000还包括柄部23100，该柄部包括外壳23120并且另外包括与外科器械23000的控制系统连通的关节运动致动器23160。关节运动致动器23160包括四向触觉控制件，该四向触觉控制件能够朝近侧、朝远侧、向上、向下以及沿复合方向运动。四向触觉控制件能够朝远侧运动以使端部执行器关节运动到柄部23100的右侧，并且能够朝近侧运动以使端部执行器关节运动到柄部23100的左侧。四向触觉控制件能够向上运动以使端部执行器向上进行关节运动，并且能够向下运动以使端部执行器向下进行关节运动。例如，四向触觉控制件还能够沿向上和朝远侧两者的复合方向运动，以使端部执行器沿向上和向右两者的方向运动。例如，四向触觉控制件还能够沿向下和朝近侧两者的复合方向运动，以使端部执行器沿向下和向左两者的方向运动。在至少一种情况下，四向触觉控制件包括四个可按压致动器，一个可按压致动器用于向右、向左、向上和向下的每个方向，并且每个可按压致动器是与外科器械23000的控制系统连通的控制电路的一部分。四向触觉控制件的运动能够由控制系统检测到，该控制系统响应于来自关节运动致动器23160的输入在三维范围内操作关节运动系统。关节运动致动器23160包括一个或多个偏置机构，诸如弹簧，所述一个或多个偏置机构被构造成能够将四向触觉控制件偏置到定心位置或至少基本上定心的位置，其中控制系统不使端部执行器10400进行关节运动。
外科器械24000示于图24中。外科器械24000在许多方面类似于外科器械23000。外科器械24000包括柄部24100，该柄部包括关节运动致动器24160。类似于关节运动致动器23160，关节运动致动器24160包括四向触觉控制件。也就是说，关节运动致动器24160包括一体的重定心特征部。更具体地，关节运动致动器24160包括可按压致动器，该可按压致动器定位在与外科器械24000的控制系统连通的关节运动致动器24160中间。当中心致动器被压下时，控制系统操作以使端部执行器10400与轴10200的纵向轴线重新对准，非常类似于上文所讨论的致动器10170的致动。由于上述原因，重定心致动器定位在四个方向致动器的中间，从而形成紧凑且直观的布置。
外科器械25000示于图25中。外科器械25000在许多方面类似于外科器械24000。外科器械25000包括柄部25100，该柄部包括关节运动致动器25160。类似于关节运动致动器23160，关节运动致动器25160包括与外科器械25000的控制系统连通的四向控制件。也就是说，四向控制件包括电容式表面，该电容式表面允许临床医生在关节运动致动器25160的表面上轻击和/或拖动他们的手指，以在三维范围内控制端部执行器的关节运动。在至少一种情况下，关节运动致动器包括触摸屏和定位在触摸屏下方的电容式传感器阵列，该电容式传感器阵列被配置成能够例如检测临床医生手指的存在和/或运动。在使用中，例如，轻击电容式表面的顶部使端部执行器10400向上进行关节运动，轻击电容式表面的底部使端部执行器10400向下进行关节运动，轻击电容式表面的远侧端部使端部执行器10400向右进行关节运动，并且轻击电容式表面的近侧端部使端部执行器10400向左进行关节运动。轻击关节运动屏幕的中心使端部执行器10400沿轴21200的纵向轴线重定心。当在关节运动致动器25160的表面上进行旋转运动时，控制系统使端部执行器10400在由旋转运动指示的方向和/或速度上旋转。在各种情况下，外科器械25000的控制系统包括脉宽调制(PWM)控制电路，该脉宽调制控制电路用于控制用于驱动外科器械25000的关节运动系统的电动马达的速度。在至少一个实施方案中，除了用于控制关节运动马达速度的PWM控制电路之外或代替PWM控制电路，控制系统包括频率调制(FM)控制电路。
如上所述，外科器械的端部执行器可在多于一个方向和/或平面上旋转。为了实现这一点，在各种实施方案中，外科器械包括用于使端部执行器以从左到右的方式运动的第一马达驱动系统和用于使端部执行器以从上到下的方式运动的第二马达驱动系统。两个马达驱动系统与外科器械的控制系统连通，并且能够由控制系统顺序地和/或同时地驱动，以沿由来自一个或多个关节运动致动器的输入指示的方向定位端部执行器。
上述许多外科器械包括握持件，该握持件被构造成能够由临床医生抓握以使轴围绕纵向轴线旋转。在各种情况下，临床医生可用一只手握住握持件，并且可例如从该手伸出他们的食指以抓住握持件并旋转轴。然而，这种布置需要临床医生具有稍大的手。尽管此类外科器械可用一只手操作，但是在图29和图30中示出的外科器械27000可能更容易使用。外科器械27000包括柄部27100和从柄部27100延伸的能够围绕纵向轴线旋转的轴27200。柄部27100包括柄部框架27110和可旋转地支撑轴27200的外壳。柄部27100还包括定位在柄部外壳27110的前侧上的致动器27220，该致动器在由临床医生旋转时使轴27200围绕其纵向轴线L旋转。致动器27220可旋转地安装到柄部外壳27110并且能够围绕平行于或至少基本上平行于轴27200的纵向轴线的轴线A旋转。致动器27220包括围绕其周边延伸的齿轮齿环，该齿轮齿环经由传动齿轮27225与围绕轴27200的周边延伸的齿轮齿环可操作地接合，使得当致动器27220围绕其轴线旋转时，轴27200围绕其纵向轴线旋转。也就是说，致动器27220的齿轮齿不与轴27200的齿轮齿直接接合；相反，可旋转地安装在柄部27100中的中间齿轮27225与致动器27220和轴27200的齿轮齿直接接合。这种布置使致动器27220和轴27200的运动同步，即，使致动器27220向右旋转使轴27200向右旋转并且使致动器27220向左旋转使轴27200向左旋转。在不引入中间齿轮27225的情况下，轴27200将沿相反方向旋转，但这种布置可提供促进器械稳定性的扭矩平衡。
除上述之外，设想了其中轴27200的旋转由电动马达驱动的实施方案。在各种实施方案中，致动器27220在沿第一方向旋转时操作电动马达以使轴27200沿第一方向旋转。相似地，当致动器27220沿第二方向旋转时，电动马达使轴27200沿第二方向旋转。在至少一个实施方案中，电动马达的输出轴包括小齿轮，该小齿轮与围绕轴27200的齿轮齿环可操作地互相啮合。此外，在至少一个实施方案中，致动器27220包括被配置成能够检测致动器27220的旋转方向和旋转度数的一个或多个传感器，所述一个或多个传感器与外科器械的控制系统连通。利用该数据，控制系统被配置成能够控制电动马达的方向和速度。在致动器27220例如沿第一方向少量旋转的情况下，轴27220沿第一方向缓慢旋转，而当致动器27220沿第一方向大量旋转时，轴27220沿第一方向快速旋转。
除上述之外，致动器27220包括具有第一端部和第二端部的杆。杆的取向与轴27200的取向同步。当杆的第一端部位于第二端部的正上方时，即第一端部最靠近轴27200时，轴27200处于其上止点(TDC)位置。对应地，当杆的第二端部位于第一端部的正上方时，即第二端部最靠近轴27200时，轴27200处于其下止点(BDC)位置。作为这种布置的结果，外科器械的用户基于致动器27220的取向具有对轴27200的取向的直观感觉。
外科器械30000示于图51和图52中。外科器械在许多方面类似于外科器械10000。与竖直关节运动致动器10160相反，外科器械30000的柄部包括水平关节运动致动器30160。水平关节运动致动器30160包括摇臂开关，该摇臂开关可朝远侧摇摆以使端部执行器向右旋转，并且可朝近侧摇摆以使端部执行器向左旋转。外科器械31000示于图53和图54中。外科器械在许多方面类似于外科器械10000。与竖直关节运动致动器10160相反，外科器械31000的柄部包括关节运动致动器31160。关节运动致动器31160包括多轴摇臂开关，该多轴摇臂开关可从近侧至远侧摇摆以使端部执行器在一个平面内进行关节运动并且可从上至下摇摆以使端部执行器在另一个平面内进行关节运动。在各种情况下，关节运动平面彼此正交，但可以任何合适的方式布置。
如上所述，外科器械的控制系统可包括算法，在某些情况下，该算法根据预先确定的标准翻转和/或以其他方式重定向外科器械的控制件。在各种情况下，同样如上所述，算法可被配置成能够基于轴相对于柄部的旋转来翻转外科器械的关节运动控制件。参考图59，外科器械包括柄部并且另外包括轴33200，该柄部包括与外科器械的控制系统连通的霍尔效应传感器33130和/或任何其他合适的传感器，该轴包括围绕轴33200的护罩或握持件10220以圆形或环形图案布置的磁体33230的阵列。每个磁体33230包括北极(N)和南极(S)，并且磁体33230以图59所示的方式布置——磁体33230中的一些磁体的N极面向柄部，而一些S极面向柄部。当轴33200相对于柄部旋转时，磁体33230的这种布置允许控制系统跟踪轴33200的位置并且理解轴33200相对于柄部的取向或旋转。在任何三个连续磁体33230内，例如，磁体33230的图案为给定旋转方向产生唯一的可识别标记。也就是说，可以使用任何合适数量和/或布置的离散磁体。尽管使用了十二个磁体33230，但可使用少于十二个磁体，例如六个磁体。此外，可使用多于十二个磁体。
参考图60，外科器械包括柄部并且另外包括轴34200，该柄部包括与外科器械的控制系统连通的霍尔效应传感器34130和/或任何其他合适的传感器，该轴包括附接到轴34200的护罩或握持件10220的连续环形磁体34230。在各种情况下，环形磁体34230包括嵌入有磁性微结构的盘或环，该磁性微结构能够由霍尔效应传感器检测到。环形磁体34230包括围绕其周边的连续但变化的磁性图案，该磁性图案为控制系统提供可跟踪图案以评估轴34200的取向或旋转。在其他实施方案中，环形磁体34230包括围绕其周边的能够由控制系统跟踪的间歇磁性图案。
参考图61，外科器械包括柄部并且另外包括轴35200，该柄部包括与外科器械的控制系统连通的RFID读取器35130，该轴包括围绕轴35200的护罩或握持件10220的RFID芯片35230的圆形或环形阵列。每个RFID芯片包括能够由RFID读取器35130检测到的唯一标识，并且利用该信息，控制系统能够评估轴35200相对于柄部的取向或旋转。值得注意的是，RFID读出器35130具有用于读取RFID芯片35230的有限范围，并且因此可仅能够读取最相邻的RFID芯片35230。在一些情况下，RFID读取器35130可具有用于读取两个最相邻的RFID芯片35230的足够的范围。轴35200包括四个RFID芯片35230，但可包括任何合适数量的RFID芯片35230。也就是说，在各种情况下，可利用更多RFID芯片来改善由控制系统作出的评估的准确性或分辨率。
参考图62，外科器械包括柄部并且另外包括轴36200，该柄部包括与外科器械的控制系统连通的霍尔效应传感器36130a和/或任何其他合适的传感器，该轴包括围绕轴36200的护罩以圆形或环形图案布置的磁体36230a的阵列。柄部还包括与外科器械的控制系统连通的RFID读取器36130b，并且另外包括围绕轴36200的护罩的RFID芯片36230b的圆形或环形阵列。控制系统被配置成能够使用来自霍尔效应传感器36130a和RFID读取器36130b的数据来评估轴36200相对于柄部的取向。值得注意的是，RFID芯片36230b定位在磁体36230a中间，这为控制系统提供相邻磁体36230a之间的可检测分辨率。相似地，磁体36230a定位在RFID芯片36230b中间，这为控制系统提供RFID芯片36230b之间的可检测分辨率。
外科器械37000示于图63至图66中。外科器械37000包括柄部37100和从柄部37100延伸的轴37200。外科器械37000还包括位于柄部37100和轴37200之间的滑动接头37900。滑动接头37900包括柄部37100和轴37200之间的电接合部。滑动接头37900包括安装在轴37200中的环形圈37930。图63和图64中描绘了四个环形圈37930，但是滑动接头可以包括任何合适数量的圈。滑动接头37900还包括柄部37100中的电接触件37130。例如，滑动接头37900包括与第一环形圈37930接合的第一电接触件37130和与第二环形圈37930接合的第二电接触件37130。也就是说，滑动接头37900可包括任何合适数量的电接触件以保持柄部和轴之间的电力和/或信号通信。在轴37200的整个旋转过程中，即在全部360度的旋转过程中，电接触件37130保持与其相应的环形圈37930电接触。在各种情况下，每个电接触件37130包括弹簧元件，该弹簧元件被构造成能够将电接触件朝向其相应的环形圈37930偏置。电接触件37130经由单独的电路与外科器械37000的控制系统连通，使得控制系统可评估电路的电阻和/或控制系统与滑动接头37900之间的电路的任何其他电特性。也就是说，滑动接头37900的电接触件和环可为任何合适的电路布置的一部分。
除上述之外，滑动接头37900可用作轴37200相对于柄部37100的绝对位置传感器。更具体地，控制系统可使用中间环形圈37930(即第一圈37930和第二圈37930之间的环形圈37930)来评估轴37200的取向。为此，滑动接头37900包括与中间环形圈37930和控制系统电连通的中间电接触件37130，作为中间电路的一部分。与第一环形圈和第二环形圈37930相比，中间环形圈37930由高电阻材料构成，并且提供例如10,000欧姆电阻。中间环形圈37930具有电联接到第一环形圈37930的第一部分、电联接到第二环形圈37930的第二环形部分、以及第一部分和第二环形部分之间的小断裂部。当轴37200相对于柄部37100旋转时，中间电接触件37130沿着中间环形圈37930滑动，并且中间电路的电阻和电压以控制系统能够检测到的方式改变，这是由于通过中间接触件37130闭合和断开该断裂部。来自中间电路的信号由控制系统的模数转换器数字化，来自该模数转换器的数据可由控制系统用来评估轴37200的取向。在各种情况下，中间环形圈37930和/或中间接触件37130中的任何合适数量的间隙可用于提供具有足够分辨率的信号以确定轴37200相对于柄部37100的取向或旋转。
在各种实施方案中，电阻材料嵌入外科器械的轴中，该电阻材料为穿过滑环的电路的一部分。当轴旋转时，电路中的电阻改变，这能够由外科器械的控制系统检测以评估轴相对于柄部的角取向。
外科器械38000的表示示于图67中。外科器械38000包括柄部38100和从柄部38100延伸的轴38200。柄部38100包括附连到柄部38100的框架和/或外壳的霍尔效应传感器38130的环形阵列。霍尔效应传感器38130沿柄部38100中的圆周定位，如图67所示。霍尔效应传感器38130经由电路与控制系统连通。轴38200包括安装到轴38200的护罩的磁体38230，该磁体与霍尔效应传感器38130的圆周对准或至少基本上对准。当轴38200围绕其纵向轴线旋转时，磁体38230沿着传感器圆周运动。传感器38130定位和布置成使得传感器38130中的一个或多个传感器可检测磁体38230的位置，并且因此控制系统可基于哪个霍尔效应传感器38130已检测到由磁体38230产生的磁场失真和失真强度来确定轴38200相对于柄部38100的取向。
在各种实施方案中，外科器械可包括一个或多个光学传感器，所述一个或多个光学传感器被配置成能够检测轴相对于柄部的取向。在至少一个实施方案中，外科器械的柄部包括与外科器械的控制系统连通的光发射器和光检测器。轴包括与轴一起旋转的反射表面。光发射器将光发射到反射表面上，并且光被反射回到光检测器中。反射表面包括具有不同反射率的不同部分，这在反射回光检测器的光中产生图案。利用该信息，控制系统可评估轴相对于柄部的取向。在各种情况下，反射表面包括开口和实心区域，以产生例如二进制关-开或低-高反射响应信号。
在各种实施方案中，外科器械包括机电换能器，诸如线性可变差动换能器，该机电换能器与机械凸轮结合使用以测量凸轮的深度并将该深度与轴的旋转角度相关联。在各种实施方案中，外科器械的柄部包括与控制系统连通的磁力计，并且另外轴包括能够由磁力计检测到的磁体。
在各种实施方案中，外科器械的轴包括位于轴中的陀螺仪传感器，控制系统使用该陀螺仪传感器来评估轴相对于柄部的取向。在至少一个此类实施方案中，柄部还包括陀螺仪传感器，该陀螺仪传感器与控制系统连通，使得可评估柄部和轴的相对取向。在各种实施方案中，外科器械的轴包括倾斜传感器，控制系统使用该倾斜传感器来评估轴相对于柄部的取向。在至少一个实施方案中，可使用SQ-MIN-200传感器。SQ-MIN-200传感器起到像常闭传感器一样的作用，该常闭传感器在倾斜或振动时颤动打开和闭合。也就是说，可使用例如任何合适的全向传感器。
在各种实施方案中，可检测元件可定位在轴的夹具驱动装置或闭合管上。当轴旋转时，闭合管与轴一起旋转。因此，柄部的一个或多个传感器可经由轴上的可检测元件来检测轴相对于柄部的取向。当闭合管平移以闭合端部执行器时，如本文所述，可检测元件相对于一个或多个传感器运动。可检测元件的这种平移也可用于验证端部执行器的闭合。在至少一种情况下，霍尔效应传感器可用于检测可检测元件的旋转和平移。在各种情况下，外科器械的控制系统被配置成能够在端部执行器闭合时防止端部执行器进行关节运动。该布置向控制系统提供反馈，以不仅确定关节运动控制件的响应性，而且确定控制系统是否应当完全响应于来自关节运动控制件的输入。
在各种实施方案中，再次参考图27和图28，外科器械10000的关节运动致动器10260的远侧端部附接到端部执行器10400，使得关节运动致动器10260的近侧平移和远侧平移使端部执行器10400围绕关节运动接头10500旋转。参考图32，外科器械10000的轴10200包括可滑动地支撑关节运动致动器10260的轴框架10210。尽管图32中未示出，但轴10200还包括从框架10210延伸的枢轴销10215。枢轴销10215紧密地接纳在限定于端部执行器10400的钉仓钳口10410中的枢轴孔口10415内，该枢轴孔口限定关节运动接头10500的关节运动轴线AA。关节运动驱动器10260包括远侧端部，该远侧端部包括限定于其中的孔口10262，并且端部执行器10400还包括从钉仓钳口10410的近侧端部延伸到孔口10262中的关节运动销10460。当关节运动致动器10260平移时，如上所述，孔口10262的侧壁接合关节运动销10460并且根据关节运动致动器10260平移的方向推动或牵拉关节运动销10460。公布于2015年8月11日的名称为“ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRINGDRIVE”的美国专利9,101,358的全部公开内容以引用方式并入本文。公布于2019年2月2日的名称为“SURGICAL STAPLING APPARATUS”的美国专利5,865,361的全部公开内容以引用方式并入本文。
除上述之外，端部执行器10400限定端部执行器轴线EA并且轴10200限定纵向轴轴线LSA。当端部执行器10400处于非关节运动位置时，端部执行器轴线EA与纵向轴轴线LSA对准或至少基本上对准。当端部执行器10400处于关节运动位置时，如图32所示，端部执行器轴线EA横向于纵向轴轴线LSA。孔口10262是细长的，以便适应关节运动销10460和关节运动驱动器10260之间的相对运动；然而，对于较大关节运动角度，关节运动驱动器10260可结合和/或挠曲，这可能在没有进一步运动的情况下导致关节运动驱动器10260从关节运动销10460脱离。据此，端部执行器10400还包括固持板10600，该固持板被构造成能够保持关节运动驱动器10260与关节运动销10460接合。固持板10600包括平面或至少基本上平面的部分，该平面或至少基本上平面的部分在关节运动驱动器10260的远侧端部上方延伸并且包括限定于其中的孔口10660，该孔口的侧壁与关节运动销10460接合。因此，关节运动驱动器10260被捕获在钉仓钳口10410和固持板10600之间，使得关节运动驱动器10260不会无意地与钉仓钳口10410脱离接合。固持板10600固定地安装到钉仓钳口10410，使得在固持板10600与钉仓钳口10410之间存在很少的(如果有)相对运动。钉仓钳口10410包括固持凸耳10430，并且固持板10600包括限定于其中的孔口10630，该孔口的侧壁与固持凸耳10430接合以将固持板10600保持到钉仓钳口10410。在各种情况下，固持板10600可包括弹簧和/或偏置构件。
现在参考图33，除了固持板10600之外或代替固持板，外科器械10000'包括端部执行器10400'和将端部执行器可旋转地连接到轴10200'的关节运动接头10500'。除上述之外，关节运动接头10500'包括从轴10200'的轴框架10210'延伸的销10560'，该销紧密地接纳在限定于钉仓钳口10410'中的孔口内，该孔口限定关节运动接头10500'的关节运动轴线AA。外科器械10000'还包括关节运动驱动器10260'，该关节运动驱动器包括远侧端部10264'，该远侧端部包括限定于其中的狭槽10262'。与上文相似，钉仓钳口10410'包括从钉仓钳口10410'延伸的关节运动销10460'，该关节运动销延伸到远侧端部10264'的狭槽10262'中，并且狭槽10262'的侧壁与关节运动销10460'之间的相互作用围绕关节运动接头10500'驱动端部执行器10400'。值得注意的是，关节运动接头10500'的销10560'包括限定于其中的间隙释放部10564'，以提供用于关节运动驱动器10260'的纵向运动的间隙。钉仓钳口10410'还包括限定于其中的间隙释放部10414'，以允许用于钉仓钳口10410'围绕关节运动接头10500'的旋转的间隙。为了防止关节运动驱动器10260'与钉仓钳口10410'脱离，参考图34至图37，关节运动销10460'包括从圆柱形部分10462'延伸的固持肩部10464'。固持肩部10464'在端部执行器10400'的整个关节运动过程中在关节运动驱动器10260'的远侧端部10264'的一部分上方延伸。因此，无论端部执行器10400'是一直向左侧进行关节运动(图35)还是一直向右进行关节运动(图37)或是向它们之间的任何位置进行关节运动，固持肩部10464'防止或至少限制关节运动驱动器10260'从钉仓钳口10410'脱离接合的可能性。
在各种实施方案中，除上述之外，间隙释放部10414'包括固持肩部或唇缘，该固持肩部或唇缘防止关节运动驱动器10260'与关节运动销10460’脱离。关节运动销10460'的固持肩部10464'的尺寸和构造被设置成使得固持肩部10464'的宽度宽于狭槽10262'的宽度。也就是说，狭槽10262'包括大于其宽度的长度，这允许固持肩部10464’穿过狭槽10262’插入，使得关节运动驱动器10260'可组装到关节运动销10460’中。狭槽10262'的宽度沿着平行于轴的纵向轴线的轴线限定，而狭槽10262'的长度沿着正交于轴的纵向轴线的轴线限定。此类布置允许端部执行器相对于轴进行关节运动，同时使端部执行器和关节运动驱动器10260'之间的结合最小化。也就是说，关节运动驱动器10260'由柔性材料构成，该柔性材料允许关节运动驱动器10260’弹性挠曲以适应端部执行器的端部关节运动。
如上所述，端部执行器10400包括被构造成能够接纳可替换钉仓(诸如钉仓10430)的钉仓钳口10410，以及被构造成能够使从钉仓10430射出的钉变形的砧座钳口10420。钉仓钳口10410包括通道，该通道包括底部支撑件和向上延伸的两个侧向侧壁，所述两个侧向侧壁被构造成能够接纳钉仓10430。钉仓10430包括近侧端部10432、远侧端部10434，以及在近侧端部10432和远侧端部10434之间延伸的平台10433。当钉仓10430插入钉仓钳口10410中时，近侧端部10432被引导到钉仓钳口10410和砧座钳口10420之间的位置中，然后安置在钉仓钳口10410中。砧座钳口10420包括近侧端部10422、远侧端部10424、在近侧端部10422和远侧端部10424之间延伸的组织压缩表面10423、以及将砧座钳口10420可旋转地连接到钉仓钳口10410的枢轴10421。参考图44，砧座钳口10420包括延伸到限定于钉仓钳口10410中的孔口10411中的侧向销。如上所述，砧座钳口10420可通过缝合器械10000的闭合驱动装置旋转到闭合位置或夹紧位置。当闭合驱动装置回缩时，砧座钳口10420打开。参考图38至图43，缝合器械10000还包括一个或多个偏置构件或弹簧10446，所述一个或多个偏置构件或弹簧被构造成能够在闭合驱动装置回缩时打开砧座钳口10420。外科器械10000包括两个开口弹簧10446，但可包括任何合适数量的偏置构件。在任何情况下，每个弹簧10446定位在限定于钉仓钳口10410中的凹陷部10416中。凹陷部10416紧密地接纳弹簧10446，使得弹簧10446在压缩负载下不屈曲；然而，凹陷部10416的尺寸和构造被设置成在砧座钳口10420闭合时适应弹簧10446的任何侧向伸展。
主要参考图42，砧座钳口10420包括与砧座10420的近侧端部10422相邻的与弹簧10446接触的侧向突片10426。当砧座钳口10420闭合时，弹簧10446被压缩在侧向突片10426与凹陷部10416的底部之间。当闭合系统回缩时，弹簧10446弹性地再次伸展并向上推动侧向突片10426，以使砧座钳口10420旋转到其打开位置或未夹紧位置。值得注意的是，主要参考图40，钉仓钳口10410具有限定于其上的止挡部分10419，当砧座10420到达其完全打开位置时，该止挡部分由砧座10420的近侧端部10422接触。砧座10420包括接触钉仓钳口10410的止挡部分10419的近侧止挡表面10429。在此类情况下，砧座钳口10420不能被进一步打开。由于上述原因，弹簧10446抵靠钉仓钳口10410的止挡部分10419保持砧座钳口10420，直到砧座钳口10420再次闭合。
当砧座钳口10420处于其打开位置时，钉仓钳口10410定位在待缝合的组织的一侧上，并且砧座钳口10420定位在相对侧上。在此类情况下，端部执行器10400相对于组织运动，直到组织被适当地定位在钉仓钳口10410和砧座钳口10420之间。砧座钳口10420包括侧向组织止挡件10427，该侧向组织止挡件与钉仓钳口10410并排向下延伸，该侧向组织止挡件被构造成能够确保定位在端部执行器10400内的组织定位在钉仓10430中的钉腔上方。主要参考图39，组织止挡件10427相对于最近侧钉腔10440朝远侧延伸。在至少一种情况下，组织止挡件10427相对于钉腔10440的每个纵向排中的至少一个钉腔10440朝远侧延伸。因此，组织止挡件10427确保捕获在端部执行器10400中的组织在未被缝合的情况下不会被组织切割刀切割。当砧座钳口10420闭合时，组织止挡件10427相对于钉仓钳口10410运动。组织止挡件10427的尺寸和构造被设置成使得组织不会意外地挤压在组织止挡件10427与钉仓钳口10410的侧向侧之间。更具体地，组织止挡件10427的底部边缘10428被构造成使得即使当砧座钳口10420处于其完全打开位置时，底部边缘也与钉仓钳口10410的侧向侧并排延伸，如图39所示。值得注意的是，钉仓钳口10410的侧向侧10415沿平台10433上方向延伸，以确保在砧座钳口10420的整个运动范围内，当从侧面观察时，组织止挡件10427与钉仓钳口10410的侧向侧10415之间存在重叠。
在各种实施方案中，除上述之外，组织止挡件10427的远侧边缘在砧座钳口10420的整个运动范围内在平台10433下方延伸。因此，当砧座钳口10420处于其完全打开位置和其完全夹紧位置时，组织止挡件10427的远侧边缘在平台10433的顶部表面下方延伸。当砧座钳口10420运动时，这种布置减少了组织被挤压的可能性。在某些实施方案中，钉仓包括与组织止挡件10427并排从平台10433向上延伸的组织止挡件。与上文相似，组织止挡件10427的远侧边缘在仓组织止挡件下方延伸通过砧座钳口10420的整个运动范围。当砧座钳口10420运动时，这种布置还减少了组织被挤压的可能性。此外，这些布置将可用于钉仓钳口10410相对于砧座钳口10420运动的实施方案中。
如上文所讨论的并且主要参考图44、图45A和图45B，端部执行器10400包括钉仓钳口10410，该钉仓钳口包括限定于其中的弹簧凹陷部10416，该弹簧凹陷部包括更宽的顶部开口10416'。弹簧凹陷部10416仍然支撑弹簧10446并防止弹簧屈曲，但是当砧座钳口10420处于其闭合位置时，弹簧凹陷部10416的较宽顶部开口10416'为侧向突片10426提供间隙。在此类布置中，侧向突片10426可运动到钉仓钳口10410中以压缩弹簧10446。在此类情况下，弹簧10446可被砧座钳口10420高度压缩，从而确保当砧座钳口10420被闭合驱动装置释放时来自弹簧10446的较强打开力。如上所述，设想不具有较宽顶部开口10416'的实施方案。在此类实施方案中，弹簧沿弹簧10446的长度由弹簧凹陷部10416紧密地接纳。
缝合器械10000的击发驱动装置的组织切割构件10251在图46和图47中示出，组织切割构件包括主体，该主体包括在钉击发行程期间穿过端部执行器10400的远侧鼻部10258和组织切割刃10259。组织切割构件10251还包括被构造成能够接合砧座钳口10420的顶部凸轮构件10255和被构造成能够在钉击发行程期间接合钉仓钳口10410的底部凸轮构件10256。在图46中可以看到砧座钳口10420的纵向狭槽中的纵向凸轮表面10425，该纵向凸轮表面在钉击发行程期间由顶部凸轮构件10255接合。钉仓钳口10410还具有由底部凸轮构件10256接合的纵向凸轮表面10419。凸轮构件10255和10256在钉击发行程期间将钳口10410和10420相对于彼此定位，并且在整个钉击发行程中将钳口10410和10420保持在其闭合构型。凸轮构件10255和10256还设定钉仓中的钉驱动器与限定在砧座钳口10420中的成形凹坑之间的钉成形间隙。
值得注意的是，图46和图47示出了处于其打开位置的砧座钳口10420和处于其非击发位置(即，钉击发行程已开始之前的位置)的组织切割构件10251。砧座钳口10420包括限定于其中的间隙凹坑10450，当组织切割构件10251处于其非击发位置时，该间隙凹坑与组织切割构件10251的顶部凸轮构件10255对准。当组织切割构件10251处于其非击发位置时，这种构造允许组织切割构件10251刚好停止在砧座钳口10420中的纵向凸轮表面10425和钉仓钳口10410中的对应凸轮表面的近侧。这种布置对于给定的钉线长度提供了更短且更可操纵的端部执行器。此外，组织切割构件10251包括组织切割刃10259，当组织切割构件处于其非击发位置时，该组织切割刃相对于限定在钉仓中的钉腔朝近侧定位并且相对于组织止挡件的远侧边缘朝近侧定位。因此，插入端部执行器中的组织不太可能被组织切割刃10259切割，直到组织切割构件10251在击发行程期间从其非击发位置朝远侧推进。
除上述之外，期望组织切割构件10251在钉击发行程开始时处于其非击发位置。如果组织切割构件10251在钉击发行程开始时未处于其非击发位置，则可能意外地绕过缝合器械10000的缺失的仓/用过的仓闭锁件。参考图41，缝合器械10000的闭锁件包括限定在钉仓钳口10410的底部中的肩部10417。如果在钉击发行程开始时适当的未用过的钉仓安置在钉仓钳口10410中，并且在钉击发行程开始时组织切割构件10251处于其非击发位置，则组织切割构件10251将被提升越过闭锁件肩部10417。更具体地，参考图46，组织切割构件10251的鼻部10258将由钉仓中的钉驱动滑动件支撑，使得击发构件10251的闭锁件突片10257和/或击发构件10251的任何其他部分不接触闭锁件肩部10417。然而，如果钉仓未被安置在钉仓钳口10410中，钉仓被安置在钉仓钳口10410中但先前已被用过，或者不正确的钉仓被安置在钉仓钳口10410中，滑动件将不支撑组织切割构件10251的鼻部10258，并且闭锁件突片10257将在钉击发行程开始时接触闭锁件肩部10417，从而防止钉击发行程。然而，如果组织切割构件10251在钉击发行程开始时以某种方式相对于闭锁件肩部10417朝远侧定位，则由外科器械10000的闭锁件提供的优点将丢失。
以下这些美国专利全文以引用方式并入本文：2006年12月5日公布的名称为“Surgical stapling instrument having a firing lockout for an unclosed anvil”的美国专利7143923；2006年5月16日公布的名称为“Surgical stapling instrumenthaving a single lockout mechanism for prevention of firing”的美国专利7044352；2006年2月21日公布的名称为“Surgical stapling instrument having separatedistinct closing and firing systems”的美国专利7000818；2006年1月24日公布的名称为“Surgical stapling instrument having a spent cartridge lockout”的美国专利6988649；以及2005年12月27日公布的名称为“Surgical stapling instrumentincorporating an E-beam firing mechanism”的美国专利6978921。
如上所述，参考图48，砧座钳口10420包括限定于其上的肩部或止挡件10455，该肩部或止挡件被构造成能够在砧座钳口10420运动到其打开位置时接触组织切割构件10251的顶部凸轮构件10255。在此类情况下，即使组织切割构件10251已经意外地朝远侧运动或定位地太远，砧座钳口10420也将组织切割构件10251定位在其非击发位置。在外科器械10000已经被使用至少一次并且钉击发系统已重置或回缩之后，这种布置尤其有用，因为在一些情况下，组织切割构件10251在最后的钉击发行程之后可能尚未完全返回到其非击发位置。由于上述原因，降低了意外绕过外科器械10000的闭锁件的可能性。值得注意的是，肩部10455和间隙凹坑10450相对于组织止挡件10427的远侧边缘定位在近侧，这确保了组织切割构件10251相对于捕获在端部执行器内的组织定位在近侧，使得组织不会意外地抵靠组织切割构件10251被切割。
如上所述，关节运动驱动器10260能够朝近侧和朝远侧平移，以使端部执行器10400围绕关节运动接头10500进行关节运动。也就是说，关节运动驱动器10260实际上是关节运动驱动系统的远侧关节运动驱动器。参考图72和图74至图76，关节运动驱动系统还包括运动远侧关节运动驱动器10260的可平移近侧关节运动驱动器10270。关节运动驱动系统还包括定位在近侧关节运动驱动器10270和远侧关节运动驱动器10260中间的关节运动锁10280，如下文更详细所述。近侧关节运动驱动器10270包括关节运动杆10272、从关节运动杆10272延伸的近侧推动突起部10274、以及从关节运动杆10272延伸的远侧牵拉突起部10276。当朝远侧推动近侧关节运动驱动器10270时，近侧推动突起部10274接触关节运动锁10280，解锁关节运动锁10280，并且朝远侧驱动远侧关节运动驱动器10260以使端部执行器10400进行关节运动。当近侧关节运动驱动器10270停止时，关节运动锁10280自动地将端部执行器10400重新锁定并保持就位。当朝近侧牵拉近侧关节运动驱动器10270时，远侧牵拉突起部10276接触关节运动锁10280，解锁关节运动锁10280，并且朝近侧牵拉远侧关节运动驱动器10260以使端部执行器10400进行关节运动。与上文相似，当近侧关节运动驱动器10270停止时，关节运动锁10280自动重新锁定。当关节运动锁10280被锁定时，防止端部执行器10400被反向驱动或无意地运动离开其位置。当关节运动锁10280解锁时，端部执行器10400可关节运动到新位置。
除上述之外，参考图72，在近侧关节运动驱动器10270的突起部10274和10276之间限定空间10275。远侧关节运动驱动器10260包括类似的布置。更具体地，远侧关节运动驱动器10260包括近侧突起部10269和远侧突起部10267，在近侧突起部和远侧突起部之间限定有空间。近侧关节运动驱动器10270的突起部10274和10276定位在限定于远侧关节运动驱动器10260的突起部10267和10269之间的该空间内并在该空间内运动。关节运动锁10280包括延伸穿过远侧关节运动驱动器10260的静止杆10282和可旋转且可滑动地安装到静止杆10282的锁定构件10284。锁定构件10284定位在两组锁定构件10284之间的弹簧10286偏置到锁定位置，这导致锁定构件10284咬合到静止杆10282中。然而，当近侧关节运动杆10270平移时，近侧关节运动杆10270推动锁定构件10284以使锁定构件旋转出其锁定位置，使得端部执行器10400可进行关节运动。
除上述之外，近侧关节运动驱动器10270的突起部10274和10276直接接触锁定构件10284。参考图74A，突起部10274和10276各自包括从其延伸的接合锁定构件10284的突起部或凸块10277。凸块10277为近侧关节运动驱动器10270提供较大推动区域以推动锁定构件10284。通过比较的方式，近侧关节运动驱动器10270'在图73和图73A中示出，该近侧关节运动驱动器在其突起部10274'和10276'上不具有凸块10277。图73和图73A的布置仍然是有用的，但是近侧关节运动驱动器10270’和锁定构件10284之间的接触面积小于近侧关节运动驱动器10270和锁定构件10284之间的接触面积。由于与锁定构件10284的较大接触面积，近侧关节运动驱动器10270中的应力和应变小于近侧关节运动驱动器10270'中的应力和应变。此外，凸块10277的布置可以增加近侧关节运动驱动器10270与锁定构件10284之间的扭矩臂，从而降低解锁关节运动锁10280所需的力。
本文描述了用于确定轴相对于柄部的取向的各种机构和方法。这些机构中的许多机构能够实时评估轴的取向，而不考虑轴的先前的一个或多个取向。这种布置例如在外科器械失去电力时特别有用。例如，当外科器械重新通电时，控制系统可以立即评估轴的取向和关节运动控制件的适当响应性。此外，本文所公开的外科器械可被构造成能够在外科器械被重新通电时立即评估端部执行器的关节运动角度。在重新通电时，控制系统将评估端部执行器是处于闭合构型还是处于打开构型。如果端部执行器在重新通电时处于闭合构型，则控制系统将确定外科器械在钉击发模式期间失去电力并提示临床医生回缩钉击发系统。如果端部执行器在重新充电时处于打开构型，或者一旦端部执行器在重新充电时处于打开位置，则控制系统将试图确保关节运动驱动系统联接到钉击发系统，使得端部执行器可被拉直，或者由临床医生以其他方式适当地定向，以从患者体内移除外科器械。图78描绘了用于控制系统以确保关节运动系统与钉击发驱动装置接合的算法39000。在该算法中，控制系统使钉击发驱动装置在与最右端部执行器位置和其最左端部执行器位置相关联的位置之间扫掠，使得如果关节运动驱动装置尚未联接到击发驱动装置，则其将变得联接到击发驱动装置。端部执行器的这些最右取向和最左取向对应于关节运动驱动器10260的最远侧位置和最近侧位置，如图77所示。这些位置也分别是关节运动驱动器10270的最远侧位置和最近侧位置。控制系统包括一个或多个非易失性装置存储器，所述一个或多个非易失性装置存储器用于存储关于关节运动驱动系统的最远侧(最右取向)位置和最近侧(最左取向)位置的信息。因此，该信息在重新通电时可用于控制系统，并且控制系统可将其评估限于该范围。在各种实施方案中，外科器械可包括传感器，该传感器被配置成能够评估关节运动驱动装置是否机械联接到钉击发驱动装置。
除上述之外，算法39000包括步骤39100，其中控制系统评估在外科器械的启动或初始化时是否按压关节运动按钮。如果在步骤39100处确定关节运动按钮未被按压，则算法遵循逻辑路径39200。在逻辑路径39200中，控制系统在步骤39300处致动驱动关节运动系统的电动马达，以朝远侧推动关节运动驱动器10260，从而使端部执行器向右进行关节运动。然后，控制系统在步骤39400处等待预先确定的时间量，之后进行到步骤39600，其中控制系统沿相反方向致动马达以朝近侧牵拉关节运动驱动器10260并且使端部执行器向左进行关节运动。然后，控制系统在步骤39700处再次等待预先确定的时间量，并且在该时间之后，在步骤39800处等待输入命令。在各种实施方案中，控制系统包括用于对适当的时间量进行计数的定时器电路。另一方面，如果在步骤39100处，控制系统检测到左关节运动控制件被致动，则算法39000遵循逻辑路径39500并且使端部执行器向左进行关节运动。如果在步骤39100处控制系统检测到右关节运动控制件被致动，则算法39000遵循使端部执行器向右进行关节运动的逻辑路径。
除上述之外，在钉击发行程期间，钉仓中的钉被击发构件逐渐射出。击发构件在钉击发行程开始时射出钉仓中的近侧钉并且在钉击发行程末端处射出远侧钉。在钉仓的所有钉适当地接触与钉仓相对定位的砧座中的钉成形凹坑的情况下，钉将适当地成形并且钉击发力将较低。在钉中的一些钉错过其钉成形凹坑的情况下，此类钉可变形，从而增加执行钉击发行程所需的力。减慢钉击发行程可改善钉成形并降低执行钉击发行程所需的力。在各种情况下，检测由钉击发系统施加的力可例如通过一个或多个力传感器和/或应变仪直接检测。在其他情况下，检测力可通过例如电流传感器或安培计电路来实现，该电流传感器或安培计电路测量到钉击发驱动装置的电动马达的电流。2019年3月22日提交的名称为“SURGICAL INSTRUMENT COMPRISING AN ADAPTIVE CONTROL SYSTEM”的美国专利申请序列号16/361,793的全部公开内容以引用方式并入本文。这些方法可适用于各种情况，但下文描述的是在钉击发行程期间评估钉击发系统的占空比的实施方案和方法。
除上述之外，外科器械10000的控制系统包括脉宽调制(PWM)控制电路，该脉宽调制控制电路被配置成能够控制击发驱动装置电动马达的速度。PWM控制电路向击发驱动装置电动马达施加电压脉冲以执行钉击发行程。在各种情况下，PWM控制电路增大其向击发驱动装置电动马达施加的电压脉冲的持续时间，以便提高击发驱动装置电动马达的速度并且对应地提高钉击发行程的速度。在其他情况下，PWM控制电路增大其向击发驱动装置电动马达施加的电压脉冲的持续时间，以便降低击发驱动装置电动马达的速度并且对应地提高钉击发行程的速度。在任一种情况下，PWM控制电路可进行这些脉冲长度调节，而基本上不增大或减小施加到马达的电压脉冲的量值。也就是说，设想了其中可改变电压脉冲或某些电压脉冲的量值的实施方案。在任何情况下，如下文更详细所述，控制系统被配置成能够通过经由PWM电路调节脉冲的持续时间来以恒定或接近恒定的速度驱动钉击发驱动装置。2013年8月6日公布的名称为“DEVICE AND METHOD FOR CONTROLLING COMPRESSION OF TISSUE”的美国专利8,499,992的全部公开内容以引用方式并入本文。
PWM电路将电压施加到电动马达的时间(接通时间)除以总时间(接通时间+关断时间)的比率为钉击发驱动马达的占空比。因此，占空比可在0％(完全关断)和100％(完全接通)即没有周期性中断的恒定电压之间的范围内。术语接通和关断表示非零电压和零电压；然而，术语接通和关断分别包括高电压和低电压。术语低或关断包括零电压和量值小于高电压或接通电压的非零电压。鉴于上述情况，表达击发驱动装置电动马达的占空比的另一种方式是PWM电路将电压施加到电动马达的时间(高时间)除以总时间(高时间+低时间)的比率。
PWM控制电路以规则的间隔向击发驱动装置电动马达施加电压脉冲；然而，控制系统可包括频率调制(FM)控制电路以改变电压脉冲间隔的频率。在各种情况下，FM控制电路减小电压脉冲之间的间隔以提高击发驱动装置电动马达和钉击发行程的速度。对应地，FM控制电路增大电压脉冲之间的间隔以降低击发驱动装置电动马达和钉击发行程的速度。除了或代替上文所述，控制系统可增大其向击发驱动装置电动马达施加的电压的量值以增大击发驱动装置电动马达和钉击发行程的速度，并且/或者减小其向击发驱动装置电动马达施加的电压的量值以减小击发驱动装置电动马达和钉击发行程的速度。
外科器械10000的控制系统包括用于控制钉击发构件的速度的算法。参考图79，控制系统包括被配置成能够以低速、中速和高速驱动钉击发构件的算法50000。低速为6mm/s，或大约6mm/s。中速为12mm/s，或大约12mm/s。高速为20mm/s，或大约20mm/s。也就是说，控制系统可被配置成能够以任何合适数量的速度和/或以任何合适的速度操作钉击发驱动装置。控制系统被配置成能够经由马达速度传感器监测钉击发驱动装置的速度，并且调节施加到钉击发驱动装置的电动马达的电压脉冲的长度以使钉击发驱动装置的速度达到目标速度。例如，如果钉击发行程中的给定点处的钉击发驱动装置的目标速度为12mm/s并且实际速度为11mm/s，则控制系统增加其施加到电动马达的电压脉冲的长度以增加钉击发驱动装置的速度。换句话讲，控制系统增加击发驱动装置电动马达的占空比以增加钉击发驱动装置的速度。对应地，控制系统被配置成能够如果钉击发驱动装置的速度超过目标速度则缩短其施加到击发驱动装置电动马达的电压脉冲的长度，直到钉击发驱动装置的速度达到目标速度。换句话讲，控制系统被配置成能够降低击发驱动装置电动马达的占空比以降低钉击发驱动装置的速度。值得注意的是，钉击发驱动装置的目标速度可在钉击发行程期间改变，如下文更详细所述。
如上所述，钉击发驱动装置的击发构件在钉击发行程期间朝远侧运动。参考图47和图79，击发构件从其近侧非击发位置朝远侧推进，以使击发构件的顶部凸轮构件10255沿限定于砧座10420中的内部狭槽10425的斜坡向上运动。近侧非击发位置与内部狭槽斜坡的远侧端部之间的距离为例如15mm或大约15mm。如果适当的未用过的钉仓被安置在端部执行器中，则击发构件的这种初始15mm运动可用于闭合端部执行器和/或越过上述击发闭锁件。也就是说，在该运动范围期间，控制系统以12mm/s的中速朝远侧运动击发构件，并且评估以该速度驱动钉击发构件所需的占空比。如果占空比在该初始范围内介于40％和60％之间，则控制系统继续以12mm/s的中速驱动钉击发驱动装置。如果占空比大于60％，则控制系统将钉击发驱动装置的目标速度降低到6mm/s的低速。当砧座10420与钉仓10430之间存在厚组织时，可出现此类情况。另一方面，如果占空比在该初始范围期间低于40％，则控制系统将目标速度增加至20mm/s的高速。当砧座10420与钉仓10430之间存在薄组织时，可出现此类情况。在图79中，该初始范围的端部由点A界定，并且值得注意的是，钉在该初始范围期间未被部署或击发。在点A之后，随着击发构件朝远侧推进，击发构件击发钉，直到击发构件到达钉击发行程的末端，以及/或者临床医生通过释放击触发器停止钉击发行程。
参考图79中的算法50000，可以看出，对于前15mm，钉击发构件以中速12mm/s被驱动，并且对于钉击发行程的其余部分，钉击发构件以高速20mm/s被驱动。如上所述，这种速度偏移的发生是因为控制系统在钉击发行程的前15mm期间测量到占空比低于40％。然而，如果击发构件在前15mm内被闭锁件阻挡，则占空比将立即突然升高到100％，并且控制系统被配置成能够响应于这种渐近占空比突然升高而立即停止钉击发行程。一旦击发构件已通过该初始15mm距离，在各种情况下，钉击发行程的其余部分包括例如大约30mm、大约45mm或大约60mm。这些长度表示当前在许多钉仓中所期望的不同钉图案长度，但可使用任何合适的钉图案长度。在一些实施方案中，在击发驱动装置占空比的初始评估之后，控制系统不重新评估钉击发驱动装置的占空比来调节击发构件的目标速度。然而，图79的实施方案的控制系统在整个钉击发行程中继续评估钉击发驱动装置的占空比。在钉击发行程中的点C处，控制系统根据上述标准对目标速度进行另一调节或保持目标速度。如图79所示，钉击发驱动装置的占空比在点C处被确定为在40％和60％之间，并且因此控制系统保持20mm/s的目标速度。点C位于点A和钉击发行程末端之间的一半，即钉图案的一半。也就是说，点C可以在任何合适的位置处。此外，控制系统可被配置成能够在钉击发行程期间的任何合适数量的点处调节钉击发驱动装置的目标速度。在至少一种情况下，控制系统可以例如在钉击发行程期间每隔15mm进行一次目标速度调节。对于30mm钉仓，控制系统可进行总共两次目标速度调节，如图79所示。例如，对于45mm钉仓，控制系统可以15mm的间隔进行总共三次目标速度调节，并且对于60mm钉仓，控制系统可以15mm的间隔进行总共四次目标速度调节。
对于上面给出的示例，控制系统使用同一组标准来评估每个目标速度调节点处的占空比。也就是说，参考图80，设想了其中控制系统在不同的目标速度调节点处使用不同组占空比标准的实施方案。例如，控制系统可在第一目标速度调节点处使用第一组占空比标准，并且在第二目标速度调节点处使用第二组占空比标准。在至少一种情况下，参考图80中的算法51000，如果占空比在第一目标速度调节点处低于45％，则控制系统增加钉击发驱动装置的目标速度。也就是说，如果占空比低于40％，则控制系统在第二目标速度调节点处增加钉击发驱动装置的目标速度。可以使用任何合适的一个或多个阈值。在图80所示的实施方案中，60％的上占空比阈值在算法51000中的第一目标速度调节点和第二目标速度调节点两者处相同。如果占空比超过60％，则控制系统缩短电压脉冲以减慢钉击发系统。在其他实施方案中，上占空比阈值在第一目标速度调节点和第二目标速度调节点处可以是不同的。
除上述之外，参考图81，控制系统的算法在点A处将目标速度从中速增加至高速，但随后在点C处将目标速度从高速降低至中速。在点C处，控制系统确定击发驱动装置电动马达的占空比高于60％并且将目标速度降低一个水平，即从高速降低到中速。值得注意的是，控制系统在点C处没有将目标速度从高速降低到低速，因为控制系统被配置成能够在每个检查点处仅将目标速度升高或降低一个水平。为了使钉击发驱动装置的目标速度从高速降低到低速，占空比将必须在两个检查点处超过上占空比阈值。这些检查点可以是连续检查点或非连续检查点。也就是说，设想了其中控制系统包括安全占空比阈值的实施方案，如果超过该安全占空比阈值，将导致控制系统将钉击发驱动装置的目标速度降低至低速，而不管在该检查点之前钉击发驱动装置的速度如何。
图82A描绘了两个曲线图：钉击发驱动装置的占空比曲线图(i)和击发力曲线图(ii)。占空比曲线图(i)和击发力曲线图(ii)相关联以展示三个不同的钉击发行程。由于击发力较低，图82A中的钉击发行程中的两个钉击发行程保持在40％占空比阈值以下。在此类钉击发行程中，控制系统根据当前算法在每个检查点处增加钉击发系统的目标速度，但其他算法也是可能的。图82A中的钉击发行程中的一个钉击发行程达到100％占空比，因为击发力较高。当占空比在目标速度调节点处超过60％时，控制系统根据当前算法降低钉击发系统的目标速度，但其他算法也是可能的。值得注意的是，该钉击发的占空比在钉击发行程开始时不高于60％阈值，并且因此如果占空比直到一个或多个检查点之后才超过60％的上阈值，则控制系统实际上可能不会降低目标速度。
图82B描绘了两个曲线图：钉击发驱动装置的占空比曲线图(i)和击发力曲线图(ii)。占空比曲线图(i)和击发力曲线图(ii)相关联以展示三个不同的钉击发行程。图82B中的钉击发行程中的两个钉击发行程保持在40％占空比阈值和60％占空比阈值之间，因为击发力相对较低。在此类钉击发行程中，控制系统根据当前算法不改变钉击发系统的目标速度，但其他算法也是可能的。然而，图82B中的钉击发行程中的一个钉击发行程达到100％占空比，因为击发力较高。当占空比在目标速度调节点处超过60％时，控制系统根据当前算法降低钉击发系统的目标速度，但其他算法也是可能的。在这种情况下，在钉击发构件的近侧非击发起始位置远侧约20mm处，占空比超过上占空比阈值。换句话讲，一旦钉击发驱动装置开始击发钉，即在超过上述15mm初始范围5mm处，占空比跳跃到60％以上。因此，控制系统可能不会对升高的占空比作出反应，直到例如30mm检查点之后。
值得注意的是，除上述之外，图82A和图82B的曲线图以及若干其他曲线图描绘了沿着钉击发行程的点流。这些点表示由控制系统获取的数据样本。点的接近度表示相当高的数据采样速率，但可使用更低或更高的数据采样率。如在这些图中可见，数据经受一定量的抖动或颤动，这可导致控制系统对异常数据作出反应，尤其是当占空比数据接近上占空比阈值或下占空比阈值时。在各种情况下，控制系统可利用数据平滑算法，该数据平滑算法使用多个收集的数据点上的数据的平均值和/或其他统计评估来确定目标速度评估点处的占空比。在至少一个此类情况中，控制系统使用三个连续占空比测量结果的平均值，例如，以确定用于评估算法标准的占空比值。
图83A描绘了三个曲线图：钉击发驱动装置的占空比曲线图(i)、击发力曲线图(ii)和击发速度曲线图(iii)。占空比曲线图(i)、击发力曲线图(ii)和击发速度曲线图(iii)相互关联以展示钉击发行程。钉击发行程的占空比在约30mm标记处从40％的下占空比阈值以下跳跃到60％的上占空比阈值以上，这在约15mm处使钉变形。占空比的这种跳跃不是因为击发力增大；相反，占空比的跳跃发生是因为控制系统根据其目标速度选择标准增加占空比以增加钉击发驱动装置的速度。图83B描绘了占空比在约20mm处的类似跳跃；然而，占空比出现这种跳跃是因为钉击发构件在使钉变形时遇到升高的电阻，并且控制系统通过增加其施加到电动马达的电压脉冲的长度来进行响应，以便将钉击发速度保持在其目标速度。换句话讲，控制系统使占空比突然增加，因为控制系统正在努力保持钉击发系统的中速，即12mm/s。这种情况未持续很长时间，因为控制系统在30mm目标速度检查点重新降低占空比，同时将钉击发行程的速度降低到其低目标速度，即6mm/s。
图84A和图84B描绘了展示用于缝合和切割实际组织的钉击发驱动装置的击发力跟踪用于缝合和切割组织类似物诸如泡沫的击发力的曲线图。
图85A和图85B描绘了在缝合和切割胃组织时发生的若干钉击发行程示例。钉击发行程遵循非常类似的占空比图案。例如，所有钉击发行程都在下占空比阈值以下开始，并且作为响应，控制系统将钉击发行程的速度从中速增加到高速。为此，控制系统增加在第一检查点处施加至钉驱动系统的电动马达的电压脉冲的持续时间。然而，在这样做时，占空比跳跃到上占空比阈值，并且在下一个检查点处，控制系统缩短电压脉冲以降低占空比并将钉击发行程减慢回到其中速。值得注意的是，在一个示例中，钉击发驱动装置的速度保持在高速。在该示例中，与在其他钉击发行程期间使用的钉相比，变形的钉更小，并且占空比保持在阈值以下。
图86A描绘了在缝合薄空肠组织时的两个钉击发行程的占空比，其中一个钉击发行程在端部执行器进行关节运动时发生，并且另一个钉击发行程在端部执行器未进行关节运动时发生。如在图86A中可以看出，两条占空比曲线非常相似，并且显著地介于约60％的占空比和约80％的占空比之间。图86B描绘了在缝合厚空肠组织时的两个钉击发行程的占空比，其中一个钉击发行程在端部执行器进行关节运动时发生，并且另一个钉击发行程在端部执行器未进行关节运动时发生。如在图86B中可以看出，两条占空比曲线非常相似，并且显著地介于约60％的占空比和约80％的占空比之间。另外，值得注意的是，与薄空肠组织(图86A)相比，厚空肠组织(图86B)的占空比略高。图86C描绘了在缝合胃组织时的两个钉击发行程的占空比，其中一个钉击发行程在端部执行器进行关节运动时发生，并且另一个钉击发行程在端部执行器未进行关节运动时发生。如在图86C中可以看出，两条占空比曲线非常相似，并且值得注意的是，一旦钉击发驱动装置在距击发构件的近侧非击发位置约15mm处开始使钉变形，即达到最大占空比。
图87包括描绘钉击发行程的占空比的曲线图63000。如曲线图63000所示，对于钉击发行程的前30mm(初始行进15mm和钉击发15mm)，占空比刚好处于或刚好低于40％，然后由控制系统升高该占空比以增加钉击发驱动装置的速度。与上文相似，在这种情况下增加占空比使占空比超过60％的顶部占空比阈值，其中该占空比对于钉击发行程的其余部分(即最后30mm)保持不变。
图88包括描绘钉击发行程的占空比的曲线图64000。如曲线图64000所示，占空比开始于40％占空比阈值以下，但随后逐渐增加到上占空比阈值和下占空比阈值之间的区域中。在此类区域中，除了将钉击发系统的速度保持在中间目标速度之外，控制系统不增加或减小钉击发系统的速度和/或以其他方式调节击发驱动装置电动马达的占空比。因此，观察到平滑的占空比曲线而没有突然变化。
图89包括描绘钉击发行程的占空比的曲线图65000。如曲线图65000所示，占空比在约40％的低占空比阈值处开始，然后一旦击发构件在15mm点处开始使钉变形，则占空比快速向上前进。事实上，占空比增加到几乎100％，直到在30mm处达到下一个检查点，其中如上所述，控制系统降低占空比以减慢钉击发驱动装置。图89描绘了此时占空比的急剧下降，但对于钉击发行程的剩余部分返回到刚好高于上占空比阈值的升高状态。
低占空比阈值在许多情况下被描述为40％，而在其他情况下被描述为45％。也就是说，低占空比阈值可以是任何合适的值，诸如30％、33％、35％或50％。相似地，上占空比阈值被描述为60％。也就是说，上占空比阈值可以是任何合适的值，诸如50％、55％、65％、67％、70％或75％。
如上所述，当临床医生释放击发触发器时，钉击发行程停止。当临床医生再次致动击发触发器时，钉击发行程恢复。在此类情况下，控制系统将钉击发行程的速度返回到恰好在钉击发行程停止之前的速度。控制系统包括一个或多个存储器装置，所述一个或多个存储器装置用于存储在钉击发行程期间钉击发行程的速度，使得控制系统可访问存储速度以重新开始钉击发行程。如果控制系统不能访问该数据，则控制系统可例如以其中速重新开始钉击发行程。
如本文所述，外科器械10000被构造成能够评估钉击发行程的速度并将钉击发行程的测量速度与目标速度进行比较。外科器械10000包括与控制系统连通的编码器，该编码器被配置成能够测量钉击发行程的速度。在至少一种情况下，编码器观察钉击发驱动装置中的齿轮以评估钉击发行程的速度。齿轮包括齿，当齿轮在钉击发行程期间旋转时，齿在编码器前方通过。控制系统使用齿通过编码器的速率来评估钉击发驱动装置的速度。在至少一种情况下，齿轮在整个钉击发行程期间进行一次完整旋转。除了或代替上文所述，齿轮由金属构成，并且控制系统包括霍尔效应传感器，该霍尔效应传感器被配置成能够感测金属齿轮齿经过霍尔效应传感器的速率。在各种实施方案中，控制系统被配置成能够评估钉击发驱动装置的平移部件的速度。
如本文所述，控制系统的算法使用击发驱动装置电动马达的占空比来评估钉击发驱动装置的速度是否应被调整，以及沿哪个方向调整，即更慢还是更快。除了击发驱动装置电动马达的占空比之外，各种其他算法还使用数据来调整钉击发行程的速度。例如，速度调整算法可利用例如端部执行器的关节运动角度、初始电池电压、可操作的电池电压、通过马达的电流、PID误差、和/或在外科器械的制造过程期间产生的PWM电路的任何表征。除了别的以外，这些参数可用于数学运算或评估公式，以确定是否调整钉击发行程的速度、调整速度的方向和/或调整的量。所使用的参数可以是瞬时测量结果和/或在若干读数上平均的测量结果。所使用的参数可包括测量结果的变化率或斜率的变化。参数的值可根据评估公式相加、相减、相乘和/或相除。
图68至图71描绘了包括砧座钳口40420和钉仓钳口10410的端部执行器40000。砧座钳口40420包括近侧部分40100和附接到近侧部分40100的远侧部分或末端40200。远侧部分40200能够在第一操作取向(图68)和第二操作取向(图70和图71)之间旋转，以使临床医生能够在使用端部执行器40000之前在直的砧座末端和成角度的砧座末端之间进行选择。
近侧部分40100包括成角度的远侧端部，该成角度的远侧端部可由第一角度40120和第二角度40130表征。第一角度40120参考由近侧部分40100的顶部限定的顶部平面来测量，而第二角度40130参考由近侧部分40100的底部限定的底部平面来测量。在各种情况下，第一角度40120和第二角度40130是互补角度。在至少一种情况下，第一角度40120和第二角度40130基本上是互补的。远侧部分40200包括附接到近侧部分40100的远侧端部的成角度的近侧端部。远侧部分40200的成角度的近侧端部可通过第一角度40220和第二角度40230来表征。在各种情况下，第一角度40220和第二角度40230是互补角度。在至少一种情况下，第一角度40220和第二角度40230基本上是互补的。在各种情况下，第一角度40120和第一角度40220为互补角度，并且第二角度40130和第二角度40230为互补角度。该构型允许砧座钳口40420的近侧部分40100和远侧部分40200具有互补的成角度的附接平面，其中近侧部分40100的远侧面40110和远侧部分40200的近侧面40210沿第一取向和第二取向两者彼此邻接。
利用附接机构，参考图69和图69A，远侧部分40200能够相对于近侧部分40100旋转，使得远侧部分40200可旋转成不同取向。为了将远侧部分40200运动到图70所示的第二取向，远侧部分40200从图68所示的第一取向旋转180度。该构型允许用户在直末端砧座钳口和成角度末端砧座钳口之间改变砧座钳口40420。在图70和图71所示的第二取向上，第一角度40120和第二角度40230彼此邻接，并且对应地，第一角度40220和第二角度40130彼此邻接。在第二取向上的附接接合部处的角度(图70)不像在第一取向上的角度(图68)那样是补充的。
所使用的附接机构可以是任何合适的附接机构。在至少一种情况下，参考图69A，附接机构包括锚固到近侧部分40100和远侧部分40200的柔性可旋转销40300。这种机构允许可旋转部分在不同取向之间旋转，同时保持近侧部分40100和远侧部分40200彼此附接。一个或多个弹簧构件和/或止动器可与销结合使用，以将该部分保持在第一操作取向或第二操作取向。附接机构可嵌入近侧部分40100和/或远侧部分40200中。附接机构可包括双稳态顺应性机构，该双稳态顺应性机构被构造成能够将部分40200偏置成任一取向以防止可旋转远侧部分40200的意外部分旋转。附接机构可包括弹簧加载止动器、活动铰链、滑动构件和/或各种其他锁定构件。附接机构还可包括近侧部分40100与远侧部分40200之间的干涉配合接合部和/或摩擦配合接合部。
除上述之外，并且再次参考图69A，柔性销40300包括安装在限定于近侧砧座部分40100中的腔室中的球形第一端部40310、安装在限定于远侧砧座部分40200中的腔室中的球形第二端部40320、以及连接第一端部40310和第二端部40320的柔性连接器40330。球形第一端部40310和球形第二端部40320可在其相应的腔室内旋转，使得柔性销40300可相对于近侧部分40100旋转和/或使得远侧部分40200可相对于柔性销40300旋转。在任一种情况下，这种相对旋转允许如上所述的远侧部分40200的旋转。柔性连接器40330的长度被选择为使得柔性连接器40300对于远侧部分40200的每个取向处于弹性拉伸状态。因此，柔性连接器40330用于抵靠第一砧座部分40100牵拉远侧部分40200。鉴于近侧部分40100包括钉成形凹坑并且远侧部分40200不包括钉成形凹坑，由销40300提供的保持力不需要承受钉成形力并且足以在端部执行器40000定位在患者体内时将远侧部分40200保持在适当位置。销可被弹簧加载在插座中，使得弹簧在腔室中朝近侧牵拉头部，从而将近侧部分40100和远侧部分40200保持在一起。为了使远侧部分40200在各取向之间旋转，可将远侧部分40200朝远侧牵拉以克服偏置力，扭转到另一个取向，以及释放使得弹簧可抵靠近侧部分40100牵拉远侧部分40200。远侧部分40200与近侧部分之间的接合部还可包括从其延伸的联锁特征部以防止相对于彼此的无意运动。例如，当远侧部分40200处于其第一取向和第二取向时，但不是当远侧部分40200被牵拉离开近侧部分40100时，齿可从一个部分延伸并延伸到限定在另一部分中的对应狭槽中。
在至少一种情况下，远侧部分40200包括例如组装在附接机构周围的两个半部。例如，这两个半部可利用弹性体来围绕销将半部保持在一起。在至少一种情况下，卡扣配合机构可用于围绕附接机构将两个半部组装在一起。
在各种情况下，近侧部分40100和远侧部分40200由一种或多种材料构成。例如，近侧部分40100可由一种或多种材料构成，并且远侧部分40200可由一种或多种材料构成。在至少一种情况下，远侧部分40200由朝向附接接合部的金属构成，并且由从金属部分朝远侧延伸的包覆模制的软末端构成。软末端可由例如橡胶和/或塑料构成。砧座钳口40410还可包括定位在近侧部分40100和远侧部分40200之间的中间部件。中间部件可容纳附接机构的一个或多个部分。中间部件还可在近侧部分40100和远侧部分40200之间提供美观和/或功能性过渡件，该过渡件可用于近侧部分40100和远侧部分40200包含多于一种材料的情形。
在至少一种情况下，第一部分40100和第二部分40200包括被设计成消除由第二部分40200相对于第一部分40100的旋转所呈现的任何锋利边缘的边缘。
如上所述，本文公开的外科器械可包括控制系统。控制系统中的每一者可以包括具有一个或多个处理器和/或存储装置的电路板。除此之外，控制系统被配置成能够存储例如传感器数据。它们还被配置成能够存储数据，该数据识别附接到例如缝合器械的钉仓的类型。更具体地讲，当钉仓附接到缝合器械时，可以通过传感器识别钉仓的类型，并且传感器数据可以储存在控制系统中。控制系统可获得该信息以评估钉仓是否适合使用。
本文所述的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。例如，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)更详细地公开了机器人外科器械系统的若干示例，该公开内容全文以引用方式并入本文。2017年5月18日公布的名称为“STAPLER WITH COMPOSITE CARDAN AND SCREW DRIVE”的国际专利公布WO 2017/083125；2017年5月18日公布的名称为“STAPLE PUSHER WITH LOSTMOTION BETWEEN RAMPS”的国际专利公布WO 2017/083126；2015年10月8日公布的名称为“SURGICAL INSTRUMENT WITH SHIFTABLE TRANSMISSION”的国际专利公布2015/153642；2017年3月17日提交的名称为“STAPLER WITH CABLE-DRIVEN ADVANCEABLE CLAMPINGELEMENT AND DUAL DISTAL PULLEYS”的美国专利申请公布2017/0265954；2017年2月15日提交的名称为“STAPLER WITH CABLE-DRIVEN ADVANCEABLE CLAMPING ELEMENT ANDDISTAL PULLEY”的美国专利申请公布2017/0265865；以及2017年3月29日提交的名称为“STAPLING CARTRIDGE”的美国专利申请公布2017/0290586的公开内容全文以引用方式并入本文。
已结合钉的部署和变形描述了本文所述的外科器械系统；然而，本文所述的实施方案不限于此。例如，设想了部署除钉之外的紧固件诸如夹具或大头钉的各种实施方案。此外，还设想了利用用于密封组织的任何合适装置的各种实施方案。例如，根据各种实施方案的端部执行器可包括被配置成能够加热和密封组织的电极。另外，例如，根据某些实施方案的端部执行器可施加振动能量来密封组织。
下述专利的全部公开内容据此以引用方式并入本文：
-公布于1995年4月4日的名称为“ELECTROSURGICAL HEMOSTATIC DEVICE”的美国专利5,403,312；
-公布于2006年2月21日的名称为“SURGICAL STAPLING INSTRUMENT HAVINGSEPARATE DISTINCT CLOSING AND FIRING SYSTEMS”的美国专利7,000,818；
-公布于2008年9月9日的名称为“MOTOR-DRIVEN SURGICAL CUTTING ANDFASTENING INSTRUMENT WITH TACTILE POSITION FEEDBACK”的美国专利7,422,139；
-公布于2008年12月16日的名称为“ELECTRO-MECHANICAL SURGICAL INSTRUMENTWITH CLOSURE SYSTEM AND ANVIL ALIGNMENT COMPONENTS”的美国专利7,464,849；
-公布于2010年3月2日的名称为“SURGICAL INSTRUMENT HAVING ANARTICULATING END EFFECTOR”的美国专利7,670,334；
-公布于2010年7月13日的名称为“SURGICAL STAPLING INSTRUMENTS”的美国专利7,753,245；
-公布于2013年3月12日的名称为“SELECTIVELY ORIENTABLE IMPLANTABLEFASTENER CARTRIDGE”的美国专利8,393,514；
-名称为“SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES”的美国专利申请序列号11/343,803，现为美国专利7,845,537；
-提交于2008年2月14日的名称为“SURGICAL CUTTING AND FASTENINGINSTRUMENT HAVING RF ELECTRODES”的美国专利申请序列号12/031,573；
-提交于2008年2月15日的名称为“END EFFECTORS FOR A SURGICAL CUTTING ANDSTAPLING INSTRUMENT”的美国专利申请序列号12/031,873(现为美国专利7,980,443)；
-名称为“MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT”的美国专利申请序列号12/235,782，现为美国专利8,210,411；
-名称为“MOTORIZED SURGICAL INSTRUMENT”的美国专利申请序列号12/235972，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、结构或特性可以任何合适的方式进行组合。因此，在无限制的情况下，结合一个实施方案示出或描述的具体特征、结构或特性可全部或部分地与一个或多个其他实施方案的特征、结构或特性组合。另外，在公开了用于某些部件的材料的情况下，也可使用其他材料。此外，根据多种实施方案，单个部件可被替换为多个部件，并且多个部件也可被替换为单个部件，以执行给定的一种或多种功能。上述具体实施方式和下述权利要求旨在涵盖所有此类修改和变型。
本文所公开的装置可被设计成在单次使用之后废弃，或者其可被设计成多次使用。然而无论是哪种情况，该装置都可在至少使用一次后经过修整再行使用。修整可包括以下步骤的任意组合，这些步骤包括但不限于拆卸装置、之后进行装置具体部件的清洁或更换、以及随后重新组装装置。具体地，修整设施和/或外科团队可拆卸装置，并且在清洁和/或更换装置的特定部件之后，可重新组装装置以供后续使用。本领域的技术人员将会理解，修整装置可利用各种技术来进行拆卸、清洁/替换和重新组装。此类技术的使用以及所得的修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 (21)
1.一种外科缝合器械，包括：
外壳；
轴，所述轴从所述外壳朝远侧延伸；
端部执行器，所述端部执行器从所述轴朝远侧延伸，所述端部执行器包括：
第一钳口，所述第一钳口具有钉仓，所述钉仓包括可移除地储存在其中的钉，其中所述钉仓包括近侧端部和远侧端部，并且其中所述钉可移除地储存在钉腔中，所述钉腔布置在所述近侧端部和所述远侧端部之间的纵向排中；以及
第二钳口，所述第二钳口能够相对于所述第一钳口在打开位置和闭合位置之间运动，其中所述第二钳口包括：
近侧部分，所述近侧部分包括：
枢轴，所述枢轴联接到所述第一钳口；以及
钉成形凹坑的纵向排，该钉成形凹坑的纵向排被构造成能够在所述钉从所述钉仓射出时使所述钉变形；以及
远侧末端，所述远侧末端可旋转地联接到所述近侧部分；以及
连接器，所述连接器包括：
近侧端部，所述近侧端部被捕获在限定于所述近侧部分中的近侧凹陷部中；
远侧端部，所述远侧端部被捕获在限定于所述远侧末端中的远侧凹陷部中；以及
弹性部分，所述弹性部分在所述近侧端部和所述远侧端部之间延伸，其中所述弹性部分被构造成能够抵靠所述近侧部分保持所述远侧末端。
2.根据权利要求1所述的外科缝合器械，其中，所述远侧末端能够相对于所述近侧部分在第一取向和第二取向之间旋转。
3.根据权利要求2所述的外科缝合器械，其中，所述第一取向和所述第二取向彼此间隔180度。
4.根据权利要求2所述的外科缝合器械，其中，所述近侧部分限定纵向轴线，其中所述远侧末端限定末端轴线，其中当所述远侧末端处于所述第一取向时，所述末端轴线与所述纵向轴线对准，并且其中当所述远侧末端处于所述第二取向时，所述末端轴线不与所述纵向轴线对准。
5.根据权利要求4所述的外科缝合器械，其中，当所述远侧末端处于所述第二取向时，所述末端轴线横向于所述纵向轴线。
6.根据权利要求2所述的外科缝合器械，其中，所述近侧部分包括顶部表面和底部表面，其中所述钉成形凹坑被限定在所述底部表面中，其中所述远侧末端包括第一表面和第二表面，其中当所述远侧末端处于所述第一取向时，所述远侧末端的所述第一表面与所述近侧部分的所述顶部表面对准，并且其中当所述远侧末端处于所述第二取向时，所述远侧末端的所述第一表面不与所述近侧部分的所述顶部表面对准。
7.根据权利要求2所述的外科缝合器械，其中，当所述远侧末端处于所述第二取向并且所述第二钳口处于所述闭合位置时，所述远侧末端指向所述钉仓。
8.根据权利要求7所述的外科缝合器械，其中，当所述远侧末端处于所述第一取向并且所述第二钳口处于所述闭合位置时，所述远侧末端未指向所述钉仓。
9.根据权利要求2所述的外科缝合器械，其中，所述远侧末端在所述第二取向中处于勺构型，并且被构造成能够便于将所述第二钳口插入组织后面。
10.根据权利要求2所述的外科缝合器械，其中，所述远侧末端在所述第二取向中处于勺构型，并且被构造成能够便于将所述第二钳口沿着限定在患者体内的体腔的侧面插入。
11.根据权利要求2所述的外科缝合器械，其中，所述近侧部分包括第一成角度表面，其中所述远侧末端包括第二成角度表面，并且其中当所述远侧末端处于所述第一取向时，所述第一成角度表面和所述第二成角度表面互补。
12.根据权利要求2所述的外科缝合器械，还包括偏置构件，所述偏置构件被构造成能够将所述远侧末端定位在所述第一取向或所述第二取向，但不定位在其他取向。
13.根据权利要求1所述的外科缝合器械，还包括将所述远侧末端连接到所述近侧部分的可旋转连接器。
14.根据权利要求1所述的外科缝合器械，其中，当所述远侧末端相对于所述近侧部分处于任何取向时，所述弹性部分处于拉伸状态。
15.一种外科器械，包括：
外壳；
轴，所述轴从所述外壳朝远侧延伸；以及
端部执行器，所述端部执行器从所述轴朝远侧延伸，所述端部执行器包括：
第一钳口；以及
第二钳口，所述第二钳口能够相对于所述第一钳口在打开位置和闭合位置之间运动，其中所述第二钳口包括：
近侧部分，所述近侧部分具有联接到所述第一钳口的枢轴；
远侧末端，所述远侧末端可旋转地联接到所述近侧部分；以及
连接器，所述连接器包括：
近侧端部，所述近侧端部被捕获在限定于所述近侧部分中的近侧凹陷部中；
远侧端部，所述远侧端部被捕获在限定于所述远侧末端中的远侧凹陷部中；以及
弹性部分，所述弹性部分在所述近侧端部和所述远侧端部之间延伸，其中所述弹性部分被构造成能够抵靠所述近侧部分保持所述远侧末端。
16.根据权利要求15所述的外科器械，其中，所述远侧末端能够相对于所述近侧部分在第一取向和第二取向之间旋转。
17.根据权利要求16所述的外科器械，其中，所述第一取向和所述第二取向彼此间隔180度。
18.根据权利要求15所述的外科器械，其中，所述远侧末端在所述第二取向中处于勺构型，并且被构造成能够便于将所述第二钳口插入组织后面。
19.根据权利要求15所述的外科器械，还包括将所述远侧末端连接到所述近侧部分的可旋转连接器。
20.根据权利要求15所述的外科器械，其中，当所述远侧末端相对于所述近侧部分处于任何取向时，所述弹性部分处于拉伸状态。
21.一种外科器械，包括：
外壳；
轴，所述轴从所述外壳朝远侧延伸；以及
端部执行器，所述端部执行器从所述轴朝远侧延伸，所述端部执行器包括：
第一钳口；以及
第二钳口，所述第二钳口能够相对于所述第一钳口在打开位置和闭合位置之间运动，其中所述第一钳口包括：
近侧部分，所述近侧部分具有联接到所述第二钳口的枢轴；
远侧末端，所述远侧末端可旋转地联接到所述近侧部分；以及
连接器，所述连接器包括：
近侧端部，所述近侧端部被捕获在限定于所述近侧部分中的近侧凹陷部中；
远侧端部，所述远侧端部被捕获在限定于所述远侧末端中的远侧凹陷部中；以及
弹性部分，所述弹性部分在所述近侧端部和所述远侧端部之间延伸，其中所述弹性部分被构造成能够抵靠所述近侧部分保持所述远侧末端。
Applications Claiming Priority (5)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US201962840715P | 2019-04-30 | 2019-04-30 | |
| US62/840,715 | 2019-04-30 | ||
| US16/846,311 | 2020-04-11 | ||
| US16/846,311 US11648009B2 (en) | 2019-04-30 | 2020-04-11 | Rotatable jaw tip for a surgical instrument |
| PCT/IB2020/053743 WO2020222081A1 (en) | 2019-04-30 | 2020-04-20 | Rotatable jaw tip for a surgical instrument |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| CN113747843A CN113747843A (zh) | 2021-12-03 |
| CN113747843B true CN113747843B (zh) | 2024-07-12 |
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| CN202080032392.3A Active CN113747843B (zh) | 2019-04-30 | 2020-04-20 | 用于外科器械的可旋转钳口末端 |
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| US (2) | US11648009B2 (zh) |
| EP (1) | EP3733083B1 (zh) |
| JP (1) | JP7494212B2 (zh) |
| CN (1) | CN113747843B (zh) |
| BR (1) | BR112021021654A2 (zh) |
| MX (1) | MX2021013374A (zh) |
| WO (1) | WO2020222081A1 (zh) |
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