CN116782839A - 具有仓释放机构的外科器械 - Google Patents

具有仓释放机构的外科器械 Download PDF

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CN116782839A
CN116782839A CN202180092157.XA CN202180092157A CN116782839A CN 116782839 A CN116782839 A CN 116782839A CN 202180092157 A CN202180092157 A CN 202180092157A CN 116782839 A CN116782839 A CN 116782839A
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cartridge
end effector
staple cartridge
staple
configuration
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F·E·谢尔顿四世
K·M·费比格
S·A·沃辛顿
S·D·霍尔德迈耶
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Cilag GmbH International
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Cilag GmbH International
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Priority claimed from PCT/IB2021/061060 external-priority patent/WO2022118168A2/en
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/0682Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil
    • A61B17/0686Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil having a forming anvil staying below the tissue during stapling
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017Electrical control of surgical instruments
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00367Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • A61B2017/00398Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0046Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
    • A61B2017/00464Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable for use with different instruments
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0046Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
    • A61B2017/00473Distal part, e.g. tip or head
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00477Coupling
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214Stapler heads
    • A61B2017/07257Stapler heads characterised by its anvil
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214Stapler heads
    • A61B2017/07271Stapler heads characterised by its cartridge
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214Stapler heads
    • A61B2017/07278Stapler heads characterised by its sled or its staple holder
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214Stapler heads
    • A61B2017/07285Stapler heads characterised by its cutter
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03Automatic limiting or abutting means, e.g. for safety
    • A61B2090/033Abutting means, stops, e.g. abutting on tissue or skin
    • A61B2090/034Abutting means, stops, e.g. abutting on tissue or skin abutting on parts of the device itself
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03Automatic limiting or abutting means, e.g. for safety
    • A61B2090/038Automatic limiting or abutting means, e.g. for safety during shipment

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Abstract

本发明提供了一种用于与外科缝合器械一起使用的端部执行器。所述端部执行器包括第一钳口和第二钳口。所述第一钳口包括砧座,所述砧座包括近侧凸轮作用构件。至少一个钳口能够相对于另一个钳口运动以闭合端部执行器。所述第二钳口包括细长通道,所述细长通道包括近侧通道孔口;和钉仓,所述钉仓能够插入所述细长通道中。所述钉仓包括仓体和仓盘。所述仓盘包括近侧盘孔口,在处于解锁构型的情况下,所述近侧盘孔口被配置成能够当所述钉仓与所述细长通道组装时定位成部分地位于所述近侧通道孔口的远侧。所述凸轮作用构件被配置成能够在所述端部执行器转变到闭合构型期间使所述仓盘相对于所述仓体从所述解锁构型朝近侧平移到锁定构型。

Description

具有仓释放机构的外科器械
背景技术
本发明涉及外科器械,并且在各种布置结构中,涉及被设计成缝合和切割组织的外科缝合和切割器械以及与它们一起使用的钉仓。
发明内容
在一个方面,本公开提供了一种用于与外科缝合器械一起使用的端部执行器。该端部执行器包括:第一钳口,该第一钳口包括砧座,该砧座包括近侧凸轮作用构件。该端部执行器还包括第二钳口,其中该第一钳口和该第二钳口中的至少一者能够相对于另一者运动以将端部执行器转变成闭合构型。该第二钳口包括:细长通道,该细长通道包括近侧通道孔口;和钉仓,该钉仓能够插入该细长通道中以用于与该细长通道组装在一起。该钉仓包括仓体和仓盘。该仓盘包括近侧盘孔口,在处于解锁构型的情况下,该近侧盘孔口被配置成能够当钉仓与细长通道组装时定位成部分地位于近侧通道孔口的远侧。该凸轮作用构件被配置成能够在端部执行器转变到闭合构型期间使仓盘相对于仓体和细长通道从解锁构型朝近侧平移到锁定构型。
在另一方面,本公开提供了一种用于与外科缝合器械一起使用的端部执行器。该端部执行器包括第一钳口,该第一钳口包括砧座。该端部执行器还包括第二钳口,其中该第一钳口和该第二钳口中的至少一者能够相对于另一者运动以抓持组织。该第二钳口包括细长通道和钉仓,该钉仓能够插入该细长通道中以用于与细长通道组装在一起。该钉仓包括仓体和附接到该仓体的仓盘。该砧座被配置成能够在细长通道内使仓盘相对于仓体和细长通道从解锁构型朝近侧平移到锁定构型。
在另一方面,本公开提供了一种用于与外科缝合器械一起使用的外科钉仓组件。该外科钉仓组件包括细长通道,该细长通道包括具有孔口的侧壁;和钉仓,该钉仓能够插入细长通道中以用于与细长通道组装在一起。该钉仓包括仓体。该仓体包括平台和限定在平台中的钉腔,其中钉腔包括钉。该仓体还包括附接到该仓体的仓盘,其中该仓盘包括在自然状态下能够被接纳在该细长通道的孔口中的可折叠棘爪。该钉仓组件还包括能够在两种不同的构型中可释放地联接到细长通道的保持器。在第一构型中,该保持器将钉保持在钉腔中。在第二构型中,该保持器使可折叠棘爪从孔口脱开合,以便于将钉仓从细长通道移除。
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是根据本公开的至少一个方面的外科器械的透视图。
图2是根据本公开的至少一个方面的马达可操作的内芯的透视图。
图3是处于打开构型的壳体和图2所示的内芯的实施方案的透视图。
图4是图3的壳体和图2所示的内芯的透视图,该壳体具有与其相关联的不同颜色并且处于闭合构型。
图5是根据本公开的至少一个方面的不可关节运动的加载单元的分解组装图。
图6是根据本公开的至少一个方面的可关节运动的加载单元的分解组装图。
图7是根据本公开的至少一个方面的加载单元的剖视图。
图8是图7的加载单元的一部分的分解图。
图9是驱动组件的远侧端部的局部侧面剖视图,示出了处于第一构型或解锁构型的击发锁定组件的闩锁构件。
图10是图9的驱动组件的远侧端部的局部侧面剖视图,示出了处于第二构型或锁定构型的闩锁构件。
图11是根据本公开的至少一个方面的加载单元的钉仓组件的局部分解图。
图12是图11的加载单元的局部剖视图。
图13是图11的钉仓组件的局部剖视图。
图14是根据本公开的至少一个方面的钉仓的局部分解图。
图15是图14的钉仓的局部剖视图。
图16是根据本公开的至少一个方面的钉仓的局部透视图。
图17是根据本公开的至少一个方面的钉仓的局部分解图。
图18是图17的钉仓的局部剖视图。
图19是根据本公开的至少一个方面的钉仓组件的局部分解图。
图20是根据本公开的至少一个方面的钉仓的顶视图和剖视图。
图21是包括图20的钉仓的钉仓组件的剖视图。
图22是根据本公开的至少一个方面的包括滑动件和保持特征部的钉仓的局部剖视图。
图23是图22的钉仓的局部倒置透视图。
图24示出了将图22的钉仓的滑动件与保持特征部组装在一起的方法。
图25部分地示出了根据本公开的至少一个方面的包括钉仓和细长通道以及加载单元的驱动构件的钉仓组件。
图26部分地示出了图25的钉仓组件,其中钉仓正确安置在细长通道中。
图27是图25的钉仓组件的局部横向剖视图。
图28是图26的钉仓组件的局部横向剖视图。
图29是根据本公开的至少一个方面的钉仓的局部透视图。
图30是图29的钉仓的局部剖视图。
图31是根据本公开的至少一个方面的描绘控制程序或逻辑配置的过程的逻辑流程图。
图32是根据本公开的至少一个方面的包括击发系统的外科缝合器械的图。
图33示出了在沿着其击发路径的三个位置处的图32的外科缝合器械的驱动构件,以及可由驱动构件推进以部署图32的外科缝合器械的钉的滑动件。
图34示出了在沿着击发路径的两个位置处的图32的驱动构件。
图35是根据本公开的至少一个方面的曲线图,其在x轴上描绘了驱动构件沿着击发路径从起始位置行进的距离(δ),并且在y轴上描绘了在动力外科缝合器械的击发行程期间马达的击发速度(V)和对应的电负载。
图36示出了根据本公开的至少一个方面的钉仓,该钉仓包括用于将滑动件保持在钉仓内的原位置处的保持特征部。
图37示出了图36的钉仓,其中滑动件在钉仓内向远侧推进超过原位置。
图38示出了图36的钉仓的保持特征部。
图39示出了根据本公开的至少一个方面的外科缝合组件的局部分解图。
图40是示出图39的外科缝合组件的滑动件检测电路在y轴上的变化电阻和滑动件在x轴上的对应行进距离的曲线图。
图41是根据本公开的至少一个方面的包括滑动件复位电路的钉仓的局部剖视图。
图42至图44示出了根据本公开的至少一个方面的钉仓上的滑动件相对于保持特征部的三个位置。
图45示出了根据本公开的至少一个方面的包括滑动件保持特征部的钉仓的局部透视图。
图46示出了图45的钉仓,其中移除了仓盘以露出滑动件保持特征部。
图47示出了根据本公开的至少一个方面的钉仓组件的简化局部剖视图,其中滑动件处于原位置并且处于与原位置不同的位置。
图48示出了根据本公开的至少一个方面的图47的钉仓组件的简化局部剖视图,其中推进驱动构件的工作端以接合滑动件复位构件的凸起部分。
图49示出了根据本公开的至少一个方面的外科器械的柄部,该柄部包括能够移动到第一位置和第二位置的击发触发器。
图50示出了根据本公开的至少一个方面的可操作地联接到滑动件复位构件的马达组件。
图51示出了根据本公开的至少一个方面的外科器械的柄部,该柄部包括击发触发器和滑动件复位致动器。
图52示出了根据本公开的至少一个方面的包括砧座的加载单元和包括用于与细长通道组装在一起的钉仓的外科缝合组件的局部分解图。
图53示出了图52的加载单元的局部剖视图,示出了组装有处于解锁构型的细长通道和处于打开构型的具有细长通道的砧座的钉仓。
图54示出了图52和图53的加载单元的局部剖视图,示出了处于锁定构型的钉仓和细长通道以及处于闭合构型的具有细长通道的砧座。
图55示出了处于锁定构型的图52的外科缝合组件的局部透视图。
图56示出了图52的外科缝合组件从锁定构型转变到解锁构型的局部透视图。
图57示出了根据本公开的至少一个方面的包括保持器、钉仓和细长通道的外科缝合组件的局部透视图。
图58至图61示出了利用图57的保持器从细长通道释放钉仓的方法。
图62示出了根据本公开的至少一个方面的钉仓组件的局部剖视图。
在若干视图中,对应的参考符号指示对应的零件。本文所述的范例以一种形式示出了本发明的某些实施方案,并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 TISSUE TREATMENT BYSURGICAL INSTRUMENT”的美国专利申请;代理人案卷END9291USNP1/200802-1M号;
-名称为“SURGICAL INSTRUMENTS WITH INTERACTIVEFEATURES TO REMEDYINCIDENTAL SLED MOVEMENTS”的美国专利申请;代理人案卷END9291USNP2/200802-2号;
-名称为“SURGICAL INSTRUMENTS WITH SLEDLOCATION DETECTION ANDADJUSTMENT FEATURES”的美国专利申请;代理人案卷END9291USNP3/200802-3号;
-名称为“DUAL-SIDED REINFORCED RELOAD FORSURGICAL INSTRUMENTS”的美国专利申请;代理人案卷END9291USNP5/200802-5号;
-名称为“SURGICAL SYSTEMS WITH DETACHABLESHAFT RELOAD DETECTION”的美国专利申请;代理人案卷END9291USNP6/200802-6号;
-名称为“SURGICAL INSTRUMENTS WITH ELECTRICALCONNECTORS FOR POWERTRANSMISSION ACROSS STERILEBARRIER”的美国专利申请;代理人案卷END9291USNP7/200802-7号;
-名称为“DEVICES AND METHODS OF MANAGINGENERGY DISSIPATED WITHINSTERILE BARRIERS OFSURGICAL INSTRUMENT HOUSINGS”的美国专利申请;代理人案卷END9291USNP8/200802-8号;
-名称为“POWERED SURGICAL INSTRUMENTS WITH EXTERNAL CONNECTORS”的美国专利申请;代理人案卷END9291USNP9/200802-9号;
-名称为“POWERED SURGICAL INSTRUMENTS WITH SMART RELOAD WITHSEPARATELY ATTACHABLE EXTERIORLY MOUNTED WIRING CONNECTIONS”的美国专利申请;代理人案卷END9291USNP10/200802-10号;
-名称为“POWERED SURGICAL INSTRUMENTS WITH COMMUNICATION INTERFACESTHROUGH STERILE BARRIER”的美国专利申请;代理人案卷END9291USNP11/200802-11号;以及
-名称为“POWERED SURGICAL INSTRUMENTS WITHMULTI-PHASE TISSUETREATMENT”的美国专利申请;代理人案卷END9291USNP12/200802-12号。
本专利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,这些临时专利申请中的每个的公开内容全文以引用方式并入本文:
·名称为“METHOD OF HUB COMMUNICATION,PROCESSING,STORAGE ANDDISPLAY”的美国专利申请序列16/209,385号;
·名称为“METHOD OF HUB COMMUNICATION”的美国专利申请序列16/209,395号;
·名称为“METHOD OF CLOUD BASED DATA ANALYTICS FOR USE WITH THE HUB”的美国专利申请序列16/209,403号;
·名称为“METHOD OF ROBOTIC HUB COMMUNICATION,DETECTION,AND CONTROL”的美国专利申请序列16/209,407号;
·名称为“METHOD OF HUB COMMUNICATION,PROCESSING,DISPLAY,AND CLOUDANALYTICS”的美国专利申请序列16/209,416号;
·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16/209,423号;
·名称为“METHOD OF USING REINFORCED FLEXIBLE CIRCUITS WITH MULTIPLESENSORS TO OPTIMIZE PERFORMANCE OF RADIO FREQUENCY DEVICES”的美国专利申请序列16/209,427号;
·名称为“METHOD OF SENSING PARTICULATE FROM SMOKE EVACUATED FROM APATIENT,ADJUSTING THE PUMP SPEED BASED ON THE SENSED INFORMATION,ANDCOMMUNICATING THE FUNCTIONAL PARAMETERS OF THE SYSTEM TO THE HUB”的美国专利申请序列16/209,433号;
·名称为“METHOD FOR SMOKE EVACUATION FOR SURGICAL HUB”的美国专利申请序列16/209,447号;
·名称为“METHOD FOR CONTROLLING SMART ENERGY DEVICES”的美国专利申请序列16/209,453号;
·名称为“METHOD FOR SMART ENERGY DEVICE INFRASTRUCTURE”的美国专利申请序列16/209,458号;
·名称为“METHOD FOR ADAPTIVE CONTROL SCHEMES FOR SURGICAL NETWORKCONTROL AND INTERACTION”的美国专利申请序列16/209,465号;
·名称为“METHOD FOR SITUATIONAL AWARENESS FOR SURGICAL NETWORK ORSURGICAL NETWORK CONNECTED DEVICE CAPABLE OF ADJUSTING FUNCTION BASED ON ASENSED SITUATION OR USAGE”的美国专利申请序列16/209,478号;
·名称为“METHOD FOR FACILITY DATA COLLECTION AND INTERPRETATION”的美国专利申请序列16/209,490号;和
·名称为“METHOD FOR CIRCULAR STAPLER CONTROL ALGORITHM ADJUSTMENTBASED ON SITUATIONAL AWARENESS”的美国专利申请序列16/209,491号。
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。
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。第一钳口包括钉仓。钉仓能够插入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。
参考图1至图4,提供了一种外科器械系统,诸如机电外科器械系统10。系统10包括柄部组件100、多种类型的适配器或轴组件(诸如适配器组件200a)以及多种类型的端部执行器(诸如端部执行器300a)。柄部组件100被配置成能够与多个适配器组件中的任一个适配器组件(例如适配器组件200a)选择性地附接,并且继而每个独特的适配器组件200a被配置成能够与任何数量的外科加载单元或端部执行器(诸如端部执行器300a)选择性地连接。端部执行器300a和适配器组件200a被构造用于由柄部组件100致动和操纵。在将一个适配器组件200a例如连接到柄部组件100并将一种类型的端部执行器(诸如端部执行器300a)连接到所选择的适配器组件200a时,形成电动手持式机电外科器械。
对于示例性机电手持式电动外科器械的构造和操作的详细描述,可参考国际公布WO 2009/039506号和美国专利申请公布2011/0121049号,所有这些专利的全部内容以引用方式并入本文。
参考图1和图2,柄部组件100包括内芯101和被配置成能够选择性地接纳和包封内芯101的壳体或壳110a。内芯101是马达可操作的并且被配置成能够驱动多种类型的端部执行器的操作。内芯101具有多组操作参数(例如,内芯101的马达的操作速度、由内芯101的马达递送到适配器组件的功率量、待致动的内芯101的马达的选择、待由内芯101执行的端部执行器的功能等)。内芯101的每组操作参数被设计成当端部执行器联接到内芯101时,驱动对相应类型的端部执行器唯一的一组特定功能的致动。例如,根据联接到内芯101的端部执行器的类型,内芯101可改变其功率输出、停用或激活其某些按钮、和/或致动其不同马达。
具体参考图2,内芯101在其中限定内壳部体腔,电源组106位于该内壳部体腔内。电源组106被配置成能够控制内芯101的各种操作。电源组106包括可操作地接合到其的多个马达108a、108b。马达108a、108b的旋转用于驱动适配器组件200a的轴和/或齿轮部件,例如以便驱动附接到其的端部执行器(例如,端部执行器300a)的各种操作。尽管在图2所示的示例中描绘了两个马达,但在其他示例中,柄部组件可包括多于或少于两个马达。
在各种示例中,柄部组件100被用机器人系统的机器人臂更换。在此类示例中,适配器组件200a也可有效地与机器人控制的或自动化外科系统的工具驱动组件一起使用。例如,本文所公开的适配器组件可与各种机器人系统、器械、部件和方法诸如但不限于名称为“SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS”的美国专利9,072,535号中公开的那些一起使用,该专利申请据此全文以引用方式并入本文。
当端部执行器300a联接到内芯101时,电源组106的马达被配置成能够驱动适配器组件200a的轴和/或齿轮部件,以便选择性地使端部执行器300a相对于端部执行器300a的近侧主体部分302a移动,使端部执行器300a围绕纵向轴线“X”旋转,使端部执行器300a的钉仓组件308a和砧座组件306a相对于彼此移动,和/或从端部执行器300a的钉仓组件308a内击发钉。
参考图3和图4,外科器械系统10还包括一次性外部壳体110。壳体110被配置成能够包封内芯101,由此在外科规程期间抑制外科碎屑穿透并污染内芯101。壳体110在使用之前选择性地包封内芯101,并且然后可在使用之后从内芯101上拆下以便处理掉,或者在一些实例中消毒以便再使用。
参考图3,壳体110包括壳体部分112a。壳体110还包括壳体部分112b,该壳体部分通过沿着壳体部分112b的上边缘定位的铰链120a可移动地联接到壳体部分112b。壳体部分112a、112b能够相对于彼此在如图4所示的闭合的完全联接构型和如图3所示的打开的部分分离构型之间枢转。当接合时,壳体部分112a、112b在其中限定腔122a,内芯101、存储器114和微处理器140可选择性地位于该腔中。在某些实例中,壳体部分112a、112b可由任何合适的材料(诸如聚碳酸酯)制成。例如,在某些实例中,存储器114和微处理器140被结合到内芯101中。
可以设想的是,存储器114可为非易失性存储器,诸如电可擦可编程只读存储器。存储器114已在其中存储内芯101的离散操作参数,这些离散操作参数对应于一种类型的端部执行器(例如,诸如端部执行器300a的端部执行器)和/或一种类型的适配器组件(诸如适配器组件200a的适配器组件)的操作。存储在存储器114中的操作参数可以是以下中的至少一者:内芯101的马达108a、108b的操作速度;内芯101的马达108a、108b在其操作期间输送的功率量;内芯101的哪些马达108a、108b将在操作内芯101时被致动;由内芯101执行的端部执行器的功能的类型;等。
图5描绘了可以美国专利5,865,361号中讨论的方式与外科器械系统10结合使用的加载单元16的示例,该专利的公开内容全文以引用方式并入本文。
如图5所示,加载单元16通常可包括工具组件17,用于执行外科规程,诸如切割组织和在切口的每一侧上施加钉。具体地,该工具组件包括仓组件18,该仓组件在其中容纳多个外科钉。工具组件17还包括钉成形砧座组件20,该钉成形砧座组件具有砧座部分204,该砧座部分具有形成在其下表面中的多个钉变形凹部。盖板208通常固定到砧座部分204的顶表面,以在其间限定砧座腔。砧座腔的尺寸被设定成接纳轴向驱动组件212的远侧端部。纵向狭槽214延伸穿过砧座部分204,以便于轴向驱动组件212的保持凸缘284进入砧座腔。凸轮作用表面209形成在砧座部分204的近侧端部上并且被定位成接合轴向驱动组件212以便于闭合砧座组件20。
仓组件18通常包括载体216,该载体限定细长支撑通道218。细长支撑通道218的尺寸和构造被设定成在其中接纳钉仓220。这种钉仓220支撑多个紧固件和推动器,如本领域已知的。多个间隔开的纵向狭槽230延伸穿过钉仓220以顺应致动滑动件234的直立凸轮楔232。中心纵向狭槽282沿着钉仓220的长度延伸,以便于形成在轴向驱动组件212上的刀片280通过。在加载单元16的操作期间,致动滑动件234平移穿过钉仓220的纵向狭槽230,以推进凸轮楔232,使其与可操作地支撑在仓220中的推动器顺序地接触,从而使推动器在钉仓220内竖直地平移并将与推动器相关联的紧固件(钉)推入砧座组件20的钉变形腔中。一对枢转构件211形成在砧座部分204的近侧端部上并且被配置成能够被接纳在形成在载体216中的狭槽213中,以使得砧座部分204可在打开位置与组织夹紧位置之间枢转。
如在图5中还可以看出,加载单元16还具有壳体部分200,该壳体部分被适配成卡扣到载体216上或以其他方式附接到该载体。轴向驱动组件212包括细长驱动梁266,该细长驱动梁具有远侧工作头268和近侧接合节段270。如已知的那样,驱动梁266可由单个材料片构成,或者优选地由多个堆叠的片构成。接合节段270包括一对接合指状物270a和270b,该一对接合指状物的尺寸和构造被设定成以装配方式接合形成在驱动构件272中的对应的一对保持狭槽272a。驱动构件272可包括近侧孔口,该近侧孔口被配置成能够接纳如美国专利5,865,361号所讨论的控制杆的远侧端部。
驱动梁266的远侧端部包括支撑刀片280的竖直支撑支柱278以及在缝合规程期间接合致动滑动件234的中心部分的邻接表面283。表面285位于表面283的基部处并且被配置成能够接纳支撑构件287,该支撑构件沿着载体216的底部可滑动地定位。刀片280通常定位成略微在致动滑动件234后面平移穿过钉仓220中的中心纵向狭槽282,以在缝合的身体组织排之间形成切口。
保持凸缘284从竖直支柱278向远侧突起并在其远侧端部处支撑凸轮作用销286。凸轮作用销286的尺寸和构造被设定成接合砧座部分204上的凸轮作用表面209,以抵靠身体组织夹紧砧座部分204。另外,片簧207可设置在砧座部分204的近侧端部与壳体200的远侧端部部分之间,以将砧座组件20偏压到常开位置。加载单元16还可包括如美国专利5,865,361号中所述的锁定装置288和弹簧304布置结构。
图6示出了可关节运动的加载单元16',该可关节运动的加载单元包括具有砧座组件20和仓组件18的工具组件17。砧座组件20包括砧座部分204,该砧座部分具有形成在其下表面中的多个钉变形凹部。盖板208固定到砧座部分204的顶表面,以在其间限定砧座腔。砧座腔的尺寸被设定成接纳轴向驱动组件212的远侧端部。纵向狭槽214延伸穿过砧座部分204,以便于轴向驱动组件212的保持凸缘284进入砧座腔。形成在砧座部分204上的凸轮作用表面209可被定位成接合轴向驱动组件212,以便于将组织夹紧在砧座组件20与仓组件18之间。
仓组件18包括在其中支撑钉仓220的载体216。钉仓220包括用于接纳多个紧固件(钉)和推动器的保持狭槽225。多个间隔开的纵向狭槽230延伸穿过钉仓220以顺应致动滑动件234的直立凸轮楔232。中心纵向狭槽282沿着钉仓220的长度延伸,以便于刀片280通过。在加载单元16'的操作期间,致动滑动件234平移穿过钉仓220的纵向狭槽230,以推进凸轮楔232,使其与可操作地支撑在仓220中的推动器顺序地接触,从而使推动器将紧固件推入砧座组件20的钉变形腔中。一对枢转构件211形成在砧座部分204上并且定位在形成在载体216中的狭槽213内以在打开位置与组织夹紧位置之间引导砧座部分204。
可关节运动的加载单元16'还包括壳体部分200,该壳体部包括上部壳体半部250和下部壳体半部252。壳体半部250的近侧端部可包括用于可释放地接合细长主体14的接合凸块254。凸块254与主体14的远侧端部形成卡口型联接,如美国专利5,865,361号中所述。如在图6中还可以看出,轴向驱动组件212包括细长驱动梁266,该细长驱动梁具有远侧工作头和近侧接合节段270。驱动梁266可由单个材料片构成,或者优选地由多个堆叠的片构成。接合节段270包括一对接合指状物270a和270b,该一对接合指状物的尺寸和构造被设定成以装配方式接合形成在驱动构件272中的对应的一对保持狭槽272a。驱动构件272包括近侧端口孔口,该近侧端口孔口被配置成能够当加载单元16'的近侧端部与如美国专利5,865,361号中所公开的外科缝合设备的细长主体14接合时接纳控制杆的远侧端部。
驱动梁266的远侧端部由支撑刀片280的竖直支撑支柱278以及在缝合规程期间接合致动滑动件234的中心部分的邻接表面283限定。在表面283的基部处的表面285可被配置成能够接纳支撑构件287,该支撑构件沿着载体216的底部可滑动地定位。刀片280通常定位成略微在致动滑动件234后面平移穿过钉仓220中的中心纵向狭槽282,以在缝合的身体组织排之间形成切口。为了随着驱动梁266轴向推进在壳体部分200内为驱动梁266提供支撑,将刀片稳定构件290安装在壳体部分200内。保持凸缘284从竖直支柱278向远侧突起并在其远侧端部处支撑一对圆柱形凸轮滚柱286。凸轮滚柱286的尺寸和构造被设定成接合砧座部分204上的凸轮作用表面209,以抵靠身体组织夹紧砧座部分204。
可关节运动的加载单元16'包括关节运动接头340,该关节运动接头包括安装组件202,该安装组件包括上部安装部分236和下部安装部分238。枢转销244形成在安装部分236、238中的每一者上并用于限定枢转轴线“A1-A1”,该枢转轴线可基本上垂直于可关节运动的加载单元16'的纵向轴线“L-L”。安装组件202通过一对联接构件246枢转地联接到壳体部分200的远侧端部。每个联接构件246具有穿过其中的孔口247,用于接纳穿过其中的对应销244。每个联接构件246的近侧端部248被配置成能够被互锁地接纳在形成在上部壳体半部250的远侧端部和下部壳体半部252的远侧端部中的对应凹槽251中。一对弹簧207设置在砧座部分204的近侧端部与上部安装部分236之间,以将砧座组件20偏压到常开位置。如美国专利5,865,361号中所教导的,可设置关节运动连杆256以使工具组件17围绕关节运动轴线“A1-A1”相对于壳体部分200进行关节运动。
图7和图8示出了与外科器械系统10一起使用的加载单元1100的示例。加载单元1100基本上如美国专利申请公布2013/0098965号和美国专利申请公布2016/0249921号中所述,这些专利全文以引用方式并入本文。加载单元1100包括近侧主体部分1102和工具组件1104。
加载单元1100还包括驱动组件1180,该驱动组件包括具有主体和工作端1184的驱动构件1182。工作端1184包括上部凸缘1186a、下部凸缘1186b、将上部凸缘1186a和下部凸缘1186b互连的竖直支柱、以及支撑在竖直支柱上或形成在竖直支柱中的刀1187。上部凸缘1186a被定位成被可滑动地接纳在砧座组件1130的通道1131内,并且下部凸缘1186b被定位成沿着钳口构件1156的外表面1156a可滑动地定位。在使用中,驱动构件1182的远侧移动初始将上部凸缘1186a推进到形成在砧板134上的凸轮作用表面中,并将下部凸缘1186b推进到与形成在钳口构件1156上的凸轮作用表面1156b接合,以使钉仓组件1150朝向砧座组件1130枢转到接近或闭合位置。随着工作端1184移动穿过工具组件1104,驱动构件1182的继续推进逐渐保持砧座组件1130与钉仓组件1150之间邻近驱动组件1180的工作端184的最小组织间隙。
致动滑动件1162在位于工作端1184远侧的位置处设置在仓组件1150内。当工作端1184处于其最近侧位置并且工具组件1104处于打开或未接近位置时,滑动件1162和工作端1184处于其初始位置。滑动件1162包括多个凸轮作用表面,该多个凸轮作用表面被定位成在仓组件1150的仓体的钉保持狭槽内接合和提升推动器。推动器定位在钉仓组件1150内,以在滑动件1162推进穿过工具组件1104时从仓体射出钉。
参考图7至图10,加载单元1100包括击发锁定组件1221,该击发锁定组件包括闩锁构件1222,该闩锁构件被枢转地支撑在下部安装部分1174的远侧端部上。闩锁构件1222包括U形主体,该U形主体具有近侧基部构件224和两个间隔开的向远侧延伸的支腿。基部构件1224设置有阻挡构件,该阻挡构件限定阻挡表面并且被焊接或固定到基部构件1224以向基部构件1224提供额外的支撑。另选地,基部构件1224和阻挡构件整体地或一体地形成。闩锁构件1222从第一位置(图9)枢转到第二位置(图10)。在图9所示的第一位置,闩锁构件1222的阻挡构件1224a与驱动构件1182的止动表面1184a对准,以防止驱动构件1182在工具组件1104内推进。在图10所示的第二位置,阻挡构件1224a与驱动构件1182的止动表面1184a不对准,以允许驱动构件1182在工具组件1104内推进。
除上述之外,将非击发钉仓组件1150插入钳口构件1156的细长通道1157中使闩锁构件1222枢转到第二位置,由此允许驱动构件1182在工具组件1104内推进。滑动件1162的近侧部分抵抗偏压构件1230的偏压力将闩锁构件1222保持在第二位置。在击发期间,当滑动件1162向远侧推进穿过仓组件1150时,滑动件1162从闩锁构件1222脱开,并且偏压构件230导致闩锁构件1222返回到第一位置,在该第一位置,闩锁构件1222重新进入与驱动构件182的锁定接合。
值得注意的是,非击发仓组件1150的偶然碰撞或摇动可能导致滑动件1162在非击发仓组件1150内轻微移动。这种移动可能是有问题的,因为未对准的滑动件1162不能通过在插入非击发钉仓组件1150时使闩锁构件1222转变到第二位置来停用击发锁定组件1221。因此,即使新的非击发钉仓组件1150准备好击发,驱动构件1182的推进仍受到阻碍。
除上述之外,由于加载单元1100的偶然碰撞或摇动,正确安装的非击发仓组件1150可能遭受相同的后果。滑动件1162的轻微移动可能导致闩锁构件1222从滑动件1162脱开,由此允许闩锁构件1222通过偏压构件1230的偏压力返回到第一位置。因此,在实际击发开始之前,击发锁定组件1221由于加载单元1100的偶然碰撞或摇动而过早地重新激活。
在任一种情况下,滑动件1162的未对准可能使期望击发明显正确安装的非击发仓组件1150以将钉部署到抓持在砧座组件1130与仓组件1500之间的组织中的用户感到沮丧。当击发不可避免地失败时,用户别无选择,只能释放组织,从而牺牲了识别最合适的组织咬合并将加载单元1100与其对准以便抓持所花费的所有时间。此外,确信仓组件是新的和非击发的,用户可尝试更换加载单元1100和/或外科器械系统10,这是昂贵的,并且如果用户将仓组件1150和未对准的滑动件1162安装到新的加载单元1100中,则这将不是成功的补救措施。
本公开提供了将滑动件1162保持在用于非击发仓组件1150的正确位置的各种解决方案。附加地或另选地,本公开提供了用于检测滑动件1162从其正确位置的偶然移动的各种机制。本公开还提供了主动地将滑动件1162返回到其正确位置的各种机制。
参考图11至图13,加载单元1200在许多方面类似于加载单元1100。例如,加载单元1200包括近侧主体部分1102(图8)和工具组件1204,该工具组件包括端部执行器,该端部执行器具有包括砧座组件1230的钳口1236和包括钉仓组件1250的钳口1256。钳口1236、1256中的至少一者能够相对于另一者运动,以在砧座组件1230与钉仓组件1250之间抓持组织。
此外,钉仓组件1250包括细长通道1257,该细长通道的尺寸和设计被设定成接纳和可释放地保持钉仓1220,该钉仓在许多方面类似于本文其他地方所述的其他钉仓(例如,钉仓220)。以与结合图1至图8的加载单元16、16'、1100所述类似的方式经由由滑动件1262促动的钉驱动器将钉从钉仓1220穿过仓平台1255部署到组织中。钉和钉驱动器储存在钉仓1220的仓体1259中。
仓盘1258附接到仓体1259的底部,以防止钉驱动器从仓体1259中掉出。仓盘1258包括盘狭槽1254,该盘狭槽与限定在仓平台1255中的仓狭槽对准。盘狭槽1254还与限定在细长通道1257的基部部分1252中的通道狭槽1253对准。在击发期间,驱动构件1182(图9)的工作端1184可滑动地移动穿过仓狭槽、盘狭槽1254和通道狭槽1253,从而使滑动件1262在仓体内从第一位置朝向第二位置向远侧推进,以使钉驱动器将钉部署穿过仓平台1255。
此外,加载单元1200包括击发锁定组件1221,该击发锁定组件被配置成能够在不存在具有正确定位的滑动件1262的非击发钉仓1220的情况下防止驱动构件1182推进。为了阻止因钉仓1220的偶然碰撞或摇动而引起的滑动件1262的移动,基部部分1252包括一个或多个保持特征部(例如,保持特征部1270a、1270b),该一个或多个保持特征部被配置成能够配合地接合滑动件1262并阻止滑动件1262移动直到达到预定力。
在某些实例中,如图13所示,滑动件1262包括限定在滑动件基部1263中的一个或多个孔口、孔、凹槽或棘爪(例如,棘爪1272a、1272b)。棘爪1272a、1272b与保持特征部1270a、1270b对准,并且被配置成能够当滑动件1262位于第一位置时接纳保持特征部。在图11至图13所示的示例中,当钉仓1220被正确地安置在细长通道1257中时,保持特征部1270a、1270b延伸穿过仓盘1258中的对应的孔口或切口1274a、1274b。
在所示示例中,当滑动件1262处于第一位置处时,保持特征部1270a、棘爪1272a和切口1274a位于纵向对分钉仓1220并沿着仓狭槽、盘狭槽1254和通道狭槽1253纵向延伸的平面的第一侧上。保持特征部1270b、棘爪1272b和切口1274b位于平面的与第一侧相对的第二侧上。
在各种示例中,保持特征部1270a、1270b是从基部部分1252向上延伸的凸块或突出部的形式。保持特征部1270a、1270b可限定斜坡和/或曲线轮廓,该斜坡和/或曲线轮廓具有曲率半径,曲率半径的尺寸被设定成当由驱动构件1182施加到滑动件1262的驱动力小于或等于预定力时阻止滑动件1262推进。
在各个方面,保持特征部可包括三棱柱形状、部分椭圆体形状、部分球形形状、部分圆柱形形状或截棱锥形状。本公开还可设想到其他形状。在各个方面,保持特征部高度可小于或等于滑动件的对应棘爪的深度,以确保滑动件在与其组装在一起时不会被保持特征部抬起。在各个方面,保持特征部的数量可多于或少于两个。在一个示例中,单个保持特征部可与对应的棘爪和切口一起使用。在另一示例中,三个或更多个保持特征部可与对应的棘爪和切口一起使用。在某些示例中,专用切口被用单个切口替换,该单个切口顺应多个保持特征部穿过其中。
当由驱动构件1182施加的驱动力超过预定力时,滑动件1262朝向第二位置移动成不与保持特征部1270a、1270b对准。在滑动件1262到达第二位置之后,驱动构件1182缩回到起始位置,在该起始位置处,击发锁定组件1221被重新激活以防止驱动构件1182再次推进,直到非击发钉仓1220与细长通道组装在一起,使得滑动件1262正确地定位在第一位置处。滑动件1262的近侧部分接合闩锁构件1222,从而停用击发锁定组件1221。
图13示出了正确安置在细长通道1257中的非击发钉仓1220的保持特征部1270a的示例。非击发钉仓1220的滑动件1262的棘爪1272a正确地对准,以在第一位置处通过切口1274a接纳保持特征部1270a,这产生击发锁定组件1221的解锁构型。保持特征部1270a包括从细长通道1257突出并延伸到切口1274a中的基部部分1277,以及从基部部分突出并延伸到滑动件1262的棘爪1272a中的头部部分1279。头部部分1279(而不是基部部分1277)穿过切口1274a延伸超过仓盘1258并延伸到棘爪1272a中。
基部部分1277确保钉仓1220与细长通道1257正确对准,并且头部部分1279确保滑动件1262保持在第一位置,直到大于预定驱动力的驱动力被施加到该滑动件。在所示示例中,基部部分1277具有矩形或至少基本上矩形的横截面。在某些实例中,头部部分1279具有曲线轮廓,该曲线轮廓限定斜坡,该斜坡在由头部部分1279的曲率半径限定的预定力或预定力以下阻止滑动件1262推进。
此外,头部部分1277的大小略小于棘爪1272a,以允许滑动件相对于头部部分1279轻微移动,而不使击发锁定组件从解锁构型意外转变到锁定构型。在所示示例中,棘爪1272a的长度d2比头部部分1279的长度d1大距离Δd(d1与d2之间的差值)。因此,滑动件能够相对于仓盘1258滑动地移动距离Δd,而不损害头部部分1279与棘爪1272a之间的配合接合。
图14和图15示出了在许多方面类似于钉仓220、1220的钉仓1220'。例如,钉仓1220'包括具有棘爪1262a的滑动件1272a。然而,与钉仓1220不同,钉仓1220'的仓盘1258'不包括用于顺应细长通道的保持特征部的切口。相反,仓盘1258'包括从仓盘1258'突出的保持特征部1270a'和1270b'。保持特征部1270a'和1270b'在许多方面类似于保持特征部1270a、1270b。例如,保持特征部1270a'和1270b'被配置成能够配合地接合滑动件1262的棘爪1272a、1272b以将滑动件1262保持在对应于击发锁定组件1221(图9)的解锁构型的第一位置处。
在图14和图15所示的示例中,保持特征部1270a'、1270b'位于盘狭槽1254的相对侧上。保持特征部1270a'、1270b'被限定在仓盘1258'的与侧壁1273a、1273b相邻的基部部分中。在所示示例中,保持特征部1270a'、1270b'跨盘狭槽1254对准。在其他示例中,保持特征部1270a'、1270b'可以是偏移的。
图16示出了在许多方面类似于本文其他地方所述的其他钉仓(诸如钉仓220、1220、1220')的钉仓1320。以与结合图1至图8的加载单元16、16'、1100所述类似的方式经由由滑动件1162促动的钉驱动器将钉从钉仓1220”穿过仓平台部署到组织中。驱动构件1182被配置成能够通过使滑动件1162相对于仓盘1258”从第一位置朝向第二位置可滑动地向远侧推进而使钉从仓体部署穿过仓平台。钉仓1220”包括在盘狭槽1254的相对侧上限定在仓盘1258”的基部部分1252”中的保持特征部1270a”、1270b”。
钉仓1220”与钉仓1220'的不同之处在于,保持特征部1270a”、1270b”为弯曲远离基部1252”的突片的形式。保持特征部1270a”、1270b”限定可折叠斜坡,该可折叠斜坡被配置成能够阻止滑动件1162移动超过第一位置,由此在滑动件1162处于第一位置时将击发锁定组件1221(图9)保持在解锁构型。
在所示示例中,滑动件1162可在接合保持特征部1270a”、1270b”之前从第一位置略微可滑动地移动。允许的移动不足以使滑动件1162从闩锁构件1222脱开,并且因此不足以使击发锁定组件1221过早地转变到锁定构型。随着滑动件1162的远侧端部部分接合保持特征部1270a”、1270b”,滑动件1162的额外推进受到持特征部1270a”、1270b”的阻止。
当由驱动构件1182施加在滑动件1162上的驱动力超过预定驱动力时,滑动件1162被推进越过保持特征部1270a”、1270b”。在某些实例中,当由驱动构件1182施加在滑动件1162上的驱动力超过预定驱动力时,保持特征部1270a”、1270b”折叠在滑动件1162下方。
图17和图18示出了在许多方面类似于本文其他地方所述的其他钉仓(诸如钉仓220、1220、1220')的钉仓1320。以与结合图1至图8的加载单元16、16'、1100所述类似的方式经由由滑动件1362促动的钉驱动器将钉从钉仓1320穿过仓平台1355部署到组织中。钉和钉驱动器储存在钉仓1320的仓体1359中。
除上述之外,使用限定在仓盘1358的侧壁的近侧部分中的保持特征部1370a、1370b将非击发钉仓1320的滑动件1362保持在默认第一位置处。在图17所示的示例中,保持特征部1370a、1370b为向内突起的片簧的形式。片簧可冲压或形成在仓盘1358的侧壁中。保持特征部1370a包括附接到仓盘1358的侧壁并从该侧壁突出的基部。顶点部分从基部延伸,并且其尺寸被设定成穿过限定在仓体1359中的切口(例如,切口1374a),并进入限定在滑动件1362的侧壁中的棘爪(例如,棘爪1372a)。保持特征部1370a限定斜坡,该斜坡阻止滑动件1362向远侧推进直到达到预定驱动力。
图19示出了在许多方面类似于钉仓组件1250的另选的钉仓组件1450。例如,与钉仓组件1250类似,钉仓组件1450包括钉仓1420,该钉仓包括滑动件1462,该滑动件被配置成能够通过将滑动件1462相对于仓盘1458从第一位置朝向第二位置向远侧可滑动地推进来将钉从仓体部署穿过仓平台。当非击发钉仓1420与加载单元的细长通道1457正确地组装在一起时,击发锁定组件1221转变成解锁构型以允许驱动构件1182向远侧推进,从而促动滑动件1462部署钉。
钉仓组件1450与钉仓组件1250的不同之处在于,细长通道1457包括为凹槽、孔、孔口或棘爪形式的保持特征部1470a、1470b。保持特征部1470a、1470b被配置成能够通过限定在仓盘1458的基部部分中的切口1474a、1474b接纳滑动件突出部1472a、1472b。保持特征部1470a、1470b被配置成能够阻止滑动件1462移动直到达到预定力。当驱动构件1182的驱动力大于预定力时,滑动件1462向远侧推进超过第一位置,导致滑动件突出部1472a、1472b离开保持特征部1470a、1470b。
图20至图21示出了在许多方面类似于钉仓组件1250、1450的另选的钉仓组件1550。钉仓组件1550包括在许多方面类似于本文其他地方所述的其他钉仓(诸如钉仓220、1220、1220'、1220”、1420)的钉仓1520。以与结合图1至图8的加载单元16、16'、1100所述类似的方式经由由滑动件1562促动的钉驱动器将钉从钉仓1520穿过仓平台1555部署到组织中。驱动构件1182被配置成能够通过使滑动件1562相对于仓盘1558从第一位置朝向第二位置向远侧可滑动地推进来将钉从仓体部署穿过仓平台1555。
钉仓1520包括一个或多个保持特征部(例如,保持特征部1570a、1570b),该一个或多个保持特征部被配置成能够阻止滑动件1562向远侧推进,直到钉仓1520完全就位或与加载单元的细长通道1557组装在一起。在所示示例中,保持特征部1570b为通过弯曲现有盘金属片而限定在仓盘1558中的可折叠片簧的形式。在所示示例中,保持特征部1570b包括朝向仓平台1555弯曲的第一部分和远离仓平台1555弯曲的第二部分。曲线部分在第一部分与第二部分之间延伸并连接该第一部分和该第二部分。在所示示例中,第二部分比第一部分稍长。
如图21所示,将钉仓1520插入细长通道1557中导致保持特征部1570a、1570b抵靠细长通道1557折叠或压平,这允许滑动件1562通过驱动构件1182向远侧移动。保持特征部1570a、1570b阻止滑动件1562推进,直到它们由于钉仓1520插入细长通道1557中而折叠。换句话讲,保持特征部1570a、1570b被配置成能够将滑动件1562保持在第一位置处,直到钉仓1520插入细长通道1557中。在这样做时,保持特征部1570a、1570b确保滑动件1562将击发锁定组件1221转变成解锁构型以允许推进驱动构件1182。
图22至图24示出了在许多方面类似于钉仓1520及其保持特征部1570a、1570b的另选的钉仓1620与保持特征部1670。例如,保持特征部1670也为通过弯曲现有盘金属片而限定在仓盘1658中的可折叠片簧的形式。然而,与保持特征部1570a、1570b不同,保持特征部1670不会由于将钉仓1620插入加载单元的细长通道中而折叠或压平。相反,钉仓1620的滑动件1662包括被配置成能够接纳保持特征部1670的凹槽、孔口、孔或棘爪1672,如图22所示。
与本文其他地方所述的其他可折叠保持特征部类似,保持特征部1670被配置成能够将滑动件1662保持在第一位置处,由此通过闩锁构件1222与滑动件1662之间的持续接合确保击发锁定组件1221的解锁构型。当由驱动构件1182施加在滑动件1662上的驱动力超过预定阈值时,保持特征部1670从棘爪1672中脱出,从而允许滑动件1662进一步推进。
在所示示例中,保持特征部1670包括第一部分1671、第二部分1673和在部分1671、1673之间延伸并将这些部分连接的中间弯曲部分1675。部分1671包括孔口1679。在组装期间,如图24所示,钩构件1681在孔口1679处接合部分1671,以暂时将保持特征部1670拉回,以允许滑动件1662可滑动地移动到第一位置。然后钩构件1681释放部分1671,这允许保持特征部1670被接纳在棘爪1672中。
现在参考图25至图28,钉仓组件1750在许多方面类似于本文其他地方所述的其他钉仓组件(诸如钉仓组件1250)。例如,钉仓组件1750包括细长通道1757,该细长通道的尺寸和设计被设定成接纳和可释放地保持钉仓1720,该钉仓在许多方面类似于本文其他地方所述的其他钉仓(诸如钉仓220、1220)。以与结合图1至图8的加载单元16、16'、1100所述类似的方式经由由滑动件1762促动的钉驱动器将钉从钉仓1720穿过仓平台部署到组织中。钉和钉驱动器储存在钉仓1720的仓体中。在击发期间,驱动构件1182的工作端使滑动件1762在仓体内从第一位置朝第二位置向远侧推进,以使钉驱动器部署钉。
与钉仓组件1250类似,钉仓组件1750包括设置在细长通道1757中的保持特征部1770。在所示示例中,保持特征部1770为片簧的形式,该片簧在偏压构型中通过硬止动件压平或至少部分地压平,该硬止动件包括限定在细长通道1757的相对侧壁1757a、1757b中的硬止动部分1771a、1771b。当非击发钉仓1720与细长通道1757正确组装在一起时,滑动件1762将硬止动部分1771a、1771b分别压入相对的侧壁1757a、1757b中,由此允许保持特征部1770从硬止动部分1771a、1771b释放。
然后,保持特征部1770的远侧部分接合滑动件1762中的对应棘爪1772,从而拉动滑动件1762并将滑动件保持在对应于锁定击发组件1221的解锁构型的第一位置处。在所示示例中,保持特征部1770与棘爪1772之间的接合允许滑动件1762在预定阈值距离“d”内轻微移动,而不使击发锁定组件1221转变到锁定构型。
如本公开的其他保持特征部更详细地描述的,保持特征部1770被配置成能够阻止滑动件1762推进直到达到预定力。当驱动构件1182的驱动力大于预定力时,滑动件1762从保持特征部1770释放,并且向远侧推进超过第一位置。滑动件1762在保持特征部1770上的推进将保持特征部1770重置成与硬止动部分1771a、1771b锁定接合。
然后,保持特征部1770通过硬止动部分1771a、1771b保持在压平或至少部分压平构型,直到另一非击发钉仓1720插入细长通道1757中。在所示示例中,将保持特征部1770保持在压平或至少部分压平构型减少了在击发的其余部分期间驱动构件1182上的阻力。
在所示示例中,滑动件1762包括一个或多个特征部1773,该一个或多个特征部的设计和尺寸被设定成接合硬止动部分1771a、1771b并将该硬止动部分压入相对的侧壁1757a、1757b中。硬止动部分1771a、1771b可被弹簧偏压,使得它们在从一个或多个特征部1773脱开之后返回到与保持特征部1770的锁定接合。
在各个方面,在将钉仓插入加载单元的细长通道中之前和之后,本公开中描述的一个或多个滑动件定位和/或保持机制可组合地将滑动件定位和/或保持在钉仓中。例如,在将钉仓插入细长通道中之前,可采用第一定位和/或保持机制以将滑动件保持在钉仓内的第一位置处。然后,在将钉仓插入细长通道中之后,可采用第二定位和/或保持机制以将滑动件保持在钉仓内的第一位置处。
在图25至图28所示的示例中,一个或多个特征部1773可被接纳在仓盘的对应的孔口或切口中,如结合图11至图13的加载单元1200所述。在将钉仓1720插入细长通道1757中之前,特征部1773将滑动件保持在钉仓1720内的第一位置处。然而,在插入之后,滑动件1762通过保持特征部1770保持在第一位置处。因此,钉仓组件(例如,钉仓组件1750)可被配置成能够在插入细长通道之前与插入细长通道之后以不同的方式将滑动件保持在第一位置处。换句话讲,将钉仓插入细长通道中可导致主动保持特征部被停用,并导致非主动保持特征部被激活。
参考图29至图30,钉仓1820在各方面类似于本文其他地方所述的其他钉仓(诸如钉仓220)。例如,与钉仓220类似,钉仓1820包括刀片280(图5)。中心纵向狭槽1882沿着中心纵向平面1884被限定在钉仓220中。刀片280通常定位成略微在滑动件1860后面平移穿过钉仓1820中的中心纵向狭槽1882,以在缝合的身体组织排之间形成切口。
在各个方面,滑动件1860通过延伸跨过中心纵向狭槽1882的保持特征部1855保持在第一位置或原位置处。在所示示例中,保持特征部1855包括在部分1885a、1885b之间延伸的弱化中心部分1885c,这些部分限定在其一个端部处分别附接到侧壁1882a、1882b的铰接门。在所示示例中,中心部分1885c包括穿孔易破主体。在其他示例中,中心部分1885c可包括比部分1885a、1885b更小的厚度。
在任何情况下,中心部分1885c的设计和尺寸被设定成阻止滑动件1860推进直到达到预定驱动力阈值。超过阈值时,刀片280向滑动件1860施加力,该力突破中心部分1885c,导致部分1885a、1885b折叠或摆动打开,从而允许滑动件1860向远侧移动超过第一位置或原位置。
如本文其他地方更详细地描述,非击发钉仓的偶然碰撞或摇动可导致滑动件在非击发钉仓内的意外移动。图31示出了过程1920的逻辑流程图,描绘了用于检测1922电动外科缝合器械的滑动件沿着其击发路径的位置并基于滑动件沿着击发路径的位置调整1924电动外科缝合器械的一个或多个马达设置或马达控制程序的控制程序或逻辑配置。
图32至图34示出了根据过程1920的电动外科缝合器械1901,该电动外科缝合器械包括击发系统1902,该击发系统被配置成能够检测滑动件沿着其击发路径的位置并基于滑动件沿着击发路径的位置调整一个或多个马达设置或马达控制程序。击发系统1902包括被配置成能够执行过程1920的控制电路1930。在所示示例中,控制电路1930包括控制器1932,该控制器包括处理器1934和存储程序指令的存储器1936,该程序指令在由处理器1934执行时使处理器1934执行过程1920的一个或多个方面。
外科缝合器械1901还包括加载单元1900,该加载单元在许多方面类似于本文其他地方所述的其他加载单元(诸如加载单元1100、1200)。例如,与加载单元1100类似,加载单元1900包括驱动组件1980,该驱动组件包括驱动构件1982。马达组件1904包括马达,该马达被配置成能够沿着预定击发路径移动驱动构件1982以向远侧推进滑动件1962,从而将钉1908从钉仓1921部署到抓持在钉仓1921与砧座组件1931之间的组织中。滑动件1962包括多个凸轮作用表面,该多个凸轮作用表面被定位成接合和提升钉仓1921的仓体的钉保持狭槽内的推动器。推动器定位在钉仓1921内,以在滑动件1962被驱动构件1982推进时从仓体射出钉1908,如图33、图34所示。
图35是曲线图1940,其在x轴上示出驱动构件1982沿着击发路径从起始位置行进的距离(δ),并且在y轴上示出在电动外科缝合器械1901(图32)的击发行程期间马达的击发速度(V)和对应的电负载,分别由线1942'、1944'、1946'、1948'、1950'、1952'和线1942、1944、1946、1948、1950、1952表示。沿着击发路径的段ΔδSC限定可接受的初始滑动件接触位置,其中驱动构件1982被配置成能够在驱动构件1982沿着击发路径推进期间首先接合(参见图33)滑动件1962。另外,沿着击发路径的段ΔδIS限定可接受的初始钉接触位置,其中由驱动构件1982驱动的滑动件1962被配置成能够首先接合(参见图33)钉仓1921内的钉1908的推动器。
在成功的击发中,如线1942、1944所示,驱动构件1982被配置成能够初始接触(1M,2M)段ΔδSC内的滑动件1982,并且由驱动构件1982驱动的滑动件1962被配置成能够初始接触(1M',2M')段ΔδIS内的钉1908的推动器。
在各个方面,马达的电负载快速增加或递升到预定范围(F-滑动件min至F-滑动件max)内的值(FS1,图33)表示检测到驱动构件1982与滑动件1962之间的初始接触。在各个方面,控制电路1930通过监测指示马达的电负载的至少一个参数(诸如马达的电流消耗)来检测滑动件1962的位置。
同样,马达的电负载快速增加或递升到大于预定范围(F-滑动件min至F-滑动件max)的预定范围(F-钉min至F-钉max)内的值(FS2,图33)表示检测到由驱动构件1982驱动的滑动件1962与钉1908的推动器之间的初始接触。在各个方面,控制电路1930通过监测指示马达的电负载的至少一个参数(诸如马达的电流消耗)来检测滑动件1962与钉推动器之间的初始接触。
如果在段ΔδSC内检测到马达的电负载的快速增加,则控制电路1930允许驱动构件1982继续以小于或等于预定最大速度(V-滑动件max)的速度沿着击发路径推进滑动件1962,直到滑动件1982接合钉仓1921的推动器,其特征在于马达的电负载再次快速增加到值(FS2,图33),如上文所讨论。滑动件1962与钉推动器之间的初始接触的检测导致控制电路1930将驱动构件1982的速度逐渐升高(1R,2R)至大于预定最小速度(V-击发min)且小于或等于预定最大速度(V-击发max)的速度。
然而,如果控制电路1930未能(4M)检测到滑动件1962在段ΔδSC内的位置,如线1950所示,则控制电路1930可例如通过使马达组件1904停止马达来使驱动构件1982停止(4R)。控制电路1930还可通过用户界面1909提示用户替换钉仓,因为滑动件1962的缺失可能是由于先前击发的钉仓附接到加载单元1900的仓通道,或钉仓的缺失。如果用户同意,则驱动构件1982返回(b)到起始位置。然而,如果用户确信非击发钉仓已附接到钉仓通道,则由于钉仓的偶然碰撞,滑动件1962可能已移动或未对准。
为了解决该问题,控制电路1930提示用户允许继续(a)推进驱动构件1982直到达到(5M,5R)在无滑动件检测的情况下行进的预定最大阈值δmax。如果未检测到滑动件1962,并且已达到预定最大阈值δmax,则控制电路1930使驱动构件返回到其起始位置(5R')。
然而,如果在达到预定阈值δmax之前检测到(6M,6R)滑动件1962,则控制电路1930可允许驱动构件1982在预定段ΔδSL中的额外推进(6R')以将驱动组件1980联接到滑动件1962,如下文更详细描述的。预定段ΔδSL限定滑动件行进的功能窗口,用于确保驱动构件1982与滑动件1962之间的联接已发生。
然后,控制电路1980使马达将驱动构件1980缩回到其起始位置,这使滑动件1962返回到其在非击发钉仓内的原位置(6R')。控制电路1930还可提示用户向下推动由于滑动件1962的无意推进而偶然提升到仓平台上方的任何钉1908。一旦滑动件返回到原位置,控制电路1930可提示用户重新启动(c)击发行程。
除了上述之外,在段ΔδSC内成功检测(1M)到滑动件1962,伴随着未能(3M')在段ΔδIS内检测到滑动件1962与钉推动器之间的初始接触,导致控制电路1930停止(3R)驱动构件1982在段ΔδIS的端部处或附近的推进。控制电路1930还可使驱动构件1982返回到起始位置。
尽管过程1920被描述为由控制电路1930执行,但这仅是为了简洁起见,并且应当理解,过程1920和本文其他地方描述的其他过程可由可包括多种硬件和/或软件部件并可位于本公开所描述的各种合适的系统(诸如组合逻辑电路或时序逻辑电路)中或与本公开所描述的各种合适的系统相关联的电路执行。
在各种形式中,马达组件1904的马达例如可以是具有大约25,000RPM的最大旋转的DC有刷驱动马达。在其他布置结构中,马达可包括无刷马达、无绳马达、同步马达、步进马达、或任何其他合适的电动马达。马达可由功率源1910供电,在一种形式中,该功率源可包括可移除电源组。功率源1910可包括例如在名称为“SURGICAL INSTRUMENT COMPRISING ASENSOR SYSTEM”的美国专利申请公布2015/0272575号中进一步详细公开的各种电源布置结构中的任个电源布置结构,该申请的全部公开内容据此以引用方式并入本文。
在至少一个示例中,外科缝合器械1901被实施为在许多方面类似于图1的外科器械系统10的手持式外科器械。在另一示例中,外科缝合器械1901被实施为与名称为“SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS”的美国专利9,072,535号中所公开类似的机器人外科缝合器械,该专利申请据此全文以引用方式并入本文。
在各种示例中,外科器械1901包括传感器1938,该传感器包括一个或多个传感器,该一个或多个传感器被配置成能够监测指示驱动构件1982沿着击发路径的位置的参数。传感器1938还可包括一个或多个传感器,该一个或多个传感器被配置成能够监测马达的电流消耗。例如,读数传感器1938可帮助控制电路1930检测驱动构件1982在段ΔδSC或段ΔδIS中的存在,检测驱动构件1982与滑动件1962之间的初始接触,和/或检测由驱动构件1982驱动的滑动件1962与钉1908的推动器之间的初始接触。
在各个方面,传感器1938可包括各种其他传感器,诸如磁传感器(诸如霍尔效应传感器)、应变仪、压力传感器、电感传感器(诸如涡流传感器)、电阻传感器、电容传感器、光学传感器和/或任何其他合适的传感器,以执行例如过程1920的一个或多个方面。
现在参考图36至图38,钉仓2020包括保持特征部2072,该保持特征部被配置成能够将滑动件2062保持在钉仓2020内的原位置或起始位置处。钉仓2020在许多方面类似于本文其他地方描述的其他钉仓(诸如钉仓1520、1620)。为了阻止因钉仓2020的偶然碰撞或摇动而引起的滑动件2062的移动,钉仓2020的仓盘2058包括一个或多个保持特征部(例如,保持特征部2020),该一个或多个保持特征部被配置成能够配合地接合滑动件2062并阻止滑动件2062移动直到达到预定力。
在所示示例中,保持特征部2072为向内突起或弯曲的片簧的形式。片簧可冲压或形成在仓盘2058的基部近侧部分中。保持特征部2072包括附接到仓盘2058的基部部分并从该基部部分突出的基部。顶点部分从基部延伸,并且其尺寸被设定成通过限定在仓盘2058中的切口(例如,切口2022),并进入限定在滑动件2062的侧壁中的棘爪(例如,棘爪2063)。保持特征部2072限定斜坡,该斜坡阻止滑动件2062向远侧推进直到达到预定驱动力。当驱动构件(例如,驱动构件1982)在滑动件2072上施加大于预定驱动力的驱动力时,保持特征部2072通过滑动件2072的推进而被压平。
钉仓2020包括滑动件检测电路2073,该滑动件检测电路被配置成能够确定滑动件2062是否在原位置或起始位置之外。滑动件检测电路2073包括保持特征部2072和从保持特征部2072的远侧部分2075延伸穿过限定在保持特征部2072的近侧部分2078中的凹槽2077的线材或杆2071。线材2071终止于电接触部2079,诸如弹簧针。电接触部2079被配置成能够使滑动件检测电路2073在保持特征部2072如图36所示弯曲时的闭合构型与保持特征部2072如图37所示通过滑动件2062压平的打开构型之间转变。
因此,控制电路(诸如外科器械1901的控制电路1930)可采用滑动件检测电路2073通过检测滑动件检测电路2073是否已从闭合构型转变到打开构型来确定滑动件2062是否在原位置或起始位置之外。滑动件检测电路2073从闭合构型切换到打开构型向控制电路1930发信号通知滑动件2062已向远侧推进超过原位置或起始位置。此外,滑动件检测电路2073返回到闭合构型向控制电路1930发信号通知滑动件检测电路2073已返回到原位置或起始位置。
现在参考图39,钉仓组件2150可与加载单元(诸如加载单元1100、1200)一起使用。在所示示例中,钉仓组件2150包括细长通道2157,该细长通道的尺寸和设计被设定成接纳和可释放地保持钉仓2120,该钉仓在许多方面类似于本文其他地方所述的其他钉仓(诸如钉仓220)。例如,也以与结合图1至图8的加载单元16、16'、1100所述类似的方式经由由滑动件2162促动的钉驱动器或推动器将钉从钉仓2120穿过仓平台部署到组织中。钉和钉驱动器储存在钉仓2120的仓体中。
仓盘2158附接到仓体的底部,以防止钉驱动器从钉仓2120中掉出。仓盘2158包括盘狭槽2154,该盘狭槽与限定在仓平台中的仓狭槽对准。盘狭槽2154还与限定在细长通道2157的基部部分2152中的通道狭槽2153对准。在击发期间,驱动构件1182的工作端1184可滑动地移动穿过仓狭槽、盘狭槽2154和通道狭槽2153,从而使滑动件2162在仓体内从第一位置朝向第二位置向远侧推进,以使钉驱动器将钉部署穿过仓平台。
如上文更详细地描述的,由于钉仓2120的偶然碰撞或摇动,滑动件(诸如滑动件2162)可从其原位置或起始位置移动。为了检测这种移动,钉仓组件2150包括滑动件检测电路2160,该滑动件检测电路被配置成能够通过通道狭槽2153的相对侧上的一系列间隔开的电接触部2170a、2170b来将滑动件2162的位置检测为原位置或起始位置以及位于原位置或起始位置远侧的附加位置。当滑动件的对应电接触部2172a、2172b抵靠一对电接触部2170a、2170b定位时,滑动件检测电路2160转变到闭合构型,并且如图41所示对于该位置唯一的信号被传输到控制电路(诸如控制电路1930)。
控制电路1930可基于所接收的信号确定滑动件2162的位置。例如,存储器1936可存储用于基于所接收的信号的一个或多个参数来确定滑动件的位置的算法、方程或查找表。处理器1934可采用这样的算法、方程和/或查找表来基于一个或多个参数的读数确定滑动件的位置。在一个示例中,读数是指示滑动件2162的位置的电流或电压读数。
在至少一个示例中,传感器1938包括电流传感器,该电流传感器被配置成能够测量在闭合构型通过滑动件检测电路2160的电流。对于给定电压,所测量的电流值将根据电阻而改变。图41示出了与滑动件2162沿着击发路径的不同位置相关联的示例性电阻。每个位置被设计成产生唯一的电阻,并且因此产生与该位置相关联的唯一电流值。因此,电流传感器的电流读数可帮助控制电路(例如,控制电路1930)确定滑动件2162是处于原位置或起始位置还是处于其他更远侧位置。
如图40所示,导回控制电路1930的滑动件检测电路2160中存在固有基线电阻。每次滑动件2162完成滑动件检测电路2160时,通道中的线所固有的附加电阻将增加总电阻,并且因此产生沿着击发路径的每个位置的唯一电流读数。在各个方面,可在每个接触点处有意地使用高电阻电路材料和/或实际电阻器。
在所示示例中,电接触部2170a、2170b升高到细长通道2157的基部部分2152上方,并且限定被配置成能够确保与钉仓2120良好连接的偏压构件。电接触部2170a、2170b延伸穿过限定在仓盘2158的基部部分2159中的切口2174a、2174b。在各个方面,仓盘2158涂覆有薄膜电绝缘体以防止短路。类似地,基部部分2152的内表面可涂覆有薄膜电绝缘体以防止短路。电接触部2170a、2170b延伸穿过仓盘2158的电绝缘薄膜。
在各个方面,来自滑动件检测电路2160的信号指示击发行程的完成。电接触部2170a、2170b可定位在击发路径的端部处或附近。在所示示例中,电接触部2170a、2170b定位在距原位置或起始位置60mm处或约60mm距离处。当滑动件2162到达击发行程的末端时,电接触部2172a、2172b接合电接触部2170a、2170b,从而将滑动件检测电路2160转变到闭合构型,并且产生指示击发行程完成的唯一信号。
在所示示例中,滑动件2162为绝缘的,限定电接触部2172a、2172b的导电部分2161除外。然而,在其他示例中,整个滑动件2162可由导电材料构成。在此类实例中,整个滑动件2162成为滑动件检测电路2160的一部分。
现在参考图41,描绘了钉仓2220。钉仓2220在许多方面类似于本文其他地方描述的其他钉仓(诸如钉仓1220'、1220'、1320、1620)。例如,钉仓2220包括保持特征部2270,该保持特征部被配置成能够阻止滑动件2262因例如钉仓2220的偶然碰撞而在钉仓2220内偶然移动。
此外,钉仓2220还装备有滑动件复位电路2264,该滑动件复位电路被配置成能够将滑动件2262缩回到原位置或起始位置2267。在所示示例中,滑动件2262包括限定在滑动件基部2263中的一个或多个孔口、孔、凹槽或棘爪(例如,棘爪2272)。棘爪2272与保持特征部2270对准并且被配置成能够接纳该保持特征部。需要大于预定阈值的驱动力来将保持特征部2270与滑动件2262分开。因此,保持特征部2270被配置成能够阻止滑动件2262的推进直到达到预定阈值。
此外,保持特征部2270位于限定在钉仓2220的仓盘2258中的通道2266中。通道2266的近侧壁2266a限定用于保持特征部2270的近侧停止位置,该近侧停止位置对应于滑动件2262的原位置或起始位置2267。通道2266的远侧端部壁2266b限定保持特征部2270在通道2266内的远侧停止位置。由于不允许保持特征部2270移动超过远侧壁2266b,因此滑动件2262的额外移动迫使滑动件2262从保持特征部2270脱离。
除了上述之外,通道2266允许滑动件2262和保持特征部2270在由通道2266的长度或近侧壁2266a与远侧壁2266b之间的距离限定的预定范围内的偶然移动,而不使滑动件2262从保持特征部2270脱离。然而,在击发之前,滑动件复位电路2264被激活以缩回保持特征部2270以抵靠近侧壁2266a。保持特征部2270的缩回使滑动件2262缩回到原位置或起始位置2267。在所示示例中,滑动件复位电路2264包括螺线管2269,当被激活时,该螺线管被配置成能够拉动或缩回联接到保持特征部2270的线材或杆2268。
如本文其他地方所述,非击发钉仓2220的滑动件2262防止击发锁定组件1221在滑动件2262处于原位置或起始位置2267时转变到锁定构型。因此,由滑动件复位电路2264缩回滑动件2262确保非击发钉仓2220不会因滑动件从原位置或起始位置2267偶然推进而被误认为先前击发的钉仓2220。值得注意的是,滑动件复位电路2264能够仅在保持特征部2270联接到滑动件2262时缩回滑动件2262。一旦滑动件2262被驱动构件向远侧推进超过其与保持特征部2270的联接接合,则钉仓2220被视为已击发。
在各个方面,滑动件复位电路2264可结合到本文其他地方公开的其他钉仓中。在某些方面,滑动件复位电路2264可联接到控制电路1930,并且可响应于控制电路1930确定滑动件2262不在原位置或起始位置2267处而由控制电路1930激活。在此类方面,传感器1938中的一个或多个传感器可检测到滑动件2262处于超出原位置或起始位置2267的位置处。作为响应,控制电路1930可激活滑动件复位电路2264以在初始化击发行程之前将滑动件2262返回到原位置或起始位置2267。
现在参考图42至图44,描绘了滑动件复位电路2364的另选的实施方案。与滑动件复位电路2264类似,滑动件复位电路2364也被配置成能够将滑动件2362缩回到滑动件2362的预定运动范围内的原位置或起始位置,在该位置,保持特征部2370保持可移动地联接到滑动件2362。超出预定范围时,驱动构件促动滑动件2362从保持特征部2370脱离。然后,保持特征部2370通过滑动件复位电路2364缩回到近侧起始位置。
现在参考图45至图46,外科缝合组件2450包括钉仓2420,该钉仓包括滑动件2462。钉仓组件2450可转变到闭合构型,以便以与结合其他钉仓组件(诸如钉仓组件1150、1250)所述类似的方式来抓持组织。驱动构件(例如,驱动构件1182)的工作端2484限定I形梁,该I形梁被配置成能够实现外科缝合组件2450的击发。
工作端2484包括第一凸缘2484a、第二凸缘、将第一凸缘2484a和第二凸缘互连的竖直支柱2484c以及支撑在竖直支柱2484c上或形成在该竖直支柱中的刀。第二凸缘被定位成被可滑动地接纳在砧座组件(例如,砧座组件1130)的通道内,并且第一凸缘2484a被定位成沿着外科缝合组件2450的外表面可滑动地定位。致动滑动件2462在位于工作端2484远侧的位置处设置在仓组件2450内。
在各个方面,柔性臂2470从工作端2484延伸到限定在钉仓2420的仓体2459的侧壁中的通道2471中。在所示示例中,柔性臂2470限定穿过通道2471并闩锁到滑动件2470的远侧部分上的片簧臂构件。柔性臂2470被配置成能够将滑动件2462缩回到原位置或起始位置。
在通道2471中,柔性臂2470压平,使得其自然地压入滑动件2462的侧面中。在至少一个示例中,柔性臂2470的远侧端部经过滑动件2462的远侧端部。在松弛位置,突片2472从柔性臂2470延伸出来,以闩锁到滑动件2462的前边缘上。在全击发行程期间在驱动钉仓组件2450的刀之前发生的工作端2484的运动将允许柔性臂2470将滑动件2462拉回到原位置或起始位置,只要滑动件2462在由侧通道2471的长度限定的阈值内即可。
图47至图51示出了用于在击发外科器械以部署钉仓2520的钉之前将钉仓(例如,钉仓2520)的滑动件缩回到原位置(H)的滑动件复位机制2500的各个方面。如本文其他地方所讨论,如果钉仓碰撞或摇动,则非击发钉仓的滑动件可能会无意中移动,这可能导致钉仓被错误地视为已击发和/或可能导致击发锁定组件被激活。滑动件复位机制2500被配置成能够使无意中移动到其在钉仓内的原位置(H)的滑动件返回,只要滑动件尚未从原位置(H)移动超过预定距离(d1)。
图47示出了钉仓2520的滑动件2562在位于原位置(H)远侧但位于由预定距离(d1)限定的远侧位置(A)近侧的位置。在击发之前,滑动件复位构件2592将滑动件2562缩回到原位置(H)。滑动件复位构件2592包括捕捉器2595,该捕捉器可为钩或弯曲部分的形式,该捕捉器被配置成能够接合滑动件2562的远侧部分以使滑动件2562返回到原位置(H)。
在各个方面,滑动件复位构件2592的一部分在滑动件2562下方延伸并且能够滑动地移动,诸如在限定在钉仓2520的仓盘中的通道内。在至少一个示例中,如图51所示,滑动件复位构件2592可通过限定在柄部2507中的致动构件2593手动操作。用户可在激活击发机制之前向近侧拉动致动构件2593以使滑动件2562返回到原位置(H)。
在另一示例中,如图49和图50所示,滑动件复位构件2592由在许多方面类似于外科器械1901的马达驱动组件1904的马达组件2504提供动力。在所示示例中,马达驱动组件2504包括线性螺纹联接器2598,该线性螺纹联接器可操作地连接到滑动件复位构件2592。在所示示例中,马达组件2504容纳在包括触发器构件2512的柄部2510中。触发器构件2512到第一位置的移动导致马达组件2504缩回滑动件复位构件2592,由此使滑动件2562返回到原位置(H)。触发器构件2512从第一位置到第二位置的第二移动激活击发行程或击发运动,以将钉从钉仓2520部署。
滑动件复位机制2500可与本公开的其他合适实施方案(诸如滑动件检测电路)结合实施。此外,滑动件复位机制2500可与外科缝合器械1901的合适部件结合实施。例如,控制电路1930可基于滑动件检测电路确定滑动件处于与原位置不同的位置。作为响应,控制电路1930可使马达组件2504将滑动件返回到原位置,这例如可由滑动件检测电路验证。
在使用中,滑动件2562通过滑动件复位构件2592返回到原位置(H),如图47所示。然后,驱动构件(例如,驱动构件1182)被配置成能够推进其工作端(例如工作端1184)以接合滑动件2562,从而推进滑动件2562以从钉仓2520部署钉。在各个方面,如图48所示,滑动件复位构件2592包括凸起部分2597,该凸起部分可为斜坡的形式,靠近捕捉器2595的近侧定位。在驱动构件2582的推进期间,工作端2584可在接合滑动件2562之前接合凸起部分2597,这使捕捉器2595移出滑动件2562的击发路径2503。在至少一个示例中,工作端2584使捕捉器2595落入限定在钉仓2520的仓盘中的通道中,这允许滑动件3562进一步推进。
在各个方面,设置可接受和/或不可接受的滑动件位置或者沿着击发路径滑动件距原位置的距离(在本文中也称为功能窗口)可至少部分地取决于钉仓大小。因此,为了准确地设置此类位置或距离,外科钉仓可包括识别码,在将钉仓附接到外科器械(例如,外科器械1901)之后,该识别码可传达给控制电路(例如,控制电路1930)。可通过与钉仓的有线连接或无线地进行通信。
在各个方面,控制电路可基于所传送的仓的识别码在给定滑动件触点的预期位置的情况下选择合适的功能窗口。在各个方面,击发系统还可调整预定击发程序的一个或多个参数,诸如基于仓的识别的感测区域和/或基于感测到的滑动件相对于其预期位置的定时/位置的致动区域两者的力/速度/行程。
现在参考图52至图56,加载单元2600在许多方面类似于本文其他地方描述的其他加载单元(诸如加载单元1100、1200)。例如,加载单元2600包括钉仓组件2650和砧座组件2630。砧座组件2630和钉仓组件2650中的至少一者能够相对于另一者从如图53所示的打开构型运动到如图54所示的闭合构型以抓持组织。钉从限定在钉仓组件2650的钉仓2620的仓体2622中的钉腔2621部署到组织中。砧座组件2630包括被配置成能够使钉变形的凹坑。
除上述之外,钉仓2620包括被配置成能够防止钉从钉腔2621中掉出的仓盘2658。仓体2622能够通过能够被接纳在限定在仓盘2658的侧壁中的对应切口2653中的突起部2623附接到仓盘2658。在各个示例中,切口26523的大小和形状被设定成接纳对应的切口2653,以将仓体2622固定到仓盘2657。
在使用中,钉仓2620被插入细长通道2657中以用于与该细长通道组装在一起。在各个方面,钉仓2620和细长通道2657包括对应的锁定特征部。在所示示例中,当钉仓2620被插入细长通道2657中时,限定在仓盘2658的侧壁中的盘突起部2656被接纳在L形狭槽2659中。
钉仓2620和细长通道2657的对应锁定特征部允许仓盘2658相对于细长通道2658的近侧平移运动以将钉仓2620锁定到细长通道2657,并且允许仓盘2658相对于细长通道2658的远侧平移运动以将钉仓2620解锁到细长通道2657。在所示示例中,L形狭槽2659的大小和形状被设定成允许对应突起部2656在L形狭槽2659的长臂中向近侧平移距离“X”,由此将钉仓2620锁定到细长通道2657,并且允许对应突起部在L形狭槽2659的长臂中向远侧平移距离“X”,由此将钉仓2620从细长通道2657解锁。
在其他示例中,突起部可被限定在细长通道中,并且对应的L形狭槽可限定在钉仓的仓盘中。此外,可实施其他合适的配合和锁定机制以产生钉仓和细长通道的锁定构型和解锁构型。例如,具有其他合适形状的狭槽可替换L形狭槽。
除上述之外,在砧座组件2630和钉仓组件2650转变到闭合构型期间自动实施钉仓2620到细长通道2657的锁定机制,如图53和图54所示。在某些示例中,砧座组件2630被配置成能够使仓盘2658相对于细长通道2657向近侧平移成锁定构型。在所示示例中,砧座组件2630包括凸轮作用构件2631,该凸轮作用构件被配置成能够当加载单元2600转变成闭合构型(图54)时将仓盘2658缩回到锁定构型。
在所示示例中,仓盘2658包括被盘狭槽2663对分的近侧舌部部分2662。近侧舌部部分2662包括在盘狭槽2663的相对侧上的切口2661。凸轮作用构件2631被配置成能够在加载单元2600的闭合运动期间接合切口2661的近侧边缘2664。随着加载单元2600转变到闭合构型,凸轮作用构件2631抵靠切口2661的近侧边缘2664施加凸轮作用力,从由此使仓盘2658向近侧平移成锁定配置。因此,加载单元2600的闭合运动自动将钉仓2620转变成具有细长通道2657的锁定构型。
在所示示例中,为了确保与凸轮作用构件2631的正确接合,近侧舌部部分2662的近侧端部朝向切口2661弯曲,由此形成边缘2664。凸轮作用构件2631被配置成能够随着凸轮作用构件2631与砧座组件2630一起朝向钉仓2620枢转而接合边缘2664。在其他示例中,可固定包括凸轮作用构件2631的砧座组件,并且细长通道朝向砧座组件枢转以产生闭合构型。在此类示例中,边缘2664朝向凸轮作用构件2631移动。当边缘2664接合凸轮作用构件2641时,凸轮作用力导致仓盘2658向近侧平移到锁定构型。
除上述之外,细长通道2657包括限定在细长通道2657的基部2672的近侧部分中的近侧狭槽或切口2671。切口2671与切口2661侧向或横向对准,或至少部分地对准。在解锁构型中,如图53所示,切口2661位于切口2671远侧。然而,在锁定构型中,如图54所示,切口2661与切口2671纵向对准,或至少比在解锁构型中更接近于与切口2671纵向对准。随着凸轮作用构件1631在切口2661、2671中枢转地移动,凸轮作用构件2631被配置成能够使切口2661向近侧移动距离“X”以与切口2671对准或至少部分地对准,如图54所示。
在击发行程完成之后,通过将仓盘2658平移到解锁构型来将用过的钉仓2620从细长通道2657移除。在所示示例中,仓盘2658包括释放特征部2655,该释放特征部可以是指状突片的形式。释放特征部2655能够在限定在仓体2622的鼻状部分2626中的对应狭槽2620中向远侧滑动地移动,以将钉仓2620转变成解锁构型,如图55和图56所示。
现在参考图57至图61,钉外科组件2750包括细长通道2757、钉仓2758和保持器2730。钉外科组件2750在许多方面类似于本文其他地方所述的其他钉外科组件。例如,钉外科组件2750可结合到本文其他地方所述的任何合适的外科器械中。
在图57所示的示例中,钉仓组件2750处于第一构型,其中保持器2730与钉仓2720组装在一起,以防止钉无意中从钉仓2720的钉腔中掉出。在第一构型中,保持器2730的长突片2731限定接合钉仓2720的仓盘2758的保持器臂,并且短突片2732限定接合钉仓2720的仓体2721的保持器臂。突片2731、2732协作以将保持器2730保持在第一构型中压靠仓体2721的平台2722,以将钉保持在它们的钉腔中。在所示示例中,仓体2721包括从平台2722侧向延伸的凸部2723。在第一构型中,凸部2723由短突片2732接合。
在击发行程完成之后,由保持器2730将用过的钉仓2720从细长通道2757移除,如图58至图61所示。在第二构型中,保持器2730的长突片2731插入穿过限定在仓体2721中的轨道或凹口2724,如图60最佳所示。突片2731将仓盘2558的可折叠构件2755从细长通道2757的对应孔口2756释放,以允许由保持器2730将钉仓2720从细长通道2757移除,如图61所示。
在所示示例中,可折叠构件2755为片簧的形式,其可冲压或形成在仓盘2758的侧壁中。突片2731包括钩特征部2733,该钩特征部被配置成能够随着突片2731在轨道2724中推进,使可折叠构件2755折叠以将可折叠构件2755从孔口2756释放,并且被进一步构造成能够在第二构型中与折叠的可折叠构件2755形成能够移动的锁定接合,如图60所示。
然后将保持器2730拉离细长通道2757以将钉仓2720从细长通道2757移除,如图61所示。随着保持器2730被拉离,钩特征部2733将可折叠构件2755提升出轨道2724,由此将钉仓2720从细长通道2757释放。
在所示示例中,孔口2756以切口的形式被限定在细长通道2757的侧壁中。在其他示例中,孔口2756可被用限定在细长通道2757的内壁的内表面上的凹部或狭槽替换。凹部或狭槽的形状和大小被设定成以与图59中关于孔口2756所示类似的方式接纳处于其自然状态的可折叠构件2755。
仍参考图59至图61,描绘了使用保持器2730将用过的钉仓2720从细长通道2757移除的方法。该方法包括将保持器2730从钉仓组件2750脱离。该方法还包括将突片2731插入轨道2724中,通过突片2731的钩特征部2733将可折叠构件2755从孔口2756释放,以及在折叠的可折叠构件2755与轨道2724中的钩特征部2733之间形成能够移动的锁定接合。该方法还包括将保持器2730拉离细长通道2757以将用过的钉仓2720从细长通道2757移除。
现在参考图62,钉外科组件2850包括快速释放特征部,该快速释放特征部便于从外科器械的细长通道2857移除钉仓2820。钉外科组件2850在许多方面类似于本文其他地方所述的其他钉外科组件。例如,钉外科组件2850可结合到本文其他地方所述的任何合适的外科器械中。
钉仓2820包括仓体2821和仓盘2858。此外,钉仓2858包括可移动地设置在仓体2821的鼻状部分2823中的仓释放构件2822。在所示示例中,仓释放构件2822能够通过限定在鼻状部分2823中的通道2824从未致动构型线性移动到致动构型。在未致动构型,如图62所示,仓释放构件2822从鼻状部分2823突出穿过通道2824的一个端部。当被致动时,例如通过向仓释放构件2822施加外部压力,该仓释放构件在通道2824中移动,并且突出穿过通道2824的另一个端部。然后,钉释放构件2822压靠细长通道2857以从细长通道2857释放钉仓2820。在所示示例中,通道2824限定与细长通道2857成锐角的仓释放构件2822的运动方向。
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13/118,241号(现为美国专利9,072,535号)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号;2017年5月18日公布的名称为“STAPLE PUSHER WITHLOST MOTION BETWEEN RAMPS”的国际专利公布WO 2017/083126号;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号;2017年3月17日提交的名称为“STAPLER WITH CABLE-DRIVEN ADVANCEABLECLAMPING ELEMENT AND DUAL DISTAL PULLEYS”的美国专利申请公布2017/0265954号;2017年2月15日提交的名称为“STAPLER WITH CABLE-DRIVEN ADVANCEABLE CLAMPINGELEMENT ANDDISTAL PULLEY”的美国专利申请公布2017/0265865号;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号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。
实施例
本文所述主题的各个方面在以下编号的实施例中陈述。
实施例1-一种用于与外科缝合器械一起使用的端部执行器。所述端部执行器包括第一钳口,所述第一钳口包括砧座,所述砧座包括近侧凸轮作用构件。所述端部执行器还包括第二钳口,其中,所述第一钳口和所述第二钳口中的至少一者能够相对于另一者运动以将所述端部执行器转变成闭合构型。所述第二钳口包括细长通道,所述细长通道包括近侧通道孔口;和钉仓,所述钉仓能够插入到所述细长通道中以用于与所述细长通道组装在一起。所述钉仓包括仓体和仓盘。所述仓盘包括近侧盘孔口,在处于解锁构型的情况下,所述近侧盘孔口被配置成能够当所述钉仓与所述细长通道组装时定位成部分地位于所述近侧通道孔口的远侧。所述凸轮作用构件被配置成能够在所述端部执行器转变到闭合构型期间使所述仓盘相对于所述仓体和所述细长通道从所述解锁构型朝近侧平移到锁定构型。
实施例2-根据实施例1所述的端部执行器,其中,当所述端部执行器转变到所述闭合构型时,所述凸轮作用构件被接纳在所述近侧盘孔口中。
实施例3-根据实施例1或2所述的端部执行器,其中,所述近侧通道孔口被配置成能够在所述端部执行器转变到所述闭合构型期间顺应所述凸轮作用构件的枢转运动。
实施例4-根据实施例1、2或3所述的端部执行器,其中,所述仓盘包括用于将所述仓盘平移至所述解锁构型的释放特征部。
实施例5-根据实施例4所述的端部执行器,其中,所述释放特征部包括指状突片。
实施例6-根据实施例4或5所述的端部执行器,其中,所述仓体包括远侧狭槽,所述远侧狭槽被配置成能够顺应所述释放特征部的平移运动。
实施例7-根据实施例1、2、3、4、5或6所述的端部执行器,其中,所述仓体包括突出部,并且其中,所述仓盘包括侧壁,所述侧壁包括孔口,所述孔口被配置成能够当所述仓体与所述仓盘组装时接纳所述突出部。
实施例8-根据实施例1、2、3、4、5、6或7所述的端部执行器,其中,所述仓盘包括突出部,其中,所述细长通道包括L形狭槽,所述L形狭槽被配置成能够当所述钉仓与所述细长通道组装时接纳所述突出部。
实施例9-根据实施例8所述的端部执行器,其中,当所述仓盘从所述解锁构型平移到所述锁定构型时,所述突出部能够在L形狭槽中移动。
实施例10-一种用于与外科缝合器械一起使用的端部执行器。所述端部执行器包括第一钳口,所述第一钳口包括砧座。所述端部执行器还包括第二钳口,其中,所述第一钳口和所述第二钳口中的至少一者能够相对于另一者运动以抓持组织。所述第二钳口包括细长通道和钉仓,所述钉仓能够插入到所述细长通道中以用于与所述细长通道组装在一起。所述钉仓包括仓体和附接到所述仓体的仓盘。所述砧座被配置成能够在所述细长通道内使所述仓盘相对于所述仓体和所述细长通道从解锁构型朝近侧平移到锁定构型。
实施例11-根据实施例10所述的端部执行器,其中,所述仓盘包括突出部,其中,细长通道包括L形狭槽,所述L形狭槽被配置成能够当所述钉仓与所述细长通道组装时接纳所述突出部。
实施例12-根据实施例11所述的端部执行器,其中,当所述仓盘从所述解锁构型平移到所述锁定构型时,所述突出部能够在所述L形狭槽中移动。
实施例13-一种用于与外科缝合器械一起使用的外科钉仓。所述外科钉仓组件包括细长通道,所述细长通道包括具有孔口的侧壁;和钉仓,所述钉仓能够插入到所述细长通道中以便与所述细长通道组装在一起。所述钉仓包括仓体。所述仓体包括平台和限定在所述平台中的钉腔,其中,所述钉腔包括钉。所述仓体还包括附接到所述仓体的仓盘,其中,所述仓盘包括在自然状态下能够被接纳在所述细长通道的孔口中的可折叠棘爪。所述钉仓组件还包括能够在两种不同的构型中可释放地联接到所述细长通道的保持器。在第一构型中,所述保持器将所述钉保持在所述钉腔中。在第二构型中,该保持器使可折叠棘爪从孔口脱开合,以便于将钉仓从细长通道移除。
实施例14-根据实施例13所述的端部执行器,其中,所述保持器包括保持器臂。
实施例15-根据实施例13或14所述的端部执行器,其中,所述侧壁包括轨道,所述轨道被配置成能够在所述第二构型中引导所述保持器臂在所述可折叠棘爪与所述孔口之间的插入。
实施例16-根据实施例15所述的端部执行器,其中,所述轨道被限定在所述侧壁的内表面中。
实施例17-根据实施例13、14、15或16所述的端部执行器,其中,所述可折叠棘爪包括在所述第一构型中能够被接纳在所述孔口中的第一接合部分。
实施例18-根据实施例17所述的端部执行器,其中,所述保持器臂包括第二接合部分,所述第二接合部分被配置成能够在所述第二构型中从所述孔口释放所述第一接合部分。
实施例19-根据实施例18所述的端部执行器,其中,所述第一接合部分和所述第二接合部分在所述第二构型中在所述轨道内处于锁定接合。
实施例20-根据实施例19所述的端部执行器,其中,所述锁定接合有利于通过使所述保持器臂从所述轨道缩回而从所述细长通道释放所述钉仓。
尽管已举例说明和描述了多个形式,但是申请人的意图并非将所附权利要求的范围约束或限制在此类细节中。在不脱离本公开的范围的情况下,可实现对这些形式的许多修改、变型、改变、替换、组合和等同物,并且本领域技术人员将想到这些形式的许多修改、变型、改变、替换、组合和等同物。此外,另选地,可将与所描述的形式相关联的每个元件的结构描述为用于提供由所述元件执行的功能的器件。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。因此,应当理解,上述具体实施方式和所附权利要求旨在涵盖属于本发明所公开的形式范围内的所有此类修改、组合和变型。所附权利要求旨在涵盖所有此类修改、变型、改变、替换、修改和等同物。
上述具体实施方式已经由使用框图、流程图和/或示例阐述了装置和/或方法的各种形式。只要此类框图、流程图和/或示例包含一个或多个功能和/或操作,本领域的技术人员就要将其理解为此类框图、流程图和/或示例中的每个功能和/或操作都可以单独和/或共同地通过多种硬件、软件、固件或实际上它们的任何组合来实施。本领域的技术人员将会认识到,本文公开的形式中的一些方面可作为在一台或多台计算机上运行的一个或多个计算机程序(例如,作为在一个或多个计算机系统上运行的一个或多个程序),作为在一个或多个处理器上运行的一个或多个程序(例如,作为在一个或多个微处理器上运行的一个或多个程序),作为固件,或作为实际上它们的任何组合全部或部分地在集成电路中等效地实现,并且根据本公开,设计电路系统和/或编写软件和/或硬件的代码将在本领域技术人员的技术范围内。另外,本领域的技术人员将会认识到,本文所述主题的机制能够作为多种形式的一个或多个程序产品进行分布,并且本文所述主题的例示性形式适用,而不管用于实际进行分布的信号承载介质的具体类型是什么。
用于编程逻辑以执行各种所公开的方面的指令可存储在系统中的存储器内,诸如动态随机存取存储器(DRAM)、高速缓存、闪存存储器或其他存储器。此外,指令可经由网络或通过其他计算机可读介质来分发。因此,机器可读介质可包括用于存储或传输以机器(例如,计算机)可读形式的信息的任何机构,但不限于软盘、光学盘、光盘只读存储器(CD-ROM)、和磁光盘、只读存储器(ROM)、随机存取存储器(RAM)、可擦除可编程只读存储器(EPROM)、电可擦除可编程只读存储器(EEPROM)、磁卡或光卡、闪存存储器、或经由电信号、光学信号、声学信号或其他形式的传播信号(例如,载波、红外信号、数字信号等)在因特网上传输信息时使用的有形的、机器可读存储装置。因此,非暂态计算机可读介质包括适于以机器(例如,计算机)可读的形式存储或传输电子指令或信息的任何类型的有形机器可读介质。
如本文任一方面所用,术语“控制电路”可指例如硬连线电路系统、可编程电路系统(例如,计算机处理器,该计算机处理器包括一个或多个单独指令处理内核、处理单元,处理器、微控制器、微控制器单元、控制器、数字信号处理器(DSP)、可编程逻辑装置(PLD)、可编程逻辑阵列(PLA)、场可编程门阵列(FPGA))、状态机电路系统、存储由可编程电路系统执行的指令的固件、以及它们的任何组合。控制电路可以集体地或单独地实现为形成更大系统的一部分的电路系统,例如集成电路(IC)、专用集成电路(ASIC)、片上系统(SoC)、台式计算机、膝上型计算机、平板计算机、服务器、智能电话等。因此,如本文所用,“控制电路”包括但不限于具有至少一个离散电路的电子电路、具有至少一个集成电路的电子电路、具有至少一个专用集成电路的电子电路、形成由计算机程序配置的通用计算设备的电子电路(如,至少部分地实施本文所述的方法和/或设备的由计算机程序配置的通用计算机,或至少部分地实施本文所述的方法和/或设备的由计算机程序配置的微处理器)、形成存储器设备(如,形成随机存取存储器)的电子电路,和/或形成通信设备(如,调节解调器、通信开关或光电设备)的电子电路。本领域的技术人员将会认识到,可以模拟或数字方式或它们的一些组合实施本文所述的主题。
如本文的任何方面所用,术语“逻辑”可指被配置成能够执行前述操作中的任一者的应用程序、软件、固件和/或电路系统。软件可体现为记录在非暂态计算机可读存储介质上的软件包、代码、指令、指令集和/或数据。固件可体现为在存储器装置中硬编码(例如,非易失性)的代码、指令或指令集和/或数据。
如本文任一方面所用,术语“部件”、“系统”、“模块”等可指计算机相关实体、硬件、硬件和软件的组合、软件或执行中的软件。
如本文任一方面中所用,“算法”是指导致所期望结果的有条理的步骤序列,其中“步骤”是指物理量和/或逻辑状态的操纵,物理量和/或逻辑状态可(但不一定)采用能被存储、转移、组合、比较和以其他方式操纵的电或磁信号的形式。常用于指这些信号,如位、值、元素、符号、字符、术语、数字等。这些和类似的术语可与适当的物理量相关联并且仅仅是应用于这些量和/或状态的方便的标签。
网络可包括分组交换网络。通信装置可能够使用所选择的分组交换网络通信协议来彼此通信。一个示例性通信协议可包括可能够允许使用传输控制协议/因特网协议(TCP/IP)进行通信的以太网通信协议。以太网协议可符合或兼容电气和电子工程师学会(IEEE)于2008年12月发布的标题为“IEEE 802.3Standard”的以太网标准和/或本标准的更高版本。另选地或附加地,通信装置可能够使用X.25通信协议彼此通信。X.25通信协议可符合或兼容由国际电信联盟电信标准化部门(ITU-T)发布的标准。另选地或附加地,通信装置可能够使用帧中继通信协议彼此通信。帧中继通信协议可符合或兼容由国际电报电话咨询委员会(CCITT)和/或美国国家标准学会(ANSI)发布的标准。另选地或附加地,收发器可能够使用异步传输模式(ATM)通信协议彼此通信。ATM通信协议可符合或兼容ATM论坛于2001年8月发布的名为“ATM-MPLS Network Interworking 2.0”的ATM标准和/或该标准的更高版本。当然,本文同样设想了不同的和/或之后开发的连接取向的网络通信协议。
除非上述公开中另外明确指明,否则可以理解的是,在上述公开中,使用术语如“处理”、“估算”、“计算”、“确定”、“显示”的讨论是指计算机系统或类似的电子计算装置的动作和进程,其操纵表示为计算机系统的寄存器和存储器内的物理(电子)量的数据并将其转换成相似地表示为计算机系统存储器或寄存器或其他此类信息存储、传输或显示装置内的物理量的其他数据。
一个或多个部件在本文中可被称为“被配置成能够”、“可配置成能够”、“可操作/可操作地”、“适于/可适于”、“能够”、“可适形/适形于”等。本领域的技术人员将会认识到,除非上下文另有所指,否则“被配置成能够”通常可涵盖活动状态的部件和/或未活动状态的部件和/或待机状态的部件。
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。
本领域的技术人员将认识到,一般而言,本文、以及特别是所附权利要求(例如,所附权利要求的正文)中所使用的术语通常旨在为“开放”术语(例如,术语“包括”应解释为“包括但不限于”,术语“具有”应解释为“至少具有”,术语“包含”应解释为“包含但不限于”等)。本领域的技术人员还应当理解,如果所引入权利要求表述的具体数目为预期的,则此类意图将在权利要求中明确表述,并且在不存在此类叙述的情况下,不存在此类意图。例如,为有助于理解,下述所附权利要求可含有对介绍性短语“至少一个”和“一个或多个”的使用以引入权利要求。然而,对此类短语的使用不应视为暗示通过不定冠词“一个”或“一种”引入权利要求表述将含有此类引入权利要求表述的任何特定权利要求限制在含有仅一个这样的表述的权利要求中,甚至当同一权利要求包括介绍性短语“一个或多个”或“至少一个”和诸如“一个”或“一种”(例如,“一个”和/或“一种”通常应解释为意指“至少一个”或“一个或多个”)的不定冠词时;这也适用于对用于引入权利要求表述的定冠词的使用。
另外,即使明确叙述引入权利要求叙述的特定数目,本领域的技术人员应当认识到,此种叙述通常应解释为意指至少所叙述的数目(例如,在没有其他修饰语的情况下,对“两个叙述”的裸叙述通常意指至少两个叙述、或两个或更多个叙述)。此外,在其中使用类似于“A、B和C中的至少一者等”的惯例的那些情况下,一般而言,此类构造意在具有本领域的技术人员将理解所述惯例的意义(例如,“具有A、B和C中的至少一者的系统”将包括但不限于具有仅A、仅B、仅C、A和B一起、A和C一起、B和C一起和/或A、B和C一起等的系统)。在其中使用类似于“A、B或C中的至少一者等”的惯例的那些情况下,一般而言,此类构造意在具有本领域的技术人员将理解所述惯例的意义(例如,“具有A、B或C中的至少一者的系统”应当包括但不限于具有仅A、仅B、仅C、A和B一起、A和C一起、B和C一起和/或A、B和C一起等的系统)。本领域的技术人员还应当理解,通常,除非上下文另有指示,否则无论在具体实施方式、权利要求或附图中呈现两个或更多个替代术语的转折性词语和/或短语应理解为涵盖包括所述术语中的一者、所述术语中的任一个或这两个术语的可能性。例如,短语“A或B”通常将被理解为包括“A”或“B”或“A和B”的可能性。
对于所附的权利要求,本领域的技术人员将会理解,其中表述的操作通常可以任何顺序进行。另外,尽管以一个或多个序列出了各种操作流程图,但应当理解,可以不同于所示顺序的其他顺序执行各种操作,或者可同时执行所述各种操作。除非上下文另有规定,否则此类替代排序的示例可包括重叠、交错、中断、重新排序、增量、预备、补充、同时、反向,或其他改变的排序。此外,除非上下文另有规定,否则像“响应于”、“相关”这样的术语或其他过去式的形容词通常不旨在排除此类变体。
值得一提的是,任何对“一个方面”、“一方面”、“一范例”、“一个范例”的提及均意指结合所述方面所述的具体特征部、结构或特征包括在至少一个方面中。因此,在整个说明书的各种位置出现的短语“在一个方面”、“在一方面”、“在一范例中”、“在一个范例中”不一定都指同一方面。此外,具体特征部、结构或特征可在一个或多个方面中以任何合适的方式组合。
在本说明书中,除非另有说明,否则如本公开中所使用的术语“约”或“大约”是指如本领域普通技术人员所确定的特定值的可接受误差,这部分地取决于如何测量或确定值。在某些实施方案中,术语“约”或“大约”是指在1、2、3或4标准偏差内。在某些实施方案中,术语“约”或“大约”是指在给定值或范围的50%、20%、15%、10%、9%、8%、7%、6%、5%、4%、3%、2%、1%、0.5%或0.05%内。
在本说明书中,除非另外指明,否则所有的数值参数在所有情况下均应理解为以术语“约”作引语或者受术语“约”修饰,其中数值参数具有用于确定参数数值的基础测量技术的固有差异性特征。在最低程度上且不试图将等同原则的应用限制到权利要求的保护范围的前提下,至少应当根据所报告的数值的有效数位并通过应用惯常的四舍五入法来解释本文描述的每一个数值参数。
本文列出的任何数值范围包括涵盖在所列范围内的所有子范围。例如,范围“1至10”包括列出的最小值1与列出的最大值10之间(包括1和10)的所有子范围,也就是说,具有等于或大于1的最小值和等于或小于10的最大值。此外,本文所列的所有范围包括所列范围的端点。例如,“1至10”的范围包括端点1和10。本说明书中列出的任何上限值旨在包括涵盖在其中的所有较小限值,并且本说明书中列出的任何下限值旨在包括涵盖在其中的所有较大限值。因此,申请人保留修正本说明书(包括权利要求)的权利,以明确地列出涵盖在明确列出的范围内的任何子范围。所有此类范围在本说明书中被固有地描述。
本说明书提及和/或在任何申请数据表中列出的任何专利申请,专利,非专利公布或其他公开材料均以引用方式并入本文,只要所并入的材料在此不一致。因此,并且在必要的程度下,本文明确列出的公开内容代替以引用方式并入本文的任何冲突材料。据称以引用方式并入本文但与本文列出的现有定义、陈述或其他公开材料相冲突的任何材料或其部分,将仅在所并入的材料与现有的公开材料之间不产生冲突的程度下并入。
概括地说,已经描述了由采用本文所述的概念产生的许多有益效果。为了举例说明和描述的目的,已经提供了一个或多个形式的上述具体实施方式。这些具体实施方式并非意图为详尽的或限定到本发明所公开的精确形式。可以按照上述教导内容对本发明进行修改或变型。选择和描述的一个或多个形式是为了说明原理和实际应用,从而使本领域的普通技术人员能够利用适用于预期的特定用途的各种形式和各种修改。与此一同提交的权利要求书旨在限定完整范围。

Claims (20)

1.一种用于与外科缝合器械一起使用的端部执行器,所述端部执行器包括:
第一钳口,所述第一钳口包括砧座,所述砧座包括近侧凸轮作用构件;
第二钳口,其中,所述第一钳口和所述第二钳口中的至少一者能够相对于另一者运动以将所述端部执行器转变成闭合构型,所述第二钳口包括:
细长通道,所述细长通道包括近侧通道孔口;和
钉仓,所述钉仓能够插入所述细长通道中以用于与所述细长通道组装在一起,其中,所述钉仓包括:
仓体;和
仓盘,所述仓盘包括近侧盘孔口,在处于解锁构型的情况下,所述近侧盘孔口被配置成能够当所述钉仓与所述细长通道组装时定位成部分地位于所述近侧通道孔口的远侧;并且
其中,所述凸轮作用构件被配置成能够在所述端部执行器转变到闭合构型期间使所述仓盘相对于所述仓体和所述细长通道从所述解锁构型朝近侧平移到锁定构型。
2.根据权利要求1所述的端部执行器,其中,当所述端部执行器转变到所述闭合构型时,所述凸轮作用构件被接纳在所述近侧盘孔口中。
3.根据权利要求1所述的端部执行器,其中,所述近侧通道孔口被配置成能够在所述端部执行器转变到所述闭合构型期间顺应所述凸轮作用构件的枢转运动。
4.根据权利要求1所述的端部执行器,其中,所述仓盘包括用于将所述仓盘平移至所述解锁构型的释放特征部。
5.根据权利要求4所述的端部执行器,其中,所述释放特征部包括指状突片。
6.根据权利要求4所述的端部执行器,其中,所述仓体包括远侧狭槽,所述远侧狭槽被配置成能够顺应所述释放特征部的平移运动。
7.根据权利要求1所述的端部执行器,其中,所述仓体包括突出部,并且其中,所述仓盘包括侧壁,所述侧壁包括孔口,所述孔口被配置成能够当所述仓体与所述仓盘组装时接纳所述突出部。
8.根据权利要求1所述的端部执行器,其中,所述仓盘包括突出部,其中,细长通道包括L形狭槽,所述L形狭槽被配置成能够当所述钉仓与所述细长通道组装时接纳所述突出部。
9.根据权利要求8所述的端部执行器,其中,当所述仓盘从所述解锁构型平移到所述锁定构型时,所述突出部能够在所述L形狭槽中移动。
10.一种用于与外科缝合器械一起使用的端部执行器,所述端部执行器包括:
第一钳口,所述第一钳口包括砧座;和
第二钳口,其中,所述第一钳口和所述第二钳口中的至少一者能够相对于另一者运动以抓持组织,所述第二钳口包括:
细长通道;和
钉仓,所述钉仓能够插入所述细长通道中以用于与所述细长通道组装在一起,所述钉仓包括:
仓体;和
仓盘,所述仓盘附接到所述仓体,其中,所述砧座被配置成能够在所述细长通道内使所述仓盘相对于所述仓体和所述细长通道从解锁构型朝近侧平移到锁定构型。
11.根据权利要求10所述的端部执行器,其中,所述仓盘包括突出部,其中,细长通道包括L形狭槽,所述L形狭槽被配置成能够当所述钉仓与所述细长通道组装时接纳所述突出部。
12.根据权利要求11所述的端部执行器,其中,当所述仓盘从所述解锁构型平移到所述锁定构型时,所述突出部能够在所述L形狭槽中移动。
13.一种用于与外科缝合器械一起使用的外科钉仓组件,所述外科钉仓组件包括:
细长通道,所述细长通道包括具有孔口的侧壁;
钉仓,所述钉仓能够插入所述细长通道中以用于与所述细长通道组装在一起,其中,所述钉仓包括:
仓体,所述仓体包括:
平台;
限定在所述平台中的钉腔,其中,所述钉腔包括钉;和
仓盘,所述仓盘附接到所述仓体,其中,所述仓盘包括在自然状态下能够被接纳在所述细长通道的所述孔口中的可折叠棘爪;和
保持器,所述保持器能够在第一构型和不同于所述第一构型的第二构型中可释放地联接到所述细长通道,其中,在所述第一构型中,所述保持器将所述钉保持在所述钉腔中,并且其中,在所述第二构型中,所述保持器使所述可折叠棘爪从所述孔口脱开,以便于将所述钉仓从所述细长通道移除。
14.根据权利要求13所述的端部执行器,其中,所述保持器包括保持器臂。
15.根据权利要求14所述的端部执行器,其中,所述侧壁包括轨道,所述轨道被配置成能够在所述第二构型中引导所述保持器臂在所述可折叠棘爪与所述孔口之间的插入。
16.根据权利要求15所述的端部执行器,其中,所述轨道被限定在所述侧壁的内表面中。
17.根据权利要求13所述的端部执行器,其中,所述可折叠棘爪包括在所述第一构型中能够被接纳在所述孔口中的第一接合部分。
18.根据权利要求17所述的端部执行器,其中,所述保持器臂包括第二接合部分,所述第二接合部分被配置成能够在所述第二构型中从所述孔口释放所述第一接合部分。
19.根据权利要求18所述的端部执行器,其中,所述第一接合部分和所述第二接合部分在所述第二构型中在所述轨道内处于锁定接合。
20.根据权利要求19所述的端部执行器,其中,所述锁定接合有利于通过使所述保持器臂从所述轨道缩回而从所述细长通道释放所述钉仓。
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US20220167972A1 (en) 2022-06-02
US20240041451A1 (en) 2024-02-08

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