CN117355266A - 用于仓安装的杠杆作用表面 - Google Patents
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Abstract
本发明提供了在端部执行器中具有至少一个旋转输入螺杆的外科装置。旋转输入螺杆可延伸穿过该端部执行器的中心纵向部分。该端部执行器可包括例如改进的闭合系统、击发系统、钉仓与该外科装置之间的杠杆作用和对准特征部、具有多钉驱动器的钉仓、单击发刀及其锁定/安全特征部、和/或经修改的钉图案。某些部件可以是3D打印部件。
Description
背景技术
本发明涉及外科器械，并且在各种布置结构中，涉及被设计成能够缝合和切割组织的外科缝合和切割器械、端部执行器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是根据本公开的至少一个方面的包括柄部、轴组件和端部执行器的外科缝合器械的透视图。
图2是根据本公开的至少一个方面的图1的外科缝合器械的端部执行器和轴组件的一部分的透视图，其中端部执行器被示为处于直的、或非关节运动构型。
图3是根据本公开的至少一个方面的图1的外科缝合器械的端部执行器和轴组件的一部分的透视图，其中端部执行器被示为处于关节运动构型。
图4是根据本公开的至少一个方面的图1的外科缝合器械的端部执行器和轴组件的一部分的分解透视图。
图5是根据本公开的至少一个方面的图1的外科缝合器械的端部执行器和轴组件的一部分的剖面正视图，其中端部执行器被示为处于非击发、夹紧构型。
图6是根据本公开的至少一个方面的图1的外科缝合器械的端部执行器和轴组件的一部分的平面图。
图7是根据本公开的至少一个方面的沿图6中的剖面线6-6截取的图1的端部执行器和轴组件的一部分的剖面正视图，其中端部执行器被示为处于打开构型。
图8是根据本公开的至少一个方面的沿图6中的剖面线7-7截取的图1的端部执行器和轴组件的一部分的剖面正视图，其中端部执行器被示为处于夹紧构型。
图9是根据本公开的至少一个方面的图1的包括轴组件和端部执行器的外科缝合组件的透视图，其中端部执行器通过关节运动接头附接到轴组件。
图10是根据本公开的至少一个方面的图9的外科缝合组件的分解透视图。
图11是根据本公开的至少一个方面的图9的外科缝合组件的剖面正视图，其中端部执行器被示为处于非击发、夹紧构型。
图12是根据本公开的至少一个方面的图1的包括轴组件和端部执行器的外科缝合组件的透视图，其中端部执行器通过关节运动接头附接到轴组件。
图13是根据本公开的至少一个方面的图12的外科缝合组件的分解透视图。
图14是根据本公开的至少一个方面的图12的外科缝合组件的剖面正视图，其中端部执行器被示为处于非击发、夹紧构型。
图15是根据本公开的至少一个方面的图1的包括轴组件和端部执行器的外科缝合组件的透视图，其中端部执行器通过关节运动接头附接到轴组件。
图16是根据本公开的至少一个方面的图15的外科缝合组件的分解透视图。
图17是根据本公开的至少一个方面的图15的外科缝合组件的剖面正视图，其中端部执行器被示为处于非击发、夹紧构型。
图18是根据本公开的至少一个方面的包括图1的端部执行器和柔性击发驱动系统的外科端部执行器组件的透视图。
图19是根据本公开的至少一个方面的图18的外科缝合组件的分解透视图。
图20是根据本公开的至少一个方面的图18的外科端部执行器组件的剖面正视图，其中外科端部执行器组件被示为处于非击发、夹紧构型。
图21是根据本公开的至少一个方面的机器人控制器的透视图。
图22是根据本公开的至少一个方面的用于机器人外科系统的机器人臂车的透视图，其示出了可操作地支撑外科工具的机器人臂车上的操纵器。
图23是根据本公开的至少一个方面的图22的外科臂车的操纵器和外科抓持工具的侧视图。
图24是根据本公开的各个方面的钉仓的透视图。
图25是根据本公开的各个方面的图24的钉仓的一部分的透视图，其描绘了钉仓中处于击发构型的三重驱动器。
图26是根据本公开的各个方面的图25的三重驱动器的透视图。
图27是根据本公开的各个方面的图26的三重驱动器的平面图。
图28是根据本公开的各个方面的图26的三重驱动器的底部透视图。
图29是根据本公开的各个方面的端部执行器的一部分的正视剖视图，其描绘了其中的钉仓，其中出于说明性目的而隐藏了该钉仓的一些部分。
图30是根据本公开的各个方面的图29的端部执行器的细部图。
图31是根据本公开的各个方面的端部执行器的一部分的正视剖视图，包括其中的钉仓。
图32是根据本公开的各个方面的三重驱动器的示意图，其用虚线描绘了经修改的几何形状并且用假想线示出了旋转驱动螺杆的相对定位。
图33是根据本公开的各个方面的仓体的底部透视图，其中出于说明性目的而隐藏了一些部分。
图34是根据本公开的各个方面的图33的仓体的一部分的细部图，其描绘了围绕内钉腔限定到仓体中的斜面。
图35是根据本公开的各个方面的驱动器的内支撑柱和图33的仓体的一部分的正视剖视图，其描绘了相对于内钉腔处于未击发构型的内支撑柱。
图36是根据本公开的各个方面的驱动器的支撑柱的一部分的透视图。
图37是根据本公开的各个方面的图36的支撑柱的一部分的正视图，其描绘了支撑在支撑柱上的钉的一部分。
图38是根据本公开的各个方面的钉仓的正视图。
图39是根据本公开的各个方面的沿图38中所示的平面截取的图38的钉仓的正视剖视图。
图40是根据本公开的各个方面的沿图38中所示的平面截取的图38的钉仓的一部分的透视剖视图，其描绘了其中处于完全击发位置的驱动器。
图41是根据本公开的各个方面的图40的驱动器的透视图。
图42是根据本公开的各个方面的驱动器的透视图。
图43是根据本公开的各个方面的砧座的一部分的透视剖视图。
图44是描绘根据本公开的各个方面的钉仓的4D打印矩阵的变形过程的示意图。
图45是根据本公开的各个方面的钉仓和通道的透视图，其描绘了用于将钉仓安装到通道中的对准和杠杆作用特征部，还描绘了相对于通道处于对准且部分安装构型的钉仓。
图46是根据本公开的各个方面的图45的钉仓的近侧部分和通道的正视图，其描绘了处于对准且部分安装构型的钉仓。
图47是根据本公开的各个方面的图45的钉仓的远侧部分和通道的透视图，其描绘了处于对准且部分安装构型的钉仓。
图48是根据本公开的各个方面的图45的钉仓的远侧部分和通道的透视图，其描绘了安装在通道中并完全就位的钉仓，还描绘了相对于钉仓处于夹紧构型的砧座。
图49是根据本公开的各个方面的图48的钉仓的远侧部分、通道和砧座的透视图，其描绘了安装在通道中并完全就位的钉仓，并且还描绘了相对于通道处于闩锁位置的钉仓的下侧上的闩锁。
图50是根据本公开的各个方面的钉仓的远侧部分、通道和砧座的透视图，其描绘了安装在通道中的钉仓和相对于钉仓处于夹紧构型的砧座，还描绘了相对于通道处于闩锁位置的钉仓的下侧上的柔性闩锁。
图51是根据本公开的各个方面的通道和钉仓的透视图，其描绘了用于将钉仓安装到通道中的对准和杠杆作用特征部，还描绘了相对于通道处于对准且部分安装构型的钉仓。
图52是根据本公开的各个方面的钉仓的一部分和通道的透视图，其描绘了与通道的侧壁中的侧向通道接合的钉仓的侧向闩锁臂。
图53是根据本公开的各个方面的图52的钉仓的一部分和通道的平面部分剖视图，其描绘了与通道的侧壁中的侧向通道接合的钉仓的侧向闩锁臂。
图54是根据本公开的各个方面的钉仓和旋转驱动螺杆的透视图。
图55是根据本公开的各个方面的图54的钉仓的远侧部分和旋转驱动螺杆的透视图，其描绘了仓体和驱动器，其中驱动器在仓体中处于其未击发位置。
图56是根据本公开的各个方面的图55的钉仓的远侧部分和旋转驱动螺杆的透视图，其中驱动器处于其未击发位置，并且出于说明性目的用虚线描绘了隐藏的内部特征部。
图57是根据本公开的各个方面的图55的钉仓的远侧部分和旋转驱动螺杆的另一个透视图，其中驱动器处于其未击发位置，并且出于说明性目的用虚线描绘了隐藏的内部特征部。
图58是根据本公开的各个方面的图54的钉仓的远侧部分的透视图，其中驱动器在仓体中移动到其击发位置。
图59是根据本公开的各个方面的图58的钉仓的远侧部分的透视图，其中驱动器处于其击发位置，并且出于说明性目的用虚线描绘了隐藏的内部特征部。
图60是根据本公开的各个方面的具有一排凹口的钉仓的近侧部分的透视图。
图61是根据本公开的各个方面的图60的钉仓的透视剖视图，其描绘了与驱动器的侧壁上的唇缘接合的仓体中的凹口。
图62是根据本公开的各个方面的仓体的一部分和具有用于接合仓体的干涉特征部的驱动器的分解透视图。
图63是根据本公开的各个方面的钉仓的分解透视图。
图64是根据本公开的各个方面的仓框架的一部分及其处于未成形构型的臂的透视图。
图65是根据本公开的各个方面的图64的仓框架的一部分和臂的透视图，其描绘了处于成形构型的臂。
图66是根据本公开的各个方面的仓体和仓框架的正视剖视图，其描绘了它们之间的热铆焊保持特征部。
图67是根据本公开的各个方面的仓体和仓框架在热铆焊工艺期间的正视剖视图。
图68是根据本公开的各个方面的仓框架和用于在图67的热铆焊工艺期间使用的插入件支撑件的透视图。
图69是根据本公开的各个方面的包括金属盘和塑料复合材料的复合仓体的透视图，其出于说明性目的用虚线描绘了隐藏的金属盘。
图70是根据本公开的各个方面的图69的复合仓体的正视图，其出于说明性目的用虚线描绘了隐藏的金属盘。
图71是根据本公开的各个方面的包括定位在其中的钉仓的外科端部执行器的一部分的透视图。
图72是根据本公开的各个方面的图71的外科端部执行器的一部分和钉仓的正视剖视图。
图73是根据本公开的各个方面的显窃启撕拉盖的透视图。
图74是根据本公开的各个方面的滑动件组件的主体的透视图。
图75是根据本公开的各个方面的包括主体和刀的图74的滑动件组件的透视分解剖视图。
图76是根据本公开的各个方面的图74的滑动件组件的透视剖视图。
图77是根据本公开的各个方面的端部执行器的正视部分剖视图，其中出于说明性目的而移除了一些部分，其描绘了图74的击发构件、仓体和滑动件组件。
图78是根据本公开的各个方面的与驱动器的排对准的滑动件组件的透视图。
图79是根据本公开的各个方面的图78的滑动件组件的透视分解图。
图80是根据本公开的各个方面的图78的滑动件组件的透视部分剖视图。
图81是根据本公开的各个方面的与击发系统接合的图78的滑动件组件的透视图，该击发系统包括旋转驱动螺杆和经螺纹联接到旋转驱动螺杆的击发构件。
图82是根据本公开的各个方面的包括处于锁定构型的闭锁件的端部执行器的透视图。
图83是根据本公开的各个方面的图82的端部执行器的一部分的透视图，其中出于说明性目的而移除了一些部件，其描绘了处于锁定构型的闭锁件。
图84是根据本公开的各个方面的图82的端部执行器的一部分的正视剖视图，其描绘了处于锁定构型的闭锁件。
图85是根据本公开的各个方面的图82的端部执行器的一部分的透视图，其中出于说明性目的而移除了一些部件，其描绘了包括安装在端部执行器中的图78的滑动件组件的钉仓，还描绘了处于解锁构型的闭锁件。
图86是根据本公开的各个方面的图85的钉仓的一部分和滑动件组件的正视图，其描绘了处于未击发位置的滑动件组件。
图87是根据本公开的各个方面的图85的钉仓的下侧的一部分和滑动件组件的平面图，其出于说明性目的用假想线描绘了击发组件的一部分。
图88是根据本公开的各个方面的图85的钉仓的正视剖视图。
图89是根据本公开的各个方面的钉仓的正视剖视图。
图90是根据本公开的各个方面的击发构件和滑动件组件的透视图，其描绘了处于未击发构型的击发构件。
图91是根据本公开的各个方面的图90的滑动件组件的分解图。
图92是根据本公开的各个方面的图90的击发构件和滑动件组件相对于出于说明性目的以虚线示出的仓体的透视图，其描绘了处于第一推进构型的击发组件，其中击发构件移动成与滑动件组件驱动接合，该滑动件组件移动成与仓体中的驱动器驱动接合。
图93是根据本公开的各个方面的图90的击发构件和滑动件组件的正视图，其中出于说明性目的用虚线示出了某些隐藏的特征部，其描绘了处于第一推进构型的击发构件。
图94是根据本公开的各个方面的沿图90中指示的平面截取的图90的击发构件和滑动件组件的正视剖视图，其描绘了处于第一推进构型的击发构件。
图95是根据本公开的各个方面的沿图93中指示的平面截取的图90的击发构件和滑动件组件的正视剖视图，其描绘了处于第一推进构型的击发构件。
图96A是根据本公开的各个方面的图90的击发构件和滑动件组件的正视图，其中出于说明性目的用虚线示出了某些隐藏的特征部，其描绘了处于第一回缩构型的击发构件。
图96B是根据本公开的各个方面的图90的击发构件和滑动件组件的正视图，其中出于说明性目的用虚线示出了某些隐藏的特征部，其描绘了处于第二回缩构型的击发构件。
图96C是根据本公开的各个方面的图90的击发构件和滑动件组件的正视图，其中出于说明性目的用虚线示出了某些隐藏的特征部，其描绘了处于第三回缩构型的击发构件。
图96D是根据本公开的各个方面的图90的击发构件和滑动件组件的正视图，其中出于说明性目的用虚线示出了某些隐藏的特征部，其描绘了处于第四回缩构型的击发构件。
图97是根据本公开的各个方面的图90的击发构件和滑动件组件相对于图92的仓体的正视图，其描绘了处于图96D的第四回缩构型的击发构件，其中出于说明性目的以假想线示出了仓体。
图98是根据本公开的各个方面的图90的击发构件和滑动件组件以及图92的仓体的平面图，其描绘了处于图96D的第四回缩构型的击发组件。
图99是根据本公开的各个方面的具有击发组件的外科端部执行器的透视图，该击发组件包括旋转驱动螺杆和具有一体式双轨道滑动件的可重复使用的击发构件。
图100A是根据本公开的各个方面的图99的可重复使用的击发构件以及与可重复使用的击发构件一起使用的单次使用的刀和击发指示器的分解透视图。
图100B是根据本公开的各个方面的组装到图99的可重复使用的击发构件的图100A的单次使用的刀和击发指示器的透视图，并且还描绘了其上的三重驱动器和钉通过可重复使用的击发构件的一体式双轨道滑动件部署。
图101是根据本公开的各个方面的图100B的三重驱动器、钉和可重复使用的击发构件的正视图。
图102是根据本公开的各个方面的图100B的三重驱动器中的一个的透视图。
图103是根据本公开的各个方面的容纳图100B的三重驱动器的仓体的一部分的平面图，并且还描绘了图100A的击发构件。
图104是根据本公开的各个方面的图103的仓体的一部分的下侧的透视图。
图105是根据本公开的各个方面的包括图103的仓体、击发构件和三重驱动器的端部执行器的正视剖视图。
图106是根据本公开的各个方面的图103的仓体的透视剖视图。
图107是根据本公开的各个方面的仓体的透视图。
图108是根据本公开的各个方面的包括图99的驱动组件的端部执行器的一部分的透视图，其描绘了包括安装到旋转驱动螺杆的闭锁螺母的闭锁布置，其中闭锁螺母处于锁定位置。
图109A是根据本公开的各个方面的图108的端部执行器的正视图，其中某些部件被移除并且其他部件被隐藏并用假想线示出，其描绘了处于锁定位置的锁定螺母。
图109B是根据本公开的各个方面的图108的端部执行器的正视剖视图，其中某些部件被移除并且其他部件被隐藏并用假想线示出，其描绘了处于解锁位置的锁定螺母。
图110是根据本公开的各个方面的图103的仓体的一部分的透视图，并且还描绘了在仓体中处于近侧位置的闭锁键。
图111是根据本公开的各个方面的图108的端部执行器的一部分的透视图，其中图110的仓体安装在端部执行器中并且闭锁键处于近侧位置，其中闭锁键定位成通过将锁定螺母移动到图109B的解锁位置来克服闭锁布置。
图112是根据本公开的各个方面的图110的仓体的下侧的一部分的透视图，其描绘了处于未击发位置的闭锁键。
图113是根据本公开的各个方面的图108的端部执行器的一部分的透视部分剖视图，其中图110的仓体安装在端部执行器中并且出于说明性目的而被部分剖切以暴露出推进到远侧位置的闭锁键。
图114是根据本公开的各个方面的图113的端部执行器的一部分和仓体的透视图，其中闭锁键处于远侧位置。
图115是根据本公开的各个方面的图108的端部执行器的一部分的透视部分剖视图，其中图110的仓体安装在端部执行器中并且出于说明性目的而被部分剖切以暴露出处于锁定位置的锁定螺母。
图116是根据本公开的各个方面的端部执行器的一部分的透视图，其中出于说明性目的某些部分被移除并且其他部分是透明的并且用假想线示出，其描绘了处于锁定构型的闭锁布置。
图117是根据本公开的各个方面的图116的端部执行器的一部分的透视图，其中出于说明性目的某些部分被移除并且其他部分是透明的，其描绘了处于锁定构型的锁定装置。
图118是根据本公开的各个方面的钉仓的平面图，其描绘了钉腔的图案。
图119是描绘根据本公开的各个方面的钉仓的钉腔图案的示意图。
图120是描绘根据本公开的各个方面的钉仓的钉腔图案的示意图。
图121是根据本公开的各个方面的钉仓的平面图，其描绘了钉腔的图案。
图122是根据本公开的各个方面的钉仓的平面图，其示意性地描绘了组织止动件。
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各种实施方案，且这种范例不应被解释为以任何方式限制本发明的范围。
具体实施方式
本申请的申请人拥有与本申请于同一日期提交且各自全文以引用方式并入本文的以下美国专利申请：
-名称为“METHOD OF USING A POWERED STAPLING DEVICE”的美国专利申请，代理人案卷END9298USNP1/200859-1M号；
-名称为“SURGICAL STAPLING ASSEMBLY COMPRISING NONPLANAR STAPLES ANDPLANAR STAPLE”的美国专利申请，代理人案卷END9298USNP2/200859-2号；
-名称为“SURGICAL STAPLE CARTRIDGE COMPRISING LONGITUDINAL SUPPORTBEAM”的美国专利申请，代理人案卷END9298USNP3/200859-3号；
-名称为“STAPLING ASSEMBLY COMPRISING ECCENTRICALLY DRIVEN FIRINGMEMBER”的美国专利申请，代理人案卷END9298USNP4/200859-4号；
-名称为“ROTARY-DRIVEN SURGICAL STAPLING ASSEMBLY COMPRISING AFLOATABLE COMPONENT”的美国专利申请，代理人案卷END9298USNP5/200859-5号；
-名称为“DRIVERS FOR FASTENER CARTRIDGE ASSEMBLIES HAVING ROTARY DRIVESCREWS”的美国专利申请，代理人案卷END9298USNP6/200859-6号；
-名称为“MATING FEATURES BETWEEN DRIVERS AND UNDERSIDE OF A CARTRIDGEDECK”的美国专利申请，代理人案卷END9298USNP7/200859-7号；
-名称为“FASTENER CARTRIDGE WITH NON-REPEATING FASTENER ROWS”的美国专利申请，代理人案卷END9298USNP9/200859-9号；
-名称为“HAVING FLEXIBLE PORTIONS FOR ADAPTING TO A LOAD DURING ASURGICAL FIRING STROKE”的美国专利申请，代理人案卷END9298USNP10/200859-10号；
-名称为“STAPLING ASSEMBLY COMPONENTS HAVING METAL SUBSTRATES ANDPLASTIC BODIES”的美国专利申请，代理人案卷END9298USNP11/200859-11号；
-名称为“MULTI-AXISPIVOT JOINTS FOR SURGICAL INSTRUMENTS AND METHODSOF MANUFACTURING SAME”的美国专利申请，代理人案卷END9298USNP12/200859-12号；
-名称为“ARRANGEMENTS FOR MULTI-PLANAR ALIGNMENT AND SUPPORT OFOPERATIONAL DRIVE SHAFTS IN ARTICULATABLE SURGICAL INSTRUMENTS”的美国专利申请，代理人案卷END9298USNP13/200859-13号；以及
-名称为“SURGICAL INSTRUMENT ARTICULATION JOINT ARRANGEMENTSCOMPRISING MULTIPLE MOVING LINKAGE FEATURES”的美国专利申请，代理人案卷END9298USNP14/200859-14号。
本申请的申请人拥有于2017年12月19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和美国专利：
-名称为“METHOD FOR DETERMINING THE POSITION OF A ROTATABLE JAW OF ASURGICAL INSTRUMENT ATTACHMENT ASSEMBLY”的美国专利10,835,330号；
-名称为“SURGICAL INSTRUMENTS WITH DUAL ARTICULATION DRIVERS”的美国专利10,716,565号；
-名称为“SURGICAL TOOLS CONFIGURED FOR INTERCHANGEABLE USE WITHDIFFERENT CONTROLLER INTERFACES”的美国专利申请序列15/847,325号，现为美国专利申请公布2019/0183491号；
-名称为“SURGICAL INSTRUMENT COMPRISING CLOSURE AND FIRING LOCKINGMECHANISM”的美国专利10,729,509号；
-名称为“ROBOTIC ATTACHMENT COMPRISING EXTERIOR DRIVE ACTUATOR”的美国专利申请序列15/847,315号，现为美国专利申请公布2019/0183594号；以及
-名称为“SURGICAL INSTRUMENT ASSEMBLY”的美国设计专利D910,847号。
本申请的申请人拥有于2017年6月28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和美国专利：
-名称为“SURGICAL INSTRUMENT COMPRISING AN OFFSET ARTICULATION JOINT”的美国专利申请序列15/635,693号，现为美国专利申请公布2019/0000466号；
-名称为“SURGICAL INSTRUMENT COMPRISING AN ARTICULATION SYSTEM RATIO”的美国专利申请序列15/635,729号，现为美国专利申请公布2019/0000467号；
-名称为“SURGICAL INSTRUMENT COMPRISING AN ARTICULATION SYSTEM RATIO”的美国专利申请序列15/635,785号，现为美国专利申请公布2019/0000469号；
-名称为“SURGICAL INSTRUMENT COMPRISING FIRING MEMBER SUPPORTS”的美国专利申请序列15/635,808号，现为美国专利申请公布2019/0000471号；
-名称为“SURGICAL INSTRUMENT COMPRISING AN ARTICULATION SYSTEMLOCKABLE TO A FRAME”的美国专利申请序列15/635,837号，现为美国专利申请公布2019/0000472号；
-名称为“SURGICAL INSTRUMENT COMPRISING AN ARTICULATION SYSTEMLOCKABLE BY A CLOSURE SYSTEM”的美国专利10,779,824号；
-名称为“SURGICAL INSTRUMENT COMPRISING A SHAFT INCLUDING A HOUSINGARRANGEMENT”的美国专利申请序列15/636,029号，现为美国专利申请公布2019/0000477号；
-名称为“SURGICAL INSTRUMENT COMPRISING SELECTIVELY ACTUATABLEROTATABLE COUPLERS”的美国专利申请序列15/635,958号，现为美国专利申请公布2019/0000474号；
-名称为“SURGICAL STAPLING INSTRUMENTS COMPRISING SHORTENED STAPLECARTRIDGE NOSES”的美国专利申请序列15/635,981号，现为美国专利申请公布2019/0000475号；
-名称为“SURGICAL INSTRUMENT COMPRISING A SHAFT INCLUDING A CLOSURETUBE PROFILE”的美国专利申请序列15/636,009号，现为美国专利申请公布2019/0000476号；
-名称为“METHOD FOR ARTICULATING A SURGICAL INSTRUMENT”的美国专利10,765,427号；
-名称为“SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTOR WITHAXIALLY SHORTENED ARTICULATION JOINT CONFIGURATIONS”的美国专利申请序列15/635,530号，现为美国专利申请公布2019/0000457号；
-名称为“SURGICAL INSTRUMENTS WITH OPEN AND CLOSABLE JAWS AND AXIALLYMOVABLE FIRING MEMBER THAT IS INITIALLY PARKED IN CLOSE PROXIMITY TO THE JAWSPRIOR TO FIRING”的美国专利10,588,633号；
-名称为“SURGICAL INSTRUMENTS WITH JAWS CONSTRAINED TO PIVOT ABOUT ANAXIS UPON CONTACT WITH A CLOSURE MEMBER THAT IS PARKED IN CLOSE PROXIMITY TOTHE PIVOT AXIS”的美国专利申请序列15/635,559号，现为美国专利申请公布2019/0000459号；
-名称为“SURGICAL END EFFECTORS WITH IMPROVED JAW APERTUREARRANGEMENTS”的美国专利10,786,253号；
-名称为“SURGICAL CUTTING AND FASTENING DEVICES WITH PIVOTABLE ANVILWITH A TISSUE LOCATING ARRANGEMENT IN CLOSE PROXIMITY TO AN ANVIL PIVOT AXIS”的美国专利申请序列15/635,594号，现为美国专利申请公布2019/0000461号；
-名称为“JAW RETAINER ARRANGEMENT FOR RETAINING A PIVOTABLE SURGICALINSTRUMENT JAW IN PIVOTABLE RETAINING ENGAGEMENT WITH A SECOND SURGICALINSTRUMENT JAW”的美国专利申请序列15/635,612号，现为美国专利申请公布2019/0000462号；
-名称为“SURGICAL INSTRUMENT WITH POSITIVE JAW OPENING FEATURES”的美国专利10,758,232号；
-名称为“SURGICAL INSTRUMENT WITH AXIALLY MOVABLE CLOSURE MEMBER”的美国专利10,639,037号；
-名称为“SURGICAL INSTRUMENT LOCKOUT ARRANGEMENT”的美国专利10,695,057号；
-名称为“ANVIL”的美国设计专利D851,762号；
-名称为“SURGICAL INSTRUMENT SHAFT”的美国设计专利D854,151号；以及
-名称为“SURGICAL FASTENER CARTRIDGE”的美国设计专利D869,655号。
本申请的申请人拥有于2017年6月27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和美国专利：
-名称为“SURGICAL ANVIL MANUFACTURING METHODS”的美国专利申请序列15/634,024号，现为美国专利申请公布2018/0368839号；
-名称为“SURGICAL ANVIL ARRANGEMENTS”的美国专利10,772,629号；
-名称为“SURGICAL ANVIL ARRANGEMENTS”的美国专利申请序列15/634,046号，现为美国专利申请公布2018/0368841号；
-名称为“SURGICAL ANVIL ARRANGEMENTS”的美国专利10,856,869号；
-名称为“SURGICAL FIRING MEMBER ARRANGEMENTS”的美国专利申请序列15/634,068号，现为美国专利申请公布2018/0368843号；
-名称为“STAPLE FORMING POCKET ARRANGEMENTS”的美国专利申请序列15/634,076号，现为美国专利申请公布2018/0368844号；
-名称为“STAPLE FORMING POCKET ARRANGEMENTS”的美国专利申请序列15/634,090号，现为美国专利申请公布2018/0368845号；
-名称为“SURGICAL END EFFECTORS AND ANVILS”的美国专利申请序列15/634,099号，现为美国专利申请公布2018/0368846号；以及
-名称为“ARTICULATION SYSTEMS FOR SURGICAL INSTRUMENTS”的美国专利10,631,859号。
本申请的申请人拥有于2020年6月2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”的美国设计专利申请序列29/736,648号；
-名称为“STAPLE CARTRIDGE”的美国设计专利申请序列29/736,649号；
-名称为“STAPLE CARTRIDGE”的美国设计专利申请序列29/736,651号；
-名称为“STAPLE CARTRIDGE”的美国设计专利申请序列29/736,652号；
-名称为“STAPLE CARTRIDGE”的美国设计专利申请序列29/736,653号；
-名称为“STAPLE CARTRIDGE”的美国设计专利申请序列29/736,654号；以及
-名称为“STAPLE CARTRIDGE”的美国设计专利申请序列29/736,655号。
本申请的申请人拥有于2016年11月14日提交且各自全文以引用方式并入本文的以下美国设计专利申请和美国专利：
-名称为“STAPLE FORMING POCKET CONFIGURATIONS FOR CIRCULAR STAPLERANVIL”的美国专利申请序列15/350,621号，现为美国专利申请公布2018/0132849号；
-名称为“CIRCULAR SURGICAL STAPLER WITH ANGULARLY ASYMMETRIC DECKFEATURES”的美国专利申请序列15/350,624号，现为美国专利申请公布2018/0132854号；
-名称为“STAPLING HEAD FEATURE FOR SURGICAL STAPLER”的美国设计专利D833,608号；以及
-名称为“SURGICAL STAPLER”的美国设计专利D830,550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。
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装置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，外科装置在许多取向和位置中使用，并且这些术语并非旨在为限制性的和/或绝对的。在以下说明中，诸如“第一”、“第二”、“顶部”、“底部”、“上”、“下”等的术语是方便的言语，并且不应当理解为限制性术语。
对单数的项目的引用应被理解为包括复数的项目，反之亦然，除非另有明确说明或从文本中清楚可见。语法连接词旨在表达连接的从句、句子、字词等的任何和所有转折和连接组合，除非另有说明或从上下文清楚可见。因此，术语“或”通常应被理解为是指“和/或”等。
除非本文另外指明，否则本文列举的数值范围并不是旨在进行限制，而是单独地指属于该范围内的任何或所有值，并且在此范围内的每个单独的值就像在本文中个别地引用那样并入本公开。当伴随数值时，字词“约”、“大约”等应被解释为指示如本领域普通技术人员将理解的偏差，以令人满意地用于预期目的。类似地，当参考物理特性使用时，近似字词诸如“大约”或“基本上”应被解释为设想了本领域普通技术人员将理解的偏差范围，以令人满意地用于对应的用途、功能、目的等。
本文所提供的任何和全部示例或示例性语言(“例如”、“诸如”等)仅仅旨在更好地举例说明实施方案，而并不用来限制实施方案的范围。说明书中的任何语言都不应理解为表示任何不受权利要求书保护的要素是实施实施方案所必需的。
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，本文所公开的各种外科装置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。外科装置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，外科装置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。
所述钉仓包括仓体。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，并且砧座被定位在待缝合的组织的第二侧上。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。设想了钉腔和钉的其他布置。
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移动以从钉腔射出钉。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。滑动件能够在与仓体的近侧端部相邻的近侧位置和与仓体的远侧端部相邻的远侧位置之间移动。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，使得在刀横切组织之前，钉被射出到组织中。
图1至图8示出了被构造成能够夹持、缝合和切割患者组织的外科缝合器械10。外科缝合器械10包括柄部20、附接到柄部20的轴组件100和端部执行器200。为了切割和缝合患者的组织，端部执行器200包括仓钳口201和砧座钳口203。砧座钳口203可相对于仓钳口203枢转以将组织夹持在砧座钳口203和仓钳口203之间。一旦组织被夹持在钳口201、203之间，外科缝合器械10可被致动以推进击发构件穿过钳口201、203以便通过端部执行器200缝合和切割组织，如下文更详细讨论的。
如下文更详细讨论的，端部执行器200可通过轴组件100的关节运动区域110进行关节运动。此类关节运动为外科缝合器械10的用户提供更准确地在目标组织附近定位和/或操纵端部执行器200的能力。
柄部20包括被构造成能够容纳各种机械和电气部件的壳体21和从壳体21延伸的柄部部分22。柄部部分22被构造成能够在使用外科缝合器械10时配合在用户的手掌中和/或由用户抓持和/或保持。柄部20还包括被构造成能够由用户致动以操作外科缝合器械10的一个或多个功能的各种致动器和/或触发器。柄部20包括闭合触发器24、击发触发器25和至少一个关节运动致动器26。当由用户致动时，闭合触发器24被构造成能够通过使砧座钳口203朝向仓钳口201运动而用端部执行器200夹持组织。当由用户致动时，击发触发器25被构造成能够通过推进击发构件以射出钉并用刀切割组织来用端部执行器200切割并缝合组织。当由用户致动时，关节运动致动器26被构造成能够通过关节运动区域110使端部执行器200相对于轴组件100进行关节运动。外科缝合器械10的触发器和致动器可触发柄部20内的一个或多个马达以致动外科缝合器械10的各种功能和/或手动地驱动各种驱动轴和部件以致动外科缝合器械10的各种功能。
柄部20还包括被构造成能够在其中支撑轴组件100的喷嘴组件30。喷嘴组件30包括致动轮31，该致动轮被构造成能够由用户旋转以使轴组件100和端部执行器200围绕纵向轴线LA相对于柄部20旋转。此类机构允许外科缝合器械10的用户仅旋转轴组件100和/或端部执行器200而不必旋转整个柄部20。
柄部20还包括电池23，该电池被构造成能够向外科缝合器械10的各种电子部件、传感器和/或马达提供电力。设想了其中外科缝合器械10直接连接到电源的实施方案。还设想了其中外科缝合器械10完全是手动的或例如非动力的实施方案。还设想了其中端部执行器的关节运动、钳口的夹紧和松开、击发端部执行器钉以缝合和切割组织、以及轴和/或端部执行器旋转都是动力系统的实施方案。
在至少一个实例中，轴组件100和端部执行器200可以是模块化的并且可从柄部20移除。在至少一个实例中，端部执行器200可以是模块化的，因为端部执行器200可从轴组件100移除并且用不同的端部执行器来替换。在至少一个实例中，轴组件100和/或端部执行器200可用于外科机器人环境中。此类实施方案将从外科机器人接口提供动力输入以致动端部执行器200的每个功能。此类外科机器人和外科工具的示例在2020年5月7日公布的名称为“ROBOTIC SURGICAL SYSTEM”的美国专利申请公布2020/0138534号中进一步描述，该专利申请公布全文以引用方式并入本文。
在至少一个实例中，轴组件100和端部执行器200被构造成能够与外科机器人一起使用。在此类实例中，轴组件100和端部执行器200被构造成能够联接到包括多个输出驱动装置的外科机器人。外科机器人的多个输出驱动装置被构造成能够与轴组件100和端部执行器200的驱动系统配合。在此类实例中，外科机器人可致动端部执行器200的各种不同功能，例如，使端部执行器围绕多个不同的关节运动接头进行关节运动，使轴组件100和/或端部执行器200围绕其纵向轴线旋转，夹紧端部执行器200以将组织夹紧在端部执行器200的钳口之间，和/或击发端部执行器200以切割和/或缝合组织。
轴组件100被构造成能够容纳外科缝合器械10的各种驱动系统部件和/或电子部件，使得端部执行器200和轴组件100可插入穿过套管针以进行腹腔镜外科手术。各种驱动系统部件被构造成能够由柄部20的各种触发器和致动器致动。此类部件可包括用于关节运动的驱动轴、用于夹紧和松开端部执行器200的驱动轴和/或用于击发端部执行器200的驱动轴。在其中轴组件100连接到柄部20或外科机器人接口中的驱动系统的实例中，此类驱动轴可由该驱动系统旋转。在各种方面中，缝合端部执行器可包括两个可独立旋转的驱动构件—例如，一个驱动构件用于抓持组织，并且一个驱动构件用于击发钉。缝合端部执行器还可包括关节运动接头，并且旋转运动可通过关节运动接头传递。在各种方面中，缝合端部执行器可包括可结合到关节运动系统、抓持系统或击发系统中的一个或多个3D印刷组件。
在其中轴组件100连接到柄部20或外科机器人接口中的驱动系统的实例中，此类驱动轴可由该驱动系统致动。此类驱动轴可包括线性致动、旋转致动或它们的组合。例如，旋转致动和线性致动的组合可采用一系列齿条齿轮和/或驱动螺杆。
在至少一个实例中，例如，轴组件100还被构造成能够容纳用于例如定位在轴组件100和/或端部执行器200内的各种传感器和/或马达的电引线。
轴组件100包括从喷嘴组件30延伸到关节运动区域110的外轴101，该外轴包括双关节运动接头，这将在下面更详细地讨论。关节运动区域110允许端部执行器200围绕两个单独轴线AA1、AA2在两个不同平面中相对于外轴101进行关节运动。
现在主要参照图4，现在将描述端部执行器200的关节运动。关节运动区域110包括两个不同的关节运动接头和两个关节运动致动器150、160。这允许端部执行器200围绕彼此独立的两个不同轴线AA1、AA2在两个不同平面中进行关节运动。关节运动区域110包括近侧接头轴部件120、中间接头轴部件130和远侧接头轴部件140。近侧接头轴部件120附接到轴组件100的远侧端部，中间接头轴部件130枢转地连接到近侧接头轴部件120和远侧接头轴部件140，并且远侧接头轴部件140通过保持环146固定地附接到端部执行器200。下面更详细地讨论，这种布置提供了端部执行器200围绕彼此独立的轴线AA1和轴线AA2相对于轴组件100的关节运动。
近侧接头轴部件120包括固定地配合在外轴101内的近侧环形部分121。近侧接头轴部件120还包括中空通道122以允许各种驱动系统部件从中穿过，并且还包括关节运动突片123，该关节运动突片包括被构造成能够接纳关节运动销125的销孔124。关节运动销125将近侧接头轴部件120枢转地连接到中间接头轴部件130的近侧关节运动突片131。为了使端部执行器200围绕轴线AA1进行关节运动，关节运动致动器150沿远侧方向或近侧方向被线性地致动。例如，此类致动器可包括由任何合适材料(诸如金属和/或塑料)制成的杆或棒。关节运动致动器150枢转地安装到关节运动交连杆151。关节运动交连杆151相对于关节运动销125偏轴地枢转安装到中间接头轴部件130，使得当关节运动致动器150被致动时，扭矩由关节运动交连杆151相对于关节运动销125偏轴地施加到中间接头轴部件130以致使中间接头轴部件130并且因此使端部执行器200相对于近侧接头轴部件120围绕轴线AA1枢转。
中间接头轴部件130通过限定轴线AA1的关节运动销125来枢转地连接到近侧接头轴部件120。具体地，中间接头轴部件130包括近侧关节运动突片131，该近侧关节运动突片通过关节运动销125枢转地连接到近侧接头轴部件120。中间接头轴部件130还包括中空通道132和远侧关节运动突片133，该中空通道被构造成能够允许各种驱动系统部件从中穿过。远侧关节运动突片133包括销孔134和远侧突出键135，该销孔被构造成能够接纳限定轴线AA2的另一个关节运动销136。
为了使端部执行器200围绕轴线AA2进行关节运动，关节运动线缆160被致动以通过键135将关节运动扭矩施加到远侧接头轴部件140的近侧突片141。关节运动线缆160固定到键135，使得当线缆160旋转时，键135相对于中间接头轴部件130枢转。键135被配合在远侧接头轴部件140的键孔144中。明显地，键135不固定到中间接头轴部件130，并且键135可相对于中间接头轴部件130旋转。关节运动线缆160还接触围绕销孔142的近侧突片141。这提供了从关节运动线缆160到远侧接头轴部件140的附加扭矩。关节运动销136被接纳在销孔142内以枢转地联接中间接头轴部件130和远侧接头轴部件140。
在至少一个实例中，关节运动线缆160仅能够在近侧方向上被拉动。在此类实例中，将仅朝近侧拉动关节运动线缆160的一侧以使端部执行器200沿期望方向进行关节运动。在至少一个实例中，对抗地推动和拉动关节运动线缆160。换句话讲，线缆160可包括刚性构造，使得关节运动线缆160的一侧被朝远侧推动，而关节运动线缆160的另一侧被朝近侧拉动。此类布置可允许关节运动力在缆线160的被推动的一半与线缆160的被拉动的一半之间分配。在至少一个实例中，推拉布置允许更大的关节运动力被传递到对应关节运动接头。此类力在具有两个关节运动接头的布置中可能是必要的。例如，如果使近侧关节运动接头进行完全关节运动，则由于用于远侧关节运动接头的关节运动致动器必须行进的拉伸和/或延长的距离，可能需要旨在使远侧关节运动接头进行关节运动的关节运动致动器的更大力。
远侧接头轴部件140还包括切口143以允许各种驱动部件从中穿过。保持环146将仓钳口201的通道210固定到远侧接头轴部件140，由此将端部执行器组件200固定到关节运动区域110的远侧端部。
如上文所讨论，砧座钳口201可相对于仓钳口203移动以通过端部执行器200夹紧和松开组织。现在将描述端部执行器200的该功能的操作。仓钳口201包括通道210和钉仓220，该钉仓被构造成能够接纳在通道210的腔214内。通道210还包括被构造成能够接纳保持环146的环形凹槽211和被构造成能够接纳钳口联接销233的一对枢转孔213。钳口联接销233允许砧座钳口203相对于仓钳口201枢转。
砧座钳口203包括砧座主体230和一对枢转孔231。砧座钳口203的近侧部分中的枢转孔231被构造成能够接纳钳口联接销233，由此将砧座钳口203枢转地联接到仓钳口201。为了相对于仓钳口201打开和闭合砧座钳口203，提供了闭合驱动装置250。
闭合驱动装置250由柔性驱动区段175致动，该柔性驱动区段包括端对端布置或形成的通用可移动接头。在各种实例中，柔性驱动区段175可包括串联3D打印万向接头，其被一起打印作为单个连续系统。下面更详细地讨论，柔性驱动区段175由穿过轴组件100的输入轴驱动。柔性驱动区段175通过双关节运动接头传递旋转致动运动。闭合驱动装置250包括闭合螺杆251和经螺纹联接到闭合螺杆251的闭合楔形件255。闭合楔形件255被构造成能够明确地用凸轮带动砧座钳口203打开和闭合。闭合螺杆251由固定在通道210内的第一支撑主体258和第二支撑主体259支撑。
为了在夹紧位置(图8)和松开位置(图7)之间移动砧座钳口203，闭合驱动轴被致动以致动柔性驱动区段175。柔性驱动区段175被构造成能够使闭合螺杆251旋转，这使闭合楔形件255移位。例如，闭合楔形件255经螺纹联接到闭合件螺杆251，并且闭合楔形件255与钉仓220的旋转行进被限制。闭合螺杆251取决于闭合螺杆251旋转的方向朝近侧或朝远侧驱动闭合楔形件255。
为了从松开位置(图7)夹紧端部执行器200，闭合楔形件255朝近侧移动。当闭合楔形件255朝近侧移动时，闭合楔形件255的近侧凸轮表面256接触限定在砧座主体230的近侧端部235中的对应凸轮表面234。当凸轮表面256接触凸轮表面234时，力被施加到砧座主体230的近侧端部235，从而致使砧座主体230围绕销233旋转到夹紧位置中(图8)。
为了从夹紧位置打开或松开端部执行器200(图8)，通过沿与致使闭合楔形件255朝近侧移动的方向相反的方向旋转闭合件螺杆251而使闭合楔形件255朝远侧移动。当闭合楔形件255朝远侧运动时，从闭合楔形件255的远侧端部延伸的一对凸块257在砧座主体230的向下延伸突片237附近接触凸轮表面234。当凸块257在突片237附近接触凸轮表面234时，力被施加到砧座主体230以使砧座主体230围绕销233旋转到打开位置中(图7)。
在至少一个实例中，凸轮表面234的轮廓对应于凸轮表面256的轮廓。例如，凸轮表面234和凸轮表面256可匹配以使得最大凸轮力被施加到砧座主体230以引起砧座主体230的期望旋转。如图8中可见，例如，由砧座主体230的近侧端部235限定的凸轮表面234包括类似于凸轮表面256的上斜坡区段的斜坡区段。
如上文所讨论，外科缝合器械10可被致动以推进击发构件穿过钳口201、203以便通过端部执行器200缝合和切割组织。现在将描述从钉仓220部署钉226并且用刀283切割组织的功能。钉仓220包括仓体221、多个钉驱动器225和可移除地存储在仓体221内的多个钉226。仓体221包括平台表面222、限定在仓体221中的布置成纵向排的多个钉腔223、以及使仓体221分叉的纵向狭槽224。刀283被构造成能够被驱动穿过纵向狭槽224以切割在砧座主体230和平台表面221之间夹紧的组织。
平台表面221包括侧向轮廓的组织支撑表面。在各个方面，平台表面221的轮廓可沿仓体221的中心部分形成顶点。此类顶点可覆盖纵向延伸的击发螺杆261，该击发螺杆延伸穿过仓体221的中心部分，这将在本文中进一步描述。在各种实例中，沿顶点的增加的高度可与沿刀283的击发路径的较小组织间隙相关联。在本公开的某些方面中，驱动器高度、所成形的钉高度、钉凹坑延伸高度和/或钉过度驱动距离也可沿平台表面221侧向变化。也设想了并且在本文中进一步描述了可侧向变化的钉成形(例如，2D钉和3D钉的组合)。
钉驱动器225被构造成能够当滑动件280被朝远侧推动穿过钉仓220时由滑动件280提升以射出在钉腔223中由钉驱动器225支撑的钉226。滑动件280包括斜面281以接触钉驱动器225。滑动件280还包括刀283。滑动件280被构造成能够由击发构件270推动。
为了部署钉226并用刀283切割组织，端部执行器200包括击发驱动装置260。击发驱动装置260由柔性驱动轴176致动。下面更详细地讨论，柔性驱动轴176由穿过轴组件100的输入轴驱动。柔性驱动轴176通过双关节运动接头传递旋转致动运动。击发驱动装置260包括被构造成能够由柔性驱动轴176旋转的击发螺杆261。击发螺杆261包括支撑在支撑构件259和通道210中的轴承内的轴颈。在各种实例中，击发螺杆261可相对于通道210浮动，如本文进一步所述。击发螺杆261包括支撑在支撑构件259和通道210内的近侧端部262、支撑在通道210内的远侧端部263、以及沿着击发螺杆261的长度的一部分延伸的螺纹265。
击发构件270经螺纹联接到击发螺杆261，使得当击发螺杆261旋转时，击发构件270沿着击发螺杆261朝远侧推进或朝近侧回缩。具体地，击发构件270包括主体部分271，该主体部分包括限定在其中的中空通道272。击发螺杆261被构造成能够被接纳在中空通道272内并且被构造成能够与击发构件270的螺纹部件273经螺纹联接。因此，当击发螺杆261旋转时，螺纹部件273向主体部分271施加线性力以使击发构件270朝远侧推进或使击发构件270朝近侧回缩。当击发构件270朝远侧推进时，击发构件270推动滑动件280。滑动件280的远侧移动穿过接合多个钉驱动器225而引起钉223的射出，如本文进一步所述。驱动器225是被构造成能够同时击发多个钉223的三重驱动器。驱动器225可包括侧向不对称，如本文进一步所述，以在各种实例中使滑动件轨道的宽度最大并且沿钉仓220的中心向下容纳击发螺杆261。
在端部执行器200的击发期间的某一点，用户可使击发构件270回缩以允许钳口201、203松开。在至少一个实例中，需要击发构件270的完全回缩以打开钳口201、203，其中上凸轮作用构件和下凸轮作用构件设置在主体部分271上，一旦击发构件270完全回缩，其仅可从钳口201、203脱离。
在各种实例中，击发构件270可为如本文进一步描述的塑料部分和金属部分的混合构造。在各种实例中，螺纹部件273可以是例如金属部件，其通过嵌件模制或包覆模制结合到击发构件主体271中。
在某些实例中，击发构件270还可被称为工字梁。击发构件270可包括在其中包括网格图案空间的复杂3D打印几何形状。在各种实例中，3D打印可允许击发构件或其一部分充当弹簧并允许一部分更容易挠曲，这可改善例如在击发行程期间的力分布和/或公差。
图9至图11描绘了外科缝合组件300，其包括轴组件310和附接到轴组件310的图1至图8的端部执行器200。轴组件310可在许多方面类似于本文所讨论的各种其他轴组件；然而，轴组件310包括单个关节运动接头和被构造成能够使端部执行器200围绕单个关节运动接头进行关节运动的关节运动杆。外科缝合组件300被构造成能够切割和缝合组织。外科缝合组件300可附接到外科器械柄部和/或外科机器人接口。外科器械柄部和/或外科机器人接口可被构造成能够致动外科缝合组件300的各种功能。轴组件310包括关节运动接头320。如下文更详细讨论的，端部执行器200被构造成能够围绕轴线AA相对于轴组件310的外轴311进行关节运动。
轴组件310包括外轴311、第一轴接头部件330和通过关节运动销354枢转地联接到第一轴接头部件330的第二轴接头部件350。第一轴接头部件330包括被构造成能够配合在外轴311的内径内的近侧管部分331。例如，此类配合可包括压配合。然而，可使用任何合适的附接装置。第一轴接头部件330还包括远侧部分332。远侧部分332包括关节运动突片333，该关节运动突片包括限定在其中的销孔334，以及中空通道335，外科缝合组件300的各种驱动部件可穿过该中空通道。此类驱动部件可包括例如关节运动致动器、闭合致动器和/或击发致动器。
第一轴接头部件330通过关节运动销354枢转地连接到第二轴接头部件350。关节运动销354还被接纳在第二轴接头部件350的朝近侧延伸的关节运动突片351的销孔353内。销孔353与销孔334轴向对准。关节运动销354允许第二轴接头部件350围绕关节运动轴线AA相对于第一轴接头部件330进行关节运动。第二轴接头部件350还包括从近侧延伸的关节运动突片351延伸的销突起部352。下面更详细地讨论，销突起部352被构造成能够枢转地联接到关节运动驱动系统。第二轴接头部件350还包括远侧部分355，该远侧部分包括被构造成能够接纳保持环358的环形凹槽356。远侧部分355还包括外科缝合组件300的各种驱动部件可穿过的中空通道357。保持环358被构造成能够通过配合在仓通道210的环形凹槽211和第二轴接头部件350的环形凹槽356内而将第一钳口201保持到第二轴接头部件350。
为了使端部执行器200围绕关节运动轴线AA进行关节运动，提供了关节运动杆360。关节运动杆360可通过任何合适的装置致动，诸如通过机器人或机动输入和/或手动柄部触发器。例如，可在近侧方向和远侧方向上致动关节运动杆360。设想了其中除了线性致动之外或代替线性致动，关节运动系统包括旋转驱动的致动的实施方案。关节运动杆360延伸穿过外轴311。关节运动杆360包括枢转地联接到关节运动连杆362的远侧端部361。关节运动连杆362枢转地联接到销突起部352，该销突起部从近侧延伸的关节运动突片351相对于关节运动轴线AA偏心地延伸。关节运动连杆362的此类偏心联接允许关节运动杆360向第二接头轴部件350施加力，以使第二接头轴部件350并且因此使端部执行器200相对于第一接头轴部件330旋转。关节运动杆360可朝远侧推进以使端部执行器200围绕关节运动轴线AA沿第一方向旋转，并且可朝近侧回缩以使端部执行器200围绕关节运动轴线AA沿与第一方向相反的第二方向旋转。
轴组件310还包括定位在关节运动接头320内的关节运动部件支撑结构340。此类支撑结构可向各种驱动部件提供支撑，该驱动部件被构造成能够在端部执行器200进行关节运动时穿过关节运动接头320到达端部执行器200。支撑结构340还可用于在使用期间将驱动部件与组织残余物隔离。
图12至图14描绘了外科缝合组件400，其包括轴组件410和附接到轴组件410的图1至图8的端部执行器200。轴组件410可在许多方面类似于本文所讨论的各种其他轴组件；然而，轴组件410包括单个关节运动接头和被构造成能够使端部执行器200围绕单个关节运动接头进行关节运动的关节运动线缆。外科缝合组件400被构造成能够切割和缝合组织。外科缝合组件400可附接到外科器械柄部和/或外科机器人接口。外科器械柄部和/或外科机器人接口可被构造成能够致动外科缝合组件400的各种功能。轴组件410包括关节运动接头420。如下文更详细讨论的，端部执行器200被构造成能够围绕轴线AA相对于轴组件310的外轴411进行关节运动。
轴组件410包括外轴411、第一轴接头部件430和通过关节运动销454枢转地联接到第一轴接头部件430的第二轴接头部件450。第一轴接头部件430包括被构造成能够配合在外轴411的内径内的近侧管部分431。例如，此类配合可包括压配合。然而，可使用任何合适的附接装置。第一轴接头部件430还包括远侧部分432，该远侧部分包括关节运动突片433，该关节运动突片包括限定在其中的销孔434。远侧部分432还包括外科缝合组件400的各种驱动部件可穿过的中空通道435。此类驱动部件可包括例如关节运动致动器、闭合致动器和/或击发致动器。
第一轴接头部件430通过关节运动销454枢转地连接到第二轴接头部件450。关节运动销454还被接纳在第二轴接头部件450的朝近侧延伸的关节运动突片451的销孔453内。关节运动销454允许第二轴接头部件450围绕关节运动轴线AA相对于第一轴接头部件430进行关节运动。第二轴接头部件450还包括驱动环结构452。驱动环结构452从朝近侧延伸的关节运动突片451延伸并且还限定销孔453的一部分。下面更详细地讨论，驱动环结构452被构造成能够由关节运动驱动系统接合。第二轴接头部件450还包括远侧部分455，该远侧部分包括被构造成能够接纳保持环458的环形凹槽456。穿过远侧部分455的中空通道457被构造成能够接纳穿过其中的外科缝合组件400的各种驱动部件。保持环458被构造成能够通过配合在仓通道210的环形凹槽211和第二轴接头部件450的环形凹槽456内而将第一钳口201保持到第二轴接头部件450。
为了使端部执行器200围绕关节运动轴线AA进行关节运动，提供了关节运动线缆460。关节运动线缆460可由任何合适的装置致动，诸如例如由机器人输入和/或手持式外科器械的柄部上的手动触发器致动。关节运动线缆460可包括对抗致动轮廓。换句话讲，当朝近侧拉动关节运动线缆460的第一侧时，允许关节运动线缆460的第二侧像滑轮系统那样朝远侧推进。相似地，当朝近侧拉动第二侧时，允许第一侧朝远侧推进。关节运动线缆460延伸穿过外轴411。关节运动线缆460围绕驱动环结构452定位并且摩擦地保持在其上以允许第二轴接头部件450在关节运动线缆460被致动时旋转。当关节运动线缆460被致动时，关节运动线缆460被构造成能够将旋转扭矩施加到第二接头轴部件450的驱动环结构452并且因此施加到端部执行器200。此类扭矩被构造成能够致使第二接头轴部件450相对于第一接头轴部件430旋转或枢转，由此使端部执行器200相对于外轴411进行关节运动。关节运动线缆460的第一侧可被拉动以使端部执行器200围绕关节运动轴线AA沿第一方向旋转，并且关节运动线缆460的第二侧可被拉动以使端部执行器200围绕关节运动轴线AA沿与第一方向相反的第二方向旋转。
轴组件410还包括定位在关节运动接头420内的关节运动部件支撑结构440。此类支撑结构440可向各种驱动部件提供支撑，该驱动部件被构造成能够在端部执行器200进行关节运动时穿过关节运动接头420到达端部执行器200。支撑结构440还可用于在使用期间将驱动部件与组织残余物隔离。
外科缝合组件400还包括闭合驱动轴区段475和击发驱动轴区段476，其各自被构造成能够通过关节运动接头420将旋转运动传递到端部执行器200。驱动轴区段475、476被构造成能够在端部执行器200进行关节运动时被动地纵向扩张和收缩。例如，关节运动可引起驱动轴区段475、476的扩张和收缩以考虑由于端部执行器200相对于轴组件410的关节运动而引起的驱动轴长度的相应纵向拉伸或收缩。在驱动轴区段475、476的扩张和收缩期间，驱动轴区段475、476维持与端部执行器200中的延伸穿过外轴411的对应输入轴和输出轴的旋转驱动接合。在至少一个实例中，输出轴包括闭合螺杆251和击发螺杆261，该闭合螺杆被构造成能够通过钳口201、203来实现抓持、闭合或组织操纵，该击发螺杆被构造成能够实现钳口201、203的夹紧和击发构件270的击发。
图15至图17示出了外科缝合组件500，其包括轴组件510和附接到轴组件510的图1至图8的端部执行器200。轴组件510可在许多方面类似于本文所讨论的各种其他轴组件；然而，轴组件510包括单个关节运动接头和被构造成能够被动地扩张和收缩的驱动轴区段。外科缝合组件500被构造成能够切割和缝合组织。外科缝合组件500可附接到外科器械柄部和/或外科机器人接口。外科器械柄部和/或外科机器人接口可被构造成能够致动外科缝合组件500的各种功能。轴组件510包括关节运动接头520。如下文更详细讨论的，端部执行器200被构造成能够围绕轴线AA进行关节运动。
轴组件510包括第一轴接头部件530和通过关节运动销543枢转地联接到第一轴接头部件530的第二轴接头部件540。第一轴接头部件530被构造成能够附接到外科器械组件和/或外科机器人接口的轴。第一轴接头部件530包括近侧部分531和关节运动突片533，该关节运动突片包括限定在其中的销孔534。在至少一个实例中，第一轴接头部件530包括中空通道，外科缝合组件400的各种驱动部件可穿过该中空通道。此类驱动部件可包括例如关节运动致动器、闭合致动器和/或击发致动器。
第一轴接头部件530通过关节运动销543枢转地连接到第二轴接头部件540。关节运动销543还被接纳在第二轴接头部件540的朝近侧延伸的关节运动突片541的销孔542内。关节运动销543允许第二轴接头部件540围绕关节运动轴线AA相对于第一轴接头部件530进行关节运动。第二轴接头部件540还包括远侧部分545，该远侧部分包括被构造成能够接纳保持环548的环形凹槽547以及外科缝合组件500的各种驱动部件可穿过的中空通道546。保持环548被构造成能够通过配合在仓通道210的环形凹槽211和第二轴接头部件540的环形凹槽547内而将第一钳口201保持到第二轴接头部件540。
任何合适的关节运动驱动系统均可用于使端部执行器200绕轴线AA进行关节运动。在至少一个实例中，端部执行器200被动地进行关节运动。在此类实例中，端部执行器200可被压靠组织，例如，以向端部执行器200施加力并致使端部执行器200围绕关节运动轴线进行关节运动。在至少一个实例中，端部执行器200还包括弹簧，该弹簧被构造成能够向第二轴接头区段540施加中性偏置力，例如，以致使端部执行器200朝向非关节运动构型偏置。
外科缝合组件500还包括闭合驱动轴区段575和击发驱动轴区段576，其各自被构造成能够通过关节运动接头520将旋转运动传递到端部执行器200。驱动轴区段575、576被构造成能够在端部执行器200进行关节运动时被动地纵向扩张和收缩。关节运动致使驱动轴区段575、576扩张和收缩以解决由于端部执行器200的关节运动而引起的驱动轴长度的纵向拉伸或收缩。在驱动轴区段575、576的扩张和收缩期间，驱动轴区段575、576维持与端部执行器200中的对应输入轴和输出轴的旋转驱动接合。在至少一个实例中，输出轴包括闭合螺杆251和击发螺杆261，其将在本文中进一步描述。
图18至图20示出了包括轴部分610和端部执行器600的外科缝合端部执行器组件600。端部执行器组件600在许多方面类似于本文所公开的各种其他端部执行器组件；然而，端部执行器组件600包括由柔性击发轴驱动的多部件击发构件。端部执行器组件600被构造成能够切割和缝合组织。端部执行器组件600可通过轴部分610的近侧突片611附接到外科器械柄部和/或外科机器人接口。外科器械柄部和/或外科机器人接口可被构造成能够致动端部执行器组件600的各种功能。端部执行器组件600包括仓通道钳口620和砧座钳口660，该砧座钳口枢转地安装到仓通道钳口620以将组织夹紧在仓通道钳口620和砧座钳口660之间。
仓通道钳口620包括：通道630，其包括近侧端部631；钉仓640，其被构造成能够在其中存储多个钉并且被构造成能够被接纳在通道630内；和支撑支架650，其配合在钉仓640内。钉仓640和支撑支架650被构造成能够在将钉仓640安装到通道630中之前组装在一起。下文更详细地讨论，支撑支架650被构造成能够当击发构件组件被推进穿过端部执行器组件600时进一步支撑击发构件组件。
砧座钳口660被构造成能够成形从钉仓640射出的钉。砧座钳口660包括近侧端部661，该近侧端部包括限定在其中的被构造成能够接纳联接销663的一对销孔662。砧座钳口660可围绕联接销663在松开位置和完全夹紧位置之间枢转。联接销663也被接纳在通道630的近侧端部631中限定的一对销孔633内。联接销663用于将砧座钳口660枢转地安装到通道630。在至少一个实例中，通道630通过围绕通道630的环形凹槽632和轴部分610的环形凹槽615配合的保持环或带安装到轴部分610。保持环或带被构造成能够将通道630保持到轴部分610。
端部执行器组件600包括闭合驱动装置670，该闭合驱动装置被构造成能够通过使砧座钳口660相对于通道630枢转而在砧座钳口660与仓通道钳口620之间夹持组织。端部执行器组件600还包括击发驱动装置680，该击发驱动装置被构造成能够通过部署来自钉仓640的多个钉来夹紧、缝合和切割组织。闭合驱动装置670包括定位在通道630内的闭合螺杆671和经螺纹联接到闭合螺杆671的闭合楔形件675。当闭合螺杆671旋转时，闭合楔形件675朝远侧推进或朝近侧回缩以分别打开或闭合砧座钳口660。闭合驱动装置670可由任何合适的装置致动。例如，旋转驱动轴可从致动接口延伸穿过轴部分610，例如以旋转闭合螺杆671。合适的旋转驱动轴的其他示例在本文中进一步描述。
击发驱动装置680包括柔性驱动轴681，该驱动轴被构造成能够线性地移动穿过端部执行器组件600。例如，柔性驱动轴681可由机器人输入和/或柄部组件的手动致动的驱动轴致动。柔性驱动轴681被构造成能够延伸穿过轴部分610的远侧端部613的中空通道614并且是柔性的，使得端部执行器组件600可相对于端部执行器600从其延伸的轴进行关节运动。柔性驱动轴681延伸穿过限定在闭合楔形件675中的间距狭槽676并且固定地附接到下击发构件682。下击发构件682被构造成能够与不同的钉仓一起重复使用。
钉仓640包括一次性上击发构件683，该一次性上击发构件被构造成能够以钩的方式接合或闩锁到下击发构件682上，使得下击发构件582可推动或驱动上击发构件683穿过钉仓640和支撑支架650。换句话讲，击发致动涉及两部分式击发构件—结合到仓640中的一次性上击发构件683和结合到击发驱动装置680中的可重复使用的下击发构件682，当钉仓640位于细长通道630中时，这些击发构件可联接在一起。两部分式击发构件在本文中进一步描述。
上击发构件683包括被构造成能够接合并定位砧座钳口660的上凸缘、被构造成能够切割组织的刀刃、以及被构造成能够以钩的方式接合下击发构件682的闩锁部分。钉仓640还包括被构造成能够接合定位在钉仓640内的钉驱动器以从钉仓640射出钉的滑动件684。因为刀和切割刃被结合到钉仓640的一次性上击发构件683中，所以新的和/或全新的切割刃可与装载到端部执行器组件600中的每个钉仓一起供应。
下击发构件682和上击发构件683被构造成能够移动穿过支撑支架650，使得与击发序列相关联的竖直负载被构造成能够通过支撑支架650、钉仓640、通道630和砧座钳口660分布。支撑支架650可由例如待插入钉仓640内的金属材料构成。支撑支架650包括被构造成能够配合在钉仓640的纵向狭槽中限定的对应键狭槽内的键轨道655。支撑支架650还包括被构造成能够接纳上击发构件683的刀的纵向狭槽653、被构造成能够接纳上击发构件683的一部分的圆柱形通道657、下击发构件682的一部分和柔性驱动轴681。支撑支架650还包括竖直键延伸部656，该竖直键延伸部被构造成能够被接纳在仓平台中的对应键孔内。当支撑支架650安装在钉仓640内时，此类延伸部可通过仓平台可见。在至少一个实例中，支撑支架650被构造成能够从钉仓640的面向通道630的底部插入到钉仓640中。
支撑支架650还包括都被构造成能够与通道630接合的近侧突片651和远侧突片653。突片651、653被构造成能够分配由击发驱动装置680和对应部件通过组件600传递的力中的至少一些力。远侧突片651可用于通过与通道630共享和/或重新分配由击发驱动装置680施加到支撑支架650的负载来阻止上击发构件683和下击发构件682被推动穿过支撑支架650的远侧端部。
当替换钉仓640以使得可重复使用端部执行器组件600时，将钉仓640从通道钳口630移除。从通道钳口630移除钉仓640会移除上击发构件683、滑动件684、支撑支架650和钉仓640。新刀可被设置有替换钉仓。
本文所公开的各种实施方案可与机器人系统700结合使用。例如，在图21至图23中示出了示例性机器人系统。图21示出了主控制器701，其可与外科机器人结合使用，例如图22中示出的从属机器人臂车800。主控制器701和从属机器人臂车800以及它们各自的部件和控制系统在本文中统称为机器人系统700。此类系统和装置的示例在名称为“MECHANICALACTUATOR INTERFACE SYSTEM FOR ROBOTIC SURGICAL TOOLS”的美国专利7,524,320号，以及名称为“SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENTARRANGEMENTS”的美国专利9,072,535号中公开，这些专利申请各自全文以引用方式并入本文。众所周知，主控制器701通常包括控制器(在图21中一般表示为703)，在外科医生经由立体显示器702观察手术的同时，该控制器由外科医生抓持并在空中操纵。控制器701通常包括手动输入装置，这些手动输入装置优选地以多个自由度运动并通常还具有用于致动工具(例如，用于闭合抓持钳口、施加电势到电极等)的可致动柄部、触发器或致动器。
如图22中可见，在一种形式中，机器人臂车800可被构造成能够致动一个或多个外科工具，通常称为900。采用主控制器和机器人臂车布置结构的各种机器人外科系统和方法在名称为“MULTI-COMPONENT TELEPRESENCE SYSTEM AND METHOD”的美国专利6,132,368号中公开，该专利申请的全部公开内容据此以引用方式并入本文。
在各种形式中，机器人臂车800包括基座702，在例示的实施方案中，该基座可支撑外科工具900。在各种形式中，外科工具900可由一系列手动关节运动的连杆(通常称为装置接头804)和机器人操纵器806支撑。在各种实施方案中，连杆和接头布置结构可有利于外科工具围绕空间点的旋转，如在名称为“REMOTE CENTER POSITIONING DEVICE WITHFLEXIBLE DRIVE”的美国专利5,817,084号中更完整地描述，该专利申请的全部公开内容据此以引用方式并入本文。平行四边形布置结构将旋转约束为围绕轴线812a(有时称为俯仰轴)枢转。支撑平行四边形连杆的连接件以枢转方式安装到装置接头804(图22)，使得外科工具还围绕轴线812b(有时称为偏航轴)旋转。俯仰轴812a和偏航轴812b在远程中心814处相交，该远程中心沿外科工具900的细长轴对准。当由操纵器806支撑时，外科工具900可具有另外的从动自由度，包括外科工具900沿纵向轴线“LT-LT”的滑动运动。当外科工具900相对于操纵器806(箭头812c)沿工具轴线LT-LT运动时，远程中心814相对于操纵器806的基座816保持固定。因此，整个操纵器通常移动以使远程中心814重新定位。操纵器806的连杆808可由一系列马达820驱动。这些马达响应于来自控制系统的处理器的命令而主动地使连杆808移动。还可采用马达820来操纵外科工具900。还设想了另选的接头结构和装置布置结构。其他接头和装置布置结构的示例例如在名称为“AUTOMATED ENDOSCOPE SYSTEM FOROPTIMAL POSITIONING”的美国专利5,878,193号中公开，该专利申请的全部公开内容据此以引用方式并入本文。
虽然结合外科工具与主控制器701之间的通信在本文中初步描述了机器人部件与机器人外科系统的处理器之间的数据通信，但应当理解，类似的通信可发生在操纵器、装置接头、内窥镜或其他图像捕获装置等的电路与机器人外科系统的处理器之间，该机器人外科系统的处理器用于部件兼容性确认、部件类型识别、部件校正(诸如偏移等)通信、部件与机器人外科系统的联接确认等。根据至少一个方面，本文所公开的各种外科器械可结合其他机器人控制的或自动外科系统使用，并且不一定限于与图21至图23所示和上述参考文献中所述的特定机器人系统部件一起使用。
在各种腹腔镜外科手术期间，通常的做法是通过已安装在患者的腹壁中的套管针插入外科器械的外科端部执行器部分，以触及位于患者腹部内的外科部位。在其最简单的形式中，套管针是在一端具有尖锐的三角形点的笔形器械，其通常在被称为插管或套管的中空管内部使用，以形成进入身体的开口，外科端部执行器可通过该开口引入。这种布置形成进入体腔的入口，外科端部执行器可通过该入口插入。套管针的插管的内径不可避免地限制可通过套管针插入的外科器械的端部执行器和驱动支承轴的尺寸。
无论所执行的外科手术的具体类型如何，一旦外科端部执行器通过套管针插管插入患者体内，通常需要相对于定位在套管针插管内的轴组件运动外科端部执行器，以便相对于待处理的组织或器官适当地定位外科端部执行器。外科端部执行器相对于保持在套管针插管内的轴部分的这种运动或定位通常被称为外科端部执行器的“关节运动”。已开发多种关节运动接头来将外科端部执行器附接到相关联的轴，以便于外科端部执行器的这种关节运动。可以预期，在许多外科手术中，希望采用具有尽可能大的关节运动范围的外科端部执行器。
由于套管针插套的尺寸所施加的尺寸约束，关节运动接头部件的尺寸必须设定成以便自由地通过套管针插套插入。这些尺寸约束还限制了各种驱动构件和部件的尺寸和组成，该驱动构件和部件与被支撑在外壳中的马达和/或其他控制系统可操作地交接，该外壳可为手持式的或包括较大自动化系统的一部分。在许多情况下，这些驱动构件必须可操作地穿过关节运动接头以可操作地耦接到外科端部执行器或与外科端部执行器可操作地交接。例如，一个此类驱动构件通常用于向外科端部执行器施加关节运动控制运动。在使用期间，关节运动驱动构件可以未被致动以将外科端部执行器定位在非关节运动位置以便于将外科端部执行器通过套管针插入，然后被致动以在外科端部执行器进入患者体内时使外科端部执行器关节运动到期望位置。
因此，上述尺寸约束对开发关节运动系统构成了许多挑战，所述关节运动系统可实现期望关节运动范围，还适合操作外科端部执行器的各个特征部所需的多种不同驱动系统。此外，一旦外科端部执行器已定位在期望的关节运动位置，在端部执行器的致动和外科手术的完成期间，关节运动系统和关节运动接头必须能够将外科端部执行器保持在该锁定位置。此类关节运动接头布置还必须能够承受在使用期间端部执行器所经历的外力。
各种外科器械采用各种不同的驱动轴布置，该驱动轴布置用于从被支撑在外科器械的柄部中或自动化或机器人控制系统的其他部分中的对应驱动运动源传递驱动运动。这些驱动轴布置必须能够适应端部执行器的显著的关节运动取向，同时有效地将此类驱动运动传递跨过外科器械的关节运动接头。此外，由于器械轴必须被插入穿过的套管针的尺寸所规定的上述尺寸限制，这些驱动轴部件必须在轴内占据尽可能小的空间。为了适应此类要求，许多驱动轴布置包括串联联接在一起的若干可移动元件。部件的小尺寸(例如，4mm直径)和数量导致困难且冗长的组装规程，其增加了装置的成本和复杂性。
如本文进一步所述，动力缝合装置可包括两个可独立旋转的驱动构件：被构造成能够实现端部执行器的钳口的闭合的第一旋转驱动构件和被构造成能够实现安装在端部执行器中的钉仓的击发的第二旋转驱动构件。第一旋转驱动构件和第二旋转驱动构件是柔性的并且被构造成能够延伸穿过至少一个关节运动接头。在此类实例中，第一旋转驱动构件和第二旋转驱动构件可在处于非挠曲构型时和处于挠曲构型时通过关节运动接头传递旋转致动运动。示例性旋转驱动构件在本文中进一步描述。
动力缝合组件还包括第一钳口、第二钳口、闭合驱动装置和击发驱动装置，该闭合驱动装置包括延伸穿过关节运动接头的第一旋转驱动构件，该击发驱动装置包括延伸穿过关节运动接头的第二旋转驱动构件。第二旋转驱动构件可独立于第一旋转驱动构件旋转。例如，闭合驱动装置可由闭合触发器激活，于是闭合驱动装置的致动引起第一旋转驱动构件的旋转，该第一旋转驱动构件通过关节运动接头将旋转运动传递到闭合螺杆。闭合驱动装置还包括经螺纹联接到闭合螺杆的闭合楔形件，其中闭合楔形件被构造成能够接合第一钳口以在第一旋转驱动构件旋转时将第一钳口从打开位置移动到闭合位置。
击发驱动装置可由例如与闭合触发器分开的击发触发器激活。第二旋转驱动构件的旋转与第一旋转驱动构件的旋转分开，并且闭合运动与击发运动分开且不同。击发驱动装置的启动实现了第二旋转驱动构件的旋转，该第二旋转驱动构件通过关节运动接头将旋转运动传递到击发螺杆。击发驱动装置还包括经螺纹联接到击发螺杆的击发构件，其中击发构件被构造成能够以凸轮方式接合第一钳口和第二钳口并且在第二旋转驱动构件的旋转时移动切割构件和/或钉击发滑动件。
在各种实例中，动力缝合装置中的至少一个部件可以是3D打印部件。3D打印部件可被结合到关节运动系统、闭合/抓持系统和/或击发系统中，如本文进一步所述。在某些实例中，可利用3D打印技术来改善部件能力。例如，3D打印可允许打印的部件表现出超材料性质，使得3D打印的部件表现出更大的结构强度和刚度，同时允许精确地形成小细节特征部并且优化部件的其他性质，例如选择性的柔性和/或润滑。动力缝合装置的示例性3D打印部件在本文中进一步描述并且包括柔性可旋转驱动构件，例如串联3D打印万向接头、击发构件或工字梁、和/或钉仓和/或它们的子部件。在一种实例中，钉仓可以是复合塑料-金属3D打印部件。各种部件的3D打印及对其的考虑在本文中进一步描述。
还设想了通过此类外科缝合组件进行缝合的方法。方法可包括获得外科缝合组件以及由闭合触发器致动闭合驱动装置，其中闭合楔形件被构造成能够接合第一钳口以在第一旋转驱动构件旋转时将第一钳口从打开位置移动到闭合位置。方法还可包括由击发触发器激活击发驱动装置，其中击发构件被构造成能够以凸轮方式接合第一钳口和第二钳口并且在第二旋转驱动构件的旋转时在击发运动期间推进切割构件和钉击发滑动件。本文进一步描述了3D打印部件在此类组件中的各种应用。
在各种实例中，外科装置的外科端部执行器和/或缝合组件可包括旋转驱动螺杆或旋转驱动构件，如本文进一步所述。旋转驱动螺杆可延伸穿过通道和/或钉仓的一部分到达端部执行器中的远侧位置。旋转驱动螺杆可便于夹紧和/或击发钉仓，如本文进一步所述。旋转驱动螺杆可沿纵向轴线延伸并且可与钉仓的从其近侧端部延伸到其远侧端部的中心线对准。
穿过端部执行器的旋转驱动螺杆可沿端部执行器及其钉仓的纵向中心部分占据有限空间的相当大部分。在各种实例中，旋转驱动螺杆可能干扰某些现有的击发部件，诸如驱动器和/或滑动件。钉仓的小占有面积以及施加到端部执行器和钉仓中的各种部件的相当大的击发力可能对结构变化和/或某些部件的重新定位提出各种挑战。
例如，需要修改具有穿过其中的旋转驱动螺杆的钉仓中的击发部件以避免干涉并且在旋转驱动螺杆周围提供足够的间隙，同时在击发行程期间承受击发力和平衡扭矩，以便最大限度地减少对部件的损坏和/或钉的误击发。在各种实例中，钉排可被压缩(即，更密集的钉布置)和/或在侧向外侧远离旋转驱动螺杆移位，以增加在钉仓的中心线周围的侧向空间。例如，重新定位和/或增加钉排的密度可能需要对击发部件(诸如驱动器和/或滑动件)进行各种调整。
在各种实例中，驱动器和/或滑动件可被修改成对应于重新定位和/或压缩的钉排，同时最大限度地减少卡住和/或误击发的发生。例如，对钉驱动器的修改可包括钉支撑柱和/或其间的桥接件的结构和几何形状变化。在某些实例中，驱动器的上部部分(例如，钉支撑柱的宽度)可相对于驱动器的中心线是不对称的。附加地或另选地，驱动器的下部部分(例如，钉支撑柱的桥接件和/或基座)可相对于驱动器的中心线是不对称的。
例如，在本公开的一个方面，钉仓可包括沿纵向轴线延伸的主体、钉排以及被构造成能够同时击发三个钉的三重驱动器。钉排可包括位于纵向轴线的第一侧上的内排，其中内排包括内钉。钉排还可包括位于纵向轴线的第一侧上的中间排，其中中间排包括中间钉。此外，钉排可包括位于纵向轴线的第一侧上的外排，其中外排包括外钉。中间排可以与内排和外排侧向等距间隔开。三重驱动器可包括限定第一宽度的内支撑柱，其中内支撑柱被构造成能够支撑内钉。三重驱动器还可包括限定第二宽度的中间支撑柱，其中中间支撑柱被构造成能够支撑中间钉。此外，三重驱动器可包括限定第三宽度的外支撑柱，其中外支撑柱被构造成能够支撑外钉。第一宽度可小于第二宽度并且小于第三宽度。在某些实例中，第一高度、第二高度和/或第三高度可都不同。
在本公开的各个方面，多钉驱动器的钉支撑柱的不同宽度可被构造成能够为滑动件轨道提供更宽的空间，同时优化旋转驱动螺杆沿钉仓的中心纵向部分的空间。本文进一步描述了对钉仓(包括对例如驱动器和仓体)的各种改进及其优点。
现在参考图24和图25，钉仓20100包括沿纵向轴线A延伸的主体20102。钉可移除地定位在主体20102中。钉可例如在击发行程期间从主体20102射出并击发到组织中。钉在纵向轴线A的任一侧上布置成纵向排。仓体20102还包括平台20104，该平台可被称为例如组织支撑表面。平台20104是侧向弯曲的组织支撑表面，并且限定从主体20102的第一侧向侧到主体20102的第二侧向侧的弯曲表面或轮廓。侧向弯曲的组织支撑平台20104中的顶点被限定在主体20102的中间部分处。例如，顶点可定位在纵向钉排之间并且覆盖纵向轴线A。在各种实例中，例如类似于击发螺杆261(图4和图5)的旋转驱动螺杆延伸穿过钉仓20100的一部分，如本文进一步所述。
钉定位在限定在仓体20102中的腔20110中。钉在纵向轴线A的任一侧上布置成纵向排。例如，腔20110布置在腔排20112中。腔排在纵向轴线A的每一侧上包括内排20112a、中间排20112b和外排20112c。中间排20112b在内排20112a与外排20112c之间侧向等距间隔开。例如，内腔排20112a可以与中间腔排20112b侧向向内间隔开一距离，并且外腔排20112c可以与中间腔排20112b侧向向外间隔开相同的距离。旋转驱动螺杆可以与纵向轴线A对准，并且可以与内腔排20112a相邻地延伸穿过仓体20102。例如，旋转驱动螺杆可位于内腔排20112a之间并且平行于内腔排。
内排20112a保持内钉，中间排20112b保持中间钉，并且外排20112c保持外钉。在各种实例中，内钉、中间钉和外钉可以是相同的。在其他实例中，例如，内钉、中间钉和/或外钉可各自在钉类型(例如，线材或冲压)、材料和/或尺寸(例如，不同高度)方面不同。读者将会知道，本文描述了各种钉、钉腔、钉驱动器和钉仓。然而，在某些实例中，可利用另选的紧固件，并且此类紧固件可结合到紧固件腔中，由紧固件驱动器驱动，和/或从在许多方面可类似于本文所述的钉腔、钉驱动器和/或钉仓的紧固件仓击发。
钉仓20100可具有不同的钉布置。例如，钉仓20100可在纵向轴线A的每一侧上具有少于三个钉排，并且在一个方面，可在纵向轴线A的每一侧上具有仅两个钉排。在又一些实例中，钉仓20100可在纵向轴线A的一个或多个侧上包括四个或更多个钉排。在各种实例中，钉排可相对于纵向轴线A是不对称的。例如，钉仓20100的第一侧可具有与钉仓20100的第二侧不同数量的钉排。
每个钉腔20110包括近侧端部、远侧端部和介于近侧端部与远侧端部之间的侧向引导表面。钉腔20110的结构和尺寸被设计成能够朝向平台20104引导驱动器20120穿过钉腔20110。更具体地，钉腔20110的几何形状可与驱动器20120的几何形状互补。例如，每个钉腔20110中的侧向引导表面被构造成能够在驱动器20120移动穿过钉腔20110时引导驱动器20120的侧壁20134(例如，钉支撑柱的侧壁)。附加地或另选地，每个钉腔20110的近侧端部和/或远侧端部可包括直立沟槽，该直立沟槽被构造成能够可滑动地接纳驱动器20120的端部和/或舌状部。还设想了另选的舌状部和沟槽布置，其可被构造成能够在从钉仓20100击发钉期间引导驱动器20120穿过钉腔20110。
驱动器20120被构造成能够支撑多个钉并且在击发行程期间从仓体20102驱动该多个钉。驱动器20120可以可移动地支撑横跨两个或更多个纵向排钉腔20112的钉。例如，驱动器20120可以可移动地支撑在钉仓20100的同一侧上的内钉、中间钉和外钉。
现在主要参考图26至图28，示出了驱动器20120。例如，多个驱动器如驱动器20120结合到钉仓20100中。驱动器20120是被构造成能够同时驱动三个钉的三重驱动器。驱动器20120包括三个支撑柱：内支撑柱20122a，其被构造成能够支撑内钉排中的内钉；中间支撑柱20122b，其在内支撑柱20122a的侧向外侧，被构造成能够支撑中间钉排中的中间钉；以及外支撑柱20122c，其在中间支撑柱20122b的侧向外侧并且被构造成能够支撑外钉排中的外钉。在各种实例中，每个驱动器20120的支撑柱20122a、20122b、20122c可以纵向错开。
驱动器20120还包括在相邻支撑柱20122之间延伸的桥接件20126。例如，第一桥接件20126a在内支撑柱20122a与中间支撑柱20122b之间延伸，并且第二桥接件20126b在中间支撑柱20122b与外支撑柱20122c之间延伸。桥接件20126a、20126b各自包括倾斜下侧20128，该倾斜下侧被构造成能够在击发行程期间由滑动件驱动地接合。换句话说，每个驱动器20120被构造成能够由沿驱动器20120的倾斜下侧20128的两个平行滑动件轨道接合和提升。例如，滑动件可被构造成能够在击发行程期间沿击发路径移动。滑动件可包括与纵向轴线A对准的中心部分、在纵向轴线A的第一侧上的第一轨道以及在纵向轴线A的第二侧上的第二轨道，第一轨道被构造成能够驱动地接合第一桥接件20126a的倾斜下侧20128，第二轨道被构造成能够驱动地接合第二桥接件20126b的倾斜下侧20128。本文进一步描述了滑动件及其击发运动。
每个支撑柱20122包括近侧端部20130、远侧端部20132，以及在近侧端部20130与远侧端部20132之间纵向延伸的一对相对的侧壁20134。侧壁20134被构造成能够在击发运动期间可滑动地接合相应钉腔20110中的侧向引导表面。每个支撑柱20122包括钉支撑托架20124。钉的基座可保持在钉支撑托架20124中。
钉支撑托架20124各自与内轴线A1、中间轴线A2或外轴线A3中的一者对准，这些轴线对应于限定钉仓20100一侧上的纵向排钉和钉腔20110的轴线。第一侧向距离D1限定在内轴线A1与中间轴线A2之间，并且第二侧向距离D2限定在外轴线A3与中间轴线A2之间。轴线侧向等距间隔开；第一侧向距离D1和第二侧向距离D2相同。尽管轴线与相邻排钉腔20110之间的侧向距离D1、D2相同，但驱动器20120相对于驱动器20120的中心线是不对称的。例如，驱动器20120的中心线对应于中间轴线A2，并且内钉和外钉定位成与中间轴线A2等距；然而，驱动器20120关于中间轴线A2是不对称的。
主要参考图27，内支撑柱20122a在其侧壁20134之间限定第一宽度Wa，中间支撑柱20122b在其侧壁20134之间限定第二宽度Wb，并且外支撑柱20122c在其侧壁20134之间限定第三宽度Wc。第一宽度Wa不同于第二宽度Wb和第三宽度Wc。例如，第一宽度Wa可减小或变窄至小于第二宽度Wb且小于第三宽度Wc，以适应穿过钉仓20100的中心部分的旋转驱动螺杆。在某些实例中，一个或多个较窄的支撑柱20122可以有效地变窄并且减小驱动器20120的占有面积，同时使桥接件20126的宽度最大化，并且因此使滑动件轨道的宽度最大化，该滑动件轨道例如接合桥接件20126的倾斜下侧20128并且将击发力传递到驱动器20120。在各种实例中，增加桥接件20126和滑动件轨道的宽度可改善滑动件轨道的刚度并且最大限度地减少滑动件轨道在击发行程期间的变形和/或其损坏。
宽度Wa、Wb和Wc都不同。例如，中间支撑柱20122b的宽度Wb大于内支撑柱20122a的宽度Wa和外支撑柱20122c的宽度Wc。宽度Wc小于中间支撑柱20122b的宽度Wb，并且大于内支撑柱20122a的宽度Wa。不同的宽度Wa、Wb和Wc被构造成能够优化驱动器20120的宽度以适应沿纵向轴线A的旋转驱动螺杆，同时例如有效地传递击发力并且最大限度地减少扭矩和误击发。
如本文所提供，在某些实例中，驱动器上的钉支撑柱的宽度可变化以适应定位在钉仓中的旋转驱动螺杆。附加地或另选地，在本公开的某些方面，驱动器的下部部分还可侧向变化并且下部部分(例如，支撑柱和/或桥接件的下部部分)可相对于穿过中间支撑柱的中心线是不对称的。例如，驱动器的下部部分可被改进以增加钉仓的纵向中心部分中的可用空间。驱动器的下部部分的不对称几何形状可被选择为改善三重驱动器的强度和刚度，同时最大限度地减小驱动器的高度。在各种实例中，尽管支撑柱厚度和/或桥接件几何形状可侧向变化，但支撑柱可与大致三角形的三重驱动器的质心等距间隔开。例如，中间支撑柱可以与质心纵向对准，并且内支撑柱和外支撑柱可以从质心纵向偏移。在各种实例中，倾斜表面可以与三重驱动器的质心侧向等距间隔开。
参考图29和图30，示出了包括钉仓20200和三重驱动器20220的端部执行器20240。钉仓20200在许多方面类似于钉仓20100(图24)，并且三重驱动器20220在许多方面类似于三重驱动器20120(图26)。例如，钉仓20200包括仓体20202，该仓体在旋转驱动螺杆20242的每一侧上包括三排钉腔，并且三重驱动器20220包括被构造成能够支撑钉的三个平行钉支撑托架20224，其中三重驱动器20220被构造成能够从内排、中间排和外排击发钉。
端部执行器20240包括旋转驱动螺杆20242和击发构件20244，它们分别类似于击发螺杆261(图4和图5)和击发构件270(图4和图5)。击发构件20244被构造成能够在击发行程期间移动穿过钉仓20200以推进滑动件并提升驱动器20220。驱动器20220包括内支撑柱20222a、中间支撑柱20222b和外支撑柱20222c。柱20222包括不同的宽度，如本文进一步所述。在本公开的各个方面，柱20222中的一个或多个柱还可包括与其他柱不同的高度。在各种实例中，不同的高度被构造成能够将钉成形为不同的高度，这些高度可对应于例如仓体的侧向弯曲的组织支撑表面或平台的轮廓。
驱动器20220的下部部分包括斜面化内边缘20236。斜面化内边缘20236是尺寸被设计成能够适应驱动螺杆20242和击发构件20244的下部部分的切口或扇形边缘。例如，驱动螺杆20242沿纵向轴线A延伸并且定位在纵向轴线A的相对侧上的驱动器20220之间。在此类实例中，驱动螺杆20242可延伸穿过钉仓20200，同时最大限度地减小钉仓20200和端部执行器20240的尺寸。斜面化内边缘20236包括进入内支撑柱20222a的基座部分中的切口，该切口为沿端部执行器20240的纵向中心部分定位的击发部件提供间隙。此外，斜面化内边缘20236被构造成能够提供更靠近端部执行器的竖直中心线的空间，即上凸轮与下凸轮之间的等距，这可改善和/或帮助平衡在击发行程期间的力。
附加地或另选地，驱动器的桥接件可侧向变化和/或相对于穿过驱动器的中间支撑柱的中心线是不对称的。现在参考图31，示出了包括钉仓20300和三重驱动器20320的端部执行器20340。钉仓20300在许多方面类似于钉仓20100(图24)，并且三重驱动器20320在许多方面类似于三重驱动器20120(见图26)。例如，钉仓20300包括仓体20302和平台20304；三排钉腔定位在旋转驱动螺杆的每一侧上，并且三重驱动器20320包括被构造成能够支撑钉的三个平行钉支撑托架20324，其中三重驱动器20320被构造成能够从内排、中间排和外排击发钉。驱动器20320在图31中以击发构型描绘，其中钉支撑柱的上部部分延伸穿过平台20304(即钉过度驱动)。
端部执行器20340可包括旋转驱动螺杆和击发构件，如本文进一步所述，击发构件在击发行程期间移动穿过钉仓20300以推进具有轨道20352的滑动件20350来提升驱动器20320。驱动器20320包括内支撑柱20322a、中间支撑柱20322b和外支撑柱20322c。柱20322包括不同的宽度，如本文进一步所述。在本公开的各个方面，柱20322中的一个或多个柱还可包括与其他柱不同的高度，如本文进一步所述。
驱动器20320的下部部分包括斜面化内边缘20336，其在许多方面类似于斜面化边缘20236(图29)。驱动器20320的下部部分还包括位于相邻钉支撑柱20322之间的桥接件20326。第一桥接件20326a将内支撑柱20322a连接到中间支撑柱20322b，并且第二桥接件20326b将中间支撑柱20322b连接到外支撑柱20322c。第一桥接件20326a的几何形状不同于第二桥接件20326b的几何形状。换句话说，桥接件20326a相对于穿过驱动器20320的竖直平面P(图31)是不对称的，并且与支撑在其上的中间钉基座/冠部的轴线对准。
第一桥接件20326a高于第二桥接件20326b。在各种实例中，如本文进一步所述，钉仓20300的中心纵向部分可更高，并且在侧向弯曲的组织支撑表面的顶点处限定比沿钉仓20300的侧面更大的高度。因此，钉仓20300可在内支撑柱20322a与中间支撑柱20322b之间适应比在外支撑柱20322c与中间支撑柱20322b之间附加的材料和/或增加的驱动器20320的高度/体积。例如，与第二桥接件20326b相比，第一桥接件20326a距基座表面的增加的高度可补偿由斜面化内边缘20336引起的刚性损失。附加地或另选地，与第二桥接件20326b相比，第一桥接件20326a的更大的高度可改善三重驱动器20320的刚度和强度，同时最大限度地减小尺寸并保持钉仓20300和端部执行器20340的紧凑形状因数。
在某些实例中，第一桥接件20326a的上部部分可被构造成能够在击发运动的初始部分期间引导驱动器20320穿过钉腔。例如，当内支撑柱20322a处于未击发位置时，内支撑柱20322a可由于仓体组件20300的中心部分中的切口而至少部分地不受侧向引导表面支撑或引导，以适应旋转驱动螺杆。在没有围绕内支撑柱20322a的某些侧向支撑表面的情况下，驱动器20320可能容易扭转和/或误击发。然而，第一桥接件20326a的增加的高度可被构造成能够在击发运动的初始部分期间接合仓体中的直立支撑表面，以改善对驱动器20320的引导和支撑。
现在参考图32，示出了驱动器20420的另选驱动器几何结构。驱动器20420是三重驱动器并且在许多方面类似于三重驱动器20120(图26)。例如，三重驱动器20420包括被构造成能够支撑钉的三个平行钉支撑托架20424，并且三重驱动器20420被构造成能够从内排、中间排和外排击发钉。驱动器20420可结合到本文所公开的各种钉仓中。例如，驱动器20420可与适于接纳沿纵向轴线延伸的旋转驱动螺杆的钉仓并且与可变高度平台一起使用。
驱动器20420包括内支撑柱20422a、中间支撑柱20422b和外支撑柱20422c。柱20422包括不同的宽度，如本文进一步所述。在本公开的各个方面，支撑柱20422中的一个或多个支撑柱还可包括与其他支撑柱不同的高度，如本文进一步所述。
驱动器20420的下部部分包括斜面化内边缘20436，其在许多方面类似于斜面化边缘20236(图29)。驱动器20420的下部部分还包括位于相邻钉支撑柱20422之间的桥接件。第一桥接件20426a将内支撑柱20422a连接到中间支撑柱20422b，并且第二桥接件20426b将中间支撑柱20422b连接到外支撑柱20422c。驱动器20420的下部部分的几何形状的变化在图32的示意图中用虚线指示。例如，为了沿钉仓的中心纵向部分为旋转驱动螺杆20442(其在许多方面类似于击发螺杆261(图4和图5))提供足够的空间和间隙，驱动器20420包括斜面化内边缘20436和在第一桥接件20426a与内支撑柱20422a之间的上角撑板20438。在此类实例中，驱动器20420可为旋转驱动螺杆20442提供空间和间隙，同时保持足够的结构完整性和刚度以适当地传递击发负载。
在各种实例中，可变高度平台和钉仓的最高高度可邻近旋转驱动螺杆20442。在此类实例中，可沿击发杆和切割边缘限定更紧密的组织间隙。可变高度平台的覆盖内支撑柱20422a和/或第一桥接件20426a的部分可限定最大高度，并且因此在某些方面中可以将升高的第一桥接件20426a和/或角撑板20438配合在介于第一桥接件20426a与内支撑柱20422a之间。
在某些实例中，一个或多个角撑板可以在第一桥接件20426a的上边缘与内支撑柱20424之间延伸。在某些实例中，角撑板20438可包括沿内支撑柱20422a和第一桥接件20426a的长度的至少一部分的纵向角撑板肋。驱动器20420相对于穿过中间支撑柱20422b的竖直平面P(图32)是不对称的，并且与支撑在其中的钉基座的纵向轴线对准。例如，由于角撑板20438和/或斜面化内边缘20436，第一桥接件20426a可限定与第二桥接件20426b不同的几何形状和不同的横截面轮廓。
在某些实例中，为了适应沿钉仓的中心部分的旋转驱动螺杆，可切除仓体的一部分。仓体可包括附加的引导件和支撑特征部，其被构造成能够引导驱动器穿过钉腔并朝向仓体的平台。即使当驱动器的一部分在钉腔内未完全就位时，引导件也可被构造成能够接合并支撑驱动器。
参考图33和图34，示出了仓体20502。在各种实例中，仓体20502可在许多方面类似于仓体20102(图24)，并且可结合到钉仓20100中并使用驱动器20120(图26)。钉可定位在限定在仓体20502中的腔20510a、20510b、20510c中。钉在纵向轴线A的任一侧上沿仓体20502的中心线布置成纵向排。例如，腔20510a、20510b、20510c布置成腔排。腔排在纵向轴线的每一侧上包括内排20512a、中间排20512b和外排20512c。旋转驱动螺杆(例如，图4和图5中的击发螺杆261)可以与纵向轴线A对准，并且可以与内腔排20512a相邻地延伸穿过仓体20502。例如，旋转驱动螺杆可位于内腔排20512a之间并且平行于内腔排。
主要参考图34，仓体20502包括围绕内排20512a中的内腔20510a延伸的引导表面20514。在各种实例中，引导表面20514被构造成能够即使当内支撑柱20122a在击发之前在内腔20510a中未完全就位时也将驱动器(例如，三重驱动器20120的内支撑柱20122a)引导到内腔20510a中并从中穿过。在各种实例中，引导表面20514是围绕内腔20510a延伸的下侧仓表面上的周向斜面。此类周向斜面被构造成能够在驱动器的内支撑柱被推进到内腔20510a中时防止意外的障碍和阻碍。在其他实例中，引导表面20514可包括例如圆角。引导表面20514可围绕内腔20510a的整个周边延伸。在其他实例中，引导表面20514可围绕周边的一部分定位，例如第一侧向侧、近侧端部和/或远侧端部。
也参考图35，示出了内腔20510a的一部分和驱动器20120。内腔20510a的下边缘包括围绕内腔20510a延伸的引导表面20514。内支撑柱20122a的顶部边缘还包括引导表面20125，该引导表面被构造成能够即使当内支撑柱20122a在击发行程和驱动器20120被滑动件初始提升之前在内腔20510a中未完全就位时也引导内支撑柱20122a与内腔20510a对准。在此类实例中，分别位于内腔20510a的下边缘和内支撑柱20122a的上边缘上的引导表面20514、20125被构造成能够相互作用，以确保内支撑柱20122a在击发行程期间平滑地移动到内腔20510a中。如本文进一步所述，由于旋转驱动螺杆沿仓体20502的中心纵向部分所需的空间，内支撑柱20122a在击发行程之前可在内腔20510a中未完全就位。
现在参考图36和图37，示出了驱动器20620的一部分。在本公开的各个方面，驱动器20620可以是三重驱动器并且在许多方面类似于驱动器20120(图26)。在本公开的各个方面，驱动器20620可结合到钉仓20100(图24)中。驱动器20620包括被构造成能够支撑钉20680(图37)的支撑柱20622。支撑柱20622包括近侧端部20630、远侧端部20632，以及在近侧端部20630与远侧端部20632之间纵向延伸的一对相对的侧壁20634。侧壁20634被构造成能够可滑动地接合相应钉腔中的侧向引导表面。支撑柱20622还包括钉支撑托架20624，并且钉20860的基座可保持在钉支撑托架20624中。
驱动器20630还包括近侧和远侧直立特征部20636、20638或延伸部，其延伸远离驱动器20630的基座并且远离钉支撑托架20624。近侧直立特征部20636是支撑柱20622的最近侧特征部并且从支撑柱20622的近侧端部20630延伸。远侧直立特征部20638是支撑柱20622的最远侧特征部并且从支撑柱20622的远侧端部20636延伸。在驱动器的未击发位置中，近侧和远侧直立特征部20636、20638可在钉仓的平台下方并且朝向平台延伸。近侧和远侧直立特征部20636、20638可被构造成能够例如支撑钉20680并在成形期间引导钉腿。
近侧和远侧直立特征部20636、20638是支撑柱20622的最高部分。在某些实例中，当驱动器移动到击发位置时，近侧和远侧直立特征部20636、20638可在平台上方延伸并且便于抓持和/或保持邻近钉20860的组织。例如，近侧和远侧直立特征部20636、20638可在钉腔的近侧端部和远侧端部处抓持组织。此外，近侧和远侧直立特征部20636、20638可用作驱动器20630的引导表面，并且在某些实例中可将支撑柱20632引导到紧固件腔中。例如，当支撑柱20622在击发之前在钉腔中未完全就位时，如本文进一步所述，近侧和远侧直立特征部20636、20638被构造成能够在击发运动期间引导支撑柱20622与钉腔对准。
在某些实例中，近侧和远侧直立特征部20636、20638可结合到内支撑柱(即，邻近击发路径和/或旋转驱动螺杆的支撑柱)中。在此类实例中，近侧和远侧直立特征部20636、20638可在击发行程期间接合钉腔，并且被构造成能够引导内支撑柱，即使内支撑柱在击发之前在钉腔中未完全就位，如本文进一步所述。在其他实例中，中间支撑柱和/或外支撑柱还可包括近侧直立特征部20636和/或远侧直立特征部20638中的至少一者。
在本公开的某些方面，当驱动器20620处于完全推进位置时，近侧和远侧直立特征部20636、20638被构造成能够被接纳到沿组织支撑平台的下侧的凹槽中。如本文进一步所述，组织支撑平台的下侧可包括配合在平台的面向砧座侧上的凹坑扩展部内的凹槽阵列。凹坑扩展部可围绕或至少部分地围绕组织支撑平台中的开口以在击发行程期间抓持组织和/或引导钉腿。在本文中进一步描述了驱动器上的特征部与组织支撑平台中的下侧凹槽的嵌套。在各种实例中，近侧和远侧直立特征部在仓平台的凹坑扩展部或脊中的嵌套可保持期望的组织间隙和平台厚度。
在某些实例中，可替换的钉仓可与每个击发行程一起使用，然后被另一可替换的钉仓替换以用于随后的击发行程。可替换的钉仓可包括仓体、驱动器、钉和滑动件，如本文进一步所述。可重复使用的多次击发切割边缘可结合到端部执行器中并且在某些实例中相对于可替换的钉仓推进。例如，端部执行器可包括击发构件，诸如I形梁或E形梁，例如沿其前缘具有面向远侧的直立切割边缘。本文进一步描述了在多个击发行程期间使用的具有可重复使用的切割边缘的示例性击发构件。在某些实例中，可重复使用的刀及其切割边缘可以是硬化部件，其制造可能是昂贵的。在某些实例中，可重复使用的刀在外科装置中的放置可限制外科装置可重复使用的次数。此外，为了抵抗多次击发使刀变钝，在某些实例中，可重复使用的刀可能不如单次使用的刀那么锋利。
在其他实例中，击发构件、端部执行器和/或外科装置可不包括多次击发组织横切刀。例如，刀可结合到可替换的钉仓中，而不是结合到外科装置本身中。在此类实例中，新的切割边缘可与每个击发行程一起使用。
本文描述了具有组织横切刀的各种可替换的钉仓组件。在一个实例中，击发构件可包括一体式滑动件部件，并且在钉仓插入到具有击发构件的外科装置或其端部执行器中时，刀可以可释放地附接或安装到该击发构件。
现在参考图99，示出了具有击发构件20841的端部执行器20840，该击发构件具有一体式滑动件20860和用于连接到单次使用的刀20830的附接特征部(例如，凹槽20846)。端部执行器20840在许多方面类似于端部执行器200(见图4和图5)，并且被构造成能够切割和缝合患者的组织。例如，端部执行器20840包括具有相对的侧壁20852的仓钳口20850，并且端部执行器20840还包括砧座钳口20854。例如，仓钳口20850被构造成能够接纳钉仓，诸如图103所示的可替换的钉仓20800。端部执行器20840还包括击发驱动系统20839，该击发驱动系统包括旋转驱动螺杆20842(图105)和击发构件20841，它们分别类似于击发螺杆261(图4和图5)和击发构件270(图4和图5)。在击发行程期间，在旋转驱动螺杆20842旋转时，击发构件20841被驱动穿过端部执行器20840以从钉仓20800击发钉。旋转驱动螺杆20842沿纵向轴线A延伸穿过紧固件仓20800。
主要参考图100A，击发构件20841包括直立主体部分20843、从直立主体部分20843的两侧侧向延伸的上凸轮构件20844以及从直立主体部分20843的两侧侧向延伸的下凸轮构件20845。当端部执行器20840处于夹紧构型(图105)时，上凸轮构件20844被构造成能够在击发行程期间以凸轮方式接合端部执行器20840的砧座钳口20854，并且下凸轮构件20845被构造成能够在击发行程期间以凸轮方式接合端部执行器20840的仓钳口20850。上凸轮构件20844和下凸轮构件20845被构造成能够在击发行程期间夹紧端部执行器20840的钳口并且限定组织间隙，如本文关于各种击发构件(例如，I形梁和E形梁)进一步所述。穿过直立主体部分20843的螺纹开口20847被构造成能够接纳穿过其中的旋转驱动螺杆20842。在其他实例中，螺母可经螺纹联接到旋转驱动螺杆20842并且安装到击发构件20841。本文进一步描述了各种螺母和另选的击发构件。
仍然参考图100A，击发构件20841还包括一体式滑动件20860。滑动件20860具有两个轨道20866。轨道20866中的一个轨道被构造成能够在外科端部执行器20800的每一侧上接合一排钉驱动器。换句话说，滑动件20860包括用于外科端部执行器20800的每一侧(即，用于钉仓20800的每一侧)的单个轨道20866(图103)。每一侧上的单个轨道可节省外科端部执行器20840中的侧向空间，这可提供附加的空间以适应沿外科端部执行器20840的中心部分的旋转驱动螺杆20842。在此类实例中，滑动件20860可为例如设置有击发构件20841和外科装置的可重复使用的部件。
主要参考图103，击发构件20841被驱动穿过钉仓20800，该钉仓包括仓体20802和可移动地定位在其中的驱动器20820、20821。驱动器20820是三重驱动器，并且驱动器20821是双重驱动器。在各种实例中，钉仓20800中的最近侧驱动器是双重驱动器20821，并且在其他实例中，最近侧驱动器中的一个或多个驱动器可以是单驱动器。双重驱动器20821包括侧凸缘，该侧凸缘包括用于由滑动件轨道20866驱动地接合的倾斜表面，该倾斜表面也与三重驱动器20820上的倾斜凹槽20818(图102)对准。换句话说，双重驱动器20821和三重驱动器20820都由紧固件仓20800的每一侧上的单个滑动件轨道20866驱动。
穿过仓体20802的平行纵向狭槽20803(图103)的尺寸被设计成能够在击发行程期间接纳轨道20866。换句话说，当击发构件20841的直立主体部分20843移动穿过仓体20802中的中心纵向狭槽20808时，轨道20866沿平行狭槽20803沿仓体20802的下侧移动。平行纵向狭槽20803也平行于纵向狭槽20808，击发构件20841的直立主体部分20843突出穿过该纵向狭槽。
在其他实例中，击发构件20841的一体式滑动件可在每一侧上具有多于一个轨道。例如，也设想了有四个轨道和六个轨道的一体式滑动件。
击发构件20841适于可释放地连接到刀20830。刀20830包括相对的弹簧臂20832，这些弹簧臂朝向击发构件20841的直立主体部分20843朝近侧延伸并且弹性地接合直立主体部分20843。弹簧臂20832卡扣在直立主体部分20843周围并且延伸到限定在直立主体部分20843中的腔20846中。刀20830还包括纵向主体20834，该纵向主体被构造成能够例如在用于旋转驱动螺杆20842的螺纹开口20847上方抵靠和/或嵌套在击发构件20841上的互补表面上。刀20830还包括直立切割边缘20836，其被构造成能够在组织支撑平台20804(图105)上方延伸以在击发行程期间横切组织。
在各种实例中，紧固件仓20800和仓钳口20850可包括对准和/或杠杆作用特征部，以便于将紧固件仓20800安装到仓钳口20850中。本文进一步描述了各种对准和杠杆作用特征部。这些特征部也可使刀20830与击发构件20841对准，并且更具体地使弹簧臂20832与腔20846对准，以确保在钉仓20800插入到仓钳口20850中时刀20830连接到击发构件20841。
在未击发钉仓20800中，刀20830与指示器滑动件20828对准，该指示器滑动件被构造成能够在击发行程期间被刀20830朝远侧推动。如本文进一步所述，当击发行程已经通过移动到仓体20802的鼻部中的窗口20806(图114)中而完成时，指示器滑动件20828向临床医生和/或用户提供可见指示，如本文进一步所述。此外，指示器滑动件20808被构造成能够在某些实例中选择性地克服遗漏的和/或用尽的仓闭锁件，如本文进一步所述。
指示器滑动件20828和刀20830是钉仓20800的部件。当钉仓20800安装在外科端部执行器20840中时，使刀20830与击发构件20841对准，使得弹簧臂20832弹性地接合开口20846。钉仓20800的插入角度被构造成能够确保弹簧臂20832和开口20846的正确对准。在此类实例中，可为每个钉仓20800并且针对每个击发行程提供新的刀。
主要参考图100B和图101，一体式滑动件20862被构造成能够在击发行程期间驱动地接合三重驱动器20820。击发构件20841和滑动件20862在击发行程期间沿钉仓20800中的纵向路径移动，以沿横向轴线提升驱动器20820。
三重驱动器20820由钉仓20800的每一侧上的单个滑动件轨道20862提升。每个三重驱动器20820包括凹陷的斜坡20818(图102)，该斜坡被定位成并且尺寸被设计成能够接纳滑动件轨道20862。换句话说，滑动件20860在中心部分的每一侧上具有单个轨道20862，并且单个轨道20872被构造成能够提升和驱动三重驱动器20820。实际上，单个轨道20862被构造成能够击发钉仓20800的一侧上的所有钉并且被构造成能够经由三重驱动器20820击发跨三排(例如，内排、中间排、外排)的钉。主要参考图102，三重驱动器20820包括凹陷的斜坡20818(图102)，该斜坡的尺寸被设计成能够接纳滑动件轨道20862。凹陷的斜坡20818沿三重驱动器20820的中心部分(例如，在中间/中部支撑柱下方)延伸，如本文进一步所述。
三重驱动器20820可在许多方面类似于三重驱动器20120(图26)。例如，三重驱动器20820被构造成能够支撑三个钉20890(图100B和图101)，并且同时提升三个钉20890。三重驱动器20820还包括三个支撑柱：内支撑柱20822a，其被构造成能够支撑内钉排中的内钉20890；中间支撑柱20822b，其在内支撑柱20822a的侧向外侧，被构造成能够支撑中间钉排中的中间钉20890；以及外支撑柱20822b，其在中间支撑柱20822b的侧向外侧并且被构造成能够支撑外钉排中的外钉20890。
三重驱动器20820还包括在相邻支撑柱20822之间延伸的桥接件20826。例如，第一桥接件20826a在内支撑柱20822a与中间支撑柱20822b之间延伸，并且第二桥接件20826b在中间支撑柱20822b与外支撑柱20822c之间延伸。与驱动轨道20866对准的凹陷的斜坡20818定位在第一桥接件20826a与第二桥接件20826b之间并且在中间支撑柱20822b近侧。
更具体地，凹陷的斜坡20818与中间支撑柱20822b纵向对准。因此，驱动器28020的中间支撑柱20822b定位在穿过仓体20802的平行纵向狭槽20803中，并且当处于仓体20802中的未击发位置时不被仓体20802支撑，或至少沿其下部部分不被仓体支撑。在此类实例中，仓体的每一侧上的中间钉排中的钉20890由中间支撑柱20822b支撑并且主要由仓体20802的组织支撑平台20804引导。在某些实例中，沿组织支撑平台20804的凹坑扩展器和/或脊还可在击发行程期间引导钉20890。
三重驱动器20820可关于沿凹陷的斜坡20818的纵向轴线是对称的。在各种实例中，三重驱动器20820可包括翼部20824，其在中间支撑柱20822b的两侧上侧向向外延伸。在某些实例中，翼部20824被构造成能够防止驱动器滚动并且加强中间支撑柱20822b。例如，当中间支撑柱20822b未被仓体20802支撑或在很大程度上未被仓体支撑时，翼部20824可帮助在击发行程期间平衡中间支撑柱20822b。
主要参考图103，翼部20824延伸到仓体20802中的互补凹槽20805中。在击发行程期间，翼部20824在凹槽20805中朝向组织支撑平台20804向上移动。主要参考图104，沟槽20805定位在中间钉腔的任一侧上并且从仓体20802的下侧延伸到组织支撑平台20804。在某些实例中，组织支撑平台20804可抓住、阻挡和/或停止翼部20824的进一步向上运动，以在击发行程完成时将驱动器20820保持在仓体20800中。
仍然参考图103，中间支撑柱20822b的远侧部分被进一步构造成能够嵌套在相邻三重驱动器20820的一部分中。更具体地，三重驱动器20820包括近侧沟槽20817(图102)，其尺寸被设计成能够接纳相邻(例如，紧接在后/靠近)三重驱动器20820的远侧末端。在其间具有嵌套特征部的端对端布置的三重驱动器20820的嵌套布置被构造成能够进一步便于三重驱动器20820在仓体20802中的对准和协作支撑。
简而言之，钉仓20800可包括三重驱动器20820，该三重驱动器被构造成能够由单个滑动件轨道20866提升，该单个滑动件轨道在击发行程期间推动三重驱动器20820的中心部分和倾斜凹槽20818。三重驱动器20820还可包括两侧上的翼部20824，这些翼部防止三重驱动器20820在击发行程期间滚动。翼部20824可在仓体20802中的对应狭槽中移动。在某些实例中，滑动件20860可与击发构件20841(例如，I形梁或E形梁)一体成形。在此类实例中，滑动件20860可连同击发构件20842一起为可重复使用的部件；然而，每个钉仓20800可设置新的刀20830。在其他实例中，滑动件可为钉仓中的离散部件，并且在某些实例中，击发构件20841可包括一体式切割边缘。
在各种实例中，如本文所述，三重驱动器和具有一体式双轨道滑动件轨道的击发构件可允许三重驱动器更窄，并且因此允许仓体中的更多空间用于旋转驱动螺杆。例如，旋转驱动螺杆可在端部执行器中向上向更远处定位得更靠近击发构件的上凸轮，而不是沿端部执行器的最低部分定位。例如，更窄的驱动器可提供更紧的钉线，这在某些实例中也可改善稳态。另外，内排钉可侧向向外移动以适应旋转驱动螺杆，这可降低钉撕裂的可能性和/或发生率。此外，仓体可提供稳固的设计，而无需更窄的支撑柱、塔部和/或钉腔之间的薄侧壁和/或用于击发构件的纵向狭槽。滑动件轨道在某些实例中还可更宽，并且因此可更不容易在相当大的击发负载下弯曲。在某些实例中，当滑动件轨道的弯曲和挠曲受到限制时，可最大限度地减少钉过度驱动。
主要参考图106，钉仓20800包括用于承受夹紧负载的稳固支撑壁，并且组织支撑平台20804限定沿中间钉腔的内边缘的厚度t1和沿中间钉腔的外边缘的厚度t2。相反地，现在参考具有仓体20802和组织支撑平台20904的钉仓20900，仓体20902的支撑壁可窄于仓体20902中的壁。此外，组织支撑平台20904具有厚度t3，其小于组织支撑平台20804的厚度t1和厚度t2。例如，仓体20902适于接纳四轨道滑动件。
当钉仓从外科端部执行器遗漏时实现击发行程可导致刀横切被夹持的组织，而没有任何用于密封横切的装置。例如，在没有钉(诸如钉)的情况下，缝合装置不能缝合和密封所切割的组织。相似地，如果空的或用尽的钉仓被加载在端部执行器中，即，没有钉或没有整套钉的钉仓，则组织也将不会沿横切被完全密封。当钉仓从端部执行器遗漏时，遗漏的仓闭锁件可防止击发行程，并且当用尽的钉仓被加载到端部执行器中时，用尽的仓闭锁件可防止击发行程。在某些实例中，当钉仓遗漏和用尽时，闭锁件可防止击发行程。在旋转击发螺杆延伸穿过端部执行器的实例中，闭锁件可被构造成能够限制和/或防止旋转击发螺杆的旋转，并且因此防止击发行程。
在一个方面，锁定螺母可定位在旋转驱动螺杆上，并且闭锁键可结合到钉仓中的可移动特征部中。在锁定构型中，锁定螺母旋转脱离击发对准并且进入端部执行器中的闭锁凹口中。在将未击发钉仓安装在端部执行器中时，闭锁键接合锁定螺母以将其旋转到击发对准并且脱离闭锁凹口。锁定螺母在击发行程期间沿旋转驱动螺杆朝远侧移动，并且闭锁键在击发行程期间也被朝远侧推动。在完成击发行程和/或击发构件的回缩时，闭锁键可保持在远侧位置中；然而，锁定螺母可返回到端部执行器中的近侧位置。因为钉仓已被击发(例如，用尽)，所以锁定螺母再次旋转脱离击发对准并且进入闭锁凹口中以防止随后的击发行程，直到替换的未击发钉仓安装在端部执行器中。在其他实例中，旋转驱动螺杆上的锁可以不与旋转驱动螺杆螺纹接合，并且弹簧可以将锁偏置到闭锁凹口中以选择性地防止击发行程。
此类闭锁布置可被构造成能够在钉仓遗漏时和/或当端部执行器中的钉仓已用尽/击发时，防止击发行程。此外，这些布置可在端部执行器中占据最小的空间量。此外，这些部件可以是简单且稳固的。在锁定螺母经螺纹联接到旋转驱动螺杆的实例中，闭锁构型仅需要端部执行器中的单个附加部件。在各种实例中，闭锁键可向临床医生提供钉仓已被击发的视觉指示。
现在参考图108至图115，示出了闭锁布置21868及其各种部件。闭锁布置21868结合到外科端部执行器21840中，该外科端部执行器在许多方面类似于外科端部执行器20840(见图99)。此外，端部执行器21840适于接纳钉仓20800(见图103)。端部执行器21840包括与仓钳口20850(见图99)类似的仓钳口21850；然而，仓钳口21850还包括限定在底侧21856中的闭锁凹口21854。
更具体地，仓钳口21850包括底侧21856和形成通道的侧壁21852，该通道的尺寸和结构被设计成能够在其中接纳钉仓20800。闭锁凹口21854包括位于底侧21856的近侧部分中的侧向凹槽或开口。当旋转驱动螺杆20842和其上的闭锁螺母21874处于未击发或近侧位置时，闭锁凹口21854与经螺纹联接到旋转驱动螺杆20842的闭锁螺母21874对准。
锁定螺母21870包括穿过主体部分的中心螺纹孔、相对的凸缘21874和凸耳21872。凸缘21874和凸耳21872从主体部分径向向外延伸。在解锁位置(图109B和图111)中，凸缘21874侧向向外延伸到仓通道21850的底侧21856的内表面并且定位成沿该内表面骑跨和/或邻近该内表面。此外，在解锁位置中，凸耳21872与击发构件20841的直立主体部分20843对准。在锁定位置(见图108、图109A、图115)，凸缘21874旋转成不与底侧21856的内表面对准，使得凸缘21874中的一个凸缘旋转到闭锁凹口21854中。此外，在锁定位置中，凸耳21872旋转脱离与击发构件20841的直立主体部分20843的击发对准。
锁定螺母21870经螺纹联接到旋转驱动螺杆20842。旋转驱动螺杆20842的旋转可以使锁定螺母21870随之一起旋转，除非锁定螺母21870的旋转被防止或阻止。最初，当端部执行器21840中没有钉仓时(图108和图109A)，旋转驱动螺杆20842的旋转被配置成能够使锁定螺母21870旋转，使得凸缘21874中的一个凸缘旋转到与其对准的闭锁凹口21854中。当未用尽的钉仓20800安装在外科端部执行器21840中时，闭锁螺母21854旋转到解锁位置。闭锁螺母21854的解锁位置在图109B中示出；然而，出于说明性目的，钉仓被隐藏。
主要参考图111和图112，闭锁键20828包括基部20827，其延伸到旋转驱动螺杆20842上方的仓体20802中的空间中。当未击发的钉仓20800安装在端部执行器21840中时，闭锁键20828的基部20827将闭锁螺母21870旋转到解锁位置。更具体地，基部20827包括斜表面，该斜表面被构造成能够接合并邻接凸耳21872，以将凸耳21872偏置并旋转成与直立主体部分20843对准。主要参考图112，仓体20802包括卡位装置20809，该卡位装置朝向仓体20802中的纵向狭槽20808延伸。卡位装置20809被构造成能够在钉仓20800插入到端部执行器21840中时将闭锁键20828保持就位。
闭锁键20828还限定对应于仓体20802中的起伏状轮廓轨道20807的起伏状轮廓20829。起伏状轮廓轨道20807被构造成能够在闭锁键20828被朝远侧推动时抵抗闭锁键20828的旋转。在各种实例中，基部20827形成凹孔，凸耳21872被接纳到该凹孔中。基部20827将凸耳20872旋转到解锁位置。随后，在击发行程期间，凸耳21872可保持与闭锁键20828中的凹孔接合，并且可将闭锁键20828朝远侧推动穿过起伏状轮廓轨道20807。击发力可足以克服将基部20827保持在仓体20802的近侧位置中的卡位装置20809。
附加地或另选地，刀20830可朝远侧推动闭锁键20828穿过仓体20802。刀20830还包括起伏状轮廓，该起伏状轮廓被构造成能够在击发行程期间行进穿过起伏状轮廓轨道20807而不旋转脱离击发对准。
现在参考图113和图114，在完成击发行程时，闭锁键20828可被推动到仓体20802中的远侧位置。在远侧位置中，闭锁键20828通过仓体20802中的窗口20806可见。例如，仓体20802的远侧鼻部可包括窗口20806，并且闭锁键20828可停驻在窗口20806附近，使得闭锁键20828可见。闭锁键20828的基部20827防止闭锁键20828穿过窗口20808从仓体20802掉出。
旋转驱动螺杆20842的反向旋转运动被构造成能够使击发构件20841回缩。如本文进一步所述，在各种实例中，刀20830可与击发构件20841一起回缩。然而，闭锁键21828可从刀20830释放并且可保持在仓体20802中的远侧位置处。主要参考图115，当击发构件20841回缩到仓体20802中的近侧位置时，闭锁螺母21870也沿旋转驱动螺杆20842朝近侧回缩。由于旋转驱动螺杆20840在回缩运动期间的旋转方向，闭锁螺母21870不旋转到闭锁凹口21854中。换句话说，闭锁螺母21870可保持在解锁位置中并且在回缩运动期间朝近侧移动经过闭锁凹口21854。然而，如果另一击发运动被发起并且旋转驱动螺杆20842的旋转方向被反转，则在端部执行器21840中朝远侧移动时，闭锁螺母21870将再次旋转脱离与击发构件20841的对准，并且闭锁螺母21870的凸缘21874可旋转到闭锁凹口21854中。
在锁定位置中，闭锁螺母21870不可相对于旋转驱动螺杆20842旋转并且不可通过端部执行器21840纵向平移。因此，旋转驱动螺杆20842的旋转运动被抵抗并且击发行程被阻止，直到闭锁螺母21870呈现解锁位置。
本文参考图108至图115描述的闭锁布置21868包括螺纹闭锁螺母21870，其联接到旋转驱动螺杆20842。螺纹闭锁螺母21870的位移是旋转驱动螺杆20840的旋转的函数。在其他实例中，闭锁布置可包括围绕旋转驱动螺杆20842定位的非螺纹锁。现在参考图116和图117，示出了闭锁布置22868及其各种部件。闭锁布置22868结合到外科端部执行器22840中，该外科端部执行器在许多方面类似于外科端部执行器20840(见图99)。端部执行器22840适于接纳钉仓20800(见图103)。端部执行器22840包括与仓钳口20850(见图99)类似的仓钳口22850；然而，仓钳口22850还包括限定在底侧21856中的闭锁凹口22854。此外，端部执行器22840包括在许多方面类似于击发构件20841的击发构件22841；然而，击发构件22841的一体式滑动件20860包括在其中具有孔22868的滑动件轨道22868，如本文进一步所述。
闭锁布置22868包括锁22870，其在许多方面类似于闭锁螺母21870；然而，锁22870不经螺纹联接到旋转驱动螺杆20842。锁22870包括穿过主体部分的中心非螺纹孔、相对的凸缘22874和凸耳22872。凸缘22874和凸耳22872从主体部分径向向外延伸。
在解锁位置中，凸缘22874侧向向外延伸到仓通道22850的底侧22856的内表面并且定位成沿该内表面骑跨和/或邻近该内表面。凸缘22874被接纳在滑动件22860中的孔22868中。例如，孔22868是滑动件轨道20866中的通孔，其尺寸和位置被设计成能够当锁22870处于解锁位置时接纳相对的凸缘22874。因此，击发构件22841及其滑动件轨道22868被构造成能够在击发行程期间沿旋转驱动螺杆20842拉动锁22870。此外，在解锁位置中，凸耳22872与击发构件22841的直立主体部分对准。
在锁定位置(图116和图117)，凸缘22874旋转成不与底侧22856的内表面对准，使得凸缘22874中的一个凸缘旋转到闭锁凹口22854中。此外，在锁定位置中，凸耳22872旋转脱离与击发构件22841的直立主体部分的击发对准。
闭锁布置22868还包括弹簧22870，该弹簧被构造成能够将锁22870偏置到闭锁凹口22854中。闭锁布置22868可像闭锁布置21868一样起作用；然而，弹簧22870可将锁22870偏置到闭锁凹口22854中，使得闭锁布置22868始终被锁定，除非未击发的钉仓20800被加载到端部执行器22840中并且其闭锁键21828暂时克服闭锁布置22868直到击发行程完成。如上文关于闭锁布置21868所述，闭锁键21828被构造成能够在击发行程完成时移动穿过仓体20802中的窗口20806以传达击发行程完成以及钉仓已被击发/用尽。
成形钉高度是钉支撑表面与钉成形表面之间的空间的函数。更具体地，(A)处于击发位置的驱动器上的钉支撑托架与(B)处于夹紧位置的砧座中的钉成形凹坑表面之间的竖直空间控制钉的成形高度。例如，对于不同的外科手术和/或不同的组织类型选择不同的成形钉高度。当钉仓包括穿过其中的旋转击发螺杆时，钉以及对应的钉腔和驱动器的布置可被改变以适应旋转击发螺杆。例如，驱动器可包括至少一个不对称性，如本文进一步所示。附加地或另选地，驱动器可更窄，并且因此需要附加的支撑和/或强度。此外，在各种实例中，期望优化组织间隙，同时保持期望的成形钉高度。例如，当端部执行器处于闭合构型时，组织支撑平台表面与砧座之间的组织间隙可最大化，同时保持期望的成形钉高度。
在各种实例中，组织支撑平台的下侧可包括起伏状和/或凹凸不平的表面，其被构造成能够在驱动器处于其完全击发和/或过度驱动位置时接纳驱动器的一个或多个部分。组织支撑平台的下侧与驱动器的面向组织侧之间的互锁和/或嵌套可使组织间隙最大化，同时仍保持期望的成形钉高度。此外，互锁特征部可以在各种实例中提高驱动器的强度。
例如，钉仓可包括主体，该主体包括组织支撑平台，其中钉腔被限定为穿过主体中的组织支撑平台，并且其中组织支撑平台包括面向组织侧，其包括隆起的或脊状的表面。组织支撑平台还包括与面向组织侧相对的下侧，其中下侧包括凹凸不平的表面。钉可以可移除地定位在钉腔中。驱动器可以可移动地支撑钉并且被构造成能够移动穿过钉腔的一部分到达击发位置以将钉从钉腔射出。每个驱动器可包括基座，该基座被容纳在钉仓中并且包括表面轮廓，该表面轮廓被构造成能够在移动到击发位置时与组织支撑平台的下侧上的凹凸不平的表面配合。
现在参考图38至图40，示出了钉仓22100。钉仓22100在许多方面类似于钉仓20100(图24)。例如，钉仓22100包括沿纵向轴线A延伸的主体22102。钉可移除地定位在主体22102中。钉可例如在击发行程期间从主体22102射出并击发到组织中。钉在纵向轴线A的任一侧上布置成纵向排，该纵向轴线与延伸穿过其中的旋转驱动轴22242(图39)对准。仓体22102还包括平台22104，该平台可被称为例如组织支撑平台。平台22104是侧向弯曲的组织支撑平台，并且限定从主体22102的第一侧向侧22101到主体22102的第二侧向侧22103的弯曲的面向组织的表面。侧向弯曲的组织支撑平台22104中的顶点22105被限定在主体22102的中间部分处。例如，顶点22105可定位在纵向钉排之间并且覆盖纵向轴线A。在各种实例中，旋转击发螺杆22242(图39)延伸穿过钉仓22100的一部分。
仓体22102还包括从组织支撑平台22104延伸的凹坑扩展部或脊22114的阵列。脊22114围绕形成在用于钉腔的组织支撑平台22104中的周边或开口延伸。脊22114可被构造成能够抓持并接合定位在钉仓22100与相对的砧座之间的组织。例如，在各种实例中，脊22114可限制和/或约束组织流动。附加地或另选地，脊22114可被构造成能够在钉的腿进入组织并被引导成与砧座的钉成形表面上的相应成形凹坑接合时引导钉的腿。例如，脊22114可围绕钉腔的近侧端部和远侧端部延伸。近侧和远侧定位的突起部或凹坑扩展部可防止向外偏置的钉腿(例如，V形钉的钉腿)向外张开并且未命中与其对准的成形凹坑中的目标位置。
在某些方面，相邻的脊22114可连接。例如，脊22114可关于纵向偏移的钉腔和/或侧向偏移的钉腔互连。
在各种实例中，侧向偏移的脊22114的阵列可限定不同的高度。在各种实例中，脊22114可沿仓体22102的宽度侧向地限定不同的高度。例如，当端部执行器被夹紧时，不同的高度可对应于组织支撑平台22104的侧向弯曲和/或用于引导钉超过组织支撑平台22104的不同的长度和/或不同的组织间隙。关于仓体22102，脊22114横跨三排侧向间隔开的钉腔22112a、22112b、22112c，并且与外排22112c对准的脊22114比内排22112a、22112b高，并且因此将在更大的距离上引导钉腿。然而，由于组织支撑平台22104的侧向弯曲和砧座的非阶梯状/非起伏状组织夹紧表面，外排22112c上的组织间隙也大于内排22112a、22112b上的组织间隙。
钉定位在限定在仓体22102中的腔中，其类似于腔20110(图24)。例如，钉在纵向轴线A的任一侧上布置成纵向排22112。腔排22112在纵向轴线A的每一侧上包括内排22112a、中间排22112b和外排22112c。中间排22112b可以在内排22112a与外排22112c之间侧向等距间隔开。旋转驱动螺杆22242可以与纵向轴线A对准，并且可以与内腔排22112a相邻地延伸穿过仓体22102。例如，旋转驱动螺杆22242可位于内腔排22112a之间并且平行于内腔排。
内排22112a保持内钉，中间排22112b保持中间钉，并且外排22112c保持外钉。在各种实例中，内钉、中间钉和外钉可以是相同的。在其他实例中，例如，内钉、中间钉和/或外钉可各自在钉类型(例如，线材或冲压)、材料和/或尺寸(例如，不同高度)方面不同。
在其他实例中，钉仓22100可具有不同的钉布置。例如，钉仓22100可在纵向轴线A的每一侧上具有少于三个钉排。在本公开的一个方面，钉仓22100可在纵向轴线A的每一侧上具有仅两个钉排。在又一些实例中，钉仓22100可在纵向轴线A的一个或多个侧上包括四个或更多个钉排。在各种实例中，钉排可相对于纵向轴线A是不对称的。例如，钉仓22100的第一侧可具有与钉仓22100的第二侧不同数量的钉排。
仓体22102中的钉腔可各自包括近侧端部、远侧端部和介于近侧端部与远侧端部之间的侧向引导表面。钉腔的结构和尺寸被设计成能够朝向平台22104引导驱动器22120穿过钉腔。主要参考图41，示出了驱动器22120。此外，在图41和图42中的钉仓22100中示出了一个驱动器22120。尽管在这些图中描绘了一个驱动器22120，但读者将会知道，类似于驱动器22120的附加驱动器将结合到钉仓22100中以在击发行程期间从附加钉腔击发钉。
钉腔的几何形状可与驱动器22120的几何形状互补。例如，每个钉腔中的侧向引导表面被构造成能够在驱动器22120移动穿过钉腔时引导驱动器22120的侧壁22134。附加地或另选地，每个钉腔的近侧端部和/或远侧端部可包括直立沟槽，该直立沟槽被构造成能够可滑动地接纳驱动器22120的端部和/或舌状部。还设想了另选的舌状部和沟槽布置，其可被构造成能够在从钉仓22100击发钉期间引导驱动器22120穿过钉腔。
驱动器22120被构造成能够支撑多个钉并且在击发行程期间从仓体22102驱动该多个钉。驱动器22120可以可移动地支撑横跨两个或更多个纵向排22112的钉。例如，驱动器22120可以可移动地支撑在钉仓22100的同一侧上的内钉、中间钉和外钉。
驱动器22120是被构造成能够同时驱动三个钉的三重驱动器。驱动器22120包括三个支撑柱：内支撑柱22122a，其被构造成能够支撑内钉排中的内钉；中间支撑柱22122b，其在内支撑柱22122a的侧向外侧，被构造成能够支撑中间钉排中的中间钉；以及外支撑柱22122c，其在中间支撑柱22122b的侧向外侧并且被构造成能够支撑外钉排中的外钉。
驱动器22120还包括在相邻支撑柱22122之间延伸的桥接件22126。例如，第一桥接件22126a在内支撑柱22122a与中间支撑柱22122b之间延伸，并且第二桥接件22126b在中间支撑柱22122b与外支撑柱22122c之间延伸。桥接件22126a、22126b各自包括倾斜下侧22128，该倾斜下侧被构造成能够在击发行程期间由滑动件驱动地接合。例如，滑动件22150(图39)可被构造成能够在击发行程期间沿击发路径移动。滑动件22150可包括与纵向轴线A对准的中心部分、被构造成能够驱动地接合第一桥接件22126a的倾斜下侧22128的第一轨道以及被构造成能够驱动地接合第二桥接件22126b的倾斜下侧22128的第二轨道。本文进一步描述了滑动件及其击发运动。
主要参考图38和图39，组织支撑平台22104包括具有脊22114的阵列的面向组织侧22115，其形成隆起的组织抓持表面。组织支撑表面22104还包括与面向组织侧22115相对的下侧22116。下侧22116包括在其中具有凹痕22118的阵列的凹凸不平的表面。凹痕22118可在下侧22116中限定凹槽和/或凹坑的图案。组织支撑平台22104限定在隆起的面向组织侧22115与凹凸不平的下侧22116之间的平台高度。平台高度变化；然而，围绕平台22104中的开口的某一最小高度在击发行程期间为钉提供最小量的引导长度。例如，如果围绕钉腔的平台太薄，则钉在部署到组织中和朝向成形凹坑的过程中可能不被充分地支撑。
当驱动器22120移动到击发位置时，驱动器22120被构造成能够与凹凸不平的下侧22116配合或嵌套。再次主要参考图41，驱动器22120的桥接件22126a、22126b包括突起部22130。突起部22130是在桥接件22126a、22126b的上部面向组织的表面上的表面轮廓和突起部，该上部面向组织的表面与桥接件22126a、22126b的倾斜下侧22128相对。突起部22130被构造成能够在驱动器22120移动到其击发位置时被接纳在组织支撑平台22104的下侧22116上的凹痕22118中。在击发位置中，主要参考图40，驱动器22120相对于平台22104被过度驱动，使得驱动器22120的一部分延伸超过面向组织侧22115并且延伸出仓体22102。
桥接件22126a和22126b的顶表面相对于相应的桥接件22126a、22126b的纵向中心线是对称的。每个桥接件22126a、22126b的中心线可在由相邻支撑柱22122的钉支撑托架22124限定的纵向轴线之间是等距的。突起部22130相对于相应的桥接件22126a、22126b的纵向中心线是对称的。
在其他实例中，驱动器、其桥接件和/或其顶表面可以是侧向不对称的，如本文进一步所述。参考图42中的驱动器22220，驱动器22200在许多方面类似于驱动器22120(图41)；然而，驱动器22200限定相对于互连的桥接件22226a、22226b和其上的相应顶表面22230的侧向不对称性。驱动器22220包括三个支撑柱22222a、22222b、22222c，每个支撑柱具有钉支撑托架22224。桥接件22226a、22226b连接侧向相邻的支撑柱22222a、22222b、22222c。桥接件22226a、22226b包括倾斜下侧22228，其在击发行程期间由滑动件驱动，如本文进一步所述。桥接件22226a、22226b的顶表面22230包括对角表面并且相对于穿过桥接件22226a、22226b的中心线是不对称的并且在击发行程期间与滑动件轨道的击发路径对准。每个桥接件22226a、22226b的中心线在与相邻钉支撑托架22224和其中的钉基座/冠部对准的轴线之间是等距的。
每个桥接件22226a、22226b的顶表面22230包括侧向斜坡的顶表面，该顶表面被构造成能够与组织支撑平台的起伏状下侧的一部分互补，诸如凹凸不平的下侧22116(图39和图40)。此类桥接件构型可提供改进的列对列支撑，这可允许整个桥接件22226a、22226b更薄，同时充分地支撑跨多排的钉。
用于外科端部执行器的砧座22370在图43中示出。砧座22370包括组织压缩表面22374和形成到组织压缩表面22374中的成对的钉成形凹坑22372。每对钉成形凹坑22372包括近侧凹坑22372a和远侧凹坑22372b。凹坑可与钉的腿(例如，钉的线材腿)对准。在击发行程期间，钉腿的末端可被接纳在钉成形凹坑22372内并且形成例如B形钉。在本公开的某些方面，钉成形凹坑22372的长度可被构造成能够匹配与其对准的钉的线材直径。例如，砧座22370中的第一对钉成形凹坑22372中的近侧凹坑22372a和远侧凹坑22372b可具有第一凹坑长度，而砧座22370中的第二对钉成形凹坑22372中的近侧凹坑22372a和远侧凹坑22372b可具有不同的凹坑长度。第一凹坑长度可对应于与第二凹坑长度不同的钉线材直径。在各个方面，较大线材直径的钉可对应于较短的凹坑长度。
一对钉成形凹坑22372中的近侧凹坑22372a和远侧凹坑22372b之间的空间d在某些实例中可被最大限度地减小以使钉的纵向成形长度最大化。通常，钉在成形过程期间过度弯曲以补偿钉回弹。然而，当成形凹坑较短并且因此在某些实例中较陡时，可减少钉的过度弯曲。在一对钉成形凹坑22372中的近侧凹坑22372a和远侧凹坑22372b之间限定较大空间或间隙d的较短且较陡的钉凹坑可减少回弹。例如，较短且较陡的钉凹坑可使钉腿更多地弯曲并使钉更多地塑性变形以减少回弹。此外，在某些实例中，较短且较陡的钉凹坑可改善顺序的钉腿弯曲。参考图43中的空间d，一对钉成形凹坑22372中的近侧凹坑22372a和远侧凹坑22372b可被缩短，并且整个对可保持相同的长度L，使得在近侧凹坑22372a与远侧凹坑22372b之间限定较大空间d。
例如，在端部执行器中，钉和/或驱动器可在排与排之间变化。在某些实例中，钉可更短，包括不同的线材直径，由具有不同的高度和/或不同的过度驱动量的驱动器提升。在某些实例中，如上所述的较短的钉成形凹坑可与这一排钉而非同一砧座中的相邻排钉一起使用。例如，较短的钉可利用缩短的凹坑来改善顺序的钉腿弯曲，例如每个钉腿上的两个顺序弯曲以呈现B形。在又一些实例中，沿内钉排(即，邻近纵向刀路径)的钉可利用缩短的凹坑来使钉更多地塑性弯曲并且减少回弹以形成更紧的排。在这些实例中，图43中的距离d可在排与排之间不同。
钉仓，诸如钉仓20100(图24)和钉仓22100(图39)，例如包括具有最小尺寸限制的部件，以确保满足合适的强度、刚度、支撑和/或制造要求。考虑到对外科端部执行器的其他约束，这些最小尺寸限制可能使得难以优化和/或增加组织间隙。例如，由于模制约束，在某些实例中，组织支撑平台的最小高度为0.01英寸。又如，由于驱动器强度约束，在某些实例中，驱动器上的支撑柱之间的桥接件的最小高度为0.022英寸。又如，由于驱动器滚动约束，在某些实例中，驱动器(例如，其支撑柱)的最小高度为0.066英寸。又如，基于钉仓的类型和目标组织，在某些实例中，钉腿的最小高度为0.166英寸，在其他实例中为0.160英寸，在其他实例中为0.150英寸，在其他实例中为0.102英寸，并且在其他实例中为0.085英寸。又如，由于砧座刚度和强度约束，砧座的最小厚度为0.134英寸，并且在某些实例中为0.154英寸。考虑到此类最小尺寸约束，在某些实例中减小部件堆叠中的最小尺寸限制和/或加倍某些尺寸限制或其部分可能是有利的。
例如，在某些实例中，驱动器的一部分可嵌套在组织支撑平台的下侧中的凹槽中，以减小某些最小尺寸限制。在各种实例中，为了确保组织支撑平台保持适当的高度，凹槽可与沿组织支撑平台具有增加的高度的局部区域对准，诸如在凹坑扩展部/组织夹紧脊下方。在其他实例中，组织支撑平台的下侧中的一个或多个附加的凹槽可被构造成能够接纳驱动器和/或其桥接件的一部分。钉仓的内表面与驱动器之间的互锁特征部的示例性错开例如在图39中示出。其他驱动器特征部可类似地被接纳在组织支撑平台的下侧上的对应凹槽内。
为了减小多个部件的竖直堆叠尺寸，钉仓(诸如钉仓20100(图24)和钉仓22100(图39))的组织支撑平台例如可具有穿过其中的预定义间隙孔，其可与钉腔隔开且不同。沿钉仓的长度和/或宽度的预定义孔可在驱动器的完全击发位置以及在各种实例中过度驱动位置中接纳驱动器的特征部(例如，桥接件的部分)。附加地或另选地，组织支撑平台可包括易碎或“断裂位置”，其被构造成能够在移动到其完全击发位置时被驱动器物理地断裂。
另外，钉仓，诸如钉仓20100(图24)和钉仓22100(图39)，例如还可包括选择性可压缩和可扩张的特征部以减小竖直堆叠尺寸。驱动器和/或仓体可包括此类特征部。
例如，竖直可膨胀驱动器可被构造成能够减小驱动器在钉仓内的静止或未击发高度。驱动器可以是伸缩式的，并且当处于未击发位置时可限定为其最终高度的约50％的高度。在此类实例中，钉可在击发之前位于仓体中的较低位置。在某些实例中，滑动件轨道的第一部分可通过克服与驱动器的主体的显著卡扣特征部并将其扩展到其最终高度来激活驱动器。然后，滑动件轨道的第二部分可完成驱动器的击发，以将支撑在其上的钉射出仓体。滑动件轨道的第一部分可以比滑动件轨道的第二部分更窄。
附加地或另选地，组织支撑平台可包括高度可变的注射模制平台，当施加预定义组织负载以增加组织间隙时，该高度可变的注射模制平台可压缩。当滑动件击发驱动器和钉时，滑动件和/或驱动器可将平台瞬间推回到组织中至增加的高度，以便暂时减小组织间隙。组织支撑平台随后可松弛或以其他方式返回到压缩状态，其对应于在滑动件已经经过之后增加的组织间隙。
例如，仓体或其组织支撑平台可包括选择性定位的壁段，这些壁段可以是薄的并且被构造成能够在预定义组织负载下屈曲，同时仍保持钉与砧座中的钉成形凹坑之间的适当对准。在某些实例中，电致动材料(例如，电活性聚合物)可结合到组织支撑平台中。当向其施加电流时，用此类材料形成的部件或特征部可变得柔软和/或更容易压缩，并且当不施加电流时，其可变得坚硬和/或更不容易压缩。在某些实例中，当材料被激励并且因此可变形以适应其中的附加结构时，驱动器的部分可被接纳在组织支撑平台中。
在某些实例中，4D打印材料可有利于钉仓(诸如钉仓20100(图24)和钉仓22100(图39))的组织支撑平台的选择性塌缩。例如，仓体可包括打印在其顶部或上半部上的4D打印材料。4D打印材料可以是热敏的。在某些实例中，该材料可具有室温与人体温度之间的玻璃化转变点。例如，当仓被夹紧到组织上时，材料可变得柔软且可偏转，从而增加组织间隙。在此类实例中，来自患者的增加的热可增加4D打印材料的热以实现形状改变。当仓体随后冷却时(例如，从与组织的热传递接触中移除)，4D打印材料可返回到其原始形状和/或高度。例如，在初始和恢复状态中，组织支撑平台可以比在加热和塌缩状态中更高。例如，在初始和恢复状态中增加的高度可确保储存在钉仓中的钉保持受到保护并且在被击发之前不从仓体突出。
现在参考图44，描绘了仓体上的4D打印矩阵的变形和恢复过程22400。在形状编程阶段22490期间，4D打印矩阵22402被加热，从原始构型变形为变形的构型22402'，并且随后冷却。在形状恢复状态22492期间，4D打印矩阵22402'被加热，并且返回到其原始构型22402，并且随后冷却。在Chen Yang等人于2019年6月出版在Materials Horizon上的文章“4D Printing Reconfigurable,Deployable and Mechanically TunableMetamaterials”中进一步描述了4D打印材料的形状编程和恢复。
在某些实例中，4D打印矩阵可与例如本文进一步所述的可折叠或可塌缩驱动器组合使用。例如，钉仓上的4D打印基质可被构造成能够选择性地折叠干涉驱动器特征部，以在一定温度下在钉仓内合并和/或压缩基部和堆叠。然后，当从干涉状态中退出时，诸如当仓体恢复初始的未变形状态时，干涉特征部可展开。在各个方面，当主动地提升和击发钉时，驱动器可完全扩张。在某些实例中，驱动器可在其完全击发位置附近遇到干涉表面，并且驱动器的上部部分可被构造成能够折叠到其自身中。在某些实例中，4D矩阵可形成干涉表面。
用户可能希望在外科手术期间快速且容易地将钉仓安装到端部执行器或一次性加载单元的通道中。还可以期望稳固的连接。某些稳固的连接可能需要临床医生克服干扰部件之间的相当大的阻力和/或摩擦力。附加地或另选地，稳固的连接可具有最小的间隙并且需要临床医生精确地对准部件。尽管可能期望钉仓与通道之间的稳固的连接，但使钉仓的安装更快、更容易和/或就临床医生而言需要更少的力和/或努力可能是有帮助的。
在某些实例中，缝合组件可包括可有利于将钉仓安装到通道中的杠杆作用特征部。例如，通道和钉仓可包括互补的几何形状对准特征部。在将钉仓的对准特征部抵靠通道的对准特征部放置时，通道的对准特征部可提供支点或邻接表面，钉仓围绕该支点或邻接表面受到杠杆作用以使钉仓与通道适当地对准。当钉仓由于对准特征部之间的邻接关系而适当地对准时，附加的对准特征部(例如，远侧凸耳和凹口)可有利于钉仓与通道之间的进一步连接。
在某些实例中，弹簧可沿垂直于插入轴线的纵向轴线将钉仓朝远侧偏置，以将钉仓完全且牢固地安置在通道中。附加地或另选地，在击发行程期间的远侧击发力可进一步使钉仓朝远侧移位以使对准特征部上的倾斜表面(例如，远侧凸耳和凹口的远侧边缘)互连。设想了另选的弹簧加载和/或弹性特征部以在相对于通道适当地放置钉仓时进一步将钉仓固定到通道。在某些实例中，用户激活的释放件可被构造成能够释放钉仓与通道之间的一个或多个弹性附接特征部。在其他实例中，击发行程可导致一个或多个弹性附接特征部的释放和/或断裂。
例如，缝合组件可包括钉仓，该钉仓包括限定纵向轴线的仓体，其中仓体包括近侧仓对准特征部和远侧仓对准特征部。缝合组件还可包括尺寸被设计成能够接纳钉仓的通道，其中通道包括侧壁，该侧壁包括近侧通道对准特征部和远侧通道对准特征部，该远侧通道对准特征部定位成在将近侧仓对准特征部定位成与近侧通道对准特征部邻接接合并且将钉仓沿插入轴线移动到通道中的第一位置时接纳远侧仓对准特征部。插入轴线可垂直于纵向轴线。弹簧可被构造成能够将钉仓在通道内沿纵向轴线从第一位置朝远侧偏置到完全就位位置。近侧对准特征部可包括起伏状邻接表面。远侧对准特征部可包括具有互补楔形远侧端部的凹口和凸耳。
在各种实例中，改进的钉仓保持和释放特征部可增加接合保持力，同时允许用户以基本上较低的力从通道释放钉仓。例如，用户可通过克服最小弹簧力而使钉仓朝近侧滑动，以快速且容易地从通道移除钉仓。在某些实例中，移除用尽的或击发的钉仓所需的力可小于移除新的、未击发的钉仓所需的力。例如，击发行程或甚至部分击发行程可被构造成能够脱离接合和/或释放将钉仓连接到通道的某些弹性附接特征部。
现在参考图45，示出了缝合组件24000。缝合组件24000包括通道24050和可移除地定位在通道24050中的钉仓24100。钉仓24100是一次性的、单次使用的部件，其被构造成能够在击发行程和随其进行的外科手术之后从通道24050移除。通道24050可以是可重复使用的并且被构造成能够在其中接纳可替换的钉仓组件。在其他实例中，钉仓24100可从通道24050移除，加载有附加的钉，并且重新安装在通道24050中。在某些实例中，通道24050可以是一次性的加载单元和/或包括砧座和/或轴部分的模块化缝合组件的部件。
钉仓24100可在某些方面类似于钉仓20100(图24)。例如，钉仓24100包括具有组织支撑平台24104的仓体24102、可移除地定位在仓体24102中的钉24160以及可移动地支撑钉24160的驱动器24120。钉24160包括端对端的基座，并且钉24106的基座沿钉仓24100的长度相对于纵向轴线A倾斜取向。钉24160可被构造成能够形成柔性钉线，其允许一定程度的扭转和/或拉伸，同时最大限度地减少对组织的损伤。在某些实例中，仓体24102可包括呈多个纵向排的钉，该多个纵向排具有呈平行于纵向轴线A的纵向排的纵向对准的钉，如本文进一步所述。
仓体24102包括具有近侧对准表面24164的至少一个对准凸块24162。在各种实例中，对准凸块24162可从仓体24102的每一侧侧向突出。近侧对准表面24164限定对准凸块24162的弯曲近侧边缘。在各种实例中，仓体24102的任一侧上的对准凸块24162可关于纵向轴线A是对称的。
仓体24102还包括对准凸耳24166，该对准凸耳具有近侧端部24168和远侧端部24170。一个对准凸耳24166定位在仓体24102的每一侧上。近侧端部24168限定相对于组织支撑平台24104的直立或竖直表面。对准凸耳24166的远侧端部24170限定具有倾斜远侧表面的楔形形状。倾斜远侧表面可沿平台24104形成较窄的尺寸并且在对准凸耳24166的相对端部处形成较宽的尺寸。在各种实例中，对准凸耳24166可定位在仓体24102的每一侧上，并且对准凸耳24166可关于纵向轴线A是对称的。对准凸耳24166比对准凸块24162更靠近仓体24102的远侧端部。
通道24050包括形成U形通道的侧向侧壁24052。钉仓24100可以可释放地固定在侧壁24052之间的U形通道中。侧壁24052和/或通道24050的其他部分可包括用于接合钉仓24100的弹性卡扣配合特征部。每个侧壁24052包括对准特征部24054，该对准特征部包括近侧对准轮廓24056。近侧对准轮廓24056包括边缘，该边缘被构造成能够捕获对准凸块24162的近侧对准表面24164。近侧对准轮廓24056抵抗对准凸块24162在近侧方向上超过近侧对准轮廓24056的纵向移位。如本文进一步所述，对准特征部24054可用作支点或支撑件，在钉仓24100插入到和安装到通道24050中期间，钉仓24100围绕该支点或支撑件受到杠杆作用。
通道24050包括对准凹口24058，该对准凹口具有近侧端部24060和远侧端部24062。对准凹口24058定位在通道24050的每一侧上。近侧端部24060限定侧壁24052中的直立或竖直表面，并且远侧端部24062限定侧壁24052中的另一直立表面，该直立表面不平行于近侧端部24060处的竖直表面。限定对准凹口24058的远侧端部24062的直立表面可限定斜坡或倾斜远侧表面，该表面可形成沿侧壁24052的上边缘具有较窄尺寸且在凹口24058的相对端部处具有较宽尺寸的楔形形状。在各种实例中，对准凹口24058可关于纵向轴线A对称地定位。对准凹口24058比对准凸块24162更靠近仓体24102的远侧端部。如本文进一步所述，每个对准凹口24058被定位并且尺寸被设计成能够在其中接纳对准凸耳24166中的一个对准凸耳。
通道24050与钉仓24100之间的对准特征部被构造成能够相互作用以便于将钉仓24100快速且容易地安装到通道24050中。例如，为了快速地将对准凸耳24166与对准凹口24058对准，临床医生可以将对准凸块24162朝近侧拉动成与通道24050上的对应对准特征部24054邻接接合。近侧对准特征部24054上的近侧对准轮廓24056用作纵向止动件，其防止钉仓24100相对于通道24050的进一步近侧移位。对准凸块24162的起伏状近侧边缘24164可以与近侧对准轮廓24056的起伏状轮廓匹配或互补。在互补轮廓配合时，对准凸耳24166也各自与其对应对准凹口24058对准。
弹簧24172定位在对准凸耳24166的直立表面与对准凹口24060的直立表面之间。更具体地，弹簧24172定位在对准凸耳24166的近侧端部24168与对准凹口24060的近侧端部24060之间。弹簧24172被构造成能够在钉仓24100插入到通道24050中时将对准凸耳24166的倾斜远侧端部24170朝远侧偏置成与通道24050的倾斜远侧端部24062匹配接触。当对准凸块24162与近侧对准轮廓24056邻接接合并且钉仓24100及其对准凸耳24166沿平行于安装轴线I的安装方向24101移动到通道24050中时，弹簧24172可在对准凹口24060的直立近侧端部24060与凸耳24166的直立近侧端部24168之间被压缩。安装轴线I垂直于纵向轴线A。
在使用中，当钉仓24100沿安装轴线I移动到通道中时，仓体24102及其凸块24162可受到抵靠通道24050的近侧对准轮廓24056的杠杆作用。对准轮廓24056的近侧杠杆位置可改善将钉仓24100及其远侧凸耳24166安装到通道24050中的机械优点。当钉仓24100沿安装方向24101移动到第一位置或插入位置中时，凸块24164可向下滑动到通道24050中。在钉仓24100已经移动到第一位置之后，其中钉仓24100被插入但在通道24050中未完全就位，弹簧24172被构造成能够沿平行于纵向轴线L的方向朝远侧将钉仓24100移位到第二位置中，其中钉仓24100在通道24050中完全就位。
主要参考图47，弹簧24172是板簧。弹簧24172是悬臂弹簧，其具有安装到对准凸耳24166的第一端部、与第一端部相对的第二端部以及在第一端部与第二端部中间的弯曲部分。弯曲部分可限定S形曲线，在近侧对准轮廓24056、24164对准并且钉仓24100朝近侧抵靠对准特征部24054杠杆作用时，该S形曲线可由临床医生以最小的力和/或努力压缩。在释放对弹簧24172的杠杆作用力和压缩力时，弹簧24172被构造成能够相对于通道24050将钉仓24100朝远侧回弹和偏置到完全就位位置(图48)。
在完全就位位置(图48)中，对准凸耳24166和对准凹口24058的远侧倾斜端部24062、24170分别配合接合。远侧端部24062、24170的底切几何形状被构造成能够将钉仓24100固定在通道24050中，直到弹簧24172被用户施加的力压缩以沿纵向轴线A朝近侧拉动钉仓24100，并且随后沿平行于安装轴线I且与安装方向24101相反的方向24103向上拉动以从通道24050移除钉仓24100。
在某些实例中，击发元件被构造成能够在击发行程期间向钉仓24100施加远侧力，以进一步将钉仓24100固定在通道24050中。例如，当钉仓24100被朝远侧推动时，倾斜远侧端部24062、24170可在钉仓24100与通道24050之间形成互锁。在某些实例中，即使没有弹簧24172的远侧偏置力，倾斜远侧端部24062、24170的远侧击发力和底切几何形状也可将钉仓24100固定到通道24050。例如，缝合组件24000可不包括被构造成能够将钉仓24100在击发行程的方向上相对于通道24050偏置的弹簧。读者将会知道，在利用远侧至近侧击发行程的缝合组件中，例如，钉仓24100与通道24050之间的底切互锁可分别位于对准凸耳24166和对准凹口24058的近侧端部24168、24060处。
主要参考图47至图48，示出了缝合组件24000，其中砧座24090相对于通道24050处于夹紧构型，并且钉仓24100在其中完全就位。仓体24102包括具有锁24180的远侧鼻部24103。锁24180包括位于仓体24102的下侧上的闩锁臂24182。闩锁臂24182被构造成能够在钉仓24100在通道24050中完全就位时与通道24050的一部分重叠。例如，通道24050包括位于其面向闩锁臂24182的下侧上的凸部或搁架24082。锁24180能够在第一位置(图49)与第二位置之间运动，在第一位置中，闩锁臂24182通过悬伸搁板24082而将仓体24102的远侧鼻部24103固定到通道24050的远侧端部，在第二位置中，闩锁臂24182释放搁板24082，从而便于钉仓24100从通道24050释放。
锁24180还包括与闩锁臂24182相对的面向砧座的释放按钮24184。面向砧座的释放按钮24184可与远侧鼻部24103的顶表面齐平或基本上齐平。面向砧座的释放按钮24148可由临床医生压下以向下和/或朝远侧驱动锁24180，从而将闩锁24182从与搁架24082的接合释放。在某些实例中，锁24180可由弹性和/或可变形材料构成，其可在接收到在面向砧座的释放按钮24184上的用户输入时挠曲以将闩锁臂24182移动到第二位置。在其他实例中，锁24180可相对于仓体24102枢转以将闩锁臂24812移动到第二位置。
在其他实例中，仓体的远侧鼻部可以是可偏转的以沿细长通道的远侧边缘可释放地接合保持特征部。例如，现在参考图50，示出了缝合组件24200，其中砧座24190相对于通道24050处于夹紧构型，并且钉仓24300在其中完全就位。钉仓24300与钉仓24100相同；然而，远侧鼻部24301由柔性材料或柔性部分构成，该柔性部分形成具有闩锁臂的锁24380，该闩锁臂被构造成能够弯曲成与通道24050的下侧上的搁板24082接合和脱离接合。在某些实例中，整个远侧鼻部24301可以是柔性的，以便于闩锁臂24382弯曲而与凸部24082脱离接合。在其他实例中，仅锁24380和/或其闩锁臂24382足够柔性以脱离接合凸部24082。
在各种实例中，仓体24302可为在不同区域中由不同材料构成的复合仓体，使得一体式复合仓体的柔性可从区域到区域变化。例如，仓体24302可为3D打印的，并且包括用于锁24380和/或闩锁臂24382的柔性和/或弹性材料以及用于仓体中的相邻区域的较低柔性和/或较低弹性材料。附加地或另选地，在某些实例中，相邻部分可打印有具有与锁24380和/或闩锁臂24382相同或相似的相对低的硬度的材料；然而，嵌入仓体内的金属(诸如金属框架和/或纵向支撑件)可增加仓体的总体强度和刚度。
设想了钉仓与通道之间的附加对准和保持特征部，其可改善钉仓相对于通道的保持和释放。各种特征部可改善对准部件的简易性以及从通道移除钉仓所需的力，同时保持钉仓与通道之间的足够保持力。这些附加对准和保持特征部可与本文进一步描述的钉仓与通道之间的近侧对准特征部组合。
图51中示出了缝合组件25000。缝合组件25000在许多方面类似于缝合组件24000，并且包括钉仓25100和通道25050；然而，缝合组件包括钉仓25100与通道25050之间的另选的近侧对准和保持特征部。另外，钉仓25100包括位于其仓体25102中的纵向排钉腔和定位在钉腔中的纵向对准的钉。钉腔平行于沿纵向狭槽延伸的纵向轴线A和仓体25102的中心线取向。
仓体25102包括对准凸耳25166，该对准凸耳包括近侧端部25168和远侧端部25170。对准凸耳25166可定位在仓体25102的每一侧上。近侧端部25168可限定直立或竖直表面，并且远侧端部24170也可包括直立或竖直表面。分别限定近侧端部25168和远侧端部25170的直立表面可以是平行的或基本上平行的。在各种实例中，对准凸耳25166可定位在仓体25102的每一侧上，并且对准凸耳25166可关于穿过仓体25102的中心线是对称的。
钉仓25100还包括从仓体25102向外突出的侧向销25180。另一对称定位的侧向销25180可在仓体25102的另一侧上侧向向外突出。
通道25050包括形成U形通道的侧向侧壁25052。钉仓25100可以可释放地固定在侧壁25052之间的U形通道中。通道25050包括对准凹口25058，该对准凹口包括近侧端部25060和远侧端部25062。对准凹口25058可定位在通道24050的每一侧上以接纳对应的对准凸耳25166。近侧端部24060限定侧壁24052中的直立或竖直表面，并且远侧端部24062限定侧壁24052中的另一直立表面。直立表面可以是平行的或基本上平行的。
在其他实例中，对准凹口25058、25166的远侧端部25062、25170可分别被底切，如本文进一步所述，以在钉仓25100在通道25050中完全就位时进一步将钉仓25100固定到通道25050。
通道25050还包括限定用于侧向销25180的内部轨道的狭槽25084。狭槽25080包括平行于钉仓25100的插入方向延伸的V形或锥形入口部分25082和平行于仓体的纵向轴线延伸的终端部分25084。V形入口部分25082为侧向销25180提供进入狭槽25084中的较宽入口区域25083，这确保临床医生不需要以严格的精度将钉仓25100与通道25050对准。此外，与将对准凸耳25166与对准凹口25058的入口区域25063对准的纵向位置的允许范围相比，狭槽25084的较宽入口区域25083可限定钉仓25100相对于通道25050的较大范围的纵向位置。
通道25050与钉仓25100之间的对准特征部被构造成能够相互作用以便于将钉仓25100快速且容易地安装到通道25050中。例如，为了快速地将对准凸耳25166与对准凹口25058对准，临床医生可以将钉仓25100定位在较大范围的纵向位置中的任何位置处，以将侧向销25180定位在狭槽25080的入口部分25083中。当侧向销25180沿狭槽25080的V形部分25082的变窄轨道移动时，凸耳25166可渐缩成与对准凹口25058对准。
在各种实例中，钉仓25100可以以最小的干涉或摩擦阻力落入通道25050中。例如，钉仓25100可不利用钉仓25100与通道25050之间的稳固的摩擦配合特征部固定到通道25050。代替此类摩擦配合特征部或除此之外，狭槽25080的几何形状可将钉仓25100固定在通道25050中。例如，在近侧至远侧击发行程期间施加在钉仓25100上的摩擦力可使侧向销25180沿狭槽25080的终端部分25084朝远侧移动，并且使钉仓25100在通道25050中朝远侧移位。在此类实例中，击发力可将凸耳25166移动到其与对准凹口25058的远侧端部25062齐平的最远侧位置中。
在各种实例中，为了从通道25050移除用尽的钉仓25100，临床医生可朝近侧拉动钉仓25100以从狭槽25080的终端部分25084移除侧向销25180。当钉仓25100由临床医生朝近侧移位(这需要最小的力和努力)时，临床医生可快速且容易地将钉仓25100提升出通道25050。
缝合组件26000的钉仓26100与通道26050之间的另选的闩锁机构在图52和图53中示出。钉仓26100在许多方面类似于本文所述的各种钉仓，并且可包括仓体26102，该仓体具有可移动地定位在仓体26102内的钉和钉支撑驱动器。通道26050包括形成U形通道轮廓的相对的侧壁26052，这些相对的侧壁被构造成能够在其间或至少大部分在其间接纳钉仓26100。例如，钉仓26100包括侧向闩锁臂26180，这些侧向闩锁臂被构造成能够沿侧壁26052的外表面可释放地接合侧向凹槽26080。
闩锁臂26180沿钉仓26000的侧向侧延伸并且可与仓体26102一体成形(例如，模制)。例如，仓体26102和闩锁臂26180可以是一体的单件部件。在各种实例中，闩锁臂26180可以是可偏转的。闩锁臂26180包括用户致动按钮26182和卡扣件26184。卡扣件26184从用户致动按钮26182纵向地偏移。杠杆臂在用户致动按钮26182与卡扣件26184之间延伸，使得按钮26182的致动被构造成能够使卡扣件26184偏转。例如，对按钮26182的向内施加的致动被构造成能够使卡扣件26184向外偏转而脱离与侧向凹槽26080的接合。在某些实例中，在临床医生致动按钮26182时卡扣件26184的偏转被构造成能够将卡扣件26184从凹槽26080移除。在其他实例中，卡扣件26184可移动到较少接合，并且因此更容易地克服相对于凹槽26080的位置。临床医生可对按钮26182施加夹捏运动以同时致动两个按钮26182并使两个卡扣件26184偏转而脱离与凹槽26080的接合。
在各种实例中，为了将钉仓26100安装在通道26050中，钉仓26100可在插入方向上竖直地移动，直到仓体26102的一部分搁置在通道26050中。在该位置中，闩锁臂26180可沿侧壁26052的外表面与纵向引导件对准。当仓体26102朝向通道26050中的完全就位位置朝近侧滑动时，闩锁臂26180沿纵向引导件移动并且卡扣件26184卡扣到凹槽26080中以将钉仓26100固定在完全就位位置中。当钉仓26100在通道26050中完全就位并且卡扣件26184接合或锁定在凹槽26080中时，缝合组件的宽度仍可在传统尺寸的套管针内(例如，12-mm轮廓)。为了从通道26050释放钉仓26100，临床医生捏住按钮26182以将卡扣件26184从凹槽26080向外偏置，使得临床医生可通过沿纵向轴线A朝远侧和/或竖直地远离通道26050拉动钉仓26100来移除钉仓。
在某些实例中，仓体26102是塑料的并且闩锁臂26180也是塑料的。例如，仓体26102和闩锁臂26180可以是模制的复合塑料部件。
在其他实例中，仓体可以是塑料和金属的复合组件。例如，闭锁臂可以是与仓体一起形成的金属弹簧。闭锁臂可以是嵌入模制的金属臂。在某些实例中，金属闩锁臂可提供比塑料臂更大的弹簧常数和锁扣闩锁特征部。
在某些实例中，缝合组件可包括易碎仓保持特征部，其被构造成能够将钉仓固定在通道中，直到易碎仓保持特征部被用户故意破坏为止。例如，临床医生可有意地破坏仓保持特征部和/或该特征部可在击发行程期间被破坏，诸如在击发行程完成时或接近完成时。易碎仓保持特征部的破坏可减小钉仓与通道之间的保持力，使得临床医生可用较小量的力移除钉仓。在各种实例中，当易碎特征部被破坏时，其可保持连接到钉仓。例如，再次参考图50中的锁24380，该锁可包括易碎部分，该易碎部分被构造成能够在用户对钉仓施加有意的动作以将其从通道移除时开裂但不脱落。
在某些实例中，钉仓可包括卡位装置，该卡位装置与通道接合并且在完成击发行程时从通道释放。现在参考图54至图59，示出了在许多方面类似于钉仓20100(图24)的钉仓26200。例如，钉仓26200包括仓体26202，该仓体包括组织支撑平台26204，该组织支撑平台具有限定在其中的钉腔；钉腔在旋转驱动螺杆26242的每一侧上布置成三个纵向排26212a、26212b、26212c，该旋转驱动螺杆在许多方面类似于击发螺杆261(见图4和图5)。钉仓26200中的钉由驱动器26220支撑，这些驱动器在许多方面类似于三重驱动器20120(图26)。例如，驱动器26220包括被构造成能够支撑钉的三个平行钉支撑托架，使得驱动器26220被构造成能够同时从内排26212a、中间排26212b和外排26212c击发钉。
钉仓26200包括可释放地接合通道的卡位装置26280。卡位装置26280能够在锁定构型(图54至图57)与解锁构型(图58和图59)之间移动。在某些实例中，邻近仓体26202定位的通道侧壁的面向内部侧可包括凹槽，该凹槽的尺寸和结构被设计成能够接纳处于锁定构型的卡位装置26280。例如，通道20852(图99)包括远侧凹槽20853。凹口被构造成能够相对于通道保持卡位装置26280并且因此保持钉仓26200，直到卡位装置26280移动到解锁构型。在其他实例中，卡位装置26280抵靠通道侧壁的向外偏置被构造成能够摩擦地接合通道而不将卡位装置26280放置在凹陷中。钉仓26000的相对侧上的相对卡位装置26280被构造成能够摩擦地接合通道以将钉仓26000保持在其中。
卡位装置26280被容纳在外排26212c中的最远侧钉腔26210中。通孔26205限定在仓体26202的外壁26203中，进入外排26212c中的远侧钉腔26210中。当卡位装置26280处于锁定构型时(图54至图57)，卡位装置26280与通孔26205对准并且在通孔26205处从仓体26202突出。杆26282从卡位装置26280延伸并且与最远侧钉腔26210中的驱动器26220可操作地接合。
当最远侧驱动器26220处于未击发位置(图54至图57)时，最远侧驱动器26200可将卡位装置26280偏置到锁定位置中。现在参考图58和图59，在完成击发行程时，当最远侧驱动器26200被滑动件提升穿过钉腔并朝向组织支撑平台26204时，最远侧驱动器26220可远离卡位装置26280移动并接合杆26282。当最远侧驱动器26220沿杆26282移动时，驱动器26220被构造成能够将杆侧向向外偏置，这使卡位装置26280向内枢转进入和/或穿过通孔26205并且脱离与通道的接合。在此类实例中，当击发行程完成时，最远侧驱动器26220释放卡扣特征部，即卡位装置26280。
在某些实例中，多个驱动器可释放的卡位装置可沿仓体26202的长度定位。在某些实例中，纵向错开的和/或纵向对称的卡位装置可沿仓体26202的两侧定位。除了驱动可释放的卡位装置26280之外，在本公开的某些方面，滑动件可被构造成能够释放卡扣配合或卡位装置特征部。此外，在某些实例中，驱动器可被构造成能够在击发行程期间卡扣或破坏卡位装置26280和/或其杆26282以释放附接特征部。
在各种实例中，本文的钉仓组件可包括被构造成能够防止驱动器从仓体释放的驱动器保持特征部。例如，某些钉仓包括金属盘，在驱动器安装在紧固件腔中之后，该金属盘被热铆焊或热成形到仓体。金属盘可围绕仓体的下侧包裹并将驱动器保持在其中。在某些实例中，驱动器可在没有独立的金属盘的情况下被保持以在仓组件的小形状因数中产生附加的空间。例如，如本文进一步所述，仓体与驱动器之间的热熔柱可保持驱动器。附加地或另选地，仓体可以用金属盘包覆模制。例如，驱动器保持特征部可包括驱动器与仓体之间的热成形干涉特征部和/或仓体内的嵌入模制部件。
钉仓26300示出在图60和图61中。钉仓26300在许多方面类似于钉仓20100(图24)。例如，钉仓26300包括仓体26302，该仓体包括组织支撑平台26304，该组织支撑平台具有限定在其中的钉腔；钉腔在仓体26302的每一侧上布置成三个纵向排26312a，26312b，26312c。钉仓26300中的钉由驱动器26320(图61)支撑，这些驱动器在许多方面类似于三重驱动器20120(图26)。例如，驱动器26320包括被构造成能够支撑钉的三个平行钉支撑托架，使得驱动器26320被构造成能够同时从内排26312a、中间排26312b和外排26312c击发钉。
仓体26302包括沿仓体26302的下部部分的一排凹口26330或凹坑。这排凹口26330可定位成当驱动器26320处于其未击发位置时接合并保持驱动器26320。在图60中，每个凹口26330被构造成能够接合驱动器26320。例如，每个驱动器26320可由邻近其相邻钉支撑柱的外表面的凹口26330保持定位。当驱动器26320处于其未击发和最下位置时，仓体26302中的凹口26330可防止驱动器从仓体26302掉出。
仓体26302中的凹口26330被构造成能够接合驱动器26320的外表面中的凹槽26321。凹槽26321可包括上唇部或边界，其防止驱动器26320相对于仓体26302的竖直移位。在各种实例中，凹口26330和相应的凹槽26320可被热成形、熔化或以其他方式与热铆焊工艺结合。热铆焊将在本文中进一步描述。
因为驱动器26320是三重驱动器，所以驱动器26320的外壁与仓体26302之间的热铆焊连接可将整个驱动器26320(包括中间支撑柱和内支撑柱)保持在仓体26302中的适当位置。凹口26330与凹槽26321之间的干涉连接可在击发行程期间由滑动件克服，以当滑动件沿这排凹口26330移动时顺序地释放和提升驱动器26320。在某些实例中，沿仓体26302中的内表面的一系列热铆焊可在击发运动期间接合每个驱动器26320。在此类实例中，驱动器26320可在击发运动期间捕获多个竖直卡扣件或凹坑。
在某些实例中，驱动器和仓体可包括模制到驱动器和/或仓体中的干涉特征部。参考图62，钉仓26400在许多方面类似于钉仓20100(图24)。例如，钉仓26400包括仓体26402，该仓体包括组织支撑平台26404，该组织支撑平台具有限定在其中的钉腔26410；钉腔26410在仓体26402的每一侧上布置成三个纵向排。钉仓26400中的钉由驱动器26420(图62)支撑，这些驱动器在许多方面类似于三重驱动器20120(图26)；然而，驱动器26420是双重驱动器。在其他实例中，本文中关于驱动器26420描述的保持特征部可结合到单个驱动器和/或三重驱动器中。
驱动器26420包括一体成形的楔形件26421，该楔形件沿楔形件26421的顶部边缘26423更窄并且沿楔形件26421的底部边缘26425更厚。楔形件26421定位在钉支撑柱的侧壁上并且被构造成能够邻接钉腔26410的侧壁。例如，钉腔26410包括与楔形件26421对准的竖直沟槽26405。楔形件26421被构造成能够在驱动器26420在击发行程期间被滑动件向上提升时沿竖直沟槽26405移动。为了适应楔形件26421，仓壁被构造成能够在驱动器26420插入到仓体26402中时向外挠曲。在使用中，滑动件的击发力足以克服干涉配合并提升驱动器26420。换句话说，在所描绘的实施例中，楔形件26421被构造成能够行进穿过垂直沟槽26405；然而，沟槽26405的深度不足以允许楔形件26421自由且畅通地穿过其中。窄顶部边缘26423可以无干涉地适配在沟槽中；然而，在窄顶部边缘26423和较厚的底部边缘26425之间，尽管有竖直沟槽26405，楔形件26421仍可能与仓体26402干涉。楔形件26421与竖直沟槽26405之间的干涉连接被构造成能够在击发运动期间将驱动器26420保持在钉腔26410内的适当位置并且抵抗向下运动；在击发行程期间，当楔形件26421沿这排凹口26330穿过仓体26402时，可通过滑动件克服干涉以顺序地释放和提升驱动器26420。当驱动器26420及其楔形件26421移动穿过腔26410时，仓体26402可继续挠曲。
现在参考图63，示出了钉仓26500。钉仓26500包括仓体26502，该仓体具有限定在其中的钉腔；钉腔在仓体26502的每一侧上布置成三个纵向排。钉仓26500中的钉26580由驱动器26520支撑，这些驱动器在许多方面类似于三重驱动器20120(图26)。钉仓26500在许多方面类似于钉仓20100(图24)；然而，钉仓26500还包括仓体26502内的插入模制的金属框架26503。插入模制的金属框架26503是包括沿仓体26502的侧面延伸的第一盘26503a和第二盘26503b的两部分式组件。盘26503a、26503b可与仓体26502一起嵌入模制，利用沿仓体26502的长度的凸台26505与盘26503a、26503b中的开口26507之间的摩擦配合卡扣配合到仓体26502，和/或可通过使沿仓体26502的长度的凸台26505在盘26503a、26503b中的开口26507内变形而热铆焊到仓体26502。
在一个方面，平坦的、非弯曲的盘可与仓体26502一起嵌入模制(例如，盘26503a、26503b可最初限定线性轮廓而不是L形轮廓)。例如，仓体26502可由沿其侧向侧的包覆模制的金属片材形成。然后，包覆模制的金属片材的暴露长度可围绕仓体26502的下侧的一部分弯曲，以至少部分地覆盖钉腔中的一些钉腔，从而将驱动器26520从其下侧保持在仓体26502中。在某些实例中，驱动器可以是横跨外钉腔、中间钉腔和内钉腔的三重驱动器。金属片材的弯曲部分可覆盖或基本上覆盖外钉腔的下部部分，以将驱动器保持在仓体中。
另选地，类似盘26503a、26503b的L形盘可卡扣配合到仓体26502的侧向侧，以将驱动器从其下侧保持在仓体26502中，而不将盘26503a、26503b嵌入模制到仓体26502中。
在一个方面，盘26503a、26503b可与仓体26502嵌入模制，并且可包括暴露的可弯曲金属凸缘或臂，其在驱动器26520已经安装在钉腔中之后围绕仓体26502弯曲。例如，现在参考图64和图65，示出了用于仓体诸如仓体26502(图63)或仓体20102(图24)的金属框架或盘26603的一部分。盘26603可与仓体嵌入模制。例如，盘26603包括框架部分26605，仓体已经模制在该框架部分上。盘26603还包括臂26609。臂26609可利用在方向F(图65)上的变形力从初始构型(图64)变形为弯曲臂26609的构型(图65)，以将臂26609包裹在钉腔的下部部分周围并将驱动器保持在其中。
在本公开的各个方面，在某些实例中，用于在外钉腔上形成金属件以将驱动器保持在其中的各种技术可应用于内钉腔。例如，在本公开的各个方面，钉仓可包括支撑支架，诸如配合在钉仓640内的支撑支架650(见图19和图20)。如本文进一步所述，钉仓640和支撑支架650可在将钉仓640安装到通道630中之前组装在一起。在某些实例中，仓体内的此类支撑支架650或其他嵌入模制的纵向框架构件可包括金属片材、盘或臂，其可围绕仓体的下侧弯曲以将驱动器保持在内排钉腔中。
如本文所述，驱动器保持和/或与仓体的互锁特征部可被热铆焊以将驱动器保持在仓体中。在本公开的至少一个方面，每个驱动器可包括与仓体相对应的热铆焊特征部。重要的是确保热铆焊深度足以保持驱动器不脱离接合但不导致与处于其未击发位置或向下位置的驱动器的干涉。可控制热铆焊和轨道成形技术以确保充分接合。
现在参考图67，示出了钉仓26700的部分，包括在其中具有驱动器26720的仓体26702。钉仓26700在许多方面类似于钉仓20100(图24)，但还包括纵向支撑框架26703和在仓体26702与纵向支撑框架26703之间的热铆焊保持特征部26705。在各种实例中，热铆焊可抵靠固体金属片材进行以将仓体26702固定到纵向支撑框架26703。然后，驱动器26720可安装在钉腔中。例如，驱动器26720和钉可安装在钉腔26710中。在已经安装驱动器26720之后，纵向支撑框架26703可在仓体26702的下侧上方弯曲以将驱动器26720保持在其中。例如，纵向支撑框架26703的一部分26709可覆盖与驱动器26720上的外钉支撑柱和外钉腔26710相关联的钉仓26702的下侧中的开口。
在某些热铆焊操作中可使用插入件支撑件，这可减小压力的量并且改善一致性。例如，可移除的插入件支撑件或衬垫可定位在每个热熔柱后面。此外，插入件支撑件可在铆焊时将驱动器推入到向上位置，以保护驱动器不变形或受热铆焊操作的其他影响。
参考图67，示出了用于钉仓26800的热铆焊操作，其中仓体26802利用热熔柱26805固定到纵向支撑框架26803。钉仓26800在许多方面类似于钉仓20100(图24)，但还包括纵向支撑框架26803和热熔柱26805。纵向支撑框架26803包括直立片材26808和从其延伸以形成L形轮廓的正交凸缘26809。直立片材26808包括穿过其中的开口26807，其与热熔柱26805对准。正交凸缘26809还包括穿过其中的开口26806，其被构造成能够在其中接纳插入件支撑件26890的指状部26892。
在热铆焊操作期间，L形支撑框架26803沿仓体26802的长度定位，并且插入件支撑件26890相对于支撑框架26803和仓体26802定位，使得指状部26892延伸穿过正交凸缘26809中的开口26806并且进入钉腔26810中。指状部26892被构造成能够朝向仓体26802的组织支撑平台26804向上推动驱动器26820。在热熔柱26805已经形成在仓体26802与L形支撑框架26803之间之后，插入件支撑件26890可从钉仓26800移除，从而允许驱动件26820向下移动并且呈现其在钉腔26810中的未击发位置。正交凸缘26809被构造成能够覆盖仓体26802的下侧的一部分，并且可覆盖多个钉支撑柱(例如，外柱和中间柱)和/或两个相邻钉支撑柱之间的桥接件，以将横跨多排钉腔26810的驱动器26820保持在仓体26802中。
如本文进一步所述，某些端部执行器部件可使用3D打印技术来构造以改善部件能力。在某些实例中，3D打印可允许打印部件表现出例如超材料性质。超材料是一种合成复合材料，其结构使得其表现出在天然材料中通常不存在的性质。3D打印是用于通过形成具有两种或更多种材料的部件或其中的结构而产生超材料的一种技术。在其他实例中，嵌入模制和包覆模制可生成在某些实例中可具有超材料性质的复合部件。
复合端部执行器部件可表现出更大的结构强度和刚度，同时允许精确地形成小的细节特征部，并且在某些实例中可提供改善的摩擦特性。例如，金属-塑料复合仓体可表现出某些超材料性质，因为其可比例如类似的注射模制的、完全塑料的或复合的仓体更坚固和更硬，同时仍允许关于小的细节特征部的精度。在某些实例中，金属-塑料复合仓体相对于可移动地定位在每个钉腔中的驱动器可表现出改善的摩擦特性。某些复合金属-塑料部件可通过嵌入模制或包覆模制形成。在其他实例中，3D打印可允许创建复杂的几何形状和/或材料组合，这些复杂的几何形状和/或材料组合原本对于利用传统模制技术来制造而言可能是过于昂贵且耗时的，或者在某些实例中，在缺少3D打印技术的情况下甚至可能不可能制造。
例如，参考图69，示出了复合金属-塑料仓体30002。在某些实例中，复合金属-塑料仓体30002可提供超材料性质。附加地或另选地，金属-塑料复合体可允许电子部件(诸如电子传感器和柔性电路)的改进的集成。
在一个方面，仓体30002形成有冲压金属框架30001或两个或更多个盘，其被冲压并且以其他方式形成为用于仓体30002的骨架形状。然后将塑料材料30003模制在金属框架30001上。在此类实例中，金属框架30001可插入模制到塑料材料30003。与完全塑料的仓体(即其中没有金属框架的注射模制的仓体)相比，金属-塑料复合仓体30002可表现出增加的强度和塌缩刚度。金属或复合材料框架上的塑料材料30003可提供具有模制到塑料材料30003中的复杂驱动器引导特征部的结构功能框架。
在某些实例中，金属框架30001可包括薄金属框架，并且塑料材料可与结构构件一起注射模制。在一个方面，金属框架可构成一个或多个集成盘，如本文进一步所述，其可节省仓体中的空间和/或增加组织间隙。另外，金属可用于与闭锁、仓识别和复位相关的某些部件。在某些实例中，金属可较不易于断裂或开裂，并且可承受相当大的力，这可有助于闭锁部件和/或机械键(例如，延伸突片或柱)防止钉仓插入到不相容的通道和/或装置中。某些金属部件在击发行程复位期间可以是弹性的，即，在制造期间回缩滑动件以测试钉仓并且确保所有部件已经安装时。此外，复合金属-塑料仓体可有利于智能仓技术、集成布线和/或柔性电路。
在某些实例中，金属框架30001可具有互连或横跨仓体中的多个壁和/或柱的凸缘。例如，仓体中的某些壁可以比其他壁薄，并且凸缘可以将较薄的壁与较厚的壁连接以更好地分布扭矩负载，而不是扭转支撑件。在某些实例中，仓体中的主直立支撑壁可通过金属框架连接到相邻的较厚支撑壁。例如，较薄的内仓壁可联接到较厚的外仓壁以改善夹紧和/或击发期间的力分布。
在其他实例中，复合塑料-金属仓体可以是3D打印的。形成复合塑料-金属仓体的3D构建的取向可被优化以确保在击发行程期间平稳的驱动器运动。例如，再次参考图69，仓体30002包括布置成多个纵向排30012的钉腔30010。钉腔30010被限定为穿过组织支撑平台30004并且进入仓体30002中。本文进一步描述的驱动器(诸如驱动器20120(图26))可将钉支撑在仓体30002中。
复合塑料-金属仓体30002可沿仓体30002的纵向轴线A逐层打印。换句话说，3D构建的取向可正交于纵向轴线A和/或正交于组织支撑平台30004。当仓体30002的定向3D打印垂直于纵向轴线A(例如，近侧到远侧)时，构建层可与击发行程期间驱动器运动的方向对准。再次参考图69，每个钉腔30010沿轴线D延伸，其垂直于纵向轴线A。当滑动件沿纵向轴线A移动穿过仓体30002时，每个驱动器沿其相应的D轴线朝向组织支撑平台30004向上提升。构建方向平行于钉腔D的轴线，驱动器在击发行程期间沿该轴线移动。在某些实例中，将3D构建层与驱动器运动的方向对准可防止当驱动器在击发行程期间被滑动件提升时驱动器被黏连和阻碍。
在某些实例中，复合塑料-金属仓体的3D构建是从近侧到远侧的。在其他实例中，例如，3D构建可以是远侧到近侧的。在某些实例中，当在仓体的较宽远侧鼻部的顶部上构建较窄主体部分时，可最大限度地减小用于某些3D构建的支撑结构。
在各种实例中，3D打印的复合仓体可包括不同的填充百分比和/或不同的材料以获得与改进仓体的强度同时最大限度地减小击发行程期间的摩擦力相关的超材料性质。此外，此类仓体的支撑壁可在其间限定开放空间、空隙和/或小室。在各种实例中，支撑壁之间的空间(诸如钉腔之间的薄壁)可被构造成能够允许夹紧负载期间改善的抗弯性。例如，仓体的支撑壁之间的空间可包括3D打印的内部圆角、斜面和/或支撑柱，其被构造成能够改善支撑壁的开孔强度。
由于穿过其中的中心击发螺杆(例如，图4和图5中的击发螺杆261，其占据仓体的紧凑形状因数中的实际面积)的占有面积，本文所述的某些仓体可包括较小的横截面几何形状、较少的材料和/或较薄的支撑壁。在击发行程期间，仓体上的高负载可对仓体施加变形力，这可导致仓体或其部分变形。例如，分隔钉腔的薄壁在某些实例中可能倾向于弯曲或屈曲，这可能引导驱动器和支撑在其上的钉不与砧座中的成形凹坑对准。在任何情况下，用桥接件连接仓体的侧向侧可加强仓体，并且即使在经受高负载时也帮助保持钉腔中的钉与其在砧座中的相关联的成形凹坑之间的对准。
现在参考图71和图72，示出了外科端部执行器30140的部分。外科端部执行器30140在许多方面类似于外科端部执行器20240(图29)。例如，端部执行器30140包括钉仓30100，该钉仓在许多方面类似于钉仓20100(图24)，并且包括仓体30102和在旋转驱动螺杆30142(图72)的每一侧上的三排钉腔，该旋转驱动螺杆在许多方面类似于例如驱动螺杆261(见图4和图5)和旋转驱动螺杆20242(图29)。钉仓30100安装在通道30150中。具有直立切割边缘30146的击发构件30144被构造成能够在击发行程期间沿旋转驱动螺杆30142移动穿过钉仓30100，以推进滑动件并提升其上的驱动器和钉，使其与砧座中的成形凹坑形成接触。
仓体30102在许多方面类似于例如仓体20102(图24)；然而，仓体30102还包括在仓体30102的两个侧向侧30102a、30102b之间延伸的桥接件30106。桥接件30106覆盖限定在仓体30102中的纵向刀接纳狭槽30108，击发构件30144的一部分在击发行程期间沿该纵向刀接纳狭槽移动。桥接件30106在仓体30102的两个侧向侧30102a、30102b之间形成连续的组织支撑平台30104。在各种实例中，桥接件30106可例如提高仓体30102的强度，并且可帮助保持钉与砧座上的成形凹坑的对准，尤其是例如在高负载下击发时。在此类实例中，桥接件30106可减轻例如由高夹紧负载导致的侧向钉未对准。
桥接件30106是易碎部分，其被构造成能够在击发行程期间被击发构件30144的直立切割边缘30146切割或横切。在各种实例中，桥接件30106的几何形状被构造成能够减轻碎裂的风险。例如，该几何形状可允许可预测的几何形状和桥接件30106受破坏的取向。在仓体30102被3D打印的实例中，例如，与仓体30102的相邻部分相比，仓体30102可沿桥接件30106或桥接件30106的部分包括不同的材料、不同的填充百分比和/或不同的填充几何形状，这可进一步有利于在击发行程期间横切桥接件30106，而不会损坏击发构件30144和/或使仓体30102受击发负载而碎裂。
在某些实例中，如本文进一步所述，钉仓30100可包括例如单次使用的刀，该单次使用的刀可在击发行程期间横切桥接件30106。在利用单次使用的刀的情况下，在横切桥接件30106的易碎部分时，刀不会有对于随后的击发行程变钝的风险。桥接件30106可包括例如塑料模制和/或3D打印的部件，其可容易地被直立切割边缘30146横切而没有显著的阻力。在其他实例中，可使用可重复使用的刀来切割桥接件30106。
在某些实例中，桥接件30106可包括成排的穿孔和/或断裂/撕裂线，桥接件30106被构造成能够沿这些穿孔和/或断裂/撕裂线从仓体30202分离。参考图73，例如，显窃启盖30200包括易碎部分30206，该易碎部分具有撕裂突片30202并且由易碎部分与盖30200的其余部分之间的断裂线30204限定。易碎部分30206可以沿断裂线30204从显窃启盖30200移除或分离。相似地，桥接件30106可沿断裂线从仓体30102移除，这便于桥接件30106从仓体30102分离。在某些实例中，桥接件30106可被沿刀接纳狭槽30108的侧壁的凹坑中断。桥接件30106的偏转和/或分离部分可被构造成能够在击发行程期间移动到凹坑中，而不是被推出仓体30102并进入夹持在它们之间的组织中。
在某些实例中，如本文进一步所述，可替换的钉仓可包括单次使用的刀，该单次使用的刀可为每个击发行程提供新的切割边缘。然而，为了切割夹持在端部执行器的钳口之间的组织，在各种实例中，刀应当延伸超过钉仓的组织支撑平台。此类突出的刀和切割边缘有在击发行程之外无意和/或意外接触的风险，这可能损坏组织和/或使切割边缘变钝。例如，在击发行程之前，诸如当钉仓正被加载到端部执行器中时，切割边缘可能意外地接触和/或切割患者和/或临床医生的组织。在其他实例中，在完成击发行程时，切割边缘可保持在远侧突出位置中，并且当端部执行器松开组织并且正从外科部位退出时，可能意外地接触和/或切割患者和/或临床医生的组织。设想了附加的无意组织接触情况。
在各种实例中，组织横切刀可安装到钉仓中的滑动件上。当滑动件移动穿过击发行程时，刀也可移动穿过仓体。此外，滑动件可与端部执行器中的击发构件(例如，I形梁或E形梁)相互作用。例如，滑动件和其上的刀可以可释放地联接到击发构件，使得滑动件和刀在击发行程期间朝远侧推进。在某些实例中，在击发行程完成或终止时，滑动件和刀可与击发构件一起朝近侧回缩。在此类实例中，在击发构件允许钳口打开之前，刀可复位和/或返回到仓体中的近侧位置。在此类实例中，突出的刀及其切割边缘可返回到在仓体的近侧端部处的可预测和/或至少部分地被遮挡的位置。在其他实例中，滑动件可包括多个可分离部件(例如，两部分式滑动件)，并且滑动件的一部分可朝近侧回缩，而滑动件的另一部分保持在远侧位置中。在某些方面，滑动件的可伸缩部分可包括刀。在其他实例中，滑动件的不可回缩部分可包括刀，当滑动件的可回缩部分移动经过刀时，刀可被向下引导到仓体中。在某些实例中，滑动件的一部分可与闭锁特征部相互作用，以在仓遗漏和/或用尽时，防止击发行程。
在本公开的一个方面，击发构件可包括朝远侧延伸的钩，并且滑动件可包括尺寸被设计成能够接纳朝远侧延伸的钩的近侧腔。此外，刀可以可枢转地联接到滑动件并且定位成选择性地接合并且保持滑动件中的朝远侧延伸的钩。例如，朝远侧延伸的钩可钩在刀的一部分周围。在各种实例中，朝远侧延伸的钩和刀的互连被构造成能够将刀相对于仓体保持在突出位置中。
在此类实例中，当击发构件推进到与滑动件接合时，刀可移动到突出位置，在该突出位置中，切割边缘定位成横切夹持在钳口之间的组织。在击发行程之前，刀可枢转到遮挡位置中，在该遮挡位置中，切割边缘的至少一部分被滑动件和/或仓体遮挡。此外，在完成击发行程时，击发构件可与滑动件一起返回到仓体中的近侧位置并且返回到其遮挡位置。在各种实例中，前述布置可避免在击发行程之外的某些意外的组织接触。
现在参考图74至图77，示出了端部执行器30340(图77)的滑动件组件30320。端部执行器30340在许多方面类似于端部执行器200(见图4和图5)，并且被构造成能够切割和缝合患者的组织。端部执行器30340可包括例如仓钳口和砧座钳口，并且仓钳口可被构造成能够接纳具有组织支撑平台30304的钉仓30300，该钉仓在许多方面类似于例如钉仓220(见图4和图5)。端部执行器30340还包括旋转驱动螺杆和击发构件30342，它们分别类似于击发螺杆261(见图4和图5)和击发构件270(见图4和图5)。仓钳口被构造成能够接纳钉仓30300，该钉仓包括当击发构件30342在钉仓30300内推进时可被射出的钉。例如，在击发行程期间，在击发螺杆旋转时，击发构件30342被驱动穿过端部执行器30340以推进滑动件组件30320。
击发构件30342包括主体部分30343、从主体部分30343的两侧侧向延伸的上凸轮构件30344、以及从主体部分30343的两侧侧向延伸的下凸轮构件30345。上凸轮构件30344被构造成能够在击发行程期间以凸轮方式接合端部执行器30340的上钳口或砧座，并且下凸轮构件30345被构造成能够在击发行程期间以凸轮方式接合端部执行器30340的下钳口或细长通道。
除了上述之外，纵向开口延伸穿过主体部分30343。纵向开口被构造成能够接纳上述旋转驱动螺杆。主体部分30343还包括被构造成能够接纳击发驱动螺母30350的切口区域30349。击发驱动螺母30350被构造成能够螺纹接合旋转驱动螺杆以将旋转驱动螺杆的旋转运动转换成击发构件30342的平移。击发驱动螺母30350还包括从击发驱动螺母30350的两侧延伸的侧向延伸构件30351。侧向延伸构件30351与下凸轮构件30345对准。因此，凸轮构件30345、30351协作以在击发行程期间以凸轮方式接合端部执行器30340的下钳口。
击发构件30342的主体部分30343还包括远侧鼻部30346，该远侧鼻部朝远侧延伸并形成远侧滑动件邻接表面30352。远侧延伸部30347从远侧滑动件邻接表面30352在基本上远侧方向上延伸，并且被构造成能够选择性地与滑动件组件30320互锁。更具体地，远侧延伸部30347包括在横向于远侧方向的方向上延伸的横向部分或卡扣件30348。远侧延伸部30347和卡扣件30347形成钩状几何形状，其选择性地接合滑动件组件30320的一部分，如本文进一步所述。
滑动件组件30320包括滑动件主体30321和刀30338，该刀具有定位成接合驱动器(诸如驱动器20120(图26))的轨道30322。轨道30322被构造成能够朝向钉仓30300的组织支撑平台30304提升驱动器。滑动件主体30321的中心部分30333在击发行程期间沿钉仓30300中的中心纵向路径移动。在各个方面，中心部分30333包括具有侧壁30335的直立毂部30334，这些侧壁的尺寸和结构被设计成能够沿钉仓30300中的纵向狭槽移动。中心部分30333还包括弧形下侧轮廓30334，其尺寸和位置被设计成能够无干涉地适应旋转驱动螺杆。
直立毂部30334包括侧壁30335之间的凹槽或空间30328以及在侧壁30335之间延伸的轴或销30336。止动件30337也在侧壁30334之间延伸，并且在本文中进一步描述。滑动件组件30320的刀30338在毂部30339处可枢转地安装到销30336。在各个方面，毂部30339可限定允许刀30338围绕销30336旋转的毂部直径。此外，刀30338包括安装狭槽30329，该安装狭槽具有比毂部直径更窄的宽度，并且销30336穿过该安装狭槽以将毂部30339固定到销30336。在各种实例中，刀30338可例如卡扣配合或压配合到销30336上。参考图75中的滑动件组件30320的分解图，刀30338可沿组件轴线A移动以将刀30338可旋转地安装到滑动件主体30321。
在各种实例中，刀30338可相对于滑动件主体30321枢转到向下或凹陷位置。例如，当刀30338处于凹陷位置时，刀30338及其切割边缘可例如大致面向下，和/或被侧壁30335遮挡。在某些实例中，偏置元件被构造成能够将刀30338朝向凹陷位置偏置。
现在主要参考图77，在击发行程期间，击发构件30340朝远侧推进到钉仓30300中，这将远侧延伸部30347和卡扣件30348驱动到直立毂部30334的侧壁30335之间的空间30328中。在插入到空间30348中时，卡扣件30348可钩在刀30338的端部部分30328周围。刀30338的端部部分30328限定平面邻接表面30327，并且球状端部30327围绕卡扣件30348延伸以抵靠平面邻接表面30327牢固地保持卡扣件30348。在此类实例中，卡扣件30348在刀30338的端部部分30328远侧的位置处保持在空间30328中。此外，刀30338旋转到突出位置中，在该突出位置中，切割边缘从仓体30302突出并且进入限定在组织支撑表面30304与砧座之间的组织间隙中。在各种实例中，远侧延伸部30347和/或端部部分30328被构造成能够在远侧击发运动期间在限定的负载下挠曲，以将远侧延伸部30347弹性地联接在滑动件组件30320的空间30328中。
此后，击发构件30340可朝远侧推进滑动件组件30320。当滑动件组件30320朝远侧移动时，刀30338从图77所示的取向在顺时针方向上被推动。对击发运动(例如，组织)的阻力可被构造成能够使刀30338在顺时针方向上旋转。刀30338可在顺时针方向上从图77中的取向旋转到与止动件30337邻接接合，该止动件被构造成能够防止刀30038的进一步顺时针旋转。在此类实例中，在击发行程的远侧运动期间，刀30338相对于组织支撑平台30304保持在直立或突出位置。例如，邻接表面30327可与卡扣件30348的内表面齐平或基本上齐平。
击发构件30320的近侧回缩运动在图77中示出，其中击发构件30320在近侧方向P上退出。击发构件30320在近侧方向B上的回缩被构造成能够朝近侧拉动远侧延伸部30347和卡扣件30348，这也在近侧方向上对端部部分30328施加力。继而，端部部分30328上的该力被构造成能够使刀30338在逆时针方向上旋转，同时使滑动件组件30320与击发构件30320一起回缩。例如，在各种实例中，刀30338的轻微顺时针旋转被配置成能够将刀30338的切割边缘向下枢转到不太可能接触和/或切割组织的取向。
在各种实例中，击发构件30340与滑动件组件30320之间的互连被构造成能够确保在钳口从击发构件30340的凸轮构件30344、30345、30351的接合释放并允许打开之前，滑动件组件30320及其刀30338复位到钉仓30300中的近侧位置中。当击发构件30340进一步回缩并从钉仓30300中退出时，远侧延伸部30347、卡扣件30348和/或端部部分30328可被构造成能够偏转以将远侧延伸部30347从滑动件主体30321释放，并且使刀30338进一步从图77中的取向逆时针枢转到遮挡取向。
在本公开的某些方面，滑动件可由金属片材冲压而成。在某些实例中，滑动件可以是由两个冲压片材形成的两部分式滑动件。在某些实例中，冲压滑动件可具有基本上W形的轮廓。例如，刀可与冲压片材中的一个冲压片材成一体。在某些实例中，两部分式滑动件可包括第一冲压部件和第二冲压部件，第一冲压部件能够与击发构件一起回缩，第二冲压部件不与击发构件一起回缩。在近侧未击发位置中，第二冲压部件被构造成能够与遗漏和用尽的仓闭锁件相互作用并且克服遗漏和用尽的仓闭锁件。在第二冲压部件不被击发构件从其回缩的远侧击发位置中，遗漏和用尽的仓闭锁件被构造成能够接合击发构件并防止击发行程。
当钉仓从端部执行器遗漏时和/或当用尽的或空的钉仓安装在端部执行器中时，两部分式滑动件和闭锁布置可防止击发行程。此外，在某些实例中，由两个冲压的金属板材形成的滑动件可提供较低成本的滑动件，该滑动件具有集成的刀和切割边缘、用于击发构件的联接特征部以及闭锁接合特征部。此类冲压金属滑动件可防止滑动件轨道在高钉成形负载下弯曲或蕈状扩展，并且在某些实例中可防止滑动件断裂或开裂。此外，冲压金属滑动件可限定允许在仓体中有更多塑料(或其他材料)的薄轨道，这可提高仓体的强度，包括钉腔之间的支撑壁的强度。在某些实例中，冲压金属滑动件的薄轮廓可允许驱动器定位成更靠近在一起，并且在某些实例中可更好地适应旋转驱动螺杆。
现在参考图74至图89，示出了端部执行器30440(见图82)的滑动件组件30420。端部执行器30440在许多方面类似于端部执行器200(见图4和图5)，并且被构造成能够切割和缝合患者的组织。端部执行器30440包括例如仓钳口30450和砧座钳口30454，并且仓钳口30450被构造成能够接纳具有仓体30402和组织支撑平台30404的钉仓30400，该钉仓在许多方面类似于例如钉仓220(见图4和图5)。端部执行器30440还包括击发驱动系统30339，该击发驱动系统包括旋转驱动螺杆30442和击发构件30441，它们分别类似于击发螺杆261(见图4和图5)和击发构件270(见图4和图5)。仓钳口30450限定具有相对的侧壁30452的通道，这些相对的侧壁被构造成能够接纳钉仓30400，该钉仓包括当击发构件30441推进穿过钉仓30400时可被射出的钉。例如，在击发行程期间，在旋转驱动螺杆30442旋转时，击发构件30341被驱动穿过端部执行器30340以推进滑动件组件30420。
主要参考图81，击发构件30441包括主体部分30443、从主体部分30443的两侧侧向延伸的上凸轮构件30444、以及从主体部分30443的两侧侧向延伸的下凸轮构件30445。上凸轮构件30444被构造成能够在击发行程期间以凸轮方式接合端部执行器30440的砧座钳口30454，并且下凸轮构件30445被构造成能够在击发行程期间以凸轮方式接合端部执行器30400的仓钳口30450。
除了上述之外，纵向开口延伸穿过主体部分30343。纵向开口被构造成能够接纳上述旋转驱动螺杆30442。在某些实例中，旋转驱动螺杆30442可经螺纹联接到主体部分30343，并且在其他实例中，可经螺纹联接到容纳在其中的击发驱动螺母，如本文进一步所述。
主要参考图78至图81，滑动件组件30420包括两个分立的滑动件，即近侧滑动件30422和远侧滑动件30424。每个滑动件30422、30424是独立且分立的冲压部件。例如，每个滑动件30422、30424可通过独立的冲压形成。滑动件30422、30424由冲压的材料片(诸如金属片材)形成。在至少一个方面，滑动件30422、30424由钢板形成；然而，也设想了其他材料。近侧滑动件30422和远侧滑动件30422协作以接合容纳在仓体30402中的驱动器30416。驱动器30416在各种情况下可为三重驱动器，并且可在许多方面类似于例如驱动器20120(图26)。
近侧滑动件30422和远侧滑动件30424可通过推动连接来连接。换句话说，当近侧滑动件30422向远侧滑动件30424施加推力时，滑动件30422、30424可保持连接。在没有推力的实例中，滑动件30422、30424是可分离部件，其在某些实例中可选择性地移动和重新定位。
每个滑动件30422、30424包括形成轨道的一对冲压楔形件。近侧滑动件30422包括用于滑动件组件30420的外轨道30423，并且远侧滑动件30424包括用于滑动件组件30420的内轨道30425。外轨道30423和内轨道30425被构造成能够在击发行程期间沿钉仓的每一侧移动，并且可以与一排驱动器30416对准。在轨道30423、30425之间，近侧滑动件30422和远侧滑动件30424分别包括中心直立部分30426、30428，其限定下部弧形轮廓30426a、30428a以适应穿过其中的旋转驱动螺杆30442(图81)。中心直立部分30426、30428还分别包括键30426b、30428b，其被构造成能够对准并引导滑动件30422、30424穿过仓体30402。键30426b、30428是弓形环，但也设想了其他几何形状。例如，正交凸缘将中心直立部分30426、30428连接到其相应轨道30423、30425。由于其冲压成形，正交凸缘具有与相关联轨道30423、30425相同的厚度。
在图88中的钉仓中示出了滑动件组件30420。金属片材的厚度可与轨道30423、30425的厚度相关。在此类实例中，内轨道30423必须具有相同的厚度，并且外轨道30423必须具有相同的厚度。在至少一个方面，尽管内轨道30423和外轨道30423单独地冲压，但它们可具有相同的厚度。在任何情况下，由薄金属片材形成，滑动件组件30420可具有减小的厚度，同时仍承受高负载而不弯曲和/或断裂。例如，轨道30423、30425可比相邻纵向排中的钉腔之间的仓壁更窄。相比之下，参考图89中具有相同总宽度和钉线几何形状的钉仓30500，仓体30502中的滑动件30530(例如，模制塑料滑动件)的内轨道30523和外轨道30525可比轨道30423、30425更宽。在此类实例中，例如，仓体30502可具有更小的空间，并且因此具有更少的材料和相关联的强度来支撑内排驱动器。
近侧滑动件30422和远侧滑动件30424可沿组装轴线A对准和组装(图79)。当组装时，中心直立部分30426、30428可以纵向错开，并且内轨道30425的近侧部分可抵靠在近侧滑动件30422的正交凸缘上(见图80)。此外，两个滑动件30422、30424的正交凸缘被构造成能够沿下支撑表面(诸如仓钳口30450的内表面)滑动或以其他方式移动(见图82)。
仍然参考图78至图81，近侧滑动件30422还包括具有面向远侧的切割边缘30432的一体式刀30430。例如，当冲压近侧滑动件30422时，可将刀30430切入到材料片中。近侧滑动件30422还包括近侧尾部或延伸部30434，其被构造成能够在钉仓30400及其驱动器组件30420安装在仓钳口30450(图82)中时与击发构件30441(图81)可释放地联接。近侧延伸部30434是T形的并且包括侧向偏置部，该侧向偏置部被构造成能够便于与击发构件30441中的T形凹槽30448(图81)联接。例如，参考图87，近侧延伸部30434最初可驻留在仓体30402中的凹口中，该凹口可将近侧滑动件30422保持在相对于仓体30402的适当位置。然后，当击发构件30442朝远侧移动时，近侧延伸部30434弯曲到T形凹槽30448中以将近侧滑动件30422锁定到击发构件30442。还设想了另选的互补轮廓用于联接近侧延伸部30434和击发构件30441。
在各种实例中，当钉仓30400安装在仓钳口30450中时，击发构件30441可与驱动器组件30420对准，并且可被构造成能够在击发构件30441在击发行程期间朝远侧移动初始距离时移动成与驱动器组件30420驱动接合，如图81所示。参考图87，例如，当击发构件30441开始朝近侧移动时，允许近侧延伸部30434偏转到凹槽30448中。
近侧延伸部30434可被偏置成与击发构件30441的主体30443中的凹槽30448保持接合，并且可在击发构件30441的近侧和远侧移位期间保持与凹槽30448接合，直到击发构件30441在击发行程完成时最终从钉仓30400或几乎从钉仓30400朝近侧退出。当击发构件30441可释放地附接到近侧滑动件30422时，击发构件30441的直立主体部分30443与刀30430对准。如图81所示，当刀30430推进穿过组织时，主体部分30443可支撑刀30430。在各种实例中，来自主体部分的附加支撑件被构造成能够防止刀30430远离击发路径和端部执行器30440的纵向轴线偏转。
远侧滑动件30424在击发行程期间被近侧滑动件30422朝远侧推动。远侧滑动件30424还包括基部30429(图86)，其从轨道30245和/或正交凸缘向下延伸。基部30429可被构造成能够在击发行程期间随着击发构件30441推动近侧滑动件30422而移动穿过仓钳口30450中的狭槽，该近侧滑动件在击发行程期间朝远侧推动远侧滑动件30424。在各种实例中，基部30429被构造成能够在远侧滑动件30424停驻在近侧未击发位置时接合端部执行器30440中的闭锁件。远侧滑动件30424及其闭锁特征部在本文中进一步描述。
主要参考图82至图84，端部执行器30440包括闭锁臂30460，其由远侧滑动件30424选择性地接合。闭锁臂30460能够在阻止击发行程的锁定位置(图82至图84)与允许击发行程的解锁位置(图85)之间移动。在某些实例中，闭锁臂30460被柔性地定位在仓钳口30450的通道部分中的纵向凹槽30453中，并且被构造成能够围绕中心枢转部分40646枢转。
闭锁臂30460包括被偏置到击发构件30341中的闭锁凹口30449中的近侧端部30466。例如，定位在仓钳口30450中的弹簧30470被构造成能够在击发构件30341处于近侧预击发行程位置时将近侧端部30466推入击发构件30341的闭锁凹口30449中。当闭锁臂30460的近侧端部30466被接纳在闭锁凹口30449中时，闭锁臂30460被构造成能够抵抗击发构件30441的平移，并且因此防止击发行程
滑动件组件30420被构造成能够通过从闭锁凹口30449移除闭锁臂30460的近侧端部30466来克服闭锁臂。更具体地，当远侧滑动件30424定位在钉仓30400中的近侧未击发位置中时，远侧滑动件30424的基部30429定位成接合闭锁臂30460的远侧端部30462(见图85)。闭锁臂30400的位于近侧端部30466与远侧端部30462之间的枢转部分30464保持在仓钳口30450中的弓形支撑件30451中。在某些实例中，枢转部分30464以及因此整个闭锁臂20468被构造成能够围绕弓形支撑件30451枢转。
例如，当钉仓30400安装在端部执行器30440中并且远侧滑动件30424处于近侧未击发位置时，闭锁臂30460从锁定位置枢转到解锁位置，这指示钉仓未用尽或变空。当击发构件30441朝远侧推动近侧滑动件30422时，闭锁臂30460从解锁位置枢转到锁定位置，这朝远侧推动远侧滑动件30422。当远侧滑动件30422底部上的基部30429移动脱离与闭锁臂30460的远侧端部30462的接合时，闭锁臂30460由于弹簧30470的偏置力而枢转。当击发构件稍后在击发行程之后返回到近侧位置并且试图使闭锁凹口30449移动经过闭锁臂30460时，弹簧30470将闭锁臂30460的近侧端部30466推入闭锁凹口30449中以防止击发行程。基部30429在击发行程期间沿通道30450中的纵向凹槽30453移动。
如本文所述，两部分式滑动件组件30420被构造成能够选择性地克服闭锁臂30460以允许击发行程。此外，滑动件组件30420包括一体式刀30430，其为单次使用的刀30420，具有适当锋利的切割边缘30432，用于横切由端部执行器30440夹持的组织。在完成击发行程时，单次使用的刀30420连同击发构件30441一起朝近侧回缩。此外，因为击发梁30441包括相对的凸轮30445、30446，所以击发构件30441可确保钳口30450、30542保持闭合，直到刀30420返回到钉仓30400中的近侧位置。
如本文所述，某些外科装置可包括可重复使用的刀，其结合到外科装置中，诸如击发构件上的面向远侧的刀边缘。在完成击发行程时，可重复使用的刀可从钉仓中缩回，并且随后与另一钉仓一起重新击发。在这种应用中，外科装置(包括其可重复使用的刀)可在外科手术之间进行清洁和灭菌。
在其他实例中，单次使用的刀可与外科装置一起使用。例如，钉仓可包括仅与该特定钉仓一起使用的单次使用的刀。当钉仓从外科装置移除时，单次使用的刀也被移除。当可替换的钉仓安装在外科装置中时，新的单次使用的刀随之被提供。在某些实例中，单次使用的刀可在击发行程期间以及甚至在击发行程之后当钉仓从外科装置移除时保持在钉仓中。在某些实例中，在击发行程之后和/或当钉仓从外科装置移除时，单次使用的刀的切割边缘可至少部分地被钉仓的特征部遮挡。在某些实例中，刀或其一部分可被折叠或以其他方式变形和/或从突出取向向下推入到钉仓中。
例如，钉仓可包括两部分式滑动件组件，该两部分式滑动件组件包括近侧滑动件和远侧滑动件。在两部分式滑动件组件插入到外科装置中时，近侧滑动件可连接到击发构件。远侧滑动件可包括直立切割边缘。在击发行程期间，击发构件被构造成能够朝远侧推动近侧滑动件，该近侧滑动件继而朝远侧推动远侧滑动件以横切组织。在完成击发行程时，近侧滑动件可通过击发构件朝近侧回缩并且可与远侧滑动件分离。当近侧滑动件朝近侧回缩时，近侧滑动件的中心凸部被构造成能够在直立切割边缘上方移动以将切割边缘向下折叠到仓体中。在各种实例中，近侧滑动件还可包括用于在击发行程期间支撑直立切割边缘的支撑特征部。
在某些实例中，两部分式滑动件组件可由冲压金属板材制造，其可作为其他制造技术的低成本替代方案。在某些实例中，对于相同尺寸的钉仓，冲压金属滑动件组件可具有更薄的轨道，但比塑料滑动件更坚固。此外，在某些实例中，冲压金属滑动件组件可形成具有更少回弹的钉和/或允许钉在钉线中更靠近地定位在一起。在某些实例中，刀可被构造成能够沿击发行程的长度在任何地方伸入和/或变形到仓体中，并且仅近侧冲压滑动件部件可与击发构件一起返回。在击发构件和近侧冲压滑动件部件的近侧回缩期间刀的折叠和/或变形可确保刀在随后的外科手术期间不再使用。在某些实例中，近侧冲压滑动件部件和击发构件可定位成在远侧击发行程期间支撑远侧冲压滑动件部件及其刀。
现在参考图90至图98，示出了两部分式滑动件组件30620。滑动件组件30620包括两个分立的滑动件，即近侧滑动件30622和远侧滑动件30624。每个滑动件30622、30624是独立且分立的冲压部件。例如，每个滑动件30622、30624可通过独立的冲压形成。滑动件30622、30624由冲压的材料片(诸如金属片材)形成。在至少一个方面，滑动件30622、30624由钢板形成；然而，也设想了其他材料。近侧滑动件30622和远侧滑动件30622协作以接合容纳在仓体30602中的驱动器30616(图92)。驱动器30616在各种情况下可为三重驱动器，并且可在许多方面类似于例如驱动器20120(图26)。
近侧滑动件30622和远侧滑动件30624可通过推动连接来连接。换句话说，当近侧滑动件30622向远侧滑动件30624施加推力时，滑动件30622、30624可保持连接。在没有推力的实例中，滑动件30622、30624是可分离部件，其在某些实例中可选择性地移动和重新定位。
每个滑动件30622、30624包括形成轨道的一对冲压楔形件。近侧滑动件30622包括用于滑动件组件30620的外轨道30623，并且远侧滑动件30624包括用于滑动件组件30620的内轨道30625。外轨道30623和内轨道30625被构造成能够在击发行程期间沿钉仓的每一侧移动，并且可以与一排驱动器30616对准。近侧滑动件30622包括中心直立部分30626和将中心直立部分30426连接到每个外轨道30623的正交凸缘30621。正交凸缘30621被构造成能够在击发行程期间沿下支撑表面(例如，沿钉仓钳口的内表面)骑跨，并且由于近侧滑动件30622的冲压成形而具有与外轨道30423相同的厚度。中心直立部分20426的尺寸被设计成能够配合在远侧滑动件20624的一部分周围并且限定凸部30627。
远侧滑动件30624包括中心直立部分30628和将中心直立部分30626连接到每个内轨道30625的正交凸缘30619。正交凸缘30619被构造成能够在击发行程期间沿下支撑表面(例如，沿钉仓钳口的内表面)骑跨，并且由于远侧滑动件30624的冲压成形而具有与内轨道30625相同的厚度。中心直立部分30628限定下部弧形轮廓30626a，其尺寸被设计成能够适应穿过其中的旋转驱动螺杆30642(图92)。旋转驱动螺杆30642在许多方面类似于击发螺杆261(见图4和图5)。中心直立部分30628还包括具有面朝远侧的切割边缘30630的延伸刀30629。近侧滑动件30622的中心直立部分30626被构造成能够配合在远侧滑动件30622的中心直立部分30628周围，除了延伸超过凸部30627和中心直立部分30626的上边缘的延伸刀30629。远侧滑动件30624还包括防回缩臂30632，该防回缩臂可被侧向偏置成与仓体30602接合，以防止远侧滑动件30624在击发行程之后朝近侧回缩。在某些实例中，防回缩臂30632可定位在远侧滑动件30624的每个侧向侧上。
主要参考图92，滑动件组件30620是钉仓30600的部件，其还包括仓体30602、驱动器30616以及可移除地定位在仓体30602中的钉。在各种实例中，钉仓30600(包括其滑动件组件30620)可被可释放地安装在外科装置或其具有仓钳口、砧座钳口和击发构件的端部执行器中，如本文进一步所述。在缝合运动完成时，钉仓30600(包括其滑动件30620)可从端部执行器移除。当将钉仓30600安装在外科端部执行器中时，滑动件组件30620可与外科端部执行器中的击发构件对准，并且当钉仓30600安装在外科端部执行器中时，远侧滑动件30622可以可释放地联接到击发构件。
现在参考图90，示出了与滑动件组件30620一起使用的击发构件30641。当组装在一起时，击发构件30641和滑动件组件30620形成击发组件30639，该击发组件被构造成能够在击发行程期间沿旋转驱动螺杆30642推进。击发构件30641包括直立主体部分30643、从主体部分30643的两侧侧向延伸的上凸轮构件30644、以及从主体部分30643的两侧侧向延伸的下凸轮构件30645。上凸轮构件30644被构造成能够在击发行程期间以凸轮方式接合端部执行器的上钳口或砧座，并且下凸轮构件30645被构造成能够在击发行程期间以凸轮方式接合端部执行器的下钳口或细长通道。凸轮构件30644、30645被构造成能够在击发行程期间夹紧端部执行器30640的钳口并且限定组织间隙，如本文关于各种击发构件(例如，I形梁和E形梁)进一步所述。
如图90所示，当包括滑动件组件30620的钉仓30600安装在外科端部执行器中时，使滑动件组件30620与击发构件30641可释放地接合。更具体地，近侧滑动件30622包括近侧指状部30638，其沿正交部分30621的每个内边缘侧向向内延伸到纵向轨道30637中。此外，击发构件30641包括定位在进入主体部分30645中的相应狭槽30646内的脊30648。由于钉仓30600相对于击发构件30641的插入角度，近侧指状部30641被提升到脊30648并且定位在击发构件30641中的狭槽30646中，以将近侧滑动件30622可释放地保持到击发构件30641。主要参考图95，近侧滑动件30622与击发构件30641之间的接合特征部关于穿过钉仓30600的纵向轴线A是对称的，并且与击发驱动螺杆30641(图92)对准。在其他实例中，接合特征部可仅定位在击发组件30639的一侧上。
当钉仓30600在外科端部执行器中正确就位并且近侧滑动件30622可释放地保持到击发构件30641时，可发起击发行程。在击发行程开始时，击发构件30641朝远侧推进，并且击发组件30639呈现图92至图95的第一推进构型。在击发行程的该初始部分中，击发构件30641相对于近侧滑动件30622朝远侧移动。例如，当脊30648沿轨道60637移动时，近侧指状部30638移动穿过击发构件30641中的狭槽30646。击发构件30641朝远侧推进，直到击发构件30641上的脊30648邻接轨道30637的端部，如图95所示。换句话说，近侧滑动件30622包括位于轨道30637的远侧端部处的正交部分30621中的硬止动件30636(图95)。脊30648不可朝远侧移动经过硬止动件30636。简言之，击发构件30641相对于近侧滑动件30622移动，直到脊30648邻接硬止动件30636，此时击发组件30639处于第一推进构型。
在第一推进构型中，击发构件30641定位成推动近侧滑动件30622，并且近侧滑动件30622定位成推动远侧滑动件30624。实际上，击发构件30341与滑动件组件30620推动接合，并且可朝远侧推动集合滑动件组件30620以击发钉并切割组织。在第一推进构型中，击发构件30641的直立主体部分30643被朝远侧推动成与刀30629邻接接合。在该构型中，击发构件30641被构造成能够在击发行程期间支撑刀30629。
在击发行程或其一部分完成时，击发构件30641可朝近侧回缩。击发构件30641的近侧回缩被构造成能够在各种情况下松开钳口，如本文进一步所述。近侧回缩运动在图96A至图96D中示出。在第一回缩构型(图96A)中，击发构件30641已经朝近侧回缩并且相对于滑动件组件60620(包括相对于近侧滑动件60622)移动。例如，击发构件30641被允许相对于近侧滑动件60622朝近侧移动，直到脊30648邻接轨道30637的近侧端部。轨道30637的近侧端部由侧向向内延伸到击发构件30641中的狭槽30645中的近侧指状部30638限定。在第一回缩构型中，脊30648邻接近侧指状部30638的远侧端部。
从第一回缩构型，击发构件30641被构造成能够使近侧滑动件30622与击发构件30641一起回缩。远侧滑动件30624上的防回缩臂30632被构造成能够在近侧滑动件30624回缩时将远侧滑动件30622保持在仓体30602中的适当位置。在第二回缩构型(图96B)中，近侧滑动件30622的中心直立部分30626上的凸部30627被拉动超过向上突出的刀30629，以使刀30629在凸部30627下方向下变形或折叠。支撑刀30629的远侧滑动件30624的中心直立部分30628包括具有至少一个拐角或弯曲部的细长梁，该细长梁可由于凸部30627在刀30629上移动而偏转。弯曲部可包括中空的内角，以便于当对其施加凸部30627的向下的力时弯曲。当击发组件从第二回缩构型移动到第三回缩构型时(图96C)，中心直立部分30628及其刀30629继续被向下推动。从第三回缩构型到第四回缩构型(图96C)，击发构件30641继续拉动近侧滑动件30622远离远侧滑动件30624及其刀30639，所述刀在近侧滑动件30622的近侧回缩运动期间已被凸部30627折叠和/或变形。
主要参考图97和图98，远侧滑动件30624保持在仓体30602的远侧部分中，并且近侧滑动件30622和击发构件30641朝近侧回缩。在各种实例中，在击发构件30641的凸轮30644、30645回缩脱离与砧座钳口和仓钳口中的凸轮表面的接合之后，钳口可被打开并且用尽的/击发的钉仓30600可从端部执行器移除。例如，由于钉仓30600的移除角度，近侧指状部30638可被提升超过脊30648以使近侧滑动件30622从击发构件30641脱离接合。在此类实例中，包括被遮挡在仓体30602内的弯曲/变形的刀30629的钉仓30600可被移除并替换为新的钉仓。
本文所述的某些钉仓可包括沿钉仓的基本长度延伸的中心纵向支撑框架和/或旋转驱动螺杆。在各种实例中，沿钉仓中心的结构可占据钉仓占有面积的相当大部分，并且尤其是占据相当大的宽度，这可影响其中的钉腔、钉驱动器和钉的布置。对钉线的某些修改可影响止血。可逐排进行对钉线构型的调节，诸如纵向排内钉的数量和其间的间距、纵向排之间的侧向间距、以及钉的数量、其间的间距和最近侧钉的放置(即偏移)的变化。本文描述了各种钉线构型，其被构造成能够在本文所述的各种钉仓组件的小占有面积内优化止血并且平衡击发力。
滑动件在击发行程期间经受相当大的力。例如，当滑动件接合驱动器并提升驱动器和其上的钉穿过组织并与砧座形成接触时，可对滑动件轨道施加相当大的横向负载。为了平滑击发行程期间的击发力，钉仓的相对侧上的钉图案可纵向偏移。
现在参考图118，钉仓25000具有仓体25002和限定在仓体25002中的钉腔25010。钉腔25010的尺寸和结构被设计成能够将驱动器和钉保持在其中，如本文进一步所述。纵向狭槽25006将仓体25002分成第一侧25002a和第二侧25002b。钉腔25010布置成两种图案：在纵向狭槽25006的第一侧25002a上的第一图案25014和在纵向狭槽25006的第二侧25002b上的第二图案25016。每个图案25014、25016包括内排25012a、中间排25012b和外排25012c。然而，第一图案25014不同于第二图案25016。
更具体地，第一图案25014从第二图案25016纵向偏移距离或纵向偏移O。因此，第一图案25014和第二图案25016相对于纵向轴线A是不对称的。第一图案25014包括最近侧钉腔，并且第二图案25016包括最近侧钉腔。在纵向轴线L的任一侧上的最近侧钉腔的近侧端部之间的纵向偏移O是纵向偏移O。
如本文进一步所述，三重驱动器包括由桥接件连接的三个钉支撑柱。三重驱动器限定从最近侧支撑柱的近侧端部到最远侧支撑柱的远侧端部的纵向长度。纵向长度是沿纵向轴线A的长度，例如，被构造成能够从第一腔25010a、第二腔25010b和第三腔25010c击发钉的驱动器的近侧到远侧长度。在某些实例中，三重驱动器的近侧端部到远侧端部长度可以是0.1936英寸。还设想了其他长度。
在各种实例中，纵向偏移被构造成能够在击发行程期间平滑滑动件的击发力。在各种实例中，纵向偏移O为容纳在钉腔中的三重驱动器的纵向长度的约25％。在其他实例中，纵向偏移O可小于三重驱动器的纵向长度的25％或大于25％。例如，设想了为三重驱动器的纵向长度的5％至35％的纵向偏移O。参考图119，利用第一图案25114与第二图案25116之间的29.5％的纵向偏移，对于0.1936英寸的近侧到远侧长度的三重驱动器，其对应于约0.0573英寸。在其他实例中，参考图120，利用第一图案25215与第二图案25216之间的9.2％的纵向偏移，对于0.1936英寸的近侧到远侧长度的三重驱动器，其对应于约0.0178英寸。图94至图96仅描绘了每个图案25014、25016、25114、25115、25214、25216的一部分，并且在某些实例中，相同的图案继续直到钉腔的远侧端部。
在某些实例中，三重驱动器可以是三角形的，并且在仓体一侧上的驱动器不与在仓体相对侧上的驱动器对准。三重驱动器在仓体中的不对称布置可允许滑动件关于纵向中心线是不对称的。在此类实例中，仓体的一侧可在近侧端部处具有附加的空间，其中驱动器的该侧在远侧方向上纵向偏移。附加空间可适应闭锁部件和/或旋转驱动器支撑件。示例性闭锁件和旋转驱动器支撑件在本文中进一步描述。在某些实例中，闭锁部件和旋转驱动支撑件可在仓体的近侧端部中至少部分地并排。
在其他实例中，滑动件轨道可纵向偏移以平衡击发力。例如，滑动件的第一侧上的滑动件轨道可从滑动件的相对侧上的滑动件轨道纵向偏移容纳在仓体25002中的三重驱动器的纵向长度的25％。
再次参考图94，在某些实例中，每一侧25002a、25002b上的纵向排25012a、25012b、25012c可以不同地侧向间隔开。例如，第二仓侧25002b上的内排25012a和中间排25012b比第一仓侧25002a上的内排25012a和中间排25012b更靠近在一起。例如，轴线25024与轴线25025之间的距离小于轴线25022与轴线25023之间的距离。此外，第二仓侧25002b上的外排25012c和中间排25012b比第一仓侧25002a上的外排25012c和中间排25012b离得更远。例如，轴线25026与轴线25025之间的距离大于轴线25021与轴线25022之间的距离。此外，在仓体25002的两侧，内排25012a与中间排25012b之间的侧向间距不同于中间排25012c与外排25012c之间的侧向间距。
在其他实例中，在仓体的一侧(例如，纵向刀狭槽的一侧)上的成排钉图案中没有一排可为重复图案。每排中的非重复且独特的图案可允许在排与排之间定制，以确保最大数量的钉腔配合在仓体中，尤其是配合在靠近组织止动件的近侧区域中。此外，在某些实例中，钉图案可沿钉线的整个长度利用相同的驱动器，例如相同的三重驱动器。在此类实例中，在钉仓中仅利用单一类型的驱动器，这可改进制造过程。在某些实例中，例如，内排和外排中的最近侧和/或最远侧的紧固件腔可以是偏移的。
现在参考图121，钉仓25300具有仓体25302和限定在仓体25302中的钉腔25310。钉腔25310的尺寸和结构被设计成能够将驱动器和钉保持在其中，如本文进一步所述。纵向狭槽25306将仓体25302分成第一侧25302a和第二侧25302b。钉腔25010布置成两种图案：在纵向狭槽25306的第一侧25002a上的第一图案25314和在纵向狭槽25006的第二侧25302b上的第二图案25316。每个图案25315包括内排25012a、中间排25012b和外排25012c。第一图案25014与第二图案相同(例如，关于纵向轴线L对称镜像)。图97仅描绘了每个图案25314、25316的一部分，并且在某些实例中，相同的图案继续直到钉腔的远侧端部。
在第一图案25314和第二图案25316中，最近侧钉腔24310a从第二最近侧钉腔25310b纵向偏移第一距离或纵向偏移O1。另外，在第一图案25314和第二图案25316中，第二最近侧钉腔24310b从第三最近侧钉腔25310c纵向偏移第二距离或纵向偏移O2。第一纵向偏移O1分别小于内排25012a、中间排25012b和外排25012c中的钉的钉冠长度L1、L2和L3的50％。基于纵向偏移O1来选择第二纵向偏移O2，以使从中间排25012c射出的钉相对于从内排25012a和外排25012c射出的钉错开。换句话说，选择第二纵向偏移O2以在排与排之间提供至少小程度的纵向重叠。第二纵向偏移O2大于第一纵向偏移O1。
仍然参考图案25314、25316，在每一侧25002a、25002b上的排25312a、25312b、25312c
与该侧上的其他排不同。更具体地，腔的数量和腔之间的间隔是相同的；然而，排25312a、25312b、25312c的起始位置是不同的。
此外，每排25312a、25312b、25312c沿平行于纵向轴线L的轴线延伸。排25312a、25312b、25312c的侧向间距，即排沿其延伸的轴线的间距，可以是不同的。例如，在两侧25302a、25302b上，内排25312a与中间排25312b之间的侧向间距小于中间排25312b与外排25312c之间的侧向间距。
在某些实例中，同一侧25002a、25002b上的排可被构造成能够接纳不同的钉和/或可与被构造成能够将钉成形为不同的尺寸和/或几何形状的成形凹坑对准。例如，在同一侧25002a、25002b上但在不同的排中，某些钉可大于其他排中的钉和/或可被构造成能够形成比其他排中的钉更高的成形高度。附加地或另选地，来自同一侧25002a、25002b的钉可成形为2D平面构型，而同一侧25002a、25002b上的钉被构造成能够成形为3D非平面钉。
如本文进一步所述，三重驱动器包括由桥接件连接的三个钉支撑柱。在各种实例中，钉图案25314和25316可专门用三重驱动器击发。换句话说，单一类型的驱动器可从图案25314、25316击发所有钉。
还设想了具有不同排的其他钉图案。例如，在某些实例中，内排和外排可关于中间排是对称的，直到最近侧腔和/或被定位成更靠近在一起以适应组织止动件的腔。在此类实例中，内排和外排将具有一些排与排之间纵向对准的钉以及其他排与排之间非纵向对准的钉。在其他实例中，其中一排可具有比其他排更少的钉。例如，外排可具有纵向间隔更远的几个钉。
现在参考图122，出于比较的目的，并排示出了两个钉仓25400和25500。钉仓25400、25500分别包括仓体25402、25502，并且在纵向A的每一侧上分别包括三排钉腔25410、25510。钉仓25400、25500在许多方面类似于本文所述的各种钉仓。
每个钉仓25400、25500还分别包括对应于组织止动件的远侧端部的基准25408、25508。当临床医生初始地将靶组织定位在砧座和钉仓之间时，重要的是靶组织被定位成使得刀不会切入目标组织中，除非目标组织首先被缝合。组织止动件可设置在砧座主体的近侧端部上，以防止目标组织朝近侧运动经过钉仓中的最近侧钉凹坑。
在某些实例中，仓体可在组织止动件近侧的纵向轴线A的每一侧上包括至少一个总的或组合钉长度。组合钉长度是定位在组织止动件近侧的一个或多个钉的长度之和或其部分。这些单个长度的总和等于组合钉长度。例如，参考钉仓25400，一个全钉和两个半钉在组织止动件近侧，实现两个钉的组合钉长度。然而，因为在组织止动件基准25408近侧期望至少一个组合钉长度，所以几乎没有空间将组织止动件基准25408朝近侧移位。
相反地，参考钉仓25500，组织止动件相对于钉仓25500的近侧端部和最近侧紧固件腔处于相对更近侧的位置。此外，仓体每一侧上的组合钉长度仍满足组织止动件基准25508近侧的至少一个组合钉长度的目标。在钉腔图案的近侧端部处使两个钉腔纵向对准或紧密对准可允许组织止动件朝近侧移动，同时仍在组织止动件近侧保持合适的组合钉长度。
本文所述主题的各个方面在以下实施例中阐述。
实施例1—一种紧固件仓，包括：主体，所述主体沿纵向轴线延伸；紧固件，所述紧固件可移除地定位在所述主体中；和驱动器，所述驱动器可移动地支撑所述紧固件，其中，所述驱动器包括第一驱动器，所述第一驱动器包括：第一支撑柱，所述第一支撑柱限定第一宽度，其中，所述第一支撑柱包括第一紧固件支撑托架；第二支撑柱，所述第二支撑柱位于所述第一支撑柱的侧向外侧并且限定第二宽度，其中，所述第二宽度不同于所述第一宽度，并且其中，所述第二支撑柱包括第二紧固件支撑托架；和桥接件，所述桥接件在所述第一支撑柱与所述第二支撑柱之间延伸。
实施例2—根据实施例1所述的紧固件仓，其中，腔被限定在所述主体中，并且其中，所述腔包括：第一腔，所述第一腔包括第一侧向引导表面，所述第一侧向引导表面被构造成能够可滑动地接合所述第一支撑柱；和第二腔，所述第二腔包括第二侧向引导表面，所述第二侧向引导表面被构造成能够可滑动地接合所述第二支撑柱。
实施例3—根据实施例2所述的紧固件仓，其中，所述第一支撑柱包括被构造成能够可滑动地接合所述第一侧向引导表面的第一侧壁，其中，所述第一宽度被限定在所述第一侧壁之间，其中，所述第二支撑柱包括被构造成能够可滑动地接合所述第二侧向引导表面的第二侧壁，并且其中，所述第二宽度被限定在所述第二侧壁之间。
实施例4—根据实施例1、2和3中任一项所述的紧固件仓，其中，所述第一宽度窄于所述第二宽度。
实施例5—根据实施例1、2、3和4中任一项所述的紧固件仓，其中，所述第一驱动器还包括：第三支撑柱，所述第三支撑柱位于所述第二支撑柱的侧向外侧并且限定第三宽度，其中，所述第三宽度不同于所述第二宽度，并且其中，所述第三支撑柱包括第三紧固件支撑托架；和第二桥接件，所述第二桥接件在所述第二支撑柱与所述第三支撑柱之间延伸。
实施例6—根据实施例5所述的紧固件仓，其中，所述第三宽度介于所述第一宽度与所述第二宽度之间。
实施例7—根据实施例5和6中任一项所述的紧固件仓，其中，所述第一宽度、所述第二宽度和所述第三宽度是不同的宽度。
实施例8—根据实施例5、6和7中任一项所述的紧固件仓，还包括滑动件，所述滑动件被构造成能够在击发行程期间沿所述纵向轴线移动，其中，所述滑动件包括：中心部分，所述中心部分与所述纵向轴线对准；第一轨道，所述第一轨道被构造成能够驱动地接合所述桥接件；和第二轨道，所述第二轨道被构造成能够驱动地接合所述第二桥接件。
实施例9—根据实施例5、6、7和8中任一项所述的紧固件仓，其中，所述紧固件布置成纵向排，所述纵向排包括：第一排，所述第一排包括第一紧固件；第二排，所述第二排与所述第一排侧向向外间隔开一距离并且包括第二紧固件；和第三排，所述第三排与所述第二排侧向向外间隔开所述距离并且包括第三紧固件；其中，所述第一紧固件支撑托架被构造成能够支撑所述第一紧固件，其中，所述第二紧固件支撑托架被构造成能够支撑所述第二紧固件，并且其中，所述第三紧固件支撑托架被构造成能够支撑所述第三紧固件。
实施例10—根据实施例1、2、3、4、5、6、7、8和9中任一项所述的紧固件仓，还包括旋转驱动螺杆，所述旋转驱动螺杆沿所述纵向轴线朝远侧延伸超过多个所述紧固件，其中，所述第一支撑柱与所述旋转驱动螺杆相邻，并且其中，所述第一支撑柱包括基座，所述基座包括被构造成能够适应所述旋转驱动螺杆的斜面化边缘。
实施例11—根据实施例1、2、3、4、5、6、7、8、9和10中任一项所述的紧固件仓，还包括侧向弯曲的组织支撑表面，其中，所述侧向弯曲的组织支撑表面包括顶点。
实施例12—根据实施例11所述的紧固件仓，其中，所述第一支撑柱与所述侧向弯曲的组织支撑表面的所述顶点相邻，并且其中，所述第一驱动器包括在所述桥接件与所述第一支撑柱之间延伸的角撑板。
实施例13—一种紧固件仓，包括：主体，所述主体沿纵向轴线延伸；紧固件，所述紧固件可移除地定位在所述主体中；和驱动器，所述驱动器可移动地支撑所述紧固件，其中，所述驱动器包括第一驱动器，所述第一驱动器包括：第一支撑柱，所述第一支撑柱限定第一宽度；第二支撑柱，所述第二支撑柱位于所述第一支撑柱的侧向外侧并且限定第二宽度；和第三支撑柱，所述第三支撑柱位于所述第二支撑柱的侧向外侧并且限定第三宽度，其中所述第一宽度、所述第二宽度和所述第三宽度是不同的宽度。
实施例14—根据实施例13所述的紧固件仓，其中，所述第一宽度小于所述第二宽度和所述第三宽度。
实施例15—根据实施例14所述的紧固件仓，其中，所述第二宽度大于所述第三宽度。
实施例16—根据实施例13、14和15中任一项所述的紧固件仓，其中，所述第一驱动器还包括：第一桥接件，所述第一桥接件在所述第一支撑柱与所述第二支撑柱之间延伸，其中，所述第一桥接件包括第一倾斜下侧；和第二桥接件，所述第二桥接件在所述第二支撑柱与所述第三支撑柱之间延伸，其中，所述第二桥接件包括第二倾斜下侧。
实施例17—根据实施例16所述的紧固件仓，还包括滑动件，所述滑动件被构造成能够在击发行程期间沿所述纵向轴线移动，其中，所述滑动件包括：中心部分，所述中心部分与所述纵向轴线对准；第一轨道，所述第一轨道被构造成能够驱动地接合所述第一倾斜下侧；和第二轨道，所述第二轨道被构造成能够驱动地接合所述第二倾斜下侧。
实施例18—根据实施例13、14、15、16和17中任一项所述的紧固件仓，还包括旋转驱动螺杆，所述旋转驱动螺杆沿所述纵向轴线延伸，其中，所述第一支撑柱与所述旋转驱动螺杆相邻，并且其中，所述第一支撑柱包括基座，所述基座包括被构造成能够适应所述旋转驱动螺杆的斜面化边缘。
实施例19—根据实施例13、14、15、16、17和18中任一项所述的紧固件仓，其中，所述紧固件布置成纵向排，所述纵向排包括：沿第一排轴线延伸的第一排，其中，所述第一排包括由所述第一支撑柱支撑的第一紧固件；沿第二排轴线延伸的第二排，其中，所述第二排包括由所述第二支撑柱支撑的第二紧固件；和沿第三排轴线延伸的第三排，其中，所述第三排包括由所述第三支撑柱支撑的第三紧固件，并且其中，所述第二排轴线与所述第一排轴线和所述第三排轴线侧向等距间隔开。
实施例20—一种紧固件仓，包括：主体，所述主体沿纵向轴线延伸；多排紧固件，所述多排紧固件包括：位于所述纵向轴线的第一侧上的内排，其中所述内排包括内紧固件；位于所述纵向轴线的所述第一侧上的中间排，其中所述中间排包括中间紧固件；和位于所述纵向轴线的所述第一侧上的外排，其中，所述外排包括外紧固件，其中，所述中间排与所述内排和所述外排侧向等距间隔开；和三重驱动器，所述三重驱动器包括不对称主体，其中，所述不对称主体相对于穿过所述三重驱动器的纵向中心线是不对称的，其中，所述纵向中心线平行于所述纵向轴线取向，并且其中，所述三重驱动器包括：内支撑柱，所述内支撑柱限定第一宽度，其中，所述内支撑柱被构造成能够支撑所述内紧固件；中间支撑柱，所述中间支撑柱限定第二宽度，其中，所述中间支撑柱被构造成能够支撑所述中间紧固件；和外支撑柱，所述外支撑柱限定第三宽度，其中，所述外支撑柱被构造成能够支撑所述外紧固件，并且其中，所述第一宽度小于所述第二宽度和所述第三宽度。
实施例21—一种紧固件仓，包括：主体，所述主体包括组织支撑平台，其中，紧固件腔被限定为穿过所述主体中的所述组织支撑平台，其中，所述紧固件腔包括第一腔，并且其中，所述组织支撑平台包括：面向组织侧；和与所述面向组织侧相对的下侧，其中，所述下侧包括与所述第一腔相邻的下侧表面轮廓；紧固件，所述紧固件可移除地定位在所述紧固件腔中；和驱动器，所述驱动器可移动地支撑所述紧固件并且被构造成能够移动穿过所述紧固件腔的一部分到达击发位置以从所述紧固件腔中射出所述紧固件，其中，所述驱动器包括第一驱动器，所述第一驱动器包括：支撑柱，所述支撑柱包括紧固件托架；和基座，所述基座从所述支撑柱侧向延伸，其中，所述基座包括顶表面轮廓，所述顶表面轮廓被构造成能够在所述第一驱动器处于所述击发位置时与所述下侧表面轮廓配合。
实施例22—根据实施例21所述的紧固件仓，其中，所述下侧表面轮廓包括凹槽，并且其中，所述顶表面轮廓包括突起部，所述突起部被构造成能够在所述第一驱动器处于所述击发位置时嵌套在所述凹槽中。
实施例23—根据实施例21和22中任一项所述的紧固件仓，其中，所述紧固件腔包括位于所述面向组织侧中的开口，并且其中，所述面向组织侧包括围绕所述开口的至少一部分延伸的脊。
实施例24—根据实施例23所述的紧固件仓，其中，所述脊包括第一脊，所述第一脊包括侧向变化的高度。
实施例25—根据实施例23和24中任一项所述的紧固件仓，其中，所述脊横跨跨相邻的紧固件腔排的至少两个开口。
实施例26—根据实施例21、22、23、24和25中任一项所述的紧固件仓，其中，所述支撑柱包括第一支撑柱，其中，所述第一驱动器还包括从所述第一支撑柱侧向偏移的第二支撑柱，其中，所述基座在所述第一支撑柱与所述第二支撑柱之间形成桥接件，并且其中，所述桥接件的顶部部分包括所述顶表面轮廓。
实施例27—根据实施例26所述的紧固件仓，还包括滑动件，所述滑动件包括被构造成能够在击发行程期间沿击发路径移动以驱动地接合所述第一驱动器的滑动件轨道，其中，所述桥接件的所述顶部部分相对于所述击发路径是不对称的。
实施例28—根据实施例27所述的紧固件仓，其中，所述第一驱动器被所述滑动件过度驱动到所述击发位置，在所述击发位置中，所述紧固件托架延伸超过所述组织支撑平台离开所述紧固件仓。
实施例29—根据实施例26所述的紧固件仓，其中，所述桥接件包括第一桥接件，其中，所述紧固件腔还包括第二腔，其中，所述下侧还包括与所述第一腔相邻的第二下侧表面轮廓，并且其中，所述第一驱动器还包括：第三支撑柱，所述第三支撑柱从所述第一支撑柱和所述第二支撑柱侧向偏移；和在所述第二支撑柱与所述第三支撑柱之间的第二桥接件，其中，所述第二桥接件的顶表面包括第二顶表面轮廓，所述第二顶表面轮廓被构造成能够在所述第一驱动器处于所述击发位置时与所述第二下侧表面轮廓配合。
实施例30—根据实施例29所述的紧固件仓，还包括滑动件，所述滑动件包括：第一滑动件轨道，所述第一滑动件轨道被构造成能够在击发行程期间沿第一击发路径移动以驱动地接合所述第一桥接件；和第二滑动件轨道，所述第二滑动件轨道被构造成能够在所述击发行程期间沿第二击发路径移动以驱动地接合所述第二桥接件，其中，所述桥接件的所述顶部部分相对于所述击发路径是不对称的。
实施例31—一种紧固件仓，包括：主体，所述主体包括组织支撑平台，其中，紧固件腔被限定为穿过所述主体中的所述组织支撑平台，并且其中，所述组织支撑平台包括：面向组织侧，所述面向组织侧包括隆起的表面；和与所述面向组织侧相对的下侧，其中，所述下侧包括凹凸不平的表面；紧固件，所述紧固件可移除地定位在所述紧固件腔中；和驱动器，所述驱动器可移动地支撑所述紧固件并且被构造成能够移动穿过所述紧固件腔的一部分到达击发位置以从所述紧固件腔射出所述紧固件，其中，每个驱动器包括基座，所述基座被容纳在所述紧固件仓中并且包括表面轮廓，所述表面轮廓被构造成能够在每个驱动器处于其击发位置时与所述组织支撑平台的所述下侧上的所述凹凸不平的表面配合。
实施例32—根据实施例31所述的紧固件仓，其中，所述凹凸不平的表面包括多个凹槽，并且其中，所述表面轮廓被构造成能够在所述驱动器处于所述击发位置时嵌套在所述凹槽中。
实施例33—根据实施例31和32中任一项所述的紧固件仓，其中，所述紧固件腔包括位于所述面向组织侧中的开口，并且其中，所述面向组织侧包括围绕所述开口的至少一部分延伸的脊。
实施例34—根据实施例31、32和33中任一项所述的紧固件仓，其中，所述脊横跨跨侧向间隔开的紧固件腔排的至少两个开口。
实施例35—根据实施例31、32、33和34中任一项所述的紧固件仓，其中，每个驱动器包括：第一支撑柱；第二支撑柱，所述第二支撑柱从所述第一支撑柱侧向偏移；和桥接件，所述桥接件在所述第一支撑柱与所述第二支撑柱之间延伸，其中，所述桥接件的顶部部分包括表面轮廓，所述表面轮廓被构造成能够与所述组织支撑平台的所述下侧上的所述凹凸不平的表面配合。
实施例36—根据实施例35所述的紧固件仓，还包括滑动件，所述滑动件包括被构造成能够在击发行程期间沿击发路径移动以驱动地接合至少一个驱动器的滑动件轨道，其中，沿所述击发路径的每个桥接件的所述顶部部分相对于所述击发路径是不对称的。
实施例37—根据实施例36所述的紧固件仓，其中，所述驱动器被所述滑动件过度驱动到所述击发位置，在所述击发位置中，所述驱动器的一部分延伸超过所述组织支撑平台。
实施例38—一种紧固件仓，包括：主体，所述主体包括组织支撑平台，其中，紧固件腔被限定为穿过所述主体中的所述组织支撑平台，并且其中，所述组织支撑平台包括：面向组织侧，所述面向组织侧包括突起部的布置；和起伏状下侧，所述起伏状下侧与所述面向组织侧相对；紧固件，所述紧固件可移除地定位在所述紧固件腔中；和驱动器，所述驱动器可移动地支撑所述紧固件并且被构造成能够移动穿过所述紧固件腔的一部分到达击发位置以从所述紧固件腔中射出所述紧固件，其中，每个驱动器包括：第一支撑柱，所述第一支撑柱包括限定第一纵向轴线的第一紧固件托架；第二支撑柱，所述第二支撑柱包括限定第二纵向轴线的第二紧固件托架；和桥接件，所述桥接件在所述主体内连接所述第一支撑柱和所述第二支撑柱，其中，所述桥接件相对于在所述第一纵向轴线与所述第二纵向轴线之间等距的纵向中心线是不对称的。
实施例39—根据实施例38所述的紧固件仓，其中，至少一个桥接件包括侧向斜坡的顶表面，所述顶表面被构造成能够与所述起伏状下侧的一部分互补。
实施例40—根据实施例38所述的紧固件仓，其中，至少一个桥接件包括起伏状顶表面，所述顶表面被构造成能够与所述起伏状下侧的一部分互补。
实施例41—一种缝合组件，包括：紧固件仓，所述紧固件仓包括：仓体，所述仓体包括对准表面和凸耳；紧固件，所述紧固件可移除地定位在所述仓体中；和驱动器，所述驱动器可移动地支撑所述紧固件；和通道，所述通道的尺寸被设计成能够接纳所述紧固件仓，其中，所述通道包括侧壁，所述侧壁包括：凹口，所述凹口的尺寸被设计成能够接纳所述凸耳；和纵向止动件，其中，当所述对准表面抵靠所述纵向止动件受到杠杆作用时，所述凹口与所述仓体上的所述凸耳对准。
实施例42—根据实施例41所述的缝合组件，其中，所述通道包括第一侧壁和第二侧壁，其中，所述通道的尺寸被设计成能够在所述第一侧壁与所述第二侧壁之间接纳所述紧固件仓，并且其中，所述凹口和所述纵向止动件被限定在所述第一侧壁中。
实施例43—根据实施例42所述的缝合组件，其中，所述凹口定位在所述第一侧壁中的所述纵向止动件的远侧。
实施例44—根据实施例41、42和43中任一项所述的缝合组件，其中，所述纵向止动件包括弯曲的邻接表面，在插入运动期间所述仓体在所述邻接表面上受到杠杆作用。
实施例45—根据实施例42和43中任一项所述的缝合组件，其中，所述纵向止动件包括第一纵向止动件并且所述凹口包括第一凹口，其中，所述第二侧壁还包括第二纵向止动件和从所述第二纵向止动件纵向偏移的第二凹口。
实施例46—根据实施例45所述的缝合组件，其中，所述对准表面包括第一对准表面，并且所述凸耳包括第一凸耳，并且其中，所述仓体还包括第二对准表面和第二凸耳，其中，当所述第二对准表面邻接所述第二纵向止动件时，所述第二凹口与所述第二凸耳对准。
实施例47—根据实施例41、42、43、44、45和46中任一项所述的缝合组件，其中，所述凹口包括近侧直立表面和远侧直立表面，其中，所述凸耳的尺寸被设计成能够配合在所述近侧直立表面与所述远侧直立表面之间，并且其中，所述近侧直立表面和所述远侧直立表面是不平行的。
实施例48—根据实施例47所述的缝合组件，还包括弹簧，其中，所述远侧直立表面包括倾斜表面，其中，所述凸耳包括倾斜远侧端部，并且其中，所述弹簧被构造成能够在所述紧固件仓安装到所述通道中时将所述倾斜远侧端部偏置成与所述倾斜表面配合接触。
实施例49—根据实施例48所述的缝合组件，其中，当所述对准表面邻接所述纵向止动件并且所述紧固件仓朝向安装在所述通道中移动时，所述弹簧在所述近侧直立表面与所述凸耳的近侧端部之间被压缩。
实施例50—根据实施例48和49中任一项所述的缝合组件，其中，所述弹簧包括板簧。
实施例51—根据实施例48、49和50中任一项所述的缝合组件，其中，所述弹簧被定位和构造成相对于所述通道将所述紧固件仓朝远侧偏置到完全就位位置。
实施例52—根据实施例41、42、43、44、45、46、47、48、49、50和51中任一项所述的缝合组件，还包括击发元件，所述击发元件被构造成能够在击发行程期间朝远侧移动穿过所述紧固件仓，其中，所述击发元件被构造成能够在所述击发行程期间相对于所述通道将所述紧固件仓朝远侧偏置到完全就位位置。
实施例53—根据实施例52所述的缝合组件，其中，所述仓体还包括侧向延伸的销，并且其中，所述通道还包括狭槽，所述狭槽的尺寸被设计成能够在所述紧固件仓插入到所述通道中时接纳所述侧向延伸的销，并且其中，所述狭槽包括：V形入口部分，所述V形入口部分平行于所述仓体的插入方向延伸；和第二部分，所述第二部分平行于所述仓体的纵向轴线延伸。
实施例54—一种缝合组件，包括：紧固件仓，所述紧固件仓包括：仓体，所述仓体限定纵向轴线，其中，所述仓体包括近侧仓对准特征部和远侧仓对准特征部；紧固件，所述紧固件可移除地定位在所述仓体中；和驱动器，所述驱动器可移动地支撑所述紧固件；通道，所述通道的尺寸被设计成能够接纳所述紧固件仓，其中，所述通道包括侧壁，所述侧壁包括近侧通道对准特征部和远侧通道对准特征部，所述远侧通道对准特征部定位成在将所述近侧仓对准特征部定位成与所述近侧通道对准特征部邻接接合并且将所述紧固件仓沿插入轴线移动到所述通道中的第一位置时接纳所述远侧仓对准特征部，其中，所述插入轴线垂直于所述纵向轴线；和弹簧，所述弹簧被构造成能够在所述通道内沿所述纵向轴线将所述紧固件仓从所述第一位置朝远侧偏置到完全就位位置。
实施例55—根据实施例54所述的缝合组件，其中，所述弹簧包括悬臂式板簧。
实施例56—根据实施例54和55中任一项所述的缝合组件，其中，所述弹簧还包括：第一端部，所述第一端部安装到所述远侧仓对准特征部；第二端部，所述第二端部与所述第一端部相对；和S形曲线，所述S形曲线位于所述第一端部与所述第二端部中间。
实施例57—根据实施例54、55和56中任一项所述的缝合组件，其中，所述仓体还包括鼻部，包括：闩锁，所述闩锁能够在第一位置和第二位置之间移动，在所述第一位置中，所述闩锁将所述鼻部固定到所述通道，在所述第二位置中，所述闩锁将所述鼻部从所述通道释放；和用户激活的释放按钮，所述用户激活的释放按钮被构造成能够将所述闩锁从所述第一位置移动到所述第二位置。
实施例58—根据实施例57所述的缝合组件，其中，所述闩锁包括臂，并且其中，所述通道包括远侧凸部，所述远侧凸部被构造成能够在所述闩锁处于所述第一位置时接纳所述臂。
实施例59—一种缝合组件，包括：紧固件仓，所述紧固件仓包括：仓体，所述仓体限定纵向轴线，其中，所述仓体包括仓对准轮廓和凸耳；紧固件，所述紧固件可移除地定位在所述仓体中；和驱动器，所述驱动器可移动地支撑所述紧固件；和通道，所述通道的尺寸被设计成能够接纳所述紧固件仓，其中，所述通道包括侧壁，所述侧壁包括通道对准轮廓和切口，所述切口定位成在将所述仓对准轮廓抵靠所述通道对准轮廓定位并将所述紧固件仓沿插入轴线移动到所述通道中时接纳所述凸耳，其中，所述插入轴线垂直于所述纵向轴线；其中，所述凸耳被构造成能够在所述紧固件仓安装在所述通道中时在所述切口中朝远侧移位到完全就位位置。
实施例60—根据实施例59所述的缝合组件，其中，当所述紧固件仓沿所述插入轴线移动到所述通道中时，所述仓体抵靠所述通道对准轮廓受到杠杆作用，并且其中，偏置元件定位成在所述切口中将所述凸耳朝远侧偏置到所述完全就位位置。
实施例61—一种线性紧固件仓，包括：仓体，所述仓体包括组织支撑平台，其中，纵向轴线延伸穿过所述仓体；内紧固件腔，所述内紧固件腔被限定为穿过所述组织支撑平台进入所述仓体中，其中，所述内紧固件腔在所述纵向轴线的第一侧上布置成内纵向排，并且其中，所述内纵向排包括内最近侧紧固件腔；中间紧固件腔，所述中间紧固件腔被限定为穿过所述组织支撑平台进入所述仓体中，其中，所述中间紧固件腔在所述纵向轴线的所述第一侧上布置成中间纵向排，并且其中，所述中间纵向排包括中间最近侧紧固件腔；和外紧固件腔，所述外紧固件腔被限定为穿过所述组织支撑平台进入所述仓体中，其中，所述外紧固件腔在所述纵向轴线的所述第一侧上布置成外纵向排，并且其中，所述外纵向排包括外最近侧紧固件腔；驱动器，所述驱动器定位在所述内紧固件腔、所述中间紧固件腔和所述外紧固件腔中；和紧固件，所述紧固件由所述驱动器支撑，其中，每个紧固件包括冠部，所述冠部包括近侧端部和远侧端部、从所述近侧端部延伸的近侧腿以及从所述远侧端部延伸的远侧腿，其中，所述冠部限定跨所述内纵向排、所述中间纵向排和所述外纵向排的均匀长度；其中，所述内最近侧紧固件腔、所述中间最近侧紧固件腔和所述外最近侧紧固件腔纵向偏移，并且其中，所述内最近侧紧固件腔与所述外最近侧紧固件腔纵向偏移小于所述冠部的所述均匀长度的一半的纵向长度。
实施例62—根据实施例61所述的线性紧固件仓，其中，所述内纵向排中的所述内紧固件腔纵向间隔开第一距离，其中，所述中间纵向排中的所述中间紧固件腔纵向间隔开第二距离，其中，所述外纵向排中的所述外紧固件腔纵向间隔开第三距离，并且其中，所述第一距离、所述第二距离和所述第三距离是相同的距离。
实施例63—根据实施例61和62中任一项所述的线性紧固件仓，其中，所述内纵向排、所述中间纵向排和所述外纵向排包括相同数量的紧固件腔，并且其中，每排与其他排侧向偏移不同的量。
实施例64—根据实施例61所述的线性紧固件仓，其中，所述内纵向排与所述中间纵向排侧向间隔开第一侧向距离，其中，所述中间纵向排与所述外纵向排侧向间隔开第二侧向距离，并且其中，所述第一侧向距离不同于所述第二侧向距离。
实施例65—根据实施例61和64中任一项所述的线性紧固件仓，其中，所述内纵向排、所述中间纵向排和所述外纵向排彼此不同。
实施例66—根据实施例65所述的线性紧固件仓，其中，所述组织支撑平台关于所述纵向轴线是对称的。
实施例67—根据实施例61、62、63、64、65和66中任一项所述的线性紧固件仓，其中，所述内纵向排中的所述紧固件限定第一未成形高度，其中，所述中间纵向排中的所述紧固件限定第二未成形高度，其中，所述外纵向排中的所述紧固件限定第三未成形高度，并且其中，所述第一未成形高度、所述第二未成形高度和所述第三未成形高度中的至少一者是不同的。
实施例68—根据实施例61、62、63、64、65、66和67中任一项所述的线性紧固件仓，其中，所述内纵向排中的所述紧固件被构造成能够呈现第一成形高度，其中，所述中间纵向排中的所述紧固件被构造成能够呈现第二成形高度，其中，所述外纵向排中的所述紧固件被构造成能够呈现第三成形高度，并且其中，所述第一成形高度、所述第二成形高度和所述第三成形高度中的至少一者是不同的。
实施例69—一种线性紧固件仓，包括：仓体，所述仓体包括组织支撑平台，其中，纵向轴线延伸穿过所述仓体；第一阵列紧固件腔，所述第一阵列紧固件腔被限定为在所述纵向轴线的第一侧上穿过所述组织支撑平台进入所述仓体中，其中，所述第一阵列紧固件腔包括第一最近侧紧固件腔；第二阵列紧固件腔，所述第二阵列紧固件腔被限定为在所述纵向轴线的第二侧上穿过所述组织支撑平台进入所述仓体中，其中，所述第二阵列紧固件腔包括第二最近侧紧固件腔；紧固件，其中，每个紧固件包括冠部、从所述冠部延伸的近侧腿和从所述冠部延伸的远侧腿；和驱动器，所述驱动器支撑所述紧固件，其中，每个驱动器包括：内支撑柱；中间支撑柱；外支撑柱；第一桥接件，所述第一桥接件连接所述内支撑柱和所述中间支撑柱；和第二桥接件，所述第二桥接件连接所述中间支撑柱和所述外支撑柱；其中，所述第一最近侧紧固件腔从所述第二最近侧紧固件腔纵向偏移一距离。
实施例70—根据实施例69所述的线性紧固件仓，其中，所述第一阵列紧固件腔和所述第二阵列紧固件腔包括相同数量的紧固件腔。
实施例71—根据实施例70所述的线性紧固件仓，其中，所述第一阵列紧固件腔和所述第二阵列紧固件腔包括相同的图案。
实施例72—根据实施例69、70和71中任一项所述的线性紧固件仓，其中，纵向驱动器长度被限定在由同一驱动器支撑的所述最近侧近侧腿和所述最远侧远侧腿之间，并且其中，所述距离小于所述纵向驱动器长度的50％。
实施例73—根据实施例72所述的线性紧固件仓，其中，所述距离为所述纵向驱动器长度的约25％。
实施例74—根据实施例72所述的线性紧固件仓，其中，所述距离为所述纵向驱动器长度的约10％。
实施例75—一种线性紧固件仓，包括：仓体，所述仓体包括组织支撑平台，其中，纵向轴线延伸穿过所述仓体；位于所述纵向轴线的第一侧上的内纵向排紧固件腔；位于所述纵向轴线的所述第一侧上的中间纵向排紧固件腔，其中，所述中间纵向排紧固件腔限定平行于所述纵向轴线的中间轴线；位于所述纵向轴线的所述第一侧上的外纵向排紧固件腔，其中，所述内纵向排紧固件腔和所述外纵向排紧固件腔相对于所述中间轴线是不对称的；横跨所述内纵向排紧固件腔、所述中间纵向排紧固件腔和所述外纵向排紧固件腔的三重驱动器；和紧固件，所述紧固件由所述三重驱动器支撑，其中，每个紧固件包括冠部，所述冠部包括近侧端部和远侧端部、从所述近侧端部延伸的近侧腿以及从所述远侧端部延伸的远侧腿，其中，所述冠部限定跨所述内纵向排、所述中间纵向排和所述外纵向排的均匀长度。
实施例76—根据实施例75所述的线性紧固件仓，其中，所述外纵向排紧固件腔包括：外紧固件腔，所述外紧固件腔包括第一近侧端部；其中，所述内纵向排紧固件腔包括：第一内紧固件腔，所述第一内紧固件腔包括第二近侧端部，其中，所述第一近侧端部和所述第二近侧端部纵向对准；和第二内紧固件腔，所述第二内紧固件腔包括第三近侧端部，其中，所述第三近侧端部相对于所述外纵向排紧固件腔中的所有紧固件腔的所述近侧端部纵向错开。
实施例77—根据实施例75和76中任一项所述的线性紧固件仓，其中，所述内纵向排紧固件腔与所述外纵向排紧固件腔具有相同的长度。
实施例78—根据实施例75、76和77中任一项所述的线性紧固件仓，其中，所述内纵向排紧固件腔包括比所述外纵向排更多的紧固件腔。
实施例79—根据实施例75、76、77和78中任一项所述的线性紧固件仓，其中，所述外纵向排包括第三紧固件腔，所述第三紧固件腔相对于位于所述纵向轴线的所述第一侧上的所有其他紧固件腔纵向错开。
实施例80—根据实施例75、76、77、78和79中的任一项所述的线性紧固件仓，其中，所述内纵向排中的所述内紧固件腔纵向间隔开第一距离，其中，所述中间纵向排中的所述中间紧固件腔纵向间隔开第二距离，其中，所述外纵向排中的所述外紧固件腔纵向间隔开第三距离，并且其中，所述第一距离、所述第二距离和所述第三距离中的至少一者与其他者不同。
本文所述的许多外科器械系统由电动马达促动；但是本文所述的外科器械系统可以任何合适的方式促动。在各种实例中，例如，本文所述的外科器械系统可由手动操作的触发器促动。在某些实例中，本文公开的马达可包括机器人控制系统的一部分或多个部分。此外，本文公开的任何端部执行器和/或工具组件可与机器人外科器械系统一起使用。例如，名称为“SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENTARRANGEMENTS”的美国专利申请序列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。
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号；
-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号；
-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号；
-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号；-公布于2010年3月2日的名称为“SURGICAL INSTRUMENT HAVING AN ARTICULATING ENDEFFECTOR”的美国专利7,670,334号；
-公布于2010年7月13日的名称为“SURGICAL STAPLING INSTRUMENTS”的美国专利7,753,245号；
-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号；
-名称为“SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES”的美国专利申请序列11/343,803号，现为美国专利7,845,537号；
-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12/031,573号；
-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12/031,873号，现为美国专利7,980,443号；
-名称为“MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT”的美国专利申请序列12/235,782号，现为美国专利8,210,411号；
-名称为“POWERED SURGICAL CUTTING AND STAPLING APPARATUS WITH MANUALLYRETRACTABLE FIRING SYSTEM”的美国专利申请序列12/249,117号，现为美国专利8,608,045号；
-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12/647,100号，现为美国专利8,220,688号；
-提交于2012年9月29日的名称为“STAPLE CARTRIDGE”的美国专利申请序列12/893,461号，现为美国专利8,733,613号；
-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13/036,647号，现为美国专利8,561,870号；
-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；
-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13/524,049号，现为美国专利9,101,358号；
-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13/800,025号，现为美国专利9,345,481号；
-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13/800,067号，现为美国专利申请公布2014/0263552号；
-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号；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号，现为美国专利8,308,040号。
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能够在单次使用之后废弃，或者其可被设计成能够多次使用。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理解，对装置进行修整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，将该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。
以引用方式全文或部分地并入本文的任何专利、公布或其他公开材料均仅在所并入的材料不与本发明所述的现有定义、陈述或其他公开材料相冲突的范围内并入本文。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。
Claims (20)
1.一种缝合组件，包括：
紧固件仓，所述紧固件仓包括：
仓体，所述仓体包括对准表面和凸耳；
紧固件，所述紧固件可移除地定位在所述仓体中；和
驱动器，所述驱动器可移动地支撑所述紧固件；和
通道，所述通道的尺寸被设计成能够接纳所述紧固件仓，其中，所述通道包括侧壁，所述侧壁包括：
凹口，所述凹口的尺寸被设计成能够接纳所述凸耳；和
纵向止动件，其中，当所述对准表面抵靠所述纵向止动件受到杠杆作用时，所述凹口与所述仓体上的所述凸耳对准。
2.根据权利要求1所述的缝合组件，其中，所述通道包括第一侧壁和第二侧壁，其中，所述通道的尺寸被设计成在能够所述第一侧壁与所述第二侧壁之间接纳所述紧固件仓，并且其中，所述凹口和所述纵向止动件被限定在所述第一侧壁中。
3.根据权利要求2所述的缝合组件，其中，所述凹口定位在所述第一侧壁中的所述纵向止动件的远侧。
4.根据权利要求3所述的缝合组件，其中，所述纵向止动件包括弯曲的邻接表面，在插入运动期间所述仓体在所述邻接表面上受到杠杆作用。
5.根据权利要求2所述的缝合组件，其中，所述纵向止动件包括第一纵向止动件并且所述凹口包括第一凹口，其中，所述第二侧壁还包括第二纵向止动件和从所述第二纵向止动件纵向偏移的第二凹口。
6.根据权利要求5所述的缝合组件，其中，所述对准表面包括第一对准表面，并且所述凸耳包括第一凸耳，并且其中，所述仓体还包括第二对准表面和第二凸耳，其中，当所述第二对准表面邻接所述第二纵向止动件时，所述第二凹口与所述第二凸耳对准。
7.根据权利要求1所述的缝合组件，其中，所述凹口包括近侧直立表面和远侧直立表面，其中，所述凸耳的尺寸被设计成能够配合在所述近侧直立表面与所述远侧直立表面之间，并且其中，所述近侧直立表面和所述远侧直立表面是不平行的。
8.根据权利要求7所述的缝合组件，还包括弹簧，其中，所述远侧直立表面包括倾斜表面，其中，所述凸耳包括倾斜远侧端部，并且其中，所述弹簧被构造成能够在所述紧固件仓安装到所述通道中时将所述倾斜远侧端部偏置成与所述倾斜表面配合接触。
9.根据权利要求8所述的缝合组件，其中，当所述对准表面邻接所述纵向止动件并且所述紧固件仓朝向安装在所述通道中移动时，所述弹簧在所述近侧直立表面与所述凸耳的近侧端部之间被压缩。
10.根据权利要求8所述的缝合组件，其中，所述弹簧包括板簧。
11.根据权利要求8所述的缝合组件，其中，所述弹簧被定位和被结构化以便使所述紧固件仓相对于所述通道向远侧偏置到完全就位位置。
12.根据权利要求1所述的缝合组件，还包括击发元件，所述击发元件被构造成能够在击发行程期间向远侧移动穿过所述紧固件仓，其中，所述击发元件被构造成能够在所述击发行程期间使所述紧固件仓相对于所述通道向远侧偏置到完全就位位置。
13.根据权利要求12所述的缝合组件，其中，所述仓体还包括侧向延伸的销，并且其中，所述通道还包括狭槽，所述狭槽的尺寸被设计成能够在所述紧固件仓插入到所述通道中时接纳所述侧向延伸的销，并且其中，所述狭槽包括：
V形入口部分，所述V形入口部分平行于所述仓体的插入方向延伸；和
第二部分，所述第二部分平行于所述仓体的纵向轴线延伸。
14.一种缝合组件，包括：
紧固件仓，所述紧固件仓包括：
仓体，所述仓体限定纵向轴线，其中，所述仓体包括近侧仓对准特征部和远侧仓对准特征部；
紧固件，所述紧固件可移除地定位在所述仓体中；和
驱动器，所述驱动器可移动地支撑所述紧固件；
通道，所述通道的尺寸被设计成能够接纳所述紧固件仓，其中，所述通道包括侧壁，所述侧壁包括近侧通道对准特征部和远侧通道对准特征部，所述远侧通道对准特征部定位成在将所述近侧仓对准特征部定位成与所述近侧通道对准特征部邻接接合并且将所述紧固件仓沿插入轴线移动到所述通道中的第一位置时接纳所述远侧仓对准特征部，其中，所述插入轴线垂直于所述纵向轴线；和
弹簧，所述弹簧被构造成能够在所述通道内沿所述纵向轴线将所述紧固件仓从所述第一位置朝远侧偏置到完全就位位置。
15.根据权利要求14所述的缝合组件，其中，所述弹簧包括悬臂式板簧。
16.根据权利要求14所述的缝合组件，其中，所述弹簧还包括：
第一端部，所述第一端部安装到所述远侧仓对准特征部；
第二端部，所述第二端部与所述第一端部相对；和
S形曲线，所述S形曲线位于所述第一端部与所述第二端部中间。
17.根据权利要求14所述的缝合组件，其中，所述仓体还包括鼻部，所述鼻部包括：
闩锁，所述闩锁能够在第一位置和第二位置之间移动，在所述第一位置中，所述闩锁将所述鼻部固定到所述通道，在所述第二位置中，所述闩锁将所述鼻部从所述通道释放；和
用户激活的释放按钮，所述用户激活的释放按钮被构造成能够将所述闩锁从所述第一位置移动到所述第二位置。
18.根据权利要求17所述的缝合组件，其中，所述闩锁包括臂，并且其中，所述通道包括远侧凸部，所述远侧凸部被构造成能够在所述闩锁处于所述第一位置时接纳所述臂。
19.一种缝合组件，包括：
紧固件仓，所述紧固件仓包括：
仓体，所述仓体限定纵向轴线，其中，所述仓体包括仓对准轮廓和凸耳；
紧固件，所述紧固件可移除地定位在所述仓体中；和
驱动器，所述驱动器可移动地支撑所述紧固件；和
通道，所述通道的尺寸被设计成能够接纳所述紧固件仓，其中，所述通道包括侧壁，所述侧壁包括通道对准轮廓和切口，所述切口定位成在将所述仓对准轮廓抵靠所述通道对准轮廓定位并将所述紧固件仓沿插入轴线移动到所述通道中时接纳所述凸耳，其中，所述插入轴线垂直于所述纵向轴线；
其中，所述凸耳被构造成能够在所述紧固件仓安装在所述通道中时在所述切口中朝远侧移位到完全就位位置。
20.根据权利要求19所述的缝合组件，其中，当所述紧固件仓沿所述插入轴线移动到所述通道中时，所述仓体抵靠所述通道对准轮廓受到杠杆作用，并且其中，偏置元件定位成在所述切口中将所述凸耳朝远侧偏置到所述完全就位位置。
Applications Claiming Priority (3)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US17/211,192 | 2021-03-24 | ||
| US17/211,192 US11903582B2 (en) | 2021-03-24 | 2021-03-24 | Leveraging surfaces for cartridge installation |
| PCT/IB2022/052537 WO2022200983A1 (en) | 2021-03-24 | 2022-03-21 | Leveraging surfaces for cartridge installation |
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| CN117355266A true CN117355266A (zh) | 2024-01-05 |
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| US (1) | US11903582B2 (zh) |
| EP (1) | EP4135596A1 (zh) |
| JP (1) | JP2024510795A (zh) |
| CN (1) | CN117355266A (zh) |
| BR (1) | BR112023019380A2 (zh) |
| WO (1) | WO2022200983A1 (zh) |
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-
2021
- 2021-03-24 US US17/211,192 patent/US11903582B2/en active Active
-
2022
- 2022-03-21 WO PCT/IB2022/052537 patent/WO2022200983A1/en active Application Filing
- 2022-03-21 EP EP22713056.4A patent/EP4135596A1/en active Pending
- 2022-03-21 JP JP2023558516A patent/JP2024510795A/ja active Pending
- 2022-03-21 CN CN202280037935.XA patent/CN117355266A/zh active Pending
- 2022-03-21 BR BR112023019380A patent/BR112023019380A2/pt unknown
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| US11903582B2 (en) | 2024-02-20 |
| JP2024510795A (ja) | 2024-03-11 |
| EP4135596A1 (en) | 2023-02-22 |
| WO2022200983A1 (en) | 2022-09-29 |
| US20220304690A1 (en) | 2022-09-29 |
| BR112023019380A2 (pt) | 2023-12-26 |
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