CN117580517A - 用于外科缝合设备的支撑件附接 - Google Patents

用于外科缝合设备的支撑件附接 Download PDF

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CN117580517A
CN117580517A CN202280045678.4A CN202280045678A CN117580517A CN 117580517 A CN117580517 A CN 117580517A CN 202280045678 A CN202280045678 A CN 202280045678A CN 117580517 A CN117580517 A CN 117580517A
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cartridge
assembly
buttress
anvil
surgical stapling
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J·C·巴里尔
R·费尔南德斯
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Covidien LP
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Covidien LP
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/0682—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil
    • A61B17/0686—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil having a forming anvil staying below the tissue during stapling
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07292—Reinforcements for staple line, e.g. pledgets
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07257—Stapler heads characterised by its anvil
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07257—Stapler heads characterised by its anvil
    • A61B2017/07264—Stapler heads characterised by its anvil characterised by its staple forming cavities, e.g. geometry or material
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07271—Stapler heads characterised by its cartridge

Abstract

一种外科缝合设备，该外科缝合设备包括装载单元和外科支撑件组件。该装载单元包括砧座组件和钉仓组件。该钉仓组件包括具有面向组织的表面的钉仓和从该面向组织的表面向外延伸的钩组件，该面向组织的表面包括缝钉凹坑和穿过该面向组织的表面限定的中心纵向狭槽。该外科支撑件组件包括砧座支撑件和仓支撑件。该砧座支撑件和该仓支撑件中的每一者包括主体、近侧接片和远侧接片。该砧座支撑件和该仓支撑件在近侧接片的接合部处互连，并且该外科支撑件组件在该接合部处折叠，使得近侧接片基本上彼此重叠。近侧接片与该钩组件接合，以将该砧座支撑件和该仓支撑件的近侧接片以可释放的方式固定到该钉仓组件。

Description

用于外科缝合设备的支撑件附接
技术领域
本申请整体涉及外科缝合设备，并且更具体地涉及用于将外科支撑件以可释放的方式固定到外科缝合设备的外科支撑件和支撑件附接组件。
背景技术
外科医生采用外科缝合设备来顺序地或同时地将一排或多排紧固件(例如，缝钉或两件式紧固件)施加到身体组织，以便将身体组织的区段连接在一起。此类设备通常包括一对钳口或指状结构，待连接的身体组织放置在该一对钳口或指状结构之间。当外科缝合设备被致动或“击发”时，纵向移动的击发杆接触钳口中的一个钳口中的缝钉驱动构件。缝钉驱动构件推动外科缝钉穿过身体组织并进入形成缝钉的相对钳口中的砧座中。如果要移除或分离身体组织，可以在设备的钳口中设置刀片以切割缝钉线之间的身体组织。
外科支撑物，例如网状物或支撑材料，可以与外科缝合设备结合使用，以克服、修复和/或增强患者内的组织缺陷。临床医生可以在外科手术期间在手术室中手动地将支撑材料附接到外科缝合设备，或利用包括例如通过昂贵的自动附接过程预安装在其上的支撑材料的外科缝合设备。支撑件材料加强缝钉或缝合线以及覆盖身体组织的接合处以减少愈合之前的泄漏。
发明内容
本公开涉及支撑件材料到外科缝合设备上的附接。本公开的外科支撑件和支撑件附接组件被设计成使得手术室中的支撑件材料附接成为简单、直接且成本有效的过程。
在一个方面，本公开提供了一种外科缝合设备，该外科缝合设备包括装载单元和外科支撑件组件。该装载单元包括砧座组件和钉仓组件。该钉仓组件包括具有面向组织的表面的钉仓和从该面向组织的表面向外延伸的钩组件，该面向组织的表面包括缝钉凹坑和穿过该面向组织的表面限定的中心纵向狭槽。该外科支撑件组件包括砧座支撑件和仓支撑件。该砧座支撑件和该仓支撑件中的每一者包括主体、近侧接片和远侧接片。该砧座支撑件和该仓支撑件在这些近侧接片的接合部处互连，并且该外科支撑件组件在该接合部处折叠，使得近侧接片基本上彼此重叠。该近侧接片与该钉仓的该钩组件接合，以将该砧座支撑件和该仓支撑件的该近侧接片以可释放的方式固定到该钉仓组件。
该钩组件可设置为靠近该钉仓的该面向组织的表面中限定的这些缝钉凹坑。该砧座支撑件和该仓支撑件的该近侧接片可限定穿过该近侧接片的近侧开口，并且该钩组件可延伸穿过该近侧开口。该近侧开口可延伸跨过限定在该钉仓中的该中心纵向狭槽。
该钩组件可包括钩，该钩具有设置在该钉仓中限定的腔内的钩体；和指状物，该指状物从该钩体向近侧延伸并延伸出该腔。该钉仓的该腔可设置为邻近该中心纵向狭槽。该钩组件可包括联接器和设置在该钉仓的该腔内的弹簧，该弹簧可使该联接器偏置成与该钩体接触。该砧座组件可包括穿过该砧座组件限定的窗口，该窗口与该钩组件的该指状物对准，并且其中当该装载单元处于闭合位置时，该指状物可延伸到该砧座组件的该窗口中。
该砧座支撑件和该仓支撑件的远侧接片可限定穿过该远侧接片的远侧开口。该砧座组件的砧座尖端可延伸穿过该砧座支撑件的该远侧接片，并且该钉仓组件的仓尖端可延伸穿过该仓支撑件的该远侧接片，以将该砧座支撑件和该仓支撑件的该远侧接片以可释放的方式固定到该砧座组件和该钉仓组件。该远侧接片可包括限定在该远侧接片中的穿孔。该穿孔可与钉仓的中心纵向狭槽对准。
在另一个方面，本公开提供了一种外科缝合设备，该外科缝合设备包括装载单元和仓支撑件。该装载单元包括砧座组件和钉仓组件。该钉仓组件包括钉仓，该钉仓具有仓体和从该仓体向远侧延伸的仓尖端，该仓体包括面向组织的表面，该面向组织的表面具有缝钉凹坑和穿过该面向组织的表面限定的中心纵向狭槽；和钩组件，该钩组件从该面向组织的表面向外延伸。该仓支撑件包括主体、从该主体向近侧延伸的近侧接片、从该主体向远侧延伸的可扩张区域、以及从该可扩张区域向远侧延伸的远侧接片。该近侧接片与该钉仓的该钩组件接合以用于将该仓支撑件的该近侧接片以可释放的方式固定到该钉仓组件，并且该远侧接片与该仓尖端接合以用于将该仓支撑件的该远侧接片以可释放的方式固定到该钉仓组件。
该仓支撑件的该可扩张区域可能够在未扩张状态和扩张状态之间转换，以在该仓支撑件装载到该钉仓组件上期间使该仓支撑件伸长。该可扩张区域可由弹性材料形成。与该可扩张区域的该弹性材料相比，该主体以及该仓支撑件的近侧接片和远侧接片由相对刚性的材料形成。该可扩张区域可包括将该主体和该远侧接片互连的一对带。
该仓支撑件的该近侧接片可限定穿过该近侧接片的近侧开口，并且该钩组件可延伸穿过该近侧开口。该近侧接片的该近侧开口可延伸跨过限定在该钉仓中的该中心纵向狭槽。该仓支撑件的该远侧接片可限定穿过该远侧接片的远侧开口，并且该仓尖端可延伸穿过该远侧开口。
该钩组件可包括设置在该钉仓的该中心纵向狭槽的相对侧上的钩。这些钩中的每个钩可包括固定到该钉仓的该面向组织的表面的臂和从该臂向近侧延伸的指状物。
附图和下文的描述中阐述了本公开的一个或多个方面的详细内容。根据说明书和附图以及权利要求书，本公开中描述的其他方面以及各方面的特征、目的和优点将显而易见。
附图说明
以下参照附图描述本公开的各个方面，这些附图被并入本说明书并构成本说明书的一部分，其中：
图1是根据本公开的一个方面的外科缝合设备的透视图；
图2是图1中所指示的细节区域2的特写视图，该特写视图示出了外科缝合设备的工具组件；
图3是图2的工具组件的各零件分离的透视图，其示出了砧座组件、钉仓组件和外科支撑件组件；
图4是图3的钉仓组件的透视图，其示出了各零件分离的钩组件；
图5是图3中所指示的细节区域5的特写视图，其示出了钉仓组件的近侧端部；
图6是图3的外科支撑件组件的顶视图；
图7是图2的工具组件的沿着图2中的剖面线7-7截取的横剖面视图，其示出为工具组件的第一钳口构件和第二钳口构件处于打开位置；
图8是图7的工具组件的横剖面视图，其示出为第一钳口构件和第二钳口构件处于闭合位置；
图9是图2的工具组件的沿着图2的剖面线9-9截取的部分横剖面视图；
图10是图9中所指示的细节区域10的特写视图；
图11是图10的细节区域的特写视图，其示出为外科缝合设备的击发行程期间；
图12是根据本公开的另一个方面的钉仓组件和仓支撑件的透视图；
图13是图12中所指示的细节区域13的特写视图，其示出了钉仓组件的钩组件；
图14是图12的仓支撑件的顶视图；
图15是图12的钉仓组件和仓支撑件的透视图，其示出为在仓支撑件处于伸展构型的情况下将仓支撑件组装到钉仓组件上期间；
图16是图15的钉仓组件和仓支撑件的透视图，其示出为在仓支撑件处于未伸展构型的情况下将仓支撑件装载到钉仓组件上期间并且
图17是根据本公开的另一个方面的砧座组件和装载到砧座组件上的砧座支撑件的透视图。
具体实施方式
现在将参考附图详细描述本公开的各方面，其中相似的附图标记表示类似或相同的元件。在整个说明书中，术语“近侧”是指距用户较近的结构的部分或其部件，并且术语“远侧”是指距用户较远的结构的部分或其部件。
现在参考图1，示出了根据本公开的各方面的用于缝合组织的示例性外科缝合设备或外科缝合器1。将在公开本公开的各方面所必需的程度上进一步描述外科缝合设备1。对于示例性外科缝合设备的结构和功能的详细描述，可以参考美国专利第6,241,139号、第6,330,965号和第7,819,896号，该等专利中的每个专利的全部内容以引用方式并入本文。应当了解，本公开的原理同样适用于具有其他构造的外科缝合设备，例如美国专利第5,964,394号、第7,128,253号和第7,334,717号中所描述的类型，该等美国专利中的每个专利的全部内容通过引用并入本文。因此，应当了解，多种外科缝合设备可以与本公开的各方面一起使用。例如，可通过美敦力公司(Medtronic)(康涅狄格州诺斯黑文(North Haven,CT))获得的腹腔镜或开口缝合器例如GIATM、Endo GIATM、TATM和Endo TATM缝合器和/或使用例如Tri-StapleTM技术的线性和径向重新装载可以与本公开的各方面一起使用。
外科缝合设备1通常包括手柄组件10、从手柄组件10向远侧延伸的细长管状主体20以及从细长管状主体20向远侧延伸的装载单元30。装载单元30包括外壳部分32和工具或钳口组件34，该工具或钳口组件包括第一钳口构件34a和第二钳口构件34b。第一钳口构件34a和/或第二钳口构件34b可相对于外壳部分32枢转，使得工具组件34可在第一钳口构件34a和第二钳口构件34b相对于彼此间隔开的打开位置与第一钳口构件34a和第二钳口构件34b基本上彼此邻近的闭合位置之间移动。
手柄组件10包括固定手柄构件12a、可移动手柄构件12b和筒形部分14。可移动手柄构件12b的致动将缝钉的线施加到在工具组件34的第一钳口构件34a与第二钳口构件34b之间捕获的组织。铰接杆16安装在筒形部分14的前端上，以促进工具组件34的铰接。可旋转构件18也安装在筒形部分14的前端上，邻近铰接杆16。可旋转构件18相对于筒形部分14的旋转使细长管状主体部分20和装载单元30相对于手柄组件10旋转，以便相对于待缝合的组织对工具组件34进行适当地定向。旋钮19可移动地沿筒形部分14定位。旋钮19向远侧推进以使工具组件34的第一钳口构件34a和第二钳口构件34b相对于彼此接近或闭合，并且向近侧缩回以使工具组件34的第一钳口构件34a和第二钳口构件34b相对于彼此不接近或打开。
装载单元30是以可释放的方式固定到细长管状主体20并且因此可用新的装载单元30更换的一次性装载单元(“DLU”)。装载单元30可以是使用一次并且然后更换以有助于对患者多次使用外科缝合设备1的单次使用装载单元(“SULU”)。例如，在外科手术期间，外科缝合设备1可以用于缝合和切割组织，并且在外科缝合设备1的每次缝合和切割操作之后更换整个SULU。装载单元30可以是可重复使用预定次数的多次使用装载单元(“MULU”)。例如，在外科手术期间，外科缝合设备1可用于缝合和切割组织，并且在外科缝合设备1的每次缝合和切割操作之后更换MULU的重新装载组件(例如，如图2所示的钉仓52)，在需要更换整个MULU之前更换预定次数。替代地，装载单元30可以永久地附连到细长管状主体20。
如图2和图3所示，工具组件34的第一钳口构件34a包括砧座组件40，并且工具组件34的第二钳口构件34b包括钉仓组件50。外科支撑件70以可释放的方式固定到砧座组件40和钉仓组件50。
砧座组件40包括砧座板42和固定在砧座板42之上的盖板44。砧座板42具有形成在其中的中心纵向狭槽41和限定在其向内或面向组织的表面46中的缝钉成形凹坑或腔43。砧座尖端48在缝钉成形凹坑43的远侧延伸，并且窗口49在缝钉成形凹坑43的近侧延伸穿过砧座板42和盖44(例如，穿过砧座板42的面向组织的表面46和盖44的外表面44a)。
钉仓组件50包括仓载体51和选择性地收纳并支撑在仓载体51内的钉仓52。钉仓52可通过例如卡扣配合连接、棘爪、闩锁以及本领域技术人员所知范围内的其他类型的连接器可移除地和/或可更换地附接到仓载体51。钉仓52包括仓体54，该仓体具有向内或面向组织的表面56，该向内或面向组织的表面限定形成于其中的缝钉凹坑或保持狭槽55。中心纵向狭槽57形成在仓体54中并且沿着该仓体的基本长度延伸，以促进驱动组件24的刀片22(图11)从中穿过。仓尖端58在缝钉凹坑55的远侧延伸，并且钩组件60在缝钉凹坑55的近侧并横向邻近中心纵向狭槽57从仓体54的面向组织的表面56向外延伸。钩组件60与砧座组件40中限定的窗口49对准。
如图4和图5所示，钩组件60包括钩62、联接器64、弹簧66和保持销68。钩62包括限定穿过其中的孔63的钩体62a和从钩体62a向近侧延伸的指状物62b。钩体62a的构造和尺寸适于定位在钉仓52中限定的腔53内，该腔邻近中心纵向狭槽57并向该中心纵向狭槽敞开，其中指状物62b延伸出腔53。定位销68的构造和尺寸适于穿过钉仓52的侧表面和钩体62a的孔63定位，以将钩62枢转地固定到钉仓52。联接器64和弹簧68可定位在钉仓52的腔53内，以用于将钩62弹簧装载到钉仓52内的位置中。联接器64包括头部64a、从头部64a向近侧延伸的轴64b以及设置在头部64a和轴64b之间的凸缘64c。弹簧66的第一端部66a被构造成定位在联接器64的轴64b周围，邻近凸缘64c并在该凸缘的近侧，并且弹簧66的第二端部66b被构造成定位在向远侧延伸到钉仓52的腔53中的柱53a(图7)周围。弹簧66使联接器64的头部64a偏置成与钩体62a接触，使得钩62的指状物62b向近侧延伸出腔53，并且设置在钉仓52的面向组织的表面56上方，在缝钉凹坑55的近侧，如图5所示。
现在参考图6，外科支撑件组件70包括砧座支撑件80和仓支撑件90，该座支撑件和该仓支撑件形成或连接在一起成为单个连续结构。如图3所示，外科支撑件组件70绕其中心部分(例如，砧座支撑件80和仓支撑件90相遇的地方)弯折或折叠，使得当装载在砧座组件40和钉仓组件50上时，砧座支撑件80和仓支撑件90基本上彼此重叠。虽然砧座支撑件80和仓支撑件90基本上相同(例如，彼此成镜像)，但是应理解，砧座支撑件80和仓支撑件90可不同，这取决于砧座组件40和钉仓组件50的构造。
继续参考图6，结合图3，砧座支撑件80包括主体82，该主体的构造和尺寸适于定位在砧座组件40的面向组织的表面46上并覆盖缝钉成形凹坑43，并且仓支撑件90包括主体92，该主体的构造和尺寸适于定位在钉仓组件50的面向组织的表面56上并覆盖缝钉凹坑55。主体82、92沿其长度具有基本上一致或恒定的宽度。砧座支撑件80和仓支撑件90各自包括从主体82、92向近侧延伸的近侧接片84、94。近侧接片84、94在宽度上小于主体82、92，并且在一些方面中，从主体82、92的近侧端向近侧逐渐变细。
近侧接片84、94各自限定穿过其中的近侧开口85、95。近侧开口85、95的构造和尺寸适于在钉仓52中限定的腔53(图5)上延伸，该腔容置钩组件60以及砧座组件40和钉仓组件50的中心纵向狭槽41、57(图3)。近侧开口85、95可向远侧延伸到砧座支撑件80和仓支撑件90的主体82、92中。例如，如图6所示，近侧开口85、95具有大致泪珠形状，包括限定在近侧接片84、94中的第一或近侧部分85a、95a和限定在主体82、92中的第二或远侧部分85b、95b。第一部分85a、95a具有比第二部分85b、95b更大的尺寸，使得第一部分85a、95a在腔53和中心纵向狭槽41、57上延伸，如上所述，并且第二部分85b、95b朝向中心纵向狭槽41、57逐渐变细并且与这些中心纵向狭槽对准。应理解，近侧开口85、95可具有其他构造，只要近侧开口85、95可接合钩组件60的指状物62b(图5)并且延伸跨过中心纵向狭槽41、57。
砧座支撑件80和仓支撑件90各自包括从主体82、92向远侧延伸的远侧接片86、96。远侧接片86、96具有弯曲端86a、96a，并且限定穿过其中的远侧开口87、97。远侧开口87、97的构造和尺寸适于环绕砧座尖端48和仓尖端58(图3)。如图6所示，远侧开口87、97具有与砧座尖端48和仓尖端58的形状互补的大致半圆形形状。应理解，远侧开口87、97可具有其他构造，只要远侧开口87、97被构造成在其中收纳和保持砧座尖端48和仓尖端58(例如，通过摩擦接合)。远侧接片86、96还包括限定在其中的穿孔81、91，这些穿孔与砧座组件40和钉仓组件50的中心纵向狭槽41、57(图3)对准。穿孔81、91可向近侧延伸到砧座支撑件80和仓支撑件90的主体82、92中，使得它们与中心纵向狭槽41、57部分重叠。
外科支撑件组件70由生物相容性材料制成，这些生物相容性材料是生物可吸收的或不可吸收的天然或合成材料。应理解，可使用天然的、合成的、生物可吸收的和/或非生物可吸收的材料的任何组合来形成外科支撑件组件70。砧座支撑件80和仓支撑件90或其部分可由相同材料或不同材料形成。在各个方面中，外科支撑件组件70是由切割成形的单片材料形成的。
砧座支撑件80和仓支撑件90可以是多孔的、无孔的或其组合。合适的多孔结构包括例如纤维结构(例如，编织结构、织造结构和非织造结构)和/或泡沫(例如，开孔或闭孔泡沫)。合适的无孔结构包括例如薄膜。本文所述的砧座支撑件80和仓支撑件90可以是单个多孔或无孔层，或者包括多个层，该多个层包含多孔层和无孔层的任何组合。例如，砧座支撑件80和/或仓支撑件90可包括以交替方式堆叠的多个多孔层和无孔层。在另一个示例中，砧座支撑件80和/或仓支撑件90可以外层是多孔的并且内层是无孔的或反之亦然的“夹心样”方式形成。砧座支撑件80和仓支撑件90可具有相同或不同的层结构。
外科支撑件中的多孔层可以增强外科支撑件吸收流体、减少出血和/或密封伤口的能力。而且，多孔层可以允许组织向内生长以将外科支撑件固定就位。外科支撑件中的无孔层可以增强外科支撑件在制造、运输、处理和/或缝合过程期间抵抗撕裂和穿孔的能力。而且，无孔层可以阻止或防止组织从周围组织向内生长，从而起到粘合屏障的作用并防止形成不需要的瘢痕组织。
在将外科支撑件组件70装载到装载单元30上的方法中，外科支撑件组件70在砧座支撑件80和仓支撑件90之间的接合部处折叠或弯折，如图3所示，使得近侧开口85、95彼此对准。当第一钳口构件34a和第二钳口构件34b处于打开位置时，如图7所示，外科支撑件组件70在砧座组件40和钉仓组件50之间滑动，直到近侧接片84、94邻近钩组件60的指状物62b设置。近侧接片84、94在指状物62b上滑动，使得指状物62b穿过近侧开口85、95，以将砧座支撑件80和仓支撑件90的近侧接片84、94保持在其上。然后，砧座支撑件80和仓支撑件90的主体82、92邻近砧座组件40和钉仓组件50的相应面向组织的表面46、56定位，并且砧座支撑件80和仓支撑件90的远侧接片86、96(图2)经由远侧开口87、97与砧座尖端48和仓尖端58接合，以将砧座支撑件80和仓支撑件90的远侧接片86、96保持在其上。可替代地，远侧接片86、96可首先固定到砧座尖端48和仓尖端58，然后近侧接片84、94可固定到钩组件60的指状物62b。当第一钳口构件34a和第二钳口构件34b移动到闭合位置时，如图8所示，钩组件60的指状物62b延伸到砧座组件40的窗口49中并且不干涉工具组件34的操作。
外科支撑件组件70的单件构造通过减少将砧座支撑件80和仓支撑件90附接到砧座组件40和钉仓组件50所需的组装步骤简化了装载到装载单元30上的装载过程，并且仅需要单个固定装置(例如，钩组件60)来同时将砧座支撑件80和仓支撑件90的近侧接片84、94固定到装载单元30。外科支撑件组件70可直接应用于装载单元30，而无需专用的施加器或装载工具，从而进一步简化装载过程并节省成本和时间。
如图9和图10所示，当外科支撑件组件70装载在工具组件34上时，仓支撑件90的近侧开口95接合钩组件60的指状物62b并且延伸跨过钉仓组件50的中心纵向狭槽57，并且远侧开口97接合仓尖端58，使得仓支撑件90的主体92延伸跨过钉仓52的面向组织的表面56。此外，仓支撑件90中的穿孔91与中心纵向狭槽57对准，并且部分设置在该中心纵向狭槽上。虽然在图9和图10中仅示出了仓支撑件90和钉仓组件50，但是应理解，砧座支撑件80和砧座组件40之间的关系与仓支撑件90和钉仓组件50之间的关系基本上相同(例如，砧座支撑件80的近侧开口85接合钩组件60的指状物62b，远侧开口97接合砧座尖端48，并且穿孔81与中心纵向狭槽41对准)。
具有装载有外科支撑件组件70的装载单元30的外科缝合设备1(图1)准备好使用。在操作中，外科缝合设备1根据本领域的技术人员已知的方法进行使用。一旦砧座组件40和钉仓组件50被夹紧到组织上，就击发外科缝合设备1，从而将外科支撑件组件70缝合到组织。如图11所示，结合图3，在击发期间，驱动组件24的刀片22向远侧行进穿过砧座组件40和钉仓组件50的中心纵向狭槽41、57，并且基本上同时切割和分割组织以及设置在所形成的缝钉排之间的外科支撑件组件70。具体地，刀片22行进穿过近侧接片84、94和限定在其中的近侧开口85、95，从而从钩组件60的指状物62b释放砧座支撑件80和仓支撑件90的近侧接片84、94。当击发完成并且砧座组件40和钉仓组件50松开时，现在被缝合到组织的砧座支撑件80和仓支撑件90拉动远离砧座组件40和钉仓组件50，并且可将工具组件34从外科部位移除。具体地，当外科支撑件组件70拉动远离砧座组件40和钉仓组件50时，通过沿着穿孔81、91撕裂远侧接片86、96，砧座支撑件80和仓支撑件90的远侧接片86、96从砧座尖端48和仓尖端58脱离。然后，可将用过的钉仓52从工具组件34移除并且用新的钉仓52更换。可如上文所述按照需要或期望将新的外科支撑件组件70安装到装载单元40上。
现在转到图12，示出了根据本公开的另一个方面的适用于外科缝合设备1的装载单元30(图1)的钉仓组件150和仓支撑件190。钉仓组件150基本上类似于图3的钉仓组件50。钉仓组件150包括仓载体151和选择性地收纳并支撑在仓载体151内的钉仓152。钉仓152包括仓体154，该仓体具有向内或面向组织的表面156，该向内或面向组织的表面限定形成于其中的缝钉凹坑或保持狭槽155。中心纵向狭槽157形成在仓体154中并且沿着该仓体的基本长度延伸，以促进刀片(未示出)从中穿过。仓尖端158在缝钉凹坑155的远侧从仓体154延伸，并且钩组件160在缝钉凹坑155的近侧从仓体154的面向组织的表面156向外延伸。
如图13所示，钩组件160包括一对钩162，其中每个钩162设置在钉仓152的中心纵向狭槽157的相对侧上。每个钩162包括臂164，该臂具有锚固或固定到钉仓152的面向组织的表面156的第一端164a和包括从其延伸的指状物166的第二端164b。臂164远离面向组织的表面156向上延伸，并且指状物166从臂164向近侧延伸，使得指状物166相对于钉仓152的面向组织的表面156成间隔开的关系设置。应理解，指状物166可具有其他构造(例如，相对于臂164成角度、弯曲或弯折)，只要指状物166面向近侧以将仓支撑件190的近侧接片194(图12)捕获到其上，如下面进一步详细描述。
如图14所示，仓支撑件190包括主体192，该主体的构造和尺寸适于定位在钉仓组件150的面向组织的表面156(图13)上并覆盖缝钉凹坑155。近侧接片194从主体192向近侧延伸。近侧接片194限定穿过其中的近侧开口195，并且具有弯曲的近侧端194a。近侧开口195的构造和尺寸适于接合钉仓152的钩组件160(图13)。仓支撑件190包括从主体192向远侧延伸的可扩张区域198和从可扩张区域198向远侧延伸的远侧接片196。可扩张区域198被构造成在向其施加力时在偏置或未扩张状态(图14)与扩张状态(图15)之间转换，以暂时将仓支撑件190从初始或未伸展构型(图14)轴向伸长到伸展构型(图15)。虽然可扩张区域198被示出为一对弹性带198a、198b，这些弹性带将主体192和远侧接片196互连并且具有限定在其间的开口199，但是应理解，可扩张区域198的其他构造是可预见的(例如，可扩张区域198可以是实心材料片)。远侧接片196限定穿过其中的远侧开口197，并且具有弯曲的远侧端196a。远侧开口197的构造和尺寸适于接合钉仓组件150的仓尖端158(图12)。远侧接片196还包括限定在其中的穿孔191，这些穿孔与钉仓组件150的中心纵向狭槽157(图12)对准。
仓支撑件190由生物相容性材料制成，这些生物相容性材料是生物可吸收的或不可吸收的天然或合成材料，如上文关于图6的外科支撑件组件70所述。与形成可扩张区域198的材料相比，仓支撑件190的主体192、近侧接片194和远侧接片196可由相同材料或由相对刚性的不同材料形成。因此，虽然仓支撑件190的主体192、近侧接片194和远侧接片196可以是柔性的并且具有少许弹性(例如，当由纤维和/或泡沫形成时)，但是仓支撑件190的伸展主要发生在可扩张区域198中。可扩张区域198由弹性材料形成，该弹性材料在施加力时伸展，并且在没有力的情况下恢复到其原始形状。
在将仓支撑件190装载到钉仓组件150上的方法中，仓支撑件190的近侧接片194在钩组件160的钩162上滑动，使得指状物166穿过近侧开口195以将仓支撑件190的近侧接片194保持在其上，如图15所示。然后，沿箭头“A”的方向向远侧拉动仓支撑件190的远侧接片196，使得仓支撑件190的主体192在钉仓组件150的面向组织的表面156上延伸，并且可扩张区域198转换到扩张状态，使得远侧接片196可环绕仓尖端158。当远侧接片196与仓尖端158接合时，如图16所示，可扩张区域198恢复到其未扩张状态，并且装载有仓支撑件190的钉仓组件150准备好使用。
另外地或可替代地，如图17所示，砧座组件140可包括钩组件160，以用于将砧座支撑件180的近侧接片184以可释放的方式固定到砧座组件140。砧座支撑件180与仓支撑件190基本上相同，并且包括构造和尺寸适于定位在砧座组件140的面向组织的表面146上的主体182、从主体182向近侧延伸的近侧接片184、从主体182向远侧延伸的可扩张区域188以及从可扩张区域188向远侧延伸的远侧接片186。在钉仓组件150和砧座组件140都包括钩组件160的各个方面中，钩组件160相对于彼此以横向或纵向间隔开的关系定位，以便不干涉第一钳口构件34a和第二钳口构件34b的打开和闭合(图1)。
砧座支撑件180和仓支撑件190的可扩张区域188、198通过在砧座支撑件180和仓支撑件190在组装在钩组件160和/或砧座尖端148或仓尖端158上期间被伸长之后使砧座支撑件180和仓支撑件190恢复回到它们的原始形状(例如，提供张力或绷紧度)来最小化装载过程期间的支撑件变形的发生。砧座支撑件180和仓支撑件190可直接应用于装载单元30，而无需专用的施加器或装载工具，从而简化装载过程并节省成本和时间。
虽然在上文中被展示为用在手持式手动致动的外科装置上，但是经考虑，并且在本公开的范围内，装载单元30被构造成与各种机电外科器械和/或电外科器械一起使用。例如，装载单元30可被构造成可拆卸地联接并且可由手持式机电外科装置控制，诸如在美国专利申请公开第2016/0310134号(其全部内容通过引用并入本文)中示出和描述的机器人外科系统。作为另一示例，装载单元30可被构造成可拆卸地联接并且可由机器人外科系统控制，诸如在美国专利申请公开第2012/0116416号(其全部内容通过引用并入本文)中示出和描述的机器人外科系统。
虽然已在附图中示出本公开的各方面，但是并不意图将本公开限制于此，因为希望本公开与本领域所允许的范围一样广泛且应以同样的方式阅读本说明书。因此，应当理解，本公开不限于所描述的精确方面并且本领域的技术人员可以在不脱离本公开的范围或精神的情况下实现各种其他变化和修改。另外，在不脱离本公开的范围的情况下，结合本公开的某些方面示出和描述的元件和特征可以与某些其他方面的元件和特征组合，并且这些修改和变化也包括在本公开的范围内。因此，上文的描述不应解释为限制性的，而仅仅作为本公开的各方面的例证。因此，本公开的范围应当由所附权利要求和其合法等同物确定，而不是由给出的示例确定。

Claims (20)

1.一种外科缝合设备，所述外科缝合设备包括：
装载单元，所述装载单元包括砧座组件和钉仓组件，所述钉仓组件包括：
钉仓，所述钉仓具有面向组织的表面，所述面向组织的表面包括缝钉凹坑和穿过所述面向组织的表面限定的中心纵向狭槽；和
钩组件，所述钩组件从所述面向组织的表面向外延伸；和
外科支撑件组件，所述外科支撑件组件包括砧座支撑件和仓支撑件，所述砧座支撑件和所述仓支撑件中的每一者包括主体、近侧接片和远侧接片，所述砧座支撑件和所述仓支撑件在所述近侧接片的接合部处互连，所述外科支撑件组件在所述接合部处折叠，使得所述近侧接片基本上彼此重叠，所述近侧接片与所述钉仓的所述钩组件接合，以将所述砧座支撑件和所述仓支撑件的所述近侧接片以可释放的方式固定到所述钉仓组件。
2.根据权利要求1所述的外科缝合设备，其中所述钩组件设置为靠近所述钉仓的所述面向组织的表面中限定的所述缝钉凹坑。
3.根据权利要求1所述的外科缝合设备，其中所述砧座支撑件和所述仓支撑件的所述近侧接片限定穿过所述近侧接片的近侧开口，并且所述钩组件延伸穿过所述近侧开口。
4.根据权利要求3所述的外科缝合设备，其中所述近侧开口延伸跨过限定在所述钉仓中的所述中心纵向狭槽。
5.根据权利要求1所述的外科缝合设备，其中所述钩组件包括：
钩，所述钩具有设置在所述钉仓中限定的腔内的钩体；和
指状物，所述指状物从所述钩体向近侧延伸并延伸出所述腔。
6.根据权利要求5所述的外科缝合设备，其中所述钉仓的所述腔设置为邻近所述中心纵向狭槽。
7.根据权利要求5所述的外科缝合设备，其中所述钩组件包括联接器和设置在所述钉仓的所述腔内的弹簧，所述弹簧使所述联接器偏置成与所述钩体接触。
8.根据权利要求5所述的外科缝合设备，其中所述砧座组件包括穿过所述砧座组件限定的窗口，所述窗口与所述钩组件的所述指状物对准，并且其中，当所述装载单元处于闭合位置时，所述指状物延伸到所述砧座组件的所述窗口中。
9.根据权利要求1所述的外科缝合设备，其中所述砧座支撑件和所述仓支撑件的所述远侧接片限定穿过所述远侧接片的远侧开口，所述砧座组件的砧座尖端延伸穿过所述砧座支撑件的所述远侧接片，并且所述钉仓组件的仓尖端延伸穿过所述仓支撑件的所述远侧接片，以将所述砧座支撑件和所述仓支撑件的所述远侧接片以可释放的方式固定到所述砧座组件和所述钉仓组件。
10.根据权利要求9所述的外科缝合设备，其中所述远侧接片包括限定在所述远侧接片中的穿孔，所述穿孔与所述钉仓的所述中心纵向狭槽对准。
11.一种外科缝合设备，所述外科缝合设备包括：
装载单元，所述装载单元包括砧座组件和钉仓组件，所述钉仓组件包括：
钉仓，所述钉仓具有仓体和从所述仓体向远侧延伸的仓尖端，所述仓体包括面向组织的表面，所述面向组织的表面具有缝钉凹坑和穿过所述面向组织的表面限定的中心纵向狭槽；和
钩组件，所述钩组件从所述面向组织的表面向外延伸；和
仓支撑件，所述仓支撑件包括主体、从所述主体向近侧延伸的近侧接片、从所述主体向远侧延伸的可扩张区域、以及从所述可扩张区域向远侧延伸的远侧接片，所述近侧接片与所述钉仓的所述钩组件接合以用于将所述仓支撑件的所述近侧接片以可释放的方式固定到所述钉仓组件，并且所述远侧接片与所述仓尖端接合以用于将所述仓支撑件的所述远侧接片以可释放的方式固定到所述钉仓组件。
12.根据权利要求11所述的外科缝合设备，其中所述仓支撑件的所述可扩张区域能够在未扩张状态和扩张状态之间转换，以在所述仓支撑件装载到所述钉仓组件上期间使所述仓支撑件伸长。
13.根据权利要求11所述的外科缝合设备，其中所述仓支撑件的所述可扩张区域由弹性材料形成。
14.根据权利要求13所述的外科缝合设备，其中与所述可扩张区域的所述弹性材料相比，所述主体以及所述仓支撑件的所述近侧接片和所述远侧接片由相对刚性的材料形成。
15.根据权利要求11所述的外科缝合设备，其中所述仓支撑件的所述可扩张区域包括将所述主体和所述远侧接片互连的一对带。
16.根据权利要求11所述的外科缝合设备，其中所述仓支撑件的所述近侧接片限定穿过所述近侧接片的近侧开口，并且所述钩组件延伸穿过所述近侧开口。
17.根据权利要求16所述的外科缝合设备，其中所述近侧接片的所述近侧开口延伸跨过限定在所述钉仓中的所述中心纵向狭槽。
18.根据权利要求11所述的外科缝合设备，其中所述仓支撑件的所述远侧接片限定穿过所述远侧接片的远侧开口，并且所述仓尖端延伸穿过所述远侧开口。
19.根据权利要求11所述的外科缝合设备，其中所述钩组件包括设置在所述钉仓的所述中心纵向狭槽的相对侧上的钩。
20.根据权利要求19所述的外科缝合设备，其中所述钩中的每个钩包括固定到所述钉仓的所述面向组织的表面的臂和从所述臂向近侧延伸的指状物。
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