CN1596833A - 具有横向移动铰接控制装置的外科器械 - Google Patents
具有横向移动铰接控制装置的外科器械 Download PDFInfo
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- 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
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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
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
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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
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2932—Transmission of forces to jaw members
- A61B2017/2943—Toothed members, e.g. rack and pinion
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B2017/320052—Guides for cutting instruments
Abstract
一种适合于内窥镜使用的铰接外科器械包括位于操作部分中的横向铰接控制装置,该控制装置为临床医生提供关于在杆远端的末端受动器的铰接的量和方向的直觉可视和触觉指示。横向控制致动器的横向运动被转换成由杆向铰接机构传递的纵向运动或旋转运动。用于旋转驱动铰接机构的横向铰接控制装置的一种形式包括后驱动铰接锁定元件,以防止引起所选量的铰接的末端受动器上的力被改变。
Description
参考的相关申请
本申请涉及同一天申请的未决并且共同拥有的四个系列申请,每份申请公开的全部内容在此作为参考文献,这四个申请分别命名为:
(1)属于Kenneth S.Wales,Douglas B.Hoffman,Frederick E.Shelton IV,和Jeff Swayze的“包含绕纵轴旋转的铰接机构(Articulation Mechanism)的外科器械”;
(2)属于Douglas B.Hoffman的“包含用于击发杆导轨的接头的外科钉合器械”;
(3)属于Kenneth S.Wales和Joseph Charles Hueil的“具有用于支撑击发杆的接头支撑板的外科钉合器械”;
(4)属于Frederick E.Shelton IV,Mike Setser,和Bruce Weisenburgh的“用于围绕接头增强的弹性的包含锥形击发杆的外科钉合器械”
技术领域
本发明大体涉及适合于内窥地将末端受动器(例如,内部切割器、抓紧器、切割器、钉合器、夹填充器、进入装置、药物/基因治疗递送装置和使用超声、RF、激光的能量装置等)插入到手术位置的外科器械,尤其涉及具有铰接杆(articulating shaft)的这样的外科器械。
背景技术
通常相对于传统的开刀手术装置人们优选内窥外科器械是由于其更小的切口并因此减少了手术后的恢复时间和并发症。因此,重要的发展已涉及到适合于将末梢的末端受动器通过套管针的套管精确放置在所需手术位置的内窥外科器械范围。这些末梢的末端受动器(例如,内部切割器、抓紧器、切割器、钉合器、夹填充器、进入装置、药物/基因治疗释放装置和使用超声、RF、激光等的能量装置)以多种方式与组织铰接以完成诊断或治疗效果。
末端受动器的定位受套管针限制。这些内窥外科器械通常包括位于末端受动器和由临床医生操作的操作部分之间的长杆。这个长杆允许插入到所需深度和围绕该杆的长轴旋转,从而将末端受动器定位到一定深度。通过套管针合理的放置以及抓紧器,例如通过另一个套管针的使用,这种定位的量通常足够了。例如像在美国专利US5465895中描述的外科钉合器和切割装置是通过插入和旋转成功定位末端受动器的内窥外科器械的示例。
根据操作种类,可能需要进一步调节内窥外科器械的末端受动器的定位而不是仅限于插入和旋转。尤其是,经常需要沿横穿器械杆的纵轴的轴定位末端受动器。末端受动器相对于器械杆的横向移动通常称为“铰接(Articulation)”。这种铰接定位使临床医生在某些情况下更容易处理组织。此外,铰接定位还有利地允许定位在末端受动器之后的内窥镜不被器械杆妨碍。
尽管前述的非铰接钉合和切割器械具有很大的实用性,并可以成功地用于许多外科步骤中,但还是需要增强它们具有铰接末端受动器的能力的操作,从而在使用中给出更大的临床灵活性。最后,四个上面相互参照的申请公开了使用旋转运动以铰接外科钉合和切割器械的末端受动器。临床医生在器械的杆基部旋转外部控制装置以完成这个铰接。在其它的铰接外科器械中,通常由作为纵向运动被传递到接头的纵向或旋转控制输入完成铰接。例如,美国专利US6241139描述了一种可操作地连接于步进凸轮传动器槽的旋转控制装置。控制装置的旋转运动横向地移动包含步进凸轮传动器槽的中间件,以铰接末端受动器。
尽管这些铰接控制装置确实完成了预计的功能,可相信一种增强的铰接控制装置可提供额外的优势。例如,如果由铰接控制提供的视觉指示和触觉感受是临床医生关于铰接的预计方向和量的直觉理解,就需要这样的装置。另外,进一步需要铰接控制装置容易接受临床医生的调节,而阻止在末端受动器上可能是不小心地改变铰接量的力。而且,进一步需要尤其适合于具有沿杆进行旋转运动以完成铰接的外科钉合和切割器械的铰接控制装置的某些形式。
因此,显然需要一种用于外科器械的改进的铰接控制装置。
发明内容
本发明通过提供一种有利地包含横向铰接控制装置(lateral articulationcontrol)的铰接外科器械,使得使用者具有末端受动器铰接的直觉控制,从而克服了上述提出的问题以及现有技术中的其它缺陷。这种器械尤其用于内窥镜应用中,其中末端受动器穿过套管通道到达手术部位。在所需的方向达到手术部位,也可能被插入到其它组织的后面,这些都通过末端受动器从杆的纵轴的铰接而简化。横向铰接控制装置提供末端受动器铰接的方向和量的直觉指示,从而帮助完成了该任务。
在本发明的一个方面中,外科器械将末端受动器定位于手术位置,以通过将它的杆插入套管通道中而完成诊断或治疗处理。杆有利地包括铰接运动传递元件,该元件允许临床医生通过控制铰接机构而从杆的纵轴铰接末端受动器,其中铰接机构枢轴地连接于杆远端的末端受动器。使用者横向定位致动器以使铰接运动通过杆被传递,而其中的横向运动通过运动转换机构转换为铰接运动。因此,使用者接收末端受动器的铰接方向以及铰接的相对量的直觉指示。
在本发明的另一方面中,外科器械通过响应旋转运动的铰接机构完成末端受动器的铰接。横向铰接控制装置通过转变横向运动为通过杆传递到铰接机构的旋转运动为使用者再一次提供直觉控制。
在本发明的另一个方面中,提供一种适合于进行例如通过具有可传递到末端受动器的三种运动,尤其是击发运动(firing motion)、闭合运动(closingmotion)和铰接运动(articulation motion)的钉合和切割这样操作的内窥镜的外科器械。横向铰接控制装置由使用者定位以产生使末端受动器铰接的铰接运动。既然末端受动器可由定位于不同于器械使用者的不同视点的内窥镜在远处观察,这种观察可能使对末端受动器的铰接量和方向的肉眼观察变得复杂。然而,在装置把手近端的横向铰接控制装置给了使用者反馈。
本发明的这些和其它的目的和优势将通过附图和对它的描述变得很明显。
附图说明
包含在说明书内并组成说明书一部分的附图显示了本发明的实施例,并且与上面给出的本发明的概述以及下面将给出的实施例的详细描述一起,用于解释本发明的原理。
图1是处于非铰接位置(nonarticulated position)的铰接外科器械(articulatingsurgical instrument)的透视图。
图2是处于铰接位置(articulated position)的铰接外科器械的透视图。
图3是图1-2中的铰接外科器械的打开的末端受动器的透视图。
图4描述了图1的外科器械的图3的末端受动器截面的侧面正视图,该截面通常沿图3的4-4线以暴露钉筒部分并显示了沿纵轴中心线的击发杆。
图5描述了击发杆完全击发后图4的末端受动器截面的侧面正视图。
图6描述了包括旋转铰接控制装置的图1的外科器械近端的操作部分截面的侧面正视图。
图7描述了图1的外科器械的近端的操作部分的透视分解图。
图8描述了俯视、前视和右视图1外科器械的操作部分的远端部分的透视图,其中操作部分被部分地切除,以暴露旋转铰接控制机构。
图9描述了仰视、后视和右视图8操作部分的远端部分的透视图,其中操作部分被部分地切除,以暴露旋转铰接控制机构并具有拆开的旋转铰接控制旋钮。
图10显示了除去击发和框架部分的图1外科器械的正齿轮铰接机构和末端受动器的顶部透视细节图。
图11描述了包括正齿轮铰接机构的图1外科器械的执行部分的透视、分解图。
图12描述了俯视、前视和右视图1外科器械的操作部分的远端部分的透视图,其中操作部分被部分地切除,以暴露横向铰接控制机构。
图13描述了图12的横向铰接控制机构的透视分解图。
图14描述了图12的横向铰接控制机构剖面的前正视图。
图15描述了锁定块在图13的横向铰接控制机构的啮合状态下的细节图。
图16描述了脱离状态下图13的横向铰接控制机构的细节图。
具体实施方式
参照附图,其中几幅图中相同的数字表示相同的元件,图1-3描述了一种外科器械,该器械在图示实施例中尤其是一种外科钉合和切割器械10,器械10能实行本发明的独特优势。尤其是,在如图1显示的非铰接状态中,外科钉合和切割器械10尺寸适合于通过套管针套管通道插入到病人体内的手术位置以执行手术过程。一旦铰接机构11和连接于末端的末端受动器12通过套管通道插入,铰接机构11通过铰接控制装置13如图2所示的进行遥控铰接。因此,末端受动器12可从需要的角度或由于其它原因到达器官后面或接近组织。例如,一种击发装置,为方便显示为E梁击发杆14(如图3所示),其切断被夹住的组织,连接伸长的通道16和枢轴连接的砧18。
外科钉合和切割装置10包括与执行部分22相连的操作部分20,执行部分22进一步包含末端终止于铰接机构11的杆23,和末端受动器12。操作部分20包括手枪式把手24,临床医生将一个关闭触发器26可转动地拉向把手24以朝向末端受动器12的延伸的通道16夹紧或关闭砧18。烧灼触发器28位于关闭触发器26更远的外侧,由临床医生将其枢轴地拉动以钉住和切断末端受动器12中被夹住的组织。然后,按下释放按钮30释放被夹住的组织。
杆23最外部的封闭套筒32响应于关闭触发器26纵向移动,以枢轴地关闭砧18。特别地,与铰接机构11相关的封闭套筒32的末端部分或封闭环33由执行部分22(在铰接机构11中部分可见)的构架34间接支持。在铰接机构11,封闭套筒32的近端部分或封闭管35与远端部分(封闭环)33相通。构架34经铰接机构11可挠地连接到伸长的通道16上,使铰接在一个平面内。构架34也纵向滑动地支持从击发触发器28到击发杆14传递击发运动的击发传动元件36。仅有击发传动元件36的击发杆14在图3进行了描述,但下面将参照各种形式的旋转控制的铰接机构11进一步详细描述击发传动元件36。
应当理解,这里使用的术语“近”和“远”是相对于临床医生抓握器械的把手而言。因此,末端受动器12位于更近的操作部分20的远端。应进一步理解的是,为方便和清楚,这里使用的例如“垂直”和“水平”这样的空间术语是相对于附图而言。然而,外科器械在许多方向和位置使用,这些术语并不是受限和绝对的。
E梁击发杆
图3-5描述了使用E梁击发杆14完成许多功能的末端受动器12。在图3中,击发杆14位于近端,允许没有用完的钉筒37安装进伸长的通道16。尤其是,击发杆14没有用完的钉38位于凹槽内,其图示为允许砧18重复地打开和关闭的砧袋40。如图4所示关闭的末端受动器,击发杆14前进到通过使上部销38进入纵向砧槽42而与砧18铰接。最下部的销,或击发杆帽44,通过使击发杆14扩展通过通道槽45而铰接伸长的通道16的下部表面。中间销46与击发杆帽44配合而滑动铰接伸长的通道16的上表面。因此,击发杆14可在击发期间与末端受动器12完全隔开,克服夹住最少数量的组织时可能发生的夹痛和夹住过多数量的组织时的钉变形。
在击发期间,位于击发杆上部销38和中间销46之间的远端切割边缘48进入钉筒37的近端垂直槽49,切断位于钉筒37和砧18之间的夹住的组织。如图4所示,中间销46通过进入钉筒37内的击发槽致动钉筒37,驱动楔形导板41进入与钉驱动器43相接触的向上的凸轮系统,以反过来驱动多个钉47从钉筒37内的钉孔51出来而形成与砧18内表面的钉袋53相接触。图5描述了击发杆14在完成切断和钉住组织后向完全远端转移。
双轴把手
参照图6-7,操作部分20包含从像填充玻璃的聚碳酸酯这样的聚合材料浇铸成的第一和第二基座部分50和52。第一基座部分50具有多个圆柱形的销54。第二基座部分包括多个延伸元件56,每一个延伸元件具有六角形的开口58。圆柱形销54容纳于六角形开口58内,并在其中摩擦保持以保持第一和第二基座部分50和52的组合。
壳帽60具有完全延伸通过它的孔62,以绕它的纵轴铰接并旋转执行部分22。壳帽60包括沿孔62的至少一部分延伸的向内突出的凸起64。凸起64容纳于在封闭套筒32近端部分形成的纵向槽66内,使得壳帽60的旋转影响封闭套筒32的旋转。应当理解,凸起64进一步延伸通过构架34并与烧灼传动元件36的一部分相接触同样也影响它们的旋转。因此,末端受动器12(在图3-4中未示出)随着壳帽60旋转。
构架34的近端68近端地穿过壳帽60并具有与通过分别延伸自基座部分50和52的相反通道固定元件72相铰接的圆周槽口70。图中仅示出了第二基座部分52的通道固定元件72。通道固定元件72从基座部分50、52延伸以将构架34固定在操作部分20上,使得构架34相对于操作部分20不纵向移动。
关闭触发器26具有把手部分74,扇形齿轮部分76,和中间部分78。孔80延伸通过中间部分78。从第二基座部分52延伸的圆柱支持元件82穿过孔80以枢轴地在操作部分20上安装关闭触发器26。从第二基座部分52延伸的第二圆柱支持元件83穿过击发触发器28的孔81以枢轴地安装在操作部分20上。圆柱形支持元件83内提供的六角开口84接收从第一基座部分50延伸的固定销(图中末示出)。
关闭轭86位于操作部分20内以用于那里的往复运动并将运动从关闭触发器转移到封闭套筒32。从第二基座部分52和通过轭86内的凹槽89延伸的固定元件72延伸的支持元件88支持操作部分20内的轭86。
封闭套筒32的近端90具有揿接在接收凹槽94内的凸缘92,其中所述接收凹槽形成于轭86的末端96内。轭86的近端98具有与关闭触发器26的扇形齿轮部分76啮合的齿条100。当关闭触发器26向操作部分20的手枪式把手24移动时,轭86以及封闭套筒32因此向远端移动,并压缩近端偏压轭86的弹簧102。封闭套筒32的远端移动导致砧18朝远端和面向末端受动器12的延伸通道16的枢轴平移运动,近端运动实现关闭,这将在下面进行讨论。
关闭触发器26通过前表面130与击发触发器28的啮合表面128相互作用而被向前偏压到打开位置。绕销106向上转动到操作部分20中后面的第一夹紧钩104限制击发触发器28朝向手枪式把手24的运动直到关闭触发器26被锁定到关闭位置。通过啮合击发触发器28内的锁定销107,钩104限制击发触发器28的运动。钩104也与关闭触发器26相接触。尤其是,钩104的向前凸出部分108啮合关闭触发器26的中间部分78上的元件110,元件110位于朝向把手部分74的孔80外。钩104偏压向与关闭触发器26的元件110相接触,并通过释放弹簧112与击发触发器28内的锁定销107啮合。当按下关闭触发器26时,钩104向上移动到后面,压缩固定于钩104上的向后突出部分114和释放按钮30上的向前突出部分116之间的释放弹簧112。
当轭86响应关闭触发器26的近端运动而远端移动时,释放按钮30的上部插销臂118沿轭86上的上表面120移动,直到掉入在轭86的近端、较低部分里存在于上面的凹处122。释放弹簧112向外驱动释放按钮30,释放按钮30向下枢轴转动上部插销臂118与存在于上面的凹处122相啮合,从而将关闭触发器26锁定在组织夹紧位置。
插销臂118可通过向内推释放按钮30移出凹处122以释放砧18。尤其是,上部插销臂118沿第二基座部分52的销123向下枢轴转动。然后允许轭86响应关闭触发器26的返回运动向近端移动。
击发触发返回弹簧124位于操作部分20内,其一个末端与第二基座部分52的销106相连而另一个末端与击发触发器28上的销126相连。击发返回弹簧124将返回力应用到销126上以在远离操作部分20的手枪式把手24的方向上偏压击发触发器28。关闭触发器26通过使击发触发器28的啮合表面128偏压关闭触发器26的前表面130也偏离手枪式把手24。
当关闭触发器26向手枪式把手24移动时,它的前表面130与击发触发器28上的啮合表面128相铰接,从而使击发触发器28移动到它的“击发”位置。当在击发位置时,击发触发器28位于相对手枪式把手24处于45°角的位置。钉击发后,弹簧124使击发触发器28返回到它的初始位置。在击发触发器28的返回运动期间,它的啮合表面128推动关闭触发器26的前表面130,使关闭触发器26返回到它的初始位置。锁定元件132从第二基座部分52延伸以阻止关闭触发器26旋转超出它的初始位置。
外科钉合和切割器械10另外包括摆动部分134,增效器136和驱动元件138。摆动部分134包括在执行部分22内的楔形导板(图6-7中未示出)和金属传动杆140。
驱动元件138包括第一和第二齿条141和142。驱动元件138上有位于第一和第二齿条141、142中间的第一槽口144。在击发触发器28的返回运动期间,击发触发器28的齿146与第一槽口144啮合以使驱动元件138在钉击发后返回到它的初始位置。第二槽口148位于金属传动杆140的近端以将金属传动杆140在它的非击发位置锁定到释放按钮30的上部插销臂118。
增效器136包括第一和第二整体小齿轮150和152。第一整体小齿轮150与在金属传动杆140上的第一齿条154相啮合。第二整体小齿轮152与驱动元件138上的第一齿条141相啮合。第一整体小齿轮150具有第一直径,第二整体小齿轮152具有小于第一直径的第二直径。
旋转铰接控制装置
参照图6-9,操作部分有利地包括使执行部分22沿外科器械10的纵轴旋转并使纵轴与末端受动器铰接成一定角度的铰接控制装置13。中空铰接驱动管200同轴地定位于封闭套筒32内,并可操作地与致动杆202连接,使得致动杆202的旋转使管200绕纵轴旋转,并产生封闭环250和末端受动器的垂直旋转或铰接。封闭环250的铰接相应于临床医生看到和操作的致动杆202的旋转角度和方向。在示例方式中,致动杆202旋转的角度与从杆23的纵轴铰接的角度之间的关系是一一对应的,因此为临床医生提供了直觉的指示。应当理解也可选择其它的角度关系。
铰接控制装置13包括与壳帽60相连接的一对呈镜像的铰接传送壳204。此外,铰接传送壳204包括纵向排列的外部小突出206,临床医生拧这些小突出以影响铰接传送壳204的旋转,以及因此影响末端受动器12绕执行部分22的纵轴的旋转。致动杆202与位于开口通常向上并垂直于杆23的圆柱形凹处210内的圆柱形铰接体208相连接。铰接体208的最低部分包括揿接在杆23附近铰接传送壳208内的开口214中的尖头212,尖头212防止铰接体208从圆柱形凹处210撤回。
环状齿轮齿216位于铰接体208下部的周围,并与铰接轭220上的齿218啮合。铰接轭220跨接在封闭套筒32内形成的铰接矩形窗口222上。封闭套筒32在铰接控制装置13内滑动地移动(在纵向方向)以打开和关闭末端受动器12。铰接驱动管200随封闭套筒相对于固定的铰接控制装置13纵向移动。窗口222为从铰接轭220向内的突出224提供间隙,铰接轭220穿过矩形窗口222以在铰接驱动管200内与槽226铰接,纵向定位铰接驱动管200以进行旋转运动。中空铰接驱动管200在封闭套筒32内从铰接机构11纵向延伸,并在封闭套筒32的锁定小突出227前面一段距离处终止。小突出227在铰接驱动管200的近端表面后向内弯曲,并因此将铰接驱动管200保持在杆23内。
应当理解,铰接传送壳204可操作地与杆23的封闭管35相联系。壳帽60将铰接轭220保持在传送壳204内,并通过位于近端的外径圆形凹槽228将铰接控制装置13保持在操作部分20内,外径圆形凹槽228啮合位于组合的基座部分50、52的远端开口的圆形内凸缘230。
图10、11以正齿轮铰接机构240的形式描述了图1-2中的齿轮铰接机构11,正齿轮铰接机构通常与上面描述的相同,但它在铰接机构240的另一侧具有额外的铰接驱动元件,从而增强了性能。铰接机构240具有同轴地位于封闭套筒32内的旋转中空铰接驱动管242,和围绕第一圆周部分246的远端凸出齿轮部分244。齿轮部分244啮合与封闭环250相连并从封闭环250近端突出的正齿轮248,其中封闭环250围绕延伸通过第一和第二枢轴点252、260的销253旋转,所述第一和第二枢轴点从封闭套筒32远端突出。因此,铰接枢轴穿过第一和第二枢轴点252、260,销253旋转地将封闭环250连接到封闭套筒32。驱动242的旋转啮合齿轮242和248,并围绕第一和第二枢轴点252、260铰接封闭环250。
为增加位于中空铰接驱动管242和封闭环250之间的齿轮接触有效表面积,中空铰接驱动管242的第二圆形部分254具有从那里延伸的凹进的远端突出齿轮部分256。齿轮部分256可操作地与第二正齿轮258相耦合,第二正齿轮258通过由构架34枢轴支持的逆转齿轮262而连接到并从关闭环250的相对侧边近端突出。逆转齿轮262啮合一侧上凹进的远端突出齿轮部分256和另一侧上封闭环250的第二正齿轮258。
当致动关闭触发器26时,中空铰接驱动管242和枢轴连接的封闭套筒32的封闭管250均向远端移动从而关闭砧18。封闭套筒32的封闭管35通过插在枢轴孔264和266中的枢轴点252、260以及从那里延伸的构架开口268而与封闭环33间隔开,其中枢轴孔位于正齿轮248、258的中央。构架开口268提供间隙使得封闭环33的近端边缘和封闭套筒32的封闭管35的远端边缘在铰接时不碰撞。
图11以分解形式描述了包括正齿轮铰接机构240的执行部分270。构架272可纵向附加到操作部分20上(如图1和2所示),在其近端处具有轴衬274,以在那里旋转啮合操作部分20。由纵向对准构架272中心的开口278形成的构架槽276比在构架槽276内纵向滑动的击发连接器280长。击发连接器280的近端旋转啮合金属传动杆140的远端(如图6所示)。击发连接器280的远端包括容纳击发杆14近端的槽282,并通过销固定在那里。击发杆14的更远端部分定位于击发杆槽形引导件288内的下部凹槽286内,击发杆槽形引导件288远端啮合铰接构架元件290和构架272。
铰接构架元件290具有远端连接到延伸的通道16内的近端部分的附加轴环294的通道固定元件292。击发杆14穿过铰接构架元件290内下部的槽295。铰接构架元件290通过击发杆槽形引导件288从构架272的远端间隔开,并由弹性连接器296可挠地连接到那里以用于铰接。弹性连接器296的加宽的近端298与在构架272远端的远端连通顶槽300相啮合,并且弹性连接器296的加宽的末端302与在铰接构架元件290内的近端连通顶槽304相啮合。因此,延伸的通道16与操作部分20相连,虽然可挠部分在它们之间。
延伸的通道16也具有枢轴地接收砧18的砧枢轴308的砧凸轮槽306。包围铰接构架元件290的封闭环250包括位于远端的小凸起310,该小凸起在砧18上的砧枢轴308的远侧啮合砧部件312近端,从而影响开口。当封闭环250向前移动时,其远端的止动面314接触远离砧18的小凸起312的斜圆柱止动面316。这个凸轮活动向下关闭砧18直到封闭环250的止动面314接触砧18的平圆柱面318。铰接机构的横向到纵向的控制
图12举例说明了一种用于外科器械402的横向铰接控制装置400,其与从铰接控制杆406纵向枢轴转动的铰接机构相结合。末端受动器408通过枢轴412以相似于上面描述但没有齿轮性能和旋转铰接驱动管的方式与杆组件连接。因此只显示了一个枢轴412,但应当理解,另一个枢轴沿第一枢轴412的轴形成,因此与末端受动器408和杆组件410的其它侧部连接。铰接开口414通过使枢轴412从杆组件的远端418和末端受动器408的近端420的周围向外延伸形成。铰接开口414的尺寸半径约为枢轴的每一个侧边,以用于预期铰接的最大允许量。
旋钮424图示成远端从杆组件410去除,以暴露通过位于旋钮424的两侧上的开口横向延伸的横向控制致动器426。横向控制致动器426的中心部分430具有近端定向的齿条432,齿条432具有的垂直排列的齿434,这些齿与垂直排列延伸的齿轮438的上部啮合。垂直排列延伸的齿轮438的下部440与近端连接于铰接控制杆406的面向右的齿条442啮合。
因此,当横向控制致动器426横向移动到左边时,从顶部观察,它的近端定向齿条432逆时针旋转延伸的齿条438,从而向近端移动面向右的齿条442,并向近端拉动铰接控制杆406。因此,由于铰接控制杆406在位于枢轴412左边的末端受动器的近端420上的销444处连接,末端受动器408铰接到左边。
应当理解也可使用各种其它横向到纵向的齿轮机构。例如,使齿条432、442均从所述相对于它们各自啮合的相对侧与延伸的齿轮438啮合,也可以实现类似的结果。此外,颠倒这两个中一个的啮合可通过将纵向控制杆406的连接从枢轴412左边换到右边而共同实现。然而进一步可选的是,将这三个方向中的一个或所有三个转换到它们各自相反的构造可反转控制,在与横向控制致动器426相反的方向铰接末端受动器408。
应当进一步理解的是,所描述的横向到纵向的齿轮机构产生一个角度,该角度与在纵向控制杆406的销444处的枢轴连接和垂直于枢轴线的末端受动器408之间的距离有关。可通过横向控制致动器426的齿条432与连接到纵向控制杆406的齿条之间的齿轮关系而改变相对于横向控制致动器426运动的铰接移动量。例如,延伸的齿轮438的上部可具有不同于下部的直径。
铰接机构的横向到旋转的控制
图13-16显示了一种横向铰接控制装置500,该装置具有与图1-11所描述相似的用于铰接外科器械502的类似于直觉诊断控制特征。尤其是,横向铰接控制装置500将横向运动转变为由铰接驱动管传递给铰接机构(在图13-16中未示出)的旋转运动。向下突出的齿条506连接到横向控制致动器510的下侧508,以与在铰接驱动管504的上表面上纵向排列的凹槽512啮合。
铰接后驱动的锁定元件516有利地包括在横向铰接控制装置500内,以防止作用在末端受动器(在图13-16中未示出)上的力改变铰接量。尤其是,置于铰接控制致动器510和齿条506之间的齿板518包括包含可挠X形锁定元件522的中心开口。铰接控制致动器510包括两个向下伸入到齿板518的中心开口520中的偏转片524、526,如图15-16的顶视图所示,这两个偏转片分别定位在由X形锁定元件522所限定的远端和近端象限中。齿506包括两个向上伸入到齿板518的中心开口520内的驱动片532、534,这两个驱动片分别定位在由X形锁定元件522限定的左边和右边象限536、538中。齿板518的中心开口520通常显示为具有斜齿540的矩形,每一个斜齿具有面向内并纵向排列的邻近表面542。这些斜齿540沿远端边缘548的右边和左边部分544、546放置,以分别棘齿地接触X形锁定元件522的右边和左边的远端臂550、552。斜齿540也沿矩形窗口520的近端边缘558的右边和左边部分554、556放置,以棘齿地接触X形锁定元件522的右边和左边的近端臂560、562。
尤其参考图14,齿条518图示为连接到旋钮564上,并因此不随着铰接控制致动器510或齿条506横向移动。铰接控制致动器510的横向运动通过在齿架518的矩形窗口520内形成的铰接后驱动锁定元件516传递。形成对照的是,铰接驱动管504和齿条506的后驱动横向运动通过铰接后驱动锁定元件516进入齿架518和旋钮560中而被阻止。因此铰接驱动管504的运动被抑制。
使用中,如图15所示,横向铰接控制装置500被放置在中心。因此,通过相等地延伸铰接控制致动器510的左、右末端566、568为临床医生提供视觉指示。偏转片524、526被放置在X形锁定元件522的中心,在臂550、552、560、562上不施加力,因此允许这些臂向它们的未压缩状态延伸进而与斜齿540邻近接触,从而防止X形锁定元件522的横向运动。齿条506的驱动片532、534与X形锁定元件522上的每个侧面相对接触。通过驱动片532、534从铰接驱动管504传递到齿条506内的任何横向力通过X形锁定元件进入齿条506而被阻止,以防止移动。
形成对照的是,如图16所示,当临床医生移动铰接控制致动器510到一侧边,偏转片524、526接触压缩这对刀片远离与矩形窗口520的接触的一对近端和远端臂(图16中左边的552、562)。因此,X形锁定元件522被允许朝着一对从动臂(例如,图16中右边的550、560)啮合的方向运动。该横向运动被允许继续直到引导臂552、562遇到如图所示的矩形窗口520的横向延伸。齿条506的驱动片532、534随X形锁定元件522移动,并因此末端受动器(图16中未示出)也最后响应铰接。
本发明按照内窥镜的步骤和装置进行了讨论。然而,这里使用的术语,如“内窥镜”不应解释为将本发明限制到仅在与内窥镜管(即,套管针)一起使用的外科钉合和切割器械。相反地,应相信可发现本发明能用于任何入口被限制到小的切口的过程,包括但不限于腹腔镜过程以及开刀过程。
尽管本发明通过几个实施例的描述进行了举例说明,并且举例说明的实施例使用了相对多的细节进行了描述,本申请的目的并不是将附带权利要求的范围约束或以任何方式限制到这样的细节。对于本领域技术人员另外的优势和修改将是显然的。
作为另外一个例子,尽管这里描述的举例说明的操作部分20由临床医生手动操作,对于具有动力(如,气动的,水力的,机电的,超声的,等)的操作部分的某些或所有功能与本发明的方面是一致的。而且,这些功能中每一个的控制可在操作部分手动显示或遥控控制(例如,无线遥控,自动遥控控制台,等)。
另一个例子,尽管这里有利地举例说明了同时完成钉合和切割的器械,具有其它类型的末端受动器(如,抓紧器,切割器,钉器,夹填充器,进入装置,药物/基因治疗递送装置和使用RF,激光的能量装置等)的旋转控制的铰接与本发明的方面一致。
Claims (3)
1.一种外科器械,包括:
末端受动器;
包括铰接运动传递元件的杆;
响应铰接运动并将末端受动器枢轴地连接到所述杆末端的铰接机构;以及
与所述杆近端部分相连接的铰接控制装置,包括:
由使用者横向可定位的致动器,
与致动器和铰接机构相连并可操作地构造成从铰接控制装置将横向运动转换为铰接运动的运动转换机构。
2.如权利要求1所述的外科器械,其中铰接控制装置进一步包括纵向控制杆,该控制杆在与铰接机构的枢轴线偏离的附件处与末端受动器相连接,其中运动转换机构可操作地构形以将横向运动转换为纵向运动。
3.如权利要求2所述的外科器械,其中运动转换机构包括耦合横向运动和纵向运动的齿轮装置。
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US10/615,972 US6981628B2 (en) | 2003-07-09 | 2003-07-09 | Surgical instrument with a lateral-moving articulation control |
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US (1) | US6981628B2 (zh) |
EP (1) | EP1522263B1 (zh) |
JP (1) | JP4667774B2 (zh) |
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AU (2) | AU2004203122A1 (zh) |
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CA2473482A1 (en) | 2005-01-09 |
AU2004203122A1 (en) | 2005-01-27 |
CA2473482C (en) | 2012-11-13 |
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BRPI0402681B1 (pt) | 2016-10-18 |
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AU2010257302A1 (en) | 2011-01-13 |
BRPI0402681B8 (pt) | 2021-06-22 |
EP1522263B1 (en) | 2017-01-18 |
JP4667774B2 (ja) | 2011-04-13 |
AU2010257302B2 (en) | 2012-03-29 |
EP1522263A1 (en) | 2005-04-13 |
US20050006430A1 (en) | 2005-01-13 |
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