CN1939232B - 用于直线型外科缝合器的基于电活化聚合物的关节运动机构 - Google Patents
用于直线型外科缝合器的基于电活化聚合物的关节运动机构 Download PDFInfo
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Abstract
提供使外科缝合器致动和/或关节运动的方法和装置。在一个实施例中，提供一种外科缝合器，该外科缝合器具有可动地与细长轴远端联接的缝合机构或端部执行器。可采用可电膨胀和可收缩致动器，如电活化聚合物致动器，通过向电活化聚合物致动器输送能量来枢转地或成角度地调节缝合机构相对于细长轴的位置。在另一个实施例中，可采用电活化聚合物致动器来致动缝钉施放组件，从而驱动一个或多个缝钉优选至少两排直排缝钉钉进组织。致动器可选择地或额外地驱动刀刃向远侧切割被缝合的组织。
Description
相关申请的交互参考
本申请是于2005年3月17日提交的、发明名称为“Surgical InstrumentIncorporating an Electrically Actuated Articulation Mechanism”的美国专利申请No.11/082,495的部分继续申请，该美国专利申请要求于2004年7月28日提交的、发明名称为“Surgical Instrument Incorporating an Electrically Actuated ArticulationMechanism”美国临时申请No.60/591,694的优先权。这些申请的内容全部引入在此作为参考。
技术领域
本发明总的涉及外科装置，尤其涉及采用可电膨胀和可收缩的致动器(如电活化聚合物)使外科缝合器进行关节运动和致动的方法和装置。
背景技术
内窥镜外科器械通常比传统的开放式外科装置更受到偏爱，这是因为较小的切口易于减少术后恢复时间和并发症。因此，在适合于将远端执行器通过套管针的套管精确地设置在所需手术部位的内窥镜外科器械领域中已经有了显著发展。这些远端执行器以多种方式接合组织以达到诊断或治疗效果(例如，内切割器、抓钳、切割器、缝合器、夹具施放器、接触装置、药物/基因治疗输送装置和使用超声波、RF、激光等的能量装置)。
已知的外科缝合器包括可相对于缝钉轴关节运动并可受致动对组织施放缝钉的端部执行器。一些直线型端部执行器同时在组织内形成纵向切口并在该切口的相对侧施放缝钉。该端部执行器包括一对相配合的钳爪构件，如果该器械用于内窥镜或结肠镜应用，这对钳爪构件能够穿过插管通道。钳爪构件中的一个容纳具有至少两排横向间隔开的缝钉的缝钉仓。另一个钳爪构件形成钉砧，该钉砧具有与钉仓内的钉排对准的缝钉形成凹槽。目前的一些缝合器还采用往复式楔形件，这些楔形件向远侧驱动时，会穿过钉仓内的开口并使驱动器支撑缝合器，以实现缝钉向钉砧的击发。
目前的缝合装置的一个缺点是，需要较大的力来实现关节运动和致动，而且该力在击发冲程的整个过程中发生改变。最新的缝合装置利用一个或多个手握扳机。在致动期间，当端部执行器接近与轴线性对准时，负荷较低，而当端部执行器进行关节运动时，负荷增大。一旦缝钉进入钉砧凹槽，当钉腿弯曲时，阻力和负载就会很快升高。而后，当形成缝合时，阻力和负载降低并再次升高。相反，操作者在击发冲程早期和中期阶段具有最大的作用力，而该作用力在闭合的最后阶段最小。实现关节运动和致动所需要的较大力以及该力的变化经常可超过外科医生的手的力量，并可潜在地导致当需要未料想到的较高力时会出现粘连或其它故障。
实现击发所需要的较大力还可干扰轴的挠性或适应性。目前，端部执行器可与轴枢转地联接，或者轴可以是挠性的以允许轴穿过弯曲的路径。力从手柄到端部执行器的传递可能不得不干扰轴的枢转或弯曲取向，可能导致其变直。
因此，存在用于实现外科缝合器致动和/或关节运动的方法和装置的需要，尤其是存在需要较低的力来实现外科缝合器的致动和/或关节运动的方法和装置的需要。
发明内容
本发明总的提供使外科缝合器致动和/或关节运动的方法和装置。在一个实施例中，提供一种外科缝合器，该外科缝合器具有可动地与细长轴远端联接的缝合机构或端部执行器。可采用可电膨胀和可收缩致动器，如电活化聚合物致动器，通过向电活化聚合物致动器输送能量来枢转地或成角度地调节缝合机构相对于细长轴的位置。在另一个实施例中，可采用电活化聚合物致动器来致动缝钉施放组件，从而驱动一个或多个缝钉(优选至少两直排缝钉)进入组织。致动器可选择地或额外地向远侧驱动刀刃，切割被缝合的组织。
在一个示例性实施例中，外科缝合器可包括至少一个联接在细长轴和直线型缝钉施放组件之间的电活化聚合物致动器，而且当向至少一个电活化聚合物致动器输送能量时，该电活化聚合物致动器可适于选择地使直线型缝钉施放组件相对于细长轴枢转。直线型缝钉施放组件可利用各种配合技术可动地与轴联接。例如，直线型缝钉施放可通过枢轴接头与细长轴联接。细长轴可包括延伸穿过其中的滑棒，该滑棒具有与用于移动直线型缝钉施放组件的枢轴关节联接的远端。
虽然可采用各种技术移动滑棒并实现缝钉施放组件的枢转运动，在一个示例性实施例中，电活化聚合物致动器可设置成当向其输送能量时向径向膨胀，以横向移动滑棒，从而实现直线型缝钉施放组件的枢转运动。在一示例性实施例中，该装置包括邻近滑棒第一侧设置的第一电活化聚合物致动器，以及邻近滑棒第二侧设置的第二电活化聚合物致动器。第一和第二电活化致动器可设置成当向其输送能量时向径向膨胀，以使滑棒横向运动。滑棒可任选地包括在其远端上形成的并适于与在枢轴关节上形成的相应齿轮啮合的齿轮。
在另一实施例中，电活化聚合物致动器可轴向收缩和径向膨胀。例如，细长轴可包括与直线型缝钉施放组件的第一侧面联接的第一电活化聚合物致动器和与直线型缝钉施放组件的相对第二侧面联接的第二电活化聚合物致动器。当向第一电活化聚合物致动器输送能量时，第一电活化聚合物致动器可轴向收缩以使直线型缝钉施放组件沿第一方向枢转，而当向第二电活化聚合物致动器输送能量时，第二电活化聚合物致动器可轴向收缩以使直线型缝钉施放组件沿与第一方向相反的第二方向枢转。
在另一实施例中，直线性缝钉施放组件可通过挠性部分可动地与细长轴联接。若干个电活化聚合物致动器可在不同位置处联接到该挠性部分上，且每个电活化聚合物致动器可设置成当能量选择地向其输送时改变取向，以使挠性部分沿所需的方向挠曲。
还提供一种缝合组织的方法，该方法可包括将外科缝合器的细长轴插入体腔内以将可动地联接至细长轴远端上的缝钉施放组件定位在手术部位附近，抓取缝钉施放组件的相对夹钳爪之间的组织，向至少一个电活化聚合物致动器输送能量以使缝钉施放组件相对于细长轴枢转，和启动缝钉施放组件，以从钳爪中的一个钳爪驱动至少一个直排缝钉并使其进入组织。在一个示例性实施例中，细长轴可包括从中延伸的滑棒，该滑棒具有与在细长轴和缝钉施放组件之间形成的枢轴关节联接的远端。向至少一个电活化聚合物致动器输送能量，能够有效地使电活化聚合物致动器径向膨胀，使滑棒横向运动，从而实现缝钉施放组件的枢转运动。向每个电活化聚合物致动器输送的能量值可对应于缝钉施放组件的运动程度。在另一个实施例中，直线型缝钉施放组件可通过挠性部分可动地与细长轴联接。电活化聚合物致动器可包括在不同位置处与该挠性部分联接的多个电活化聚合物致动器，且能量可选择地输送到多个电活化聚合物致动器，使挠性部分沿所需方向挠曲。
在又一实施例中，提供一种外科缝合器，该外科缝合器具有一细长轴，该细长轴具有在其远端上形成的且适于收纳组织的直线型缝钉施放组件。该缝钉施放组件与至少一个电活化聚合物致动器联接，该致动器设置成当向电活化聚合物致动器输送能量时驱动至少一直排缝钉钉入组织。在一个示例性实施例中，缝钉施放组件包括缝合机构和与该缝合机构相对的钉砧。该缝合机构可包括设置在其中的驱动器并适于从缝合机构向钉砧驱动多个缝钉。电活化聚合物可与多个驱动器的每一个联接，从而能量可选择地输送到至少一个电活化聚合物致动器以移动至少一个驱动器，从而驱动至少一个缝钉钉入组织。在另一实施例中，多个电活化聚合物可设置在缝钉施放组件内，且当向其输送能量时，每个电活化聚合物可有效驱动一直排缝钉钉入组织。该电活化聚合物可适于分别致动以从缝合机构向钉砧驱动缝钉。
在又一实施例中，外科缝合器可包括可滑动地设置在细长轴内的推杆，并且该推杆可联接至电活化聚合物致动器上，当向该电活化聚合物致动器输送能量时，该电活化聚合物适于使推杆向远侧运动。在一示例性实施例中，当向其输送能量时，与推杆联接的电活化聚合物致动器适于轴向膨胀和径向收缩，以使推杆向远侧运动。
还提供一种用于向组织施放一个或多个外科缝钉的方法，且该方法可包括抓取相对的第一和第二钳爪之间的组织，以及向电活化聚合物致动器输送能量，驱动至少一直排缝钉从第一钳爪穿过组织并抵靠在形成于第二钳爪上的钉砧上。在一个实施例中，一个或多个驱动器可动地设置在第一钳爪内，传送至电活化聚合物致动器的能量可使驱动器在第一钳爪内运动，以驱动缝钉从中穿过并抵靠在钉砧上。在另一实施例中，向电活化聚合物致动器输送能量可使推杆向远侧运动，以推进多个缝钉驱动器，这些驱动器驱动至少一直排缝钉从第一钳爪穿过组织并抵靠在形成于第二钳爪上的钉砧上。在其它方面，能量可选择地输送到设置在第一钳爪内的多个电活化聚合物致动器，以驱动至少一直排缝钉从第一钳爪穿过组织并抵靠在形成于第二钳爪上的钉砧上。在又一实施例中，向电活化聚合物致动器输送能量能够有效地向远侧推动刀刃，以切割被缝合的组织。
本发明还涉及如下方面：
(1)一种外科缝合器，包括：
细长轴，其限定了纵向轴线；
直线型缝钉施放组件，其可动地与所述细长轴联接并适于输送多个缝钉；以及
电活化聚合物致动器，其联接在所述细长轴和直线型缝钉施放组件之间，当向该电活化聚合物致动器输送能量时，所述电活化聚合物致动器适于选择地使直线型缝钉施放组件相对于细长轴枢转。
(2)根据第(1)项所述的外科缝合器，其中，所述直线型缝钉施放组件通过枢轴关节可动地联接到所述细长轴上。
(3)根据第(2)项所述的外科缝合器，其中，所述细长轴包括穿过其中延伸的滑棒，该滑棒具有联接到枢轴关节上的远端，电活化聚合物致动器使该滑棒横向运动，从而实现直线型缝钉施放组件的枢转运动。
(4)根据第(3)项所述的外科缝合器，其中，所述电活化聚合物致动器包括邻近滑棒第一侧设置的第一电活化聚合物致动器以及邻近滑棒第二侧设置的第二电活化聚合物致动器，所述第一和第二电活化聚合物致动器在被输送能量时横向膨胀，使所述滑棒横向运动。
(5)根据第(3)项所述的外科缝合器，其中，所述滑棒的远端包括齿轮，该齿轮适于与在枢轴关节上形成的相应齿轮啮合。
(6)根据第(1)项所述的外科缝合器，其中，所述电活化聚合物致动器包括在细长轴的第一侧和直线型缝钉施放组件的第一侧之间延伸的第一电活化聚合物致动器，以及在细长轴的相对第二侧和直线型缝钉施放组件的相对第二侧之间延伸的第二电活化聚合物致动器。
(7)根据第(6)项所述的外科缝合器，其中，所述第一和第二电活化聚合物致动器适于轴向收缩，使直线型缝钉施放组件相对于细长轴枢转。
(8)根据第(1)项所述的外科缝合器，其中，所述直线型缝钉施放组件通过挠性部分可动地与细长轴联接。
(9)根据第(8)项所述的外科缝合器，其中，所述电活化聚合物致动器包括在不同位置处联接至所述挠性部分上的多个电活化聚合物致动器，所述多个电活化聚合物致动器的每一个在被选择地输送能量时，改变取向以使挠性部分挠曲。
(10)根据第(1)项所述的外科缝合器，还包括在细长轴近端上形成的手柄，该手柄上具有用于向至少一个电活化聚合物致动器输送能量的控制机构。
(11)一种外科缝合器，包括：
细长轴，该细长轴具有可动地联接至其远端上的直线型缝钉施放组件，该缝钉施放组件与电活化聚合物致动器通信，所述电活化聚合物致动器在被输送能量时，成角度地调节缝钉施放组件相对于细长轴的位置。
(12)根据第(11)项所述的外科缝合器，其中，所述电活化聚合物致动器适于在被输送能量时轴向膨胀和径向收缩，以成角度地调节缝钉施放组件相对于细长轴的位置。
(13)根据第(12)项所述的外科缝合器，其中，所述细长轴其中包括滑棒，该滑棒与缝钉施放组件和细长轴之间形成的枢轴关节联接，电活化聚合物致动器适于在被输送能量时，使滑棒横向运动，以成角度地调节缝钉施放组件相对于细长轴的位置。
(14)根据第(11)项所述的外科缝合器，其中，所述电活化聚合物致动器适于在被输送能量时，径向膨胀和轴向收缩，以成角度地调节缝钉施放组件相对于细长轴的位置。
(15)根据第(14)项所述的外科缝合器，其中，所述电活化聚合物致动器包括联接至缝钉施放组件第一侧上的第一电活化聚合物致动器以及联接至缝钉施放组件相对第二侧的第二电活化聚合物致动器，该第一电活化聚合物致动器在被输送能量时，适于使缝钉施放组件沿第一方向枢转，该第二电活化聚合物致动器在被输送能量时，适于使缝钉施放组件沿向相反的第二方向枢转。
(16)一种缝合组织的方法，包括：
将外科缝合器的细长轴插入体腔内，以将可动地联接至细长轴远端上的缝钉施放组件定位在手术部位附近；
抓取缝钉施放组件的相对钳爪之间的组织；
向电活化聚合物致动器输送能量，以使缝钉施放组件相对于细长轴枢转；以及
致动缝钉施放组件，以从钳爪中的一个驱动至少一排直排缝钉并使其钉入组织。
(17)根据第(16)项所述的方法，其中，所述细长轴包括穿过其中延伸的滑棒，该滑棒具有与细长轴和缝钉施放组件之间形成的枢轴关节联接的远端，向电活化聚合物致动器输送能量有效地使该电活化聚合物致动器径向膨胀，以使滑棒横向运动，从而实现缝钉施放组件的枢转运动。
(18)根据第(16)项所述的方法，其中，所述细长轴包括穿过其中延伸的滑棒，该滑棒具有与细长轴和缝钉施放组件之间形成的枢轴关节联接的远端，向电活化聚合物致动器输送能量有效地使该电活化聚合物致动器轴向膨胀，以使滑棒向轴向运动，从而实现缝钉施放组件的枢转运动。
(19)根据第(16)项所述的方法，其中，向第一电活化聚合物致动器输送能量，以使缝钉施放组件沿第一方向运动，向第二电活化聚合物致动器输送能量，以使缝钉施放组件向相反的第二方向运动。
(20)根据第(16)项所述的方法，其中，向电活化聚合物致动器输送的能量值对应于缝钉施放组件的运动程度。
(21)根据第(16)项所述的方法，其中，所述直线型缝钉施放组件通过挠性部分可动地联接至细长轴上。
(22)根据第(16)项所述的方法，其中，所述电活化聚合物致动器包括在不同位置处联接至所述挠性部分上的多个电活化聚合物致动器，选择地向多个电活化聚合物致动器输送能量，以使所述挠性部分向所需的方向挠曲。
附图说明
从下面结合附图进行的详细描述将更全面理解本发明，附图中：
图1A是现有技术纤维束类型的EAP致动器的横截面图；
图1B是图1A中所示现有技术致动器的径向截面图；
图2A是具有多个EAP复合层的现有技术层压类型EAP致动器的横截面图；
图2B是图2A所示现有技术致动器的一个复合层的透视图；
图3是外科缝合器的一个示例性实施例的侧视图，该外科缝合器具有手柄、细长轴和与细长轴远端联接的端部执行器；
图4A是图3所示端部执行器的部分横截面图，示出用于实现端部执行器关节运动的EAP致动器；
图4B是图4A所示端部执行器的横截面图，示出非致动状态的EAP致动器；
图4C是图4A所示端部执行器的横截面图，示出被电致动而使端部执行器关节运动的EAP致动器中的一个；
图5A是端部执行器另一个实施例的部分横截面图，该端部执行器可动地与细长轴的远侧部分联接并具有用于使端部执行器关节运动的EAP致动器；
图5B是图5A所示端部执行器和细长轴的部分横截面视图，示出被电致动使端部执行器关节运动的EAP致动器中的一个；
图6A是端部执行器又一个实施例的部分横截面图，该端部执行器可动地联接至细长轴的远侧部分并具有用于使端部执行器关节运动的EAP致动器；
图6B是图6A所示端部执行器和细长轴的部分横截面视图，示出被电致动使端部执行器关节运动的EAP致动器中的一个；
图7是与细长轴联接的端部执行器另一个实施例的透视图，该细长轴具有使端部执行器关节运动的挠性部分，并具有用于使挠性部分弯曲的多个EAP致动器；
图8A是示出图3所示外科缝合器的端部执行器和细长轴的各个部件的分解透视图；
图8B是图3端部执行器的端部透视图，示出处于打开位置的相对钳爪；
图8C是图8B所示端部执行器的侧面剖视图，示出近侧位置处的切割刃；
图8D是图8C所示端部执行器的侧面剖视图，示出远侧位置处的切割刃；
图9A是端部执行器另一个实施例的一部分的俯视图，该端部执行器具有用于驱动缝钉的驱动器元件和用于驱动驱动器元件的EAP致动器带；
图9B是图9A所示端部执行器的侧视图，示出定位成驱动若干驱动器元件的EAP致动器带中的一个；
图10A是与外科缝合器一起使用的端部执行器另一实施例的俯视图，示出用于直接驱动缝钉的EAP驱动器；以及
图10B是图10A所示端部致动器的部分俯视图，示出位于EAP驱动器中的一个上的缝钉。
具体实施方式
本发明总的提供用于实现外科缝合器的一个或多个部件运动的方法和装置。在一个示例性实施例中，提供一种外科缝合器，该外科缝合器具有可动地联接至细长轴远端上的缝合机构或端部执行器。可采用可电膨胀和可收缩致动器，如电活化聚合物致动器，通过向电活化聚合物致动器输送能量来枢转或成角度地调节缝合机构相对于细长轴的位置。在另一个实施例中，可采用电活化聚合物致动器使端部执行器关节运动，从而驱动一个或多个缝钉，且优选驱动至少两直排缝钉钉入组织内。该致动器可选择地或额外地向远侧驱动刀刃切割被缝合的组织。本领域技术人员将会理解，该外科缝合器可具有各种结构，而且该电活化聚合物致动器可联接至外科缝合器的一个或多个部件上以实现运动。
电活化聚合物
电活化聚合物(EAPs)，也称为人造肌，是响应于电场或机械场表现压电、热电或电致伸缩性质的材料。具体地说，EAPs是一组导电掺杂聚合物，当施加电压时所述导电掺杂聚合物改变形状。可以使用电极使所述导电聚合物与某种形式的离子流体或凝胶配对。一旦对电极施加电压电位，离子从流体/凝胶流入或流出导电聚合物，可以引起聚合物的形状变化。通常，可以根据使用的具体聚合物和离子流体或凝胶施加在大约1V-4kV范围内的电压电位。特别需要注意的是，EAPs在被供能时并不改变体积，而是它们仅仅在一个方向上扩张并且在横向方向上收缩。
EAPs的主要优点中的一个是能够电控制和微调它们的性能和特性。可以通过在EAP上施加外部电压重复变形EAPs，并且当倒转所施加的电压的极性时，它们可以快速回复到它们的初始构型。可以选择特定聚合物，以形成不同类型的运动结构，包括扩张、线性运动和弯曲结构。EAPs也可以与机械机构(例如弹簧或挠性板)配对，从而当电压施加到EAP时改变EAP对机械机构的影响。输送到EAP的电压的大小也可以与产生的运动量或尺寸变化量对应，因此可以控制能量输送，从而实现所需的变化量。
有两种基本类型的EAPs，每种类型有多种构型。第一种类型是纤维束，其可以包括捆在一起协同工作的许多纤维。所述纤维通常具有大约30-50微米的尺寸。这些纤维可以被编织成很像织物的束，并且它们常常被称为EAP纱线。在使用中，EAP的机械构型确定了EAP致动器和其运动能力。例如，EAP可以形成长股线并且缠绕单个中心电极。挠性外部外护套将形成用于致动器的另一电极并且包含实现装置的功能所必须的离子流体。当对其施加电压时，EAP将扩张，使所述股线收缩或缩短。可在商业上获得的纤维EAP材料的一个例子由Santa Fe Science and Technology公司制造并且作为PANIONTM纤维出售，其描述于美国专利No.6,667,825中，通过参考将该文献的全部内容并入本文。
图1A和1B示出了由纤维束形成的EAP致动器100的一个示例性实施例。如图所示，致动器100通常包括挠性导电外护套102，该外护套采用细长圆柱形构件的形式，其上形成有相对的绝缘端帽102a和102b。然而，导电外护套102可以根据预期用途具有各种其它形状和尺寸。如进一步所显示的，导电外护套102联接到回流电极108a上，能量输送电极108b通过绝缘端帽中的一个(例如端帽102a)延伸，通过导电外护套102的内腔，并且进入相对的绝缘端帽(例如端帽102b)中。能量输送电极108b例如可以是铂阴极线。导电外护套102也可以包括布置在其中的离子流体或凝胶106，以用于将能量从能量输送电极108b输送到布置在外护套102内的EAP纤维104。具体地说，一些EAP纤维104平行布置并且在每个端帽102a，102b之间和延伸，并延伸进入端帽102a和102b。如上所述，纤维104可以布置成各种方位，以提供预期结果，例如径向地扩张或收缩或者弯曲运动。在使用中，能量可以通过有源能量输送电极108b和导电外护套102(阳极)输送到致动器100。所述能量将使离子流体中的离子进入EAP纤维104，由此使纤维104在一个方向上扩张(例如径向地扩张，使得每个纤维104的外径增加)和在横向方向上收缩(例如轴向地收缩，使得所述纤维的长度减小)。因此，端帽102a，102b将被朝着彼此被牵引，从而收缩和减小挠性外护套102的长度。
另一种类型的EAP是层压结构，其包括一个或多个EAP层、布置在每个EAP层之间的离子凝胶或流体层和连接到所述结构上的一个或多个挠性导电板，例如正电极板和负电极板。当施加电压时，层压结构在一个方向上扩张并且在横向或垂直方向上收缩，从而使与之联接的一个或多个挠性板根据EAP相对于一个或多个挠性板的构型缩短或伸长，或者弯曲或挠曲。可在商业上获得的层压EAP材料的一个例子由SRI Laboratories的一个分部Artificial Muscle Inc制造。称为薄膜EAP的板状EAP材料也可从日本的EAMEX获得。
图2A和2B示出了由层压材料形成的EAP致动器200的一个示例性构型。首先参照图2A，致动器200可以包括层压EAP复合层的多个层(例如显示了五个层210、210a、210b、210c、210d)，所述层由布置在它们之间的粘合剂层103a、103b、103c、103d彼此粘合。在图2B中更详细地显示了所述层中的一个，即层210，如图所示，层210包括第一挠性导电板212a、EAP层214、离子凝胶层216和第二挠性导电板212b，所有这些层都彼此连接，以形成层压复合层。如图2B中进一步所示，所述复合层也可以包括联接到挠性导电板212a，212b上的能量输送电极218a和回流电极218b。在使用中，能量可以通过有源能量输送电极218a输送到致动器200。所述能量使离子凝胶层216中的离子进入EAP层214，从而使层214在一个方向上扩张并且在横向方向上收缩。因此，将迫使挠性板212a，212b挠曲或弯曲，或者以其它方式随EAP层214改变形状。
外科缝合器
如前所述，在一示例性实施例中提供外科缝合方法和装置，其利用可电膨胀和可收缩致动器，如EAP致动器，以实现该装置各个部件的关节运动和/或致动。虽然各个实施例描述成具有用于在无机械辅助情况下进行关节运动和/或致动的EAP致动器，这些致动器可选择地设置成补充机械关节运动或致动。例如，EAP致动器可用于减少闭合外科缝合器上的端部执行器所需的力，包括击发缝钉和任选地驱动刀具或刀刃穿过组件来切割缝合的组织。图3示出外科缝合器10的一个示例性实施例，其可包括一个或多个用于实现关节运动和/或致动的EAP致动器。如前所述，在此描述的用于实现关节运动和致动的各种方法和装置可实际结合到任何现有技术中已知的外科缝合器内。所示出的外科缝合器10还可包括各种现有技术已知但未在此公开的其它特征。
通常，缝合器10包括细长轴12，该细长轴12具有联接到其近端12a上的手柄14，以及联接到其远端12b上的缝钉施放组件或端部执行器16。端部执行器16包括适于在其间收纳组织的相对的第一和第二钳爪18，20。第一钳爪18适于容纳钉仓，钉仓中具受驱动可钉入组织的多个缝钉，而第二钳爪20形成用于使缝钉变形的钉砧。手柄14可包括一个或多个与其联接的扳机，所述扳机用于使端部执行器16相对于细长轴12关节运动、闭合端部执行器16和/或致动(击发)缝合装置。图3示出可动地与手柄14联接、用于闭合端部执行器16的相对钳爪18，20的第一扳机14a。第一板机14a的致动有效地使闭合管12c滑过钳爪18，20，闭合钳爪18，20。手柄14还包括可动地与其联接的第二扳机14b，用于击发第一钳爪20内的钉仓，向组织内输送一个或多个缝钉。第二扳机14b还可有效地向远侧推进刀刃穿过第一钳爪18内的钉仓，以切割被缝合的组织。用于击发缝钉和切割组织的示例性技术将在下面进行更详细的描述。虽然未示出，手柄14可额外地或选择地包括扳机、可旋转调节钮、控制杆、滑动调节钮或用于使端部执行器16相对于细长轴16关节运动、闭合钳爪以及致动端部执行器16的其它机构。使用时，外科缝合器10尤其适合于内窥镜和结肠镜检查操作，因为细长轴12较小的直径允许其适于穿过较小的入口或路径。然而，缝合器可适用于各种医疗操作。
关节运动
图4A-7示出了各种技术的示例性实施例，所述技术用于使端部执行器16相对于细长轴12关节运动，有利于使端部执行器16在待缝合组织附近定位。首先参见图4A-4C，所示细长轴12的远端12b通过枢轴关节22联接到端部执行器16的近端，从而端部执行器16可绕枢轴关节22相对于轴12枢转。装置10还包括滑棒24，滑棒24延伸穿过细长轴并具有远端24d，远端24d上具有轮齿24t，轮齿24t适于与在端部执行器16上形成的相应轮齿16t啮合。装置10还要包括一个或多个可电膨胀和可收缩致动器，如EAP致动器，用于移动滑棒24，使滑棒24上的轮齿24t带动端部执行器16上的轮齿16t，从而使端部执行器16相对于细长轴12枢转。虽然EAP致动器可采用各种技术实现滑棒24的运动，在一个示例性实施例中，EAP致动器可构造成使滑棒24横向运动。具体地说，第一EAP致动器26a可延伸穿过细长轴12邻近滑棒24第一侧面的至少一部分，而第二EAP致动器26b可延伸穿过细长轴12邻近滑棒24相对第二侧面的至少一部分，如图4A-4C所示。可以采用任何一种类型的EAP致动器，但在一示例性实施例中，EAP致动器26a，26b是层压类型的EAP致动器，当向该EAP致动器输送能量时，其适于横向膨胀。图4A和4C示出第一EAP致动器26a横向膨胀使滑棒24向第二EAP致动器26b横向运动，从而导致滑棒24使端部执行器16沿与滑棒24运动的方向相反的方向枢转。图4B示出均处于未膨胀非致动状态的两个致动器26a，26b，此时不向任何一个致动器26a，26b输送能量。可例如通过电源插座或其它能量源由电极向致动器26a，26b输送能量，所述电极延伸穿过轴12并与联接至设置在手柄14内或与手柄12联接的能量源上。手柄14还可包括与其联接并适于控制向每个致动器26a，26b输送的能量值的控制机构，如可旋转调节钮或拨盘。向每个致动器26a，26b输送的能量值由致动器26a，26b的膨胀量决定，从而允许选择地调节端部致动器16的枢转运动量。
本领域技术人员理解，虽然图4A-4C示出了带有横向膨胀EAP致动器26a，26b的横向运动滑棒24，滑棒24和致动器26a，26b可具有各种其它结构。例如，纤维束形式的多个EAP致动器可在细长轴12内表面和滑棒24之间横向延伸。当向致动器输送能量时，致动器可收缩或缩短，以将滑棒24拉向细长轴12，从而使滑棒24横向运动。可选择地，滑棒24可设置成纵向运动，以实现端部执行器16的运动，并且可采用EAP来实现滑棒24的纵向运动。在其它实施例中，滑棒自身或至少滑棒的一部分可由EAP致动器形成，该EAP致动器适于沿所需的方向轴向膨胀，以使滑棒横向运动。
图5A和5B示出了用于使端部执行器16’相对于细长轴12’关节运动的技术的另一实施例。在该实施例中，细长轴12’包括延伸穿过其中的滑棒24’，且该滑棒24’具有在其远端上形成的球24t’，并且该球24t’容纳于在端部执行器16’近端上形成的相应凹槽16s’内。滑棒24’还包括在其上形成的凸轮表面25a’，25b’，优选位于邻近细长轴12’远端的近侧。凸轮表面25a’，25b’可具有各种形状和尺寸，但在一示例性实施例中，如所示，凸轮表面25a’，25b’从滑棒24’的相对侧向外伸出且其为宽度向从近侧到远侧方向逐渐增加的楔形件。该装置还包括第一和第二致动件26a1’，26b1’，其延伸穿过细长轴12’且位于滑棒24’的相对侧上。每个致动件26a1’，26b1’包括形成在其上的凸轮表面27a’，27b’，适于邻接抵靠在形成于滑棒24’上的凸轮表面25a’，25b’上。因此，第一致动件26a’向远侧的运动使形成于其上的凸轮表面27a’在滑棒24’上形成的凸轮表面25a’上滑动，从而使滑棒24’从第一致动件26a’横向移开。由于滑棒24’横向运动，球24t’使端部执行器16’相对于细长轴12’枢转。相反，第二致动件26b’向远侧的运动使形成于其上的凸轮表面27b’在形成于滑棒24’上的凸轮表面25b’上滑动，从而使滑棒24’从第二致动件26b’横向移开，进而使端部执行器16’向相反的方向枢转。可在滑棒24’的每一侧上设置偏压元件(未示出)，如弹簧，以将滑棒24’偏压至如图5A所示的中央静止位置，从而当致动件26a’，26b’向近侧运动时允许滑棒24’返回到静止位置。
在一示例性实施例中，每个致动件26a1’，26b1’的运动可采用联接到其上的EAP致动器来实现。如图5A和5B所示，优选为纤维束类型致动器形式的EAP致动器绳索26a2’，26b2’分别在致动件26a1’，26b1’的远端和轴12’的远端之间延伸。当选择地向EAP致动绳索中的一个，如第一致动绳索26a2’输送能量时，绳索26a2’将会轴向收缩或缩短，如图5B所示，从而将联接至受致动的EAP绳索26a2’上的致动件26a1’沿远侧方向拉动。致动件26a1’上的凸轮表面27a’将抵靠在滑棒24’上的凸轮表面25a’上，以使滑棒24’横向移向第二致动件26b1’。因此，滑棒24’远端上的球24t’使端部执行器16’关节运动或绕其枢转。
本领域技术人员将会理解，EAP致动器可具有各种其它结构，且它们可采用各种其它技术实现滑棒24’的运动。例如，当向EAP致动绳索26a2’，26b2’输送能量时，不是向远侧拉动滑棒24’，而是可使EAP致动器联接至滑棒24’的近端上且它们可适于向远端推动滑棒24’。在其它实施例中，在每个致动件26a1’，26b1’上形成的凸轮表面27a’，27b’可由EAP致动器形成，从而输送到凸轮表面27a’，27b’的能量使凸轮表面27a’，27b’向滑棒24’膨胀，由此使滑棒24’沿所需的方向运动，使缝钉施放装置16’关节运动。每个致动件26a1’，26b1’的运动量以及缝钉施放装置16’的关节运动量还可通过控制输送到每个EAP致动器的能量值来进行控制。
图6A和6B示出用于使端部执行器16”关节运动的技术的又一实施例。在该实施例中，不是采用滑棒来使端部执行器16”枢转，而是使两个致动件26a”，26b”直接联接至缝钉施放装置16”的相对侧上以推拉缝钉施放装置16”，实现关节运动。具体地，每个致动件26a”，26b”的远端通过枢轴关节联接至缝钉施放装置16”的近端上，从而第一致动件26a”向近侧的运动使缝钉施放装置16”绕第二致动件26b”枢转，并且第二致动件26b”向近侧的运动使缝钉施放装置16”绕第一致动件26a”枢转。可采用各种技术使致动件26a”，26b”运动。例如，每个致动件26a”，26b”的全部或部分可由适于轴向膨胀的EAP形成，或者致动件26a”，26b”可联接至EAP致动器上，使致动件26a”，26b”向近侧和远侧运动，从而使端部执行器关节运动。
图7示出使端部执行器16”关节运动的技术的另一实施例。在该实施例中，细长轴12”包括适于允许端部执行器16
相对于轴12
关节运动的挠性部分12p。一个或多个EAP致动器可在各种位置定位在细长轴12的挠性部分12p之内、之上或周围，且EAP致动器可设置成当向致动器输送能量时使挠性部分12p挠曲，从而使端部执行器16关节运动。图7示出沿细长轴12
的挠性部分12p
的不同部分轴向延伸的多个EAP致动器261，262，263，264，265。虽然未示出，多个EAP致动器可定位于挠性部分12p
圆周周围各其它位置处。使用时，例如，向第一致动器261输送的能量可使第一致动器261轴向收缩，从而使挠性部分12p的一部分弯曲。用户从而可选择地向一个或多个致动器输送能量以使端部执行器16
按照需要进行关节运动和定位。
本领域技术人员将会理解，EAP致动器可以结合到各种其它关节运动机构内来实现端部执行器的关节运动。作为非限制性实例的形式，于2005年2月18日提交的，发明名称为“Surgical Instrument Incorporating A Fluid TransferControlled Articulation Mechanism”的美国专利申请No.10/061,908公开了各种利用流体气囊来实现外科缝合组件的关节运动的关节运动机构，该申请的全部内容通过引用并入本文。代替采用流体气囊外，也可采用EAP致动器向该装置施加力以实现关节运动。
致动
如前所述，本发明还提供用于致动外科缝合器上的端部执行器的示例性方法和装置，包括击发缝钉和选择地驱动刀具或刀刃穿过组件以切割缝合的组织。图8A-10B示出用于采用一个或多个EAP致动器击发端部执行器16和驱动刀具或刀刃穿过组件以切割缝合的组织的技术的各种示例性实施例。本领域技术人员将会理解，端部执行器可具有各种结构，EAP致动器可结合至各种其它端部执行器中以实现击发和/或切割。
图8A-8D示出采用EAP致动器击发缝钉和切割组织的技术的一个示例性实施例。在该实施例中，采用EAP致动器纵向驱动组件穿过细长轴来驱动设置在钉仓内的多个缝钉驱动器，并且切割被缝合的组织。图8A更详细地示出了图3中的外科缝合装置10的远侧部分，其中示出了形成细长轴12和端部执行器16的一些部件。如前面所描述的，端部执行器16包括第一和第二相对钳爪18，20，其在图8B中示出为处于打开位置。第一钳爪18收纳有盛放钉仓34的托盘30。钉仓34适于容纳优选定向为纵向延伸的多排缝钉33，以及也优选定向为纵向延伸的多排缝钉驱动器32。驱动器32有效地驱动缝钉33穿过在钉仓34内形成的开口34a。具体地，如图8C所更详细示出的，驱动器32向第二钳爪20的运动将会推动缝钉33穿过在钉仓34内形成的开口34a并将其推向在第二钳爪20内形成的相应凹槽20a，其中第二钳爪20形成钉砧。
可采用各种技术使驱动器32运动，但在所示出的实施例中，通过推动楔形滑块驱动器42穿过在钉仓34内形成的纵向延伸槽来移动驱动器32。楔形滑块驱动器42可包括凸轮表面，该凸轮表面与缝钉驱动器32接触并将缝钉驱动器32向上升起，驱动缝钉向上穿过钉仓34内形成的开口34a并进入第二钳爪20内形成的相应凹槽20a。在一示例性实施例中，可采用推杆40使楔形滑块驱动器42运动，推杆40可滑动地穿过细长杆12且包括与楔形滑块驱动器42接合的远端41，使楔形滑块驱动器42相对于钉仓34滑动。推杆40的远端41还可包括在其上形成的切割表面41a，用于在组织缝合期间或之后切割组织。
在一个示例性实施例中，可采用EAP致动器推动推杆40穿过装置10的细长轴12。如图8A所示，推杆40的近端设置成与击发槽44联接。EAP致动器46延伸穿过击发槽44并在其远端与击发槽44配合。EAP致动器46的近端可联接至壳体14的一部分上，可采用电极从设置在壳体14内或与壳体14联接的能量源向EAP致动器46输送能量。当向EAP致动器46输送能量时，致动器可轴向膨胀以使击发槽44和推杆40从如图8C所示的初始位置运动到如图8D所示的最远侧位置。当击发槽44和推杆40向远侧运动时，楔形滑块驱动器42驱动设置在钉仓34内的缝钉驱动器32向第二钳爪20运动，从而驱动缝钉33穿过接合在第一和第二钳爪18，20之间的组织。当终止能量输送时，EAP致动器46将返回其未膨胀状态，从而使推杆40和击发槽44向近侧运动到其初始位置，并允许驱动器32返回其初始、未受致动的位置。如图8A所进一步示出的，推杆40的一部分可延伸穿过有效保持推杆40与钉仓34对准的引导装置37。还可在推杆40和击发槽44周围设置框架36，且整个组件可以在细长轴12的闭合管12c内纵向运动。
在一个实施例中，可采用可动地与壳体联接的第二扳机14b控制向EAP致动器46输送的能量。第二扳机14b可联接至任何能量源上，如设置在壳体14内的电池、外部电池组或电源插座。第二扳机14b的致动可有效增加从能量源通过电极向EAP致动器46输送的能量值，从而使击发槽44和推杆30运动。所输送的能量值可对应于击发槽44和推杆30的运动量。可选择地，代替采用枢转扳机14b，手柄14可包括按钮、杠杆、旋钮、拨盘或其它机构来控制向EAP致动器46输送的能量。本领域技术人员将会理解，可采用各种技术来控制向EAP致动器46输送的能量。
虽然图8A-8D示出了向远侧驱动击发槽44和推杆40的EAP致动器46，EAP致动器可具有使楔形滑块驱动器42运动穿过钉仓34的各种其它结构。例如，在另一实施例中，EAP致动器可设置成轴向收缩或缩短，而不是轴向膨胀或伸长。这样，EAP致动器可以与击发槽44或推杆40联接，当EAP致动器轴向收缩时，允许EAP致动器将击发槽44或推杆40拉向远侧。在另一实施例中，EAP致动器46可代替击发槽44且其可以直接连接到推杆40上，使推杆40运动穿过细长轴12。可选择地，推杆40的一部分可由用于直接移动推杆40的EAP致动器形成，或者EAP致动器可代替整个推杆40，直接驱动楔形滑块驱动器42穿过钉仓34。
在另一实施例中，代替采用楔形滑块驱动器42来移动驱动器32，可采用多个EAP致动器带来直接驱动设置在钉仓内的多个缝钉驱动器。在图9A-9B中示出这样一个示例性实施例，其中示出闭合管12c’的一部分和钉仓的一部分。如图所示，钉仓包括多排纵向延伸的驱动器32’，每排驱动器32’可包括一个或多个EAP致动器带35’，其设置在驱动器32’下方并适于在被输送能量时膨胀或增加高度，使驱动器32’移向钉砧或第二钳爪20。在一示例性实施例中，EAP致动器带35’是层压类型的。EAP致动器带35’的数量以及由每个EAP致动器带35’驱动的驱动器32’的数目可以改变。在图9A和9B示出的实施例中，钉仓(未示出)包括六排纵向延伸的缝钉驱动器32’，每排中有11个驱动器32’。单个EAP致动器35’可设置在每个驱动器32’下面，或者一个或多个细长EAP致动器带35’可设置在几个驱动器32’的下面。图9A和9B示出设置在第一排驱动器中的六个驱动器32’下面的纵向定向的EAP致动器带35’。当向EAP致动器带35’输送能量时，EAP致动器带35’膨胀，使设置在其上的驱动器32’移向第二钳爪(未示出)。这样，驱动器32’驱动设置在其上的缝钉33’进入在第二钳爪内形成的凹槽中，从而钉进设置在钳爪之间的组织。能量可通过电极37’向每个致动器带35’输送，电极37’与每个致动器带联接并与电源联接。
如图9A和9B所进一步示出的，该装置还可包括位于多排缝钉驱动器32’之间的切割刃41’。切割刃41’可设置成在缩回位置和伸出位置之间上下运动，在缩回位置，切割刃41’缩进钉仓，在伸出位置，切割刃41’伸向第二钳爪(未示出)。纵向取向的EAP致动器带(未示出)可设置在切割刃41’下面，且其在被输送能量时膨胀或增加高度，使切割刃41’从缩回位置运动到伸出位置，从而切割接合在钳爪之间的组织。终止向EAP致动器的能量输送将使切割刃41’返回其缩回位置。
图10A-10B示出采用EAP致动器击发缝钉的技术的又一实施例。在该实施例中，采用多个EAP致动器直接驱动设置在钉仓内的多个缝钉。如所示，与闭合管12c”的远端联接的钉仓34”包括设置在其中的多个细长EAP致动器带35a-g”。致动器带35a-g”被布置成通过钉仓34”向第二钳爪直接驱动缝钉33”，其中第二钳爪形成钉砧。可采用多个致动器带35a-g”，因为它们能够分别驱动多组或多个区域的缝钉33”钉进组织。本领域技术人员将会理解，每个EAP致动器35a-g”可设置成单独驱动单个缝钉或任何数目的缝钉。使用时，当例如通过电极向致动器35a-g”输送能量时，致动器35a-g”向第二钳爪膨胀，以向第二钳爪驱动缝钉33”。当终止能量输送时，致动器35a-g”收缩返回至未膨胀状态。
基于上述实施例，本领域技术人员将会理解本发明的进一步的特征和优点。因此，本发明不受已具体示出和描述的内容的限制，除非后附权利要求书所指明。在此引证的公开内容和参考内容全部清楚地通过引用并入本文。
Claims (8)
1.一种外科缝合器(10)，包括：
细长轴(12)，其限定了纵向轴线；
直线型缝钉施放组件(16)，其可动地与所述细长轴联接并适于输送多个缝钉；以及
电活化聚合物致动器(26a、26b)，其联接在所述细长轴(12)和直线型缝钉施放组件(16)之间，当向该电活化聚合物致动器输送能量时，所述电活化聚合物致动器适于选择地使直线型缝钉施放组件相对于细长轴枢转；
其中所述直线型缝钉施放组件通过枢轴关节(22)可动地联接到所述细长轴上并且所述细长轴(12)包括穿过其中延伸的滑棒(24)；
其特征在于：
该滑棒(24)具有联接到枢轴关节(22)上的远端(24d)，电活化聚合物致动器(26a、26b)使该滑棒(24)横向运动，从而实现直线型缝钉施放组件(16)的枢转运动。
2.根据权利要求1所述的外科缝合器(10)，其特征为，所述电活化聚合物致动器包括邻近滑棒第一侧设置的第一电活化聚合物致动器(26a)以及邻近滑棒第二侧设置的第二电活化聚合物致动器(26b)，所述第一和第二电活化聚合物致动器在被输送能量时横向膨胀，使所述滑棒横向运动。
3.根据权利要求1所述的外科缝合器，其特征为，所述滑棒(24)的远端(24d)包括齿轮(24t)，该齿轮适于与在枢轴关节(22)上形成的相应齿轮啮合。
4.根据权利要求1所述的外科缝合器(10)，其特征为，所述电活化聚合物致动器包括在细长轴(12)的第一侧和直线型缝钉施放组件(16)的第一侧之间延伸的第一电活化聚合物致动器(26a)，以及在细长轴的相对第二侧和直线型缝钉施放组件的相对第二侧之间延伸的第二电活化聚合物致动器(26b)。
5.根据权利要求4所述的外科缝合器(10)，其特征为，所述第一和第二电活化聚合物致动器(26a、26b)适于轴向收缩，使直线型缝钉施放组件(16)相对于细长轴(12)枢转。
6.根据权利要求1所述的外科缝合器(10)，其特征为，所述直线型缝钉施放组件(16)通过挠性部分(12p)可动地与细长轴(12)联接。
7.根据权利要求6所述的外科缝合器(10)，其特征为，所述电活化聚合物致动器包括在不同位置处联接至所述挠性部分(12p)上的多个电活化聚合物致动器，所述多个电活化聚合物致动器的每一个在被选择地输送能量时，改变取向以使挠性部分挠曲。
8.根据权利要求1所述的外科缝合器(10)，还包括在细长轴近端(12a)上形成的手柄，该手柄上具有用于向所述电活化聚合物致动器输送能量的控制机构。
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- 2006-09-28 CA CA2561653A patent/CA2561653C/en not_active Expired - Fee Related
- 2006-09-28 CA CA2561473A patent/CA2561473C/en not_active Expired - Fee Related
- 2006-09-28 AU AU2006222753A patent/AU2006222753B2/en not_active Ceased
- 2006-09-29 AT AT06255062T patent/ATE432048T1/de not_active IP Right Cessation
- 2006-09-29 JP JP2006267291A patent/JP2007098132A/ja active Pending
- 2006-09-29 EP EP06255065A patent/EP1769754B1/en active Active
- 2006-09-29 DE DE602006006953T patent/DE602006006953D1/de active Active
- 2006-09-29 JP JP2006267300A patent/JP5349746B2/ja not_active Expired - Fee Related
- 2006-09-29 BR BRPI0604765-3A patent/BRPI0604765A/pt not_active Application Discontinuation
- 2006-09-29 EP EP06255062A patent/EP1769757B1/en active Active
- 2006-09-29 BR BRPI0604720-3A patent/BRPI0604720A/pt not_active Application Discontinuation
- 2006-09-30 CN CN2006101463805A patent/CN1939232B/zh not_active Expired - Fee Related
- 2006-09-30 CN CN2006101463792A patent/CN1939231B/zh not_active Expired - Fee Related
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Also Published As
| Publication number | Publication date |
|---|---|
| AU2006222753B2 (en) | 2012-09-27 |
| AU2006222753A1 (en) | 2010-03-11 |
| CN1939231B (zh) | 2010-08-18 |
| AU2006222756B2 (en) | 2012-09-27 |
| AU2006222756A1 (en) | 2007-04-19 |
| JP2007098132A (ja) | 2007-04-19 |
| EP1769757B1 (en) | 2009-05-27 |
| CA2561473C (en) | 2014-07-29 |
| CA2561473A1 (en) | 2007-03-30 |
| CA2561653C (en) | 2014-07-08 |
| EP1769754B1 (en) | 2010-06-16 |
| CN1939232A (zh) | 2007-04-04 |
| JP5349746B2 (ja) | 2013-11-20 |
| BRPI0604720A (pt) | 2007-08-28 |
| JP2007098133A (ja) | 2007-04-19 |
| DE602006006953D1 (de) | 2009-07-09 |
| BRPI0604765A (pt) | 2007-09-04 |
| EP1769757A1 (en) | 2007-04-04 |
| ATE432048T1 (de) | 2009-06-15 |
| EP1769754A1 (en) | 2007-04-04 |
| CN1939231A (zh) | 2007-04-04 |
| CA2561653A1 (en) | 2007-03-30 |
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