CN1947663A - 带有端部执行器支承件的外科缝合器 - Google Patents

带有端部执行器支承件的外科缝合器 Download PDF

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CN1947663A
CN1947663A CNA2006101422951A CN200610142295A CN1947663A CN 1947663 A CN1947663 A CN 1947663A CN A2006101422951 A CNA2006101422951 A CN A2006101422951A CN 200610142295 A CN200610142295 A CN 200610142295A CN 1947663 A CN1947663 A CN 1947663A
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马克·S·奥尔蒂斯
迈克尔·斯托克斯
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Abstract

本发明提供了一种外科缝合器，它具有用于保持钉的钉仓臂、与该钉仓臂可枢转地连接从而使从钉仓臂击发的钉变形的砧座和在钉击发过程中基本上防止砧座变形以帮助确保正确地形成钉的支承件。当处于第一位置时，一些支承件允许砧座和钉仓臂之间的枢转，但当处于第二位置中时防止或阻止枢转运作。支承件还适于与砧座在相对于砧座和钉仓臂之间的枢轴点的远侧位置处接触。本发明描述了以一个或多个连接件或套管体现的示例性支承件的结构。本发明还讨论了使用方法。

Description

带有端部执行器支承件的外科缝合器
技术领域
本发明广泛涉及外科装置，更具体地说涉及具有用于端部执行器的支承件的外科缝合器和/或切割器。
背景技术
内窥镜和腹腔镜外科器械通常比传统的开放式外科装置更受欢迎，因为(内窥镜的)自然孔口或(腹腔镜的)较小切口的使用有助于缩短术后康复时间并减少并发症。因此，适于将远端执行器精确设置在需要的手术部位的内窥镜和腹腔镜外科器械领域得到了极大的发展。这些远端执行器以多种方式(例如，内切割器、抓钳、切割器、缝合器、夹具施放器、进入装置、药物/基因治疗输送装置以及使用超声、RF、激光等的能量装置)与组织接合，从而实现诊断或治疗效果。
通常，内窥镜和腹腔镜外科缝合器具有缝合机构一端部执行器，该端部执行器适于通过插管配合使端部执行器相对于待缝合的组织定位。所述端部执行器具有容纳带有钉的钉仓的钉仓臂和与该钉仓臂可枢转地连接的砧座。钉仓臂和砧座分别用作分开的钳口，以便将待缝合的组织闭合并保持在一起。当钉仓致动时，钉从钉仓臂中被驱动、穿过组织、抵靠与在砧座中形成并与钉仓臂的钉对准的钉形成槽，由此形成将组织保持在一起的钉。
当缝合器同时击发成线性设置的多个钉时，砧座可发生变形。特别地，在砧座的未受支撑长度相对较长的情况下驱动钉所需的力可能会在砧座的远端形成很大的扭矩，导致变形。这可能产生畸形的钉，特别是向着相对较长的端部执行器的远端。由于内窥镜或腹腔镜手术采用小孔口或进入孔，端部执行器的厚度或外径必须受到限制。即使使用刚度非常高的材料(例如，钢或钛)作为砧座，当缝合器致动时变形仍然很显著。
因此，需要用于缝合和/或切割组织的改进的装置和方法。
发明内容
本发明总的提供了用于将砧座支撑于外科缝合器和/或切割器上的方法和装置。在一种实施方式中，外科缝合器包括端部执行器，该端部执行器具有用于保持一个或多个钉的钉仓臂，和与该钉仓臂可枢转地连接并使钉变形的砧座。所述装置还可包括当一个或多个钉从钉仓臂被驱动并抵靠砧座变形时适合与端部执行器接触并减小砧座的变形的支承件。在一种示例性实施方式中，钉仓臂可适于将多个钉保持为成至少一个线性的排。在其它实施方式中，当支承件处于塌缩位置允许端部执行器配合入小孔口或插管中时，端部执行器和支承件还可具有小于大约16mm的最大外径。
所述支承件可具有各种构造，但在一种实施方式中，它可适于在枢轴点的远侧位置与砧座接触。例如，该支承件可与砧座滑动连接，并可在近侧位置和远侧位置之间运动，在所述近端位置中砧座可围绕枢轴点运动，在远侧位置中支承件防止砧座围绕枢轴点运动。在一种示例性实施方式中，该支承件可包括彼此可枢转地连接的至少两个连接件，其中一个连接件与砧座可滑动地连接。特别地，所述支承件包括：与砧座滑动连接的远侧连接件，一端与远侧连接件枢转连接且相对端与从钉仓臂向近侧延伸的细长轴枢转连接的近侧连接件，和一端与所述细长轴枢转连接且相对端与远侧连接件和近侧连接件枢转连接的中间连接件。在另一种实施方式中，该支承件可以是可在第一位置和第二位置之间运动的套管的形式，在所述第一位置中砧座可相对于钉仓臂枢转，在所述第二位置中防止砧座相对于钉仓臂枢转。在其它实施方式中，所述装置可包括用于限制所述支承件向远侧运动的止动构件。例如，砧座可包括至少一个细长狭槽，用于滑动地容纳在支承件上形成的至少一个销构件。该狭槽可终止于砧座的大致中间位置，以限制支承件向远侧运动。
还提供了用于缝合组织的示例性方法。在一种实施方式中，该方法可包括将组织定位在外科缝合器的钉仓臂和砧座之间，并使支承件相对于砧座行进，当一个或多个钉被从钉仓驱动穿过定位在砧座和钉仓臂之间的组织并抵靠砧座变形而对组织进行缝合时，防止砧座相对于钉仓臂变形。
更具体地说，本发明涉及了如下内容：
(1)一种外科缝合器，包括：
端部执行器，该端部执行器具有用于保持至少一个钉的钉仓臂和与所述钉仓臂可枢转地连接并使所述至少一个钉变形的砧座；和
支承件，该支承件连接到所述端部执行器并可在近侧位置和远侧位置之间运动，在所述近侧位置中砧座和钉仓可相对彼此枢转，在所述远侧位置中所述支承件可与该端部执行器的至少中间部分接合，从而当至少一个钉从钉仓臂被驱动并抵靠砧座变形时防止砧座相对于钉仓臂变形。
(2)如第(1)项所述的外科缝合器，其中，当所述支承件处于近侧位置时该支承件与端部执行器轴向对准，并且当所述支承件处于远侧位置时该支承件大致横跨所述端部执行器(transverse to theend effector)延伸。
(3)如第(1)项所述的外科缝合器，其中，所述支承件包括与所述砧座可滑动连接的连接件。
(4)如第(3)项所述的外科缝合器，其中，所述连接件包括：与从该端部执行器向近侧延伸的细长轴可枢转地连接的近侧连接件，以及一端与所述近侧连接件可枢转地连接且相对端与砧座连接的远侧连接件。
(5)如第(4)项所述的外科缝合器，其中，所述远侧连接件在形成于砧座和钉仓臂之间的枢轴点的远侧的位置与砧座连接。
(6)如第(1)项所述的外科缝合器，其中，所述支承件包括可滑动地设置于砧座的至少一部分上方的套管。
(7)如第(1)项所述的外科缝合器，还包括与所述端部执行器连接并适于向着所述钉仓臂推动砧座的致动器。
(8)如第(1)项所述的外科缝合器，其中，所述支承件适于向着所述钉仓臂推动砧座。
(9)一种外科缝合器，包括：
适于保持多个钉的钉仓臂；
具有近端和远端的砧座，所述近端在枢轴点处连接到钉仓臂；和
支承件，该支承件与砧座可动地连接并适于在所述枢轴点的远侧的位置与砧座接触，从而当多个钉从钉仓臂被驱动并抵靠砧座变形时减小砧座的变形。
(10)如第(9)项所述的外科缝合器，其中，所述支承件可在近侧位置和远侧位置之间运动，在所述近侧位置中砧座可围绕枢轴点运动，在所述远侧位置中支承件防止砧座围绕枢轴点运动。
(11)如第(9)项所述的外科缝合器，其中，所述支承件包括至少两个彼此可枢转地连接的连接件，至少其中一个连接件与砧座可滑动地连接。
(12)如第(9)项所述的外科缝合器，其中，所述支承件包括：
与所述砧座可滑动地连接的远侧连接件；
在一端与所述远侧连接件可枢转地连接且相对端与从钉仓臂向近侧延伸的细长轴可枢转地连接的近侧连接件；和
在一端与所述细长轴可枢转地连接且相对端与所述远侧连接件和所述近侧连接件可枢转地连接的中间连接件。
(13)如第(9)项所述的外科缝合器，还包括适于限制所述支承件相对砧座向远侧运动的止动件。
(14)如第(13)项所述的外科缝合器，其中，所述止动件包括在砧座中形成的细长狭槽，和与所述支承件连接并可滑动地设置在该细长槽中的销构件。
(15)如第(14)项所述的外科缝合器，其中，在砧座中的所述细长狭槽在砧座的远端的近侧终止。
(16)如第(9)项所述的外科缝合器，其中，所述支承件包括可滑动地设置于砧座上方的套管。
(17)如第(9)项所述的外科缝合器，其中，所述钉仓臂包括设置于其中并容纳有布置成至少一个线性的排的多个钉的钉仓。
(18)如第(9)项所述的外科缝合器，其中，所述钉仓臂和砧座具有至少大约60mm的长度。
(19)如第(9)项所述的外科缝合器，其中，所述钉仓臂和砧座具有至少大约90mm的长度。
(20)如第(10)项所述的外科缝合器，其中，当所述支承件处于近侧位置时，所述钉仓臂、砧座和支承件具有小于大约16mm的最大外径。
(21)一种用于缝合组织的方法，包括：
将组织定位在外科缝合器的钉仓和砧座之间；
使支承件相对于砧座行进，以便防止该砧座相对于钉仓的运动；和
从钉仓驱动至少一个钉穿过定位在砧座和钉仓臂之间的组织并抵靠砧座，从而使钉变形而由此对组织进行缝合。
(22)如第(21)项所述的方法，其中，在定位组织之前，经过进入导管插入所述外科缝合器。
(23)如第(21)项所述的方法，还包括在驱动至少一个钉之前，在一段用户确定的时间内紧密接触位于砧座和钉仓之间的组织。
(24)如第(21)项所述的方法，其中，驱动至少一个钉包括驱动定向成至少一条直线的多个钉。
附图说明
通过下列结合附图的详细说明将会更全面地理解本发明，其中：
图1是根据本发明的一种实施方式的外科缝合器的侧视图；
图2A是图1的外科缝合器的端部执行器的透视图，显示出处于塌缩位置的支承件和枢转离开钉仓臂的砧座的一种实施方式；
图2B是图2A的端部执行器的透视图，显示出处于塌缩位置的支承件以及枢转到一起的砧座和钉仓臂；
图2C是图2A的端部执行器的透视图，显示出处于相对于砧座部分伸展位置的支承件；
图2D是图2A的端部执行器的透视图，显示出处于完全伸展位置以防止砧座变形的支承件；
图3A是外科缝合器的端部执行器的另一种实施方式的透视图，具有与钉仓臂枢转连接的砧座，和处于近侧位置以允许砧座枢转离开钉仓臂的支承套管；
图3B是图3A的端部执行器的透视图，显示出向着彼此枢转的砧座和钉仓臂，以及向着远侧位置行进以阻止砧座的运动的支承套管；和
图3C是图3A中所示的外科缝合器的手柄部分的透视图，显示出用于使支承套管在近侧和远侧位置之间运动的杆。
具体实施方式
总的来说，本发明提供了外科缝合器和/或切割器，该外科缝合器和/或切割器具有用于将钉输送到组织的端部执行器，和用于防止端部执行器变形的支承件。特别地，该端部执行器可包括适于保持钉的钉仓臂，和与所述钉仓臂枢转连接并适于使从钉仓臂驱动的钉变形的砧座。所述支承件可与端部执行器连接，并且它可在第一塌缩位置和第二伸展位置之间运动，在该第一塌缩位置中砧座臂可相对于钉仓臂枢转，在该第二伸展位置中支承件与砧座接合，从而当一个或多个钉被从钉仓臂被驱动并抵靠砧座变形时基本上限制砧座的变形。所述支承件特别有效地用于具有用于传送一个或多个线性的排或线的钉的相对较长的端部执行器的线性外科缝合器和/或切割器，这是因为在应用长的钉线期间该支承件可基本上防止砧座远端的变形。例如，该外科缝合器可具有端部执行器，该端部执行器的长度在大约60mm到90mm的范围中。该支承件还特别有效地用于内窥镜和腹腔镜手术，这是因为该支承件能够塌缩以允许端部执行器和支承件经过天然孔口(例如喉)被引入或者经过小的进入端口(例如插管和其它小通道)引入。例如，在示例性实施方式中，当支承件处于塌缩位置以允许支承件经过具有直径大约为16mm或更小的通道被插入时，端部执行器和支承件可具有小于大约16mm的最大外径。本领域技术人员将会理解，支承件可与各种紧固件输送装置一起使用，并且这里公开的线性缝合器仅仅作为参考而显示。
图1示出了具有用于限制或防止砧座变形的支承件30的外科缝合器10的一种示例性实施方式。如图所示，装置10通常包括手柄14，该手柄14具有从其延伸并包括近端12a和远端12b的细长轴12。轴外壳13被显示为设置在一部分细长轴12的上方。在细长轴12的远端12b上形成钉施加组件或者说端部执行器20。该端部执行器20包括相对的臂，称为钉仓臂24和砧座22，它们在其近端通过枢轴点26彼此可枢转地连接，并且适于将组织容纳于其间。钉仓臂24适于容纳钉仓，所述钉仓具有多个设置在其中并构造为被驱动到组织中的钉，砧座22包括多个在其中形成的槽，用于使钉变形。装置10还可包括一个或多个与其连接的触发器，用于致动端部执行器20，例如打开或闭合端部执行器的相对的钳口，和/或驱动切割刀穿过端部执行器20。图1示出了与手柄14可动连接、用于闭合端部执行器20的相对钳口的第一触发器14a。手柄14还包括第二触发器14b，该第二触发器14b可与手柄14可动连接、用于击发钉仓以便将一个或多个钉传送到组织中。第二触发器14b还可有效地使刀向远侧行进穿过钉仓来切割缝合的组织。虽然显示了两个触发器14a、14b，手柄14可另外或者作为替代地包括其它致动机构，例如旋钮、杆、滑动按钮等，用于致动端部执行器20。本领域技术人员将会理解，该装置可包括这里没有提及的各种其它零件。例如，该装置可包括在细长轴12和端部执行器20之间形成的关节运动接头，用于允许端部执行器20相对于细长轴12的带一定角度的运动。可在手柄上设置触发器或其它机构，用于对端部执行器20进行角度调节。
在图2A-2D中更详细地显示了支承件30。如图所示，支承件30采用连接组件的形式，其可动地连接于细长轴12和砧座22之间。特别地，支承件30包括近侧连接件32、远侧连接件34和中间连接件36，它们彼此枢转连接并可相对于细长轴12和端部执行器20运动。近侧连接件32具有以可枢转并可滑动的方式连接于细长轴12的一部分的近端32a(图2D)，和可枢转地连接于远侧连接件34的近端34a的远端32b。远侧连接件34从近侧连接件32的远端32b向远侧延伸，并且该远侧连接件34包括与砧座22以可枢转并可滑动的方式连接的远端34b。可使用各种技术来形成近侧连接件32的近端32a和细长轴12的远端12b之间的滑动和枢转连接、以及远侧连接件3的远端34b和砧座22之间的滑动和枢转连接。例如，近侧连接件32可与细长轴12的一部分连接，该细长轴12例如可使滑动顶杆50(图2D)滑动，并且可允许近侧连接件32相对其进行枢转运动。远侧连接件34可包括销构件，该销构件在砧座中形成的狭槽22c内滑动并且可允许远侧连接件34相对于砧座22的枢转运动。如上所述，支承件30还可包括中间连接件36。如图2C和2D所示，中间连接件36的第一端部36a与近侧连接件32的远端32b枢转连接，并与远侧连接件34的近端34a枢转连接，从而使所有三个连接件32、34、36在支承件30的中间部分彼此枢转连接。中间连接件36的第二端部36b在固定的枢轴点36c处与细长轴12枢转连接，从而使中间连接件36不能相对于细长轴12滑动。
在使用时，连接件32、34、36之间的连接允许支承件30在近侧塌缩位置和远端伸展位置之间运动，在近侧塌缩位置中砧座22可相对于钉仓臂24枢转，在远端伸展位置中，当一个或多个钉从钉仓臂24被驱动并抵靠砧座22变形时，支承件30有效地限制或防止砧座22变形。在图2A和2B中显示了近侧塌缩位置，并且如图所示，连接件32、34、36与端部执行器20基本上轴向对准，从而使细长轴12、端部执行器20和支承件30的最大外径沿着它们的长度基本不变，以允许装置10的远侧部分经过小通道(例如直径16mm或更小的通道)被引入。特别地，例如使用在缝合器的手柄上形成的触发器或其它机构(见下面更详细地讨论)使近侧连接件32沿着向近侧的方向完全缩回，以便沿着向近侧的方向拉动远侧连接件34，从而使远侧连接件34的远端34b处于相对于砧座22的最近侧位置。近侧连接件32向近侧的回缩还沿着向近侧的方向枢转中间连接件36的第一端部36a(在图2A和2B中未显示)，从而使中间连接件36容纳于在细长轴12中形成的开口中。在该位置，砧座22相对于钉仓臂24可自由打开或闭合。图2A示出了砧座22处于打开位置，用于将组织容纳于其间，图2B示出了砧座22处于闭合位置，用于接合其间的组织。如图2B所示，单独的闭合机构可用于将砧座22运动到闭合位置，或者作为替代，当支承件30向远侧伸展位置运动时支承件30可用于向着钉仓臂24推动砧座22。
在图2C和2D中支承件30显示为处于远侧伸展位置。如图所示，如在下面更详细讨论地那样，例如使用在缝合器的手柄上形成的触发器或者其它机构使近侧连接件32沿着向远侧方向朝着端部执行器20行进。近侧连接件32的向远侧运动可引起中间连接件36的第一端部36a围绕在中间连接件36的第二端部36b和细长轴12之间形成的固定枢轴点36c枢转。由于中间连接件36的第一端部36a运动离开细长轴12并围绕固定枢轴点36c枢转，远侧连接件34的近端34a将同样运动离开细长轴12，也就是说，相对于细长轴12旋转，并且远侧连接件34的远端34b将在砧座22中形成的细长狭槽22c中向远侧滑动。当远侧连接件34到达最远侧位置时，施加到近侧连接件32上的力不再使远侧连接件34行进，而是产生由远侧连接件34施加到砧座22上的向下的力，从而当钉从钉仓臂24向着砧座22被驱动时限制或阻止砧座22相对于钉仓臂24变形。
虽然支承件30可与砧座22的任何部分接合，在示例性实施方式中，支承件30可适于与砧座22的大致中间部分接合。这种构造可确保远侧连接件34在砧座22上施加向下的力，这种向下的力可选地使砧座运动到闭合位置。例如可使用止动构件限制支承件30相对于砧座22的运动来实现砧座22的中间部分的接合。在图2C和2D中所示的实施方式中，当狭槽22在砧座22的最远端终止时，在砧座22中形成的细长狭槽22c的端点22d用作止动构件。由此，端点22d将阻止远侧连接件34向远侧滑动到狭槽22c的最远端之外，由此引起远侧连接件34与砧座22的中间部分接合。还可使用可动的止动销调节狭槽的端点。该狭槽可包括止动销可插入其中的多个位置，止动销的位置可决定在不能发生进一步滑动之前远侧连接件能够向着砧座的远端滑动的程度。本领域技术人员将会理解，各种其它技术可用于形成限制支承件向远侧运动的止动件或其它机构。
如前所述，各种其它技术可用于使支承件30在近侧和远侧位置之间运动。例如，在一种实施方式中，近侧连接件可与穿过细长轴12延伸的顶杆50(图2D)枢转连接，该顶杆适于相对于细长轴12可滑动地运动，使近侧连接件32前进或回缩，由此使支承件30在近侧和远侧位置之间运动。可设置在装置的手柄上形成的杆、触发器或者其它机构来使顶杆50运动。本领域技术人员将会理解，支承件的运动和/或砧座以及钉仓臂的枢转可同时完成或者彼此独立完成，并且不依赖于钉从钉仓臂34的击发。
所述支承件还可具有各种其它构造来防止外科缝合器上的砧座变形。在另一种实施方式中，如图3A-3C所示，该支承件可以是可在第一位置和第二位置之间相对于端部执行器运动的套管形式。如图所示，外科缝合器300通常包括细长轴310，该细长轴310在其远端上形成端部执行器，该端部执行器包括砧座320和与砧座320枢转连接的钉仓臂330。套管340可滑动地设置在细长轴310的外壳内，并且能在近侧回缩位置(显示于图3A中)和远侧伸展位置(显示于图3B中)之间运动。套管340可具有各种形状和尺寸，并且可以基本上为管状，或者如图3A和3B中所示具有带有大致为半圆形横截面的大体细长的形状。当套管340处于近侧位置中(如图3A所示)时，套管340相对于砧座320完全回缩，从而允许砧座320相对于钉仓臂330枢转。当套管340行进到远侧位置时，套管340在枢轴点350的远侧位置处在砧座320上方滑动并与其接触，由此阻止或防止砧座320相对于钉仓臂330的相对运动。因此，当钉被击发时，套管340可限制或防止砧座320变形。
如与图2A-2D所示的实施方式一样，支承套管340的运动可以各种方式来实现。在一种实施方式中，如图3C所示，装置300的手柄370包括在其上形成并与套管340的近端连接的滑动按钮360。由此，滑动按钮360在近侧和远侧位置之间的运动有效地使套管340在近侧和远侧位置之间运动。
本领域技术人员将会理解，套管可具有各种其它构造，并且其不必在回缩和伸展位置之间运动。例如，套管可在第一位置和第二位置之间旋转，在该第一位置中套管在钉仓臂附近并允许砧座和钉仓臂的枢转，在第二位置中套管在砧座附近并限制或防止砧座相对于钉仓臂枢转。
本发明还提供了用于缝合组织的示例性方法。在一种示例性实施方式中，该方法可包括将外科缝合器的端部执行器引入到手术部位。该端部执行器可经天然孔口以内镜方式插入，或者可经小的切口或者进入口(例如插管)经腹腔镜引入。所述端部执行器优选以支承件处于回缩位置的状态被引入，在该回缩位置中，所述装置的细长轴的外径为其最小外径或者保持最小。例如，对于在图2A-2D中显示的装置10，支承件30优选以近侧塌缩位置引入。对于在图3A-3C中显示的实施方式，支承套管340可以任意位置引入，这是因为套管340没有增大该装置的外径。
一旦端部执行器靠近待缝合的组织定位，则操纵砧座和钉仓臂将组织定位在它们之间。然后例如使用支承件或者使用单独的闭合机构使砧座向着钉仓臂枢转，以接合砧座和钉仓臂之间的组织。如果没有将支承件用于闭合砧座，可使支承件行进以避免或防止砧座相对于钉仓臂的运动。可选地将所述组织挤压一段时间，以便促使组织“泌乳(milking)”，然后可致动端部执行器从钉仓臂驱动钉穿过砧座和钉仓臂之间的组织抵靠到砧座上。钉可抵靠砧座变形，并且支承件将防止砧座的变形。
基于上述实施方式，本领域技术人员将会理解本发明的其它特征和优点。因此，本发明不由已经具体显示和描述的实施方式来限定，而由所附的权利要求书来说明。

Claims (8)

1.一种外科缝合器，包括：
端部执行器，该端部执行器具有用于保持至少一个钉的钉仓臂和与所述钉仓臂可枢转地连接并使所述至少一个钉变形的砧座；和
支承件，该支承件连接到所述端部执行器并可在近侧位置和远侧位置之间运动，在所述近侧位置中砧座和钉仓可相对彼此枢转，在所述远侧位置中所述支承件可与该端部执行器的至少中间部分接合，从而当至少一个钉从钉仓臂被驱动并抵靠砧座变形时防止砧座相对于钉仓臂变形。
2.如权利要求1所述的外科缝合器，其中，当所述支承件处于近侧位置时该支承件与端部执行器轴向对准，并且当所述支承件处于远侧位置时该支承件大致横跨所述端部执行器延伸。
3.如权利要求1所述的外科缝合器，其中，所述支承件包括与所述砧座可滑动连接的连接件。
4.如权利要求3所述的外科缝合器，其中，所述连接件包括：与从该端部执行器向近侧延伸的细长轴可枢转地连接的近侧连接件，以及一端与所述近侧连接件可枢转地连接且相对端与砧座连接的远侧连接件。
5.如权利要求4所述的外科缝合器，其中，所述远侧连接件在形成于砧座和钉仓臂之间的枢轴点的远侧的位置与砧座连接。
6.如权利要求1所述的外科缝合器，其中，所述支承件包括可滑动地设置于砧座的至少一部分上方的套管。
7.如权利要求1所述的外科缝合器，还包括与所述端部执行器连接并适于向着所述钉仓臂推动砧座的致动器。
8.如权利要求1所述的外科缝合器，其中，所述支承件适于向着所述钉仓臂推动砧座。
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US8096459B2 (en) 2012-01-17
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