CN1951333A - 具有端部执行器夹持表面的外科缝合器械 - Google Patents
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Abstract
一种外科器械，用于以内窥镜方式或者以腹腔镜方式插入套管针的插管内进入充气的体腔或者腔体(“手术部位”)中，以便同时进行组织的缝合和切割，该外科器械包括在上和下钳口的内表面上的夹持表面，其增强了用作夹持器械的作用，以便在执行缝合和切割手术之前对组织进行预定位。一种示出的形式有利地包括单独的闭合触发器和便于用作抓钳而不会无意中击发(例如，缝合和切割)的闭合机构。
Description
技术领域
本发明总的涉及一种外科缝合器械，它能够向组织施加成排钉，同时在那些钉线之间切割组织，更具体地说，本发明涉及有关缝合器器械的改进以及用于形成这种缝合器器械的各种组成元件、包括向被切割和缝合的组织增加垫材料的方法的改进。
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手术装置受欢迎，因为较小的切口易于减小术后恢复时间和并发症。内窥镜和腹腔镜手术的使用已经比较流行，并且已经形成了对进一步发展该手术的附加的激励。在腹腔镜手术中，通过小的切口在腹部内执行手术。类似地，在内窥镜手术中，通过经由皮肤上的小的进入伤口插入的狭窄内窥式导管在身体的任何中空内脏中执行手术。
腹腔镜和内窥镜手术通常要求对手术区域吹气。因此，必须密封插入体内的任何器械，以确保气体不会通过切口进入身体中或者从体内排出。而且，腹腔镜和内窥镜手术经常要求医生对远离切口的器官、组织和/或血管进行操作。这样，在这种手术中使用的器械一般长而窄，同时其在功能上可从该器械的近端进行控制。
在适于在所需的手术部位通过套管针的插管精确放置远端执行器的内窥镜外科器械的领域中已经有了重大发展。这些远端执行器以各种方式接合组织(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)，以获得诊断或者治疗效果。
已知的外科缝合器包括端部执行器，该端部执行器可同时在组织上制造纵向切口和在该切口的相对侧上施加成排钉。所述端部执行器包括一对协作的钳口构件，如果要将该器械用于内窥镜和腹腔镜应用场合，所述成对钳口构件能够通过插管通道。其中一个钳口构件容纳钉仓，该钉仓具有至少两排横向隔开的钉。另一个钳口构件形成砧座，该砧座具有与钉仓中的成排钉对准的钉形成槽。所述器械包括多个平移楔形件，当被向远侧驱动时，所述楔形件通过在钉仓中的开口并与支撑钉的驱动器接合，以使钉向着砧座击发。
最近，如在于2003年6月20日提交、名称为“Surgical StaplingInstrument Having a Firing Lockout for an Unclosed Anvil”的美国专利申请No.10/441,580中所描述的，改进的外科缝合和切割器械增强了组织定位以及缝合和切割的临床灵活性，该文献的全部内容通过引用结合到本文中。单独的闭合触发器能够被用作抓钳，而不会有无意中击发的危险(例如，同时缝合和切割)。尽管是有效的手段，还希望进一步增强，从而外科缝合和切割器械可用作抓钳。
因此，迫切需要一种改进的外科缝合和切割器械，它包括钉施加组件(端部执行器)，该钉施加组件能够有效地夹持组织，用于在执行缝合和切割手术前进行预定位。
发明内容
本发明通过提供一种外科器械来克服上述和其它现有技术的缺陷，所述外科器械包括一种外科缝合器械，该外科缝合器械具有向上分配钉的下钳口，所述钉抵靠以可枢转的方式连接的上钳口的内表面而形成。手柄通过细长轴进行操作，以分配钉并且穿过被夹钳的组织形成钉。在缝合之前，可以选择性地采用触发器，以便打开或闭合上钳口，同时操纵所述手柄并由此操纵各钳口，用作抓钳来定位组织，准备缝合或用于其它目的。在所述钳口的内表面上的非平面夹持表面有益地辅助夹持组织，以便进行定位。由此增强了临床灵活性和效率。
在本发明的一个方面中，在相对的各钳口的内表面上的夹持表面协作来夹持组织。
在本发明的另一个方面中，在致动所述击发触发器以便作为缝合和切割器械进行操作之前，单独的闭合触发器和击发触发器与夹持表面一起增强了用作夹持器械的操作。
参考附图及其说明，本发明的这些和其它目的和优点将会很清楚。
附图说明
结合入本说明书并构成其一部分的附图示出了本发明的实施方式，并且，它与上述本发明的总体说明和以下对实施方式的具体说明一起用于解释本发明的原理。
图1是外科缝合和切割器械的左侧的等轴测图，其中具有组织夹持表面的端部执行器(钉施加组件)张开。
图2是图1所示钉施加组件的左视图，在各个张开的钳口上带有相对的夹持表面。
图3是图2所示钉施加组件的左视图，带有闭合的钳口，以及非平面的松散啮合(联锁)的夹持表面。
图4是图2所示钉施加组件的从左下侧看的等轴测图，其中钳口张开。
图5是图2所示钉施加组件的从左上侧看的等轴测图，其中钳口张开。
具体实施方式
参照附图，在所有附图中，相同的附图标记表示相同的组成元件。在图1-5中，外科缝合和切割器械10包括手柄部分12(图1)，操纵该手柄部分12，以便定位由从远侧连接到细长轴18的紧固的端部执行器、具体地说是钉施加组件16形成的执行部分14。该执行部分14的尺寸被设定成可通过套管针的插管(未示出)插入，以用于内窥镜或腹腔镜外科手术。除了此处所描述的将夹持表面20增加到形成端部执行器16的下钳口22和可枢转地连接的上钳口(砧座)24的内表面上的特征之外，所述外科缝合和切割器械10如Shelton等人的名称为“Surgical Stapling Instrument Incorporating AMulti-Stroke Firing Mechanism With Return Spring Rotary ManualRetraction System”、序列号为No.11/052,387的美国专利申请中所述的一样，该文献的全部内容通过引用结合到本文中。这些夹持表面20改善了作为抓钳的使用，并且加强了在切割和缝合过程中组织的定位。
在使用过程中，将钉仓26插入细长的钉通道28中，以形成所述的下钳口22。医生向着手柄部分12的手枪式握把32枢转闭合触发器30。由此，闭合套管34向远侧平移，从而枢转闭合砧座24。然后，执行部分14被插入套管针的插管中进入充气的体腔或腔体中。医生可以通过转动经过手柄12的远端和细长轴18的近端接合的轴旋钮36来使执行部分14围绕其纵向轴线旋转。
此后，可以反复操作闭合触发器30，并且使手柄12定位，以便夹持和运动组织。靠近砧座24的内表面40上的远端的上横向夹持凸脊38(图2-4)与下钳口22的内表面44上的下横向夹持凸脊42(图1-5)协作。当钳口22、24闭合时，上夹持凸脊38和下夹持凸脊42松散啮合，从而在介于其间的组织上形成强有力的夹持，以辅助定位。在砧座24的内表面40上的钉形成孔46(图4)的形状和在钉仓26的内表面44中的钉分配孔48(图5)可有益地增强更靠近地置于钉施加组件16中的组织上的夹持力。
在图1中，一旦对钳口22、24在组织上的定位感到满意，医生进一步压下闭合触发器30，直到闭合触发器30锁定到靠近该手枪式握把32的位置。然后将击发触发器50压下，也许是多次，并且击发进程显示在手柄部分12上的击发计量器52上。击发触发器50被拉向闭合触发器24和手枪式握把32，从而使击发构件(未示出)在细长轴18内向远侧行进，以便在钉施加组件16内进行缝合和切割。之后，松开击发触发器50。如果击发构件没有自动地缩回，医生可抬起手动缩回杆54来帮助缩回。然后，将闭合松开钮56压下，以解锁闭合触发器30，从而张开钉施加组件16，并且由此松开组织的缝合好的切割端。
尽管通过几个实施方式的说明阐明了本发明，并且相当详细地描述了所示出的实施方式，但申请人并不是想要限制所附的权利要求的范围，或者将所附权利要求的范围限制到这样的细节。其它的优点和变型对本领域技术人员来说是容易想到的。
尽管描述的是带横向凸脊的表面38、42，应该理解，也可以使用带齿的表面、带凸缘的表面等。
作为另一个实施例，尽管所示出的形式包括设置在钉施加组件16的缝合和切割区域的远侧的夹持部分，根据本发明的应用可以包括其轮廓被设置成与砧座的内表面的镜像轮廓啮合的钉仓，以便增加夹持力。例如，砧座和细长通道的每一个的外横向边缘可以包括沿着它们的长度松散啮合的齿条部分。
作为又一个实施例，尽管外科缝合和切割器械包括单独的闭合触发器和击发触发器，根据本发明各个方面的应用可包括带有可顺序地闭合端部执行器的单个触发器以及进一步运动导致切割和缝合的那些应用。
作为再一个实施例，尽管为了清楚起见描述了手动操作的外科缝合和切割器械10，应该理解，可由机器人操纵和/或控制的紧固装置可包括力控制的击发杆。
Claims (10)
1.一种外科器械，包括：
在操作上被构造成向上分配钉的下钳口；
以可枢转的方式连接到所述下钳口的上钳口；
连接到所述下钳口的细长轴；
手柄部分，其从近侧连接到所述细长轴，并且在操作上被构造成从下钳口驱动钉；
连接成向该手柄部分进行运动的触发器，其在操作上被构造成闭合所述上钳口；以及
设置在包括所述上钳口和下钳口的组中的至少一个的内表面上的非平面夹持部分。
2.如权利要求1所述的外科器械，其中，所述非平面夹持部分包括带凸脊的表面。
3.如权利要求1所述的外科器械，其中，所述上钳口的内表面包括被对准成与在所述下钳口的内表面上的下夹持表面松散啮合的上夹持表面。
4.如权利要求3所述的外科器械，其中，所述上和下夹持表面包括带横向凸脊的表面。
5.如权利要求1所述的外科器械，其中，所述手柄部分还包括击发触发器，该击发触发器在操作上被构造成切割夹钳在所述上和下钳口之间的组织，并且从所述下钳口分配钉，用于抵靠所述上钳口的内表面使钉成形。
6.一种外科器械，包括：
在操作上被构造成向上分配钉的下钳口；
以可枢转的方式连接到所述下钳口的上钳口；
连接到所述下钳口的细长轴；
手柄部分，通过所述细长轴可操作地连接到上钳口；
连接成向该手柄部分进行运动的触发器，其在操作上被构造成闭合所述上钳口；
设置在所述上钳口的内表面上的上非平面夹持表面；以及
设置在所述下钳口的内表面上且与所述上非平面夹持表面对准的下非平面夹持表面。
7.如权利要求6所述的外科器械，其中，所述上和下夹持表面包括带横向凸脊的表面。
8.如权利要求6所述的外科器械，其中，所述手柄部分还包括击发触发器，该击发触发器在操作上被构造成切割夹钳在所述上和下钳口之间的组织，并且从所述下钳口分配钉，用于抵靠所述上钳口的内表面使钉成形。
9.一种外科器械，包括：
细长的钉槽；
接合到所述细长钉槽中以形成下钳口的钉仓；
以可枢转的方式连接到所述下钳口的砧座；
连接到所述下钳口的细长轴；
手柄部分，其从近侧连接到所述细长轴，并且通过所述细长轴可操作地连接到所述砧座；
连接成向该手柄部分进行运动的闭合触发器，其在操作上被构造成闭合所述砧座；
连接成向该手柄部分进行运动的击发触发器，其在操作上被构造成通过所述钉仓进行缝合，并且切割在所述钳口之间的组织；
设置在所述上钳口的内表面上的上非平面夹持表面；以及
设置在所述下钳口的内表面上且与所述上夹持表面对准的下非平面夹持表面。
10.如权利要求9所述的外科器械，其中，所述非平面夹持部分包括带凸脊的表面。
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US11/235,591 | 2005-09-26 | ||
| US11/235,591 US7451904B2 (en) | 2005-09-26 | 2005-09-26 | Surgical stapling instrument having end effector gripping surfaces |
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| CN1951333A true CN1951333A (zh) | 2007-04-25 |
| CN1951333B CN1951333B (zh) | 2012-02-01 |
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| US (1) | US7451904B2 (zh) |
| EP (2) | EP2263565B1 (zh) |
| JP (1) | JP5259065B2 (zh) |
| CN (1) | CN1951333B (zh) |
| AU (1) | AU2006222671B2 (zh) |
| CA (1) | CA2560808C (zh) |
| PL (2) | PL1767157T3 (zh) |
Cited By (97)
| Publication number | Priority date | Publication date | Assignee | Title |
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-
2005
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2006
- 2006-09-25 CA CA2560808A patent/CA2560808C/en not_active Expired - Fee Related
- 2006-09-25 PL PL06254953.0T patent/PL1767157T3/pl unknown
- 2006-09-25 AU AU2006222671A patent/AU2006222671B2/en not_active Ceased
- 2006-09-25 PL PL10177535T patent/PL2263565T3/pl unknown
- 2006-09-25 EP EP10177535.1A patent/EP2263565B1/en active Active
- 2006-09-25 EP EP06254953.0A patent/EP1767157B1/en active Active
- 2006-09-25 JP JP2006259059A patent/JP5259065B2/ja active Active
- 2006-09-26 CN CN2006101393395A patent/CN1951333B/zh active Active
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| US20070068989A1 (en) | 2007-03-29 |
| CN1951333B (zh) | 2012-02-01 |
| AU2006222671B2 (en) | 2012-08-23 |
| EP1767157A1 (en) | 2007-03-28 |
| CA2560808A1 (en) | 2007-03-26 |
| EP1767157B1 (en) | 2016-03-30 |
| PL2263565T3 (pl) | 2017-04-28 |
| BRPI0603966A (pt) | 2007-06-12 |
| JP5259065B2 (ja) | 2013-08-07 |
| CA2560808C (en) | 2014-08-05 |
| JP2007090070A (ja) | 2007-04-12 |
| EP2263565B1 (en) | 2016-10-26 |
| US7451904B2 (en) | 2008-11-18 |
| AU2006222671A1 (en) | 2007-04-19 |
| EP2263565A1 (en) | 2010-12-22 |
| PL1767157T3 (pl) | 2016-10-31 |
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