CN1960679B - 外科切割及钉缝设备 - Google Patents

外科切割及钉缝设备 Download PDF

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CN1960679B
CN1960679B CN2005800099196A CN200580009919A CN1960679B CN 1960679 B CN1960679 B CN 1960679B CN 2005800099196 A CN2005800099196 A CN 2005800099196A CN 200580009919 A CN200580009919 A CN 200580009919A CN 1960679 B CN1960679 B CN 1960679B
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CN1960679A (zh
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迈克尔·P·惠特曼
大卫·A·尼古拉斯
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Abstract

根据本发明的各种实施方式，本发明涉及用于切割和钉缝一部分组织的至少一个的外科设备。该外科设备包括含有至少两个驱动器的外壳。外科设备还包括能够机械地附连到该外壳并能够相对于该外壳在打开位置和关闭位置之间移动的砧。第一驱动器运行而将砧相对于该外壳移动到位于该打开位置和关闭位置之间的中间位置。第二驱动器运行而将该外壳的至少一部分相对于砧在该中间位置和关闭位置之间移动。

Description

外科切割及钉缝设备
相关申请交叉参考
本申请涉及如下专利申请：1999年6月2日提交的第09/324,452号美国专利申请，该申请授予第6,443,973号美国专利；2000年11月28日提交的第09/723,715号美国专利申请；1999年6月2日提交的第09/324,451号美国专利申请，该申请授予第6,315,184号美国专利；1999年7月12日提交的第09/351,534号美国专利申请，该申请授予第6,264,087号美国专利；2000年2月22日提交的第09/510,923号美国专利申请，该申请授予第6,517,565号美国专利；2000年2月22日提交的第09/510,927号美国专利申请；2000年2月22日提交的第09/510,932号美国专利申请，该申请授予第6,491,201号美国专利；2001年4月17日提交的第09/836,781号美国专利申请；2001年7月22日提交的第09/887,789号美国专利申请；在此明确引入各文献全文以供参考。
技术领域
本发明涉及一种机电外科系统，更具体地涉及一种机电外科系统的外科附属装置，其用于将患者身体中的组织夹紧、切割及钉缝。
背景技术
许多外科手术需要将外科器械引入到孔窍内。这样的外科手术的其中一个例子为：通过患者的口腔引入——例如插入——圆形的夹紧、切割及钉缝器械以从口腔通道切除癌变的或异常的组织。
此类外科手术期间所面临的一个问题是：当向孔窍内引入或者已经引入外科器械孔窍时，该孔窍可能会受到损伤。当外科设备被引入的孔窍包括脆弱的组织——例如口腔内的组织时，当接触时这些组织很容易受到损伤，这是特别成问题的。此类外科手术期间所面临的另一个问题是：当向孔窍内引入或者已经引入外科器械时，外科器械可能会受到损坏。避免外科设备的损坏是特别重要的，因为若外科设备的功能不正常，患者也可能受到伤害。
尽管外科器械的小型化方面取得了显著的进展，但是传统的外科器械一般还是不能在患者的比较小的孔窍或通道内使用，例如口腔。从而，传统的外科设备和外科手术仍然具有损害外科设备和孔窍/通道的其中一个或两个的危险。
从而，需要一种设备，该设备使得在将外科设备引入孔窍时，损害外科设备和患者的孔窍或通道——例如口腔通道——的其中一个或两个的可能性最小。
发明内容
根据本发明的各种实施方式，本发明涉及用于切割和钉缝一部分组织这二者至少其中之一的外科设备。该外科设备包括含有至少两个驱动器的外壳，外科设备还包括可机械地附连到该外壳并可相对于该外壳在打开位置和关闭位置之间移动的砧。操作第一驱动器而将砧相对于该外壳移动到位于该打开位置和关闭位置之间的中间位置。操作第二驱动器而将该外壳的至少一部分相对于砧在该中间位置和关闭位置之间移动。
有利地，该砧和外壳分别形成了第一和第二夹紧面。当砧位于关闭位置时，外科设备构造成夹紧在该砧的第一夹紧面和该外壳的第二夹紧面之间的一部分组织。该外壳可包括切割元件，该切割元件构造成由第二驱动器在缩回位置和延伸位置之间驱动。该外壳可还包括钉缝元件，该钉缝元件构造成由第二驱动器在缩回位置和延伸位置之间驱动。该钉缝元件包括：钉盒，该钉盒构造成由第二驱动器在该外壳内在缩回位置和延伸位置之间轴向地移动；和钉推进器，该钉推进器构造成将存储在钉盒的各个钉槽内的钉从钉槽推出并推到该砧的钉引导件中。
根据本发明的不同实施方式，本发明还涉及到用于钉缝一部分组织的外科设备。该外科设备包括钉推进器和构造成存储钉的外壳。该外壳能够相对于该钉推进器选择性地移动。该外科设备还包括相对于该钉推进器和外壳可移动的砧。该砧的运动导致该外壳相对于该钉推进器移动。该砧可相对于该钉推进器在第一位置和第二位置之间移动，在该第一位置该砧与该外壳的夹紧面隔开，在该第二位置该砧接触到该外壳的夹紧面。此外，该砧可相对于钉推进器在第二位置和第三位置之间移动，其中存储在外壳内的钉由钉推进器从外壳中推出以抵靠着砧而闭合。在一个实施方式中，该外壳通过剪力销连接到该钉推进器，其中该剪力销构造成在如下情形时剪切：当通过该砧在第二和第三位置之间运动而使得该砧在该外壳的夹紧面上施加预定量的压力时。
根据本发明的不同实施方式，本发明还涉及到用于切割一部分组织的外科设备。该外科设备包括切割元件和具有夹紧面的外壳。该外壳可相对于该切割元件选择性地移动。该外科设备还包括相对于该切割元件和外壳可移动的砧。该砧的运动促使该外壳相对于该切割元件移动。该砧可相对于该切割元件在第一位置和第二位置之间移动，在该第一位置该砧与该外壳的夹紧面隔开，在该第二位置该砧接触到该外壳的夹紧面。此外，该砧可相对于该切割元件在第二位置和第三位置之间移动，在该第三位置中，该切割元件被带到与该砧接触。在一个实施方式中，该外壳通过剪力销连接到该切割元件，其中该剪力销构造成在如下情形时剪切：当通过该砧在第二和第三位置之间的运动而使得该砧在该外壳的夹紧面上施加预定量的压力时。
根据本发明的不同实施方式，本发明还涉及到用于切割和钉缝一部分组织这二者至少其中之一的外科设备。该外科设备包括形成第一夹紧面的外壳。该外科设备还包括砧，该砧可机械地附连到外壳并可相对于该外壳沿着轴线在延伸位置和缩回位置之间移动。该砧形成有第二夹紧面。第一和第二夹紧面的至少一部分不垂直于该轴线。优选地，当该砧位于关闭位置时，该外科设备构造成夹紧第一和第二夹紧面之间的一部分组织。此外，第一和第二夹紧面可相对于彼此而平行。第一驱动器可用于使该砧相对于该外壳而移动。第二驱动器也可使用，其中该外壳包括切割元件，该切割元件构造成由第二驱动器在缩回位置和延伸位置之间驱动。此外，该外壳可包括钉缝元件，该钉缝元件构造成由第二驱动器在缩回位置和延伸位置之间驱动。
根据本发明的不同实施方式，本发明还涉及到用于切割和钉缝一部分组织这二者至少其中之一的外科设备。该外科设备还包括外壳，该外壳包括钉缝元件。该钉缝元件包括形成了多个槽的钉盒并且将钉存储在该槽内。该钉缝元件还包括钉推进器，该钉推进器具有与多个槽对准的钉推进器指部。该外科设备还包括构造成在缩回位置和中间位置之间一起移动钉盒和钉推进器的驱动器。在中间位置，驱动器将钉推进器相对于钉盒移动到延伸位置。该外科设备也可包括干涉元件，该干涉元件构造成：当驱动器使钉盒和钉推进器在缩回位置和中间位置之间一起移动时，保持钉盒与钉推进器的相对位置。该中间位置可为钉盒充分地夹紧一部分组织的位置或钉盒相对于外壳轴向地锁紧在合适位置的位置。该干涉元件可为易碎部件。可选地，该干涉元件可连接到钉推进器并可包括径向延伸的凸缘，该凸缘保持与一部分钉盒接触，直到达到预定的压力。该外科设备可还包括切割元件，例如刀片，其中该干涉元件的径向延伸的凸缘接触钉盒和刀片的相对设置的、径向延伸的凸缘。
根据本发明的不同实施方式，本发明还涉及到用于切割和钉缝一部分组织这二者至少其中之一的外科设备。该外科设备可包括外壳。该外科设备可还包括设置在外壳远端、形成多个槽的钉盒和存储在槽中的钉。该外科设备可还包括钉推进器，该钉推进器邻近钉盒设置并具有与多个槽对准的多个钉推进器指部。该外科设备可还包括推进器元件，该推进器元件邻近钉推进器设置、并构造成在外壳内同时旋转和相对于钉盒朝向远端推进。该推进器元件具有向钉推进器延伸的凸轮元件，使得凸轮元件顺序地推压多个钉推进器指部。该推进器元件可用键接合到例如十字头螺纹元件的颈部等可转动构件，该可转动构件朝向钉盒纵向地延伸。该外科设备还可包括邻近推进器元件设置的螺母，该螺母具有内螺纹孔，其中该螺母的内螺纹孔螺接到可转动构件。
根据本发明的不同实施方式，本发明还涉及到用于方便外科设备插入到患者的其中一个孔窍和通道的套筒，该外科设备具有形成横截面的远端。该外壳设备可包括构造成遮蔽外科设备的至少一部分的第一部分。该外壳设备还可包括选择性地在插入位置和缩回位置之间移动的至少一个闭合(closure)元件，其中在该插入位置，该闭合元件的横截面逐渐减小到小于该外科设备远端的横截面；在该缩回位置，该外科设备构造成通过该闭合元件在患者的孔窍和通道的其中一个内执行外科手术。
附图说明
图1是根据本发明的一个实施方式的机电外科系统的立体图。
图2是根据本发明的一个实施方式的远程电源控制台的立体图。
图3是图1所示的机电外科系统的柔性轴的局部剖开的侧视图。
图4是沿着图3所示的线4-4的柔性轴的剖视图。
图5(a)是图3所示的柔性轴的第一耦连器的后端视图。
图5(b)是图3所示的柔性轴的第二耦连器的前端视图。
图6(a)是图1所示的机电外科系统的马达装置的示意图。
图6(b)是图1所示的机电外科系统的示意图。
图6(c)是图3和图4中所示的柔性轴的编码器的示意图。
图6(d)是根据本发明的一个实施方式的存储器设备的示意图。图6(e)是根据本发明的一个实施方式的无线RCU的示意图。图6(f)是根据本发明的一个实施方式的有线RCU的示意图。
图7(a)是根据本发明的一个实施方式的手柄部分的前视立体图。
图7(b)是图7(a)示出的手柄部分的后视立体图。
图7(c)是图7(a)示出的手柄部分的分解前视立体图。
图7(d)是图7(a)示出的手柄部分的俯视图。
图7(e)是图7(d)示出的手柄部分的沿着线A-A的侧视截面图。
图7(f)是图7(d)示出的手柄部分的沿着线B-B的侧视截面图。
图8是根据本发明的一个实施方式的切割和钉缝部件位于展开状态的立体图。
图9是根据本发明的一个实施方式的切割和钉缝部件位于部分闭合状态的立体图。
图10(a)示出了根据本发明的一个实施方式的砧(anvil)组件的部件的立体图。
图10(b)示出了根据本发明的一个实施方式的钉和刀片(blade)部分的一些部件在分解状态下的立体图。
图10(c)示出了根据本发明的一个实施方式的钉和刀片部分的其余部件在分解状态下的立体图。
图11(a)示出了根据本发明的一个实施方式的切割和钉缝部件的俯视截面图。
图11(b)示出了根据本发明的一个实施方式的切割和钉缝部件的侧 视截面图。
图12(a)是根据本发明的一个实施方式的切割和钉缝部件的立体图。
图12(b)和12(c)示出了根据本发明的一个实施方式的线缆延伸元件的附加特征的侧视截面图。
图13(a)到13(c)示出了根据本发明的另一个实施方式的手柄部分。
图14(a)示出了根据本发明的另一个实施方式的切割和钉缝部件位于装配和部分闭合状态的前视立体图。
图14(b)示出了图14(a)所示的切割和钉缝部件位于装配和部分闭合状态的后视立体图。
图14(c)示出了图14(a)所示的切割和钉缝部件位于装配和部分闭合状态的侧视图。
图14(d)示出了图14(a)所示的切割和钉缝部件位于装配和部分闭合状态的后视图。
图15(a)示出了根据本发明的另一个实施方式的砧组件部件的前视分解图。
图15(b)示出了图15(a)所示的钉和刀片部分的一些部件的分解立体图。
图15(c)示出了图15(a)所示的钉和刀片部分的其余部件的分解立体图。
图15(d)示出了图15(a)所示的钉和刀片部分的一些部件的装配侧视截面图。
图16示意性地示出了根据本发明的另一个实施方式的外科附属装置的一些部件的侧视截面图。
图17示意性地示出了根据本发明的另一个实施方式的外科附属装置的一些部件的侧视截面图。
图18(a)示出了根据本发明的另一个实施方式的钉和刀片部分的一些部件的分解立体图。
图18(b)示出了图18(a)所示的钉和刀片部分的部件的装配侧视截面图。
图19(a)示出了根据本发明的一个实施方式的构造成遮蔽外科设备的套筒的分解立体图。
图19(b)示出了图19(a)所示的套筒部分在关闭位置的侧视截面图。
图19(c)示出了在打开位置的图19(a)所示的套筒的闭合元件。
图19(d)是根据本发明的另一个实施方式的构造成在插入位置遮蔽外科设备的套筒的立体图。
图19(e)是图19(d)所示的套筒在缩进位置的立体图。
具体实施方式
本发明涉及机电外科系统。图1是根据本发明的一个实施方式的机电外科系统10的立体图。
如图1所示，机电外科系统10包括远程电源控制台12，该远程电源控制台12带有从其上延伸的柔性轴20。该柔性轴20包括至少第一可转动驱动轴30和第二可转动驱动轴32。远程电源控制台12的另外的细节将结合例如图2描述并示出。柔性轴20的另外的细节将结合例如图3到图6描述并示出。
外科附属装置100在柔性线缆20的远端24附连到或可附连到耦连器26。外科附属装置100构造成执行外科手术。仅为了示例的目的，外科附属装置此后描述为圆形的夹紧、切割和钉缝设备，该设备构造成执行例如吻合手术。然而，应该认识到，外科附属装置可以是任意合适类型的外科设备。此外，仅为了示例的目的，此后描述的外科附属装置在患者的口腔通道中使用。然而，应该认识到，外科附属装置可以在患者的任意类型的孔窍或通道中使用。有利地，此后描述的外科附属装置具有比较小的横截面积，从而便于其进入到患者的例如口腔通道中。
外科附属装置100可包括手柄部分102。手柄部分102的近端102a在柔性线缆20的远端24可附连到耦连器26。外科附属装置100还可包括柔性轴104，至少第一驱动轴104a和第二驱动轴104b穿过该柔性轴延伸。手柄部分102的远端102b可附连到柔性轴104的近端104a。柔性轴104可由组织兼容的、可消毒的弹性体材料制成。优选地，柔性轴104可由耐高压加热的材料制成。此外，柔性轴104可由具有高或比较高的润滑性的材料制成。例如，柔性轴104可由如下材料形成：例如TeflonTM(即含氟聚合物，例如聚四氟乙烯——“PTFE”)、硅酮、TeflonTM/硅酮化合物，例如SIL-KORETM(由W.L.Gore & Associates制造)、“EPTFE”，例如膨胀特氟隆等。可采用的其它合适的材料和密封装置在2002年3月15日提交的本申请人的共同未决的美国专利申请10/099,634中作了进一步的详细描述，该文在此全文引入以供参考。
外科附属装置100可还包括切割和钉缝部件103。柔性轴104的远端104b附连或可附连到切割和钉缝部件103的近端103a。切割和钉缝部件103的一个示例性实施方式在图8到12(c)中示出。如图8所示，切割和钉缝部件103包括钉和刀片部分106。套针轴108——例如可以是柔性的线缆——沿轴向延伸穿过钉和刀片部分106中央设置的开口。套针110设置在套针轴108的远端108a处。套针110构造成接合到砧组件112。外科附属装置100构造成使得砧组件112可相对于钉和刀片部分106选择性地移动，例如延伸并缩回，这将在下面更全面地描述。
参照图2，可看到根据本发明的示例性实施方式的机电外科系统10的遥控电源控制台12和柔性轴20。遥控电源控制台12可包括具有前面板15的外壳14。显示设备16和指示器18a和18b安装在前面板15a上，其将在下面更全面地描述。柔性轴20可从外壳14延伸，并由第一耦连器22可拆卸地固定到该外壳上。柔性轴20的远端24可包括例如耦连器26的第二耦连器，该耦连器适于将外科附属装置100可拆卸地固定到柔性轴20的远端24。
参照图3，可看到柔性轴20局部剖开的侧视图。根据一个实施方式，柔性轴20可包括管状护套28，该护套可包括覆盖层或其它密封装置，以在其内部通道40和外部环境之间提供液密式的密封。护套28可由组织兼容的、可消毒的弹性体材料制成，例如上面介绍柔性轴104时所列举的材料。此外，护套28可还由耐高压加热的材料制成。设置在柔性轴20的内部通道40内并在其全长上延伸的是第一可转动驱动轴30和第二可转动驱动轴32，以及第一操纵线缆34、第二操纵线缆35、第三操纵线缆36、第四操纵线缆37和数据传输线缆38。图4是图3中示出的柔性轴20沿着线4-4剖开的截面图，并进一步示出了数条线缆30、32、34、35、36、37、38。操纵线缆34、35、36、37的各个远端附连到柔性轴20的远端24。数条线缆30、32、34、35、36、37、38中的每一个可容纳在各自的护套中。
第一可转动驱动轴30和第二可转动驱动轴32可构造成例如高柔性驱动轴，例如编织的或螺旋的驱动线缆。需要理解的是，这样的高柔性驱动线缆具有有限的扭矩传送特性和能力。还需要理解的是，图1中示出并在下面描述的外科附属装置100可能需要比第一和第二可转动驱动轴30、32可传送的扭矩更高的扭矩输入。从而，第一和第二可转动驱动轴30、32可构造成传送低扭矩但高速度，该高速度/低扭矩由例如设置在外科附属装置100和/或远程电源控制台12中的驱动柔性轴20的远端24和/或近端20a处的齿轮传动装置转换成低速度/高扭矩。需要理解的是，这样的齿轮传动装置可沿着在外壳14中设置的马达与外科附属装置100之间的传动系设置在任意合适的位置，该外科附属装置100可拆卸地附连到柔性轴20。这样的齿轮传动装置可包括例如正齿轮传动装置、行星齿轮传动装置、谐波齿轮传动装置、摆线驱动装置、周转齿轮传动装置等。
现在参照图5(a)，可看到第一耦连器22的后端。第一耦连器22包括第一接头44、第二接头48、第三接头52和第四接头56，各个接头可转动地固定到第一耦连器22。各个接头44、48、52和56包括各自的凹入部46、50、54、58。如图5(a)所示，各个凹入部46、50、54、58可为六边形形状。然而，需要理解的是，凹入部46、50、54、58可具有任意形状和构造，以将接头44、48、52、56不可转动地耦连到并刚性地附连到容纳在外壳12内的马达装置的各个驱动轴，这一点将在下面更全面地描述。需要理解的是，互补的突出物可设置在马达装置的各个驱动轴上，从而如下所述地驱动柔性轴20的驱动元件。还需要理解的是，凹入部可设置在驱动轴上，并且互补的突出物可设置在接头44、48、52、56上。可提供任意其它的构造成将接头44、48、52、56与马达装置的驱动轴不可转动地并可松开地耦连的耦连装置。
接头44、48、52、56的其中一个不可转动地固定到第一可转动驱动轴30，接头44、48、52、56的其中另外一个不可转动地固定到第二可转动驱动轴32。接头44、48、52、56的剩余两个与传送元件接合，传送元件构造成在操纵线缆34、35、36、37上施加拉力，从而操纵柔性轴20的远端20b。数据传输线缆38与数据接头60电连接并且逻辑连接。数据接头60包括例如电触头，电触头的数量相应于并等于容纳在数据线缆38内的单根电线的数量。第一耦连器22包括键结构42，以使得第一耦连器22正确地定向到设置在远程电源控制台12上的配合及互补耦连装置。此键结构42可设置在第一耦连器22和设置在远程电源控制台12的配合及互补耦连装置的其中一个或者两个上。第一耦连器22可包括快速连接类型的接头，其可使用例如简单的推动将第一耦连器22与外壳12接合。可与数个接头44、48、52、56、60的任一个一起提供有密封，以在第一耦连器22的内部和环境之间提供密闭流体的密封。
现在参照图5(b)，可看到柔性轴20的第二耦连器26的前端。第二耦连器26包括第一接头66和第二接头68，每个都可转动地固定到第二耦连器26并且每个都不可转动地固定到第一和第二可转动驱动轴30、32各自的一个的远端。在第二耦连器26上提供有快速连接类型的配件64，用于将外科附属装置100可拆卸地固定到该第二耦连器26。快速连接类型的配件64可例如为转动快速连接类型的配件、卡口类型的配件等。在第二耦连器26上设置有用于使外科器械或附属装置与第二耦连器26准确地对准的键结构74。在第二耦连器26和外科附属装置100的其中一个或者两个上可设置有用于使外科附属装置100与柔性轴20准确地对准的键结构74或其它装置。此外，在外科附属装置100上可设置有快速连接类型的配件。在第二耦连器26内也设置有具有电触头的数据接头70。如同第一耦连器22的数据接头60，第二耦连器26的数据接头70包括电连接和逻辑地连接到数据传输线缆38的各电线和数据接头60的触头62上的触头72。可与接头66、68、70一起提供有密封，以在第二耦连器26的内部和环境之间提供密闭流体的密封。
在远程电源控制台12的外壳14的内部设置有机电驱动元件，机电驱动元件构造成驱动驱动轴30、32和操纵线缆34、35、36、37，从而操作机电外科系统10和附连到第二耦连器26的外科附属装置100。在图6(a)示意性地示出的示例性实施方式中，5个电动马达76、80、84、90、96可设置在远程电源控制台12内，每个马达都通过电源而运行。然而，需要理解的是，可提供任意适当数量的马达，并且马达可通过电池电源、线路电流、直流电源、电控直流电源等而运行。也需要理解的是，马达可连接到直流电源，直流电源又连接到线路电流并且向马达供应工作电流。
图6(a)示意性地示出了马达的一个可能的装置。当第一耦连器22接合到外壳14从而柔性轴20接合到外壳14时，第一马达76的输出轴78与第一耦连器22的第一接头44接合，由此驱动第一驱动轴30和第二耦连器26的第一接头66。类似地，当第一耦连器22接合到外壳14从而柔性轴20接合到外壳14时，第二马达80的输出轴82与第一耦连器22的第二接头48接合，由此驱动第二驱动轴32和第二耦连器26的第二接头68。当第一耦连器22接合到外壳14从而柔性轴20接合到外壳14时，第三马达84的输出轴86与第一耦连器22的第三接头52接合，由此通过第一皮带轮装置88驱动第一和第二操纵线缆34、35。当第一耦连器22接合到外壳14从而柔性轴20接合到外壳14时，第四马达90的输出轴92与第一耦连器22的第四接头56接合，由此通过第二皮带轮装置94驱动第三和第四操纵线缆36、37。第三和第四马达84、90可被固定到支架100上，支架100通过第五马达96的输出轴98而选择性地在第一位置和第二位置之间移动，以选择性地使第三和第四马达84、90与各自的皮带轮装置88、94接合和脱离，从而允许柔性轴20根据需要变得拉紧和可操纵或柔软。需要理解的是，其它的机械、电或机电的机构可用作选择性地接合和脱离该操纵结构。马达可如第09/510,923号、标题为“在柔性轴中用于控制操纵线机构的支架组件(A Carriage Assembly forControlling a Steering Wire Mechanism Within a Flexible Shaft)”的美国专利申请所描述地那样设置和构造，该申请在此全部引入以作参考。
需要理解的是，马达76、80、84、90、96的其中任意一个或多个可以是高速/低扭矩马达或低速/高扭矩马达。如上所述，第一可转动驱动轴30和第二可转动驱动轴32可构造成传递高速和低扭矩。从而，第一马达76和第二马达80可构造成高速/低扭矩马达。可选地，第一马达76和第二马达80可构造成低速/高扭矩马达，其中在第一马达76和第二马达80以及第一可转动驱动轴30和第二可转动驱动轴32的相应的其中一个之间设置有降低扭矩/提高速度的齿轮传动装置。这样的降低扭矩/提高速度的齿轮传动装置可包括例如正齿轮传动装置、行星齿轮传动装置、谐波齿轮传动装置、摆线驱动装置、周转齿轮传动装置等。需要理解的是，任意这样的齿轮传动装置可设置在远程电源控制台12中或设置在柔性轴20的近端，例如在第一耦连器22中。需要理解的是，齿轮传动装置设置在第一可转动驱动轴30和/或第二可转动驱动轴32的远端和/或近端，以防止其扭曲和破裂。
现在参照图6(b)，可以看到机电外科系统10的示意图。控制器1122设置在远程电源控制台12的外壳14中，并构造成控制机电外科系统10和附连到柔性轴20的外科附属装置100的所有功能和操作。设置有存储器单元1130，其可包括例如ROM部件1132和/或RAM部件1134等存储器设备。ROM部件1132通过线1136与控制器1122形成电连接和逻辑连接，而RAM部件1134通过线1138与控制器1122形成电连接和逻辑连接。RAM部件1134可包括任意类型的随机存取存储器，例如磁存储器设备、光存储器设备、磁一光存储器设备、电子存储器设备等。类似地，ROM部件1132可包括任意类型的只读存储器，例如可移动的存储器设备，例如PC卡或PCMCIA类型的设备。需要理解的是，ROM部件1132和RAM部件1134可实现为单个单元或者可以是分开的单元，并且ROM部件1132和/或RAM部件1134可以设置成PC卡或PCMCIA类型的设备的形式。控制器1122还连接到外壳14的前面板15，并且更具体地通过线1154连接到显示设备16，且通过各条线1156、1158连接到指示器18a、18b。线1116、1118、1124、1126、1128分别将控制器1122电连接和逻辑连接到第一、第二、第三、第四和第五马达76、80、84、90、96。有线远程控制单元(“RCU”)1150通过线1152电连接和逻辑连接到控制器1122。还设置有无线RCU1148，其通过无线链接1160与通过线1144连接到收发器1140的接收/发送单元1146通信。收发器1140通过线1142电连接和逻辑连接到控制器1122。无线链接1160可为例如光链接，例如红外链接、无线链接或任意其它形式的无线通信链接。
开关设备1186可为例如一列DIP开关，其可通过线1188连接到控制器1122。开关设备1186可用作例如选择用于在显示设备16上显示信息和提示的多种语言中的一种语言。信息和提示可涉及例如机电外科系统10和/或附连到其上的外科附属装置的操作和/或状态。
根据本发明的示例性实施方式，在第二耦连器26内设置有第一编码器1106，并且第一编码器1106构造成响应于和根据第一驱动轴30的转动而输出信号。在第二耦连器26内也提供有第二编码器1108，并且第二编码器1108构造成响应于和根据第二驱动轴32的转动而输出信号。每个编码器1106、1108输出的信号可代表相应的驱动轴30、32的转动位置及其转动方向。此种编码器1106、1108可例如为霍耳效应设备、光学设备等。尽管编码器1106、1108被描述为设置在第二耦连器26内，需要理解的是，编码器1106、1108可设置在马达系统和外科器械或附属装置之间的任何位置。需要理解的是，在第二耦连器26内或者在柔性轴20的远端提供编码器1106、1108精确确定了驱动轴转动。若编码器1106、1108设置在柔性轴20的近端，第一和第二可转动驱动轴30、32的扭曲可导致测量误差。
图6(c)是编码器1106、1108的示意图，其包括霍耳效应设备。具有北极242和南极244的磁铁240不可转动地安装在驱动轴30、32上。编码器1106、1108还包括第一传感器246和第二传感器248，其相对于驱动轴30、32的纵轴或转轴设置成隔开大致90度。传感器246、248的输出是持续的并作为传感器的检测范围内的磁场极性的变化的函数而改变其状态。从而，基于编码器1106、1108的输出信号，驱动轴30、32的角位置可在四分之一转内确定，并且可确定驱动轴30、32的转动方向。每个编码器1106、1108的输出通过数据传输线缆38的各条线1110、1112传输到控制器1122。控制器1122通过根据来自编码器1106、1108的输出信号而追踪驱动轴30、32的角位置和转动方向，从而可确定连接到机电外科系统10的外科附属装置100的部件的位置和/或状态。即，控制器1122通过对驱动轴30、32的转数进行计数可确定连接到机电外科系统10的外科附属装置100的部件的位置和/或状态。
根据一种实施方式并如图6(d)所示，外科附属装置100还可包括数据接头1272，该接头的尺寸和构造适于电连接和逻辑连接到第二耦连器26的接头70。在示例性的实施方式中，数据接头1272包括数目等于接头70的引线72的数目的触头(未示出)。容纳在外科附属装置100内的存储器单元1174电连接和逻辑地连接到数据接头1272。存储器单元1174的形式例如可为EEPROM、EPROM等，并可例如容纳在外科附属装置100的钉和刀片部分106中。
图6(d)示意性地示出存储器单元1174。如图6(d)所示，数据接头1272包括触头1276，每个触头通过各条线1278电连接和逻辑连接到存储器单元1174。存储器单元1174构造成例如存储序列号数据1180、附属类型标识器(ID)数据1182和使用数据1184。存储器单元1174还可存储其它数据。序列号数据1180和ID数据1182都可构造成只读数据。在示例性的实施方式中，序列号数据1180是唯一标识特定的外科附属装置的数据，而ID数据1182是标识附属装置的类型的数据(例如当其它类型的附属装置可由设备使用时)。使用数据1184表示了特定的附属装置的使用，例如外科附属装置100的砧组件112缩回或延伸的次数，或外科附属装置100的钉推进器220推进或发射的次数，这将在下面更全面地描述。
需要理解的是，可附连到柔性轴20的远端24的外科附属装置100可设计并构造成一次使用或多次使用。外科附属装置100还可设计并构造成使用预定数目的次数。因此，使用数据1184可用于确定外科附属装置100是否已经使用并且使用次数是否已经超过所允许使用的最大次数。正如下面将更全面地描述的那样，在已经达到允许使用的最大次数后，试图使用外科附属装置100将出现错误(ERROR)情形。
再参照图6(b)，根据本发明的示例性实施方式，控制器1122构造成当外科附属装置100开始连接到柔性轴20时从外科附属装置100的存储器单元1174读取ID数据1182。存储器单元1174通过数据传输线缆38的线1120电连接和逻辑连接到控制器1122。基于读到的ID数据1182，控制器1122构造成从存储器单元1130读取或选择相应于连接到柔性轴20的附属装置或外科器械的类型的操作程序或算法。存储器单元1130构造成存储用于每种可用的外科器械或附属装置的操作程序或算法，控制器1122根据从附连的外科器械或附属装置的存储器单元1174读取的ID数据1182而从存储器单元1130选择和/或读取操作程序或算法。如上所述，存储器单元1130可包括可移动的ROM部件1132和/或RAM部件1134。从而，存储在存储器单元1130中的操作程序或算法可以根据需要更新、增加、删除、改进或者以其它方式修改。存储在存储器单元1130中的操作程序或算法可基于例如用户的特定需要而定制。例如键盘、鼠标、点击设备、触摸屏等数据输入设备可以通过例如数据连接器端口连接到存储器单元1130以便于操作程序或算法的定制。可选地或额外地，操作程序或算法可以从机电外科系统10远程地定制并预编程到存储器单元1130中。需要理解的是，序列号数据1180和/或使用数据1184可还用于确定从存储器单元1130中读取或选择多个操作程序或算法中的哪一个。需要理解的是，操作程序或算法可选地可存储在外科附属装置100的存储器单元1174并通过数据传输线缆38传输到控制器1122。一旦合适的操作程序或算法被控制器1122读取、选择或传送到控制器1122，控制器1122使得操作程序或算法根据用户通过有线RCU 1150和/或无线RCU 1148执行的操作而运行。如上所述，控制器1122通过各条线1116、1118、1124、1126、1128电连接和逻辑连接到第一、第二、第三、第四和第五马达76、80、84、90、96，并按照通过各条线1116、1118、1124、1126、1128读取、选择或传送的操作程序或算法来控制这些马达76、80、84、90、96。
现在参照图6(e)，可以看到无线RCU 1148的示意图。无线RCU 1148包括操纵控制器1300，该控制器具有设置在四向摇杆1310下方的多个开关1302、1304、1306、1308。开关1302、1304通过摇杆1310的操作通过第三马达84控制第一和第二操纵线缆34、35的操作。类似地，开关1306、1308通过摇杆1310的操作通过第四马达92控制第三和第四操纵线缆36、37的操作。需要理解的是，摇杆1310和开关1302、1304、1306、1308如此设置：开关1302、1304的操作在南北方向上操纵柔性轴20，而开关1306、1308的操作在东西方向上操纵柔性轴20。这里所指的东、西、南和北设定在一个相对坐标系统。可选地，可设置数码操纵杆、模拟操纵杆等，用来替代摇杆1310和开关1302、1304、1306、1308。还可使用电位计或任意其它类型的致动器来替代开关1302、1304、1306、1308。
无线RCU 1148还包括操纵接合/分离开关1312，该开关的操作控制第五马达96的运行，以选择性地接合和分离操纵机构。无线RCU 1148还包括双向摇杆1314，该摇杆具有可由其操作的第一和第二开关1316、1318。如果有的话，这些开关1316、1318的操作根据与所附连的外科附属装置相应的操作程序和算法来控制机电外科系统10和附连到柔性轴20的例如外科附属装置100等任意外科附属装置的某些功能。例如若外科器械为外科附属装置100，例如图1中所示并如下所述，双向摇杆1314的操作可控制外科附属装置100的砧组件112的延伸和缩回。无线RCU1148设置有另一开关1320，如果有的话，该开关1320的操作还可根据与所附连的外科附属装置相应的操作程序和算法来控制机电外科系统10和附连到柔性轴20的任意外科附属装置的操作。例如，当外科附属装置100附连到柔性轴20时，开关1320的操作可启动钉推进器220的前进或发射顺序。
无线RCU 1148包括控制器1322，该控制器通过线1324电连接和逻辑连接到开关1302、1304、1306、1308，通过线1326连接到开关1316、1318，通过线1328连接到开关1312并通过线1330连接到开关1320。无线RCU 1148可包括对应于前面板15的指示器18a、18b的指示器18a’、18b’，和对应于前面板15的显示设备16的显示设备16’。若提供的话，指示器18a’、18b’通过各条线1332、1334电连接和逻辑连接到控制器1322，显示设备16’通过线1336电连接和逻辑连接到控制器1322。控制器1322通过线1340电连接和逻辑连接到收发器1338，而收发器1338通过线1344电连接和逻辑连接到接收器/发送器1342。例如电池等未示出的电源可设置在无线RCU 1148中以供电。从而，无线RCU 1148可用于通过无线链接1160控制机电外科系统10和附连到柔性轴20的任意外科附属装置100的操作。
无线RCU 1148可包括通过线1348连接到控制器1322的开关1346。开关1346的操作通过无线链接1160向发送器/接收器1146发送数据信号。数据信号包括唯一地识别无线RCU 1148的标识数据。此标识数据由控制器1122用作防止机电外科系统10的未授权操作，并防止其它无线RCU干扰机电外科系统10的操作。无线RCU 1148和机电外科系统10之间的每个继发通信可包括标识数据。从而，控制器1122可在多个无线RCU之间识别，由此仅允许单个可标识的无线RCU 1148来控制机电外科系统10和附连到柔性轴20的任意外科附属装置的操作。
根据附连到柔性轴20的外科附属装置100的部件的位置——该位置按照来自编码器1106、1108的输出信号而确定，控制器1122可如与所附连的外科附属装置100相应的操作程序和算法所定义的那样选择性地使机电外科系统10的功能发挥作用或失效。例如当外科附属装置为图1中示出的外科附属装置100时，由开关1320的操作所控制的发射功能失效，除非砧组件112与钉和刀片部分106之间的距离或缝隙确定为位于可接受的范围内。砧组件112与钉和刀片部分106之间的距离或缝隙根据来自编码器1106、1108的输出信号确定，正如上文所更全面描述的那样。需要理解的是，开关1320自身仍然可操作，而控制器1122不会实现相应的功能，除非该距离或缝隙被确定为位于可接受的范围内。
现在参照图6(f)，可以看到有线RCU 1150的示意图。在示例性的实施方式中，有线RCU 1150包括与无线RCU 1148大致相同的控制元件，从而将忽略对这些元件的进一步描述。相似的元件在图6(f)中带有伴随的上标。需要理解的是，机电外科系统10和附连到柔性轴20的任意外科附属装置可由有线RCU 1150和/或无线RCU 1148控制。当例如无线RCU 1148中的电池失效时，有线RCU 1150可用于控制机电外科系统10和附连到柔性轴20的任意外科附属装置100的功能。
如上所述，外壳14的前面板15包括显示设备16和指示器18a、18b。显示设备16可包括字符数字显示设备，例如LCD显示设备。显示设备16还可包括音频输出设备，例如扬声器、蜂鸣器等。显示设备16可由控制器1122根据与附连到柔性轴20的外科附属装置100相应的操作程序或算法而操作并控制。若没有外科附属装置如此附连，默认的操作程序或算法可由控制器1122读取、选择或传送到控制器1122，由此控制显示设备16的操作以及机电外科系统10的其它方面和功能。若图1中示出的外科附属装置100附连到柔性轴20，显示设备16可显示例如指示砧组件112与钉和刀片部分106之间缝隙的数据，该缝隙根据编码器1106、1108的输出信号所确定，正如上文更全面地描述的那样。
类似地，指示器18a、18b由控制器1122根据与附连到柔性轴20的外科附属装置100相应的操作程序或算法而操作并控制。指示器18a和/或18b可包括音频输出设备，例如扬声器、蜂鸣器等，和/或可视指示器设备，例如LCD、灯、光等。若图1中示出的外科附属装置100附连到柔性轴20，指示器18a可指示例如机电外科系统10位于电源开状态，而指示器18b可例如指示砧组件112与钉和刀片部分106之间的缝隙是否确定为位于可接受的范围内，正如上文更全面地描述的那样。需要理解的是，尽管仅描述了两个指示器18a、18b，可根据需要设置任意数目的另外的指示器。此外，需要理解的是，尽管描述了单个显示设备16，可根据需要设置任意数目的另外的显示设备。
无线RCU 1150的显示设备16’和指示器18a’、18b’与有线RCU 1148的显示设备16”和指示器18a”、18b”由各自的控制器1322、1322’根据与附连到柔性轴20的外科附属装置100相应的操作程序或算法而类似地操作和控制。
此后，根据本发明的不同实施方式，描述例如图1中示出的外科附属装置100。
图7(a)到7(f)是根据本发明一个实施方式的外科附属装置100的手柄部分102的不同视图。例如，图7(a)是包括外壳301的手柄部分102的前视立体图，而图7(b)是其后视立体图。在外壳301的近端301a设置有齿轮箱302。在外壳301的远端301b设置有耦连块305。快速连接的耦连器304和延伸杆308从齿轮箱302延伸。
快速连接的耦连器304安装到齿轮箱302上并可例如由一组弹簧偏置。齿轮箱302包括第一驱动管座(socket)304a和第二驱动管座304b。图7(c)是手柄部分102的分解前视图。如图7(c)所示，第一驱动管座304a包括第一输入元件306a，其一端3061延伸穿过齿轮箱302的开口3021并且其另一端3062包括正齿轮齿3063。第二驱动管座304b包括第二输入元件306b，其一端3064延伸穿过齿轮箱302的第二开口3022而其另一端3065包括正齿轮齿3066。
延伸杆308延伸穿过齿轮箱302中的延伸杆开口3025。延伸杆308的远端308b具有大于延伸杆开口3025的凸缘3081，使得延伸杆308的凸缘3081保持在齿轮箱302中。延伸杆308的凸缘3081抵靠住正齿轮310的一侧，该正齿轮310座落于齿轮箱302的内部凹陷3023内。正齿轮310沿其外周设置有正齿轮齿3101，该正齿轮齿对应于第一输入元件306a的正齿轮齿3063。外螺纹杆312穿过正齿轮310的内螺纹孔3102延伸，该外螺纹杆相对于延伸杆308同轴地设置。杆312连接到耦连元件314，该耦连元件设置在耦连块305的第一开口3052内。杆耦连器314可提供到柔性轴104的第一驱动轴104a的连接。
正齿轮318也座落在齿轮箱302的内部凹陷3024内。正齿轮318沿其外周设置有正齿轮齿3181，该正齿轮齿对应于第二输入元件306b的正齿轮齿3066。正齿轮318具有一个穿过其延伸的孔3182。轴驱动元件316的第一端3161不可转动地接合在正齿轮318的孔3182内。轴驱动元件316的第二端3162构造成与柔性轴104的第二驱动轴104b不可转动地接合，而第二驱动轴104b延伸穿过耦连块305的远端面3051中的第二开口3053。
图7(d)是图7(a)示出的手柄部分102的俯视图。图7(e)是图7(d)示出的手柄部分102沿着线A-A的侧视截面图。图7(f)是图7(d)示出的手柄部分102沿着线B-B的侧视截面图。
图8是根据本发明一个实施方式的外科附属装置100的切割和钉缝部件103的立体图。如图8所示并如前所述，切割和钉缝部件103包括钉和刀片部分106。套针轴108在轴向上延伸穿过钉和刀片部分106居中设置的开口。该套针轴108可以是柔性的。在一个实施方式中，套针轴108是线缆。套针110设置在套针轴108的远端108a处。套针110具有尖锐的或削尖的端部，该端部构造成被按压穿过组织的一部分。此外，套针110构造成接合到砧组件112，优选地，可通过将套针110插入到砧组件112的槽内，以将套针110可拆卸地固定到砧组件112，从而套针轴108在该处附连到砧组件112，正如下文更全面地描述。外科附属装置100如此构造：套针轴108以及在该处所附连的砧组件112可以相对于钉和刀片部分106选择性地移动，例如延伸和缩回，正如下文更全面地描述。特别地，其端部设置有套针110的套针轴108通过相对于钉和刀片部分106在例如远和近方向的第一和第二方向上分别移动所期望的距离而延伸和缩回。
图9示出了根据本发明一个实施方式的切割和钉缝部件103的立体图。图9示出切割和钉缝部件103位于装配的部分关闭位置。特别地，图9示出相对于钉和刀片部分106位于部分缩回位置的砧组件112。
图10(a)示出了根据本发明一个实施方式的砧组件112的部件的立体图。图10(a)示出了砧组件112位于分解情形下。如图10(a)所示，砧组件112包括砧端盖202。砧端盖202具有在轴向上居中设置的开口2021。砧端盖202还包括在端盖202的远侧2025径向设置的槽2022，和在砧端盖202的近侧2026上的夹紧面2023。夹紧面2023具有一个凹入的部分，其形成了刀片容座2024。该夹紧面2023还形成了钉引导件2026。
砧组件112还包括在截面上对应于砧端盖202的槽2022的销204。砧组件112还包括中空的砧套筒208。砧套筒208的远端2081在截面上对应于砧端盖202的开口2021。此外，砧套筒208的远端2081形成了开口2082，该开口在截面上对应于砧销204。在砧套筒208的近端2084形成了凹陷2086，该凹陷在周向上围绕砧套筒208而延伸，并且其半径小于砧套筒208的其它部分的半径，包括位于砧套筒208的最近端的几个径向延伸的齿2087的半径。砧套筒208的近端2084还形成了多个轴向槽2088，例如4个，这些轴向槽延伸穿过凹陷2086和齿2087，由此使得砧套筒208的近端2084可被径向地压住。砧套筒208在其外表面上还包括一个或多个纵向延伸的键2085。
砧组件112还包括砧延伸杆206。砧延伸杆206的远端2061可以是扁平的并形成开口2062。砧延伸杆206还具有中央区域2063，该区域是圆的并在截面上对应于砧套筒208的凹陷2086的内径。砧延伸杆206的远端2061在截面上大于砧套筒208的凹陷2086的内径。砧延伸杆206还具有近端2063，该近端形成了套针容纳槽2065。
图10(b)示出了根据本发明一个实施方式的钉和刀片部分106的一些部件的立体图。图10(b)以分解情形示出了这些部件。如图10(b)所示，钉和刀片部分106包括中空的砧套筒引导件210。砧套筒引导件210的内表面包括一个或多个键槽2101。砧套筒引导件210的外表面包括唇部2102，使得砧套筒引导件210的近端2103与砧套筒引导件210的远端2104相比具有更大的半径。
钉和刀片部分106还包括外壳套筒212。外壳套筒212在其远端2122具有一个或多个开口2121，并在其远端2124具有径向向内延伸的唇部2123。钉和刀片部分106还包括钉盒214。钉盒214形成了多个轴向设置的钉容纳槽2141，钉2142容纳在该钉容纳槽2141中。在图10(b)示出的实施方式中，钉容纳槽2141在周向上环绕钉盒214设置成径向隔开的两行，其中第一行中的钉容纳槽2141重叠在第二行中的钉容纳槽2141上。钉盒214还包括：径向向内延伸的唇部2145，该唇部位于钉盒214的远端2147附近；和径向向外延伸的唇部2143，该唇部位于钉盒214的近端2144附近。此外，钉盒214的远端2147形成有夹紧面2146。
钉和刀片部分106还包括易碎刀片保护环216，该刀片保护环216在其内部形成有槽2161。此外，钉和刀片部分106包括刀片218。刀片218具有在其远端2184上周向延伸的切割边缘2183。此外，刀片218在其近端2182形成有径向向内延伸的突出物或唇部2181。
钉和刀片部分106还包括钉推进器220。钉推进器220具有多个轴向设置的推进齿2201，每个推进齿对应于并且对准钉盒214的钉容纳槽2141。钉推进器220还包括在其外表面上的键2202。
钉和刀片部分106还包括钉推进器支架元件222，该支架元件具有颈部2221和凸缘部2222，该颈部2221相对于凸缘部2222在远端方向轴向地延伸。颈部2221的内表面包括螺纹2223，而颈部2221的外表面形成有周向设置的凹陷2224。此外，凸缘2222的径向最外边缘包括有键2225。
图10(c)示出了根据本发明一个实施方式的钉和刀片部分106的其余部件在分解情形下的立体图。如图10(c)所示，钉和刀片部分106还包括开口环224。开口环224包括一对半圆形的环部2241和2242，当环部2241和2242设置成环的形状时，在其间形成一对键槽2243和2244。钉和刀片部分106还包括垫圈226。钉和刀片部分106还包括推力元件228，该推力元件具有颈部2281和凸缘部2282，该颈部2281相对于凸缘部2282在远端方向轴向地延伸。孔2283形成于颈部2281的内部，而颈部2281的外表面形成有螺纹2284，该螺纹对应于位于钉推进器支架元件222的颈部2221的内表面上的螺纹2223。推力元件228的凸缘2282在其朝向远端的表面内包括一个或多个孔2285，和具有例如圆形截面的在近端延伸的销2286。
钉和刀片部分106还包括第一正齿轮230。第一正齿轮230形成有内孔2301，该内孔在截面上对应于推力元件228的销2286。第一正齿轮230还包括在周向上设置的正齿轮齿2302。钉和刀片部分106还包括垫圈232和内壳轴套234。内壳轴套234包括位于内壳轴套234远端并具有第一内径的内孔2341。内孔2341朝向径向向内延伸的唇部2345而向近端延伸，在该点，内孔2342的内径减小。内孔2342进一步向近端延伸到第二径向向内延伸的唇部2346，在该点，内孔2342的内径再次减小。齿轮齿2347靠近第二唇部2346，该齿轮齿在内壳轴套234的内表面上周向地延伸。例如靠近于齿轮齿2347的近端2343具有光滑的内表面，并且具有形成于其内的一个或多个径向开口2344。
钉和刀片部分106还包括恒星齿轮元件236，该恒星齿轮元件具有颈部2361和凸缘部2362，该颈部2361相对于凸缘部2362在远端方向轴向地延伸。孔2363形成于颈部2361的内部，而颈部2361的外表面具有周向设置的齿轮齿2364，该齿轮齿对应于第一正齿轮230的齿轮齿2302。该凸缘部2362包括向近端延伸的例如具有圆形截面的销2366。钉和刀片部分106还包括垫圈238。
钉和刀片部分106还包括具有内孔2401的第一行星齿轮240。第一行星齿轮240的外表面具有周向设置的齿轮齿2402。钉和刀片部分106还包括具有内孔2421的恒星齿轮242。恒星齿轮242的外表面具有周向设置的齿轮齿2422，该齿轮齿2422对应于第一行星齿轮240的齿轮齿2402。钉和刀片部分106还包括具有突出物2441的垫圈244。钉和刀片部分106还包括具有内孔2461的第二行星齿轮246。第二行星齿轮246的外表面具有周向设置的齿轮齿2462，该齿轮齿2462对应于恒星齿轮242的周向设置的齿轮齿2422。
钉和刀片部分106还包括输入元件248。输入元件248的远端2481具有内孔2483，其可具有例如方形截面。输入元件248的远端2481的外表面上是周向设置的齿轮齿2482，该齿轮齿2482对应于在第二行星齿轮246的外表面上周向设置的齿轮齿2462。输入元件248的近端2484具有圆形的外周和内孔2485。
钉和刀片部分106还包括外壳后端盖250，该后端盖250具有中心孔2501、相对于中心孔2501径向偏置的第二孔2502和凹陷2503，销2504从该凹陷2503向远端延伸。外壳后端盖250还包括径向向外的唇部2505。至少一个开口2506相对于该径向向外的唇部2505位于远端，这些开口形成于圆形的外周表面2507内。外壳后端盖250在其近端还包括一个或多个与中心孔2501连通的键槽2509。
钉和刀片部分106还包括中心后端盖轴套252，穿过该轴套设置有孔2521。在中心后端盖轴套252的远端2522，孔2521限定了径向向内延伸的边缘2523。在中心后端盖轴套252的近端2524是相对设置的键槽2525。
钉和刀片部分106还包括保持套筒254，穿过该套筒设置有孔2541。相对设置的键2543位于保持套筒254的近端2542，该键2543对应于位于中心后端盖轴套252的近端2524的键槽2525和外壳后端盖250的键槽2509。
图11(a)示出了根据本发明一个实施方式的切割和钉缝部件103的俯视截面图，而图11(b)是其侧视截面图。图11(a)和11(b)示出切割和钉缝部件103位于装配好的并部分缩回的位置，如下文更全面地所述。如图11(a)和11(b)所示，砧套筒208的远端2081插入到砧端盖202中对应的居中设置的开口2021中。砧销204穿过端盖202的径向设置的槽2022并穿过砧套筒208的远端2081中相对地设置的开口2081而插入，使得砧端盖202相对于砧套筒208轴向地且可转动地固定。砧延伸杆206的远端2061在砧套筒208的近端2084轴向地保持在凹陷2086内。砧套筒208轴向地且可滑动地保持在砧套筒引导件210的内部。通过砧套筒208的键2085在砧套筒引导件210的键槽2101内的接合，防止了砧套筒208相对于砧套筒引导件210转动。
中心后端盖轴套252延伸穿过外壳后端盖250的中心开口2501，并进入到砧套筒引导件210的近端2103。在所示出的位置，中心后端盖轴套252的边缘接合在砧套筒208的凹陷2086中，由此，轴向地彼此固定中心后端盖轴套252和砧套筒208。保持套筒254插入到中心后端盖轴套252的孔2521中。保持套筒254的键2543接合到中心后端盖轴套252的键槽2525和外壳后端盖250的键槽2509，从而防止保持套筒254、中心后端盖轴套252和外壳后端盖250之间的相对转动。
输入元件248可转动地保持在外壳后端盖250的第二开口2502中。输入元件248的齿2482啮合到第二行星齿轮246的周向设置的齿2462，第二行星齿轮246可转动地安装在销2504上，该销从外壳后端盖250的凹陷2503向远端延伸。第二行星齿轮246的周向设置的齿2462还啮合到恒星齿轮242的周向设置的齿2422。恒星齿轮242通过其内孔2421可转动地安装在砧套筒引导件210的近端2103。
恒星齿轮242的周向设置的齿2422还啮合到第一行星齿轮240的周向设置的齿2402。第一行星齿轮240可转动地安装在销2361上，该销从恒星齿轮元件236的凸缘部2362向近端延伸。第一行星齿轮240的周向设置的齿2402还啮合到齿轮齿2347，该齿轮齿2347绕内壳轴套234的内表面在周向上延伸。内壳轴套234相对于外壳后端盖250可转动且轴向地固定，并通过穿过分别位于外壳套筒212、内壳轴套234和外壳后端盖250中的对准的开口2121、2344和2506以插入例如销或螺钉等紧固件256而固定到外壳套筒212。
恒星齿轮元件236通过其内孔2363可转动地安装在砧套筒引导件210上。在恒星齿轮元件236的颈部2361的外表面上周向设置的齿轮齿2364啮合到第一正齿轮230的周向设置的齿轮齿2302。第一正齿轮230通过其内孔可转动地安装在推力元件228上，该内孔内插入有推力元件228的向近端延伸的销2286。第一正齿轮230的周向设置的齿轮齿2302还啮合到齿轮齿2347，该齿轮齿在内壳轴套234的内表面上周向地延伸。
推力元件228由配合在推力元件228的内孔2283内的砧套筒引导件210可转动地安装在砧套筒引导件210上。垫圈232位于推力元件282的凸缘2282的近端表面和内壳轴套234的第二唇部2346之间，而垫圈226位于推力元件282的凸缘2282的远端表面和钉推进器支架元件222的凸缘2222之间。
钉推进器支架元件222安装在推力元件228上，使得位于钉推进器支架元件222的颈部2221的内表面上的螺纹2223与位于推力元件228的颈部2281的外表面上的螺纹2284螺接。钉推进器支架元件222的键2225接合到由开口环224形成的键槽2243内，由此使得钉推进器支架元件222相对于开口环224可轴向地滑动。开口环设置在内壳轴套234的远端2342处的孔2341内。
钉推进器220位于开口环224内，并抵靠住推力元件228的凸缘2282。钉推进器220的键2202接合到由开口环224形成的键槽2243内，由此使得钉推进器220相对于开口环224可轴向地滑动。钉推进器220的推进齿2201向远端延伸并对准钉盒214的钉容纳槽2141。
钉盒214相对于钉推进器220设置在远端，并保持在外壳套筒212的内部。钉盒214可在外壳套筒212内从图11(a)和11(b)示出的位置朝向远端的方向轴向地移动，直到钉盒214的径向向外延伸的唇部2143抵靠住外壳套筒212的径向向内延伸的唇部2123，如下文更全面地描述。
刀片218位于钉推进器220和钉推进器支架元件222之间。位于该刀片的远端2182的径向向内延伸的突出物或唇部2185接合在位于钉推进器支架元件222的颈部2221的外表面上的凹陷2224中。刀片218的切割边缘2183套在易碎刀片保护环216的槽2161中。易碎刀片保护环216轴向地抵靠住钉盒214的径向向内延伸的唇部2144。
操作时，外科附属装置100通过手柄部分102的快速连接耦连器304附连到柔性轴20，使得柔性轴20的第一可转动驱动轴30例如不可转动地耦连到手柄部分102的第一输入元件306a，并使得柔性轴20的第二可转动驱动轴32例如不可转动地耦连到手柄部分102的第二输入元件306b。起初，外科附属装置100的套针轴108可位于缩回位置，例如如图9所示，从而便于将外科附属装置100插入到患者体内。例如在该位置钉和刀片部分106可插入到患者的口腔通道中。控制器1122起初可配置成在夹紧模式下操作。在夹紧模式中，第一可转动驱动轴30在例如从近端观察的顺时针方向的第一方向的转动使得输入元件306a在第一方向上转动。通过第一输入元件306a的齿轮齿3063啮合到正齿轮3 10的正齿轮齿3101，使得正齿轮310在例如从近端观察的逆时针方向的第二方向上转动。正齿轮310在第二方向上的转动使得杆312在外壳部分102内轴向地移动，该杆3 12的螺纹接合在正齿轮310的内螺纹孔3102中。杆312端部的耦连元件314例如不可转动地接合到柔性轴104的第一驱动轴104a，该第一驱动轴104a又例如不可转动地接合到穿过切割和钉缝部件103的钉和刀片部分106延伸的套针轴108。由此方式，在其端部设置有套针110的套针轴108可通过在例如朝向远端的第一方向上移动相对于钉和刀片部分106所期望的距离而延伸。套针110受推而穿过需要被缝合的一部分组织，并插入在砧延伸杆206的套砧容纳槽2065中，从而相对于砧延伸杆206轴向地固定。然后通过在相反方向上操作第一可转动驱动轴30而缩回套针轴108，从而将砧延伸杆206及砧组件112的其它部件拖入到砧套筒引导件210中。
当第一可转动驱动轴30继续在例如第二方向上转动，而使得套针轴108进一步缩回时，砧套筒208的键2085接合到砧套筒引导件210中的键槽2101，由此将砧组件112与钉和刀片部分106对准。更进一步地缩回套针轴108使得套针轴108在砧套筒引导件210内向近端移动，直到中心后端盖轴套252的边缘2523座落在砧套筒208的凹陷2086中。当中心后端盖轴套252的边缘2523座落在砧套筒208的凹陷2086中时，砧组件112相对于钉和刀片部分106轴向地锁定在合适位置。根据本发明的一个实施方式，当砧端盖202的夹紧面2023与钉盒214的夹紧面2146相距约为5毫米时，砧组件112相对于钉和刀片部分106轴向地锁定在合适位置。
一旦砧组件112相对于钉和刀片部分106轴向地锁定在合适位置，控制器1122可停止第一可转动驱动轴30在第二方向上的转动。然后控制器1122可改变到操作的发射模式。在操作的发射模式中，第二可转动驱动轴32可在例如顺时针方向的第一方向上转动，接着该第二可转动驱动轴32在第一方向上转动输入元件306b。通过输入元件306b的齿轮齿3066与正齿轮318的正齿轮齿3181的啮合，使得正齿轮318在例如逆时针方向的第二方向上转动。正齿轮318在第二方向上的转动使得轴驱动元件316和柔性轴104的第二驱动轴104b在第二方向上转动，该第二驱动轴104b不可转动地连接到该轴驱动元件316。由此，柔性轴104的第二驱动轴104b的转动使得钉和刀片部分106的输入元件248也在第二方向上转动，该输入元件248不可转动地耦连到该第二驱动轴104b。从而，输入元件248在外壳后端盖250的第二开口2502中转动。通过输入元件248的齿2482与第二行星齿轮246的周向设置的齿2462的啮合，输入元件248在第二方向上的转动使得销2504上的第二行星齿轮246在第一方向上转动。此外，通过将第二行星齿轮246的周向设置的齿2462与恒星齿轮242的周向设置的齿2422的啮合，第二行星齿轮246在第一方向上的转动使得恒星齿轮242绕着砧套筒引导件210的近端2103在第二方向上转动。
通过恒星齿轮242的周向设置的齿2422与第一行星齿轮240的周向设置的齿2462的啮合，恒星齿轮242绕着砧套筒引导件210的近端2103在第二方向上的转动使得销2361上的第一行星齿轮240在第一方向上转动，该销从恒星齿轮元件236的凸缘部2362向近端延伸。通过第一行星齿轮240的周向设置的齿2402与内壳轴套234的齿轮齿2347的啮合，并且由于内壳轴套234可转动地固定在钉和刀片部分106内，第一行星齿轮240在第一方向上的转动使得第一行星齿轮240在内壳轴套234内在第二方向上转动。由于第一行星齿轮240安装在从恒星齿轮元件236的凸缘部2362向近端延伸的销2361上，第一行星齿轮240在第二方向上的转动使得恒星齿轮元件236绕着砧套筒引导件210在第二方向上转动。
通过恒星齿轮元件236的颈部2361的外表面上的齿轮齿2364与第一正齿轮230的齿轮齿2302的啮合，恒星齿轮236在第二方向上的转动使得第一正齿轮230在第一方向上转动。通过第一正齿轮230的周向设置的齿轮齿2302与内壳轴套234的齿轮齿2347的啮合，并由于内壳轴套234可转动地固定在钉和刀片部分106内，第一正齿轮230在第一方向上的转动使得第一正齿轮230在内壳轴套234内在第二方向上转动。此外，由于第一正齿轮230安装在从推力元件228的凸缘部2282向近端延伸的销2286上，第一正齿轮230在第二方向上的转动使得推力元件228绕着砧套筒引导件210在第二方向上转动。
推力元件228绕着砧套筒引导件210在第二方向上的转动使得钉推进器支架元件222相对于推力元件228移动，这是由于位于推力元件228的颈部2281的外表面上的螺纹2284螺接到位于钉推进器支架元件222的颈部2221的内表面上的螺纹2223。因为钉推进器支架元件222的键2225接合在由开口环224形成的键槽2243中，使得钉推进器支架元件222在开口环224内向远端方向轴向地滑动。钉推进器支架元件222向远端的运动使得钉推进器220也向远端方向运动，这是由于推力元件228的凸缘2282抵靠住钉推进器220。
钉推进器220向远端方向的运动使得刀片218与钉推进器220一起向远端方向运动。套在易碎刀片保护环216的槽2161内的刀片218的切割边缘2183使得易碎刀片保护环216向远端运动。由于易碎刀片保护环216轴向地抵靠住钉盒214的向内的唇部2144，易碎刀片保护环216的向远端的运动还使得钉盒214向远端运动。从而，在此操作阶段，钉推进器220、刀片218、易碎刀片保护环216和钉盒214一起向远端运动。钉盒214向远端运动从而进一步夹紧位于砧端盖202的夹紧面2023和钉盒214的夹紧面2146之间的一部分组织(未示出)。根据该部分组织的厚度，钉盒214可向远端运动，直到钉盒214的唇部2143抵靠住外壳套筒212的径向向内延伸的唇部2123。
一旦钉盒214已经向远端运动到足以完全夹住一部分组织，第二可转动驱动轴32继续转动，而使得钉推进器220、易碎刀片保护环216和刀片218继续向远端运动。一旦易碎刀片保护环216和钉盒214因接触到被压缩的一部分组织而被阻止进一步向远端运动，使得钉推进器220和刀片218继续相对于这些部件向远端运动。特别地，刀片218的进一步向远端的运动使得刀片218的切割边缘2183穿透易碎刀片保护环216，由此切割已被夹紧的那部分组织。有利地，这些部件构造成使得采用约70lbs或更大的压力来使得刀片218的切割边缘2183穿透易碎刀片保护环216，由此切割该部分组织。从而确保该部分组织在切割之前被足够地夹紧。同时，钉推进器220的进一步向远端的运动使得钉推进器220的推进齿2201开始向远端穿过钉容纳槽2141而运动，该推进齿2201与钉盒214的钉容纳槽2141对准。保持在钉盒214的钉容纳槽2141内的钉2142由此被推进而穿过该部分被夹紧的组织，并被推入到砧端盖202的夹紧面2023的钉引导件2026，直到钉2142闭合。
当钉2142完全闭合时，该部分组织上的夹紧力可通过第二驱动轴32在相反方向上的转动而减小。一般而言，当第二驱动轴32在相反方向上转动时，通过钉和刀片部分106的多个部件的反向运动，而使得推力元件228也在与上面描述相反的方向上转动，由此使得钉推进器支架元件222缩回，例如向近端运动。刀片218还通过刀片218的唇部2181接合在位于钉推进器支架元件222的颈部2221的外表面上的凹陷2224中而缩回，例如向近端运动。一旦砧端盖202的夹紧面2023和钉盒214的夹紧面2146之间的夹紧力已经足够地减小，已经被切割并钉缝的该部分组织从砧端盖202的夹紧面2023和钉盒214的夹紧面2146之间取下，并且外科附属装置100可从患者体内取出。
图12(a)到12(c)示出了根据本发明另一实施方式的切割和钉缝部件的一些部件。特别地，图12(a)是包括钉和刀片部分4106的切割和钉缝部件4103的立体图。例如线缆的柔性套针轴4108在轴向上延伸穿过钉和刀片部分4106的居中设置的开口。形成有套针容纳槽4065的线缆延伸元件4206设置在柔性套针轴4108的远端4108a。套针容纳槽4065在其近端具有宽的部分4066，并在其远端具有窄的部分4067。
切割和钉缝部件4103还包括砧组件4112。砧组件4112包括砧端盖4202。砧端盖4202具有从那里向近端延伸的砧套筒4208。其上附连有套针4220的柔性线缆4212从砧套筒4208的最近端延伸。套针4220包括例如球形体的第一部分4213，从该部分延伸有圆柱形的指部4214。圆柱形的指部4214逐渐变细到套针尖4215。
图12(b)是示出了线缆延伸元件4206的其它特征的侧视截面图。特别地，线缆延伸元件4206形成有轴向延伸的中心孔4207，套针容纳槽4065的宽的部分4066和窄的部分4067通过该中心孔而连通。柱塞4251设置在中心孔4207内并靠近套针容纳槽4065，该柱塞由例如弹簧的偏置元件4250向远端方向偏置。如图12(b)所示，套针尖4215构造成推压并移动被偏置的柱塞4251，使得套针4220的例如球形体的第一部分4213设置成靠近套针容纳槽4065的窄的部分4067。
如图12(c)所示，一旦套针4220的例如球形体的第一部分4213设置成靠近套针容纳槽4065的窄的部分4067，使得套针4220降低而穿过套针容纳槽4065并进入到中心孔4207中。柱塞4251然后由偏置元件4250向远端方向偏置，从而使套针4220的第一部分4213座落于中心孔4207的宽的部分4258和窄的部分4259的交界面处。中心孔4207的窄的部分4259保持套针4220，使得当套针轴4108相对于钉和刀片部分4106缩回时，砧组件4112也缩回。
切割和钉缝部件4103的该实施方式提供了一种装置，其便于将套针轴4108连接到砧组件4112。特别地，砧组件4112的柔性轴4212和柔性套针轴4108使得砧组件4112可以更容易地连接到柔性套针轴4108。例如该装置可使得砧组件4112连接到柔性套针轴4108，而在这样的连接之前无需将砧组件4112对准柔性套针轴4108，和/或在这样的连接之前无需将其中设置有砧组件4112和柔性套针轴4108的组织边缘对准。此外，该装置还支持高的拉伸载荷，从而使得与传统的外科设备中可能的情况相比，被切割和钉缝的该部分组织以更大的夹紧力夹紧。需要认识到的是，尽管图12(a)到12(c)示出的实施方式具有附连到砧组件4112的套针4220和附连到套针轴4108的线缆延伸元件4206，在另一实施方式中，套针4220可以附连到套针轴4108而线缆延伸元件4206可以附连到砧组件4112。
图13(a)到13(c)示出了根据本发明另一实施方式的手柄部分。特别地，图13(a)是包括外壳5301的手柄部分5102的前视立体图，而图13(b)是其后视立体图。在外壳5301的近端5301a设置有齿轮箱5302。插入管5305在外壳5301的远端5301b延伸。快速连接的耦连器5304和管5308从齿轮箱5302延伸。
快速连接的耦连器5304安装到齿轮箱5302上，并可例如由一组弹簧偏置。齿轮箱5302包括第一驱动管座5304a和第二驱动管座5304b。图13(c)是手柄部分5102的分解前视立体图。如图13(c)所示，齿轮箱5302与齿轮保持板5401相配合，从而将其余的齿轮部件保持在相对的位置。第一驱动管座5304a包括第一输入元件5306a，该第一输入元件的一端5061延伸穿过齿轮箱5302的开口5021。第一正齿轮5310具有内孔5101和周向设置的正齿轮齿5102。第一输入元件5306a的第二端5062例如不可转动地延伸穿过第一正齿轮5310的内孔5101。第一正齿轮5310的齿5102接合到具有内螺纹的轴向延伸的孔5411的齿轮帽5410，柔性轴104的第一驱动轴104a可以螺接方式插入到该孔5411中。齿轮帽5410座落在齿轮轴承5412的凹陷5413中。齿轮轴承5412座落在齿轮箱5302的凹陷5023中。齿轮轴承5412的颈部5415具有内孔5416并向近端延伸穿过齿轮箱5302的开口5417。
第二驱动管座5304b包括第二输入元件5306b，该输入元件的一端5064延伸穿过齿轮箱5302的第二开口5022，另一端5065包括正齿轮齿5066。正齿轮5318也座落在齿轮箱5302的内部凹陷5024中。正齿轮5318沿其外部半径设置对应于第二输入元件5306b的正齿轮齿5066的正齿轮齿5181。正齿轮5318具有穿过其延伸的孔5182。轴驱动元件5316的第一端5161不可转动地接合在正齿轮5318的孔5182中。轴驱动元件5316的第二端5162构造成不可转动地接合到柔性轴104的第二驱动轴104b，该第二驱动轴穿过插入管5305并延伸到轴驱动元件5316的第二端5162。
操作时，手柄部分5102通过快速连接耦连器5304附连到柔性轴20，使得柔性轴20的第一可转动驱动轴30例如不可转动地耦连到手柄部分5102的第一输入元件5306a，并使得柔性轴20的第二可转动驱动轴32例如不可转动地耦连到手柄部分5102的第二输入元件5306b。在夹紧模式中，第一可转动驱动轴30在例如顺时针方向的转动使得输入元件5306a在第一方向上转动。通过第一输入元件5306a的齿轮齿5063与正齿轮5310的正齿轮齿5101的啮合，使得正齿轮5310在例如逆时针方向的第二方向上转动。正齿轮5310在第二方向上的转动使得齿轮帽5410在第一方向上转动。通过将柔性轴104的第一驱动轴104a螺接到正齿轮5310的内孔5101，使得柔性轴104的第一驱动轴104a轴向地运动，从而使得第一驱动轴104a所附连的套针轴108轴向地运动。由此方式，套针轴108可在例如向远端的第一方向延伸与钉和刀片部分106相距所需的距离。一旦套针110插入在砧延伸杆206的套针容纳槽2065中，然后套针轴108可通过第一可转动驱动轴30在相反的方向上的操作而缩回。
在操作的发射模式中，第二可转动驱动轴32可在例如顺时针方向的第一方向上转动，从而使输入元件5306b在第一方向上转动。通过输入元件5306b的齿轮齿5066与正齿轮5318的正齿轮齿5181的啮合，使得正齿轮5318在例如逆时针方向的第二方向上转动。正齿轮5318在第二方向上的转动使得轴驱动元件5316和不可转动地连接到该轴驱动元件5316的柔性轴104的第二驱动轴104b在第二方向上转动。由此，柔性轴104的第二驱动轴104b的转动使得钉和刀片部分106的输入元件248也在第二方向上转动，该输入元件248不可转动地耦连到该第二驱动轴104b上。由此方式，钉和刀片部分106的钉盒214可相对于砧组件112运动，从而夹紧位于其间的一部分组织，并且该组织可如上文更全面地描述地被切割和钉缝。
图14(a)到14(d)和图15(a)到15(d)示出了根据本发明另一实施方式的切割和钉缝部件。特别地，图14(a)是前视立体图，图14(b)是后视立体图，其示出了位于已组装的和部分关闭位置的切割和钉缝部件603。图14(c)是侧视图，图14(d)是后视图，其示出了位于同一位置和情形的切割和钉缝部件603。如图所示，切割和钉缝部件603包括砧组件612及钉和刀片部分606。
图15(a)示出了砧组件612的多个部件的前视分解视图。砧组件612包括砧端盖602。砧端盖602具有沿轴向的居中设置的开口6021。砧端盖602还包括在端盖602的远端侧6025上径向设置的槽6022，和在砧端盖602的近端侧6026上的夹紧面6023。夹紧面6023具有形成刀片容座6024的凹陷部分，其目的将在下面更详细地描述。夹紧面6023还形成有钉引导件6027。
砧组件612还包括在截面上对应于砧端盖602的槽6022的销604。砧组件612还包括中空的砧套筒608。砧套筒608的远端6083在截面上对应于砧端盖602的开口6021。此外，砧套筒608的远端6083形成有在截面上对应于砧销604的开口6082。在砧套筒608的近端6084形成有凹陷6086，其绕着砧套筒608在周向上延伸，并且其半径小于砧套筒608的其它部分的半径，包括位于砧套筒608的最近端的多个径向设置的齿6087的半径。砧套筒608的近端6084还形成了多个轴向槽6088，例如4个，这些轴向槽延伸穿过凹陷6086和齿6087，由此使得砧套筒608的近端6084可被径向地压住。砧套筒608在其外表面上还包括一个或多个轴向设置的键6085。
砧组件612还包括砧延伸杆606。砧延伸杆606的远端6061可以是平的并形成开口6062。砧延伸杆606还具有中央区域6063，该区域是圆的并在截面上对应于砧套筒608的凹陷6086的内径。砧延伸杆606的远端6061在截面上大于砧套筒608的凹陷6086的内径。砧延伸杆606还具有近端6063，该近端形成了套针容纳槽6065。
图15(b)示出了根据本发明一个实施方式的钉和刀片部分606的一些部件的分解立体图。如图15(b)所示，钉和刀片部分606包括中空的砧套筒引导件610。砧套筒引导件610的内表面包括一个或多个键槽6101。砧套筒引导件610的外表面包括唇部6102，使得砧套筒引导件610的近端6103与砧套筒引导件610的远端6104相比具有更大的半径。
钉和刀片部分606还包括外壳套筒612。外壳套筒612在其近端6122具有一个或多个开口6121，并在其远端6124具有径向向内延伸的唇部6123。钉和刀片部分106还包括钉盒614。钉盒614形成了多个轴向设置的钉容纳槽6141，钉6142容纳在该钉容纳槽6141中。在图15(b)示出的实施方式中，钉容纳槽6141在周向上环绕钉盒614设置成径向隔开的两行，其中第一行中的钉容纳槽6141重叠在第二行中的钉容纳槽6141上。钉盒614还包括径向向内延伸的唇部6145和径向向外延伸的唇部6143，该唇部6143位于钉盒614的近端6144附近。此外，钉盒614的远端6147形成有夹紧面6146。
钉和刀片部分606还包括易碎刀片保护环616和推进器元件617。推进器元件617在其远端具有径向向外延伸的凸缘6171。此外，钉和刀片部分106包括刀片618。刀片618具有在其远端6184上周向延伸的切割边缘6183。此外，刀片618在其近端形成有径向向内延伸的突出物或唇部6181。
钉和刀片部分606还包括钉推进器620。钉推进器620具有多个轴向设置的推进齿6201，每个推进齿对应于并且对准钉盒614的钉容纳槽6141。钉推进器620还包括在其外表面上的键6202。
钉和刀片部分606还包括钉推进器支架元件622，该支架元件具有颈部6221和凸缘部6222，该颈部6221相对于凸缘部6222在远端方向轴向地延伸。颈部6221的内表面包括螺纹6223，而颈部6221的外表面形成有周向设置的凹陷6224。此外，凸缘6222的径向最外边缘包括有键6225。
图15(c)示出了根据本发明一个实施方式的钉和刀片部分606的其余部件在分解情形下的立体图。如图15(c)所示，钉和刀片部分606还包括开口环624。开口环624包括一对半圆形的环部6241和6242，当环部6241和6242设置成环的形状时，在其间形成一对键槽6243和6244。钉和刀片部分606还包括垫圈626。钉和刀片部分606还包括推力元件628，该推力元件具有颈部6281和凸缘部6282，该颈部6281相对于凸缘部6282在远端方向轴向地延伸。孔6283形成于颈部6281的内部，而颈部6281的外表面形成有螺纹6284，该螺纹对应于位于钉推进器支架元件622的颈部6221的内表面上的螺纹6223。推力元件628的凸缘6282在其朝向远端的表面内包括一个或多个孔6285，和具有例如圆形截面的在近端延伸的三个销6286。
钉和刀片部分606包括第一正齿轮630a、第二正齿轮630b和第三正齿轮630c。第一正齿轮630a、第二正齿轮630b和第三正齿轮630c中的每一个都形成有内孔6301，该内孔在截面上对应于推力元件628的销6286。第一正齿轮630a、第二正齿轮630b和第三正齿轮630c中的每一个还包括周向设置的正齿轮齿6302。
钉和刀片部分606还包括垫圈632和内壳轴套634。内壳轴套634包括位于内壳轴套634远端并具有第一内径的内孔6341。内孔6341朝向径向向内延伸的唇部6345而向近端延伸，在该点，内孔6341的内径减小。内孔6341进一步向近端延伸到第二径向向内延伸的唇部6346，在该点，内孔6341的内径再次减小。齿轮齿6347靠近第二唇部6346，该齿轮齿在内壳轴套634的内表面上周向地延伸。例如靠近于齿轮齿6347的近端具有光滑的内表面，并且具有形成于其内的一个或多个径向开口6344。
钉和刀片部分606还包括恒星齿轮元件636，该恒星齿轮元件具有颈部6361和凸缘部6362，该颈部6361相对于凸缘部6362在远端方向轴向地延伸。孔6363形成于颈部6361的内部，而颈部6361的外表面具有周向设置的齿轮齿6364，该齿轮齿对应于第一正齿轮630的齿轮齿6302。该凸缘部6362包括三个向近端延伸的例如具有圆形截面的销6366。钉和刀片部分606还包括垫圈638。
钉和刀片部分606还包括第一行星齿轮640a、第二行星齿轮640b和第三行星齿轮640c。第一行星齿轮640a、第二行星齿轮640b和第三行星齿轮640c的每一个都具有内孔6401，该孔在截面上对应于推力元件636的销6366。第一行星齿轮640a、第二行星齿轮640b和第三行星齿轮640c的每一个还包括周向设置的齿轮齿6402。
钉和刀片部分606还包括具有内孔6421的恒星齿轮642。恒星齿轮242的外表面具有周向设置的齿轮齿6422，该齿轮齿6422对应于第一行星齿轮640a、第二行星齿轮640b和第三行星齿轮640c的齿轮齿6402。钉和刀片部分606还包括具有内孔6461的第二行星齿轮646。第二行星齿轮646的外表面具有周向设置的齿轮齿6462，该齿轮齿6462对应于恒星齿轮642的周向设置的齿轮齿6422。
钉和刀片部分606还包括输入元件648。输入元件648的远端6481具有内孔6483，其中例如通过方形截面不可转动地插入有齿轮元件6483。齿轮元件6483的外表面上是周向设置的齿轮齿6482，该齿轮齿6482对应于在第二行星齿轮646的外表面上周向设置的齿轮齿6462。输入元件648的近端具有圆形的外周和内孔6485。
钉和刀片部分606还包括外壳后端盖650，该后端盖650具有中心孔6501、相对于中心孔6501径向偏移的第二孔6502和凹陷6503，销6504从该凹陷6503向远端延伸。外壳后端盖650还包括径向向外的唇部6505。至少一个开口6506相对于该径向向外的唇部6505位于远端，这些开口形成于圆形的外周表面6507内。外壳后端盖650在其近端还包括一个或多个与中心孔6501连通的径向孔6509。
钉和刀片部分606还包括中心后端盖轴套652，穿过该轴套设置有孔6521。此外，中心后端盖轴套652具有穿过其延伸的径向孔6252。钉和刀片部分606还包括销止挡件655，该销止挡件655的尺寸和形状构造成穿过外壳后端盖650的径向开口6509而插入。销止挡件655的尺寸和形状还构造成穿过插入管658的径向开口659而插入。当销止挡件655同时穿过外壳后端盖650的径向开口6509和插入管658的径向开口659而插入时，外壳后端盖650和插入管658相对于彼此而固定在合适位置。使用插入管658而将例如图7(a)到7(f)中示出的手柄部分102或图13(a)到13(c)中示出的手柄部分5102的手柄部分连接到例如图9到11(b)中示出的钉和刀片部分106或图15(a)到15(c)中示出的钉和刀片部分606的钉和刀片部分。有利地，插入管6258由与组织兼容的可消毒的弹性材料制成。优选地，插入管6258可由耐高压加热的材料制成。此外，插入管6258可由具有高或比较高的润滑性的材料制成。例如插入管6258可由例如TeflonTM(即含氟聚合物，例如聚四氟乙烯——“PTFE”)、硅酮、TeflonTM/硅酮化合物，例如SIL-KORETM(由W.L.Gore & Associates制造)、“EPTFE”，例如膨胀特氟隆等制造。可采用的其它合适的材料在2002年3月15日提交的本申请人的共同未决的美国专利申请10/099,634中作了进一步的详细描述，如前所述该文在此全文引入以供参考。
图15(d)是钉和刀片部分606的一些部件在已装配情形下的侧视截面图。图15(d)中未示出的钉和刀片部分606的部件以大致类似于图11(a)和11(b)中示出的钉和刀片部分106的装置的方式设置。参照图15(d)，推力元件628(为了清楚，这里示出部分)可转动地安装在砧套筒引导件610(未示出)上。钉推进器支架元件622安装在推力元件628上，使得位于钉推进器支架元件622的颈部6221的内表面上的螺纹6223螺接到位于推力元件628的颈部6281的外表面上的螺纹6284。钉推进器支架元件622在外壳套筒612内可轴向地滑动。
钉推进器620抵靠住钉推进器支架元件622的凸缘6222。钉推进器620在外壳套筒612内可轴向地滑动。钉推进器620的推进齿6201向远端延伸并对准钉盒614的钉容纳槽6141。
钉盒614设置在相对于钉推进器620的远端，并保持在外壳套筒612的内部内。钉盒614可轴向地在外壳套筒612内朝向远端的方向从图14示出的位置移动，直到钉盒614的径向向外延伸的唇部6143抵靠住外壳套筒612的径向向内延伸的唇部6123。
刀片618位于钉推进器620和钉推进器支架元件622之间。位于该刀片的远端的径向向内延伸的突出物或唇部6185接合在位于钉推进器支架元件622的颈部6221的外表面上的凹陷6224中。刀片618的切割边缘6183套在易碎刀片保护环616中。易碎刀片保护环616的近端抵靠住钉盒614的径向向内延伸的唇部6144。
钉盒推进器617沿刀片618设置，使得钉盒推进器617的近端抵靠住钉推进器620。钉盒推进器617的径向向外延伸的凸缘6171抵靠住钉盒614的径向向内延伸的唇部6145。钉盒推进器617的径向向外延伸的凸缘6171的尺寸和形状构造成使得，起初钉盒推进器617的径向向外延伸的凸缘6171大于钉盒614的径向向内延伸的唇部6145和刀片618的外表面之间的距离。
操作时，图15(d)中未示出的钉和刀片部分606的部件以大致类似于图11(a)和11(b)中示出的钉和刀片部分106的那些部件的操作方式而操作，如上文更全面地描述。参照图15(d)，例如通过柔性轴20的第一可转动驱动轴30的使用者的操作，使得推力元件628绕着砧套筒引导件610在例如第二方向上转动。
推力元件628绕着砧套筒引导件610在第二方向上的转动使得钉推进器支架元件622相对于推力元件628运动，这是由于位于推力元件628的颈部6281的外表面上的螺纹6284螺接到位于钉推进器支架元件622的颈部6221的内表面上的螺纹6223。因为钉推进器支架元件622的键6225接合在由开口环624形成的键槽6243中，使得钉推进器支架元件622在开口环624内向远端方向轴向地滑动。钉推进器支架元件622向远端的运动使得钉推进器620也向远端方向运动，这是由于推力元件628的凸缘6282抵靠住钉推进器620。
钉推进器620向远端方向的运动使得刀片618和覆盖刀片618的切割边缘6183的易碎刀片保护环616也与钉推进器620一起向远端方向运动。此外，由于钉盒推进器617的径向向外延伸的凸缘6171起初大于钉盒614的径向向内延伸的唇部6145和刀片618的外表面之间的距离，钉推进器620在向远端方向的运动还使得钉盒614与钉推进器620一起向远端方向运动。从而此操作阶段，钉推进器620、刀片618、易碎刀片保护环616、钉盒推进器元件617和钉盒614一起向远端方向运动。钉盒614向远端运动，从而夹住位于砧端盖602的夹紧面6023和钉盒614的夹紧面6146之间的一部分组织(未示出)。根据该部分组织的厚度，钉盒614可向远端运动，直到钉盒614的径向向外延伸的唇部6143抵靠住外壳套筒612的径向向内延伸的唇部6123。
一旦钉盒614已经向远端运动到足以完全夹住一部分组织，易碎刀片保护环616和钉盒614通过接触到被压缩的一部分组织而被阻止进一步向远端运动。继续操作第二可转动驱动轴32，例如当约70lbs.或更大的压力施加在被夹紧的该部分组织上时，最终使得钉盒推进器元件617的径向向外延伸的凸缘6171被推到钉盒614的径向向内延伸的唇部6145和刀片618的外表面之间，由此克服这些部件之间的干涉配合。这里，钉盒614不向远端移动，而是使得钉推进器620和刀片618相对于钉盒614向远端继续运动。钉盒614的继续向远端运动使得刀片618的切割边缘6183穿透易碎刀片保护环616，由此切割已被夹紧的该部分组织。同时，钉推进器620的进一步向远端的运动使得钉推进器620的推进齿6201开始向远端穿过钉容纳槽6141而运动，该推进齿6201与钉盒614的钉容纳槽6141对准。保持在钉盒614的钉容纳槽6141内的钉6142由此被推进而穿过该部分被夹紧的组织，并被推入到砧端盖602的夹紧面6023的钉引导件6026，直到钉6142闭合。
当钉6142完全闭合时，该部分组织上的夹紧力可通过第二驱动轴32在相反方向上的转动而减小。一般而言，当第二驱动轴32在相反方向上转动时，通过钉和刀片部分106的多个部件的相反运动，而使得推力元件628也在与上面描述相反的方向上转动，由此使得钉推进器支架元件622缩回，例如向近端运动。刀片618还通过刀片618的唇部6185接合在位于钉推进器支架元件622的颈部6221的外表面上的凹陷6224中而缩回，例如向近端运动。此外，通过保持在钉盒614的径向向内延伸的唇部6145和刀片618的外表面之间的钉盒推进器617的径向向外延伸的凸缘6171的干涉配合，而使得钉盒614缩回。一旦砧端盖602的夹紧面6023和钉盒614的夹紧面6146之间的夹紧力已经足够地减小，已经被切割并钉缝的该部分组织可从砧端盖602的夹紧面6023和钉盒614的夹紧面6146之间取下，并且外科附属装置600可从患者体内取出。
图16是示意性地示出了根据本发明另一实施方式的外科附属装置700的一些部件的侧视截面图。外科附属装置700包括砧端盖702，该砧端盖连接到例如线缆的套针轴708。砧端盖702包括夹紧面7023。夹紧面7023具有形成刀片容座7024的凹陷部分。该夹紧面7023还形成了钉引导件7026。套针轴708穿过钉和刀片部分706延伸，并可通过套针轴708的延伸和缩回而相对于钉和刀片部分706移动，例如通过操作例如第一可转动驱动轴30的可转动驱动轴，如图1并结合其所述。
钉和刀片部分706包括外壳套筒712，该外壳套筒在其近端固定地连接到外壳后端盖750，并在其远端固定地连接到钉盒714。钉盒714形成有多个钉容纳槽7141，其中设置有钉7142。钉容纳槽7141构造成对应于并对准形成于砧端盖702的夹紧面7023中的钉引导件7026。钉盒714的远端形成有夹紧面7146，其具有一个或多个朝向远端的突出物7147。
钉和刀片部分706还包括具有钉推进器指部7201的钉推进器720，该指部对应于并对准钉盒714的钉容纳槽7141。刀片718安装在钉推进器720的远端。剪力销751位于钉推进器720的近端，该剪力销至少起初将钉推进器720连接到外壳后端盖750。
操作时，例如希望被切割并钉缝的一部分口腔组织的一部分组织设置在砧端盖702的夹紧面7023和钉盒714的夹紧面7146之间。当操作例如第一可转动驱动轴30的合适的驱动机构时，套针轴708相对于钉和刀片部分706缩回，直到该部分组织充分地夹紧在砧端盖702的夹紧面7023和钉盒714的夹紧面7146之间。一旦该部分组织充分地夹紧在砧端盖702的夹紧面7023和钉盒714的夹紧面7146之间，继续操作例如第一可转动驱动轴30的合适的驱动机构，使得剪力销751发生剪切。有利地，剪力销751剪切处的压力预定为在该部分组织被切割并钉缝前最优地夹紧时的压力。一旦使得剪力销751发生剪切，钉盒714以及外壳套筒712和外壳后端盖750被允许相对于钉推进器720向近端运动。钉盒714相对于钉推进器720向近端的运动使得钉推进器720的钉推进器指部7201穿过钉盒714的各个钉容纳槽7141而运动。通过例如第一可转动驱动轴30的合适的驱动机构的继续操作，钉7142逐渐地被推出钉盒714的钉容纳槽7141，穿过该部分组织并顶住钉端盖702的钉引导件7026，直到钉7142闭合。此外，并且大致同时地，一旦使得剪力销751发生剪切，则使得钉盒714相对于安装在钉推进器720的远端处的刀片718而向近端运动。钉盒714相对于刀片718向近端的运动使得刀片718穿过夹紧在砧端盖702的夹紧面7023和钉盒714的夹紧面7146之间的该部分组织。通过例如第一可转动驱动轴30的合适的驱动机构的继续操作，刀片718被逐步地推动着穿过该部分组织并进入到砧端盖702的刀片容座7024中，直到该部分组织被完全切割。
因此，根据本发明一个实施方式的外科附属装置700提供一种装置，其中钉推进器720、钉7142和刀片718被保持在相对静止的位置。砧组件712被导致相对于钉推进器720、钉7142和刀片718移动，从而切割和钉缝设置在其间的该部分组织。该装置可提供改进的性能，因为与传统的圆形切割和钉缝设备相比，其可施加增大的夹紧力。这些增大的夹紧力是可能的，因为与采用齿轮装置等推动钉推进器、钉和刀片而顶住静止的砧的传统的圆形切割和钉缝设备不同，外科附属装置700提供一种位于砧组件中的装置，该装置被拉动而朝向并顶住保持在相对静止位置的钉推进器、钉和刀片。
图17是示意性地示出了根据本发明另一实施方式的外科附属装置800的一些组件的侧视截面图。外科附属装置800包括砧端盖802，该砧端盖连接到例如线缆的套针轴808。砧端盖802包括夹紧面8023。夹紧面8023不垂直于——例如倾斜于——由套针轴808限定的轴880。夹紧面8023具有形成有刀片容座8024的凹陷部。夹紧面8023还形成有钉引导件8026。套针轴808延伸穿过钉和刀片部分806，并例如可通过例如在图1中示出并结合其描述的第一可转动驱动轴30的可转动驱动轴的操作以延伸和缩回套针轴808而使该套针轴808相对于钉和刀片部分806运动。
钉和刀片部分806包括钉盒814。钉盒814形成有多个钉容纳槽8141，该钉容纳槽中设置有钉8142。钉容纳槽8141构造成对应于并对准形成于砧端盖802的夹紧面8023中的钉引导件8026。钉盒814的远端形成有夹紧面8146。夹紧面8146不垂直于——例如倾斜于——由套针轴808限定的轴880。优选地，夹紧面8023的形状和取向构造成平行于砧端盖802的夹紧面8023。
钉和刀片部分806还包括具有钉推进器指部8201的钉推进器820，该钉推进器指部8201构造成对应于并对准钉盒814的钉容纳槽8141。刀片818安装在钉推进器820的远端。
操作时，例如希望被切割并钉缝的一部分口腔组织的一部分组织设置在砧端盖802的夹紧面8023和钉盒814的夹紧面8146之间。当例如第一可转动驱动轴30的合适的驱动机构操作时，套针轴808相对于钉和刀片部分806缩回，直到该部分组织被充分地夹紧在砧端盖802的夹紧面8023和钉盒814的夹紧面8146之间。通过一种装置，例如第一可转动驱动轴30的合适的驱动机构的操作使得套针轴808相对于钉和刀片部分806缩回，该装置可以是例如上文所述的齿轮装置，或者可以是任意其它合适的机械装置。一旦该部分组织被充分地夹紧在砧端盖802的夹紧面8023和钉盒814的夹紧面8146之间，继续操作例如第一可转动驱动轴30的合适的驱动机构，使得钉盒814和钉推进器820相对于彼此而运动。可由合适的驱动机构相对于钉盒814而推动钉推进器820而使该相对运动便于实现，该合适的驱动机构的一些例子如上所述，或者可由例如在上文中结合图16描述的相对于钉推进器820拉动砧端盖802而使该相对运动便于实现。任意其它的机械装置也可用于此目的。钉盒814相对于钉推进器820的运动使得钉推进器820的钉推进器指部8201穿过钉盒814的相应的钉容纳槽8141而运动。通过继续操作例如第一可转动驱动轴30的合适的驱动机构，钉8142被逐渐地从钉盒814的钉容纳槽8141推出，穿过该部分组织并顶住砧端盖802的钉引导件8026，直到钉8142闭合。此外，并大致同时地，钉盒814相对于安装在钉推进器820的远端处的刀片818的运动使得刀片818穿透夹紧在砧端盖802的夹紧面8023和钉盒814的夹紧面8146之间的该部分组织。通过继续操作例如第一可转动驱动轴30的合适的驱动机构，刀片818被逐渐地推动而穿过该部分组织并进入到砧端盖802的刀片容座8024中，直到该部分组织被完全切割。
根据本发明一个实施方式的外科附属装置800提供一种装置，其中钉和刀片部分806可更容易地插入到患者体内。在传统的圆形切割和钉缝设备中，钉和刀片部分一般具有垂直设置的夹紧面，例如垂直于由钉和刀片部分或穿过该钉和刀片部分的套针轴所限定的总轴的夹紧面。该垂直设置的夹紧面与钉和刀片部分的外壳在周向边缘相交，其截面大致为直角。当插入到患者体内、特别是患者的具有非常小的截面积的口腔通道时，由垂直设置的夹紧面和钉和刀片部分的外壳形成的周向边缘摩擦口腔通道的内表面，由此使得插入困难。此外，该周向边缘摩擦口腔通道的内表面可能会损伤口腔通道。与此相反，钉盒814的夹紧面8146的不垂直的——例如倾斜的——设置减小了所经受的与口腔通道的内表面摩擦的程度，由此，便于通过口腔通道而插入钉和刀片部分806，并减小损伤口腔通道的内表面的可能性。
图18(a)和18(b)示出了根据本发明另一实施方式的钉和刀片部分。特别地，图18(a)是一个分解的立体图，示出了钉和刀片部分906的一些部件。如图18(a)所示，钉和刀片部分906包括外壳套筒904。外壳套筒904具有齿轮箱9043，其在近端形成有轴孔9042和第二孔9044。外壳套筒904还具有沿其内表面纵向延伸的键槽9041。
钉和刀片部分906还包括输入轴902，该输入轴902构造成不可转动地连接到例如柔性轴104的第二可转动驱动轴104b的驱动轴，该驱动轴接着可通过例如手柄部分102的手柄部分连接到柔性轴20的第二可转动驱动轴32。输入轴902的远端具有延伸部，该延伸部例如通过延伸部的方形截面可以不可转动地插入到输入齿轮906。在输入齿轮906的外表面上周向设置有齿轮齿9061。
钉和刀片部分906还包括具有中心孔9081的恒星齿轮908。恒星齿轮908的外表面具有周向设置的齿轮齿9082，该齿轮齿对应于输入齿轮906的齿轮齿9061。钉和刀片部分906还包括垫圈910。钉和刀片部分906还包括环形齿轮912。环形齿轮912具有沿环形齿轮912的内表面周向延伸的齿轮齿9121。
钉和刀片部分906还包括第一行星齿轮914a、第二行星齿轮914b和第三行星齿轮914c。第一行星齿轮914a、第二行星齿轮914b和第三行星齿轮914c的每一个都形成有内孔9141。此外，第一行星齿轮914a、第二行星齿轮914b和第三行星齿轮914c的每一个还包括周向设置的齿轮齿9142。
钉和刀片部分906还包括十字头螺纹元件916，该螺纹元件包括颈部9162和凸缘部9161，该颈部9162相对于该凸缘部9162向远端轴向地延伸。中心孔9166延伸穿过十字头螺纹元件916。颈部9162的外表面形成有螺纹9164。此外，颈部9162的外表面形成有纵向延伸的键槽9165。十字头螺纹元件916的凸缘部9161包括三个向近端延伸的销9163，该销的截面例如为圆形，并对应于第一行星齿轮914a、第二行星齿轮914b和第三行星齿轮914c的孔9141。
钉和刀片部分906还包括具有大致平坦的盘形构造的螺母918。螺母918具有穿过其延伸的中心孔9181。中心孔9181形成有对应于十字头螺纹元件916的颈部9162的外表面上的螺纹9164的螺纹9182。螺母918的远端面形成有周向的沟槽9183。此外，螺母918的径向外侧边缘形成有键9184，该键的尺寸和形状对应于外壳套筒904的内表面上的键槽9041。
钉和刀片部分906还包括旋转推进器920，该旋转推进器也具有大致平坦的盘形构造。旋转推进器920具有穿过其延伸的中心孔9201。中心孔9181形成有键9202，该键的尺寸和形状对应于在十字头螺纹元件916的颈部9162上纵向延伸的键槽9165。旋转推进器920的近端面形成有周向的沟槽9204，该周向的沟槽9204与螺母918的远端面上的周向的沟槽9183对准。旋转推进器920的远端面上设置有推进器凸轮9203。
此外，钉和刀片部分906包括刀片922。刀片922具有沿其远端周向延伸的切割边缘9221。钉和刀片部分906还包括钉盒924。钉盒924限定有多个轴向设置的钉容纳槽9241，该钉容纳槽中储存有钉9242。在图18(a)示出的实施方式中，钉容纳槽9241绕钉盒924周向地设置成径向隔开的两行，其中第一行中的钉容纳槽9241重叠在第二行中的钉容纳槽9241上。此外，钉盒924的远端形成有夹紧面9243。
钉和刀片部分906还包括钉推进器928。钉推进器928具有多个轴向设置的推进齿9281，每个推进齿对应于并且对准钉盒924的钉容纳槽9241。钉推进器928还包括在其外表面上的键9202。
图18(b)是示出了已装配情形下的钉和刀片部分906的多个部件的侧视截面图。输入轴902延伸穿过齿轮箱9043的第二孔9044，并构造成在该孔内转动。输入齿轮906安装在并不可转动地连接到输入轴902的远端。恒星齿轮908座落在外壳套筒904的近端，使得外壳套筒904的在远端延伸的圆柱形芯9045插入穿过恒星齿轮908的中心孔9081。在输入齿轮906的外表面上周向设置的齿轮齿9061啮合到恒星齿轮908的周向设置的齿轮齿9082。环形齿轮912固定在外壳套筒904的近端。首先，第一行星齿轮914a、第二行星齿轮914b和第三行星齿轮914c径向地设置在恒星齿轮908和环形齿轮912之间，使得第一行星齿轮914a、第二行星齿轮914b和第三行星齿轮914c的周向设置的齿轮齿啮合到沿着环形齿轮912的内表面周向延伸的齿轮齿9121，且啮合到恒星齿轮908的齿轮齿9082。垫圈910抵靠住第一行星齿轮914a、第二行星齿轮914b和第三行星齿轮914c的近端侧和输入齿轮906的远端侧，从而防止这些部件轴向运动。
从十字头螺纹元件916的凸缘部916延伸的销9163插入在第一行星齿轮914a、第二行星齿轮914b和第三行星齿轮914c的内孔9141中，由此保持第一行星齿轮914a、第二行星齿轮914b和第三行星齿轮914c的周向间隔。从而，十字头螺纹元件916的凸缘部9161抵靠住第一行星齿轮914a、第二行星齿轮914b和第三行星齿轮914c的远端侧。
十字头螺纹元件916的颈部9162向远端延伸穿过螺母918的中心孔9181，使得颈部9162的外表面上的螺纹9164螺接到螺母918的中心孔9181内的螺纹9182。螺母918的键9184接合在外壳套筒904的内表面中的键槽9041内。
十字头螺纹元件916的颈部9162还向远端延伸穿过旋转推进器920的中心孔9201。旋转推进器920的中心孔9201内的键9202接合在十字头螺纹元件916的颈部9162中的键槽9165内。此外，一组滚珠轴承926分别设置在螺母918和旋转推进器920的周向沟槽9183和9204内，并在螺母918和旋转推进器920之间提供基本上无摩擦的接触。
十字头螺纹元件916的颈部9162还向远端延伸穿过刀片922的钉推进器928的中心。钉推进器928和刀片922的近端抵靠住旋转推进器920的远端面。钉推进器928的推进器指部9281向远端延伸并对准钉盒924的钉容纳槽9241。钉盒924设置在外壳套筒904的远端内，该钉盒的夹紧面9243形成钉和刀片部分906的远端面。
操作时，例如希望被切割并钉缝的一部分口腔组织的一部分组织设置在例如上文更全面地描述的砧组件的砧组件的夹紧面和钉盒924的夹紧面9243之间。当例如第一可转动驱动轴30的合适的驱动机构操作时，延伸穿过钉和刀片部分906的例如线缆的套针轴相对于钉和刀片部分906缩回，直到该部分组织充分地夹紧在各个夹紧面之间。通过一种装置，例如第一可转动驱动轴30的合适的驱动机构的操作使得套针轴相对于钉和刀片部分906缩回，该装置可以是例如上文所述的齿轮装置，或者可以是任意其它合适的机械装置。
参照图18(b)，输入轴902可连接到驱动轴，例如柔性轴104的第二可转动驱动轴104b。该驱动轴可接着由例如手柄部分102的手柄部分连接到柔性轴20的第二可转动驱动轴32。该驱动轴在例如顺时针方向的第一方向上的转动使得输入轴902在齿轮箱9043的第二孔9044内在第一方向上转动。通过输入轴902的远端与输入齿轮906不可转动的连接，输入轴902在第一方向上的转动使得输入齿轮906也在第一方向上转动。
通过输入齿轮906的周向设置的齿轮齿9061与恒星齿轮908的周向设置的齿轮齿9082的啮合，输入齿轮906在第一方向上的转动使得恒星齿轮908绕着向远端延伸的圆柱芯9045在外壳套筒904内在例如逆时针方向的第二方向上转动。此外，通过第一行星齿轮914a、第二行星齿轮914b和第三行星齿轮914c的外表面上周向设置的齿轮齿9142与恒星齿轮908的周向设置的齿轮齿9082的啮合，恒星齿轮908在第二方向上的转动使得第一行星齿轮914a、第二行星齿轮914b和第三行星齿轮914c在第一方向上转动。因为第一行星齿轮914a、第二行星齿轮914b和第三行星齿轮914c的外表面上周向设置的齿轮齿9142还啮合到沿环形齿轮912的内表面周向延伸的齿轮齿9121，并且因为该环形齿轮912转动地固定在外壳套筒904的近端，所以第一行星齿轮914a、第二行星齿轮914b和第三行星齿轮914c在第一方向上的转动导致第一行星齿轮914a、第二行星齿轮914b和第三行星齿轮914c绕着恒星齿轮908在第二方向上转动。
由于从十字头螺纹元件916的凸缘部916延伸的销9163插入在第一行星齿轮914a、第二行星齿轮914b和第三行星齿轮914c的内孔9141中，第一行星齿轮914a、第二行星齿轮914b和第三行星齿轮914c绕着恒星齿轮908在第二方向上的转动使得十字头螺纹元件916也在第二方向上转动。通过将颈部9162的外表面上的螺纹9164螺接到螺母918的中心孔9181内的螺纹9182，并且因为螺母918的键9184接合在外壳套筒904的内表面中的键槽9041内，所以十字头螺纹元件916在第二方向上的转动使得螺母918沿着十字头螺纹元件916的颈部9162向远端前进。
因为旋转推进器920的中心孔9021中的键9202接合在十字头螺纹元件916的颈部9162中的键槽9165，十字头螺纹元件916在第二方向上的转动使得旋转推进器920在第二方向上转动。旋转推进器920的近端侧接触到螺母918的远端侧，从而螺母918沿着十字头螺纹元件916的颈部9162向远端的前进使得旋转推进器920也沿着十字头螺纹元件916的颈部9162向远端前进。设置在螺母918和旋转推进器920的分别的周向沟槽9183和9204内的该组滚珠轴承926在螺母918和旋转推进器920之间提供大体上无摩擦的接触，其中螺母918是不转动的，而旋转推进器920是转动的。
旋转推进器920沿着十字头螺纹元件916的颈部9162向远端的前进使得刀片922穿过钉盒924的中心孔9244而向远端运动，以切割位于钉盒924的夹紧面9243和砧组件(未示出)的夹紧面之间的一部分组织，如上文中如前所述。此外，旋转推进器920沿着十字头螺纹元件916的颈部9162向远端的前进使得旋转推进器920的推进器凸轮9203在远端方向上推动钉推进器元件928。由于旋转推进器920在向远端前进的同时还转动，导致推进器凸轮9203依次接触并推压钉推进器928的钉推进器指部9281。特别地，当旋转推进器920绕着十字头螺纹元件916的颈部9162逐步转动时，推进器凸轮9203接触并推压第一钉推进器指部9281，然后是第二钉推进器指部9281，等等。当旋转推进器920绕着十字头螺纹元件916的颈部9162转动一圈后，推进器凸轮9203已经接触并推压钉推进器元件928的所有钉推进器指部9281。根据推进器凸轮9203相对于旋转推进器920的远端侧的高度，并根据钉9242的尖头的长度，一旦推进器凸轮9203接触到钉推进器元件928，可能需要旋转推进器920完成数圈转动，以使推进器凸轮9203将钉从钉盒924的槽9241中完全推出，并使钉9242顶住砧组件(未示出)的钉引导件而完全闭合。
如前所述，在插入到患者体内的外科设备——特别是传统的切割和钉缝设备——使用的过程中，所遇到的其中一个问题是，这些设备需要被插入到患者的截面积较小的孔窍或通道内，例如患者的口腔。因而外科设备的插入可能是困难的或者不可能的，和/或可能会损伤口腔通道的内表面。根据本发明的一个实施方式，为了便于将外科设备插入并穿过患者的小孔窍或通道，可能会使用套筒。例如图19(a)到19(e)示出了可能会采用的多种套筒，以便于将外科设备插入并穿过患者的小孔窍或通道。
图19(a)是套筒8000的分解立体图，其构造成在根据本发明的一个实施方式的例如圆形的切割和钉缝设备的外科设备插入到患者体内的过程中，该套筒遮蔽该外科设备。有利地，套筒8000的尺寸和形状和/或轮廓一般类似于由其所遮蔽的外科设备的尺寸和和形状和/或轮廓。仅出于示例性的目的，下面描述的套筒描述为通过与外科附属装置100结合而使用，然而应该认识到该套筒可用于遮蔽任意类型的外科设备。此外，仅出于示例性的目的，下面描述的套筒描述为用于遮蔽外科设备，该外科设备用于插入在患者的空腔通道内，然而应该认识到该套筒可在向患者的任意类型的孔窍或通道插入外科设备时用于遮蔽该外科设备。
套筒8000可由组织兼容的、可消毒的弹性体材料制成。优选地，套筒8000可由耐高压加热的材料制成。此外，套筒8000可由具有高或比较高的润滑性的材料制成。例如，套筒8000可由例如TeflonTM(即含氟聚合物，例如聚四氟乙烯——“PTFE”)、硅酮、TeflonTM/硅酮化合物，例如SIL-KORETM(由W.L.Gore & Associates制造)、“EPTFE”，例如膨胀特氟隆等。可采用的其它合适的材料和密封装置在2002年3月15日提交的本申请人的共同未决的美国专利申请10/099,634中作了进一步的详细描述，该文在此全文引入以供参考。
套筒8000包括一个或多个闭合元件，例如闭合元件8020和8022，该闭合元件构造成在插入位置和缩回位置之间选择性地调整。套筒8000还包括远端部分8024。远端部分8024可构造成遮蔽例如钉和刀片部分106的外科设备的远端部分或外科设备的任意其它远端部分。套筒8000还可包括近端部分8026。近端部分8026可构造成覆盖外科设备的近端部分。例如，套筒8000的近端部分8026可构造成遮蔽例如图1中示出并结合其描述的柔性轴20或柔性轴104等的柔性轴，或者例如图7(a)示出并结合其描述的手柄部分102或者图13(a)中示出并结合其描述的手柄部分5102等的手柄部分。环形导引器元件8010可连接到套筒8000的近端部分8026，并用作便于将外科设备插入在套筒8000中。
图19(b)是根据本发明一个实施方式的套筒8000的一部分的侧视截面图。在该实施方式中，闭合元件8020和8022示出为逐渐变细，从而形成类似于“鸭嘴”的形状。应该认识到，套筒8000的闭合元件可具有便于将外科附属装置100插入到口腔通道中的任意合适的形状。图19(b)示出了位于关闭位置的闭合元件8020和8022，其中套筒8000适于插入到口腔通道中。当闭合元件8020和8022位于关闭位置时，如图所示，闭合元件8020和8022的逐渐变细的设置使得套筒8000及由该套筒所遮蔽的外科附属装置100可以更方便地插入到口腔通道中，由此减小损伤口腔通道的内表面的可能性。在一种实施方式中，闭合元件8020和8022可通过附连到外科附属装置100的一部分而保持在关闭位置，例如通过附连到例如图1中示出并结合其描述的套针110的套针。
图19(c)示出了位于打开位置的闭合元件8020和8022。特别地，当套筒8000已插入到口腔通道中后，闭合元件8020和8022可被打开，从而使得套筒8000内的外科附属装置100可以执行所期望的外科手术。例如，闭合元件8020和8022可被打开从而使得砧组件112可连接到钉和刀片部分106，然后朝向钉和刀片部分106缩回并顶住钉和刀片部分106。
为了打开闭合元件8020和8022，远端部分8024和/或闭合元件8020和8022可具有缩回机构。例如，图19(a)示出薄片8028，该薄片是套筒8000的远端部分8024的一部分，或从该远端部分延伸。这些薄片8028可连接到闭合元件8020和8022，例如通过层压到其上或通过穿过闭合元件8020和8022的周向设置的槽8030而插入。从而，当套筒8000插入到口腔通道中后，套筒8000可相对于外科附属装置100在近端方向上运动。套筒8000相对于外科附属装置100在近端方向上的运动使得闭合元件8020和8022枢转或打开。
根据套筒8000和外科附属装置100的尺寸和形状，一旦闭合元件8020和8022打开，套筒8000可留在原位。在此情形下，随后可使用套筒8000——例如外科操作完成后——以便于从口腔通道取出外科附属装置100。可选地，一旦闭合元件8020和8022打开，可通过套筒8000相对于外科附属装置100在向近端方向的持续运动而将套筒8000从口腔通道中取出，而外科附属装置100仍然在口腔通道中。在此情形下，导致包括闭合元件8020和8022的套筒8000在外科附属装置100上滑动。尽管薄片8028在图19(a)中示出为在纵向上是直的，在其它实施方式中，薄片可具有不同的形状，例如钩状、环形等。
图19(d)和19(e)示出了根据本发明另一实施方式的套筒8100。特别地，图19(d)示出了位于插入位置的套筒8100。在该插入位置，套筒8100构造成遮蔽外科附属装置100，还使得外科附属装置100便于插入到口腔通道中。
套筒8100可包括远端部分8105。远端部分8105可构造成遮蔽外科附属装置100的远端部分，例如钉和刀片部分106。套筒8100可还包括近端部分8107。近端部分8107可构造成遮蔽外科附属装置100的近端部分或连接到外科附属装置100的任意其它部件。例如，套筒8000的近端部分8107可构造成遮蔽例如图1中示出并结合其描述的柔性轴20或柔性轴104等的柔性轴，或者例如图7(a)示出并结合其描述的手柄部分102或者图13(a)中示出并结合其描述的手柄部5102等的手柄部分。
套筒8100还可包括闭合元件。该闭合元件可构造成环8102，然而可采用其它的形状。当套筒8100在插入位置中时，环8102设置为：由环8102所限定的轴线8104基本上垂直于由钉和刀片部分106所限定的纵轴8106。通过将环8102附连到外科附属装置100的一部分，例如附连到延伸穿过钉和刀片部分106的套针110，环8102可保持在此位置。在此位置，环8102的一侧8110与钉和刀片部分106的远端侧接触，并且环8102的相对侧8112对着钉和刀片部分106设置。环8102的外圆周提供了通常的曲面，该曲面一旦插入口腔通道内，就在外科附属装置100通过口腔通道之前逐渐打开口腔通道。以此方式，使得外科附属装置100便于插入到口腔通道中。
图19(e)示出了环8102处在缩回位置。特别地，当其中具有外科附属装置100的套筒8100插入到口腔通道内之后，环8102可相对于外科附属装置100运动，从而允许外科附属装置100执行所期望的外科手术。例如，环8102可相对于轴线8109转动，从而允许砧组件112连接到并然后朝向钉和刀片部分106缩回。为了缩回环8102，套筒8100可在近端方向相对于外科附属装置100运动。套筒8100在近端方向相对于外科附属装置100的运动使得环8102从外科附属装置100的例如套针100上分离并且朝向并顶住钉和刀片部分106而拉动。套筒8100相对于外科附属装置100在向近端方向的持续运动将使得环8102转动并且最终设置成由环8102所限定的轴线8104与由钉和刀片部分106所限定的轴线8106同轴。在此位置，如果环8102的外径小于钉和刀片部分106的外径，环8102可如图19(e)所示由其整个圆周接触钉和刀片部分106。因此，套筒8100可在外科手术期间继续遮蔽钉和刀片部分106并且随后可被用于——例如外科操作完成之后——使外科附属装置100便于从口腔通道中取出。可选地，如果环8102的外径大于钉和刀片部分106的外径，套筒8100相对于外科附属装置的持续运动将使得环8102滑过外科附属装置100，用于从口腔通道中取出套筒8100。
因此，以最有效的方式达到了本发明的几个上述的目标和优点。本领域技术人员能够理解的是，以上描述的示例性实施方式的多种修改可在不偏离本发明的精神和范围下获得。尽管这里本发明描述和详细披露了单独的示例性实施方式，需要理解的是，本发明的范围并不限制于此，并且其范围由其所附的权利要求来确定。

Claims (12)

1.一种用于切割和钉缝一部分组织这二者至少其中之一的外科设备，包括：
用于钉的外壳，该外壳形成有孔并具有远端，所述外壳还具有内表面，一环形边缘从所述内表面到所述孔径向向内延伸；
套针轴，该套针轴穿过该外壳的孔设置，从而能够相对于该外壳移动，所述套针轴包括套针；和
砧，该砧能够附连到该套针轴并构造成能够通过该套针轴的运动而相对于该外壳移动，所述砧包括从所述砧向近侧延伸的砧套筒和构造成容纳所述套针的套针容纳槽，所述砧套筒具有形成在其外表面上并围绕其径向延伸的周向凹陷通道，从而当所述砧套筒设置在所述孔中时，所述周向凹陷通道构造成容纳所述边缘以使所述砧套筒可松开地且轴向地固定在所述孔中并且使所述砧相对所述外壳轴向地锁定在预定位置；
其中所述套针轴的至少一部分是柔性的，所述至少一部分是如下的部分：其相对于在外壳的远端处的夹紧面能够向远侧延伸并且能够在所述夹紧面和所述砧之间延伸。
2.如权利要求1所述的外科设备，其中所述套针容纳槽形成于线缆延伸元件内，该线缆延伸元件具有连通到该套针容纳槽的轴向延伸孔。
3.如权利要求2所述的外科设备，其中所述轴向延伸孔具有能够插入所述套针的宽的部分和将该套针保持在该轴向延伸孔中的窄的部分。
4.如权利要求3所述的外科设备，其中通过操作第一驱动器，所述套针轴能够相对于该外壳在延伸位置和所述砧套筒的周向凹陷通道容纳所述边缘的位置之间移动。
5.如权利要求4述的外科设备，其中所述第一驱动器能够通过第一可转动驱动轴的转动而操作。
6.如权利要求5所述的外科设备，其中所述第一可转动驱动轴由至少一个马达选择性地转动。
7.如权利要求6所述的外科设备，其中所述第一可转动驱动轴在控制器的控制下选择性地转动。
8.如权利要求7所述的外科设备，其中所述外科设备被构造成：当所述边缘容纳在所述砧套筒的周向凹陷通道中时，通过操作第二驱动器进行切割和钉缝组织这二者至少其中之一。
9.如权利要求8述的外科设备，其中所述第二驱动器能够通过第二可转动驱动轴的转动而操作。
10.如权利要求9所述的外科设备，其中所述第二可转动驱动轴由至少一个马达选择性地转动。
11.如权利要求10所述的外科设备，其中所述第二可转动驱动轴在控制器的控制下选择性地转动。
12.一种用于切割和钉缝一部分组织这二者至少其中之一的外科设备，包括：
用于钉的外壳，该外壳形成有孔并具有远端，所述外壳还具有内表面，一环形边缘从所述内表面到所述孔径向向内延伸；
套针轴，该套针轴穿过该外壳的孔设置，从而能够相对于该外壳移动，所述套针轴包括套针；和
砧，该砧能够附连到该套针轴并构造成能够通过该套针轴的运动而相对于该外壳移动，所述砧包括从所述砧向近侧延伸的砧套筒和构造成容纳所述套针的套针容纳槽，所述砧套筒具有形成在其外表面上并围绕其径向延伸的周向凹陷通道，从而当所述砧套筒拖入到所述孔中时，所述周向凹陷通道构造成容纳所述边缘以使所述砧套筒轴向地固定在所述孔中并且使所述砧相对所述外壳锁定在预定纵向位置，
其中所述套针轴的至少一部分是柔性的，所述至少一部分是如下的部分：其相对于在外壳的远端处的夹紧面能够向远侧延伸并且能够在所述夹紧面和所述砧之间延伸。
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