JP2014514012A - 多速度方向切替機構を有する外科用器具 - Google Patents
多速度方向切替機構を有する外科用器具 Download PDFInfo
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Abstract
遠隔制御可能なユーザーインターフェースと、遠隔制御可能なユーザーインターフェースの第1の作動時の回転発射運動及び遠隔制御可能なユーザーインターフェースの他の作動時の回転後退運動を発生させるように構成される、発射駆動部と、を有する、外科用器具。該器具は、遠隔制御可能なユーザーインターフェースが選択的に係合可能である第1の駆動部材と、遠隔制御可能なユーザーインターフェースが選択的に係合可能である第2の駆動部材と、を含む。該器具は、第1の駆動部材及び第2の駆動部材と動作可能に係合される細長いシャフトアセンブリも含む。該器具は、細長いシャフトアセンブリに連結されるエンドエフェクタを更に含む。エンドエフェクタは、内部でステープルカートリッジを動作可能に支持するように構成される細長いチャネルと、細長いチャネルに移動可能に連結されるアンビルとを含む。エンドエフェクタは、細長いシャフトアセンブリと動作可能に係合される、細長いチャネル内で動作可能に支持される切断部材も含む。該器具は、遠隔制御可能なユーザーインターフェースが第1の駆動部材を動作させるときに、第1の作動が切断部材を第1の距離だけ前進させ、遠隔制御可能なユーザーインターフェースが第2の駆動部材を動作させるときに、他の作動が切断部材を第2の距離だけ後退させ、第2の距離が第1の距離より大きい器具である。
Description
(関連出願の相互参照)
本出願は、2007年6月6日に出願された米国特許第11/810,015号、表題「Surgical Instrument Having a Multiple Rate Directional Switching Mechanism」の利益を主張する一部継続出願である。本出願は、本明細書と同時に出願される以下の同一所有者の米国特許出願に関し、参照によりそれらの全体が本明細書に組み込まれる。
(1)米国特許第7,832,408号、代理人整理番号070058/END6088USNPとして2010年11月16日発行された米国特許出願第11/810,016号、表題「SURGICAL INSTRUMENT HAVING A DIRECTIONAL SWITCHING MECHANISM」、及び
(2)米国特許第7,819,299号、代理人整理番号070060/END6090USNPとして2010年10月26日発行された米国特許出願第11/809,935号、表題「SURGICAL INSTRUMENT HAVING A COMMON TRIGGER FOR ACTUATING AN END EFFECTOR CLOSING SYSTEM AND A STAPLE FIRING SYSTEM」。
本出願は、2007年6月6日に出願された米国特許第11/810,015号、表題「Surgical Instrument Having a Multiple Rate Directional Switching Mechanism」の利益を主張する一部継続出願である。本出願は、本明細書と同時に出願される以下の同一所有者の米国特許出願に関し、参照によりそれらの全体が本明細書に組み込まれる。
(1)米国特許第7,832,408号、代理人整理番号070058/END6088USNPとして2010年11月16日発行された米国特許出願第11/810,016号、表題「SURGICAL INSTRUMENT HAVING A DIRECTIONAL SWITCHING MECHANISM」、及び
(2)米国特許第7,819,299号、代理人整理番号070060/END6090USNPとして2010年10月26日発行された米国特許出願第11/809,935号、表題「SURGICAL INSTRUMENT HAVING A COMMON TRIGGER FOR ACTUATING AN END EFFECTOR CLOSING SYSTEM AND A STAPLE FIRING SYSTEM」。
(発明の分野)
本発明は、概して、外科用ステープリング器具、より具体的には、エンドエフェクタ閉鎖システム及びステープルを展開するための発射システムを有する外科用ステープラに関する。
本発明は、概して、外科用ステープリング器具、より具体的には、エンドエフェクタ閉鎖システム及びステープルを展開するための発射システムを有する外科用ステープラに関する。
当該技術分野において既知であるように、外科用ステープラは、多くの場合、例えば、特に組織が横切開される際に、ステープルを軟組織内に展開して、軟組織からの出血を低減させるか、又は除去するために使用される。例えば、エンドカッター等の外科用ステープラは、多くの場合、第1の顎部材と第2の顎部材との間に軟組織を固定するように構成されるエンドエフェクタを備える。第1の顎部材は、多くの場合、内部でステープルを取り外し可能に格納するように構成されるステープルカートリッジを含み、第2の顎部材は、多くの場合、アンビルを含む。使用中、ステープルは、典型的には、ステープルカートリッジ内のチャネルを横断し、ステープルをアンビルに対して変形させ、かつ軟組織の層をともに固定させる駆動部によってステープルカートリッジから展開される。多くの場合、当該技術分野において既知であるように、ステープルは、組織の層をより正確に一緒に固定するため、いくつかのステープルライン又は列で展開される。エンドエフェクタはまた、切断部材、例えば、ナイフを含んでもよく、これは2列のステープルの間で前進し、軟組織の層が一緒にステープリングされた後に軟組織を切除する。
駆動部及び切断部材がエンドエフェクタ内で前進した後、多くの場合、駆動部及び/又は切断部材をそれらの始動位置に後退させる必要がある。以前の外科用ステープラは、外科用ステープラの解放ボタン又はトグルスイッチが外科医によって作動させられた後、切断部材をステープルカートリッジに対して後退させる、戻りばねを含んでいる。しかしながら、そのようなステープラは、切断部材を部分的に後退させることができず、その結果として、切断部材が再前進し得る前に、切断部材は、完全に後退しなければならない。他の以前の外科用ステープラは、顎部材を閉鎖し、かつ駆動部及び切断部材を前進及び/又は後退させるためのシステムと動作可能に係合される、複数のトリガを含んでいる。そのような装置は、それら本来の目的に好適であるが、多くの場合、外科医に、閉鎖システムと動作可能に係合されるトリガを解放し、かつステープル駆動部及び切断部材を前進させるためのシステムに動作可能に係合される異なるトリガを把持するために手の位置を変えるように要求する。以前の外科用ステープラは、顎部材の閉鎖と駆動部及び切断部材の前進の両方を行うための単一のトリガを有するように開発されたが、そのような装置は、トリガの初期作動時に両方の機能を実行する。ある状況下では好適であるが、同一のトリガ作動で両方の機能を実行する装置は、多くの場合、トリガを作動させるために強度の力が必要とされるため、動作するのが極めて困難である。更に、そのような装置は、同一のトリガ作動において顎部材を閉鎖し、ステープルを展開するため、ステープルが軟組織内で展開される前に、閉鎖された顎部材の位置を評価し、顎部材の位置を変える機会を外科医に提供しない。上記に対する改善が求められている。
添付の図面と関連してなされる本発明の実施形態の以下の説明を参照することにより、本発明の様々な実施形態の上記及び他の特徴並びに利点、それらを得る方法がより明らかとなり、本発明自体がより理解される。
本発明の実施形態に従う外科用器具の斜視図。
図1の外科用器具のシャフト部分及びエンドエフェクタの分解図。
図1の外科用器具のハンドル部分の分解図。
外科用器具のいくつかの構成要素が取り除かれた、図3のハンドル部分の部分側面図。
外科用器具のいくつかの構成要素が取り除かれた、エンドエフェクタ内の切断部材を前進させる構成の外科用器具を例示する図3のハンドル部分の上面図。
外科用器具のいくつかの構成要素が取り除かれた、エンドエフェクタ内の切断部材を前進させる構成の外科用器具を例示する図3のハンドル部分の底面図。
外科用器具のいくつかの構成要素が取り除かれた、図3のハンドル部分の部分斜視図。
トリガの第1の作動時の外科用器具の構成を例示する図1の外科用器具の斜視図。
外科用器具のいくつかの構成要素が取り除かれた、図8に例示されるように構成された図1の外科用器具の部分斜視図。
図1の外科用器具のエンドエフェクタ閉鎖システムのカムの斜視図。
アンビル閉鎖システムのロックの様々な相対位置を例示する図10のカムの正面図。
トリガの第1の作動後にトリガが解放された後の外科用器具の構成を例示する、図1の外科用器具の斜視図。
トリガの第2の作動時の外科用器具の構成を例示する、図1の外科用器具の斜視図。
図13に例示されるように構成された図1の外科用器具の部分斜視図。
トリガの第3の作動時の外科用器具の構成を例示する図1の外科用器具の斜視図。
トリガの第4の作動時の外科用器具の構成を例示する、図1の外科用器具の斜視図。
トリガがトリガの第4の作動後に解放され、外科用器具の切替機構が動作させられた後の外科用器具の構成を例示する、図1の外科用器具の斜視図。
切断部材が完全に後退させられた、トリガの第7の作動時の外科用器具の構成を例示する、図1の外科用器具の斜視図。
外科用器具の構成要素が取り除かれ、図18の構成で例示される、図1の外科用器具の部分正面図。
トリガの第7の作動後の発射駆動部及びハウジングの相互作用を例示する、図1の外科用器具のハウジングの部分斜視図。
分解されたギヤ減速ハウジングの一部分を伴い、本発明の代替の実施形態に従う外科用器具のためのギヤ減速機構の斜視図。
図21のギヤ減速機構の分解図。
本発明の代替の実施形態に従う外科用器具の斜視図。
図23の外科用器具のエンドエフェクタ及びシャフトアセンブリの分解図。
図23の外科用器具のハンドル部分の分解図。
外科用器具の構成要素が取り除かれた、図23の外科用器具の分解図。
外科用器具の構成要素が取り除かれた、図23の外科用器具の斜視図。
外科用器具の構成要素が取り除かれた、図23の外科用器具の第2の斜視図。
エンドエフェクタ内で切断部材を前進させるように構成される図23の外科用器具の側面図。
エンドエフェクタ内で切断部材を後退させるように構成される図23の外科用器具の側面図。
いくつかの構成要素が分解され、他の構成要素が断面図で例示される、本発明の代替の実施形態に従う方向切替機構の斜視図。
いくつかの構成要素は取り除かれ、他の構成要素は断面図で例示される、図31の方向切替機構の平面図。
本発明の代替の実施形態に従う双安定適合機構の図。
対応する参照符合は、複数の図面を通じて対応する部材を示す。本明細書において説明される例示は、一形態における本明細書の好ましい実施形態を例示し、このような例示はいかなる方法においても本発明の範囲を制限するものとして解釈されるべきではない。
本明細書に開示される装置、並びに方法の構造、機能、製造、及び使用の原理の全体的な理解を与えるため、特定の例示的実施形態について以下に説明する。これらの実施形態の1以上の例を添付図面に示す。本明細書で詳細に説明され、添付の図面に示される装置及び方法は、非限定的な例示的実施形態であること、並びに、本発明の各種の実施形態の範囲は、特許請求の範囲によってのみ定義されることは、当業者には理解されよう。例示的な1つの実施形態に関連して図示又は説明される特徴は、他の実施形態の特徴部と組み合わせることができる。そのような改変及び変形は、本発明の範囲に含まれるものとする。
様々な実施形態において、本発明に従う外科用器具は、例えば、軟組織内に外科用ステープルを挿入するためのシステムを含み得る。少なくとも一実施形態において、外科用器具は、内部でステープルを取り外し可能に格納するように構成されるステープルカートリッジと、ステープルカートリッジから展開される、ステープルを変形させるためのアンビルとを含み得る。ステープルを展開するために、外科用器具は、ステープルカートリッジを横断するように構成されるステープル駆動部と、ステープルカートリッジ内でステープル駆動部を前進させるための発射駆動部とを含み得る。様々な実施形態において、発射駆動部は、発射駆動部と動作可能に係合されるトリガによってほぼ線形方向に平行移動される駆動バーを含み得る。他の実施形態において、発射駆動部は、トリガによって回転させられる駆動シャフトを含み得る。そのような実施形態において、外科用器具は、駆動シャフトの回転運動を線形運動に転化し、ステープルカートリッジ内でステープル駆動部を平行移動し得る、シャフトアセンブリを含み得る。図1〜20に例示され、以下に記載される例示の実施形態は、回転駆動シャフトを有する発射駆動部を含むが、本発明はそのようには限定されない。更に、回転駆動シャフトを有する発射駆動部の一般的説明が以下に提供されるが、他のそのような装置が2006年6月27日に出願された同一所有者の同時係属中の米国特許出願第11/475,412号、表題MANUALLY DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENTにより詳細に記載及び例示され、その全ての開示内容が参照によって本明細書に組み込まれる。
図1を参照すると、外科用器具50は、ハンドル部分52、トリガ54、細長いシャフトアセンブリ56、及びエンドエフェクタ58を含み得る。様々な実施形態において、エンドエフェクタ58は、アンビル62及びステープルカートリッジチャネル64を含み得、チャネル64はステープルカートリッジ66を受けるように構成され得、アンビル62はチャネル64に枢軸旋回可能に接続され得る。少なくとも一実施形態において、アンビル62及びチャネル64のうちの少なくとも1つは、トリガ54の作動時に、アンビル62が図8に例示される閉鎖位置内へと回転され得るようにトリガ54に動作可能に接続され得る。様々な実施形態において、図2〜4を参照すると、トリガ54は、細長いシャフトアセンブリ56の外部シース57に対してアンビル62及びチャネル64の両方を平行移動するように構成される、閉鎖駆動システムと動作可能に係合され得る。主として図4を参照すると、閉鎖駆動部は、トリガ54の第1の作動がピン70の周囲でカム68を回転させ、閉鎖リンク72をほぼ線形方向に駆動し得るようにトリガ54と動作可能に係合されるカム68を含み得る。より具体的には、トリガ54は、トリガ54から延在し、カム68及びリフトカム68の表面71に接触して図8に例示される位置へと動くように構成され得る、リフトピン55(図3)を含み得る。カム68はカムスロット69を更に含み得、カム68が図4に例示される位置から図8に例示される位置へと回転させられると、カムスロット69の側壁は、閉鎖リンクピン76と、そして本実施形態においては、摺動閉鎖リンク72とを矢印A(図4)によって例示される方向に係合し得る。
図2及び4を参照すると、外科用器具50は、細長いシャフトアセンブリ56(図1)内に付属肢アセンブリを更に含み得、付属肢アセンブリは、近位チャネル部分78と、遠位チャネル部分80と、を含み得る。様々な実施形態において、チャネル部分78及び80は、突起部又はトング84及び溝86の協働的係合によって相互接続され得る。より具体的には、図2を参照すると、近位チャネル部分78は、様々な実施形態において、突起部84が溝86内で固定されるように遠位チャネル部分80に組立てられ得る、第1の半分77及び第2の半分79を含み得る。少なくとも一実施形態において、近位チャネル部分の半分77及び79は、近位チャネル部分の半分77と79との間にスナップ嵌め又はプレス嵌め係合を提供するように構成される、突起部81及び/又は開口部83を含み得る。他の様々な実施形態において、チャネル部分78及び80は、いずれの好適な手段によっても相互接続され得、少なくとも一実施形態において、例示されないが、部分78及び80は一体的に成形され得る。上記と同様に、図2を参照すると、遠位チャネル部分80は、ステープルカートリッジチャネル64と接続され得る遠位端88を含み得る。より具体的には、遠位チャネル部分80及びステープルカートリッジチャネル64は、その間にいずれの好適な相互接続も使用され得るが、例えば、プレス嵌め又はスナップ嵌め相互接続を間に提供し得る、協働するトング及び溝機能を含み得る。
図4を参照すると、チャネル部分78の近位端82は、閉鎖リンク72がカム68によって平行移動されるときに、チャネル部分78が細長いシャフトアセンブリ56内で平行移動されるように、ピン53によって閉鎖リンク72に連結され得る。少なくとも一実施形態において、チャネル部分78は、チャネル部分78から延在し、ハウジング部分90内の陥凹部85(図3)内で摺動し、軸に沿ったチャネル部分78の平行移動をほぼ制限するように構成され得る、突起部87を更に含み得る。ステープルカートリッジチャネル64は遠位チャネル部分80を介して近位チャネル部分78に接続されると、チャネル64及びチャネル64に枢軸旋回可能に接続されるアンビル62は、カム68が上記のようにトリガ54によって回転させられるときに、方向Aに移動され得る。少なくとも一実施形態において、図2を参照すると、アンビル62の近位端63は、チャネル64及びアンビル62がシース57に対して平行移動されるときに、細長いシャフトアセンブリ56の外部シース57に隣接するように構成され得る。アンビル62の近位端63が外部シース57に接触した後、アンビル62は、図8に例示されるように、アンビル62を閉鎖するためにチャネル64及びステープルカートリッジ66に向かって回転するように構成され得る。様々な実施形態において、図2を参照すると、チャネル64は、チャネル64に対して軸受旋回されるときにアンビル62を導くように構成され得る、スロット65を中に含み得る。アンビル62が一度閉鎖されると、外科用器具はアンビル62を閉鎖位置に保持するロックを更に含み得る。様々な実施形態において、図9〜11を参照すると、外科用器具50は、ハウジング90に装着されるばねロック92を含み得、ばねロック92は、外科医が以下に更に詳述されるアンビル62を開放することを所望するまで、結果として、閉鎖リンク72、チャネル部分78及び80、チャネル64、並びにアンビル62を所定の位置に保持する、カム68を着脱可能に保持するように構成され得る。
様々な実施形態において、アンビル62がその閉鎖位置に置かれた後、トリガ54は、エンドエフェクタ58内で切断部材96を前進させる発射駆動部を動作させるように再度作動させられ得る。少なくとも一実施形態において、発射駆動部は、トリガ54の第1の作動の前にトリガ54から係脱され得る。そのような実施形態において、トリガ54の第1の作動は、発射駆動部がトリガ54と動作可能に係合される状態になるようにトリガ54を発射駆動部と動作可能に係合し、及び/又は発射駆動部の構成要素を解放し得る。例示される実施形態において、図3及び4を参照すると、発射駆動部は、以下に更に詳述されるように、トリガ54から延在するトリガギヤ部分100と、歯車列102と、ギヤ可動台130と、エンドエフェクタ58内で切断部材96を前進させるように構成され得る回転可能な駆動シャフト106とを含み得る。図3〜7に例示されるように、歯車列102は、ラチェットギヤ108と、主駆動ギヤ110と、ベベル駆動ギヤ112と、ベベルギヤ114とを含み得、トリガ54の第1の作動の前に、カム68は、主駆動ギヤ110から係脱してラチェットギヤ108を付勢するように構成され得る。より具体的には、図3を参照すると、ラチェットギヤ108は、シャフト116及びつば118を含み得、カム68は、ラチェットギヤ108上のラチェット面109が主駆動ギヤ110上のラチェット面111と係合されないように、つば118と接触し、主駆動ギヤ112から離れてラチェットギヤ108を付勢するように構成され得る。
トリガ54の第1の作動時に、上記のように、カム68は、図8に例示される位置へと回転させられ、そのような回転の結果として、カム68内の溝120(図4及び5)は、ラチェットギヤ108を解放するように構成され得る。より具体的には、図5〜7を参照すると、溝120は、カム68の回転が溝120をつば118と整列させると、つば118はカム68を通り過ぎて摺動し得、かつラチェットばね122がラチェットギヤ108を付勢して主駆動ギヤ110と動作可能に係合することを可能にするように寸法決めされ得る。その後、トリガ54は解放され、次いでトリガばね124によってその始動位置に戻され得、トリガばね124は、ハウジング90から延在するピン126及びトリガ54から延在するピン128に接続され得る。特に、たとえトリガ54がその始動位置に戻され得るとしても、カム68は上記のようにロック92によって第2の位置にロックされたままであり得、それによって溝120とつば118との間の位置合わせを維持する。ここでラチェットギヤ108が駆動ギヤ110と動作可能に係合され、トリガ54の第2の作動がエンドエフェクタ58内で切断部材96及びステープル駆動部を前進させ得る。
主として図3及び4を参照すると、トリガ54の作動は、ピン70によって画定される軸の周囲でトリガギヤ部分100を回転させ得る。トリガギヤ部分100は、トリガギヤ部分100の外周に沿って延在し、図5及び6を参照すると、例えば、ラチェットギヤ108の周径付近に延在するギヤ歯と係合され得るギヤ歯を含み得る。使用中、その結果として、トリガ54の作動又は回転は、シャフト116及びピン117(図3)によって画定される軸の周囲でラチェットギヤ108を回転させ得る。上記のように、図5及び6を参照すると、ラチェットギヤ108は、主駆動ギヤ110のラチェット面111を係合するように構成され得るラチェット面109を含み得る。少なくとも一実施形態において、ラチェット面109及び111は、トリガ54の第2の作動又は他の後続する作動時に主駆動ギヤ110にトリガ54の回転運動を伝動するように、そしてトリガ54が解放され、作動されない位置に戻されたときに、その間で相対摺動運動を可能とするように構成され得る。実際には、ラチェット面109及び111は、ラチェットギヤ108が一方向に回転させられるときに回転運動を主駆動ギヤ110に伝動するが、ラチェットギヤ108が反対の方向に回転させられるときには、主駆動ギヤ110に回転運動を伝動しないように構成され得る。ラチェット機構が本明細書に記載及び例示されているが、トリガ54と主駆動ギヤ110との間の運動を伝動する他の好適ないずれの機構も使用され得る。更に、トリガ54がレバーとして記載及び例示されているが、他の好適ないずれの装置も本明細書に記載される発射及び閉鎖駆動部を動機付けするように使用されてもよい。
主として図5〜7を参照すると、主駆動ギヤ110は、主駆動ギヤ110の周径付近に延在し、例えば、外周の周囲に延在する、例えばベベル駆動ギヤ112のギヤ歯と係合され得るギヤ歯を含み得る。使用中、その結果として、例えば、ラチェットギヤ108から主駆動ギヤ110に伝動された回転運動は、ベベル駆動ギヤ112に伝動され得る。様々な実施形態において、ベベル駆動ギヤ112は、シャフト113に装着され、又はシャフト113と一体的に成形され得、シャフト113は、ベベル駆動ギヤ112が回転させられ得る軸を画定し得る。少なくとも一実施形態において、図3を参照すると、外科用器具50は、ベベル駆動ギヤ112及びシャフト113が周囲で回転させられ得るブラケット115を更に含み得る。以下により詳細に記載されるように、ブラケット115は、ギヤ可動台130の少なくとも一部分を摺動可能に支持するように構成され得る支持体119も含み得る。様々な実施形態において、図5〜7を参照すると、ベベルギヤ114は、ベベル駆動ギヤ112に取り付けられ得、又は別の方法としては、ベベルギヤ114は、シャフト113に装着され、又はシャフト113と一体的に成形され得る。どちらの場合でも、ベベル駆動ギヤ112に伝動される回転運動はベベルギヤ114に伝動され得る。
様々な実施形態において、例示されないが、ベベルギヤ114は、協働するベベルギヤ歯を介して駆動シャフト106と直接係合され得るであろう。少なくともそのような一実施形態において、ベベルギヤ114は、以下に記載されるように、駆動シャフト106を、例えば、時計回りに回転させ、エンドエフェクタ58内で切断部材96を前進させ得るであろう。そのような実施形態において、トリガ54の作動は、エンドエフェクタ58内で切断部材96を前進させ得るであろうが、切断部材96は、手動又は付加的後退システムによって後退させられなければならないであろう。本発明の例示される実施形態において、図3及び5〜7を参照すると、外科用器具50は、駆動シャフト106が時計回り又は反時計回りで回転させられることを可能にし得、同様に切断部材96がトリガ54の作動によって前進又は後退させられることを可能にし得る、切替機構を更に含み得る。様々な実施形態において、主として図5及び6を参照すると、切替機構は、例えば、ベベルギヤ114の回転運動が駆動シャフト106を時計回りに回転させる第1の位置とベベルギヤ114の回転運動が駆動シャフト106を反時計回りに回転させる第2の位置との間で転位され得る、ギヤ可動台130を含み得る。
様々な実施形態において、図5〜7を参照すると、ギヤ可動台130は、ハウジング132と、前進ギヤ134と、前進ギヤ134及び逆転ギヤ136がハウジング132に回転可能に装着され得る逆転ギヤ136とを含み得る。少なくとも一実施形態において、駆動シャフト106は、例えば、前進ギヤ134及び逆転ギヤ136が駆動シャフト106と回転可能に係合されるようにギヤ134及びギヤ136内の開口部(例示せず)で受けられ得る、ほぼ六角形状の端部107を含み得る。他の様々な実施形態において、端部107は、ギヤ134及び136が駆動シャフト106に回転可能に係合されるように他のいずれの好適な形状又は構成も含み得る。どちらの場合でも、図5を参照すると、ギヤ可動台130は、前進ギヤ134又は逆転ギヤ136がベベルギヤ114と係合され得るように端部107に沿って摺動され得る。使用中、例えば、前進ギヤ134がベベルギヤ114と係合されるとき、ベベルギヤ114の回転運動は前進ギヤ134に伝動され、端部107及び前進ギヤ134内の開口部の協働する幾何学的形状のために、ギヤ134の回転運動は駆動シャフト106に伝動され得る。駆動シャフトを反対方向に回転させるために、ギヤ可動台130は、逆転ギヤ136がベベルギヤ114を係合するように近位又は後方に摺動され得る。ギヤ可動台130をこの方法で動機付けるための機構が以下に更に記載される。
様々な実施形態において、前進ギヤ134が図5に例示されるようにベベルギヤ114と係合されるとき、逆転ギヤ136は、逆転ギヤ136が駆動シャフト106と自由に回転するようにベベルギヤ114から係脱され得る。少なくとも一実施形態において、ギヤ可動台130は、ギヤ134及び136を回転可能に支持及び整列させ、なおギヤ134及び136が互いに独立して回転できるように構成され得る、スペーサ135を更に含み得る。いくつかの実施形態において、ギヤ可動台130は、前進及び後方位置の中間位置に配置され得、したがって、ギヤ134及び136の両方は、トリガ54が作動させられ得ないようにベベルギヤ114を係合し、駆動シャフト106を「ロックアウト」状態に保持する。他の様々な実施形態において、ギヤ可動台130は、ギヤ134も136もベベルギヤ114を係合しないように中間位置に配置され得る。そのような実施形態において、発射駆動部は「自由な」状態にあり、ベベルギヤ114の回転運動は駆動シャフト106に伝動されない。
様々な実施形態において、主として図2を参照すると、駆動シャフト106は、発射ナット140と動作可能に係合され得るねじ付き駆動部分138を更に含み得る。少なくとも一実施形態において、ねじ付き駆動部分138は、駆動シャフト106の回転運動に反応して発射ナット140を摺動可能に前進及び/又は後退させるように構成され得る。より具体的には、発射ナット140は、駆動シャフト106の回転が発射ナット140を遠位に前進させる反応力を発生させるようにねじ止めによりねじ付き駆動部分138を受けるように構成され得る、ねじ付き開口部141を含み得る。少なくとも一実施形態において、発射ナット140は、発射ナット140から延在し、軸に沿った発射ナット140の移動を限定するために近位チャネル部分の半分77と近位チャネル部分の半分79との間に画定されるスロットを通って延在するように構成され得る、突起部142を含み得る。実際には、スロットは発射ナット140が駆動シャフト106と回転することを防止し得、発射ナット140がチャネル部分78内で平行移動されると、突起部142のための経路を画定し得る。
様々な実施形態において、図2を参照すると、切断部材96は、上記のように、発射ナット140の平行移動がエンドエフェクタ58内で切断部材96の平行移動をもたらし得るように発射ナット140と動作可能に係合され得る。少なくとも一実施形態において、外科用器具50は、発射ナット140に接続される発射棒144と、切断部材96に接続される駆動バー146と、駆動バー146を発射棒144に接続するように構成されるアダプタ148と、を更に含み得る。様々な実施形態において、発射棒144は、プレス嵌め法で少なくとも発射ナット140の一部分を受けるように構成される開口部を含む、近位端145を含み得る。少なくとも一実施形態において、発射棒144の近位端145は、変形可能な部材147が陥凹部143に向かって内部に押され、又は変形された後、発射ナット140内の陥凹部143に係合するように構成され得る、変形可能な部材147を含み得る。どちらの場合でも、発射棒144は、例えば、プレス嵌め法でプラグ150を受けるように構成され得る遠位端149を更に含み得、プラグ150は、プラグ150から延在し、アダプタ148のスロット154内に受けられ得る突起部152を含み得る。様々な実施形態において、アダプタ148は、スロット151を更に含み得、スロット151は、アダプタ148が発射棒144によって平行移動されると、駆動バー146が遠位保持器セクション80内で平行移動され得るように駆動バー146のコネクタ留め金154を受けるように構成され得る。少なくとも一実施形態において、駆動バー146は、切断部材96内の陥凹部97を係合し、エンドエフェクタ58内の切断部材96を前進及び/又は後退させるように構成され得る、遠位端156を更に含み得る。上記のように、切断部材96は、切断部材96がエンドエフェクタ58内で前進させられると、アンビル62とステープルカートリッジ66との間に位置付けられる組織を切開するように構成され得る、ナイフ99を含み得る。更に、上記のように、切断部材96は部分95を含み得、部分95は、ステープルカートリッジ66内のステープル駆動部(例示せず)を押し、中に取り外し可能に格納されるステープル(例示せず)を展開するように構成され得る。
様々な実施形態において、外科用器具は、トリガ54の単一の作動時、すなわち、トリガ54の第1の作動が上記のようにアンビル62を閉鎖する実施形態におけるトリガ54の第2の全体的作動時に、所望の距離だけ切断部材96を前進させるように構成され得る。しかしながら、他の実施形態において、トリガ54の複数の作動は、切断部材96を所望の距離だけ前進させるように使用され得る。少なくともそのような一実施形態において、図12〜16を参照すると、トリガ54は3回作動されて、切断部材96をエンドエフェクタ58の近位端59から遠位端61へと前進させ得る。しかしながら、他の実施形態におけるそのような作動の量は、切断部材96が変位される全体的距離及びそれぞれの作動の結果としての切断部材96の変位に大きく依存するであろう。特に、トリガ54の第2の作動前に、切断部材96はエンドエフェクタ58の近位端59に位置付けられ得、発射ナット140は最も近位な位置に位置付けられ得る。図13及び14を参照すると、トリガ54の第2の作動時に、切断部材96は近位端59と遠位端61との間の距離のおよそ3分の1だけ前進させられ得、同様に、発射ナット140は駆動シャフト106に沿って遠位に前進させられ得る。図15を参照すると、その後、切断部材はトリガ54の第3の作動時に近位端59と遠位端61との間の距離の更に3分の1だけ前進させられ得、同様に、図16を参照すると、切断部材96は、トリガ54の第4の作動時にエンドエフェクタ58の遠位端61中に前進させられ得る。
様々な実施形態において、トリガ54が作動させられた回数の合計を監視する際に外科医を補助するために、外科用器具50は、トリガ54が作動された回数の合計及び/又はステープルカートリッジ内の全てのステープルを展開するように残る作動の合計を表示するように構成され得る、集計機構を含み得る。どちらの場合でも、主として図3及び9を参照すると、集計機構170の一実施形態は、表示器ナット172と、表示器プレート174と、ハウジング90内の表示器窓171(図1)と、を含み得る。少なくとも一実施形態において、表示器プレート174は、トリガ54が切断部材96を前進させるように作動させられた回数の合計を外科医に通信し得る兆候を上に含む。そのような実施形態において、表示器プレート174は、トリガ54の第1の作動、すなわち上記のようにアンビル62を閉鎖するトリガ54の作動前後に窓171を通して可視である、ブランク部分173を含み得る。トリガ54の第2の作動時に、駆動シャフト106の回転は、表示器プレート174上に数字「1」又は他の好適な兆候が表示器窓171を通して見られ得るように、表示器ナット172及び表示器ナット172に装着される表示器プレート174を遠位に前進させ得る。したがって、そのような兆候は、切断部材96がトリガ54の1つの作動によって前進させられたことを外科医に対して表示し得る。発射ナット140と同様に、表示器ナット172は、駆動シャフト106の回転が表示器ナット172に反応力を適用し、遠位に前進させるように駆動シャフト106のねじ付き部分176とねじ止めにより係合され得る、ねじ付き開口部を含み得る。トリガ54の後続の作動は、表示器窓171の下の数字「2」及び「3」を動かし得る。
上記で概観されたように、切断部材96を後退させるために、ギヤ可動台130は前進ギヤ134がベベルギヤ114から係脱されるように転位され得、図17及び18を参照すると、逆転ギヤ136はベベルギヤ114と係合される。その後、トリガ54の後続の作動は、駆動シャフト106を反対方向に回転させ、発射ナット140を近位に平行移動させ得る。より具体的には、駆動シャフト106の発射ナット140とねじ付き部分138との間のねじ付き係合のために、シャフト106の反対方向への回転は、発射ナット140を近位方向に変位させる反応力を発射ナット140に適用する。したがって、発射棒144、駆動バー146、及び切断部材96は、上記のように発射ナット140に接続され得、近位方向にも変位され、それによってエンドエフェクタ58内の切断部材96を後退させる。同様に、シャフト106の反対方向への回転は、表示器アセンブリ170の表示器ナット172も近位に変位させ得る。より具体的には、ギヤ可動台130が転位された後、すなわちトリガ54の第5の全体的作動後のトリガ54の第1の作動は、駆動シャフト106に表示器ナット172に反応力を適用させ、ナット172を近位に移動させ得る。そのような状況において、表示器ナット172は、数字「2」が、トリガ54の更に2回の作動が切断部材96を完全に後退させるために必要とされることを外科医に想起させ得る表示器窓171を通して可視であるように、窓171に対して表示器プレート174を移動させ得る。
本実施形態において、トリガ54は、切断部材96を前進及び/又は後退させるために3回作動させられるが、切断部材96を前進させるために必要とされる作動は、他の実施形態で切断部材96を後退させるために必要とされる作動と異なる可能性がある。異なる速度で切断部材96を前進及び後退させるための特徴を含む例示の実施形態が、以下に更に記載される。更に、少なくとも一実施形態において、切断部材96の部分95は、切断部材96の後退がステープル駆動部も後退させるようにステープル駆動部と係合され得る。しかしながら、他の実施形態において、ステープル駆動部はステープルカートリッジ内に残置され得、切断部材96のみが後退させられる。そのような実施形態は、消耗したステープルカートリッジアセンブリが中に独自のステープル駆動部を含む新しいステープルカートリッジアセンブリと交換され、結果として、使用されたステープル駆動部を消耗したカートリッジに残すことが所望であり得る場合に使用されてもよい。
上記のようにギヤ可動台130を動機付けるために、外科用器具50は、図3〜5を参照すると、切替機構160を含み得る。少なくとも一実施形態において、切替機構160は、シャフトスイッチ162と、シャフトスイッチ162から延在するシフトレバーハンドル164と、シフトレバーリンク166とを含み得、シフトレバーリンク166は、シフトレバーピン169を介してシャフト162に、かつピン168を介してギヤ可動台ハウジング132に接続され得る。上記のように、駆動シャフト106に対してギヤ可動台130を摺動させるために、シフトレバーハンドル164は、シャフト162から延在するクランクアーム163が駆動シャフト106の軸105に沿ってシフトレバーリンク166及び駆動ギヤ可動台130を変位させるように、シャフト162を回転させるように構成され得る。例示される実施形態において、シフトレバーハンドル164が図8に例示されるようにほぼ下向き方向に配置されると、クランクアーム163は、ほぼ上向き方向に配置される。この構成において、図5を参照すると、ギヤ可動台130は、前進ギヤ134がベベルギヤ114と動作可能に係合されるように最も後方、又は近位位置に位置付けられる。切断部材96が後退させられる構成に外科用器具50を転位させるために、シフトレバーハンドル164は、図17に例示されるように上向き方向に回転させられ、クランクアーム163を前方又は遠位に回転させる。同様に、クランクアーム163は、リンクアーム166を遠位に変位し、ギヤ可動台130を最も遠位位置へと引くように構成され得、それによって逆転ギヤ136をベベルギヤ114と係合させる。外科医が切断部材96を少なくとも部分的に後退させた後に切断部材96を前進させることを所望する場合、外科医は、シフトレバーハンドル164を下向きに回転させ、前進ギヤ134をベベルギヤ114と再係合させ得る。
様々な実施形態において、図3及び5を参照すると、外科用器具50は、ギヤ134又は136のうちの1つがベベルギヤ114と係合される構成に切替機構160を付勢するための双安定適合機構を更に含み得る。別様に記述されるならば、双安定適合機構は、外科医がシフトレバーハンドル164を部分的にのみ回転させると、切替機構160を動力的に不安定にさせ得る。そのような状況において、双安定適合機構は、切替機構160を安定的である2つの構成、すなわち前進及び逆転構成のうちの1つへと付勢し得る。様々な実施形態において、双安定適合機構180は、主として図3を参照すると、レシーバ182と、ばね184と、プランジャ186と、トグルピン188と、を含み得る。少なくとも一実施形態において、トグルピン188はプランジャ186をスイッチシャフト162に接続し得、レシーバ182はハウジング90から延在する突起部183に接続され得る。使用中、ばね184は、プランジャ186によってシャフト162に付勢力を適用するように構成され得、シャフト162が前進位置と逆転位置との間で部分的にのみ回転させられる場合、シャフト162を回転させるように構成され得る。
様々な実施形態において、一度切断部材96が完全に後退させられると、エンドエフェクタ閉鎖システム及びステープル発射システムは、消耗したステープルカートリッジが外科用器具50から取り外され得、新しいステープルカートリッジ66がステープルカートリッジチャネル64内に位置付けられ得、外科用器具50が上記のように組織を更にステープル留め及び切断するように使用され得るように再設定され得る。例示される実施形態において、カム68は、アンビル62を開放し、エンドエフェクタ閉鎖システムを再設定するようにロック92から解放され得る。同様に、ラチェットギヤ108は、主駆動ギヤ110から係脱され、トリガ54を歯車列102から係脱し、ステープル発射システムを再設定し得る。少なくとも一実施形態において、カム68及びラチェットギヤ108は、手動で再設定され得るが、主として図3〜5、9、10、19、及び20を参照すると、外科用器具50は、上記のエンドエフェクタ閉鎖システム及びステープル発射システムを自動で再設定し得る再設定システムを含み得る。様々な実施形態において、トリガ54の最終帰還作動は、以下に詳細に記載されるようにこれらのシステムを再設定し得る。
上記で概観されたように、トリガ54の第1の作動は、カム68を図8に例示される位置へと回転させ得、ばねロック92は、発射駆動部がトリガ54の後続する作動によって動作させられると、カム68を定位置に保持するように構成され得る。また、図8に例示されるように、外科用器具50は、カム68を下向きに付勢するように構成され得、図9及び10を参照すると、カム68から延在するカムロックアーム73をばねロック92に対して保持するカムばね67を更に含み得る。そのような実施形態において、カムロックアーム73は、ばねロック92の少なくとも一部分を受けるように構成され得る陥凹部74を含み得る。カム68がトリガ54の後続する作動中に上向きに上昇することを防止し、カムばね92から係脱される際にカムばね67を補助するために、表示器ナット174はカムレール75と接触し、カムロックアーム73をばねロック92に対して保持するように構成され得る。より具体的には、表示器ナット174が上記のように遠位に前進させられると、表示器ナット174は接触レール75に沿って摺動され得、カム68がそれに対して回転し得ない積極的停止を提供する。一度、表示器ナット174が最も近位位置に戻されるが、表示器ナット174はランプ89と整列され得、その結果として、トリガ54の第3の帰還作動がカム68を上向きにわずかに回転させ、それによって図10に例示されるようにロックアーム73をばねロック92から係脱させる。
カム68がロック92から解放された後、カム戻りばね67は、カム68を下向きに回転させ元の位置に戻すように構成され得る。カム68が下向きに回転されると、カムスロット69の壁部は、閉鎖リンク72を遠位に駆動し、同様にチャネル部分78及び80、並びにステープルカートリッジチャネル64も遠位に駆動するように構成され得る。少なくとも一実施形態において、エンドエフェクタ58は、ステープルカートリッジチャネル64が遠位に摺動されると、すなわち、細長いシャフトアセンブリ56の外部シース57から離れると、アンビル62を上向きに付勢するように構成されるばね(例示されず)を更に含み得る。他の様々な実施形態において、例示されないが、外科用器具50は、外科医がアンビル62を開放位置へと引き、又は押すように動作させ得る作動装置を更に含み得る。どちらの場合でも、少なくとも一実施形態において、カム戻りばね67は、カム68が主駆動ギヤ110から係脱してラチェットギヤ108を変位させるために十分な力を行使し得、その結果として、発射駆動部を再設定する。他の様々な実施形態において、カム戻りばね67は、ラチェットギヤ108を主駆動ギヤ110から係脱するために十分な力で、カム68を下向きに引くには十分強くない場合がある。少なくともそのような一実施形態において、外科用器具50は、図3〜5及び19を参照すると、ラチェットギヤ108を主駆動ギヤ110から離れて選択的に付勢し得るトグルスイッチアセンブリを更に含み得る。
様々な実施形態において、主として図3、4及び9を参照すると、トグルスイッチアセンブリ190は、駆動シャフト106に装着されるトグル作動装置192を含み得、トグル作動装置192は、トグル作動装置192から延在するトグルアーム193を含み得る。トリガ54の最終帰還作動時に、少なくとも一実施形態において、表示器ナット172は、トグルアーム193がラチェットギヤ108に向かって回転するようにトグル作動装置192と接触し、駆動シャフト106の周囲で回転させ得る。少なくともそのような一実施形態において、図9を参照すると、表示器ナット172は、トグル作動装置192から延在する突起部191を係合し、トグル作動装置192を駆動シャフト106の周囲で時計回りに回転させるように構成され得るランプ179を更に含み得る。様々な実施形態において、トグルアーム193は、駆動シャフト106の周囲で回転させられると、ラチェットギヤ108と接触し、ラチェットギヤ108を主駆動ギヤ110から離れて変位させるように構成され得る。少なくとも一実施形態において、ラチェットギヤ108は、カム戻りばね67がカム68をつば118に隣接して位置付けることを可能とするように駆動ギヤ110から十分離れて変位され得る。その後、カム68は、カム68が上記のように上向きに回転させられるまで、この位置にラチェットギヤ108を保持し得る。
上記の機構はカム68及びラチェットギヤ108を初期の位置に再設定し得るが、少なくとも例示される実施形態におけるトグル作動装置192のトグルアーム193は、ラチェットギヤ108のつば118に対して位置付けられたままであり得る。したがって、たとえカム68が、溝120がトリガ54の第1の作動時につば118と整列されるように上向きに回転させられても、ラチェットギヤ108は、上記のように主駆動ギヤ110を係合するように解放されない場合がある。これを考慮して、少なくとも一実施形態において、外科用器具50は、ラチェットギヤ108から係脱してトグルアーム193を回転させるための再設定機構を含み得る。そのような機構は、様々な実施形態において、例えば、手動で動作させられ、及び/又はトリガ54の作動に反応して自動的に動作させられ得る。少なくとも一実施形態において、図20に例示されるように、ハウジング90は、ハウジング90から延在し、駆動シャフト106の周囲でトグル作動装置192を回転させ、図9に例示されるように、元の作動されない位置に戻すように構成され得る、突起部91を含み得る。より具体的には、様々な実施形態において、突起部91は、ギヤ可動台130が、逆転ギヤ136がベベルギヤ114と係合される遠位位置から前進ギヤ134がベベルギヤ114と係合される近位位置へと移動されると、トグルリンク194(図3)に係合するように構成され得る。そのような移動は、シフトレバーハンドル164がギヤ可動台130を近位に移動させ、外科用器具50を上記の「前進」構成に置くように下向きに回転させられると切替機構160によって成し遂げられ得る。トグルリンク194と突起部91との間の接触の結果として、トグルリンク194は、トグルリンク194が作動装置アーム193と接触し、駆動シャフト106の周囲でトグル作動装置192を反時計回りに回転させるようにピン195の周囲で回転され得る。様々な実施形態において、トグルスイッチアセンブリ190は、トグルスイッチアセンブリ190が中間的構成で動けなくならないことを確実にする際に、補助し得る双安定適合機構196を更に含み得る。
上記のように、本発明に従う外科用器具は、エンドエフェクタ閉鎖システム及びステープル発射システムの両方を作動させるための単一のトリガを含み得る。上記の特徴はそのような単一のトリガ外科用器具と合わせて記載されたが、上記の特徴のいくつかは、エンドエフェクタ閉鎖システムを作動させるための第1のトリガと、ステープル発射システムを作動させるための第2のトリガとを有する外科用器具において使用され得る。例えば図23〜30を参照すると、外科用器具200は、エンドエフェクタ閉鎖システムを作動させるためのトリガ201と、ステープル発射システムを作動させるためのトリガ204とを含み得る。様々な実施形態において、図25を参照すると、エンドエフェクタ閉鎖システムは、ピン209によって閉鎖トリガ201と動作可能に係合される閉鎖リンク203を含み得る。エンドエフェクタ閉鎖システムは、摺動体205及び閉鎖管207(図23)を更に含み得、閉鎖管207は、摺動体205及びピン211によって閉鎖リンク203に動作可能に接続され得る。より具体的には、図29を参照すると、閉鎖管207は、摺動体205の摺動運動が閉鎖管207に伝動されるように摺動体205のスロット215内で受けられるように構成され得る、最も近位端のフランジ213を含み得る。
主として図29及び30を参照すると、使用中、トリガ201の作動は、閉鎖リンク203を遠位に平行移動させ、同様に摺動体205及び閉鎖管207も遠位に平行移動させ得る。様々な実施形態において、閉鎖管207は、閉鎖管207の平行移動がアンビル62をステープルカートリッジチャネル64に向かって回転させるようにアンビル62と協働的に係合される機能を含む。より具体的には、図24を参照すると、アンビル62は、アンビル62から延在し、開口部217の側壁が突起部51と隣接し、アンビル62を下向きに回転させ得るように閉鎖管207の開口部217内で受けられ得る突起部51を含み得る。アンビル62を導くために、上記で概観されたように、ステープルカートリッジチャネル64は、回転されると、アンビル62のための経路を画定し得るスロット65を含み得る。外科用器具200は、作動させられる位置でトリガ201を保持するように構成され得、それによってアンビル62を閉鎖位置に保持するロック219を更に含み得る。アンビル62を開放するために、ロック219(図28)は、トリガ201が作動させられない位置に戻され得るようにトリガ201から係脱され得る。トリガ201が作動させられない位置に戻されると、トリガ201は、摺動体205及び閉鎖管207を近位に駆動し、かつ突起部51と開口部217との間の動作可能な係合のために、アンビル62を上向きに回転させ得る。
上に示されたように、本発明に従う外科用器具は、例えば、第1の速度で切断部材を前進させ、異なる速度で切断部材を後退させるように構成され得る、発射駆動部を含み得る。様々な実施形態において、図23〜30を参照すると、外科用器具200はトリガ204と、駆動シャフト206と、第1のラチェットアセンブリ210と、第2のラチェットアセンブリ212とを備え得る、発射駆動部202を含み得る。少なくとも一実施形態において、ラチェットアセンブリ210及び212は、エンドエフェクタ58内で切断部材96を前進又は後退させるために、駆動シャフト206を時計回り及び反時計回り方向にそれぞれ回転させるように構成され得る。様々な実施形態において、図25を参照すると、トリガ204は、トリガ204が作動させられると、ラチェットアセンブリ210及び212のうちの1つのみがトリガ204によって駆動されるようにラチェットアセンブリ210及び212と選択的に係合可能であり得る。少なくともそのような一実施形態において、トリガ204は、ラチェットアセンブリ210及び212のうちの1つとトリガ204を係合するようにピン214に沿って摺動可能であり得る。例示される実施形態において、ピン214は、ハウジング部分218内の開口部216内で回転可能に受けられ、トリガ204のための回転軸を提供し得る。
様々な実施形態において、図27を参照すると、トリガ204は、トリガ204に枢軸旋回可能に装着され得る歯止め220がラチェットホイール222と係合され、かつトリガ204の作動時に、ラチェットホイール222が歯止め220によってピン214の周囲で回転させられるように位置付けられ得る。トリガ204を解放すると、歯止め220は、ラチェットホイール222のラチェット歯224上で摺動し得、間で相対移動を可能にする。少なくとも一実施形態において、ラチェットアセンブリ210は、歯止め220を付勢してラチェット歯224と係合し、トリガ204が再作動させられると、歯止め220をラチェット歯224と再係合するように構成される歯止めばね(例示されず)を更に含み得る。ラチェットホイール222の回転を駆動シャフト206に伝動するために、駆動シャフト206は、駆動シャフト206に接続される前進ギヤ226を含み得る。より具体的には、少なくとも一実施形態において、ラチェットホイール222は、ラチェットホイール222の回転が軸230(図25)の周囲で前進ギヤ226及び駆動シャフト206を回転させるように前進ギヤ226と動作可能に係合され得る、ギヤ歯228を更に含み得る。様々な実施形態において、前進ギヤ226は、例えば、駆動シャフト206上にプレス嵌めされ得、又は他の様々な実施形態において、前進ギヤ226は駆動シャフト206と一体的に成形され得る。
様々な実施形態において、上記の外科用器具と同様に、駆動シャフト206は、図24を参照すると、近位保持器部分232内で発射ナット140を平行移動するように発射ナット140と動作可能に係合され得る。また、上記のように、発射ナット140の平行移動は、エンドエフェクタ58内で切断部材96を前進させるように駆動バー146によって切断部材96に伝動され得る。エンドエフェクタ58内で切断部材96を後退させるために、少なくとも一実施形態において、トリガ204は、トリガ204が作動させられると、駆動シャフト206が反対方向に回転させられるように摺動させられ、第2のラチェットアセンブリ212と係合し得る。図28を参照すると、ラチェットアセンブリ210と同様に、ラチェットアセンブリ212はラチェットホイール234及び歯止め236を含み得、歯止め236はトリガ204に枢軸旋回可能に装着され得、ラチェット歯238によってラチェットホイール234と動作可能に係合され得る。ラチェットホイール222と同様に、ラチェットホイール234は、駆動シャフト206に装着される逆転ギヤ242と動作可能に係合され得るギヤ歯240を含み得る。ラチェットホイール222及び234がほぼ反対側の駆動シャフト206を係合すると、ラチェットホイール222及び234は駆動シャフト206を反対方向、すなわち時計回り及び反時計回り方向にそれぞれ回転させ得る。したがって、切断部材96がエンドエフェクタ58内で前進又は後退させられるかどうかを選択するために、トリガ204は摺動され、第1のラチェットアセンブリ210又は第2のラチェットアセンブリ212と動作可能に係合し得る。
様々な実施形態において、例示されないが、第1のラチェットホイール222及び第2のラチェットホイール234は、ほぼ同じ直径又はピッチ半径を有し得る。別様に記述されるならば、ラチェットホイールの中心又は回転軸とラチェットホイールのギヤ歯との間の距離は、同じであり得る。そのような実施形態において、切断部材96がトリガ204の1作動毎に前進させられる距離は、切断部材96がトリガ204の1作動毎に後退させられる距離とほぼ同じであろう。いくつかの状況では好適であるが、そのような実施形態は、切断部材96が完全に後退させられる前に外科医にトリガ204を数回作動させることを要求する場合がある。上記に鑑みると、様々な実施形態において、第1のラチェットホイール222は第2のラチェットホイール234のピッチ半径と異なるピッチ半径を有し得る。少なくとも一実施形態において、切断部材96が、切断部材96がトリガ204の1作動毎に前進させられる距離よりも大きいトリガ204の1作動毎の距離だけ後退させられるように第2のラチェットホイール234は、第1のラチェットホイール222より大きなピッチ半径を有し得る。別様に記述されるならば、第2のラチェットアセンブリ212は、少なくともこれらの実施形態において、前進させられるより速い速度で切断部材96を後退させる。そのような実施形態において、第1のラチェットアセンブリ210は、より遅い前進速度のために、より大きなトルク又は前進力を切断部材96に提供し得るが、第2のラチェットアセンブリ212は、より速い後退速度のために、外科医が切断部材を後退させることを要求する回数を低減し得る。
上記で使用された用語「速度」は切断部材96がトリガ204の1作動毎に前進又は後退させられ得る距離を記載するために使用されるが、用語「速度」はそのように限定されない。少なくとも一実施形態において、用語「速度」は、切断部材が移動される速度及び/又は加速度を記載するために使用され得る。そのような実施形態において、切断部材をより良好に制御するより低い速度及び/又は加速度で前進させられ、かつ切断部材を後退させるように要求される回数を低減するより大きい速度及び/又は加速度で後退させられる、切断部材を有することが所望である場合がある。更に、例示される実施形態は異なる前進及び後退速度を提供するためのラチェットアセンブリを含むが、本発明はそのように限定されない。これに対して、平歯車列、ベベルギヤ、及び/又は他の運動伝動装置を含む他の実施形態が想像される。
様々な実施形態において、本発明に従う外科用器具は、駆動シャフトの回転速度を増加又は減少させるためのギヤボックスを含んでもよい。少なくとも一実施形態において、図25を参照すると、外科用器具200は駆動シャフト206、並びにラチェットアセンブリ210及び212の中間に動作可能に位置付けられ得るギヤボックス250を更に含み得る。様々な実施形態において、ギヤボックス250は、シャフト206がギヤボックス250が使用されないときより低い速度で回転するように駆動シャフト206の速度を「ギヤダウン」するために使用され得る。代替の実施形態において、ギヤボックスは、駆動シャフト206がより速い速度で回転するように駆動シャフト206の速度を「ギヤアップ」するために使用され得る。少なくとも一実施形態において、ギヤボックス250は駆動シャフト206の速度を変更するための少なくとも1組のプラネタリギヤを含み得る。他の様々な実施形態において、図21及び22に例示されるギヤボックス252等のギヤボックスはハウジング253と、入力シャフト256に装着される入力ギヤ254と、ピニオンギヤ258と、出力シャフト262に装着される出力ギヤ260とを含み得る。そのような実施形態において、入力ギヤ254及び出力ギヤ260の異なるピッチ半径のために、入力シャフト256及び出力シャフト262は異なる速度で回転するであろう。ハウジング253内のギヤ254、258、及び260の回転運動を容易にするために、ギヤボックス252は図22に例示される、様々な支持プレート264、スペーサ266、及びピン268を更に含み得る。上記に加えて、ギヤボックス252は、また、入力シャフト256の時計回り運動を、例えば、出力シャフト262の反時計回り運動に転化するように使用され得る。
上記の様々な実施形態において、外科用器具200のトリガ204は、第1のラチェットアセンブリ210と動作可能に係合される第1の位置と第2のラチェットアセンブリ212と動作可能に係合される第2の位置との間で摺動され得る。少なくとも一実施形態において、発射駆動部202は、例えば、第1の歯止め220が、第2の歯止め236が第2のラチェットホイール234と係合される前に第1のラチェットホイール222から係脱されるように構成され得る。そのような実施形態において、トリガ204は、第1のラチェットアセンブリ210又は第2のラチェットアセンブリ212と動作可能に係合されない中間位置に位置付けられてもよい。様々な実施形態において、その結果として、発射駆動部202はトリガ204の作動が駆動シャフト206の回転をもたらさない「自由な」状態にあり得る。代替の実施形態において、発射駆動部202は、例えば第2の歯止め236が、第1の歯止め220が第1のラチェットホイール222から動作可能に係脱される前に第2のラチェットホイール234と係合されるように構成され得る。そのような実施形態において、トリガ204は、トリガ204は作動させられ得ず、それによってトリガ204がラチェットアセンブリのうちのどれか1つと完全に係合されず、かつトリガ204が更なる調整を必要とすることを外科医に表示する、中間の「ロックされた」状態に位置付けられてもよい。
様々な実施形態において、外科用器具200は、トリガ204を付勢して第1のラチェットアセンブリ210及び第2のラチェットアセンブリ212のうちの1つと係合する装置を含み得る。少なくとも一実施形態において、図33を参照すると、外科用器具200は、トリガ204を上記の中間位置から付勢して第1のラチェットアセンブリ210又は第2のラチェットアセンブリ212と係合し得る、双安定適合機構270を更に含み得る。様々な実施形態において、双安定適合機構270は、ばね272及びリンク274を含み得、ばね272は、付勢力が図33に例示される中間位置からトリガ204を移動するように作用し、第1のラチェットホイール222又は第2のラチェットホイール234と係合するようにリンク274によってトリガ204に付勢力を適用し得る。より具体的には、トリガ204が中間位置に位置付けられると、ばね272は長さX1に伸張され得、ばね272の弾力性のために、ばね272は伸張されない長さ又は少なくとも、例えば、長さX2のようなX1より短い長さに短縮することを試み得る。ばね272自体が長さX2に短縮するために、ばね272はピン275の周囲でリンク274を回転させることができ、そこからピン275が延在し、外科用器具ハウジング218にリンク274を枢軸旋回可能に装着することができる。より具体的には、ばね272の第1の端部がハウジング218から延在するピン276に装着され、かつばね272の第2の端部がリンク274から延在するピン277に装着されると、ばね272はピン277をピン276のより近くに移動することによって短縮し、これは、リンク274をピン275の周囲で回転させることにより最も容易に成し遂げられる。リンク274がピン275の周囲で回転させられると、リンク274内のスロット278の側壁はトリガ204から延在するピン279を係合し、トリガ204を摺動させて第1のラチェットホイール222又は第2のラチェットホイール234と係合するように構成され得る。実際には、図33に例示されるトリガ204の中間位置は動的に不安定な位置を表し、トリガ204がラチェットホイール222及び234と係合されるトリガ204の位置は発射駆動部システムの動的に安定した位置を表す。
様々な実施形態において、上記のように、本発明に従う外科用器具は、例えば、駆動シャフトがエンドエフェクタ内で切断部材を前進させる第1の方向及び駆動シャフトが切断部材を後退させる第2の方向に駆動シャフトを回転させるための装置を含み得る。少なくとも一実施形態において、図31及び32を参照すると、外科用器具は、例えば、外科医が、駆動シャフトが切断部材を前進又は後退させるかどうかを選択することを可能にし得る伝動装置280を含み得る。様々な実施形態において、伝動装置280はハウジング282と、内部入力シャフト284と、外部入力シャフト285と、出力駆動シャフト286と、切替機構288とを含み得、切替機構288は内部入力シャフト284及び外部入力シャフト285を出力シャフト286と選択的に係合するように構成され得る。例示されないが、外科用器具は、例えば、駆動シャフト285を軸287の周囲で時計回りに回転させるように外部駆動シャフト285と動作可能に係合される、例えばトリガを更に含み得る。少なくとも一実施形態において、伝動装置280はハウジング282内に回転可能に装着されるピニオンギヤ292と、外部入力シャフト285に固定されて装着される入力ギヤ293と、出力駆動シャフト286に装着される出力ギヤ294とを含み得、入力ギヤ293は、外部シャフト285の回転がピニオンギヤ292に伝動されるようにピニオンギヤ292の外側ギヤ歯290と動作可能に係合され得る。
伝動装置280の第1の構成において、出力ギヤ294は、ピニオンギヤ292の回転が出力駆動シャフト286に伝動されるようにピニオンギヤ292の内側ギヤ歯291と動作可能に係合され得る。より具体的には、出力ギヤ294は、出力ギヤ294が軸287の周囲で出力駆動シャフト286を駆動するようにスプラインされた端部296によって出力駆動シャフト286と動作可能に係合され得る。この第1の構成において、例えば、外部入力シャフト285の時計回り回転は出力駆動シャフト286の反時計回り運動に転化され得る。伝動装置280の第2の構成において、出力ギヤ294は、外部入力シャフト285の回転がピニオンギヤ292を介して出力駆動シャフト286に伝動されないようにピニオンギヤ292から係脱され得る。出力ギヤ294をピニオンギヤ292から係脱するために、内部駆動シャフト284は、入力ギヤ297が出力ギヤ294で陥凹部298と接触し、ピニオンギヤ292から離れて出力ギヤ294を押すように外部駆動シャフト285に対して摺動され得る。少なくとも一実施形態において、陥凹部298は、内部入力シャフト284の回転が出力駆動シャフト286に伝動されるように内部入力シャフト284の入力ギヤ297と動作可能に係合され得る歯299を含み得る。伝動装置280のこの第2の構成において、内部入力シャフト284の時計回り回転は、出力シャフト286が時計回りにも回転するように出力駆動シャフト286に直接伝動され得る。出力ギヤ294をピニオンギヤ292と再係合するために、内部入力ギヤ284は、ばね281がスプラインされた端部296に沿って出力ギヤ294を摺動することを可能とするように出力ギヤ294から係脱され得る。
上記の実施形態において、外科医は外部入力シャフト285に対して内部入力シャフト284を選択的に移動し、伝動装置280を前進又は逆転構成に置き得る。入力シャフト284を移動するために、様々な実施形態において、外科用器具は内部入力シャフト284を平行移動するように構成される作動装置又はトリガを更に含み得る。少なくとも一実施形態において、外科用器具は外部入力シャフト285を回転させるための第1の作動装置又はトリガと、外部シャフト285に対して内部シャフト284を平行移動するための第2の作動装置又はトリガとを含み得る。そのような実施形態において、内部入力シャフト284は、外部シャフト285の回転が内部シャフト284に伝動されるが、それにも拘わらず摺動運動が間で可能とされるように、外部入力シャフト285と摺動可能に係合され得るスプライン283を含み得る。少なくとも一実施形態において、伝動装置280は入力ギヤ293を回転可能に支持し得るベアリング300を更に含み、入力ギヤ293とハウジング282の間で圧迫されると、入力ギヤ293をピニオンギヤ292と動作可能に係合された状態に保持するように付勢力を提供し得る。様々な実施形態において、出力シャフト286は、出力シャフト286から延在し、出力シャフト286とハウジング282との間の相対移動を低減し、又は除去までするようにハウジング282の陥凹部301内で受けられるように構成され得る部材302を含み得る。少なくとも一実施形態において、例示されないが、伝動装置280は1つのピニオンギヤ292のみを有し、上記の方法でなお動作してもよい。
様々な実施形態において、伝動装置280は後退させられる速度とは異なる速度で、例えば切断部材96も前進させるように構成され得る。少なくとも一実施形態において、図31及び32を参照すると、内部入力シャフト284と出力シャフト286との間の動作可能な係合は切断部材96を前進させるように使用され得、入力ギヤ297と出力ギヤ294との間の直接的係合のために、内部入力シャフト284及び出力シャフト286は1対1の比率、すなわち内部入力シャフト284のすべての回転につき出力シャフト286が1度回転させられる割合で回転し得る。様々な実施形態において、外部入力シャフト285と出力シャフト286との間の動作可能な係合は切断部材96を後退させるように使用され得、入力ギヤ293及び出力ギヤ294の異なるピッチ半径、並びにピニオン292との動作可能な係合のために、外部入力シャフト285及び出力シャフト286は1対1とは異なる比率で回転し得る。例示される実施形態において、出力シャフト286は、ピニオン292によって嵌合されると、外部入力シャフト285より速い速度で回転し得る。様々な実施形態において、その結果として、切断部材96は内部入力シャフト284が出力シャフト286と動作可能に係合されるときより、外部入力シャフト285が出力シャフト286と動作可能に係合されるときに速い速度で平行移動され得る。
上記の発明はロボット式外科用システムへの適用性も有する。そのようなシステムは当該技術分野において周知であり、Intuitive Surgical,Inc.,Sunnyvale,CAから入手可能なそれらを含む。実施例は、米国特許第6,783,524号、同第7,524,320号、及び同第7,824,401号にも記載される。本明細書における全ての引用文献は参照により本明細書に組み込まれる。
概ね、ロボット式外科用システムは外科用器具及びシステムとインターフェース接続し、外科用器具及びシステムを動作させるように構成される、遠隔制御可能なユーザーインターフェース及び遠隔制御可能なアームを有する。アームは、典型的に、ユーザがインターフェース接続する局部的操作卓に適合する電子制御システム(複数可)で制御可能である。器具は外科用システムによって局部的に電源供給され、又は全ロボット制御からの分離された電源供給システムを有し得る。
ロボット式外科用システムは、作動アセンブリと、モニターと、ロボットと、少なくとも1つの外科的課題を実行し、アームの遠位端に着脱可能に取付けられるように構成される、少なくとも1つの外科用器具を有するロボットアームに取付けられた、確実に取付けられた少なくとも1つの装着ユニットとを含む。
なお別の実施形態において、ロボット式外科用システムはプロセッサと、少なくとも1つの電動ジョイントの位置を決定する少なくとも1つのエンコーダと、ステープルユニットから伝送された電気信号を受信し、運動を制御するためのレシーバとを含む。
ロボットと使用するための例示的な使い捨て装着ユニットは、Toveyらへの米国特許第6,231,565号に開示される。比例的な外科医の制御を伴う例示的な外科用ロボットは、Smithらへの米国特許第5,624,398号に開示される。
本発明の別の態様において、ロボット式システムは、フレームと、フレームに対して移動可能であり、ステープル留めアセンブリをロボットアームに接続する伸長されたチューブを伴うステープル留めアセンブリを有するロボットアームとを有する。ステープル留めアセンブリを伴う伸長されたチューブ及びステープル留めアセンブリ自体の両方がロボットアームに着脱可能に取付けられ、動作可能に連結される。ステープル留めアセンブリの1つの構成は除去され、異なる構成が取付けられ、動作させられ得る。
図23及び24について。ロボット式システムは閉鎖管207の近位端に着脱可能に付属し、駆動シャフト206の近位端に半径方向に連結する連結部材を含む。
本明細書において開示される装置は、1回の使用の後に処分されるような設計とするか、又は複数回使用されるような設計とすることができる。しかしながら、いずれの場合も、デバイスは少なくとも1回の使用後、再使用のために再調整されることができる。再調整は、装置の分解工程、これに続く洗浄工程又は特定部品の交換工程、及びその後の再組み付け工程の任意の組み合わせを含むことができる。詳細には、装置は分解可能であり、装置の任意の数の特定の部品又は部材を、任意の組み合わせで選択的に交換又は取り外すことができる。特定の部材の洗浄及び/又は交換に際し、装置を再調整施設において、あるいは外科手術の直前に手術チームによって再組み付けしてからその後の使用に供することができる。当業者であれば、装置の再調整に、分解、洗浄/交換、及び再組み付けのための様々な技術を利用できる点は認識されるであろう。このような技術の使用、及びその結果として得られる再調整された装置は、全て、本出願の範囲内にある。
好ましくは、本明細書で説明した本発明は、外科手術の前に処理される。まず、新しい又は使用済みの器具を得て、必要に応じて洗浄する。次に、器具を滅菌することができる。1つの滅菌法では、プラスチック又はTYVEKバッグなどの閉鎖かつ密封された容器に器具を入れる。次いで容器及び器具を、ガンマ線、X線又は高エネルギー電子線などの、容器を貫通することができる放射線野の中に置く。この放射線によって器具上及び容器内の細菌が殺菌される。滅菌された器具は、その後、無菌容器内で保管することができる。密封容器は医療施設において開封されるまで器具を無菌状態に保つ。
以上、本発明を例示的な構成を有するものとして説明したが、本発明は本開示の趣旨及び範囲内で更に改変することができる。したがって、本出願はその一般的原理を利用した本発明のあらゆる変形、使用又は適応を網羅するものとする。更に、本出願は、本発明が関連する技術分野における公知の、又は従来の実施に含まれるところの本開示からの発展形を網羅するものとする。
〔実施の態様〕
(1) 外科用器具であって、
遠隔制御可能なユーザーインターフェースと、
前記遠隔制御可能なユーザーインターフェースの第1の作動時の回転発射運動と、遠隔制御可能なユーザーインターフェースの他の作動時の回転後退運動とを発生させるように構成される発射駆動部であって、
前記遠隔制御可能なユーザーインターフェースが選択的に係合可能である第1の駆動部材と、
前記遠隔制御可能なユーザーインターフェースが選択的に係合可能である第2の駆動部材と、を備える、発射駆動部と、
前記第1の駆動部材及び前記第2の駆動部材と動作可能に係合される細長いシャフトアセンブリと、
前記細長いシャフトアセンブリに連結されるエンドエフェクタであって、
内部でステープルカートリッジを動作可能に支持するように構成される細長いチャネルと、
前記細長いチャネルに移動可能に連結されるアンビルと、
前記細長いチャネル内に動作可能に支持される切断部材であって、前記切断部材が前記細長いシャフトアセンブリと動作可能に係合し、前記遠隔制御可能なユーザーインターフェースが前記第1の駆動部材を動作させるとき、前記第1の作動が前記切断部材を第1の距離だけ前進させ、前記遠隔制御可能なユーザーインターフェースが前記第2の駆動部材を動作させるときに、前記他の作動が前記切断部材を第2の距離だけ後退させ、前記第2の距離が前記第1の距離よりも大きい、切断部材と、を備える、エンドエフェクタと、を備える、外科用器具。
(1) 外科用器具であって、
遠隔制御可能なユーザーインターフェースと、
前記遠隔制御可能なユーザーインターフェースの第1の作動時の回転発射運動と、遠隔制御可能なユーザーインターフェースの他の作動時の回転後退運動とを発生させるように構成される発射駆動部であって、
前記遠隔制御可能なユーザーインターフェースが選択的に係合可能である第1の駆動部材と、
前記遠隔制御可能なユーザーインターフェースが選択的に係合可能である第2の駆動部材と、を備える、発射駆動部と、
前記第1の駆動部材及び前記第2の駆動部材と動作可能に係合される細長いシャフトアセンブリと、
前記細長いシャフトアセンブリに連結されるエンドエフェクタであって、
内部でステープルカートリッジを動作可能に支持するように構成される細長いチャネルと、
前記細長いチャネルに移動可能に連結されるアンビルと、
前記細長いチャネル内に動作可能に支持される切断部材であって、前記切断部材が前記細長いシャフトアセンブリと動作可能に係合し、前記遠隔制御可能なユーザーインターフェースが前記第1の駆動部材を動作させるとき、前記第1の作動が前記切断部材を第1の距離だけ前進させ、前記遠隔制御可能なユーザーインターフェースが前記第2の駆動部材を動作させるときに、前記他の作動が前記切断部材を第2の距離だけ後退させ、前記第2の距離が前記第1の距離よりも大きい、切断部材と、を備える、エンドエフェクタと、を備える、外科用器具。
Claims (1)
- 外科用器具であって、
遠隔制御可能なユーザーインターフェースと、
前記遠隔制御可能なユーザーインターフェースの第1の作動時の回転発射運動と、遠隔制御可能なユーザーインターフェースの他の作動時の回転後退運動とを発生させるように構成される発射駆動部であって、
前記遠隔制御可能なユーザーインターフェースが選択的に係合可能である第1の駆動部材と、
前記遠隔制御可能なユーザーインターフェースが選択的に係合可能である第2の駆動部材と、を備える、発射駆動部と、
前記第1の駆動部材及び前記第2の駆動部材と動作可能に係合される細長いシャフトアセンブリと、
前記細長いシャフトアセンブリに連結されるエンドエフェクタであって、
内部でステープルカートリッジを動作可能に支持するように構成される細長いチャネルと、
前記細長いチャネルに移動可能に連結されるアンビルと、
前記細長いチャネル内に動作可能に支持される切断部材であって、前記切断部材が前記細長いシャフトアセンブリと動作可能に係合し、前記遠隔制御可能なユーザーインターフェースが前記第1の駆動部材を動作させるとき、前記第1の作動が前記切断部材を第1の距離だけ前進させ、前記遠隔制御可能なユーザーインターフェースが前記第2の駆動部材を動作させるときに、前記他の作動が前記切断部材を第2の距離だけ後退させ、前記第2の距離が前記第1の距離よりも大きい、切断部材と、を備える、エンドエフェクタと、を備える、外科用器具。
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US13/037,409 | 2011-03-01 | ||
US13/037,409 US8534528B2 (en) | 2007-06-04 | 2011-03-01 | Surgical instrument having a multiple rate directional switching mechanism |
PCT/US2012/026995 WO2012118842A1 (en) | 2011-03-01 | 2012-02-28 | Surgical instrument having a multiple rate directional switching mechanism |
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JP2013556814A Pending JP2014514012A (ja) | 2011-03-01 | 2012-02-28 | 多速度方向切替機構を有する外科用器具 |
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US (1) | US8534528B2 (ja) |
EP (1) | EP2680760A1 (ja) |
JP (1) | JP2014514012A (ja) |
CN (1) | CN103402445B (ja) |
AU (1) | AU2012223478B2 (ja) |
BR (1) | BR112013022119A2 (ja) |
CA (1) | CA2828714C (ja) |
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Also Published As
Publication number | Publication date |
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BR112013022119A2 (pt) | 2016-12-06 |
WO2012118842A1 (en) | 2012-09-07 |
CA2828714A1 (en) | 2012-09-07 |
RU2628048C2 (ru) | 2017-08-14 |
CN103402445A (zh) | 2013-11-20 |
CN103402445B (zh) | 2016-03-30 |
AU2012223478B2 (en) | 2016-09-01 |
CA2828714C (en) | 2019-03-12 |
US20110155786A1 (en) | 2011-06-30 |
EP2680760A1 (en) | 2014-01-08 |
RU2013143950A (ru) | 2015-04-10 |
US8534528B2 (en) | 2013-09-17 |
AU2012223478A1 (en) | 2013-08-22 |
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