JP2022056288A - ハンドヘルド外科手術器具 - Google Patents

ハンドヘルド外科手術器具 Download PDF

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JP2022056288A
JP2022056288A JP2020200804A JP2020200804A JP2022056288A JP 2022056288 A JP2022056288 A JP 2022056288A JP 2020200804 A JP2020200804 A JP 2020200804A JP 2020200804 A JP2020200804 A JP 2020200804A JP 2022056288 A JP2022056288 A JP 2022056288A
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joint
nut
screw
end portion
end effector
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エー． ニコラス デイビッド
David A Nicholas
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Covidien LP
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/0682—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil
    • A61B17/0686—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil having a forming anvil staying below the tissue during stapling
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/32—Surgical cutting instruments
    • A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
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    • A61B2017/00398—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
    • A—HUMAN NECESSITIES
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0042—Surgical instruments, devices or methods, e.g. tourniquets with special provisions for gripping
    • A61B2017/00424—Surgical instruments, devices or methods, e.g. tourniquets with special provisions for gripping ergonomic, e.g. fitting in fist
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
    • A61B2017/00473—Distal part, e.g. tip or head
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00681—Aspects not otherwise provided for
    • A61B2017/00734—Aspects not otherwise provided for battery operated
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07271—Stapler heads characterised by its cartridge
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2946—Locking means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0807—Indication means
    • A61B2090/0811—Indication means for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/70—Manipulators specially adapted for use in surgery
    • A61B34/76—Manipulators having means for providing feel, e.g. force or tactile feedback

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Abstract

Figure 2022056288000001
【課題】ハンドヘルド外科手術器具の提供。
【解決手段】ハンドヘルド外科手術器具は、ハンドルハウジング１８と、ハンドルハウジングに対して遠位に延在するように構成された細長いシャフト部分１６と、シャフト部分の遠位端部分１６ｂに連結されるように構成された外科用エンドエフェクタ２００とを含む。関節ネジは、外科用エンドエフェクタに作動可能に連結され、関節ナット５２は、関節ネジ５４の周りに配置され、作動可能に連結される。関節ネジは、関節ナットの回転に応答して並進するように構成され、それにより、関節ネジは、シャフト部分に対して平行な向きとシャフト部分に対して非平行な向きとの間で外科用エンドエフェクタを関節運動させる。
【選択図】図２

Description

関連出願の相互参照
本出願は、２０２０年９月２９日出願の米国特許仮出願第６３／０８４，６５６号の利益および優先権を主張し、その開示全体が、参照により本明細書に組み込まれる。
多数のハンドルアセンブリ製造業者が、電気機械外科手術器具を動作および／または操作するための専有の駆動システムを有する製品ラインを開発してきた。多くの場合、電気機械外科手術器具は、再使用可能なハンドルアセンブリ、および使い捨てローディングユニットおよび／または、例えば、使用前にハンドルアセンブリに選択的に接続され、その後、廃棄したり、場合によっては再使用のために滅菌したりするために使用後にハンドルアセンブリから切り離される外科手術エンドエフェクタなどの１回使用のローディングユニットを含む。
本開示の一態様では、ハンドヘルド外科手術器具が提供され、内部に空洞を画定するハンドルハウジングと、ハンドルハウジングに対して遠位に延在するように構成された細長いシャフト部分と、シャフト部分の遠位端部分に連結され、シャフト部分に対して関節運動するように構成された外科用エンドエフェクタと、発射シャフトと、関節ネジと、関節ナットと、を含む。発射シャフトは、駆動器に駆動連結されるように構成された近位端部分および外科用エンドエフェクタの被駆動要素に作動可能に連結されるように構成された遠位端部分を有する。関節ネジは、外科用エンドエフェクタに作動可能に連結され、関節ナットは、関節ネジの周りに配置され、作動可能に連結される。関節ネジは、関節ナットの回転に応答して並進するように構成され、それにより、関節ネジは、シャフト部分に対して平行な向きとシャフト部分に対して非平行な向きとの間で外科用エンドエフェクタを関節運動させる。
一態様では、関節ナットは、ハンドルハウジングに対して軸方向に拘束され、回転可能に支持され得る。関節ネジは、関節ナット内に受容することができる。
一態様では、関節ナットは、関節ネジの外面にねじ連結され得、関節ナットを第１の回転方向に回転させると、遠位または近位のいずれかに関節ネジが並進する。関節ナットを第２の反対の回転方向に回転させると、遠位または近位のうちの他方に関節ネジが並進する。
一態様では、関節ネジおよび関節ナットのそれぞれは、管状構成を有することができる。
一態様では、関節ネジおよび関節ナットは、発射シャフトの周りに同心円状に配置され得る。
一態様では、ハンドヘルド外科手術器具は、関節ナットの周りに配置され、関節ノブの手動回転が関節ナットを回転させ得るように関節ナットに回転固定される関節ノブをさらに含むことができる。
一態様では、関節ノブは、関節ナットに接続されるか、または関節ナットと一体的に形成することができる。
一態様では、ハンドヘルド外科手術器具は、関節ネジに軸方向に固定された近位端部分を有する関節リンクをさらに含むことができる。関節リンクは、外科的エンドエフェクタに作動可能に連結されるように構成された遠位端部分を有することができる。
一態様では、関節リンクは、関節リンクの近位端部分から横方向に外側に延在するピンを有することができる。ピンは、関節ネジの遠位端部分に固定することができる。
一態様では、ハンドヘルド外科手術器具は、発射ネジにねじ連結され、発射ネジの回転に応答して並進して外科用エンドエフェクタのステープル機能を実現するように構成された発射ナットをさらに含むことができる。
一態様では、ハンドヘルド外科手術器具は、シャフト部分を通って延在する発射ロッドをさらに含むことができる。発射ロッドは、発射ナットに固定された近位端部分と、外科用エンドエフェクタの被駆動要素に連結された遠位端部分とを有することができる。
一態様では、ハンドヘルド外科手術器具は、ハンドルハウジングに対して軸方向に拘束されたチューブハウジングをさらに含むことができる。発射ナットは、チューブハウジング内に配置され、発射ナットとチューブハウジングとの間の相対回転に抵抗するようにチューブハウジングに締結され得る。
一態様では、ハンドヘルド外科手術器具は、ハンドルハウジングの空洞内で受容するように構成された器具モジュールをさらに含むことができる。器具モジュールは、モータおよび駆動器を含むことができる。駆動器は、モータに作動可能に連結され、駆動器の回転が発射シャフトの回転をもたらすように、発射シャフトの近位端部分に作動可能に連結するように構成され得る。
一態様では、ハンドヘルド外科手術器具は、ハンドルハウジングに連結されたボタンと、プリント回路基板とをさらに含むことができる。ボタンは、ボタンの作動がモータを起動させるように、プリント回路基板に関連付けることができる。
本開示のさらなる態様によれば、ハンドヘルド外科手術器具の使い捨てハンドルアセンブリが提供され、内部に空洞を画定する細長いハンドルハウジングと、ハンドルハウジングの遠位端部分によって回転可能に支持された関節ナットと、関節ナット内に受容され、関節ナットにねじ連結された関節ネジと、関節ナットの周りに配置され、関節ノブの手動回転が関節ナットを回転させて関節ネジを関節ナットに対して並進させるように関節ナットに回転固定される関節ノブと、を含む。
一態様では、関節ネジは、関節ネジを通る細長い通路を画定することができる。
一態様では、使い捨てハンドルアセンブリは、通路内に配置され、関節ネジに軸方向に固定された近位端部分を有する関節リンクをさらに含むことができる。
一態様では、関節リンクは、関節リンクの近位端部分から横方向に外側に延在するピンを有することができる。ピンは、関節ネジの遠位端部分に固定することができる。
一態様では、使い捨てハンドルアセンブリは、ハンドルハウジングの空洞内に受容された近位端部分を有する発射シャフトをさらに含むことができる。関節ネジおよび関節ナットは、発射シャフトの周りに同心円状に配置することができる。
一態様では、関節ノブは、関節ナットに接続されるか、または関節ナットと一体的に形成することができる。
本明細書で使用される場合、平行したおよび垂直なという用語は、真の平行および真の垂直から最大で約＋または－１０度まで、略平行および略垂直である相対的な構成を含むものと理解される。
例えば、本願は以下の項目を提供する。
（項目１）
内部に空洞を画定するハンドルハウジングと、
上記ハンドルハウジングに対して遠位に延在するように構成された細長いシャフト部分と、
上記シャフト部分の遠位端部分に連結され、上記シャフト部分に対して関節運動するように構成された外科用エンドエフェクタと、
駆動器に駆動連結されるように構成された近位端部分および上記外科用エンドエフェクタの被駆動要素に作動可能に連結されるように構成された遠位端部分を有する発射シャフトと、
上記外科用エンドエフェクタに作動可能に連結された関節ネジと、
上記関節ネジの周りに配置され、上記関節ネジに作動可能に連結された関節ナットであって、上記関節ネジが、上記関節ナットの回転に応答して並進するように構成され、それにより、上記関節ネジが、上記シャフト部分に対して平行な向きと上記シャフト部分に対して非平行な向きとの間で上記外科用エンドエフェクタを関節運動させる、関節ナットと、を備える、ハンドヘルド外科手術器具。
（項目２）
上記関節ナットが、上記ハンドルハウジングに軸方向に拘束され、かつ上記ハンドルハウジングに回転可能に支持され、上記関節ネジが、上記関節ナット内に受容される、上記項目に記載のハンドヘルド外科手術器具。
（項目３）
上記関節ナットが、上記関節ネジの外面にねじ連結され、上記関節ナットを第１の回転方向に回転させると、遠位または近位のいずれかに上記関節ネジが並進し、上記関節ナットを第２の反対の回転方向に回転させると、遠位または近位のうちの他方に上記関節ネジが並進する、上記項目のいずれか一項に記載のハンドヘルド外科手術器具。
（項目４）
上記関節ネジおよび関節ナットの各々が、管状構成を有する、上記項目のいずれか一項に記載のハンドヘルド外科手術器具。
（項目５）
上記関節ネジおよび上記関節ナットが、発射シャフトの周りに同心円状に配置されている、上記項目のいずれか一項に記載のハンドヘルド外科手術器具。
（項目６）
上記関節ナットの周りに配置された関節ノブであって、上記関節ノブの手動回転が上記関節ナットを回転させるように上記関節ナットに回転固定される関節ノブをさらに備える、上記項目のいずれか一項に記載のハンドヘルド外科手術器具。
（項目７）
上記関節ノブが、関節ナットに接続されているか、または上記関節ナットと一体的に形成されている、上記項目のいずれか一項に記載のハンドヘルド外科手術器具。
（項目８）
上記関節ネジに軸方向に固定された近位端部分と、上記外科用エンドエフェクタに作動可能に連結されるように構成された遠位端部分とを有する関節リンクをさらに備える、上記項目のいずれか一項に記載のハンドヘルド外科手術器具。
（項目９）
上記関節リンクが、上記関節リンクの上記近位端部分から横方向に外側に延在するピンを有し、上記ピンが、上記関節ネジの遠位端部分に固定されている、上記項目のいずれか一項に記載のハンドヘルド外科手術器具。
（項目１０）
上記発射ネジにねじ連結され、上記発射ネジの回転に応答して並進して上記外科用エンドエフェクタのステープル機能を実現するように構成された発射ナットをさらに備える、上記項目のいずれか一項に記載のハンドヘルド外科手術器具。
（項目１１）
上記シャフト部分を通って延在し、上記発射ナットに固定された近位端部分と、上記外科用エンドエフェクタの上記被駆動要素に連結された遠位端部分とを有する発射ロッドをさらに備える、上記項目のいずれか一項に記載のハンドヘルド外科手術器具。
（項目１２）
上記ハンドルハウジングに対して軸方向に拘束されたチューブハウジングをさらに備え、上記発射ナットが、上記チューブハウジング内に配置され、上記チューブハウジングに締結されて、上記発射ナットと上記チューブハウジングとの間の相対回転に抵抗する、上記項目のいずれか一項に記載のハンドヘルド外科手術器具。
（項目１３）
上記ハンドルハウジングの上記空洞内で受容するように構成された器具モジュールであって、
モータと、
上記駆動器であって、上記モータに作動可能に連結され、上記駆動器の回転が上記発射シャフトの回転をもたらすように、上記発射シャフトの上記近位端部分に作動可能に連結するように構成された駆動器と、を含む器具モジュールをさらに備える、上記項目のいずれか一項に記載のハンドヘルド外科手術器具。
（項目１４）
上記ハンドルハウジングに連結されたボタンと、
プリント回路基板であって、上記ボタンは、上記ボタンの作動が上記モータを起動させるように上記プリント回路基板に関連付けられている、プリント回路基板と、をさらに備える、上記項目のいずれか一項に記載のハンドヘルド外科手術器具。
（項目１５）
内部に空洞を画定する細長いハンドルハウジングと、
上記ハンドルハウジングの遠位端部分によって回転可能に支持された関節ナットと、
上記関節ナット内に受容され、上記関節ナットにねじ連結された関節ネジと、
上記関節ナットの周りに配置された関節ノブであって、上記関節ノブの手動回転が上記関節ナットを回転させて上記関節ネジを上記関節ナットに対して並進させるように上記関節ナットに回転固定される関節ノブと、を備える、ハンドヘルド外科手術器具の使い捨てハンドルアセンブリ。
（項目１６）
上記関節ネジが、上記関節ネジを通る細長い通路を画定する、上記項目に記載の使い捨てハンドルアセンブリ。
（項目１７）
上記通路内に配置され、上記関節ネジに軸方向に固定された近位端部分を有する関節リンクをさらに備える、上記項目のいずれか一項に記載の使い捨てハンドルアセンブリ。
（項目１８）
上記関節リンクが、上記関節リンクの上記近位端部分から横方向に外側に延在するピンを有し、上記ピンが、上記関節ネジの遠位端部分に固定されている、上記項目のいずれか一項に記載の使い捨てハンドルアセンブリ。
（項目１９）
上記ハンドルハウジングの上記空洞内に受容された近位端部分を有する発射シャフトをさらに備え、上記関節ネジおよび上記関節ナットが、上記発射シャフトの周りに同心円状に配置されている、上記項目のいずれか一項に記載の使い捨てハンドルアセンブリ。
（項目２０）
上記関節ノブが、関節ナットに接続されているか、または上記関節ナットと一体的に形成されている、上記項目のいずれか一項に記載の使い捨てハンドルアセンブリ。
（摘要）
ハンドヘルド外科手術器具は、ハンドルハウジングと、ハンドルハウジングに対して遠位に延在するように構成された細長いシャフト部分と、シャフト部分の遠位端部分に連結されるように構成された外科用エンドエフェクタとを含む。関節ネジは、外科用エンドエフェクタに作動可能に連結され、関節ナットは、関節ネジの周りに配置され、作動可能に連結される。関節ネジは、関節ナットの回転に応答して並進するように構成され、それにより、関節ネジは、シャフト部分に対して平行な向きとシャフト部分に対して非平行な向きとの間で外科用エンドエフェクタを関節運動させる。
本開示の実施形態は、添付の図面を参照して本明細書に記載される。
ハンドルアセンブリ、ハンドルアセンブリに連結されたシャフト部分、およびシャフト部分に連結された外科用エンドエフェクタを含む、ハンドヘルド電気機械外科手術器具を示す側面斜視図である。 図１Ａのハンドヘルド電気機械外科手術器具を示す側面斜視図であり、動力アセンブリがハンドルアセンブリから分離されて示されている。 図１Ａの外科手術器具を示す、部品が分離された斜視図である。 関節ノブ、発射シャフト、およびＰＣＢ接続部を含む、図１Ａの外科手術器具の構成要素を示す拡大斜視図である。 図１Ａの外科手術器具の縦断面図である。 手動で動作させる関節アセンブリと、関節アセンブリ内に配置されたモータ動力型発射アセンブリとを含む、図１Ａの外科手術器具の縦断面図である。
そのハンドルアセンブリを含む本開示の外科手術器具の実施形態が、図面を参照して詳細に説明されており、図面において、同様の参照番号は、いくつかの図の各々において同一または対応する要素を指定する。本明細書で使用されるとき、用語「遠位」は、ユーザからより遠い、外科手術器具のその部分またはその構成要素を指し、一方、用語「近位」は、ユーザにより近い、外科手術器具のその部分またはその構成要素を指す。
以下で詳細に説明するように、人間工学に基づいた使い捨てのハンドルハウジング、再利用可能な動力アセンブリ（例えば、滅菌または非滅菌の外部ケーシング内に収容された器具モジュール）を有するハンドヘルド外科手術器具のハンドルアセンブリ、ハンドルハウジングから遠位に延在するシャフト部分、およびシャフト部分の遠位端に枢動可能に連結された外科用エンドエフェクタが提供される。動力アセンブリ以外の外科手術器具の全ての構成要素は、使い捨てであることが企図されている。
外科手術器具は、ハンドルハウジングとシャフト部分との間に配置され、外科手術器具に対して回転するように構成された手動関節ノブを有する。関節ノブは、関節ネジにねじ連結された関節ナットの周りに回転固定されている。関節ネジは、軸方向に並進可能な関節リンクを支持しており、軸方向に並進可能な関節リンクは、関節ノブの手動回転に応答して、シャフト部分に対して外科用エンドエフェクタを関節運動させるために外科用エンドエフェクタに作動可能に連結する。外科用エンドエフェクタの開閉機能およびステープル機能を実現するように構成された発射アセンブリは、関節アセンブリを通って同軸に延在し、動力アセンブリによって作動される。開示された外科手術器具の他の特徴および利点は、以下にさらに詳述される。
図１Ａ、１Ｂ、２、および３を参照すると、本開示の実施形態による外科手術器具は、概して１０として指定されており、外科用エンドエフェクタ２００を作動および操作するための電動ハンドヘルド電気機械外科手術器具の形態をしている。ハンドヘルド電気機械外科手術器具１０は、ハンドルアセンブリ１２、ハンドルアセンブリ１２に連結された関節ノブハウジング１４、および関節ノブハウジング１４から遠位に延在し、そこにエンドエフェクタ２００が取り付けられたシャフト部分１６を含む。
ハンドルアセンブリ１２は、使い捨てで滅菌の細長いハンドルハウジング１８と、ハンドルハウジング１８の近位端部分１８ａに枢動可能に連結されたヒンジ付きドア２０とを含む。ドア２０は、非滅菌の再利用可能な器具モジュールまたは動力アセンブリ２２の挿入または取り外しを可能にするために、選択的に開閉される。ハンドルハウジング１８およびドア２０はそれぞれ、ドア１２０を閉鎖するときに器具モジュール２２のための内部空洞１７を集合的に画定する内周を有する。一態様では、近位端部分１８ａまたはハンドルハウジング１８の任意の適切な位置には、ディスプレイ（例えば液晶、図示せず）の表示を可能にするための透明な窓（図示せず）を有していてもよい。
ハンドルアセンブリ１２は、発射／閉鎖スイッチ２４ａおよび開放スイッチ２４ｂを有する。発射スイッチ２４ａは、エンドエフェクタ２００のジョー部材２０６、２０８を閉鎖し、最終的にエンドエフェクタ２００のステープル機能を実行するように構成および適合されている。開放スイッチ２４ｂは、エンドエフェクタ２００のジョー部材２０６、２０８を開放するように構成される。スイッチ２４ａ、２４ｂは、関節ノブハウジング１４の近位および隣接する位置でハンドルハウジング１８に移動可能に連結されたボタンとして構築され得る。発射スイッチ２４ａの起動により、器具モジュール２２のモータ２５が起動し、スイッチ２４ａまたはスイッチ２４ｂのどちらが作動されるかに応じて、外科手術器具１０の発射ロッド４４（図４および５）が前進または後退する。発射ロッド４４は、（ナイフロッドおよび作動スレッドを含む）エンドエフェクタ２００の被駆動要素（明示的に図示せず）に連結され、その結果、発射ロッド４４の前進により、エンドエフェクタ２００の被駆動要素が前進する。これにより、安全スイッチ２８が作動状態にあるときに、エンドエフェクタ２００のジョー部材２０６、２０８が閉鎖され、エンドエフェクタ２００を発射する。
外科用エンドエフェクタ２００の構造および動作の詳細な議論については、２００９年８月３１日に出願された「ＴＯＯＬ ＡＳＳＥＭＢＬＹ ＦＯＲ Ａ ＳＵＲＧＩＣＡＬ ＳＴＡＰＬＩＮＧ ＤＥＶＩＣＥ」と題された米国特許第７，８１９，８９６号、２００７年４月５日に出願された「ＳＵＲＧＩＣＡＬ ＳＴＡＰＬＩＮＧ ＤＥＶＩＣＥ ＷＩＴＨ ＤＩＳＳＥＣＴＩＮＧ ＴＩＰ」と題された米国特許第８，０６６，１６６号、および、２０１１年５月１２日に出願された「ＲＥＰＬＡＣＥＡＢＬＥ ＳＴＡＰＬＥ ＣＡＲＴＲＩＤＧＥ」と題された米国特許第９，８２０，７４１号を参照することができ、それぞれの内容全体は、参照により本明細書に組み込まれる。
安全スイッチ２８は、ハンドルハウジング１８を通って横方向に延在する触覚スイッチとして構築されている。安全スイッチ２８は、ハンドルハウジング１８の外面から露出した対向端部を有し、臨床医が発射無効位置と発射可能位置との間で安全スイッチ２８を摺動させることを可能にする。発射無効位置では、安全スイッチ２８は、ハンドルアセンブリ１２のプリント回路基板３２（図３）上の接触スイッチ３０（図３）に接触するか、または係合解除するかのいずれかであり、それにより、器具モジュール２２のプロセッサ（明示的に図示せず）は、発射スイッチ２４ａの作動にもかかわらず、モータ２５の起動を防止するように信号を送られる。発射可能位置では、安全スイッチ２８が、接触スイッチ３０を接触または係合解除し、それにより、プロセッサは、発射スイッチ２４ａを作動するとモータ２５の起動を可能にするように信号を送られる。一態様では、安全スイッチ２８は、安全スイッチ２８の位置を示すために、点滅するか、または定常状態に留まるように構成されたライトを内部に有することができる。
いくつかの実施形態では、ハンドルアセンブリ１２のスイッチ２４ａ、２４ｂ、２８は、様々な外科的エンドエフェクタによって実行される様々な機能を作動させるように割り当てることができる。スイッチ２４ａ、２４ｂ、２８は、例えば、スイッチ、ロッカー、フラップ、ラッチ、レバー、ダイヤル、ボタン、またはタッチスクリーンなど、様々に構成され得ることが企図されている。
ハンドルアセンブリ１２の再利用可能な器具モジュールまたは動力アセンブリ２２は、例えば、電気駆動モータなどのモータ２５を含み、電気駆動モータは、例えば、ソケットおよび／またはピニオン歯車などの出力部２７に駆動連結されている。モータ２５は、モータコントローラまたはプロセッサおよびバッテリ（明示的に図示せず）に電気的に接続されているか、または無線で接続されている。一態様では、バッテリは、昇圧回路を含んでもよく、（例えば、無線で）再充電可能であってもよい。バッテリは、スイッチ２４ａ、２４ｂおよび安全スイッチ２８からバッテリへの連絡を可能にするために、プリント回路基板３２のカードエッジヘッダ３４の取り外し可能な受容のために構成されたカードエッジコネクタ（明示的に図示せず）を有する。プロセッサは、バッテリをＵＳＢ充電器でまたは無線で（例えば、誘導を介して）再充電することを可能にするために、ＵＳＢ充電コネクタを含むことができる。
器具モジュール２２に関するさらなる詳細は、上記の参照により組み込まれる、２０２０年８月１３日に出願された米国特許仮出願第６３／０６４，９７７号に見出すことができる。
図２～５を参照すると、外科手術器具１０は、外科用エンドエフェクタ２００の開閉およびステープル機能を駆動するための発射アセンブリ４０、および外科用エンドエフェクタ２００の関節を駆動するための関節アセンブリ５０をさらに含む。発射アセンブリ４０は、概して、例えば、親ネジ、発射ナット４３、および発射ロッド４４などの発射シャフト４２を含む。発射シャフト４２は、ハンドルハウジング１８から遠位に、関節ノブハウジング１４を通って、シャフト部分１６の近位端部分１６ａ内に延在する。発射シャフト４２は、器具モジュール２２が空洞１７に受容されたときに器具モジュール２２の出力部２７（図１Ｂ）に回転不能に接続するために、ハンドルハウジング１８の空洞１７内に近位に突出する近位端部分４２ａを有する。発射シャフト４２の近位端部分４２ａは、トライローブ構成を有し得、出力部２７は、それらの間に回転不能な接続部を形成するための対応する形状のソケットを有することができる。バヨネットタイプの接続部など、他のタイプの回転不能な接続部も企図されている。スラストベアリングおよびシールは、発射シャフト４２の近位端部分４２ａとハンドルハウジング１８の遠位端部分１８ｂとの間に設けることができる。
発射ナット４３は、発射シャフト４２の周りに配置され、発射シャフト４２の回転方向に応じて発射ナット４３が近位または遠位のいずれかに並進するように、発射シャフト４２にねじ連結されている。発射ナット４３は、細長い形状であり、例えば、Ｄ字型構成などの非円形断面構成を有する。発射ナット４３については、例えば、長方形、三角形などの他の断面構成が企図されている。
発射ナット４３は、管状ハウジング４８内の発射ナット４３の回転を防止するために、または発射シャフト４２が回転するときに発射シャフト４２によって、管状ハウジング４８の対応する形状の内面４６に締結される。管状ハウジング４８は、ハンドルハウジング１８の遠位端部分１８ｂに画定されたポケット４９内に軸方向および回転可能に拘束された近位端部分４８ａ（図５）を有する。管状ハウジング４８は、シャフト部分１６の近位端部分１６ａとノブハウジング１４の遠位端部分との間に支持された遠位端部分４８ｂを有する。
発射ロッド４４は、発射ナット４３の遠位端部分４３ｂに固定された近位端部分４４ａを有する。発射ロッド４４は、外科用エンドエフェクタ２００の被駆動要素に連結された遠位端部分（明示的に図示せず）で終端するシャフト部分１６を通って遠位に延在する。
図２、４、および５を参照すると、ハンドルアセンブリ１２の関節アセンブリ５０は、エンドエフェクタ２００の関節を作動させるように構成される（例えば、エンドエフェクタ２００を、水平面に沿って、シャフト部分１６と同軸の位置と、シャフト部分１６と整列していない複数の位置との間で移動させる）。関節アセンブリ５０は、ノブハウジング１４、関節ナット５２、および関節ネジ５４を含む。関節ノブまたはノブハウジング１４は、近位端１４ａでハンドルハウジング１８に回転可能に連結され、遠位端１４ｂでシャフト部分１６に回転可能に連結される。
関節ナット５２は、ハンドルハウジング１８の遠位端部分１８ｂに受容された近位端部分５２ａを有する。関節ナット５２の近位端部分５２ａは、ハンドルハウジング１８の遠位端部分１８ｂによって軸方向に拘束されている間、回転可能に支持されている。関節ノブ１４は、関節ナット５２の周りに配置され、関節ノブ１４の手動回転が関節ナット５２を回転させるように、関節ナット５２に回転固定される。一態様では、関節ノブ１４は、関節ナット５２に接続されるか、関節ナット５２と一体的に形成されるか、または他の場合には関節ナット５２に連結され得る。
関節ネジ５４は、関節ナット５２内に受容され、関節ナット５２のネジ付き内面５６にねじ連結された近位端部分５４ａを有する。関節ネジ５４は、関節ナット５２の回転方向に応じて、関節ナット５２に対して近位または遠位のいずれかに並進するように構成される。関節ネジ５４は、関節ネジ５４を通る細長い通路５６（図２）を画定する。発射アセンブリ４０は、関節ネジ５４の通路５６内に同心円状に配置され、関節ネジ５４は、関節ナット５２内に同心円状に配置され、それにより、これらの構成要素のコンパクトなアセンブリを提供する。
関節アセンブリ５０はさらに、管状ハウジング４８の内面４６と発射ナット４３の外面との間に画定された空間６０（図５）内の関節ネジ５４の通路５６内に配置された近位端部分５８ａを有する関節リンク５８を含む。関節リンク５８の近位端部分５８ａは、そこから横方向に外側に延在するピン６２を有する。ピン６２は、管状ハウジング４８の横方向開口部６４を通って延在し、関節ネジ５４の遠位端部分５４ｂに固定され、それにより、関節リンク５８を関節ネジ５４に軸方向に固定する。関節ネジ５４の遠位端部分５４ｂは、関節ナット５２の回転中の関節ネジ５４の回転に抵抗するために、ファスナ６６を介して管状ハウジング４８に回転不能に固定され得る。
関節リンク５８は、シャフト部分１６の遠位端部分１６ｂで枢動可能に支持された枢動可能なリンク（明示的に図示せず）に連結された遠位端部分（明示的に図示せず）を有する。枢動可能なリンクは、関節リンク５８と外科用エンドエフェクタ２００とを互いに枢動可能に連結し、関節リンク５８の遠位方向の並進により、枢動可能なリンクが、シャフト部分１６に対して第１の方向に外科用エンドエフェクタ２００を関節運動させる。関節リンク５８の近位方向の並進は、枢動可能なリンクに、反対の第２の方向で、シャフト部分１６に対して外科用エンドエフェクタ２００を関節運動させる。
外科用エンドエフェクタをシャフト部分に枢動可能に連結する機構のさらなる詳細については、２０１９年１１月２６日に出願された米国特許出願第１６／６９５，３８０号を参照することができ、その全内容は参照により本明細書に組み込まれる。
動作中、器具モジュール２２はハンドルハウジング１８に挿入され、ドア２０は閉鎖され、それにより、滅菌の再利用可能な器具モジュール２２を滅菌のハンドルハウジング１８に密封する。ハンドルアセンブリ１２のプリント回路基板３２のカードエッジヘッド３４は、器具モジュール２２のカードエッジコネクタに接続されている。器具モジュール２２を適切に挿入すると、器具モジュール２２の出力部２７（図１Ｂ）は、発射シャフト４２の近位端部分４２ａに駆動連結する。
外科用エンドエフェクタ２００を動作させるために、ボタン２４ａを作動させることができ、それにより、器具モジュール２２のバッテリが、出力部２７の回転を駆動するモータ２５に電力を供給する。出力部２７が第１の方向に回転すると、発射シャフト４２が回転して、駆動ナット４３および取り付けられた発射ロッド４４の並進を駆動する。発射ロッド４４の並進により、ジョー部材２０６、２０８が閉鎖する。ジョー部材２０６、２０８を開放させるために、代わりにボタン２４ｂを作動させることができる。ジョー部材２０６、２０８が閉鎖した状態で、外科用エンドエフェクタ２００からステープルを発射するために、安全スイッチ２８が作動され、次いでボタン２４ａが作動され得、それにより、外科用エンドエフェクタ２００の被駆動要素（例えば、ステープルスレッド）は、ジョー部材２０８（例えば、カートリッジアセンブリ）を通って並進し、ステープルを組織に発射する。
外科用エンドエフェクタ２００を（臨床医の視点から）右に関節運動させるために、関節ノブハウジング１４を手動で（臨床医の視点から）時計回りに回転させ、これにより、回転運動はノブハウジング１４から関節ナット５２に伝達される。関節ナット５２の回転は、関節ナット５２に対する関節ネジ５４の近位方向の並進を駆動し、それにより、関節リンク５８が近位に駆動されて、外科用エンドエフェクタ２００を関節運動させる。同様に、外科用エンドエフェクタ２００を左に関節運動させるために、関節ノブハウジング１４を手動で反時計回りに回転させることができる。したがって、関節ノブハウジング１４の手動作動により、外科用エンドエフェクタ２００は、外科用エンドエフェクタ２００の非関節方向に対応する第１の位置（すなわち、外科用エンドエフェクタ２００は、シャフト部分１６と同軸である）から、外科用エンドエフェクタ２００の関節方向に対応する第２の位置（すなわち、外科用エンドエフェクタ２００は、シャフト部分１６に対して非平行な角度に枢動される）に移動する。一態様では、ノブハウジング１４の回転は、電子的またはロボット的に達成することができる。
本明細書に記載の構成要素のいずれも、強度、耐久性、耐摩耗性、重量、耐腐食性、製造の容易さ、製造コストなどを考慮して、金属、プラスチック、樹脂、複合材料などのいずれかから製造され得る。本明細書に開示される歯車のいずれも、ベベル歯車、平歯車、スパイラル歯車、ウォーム歯車などの任意の適切な歯車として構成することができる。
スイッチアセンブリを含む本開示の外科手術器具の実施形態に対して種々の改変がなされ得ることが理解されるであろう。したがって、上の説明は、限定するものではなく、単に実施形態の例証として解釈されるべきである。当業者であれば、本開示の範囲および趣旨内での他の改変を想定するであろう。

Claims (20)

  1. 内部に空洞を画定するハンドルハウジングと、
    前記ハンドルハウジングに対して遠位に延在するように構成された細長いシャフト部分と、
    前記シャフト部分の遠位端部分に連結され、前記シャフト部分に対して関節運動するように構成された外科用エンドエフェクタと、
    駆動器に駆動連結されるように構成された近位端部分および前記外科用エンドエフェクタの被駆動要素に作動可能に連結されるように構成された遠位端部分を有する発射シャフトと、
    前記外科用エンドエフェクタに作動可能に連結された関節ネジと、
    前記関節ネジの周りに配置され、前記関節ネジに作動可能に連結された関節ナットであって、前記関節ネジが、前記関節ナットの回転に応答して並進するように構成され、それにより、前記関節ネジが、前記シャフト部分に対して平行な向きと前記シャフト部分に対して非平行な向きとの間で前記外科用エンドエフェクタを関節運動させる、関節ナットと、を備える、ハンドヘルド外科手術器具。
  2. 前記関節ナットが、前記ハンドルハウジングに軸方向に拘束され、かつ前記ハンドルハウジングに回転可能に支持され、前記関節ネジが、前記関節ナット内に受容される、請求項１に記載のハンドヘルド外科手術器具。
  3. 前記関節ナットが、前記関節ネジの外面にねじ連結され、前記関節ナットを第１の回転方向に回転させると、遠位または近位のいずれかに前記関節ネジが並進し、前記関節ナットを第２の反対の回転方向に回転させると、遠位または近位のうちの他方に前記関節ネジが並進する、請求項１に記載のハンドヘルド外科手術器具。
  4. 前記関節ネジおよび関節ナットの各々が、管状構成を有する、請求項１に記載のハンドヘルド外科手術器具。
  5. 前記関節ネジおよび前記関節ナットが、発射シャフトの周りに同心円状に配置されている、請求項４に記載のハンドヘルド外科手術器具。
  6. 前記関節ナットの周りに配置された関節ノブであって、前記関節ノブの手動回転が前記関節ナットを回転させるように前記関節ナットに回転固定される関節ノブをさらに備える、請求項１に記載のハンドヘルド外科手術器具。
  7. 前記関節ノブが、関節ナットに接続されているか、または前記関節ナットと一体的に形成されている、請求項６に記載のハンドヘルド外科手術器具。
  8. 前記関節ネジに軸方向に固定された近位端部分と、前記外科用エンドエフェクタに作動可能に連結されるように構成された遠位端部分とを有する関節リンクをさらに備える、請求項１に記載のハンドヘルド外科手術器具。
  9. 前記関節リンクが、前記関節リンクの前記近位端部分から横方向に外側に延在するピンを有し、前記ピンが、前記関節ネジの遠位端部分に固定されている、請求項８に記載のハンドヘルド外科手術器具。
  10. 前記発射ネジにねじ連結され、前記発射ネジの回転に応答して並進して前記外科用エンドエフェクタのステープル機能を実現するように構成された発射ナットをさらに備える、請求項１に記載のハンドヘルド外科手術器具。
  11. 前記シャフト部分を通って延在し、前記発射ナットに固定された近位端部分と、前記外科用エンドエフェクタの前記被駆動要素に連結された遠位端部分とを有する発射ロッドをさらに備える、請求項１０に記載のハンドヘルド外科手術器具。
  12. 前記ハンドルハウジングに対して軸方向に拘束されたチューブハウジングをさらに備え、前記発射ナットが、前記チューブハウジング内に配置され、前記チューブハウジングに締結されて、前記発射ナットと前記チューブハウジングとの間の相対回転に抵抗する、請求項１０に記載のハンドヘルド外科手術器具。
  13. 前記ハンドルハウジングの前記空洞内で受容するように構成された器具モジュールであって、
    モータと、
    前記駆動器であって、前記モータに作動可能に連結され、前記駆動器の回転が前記発射シャフトの回転をもたらすように、前記発射シャフトの前記近位端部分に作動可能に連結するように構成された駆動器と、を含む器具モジュールをさらに備える、請求項１に記載のハンドヘルド外科手術器具。
  14. 前記ハンドルハウジングに連結されたボタンと、
    プリント回路基板であって、前記ボタンは、前記ボタンの作動が前記モータを起動させるように前記プリント回路基板に関連付けられている、プリント回路基板と、をさらに備える、請求項１３に記載のハンドヘルド外科手術器具。
  15. 内部に空洞を画定する細長いハンドルハウジングと、
    前記ハンドルハウジングの遠位端部分によって回転可能に支持された関節ナットと、
    前記関節ナット内に受容され、前記関節ナットにねじ連結された関節ネジと、
    前記関節ナットの周りに配置された関節ノブであって、前記関節ノブの手動回転が前記関節ナットを回転させて前記関節ネジを前記関節ナットに対して並進させるように前記関節ナットに回転固定される関節ノブと、を備える、ハンドヘルド外科手術器具の使い捨てハンドルアセンブリ。
  16. 前記関節ネジが、前記関節ネジを通る細長い通路を画定する、請求項１５に記載の使い捨てハンドルアセンブリ。
  17. 前記通路内に配置され、前記関節ネジに軸方向に固定された近位端部分を有する関節リンクをさらに備える、請求項１６に記載の使い捨てハンドルアセンブリ。
  18. 前記関節リンクが、前記関節リンクの前記近位端部分から横方向に外側に延在するピンを有し、前記ピンが、前記関節ネジの遠位端部分に固定されている、請求項１７に記載の使い捨てハンドルアセンブリ。
  19. 前記ハンドルハウジングの前記空洞内に受容された近位端部分を有する発射シャフトをさらに備え、前記関節ネジおよび前記関節ナットが、前記発射シャフトの周りに同心円状に配置されている、請求項１５に記載の使い捨てハンドルアセンブリ。
  20. 前記関節ノブが、関節ナットに接続されているか、または前記関節ナットと一体的に形成されている、請求項１５に記載の使い捨てハンドルアセンブリ。
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