KR20070079048A - 기록 성능을 갖는 수술 기구 - Google Patents
기록 성능을 갖는 수술 기구 Download PDFInfo
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- KR20070079048A KR20070079048A KR1020070009923A KR20070009923A KR20070079048A KR 20070079048 A KR20070079048 A KR 20070079048A KR 1020070009923 A KR1020070009923 A KR 1020070009923A KR 20070009923 A KR20070009923 A KR 20070009923A KR 20070079048 A KR20070079048 A KR 20070079048A
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Abstract
본 발명은 수술 기구에 관한 것이다. 수술 기구는 단부 이펙터 및 단부 이펙터와 연통하는 트리거를 구비한다. 수술 기구는 또한, 제 1 센서 및 제 1 센서와 연통하는 외부적으로 억세스할 수 있는 메모리 장치를 구비한다. 제 1 센서는 단부 이펙터 또는 트리거 중 어느 하나의 제 1 상태를 나타내는 출력을 갖는다. 메모리 장치는 제 1 센서의 출력을 기록하도록 구성된다. 다양한 실시예에서, 메모리 장치는 출력 포트 및/또는 제거가능한 기록 매체를 포함할 수 있다.
수술 기구, 메모리 장치, 트리거, 단부 이펙트, 스테이플 카트리지, 나이프
Description
도 1 및 도 2는 본 발명의 다양한 실시예에 따른 수술 절개 및 고정 기구의 사시도.
도 3 내지 도 5는 본 발명의 다양한 실시예에 따른 설비의 단부 이펙터 및 샤프트의 분해도.
도 6은 본 발명의 다양한 실시예에 따른 단부 이펙터의 측면도.
도 7은 본 발명의 다양한 실시예에 따를 기구의 손잡이의 분해도.
도 8 및 도 9는 본 발명의 다양한 실시예에 따른 손잡이의 부분 사시도.
도 10은 본 발명의 다양한 실시예에 따른 손잡이의 측면도.
도 10a 및 도 10b는 본 발명의 다양한 실시예에 따라 사용되는 비례 센서를 도시한 도면.
도 11은 본 발명의 다양한 실시예에 따른 기구에서 사용되는 회로의 개략도.
도 12 및 도 13은 본 발명의 다른 실시예에 따른 손잡의 측면도.
도 14 내지 도 22는 본 발명의 다양한 실시예에 따른 폐쇄 트리거를 록킹하기 위한 다른 메커니즘을 도시한 도면.
도 23a 및 도 23b는 본 발명의 다양한 실시예에 따른 기구의 관절 지점에서 채택될 수 있는 유니버설 조인트(u-조인트)를 도시한 도면.
도 24a 및 도 24b는 본 발명의 다양한 실시예에 따른 기구의 관절 지점에서 채택될 수 있는 비틀림 케이블을 도시한 도면.
도 25 내지 도 31은 본 발명의 또 다른 실시예에 따른 파워 보조기를 구비한 수술 절개 및 고정 기구를 도시한 도면.
도 32 내지 도 36은 본 발명의 여전히 또 다른 실시예에 따른 파워 보조기를 구비한 수술 절개 및 고정 기구를 도시한 도면.
도 37 내지 도 40은 본 발명의 실시예에 따른 촉감 피드백을 구비한 수술 절개 및 고정 기구를 도시한 도면.
도 41은 본 발명의 다양한 실시예에 따른 기구의 샤프트 및 단부 이펙터의 분해도.
도 42는 본 발명의 다양한 실시예에 따른 기계적 기구의 손잡이의 측면도.
도 43은 도 42의 기계 작동식 기구의 손잡이의 분해도.
도 44는 본 발명의 다양한 실시예에 따른 기구의 다양한 조건을 기록하기 위한 기록 시스템의 블록도.
도 45 및 도 46은 본 발명의 다양한 실시예에 따른 다양한 센서를 보여주는 기구의 손잡이의 파단 측면도.
도 47은 본 발명의 다양한 실시예에 따른 다양한 센서를 보여주는 기구의 단부 이펙터를 도시하는 도면.
도 48은 본 발명의 다양한 실시예에 따른 센서를 포함하는 기구의 발사 바아 를 예시하는 도면.
도 49는 본 발명의 다양한 실시예에 따른 센서를 도시하는 기구의 발사 바아, 손잡이 및 단부 이펙터의 측면도.
도 50은 본 발명의 다양한 실시예에 따른 다양한 센서를 도시하는 기구의 스테이플 카트리지의 일부 및 스테이플 채널의 분해도.
도 51은 본 발명의 다양한 실시예에 따른 다양한 센서를 보여주는 기구의 스테이플 채널의 상면도.
도 52a 및 도 52b는 다양한 실시예에 따른 기구를 작동시키기 위한 방법을 도시하는 플로우차트.
도 53은 본 발명의 다양한 실시예에 따른 기구의 예시적으로 기록된 조건을 보여주는 메모리 차트.
* 도면의 주요 부분에 대한 부호의 설명*
6 : 손잡이 8 : 샤프트
10 : 고정 기구 12 : 단부 이펙터
14 : 관절 선회부 16 : 관절 제어부
18 : 폐쇄 트리거 20 : 발사 트리거
22 : 스테이플 채널 24 : 앤빌
본 발명은 현재 출원중이고 참조에 의해 본원 발명에 통합되는 다음의 미국 특허 출원에 관한 것이다:
-- 사용자 피드백 시스템을 구비한 수술 절개 및 고정 기구: 발명자 : 셀톤 프레데릭 이. 4세, 존 아워커크, 및 모르간 제롬 알.(대리인 도켓 넘버 050519/END5687USNP)
-- 장전력(loading force) 피드백을 구비한 모터 구동 수술 절개 및 고정 기구: 발명자 : 셀톤 프레데릭 이. 4세, 아워커크 존 엔., 모르간 제롬 알., 및 쉐이지 제프리 에스.(대리인 도켓 넘버 050516/END5692USNP)
-- 촉감 위치 피드백을 구비한 모터 구동 수술 절개 및 고정 기구: 발명자 : 셀톤 프레데릭 이. 4세, 아워커크 존 엔., 모르간 제롬 알., 및 쉐이지 제프리 에스.(대리인 도켓 넘버 050515/END5693USNP)
-- 적응성 사용자 피드백을 구비한 모터 구동 수술 절개 및 고정 기구: 발명자 : 셀톤 프레데릭 이. 4세, 아워커크 존 엔., 및 모르간 제롬 알.(대리인 도켓 넘버 050513/END5694USNP)
-- 관절화 가능한 단부 이펙터(end effector)를 구비한 모터 구동 수술 절개 및 고정 기구: 발명자 : 셀톤 프레데릭 이. 4세, 및 길럼 크리스토프 엘.(대리인 도켓 넘버 050692/END5769USNP)
-- 기계식 폐쇄 시스템을 구비한 모터 구동 수술 절개 및 고정 기구: 발명자 : 셀톤 프레데릭 이. 4세, 및 길럼 크리스토프 엘.(대리인 도켓 넘버 050692/END5770USNP)
-- 폐쇄 트리거 록킹 메커니즘을 구비한 수술 절개 및 고정 기구: 발명자 : 셀톤 프레데릭 이. 4세, 및 케빈 알. 돌(대리인 도켓 넘버 050694/END5771USNP)
-- 동력화된 수술 절개 및 고정 기구를 위한 기어링 셀렉터: 발명자 : 셀톤 프레데릭 이. 4세, 쉐이지 제프리 에스., 및 팀퍼만 유진 엘.(대리인 도켓 넘버 050697/END5772USNP)
-- 제거 가능한 배터리를 가지는 수술 기구: 발명자 : 셀톤 프레데릭 이. 4세, 케빈 알. 돌, 아워커크 존 엔., 및 팀퍼만 유진 엘.(대리인 도켓 넘버 050699/END5774USNP)
-- 전자 안전잠금장치 및 이를 포함하는 수술 설비: 발명자 : 쉐이지 제프리 에스., 셀톤 프레데릭 이. 4세, 및 케빈 알. 돌(대리인 도켓 넘버 050700/END5775USNP)
-- 샤프트에 대해 관절화하는 손잡이를 구비한 내시경 수술 기구: 발명자 : 셀톤 프레데릭 이. 4세, 쉐이지 제프리 에스., 마크 에스. 오티스, 및 레슬리 엠. 후기카와(대리인 도켓 넘버 050701/END5776USNP)
-- 병렬 폐쇄 및 앤빌 얼라인먼트 부품을 구비한 회전 발사(firing) 및 폐쇄 시스템을 가지는 전자-기계적 수술 절개 및 고정 기구: 발명자 : 셀톤 프레데릭 이. 4세, 스테판. 제이. 발레크, 및 팀퍼만 유진 엘.(대리인 도켓 넘버 050702/END5777USNP)
-- 수술 절개 및 고정 기구 및 모듈러와 함께 사용하기 위한 조직 로케이터를 구비한 앤빌을 가지는 일회용 스테이플 카트리지 및 이를 위한 단부 이펙터 시 스템: 발명자 : 셀톤 프레데릭 이. 4세, 미쉘 에스. 크로퍼, 오수나 엠. 베롤, FIS 에스. 크리스프, 제미손 제이. 플로트, 및 팀퍼만 유진 엘.(대리인 도켓 넘버 050703/END5778USNP)
-- 피드백 시스템을 가지는 수술 기구: 발명자 : 셀톤 프레데릭 이. 4세, 모르간 제롬 알., 케빈 알. 돌., 쉐이지 제프리 에스., 및 팀퍼만 유진 엘.(대리인 도켓 넘버 050705/END5780USNP)
본 발명은 수술 기구에 관한 것이고, 보다 상세하게는 상기 수술 기구의 다양한 상태를 기록할 수 있는 침입성 수술 기구에 관한 것이다.
내시경 수술 기구들은 종종 보다 작은 절개가 수술후 회복 시간 및 병발증을 감소시키는 경향이 있기 때문에 전통적인 개구 수술 기구 이상으로 바람직하다. 결과적으로, 투관침(trocar)의 캐뉼라를 통한 필요한 수술 위치에 말단 단부 이펙터를 정확하게 배치하는데 적합한 내시경 수술 범위에 상당한 발전이 있었다. 이러한 말단 단부 이펙터는 진단 또는 치료 효과를 달성하는 다양한 방식으로 조직을 결합한다(예를 들어, 엔도커터(endocutter), 글래스퍼(grasper), 커터, 스테이플러, 클립 어플라이어, 억세스 디바이스, 약물/유전자 치료 전달 기구, 및 초음파, 무선 주파수(RF), 레이저 등을 사용하는 에너지 기구).
공지된 수술용 스테이플러는 조직에 길이 방향의 절개부를 만들고 또한 절개부의 양측에 스테이플의 라인을 동시에 적용하는 단부 이펙터를 포함한다. 단부 이펙터는 한 쌍의 상호 작용 죠(jaw)를 포함하고, 죠는 기구가 내시경 또는 복강경 적용을 위하여 의도되면 캐뉼라 통로를 통과할 수 있다. 죠 부재 중 하나는 적어 도 2개의 측방향으로 이격된 죠의 열들을 가지는 스테이플 카트리지를 수용한다. 다른 죠 부재는 카트리지에 있는 스테이플의 열과 정렬된 스테이플 형성 포켓을 가지는 앤빌을 형성한다. 기구는 다수의 웨지(wedge)들을 포함하며, 웨지들은 말단으로 구동될 때 스테이플 카트리지에 있는 개구를 통과하고, 앤빌을 향하여 스테이플의 발사를 실행하도록 스테이플의 지지하는 드라이버를 결합한다.
내시경 적용에 적합한 수술용 스테이플러의 예가 크노돌 등의 발명의 명칭이 "수술 스테이플 기구"인 미국 특허 제5,465,895호에 개시되어 있으며, 이는 별개의 폐쇄 및 발사 작용을 구비한 엔도커터를 개시한다. 이러한 기구를 사용하는 임상의는 발사에 앞서 조직을 위치시키도록 조직위에 죠 부재를 접근시킬 수 있다. 죠 부재들이 적절하게 조직을 파지하는 것을 임상의가 결정하였으면, 임상의는 단일 발사 행정으로 수술용 스테이플러를 발사할 수 있고, 이에 의해 조직을 절개하고 스테이플링한다. 동시적인 절개 및 스테이플링은, 각각으로 단지 절개 및 스테이플링하는 다른 수술 도구를 가지고 이러한 작용을 연속적으로 수행할 때 발생할 수 있는 발병증을 방지한다.
발사 전에 조직에 접근할 수 있는 하나의 특정 이점은, 마주하는 죠들 사이에 포획된 충분한 양의 조직을 포함하는, 절개에 필요한 로케이션이 달성되었던 내시경을 통하여 임상의가 입증할 수 있다는 것이다. 그 밖에, 마주하는 죠들은 서로 너무 가까이 당겨질 수도 있으며, 특히 이것들의 말단 단부들에서 꼬집으므로, 절개된 조직에서 접근된 스테이플을 형성하지 않는다. 다른 극단적인 예에서, 과 잉양의 클램핑된 조직은 발사를 속박하여 불완전하게 할 수도 있다.
내시경 수술 기구가 고장났을 때, 이들은 종종 고장의 분석을 위해 제조업자 또는 다른 집단에게로 보내진다. 기구내의 임계적 부류의 결함에서 고장이 초래되는 경우, 제조업자는 고장의 원인을 판정하고 설계 변경이 필요한지 여부를 결정할 필요가 있다. 이 경우, 제조업자는 고장난 기구를 분석하고, 기구에 대한 손상에만 기초해 고장나게 되는 상황을 재구성하기를 시도하는데 수백의 인시(man-hour)를 소요하게 된다. 이 방식으로 기구의 고장을 분석하는 것은 매우 많은 비용이 소요되며, 매우 어렵다. 또한, 이들 분석 중 다수는 원인이 기구의 부적절한 사용이었던 것으로 단순히 결론지어진다.
한가지 포괄적 양태에서, 본 발명은 수술 기구에 관한 것이다. 수술 기구는 단부 이펙터 및 단부 이펙터와 연통하는 트리거를 구비한다. 수술 기구는 또한, 제 1 센서 및 제 1 센서와 연통하는 외부적으로 억세스할 수 있는 메모리 장치를 구비한다. 제 1 센서는 트리거 또는 단부 이펙터 중 어느 하나의 제 1 조건을 나타내는 출력을 갖는다. 메모리 장치는 제 1 센서의 출력을 기록하도록 구성된다. 다양한 실시예에서, 메모리 장치는 출력 포트 및/또는 제거가능한 저장 매체를 포함할 수 있다.
또한, 다양한 실시예에서, 제 1 단부 이펙터의 출력은 단부 이펙터의 조건을 나타내고, 기구는 트리거의 조건을 나타내는 출력을 갖는 제 2 센서를 부가로 포함한다. 메모리 장치는 제 1 센서 및 제 2 센서의 출력을 기록하도록 구성된다.
다른 포괄적 양태에서, 본 발명은 수술 기구의 상태를 기록하는 방법에 관한 것이다. 본 방법은 복수의 센서의 출력을 감시하는 단계를 포함한다. 출력은 수술 기구의 조건을 나타낸다. 또한, 이 방법은 수술 기구의 조건 중 적어도 하나가 변할 때, 메모리 장치에 이 출력을 기록하는 단계를 포함한다. 다양한 실시예에서, 이 방법은 또한, 복수의 센서의 기록된 출력을 외부 장치에 제공하는 단계를 포함할 수 있다.
도 1 및 도 2는 본 발명의 다양한 실시예에 따른 수술 절개 및 고정 기구(10)를 도시한다. 도시된 실시예는 내시경적 수술 기구(10)이며, 일반적으로 본 명세서에 개시된 기구(10)의 실시예들은 내시경적 수술 절개 및 고정 기구들이다. 그러나, 본 발명의 다른 실시예에 따른 기구(10)는 복강경적 기구와 같은 비내시경적 수술 절개 기구일 수도 있다는 것을 유의해야 한다.
도 1 및 도 2에 도시된 수술 기구(10)는 손잡이(6), 샤프트(8), 및 관절 선회부(14)에서 샤프트(8)에 선회 가능하게 연결되는 관절 단부 이펙터(12)를 포함한다. 관절 제어부(16)는 관절 선회부(14)를 중심으로 단부 이펙터(12)의 회전을 실행하도록 손잡이(6)에 인접하여 제공될 수도 있다. 다양한 실시예는 비선회 단부 이펙터를 포함하고, 따라서 괄절 선회부(14) 또는 관절 제어부(16)를 갖지 않는다. 또한 도시된 실시예에서, 단부 이펙터(12)는, 비록 다른 실시예에서, 글래스퍼, 커터, 스태이플러, 클립 어플라이어, 접근 기구, 약물/유전자 치료 기구, 초음파, 무선 주파수 또는 레이저 기구 등과 같은 다른 형태의 수술 기구를 위한 단부 이펙터와 같은 상이한 형태의 단부 이펙터(12)들이 사용될 수도 있을지라도, 조직을 클램 핑, 절개, 스테이플링하기 위한 엔도커터로서 작용하도록 구성된다.
기구(10)의 손잡이(6)는 폐쇄 트리거(18)와 단부 이펙터(12)를 작동시키기 위한 발사 트리거(20; firing trigger)를 포함할 수도 있다. 상이한 수술 업무에 관련된 단부 이펙터를 가지는 기구가 상이한 수의 또는 형태의 트리거, 또는 단부 이펙터(12)를 동작시키기 위한 다른 적절한 제어부들을 포함한다는 것은 자명한 것이다. 단부 이펙터(12)는 바람직하게는 가늘고 긴 샤프트(8)에 의하여 손잡이(6)로부터 분리되어 도시되어 있다. 하나의 실시예에서, 임상의 또는 기구(10)의 조작자는 참조에 의해 본 발명에 통합되는 게오프레이 씨. 휴일 등에 의해 "관절 단부 이펙터를 가지는 수술 기구"라는 명칭으로 2006년 1월 26일 출원되어 계류중인 미국 특허출원 제11/39,020호에 보다 상세하게 기술된 바와 같은 관절 제어부(16)를 이용하는 것에 의하여 샤프트(8)에 관련하여 단부 이펙터(12)에 관절화할 수도 있다.
단부 이펙터(12)는 이 예에서 무엇보다도 스테이플 채널(22)과, 앤빌(24)과 같은 선회 가능하게 전달될 수 있는 클램핑 부재를 포함하고, 이것들은 단부 이펙터(12)에 클램핑된 조직의 효과적인 스테이플링 및 절개을 보장하는 공간에서 유지된다. 손잡이(6)는 피스톨 그립(26)을 포함하고, 폐쇄 트리거(18)는, 앤빌(24)과 채널(22) 사이에 위치된 조직을 클램핑하도록 단부 이펙터(12)의 스테이플 채널(22)을 향한 앤빌(24)의 클램핑 또는 폐쇄를 유발하도록 피스톨 그립(26)을 향하여 임상의에 의해 선회 가능하게 당겨진다. 발사 트리거(20)는 폐쇄 트리거(18)보다 더 외측에 있다. 폐쇄 트리거(18)가 추후에 기술되는 바와 같이 폐쇄 위치에서 록킹되면, 발사 트리거(20)가 피스톨 그립(26)을 향하여 약간 회전할 수도 있어서, 발사 트리거(20)는 조작자가 한 손을 사용하여 도달될 수 있다. 그런 다음, 조작자는 단부 이펙터(12)에서 클램핑된 조직의 스테이플링 및 절개을 유발하도록 피스톨 그립(26)을 향하여 발사 트리거(20)를 선회 가능하게 당길 수도 있다. 다른 실시예에서, 예를 들어, 마주하는 죠와 같은 앤빌(24) 이외의 상이한 형태의 클램핑 부재들이 사용될 수 있다.
용어 "기단" 및 "말단"이 기구(10)의 손잡이(6)를 파지하는 임상의를 참조하여 본 명세서에 사용되는 것이 예상될 수 있다. 그러므로, 단부 이펙터(12)는 보다 인접한 손잡이(6)에 대해 말단이다. 편의성 및 명료성을 위하여, "수직" 및 "수평"과 같은 공간적인 용어들이 도면을 참조하여 본 명세서에서 사용되는 것을 예상할 수 있다. 그러나, 수술 기구들은 다양한 배향 및 위치에서 사용되며, 이러한 용어들은 제한 및 절대적인 것으로 의도되지 않는다.
폐쇄 트리거(18)가 먼저 작동될 수도 있다. 임상의가 단부 이펙터(12)의 위치 선정이 만족되면, 임상의는 피스톨 그립(26)에 인접한 폐쇄 트리거의 완전 폐쇄, 록킹 위치로 폐쇄 트리거(18)를 다시 당길 수도 있다. 발사 트리거(20)는 그런 다음 작동된다. 발사 트리거(20)는 임상의가 이후에 보다 상세하게 도시되는 바와 같이 압력을 제거할 때 개방 위치(도 1 및 도 2에 도시됨)로 복귀한다. 손잡이(6)에 있는 해제 버튼은 눌려졌을 때 록킹된 폐쇄 트리거(18)를 해제할 수도 있다. 해제 버튼은 예를 들어 도 42 및 도 43에 도시된 슬라이드 해제 버튼(30), 도 14에 도시된 슬라이드 해제 버튼(160), 및/또는 도 16에 도시된 버튼(172)과 같이 다양한 형태로 실시될 수도 있다.
도 3 내지 도 6은 다양한 실시예에 따른 회전 구동 단부 이펙트(12) 및 샤프트(18)의 실시예를 도시한다. 도 3은 다양한 실시예에 따른 단부 이펙터(12)의 분해도이다. 예시된 실시예에 도시된 바와 같이, 단부 이펙터(12)는 이전에 언급된 채널(22) 및 앤빌(24)에 더하여, 절개 기구(32), 슬래드(33, sled), 채널(22)에 제거 가능하게 안치된 스테이플 카트리지(34), 및 헬리컬 스크루 샤프트(36)를 포함할 수도 있다. 절개 기구(32)는 예를 들어 나이프일 수 있다. 앤빌(24)은 채널(22)의 기단 단부에 연결된 선회 지점(25)에서 선회 가능하게 개방 및 폐쇄된다. 앤빌(24)은 또한 그 기단 단부에 있는 탭(27)을 포함하며, 탭은 앤빌(24)을 개방 및 폐쇄하도록 기계적인 폐쇄 시스템(이후에 기술됨)의 부품으로 삽입된다. 폐쇄 트리거(18)가 작동될 때, 즉 기구(10)의 사용자에 의해 안으로 당겨질 때, 앤빌(24)은 선회 지점(25)을 중심으로 클램핑 또는 폐쇄 위치로 선회할 수도 있다. 단부 이펙터(12)의 클램핑이 충분하면, 조작자는 발사 트리거(20)를 작동시키고, 이후에 보다 상세하게 기술되는 바와 같이, 이러한 것은 나이프(32)과 슬래드(33)가 채널(22)을 따라서 길이 방향으로 횡단하도록 하여, 단부 이펙터(12) 내에서 클램핑된 조직을 절개하도록 한다. 채널(22)을 따르는 슬래드(33)의 움직임은 스테이플 카트리지(34)의 스테이플들을 절개된 조직을 통하여 폐쇄된 앤빌(24)을 향하여 구동시키고, 절개된 조직을 체결하도록 스테이플을 회전시킨다. 다양한 실시예에서 슬래드(33)는 카트리지(34)의 일체형 부품일 수 있다. 참조에 의해 본 발명에 통합되는 셀톤 등의 "E-빔 발사 메커니즘을 통합한 수술용 스테이플링 기구"라 는 명칭의 미국 특허 제6,978,921호는 2-행정 절개 및 고정 기구에 관한 상세한 설명을 제공한다. 슬래드(33)는 카트리지(34)의 부분일 수 있으므로, 나이프(32)가 절개 작업 후에 후퇴할 때, 슬래드(33)는 후퇴하지 않는다.
비록 본 명세서에 개시된 기구(10)의 실시예들이 절개된 조직을 스테이플링하는 단부 이펙터(12)를 채택할지라도, 다른 실시예에서, 절개된 조직을 체결 또는 밀봉하기 위하여 다른 기술이 사용될 수도 있다. 예를 들어, 절개된 조직을 체결하도록 무선 주파수 에너지 또는 접착제들을 사용하는 단부 이펙터가 또한 사용될 수도 있다. 참조에 의해 본 발명에 통합되는 "오목 및/또는 편심 전극들을 구비한 전자 수술의 지혈 기구"라는 명칭의 예이트 등의 미국특허 제5,688,270호 및 "전자 수술의 지혈 기구"라는 명칭의 예이트 등의 미국특허 제5,709,680호는 절개된 조직을 밀봉하도록 무선 주파수 에너지를 사용하는 내시경 절개 기구를 개시한다. 또한, 참조에 의해 본 발명에 통합되는 제롬 알. 모르간 등의 미국특허출원 제11/267,811호 및 프레데릭 이. 셀톤 4세 등의 미국특허출원 제11/267,383호는 절개된 조직을 밀봉하도록 접착제를 사용하는 내시경 절개 기구를 개시한다. 따라서, 비록 본 명세서의 기술이 이후에 절개/스테이플링 작업 등을 언급할지라도, 이러한 것은 예시적인 실시예이고 제한을 의미하는 것이 아니라는 것을 인식할 것이다. 다른 조직-체결 기술이 또한 사용될 수도 있다.
도 4 및 도 5는 다양한 실시예에 따른 단부 이펙터(12) 및 샤프트(8)의 분해도이고, 도 6은 측면도이다. 예시된 실시예에 도시된 바와 같이, 샤프트(8)는 기단폐쇄 튜브(40)와, 선회 링크(44)에 의하여 선회 가능하게 링크된 말단 폐쇄 튜 브(42)를 포함할 수도 있다. 말단 폐쇄 튜브(42)는 개구(45)를 포함하고, 탭(27)은 추후에 기술되는 바와 같이 앤빌(24)을 개방 및 폐쇄하기 위하여 개구로 삽입된다. 기단 스핀 튜브(46)가 폐쇄 튜브(40) 내측에 배치될 수도 있다. 베벨 기어 조립체(52)를 통하여 2차(또는 말단) 구동 샤프트(50)와 통하는 주(또는 기단) 회전 구동 샤프트(48)가 기단 스핀 튜브(46) 내측에 배치될 수도 있다. 2차 구동 샤프트(50)는 헬리컬 스크루 샤프트(36)의 기단 구동 기어(56)를 결합하는 구동 기어(54)에 연결된다. 수직 베벨 기어(52b)는 기단 스핀 튜브(46)의 말단 단부에 있는 개구에 안치되어 선회할 수도 있다. 말단 스핀 튜브(58)는 2차 구동 샤프트(50)와 구동 기어(54,56)들을 둘러싸도록 사용될 수도 있다. 총체적으로, 주 구동 샤프트(48), 2차 구동 샤프트(50) 및 관절 조립체(예를 들어 베벨 기어 조립체(52a-c)들은 "주 구동 샤프트 조립체"로서 때때로 기술된다.
스테이플 채널(22)의 말단 단부에 위치된 베어링(38)은 헬리컬 스크루 샤프트(36)를 수용하여, 헬리컬 스크루 샤프트(36)가 채널(22)에 대해 자유롭게 회전하는 것을 허용한다. 헬리컬 스크루 샤프트(36)가 나이프(32)의 나사 개구(도시되지 않음)를 조정하여서, 샤프트(36)의 회전은 스테이플 채널(22)을 통하여 말단 또는 기단으로(회전 방향에 따라서) 나이프(32)를 이동시킨다. 따라서, 주 구동 샤프트(48)가 발사 트리거(20)의 작동에 의하여 회전할 때(이후에 보다 상세하게 설명되는 바와 같이), 베벨 기어 조립체(52a-c)는 2차 구동 샤프트(50)를 회전시키고, 구동 기어(54,56)의 결합 때문에, 순차적으로 헬리컬 스크루 샤프트(36)를 회전시키며, 이는 단부 이펙터 내에 클램핑된 어떠한 조직도 절개하도록 나이프 구동 부 재(32)를 채널(22)을 따라서 길이 방향으로 횡단시킨다. 슬래드(33)는 예를 들어 플라스틱으로 만들어질 수도 있으며, 경사진 말단 표면을 가질 수도 있다. 슬래드(33)가 채널(22)을 통하여 횡단함으로써, 경사진 전방 표면은 클램핑된 조직을 통하여 앤빌(24)을 향해 스테이플 카트리지에 있는 스테이플을 밀어 올리거나 또는 구동할 수도 있다. 앤빌(24)은 스테이플을 회전시키고, 이러한 것에 의하여 절개된 조직을 스테이플링한다. 나이프(32)가 후퇴될 때, 나이프(32)과 슬래드(33)는 분리되고, 이러한 것에 의하여 채널(22)의 말단 단부에 슬래드(33)를 남긴다.
상기된 바와 같이, 절개/스테이플링 작업을 위한 사용자 피드백의 부족 때문에, 일부 의사들은 절개/스테이플링 작업이 단지 버튼을 누르는 것에 의하여 작동되는 모터 구동 엔도커터를 수용하는 것을 대체로 꺼려한다. 대조적으로, 본 발명의 실시예는 단부 이펙터에 있는 절개 기구의 전개, 힘 및/또는 위치의 사용자 피드백을 구비한 모터 구동 엔도커터를 제공한다.
도 7 내지 도 10은 모터 구동 엔도커터의 예시적인 실시예, 특히 단부 이펙터에 있는 절개 기구의 전개 및 장전력에 관한 그 손잡이를 도시한다. 아울러, 실시예는 기구를 구동시키도록 발사 트리거(20)를 후퇴시에 사용자에 의해 제공되는 힘을 사용한다. 예시된 실시예에 도시된 바와 같이, 손잡이(6)는 대체로 손잡이(6)의 외부를 형성하도록 함께 맞추어지는 외부 하측편(59,60) 및 외측 상부편(61,62)을 포함한다. 리튬 이온 배터리와 같은 배터리(64)가 손잡이(6)의 피스톨 그립(26)에 제공될 수도 있다. 배터리(64)는 손잡이(6)의 피스톨 그립(26)의 상부 부분에 배치된 모터(65)를 구동시킨다. 다양한 실시예에 따라서, 모터(65)는 대략 5000RPM의 최대 회전속도를 가지는 DC 브러쉬 구동 모터일 수도 있다. 모터(65)는 제 1 베벨 기어(68) 및 제 2 베벨 기어(70)를 포함하는 90° 베벨 기어 조립체(66)일 수 있다. 베벨 기어 조립체(66)는 유성 기어 조립체(72)를 구동시킬 수 있다. 유성 기어 조립체(72)는 구동 샤프트(76)에 연결된 피니언 기어(74)를 포함할 수도 있다. 피니언 기어(74)는 구동 샤프트(82)를 통하여 헬리컬 기어 드럼(80)을 구동시키는 짝을 이루는(mating) 링 기어(78)를 구동시킬 수도 있다. 링(84)은 헬리컬 기어 드럼(80)에 나사 결합될 수도 있다. 그러므로, 모터(65)가 회전할 때, 링(84)은 개재되어 있는 베벨 기어 조립체(66), 유성 기어 조립체(72) 및 링 기어(78)에 의하여 헬리컬 기어 드럼(80)을 따라서 주행하게 된다.
손잡이(6)는 또한 발사 트리거(20)가 조작자에 의하여 손잡이(6)의 피니언 기어(74)를 향하여 당겨져 단부 이펙터(12)에 의해 절개/스테이플링 작동을 작동시킬 때를 검출하도록 발사 트리거(20)와 통신하는 모터 구동 센서(110)를 포함할 수도 있다. 센서(110)는 예를 들어 가감(rheostat) 또는 가변 저항기와 같은 비례제어 센서일 수도 있다. 발사 트리거(20)가 당겨질 때, 센서(110)는 움직임을 검출하여, 공급되는 전압(또는 전력)을 지시하는 전기 신호를 모터(65)에 보낸다. 센서(110)가 가변 저항기 등일 때, 모터(65)의 회전은 대체로 발사 트리거(20)의 움직임 양에 비례한다. 즉, 조작자가 발사 트리거(20)를 약간 당기거나 폐쇄하면, 모터(65)의 회전은 비교적 작다. 발사 트리거(20)가 완전하게 당겨질 때(또는 완전하게 폐쇄된 위치로), 모터(65)의 회전은 그 최대이다. 다시 말하면, 사용자가 발사 트리거(20)를 당기면 당길수록, 보다 많은 모터 전압이 모터(65)에 적용되어 보다 큰 회전 속도를 유발한다.
손잡이(6)는 발사 트리거(20)의 상부 부분에 인접한 중간 손잡이편(104)을 포함한다. 손잡이(6)는 또한 중간 손잡이편(104)에 있는 지주(post)들과 발사 트리거(20) 사이에 연결되는 편향 스프링(112)을 포함할 수도 있다. 편향 스프링(112)은 발사 트리거(20)를 발사 트리거의 완전 개방 위치로 편향시킨다. 이러한 방식으로, 조작자가 발사 트리거(20)를 해제할 때, 편향 스프링(112)은 그 개방 위치로 발사 트리거(20)를 당기게 되는 것에 의하여, 센서(110)의 작동을 제거하여, 모터(65)의 동작을 정지시킨다. 더욱이, 편향 스프링(112)에 의하여, 사용자는 언제라도 발사 트리거(20)를 폐쇄하고, 사용자는 폐쇄 작업에 대한 저항을 체험하게 되어서, 모터(65)에 의해 발휘되는 회전양에 대한 피드백이 사용자에게 제공된다. 아울러, 조작자는 센서(110)로부터 힘을 제거하도록 발사 트리거(20)를 후퇴시키는 것을 중지하여, 모터(65)를 정지시킨다. 이러한 것으로서, 사용자는 단부 이펙터(12)의 전개를 중지하여, 조작자에게 절개/체결 작업의 제어 조치를 제공한다.
헬리컬 기어 드럼(80)의 말단 단부는 피니언 기어(124)와 맞물리는 링 기어(122)를 구동시키는 말단 구동 샤프트(20)를 포함한다. 피니언 기어(124)는 주 구동 샤프트 조립체의 주 구동 샤프트(48)에 연결된다. 이러한 방식으로, 모터(65)의 회전은 주 구동 샤프트 조립체가 회전하도록 하고, 이러한 것은 상기된 바와 같은 단부 이펙터(12)의 작동을 유발한다.
헬리컬 기어 드럼(80)에 나사 결합된 링(84)은 슬롯 암(90)의 슬롯(88) 내에 배치된 지주(86)를 포함한다. 슬롯 암(90)은 손잡이 외부 측편(59,60) 사이에 연결되는 선회핀(96)을 수용하는 개구(92)를 그 반대편 단부에서 가진다. 선회핀(96)은 또한 발사 트리거(20)에 있는 개구(100) 및 중간 손잡이편(104)에 있는 개구(102)를 통하여 배치된다.
아울러, 손잡이(6)는 모터 역회전(또는 행정의 종료점) 센서(130)) 및 모터 정지(또는 행정의 개시) 센서(142)를 포함할 수도 있다. 다양한 실시예에서, 모터 역회전 센서(1300는 헬리컬 기어 드럼(80)의 말단 단부에 위치된 리미트 스위치일 수 있어서, 헬리컬 기어 드럼(80)에 나사 결합된 링(84)은 링(84)이 헬리컬 기어 드럼(80)의 말단 단부에 도달할 때 모터 역회전 센서(130)에 접촉하여 걸린다. 모터 역회전 센서(130)는 활성화될 때 그 회전 방향을 반전시키도록 신호를 모터(65)에 보내어, 절개 작업 후에 단부 이펙터(12)의 나이프(32)를 회수한다.
모터 정지 센서(142)는 예를 들어 통상 폐쇄된 리미트 스위치일 수도 있다. 다양한 실시예에 있어서, 이것은 헬리컬 기어 드럼(80)의 기단 단부에 위치될 수 있어서, 링(84)이 헬리컬 기어 드럼(80)의 기단 단부에 도달할 때, 링(84)은 스위치(142)에 걸린다.
작업에 있어서, 기구(10)의 조작자가 발사 트리거(20)를 다시 당길 때, 센서(110)는 발사 트리거(20)의 전개를 검출하여, 예를 들어, 조작자가 발사 트리거(20)를 어떻게 다시 강력하게 당기는 가에 비례하는 속도로 모터(65)의 정방향 회전을 유발하도록 모터(65)에 신호를 보낸다. 모터(65)의 정방향 회전은 순차적으로 유성 기어 조립체(72)의 말단 단부에 있는 링 기어(78)를 회전시켜, 헬리컬 기어 드럼(80)을 회전시키고, 또한 헬리컬 기어 드럼(80)에 나사 결합된 링(84)을 헬리컬 기어 드럼(80)을 따라서 말단으로 주행시킨다. 헬리컬 기어 드럼(80)의 회전은 또한 상기된 바와 같이 주 구동 샤프트 조립체를 구동시키고, 이는 순차적으로 단부 이펙터(12)에 있는 나이프(32)의 전개를 유발한다. 즉, 나이프(32)과 슬래드(33)는 길이 방향으로 채널(22)을 횡단하는 것에 의하여, 단부 이펙터(12)에 클램핑된 조직을 절개한다. 또한, 단부 이펙터(12)의 스테이플링 작업은 스테이플링 형태의 단부 이펙터가 사용되는 실시예에서 발생된다.
단부 이펙터(12)의 절개/스테이플링 작업이 종료될 때까지, 헬리컬 기어 드럼(80)에 있는 링(84)은 헬리컬 기어 드럼(80)의 말단 단부에 도달하게 되어, 모터 역회전 센서(130)를 걸리게 하며, 이러한 것은 그 회전을 역전하도록 모터(65)에 신호를 보낸다. 이러한 것은 순차적으로 나이프(32)를 후퇴시키고, 또한 헬리컬 기어 드럼(80)에 있는 링(84)을 헬리컬 기어 드럼(80)의 기단 단부로 다시 이동시킨다.
중간 손잡이편(104)은 도 8 및 도 9에 가장 잘 도시된 바와 같이 슬롯 암(90)을 결합하는 배면측 어깨부(106)를 포함한다. 중간 손잡이편(104)은 또한 발사 트리거(20)를 결합하는 전진 운동 스토퍼(107)를 가진다. 슬롯 암(90)의 움직임은 상기된 바와 같이 모터(65)의 회전에 의하여 제어된다. 슬롯 암(90)이 반시계 방향(CCW)으로 회전할 때, 링(84)이 헬리컬 기어 드럼(80)의 기단 단부로부터 말단 단부로 주행함으로써, 중간 손잡이편(104)은 반시계 방향으로 회전하도록 자유롭게 된다. 그러므로, 사용자가 발사 트리거(20)를 당김으로써, 발사 트리 거(20)는 중간 손잡이편(104)에 있는 전진 운동 스토퍼(107)를 결합하게 되어, 중간 손잡이편(104)을 반시계 방향으로 회전시킨다. 그러나, 배면측 어깨부(106)가 슬롯 암(90)을 결합하는 것으로 인하여, 중간 손잡이편(104)은 단지 슬롯 암(90)이 허용하는 만큼만 반시계 방향으로 회전할 수 있게 된다. 이러한 방식으로, 모터(65)가 동일한 이유로 회전을 정지하여야만 하면, 슬롯 암(90)은 회전이 중지되고, 중간 손잡이편(104)이 슬롯 암(90)으로 인하여 반시계 방향으로 회전하는 것이 자유롭지 못하기 때문에, 사용자는 발사 트리거(20)를 더 당길 수 없다.
도 10a 및 도 10b는 본 발명의 다양한 실시예에 따른 런 모터 센서(110)로서 사용될 수 있는 다양한 센서의 두 가지 상태를 예시한다. 센서(110)는 전면부(280), 제 1 전극(A)(282), 제 2 전극(B)(284) 및 예로서, 전기활성 폴리머(EAP) 같은 전극(284, 282) 사이의 압축성 유전체 재료(286)를 포함할 수 있다. 센서(110)는 수축시 전면부(280)가 발사 트리거(20)와 접촉하도록 배치될 수 있다. 따라서, 발사 트리거(280)가 수축될 때, 도 10b에 도시된 바와 같이, 유전체 재료(286)가 압축되고, 그래서, 전극(282, 284)이 함께 접근한다. 전극(282, 284) 사이의 거리"b"는 전극(282, 284) 사이의 임피던스에 직접적으로 관련되고, 거리가 보다 크면 클수록 임피던스가 보다 커지고, 거리가 보다 가까우면 가까울수록 임피던스가 보자 작아진다. 이 방식으로, 발사 트리거(20)(도 42에 힘 "F"로 표시)의 수축으로 인해 유전체(286)가 압축되는 양은 전극(282, 284) 사이의 임피던스에 비례하며, 이는 모터(65)를 비례제어하도록 사용될 수 있다.
폐쇄 트리거(18)를 후퇴시키는 것에 의하여 단부 이펙터(12)의 앤빌(24)을 폐쇄하기(또는 클램핑하기) 위한 예시적인 폐쇄 시스템의 부품들이 또한 도 7 내지 도 10에 도시되어 있다. 예시된 실시예에서, 폐쇄 시스템은 폐쇄 트리거(18)와 요크(250)에서 정렬된 개구들을 통하여 삽입되는 핀(251)에 의하여 폐쇄 트리거(18)에 연결되는 요크(250)를 포함한다. 폐쇄 트리거(18)가 이를 중심으로 선회하는 선회핀(252)은 폐쇄 트리거(18)에 있는 편심된 또 다른 개구를 통하여 삽입되고, 핀(251)은 상기 개구로부터 폐쇄 트리거(18)를 통해 삽입된다. 그러므로, 폐쇄 트리거(18)의 후퇴는 폐쇄 트리거(18)의 상부 부분을 반시계 방향으로 회전시키고, 요크(250)는 핀(251)을 경유하여 폐쇄 트리거의 상부 부분에 부착된다. 요크(250)의 말단 단부는 핀(254)을 경유하여 제 1 폐쇄 브래킷(256)에 연결된다. 제 1 폐쇄 브래킷(256)은 제 2 폐쇄 브래킷(258)에 연결된다. 총체적으로, 폐쇄 브래킷(256,258)들은 개구를 한정하고, 기단 폐쇄 튜브(40)(도 4)의 기단 단부가 상기 개구에 안치되어 유지되어서, 폐쇄 브래킷(256,258)들의 길이 방향 움직임은 기단 폐쇄 튜브(40)에 의하여 길이 방향 움직임을 유발한다. 기구(10)는 또한 기단 폐쇄 튜브(40) 내측에 배치된 폐쇄봉(260, closure rod)을 포함한다. 폐쇄봉(260)은 윈도우(261)를 포함할 수 있으며, 예시된 실시예에 있는 외부 하측편(59)과 같은 손잡이 외부편중 하나에 있는 지주(263)가 윈도우 내에 배치되어 폐쇄봉(260)을 손잡이(6)에 고정적으로 연결한다. 이러한 방식에 있어서, 기단 폐쇄 튜브(40)는 폐쇄봉(260)에 관계하여 길이 방향으로 움직일 수 있다. 폐쇄봉(260)은 또한 말단 나이프라(267)를 포함할 수 있으며, 말단 나이프라는 기단 스핀 튜브(46)에 있는 공동(269)으로 맞추어져서, 캡(271)(도 4 참조)에 의하여 거기에서 유지된다.
동작에 있어서, 요크(250)가 폐쇄 트리거(18)의 후퇴로 인하여 회전할 때, 폐쇄 브래킷(256, 258)은 기단 폐쇄 튜브(40)를 말단으로(즉, 기구(10)의 손잡이의 단부로부터 멀리) 이동시키고, 이는 말단 폐쇄 튜브(42)를 말단으로 이동시켜, 앤빌(24)을 클램핑 또는 폐쇄된 위치로 선회 지점(25)을 중심으로 회전시킨다. 폐쇄 트리거(18)가 록킹된 위치로부터 해제될 때, 기단 폐쇄 튜브(40)는 기단으로 활주하고, 이는 말단 폐쇄 튜브(42)를 기단으로 활주시키고, 말단 폐쇄 튜브(42)의 윈도우(45)에 삽입되는 탭(27)에 의하여, 앤빌(24)을 개방 또는 클램핑되지 않은 위치로 선회 지점(25)을 중심으로 선회시킨다. 이러한 방식에 있어서, 폐쇄 트리거(18)를 후퇴시켜 록킹하는 것에 의하여, 조작자는 앤빌(24)과 채널(22) 사이에서 조직을 클램핑할 수도 있으며, 록킹된 위치로부터 폐쇄 트리거(18)를 해제하는 것에 의하여 절개/스테이플링 작업후에 조직을 클램핑해제 할 수 있다.
도 11은 본 발명의 다양한 실시예에 따른 기구(10)의 전기 회로의 개략도이다. 조작자가 초기에 폐쇄 트리거(18)를 록킹한 후에 발사 트리거(20)를 당길 때, 센서(110)가 활성화되어, 전류가 흐르는 것을 허용한다. 통상 개방된 모터 역회전 센서 스위치(130)가 개방되면(단부 이펙터 행정의 종료를 의미), 전류는 단극의 더블 드로우(double throw) 릴레이(132)로 흐르게 된다. 역전 모터 센서 스위치(130)가 폐쇄되지 않기 때문에, 릴레이(132)의 인덕터(134)는 전기가 인가되지 않게 되어서, 릴레이(132)는 전기 인가되지 않은 상태로 있게 된다. 회로는 또한 카트리지 안전 잠금 센서(136)를 포함한다. 단부 이펙터(12)가 스테이플 카트리지(34)를 포함하면, 센서(136)는 폐쇄된 상태로 있게 되어 전류가 흐르는 것을 허 용한다. 그 밖에, 단부 이펙터(12)가 스테이플 카트리지(34)를 포함하지 않으면, 센서(136)는 개방되어서, 배터리(64)가 모터(65)에 동력을 공급하는 것을 방지한다.
스테이플 카트리지(34)가 존재할 때, 센서(136)는 폐쇄되고, 이는 단극의 싱글 드로우 릴레이(138)에 전기를 인가한다. 릴레이(138)에 전기가 인가될 때, 전류는 릴레이(138)를 통하여, 가변 저항 센서(110)를 통하여 이중극의, 더블 드로우 릴레이(140)를 경유하여 모터(65)로 흘러, 모터를 구동하여 모터가 전진 방향으로 회전하는 것을 허용한다.
단부 이펙터(12)가 그 행정의 종료점에 도달할 때, 모터 역회전 센서(130)가 활성화되어, 스위치(130)를 폐쇄하여, 릴레이(134)에 전기를 인가한다. 이러한 것은 릴레이(134)에 전기가 인가된 상태를 보장하고(도 11에 도시되지 않음), 이는 전류가 카트리지 안전 잠금 센서(136)와 가변성 저항 센서(110)를 우회하도록 하고, 하나의 방식에 있어서, 릴레이(140)를 경유하여 대신에 전류가 통상 폐쇄된 이중극의, 더블 드로우 릴레이(142) 그리고 다시 모터(65)로 흐르도록 하여, 모터(65)가 그 회전 방향을 역전시키도록 한다.
모터 정지 센서(142)가 통상 폐쇄되기 때문에, 전류는 스위치(142)가 개방할 때가지 이러한 것을 유지하도록 릴레이(134)로 다시 흐르게 된다. 나이프(32)가 완전히 후퇴될 때, 모터 정지 센서 스위치(142)가 활성화되어, 스위치(142)를 개방시켜, 모터(65)로부터 전력을 제거한다.
다른 실시예에 있어서, 비례 제어 형태의 센서(110) 대신에 온-오프 형태의 센서가 사용될 수 있다. 이러한 실시예에 있어서, 모터(65)의 회전 속도는 조작자에 의해 적용되는 힘에 비례하지 않게 된다. 오히려, 모터(65)는 대체로 일정한 속도로 회전하게 된다. 그러나, 조작자는 발사 트리거(20)가 기어 구동 트레인에 기어 결합되기 때문에 여전히 힘 피드백을 체험하게 된다.
도 12는 또 다른 실시예에 따른 파워 보조 기동 엔도커터의 손잡이(6)의 측면도이다. 도 12의 실시예는 도 12의 실시예에서 헬리컬 기어 드럼(80)에 나사 결합된 링(84)에 슬롯 암이 연결되지 않는 것 외에 도 7 내지 도 10에 도시된 것과 유사하다. 대신에, 도 12의 실시예에서, 링(84)은 헬리컬 기어 드럼(80)에서 링(84)이 아래로 나아감으로써(그리고 뒤로) 링(84)과 함께 움직이는 센서 부분(114)을 포함한다. 센서 부분(114)은 노치(116)를 포함한다. 모터 역회전 센서(130)는 노치(116)의 말단 단부에 배치될 수 있으며, 모터 정지 센서(142)는 노치(116)의 기단 단부에 배치될 수 있다. 링(84)이 헬리컬 기어 드럼(80) 아래로(그리고 뒤로) 움직임으로써, 센서 부분(114)은 이와 함께 움직이다. 아울러, 도 12에 도시된 바와 같이, 중간 손잡이편(104)은 노치(116)로 연장하는 암(118)을 가질 수 있다.
동작에 있어서, 기구(10)의 조작자가 발사 트리거(20)를 피니언 기어(124)를 향하여 후퇴시킴으로써, 구동 모터 센서(110)는 움직임을 검출하여 모터(65)를 구동하도록 신호를 보내고, 무엇보다도, 헬리컬 기어 드럼(80)을 회전시킨다. 또한, 발사 트리거(20)의 당겨짐으로 인하여, 중간 손잡이편(104)은 발사 트리거(20)를 결합하는 전진 운동 스토퍼(107)로 인하여 발사 트리거(20)와 함께 반시계 방향으 로 회전된다. 중간 손잡이편(104)의 반시계 방향 회전은 암(118)을 링(84)의 센서 부분(114)과 함께 반시계 방향으로 회전시켜서, 암(118)은 노치(116)에 배치된 상태로 있다. 링(84)이 헬리컬 기어 드럼(80)의 말단 단부에 도달할 때, 암(118)은 모터 역회전 센서(130)에 접촉하여 걸린다. 유사하게, 링(84)이 헬리컬 기어 드럼(80)의 기단 단부에 도달할 때, 암은 모터 정지 센서(142)에 접촉하여 걸리게 된다. 이러한 작용들은 상기된 바와 같이 모터(65)를 역전시키고 정지시킨다.
도 13은 또 다른 실시예에 따른 파워 보조 동력화된 엔도커터의 손잡이(6)의 측면도이다. 도 13의 실시예는 암(90)에 도 13이 슬롯이 없는 것 외에는 도 7 내지 도 10에 도시된 실시예와 유사하다. 대신에, 헬리컬 기어 드럼(80)에 나사 결합된 링(84)은 수직 채널(126)을 포함한다. 슬롯 대신에, 암(90)은 채널(126)에 배치되는 지주(128)를 포함한다. 헬리컬 기어 드럼(80)이 회전함으로써, 헬리컬 기어 드럼(80)에 나사 결합된 링(84)은 전진한다(또는 그 회전에 따라서 후퇴한다). 암(90)은 링(84)이 도 13에 도시된 바와 같이 채널(126)에 배치된 지주(128)로 인하여 나아감으로써 반시계 방향으로 회전한다.
상기된 바와 같이, 2 행정 기동 기구를 사용하여, 조작자는 먼저 폐쇄 트리거(18)를 뒤로 당겨 록킹한다. 도 14 및 도 15는 손잡이(6)의 피스톨 그립 부분(26)에 폐쇄 트리거(18)를 록킹하는 방식의 한 예를 도시한다. 예시된 실시예에서, 피스톨 그립 부분(26)은 비틀림 스프링(152)에 의하여 선회 지점을 중심으로 반시계 방향으로 회전하도록 편향된 훅(150)을 포함한다. 또한, 폐쇄 트리거(18)는 폐쇄 바(154)를 포함한다. 조작자가 폐쇄 트리거(18)를 당김에 따라서, 폐쇄 바(54)는 훅(150)의 경사부(156)를 결합하여, 훅(150)의 오목한 노치(158)로 지나가는 경사부(156)를 폐쇄 바(154)가 완전히 지날 때까지 훅(150)을 상향(또는 도 12 및 도 13에서 시계방향으로)으로 회전시키며, 이는 폐쇄 트리거(18)를 적소에 록킹한다. 조작자는 피스톨 그립 부분(26)의 후방 또는 마주한 측부에 슬라이드 해제 버튼을 아래로 누르는 것에 의하여 폐쇄 트리거(18)를 해제할 수도 있다. 슬라이드 해제 버튼(160)을 누르는 것은 훅(150)을 시계 방향으로 회전시켜서, 폐쇄 바(154)는 오목한 노치(158)로부터 해제된다.
도 16은 다양한 실시예에 따른 또 다른 폐쇄 트리거 록킹 메커니즘을 도시한다. 도 16의 실시예에서, 폐쇄 트리거(18)는 화살형 헤드 부분(161)을 가지는 웨지(160)를 포함한다. 화살형 헤드 부분(161)은 판스프링(162)에 의하여 아래(또는 시계 방향)로 편향된다. 웨지(160)와 판스프링(162)은 예를 들어 성형 플라스틱으로 만들어진다. 폐쇄 트리거(18)가 후퇴될 때, 화살형 헤드 부분(161)은 손잡이(6)의 피스톨 그립 부분(26)에 있는 개구(164)를 통해 삽입된다. 화살형 헤드 부분(161)의 하부 모따기 면(166)은 개구(164)의 하부 측벽(168)을 결합하여, 화살형 헤드 부분(161)을 반시계 방향으로 회전하도록 가압한다. 궁극적으로, 하부 모따기 면(166)은 하부 측벽(168)을 완전히 지나가, 화살형 헤드 부분(161)에서의 반시계 방향 힘을 제거하고, 하부 측벽(168)을 화살형 헤드 부분(161) 뒤에 있는 노치(170)에 있는 록킹 위치로 미끄러지게 한다.
폐쇄 트리거(18)를 록킹 해제하도록, 사용자는 폐쇄 트리거(18)의 반대편에 있는 버튼(172)을 눌러, 화살형 헤드 부분(161)을 반시계 방향으로 회전시켜, 화살 형 헤드 부분(161)이 개구(164)로부터 슬라이딩하는 것을 허용한다.
도 17 내지 도 22는 또 다른 실시예에 따른 폐쇄 트리거 메커니즘을 도시한다. 이 실시예에 도시된 바와 같이, 폐쇄 트리거(18)는 가요성 길이방향 암(176)을 포함하고, 암은 이로부터 연장하는 측방향 핀(178)을 포함한다. 암(176)과 핀(178)은 예를 들어 성형 플라스틱으로 만들어진다. 손잡이(6)의 피스톨 그립 부분(26)은 측방향 연장 웨지(182)를 배치되는 개구(180)를 포함한다. 폐쇄 트리거(18)가 후퇴될 때, 핀(18)은 웨지(182)를 결합하고, 핀(178)은 도 17 및 도 18에 도시된 바와 같이 웨지(182)의 하부면(184)에 의하여 아래로 강요된다(즉, 암(176)은 시계 방향으로 회전된다). 핀(178)이 완전하게 하부면(184)을 지나갔을 때, 암(176)에서의 시계 방향 힘은 제거되고, 핀(178)이 반시계 방향으로 회전되어서, 핀(178)은 도 19에 도시된 바와 같이 웨지(182) 뒤에 있는 노치(176)에 있게 되어, 폐쇄 트리거(18)를 록킹한다. 핀(178)은 웨지(184)로부터 연장하는 가요성 스토퍼(188)에 의하여 록킹된 위치에서 적소에 더욱 유지된다.
폐쇄 트리거(18)를 록킹 해제하도록, 조작자는 폐쇄 트리거(18)를 더욱 쥐어 짜, 핀(178)을 개구(18)의 경사 후벽(190)에 결합하여, 도 20 및 도 21에 도시된 바와 같이 핀(178)을 가요성 스토퍼(188)를 지나서 위로 강요한다. 핀(178)은 그런 다음 개구(180)에 있는 상부 채널(192) 외부로 주행하도록 자유롭게 되어서, 폐쇄 트리거(18)는 도 22에 도시된 바와 같이 더 이상 피스톨 그립 부분(26)에 록킹되지 않는다.
도 23a 및 도 23b는 유니버설 조인트(195, u-조인트)를 도시한다. 유니버설 조인트(195)의 제 2 부분(195-2)은 제 1 부분(195-1)이 놓이는 수평면에서 회전한다. 도 23a는 선형(180°) 정위에 있는 유니버설 조인트(195)를 도시하고, 도 23b는 대략 150° 정위에 있는 유니버설 조인트(195)를 도시한다. 유니버설 조인트(195)는 단부 이펙터(12)에 관절화하도록 주 구동 샤프트 조립체의 관절 선회부(14)에서 베벨 기어(52a-52c) 대신 사용될 수 있다. 도 24a 및 도 24b는 단부 이펙터(12)의 관절화를 실현하도록 베벨 기어(52a-52c) 및 유니버설 조인트(195) 대신에 비틀림 케이블(197)이 사용될 수 있다는 것을 도시한다.
도 25 내지 도 31은 본 발명의 또 다른 실시예에 따른 파워 보조를 구비한 기동된 2행정 수술 절개 및 고정 기구(10)의 또 다른 실시예를 도시한다. 도 25 내지 도 31은 헬리컬 기어 드럼(80) 대신에 도 25 내지 도 31의 실시예가 대안적인 기어 구동 조립체를 포함하는 것 외에 도 6 내지 도 10의 실시예와 유사하다. 도 25 내지 도 31의 실시예는 기어 박스 조립체(200)를 포함하고, 기어 박스 조립체는 프레임(201)에 배치된 다수의 기어들을 포함하며, 기어들은 유성 기어(72)와, 구동 샤프트(48)의 기단 단부에 있는 피니언 기어(124) 사이에 연결된다. 이후에 설명되는 바와 같이, 기어 박스 조립체(200)는 발사 트리거(20)를 통하여 사용자에 대한 피드백을 제공한다. 또한, 사용자는 단부 이펙터(12)의 전개를 보조하도록 기어 박스 조립체(200)를 경유하여 시스템에 동력을 제공할 수 있다. 이러한 의미에 있어서, 상기된 실시예처럼, 도 25 내지 도 31의 실시예는 절개 기구에 의해 체험된 장전력에 관하여 사용자에게 피드백을 제공하는 또 다른 파워 보조 기동 기구(10)이다.
예시된 실시예에서, 발사 트리거(20)는 주 몸체 부분(202) 및 딱딱한 부분(204)의 2개의 부분을 포함한다. 주 몸체 부분(202)은 예를 들어 플라스틱으로 만들어질 수 있고, 딱딱한 부분(204)은 금속과 같은 보다 단단한 재료로 만들어질 수 있다. 예시된 실시예에서, 딱딱한 부분(204)은 주 몸체 부분(202)에 인접하지만, 다른 실시예에 따라서, 딱딱한 부분(204)은 주 몸체 부분(202)의 내측에 배치될 수 있다. 선회 핀(209)은 발사 트리거 부분(202, 204)에 있는 개구들을 통하여 삽입될 수 있고, 이를 중심으로 발사 트리거(20)가 주위를 회전하는 지점일 수도 있다. 아울러, 스프링(222)은 발사 트리거(20)를 반시계 방향으로 회전하도록 편향시킬 수도 있다. 스프링(222)은 발사 트리거(20)의 부분(202, 204)들에 연결되는 핀(224)에 연결되는 말단 단부를 가질 수 있다. 스프링(222)의 기단 단부는 손잡이 외부 하측편(59, 60) 중 하나에 연결될 수 있다.
예시된 실시예에서, 주 몸체 부분(202)과 딱딱한 부분(204) 모두는 이것들의 상부 단부 부분에 (각각) 있는 기어 부분(206, 208)을 포함한다. 기어 부분(206, 208)은 이후에 기술되는 바와 같이 주 구동 샤프트 조립체를 구동하고 단부 이펙터(12)의 전개에 관하여 사용자에게 피드백을 제공하도록 기어 박스 조립체(200)에 있는 기어를 결합한다.
기어 박스 조립체(200)는 예시된 실시예에서 도시된 바와 같이 6개의 기어들을 포함할 수 있다. 기어 박스 조립체(200)의 제 1 기어(210)는 발사 트리거(20)의 기어 부분(206, 208)들을 결합한다. 아울러, 제 1 기어(210)는 보다 작은 제 2 기어를 결합하고, 보다 작은 제 2 기어(212)는 큰 제 3 기어(214)와 공축이다. 제 3 기어(214)는 보다 작은 제 4 기어(216)를 결합하고, 보다 작은 제 4 기어는 제 5 기어(218)와 공축이다. 제 5 기어(218)는 90°의 베벨 기어이며, 주 구동 샤프트(48)를 구동시키도록 피니언 기어(124)에 연결되는 짝을 이루는 90°의 베벨 기어(220)를 결합한다.
동작에 있어서, 사용자가 발사 트리거(20)를 후퇴시킬 때, 모터 구동 센서(도시되지 않음)는 활성화되고, 이는 조작자가 발사 트리거(20)를 후퇴시키는 범위 또는 힘에 비례하는 속도로 모터(65)가 회전하도록 신호를 보낸다. 이러한 것은 센서로부터의 신호에 비례하는 속도로 모터(65)를 회전시킨다. 센서는 이 실시예에 대해 도시되지 않았지만, 상기된 모터 구동 센서(110)와 유사할 수 있다. 센서는 발사 트리거(20)가 후퇴될 때 눌려지도록 손잡이(6)에 배치될 수 있다. 또한, 비례 제어 형태의 센서 대신에, 온/오프 형태의 센서가 사용될 수도 있다.
모터(65)의 회전은 베벨 기어(66,70)를 회전시키고, 이는 유성 기어(72)를 회전시켜, 구동 샤프트(76)를 경유하여 링 기어(122)를 회전시킨다. 링 기어(122)는 주 구동 샤프트(48)에 연결되는 피니언 기어(124)와 맞물린다. 그러므로, 피니언 기어(124)의 회전은 주 구동 샤프트(48)를 구동시키고, 이는 단부 이펙터(12)의 절개/스테이플링 동작을 활성화한다.
피니언 기어(124)의 정방향 회전은 순차적으로 베벨 기어(220)를 회전시키고, 이는 기어 박스 조립체(200)의 기어들의 정지의 방식에 의하여 제 2 기어(210)를 회전시킨다. 제 1 기어(210는 발사 트리거(20)의 기어 부분(206,208)을 결합하여, 모터(65)가 단부 이펙터(12)의 전진 구동을 제공할 때 발사 트리거(20)를 반시 계 방향으로 회전시킨다(모터(65)가 단부 이펙터(12)를 후퇴시키도록 반대 방향으로 회전할 때 시계 방향으로). 이러한 방식에 있어서, 사용자는 발사 트리거(20)에서의 사용자의 파지의 방식에 의하여 단부 이펙터(12)의 장전력 및 전개에 관한 피드백을 체험한다. 그러므로, 사용자가 발사 트리거(20)를 후퇴시킬 때, 조작자는 단부 이펙터(12)에 의해 체험되는 장전력에 관한 저항을 체험하게 된다. 유사하게, 그 본래의 위치로 발사 트리거가 복귀하도록 절개/스테이플링 동작 후에 조작자가 발사 트리거(20)를 해제할 때, 사용자는 대체로 모터(65)의 역회전속도에 비례하는 발사 트리거(20)로부터의 시계 방향의 회전력을 체험하게 된다.
또한, 이 실시예에서, 사용자가 발사 트리거(20)를 후퇴시키는 것을 통하여 주 구동 샤프트 조립체(그러므로 단부 이펙터(12)의 절개/스테이플링 동작)에 힘(모터(65)로부터의 힘 대신에 또는 이에 더하여)을 적용할 수 있다는 것을 유의해야 한다. 즉, 발사 트리거(20)를 후퇴시키는 것은 기어 부분(206,208)을 반시계 방향으로 회전시키고, 이는 기어 박스 조립체(200)의 기어를 회전시켜, 피니언 기어(124)를 회전시키고, 이는 주 구동 샤프트(48)를 회전시킨다.
비록 도 25 내지 도 31에 도시되지 않았을지라도, 기구(10)는 모터 역회전 및 모터 정지 센서들을 추가로 포함할 수도 있다. 상기된 바와 같이, 모터 역회전 센서 및 모터 정지 센서는 각각 절개 행정의 종료점 (나이프/슬래드 구동 부재(32)의 완전한 전개) 및 후퇴 동작의 종료점(나이프/슬래드 구동 부재(32)의 완전한 후퇴)을 검출한다. 도 11과 관련하여 상기된 것과 유사한 회로가 모터(65)를 적절하게 구동하도록 사용될 수도 있다.
도 32 내지 도 36은 또 다른 실시예의 파워 보조를 구비한 2행정 기동 수술 절개 및 고정 기구(10)를 도시한다. 도 32 내지 도 36의 실시예는 도 32 내지 도 36의 실시예에서 발사 트리거(20)가 하부 부분(228)과 상부 부분(230)을 포함하는 것 외에는 도 25 내지 도 31의 실시예와 유사하다. 두 부분(228,230)은 각 부분(228,230)을 통하여 배치되는 선회 핀(207)에 연결되어 이를 중심을 선회한다. 상부 부분(230)은 기어 박스 조립체(200)의 제 1 기어(210)를 결합하는 기어 부분(232)을 포함한다. 스프링(222)은 상부 부분(230)에 연결되어서, 상부 부분은 시계 방향으로 회전하도록 편향된다. 상부 부분(230)은 또한, 상부 부분(230)이 하부 부분(228)을 시계 방향으로 회전시킬 때 또한 회전하고 하부 부분(228)이 상부 부분(230)을 반시계 방향으로 회전시킬 때 또한 회전하도록, 발사 트리거(20)의 하부 부분(228)의 상부면을 접촉하는 하부 암(2340을 포함한다. 유사하게, 하부 부분(228)은 상부 부분(230)의 하부 어깨부를 결합하는 회전 스토퍼(238)를 포함한다. 이러한 방식으로, 상부 부분(230)이 하부 부분(228)을 반시계 방향으로 회전시킬 때 또한 반시계 방향으로 회전하고, 하부 부분(228)이 상부 부분(230)을 시계 방향으로 회전시킬 때 또한 시계 방향으로 회전한다.
예시될 실시예는 또한 모터(65)로의 신호와 통신하는 모터 구동 센서(110)를 포함하고, 이는 다양한 실시예에서 발사 트리거(20)를 후퇴시킬 때 조작자에 의하여 적용되는 힘에 비례하는 속도로 모터를 회전시킨다. 센서(110)는 예를 들어 상기된 바와 같이 가감 또는 가변 저항 센서일 수도 있다. 아울러, 기구(10)는 발사 트리거(20)의 상부 부분(230)의 전방면(242)에 의해 접촉될 때 걸리거나 스위칭되 는 모터 역회전 센서(130)를 포함할 수도 있다. 활성화될 때, 모터 역회전 센서(130)는 역회전하도록 모터(65)에 신호를 보낸다. 또한 기구(10)는 발사 트리거(20)의 하부 부분(228)에 의해 접촉될 때 걸리거나 활성화되는 모터 정지 센서(142)를 포함한다. 모터 정지 센서(142)는 모터(65)의 역회전을 정지시키도록 신호를 보낸다.
동작에 있어서, 조작자가 폐쇄 트리거(18)를 록킹된 위치로 후퇴시킬 때, 발사 트리거(20)는 약간 후퇴되어서(참조에 의해 본 발명에 통합되는 프레데릭 셀톤 4세 등에게 허여된 미국특허 제6,978,921호와 제프리 에스. 쉐이지 등에게 허여된 미국특허 제6,905,057호를 포함하는 종래의 기술에서 공지된 메커니즘을 통하여), 사용자는 도 32 및 도 33에 도시된 바와 같이 절개/스테이플링 동작을 개시하도록 발사 트리거(20)를 파지할 수 있다. 이 지점에서, 도 33에 도시된 바와 같이, 발사 트리거(20)의 상부 부분(230)의 기어 부분(232)은 기어 박스 조립체(200)의 제 1 기어(210)와 결합으로 움직인다. 조작자가 발사 트리거(20)를 후퇴시킬 때, 다양한 실시예에 따라서, 발사 트리거(20)는 도 34에 도시된 바와 같이 모터 구동 센서(110)에 걸리기 전에 5°만큼 작은 양 회전한다. 센서(110)의 활성화는 조작자에 의해 적용되는 후퇴력에 비례하는 속도로 모터(65)를 정방향으로 회전시킨다. 모터(65)의 정방향 회전은 상기된 바와 같이 주 구동 샤프트(48)를 회전시키고, 이는 단부 이펙터(12)에 있는 나이프(32)를 전개시킨다(즉, 채널(22)을 횡단하기 시작한다). 주 구동 샤프트(48)에 연결된 피니언 기어(124)의 회전은 기어 박스 조립체(200)에 있는 기어(210-220)들을 회전시킨다. 제 1 기어(210)가 발사 트리 거(20)의 상부 부분(230)의 기어 부분(232)과 결합하고 있기 때문에, 상부 부분(230)은 반시계 방향으로 회전되고, 이는 하부 부분(228)을 반시계 방향으로 회전시킨다.
나이프(32)가 완전하게 전개될 때(즉 절개 행정의 종료점에 있을 때), 상부 부분(230)의 전방면(242)은 모터 역회전 센서(130)에 걸리고, 이는 역회전 방향으로 회전하도록 모터(65)에 신호를 보낸다. 이러한 것은 나이프(32)를 후퇴시키도록 주 구동 샤프트 조립체를 역회전시킨다. 주 구동 샤프트 조립체의 역회전은 기어 박스 조립체(200)에 있는 기어(210-220)들을 역회전시키고, 이는 발사 트리거(20)의 상부 부분(230)을 시계 방향으로 회전시키고, 이는 발사 트리거(20)의 하부 부분(228)이 모터 정지 센서(142)에 걸리거나 활성화할 때까지 하부 부분(228)을 시계 방향으로 회전시키고, 나이프(32)가 완전히 후퇴될 때 모터(65)를 정지시킨다. 이러한 방식으로, 사용자는 발사 트리거(20) 상에서의 사용자의 파지의 방식으로 단부 이펙터(12)의 전개에 관한 피드백을 체험한다. 그러므로, 사용자가 발사 트리거(20)를 후퇴시킬 때, 조작자는 단부 이펙터(12)의 전개에 관련된 저항, 특히 나이프(32)에 의하여 체험되는 장전력을 체험한다. 유사하게, 발사 트리거(20)가 그 본래의 위치로 복귀하도록 절개/스테이플링 동작 후에 조작자가 발사 트리거(20)를 해제할 때, 사용자는 대체로 모터(65)의 역회전 속도에 비례하는 발사 트리거(20)로부터의 시계 방향의 회전력을 체험하게 된다.
또한, 이 실시예에서, 사용자가 발사 트리거(20)를 후퇴시키는 것을 통하여 주 구동 샤프트 조립체(그러므로 단부 이펙터(12)의 절개/스테이플링 동작)에 힘 (모터(65)로부터의 힘 대신에 또는 이에 더하여)을 적용할 수 있다는 것을 유의해야 한다. 즉, 발사 트리거(20)를 후퇴시키는 것은 상부 부분(230)의 기어 부분(232)을 반시계 방향으로 회전시키고, 이는 기어 박스 조립체(200)의 기어를 회전시켜, 피니언 기어(124)를 회전시키고, 이는 주 구동 샤프트를 회전시킨다.
상기된 실시예는 2행정 기동 수술 절개 및 고정 기구를 위한 적응성의 제어(예를 들어 모터, 기어 구동 트레인, 및 단부 이펙터의 폐루프 시스템의 외측에 있는 센서(110,130)를 사용하여)로 또는 제어 없이 파워 보조 사용자 피드백을 채택하였다. 즉, 발사 트리거(20)를 사용자가 후퇴시키는 것에 의하여 적용되는 힘은 모터(65)와 주 구동 샤프트(48) 사이의 기어 구동 트레인으로(직접 또는 간접적으로) 기어 결합된 발사 트리거(20)에 의하여 모터(65)에 의하여 적용되는 힘에 부가될 수 있다. 본 발명의 다른 실시예에서, 사용자는 단부 이펙터에 있는 나이프(32)의 위치에 관한 촉감 피드백을 구비할 수 있지만, 기어 구동 트레인에 기어 결합된 발사 트리거(20)를 구비하지 않는다. 도 37 내지 도 40은 이러한 촉감 위치 피드백 시스템을 구비한 동력화된 수술 절개 및 고정 기구를 도시한다.
도 37 내지 도 40의 예시된 실시예에서, 발사 트리거(20)는 도 32 내지 도 36에 도시된 기구(10)와 유사한 하부 부분(228) 및 상부 부분(230)을 가질 수 있다. 그러나, 도 32 내지 도 36의 실시예와는 달리, 상부 부분(230)은 기어 구동 트레인의 부분과 맞물리는 기어 부분을 가지지 않는다. 대신, 기구는 나사 결합되는 나사봉(266)을 구비한 제 2 모터(265)를 포함한다. 나사봉(266)은 회전 방향에 따라서 모터(65)가 회전함으로써 모터(265)에서 그리고 모터로부터 길이방향으로 왕복한다. 기구(10)는 또한 예를 들어 주 구동 샤프트(48, 또는 주 구동 조립체의 다른 부품)의 증분의 각도 운동을 대응하는 직렬의 디지털 신호로 변환시키기 위하여 주 구동 샤프트(48)의 회전에 반응하는 인코더(268)를 포함한다. 예시된 실시예에서, 피니언 기어(124)는 인코더(268)에 연결하는 기단 구동 샤프트(270)를 포함한다.
기구(10)는 또한, 인코더(268)로부터의 디지털 신호를 수신하는 마이크로컨트롤러 또는 다른 형태의 집적회로를 사용하여 실시될 수 있는 제어 회로(도시되지 않음)를 포함한다. 인코더(268)로부터의 신호에 기초하여, 제어 회로는 단부 이펙터(12)에 있는 나이프(32)의 전개의 단계를 계산할 수 있다. 즉, 제어 회로는 나이프(32)가 완전히 전개되거나, 완전히 후퇴되거나, 또는 간헐 단계에 있으면 계산할 수 있다.단부 이펙터(12)의 전개 단계의 계산에 기초하여, 제어 회로는 나사봉(266)의 왕복 운동을 제어하도록 그 회전을 제어하기 위하여 제 2 모터(265)에 신호를 보낼 수 있다.
동작에 있어서, 도 37에 도시된 바와 같이, 폐쇄 트리거(18)가 클램핑된 위치로 록킹되지 않을 때, 발사 트리거(20)는 손잡이(6)의 피스톨 그립 부분(26)로부터 멀리 회전하여서, 발사 트리거(20)의 상부 부분(230)의 전방면(242)은 나사봉(266)의 기단 단부와 접촉하지 않는다. 조작자가 폐쇄 트리거(18)를 후퇴시키고 이를 클램핑된 위치에 록킹할 때, 발사 트리거(20)는 폐쇄 트리거(18)를 향하여 약간 회전하여서, 조작자는 도 38에 도시된 바와 같이 발사 트리거(20)를 파지할 수 있다. 이 위치에서, 상부 부분(230)의 전방면(242)은 나사봉(266)의 기단 단부를 접촉한다.
그런 다음, 사용자가 발사 트리거(20)를 후퇴시킴으로써, 초기 회전량(예를 들어 5°의 회전) 후에, 모터 구동 센서(110)는 활성화되어서, 상기된 바와 같이, 센서(110)는 조작자에 의해 발사 트리거(20)에 적용되는 후퇴력의 양에 비례하는 정방향 회전 속도로 회전하도록 모터(65)에 신호를 보낸다. 모터(65)의 정방향 회전은 기어 구동 트레인을 통하여 주 구동 샤프트(48)를 회전시키고, 이는 나이프(32)과 슬래드(33)를 채널(22) 아래로 주행시키고 단부 이펙터(12)에 클램핑된 조직을 절개한다. 제어 회로는 주 구동 샤프트 조립에의 증분 회전에 관하여 인코더(268)로부터의 출력 신호를 수신하고, 제 2 모터(265)를 회전시키도록 제 2 모터(265)에 신호를 보내어, 나사봉(266)을 모터(65)로 후퇴시킨다. 이러한 것은 발사 트리거(20)의 상부 부분(230)을 반시계 방향으로 회전시키고, 이는 발사 트리거의 하부 부분(228)을 또한 반시계 방향으로 회전시킨다. 이러한 방식으로, 나사봉(266)의 왕복 운동이 주 구동 샤프트 조립체의 회전과 관계되기 때문에, 발사 트리거(20)에서의 그의/그녀의 파지의 방식에 의하여, 기구(10)의 조작자는 단부 이펙터(12)의 위치에 대한 촉감 피드백을 체험한다. 그러나, 조작자에 의해 적용되는 후퇴력은 발사 트리거(20)가 이 실시예에서 기어 구동 트레인으로 기어 결합되지 않기 때문에 주 구동 샤프트 조립에의 구동에 직접적으로 영향을 주지 않는다.
인코더(268)로부터의 출력 신호를 통하여 주 구동 샤프트 조립체의 증분 회전를 추적하는 것에 의하여, 제어 회로는 나이프(32)가 완전히 전개될 때(즉, 완전히 확장될 때) 계산할 수 있다. 이 지점에서, 제어 회로는 나이프(32)의 후퇴를 유발하도록 모터(65)를 역회전시키도록 신호를 모터(65)에 보낸다. 모터(65)의 역회전은 주 구동 샤프트 조립체의 회전 방향을 역전시키고, 이는 또한 인코더(268)에 의해 검출된다. 인코더(268)에 의하여 검출된 역회전에 기초하여, 제어 회로는 제 2 모터를 역회전시키도록 제 2 모터(265)에 신호를 보내어, 나사봉(266)은 모터(265)로부터 길이방향으로 연장하기 시작한다. 이러한 움직임은 발사 트리거(20)의 상부 부분(230)을 시계 방향으로 회전하도록 강요하고, 이는 하부 부분(228)을 시계 방향으로 회전시킨다. 이러한 방식에 있어서, 조작자는 발사 트리거(20)로부터 시계 방향 힘을 체험하여, 단부 이펙터(12)에 있는 나이프(32)의 후퇴위치에 대하여 조작자에게 피드백을 제공한다. 제어 회로는 나이프(32)가 완전하게 후퇴될 때를 결정할 수 있다. 이 지점에서, 제어 회로는 모터(65)를 회전 정지시키도록 신호를 모터(65)에 보낼 수 있다.
다른 실시예에 따라서, 나이프(32)의 위치를 결정하는 제어 회로를 가지는 대신에, 모터 역회전 및 모터 정지 센서들이 상기된 바와 같이 사용될 수 있다. 아울러, 모터(65)의 회전을 제어하도록 비례제어 센서(110)를 사용하는 대신에, 온/오프 스위치 또는 센서가 사용될 수 있다.이러한 실시예에서, 조작자는 모터(65)의 회전 속도를 제어할 수 없다. 오히려, 모터는 프로그래밍된 속도로 회전하게 된다.
도 41 내지 도 43은 본 명세서에 참조로 통합되어 있는 발명의 명칭이 "발사 여정 수축의 자동 종점을 구비한 다행정 발사 메커니즘을 포함하는 수술 스테이플링 기구"인 미국 특허 출원 제 11/052,632호에서 발견될 수 있다. 도 41을 참조하 면, 단부 이펙터(12)는 수직방향으로 돌출하는 앤빌 탭(27)에 근접하는 측방향으로 돌출하는 앤빌 피봇 핀(25)을 포함하는 앤빌 기단 단부(1004)에 연결된 앤빌 전면(1002)을 포함함으로써, 손잡이(6)(도 41에는 미도시)로부터의 폐쇄 운동에 먼저 응답한다. 앤빌 피봇 핀(25)은 채널(22)에 대하여 앤빌(24)을 개방 및 폐쇄하도록 스테이플 채널(22)내의 콩팥 형상 개구(1006)내에서 병진한다. 탭(27)은 폐쇄 튜브(1005)의 말단 단부(1008)상의 탭 개구(45)내에서 내향 연장하는 굴곡 탭(1007)과 결합하며, 폐쇄 튜브는 앤빌 전면(1002)에 대하여 추진하는 말단 에지(1008)에서 말단방향에서 종결한다. 따라서, 폐쇄 튜브(1005)가 그 개방 위치로부터 기단방향으로 이동할 때, 폐쇄 튜브(1005)의 굴곡 탭(1007)은 앤빌 탭(27)을 기단방향으로 견인하고, 앤빌 피봇 핀(25)은 스테이플 채널(22)의 콩팥형 개구(1006)를 추종하여 앤빌(24)이 동시에 기단방향으로 병진 및 개방 위치로 상향 회전하게 한다. 폐쇄 튜브(1005)가 말단방향으로 이동할 때, 탭 개구(45)내의 굴곡 탭(1007)은 탭(27)으로부터 해제되고, 말단 에지(1008)는 앤빌 전면(1002)을 추진하여, 앤빌(24)을 폐쇄한다.
도 41을 계속 참조하면, 샤프트(8) 및 단부 이펙터(12)는 또한 발사 로드(1010)의 발사 동작에 응답하는 구성요소를 포함한다. 특히, 발사 로드(1010)는 종방향 리세스(1014)를 갖는 발사 통과 부재(1012)와 회전가능하게 결합한다. 발사 통과 부재(1012)는 발사 로드(1010)의 종방향 운동에 직접 응답하여 프레임(1016)내에서 종방향으로 이동한다. 폐쇄 튜브(1005)내의 종방향 슬롯(1018)은 손잡이(6)의 좌측 및 우측 외부 측부 손잡이 부재(61, 62)와 동작가능하게 결합한 다(도 41에는 미도시). 폐쇄 튜브(1005)내의 종방향 슬롯(1018)의 길이는 프레임 통과 부재(1012)내의 종방향 리세스(1014)와 활주식 결합하도록 프레임(1016)내의 종방향 슬롯(1020)을 통과하는 손잡이 부재(61, 62)의 결합에 관하여 발사 및 폐쇄 운동을 달성하도록 손잡이 부재(61, 62)에 대한 상대적 종방향 운동을 가능하게 하도록 충분히 길다.
프레임 통과 부재(1012)의 말단 단부는 단부 이펙터(12)내로, 나이프(32)를 말단방향으로 돌출시키도록 프레임(1016)내에서, 구체적으로는 그 내부의 가이드(1024)내에서 이동하는 발사 바아(1022)의 기단 단부에 부착된다. 단부 이펙터(12)는 나이프(32)에 의해 작동되는 스테이플 카트리지(34)를 포함한다. 스테이플 카트리지(34)는 스테이플 카트리지 본체(2030)를 유지하는 트레이(1028), 웨지 슬레드 구동부(wedge sled driver)(33), 스테이플 구동부(1034) 및 스테이플(1036)을 구비한다. 웨지 슬레드 구동부(33)는 카트리지 본체(1030)와 카트리지 트레이(1028) 사이에 배치된 발사 리세스(미도시)내에서 종방향으로 이동한다는 것을 알 수 있다. 웨지 슬레드 구동부(33)는 스테이플 구동부(1034)와 접촉하여 이를 상향으로 들어올리고, 스테이플(1036)을 구동하는 캠면을 제공한다. 스테이플 카트리지 본체(1030)는 나이프(32)의 통로를 위한 기단방향 개방 수직 슬롯(1031)을 포함한다. 구체적으로, 절단면(1027)은 스테이플링된 이후 조직을 절단하도록 나이프(32)의 말단 단부를 따라 제공된다.
샤프트(8)는 비관절식 샤프트로서 도 4에 도시되어 있다는 것을 유의하여야 한다. 그럼에도 불구하고, 본 발명의 용례는 예로서, 도 1 내지 도 4를 참조로 상 술되고, 그 전문이 본 명세서에 참조로 각각 통합되어 있는 하기의 미국 특허 및 특허 출원에 설명된 바와 같은 관절동작할 수 있는 기구를 포함할 수 있다 : (1) 2003년 7월 9일자로 출원된, 셀톤 프레데릭 이. 4세, 헤멜간 브라이언 제이., 쉐이즈 제프리 에스., 에일즈 케니스 에스.에 의한 발명의 명칭이 "종축 둘레에서 회전하는 관절 메커니즘을 포함하는 수술 기구"인 미국 특허 출원 공보 제 2005/0006434호, (2) 브라이언 제이. 헤멜간에게 허여된 발명의 명칭이 "발사 바아 트랙을 위한 관절식 조인트를 포함하는 수술 스테이플링 기구"인 미국 특허 제6,786,382호, (3) 제프리 에스. 스웨이즈에게 허여된 발명의 명칭이 "측방향 이동 관절 제어부를 가지는 수술 기구"인 미국 특허 제6,981,628호, (4) 프레데릭 이. 셀톤 4세, 마이클 세트서, 브루스 웨이슨버 2세에게 허여된 발명의 명칭이 "관절 조인트 둘레에서 유연성이 증가된 테이퍼형 발사 바아를 포함하는 수술 스테이플링 기구"인 미국 특허 제6,964,363호 및 (5) 2003년 7월 9일자로 출원된, 제프리 에스. 스웨이즈, 조셉 샤를 휴일의 발명의 명칭이 "발사 바아를 지지하기 위한 관절 조인트 지지판을 가지는 수술 스테이플링 기구"인 미국 특허 출원 공보 제 2005/0006431호.
도 42 및 도 43은 도 41에 도시된 바와 같은 단부 이펙터(12) 및 샤프트(8)의 실시예에 따른 기계적 작동식 엔도커터에 사용하도록 구성된 손잡이(6)의 실시예를 도시한다. 임의의 손잡이 디자인이 단부 이펙터(12)를 발사하고, 기계적으로 폐쇄하기 위해 사용될 수 있다는 것을 알 수 있을 것이다. 도 42 및 도 43에서, 수술 스테이플링 및 절단 기구(10)의 손잡이는 증가된 강도, 감소된 손잡이 크기, 최소화된 바인딩 등 같은 특징을 제공하는 연동 전송형 발사 메카니즘(linked transmission firing mechanism)(1060)을 포함한다.
단부 이펙터(12)의 폐쇄(도 42 및 도 43에는 도시되지 않음)는 손잡이(6)의 피스톨 그립(26)을 향하여 폐쇄 트리거(18)를 압축함으로써 유발된다. 폐쇄 트리거(18)는 폐쇄 피봇 핀(252) 둘레에서 피봇하여 폐쇄 트리거(18)의 상부 부분(1094)이 전향 이동하게 하며, 폐쇄 피봇 핀은 손잡이(6)의 우측 및 좌측 외부 하부 측부 부재(59, 60)에 결합된다. 폐쇄 튜브(1005)는 폐쇄 요크 핀(1044)과 폐쇄 링크 핀(1046)에 의해 각각 폐쇄 링크(1042) 및 폐쇄 트리거(18)의 상부 부분(1094)에 핀 결합된 폐쇄 요크(250)를 경유하여 이 폐쇄 운동을 수용한다.
도 42의 완전 개방 위치에서, 폐쇄 트리거(18)의 상부 부분(1094)은 도시된 위치에서 피봇 폐쇄 해제 버튼(30)의 로킹 아암(1048)과 접촉하여 이를 유지한다. 폐쇄 트리거(18)가 그 완전히 눌러진 위치에 도달할 때, 폐쇄 트리거(18)는 로킹 아암(1048)을 해제하고, 접촉면(1050)이 피봇 로킹 아암(1048)의 말단 우향 노치(1052)와 결합하도록 회전하여, 폐쇄 트리거(18)를 이 클램핑 또는 폐쇄된 위치에 유지한다. 로킹 아암(1048)의 기단 단부는 부재(59, 60)와의 측방향 피봇 연결부(1056) 둘레에서 피봇하여 폐쇄 해제 버튼(30)을 노출시킨다. 폐쇄 해제 버튼(30)의 중간 말단 측부(1056)는 압축 스프링(1058)에 의해 기단방향으로 압박되며, 압축 스프링은 하우징 구조체(1040)와 폐쇄 해제 버튼(30) 사이에서 압축되어 있다. 결과는 폐쇄 해제 버튼(30)이 로킹 아암(1048)을 폐쇄 트리거(18)의 접촉면(1050)과의 로킹 접촉 상태로 반시계방향으로(좌측으로부터 볼 때) 압박하는 것 이며, 이는 연동 전송 발사 시스템(1040)이 비수축 상태에 있을 때, 폐쇄 트리거(18)의 클램핑 해제를 방지한다.
폐쇄 트리거(18)가 수축 및 완전히 눌러진 상태에서, 발사 트리거(20)가 로킹 해제되고, 피스톨 그립(26)을 향해 본 실시예에서는 다수회, 눌러져 단부 이펙터(12)의 발사를 실행할 수 있다. 도시된 바와 같이, 연동 전송 발사 메커니즘(1060)은 최초에 수축되고, 손잡이(6)의 피스톨 그립(26)내에 속박되어 있는 조합 인장/압축 스프링(1062)에 의해, 그 비 가동 단부(1063)가 부재(59, 60)에 연결되고, 가동 단부(1064)가 강철 밴드(1066)의 하향 굴곡된, 기단의 수축된 단부(1067)에 연결된 상태로 이 위치에서 잔류하도록 압박된다.
강철 밴드(1066)의 말단에 배치된 단부(1068)는 구조적 로딩을 위해 링크 커플링(1070)에 부착되고, 링크 커플링은 순차적으로, 링크된 래크(1074)를 형성하는 복수의 링크(1072a-1072d)의 전방 링크(1072a)에 부착된다. 링크된 래크(1074)는 유연하지만, 직선 강체 래크 조립체를 형성하는 말단 링크를 구비하며, 직선 강체 래크 조립체는 현저한 발사력을 샤프트(6)내의 발사 로드(1010)를 통해 전달할 수 있지만, 쉽게 피스톨 그립(26)내로 수축하여 손잡이(6)의 종방향 길이를 축소시킨다. 조합 인장/압축 스프링(1062)은 단일 스프링 보다 절반 만큼 최소 길이를 실질적으로 감소시키면서, 가용한 발사 여정의 양을 증가시킨다는 것을 이해하여야 한다.
발사 트리거(20)는 손잡이 부재(59, 60)에 연결된 발사 트리거 핀(96) 둘레에서 피봇한다. 발사 트리거(20)의 상부 부분(228)은 발사 트리거(20)가 피스톨 그립(26)을 향해 눌러질 때, 발사 트리거 핀(96) 둘레에서 말단 방향으로 이동하여, 발사 트리거(20)의 상부 부분(228)과 부재(59, 60) 사이에서 기단 방향에 연결되어 있는 기단에 배치된 발사 트리거 인장 스프링(22)을 신장시킨다. 발사 트리거(20)의 상부 부분(228)은 발사 트리거(20)가 해제될 때 연시 분리하는 트랙션 편의 메커니즘(1078)에 의해 각 발사 트리거 누름 동안 링크된 래크(1074)와 결합한다. 발사 트리거 인장 스프링(222)은 해제되었을 때, 발사 트리거(20)를 말단 방향으로 압박하고, 트랙션 편의 메커니즘(1078)을 분리한다.
연동 전송 발사 메커니즘(1040)이 작동할 때, 아이들러 기어(1080)는 링크된 래크(1074)의 치형 상부면(1082)과의 결합에 의해, 시계 방향(좌측으로부터 볼 때)으로 회전된다. 이 회전은 지시기 기어(1084)에 연결되고, 지시기 기어는 따라서, 아이들러 기어(1080)에 응답하여 반시계 방향으로 회전한다. 아이들러 기어(1080) 및 지시기 기어(1084)는 손잡이(6)의 부재(59, 60)에 회전가능하게 연결된다. 링크된 래크(1074), 아이들러 기어(1080) 및 지시기 기어(1084) 사이의 기어 관계는 치형 상부면(1082)이 적절히 강하면서, 지시기 기어(1084)가 연동 전송 발사 메커니즘(1060)의 전체 발사 여정 동안 1회전 이상 회전하지 않는 이빨 치수를 갖도록 유리하게 선택될 수 있다.
보다 상세히 후술된 바와 같이, 지시기 기어(1084)는 적어도 4개 기능을 수행한다. 첫 번째로, 링크된 래크(1074)가 완전히 수축되고, 트리거(18, 20) 양자 모두가 도 42에 도시된 바와 같이 개방되어 있을 때, 지시기 기어(1084)의 좌측부상의 원형 리지(1088)내의 개구(1086)는 로킹 아암(1048)의 상부면(1090)에 제공된 다. 로킹 아암(1048)은 폐쇄 트리거(18)와의 접촉에 의해 개구(1086)내로 편의되고, 폐쇄 트리거는 순차적으로, 폐쇄 인장 스프링(1092)에 의해 개방 위치로 압박된다. 폐쇄 트리거 인장 스프링(1092)은 손잡이 부재(59, 60) 및 폐쇄 트리거(18)의 상부 부분(1094)에 기단방향으로 연결되며, 따라서, 폐쇄 트리거(18)의 폐쇄 동안 저장된 에너지를 가지며, 이는 폐쇄 트리거(18)를 그 비폐쇄 위치로 말단방향으로 압박한다.
지시기 기어(1084)의 두 번째 기능은 손잡이(6)상에 외부적으로 배치된 지시 수축 노브(1096)에 연결되는 것이다. 따라서, 지시기 기어(1084)는 의사가 완전한 발사를 위해 얼마나 많은 수의 발사 트리거(20)의 행정이 필요한지의 시각적 지표를 갖도록 지시 수축 노브(1096)에 대한 발사 메커니즘(1060)의 상대 위치를 통신한다.
지시기 기어(1084)의 세 번째 기능은 수술 스테이플링 및 절단 기구(10)가 작동될 때, 안티 백업 메커니즘(일방 클러치 메커니즘)(1097)의 안티 백업 해제 레버(1098)를 종방향 및 각도 방향으로 이동시키는 것이다. 발사 행정 동안, 안티 백업 해제 레버(1098)의 지시기 기어(1084)에 의한 기단방향 이동은 안티 백업 메커니즘(1097)을 작동시키며, 이는 발사 바아(1010)의 말단 이동을 가능하게 하고, 발사 바아(1010)의 기단 이동을 방지한다. 이 이동은 또한 조작자의 작동을 위해 손잡이 부재(59, 60)의 기단 단부로부터 안티 백업 해제 버튼(1100)을 연장시키며, 이는 발사 행정 동안 연동 전송 발사 메커니즘(1060)의 수축을 위해 필요하다. 발사 행정의 완료 이후, 지시기 기어(1084)는 발사 메커니즘(1060)이 수축할 때, 회 전 방향을 반전시킨다. 반전된 회전은 안티 백업 메커니즘(1097)을 비활성화하고, 안티 백업 해제 버튼(1100)을 손잡이(6)내로 후퇴시키며, 안티 백업 해제 레버(1098)를 우측으로 측방향 회전시켜, 지시기 기어(1084)의 지속적 역방향 회전을 가능하게 한다.
지시기 기어(1084)의 네 번째 기능은 안티 백업 메커니즘(1097)이 로킹 해제된 상태에서, 발사 메커니즘(1060)을 수축시키도록 지시 수축 노브(1096)로부터 수동 회전(도 42의 도면에서 시계방향)을 수용하여, 조합 인장/압축 스프링(1062)에 의해 쉽게 극복되지 않는 발사 메커니즘(1060)내의 임의의 결속을 극복하는 것이다. 이 수동 수축 보조는 아니 백업 해제 버튼(1100)이 안티 백업 해제 레버(1098)를 측방향으로 이동시키지 않도록 안티 백업 해제 버튼(1100)을 후퇴시키는 안티 백업 메커니즘(1097)에 의해 방지되어야하는 발사 메커니즘(1060)의 부분 발사 이후에 사용될 수 있다.
도 42 및 도 43을 계속 참조하면, 안티 백업 메커니즘(1097)은 안티 백업 해제 버튼(1100)에 기단 단부에서 동작가능하게 결합되고, 말단 단부에서 안티 백업 요크(1102)에 결합되어 있는 조작자 억세스 가능한 안티 백업 해제 레버(1098)로 구성된다. 특히, 안티 백업 해제 레버(1098)의 말단 단부(1099)는 안티 백업 요크 핀(1104)에 의해 안티 백업 요크(1102)에 결합된다. 안티 백업 요크(1102)는 안티 백업 캠 슬롯 튜브(1106)에 회전을 부여하도록 종방향으로 이동하며, 안티 백업 캠 슬롯 튜브는 손잡이 부재(59, 60)에 의해 종방향으로 속박되고, 링크된 래크(1074)의 링크 커플링(1070)에 대한 발사 로드(1010)의 연결부에 대해 말단방향으로 발사 로드(1010)를 둘러싼다. 안티 백업 요크(1102)는 안티 백업 해제 레버(1098)로부터의 종방향 이동을 캠 슬롯 튜브 핀(1108)을 경유하여 안티 백업 캠 슬롯 튜브(1106)에 전달한다. 즉, 안티 백업 캠 슬롯 튜브(1106)내의 각진 슬롯내에서의 캠 슬롯 튜브 핀(1108)의 종방향 이동은 안티 백업 캠 슬롯 튜브(1106)를 회전시킨다.
안티 백업 캠 슬롯 튜브(1106)와 프레임(1016)의 기단 단부 각각 사이에는 안티 백업 압축 스프링(1110), 안티 백업 판(1112) 및 안티 백업 캠 튜브(1114)가 포획되어 있다. 도시된 바와 같이, 발사 로드(1010)의 기단방향 이동은 안티 백업 판(1112)이 위쪽에서 후방으로 피봇하게 하고, 발사 로드(1010)에 증가된 마찰 접촉을 제공하며, 이는 발사 로드(1010)의 추가 기단방향 이동을 저지한다.
이 안티 백업 판(1112)은 안티 백업 캠 슬롯 튜브(1106)가 안티 백업 캠 튜브(1114)에 대해 근접 이격되어 있을 때, 스크린 도어를 개방상태로 유지하는 스크린 도어 로크의 것과 유사한 방식으로 피봇한다. 구체적으로, 안티 백업 압축 스프링(1110)은 안티 백업 판(1112)을 그 로킹된 위치로 기울이도록 판(1112)의 상단면상에 작용할 수 있다. 안티 백업 캠 슬롯 튜브(1106)의 회전은 안티 백업 캠 튜브(1114)의 말단 방향 캠 이동을 유발하며, 그에 의해, 안티 백업 판(1112)의 상단부를 말단방향으로 밀고, 안티 백업 압축 스프링(1110)으로부터의 힘을 극복하며, 따라서, 안티 백업 판(1112)을 기울어지지 않은(수직), 로킹해제 위치에 배치하고, 이는 발사 로드(1010)의 기단방향 수축을 가능하게 한다.
도 43을 특히 참조하면, 트랙션 편의 메커니즘(1078)은 발사 트리거(209)의 상부 부분(230)에서 구멍(1076)을 통해 회전가능하게 삽입되는 그 기단 단부의 우향 돌출 측방향 핀(1120)과 말단방향 돌출 좁은 팁(1118)을 갖는 포올(1116)로 구성되는 것으로 도시되어 있다. 발사 트리거(20)의 우측상에서, 측방향 핀(1120)은 편의 휠(1122)로서 도시되어 있는 편의 부재를 수용한다. 발사 트리거(20)가 전후로 병진할 때, 편의 휠(1122)은 손잡이(6)의 우측 절반 부재(59)에 대해 기단방향의 원호를 횡단하고, 이동의 그 말단 부분에서, 우측 절반 부재(59)에 일체로 형성된 편의 경사부(1124)위로 이동한다. 편의 휠(1122)은 포올(1116)의 측방향 핀(1120)내로의 반시계 방향 회전(좌측으로부터 볼 때)을 유도하는 탄성 마찰 재료로 형성되는 것이 바람직하며, 따라서, 트랙션은 링크된 래크(1074)와 결합하도록 가장 근접한 링크(1072a-d)의 경사진 중앙 트랙(1075)내로 하향으로 말단 방향 돌출 좁은 팁(1118)을 편의시킨다.
발사 트리거(20)가 해제될 때, 편의 휠(1122)은 따라서, 폴(1116)을 반대 방향으로 트랙션 편의시키며, 링크된 래크(1074)의 경사진 중앙 트랙(1075)으로부터 좁은 팁(1118)을 상승시킨다. 고 부하 조건 및 포올(1116)의 거의 완전한 말단 이동에서의 팁(1118)의 분리를 보증하기 위해, 포올(1116)의 우측부는 경사진 중앙 트랙(1075)으로부터 좁은 팁(1118)을 분리시키도록 폐쇄 요크(250)의 우측상의 기단방향 및 상향 지향 경사면(1126)상으로 올라간다. 편의 휠(1122)이 도시되어 있지만, 편의 부재 또는 휠(1122)의 형상은 예시적인 것이며, 단부 이펙터(12)의 발사를 결합 및 분리하기 위해 마찰 또는 트랙션을 사용하는 다양한 형상을 수용하도록 변형될 수 있다는 것을 이해하여야 한다.
수술 기구(10)의 다양한 실시예는 사용 동안 1회 이상 기구 상태를 기록하기 위한 기능을 갖는다. 도 44는 기구(10)의 기록 상태를 위한 시스템(2000)의 블록도를 도시한다. 시스템(200)은 예로서, 도 1 내지 도 40을 참조로 상술된 바와 같이, 모터식 또는 모터 보조식 발사를 갖는 기구(10)의 실시예 및 도 41 내지 도 43을 참조로 상술된 바와 같이, 예로서, 기계적 작동식 발사를 갖는 기구(10)의 실시예에서 구현될 수 있다는 것을 주의하여야 한다.
시스템(2000)은 기구 상태를 감지하기 위해 다양한 센서(2002, 2004, 2006, 2008, 2010, 2012)를 포함할 수 있다. 센서는 예로서, 기구(10)내에 또는 그 위에 배치될 수 있다. 다양한 실시예에서, 센서는 시스템(200)을 위해서만 출력을 제공하는 전용 센서일 수 있거나, 기구(10)와 함께 다른 기능을 수행하는 이중 용도 센서일 수 있다. 예로서, 상술된 센서(110, 130, 142)는 시스템(2000)의 출력을 또한 제공하도록 구성될 수 있다.
직접 또는 간접적으로, 각 센서는 메모리 장치(2001)에 신호를 제공하며, 메모리 장치는 이 신호를 보다 상세히 후술된 바와 같이 기록한다. 메모리 장치(2001)는 센서 신호를 저장 또는 기록할 수 있는 임의의 종류의 장치일 수 있다. 예로서, 메모리 장치(2001)는 마이크로프로세서, 전기적 삭제가능 프로그램형 판독 전용 메모리(EEPROM) 또는 임의의 적절한 저장 장치를 포함할 수 있다. 메모리 장치(2001)는 임의의 적절한 방식으로, 센서에 의해 제공된 신호를 기록할 수 있다. 예로서, 일 실시예에서, 메모리 장치(2001)는 신호가 상태가 변할 때, 특정 센서로부터의 신호를 기록할 수 있다. 다른 실시예에서, 메모리 장치(2001)는 시스 템(2000)의 상태, 예로서, 임의의 센서로부터의 신호가 상태가 변할 때, 시스템(2000)내에 포함된 센서 모두로부터의 신호를 기록할 수 있다. 이는 기구(10)의 상태의 스냅샷을 제공할 수 있다. 다양한 실시예에서, 메모리 장치(2001) 및/또는 센서는 예로서, 1-WIRE EEPROM 같은 DALLAS SEMICONDUCTOR로부터 입수할 수 있는 1-WIRE 버스 제품을 포함하도록 구성될 수 있다.
다양한 실시예에서, 메모리 장치(2001)는 외부적으로 억세스가능하며, 컴퓨터 같은 외부 장치가 메모리 장치(2001)에 의해 기록된 기구 상태를 억세스할 수 있게 한다. 예로서, 메모리 장치(2001)는 데이터 포트(2020)를 포함할 수 있다. 데이터 포트(2020)는 예로서, 직렬 또는 병렬 포맷으로 임의의 유선 또는 무선 통신 프로토콜에 따라 저장된 기구 상태를 제공할 수 있다. 메모리 장치(2001)는 또한, 외부 포트(2020)에 부가하여, 또는 그 대신, 제거가능한 매체(2021)를 포함할 수도 있다. 제거가능한 매체(2021)는 기구(10)로부터 제거될 수 있는 임의의 종류의 적절한 데이터 저장 장치일 수 있다. 예로서, 제거가능한 매체(2021)는 퍼스널 컴퓨터 메모리 카드 인터네셔널 어소세이션(PCMCIA) 카드, COMPACTFLASH 카드, MULTIMEDIA 카드, FLASHMEDIA 카드 등 같은 임의의 적절한 종류의 플래시 메모리를 포함할 수 있다. 제거가능한 매체(2021)는 또한, 예로서 휴대용 하드 드라이브, 콤팩트 디스크(CD), 디지털 비디오 디스크(DVD) 등을 포함하는 임의의 적절한 종류의 디스크 기반 저장부를 포함할 수도 있다.
폐쇄 트리거 센서(2002)는 폐쇄 트리거(18)의 상태를 감지한다. 도 45 및 도 46은 폐쇄 트리거 센서(2002)의 예시적 실시예를 도시한다. 도 45 및 도 46에 서, 폐쇄 트리거 센서(2002)는 폐쇄 트리거(18)와 폐쇄 피봇 핀(252) 사이에 배치되어 있다. 폐쇄 트리거(18)를 피스톨 그립(26)을 향해 당기는 것은 폐쇄 트리거(18)가 폐쇄 피봇 핀(252)상에 힘을 작용하게 한다는 것을 알 수 있다. 센서(2002)는 이 힘을 감지할 수 있으며, 그에 응답하여 신호를 예로서, 도 10a 및 도 10b에서, 그리고, 센서(110)에 관하여 상술한 바와 같이 생성한다. 다양한 실시예에서, 폐쇄 트리거 센서(2002)는 폐쇄 트리거(18)의 위치 및/또는 폐쇄 트리거(18)상에 작용하는 힘을 나타내는 아날로그 센서일 수 있다. 폐쇄 트리거 센서(2002)가 아날로그 센서인 경우, 아날로그 대 디지털 변환기가 논리적으로, 센서(2002)와 메모리 장치(2001) 사이에 배치될 수 있다. 또한, 폐쇄 트리거 센서(2002)는 폐쇄 트리거의 상태를 감지할 수 있게 하는 임의의 적절한 위치에 배치되며, 임의의 적절한 형태를 취할 수 있다는 것을 주의하여야 한다.
앤빌 폐쇄 센서(2004)는 앤빌(24)이 폐쇄되었는지 여부를 감지할 수 있다. 도 47은 예시적 앤빌 폐쇄 센서(2004)를 도시한다. 센서(2004)는 도시된 바와 같이, 스테이플 채널(22)의 콩팥형 개구(1006)내에 또는 그에 인접하게 배치된다. 앤빌(24)이 폐쇄될 때, 앤빌 피봇 핀(25)이 콩팥형 개구(1006)를 통해 활주하며, 센서(2004)와 접촉하여, 센서(2004)가 앤빌(24)이 폐쇄된 것을 나타내는 신호를 생성하게 한다. 센서(2004)는 근접도 센서를 포함하는 임의의 적절한 유형의 디지털 또는 아날로그 센서일 수 있다. 앤빌 폐쇄 센서(2004)가 아날로그 센서인 경우, 아날로그 대 디지털 변환기가 논리적으로 센서(2004)와 메모리 장치(2001) 사이에 배치될 수 있다는 것을 주의하여야 한다.
앤빌 폐쇄 부하 센서(2006)는 스테이플 채널(22)의 내부 저면상에 배치된 것으로 도시되어 있다. 사용시, 센서(2006)는 스테이플 카트리지(34)(도 46에는 미도시)의 저면 측부와 접촉할 수 있다. 앤빌(24)이 폐쇄될 때, 이는 스테이플 카트리지(34)상에 힘을 작용하며, 이것이 센서(2006)에 전달된다. 응답하여, 센서(2006)는 신호를 생성한다. 신호는 앤빌(24)의 폐쇄로 인해, 스테이플 카트리지(34)에 의해 센서(2006)에 작용되는 힘에 비례하는 아날로그 신호일 수 있다. 도 44를 참조하면, 아날로그 신호가 아날로그 대 디지털 변환기(2014)에 제공될 수 있으며, 변환기는 신호를 메모리 장치(2001)에 제공하기 이전에, 아날로그 신호를 디지털 신호로 변환한다. 센서(2006)가 디지털 또는 이진 센서인 실시예는 아날로그 대 디지털 변환기(2014)를 포함하지 않을 수 있다는 것을 주의하여야 한다.
발사 트리거 센서(110)는 발사 트리거(20)의 위치 및/또는 상태를 감지한다. 모터식 또는 모터 보조식 기구의 실시예에서, 발사 트리거 센서는 상술된 런 모터 센서(110)로서 이중화될 수 있다. 부가적으로, 발사 트리거 센서(110)는 상술한 임의의 형태를 취할 수 있으며, 아날로그 또는 디지털일 수 있다. 도 45 및 도 46은 발사 트리거 센서(110)의 부가적인 실시예를 도시한다. 도 45 및 도 46에서, 발사 트리거 센서는 발사 트리거(20)와 발사 트리거 피봇 핀(96) 사이에 장착된다. 발사 트리거(20)가 당겨질때, 이는 발사 트리거 피봇 핀(96)상에 힘을 작용하고, 이 힘이 센서(110)에 의해 감지된다. 도 44를 참조하면, 발사 트리거 센서(110)의 출력이 아날로그인 실시예에서, 아날로그 대 디지털 변환기(2016)는 메모리 장치(2001)와 발사 트리거 센서(110) 사이에 논리적으로 포함된다.
나이프 위치 센서(2008)는 스테이플 채널(22)내의 나이프(32) 또는 절단면(1027)의 위치를 감지한다. 도 47 및 도 48은 도 41에 도시된 기계 작동식 샤프트(8) 및 단부 이펙터(12)와 함께 사용하기에 적합한 나이프 위치 센서의 실시예를 도시한다. 센서(2008)는 기구(10)의 발사 바아(1022)에 결합된 자석(2009)을 포함한다. 코일(2011)은 발사 바아(1022) 둘레에 배치되며, 예로서, 발사 홈통 부재(1012)(도 41 참조)의 종방향 리세스(1014)를 따라 설치될 수 있다. 나이프(32) 및 절단면(1027)이 스테이플 채널(22)을 통해 왕복될 때, 발사 바아(1022) 및 자석(1009)은 코일(2011)을 통해 전후로 이동할 수 있다. 코일에 대한 이 이동은 스테이플 채널(22)내의 절단 에지(1027) 및 코일내의 발사 로드의 위치에 비례하는 코일내의 전압을 유도한다. 이 전압은 예로서, 아날로그 대 디지털 변환기(2018)를 경유하여 메모리 장치(2001)에 제공될 수 있다.
다양한 실시예에서, 나이프 위치 센서(2008)는 샤프트(8)내부 또는 그 위의 다양한 위치에 배치된 일련의 디지털 센서(미도시)로서 구현될 수 있다. 디지털 센서는 샤프트(8)를 통해 특징부가 왕복할 때, 예로서, 자석(2009) 같은 발사 바아(1022)의 특징부를 감지한다. 샤프트(8)내의 발사 바아(1022)의 위치 및 연장에 의한, 스테이플 채널(22)내의 나이프(32)의 위치가 이동된 최종 디지털 센서의 위치로서 추정될 수 있다.
나이프 위치는 또한, 예로서, 도 3 내지 도 6에 관하여 상술한 바와 같이, 예로서, 샤프트(8) 및 회전 구동 단부 이펙터(12)를 가지는 기구(10)의 실시예에서 감지될 수 있다. 인코더(268) 같은 인코더는 나선 나사 샤프트(36) 또는 임의의 다른 구동 샤프트나 기어의 회전에 비례하는 신호를 생성하도록 구성될 수 있다. 샤프트(8) 및 기타 구동 샤프트 및 기어의 회전이 채널(22)을 통한 나이프(32)의 이동에 비례하기 때문에, 인코더(268)에 의해 생성된 신호도 나이프(32)의 이동에 비례한다. 따라서, 인코더(268)의 출력은 메모리 장치(2001)에 제공될 수 있다.
카트리지 존재 센서(2010)는 스테이플 채널(22)내의 스테이플 카트리지(34)의 존재를 감지할 수 있다. 모터식 또는 모터 보조식 기구에서, 카트리지 존재 센서(2010)는 도 11에 관하여 상술된 카트리지 로크 아웃 센서(136)로서 이중화될 수 있다. 도 50 및 도 51은 카트리지 존재 센서(2010)의 실시예를 도시한다. 도시된 실시예에서, 카트리지 존재 센서(2010)는 두개의 접점(2011, 2013)을 포함한다. 어떠한 카트리지(34)도 존재하지 않을 때, 접점(2011, 2013)은 개방 회로를 형성한다. 카트리지(34)까 존재할 때, 스테이플 카트리지(34)의 카트리지 트레이(1028)는 접점(2011, 2013)와 접촉하며, 폐쇄 회로가 형성된다. 회로가 개방되어 있을 때, 센서(2010)는 로직 0을 출력할 수 있다. 회로가 폐쇄되어 있을 때, 센서(2010)는 로직 1을 출력할 수 있다. 센서(2010)의 출력은 도 44에 도시된 바와 같이 메모리 장치(2001)에 제공된다.
카트리지 상태 센서(2012)는 스테이플 채널(22)내에 설치된 카트리지(34)가 발사 또는 소진되었는지 여부를 나타낼 수 있다. 나이프(32)가 단부 이펙터(12)를 통해 병진될 때, 이는 슬레드(33)를 추진하고, 이는 스테이플 카트리지를 발사한다. 그후, 나이프(32)는 그 원래 위치로 복귀 병진하고, 슬레드(33)를 카트리지의 말단 단부에 남겨둔다. 이를 가이드하기 위한 슬레드(33)가 없으면, 나이프(32)는 로크 아웃 포켓(2022)내에 떨어질 수 있다. 센서(2012)는 나이프(32)가 로크 아웃 포켓(2022)내에 존재하는지 여부를 감지하며, 이는 간접적으로, 카트리지(34)가 소진되었는지 여부를 나타낸다. 다양한 실시예에서, 센서(2012)는 카트리지(34)의 기단 단부에서의 슬레드의 존재를 직접적으로 감지할 수 있으며, 따라서, 로크 아웃 포켓(2022)내로 나이프(32)가 떨어질 필요성을 제거할 수 있다는 것을 주의하여야 한다.
도 52a 및 도 52b는 엔도커터로서 구성되고, 다양한 실시예에 따른 기구 상태를 기록하기 위한 기능을 가지는 수술 기구(10)의 실시예를 동작시키기 위한 프로세스 흐름(2200)을 도시한다. 박스 2202에서, 기구(10)의 앤빌(24)이 폐쇄될 수 있다. 이는 폐쇄 트리거 센서(2002) 및/또는 앤빌 폐쇄 센서가 상태가 변하게 한다. 응답하여, 메모리 장치(2001)는 박스 2203에서 시스템(2000)내의 모든 센서의 상태를 기록할 수 있다. 박스 2204에서, 기구(10)는 환자 내부로 삽입될 수 있다. 기구가 삽입되었을 때, 앤빌(24)은 예로서, 수술 부위의 조직을 조작하기 위해 박스 2206에서 폐쇄 및 개방될 수 있다. 앤빌(24)의 개방 및 폐쇄 각각은 폐쇄 트리거 센서(2002) 및/또는 앤빌 폐쇄 센서(2004)가 상태가 변하게 한다. 응답하여, 메모리 장치(2001)는 박스 2205에서 시스템(2000)의 상태를 기록한다.
박스 2208에서, 조직은 절단 및 스테이플링을 위해 클램핑된다. 앤빌(24)이 판정 블록 2210에서 폐쇄되어 있지 않으면, 지속적 클램핑이 필요하다. 앤빌(24)이 폐쇄되어 있는 경우, 이때, 센서(2002, 2004 및/또는 2006)는 상태가 변할 수 있으며, 메모리 장치(2001)가 박스 2213에서 시스템의 상태를 기록하게된다. 이 기록은 센서(2006)로부터 수신된 폐쇄 압력을 포함할 수 있다. 박스 2212에서, 절단 및 스테이플링이 이루어질 수 있다. 발사 트리거 센서(110)는 발사 트리거(20)가 피스톨 그립(26)을 향해 당겨질 때, 상태가 변할 수 있다. 또한, 나이프(32)가 스테이플 채널(22)을 통해 이동할 때, 나이프 위치 센서(2008)는 상태가 변할 수 있다. 응답하여, 메모리 장치(2001)는 박스 2013에서 시스템(2000)의 상태를 기록할 수 있다.
절단 및 스테이플링 동작이 완료되었을 때, 나이프(32)는 발사 전 위치로 복귀할 수 있다. 카트리지(34)가 이제 발사되었기 때문에, 나이프(32)는 로크 아웃 포켓(2022)내로 떨어지고, 카트리지 상태 센서(2012)의 상태가 변하고, 메모리 장치(2001)가 박스 2015에서 시스템(2000)의 상태를 기록하는 것을 촉발한다. 앤빌(24)은 그후, 조직을 제거하도록 개방될 수 있다. 이는 폐쇄 트리거 센서(2002), 앤빌 폐쇄 센서(2004) 및 앤빌 폐쇄 부하 센서(2006) 중 하나 이상의 상태가 변하게 하고, 박스 2017에서 시스템(2000)의 상태의 기록을 초래한다. 조직이 제거된 이후, 앤빌(24)은 다시 박스 2220에서 폐쇄된다. 이는 적어도 센서(2002, 2004)에 대한 다른 상태 변경을 유발하며, 이는 순차적으로, 메모리 장치(2001)가 박스 2019에서, 시스템의 상태를 기록하게 한다. 그후, 기구(10)는 박스 2222에서 환자로부터 제거될 수 있다.
기구(10)가 다시 동일한 절차 동안 사용되는 경우, 앤빌은 박스 2224에서 개방될 수 있고, 박스 2223에서의 시스템 상태의 다른 재기록을 촉발한다. 소진된 카트리지(34)는 박스 2226에서 단부 이펙터(12)로부터 제거될 수 있다. 이는 카트 리지 존재 센서(2010)의 상태가 변하게 하며, 박스 2225에서의 시스템 상태의 기록을 유발한다. 다른 카트리지(34)가 박스 2228에서 삽입될 수 있다. 이는 카트리지 존재 센서(2010)의 상태 변경 및 박스 2227에서의 시스템 상태의 기록을 유발한다. 판정 블록 2230에서 다른 카트리지(34)가 새로운 카트리지인 것으로 나타난 경우, 그 삽입은 또한 카트리지 상태 센서(2012)에 대한 상태 변경을 유발한다. 이 경우, 시스템 상태는 박스 2231에서 기록된다.
도 53은 다양한 실시예에 따른 메모리 장치(2001)로부터의 예시적 메모리 맵(2300)을 도시한다. 메모리 맵(2300)은 일련의 컬럼(2302, 2304, 2306, 2308, 2310, 2312, 2314, 2316) 및 로우(참조번호 없음)를 포함한다. 컬럼(2302)은 로우 각각을 위한 이벤트 수를 나타낸다. 다른 컬럼은 시스템(2000)의 일 센서의 출력을 나타낸다. 주어진 시간에 기록된 센서 기록 모두는 동일 이벤트 수하에 동일 로우에 기록된다. 여기서, 각 로우는 시스템(2000)의 센서로부터의 신호 중 하나 이상이 기록되는 경우를 나타낸다.
컬럼(2304)은 각 이벤트에 기록된 폐쇄 부하를 나열한다. 이는 앤빌 폐쇄 부하 센서(2006)의 출력을 반영할 수 있다. 컬럼(2306)은 발사 행정 위치를 나열한다. 이는 나이프 위치 센서(2008)로부터 유도될 수 있다. 예로서, 나이프(32)의 총 여정은 구획으로 분할될 수 있다. 컬럼(2306)에 나열된 수는 나이프(32)가 현재 존재하는 구획을 나타낼 수 있다. 발사 부하는 컬럼(2308)에 나열된다. 이는 발사 트리거 센서(110)로부터 유도될 수 있다. 나이프 위치는 컬럼 2310)에 나열된다. 나이프 위치는 발사 행정과 유사하게 나이프 위치 센서(2008)로부터 유도 될 수 있다. 앤빌(24)이 개방되어 있는지 폐쇄되어 있는지 여부가 컬럼(2312)에 나열될 수 있다. 이 값은 앤빌 폐쇄 센서(2004) 및/또는 앤빌 폐쇄 부하 센서(2006)의 출력으로부터 유도될 수 있다. 슬레드(33)가 존재하는지 여부 또는 카트리지(34)가 소진되었는지 여부는 컬럼(2314)에 표시될 수 있다. 이 값은 카트리지 상태 센서(2012)로부터 유도될 수 있다. 마지막으로, 카트리지(34)가 소진되었는지 여부는 컬럼(2316)에 나타날 수 있다. 이 값은 카트리지 존재 센서(2010)로부터 유도될 수 있다. 예로서, 센서(130, 142)에 의해 측정된 예로서, 발사 행정의 시작 및 종료를 포함하는 다양한 다른 값이 메모리 장치(2001)에 포함될 수 있다는 것을 주의하여야 한다.
본 발명을 다수의 실시예의 설명에 의거하여 예시하였지만, 그리고, 예시적 실시예를 현저히 상세히 설명하였지만, 본 출원인은 이런 세부사항에 첨부된 청구범위의 범주를 규제하거나 소정의 방식으로 제한하고자 하는 것은 아니다. 부가적인 장점 및 변형을 본 기술의 숙련자들은 쉽게 명백히 알 수 있을 것이다.
예로서, 비록, 상술된 실시예가 내시경적으로 사용되는 수술 절단 및 스테이플링 기구(100)를 위해 장점을 갖지만, 유사한 실시예는 다른 임상 절차에 사용될 수 있다. 일반적으로, 내시경 절차는 복강경 절차 보다 일반적인 것으로 받아들여진다. 따라서, 본 발명은 내시경 절차 및 장치에 관하여 설명되었다. 그러나, "내시경" 같은 용어를 여기서 사용하는 것은 본 발명을 단지 내시경 튜브(즉, 투관침)와 연계하여 사용하기 위한 수술 기구로 한정하고자 하는 것은 아니다. 대조적 으로, 본 발명은 복강경 절차 및 개복 절차를 비제한적으로 포함하는 접근로가 작은 절개부에 한정되는 임의의 절차에 사용될 수 있는 것으로 믿어진다.
여기에 참조로 통합된 것으로 언급된 임의의 특허, 공보 또는 정보는 전체적으로 또는 부분적으로, 통합된 자료가 본 문서에 기술된 기존 정의, 선언 또는 다른 문헌 자료와 상충되지 않는 정도로만 여기에 통합되어 있다. 이 때문에, 여기에 명시적으로 기술된 바와 같은 내용은 참조로 여기에 통합된 임의의 상충되는 자료를 대체한다.
Claims (20)
- 단부 이펙터,상기 단부 이펙터와 연통하는 트리거,상기 단부 이펙터 및 상기 트리거로 구성되는 그룹 중 적어도 하나의 제 1 상태를 나타내는 출력을 갖는 제 1 센서, 및상기 제 1 센서의 출력을 기록하도록 구성되고, 상기 제 1 센서와 연통하는 외부적으로 억세스할 수 있는 메모리 장치를 포함하는 수술 기구.
- 제 1 항에 있어서, 상기 메모리 장치는 출력 포트를 포함하는 수술 기구.
- 제 1 항에 있어서, 상기 메모리 장치는 제거가능한 매체를 포함하는 수술 기구.
- 제 1 항에 있어서, 상기 메모리 장치와 연통하는 제 2 센서를 부가로 포함하고, 상기 제 2 센서는 상기 단부 이펙터와 상기 트리거로 구성되는 그룹 중 적어도 하나의 제 2 상태를 나타내는 출력을 가지며, 상기 메모리 장치는 부가로 상기 제 2 센서의 출력을 기록하도록 구성되는 수술 기구.
- 제 4 항에 있어서, 상기 메모리 장치는 상기 제 1 상태가 변할 때, 그리고, 상기 제 2 상태가 변할 때, 상기 제 1 센서의 출력 및 상기 제 2 센서의 출력을 기록하도록 구성되는 수술 기구.
- 제 1 항에 있어서, 상기 제 1 상태는 상기 단부 이펙터의 앤빌이 개방 위치에 있는지 폐쇄 위치에 있는지를 나타내는 수술 기구.
- 제 1 항에 있어서, 상기 제 1 상태는 상기 단부 이펙터내의 나이프의 위치, 상기 트리거의 위치, 상기 트리거상에 작용되는 압력 및 상기 단부 이펙터에 의해 작용되는 압력으로 구성되는 그룹 중 적어도 하나를 나타내는 수술 기구.
- 제 1 항에 있어서, 상기 트리거 및 상기 단부 이펙터와 연통하는 모터식 구동 시스템을 부가로 포함하는 수술 기구.
- 제 1 항에 있어서, 상기 단부 이펙터 및 상기 트리거와 연통하는 기계적 구동 시스템을 부가로 포함하는 수술 기구.
- 제 1 항에 있어서, 상기 메모리 장치는 마이크로콘트롤러 및 전기적으로 삭제가능한 프로그램형 판독 전용 메모리(EEPROM)로 구성되는 그룹 중 적어도 하나를 포함하는 수술 기구.
- 제 1 항에 있어서, 상기 제 1 센서는 이진(binary) 센서인 수술 기구.
- 제 1 항에 있어서, 상기 제 1 센서는 아날로그 센서인 수술 기구.
- 제 12 항에 있어서, 상기 수술 기구는 상기 메모리 장치 및 상기 제 1 센서와 연통하는 아날로그 대 디지털 변환기를 부가로 포함하는 수술 기구.
- 단부 이펙터,상기 단부 이펙터와 연통하는 트리거,상기 단부 이펙터의 상태를 나타내는 출력을 갖는 제 1 센서,상기 트리거의 상태를 나타내는 출력을 갖는 제 2 센서, 및상기 제 1 센서 및 제 2 센서와 통신하며, 상기 제 1 센서의 출력 및 상기 제 2 센서의 출력을 기록하도록 구성된 메모리 장치를 포함하는 수술 기구.
- 제 14 항에 있어서, 상기 메모리 장치는 출력 포트 및 제거가능한 저장 매체 중 적어도 하나를 포함하는 수술 기구.
- 제 14 항에 있어서, 상기 단부 이펙터의 상태는 상기 단부 이펙터의 나이프의 위치, 상기 단부 이펙터의 앤빌의 위치, 상기 단부 이펙터의 스테이플 카트리지의 존재, 상기 단부 이펙터에 의해 작용되는 힘 및 상기 단부 이펙터내의 스테이플 카트리지의 상태로 구성되는 그룹 중 적어도 하나를 나타내는 수술 기구.
- 제 14 항에 있어서, 상기 트리거의 상태는 상기 트리거의 위치 및 상기 트리거상에 작용하는 힘으로 구성되는 그룹 중 적어도 하나를 나타내는 수술 기구.
- 수술 기구의 상태를 기록하는 방법으로서,상기 수술 기구의 상태를 나타내는, 복수의 센서의 출력을 감시하는 단계, 및상기 수술 기구의 상태 중 적어도 하나가 변화할 때, 메모리 장치에 상기 복수의 센서의 출력을 기록하는 단계를 포함하는 수술 기구 상태 기록 방법.
- 제 18 항에 있어서, 상기 복수의 센서의 기록된 출력을 외부 장치에 제공하는 단계를 부가로 포함하는 수술 기구 상태 기록 방법.
- 제 19 항에 있어서, 상기 복수의 센서의 기록된 출력을 외부 장치에 제공하는 단계는 상기 메모리 장치의 출력 포트에 상기 복수의 센서의 출력을 제공하는 단계 및 제거가능한 저장 매체에 상기 복수의 센서의 출력을 제공하는 단계 중 적어도 하나를 부가로 포함하는 수술 기구 상태 기록 방법.
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